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Accurate determination of intestinal viability is the key step in the management of acute mesenteric ischemia. For patients with the possibility of intestinal necrosis, the application of laparoscopy for the primary exploration or second look, is significantly less invasive than laparotomy, so to avoid the unnecessary operative trauma for those with negative results. For critical patients, application of bed-side laparoscopy, with the avoidance of risks during transport process, is an effective and safer diagnostic method. And the combination with intraoperative indocyanine green fluorescence angiography may further improve the reliability of exploration so to result in more precise surgical management for these severe situation. So in the era of endovascular management for acute mesenteric ischemia, as an mimmally invasive and precise method for accurate determination of existence or not of intestinal necrosis, laparoscopy is effective in further improving the outcome of these patients.
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With the development of minimally invasive surgery and the application of enhanced recovery after surgery (ERAS) protocol, the postoperative recovery of colorectal surgery was improved dramatically. Ambulatory colorectal surgery is gradually realized in this situation. In 2009, the first report of ambulatory colorectal surgery was published. And the results of several cohorts published in past 3 years showed that about one-third colorectal patients are the appropriate candidates of ambulatory colorectal surgery. Proper eligibility criteria, application of advanced minimally invasive surgery and enhanced recovery after surgery protocol, in combination with effective and strict complication surveillance and follow up after discharge, are the key points for the realization of successful ambulatory colorectal surgery. On the basis of reviewing and analyzing the history and current situation of daytime colorectal surgery, this paper will summarize the key point of daytime colorectal for clinical reference.
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With the dramatically development of artificial intelligence (AI), especially the advent of deep learning, now it can be applied to medicine reliably and efficiently. In the field of colorectal surgery, the application of AI has resulted in profound affect. The detection of colon polyp and assessment of invasiveness depth of colorectal cancer were improved by AI-assisted colonoscopy. Based on the routine data from medical imaging, demographic and clinicopathological parameters, AI may provide more accurate predictions about prognosis, surgical complication and outcome, so to help decision making and perioperative management. And the advent of real intelligent operative robot will make automatic operation possible in the future. The application of AI will improve the development of colorectal surgery significantly and make it more precise, effective and intelligent.
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In recent decade, based on the generalization of minimally invasive surgery, new techniques, such as single incision laparoscopic surgery(SILS), transanal total mesorectal excision (taTME) and natural orifice specimen extraction surgery (NOSES) were introduced to the clinical practice, especially in colorectal surgery. As an revolutionary evolution, these new techniques resulted in a further decreased iatrogenic trauma, shorter incision and better cosmetic effect. These techniques brought an entirely new outlook of concurrent surgery, and can be called the next-generation minimally invasive surgery. On the other hand, due to the evolution of these techniques, the difficulties were also improved, and some traditional operative procedures were eradicated. So the safety and efficacy of these techniques become well-concerned since the day of them appeared, especially the oncological safety when they were applied in the management of colorectal cancer. To date, the existed practice provide a preliminary evidence, and further high level evidence-based medical researches are essential.
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Objective To investigate clinical efficacy and safety of the memantine and donepezil in the treatment of moderate to severe Alzheimer's disease,in order to provide the basis for clinical treatment.Methods One hundred and twelve cases of moderate to severe Alzheimer's disease patients were given memantine plus donepezil(observation group) ,and single use of memantine treatment(control group), and the treatment for 24 weeks.Respectively before and after treatment, Mini Mental State Scale (MMSE), Alzheimer' s disease assessment scale (ADAS-cog), Alzheimer' s disease collaborative learning, daily life ability questionnaire (ADCS-ADL) ,and neuropsychological questionnaire (NPI) score, and adverse reactions were observed in the process of two kinds of therapy, the efficacy and safety of two kinds of treatment methods were evaluated.Results After treatment, the patients in observation group with MMSE, ADAS-cog, ADL and NPI evaluation results were (12.1 ± 2.1), (32.9 ± 8.3), (33.4 ± 5.0), (6.1 ± 3.1) scores, significantly improved compared with scoring (9.9±2.8), (46.2±7.6), (42.1±6.0), (10.5±2.9) scores before treatment,and the differences were statistically significant (t =2.138,-2.411,2.398, 2.107 respectively, P ＜ 0.05).The control group after treatment in patients with MMSE, ADAS-cog, ADL and NPI evaluation results were (12.3±2.6), (33.1 ±7.2), (35.1 ±6.6), (6.7 ± 2.9) scores, significantly improved compared with scoring 11.0 ± 2.5,44.9 ± 6.9,42.2 ±6.6,10.9 ± 3.5 before treatment, and the difference had statistical significanc (t =2.101,-2.033,2.105, 2.400 respectively, P＜0.05).After treatment, the difference of patients in the two groups of MMSE, NPI score had statistical significance(t =2.553,2.176, P＜0.05).The adverse reactions in two group respectively were 32.14％ (18/56) and 26.79％ (15/56), less difference was no statistical significance (P＞0.05).Vital signs checks,regular laboratory examination and ECG examination showed no obvious abnormalities.Conclusion Memantine combined with donepezil in the treatment of moderate and severe AD patients is superior to the singleeffect of memantine, and long-term use will not increase the risk of adverse reactions, which is safe and effective in the combined application.
