Trocar puncture with modified sump drainage for duodenal stump fistula after radical gastrectomy for gastric cancer: A retrospective controlled study.

Duodenal stump fistula (DSF) is a serious complication of radical gastrectomy for gastric cancer. Herein, we illustrated an innovative choice for treating duodenal stump fistulas by placing a modified sump drainage through trocar puncture into the DSF-related abscess (DSF-abscess) cavity. We retrospectively analyzed 974 consecutive patients who underwent gastrectomy for gastric cancer between 2011 and 2021. Of these patients, 34 who developed postoperative duodenal stump fistulas postoperatively were enrolled into our study, and their clinical data were retrospectively assessed. From January 2011 to December 2017, 15 patients received conventional treatments (percutaneous catheter drainage, PCD group) known as the traditional percutaneous method, and 19 patients from January 2018 to December 2021 received new treatments (Troca's SD group) consisting of conventional therapies and placement of a modified sump drainage through trocar puncture into DSF-abscess cavity. The demographics, clinical characteristics and treatment outcomes were compared between two groups. Compared with the PCD group, the rates of postoperative complications, duodenostomy creation, subsequent surgery, fistula healing rates of the DSF, and length of postoperative hospital stay were significantly decreased in the Troca SD group. However, there was no significant difference in the abscess recurrence rate and mortality rates. Trocar puncture with a modified sump drainage is an safe, effective, and technically feasible treatment for duodenal stump fistula after radical gastrectomy for gastric cancer. This novel technique should be further investigated using large-scale RCT research.

[Effects of Land Use Type on the Content and Stability of Organic Carbon in Soil Aggregates].

The distribution and stability of soil aggregates under different land use types, and the distribution of organic carbon in various aggregates, were explored in order to provide a basis for the improvement of soil structure and the maintenance and improvement of soil organic carbon in Chongqing. Focusing on six representative subtropical land use types in the Beibei District of Chongqing (coniferous and broadleaf mixed forest, bamboo forest, orchard, dryland, paddy field, and waste grassland), soils were sorted using the wet sieving method and the six soil types were compared and analyzed. The distribution of aggregates and their organic carbon content were determined at soil profile depths of 0-20, 20-40, 40-60, and 60-100 cm for each land use type. The results showed that there were significant differences in soil structure and fertility levels under the different land use types. Among the particle size aggregates of the 0-100 cm soil layer, the aggregate particle size of the six land use types was mainly >0.25 mm; the content of >0.25 mm aggregate fraction of bamboo forest soil is the highest, followed by the grassland soil, and the dryland and orchard soils is the lowest. Granular aggregates in the size class 0.25-2 mm were mainly distributed in the 0-20 cm soil layers (28.78%-50.08%), while the aggregate size fractions 0.053-0.25 mm and<0.053 mm were mainly concentrated in the 40-60 cm soil layers. Across the entire profile depth, the aggregate MWD and GMD of the bamboo forest and barren grassland soils were higher than the other land use types, i. e., the soil aggregates in these soils were more stable. The stability of soil aggregates was significantly positively correlated with soil aggregate organic carbon content (r=0.569, P<0.01). In the 0-100 cm soil layer, the organic carbon content of soil aggregates was higher for the 0.25-2 mm and<0.053 mm fractions, with an average content of 56.54 g·kg-1 in the 0.25-2 mm fraction. Except for the organic carbon content of the soil aggregates with different particle size of dryland was the highest in the 20-40 cm soil layer, while under the other land use types, the organic carbon content in soil aggregates decreased with depth, showing significant surface enrichment. Overall, under the six different land use types, the soil aggregates in bamboo forest soils and waste grassland soils showed good stability, and at each soil depth, the organic carbon content of aggregates was highest in the bamboo forest soil.

Analysis of Factors Related to Hypopituitarism in Patients with Nonsellar Intracranial Tumor.

