Looking back 2018--focused on surgical infection / 中华胃肠外科杂志

The published clinical research in 2018 in surgical infection are changing current opinions in the management of acute appendicitis, antibiotics usage, resuscitation of septic shock, and choice of nutritional therapy in critically ill patients. In the management of uncomplicated acute appendicitis, antibiotic therapy can be successful in selected patients who wish to avoid surgery. Delayed primary wound closure can not reduce superficial surgical site infection rates compared to primary wound closure for complicated appendicitis. Infusion of antibiotics 30 minutes before the start of operation may influence their prophylactic effect on surgical site infection. After adequate source control, long-course antibiotic therapy in critically ill post-operative patients is not associated with any clinical benefit. Although susceptible in the test, piperacillin-tazobactam can not replace carbapenems in patients with Escherichia coli and Klebsiella pneumoniae bloodstream infection that produce extended-spectrum beta-lactamase for definitive treatment. Deresuscitation of critically ill patients is associated with reduced mortality. Hydrocortisone therapy has potential role in the patients with septic shock and worth further evidence. The use of an energy-dense formulation for enteral delivery of nutrition can not improve 90-day survival rate in patients undergoing mechanical ventilation. Compared with early isocaloric parenteral nutrition, early enteral nutrition did not reduce mortality or the risk of secondary infections, but was associated with a greater risk of digestive complications in critically ill adults with septic shock.

Status of diagnosis and management of acute appendicitis in 2017: a national multi-center retrospective study / 中华胃肠外科杂志

OBJECTIVE@#To analyze the current status of diagnosis and management of acute appendicitis (AA) in China.@*METHODS@#Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary.@*RESULTS@#A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001).@*CONCLUSIONS@#The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.

Chinese experts consensus on diagnosis and treatment of non-perianal fistulating Crohn disease / 中华胃肠外科杂志

Crohn disease (CD) is a chronic inflammatory disease involving the entire digestive tract and non-perianal fistula is the most serious surgical complication of CD. The goal of treatment is to cure intestinal fistula and intra-abdominal infection, restore the continuity of digestive tract, reduce postoperative recurrence, and improve the quality of life. Evaluation of nutritional status, especially during perioperative period, is important and nutrition support for malnutritional CD patients is necessary. Full assessment of non-perianal fistula and promotion of self-healing is the principal treatment, and surgical drainage combined with enteral nutrition may be a feasible treatment. Trocar puncture with sump drain is recommended to control intra-abdominal abscess. Surgical treatment of enterocutaneous fistula, enteroenteric fistula, enterovesical fistula or enterogynaecological fistula should be considered if medical treatment, nutrition support and surgical drainage fail. Laparoscopic surgery is recommended for patients with mild adhesion of non-perianal fistulating CD. Postoperative medical treatment and risk assessment should be carried out to reduce postoperative recurrence of CD and fistula.

Surgical site infection following abdominal surgery in China: a multicenter cross-sectional study / 中华胃肠外科杂志

