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Objective:To compare the diagnostic value of three quantitative evaluation methods based on three-dimensional rapid fluid attenuation inversion recovery sequence (3D-FLAIR) vein-enhanced labyrinth images in endolymphatic hydrops.Methods:From October 2017 to April 2019, a retrospective study was conducted on 86 patients with unilateral otogenic vertigo who were admitted to Beijing Tongren Hospital, Capital Medical University. MRI was performed 8 h after the single-dose Gd-DTPA intravenously injection in all patients. Three evaluation methods were used to calculate the ratio of the endolymphatic area to the total lymphatic area, the ratio of the saccule to utricle area, and the ratio of the endolymphatic volume to the total lymphatic volume, respectively. The paired t test was used to compare the three ratios between the affected and healthy ears. With clinical diagnosis as the gold standard, the receiver operating characteristic (ROC) curve analysis was used to analyze the efficacy of three methods in diagnosing endolymphatic hydrops. Results:Totally 65 cases were finally diagnosed endolymphatic hydrops clinically. There were statistically significant differences of all the 3 ratios between the affected and healthy ears ( t=9.93, 7.22, 8.20, all P<0.001). The ROC curve showed that the area under the curve (AUC) of endolymph/total lymph area ratio, saccule/utricle area ratio, endolymph/total lymph volume ratio for diagnosis of endolymphatic hydrops were 0.882, 0.768, 0.884 (all P<0.001). And there were no significant differences between each paired AUCs (all P>0.05). Conclusions:All three methods of endolymph/total lymph area ratio, saccule/utricle area ratio, endolymph/total lymph volume ratio can quantitatively evaluate endolymphatic hydrops. The endolymphatic/total lymphatic area ratio method is still the most convenient method at present.
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Objective:To compare and analyze the efficacy of supraumbilical longitudinal auxiliary incision and left lower abdominal oblique auxiliary incision during laparoscopic radical resection of rectal cancer.Methods:The data of 196 patients with rectal cancer treated in the Second Affiliated Hospital of Xiamen medical college from January 2015 to December 2020 were analyzed retrospectively. Different abdominal auxiliary incisions were used for grouping. The control group (101 cases) used the oblique auxiliary incision of the left lower abdomen, and the observation group (95 cases) used the longitudinal auxiliary incision of the upper umbilical cord. The intraoperative indicators (operative time, intraoperative blood loss, auxiliary incision length, distance between anastomotic teeth and dentate line), postoperative indicators (first postoperative exhaust time, postoperative pain score, fluid intake time, first out of bed time and hospital stay) and operative complications between the two groups were compared.Results:The first postoperative exhaust time ((56.8±4.3) h vs. (70.3±5.8) h, t=4.796) and the first postoperative out of bed time ((38.81±2.04) h vs. (47.93±2.63) h, t=5.113) in the observation group were significantly shorter than those in the control group, and the pain scores at 24 hours ((2.01±0.22) vs.(2.43±0.40), t=5.882) and 48 hours pain score ((2.23±0.44) vs. (3.14±0.72), t=6.58) after operation were significantly lower than those in the control group (all P<0.05). The incidence of incision hernia in the observation group was significantly lower than that in the control group (5.3% (5/95) vs.9.9% (10/101), χ 2=4.29)( P<0.05). Conclusion:Compared with the left lower abdominal oblique auxiliary incision,the supraumbilical longitudinal auxiliary incision in laparoscopic radical resection of rectal cancer can not only significantly reduce the postoperative pain scores and recover the postoperative intestinal function as soon as possible, but also significantly reduce the incidence of postoperative incision hernia.
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OBJECTIVE：To study the improvement effects of paeon iflorin（PF）on myocardial injury in type 2 diabetes mellitus（T2DM）model rats and its mechanism. METHODS ：The experiment was set up in the normal group ，model group ， positive control group （metformin 90 mg/kg），PF high-dose ，medium-dose and low-dose groups （90，60，30 mg/kg），with 8 rats in each group. Except for normal group ，other groups were given high-glucose and high-fat diet and intraperitoneal injection of streptozotocin （30 mg/kg） to induce T 2DM model. After modeling ， administration groups were given relevant medicine intragastrically，normal group and model group were given constant volume of normal saline intragastrically ，once a day ，for consecutive 4 weeks. The body weight ，fasting blood glucose and oral glucose tolerance were measured ；serum levels of glycosylated serum protein （GSP），total cholesterol （TC），triacylglycerol（TG），glutathione peroxidase （GSH-Px），superoxide dismutase（SOD），malondialdehyde（MDA），creatine kinase isoenzyme-MB （CK-MB） and troponin Ⅰ （cTn Ⅰ） were determined. The pathomorphological changes of myocardium were observed. The apoptosis index of rat cardiomyocytes was （ detected. The protein expression of B-cell lymphoma 2 （Bcl-2），Bcl-2 related X protein （Bax）and caspase- 3 in rat myocardium were detected by immunohistochemistry and Western blot. RE SULTS：Compared with normal group ，the body weight ，serum levels of GSH-Px and SOD ，protein expression of Bcl- 2 in myocardium were decreased significantly in model group（P＜0.01）；while fasting blood glucose ，area under blood glucose curve ，serum levels of biochemical indexes （GSP，TC， TG，MDA，CK-MB，cTnⅠ），cardiomyocyte apoptosis index ，protein expression of Bax and caspase- 3 in myocardium were increased significantly （P＜0.05 or P＜0.01）. The arrangement of myocardium was relatively irregular ，and some muscle fibers were broken. Compared with model group ，except for body weight ，serum levels of SOD and MDA ，the protein expression of Bax in myocardium in PF low-dose group ， above indexes of PF groups were reversed significantly （P＜0.05 or P＜0.01）. CONCLUSIONS：PF can regulate glycolipid metabolism ，enhance antioxidant ability ，inhibit cardiomyocyte apoptosis and improve myocardial injury in T 2DM model rats ；the mechanism may be associated with increasing the protein expression of Bcl- 2 and down-regulating the protein expression of Bax and caspase- 3 in myocardium.
