Objective:To analyze the relationship between the optimal surgical margin value and clinical prognosis of transoral robotic surgery（TORS） in treating human papillomavirus（HPV） -positive oropharyngeal squamous cell carcinoma. Methods:A single-center, prospective, observational cohort study was conducted, enrolling patients with early and moderated stage（≤T3 stage） oropharyngeal carcinoma undergoing TORS between July 2020 and April 2024. The proposed optimal surgical margin cutoff value for TORS was set as 2 mm. The primary objectives were to evaluate the optimal clear margin for TORS and its association with overall survival（OS） and progression-free survival（PFS）. Logistic regression was used to analyze correlations between surgical margins and clinical variables, while Cox regression models assessed the impact of surgical margins on OS and PFS. Results:A total of 90 patients（60 males, 66.7%） were included, all had squamous cell carcinoma, with a mean age of 58.0±9.0 years（range: 39-84 years） old. The 1, 2 and 3-year OS rates were 92.3%, 89.9% and 85.0%, respectively, while the 1, 2 and 3-year PFS rates were all 90.1%. For surgical margins ≤2 mm, the 1, 2 and 3-year OS rates were 80.8%, 69.3% and 69.3%, respectively, and PFS rates were 77.9% across three time points. For surgical margins>2 mm, the 1, 2 and 3-year OS rates were 96.5%, 96.5% and 90.6%, respectively, with PFS rates of 94.6%. Logistic regression showed no correlation between surgical margins and tumor type, T/N stage, smoking, alcohol use, or gender（P>0.05）. Cox analysis identified surgical margins>2 mm as a significant factor improving PFS（HR=0.14, 95%CI 0.02-0.90, P=0.038）. Conclusion:This systematic analysis suggests setting a 2 mm and longer as clear surgical margin for TORS. Margins>2 mm are associated with superior postoperative PFS rate and prolonged PFS time in HPV-positive oropharyngeal carcinoma patients.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Carcinoma, Squamous Cell/virology* ; Human Papillomavirus Viruses/isolation & purification* ; Margins of Excision ; Oropharyngeal Neoplasms/virology* ; Papillomavirus Infections/virology* ; Prognosis ; Prospective Studies ; Robotic Surgical Procedures/methods*

Objective:To study the urinary iodine levels of children in Jiangxi Province and provide a basis for prevention and treatment of iodine deficiency disorders and scientific iodine supplementation.Methods:From March to July in 2022, a systematic sampling method was used in 99 counties (cities, districts, abbreviated as counties) in Jiangxi Province. One township (street) was selected from each county in five directions: east, west, south, north and middle. One primary school was selected from each township (street), and 40 non boarding children aged 8 - 10 (half male and half female) were selected from each primary school. One random urine sample was collected to test urinary iodine, and the distribution of urinary iodine in different regions, genders, and ages were compared.Results:A total of 19 842 urine samples were collected from children, with a median urinary iodine level of 181.90 μg/L. The median urinary iodine levels of children in different cities ( H = 1 014.05, P < 0.001), genders ( Z = 6.44, P < 0.001) and ages groups ( H = 29.82, P < 0.001) were compared, and the differences were statistically significant. Conclusion:The urinary iodine level of children in Jiangxi Province is at an appropriate level, but the distribution of urinary iodine is uneven among different regions, genders, and ages, indicating that scientific and precise iodine supplementation is necessary for the prevention and treatment of iodine deficiency disorders.

Objective To explore the application effect of visualization pre-hospital and in-hospital information connection technique in pre-examination and triage of emergency critically ill patients.Methods The critically ill patients transferred by 120 ambulances to the Affiliated Hospital of Jiaxing University,the First Hospital of Jiaxing from March to August 2023 were selected as research objects.Prospective non-concurrent control was adopted.The 90 critically ill patients transferred by 120 ambulances to our hospital from June to August 2023 were used as an experimental group,while the 90 critically ill patients transferred by 120 ambulances to our hospital from March to May 2023 were used as a control group.Before establishing visualization pre-hospital and in-hospital information connection technique,the patients or their family members in the control group called an ambulance;after pre-hospital rescuers sent the patients to the hospital,they connected with in-hospital medical workers in an oral or written form;pre-examination nurses received the patients,performed illness evaluation,obtained their identity information,and helped card registration;and meanwhile,the in-hospital medical workers conducted standardized treatment for the patients.After establishing visualization pre-hospital and in-hospital information connection technique,the patients or their family members in the experimental group called an ambulance;pre-hospital rescuers input corresponding basic information of the patients(including name,gender,age,vital sign,severity of illness,etc.)via the special APP of the emergency center,and pushed relevant information to the target network hospital;pre-examination nurses received the message that the ambulance was about to arrive via the pre-hospital and in-hospital collaborative treatment platform,obtained the basic information of the patients provided before admission in the emergency pre-examination system,performed card registration in advance,and opened a green channel;and meanwhile in-hospital medical workers developed a rescue plan according to the severity of illness assessed by 120 doctors.The time of critically ill patients setting up a medical card,the time of pre-examination nurses completing triage,and the satisfaction of the patients and their family members with the emergency treatment process were compared between the two groups.Results The time of critically ill patients setting up a medical card and the time of pre-examination nurses completing triage in the experimental group were significantly shorter than those in the control group[the time of critically ill patients setting up a medical card(minutes):1.3±0.3 vs.2.6±0.4,the time of pre-examination nurses completing triage(minutes):1.1±0.3 vs.3.5±0.7,both P<0.05].Moreover,the satisfaction of the patients and their family members on the emergency treatment process in the experimental group was obviously higher than that in the control group[95.6%(86/90)vs.86.7%(78/90),P<0.05].Conclusion The establishment of visualization pre-hospital and in-hospital information connection technique can achieve pre-hospital and in-hospital data transmission and accomplish"information goes ahead of patients",which effectively shortens pre-examination and triage time for critically ill patients,wins an opportunity to rescue them,improves pre-examination and triage efficiency for ordinary patients,and enhances their medical experience.

