ObjectiveTo investigate the application significance of serum histidine decarboxylase (HDC) and D-lactate for early-stage of strangulated intestinal obstruction in rats. MethodsThirty male Wistar rats were randomly divided into two groups:blank control group (n=10) and experimental group (n=20). Rats of experimental group were established to be strangulated intestinal obstruction model by ligating 4 cm-long ileum, and were divided into obstruction-1 hour group (n=10) and obstruction-3 hour group (n=10) according to the time of intestinal obstruction. Rats of blank control group only underwent sham operation. When intestinal obstruction models were built, the change of pathology in ileum tissue was observed by light microscope. The Park/Chiu scale was used to evaluate the severity of intestinal lesion. At the same time, blood was drawn from the heart to measure the concentration of serum HDC and D-lactate by ELISA method. Real time quantitative PCR was used to detect the expression of HDC mRNA in ileum tissues. ResultsThe median injury score of ileum tissues of rats in blank control group, obstruction-1 hour group, and obstruction-3 hour group were 0 (0-1), 2 (2-3), and 5 (4-5) respectively, and increased in blank control group, obstruction-1 hour group, and obstruction-3 hour group one by one (P<0.01). The median concentrations of serum HDC of rats in blank control group, obstruction-1 hour group, and obstruction-3 hour group were 10.5 pg/mL (4.60-17.18 pg/mL), 87.93 pg/mL (41.33-119.03 pg/mL), and 150.67 pg/mL (67.33-198.14 pg/mL) respectively, and increased in blank control group, obstruc-tion-1 hour group, and obstruction-3 hour group one by one (P<0.05). The median concentrations of serum D-lactate in rats of blank control group, obstruction-1 hour group, and obstruction-3 hour group were 0 ng/mL (0-3.90 ng/mL), 0 ng/mL (0-15.63 ng/mL), and 4.92 ng/mL (0-48.13 ng/mL) respectively, and there was no significant difference among the 3 groups (P>0.05). The median expression levels of HDC mRNA in ileum tissue of rats in obstruction-3 hour group was 7.81 (7.05-8.39), which was significantly higher than those of the obstruction-1 hour group[1.77 (1.74-1.94)] and blank control group[0.97 (0.88-1.15)], P<0.01, but there was no significant difference between obstruction-1 hour group and blank control group (P>0.05). ConclusionsConcentration of serum HDC can be used for early diagnosis of strangulated intestinal obstruction. Serum D-lactate has no significant change at early-stage of strangulated intestinal obstruction.
ObjectiveTo summarize cardiopulmonary bypass (CPB) management experience in tetralogy of Fallot (TOF) infants weighing less than 8 kg. MethodsA total of 120 TOF infants weighing less than 8 kg received surgical repair in Wuhan Union Hospital from July 2009 to August 2013. There were 85 males and 35 females with their age of 1-18 months and body weight of 4-8 kg.The diagnosis of all the patients was made with echocardiography and diagnostic cardiac catheterization. Moderate hypothermia or profoundly hypothermic CPB with low-flow perfusion was used according to different surgical procedures. Imported membrane oxygenators and 4:1 cold blood cardioplegia were used. Zero-balance ultrafiltration during CPB and modified ultrafiltration during rewarming were performed. ResultsCPB time was 65-200 (115.3±9.6) minutes, and aortic cross-clamping time was 40-110 (60.3 ±10.2) minutes. A total of 112 patients received moderate hypothermia and low-or moderate-flow perfusion, and 8 patients received profound hypothermia and low-flow perfusion. Ultrafiltration volume was 780.5±50.3 ml, and hematocrit (HCT) increased to 0.35-0.40 after modified ultrafiltra-tion. Heart beat was automatically recovered in 114 patients (95%) after aortic unclamping. Weaning off CPB was successful in 119 patients, and 1 patient received extracorporeal membrane oxygenation because of difficult weaning from CPB. Postoperative mechanical ventilation time was 26.5±14.5 hours, and length of ICU stay was 121.5±16.5 hours. Five patients died of low cardiac output syndrome, and the other 115 patients were discharged successfully. ConclusionAppropriate hemodilution and colloidal pump priming solutions, perfusion methods suitable with surgical procedures, 4:1 cold blood-potassium cardioplegia, continuous zero-balance ultrafiltration during CPB and modified ultrafiltration during rewarming to maintain reasonable HCT and colloid osmotic pressure are all crucial factors in CPB management for surgical repair of TOF in infants.
