Comparative analysis of two digestive tract reconstruction methods in total laparoscopic radical total gastrectomy.

BACKGROUND: The incidence of gastric cancer has significantly increased in recent years. Surgical resection is the main treatment, but the method of digestive tract reconstruction after gastric cancer surgery remains controversial. In the current study, we sought to explore a reasonable method of digestive tract reconstruction and improve the quality of life and nutritional status of patients after surgery. To this end, we statistically analyzed the clinical results of patients with gastric cancer who underwent jejunal interposition double-tract reconstruction (DTR) and esophageal jejunum Roux-en-Y reconstruction (RY). AIM: To explore the application effect of DTR in total laparoscopic radical total gastrectomy (TLTG) and evaluate its safety and efficacy. METHODS: We collected the relevant data of 77 patients who underwent TLTG at the Fourth Hospital of Hebei Medical University from October 2021 to January 2023. Among them, 35 cases were treated with DTR, and the remaining 42 cases were treated with traditional RY. After 1:1 propensity score matching, the cases were grouped into 31 cases per group, with evenly distributed data. The clinical characteristics and short- and long-term clinical outcomes of the two groups were statistically analyzed. RESULTS: The two groups showed no significant differences in basic data, intraoperative blood loss, number of lymph node dissections, first defecation time after operation, postoperative hospital stay, postoperative complications, and laboratory examination results on the 1st, 3rd, and 5th days after operation. The operation time of the DTR group was longer than that of the RY group [(307.58 ± 65.14) min vs (272.45 ± 62.09) min, P = 0.016], but the first intake of liquid food in the DTR group was shorter than that in the RY group [(4.45 ± 1.18) d vs (6.0 ± 5.18) d, P = 0.028]. The incidence of reflux heartburn (Visick grade) and postoperative gallbladder disease in the DTR group was lower than that in the RY group (P = 0.033 and P = 0.038). Although there was no significant difference in body weight, hemoglobin, prealbumin, and albumin between the two groups at 1,3 and 6 months after surgery, the diet of patients in the DTR group was better than that in the RY group (P = 0.031). CONCLUSION: The clinical effect of DTR in TLTG is better than that of RY, indicating that it is a more valuable digestive tract reconstruction method in laparoscopic gastric cancer surgery.

Impact of glucocorticoids and rapamycin on autophagy in Candida glabrata-infected macrophages from BALB/c mice.

Objective: In the defense against microorganisms like Candida albicans, macrophages recruit LC3(Microtubule-associated protein 1A/1B-light chain 3) to the periplasm, engaging in the elimination process through the formation of a single-membrane phagosome known as LC3-associated phagocytosis (LAP). Building on this, we propose the hypothesis that glucocorticoids may hinder macrophage phagocytosis of Candida glabrata by suppressing LAP, and rapamycin could potentially reverse this inhibitory effect. Methods: RAW264.7 cells were employed for investigating the immune response to Candida glabrata infection. Various reagents, including dexamethasone, rapamycin, and specific antibodies, were utilized in experimental setups. Assays, such as fluorescence microscopy, flow cytometry, ELISA (Enzyme-Linked Immunosorbent Assay), Western blot, and confocal microscopy, were conducted to assess phagocytosis, cytokine levels, protein expression, viability, and autophagy dynamics. Results: Glucocorticoids significantly inhibited macrophage autophagy, impairing the cells' ability to combat Candida glabrata. Conversely, rapamycin exhibited a dual role, initially inhibiting and subsequently promoting phagocytosis of Candida glabrata by macrophages. Glucocorticoids hinder macrophage autophagy in Candida glabrata infection by suppressing the MTOR pathway(mammalian target of rapamycin pathway), while the activation of MTOR pathway by Candida glabrata diminishes over time. Conclusion: Our study elucidates the intricate interplay between glucocorticoids, rapamycin, and macrophage autophagy during Candida glabrata infection. Understanding the implications of these interactions not only sheds light on the host immune response dynamics but also unveils potential therapeutic avenues for managing fungal infections.

Comparison of the effects of different artificial discs on hybrid surgery: A finite element analysis.

