BACKGROUND:Culture condition,isolation method and efficiency are different in reported human umbilical cord-derived mesenchymal stem cells,which lack of unified identification standards.Therefore,it is necessary to establish a high-efficiency and economical culture system for human umbilical cord-derived mesenchymal stem calls(hUCMSCs).OBJECTIVE:To isolate hUCMSCs and induced differentiate into adipocytes and osteblasts.METHODS:The hUCMSCs were isolated form human umbilical cord by tissue adherence and digested with collagenase.The morphology,proliferation and immunophenotype of the 3rd passage cells were analyzed,and then cells were induced to osteogenic and adipogenic differentiation in vitro.RESULTS AND CONCLUSION:The hUCMSCs isolated from human umbilical cord by tissue adherence and digested with collagenase could be cultured and proliferated in vitro.Flow cytometry analysis revealed that the hUCMSCs were positive for CD29 CD44,CD59,CD105,but were negative for CD40,CD86 and HLA-DR.These calls could be induced to differentiate into adipocytes and osteblasts under proper inducing conditions.The hUCMSCs retained the appearance and phenotype even after being expanded more than 40 passages in vitro.This confirmed that the existence of MSCs in human umbilical cord and they had the capacity of differentiating into adipocytes and osteblasts.

Objective:To investigate the application value of three-dimensional (3D) printing technology assisted laparoscopic anatomic liver resection of segment 8 (Lap-S8).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 8 liver cancer patients including 7 cases with hepatocellular carcinoma and 1 case with intrahepatic cholangio-carcinoma who underwent 3D printing technology assisted Lap-S8 in the Hunan Provincial People′s Hospital from January 2019 to December 2020 were collected. There were 7 males and 1 female, aged from 49.0 to 80.0 years, with a median age of 56.5 years. Of the 8 patients, 6 cases underwent laparoscopic anatomic liver resection of the entire segment 8, 1 case underwent laparoscopic anatomic liver resection of ventral subsegmental of the segment 8 and 1 case underwent laparoscopic anatomic liver resection of dorsal subsegmental of the segment 8. 3D printing technology was used to assist preoperative evaluation and intraoperative navigation for all 8 patients. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted using outpatient examination, internet or telephone interview to detect survival and tumor recurrence of patients after operation up to March 2021. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations: all the 8 patients underwent 3D printing technology assisted Lap-S8 successfully, without conversion to open surgery. The operation time, hepatic portal occlusion time and volume of intraoperative blood loss of the 8 patients were (216±41)minutes, (56±11)minutes and 75 mL(range, 50 to 300 mL), respectively. There was no intraoperative blood transfusion in 8 patients, and the surgical margin of the 8 patients was negative. (2) Postoperative situations: the duration of postoperative hospital stay of the 8 patients were (9±3)days. There was no complication such as postoperative hemorrhage, biliary fistula, liver abscess or abdominal infection occurred. (3) Follow-up: all the 8 patients were followed up for 3.0?24.0 months, with a median follow-up time of 12.5 months. During the follow-up, 1 of 8 patients with preoperative diagnosis of recurrent hepatocellular carcinoma developed tumor recurrence at 5 months after operation. The patient underwent laparoscopic surgery followed with the transcatheter arterial chemoembolization and target therapy, and survived with tumor. There was no tumor recurrence in the other 7 patients.Conclusion:3D printing technology assisted Lap-S8 is safe and feasible.

