Objective To investigate the learning curve of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.Methods The clinical data of 450 cases of patients who received laparoscopic inguinal hernia repair by the same group of surgeons from December 2012 to August 2016 in our hospital were sequentially divided into three groups,with 150 cases in each group.The cases of each group who received TEP inguinal hernia repair were extracted and enrolled into group A,B and C.The preoperative,intraoperative and postoperative indicators were compared among the three groups.Results Before operation,no statistically significant difference was found in age,gender,incidence rates of scrotum hernia,recurrent hernia and bilateral hernia,and types of hernia among the three groups (P＞0.05).And there was no statistically significant difference in incidence rates of postoperative urinary retention,analgesia and seromas,and hospitalization expenses among the three groups (P＞0.05).During operation,differences in conversion rate,operative time and volume of blood loss among the three groups were statistically significant (P＜0.05).Moreover,statistically significant differences in conversion rate,operative time and volume of blood loss were found between group A and group B (P＜0.05),while there was no statistically significant difference between group B and group C (P＞0.05).The regression curves were drawn based on operation time,volume of blood loss and the number of cases,which estimated the inflection point was 150.Conclusion The learning curve of TEP inguinal hernia repair include approximately 150 cases of laparoscopic inguinal hernia repair (including 16 cases of patients received TEP).The TEP inguinal hernia repair operation during the learning curve can be safety on the basis of preoperative evaluation and appropriate case selection.

Objective To investigate influencing factors of the number of lymph node harvest after radical resection of colorectal cancer.Methods The retrospective case-control study was conducted.The clinicopathological data of 227 patients with colorectal cancer who underwent radical resection in People's Hospital of Changshou Chongqing from June 2010 to June 2016 were collected.The surgical method and resection extention were determined depending on the tumor location showed on imaging examinations,and all patients underwent radical resection and sufficient lymph nodes dissection.Observation indicators:(1) intra-and post-operative situations;(2) influencing factors analysis of the number of lymph nodes harvest after radical resection of colorectal cancer;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival up to October 2016.Measurement data with normal distribution were represented as (x)±s.Univariate analysis was done using the chi-square test or Fisher exact probability method.Multivariate analysis was performed using the binomial Logistic regression analysis.Results (1) Intra-and postoperative situation:all the 227 patients underwent successful radical resection of colorectal cancer,including 67 with radical resection of right colon cancer,16 with radical resection of left colon cancer,26 with radical resection of sigmoid colon cancer and 118 with radical resection of rectal cancer.Of 227 patients,118 received laparoscopic surgery,109 received open surgery including 8 converted to open surgery from laparoscopic surgery.Tumor located in right hernicolon,left hemicolon,sigmoid colon and rectum were respectively detected in 67,16,26 and 118 patients,same as results of imaging examintions.Operation time,volume of intraoperative blood loss and number of lymph nodes harvest in 227 patients were (192 ± 72) minutes,(94± 84) mL and 14 ± 4.Of 8 patients in 227patients with postoperative complications,2 received secondary suture due to wound infection,2 received reoperation due to intestinal obstruction,1 received transverse colostomy due to anastomotic leakage,and 3 received stoma reconstruction due to stoma retraction.Duration of postoperative hospital stay of 227 patients was (22±9) days.Postoperative pathological examininations:35 and 192 patients were respectively diagnosed with rnucinous adenocarcinoma and non-mucinous adenocarcinoma.Moderate-and low-differentiated carcinoma and high-differentiated carcinoma were respectively detected in 47 and 180 patients.(2) The influencing factors analysis of the number of lymph nodes harvest after radical resection of colorectal cancer:univariate analysis showed that tumor location and tumor pathological T stage were related factors affecting the number of lymph node harvest after radical resection of colorectal cancer (x2=10.066,P＜0.05).Multivariate analysis showed the tumor location and tumor pathological T stage were independent factors affecting the number of lymph nodes harvest after radical resection of colorectal caucer (OR=1.283,6.075,95％ confidence interval:1.031-1.597,1.215-30.385,P＜0.05).(3) Follow-up and survival situations:190 of the 227 patients were followed up for 4-72 months,with a median time of 32 months.During the follow-up,21 patients died,23 patients survived with tumor,and 146 patients survived without disease.Conclusion Tumor location and tumor pathological T stage are independent factors affecting the number of lymph node harvest after radical resection of colorectal cancer.