OBJECTIVE@#To determine the incidence of surgical site infection (SSI) after abdominal surgery and to further evaluate the related risk factors of SSI in China.@*METHODS@#The multicenter cross-sectional study collected clinical data of all adult patients who underwent abdominal surgery from May 1, 2018 to May 31, 2018 in 30 domestic hospitals, including basic information, perioperative parameters, and incisional microbial culture results. The primary outcome was the incidence of SSI within postoperative 30 days. SSI was classified into superficial incision infection, deep incision infection, and organ/gap infection according to the US Centers for Disease Control and Prevention (CDC) criteria. The secondary outcome variables were ICU stay, postoperative hospital stay, total hospital stay, 30-day mortality and treatment costs. Multivariate logistic regression was used to analyze the risk factors of SSI.@*RESULTS@#A total of 1666 patients were enrolled in the study, including 263 cases of East War Zone Hospital of PLA, 140 cases of Affiliated Hospital of Qingdao University, 108 cases of The First Affiliated Hospital of Nanchang University, 87 cases of Central War Zone Hospital of PLA, 77 cases of West China Hospital, 74 cases of Guangdong General Hospital, 71 cases of Chenzhou First People's Hospital, 71 cases of Zigong First People's Hospital, 64 cases of Zhangjiagang First People's Hospital, 56 cases of Nanyang City Central Hospital, 56 cases of Lanzhou General Hospital of Lanzhou Military Command, 56 cases of Shandong Provincial Hospital, 52 cases of Shangqiu First People's Hospital, 52 cases of People's Hospital of Xinjiang Uygur Autonomous Region, 48 cases of The Second Xiangya Hospital of Central South University, 48 cases of Chinese PLA General Hospital, 44 cases of Affiliated Hospital of Xuzhou Medical University, 38 cases of Hunan Province People's Hospital, 36 cases of Dongguan Kanghua Hospital, 30 cases of Shaoxing Central Hospital, 30 cases of Northern Jiangsu People's Hospital, 29 vases of The First Affiliated Hospital of Zhengzhou University, 27 cases of General Hospital of Tianjin Medical University, 22 cases of Zigong Fourth People's Hospital, 21 cases of The Second Hospital of University of South China, 18 cases of Tongji Hospital, 15 cases of Nanchong Central Hospital, 12 cases of The 901th Hospital of PLA, 11 cases of Hunan Cancer Hospital, 10 cases of Lanzhou University Second Hospital. There were 1019 males and 647 females with mean age of (56.5±15.3) years old. SSI occurred in 80 patients (4.8%) after operation, including 39 cases of superficial incision infection, 16 cases of deep incision infection, and 25 cases of organ/interstitial infection. Escherichia coli was the main pathogen of SSI, and the positive rate was 32.5% (26/80). Compared with patients without SSI, those with SSI had significantly higher ICU occupancy rate [38.8%(31/80) vs. 13.9%(220/1586), P<0.001], postoperative hospital stay (median 17 days vs. 7 days, P<0.001) and total hospital stay (median 22 days vs. 13 days, P<0.001), and significantly higher cost of treatment (median 75 000 yuan vs. 44 000 yuan, P<0.001). Multivariate analysis showed that male rise(OR=2.110, 95%CI:1.175-3.791, P=0.012), preoperative blood glucose level rise(OR=1.100, 95%CI: 1.012-1.197, P=0.026), operative time (OR=1.006, 95%CI:1.003-1.009, P<0.001) and surgical incision grade (clean-contaminated incision:OR=10.207, 95%CI:1.369-76.120, P=0.023; contaminated incision: OR=10.617, 95%CI:1.298-86.865, P=0.028; infection incision: OR=20.173, 95%CI:1.768-230.121, P=0.016) were risk factors for SSI; and laparoscopic surgery (OR=0.348, 95%CI:0.192-0.631, P=0.001) and mechanical bowel preparation(OR=0.441,95%CI:0.221-0.879, P=0.020) were protective factors for SSI.@*CONCLUSIONS@#The incidence of postoperative SSI in patients with abdominal surgery in China is 4.8%. SSI can significantly increase the medical burden of patients. Preoperative control of blood glucose and mechanical bowel preparation are important measures to prevent SSI.

Analysis of high risk factors for acute complex appendicitis in adults / 中华胃肠外科杂志

