Analysis of risk factors for anastomotic infectious complications following bowel resection for Crohn disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the risk factors for anastomotic infectious complications after bowel resection in patients with Crohn disease.</p><p><b>METHODS</b>Clinical data of 124 patients with Crohn disease undergoing bowel resection between January 1990 and October 2012 were analyzed retrospectively. The risk factors were identified by χ(2) test and Logistic regression.</p><p><b>RESULTS</b>Fourteen patients (12.3%, 14/114) developed anastomotic infectious complications in the postoperative period, including anastomotic leak (n=7), intra-abdominal abscess (n=6), and enterocutaneous fistula (n=1). Crohn disease activity index (CDAI)>150 (OR=2.185, 95%CI:1.098-6.256, P=0.040), steroid usage (OR=2.674, 95%CI:1.118-8.786, P=0.027), and the presence of preoperative abscess/fistula (OR=3.447, 95%CI:1.254-10.462, P=0.014) were identified as independent risk factors of anastomotic infectious complications. In the absence of these 3 risk factors, the rate of anastomotic infectious complication was 5.7% (3/53), which increased to 11.4% (4/35) when one risk factor was present, 21.1% (4/19) when two risk factors were present, and 42.9% (3/7) when all the 3 risk factors were present.</p><p><b>CONCLUSIONS</b>CDAI>150, steroid usage and preoperative abscess/fistula are associated with higher rates of anastomotic infectious complications following bowel resection for Crohn disease. A prudent management should be carried out if risk factors can not be eliminated preoperatively.</p>

Value of pulse transit time in detecting respiratory drive / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To assess the accuracy of pulse transit time (PTT) in classification of apnea events, and collect data for clinical application reference.</p><p><b>METHODS</b>Thirty-two obstructive sleep apnea-hypopnea syndrome (OSAHS) patients included in the research had Polysomnography (PSG), and 10 305 apnea events were recorded. All the events were analyzed by PTT and esophageal pressure (Pes) respectively. The results were analyzed to assess the accuracy of PTT and compare the accuracy of pulse transit time between REM stage and NREM stage, and analyze the correlation between age, body mass index (BMI), apnea hypopnea index (AHI) and concordance rate in every patient.</p><p><b>RESULTS</b>The total concordance rate between PTT and Pes in classification of apnea was 96.7% (9970/10305). The sensitivities of PTT in detecting central, mixed and obstructive apnea were 88.0%, 91.3% and 97.8% respectively and the specificities were 99.8%, 97.8% and 92.8% respectively. The false determinations of apnea events mainly concentrated on the false determinations between the obstructive and mixed apnea. There was no statistical significant between the accuracy of PTT in different sleep stages. There was a negative relationship between the age, BMI, Lowest SaO2, AHI and the concordance rate.</p><p><b>CONCLUSIONS</b>There was good concordance between PTT and Pes in classification of apnea. PTT had very high sensitivity and specificity in detecting all kinds of apnea. This study showed that PTT can detect respiratory drive noninvasively with high accuracy.</p>

An epidemiological survey on saturnism among children due to lead pollution released from township enterprise / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand the current situations of saturnism and blood lead levels of children resided in village and circumjacent areas, and to know its relations with sex, age and other factors on children' s health as to providing some evidences for prevention and control.</p><p><b>METHODS</b>An epidemiological survey was conducted for finding out the pollution sources and for a better understanding of the surrounding environment. All 221 children under 14 years old, from the lead pollution villages and surrounding establishments were enrolled, and their blood lead levels were detected by graphite atomizer absorption spectrophotometer method. Symptoms of the saturnism were investigated through a standardized questionnaire. SPSS13.0 software was administrated for data analysis.</p><p><b>RESULTS</b>High blood lead level identification rate was 66.06% (146/221), and saturnism rate 32.13% (71/221). The children's blood lead levels among group 1, group 2, group 3 in this village and jade factory were (161.20 +/- 32.94), (176.60 +/- 43.62), (258.00 +/-106.08) and (238.01 +/- 55.20) microg/L respectively and the significant differences were observed through Kruskal-Wallis test (chi2 = 51.84, df= 3, P<0. 01). The blood lead levels of children from group 3 in this village and the jade factory were higher than those of other two groups. No correlation was found between children's age and blood lead level (r = 0.10, P = 0.13). There was a significant difference in blood lead levels between boys and girls (t' = 3.83, P<0.01). With the children's blood lead levels rising, the occurrence rate of main saturnism symptoms was significantly increased. This survey suggested that the pollution source was a coarse lead smelter.</p><p><b>CONCLUSION</b>The blood lead level should ke overwhelmingly increased among children who live nearby the higher level of lead blood, that living nearby the lead smeltery,might result in stautnism and negative effect on children's healthy.</p>