OBJECTIVE: Previous studies have suggested that postoperative hypopituitarism in patients with nonsellar intracranial tumors is caused by traumatic surgery. However, with development of minimally invasive and precise neurosurgical techniques, the degree of injury to brain tissue has been reduced significantly, especially for parenchymal tumors. Therefore, understanding preexisting hypopituitarism and related risk factors can improve perioperative management for patients with nonsellar intracranial tumors. METHODS: Chart data were collected retrospectively from 83 patients with nonsellar intracranial tumors admitted to our hospital from May 2014 to April 2015. Pituitary function of each subject was determined based on results of preoperative serum pituitary hormone analysis. Univariate and multivariate logistic regression methods were used to analyze relationships between preoperative hypopituitarism and factors including age, sex, history of hypertension and secondary epilepsy, course of disease, tumor mass effect, site of tumor, intracranial pressure (ICP), cerebrospinal fluid content, and pituitary morphology. RESULTS: A total of 30 patients (36.14%) presented with preoperative hypopituitarism in either 1 axis or multiple axes; 23 (27.71%) were affected in 1 axis, and 7 (8.43%) were affected in multiple axes. Univariate analysis showed that risk factors for preoperative hypopituitarism in patients with a nonsellar intracranial tumor include an acute or subacute course (≤3 months), intracranial hypertension (ICP >200 mm H2O), and mass effect (P < 0.05). Multivariate logistic regression analysis showed that mass effect is an independent risk factor for preoperative hypopituitarism in patients with nonsellar intracranial tumors (P < 0.05; odds ratio, 3.197). CONCLUSIONS: Prevalence of hypopituitarism is high in patients with nonsellar intracranial tumors. The occurrence of hypopituitarism is correlated with factors including an acute or subacute course (≤3 months), intracranial hypertension (ICP >200 mm H2O), and mass effect (P < 0.05). Mass effect is an independent risk factor for hypopituitarism.

Pyrone derivatives from the endophytic fungus Alternaria tenuissima SP-07 of Chinese herbal medicine Salvia przewalskii.

Three new pyrones, solanapyrones P-R (1-3), were afforded by the extracts of the endophytic fungus Alternaria tenuissima SP-07 isolated from the fresh root of Chinese herbal medicine Salvia przewalskii, along with the known solanapyrones (4-6) and benzopyrones (7-9). Solanapyrones P (1) and Q (2) possess an unprecedented nor-solanapyrone skeleton as natural products. Their structures were determined on the basis of NMR and HR-ESI-MS analysis. The plausible biosynthetic pathways to those unknown compounds were discussed. All the isolated compounds were evaluated for their antibacterial activities against six bacteria.

New isocoumarins and alkaloid from Chinese insect medicine, Eupolyphaga sinensis Walker.

Two new isocoumarins (1 and 2), a new alkaloid (3), and a known N-acetyldopamine dimer (4) were isolated from the ethyl acetate extract of Chinese insect medicine Eupolyphaga sinensis. Their structures were elucidated on the basis of detailed spectroscopic investigations, such as 1D- and 2D NMR spectroscopy, as well as by means of HR-MS. The structure of 1 was firmly confirmed by X-ray crystallography, and the absolute configuration was revealed by experimental and computational optical rotation analyses. Cytotoxicities of 1-4 were measured in vitro against 10 selected cancer cell lines.

The biosynthetic products of Chinese insect medicine, Aspongopus chinensis.

A new oxazole (1) was obtained from Chinese insect medicine Aspongopus chinensis, along with three known N-acetyldopamine derivatives (2-4). Their structures were determined on the basis of NMR and ESI-MS analyses. The possible biosynthetic pathways of the isolated compounds are discussed. Cytotoxicities of those compounds against 10 selected cancer cells were measured in vitro.

[Application of multiple tumor markers's protein chip in the screen program of the elderly].

