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Objective:To investigate the value of the venous-to-arterial CO 2 gap (Δ CO 2 gap) before and after the fluid challenge (FC) in determining the fluid responsivenessin septic shock patients. Methods:A total of 104 septic shock patients admitted to the Medical Intensive Care Unit (MICU) of Peking Union Medical College Hospital were included in the retrospective study. All patients were monitored by Swan Ganz floating catheter during the FC. Hemodynamics and blood gas indices were collected before FC (T0) and immediately (T1), 10 min (T2), 30 min (T3) and 60 min (T4) after FC. Responders were defined as patients with a > 10% increase in cardiac output (CO) after FC. Spearman correlation analysis was used to evaluate the correlation between CO 2 gap and CO. The value of ΔCO2 gap were calculated by the area under the receiver operating characteristic (AUROC) curve in the whole population. Results:Among 104 patients, the effective rates of FC at T1, T2, T3 and T4 were 59% (61/104), 72% (75/104), 73% (76/104), and 77% (80/104), respectively. CO of patients in the reactive group was lower than that in the non-reactive group at T2 [6.0 (4.7, 7.5) vs. 7.2 (6.4, 8.5) L/min, P=0.019], and there was no significant difference in CO 2 gap between the two groups before FC. Spearman correlation analysis showed that CO 2 gap was negatively correlated with CO, and the correlations between CO 2 content gap and CO was -0.34, and -0.33 of CO 2 pressure gap and CO, respectively (both P <0.05). ROC curve analysis showed that the ΔCO 2 gap at T1 could weakly judge the reactivity at T2, T3 and T4, but could not judge the reactivity at T1. The AUROC at T2 was 0.669 of ΔCO 2 content gap and 0.684 of ΔCO 2 pressure gap (both P <0.05). Conclusions:The evaluate time judging the effect of FC should be appropriately extended. The change value of CO 2 gap before and immediately after volume expansion in septic shock patients can judge the fluid responsiveness within 10 min after FC.
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Objective:To compare liver adhesive suspension method and V-shaped liver suspension of anterior abdominal wall in laparoscopic radical gastrectomy.Methods:This study retrospectively evaluated 115 patients who underwent laparoscopic radical gastrectomy from Jan 2018 to Dec 2019 at Shanxi Provincial People′s Hospital, 59 cases were under liver adhesive suspension (study group) and 56 cases under V-shaped liver suspension of anterior abdominal wall (control group). Intraoperative and postoperative conditions were observed and compared between the two groups.Results:All the 115 cases successfully completed surgery. The liver suspension time in study group was (2.4±0.5)min, which was significantly shorter than that of the control group((12.5±2.6) min)( t=-28.100, P<0.01). The total operation time in was (284±69) min and (307±78) min, respectively, ( t=-1.656, P=0.10). There were no statistically significant differences between the two groups in preoperative ALT, AST, total bilirubin, intraoperative incidence of hepatic lacerations and subcapsular hematoma, postoperative total bilirubin level, AST on the day 7 postoperatively, tumor location, TNM staging, surgical method, postoperative duration of hospital stay, and VAS score ( P>0.05). Conclusions:Both methods of liver suspension are safe and feasible in laparoscopic surgery for gastric cancer.Compared with V-shaped liver suspension of anterior abdominal wall, liver adhesive suspension has the advantages of less invasive, safe, and time-saving.
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Objective To investigate the effects of lentivirus-mediated RNA interference (RNAi) targeting DNA binding protein A (dbpA) on the proliferation and the biological behavior of colorectal cancer cell line SW620.Methods The experiment was divided into 3 groups:KD group (siRNA-dbpA,lentivirus interference group),CON group (non-specific sequence group) and NC group (blank control group).The lentiviral vector siRNA-dbpA was constructed and verified by PCR and DNA sequencing.SW620 cells were transfected with siRNA-dbpA plasmid,nontargeting siRNA plasmid,or empty plasmid.After 48 h the transfection,the cells were examined for dbpA expression using Western blot.After 72 hrs transfection,flow cytometry was used to detect the cell apoptosis and cell cycle changes.The cell growth inhibition rate was detected by MTT (4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide) assay,and then clone formation was detected,and the ability of SW620 cells to form tumors in vivo after dbpA was silenced was studied in nude mice.Results PCR analysis and DNA sequencing demonstrated that the RNAi sequence targeting dbpA gene was successfully inserted into the lentiviral vector.siRNA-dbpA transfection resulted in reduced expression of dbpA in SW620 cells.After transfection,the apoptosis rate of siRNA-dbpA-transfected cells increased to 26.60％ ± 0.38％,significantly higher than that in cells transfected with the nontargeting plasmid or the empty plasmid 12.54％ ± 0.25％ and 4.46％ ± 0.19％,respectively (F =28.159,P ＜0.01).The growth inhibition test indicate that the OD value of the fifth day in siRNA-dbpA group was 0.194 ±0.037,significantly lower than that in the other two groups 0.814 ±0.043 and 1.625 ±0.061,respectively(F =23.214,P ＜ 0.01).The colony formation number is 37 ± 3,64 ± 5and 175 ± 10 respectively,siRNA-dbpA is significantly higher than that in the other two groups(F =40.254,P ＜ 0.01).After the completion of nude mouse transplantation tumor model,through the detection of tumor volume,KD group (group siRNA-dbpA) tumor volume after 14 d and CON and NC group had obvious difference (F =38.256,P ＜ 0.05),and after 21d is more significant difference in tumor size (F =40.241,P ＜ 0.01),can be clearly observed after 35 d KD group (group siRNA-dbpA) growing tumors had differences with the control group (F =30.257,P ＜ 0.05).Conclusion Lentivirus-mediated RNAi targeting dbpA can effectively suppress the expression of dbpA in colorectal tumor in nude mice,it is proved that dbpA silencing has a significant inhibitory effect on the growth of living tumor cells and decrease the proliferation of the colorectal cells.
