【摘要】 目的 总结腹腔镜对小儿美克尔憩室的临床诊断和应用价值。 方法 2005年4月-2009年12月，将41例行美克尔憩室切除术患儿随机分为两孔法腹腔镜手术组和传统手术组，就手术治疗、术后并发症、术后效果等临床资料进行对比分析。 结果 腹腔镜手术组患儿手术时间、术中出血量、下床活动时间、住院时间等均优于传统手术组；术后并发症发生例数均明显少于传统手术组。 结论 腹腔镜对患儿美克尔憩室的诊断和治疗具有明显优越性，可作为小儿美克尔憩室治疗的首选方式。【Abstract】 Objective To investigate the diagnostic and applicative value of laparoscopy for Meckel’s diverticulum in children. Methods The clinical data of 41 children with Meckel’s diverticulum who underwent resection between April 2005 to December 2009 were retrospectively analyzed. The patients were divided into tow-port laparoscopy-assisted resection group (group A,19 patients) and traditional resection group (group B, 22 patients). The intra-operative accidental injury, postoperative complications, postoperative general condition and prognosis were evaluated via randomized contrast analysis. Results The time of operation, amount of bleeding, recover intestinal peristalsis,out-of-bed activities time and the average days in hospital in group A were less than those in group B. The postoperative complications occurred in one and eight patients in group A and B respectively. Conclusion Laparoscopy had obvious superiority for the children’s Meckel’ s diverticulum in diagnosis and treatment,which should be the best choice.
Objective To investigate the effects of ischemic postconditioning （IPO） on inflammatory response inischemia-reperfusion （IR） injury of rat lungs in vivo. Methods Forty SD rats were randomly divided into 5 groups inclu-ding a sham surgery group （S group），a 30-minute IR group （I/R-30 group），a 120-minute IR group（IR-120 group），a 30-minute IPO group （IPO-30 group），and a 120-minute IPO group （IPO-120 group）. There were 8 rats in each group. All therats received left thoracotomy after anesthesia. In the sham surgery group，a line was only placed around the left hilum butnot fastened. In the I/R-30 group and I/R-120 group，a line was fastened to block the blood flow of the left lung for 1 hour，then loosened for reperfusion for 30 minutes and 120 minutes respectively. In the IPO-30 group and IPO-120 group，afterblocking the blood flow of the left lung for 1 hour，the left hilum was fastened for 10 seconds and loosened for 10 seconds（repeating 3 times for 1 minute），then the line was loosened for 30 minutes and 120 minutes respectively. The levels of interleukin-10 （IL-10） in lung tissues and soluble intercellular adhesion molecule-1 （sICAM-1） in plasma were measured. Histopathological changes of lung tissues were observed and diffuse alveolar damage （DAD） scores was calculated.Results The levels of plasma sICAM-1 in the I/R-30 group and I/R-120 group were significantly higher than that of S group ［（2.140±0.250）μg/L vs. （0.944±0.188）μg/L，P=0.003；（2.191±0.230）μg/L vs. （0.944±0.188）μg/L，P=0.003］. IL-10levels in lung tissues in the I/R-30group and I/R-120 group were also significantly higher than that of S group［（15.922±0.606）pg/mg pro vs. （7.261±0.877）pg/mg pro，P=0.037；（17.421±1.232）pg/mg pro vs. （7.261±0.877）pg/mg pro，P=0.042］. Pathologic lesions of lung tissues in the I/R-30 group and I/R-120 group were more severe than that of S group. After IPO, plasma sICAM-1 levels in the IPO-30 group and IPO-120 group were significantly lower than those in the I/R-30group and I/R-120 group respectively ［（1.501±0.188）μg/L vs.（2.140±0.250）μg/L，P=0.038；（1.350±0.295）μg/L vs.（2.191±0.230）μg/L，P=0.005］. IL-10 levels in lung tissues in the IPO-30 group and IPO-120 group were significantly higherthan those in the I/R-30 group and I/R-120 group respectively ［（20.950±1.673）pg/mg pro vs.（15.922±0.606）pg/mgpro，P=0.008；（25.334±1.173）pg/mg pro vs.（17.421±1.232）pg/mg pro，P=0.006］. DAD scores in the IPO-30 group andIPO-120 group were significantly lower than those in the I/R-30 group and I/R-120 group respectively ［6.8±1.4 vs. 11.5±1.9，P=0.007；7.5±1.6 vs. 13.2±1.7，P=0.005］. Pathological lesions of the lung tissues of IPO groups were less severe than those of I/R groups. Conclusion IPO can attenuate IR injury by inhibiting inflammatory response in rat lungs.