OBJECTIVE: To evaluate the application of the multiple tumor markers's protein chip (C12 chip) in the screen program of the elderly. METHODS: The C12 chip included alpha-fetoprotein (AFP), neuron-specific enolase (NSE), prostate special antigen (PSA), free-PSA (f-PSA), carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), carbohydrate antigen 153 (CA153), carbohydrate antigen 199 (CA199), carbohydrate antigen 242 (CA242), human chorionic gonadotropin-beta (ß-HCG), human growth hormone (HGH)and ferritin. The sera of the 399 healthy elderly under the screening program and 1791 adults were detected by the C12 chip. Definition of positive was set as: one or more tumor markers higher than or equal to the reference value. RESULTS: The positive rates of AFP, PSA, f-PSA, CEA, CA125, CA153 and CA199 between the elderly group and the adult group were significantly different (P < 0.05). The normal test value of AFP, PSA, f-PSA, CEA, CA125, CA199, CA242 and ferritin between the elderly group and the adult group were significantly different (P < 0.05). CONCLUSION: AFP, PSA, f-PSA, CEA, CA125, CA153 and CA199 of the C12 chip were useful in the screening program of the elderly to discover the sign of tumor at an early stage.

[Analysis of prognostic risk factors in the patients with acute exacerbation of chronic cor pulmonale and obstructive sleep apnea-hypopnea syndrome in high altitude area].

OBJECTIVE: To assess the prognostic risk factors in the patients with acute exacerbation of chronic cor pulmonale (AEHACCP) and obstructive sleep apnea-hypopnea syndrome (OSAHS) in high altitude area. METHODS: The relations between neck circumference (Nc), body mass index (BMI), arterial blood gases, polysomnography (PSG) parameters and prognosis from 66 patients with AEHACCP and OSAHS (31 survivors, 35 non-survivors) were studied by one variable analysis and multivariable Logistic regression analysis. RESULTS: The results of one variable analysis showed that in patients with AEHACCP and OSAHS, Nc> or =45 cm, BMI > or =28 kg/m(2) , arterial oxygen partial pressure (PaO(2))< or =40 mm Hg (1 mm Hg= 0.133 kPa), mean pulmonary arterial pressure (mPAP)> or =45 mm Hg, apnea-hypopnea index (AHI)> or = 40 times/h, sleep mean arterial oxygen saturation (MSaO(2))< or =0.70, percentage of the duration of SaO(2)<0.70 during sleep(T(70) )> or =50% and difference between basic and minimum SaO(2) during sleep(Delta SaO(2))> or = 0.20 were closely correlated with prognosis. The Logistic regression models showed that Nc> or =45 cm [odds ratio (OR)=6.781, 95% confidence interval (95%CI)=1.153-17.502, P=0.007], BMI> or =28 kg/m(2) (OR=7.562, 95%CI=1.012-23.457, P=0.004), mPAP> or =45 mm Hg (OR=6.991, 95%CI=1.353-20.155, P=0.003), AHI> or =40 times/h (OR=7.258, 95%CI=1.526-18.022, P=0.006), MSaO(2)< or =0.70 (OR=6.488, 95%CI=1.562-26.878, P=0.008), T(70) > or =50% (OR=5.593, 95%CI=1.265-21.589, P=0.008) and Delta SaO(2)> or =0.20 (OR=6.551, 95%CI=1.495-18.920, P=0.007) were independent significant risk factors in prognosis of patients with AEHACCP and OSAHS. CONCLUSION: The patients with AEHACCP and OSAHS, Nc> or =45 cm, BMI> or =28 kg/m(2), mPAP> or =45 mm Hg, AHI> or = 40 times/h, MSaO(2)< or =0.70, T(70) > or =50% and Delta SaO(2)> or =0.20 are risk factors leading to a rise in mortality. It is important to use these parameters to guide clinical therapy, and to judge the prognosis so as to reduce the mortality of patients with AEHACCP and OSAHS by monitoring the above risk factors in clinical practice.

[Acute high altitude reaction syndrome and systemic inflammatory response syndrome].

Critical care medicine (CCM) is one of the challenging issue in clinical practice. The key issues of CCM include acute lung injury, acute respiratory distress syndrome, and multiple organ dysfunction syndrome (MODS), generally termed as systemic inflammatory response syndrome (SIRS). When SIRS occurs at high altitude areas (H-SIRS), it will need be distinguished with an idiopathic acute high altitude sickness (generally termed as acute high altitude reaction syndrome), that make the differential diagnosis and treatment of H-SIRS even more difficult. It has became a high priority to properly address the relevant issues in this field: construction of disciplines; identification of speciality scopes; standardization of the diagnosis and treatment of CCM; and decreasing of the mortality of MODS at high altitude.

