Effect of neoadjuvant chemotherapy on nutritional status of locally advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the effect of neoadjuvant chemotherapy on nutritional status in patients with locally advanced gastric cancer.</p><p><b>METHODS</b>Cases inclusion criteria: (1)18-65 years old; (2) Gastric cancer confirmed by gastroscopic biopsy; (3) Preoperative TNM stage III( according to the AJCC stage 2000 standard; (4) Kamosfsky functional status score> 60 points; (5)Receiving neoadjuvant chemotherapy voluntarily and signing the informed consent form. Case exclusion criteria: (1)Having contraindications of chemotherapy and surgery; (2) Suffering from heart, liver and kidney and other underlying diseases; (3) Concurrent with malignant diseases, wasting disease or other digestive diseases. According to the above criteria, clinical data of 73 patients of stage III( gastric cancer receiving neoadjuvant chemotherapy at Weifang People's Hospital from May 2015 to March 2017 were prospectively collected. The cohort study was adopted. After removing 3 patients who did not complete the chemotherapy, a total of 70 patients who completed the chemotherapy were included in the study. All the patients received SOX chemotherapy without nutritional support during chemotherapy. Changes of body composition and nutritional indicators were analyzed before and after chemotherapy, and according to the tumor regression after chemotherapy, patients were divided into response group (complete or sub-total tumor regression) and non-response group (tumor part, with or without a small amount of retreat) for stratified analysis.</p><p><b>RESULTS</b>Of 70 gastric cancer patients, 40 were male and 30 were female with a age of (53.8±6.4) (28 to 64) years. There were 26 cases (37.1%) of stage III(a, 35 cases (50.0%) of stage III(b and 9 cases (12.9%) of stage III(c. There were 41 cases in response group and 29 cases in non-response group. Three patients (4.3%) were complete remission (CR) and 38 patients (54.3%) were partial remission (PR) in response group, while 23 cases (32.9%) were stable disease (SD) and 6 cases (8.6%) were progressive disease (PD). After neoadjuvant chemotherapy, the extracellular fluid of the whole patients increased from (13.3±1.7) L to (13.5±1.6) L (t=-2.044, P=0.045); the intracellular fluid decreased from (21.4±2.5) L to (21.1±2.4) L (t=2.369, P=0.021); the lymphocyte count decreased from (0.31±0.10)×10/L to (0.29±0.10)×10/L (t=1.706, P=0.009); the other indexes were not significantly different (all P>0.05). Stratified analysis showed that after neoadjuvant chemotherapy in response group, body mass increased from (60.1±8.8) kg to (61.0±8.3) kg (t=-2.773, P=0.008); body mass index increased from (21.9±2.4) kg/m to (22.3±1.9) kg/m(t=-3.479, P=0.001), while above two parameters did not differ significantly in non-response group. No significant differences in body mass, body mass index, skeletal muscle, inorganic salt, extracellular fluid, body fat, protein, upper arm circumference and intracellular fluid were found between two groups before and after neoadjuvant chemotherapy(all P>0.05). Except slight decrease in hemoglobin and lymphocyte, the other nutritional indicators were slightly elevated in response group, while the differences were not statistically significant(all P>0.05). All nutritional indicators in non-response group were slightly decreased without significant differences as well (all P>0.05).</p><p><b>CONCLUSION</b>Neoadjuvant chemotherapy does not aggravate malnutrition in patients with locally advanced gastric cancer.</p>

Clinical value of precise staging for pancreatic carcinoma / 中华肝胆外科杂志

Pancreatic carcinoma remains one of the most challenging malignant tumor with an increasing morbidity in China.The significance of multidisciplinary and comprehensive treatment of pancreatic cancer has been recognized in recent years.Moreover,several novel clinical staging standards of pancreatic cancer have emerged to help optimize the treatment strategies and improve patients' prognosis in precise treatment era.Currently,in addition to the traditional TNM stage,usage of histologic grade (G),resection marginstatus (M),lymphatic invasion status (L),vascular invasion status (V),perineurial invasion status (P) and combination of these stages recommended by NCCN guideline as GTNMLVP stage have emerged.Other novel staging standards include respectability status,standardized pancreatic surgery classification,genetics classification,etc.This review summarized the characteristics and clinical significance of these novel established methods for pancreatic cancer precise staging.

