With the development of the ultrasonic molecular imaging,the invention of a variety of new ultrasound contrast agents can not only improve the sensitivity and specificity of the diagnosis,but also provide new ideas and means for early diagnosis and treatment of hepatocellular carcinoma.The development and perspective of the relative researches were described in this article.

Objective To study the relationship between the recurrence of stomach cancer and the procedure of primary operation.Method 1106 cases of gastric were analyzed cancer retrospectively.Results There are 853 cases in all patients we got the material of follow up. The outcome of distal radical resection is better than that of other resection according to the site of lesion. The most procedure is D2 resection according to the area of lymph node disection. The survival rate is higher in D1 resection than other resection.Conclusion Different procedures should be adopted in different site of lesion, area of lymph node metastasis and condition of tumor infiltration. Extraresection can be done only in selective patients.

Objective:To present the learning curve of robotic assisted laparoscopic partial nephrectomy by a single surgeon.Methods:The clinical data of 100 patients with renal tumor who underwent robot assisted laparoscopic partial nephrectomy in Peking Union Medical College Hospital from February 2016 to April 2018 were retrospectively analyzed. There were 64 males and 36 females. The average age was 51.5(18-79) years. The average body mass index (BMI) was 24.9(19-31)kg/m 2. TNM stage was T 1N 0M 0, which indicated partial nephrectomy. The tumors were located on the left in 38 cases and on the right in 62 cases. The average maximum diameter of tumor was 3.9(1.0-6.7) cm, and the average R. E.N.A.L. score was 6.7(4-11). All operations were performed by a single surgeon. This group of operations were the first 100 robot cases for this surgeon. The mean machines docking time was 14(10-30) min, the mean operation time was 119.2(60-240) min, the mean warm ischemia time was 16.7(0-45) min, and the estimated mean blood loss was 105.2(30-500) ml. There was no conversion to open surgery or laparoscopic radical nephrectomy. No serious complications occurred (Dindo calvein grade ≥ grade Ⅲ). There were 1 case of lower extremity intramuscular venous thrombosis, 1 case of urinary fistula, 1 case of pulmonary infection and 1 case of peri-kidney hematoma after operation. All patients were cured after conservative treatment without further operation or intervention. Cumulative Sum (CUSUM) test was used to fit the learning curve of docking time and operation time, and to judge the three different learning stages of robot surgery according to the inflection of the curve (CUSUM stop rising, and CUSUM begin to decline). The characteristics of patients and perioperative data of different learning stages were compared. Result:According to the CUSUM, the learning curve of robot assisted laparoscopic partial nephrectomy was 19 cases. According to the inflection point of operation time learning curve, 100 cases could be divided into three stages, 1st-19th cases were learning stage, 20th-43rd cases were mastering stage and 44th-100th cases are proficient stage. There were no significant differences in age, gender, tumor side, intraoperative bleeding volume, postoperative pathological type, total cost of hospitalization and incidence of complications among the three stages ( P>0.05). The median BMI in the learning stage was significantly lower than that in the mastery stage and the proficiency stage (23 kg/m 2, 26 kg/m 2, 25 kg/m 2, P=0.02). The median docking time(20 min, 12 min, 12 min), median operation time (150 min, 120 min, 100 min) and median warm ischemia time (21 min, 18 min, 15 min)were gradually shortened in the learning stage, mastering stage and proficient stage ( P<0.001). The median length of postoperative hospital stay in mastering stage and proficient stage was shorter than that in learning stage (7 d, 6 d, 6 d, P=0.011). The median maximum diameter of tumor (3.7 cm, 3.9 cm, 4.0 cm)and median R. E.N.A.L. score (6, 7, 7)increased gradually in learning stage, mastering stage and proficient stage, but the difference was not statistically significant( P=0.75, P=0.16). Conclusions:The learning curve of robotic assisted laparoscopic partial nephrectomy for an experienced surgeon is about 19 cases. After the completion of the learning curve, the docking time, operation time, warm ischemia time and postoperative hospital stay of patients can be significantly shortened than the initial period, and more difficult renal tumor operations can be accomplished.

Objective:To investigate the safety and efficacy of domestic Kangduo robotic surgery system in adrenalectomy.Methods:This study summarized the clinical data of patients with adrenal adenoma who were operated by domestic kangduo robot from November 2020 to April 2021. This study was approved by the hospital ethics committee, and the clinical trials of medical devices were filed. Inclusion criteria: age 18-75 years old; all of them in accordance with the indication of adrenalectomy; tumor volume≤6 cm; agree to sign the informed consent, follow the doctor's advice and follow up regularly. Exclusion criteria: patients with ipsilateral upper abdominal surgery history; patients with severe uncontrolled disease or acute infection; patients with cardiovascular and cerebrovascular diseases, blood system diseases and immune system diseases that are not controlled and can not reach the operation standard; pregnant or lactating women. All patients underwent robot assisted adrenalectomy. The general information and perioperative data of the patients were summarized.Results:Five patients were included in this study, including 1 male and 4 female. The average age was 49 (34-61)years old. There were 2 cases on the left and 3 cases on the right. The average diameter of tumor was 2.2 (1.1-3.7) cm. All patients showed adenoma by CT examination. Two cases were diagnosed as primary aldosteronism, one as Cushing's syndrome, and two as nonfunctional adenoma. All the operations were successfully completed in 5 cases, including 4 cases via retroperitoneal approach and 1 case via peritoneal approach. The average docking time was 3.8 (3-6) min, the average operation time was 56.2 (21-92) min, and the average blood loss was 34 (20-50) ml. The postoperative pathology was adrenal cortical adenoma. The average postoperative hospital stay was 3.6 (3-5) days. No postoperative complications occurred in 5 cases. Two patients with primary aldosteronism had hypertension and hypokalemia before operation, and they needed oral antihypertensive drugs to control them. They did not need medication after operation, and their blood pressure and potassium were maintained at normal levels. All patients were followed up for average 1.5(0.5-5.0)months.Conclusions:Domestic robot assisted laparoscopic adrenalectomy has the advantages of few blood loss, short operation time, few complications. It’s a safe and effective operation, but the conclusion needs to be further verified by large sample and multi-center study.

