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Objective:To investigate the effect of neoadjuvant chemotherapy on the safety of laparoscopic D 2 radical resection and prognosis of patients with locally advanced gastric cancer. Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 351 patients with locally advanced gastric cancer who underwent laparos-copic D 2 radical resection in the Second Affiliated Hospital of Air Force Medical University from December 2016 to December 2021 were collected. There were 256 males and 95 females, aged (58±9)years. Of the 351 patients, 124 cases undergoing neoadjuvant chemotherapy were divided into the neoadjuvant chemotherapy group, 227 patients undergoing postoperative adjuvant chemotherapy were divided into the adjuvant chemotherapy group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) effect evaluation of neoadjuvant chemotherapy; (3) intraoperative and postoperative situations; (4) postoperative histopathological examinations; (5) follow-up. Propensity score matching was done by the 1∶1 nearest neighbor matching method. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measure-ment data with skewed distribution were represented as M(range) or M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. The Kaplan-Meier method was used to draw survival curves, and the Log-Rank test was used for survival analysis. Results:(1) Propensity score matching conditions and comparison of general data of patients between the two groups of patients after matching. Of 351 patients, 154 cases were successfully matched, including 77 cases in the neoadjuvant chemotherapy group and 77 cases in the adjuvant chemotherapy group. The elimination of gender, age, preoperative body mass index, clinical T staging and clinical N staging confounding bias ensured comparability between the two groups after propensity score matching. (2) Effect evaluation of neoadjuvant chemotherapy. Of the 77 patients receiving neoadjuvant chemotherapy, none of patient achieved complete response, 26 patients achieved partial response, 46 patients showed stable disease, 5 patients had progression of disease, showing the objective response rate as 33.8%(26/77) and the disease control rate as 93.5%(72/77). There were 15 males and 11 females sensitive to neoadjuvant chemotherapy, while 46 males and 5 females not sensitive, showing a significant difference between them ( χ2=11.05, P<0.05). (3) Intra-operative and postoperative situations. The operation time, volume of intraoperative blood loss, cases with intraoperative blood transfusion, time to postoperative first flatus, time to postoperative first liquid food intake, duration of postoperative hospital stay, cases with postoperative immediate complications, cost of hospital stay were (308±71)minutes, 100(range, 20?600)mL, 5, 3.0(range, 2.0?10.0)days, 4.0(range, 2.0?12.0)days, 9.0(range, 4.0?31.0)days, 7, 7.96(7.37,8.58) ten thousand yuan in patients of the neoadjuvant chemotherapy group, versus (296±67)minutes, 100(range, 20?500)mL, 4, 3.5(range, 1.0?14.0)days, 4.0(range, 2.0?15.0)days, 8.0(range, 5.0?45.0)days, 11, 8.18(7.52,9.19) ten thousand yuan in patients of the adjuvant chemotherapy group, showing no signifi-cant difference in the above indicators between the two groups ( t=1.13, Z=?0.37, χ2=0.12, Z=?1.26, ?0.33, ?0.70, χ2=1.01, Z=?1.04, P>0.05). (4) Postoperative histopathological examinations. Results of postoperative histopatho-logical examinations showed that all 154 patients achieving R 0 resection. Cases with pathological T staging as stage T1, stage T2, stage T3, stage T4, cases with pathological N staging as stage N0, stage N1, stage N2, stage N3, number of positive lymph nodes, cases with human epidermal growth factor receptor 2 (negative, positive) were 3, 7, 5, 62, 27, 19, 19, 12, 1(range, 0?28), 59, 18 in patients of the neoadjuvant chemotherapy group, versus 0, 0, 2, 75, 17, 15, 21, 24, 3(range, 0?31), 44, 33 in patients of the adjuvant chemotherapy group, showing significant differences in the above indicators between the two groups ( Z=?3.39, ?2.55, ?3.12, χ2=6.60, P<0.05). (5) Follow-up. Of the 154 patients, 143 patients were followed up for 37(range, 5?69)months. The 3-year overall survival rate and 3-year disease-free survival rate was 72.1% and 70.0%, respectively, in patients of the neoadjuvant chemotherapy group, versus 74.8% and 76.6% in patients of the adjuvant chemo-therapy group, showing no significant difference in the above indicators between the two groups ( χ2=0.14, 0.60, P>0.05). Conclusions:Compared to postoperative adjuvant chemotherapy, neoadjuvant chemotherapy does not bring additional surgical risks, but can reduce the tumor stage of patients who underwent laparoscopic D 2 radical resection for locally advanced gastric cancer. However, it does not show any advantage in improving survival of patients.
