Cornea ; Epithelium, Corneal ; Iontophoresis ; Riboflavin

Objective to analyze the differences and changes before and after the introduction of supply processing distribution (SPD) supply chain management mode in a public hospital, analyze the typical problems existing in the clinical practice and development of SPD mode, and explore the countermeasures to improve the SPD supply chain management. Methods the changes of 20 management functions before and after the introduction of SPD supply chain management mode were compared. The advantages and disadvantages of SPD management mode were analyzed. The improvement measures and countermeasures were proposed. Results among the 20 management functions, 11 of them were reduced, 5 of them were equal, and 4 of them were increased. The overall efficiency of hospital management was improved. Because the external medicine supplier has not been included in the hospital rules, regulations system and process. The role positioning was not clear. There were defects in institutional and continuous guarantee. Conclusion SPD supply chain management mode can be improved and innovated to promote the supply channel reform of drugs and medical consumables, and improve the fine management level of drugs and medical consumables.

Objective:To compare the clinical efficacy of transperitoneal robot assisted laparoscopic radical prostatectomy (RARP) versus extraperitoneal single port RARP.Methods:A retrospective analysis was perfoumed on 142 cases of RARP from July 2019 to June 2020 in Robotic Minimally Invasive Center of Sichuan Provincial People's Hospital, including 82 cases(Group A) , aged 70.0(65.6-78.0), undergoing transperitoneal RARP and 60 cases(Group B), aged 68.2 years old(60.1-79.2), undergoing extraperitoneal single port RARP. For group A, PSA was 12.9(5.6-64.0) ng/ml, with 26 cases of less than 10 ng/ml(31.7%), 40 cases of 10-20 ng/ml(48.8%), and 16 cases of more than 20 ng/ml(19.5%), the Gleason score was 7.2(6.0-10.0), with 14 cases(17.1%) of ≤6, 56 cases(68.3%) of 7, and 12 cases(14.6%) of ≥8, and the prostate volume was 61.3(29.0-112.0) ml. There were 49 cases with BMI≤25 kg/m 2, accounting for 59.8%, and 33 cases with BMI>25 kg/m 2, accounting for 40.2%. There were 17 cases(20.7%) of T 1, 44 cases(53.7%) of T 2 and 21 cases(25.6%) of T 3. The proportion of lymph node dissection was 17.1%, and 4 cases(4.9%)had a history of operation. For group B, the PSA was 12.2(1.0-42.6)ng/ml, with 20 cases (33.3%) of <10 ng/ml, 31 cases(51.7%)of 10-20 ng/ml, and 9 cases (15%) of >20 ng/ml. Gleason score was 7.1(6.0-9.0), with 12 cases (20.0%) of ≤6, 42 cases (70.0%) of 7, and 6 cases (10.0%)of ≥8. Prostate volume was 42.4(31.2-72.8)ml on average. There were 37 cases (61.7%) with BMI≤25 kg/m 2, and 23 cases (38.3%)with BMI >25 kg/m 2 . There were 17 cases(28.3%)of T 1, 32 cases(53.3%)of T 2 and 11 cases(18.3%)of T 3.The proportion of lymph node dissection was 11.7% and 4 cases (6.7%) had a history of operation.There was no statistically significant difference in term of age, PSA level, Gleason score, BMI, clinical stage, proportion of lymph node dissection or history of operation between the two groups( P>0.05), but there was statistically significant difference for prostate volume( P<0.05). All operations were performed by the same operator. Four different ways of bladder neck and urethral dissociation was selected according to the intraoperative conditions in Group A, include VIP style, T-shape incision style, VIP plus T-shape incision style or the style along the lateral side of the bladder neck. Small and single anterograde incision stripping of bladder neck was routinely performed in the Group B. Postoperative follow-up was performed to compare the operation time, intraoperative blood loss, bladder neck and urethral anastomosis time, postoperative hospital stay, postoperative exhaust time, postoperative complications, positive rate of surgical margin, indwelling time of urinary catheter, urinary continence satisfaction rate of immediately after operation, 3 months and 6 months after operation, wound healing and aesthetics. Results:All of the operations were successfully completed under robot-assisted laparoscopy, and there was no conversion to open surgery. The operation time was 56.0(45.0-112.0) min in the Group A and 65.4(55.5-96.8) min in the Group B, and there was no statistically significant difference( P>0.05). The intraoperative blood loss was 76.2(30.0-120.5) ml and 55.6(45.5-114.6) ml, respectively, and the difference was not statistically significant( P>0.05). The time of bladder neck urethral anastomosis was 18.9(12.6-25.6) min and 16.2(10.7-19.3) min, respectively, and the difference was not statistically significant( P>0.05). The postoperative hospital stay days were 9.3(8.0-16.0) d and 8.4(7.0-13.0) d, respectively, and the difference was not statistically significant( P>0.05). The postoperative exhaust time was 1.3(0.7-3.0) d and 3.4(2.0-7.0) d, respectively, and the difference was statistically significant( P<0.05). There was 1 case of anastomotic fistula with ureteral injury in Group A, and no serious complication in Group B, and the difference was not statistically significant( P>0.05). The number of positive surgical margin in the two groups was 13(15.9%)and 9(15.0%)respectively, and the difference was not statistically significant( P>0.05). The indwelling time of urinary catheter after operation was 9(7-21) d and 6(4-8) d, respectively, and the difference was statistically significant( P<0.05). The number of patients with satisfactory urinary continence immediately after surgery, 3 months and 6 months after surgery in the two groups were 8(9.8%), 51(62.2%), 62(75.6%) and 17(28.3%), 43(71.7%) and 54(90.0%), respectively. The differences were statistically significant( P<0.05). The total incision lengths in the two groups were 12.1(10.4-13.4) cm and 5.6(5.0-6.0) cm, respectively, and the difference was statistically significant( P<0.05). Conclusions:The extraperitoneal single port RARP is safe and feasible, and the postoperative effect is similar to that of transperitoneal RARP. It has the advantages of shorter recovery time, higher urinary continence satisfaction rate, neater and more beautiful incision. The long-term therapeutic effect needs further confirming by prospective study.