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Objective:To investigate the causes of the outbreak of Candida Pelliculosa catheter-related bloodstream infection in the neurosurgical intensive care unit (ICU), find out the source of infection and the route of transmission, and provide evidence for the prevention and control of nosocomial infection. Methods:An epidemiological investigation and environmental hygiene monitoring were made in patients with Candida Pelliculosa catheter-related bloodstream infection who received treatment in March and April 2019 in Houma People's Hospital, China. Comprehensive measures were taken to control the outbreaks of Candida Pelliculosa catheter-related bloodstream infection. Results:There were four patients with Candida Pelliculosa catheter-related bloodstream infection in the ICU of Neurosurgery Department of Houma People's Hospital, China. Eight samples were collected from these four patients. Ten strains were isolated and identified positive for Candida Pelliculosa. Drug sensitivity test revealed identical results: the minimum inhibitory concentration (MIC) of 5-fluorocytosine, amphotericin B, fluconazole, itraconazole and voriconazole was ≤ 4 mg/L, ≤ 0.5 mg/L, < 1 mg/L, ≤ 0.12 mg/L and ≤ 0.06 mg/L, respectively. No target bacteria were detected from the environment. Candida Pelliculosa infection was not observed after taking comprehensive control measures such as strengthening hand hygiene supervision in medical staff and thorough disinfection of the environment. Conclusion:Poor hand hygiene compliance in medical staff in neurosurgical ICU and non-sufficient environmental disinfection may be the main causes for the outbreak of Candida Pelliculosa catheter-related bloodstream infection.
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Objective To compare the efficacy and tolerance of platinum-based doublet chemotherapy versus single-agent chemotherapy as second-line treatment in elderly patients with advanced non-small cell lung cancer(NSCLC).Methods A total of 85 elderly patients with advanced NSCLC after first-line treatment were retrospectively analyzed and divided into the combination therapy group(n=40,taking platinum-based doublet chemotherapy)and the single-agent chemotherapy group(n=45,receiving single-agent second-line chemotherapy).Results There were no significant differences in the objective response rate (ORR)and the disease control rate (DCR)between the combination therapy group and the single-agent chemotherapy group(27.5 ％ or 11/40 vs.20.0 ％ or 9/45,60.0％ or 24/40 vs.73.3％ or 33/45,x2 =0.662 and 1.704,P=0.416 and 0.192).The median progression-free survival(PFS)was 3.8 months for the combination therapy group and 2.8 months for the single-agent chemotherapy group(P =0.045).The rate of grade Ⅲ/Ⅳ hematological toxicity was higher in the combination therapy group than in the single-agent chemotherapy group.Conclusions Platinum-based doublet chemotherapy has longer PFS than the single-agent chemotherapy as secondline treatment in elderly patients with advanced non-small cell lung cancer,and more attention should be paid to its high hematological toxicity.
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Objective@#To investigate the clinical effects of first generation epithelial growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) compared with platinum-based chemotherapy as first-line therapy in advanced lung adenocarcinoma patients with uncommon EGFR mutations.@*Methods@#Clinical data of 4 276 patients diagnosed as advanced lung adenocarcinoma (ⅢB/Ⅳ) underwent EGFR gene detection at the Affiliated Cancer Hospital of Zhengzhou University from January 2012 to February 2018 were collected and 99 cases with uncommon EGFR mutations were selected. The clinical pathological features, treatment outcomes, treatment options and prognosis after first-line treatment of the 99 cases were analysed and compared with other patients with common EGFR mutations.@*Results@#The objective response rates of patients with uncommon EGFR mutations receiving EGFR-TKIs or platinum-based chemotherapy were 33.0% and 27.1%, respectively. The disease control rates were 76.5% and 87.5%, respectively. The progression-free survival (PFS) of patients treated with EGFR-TKIs was 7.2 months, significantly superior than 4.9 months of patients receiving chemotherapy (P=0.009). The overall survival of patients treated with EGFR-TKIs was 14.3 months, significantly worse than 20.7 months of patients receiving chemotherapy (P=0.034). Multivariate analysis showed that distant metastases (P=0.001) and smoking history (P=0.013) were independent prognostic factors for OS of lung adenocarcinoma patients with EGFR uncommon mutations.@*Conclusions@#Compared with chemotherapy, the usage of first generation of EGFR-TKIs as first-line therapy can improve the short-term efficacy of advanced lung adenocarcinoma patients with EGFR uncommon mutations. However, platinum-based chemotherapy shows a longer overall survival.
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Objective To explore the relationship between placental thickness,MRI signs and postpartum hemorrhage in placenta accreta(PA)patients.Methods 28 PA patients with postpartum hemorrhage and 3 9 PA patients without postpartum hemorrhage were analyzed retrospectively.We compared the clinical features and MRI signs between the two groups,and analyzed the correlation between placental thickness and PA related postpartum hemorrhage.Results The mean placental thickness was significantly higher in the hemorrhage patients (62.04±13.826)mm than that in the patients without hemorrhage (39.72±11.362)mm.Among the clinical features, there were no correlations between age,previous intrauterine operation history,previous cesarean section history and occurrence of the PA related postpartum hemorrhage.The following MRI signs were related to the occurrence of the PA related postpartum hemorrhage,including placenta previa,local bulging of the uterine,heterogeneous signal intensity in the placenta,intraplacental hypointensity bands,intraplacental abnormal vascularity,scar covered by placenta,abnormal signal intensity around the cervix,thinning of myometrium.Conclusion Measurement of placental thickness by MRI combined with placenta previa,local bulging of the uterine,heterogeneous signal intensity in the placenta,intraplacental hypointensity bands,intraplacental abnormal vascularity,scar covered by placenta,heterogeneous signal intensity around the cervix, thinning of myometrium are valuable in predicting PA related postpartum hemorrhage.