OBJECTIVE: To investigate the prevalence and relevant influencing factors of gynecological diseases of grassroot level female medical staffs. METHODS: A total of 2 308 female medical workers from county, town and village in hengxian County of Guangxi Zhuang Autonomous Region were selected as study subjects by cluster sampling method. The basic information, occupational history, reproductive health and fertility of these subjects were investigated by Reproducetive Health Survey Questionnaine of Female Workers. RESULTS: The total prevalence of gynecological diseases in female medical staffs was 21.6%. Among them, the prevalence of genital tract infections was 15.6%, and gynecological tumors was 6.0%. The top three gynecologic diseases were vaginitis(9.2%), uterine fibroids(4.3%) and cervicitis(3.5%). Multivariate logistic regression analysis results indicated that the younger the patients, the higher the risk of reproductive tract infectious diseases(P<0.01), and the lower the risk of gynecological tumors(P<0.01). The risk of reproductive tract infectious diseases and gynecological tumors in married patients was higher than that in unmarried staffs(P<0.05). The higher the number of abortions, the higher the risk of reproductive tract infectious diseases and gynecological tumors(P<0.01). The risk of reproductive tract infectious diseases was higher and the risk of gynecological tumors was lower in female shift workers than that of non-shift workers(P<0.05). CONCLUSION: Vaginitis, uterine fibroids and cervicitis are the main gynecological diseases in grassroot level female medical staffs. The incidence of gynecological diseases is related to age, history of marriage, childbirth and abortion, and work-shifts.

Objective To explore the effect of sitting and lateral sputum aspiration on the retention time of tracheal cannula in patients with neurosurgical tracheotomy. Methods Totally 120 cases of neurosurgery tracheotomy in hospitalized patients complicated with pulmonary infection by random number table method, 58 cases were divided into experimental group and control group 62 examples, two groups of patients with sputum top all joint taps to the back of the chest, the experimental group after taps take seat effectively causes cough; In the control group, the lateral position was used to effectively cough or induce cough, and the daily sputum volume of the two groups of patients was observed. To observe the time when the body temperature was restored to normal after the phlegm of the two groups of patients, the time of the lung auscultation, and the time of the tracheal tube retention. Results Implementing position row of phlegm daily sputum volume within a week the experimental group were (44.84±6.85) ml, (44.60±6.80) ml, (43.79±5.98) ml, (44.38±5.42) ml, (42.22±5.45) ml, (38.12±4.77) ml, (36.88±4.57) ml and control group were(36.13±7.34) ml, (35.15±7.34) ml, (36.13±7.34) ml, (37.13±7.34) ml, (37.13±7.34) ml, (32.97±7.17) ml, (31.35±4.36) ml, the difference had statistical significance (t=4.30-7.31, P<0.01);In the two groups, the time of normal body temperature recovery, the time of hearing and the time of the lung and the time spent in the tracheal tube were compared, and the experimental group were respectively (9.93±2.02) d, (32.33±1.50) d, (37.33±1.50) d, while control group were(15.77±1.05) d, (37.63 ± 2.33) d, (42.63 ± 2.33) d, the difference had statistical significance (t=20.04, 14.71, P<0.01). Conclusions It is better to reduce the retention time of tracheal tube in patients with neurosurgical patients than the lateral position.

Red-based recombineering has been widely used in Escherichia coli genome modification through electroporating PCR fragments into electrocompetent cells to replace target sequences. Some mutations in the PCR fragments may be brought into the homologous regions near the target. To solve this problem in markeless gene deletion we developed a novel method characterized with two-step recombination and a donor plasmid. First, generated by PCR a linear DNA cassette which comprises a I-Sec I site-containing marker gene and homologous arms was electroporated into cells for marker-substitution deletion of the target sequence. Second, after a donor plasmid carrying the I-Sec I site-containing fusion homologous arm was chemically transformed into the marker-containing cells, the fusion arms and the marker was simultaneously cleaved by I-Sec I endonuclease and the marker-free deletion was stimulated by double-strand break-mediated intermolecular recombination. Eleven nonessential regions in E. coli DH1 genome were sequentially deleted by our method, resulting in a 10.59% reduced genome size. These precise deletions were also verified by PCR sequencing and genome resequencing. Though no change in the growth rate on the minimal medium, we found the genome-reduced strains have some alteration in the acid resistance and for the synthesis of lycopene.
Chromosomes, Bacterial ; genetics ; DNA ; Endonucleases ; metabolism ; Escherichia coli ; genetics ; Genetic Engineering ; methods ; Recombination, Genetic ; Sequence Deletion

