Application of double-pouch anastomosis in laparoscopic radical resection of rectal cancer assisted by small incision / 中华胃肠外科杂志

OBJECTIVE@#To explore the feasibility, safety and the economical efficiency of double-pouch anastomosis in laparoscopic radical rectal cancer assisted by small incisions.@*METHODS@#Clinical data of 224 patients undergoing gastrointestinal surgery at Taizhou People's Hospital of Jiangsu Province from January 2011 to December 2017 were retrospectively analyzed. Indusion criteria: patients were diagnosed as primary rectal adenocarcinoma by preoperative enteroscopy pathology, the distance of the tumor to anal margin was from 4 to 15 cm, and patients were treated with laparoscopic total mesorectal excision(TME) through small incision. Patients were divided into two groups according to different anastomosis method, double-pouch group(108 cases) and single-pouch group (116 cases). The surgical indexes, tumor safety indexes, short-term efficacy and economic indexes were compared between the two groups.@*RESULTS@#There was no significant difference between two groups in baseline data, operative time, blood loss, number of lymph nodes dissection, average length of proximal and distal bowel, or incidence of urination and sexual dysfunction (all P>0.05). Compared with the single-pouch group, the double-pouch group presented lower anastomotic secondary bleeding rate [0.9%(1/108) vs. 6.0% (7/116), χ²=4.238, P=0.040], lower incidence of anastomotic leakage[1.9%(2/108) vs. 7.8%(9/116), χ²=4.179, P=0.041], lower incidence of anastomotic stricture [1.9% (2/108) vs. 8.6% (10/116), χ²=5.054, P=0.025], shorter hospital stay [(13.4±3.9) days vs. (15.9±9.8) days, t=2.524, P=0.013] and less average hospitalization costs [(34 000±7 000) yuan vs. (46 000±23 000) yuan, t=5.047,P0.05).@*CONCLUSION@#Laparoscopic TME assisted by small incision with double-pouch anastomosis is a safe, feasible and economical method.

Isolation, cultivation, and identification of human fibroblasts from cirrhotic liver / 国际外科学杂志

Objective To establish a method for isolating and culturing fibroblasts from cirrhotic liver in vitro,observe the biological characteristics of fibroblasts.Methods Human fibroblasts from cirrhotic liver were isolated and cultured by adhering to the culture plastic.The morphologic and growth characteristics of the acquired cells were observed by microscopy imaging and cell counting.The expression of FSP-1 and Vimentin of fibroblasts was detected through immunofluorescence and western blotting.Results The tissue blocks were well-adherent to the culture plastic within 2 hours.Hepatocyte-like cells were observed surrounding the blocks within about 1 week,and spindle-shaped fibroblasts were observed within about 2 weeks.After a series of passage,the attached cells became proliferated quickly.The growth curves of the passage 3,4 and 5 were quite similar.The result of immunofluorescence showed the expression of FSP1 and Vimentin was positive.The positive rate was respectively (90.6 ± 1.0) ％ and (91.2-± 4.1) ％.Conclusions Human fibroblasts from cirrhotic liver can be cultured successfully through adherent property.The method for isolation and culture of fibroblasts from cirrhotic liver is convenient,efficient,stable and cultured cells remain naive biological characteristics.