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Objective To investigate the risk factors of perioperative complications of laparoscopic radical distal gastrectomy and influence of body shape on the short-term therapeutic effects.Methods The retrospective case-control study was conducted.The clinicopathological data of 506 patients (328 males and 178 females,average age 60 years with the range of 24-85 years) who underwent laparoscopic radical distal gastrectomy+D2 lymph nodes dissection in the 8 clinical centers between March 2016 and November 2018 were collected,including 143 in the First Affiliated Hospital of Xiamen University,66 in the Affiliated Hospital of Qinghai University,66 in the Second Affiliated Hospital of Wenzhou Medical University,64 in the Zhongshan Hospital of Xiamen University,54 in the Affiliated Hangzhou First people's Hospital of Zhejiang University School of Medicine,48 in the Zhangzhou Affiliated Hospital of Fujian Medical University,35 in the Affiliated Quanzhou First Hospital of Fujian Medical University,30 in the Second Affiliated Hospital of Xiamen Medical College.The maximum thickness of subcutaneous fat at the level of umbilicus (USCF),the maximum vertical distance between the anterior abdominal skin and the back skin at the level of the umbilicus (UAPD),the maximum horizontal distance between the anterior abdominal skin and the back skin at the level of the umbilicus (UTD),the maximum verticaldistance between the anterior abdominal skin and the back skin at the level of the xiphoid bone (XAPD),the maximum horizontal distance between the.anterior abdominal skin and the back skin at the level of the xiphoid bone (XTD),the distance between the anterior abdominal skin and the root of celiac artery (CAD) and the maximum horizontal distance at a right angle to CAD (CATD) were measured using preoperative imaging examinations.Observation indicators:(1) intraoperative and postoperative situations;(2) follow-up situations;(3) risk factors analysis of perioperative complications;(4) influence of body shape related indexes on intraoperative situations and postoperative recovery:① Pearson univariate correlation analysis,② liner regression model analysis.Followup using outpatient examination and telephone interview was performed to detect the postoperative survival and tumor recurrence or metastasis up to December 2018.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were described as M (range).Comparisons of count data were analyzed using the chi-square test.Comparisons of ordinal data were analyzed by Mann-Whitney U nonparametric test.Risk factors of perioperative complications of laparoscopic distal gastrectomy were analyzed by Logistic regression model.Influence of body shape related indexes on intraoperative situations and postoperative recovery was analyzed by Pearson univariate correlation analysis and liner regression model.Results (1) Intraoperative and postoperative situations:all the 506 patients underwent successful laparoscopic distal gastrectomy,including 103 with Billroth Ⅰ anastomosis,140 with Billroth Ⅱ anastomosis,201 with Billroth Ⅱ + Braun anastomosis,62 with Roux-en-Y anastomosis.The operation time,volume of intraoperative blood loss,number of lymph nodes dissected,time to postoperative anal exsufflation,time for initial fluid diet intake,time for initial semi-fluid diet intake and duration of postoperative hospital stay were (233±44)minutes,(102±86)mL,34±13,(3.6±1.5)days,(5.8±3.3)days,(8.3±3.8)days,(12.2±5.7)days respectively in the 506 patients.Of 506 patients,196 were defined as pathological stage Ⅰ,122 were defined as pathological stage Ⅱ and 188 were defined as pathological stage Ⅲ postoperatively.Of 506 patients,93 had 106 times of perioperative complications,including 33 times of pulmonary and upper respiratory infection,12 times of incisional infection,11 times of anastomotic leakage,11 times of abdominal infection,8 times of intestinal obstruction,8 times of gastroplegia,6 times of abdominal hemorrhage,5 times of bacteremia,3 times of anastomotic hemorrhage,3 times of lymph fluid leakage,2 times of pancreatic leakage,1 time of urinary infection,1 time of anatomotic stenosis,1 time of deep venous thrombosis and 1 time of pulmonary embolism;the same patient can merge multiple complications.Eleven patients were in the Clavien-Dindo classification ≥ Ⅲ.(2) Follow-up situations:465 of 506 patients were followed up for 1-32 months with a median time of 12 months.During the follow-up,451 had postoperative survival and 38 had tumor recurrence or metastasis.(3) Risk factors analysis of perioperative complications.① Results of univariate analysis showed that age,body mass index (BMI),preoperative hemoglobin,preoperative serum albumin and XAPD were related factors affecting perioperative complications of laparoscopic distal gastrectomy (x2 =10.289,7.427,5.269,5.481,4.285,P＜ 0.05).② Results of multivariate analysis showed that age,BMI,preoperative serum albumin were independent related factors affecting perioperative complications of laparoscopic distal gastrectomy (odds ratio =1.033,1.118,0.937,95％ interval confidence:1.011-1.057,1.025-1.219,0.887-0.990,P＜0.05).(4) Influence of body shape related indexes on intraoperative situations and postoperative recovery.① Results of Pearson univariate correlation analysis showed correlations between UAPD,XAPD,CAD,CATD and volume of intraoperative blood loss (r=0.107,0.169,0.179,0.106,P＜0.05),between UAPD,XAPD,CAD and the number of lymph nodes dissected (r=-0.137,-0.143,-0.173,P＜0.05),between USCF,XAPD and time to postoperative anal exsufflation (r =0.122,0.109,P＜0.05),between USCF,XAPD,CAD and time for initial fluid diet intake (r=0.132,0.108,0.132,P＜0.05),between USCF,XAPD and duration of postoperative hospital stay (r=0.116,0.100,P＜0.05).② Results of liner regression model analysis showed a positive correlation between CAD and volume of intraoperative blood loss (r =6.776),a negative correlation between CAD and the number of lymph nodes dissected (r =-0.841),with statistically significant differences (t =2.410,-1.992,P＜ 0.05);a positive correlation between USCF and time to postoperative anal exsufflation (r=0.170),between USCF and time for initial fluid diet intake (r=0.365),between USCF and duration of postoperative hospital stay (r=0.636) respectively,with statisticallysignificant differences (t =2.188,1.981,2.107,P＜ 0.05).Conclusions Abdominal shape can influence intraoperative situations and postoperative recovery of laparoscopic distal gastrectomy,but cannot increase risks ofperioperative complications.Age,BMI and preoperative serum albumin are independent related factors affecting perioperative complications of laparoscopic distal gastrectomy.
