Although the ambulatory surgery started late in France, it has a unique set of definitions and criteria for defining the scope. In France, the time required for ambulatory surgery is more stringent, and the ambulatory surgery center is open for no more than 12 hours to control the total length of treatment. The patients should enter the ambulatory surgery center in the morning and leave it before the end of afternoon. The development of ambulatory surgery in France is stable and continuous. This article introduces the development of French ambulatory surgery from the origin, development and future of French ambulatory surgery, organizational management and clinical path, in order to promote the standardization of Chinese ambulatory surgery management.
Objective To analyze the efficacy of no-touch technique and traditional technique in drawing great saphenous vein during coronary artery bypass grafting. Methods We searched the literatures on no-touch technique versus traditional technique in drawing great saphenous vein during coronary artery bypass grafting in PubMed, Cochrane Library, Chinese Journal Full-text Database, Wanfang database between January 1997 and November 2017. Jadad scale was used for quality verification. RevMan 5.0 was used for analysis. Results Six studies were included. Jadad scale for both 6 randomized controlled trials was 5 points. Meta-analysis showed that there was no statistical difference in postoperative mortality between the two groups with RR=0.68 and 95%CI 0.11 to 4.11(P=0.67). There was no statistical difference in leg wounds with RR=1.46 and 95%CI 0.23 to 9.16 (P=0.68). There was no statistical difference in short-term cardiogenic death with RR=0.33, 95%CI 0.10 to 1.03 ( P=0.06). The no-touch group’s long-term cardiogenic death was significantly lower than the traditional group withRR=0.36, 95%CI 0.16 to 0.79(P=0.01). Postoperative no-touch group’s short-term patency rate was significantly better than that of the traditional group with MD=3.08 and 95%CI 1.58 to 5.99 (P<0.01). The long-term patency rate in the no-touch group was also higher than that of the traditional group withMD=3.08 and 95%CI 1.58 to 5.99 (P<0.01). Conclusion Compared with the traditional group, the no-touch group increases postoperative long-term survival rate, short-term and long-term patency rate.
Objective To compare the patency of the postoperative vessel bridge grafts between the no-touch technique and the conventional technique for saphenous vein harvest in the coronary artery bypass grafting. Methods A total of 70 patients underwent coronary artery bypass grafting from January 2014 to January 2015 in the First Affiliated Hospital of Zhengzhou University. They were randomly divided into a conventional technique group (saphenous vein obtained by traditional technique) and a no-touch technique group (saphenous vein obtained by no-touch technique). There were 34 patients in the conventional technique group, including 16 males and 18 females with an average age of 61.6±6.4 years. There were 36 patients in the no-touch technique group, including 16 males and 20 females with an average age of 62.2±6.6 years. The 1-year postoperative coronary CT angiography (CTA) results were compared. Results Seventy patients underwent coronary CTA examination 1 year postoperatively. The patency rate of the conventional technique group and no-touch technique group were 83/116 (71.6%) and 113/122 (92.6%). Logistic regression analysis showed a statistical difference between the non-touch technique and the conventional technique (P<0.05). Conclusion The short-term patency rate of vessel bridge grafts is higher when the no-touch technique is used.
Objective To observe the effects of extracellular-signal regulated kinase (ERK) 1/2 inhibitor U0126 on hepatoma carcinoma cell proliferation and apoptosis. Methods Hepatoma SMMC-7721 cell strain was divided into blank control group and different concentrations of U0126 groups. The proliferation inhibition was measured by MTT assay. FCM was used to analyze the cell cycle distribution and apoptosis. Results U0126 obviously inhibited cell proliferation, induced cell apoptosis and G0/G1 phase cell cycle arrest. There were significant differences between control group and different concentrations of U0126 groups on cell proliferation and apoptosis （P＜0.05， P＜0.01）. Conclusion Blocking ERK1/2 pathway may be an important treatment strategy for liver cancer.
【Abstract】Objective To investigate the surgical technique of orthotopic liver transplantation using two-cuff technique and prevention of operational complications in rats. Methods The model was established with modified cuff technique.Before donor livers were harvested,the portal vein and hepatic artery were interrupted for 10 min,and reflow was initiated for another 10 min.The donor liver was perfused through abdominal aorta and portal vein respectively.The infrahepatic vena vein and portal vein were anastomosed by means of cuff method； the anastomosis of the suprahepatic vena vein was performed with suture method. The anastomosis of the common bile duct was performed with an internal stent. Results One hundred and twenty rats underwent orthotopic liver transplantation using twocuff technique and the successful rate was 90.8%. The average nonhepatic time of recipients was (21.0±3.5) min and the total surgical time was (46.0±4.5) min. The oneweek survival rate of recipients was 87.2%. Conclusion Good exposure of operative field, sophisticated microsurgical technique and delicate surgical manipulation can benefit decreasing nonhepatic and total surgical time of recipients and increasing the survival rate of recipients.
