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Objective:To intestigate the clinical efficacy between modified Overlap anastomosis and traditional auxiliary incision anastomosis in laparoscopic total gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 115 patients with gastric cancer who were admitted to the Second Affiliated Hospital of Fujian Medical University from January 2016 to December 2018 were collected. There were 62 males and 53 females, aged from 27 to 83 years, with a median age of 62 years. Of 115 patients, 51 patients undergoing totally laparoscopic total gastrectomy with modified Overlap anastomosis using linear stapler were divided into modified Overlap group and 64 patients undergoing laparoscopic assisted total gastrectomy with traditional auxiliary incision anastomosis using circular stapler were divided into traditional assisted group. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) anastomotic complications; (4) follow-up. Follow-up using outpatient examination or telephone interview was conducted to detected tumor recurrence and survival of patients up to December 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ranked data was analyzed using the rank sum test. Results:(1) Surgical situations: the operation time, time of esophagojejunostomy, volume of intraoperative blood loss, the number of lymph node dissected, length of proximal incisional margin and length of auxiliary incision of the modified Overlap group were (234.0±11.0)minutes, (29.4±2.1)minutes, (53±14)mL, 42±13, (2.0±0.3)cm and (5.1±0.4)cm, respectively. The above indicators of the traditional assisted group were (231.0±11.0)minutes, (29.2±2.2)minutes, (50±13)mL, 40±10, (2.2±0.4)cm and (8.2±0.4)cm, respectively. There was significant difference in the length of auxiliary incision between the two groups ( t=-43.098, P<0.05), and there was no significant difference in the operation time, time of esophagojejunostomy, volume of intraoperative blood loss, the number of lymph node dissected, length of proximal incisional margin between the two groups ( t=1.168, 0.460, 0.990, 1.127, -1.926, P>0.05). (2) Postoperative situations: cases with mild, moderate, severe pain (postoperative pain degree), time to first flatus, time to initial fluid diet intake, duration of postoperative hospital stay of the modified Overlap group were 40, 9, 2, (2.9±1.0)days, (4.8±2.2)days, (11.7±2.8)days, respectively. The above indicators of the traditional assisted group were 31, 27, 6, (3.9±1.4)days, (6.5±2.5)days, (13.0±3.1)days, respectively. There were significant differences in the above indicators between the two groups ( Z=-3.217, t= -4.344, -3.888, -2.261, P<0.05). (3) Anastomotic complications: cases with anastomotic leakage, cases with anastomotic bleeding, cases with anastomotic stenosis of the modified Overlap group were 1, 1, 0, respectively. The above indicators of the traditional assisted group were all 1. There was no significant difference in the above indicators between the two groups ( P>0.05). Cases with anastomotic leakage were cured after the treatment of enteral nutritional support through nasogastric catheterization, which were confirmed by gastroenterography. Cases with anastomotic bleeding were improved by active hemostatic therapy. Cases with anastomotic stenosis were improved after the symptomatic treatment of anti-inflammatory and anti-swelling. (4) Follow-up: 109 of the 115 patients were followed up. Forty-eight of 51 patients in the modified Overlap group were followed up for 15.0-45.0 months, with a median follow-up time of 33.5 months. Sixty-one of 64 patients in the traditional assisted group were followed up for 16.0-46.0 months, with a median follow-up time of 27.0 months. There was no tumor recurrence in the modified Overlap group. One patient in the traditional assisted group had tumor recurrence with liver metastasis and survived with tumor. There was no significant difference in tumor recurrence rate between the two groups ( P>0.05). There was no patient died during the follow-up. Conclusion:Compared with traditional auxiliary incision anastomosis, patients undergoing total laparoscopic total gastrectomy with modified Overlap anastomosis have small incision, good postoperative recovery.
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Seizures during sleep increase the probability of complication and sudden death. Effective prediction of seizures in sleep allows doctors and patients to take timely treatments to reduce the aforementioned probability. Most of the existing methods make use of electroencephalogram (EEG) to predict seizures, which are not specific developed for the sleep. However, EEG during sleep has its characteristics compared with EEG during other states. Therefore, in order to improve the sensitivity and reduce the false alarm rate, this paper utilized the characteristics of EEG to predict seizures during sleep. We firstly constructed the feature vector including the absolute power spectrum, the relative power spectrum and the power spectrum ratio in different frequencies. Secondly, the separation criterion and branch-and-bound method were applied to select features. Finally, support vector machine classifier were trained, which is then employed for online prediction. Compared with the existing method that do not consider the characteristics of sleeping EEG (sensitivity 91.67%, false alarm rate 9.19%), the proposed method was superior in terms of sensitivity (100%) and false alarm rate (2.11%). This method can improve the existing epilepsy prediction methods and has important clinical value.
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Objective@#To summarize the postoperative nursing experience of 1 patient with pancreatic cancer who underwent pancreaticoduodenectomy combined with superior mesenteric vein resection and artificial vascular reconstruction.@*Methods@#The nursing measures included: paying attention to anticoagulation treatment and observing its effect, strengthening pain management, giving nutritional support, pertinent nursing care for gastroparesis, guiding quantitative respiratory treatment for patient, preventing the lack of trace elements during jejunitas.@*Results@#Through active and effective nursing, the patients were discharged smoothly forty-seven days after operation.@*Conclusions@#Through nursing of 1 patient with pancreatic cancer underwent pancreatoduodenectomy combined with superior mesenteric vein resection and artificial vascular reconstruction after surgery, nurses can improve the nursing skills and nursing observation ability, as well as the theoretical basis and practical experience for the future clinical work.