Objective:To evaluate the feasibility and clinical efficiency of robot-assisted laparoscopic radical prostatectomy (RARP) via extraperitoneal PORT-free single incision approach.Methods:The data of 33 patients with prostate cancer underwent the extraperitoneal PORT-free single incision RARP from November 2020 to January 2021 in Sichuan Provincial People's Hospital was retrospectively reviewed. The average age was 66.7 (58-78) years, the median PSA was 20.77 (2.89, 56.44) ng/m, and the mean Gleason score was 7.0 (6.0-9.0). The mean prostate volume was 48.4 (25.0-220.0) ml. Clinical stage: 32 cases was in cT 2a-2cN 0M 0, 1 case in cT 3aN 0M 0. 16 cases had a history of operation. All 33 operations were performed by the same operator. All operations were performed by extraperitoneal PORT-free single-incision approach. The surgical condition, postoperative complication, pathology, and follow-up results were observed. Results:In this study, 33 operations were successfully completed without conversion to open or additional single hole channel instruments. The average operation time was 61.3 (38.0-120.0) min, with the mean intraoperative bleeding volume of 72.2 (45.0-220.0) ml and the mean bladder neck urethral anastomosis time of 11.7 (8.5-15.7) min. The mean postoperative hospital stay was 7.9 (6.0-15.0) d, the mean postoperative indwelling time of urinary catheter was 6.8 (6.0-14.0) d, and the mean postoperative evacuation time was 1.0 (0.5-3.0) d. The average incision length was 5.2 (4.6-5.8) cm. There was no obvious complications. The postoperative pathological stage: 21 cases were in < pT 3a, 12 cases were in ≥ pT 3a, and 6 cases (18.8%) had positive resection margin. 29 cases (88.9%) acquired satisfactory urinary continence after operation, and the frequency of urinary pad use was ≤ 1 tablet/day. Conclusions:The extraperitoneal single-incision RARP surgical channel without PORT is safe and feasible with a satisfying cosmetic effect, which saves costs and requires less specific channel device. Simultaneously, the new approach has strong replicability, short-term tumor control and urinary control effect with rapid postoperative recovery. However, the sample size of this study is relatively small, which needs further research and demonstration