Objective To estimate the feasibility and efficacy of respiratory function score ( RFS)guided ventilator weaning in mechanical ventilated patients with respiratory failure. Methods By a prospective control study,136 patients with acute respiratory failure who had received endotracheal intubation and mechanical ventilation from January 2010 to May 2012 were randomly divided into three group, ie. a RFS-guided 3-4 group ( n=60) , a RFS-guided 5-6 group ( n = 51) , and a traditional group ( n =25) . TheRFS-guided groups underwent ventilator weaning by guidance of RFS 3-4 and 5-6 respectively. The traditional group underwent ventilator weaning by ordinary way. The ventilation and oxygenation index, RFS,direct weaning success rate, total weaning success rate, total mechanical ventilation time, re-intubation rate,and ventilator-associated pneumonia ( VAP) incidence rate were observed.Results The direct weaning success rate in the RFS-guided 3-4 group, the RFS-guided 5-6 group, and the traditional group was 98. 3%( 59/60) , 82. 4% ( 42 /51) , and 100% ( 25 /25) , respectively. The total duration of mechanical ventilation was ( 5. 2 ±2. 5) days, ( 5. 0 ±3. 0) days, and( 7. 5 ±3. 5) days, respectively. the re-intubation rate was 0( 0 /60) , 1. 9% ( 1 /51) , and 0 ( 0/25) , respectively. VAP incidence rate was 11. 7% ( 7/60) , 13. 7%( 7 /51) and 24% ( 6 /25) , respectively. Compared with the traditional group, the direct weaning success rate and total weaning success rate in the RFS-guided 3-4 group were not significant different( P gt;0. 05) , while the total mechanical ventilation time and VAP incidence rate were significantly lower ( P lt; 0. 05) . Compared with the traditional group, the direct weaning success rate and total mechanical ventilation time in the RFSguided 5-6 group were significantly lower ( P lt;0. 05) , but the total weaning success rate was not significantly different ( P gt;0. 05) . Compared with the RFS-guided 5-6 group, the directweaning success rate in the RFSguided 3-4 group was significantly increased. Conclusions Mechanical ventilator weaning of patients with respiratory failure under RFS guidance is safe and feasible. RFS 3-4 guided ventilator weaning can significantly improve the therapeutic effect.