【Abstract】ObjectiveTo investigate the effects of liver transplantation on splenic function in rats with hepatic cirrhosis. MethodsHepatic cirrhosis model was established in rats by subcutaneous injections of carbon tetrachloride. Liver transplantation model was established with twocuff technique. Spleen index, morphological changes of spleen were observed before and after liver transplantation in hepatic cirrhosis rats. Spleen T lymphocyte subgroups before and after liver transplantation were also assayed by immunofluorescence staining and flow cytometry. ResultsBefore liver transplantation, spleen index was increased from (2.42±0.11) mg/g to (3.62±0.14) mg/g， P＜0.01; pathological examination of spleen samples showed that the areas of white pulp were decreased from (23.47±2.30)% to (7.70±2.01)%， P＜0.01， and the areas of spleen trabecula were increased from (1.75±0.61)% to (4.46±0.71)%， P＜0.01. Meanwhile, the ratio of CD4/CD8 of spleen T lymphocyte subgroups was decreased from 2.67±0.15 to 1.18±0.15, P＜0.01. After liver transplantation, spleen index was decreased from (3.62±0.14) mg/g to (2.62±0.11) mg/g， P＜0.01; pathological examination of spleen showed that the areas of white pulp were increased from (7.70±2.01)% to (15.07±1.97)%， P＜0.01, and those of spleen trabecula were decreased from (4.46±0.71)% to (3.11±0.51)%， P＜0.05. Meanwhile, the ratio of CD4/CD8 of spleen T lymphocyte subgroups was increased from 1.18±0.15 to 2.32±0.11, P＜0.01. ConclusionImpaired function of spleen resulting from liver function damage can be improved in rats with hepatic cirrhosis after liver transplantation.
ObjectiveTo explore the method and effectiveness of multidirectionally three-dimensional steel wire ring sleeve fixation in the treatment of inferior patellar pole avulsion fractures.MethodsBetweern January 2015 and January 2019, 22 patients with inferior patellar pole avulsion fractures were admitted and treated. There were 12 males and 10 females. The age ranged from 20 to 69 years, with an average age of 39.4 years. The causes of injury included 9 cases of traffic accident and 13 cases of falling. All of them were unilateral closed injury of knee joint, including 7 cases of skin contusion around patella. Preoperative range of motion of the affected knee was (20.82±7.16)° (range, 10°-35°). The time from injury to operation ranged from 3 to 12 days, with an average of 5.9 days. During the operation, the inferior patellar avulsion fracture was reduced with forceps; the patella was circumferentially ligated through the distal bone surface of the fracture with 0.8 mm diameter steel wire; then 3 longitudinal bone tunnels were made in the upper patella, respectively. The 0.8 mm diameter steel wire passed through the bone tunnel, and the longitudinal ring was attached to the ring to fix the upper and inferior patellar fracture. Tighten the transverse and longitudinal rings with No.2 tendon suture line, then longitudinally ringed and sutured to strengthen the patella. The knee range of motion, fracture healing time, and complications were recorded. The functional recovery of the knee joint was evaluated by Böstman score.ResultsAll incisions healed by first intention, and no incision related complications occurred. All the 22 patients were followed up 13 months to 5 years with an average of 26.7 months. The fracture healing time was 9-12 weeks (mean, 10.9 weeks). At last follow-up, the knee range of motion was (129.77±2.35)° (range, 126°-135°), showing significant difference when compared with preoperative one (t=−67.022, P=0.000). The Böstman score ranged from 31 to 36, with an average of 34.3. No reduction loss, fracture of steel wire, failure of internal fixation, and other complications occurred during follow-up.ConclusionMultidirectionally three-dimensional steel wire ring sleeve fixation in the treatment of inferior patellar pole avulsion fractures has the advantages of reliable fixation, early functional recovery, and fewer complications, so the effectiveness is satisfactory.
Objective To summarize the short-term results of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) in the treatment of bioprosthetic valve failure after aortic valve replacement. Methods We reviewed the clinical data of patients who underwent ViV-TAVI from 2021 to 2022 in the First Affiliated Hospital of Zhengzhou University. The valve function was evaluated by echocardiography before operation, immediately after operation and 3 months after operation. The all-cause death and main complications during hospitalization were analyzed. Results A total of 13 patients were enrolled, including 8 males and 5 females with a mean age of 65.9±8.5 years, and the interval time between aortic valve replacement and ViV-TAVI was 8.5±3.4 years. The Society of Thoracic Surgeons mortality risk score was 10.3%±3.2%. None of the 13 patients had abnormal valve function after operation. The mean transvalvular differential pressure of aortic valve was decreased (P<0.001), the peak flow velocity of aortic valve was decreased (P<0.001), the left ventricular ejection fraction was not changed significantly (P=0.480). There were slight perivalvular leakage in 2 patient and slight valve regurgitation in 3 patients. Three months after operation, the mean transvalvular pressure difference and peak flow velocity of aortic valve in 12 patients were significantly different from those before operation (P≤0.001). Conclusion This study demonstrates that ViV-TAVI for the treatment of bioprosthetic valve failure after aortic valve replacement is associated with sustained clinical and functional cardiovascular benefits, the short-term results are satisfactory.