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Laparoscopic radical resection of left hemicolon cancer is difficult in lymph node dissection, splenic flexure dissociation and digestive tract reconstruction. The high resolution recognition ability of 4K laparoscopic system can help complete mesocolic excision and neuroprotec-tion of the left colon. The authors discuss the key points of 4K totally laparoscopic radical resection of left hemicolon cancer and intraperitoneal overlap digestive reconstruction through surgical examples.
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In recent years, minimally invasive surgery represented by laparoscopic technology has been carried out and gradually become a trend in the treatment of gastric cancer. The building of an excellent team is an important guarantee for the successful operation. As a high-imaging technology, 4K laparoscopy effectively improves the surgical field of vision and contri-butes to the development of laparoscopic surgery. Therefore, paying high attention to the building of a laparoscopic surgery team and comprehensive improvement of the team′s execution are conducive to the timely and effective application of various new technologies including 4K laparoscopy in the minimally invasive surgery for radical gastrectomy.
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Radical resection is still the main method to cure gastric cancer. Lymph node metastasis is a common metas-tatic pattern of gastric cancer. The risk of local lymph node invasion increases with the tumor invasion depth of gastric wall. Standard lymph node dissection is an important step to improve the prognosis of patients with gastric cancer. At present, D 2 radical gastrectomy is the standard procedure for locally advanced gastric cancer. Therefore, it is of great significance to popularize the standardization of lymph node dissection in radical gastrectomy on the basis of 4K laparoscopic platform, which can improve the treatment level of gastric cancer surgeons and provide "homogenized" diagnosis and treatment services for patients.
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In recent years, minimally invasive surgery represented by laparoscopic technology has been carried out and gradually become a trend in the treatment of gastric cancer. The building of an excellent team is an important guarantee for the successful operation. As a high-imaging technology, 4K laparoscopy effectively improves the surgical field of vision and contri-butes to the development of laparoscopic surgery. Therefore, paying high attention to the building of a laparoscopic surgery team and comprehensive improvement of the team′s execution are conducive to the timely and effective application of various new technologies including 4K laparoscopy in the minimally invasive surgery for radical gastrectomy.
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Radical resection is still the main method to cure gastric cancer. Lymph node metastasis is a common metas-tatic pattern of gastric cancer. The risk of local lymph node invasion increases with the tumor invasion depth of gastric wall. Standard lymph node dissection is an important step to improve the prognosis of patients with gastric cancer. At present, D 2 radical gastrectomy is the standard procedure for locally advanced gastric cancer. Therefore, it is of great significance to popularize the standardization of lymph node dissection in radical gastrectomy on the basis of 4K laparoscopic platform, which can improve the treatment level of gastric cancer surgeons and provide "homogenized" diagnosis and treatment services for patients.
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Surgery is the basis of the treatment for rectal cancer, especially for low rectal cancer. How to maintain a good quality of life and keep physiological function for patients after surgery while pursuing a long-term survival has been an important issue. In recent years, function preservation operation for low rectal cancer has continuously developed because of the deep understanding of the pathology and molecular pathology of rectal cancer, optimization and development of multidisciplinary diagnosis and treatment, introduction of total mesorectal excision and pelvic autonomic nerve preservation, and the continuous innovation of medical equipment and surgical operation. The development of rectal cancer surgery will undoubtedly be more manifested in functional preservation and protection. For low rectal cancer patients, achieving maximum function preservation under the premise of radical resection relies on the precise treatment based on evidence-based medicine and the individualized anus preserving operation.
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With the standardization and promotion of laparoscopic technology,totally laparoscopic radical gastrectomy(TLRG) has been applied widely.The main difficult points of TLRG focus on digestive tract reconstruction.The common methods of digestive tract reconstruction in TLRG include circular stapler,linear stapler and manual suture.Compared with the circular stapler method and manual suture method,the linear stapler has the advantages of simple operation,better field of vision and larger caliber of anastomotic stoma.This article introduces and evaluates the common anastomotic methods of digestive tract reconstruction with linear stapler in TLRG.
