Objective To compare the efficacy of completely thoracoscopic lobectomy and small-incision thoracotomy for pulmonary lobectomy in the treatment of non-small cell lung cancer and the influence on serum carcinoembryonic antigen(CEA),thymidine kinase 1(TK1)and blood gas indexes.Methods From April 2017 to March 2019,96 patients with non-small cell lung cancer diagnosed by pathological examination in Hunan University of Medicine General Hospital were randomly divided into control group and observation group,with 48 cases in each group.Completely thoracoscopic lobectomy was performed in the observation group,and thoracotomy for pulmonary lobectomy was performed in the control group.Mediastinal lymphadenectomy was given in both groups.The perioperative indexes and the incidence of postoperative complications were compared between the 2 groups.Venous blood was collected before and after the operation.The serum was collected to determine tumor necrosis factor-α(TNF-α),procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP),CEA,and TK1.The visual analogue scale(VAS)scores and radial artery blood gas indexes were compared between the 2 groups before and after surgery.The survival of the 2 groups was recorded during 2-year follow-up.Results The operative time,intraoperative blood loss,activity time out of bed and hospitalization time in the observation group were significantly lower than those in the control group(all P<0.05).No significant difference was found in the number of dissected lymph nodes between the 2 groups(P>0.05).Serum PCT,hs-CRP and TNF-α levels were increased after surgery in both groups,and these indexes in the observation group were significantly lower than those in the control group(all P<0.05).Partial pressure of oxygen(PaO2),partial pressure of carbon dioxide(PaCO2)and base excess(BE)levels were decreased after surgery in both groups.Postoperative PaO2 in the observation group was significantly higher than that in the control group(P<0.05).Serum CEA and TK1 levels in 2 groups after operation were significantly lower than those before operation(both P<0.05),but there was no significant difference in the CEA or TK1 between the groups(P>0.05).There was no significant difference in the preoperative VAS scores between the groups.The VAS scores on the 1st,3rd,and 7th day after operation in the observation group were significantly lower than those in the control group(P<0.05).The incidence of postoperative complications in the observation group was significantly lower than that in the control group(6.25% vs.22.92% ,P<0.05).After 24 months of follow-up,there was no significant difference in survival rate between the 2 groups(P>0.05).Conclusion Completely thoracoscopic lobectomy can effectively reduce postoperative pain,improve lung function,shorten hospitalization time,and has fewer complications.Its therapeutic effect is equivalent to small-incision thoracotomy.It is worthy of clinical promotion with both high efficiency and safety.

Renal cell carcinoma is rarely diagnosed during pregnancy, but it is commonly reported urinary system tumors during pregnancy. The management is a real challenge due to the sparse literature and lack of standard guidelines. Following the continuous development of medical technology, the health and fertility needs of these patients have been well protected in recent years. The aim of this article is to review the epidemiology, risk factors, diagnosis, treatment, and prognosis of renal cell carcinoma during pregnancy.