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Objective To prospectively study the clinical diversity of the middle and lower segment of stage of esophageal cancer patients who accepted the thoracoscopic combined with laparoscopic esophagectomy ( TLE) between Mongolian and Han nationalities in Inner Mongolia , to further clarity the feasibility of TLE.Methods 92 consecutive cases of middle and lower segment of stage of esophageal cancer patients of Mongolian and Han were selected,and the patients accepted the TLE ,including 41 cases of Mongolian and 51 cases of Han.The postoperative pain was evaluated with the visual analog scale (VAS) at 1-14d after operation,and the postoperative complication , the hospitalization of postoperation and the postoperative pathological situation were compared .Results Compared with the Han patients,the postoperative pain of Mongolian significantly reduced ,duration of postoperative of pain significantly shorter in the 1-5 d after surgery(P <0.05).Mongolian patients turned to mild pain in the second day of the postoperative period,and Han turned to mild pain in the fourth day after surgery .The postoperative pain in the 6-14 d after surgery of the Mongolian was not significantly different from Han (P >0.05).The Mongolian had lower incidence rate of postoperative complication compared with Han (9.8% vs.27.5%,χ2 =4.522,P <0.05).For example,the incidence rates of respiratory complications in Mongolian patients ,such as pulmonary infection,atelectasis and the occurrence of pleural effusion that need to be treated were significantly lower than those in Han (7.3% vs. 23.5%,2.4% vs.15.7%,4.9% vs.19.6%,P <0.05).There was no statistically significant difference in the incidence of other complications(P >0.05).The postoperative hospitalization of Mongolian was significantly shorter than that of Han[(11.9 ±1.2) d vs.(15.5 ±1.0) d,t =-15.811,P <0.05].No significant difference in the total number of cases of lymph node dissection ,the abdominal lymph node dissection and the chest lymph node dissection . The number of the regional lymph nodes metastasis of Mongolian was higher than that of Han [(3.9 ±0.7) vs. (1.8 ±0.7),t =13.460,P <0.05],most of which were poorly differentiated (6 /25/10 vs 20 /20 /11,χ2 =7.139, P <0.05).Meanwhile,the incidence rates of cancer embolus in the vasculature and nerve invasion of Mongolian were higher than those of Han(75.6% vs.47.1%,70.7% vs.17.6%,χ2 =7.706,26.418,all P <0.05).Conclusion The Mongolian were more easily tolerant to the TLE,which has the advantages of reducing pain ,trauma,rapid recovery, satisfactory curative effect and the lesser postoperative complications .The degree of the malignancy of esophageal cancer of Mongolian was higher than Han .Mongolian who suffered from esophageal cancer needed earlier discovery , earlier treatment and further research of the causes of difference .
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Objective To investigate the effects of different target blood glucose control on postoperative complications during fasting after abdominal surgery by Meta-analysis. Methods From January 1990 to May 2016 the computer retrieval of related Chinese and foreign literature into surgery during the fasting blood glucose control in different range of patients, were randomly divided into control group and intervention group, from two independent data extraction and document evaluation. Meta-analysis using RevMan5.3 software. Results A total of 6 articles were included. Meta-analysis results showed that after abdominal surgery during the fasting of different target blood glucose control on the incidence of hypoglycemia, the incidence of postoperative complications of surgical incision infection after operation, the differences were statistically significant (P<0.05), However, there was no significant difference in postoperative mortality rate (P>0.05). Conclusions After abdominal surgery in patients with intensive glycemic control during the fasting ,value at the lower range (4.4-6.1mmol/L) can effectively reduce the incision infection and the incidence of postoperative complications, is conducive to the rehabilitation of patients, but increase the risk of hypoglycemia, and it has little effect on the mortality of patients during hospitalization. The control group included blood glucose range is too large or lack of continuity and included in the study Chinese literature is too small, leads to a limitation of the research, the analysis results still need more clinical nursing practice and a large number of high quality documents to support.
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Objective:This study aims to investigate the protein expression of CD133, CD117, and Ki-67 in human osteosarcoma tissues and explore their relationships with the clinico-pathological features and risk of osteosarcoma. Methods:Immunohistochemical method was used to examine the protein expression of CD133, CD117, and Ki-67 gene in the paraffin specimens of 55 and 20 cases of osteosarcoma and osteochondroma, respectively. SPSS17.0 statistical software was used to explore the relationships among the expressions of CD133, CD117, and Ki-67 gene and the biological behavior and prognosis of osteosarcoma. Test criterion:P<0.05 was considered statistically significant. Results:The positive expression rates of CD133, CD117, and Ki-67 were significantly higher in the osteosarcoma tissues than in the benign osteochondroma tissues, and the differences were significant (P=0.016, P=0.008, and P<0.001, respectively). The mean survival and metastasis time were shorter in the CD133 or Ki-67 positively expressed osteosarcoma patients than in those with CD133 or Ki-67 negatively expressed osteosarcoma. The differences were significant (P<0.05). The expression of CD133 and Ki-67, surgical staging, and distal metastasis were relevant to the prognosis of osteosarcoma patients. The expression of CD133 and distal metastasis are the independent risk factors that affect the prognosis of these patients. Conclusion:The positive expressions of CD133 and Ki-67 closely correlated with the occurrence and progression of osteosarcoma, and may be used as an indicator for prognosis of the cancer.