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At present, Laparoscopy has become a professional skill that surgeons have to master. In cultivating surgeons in laparoscopy in our country, there are some deficiencies such as unbalanced regional development, technical difficulties, long learning curve, lack of standardized training mode and so on. Based on the original foundations, the Department of Gastrointestinal Surgery, Tangdu Hospital, the Air Force Military Medical University, has been constructing and improving the cultivating system by modifying the course contents, improving the training of endoscopic simulator, endoscopic surgery training on animal and endoscopic clinical practice, and managing the processes. Based on the above measures, certain results have been achieved.
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<p><b>OBJECTIVE</b>To investigate the application value of the clearance of No.253 lymph nodes with priority to fascial space and preserving left colic artery (LCA) in patients undergoing laparoscopic radical proctectomy.</p><p><b>METHODS</b>From August 2015 to August 2016, 97 consecutive middle-low rectal cancer patients underwent laparoscopic radical proctectomy using the clearance of No.253 lymph nodes with priority to fascial space and preserving LCA at Department of General Surgery, Tangdu Hospital. Among 97 patients, 45 were females , 52 were males, mean age was (64.3±5.5) years and mean BMI was (22.4±1.8) kg/m. Brief steps of this clearance: traditional medial approach was the commencement of the dissection at the membrane bridge line in front of iliac vascular bifurcation, then entering into the Toldt's space; superior rectal artery served as the top of the tent and the Toldt's space was extended as far as possible; blunt separation was developed caudally (reaching 2 cm below the sacral promontory), cephalad (reaching the lower part of the pancreas), left laterally (reaching Toldt's line), dextrally (reaching abdominal aorta); after giving priority to fascias space, from the root of inferior mesenteric artery, LCA was exposed and No.253 lymph nodes were dissected. This regimen was suitable for the rectal adenocarcinoma patients without distant metastasis.</p><p><b>RESULTS</b>There was no tension in the intestine and mesenteria after anastomosis in all the 97 patients. One patient received LCA ligation during the clearance, because of thinner LCA resulting in bleeding. The other 96 cases completed the clearance and operation successfully. The mean No.253 lymphadenectomy time was 11-27(17.1±5.3) minutes. The mean number of harvested No.253 lymph node was 0-6(4±2). The No.253 lymph nodes of 6 patients were positive. No.253 regional mesentery was complete in 95 patients. The total harvested number of lymph node was 11-26(17.3±5.3). Six patients with positive lymph nodes aged from 68 to 72 years old and all of them underwent TME operation 6-8 weeks after neoadjuvant chemoradiotherapy. The mean operative time was 89-189(125±35) minutes. The mean estimated blood loss was 10.5-38.6(22.4±10.5) ml. The first exhaust time was 3.0-6.0(5.6±2.1) days. The mean time to extracting the drainage tube was 3.0-5.0(4.5±2.5) days. Anastomotic fistula appeared in 1 case and hemorrhage appeared in 1 case, and these 2 cases were cured by conservative treatment. No perioperative death occurred. The mean postoperative hospital stay was 3.0-10.0(3.6±2.6) days.</p><p><b>CONCLUSION</b>The clearance of No.253 lymph nodes with priority to fascial space and preserving LCA in laparoscopic radical proctectomy is safe and feasible.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Digestive System Surgical Procedures , Methods , Laparoscopy , Lymph Node Excision , Lymph Nodes , Mesenteric Artery, Inferior , General Surgery , Rectal Neoplasms , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To investigate the application value of the Overlap method in digestive tract reconstruction of totally laparoscopic left colectomy(TLLC) and its potential advantage.</p><p><b>METHODS</b>The retrospective cohort study was adopted. Clinicopathological data of 16 patients with left colon cancer who underwent TLLC and Overlap anastomosis between August 2016 and August 2017 at Tangdu Hospital were retrospectively collected as Overlap group. Twenty-one patients who underwent laparoscopic assisted left colectomy (LALC) between January 2015 and July 2016 at Tangdu Hospital were used as control (traditional group). The intraoperative and postoperative data were compared between the two groups. During digestive tract reconstruction in the Overlap group, the proximal colon and distal colon were lined up side by side; a side-to-side anastomosis was conducted on colic band with a 60 mm linear stapler; and the common entry hole was closed using running suture. While in traditional group, the bowel was pulled out of abdominal wall through the assisted incision; the sample was resected and a proximal and distal end-to-end anastomosis was performed.