Objective To investigate the effect of the endoscopic surveillance system in irrigating fluid absorption and bleeding during transurethral resection of the prostate.Methods In vitro trials,we simulated the fluid absorption and bleeding in the operation by using self-developed endoscopic surveillance system from January 2013 to June 2013.Continuous irrigation of 5 ％ mannitol solution,we extracted 5 times irrigating fluid (each time 100 ml and a total of 500 ml) in the process of irrigation and recorded absorption measurements of every time extraction rinses.At the same time,we dripped human whole blood 5 times(each time 5 ml and a total of 25 ml) in the process of irrigation and recorded the bleeding measurements.The above process was repeated three times to detect the accuracy and consistency of the endoscopic surveillance system.In clinical trials,50 cases of BPH were monitored in surgery and the biochemical index,hemodynamics,irrigating fluid absorption and bleeding were compared from October 2016 to April 2017.The included criteria contained as follow:the age of patients should be more than 50 years.The transabdominal ultrasound showed that the volume of prostate should be more than 60 ml.The maximal uroflowmetry should be less than 15ml/s.The IPSS scores should be more than 8.Based on the operative time,two groups (＜60 min and ≥ 60 min) were classified.Results We developed the endoscopic surveillance system which is original in the world.In vitro trials,the average irrigating fluid were (100.60 ± 2.07) ml,(201.00±3.39) ml,(302.00±4.67) ml,(403.60±4.39) ml and (502.40 ±7.57) ml;and the average bleeding were (5.06 ± 0.11) ml,(10.10 ± 0.16) ml,(15.04 ± 0.15) ml,(20.06 ± 0.11) ml and (25.10 ± 0.16) ml.No significant difference was observed in all groups (P ＞ 0.05).In clinical trials,we compared some preoperative and postoperative indexes.The average blood oxygen saturation were (94.46 ± 2.49) ％ and (92.39 ± 2.77) ％ (P ＜ 0.01),the average Serum sodium ion concentration were (141.05 ± 2.52) mmol/L and (138.06 ± 4.27) mmol/L(P ＜ 0.01),the average HGB were (143.50 ± 13.43) g/L and (137.04 ± 14.25) g/L(P ＜ 0.01).The average HCT were (42.05 ± 4.09) ％ and (137.04 ± 14.25) ％ (P ＜ 0.01).The average HR were (77.9 ± 7.6) beats per minute and (77.93 ± 6.93) beats per minute (P＞0.05).The MAP were (90.32 ± 9.75) mmHg and (91.07±8.96)mmHg(P＞0.05).The average serum potassium ion concentration were (4.13 ± 0.53) mmol/L and (4.09 ± 0.37) mmol/L (P ＞ 0.05).The average irrigating fluid absorption of the group less than 60 minutes and the group equal or more than 60 minutes were (401.83 ± 279.23) ml and (885.25 ± 367.68) ml (P ＜ 0.01).The average blood loss were (64.10 ±47.47) ml and (158.40 ± 65.22) ml(P ＜0.01).The preoperative and postoperative hemodynamic,blood biochemical and hematology showed difference in our trials.Irrigating fluid absorption and blood loss were positively associated with operation time.Conclusions The endoscopic surveillance system was safety and accuracy.It can offer real-time monitoring data and alarm mechanism for the surgeons that possibly improve operation safety.

Objective To investigate the training process of clinical practice ability in medical undergraduates in the context of tutorial system,as well as new clinical training models and evaluation methods.Methods A total of 40 medical undergraduates who entered the stage of clinical practice were randomly divided into tutorial group and control group,with 20 undergraduates in each group.A diversified evaluation system was used to perform a comprehensive evaluation of clinical practice ability of medical undergraduates at different stages,with a combination of professional theory examination,Mini-Clinical Evaluation Exercise,Direct Observation of Procedural Skills,and clinical case report.All the data were analyzed by SPSS 23.0,t test was used for statistical analysis.Results Compared with the control group after the internship ended,the tutorial group had significantly higher scores of clinical professional theory (86.24 ± 2.93),clinical practice ability (7.53 ± 0.48),clinical operation skills (4.35 ± 0.47),and clinical thinking ability (6.31 ± 0.52) (all P＜0.05).Conclusion The application of the tutorial training mode during the internship of medical undergraduates can improve their comprehensive qualities such as professional quality,medical theory,and practical skills.The diversified evaluation system can evaluate the teaching effect and reflect the cultivation of comprehensive quality among students.

To optimize the monitoring time of interictal epileptiform discharges (IED) in patients with epilepsy by long-term video electroencephalogram (VEEG).The cumulative percentages of IED detected by VEEG in 346 epilepsy patients (349 times) with different purposes, different waking sleep states and different MRI findings were retrospectively analyzed. According to the purposes, there were 164 patients (165 times) for clarifying diagnosis, 124 patients (124 times) for preoperative evaluation and 58 patients (60 times) for adjustment of medications. According to MRI results, there were responsible lesions in 98 patients (98 times) and no responsible lesions in 173 patients (174 times).Among 346 patients (349 times), IED was detected within 24 h in 231 patients (times). The percentage of detection in patients with purpose of preoperative evaluation was higher than those with purpose of diagnosis and medication adjustment. The detection of LED was gradually increased in first 8 h with 59.0%, then stably in 24 h. 46.8% IED was recorded during sleep time, particularly in the second stage of sleep. The cumulative percentage of IED in patients with abnormal MRI findings was higher in all periods. It reached 83.7% within 8 h, and then tended to be stable.The study shows that LED should be monitored by VEEG at least 8 hours and should include the second stage of sleep in patients with epilepsy. Patients with refractory epilepsy and with abnormal lesions on MRI should record IED more frequently.
Brain ; diagnostic imaging ; pathology ; Brain Waves ; Electroencephalography ; methods ; statistics & numerical data ; Epilepsy ; pathology ; physiopathology ; Female ; Humans ; Magnetic Resonance Imaging ; statistics & numerical data ; Male ; Retrospective Studies ; Sleep ; physiology ; Time Factors

