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Objective:To compare the advantages of high or low inferior mesenteric artery (IMA) ligation in laparoscopic anterior resection of rectum based on CT precise guidance.Methods:One hundred and twenty patients with rectal cancer who underwent laparoscopic anterior resection of rectum in Shanghai Sixth People′s Hospital South Campus from January 2016 to June 2020 were selected. Surgical protocol was selected according to the principle of voluntariness. Sixty-eight cases underwent high IMA ligation (high IMA ligation group), and 52 cases underwent low IMA ligation (low IMA ligation group). The perioperative conditions (operative time, intraoperative blood loss, postoperative anal exhaust time, abdominal drainage, hospitalization time and ileostomy), postoperative pathological data (proximal margin distance, distal margin distance, total number of dissected lymph nodes and number of positive lymph nodes) and postoperative recovery (anastomotic stoma fistula, urinary retention, sexual dysfunction and daily number of defecation) were recorded. The quality of life 6 months after surgery was evaluated by the quality of life instruments for colorectal cancer scale (QLQ-CR38). Patients were followed up for 6 to 36 months, and the local recurrence and distant metastasis were recorded.Results:The postoperative anal exhaust time in low IMA ligation group was significantly shorter than that in high IMA ligation group: (2.87 ± 1.04) d vs. (3.26 ± 1.00) d, and there was statistical difference ( P<0.05); there were no statistical differences in operative time, intraoperative blood loss, abdominal drainage, hospitalization time and rate of ileostomy between 2 groups ( P>0.05). There were no statistical difference in proximal margin distance, distal margin distance, total number of dissected lymph nodes and number of positive lymph nodes between 2 groups ( P>0.05). The incidences of anastomotic stoma fistula, urinary retention and sexual dysfunction in low IMA ligation group were significantly lower than those in high ligation group: 3.85% (2/52) vs. 13.24% (9/68), 3.85% (2/52) vs. 11.76% (8/68) and 5.77% (3/52) vs. 14.71% (10/68), the daily number of defecation was significantly less than that in high ligation group: (2.87 ± 0.98) times vs. (4.05 ± 1.56) times, and there were statistical differences ( P<0.05 or <0.01). The functional dimension, symptom dimension and aggregate score of QLQ-CR38 in low IMA ligation group were significantly higher than those in high ligation group: (15.46 ± 4.22) scores vs. (13.68 ± 3.56) scores, (51.82 ± 13.54) scores vs. (45.65 ± 12.42) scores and (67.28 ± 14.28) scores vs. (59.33 ± 12.85) scores, and there were statistical differences ( P<0.05 or <0.01). There were no statistical difference in the rates of local recurrence and distant metastasis between 2 groups ( P>0.05). Conclusions:The application of low IMA ligation based on CT precise guidance in laparoscopic anterior resection of rectum can obtain the same surgical effect as the high IMA ligation. It can promote the recovery of gastrointestinal function after surgery, reduce the risk of complications, have less effect on the defecation function, which can improve the life quality after the surgery.
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Objective To evaluate the safety and effectiveness of enhanced recovery after surgery (ERAS) in laparoscopic radical gastrectomy for gastric cancer.Methods From May 2015 to July 2017,149 patients with gastric cancer in our department were prospectively enrolled and randomly divided into the ERAS group (n =75) and control group (n =74).Results In ERAS group compared to control group,the time to first passage of flatus was (51 ± 11)vs.(62 ± 11)h,first feeding time (46 ± 12) vs.(68 ±20)h,gastric tube removal time (13 ± 12)h vs.(70 ± 16) h,pain score on the first day after surgery (3.9 ±1.3) vs.(5.2 ±0.9),C-reaction protein level (8.5 ±2.6) mg/L vs.(10.1 ±3.0)mg/L,post-op hospital stay (6.9 ± 2.9) d vs.(11.2 ± 3.5) d,were all significantly different (all P ＜ 0.05).The postoperative complication rates was 25％ vs.28％ respectively,(x2 =0.101,P =0.750).Conclusions Enhanced recovery after surgery can promote the postoperative recovery and shorten the time of hospitalization in laparoscopic-assisted radical gastrectomy for gastric cancer.
