0.05).Conclusion The expression of TM in different TCM syndromes of gastric carcinoma was different.There exists a certain relation in the expression of TM1 and TM2 in different TCM syndromes of gastric cancer.

Objective To compare the clinical efficacy of Da Vinci robot-assisted esophagectomy and combined thoracoscopy-and laparoscopy-assisted esophagectomy for esophageal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 116 patients who underwent minimally invasive radical resection of esophageal cancer in the Shanghai Chest Hospital of Shanghai Jiaotong University between November 2015 and September 2016 were collected.Fifty-eight patients undergoing combined thoracoscopy-and laparoscopy-assisted esophagectomy and 58 undergoing Da Vinci robot-assisted esophagectomy were respectively allocated into the thoracoscopy-and laparoscopy-assisted and Da Vinci robot-assisted groups.Patients received esophagectomy by right thorax-left cervico-abdominal triple incisions,thorax-cervico 2-field lymph node dissection of esophageal cancer and digestive tract reconstruction via assisted incision.Observation indicators:(1) surgical and postoperative situations;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were described as (x)±s.Measurement data with skewed distribution were described as M (range).Comparison between groups was analyzed by the nonparametric test,and comparisons of count data were done by the chi-square test and Fisher's exact probability.Results (1) Surgical and postoperative situations:all patients received successful surgery,without conversion to open surgery.The number of lymph nodes dissected along the recurrent laryngeal nerve (RLN) and duration of postoperative hospital stay were 2.8±2.2,13 days (range,9-131 days) in the thoracoscopy-and laparoscopy-assisted group and 4.8±3.7,11 days (range,7-81 days) in the Da Vinci robot-assisted group,respectively,with statistically significant differences between the 2 groups (t =3.480,Z =2.361,P＜0.05).The total operation time,numbers of patients with overall complications,anastomotic leakage,injury of the RLN,pleural effusion,pulmonary infection,respiratory failure,chylothorax,arrhythmia and tracheoesophageal fistula were respectively (276±61)minutes,24,15,7,6,5,4,2,1,0 in the thoracoscopy-and laparoscopy-assisted group and (261±50)minutes,21,8,10,4,2,2,1,1,1 in the Da Vinci robot-assisted group,with no statistically significant difference (t =1.296,x2 =0.327,2.657,0.620,0.438,1.368,0.703,0.342,1.009,P＞0.05).Some of the patients had postoperative multiple complications.Patients with anastomotic leakage received local dressing changes,continuous gastrointestinal decompression and vacuum aspiration.The pronunciation and bucking response were observed in patients with injury of the RLN (unilateral injury).Patients with pleural effusion received pleural puncture fluid or closed thoracic drainage.Patients with pulmonary infection underwent antibiotic therapy and regular aerosol inhalation.Patients with respiratory failure underwent tracheotomy and assisted breathing with ventilator.Patients with chylothorax received fasting and closed thoracic drainage.Patients with arrhythmia were treated by drug.Patients with tracheo-esophageal fistula underwent conservative treatment.All the patients with complications were improved or cured.There were no wotmd infection,deep venous thrombosis of lower extremity,pulmonary embolism,reoperation and death within 30 days postoperatively in patients of 2 groups.(2) Follow-up and survival situations:all the 116 patients were followed up for 5-15 months,with a median time of 8 months.Numbers of patients with tumor-free survival,tumor recurrence and tumor metastasis were 50,6,4 (2 with simultaneous tumor recurrence and metastasis) in the thoracoscopy-and laparoscopy-assisted group and 51,5,4 (2 with simultaneous tumor recurrence and metastasis) in the Da Vinci robot-assisted group,respectively,showing no significant difference between the 2 groups (x2=0.077,1.000,P＞0.05).Conclusions Da Vinci robot-assisted esophagectomy is safe and feasible in the treatment of esophageal cancer.Compared with combined thoracoscopy-and laparoscopy-assisted esophagectomy,Da Vinci robot-assisted esophagectomy has comparable operation time,and is associated with a greater yield of lymph nodes along the RLN.

