Graphite ; Humans ; Spectrophotometry, Atomic ; methods ; Vanadium ; urine

The research data at home and abroad show that the overall burnout rate of clinical professional graduate students was high. They are vulnerable to burnout because of long duty hours, learn-ing pressure, intense and overloading work and especially the significantly reduced personal accomplish-ment in the situation of the contradiction between doctors and patients in our country. Burnout not only re-sults in psychological distress and physical symptoms, but also has negative effect on the quality of graduate medical education during residency training. Therefore, educators need to develop an active awareness of burnout and ought to perform interventions such as formulating the appropriate learning goals, improving the work efficiency, reducing work hours, positive psychological counseling and stress management training to prevent such occurrences.

Objective To evaluate the indications and intraoperative management of nephron-spar- ing surgery (NSS) for renal cell carcinoma (RCC).Methods A total of 53 patients (32 men and 21 women;age range,21 -76 years) with unilateral RCC and a normal contralateral kidney underwent NSS.The disease course ranged from 1 week to 13 months.The unilateral RCCs were detected by B-uhrasonography. Partial nephrectomy was performed on 38 cases of polar RCC and wedge nephrectomy was performed on 15 cases of central RCC.Both renal vein and artery were blocked for 10 - 15 min,and unclamped for 1 -2 min if necessary.The resections were finished within 7 -21 min (mean,12 min).No inosine and regional hypo- thermia were used during operation.Absorbable hemostatic gauze and terylene flake were used to suture renal wound surface.After operation all patients were treated with interferon hypodermic injection of 5 000 000 U every other day for 3 months.Results The diagnosis of RCC with negative cutting margin was confirmed by pathological examination in all patients.The greatest dimension of the renal cancers were＜4 cm except for one of 6 cm.The clinical stage was T_1N_0M_0 in all patients.During the follow-up of 6 -48 months,all pa- tients were alive without recurrence and had normal renal function.Conclusions NSS can be rapidly per- formed for T_1 stage renal cancer＜4 cm or single clearly localized cancer＞4 cm in diameter.The follow-up results are satisfactory.

Animals ; Carps ; genetics ; Cloning, Molecular ; Fish Proteins ; genetics ; Hydroxylation ; Hypoxia-Inducible Factor 1, alpha Subunit ; genetics ; Lakes

OBJECTIVEThe study aimed to evaluate the efficacy of endoscopic therapy for early postoperative anastomotic hemorrhage.

METHODSFourteen patients experienced an episode of early postoperative anastomotic hemorrhage and were treated endoscopically from January 2005 to June 2010. The clinical data was analyzed retrospectively.

RESULTSFourteen patients(9 males and 5 females, median age 57.5 years, range 26-74 years) were diagnosed with postoperative hemorrhage between 6 hours to 14 days after surgery. The blood loss ranged from 500 to 1500 ml. Sclerosing agent injection, electrocoagulation, and hemoclips were attempted to control the bleeding. Endoscopic approach to control early postoperative anastomotic hemorrhage was successful in all the patients. No recurrent bleeding was observed during the follow-up. No complications associated with endoscopic therapy.

CONCLUSIONEndoscopic approach for the management of early postoperative anastomotic hemorrhage is feasible with high success rate and associated with no complications.

Adult ; Aged ; Female ; Hemostasis, Endoscopic ; Humans ; Male ; Middle Aged ; Postoperative Hemorrhage ; surgery ; Retrospective Studies ; Surgical Stomas ; Treatment Outcome

OBJECTIVETo explore the safety of video-assisted thoracoscopic esophagectomy for esophageal carcinoma.

METHODSFrom January 2005 to March 2012, 260 patients with esophageal carcinoma received thoracoscopic esophagectomy (TE group), while 322 patients underwent conventional open esophagectomy (OE group). Operative procedures, perioperative complications, reoperation, readmission to intensive care unit (ICU), and perioperative mortality were compared between the two groups.

