Objective:To explore scientific and effective methods of management regarding the features of Da Vinci Surgical Robotic System and clinical applications.Methods: Enhance operation room management of Da Vinci Surgical Robotic System; Establish surgical robotic system management system to carry out inter-provincial communication and cooperation, thereby building novel forms of treatment by teamwork and multidisciplinary integration; Regular maintenance and reparation of the equipment by engineers to avoid or reduce the possibility of equipment failure during the operation of equipment.Results: Proposing scientific and effective suggestions for clinical application and management of Da Vinci Surgical Robotic System to provide references for using of such equipment.Conclusion: Via surgical management of Da Vinci Surgical Robotic System and its operation room as well as quality control and preventive maintenance during the operation of equipment, the methods play an important role in reducing the usage risk of equipment, improving usage efficiency of equipment, extending life span of equipment and improving surgical precision and security.

A new compound and five known compounds were isolated from the ethanolic extract of the leaves of Ilex pernyi Franch. Their structures were established on the basis of spectral analysis and identified as trans-isoeugenyl-α-L-arabinopynosyl(1→6)-β-D-glucopyranoside (1), kaempferol-3-O-sambubioside (2), quercetin-3-O-sambubioside (3), isoquercitrin (4), (+)-syringaresinol-O-β-D-glucopyranoside (5), amarantholidoside IV (6). Among them, compound 1 is a new phenolic glycoside, named as ilexperphenoside A, and compounds 2-6 were isolated from this plant for the first time.

BACKGROUND: Dexmedetomidine has been shown to fight against ischemia/reperfusion injury induced by tourniquets. OBJECTIVE: To study the effects of dexmedetomidine on the oxidative stress and inflammatory damage caused by tourniquet-induced ischemia/reperfusion injury. METHODS: Seventy-six patients scheduled for lower limb operation were randomized into two groups: patients in dexmedetomidine group were given the intravenous injection of 1 μg/kg dexmedetomidine for 10 minutes, followed by 0.5 μg/kg?h until the end of operation; while the controls were subjected to 0.9% saline injection at an equivalent velocity and volume. The levels of serum propanediol, lactic dehydrogenase, superoxyde dismutase, tumor necrosis factor-α, interleukin-6 and -8 were detected before tourniquet inflation, 10, 60 and 120 minutes after tourniquet release. RESULTS AND CONCLUSION: In both two groups, the serum levels of propanediol, lactic dehydrogenase, tumor necrosis factor-α, interleukin-6 and -8 after tourniquet release were significantly higher and the serum superoxide dismutase level was significantly lower than those before tourniquet inflation (P < 0.05). Compared with the control group, dexmedetomidine significantly reduced the serum levels of propanediol, lactic dehydrogenase, tumor necrosis factor-α, interleukin-6 and -8, and increased the serum superoxyde dismutase level after tourniquet release (P < 0.05). These results suggest that dexmedetomidine can attenuate the oxidative stress and inflammatory damage resulting from tourniquet-induced ischemia/reperfusion injury probably by up-regulating the serum superoxyde dismutase level, and down-regulating the serum levels of propanediol, lactic dehydrogenase, tumor necrosis factor-α, interleukin-6 and -8.

Objective:To compare the diagnostic efficacy and ability of Thyroid Imaging Reporting Data System version (TI-RADS) of American College of Radiology (ACR) and artificial intelligence(AI) TI-RADS in diagnosis of thyroid nodules.Methods:A retrospective analysis was done on 266 patients(276 nodules) proved by ultrasound-guided fine-needle aspiration cytology (US-FNAC) in General Hospital of Eastern Theater Command from January to December 2019. The ROC curve of the two TI-RADS versions was drawn and the area under the curve (AUC) was calculated and compared.Results:AUCs of ACR TI-RADS and AI TI-RADS were 0.747 and 0.853. The sensitivity, specificity, positive predictive value and negative predictive value (96.62%, 62.50%, 74.87%, 94.12%) of AI TI-RADS were higher than ACR TI-RADS (95.27%, 44.53%, 66.51%, 89.06%). AI TI-RADS was able to avoid more unnecessary FNAC (71.74%) than ACR TI-RADS (67.03%).Conclusions:Both ACR TI-RADS and AI TI-RADS have good performances for differential diagnosis of thyroid nodules. AI TI-RADS is a more simple scoring system with better overall diagnostic performance and ability to exclude unnecessary FNAC with high negative predictive value than ACR TI-RADS.