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BACKGROUND@#Bevacizumab combined with platinum-based chemotherapy has been recommended as the first-line agent in advanced nonsquamous non-small cell lung cancer (NSCLC) without driven gene, but this regimen is not common in the second-line or later-line treatment of non-squamous NSCLC. The aim of this study is to investigate the efficacy and safety of bevacizumab combined with chemotherapy as second-line or later-line treatment in advanced non-squamous NSCLC.@*METHODS@#We retrospectively reviewed the clinical data of advanced nonsquamous NSCLC patients who were treated with bevacizumab after first-line treatment failure and they were hospitalized in the Affiliated Cancer Hospital of Zhengzhou University from January 2014 to June 2017, and Kaplan-Meier method, Log-rank test and Cox model were used for analysis.@*RESULTS@#A total of 62 patients were included in the analysis. The total objective response rate (ORR) was 32.2%, and the disease control rate (DCR) was 96.8%. The median progression-free survival (PFS) was 6.4 months (95%CI: 6.05-6.83), and the median overall survival (OS) was 20.4 months (95%CI: 12.98-27.76). In the subgroup analysis, there was no significant difference in median PFS between patients with brain metastases and those without brain metastases (6.2 months vs 6.4 months, P=0.052). Cycles of bevacizumab (>6 or ≤6 cycles) was an independent influencing factor of PFS (P=0.004). The most common adverse events were leukopenia, fatigue, nausea, thrombocytopenia and hypertension.@*CONCLUSIONS@#In the second-line or later-line treatment, bevacizumab combined with chemotherapy is an effective and safe regimen for advanced non-squamous NSCLC.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Bevacizumab , Therapeutic Uses , Brain Neoplasms , Carcinoma, Non-Small-Cell Lung , Drug Therapy , Pathology , Disease-Free Survival , Lung Neoplasms , Drug Therapy , Pathology , Retrospective Studies , Safety , Treatment OutcomeABSTRACT
Objective@#To investigate the changes of brain gray matter volume in patients with occupational noise-induced hearing loss by voxel based morphometry (VBM) .@*Methods@#16 age-and education-matched healthy controls and 42 patients with occupational noise induced hearing loss, including 27 in mild group and 15 in severe group, received MRI 3D-FSPGR sequence T1WI sagittal scan, and then underwent VBM of brain gray matter volume data analysis.@*Results@#The brain gray matter volume of the left occipitotemporal lateral gyrus, the anterior cingulate gyrus, the bilateral angular gyrus, the precuneus and the near midline area of cerebellum differed between experimental group and control group (P<0.01) .@*Conclusion@#The volume of gray matter in specific brain areas of patients with occupational noise-induced hearing loss was changed, and the effect of noise on brain structure was revealed from the perspective of imaging.
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Objective To investigate the short-term clinical effects of selecting duodenal transection timing on laparoscopic-assisted distal gastrectomy (LADG).Methods The retrospective cohort study was conducted.The clinicopathological data of 239 gastric cancer (GC) patients undergoing LADG in the 5 medical centers between March 2016 and March 2018 were collected,including 104 in the First Affiliated Hospital of Xiamen University,45 in Zhangzhou Affiliated Hospital of Fujian Medical University,35 in Quanzhou Affiliated Hospital of Fujian Medical University,30 in the Second Affiliated Hospital of Xiamen Medical College,25 in Zhongshan Hospital of Xiamen University.Of 239 patients undergoing LADG + D2 lymph node dissection,107 receiving duodenal transection and then lymph node dissection in the upper region of pancreas after lymph node dissection in the lower region of pylorus and 132 receiving lymph node dissection in the upper region of pancreas and then duodenal transection were respectively divided into anterior approach group and posterior approach group.Sixty-four,8,16,14 and 5 patients in the anterior approach group and 40,37,19,16 and 20 patients in the posterior group respectively came from the First Affiliated Hospital of Xiamen University,Zhangzhou Affiliated Hospital of Fujian Medical University,Quanzhou Affiliated Hospital of Fujian Medical University,Second Affiliated Hospital of Xiamen Medical College and Zhongshan Hospital of Xiamen University.Observation indicators:(1) surgical and postoperative situations;(2) postoperative complications;(3) stratified analyses of surgical and postoperative situations in patients with different TNM staging,body mass index (BMI) and maximum tumor dimension;(4) follow-up and survival.Follow-up using outpatient examination and telephone interview was performed to detect postoperative overall survival and tumor recurrence or metastasis up to April 2018.Measurement data with normal distribution were represented as (-x)±s,and comparison between groups was analyzed using the independent-samples t test.Measurement data with skewed distribution were described as M (Q),and comparison between