Objective:To study the effect of diazocine combined with sufentanil analgesia after radical operation for esophageal cancer on release of neurotransmitters and stress mediators.Methods:A total of 170 cases of patients...Objective:To study the effect of diazocine combined with sufentanil analgesia after radical operation for esophageal cancer on release of neurotransmitters and stress mediators.Methods:A total of 170 cases of patients with primary esophageal cancer who underwent surgical treatment in this hospital between September 2015 and May 2017 were divided into control group (n=85) and study group (n=85) by random number table method. Control group received postoperative sufentanil analgesia, and study group received postoperative diazocine combined with sufentanil analgesia. The differences in the perioperative contents of monoamine neurotransmitters, amino acid neurotransmitters and stress mediators were compared between the two groups.Results: Before operation, there was no statistically significant difference in the serum contents of monoamine neurotransmitters, amino acid neurotransmitters and stress mediators between the two groups. 12 h after surgery, 24 h after surgery and 36 h after surgery, serum monoamine neurotransmitters DA, NE and 5-HT contents of study group were lower than those of control group;amino acid neurotransmitters Ach, GABA and Glu contents were higher than those of control group;serum stress mediators ACTH, ALD and Cor contents were lower than those of control group.Conclusion: diazocine combined with sufentanil analgesia after radical operation for esophageal cancer can effectively optimize the secretion of neurotransmitters and inhibit the synthesis of stress mediators to alleviate the patients' pain perception.展开更多
BACKGROUND Combined hepatocellular-cholangiocarcinoma(cHCC-CCA)is a form of rare primary liver cancer that combines intrahepatic cholangiocarcinoma(ICC)and hepatocellular carcinoma.AIM To investigate overall survival(...BACKGROUND Combined hepatocellular-cholangiocarcinoma(cHCC-CCA)is a form of rare primary liver cancer that combines intrahepatic cholangiocarcinoma(ICC)and hepatocellular carcinoma.AIM To investigate overall survival(OS)and recurrence-free survival(RFS)after radical resection in patients with cHCC-CCA,and the clinicopathological factors affecting prognosis in two center hospitals of China.METHODS We reviewed consecutive patients with cHCC-CCA who received radical resection between January 2005 and September 2021 at Peking Union Medical College and the 5th Medical Center of the PLA General Hospital retrospectively.Regular follow-up and clinicopathological characteristics were systematic collected for baseline and prognostic analysis.RESULTS Our study included 95 patients who received radical resection.The majority of these patients were male and 82.7%of these patients were infected with HBV.The mean tumor size was 4.5 cm,and approximately 40%of patients had more than one lesion.The median OS was 26.8(95%CI:18.5-43.0)mo,and the median RFS was 7.27(95%CI:5.83-10.3)mo.Independent predictors of OS were CA19-9≥37 U/mL(HR=8.68,P=0.002),Child-Pugh score>5(HR=5.52,P=0.027),tumor number>1(HR=30.85,P=0.002),tumor size and transarterial chemoembolization(TACE)after surgery(HR=0.2,P=0.005).CONCLUSION The overall postoperative survival of cHCC-CCA patients is poor,and most patients experience relapse within a short period of time after surgery.Preoperative tumor biomarker(CA19-9,alphafetoprotein)levels,tumor size,and Child-Pugh score can significantly affect OS.Adjuvant TACE after surgery prolongs RFS,suggesting that TACE is a possible option for postoperative adjuvant therapy in patients with cHCC-CCA.展开更多
AIM: To evaluate the significance of extended radical operation and its indications.METHODS: Between January 1995 and December 1998, 56inpatients with pancreatic head cancer received operation.Among them 35 patients (...AIM: To evaluate the significance of extended radical operation and its indications.METHODS: Between January 1995 and December 1998, 56inpatients with pancreatic head cancer received operation.Among them 35 patients (group 1) experienced the Whipple operation, and 21 patients (group 2) received the extended radical operation. The 1-, 2-, 3-year cumulative survival rates were used to evaluate the efficacy of the two operative procedures. Clinical stage (CS) was assessed retrospectively with the help of CT. The indications for extended radical operation were discussed.RESULTS: There was no difference in hospital mortality and morbidity rates. Whereas the 1-, 2-, 3-year cumulative survival rates were 84.8%, 62.8%, 39.9% in the extended radical operation group, and were 70.8%, 47.6%, 17.2%in the Whipple operation group, there was a significant difference between the two groups (P<0.001, P<0.001,P<0.001, respectively). Most of the deaths within 3 years after operation were due to recurrence in the two groups.However, the 1-, 2-, 3-year cumulative rates of death due to local recurrence were decreased from 37.4% in patients that received the Whipple procedure to 23.8% in those who received by extended radical operation. Patients who survived for more than 3 years were only noted in those with CS1 in the Whipple procedure group and were founded in cases with CS1, CS2 and part of CS3 in the extended radical operation group.CONCLUSION: The extended radical operation appears to benefit patients with pancreatic head carcinoma which was indicated in CS1, CS2 and part of CS3 without severe invasion.展开更多
This study proposes a combined hybrid energy storage system(HESS) and transmission grid(TG) model, and a corresponding time series operation simulation(TSOS) model is established to relieve the peak-shaving pressure o...This study proposes a combined hybrid energy storage system(HESS) and transmission grid(TG) model, and a corresponding time series operation simulation(TSOS) model is established to relieve the peak-shaving pressure of power systems under the integration of renewable energy. First, a linear model for the optimal operation of the HESS is established, which considers the different power-efficiency characteristics of the pumped storage system, electrochemical storage system, and a new type of liquid compressed air energy storage. Second, a TSOS simulation model for peak shaving is built to maximize the power entering the grid from the wind farms and HESS. Based on the proposed model, this study considers the transmission capacity of a TG. By adding the power-flow constraints of the TG, a TSOS-based HESS and TG combination model for peak shaving is established. Finally, the improved IEEE-39 and IEEE-118 bus systems were considered as examples to verify the effectiveness and feasibility of the proposed model.展开更多