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Objective To survey the effects of repetitive transcranial magnetic stimulation (rTMS) on learning,memory and the dendrite morphology of neurons in the CA1 area of the hippocampus in rats with vascular dementia.Methods Thirty-six male SD rats were divided into a control group,a model group and a rTMS group randomly,12 rats in each group.A model of vascular dementia (VaD) was established using the two vessel occlusion method.The rats in the rTMS group were given rTMS treatment.The rats in the other two groups had no therapy.The Morris water maze (MWM) test was used to evaluate the rats' learning and memory abilities on the 30th day after the operation.After the MWM test the dendrite morphology of the pyramidal cells in the CA1 area of the hippocampus was detected after Golgi-Cox staining using light microscopy and the expression of brain-derived neurotrophic factor (BDNF) was detected using immunohistochemistry methods.Results The average MWM escape latency in the rTMS group was shorter than in the model group on the 1 st,2nd,3rd and 4th day.The number of crossings of the platform quadrant in the rTMS group was significantly more than in the model group.The number of branch segments,their total length and the dendritic spine density of pyramidal cell dendrites in the CA1 area of the hippocampus were all significantly lower in the model group than in the control group,but in the rTMS group all these indicators were significantly improvedcompared with the model group.The expression of BDNF in the CA1 area in rTMS group was significantly higher than in the model group.Conclusions rTMS can improve learning and memory in VaD,at least in rats.The mechanism may be associated with rTMS promoting the expression of BDNF in the hippocampus and so improving the dendrite morphology of pyramidal cells.
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BACKGROUND: Transformation growth factor β1 (TGF-β1) can promote bone marrow mesenchymal stem cells (BMSCs) migration and proliferation, but the underlying mechanisms remain unclear.OBJECTIVE: To observe the invasiveness of TGF-β1 on BMSCs cultured in vitro, and to investigate regulatory effect on Snail and matrix metalloproteinase 2 (MMP-2) expression.METHODS: Rat BMSCs were isolated and cultured with density gradient centrifugalization and adherence method. The influence of different concentrations of TGF-β1 on the BMSC migration was detected using the modified Transwell chambers. Small interfering RNA for Snail gene was synthesized and transfected into BMSCs by liposomel before TGF-β1 was treated, and the expression of Snail and MMP-2 before and after transfection were measured by western blot assay.RESULTS AND CONCLUSION: The exogenous TGF-β1 can induce a dose-dependent increase in cell migration, which peaked at 2 μg/L. The expression levels of Snail mRNA and MMP-2 mRNA were significantly increased after 2 μg/L TGF-β1 treatment. Snail gene can effectively inhibit the expression of MMP-2 promoted by TGF-β1. Experimental findings indicate that TGF-β1 could increase the MMP-2 expression and then promote the BMSCs migration through the upregulation of the Snail expression.
