Objective To investigate the clinical value of enhanced recovery after surgery (ERAS) in radical resection of hepatocellular carcinoma (HCC).Methods The propensity score matching (PSM) and retrospective cohort study were conducted.The clinicopathological data of 116 patients with HCC who were admitted to the Fuzhou General Hospital of Nanjing Command of PLA from June 2014 to January 2016 were collected.Fifty-eight patients using pre-,intra-and post-operative ERAS managements were allocated into the ERAS group and 58 using traditional perioperative managements were allocated into the control group.Observation indicators:(1) operation situations;(2) postoperative recovery:postoperative recovery time of bowel sound,time to initial anal exsufflation,time of drainage-tube removal,levels of alanine transaminase (ALT),total bilirubin (TBil),C-reactive protein (CRP) at 1,3 and 7 days postoperatively,postoperative complications (vomiting,abdominal distension,wound infection,intra-abdominal infection and pulmonary infection),duration of postoperative hospital stay,hospital expenses and satisfaction degree of patients;(3) follow-up situation.Followup using outpatient examination and telephone interview was performed to detect survival of patients up to March 2016.Measurement data with normal distribution were described as x±s.The comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range).The comparison between groups was analyzed using the paried rank sum test.Repeated measurement data were evaluated by the repeated measures ANOVA.Results (1) Operation situations:all the patients underwent successful operations,without perioperative death.(2) Postoperative recovery:postoperative recovery time of bowel sound,time to initial anal exsufflation,time of drainage-tube removal,levels of ALT,TBil and CRP at 1,3 and 7 days postoperatively,duration of postoperative hospital stay,hospital expenses and satisfaction degree of patients were (49±10)hours,(60±10)hours,(3.3±0.7)days,(379±99)U/L,(222±65)U/L,(98±16)U/L,(20.4±4.7)μmol/L,(15.5±2.1)μmol/L,(13.4±1.8)μmol/L,(49±10)mg/L,(124±21)mg/L,(30± 5)mg/L,(9.7±0.9)days,(4.1±0.6) ×104 yuan,8.6±0.9 in the ERAS group and (53±5)hours,(64±7)hours,(6.2±1.6)days,(445± 114)U/L,(278±79) U/L,(116± 25) U/L,(18.6± 3.5) μmol/L,(17.0±2.7) μmol/L,(14.2±1.9)μmol/L,(53±11)mg/L,(135±35)mg/L,(34±6)mg/L,(10.0± 1.0) days,(4.3±0.5)x104 yuan,8.2±1.0 in the control group,respectively,with statistically significant differences between the 2 groups (t=2.537,2.479,2.065,F=20.075,14.357,13.460,t=2.060,2.197,2.370,P＜0.05).Number of patients with postoperative vomiting,abdominal distension,wound infection,intra-abdominal infection and pulmonary infection were 5,3,2,1,1 in the ERAS group and 6,6,7,5,3 in the control group,respectively,with no statistically significant difference between the 2 groups (x2=0.100,1.084,3.011,0.206,0.618,P＞ 0.05).(3) Follow-up situation:all the 116 patients were followed up for 1-20 months,with a median time of 11 months.During the follow-up,2 patients in the ERAS group died (1 dying of tumor recurrence and 1 dying of respiratory failure) and 3 in the control group died (1 dying of multiple organs metastasis,1 dying of lung metastasis of HCC and 1 dying of myocardial infarction).Conclusion ERAS in the perioperative management after radical resection of HCC is safe and effective,and it can quickly improve postoperative recovery of patients.

Objective To assess the diagnostic value of three-dimensional(3D) helical CT imaging in the cases of complex maxillofacial fractures and to discuss the clinical usefulness of 3D to surgeons.Methods 26 patients with trauma suspected of having complex facial fractures were examined with thin-slice CT scan and 3D reconstruction.Results The location,shape and displacement of fragment of complex maxillofacial fractures were demonstrated steroscopically by three-dimensional images reconstructed from helical CT.Conclusion 3D helical CT imaging can provide valuable information in demonstrating the space relationships of maxillofacial fractures.