Objective:To discuss the efficacy of Bispectral index (BIS)-monitored closed-loop targeted-controlled infusion of propofol for laparoscopic radical operation for gastric cancer.Methods:A total of 106 patients with pri...Objective:To discuss the efficacy of Bispectral index (BIS)-monitored closed-loop targeted-controlled infusion of propofol for laparoscopic radical operation for gastric cancer.Methods:A total of 106 patients with primary gastric cancer who underwent laparoscopic radical operation for gastric cancer in our hospital between August 2015 and February 2018 were chosen as the research subjects and divided into the control group (n=53) and the observation group (n=53) according to the different anesthesia methods. Control group of patients received BIS-monitored manually adjusted targeted-controlled infusion concentration of propofol, and observation group of patients received BIS-monitored closed-loop targeted-controlled infusion of propofol. The differences in hemodynamic index levels as well as serum contents of inflammatory factors and stress hormones were compared between the two groups of patients before anesthesia (T0), 30 min after surgery started (T1) and 30 min before surgery ended (T2).Results:At T0, the differences in hemodynamic index levels as well as serum contents of inflammatory factors and stress hormones were not statistically significant between the two groups. At T1 and T2, hemodynamic indexes MAP and HR levels of observation group were lower than those of control group at the corresponding time points;serum inflammatory factors sICAM-1, IL-1β, IL-8 and TNF-α contents were lower than those of control group at the corresponding time points;serum stress hormones Cor, T4 and glucagon contents were lower than those of control group at the corresponding time points.Conclusion: BIS-monitored closed-loop targeted-controlled infusion of propofol can effectively stabilize the intraoperative hemodynamics and inhibit the systemic inflammatory stress response in patients with laparoscopic radical operation for gastric cancer.展开更多
Objective: To investigate the effect of epidural block combined with intravenous anesthesia on stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy. Methods: In our hos...Objective: To investigate the effect of epidural block combined with intravenous anesthesia on stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy. Methods: In our hospital from July 2016 to June 2017 undergoing radical mastectomy for breast cancer of 88 patients were randomly divided into observation group and control group of 44 cases, 2 patients underwent routine preoperative preparation, and routine blood pressure, heart rate, pulse, oxygen saturation, ECG monitoring, control group with intravenous anesthesia. The observation group was treated with epidural block combined with intravenous anesthesia. 2 groups of patients before anesthesia, 30 MIM (T0), 1 h after skin incision (T1), 4 h after operation (T2), 24 h after operation (T3), 48 h after operation (T4) from peripheral venous blood were measured by interleukin-8 (IL-8) and interferon gamma (IFN-γ), cortisol (Cor), prolactin (PRL), growth hormone (GH) and T lymphocyte subsets (CD3+, CD4+, CD8+), the calculation of CD4+/CD8+ value. Results: the serum IL-8 level of T1, T2, T3and T4 decreased gradually, were lower than at T0, and the control group at each time point had no significant difference, T1, T2, T3group, T4IL-8 levels lower than the control group;the 2 groups of serum IFN-γ levels T1 and T2had no significant change, T3and T4increased gradually, was higher than that of T0, but no significant difference between the 2 groups of IFN-γ levels. 2 serum Cor levels peaked at T1, decreased at T2, was higher than that of T0, T3, T4returned to T0, the observation group T1, T2Cor level lower than the control group;the serum PRL levels of 2 groups reached a peak at T1, T2, T3at the time of T4decreased gradually, was higher than that of T0, T1, T2, T3of the observation group at the PRL level is lower than the control group;the serum level of GH 2 in group T1increased gradually, reached a peak at T2, T3and T4 decreased gradually, was higher than that of T0, the observation group T1, T2, T3, T4, GH levels lower than the control group. 2 groups of CD3+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD3+ was higher than the control group;group CD4+ decreased gradually in T1, T2, T3and T4were lower than control, T0when, and the observation group CD4+ in T1, T2, T3, T4, no significant changes were observed in group T1, T2, T3, T4and CD4+ higher than that of the control group;the 2 group CD8+ had no obvious changes in T1, T2, T3, T4;observation group CD4+/CD8+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD4+/CD8+ was higher than the control group. Conclusion: epidural block combined with intravenous anesthesia for breast cancer radical mastectomy can effectively relieve the stress and inflammatory reaction, alleviate the immunosuppression, and help to restore the postoperative immune function.展开更多
Objective: The aim of this study was to explore clinical value of thoracic small incision in radical operation for lung and esophageal cancer in assuring same treatment effects with conventional incision. Methods: Col...Objective: The aim of this study was to explore clinical value of thoracic small incision in radical operation for lung and esophageal cancer in assuring same treatment effects with conventional incision. Methods: Collected data of patients was given radical operation for lung and esophageal cancer in our department from January 1, 2006 to January 1, 2007, and performed retrospective analysis, among them, small incision group (improved group) was 143 cases, and conventional group was 167 cases including 6 cases which was changed from small incision to conventional incision in operation. Compared operation time, incision length, intraoperative blood loss, postoperative drainage flow, number of lymph node dissected, recovery time of postoperative upper limb function, postoperative pain, postoperative complications etc. between both groups. Results: Compared with conventional group, intraoperative blood loss, postoperative drainage flow, postoperative pain, recovery time of postoperative upper limb function in improved group was improved significantly, and there was no obvious difference in operation time and number of lymph node dissected between both groups. Conclusion: Small incision in radical operation for lung and esophageal cancer is small trauma, and quick recovery after operation, treatment effects of it is basically similar to that of conventional operation method, however, its application is limited in few cases.展开更多
Neuroendocrine tumors (NETs) are often misdiagnosed because they can involve any part of the body and have non-specific symptoms. Here, we report a case of a 39-year-old man with rectal neuroendocrine tumor (RNET) and...Neuroendocrine tumors (NETs) are often misdiagnosed because they can involve any part of the body and have non-specific symptoms. Here, we report a case of a 39-year-old man with rectal neuroendocrine tumor (RNET) and hepatic metastases treated with a combination of radical surgery and Everolimus therapy. The patient complained of abdominal distension, pain, and constipation of one month duration. Enhanced CT scan of the abdomen, colonoscopy and Biopsy findings confirmed the diagnosis of rectal neuroendocrine tumor. As the anatomical structures were clear and the masses seemed to be resectable, we decided to initiate treatment with radical operation and Everolimus therapy. The patient has responded well to the treatment with no evidence of recurrence after 4 years of follow-up. This case is interesting because of the rarity of this neoplasm and its initial misdiagnosis as a giant hepatic carcinoma (hepatoma). It also demonstrates that a combination of curative surgical resection and Everolimus is a good option in a patient with large colorectal neuroendocrine tumors and massive hepatic metastases.展开更多
