Hilar cholangiocarcinoma (h-CCA) is a serious health hazard in China, of which the morbidity and mortality rates are on the rise. Radical surgical resection is the only effective cure to h-CCA. However, due to the advanced stage at diagnosis, complex anatomy of the hilar region and the inability to accurately locate high-grade bile duct tumors, the rate of radical resection is low. As a result, the long-term survival rate of patients with h-CCA in China is much lower than the interna-tional leading level. With the extensive development of high-precision imaging methods and endos-copic biopsy, it is now possible to accurately assess the invasive range of h-CCA before surgery. While the assessment of the intraoperative high bile duct dissection point can only be determined by the surgeons′ experience, which mainly based on the anatomical relationship between the bile ducts and blood vessels in the hilar region, as well as the hardness and softness of bile ducts on palpation. There is an urgent need for intraoperative imaging aids that can provide real-time imaging of the h-CCA invasive extension and precisely guide bile duct dissections to increase the radical resection rate, reduce postoperative complications, thus improving the long-term survival rate of h-CCA. The authors summarize the status of preoperative planning methods and intraoperative navigation tech-niques for h-CCA and analyze the first international example of intraductal ultrasound guided tumor real-time bile duct dissections, which present a prospective view for the development of intraopera-tive navigation techniques.

Objective To investigate the technique and dosage selection of indocyanine green(ICG)fluorescence staining in laparoscopic anatomical hemihepatectomy.Methods A retrospective cross-sectional study was conducted.The clinical date of the patients who underwent laparoscopic anatomical hemihepatectomy in the Cancer Hospital of the Chinese Academy of Medical Sciences from October 2020 to October 2023 was collected and analyzed,and the management of the Glissonean pedicle,the method and effect of ICG fluorescence staining during the operation,the dose of ICG injection,and the postoperative recovery were analyzed.Results A total of 91 laparoscopic anatomical hemihepatectomies were enrolled in this study,including 28 right hemihepatectomies and 63 left hemihepatectomies.The Glissonean pedicle was dissected intra-sheath in 9 cases and extra-sheath in 82 cases.ICG fluorescence staining was all performed using the negative staining method,of which 69 cases(75.8%)were successfully stained.The success rate of staining in the extra-sheath dissection and low-dose ICG group was higher than that in the intra-sheath dissection and high-dose ICG group.The average operation time was(168.5±32.2)minutes,the intraoperative bleeding volume was(152.4±56.3)ml,and the intraoperative blood transfusion rate was 6.6%(6/91),the average postoperative hospital stay was(8.5±2.6)days.One case was converted to laparotomy due to exophytic growth of the tumor compressing the Glissonean pedicle.Four cases had Clavien-Dindo Ⅰ-Ⅱ complications,all of which improved after treatment.There were 3 cases of grade Ⅲa complications,all of which were caused by bile leakage and abdominal cavity infection.They were cured by puncture and drainage.And there were no serious complications above grade Ⅲb.Conclusions In laparoscopic anatomical hemihepatectomy,the ICG fluorescence staining method was recommended to use the negative staining method of the extra-sheath dissection of the Glissonean pedicle,and a lower dose of ICG could help to increase the success rate of fluorescence staining.

Objective To investigate the epidemiological characteristics of nosocomial fungal infections in severe sepsis patients and analyze the influencing factors by logistic regression.Methods The clinical data of 578 patients with severe sepsis admitted to our hospital from January 2008 to January 2016 were retrospectively analyzed.The epidemiological characteristics were investigated.The possible influencing factors of nosocomial fungal infection were analyzed by univariate analysis and multivariate logistic regression analysis.Results Among 578 cases of severe sepsis,215 cases were accompanied by nosocomial fungal infection (infection rate 37.20％).The infection sites were mostly lungs and the fungal types were Candida albicans.The prognosis of the patients was poor.The survival time was less than 90 days,accounting for 42.33％ (91/215).There were significant differences in age,length of stay in intensive care unit (ICU),duration of more than two antibiotics,use of ventilators,hormones,invasive procedures,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score between the infected group and the uninfected group (P ＜ 0.05).The danger degree from high to low of the risk factors were ICU stay ≥ 100 h (OR =5.697),use respirator (OR =5.388),invasive operation (OR =4.987),age ≥65 years (OR =4.584),and continuous use of two antibiotics ＞ 7 d (OR =3.287),use steroid (OR =2.141).Conclusions Severe sepsis with hospital acquired fungal infection is more common in the lung,and most of them are Candida albicans infection,with poor prognosis and high mortality.ICU stay ≥ 100 h,use respirator and steroid,invasive operation,age ≥65 years,and continuous use of two antibiotics ＞ 7d are risk factors.Specific preventive measures should be taken to reduce fungal infections.

Objective To evaluate the effects of sevoflurane on right ventricular systolic function after cardiopulmonary bypass in patients undergoing coronary artery bypass grafting(CABG). Methods Eighteen patients with coronary heart disease,13 males,5 females,ASA Ⅱ or Ⅲ,aged 50-80 years,measuring 1 50-182 cm in height,weighing 5 1-96 kg,scheduled for CABG under CPB were enrolled in this study.Anesthesia was maintained with intravenous anesthesia, and 1 MAC sevoflurane inhalation lasted for 60 min after CPB.Hemodynamic indicators such as HR,MAP, CVP,cardiac output (CO),Systemic vascular resistance (SVR)and right ventricular parameters in-cluding tricuspid annular plane systolic excursion (TAPSE)and velocity (TAPSV)were recorded be-fore sternotomy (T2 ),30 min after CPB (T3 ),60 min after CPB (T4 ).Results Compared with T1 , CO was increased at T2 (P <0.05);compared with T2 ,CO was decreased at T3 and T4 (P <0.05 or P <0.01),with a statistical significance;compared with T1 ,TAPSE and TAPSV were increased at T2 (P <0.05 or P <0.01);compared with T2 ,TAPSE and TAPSV were decreased at T3 and T4 (P<0.05);with a statistical significance in TAPSE and TAPSV.Conclusion For the patients undergo-ing CABG under CPB,1 MAC sevoflurane inhalation after CPB can reduce right ventricular systolic function,which,however,is within the normal ranges.