Objective To investigate the risk factors associated with early mortality (within 30 days) of patients with spontaneously ruptured hepatocellular carcinoma (SRHCC) and assess the efficacies of different treatment regimens. Methods The clinical data of 28 patients with SRHCC who had been admitted to our hospital from January 1999 to January 2006 were retrospectively analyzed. Multiple factors that might cause early mortality were determined, and the efficacies of different treatment regimens were assessed. Results Eleven patients died within 30 days. with the mortality rate of 39%. Univariate analysis showed that shock, Child C status, hemoglobin. ALT, and volume of blood transfusion were associated with early mortality (X2=3.020, 13.741, Z=-2.059, -2.210, -4.153, P<0.05). Child C status and volume of blood transfusion were the independent risk factors. All the patients were divided into hepatectomy group (8 cases), surgical hemostasis group (7 cases), transarterial embolization group (7 cases) and conservative group (6 cases). Patients in hepatectomy group had a better 30-day and median time survival rate compared with those in the other 3 groups (X2=8.098, 8.098, 15.025, Z=-3.127, -2.840, -3.004, P<0.05). Conclusions Poor hepatic functional reserve and severe hemorrhage are closely associated with early mortality of patients with SRHCC. Hepatectomy is a better choice for SRHCC.

BACKGROUND:We built Sprague-Dawley rat models with mild, moderate, and severe spinal cord injuries to accord with the spinal cord injury types for basic empirical study, and consequently to further understand the microenvironmental change in Sprague-Dawley rats with spinal cord injury, and to provide help for clinical treatment. OBJECTIVE:To observe the changes in nerve function, pathological manifestation and motor sensory evoked potential in Alen’s models and Sprague-Dawley rats with complete spinal cord transection at different time points after spinal cord injury by simulating the microenviroment in Sprague-Dawley rats. METHODS: A total of 125 healthy adult female Sprague-Dawley rats were selected and randomly divided into group sham operation group, 100 gcf hit potential group (20 g×5 cm), 200 gcf hit potential (20 g×10 cm), 300 gcf hit potential group (20 g×15 cm), and spinal cord complete transection group with 25 rats in each group. At 1, 5, 7, 14 and 28 days after model establishment, the degree of spinal cord injury was identified by the BBB scores of motion function, motor evoked potential, and pathological section. RESULTS AND CONCLUSION:(1) Totaly 24 Sprague-Dawley rats died in the experiment. The death rate and the rate of complications were highest in the spinal cord complete transection group. The BBB score of each group was decreased. The BBB scores in every group increased as time went on. There were significant differences between each surgery group and the sham operation group at corresponding time points (P < 0.05). No significant difference was found between the 300 gcf hit potential group and the spinal cord complete transection group at corresponding time points (P > 0.05). (2) In each surgery group, the infiltration of inflammatory cels and obvious sweling of neurons were visible at 1 day after injury. Neural cels reduced with time prolonged. At 28 days after injury, a large number of astrocytes proliferated, scar and spinal cord cavity formed. Above symptoms were worse in the 300 gcf hit potential group and spinal cord complete transection group than in the 100 gcf and 200 gcf hit potential groups. (3) Significant differences in amplitude and latency were detectable between each surgery group and the sham operation group (P < 0.05). No significant difference in amplitude and latency was detected between the 300 gcf hit potential group and the spinal cord complete transection group at corresponding time points (P > 0.05). Results confirmed that hit potential of 20 g×5 cm, 20 g×10 cm and 20 g×15 cm can simulate the microenvironment of Sprague-Dawley rats with mild, moderate and severe spinal cord injury. The rate of complication was lower in modified Alen’s model of different hit potentials than in models of spinal cord complete transection, and was more accorded with basic research.

Objective To detect EPPB41L3 methylation frequency difference between esophageal squamous cell carcinoma (ESCC) tissues and the normal tissues and between ESCC patients′plasma and healthy volenteers′plasma, and to analyze the correlation with clinicopathological parameters. Methods We collected esophageal squamous cell carcinoma tissues (n = 42 patients) and adjacent surrounding normal tissues (n = 42 patients), and plasma from 42 patients with ESCC and from 50 healthy individuals. We used methylation specific PCR (MSP) combined with agarose gel electrophoresis to detect the methylation status of the EPB41L3. We used the SPSS 13.0 software for statistical analysis by χ2 test and Fisher′s exact test. Results EPB41L3 frequency of methylation was significantly higher in tumor tissues than in the adjacent tissues (59.5% vs. 4.8%), the difference was statistically significant (χ2 = 28.873, P < 0.001). For plasma, EPB41L3 methylation frequency was 31.0%in cancer patients, while was not detectable in the healthy volunteers. Methylation of EPB41L3 in tissues was more frequently found in patients with tumor size of ≥ 5 cm or T3 than in patients with tumor size of < 5 cm or T1-2. Conclusions The methylation frequency of EPB41L3 is higher in ESCC tissues than in control normal tissues, and higer in plasma from ESCC patients than that from the healthy volunteers. EPB41L3 methylation is more frequently found in patients with more advanced disease.

