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Objective:To investigate the application value of hybrid approach in laparoscopic radical resection of left hemicolon cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 96 patients with left hemicolon cancer who were admitted to Henan Provincial People′s Hospital between January 2015 and March 2018 were collected. There were 52 males and 44 females, aged from 29 to 75 years, with an average age of 61 years. Patients underwent laparoscopic radical resection of left hemicolon cancer. Observation indicators: (1) surgical situations and postoperative recovery; (2) postoperative pathological examination; (3) postoperative chemotherapy; (4) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival, tumor recurrence and metastasis of patients up to October 2019. Measurement data with skewed distribution were represented as M (range), and count data were described as absolute numbers. Results:(1) Surgical situations and postoperative recovery: all the 96 patients underwent laparoscopic radical resection of left hemicolon cancer with hybrid approach. Of 96 patients, 5 underwent laparoscopic multiple organ resection including 2 combined with splenectomy, 2 combined with gastric wall wedge resection, 1 combined with splenectomy and distal pancreatectomy; 7 underwent hand-assisted laparoscopic surgery including 5 undergoing multiple organ resection due to tumor invasion, 2 combined with terminal ileostomy due to poor exposure caused by severe obstruction in proximal intestinal canal; 84 underwent laparoscopic-assisted surgery. There was no intraoperative conversion to laparotomy. Of 96 patients, 3 received posterior ileum anastomosis, 2 received rotating ascending colon anastomosis, 91 received in situ anastomosis. Operation time, volume of intraoperative blood loss, and time to first flatus were 140 minutes (range, 70-250 minutes), 50 mL (range, 30-140 mL), 2 days (range, 1-4 days), respectively. Of 96 patients, 5 had postoperative incision infection, 5 had pulmonary infection, 3 had adhesive intestinal obstruction, 1 had anastomotic leakage, and they were cured after conservative treatment. Duration of postoperative hospital stay of the 96 patients was 8 days(range, 5-27 days). (2) Postoperative pathological examination: of the 96 patients, the number of lymph nodes dissected and length of surgical specimen were 19 (range, 13-25) and 35 cm (range, 25-50 cm). All the 96 patients had negative surgical margin. Pathological T staging of 96 patients: 5 patients were in pT1 stage, 46 in pT2 stage, 37 in pT3 stage, 8 in pT4 stage. Pathological N staging of 96 patients: 32 patients were in pN0 stage, 47 in pN1 stage, 17 in pN2 stage. Pathological types of 96 patients: 7 patients had mucinous adenocarcinoma, 16 had poorly differentiated adenocarcinoma, 46 had moderately differentiated adenocarcinoma, and 27 had well differentiated adenocarcinoma. (3) Postoperative chemotherapy: 68 of the 96 patients underwent standard chemotherapy of XELOX regimen, and 28 had no chemotherapy. (4) Follw-up: 86 patients were followed up for 19-58 months, with a median time of 11 months. During the follow-up, all the 86 patients survived, of which 82 had no tumor recurrence, 3 survived with tumor after detection of liver metastasis, and 1 survived with tumor after detection of liver and pulmonary metastasis.Conclusion:The hybrid approach is safe and feasible in the laparoscopic radical resection of left hemicolon cancer.
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Objective To evaluate the clinical curative effect and prognosis of hand-assisted laparoscopic (HALS) and laparoscopic assisted surgery for Siewert Ⅱ,Ⅲ gastroesophageal junction adenocarcinoma (AEG).Methods A retrospective analysis of 105 patients with advanced Siewert type Ⅱ and Ⅲ AEG between Jan 2012 and Jan 2013 was made on the operation time,amount of blood loss,number of lymph nodes dissected,postoperative complications,postoperative hospital stay and postoperative 5-year survival rate.Results HALS resulted in significantly shorter operation time and the average postoperative hospital stay [(203±54) min比(283±72) min,t=-4.902,P=0;(10±4) d 比(13±3)d,t=-0.939,P =0.002] for advanced Siewert type Ⅱ and Ⅲ AEG.There was no conversion to open surgery in HALS group,while there was 3 cases in laparoscopy assisted surgery group (x2 =4.118,P =0.042).5 year overall survival (OS) in HALS group was 46.7％ (95％ CI39.98-53.88),and it was 60.9％ for stage Ⅱ patients 37.8％ for stage Ⅲ.5 years OS rate was not significantly different between the two groups.Conclusion HALS compared with laparoscopy assisted surgery in the treatment of advanced Siewert type Ⅱ and type Ⅲ AEG has shorter operation time,higher safety operation,shorter postoperative recovery time.The number of patients with postoperative complications and the 5-year survival rate after surgery are not significantly different between the two groups.