groups was analyzed using the nonparametric test.Comparisons of count data were analyzed using chi-square test or Fisher exact probability.Comparison of ordinal data was done by the rank-sum test.Results (1) Surgical and postoperative situations:all the patients underwent successful operation,without perioperative death.Number of lymph node dissection in the upper region of pylorus in the anterior and posterior approach groups were respectively 3.9±2.6 and 3.0±2.5,with a statistically significant difference between groups (t=2.778,P＜0.05).Cases with Billroth Ⅰ,Billroth Ⅱ,Billroth Ⅱ +Bruan and Roux-en-Y of digestive tract reconstruction,operation time,dissected times of lymph nodes in greater curvature of stomach,lower region of pylorus,upper region of pancreas and lesser curvature of stomach,cases with visible port vein,volume of intraoperative blood loss,number of overall lymph node dissection,numbers of lymph node dissection in greater curvature of stomach,lower region of pylorus,upper region of pancreas and lesser curvature of stomach,time to postoperative anal exsufflation,time for postoperative fluid diet intake,time for postoperative semi-fluid diet intake,intraperitoneal drainage-tube removal time and duration of postoperative hospital stay were respectively 16,32,47,12,(233.0±41.0)minutes,(14.6±5.4)tninutes,(21.9±6.3)nminutes,(32.7±6.8) minutes,(7.4±2.9)minutes,74,(87±73)mL,35.0±10.0,8.5±4.1,4.8±4.2,13.3±5.2,4.3± 3.3,(4.1±2.6)days,(5.4±2.8) days,(7.9± 3.5) days,(8.9± 2.9) days,(11.7± 4.5) days in the anterior approach group and 17,47,61,7,(243.0±44.0) minutes,(15.7±5.2) minutes,(23.1±8.0) minutes,(34.2±7.1) minutes,(7.9±2.8)minutes,79,(93±57)mL,33.0±10.0,8.1±4.8,5.3±4.9,12.5±5.6,3.8±2.4,(3.8±3.3)days,(5.0±3.6)days,(7.5±4.0) days,(8.5±3.8)days,(11.3±5.7) days in the posterior approach group,with no statistically significant difference between groups (x2 =3.431,t =-1.836,-1.546,-1.324,-1.634,-1.228,x2=2.552,t=-0.684,1.630,0.797,-0.871,1.148,1.314,0.954,0.951,0.884,1.065,0.694,P＞0.05).(2) Postoperative complications:cases with overall complications,anastomotic leakage,anastomotic stenosis,anastomotic bleeding,pancreatic fistula,postoperative gastroparesis,intra-abdominal hemorrhage,incision infection,pneumonia,intra-abdominal infection,bacteremia,intestinal obstruction,endolymphatic leakage,Clavien-Dindo grade Ⅰ,Ⅱ,Ⅲa,Ⅲb and Ⅳa of postoperative complications were respectively 15,1,1,1,0,3,1,2,3,0,1,3,0,3,9,1,2,0 in the anterior approach group and 25,3,0,1,2,2,2,5,7,3,2,3,1,6,14,1,2,2 in the posterior approach group,with no statistically significant difference between groups (x2=1.027,0.643,0.022,0.479,0.161,0.765,0.921,0.161,0.063,Z=-1.055,P＞0.05).Patients in 2 groups with complications were cured by symptomatic treatment.(3) Stratified analyses of surgical and postoperative situations in patients with different TNM staging,BMI and maximum tumor dimension:operation time,dissected times of lymph nodes in upper region of pancreas,cases with visible port vein,number of overall lymph node dissection,numbers of lymph node dissection in upper region of pylorus and upper region of pancreas were respectively (236.0±41.0)minutes,(33.9±6.2) minutes,32,36.0±12.0,3.8±3.0,13.4±5.5 in patients of the anterior approach group with Ⅲ stage of TNM staging and (253.0± 45.0) minutes,(36.5 ±7.0) minutes,29,31.0±t9.0,2.5±2.0,11.4±4.6 in patients of the posterior approach group with Ⅲ stage of TNM staging,with statistically significant differences between groups (t =-1.988,-2.066,x2 =4.686,t =2.472,2.757,2.016,P＜0.05).Numbers of overall lymph node dissection and number of lymph node dissection in upper region of pylorus were respectively 37.0± 12.0,3.6±3.1 in patients of the anterior approach group with BMI ≥ 25 kg/m2 and 30.0±7.0,2.0± 1.3 in patients of the posterior approach group with BMI ≥ 25 kg/m2,with statistically significant differences between groups (t =2.211,2.205,P＜0.05).Volume of intraoperative blood loss and number of lymph node dissection in upper region of pylorus were respectively (80±45) mL,4.0±2.6 in patients of the anterior approach group with maximum tumor dimension ≥ 3.3 cm and (110±67)mL,2.8± 1.8 in patients of the posterior approach group with maximum tumor dimension ≥ 3.3 cm,with statistically significant differences between groups (t =-2.320,2.589,P ＜ 0.05).(4) Follow-up and survival:of 239 patients,202 were followed up for 2-24 months,with a median time of 12 months,including 89 in the anterior approach group and 113 in the posterior approach group.During the follow-up,cases with overall survival,tumor recurrence and metastasis were respectively 85,3,8 in the anterior approach group and 109,3,11 in the posterior approach group,with no statistically significant difference between groups (x2=0.032,0.089,0.119,P＞0.05).Conclusions Both of anterior approach and posterior approach are safe and feasible in LADG,with equivalent short-term efficacies.The anterior approach in LADG has an advantage of the lymph node dissection in the upper region of pylorus compared with posterior approach,and it also is better for patients with later tumor staging,higher BMI and bigger tumor.