Objective This study aims to predict the coronavirus disease 2019(COVID-19)epidemic in Xi'an based on SEAIQR model and Dropout-LSTM model,and to provide a scientific basis for evaluating the effectiveness of the"dynamic zero-COVID policy".Methods Considering a large number of asymptomatic infections,the changing parameters,and control procedures,we developed a time-dependent susceptible-exposed-asymptomatic-infected-quarantined-removed(SEAIQR)model with stage-specific interventions.Considering the time-series characteristics of COVID-19 data and the nonlinear relationship between them,we constructed a deep learning Dropout-LSTM model.The data of newly confirmed cases in Xi'an from December 9th,2021 to January 31st,2022 were used to fit the model,and the data from February 1st,2022 to February 7th,2022 were used to evaluate the model performance of forecasting.We then calculated the effective reproduction number(Rt)and analyzed the sensitivity of the different measurement scenarios.Results The peak of newly confirmed cases predicted by the SEAIQR model would appear on December 26th,2021,with 176 cases,and the"dynamic zero-COVID policy"may be achieved in January 24th,2022,with R2=0.849.The Dropout-LSTM model can reflect the time-series and nonlinear characteristics of the data,and the predicted newly confirmed cases were highly consistent with the actual situation,with R2=0.937.The MAE and RMSE of the Dropout-LSTM model were lower than those of the SEAIQR model,indicating that the predicted results were more ideal.At the beginning of the outbreak,R0 was 5.63.Since the implementation of comprehensive control,Rt has shown a gradual downward trend,dropping to below 1.0 on December 27th,2021.With the reduction of effective contact rate,the early implementation of control measures and the improvement of immunity threshold,the peak of newly confirmed cases will continue to decrease.Conclusion The proposed Dropout-LSTM model forecasts the epidemic well,which can provide a reference for decision-making of the"dynamic zero-COVID policy."

Background and purpose:16α-[18F]lfuoroestradiol (18F-FES) is an in vivo speciifc imaging agent for estrogen receptor (ER). We investigated the concordance between tumor ER status as determined by FES-PET and in vitro immunohistochemical assays. Methods: 18F-FES was prepared by ourselves. Twenty-six patients were enrolled (17 primary and 9 metastatic/recurrent). Patients underwent both 18F-FES and 18F-FDG PET/CT. Results:We found good overall agreement (96.15%) between in vitro ER assays and FES-PET. The ER status diagnosis sensitivity of 18F-FES was 93.33%and the speciifcity was 100%when using cut-off value of SUVmax≥1.5. There was a positive correlation between in vitro ER, PR assays and the SUVmax of 18F-FES while in vitro HER-2/neu assays correlatived negatively with 18F-FES SUVmax. Conclusion:These results suggested 18F-FES may be useful for studying the ER expression of all malignant lesions in patients with breast cancer and guiding individual therapy.

Objective Because of high precision and mild side effects,intensity-modulated proton therapy (IMPT) has become a hot spot in the radiotherapy field.Nevertheless,the precision of IMPT is extremely sensitive to the range uncertainties.In this paper,a novel robust optimization method was proposed to reduce the effect of range uncertainty upon IMPT.Methods Firstly,the robust optimization model was established which contained three types of range including the increased range,the normal range and the shortened range.The objective function was expressed in quadratic function.The organ dose contribution matrix of each range was calculated by proton pencil beam algorithm.The range deviation was discretized and the probability of each range was obtained based on the Gauss distribution function.Finally,the conjugate gradient method was adopted to find the optimal solution to make the actual dose coverage of the target area and the organs at risk distributed within the expected dose as possible.Results The 3 sets of simulation tests provided by the AAPM TG-119 Report were utilized to evaluate the effectiveness of this method:nasopharyngeal carcinoma,prostate and "C"-type cases.Compared with conventional IMPT optimization approach,this novel method was less sensitive to the range uncertainty.When the range deviation occurred,the dose coverage of the target area and organs at risk of the nasopharyngeal carcinoma and prostate cases almost reached the expected dose,and the high dose coverage of the target area and organs at risk protection were improved in the"C"-type cases.Conclusions To compensate for the range uncertainty,this novel method can enhance the dose coverage of the target area and reduce the dose coverage of the organs at risk.

