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@#Objective To analyze and compare the perioperative efficacy difference between full-port Da Vinci robotic surgery and thoracoscopic surgery in patients with mediastinal tumor resection. Methods The data of 232 patients with mediastinal tumors treated by the same operator in the Department of Thoracic Surgery of the Second Affiliated Hospital of Harbin Medical University were included. There were 103 (44.4%) males and 129 (55.6%) females, with an average age of 49.7 years. According to the surgical methods, they were divided into a robot-assisted thoracic surgery (RATS) group (n=113) and a video-assisted thoracoscopic surgery (VATS) group (n=119). After 1 : 1 propensity score matching, 57 patients in the RATS group and 57 patients in the VATS group were obtained. Results The RATS group was better than the VATS group in the visual analogue scale pain score on the first day after the surgery [3.0 (2.0, 4.0) points vs. 4.0 (3.0, 5.0) points], postoperative hospital stay time [4.0 (3.0, 5.5) d vs. 6.0 (5.0, 7.0) d] and postoperative catheterization time [2.0 (2.0, 3.0) d vs. 3.0 (3.0, 4.0) d] (all P<0.05). There was no statistical difference between the two groups in terms of intraoperative blood loss, postoperative complications, postoperative thoracic closed drainage catheter placement rate or postoperative total drainage volume (all P>0.05). The total hospitalization costs [51 271.0 (44 166.0, 57 152.0) yuan vs. 35 814.0 (33 418.0, 39 312.0) yuan], operation costs [37 659.0 (32 217.0, 41 511.0) yuan vs. 19 640.0 (17 008.0, 21 421.0) yuan], anesthesia costs [3 307.0 (2 530.0, 3 823.0) yuan vs. 2 059.0 (1 577.0, 2 887.0) yuan] and drug and examination costs [9 241.0 (7 987.0, 12 332.0) yuan vs. 14 143.0 (11 620.0, 16 750.0) yuan] in the RATS group was higher than those in the VATS group (all P<0.05). Conclusion Robotic surgery and thoracoscopic surgery can be done safely and effectively. Compared with thoracoscopic surgery, robotic surgery has less postoperative pain, shorter tube-carrying time, and less postoperative hospital stay, which can significantly speed up the postoperative recovery of patients. However, the cost of robotic surgery is higher than that of thoracoscopic surgery, which increases the economic burden of patients and is also one of the main reasons for preventing the popularization of robotic surgery.
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Activation of inflammatory responses regulates the transmission of pain pathways through an integrated network in the peripheral and central nervous systems. The immunopotentiator thymosin alpha-1 (Tα1) has recently been reported to have anti-inflammatory and neuroprotective functions in rodents. However, how Tα1 affects inflammatory pain remains unclear. In the present study, intraperitoneal injection of Tα1 attenuated complete Freund's adjuvant (CFA)-induced pain hypersensitivity, and decreased the up-regulation of pro-inflammatory cytokines (TNF-α, IL-1β, and IL-6) in inflamed skin and the spinal cord. We found that CFA-induced peripheral inflammation evoked strong microglial activation, but the effect was reversed by Tα1. Notably, Tα1 reversed the CFA-induced up-regulation of vesicular glutamate transporter (VGLUT) and down-regulated the vesicular γ-aminobutyric acid transporter (VGAT) in the spinal cord. Taken together, these results suggest that Tα1 plays a therapeutic role in inflammatory pain and in the modulation of microglia-induced pro-inflammatory cytokine production in addition to mediation of VGLUT and VGAT expression in the spinal cord.
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Objective To investigate the effect of knee joint injection of sodium hyaluronate combined with oral administration of diacerein and/or glucosamine sulfate on knee joint of Kaschin-Beck disease.Methods The method of prospective study was used,80 patients with Kaschin-Beck disease admitted to the General Internal Medicine,Guang'an People's Hospital from January 2015 to December 2017 were selected as subjects.They were divided into 4 groups according to the difference of their medication methods,20 cases per group.Group A was treated with intra-articular injection of sodium hyaluronate,Group B was treated with intra-articular injection of sodium hyaluronate + oral diacerein,Group C was treated with intra-articular injection of sodium hyaluronate + oral glucosamine sulfate,Group D was treated with intra-articular injection of sodium hyaluronate + oral diacerein and glucosamine sulfate,and the overall therapeutic effects of the 4 groups were compared.Results The knee joint scores of Group D at 7,14,90,and 180 days after treatment were (6.25 ± 2.01),(4.22 ± 1.15),(2.21 ± 1.01),and (1.15 ± 0.15) scores,respectively,they were significantly lower than those of Group A [(12.11 ± 3.02),(11.91 ± 2.98),(11.85 ± 2.85),(11.05 ± 2.52) scores],Group B [(9.11 ± 2.85),(8.32 ± 2.45),(7.55 ± 2.32),(6.15 ± 2.01) scores] and Group C [(9.12 ± 2.84),(8.23 ± 2.32),(7.43 ± 2.29),(6.11 ± 2.00) scores],the differences were statistically significant (P ＜ 0.05).The total effective rates of the 4 groups were 60％ (12/20),65％ (13/20),70％ (14/20),and 90％ (18/20),respectively,Group D was significantly higher than those of other 3 groups (x2 =18.250,18.250,16.000,P ＜ 0.05).The scores of 20 m walking pain and joint tenderness in Group D after treatment and follow-up period were lower than those of other 3 groups (P ＜ 0.05).Conclusions In the clinical practice of Kaschin-Beck disease,intra-articular injection of sodium hyaluronate combined with oral diacerein and glucosamine sulfate can improve the knee joint function of patients,alleviate pain and enhance the overall therapeutic effect.The combined therapy has great clinical value.