</p><p><b>RESULTS</b>In Overlap group, 10 cases were male and 6 cases were female, with a mean age of (66.4±4.8) years and a BMI of (23.6±2.3) kg/m; the tumor located in distal transverse colon in 1 case, in splenic flexure in 2 cases, in descending colon in 4 cases, in upper sigmoid colon in 9 cases. TLLC was successfully completed in all the cases without conversion to laparotomy. In traditional group, 12 cases were male and 9 cases were female, with mean age of (65.9±5.8) years and BMI of (22.7±2.8) kg/m; the tumor located in the distal transverse colon in 1 case, in the splenic flexure in 3 cases, in the descending colon in 6 cases, in the upper sigmoid colon in 11 cases. No statistically significant differences in baseline data were found between the two groups (all P>0.05). Compared to the traditional group, the total operation time was shorter [(143.4±11.1) minutes vs. (166.4±16.5) minutes, t=4.792, P=0.000], the anastomosis time was prolonged [(44.3±3.3) minutes vs. (22.4±3.0) minutes, t=-20.948, P=0.000], the amount of bleeding was reduced [(46.6±13.6) ml vs. (70.5±20.0) ml, t=4.106, P=0.000], and the incision length was shorter [(3.9±0.9) cm vs. (6.7±1.3) cm, t=7.056, P=0.000] in the Overlap group. There were no significant differences in lymph nodes harvested (17.3±2.9 vs. 15.5±3.0), time to flatus [(2.8±1.3) days vs. (2.6±1.0)days], postoperative complications [6.2%(1/16) vs. 9.5%(2/21)] and postoperative hospitalization [(4.6±1.4) days vs.(4.7±1.2) days] between the two groups (all P>0.05).</p><p><b>CONCLUSION</b>The Overlap reconstruction method in totally laparoscopic left colectomy is a safe and feasible procedure, and provides less injury and better cosmetic outcome of abdominal wall.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Colectomy , Colonic Neoplasms , General Surgery , Laparoscopy , Laparotomy , Plastic Surgery Procedures , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To investigate the application value of the modified Overlap method in digestive tract reconstruction of totally laparoscopic total gastrectomy (TLTG).Methods The retrospective cohort study was conducted.The clinicopathological data of 50 patients with gastric cancer who underwent TLTG with Overlap anastomosis between January 2016 and December 2016 in the Tangdu Hospital of the Fourth Military Medical University were collected.Twenty-six patients using classic Overlap method and 24 patients using modified Overlap method were respectively allocated into the classic Overlap group and modified Overlap group.All the patients underwent D2 lymph node dissection.Patients in the classic Overlap group underwent totally laparoscopic catastalsis side-to-side esophagojejunostomy.During digestive tract reconstruction in the modified Overlap group,there was no esophageal transection before anastomosis,and gastric fundus traction fully exposed to the lower esophagus.Esophagus was spun anticlockwise,and a hole was opened at the left posterior esophageal wall.Transection of jejunum was 25 cm away from Treitz ligment,and opening a hole at mesenteric margin was 6 cm away from distal jejunum to transected end of jejunum.Esophagus-distal jejunum side-to-side anastomosis was done using 60 mm linear stapler,and then laterally closing openings and transecting esophagus.Observation indicators:(1) intra-and post-operative recovery:total operation time,time of esophagus-jejunum anastomosis,volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation,cases with complications and duration of postoperative hospital stay;(2) follow-up and survival.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative tumor-free survival and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the independent-sample t test.Comparison of count data was analyzed using the chi-square test or Fisher exact probability.Results (1) Intra-and post-operative recovery:all the 50 patients underwent successful TLTG using Overlap method,without conversion to open surgery.Total operation time and time of esophagus-jejunum anastomosis were respectively (278.6± 14.9) minutes,(46.5 ± 4.4) minutes in the classic Overlap group and (253.3 ± 12.8) minutes,(20.4 ± 2.3) minutes in the modified Overlap group,with statistically significant differences between the 2 groups (t =5.459,22.482,P＜0.05).Volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation,cases with complications and duration of postoperative hospital stay were respectively (73±25) mL,34±6,(2.7± 1.0) days,2,(9.7± 1.6) days in the classic Overlap group and (71 ± 22) mL,35± 5,(2.6± 1.3) days,2,(9.8± 1.5) days in the modified Overlap group,with no statistically significant difference between the 2 groups (t =0.175,-0.616,0.293,-0.217,P＞ 0.05).Two patients in the classic Overlap group were respectively complicated with esophagus-jejunum anastomotic fistula and pancreatic leakage,2 patients in the modified Overlap group were respectively complicated with pulmonary infection and subcutaneous emphysema,and they were improved by symptomatic treatment.(2) Follow-up and survival:41 of 50 patients were followed up for 3-15 months,with a median time of 7 months,including 20 in the classic Overlap group and 21 in the modified Overlap group.During follow-up,patients had tumor-free survival,without tumor recurrence and metastasis.Conclusion Compared with classic Overlap method,the modified Overlap method can simplify the anastomotic procedures,shorten operation time and achieve similar efficacy,and it is also a simple and effective method for digestive tract reconstruction after TLTG.