Objective To evaluate the dosimetric effect of carbon fiber tabletop on the patient doses in radiotherapy. Methods The transmission factors of couch and inserts were measured in air and solid water phantom using 0.6 cm3 ion chamber and PTW 2D ion chamber array for 6 MV ,10 MV and 18 MV X-ray,respectively. Absorbed doses at depth of maximum dose ,5 cm and 10 cm in solid water were measured with the 2D ion chamber array. Absorbed doses fluctuations with different gantry angles and air gaps between phantom and couch were also measured. Results The posterior field measurement showed that the reductions of absorbed doses at the depth maximum dose,5 cm and 10 cm were within 5%. The ratios of the absorbed doses with to without couch increased with the oblique incident angles and varied slightly with the air gap at depth of 5 cm. The transmission factors of inserts were less than those of couch owing to its thinner thickness. Conclusion The carbon-fiber tabletop affects the absorbed doses and dose distributions of the target, and this effect changes with the gantry angle and air gap. Special considerations should be taken during treatment planning.

Objective:To compare and analyze the chemical constituents of volatile oils extracted from the different parts ( flow-ers,leaves and roots) of Stelleropsis tianschanica by chromatography-mass spectrometry (GC-MS). Methods:The volatile oil was ex-tracted by diethyl ether-Soxhlet extraction method and analyzed by GC-MS with a capillary gas chromatographic column. The relative contents of the volatile compounds were calculated by chromatographic peak area normalization method.Results: Totally 179 volatile constituents in the different parts of Stelleropsis tianschanica were identified. Among them,81 compounds were identified in leaves,and the relative content accounted for 82.77% of the total volatile compounds;108 compounds were identified in flowers,and the relative content accounted for 82.85% of the total volatile compounds;112 compounds were identified in roots, and the relative content ac-counted for 85.98% of the total volatile compounds. Totally 33 compounds existed in all the three parts,and the content accounted for 39.24% of the total volatile components in leaves,35.86% in flowers and 48.89% in roots. The relative content of(Z,Z)-9,12-oc-tadecadienoic acid in leaves,flowers and roots of S. tianschanica was the highest,which accounted for 11.12%,9.8% and 22.49%, respectively. Conclusion:The different parts of S. tianschanica have similar volatile components, while the specific substances and the contents are different.

Objective To observe the clinical effect of osteoporotic vertebral compression fracture(OVCF)and analyze the value of magnetic resonance imaging(MRI)and bone metabolism indexes in predicting the poor prognosis.Methods A total of 258 OVCF patients admitted to Hangzhou Ninth Peopl's Hospital from March 2021 to March 2023 were selected as study objects.After percutaneous kyphoplasty(PKP)or percutaneous vertebroplasty(PVP),visual analogue scale(VAS)score and Cobb angle were collected.The patients were divided into poor prognosis group and good prognosis group according to whether the fracture was repeated after surgery.MRI and bone metabolism indexes of patients were collected,and the influencing factors of prognosis were analyzed.Results The VAS scores of OVCF patients decreased with the extension of time(P<0.05).One month and three months after surgery,the Cobb angle of injured vertebrae in OVCF patients was significantly lower than that before surgery(P<0.05).The proportion of vertebral fluid signs in poor prognosis group was significantly higher than that in good prognosis group(P<0.05),and N-terminal midragment of osteocalcin(N-MID)and 25-hydroxyvitamin D[25(OH)D]in poor prognosis group were lower than those in good prognosis group(P<0.05).Vertebral fluid signs,N-MID and 25(OH)D were all associated with poor prognosis in OVCF patients(P<0.05).The area under the curve(AUC)of vertebral fluid signs,N-MID and 25(OH)D alone for predicting poor prognosis of OVCF was 0.744,0.872 and 0.822,the sensitivity was 56.5%,87.0%and 73.9%,and the specificity was 92.3%,74.5%and 80.9%,respectively.Above indicators combined AUC,sensitivity and specificity were 0.967,95.7%and 80.9%.Conclusion PKP/PVP can reduce pain and improve function in OVCF patients.MRI vertebral fluid signs,N-MID and 25(OH)D are all factors affecting the poor prognosis of OVCF patients,and the combination of three factors can predict the poor prognosis of OVCF patients.

Objective To evaluate the change of clinicopathological features and prognosis of papillary thyroid cancer over a 15-year period.Methods The clinicopathological features and outcomes of papillary thyroid cancer patients were analyzed in three groups according to the time of diagnosis:group Ⅰ (1997-2001),group Ⅱ (2002-2006),and group Ⅲ (2007-2011).Results As time advanced,the average age of papillary thyroid cancer patients increased,tumor stage,like size,extrathyroid invasion and lymph node metastasis decreased dramatically (P ＜ 0.01).The percentage of multifocality and bilaterality increased.The long-term follow up data (median follow up time was 6.6 years),indicated that the 15-year over all survival was 97.8％ and the 15-year disease-free survival was 90.2％.Tumor ≥3 cm,bilaterality,extrathyroid invasion,lymph node metastasis and AJCC stage were correlated with tumor recurrence.By multivariate COX-regression analysis only lymph node metastasis and bilaterality were independent risk factors.Conclusion The clinicopathological features of papillary thyroid cancer changed over 15 years,with the percentage of early-staged patients increased.Lymph node metastasis and bilaterality are two risk factors for tumor recurrence.