Objective To compare the efficacy and adverse reactions of intensity-modulated radiation therapy (IMRT) and conventional pelvic field radiation therapy for middle and advanced cervical cancer. Methods A total of 144 patients with stageⅡB-ⅢB cervical cancer from October 2007 to September 2012 were divided into IMRT group (72 cases), and routine radiotherapy group (72 cases) by using random number table method. The IMRT group was exposed to the 6 MV-X line 7 field, a dose of 46-50 Gy for planning target volume (PTV), 54-60 Gy for gross tumor volume (GTVnd) simultaneously integrated boosted, in 25-28 fractions. The central block of lead 4 cm was changed to 4 fields irradiation, adding to 46-54 Gy for the conventional group after 30-40 Gy of the whole pelvic field. The total dose for the two groups of patients was 30-45 Gy, after completed 30 Gy in vitro exposure, to the cavity irradiation, 5-7 Gy/fraction, and synchronous cisplatin (DDP) sensitization chemotherapy was done synchronously. Results The recent complete remission, partial remission, overall survival ratio of two groups were compared respectively, and the difference was not statistically significant (P > 0.05). The difference in 1 year survival rate of IMRT group and routine radiotherapy group was not statistically significant (χ2= 1.455, P> 0.05). The difference in 3 and 5 year survival rate was statistically significant [76.4 % (55/72) vs. 59.7 % (43/72); 72.2 % (52/72) vs. 55.6 %(40/72), P< 0.05]. Acute radiotherapy major adverse reactions included the digestive system, urinary system, skin response and haematological toxicity (bone marrow suppression). The incidence and degree of skin response in IMRT group was lower than that in routine radiotherapy group (P<0.05). The adverse effects of late radiotherapy were mainly rectal, bladder, skin response and hematological toxicity (bone marrow suppression). The incidence rectal and skin response in IMRT group was lower than that in routine radiotherapy group (P< 0.05). Conclusion The IMRT can improve the survival rate of advanced cervical cancer patients for 3-5 years, reduce the adverse effects of acute and terminal radiotherapy, and improve the quality of life.

Objective To investigate the correlation between microembolic signal (MES) and immune inflammation in patients with acute ischemic stroke. Methods The consecutive patients with acute ischemic stroke were enroled. According to the results of MES, they were divided into either a positive group or a negative group. The Immune inflammatory indexes, demographics, and baseline clinical data in both groups were compared. Multivariate logistic regression analysis was used to analyze the independent influencing factors of MES in acute ischemic stroke. Results A total of 237 patients were enroled, including 52 in the MES positive group and 185 in the MES negative group. There were significant differences in the levels of triglyceride (2. 130 ± 0. 933 mmol/L vs. 1. 811 ± 0. 962 mmol/L; t = 2. 126, P = 0. 035), plasma fibrinogen (2. 946 ± 0. 255 g/L vs. 2. 833 ± 0. 322 g/L; t = 2. 332, P = 0. 021 ), Lp-PLA2 level ( 288. 265 ± 27. 855 μg/L vs. 261. 652 ± 29. 961 μg/L; t = 2. 897, P = 0. 004 ), as wel as the proportions of CD4 + CD25high Treg (8. 695% ± 1. 461% vs. 9. 445% ± 1. 397% ; t = 3. 386, P = 0. 001), artery stenosis ≥70% (21. 15% vs. 5. 41% ; χ2 = 10. 592, P = 0. 001 ) and smal arterial occlusive stroke (9. 62% vs. 23. 24% ; χ2 = 4.667, P = 0. 031) between the MES positive group and the MES negative group. Multivariate logistic regression analysis showed that the increased plasma fibrinogen level (odds ratio [OR] 3. 257, 95%confidence interval [CI] 1. 124 - 9. 438; P = 0. 030), artery stenosis ≥ 70% (OR 3. 585, 95% CI 1. 394 -9. 219; P = 0. 008), and the decreased ratio of Treg (OR 3. 801, 95% CI 1. 190 - 12. 148; P = 0. 024) were the independent risk factors for positive MES, and smal arterial occlusive stroke was its independent protective factor (OR 0. 244, 95% CI 0. 072 - 0. 829; P = 0. 024). Conclusions MES may be associated with immune inflammation. The relationship between stroke and immune inflammation should be taken seriously.

