Analysis of influencing factors on surgical outcome and exploration of technical principles during pancreaticojejunostomy / 中华外科杂志

Pancreaticojejunostomy is the most common anastomosis following pancreaticoduodenectomy and middle pancreatectomy. The detailed surgical technics of pancreaticojejunostomy vary dramatically, but none of them can achieve zero fistula rate. In recent years,with the development of new surgical concept,application of new surgical technology, high-tech materials and instruments,the incidence of pancreatic fistula has decreased. At the same time,researches on investigating the risk factors of pancreaticojejunostomy are gradually deepening. Based on years of surgical experience on pancreaticojejunostomy and current literatures, this paper analyzes the factors affecting the effect of pancreaticojejunostomy, such as the patient's basic physical state,pancreatic texture and diameter of the pancreatic duct,pathology and course of the disease,surgical technology and perioperative management,and summarizes six technical principles for pancreaticojejunostomy to be shared with surgical comrades:appropriate tension,protection of blood supply,hermetic closure of pancreatic section,accurate connection of pancreatic duct and intestinal mucosa,individualization,learning and accumulation of experience.

Effects of low molecular weight heparin on clot rate and activated clotting time: an in vitro study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Due to lack of point-of-care testing, the use of low-molecular-weight heparin (LMWH) therapy in some special patients is restricted. This study was designed to explore the effects of LMWH on clot rate (CR) and activated clotting time (ACT), and to search for an appropriate method for bedside monitoring of anticoagulant activity of LMWH.</p><p><b>METHODS</b>Thirty-two healthy volunteers were selected from the staff of Beijing Tongren Hospital. CR and ACT were measured with different reagents (glass beads, diatomite, kaolin and magnetic bar) on blood samples spiked with increasing concentrations of LMWH (dalteparin, 0.2-1.8 IU/ml). Correlations between concentrations of LMWH and values of CR and ACT were analysed based on the data obtained and regression analysis was performed to establish a regression equation.</p><p><b>RESULTS</b>With the increase in doses of dalteparin, CR values reduced gradually. The values of CR of four reagents (glass beads, diatomite, kaolin and magnetic bar) were 20.4-4.5 IU/min, 27.4-6.9 IU/min, 27.5-7.9 IU/min and 7.8-0.1 IU/min respectively and an linear relationship was observed between the CR values and dalteparin concentrations (P < 0.05). The values of ACT were 173-615 seconds, 130-270 seconds, 123-226 seconds, 337-1411 seconds respectively, which showed a linear regression between the ACT values and dalteparin concentrations (P < 0.01). Differences in slope of the regression curves of ACT were observed with all the reagents tested (glass beads 248.2 s/IU, diatomite 74.8 s/IU, kaolin 58.2 s/IU and magnetic bar 1112.2 s/IU, P < 0.01). While the minimum concentration of dalteparin was 0.2 IU/ml, 0.4 IU/ml, 1.4 IU/ml and 0.2 IU/ml separately, the ACT values of the four coagulants (glass beads, diatomite, kaolin and magnetic bar) were beyond the normal limit and showed a noticeable increase respectively (P < 0.01).</p><p><b>CONCLUSIONS</b>This study showed that there was an excellent linear relationship between the CR and ACT values and dalteparin concentrations for all the four reagents (glass beads, diatomite, kaolin and magnetic bar) in vitro. The sensitivity of different coagulation reagents to LMWH different. Choosing a suitable reagent, both CR and ACT were possible to be used as a convenient bedside test for LMWH.</p>

Pathogenesis and prognosis of chronic hydrocephalus following aneurismal subarachnoid hemorrhage treated by endovascular embolization with Guglielmi detachable coils / 中华神经医学杂志

Objective To explore the risk factors and the prognosis of chronic hydrocephalus following aneurysmal subarachnoid hemorrhage (SAH) treated by endovaseular embolization with Guglielmi detachable coils (GDCs). Methods Endovascular embolization with GDCs were performed in 132 patients with aneurysmal subarachnoid hemorrhage that satisfied our research standard. After endovascular embolization, ventricular drainage was conventionally performed in patients who occurred intraventricular hemorrhage combined with obstruction in the ventricular system, while cerebrospinal fluid permutation was performed in other patients. Chronic hydrocephalus was evaluated by CT 1 month after SAH. Ventricle-peritoneal shunt was carried out for patients with severe chronic hydrocephalus while only clinical observation was needed for patients with mild chronic hydrocephalus. Clinical follow-up evaluation was carried out 6 months after SAIl according to the modified Rankin scale score. The risk factors related to chronic hydrocephalus were noted through the statistical analysis of the patients' data and the relation between the appearing of chronic hydrocephalus and clinical prognosis of SAH was analyzed. Results The overall incidence rate of chronic hydrocephalus following aneurysmal subarachnoid hemorrhage was 12.12% and age, Fisher grade and Hunt-Hess grade had important value in the prognosis of chronic hydrocephalus. Clinical prognosis of SAH was not significantly related to chronic hydrocephalus following SAH (P >0.05). Conclusion Chronic hydrocephalus following aneurysmal subarachnoid hemorrhage is not only resulted from one single risk factor and good clinical prognosis can be achieved by promptly performing ventricle-peritoneal shunt in patients with severe chronic hydrocephalus.