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Objective To evaluate the feasibility and safety of hand assisted laparoscopic total gastrectomy for gastric cancer by two different operative approaches.Methods 191 patients of proximal or gastric corpus cancer operated at our department from Jan 2015 to Dec 2017 were divided into two groups:by outer omental bursa approach group (OBA) and through inner omental bursa approach group (IBA).Operative time,estimated blood loss,number of lymph node retrieval,times of analgesic injection,time to the first flatus and postoperative hospital stay were compared between the two groups.Results Estimated blood loss,times of analgesic injection,time to the first flatus and postoperative hospital stay were not statistically different between the two groups.The operative time was significantly shorter in the IBA than the OBA.There were no significant differences in tumor size,retrieved lymph nodes,AJCC/UICC staging and resection margins between the two groups.Conclusion Hand assisted laparoscopic total gastrectomy by the outer omental bursa approach is technically feasible and safe,and allows for adequate lymphadenectomy.
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Objective To investigate the feasibility and safety of hand assisted laparoscopic total gastrectomy with D2 lymphadenectomy for advanced cardiac cancer compared with open surgery.Methods 174 patients suffering cardiac,upper,middle or whole gastric cancer operated in our department from October 2013 to October 2014 were divided into open surgery group and laparoscopic group.Perioperative parameters were compared between the two groups.Results Patients in loparoscopic group were associated with significantly less operative blood loss [(110 ± 17) ml vs.(345 ± 95) ml,t =4.95,P =0.011],and shorter postoperative hospital stay [(8.7 ± 0.6) d vs.(14.3 ± 2.1) d,t =0.26,P =0.031],but longer operative time [(295 ± 37) min vs.(215 ± 23) min,t =3.78,P =0.004],compared with that of open surgery.There was no significant difference in the numbers of lymph node dissection between the two groups.Esophagus resection length in open group was (4.0 ± 1.2) cm,and that was (4.1 ±1.0)cm in laparoscopic group (t =0.95,P =0.147).Two patients in open group had positive margins and underwent thoracoabdominal resection.There was no difference in major complications between the two groups.Conclusion Hand assisted laparoscopic total gastrectomy for advanced cardiac carcinoma is a safe,feasible,and oncologically sound procedure compared to open procedure.
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BACKGROUND:Valgus-varus constrained polyethylene insert is selected in strict accordance with the principle of“to obtain reliable stability using minimum restriction”. The stability of the prosthesis is elevated, but the restriction is not increased. OBJECTIVE:To retrospectively analyze the application experience of constrained polyethylene insert in valgus and varus instability of primary total knee arthroplasty for older patients and to summarize the indications and clinical effects of this kind of implements. METHODS:From March 2010 to March 2012, a total of 70 patients combined valgus and varus malfomation who accepted primary total knee arthroplasty were enrol ed in this study, including 56 varus patients (averagely 15°-30°) and 14 valgus patients (averagely 10°-20°). Constrained polyethylene insert was performed in 23 patients (25 knees) who stil had remaining unilateral valgus or varus RESULTS AND CONCLUSION:Patients were fol owed up for 2 years on average (18-42 mouths). The knee pain symptoms of al cases disappeared. The joint stability was obviously improved. The lower limb power lines were correct. The Knee Society Score scores were improved from an average of 39.4 points preoperation to an average of 88.5 points postoperation. Al cases did not need the protection of knee braces. The maximum degree of flexion was 110°(96°-130°). The satisfaction degree of 36-Item Short Form Health Survey was 98%. No dislocation or infection happened. Results indicated that constrained polyethylene insert could be applied in the cases of less than 6 mm valgus and varus instability when finished operation of standard osteotomy and soft tissue balancing in total knee arthroplasty for older patients. This kind of implements can preserve bone mass, simplify operational process and have good clinical outcome in a short period.