Application of three-dimensional visualization in pancreatic tumor: a pilot study / 中华外科杂志

Objective@#To study the value of three-dimensional(3D) visualization in the diagnosis and surgical treatment for pancreatic tumor.@*Methods@#From June to September 2016, 26 patients with pancreatic tumors in Jinling Hospital, Medical School of Nanjing University were involved. The study included 26 patients(8 females and 18 males) with mean age of (57±12)years (ranging from 23 to 77 years). And there were 20 malignant tumors and 6 benign tumors. All of them were examined with abdominal thin slice CT scanning and the CT images were imported into 3D visualization system for 3D visualization. The main elements examined by 3D visualization included tumor shape, size, and location; distribution and morphology of the peripancreatic lymph node; the relationships among neoplasms, organs and blood vessels.@*Results@#Among the 26 patients, there were 21 cases with pancreatic cancer, of which 15 cases successfully underwent standard pancreatectomy. All patients were operated underwent accurate assessment. The 3D model demonstrated the origination and bifurcations of blood vessels, and the relationships among neoplasms, organs and blood vessels efficiently. The 3D technique could facilitate to evaluate response of neiadjuvant chemotherapy in the pancreatic cancer patients (n=5).3D reconstruction could detect the lymph-node metastases accurately (n=12) in patients with pancreatic cancer. 3D reconstruction were applied to evaluate the the size and range of tumor on 5 cases.@*Conclusions@#3D reconstruction allows stereoscopic identification of the spatial relationships between physiologic and pathologic structures.The 3D technique could facilitate to evaluate distribution and morphology of the peripancreatic lymph node, and to evaluate the relationships among neoplasms, organs and blood vessels.

Impact of diabetes on early complications after pancreaticoduodenectomy in patients with pancreatic cancer / 中国综合临床

Objective To investigate the influence of diabetes on the early complications after pancreaticoduodenectomy in patients with pancreatic cancer,and to provide reference for clinical diagnosis and treatment.Methods A total of 179 patients with pancreatic cancer confirmed by pathology underwent pancreaticoduodenectomy were divided into 81 cases of diabetes group and 98 cases of non-diabetes group according to the level of blood sugar.The fast blood glucose of patients in diabetes group were controlled at 5.6-11.2 mmol/L before surgery,the clinical and pathological data,surgery-related complications and systemic complications of two groups were compared.Results Of 179 patients,5 patients (2.79％) died of severe infection combined with cardiac and respiratory failure.Firm pancreatic texture occurred more in diabetes group than that in non-diabetes group(79.0％ vs 42.9％,x2 =13.62,P＜0.01),but no statistically significant difference in duration of operation,total bleeding,length of stay in hospital,diameter of pancreatic duct,tumor size,pathological pattern,whether reserved pylorus and methods of anastomosis between the two groups (P ＞0.05).There was no statistically significant difference in the incidence of pancreatic fistula,delayed gastric emptying,hemorrhage and infection between diabetes group and non-diabetes group (P ＞ 0.05),but the incidence of respiratory failure (4.9％ (4/81)),cardiac failure (9.9％ (8/81)) and renal failure (1.2％ (1/81)) in diabetes group were significantly higher than that in non-diabetes group (2.0％ (2/98),3.1％ (3/98),0(0/98);P=0.031,0.014,0.007).The incidence of pancreatic fistula was 26.3％ (47/179),and that of patients combined with diabetes (38.3％ (18/47)) and firm pancreatic texture (40.4％ (19/47)) were statistically lower than patients without diabetes and soft pancreatic texture (x2 =8.53,P ＜ 0.05;x2 =11.20,P＜0.01).Conclusion Pancreatic cancer has a big risk in pancreaticoduodenectomy,and those with diabetes would not increase the risk of pancreatic fistula,delayed gastric emptying,hemorrhage and infection when blood glucose is well controlled before surgery,but it has severe impact on systemic complications,so the perioperative blood glucose should be well controlled.

