Relation between blood glucose and the prognosis of severe coronavirus disease 2019 / 中南大学学报(医学版)

OBJECTIVES@#To describe the clinical characteristics and outcomes of severely ill patients with coronavirus disease 2019, and to investigate the relationship between plasma glucose level and the prognosis of severely ill patients with coronavirus disease 2019.@*METHODS@#We enrolled 52 severely ill patients with coronavirus disease 2019. Among them, 12 cases progressed to critical illness. The clinical and biochemical characteristics of severely and critically ill patients were compared.@*RESULTS@#Compared with the severely ill patients, critically ill patients had higher white blood cell and neutrophil counts, as well as higher levels of -dimer, IL-6 and C-reactive protein (all <0.05). Before treatment, the fasting plasma glucose (FPG) levels were significantly higher in the critically ill patient's group [(10.23±3.71) mmol/L] compared to those in the severely ill patients [(7.12±3.35) mmol/L, <0.05]. After adjusting for age, gender, and course of the disease, fasting blood glucose at admission (OR=1.308, 95% CI 1.066 to 1.606, =0.01) and hyperglycemia at admission (OR=29.198, 95% CI 2.903 to 293.639, =0.004) were closely related to whether severely ill patients progressed to critical patients with coronavirus disease 2019. In our study, 15 (34.8%) of the severely ill and 10 (83.3%) critically ill patients received the steroid treatment. Compared with the severely ill patients, the FPG levels in critically ill patients were higher (<0.05).@*CONCLUSIONS@#Fasting hyperglycemia at admission is a significant predictor for the prognosis of severely ill patients with coronavirus disease 2019. Closely monitoring and the optimal management of hyperglycemia may improve the prognosis of patients with coronavirus disease 2019.

Influence of high ligation of the inferior mesenteric artery on postoperative complications after radical resection of rectal cancer / 肿瘤研究与临床

Objective To identify the risk factors for postoperative complications after radical resection of rectal cancer, and study the influence of high ligation of the inferior mesenteric artery on postoperative complications of rectal cancer. Methods Clinical data of the patients who underwent radical resection of rectal cancer in the Affiliated Hospital of North Sichuan Medical College from January 2011 to December 2015 were analyzed. The χ 2test and t test were used for all the data. Results A total of 431 patients with rectal cancer were included, of which 80 cases were excluded, and finally 351 cases met the standard. Among them, 196 cases were in high ligation group, and 155 cases were in low ligation group. The total incidence of postoperative complications was 20.4 %(40/196) in the high ligation group and 27.1 %(42/155)in the low ligation group respectively,the difference of which was not statistically significant(χ2=1.336, P= 0.245). The incidence of anastomotic leakage was 10.2 % (20/196) in the high ligation group and 7.7 % (12/155) in the low ligation group respectively, and there was no significant difference between them (χ2=0.529, P= 0.467). Logistic regression analysis revealed that gender (OR= 2.102, 95 % CI 1.278-3.459, P=0.003), body mass index (OR= 2.492, 95 % CI 1.070-5.800, P= 0.027), with or without anemia before surgery(OR=2.203,95 % CI 1.085-4.472,P=0.029), and location of tumor(OR=2.861, 95 % CI 1.288-16.007,P=0.019) were independent risk factors for postoperative complications. Conclusions High ligation of the inferior mesenteric artery does not increase the incidence of postoperative complications after radical resection of rectal cancer. Anastomotic leakage after rectal cancer resection is related to gender, body mass index,with or without anemia before surgery,and location of tumor.

Enhanced recovery after surgery in laparoscopic radical gastrectomy for gastric cancer / 中华普通外科杂志

Objective To evaluate the safety and effectiveness of enhanced recovery after surgery (ERAS) in laparoscopic radical gastrectomy for gastric cancer.Methods From May 2015 to July 2017,149 patients with gastric cancer in our department were prospectively enrolled and randomly divided into the ERAS group (n =75) and control group (n =74).Results In ERAS group compared to control group,the time to first passage of flatus was (51 ± 11)vs.(62 ± 11)h,first feeding time (46 ± 12) vs.(68 ±20)h,gastric tube removal time (13 ± 12)h vs.(70 ± 16) h,pain score on the first day after surgery (3.9 ±1.3) vs.(5.2 ±0.9),C-reaction protein level (8.5 ±2.6) mg/L vs.(10.1 ±3.0)mg/L,post-op hospital stay (6.9 ± 2.9) d vs.(11.2 ± 3.5) d,were all significantly different (all P ＜ 0.05).The postoperative complication rates was 25％ vs.28％ respectively,(x2 =0.101,P =0.750).Conclusions Enhanced recovery after surgery can promote the postoperative recovery and shorten the time of hospitalization in laparoscopic-assisted radical gastrectomy for gastric cancer.

