As the economic reformation goes on, the traditional culture and ethics anr chanllenged. Should we carry on the spirit of Betheune? The hospital, cultural development focuses on how to carry forward the spirit of Betheune. Acording to his experience, the author explained his view and put several points that we should notice in new situation. 1. Emancipate the mind and change the view; 2. Advocate the unselfish contribution combined with the policy of contribution considering oneself; 3. Requine the level of conbined with regulatiton.

Objective To evaluate the diagnostic value of CT guided percutaneous transthoracic core needle biopsy (TCNB). Methods CT guided TCNB were performed on 121 cases who had suffered from pulmonary diseases. Cook QC 18G, 19G, or 20 gauge needles were used. The diameter of the pulmonary lesions was ranged from 0.8cm to 9.5cm, mean (3.4?1.9)cm. Postbiopsy complications were observed by routine CT scan. Results According to the Westcott's method, the final diagnosis of 86 cases of malignancy and 35 cases of benignancy had been established. Seventy nine malignant and 32 benign ones could be accurately diagnosed by TCNB. The overall diagnostic accuracy was 91.7%(111/121). The sensitivity of TCNB in the malignancy was 91.9%(79/86) with 7 cases of false negative, and the specificity was 100%. Seventy cases of malignancy could be made definitely. The sensitivity of benignancy was 91.4%(32/35). Complication of pneumothorax in 22 cases (18.2%) and pulmonary hemorrhage in 19 cases (15.7%) resolving spontaneously. Conclusions CT guided TCNB is a safe, reliable method with high accuracy in diagnosis and less complications, especially for non lung cancer malignancy and benign lesions.

Objective To study the feasibility of endoscopically subcutaneous mastectomy and immediate mammary prosthesis reconstruction.Methods From December 2006 to October 2007，9 breast cancer patients underwent endoscopic skin sparing mastectomy and immediate implanting breast reconstruction，with preoperatively performed systemic TE chemotherapy two to six times.Whether or not the nipple-areola complexes were preserved depended on the results of frozen pathological examination.Results Of 9 patients，bilateral skin sparing mastectomy were performed in two patients，and others underwent single lateral masteetomy with the nipple-areola complexes，at the same time sentinel lymph node biopsy was done in 8 cases of all.Combined level Ⅰ and Ⅱ axillary dissections were carried out vvia the sarne incisions underthe axillaries in 7 patients，and 2 patients spared axillary dissections.8 of them got satisfactory results，one patient did not.The postoperation complications included subcutaneous seromas 1 case，epidermic nipple necrosis 1 case and bleeding of skin flap 1 case.No local reeurrence occurred during the follow-up ranged 1～10 months.Conclusion It is technically safe and feasible that endoscopically subcutaneous mastectomy with immediate mammary prosthesis reconstruction.The technique can minimize skin incision With little trauma,and offers a greater esthetic advantage tomostpatients.

Objective To explore the feasibility and cosmetic results of video-assisted subcutaneous mastectomy and immediate reconstruction. Methods Two patients who suffered from breast diseases and need to excise the breasts received a video-assisted total subcutaneous mastectomy and immediate reconstruction in our center. Results Both patients felt satisfied on the cosmetic result. According to the operative experience of these two patents combined with review, the key point of the operation was summarized as follows. The incisions on the anterior axillary line were small and concealing. External retraction method was used to establish the working space. Video-assisted operation was combined with euthyphoria. Blunt dissection was combined with electrical surgery unit and ultrasound knife to isolate the breast skin flap. After breast glandectomy was completed, silica gel prosthesis was put into the interspace behind ectopectoralis. Pressure dressing for 3 weeks was done to prevent the prosthesis upward displacement. Conclusion The video-assisted subcutaneous mastectomy and immediate reconstruction is a safe and feasible operation method with the better cosmetic result.