Objective:To investigate the effect of arterial interventional chemotherapy before radical operation for gastric cancer on serum tumor markers and cell growth in the lesion.Methods:90 patients with primary gastric can...Objective:To investigate the effect of arterial interventional chemotherapy before radical operation for gastric cancer on serum tumor markers and cell growth in the lesion.Methods:90 patients with primary gastric cancer who underwent radical operation for gastric cancer in our hospital were chosen as the research subjects and divided into the control group (n=48) (did not receive preoperative arterial interventional chemotherapy) and the arterial interventional chemotherapy group (n=42) (received preoperative arterial interventional chemotherapy). The differences in tumor markers in serum as well as proliferation and apoptosis gene expression in gastric cancer tissues were compared.Results: Before surgery started, serum CA199, CA153, CA724 and AFP levels of arterial interventional chemotherapy group were significantly lower than those immediately after admission whereas serum CA199, CA153, CA724 and AFP levels of control group were not significantly different from those immediately after admission. After surgery, proliferation genes CUL4A and NTSR1 mRNA expression in gastric cancer tissues of arterial interventional chemotherapy group were lower than those of control group whereas DADS and FAM96B mRNA expression were higher than those of control group;apoptosis genes Livin and Bcl-2 mRNA expression were lower than those of control group whereas p53, p21 and Bax mRNA expression were higher than those of control group.Conclusion:Preoperative arterial interventional chemotherapy combined with radical operation for gastric cancer can more effectively inhibit the malignant degree of tumor and delay the growth of cancer cells.展开更多
Objective:To investigate the effects of different chemotherapy regimens before radical operation for lung cancer on cancer cell growth and antitumor immune response.Methods: A total of 180 patients with primary lung c...Objective:To investigate the effects of different chemotherapy regimens before radical operation for lung cancer on cancer cell growth and antitumor immune response.Methods: A total of 180 patients with primary lung cancer who underwent surgery in this hospital between February 2013 and August 2017 were divided into the cisplatin group (n=93) who received cisplatin & paclitaxel chemotherapy and the lobaplatin group (n=87) who received lobaplatin & paclitaxel chemotherapy according to different preoperative neoadjuvant chemotherapy regimens. The differences among the expression of proliferation genes and apoptosis genes in tumor tissues as well as the contents of Th1/Th2 cytokines in serum were compared between the two groups.Results: Proliferation genes DDX17, GPx1, MACC1, RACK1 and SIRT1 mRNA expression levels in tumor tissue of lobaplatin group were lower than those of cisplatin group whereas LRRC3B mRNA expression level was higher than that of cisplatin group;apoptosis gene Fas, FasL and Caspase-3 mRNA expression levels were higher than those of cisplatin group whereas Survivin and Bcl-2 mRNA expression levels were lower than those of cisplatin group;serum Th1 cytokines IFN-γ and IL-12 contents were higher than those of cisplatin group whereas Th2 cytokines IL-5 and IL-10 contents were lower than those of cisplatin group.Conclusion: Lobaplatin chemotherapy before radical operation for lung cancer is more effective than cisplatin chemotherapy to inhibit the proliferation activity and enhance the apoptosis activity of lung cancer cells and optimize the anti-tumor immune response.展开更多
Objective:Radical cystectomy is a complex lengthy procedure associated with postoperative morbidity.We aimed to assess the operative time(OT)in patients undergoing radical cystectomy and its impact on 90-day postopera...Objective:Radical cystectomy is a complex lengthy procedure associated with postoperative morbidity.We aimed to assess the operative time(OT)in patients undergoing radical cystectomy and its impact on 90-day postoperative complications and readmission rates.Methods:The retrospective cohort study included 296 patients undergoing radical cystectomy and urinary diversion from May 2010 to December 2018 in our institution.The OT of 369 min was set as a cutoff value between short and long OT groups.The primary outcome was 90-day postoperative complication rates.Secondary outcomes were gastrointestinal recovery time,length of hospital stay,and 90-day readmission rates.Results:The overall incidence of 90-day postoperative complications was 79.7%where 43.2%representing low-grade complications according to the ClavieneDindo classification(Grade 1 and Grade 2),and 36.5%representing high-grade complications(Grade3).Gastrointestinal tract and infectious complications are the most common complications in our data set(45.9%and 45.6%,respectively).On multivariable analysis,prolonged OT was significantly associated with odds of high-grade complications(odds ratio 2.340,95%confidence interval 1.288e4.250,p=0.005).After propensity score-matched analysis,a higher incidence of major complications was identified in the long OT group 55(51.4%)compared to 35(32.7%)in the short OT group(p=0.006).A shorter gastrointestinal tract recovery time was noticed in the short OT group(p=0.009).Prolonged OT was associated with a higher 90-day readmission rate on univariate and multivariate analyses(p<0.001,p=0.001,respectively).展开更多
Objective: To study the effect of the adaptive intermittent ventilation before radical operation for lung cancer under one-lung ventilation on non-ventilated lung tissue injury and apoptosis molecule protein expressio...Objective: To study the effect of the adaptive intermittent ventilation before radical operation for lung cancer under one-lung ventilation on non-ventilated lung tissue injury and apoptosis molecule protein expression. Methods: A total of 288 patients who received radical operation for lung cancer in the hospital between February 2015 and January 2017 were divided into control group and observation group by random number table method, each with 144 cases. Control group received routine one-lung ventilation, and observation group received preoperative adaptive intermittent ventilation of non-ventilated lung tissue. The differences in the levels of inflammatory factors and oxidative stress indexes in serum as well as the apoptosis molecule protein expression in affected-side normal lung tissue were compared between the two groups of patients immediately after intubation and at two-lung ventilation (T0) as well as 10 min before operation ended and at one-lung ventilation (T1). Results: At T0, the differences in the levels of inflammatory factors and oxidative stress indexes in serum as well as the apoptosis molecule protein expression in affected-side normal lung tissue were not significantly significant between the two groups of patients;at T1, IL-1β, IL-8, TNF-α, MPO and MDA levels in serum as well as Bax, caspase-2 and caspase-3 protein expression in normal lung tissue of observation group were lower than those of control group while SOD level in serum and Bcl-2 protein expression in normal lung tissue were higher than those of control group. Conclusion: Adaptive intermittent ventilation before radical operation for lung cancer under one-lung ventilation can effectively reduce the non-ventilated lung tissue injury and inhibit the apoptosis of normal lung cells.展开更多