Pulmonary protection of dexmedetomidine under general anesthesia in patients with sepsis / 中华麻醉学杂志

Objective To evaluate pulmonary protection of dexmedetomidine under general anesthesia in the patients with sepsis.Methods Fifty patients with sepsis,aged 50-64 yr,weighing 50-75 kg,of ASA physical status Ⅲ or Ⅳ,were randomly divided into 2 groups (n =25 each) using a random number table:control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with midazolam,fentanyl,propofol and cisatracurium,and maintained with infusion of remifentanil and propofol and intermittent iv boluses of cisatracurium.The patients were endotracheally intubated and mechanically ventilated.In group D,dexmedetomidine 1.0 μg/kg was infused over 10 min,followed by infusion at 0.4 μg · kg-1 · h-1 for 2 h before induction of anesthesia.While the equal volume of normal saline was given in group C.BIS value was maintained at 40-60.Immediately before skin incision,at 2 h after beginning of skin incision,and at 24 h after operation,arterial and venous blood samples were taken for blood gas analysis and for determination of the concentrations of serum procalitonin,interleukin-6 and tumor necrosis factor-alpha.Oxygenation index was calculated.Results Compared with group C,oxygenation index was significantly increased,the concentrations of serum procalitonin,tumor necrosis factor-alpha and interleukin-6 were decreased,and the rate of improvement of pulmonary function was increased in group D.Conclusion Dexmedetomidine (infusion at 0.4 pg · kg-1 · h 1 for 2 h after infusion of 1.0 μg/kg) before induction of anesthesia provides pulmonary protection under general anesthesia in the patients with sepsis.

Research progress of neoadjuvant therapy for borderline resectable pancreatic cancer / 医学研究生学报

Pancreatic cancer is known as one of the most fatal malignant diseases in digestive system.Approximately 15%-20%of patients are deemed resectable at the time of diagnosis.Neoadjuvant therapy to the borderline resectable pancreatic cancer ( BRPC) has been challenged to achieve down-staging of cancer, to avoid unnecessary major operation if the pancreatic cancer progres-ses and distant metastasis develops during preoperative treatment.However, there are some controversial issues influencing the clinical decision of surgeon in managing BRPC.This manuscript reviews the current controversial issues in managing BRPC in order to enhance proper understanding for the current status and potential role of neoadjuvant therapy in managing BRPC.

Clinical study of postoperative three-dimensional conformal radiotherapy concurrent with paclitaxel and TS-1 chemotherapy in the treatment of advanced gastric carcinoma / 中国医师进修杂志

Objective To investigate the clinical efficacy of postoperative three-dimensional conformal radiotherapy concurrent with paclitaxel +TS-1 chemotherapy in the treatment of advanced gastric carcinoma.Methods A total of 60 patients with advanced gastric carcinoma were randomly divided into treatment group and control group.In treatment group,30 patients received simultaneous three-dimensional conformal radiations therapy combined with paclitaxel +TS-1 chemotherapy.In control group,30 patients received paclitaxel +TS-1 chemotherapy.The long term survival rate,local recurrence rate and side reactions were observed in two groups.Results The 1,2-year survival rate in treatment group [93.1％ (27/29),75.9 ％ (22/29)] and control group [72.4 ％ (21/29),48.3 ％ (14/29)] had significant difference (P ＜ 0.05).The 1,2-year local recurrence rate in treatment group [6.9％ (2/29),13.8％ (4/29)] and control group [31.0％ (9/29),44.8 ％ (13/29)] had significant difference (P ＜ 0.05 or ＜ 0.01).The side reactions in two groups were mainly manifested as leukopenia,thrombocytopenia,anemia,nausea,vomiting,liver function damage and oral mucositis.The incidence rate of nausea,vomiting in treatment group was significantly higher than that in control group [83.3％ (25/30) vs.53.3％ (16/30)] (P =0.012).Conclusions Postoperative threedimensional conformal radiotherapy concurrent with paclitaxel +TS-1 chemotherapy in the treatment of advanced gastric carcinoma may improve the long-term survival rate,lower local recurrence rate.But the adverse reactions are increased.