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Objective To analyze retrospectively the results of single-patch with elevation of the left-sided atrioventricular valve repair for complete atrioventricular septal defect(CAVSD) in therapeutic effects and safety.Methods Fourteen consecutive patients (2 males and 12 females) with CAVSD were enrolled in the study from April 2012 to December 2017.All patients underwent single-patch with the elevation of left-sided atrioventricular valve repair for CAVSD by regular sternotomy.The median age at operation was 12.5 months(range,11.7 months to 63 months) and the duration of follow-up was(3.27 ± 2.02)years.Echocardiography and electrocardiogram were used during follow-up according to the protocol.Results Compared with pulmonary arterial pressure(PAP) during pre-and post-operation (65.92 ± 6.91 and 62.97 ± 17.29) mmHg (1 mmHg =0.133 kPa),PAP(53.29 ± 20.99) mmHg decreased significantly during follow-up period.There were significant difference during post-operation and follow-up for LAVVR and RAVVR.The extent of regurgitation of atrioventricular valve statistically decreased during follow-up period.None of patients suffered from atrioventricular block and reoperation during follow-up.Conclusion Single-patch with elevation of the left-sided atrioventricular valve repair for CAVSD yields good outcomes,without occurrence of severe LAVVR,during early and mid-term follow-up period.
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Background Researches showed that triterpenoids,with a similar structure to lanosterol,has therapeutical effect on many systemic diseases,and lanosterol was determined to have a therapeutical effect on cataract recently.However,how the lanosterol plays effects on other eye diseases is still unelucidated.Understanding the distribution of lanosterol in ocular tissue is helpful for us to elucidate the relationship of lanosterol with eye diseases.Objective This study attempted to investigate the distribution of lanosterol synthase (LSS) and lanosterol in cornea,lens and retina tissue of rats and offer a basis for the targeting treatment of eye diseases.Methods Fifteen SPF male SD rats were sacrificed by excessive anesthesia to obtain the eyeballs.The relative expressions of LSS protein and gene in the cornea,lens and retina tissue of the rats were detected by Western blot and reverse transcription (RT)-PCR,respectively.Immunofluorescence staining technology was used to locate the distribution of LSS in cornea,lens and retina tissue.The contents of lanosterol in the cornea,lens and retina tissue were analyzed by liquid chromatograph mass spectrometer (LC-MS).Results No LSS protein and mRNA was expressed in the retinal tissue in normal rats.The mean relative expression of LSS protein in the lens and cornea was 0.43±0.05 and 0.25±0.03,respectively,showing a significant difference between them (t =-5.35,P＜ 0.01).The relative expression of LSS mRNA was 0.51 ±0.04 and 0.29 ±0.02 in the lens and cornea,respectively,with a stronger expression in the lens in comparison with the cornea (t =-8.34,P＜0.01).Immunofluorescence staining showed that LSS primarily located in corneal epithelial layer,stromal layer and endothelial layer as well as lens epithelial cells and shallow cortex layer and hardly expressed in retina,and no co-expression of LSS with the neuron marked by NeuN and the Müller cell marked by glutamine synthetase (GS) in retinal tissue.LC-MS analysis revealed that the contents of lanosterol in lens and cornea was (24.37 ±2.91) ng/mg and (5.31 ±0.58) ng/mg,respectively,with a significant difference between them (t =-11.13,P＜0.01).Conclusions LSS and lanosterol extensively distribute in cornea and lens of normal rats,but not in retina tissue.These results offer new strategies for the target treatment of relevant eye diseases.
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Objective To explore the advantages and disadvantages of laparoscopic combined with colonoscopic surgery (double endoscope surgery) and open surgery in the treatment of special types of colorectal polyps. Methods The clinical data of 62 patients with special types of colorectal polyps (wide base sessile, special parts or suspected cancerous, endoscopic resection difficult or high risk) were retrospectively analyzed. Among them, 42 patients underwent double endoscope surgery (double endoscope group), and 20 patients underwent open surgery (open group). The operating time, amount of bleeding during operation, postoperative exhaust time, postoperative hospital stay and complication rate were compared between 2 groups. Results All the patients had successful resection of the polyps, and there were no operative deaths. There was no conversion to open surgery in double endoscope group. Two patients in the open group were unable to locate the lesion by the tactile sensation of the hand and then succeeded in locating by intraoperative colonoscopy. The operating time, amount of bleeding during operation, postoperative exhaust time, postoperative hospital stay and complication rate in double endoscope group were significantly lower than those in open group: (60.5 ± 25.4) min vs. (75.8 ± 20.6) min, (30.5 ± 15.8) ml vs. (55.2 ± 24.6) ml, (24.6 ± 10.5) h vs. (40.5 ± 16.8) h, (3.2 ± 1.0) d vs. (5.8 ± 2.2) d and 0 vs. 20% (4/20), and there were statistical differences (P<0.05). There was 1 case with early postoperative inflammatory bowel obstruction, 1 case with abdominal infection and 2 cases with incision infection in open group. There was no operative death in the two groups, and these patients were cured by conservative treatment. The follow-up time was 3-36 (18.6 ± 12.3) months, and all the patients survived. The patients in 2 groups had no recurrence and metastasis, no anastomotic stenosis, anastomotic leakage and other complications. Conclusions For the special types of colorectal polyps, double endoscope surgery is less invasive, with faster recovery and less complications. It is the first choice except for endoscopic resection.