Objective: To study the effects of enteral nutrition via jejunostomy catheter on immune response and intestinal mucosal barrier function after radical operation for esophageal cancer. Methods: A total of 90 patients w...Objective: To study the effects of enteral nutrition via jejunostomy catheter on immune response and intestinal mucosal barrier function after radical operation for esophageal cancer. Methods: A total of 90 patients who were diagnosed with esophageal cancer and received radical operation in Xishui People's Hospital between February 2015 and May 2017 were selected and randomly divided into the EN group who accepted enteral nutrition via jejunostomy catheter and the PN group who received parenteral nutrition. 1 week and 2 weeks after surgery, the expression of immune cell transcription factors in peripheral blood as well as the contents of intestinal mucosal injury markers and inflammatory stress markers in serum were measured. Results: 1 week and 2 weeks after surgery, T-bet expression intensity in peripheral blood of EN group was greatly higher than that of PN group while GATA3, RORγt and Foxp3 expression intensity in peripheral blood as well as DAO, Galectin-1, Galectin-3, Claudin, NE, E, Cor, CRP and CER levels were greatly lower than those of PN group. Conclusion: Enteral nutrition via jejunostomy catheter can improve the immune response and intestinal mucosal barrier function after radical operation for esophageal cancer.展开更多
The determination of source-side extracted heating parameters is of great significance to the economic operation of cogeneration systems.This paper investigated the coupling performance of a cogeneration heating and p...The determination of source-side extracted heating parameters is of great significance to the economic operation of cogeneration systems.This paper investigated the coupling performance of a cogeneration heating and power system multidimensionally based on the operating characteristics of the cogeneration units,the hydraulic and thermodynamic characteristics of the heating network,and the energy loads.Taking a steam network supported by a gas-steam combined cycle cogeneration system as the research case,the interaction effect among the source-side prime movers,the heating networks,and the terminal demand thermal parameters were investigated based on the designed values,the plant testing data,and the validated simulation.The operating maps of the gas-steam combined cycle cogeneration units were obtained using THERMOFLEX,and the minimum source-side steam parameters of the steam network were solved using an inverse solution procedure based on the hydro-thermodynamic coupling model.The cogeneration operating maps indicate that the available operating domain considerably narrows with the rise of the extraction steam pressure and flow rate.The heating network inverse solution demonstrates that the source-side steam pressure and temperature can be optimized from the originally designed 1.11 MPa and 238.8°C to 1.074 MPa and 191.15°C,respectively.Under the operating strategy with the minimum source-side heating parameters,the power peak regulation depth remarkably increases to 18.30%whereas the comprehensive thermal efficiency decreases.The operation under the minimum source-side heating steam parameters can be superior to the originally designed one in the economy at a higher price of the heating steam.At a fuel price of$0.38/kg and the power to fuel price of 0.18 kg/(kW·h),the critical price ratio of heating steam to fuel is 119.1 kg/t.The influence of the power-fuel price ratio on the economic deviation appears relatively weak.展开更多
BACKGROUND There are very few cases of cardiac occluder detachment,and it is rare to completely remove the occluder using interventional methods without undergoing thoracotomy surgery after detachment.This case innova...BACKGROUND There are very few cases of cardiac occluder detachment,and it is rare to completely remove the occluder using interventional methods without undergoing thoracotomy surgery after detachment.This case innovatively used ultrasound guidance combined with digital subtraction angiography(DSA)to completely remove the occluder,accumulating some experience.CASE SUMMARY The patient underwent left atrial appendage occlusion surgery in our hospital due to atrial fibrillation.After the surgery,the occluder fell off and became free in the left ventricle,which is very dangerous.We innovatively used ultrasound guidance,combined with DSA,and interventional surgery to successfully capture the free occluder using a catcher,completely remove it,and then re implant a new left atrial appendage occluder.After the surgery,the patient recovered very well.CONCLUSION The size selection of the occluder is slightly conservative,and the shape of the left atrial appendage opening is irregular.展开更多
Currently,the operational performance assessment system in the power market primarily focuses on power generation and electricity retail companies,lacking a system tailored to the operational characteristics of power ...Currently,the operational performance assessment system in the power market primarily focuses on power generation and electricity retail companies,lacking a system tailored to the operational characteristics of power generation/selling integrated companies.Therefore,this article proposes an assessment index system for assessing the operational performance of a power generation/selling integrated company,encompassing three dimensions:basic capacity,development potential,and external environment.A dynamic proportional adjustment coefficient is designed,along with a subjective and objective weighting model for assessment indexes based on a combined weightingmethod.Subsequently,the operational performance of an integrated company is assessed using extension theory.The results in the case study demonstrate the feasibility and effectiveness of the proposed dynamic proportional adjustment coefficient.展开更多
Objective: Potential of combined androgen blockade(CAB) has not been explored extensively in Chinese males with prostate cancer(PCa). Therefore, this study evaluated the 2-year prostate-specific antigen(PSA) recurrenc...Objective: Potential of combined androgen blockade(CAB) has not been explored extensively in Chinese males with prostate cancer(PCa). Therefore, this study evaluated the 2-year prostate-specific antigen(PSA) recurrence rate and quality of life(Qo L) in patients with high-risk localized and locally advanced PCa receiving adjuvant hormone therapy(HT) after radical prostatectomy(RP).Methods: This prospective, multicenter, observational study conducted in 18 centers across China enrolled patients with high-risk factor(preoperative PSA>20 ng/m L or Gleason score >7) or locally advanced PCa. Different adjuvant HT were administered after RP according to investigator’s decision in routine clinical practice.Relationship of baseline and postoperative characteristics was assessed with recurrence rate. PSA recurrence rate and Functional Assessment of Cancer Therapy-Prostate(FACT-P) Qo L scores were recorded at 12 months and 24 months. Kaplan-Meier analysis was used to construct the PSA recurrence rate during follow-up.Results: A total of 189 patients(mean age: 