Transplantation of Autologous Peritoneum Using Ileal Seromuscular Flaps for Orthotopic Neobladder Reconstruction / 中国医学科学院学报

To develop an ideal surgical procedure for neobladder reconstruction in experimental porcine models. Six experimental female pigs weighting 28-33 kg underwent transplantation of autologous peritoneum for bladder reconstruction under general anesthesia.The flaps were used to reconstruct the orthotopic neobladder by suturing with the edges of the triangle and neck of the remnant bladder.The ureteral catheters were removed on the 5 postoperative day and the balloon catheter was removed on the 7 postoperative day.Voiding behaviour was monitored.The animals were euthanized at week 12 for routine pathology,immunohistochemistry,and electron microscopy. All the pigs survived after the surgery,and no postoperative complication such as peritonitis,intestinal obstruction,or urinary fistula was observed.All the peritoneum-ileum composite free valves survived after transplantation.Voiding behaviour was normal after catheter removal,and the urine was clear.At autopsy,reconstructed bladders were healthy.Pathological examination showed the neobladder had been covered by continuous urothelium while the peritoneum disappeared and showed no ileal mucosa regrowth and residual.Scanning electron microscope showed the transitional cells of neobladder were complete and orderly,and the urothelium around suture border was continuous and showed no malposition. Reconstruction of bladder by autologous peritoneum and ileal seromuscular flaps is an ideal approach in the experimental pigs as it can prevent regrowth of ileal epithelial cells and avoid the complications of conventional enterocystoplasty.Its clinical application deserves further investigations.

Details of enteral nutrition for gastric carcinoma patients / 中华胃肠外科杂志

Enteral nutrition can provide adequate nutrients and enhance immunity. Because it is inexpensive, no significant side effects, and convenient, enteral nutrition has been used widely. However, enteral nutrition has its limitation, therefore some details should be noticed during the management. In this paper, we discuss the details about enteral nutrition based on the data of our gastric carcinoma patients.

Expression of transcription factor SP1, vascular endothelial growth factor and CD34 in serosa-infiltrating gastric cancer and their relationship with biological behavior and prognosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of transcription factor SP1, vascular endothelial growth factor(VEGF) and CD34 in serosa-infiltrating gastric cancer and their relationship with biological behavior and survival rate.</p><p><b>METHODS</b>Immunohistochemical technique was used to detect the expression of SP1, VEGF and CD34(described by microvessel density, MVD) in 68 specimens with serosa-infiltrating gastric cancer.</p><p><b>RESULTS</b>The positive expression rates of SP1 and VEGF in serosa-infiltrating gastric cancer were 50.0% and 52.9% respectively. In positive SP1 specimens, the positive rate of VEGF(73.5%) was significantly higher than that of negative SP1 specimens (32.4%, chi(2)=11.57, P=0.01). The mean tumor MVD was correlated with the expression levels of SP1 and VEGF(P<0.01). There was a significant correlation of the SP1 expression with tumor size and growth pattern(P =0.01). The expression levels of VEGF and MVD were correlated with Borrmann types, cell differentiation, metastatic lymph nodes and growth pattern(P<0.01). Univariate analysis revealed that SP1 and VEGF expression, MVD, Borrmann types, lymph node metastasis, tumor size and growth pattern were significant prognostic factors related to survival time. Multivariate analysis showed that SP1 expression, MVD and growth pattern were independently prognostic factors of poor survival.</p><p><b>CONCLUSIONS</b>The activation of SP1 contributes to angiogenesis and metastasis in gastric cancer through the up-regulation of VEGF. SP1, VEGF and MVD may serve as valuable indicators of biological behavior of gastric cancer. SP1 protein expression is not related with the number of metastatic lymph nodes. SP1 expression and MVD may serve as valuable indicators of prognosis in gastric carcinoma.</p>

Expression of hepatocyte growth factor, transcription factor SP1, vascular endothelial growth factor and CD34 in serosa-infiltrative gastric cancer and their relations with defluxion of gastric cancer cell and prognosis / 中华外科杂志

