Objective To explore the feasibility of a novel technique of anvil placement in combined use of laparoscopic and thoracoscopic Ivor Lewis esophagectomy. Methods From June 2011 to October 2012, we performed a novel technique of minimally invasive Ivor Lewis esophagogastrectomy in 20 patients with midthoracic esophageal cancer.The anvil was placed to connection with the esophageal stump under thoracoscopic vision, and an apical pleural stomach esophagus anastomosis was performed by using normal stapling. Results The mean operation time lasted for 200 minutes (150-300 minutes) with a mean blood loss of 180 ml (150-250 ml) without blood transfusion.The mean number of lymph nodes resected was 18 (12-44).No additional incision was required. There were no complications at post-operation and no anastomic leakage.The patient’s hospital stay lasted a mean of 10 days (8-12 days) .Follow-up reviews were conducted for 6 months and no recurrence was found in all the 20 patients. Conclusion Laparoscopic and thoracoscopic Ivor Lewis esophagectomy with novel technique of anvil placement for the treatment of esophageal carcinoma ensures the feasibility and safety.

OBJECTIVE: To observe the characteristics of serum protein in patients with benign paroxysmal positional vertigo (BPPV) during the symptomatic period. METHOD: Fifty-five patients with BPPV and 58 control subjects were enrolled in the study. All the patients underwent the Dixe-Hallpike and Roll maneuver to confirm the type of BPPV. The average time of onset was (1.0 ± 0.8)days in the group of BPPV. The clinical features and the laboratory tests of serum protein electrophoresis, blood counts, and liver and kidney function were performed in both groups. RESULT: The levels of serum albumin (Alb), α1 globulin, α2 globulin and β globulin of BPPV group did not differ statistically in the two groups (P > 0.05); The γ-globulin levels were significantly higher in patients with BPPV than in controls (P < 0.05). CONCLUSION The γ-globulin levels are increased when BPPV is attacking.
Alpha-Globulins ; analysis ; Benign Paroxysmal Positional Vertigo ; blood ; diagnosis ; Beta-Globulins ; analysis ; Case-Control Studies ; Humans ; Serum Albumin ; analysis ; gamma-Globulins ; analysis

Objective To study the subjective sleep quality in patients with obstructive sleep apnea syndrome(OSAS). Methods Two hundred and seventeen patients with OSAS confirmed by an all-night (7 hrs) polysomnogram(PSG) were evaluated by Pittsburgh Sleep Quality Index (PSQI). Results According to the testing results of PSQI, 88 subjects (40.5%) were identified as "poor sleepers" (4≤PSQI

Objective To develop recruits training burnout self-reported questionnaires, and test the reliability and validity.Methods 780 recruits(360 for first test ,420 for second test) in Xinjiang were randomly assesscd with training burnout self-reported questionnaires.Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were applied to the data, and tested the reliability and validity of recruits training burnout self-reported questionnaires.Results The questionnaires consisted of 13 items and 3 dimensions.One of the dimensions (physically and psychologically exhausted situation, training-alienation, low accomplishment) , explained 61.599％ of the total variance.Cronbach's α coefficient of the whole questionnaire was 0.837, Cronbach's α coefficient of each partial scale were between 0.775 and 0.807.Split-half reliability of the whole scale reached to 0.817, split-half reliability of each partial were between 0.758 and 0.793.The correlation coefficient among each dimensions were 0.267 to 0.569 (P＜0.01) ,and the coefficient between each dimensions and the total score were between 0.671 and 0.857(P＜0.01).Confirmatory factor analysis showed that three factor model was optimal (GFI =0.935, AGFI =0.902, NFI =0.907, CFI =0.936, IFI =0.935, RMSEA =0.050).The three dimensions and the total questionnaire had significant positive correlations with mental stress (r=-0.215--0.313, P＜ 0.01) and significant negative correlations with depression(r=0.319-0.602, P＜0.01).Conclusion The recruits training burnout self-reported questionnaires meets the requirements of psychological surveying, and could be used to text recruits training burnout.

Objective To investigate the relationship among A-type behavior,job burnout and psychosomatic health in grassroots officers and soldiers stationed in Xinjiang, which provides the theoretical basis to maintain their psychosomatic health.Methods Evaluation was carried out with A-type behavior questionnaire, military job burnout scale and simple soldiers psychosomatic health scale in 1 939 grassroots officers and soldiers chosen by random cluster sampling method from army stationed in Xinjiang.Results ①The total scores and each factor scores of the scale had significant positive correlation among the physical scale, the job buruout scale and time hurry (TH) ,competitive and hostility (CH) (r=0.170-0.716, P＜0.01).②Job burnout entered into the physical and mental health regression equation and could explain 68.6％ of the variance(β=0.195, t=32.211, P＜0.01);TH, CH entered the regression equation of job burnout and could explain 29.5％ of the variance(t=4.925,4.427).③ TH indirectly affected physical and mental health through job burnout, the mediating effect of the amount was 0.27 ×0.83=0.2241;CH indirectly affected physical and mental health by job bumout,the mediating effect of the amount was 0.30×0.83 =0.2490.Conclusion Job burnout has fully mediated effect between TH, CH and physical and mental health.