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<p><b>OBJECTIVE</b>To analyze the common hemorrhage sites during laparoscopic rectal cancer surgery in order to take reasonable prevention and management.</p><p><b>METHODS</b>Clinical data of 355 rectal cancer patients who underwent laparoscopic total mesorectal excision in Shanxi Provincial People's Hospital from January 2012 to December 2014 were retrospectively analyzed. Common bleeding sites, blood loss, and hemostasis time were recorded. According to the date of operation, patients were divided into 2012 group (91 cases), 2013 group (122 cases) and 2014 group(142 cases). Hemorrhage rates were compared among three groups.</p><p><b>RESULTS</b>No significant differences were observed in the baseline data among the three groups(all P>0.05). The location in the order of the hemorrhage rate from high to low was seminal vesicle tail (63.0%, 131/208), inferior mesenteric vessels (27.3%, 97/355), Toldt's space (24.2%, 86/355), lateral rectal ligaments (12.1%, 43/355) and post-rectal spatial (8.2%, 29/355). According to the blood loss, post-rectal spatial[(14.1±7.1) ml], inferior mesenteric vessels [(12.7±6.1) ml] and seminal vesicle tail [(12.4±6.5) ml] were ranked in top three. The hemostasis time of seminal vesicle tail [(11.5±6.6) minutes] and post rectal spatial [(10.3±7.8) minutes] was longer than the others. Compared with 2012 group, shorter operative time [(205±50) minutes vs. (235±55) minutes, t=4.296, P=0.001], less blood loss [(35±19) ml vs. (81±24) ml, t=16.243, P=0.001] and lower hemorrhage rate [Toldt's space: 7.7%(11/142) vs. 39.6%(36/91), inferior mesenteric vessels: 9.2%(13/142) vs. 44.0%(40/91), post-rectal spatial: 0.7%(1/142) vs. 15.4%(14/91), lateral rectal ligaments: 2.1%(3/142) vs. 29.7%(27/91) and seminal vesicle tail: 50.6%(41/81) vs. 79.6%(43/54)] were found in 2014 group. The decline of hemorrhage rate in seminal vesicle tail was the slowest (χ=11.792, P=0.003).</p><p><b>CONCLUSIONS</b>The common hemorrhage sites during the laparoscopic rectal cancer surgery are inferior mesenteric vessels, Toldt's space, lateral rectal ligaments, post rectal spatial and seminal vesicle tail. Appropriate preventive measures can ameliorate the intraoperative bleeding significantly, however, more attention should be paid to the seminal vesicle tail during operation because of its higher hemorrhage rate, more blood loss and difficult hemostasis.</p>
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Objective To investigate the action and skills of camera-assisted laparoscopic rectal cancer radical surgery.Methods From January 2009 to May 2015,a total of 577 cases with rectal cancer underwent laparoscopic rectal cancer radical surgery,including 152 cases of abdominal perineal resection,and 425 cases of abdominal resection.The skills of camera-assisted operation were summarized.Results All the operations were successfully completed without serious complications.Conclusions Regarding for skills of camera assistant,mastering the clinical topography of rectum,understanding the operational habit of operator,understanding operating procedure and operation characteristics are the necessary condition to complete laparoscopic rectal cancer radical surgery.