Effect comparison of minilaparotomy and laparoscopic-assisted right hemicolectomy on immune function of patients with colon cancer / 肿瘤研究与临床

Objective To explore the cell-mediated immune function in patients with colon cancer undergoing minilaparotomy or laparoscopic assisted right hemicolectomy. Methods From January 2009 to August 2014, the colon cancer patients receiving right hemicolectomy were retrospectively analyzed. According to the operation mode, the patients were divided into minilaparotomy group and laparoscopic-assisted group. The clinical and pathological data was analyzed. Cell counts of total CD3, CD4, CD8, CD19 as well as NK cells in venous blood samples were compared between 1 day before surgery and postoperative days (POD) 1 and 5. Measurement data with normal distribution was compared using the t test or Q test. Count data was analyzed usingχ2 test or Fisher exact probability. Results There were 408 patients with colon cancer undergoing right hemicolectomy, 26 patients of whom were excluded. The remaining 382 patients were recruited in the research, which were divided into minilaparotomy group (182 cases) and laparoscopic-assisted group (200 cases). There was no significant difference in the age, gender, body mass index, TNM staging, histological type, blood loss, return of bowel function, tumor location, hospital stay and postoperative complications between the two groups (all P> 0.05). The operating time in minilaparotomy group [(131.53 ± 22.57) min] was shorter than that in laparoscopic-assisted group [(167.53 ± 22.04) min], and there was significant difference (t=15.76, P= 0.00). Compared with prior to surgery, cell numbers of CD3, CD4, CD8, CD19 and NK cells were lower on POD 1 and POD 5 (all P0.05). Conclusion The minilaparotomy and laparoscopic-assisted right hemicolectomy have same effect on cellular immune function of patients with colon cancer.

Role of local citrate anticoagulation in continuous blood purification to patients at high risk of bleeding in ICU / 中南大学学报(医学版)

To evaluate the safety and efficiency of citrate anticoagulant-based continuous blood purification in patients at high risk of bleeding. 
 Methods: One hundred and fifty-two patients at high risk of bleeding were divided into local citrate group (group A, n=68) and heparin group (group B, n=84). Clotting function, change of pH, ionized sodium, bicarbonate ion, ionized calcium, activated clotting time (ACT) and complications were monitored before and during treatment. 
 Results: Compared to the group A, the incidence of clotting in filter and chamber, the degree of bleeding or fresh bleeding were significantly reduced in the group B (P0.05). The pH value, the levels of ionized sodium, bicarbonate ion and ionized calcium during the treatment were maintained in normal range in both group A and group B.
 Conclusion: Local citrate-based continuous blood purification can achieve effective anticoagulation and decrease the incidence of bleeding. It is an ideal choice for patients at high risk of bleeding.

Analysis of postoperative complications and their related factors after laparoscopic-assisted radical surgery in rectal cancer / 肿瘤研究与临床

Objective To investigate the factors associated with postoperative complications after laparoscopic-assisted radical surgery in rectal cancer.Methods The clinical data of 310 patients with rectal cancer performed by laparoscopic-assisted radical resection from November 2010 to August 2013 were analyzed retrospectively.The differences between patients with and without postoperative complications were compared.All the data were analyzed by the t test,chi-square test or Logistic regression analysis.Results Among the 310 patients,postoperative complication occurred in 80 patients.On univariate analysis,postoperative complication was associate with gender,age,body mass index,preoperative comorbidity,diameter and location of tumor,TNM staging,operative time and surgeon experience (all P ＜ 0.05).Logistic regression analysis revealed that gender,body mass index,preoperative comorbidity,location of tumor,TNM staging and surgeon experience were independent risk factors for postoperative complications (all P ＜ 0.05).Follow-up was available in 260 patients,with a median follow-up of 18 months (3-30 months).Differences in survival rates between patients with and without postoperative complications were no statistical significance (x2 =1.201,P =0.273).Conclusions Gender,body mass index,preoperative comorbidity,location of tumor,TNM staging and surgeon experience are independent risk factors for postoperative complications in laparoscopic-assisted radical surgery for rectal cancer.The short and medium-term survival time between patients with and without postoperative complications are similar.