OBJECTIVE@#To explore the high risk factors of adult complex appendicitis, and to provide a reference for the development of a reasonable treatment strategy for acute appendicitis.@*METHODS@#A retrospective case-control study was conducted to collect clinical data of 312 adult patients with acute appendicitis confirmed by pathology undergoing appendectomy, including open and laparoscopic surgery, from May 2011 to August 2016 at Affiliated Hospital of Qingdao University. Age <14 years old, pregnant women, complicating abscess around the appendix, AIDS, blood system diseases, autoimmune diseases, inflammatory bowel disease or progressive cancer patients were excluded. According to the intra-operative findings and pathological types, patients were divided into complex appendicitis(112 cases, including gangrene and perforation) and non-complex appendicitis (200 cases, including simple and non-perforated appendicitis, ie suppurative appendicitis). After comparing the clinical data of these two groups, statistically significant variables were induded for multivariate logistic regression analysis to identify risk factors of complex appendicitis, and to establish a regression model. Enter method was applied to establish the regression equation: P=ExpiΣBiXi/1+ExpΣBiXi, and to calculate the relative risk of each variable. Meanwhile, retrospective and prospective verification was performed on this predictive model (cases of acute appendicitis from September 2016 to December 2017 were further collected). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of complex appendicitis were calculated with the regression model.@*RESULTS@#Comparison of the clinical data between the complex appendicitis group and the non-complex appendicitis group showed that differences of 10 preoperative indexes were statistically significant, including period from abdominal pain to admission [(59.1±42.6) hours vs. (47.5±34.4) hours, t=3.051, P=0.002], white blood cell count [(12.9±3.7)×10/L vs. (9.2±4.0)×10/L, t=9.755, P<0.001], neutrophil count [(9.8±4.0)× 10/L vs.(7.1±3.9)×10/L, t=6.020, P<0.001], neutrophil percentage[(84.5±8.7)% vs.(68.2±16.0)%, t=12.754, P<0.001], C-reactive protein levels [(86.0±45.4) μg/L vs. (55.9±35.8) μg/L, t=7.614, P<0.001], serum albumin levels [(334.0±4.8) g/L vs. ( 41.0±4.3) g/L, t=16.055, P<0.001], vomiting ratio [44.6%(50/112) vs. 23.5%(47/200), χ²=14.980, P<0.001], high fever(≥39°C) ratio [16.1%(18/112) vs. 7.5%(15/200), χ²=5.577, P=0.022], the proportion of patients ≥60 years old [22.3%(25/112) vs. 13.0%(26/200), χ²=4.562, P=0.038] and previous history of appendicitis [16.1%(18/112) vs. 7.5%(15/200), χ²=5.577, P=0.022]. The above 10 variables were included in the logistic regression model for multivariate analysis. The results showed that six variables were associated with complex appendicitis. According to their strength, they were old age (≥60 years old) X1(OR=5.094), high fever (≥39°C) X2(OR=4.464), neutrophil count X6 (OR=1.269), neutrophil percentage X4 (OR=1.077), C-reactive protein level X5 (OR=1.027), and serum albumin level X3 (OR=0.763). A predictive regression model was established: P=1/[1+e], whose sensitivity and specificity of judging complex appendicitis were 76.8%(86/112) and 90.0%(180/200),respectively. Sensitivity and specificity for predictive value of complex appendicitis in further prospective validation of the model were 76.2%(48/63) and 81.1% (30/37), respectively.@*CONCLUSIONS@#Age ≥ 60 years old, body temperature ≥39°C, increased neutrophil count, neutrophil percentage and C-reactive protein levels, and hypoalbuminemia are risk factors for complex appendicitis. The establishment of predictive model may help determine complex appendicitis.

Assessment of bronchial and pulmonary blood supply in lung adenocarcinoma and squamous cell carcinoma using dual-input perfusion CT / 中国医学影像技术

Objective To evaluate the dual blood supply of lung adenocarcinoma and squamous cell carcinoma using dualinput perfusion CT.Methods A total of 40 patients confirmed with lung cancer pathologically underwent CT perfusion (CTP) scanning.The pulmonary flow (PF),bronchial flow (BF),perfusion index (PI,PI=PF/[PF+BF])and tumor volume,location were measured and recorded by 2 experienced radiologists.The differences in CTP parameters between lung adenocarcinomas and squamous cell carcinomas,the central lung cancers and peripheral lung cancers were analyzed.The correlation between the tumor volume and CTP parameters was analyzed.Interobserver agreements were assessed with intraclass correlation coefficient (ICC).Results The average of PF,BF and PI of all 40 cases was (54.26± 21.07)ml/ (min · 100 ml),(64.41±22.06)ml/(min · 100 ml) and (43.38±16.07)％,respectively.Tumor histology was consistent with adenocarcinomas in 23 cases and squamous cell carcinomas in 17 cases,lung adenocarcinomas showed lower PI than that of squamous cell carcinomas (t=-2.196,P=0.034).There were 17 peripheral lung cancers and 23 central lung cancers,and the PI of the peripheral lung cancers was higher than that of the central lung cancer (t=2.305,P=0.027).No statistically significant differences were found for BF and PF between two types of lung cancers and central lung cancers and the peripheral cancers (all P＞0.05).Tumor volume was negatively associated with PI (r =-0.39,P=0.01).Good agreement was found between the two observers,the ICC for BF,PF and PI was 0.97,0.93 and 0.91,respectively.Conclusion Dual-input CTP technique can be used to evaluate the differences of blood supply between different pathological types and locations of lung cancer,with PI depending both on tumor size and location.