Objective:To investigate the clinical effect of different bladder neck separation methods in robot-assisted laparoscopic radical prostatectomy (RARP).Methods:To retrospective analysis the data of robot-assisted laparoscopic radical prostatectomy (RARP)in our center from October, 2014 to October, 2018. All operations were performed by the same urologist. According to the different methods of bladder neck separationAccording to the different methods of bladder neck separation, all the patients were divided into four groups. Group A routine forward peeling method (500 cases): Make a 1cm incision at 12 o'clock on the front of the bladder neck, cut off the detrusor muscle and cut the bladder neck. Group B T-cut incision of the bladder neck (133 cases): identify the bladder and prostate Junction, T-shaped incision of the anterior wall of the bladder neck. Group C conventional stripping method combined with T-shaped incision of the bladder neck (81 cases). Group D lateral approach (36 cases): along the lateral side of the bladder neck and the medial posterior ligament of the prostate is separated and merges with the previously established Dirichlet space. The general data of patients were analyzed statistically.The average ages of groups A, B, C, and D were 63 years (62.5 to 67 years), 65 years (61 to 68 years), 66 years (64.5 to 70.5 years), and 62 years (59.5 to 66.5 years)respectively, there was no statistical significance difference in terms of age in 4 groups( P>0.05); PSA is 13 ng/ml(9.0 to 22 ng/ml), 7.4 ng/ml(6.4 to 26.0 ng/ml), 6.2 ng/ml(5.3 to 27.0 ng/ml), 14ng/ml(8.4 to 21.0 ng/ml), ( P>0.05); Gleason scores of puncture were 6.9(5 to 9), 7(6 to 12), 9(8 to 16), 10(6 to 18), ( P>0.05); the prostate volume was 66ml(42 to 78 ml), 70ml(50 to 89 ml), 53ml (43 to 72 ml), 80 ml (68 to 92 ml), ( P>0.05); the proportions of body mass index ≤25 kg/m 2 were 60.0%, 63.9%, 39.1%, 42.0%, and>25 kg/m 2 were 40%, 36.1%, 60.9%, and 58.0%, respectively, ( P>0.05). The operation time, bleeding volume, anastomosis time, postoperative hospital stay, postoperative complications, positive rate of proximal incision margin, urinary indwelling time, and urinary control rate in the four groups analyzed. Results:All 750 RARP operations were successful, and none were converted to open.The operation time of groups A, B, C, and D were 100 min(70 to 120 min), 89 min(70 to 95 min), 105 min(80 to 127 min), and 110 min(90 to 130 min), ( P>0.05); anastomosis time was 20.5 min (18.0 to 25.0 min)、16.1min (10.7 to 17.3 min)、25.4 min (18.9 to 27.0 min)、and 28.5 min (21.0 to 32.0 min), the anastomosis time in group B was significantly shorter than other groups ( P<0.05); the postoperative hospital stays were 9.3 days (8.0 to 13.0 days), 8.4 days (6.0 to 16.0 days), 10.8 days (8.0 to 16.0 days)and 7.8 days (7.0 to 14.0 days), ( P>0.05). Postoperative complications: Anastomotic fistula and ureteral injury occurred in 3 cases in group A, and no serious complications occurred in the other 3 groups. Proximal marginal positive rate: 40 cases (8.0%) in group A, 0 cases in group B, 6 cases (7.3%) in group C, 3 cases (8.3%) in group D, and low positive rate of margin incision in group B( P<0.05). The urinary indwelling time was 7 d (6 to 8 d), 6 d(4 to 8 d), 12 d(6 to 18 d), 10 d(6 to 13 d), ( P>0.05). Six-month postoperative urine control rate: 381 cases (75.2%) in group A, 102 cases (76.9%) in group B, 61 (75.4%) in group C, and 27 (73.8%) in group D, ( P>0.05). Conclusions:The above four method of bladder neck separation during robot-assisted laparoscopic radical prostatectomy is safe and feasible, which can effectively avoid ureteral damage. Each method can obtain better urine control within six months after surgery rate. The positive rate of proximal incision margin after T-shaped bladder neck was lowest among four groups.