Objective To investigate the characteristics of video electroencephalogram (VEEG) in patients with occipital lobe epilepsy (OLE) to improve the clinical diagnostic rate of OLE.Methods Twenty-five patients with OLE were collected in our hospital from June 2013 to February 2017 and received VEEG monitoring in our epilepsy center.Their clinical symptoms and VEEG characteristics were retrospectively analyzed.Results Nineteen patients (76.00％) had visual auras based on previous history,five (38.46％) had visual auras during VEEG monitoring.Three patients had epileptic discharge confined to occipital lobe and two had epileptic discharge confined to posterior temporal lobe in interictal phase,while 20 had epileptic discharge involved more than one lobe of the brain.In ictal phase,8 had clear discharge origin or earliest evolution in occipital lobe.Five showed abnormal EEG in the other brain areas,which needed other clinical information for diagnosing OLE.Conclusions The visual aura is typical characteristic of OLE,and there are specific manifestations of EEG in both inter-ictal phase and ictal phase.

Objective Postictal language testing can provide useful diagnostic information for seizure lateralization.However no such a study based on non-English language was done previously.We investigated the latency of language recovery in Chinese patients with temporal lobe epilepsy (TLE).Methods Complex partial seizures in patients with TLE were extracted from our video-electroencephalogram (EEG) database.For all patients,consciousness testing started as soon as seizures were detected.When they were alert and cooperative,they were asked to read out a sentence “昨晚他们听到老在电台里讲话”which was printed on a card.When the patients were able to read the sentence correctly,the language function was considered recovered.Results Totally 65 complex partial seizures from 22 cases of TLE (11 left and 11 right) were included.Patients were cooperative to language testing in 54 seizures (83％).The latency for consciousness recovery (CRL) and latency for consciousness language recovery (LRL) were not associated with seizure duration,but the seizure lateralization.The CRL (median,161 s) and LRL (281 s) in the left TLE were statistically significantly longer than that in the right TLE (30 s,54 s respectively).Using 150 s recovery time as bound language recovery ratio was 87％ (27/31) in right TLE and 13％ (3/23) in left TLE.Conclusion Postictal language testing based on ideographic Chinese words helps to establish seizure lateralization in patients with TLE.

OBJECTIVEQuantitative EEG and event-related potential P300 were used to evaluate impairment of cerebral function in patient with partial epilepsy.

METHODSW value was calculated (power of EEG δ and θ rhythm divided by power of α and β rhythm ) for the extent of focal cortical dysfunction. The W values in left partial epilepsy group, right partial epilepsy group and control group during interictal period compared. The latency, amplitude and reaction time of P300 potential change were observed in each groups.

RESULTSThe W values in F(8), T(4) and T(6) regions in patients with left partial epilepsy (P <0.05). The W values in T(3). O(1) regions of patients with left partial epilepsy were higher than those in patients with right partial epilepsy (P < 0.05). Furthermore, the W value in T(6) regions of patients with a disease course longer than 5y was significantly higher than that of patients with a disease course 1-5 y or less than 1y; the W value in O(2) regions of patients with a disease course longer than 5y was significantly higher than that of patients with a disease course between 1-5y (P < 0.05). In patients with right or left partial epilepsy, the total abnormal rate of P300 was 54. 76%, the latency, amplitude and reaction team were significantly different to the control group. The abnormal rate of P300 in left and right partial epilepsy groups were 77. 78% and 37.50%, respectively, and the former is significantly higher than the latter. The amplitudes of P300 in C(z) and P(z) of left partial epilepsy were significantly lower than those of right partial epilepsy and control group (P < 0.05). The latency and reaction time of P300 in C(z) and P(z) of all partial epilepsy were significantly longer than those of control group (P < 0.05), however, no difference was found between left and right partial epilepsy.