Objective:To construct eukaryotic expressing vector of the full length coding sequence of Bad gene and to express the gene in the basal cell carcinima A431 cells.Methods:Bad gene was amplified from Hela cell line by RT-PCR and the fragment of the cDNA was cloned into eukaryotic expressing vector pcDNA3.1-myc by ligating the fragment into XhoI and EcoRI site.The recombinant plasmid pcDNA3.1-myc-Bad was identified by DNA sequencing and restriction enzyme analysis.The gene transfection mediated by lipofectin was used to introduce the eukaryotic expressing vector of pcDNA3.1-myc-Bad into human basal cell carcinima A431 cells. After selection with G418, resistant colonies were obtained.Trasfection efficiency was identified by Western blot and SABC-FITC assay.Cell proliferation was examined by cell counting and colonogenic assay after transfection.Results:A 500 bp DNA fragment was amplified with RT-PCR.Sequence and restriction enzyme analysis showed that the recombinant plasmid pcDNA3.1-myc-Bad was constructed successfully.In human basal cell carcinima cell line A431 Bad gene was expressed.The cell proliferation was inhibited by 62.6% and colonogenesis by 39.9% by the transfection of the gene.Conclusion: Human Bad gene was successfully cloned.Transfection of basal cell carcinoma cells with the gene may inhibit the cell proliferation and colonogenesis.

BACKGROUND: According to up-to-date development, the best timing to repair cleft palateis at 9-12 months old after birth when the articulation does not begin to develop.However, there are many over-eight-year-old children who still suffer from unrepaired cleft palate. Therefore, it is veryimportant to adopt proper surgery for these patients to improve palate form and articulatory function. OBJECTIVE: To study the characteristics of the cleft palate in patients of over 8 years old and the effects of palate repair and posterior pharyngeal flap transplantation (PPFT) on articulation. DESIGN:A controlled study with children patients as subjects. SETTING: Department of Maxillofacial Surgery, Medical College of Stomatology, Fourth Military Medical University of Chinese PLA PARTICIPANTS: Twenty-four children patients of cleft palate who were treated in the Department of Maxillofacial Surgery ,Medical College of Stomatology, Fourth Military Medical University of Chinese PLA from January 2000 through December 2003 were enrolled in the study. Fourteen were male and ten female. Their ages varied from 8 to 20 years old (mean 13.8 years). Three cases were bilateral complete cleft palate and twelve cases were unilateral complete cleft palate. Nine were incomplete cleft palate. METHODS :Two flap palatoplasty and upper pedicle PPFT were conducted in all the patients. In thirty days after surgical treatment, the patients were asked to repeat the words of a doctor in the phonetic lab with his or her lips 10 cm away from microphone. The words of the patients were recorded and evaluated subjectively by 5 doctors specialized in pathologic phones. MAIN OUTCOME MEASURES :The palatopharynx was observed with nasopharyngoscope before and after operation. And the improvement of nasal gas leakage and enhanced rhinophonia were also evaluated. RESULTS: The repaired cleft palate was healed in the first intention in all the patients. The soft palate retreated satisfactorily and the palatopharynx was apparently closed, which created good preconditions for articulation. The patients' articulation was also improved in different degrees. All the 24 patients had the fourth grade of enhanced rhinophonia and nasal gas leakage before repairing. After palate repair and PPFT, the enhanced rhinophonia and nasal gas leakage of grade 1 was in 3 patients, grade 2 in seven, grade 3 in six and grade 4 in eight patients. CONCLUSION: The combination of palate repair and pharyngoplasty is able to improve the form of soft palate and the articulation of over-eightyear-old patients with cleft palate.

Purpose:To study the determining prognostic factors that affect the survival of patients with bilateral breast cancer. Methods:The records of 21 women with bilateral breast cancer were analyzed.4(19%) presented simultaneous bilateral tumor.17(81%)developed bilateral breast cancer with interval in between. Patients were treated with surgery, radiation treatment and chemotherapy. Analysis of high risk factors of breast cancer and possible relation to postoperative survival was carried out.Results:The size of the tumor, the number of involved axillary nodes, and the adequacy of the initial treatment still remain the major prognostic factors ,correlated with the time interval between two cancers. 2 year, 5 year, 10 year, survival was recorded to be 90%, 71.4%, 66.7%. Conclusions:If treatment is correct for bilateral breast cancers, its 5 year survival rate still rather high. Time interval between two breast cancers was the most prominent prognostic factor, correlated with the overall survival. The early diagnosis and prompt adequate treatment of the seconed primary breast cancer are still the key to longer survival rates of bilateral breast cancer.

