目的 探讨中低位直肠癌经全系膜切除（TME）并双吻合器吻合术后吻合口的局部效果。方法 选取我院2004年3月至2008年6月期间收治的142例行TME并双吻合器吻合术的中低位直肠癌患者的临床资料进行回顾性分析。结果 所有病例手术操作均顺利，术中无死亡。术后无吻合口漏等严重并发症发生。吻合口狭窄发生率为6.3%（9/142）。术后24个月时局部复发率为7.6%（8/105）。结论 在中低位直肠癌治疗中只要合理选择病例、严格规范术中操作、术后积极观察处理，TME并双吻合器吻合术可以有效降低吻合口并发症的发生。
目的探讨因结肠癌侵犯所致十二指肠结肠瘘的诊疗方法。 方法收集笔者所在医院1990年1月至2011年12月22年间收治的7例结肠癌并发十二指肠结肠瘘患者的临床资料，对其手术处理方式及愈后情况进行分析。 结果7例均行手术治疗，其中6例肿瘤切除，术后临床症状及体征消失，存活8～39个月后死亡，平均存活时间15.3个月；另1例未能行肿瘤切除，术后37 d因营养不良及多脏器功能衰竭死亡。 结论十二指肠结肠瘘为结肠癌晚期并发症，手术根治效果差，术后生存时间由原发肿瘤特性决定；合理选择手术方式可以有效缓解患者痛苦，提高其生存质量并延长生存期。
Objective To observe the effects of vascular endothelial growth factor antisense oligonucleotide (VEGF-ASODN) on expression of vascular endothelial growth factor (VEGF) and growth in gastric cancer cells. Methods The VEGF-ASODN was synthesized artificially with phosphorothioic acid. After transfecting with VEGF-ASODN in gastric cancer cells SGC-7901, the initial copy number of mRNA was detected by real-time RT-PCR, and the quantity of VEGF protein in both cell and supernatant were detected by ELISA. The levels of expression of survivin protein in cells were measured by Western blot. FCM and MTT method were used to detect cellular apoptosis and the activity of cells, respectively. The effect of transfection on the growth of cells was evaluated by growth curve. Results The copy number of VEGR mRNA, protein levels of VEGF in the cells and in culture fluid all decreased when the concentration of transfected VEGF-ASODN increased, as well as the levels of survivin protein （P＜0.05）. The ratio of apoptosis increased, the activity of cells also decreased as the concentration of transfected VEGF-ASODN increased （P＜0.05）. Conclusion Transfection with VEGF-ASODN in gastric cancer cells SGC-7901 can inhibit the expressions of VEGF and survivin remarkably. It can enhance cellular apoptosis and suppress growth of cells.
ObjectiveTo systematically review the methodological quality of guidelines concerning attention-deficit/hyperactivity disorder (ADHD) in children and adolescents, and to compare differences and similarities of the drugs recommended, in order to provide guidance for clinical practice. MethodsGuidelines concerning ADHD were electronically retrieved in PubMed, EMbase, VIP, WanFang Data, CNKI, NGC (National Guideline Clearinghouse), GIN (Guidelines International Network), NICE (National Institute for Health and Clinical Excellence) from inception to December 2013. The methodological quality of included guidelines were evaluated according to the AGREE Ⅱ instrument, and the differences between recommendations were compared. ResultsA total of 9 guidelines concerning ADHD in children and adolescents were included, with development time ranging from 2004 to 2012. Among 9 guidelines, 4 were made by the USA, 3 in Europe and 2 by UK. The levels of recommendations were Level A for 2 guidelines, and Level B for 7 guidelines. The scores of guidelines according to the domains of AGREE Ⅱ decreased from "clarity of presentations", "scope and purpose", "participants", "applicability", "rigour of development" and "editorial independence". Three evidence-based guidelines scored the top three in the domain of "rigour of development". There were slightly differences in the recommendations of different guidelines. ConclusionThe overall methodological quality of ADHD guidelines is suboptimal in different countries or regions. The 6 domains involving 23 items in AGREE Ⅱ vary with scores, while the scores of evidence-base guidelines are higher than those of non-evidence-based guidelines. The guidelines on ADHD in children and adolescents should be improved in "rigour of development" and "applicability" in future. Conflicts of interest should be addressed. And the guidelines are recommended to be developed on the basis of methods of evidence-based medicine, and best evidence is recommended.