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ObjectiveTo assess the effect of hemodialysis(HD),hemodiafiltration(HDF) and hemodialysis(HD) and hemoperfusion(HDP) on the quality of life,cognitive function and nutritional status in chronic renal failure(CRF) patients.MethodsAll patients were randomly divided into HD,HDF and HDP group.Mini-mental state examination(MMSE),Wisconsin card sorting test (WCST),SF-36 were measured for cognitive function,quality of life and nutrition indicators test.ResultsAfter 3,6 months treatment,MMSE ( respectively ( 22.62 ±3.85),(25.10 ±2.26),(25.35 ±2.44)and (23.87 ±4.19),(25.10 ±2.26),(27.19 ±2.23)),WCST indicators were statistically significant in the three groups (P ＜ 0.05 ) ;after 1,3,6 months treatment,the PF,RP,BP,GH,SF and nutrition indicators were significant difference too(P＜0.05 ) ; HDP and HDF,HD groups were statistically significant(P＜ 0.05 ).ConclusionHDF and HDP obviously influence on long-term cognitive function,physical health domains and nutritional status in CRF patients,and superior to HD.
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Objective To study the significance on dynamic changes of serum vascular endothelial growth factor( VECF) and matrix metalloproteinase 9( MMP-9) in patients with acute cerebral infarction. Methods 123 patients with acute cerebral infarction were selected as research object, and they were the observation group, and 80 healthy peoples at the same time were selected as control group. Then the serum VEGF and MMP-9 in patients with acute cerebral infarction after pathogenesis at first,third,fifth,seventh and fourteenth day were detected,and the correction between the levels and infarct size,prognosis were studied. Results The serum VECF and MMP-9 of observation group compared with those of control group,the change showed increased first and decreased afterwards,but the levels were all higher than those of control group (P ＜ 0.01). There were correction between the levels and infarct size, prognosis.The serum VEGF[(369.3 ± 108.7,476.2 ± 118.4,551.5 ± 144.5,661.7 ± 164.6,437.6 ± 123.9)ng/L]and MMP-9[(333.8±101.4,459.7±119.9,370.3 ±119.5,320.5 ± 129.1,255.4 ± 101.6)ng/L] in poor prognosis patients after pathogenesis at first,third,fifth,seventh and fourteenth day were all higher than those of good prognosis patients ( P ＜0.01). Conclusion The serum VEGF and MMP-9 in patients with acute cerebral infarction showed dynamic change,and there was close relationship between the levels and infarct size.
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Objective To examine the influence of 3R intensive nursing on working memory dysfunction of patients with early Parkinson's disease. Methods 30 patients with early Parkinson's disease were assessed by Working Memory Test Battery,and acceped 3R- nursing. The condition of working memory dysfunction was compared before and after nursing intervention. Results The patients with early Parkinson's disease had evident difference than the normal controls, especially the visualspatial working memory. After 3R- nursing, the subtest scores and dimensions were improved apparently. Conclusions The clinical effect of 3R- nursing method in patients with early Parkinson's disease has significant predominance ,so it is worth popularizing.