Objective To investigate the specific measures and effect of the nursing care for elderly lung cancer patients who were receiving the treatment of CT-guided permanent interstitial co-implantation of 125I seeds and slow-released fluorouracil.Methods Active care,including adequate preoperative preparation,proper support during operation and postoperative nursing,was carried out for fifty-three elderly patients with lung cancer during their treatment course of CT-guided permanent interstitial brachytherapy with co-implantation of 125I seeds and slow-released fluorouracil.Results In order to ensure accurate puncture and the smooth particle implantation,the possible conditions which might happen after the procedure were informed to the patients before the surgery and useful advice was given to patients to guide their daily activities.All 53 patients showed no obvious fear before surgery and made good cooperation during the procedure,moreover,they well responded to the therapy and recovered pretty soon.Conclusion CT-guided permanent interstitial co-implantation of 125I seeds and slow-released fluorouracil is a safe,minimally-invasive and newly-developed technique with reliable effect,which is especially suitable for aged patients.Active and adequate nursing care is essential during the whole therapeutic course.

Objective:To investigate the application value of three-dimensional (3D) visualization combined with indocyanine green (ICG) fluorescence imaging in anatomical hepatectomy for hepatocellular carcinoma (HCC).Methods:Clinical data of 45 patients with HCC who underwent anatomical hepatectomy in the Department of Hepatobiliary Surgery, the 900th Hospital of Joint Logistic Support Force of People′s Liberation Army from September 2019 to December 2020 were retrospectively analyzed. Among them, 27 patients were males and 18 were females, aged from 28 to 73 years, aged (57.76±10.95) years on average. According to the different surgical methods, all patients were randomly divided into ICG group ( n=24) and control group ( n=21). In ICG group, 15 patients were males and 9 females, aged (58.21±11.81) years on average. Anatomical hepatectomy was performed using 3D visualization combined with ICG fluorescence imaging. In control group, 12 patients were male and 9 female, aged (57.24±11.35) years on average. Conventional anatomical hepatectomy was performed. The operation duration, bleeding volume, the numbers of cases underwent blood transfusion, occlusion durations, days of hospitalization, highest postoperative serum ALT and TBiL, duration of recovery of postoperative serum ALT and TBiL, and incidence of complications were observed. Measurement data with approximately normal distribution were represented by ( Mean± SD) and groups were compared using t test. Measurement data with skewed or uneven distribution were represented by M (rang) and groups were compared using Man-Whitney U test. Count date were compared using Fisher exact test. Results:All the patients underwent successful operations, without perioperative death. In ICG group, the operation duration was 110.50 (44.00-145.00) min and the occlusion durations was (15.17±2.14) min respectively, shorter than 122.00(80.00-255.00) min and (17.29±4.35) min in control group, the difference between the two groups were statistically significant ( Z=-2.002, -2.115; P<0.05). In ICG group, the numbers of cases underwent blood transfusion was 2 cases, less than 8 cases in control group, the difference between the two groups was statistically significant ( χ2=4.147, P<0.05). The bleeding volume, days of hospitalization, highest postoperative serum ALT and TBiL, duration of recovery of postoperative serum ALT and TBiL, postoperative complications between the two groups were not statistically different ( P>0.05). Conclusions:3D visualization combined with indocyanine green fluorescence imaging technique is a feasible surgical method for anatomical hepatectomy. It is helpful for liver surgeons to visualize and recognize the boundary between hepatic segments and improve the safety of anatomic hepatectomy.

Objective To study the correlation between the renin-angiotensin-aldosterone system angiotensinogen (AGT) gene M235T,angiotensin Ⅱ type 1 receptor (AGTR1) gene Al166C,aldosterone synthase (CYP11B2) gene -344C/T polymorphisms and large-artery atherosclerotic (LAA) stroke in a southern Chinese Han population.Methods Polymerase chain reaction and gene sequencing technology were used for the genotyping in patients with LAA and normal controls with AGT gene M235T,AGTR1 gene A1166C,and CYP11B2 gene - 344C/T polymorphisms in a southern Chinese Han population,and to determine the correlation between the 3 gene polymorphisms and LAA by binary logistic regression analysis.Results A total of 107 patients with LAA and 142 healthy controls were included in the study.The frequencies of the AGT gene 253TT genotype (66.36％ vs.50.70％,x2 =6.122,P =0.047) and T allele (79.44％ vs.70.07％ ％,x2 =5.581,P =0.018) in the LAA group were significantly higher than those in the control group.The frequencies of the AGTR1 gene 1166CC genotype (0％ vs.0％,x2 =1.494,P =0.222) and C allele (7.48％ vs.4.93％,x2 =1.399,P =0.237) in the LAA group were no significantly differences with those in the control group.The frequencies of the CYP11B2 gene - 344CC genotype (9.35％ vs.4.23％,x2 =3.603,P =0.165) and C allele (27.10％ vs.26.06％,x2 =0.069,P =0.793) in the LAA group were no significant differences with those in the control group.Binary logistic regression analysis showed that there was no significant correlation between the three gene polymorphisms and the simple LAA diseases.The frequencies of AGT gene 235TT genotype (68.00％ vs.41.90％,x2 =12.446,P =0.002) and T allele (79.33％ vs.64.76％,x2 =8.993,P =0.003) in the LAA patients complicated with hypertension were significantly higher than those in the normotensive control group.Logistic regression analysis showed that the odds ratio (OR) exposed to TT genotype was 2.153 (95％ confidence interval [CI] 0.789-5.872).The OR of T allele was 2.089 (95％ CI 1.285-3.396).Conclusions The AGT gene M235T polymorphism is not associated with the simple LAA in the southern Chinese Han population,but it may be associated with the risk of LAA complicated with hypertension;CYP11B2 gene -344C/T polymorphism and AGTR1 gene A1166C polymorphism are not associated with the onset of LAA in the southern Chinese Han population.