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Objective To study the effects of repetitive transeranial magnetic stimulation (rTMS) on depression behavior and hippocampus neuron regeneration in rats with chronic stress depression and to explore the therapeutic mechanism of rTMS on depressive disorder.Methods Thirty-sixth rats were divided into a control group, a model group and a rTMS group randomly, with 12 rats in each group.The depression model of rat was established by exerting long-term unpredictable moderate stress on the animals.Rats in rTMS group were given rTMS treatment after stress, while those in the control group were not given rTMS treatment.Open-field test was performed to test depression behavior of rats in each group before and after 2 weeks of rTMS treatment.Immunohistochemistry technique was used to detect expression of nestin, a marker of dentate gyrus (DG) neural precursor cells.Neuron regeneration was observed by use of 5-bromodeoxyuridine(5-BrdU).The expression of brain-derived neurotrophic factor (BDNF) in hippocampus was detected through western blot.Results There observed neural precursor cells in DG area of rats in control group and some of them were proliferating.Compared with control group, the number of DG progenitor cells and proliferating ability of DG progenitor cells decreased in model group.The expression level of BDNF in model group was lower than that in model group as well.After rTMS treatment, depression behavior of rats in rTMS group improved significantly, number of DG progenitor cells increased and proliferating ability of DG progenitor cells elevated significantly.The expression level of BDNF in rTMS group was higher than that in model group as well.Conclusion rTMS therapy could ameliorate depressive behavior of depression rat.The therapeutic mechanism may be associated with rTMS promoting expression of BDNF in hippocampus, which increasing number of neural precursor cells in DG and promoting the proliferation DG neurons as results.
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ObjectiveTo evaluate the safety and efficacy of biological meshes (human aceUular dermal matrix mesh) in single-stage repair of infected or contaminated abdominal abdominal wall defects and abdominal hernias. MethodsSeventeen patients with abdominal wall defects or abdominal hernias were enrolled. The wounds of all these patients were infected or contaminated due to the existence of enterocutaneous fistula or stoma, wound infection and synchronous colonic resection. The diagnosis included enterocutaeneous fistula 8 cases, incisional hernia 6 cases, incarcerated inguinal hernia 1 case and cylindrical abdominoperineal resection for rectal cancer for 2 cases. The sizes of abdominal defects ranged from 3 cm × 2 cm to 6 cm × 17 cm, and all the cases were repaired with human acellular dermal matrix mesh(RENOV(R)). Most of the patients were repaired with intraperitoneal onlay mesh technique( IPOM, for 12 cases), and other methods included Lichtenstein operation for 1 case, inlay repair for 2 cases and sublay for 2 cases. Results All the 17 patients recovered uneventfully. For 12 patients, the wounds were sutured at operation and only one case of delayed healing occurred due to fat liquefaction. For the other 5 patients, the wounds were left open and healed after vacuum assisted closure (VAC) therapy or wet- to- dry dressing changes. On follow up for 8.3 ±4.5 months ( 1 to 15 months), no occurrence of incisional hernia or recurrence was found. laxity of abdominal wall occurred in one case. A patient complained intermittent pain of the site of suture for mesh fixing two months after operation and the pain resolved spontaneously one month later. ConclusionsThe biological mesh, acellular dermal matrix mesh, could be used in single- stage repair of infected or contaminated abdominal wall defects safely and effectively, although the long-term outcome still needs further evaluation.
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The effect of transcranial magnetic stimulation (TMS) on the neurological functional recovery and expression of c-Fos and brain-derived neurotrophic factor (BDNF) of the cerebral cortex in rats with cerebral infarction was investigated. Cerebral infarction models were established by using left middle cerebral artery occlusion (MCAO) and were randomly divided into a model group (n=40) and a TMS group (n=40). TMS treatment (2 times per day, 30 pulses per time) with a frequency of 0.5 Hz and magnetic field intensity of 1.33 Tesla was carried out in TMS group after MCAO. Modified neurological severity score (NSS) were recorded before and 1, 7, 14, 21, and 28 day(s) after MCAO. The expression of c-Fos and BDNF was immunohistochemically detected 1, 7,14, 21, and 28 day(s) after infarction respectively. Our results showed that a significant recovery of NSS (P＜0.05) was found in animals treated by TMS on day 7, 14, 21, and 28 as compared with the animals in the model group. The positive expression of c-Fos and BDNF was detected in the cortex surrounding the infarction areas, while the expression of c-Fos and BDNF increased significantly in TMS treatment group in comparison with those in model group 7, 14, 21, and 28 days (P＜0.05) and 7,14, 21 days (P＜0.01) after infarction, respectively. It is concluded that TMS has therapeutic effect on cerebral infarction and this may have something to do with TMS's ability to promote the expression of c-Fos and BDNF of the cerebral cortex in rats with cerebral infarction.
