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Effect of small incision versus traditional incision thoracotomy for aortic valve replacement: A case control study

ObjectiveTo compare the clinical efficacy of small incision with traditional thoractomy for aortic valve replacement.MethodsWe retrospectively analyzed the clinical data of 78 patients with heart valve replacement in our hospital between May 2014 and June 2016. The patients were divided into a small incision group and an open chest group with 39 patients in each group. In the small incision group, 18 males and 21 females, aged 56.4±10.8 years, underwent cardiac surgery with a small incision. And in the open chest group, 17 males and 22 females, aged 57.1±9.7 years, underwent cardiac surgery by thoracotomy.ResultsThe extracorporeal circulation time, aortic cross clamping time of the small incision group were longer than those of the open chest group (P<0.05). But the amount of intraoperative blood transfusion and postoperative 24 h drainage volume of the small incision group were significantly less than those of the open chest group (P<0.05). Postoperative mechanical ventilation time, and postoperative hospitalization time of the small incision group were significantly shorter than those of the open chest group (P<0.05). Pain score of the small incision group was significantly lower than that of the open chest group significantly (P<0.05). There was no statistical difference in complications rate between the two groups after 6 months (P>0.05).ConclusionCompared with traditional open chest cardiac surgery, small incision cardiac surgery is effective and safe, and is worth popularizing in clinic.

CT Diagnosis and Treatment of Retroperitoneal Cystic Lymphangioma(Report of 5 Cases)

目的 探讨腹膜后囊性淋巴管瘤的CT诊断价值和治疗方法。方法 回顾性分析2004年6月至2010年5月期间我院收治的5例经病理检查证实的腹膜后囊性淋巴管瘤患者的临床表现、CT影像特征、手术治疗及术后随访的资料。结果 5例患者术前CT均诊断为囊性淋巴管瘤，均行手术完整切除肿瘤，术后病理结果均证实为囊性淋巴管瘤。术后7 d顺利出院，随访3个月～6年均无复发。结论 CT对腹膜后囊性淋巴管瘤的诊断具有重要意义，手术完整切除整个囊壁是治疗及预防术后复发的最好方法。

THE EXAMINATION OF APOPTOSIS AND EXPRESSION OF PROLIFERATING CELL NUCLEAR ANTIGEN IN HEPATOCELLULAR CARCINOMA

Objective To examine the relationship between ratio of proliferating cell nuclear antigen (PCNA)/apoptosis and biology of hepatocellular carcinoma. Methods Thirty five cases of hepatocellular carcinoma were studied with TUNEL and immunohistochemistry. Results Positive rate of apoptosis in grade Ⅰ, Ⅱ, Ⅲand Ⅳ was 1.37%,0.70%, 0.67% and 0.25% respectively. Positive rate of PCNA in grade Ⅰ, Ⅱ, Ⅲ and Ⅳ was 17%, 19%, 75% and 80%. Ratio of PCNA/apoptosis in grade Ⅰ,Ⅱ,Ⅲ and Ⅳ was 19.04, 75.51, 138.01 and 345.52. Conclusion Ratio of PCNA/apoptosis is correlated with histological classification.

非体外循环双向Glenn分流术治疗

目的 总结非体外循环下行双向Glenn分流术治疗紫绀型复杂先天性心脏病的临床经验，以提高手术疗效。 方法 2001年5月至2007年5月，56例患者在非体外循环下行双向Glenn分流术，术后采用电话和信件问卷方式对患者进行随访。 结果 术后早期死亡3例，死于低心排血量综合征。术后肺动脉压较术前增高(16.3±3.2 mm Hg vs. 12.4±2.1 mm Hg，Plt;0.05);术后动脉血氧饱和度较术前提高（91％±5％ vs. 74％±10％，Plt;0.05)。随访39例，随访时间3个月～6年，失访14例。随访期间死亡2例，其中1例出院后即死于心力衰竭，1例于3年后死于肺气肿。37例生存患者的5年生存率为95% (37/39)，32例紫绀有所减轻，21例患者于术后3～6个月行心电图、彩色超声心动图检查，腔静脉肺动脉吻合口均通畅，肺动脉压为17.3±1.8 mm Hg。 2例患者于术后2年行全腔静脉肺动脉连接术，二期手术后效果满意。 结论 非体外循环下双向Glenn手术安全、可靠，是一种治疗难以解剖根治或一期生理矫治的紫绀型复杂先天性心脏病患者的较好术式。

支气管扩张症138例

目的 总结支气管扩张症外科治疗的临床诊断和治疗经验. 方法 回顾性分析1985～ 1999年手术治疗138例支气管扩张症患者的诊断和治疗情况. 结果 全组无1例手术死亡,94例单叶或双叶支气管扩张患者症状消失;13例双侧或广泛支气管扩张患者,症状均改善. 结论 把握好手术适应证和肺的切除范围,可降低手术死亡率和并发症发生率,提高治疗效果.肺切除术对治疗单叶或双叶支气管扩张疗效十分显著,尽可能完全切除病灶是获得最佳治疗效果的前提.