A novel cetyltrimethyl ammonium silver bromide complex and silver bromide nanoparticles obtained by the surfactant counterion.

A novel cetyltrimethyl ammonium silver bromide (CTASB) complex has been prepared simply through the reaction of silver nitrate with cetyltrimethyl ammonium bromide (CTAB) in aqueous solution at room temperature by controlling the concentration of CTAB and the molar ratio of CTAB to silver nitrate in the reaction solution, in which halogen in CTAB is used as surfactant counterion. The structure and thermal behavior of cetyltrimethyl ammonium silver bromide have been investigated by using X-ray diffraction (XRD), infrared spectroscopy (IR), X-ray photoelectron spectroscopy (XPS), UV/vis spectroscopy, thermal analysis (TG-DTA), transmission electron microscopy (TEM), and scanning electron microscopy (SEM). The results show that the complex possesses a metastable layered structure. Upon heating the CTASB aqueous dispersion to above 80 degrees C, the structure change of the complex took place and CTAB-capped nanosized silver bromide particles further formed.

[Multiple organ dysfunction scoring system: comparison and evaluation of correlation and accuracy of the three scoring systems in predicting the outcome of multiple organ dysfunction syndrome on highland].

OBJECTIVE: To study the characteristics of the diagnostic parameters of acute respiratory distress syndrome/multiple organ dysfunction syndrome on plateau (H-ARDS/MODS) and compare the accuracy of the three MODS scoring criteria in predicting the outcome of syndrome. METHODS: Five hundred and forty cases fulfilling the criteria of MODS were divided into four groups according to the altitude of their inhabitation area: control group (on plain, CG, n=113, altitude: <430 m), moderate high altitude group 1 (H1G, n=314, altitude: 1,517 m), moderate high altitude group 2 (H2G, n=78, altitude: 2,261 m to 2,400 m) and high altitude group (HG, n=35, altitude: 2 808 m to 3 400 m). According to the diagnostic criteria of Lushan conference and Marshall (1995) commonly used on plain, and Lanzhou criteria drafted by the authors, three data analyzing models were set up to draw the receiver operating characteristic (ROC) curves, the Yordon Index and the optimum cutoff points of the parameters were calculated and the accuracy of the three respective diagnostic criteria was evaluated in predicting the outcome of ARDS/MODS. Multiple factors affecting the outcome of MODS were analyzed using the method of stepwise forward regress model. RESULTS: Following the increase in altitude, Lanzhou criteria was clearly superior to the other two criteria in the area of ROC, the sensitivity, the specificity, and also for the optimum cutoff points of MODS. Multi-variable regression analysis showed that the impacting factor of Lanzhou criteria was the highest (P<0.05). CONCLUSION: (1)Some parameters of the current diagnostic criteria of ARDS/MODS are not suitable in moderately high or high altitude areas. It is necessary to set up the diagnostic criteria of H-ARDS/MODS. (2)Some clinical characteristics might change in areas 1,500 m altitude or higher. The pathophysiological mechanism might be attributable to peculiar biologic reactions due to hypoxia stress reaction, and it is worth further study.

[Criteria suitable for diagnosis of acute respiratory distress syndrome/multiple organ dysfunction syndrome at moderately high altitude area].