<p><b>OBJECTIVE</b>To observe the expression of hepatocyte growth factor (HGF), transcription factor SP1, vascular endothelial growth factor (VEGF) and CD34 (demonstrating by microvessel density, MVD) in serosa-infiltrative gastric cancer (T3) and their relations with the pathobiological behavior of the tumor, and to investigate the molecular basis of the defluxion of gastric cancer cells in abdominal cavity and its influence on prognosis.</p><p><b>METHODS</b>Selective collection of peritoneal lavage was obtained from 80 patients with serosa-infiltrative gastric cancer received operation from April to December in 2007. The cancer cells were detected by using peritoneal lavage cytology (PLC) and immunochemistry of cytokeratin 18 (CK18). Immunohistochemistry was applied to detect the HGF, SP1, VEGF and CD34 in serosa-infiltrative gastric cancer tissues. The rigorous follow-up was carried out for the patients.</p><p><b>RESULTS</b>The positive rate of PLC was 63.8% (51/80), and the positive rate of immunochemistry of CK18 was 75.0% (60/80). The positive cases in PLC were positive in immunochemistry of CK18 also, while 9 negative cases in PLC were positive with CK18, and of them 6 cases were determined positive with exfoliated cancer cells through pathological consulting. So the positive rate of exfoliated cells of this group was 71.3% (57/80). The positive rates of HGF, SP1 and VEGF in gastric cancer tissues were 57.5%, 52.5% and 55.0%, respectively, and were all significantly correlated with the MVD (P < 0.05). HGF, SP1, VEGF and MVD were correlated with the positive rate of exfoliated cells (P < 0.05). HGF, SP1, VEGF and MVD were found significantly related to prognosis on univariate analysis (P < 0.05), and it was demonstrated that HGF, SP1 and VEGF were independent prognostic influential factors on Logistic regression analysis (P < 0.05).</p><p><b>CONCLUSIONS</b>The expression of HGF, SP1, VEGF and MVD are related with the biological behaviour of serosa-infiltrative gastric cancer. The detection of these factors might be helpful in predicting the defluxion of gastric cancer cells and postoperative recurrence.</p>

Value of Epworth sleepiness scale in assessment the degree of sleep disordered breathing / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the value of Epworth sleepiness scale in assessment of obstructive sleep apnea hypopnea syndrome (OSAHS) severity.</p><p><b>METHODS</b>The polysomnography (PSG) data of 620 suspected OSAHS patients from Jan. 2000 to Dec. 2003 were retrospectively analyzed. There were 556 males and 64 females, and their age ranged from 21 to 79 years (median 45.0 years). Of the all 620 patients, the median of the weight was 82.0 kg ( range 50 to 130 kg), median of height was 172.0 cm (range 147 to 178 cm), median of body mass index was 28.0 (range 18.5 to 42.9), median of apnea-hypopnea index (AHI) was 37.2 (range 0 to 126.1), median of lowest arterial oxygen saturation (LSAT) was 0.75 (range 0.21 to 0.93), median of ESS was 13.0 (range 0 to 24). OSAHS was diagnosed in 513 patients and simple snorer was diagnosed in 107 patients by PSG. All the patients filled in ESS questionnaire in sleep disorder centre before PSG.</p><p><b>RESULTS</b>The correlation coefficients of the ESS and AHI, LSAT was -0.314 and -0.312 respectively (P <0. 05). The median of ESS in severe OSAHS group was higher than that in simple snorer, mild and moderate OSAHS groups (P < 0.001), but no difference was found among the simple snorer, mild and moderate OSAHS groups (P < 0.05). The median of ESS in severe hypoxemia group was higher than that in no, mild and moderate hypoxemia groups (P < 0.001), but no difference was found among no, mild and moderate hypoxemia groups (P > 0.05).</p><p><b>CONCLUSIONS</b>The Epworth sleepiness scale has little value in assessment of OSAHS severity. A new sleepiness scale method which is suitable for Chinese should be made.</p>

Assay of carnitine in plasma and urine of healthy adults / 中国医学科学院学报

<p><b>OBJECTIVE</b>To determine the levels of carnitine in plasma and daily excretion of carnitine in urine of healthy adults so as to provide the reference standard for studying the changes of carnitine in patients.</p><p><b>METHODS</b>Carnitine in plasma and urine was assayed with high performance liquid chromatography (HPLC). The levels of total carnitine (TC), free carnitine (FC) and acetyl-carnitine (AC) in fasting plasma and the daily excretion of TC, FC and AC in urine were assayed in 40 healthy adults (20 men and 20 women) with standard diet.</p><p><b>RESULTS</b>Good linearity (r 2 > or = 0.999) was observed in assaying TC, FC and AC. The relative standard deviation (RSD) was lower than 9.1% and bias lower than 5.6%. It was showed that the plasmatic levels of TC, FC and AC in healthy men [(53.1 +/- 8.5), (41.2 +/- 6.1), (6.2 +/- 0.6) mumol/L] were significantly higher than those in healthy women [(45.4 +/- 5.6), (35.2 +/- 4.9), (5.7 +/- 0.7) mumol/L] (P = 0.002, 0.002, 0.035). The daily urinary excretion of TC, FC and AC in healthy men [(386.1 +/- 22.9), (180.5 +/- 31.8), (33.8 +/- 3.3) mumol] were also significantly higher than those in healthy women [(240.1 +/- 35.6), (112.7 +/- 22.6), (29.3 +/- 4.3) mumol] (P < 0.0005, < 0.0005, < 0.0005) when the adults were given standard diet. Both the plasmatic levels and the daily urinary excretion of TC, FC and AC were of significantly positive correlation with lean body mass (LBM) (r = 0.501-0.856). The (TC-FC)/FC ratios in plasma were 0.29 +/- 0.05 for male and 0.29 +/- 0.04 for female.</p><p><b>CONCLUSION</b>Good precision and accuracy were observed in assaying carnitine with HPLC. After standard diet, both the level of carnitine in fasting plasma and the daily urinary carnitine excretion of healthy adults were positively correlated with LBM.</p>