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Objective To observe the effect of Tongbi decoctionon for the changes of the endothelial function and hemorheology in patients with coronary heart disease. Methods A total of 90 patients with angina pectoris were divided into the observation group and the control group according to the random number table method, with 45 in each group. The control group was given routine clinical treatment, and the observation group was treated with Tongbi decoction on the basis of the control group. After treated for 4 weeks, the pain severity of angina pectoris was observed before and after treatment, and the frequency and duration of angina pectoris were recorded. The levels of serum vascular endothelin (ET) and endothelin (VEGF) were measured by ELISA. The serum NO was measured by nitrate reductase method, and whole blood viscosity and plasma viscosity were measured by blood viscometer. The hematocrit was measured by hematocrit analyzer and optical density method. The erythrocyte aggregation index was measured, and the fibrinogen level was measured by heating precipitation method. And the clinical efficacy was evaluated. Results After treatment, the total effective rate was 93.3％ (42/45) in the observation group and 77.8％ (35/45) in the control group, and there was significant difference between the two groups (Z=-3.164, P=0.002). After treatment, the score of angina pain (0.62 ± 0.05 vs. 1.17 ± 0.14, t=5.733) , the frequency of angina attack (3.62 ± 0.43 times/week vs. 5.02 ± 0.64 times/week, t=5.042), the duration of angina attack (3.17 ± 0.42 minutes/time vs. 4.06 ± 0.51 minutes/time, t=4.781) in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the levels of VEGF and NO in the observation group were significantly higher than those in the control group (t value was 5.892, 5.347, all Ps<0.05), and ET was significantly lower than that in the control group (t=4.926, P=0.037). After treatment, the whole blood viscosity, plasma viscosity, hematocrit, aggregation index and fibrinogen levels in the observation group were significantly lower than those in the control group (t values were 4.832, 4.233, 5.031, 4.136, 4.531, all Ps<0.05). Conclusions The application of Tongbi decoction can improve the endothelial function of patients with angina pectoris, adjust the hemorheological indexes and relieve the symptoms related to angina pectoris.
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Objective To compare the difference of echocardiography and magnetic resonance imaging (MRI) in measurement of cardiac function in patients with dilated cardiomyopathy (DCM).Methods Totally 41 patients with DCM underwent echocardiography and MRI to measure cardiac function,the parameters included left ventricular end-diastolic volume (LVEDV),end systolic volume (LVESV),left ventricular ejection fraction (LVEF) and stroke volume (SV).The vertical long axis (VLA),horizontal long axis (HLA) and short axis (SA) of heart were measured by echocardiography.The differences of echocardiography and MRI were compared by linear regression and linear correlation.Results ①The value of LVEDV and LVESV obtained by the two methods:the value of LVEDV [(262.6 ± 117.0) ml] and LVESV [(196.4 ± 109.8) ml] obtained by MRI were higher than those of echocardiography [(211.4 ± 90.6),(216.5 ± 71.5),(219.1 ± 80.1) ml;(153.3 ± 76.1),(153.9 ± 54.1),(157.0 ± 61.1) ml,all P ＜ 0.05].②The value of SV and LVEF obtained by the two methods:the value of SV[(66.2 ± 21.3) ml] obtained by MRI was higher than that of echocardiography VLA [(58.1 ± 14.4) ml,P ＜ 0.05].The value of LVEF [(25.2 ±7.2)％] obtained by MRI was lower than those of echocardiography HLA and echocardiography SA [(28.9 ± 6.1)％,(28.3 ± 6.1)％,all P ＜ 0.05].③The value of LVEDV and LVESV obtained by echocardiography SA were associated with those obtained by MRI (r =0.785,0.653,all P ＜ 0.05).The value of LVEF obtained by echocardiography VLA was associated with it obtained by MRI (r =0.690,P ＜ 0.05).The value of SV obtained by echocardiography HLA and echocardiography SA were associated with those obtained by MRI (r =0.734,0.701,all P ＜ 0.05).Conclusion There are differences in accuracy and reliability using echocardiography and MRI when measuring dilated cardiomyopathy heart function,which must be treated differently.
