Objective:To compare the therapeutic efficacy of laparoscopic versus open hepatectomy based on three-dimensional image reconstruction in the treatment of hepatocellular carcinoma (HCC) in the central region of liver.Methods:Clinical data of 118 patients with HCC located in the central region of liver undergoing hepatectomy in the People's Hospital of Zhengzhou University from January 2020 to December 2023 were retrospectively analyzed, including 85 males and 33 females, aged (57.5±8.9) years old. According to surgical approach, patients were divided into two groups: the open surgery group ( n=66) and laparoscopic surgery group ( n=52). All patients underwent three-dimensional image reconstruction preoperatively to determine the tumor location and its relationship with the hepatic vessels. The operative duration, intraoperative blood loss, incidence of postoperative complications, postoperative hospital stay, and prognosis were compared between the groups. Results:Compared to open surgery, patients in laparoscopic group were younger [(55±9) years old vs. (59±8) years old], and experienced a longer operative time [212.5 (152.5, 262.3) min vs. 161.5 (135.8, 210.0) min] and a shorter postoperative hospital stay [11.0(9.0, 13.0) d vs. 13.0(11.0, 15.3) d] (all P<0.05). Postoperative pathology indicated that R0 resection was achieved in both groups. The incidence of postoperative complications were comparable between the two groups [34.6% (18/52) vs. 39.4% (26/66), χ2=0.28, P=0.594]. The 1-year and 3-year recurrence-free survivals were 69.7% and 53.0% in laparoscopic group, similar to those in open group (71.2% and 53.8%, respetctively, P=0.953). Conclusion:Laparoscopic hepatectomy based on three-dimensional image reconstruction is safe and feasible for HCC in central region in terms of clinical prognosis. Laparoscopic surgery is also associated with a shorter postoperative hospital stay.

Objective:To discuss the damage effect of vesicular stomatitis virus(VSV)on the vascular endothelial(VE)barrier,and to clarify its mechanism.Methods:The canine kidney cells were used to amplify VSV.The half tissue culture infective dose(TCID50)of VSV was determined using mouse brain endothelial tumor bEnd.3 cells,and subsequent experiment was conducted using 300 times the TCID50.The bEnd.3 cells were divided into infection 0 h group,infection 4 h group,infection 8 h group,and infection 12 h group for VE barrier damage experiments due to VSV infection.The bEnd.3 cells were also divided into control group,infection group,and correction group for experiments to inhibit the VSV replication and restore the VE barrier.The bEnd.3 cells were inoculated into Transwell chambers to construct an in vitro VE barrier model.Cell voltage resistance meter was used to detect the transepithelial resistance(TER)in various groups after the bEnd.3 cells were infected with VSV at different time points;fluorescein isothiocyanate-dextran leakage assay was used to detect the permeability coefficients of the cells in various groups;immunofluorescence staining was used to observe the localization changes of VE-cadherin,β-catenin,and phosphorylated β-catenin(p-β-catenin)in cytoskeleton and adherens junctions(AJs)of the bEnd.3 cells after VSV infection;real-time fluorescence quantitative PCR(RT-qPCR)method was used to detect the expression levels of Wnt and β-catenin mRNA in the cells in various groups;Western blotting method was used to detect the expression levels of Wnt,β-catenin,and p-β-catenin proteins in the cells in various groups.Results:The TCID50 of VSV was 10-4.5·100 μL-1.TheTranswell chamber experiment results showed that compared with infection 0 h group,the TERs in the cells in the other groups were significantly decreased(P＜0.05),and the permeability coefficients were significantly increased(P＜0.05).The immunofluorescence staining results showed that compared with control group,the cytoskeleton of the bEnd.3 cells in infection group was disordered,the cell gaps was increased,the linear index of AJs was significantly decreased(P＜0.05),and β-catenin and p-β-catenin translocated from the cell membrane to the perinuclear area.The RT-qPCR results showed that compared with infection 0 h group,the expression levels of Wnt mRNA in the cells in the other groups were significantly decreased(P＜0.05),while the expression levels of β-catenin mRNA showed no statistically significant difference(P＞0.05).The Western blotting results showed that compared with infection 0 h group,the expression levels of Wnt protein in the cells in the other groups were significantly decreased(P＜0.05),the expression levels of β-catenin showed no statistically significant differences(P＞0.05),and the expression levels of p-β-catenin were significantly increased(P＜0.05).After inhibiting the VSV replication and correcting the low density lipoprotein receptor(LDLR)abnormalities,the Transwell chamber experiment results showed that compared with infection group,the TER in the cells in correction group was significantly increased(P＜0.05),and the permeability coefficient was significantly decreased(P＜0.05).The immunofluorescence staining results showed that compared with infection group,the gaps in the cells in correction group were reduced,and the perinuclear aggregation of β-catenin and p-β-catenin in the cells was restrained.The RT-qPCR results showed that compared with infection group,the expression level of Wnt mRNA in the cells in correction group was significantly increased(P＜0.05).The Western blotting results showed that compared with infection group,the expression level of Wnt protein in the cells in correction group was significantly increased(P＜0.05),the expression level of β-catenin showed no statistically significant difference(P＞0.05),and the expression level of p-P-catenin was significantly decreased(P＜0.05).Conclusion:VSV infection can cause the LDLR inactivation,reduce the expression level of Wnt protein,increase the phosphorylation level of β-catenin and cause its internalization,disrupt the stability of AJs,and ultimately lead to VE barrier damage.