Objective To detect the expressions of CXCR4,Smoothened (Smo) and Patched (Ptch) in breast cancer,to analyze the clinical significance of the expression of CXCR4,and to evaluate the relationships among CXCR4,Smo and Ptch.Methods The expressions of CXCR4,Smo and Ptch from 121 cases of breast cancer specimens were detected by immunohistochemistry,and the results were analyzed.Results The positive expression rate of CXCR4 in breast cancer was 66.9％,which was positively associated with the lymph node metastasis (r =0.181,P =0.044).The positive expression rates of Smo and Ptch in breast cancer were respectively 58.9％ and 64.5％.The expressions of Smo and Ptch were positively associated with the expression of CXCR4 in breast cancer (r =0.189,P =0.036 ; r =0.230,P =0.010).Conclusion The expression of CXCR4 in breast cancer is associated with the lymph node metastasis,and it is positiviely associated with the expressions of Smo and Ptch.Patients with breast cancer who express both CXCR4 and Hedgehog signaling pathway may have a higher risk of recurrence.

OBJECTIVE:To analyze the features and general patterns of adverse drug reactions (ADR) occurred in our hospital. METHODS: 209 ADR case reports collected in our hospital in 2007 were analyzed statistically in respect of patients' age and sex, route of administration, category of the drugs, organs and systems involved, and clinical manifestation of the ADRs. RESULTS: The ADR were more likely caused via intravenous dip (129 cases, 61.72%). Anti-infectives had the highest proportion to induce ADR(94 cases,44.98%), followed by nervous system drugs and cardiovascular system drugs. Quinolones were the leading anti-infective drugs causing ADR(35 cases, 37.23%), of which, Levofloxacin dominated the first place. The main presentation of the ADR was damage of skin and its appendages such as erythra and pruritus etc, followed by the lesions of digestive system and circulatory system. CONCLUSION: ADR monitoring awareness should be strengthened and the related ADR reporting system should be improved.

The RNA dot hybridization with human IL-6 cDNA showed that panaxatriol saponin (PTS) enhanced the interleukine-6(IL-6) mRNA concentration within PHA activated peripheral blood mononuclear cell (PBMC) byabout 4 folds,suggesting that PTS could promote the IL-6 gene transcription of lymphoid tissue

Objective: TO establish methods for sensitive, rapid, economical detection of Th1/Th2 Cytokine gene expression. Method: sixpairs of Primers specific for the IL-2, IL-4, IL-10, IL-13, IFNr and B-actin were designed. A Sensitive and rapid method for detection of Th1/Th2cytokine genes by RT-RCR was established. Meanwhile another method: the RNA hybridization with sir cDNA probes were established. Results:The RT-PCR reaction and RNA hybridization was used to test five kinds of Cytokine mRNAs expressed 20 tumor cell lines on mRNAs were expressed in eleven Cell lines;The mRNAs in eight cell lines. Conclusion:The preliminary results suggested that RT-PCR and RNA hybridizationnight be used to test Th1/Th2 cytokine gene expression.

Objective To get more detailed information about the microsurgery of the Willis circle,in order to provide evidence of clinical operation.Methods The microsurgical anatomy of the Willis circle via combined frontotemporal-orbitozygomatic approach was studied in 5 adult cadaver brains under microsurgical scope. Results The Willis circle was composed of anterior communicating artery (ACOA), A 1 segments of the right and left anterior cerebral arteries (ACA), right and left internal carotid arteries(ICA) right and left, posterior communicating artery (PCOA), Pi segments of the right and left posterior cerebral arteries (PCA).The variation are present obviously in A 1 segment of the ACA. The outer diameter of left A 1 segment are larger than that of right ones. There are many perforating arteries of each part of Willis circle. Most of them arise from their original arteries, then course medial-superiorly to the optic tract, the pituitary stalk, the optic chiasm, the thalamus, hypothalamus, the floor of third ventricle, basal nuclei and internal capsule etc blood supplied areas. Conclusion To understand the microsurgical anotamy of the Willis circle and protections against its penetrating branches perfectly are the key to gain a good curative effect during the concerned operation .

The objective structured teaching evaluation (OSTE) is a new method for training and objective assessment of the teaching ability of clinical faculty by using standardized students and teaching scenario.It is mainly used to evaluate training programs,train teaching skills and assess teaching ability of clinical faculty.The differences and association between teaching ability,teaching skills and teaching scenario should be clarified before designing OSTE.Although there are some differences in various studies,OSTE can be summarized into two aspects:teaching administration knowledge and special teaching skills.Given the great potential of OSTE in training and assessing faculty,medical educators in general should actively explore its concept and application.