Objective:To evaluate the efficacy and safety of laparoscopic spleen-preserving splenic hilar lymphadenectomy through endovascular arch approach for superior gastric cancer.Methods:From Oct. 2018 to Feb. 2019, 20 cases of upper gastric cancer underwent laparoscopic total gastrectomy in Gastrointestinal Surgery Ward 1 of Yantai Yuhuangding Hospital. The splenic hilar lymph nodes were dissected by endogastric omentum vascular arch approach. The total operation time, intraoperative bleeding volume, operation time and bleeding volume of splenic hilar lymph nodes dissection, total number of lymph nodes and metastatic lymph nodes, number of splenic hilar lymph nodes and metastatic lymph nodes, postoperative exhaust time, first feeding fluid time and postoperative hospital stay time, and postoperative complications such as abdominal infection, anastomotic leakage, pulmonary infection, incision infection and bleeding were recorded. The complications of splenic hilar lymph node dissection were bleeding, conversion to laparotomy, splenic ischemia and splenic necrosis. One year after operation, follow-up was carried out by telephone and outpatient.Results:Laparoscopic total gastrectomy and splenic hilar lymph node dissection were successfully performed in all cases. The total operation time ranged from 200 to 268 min, with an average of (240.8±31.7) min, intraoperative bleeding volume of 50 to 200 ml, with an average of (90.4±43.8) ml; the time of splenic lymph node dissection was (18.5±4.0) min; the amount of splenic lymph node dissection bleeding ranged from 5 to 20 ml, with an average of (10.2 ± 5.8) ml; the number of total lymph nodes dissection was 25 to 58, with an average of 37.68±3.89 and the number of metastatic lymph nodes 4.31±2.54; The number of splenic lymph nodes was 2 to 10, with an average of 3.51± 1.79; The number of metastatic lymph nodes was 0 to 4 lymph nodes, with an average of 0.98±1.19. The average time of anal exhaust was (3.5±1.9) days, the time of fluid intake was (4.5±1.7) days, and the postoperative hospital stay was (7.5±1.5) days. Postoperative complications were as following: one case had abdominal infection, one had pulmonary infection, one had anastomotic leakage and there were no complications related to splenic hilar lymph node dissection such as conversion to laparotomy, splenic ischemia or splenic necrosis. There was no recurrence or metastasis of the tumor and no death occurred one year after the operation.Conclusion:Laparoscopic spleen-preserving splenic hilar lymphadenectomy via endovascular arch approach is safe and effective.

Objective:To explore the efficacy and prognostic factors of intensity-modulated radiotherapy (IMRT) in elderly patients with locally advanced esophageal cancer.Methods:The clinical data of 87 elderly patients with locally advanced esophageal cancer who received IMRT and 79 elderly patients with locally advanced esophageal cancer who received three-dimensional conformal radiotherapy (3DCRT) from January 2005 to December 2015 in Changzhou Cancer Hospital Affiliated to Soochow University were retrospectively analyzed, and their efficacy and adverse reactions were observed. The log-rank test and Cox proportional hazards model were used for univariate and multivariate analyses to analyze the prognostic factors of patients receiving IMRT.Results:In the IMRT group, 27 cases (31.0%) achieved complete remission, and 60 cases (69.0%) achieved partial remission; in the 3DCRT group, 18 cases (22.8%) achieved complete remission, and 61 cases (77.2%) achieved partial remission. There was no statistical difference in the short-term efficacy (CR+PR) between the two groups ( χ2 = 1.43, P = 0.232). The 1-, 3-, and 5-year overall survival rates in the IMRT group were 77.0%, 46.0% and 23.0%, respectively, and the 3DCRT group were 70.1%, 40.5% and 10.1%, respectively. There was a statistical difference in the overall survival between the two groups ( χ2 = 4.89, P = 0.027). For elderly patients with locally advanced esophageal cancer who received IMRT, univariate analysis showed that gender, lesion location, T stage, gross tumor volume, and short-term efficacy were prognostic factors (all P < 0.05); multivariate analysis showed that lesion location, T stage, gross tumor volume, and short-term efficacy were independent prognostic factors (all P < 0.05). In the IMRT group, the incidence rate of ≥ grade 2 radiation pneumonitis was 10.3% (9/87), the incidence rate of ≥ grade 2 radiation esophagitis was 32.2% (28/87), the incidence rate of leukopenia was 18.4% (16/87), and the incidence rate of hemoglobin reduction was 7.0% (6/87), and there was no statistical difference in the incidence of acute adverse reactions between the IMRT group and the 3DCRT group (all P > 0.05). Conclusions:IMRT has more advantages than 3DCRT in the treatment of elderly patients with locally advanced esophageal cancer, especially those with upper cervical and thoracic lesion, T 1-3 stage, gross tumor volume ≤40 cm 3, and complete remission in a short term can benefit from it, and the adverse reactions are mild.

