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Objective@#To investigate short-term efficacy of laparoscopic spleen-preserving splenic hilus lymphadenectomy and left epigastrium mesogastric excision for advanced proximal gastric cancer based on mesangial anatomy.@*Methods@#A case series study was carried out. Case inclusion criteria: (1) patient was confirmed as gastric adenocarcinoma by gastroscopic biopsy before operation; (2) locally advanced gastric cancer was confirmed by abdominal CT before operation; (3) no distant metastases such as liver, lung, and posterior peritoneal lymph nodes, and no tumor directly invading the pancreas, spleen, liver, and colon were verified by superficial lymph node ultrasound, chest and abdominal CT before operation;(4) total gastrectomy or proximal gastrectomy plus D2 lymphadenectomy were performed, and R0 resection was confirmed by postoperative pathology. Exclusion criteria: (1) intraperitoneal dissemination or distant metastasis was found during laparoscopic exploration; (2) No.10 lymph nodes were significantly enlarged or fused into clusters; (3) pathological diagnostic data were incomplete. According to above criteria, the clinicopathological data of 36 patients who underwent laparoscopic spleen-preserving No.10 lymphadenectomy and left epigastrium mesogastric excision based on interspace anatomy for advanced proximal gastric cancer in The First Affiliated Hospital of Zhengzhou University from June 2017 to March 2018 were retrospectively collected and analyzed. The intraoperative conditions, postoperative recovery and complications of patients were analyzed.@*Results@#In 36 patients, the mean age was (59.8±8.0) years, the mean BMI was (23.9±3.5) kg/m2, and 8 cases (22.2%) received preoperative chemotherapy. All the patients underwent successfully the laparoscopic spleen-preserving splenic hilus lymphadenectomy and left epigastrium mesogastric excision. In the examination of postoperative resected specimens, it was found that the mesangial boundary of the upper and posterior part of the stomach was smooth, indicating the efficiency of complete mesangial resection. No case was converted to open operation. The mean time of lymph node dissection and mesangial resection was (34.2±11.4) minutes. The mean blood loss during operation was (44.8±21.3) ml. The mean number of lymph node dissection per patient was 45.6±17.6. The mean number of No. 11p+11d lymph node dissection was 3.1± 2.8 per patient, and 7 patients were pathologically positive with metastasis rate of 19.4% (7/36). The mean number of No.10 lymph node dissection was 2.9±2.5 per patient, and 2 patients were pathologically positive with metastasis rate of 5.6% (2/36). The time to postoperative flatus was (3.8±0.6) days, time to removal of nasogastric was (1.9±0.7) days, time to the first intake of fluid was (3.0±0.4) days, time to removal of drainage tube was (6.0±1.2) days. Postoperative mean hospital stay was (12.8±4.0) days. One case (2.7%) developed pulmonary embolism and 1 case (2.7%) developed gastroplegia after operation. The morbidity of postoperative complication was 5.6% (2/36). No operative site infection, postoperative bleeding and death within postoperative 30-day were observed. All the 36 patients were followed up and the median follow-up was 18 months (12-28 months). Seven patients died of tumor relapse and metastasis (3 cases died within postoperative 1 year) and another 1 case developed colonic cancer 17 months after operation.@*Conclusion@#Laparoscopic spleen-preserving splenic hilus lymphadenectomy and left epigastrium mesogastric excision for advanced proximal gastric cancer based on mesangial anatomy is safe and feasible.
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Objective To investigate the value of D-dimer in predicting the progression of lower extremity deep venous thrombosis (DVT) during perioperative period of gastrointestinal surgery.Methods Color Doppler ultrasound was used to dynamically monitor the formation and changes of perioperative deep venous thrombosis (DVT) in 239 patients receiving abdominal surgery in our department from Nov 2014 to Aug 2016.Changes of plasma D-dimer were measured,and clinical data of malignant tumor,infection,age,BMI were collected.The relationship between D-dimer elevation and DVT progression was analyzed.Results Lower extremity DVT after surgery developed in 97 patients,and thrombosis progression occurred in 16.6％ (16/97).Univariate logistic regression analysis showed that continuous increase of postoperative D-dimer was closely related to the progression of thrombosiss.Multivariate Logistic regression analysis showed that the continuous rise of D-dimer was an independent risk factor for thrombosis.ROC curve analysis showed significantly increased risk of thrombosis progression,when plasma D-dimer polymerization increased ＞0.87 mg/L on the 3rd day.Conclusion The continuous increase of D-dimer ＞ 0.87 mg/L predicts DVT progression of lower extremity DVT.