Objective:To investigate the value of tumor budding in the clinicopathology and prognosis of pancreatic neuroendocrine tumors.Methods:The Cliniccal data of 105 pancreatic neuroendocrine tumor patients underwent resection in Henan Provincial People's Hospital from Jan 2010 to Dec 2016 were retrospectively analyzed. Tumor budding was calculated through hematoxylin-eosin (HE) and immunohistochemical stained slides. Based on the receiver operating characteristic curve (ROC), the number of tumor budding ≥10 was defined as the high-grade budding group, and <10 as the low-grade budding group. Multiple analysis was performed to determine the relationship between tumor budding and clinicopathology as well as prognosis.Results:High-grade budding group was observed in 35 cases and low-grade group in 70. High-grade budding were more common in tumors with advanced T stage, high risk of lymphatic metastasis, preoperative liver metastasis, vascular invasion and postoperative recurrence (respectively χ 2=9.043, 4.286, 10.130, 12.090, 9.260, all P<0.05). Multivariate COX regression analysis showed that tumor budding ( P=0.018), tumor grade ( P=0.026), preoperative liver metastasis ( P=0.042), vascular invasion( P=0.048) was independent risk factors predicting poor prognosis. Conclusion:Tumor budding is highly correlated with clinicopathological parameters which reflect the aggressiveness of pancreatic neuroendocrine tumor, it is also an important prognostic factor.

Objective To review the clinical features of the patients received massive transfusion (MT) in plastic surgery department.Methods Ten cases were reviewed.The reason of massive transfusion,the type and dosage of transfusion,the reaction of patients were included.For all the patients,consultation of related department preoperatively was necessary.Based on the through and detailed analysis of the patients' condition,necessary blood product should be prepared ahead of operation.During the therapy,adjustment of treatment plan was made from time to time,according to the patient's condition.Therefore efficient and prompt therapeutic result was achieved.Results In all the 10 MT cases suffered from acute blood loss,2 of them were in hemorrhagic shock before administration.Coagulation disorders happened in 2 patients,and recovered after appropriate treatment.RBC,which was 58.3％ of total amount of transfusion,used most commonly;the second was fresh frozen plasma (FFP),which was 38.6％ according to the total amount.All the patients had satisfactory recovery,without hemolysis or any other functional disorder.Conclusions For MT patients in the Department of Plastic Surgery,the main proposes are to restore and maintain an effective circulatory blood volume,while preventing the coagulation disorder.Also,detailed analysis,through consultation and timely adjustment are of great importance for the MT patients.It is also the essential of an effective perioperative management.