In vitro anticoagulation monitoring of low-molecular-weight heparin / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although low-molecular-weight heparin has replaced unfractionated heparin to become the primary anticoagulation drug for treatment of acute coronary syndrome, there is no convenient bedside monitoring method. We explored the best laboratory monitoring method of low-molecular-weight heparins (enoxaparin, dalteparin, and nadroparin) by use of the Sonoclot coagulation analyzer to monitor the activated clotting time.</p><p><b>METHODS</b>A total of 20 healthy volunteers were selected and 15 ml of fasting venous blood samples were collected and incubated. Four coagulants, kaolin, diatomite, glass bead, and magnetic stick, were used to determine the activated clotting time of the low-molecular-weight heparins at different in vitro anti-Xa factor concentrations. A correlation analysis was made to obtain the regression equation. The activated clotting time of the different low-molecular-weight heparins with the same anti-Xa factor concentration was monitored when the coagulant glass beads were applied.</p><p><b>RESULTS</b>The activated clotting time measured using the glass beads, diatomite, kaolin, and magnetic stick showed a linear correlation with the concentration of nadroparin (r = 0.964, 0.966, 0.970, and 0.947, respectively). The regression equation showed that the linear slopes of different coagulants were significantly different (glass beads 230.03 s/IU, diatomite 89.91 s/IU, kaolin 50.87 s/IU, magnetic stick could not be calculated). When the concentration of the anti-Xa factor was the same for different low-molecular-weight heparins, the measured activated clotting time was different after the application of the glass bead coagulant.</p><p><b>CONCLUSIONS</b>The glass bead coagulant is most feasible for monitoring the in vitro anticoagulation activity of nadroparin. The different effects of different low-molecular-weight heparins on the activated clotting time may be related to the different anti-IIa activities.</p>

Estrogen deficiency on growth of intracranial aneurysm in rats / 中华神经医学杂志

Objective To construct an aneurismal model with estrogen deficiency and investigate the mechanism of estrogen deficiency in the formation and development of intracranial aneurysm. Methods Female Wistar rats were randomly divided into experimental, sham-operative and blank control groups (n=10). Rats in the experimental group were ovariectomized and those in the sham-operative group were removed the adipose issue nearby the ovary only; while the rats in the blank control group were done nothing. Two weeks after the ovariectomized or sham operation, elastase dropped around the right external carotid artery and the crotch of the carotid artery and the carotid artery was ligated by two lines at 1.5 mm far from the crotch, and then sheared between the two lines to successfully induce the aneurysm. At 6 weeks of the successful construction of aneurysm model, the estrogen was detected and the aneurysm was harvested for pathological staining. Results The experimental group showed a lower estrogen level (105.00±12.96 pmol/L) than the sham-operative group (178.50±25.96 pmol/L) and the blank control group (180.40±18.70 pmol/L, P<0.05). Aneurismal length dilatation rates in the experimental group and the sham-operative group were (131.31±6.63)% and (109.90±3.44) %, respectively (P<0.05). Aneurismal diameter dilatation rates in the experimental group and sham-operative group were (125.10±5.49) % and (106.82±2.49) %, respectively (P<0.05). Conclusion Estrogen deficiency may promote the formation and development of the intracranial aneurysm. This experiment provides a simple model for investigating the relationship between estrogen deficiency and aneurysm development.