ObjectiveTo evaluate the relationship between OPRM1 gene rs1799971 polymorphism and opioid analgesics requirement after surgery in Asians. MethodsWe electronically searched databases including CNKI, CBM, VIP, WanFang Data, EMbase and MEDLINE to collect studies about the correlation between OPRM1 gene rs1799971 polymorphism and opioid analgesics requirement after surgery in Asia. The retrieval time was from the establishment to March 1st, 2015. Two reviewers independently screened literature, extracted data and assessed the risk bias of including studies, and then meta-analysis was performed by using RevMan 5.2 software. ResultsA total of 10 case-control studies involving 1 612 patients were included. The results of meta-analysis showed that the requirement of opioid analgesics after surgery for GG genotype carriers was more than AG carriers (SMD=-0.44, 95%CI -0.61 to -0.28, P<0.000 01), AA genotype carriers (SMD=-0.55, 95%CI -0.71 to -0.38, P<0.000 01), and AA+AG genotype carriers (SMD=-0.50, 95%CI -0.66 to -0.35, P<0.000 01). ConclusionThe current evidence showed that the requirement of opioid analgesics after surgery for GG genotype of rs1799971 polymorphism in OPRM1 gene is higher in Asians. Due to the limited quality and quantity of included studies, the above results are needed to be further validated by more studies.
Objective To study the clinical and angiographic features in ST Segment Elevation Myocardial Infarction (STEMI) patients with spontaneous reperfusion. Methods A total of 519 patients with STEMI underwent Primary percutaneous coronary intervention (PCI) from January 2006 to December 2009 in Anzhen Hospital were enrolled. All patients were divided into the spontaneous reperfusion group (TIMI flow gradeⅢ ) and the non-spontaneous reperfusion group (TIMI flow grade 0-Ⅱ ) according to the TIMI flow grade before primary PCI. The incidence rate of spontaneous reperfusion through coronary angiography before primary PCI was observed, and the clinical relevant factors and angiographic lesion features of spontaneous reperfusion were analyzed. Results There were significant differences in age, CTnI peak value, high thrombus burden, and lesion location in distant LAD (P=0.000, 0.000, 0.002, 0.000, and 0.003, respectively) between the two groups. But there were no significant differences in gender, hypertension, diabetes mellitus, smoking history, hyperlipemia, angina pectoris history, culprit vessel distribution, lesion distribution in LCX and RCA, and collateral circulation between the two groups (Pgt;0.05 for all). Conclusion Compared to the patients without spontaneous reperfusion, patients with spontaneous reperfusion are younger in age, lower in CTnI peak value, and heavier in thrombosis burden, with culprit lesions mostly located in the distant LAD.
ObjectiveTo investigate the effects of intravitreous injection of conbercept for macular edema secondary to retina1vein occlusion(RVO) during 6 months period. MethodsA retrospective clinical study. 34 patients (34 eyes) were included in this study,who were diagnosed with macular edema due to retinal vein occlusion by ophthalmologic examination, fundus photography, optical coherence tomography (OCT), fundus fluorescein angiography and other methods. The best corrected visual acuity (BCVA) was examined using the international standard visual acuity chart, and the results were converted to the logMAR visual acuity. The average logMAR BCVA was 0.90±0.68, and the mean macular central retinal thickness (CMT) was (672.27±227.51) μm before treatment. All subjects received intravitreal injection of 0.5 mg conbercept (0.05 ml) at the first visit. Injections were repeated based on the visual acuity changes and the OCT findings. 34 eyes received 69 times of injection, the average number of injections was 2.03±1.03. BCVA, OCT were examined before and after treatment using the same method. BCVA and CMT changes, drugs and treatments associated cardiac and cerebral vascular accident, intraocular pressure elevation, retinal tears, retinal detachment, endophthalmitis and other complications after treatment were observed. Linear correlation analysis was used to analyze the correlation between prognosis BCVA and baseline BCVA, correlation between prognosis BCVA and baseline CMT, and also correlation between BCVA and CMT at different time points before and after treatment. ResultsAt 1 week and 1, 2,3, 6 months after treatment, the average logMAR BCVA was 0.65±0.61, 0.56±0.61, 0.46±0.55, 0.56±0.71, 0.44±0.48 respectively. During 1, 2, 3, 6 months after treatment, the mean logMAR BCVA were improved with statistically