Objective To explore the diagnosis and treatment of Kaposiform hemangioendothelioma (KHE),deepen the understanding of KHE and Kasabach-Merritt phenomenon (KMP),and discuss the optimal treatment for KHE.Methods From January 2008 to August 2016,13 cases of KHE were confirmed by surgery or biopsy pathology and admitted to the First Affiliated Hospital of Sun Yat-Sen University,and the clinical diagnosis and treatment were analyzed retrospectively.Results There were 13 patients(7 males and 6 females) with a median age of 1.0 years(0.2-10.0 years),and 84.6%(11/13 cases) were infants and young children,76.9% (10/13 cases) involved with deep tissue,23.1% (3/13 cases) were associated with KMP and they were younger than 1 year old,and 15.4% (2/13 cases) coexisted with hemangioma or lymphangioma.The location,extent and infiltration depth of the lesion were observed by imaging examinations and histopathology showed nodule shaped spindle tumor cells.Radical resection was considered if possible.Dose of Vincristine (0.5 mg/m2 weekly) and Propranolol [1 mg/(kg·d)] were administered.The prognosis was different in thirteen cases undergoing different treatments.After 3 months to 9 years follow-up,41.7% (5/12 cases) survived after tumor treatment.Conclusions KHE happens mostly in infants and young children,with varying clinical manifestations and a high recurrence rate.The diagnosis of KHE is based on histological examination,computed tomography and magnetic resonance imaging while it still need explicit pathological diagnosis is needed.KHE may be accompanied by hemangioma or lymphangioma.Prognosis is affected by many factors and the comprehensive treatment is required.KMP should be remedied preferentially,individual treatment protocol and long term follow-up are necessary.

BACKGROUND:Surgical treatment for pigmented vil onodular synovitis can maximize the excision of synovial lesions and recovery of joint function.
OBJECTIVE:To investigate the knee joint function and relapse rate fol owing treatment of pigmented vil onodular synovitis with total knee replacement and arthroscopic synovectomy.
METHODS:We retrospectively analyzed 34 cases of knee pigmented vil onodular synovitis admitted for surgical treatment in the Department of Orthopedics, Xiangya Hospital of Central South University, China from December 2006 to December 2011. In these cases, 24 patients received arthroscopic synovectomy and 10 patients were subjected to total knee replacement. Adjuvant radiotherapy was conducted according to postoperative patient’s conditions. Lysholm scoring was employed in the arthroscopic synovectomy group, and American Knee Society scoring was used in the total knee replacement group. Knee function in two groups was compared before and after treatment. Fol ow-up observation was performed to compare knee function recovery and relapse rate between two groups.
RESULTS AND CONCLUSION:Thirty-four patients were effectively fol owed up for 12-66 months, mean 41.3 months. Statistical analysis showed that in the arthroscopic synovectomy group, the postoperative Lysholm score was (86.3± 10.3) points, significantly higher than the preoperative score which was (55.5±13.2) points (t=3.81, P=0.016, P<0.05). In the total knee arthroplasty group, the American Knee Society score was increased from (40.7±2.2) points preoperatively to (90.2±1.1) points postoperatively (t=6.27, P<0.01). In the arthroscopic synovectomy group, the American Knee Society score was increased from (34.2±3.9) points preoperatively to (80.8±1.9) points postoperatively (t=16.58, P<0.01). Arthroscopic synovectomy combined with adjuvant radiotherapy can achieve better outcomes in pigmented vil onodular synovitis patients, while the total knee replacement for advanced with advanced knee diffuse pigmented vil onodular synovitis is better to restore knee function and the recurrence rate is low.