Purpose To explore the value of Doppler ultrasound in the diagnosis of congenital hypertrophic pyloric stenosis (CHPS) by observing pylorus. Materials and Methods Sixyt-five children with CHPS diagnosed by ultrasound in Neonatology Department of Guangzhou First People's Hospital from 2006 to 2015 were retrospectively analyzed. CHPS group and 50 infants in control group were examined by Doppler ultrasound to observe the features of blood flow distribution and blood flow grading, and Doppler spectrum analysis was performed to observe contrast agent passing through pyloric canal. Results The difference of the thickness of muscular layer and mucous layer, and that of the long diameter and inner diameter of pyloric canal in CHPS group and control group all suggested marked statistical significance (P<0.01); the blood flow grading in muscular layer and mucous layer between the two groups showed statistical significance (t=13.33 and 18.77, all P<0.01). The blood flow velocity in muscular layer of CHPS group was (16.96±0.91) cm/s, resistance index (RI) 0.68±0.33, inner diameter of pyloric canal (1.98±0.33) mm. Conclusion Doppler ultrasound enables us to grasp the distribution and grading of blood flow of pylorus as well as the condition of contrast agent passing through pyloric canal, in which way the degree of pyloric stenosis can be evaluated by combining indexes such as Vmax and RI, and an objective basis for clinical choice of treatment can be provided, possessing high application value.

Objective To evaluate the result of laparoscopic pancreaticoduodenectomy (LPD).Methods We retrospectively analyzed the perioperative clinical data of 111 consecutive LPD procedures performed from Jan 2015 to Aug 2018 at Department of General Surgery,the Affiliated Hospital of Xuzhou Medical University.Results Of the 111 patients undergoing laparoscopic procedure,24 patients (21.6％) had abdominal surgery history.The mean operative time was (360.9 ± 108.9)minutes.The mean blood loss was (270.9 ± 184.9)m1.The mean operative time of pancreatojejunostomy and choledochojejunostomy was (46.2 ± 11.6) minutes and (19.0±7.2) minutes,respectively.The mean postoperative hospital stay was (14.9 ± 4.7) days.The rate of pancreatic fistula grade B was 6.3％ and pancreatic fistula grade A was 20.7％.The rate of bile leakage was 1.8％.Second surgical operation was necessary for 5 cases (4.5％),delayed postoperative hemorrhage occurred in 2 cases (1.8％).The mean number of lymph nodes harvested was(14.2 ± 7.9) and the positive rate number was (0.9 ± 1.8).Conclusions LPD improves the operation quality,reduces intraoperative hemorrhage and accelerates the postoperative recovery.

Objective:To investigate the correlations of squamous cell carcinoma antigen (SCC), peripheral blood lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) before concurrent chemoradiotherapy with recurrence of cervical cancer after concurrent chemoradiotherapy, and to explore the predictive value of the three above indicators for recurrence.Methods:The data of 90 cervical cancer patients who received concurrent chemoradiotherapy in Shanxi Provincial Cancer Hospital from January to December 2018 were retrospectively analyzed, and the patients were divided into recurrence group and non-recurrence group according to whether they relapsed. The patients' basic information and the levels of SCC, LMR and PLR before concurrent chemoradiotherapy were recorded, and the median follow-up was 17 months (5-24 months). Logistic regression was used to analyze the risk factors affecting the recurrence of cervical cancer after concurrent chemoradiotherapy, the obtained risk factors were used to construct a recurrence prediction model, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of different indicators for recurrence.Results:Among 90 patients, 26 patients (28.9%) relapsed and 64 patients (71.1%) did not relapse during follow-up. The proportions of patients with tumor maximum diameter ≥ 4 cm [57.7% (15/26) vs. 34.4% (22/64)], lymph node metastasis [53.8% (14/26) vs. 31.2% (20/64)], Karnofsky score 70-75 points [30.8% (8/26) vs. 21.9% (14/64)], Karnofsky score 76-80 points [42.3% (11/26) vs. 17.2% (11/64)], International Federation of Gynecology and Obstetrics (FIGO) stage Ⅳ [42.3% (11/26) vs. 17.2% (11/64)] in the recurrence group were higher than those in the non-recurrence group, and the differences were statistically significant (all P < 0.05). The SCC and PLR in the recurrence group before concurrent chemoradiotherapy were (4.26±0.53) ng/ml and 144.02±11.16, which were higher than those in the non-recurrence group [(2.91± 0.48) ng/ml and 125.18±12.32], and the LMR in the recurrence group before concurrent chemoradiotherapy was 3.93±0.61, which was lower than that in the non-recurrence group (4.68±0.55), and the differences in SCC, PLR and LMR between the two groups were statistically significant (all P < 0.05). The area under the ROC curve of SCC, LMR and PLR before concurrent chemoradiotherapy alone for predicting the recurrence of cervical cancer after concurrent chemoradiotherapy was 0.819 (95% CI 0.708-0.948), 0.763 (95% CI 0.677-0.860) and 0.735 (95% CI 0.590-0.916), and the best cut-off values were 2.13 ng/ml, 4.08 and 133.65. Multivariate logistic regression analysis showed that the tumor maximum diameter ≥4 cm ( OR = 2.116, 95% CI 1.204-3.718), lymph node metastasis ( OR = 2.669, 95% CI 1.022-6.970), FIGO stage Ⅳ ( OR = 2.699, 95% CI 1.359-5.362) and SCC≥2.13 ng/ml ( OR = 4.256, 95% CI 1.194-15.170), LMR≤4.08 ( OR = 5.216, 95% CI 2.987-9.108) and PLR≥133.65 ( OR = 3.256, 95% CI 1.456-7.281) before concurrent chemoradiotherapy were the risk factors for recurrence of cervical cancer after concurrent chemoradiotherapy (all P < 0.05). The area under the ROC curve of the recurrence prediction model constructed by the above risk factors for cervical cancer after concurrent chemoradiotherapy was 0.857 (95% CI 0.744-0.987), the best cut-off value was 157.24, the sensitivity was 0.873, the specificity was 0.845, and the Youden index was 0.718. Conclusions:The recurrence of cervical cancer after concurrent chemoradiotherapy is associated with many factors. The patients with higher SCC, higher PLR and lower LMR before concurrent radiotherapy have higher risk of recurrence. The combined detection of multiple indicators has high value for predicting recurrence.