RESULTSCompared with OE group, TE group possessed less thoracic operative time [(105±30) min vs. (112±41) min, P=0.000], less blood loss [(95±48) ml vs. (107±44) ml, P=0.002], shorter postoperative hospital stay [(14.3±7.5) d vs. (16.9±9.5) d, P=0.000] and more lymph node harvest from thorax [(13.5±5.0) vs. (11.6±4.7), P=0.000]. The total perioperative complication rate was lower in TE group than that of OE group (34.6% vs. 45.0%, P=0.011), as well as perioperative mortality (0.8% vs. 3.4%, P=0.032). Lower rate of readmission to ICU (5.4% vs. 10.6%, P=0.024) was found in the TE group as compared to the OE group, while the reoperation rate was comparable (1.5% vs. 2.5%, P=0.425).

CONCLUSIONThoracoscopic esophagectomy is advantageous than open procedure in terms of surgical safety.

Aged ; Esophageal Neoplasms ; surgery ; Esophagectomy ; adverse effects ; methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Thoracoscopy ; adverse effects ; methods ; Video-Assisted Surgery

OBJECTIVETo compare the safety and efficacy between two different surgical approaches for thoracoscopic esophagectomy including left lateral decubitus position and prone position.

METHODSFrom January 2008 to December 2009, 88 patients who underwent thoracoscopic esophagectomy were enrolled in this study. Among them, 52 patients were placed in decubitus position and 36 patients were placed in prone position.

RESULTSNo conversion to thoracotomy occurred in either group. The operative time was shorter in the prone group than that in the decubitus group (70 ± 20 min vs. 82 ± 17 min, P<0.01). Blood loss during operation was less in the prone group(100 ± 52 ml vs. 139 ± 54 ml, P<0.01). More lymph nodes were harvested from chest in the prone group(12.2 ± 6.2 vs. 8.6 ± 4.3, P<0.01). There was no significant difference between the two groups in morbidity.

CONCLUSIONThoracoscopic esophagectomy in prone position is associated with better exposure of surgical filed, shorter operative time, less blood loss, and more extensive lymph node dissection as compared to decubitus position.

Aged ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Female ; Humans ; Male ; Middle Aged ; Posture ; Prone Position ; Retrospective Studies ; Thoracoscopy ; Treatment Outcome

OBJECTIVETo evaluate the efficacy of prophylactic transcatheter arterial chemoembolization (TACE) on postoperative recurrence of hepatocellular carcinoma.

METHODSA retrospective analysis was performed on clinicopathologic data of 260 hepatocellular carcinoma patients who underwent curative hepatectomy in Eastern Hepatobiliary Surgery Hospital, Second Military Medical University from January 2004 to June 2007. Among the 260 patients, 104 underwent postoperative prophylactic TACE and the other 156 were not.

RESULTSThe overall survival rates at 1- and 2-years were 84.1% and 70.5% respectively. The overall disease-free survival rates at 1- and 2-years were 69.2% and 58.4% respectively. Of 260 overall patients, the disease-free survival rates at 1- and 2-years were 72.8% and 54.9% respectively in TACE group, and 66.9% and 59.7% respectively in non-TACE group, statistically significant difference of the cumulative disease-free survival rates at 1- and 2-years between TACE group and non-TACE group were not observed (P = 0.145, P = 0.405). Of 62 patients with tumor size >or= 10 cm, the disease-free survival rates at 1- and 2-years were respectively 66.6% and 48.7% in TACE group, and respectively 44.6% and 31.2% years between TACE group and non-TACE group were observed (P = 0.025, P = 0.025). Of 38 patients with vascular tumor thrombi, the disease-free survival rates at 1- and 2-years were respectively 33.0% and 0 in TACE group, and respectively 26.2% and 21.8% in non-TACE group, statistically significant difference of the cumulative disease-free survival rates at 1-years between TACE group and non-TACE group was observed (P = 0.025), and not at 2-years (P = 0.122).

CONCLUSIONSIn non-TACE group, statistically significant difference of the cumulative disease-free survival rates at 1- and 2-Prophylactic TACE is preferred for hepatocellular carcinoma patients with high risk factors for recurrence such as tumor size >or= 10 cm and presented vascular tumor thrombi.

Adolescent ; Adult ; Aged ; Carcinoma, Hepatocellular ; surgery ; therapy ; Chemoembolization, Therapeutic ; Female ; Follow-Up Studies ; Hepatectomy ; Humans ; Liver Neoplasms ; surgery ; therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; prevention & control ; Postoperative Care ; Retrospective Studies ; Young Adult

OBJECTIVETo explore the possibility of treating solid tumor with siCD44.