Six patients with prostate cancer, treated by suprapubic extraperitoneal single-port robot-assisted radical prostatectomy, had been studied retrospectively from December 2019 to January 2020. All 6 patients have been treated by suprapubic peritoneum single port robot assisted laparoscopic surgery without other channels. The robot assisted laparoscopic radical prostatectomy via suprapubic peritoneum is safe and feasible when based on reasonable selection criteria of patients. It has been shown that the postoperative recovery was fast and the tumor control and continence rate were good under the short-term follow-up. However, the long-term outcome should be evaluated by a long-term follow-up.

ObjectiveTo investigate the expression and clinical significance of protein kinase CK2β in hepatocellular carcinoma (HCC) tissue and the association of CK2β expression with patient prognosis. MethodsHCC tissue and adjacent tissue samples were collected from 127 HCC patients Who were diagnosed in Department of Hepatopancreatobiliary Surgery, The first Affiliated Hospital of Zhengzhou University from Januany 2012 to June 2013, and immunohistochemistry was used to measure the expression of CK2β. The association of CK2β expression with clinical features of HCC patients was analyzed. A total of 20 HCC tissue samples, 20 adjacent tissue samples, 20 cirrhotic tissue samples, and 20 normal liver tissue samples were collected from March to June 2018 in our hospital, and Western blot and real-time PCR were used to measure the protein and mRNA expression of CK2β in these tissue samples. A one-way analysis of variance was used for comparison of means between multiple groups, and Bonferroni test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups. The Mann-Whitney U test or the Kruskal-Wallis H test was used to investigate the association of CK2β expression with clinical features. The Kaplan-Meier method was used for survival analysis, and the log-rank test was used for comparison between groups. ResultsWestern blot and real-time PCR showed that the expression rate of CK2β in HCC tissue was significantly higher than that in adjacent tissue, cirrhotic tissue, and normal liver tissue (P＜0.05); there was no significant difference in the expression of CK2β between adjacent tissue and cirrhotic tissue (P＞0.05), and the expression of CK2β in adjacent tissue and cirrhotic tissue was significantly higher than that in normal liver tissue (P＜0.05). Immunohistochemical staining showed that there was a significant difference in the positive rate of CK2β between HCC tissue and adjacent tissue in the 127 HCC patients (85.8% vs 63.0%, P＜0.001). There was a significant difference in CK2β expression distribution between HCC patients with different ages (Z=-2.277, P=0.023), presence or absence of liver cirrhosis (Z=-2.144, P=0.032), different tumor sizes (Z=-2.289, P=0.004), or different Edmondson-Steiner pathological grades (χ2=8.210, P=0.016). The Kaplan-Meier survival curve analysis showed that the strongly positive CK2β expression group had a significantly shorter postoperative survival time than the moderately positive, weakly positive, and negative CK2β expression groups (all P＜0.001). ConclusionCK2β may be involved in the development and progression of HCC, and its positive expression is associated with the prognosis of HCC patients.

