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Objective To evaluate surgical treatment for hepatocellular carcinoma (HCC) with hepatic vein tumor thrombus(HVTT).Methods We retrospectively analyzed the clinical and pathological data of 23 HCC patients with HVTT undergoing surgical treatment at the Department of Hepatobiliary Surgery,Fujian Provincial Hospital from June 2011 to June 2017,including 14 patients with HVTT and 9 patients with inferior vena cava tumor thrombosis (IVCTT).Results 21 patients with HVTT underwent anatomical hepatectomy and 2 underwent partial resection.The HVTT operation time was (235 ± 45) min,and the IVCTT operation time was (308 ± 75) min.The intraoperative blood loss was (880 ± 677) ml,(1 150 ±808) ml,respectively.The follow-up time after surgery was 3 to 44 months.The median tumor-free survival time of the 23 patients was 5 months,and the median survival time was 16 months.The median survival time of HVTT and IVCTT was 14 months and 17 months,respectively.The 1-,2-,and 3-year survival rates of the 23 HCC with HVTT/IVCTT were 56.5％,21.7％,and 8.7％,respectively.Conclusions Surgical treatment is a choice of therapy for HCC patients with HVTT/IVCTT having good liver function,limited and removable lesion,and no distant metastasis.
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Objective@#To report the operation methods and clinical effects of repairing finger tip defect with the free tibial dorsal nerve flap of the second toe.@*Methods@#13 patients with finger tip defects were repaired by the tibial dorsal nerve flap of the second toe. The area of finger tip defect was 2.5 cm×1.5 cm-1.3 cm×1.0 cm, and the area of cutting flap was 2.7 cm×1.7 cm-1.5 cm×1.1 cm. All donor site defects on the second toe were covered with full-thickness skin graft.@*Results@#There were 13 cases in this group, and all the flaps and skin grafts were survived. Postoperative follow-up ranged from 6 to 18 months, with an average of 13 months. The appearance of the fingers was satisfied and the sensory recovery was good. Two-point discrimination of the flaps returned to 7-13 mm, with an average of 9 mm. According to the total active move(TAM)scale, results were excellent in 11 fingers, good in 1 finger, and fair in 1 finger. The donor site skin graft was well healed, the second toe pulp was full, and the two-point discrimination of the toe pulps were 6-10 mm, with an average of 8 mm.@*Conclusions@#Compared to the traditional method of repairing finger tip defect with the tibial inherent nerve flap of the second toe, our new method can reduce the damage to the donor site, and we can repair finger tip defect as well as the traditional one at the same time. So it was a better operative method to repair finger tip defect with the tibial dorsal nerve flap of the second toe.
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Objective To evaluate the safety and efficacy of treating bifurcation lessions with jailed-balloon technique in simple strategy. Methods Ninety patients with bifurcation lessions (Duke D or F type) who received the side branch protection technique with simple strategy were involved in a single center retrospective analysis. Patients were randomly divided into jailed-balloon protection group (n=48) and jailed guidewire group (n=42). The process operating, procedural success of percutaneous coronary intervention (PCI) and percutaneous transluminal coronary angioplasty (PTCA), complications and the results of follow-up were investigated. Results The clinical baseline date and the bifurcation lesions were not significant different between jailed-balloon group and jailed guidewire group (P>0.05). The procedural success rate of PCI was 100%in jailed-balloon group and 97.6%in jailed guidewire group, no significance difference user between two groups (P>0.05). The perioperative complications (the rate of no reflow) was lower in jailed-balloon group than those of jailed guidewire group (1.0%vs. 19.0%, P0.05) and the maximum restenotic level (19.24%vs. 21.46%,P>0.05) in the main branch were not significant different between jailed-balloon group and jailed guidewire group. But the maximum restenotic level in the opening of side branch was lower in jailed-balloon group than that of jailed guidewire group (51.2% vs. 72.46%, P < 0.01). Conclusion The jailed-balloon technique reduces the operation complications, exposure time and amount of contrast agent, and also saves surgical consumables. The procedure of branch with simple strategy is safe and effective in treatment of bifurcation lesions.
