ObjectiveTo summarize the clinical advantages and the treatment of perineal defect of extra-levator abdominoperineal excision, and to discuss the treatments of postoperative complications. MethodsChinese or English literatures about extra-levator abdominoperineal excision were collected to summarize and analyze the clinical signifi-cance of it. ResultsExtra-levator abdominoperineal excision had a lot of advantages in reducing the circumferential resection margin involvement rate and intraoperative perforation rate for patients with low rectal cancer. The huge perineal defect caused by the operation could achieve good healing after appropriate treatment. At the same time, we should avoid the occurrence of urogenital system dysfunction and perineal pain. ConclusionExtra-levator abdomino-perineal excision is a safe and effective procedure aimed at patients with low rectal cancer, and can be applied during clinical practice.
ObjectiveTo assess whether pre-operative use of infliximab (IFX) will increase the risk of post-operative infectious complications in patients with inflammatory bowel disease (IBD). MethodsPubmed, Web of Science, CBM, CNKI and Wanfang database were searched for all the trials that investigated the effects of infliximab on postoperative infectious complication rates in patients with IBD between January 1990 and April 2013. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. ResultsTotally, 14 cohort studies were finally included in the review. There was no significant difference on infectious complications [RR=0.99, 95%CI (0.47, 2.07), P=0.97] between IFX groups and control groups with ulcerative colitis. The same results were found in patients with Crohn's disease on infectious complications [RR=1.32, 95%CI (0.87, 1.98), P=0.19]. ConclusionPre-operative infliximab use is safe and does not increase the risk of post-operative infectious complications in patients with IBD.
An adaptive inertia weight particle swarm algorithm is proposed in this study to solve the local optimal problem with the method of traditional particle swarm optimization in the process of estimating magnetic resonance (MR) image bias field. An indicator measuring the degree of premature convergence was designed for the defect of traditional particle swarm optimization algorithm. The inertia weight was adjusted adaptively based on this indicator to ensure particle swarm to be optimized globally and to avoid it from falling into local optimum. The Legendre polynomial was used to fit bias field, the polynomial parameters were optimized globally, and finally the bias field was estimated and corrected. Compared to those with the improved entropy minimum algorithm, the entropy of corrected image was smaller and the estimated bias field was more accurate in this study. Then the corrected image was segmented and the segmentation accuracy obtained in this research was 10% higher than that with improved entropy minimum algorithm. This algorithm can be applied to the correction of MR image bias field.
ObjectiveTo evaluate the viability, short-term clinical efficacy, and safety of ultrasound-guided radioactive seed 125I permanent implantation in tissue in patients with advanced colorectal cancer. MethodsA total of 9 patients were recruited in this study. All of the patients came from China-Japan Union Hospital of Jilin University from October 2012 to October 2014, which had been selected after strict screening. Five cases of male patients, 4 cases of female patients; the age was between 46-78 years old, the median age was 54 years old. There were 5 cases of patients with pain. There were 14 lesions in total, 1 lesion was local tumor recurrence, 2 lesions were pelvic metastasis, 8 lesions were liver metastases, and 3 lesions were abdominal lymph node metastasis. CEA increased in 6 cases before implantation. All patients were confirmed metastasis by CT, MRI examination or pathology. The 125I radioactive seed implantation was guided by real-time ultrasound. CT scanning was taken in two months after treatment. The degree of pain relief, tumor local control, and the occurrence of complications were observed. ResultsIn 2 months after implantation of 125I radioactive particles, the CT scanning results showed that 2 cases obtained complete response (CR), 5 cases obtained partial response (PR), 1 case got stable disease (SD), and 1 case got progress disease (PD). Total effective was 7/9, and disease control was 8/9. Five cases with pain symptoms were relieved after treatment. One walk metal particle in the abdominal cavity was found by abdominal CT scanning in 1 case. There were no serious complications intraoperative and postoperative. ConclusionsUltrasound guided radioactive seeds 125I implantation in the treatment of advanced colorectal cancer can significantly relieve the clinical symptoms, improve the quality of life, and can effectively control the metastasis. It is safe and feasible, and the postoperative hospitalization time is short, it has the avantages of safety, effectiveness, and low incidence of complications.