Objective To observe the condition of Keshan disease (KSD) in Gansu Province in order to provide a scientific basis for prevention and control of the disease. Methods In 2011, according to “The national Keshan Disease Monitoring Program (trial edition)”, based on searching of KSD cases, 12 villages of 12 towns in 6 counties of Gansu Province, were selected as surveillance sites. All the residents in surveillance sites were clinically examined and given 12-lead ECG tracings; suspected cases were taken anterior chest X-rays in the distance of 2 meters, while staple food and life conditions of the residents were surveyed. Diagnosis of KSD was based on“Keshan Disease Diagnostic Criteria”(WS/T 210-2011). Results Among investigated 5 484 residents, the incidence of abnormal electrocardiogram was 15.41%. Of the 196 X-ray films, 61 cases had enlarged heart(in which 22 of mild, 21 of moderate and 18 of severe). Two hundred and forty-three cases of KSD were detected, the general detection rate was 4.43%, in which 31 cases of chronic, the detection rate was 0.56%; 212 cases of potential, the detection rate was 3.87%. In all cases, 47 cases were under the age of 30, including 46 cases of potential and 1 case of chronic. The major abnormal electrocardiogram change of KSD cases was ST-T changes[22.68%(71/313)], followed by complete right bundle branch block[16.29%(51/313)], low voltage[12.46%(39/313)], and left anterior fascicular block[6.71%(21/313)]. Per-capita annual income in surveillance site was 1 763 Yuan;and the major staple food was flour, accounted for 87%, and the staple food rice accounted for 5%. Conclusion The detection rate of KSD in Gansu Province is mainly to potential, and there is a cosiderable portion of patients under the age of 30;monitoring and investigation should also be strengthened in the younger age of KSD cases detected village.

Objective To explore the qualitative evaluation of contrast-enhanced ultrasound (CEUS) in the differential diagnosis between benign and malignant thyroid nodules (TNs).Methods Totally 110 outpatients with 132 TNs underwent CEUS were enrolled in this study in Jinling Hospitall Medical School of Nanjing University (Nanjing General Hospital of Nanjing Military).Nanjing General Hospital of Nanjing Military All the nodules underwent ultrasound guided fine needle aspiration biopsy (FNAB).113 TNs were histologically diagnosed,the characteristics of enhancement for each noudle were scored.The characteristicsof enhancement between benign and malignant TNs were compared by chi-square test.The receiver operating characteristic (ROC) curve analysis were conducted to determine the diagnostic values of thyroid CEUS.Results Contrast-enhanced patterns were significantly different between benign and malignant TNs in the degree,homogeneity of enhancement,enhanced ring and boundary,shape and size of the enhanced lesions (x2=23.85,P ＜ 0.001;x2=7.43,P=0.04;x2=34.54,P ＜ 0.001;x2=25.7,P ＜ 0.001;x2=53.10,P ＜ 0.001;x2=22.78,P ＜ 0.001;x2=30.90,P ＜ 0.001).Contrast-enhanced patterns were not significantly different between benign and malignant TNs in the process and completeness of enhancement.Malignant lesions had concentric (79.5％),inhomogeneous (89.0％) and low (71.1％) enhanced with irregular (79.5％) and unclear (64.4％) boundary and bigger size (63.0％).The typical CEUS feature of benign nodules was peripheral ring hyperenhancement (34.7％).According to ROC curve,the cut off value was 3.5 points.The area under the ROC curve (AUC) for CEUS was 0.862 (95％CI:0.797-0.927).The sensitivity,specificity and accuracy for CEUS were 80.8％,79.6％,80.3％ respectively.Conclusion The pattem of CEUS may assist in differential diagnosis of benign and malignant TNs.

0.1 ?mol?L-1), inducing differentiation through enhancement of melanogenesis and increase of the activity of tyrosinase at lower doses(