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Aim To explore the expressed level of ini-tiative key factors TSLP and IL-33 in a human kerati-nocyte cell line,HaCaT cells were chosen to be stimu-lated by different stimulants,and develop a stable and effective in vitro model to observe allergic sensitization. Methods HaCaT cells were cultured in K-SFM with different stimulants to screen out the stimulants which could significantly improve the expressed level of TSLP and IL-33.Expressed level of TSLP and IL-33 was an-alyzed by ELISA kits and immunofluorescence.Re-sults (1 )The dose-response relationship of single stimulant indicated that both Poly(I:C)and TNF-αcould significantly improve expressed level of TSLP and IL-33 in HaCaT cells,but the rest of stimulants was not observed significant stimulation in concentration range of this experiment.(2)Dose-effect relationship of combined stimulants indicated that poly(I ∶C)1 00 mg·L -1 combined with TNF-α20 μg·L -1 was the most efficient.(3)Time-effect relationship of the a-bove-mentioned combined stimulants showed that 1 2 h was the optimal time of stimulation.Conclusions Different stimulants and different time result in various expressed levels of TSLP and IL-33 in HaCaT cells.1 2 h stimulus duration of Poly(I:C)1 00 mg·L -1 com-bined with TNF-α20 μg · L -1 is the most efficient stimulating way.This result provides an effective in vitro model to study the pathomechanism and drug effi-cacy of allergic sensitization.
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Bronchial asthma is a kind of respiratory disease which affects people 's life quality seriously. Many factors in-volved in the occurrence and development of such disease, of which the aberrant expression of E-cad plays a critical role in it. Research found that E-cad is an important cell adhesion molecu-lar, and its main function is to maintain the structural integrity of cells and participate in the improvement of airway remodeling as well as restoration of immune function. Further study showed that the role of mucosal barrier of airway epithelial cells in bronchial asthma patients was often damaged. Moreover, the protein ex-pression of E-cad decreased significantly in mucosal molecular, which suggested that the abnormal expression of E-cad was in-volved in the development of bronchial asthma. A review on the relations between the abnormal expression of E-cad protein and bronchial asthma has been discussed in this paper, also it in-cludes the discussion about the mechanisms of E-cad’ s disorder-induced bronchial asthma as well as explores the strategies of bronchial asthma treatment, which may provide references for the follow-up research and clinical treatment.
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Aim To establish a HPLC method for de-termining cimifugin in rat plasma and investigate the pharmacokinetic characteristics of cimifugin in rats. Methods The plasma concentration of cimifugin was detected by HPLC in acetonitrile protein precipitation method after intragastric administration of cimifugin. The pharmacokinetic parameters were calculated by the procedure of DAS 2 . 1 . Results The regression equa-tion of cimifugin in rats plasma was Y =0. 187 X -0. 0236 (R2 =0. 998 2),which shows a good linear re-lation at 1 - 70 mg · L-1 . The concentration-time curves conformed to two-compartment model. The main pharmacokinetic parameters of Tmax, Cmax, T1/2α, T1/2z, Vd ,AUC(0-t) and AUC(0-∞) were 80 min, 10. 359 mg ·L-1 , 93. 131 min, 2. 179 L · kg-1 , 1946. 085 mg ·L-1 · min, 2138. 57 mg · L-1 · min, respectively. Conclusions We established a HPLC method to de-termine the concentration of cimifugin in plasma. The method is so highly specified and sensitive that it can be used in quantitative analysis in vivo on cimifugin. Cimifugin can be rapidly absorbed, reach the highest concentration and produce effect.
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Objective To evaluate the correlation of Omentin-1, the high sensitivity C-reactive protein (hsCRP) and coronary heart disease (CHD). Methods Sixty-eight patients with CHD were divided into the unstable angina pectoris (UAP) group (n=36), stable angina pectoris (SAP) group (n=32). And 30 normal subjects without CHD diagnosed by coronary arteriography (CAG) were served as the control group. The serum level of Omentin-1 was measured by enzyme linked immu-nosorbent assay (ELISA) and the serum level of hsCRP was measured by turbidmetric immunoassay. Results The serum level of Omentin-1 was significantly lower, but the serum level of hsCRP was significantly higher in CHD group than that of control group (P0.05). The serum level of Omentin-1 was significantly lower in patients with single, double and three-vessel lesion group than that of control group, but the serum level of hsCRP was significantly higher in CHD group than that of control group (P0.05). The se-rum level of Omentin-1 was negatively correlated with serum level of hsCRP (P<0.01). Conclusion The serum level of Omentin-1 and hsCRP may correlate with CHD, but which may not reflect the severity of artery stenosis.