Objectives To explore the correlation between the population characteristics of sero-reactivity with quantitative antibody based-IHA and the transmission parameters,such as epidemic situation,transmission status or infection trend in population.Methods The residents in one endemic administrative village were simultaneously examined by Kato-Katz technique for parasitological stool examination,as well as by immuno-diagnostic technique IHA for detection of IgG antibody against soluble egg antigen for two consecutive years.The results of examination were analyzed and compared on the diagnostic parameters of IHA,the correlation of the changes of positive rates and antibody levels of IHA with the changes of infection trend in population and the distribution of antibody levels between 'the true negative' and 'the true positive'.Results When Kato-Katz technique based on 2 stool samples,each read in 3 thick smears,was used as the reference,the overall sensitivity of IHA was high (from 77.27% to 85.48%) with a relatively poor specificity of lower than 60%,the negative predict value (NPV) was excellent of higher than 94%.The specificity of IHA decreased with the increase of the age in different age-groups of population,showing the highest among the younger less than 15 years old.The distribution trends of positive rates of antibody in different age groups by IHA showed similar to that of egg positive rate detected by Kato-Katz although the positive rates of IHA were higher than these by Kato-Katz,which showed that a higher false positive (from 41.90% to 44.56%) and a certain false negative (from 14.52% to 22.73%)existed in IHA.The positive rate of antibody decreased slowly among the individuals with S.japonicum infection,who received treatment.There was an overlap in the distribution of antibody levels between ' the true negative' and ' the true positive'.Conclusions Under the current schistosomiasis epidemic situation in China,IHA is valuable in the epidemiologic surveys.It should be of further deliberation applying IHA as the screening approaches for identification of target individuals for treatment or determination of the infection rate in community and IHA needs to be combined with the parasitological examination.

Objective To investigate the effect of hyperthermia on the expression of E6 and E7 genes of human papillomavirus (HPV) type 6 and 11 in HPV-infected human skin. Methods Tissue samples were obtained from the lesions of condyloma accuminatum (CA) in 6 patients after informed consent. Each sample was divided into 4 parts: one was embedded and directly stored at -80 ℃; the other 3 parts were placed in culture medium and the surface of the samples was irradiated for 30 minutes with a thermotherapy apparatus at 37℃, 42 ℃, 45 ℃, respectively, then the samples were taken out and stored at -80 ℃. RNA was extracted from the specimens, real time quantitative PCR (qPCR) was performed to detect the expression of E6 and E7 genes of HPV-6 and -11. Results Of the 6 patients, 2 were infected with HPV-6 and -11 respectively, 4 with both HPV-6 and HPV-11. The expression of E6 and E7 mRNA decreased with the increase in irradiation temperature. The relative mRNA expression levels at 37 ℃, 42 ℃ and 45 ℃ were 1.00 ± 0.00, 0.61 ± 0.17, 0.27 ± 0.15, respectively, for HPV-6 E6 gene, 1.00 ± 0.00, 0.56 ± 0.21, 0.16 ± 0.11 respectively, for HPV-6 E7 gene, 1.00 ± 0.00, 0.60 ± 0.22, 0.16 ± 0.08, respectively, for HPV-I1 E6 gene, 1.00 ± 0.00, 0.55 ± 0.15, 0.24 ± 0.06, respectively, for HPV-11 E7 gene; statistical difference was noted among them between the specimens irradiated at different temperature (all P < 0.01). Conclusion Hyperthermia can remarkably suppress the expression of HPV-6/I 1 E6 and E7 genes, which may be a possible mechanism under the regression of warts induced by local hyperthermia.