Efficacy analysis of porcine small intestine submucosa-derived mesh and polypropylene mesh applied in anterior abdominal wall incisional hernia repair / 中华消化外科杂志

Objective To investigate the clinical efficacy of porcine small intestine submucosa-derived (SIS) mesh and polypropylene (PP) mesh applied in anterior abdominal wall incisional hernia repair.Methods The retrospective cohort study was conducted.The clinical data of 59 patients who underwent anterior abdominal wall incisional hernia repair in the First Affiliated Hospital of Sun Yat-Sen University between January 2012 and December 2017 were collected.Of 59 patients,22 undergoing anterior abdominal wall incisional hernia repair with SIS mesh and 37 undergoing anterior abdominal wall incisional hernia repair with PP mesh were respectively allocated into the SIS group and PP group.Surgeons selected surgical procedures according to hernia ring situations of patients.Observation indicators:(l) intra-and post-operative recovery situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect long-term complications of patients including foreign body sensation or pain in abdominal wall and hernia recurrence up to May 2018.Measurement data with normal distribution were represented as (x)±s,and comparison between groups was done using t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was done using Mann-Whitney U test.Comparison of count data was analyzed using the chi-square test or Fisher exact probability.Results (1) Intra-and post-operative recovery situations:patients of the SIS group and PP group underwent successfully anterior abdominal wall incisional hernia repair.There were 2,3,3,14 and 5,26,1,5 patients undergoing open Onlay repair,open Sublay repair,laparoscopic intraperitoneal onlay mesh repair,laparoscopic combined with open mesh repair in the SIS group and PP group respectively.The volume of intraoperative blood loss,cases of postoperative incisional seroma and surgical site infection were (23± 11)mL,7,5 in the SIS group and (30± 13)mL,3,1 in the PP group respectively,with statistically significant differences between groups (t=-2.238,P＜0.05).(2) Follow-up:patients of the SIS group and PP group were respectively followed up for 29.3 months (6.0-66.0 months) and 31.0 months (7.0-76.0 months),with no statistically significant difference between groups (Z =-1.388,P＞0.05).During the follow-up,foreign body sensation or pain in abdominal wall and hernia recurrence were detected in 6,6 patients in the SIS group and 4,2 patients in the PP group respectively,with a statistically significant difference in hernia recurrence between groups (P＜0.05) and with no statistically significant difference in foreign body sensation or pain in abdominal wall between groups (P＞0.05).Conclusion Compared with polypropylene mesh,anterior abdominal wall incisional hernia repair using SIS mesh has higher incidence rate of postoperative incisional seroma,surgical site infection and hernia recurrence,but fewer volume of intraoperative blood loss.

Observation of the efficacy of biological patch in hybrid technique for incisional herniorrhaphy: 5-year follow-up results from a single center / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To observe the safety and efficacy of biological patch (Biodesign Surgisis mesh, SIS) in hybrid technique for incisional herniorrhaphy.</p><p><b>METHODS</b>Clinical and follow-up data of 14 incisional hernia patients who underwent incisional herniorrhaphy with hybrid technique, using porcine small intestinal submucosa acellular matrix patch, at the First Affiliated Hospital of Sun Yat-sen University from January 1, 2012 to June 31, 2016 were analyzed retrospectively. This Biodesign Surgisis patch for incisional hernia is produced by the Cook company in the United States. The size of patch ranged from 9 cm × 15 cm to 20 cm × 25 cm. During operation, according to abdominal wall defect, the patch was cut to ensure the distance from its edge to the border of abdominal wall defect more than 5 cm.</p><p><b>RESULTS</b>There were four male and tenfemale patients with average age of (67.7±11.6) years and average body mass index(BMI) of (25.5±1.7) kg/m². As for operative history of these 14 cases, 7 cases had gastrointestinal tumor surgery, 2 had appendectomy, 1 had upper abdominal white line hernia repair, 1 had hysterectomy, 1 had cholecystectomy, 1 had splenectomy plus portal vein dissection, and 1 had right kidney and right ureter total resection plus partial excision of bladder wall. Ten casesdeveloped incisional infection after previous surgery. The duration of incisional hernia ranged 1 to 180 months (median, 8 months). Two cases were refractory hernia, 1 was incarcerated hernia, and 11 were reversible hernia. The locations of incisional hernia included 4 cases of right ventral wall, 1 case of left ventral wall, 2 cases of supra-umbilical incision, 4 cases of infra-umbilical midline incision, and 3 cases of peri-umbilical midline incision. There were 3 cases of middle incisional hernia, 5 cases of large incisional hernia and 6 cases of huge incisional hernia. All the patients completed operations eventlessly. The average operative time was (202.5±72.9) minutes. The average length and width of hernia ring were (10.9±4.3) cm and (9.3±3.9) cm, respectively. Clean operation was performed in 11 cases, potential contaminative operation in 2 cases and contaminative operation in 1 case. The amount of operative bleeding was (15.0±4.8) ml. The NRS pain scores within 24 hours after the operation, at POD3 and at POD7 were 5.1±0.9, 4.2±0.7 and 3.7±0.9, respectively. The time to flatus after operation was (2.5±0.9) days and the time to liquid diet was (3.8±1.2) days. No patient died during the perioperative period. The average hospitalization time was (21.5±12.0) days. Postoperative complications occurred in 8 cases, including 4 cases of fever, 8 cases of incision complications, 4 cases of abdominal infection, 4 cases of intestinal obstruction, 5 cases of effusion under patch, 2 cases of pneumonia, and 1 case of acute myocardial infarction. According to the Clavien-Dindo classification, 3 cases were grade zero, 3 cases were grade I(, 6 cases were grade II(, 1 case was grade III(, and 1 case was grade IIII(. Thirteen patients received follow-up and the average follow-up time was (33.2±12.3) (18.2-61.0) months. One patient died of cerebral infarction 38 months after operation. The chronic abdominal pain or discomfort was found in 4 cases. The recurrent incisional hernia developed in 5 cases and the average time of recurrence was (11.0±8.3) months.</p><p><b>CONCLUSIONS</b>Biological patch can be used safely and effectively in hybrid technique for incisional herniorrhaphy. However, the morbidity of postoperative complication and the risk of recurrence are high. Terefore, the long-term outcome is still subject to observation.</p>