Objective To compare efficacy of small incision cataract surgery whether combined with nucleus chopping or not in the treatment of cataract. Methods From March 2014 to September 2015,125 cases of age-related cataract(146 eyes) in the the First People′s Hospital of Xiantao were divided into 60 cases(75 eyes) of observation group and 65 cases(71 eyes) of control group by method of random sampling. The observation group accepted small incision cataract surgery combined with chopping nucleus. The control group only underwent small incision cataract surgery. The postoperative visual acuity,corneal astigmatism and operation time,and complications and so on in the two groups were compared. Results There was statistically significant difference in postoperative visual acuity after 1 week between the two groups(Z = -2. 078,P <0. 05),but there was no statistically significant difference in postoperative visual acuity after 1 month or 3 months between the two groups(Z= -0. 960,-0. 743,all P>0. 05). The postoperative corneal astigmatism after 1 week or 1 month between the observation group and the control group had statistically significant differences[(1. 33 ± 0. 45) D vs. (1. 52 ± 0. 49) D,(1. 03 ± 0. 42) D vs. (1. 18 ± 0. 44)D,t=2. 442,2. 108,all P<0. 05)],but there was no statistically significant difference in postoperative corneal astigmatism after 3 months between the two groups(t =0. 432,P >0. 05). There was no statistically significant difference in the operation time between the observation group and the control group[(11. 28 ± 2. 32) min vs. (11. 87 ± 2. 52)min,t=1. 473,P>0. 05]. One case of posterior capsular rupture occurred in the two groups,respec-tively. But serious complications such as lens nucleus escaped into vitreous cavity, explosive haemorrhage from the choroid or corneal endothelial decompensated had not been found. Conclusion The small incision cataract surgery combined with nucleus chopping has advantages in acquiring fast visual rehabilitation acuity in the early stage after operation,lower corneal astigmatism compared to that without nucleus chopping. Therefore,the small incision cataract surgery combined with nucleus chopping is worthy of clinical popularization and application.

Objective To explore the characteristics and influencing factors of methamphetamine dependence adolescents’ emotional faces recognition ability. Methods Eighty-six adolescents methamphet-amine addicts and 85 healthy volunteers were tested by a self-designed questionnaire and an experiment of e-motional faces identification. Results (1)There was no significant correlation between the emotional faces recognition ability of the experimental group with their age,education level and drug time (P>0. 05). (2)The correct number of positive(32. 58 ±8. 56),neutral (32. 76±8. 06),and negative(56. 28±20. 04) emotional faces recognition in the experimental group was significantly lower than that in the control group of positive (35. 64±3. 91),neutral(35. 47±4. 00),and negative(71. 02±8. 62) emotional faces recognition(t=-3. 00,-2. 79,-6. 24,P<0. 05). Meanwhile,the response time of positive(( 401. 32± 175. 13) ms) and negative ((502. 08±194. 42)ms) emotional faces recognition in the experimental group was significantly lower than that in the control group of positive((300. 83±139. 48)ms) and negative((379. 91±197. 30)ms) emotional faces (t=4. 15,4. 08,P<0. 05). Nevertheless,there was no significant difference between the experimental group((400. 90±174. 21) ms) and the control group ((356. 67±156. 70) ms) in the recognition response time of neutral emotional faces (t=1. 75,P>0. 05). Conclusion Methamphetamine dependence impairs the ability of adolescents’ emotional faces recognition,and their positive and negative emotional recognition abili-ty has processing defects. The ability of methamphetamine dependence adolescents to emotional faces recogni- tion is not affected by their age,education level and time of drug uses.

Objective To discuss CT,MRI features of fibrous hamartoma of infancy (FHI) compared with pathology.Methyls Cinical data,CT and MRI findings,as well as pathological results of 15 patients with FHI were retrospectively analyzed.Results Totally,there were 17 lesions of FHI in 15 cases,including 13 cases with single lesion and 2 cases with double lesions.The lesions manifesting as subcutaneous-,skin-and mixed-type on CT or MR images accounted for 58.82％ (10/17),17.65％ (3/17) and 23.53％ (4/17),respectively.The subcutaneous-and mixed-type lesions showed " cloud sign" (including "thin-cloud sign" and "thick-cloud sign").The thin-cloud sign lesions composed mainly of mature adipose tissue,while the triphasic composition ratio of adipose,fibrous and primitive mesenchymal cells were relatively consistent in the lesions with thick-cloud sign.The skin-type lesions showed "mountain-inverted sign",which composed mainly of immature mesenchymal component.Conclusion CT and MRI features of FHI are complex,yet have certain characteristics,which can preferably reflect the histopathological features of FHI.