66.9±6.5 years) were recruited, among which 112(59.3%) patients showed serum PSA>20 ng/m L preoperatively. The highest postoperative pathological advancement noticed was from clinical T2(c T2) to pathological T3(p T3)(43.9%) stage. The majority of the patients(66.1%) received CAB as adjuvant HT, for a median duration of 20.0 months. The least recurrence(15.2%) was noticed in patients treated with CAB, followed by those treated with luteinizing hormone-releasing hormone agonist(LHRHa)(16.1%), and antiandrogen(19.0%), with non-significant difference noted among the groups. None of the baseline or postoperative characteristics was related with PSA recurrence in our study. The 24-month FACT-P Qo L score of119 patients treated for >12 months showed significant improvement above baseline compared with those treated for ≤12 months.Conclusions: Adjuvant CAB therapy after RP showed reduction trend in 2-year PSA recurrence rate in highrisk Chinese patients with localized and locally advanced PCa, compared with adjuvant anti-androgens(AA) or LHRHa therapy. Further long-term therapy(>12 months) significantly improved Qo L compared to short-term HT therapy, suggesting the beneficial effect of long-term CAB therapy in improving Qo L.展开更多
文摘Objective:To study the effect of diazocine combined with sufentanil analgesia after radical operation for esophageal cancer on release of neurotransmitters and stress mediators.Methods:A total of 170 cases of patients with primary esophageal cancer who underwent surgical treatment in this hospital between September 2015 and May 2017 were divided into control group (n=85) and study group (n=85) by random number table method. Control group received postoperative sufentanil analgesia, and study group received postoperative diazocine combined with sufentanil analgesia. The differences in the perioperative contents of monoamine neurotransmitters, amino acid neurotransmitters and stress mediators were compared between the two groups.Results: Before operation, there was no statistically significant difference in the serum contents of monoamine neurotransmitters, amino acid neurotransmitters and stress mediators between the two groups. 12 h after surgery, 24 h after surgery and 36 h after surgery, serum monoamine neurotransmitters DA, NE and 5-HT contents of study group were lower than those of control group;amino acid neurotransmitters Ach, GABA and Glu contents were higher than those of control group;serum stress mediators ACTH, ALD and Cor contents were lower than those of control group.Conclusion: diazocine combined with sufentanil analgesia after radical operation for esophageal cancer can effectively optimize the secretion of neurotransmitters and inhibit the synthesis of stress mediators to alleviate the patients' pain perception.
基金the CAMS Innovation Fund for Medical Sciences(CIFMS),No.2021-I2M-1-061 and No.2021-1-I2M-003CSCO-hengrui Cancer Research Fund,No.Y-HR2019-0239CSCO-MSD Cancer Research Fund,No.YMSDZD2021-0213.
文摘BACKGROUND Combined hepatocellular-cholangiocarcinoma(cHCC-CCA)is a form of rare primary liver cancer that combines intrahepatic cholangiocarcinoma(ICC)and hepatocellular carcinoma.AIM To investigate overall survival(OS)and recurrence-free survival(RFS)after radical resection in patients with cHCC-CCA,and the clinicopathological factors affecting prognosis in two center hospitals of China.METHODS We reviewed consecutive patients with cHCC-CCA who received radical resection between January 2005 and September 2021 at Peking Union Medical College and the 5th Medical Center of the PLA General Hospital retrospectively.Regular follow-up and clinicopathological characteristics were systematic collected for baseline and prognostic analysis.RESULTS Our study included 95 patients who received radical resection.The majority of these patients were male and 82.7%of these patients were infected with HBV.The mean tumor size was 4.5 cm,and approximately 40%of patients had more than one lesion.The median OS was 26.8(95%CI:18.5-43.0)mo,and the median RFS was 7.27(95%CI:5.83-10.3)mo.Independent predictors of OS were CA19-9≥37 U/mL(HR=8.68,P=0.002),Child-Pugh score>5(HR=5.52,P=0.027),tumor number>1(HR=30.85,P=0.002),tumor size and transarterial chemoembolization(TACE)after surgery(HR=0.2,P=0.005).CONCLUSION The overall postoperative survival of cHCC-CCA patients is poor,and most patients experience relapse within a short period of time after surgery.Preoperative tumor biomarker(CA19-9,alphafetoprotein)levels,tumor size,and Child-Pugh score can significantly affect OS.Adjuvant TACE after surgery prolongs RFS,suggesting that TACE is a possible option for postoperative adjuvant therapy in patients with cHCC-CCA.
文摘AIM: To evaluate the significance of extended radical operation and its indications.METHODS: Between January 1995 and December 1998, 56inpatients with pancreatic head cancer received operation.Among them 35 patients (group 1) experienced the Whipple operation, and 21 patients (group 2) received the extended radical operation. The 1-, 2-, 3-year cumulative survival rates were used to evaluate the efficacy of the two operative procedures. Clinical stage (CS) was assessed retrospectively with the help of CT. The indications for extended radical operation were discussed.RESULTS: There was no difference in hospital mortality and morbidity rates. Whereas the 1-, 2-, 3-year cumulative survival rates were 84.8%, 62.8%, 39.9% in the extended radical operation group, and were 70.8%, 47.6%, 17.2%in the Whipple operation group, there was a significant difference between the two groups (P<0.001, P<0.001,P<0.001, respectively). Most of the deaths within 3 years after operation were due to recurrence in the two groups.However, the 1-, 2-, 3-year cumulative rates of death due to local recurrence were decreased from 37.4% in patients that received the Whipple procedure to 23.8% in those who received by extended radical operation. Patients who survived for more than 3 years were only noted in those with CS1 in the Whipple procedure group and were founded in cases with CS1, CS2 and part of CS3 in the extended radical operation group.CONCLUSION: The extended radical operation appears to benefit patients with pancreatic head carcinoma which was indicated in CS1, CS2 and part of CS3 without severe invasion.
基金supported by the State Grid Science and Technology Project (No.52999821N004)。
文摘This study proposes a combined hybrid energy storage system(HESS) and transmission grid(TG) model, and a corresponding time series operation simulation(TSOS) model is established to relieve the peak-shaving pressure of power systems under the integration of renewable energy. First, a linear model for the optimal operation of the HESS is established, which considers the different power-efficiency characteristics of the pumped storage system, electrochemical storage system, and a new type of liquid compressed air energy storage. Second, a TSOS simulation model for peak shaving is built to maximize the power entering the grid from the wind farms and HESS. Based on the proposed model, this study considers the transmission capacity of a TG. By adding the power-flow constraints of the TG, a TSOS-based HESS and TG combination model for peak shaving is established. Finally, the improved IEEE-39 and IEEE-118 bus systems were considered as examples to verify the effectiveness and feasibility of the proposed model.