Objective:To describe the epidemiological characteristics of mental disorders in Ximeng Wa Au-tonomous County and explore psychosocial risk factors of mental disorders. Methods:Two thousand three hundred and eighty one residents aged 1 8 years and over were sampled using multistage sampling in Ximeng Wa Autono-mous County in 2013. All respondents were investigated by face-to-face interview. Mental disorders were screened out by using the General Health Questionnaire (GHQ)and diagnosed according to the International Classification of Diseases Checklist (ICD-10-Checklist)criteria. Results:Life time prevalence of any mental disorder was 19. 86%(419/2110). The lifetime prevalence rates of substance use disorder,anxiety disorder,insomnia,mood disorder, schizophrenia were 12. 99%(274/2110),6. 30%(133/2110),2. 94%(62/2110),2. 32%(49/2110)and 1. 00%(21/2110)respectively. Male (OR=0. 43),older age (35 -49 years,OR=1. 78;50 -64 years,OR=2. 59;≥65 years,OR=3. 5 1 ),unmarried and other marital status (OR=0. 3 1 ),non-Wa and non-Lahu ethnic groups (OR=0. 29)were associated with neurotic,stress-related and somatoform disorders. Male (OR=2. 41),older age (35 -49 years,OR=2. 29;50-64 years,OR=3. 20;≥65 years,OR=4. 58),non-farmer and non-self-employed occupation (OR=0. 41),and non-Wa and non-Lahu ethnic groups (OR=0. 32)were associated with psychoactive substance use disorder. Male (OR =0. 35 ) and order age (≥65 years,OR =3. 05 ) were associated with mood disorders. Conclusion:Lifetime prevalence of any mental disorder,substance use disorders and anxiety disorders are high in Ximeng Wa Autonomous County. Measures should be strengthened against prevalence of mental disorders in ethnic minority areas.

Cardiovascular Diseases ; Humans ; T-Lymphocytes, Regulatory ; Th17 Cells

Humans ; Hypertension ; metabolism ; pathology ; Transient Receptor Potential Channels ; metabolism ; physiology

Objective For benign or tumor of borderline malignancy in the distal pancreas,a spleen-preserving distal pancreatectomy can be carried out.This study aimed to assess the safety and feasibility of this operation.Methods Between June 2009 and March 2012,7 patients underwent laparoscopic distal pancreatectomy assisted by the da Vinci Robotic System (RDP) for benign or pancreatic tumor with borderline malignancy.The clinical data were analyzed.Results Robotic-assisted spleen-preserving laparoscopic distal pancreatectomy was successfully carried out in 6 patients,with robotic assisted splenectomy and distal pancreatectomy on the remaining patient.Among them,to the 6 patients with distal pancreatectomy,one patient received right adrenal tumor resection and another patient received cholecystectomy.The average operation time was 368 minutes,and the blood loss was 200 ml.One patient developed postoperative bleeding,and was treated conservatively with hemostatic drugs (grade Ⅱ).There was no conversion to laparotomy.According to the international pancreatic fistula research team's classification of postoperative pancreatic fistula,1 patients were diagnosed to have pancreatic fistula (grade A).The mean postoperative hospital stay was 8.7 days.There were no other complications.Conclusions Robotic-assisted spleen-preserving laparoscopic distal pancreatectomy was safe and feasible.The Kimura operation was used in spleen-preserving operations because its 3D visual field and stability in control helped to preserve splenic blood supply and reduced the chance of postoperative regional portal hypertension.

To analyze and evaluate the knowledge of Chinese Guidelines of Diabetes Prevention and Treatment in Shanghai medical staff. 175 medical staff working in endocrinology or community health were enrolled and evaluated by a questionnaire of guidelines about the state of professional, training, and related knowledge. Only 16. 6% medical staffwere trained about the guidelines( 46. 67% from the general hospitals, 14. 75% from secod-level hospital and 7. 14% persons from the community hospitals, P＜0. 01 ). The total correct answer rate of the guidelines was 37. 36%. The correct rate of community hospitals was lower than others( P＜0. 05 ). The rate of doctors' was higher than nurses'( P＜0. 05 ). There were difference between doctors and nurses with the key point of diabetes care knowledge in different level hospitals. The effective method of clinical training in diabetes care should be explored. We still have to work hard to promote the effect of diabetes control and prevention. Effective training about the guidelines should be enhanced. The cooperation between general hospitals and community health institutions in diabetes prevention and treatment should be enhanced.

Objective: To extract the polysaccharides of Curcuma zedoaria Rosc (PCZ) and study its bioactivities. Methods: The crude polysaccharides were extracted from herbal slice of Curcuma zedoaria Rosc with hot water ,and precipitated by ethanol and savage deproteinization and depigmentation with activated charcoal. The constituents were isolated by column chromatography and the total polysaccharides content was determined. Experiments of immune function,anti-oxidation and anti-tumor activity of KM mice and in viro were studied. Results: The content of total polysaccharides of Curcuma zedoaria Rosc was 33.12%. and the extraction rate was 1.938% . It could raise spleen cell proliferation and transformation rate of lymphocyte and SOD activity in blood of mice. A higher antitumor effect of the polysaccharides by injection was observed dose-dependently. Conclusion: PCZ could raise the immune and anti-oxidative activities and then had a higher antitumor effect.