ObjectiveTo investigate the status of research and development methods of Cochrane overviews. MethodsThe Cochrane Library and PubMed were searched up to March 2014 to identify Cochrane overviews. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed and analyzed search strategy, quality assessment method, data analysis, and study results. ResultsA total of 18 Cochrane overviews were included. Among them, 4 (22.2%) overviews included formal statistical indirect comparison; 8 (44.4%) included only results from direct comparison; 6 (33.4%) only systematically analyzed current studies without data pooling; 12 (66.7%) only searched The Cochrane Library, while 6 (33.3%) expanded search to other databases; 14 (77.8%) applied the AMSTAR tool to assess methodological quality of included literature; 12 (66.7%) applied the GRADE system to assess the quality of evidence; and 9 (50%) yielded new outcomes. ConclusionCurrently, the development and reporting standards of Cochrane overviews are still immature. Investigators should choose proper methods based on research objectives when developing Cochrane overviews.
ObjectiveTo investigate the guidance of preoperative nutritional risk screening in perioperative nutrition support for colon cancer, in order to provide evidence for the rationally clinical application of nutrition support. MethodsNutritional risk screening was carried out in 95 hospitalized patients with colon cancer who were treated in the Liao He Oil Center Hospital from Jul. 2012 to Jul. 2014, with the nutritional risk screening 2002 score summary table. Patients were divided into nutritional risk group and non-nutritional risk group according to the screening results, and postoperative bowel function recovery and nutritional indicators were compared between patients who received perioperative nutrition support according to the screening results and those who did not. ResultsThere were 29 patients received perioperative nutrition support among 53 patients at nutritional risk and 19 patients received perioperative nutrition support among 42 patients without nutritional risk. Among 53 patients at nutritional risk, the time to first flatus, time to first defecation, hospital stay, postoperative complications rate, and postoperative recurrence/metastasis rate of patients who received perioperative nutrition support were shorter or lower than those of patients who didn't receive perioperative nutrition support (P<0.05), but there was no significant difference in mortality (P≥0.05); in addition, the levels of albumin, prealbumin, and transferring on 7-day after surgery were all higher in patients received perioperative nutrition support (P<0.05). Among 42 patients without nutritional risk, there was no significant difference in time to first flatus, time to first defecation, hospital stay, postoperative complications rate, postoperative recurrence/metastasis rate, and levels of albumin, prealbumin, and transferring on 1- and 7-day after surgery between patients received perioperative nutrition support and those who did not (P>0.05). ConclusionsIt is important to evaluate the nutritional risk in hospitalized patients with colon cancer. Nutritional support is benefical to the patients with nutritional risk, but it isn't necessary to patients without nutritional risk.
ObjectiveTo observe the morphological and pathological changes after transplantation of polytetrafluoroethylene (PTFE) in vivo. MethodsPTFE microporous polypropylene tube which was encircled by spiral steel wire was used to prepare the artificial trachea.Forty New Zealand white rabbits (weighing,4-5 kg) were selected,and were divided into 2 groups.After the cervical trachea (2 cm in length) was removed,the end-to-end anastomosis between the trachea and PTFE artificial trachea was performed in the experimental group (n=20),and end-to-end anastomosis of the trachea in the control group (n=20).The survival of the rabbits was observed after operation;the X-ray,gross,and histological observations were carried out at 2,4,and 6 months after operation.The longitudinal tensile and radial support biomechanical tests were performed before and after transplantation. ResultsThe survival time was more than 2 months and the artificial airway was patency in 15 rabbits of the experimental group;the tissue outside the artificial trachea was like tracheal tissue,which filled in the defect,but it was more than 4 months.X-ray observation showed that the PTFE artificial trachea had no obvious displacement in the experimental group,and no tracheostenosis was observed in the control group.After 2 months,there was no epithelial tissue on the artificial airway wall;after 4 months,there was some epithelial cells on the artificial airway wall,incomplete endothelialization and trachea layer structure were seen with no tracheal ciliated columnar epithelium;after 6 months,the artificial trachea wall was covered with epithelium basically,and some ciliated columnar epithelium cells were found,which had the physiological function of the trachea.The transplanted PTFE artificial trachea could keep the stability of the biological mechanics performance,and could be used for the rabbit tracheal reconstruction. ConclusionPTFE artificial trachea can induce to form a tracheal tissue in the trachea tissues of recipients,each layer of the trachea is relatively complete and the experiment animals can be short-term survival.