Clinical significance of No.12 lymph node dissection for advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical significance of No.12 lymph node dissection for advanced gastric cancer with D2 lymphadenectomy.</p><p><b>METHODS</b>Clinicopathologic data and No.12 lymph node dissection of 256 advanced gastric cancer patients undergoing radical operation in our department between January 2005 and December 2010 were retrospectively summarized and the influence factors of metastasis in No.12 lymph nodes were analyzed.</p><p><b>RESULTS</b>Of 256 patients, 179 were male and 77 were female with the average age of 59.2 years. Tumor located in the upper of stomach in 24 cases, middle of stomach in 41 cases, lower of stomach in 174 cases, multi-focus or diffuse distribution of stomach in 17 cases. Tumor diameter was <3 cm in 39 cases, 3 to 5 cm in 100 cases, >5 cm in 117 cases. Serum carcinoembryonic antigen (CEA) level increased in 61 cases, serum carbohydrate antigens (CA)72-4 increased in 56 cases and CA19-9 increased in 61 cases. The number of No.12 lymph nodes resected from all the patients was 1 152, and the average number was 4.5±1.9. The metastasis rate of No.12 lymph nodes was 9.4%(24/256) after hematoxylin eosin staining (positive group). All the patients received effective follow-up to December 2015, and the average follow-up time was 101.2 months. The median survival time of positive No.12 group (24 cases) was 29.8 months and of negative No.12 group (232 cases) was 78.2 months, whose difference was statistically significant (χ=21.715, P=0.000). Univariate analysis found that No.12 lymph node metastasis was not associated with age, gender, tumor differentiation (all P>0.05), but was associated with tumor location, tumor diameter, invasive depth (all P<0.05), and was closely associated with Borrmann type, outside metastatic lymph nodes of No.12 and high levels of serum CEA, CA72-4 and CA19-9 (all P=0.000). Multivariate regression analysis found that tumor location (RR=2.452, 95%CI:1.537 to 3.267, P=0.000), Borrmann type (RR=1.864, 95%CI:1.121 to 3.099, P=0.016) and number of outside metastatic lymph nodes of No.12 (RR=2.979, 95%CI: 2.463 to 3.603, P=0.000) were the independent risk factors of the No.12 metastasis (P<0.05).</p><p><b>CONCLUSIONS</b>Metastasis in No.12 lymph nodes indicates poorer prognosis. The No.12 lymph nodes of advanced gastric cancer patients with curative resection, especially those with the tumor located in the lower part, Borrmann type IIII(, outside metastatic lymph nodes of No.12, should be regularly cleaned.</p>

Clinical study of preserving left colic artery during laparoscopic total mesorectal excision for the treatment of rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility, safety, radicality and short-term outcome of preserving left colic artery (LCA) during laparoscopic total mesorectal excision (TME) for the treatment of rectal cancer.</p><p><b>METHODS</b>From January 2013 to December 2016,136 patients with mid-lower rectal cancer received laparoscopic TME in the Gastrointestinal Surgery Department of Taizhou People's Hospital of Jiangsu Province. Patients with rectal tumor within 10 cm to the anal verge were enrolled into the study. All the enrolled patients had complete data of pathology and follow-up. Those receiving neoadjuvant chemoradiotherapy, with severe base diseases, multifocal tumor, tumor invasion of surrounding tissues, fixation of tumor, recurrent tumor, complications such as acute ileus, bleeding, perforation were excluded. In this study, 72 patients did not undergo preservation of LCA (high ligation group) and 64 patients underwent preservation of LCA (low ligation group). Operative parameters, clinicopathological data and short-term outcome were collected and compared between two groups.</p><p><b>RESULTS</b>The baseline data including gender, age, body mass index, tumor stage, and distance of tumor from anal verge of two groups were comparable (P>0.05). The differences between two groups about the mean time of operation and the operative blood loss were not significant [(164.0±12.6) min vs. (167.3±9.4) min, (30.0±3.6) ml vs. (30.1±3.0) ml, all P>0.05]. There was no operative death in both groups. Differences in the lymph node dissection (13.7±2.6 vs. 13.3±2.1) and the specimen length of proximal resection margin [(16.4±1.9) cm vs. (16.7±2.1) cm] or distal resection margins [(3.9±0.6) cm vs. (4.1±0.9) cm] between high and low ligation groups were not significant (all P>0.05). Compared with high ligation group, the low ligation group had higher rate of sphincter preservation [92.2% (59/64) vs. 79.2% (57/72), χ=4.580, P=0.032], lower rate of anastomotic leakage [1.6% (1/64) vs. 9.7% (7/72), χ=4.075, P=0.044], anastomotic stenosis [3.1% (2/64) vs. 12.5%(9/72), χ=4.006, P=0.045], and voiding and sexual dysfunction [6.3%(4/64) vs. 18.1%(13/72), χ=4.317, P=0.038]. Mean time of follow-up was 19 months. In high ligation group, the local recurrent rate was 5.56%, distant metastasis rate was 13.89%, overall survival rate was 90.28%, disease-free survival rate was 80.56%, while in low ligation group, the local recurrence rate was 4.69%, distant metastasis rate was 12.50%, overall survival rate was 90.63%, disease-free survival rate was 82.81%, whose differences between two groups were not significant (all P>0.05).</p><p><b>CONCLUSION</b>Preservation of LCA during laparoscopic TME for the treatment of rectal cancer is safe and feasible, which can reduce the incidence of anastomotic leakage and stenosis, and voiding and sexual dysfunction.</p>