BACKGROUND: Decrease of regional cerebral blood flow (rCBF) perfusion of different degree exists in depressive patients, but the decreased ranges were different, different cerebral cortical and subcortical regions are involved.OBJECTIVE: To observe the types of abnormal rCBF perfusion in patients with depressive disorder.DESIGN: A diagnosis-based case-control analysis.SETTINGS: Department of Nuclear Medicine, Ruijin Hospital Affiliated to the Medical College of Shanghai Jiaotong University; Staff Room of Biomedical Engineering, Medical College of Shanghai Jiaotong University;Putuo District Mental Health of Shanghai City.PARTICIPANTS: The patients with depressive disorder were selected from the Putuo District Mental Health Center from January 1999 to December 2000, and 19 normal subjects matched by age were selected from the medical staff of the hospital as normal controls.METHODS: The patients with depressive disorder and healthy subjects were examined by single photon emission computerized tomography (SPECT), ethyl cysteinate dimmer (99Tcm-ECD) was performed, and the images were analyzed with the statistical parametric mapping (SPM). All the SPECT images were converted into DICOM format or ANALYZE-7 format at first, and then the images were standardized by taking MRI template as the template and smoothed, and the significantly different regions were evaluated by the statistical analysis and inferences with the Gaussian random theory.MAIN OUTCOME MEASURES: The differences of the cerebral blood flow perfusion in specific region and the changes of average rCBF images were mainly observed in the depressive disorder group and normal control group.RESULTS: All the 12 patients with depressive disorder and 19 normal healthy subjects entered the analysis of results. The SPM showed that the blood flow perfusion was decreased in bilateral frontal lobes, left superior temporal gyrus, left Brodmann area 20, left mamillary body of thalamus,right cingulated gyrus and right putamen in the patients with depressive disorder. The blood flow perfusion was increased in the right central frontal gyrus, right superior temporal gyrus, right occipital lobe and left central frontal gyrus.CONCLUSION: The rCBF is obviously changed in the frontal lobe, temporal lobe and limbic system of patients with depressive disorder.

[Objective] To investigate the clinical value of using prospective ECG-gating Helical protocol in whole aorta and coronary arteries CT angiography combined with low tube voltage,low contrast medium injection rate and dose technology.[Methods]A total of 60 patients (heart rate≤ 75 bpm and normal heart rhythm) with suspected aortic disease or post-operation were randomly divided into 2 groups:G1 (n =30;tube voltage:80 kV;contrast medium injection rate:3 mL/s;contrast medium dose:0.65 mL/kg)and G2 (n =30;tube voltage:120 kV;contrast medium injection rate:4 mL/s;contrast medium dose:1.2 mL/kg).The two groups underwent aorta angiography with prospective ECG-gating Helical protocol by using 320-detector CT.The mean CT values and standard deviation of aorta,coronaries and adjacent adipose tissue were measured,signal to noise ratio (signal-to-noise ratio,SNR)and contrast to noise ratio (contrast-to-noise ratio,CNR) were calculated.The subjective quality scoring of 3-d post-processing images were evaluated independently by 2 senior radiologists.The mean CT values and standard deviation of aorta,coronaries and adipose tissue,SNR,CNR,subjective quality scoring,contrast medium dose and radiation dose were compared and analyzed.[Results] The abnormal and normal rate of aorta in two groups were 83.33％ (25/30),16.67％ (5/30) and 86.67％ (26/30),13.33％(4/30);while the abnormal and normal rate of coronary arteries in two groups were 43.33％ (13/30),56.67％ (17/30) and 53.33％(16/30),46.67％ (14/30).SNR values of ascending aorta,descending aorta,abdominal aorta,superior mesenteric artery,bilateral renal artery,left main coronary artery,left anterior descending branch,left circumflex branch,right coronary artery and CNR values of abdominal aorta,superior mesenteric artery,bilateral renal artery,left anterior descending branch,left circumflex branch had no statistical significance,while the other indicators were significant differences between the two groups.The radiation dose and the contrast medium dose of G1 was significantly lower than G2 (P ＜ 0.05).There was no difference in the subjective image quality of 3D post-processing images between the two groups (P ＞ 0.05).[Conclusions] Using prospective ECG-gating Helical protocol in whole aorta and coronary arteries CT angiography combined with low tube voltage,low contrast medium injection rate and low contrast medium dose technology can help to reduce radiation and contrast medium dose without impacting on the imaging quality satisfactorily.