ObjectiveTo investigate the prognosis after breast conserving surgery (BCS) and modified radical mastectomy (MRM) in patients with stage Ⅰ–Ⅱ breast cancer, and analyze the factors related to locoregional recurrence (LRR).MethodsThe clinicopathologic and prognostic data of patients with stage Ⅰ–Ⅱ breast cancer who underwent the surgical treatment in the First Affiliated Hospital of Chongqing Medical University from January 2011 to December 2014 were analyzed. The clinicopathologic characteristics and prognostic differences of the BCS group and MRM group were compared. The factors related to LRR of patients underwent the BCS and MRM were analyzed.ResultsA total of 1 330 patients with stage Ⅰ–Ⅱ breast cancer were included in this study, including 230 in the BCS group and 1 100 in the MRM group. Compared with the MRM group, the patients in the BCS group had higher height (P<0.001), younger age (P<0.001), smaller tumor diameter (P<0.001), and less axillary lymph node metastasis (P<0.001). Up to August 2019, 149 cases (18 cases in the BCS group and 131 cases in the MRM group) were lost, with a follow-up rate of 88.8%. The median follow-up time was 71 months (4－103 months). The LRR rate of the BCS group was higher than that of the MRM group (6.1% versus 2.5%, χ2=7.002, P<0.01). The locoregional recurrence-free survival of the MRM group was better than that of the BCS group (χ2=7.886, P<0.01). However, there were no statistical differences between the two groups in terms of the distant metastasis-free survival and disease-free survival (P>0.05). In the patients underwent the BCS, the HER-2 was associated with the LRR (P<0.05), and the axillary lymph node metastasis was associated with the LRR in the patients underwent the MRM (P<0.05).ConclusionsAccording to results of this study, although there is a significant difference in locoregional recurrence-free survival between BCS group and MRM group in patients with stage Ⅰ–Ⅱ breast cancer, there are no statistical differences in distant metastasis-free survival and disease-free survival between the two groups. Therefore, it is safe and feasible for choosing appropriate patients with stage Ⅰ–Ⅱ breast cancer to underwent breast-conserving treatment.
Objective To develop a drug-loaded composite microsphere that can simultaneously release the berberine (BBR) and naringin (NG) to repair infectious bone defects. MethodsThe NG was loaded on mesoporous microspheres (MBG) to obtain the drug-loaded microspheres (NG-MBG). Then the dual drug-loaded compound microspheres (NG-MBG@PDA-BBR) were obtained by wrapping NG-MBG with polydopamine (PDA) and modifying the coated PDA with BBR. The composite microspheres were characterized by scanning electron microscopy, X-ray diffraction, specific surface area and pore volume analyzer, and Fourier transform infrared spectroscopy; the drug loading rate and release of NG and BBR were measured; the colony number was counted and the bacterial inhibition rate was calculated after co-culture with Staphylococcus aureus and Escherichia coli for 12 hours to observe the antibacterial effect; the biocompatibility was evaluated by live/dead cell fluorescence staining and cell counting kit 8 assay after co-culture with rat’s BMSCs for 24 and 72 hours, respectively, and the osteogenic property was evaluated by alkaline phosphatase (ALP) staining and alizarin red staining after 7 and 14 days, respectively. Results NG-MBG@PDA-BBR and three control microspheres (MBG, MBG@PDA, and NG-MBG@PDA) were successfully constructed. Scanning electron microscopy showed that NG-MBG@PDA-BBR had a rough lamellar structure, while MBG had a smooth surface, and MBG@PDA and NG-MBG@PDA had a wrapped agglomeration structure. Specific surface area analysis showed that MBG had a mesoporous structure and had drug-loading potential. Low angle X-ray diffraction showed that NG was successfully loaded on MBG. The X-ray diffraction pattern contrast showed that all groups of microspheres were amorphous. Fourier transform infrared spectroscopy showed that NG and BBR peaks existed in NG-MBG@PDA-BBR. NG-MBG@PDA-BBR had good sustained drug release ability, and NG and BBR had early burst release and late sustained release. NG-MBG@PDA-BBR could inhibit the growth of Staphylococcus aureus and Escherichia coli, and the antibacterial ability was significantly higher than that of MBG, MBG@PDA, and NG-MBG@PDA (P<0.05). But there was a significant difference in biocompatibility at 72 hours among microspheres (P<0.05). ALP and alizarin red staining showed that the ALP positive area and the number of calcium nodules in NG-MBG@PDA-BBR were significantly higher than those of MBG and NG-MBG (P<0.05), and there was no significant difference between NG-MBG@PDA and NG-MBG@PDA (P>0.05). Conclusion NG-MBG@PDA-BBR have sustained release effects on NG and BBR, indicating that it has ideal dual performance of osteogenesis and antibacterial property.