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Objective To investigate the expression of DNA binding protein A (dbpA) in patients with colorectal carcinoma of different stages and its significance.Methods Expression of dbpA protein and mRNA in specimens of normal tissues and colorectal cancer were detected by immunohistochemistry,expression of dbpA mRNA and protein of colorectal cancer cell lines SW480,RKO,SW620,DLD-1,HT-29,SW1463 and tissues were detected by immunohistochemistry,RT-PCR and Western blot.Results There was no positive staining dbpA protein and mRNA in normal colorectal tissues.However,dbpA was expressed in epithelial cells of colorectal mucosa [dbpA mRNA:80.0 ％ (48/60),10.0 ％ (6/60);dbpA protein:83.3 ％ (50/60),10.0 ％ (6/60),P ＜ 0.01].And there was no expression in normal colorectal cell,but its expression was high in 6 colorectal cancer cells (P ＜ 0.05).The high expression of dbpA was correlation with the infiltration depth,lymph node metastasis and type of histology (P ＜ 0.05),and had effect in prognosis of colorectal cancer (P ＜ 0.05).Conclusion Elevated dbpA may be related to the pathogenesis and development of colorectal carcinoma,and dbpA may be a prognostic factor of colorectal carcinoma.
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<p><b>OBJECTIVES</b>To investigate the regression pattern of mid and low rectal cancer treated with neoadjuvant chemoradiotherapy and then to provide the pathological proofs for reasonable resectional margin in rectal cancer surgery.</p><p><b>METHODS</b>Forty cases of mid and low rectal cancer patients received concurrent chemoradiotherapy and then underwent radical operation. The whole-mount serial sections of resected rectal cancer specimen were stained with cytokeratin antibody using immunohistochemical techniques to show the residual cancer cells under the mucosa. The microscopic measurement was performed to determine the reverse infiltration of cancer cells in the rectal wall and to describe the cancer cells scatter ways in the cancer mass. The Ki-67 immunohistochemical stain was also performed to show the proliferation activity of residual cancer cells after neoadjuvant chemoradiotherapy.</p><p><b>RESULTS</b>The length of specimen was shrinking continuously during the pathologic section production and the shrink rate was 18%. There were remanent cancer cells which showed positive Ki-67 expression and the chemoradiotherapy decreased the Ki-67 expression significantly. The lower edge of remaining ulcers or scars could be used as the reference point from which the cancer infiltration could be measured. According to our measurement, the average reverse infiltration of cancer cells in the whole-mount section was (6.1±4.7) mm, the deepest one was 11.0 mm in the section which could be converted into fresh bowel length of 12.98 mm. The pathology showed that the residual cancer cells scattered in the fibrous tissue of ulcers, scars and manifested a regression of spatial distribution.</p><p><b>CONCLUSIONS</b>The rectal cancers show regression in different degrees after neoadjuvant chemoradiotherapy. The residual cancer cells in the fiber tissues manifest proliferation activity. The distal end of resection should be at least 2 cm away from the lower edge of ulcers or scars of primary tumor in the rectal wall in patients after neoadjuvant chemoradiotherapy. The circumferential resection margin should include all the fibrous scar of the tumor area to ensure the remove of tumor cells completely.</p>
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Aged , Female , Humans , Male , Middle Aged , Chemoradiotherapy , Neoadjuvant Therapy , Rectal Neoplasms , Pathology , General Surgery , TherapeuticsABSTRACT
Treating tumors with electric field is an interdisciplinary integrated and comprehensive research which applies electro-technology to tumor treatment.This therapy has the characteristics of safe,practical to its users and the parameters are easily to be controlled,which has attracted considerable attention in recent years.The main types of electric field in current research or application are pulsed electric field and direct current electric field.Both of the types can change the environment where tumors grow with different mechanisms,and the tumors would be killed through their pathological changes.Alternating electric field in intermediate frequency is a new type of tumor treating field,which has a promising application prospect.This article reviews the international and domestic research progress of the effects and mechanisms of the three kinds of electric fields used in the treatment of tumors.
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Objective To investigate lymph node metastases in distal gastric cancer and its clinical significance. Methods From June 2006 to December 2007, 129 distal gastric cancer patients underwent radical gastrectomy with lymphadenectomy. Dissected lymph nodes were collected in groups, and histopathological studies were performed to detect lymph node metastasis. The relationship between lymph node metastasis and tumor parameters such as diameter, location, infiltrating depth, histological category,Borrmann typing was evaluated. Results Lymph node metastases was found in 80 out of 129 patients (62%). A total of 3295 lymph nodes were harvested with an average of 25.54 lymph nodes per patient,among those 889 lymph nodes were identified with metastasis. The metastasis rate was 18.60%, 48. 84%,37. 98%, 38. 76%, 44. 19%, 31.01%, 10. 85%, 14. 73%, 4. 65%, 1.55% and 0. 78% respectively in No. 1, No. 3, No. 4d, No. 5, No. 6, No. 7, No. 8a, No. 9, No. 11 p, No. 12a, No. 14v lymph node group.No. 3 and No. 6 group nodes were moat frequently invaded by metastasis. Conclusion This study provides the regular pattern of lymph node metastasis in distal gastric carcinoma patients undergoing radical gastrectomy and perigastric lymphadectomy which helps to guide lymphadectomy in terms of less trauma and favorite prognosis.