Predictive value of procalcitonin in postoperative intra-abdominal infections after definitive operation of intestinal fistulae / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the predictive value of procalcitonin(PCT) in postoperative intra-abdominal infections (IAI) after definitive operation of intestinal fistulae(IF).</p><p><b>METHODS</b>With the exclusion of emergence operation, preoperative clinical infection, preoperative renal or hepatic dysfunction, and age less than 18 years, a total of 356 consecutive patients who underwent elective digestive tract reconstruction of intestinal fistulae from February 2012 to December 2015 at Intestinal Fistula Center of Jinling Hospital were prospectively enrolled in the study. All the patients were divided into IAI group (26 cases, 21 of anastomosis leakage and 5 of peritoneal abscess) and non-IAI group (330 cases) based on the existence of postoperative IAI. The non-IAI group was then divided into two subgroups of other infection (93 cases) and non-infection(237 cases) according to the presence of other infections. Plasma PCT level, serum CRP concentration and WBC count were assessed preoperatively and on postoperative days (PODs) 1, 3, 5, 7 by immunofluorescence, turbidimetry and automatic blood analyzer, respectively. The predictive value of each marker for IAI was calculated by receiver operating characteristic (ROC) curve.</p><p><b>RESULTS</b>There was no significant difference in general clinical data between IAI and non-IAI group (all P>0.05). The proportions of multi-IF (53.8%, 14/26) and colectomy (61.5%, 16/26) in IAI group were higher than those of non-IAI group [20.0% (66/330), χ=15.847, P=0.000 and 31.2%(103/330), χ=9.961, P=0.002]. Differences of preoperative PCT, CRP and WBC levels among IAI, other infection and non-infection groups were not significant. These three markers all increased obviously and immediately after surgery. PCT and WBC values reached the peak point on POD 1, whereas CRP on POD 3. In IAI group, mean PCT values were (5.4±4.2) μg/L, (2.9±1.9) μg/L and (1.6±1.8) μg/L on POD 1, POD 3 and POD 5, respectively, which were higher than those of other infection group [(4.2±8.7) μg/L, (1.9±3.8) μg/L and (0.6±0.8) μg/L] and non-infection group [(2.7±5.8) μg/L, (1.1±1.7) μg/L and (0.5±0.7) μg/L, all P<0.05]. Mean CRP values in IAI group were 99.4 mg/L and 183.9 mg/L respectively on POD 1 and POD 3,and mean WBC values of IAI group on POD 1, POD 3 and POD 5 were 16.0×10/L, 10.8×10/L and 8.7×10/L, respectively, which were all significantly higher than those in the other 2 groups (all P<0.05). No significant differences were obtained between other infection group and non-infection group in all these three markers (all P>0.05). ROC curve demonstrated that PCT had the biggest area under the curve (AUC) of 0.86 and 0.84 on POD 3 and POD 5, with the cut-off value of 0.98 μg/L and 0.83 μg/L, 92.0% sensitivity and 74.0% specificity, 91.0% sensitivity and 73.0% specificity, respectively. The highest AUC was 0.72 on POD 3 for CRP and 0.71 on POD 3 for WBC, with 80.0% sensitivity and 54.0% specificity, 56.0% sensitivity and 73.0% specificity, respectively.</p><p><b>CONCLUSION</b>The value of procalcitonin above 0.98 μg/L on POD 3 and 0.83 μg/L on POD 5 can predict the occurrence of IAI after definitive operations of intestinal fistulae.</p>

Efficacy of over-the-scope clip for gastrointestinal fistula / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the efficacy of over-the-scope clip (OTSC) in the treatment of gastrointestinal fistula.</p><p><b>METHODS</b>Clinical data of 12 gastrointestinal fistula patients, including 3 internal fistula and 9 external fistula treated with OTSC in our institute from March 2015 to May 2016 were retrospectively analyzed. OTSC was performed when pus was drained thoroughly and intra-abdominal infection around gastrointestinal fistula was controlled, and each patient received one clip to close fistula.</p><p><b>RESULTS</b>There were 6 female and 6 male patients with mean age of (50.1±12.6) years. The successful rate of endoscopic closure was 100% without complications including bleeding and intestinal obstruction during and after OTSC treatment. According to comprehensive evaluation, including drainage without digestive juices, no recurrence of intra-abdominal infection, no overflow of contrast medium during digestive tract radiography, and CT examination without intra-abdominal abscess, clinical gastrointestinal fistula closure was 91.7%(11/12). There was no recurrence of gastrointestinal fistula during 3 months of follow-up in 11 patients. In the remaining 1 case, the gastric fistula after laparoscopic sleeve gastrectomy recurred one week after OTSC treatment because of intra-abdominal infection surrounding fistula, and was cured by surgery finally.</p><p><b>CONCLUSION</b>The endoscopic closure treatment of OTSC for gastrointestinal fistula is successful and effective, and control of intra-abdominal infection around fistula with adequate drainage is the key point.</p>

