Mid-term efficacy of sacral nerve stimulation for the treatment of chronic constipation / 中华胃肠外科杂志

Objective: To investigate the mid-term efficacy of sacral nerve stimulation (SNS) for chronic constipation. Methods: A descriptive case series study was conducted. Patients with chronic constipation were treated in Xijing Hospital of Digestive Disease from February 2013 to December 2018 were retrospectively enrolled. The types of constipation were confirmed based on colon slow transit test, anorectal manometry and defecography in Xi'an Mayinglong Coloproctological Hospital. This study has been registered in China clinical trial registry (Registration No.: ChiCTR-ROC-16008945). Case inclusion criteria: (1) constipation was diagnosed according to Rome III criteria; (2) traditional treatment, including education, diet adjustment, laxative, biofeedback treatment, failed for at least 1 year; (3) there were no constipation-related organic diseases. After excluding neurogenic diseases, including spinal cord injury and multiple sclerosis, 21 patients were included in this study. There were 10 males and 11 females, with an average age of 50.9 (14-76) years. After the relevant examination and evaluation of patients, they underwent percutaneous nerve evaluation (PNE). If patient experienced a good response to PNE after 2 or 3 weeks (≥50%), permanent SNS implantation was performed. The improvement of clinical symptoms and quality of life between the baseline, PNE, and latest follow-up time points were compared. Improvement of clinical symptoms, including autonomic stool frequency per week, autonomic stool days per week, defecation time, visual analogue scale (VAS, lower score indicates more serious symptoms) score and Cleveland clinic constipation score (CCCS, higher score indacates more serious symptoms) criteria. The change of quality of life was scored by SF-36 questionnaires (the higher score indicates better quality of life). Results: Of 21 patients, 18 (85.7%) experienced significant improvement in symptoms with PNE, and 2 patients discontinued treatment due to their dissatisfaction. Sixteen patients (76.2%) received permanent SNS implantation, two of whom underwent bilateral PNE implantation. These patients were followed-up for mean 56 (34-72) months. The treatment was continuously effective in 13 patients (61.9%), including 3 of ODS, 1 of STC and 9 of mixed constipation. Compared with baseline, the score of constipation patients receiving permanent SNS implantation at latest follow-up was shown. The median autonomic stool frequency per week increased from 1.0 (0-7) to 7.5 (0-10) (P<0.001), the median autonomic stool days per week increased from 1.0 (0-7) d to 4.5 (0-7) d (P<0.001), the median defecation time decreased from 19.0 (8-40) minutes to 4.0 (3-31) minutes (P<0.001), the median CCCS decreased from 20.0 (13-30) to 9.0 (6-30) (P<0.001), and the median VAS score increased from 9.0 (7-40) to 80.0 (15-90) (P<0.001). The values of the 8 parts of the SF-36 questionnaire increased (all P<0.05). Conclusion: SNS implantation is safe and has obvious effects on severe constipation with stable mid-term efficacy.

Death causes of malignant tumors among residents in Ouhai District of Wenzhou City from 2010 to 2012 / 上海预防医学

Objective] To analyze the death causes of malignant tumors among residents in Ouhai District of Wenzhou City and provide basis for formulating targeted intervention . [ Methods] The causes of death from 2010 to 2012 were classified according to International Classification of Diseases ( ICD-10 ) and statistically analyzed by the death cause statistical software DeathReg 2005, Excel, and SPSS13.0. [ Results] The annual average mortality of malignant tumors among residents in Ouhai District was 150.41/100 000, the standardized mortality rate was 130.02/100 000.The mortality of malignant tumors was 197.48/100 000 in males and 101.93/100 000 in females, and there was significant gender difference .The top five death causes of malignant tumors were lung cancer , hepatic carcinoma , gastric cancer , colon-rectum-anus cancer , and esophagus carcinoma .The malignant tumor death causes in different age groups were different , and the mortality rate rose with the increase of age .The potential years of life lost ( PYLL) of malignant tumor death was 14 634.5 person-years.The average years of life lost ( AYLL) and PYLL rate were 8.01 years/person and 12.05‰, respectively. [Conclusion] The first cause of death among residents is malignant tumor in Ouhai District of Wenzhou City .According to characteristics of different tumors for different population, comprehensive intervention measures should be implemented to reduce the morbidity of malignant tumors .