In recent years, artificial cervical discs have been used in intervertebral disc replacement surgery and hybrid surgery (HS). The advantages and disadvantages of different artificial cervical discs in artificial cervical disc replacement surgery have been compared. However, few scholars have studied the biomechanical effects of various artificial disc prostheses on the human cervical spine in HS which include the Anterior Cervical Discectomy and Fusion (ACDF) and Cervical Disc Arthroplasty (CDA). This study compared the biomechanical behavior of Mobi-C and Prestige LP in the operative and adjacent segments during two-level hybrid surgery. A three-dimensional finite element model of C2-C7 was first established and validated. Subsequently, clinical surgery was then simulated to establish a surgical model of anterior cervical fusion at the C4-C5 level. Mobi-C and Prestige-LP artificial disc prostheses were implanted at the C5-C6 level to create two hybrid models. All finite element models were fixed on the lower endplate of the C7 vertebra and subjected to a load of 73.6 N and different directions of 1 Nm torque on the odontoid process of the C2 vertebra to simulate human flexion, extension, lateral bending, and axial rotation. This paper compares the ROM, intervertebral pressure, and facet joint force after hybrid surgery with the intact model. The results show that compared with Prestige LP, Mobi-C can improve ROM of the replacement segment and compensate for the intervertebral pressure of the adjacent segment more effectively, but the facet joint pressure of the replacement segment may be higher.

A case series of 10 patients undergone linear cutter/stapler guiding device-led overlapped esophagojejunostomy: a preliminary study.

Background: In laparoscopic total gastrectomy with overlap esophagojejunostomy (EJS), esophageal 'false track' is easily formed during EJS. In this study, a linear cutter/stapler guiding device (LCSGD) was used in EJS, so that the linear cutting stapler can complete the technical action with high speed and high efficiency in a narrow space, while avoiding the formation of 'false passage', optimizing the quality of common opening and shortening the anastomosis time. The LCSGD is safe and feasible in laparoscopic total gastrectomy overlap EJS, and the clinical effect is satisfactory. Methods: A retrospective, descriptive design was adopted. The clinical data of 10 gastric cancer patients admitted to the Third Department of Surgery of the Fourth Hospital of Hebei Medical University from July 2021 to November 2021 were collected. The cohort comprised 8 males and 2 females aged 50-75 years. Results: (I) The intra-operative conditions: 10 patients received LCSGD-guided overlap EJS after radical laparoscopic total gastrectomy. Both D2 lymphadenectomy and R0 resection were achieved in these patients. No combined multiple organ resection was performed. There was neither conversion to an open thoracic or abdominal procedure nor conversion to other EJS approaches. The average time from the entry of the LCSGD into the abdominal cavity to the completion of the firing of the stapler was 1.8±0.4 minutes, the average time for manual suturing of the EJS common opening was 14.4±2.1 minutes (mean: 18±2 stitches), and the average operative time was 255±52 minutes. (II) The postoperative outcomes: the time to the first ambulation was 1.9±1.4 days, the average time to the first postoperative exhaust/defecation was 3.5±1.3 days, the average time to a semi-liquid diet was 3.6±0.7 days, and the average postoperative hospital stay was 10.4±4.1 days. All patients were smoothly discharged, without any secondary surgery, bleeding, anastomotic fistula, or duodenal stump fistula. (III) Follow-up: The telephone follow-up lasted 9-12 months. No eating disorders or anastomotic stenosis was reported. One patient experienced Visick grade II heartburn, and the condition of the remaining 9 patients was Visick grade I. Conclusions: Application of the LCSGD in overlap EJS after laparoscopic total gastrectomy is safe and feasible, with satisfactory clinical effectiveness.

Deep Fungal Infections Among General Hospital Inpatients in Southwestern China: A 5-Year Retrospective Study.