Maintenance of intestinal barrier function in patients with chronic critical illness / 中华胃肠外科杂志

The syndrome known as chronic critical illness (CCI) is defined as that critically ill patients survive their initial acute illness but go on to experience persistent organ failures necessitating prolonged intensive care. Intestinal barrier is the physical barrier that separates the internal and external environments and prevents the invasion of pathogenic antigens. Due to its pathogenesis, many CCI patients have injured intestinal barrier. Gut is the motor organ of stress responses, and gut-associated infections may initiate multiple organ dysfunction. In this way, it is important to maintain intestinal barrier of such patients. Apart from treatment for underlying diseases, resuscitation aiming at improving tissue perfusion, appropriate nutritional support, protection of normal intestinal flora, and provision of probiotics can maintain intestinal barrier of CCI patients. The maintenance and support of barrier function requires attention.

Effect of exercise training on rehabilitation of the chronic critical illness patients / 中华胃肠外科杂志

Over the past decades, the evolution of the techniques used in the intensive care has led on one side to better survival rates in ICU patients. On the other side, it has resulted in a growing number of patients who survive an acute event to chronic condition, and who then become dependent on one or more life support treatments. Such patients are called chronic critical illness(CCI) patients. Even these patients can dismiss from intensive care unit (ICU) or transfer to specialized rehabilitation care settings, the mortality of these patients is still very high. Therefore, how to promote the rehabilitation of CCI patients is one of the most important research points of epidemiology, public health and social economics. Exercise training can promote rehabilitation, improve quality of life and independent functional status in these patients, which should be used as one of the standard treatment protocols for CCI patients.

Regenerative surgery: promises, strategies, and translational perspectives / 中华外科杂志

Regenerative surgery is an emerging multidisciplinary field that has the potential to transform the surgical treatment for diseases and injuries. This article provides a brief overview of the history of surgery and regenerative medicine, introduces the new concept of regenerative surgery, describes the surgical procedures, and discusses the role of surgeons in developing and implementing these technologies. Insights gained from recent clinical research of regenerative medicine are beginning to yield three strategies for regenerative therapies for surgical diseases, and this review also provides the challenges and translational perspectives of these different strategies.

The comparison between X-ray plain radiography, CT, and MR findings of gouty arthritis / 中华内分泌代谢杂志

Objective To make a comparison between the plain radiograph, CT, and MR findings of gouty arthritis and to analyse the relationship between clinical data and imaging findings. Methods Fifty-four joints of 33 patients with a confirmed diagnosis of gouty arthritis were included in this study. In the morning, the blood uric acid level of patients was tested before meal. In the afternoon, their clinical data were recorded and joints were examinated by plain radiography, CT, and MRI. The imaging findings were evaluated by tophi, bone erosion, soft tissue swelling, hydrarthrosis, synovial thickness, and bone oedema. The data was analyzed by Chi-square test, indepentdent-samples t test, and logistic regression. Results The Chi-square test was utilized to evaluate number of joints with tophi(CT>plain radiography, MR>plain radiography, PCT>plain radiography, PCT, P<0. 01). In addition, 35 joints had bone oedema and 50 joints had synovial thickness. The course of disease(tophi positive group vs tophi negative group, P<0. 01) was analyzed by indepentdent-samples t test. The tophi's causative agents including bone erosion and course of disease were analysed by logistic regression(P<0. 01). Conclusions MRI is superior to CT and plain radiography on the early diagnosis of gout. Tophi and bone erosion may not affect the blood uric acid level. With the progression of disease, the probability of tophi formation increases. The relationship between the formation of tophi and bone erosion may be interpromotied.

