Countermeasures and treatment for aortic acute syndrome with novel coronavirus pneumonia / 中华外科杂志

The novel coronavirus pneumonia (NCP) has cost a great loss to the health and economic property of Chines people. Under such a special circumstance, how to deal with such patients with acute aortic syndrome has become a serious challenge. Rapid diagnosis of concomitant NCP, safe and effective transportation, implementation of the interventional procedure, protection of vascular surgical team and postoperative management and follow-up of such patients have become urgent problems for us. Combined with the latest novel government documents, the literature and the experiences from Wuhan, we answered the above questions briefly and plainly. It also hopes to inspire the national vascular surgeons to manage critical emergencies in vascular surgery and even routine vascular diseases with NCP, as a final point to limit the severe epidemic situation, and minimize the damage of NCP.

Evaluation of acute kidney injury as defined by the risk, injury, failure, loss, and end-stage criteria in critically ill patients undergoing abdominal aortic aneurysm repair / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute kidney injury (AKI) is considered as a common and significant complication following abdominal aortic aneurysm (AAA) repair. This study aimed to assess the associated risk factors of AKI in the critically ill patients undergoing AAA repair and to evaluate the appropriate AKI management in the specific population.</p><p><b>METHODS</b>We retrospectively examined data from all critically ill patients undergoing AAA repairs at our institution from April 2007 to March 2012. Multivariable analysis was used to identify factors associated with postoperative AKI, which was defined by risk, injury, failure, loss and end-stage (RIFLE) kidney disease criteria. The goal-directed hemodynamic optimization (maintenance of optimal hemodynamics and neutral or negative fluid balance) and renal outcomes were also reviewed.</p><p><b>RESULTS</b>Of the 71 patients enrolled, 32 (45.1%) developed AKI, with 30 (93.8%) cases diagnosed on admission to surgical intensive care unit (SICU). Risk factors for AKI were ruptured AAA (odds ratio (OR) = 5.846, 95% confidence interval (CI): 1.346 - 25.390), intraoperative hypotension (OR = 6.008, 95%CI: 1.176 to 30.683), and perioperative blood transfusion (OR = 4.611, 95%CI: 1.307 - 16.276). Goal-directed hemodynamic optimization resulted in 75.0% complete and 18.8% partial renal recovery. Overall in-hospital mortality was 2.8%. AKI was associated with significantly increased length of stay ((136.9 ± 24.5) hours vs. (70.4 ± 11.3) hours) in Surgical Intensive Care Unit.</p><p><b>CONCLUSIONS</b>Critically ill patients undergoing AAA repair have a high incidence of AKI, which can be early recognized by RIFLE criteria. Rupture, hypotension, and blood transfusion are the significant associated risk factors. Application of goal-directed hemodynamic optimization in this cohort appeared to be effective in improving renal outcome.</p>

Application of the multi-planar reconstruction in endovascular treatment of type B aortic dissection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although Multi-planar reconstruction (MPR) has been considered a diagnostic imaging technique that observes more perspectives for diseases, few people have applied it surgically. In fact, MPR is also very useful to clinical operation, especially for patients with type B aortic dissection. It helps the surgeon to locate accurately with more information about aortic dissection, so that the safety and effectiveness of operation can be improved. This study examined the application of the MPR in intraoperative DSA imaging for precise positioning by accurately obtaining a cross-section, a spin angle of the coronal plane, and a tilt angle of the sagittal plane in treatment of type B aortic dissection.</p><p><b>METHODS</b>The conventional and the MPR approaches were compared on positioning the aortic arch for surgery. A group of 40 patients (group A) and another group of 42 patients (group B) was sampled. About the comparison of baseline characteristics, a fourfold table χ(2) test was conducted on gender, and two independent samples t-test was applied to age between group A and group B. Spin as well as tilt angles for group A were obtained from the patients using both approaches, and their effectiveness was compared with pair t-tests; The MPR data guided stent-grafting in this group. Stent graft placement of group B was based on the conventional approach. Percentages of proximal distributed markers as well as incidences of complications were collected from both groups after stent graft placement. They were also compared with a fourfold table χ(2) test.</p><p><b>RESULTS</b>Gender difference was not found between group A and group B (χ(2)0.80, P > 0.05), and age difference was not statistically significant (F = 2.55, homogeneity of variance, t = -1.46, P > 0.05). A significant difference was found between the conventional and the MPR approaches for spin angle (t = 9.17) as well as tilt angle (t = 2.07), P < 0.05. Percentage of proximal distributed markers (5.0%) of group A was significantly lower than that of group B (42.9%), χ(2) = 15.92, P < 0.05; and incidence of complications (5.0%) of group A was also significant lower than that of group B (21.4%), χ(2) = 4.76, P < 0.05.</p><p><b>CONCLUSIONS</b>Application of the MPR facilitated intraoperative angle adaption and led to satisfactory DSA. It is feasible in endovascular treatment of type B aortic dissection, and can effectively and safely guide surgical operations.</p>

Mechanism research in somatostatin reverting the chemosensitivity of GBC-SD cell line / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the mechanism of increasing chemosensitivity of gallbladder carcinoma stimulated by somatostatin.</p><p><b>METHODS</b>GBC-SD cells were divided into four groups: SST-alone-treated group, Doxorubicin (DOX)-alone-treated group and co-treated group (co-treatment of SST and DOX). In the control group, the cells were cultivated by medium only. In SST-alone-treated group, the cells were cultivated by medium with SST in the concentration of 75 microg/ml. In DOX-alone-treated group, the cells were cultivated by medium with DOX in the gradient concentrations of 5, 10, 20 microg/ml. In the co-treated group, cells were first cultivated by medium with 75 microg/ml SST for 24 h, followed by the addition of DOX in the gradient concentrations mentioned above. Cell viability curve was measured by MTT assay at 24, 48, 72 and 96 h, respectively. Meanwhile, the alterations of protein expressions of ICBP90 and Topo IIalpha after treatment of SST were examined by Western blot.</p><p><b>RESULTS</b>The treatment of SST alone on GBC-SD cells did not exert significantly inhibitory effect compared to the control group (P > 0.05). However, 24 h after the treatment of SST, the protein expressions of ICBP90 and Topo IIalpha were both up-regulated (P < 0.05).</p><p><b>CONCLUSION</b>Up-regulated the expression of ICBP90 by somatostatin maybe the cause of overexpression of Topo IIalpha, which leads to the enhanced lethal effect of DOX.</p>