Screening for predictive biomarkers of bevacizumab treatment in gastric cancer subcutaneous xenografts / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To establish subcutaneous xenograft models of gastric cancer in nude mice and to screen the predictive biomarkers of bevacizumab effectiveness.</p><p><b>METHODS</b>Subcutaneous xenograft models were established using BGC823 gastric cancer cell line in 20 male 4-week old BALB/C-nu/nu nude mice and were randomly divided into four groups, bevacizumab group(15 mg/kg), 5-FU group(15 mg/kg), combined group and control group, with 5 mice in each group. Bevacizumab and 5-FU were administered intraperitoneally every other day for three weeks. After treatment, tumor size and inhibition rate were calculated. Expression of CD31 was examined by immunohistochemistry for evaluation of microvascular density(MVD). Levels of human vascular endothelial growth factor(VEGF), basic fibroblast growth factor (bFGF), placental growth factor (PIGF) and interleukin 8(IL-8) were tested by enzyme linked immunosorbent assay(ELISA).</p><p><b>RESULTS</b>Compared to the control group, bevacizumab group and combined group had a significantly lower MVD(5.2±1.0 and 4.3±1.2 vs. 13.8±1.6, P<0.05), a smaller tumor volume [(305.6±184.1) mm(3) and (242.2±71.4) mm(3) vs.(1535.2±625.1) mm(3), P<0.05], and lower levels of VEGF and IL-8 in tumor tissues [VEGF:(351.6±84.1) ng/L and (242.2±71.4) ng/L vs. (1256.7±702.1) ng/L, P<0.05); IL-8:(20 903±1485) ng/L and (27 489±6772) ng/L vs. (57 032±2437) ng/L, P<0.05]. The above parameters were not significantly different between 5-FU group and control group(all P>0.05). Levels of bFGF and IGF were not significantly different among four groups as well(all P>0.05).</p><p><b>CONCLUSION</b>VEGF and IL-8 may be used to be biomarkers candidates to predict bevacizumab effectiveness on human gastric cancer.</p>

Clinicopathologic features and survivals of postoperative gastric carcinoma patients by different tumor locations / 中华普通外科杂志

Objective To summarise the clinicopathologic features and survival of gastric cancer at different tumor locations.Methods A total of 942 adult gastric cancer patients undergoing curative gastrectomy with lymphadenectomy were recruited from the First Affiliated Hospital,Sun Yat-sen University,and examined retrospectively.In all cases,patients' age,gender,pTNM stage and survival time were identified and recorded.Results There were 208 carcinoma cases at gastroesophageal junction (GEJ,22.1％),261 fundus/body cases (27.7％),445 antrum/pylorus cases (47.2％) and 28 whole stomach cases (3.0％).Compared with fundus/body and antrum/pylorus carcinoma,GEJ carcinomas were more often seen in males,among older patients,with larger tumor size and deeper infiltrated tumors,higher stage and worse 5-year disease-free survivals.Whole stomach carcinoma had predilection in female,younger patients,and at later stages and worst 5-year disease-free survival.Conclusions Gastric carcinomas differ greatly in biologic behavior and prognosis by anatomic locations.GEJ carcinoma has independent biologic features.Whole stomach carcinoma is of the highest malignancy and worst prognosis.

Study on the treatment of experimental autoimmune encephalomyelitis in rats by thymopentin / 中华微生物学和免疫学杂志

Objective To investigate the therapeutic effects of thymopentin(TP-5)for the experimentsl autoimmune encephalomyelitis(EAE)in rats.Metbods The EAE model wss established in wistar rats immunized with fresh guinea pig spinal cord homogenate(GPSCH)and complete Freund's adjuvant (CFA).Wistar rats were divided randomly into five groups:normal control group,EAE group,dexamethaSone(DXM)group,low dose TP-5 treated group,hish dose TP-5 treated group.The levels of IL-12 and IL-10 in serum of wistar rats were detected by sandwich-ELISA on day 7,14 and 21 post immunization.Resuits Morbidity and clinical score of low dose TP-5 treated group and DXM group were significantly lower than those of EAE group and hish dose TP-5 treated group(P＜0.01).Morbidity and clinical score of DXM group were significantly lower than those of low dose of TP-5 treated group(P＜0.01).The levels of IL-12 of EAE group,DXM group,low dose TP-5 treated group and high dose TP-5 treated group were significantly higher than of normal control group at each time point(P＜0.01).The levels of IL-12 of DXM group and low dose TP-5 treated group were significantly lower than that of EAE group(P＜0.01),meanwhile the levels of IL-10 of DXM group and low dose TP-5 treated group were significantly higher than that of the rest groups on day 14 and 21 post immunization(P＜0.01).Conclusion TP-5 has protective effects on EAE,and its functional mechanism may be associated with down.regulation of IL-12 as well as up-regulation of IL-10,so as to reverse the imbalance of TH1/TH2 responses by bidirectional regulation.