Application of biological dressing A in the treatment of non Ⅲ° deep burn wound / 中国基层医药

Objective To investigate the clinical efficacy of biological dressing A covering bandage of Ⅲ° burn wounds given comprehensive treatment including dermabrasion.Methods For patients of non Ⅲ° ° burn wounds (deep Ⅱ ° and partial superficial Ⅲ ° wounds),28 cases in the treatment group,were given improved dermabrasion with tangential excision plus thin layer of skin graft from the body,the wounds were covered with biological dressing A bandage.21 patients in the control group were treated by traditional tangential excision,escharectomy and self-skin grafting.The clinical treatment effect was observed and compared between the two groups.Results The wounds were healed 2 ～ 3 weeks after surgery in treatment group,the cure rate of burns in patients with a total area of 40％ ～ 50％ TBSA was 99％,and after treatment the scar formation significantly reduced,self-donated skin significantly reduced,the hospital stay and postoperative recovery time of the patients were significantly shorter,patients were easier to accept.In the control group,the operation time was longer,the blood loss was more,the wounds had more scar healing wounds.The wound healing time of the treatment group was (14.8 ± 1.8) d,which was significantly shorter than (19.4 ± 3.0) d of the control group (P ＜ 0.05).Conclusion The improved grinding A scab plus biological dressings covering bandage has the advantages of simple operation,light damage,less complications,need less skin,to maximize retention of healthy tissue,wound healing speed up,healing scar lessened.

Nutritional support in patients undergoing hepatobiliary surgery: trends, recent advances and controversies / 中华肝胆外科杂志

Patients undergoing hepatobiliary surgery are very vulnerable to malnutrition while surgeons' knowledge on evidence-based guidelines in surgical nutrition remains poor. Efforts are therefore necessary to implement routine nutritional screening and nutritional support. Rea sonable measures in perioperative nutritional intervention ameliorate pre- and postoperative status of the patient and reduce surgical complications through regulation of immunity,adjustment of glucose concentration and maintenance of tissue and organ functions. Modern surgical achievements using fast- track surgery and minimally invasive surgery provide the opportunity to focus on early intestinal feeding to hepatobiliary surgery patients in the postoperative period.Perioperative nutrition support not only provides nutritional substrates but also modifies the composition of nutritional regimen by adding supernormal doses of specific substrates to improve surgical outcomes. As a consequence,the term “nutrition therapy” instead of “nutrition support” is more acceptable in this era of immunonutrition.

Effect of dexmedetomidine on inflammatory response during perioperative period in patients with acute craniocerebral trauma / 中华麻醉学杂志

Objective To investigate the effect of dexmedetomidine on inflammatory response during the perioperative period in patients with acute craniocerebral trauma.Methods Seventy ASA Ⅰ-Ⅳ patients of both sexes,aged 20-68 yr,with craniocerebral trauma,who required decompressive craniectomy within the next 24 h,were randomly divided into 2 groups (n =35 each) ∶ control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with fentanyl,propofol and cisatracurium and maintained with remifentanil,sevoflurane and propofol and intermittent iv boluses of cisatracurium.In group D,dexmedetomidine 1 μg/kg was infused over 10 min,followed by infusion at 0.4 μg· kg-1 · h-1 for 2 h.Venous blood samples were taken before induction of anesthesia (baseline),2 h after the beginning of operation,at the end of operation and at 24 h after operation (T1-T4) to determine the concentrations of serum neurone specific enolase (NSE),interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α).Results Compared with group C,the concentrations of serum NSE,IL-6 and TNF-α were significantly decreased in group D (P ＜ 0.05).The concentrations of serum NSE,IL-6 and TNF-αwere significantly higher at T2 and T3,and the concentration of serum TNF-α was significantly lower at T4 than at T1 in group C (P ＜ 0.05).The concentrations of serum NSE and IL-6 were significantly higher at T2 and T3 and lower at T4 and the concentration of serum TNF-α was significantly higher at T3 and T4 than at T1 in group D (P ＜0.05).Conclusion Dexmedetomidine protects the brain against acute craniocerebral trauma by inhibiting systemic inflammatory response during the perioperative period.