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BACKGROUND: Common complication of traditional joint replacement is hip joint dislocation and large head joint implant can effectively solve this problem. OBJECTIVE: To investigate the preliminary efficacy of large head metal-on-metal implants for patients undergoing total hip arthroplasty. DESIGN, TIME AND SETTING: Prospective cohort study. The patients were selected from Department of Joint Surgery, Xinjiang Hospital of Traditional Chinese Medicine between February 2007 and January 2008. PARTICIPANTS: A total of 65 patients (71 hips) undergoing large head metal-on-metal implantation in Xinjiang Hospital of Traditional Chinese Medicine were selected, including 21 females and 44 males with an average age of 54.6 years (ranging 19 to 77 years). Of them, there were 28 cases of necrosis of the femoral head, 24 of hip osteoarthritis, 9 of femoral neck fracture and 4 of acetabular dysplasia. METHODS: According to age, sex, cause of disease and preoperative joint function, the patients were divided into traditional prosthesis (n=30, 33 hips, metal-on-polyethylene implant) and large head M-O-M group (n=35, 38 hips, ASR/XL prosthesis, DePuy, Motech, Warsaw, IN, USA). MAIN OUTCOME MEASURES: The pre and postoperative Harris scores for the hip, range of motion, periprosthetic radiolucency, leg-length inequality and complications were recorded and compared. RESULTS: All patients were followed-up. The traditional group was followed up for 20 months (ranging 13-28 months), and the large head M-O-M group was followed up for 17 months (ranging 10-26 months). The mean Harris score was 89 points (ranging 59-98) in traditional group, and 94 points (ranging 71-100) in large head M-O-M group (P=0.014). The range of motion of hip was improved, and the large head M-O-M group (34?) was superior to traditional group (26?, P=0.004) at 6 months after surgery; the range of motion was improved 27? in traditional group and 37? in large head M-O-M group (P=0.009) over 1 year of follow up. The leg-length inequality was 4 mm (2-11 mm) in large head M-O-M group and 7 mm (5-16 mm) in traditional group (P=0.005). Both groups exhibited periprosthetic radiolucency (≤1 mm, 2 cases in traditional group and 3 cases in large head M-O-M group). One patient in the traditional group suffered dislocation. CONCLUSION: The large head M-on-M implants in total hip arthroplasty has excellent short-term effects on patients compared with traditional prosthesis. They offer the more stability and better restoration of hip articulation function and biomechanical reconstruction.
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Microglia is the principal immune effector cell in brain. It plays some important roles in support, nutrition, protection, and repair in the physiological activities of neuron. Microglia can be quickly activated, which may proliferate after cerebral ischemia, and promote phagocytosis of macrophage. It exerts dual effects by producing neurotoxic molecules and neurotrophic factors. Therefore, to study the relationship between microglia and cerebral ischemia, give full play to its protective functions and reduce its damage will help to improve the therapeutic effects of cerebral ischemic injury.
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Objective To study the effects of bone marrow stromal cells derived neural stem cells on apoptosis and the expression of Bcl-2 and Bax after focal cerebral ischemia and reperfusion.Methods The model of middle cerebral artery occlusion (MCAO) and reperfusion was set up by Longa. Thirty-two Sprague-Dawley rats were divided into 4 groups: sham-operated group (A), ischemia control group (B), bone marrow stromal cells transplanted group (C) and bone marrow stromal cells derived neural stem cells transplanted group (D). The rats were killed on the day 7 and 14 after transplantation. The brain sections were used for terminal deoxynucleotidyl transferase dUTP mickend labeling (TUNEL) staining and Bcl-2, Bax immunohistochemical staining.Results The number of apoptotic cells in groups C and D was decreased as compared with that in group B on the day 7 and 14 after transplantation (P
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OBJECTIVE:To study the analgesic and anti-inflammatory action of Lamiphlomis from different growing areas.METHODS:The analgesic action was observed with hot plate test and writhing test and the anti-inflammatory action with xylolinduced ear swelling test and acetic acid-induced peritoneal capillary permeability test in mice.RESULTS:Lamiphl_ omis could obviously inhibit the pain induced by hot plate and acetic acid as well as the ear swelling induced by xylol and the capillary permeability resulting from peritoneal injection of acetic acid.CONCLUSION:Lamiphlomis possesses analgesic and anti-inflammatory action and on this point,the actions of Lamiphlomis from three growing areas are more or less alike.