OBJECTIVE: To compare the diagnostic parameters of acute respiratory distress syndrome/multiple organ dysfunction syndrome (ARDS/MODS) at high altitude (H-ARDS/MODS) with that on plain, and to establish a more practical diagnostic criterion of H-ARDS/MODS. METHODS: Five hundred and five cases fulfilled the criteria for the diagnosis of ARDS/MODS were divided into three groups according to the altitude of their habitation: control group including inhabitants (<430 m) on plain (CG, n=113), moderate high altitude group 1 inhabitants at the altitude of 1,517 m (H1G, n=314), moderate high altitude group 2 inhabitants at the altitude of 2,261 m to 2,400 m (H2G, n=78). The ARDS/MODS scores of the three groups were made according to the diagnostic criteria of Lushan conference, Marshall(1995) and Lanzhou criteria drafted by the authors respectively to set up three data analyzing models, followed by plotting of receiver operating characteristic curves (ROC curve) and calculation of the Yordon Index and the optimum cutoff points of the parameters,in order to study the accuracy of the three diagnostic criteria in predicting the outcome of the patients suffering from ARDS/MODS. RESULTS: In CG group, the differences were not significant in area of ROC, the maximal Yordon Index, the optimum cutoff points and the sensitivity and the specificity for three criteria; but the differences were significant for the three criteria in H1G group. Further investigation in comparing the ROC values of lung, brain, heart and kidney, the Lanzhou criteria were more advantageous in the high altitude than the other criteria. CONCLUSION: (1)The current diagnostic criteria of ARDS/MODS are not suitable for the diagnosis of these syndromes in moderately high or high altitude areas. It is necessary to revise the diagnostic criteria of H-ARDS/MODS. (2)One thousand five hundred and seventeen meters in altitude might be considered to be an important borderline, above with the diagnostic criteria of ARDS/MODS for patients inhabiting on plain could not be suitably applied to those living above this level.

Th2 predominance and CD8+ memory T cell depletion in patients with severe acute respiratory syndrome.

UNLABELLED: The immune spectrum of severe acute respiratory syndrome (SARS) is poorly understood. To define the dynamics of the immune spectrum in SARS, serum levels of cytokines, chemokines, immunoglobulins, complement and specific antibodies against SARS-associated coronavirus (SARS-CoV) were assayed by enzyme-linked immunosorbent assay (ELISA), and phenotypes of peripheral lymphocytes were analyzed by flow cytometry in 95 SARS-infected patients. Results showed that interleukin (IL)-10 and transforming growth factor beta (TGF-beta) were continuously up-regulated during the entirety of SARS. Regulated on activation normally T cell-expressed and secreted (RANTES) levels were decreased, while monocyte chemoattractant protein-1 (MCP-1) was elevated in acute patients. Immunoglobulins and complement were elevated during the first month of SARS. Both serum-positive rates and titers of specific IgM and IgG antibodies responding to SARS-CoV peaked at days 41-60 from the onset of SARS. CD4+ and CD8+ T lymphocytes decreased significantly in acute-phase. CD3+CD8+CD45RO+ T lymphocytes were decreased by 36.78% in the convalescent patients. CONCLUSION: SARS-CoV seemed to elicit effective humoral immunity but inhibited cellular immunity, especially CD8+ memory T lymphocytes over time. Prolonged overproduction of IL-10 and TGF-beta may play an important role in the disease.

[Effects of central and peripheral administration of a nitric oxide synthase inhibitor on AVP-induced hypothermia in rats].

AIM: To explore the role of nitric oxide (NO) in arginine vasopressin (AVP)-induced hypothermia. METHODS: Colonic temperature was measured at 30 min intervals with a digital thermometer. Effects of central and peripheral administration of nitric oxide synthase (NOS) inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME) on AVP-induced hypothermia were observed in rats. RESULTS: (1) Intravenous injection (i.v.) of AVP (4 microg x kg(-1)) and L-NAME (30 mg x kg(-1)) produced a significant drop in body temperature, respectively. Coadministration of L-NAME i.v. with AVP i.v. did not significantly influence the magnitude of AVP-induced hypothermia. (2) Intracerebroventricular (i.c.v.) injection of L-NAME (1 mg x kg(-1)) caused a significant increase in body temperature, but when the treatments with AVP and L-NAME were combined, i.c.v. injection of L-NAME markedly blocked the hypothermic effect of AVP intravenous injection. CONCLUSION: Endogenous NO in the central nervous system plays a major role in AVP-induced hypothermia. In addition, central NO seems to play a tonic thermoregulatory role by reducing normal body temperature because an increase in body temperature was observed after treatment with NOS inhibitor L-NAME.