Background: Deep fungal infection is a type of life-threatening opportunistic infection. Its incidence has been increasing in recent years. This infection can affect the prognosis of patients, prolong hospital stays and raise costs for patients and their families. Objective: We aimed to understand the current situation of deep fungal infections in the First Affiliated Hospital of Kunming Medical University and to provide a basis for the clinical diagnosis and treatment of deep fungal infections. Methods: This was a retrospective analysis of 528,743 cases in the hospital from 2015 to 2019, including the epidemiological characteristics, treatment and prognosis of deep fungal infections. Results: A total of 274 cases (0.05%) with deep fungal infections were identified, accounting for 0.05% of the total number of hospitalizations. The incidence of deep fungal infections in the hospital showed an increasing trend from 2015 to 2019. The most commonly infected site was the respiratory tract (93.07%). Among patients with deep fungal infections, 266 specimens were positive for fungal culture, by which 161 cultured Candida albicans (C. albicans), accounting for 60.53%, the main pathogen causing deep fungal infection. From 2015 to 2019, the percentage of C. albicans cases showed a downward trend, while that of non-C. albicans showed an opposite trend. Antibiotics were the most common predisposing factor for deep fungal infections (97.45%). Among the underlying diseases of patients with deep fungal infections, infectious diseases (59.49%) were the most common. Those with underlying diseases such as renal insufficiency and neurological diseases had a worse prognosis. Indwelling catheters, nervous system disease and tumors were risk factors for a poor prognosis. Conclusions: We report for the first time the epidemiological data of deep fungal infections in a general hospital in southwestern China from 2015 to 2019. In the past 5 years, the number of patients with deep fungal infections in the First Affiliated Hospital of Kunming Medical University has been increasing. Although the clinical data are limited, these results can provide references for the diagnosis and treatment of deep fungal infections.

Effect of Antifungal-Treated Host Macrophages on Candida glabrata.

OBJECTIVE: Candida glabrata (C. glabrata) causes infections associated with severe sepsis and high mortality. This study describes the effects of micafungin (MCF), itraconazole (ICZ), and amphotericin B (AmB) on the function of macrophages during C. glabrata infection. METHODS: RAW264.1 macrophages were treated with MCF, ICZ, or AmB and then challenged with C. glabrata. Cytokines from infected macrophage supernatants and the levels of superoxide dismutase (SOD) in macrophages were measured at different time points after phagocytosis. RESULTS: The activity of SOD was significantly increased in RAW264.1 cells that phagocytized C. glabrata and reached a peak level at 6 hours (P < 0.05). ICZ and AmB did not affect the SOD activity in cells that phagocytized C. glabrata versus that in untreated macrophage. C. glabrata stimulated macrophages to secrete cytokines. Neither ICZ nor AmB affected the secretion of interleukin-6 (IL-6), interleukin-8 (IL-8), or tumor necrosis factor-α (TNF-α) by C. glabrata-infected macrophages. However, MCF downregulated the secretion of TNF-α by infected macrophages and reduced the SOD activity of C. glabrata compared with those in untreated controls. CONCLUSION: Echinocandins may increase their antifungal efficacy by altering the innate immune response of macrophages and attenuating antioxidants of this organism.

Susceptibilities of Malassezia strains from pityriasis versicolor, Malassezia folliculitis and seborrheic dermatitis to antifungal drugs.

The human pathogenic yeast genus Malassezia may be an etiological agent of skin disorders and has received considerable attention from dermatologists in recent years. To investigate the different susceptibilities of Malassezia species to four antifungal drugs, we isolated a total of 244 Malassezia strains and identified six species of Malassezia from patients with clinical skin diseases. The minimum inhibitory concentration (MIC) of the four antifungal drugs was obtained by comparing the susceptibility of the isolated Malassezia strains to four antifungal drugs (ketoconazole (KTZ), itraconazole (ITZ), fluconazole (FLC) and amphotericin B (Am B)). We demonstrated that M. furfur, M. sympodialis, M. pachydermatis and M. globosa are the most common Malassezia species in the three skin diseases. The MICs of KTZ, ITZ, FLC and Am B against M. furfur, M. sympodialis, M. pachydermatis and M. globosa ranged from 0.03 - 16 mg/L, 0.03 - 2.0 mg/L, 0.03 - 8 mg/L, and 13 - 64 mg/L, respectively. The sensitivities of Malassezia to the four antifungal drugs from high to low were ITZ ≥ KTZ > Am B > FLC. The susceptibilities of the various Malassezia species to the four antifungal drugs were different, and the susceptibility of M. furfur to KTZ was significantly different from those of the three skin diseases (pityriasis versicolor, Malassezia folliculitis and seborrheic dermatitis). Our results suggested that the MIC analysis of the four antifungal drugs would be helpful in preventing drug resistance in the clinical screening of Malassezia and choosing better antifungal drugs to treat Malassezia-associated skin diseases.