Application study on regional infusion chemotherapy by celiac trunk during operation in advanced gastric cancer patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility, safety and efficacy of intraoperative regional infusion chemotherapy by celiac trunk in advanced gastric cancer patients.</p><p><b>METHODS</b>One hundred and twenty-six patients with advanced gastric cancer(stageII(-III() were screened from database of Gastrointestinal Surgery Department of Taizhou People's Hospital between January 2008 and December 2010 who underwent R0 resection and D2 lymphadenectomy, received postoperative chemotherapy(XELOX or FOLFOX), and had complete follow-up data. They were divided into infusion chemotherapy group (65 cases) and control group (61 cases) according to regional infusion chemotherapy or not (fluorine 1 000 mg and cisplatin 60 mg). The side effects of chemotherapy, parameters related to the operation, long-term survival and relapse rate were compared between the two groups.</p><p><b>RESULTS</b>The baseline data between the two groups were comparable(all P>0.05). Postoperative III( and IIII( adverse reaction of chemotherapy was not significantly different between the two groups (P>0.05). The time of postoperative intestinal function recovery [(67.9±14.8) hours vs. (68.9±15.0) hours, t=-0.380, P=0.705), volume of postoperative 1-week drainage [(66.1±17.1) ml vs.(61.9±18.2) ml, t=1.478, P=0.142], recent morbidity of complications[55.4%(36/65) vs. 49.2%(30/61), χ=0.256, P=0.613], and the long-term morbidity of complications [16.9% (11/65) vs. 14.8% (9/61), χ=0.111, P=0.739] were all not significantly different between the two groups. The 3-year survival rate and 3-year relapse-free survival rate in infusion chemotherapy group were significantly higher than those in control group(58.4% vs. 37.7%, χ=5.382, P=0.020; 58.4% vs. 34.4%, χ=6.636, P=0.010).</p><p><b>CONCLUSION</b>Regional infusion chemotherapy by celiac trunk during operation for advanced gastric cancer patients is safe and feasible, and can reduce the risk of local recurrence and improve survival rate.</p>

Effect of DPP4 inhibitor sitagliptin on expressions of early growth response-1 and fibronectin in the kidney of ApoE gene knockout mice / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effects of the DPP4 inhibitor sitagliptin on the expressions of early growth response-1 (Egr-1) and fibronectin in the kidney of ApoE gene knockout mice.</p><p><b>METHODS</b>Eight-week-old male ApoE gene knockout mice were randomly divided into sitagliptin + apoE(-/-) group and apoE(-/-) group (n=6), with 6 C57BL mice as the normal control group. After feeding with high-fat diet and drug treatment for 16 weeks, the mice underwent intraperitoneal glucose tolerance test (IPGTT) and were measured for 24-h urinary albumin using ELISA. All the mice were then sacrificed to examine the changes of blood lipid profile and for detection of Egr-1 and fibronectin mRNA and proteins in the renal tissue using real-time PCR and Western blotting.</p><p><b>RESULTS</b>The mice in both apoE(-/-) group and sitagliptin+apoE(-/-) group all showed prominently increased blood lipids as compared with the control group (P<0.05) without significant differences between the two apoE(-/-) groups. The level of HDL was significantly higher in sitagliptin +apoE(-/-) group than in apoE(-/-) group (P<0.001) and control group (P<0.001). IPGTT showed no significant differences in the levels of blood glucose among the 3 groups. The excretion of urinary albumin was increased in apoE(-/-) group compared with the control group (P<0.01), but was significantly lower in sitagliptin+ apoE(-/-) group than in apoE(-/-) group (P<0.01). Real-time PCR and Western blotting showed significantly decreased mRNA and protein expressions of renal cortical Egr-1 and fibronectin in sitagliptin+apoE(-/-) group compared with apoE(-/-) group.</p><p><b>CONCLUSION</b>Sitagliptin can reduce the renal expression of fibronectin by regulating the expression of Egr-1 to achieve renal protection.</p>

