Objective To explore the influence of dexmedetomidine on wake-up test during spinal orthopaedic surgery. Methods All 80 patients taking spinal orthopaedic surgery were randomly divided into the trial group and the control group, with 40 cases in each group. The endotracheal intubation anesthesia was adopted in both groups with same anesthesia induction. Additionally, dexmedetomidine 0.8 μg/ (kg·h) was infused within 10 min in the trial group before anesthesia induction, and then another 0.5 μg/ (kg·h) was also infused from the intraoperation to suture of incision. For the control group, the same amount of normal saline was infused, and all the narcotics were stopped pumping 15 min before the wake-up test, but then were continued pumping after the wake-up test. Finally, the following indexes were analyzed: wake-up time, wake-up quality, hemodynamic changes at the time of 15 min before wake-up (T1), recovery of spontaneous breathing (T2), wake-up (T3) and 15 min after wake-up (T4), dosage of narcotics, and the incidence of adverse events. Results There was no significant difference in the operation time before wake-up between the two groups (P=0.07). For the trial group, the dosage of sevoflurane (P=0.03) and sufentanil (P=0.00) used before wake-up was significantly lower, the wake-up time (P=0.04) and bleeding amount during wake-up (P=0.00) were significantly less, the wake-up quality (P=0.03) was significantly higher, the blood pressure (P=0.00) and heart rate (P=0.00) when wake-up were significantly lower, and the incidence of adverse events (P=0.04) was significantly lower, compared with the control group. Conclusion Dexmedetomidine adopted in spinal orthopaedic surgery can significantly improve patient’s wake-up quality, shorten wake-up time, reduce bleeding amount when wake-up and adverse events after wake-up, and maintain the hemodynamic stability, so it has better protective effects.
Objective To explore the medium- and long-term clinical effects of procedure for prolapse and hemorrhoids (PPH) combined with Block operation for obstructed defecation syndrome (ODS). Methods Clinical data of 187 patients with ODS caused by rectocele (RE) who received PPH+Block operation or pure PPH operation in The Chaoyang City Central Hospital from Mar. 2011 to May. 2013, were collected retrospectively, in which 95 patients underwent PPH+Block operation (PPH+Block group) and 92 patients underwent PPH operation (PPH group). Compared the postoperative Longo’s score, postoperative clinical effect, operative effect, and recurrence rate between the 2 groups. Results ① The postoperative Longo’s score: the postoperative Longo’s scores of the PPH+Block group were both lower than those of the PPH group at 1- and 3-year after operation (P<0.05). ② Postoperative curative effect: the total effective rate of the PPH+Block group and the PPH group were both 100%, but the clinical effect of the the PPH+Block group was better than that of the PPH group (Z=–10.15, P<0.05). ③ Operative effect: there was no statistical significance on operative time, intraoperative blood loss, returned to normal activity time, hospital stay, and postoperative visual analogy score (VAS) between the 2 groups (P>0.05). In addition, there were no statistical significance on the incidences of urinary retention, hematochezia, exhaust anal incontinence, and anal fissure between the 2 groups (P>0.05), but the incidence of urgent or high anal straining feeling in the PPH+Block group was significantly higher than that of the PPH group (P<0.05). ④ Medium- and long-term recurrence rate: the recurrence rate of 1-year after operation was similar between these2 groups (P>0.05), but the recurrence rate of 3-year after operation in the PPH+Block group was significantly lower than that of the PPH group (P<0.05). Conclusions The medium clinical effect has no obvious difference between PPH+Block and PPH operation, but the long-term recurrence rate of the former is lower than that of the latter, and the medium- and long-term effect is stable in PPH+Block operation for ODS caused by RE.
Objective To summarize the experience of surgical treatment of late-onset mesh infection after open inguinal hernia tension-free repair. Methods The retrospective descriptive study was conducted. The clinical data of 128 mesh infection patients after open inguinal tension-free hernia who were admitted to the Department of General Surgery of Shaanxi Provincial People’s Hospital form December 2016 to December 2021 were collected. All patients underwent debridement under general anesthesia through a treatment process of laparoscopic exploration, methylene blue staining, removal of mesh, wound irrigation, and negative pressure closed drainage. Patients were observed for completion of surgery, postoperative recovery, and follow-up results. Results One hundred and twenty-eight patients underwent open debridement successfully. In 98 patients, no abnormality was found on laparoscopic exploration and the infected meshs were removed by direct debridement surgery. In 28 patients, laparoscopic exploration revealed that the meshs had broken through the peritoneum and were tightly adherent to the mesentery and intestinal canal. In 2 patients, revealed abdominal abscesses at the paracolic sulcus of the ascending colon and at the ileocecal tract. The infected meshs were removed relatively intact in 112 patients, and the residual meshs were not removed intact in 16 patients. The operative time of 128 patients were 75–345 minutes with an average of 154 minutes, the bleeding volume was 10–200 mL with an average of 37.4 mL, the time to remove the negative pressure drainage tube after surgery were 5–14 days with an average of 8.4 days, the postoperative hospital stay were 6–18 days with an average of 11.6 days. There were 114 cases of class A healing, 12 cases of class B healing, and 2 cases of class C healing. One hundred and twenty-eight patients underwent postoperative follow-up for 6 to 60 months, with a media follow-up time of 30 months. During the follow-up period, 4 patients developed ipsilateral inguinal hernia recurrence, 4 patients developed reinfection, and 3 patients developed varying degrees of pain in the inguinal region. Conclusions Late-onset mesh infection after open inguinal tension-free hernia repair requires removal mesh by surgical treatment. Laparoscopic exploration, methylene blue-assisted debridement, complete removal of the mesh, strict wound irrigation and negative pressure closure drainage are safe and reliable treatment.