文摘Objective:To discuss the efficacy of Bispectral index (BIS)-monitored closed-loop targeted-controlled infusion of propofol for laparoscopic radical operation for gastric cancer.Methods:A total of 106 patients with primary gastric cancer who underwent laparoscopic radical operation for gastric cancer in our hospital between August 2015 and February 2018 were chosen as the research subjects and divided into the control group (n=53) and the observation group (n=53) according to the different anesthesia methods. Control group of patients received BIS-monitored manually adjusted targeted-controlled infusion concentration of propofol, and observation group of patients received BIS-monitored closed-loop targeted-controlled infusion of propofol. The differences in hemodynamic index levels as well as serum contents of inflammatory factors and stress hormones were compared between the two groups of patients before anesthesia (T0), 30 min after surgery started (T1) and 30 min before surgery ended (T2).Results:At T0, the differences in hemodynamic index levels as well as serum contents of inflammatory factors and stress hormones were not statistically significant between the two groups. At T1 and T2, hemodynamic indexes MAP and HR levels of observation group were lower than those of control group at the corresponding time points;serum inflammatory factors sICAM-1, IL-1β, IL-8 and TNF-α contents were lower than those of control group at the corresponding time points;serum stress hormones Cor, T4 and glucagon contents were lower than those of control group at the corresponding time points.Conclusion: BIS-monitored closed-loop targeted-controlled infusion of propofol can effectively stabilize the intraoperative hemodynamics and inhibit the systemic inflammatory stress response in patients with laparoscopic radical operation for gastric cancer.
文摘Objective: To investigate the effect of epidural block combined with intravenous anesthesia on stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy. Methods: In our hospital from July 2016 to June 2017 undergoing radical mastectomy for breast cancer of 88 patients were randomly divided into observation group and control group of 44 cases, 2 patients underwent routine preoperative preparation, and routine blood pressure, heart rate, pulse, oxygen saturation, ECG monitoring, control group with intravenous anesthesia. The observation group was treated with epidural block combined with intravenous anesthesia. 2 groups of patients before anesthesia, 30 MIM (T0), 1 h after skin incision (T1), 4 h after operation (T2), 24 h after operation (T3), 48 h after operation (T4) from peripheral venous blood were measured by interleukin-8 (IL-8) and interferon gamma (IFN-γ), cortisol (Cor), prolactin (PRL), growth hormone (GH) and T lymphocyte subsets (CD3+, CD4+, CD8+), the calculation of CD4+/CD8+ value. Results: the serum IL-8 level of T1, T2, T3and T4 decreased gradually, were lower than at T0, and the control group at each time point had no significant difference, T1, T2, T3group, T4IL-8 levels lower than the control group;the 2 groups of serum IFN-γ levels T1 and T2had no significant change, T3and T4increased gradually, was higher than that of T0, but no significant difference between the 2 groups of IFN-γ levels. 2 serum Cor levels peaked at T1, decreased at T2, was higher than that of T0, T3, T4returned to T0, the observation group T1, T2Cor level lower than the control group;the serum PRL levels of 2 groups reached a peak at T1, T2, T3at the time of T4decreased gradually, was higher than that of T0, T1, T2, T3of the observation group at the PRL level is lower than the control group;the serum level of GH 2 in group T1increased gradually, reached a peak at T2, T3and T4 decreased gradually, was higher than that of T0, the observation group T1, T2, T3, T4, GH levels lower than the control group. 2 groups of CD3+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD3+ was higher than the control group;group CD4+ decreased gradually in T1, T2, T3and T4were lower than control, T0when, and the observation group CD4+ in T1, T2, T3, T4, no significant changes were observed in group T1, T2, T3, T4and CD4+ higher than that of the control group;the 2 group CD8+ had no obvious changes in T1, T2, T3, T4;observation group CD4+/CD8+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD4+/CD8+ was higher than the control group. Conclusion: epidural block combined with intravenous anesthesia for breast cancer radical mastectomy can effectively relieve the stress and inflammatory reaction, alleviate the immunosuppression, and help to restore the postoperative immune function.
基金supported by Major International(Regional)Joint Research Project of the National Natural Science Foundation of China(61320106011)National High Technology Research and Development Program of China(863 Program)(2014AA052802)National Natural Science Foundation of China(61573224)
文摘Objective: The aim of this study was to explore clinical value of thoracic small incision in radical operation for lung and esophageal cancer in assuring same treatment effects with conventional incision. Methods: Collected data of patients was given radical operation for lung and esophageal cancer in our department from January 1, 2006 to January 1, 2007, and performed retrospective analysis, among them, small incision group (improved group) was 143 cases, and conventional group was 167 cases including 6 cases which was changed from small incision to conventional incision in operation. Compared operation time, incision length, intraoperative blood loss, postoperative drainage flow, number of lymph node dissected, recovery time of postoperative upper limb function, postoperative pain, postoperative complications etc. between both groups. Results: Compared with conventional group, intraoperative blood loss, postoperative drainage flow, postoperative pain, recovery time of postoperative upper limb function in improved group was improved significantly, and there was no obvious difference in operation time and number of lymph node dissected between both groups. Conclusion: Small incision in radical operation for lung and esophageal cancer is small trauma, and quick recovery after operation, treatment effects of it is basically similar to that of conventional operation method, however, its application is limited in few cases.
文摘Neuroendocrine tumors (NETs) are often misdiagnosed because they can involve any part of the body and have non-specific symptoms. Here, we report a case of a 39-year-old man with rectal neuroendocrine tumor (RNET) and hepatic metastases treated with a combination of radical surgery and Everolimus therapy. The patient complained of abdominal distension, pain, and constipation of one month duration. Enhanced CT scan of the abdomen, colonoscopy and Biopsy findings confirmed the diagnosis of rectal neuroendocrine tumor. As the anatomical structures were clear and the masses seemed to be resectable, we decided to initiate treatment with radical operation and Everolimus therapy. The patient has responded well to the treatment with no evidence of recurrence after 4 years of follow-up. This case is interesting because of the rarity of this neoplasm and its initial misdiagnosis as a giant hepatic carcinoma (hepatoma). It also demonstrates that a combination of curative surgical resection and Everolimus is a good option in a patient with large colorectal neuroendocrine tumors and massive hepatic metastases.