Correlation between urine protein and vascular endothelial growth factor in IgA nephropathy / 重庆医学

Objective To investigate the correlation between urine protein and VEGF in of IgA nephropathy patients .Methods Selected data of 67 patients of IgA nephropathy patients in Xinxiang Medical University ,VEGF expression was tested by immuno-histochemistry in renal tissue ,enzyme linked immunosorbent assay were used to detect the serum and urine levels of VEGF and ana-lyze the distribution of different pathological parameters .Analyzed correlation between urine protein and VEGF by regression analy-sis ,and analyzed the therapeutic effect and biochemical index in different combination of urinary protein and VEGF .Results (1)u-rine and serum VEGF levels in patients with IgA nephropathy were higher than healthy controls and patients with lupus nephritis group ,expression of VEGF in renal tissue was higher than that of lupus nephritis group (P<0 .01) ,and the difference of VEGF lev-el of IgA nephropathy group in Lee's classification ,renal tubular interstitial lesions and Katafuchi total score had statistically signifi-cant(P<0 .05) ,and increased with the severity of the pathological ;(2)Renal tissue VEGF urine and blood VEGF level were statis-tically significant in different levels of urinary protein of IgA nephropathy ,and increased according to urine protein was less than 1 .0 g ,1 .0 to 3 .0 g and more than 3 .0 g(P<0 .05) .Levels of urinary protein and VEGF expression in the kidney ,urinary VEGF and serum VEGF levels were positively correlated (r=0 .59 ,P<0 .01 ;r=0 .46 ,P<0 .01;r=0 .37 ,P<0 .05);(3) IgA nephropathy with urinary protein level between different levels of VEGF sAlb ,blood IgA ,Cr ,eGFR ,β2-MG ,urine osmotic pressure ,BUN and the effect rate of treatment differences were statistically significant (P<0 .05) .Conclusion Renal tissue VEGF expression in pa-tients with IgA nephropathy enhance ,while levels of VEGF in blood and urine were increased and associated with urinary protein . Pathological factors and treatment effect have statistically significant difference between different urinary protein and VEGF combi-nation .

Effect of arsenic trioxide combined with adriamycin on the proliferation and apoptosis of human lymphoma cells / 中南大学学报(医学版)

OBJECTIVE@#To determine the effect of arsenic trioxide combined with adriamycin(ADM) on the proliferation and apoptosis of human lymphoma cells.@*METHODS@#Raji cells were divided into an experimental group and a control group, and the experimental group was further divided into 1 micromol/L As(2)O(3) group,2 micromol/L As(2)O(3) group, ADM group,1 micromol/L As(2)O(3) and ADM group,2 micromol/L As(2)O(3) and ADM group. Human lymphoma cells Raji were treated with As(2)O(3) combined with ADM. Wright-Giemsa dying assay was used to observe the apoptosis morphology of lymphoma cells. The proliferation of the cells treated with As(2)O(3) and adriamycin was detected by the method of 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide(MTT). Flow cytometry(FCM) was used to detect the apoptosis rate of lymphoma and the fluorescene density in the lymphocytes. Effect of arsenic trioxide and adriamycin on the mutant p53 expression in Raji cells was detected by semi-quantitive RT-PCR.@*RESULTS@#Evident apoptotic morphological changes of Raji cells were observed 24 hours after treatment with As(2)O(3) or ADM. Compared with As(2)O(3) or ADM alone, As(2)O(3) combined with ADM could increase the inhibition ratio significantly (P0.05).@*CONCLUSION@#As(2)O(3) and ADM alone or combined can inhibit the proliferation, induce cell apoptosis, and downregulate the expression of mutant p53 in vitro. As(2)O(3) combined with ADM has synergistic anti-lymphoma cell effect in vitro. As(2)O(3) has no significant effect on the concentration of ADM on the Raji cells, but can enhance the chemosensitivity of Raji cells, and its mechanism may be that it can downregulate the expression of mutant p53.

Determination of trace silver by solid substrate room temperature phosphorescence quenching method based on lead carboxymethyl cellulose particles (Pb(CMC)2) containing luminescent salicyl fluorenes molecules.