Objective To investigate the risk factors of chronic obstructive pulmonary disease (COPD) combined with obstructive sleep apnea (OSA) and its relationship with apnea-hypopnea index (AHI). Methods Clinical data of 216 COPD patients with OSA were retrospectively chosen in the period from January 2016 to December 2019 in our hospital. All patients were divided into different groups according to with or without OSA and the clinical features of patients with and without OSA were compared. Multivariate analysis was used to analyze the influencing factors of COPD with OSA and the correlation between AHI and COPD with OSA was also evaluated. Results ① The age, body mass index (BMI), neck circumference, smoking index, forced expiratory volume in 1 second (FEV1), FEV1% predicted (FEV1pred), the ratio of FEV1 to the forced vital capacity of the lungs (FEV1/FVC), COPD assessment test (CAT) score, Epworth sleepiness scale (ESS) score, Charlson comorbidity index (CCI) score, sleep apnea clinical score (SACS) score and proportion of patients with essential hypertension in OSA group were significantly higher than non-OSA group (P<0.05). The course of disease and the proportion of severe COPD and GOLD grade 4 in OSA group were significantly less than non-OSA group (P<0.05). ② AHI was positively correlated with age, BMI, neck circumference, smoking index, FEV1%pred, FEV1%pred<50%, CAT score, ESS score, CCI score and SACS score (P<0.05); and negatively correlated with FEV1%pred<50% (P<0.05). ③ Multivariate analysis showed that BMI, FEV1%pred<50%, CAT score and ESS score were the independent factors of COPD patients with OSA (P<0.05). ④ The proportion of AHI<5 times/h in GOLD grade 4 was significantly higher than GOLD grade 1-3 (P<0.05). The proportion of AHI> 30 times/h in GOLD grade 4 was significantly lower than GOLD grade 1-3 (P<0.05). Conclusion The incidence of COPD with OSA was independently correlated with BMI, FEV1%pred, CAT score and ESS score; patients with severe COPD possess lower OSA risk.
【摘要】 目的 研究过氧化酶增殖因子活化受体γ（peroxisome proliferator-activated receptor gamma， PPARγ）和血管内皮生长因子C（vascular endothelial growth factor C， VEGF-C）在胃癌组织中表达的相关性，分析其表达与临床病理因素之间的关系。 方法 2005年3月-2009年3月间采用逆转录-聚合酶链反应方法检测36例胃癌手术标本中PPARγ和VEGF-C mRNA的表达，同时选取相同患者的胃正常组织作为对照。 结果 PPARγ mRNA在胃癌中的表达量高于癌旁正常组织，两者的差异有统计学意义（P=0.007）；VEGF-C在胃癌中的表达量高于癌旁正常组织，两者的差异有统计学意义（P=0.004）；PPARγ的表达与VEGF-C表达无关联性（r=0.135，P=0.414）；PPARγ表达与胃癌组织中浸润程度有关（χ2=4.620，P=0.032）、淋巴结转移有关（χ2=15.753，P=0.000）和临床病理分期有关（χ2=4.610，P=0.032）；VEGF-C表达与胃癌组织中淋巴结转移有关（χ2=4.729，P=0.030）、远处转移有关（χ2=4.064，P=0.044）和临床病理分期有关（χ2=6.300，P=0.012）。 结论 PPARγ和VEGF-C可能在胃癌新生淋巴管形成中起重要作用，两者的表达水平与胃癌患者的病情判断及预后评价密切相关。【Abstract】 Objective To investigate the significance of expressions of peroxisome proliferator-activated receptor gamma (PPARγ) and vascular endothelial growth factor C (VEGF-C) in gastric carcinoma as well as their correlation, and to study the relationship between the expressions and clinicopathologic characteristics of gastric carcinoma. Methods Thirty-six pairs of normal mucosa and cancer specimens were obtained from patients who had undergone gastric operation for primary gastric carcinoma and subjected to reverse transcription-ploymerase chain reaction (RT-PCR) for PPARγ and VEGF-C mRNA detection. Results The positive rate and level of PPARγ mRNA expression were higher in gastric cancer tissues than those in normal gastric mucosa (P=0.007). The positive rate and level of VEGF-C mRNA expression were also higher in gastric cancer tissues than those in normal gastric mucosa (P=0.004). Simultaneously, the expression of PPARγ was not correlated with that of VEGF-C (r=0.135, P=0.414), while the highly productions of PPARγ and VEGF-C in gastric carcinomas were both associated with the lymph node metastasis and the clinical stage (Plt;0.05). Conclusion PPARγ and VEGF-C may play an important role in the lymphangio-genesis of gastric cancer, and united detection of PPARγ and VEGF-C expressions may be correlated with making diagnosis, evaluating prognosis in patients with gastric cancer at the same time.