METHODSHuman nasopharyngeal carcinoma cell CNE-2L2 with high expression of CD44 was used in this study. The malignant activities of cells were examined by colony formation test, tumorigenesis, and lung metastasis of the tumor in nude mice. Ad5-siCD44 was constructed and adenoviruses were produced in 293 cells. CNE-2L2 cells were subcutaneously inoculated into nude mice. When tumors grew to 50-100 mm3, Ad5-siCD44 was injected into tumors, and Ad5-egfp and PBS were also injected as controls. The size and weight of tumors were compared after 2 weeks.

RESULTSSuppression of CD44 expression profoundly inhibited the malignant activities of CNE-2L2 cell. The average sizes of the tumors were (3.139 +/- 0.850), (3.612 +/- 0.888), and (1.512 +/- 0.742) cm3 after the intra-tumor injection of PBS, Ad5-egfp, and Ad5-siCD44, respectively, after two weeks. Significant difference was found between Ad5-siCD44 group and control groups (P < 0.05). The average weights were (2.28 +/- 0.73), (1.83 +/- 0.26), and (1.20 +/- 0.64) g, respectively, and significant difference was also found between Ad5-siCD44 group and control groups (P < 0.05).

CONCLUSIONIntra-tumor injection of Ad5-siCD44 can exhibit the therapeutic effect on the tumor inoculated with CNE-2L2 cells with high expression of CD44 in nude mice.

Adenoviridae ; genetics ; Animals ; Cell Line, Tumor ; Genetic Therapy ; Humans ; Hyaluronan Receptors ; biosynthesis ; genetics ; Injections, Intralesional ; Mice ; Mice, Nude ; Nasopharyngeal Neoplasms ; genetics ; pathology ; therapy ; Neoplasm Transplantation ; Transplantation, Heterologous

BACKGROUNDGlaucoma filtering surgery (GFS) is the most common procedure performed in the treatment of glaucoma. Although antiscarring agents help prevent postsurgical scarring and improve glaucoma surgical outcomes, they may be associated with an increased incidence of severe and potentially blinding complications. Poly(DL-lactide-co-glycolide) (PDLLA/GA) is a bioresorbable polymer, which can be prepared with a large range of physical, mechanical, and biological properties and has been widely used in medicine, including as an absorbable suture and a drug carrier and especially as a scaffold in tissue engineering. This study aimed to evaluate the effect of PDLLA/GA on scar formation after glaucoma filtration surgery (GFS).

METHODSForty-eight New Zealand white rabbits were divided into two groups randomly and GFS was performed on the right eye of each. PDLLA/GA membranes were put under the sclera flap for evaluation. GFS with no membrane inserted served as control. Clinical evaluations of intraocular pressure (IOP) and the presence of a filtration bleb were performed at intervals (3 days, 1, 2, 4, 8, 12, 20, and 24 weeks) postoperatively. At each time point, three eyes per group were excised to observe histological changes such as inflammation and scar formation and the expression of collagen type IV, proliferating cell nuclear antigen (PCNA), matrix metalloproteinase-9 (MMP-9), and tissue inhibitor of metalloproteinase-1 (TIMP-1). The expression of connective tissue growth factor (CTGF) mRNA was determined by reverse transcription-polymerase chain reaction.

RESULTSThe lower IOP level and an effective bleb were maintained for a long time after GFS in the PDLLA/GA group. The histological analysis showed less inflammation and scar formation, weaker expression of collagen type IV and PCNA, more intense MMP-9 and TIMP-1, slightly elevated ratio of MMP-9 and TIMP-1, and a smaller increase in CTGF mRNA postoperatively in the PDLLA/GA group but less than the control group (P < 0.05).

CONCLUSIONPDLLA/GA membranes may be promising for preventing fibrosis after GFS.

Animals ; Biocompatible Materials ; therapeutic use ; Cicatrix ; prevention & control ; Filtering Surgery ; Glaucoma ; drug therapy ; surgery ; Lactic Acid ; therapeutic use ; Polyglycolic Acid ; therapeutic use ; Rabbits