Objective To evaluate the clinical effects of the totally laparoscopic and laparoscopic-assisted radical gastrectomy for gastric cancer,and evaluate the feasibility and safety of the two methods.Methods Eighty patients with gastric cancer undergoing radical D2 gastrectomy from Mar 2016 to Jul 2017 were enrolled.Patients were divided into totally laparoscopically hand-sewn escophagojejunostomy group (35 cases) and control group of hand-assisted laparoscopic esophagojejunostomy (45 cases).Results Compared with the control group,the operation time,blood loss,lymph node dissection in the control group were not significantly different [(256 ± 53) min vs.(248 ± 62) min,t =2.40,P ＞ 0.05;(123 ±78)ml vs.(162±56)ml,t=-1.94,P＞0.05;(28±6) vs.(30±7),t=-3.18,P＞0.05].The postoperative ambulation time,first exhaust time,postoperative hospital stay,incision complications were all in favor of the totally laparoscopic group [(1.5 ± 0.7) d vs.(2.6 ± 0.6) d,t =-2.41,P ＜ 0.05;(2.7 ±0.8)d vs.(4.0 ±1.2)d,t =-4.63,P＜0.01;(6.8 ±0.8)d vs.(9.2 ± 1.6)d,t =-7.32,P＜0.05].Conclusions Totally laparoscopic radical gastrectomy and hand-sewn esophagojejunostomy for gastric cancer is safe and reliable and has advantages such as less pain and fast recovery.

Objective To evaluate the learning curve of video-assisted thoracoscopic sleeve lobectomy in patients with central lung cancer.Methods A total of 86 consecutive patients with resected central lung cancer in the second department of thoracic surgery of Hunan Cancer Hospital between Apirl 2016 and July 2018 were retrospectively enrolled.Video-assisted tho-racoscopic tracheoplasty with sleeve resection and lobectomy were performed in 56 patients, video-assisted thoracoscopic tra-cheoplasty with wedge resection and lobectomy were performed in 20 patients, and 10 patients transit to thoracotomy.Surgical parameter of patients who underwent video-assisted thoracoscopic sleeve lobectomy were investigated to assess the learning curve, including operation duration, bleeding volume, amount of lymph nodes examined(medianstinal and intrapulmonary). Lowess smoothing method was performed to fit curve to evaluate the variation tendency of surgical parameters .Cut-off point, as well as the confidence interval, were identified using piecewise regression analysis.Results Surgical duration tend to be stable (almost 200 min) when the cumulative case amount of video-assisted thoracoscopic sleeve lobectomy reach 40.Surgical bleed-ing tend to be stable( almost 200 ml) when the cumulative case amount of video-assisted thoracoscopic sleeve lobectomy reach 20.There is no significant correlation between the amount of lymph node harvest and surgical volume .Conclusion The cut-off point for video-assisted thoracoscopic sleeve lobectomy is approximately 40 cases.

OBJECTIVE: To explore the feasibility of detecting maternal hereditary mitochondrial tRNA METHODS: We performed sequence analysis of mitochondrial DNA in blood samples from 2070 cases of maternal hereditary mitochondrial disease in the First Affiliated Hospital of Wenzhou Medical University, and identified 3 patients with m.15927G>A mutation.Buccal swabs and blood samples were obtained from the 3 patients (mutation group) and 3 normal volunteers (control group).After extracting whole genomic DNA from all the samples, the DNA concentration and purity were analyzed.The PCR products were subjected to dot blot hybridization, Southern blot hybridization, and DNA sequencing analysis to verify the feasibility of detecting m.15927G>A mutation using buccal swabs. RESULTS: There was no significant difference in DNA concentration extracted from buccal swabs and blood samples in either the mutation group or the control group ( CONCLUSIONS Buccal swabs collection accurate is an accurate and sensitive method for the detection of m.15927G>A mutation.
DNA, Mitochondrial/genetics* ; Humans ; Mitochondria ; Mutation ; RNA, Transfer ; Sequence Analysis, DNA

Objective 　To evaluate the role of surgical resection on synchronous multiple pulmonary nodules identified difficultly in clinics. Methods 　The clinical data of 97 patients with synchronous multiple pulmonary nodules who received surgical resection between 2012 and 2019 in Hunan Cancer Hospital were retrospectively analyzed. There were 72 males and 25 females, aged 58.1卤9.0 years. Among these patients, there were 78 patients with ipsilateral and 19 patients with bilateral pulmonary nodules. Clinicopathological parameters between main nodules and secondary nodules were evaluated. Perioperative morbidity was also assessed. Results 　The operation was successfully completed on all patients for the ipsilateral and bilateral lesions. Totally, 71.1% of mian lesions was mostly removed by lobectomy, and the completion rate of video-assisted thoracoscopic surgery (VATS) was 69.1% (67/97); 80.4% of secondary lesions were mostly removed by wedge resection, and the completion rate of VATS was 71.1% (69/97). The incidence of grade 3 or higher complications after unilateral or bilateral surgery was 12.8% and 5.3%, respectively. Postoperative pathology confirmed that the main lesions were malignant in 65 patients (67.0%), mainly adenocarcinoma (63.1%), of which 43.1%were in the stage Ⅰ; 32 patients were benign, mainly tuberculoma (56.3%). There were 29 patients of malignant secondary lesions, 67 benign, and 1 both benign and malignant; the pathological agreement rate of primary and secondary lesions was 54.6% (lung cancer metastases in the lung and all the benign). When the primary lesion was malignant with its diameters of <3 cm, 3-<5 cm, 5-7 cm, >7 cm, the metastatic rate of secondary lesions was 42.5%, 15.8%, 20.0%, 0, respectively. When the primary lesion was malignant with lymph node metastasis, the probability of the secondary lesion being a metastatic tumor was higher than that without lymph node metastasis (46.7% vs. 30.0%, P>0.05). When the primary lesion was malignant and the primary and secondary lesions were located in the same lobe, the secondary lesions were more likely to metastasize (54.5%), while when they were located on different lobes on the same side or different sides, the secondary lesions were more likely to be benign (58.1%, 72.7%), and the possibility of metastasis was small ( 32.6%, 9.1%). When the primary lesion was benign and clinical differential diagnosis was difficult, the secondary lesion was benign. Conclusion    For synchronous multiple pulmonary nodules, the diameter of the primary lesion is large, the metastatic rate of secondary lesions tends to decrease. In ipsilateral synchronous multiple pulmonary nodules, especially with node metastasis, the risk of metastatic nodule increases. Bilateral surgical resection does not significantly increase the perioperative morbidity.