文摘Objective:To investigate the effect of arterial interventional chemotherapy before radical operation for gastric cancer on serum tumor markers and cell growth in the lesion.Methods:90 patients with primary gastric cancer who underwent radical operation for gastric cancer in our hospital were chosen as the research subjects and divided into the control group (n=48) (did not receive preoperative arterial interventional chemotherapy) and the arterial interventional chemotherapy group (n=42) (received preoperative arterial interventional chemotherapy). The differences in tumor markers in serum as well as proliferation and apoptosis gene expression in gastric cancer tissues were compared.Results: Before surgery started, serum CA199, CA153, CA724 and AFP levels of arterial interventional chemotherapy group were significantly lower than those immediately after admission whereas serum CA199, CA153, CA724 and AFP levels of control group were not significantly different from those immediately after admission. After surgery, proliferation genes CUL4A and NTSR1 mRNA expression in gastric cancer tissues of arterial interventional chemotherapy group were lower than those of control group whereas DADS and FAM96B mRNA expression were higher than those of control group;apoptosis genes Livin and Bcl-2 mRNA expression were lower than those of control group whereas p53, p21 and Bax mRNA expression were higher than those of control group.Conclusion:Preoperative arterial interventional chemotherapy combined with radical operation for gastric cancer can more effectively inhibit the malignant degree of tumor and delay the growth of cancer cells.
文摘Objective:To investigate the effects of different chemotherapy regimens before radical operation for lung cancer on cancer cell growth and antitumor immune response.Methods: A total of 180 patients with primary lung cancer who underwent surgery in this hospital between February 2013 and August 2017 were divided into the cisplatin group (n=93) who received cisplatin & paclitaxel chemotherapy and the lobaplatin group (n=87) who received lobaplatin & paclitaxel chemotherapy according to different preoperative neoadjuvant chemotherapy regimens. The differences among the expression of proliferation genes and apoptosis genes in tumor tissues as well as the contents of Th1/Th2 cytokines in serum were compared between the two groups.Results: Proliferation genes DDX17, GPx1, MACC1, RACK1 and SIRT1 mRNA expression levels in tumor tissue of lobaplatin group were lower than those of cisplatin group whereas LRRC3B mRNA expression level was higher than that of cisplatin group;apoptosis gene Fas, FasL and Caspase-3 mRNA expression levels were higher than those of cisplatin group whereas Survivin and Bcl-2 mRNA expression levels were lower than those of cisplatin group;serum Th1 cytokines IFN-γ and IL-12 contents were higher than those of cisplatin group whereas Th2 cytokines IL-5 and IL-10 contents were lower than those of cisplatin group.Conclusion: Lobaplatin chemotherapy before radical operation for lung cancer is more effective than cisplatin chemotherapy to inhibit the proliferation activity and enhance the apoptosis activity of lung cancer cells and optimize the anti-tumor immune response.
基金Earlier version of this article was presented as a poster in the bladder section:invasive(MP 13-12)AUA-2021.
文摘Objective:Radical cystectomy is a complex lengthy procedure associated with postoperative morbidity.We aimed to assess the operative time(OT)in patients undergoing radical cystectomy and its impact on 90-day postoperative complications and readmission rates.Methods:The retrospective cohort study included 296 patients undergoing radical cystectomy and urinary diversion from May 2010 to December 2018 in our institution.The OT of 369 min was set as a cutoff value between short and long OT groups.The primary outcome was 90-day postoperative complication rates.Secondary outcomes were gastrointestinal recovery time,length of hospital stay,and 90-day readmission rates.Results:The overall incidence of 90-day postoperative complications was 79.7%where 43.2%representing low-grade complications according to the ClavieneDindo classification(Grade 1 and Grade 2),and 36.5%representing high-grade complications(Grade3).Gastrointestinal tract and infectious complications are the most common complications in our data set(45.9%and 45.6%,respectively).On multivariable analysis,prolonged OT was significantly associated with odds of high-grade complications(odds ratio 2.340,95%confidence interval 1.288e4.250,p=0.005).After propensity score-matched analysis,a higher incidence of major complications was identified in the long OT group 55(51.4%)compared to 35(32.7%)in the short OT group(p=0.006).A shorter gastrointestinal tract recovery time was noticed in the short OT group(p=0.009).Prolonged OT was associated with a higher 90-day readmission rate on univariate and multivariate analyses(p<0.001,p=0.001,respectively).
文摘Objective: To study the effect of the adaptive intermittent ventilation before radical operation for lung cancer under one-lung ventilation on non-ventilated lung tissue injury and apoptosis molecule protein expression. Methods: A total of 288 patients who received radical operation for lung cancer in the hospital between February 2015 and January 2017 were divided into control group and observation group by random number table method, each with 144 cases. Control group received routine one-lung ventilation, and observation group received preoperative adaptive intermittent ventilation of non-ventilated lung tissue. The differences in the levels of inflammatory factors and oxidative stress indexes in serum as well as the apoptosis molecule protein expression in affected-side normal lung tissue were compared between the two groups of patients immediately after intubation and at two-lung ventilation (T0) as well as 10 min before operation ended and at one-lung ventilation (T1). Results: At T0, the differences in the levels of inflammatory factors and oxidative stress indexes in serum as well as the apoptosis molecule protein expression in affected-side normal lung tissue were not significantly significant between the two groups of patients;at T1, IL-1β, IL-8, TNF-α, MPO and MDA levels in serum as well as Bax, caspase-2 and caspase-3 protein expression in normal lung tissue of observation group were lower than those of control group while SOD level in serum and Bcl-2 protein expression in normal lung tissue were higher than those of control group. Conclusion: Adaptive intermittent ventilation before radical operation for lung cancer under one-lung ventilation can effectively reduce the non-ventilated lung tissue injury and inhibit the apoptosis of normal lung cells.