Objective:To investigate the short-term efficacy of totally laparoscopic distal gastrectomy (TLDG) after endoscopic submucosal dissection (ESD) versus direct TLDG for early gastric cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 623 patients with early gastric cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University from March 2014 to December 2019 were collected. There were 405 males and 218 females, aged from 26 to 86 years, with a median age of 62 years. Of 623 patients, 25 cases undergoing TLDG after ESD were divided into ESD+TLDG group and 598 cases undergoing TLDG directly were divided into TLDG group. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after propensity score matching; (2) intraoperative and postoperative situations of TLDG; (3) stratification analysis of the ESD+TLDG group. The propensity score matching was conducted by 1∶2 matching using the nearest neighbor method. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range) and comparison between groups was done using the Mann-Whitney U test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. Results:(1) The propensity score matching conditions and comparison of general data between the two groups after propensity score matching: 75 of 623 patients had successful matching, including 25 in the ESD+TLDG group and 50 in the TLDG group. Before propensity score matching, the body mass index (BMI), cases with tumor diameter ≤20 mm, 21 to 30 mm or>30 mm, cases with tumor classified as stage Ⅰ, stage Ⅱ or stage Ⅲ of clinical staging were (22.3±3.6)kg/m 2, 16, 6, 3, 24, 1, 0 of the ESD+TLDG group, respectively, versus (24.3±2.7)kg/m 2, 238, 125, 235, 312, 126, 160 of the TLDG group, showing significant differences in the above indicators between the two groups ( t=2.744, Z=?2.834, ?4.209, P<0.05). After propensity score matching, the BMI, cases with tumor diameter ≤20 mm, 21 to 30 mm or >30 mm, cases with tumor classified as stage Ⅰ or stage Ⅱ of clinical staging were (22.3±3.6)kg/m 2, 16, 6, 3, 24, 1 of the ESD+TLDG group, versus (23.6±2.9)kg/m 2, 29, 12, 9, 48, 2 of the TLDG group, showing no significant difference between the two groups ( t=1.542, Z=?0.597, 0.000, P>0.05). (2) Intraoperative and postoperative situations of TLDG: after propensity score matching, the operation time and time to postoperative drainage tube removal were 180 minutes(range, 124 to 289 minutes) and 6 days(range, 4 to 13 days) of the ESD+TLDG group,respectively,versus 170 minutes(range, 106 to 250 minutes) and 6 days (range, 4 to 9 days) of the TLDG group, showing significant differences between the two groups ( Z=-2.396, -3.039, P<0.05). Cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL, the number of lymph node dissected, duration of postoperative hospital stay, cases with perioperative complications as incision fat liquefaction, delayed gastric emptying, anastomotic bleeding or pulmonary infection were 7, 9, 9,34(range, 16 to 58), 8 days(range, 6 to 31 days), 1, 1, 0, 0 of the ESD+TLDG group,respectively,versus 18, 26, 6, 39 (range, 22 to 68), 8 days (range, 6 to 29 days), 0, 0, 1, 1 of the TLDG group, showing no significant difference between the two groups ( Z=-1.703, -1.958, -1.139, χ2=0.033, P>0.05). Cases with anastomotic bleeding were recovered after hemostasis under endoscopy and cases with other perioperative complications were recovered after conservative treatment. (3) Stratification analysis of the ESD+TLDG group. ① For 5 cases undergoing TLDG ≤14 days after ESD and 20 cases undergoing TLDG >14 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 200 minutes(range, 170 to 289 minutes), 0, 3, 2, 36(range, 9 to 57), 7 days(range, 5 to 9 days), 8 days(range, 7 to 9 days), 1 and 180 minutes (range, 124 to 253 minutes), 8, 6, 6, 34(range, 8 to 78), 6 days(range, 4 to 13 days), 8 days(range, 6 to 31 days), 1, respectively, showing no significant difference in the operation time of TLDG, volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative tube removal and duration of postoperative hospital stay between the two groups ( Z=?1.536, ?1.993, ?0.238, ?0.932, ?0.589, P>0.05), and no significant difference in cases with perioperative complications between the two groups ( P>0.05). ② For 13 cases undergoing TLDG ≤21 days after ESD and cases undergoing TLDG >21 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss as <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 200 minutes(range, 145 to 289 minutes), 2, 6, 5, 34(range, 8 to 57), 6 days(range, 4 to 11 days), 8 days(range, 6 to 11 days), 1 and 179 minutes(range, 124 to 240 minutes), 6, 3, 3, 34(range, 16 to 78), 6 days(range, 5 to 13 days), 8 days(range, 6 to 31 days), 1, respectively, showing a significant difference in the operation time of TLDG between the two groups ( Z=?2.241, P<0.05), while showing no significant difference in the volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay between the two groups ( Z=?1.471, ?0.163, ?0.084, ?0.194, P>0.05) and no significant difference in cases with perioperative complications between the two groups ( P>0.05). ③ For 15 cases undergoing TLDG ≤28 days after ESD and 10 cases undergoing TLDG >28 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 190 minutes (range, 145 to 289 minutes), 2, 7, 6, 33(range, 8 to 57), 6 days(range, 4 to 11 days), 8 days(range, 6 to 31 days), 1 and 179 minutes(range, 124 to 240 minutes), 6, 2, 2, 37(range, 16 to 78), 6 days (range, 5 to 13 days), 8 days(range, 6 to 14 days), 1, respectively, showing no significant difference in the operation time of TLDG, volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative tube removal and duration of postoperative hospital stay between the two groups ( Z=?1.619, ?2.000, ?0.667, ?0.370, ?0.057, P>0.05), and no significant difference in cases with perioperative complications between the two groups ( P>0.05). Conclusions:Compared with cases undergoing TLDG directly, the operation time to TLDG and time to drainage tube removal after TLDG for cases undergoing ESD+TLDG are prolonged, but there is no difference in the short-term efficacy. For cases undergoing TLDG ≤21 days after ESD and cases undergoing TLDG >21 days after ESD, there is a significant difference in the operation time of TLDG.