Objective To investigate the therapeutic effect of ambroxol hydrochloride on severe pneumonia, and the influence on the inflammatory cytokines of TNF-alpha and hs-CRP etc.MethodsThe clinical data of 70 patients with severe pneumonia patients treated in our hospital from December 2014 to August 2016 were retrospectively analyzed.The patients were divided into control group(n=30) and observation group(n=40) according to the treatment methods, the control group was given routine treatment, the observation group was given ambroxol hydrochloride on the basis of conventional treatment.The therapeutic effect of the two groups was observed, the differences of serum levels of inflammatory cytokines, pulmonary function, cough and expectoration symptom scores of the two groups were compared before and after treatment.ResultsThe effective rate of the observation group was 97.50%, which was significantly higher than that of the control group(80.00%);There was no significant difference in serum inflammatory cytokine levels between the two groups before treatment, after treatment,the levels of IL-6, IL-8, hs-CRP and TNF-alpha the observation group were lower than those in the control group;There was no significant difference in the indexes of lung function between the two groups before treatment.After treatment, the levels of FVC, FEV1 and FEV1/FVC in the observation group were higher than those in the control group;There was no significant difference in symptom score between the two groups before treatment.After treatment, cough, sputum volume, cough ease and wheezing scores in the observation group were lower than in the control group.ConclusionAmbroxol hydrochloride has a good therapeutic effect on severe pneumonia,which can significantly reduce the levels of inflammatory cytokines such as TNF-α and hs-CRP, and improve the related symptoms, and has good application value.

Objective To observe the effect of tiotropium combined Seretide in the treatment of elderly patients with moderate to severe COPD clinical curative effect and the influence on the quality of life of patients.Methods114 cases of moderate or severe COPD in our hospital from January 2014 to January 2016,were randomly divided into observation group and control group, 57 cases in each group.The control group was treated with Seretide treatment, the observation group were treated by tiotropium combined with Seretide treatment, compared two groups of patients with curative effect and quality of life.ResultsBefore treatment, there were no significant differences in lung function index, MRC score, 6MWT and WHOQOL-100 scores between the two groups;After treatment, FEV1/FVC and FEV1% in the observation group were significantly higher than in the control group, and the difference was statistically significant (P<0.05);the dyspnea severity score (MRC) and six minute walk test (6MWT) in the observation group were significantly better than those in the control group, and the differences were statistically significant (P<0.05);the quality of life score (WHOQOL-100) in the observation group was significantly higher than in the control group, the difference was statistically significant (P<0.05).ConclusionTiotropium bromide combined with nimesulide in the treatment of elderly patients with moderate or severe COPD is effective, and can effectively improve the level of pulmonary function, improve the quality of life of patients.

Objective To study whether methicillin-resistant Staphylococcus aureus (MRSA)will increase the burden of patients with hospital-acquired pneumonia (HAP).Methods Patients with Staphylococcus aureus HAP in a hospital between January 1 ,2013 and November 31 ,2014 were selected,patients with MRSA HAP were as case group,patients with methicillin-sensitive Staphylococcus aureus (MSSA)HAP were as control group,propen-sity score matching (PSM)analysis were conducted to compare the prognosis of MRSA HAP and MSSA HAP (length of hospital stay, duration from infection to discharge, mortality, total therapeutic cost ). Results APACHE II score in case group was higher than control group before PSM was conducted,length of hos-pital stay and duration from infection to discharge were both longer than control group (40[20,94]d vs 28[21 ,53] d;19[10,46]d vs 17[8,29]d,respectively,both P <0.05).APACHE II score in case group and control group af-ter conducting PSM was not significantly different(P >0.05 ),data were balanced and comparable;there were no significant difference in length of hospital stay between two groups (28[21 ,52]d vs 28[21 ,53]d),duration from in-fection to discharge (15[9,25]d vs17[8,29]d),mortality(10.87% vs 15.22%),and total therapeutic cost (121 013.5[80 747.21 ,176 200]yuan vs 119 911 .2[66 994.08,241 184.7]yuan)(all P >0.05).Conclusion APACHE II score is an important factor affecting prognosis;after balancing this factor,there is no difference in the prognosis of patients with MRSA and MSSA HAP,MRSA HAP can not increase the burden of disease.