Identification of brain tumor stem cells and research on their characters of proliferation and drug-resistance / 中华神经医学杂志

Objective To isolate and culture brain tumor stem cells (BTSCs) from glioma tissues and explore the biological characteristics of BTSCs. Methods Different grade glioma tissues were obtained from 20 clinical cases. After tumors were dissociated, the sample was triturated into the single cells and then filtered. The primary glioma cells were collected and cultured in the DMEM/F12 medium containing epidermal growth factor (EGF), leukemia inhibitory factor (LIF) and basic fibroblast growth factor (bFGF), in order to promote the proliferation of BTSCs. CD133 + cells were separated by immunomagnetic bead method and identified by testing the expressions of CD133, NSE and GFAP using immunocytochemistry. CCK8 was employed to assay the proliferating situation of CD133+ cells in the different grade gliomas, and to compare the drug resistance between the CD133+ and CD133- cells in the medium containing VM-26. Results CD133+ cells were successfully separated from glioma tissues.CD133+ cells proliferated by self-renewal, then differentiated into NSE+ cells and GFAP+ ones respectively. CD133+ cells in the high grade gliomas showed the faster generation than the ones in the low grade gliomas. CD133+ cells survived more easily than the CD133- cells in the medium containing VM-26. Conclusions BTSCs exist in the glioma tissues, and possess the more tolerant to the VM-26.CD133+ cells in the high grade glioma can proliferate much more easily.

Growth suppressive effect of encapsulating antisense oligodeoxynucleotides in a butylcyanoacrylate nanoparticles on C6 glioma cells / 中华神经医学杂志

Objective To optimize the preparation of nanoparticles (NP) encapsulating antisense oligodeoxynucleotides (ASODN) and investigate the effects on inhibition of C6 glioma cells. Methods ASODN coated in NT were prepared by interfacial polymerization of butyleyanoacrylate (BCA). Inverted microscope was used to observe the viability of C6 cells transfected by free ASODN, ASODN in NP, ASODN-NP (ASODN sticking to NP) and BCA-NP, respectively. Cell cycle of C6 cells was studied by flow cytometry (FCM), and CCK-8 assay was performed to examine the cytotoxicity and proliferation of C6 cells. Results Compared with the control group, all groups, except BCA-NP group, after transfection with NPs appeared cell morphological changes; C6 cells were detached from the matrix, the cell density was reduced and the cell viability was poor; ASODN in NP group was most significant in a time-dependent manner. The cell cycle in ASODN-in-NP group varied obviously compared with the BCA-NP group, and the number of the cells in the GO/GI phase was increased and the cell number in S phase was decreased significantly (P<0.05). The results of CCK-8 assay showed that all groups, but BCA-NP group, produced the inhibition of the cell proliferation to different degrees, and the inhibitory effect was increased with the final concentration increment, especially remarkably in ASODN-in-NP group (P<0.05). Conclusion ASODN in NP can inhibit the proliferation and cause cell cycle changes of C6 cells effectively after transfected with ASODN in NP, exerting significantly growth inhibitory effect on C6 glioma cells.

Expression of TGFbeta1 and its type I receptors ALK1 and ALK5 mRNA in brain arteriovenous malformation / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the expression of transforming growth factor beta1 (TGFbeta1) and its type I receptors activin-like kinase 1 (ALK1) and ALK5 mRNA in the development of brain arteriovenous malformation (BAVM).</p><p><b>METHODS</b>The mRNA expressions of TGFbeta1, ALK1and ALK5 were detected with semiquantitative RT-PCR in patients with BAVM.</p><p><b>RESULTS</b>The expressions of TGFbeta1 and ALK5 mRNA increased significantly in BAVM, and their relative expression quantity were 0.777-/+0.047 and 0.585-/+0.074, respectively. However, ALK1 mRNA expression declined significantlies with a relative expression of 0.173-/+0.044 in comparison with the control group (0.720-/+0.098, P<0.01).</p><p><b>CONCLUSION</b>The balance of TGFbeta1 and its type I receptors ALK1 and ALK5 mRNA expressions may play important role in the development of BAVM.</p>

Research on the hyperthermia-therapy performances of invasive microwave antennas / 中国医疗器械杂志

The paper introduces four kinds of 2450 MHz antennas including noninsulted (bare), insulated-open-tip (I.O.T.), dipole-type and sleeve invasive microwave ones. The comparison between the antennas' hyperthermia performances in the muscle tissue phantom made by specific absorption rate (SAR) shows that the sleeve antenna is the best. It has a bigger heating range and a changeless shape and is independent of the inserting depth.

Development of an analysis system for X-ray cephalometry by Windows platform / 中国医疗器械杂志

Here in this paper introduced is an analysis system for X-ray cephalometry developed through Windows platform,which includes three parts: data input, cephalometry analysis & calculation, and display & printing of diagnostic results. It has been applied in orthodontic department of Stomatological Hospital of the Fourth Military Medical University, and it is quite convenient for doctors' cephalometry diagnosis.