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Objective To identify the risk factors for postoperative complications after radical resection of rectal cancer, and study the influence of high ligation of the inferior mesenteric artery on postoperative complications of rectal cancer. Methods Clinical data of the patients who underwent radical resection of rectal cancer in the Affiliated Hospital of North Sichuan Medical College from January 2011 to December 2015 were analyzed. The χ 2test and t test were used for all the data. Results A total of 431 patients with rectal cancer were included, of which 80 cases were excluded, and finally 351 cases met the standard. Among them, 196 cases were in high ligation group, and 155 cases were in low ligation group. The total incidence of postoperative complications was 20.4 %(40/196) in the high ligation group and 27.1 %(42/155)in the low ligation group respectively,the difference of which was not statistically significant(χ2=1.336, P= 0.245). The incidence of anastomotic leakage was 10.2 % (20/196) in the high ligation group and 7.7 % (12/155) in the low ligation group respectively, and there was no significant difference between them (χ2=0.529, P= 0.467). Logistic regression analysis revealed that gender (OR= 2.102, 95 % CI 1.278-3.459, P=0.003), body mass index (OR= 2.492, 95 % CI 1.070-5.800, P= 0.027), with or without anemia before surgery(OR=2.203,95 % CI 1.085-4.472,P=0.029), and location of tumor(OR=2.861, 95 % CI 1.288-16.007,P=0.019) were independent risk factors for postoperative complications. Conclusions High ligation of the inferior mesenteric artery does not increase the incidence of postoperative complications after radical resection of rectal cancer. Anastomotic leakage after rectal cancer resection is related to gender, body mass index,with or without anemia before surgery,and location of tumor.
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Objective To explore the cell-mediated immune function in patients with colon cancer undergoing minilaparotomy or laparoscopic assisted right hemicolectomy. Methods From January 2009 to August 2014, the colon cancer patients receiving right hemicolectomy were retrospectively analyzed. According to the operation mode, the patients were divided into minilaparotomy group and laparoscopic-assisted group. The clinical and pathological data was analyzed. Cell counts of total CD3, CD4, CD8, CD19 as well as NK cells in venous blood samples were compared between 1 day before surgery and postoperative days (POD) 1 and 5. Measurement data with normal distribution was compared using the t test or Q test. Count data was analyzed usingχ2 test or Fisher exact probability. Results There were 408 patients with colon cancer undergoing right hemicolectomy, 26 patients of whom were excluded. The remaining 382 patients were recruited in the research, which were divided into minilaparotomy group (182 cases) and laparoscopic-assisted group (200 cases). There was no significant difference in the age, gender, body mass index, TNM staging, histological type, blood loss, return of bowel function, tumor location, hospital stay and postoperative complications between the two groups (all P> 0.05). The operating time in minilaparotomy group [(131.53 ± 22.57) min] was shorter than that in laparoscopic-assisted group [(167.53 ± 22.04) min], and there was significant difference (t=15.76, P= 0.00). Compared with prior to surgery, cell numbers of CD3, CD4, CD8, CD19 and NK cells were lower on POD 1 and POD 5 (all P0.05). Conclusion The minilaparotomy and laparoscopic-assisted right hemicolectomy have same effect on cellular immune function of patients with colon cancer.