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<p><b>OBJECTIVE</b>To explore the technical feasibility, safety, and clinical efficacy of β-shaped Roux-en-Y reconstruction(β reconstruction) in totally laparoscopic distal gastrectomy (TLDG).</p><p><b>METHODS</b>Clinical data of 21 patients with gastric cancer undergoing TLDG with β reconstruction from January 2014 to May 2014 were retrospectively analyzed.</p><p><b>RESULTS</b>TLDG with β reconstruction was successfully performed in all the patients. The mean time of operation and β reconstruction was (229.0±18.7) min and (27.5±4.2) min. The blood loss was (91.0±38.3) ml and number of dissected lymph node was 33.2±4.6 per patient. The length of upper and lower segment of resection from lesion was (5.9±0.4) cm and (3.2±0.8) cm. The average time to resume fluid diet, time to restore flatus and hospital stay were (2.1±0.8) d, (3.1±0.9) d and (5.9±2.4) d, respectively.</p><p><b>CONCLUSION</b>The β reconstruction is a safe and feasible procedure for TLDG and provides satisfactory short-term efficacy.</p>
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<p><b>OBJECTIVE</b>To compare the short-term efficacy of modified medial (M-M) with traditional medial(T-M) approach in laparoscopic right hemicolectomy(LRHC)/or extended laparoscopic right hemicolectomy(ELRHC) for right or hepatic flexure colon cancer.</p><p><b>METHODS</b>A comparative, retrospective study was performed that included all the patients scheduled for LRHC or ELRHC for right or hepatic flexure colon cancer between June 2013 and August 2014. The following factors of two groups were assessed: patient characteristics, operative details, pathology, and surgical outcomes.</p><p><b>RESULTS</b>A total of 99 patients were evaluated, including 52 patients in the M-M group and 47 patients in the T-M group. Age, gender, body mass index, American Society of Anesthesiology(ASA) class, tumor location, diameter of tumor were not significantly different between the two groups. As compared to the T-M group, M-M group was associated with a significantly shorter operative time [(105.6±38.8) min vs. (138.2±39.5) min, P<0.05], less estimated mean blood loss[(38.4±12.4) ml vs. (87.2±24.6) ml, P<0.05] and lower intraoperative vascular damage rate [5.8%(3/52) vs. 25.5%(12/47), P<0.05]. There were no significant differences between these two groups in terms of intraoperative complications, CME, conversion rate, number of harvested lymph node, postoperative ileus, hospital stay, wound, lung and urinary system infections.</p><p><b>CONCLUSION</b>The use of M-M approach in laparoscopic right hemicolectomy provides short-term benefits in operative time and estimated blood loss compared with traditional medial approach.</p>
Subject(s)
Humans , Case-Control Studies , Colectomy , Colon, Ascending , Colonic Neoplasms , Ileus , Intraoperative Complications , Laparoscopy , Length of Stay , Operative Time , Postoperative Complications , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To compare the short-term efficacy between totally laparoscopic distal gastrectomy(TLDG) with delta-shaped anastomosis (DS) and laparoscopic-assisted distal gastrectomy (LADG) with BrillrothI ( anastomosis (BI(), and to evaluate the application of DS.