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Objective To investigate the efficacies of conventional and modified laparoscopic gastric bypass in the treatment of type 2 diabetes mellitus.Methods The clinical data of 30 patients with type 2 diabetes mellitus who were admitted to the Xijing Hospital of the Fourth Military Medical University from January 2012 to October 2012 were prospectively analyzed.All the 30 patients were randomly divided into the conventional group (15 patients) and the modified group (15 patients) according to the random number table.Patients in the 2 groups received conventional and modified laparoscopic gastric bypass,respectively.The operation time,blood loss,anal exhaust time,duration of postoperative hospital stay,incidence of severe complications,postoperative 3-month body mass index (BMI),fasting plasma glucose (FPG),fasting serum insulin (Fins),fasting serum C-peptide (FC-P) and glycosylated hemoglobin (HbAlc) of the 2 groups were compared.The measurement data were analyzed using the t test,and the count data were analyzed using the Fisher exact probability.Results The operation time of the conventional group and the modified group were (141 ± 22)minutes and (113 ± 26)minutes,with significant difference between the 2 groups (t =3.184,P ＜ 0.05).The volume of intraoperative blood loss,anal exhaust time,duration of postoperative hospital stay,postoperative 3-month BMI,FPG,Fins,FC-P and HbAlc were (65 ±29)ml,(2.5 ±1.2)days,(7.5 ±2.1)days,(27 ±4)kg/m2,(6.7 ±1.5)mmol/L,(18 ± 8) mU/L,(2.0 ± 0.6) μg/L and 5.8％ ± 1.5 ％ in the conventional group,and (57 ± 25) ml,(2.1 ± 1.0) days,(7.1 ± 1.9) days,(28 ± 4) kg/m2,(6.4 ± 2.0) mmol/L,(17 ± 6) mU/L,(1.9 ± 0.6) μg/L and 6.1％ ± 1.4％ in the modified group,with no significant difference between the 2 groups (t =0.809,0.992,0.545,0.485,0.463,0.523,0.130,0.572,P ＞ 0.05).The levels of preoperative BMI,FPG,Fins,FC-P and HbAle of the conventional group were (31 ± 4) kg/m2,(11.3 ± 2.3) mmol/L,(13 ± 4) mU/L,(1.4 ± 0.5) μg/L and 8.6％ ± 1.0％,which were significantly different from those at 3 months after operation (t =2.304,6.615,3.109,2.920,5.997,P ＜ 0.05).The levels of preoperative BMI,FPG,Fins,FC-P and HbAlc of the modified group were (31 ±4)kg/m2,(11.9±2.4)mmol/L,(12±5)mU/L,(1.4 ±0.6) μg/L and 8.9％±0.9％,which were significant different from those at 3 months after operation (t =2.165,6.711,2.616,2.478,6.571,P ＜0.05).Conclusion The safety and short-term efficacy of modified laparoscopic gastric bypass are comparable to those of the conventional laparoscopic gastric bypass,but the operation time of the modified method is significantly shorter.
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<p><b>OBJECTIVE</b>To evaluate the impact of preoperative platelet-lymphocyte ratio (PLR) on the prognosis in patients with operable colorectal cancer.</p><p><b>METHODS</b>The clinical data of 140 patients with operable colorectal cancer were analyzed retrospectively. According to preoperative PLR, the patients were divided into low PLR group (PLR<250) and high PLR group (PLR≥250). The overall 5-year survival rates and the clinicopathological factors in the two groups were analyzed using univariate analysis and COX regression model.</p><p><b>RESULTS</b>The patients with a high PLR had a significantly lower overall 5-year survival rate than those with a low PLR (71.4% vs 51.5%, P=0.045). Univariate analyses identified tumor location, the depth of tumor invasion, lymph nodes metastasis, TMN stage, and PLR as significant risk factors for reduced overall 5-year survival. In COX regression model, a high PLR was identified as an independent risk factor for poorer prognosis in patients with resectable colorectal cancer (RR: 2.213; 95%CI: 1.007-4.863, P=0.0048).</p><p><b>CONCLUSION</b>Preoperative PLR can be a clinically significant factor for assessment of prognosis of resectable colorectal cancer.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Blood Platelets , Cell Biology , Colorectal Neoplasms , Diagnosis , Mortality , Lymphocyte Count , Lymphocytes , Cell Biology , Platelet Count , Prognosis , Retrospective Studies , Survival RateABSTRACT
ObjectiveTo report the clinical results of applying free second toe hemiarthrosis to repair finger hemiarthrosis injury,and discussed the countermeasures of relative problems.MethodsFrom June 2005 to January 2010, thirteen fingers of 13 patients with traumatic finger joint injury had repaired by using vascularized second toe hemiarthrosis graft.ResultsAll 13 grafted fingers survived,and all wounds were primary healing.The time of follow-up was between 1.5 and 4.5 years,average of 3.2 years.All grafted joints were healed and the remaining joints were normal in morphology and structure,except for 1 patient subluxation with dorsal slightly convex.No degenerative changes happened to the grafted joints.No pain and no joint instability phenomenon.Nonunion and re-fracture phenomenon did not appear.The average extension of joint motion was 0°.The average flexion was 80°.Healing of the foot donate areas were satisfactory,and did not affect walking function.Using TAM assessment method of the hand joint function,the excellent rate was 90％.ConclusionThe way of using free second toe hemiarthrosis to repair finger hemiarthrosis injury could achieve satisfactory clinical efficacy.To completed set-up of transplanted joint structure and function units,a delicate surgery were improved to be important factors of the surgical treatment.