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Objective To establish HPLC method to detect docetaxel and compare the stability of a novel polyethylene glycol mediated lipid nanoemulsion of docetaxel with docetaxel injection saline dilutions .Methods HPLC method was estab‐lished to detect docetaxel concentration .The stability of a novel polyethylene glycol mediated lipid nanoemulsion of docetaxel and docetaxel saline dilutions were investigated by drug concentration pH value and particle size using membranes filtration method .Results The linear range of docetaxel was 1‐256 μg/ml ,regression equation was Y=21 .199X+20 .488 ,r=0 .999 9 . The drug concentration pH value and particle size of polyethylene glycol mediated lipid nanoemulsion of docetaxel was stable at room temperature in 24 hours .However the docetaxel injection saline dilutions was discovered drug precipitation in about two hours after preparation and the drug concentration was significant decreased in the filtration of docetaxel injection saline dilu‐tions .Conclusion The novel polyethylene glycol mediated lipid nanoemulsion of docetaxel was a new stable docetaxel formula‐tion and significantly increased the safety in clinical .
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Objective To investigate the factors associated with postoperative complications after laparoscopic-assisted radical surgery in rectal cancer.Methods The clinical data of 310 patients with rectal cancer performed by laparoscopic-assisted radical resection from November 2010 to August 2013 were analyzed retrospectively.The differences between patients with and without postoperative complications were compared.All the data were analyzed by the t test,chi-square test or Logistic regression analysis.Results Among the 310 patients,postoperative complication occurred in 80 patients.On univariate analysis,postoperative complication was associate with gender,age,body mass index,preoperative comorbidity,diameter and location of tumor,TNM staging,operative time and surgeon experience (all P ＜ 0.05).Logistic regression analysis revealed that gender,body mass index,preoperative comorbidity,location of tumor,TNM staging and surgeon experience were independent risk factors for postoperative complications (all P ＜ 0.05).Follow-up was available in 260 patients,with a median follow-up of 18 months (3-30 months).Differences in survival rates between patients with and without postoperative complications were no statistical significance (x2 =1.201,P =0.273).Conclusions Gender,body mass index,preoperative comorbidity,location of tumor,TNM staging and surgeon experience are independent risk factors for postoperative complications in laparoscopic-assisted radical surgery for rectal cancer.The short and medium-term survival time between patients with and without postoperative complications are similar.
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Objective To evaluate the diagnostic accuracy of the combination of endorectal ultrasonography and serum CEA in preoperative diagnosis of rectal wall invasion (T staging) and nodal involvement (N staging) of rectal carcinoma.Methods We retrospectively analyzed clinical records of 310 patients with rectal carcinoma who underwent endorectal ultrasonography and serum CEA evaluation in Shanxi Province Tumor hospital from January 2007 to January 2010.The positive standard of CEA is more than 5 μg/L.The endorectal ultrasonography staging with postoperative pathological staging,and calculated the overall accuracy of T staging and N staging based on TRUS alone or on TRUS combined with serum CEA level were compared.Results The difference in serum CEA level was statistically significant from T1 to T4 (P ＜ 0.05).The accuracy rate of preoperative T staging of rectal carcinoma by TRUS alone was 71％ (219/310) and was 82 ％ (254/310) with TRUS combined with serum CEA level,showing significant statistical difference (x2 =10.92,P ＜ 0.01).The accuracy rate of preoperative N staging of rectal carcinoma was 69 ％ (211/308)with TRUS alone and was 77 ％ (238/308) with TRUS combined with serum CEA level,the difference of which was statistically significant (x2 =5.00,P ＜ 0.05).Conclusion Serum CEA level increases with an increasing pathological stage of rectal cancer.The combination of TRUS and serum CEA improves the accuracy of preoperative staging of rectal cancer.