</p><p><b>METHODS</b>Between March 2013 and February 2014, 50 patients underwent TLDG with DS using linear staplers, and 43 patients underwent LADG with BI( using circular staplers. Clinical features and short-term efficacy of the two groups were analyzed retrospectively.</p><p><b>RESULTS</b>There were no significant differences between the two groups in terms of demographic indicators, operation time, intraoperative blood loss, number of removal lymph node, time to first flatus, incidence of complication and postoperative discharge day(all P>0.05). First-day postoperative pain was milder (3.1 ± 1.0 vs. 4.6 ± 1.4), and operative incision was shorter [(3.4 ± 0.4) cm vs. (6.9 ± 0.8) cm] significantly in TLDG with DS group(P<0.05).</p><p><b>CONCLUSION</b>TLDG with DS is safe and feasible for patients with gastric cancer, and has more advantages in cosmetic and comfort level than LADG with BI.</p>
Subject(s)
Humans , Anastomosis, Surgical , Gastrectomy , Laparoscopy , Lymph Node Excision , Operative Time , Postoperative Period , Retrospective Studies , Stomach , General Surgery , Stomach NeoplasmsABSTRACT
Objective Discussed the efficacy of applying standardized patient in clinical surgical practice teaching.Method Twenty eight-year-medical students in our college were enrolled and students' theoretical knowledge mastering ability,students' evaluation on the teaching and students'clinical ability were surveyed.Result Students' score significantly increased compared to last year scores (P ＜0.01).100％ of the participants found the SP teaching methods can increase the interest in learning; 90％ of students found the SP as a guide to better grasp the teaching content; 95％ of students found the SP teaching methods can improve the ability to communicate with patients.Conclusions The class atmosphere was improved,students' enthusiasm was activated,students' clinical ability was promoted and satisfactory teaching effect was obtained after applying standardized patient.
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Objective To establish a method of inducing dendritic cells(DC)from rat bone marrow cells in vitro,and identify the phenotype and function characteristics.Methods The rat bone malToW cells were collected and cultured in vitro under the condition of recombinant rat GM-CSF(rrGM-CSF)and recombinant rat IL-4(rrIL-4).After 2 weeks,the morphological character of DCs was observed under light microscope and scanning electron microscope.Expression of MHC-Ⅱ,CD80 and CD86 were detected by flow cytometry.The ability to stimulate allogenic T cells of the cultured DCs was detected by mixed lymphocyte reaction.Results DCs showed typical morphology with elongated dendritic processes under inversion microscope and scanning electron microscope.DCs at day 6 revealed immature phenotype,including MHC-Ⅱ(29.03 ±4.39)%,CD80(21.98±7.08)%and CD86(25.94±6.80)%.DCs at day 12 showed higher expression of MHC-Ⅱ(74.05±5.97)%,CD80(79.85±6.53)%and CD86(81.00±7.47)%,and stimulatory capacity of allogenic T cells,compared with that in DCs at day 6.Conclusion Matured DCs could be generated from rat bone marrow cells and attendance with rrGM-CSF and rrIL-4,which present the feasibility for further research on its application to allograft immunorejection.