Objective:To investigate the safety and efficacy of using bio-artificial dura mater to wrap around skeletonized hepatic artery during pancreatoduodenectomy in the prevention of gastroduodenal artery(GDA)stump related delayed bleeding.Methods:Clinical data were collected from 45 patients undergoing the bio-artificial dura mater wrapping skeletonized hepatic artery during pancreatoduodenectomy from Oct 2022 to Apr 2023 at Department of General Surgery, the Affiliated Hospital of Xuzhou Medical University.Results:Among the 45 patients, the bio-artificial dura mater was used to completely wrap the GDA stump and part of the common hepatic artery and the proper hepatic artery. The mean operative time was (308.1±93.1) min, the mean wrapping artery time was (18.7±7.5) min. Clinically relevant postoperative grade B pancreatic fistula (CR-POPF) occurred in 6 cases (13.3%), and intra-abdominal infection in 2 cases (4.4%).The rate of bile leakage was 2.2%.There were no second surgical operation, nor perioperative death. Postoperative delayed bleeding occurred in one case (2.2%) on the right hepatic artery branch near the hepatic portal. No pseudoaneurysm formation, nor bleeding occurring in any of the arteries wrapped by bio-artificial dura mater (including the GDA stump) after PD. There were no postoperative hepatic artery wrapping complications, such as hepatic artery stenosis, mesh-associated fluid accumulation and infection.Conclusion:Bio-artificial dura mater wrapping skeletonized hepatic artery technique in the process of pancreaticoduodenectomy can reduce the risk of delayed bleeding due to erosion of GDA stumps in case of post-PD pancreatic fistula.

Objective:To find out whether surgeon's proficiency in laparoscopic gastrectomy helps to get over the learning curve of laparoscopic pancreaticoduodenectomy (LPD) more quickly.Methods:From January 2015 to October 2016, the clinical and perioperative data of 41 consecutive patients who underwent LPD at the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. The learning curves were evaluated using the CUSUMOT method and RA-CUSUM method.Results:Of 41 patients, 25 were males and 16 were females, with age ranging from 25.0 to 83.0 (60.6±13.7) years. These patients all successfully underwent LPD, with operation time Mean±SD being (456.3±85.9) min. There were 4 patients (9.8%) who developed biochemical fistula and 4 patients (9.8%) grade B pancreatic fistula. There was no grade C pancreatic fistula after operation. There were 10 patients who developed postoperative complications ≥ Clavien-Dindo grade III (24.39%) and 1 died. The data of the CUSUMOT method showed the learning curve to be over after the 33rd patient and the data of the RA-CUSUM method showed the learning curve to be over after the 31st patient.Conclusions:Laparoscopic gastrectomy helped surgeons to master the key techniques in LPD faster, and to get over the learning curve more safely and quickly.