Objective Toexploretheclinicalefficacyandtoxicityofintensitymodulatedradiationtherapy(IMRT)combined with high intensity focused ultrasound(HIFU) for inoperatable recurrent hepatic carcinoma after operation and TACE .Methods Total 60 patients with inoperatable recurrent hepatic carcinoma after operation and TACE were randomly divided into two group ,30 patients in observation group received IMRT and HIFU ,while 30 patients in control group received only IMRT .For both groups , the same radiotherapy technic was given with IMRT in 6 MV X‐ray ,the total dose was 54 -70 Gy/6 -7 weeks .In observation group ,HIFU was carried out concurrently with IMRT (5 days/week ,6-7 weeks) .Results The difference of the short‐term effi‐cacy between the observation group and the control group was statistically significant (P<0 .05) ,there was no significant difference in acute radioactive toxicity between the two groups (P>0 .05) .The one and two year overall survival rate 89 .9% ,78 .9% in obser‐vation group ,while 72 .8% ,36 .2% in control group ,the differnces were statistically significant (P<0 .05);the one and two year progression‐free survival rate were 85 .9% and 50 .9% in observation group ,while 64 .3% and 28 .1% in control group ,the differ‐ences between two groups were statistically significant (P<0 .05) .The medium survival time was 36 months in observation group , and 24 months in control group;the medium progression‐free survival was 27 months in observation group ,and 17 months in control group .Conclusion For recurrent unresectable or reject surgery after TACE in patients with primary hepatic carcinoma ,the efficacy of IMRT combined with HIFU treatment is effective ,the toxicity can be tolerated ,and has certain application value .