Early prediction of acute kidney injury in infants and young children after cardiopulmonary bypass surgery / 中华儿科杂志

<p><b>OBJECTIVE</b>To understand the incidence of acute kidney injury (AKI) in infants and toddlers and evaluate the possibility of predicting AKI with urine neutrophil gelatinase-associated lipocalin (NGAL), interleukin 18 (IL-18), N-acetyl-beta-D-glucosaminidase (NAG), microalbumin (MA) and α1-microglobulin (α1-MG) after surgeries for congenital heart diseases with cardiopulmonary bypass (CPB).</p><p><b>METHOD</b>Fifty-eight children (ages ≤ 3 years) who had undergone surgery for congenital heart diseases with CPB were enrolled. Urinary samples were collected before and 4 h, 6 h, 12 h, 24 h post CPB to detect the concentration of NGAL, IL-18, NAG, MA and α1-MG.</p><p><b>RESULT</b>The AKI group had 29 cases, none AKI group also had 29 cases. Urinary concentration of NGAL 4, 6, and 12 h post CPB were significantly higher in AKI group (2820 µg/g, 905.7 µg/g, 76.1 µg/g separately) than in none AKI group (27.6 µg/g, 19.5 µg/g, 16.0 µg/g separately, P < 0.01). Urinary concentration of IL-18 4, 6, 12 and 24 h post CPB were significantly higher in AKI group than in none AKI group (P < 0.05). Urinary concentration of NAG 4 h and 6 h post CPB were significantly higher in AKI group than in none AKI group (P < 0.01). Urinary concentration of MA/UCr post CPB 4 h, 6 h and 12 h were significantly higher in AKI group than in none AKI group (P < 0.05). Urinary concentration of α1-MG/UCr post CPB 4 h, 6 h and 12 h were significantly higher in AKI group than in none AKI group (P < 0.01). All the five biomarkers had predictive abilities at 4-hour after surgery.</p><p><b>CONCLUSION</b>Urine biomarkers NGAL, IL-18, NAG, MA and α1-MG were valuable early predictors of AKI after CPB surgery.</p>

Totally laparoscopic Billroth II( gastrectomy without intracorporeal hand-sewn sutures / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and feasibility of a novel totally laparoscopic Billroth II gastrectomy.</p><p><b>METHODS</b>Twelve gastric cancer patients underwent totally laparoscopic D2 dissection without intracorporeal hand-sewn sutures in the Xijing Hospital of Fourth Military Medical University between May 2011 and July 2011. In this technique, circular stapling device was used for gastrojejunostomy, and an Endo GIA was used to close the incision at the greater curvature of the stomach. After the completion of the anastomosis, a side-to-side anastomosis (jejunum-afferent loop or jejunum-efferent loop) was performed using an Endo-GIA.</p><p><b>RESULTS</b>No patients required conversion to laparoscopy-assisted or open surgery. The operative time was 196.0±19.3 min, and the blood loss was 169.5±28.8 ml. The number of lymph node harvested was 25.1±3.3. The proximal resection margin and distal resection margin were 8.8±2.4 cm and 6.9±5.5 cm, respectively. The mean time to the first postoperative flatus was 3.1±1.3 days. The length of hospital stay was 4.5±1.9 days.</p><p><b>CONCLUSION</b>This technique is simple and quick. There is no need for laparoscopic hand-sewn suturing. It is safe to perform for totally laparoscopic gastrectomy and reconstruction.</p>

Intracorporeal hand-sewn technique used in totally laparoscopic colectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and feasibility of hand-sewn anastomosis in totally laparoscopic colectomy.</p><p><b>METHODS</b>Clinical data of 19 consecutive patients with benign(n=5) or malignant colonic diseases(n=14, 4 ascending colon cancers, 2 transverse colon cancers, and 8 sigmoid colon cancers) treated with totally laparoscopic colectomy with a hand-sewn anastomosis were reviewed. All the procedures were performed by the same surgeon team including totally laparoscopic resection and hand-sewn anastomosis, ileocolic anastomosis after right hemicolectomy, and hand-sewn purse-string sutures in the colon.</p><p><b>RESULTS</b>Hand-sewn anastomosis was performed for 11 patients and circular-stapled anastomosis with hand-sewn purse-string sutures was performed for other 8 patients. The mean hand-sewn anastomosis time was (49.5 ± 29.4) min, and the mean hand-sewn purse-string sutures time was (13.3 ± 5.5) min. No patients required conversion to laparoscopy-assisted or open surgery, and there were no postoperative complications related to anastomosis. One patient with transverse colon lipoma developed mild intra-abdominal infection after surgery and recovered after conservative treatment.</p><p><b>CONCLUSION</b>Totally laparoscopic intracorporeal hand-sewn anastomosis or hand-sewn purse-string sutures for colectomy is feasible and safe when performed by experienced laparoscopic surgeons.</p>