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Objective:To establish a simplified heterotopic whole small bowel transplantation model in rat.Methods:Ninety pairs of inbred male Wistar rats were used as donors and recipients.The whole small intestine with a vascular pedicle composed of superior mesenteric artery and portal vein was harvested as the graft.After left nephrectomy of recipient,revascularzation of graft was accomplished by end-to-side anastomosis between donor superior mesenteric artery and recipient infra-renal aorta using a 9-0 continuous suture and an end-to-end anastomosis between the donor portal vein and left renal vein of the recipient with the cuff technique.The proximal end of the graft was ligated and the distal end was exteriorized to form an enterostoma.Results:Average time of an operation was 130 min and the mean warm ischemia time of grafts was 30 min.The successful rate of this model was 100% and 86(95.6%) recipients survived longer than 7 days after operation.Conclusion:The simplified techniques we used was effective and parcticable in improving successful rate of rat heterotopic small bowel transplantation.
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Objective To study the effects of transcranial magnetic stimulation (TMS) on the expression of c-Fos and brain-derived neurotrophic factor (BDNF) of the cerebral cortex in rats with cerebral infarction. Methods Cerebral infarction models were established by using of left middle cerebral artery occlusion (MCAO) and randomly divided into a model group (n=40) and a TMS group (n=40), in additional, TMS treatment (2 times per day, 30 pulses per time) with frequency of 0.5 Hz and magnetic field intensity of 1.33 Tesla was carried out in TMS group after infarction. The expression of c-Fos and BDNF was measured at 1 d, 7 d, 14 d, 21 d and 28 d after infarction, respectively. Results The positive expression c-Fos and BDNF was detected in the cortex around the infarction areas, while the expression of c-Fos and BDNF was increased significantly in TMS group in comparison to those in model group at 7 d, 14 d, 21 d, 28 d (P
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Objective To evaluate the effects of TMS on the brain plasticity and functional outcome after cerebral infarction in rats. Methods Twenty-four male Sprague-Dawley rats were divided randomly into a model group and a TMS group. The rat models of focal cerebral infarction were established with unilateral middle cerebral artery (MCA) suture occlusion method. The rats of TMS group were given additional 4 weeks of TMS treatment commenced at!1 day after infarction (2 times per day, 30 pulses per time), while those in the control group were reared in their original living state. Synaptic substructure in the sensori-motor cortex area was assessed morphologically and quantitatively. Results When compared with the model group, the rats in the experimental group had a significant improvement in terms of their neural functions (P
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<p><b>OBJECTIVE</b>To evaluate the safety of enteral rehabilitative therapy in rat small bowel transplantation.</p><p><b>METHODS</b>Forty-eight rat recipients of allogeneic heterotopic small bowel transplantation (SD and Wistar) were randomly divided into 4 groups according to the application or not of enteral rehabilitative therapy and cyclosporine A (CsA). The pathological changes of the graft, IL-2 receptor expression in lamina propria lymphocytes, serum IL-2 concentrations, results of spleen lymphocytes transformation test and the IL-2 secretion capacity were determined and compared.</p><p><b>RESULTS</b>Enteral rehabilitative therapy could promote the immune function of the recipient so as to augment the acute rejection. But such effects could be blocked by the commonly used immunosuppressant CsA. Under the immunosuppression of CsA (10 mg.kg(-1).d(-1), i.m.), application of enteral rehabilitative therapy did not induce or aggravate acute rejection.</p><p><b>CONCLUSION</b>Under effective immunosuppression, application of enteral rehabilitative therapy is safe in rat small bowel transplantation.</p>
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Animals , Male , Rats , Cyclosporine , Therapeutic Uses , Immunosuppressive Agents , Therapeutic Uses , Interleukin-2 , Blood , Intestine, Small , Transplantation , Lymphocyte Activation , Allergy and Immunology , Rats, Sprague-Dawley , Rats, Wistar , Receptors, Interleukin-2 , Allergy and Immunology , Transplantation, Heterotopic , Transplantation, HomologousABSTRACT
