With the development of precision diagnosis and treatment and minimally invasive concepts, the treatment strategies for gastric cancer have gradually diversified and refined, but for patients with advanced gastric cancer, radical surgical resection is still the key process in the treatment. With the promotion and application of laparoscopic technology, laparoscopic total gastrectomy has been widely carried out in tertiary hospitals across China. Therefore, only a detailed and complete set of surgical lymph node dissection strategies for gastric cancer can be developed to guarantee the quality of laparoscopic gastric cancer surgery in hospitals of all levels. Laparoscopic total gastrectomy requires multi-level and multi-space separation and dissection around the stomach, accurate naked dissection of perigastric blood vessels, and thorough dissection of perigastric lymph nodes, in order to ensure the radical operation. The dissection of perigastric lymph nodes is usually divided into five regions: subpyloric region, suprapancreatic region, suprapyloric region, splenic hilum region and cardiac region. In the process of cleaning each area, the tacit cooperation of the surgeon, the assistant and the mirror holder is required to ensure the smooth progress of laparoscopic total gastrectomy lymph node dissection.
Systematic treatment of breast cancer can reduce the risk of recurrence and prolong the survival，which has been widely recognized in clinical practice. Chemotherapy for breast cancer patients often contains corrosive drugs. According to the Health Industry Standard of China，corrosive drugs should not be infused through peripheral vein. In order to standardize the clinical application of chemotherapy infusion pathway，the Chinese Society of Breast Surgery（CSBrS）issued the Clinical Practice Guide for Central Venous Access for breast cancer，and recommended totally implantable venous access port as a safe infusion access for chemotherapy. Due to the safe operation precedure and low incidence of serious complications such as pneumothorax and hemothorax，implantable venous access port via basilic vein can be used as one of the options for chemotherapy infusion pathway.
To achieve efficient, rational, safe and standardized ultrasound contrast infusion, relevant medical, and nursing experts in China summarized the domestic and international literature and clinical experience evidence. After a thorough discussion under the principles of evidence-based medicine, the consensus was proposed, aiming to provide reference opinions for achieving standardization of safe ultrasound contrast infusion in China. The consensus introduces the current situation and safety of ultrasound contrast agent application, relevant regulations and procedures, standardized care before, during, and after imaging, and proposes 16 recommendations. It suggests that the current ultrasound contrast agents approved for market use in China have a high safety profile, and it recommends that healthcare professionals should dispense and administer them according to the latest instructions or expert consensus and that they should be standardized in terms of contrast room management, risk planning, and personnel qualifications.
It has been more than one year since the General Office of the National Health Commission issued the notice on strengthening the diagnosis, treatment and management of chronic refractory wounds (ulcers) on the body surface (Medical Letter [2019] No. 865, hereinafter referred to as the "notice" ), and the establishment of wound repair departments has set off a fever all over the country. Although the National Health Commission has principled requirements for the construction of the wound repair department in the "notice" , in practical practice, many colleagues do not know how to configure the wound repair department to meet the basic needs of the diagnosis and treatment of wound patients. Aiming at the needs of tertiary hospitals (general wound repair department, research-based wound repair department) and secondary hospitals to carry out wound repair diagnosis and treatment, the basic configuration of wound repair department was put forward for the reference of colleagues and medical institutions preparing to establish wound repair department in China.
【内容简介】 烧伤患者尤其是重度烧伤患者的护理中，体位护理、气道护理、静脉置管护理是极为重要的关键措施。
翻身床广泛应用于烧伤患者的治疗，尤其是大面积烧伤患者，已成为我国烧伤患者治疗中必不可少的治疗性仪器设备，对重度烧伤患者体位管理尤为重要。由铁/钢制材料制成，通过改变体位来满足烧伤患者体位引流、创面减压、方便换药、方便手术等诸多益处。熟练掌握烧伤翻身床技术，是每一位烧伤专科护士的核心技能，创面修复期每日翻身4~6次。翻身前，需要先与患者进行充分沟通，取得配合后，开始准备。翻身时，需要整理所有管道和监护设备导线，同时监测患者的生命体征、意识、气道通畅情况以及脉搏氧饱和度等。一般翻身时，尤其是特别危重的烧伤患者，在翻身床转动前一刻移除呼吸机，翻身到位后第一时间检查气道同时连接呼吸机，保留脉搏氧饱和度导联监测。翻身后，立即解除翻身床片，摆放体位，检查各个管道的在位情况，做好患者安抚工作。
