In order to find out appropriate model to best disseminate laparoscopy for colorectal cancer clinical advanced technologies,it is necessary to establish a whole set of training system,which included selecting training site,intensive training,operation observation,advanced study at home and abroad,technical support,etc..Evaluation was based on operation time,hemorrhage in surgery,other injuries in surgery,conversion to open surgery and the ratio of in situ relapse in one year post surgery.These five indexes were compared between the training group and the control group with the gradually stable trend of learning curve as standard.Without previous laparoscopic surgery experience,the training group required 13.8±0.75,14±0.89,10.2±0.74,16.4±0.49 and 20.4±0.49 cases,respectively,to achieve expected proficiency,and the control group required 28.6± 1.69,29.2±1.16,27.8 ± 0.74,22.8 ± 0.40 and 25.4± 1.03 cases,respectively.The learning time required 13.4± 1.02 months on average for the training group and 27.8±2.13 months for the control group.In conclusion,the training system achieved obvious superiority to the controls to achieve expected skills and proficiency in laparoscopy for colorectal cancer.

Exosomes are vesicles with a diameter of about 50-150 nm released by a variety of cells and contain miRNA, mRNA, and protein, with the potential to regulate the signal transduction pathways in receptor cells. Exosomes provide nucleic acids and proteins to coordinate cell-cell communication and microenvironment regulation. This article summarizes the latest research advances in the role of exosomes in hepatocellular carcinoma (HCC) and analyzes the effect of exosomes on the development and progression of HCC, including chemotherapy resistance, epithelial-mesenchymal transition, angiogenesis, metastasis, and immune response. The analysis shows that exosomes have a promising future in the treatment of HCC.

Objective To investigate the current prevalence of pubertal development in healthy Shanghai schoolchildren.Methods This study was a cross-sectional investigation focused on current pubertal development conducted in healthy Shanghai schoolchildren by multi-stage cluster sampling.The sample included 17 571 children in grades 1-5 investigated in June 2014.The data were weighted by inverse probability weighting (IPW) to make them more representative.At examination,stages of breast and pubic hair development were rated according to the Tanner method.Testicular volume was determined.Data on menarche and spermatorrhea were collected by the status quo method.The rates of precocious puberty,breast,and pubic hair development of Tanner stage ≥ Ⅱ in girls aged 6-7 years,menarche in girls aged 6-9 years,and testicular volume ≥4 ml and pubic hair development of Tanner stage ≥ Ⅱ in boys aged 6-8 years were calculated.All the data were weighted by IPW.Results After data processing,16 197 children's data were analyzed.In girls aged 6-7 years,17.2％ and 2.5％ showed evidence of breast and pubic hair development at Tanner stage ≥ Ⅱ,respectively.In girls aged 6-9 years,0.3％ had experienced menarche.Schoolgirls' rate of menarche was 4.7％.In girls aged 6-7 years,19.0％ were diagnosed with precocious puberty according to the classic criteria.In boys aged 6-8 years,1.7％ had testicular volume ≥4 ml,and 0.6％ showed evidence of pubic hair development at Tanner stage ≥ Ⅱ.Schoolboys' incidence rate of spermatorrhea was 0.1％.In boys aged 6-8 years,2.3％ were diagnosed with precocious puberty according to the classic criteria.All the numbers above were weighted.Conclusion Proper education on adolescence and sex is essential for Shanghai schoolchildren.

Objective To investigate the current prevalence of pubertal development in healthy Shanghai schoolchildren.Methods This study was a cross-sectional investigation focused on current pubertal development conducted in healthy Shanghai schoolchildren by multi-stage cluster sampling.The sample included 17 571 children in grades 1-5 investigated in June 2014.The data were weighted by inverse probability weighting (IPW) to make them more representative.At examination,stages of breast and pubic hair development were rated according to the Tanner method.Testicular volume was determined.Data on menarche and spermatorrhea were collected by the status quo method.The rates of precocious puberty,breast,and pubic hair development of Tanner stage ≥ Ⅱ in girls aged 6-7 years,menarche in girls aged 6-9 years,and testicular volume ≥4 ml and pubic hair development of Tanner stage ≥ Ⅱ in boys aged 6-8 years were calculated.All the data were weighted by IPW.Results After data processing,16 197 children's data were analyzed.In girls aged 6-7 years,17.2％ and 2.5％ showed evidence of breast and pubic hair development at Tanner stage ≥ Ⅱ,respectively.In girls aged 6-9 years,0.3％ had experienced menarche.Schoolgirls' rate of menarche was 4.7％.In girls aged 6-7 years,19.0％ were diagnosed with precocious puberty according to the classic criteria.In boys aged 6-8 years,1.7％ had testicular volume ≥4 ml,and 0.6％ showed evidence of pubic hair development at Tanner stage ≥ Ⅱ.Schoolboys' incidence rate of spermatorrhea was 0.1％.In boys aged 6-8 years,2.3％ were diagnosed with precocious puberty according to the classic criteria.All the numbers above were weighted.Conclusion Proper education on adolescence and sex is essential for Shanghai schoolchildren.

OBJECTIVE: To evaluate the effects of the pestle needling therapy on the vibration perception threshold (VPT) and the quality of life (QOL) in the patients of high-risk diabetic foot. METHODS: A total of 132 patients of high risk diabetic foot were randomized into an observation group and a control group, 66 cases in each one. In the control group, the routine treatment and nursing for diabetes were applied. In the observation group, on the base of the treatment as the control group, the pestle needling therapy was used at , , , Zusanli (ST 36), Yongquan (KI 1), Sanyinjiao (SP 6) and Taixi (KI 3). The intervention with the pestle needling therapy was given once every day, consecutively for 4 weeks. The follow-up visit was conducted in 3 months and 6 months after the intervention. Vibration perception threshold (VPT) was observed before and after intervention in the two groups. Separately, before intervention, at the end of intervention, 3 months after intervention and 6 months after intervention, the type 2 diabetes mellitus quality life scale (DMQLS), the revised edition was adopted to compare the QOL between the two groups. The effects were evaluated in the two groups. RESULTS: After intervention, the VPT and QOL were all improved in the two groups (<0.01, <0.05). In the observation group, after intervention, VPT at the first toes and the dorsum of the feet was lower than the control group at the same time point (all <0.01). In the observation group, the total scores and the score of each dimension item in the DMQLS of the revised edition were all lower than the control group correspondently at the end of intervention, 3 months after intervention and 6 months after intervention (<0.01, <0.05). The repeated ANOVA results showed that the differences were significant in the total scores and the score of each dimension in the aspects of time, inter-group and interaction effect (<0.01, <0.05). The total scores and score of each dimension item in the DMQLS were lower than those the earlier time point (<0.01, <0.05). The total effective rate was 100.0% in the observation group, which was superior to 95.1% (59/62) in the control group (<0.05). CONCLUSION The pestle needling therapy reduces the foot VPT and improves the sensory nerve function of the foot and the QOL in the patients of high-risk diabetic foot.
Acupuncture Therapy ; Diabetes Mellitus, Type 2 ; Diabetic Foot ; therapy ; Humans ; Perception ; Quality of Life ; Vibration