Updates in the research of Crohn's disease complicated by colorectal cancer / 中华消化外科杂志

Crohn's disease is a relapsing systemic inflammatory disease mainly affecting the gastrointestinal tract.Recently,the incidence and prevalence of Crohn's disease is increasing dramatically in Asia,and colorectal cancer is one of the most fatal complications of Crohn's disease.A thorough understanding of the carcinogenesis of Crohn' s disease and enhance the surveillance of colorectal cancer among Crohn's disease is therefore of significant importance to reduce the mortality.In this review,the tendency and molecular mechanism of carcinogenesis of Crohn's disease were discussed,and the present research on the prevention against colorectal cancer in patients with Crohn's disease was introduced.

Biocompatibility, biodegradation, and neovascularization of human single-unit platelet-rich fibrin glue: an in vivo analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The clinical applications of fibrin glue span over several surgical modalities. The aim of this study was to evaluate the biocompatibility and biodegradation of different formulations of platelet-rich fibrin glue in vivo and examine its effects on the neovascularization of wound sites.</p><p><b>METHODS</b>Human-derived single-unit fibrin glue was prepared. Incisions were made on the backs of rats, and these were coated with homemade glues containing different concentrations of aminomethylbenzoic acid (Groups A-F) or commercial adhesives (Group G). A sham control group was included (Group H). The wounds were examined by histological analysis and immunohistochemistry at several time points.</p><p><b>RESULTS</b>Successful wound closure was achieved in all groups by day 12. Acute inflammation occurred during the first six days, but gradually disappeared. The longest sealant duration was achieved using the lowest concentration of anti-fibrinolytic agent in a 1:10 volume ratio with cryoprecipitate. Expression levels of the platelet endothelial cell adhesion molecule-1 were significantly higher in Groups A and C compared to the control groups (Groups G and H) on day 3 (P < 0.05).</p><p><b>CONCLUSIONS</b>Single-unit platelet-rich fibrin glue has excellent biocompatibility and is associated with the upregulation of neovascularization. The addition of aminomethylbenzoic acid could prevent the degradation of fibrin glue.</p>

Intestinal rehabilitation in the management of acute gastrointestinal injury / 中华消化外科杂志

Acute gastrointestinal injury (AGI) is a malfunctioning of the gastrointestinal tract in intensive care patients due to their acute illness.AGI could be divided into 4 types,including AGI grade Ⅰ:increased risk of developing gastrointestinal dysfunction or failure; AGI grade Ⅱ:gastrointestinal dysfunction; AGI grade Ⅲ:gastrointestinal failure; AGI grade Ⅳ:gastrointestinal failure complicated with distal organ dysfunction.The symptoms of AGI include vomiting and regurgitation,gastric retention,diarrhea,gastrointestinal bleeding,paralytic intestinal obstruction,bowel dilatation and abnormal bowel sounds.Intestinal rehabilitation therapy was used to promote the patients with short bowel syndrome to restore enteral or oral feeding,and it could be used to improve the gastrointestinal function in patients with AGI.The procedure of intestinal rehabilitation therapy include total parenteral nutrition,parenteral and enteral nutrition,total enteral nutrition and oral feeding.The specific therapy could be implemented according to the severity of AGI and early enteral nutrition should be tried frequently.Intestinal tissue specific nutrients should also be provided either through enteral or parenteral approaches.

Safety of infliximab during perioperative period in Crohn disease patients / 国际外科学杂志

With the appearance of new biological agents represented by infliximab,the medical therapy of crohns' disease has made breakthrough of progress.However,the controversial still remains about the use of infliximab during perioperative period in Crohn's disease patients.The aim of this article is to explore the influence of infliximab on postoperative complications in Crohn's disease patients.