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Objective To measure 5Fu concentration after intraoperative regional arterial perfusion chemotherapy in gastric antrum cancer patients.Method In this study,32 gastric antrum cancer patients intraoperatively received through right gastroepiploic artery intraarterial perfusion of 5-Fu (1000 mg/m2),and drug conentrations were measured in portal venous blood,peripheral venous blood,peritoneal fluid and in removed cancer tissues 2,5,10,20,30,60 minutes after infusion started by high performance liquid chromatography method.Result 5-Fu in portal vein blood and peritoneal fluid reached peak concentration after 2 minutes at (48.8 ±6.8) μg1/ml and (75.3 ±30.7) μg/ml,respectively.The drug concentration in portal venous blood was (19.2 ± 2.0) μg/ml at 30 minutes and that in peritoneal fluid was (17.3 ±7.4) μg/ml at 60 minutes,both were higher than that of the effective experimental tumor suppressing concentration (15 μg/ml).Peripheral venous blood concentration reached peak concentration of (5.4 ± 2.0) μg/ml at 5 minute.The drug concentration in removed cancer tissues was (80.5 ± 20.1) μg,/ml.Conclusions Regional intraarterial perfusion chemotherapeutics in gastric antrum cancer patients during operation immediately makes the concentration of chemotherapy rise in the portal vein blood and peritoneal fluid and in cancer tissues to a much higher level than that in peripheral blood.This helps kill cancer cells that fell out during the surgery.
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Objective To identify risk factors for anastomotic leakage,and study the influence of high ligation of the inferior mesenteric artery on anastomotic leakage after rectal cancer resection.Methods The chi-test and the student t test were used for statistics.Clinical data were analyzed for 291 patients who underwent rectal cancer resection between August 2008 and November 2011.Results Anastomotic leakage occurred in 27 (9.3％) patients.Anastomotic leakage significantly increased in patients with tumours located within 10 cm from the anal verge,in male patients,and intraoperative blood loss.The use of high ligation of inferior mesenteric artery,which was associated with lower tumor location and surgical modality,was not a risk factor for anastomotic leakage,though it was associated with tumor stage and postoperative urinary retention.Conclusions Anastomotic leakage after rectal cancer resection is related to the tumor level,male gender,and perioperative bleeding,use of a high tie was not associated with an increased rate of symptomatic anastomotic leakage.
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BACKGROUND: Eggembryosin is characterized by tonifying kidney and vital essence, invigorating qi and spleen, replenishing and activating blood, beautifying and nourishing face, and improving constitution of whole organism.OBJECTIVE: To observe the influence of eggembryosin on aging index,quantity of hemocytes and quality of immune organs of animal models, and analyze its effect on cosmetology, anti-senility and immunoloregulation.DESIGN: Randomized controlled observation.SETTING: Department of Pharmacology, Xinxiang Medical College.MATERIALS: The experiment was carried out in the Department of Pharmacology of Xinxiang Medical College between April 1998 and September 2002. A total of 80 Kunming mice of both sexes were selected in this study.METHODS: ① Effect of eggembryosin on activity of superoxide dismutase (SOD) in serum, content of malondialdehyde (MDA), lipofuscin and hydroxyproline respectively in serum, liver and tendon of tail of aging mice: Thirty mice were divided into 3 groups according to randomly lined table, including eggembryosin group, D-galactose model group and normal control group with 10 in each group. The former two groups were injected with D-galactose to copy aging models, and eggembryosin group were perfused with eggembryosin to measure activity of SOD in serum, content of MDA, lipofuscin (aging index) and hydroxyproline (elasric index of skin) respectively in serum, liver and tendon of tail. ② Effect of eggembryosin on mass of immune organs of mice with low immunological function: Thirty mice were selected and divided as the same way mentioned above. Mice in eggembryosin group were perfused with eggembryosin. In addition, those in eggembryosin group and cyclophosphamide (CAP) group were peritoneally injected with CAP to copy immunosuppression models and calculate index of thymus (spleen) (mg/g) = weight of thymus (spleen)/body. ③ Effect of eggembryosin on quantities of erythrocytes and hemoglobin of mice with blood deficiency: Twenty mice were divided into 2 groups according to randomly lined table, including eggembryosin group and normal control group with 10 in each group. Values of erythrocytes and hemoglobins of mice were measured before administration. Models in types of blood-deficiency blood-loss were copied with tail xsanguinations, and then, mice were perfused with eggembryosin and saline, respectively. Blood of mice were collected from their tails to measure values of erythrocytes and hemoglobin.MAIN OUTCOME MEASURES: Activity of superoxide dismutase (SOD) in serum, content of malondialdehyde (MDA), lipofuscin and hydroxyproline respectively in serum, liver and tendon of tail of aging mice, index of thymus, and spleen, contents of blood erythrocytes and hemoglobins.RESULTS: A total of 80 mice were involved in the final analysis without any loss. ① Activity of SOD in serum and contents of hydroxyproline in tendon of tail of mice in eggembryosin group were significantly higher than those of mice in D-galactose model group (P ＜ 0.01); content of MDA in serum and content of lipofuscin in liver of mice in eggembryosin group were significantly lower than those of mice in D-galactose model group (P＜ 0.01). ② Indexes of thymus and spleen of mice in eggembryosin group were higher than those of mice in CAP group (P ＜ 0.05-0.01). ③ Increasing values of blood erythrocytes and hemoglobin of mice in eggembryosin group were significantly higher than those of mice in normal control group (P ＜ 0.01).CONCLUSION: Eggembryosin taken orally can improveanti-oxidation of organism and elasticity of skin, increase quality of immune organs damaged by CAP and immunological function, and nourish the blood.