TPPA titer as a new adaptation for early diagnosis of congenital syphilis: a retrospective analysis of observation over three years in Yunnan, China.

BACKGROUND: Early diagnosis of congenital syphilis (CS) is difficult. This study aimed to determine the serological response discipline of syphilis passive antibody (SPA) in infants born to mothers with syphilis and provide the basis for the early diagnosis of CS. METHODS: Thirty-three infants born to mothers with syphilis and six infants with CS were recruited. The toluidine red unheated serum test (TRUST) and Treponema pallidum particle agglutination (TPPA) titers were followed up after birth. RESULTS: The results showed that serological response in the serum of infants with the TPPA titer decreased threefold at 3rd month, or the titer dropped to a minimum of 1:40 at 9th month was SPA. The TPPA titer of 6 CS cases remained positive after 3-year follow-up, and the titer did not decline after treatment and maintained longer. The infants with TRUST titer ≥ 1:4 at birth were prone to become syphilis serofast, while TRUST titer < 1:4 turned to negative quickly. CONCLUSION: In infants with SPA, the TRUST converted negative earlier than the TPPA. The lower the TPPA initial titer was, the shorter the seroreversion time required. The TPPA titer can be used to predict CS in infants born to mothers with syphilis.

Role of Vitamin C in Skin Diseases.

Vitamin C (ascorbic acid) plays an important role in maintaining skin health and can promote the differentiation of keratinocytes and decrease melanin synthesis, leading to antioxidant protection against UV-induced photodamage. Normal skin needs high concentrations of vitamin C, which plays many roles in the skin, including the formation of the skin barrier and collagen in the dermis, the ability to counteract skin oxidation, and the modulation of cell signal pathways of cell growth and differentiation. However, vitamin C deficiency can cause or aggravate the occurrence and development of some skin diseases, such as atopic dermatitis (AD) and porphyria cutanea tarda (PCT). Levels of vitamin C in plasma are decreased in AD, and vitamin C deficiency may be one of the factors that contributes to the pathogenesis of PCT. On the other hand, high doses of vitamin C have significantly reduced cancer cell viability, as well as invasiveness, and induced apoptosis in human malignant melanoma. In this review, we will summarize the effects of vitamin C on four skin diseases (porphyria cutanea tarda, atopic dermatitis, malignant melanoma, and herpes zoster and postherpetic neuralgia) and highlight the potential of vitamin C as a therapeutic strategy to treat these diseases, emphasizing the clinical application of vitamin C as an adjuvant for drugs or physical therapy in other skin diseases.

Intraoperative Perfusion Computed Tomography in Carotid Endarterectomy: Initial Experience in 16 Cases.

BACKGROUND This study aimed to evaluate the changes in perfusion computed tomography (PCT) parameters in carotid endarterectomy (CEA), and to discuss the use of intraoperative PCT in CEA. MATERIAL AND METHODS Sixteen patients with carotid stenosis who also underwent CEA with intraoperative CT were recruited in this study. We calculated quantitative data on cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), and the relative parameter values, including relative CBF (rCBF), relative CBV (rCBV), and relative TTP (rTTP). The role of PCT was assessed and compared to conventional monitoring methods. RESULTS There were no significant differences in any of the parameters in the anterior cerebral artery (ACA) territory (P>0.05). In the middle cerebral artery (MCA) territory, the CBF and CBV increased and TTP decreased in the operated side during CEA; the rCBF and rCBV increased and the rTTP decreased significantly (P<0.05). In 16 patients, CT parameters were improved, SSEP was normal, and MDU was abnormal. In 3 patients, CBF increased by more than 70% during CEA. Relative PCT parameters are sensitive indicators for detecting early cerebral hemodynamic changes during CEA. Cerebral hemodynamics changed significantly in the MCA territory during CEA. CONCLUSIONS Intraoperative PCT could be an important adjuvant monitoring method in CEA.