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Background Corneal biomechanical properties is important in the safety assessment of corneal refractive surgery.Corvis is a new device for measuring corneal biomechanics properties.Objective This study was to observe the correlation among corneal thickness, Corvis intraocular pressure and corneal biomechanical properties with Corvis.Methods A prospective observational study was performed.One hundred and fifty eyes of 75 patients with corneal thickness from 501 μm to 590 μm were divided into three groups according to the corneal thickness:low corneal thickness group (corneal thickness range from 501 μm to 530 μm), middle corneal thickness group (corneal thickness range from 531 μm to 560 μm) ,and high corneal thickness group (corneal thickness range from 561 μm to 590 μm);and 50 eyes of 25 patients for each group.The difference of intraocular pressure, corneal thickness and deformation amplitude (DA) among the three groups were analyzed by one-way ANOVA and the correlation among the groups were analyzed by liner regression.Results The DA in the low corneal thickness group and middle corneal thickness group were significantly higher than that in the high corneal thickness group (P ＜ 0.05).The intraocular pressure was statistically different among the 3 groups (F =9.98, P＜0.05).DA was negatively correlated with intraocular pressure and corneal thickness (r=-0.84,-0.33;both at P＜0.01), with the linear regression DA =1.69-0.04×IOP (F=366.19, t=-19.14,P＜0.01).Conclusions Corneal thickness cannot simply represent the corneal biomechanical properties in the safety assessment of corneal refractive surgery,IOP should be considered.
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BACKGROUND:Atorvastatin has been shown to reduce bone loss and fracture, but its effects on implant osseointegration remain unknown. OBJECTIVE:To investigate the effects of atorvastatin on implant osseointegration in osteoporotic rats and the underlying mechanisms. METHODS:Forty-eight Sprague-Dawley rats were randomized into sham-surgery, ovariectomy, and atorvastatin (10 and 20 mg/kg per day) treatment groups, respectively. Al rats received ovariectomy and implant surgery except those in the sham-surgery group. Bone mineral density of the lumbar vertebra, osseointegration ratio and pul-out strength of implants were measured after 12-week treatment.Levels of bone formation and resorption markers in osteoblasts treated with atorvastatin were determined by ELISA. Wnt pathway-relatedgene expression was detected by RT-PCR. RESULTS AND CONCLUSION:Bone mineral density, osseointegration ratio and pul-out strength of implants were significantly increased in 20 mg/kg per day of atorvastatin treatment group compared with ovariectomy group (P< 0.05). Levels of alkaline phosphatase, osteocalcinand osteoprotegerinwere significantly increased in osteoblasts treated with atorvastatinin vitro(P<0 .05), and the level of osteoclast differentiation factor RANKL was significantly inhibited (P< 0.05). Meanwhile, atorvastatin significantly promoted the mRNA expression of low-density lipoprotein associated protein 5and β-catenin, and inhibited the mRNA expression of dickkopfWnt signal pathway inhibitor 1and sclerostin. Our results suggest that atorvastatin promotes implant osseointegration in osteoporotic rats by activating Wnt/β-catenin signal pathway.
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Objective To observe the effects of baicalin on forms of hepatic tissue, liver apoptosis, mRNA expressions of iNOS, NF-κB and protein expression of Caspase-3 in rats with ischemia reperfusion injury; To discuss its mechanism of action.Methods The rat models of liver ischemia reperfusion were performed according to the Pringle's method. Rats were randomly divided into sham-operation group, model group and baicalin group. Sham-operation group and model group were given normal saline for gavage, while baicalin group was given baicalin for gavage. Morphological characteristic was observed by HE staining. Hepatocyte apoptosis was determined by TUNEL. The mRNA expressions of iNOS and NF-κB were determined by RT-PCR. The protein expression of Caspase-3 was determined by Western blot.Results Compared with the sham-operation group, mRNA expressions of iNOS and NF-κB and the protein expression of Caspase-3 in the model group increased, as well as liver apoptosis rate (P<0.05,P<0.01); compared with the model group, mRNA expressions of iNOS and NF-κB and the protein expression of Caspase-3 in the baicalin group decreased, as well as liver apoptosis rate (P<0.05), and the hepatic lesion significantly improved in the baicalin group.Conclusion Baicalin can restrain Caspase-3 induced apoptosis by reducing the expressions of iNOS and NF-κB, with a purpose to realize the hepatoprotective effect for liver of rats with ischemia reperfusion injury.
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Objectives To evaluate the effect of the positive psychology intervention on SWB in elderly patients with chronic obstructive pulmonary disease(COPD).Methods A total of 108 patients with COPD were divided into control group and intervention group according to the principle of control matches,with 54 patients in each group.Patients in intervention group received a period of three months of positive psychology oriented psychological journal ,patients in control group were blank.Before and after the intervention,both groups of patients were assessed by Memorial University of Newfoundland Scale of Happiness (MNusH) and 12 General Health Questionnaire (GHQ-12),and used t tests andx2 test to compare two groups of patients,as well as the intervention group itself differences.Results After the intervention,the score of MNusH in the intervention group was (35.8 ± 8.3),which was significant higher than that of in the control group,t=7.110,P ＜0.05.The scores of positive emotion and positive experience of MNusH Scale of patients in intervention group were higher than control group,the scores of negative emotions and negative experience of patients in intervention group were lower than control group,the difference was statistically significant,t value was 3.269,6.878,8.156 and 7.801respectively,P ＜0.05.The intervention significantly reduced the incidence of psychological disorder of patients,x2=42.335,P＜0.05.Conclusion Positive psychology interventions can effectively improve negative emotions of the elderly hospitalized COPD patients,improve SWB of the elderly patients with COPD.