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Objective To evaluate the correlation between ultrasonography and histopathology in acute lung injury of rats.Methods Twenty male Wistar rats were randomly divided into control group (4 rats) and experimental group (16 rats),in the experimental group acute lung injury models were step-by-step induced by oleic acid (OA) and sequentially by OA and lipopolysaccharide (LPS).After the end of each step of models,ultrasound examination was applied,and the rats were sacrificed to take the lung specimens to be observed.The ultrasonography and pathological results were analyzed,and the numbers of alveolar were counted under microscope (200 times).Results With the aggravation of acute lung injury,the sonographic findings showed unclear or disappeared pleural line,close-set of B-lines,and pulmonary consolidation with air bronchogram.For control group,the ultrasonographic score was 0.25 ± 0.50,lung injury pathological score was 0.50 ± 0.58,and the numbers of alveolar were 25 ± 3.For OA group,the ultrasonographic score was 2.86-± 1.35,lung injury pathological score was 6.28-± 0.76,and the numbers of alveolar were 10-± 2.For OA + LPS group,the ultrasonographic score was 5.83-± 2.32,lung injury pathological score was 9.83 ± 0.98,and the numbers of alveolar were 6-± 2.All 3 groups were significant different on ultrasonographic score,pathological score and alveolar counts (P ＜ 0.01).Conclusions The ultrasonography image of acute lung injury of rats were positively correlated with its histopathological alteration.The ultrasonography can effectively evaluate the degree of acute lung injury of rats.
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Objective To establish a less-damage method for tracheal intubation so as to improve the quality of post-cardiac arrest syndrome.Methods Thirty rabbits wvere divided into 3 groups of 10 rabbits each according to the random number table:group A receiving direct endotracheal intubation after anesthesia,Group B separation of cervical tissue and retrograde tracheal intubation after anesthesia and Group C percutaneous retrograde tracheal intubation after anesthesia.After the intravenous injection of forskolin,cardiac arrest was induced by endotracheal tube clamping.After 5 minutes of untreated arrest,conventional cardiopulmonary resuscitation was initiated.Changes in arterial pressure,occurrence of post-resuscition syndrome and survival time were examined in all groups.Results Groups A,B and C showed 40％,60％ and 80％ success rate in cardiopulmonary resuscitation (P ＜ 0.01) and animal survival time of 23.4 hours (11.6-35.8 hours),62.7 hours (29.4-88.6 hours) and 79.5 hours (40.9-118.2 hours) (P ＜ 0.01).Conclusions Percutaneous retrograde tracheal intubation is suitable to increase cardiopulmonary resuscitation rate and survival rate in rabbits with post-cardiac arrest.The model has good stability and repeatability and can be used for study of post-cardiac arrest syndrome.
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Objective To investigate the efficiency of ultrasound microbubble-mediated HGF gene transfer on liver fibrosis in rats. Methods The eukaryotic expression vector pMD18-T/HGF was constructed. The rats were randomly divided into 5 groups: normal group, model group, low dose group,middle dose group and high dose group. The rat liver fibrosis were induced. At day 14 after treatment, the rats were sacrificed, the ALT lever were evaluated, pathological evaluation of liver fibrosis were made,immunohistochemical evaluation of HGF protein expressions were observed, HGF mRNA expression were detected by RT-PCR. Results Liver 1function after the treatment showed that the treatment groups were better than model group ( P ＜ 0. 05). The difference between low dose group and normal group showed significant difference ( P ＜0.05), and the difference between middle/high dose groups and normal group showed no significant ( P ＞0. 05). Pathological results showed that the treatment groups could reduce liver fibrosis;treatment groups had the positive HGF expression by immunohistochemistry and the expression level increased with the increasement of the treatment dose ( P ＜0.05). RT-PCR showed HGF mRNA expression in the treatment groups were higher than in model group ( P ＜0.05). Conclusions Ultrasound microbubbles which carrying HGF can inhibit the process of hepatic fibrosis.
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Objective To study the expression of substance P(SP) and substance P receptor(SPR) during the development of mice brains. Methods The expression of SP and SPR during the development of mice brains from embryonic day(E) 11 to postnatal day(P) 0 days was analyzed by immunohistochemical method. Results The expression of SP began at E11 and gradually increased until birth. The expression of SPR began at E11 and maintained stable expression until birth. SP mostly expressed at striatum and SPR mostly expressed at medullary raphe.Conclusion The expression of SP and SPR during the embryo brain stage may indicate that SP could be an important factor involved in the early organization and maturation of neuron.