[Preliminary application of intraoperative CT in treatment of severe scoliosis with posterior total pedicle screws].

OBJECTIVE: To study the clinical effects and application value of intraoperative CT in treatment of severe scoliosis with posterior total pedicle screws. METHODS: Thirty-two cases of severe scoliosis were retrospectively analysed in our hospital from June 2009 to June 2011,which were treated by posterior total pedicle screws with intraoperative CT including 12 males and 20 females with an average age of 16.8 years ranging from 10 to 38 years. There were 19 cases combined with thoracic kyphosis among 32 cases. Multiple planar reconstruction technology of intraoperative CT was applied to assess screw position. The numbers (rates) of pedicle screws were calculated and evaluated as different grades in upper thoracic vertebra (T1-T4) ,middle thoracic vertebra (T5-T8), lower thoracic vertebra (T9-T12) and lumbar vertebra. The pedicle screws of 2 grade and 3 grade were defined as malpositioned screws. Times of applicating intraoperative CT were calculated. Cobb angle of all cases and kyphosis angle of the cases combined with thoracic kyphosis were measured before and after surgery. Scoliosis correction rates and kyphosis correction rates were calculated. RESULTS: There were 686 pedicle screws placed in thoracolumbar of 32 patients (including 544 thoracic pedicle screws,142 lumbar pedicle screws) and 14 patients underwent osteotomy. The rate of malpositioned screws in thoracolumbar was 7.3% by evaluating with intraoperative CT,and it respectively was 5.6%,11.1%, 6.7% and 4.3% in upper thoracic vertebra, middle thoracic vertebra,lower thoracic vertebra and lumbar vertebra. The malpositioned screws were amended in surgery. The mean times of intraoperative CT was 2.6 times (ranged from 2 times to 4 times). The mean preoperative Cobb angle was 95 degrees (ranged from 78 degrees to 123 degrees) and the mean postoperative Cobb angle was 340 (ranged from 19 degrees to 53 degrees). The mean correction rate of Cobb angle was 64%. The mean preoperative kyphosis angle of the patients combined with thoracic kyphosis was 69 degrees (ranged from 46 degrees to 82 degrees) and the mean postoperative kyphosis angle was 32 degrees (ranged from 22 degrees to 45 degrees). The mean correction rate of kyphosis angle was 54%. Four patients suffered cerebrospinal fluid leak after surgery. No infection, vascular lesion and nervous lesion were found. All patients had an average 18-month follow-up (ranged from 12 to 26 months). No broken nails, broken rods and pseudarthrosis were founded. CONCLUSION: Application of in traoperative CT in severe scoliosis with posterior total pedicle screws can detect and amend malpositioned screws timely in surgery, to avoid secondary surgery for malpositioned screws and protect the safety of surgery. The effects of surgery is satisfactory.

Intraoperative CT-guided cochlear implantation in congenital ear deformity.

CONCLUSIONS: Intraoperative computed tomography (iCT)-guided cochlear implantation is practical and effective for correct electrode placement in the cochlea of patients with congenital inner ear and/or complex middle ear malformation. OBJECTIVES: The operation in patients with inner ear and/or complex middle ear malformation including abnormal facial nerve course is difficult. This study evaluated the efficacy of cochlear implantation under the guidance of iCT to insure correct electrode placement. METHODS: This was a prospective interventional case series. Ten patients with severe to profound sensorineural hearing loss due to ear malformations were enrolled, and iCT was used to confirm the right placement of electrodes. RESULTS: Intraoperative CT was performed three times in one patient, twice in two, and once in the others. Interruption of the surgical process for each iCT until resumption of surgery was 9.64 ± 0.63 min. iCT revealed incorrectly positioned cochlear implants in two patients, which were immediately corrected. There were no reoperations due to misplacement of electrodes. iCT helped locate the cochlea in the middle ear of one patient with an abnormal facial nerve course. The overall intervention rate based on iCT findings was 30%. LEVEL OF EVIDENCE: level 4.

Application of intraoperative computed tomography with or without navigation system in surgical correction of spinal deformity: a preliminary result of 59 consecutive human cases.