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BACKGROUND: Kadsurenone is characterized by obvious anti-oxidation and calcium ion resistant effect and can effectively clear oxygen-derived free radicals, decrease activity of pancreatic enzyme, and relieve self-digestion of pancreatic tissue.OBJECTIVE: To observe the effects of kadsurenone on the splanchnic blood flow in rats with severe acute pancreatitis (SAP), especially the mechanism of pancreatic blood flow.DESIGN: Contrast observational animal study.SETTING:Laboratory of General Surgery and Central Laboratory of Tangdu Hospital, the Fourth Military Medical University of Chinese PLA.MATERIALS: A total of 40 male Sprague-Dawiey (SD) rats, of clean grade and weighing 200-280 g, were selected in this study. Kadsurenone (150 mg) was provided by Pharmacological College of Peking University (batch number: 20050347); sodium taurocholate by Sigma Company (batch number: 86339); amylase reagent by Roche Company (batch number: irp 170505); Imexlab9100 Doppler ultrasound diagnostic meter by Imex Company; 8 mHz probe privated by Doppler ultrasound diagnostic meter by Imex Company, USA (number: X1-M0008).METHODS: The experiment was carried out in the Laboratory of General Surgery, Tangdu Hospital, Fourth Military Medical University of Chinese PLA from April to October 2006. Eight rats were randomly selected as sham operation group, and other rats were used to establish SAP models at 12 hours after fasting. Continuously, 32 SAP rats were randomly divided into two subgroups after model establishment, including kadsurenone group (n =16) and model group (n =16). In addition, all rats in the two subgroups were observed at 12 and 24 hours after operation with 8 rats at each time point. However, rats in the sham operation group did not give any treatment. At 3 hours after operation, rats in kadsurenone group were given 10 mg/kg kadsurenone through jejunum fistula once every 6 hours for one or two times in total. Kadsurenone was dissolved in 25 g/L dimethyl sulfoxide. In addition, rats in model group were given the same dosage of dimethyl sulfoxide through jejunum fistula; furthermore, rats in sham operation group were only opened their abdomens. Blood starch was respectively measured in sham operation group at 12 hours after abdominal operation, model group at 12 hours and kadsurenone group at 24 hours after acute pancreatic operation; meanwhile, Doppler ultrasound was used to detect local artery of pancreas (relative to the crossed site between head and body of pancreas), blood flow of portal vein, splenic artery and blood flow of superior mesenteric artery.MAIN OUTCOME MEASURES: Changes of plasma amylase and blood flow at various time points.RESULTS : All 40 SD rats were involved in the final analysis.①Measuring results of plasma amylase: Level of plasma amylase was increased in both model group and kadsurenone group at various time points as compared with that in sham operation group (P＜0.01 ). With the time passing by, level of plasma amylase was still increased in model group, and there was significant difference from that at 12 hours after operation (P＜0.05). ②Blood flow of local pancreatic artery: At 12 and 24 hours after operation, blood flow was lower in kadsurenone group and model group than that in sham operation group (P＜0.01). With the development of illness course, blood flow was still decreased in kadsurenone group (P＜0.05); however, blood flow was obviously higher than that in model group at various time points (P＜0.01 ). ③ Blood flow of superior mesenteric arterial root, portal vein and splenic artery: Blood flow was lower in kadsurenone group and model group than that in sham operation group at 12 and 24 hours after operation, respectively (P＜0.01). In addition, blood flow was remarkably increased in kadsurenone group as compared with that in model group at various time points (P＜0.01).CONCLUSION: Kadsurenone can increase the pancreatic blood flow and relieve pathological injury in SAP rats.
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Objective: To construct and identify the eukaryotic expression vector targeting the CD40 gene in rats.Methods: Two sequences corresponding to the rat CD40 gene were designed on Ambion's Web.The two complementary oligonucleotide strands of DNA fragments were synthesized by chemosynthesis.After annealing of the complementary strands,the DNA fragments were connected to the polyclone sites of the pSilencer 4.1-CMV neo vector,followed by transformation,amplification,plasmid extraction and identification of the recombinant plasmids by BamH Ⅰ and Hind Ⅲ digestion and DNA sequence analysis.Results: The connections between the DNA fragments encoding CD40-targeted siRNA and the pSilencer 4.1-CMV neo vector were correct,as confirmed by agarose gel electrophoresis and DNA sequence analysis.Conclusion: The two recombinant plasmids expressing siRNA of the rat CD40 gene were successfully constructed,which prepared the groundwork for future research on the role of the CD40 gene in homograft rejection.
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Objective: To observe the expressions of NMDAR2 and GLAST in the hippocampal gyrus and supraoptic nucleus(SON) under sleep deprivation in young rats.Methods: The changes in expressions of NMDAR2 and GLAST in SON and hippocampal gyrus under sleep deprivation in younger rats were observed by immunohistochemistry method. Results:The expressions of NMDAR2 and GLAST in SON and the hippocampal gyrus were significantly increased on the 3rd day of sleep deprivation,even more sigificantly on the 5th day,decreased gradually on 7th day,and became similar to those of control group on the 14th day.Conclusion: Sleep deprivation can affect the expressions of NMDAR2 and GLAST in the hippocampal gyrus and supraoptic nucleus,but the effect diminisshes gradually with prolonged time,which may be associated with self-regulation and self-protection of the central nervous system.