文摘Objective: To study the effects of enteral nutrition via jejunostomy catheter on immune response and intestinal mucosal barrier function after radical operation for esophageal cancer. Methods: A total of 90 patients who were diagnosed with esophageal cancer and received radical operation in Xishui People's Hospital between February 2015 and May 2017 were selected and randomly divided into the EN group who accepted enteral nutrition via jejunostomy catheter and the PN group who received parenteral nutrition. 1 week and 2 weeks after surgery, the expression of immune cell transcription factors in peripheral blood as well as the contents of intestinal mucosal injury markers and inflammatory stress markers in serum were measured. Results: 1 week and 2 weeks after surgery, T-bet expression intensity in peripheral blood of EN group was greatly higher than that of PN group while GATA3, RORγt and Foxp3 expression intensity in peripheral blood as well as DAO, Galectin-1, Galectin-3, Claudin, NE, E, Cor, CRP and CER levels were greatly lower than those of PN group. Conclusion: Enteral nutrition via jejunostomy catheter can improve the immune response and intestinal mucosal barrier function after radical operation for esophageal cancer.
基金Guangdong Province Key Laboratory of Efficient and Clean Energy Utilization(South China University of Technology)(2013A061401005)Research Fund(JMSWFW-2110-044)from Zhongshan Jiaming Electric Power Co.,Ltd.
文摘The determination of source-side extracted heating parameters is of great significance to the economic operation of cogeneration systems.This paper investigated the coupling performance of a cogeneration heating and power system multidimensionally based on the operating characteristics of the cogeneration units,the hydraulic and thermodynamic characteristics of the heating network,and the energy loads.Taking a steam network supported by a gas-steam combined cycle cogeneration system as the research case,the interaction effect among the source-side prime movers,the heating networks,and the terminal demand thermal parameters were investigated based on the designed values,the plant testing data,and the validated simulation.The operating maps of the gas-steam combined cycle cogeneration units were obtained using THERMOFLEX,and the minimum source-side steam parameters of the steam network were solved using an inverse solution procedure based on the hydro-thermodynamic coupling model.The cogeneration operating maps indicate that the available operating domain considerably narrows with the rise of the extraction steam pressure and flow rate.The heating network inverse solution demonstrates that the source-side steam pressure and temperature can be optimized from the originally designed 1.11 MPa and 238.8°C to 1.074 MPa and 191.15°C,respectively.Under the operating strategy with the minimum source-side heating parameters,the power peak regulation depth remarkably increases to 18.30%whereas the comprehensive thermal efficiency decreases.The operation under the minimum source-side heating steam parameters can be superior to the originally designed one in the economy at a higher price of the heating steam.At a fuel price of$0.38/kg and the power to fuel price of 0.18 kg/(kW·h),the critical price ratio of heating steam to fuel is 119.1 kg/t.The influence of the power-fuel price ratio on the economic deviation appears relatively weak.
文摘BACKGROUND There are very few cases of cardiac occluder detachment,and it is rare to completely remove the occluder using interventional methods without undergoing thoracotomy surgery after detachment.This case innovatively used ultrasound guidance combined with digital subtraction angiography(DSA)to completely remove the occluder,accumulating some experience.CASE SUMMARY The patient underwent left atrial appendage occlusion surgery in our hospital due to atrial fibrillation.After the surgery,the occluder fell off and became free in the left ventricle,which is very dangerous.We innovatively used ultrasound guidance,combined with DSA,and interventional surgery to successfully capture the free occluder using a catcher,completely remove it,and then re implant a new left atrial appendage occluder.After the surgery,the patient recovered very well.CONCLUSION The size selection of the occluder is slightly conservative,and the shape of the left atrial appendage opening is irregular.
基金supported in part by the Science and Technology Innovation Program of Hunan Province under Grants 2023JJ40046 and 2023JJ30049.
文摘Currently,the operational performance assessment system in the power market primarily focuses on power generation and electricity retail companies,lacking a system tailored to the operational characteristics of power generation/selling integrated companies.Therefore,this article proposes an assessment index system for assessing the operational performance of a power generation/selling integrated company,encompassing three dimensions:basic capacity,development potential,and external environment.A dynamic proportional adjustment coefficient is designed,along with a subjective and objective weighting model for assessment indexes based on a combined weightingmethod.Subsequently,the operational performance of an integrated company is assessed using extension theory.The results in the case study demonstrate the feasibility and effectiveness of the proposed dynamic proportional adjustment coefficient.
文摘Objective: Potential of combined androgen blockade(CAB) has not been explored extensively in Chinese males with prostate cancer(PCa). Therefore, this study evaluated the 2-year prostate-specific antigen(PSA) recurrence rate and quality of life(Qo L) in patients with high-risk localized and locally advanced PCa receiving adjuvant hormone therapy(HT) after radical prostatectomy(RP).Methods: This prospective, multicenter, observational study conducted in 18 centers across China enrolled patients with high-risk factor(preoperative PSA>20 ng/m L or Gleason score >7) or locally advanced PCa. Different adjuvant HT were administered after RP according to investigator’s decision in routine clinical practice.Relationship of baseline and postoperative characteristics was assessed with recurrence rate. PSA recurrence rate and Functional Assessment of Cancer Therapy-Prostate(FACT-P) Qo L scores were recorded at 12 months and 24 months. Kaplan-Meier analysis was used to construct the PSA recurrence rate during follow-up.Results: A total of 189 patients(mean age: 66.9±6.5 years) were recruited, among which 112(59.3%) patients showed serum PSA>20 ng/m L preoperatively. The highest postoperative pathological advancement noticed was from clinical T2(c T2) to pathological T3(p T3)(43.9%) stage. The majority of the patients(66.1%) received CAB as adjuvant HT, for a median duration of 20.0 months. The least recurrence(15.2%) was noticed in patients treated with CAB, followed by those treated with luteinizing hormone-releasing hormone agonist(LHRHa)(16.1%), and antiandrogen(19.0%), with non-significant difference noted among the groups. None of the baseline or postoperative characteristics was related with PSA recurrence in our study. The 24-month FACT-P Qo L score of119 patients treated for >12 months showed significant improvement above baseline compared with those treated for ≤12 months.Conclusions: Adjuvant CAB therapy after RP showed reduction trend in 2-year PSA recurrence rate in highrisk Chinese patients with localized and locally advanced PCa, compared with adjuvant anti-androgens(AA) or LHRHa therapy. Further long-term therapy(>12 months) significantly improved Qo L compared to short-term HT therapy, suggesting the beneficial effect of long-term CAB therapy in improving Qo L.