The combination of transrectal ultrasonography and serum CEA in preoperative staging of rectal carcinoma / 肿瘤研究与临床

Objective To evaluate the diagnostic accuracy of the combination of endorectal ultrasonography and serum CEA in preoperative diagnosis of rectal wall invasion (T staging) and nodal involvement (N staging) of rectal carcinoma.Methods We retrospectively analyzed clinical records of 310 patients with rectal carcinoma who underwent endorectal ultrasonography and serum CEA evaluation in Shanxi Province Tumor hospital from January 2007 to January 2010.The positive standard of CEA is more than 5 μg/L.The endorectal ultrasonography staging with postoperative pathological staging,and calculated the overall accuracy of T staging and N staging based on TRUS alone or on TRUS combined with serum CEA level were compared.Results The difference in serum CEA level was statistically significant from T1 to T4 (P ＜ 0.05).The accuracy rate of preoperative T staging of rectal carcinoma by TRUS alone was 71％ (219/310) and was 82 ％ (254/310) with TRUS combined with serum CEA level,showing significant statistical difference (x2 =10.92,P ＜ 0.01).The accuracy rate of preoperative N staging of rectal carcinoma was 69 ％ (211/308)with TRUS alone and was 77 ％ (238/308) with TRUS combined with serum CEA level,the difference of which was statistically significant (x2 =5.00,P ＜ 0.05).Conclusion Serum CEA level increases with an increasing pathological stage of rectal cancer.The combination of TRUS and serum CEA improves the accuracy of preoperative staging of rectal cancer.

The influence of high ligation of the inferior mesenteric artery on anastomotic leakage after rectal cancer resection / 中华普通外科杂志

Objective To identify risk factors for anastomotic leakage,and study the influence of high ligation of the inferior mesenteric artery on anastomotic leakage after rectal cancer resection.Methods The chi-test and the student t test were used for statistics.Clinical data were analyzed for 291 patients who underwent rectal cancer resection between August 2008 and November 2011.Results Anastomotic leakage occurred in 27 (9.3％) patients.Anastomotic leakage significantly increased in patients with tumours located within 10 cm from the anal verge,in male patients,and intraoperative blood loss.The use of high ligation of inferior mesenteric artery,which was associated with lower tumor location and surgical modality,was not a risk factor for anastomotic leakage,though it was associated with tumor stage and postoperative urinary retention.Conclusions Anastomotic leakage after rectal cancer resection is related to the tumor level,male gender,and perioperative bleeding,use of a high tie was not associated with an increased rate of symptomatic anastomotic leakage.

The effects of Xuebijing on heat shock protein 70 in rats with severe acute pancreatitis / 中华急诊医学杂志

Objective To study Xuebijing(XBJ,a Chinese herbal preparation)on heat shock protein 70(HSP 70)in rats with severe acute pancreatitis(SAP).Methods Sixty healthy male SD rats were randomly(random number)and equally divided into sham operation group(A),SAP group(B),SAP with low-dose XBJ(4 ml/kg)intervention group(C)and high-dose XBJ(8 ml/ kg)intervention group(D).The SAP model was made by retrograde infusion of 5 ％ sodium taurocholate into the bilepancreatic duct.The rats in group C and group D were treated with 4 ml/kg XBJ and 8 ml/kg XBJ injected intraperitoneally and the treatment repeated once 12 hours later.Rats were sacrificed separately 6 h,12 h and 24 hours after modeling with/without XBJ and the blood samples were collected.Serum HSP 70 and cytokines TNF-α,IL-1β,IL-6 levels were measured by using enzyme-linked immunosorbent assay (ELISA); and correlation between serum HSP 70 and cytokines was analyzed.Results Levels of serum HSP 70 and TNF-o,IL-1β,IL-6 did not change significantly in rats of group A.Compared with group B,levels of serum HSP 70 and TNF-α,IL-1 β,IL-6 in all blood samples were lower significantly in groups C and D,and levels of those biomarkers decreased much more in group D than those did in group C.Thelevels of serum HSP 70 were positively correlated with cytokines TNF-α,IL-1β and IL-6(P ＜ 0.05).Conclusions Levels of serum HSP 70 in rats with SAP increased significantly.XBJ could reduce serum HSP 70 level in rats with SAP,and this may be the mechanism of the anti-inflammatory effects of XBJ.