Luminescent particles of lead carboxymethyl cellulose (Pb(CMC)2) containing salicyl fluorones (THBF), Pb(CMC)2-THBF were synthesized by the sol-gel method, using sodium carboxymethyl cellulose (NaCMC) as precursor and Pb2+ as precipitant. Pb(CMC)2-THBF can emit the intense and stable solid substrate room temperature phosphorescence (SS-RTP) on filter paper. And EDTA can chelate Pb2+ in Pb(CMC)2-THBF, causing it to decompose into aqueous soluble components PbY2-, CMC- and THBF, which can react with Ag+ to form Ag(CMC)2-THBF, causing the decrease of phosphorescence intensity. Based on the facts above, a new method for the determination of trace silver by SS-RTP quenching method was established. The linear range of this method is 8.0-40.0 fg spot(-1) (20.0-100.0 pg ml(-1)), with a detection limit (LD) of 2.2 fg spot(-1) (corresponding to a concentration range of 5.5 x 10(-13) g ml(-1)), and the regression equation of working curve is DeltaI(p) = 12.56 + 0.5527C(Ag+) (fg spot(-1), 0.4 microl spot(-1)), n = 8, r = 0.9992. This method has been applied to the determination of trace silver in human hair and tea sample with satisfactory results. The mechanism of SS-RTP emission is also discussed.

Endocardial mapping and ablation of tachycardia guided by noncontact balloon catheter mapping system / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To describe a new noncontact balloon catheter mapping system and to assess the clinical utility of this system for guiding endocardial mapping and ablation of tachycardia.</p><p><b>METHODS</b>Five patients with tachycardia underwent endocardial mapping and radiofrequency ablation using the noncontact balloon catheter mapping system. A 9 French, 64-electrode balloon catheter and a conventional 7 French electrode catheter for mapping and ablation were positioned in the same ventricular chamber. Ventricular three-dimensional geometry was established by the computerized mapping system. Using a boundary element inverse solution, 3360 virtual endocardial electrograms were computerized and used to derive isopotential maps. The earliest endocardial activation site, the exit site and the activation sequence of tachycardia or the critical isthmus of the reentry circuit were identified. Radiofrequency ablation with circular or linear lesion was performed at the target sites guided by the locator system.</p><p><b>RESULTS</b>Six clinical types of tachycardia, 5 of which were ventricular tachycardia and one was concealed fasciculoventricular fiber mediated tachycardia, were induced by programmed stimulation. The mean cycle length of these tachycardias was 336.6 +/- 42.69 msec. The earliest activation site and the exit site of 5 mapped tachycardias were all identified using the system. One type of ventricular tachycardia was hemodynamically unstable and difficult to terminate, and could not be mapped. Among the 6 types of tachycardias, radiofrequency ablation was successful in 4. There was no complication during and after the procedure. During the mean follow-up of 6 months, no tachycardia recurred in the patients with a successful ablation.</p><p><b>CONCLUSIONS</b>The noncontact mapping system described in this study has advantage over conventional mapping techniques for refractory tachycardia. It is not only helpful for understanding the electrophysiologic mechanism of a complex case, but also suitable for mapping hemodynamically intolerated and nonsustained ventricular tachycardia.</p>

The long-term results of intertrochanteric varus medial-displacement osteotomy for Perthes disease / 中华骨科杂志

Objective To observe the long term results of intertrochanteric varus medial displacement osteotomy(IVMDO) for Perthes disease. Methods Thirty eight patients with Perthes disease treated with IVMDO were reviewed. The results were evaluated based on a criteria made by the authors including clinical and radiographic parameters. The duration of follow up ranged from 3 to 15 years, with an average of 7 years. Results Fifteen patients were evaluated as having excellent result, 17 good, 3 fair and 3 poor respectively. The overall excellent or good rate was 84.2%. Considering the relationship between the outcome and staging of the disease, the overall excellent or good rate was 94.7% in stage Ⅱ lesion, 85.7%in stage Ⅲ lesion, and 40.0% in stage Ⅳ lesion. Conclusion The treatment of Perthes disease with IVMDO has the advantages of simple manipulation, less trauma and good results, and is worthy of populariztion.