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Objective To investigate the effect of omeprazole combined with FOLFOX scheme as an adjuvant therapy for stage Ⅱ or Ⅲ colon cancer patients after a radical resection.Methods 98 stage Ⅱ or Ⅲ colon cancer patients in our hospital from January 2008 to December 2009 were randomly divided into study group (48 cases) receiving regimen of omeprazole combined with FOLFOX and control group (50 cases) treated with FOLFOX chemotherapy after radical colectomy.Surgical specimens were examined for expression of V-ATPase protein.Chemotherapy period was 6 months,8-12 courses.We observed results of follow-up curative effect,comparing the side effects and postoperative 2 year,3 year and 5 year disease-free survival rate (DFS) difference using statistical analysis.Results Study was completed in all 93 cases,5 cases were lost to follow-up.The baseline data distribution in the two groups were balanced basically.In study group the gastrointestinal side effects of chemotherapy was lower than the control group (x2 =4.924 6,P =0.026).In the two groups,the 2-year,3-year and 5-year DFS were 73％ vs 60％ (x2 =1.743 7,P =0.187),62％ vs50％ (x2 =1.4075,P=0.235),49％ vs40％ (x2 =0.8159,P=0.366) (P＞0.05).V-ATPase protein expression was 71％ (70/98) in all samples.The 2-year and 3-year DFS of patients for V-ATPase protein positive expression in the two groups were 75％ vs 51％ (x2 =3.970 8,P =0.046),66％ vs 40％ (x2 =4.399 5,P =0.036).Compared with the control group,the 2-year,3-year DFS increased in the study group (P ＜ 0.05).In stage Ⅲ colon cancer patients,the 2-year DFS was 73％ vs 47％ (x2 =4.504 5,P =0.034).Conclusions PPI combined with FOLFOX in V-ATPase protein positive expression or Ⅲ stage colon cancer patients after radical colectemy improves long-term survival,as well as reduces the gastrointestinal side effects of chemotherapy.
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Objective To investigate the expression of Vacuolar-H +-ATPase (V-ATPase) and P-glyeoprotein (P-gp) protein in colon carcinoma tissues,the correlation between the expression of V-ATPase and P-gp and their clinicopathological significance.Methods In samples from 80 cases of colon cancer,20 cases of colon adenoma and 10 cases of normal colonic mucosa tissues,the expression of V-ATPase and P-gp protein were detected by immunohistochemical method,their relationship was analyzed,the clinicopathological features and prognosis were evaluated.Results In colon cancer,V-ATPase and P-gp protein expression was 72％ and 80％,higher than that in colon adenomas (40％,35％),and in normal colon mucosa (20％,20％),the difference was statistically significant (P ＜ 0.05).There was a positive correlation between the expression of V-ATPase and that of P-gp (r =0.567,P ＜0.01).V-ATPase and P-gp protein expression in colon cancer was associated with TNM stage,lymph node metastasis and tumor differentiation (P ＜ 0.05).Patients with high V-ATPase expression had lower 5-year survival rate than those with low V-ATPase expression (P =0.023),and 5-year recurrence rate was higher than those with low expression (P =0.024).Conclusions The expression of V-ATPase is up-regulated in colon cancer,there is a positive correlation with colon cancer progress and metastasis,and high V-ATPase protein expression predicts poor prognosis.
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Objective To evaluate the prognostic impact of a wide spectrum of pathologic parameters in a consecutive series of homogenously treated and well-characterized patients with stage Ⅰ and Ⅱ colorectal cancer, and to investigate the prognostic value of lymph node occult disease (micrometastasis) in disease-free survival rate detected by immunohistochemistry with epithelial membrane antigen and carcinoembryonic antigen. Methods The study included 126 patients operated on by a single surgeon for stage Ⅰ and Ⅱ colorectal tumors. The postoperative follow-up was performed for 64 to 106 months. At least 10 lymph nodes were harvested and examined in all the specimens. The prognostic value of 10 pathologic parameters, including lymph node occult disease (micrometastasis) detected by immunohistochemistry was investigated. Results Multivariate analysis identified lymphatic vessel invasion (absent or present;P=0.009) in lymph node positive and negative by immunohistochemistry. The five-year disease-free survival rates were 78.7%, 65.5% and 43.8% for the lymph node negative, isolated tumor cells and micrometastasis groups, respectively. There was significant difference between the lymph node negative and micrometastasis groups (P=0.005). However, the difference between the lymph node negative and isolated tumor cells groups was not statistically significant (P=0.144). Conclusions We propose that for patients found micrometastasis in lymph node with high-risk stage Ⅰ and Ⅱ colorectal cancer, adjuvant therapies are justified and effective.