<p><b>OBJECTIVE</b>To observe the effects of recombinant human growth hormone (rhGH) on graft structure and recipient protein metabolism in rat small bowel transplantation (SBT) and total parenteral nutrition (TPN) models.</p><p><b>METHODS</b>Twenty recipients of rat allogeneic heterotopic small bowel transplants (SD-->Wistar) were divided into two groups (GH group and control group). Both groups were supported by standard TPN. Acute rejection was suppressed with CsA 10 mg x kg(-1) x d(-1) intramuscularly. All rats in the experimental group received subcutaneous rhGH 1 U x kg(-1) x d(-1) after transplantation. Morphological mucosal indices of transplanted gut and metabolic parameters such as body weight, nitrogen balance, urinary 3-methyl histidine excretion and serum albumin of the recipients were compared between two groups.</p><p><b>RESULTS</b>The application of rhGH promoted graft recovery significantly compared with standard TPN support alone. On postoperative day 14, all morphological indexes of transplanted gut recovered to the preoperative state. Protein metabolism in the recipient was also significantly improved. rhGH decreased the catabolism of protein, accelerated regaining of positive nitrogen balance and corrected hypoalbuminemia.</p><p><b>CONCLUSION</b>GH is an effective metabolic intervention in SBT. It may promote the structural repair of the graft and correct the metabolic disturbance. It is useful in improving the outcome of clinical SBT.</p>
Subject(s)
Animals , Humans , Rats , Body Weight , Human Growth Hormone , Pharmacology , Intestinal Mucosa , Pathology , Intestine, Small , Transplantation , Methylhistidines , Urine , Nitrogen , Metabolism , Rats, Sprague-Dawley , Rats, Wistar , Recombinant Proteins , Pharmacology , Serum Albumin , MetabolismABSTRACT
Objective:To evaluate the effect of enteral rehabilitative therapy in improving graft structure recovery in rat small bowel transplantation.Methods:Fourty eight recipients of rat allogeneic heterotopic small bowel transplantation(SD→Wistar rat)were dvided into 4 groups randomly according to the presence or absence of glutamine or rhGH in TPN regimen.Cyclosporine A was used as the immunosuppressant.The morphological mucosal indices of transplanted gut were observed and compared.Results:The application of rhGH and glutamine-enriched TPN,especially the enteral rehabilitation therapy which composed both these two agents,can promote the recovery of graft structure significantly compared with standard TPN support.On the postoperative day 14,in the enteral rehabilitation therapy group,all the morphological indexes of transplanted gut recovered to the preoperative state.Conclusion:Enteral rehabilitation therapy is appropriate to the host metabolic status,so it can improve the graft structure recovery more effectively.
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0 05).Conclusion:Intraoperative lymphatic mapping with methylene blue is easily performed in early breast cancer patients.To determine the sentinel lymph node and status of axillary lymph node metastasis by pathological examination of the stained lymph nodes,there was hight false negative rate and unacceptable rate of misdiagnosis.So,its feasibility need further evaluation.[
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Objective: To evaluate the safety of application of enteral rehabilitative therapy in small bowel transplantation.Methods: Forty-eight recipients of rat allogeneic heterotopic small bowel transplantation(SD→Wistar)were divided into 4 groups randomly according to the application or not of enteral rehabilitative therapy or cyclosporine A.The pathological changes of graft,IL-2 receptor expression of lamina propria lymphocyte,serum IL-2 concentration,transformation test of spleen lymphocyte and its IL-2 secretion capacity were determined and compared.Results: The enteral rehabilitative therapy may promote the immune function of recipient so to augment the acute rejection of small bowel transplantation.But such effects can be block by the common used immunosuppressant-cyclosporine A.Under the immunosuppression of CsA(10mg?kg -1 ?d -1 ,IM),application of enteral rehabilitative therapy can not induce or promote acute rejection of small bowel transplantation.Conclusion: Enteral rehabilitative therapy can augment the acute rejection of small bowel transplantation,but cyclosporine A can block its immunoenhancement effects.So under effective immunosuppression,application of enteral rehabilitative therapy is safe in small bowel transplantation.