STUDY DESIGN: A retrospective analysis of patients undergoing spinal deformity correction surgery by the assistance of intraoperative computed tomography (iCT) with or without navigation system. OBJECTIVE: To share our preliminary experience and analysis of the iCT navigation system applied to spinal deformity surgery. SUMMARY OF BACKGROUND DATA: The iCT navigation system has been shown to improve accuracy and safety in posterior instrumentation. It not only decreased the operation time but also prevented excessive radiation exposure to the medical staff. To date, there are only few reports about the application of the iCT navigation system in spinal deformity surgery. METHODS: From April 2009 to September 2010, 59 patients who had a diagnosis of scoliosis, kyphosis, or scoliokyphosis and underwent iCT-assisted surgical correction were included. Without randomization, 28 patients were operated with the iCT-navigation system, and the other 31 patients were operated with standard procedure under iCT assistance. The detailed procedures, preoperative and intraoperative images were illustrated. The accuracy of screw placement, time for screw insertion, postoperative correction rate, and iCT scanning data were analyzed. RESULTS: There were significant differences between 2 groups in (1) the preoperative Cobb angle (76.2° and 62.6° in the navigation and non-navigation groups), (2) the accuracy and the revision rate of thoracic pedicle screws and total pedicle screws, and (3) the average screw insertion time. The breach rate and the revision rate of thoracic pedicle screws and total pedicle screws were significantly lower and the average screw insertion time was significantly lesser in the navigation group than in the non-navigation group. There were no statistically significant difference in (1) the breach rate and the revision rate of lumbar pedicle screws, (2) the mean iCT scanning time and time-out, (3) the mean number of fusion segments, (4) the mean number of iCT scans, and (5) the postoperative correction rate. Complications were encountered in 2 patients in the non-navigation group but none in the navigation group. There was no reoperation due to implant malposition in both groups. CONCLUSION: The iCT navigation system provides desirable accuracy of posterior spinal instrumentation for patients during surgical correction of spinal deformity without radiation exposure to the medical staff, especially in thoracic spine instrumentation. Meanwhile, the iCT in itself is an effective means of assessing complex instrumentation of the spinal deformity.

[Application of intraoperative CT navigation in posterior thoracic pedicle screw placement for scoliosis patients].

OBJECTIVE: To investigate the application value of intraoperative CT navigation in posterior thoracic pedicle screw placement for scoliosis patients. METHODS: Between October 2009 and December 2011, 46 patients with scoliosis were treated with thoracic pedicle screw placement under intraoperative CT navigation in 21 cases (group A) or under C-arm fluoroscopy in 25 cases (group B). There was no significant difference in age, gender, type of scoliosis, involved segment, and Cobb angle of main thoracic curve between 2 groups (P > 0.05). A total of 273 thoracic pedicle screws were placed in group A and 308 screws in group B. The pedicle screw position evaluated and classified by intraoperative CT images according to the Modi et al. method; and the accurate rate, the safe rate, and the potential risk rate of pedicle screws were calculated on the upper thoracic spine (T1-4), the middle thoracic spine (T5-8), the lower thoracic spine (T9-12), and the entire thoracic spine (T1-2). The accuracy and security of thoracic pedicle screw placement were compared between 2 groups. RESULTS: On the entire thoracic spine, the accurate rate of group A (93.4%) was significantly higher than that of group B (83.8%), the safe rate of group A (98.9%) was significantly higher than that of group B (92.5%), showing significant differences between 2 groups (P < 0.05). However, the potential risk rate of group B (7.5%) was significantly higher than that of group A (1.1%) (P < 0.05). On the upper, the middle, and the lower thoracic spines, there was no significant difference in the accurate rate, the safe rate, and the potential risk rate of pedicle screws between 2 groups (P > 0.05). According to CT evaluation results, the potential risk pedicle screws were revised or removed during operation. The patients of 2 groups had no neurological deficits through physical examination of nervous system at 3 days after operation. CONCLUSION: Intraoperative CT navigation can improve the accuracy and security of posterior thoracic pedicle screw placement and it can ensure the safety of operation by finding and promptly removing or revising the potential risk pedicle screws.