Clinical features and long-term prognosis of patients with anomalous origin of the left coronary artery from the pulmonary artery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart anomaly. We aimed to illustrate the clinical features and long-term prognosis of patients with ALCAPA.</p><p><b>METHODS</b>Twenty three patients (13 males and 10 females, ages ranging from 2.5 months to 65 years) identified as ALCAPA in Beijing Anzhen Hospital from April 1984 to June 2009 were divided into two groups, based on the age of onset: group 1 (≤ 12 months, n = 16) and group 2 (> 12 months, n = 7).</p><p><b>RESULTS</b>Fifty six point three percent of patients in group 1 had been misdiagnosed as endocardial fibroelastosis (9/16), 18.8% as dilated cardiomyopathy (3/16) and 6.3% as myocardial infarction (1/16). Patients in group 2 were usually diagnosed as coronary heart disease, myocarditis, or patent ductus arteriosus. Electrocardiography in group 1 revealed abnormal Q waves with T wave inversion in leads I, avL, V(4)-V(6), especially in lead avL (deep and wide Q wave); but no specific manifestations in group 2. A higher percentage of patients in group 1 had cardiomegaly on chest radiograph (86.7% vs. 33.3%, P = 0.031), while pulmonary artery protrusion was more common in group 2 (26.7% vs. 83.3%, P = 0.046). Lower left ventricular ejection fraction (LVEF) was present in group 1 than in group 2 ((48.5 ± 11.5)% vs. (65.0 ± 6.1)%, P < 0.001). Apical ventricular aneurysm (62.5% vs. 0%, P = 0.007), enhanced echogenicity of papillary muscles (87.5% vs. 28.6%, P = 0.011) and endocardial thickening (93.8% vs. 14.3%, P < 0.001) were more frequent in group 1 than in group 2. The ratio of the proximal right coronary artery (RCA) diameter to the aortic root diameter exceeded 0.14 in all cases, more prominent in group 2 (0.26 ± 0.05 vs. 0.33 ± 0.03, P = 0.009). Increased coronary artery collaterals within the interventricular septum were detected in 18 patients (78.3%) by Doppler imaging. Twenty one patients underwent cardiac surgery, including left coronary artery (LCA) ligation (1/21), LCA ligation plus coronary artery bypass grafting (1/21), Takeuchi operation (7/21), and LCA reimplantation surgery (12/21). Four patients underwent concomitant mitral valve repair and one received mitral valve replacement. Aneurysm resection was performed in 3 cases. Six patients died in hospital after surgery, and the rest of the cohort had no overt symptoms during a follow-up period of 6 to 166 months. Their abnormal Q waves gradually regressed or disappeared, and the LVEF and left ventricle size returned to normal range with alleviation of mitral insufficiency.</p><p><b>CONCLUSIONS</b>The accurate diagnosis of ALCAPA can be made with serial diagnostic methods. ALCAPA can be successfully treated with several types of cardiac surgery, and surgeries of establishing two-coronary-artery circulation are the preferred operations nowadays, with good long-term prognosis.</p>

Laparoscopy-assisted D2 total gastrectomy in advanced gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and advantages of laparoscopy-assisted total gastrectomy (LATG) with D2 dissection of lymph nodes versus conventional open D2 total gastrectomy (OTG) in advanced gastric cancer.</p><p><b>METHODS</b>One hundred and twenty-five patients with advanced gastric cancer in the middle or upper third of the stomach were operated on from July 2005 to March 2007. Of the patients, 59 cases received LATG and 66 OTG with D2 lymph nodes dissection. Clinical data were recorded and compared between the two groups.</p><p><b>RESULTS</b>No patient in the LATG group converted to conventional operation with laparotomy. No operation mortality and no severe morbidity occurred in LATG group. As compared with OTG group, in LATG group operation time was longer [(330 +/- 71) min vs. (261 +/- 54) min, P =0.005] in LATG group, but with similar number of lymph node retrieval (36 +/- 13 vs. 34 +/- 16, P =0.450), less operation blood loss [(175 +/- 101) ml vs. (359 +/- 210) ml, P =0.003], earlier recovery of bowel activity (P = 0.015), and a shorter duration of fever after operation (P = 0.024).</p><p><b>CONCLUSIONS</b>LATG with D2 lymph node dissection in advanced gastric cancer is safe and technically feasible with better operative access and visual field, less operation blood loss and earlier recovery.</p>

Research Progress on Biodiesel Production by Lipase Catalysis / 中国生物工程杂志

As a renewable clean energy,biodiesel has been the subject of much research in recent years owing to its excellent environmental performance.The bio-enzymatic method possesses unparalleled advantages over conventional chemical catalysis,and it would be the direction in biodiesel industrialization process.The progress and application of three biocatalytic approaches for biodiesel production including immobilized lipase,free lipase and whole-cell catalysis were summerized.Finally,the challenges of biodiesel industrialization in China are analyzed,and some effective measures are put forward.