ObjectiveTo explore the clinical effectiveness of two kinds of treatment methods to nurse wound after tracheotomy. MethodsWe collected 108 cases and randomly divided them into two groups between March 2012 and May 2013. The experimental group (n=52) received tracheotomy care with PermaFoam dressing, while the control group (n=56) was treated with traditional sterile absorbent gauze. We analyzed the differences in terms of infection of wound, errhysis and frequency of dressing changes between the two groups. ResultsThe experimental group had a lower rate of wound infection than the control group (P<0.05). Moreover, the experimental group was superior to the control group in the total number of dressing changes, wound redness and oozing (P<0.05). ConclusionPermaFoam dressing can reduce wound complications and frequency of dressing changes effectively. It is easy to operate, and can reduce the workload of clinical nursing, and deserves clinical application.
ObjectiveTo analyze the application of artificial pricing system in wound care clinic. MethodsWe retrospectively analyzed the pricing and charging by five nurses with artificial pricing system between January and May 2013 in the wound care clinic of a grade-A level-three hospital in Beijing. Among the 1012 times of pricing, 448 were out-of-pocket cases, 372 were insurance cases and 192 were military cases. ResultsGenerally, the average fee of the three types of cases had no significant difference (P>0.05). The military case was a little higher than the other two kinds of cases, and the cost of insurance cases was the lowest of all. There were no significant difference between the average price of out-of-pocket cases and military cases, and the general average price, but there was some differences in the aspect of insurance pricing. In the insurance cases, two nurses' pricing was significantly lower and one significantly higher than the general average (P<0.05). ConclusionThe artificial pricing system is unstable and uncertain, and it has high risk on patients'safety in wound care clinic.
ObjectiveTo investigate the feasibility and effectiveness of a modified cross-lip flap with lip artery anatomosis so as to shorten inward time. MethodsBetween August 2010 and January 2014, 11 patients underwent cross-lip flap surgery with lip artery anatomosis to repair upper lip defects. There were 9 males and 2 females with an average age of 62 years (range, 13-70 years). The defects causes were tumors removal in 6 cases, animal bites in 2 cases, and secondary deformity after cleft lip repair surgery in 3 cases. The width and height of defect were 1.5-4.0 cm and 1.8- 3.5 cm respectively; the width and height of flap were 1.5-3.2 cm and 1.5-3.0 cm respectively. The donor site was directly sutured. ResultsAll flaps survived, and wound healed by first intention. The flap pedicle was cut off at 5 days after operation. No blister, desquamation, or circulatory malfunction was found. Delayed healing of incision occurred in 1 patient with diabetes. Eleven patients were followed up 5-24 months (mean, 11 months). The patients had normal facial expression, food intake, and language function. The function of brush directional stroke test sensation recovered in 7 (77.8%) of 9 followed patients at 12 months after operation. ConclusionThe modified cross-lip flap with lip artery anatomosis is feasible and effective in repair of upper lip defects, because it can gain much more blood supply from lip right now in first surgery, shorten inward time, and relief patient's discomfort.