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Objective To observe the antidiarrheal and analgesic effects of Dingguier paste on the mouse. Methods Tho diarrhea mouse models were made by senna leaf or castor oil to detect the antidiarrheal effect of Dingguier paste combination with other drugs. The hot plate test and acetic acid test were used to observe the analgesic effect of Dingguier oral medicine and Dingguier paste in combined use with other drugs. Results Compared with senna leaf model group, Dingguier paste low-dose, middle-dose, high-dose combined with diphenoxylate, Bupi-Yichang pill and Dingguier oral medicine group could decrease the number of feces in 2 h [Number of each group feces was(0.50±1.27), (2.27±2.90), (1.18±1.83);(2.00±2.26), (3.40±2.17), (3.82±1.72);(0.73±1.56), (1.91±2.95), (2.55±2.11)]. Dingguier paste low-dose and high-dose combined with diphenoxylate could decrease the number of feces in 4h [Number of each group feces was (6.70±2.11), (6.27±3.20)]. Dingguier oral group decrease the number of feces in 6h [Number of feces was (6.91±2.77)]. Compared with castor oil model group, Dingguier paste low-dose combined with diphenoxylate could obviously decrease the number of feces in 2 h, 4 h and 6 h [Number of each group feces was(0.45±0.82), (0.45±0.82), (4.27±2.15)]. Dingguier paste middle-dose combined with diphenoxylate could decrease the number of feces in 6 h [Number of feces was (4.64±2.45)]. Dingguier oral group decrease the number of feces in 2 h, 4 h, 6 h [Number of each group feces was (0.45±0.82), (2.91±2.07), (4.27±2.15)].Compared with normal group, the threshold of pain stimulated by hot plate of the Dingguier paste each dose combined with rotundin could increased remarkable after 30 min, 60 min, 90 min and 120 min[The time of Dingguier paste low-dose was(52.32 ± 17.29)s, (56.24 ± 12.48)s, (57.28 ± 6.61)s, (58.58 ± 4.70)s; the time of Dingguier paste middle-dose was (48.27±19.35)s, (54.92±12.59)s, (55.91±11.48)s, (55.15±12.49)s;the time of Dingguier paste high-dose was (49.15±15.69)s, (56.24±11.89)s, 60 s is(59.08±2.93)s]. Compared with normal group, the eclipse time of pain irritated by acetic acid of the Dingguier paste middle-dose combined with indomethacin could increased remarkable(14.72±5.99)min, the writhing frequency could decrease of the Dingguier paste each dose combined with indomethacin[Number of each dose writhing frequency was (7.62±8.31), (3.62± 6.14), (11.25±9.46)]. Conclusion Dingguier paste in the combination use with other drugs and Dingguier oral medicine may have some antidiarrheal and analgesia effects.
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Objective To study the diagnostic value of MR coronal iterative decomposition of water and fat with echo asymmetry and least-squares estimation(IDEAL) water imaging in the far later lumbar disc herniation(FLLDH).Methods A retrospective analysis of pre-operative routine CT axial imaging and MPR post-processing,conventional MR axial plane,sagittal plane and IDEAL imaging was performed in 10 patients with pathologically FLLDH.The above images were observed to find whether it could clearly show the spatial relationship outline of the nucleus pulposus and the nerve root,including the number of affected nerve root(1 or 2),and the compressed part(dorsal root ganglion,postganglionic nerve root or preganglionic nerve root),and the morphological changes of the compressed nerve root(distortion,thinning,enlargement),and were compared with surgical results.Results Surgery showed 2 cases with extra-intervertebral foramen herniation,2 cases with intra-intervertebral foramen herniation,6 cases with mixed herniation.Nine cases involved 1 nerve root,and 1 case involved 2 nerve roots.The conventional CT axial plane could roughly show the local relationship between nucleus pulposus and the nerve root.On conventional CT axial plane,9 cases were diagnosed correctly but 1 case of herniation of extra-intervertebral foramen shifting cephalic to the lower vertebral level was missed.Seven cases of the compressed nerve root were identified with difficulty,2 cases showed obliteration of the fat space and displacement of the nerve root.The spatial relationship of the nucleus pulposus and the nerve root was more visualized by CT MPR images than conventional CT images,but the image was less clear and it could not display the full view.Ten cases on CT MPR images were diagnosed correctly.Nine cases involved 1 nerve root,and 1 case involved 2 nerve roots,the image finding was obliteration of the fat space.Eight cases involved distortion of the compressed nerve root,3 cases involved thinning of the compressed nerve root,1 case involved thickening of the nerve root,6 cases were with no change or no confirmed diagnosis.MR regular scans could roughly show the local relationship of the nucleus pulposus and the nerve root and it is superior to the conventional CT axial scanning.On the conventional axial plane,7 cases of the compressed nerve root were identified with difficulty,3 cases showed obliteration of the fat space and displacement of the compressed nerve root.On the sagittal plane through the intervertebral foramen:5 cases of mixed herniation and 2 cases herniation of intra-intervertebral foramen showed intervertebral disc into the intervertebral foramen,with displacement or annihilation of the compressed nerve root.Two cases of extra-intervertebral foramen herniation were without positive findings.On MR coronal IDEAL water imaging,it could clearly and accurately show the spatial relationship of the nucleus pulposus and the nerve root.It is superior to the conventional CT axial image,CT MPR image and the conventional MR scanning.Ten cases were diagnosed correctly.Four cases were identified as compressed DRG,5 cases were identified as compressed postganglionic nerve root,1 case was identified with compressed L4 postganglionic nerve root and compressed L5 preganglionic nerve root.Ten cases were all identified with distortion of the compressed nerve root,6 cases were identified with the compressed thinning nerve root,and 2 cases with the compressed thickening nerve root.The other nerve roots were not compressed.Conclusion MR coronal IDEAL water imaging is a good tool to show the spatial relationship of nucleus pulposus and the nerve root in FLLDH patients,and it possesses diagnostic value.