Objective To realize the effect of WHO multimodal hand hygiene improvement strategy (MHHIS)on improving hand hygiene compliance of health care workers(HCWs).Methods From June to December 2012,HCWs in a hospital was intervened by adopting MHHIS,hand hygiene compliance rate before and after intervention was com-pared,and effectiveness of intervention was assessed.Results Hand hygiene compliance of doctors and nurses improved from 14.06%(35/249)and 28.62%(81/283)before intervention to 31.73%(79/249)and 57.60%(163/283)after inter-vention respectively(both P <0.05).Except outpatient and emergency department,hand hygiene compliance of the other departments significantly improved (all P <0.05);hand hygiene compliance of various hand hygiene indicators significantly improved except ‘after contact with patient surrounding’(all P <0.05),the differences were statistically different (P<0.05).Conclusion Using WHO MHHIS can effectively improve hand hygiene compliance of HCWs.

Objective To analyze the present medical teaching textbooks and practice skill guidelines,and explore the profound causes of poor hand hygiene idea among doctors.Methods Three sets of unified textbook series used for domestic medical colleges and universities and two sets of manipulation skill guidelines were studies.Statistical method was conducted to analyze whether concepts and methods of hand hygiene,hand-washing and antiseptic han-drubbing were included in these teaching textbooks;as to eight aseptic manipulation skills,coverage of knowledge, steps of hand-washing and antiseptic handrubbing in manipulation skill guidelines were also analyzed.Results The mentioning rate of hand hygiene,hand-washing and antiseptic handrubbing in 8-year and 5-year program teaching textbooks were both 0 ,in nursing teaching textbooks was 1 00 % ;as to 8 aseptic manipulation in 2 sets of skill practice guidelines,mentioning rate of hand washing was 37 .50 % ,and method and steps of antiseptic handrubbing were both 0 .Conclusion School teaching and skill assessment are the basis,it is difficult to form the right idea by only relying on continuing education without basic education.Hand hygiene should be stressed in the written of teaching textbooks,guidelines should be written following the newest progress,so as to form the correct idea of hand hygiene among doctors.

Objective To study the increased radiosensitivity of tumor cells by triterpene acids of loquat leaf (TAL) and mechanism.Methods C6 and MG63 cells were pretreated by TAL,and then were exposed to X-rays at 1,2,3,5,7 Gy.Clonogenic assay was used to evaluate those tumor cells survival fraction (SF) to calculate the sensitization enhancement ratios (SER) of TAL.The cellular micronuclei ratios of tumor cells were analyzed by micronuclei assay.Additionally,the changes of Rad51 and XRCC4 levels were observed by RT-PCR and Western blot.Results D0 values were decreased to 1.31 and 2.85 Gy in C6 and MG63 cells by TAL pretreatment respectively.The SER value of the effect of TAL on C6 and MG63 cells was 1.73 and 2.04,respectively.There was a statistical difference in the cellular micronuclei ratios between tumor cells with TAL above 2 Gy and those without TAL (C6:t =-8.372--2.476,P ＜0.05 ; MG63:t =-4.03--2.557,P ＜ 0.05).TAL attenuated the expression of XRCC4 at transcriptional and translational level,but not for Rad51,a key gene in homologous recombination repair (HRR).Conclusions TAL pretreatment could increase the lethal effect of X-rays on tumor cells in vitro.The mechanism might be involved in the inhibition of non-homologous end joining (NHEJ).