ObjectiveTo investigate the utility of indocyanine green angiography in flap reconstructive surgery and possibility of decrease the complications. MethodsIndocyanine green angiography was performed on 14 patients undergoing flap reconstructive surgery between February and December 2014 to evaluate the blood perfusion of the flap and to adjust the operation plan. Of 14 cases, 2 were male and 12 were female, aged 23-58 years (mean, 35.5 years); 11 flaps were used for breast reconstruction [including 3 free deep inferior epigastric antery perforator (DIEP) flaps, 4 pedicled transverse rectus abdominis myocutaneous flaps (TRAM), 2 pedicled TRAM and free TRAM, and 2 pedicled latissimus dorsi myocutaneous flaps and prosthesis], 1 pedicled latissimus dorsi myocutaneous flap for repairing chest wall defect, 1 pedicled profunda artery perforator (PAP) flap for upper leg defect, and 1 pedicled descending genicular artery perforator flap for knee defect. The size of the flaps ranged from 9 cm×6 cm to 26 cm×12 cm. ResultsA total of 32 indocyanine green angiography were performed. There was no adverse reactions to the infusion of indocyanine green. The surgery management was adjusted according to results of indocyanine green angiography findings in 5 of 14 cases. The distal part of flap were discarded because of poor perfusion in 3 cases (1 DIEP flap, 1 TRAM, and 1 PAP flap) and the other 2 cases (pedicled TRAM) needed additional free anastomosis to ensure sufficient blood supply (pedicled TRAM and free TRAM); the other flaps were harvested according to preoperative plan and repaired defect successfully. The mean follow-up was 5 months (range, 1-9 months). The other flaps survived without infection or fat necrosis except 1 PAP flap with distal necrosis. ConclusionIntraoperative indocyanine green angiography can provide real-time information of flap perfusion and then the operation plan can be adjusted in time to ensure the flap survival.
This study aimed to characterize and magnetic resonance imaging (MRI) track the mesenchymal stem cells labeled with polylysine-coated superparamagnetic iron oxide (PLL-SPIO). Rat bone marrow derived mesenchymal stem cells (rMSCs) were labeled with 25, 50 and 100 μg/mL PLL-SPIO for 24 hours. The labeling efficiency was assessed by iron content, Prussian blue staining, electron microscopy and in vitro MR imaging. The labeled cells were also analyzed for cytotoxicity and differentiation potential. Electron microscopic observations and Prussian blue staining revealed that 75%-100% of cells were labeled with iron particles. PLL-SPIO did not show any cytotoxicity up to 100 μg/mL concentration. Both 25 μg/mL and 50 μg/mL PLL-SPIO labeled stem cells did not exhibit any significant alterations in the adipo/osteo/chondrogenic differentiation potential compared to unlabeled control cells. The lower concentration of 25 μg/mL iron labeled cells emitted an obvious dark signal in T1W, T2WI and T2*WI MR image. The novel PLL-SPIO enables to label and track rMSCs for in vitro MRI without cellular alteration. Therefore PLL-SPIO may potentially become a better MR contrast agent especially in tracking the transplanted stem cells and other cells without compromising cell functional quality.
ObjectiveTo observe the changes of peripheral blood lymphocyte subsets of patients with primary hepatocellular carcinoma (PHCC) treated with radiofrequency ablation (RFA). MethodsThe data of 70 cases of hospitalized patients with PHCC that voluntary accepted RFA diagnosed by clinical and pathological in our hospital between July 2011 and December 2014 were collected. According to the numbers of HCC lesions, 70 cases were divided into single focus group (n=41) and multifocal group (n=29). The changes of their immune parameters before and after RFA were analyzed. Results①The ratioes of peripheral blood CD3+/CD19-, CD3+/CD4+, CD4+/CD8+, and NK cells on 7 days and 14 days after RFA treatment of 70 cases were significantly higher than those on 1 day before RFA treatment (P < 0.05). The ratio of CD3+/CD8+ T cells reduced from 1 day before RFA treatment to 14 days after RFA treatment, but the difference was no statistically significant (P > 0.05).②The changing trend of peripheral blood lymphocyte subsets before and after RFA treatment in single focus group and multifocal group were similar to the above.③Compared with single focus group, the ratioes of peripheral blood CD3+/CD19-, CD3+/CD4+, CD4+/CD8+, and NK cells before and after RFA treatment in multifocal group were lower, and the ratio of CD3+/CD8+ T cells was higher, but the difference were not statistically significant (P > 0.05). ConclusionRFA can not only destroy small PHCC foci, but also to significantly improve immune function and enhance the anti-tumor effect.