Objective To examine the effects of acute hypobaric hypoxia on abilities of learning and memory,the water content in brain,the level of nitric oxide(NO) and endothelin-1 (ET-1) in hippocampus of mice.Methods The acute hypobaric hypoxia environment were made by putting the mice in a hypobaric chamber simulated at altitude of 6 000 meters for 8 hours.The capabilities of learning and memory of mice were detected by Morris water maze test.The content of water in hippocampus were examined by measuring the ratio of dry/wet weight,and the level of NO and ET-1 in brain was detected by colorimetric method.Results Morris water maze test showed that the mean escape latency of mice in the hypobaric hypoxia group were longer than that in the normobaric normoxia group((44.60±7.80) s vs (26.39±8.44)s,P＜0.01),and the target quadrant residence time were decreased((19.78±2.74) s vs (22.98±6.14)s,P＜ 0.05).Compared with the normobaric normoxia group (NO:(2.37 ± 1.07) μmol/gProt,ET-1:(38.87 ± 6.17) ng/L),the water content in brain of mice in the hypobaric hypoxia group was increased (P＜ 0.05),meanwhile,both the level of NO ((4.48 ± 1.45) μmol/gProt) and ET-1 ((52.09±6.75)ng/L) in brain were increased too(P＜0.01).Conclusion Hypobaric hypoxia can decrease the abilities of learning and memory of mice,and these changes might be related with the increased water content and the increased level of NO and ET-1 in hippocampus of mice.

Objective To evaluate the surgical methods and clinical effects of the reconstruction of soft tissue defect in distal thumbwith dorsal thumb neurocutaneous vascular flap.Methods From January,2014 to December,2016,32 patients with soft tissue defects of distal thumb were repaired with dorsal thumb neurocutaneous vascular flaps,including left thumbs in 11 cases and right thumbs in 21 cases.They were including 7 cases of nail bed defects,9 cases of pulp defects under nails,16 cases ofthe defects of tips or stump of fingers;skin and soft tissue defects range of 1.5 cm×1.0 cm-3.5 cm×3.2 cm;Flap cutting areas range of 2.0 cm×l.5 cm-4.0 cm×3.5 cm.If the donor areas could be sutured directly,be sutured;if they could not,be covered with intermediate split thickness skin grafts.All patients were followed up when they were reviewed in outpatient department,and to be evaluated the shape,texture,sensation,flexion and extension function,and donor site of the flaps.Results One case of flaps blood circulation disordereddue to tight suture,and eased after the removal of part of the sutures;One case of flaps atrophied,and the phalangette was exposed after 3 months,so we removed the end part of bone and the wound was closed;other flaps were survived,with primary wound healing.In the total 32 patients,they were followed up range of 3 to 36 months,with an average of 12 months.Eighteen cases were followed up at least 6 months,which were 4 of the 7 cases of nail bed defects,5 of the 9 cases of pulp defects under nail and 9 of the 16 cases of the defects of tip or stump of fingers.The appearances and textures of flaps were good,protective sensations were restored,and skin flap two-point discriminationswere 8-10 mm.According to the Trial Standard for Evaluation of Upper Limb Function of Chinese Society of Hand Surgery,it was excellent in 11 cases,good in 17 cases and moderate in 4 cases,with the excellent and good rate of 87.5％.Conclusion It has advantages of simple operation,low risk,high success rate and satisfactory curative effects of the use of dorsal thumb neurocutaneous vascular flap for repair of distal thumb defect of skin and soft tissue.It is not only suitable for the hospital with good technical and equipment,but also suitable for the primary hospital.

Berberine was an isoquinoline type alkaloid extracted from Chinese herbs such as Coptis chinensis.Recently, as a great many berberine derivatives had been synthesized with comprehensive physiological functions , the structural modification and ap-plication of berberine showed great promising significance .Recent literatures had been systematically analyzed and summarized in this review.With abundant pharmacological activities of berberine different sites ′derivatives had been presented , systematical information of berberine structural modification as a lead compound and new drug R&D were provided in this article .