Objective Anti-calcification and surface modification of the transcatheter heart valve is the priority research area and development direction of bioprosthesis heart valve.In present study,the Arginine-Glycine-Aspartic acid(RGD) coating technology and anti-calcification with epoxy chloropropane(EC) treatment were applied to investigate surface modification property of the transcatheter heart valve compared to the traditional anti-calcification method with glutaraldehyde (GA) treatment to demonstrate the improvement of structure and surface biological properties of the transcatheter heart valve.Methods Morphological characteristics of mesenchymal stem cells(MSCs) seeded on the transcatheter heart valve with the various anticalcification treatments were observed by scanning electron microscopy and the apoptosis rates of MSCs seeded on the transcatheter heart valve with the various anti-calcification interventions were studied by TUNEL staining.The cell adhesion and expression of the cytoskeletal protein,Vinment of MSCs treated as described were analyzed by cell-counting method and fluorescence immunohistochemical method respectively.Results The apoptosis rate of MSCs was markedly decreased while the expression of vinment and the cell adhesion strength of MSCs were elevated in the groups of GA-EC and RGD-EC treatments.The biological indices of RGD-EC group has significant difference(P ＜ 0.05) compared with GA group.Conclusion Biological properties of the surface of transcatheter heart valve can be remarkably improved by GA-EC and RGD-EC anti-calcification treatments.

Objective:To study our initial experience on feasibility and safety of magnetic compression anastomosis in laparoscopic pancreaticoduodenectomy(LPD).Methods:A retrospective analysis was conducted on the data of 7 patients who underwent LPD with laparoscopic magnetic compression choledochojejunostomy (LMC-CJ) or pancreaticojejunostomy (LMC-PJ) at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi’an Jiaotong University from May 2018 to September 2019. There were 6 males and 1 female. The median age of patients was 63 (56-83) years. Data analyzed included the model of the magnetic anastomosis device, operation time of the LMC-CJ or LMC-PJ, other operation-related parameters, postoperative complications, time to perform magnetic anastomosis, and time of discharge of the magnet from patients’ body.Results:All 7 patients completed LPD successfully, including 7 LMC-CJ and 2 LMC-PJ. The median operation time was 340 (310-450) minutes. The median diameter of the biliary-enteric magnetic anastomosis ring used was 10 (9-12) mm, and the median time of the biliary-enteric magnetic anastomosis was 11 (8-16) min. The diameter of the pancreaticojejunal magnetic anastomosis ring was 5 mm in the two anastomoses, and the times taken were 12 min and 15 min. Complications occurred in 4 patients, including 1 patient each for grade A and grade B pancreatic fistula, 2 patients with abdominal infection, 2 patients with postoperative gastric emptying disorder, and 1 patient with abdominal hemorrhage. All patients responded to conservative treatment. There was no biliary or pancreatic fistula at the magnetic anastomoses. Pancreaticojejunostomy functioned at 24 and 30 days after operation. The median time for the magnets to pass out from the body of all patients was 50 (40-170) days. The median follow-up was 11 (4-18) months. No biliary-enteric or pancreaticojejunostomy stenosis was detected.Conclusion:Magnetic compressive anastomosis was simple, feasible, and safe for choledochojejunostomy or pancreaticojejunostomy in LPD.

Deep brain stimulation is widely used for treatment of neuropsychiatric diseases, showing its unique advantages in the treatment of central nervous diseases, such as epilepsy, Parkinson's disease, essential tremor, drug-refractory psychiatric diseases, drug-refractory pain, improvement of arousal and cognitive functions, and addiction diseases. After more than 30 years of clinical research, animal experiments and material research, the scopes and modes of DBS use have been fully developed, and important progress has been made in seeking better stimulation targets and modes. The complexity and individuality of the disease lead to differences in the response of each patient to DBS treatment, so it is necessary to further clarify its mechanism of action and explore better therapeutic targets and parameters to meet higher clinical requirements. This paper reviews the clinical application of DBS as follows.