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Objective To investigate the efficacy of laparoscopic percutaneous common bile duct exploration (LPCBDE) with internal draining tube placement for the treatment of cholelithiasis. Methods The clinical data of 962 patients with choledocholithiasis who were admitted to the No. 451 Hospital of PLA were retrospectively analyzed. A self-made internal draining tube was placed in the common bile duct and duodenum to drain bile internally. The correct position of the internal draining tube was comfirmed by injecting water into and draining water from duodenum. The internal draining tube was pulled out with the help of duodenoscope at 30 days after the operation. Results LPCBDE with internal draining tube placement was successfully performed on 864 patients. Forty-two patients were transferred to open surgery, and 56 patients were transferred to receive LPCBDE with T-tube drainage. The mean operation time was (36 ± 18) minutes (range, 20-72 minutes), and the length of postoperative hospital stay was (6.6 ±2.1)days. Two patients were complicated with retroperitoneal abscess and they were cured by puncture and drainage, 32 patients were complicated with bile leakage and they were cured by conservative treatment. A total of 862 patients were followed up by B ultrasound at 30 days after the operation. The internal draining tube which was confirmed in the common bile duct was extracted with duodenoscope in 603 patients; the internal draining tube which was drawn back in 1 patient was removed with endoscopic sphincterotomy ( EST); the internal draining tube was removed naturally in 258 patients. The follow-up period ranged from 1 to 3 years, 26 patients had recurrent cholelithiasis and they were treated by EST. Conclusions LPCBDE with internal draining tube placement is a safe and minimally invasive method for the treatment of cholelithiasis.
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Fibro-optic bronchoscopy (FB) examinations were undertaken in 42 cases with lung cancer and 25 cases with benign lung disease; methylation-specific PCR was performed in plasma, sputum and bronchoalveolar lavage fluid (BALF) specimen for detection of p16 gene promoter methylation in all patients.Of the 42 cases of lung cancer, the positive rates of p16 gene promoter methylation were 59.5% in BALF, 52.4% in plasma and 47.6% in sputum, respectively; while p16 gene promoter methylation was detected only in one plasma sample from 25 cases with benign lung disease ( P ＜ 0.05 ).The sensitivity,specificity and overall accuracy of FB were 59.5%, 100.0% and 74.6%, respectively.The sensitivity,specificity and overall accuracy of FB combined with aberrant p16 gene methylation in diagnosis of lung cancer were 92.9%, 96.2% and 94.0%, respectively.The FB examinations combined with detection of aberrant p16 gene methylation can further improve the accuracy to diagnosis of lung cancer.
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Objective To explore the curative effect and prevention of complications of emergency laparoscopic cholecystectomy(LC) for acute cholecystitis.Methods The clinical data of 1 278 patients with acute cholecystitis who were treated with emergency laparoscopic cholecystectomy from July 2004 to July 2010 in our haspital were collected and analyzed retrospectively.Among these patients,471 cases had mild acute cholecystitis,720 cases had acute suppurative cholecystitis and 87 cases had acute gangrenous cholecystitis.The impaction of stones in the neck of gallbladder was present in 823 cases.The impaction of stones in the cystic duct was present in 157 cases.In 96 cases emergency operation was performed within 48 hours after the synptoms occurred,in 799 cases operation was performed from 48 to 72 hours,and in 383 cases operation was undertaken after 72 hours.Results The mean operation time was 40min(20-90 min) and the mean blood loss was 80ml(20-300 mL).Early postoperative fever(38.0～39.5℃) developed in 375 cases.Temporary jaundice was found in 108 cases.Bile leakage occurred in 17 cases.No LC cases were converted to open cholecystectomy.No cases were complicated with bile duct injury and there was no mortality.Conclusions Emergency laparoscopic cholecystectomy for acute cholecystitis is difficult.The probable complication rate is quite high.Severe complications can be avoided with skillful surgical technique and rich operative experience.Acute cholecystitis is not a contraindication for emergency laparoscopic cholecystectomy.