Objective To determine whether an increased number of transrectal biopsy cores improves the accuracy of biopsy Gleason score. Methods This study reviewed a total of 86 patients who were diagnosed as prostate cancer by transrectal needle biopsy and subsequently underwent radical prostatectomy (RP) without neoadjuvant therapy.The rate of grading concordance between biopsy and RP specimens was analyzed by dividing these patients into 2 groups according to the biopsy cores:group A,46 patients who underwent transrectai biopsy sampling of 6 cores,and group B,40 patients who underwent biopsy sampling of 13 cores. Results The concordance between prostate biopsy and radical prostatectomy Gleason score was 65.0%and 34.8% for 13 core and 6 core biopsy,respectirely (P＜0.05).Furthermore,these findings tended to be more prominent as the biopsy Gleason score was lower.Multivariate analysis identified the number of biopsy cores and percent of positive biopsy cores as independent predictors of accurate Gleason grading regardless of other parameters examined in this study. Conclusion Extended needle biopsy may increases the accuracy of biopsy Gleason score for assessing final prostate cancer grade.

Objective: Using previous total mesorectal excision with pelvic autonomic nerve preservation (PANP+TME) and simple total mesorectal excision (TME) without emphasis on retained nerves as control, we explore the advantages of nerve plane-oriented laparoscopic total mesorectal excision (NPO+LTME) on urinary and sexual function. Methods: A retrospective cohort study was carried out. Case inclusion criteria: (1) male patients with pathologically confirmed middle and low rectal adenocarcinoma (4 to 11 cm from the anus); (2) stage T1-2tumor; (3) normal sexual life before operation. Exclusion criteria: (1) no pathological diagnosis before surgery; (2) local recurrence or distant metastasis; (3) preoperative neoadjuvant chemoradiotherapy; (4) opensurgery and laparoscopic surgery conversionto open; (5) no follow-up data. According to the above criteria, clinical data of 173 male patients with low and middle rectal adenocarcinoma who underwent radical operation for laparoscopic rectal cancer from July 2003 to July 2018 at the Department of Gastrointestinal Surgery, Wuhan University People′s Hospital were collected. According to different surgical methods, patients were divided into TME group (58 cases), PANP+TME group (63 cases) and NPO+LTME group (52 cases). There were no significant differences in the baseline data including age, body mass index and pathological examination between the 3 groups (all P>0.05). The nerve plane referred to the nerve, the adipose tissue, the extremely finecapillaries around the nerve with overlying fine membranous tissue. NPO+LTME referred to the process of laparoscopic TME guided by the nerve plane, performing in the loose connective tissue between the nerve plane and the rectal properfascia, in order to ensure the integrity of the nerve plane, and maximally protect the patient's urinary and reproductive functions. The operation time, intraoperative blood loss, urinary catheter removal time, urinary function grading, postoperative first erection time, and erectile function and ejaculation function were observed and compared among the 3 groups at 3- and 6-month after operation. Results: In the NPO+LTME group, the PANP+TME group and the TME group, the operation time was (181.9±24.5) minutes, (176.7±29.2) minutes and (137.7±16.2) minutes, respectively (F=54.868, P<0.001); the intraoperative blood lost was (6.0±1.4) ml, (6.5±1.8) ml and (12.8±4.6) ml, respectively (F=95.016, P<0.001); the time to postoperative removal of the catheter was (2.4±1.1) days, (3.7 ±1.7) days and (6.5±2.4) days, respectively (F=79.409, P<0.001); the first postoperative erection time was (1.6±0.6) days, (8.9±2.7) days and (15.9±6.8) days (F=177.677, P<0.001), respectively, whose differences were all statistically significant (all P<0.01). In comparison of urinary function grading, the proportion of grade I (normal function, no urinary dysfunction) in the NPO+LTME, the ANP+TME group and the TME group was 84.1% (53/63), 39.7% (23/58) and 19.2% (10/52), respectively, and the difference was statistically significant (H=52.915, P<0.001). At postoperative 3- and 6-month, proportion of patients with grade I erectile function (normal erectile function) was 77.8% (49/63) and 85.7% (54/63), 44.8% (26/58) and 53.4% (31/58), 28.8% (15/52) and 48.1% (25/52) in the NPO+LTME group, the PANP+TME group, and the TME group, respectively. The differences were statistically significant (H=91.709, P<0.001; H=79.692, P<0.001). The proportion of patients with grade I ejaculation function (with ejaculation, no abnormalities in routine semen examination before and after surgery) at 3- and 6-month after surgery in the NPO+LTME group, the PANP+TME group and the TME group was 82.5% (52/63) and 87.3% (55/63), 53.4% (31/58) and 60.3% (35/58), 28.8% (15/52) and 46.1% (24/52), respectively. The differences were statistically significant as well (H=86.543, P<0.001; H=78.667, P<0.001). Patients in the NPO+LTME group had no grade III erections and ejaculation disorders. Conclusion The surgical procedure of NPO+LTME can promote the recovery of postoperative neurological function and preserve urination and sexual function better.