significant difference (Z=34.029, 47.294, 41.338, 43.603;P < 0.05), while 1 week after treatment showed no obvious improvement (Z=21.941,P > 0.05). At 1 week and 1, 2, 3, 6 months after treatment, the average CMT was (285.89±96.69), (256.65±143.39), (278.68±156.92), (290.11±188.17), (217.15±48.04) μm respectively. At 1 week and 1,2,3,6 months after treatment, the mean CMT were all decreased with statistically significant difference (Z=68.500, 98.735, 93.235, 91.132, 109.162; P < 0.05). There was a positive correlation between the prognosis visual acuity and preoperative visual acuity (r=0.682,P < 0.05). However,there was no correlation between the prognosis vision and the degree of macular edema before treatment (r=0.078,P > 0.05). Before and 3, 6 months after treatment, BCVA was negatively correlated with CMT (r=0.491, 0.416, 0.386; P < 0.05), while there was no correlation in other time points (r=0.145, 0.217, 0.177; P > 0.05). Systemic adverse reactions and persistent intraocular pressure elevation, iatrogenic cataract, retinal detachment, retinal tear, endophthalmitis and ocular complications were never found in the follow-up period. ConclusionIntravitreal conbercept is a safe and effective approach for RVO,which can significantly improve visual acuity and reduce CMT.
In recent years, the pollution problem of particulate matter, especially PM2.5, is becoming more and more serious, which has attracted many people’s attention from all over the world. In this paper, a Kalman prediction model combined with cubic spline interpolation is proposed, which is applied to predict the concentration of PM2.5 in the micro-regional environment of campus, and to realize interpolation simulation diagram of concentration of PM2.5 and simulate the spatial distribution of PM2.5. The experiment data are based on the environmental information monitoring system which has been set up by our laboratory. And the predicted and actual values of PM2.5 concentration data have been checked by the way of Wilcoxon signed-rank test. We find that the value of bilateral progressive significance probability was 0.527, which is much greater than the significant level α = 0.05. The mean absolute error (MEA) of Kalman prediction model was 1.8 μg/m3, the average relative error (MER) was 6%, and the correlation coefficient R was 0.87. Thus, the Kalman prediction model has a better effect on the prediction of concentration of PM2.5 than those of the back propagation (BP) prediction and support vector machine (SVM) prediction. In addition, with the combination of Kalman prediction model and the spline interpolation method, the spatial distribution and local pollution characteristics of PM2.5 can be simulated.
Cranial defects may result from clinical brain tumor surgery or accidental trauma. The defect skulls require hand-designed skull implants to repair. The edge of the skull implant needs to be accurately matched to the boundary of the skull wound with various defects. For the manual design of cranial implants, it is time-consuming and technically demanding, and the accuracy is low. Therefore, an informer residual attention U-Net (IRA-Unet) for the automatic design of three-dimensional (3D) skull implants was proposed in this paper. Informer was applied from the field of natural language processing to the field of computer vision for attention extraction. Informer attention can extract attention and make the model focus more on the location of the skull defect. Informer attention can also reduce the computation and parameter count from N2 to log(N). Furthermore,the informer residual attention is constructed. The informer attention and the residual are combined and placed in the position of the model close to the output layer. Thus, the model can select and synthesize the global receptive field and local information to improve the model accuracy and speed up the model convergence. In this paper, the open data set of the AutoImplant 2020 was used for training and testing, and the effects of direct and indirect acquisition of skull implants on the results were compared and analyzed in the experimental part. The experimental results show that the performance of the model is robust on the test set of 110 cases fromAutoImplant 2020. The Dice coefficient and Hausdorff distance are 0.940 4 and 3.686 6, respectively. The proposed model reduces the resources required to run the model while maintaining the accuracy of the cranial implant shape, and effectively assists the surgeon in automating the design of efficient cranial repair, thereby improving the quality of the patient’s postoperative recovery.