Analysis of pathogen spectra and their drug resistance in patients with enterocutaneous fistula complicated with abdominal infection / 中华消化外科杂志

Objective To study the pathogen spectra in patients with enterocutaneous fistula complicated with abdominal infection and their resistance to antibiotics. Methods The abdominal pus was collected from 226 patients with enterocutaneous fistula complicated with abdominal infection for bacterial culture and antibiotic susceptibility test. Results A total of 520 bacterial strains were harvested, including 333 strains of gram-negative bacteria, I 80 strains of gram-positive bacteria and 7 strains of fungi. The top 10 bacteria cultured were Escherichia coli (131 strains), Staphylococcus aureus (62 strains), Enterococcus (59 strains), Pseudomonas aeruginosa (50 strains), Klebsiella pneumoniae (23 strains), Acinetobacter baumannii (18 strains), Enterobacter cloacae (17 strains), Proteus mirabilis (15 strains), Morganella morganii (15 strains) and Enterococcus faecalis (12 strains). The extended spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae were 102 and 17 strains, respectively. Methicillin-resistant Staphylococcus aureus were 60 strains. Conclusions Gram-negative bacteria were the main pathogens in patients with enterocutaneous fistula complicated with abdominal infection. The positive rate of the extended spectrum beta-lactamase is high. Most of the Staphylococcus aureus were resistant to Methicillin.

Duct-to-mucosa anastomosis and incidence of pancreatic fistula following pancreaticoduodenectomy / 医学研究生学报

0.05) and hospital mortality(both 3.1%) between the two groups.All the pancreatic fistula patients were cured by non-surgical treatment.Conclusion: The comparative study of the two reconstructive techniques revealed no difference in the incidence of pancreatic fistulas following pancreaticoduodenectomy.

Effects of enteral, parenteral nutrition and major gastrointestinal operation on levels of IL-10, CRP and HLA-DR expression / 肠外与肠内营养

Objectives: To evaluate the influences of enteral nutritfion(EN), parenteral nutrition(PN) and major gastrointestinal operation on HLA DR, CRP and IL 10 level. Methods: A prospective, successive and controlled trial was taken. 39 non infection patients with intestinal fistula and severe acute pancreatitis were divided into EN group ( n =18) and PN group ( n =21). 8 patients with major gastrointestinal operation(OP) were taken as OP group.10 patients admitted with the diagnoses of cholecystopolyp and inguinal hernia were taken as control group. The blood levels of HLA DR, CRP and IL 10 were measured and compared between groups. Results: Compared to control group〔(96.35? 4.282)%〕, OP group〔(60.23? 10.419)%〕 and PN group〔(78.72? 13.21)%〕 had significant decreases ( P

Closure of enterocutaneous fistulas using fibrin sealant / 解放军医学杂志

Objective To study the method of promoting spontaneous closure of enterocutaneous fistula with fibrin sealant. Methods In twenty-seven patients with enterocutaneous fistula the selective fibrin sealant occlusion method was applied, and fistulagraphy was used to confirm closure. Results Fistula occlusion was attained within 2 weeks in 25 of the 27 patients, and there had been no sign of recurrence over a follow-up period of 1-15 months (average 5.6 months). Conclusion Selective fibrin sealant occlusion is highly effective for the closure enterocutaneous fistula.