Objective:To study the effect of enhanced recovery after surgery (ERAS) on intestinal function and gut microbiota changes in patients who underwent laparoscopic gastrectomy.Methods:From Aug. 2018 to Dec. 2019, 80 patients who underwent laparoscopic radical D2 gastrectomy for gastric cancer in the first Department of Gastrointestinal Surgery of Yantai Yuhuangding Hospital were selected. According to whether it adopts ERAS treatment or not, patients were divided into 2 groups (n=40) : ERAS group and traditional perioperative treatment group. The time of postoperative bowel sounds, the time of first exhaust and defecation, the proportion of antibiotic-related diarrhea and surgical site infection (SSI) were recorded. Stools were collected before operation, first time after operation, 1, 2 weeks and 1 month after operation. 16S rRNA sequencing method was used to identify the diversity and species of gut microbiota. The diversity index of intestinal flora in the perioperative period and changes in the proportion of probiotics (bifidobacterium and lactobacillus) were compared.Results:The appearance time of bowel sounds, the first exhaust and defecation time [ (16.25±6.41) h, (23.95±6.02) h, (34.95±9.34) h] in ERAS group were significantly earlier than those in the traditional treatment group [ (22.3±6.49) h, (28.45±7.12) h, (48.1±15.64) h], and the difference was statistically significant ( P<0.05) . The incidence of antibiotic-related diarrhea was higher in the traditional treatment group (3/40) than in ERAS group (1/40) , but the difference was not statistically significant ( P>0.05) . The ratio of postoperative SSI was slightly higher in ERAS group, but the difference was not statistically significant ( P>0.05) . In the perioperative period, the intestinal flora diversity index (Chao1 and Shannon index) and the proportion of probiotics (lactobacillus acidophilus and bifidobacterium) were not significantly different between the two groups before surgery ( P>0.05) ; while at the first time, one week, 2 weeks after the operation, and 1 month after the operation, ERAS group was higher than the traditional group ( P<0.05) ; and at each postoperative time point, the traditional group decreased significantly than the ERAS group. The first time decrease was the largest, ( P<0.05) ; With the passage of time after operation, the diversity of intestinal flora and the proportion of probiotics gradually recovered. By 1 month after operation, the two groups did not return to the preoperative gut microbiota diversity state or proportion. Conclusion:The concept of enhanced recovery after surgery (ERAS) promotes the recovery of intestinal function in patients with gastric cancer, does not reduce the proportion of antibiotic-associated diarrhea (AAD) or surgical site infections (SSI) , and maintains the diversity of gut microbiota balance and stability.