Background and purpose: Human epididymis protein 4 (HE4) has been suggested to be a novel biomarker of epithelial ovarian cancer (EOC). The present study aimed to evaluate and compare HE4 with the commonly used marker, carbohydrate antigen 125 (CA125) and imaging examinations in detecting the recurrence of postoperative EOC. Methods:In this study, 92 patients with the recurrence of postoperative EOC were analyzed retro-spectively. The treatments method included the secondary operation (48 patients) and chemotherapy (44 patients). The sensitivity of CA125, HE4 and CT/MRI examinations in detecting the recurrence of postoperative EOC were analyzed and correlated with surgical pathology and clinical follow-up results. Results:The sensitivity of CA125 and HE4 were 58.7%and 61.9%with no signiifcant difference (P>0.05). The diagnostic sensitivity of CA125 combined with HE4 (80.4%) was statistically higher than that of 2 tumor marks being applied independently (P>0.05). The diagnostic sensitivity of CT/MRI examinations (88.0%) was statistically higher than that of CA125 and HE4 (P<0.05), and no signiifcant difference was observed between CT/MRI and combined CA125 and HE4 (P>0.05). The highest diagnostic sensitivity (97.8%) was attained by combining of CA125, HE4 and CT/MRI examinations, which was statistically high-er than that of CA125 combined with HE4 (P<0.01), and CT/MRI examinations (P<0.05). Conclusion:Serum HE4 is an effective tumor marker in detecting the recurrence of postoperative EOC as well as serum CA125. HE4 and CA125 may improve the diagnostic sensitivity statistically. The highest diagnostic sensitivity was attained by combining of CA125, HE4 and CT/MRI examinations, which is the suitable strategy in screening the patient of postoperative EOC.

Objective To investigate the effective ways of improving medical students' clinical competence during the process of internship. Methods Totally 398 students of clinical medicine from 2006 and 2007 grade in Soochow University were enrolled as research objects. Forty objects distribut-ed to the First Affiliated Hospital were taken as experiment group while 358 objects distributed to other hospital as control group. In experiment group, objective structured clinical examination (OSCE) was introduced during regular internship, innovation was made on test on completion of a course and autonomous learning and clinical practice was advocated and enhanced. Traditional practice and ex-amination method was used in control group. SPSS 19.0 was used to do statistical analysis on the test scores of students. Paired sample t test and independent sample t test were employed. Measurement data is expressed as x±s and P<0.05 signifies statistically significant differences. Results Clinical practice ability of students in experiment group was enhanced to various degrees after internship com-pared with that before internship. ECG interpretation, heart and lung auscultation, interrogation tech-nique, medical and surgical operation performances of students in experiment group were promoted significantly (P<0.05). Students' overall competence in the final graduation skill test was better in ex-periment group than in control group (P<0.05). Conclusions OSCE-test on completion of a course not only make intern management more effective, but also make students' aim more definite, therefore it is conducive to enhancing clinical competence.

Objective To determine the retest reliability and measurement error of walking energy consumption measurement in children with cerebral palsy in special school. Methods 13 children with cerebral palsy studying in Shanghai Pudong Special Education School from September to December in 2010 were enrolled in this study. They were asked to walk up and down continuously on a 50-meter-long walking pace in 6 minutes, while the distance of walking and the heart rate of both rest and walking were measured to calculate physical cost index (PCI). After 1 week, they took the 2nd measurement at the same time, the same location and the same condition. Then the results between the former and the later measurements were compared to identify the retest reliability and measurement error. Results The study showed a good retest reliability in heart rate of walking, distance of walking and PCI (ICC=0.77~0.83), but a low retest reliability in heart rate of rest (ICC=0.38). The study also showed a high measurement error in PCI. Conclusion PCI had good retest reliability and high measurement error, and was easily affected by the emotion of the children. So it was limited as a measurement of walking energy consumption in children with cerebral palsy.

Objective To identify the reliability and validity of Chinese version of expanded and revised Gross Motor Function Classification System (GMFCS E&R). Methods 101 children with cerebral palsy aged 6～18 from 2 special schools in Shanghai and Guangzhou participated in this study. The interrater reliability was identified by analyzing the assessment results among different raters, including rehabilitation doctors, physical therapists, teachers and parents. Gross Motor Function Measure (GMFM) was used as the criterion to identify the parallel validity. Results GMFCS E&R had good interrater reliability (ICC=0.79～0.91) as well as the parallel validity (Spearman rank correlation coefficient is -0.46～-0.86). Conclusion Chinese version of GMFCS E&R has good reliability and validity. It is suitable for children with cerebral palsy as the tool of function classification in China.