烧伤患者，尤其是发生头面颈部或大面积烧伤时，早期预防性建立人工气道，做好人工气道的护理已成为烧伤专科护士重要的护理工作，也是患者救治成功的重要举措之一。烧伤休克期，因组织严重水肿造成窦道形成较晚，防止导管异位及脱管是早期烧伤患者气道维护的重中之重。套管绳的松紧度以1指为宜，必要时可于患者耳垂下方或颈后垫无菌敷料。如遇颈部烧伤创面时，采用衬带外套上柔软塑料管作为气管切开固定器具，以防止衬带被颈部烧伤创面的渗液浸渍、变硬，引起患者不适，甚至加重颈部烧伤创面。
烧伤这一特殊致伤因素，致使患者正常皮肤大面积缺失，表浅静脉严重受损，而休克期快速补液、回吸收期抗感染药物的应用及静脉高营养需求等，致使患者在治疗过程中通常更加依赖中心静脉置管，而经创面或近创面置管更是无法避免。因此，保持导管通畅、预防导管相关性血流感染的发生并制定适用于重度烧伤患者静脉通路的护理流程至关重要。经/近创面置管时多采用缝合固定，可采用吸附性较好的含银敷料包绕穿刺点及固定翼、无菌纱布垫于创面与穿刺导管之间，每4~8 h换药1次，若有污染随时更换；局部烤灯照射，保持干燥。应用10~20 mL 0.9%氯化钠溶液以脉冲式每8 h冲管1次(冲管前抽回血确认导管在位)，正压封管，双腔中心静脉导管采用2枚20 mL注射器由同一人冲、封管。输液接头每周更换1次，被渗血、渗液污染则随时更换。加强培训，严格无菌操作。
【视频简介】 当今世界下，国际细胞相关研究正如火如荼的开展，目前细胞研究方向除了细胞治疗、组织器官移植修复、基因治疗之外，还向着药物研发、毒性评估工具、发育生物学模型等领域转变。随着细胞基本原理和相关技术的成熟和更新，以及监管政策的不断转暖，各国已纷纷加快细胞的临床研究，并将其列入国家科技战略必争领域。
本视频介绍了如今国际细胞治疗产业发展的现状及面临的机遇与挑战，从A面来看：产业链条相对完善，投融资活动活跃，资本市场看好，不断有新产品获批上市；从B面来讲这种发展是一种非理性繁荣，在这背后更是面临"未被满足"的临床需求。基于国际发展的现状，刘沐芸博士对国内细胞治疗产业"未来该何去何从"提出了几点看法与建议，应当将产业发展的A、B面进行协调统一，通过数字化、自动化与智能化实现细胞产业发展的提质增效，提供终极解决方案。
近年来，二氧化碳激光辅助深层巩膜切除术(CLASS)已成为青光眼手术治疗方式之一。由于缺少操作规范，国内各级眼科医师的应用水平存在一定的差异。为此，专家团队结合国内现状及手术经验并参考国内外文献，从CLASS术式的原理、适应证和禁忌证、一般要求、术前准备、操作步骤及要点、术后随访及处理六个部分共同制定此专家共识，以供眼科医师在临床工作中参考使用。
痉挛性斜颈（ST）是较为常见的局灶性肌张力障碍，临床症状主要表现为头颈部运动障碍，严重影响患者生活质量及社交信心，患者往往对治疗该病具有极大的期望。自Keen（1891年）创建外科切断局部神经治疗ST以来，已形成了多种术式，而每种术式各有其自身的优缺点。近年来，中日友好医院在结合传统术式基础上，探索的改良Foerster-Dandy手术，通过个体化治疗，取得了良好的手术疗效。本文就改良Foerster-Dandy术治疗ST的研究进展进行论述，旨在为临床医生提供对ST的诊疗及手术方式的切实可行的建议。
Anterior cruciate ligament(ACL) reconstruction of the knee is associated with a certain risk of failure, and the failure rate is higher in high-risk patients. With the discovery and recognition of roles of anterolateral structure(ALS) in maintaining the rotation stability in normal knee, it is possible to augment or reconstruct ALS in combination with ACL reconstruction to reduce the failure rate in the patients with high-risk factors for ACL injuries. Therefore, on the basis of evidence-based medicine, the expert group summarized and discussed literature on the definition, preoperative evaluation, surgical indications, surgical techniques and strategies, principles in postoperative rehabilitation, and prevention and management of complications for the ALS of knee, and developed this consensus. The proposed consensus will provide physicians with a complete set of clinical routines and pathways for the diagnosis and managment in selecting ALS augmentation or reconstruction when performing ACL reconstruction in the patients with high risks of failure and revision surgeries.
This paper reviews the efforts and achievements of Chinese scientists in studying the pathogenesis, molecular mechanism, and early diagnosis and treatment of esophageal squamous cell carcinoma (ESCC) based on our work. It is suggested that: (1) ESCC is a typical multifactorial disease, and it is very important to protect the esophagus from various physical and chemical injuries to prevent the development of this malignancy; (2) based on a variety of omics studies, it is necessary to adopt a high-quality prospective population study design, integrate existing results to carry out systematic analysis, and explore potential intervention targets in depth; and (3) in the absence of high attributable risk factors, large-scale screening needs to be evaluated in randomized controlled studies to evaluate its effects and health economic value, and at the same time, existing screening models need to be further improved with regard to precision and individualization.
It is usually difficult to expose superior mesenteric vein (SMV)/portal vein by conventional approach in patients with chronic pancreatitis. Multiple superior mesenteric artery (SMA) approach combined with inferior colon approach can ensure the safety of LPD in this case. In this case, the posterior approach of SMA (1/3 of proximal SMA is easy to be exposed) was used to detect whether the root of SMA was invaded by tumor, and the radical operation or arterial resection and reconstruction was first judged. Then combined with the anterior approach of SMA (2/3 of distal SMA is easy to be exposed) to disconnect the feeding artery of uncinate process, meanwhile the sufficient operation space was exposed for the subsequent naked or resection and reconstruction of superior mesenteric vein. SMV can be traced anterogradely from the foot to the head through the subcolonic approach, which can avoid the injury of SMV caused by forcibly separating the severe adhesion area of the pancreatic neck.