[Current status of intraoperative lymph node dissection for hilar cholangiocarcinoma].

Lymphatic metastasis is an independent prognostic factor for surgical prognosis of patients with hilar cholangiocarcinoma (HCCA) . Lymph node dissection is an important content of radical resection of HCCA, but there are still many disputes about the definition, scope and dissection numbers of intraoperative lymph node dissection. There has been a lot of research being done at home and abroad in recent years focusing on the above problems, and novel insights have also been proposed.According to the current view, routine skeletal dissection of lymph nodes in the duodenum ligament of liver, the common hepatic artery, and the posterior part of the duodenum of pancreas head (the 12(th) group, the 8(th) group and the 13(th) group) during operation can bring significant survival benefits to patients with HCCA. However, it is still not clear whether the dissection of peripheral lymph node in truncus coeliacus, aorta abdominalis, and venae cava inferior during operation can bring survival benefits to HCCA patients during operation. Properly increasing the number of lymph node dissection during operation can not only significantly improve the survival prognosis of the patients of HCCA with stage N0, but also improve the detection rate of positive lymph nodes and obtain enough information for the stage of the disease. However, the excessive increase of total lymph node count is not only difficult to achieve in practice, but may also lead to an increase in the incidence of postoperative complications. Therefore, further investigation is needed in intraoperative lymph node dissection of HCCA.

Effects of heparin catheter-sealing solution for implantable venous access ports on D-dimer levels in older cancer patients.

OBJECTIVE: To investigate the effects of different concentrations of heparin catheter-sealing solution for implantable venous access ports (VAPs) on D-dimers (D-D) in older cancer patients. PATIENTS AND METHODS: A total of 208 older cancer patients who received intravenous chemotherapy for the first time were randomly divided into four groups: the normal saline group, the low concentration heparin group (25 U/ml), the medium concentration heparin group (50 U/ml), and the high concentration heparin group (75 U/ml), with 52 patients in each group. VAPs were sealed by the positive pressure technique every day before and after perfusion, as well as at the end of a course of chemotherapy when the butterfly needle was removed. The patients were followed-up for three courses of chemotherapy, and comparisons of the clinical effects were conducted. RESULTS: Before treatment and at the end of follow-up, no significant differences among groups were found in platelet count, prothrombin time, thrombin time, or activated partial thromboplastin time (p>0.05). At the end of follow-up, the high concentration heparin group had reduced fibrinogen (FIB) and increased D-D compared with the other groups, and the differences were statistically significant (p<0.05). The other three groups showed no significant differences in FIB or D-D before treatment or at the end of follow-up (p>0.05). The high concentration heparin group had higher local bleeding rate, while the saline group had higher partial and complete prevalence of blockage compared with the other groups. The differences were statistically significant (p<0.05). CONCLUSIONS: 25-50 U/ml heparin catheter-sealing solution had little effect on blood circulation and coagulation. Additionally, it did not increase the risk of local bleeding or thrombotic blockage.

[Chemical constituents of Diuranthera inarticulata].

AIM: To investigate the chemical constituents from the roots of Diuranthera inarticulata Wang et K. Y. Lang. METHODS: The compounds were isolated with silica gel column chromatography and their structures were identified on the basis of spectral data and TLC with authentic samples. RESULTS: From the methanolic extracts of the roots of Diuranthera inarticulata, ten compounds were obtained and nine of them were identified as chloromaloside A (III), diuranthoside A (IV), diuranthoside B (V), diuranthoside F (VI), diuranthoside G (VII), 2 alpha, 3 alpha, 19 alpha-trihydroxy-urs-12-en-28-oic acid (VIII), 3,6,7,3',4'-pentamethoxy flavone (IX), gitogenin (X) and daucosterol (XI). III-VI showed inhibition of growth with the yeast, Candida albicans. III, IV and VI also showed inhibition of growth with fungus, Aspergillus niger, in the test of antibacterial activity. CONCLUSION: All of these compounds were isolated from this plant for the first time. Among them, VI and VII are new steroidal saponins.