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Objective To investigate the expressions of ER? protein and ER? isoform mRNA in sigmoid colon of female slow transit constipation patients. Methods RT-PCR and Western blot were used to detect the expression of ER? protein and ER? isoform mRNA of 20 patients with STC and 20 age-matched controls. Results ER? protein and ER?1, ER?2 and ER?5 mRNA were detected in the two groups lower in STC group than that in control group (P
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Objective To classify the taxonomic status of O.cheni in relation to O.turkestanicum var. tuberculata from the mainland of China by comparing their nucleotide sequences of nuclear ribosomal partial large subunit gene (LSU). Methods The genomic DNA of adult worms were extracted by the GNT-K method. The target gene was amplified by PCR using specific primers. The PCR products were purified before ligation into the plasmid PCR-blunt (Invitrogen). Recombinant plasmids were amplified in E.coli , extracted and purified using routine methods and then sequenced using M13 primers (F/R) on a Licor long-read auto-sequencer. Sequences of O. turkestanicum was retrieved from GenBank and aligned with our data in BioEdit. Results The nucleotide sequences of LSU between O.turkestanicum var. tuberculata and O.cheni was 100% identical, and 99.99% identical between O.turkestanicum var. tuberculata and O.turkestanicum . Conclusion This study demonstrated high similarity in LSU nucleotide sequences, and the results do not support O.cheni as an independent species. O.cheni may be a synonym of O.turkestanicum var. tuberculata , and O.turkestanicum var. tuberculata is probably also a synonym of O.turkestanicum .
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Objective To determine the phylogenetic position of Schistosoma sinensium in the genus Schistosoma using mitochondrial cytochrome C oxidase 1 (CO1) and NADH dehydrogenase 1(ND1) as molecular markers. Methods The genomic DNA of adult worms were extracted by the GNT\|K method. The target regions were amplified by PCR using specific primers. The PCR products were purified before ligation into the plasmid Zero\|Blunt. Recombinant plasmids were amplified in E.coli, extracted and purified using routine methods and then sequenced using M13 primers (F/R) on a Licor long\|read auto\|sequencer. Sequences of related schistosomes were retrieved from GenBank and aligned with our data in the sequence editor ESEE. Gene trees were constructed in PHYLIP and MEGA using both maximum parsimony and neighbor\|joining methods. For parsimony analysis, all characters were treated as unordered and with equal weights. At least \{3 000\} cycles of bootstrapping were carried out. For analysis in MEGA, all gap columns were deleted. The third position of codon was included. Results The nucleotide and amino acid sequences of CO1 and ND1 of S.sinensium were obtained. Conclusion The phylogenetic trees from these molecular data suggested that S.sinensium belongs to the Asian schistosome group, and the results coincided with the previous rDNA (ITS2 & LSU) analysis results.