Objective:To study the use of the da Vinci robot in distal pancreatectomy.Methods:The data of 53 patients who underwent minimally invasive distal pancreatectomy at the Department of General Surgery of the Affiliated Hospital of Xuzhou Medical University from February 2017 to March 2022 were retrospectively analysed. There were 16 males and 37 females, aged (48.2±16.9) years. These patients were divided into the robot assisted pancreatectomy group (the robot group, n=18) and the laparoscopic pancreatectomy group (the laparoscopic group, n=35) based on the surgical treatment methods. The operations were performed by the same team of surgeons. All patients were diagnosed to have benign or borderline malignant tumors of body and tail of pancreas by preoperative examinations. The success rate of spleen preservation distal pancreatectomy, operation time, intraoperative bleeding, and postoperative complications (including pancreatic fistula, postoperative bleeding, abdominal infection) were compared between the two groups. Results:Spleen preserving distal pancreatectomy was successfully carried out in 13 patients (72.2%) in the robot group and 15 patients (42.9%) in the laparoscopic group. The rate of spleen preservation in the robot group was significantly higher than that in the laparoscopic group (χ 2=4.11, P=0.043). Intraoperative blood loss (104.4±69.3) ml and time to first postoperative passage of flatus were (3.7±1.0) d in the robot group were significantly better than the laparoscopic group (199.4±102.9) ml and (4.8±1.3) d, respectively (both P<0.05). The total incidence of complications in the robot group was 7 cases (38.9%), compared with 14 cases (40.0%) in the laparoscopic group, with no significant difference between the two groups(χ 2=0.006, P=0.938). Conclusions:Robotic-assisted distal pancreatectomy was safe and feasible, and it had advantages in resulting in better spleen preservation than laparoscopic distal pancreatectomy.

Objective To investigate the effect of remote medical information platform on efficiency of chest pain diagnosis and treatment and on clinical decision analyses in chest pain center.Methods A total of 537 chest pain patients who met the inclusion and exclusion criteria were consecutively enrolled and divided into two groups.The group without the chest pain platform(before setting up the platform)was 251 cases,and the group with chest pain platform(after setting up the platform)was 286 cases.The constituent ratio of acute coronary syndrome (ACS),the numbers of cases of both emergency thrombolysis and emergency percutaneous coronary intervention(PCI),the mean transfer treatment time,the first time medical contact to balloon catheter technique(FMC-to-B) and the door-to-balloon(D-to-B) time were compared between the two groups.The important multivariate factors affecting the D-to-B time were analyzed.Results The group with versus without chest pain platform showed the statistically significant improvements in the parameters as follows:(1)getting long range treatment (249 cases or 87.1％ vs.92 cases or 36.7 ％,x2 =146.56,P ＜0.05),(2) receiving thrombolysis(64 cases or 22.4％ vs.15 cases or 6.0％,x2 =28.61,P＜0.05),(3)average transfer treatment time(TTT) (176.3 ± 86.1 min vs.360.7 ± 107.4 min,t =11.53,P ＜0.05),(4)FMC-to-B(203.8±65.9 min vs.583.4±125.1 min,t =8.41,P＜0.05)and (5)D-to-B time(86.5±30.6 min vs.148.2 ± 41.7 min,t =4.49,P ＜ 0.05).Especially,patients after setting up the chest pain platform reached the standard of D-to-B time less than 90 min.According to whether reaching the standard of D-to-B time or not,clinical decision-making model analysis showed that the average Gini coefficient achieving the millennium development goal(MDG) was highest in the hospital referral,followed by the average transfer treatment time and emergency thrombolysis.Conclusions Reducing average transfer treatment time,improving the efficiency of hospital referral,and refining the remote terminal information platform for chest pain diagnosis and treatment are important for chest pain center by analyzing clinical data of chest pain patients.

Objective:To compare Da-vinci robotic surgical system with laparoscopic surgery for the repair of hiatal hernia.Methods:The clinical data of 115 patients undergoing minimally invasive Nissen fundoplication at the Department of Hernia and Abdominal Wall Surgery, the Affiliated Hospital,Xuzhou Medical University from Dec 2019 to May 2022 were retrospectively studied. After propensity score matching (PSM), 46 cases in each group were included:Robot-assisted surgery (RS group) and laparoscopic surgery (LS group). Postoperative complications were collected and GERD Questionnaire (GERDQ) were used as the standard in evaluation of the results.Results:Patients in RS group had less intraoperative bleeding ( P<0.001), shorter postoperative gastrointestinal recovery time ( P<0.001), and shorter postoperative hospital stay ( P=0.002). The LS group had a shorter operative time ( P<0.001) and lower total hospital cost ( P<0.001). GERD-Q scores decreased significantly in both groups at 3 and 6 months postoperatively compared with preoperative scores ( P<0.001). There was no statistically significant difference between the two groups in the incidence of postoperative complications ( P>0.05). No recurrence was seen in both groups during postoperative follow-up. Conclusion:Da-vinci robot-assisted repair of hiatal hernia is as safe and feasible as laparoscopic procedures, with less intraoperative trauma and quicker, earlier recovery.