Expression of minichromosome maintenance protein 2 in colonic adenocarcinoma, adenoma and normal colonic mucosa and its clinical significance / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the expression differences of minichromosome maintenance 2 (MCM2) mRNA and protein among colon adenocarcinoma, colon adenoma and normal mucosa, and among different clinicopathological types of adenomas.</p><p><b>METHODS</b>Fifty specimens, including 33 colonic adenomas, 12 colonic adenocarcinomas and 5 normal colonic mucosa were selected. Each specimen was divided into two parts, one for immunohistochemistry and the other for real-time RT-PCR. Expression differences of MCM2 mRNA among the colonic adenocarcinoma, adenoma and normal colonic mucosa were evaluated by REST-XL software.</p><p><b>RESULTS</b>The expression of MCM2 was observed in the basal third to half of the colonic crypts in normal mucosa, while throughout the epithelium in the colonic adenocarcinomas and adenomas. However, the expression of MCM2 mRNA in the adenocarcinomas was significantly higher than that in the adenomas(P=0.001). The MCM2 mRNA expression was elevated in the adenoma with villous type, in the conditions of high-grade dysplasia, larger size, sessile morphology and in patients of older ages, but the difference was not significant by REST-XL (P>0.05).</p><p><b>CONCLUSION</b>The difference of MCM2 expression between the adenoma and the adenocarcinoma indicates its potential value in the early diagnosis of colonic cancer.</p>

Distribution of micrometastatic nodules of low rectal cancer in mesorectum: a pathological study using whole-mount sections / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the regional spread of micrometastatic nodules in the mesorectum from low rectal cancer, and provide further pathological evidence to optimize radical resection procedure for rectal cancer.</p><p><b>METHODS</b>A total of 62 patients with low rectal cancer underwent low anterior resection and total mesorectal excision (TME) was included in this study. Surgical specimens were sliced transversely and serial embedded blocks were made at 2.5 mm interval, and paraffin sections were stained with hematoxylin and eosin. The mesorectum on whole-mount sections was divided into three regions: outer region of mesorectum (ORM), middle region of mesorectum (MRM) and inner region of mesorectum (IRM). Microscopic spread were examined microscopically on the sections for the distribution in different mesorectal regions, frequency, types, involvement of lymphatic system and correlation with the primary tumor.</p><p><b>RESULTS</b>Microscopic spread of the tumor in mesorectum and ORM was observed in 38.7% (24/62) and 25.8% (16/62) of the patients, respectively. Circumferential resection margin (CRM) involved by microscopic tumor foci occurred in 6.5% (4/62) of the patients, and distal mesorectum (DMR) involvement was recorded in 6.5% (4/62) with a spread extent within 3 cm of distal border of the main lesions. Most (20/24) of the patients with microscopic spread in mesorectum were in TNM stage III.</p><p><b>CONCLUSION</b>Results of the present study support that complete excision of mesorectum without destruction of the ORM is essential for surgical management of low rectal cancer, and an optimal DMR clearance resection margin should not be less than 4 cm.</p>