Objective: To assess the safety and feasibility of the application of the laparoscopic modality in the perioperative treatment of central liver tumors. Methods: Collecting all the clinical information of a total of 40 patients with central liver tumors who received laparoscopic resection treatment carried out at Department of Hepatological Surgery of People′s Hospital of Hunan Provincial from January 2016 to December 2018 to take a retrospective review. There were 19 males and 21 females.The age was (59.5±14.5) years (range: 15 to 71 years) . There were 26 cases of primary hepatic carcinoma (24 cases of hepatocellular carcinoma, 2 cases of cholangiocellular carcinoma) , 8 cases of hepatic cavernous hemangioma, 1 case of metastatic hepatic carcinoma, 5 cases of hepatocellular adenoma. The maximum diameter of tumors were (6.2±2.9) cm (range: 2 to 13 cm) . The patient′s information about hepatectomy methods, blocking mode and time of blood flow, operation time, intraoperative blood loss, intraoperative blood transfusion rate, post-operative hospitalization time, perioperative reoperation and postoperative complications were collected. Results: A total of 40 patients all were treated with laparoscopic surgery. The surgical procedure was as follows: 2 patients received the right hepatic lobectomy (Ⅴ, Ⅵ, Ⅶ and Ⅷ segments) , 2 patients received the left hepatic lobectomy (Ⅱ, III and Ⅳ segments) , 13 patients received mesohepatectomy (Ⅳ, Ⅰ and Ⅷ segments) , 2 patients received left hepatic trisegmentectomy (Ⅱ, Ⅲ, Ⅳ and Ⅷ segments) , 2 patients received right hepatic trisegmentectomy (Ⅳ, Ⅴ, Ⅵ, Ⅶ and Ⅷ segments) , 7 patients received Ⅷ segmentectomy, 1 patient received Ⅳ segmentectomy, 3 patients received Ⅴ and Ⅷ segmentectomy, 5 patients received hepatic caudate lobe resection (Ⅰ, Ⅸ segments) , and 3 patients received local tumors resection.Pathological results: there were 26 cases of primary hepatic carcinoma (24 cases of hepatocellular carcinoma, 2 cases of cholangiocellular carcinoma) , 8 cases of hepatic cavernous hemangioma, 1 case of metastatic hepatic carcinoma, 5 cases of hepatocellular adenoma; the pathological reports of all malignant tumor cases all showed negative incisal edge. The operative time was (333±30) minutes (range: 280 to 380 minutes) ; the intraoperative hepatic portal occlusion period was (58±13) minutes (range: 30 to 90 minutes) ; the intraoperative hemorrhage was (173±129) ml (range: 20 to 600 ml) ; the intraoperative blood transfusion rate was 2.5% (1/40) ; the postoperative incidence of bile leakage was 2.5% (1/40) , the hospital discharge of 1 patient with bile leakage was approved after conservative treatments like T pipe decompression and adequate drainage; there was 1 case of abdominal infection and 1 case of pulmonary infection, both of which were discharged from the hospital with conservative treatments; there were no other serious postoperative complications. The postoperative hospital stay was (10.7±2.7) days (range: 6 to 16 days) ; there were no perioperative mortality and reoperation cases. Conclusion In the centers with abundant laparoscopic hepatectomy experiences, the laparoscopic resection is proved to be safe and feasible in the perioperative treatments of central liver tumors by the highly selective cases, the adequate preoperative assessment and reasonable surgical techniques and approach.

Objective:To analyze the efficacy and safety of cranial approach priority, counterclockwise sequential comple mesocolic excision in laparoscopic right hemicolectomy.Methods:From Jan. 2020 to Dec. 2020, 30 patients with right colon cancer in Department of Gastrointestinal Surgery were retrospectively analyzed. Laparoscopic radical right hemicolectomy was performed via the approach of complete mesocolic excision. The general clinicopathological data of the patients, perioperative data such as operation time, intraoperative blood loss, number of cases of hemorrhage caused by Henle trunk and subordinate branch injury, whether or not converted to open surgery, postoperative pathological data (TNM staging, total number of dissected lymph nodes and the number of metastatic lymph nodes) , postoperative recovery (exhaust time, the time of fluid intake, drainage tube removal and hospital stay) , and complications (such as bleeding, anastomotic leakage, secondary surgery, lymphatic leakage, pulmonary infection, abdominal infection, incision infection, etc) were recorded. Follow-up was performed by telephone or outpatient in 1 year after surgery.Results:The total operation time was (197.80±31.20) minutes, ranging from 150 to 275 minutes, and the intraoperative blood loss was (58.33±30.30) ml, ranging from 10 to 100 ml. There were no cases of intraoperative Henle stem and branch injury bleeding or conversion to open surgery. Postoperative exhaust time was (2.97±0.67) d, ranging from 2 to 4d; postoperative fluid intake time was (3.67±0.76) d, ranging from 3 to 5d; postoperative drainage tube removal time was (6.60±4.00) d, ranging from 4 to 25 days; postoperative hospital stay was (7.87±3.94) days, ranging from 5 to 26 days. pTNM staging: 9 cases of stage I, 5 cases of stage IIA, 1 case of stage IIB, 6 cases of stage IIIA, 4 cases of stage IIIB, and 5 cases of stage IIIC. The total number of lymph nodes dissected was (29.50±8.18) , ranging from 19 to 51; the number of metastatic lymph nodes was (1.40±1.77) , ranging from 0 to 6. Postoperative complications included incision infection in 1 case, anastomotic leakage in 1 case, lymphatic leakage in 2 cases, and lung infection in 1 case. No tumor recurrence or metastasis was found during follow-up, and no patient died.Conclusion:Cranial approach priority, counterclockwise sequential complete mesocolic excision is safe and effective in laparoscopic right hemicolectomy.