ObjectiveTo summarize experiences of surgical treatment of complex giant cavernous hemangioma of the liver. MethodThe clinical data of 55 patients with complex hepatic cavernous hemangioma with tumor diameter more than 10 cm and in close proximity to hepatic hilar region or vena cava inferior underwent surgical treatment from January 2009 to December 2014 were analyzed retrospectively. ResultsAmong these 55 patients with complex giant cavernous hemangioma,13 cases (23.6%) were male,42 cases (76.4%) were female.The median age was 49.2 years (range from 23 to 68 years).Hepatic hemangioma with multiple lesions was most common (71.0%,39/55).The tumor happened mostly in the right hepatic lobe (47.3%,26/55).The median size of complex giant cavernous hemangioma was 16.2 cm (10.2-50.0 cm).The liver functions of all the patients were normal (Child-Pugh A).Different methods of hepatic inflow occlusion and surgical procedures were performed according to the tumor location and size.Of the patients,17 cases were underwent Pringle maneuver,12 cases were underwent modified Pringle maneuver and 1 case was underwent hemihepatic vascular occlusion;28 cases were treated by extracapsular enucleation,27 cases by liver resection.The average operative time was 202 min (85-420 min).The average intraoperative blood loss was 855.5 mL (50-3 000 mL).Twenty-six cases (47.3%) had no blood transfusion,and 10 cases (18.2%) had autologous blood transfusion.The associated complications occurred in 7 patients after surgery,and no surgical death occurred.The median postoperative hospital stay was 14.8 d. ConclusionsThe essential points in operation for the complex giant cavernous hemangioma are the control and management of the operative massive bleeding,and the preservation of the normal hepatic parenchyma as much as possible.The surgical treatment is safe and feasible under the proper hepatic inflow occlusion and resection methods.The prevention and management of bile leakage is also important.
ObjectiveTo evaluate the effectiveness of acellular dermal matrix (ADM) with autologous buccal micro mucosa and micro skin graft in vaginoplasty. MethodsA retrospective analysis was made on the clinical data of 67 patients with vaginal agenesis treated between July 2006 and June 2013. ADM and mixed particles were used in 20 cases (ADM group) and mixed particles graft in 47 cases (control group) in vaginoplasty. There was no significant difference in age between 2 groups (t=0.233, P=0.816). The depth, diameter, and volume of neovagina, epithelization time, stent needing time, and female sexual function index (FSFI) score were compared between 2 groups. ResultsThere was no significant difference in operation time and amount of bleeding between 2 groups (t=-1.922, P=0.059; t=0.398, P=0.692). The patients were followed up 11-38 months (mean, 16.08 months). Fifteen cases in ADM group and 29 cases in control group had sexual life after operation. Bleeding after operation occurred in 6 cases (2 in ADM group and 4 in control group). No stenosis was observed. Difference in epithelization time was not statistically significant (t=-1.938, P=0.057). However, the stent needing time of ADM group was significantly shorter than that of control group (t=7.020, P=0.000). The neovagina was ideal in wetness degree, smoothness, flexibility, and hairlessness during follow-up. The depth, diameter, and volume of vagina had no significant difference between 2 groups (P>0.05) at last follow-up, which were close to normal vagina. The other patients had normal sexual function except 1 patient whose FSFI score was less than 23; no statistically significant difference was found in FSFI score between 2 groups (P>0.05). ConclusionOn the basis of mixed particles grafting, the ADM could improve trestle structure for resisting contracture. The effectiveness is better than merely mixed particles graft. The procedure has satisfactory anatomical and functional results.