Objective To investigate the expression of hypoxia inducing factor 1 alpha (HIF-1α) in human breast cancer and its relationships with microvessel density （MVD）, proliferating cell nuclear antigen (PCNA) protein, other tumor biomarkers and clinicopathologic factors. Methods Immunohistochemical staining (SP) was used to measure the expressions of HIF-1α and PCNA in human breast fibroadenoma, usual hyperplasia and adenocarcinoma, and the MVD was determined by anti-CD34 immunostaining. Results No HIF-1α was observed in the lesions of breast fibroadenoma and hyperplasia. However, the positive expression rate of HIF-1α in the ductal carcinoma in situ （DCIS） was 55.0% (11/20) and the infiltrative breast cancer was 85.0%(51/60). The total high expression rate of PCNA in breast cancer was 75.0% (60/80), in which the rate of DCIS counted for 65.0% (13/20) and the rate of infiltrative adenocarcinoma counted for 78.3% (47/60). There were positive correlations between the expresson of HIF-1α and the expression of PCNA (r=0.693， P＜0.01) and MVD in DCIS (r=0.682, P＜0.05), respectively, but there was no relation between HIF-1α and MVD in infiltrative breast cancer. The expression of HIF-1α was associated with tumor cell proliferation, lymph node metastasis, estrogen receptor status (P＜0.01). Conclusion The expression of HIF-1α increased in breast cancer and it is associated with tumor cell proliferation, lymph node metastasis, estrogen receptor status. Thus, HIF-1α may play an important role in the tumor cell proliferation, vasiformation, progression and metastasis of breast cancer, and may become a new target for tumor treatment.
Objective To investigate effect of hepatocyte growth factor (HGF) after lentivirus-mediated RNA interference (RNAi) targeting c-Met on invasion of colonic carcinoma cell line SW480. Methods The experiment was assigned into 3 groups: NC group, the normal cells were infected by the shRNA negative control virus (the NC-20 andNC-40 represented the negative group which were added 20 ng/mL and 40 ng/mL respectively HGF after being infected); KD group, the normal cells were infected by the shRNA-c-Met target virus (the KD-20 and KD-40 represented the interfered group which were added 20 ng/mL and 40 ng/mL HGF respectively after being infected; KD1, KD2, KD3, and KD4 represented the different RNAi targets for the purpose gene); CON group, the normal cells were not infected by any virus. The lentiviral vector shRNA-c-Met was constructed and verified by polymerase chain reaction (PCR) and DNA sequencing. The SW480 cells were infected with the shRNA-c-Met after packed with lentivirus plasmid. Fourty-eight hours transfection later, the c-Met mRNA of the transfected SW480 cell was detected by real time PCR and the c-Met protein was examined by Western blot. Seventy-two hours after transfection, the cell apoptosis was detected by flow cytometry and the invasions in the different cells with stable transfection were detected by Transwell test. Results The RNAi sequence targeting c-Met gene was successfully inserted into the lentiviral vector. The shRNA-c-Met transfection resulted in an obviously reduced expression of c-Met mRNA in the SW480 cells. The efficency of gene knock down of the KD4 (the cells with No.4 target spot knocked down) was 81.4%. The shRNA-c-Met tansfection resulted in an obviously reduced expression of c-Met protein in the SW480 cells. After transfection, the apoptosis rate of the KD group was significantly higher than that in the NC group (P<0.001) or the CON group (P<0.001). The invasion ratios in the NC group, NC-20 group, and NC-40 group were significantly higher than those in the KD group (P<0.001), KD-20 group (P=0.015), and KD-40 group (P=0.017), respectively; which in the NC-20 group and NC-40 group were increased as compared with the NC group (P<0.001,P<0.001), and in the NC-40 group was increased as compared with the NC-20 group (P=0.005). The invasion ratios in the KD-20 group and KD-40 group were increased as compared with the KD group (P<0.001,P<0.001), and in the KD-40 group was increased as compared with the KD-20 group (P=0.014). Conclusion Lentivirus-mediated RNAi targeting c-Met could effectively suppress expression of c-Met in SW480 cells and could reduce invasion of HGF on SW480 cells with knocked down c-Met.