Objective To discuss the teaching effects of PBL teaching approach applied in clinical practice of medical oncology.Methods Throush clinical practice of medical onclolgy with the PBL teaching approach and the traditional one.A contrast between two teaching modes was made.And the teaching results were investigated based on the questionaic.Results The PBL teaching approach is superior to the traditional one.Conclusion The PBL teaching approach has an obvious advantage in the teaching of clinical practice of medical oncology and can improve the teaching quality

Human embryonic stem cells can be induced to differentiate into all kinds of cells in vitro to be applied to clinical medicine and scientific research. Because they have to be isolated from human embryos, any attempt to establish human stem cell line is prohibited by religion and ethics in some areas and countries. Parthogenetic embryonic stem cells have similar capacity of totipotency and proliferation, and can be established from parthenogenetic activation of discarded oocytes. This paper reviews the progress in the studies of the establishment of parthenogenetic embryonic stem cell line and its differentiation capacities.
Animals ; Cell Differentiation ; Embryo, Mammalian ; cytology ; Humans ; Parthenogenesis ; Stem Cell Transplantation ; Stem Cells ; cytology

Objective To compared analgesic effect of sufentanil and fentanyl in surgery patients during mechanical ventilation, and to explore the rational dosage of analgesic and sedative drugs. Methods A prospective randomized controlled trial was conducted. 600 postoperative critically ill patients underwent mechanical ventilation for 12-72 hours admitted to Department of Critical Care Medicine of the Second Affiliated Hospital of Kunming Medical University from April 2013 to March 2015 were enrolled. They were randomly divided into two groups, sufentanil and fentanyl was used for analgesia respectively, and 300 patients in each group. The initiate dosage of sufentanil and fentanil was 5 μg/h and 50 μg/h, and the dosage was adjusted. A postoperative pain score (Prince-Henry score) of 0-1, and Richmond agitation-sedation scale (RASS) score -1-0 were targeted. 1 mg/kg of propofol was used if patient could not fall in sleep or felt anxious after loading dose of sufentanil (5 μg) or fentanil (50 μg) for 5 minutes. The use of analgesic drugs, the proportion and dosage of propofol was observed in the two groups, and adverse reactions were recorded. Results The mean dose of sufentanil for analgesia was (0.07±0.02) μg·kg-1·h-1, and the mean dose of fentanyl was (0.67±0.12) μg·kg-1·h-1. The patients in the two groups received propofol 40 to 60 mg/h in night, and the use proportion of propofol in sufentanil group was slightly less than that in fentanyl group (25.7% vs. 28.3%), but the difference was not statistically significant (P > 0.05). It was found by subgroup age analysis that, the mean analgesic dose of sufentanil or fentanyl in patients over 80 years old was lower than that in 70-79 years, 60-69 years and < 60 years groups but without statistical significance. There were 11 cases (3.7%) and 21 cases (7.0%) patients suffered from respiratory depression in sufentanil group and fentanyl group, respectively, without statistical significance (P = 0.069). The hemodynamics of patients in two groups was stable during analgesia, and no accidental extubation due to restlessness was found. Conclusions A smaller dose of sufentanil for postoperative patients underwent mechanical ventilation with satisfactory analgesia was (0.07±0.02) μg·kg-1·h-1, but need to be added with 40-60 mg/h and a small dose of propofol to improve anxiety and sleep. The proportion of patients needing propofol addition was slightly lower than that of fentanyl.

Objective To investigate the ipratropium bromide combined with Ambroxol Aerosol Inhalation on preventive effect of pulmonary complications after thoracotomy. Method 115 patients undergoing thoracic operation were randomly divided into 2 groups, 2 groups were given routine nursing before operation, the control group on the basis of Mucosolvan atomization inhalation, the observation group in the conventional nursing combined with ipratropium bromide and atomization inhalation of ambroxol. Results the curative effect of therapeutic group was signiifcantly better than the control group (P<0.05); lung infection in the observation group was significantly lower than that of the control group (P<0.05). Conclusion ipratropium bromide and Mucosolvan aerosol inhalation signiifcantly on the prevention of pulmonary complications after thoracotomy and effect, will help the patient restore.