Characteristics and treatment of the complications of Crohn's disease / 中华消化外科杂志

Objective To investigate the characteristics and treatment of the complications of Crohn's disease. Methods The clinical data of 202 patients with Crohn's disease and relevant complications who were admitted to the Nanjing General Hospital of Nanjing Military Command from January 2000 to December 2007 were retrospectively analyzed. The main complications included intestinal obstruction, fistula, acute perforation,abscess, abdominal mass and et al. Results Of the 202 patients, 116 had more than two complications. Intestinal obstruction (72 patients) was the most common complication among the initial complications, and followed by fistula (31 patients), acute perforation (23 patients), abscess (22 patients), abdominal mass (22 patients),anal complications (21 patients) and gastrointestinal bleeding (11 patients). Fistula was mostly observed in patients with secondary complications during the early stage (≤three months), while obstruction (24 patients),fistula (22 patients) and obscess (11 patients) were prevalent during the mid-late stage (＞ three months). Of the 202 patients with primary complications, 170 received surgical treatment and 32 received non-surgical treatment. Of the 116 patients with secondary complications, 96 received surgical treatment and 20 received non-surgical treatment. A total of 127 patients were cured by surgical treatment, the condition of 33 patients was improved and six patients died. The condition of patients received non-surgical treatment was improved, and no patient died.Conclusions The incidence of complications of Crohn's disease is increasing steadily. Intestinal obstruction is the most common complication, and then followed by fistula. Surgery is important in the treatment of the complications of Crohn's disease.

Correlation between Th17 cells and Crohn' s disease / 国际外科学杂志

As a novel T cell population,Th17 cells are demonstrated to play an important role in autoimmune diseases,including Crohn' s disease.Several recent studies indicate the specific contributions of IL-23/Th17 axis and cytokines secreted by Th17 cells to the inflammatory bowel disease.This article is dedicated to describe the correlation between Th17 cells and Crohn' s disease.

Influence of frequency of ventilator pipe replacement on bacterial colonization in patients with abdominal infection / 中国实用护理杂志

Objective To discuss the frequency of ventilator pipe replacement in ICU ward for reducing the frequency of VAP occurrence caused by bacterial colonization in ventilator-line. Methods 30 patients hospitalized to ICU ward from Janurary,2008 to June, 2009 who had mechanical-ventilation above 48h were randomly divided into group A, B and C with 30 patients in each group, then bacteria culture and strain analysis were employed for the pipeline sample of ventilator inspiratory side at the time point to be use and used mechanical ventilation for 1 day, 3 days and 7 days. Results There was no bacteria grew after ventilator-line sterilization, and positive ratio of bacterial culture in 1d, 3d and 7d were 46.66%,53.33% and 100.00%, respectively. Conclusions The frequency of ventilator pipe replacement should be shortened in patients with abdominal infection, to replace every 3 days is suitable in ICU where infectious patients gathered.

Changes of the plasma amino acid level in patients with abdominal inflammation and acute renal failure during continuous veno-venous hemofiltration / 中华消化外科杂志

Objective To evaluate the plasma amino acid level alteration and determine amino acid loss in patients with abdominal inflammation and acute renal failure during continuous veno-venous hemofiltration (CVVH). Methods Ten patients with abdominal infection and acute renal failure were admitted to the Nanjing General Hospital of Nanjing Military Command of PLA from September 2008 to September 2009. CVVH was performed with AV600S polysulfone hemofilter for 24 hours. Samples of plasma amino acid were obtained before,at 12 and 24 hours after the beginning of CVVH. High pressure liquid chromatography was used to detect amino acid concentrations in plasma and replacement fluid. All data were analyzed using t test or Wilcoxon rank sum test. Results Of the ten patients, three died of septic shock and three died of multi-organ dysfunction syndrome.The level of plasma amino acids decreased significantly after CVVH, and the levels of histidine, isoleucine, cysteine and glutamine decreased from (22.1 ±10.3), (20.0 ±7.6), (10.3±4.7), (122.3 ±72.2)μmol/L to (5.6 ±3.4), ( 6.4 ± 2.5 ), ( 2.9 ± 2.4 ), (42.5 ± 33.6) μ mol/L. The total plasma amino acid levels significantly reduced by 52% at 12 hours after the beginning of CVVH and by 59% at 24 hours after the beginning of CVVH.The mean amino acid loss was (9631± 1089)mg/d. The mean losses of essential and non-essential amino acids were ( 5072 ± 618 ) mg/d and ( 3747 ± 654 ) mg/d, respectively, with a significant difference ( t = 4. 52,P ＜0.05 ). There was a positive correlation between individual amino acid loss and the plasma concentrations of respective amino acids at 12 hours after the beginning of CVVH ( r = 0. 68, P ＜ 0.05 ). Conclusions Plasma amino acid would be cleared through hemofilter during CVVH in patients with abdominal inflammation and acuterenal failure. As a result, it is necessary to take account of the ultrafiltrate amino acid loss when setting nutritional schedule, especially increasing the non-essential amino acid content of total parenteral nutrition.