封闭式负压引流技术联合腓肠神经营养血管皮瓣治疗跟腱部软组织缺损

目的 总结封闭式负压引流技术（vacuum sealing drainage，VSD）联合腓肠神经营养血管皮瓣治疗跟腱部软组织缺损的临床疗效。 方法 2008 年1 月－ 2010 年6 月，收治14 例跟腱中下部软组织缺损患者。男9 例，女5 例；年龄18 ～ 67 岁，平均46 岁。交通事故伤6 例，重物砸伤4 例，炸伤2 例。受伤至入院时间为2 ～ 6 h，平均3.5 h；外院清创缝合后感染致皮肤坏死2 例。软组织缺损部位：跟腱部软组织缺损11 例，其中4 例伴跟腱断裂；跟腱及跟骨结节处软组织缺损3 例。创面范围为3 cm × 3 cm ～ 8 cm × 6 cm。入院后先行VSD 治疗，待创面有新鲜肉芽组织后，采用大小为4.5 cm × 4.0 cm ～ 10 cm × 8 cm 的腓肠神经营养血管皮瓣修复创面。供区直接缝合或植皮修复。 结果 采用VSD 治疗1 次11 例，2 次2 例，3 次1 例。术后第8 天1 例发生皮瓣远端周缘坏死，经换药后10 d 愈合；其余皮瓣及植皮均顺利成活，创面Ⅰ期愈合。患者术后均获随访，随访时间6 ～ 20 个月，平均12 个月。皮瓣外形、质地良好，无臃肿，局部无明显瘢痕挛缩，耐磨性良好。术后6 个月踝关节功能采用美国足踝外科学会（AOFAS）评分系统，获优9 例，良3 例，可1 例，差1 例，优良率为85.7%。 结论 VSD 能有效预防和控制感染，促进肉芽生长，为皮瓣修复提供良好条件；腓肠神经营养血管皮瓣是修复跟腱中下部软组织缺损的有效方法。

Research Progress of Pancreatic Fistula Following Pancreaticoduodenectomy

ObjectiveTo summarize the prevention method for pancreatic fistula following pancreaticoduodenec-tomy. MethodLiteratures related to the prevention methods for postoperative pancreatic fistula at home and abroad in recent years were retrieved and summarized. ResultsThe pancreatic fistula was a common complication following pancreaticoduodenectomy. It was mainly caused by preoperative continuous high jaundice, selection of intraoperative anastomosis, and early postoperative pancreatic juice secretion. Trypsinogen was activated by alkaline intestinal juice and then the nearby tissue was digested. Pancreatic juice flowed into abdominal cavity to digest the tissue, then caused serious complications or even death. Through the prevention of drugs, preoperative biliary drainage and intraoperative anastomosis, etc., the incidence of postoperative pancreatic fistula was slightly decreased. ConclusionThe prevention for postoperative pancreatic fistula is an integrated process, and it needs to be ran through the whole perioperative period.

Dubin-Jonhson综合征合并胆囊结石1例报道

Study on adsorption of microRNA-124 by long chain non-coding RNA MALAT1 regulates osteogenic differentiation of mesenchymal stem cells

ObjectiveTo investigate the regulatory effect of long chain non-coding RNA (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) adsorbing microRNA-124 (miR-124) on osteogenic differentiation of mesenchymal stem cells (MSCs).MethodsC3H10T1/2 cells derived from mouse embryos were cultured in vitro, then randomly divided into control group (group A), lncRNA MALAT1 no-load plasmid group (group B), lncRNA MALAT1 overexpression plasmid group (group C), lncRNA MALAT1 small interfering RNA (siRNA) group (group D), and lncRNA MALAT1 siRNA negative control group (group E). The cells were transfected into plasmids and siRNA, then induced to differentiate into osteoblasts. Alkaline phosphatase (ALP) and alizarin red staining were used to detect the osteogenic differentiation of cells in each group, real-time fluorescence quantitative (qRT-PCR) analysis was used to detect the expressions of lncRNA MALAT, miR-124, and osteogenesis-related genes such as Runt-related transcription factor 2 (Runx2), osteopontin (OPN), and osteocalcin (OCN) in each group. Double luciferase reporter gene was used to detect the targeting regulation of lncRNA MALAT1 to miR-124.ResultsThe relative contents of ALP positive cells, mineralized nodule, and the relative mRNA expressions of lncRNA MALAT1, Runx2, OPN, and OCN in group C were significantly higher than those in other groups (P<0.05), while in group D significantly lower than in other groups (P<0.05); the relative expression of miR-124 in group C was significantly lower than that in other groups(P<0.05), while in group D significantly higher than in other groups (P<0.05). There was no significant difference in these indexes between groups A, B, and E (P>0.05). The results of double luciferase reporter gene assay showed that lncRNA MALAT1 targeting down-regulated the expression of miR-124.ConclusionLncRNA MALAT1 can targeting down-regulate the expression of miR-124 and promote the osteogenic differentiation of MSCs.

Investigation of Cognition Degree and Clinical Use of 2011 GOLD New COPD Classification System in Respiratory Specialist from Chongqing

Objective To investigate the cognition degree and clinical use of new COPD classification system of 2011 GOLD in respiratory specialists, and further analyze the reasons of failing to clinical use. Methods Respiratory specialists from 42 hospitals in Chongqing were investigated through questionnaire survey. The questionnaire contains two parts. The first part contains nine questions about the knowledge of 2011 GOLD new COPD classification system and its clinical use. The second part contains six questions about the reasons of failing to clinical use of the COPD classification system. Results A total of 204 valid questionnaires were recovered. More than 90% respiratory specialists had understood the new COPD classification system with different degree, and believed it is suitable for clinical use. More than twothirds respiratory specialists knew well the ways about CAT and mMRC, but only 24% specialists were using these ways. The main reasons of failing to clinical use were as follows: 60% specialists believed the pulmonary function test can evaluate the COPD classification, and 66. 7% specialists were limited by short visit time. The cognition degree and clinical use of the new COPD classification systemin the specialists from third grade A class hospitals was better than those from the other hospitals. But the difference was not significant among specialists with different professional title.Conclusion Respiratory specialists in Chongqing knew well about the new COPD classification systemin 2011 GOLD, but did not use it widely in clinical works due to the complicated operation of the new COPD classification system.