ObjectiveTo evaluate the metastasis feature and the dissecting value of cervicothoracic lymph node for middle esophageal squamous carcinoma. MethodsA total of 303 patients admitted to the Rugao Boai Hospital(107 patients) and the Rugao People's Hospital (196 patients) received the stapled cervical esophagogastrostomy via different thoracic approach according to the admission order number between March 2005 and February 2013. There were 290 patients with Ro resections including 149 patients by Ivor-Lewis approach (an Ivor-Lewis group) and 141 patients by Sweet approach (a Sweet group). The data of lymph nodal dissection and PTNM stage and follow-up of the two groups were analyzed. ResultsThe number of positive lymph nodes dissected from the cervicothoracic junction in the IvorLewis group was significantly greater than that in own upper abdomen (Z=3.12, P<0.05) and that in the cervicothoracic junctionin in the Sweet group (Z=3.30, P<0.05). The lymph node metastasis rate of the cervicothoracic junction in the Ivor-Lewis group was significantly higher than that in own upper abdomen(χ2=10.76, P<0.05)and that in the cervicothoracic junction in the Sweet group (χ2=7.34, P<0.05). The lymph node ratio (LNR) of the cervicothoracic junction in the Ivor-Lewis group was significantly higher than that in own upper abdomen (χ2=11.67, P<0.05) and that in the cervicothoracic junction in the Sweet group (χ2=5.99, P<0.05). The proportion of patients which PTNM were Ⅲa or Ⅲb as N＞N1 in the Ivor-Lewis group was significantly higher than that in the Sweet group(χ2=5.59, P<0.05). After surgery of 1 year, 3 years, 5 years, the rate of lymph node local recurrence and the total rate of tumor metastasis or recurrence in the Ivor-Lewis group were significantly lower than in the Sweet group (P<0.05). The survival rate in the Ivor-Lewis group was significantly greater than that in the Sweet group (P<0.05). ConclusionThe cervicothoracic junction has a higher incidence of lymphatic metastasis, which transfer intensity is greater than that of upper abdomen. The extended cervicothoracic lymph node dissection should be indeed indispensible to increase of radical resection and the accuracy of PTNM stage and to improve the long term survival for middle esophageal carcinoma.
Objective To determine if laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising enables better perioperative and medium-term outcome than Ivor-Lewis cervical stapled esophagogastrostomy via thorax for middle esophageal carcinoma without intumescent lymphnode of neck. Methods The perioperative and medium-term outcome of a series of 55 patients underwent Ivor-Lewis cervical stapled esophagogas-trostomy via thorax between April 2010 and December 2012 were as a historic cohort (group A, 36 males, 19 females at age of 65±8 years). And 46 patients underwent laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising between January 2013 and March 2015 were as a prospective cohort (group B, 31males, 15 females at age of 66±7 years). Perioperative indexes, lymphadenectomy, and result at end of one year following up were compared. Results Compared with group A, there was shorter thoracic operation time (t=5.94, P < 0.05), shorter time of restored anus exhaust (t=2.08, P < 0.05), less pulmonary complication (χ2=3.08, P < 0.05) and less total perioperative complications (χ2=4.30, P < 0.05), shorter postoperative hospital stay (t=3.20, P < 0.05) in the group B. While no statistically significant difference was found between the two group in postoperative morbidity of circulation or digestive and associated with surgical techniques (all P>0.05), lymph node metastasis rate of cervico-thoracic (include cervical paraesophageal) or mediastinum or abdominal cavity (χ2=0.03, 0.15, 0.08, all P>0.05), lymph node ratio (LNR) of cervical thoracic (include cervical paraesophageal) or mediastinum or abdominal cavity (χ2=0.01,0.71, 0.01, all P>0.05), recurrence rate of tumour (χ2=0.04, P>0.05), or survival rate (χ2=0.13, P>0.05) one year after the surgery. Conclusion Laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising is a more rational surgery of cervicothoracic and cervical paraesophageal lymph nodes dissection via intrathoracic instead of cervical approach for middle esophageal carcinoma.