CONCLUSIONIn partial epilepsy the cortical dysfunction occurs ipsilaterally to the epileptogenic zone, and extent of cortical dysfunction is positively correlated with duration of disease course. Cerebral dysfunction in left partial epilepsy is more severe than that in right partial epilepsy.

Adult ; Electroencephalography ; Epilepsies, Partial ; physiopathology ; Event-Related Potentials, P300 ; physiology ; Female ; Humans ; Male ; Middle Aged ; Young Adult

ObjectiveTo investigate the etiology and management of male urethral stricture at 8 medical centers in China during the period from 2004 to 2009 years,and to investigate whether there were any changes in etiology and management of urethral stricture with time change.MethodsThe database on 3455 male patients with urethral stricture who underwent treatment at 8 medical centers in China between January 2004 and December 2009 were prospectively collected.The databases were analyzed for possible cause of stricture and treatment techniques for urethral stricture,and for the changes in etiology and management with time change.ResultsThere were 3455 operations for urethral stricture during the study period.The main causes of urethral strictures were traumas in 1833 patients (53.05％),among which pelvic fractures were in 1327 (38.41％) and perineal trauma in 506 (14.65％).The second cause was iatrogenic causes in 1181 patients (34.18％ ),among which transurethral operations or examinations were in 602 (17.42％),hypospadias surgery in 291 (8.42％) and urethral catheterization in 164 (4.75％ ).Less common causes were urethritis in 201 patients (5.82％),lichen sclerosus in 149 (4.31％),undefined in 91 (2.63％).The treatments of urethral strictures were endourological surgery including internal urethrotomy and dilation and open urethroplasty including end-to-end urethroplasty and the substitude urethroplasty etc.The ratios of using various techniques in total number of patients were obviously different by time.The most application technique for treatment of urethral stricture was endourological surgery ( 709 ) during 2004 -2006 and occupied 52.67％ in total number of patients.It was gradually decreased during 2007 -2009 (726) and only occupied 34.42％ (P ＜0.01 ).Open urethroplasty gradually increased during 2007 -2009 ( 1243,58.94％ ) compared with the first three years (563,41.83％ ) (P ＜ 0.01 ). Conclusions During the recent years there was an increase in the incidence of urethral stricture being trauma and iatrogenic causes.The main treatments of urethral strictures were endourological surgery and open urethroplasty.Endourological surgery was significantly decreased in total number of patients,while open urethroplasty were significantly increased during the late three years.

ObjectiveTo investigate the condition of infants with urolithiasis caused by melaminetainted powdered formula at one-year follow-up. Methods Eighty-one young children with melamine-induced urolithiasis were followed up,which included urinalysis,renal-function tests,urinary tests for biochemical markers of renal glomerular and tubular function,and ultrasonography.Eighty-one age-matched healthy infants without exposure to melamine-contaminated formulas were enrolled as controls. Results Fifty-one of the patients were male and 30 female,with a mean age of 26 months (range 13 -48 months).The 81 children were divided into 2 groups according to treatment protocols.Group 1 received conservative treatment ( n =54 ) and Group 2 received surgical treatment ( n =27 ).In Group 1,3 patients (5.6％) had stone-residual:1 girl had calculus of 0.4 cm in diameter in the left kidney and 2 girls had calculus of 0.3 cm in diameter in the right kidney.In Group 2,2 patients (7.4％) had stone-residual,1 boy had crystallization of 0.2 cm in diameter in the right kidney and 1 boy had calculus of 1.5 cm in diameter in the left kidney,positive stone was confirmed by X-ray and accepted percutaneous nephrolithotomy.Urinary microalbumin levels were significantly increased in the children with melamine-induced urolithiasis compared with the control group (P ＜0.01 ).Blood urea nitrogen and serum creatinine were within the normal range with no significant difference between the 2 groups. ConclusionsAt one-year follow-up most of the children exposed to melamine-tainted infant formula in both treatment groups had returned to a healthy state,suggesting a satisfactory outcome for both treatment options.However,surgery is recommended in patients with stoneresidual ＞ 10 mm.