Establishment of a rabbit model of small diameter vascular graft replacement / 南方医科大学学报

<p><b>OBJECTIVE</b>To establish an rabbit model that mimics the hemodynamics of the bypass graft after coronary artery bypass surgery.</p><p><b>METHODS</b>Sixteen New Zealand rabbits were randomly divided into two groups for abdominal aortic artery replacement using a 3-cm-long ePTFE graft with an inner diameter 4 mm through an incision at 1/3 from the middle to the lower part of the abdomen (group A) or in the lower abdomen (group B). The general conditions of the rabbits, operative time, number of collateral vessels that needed to be ligated, rate of massive intraoperative bleeding, fluctuation of vascular anastomosis after surgery, patency rate of the graft on day 7 after the operation were compared between the two groups.</p><p><b>RESULTS</b>The two groups of rabbits had similar body weight, diameter of the abdominal aortic artery, intraoperative bleeding rate and occlusion rate of the vascular graft at 7 days after the procedure. The operative time was longer in group A, but the difference was not statistically significant. In group A, the number of the vascular branches that needed to be ligated was smaller and the rate normal femoral artery pulsation was higher than those in group B.</p><p><b>CONCLUSION</b>It is feasible to establish models of small diameter vascular graft replacement in rabbits, and the patency rate of the graft can be monitored by observation of the general condition and ultrasound examination of the rabbits.</p>

Surgical treatment of giant thymoma in a patient with myasthenia gravis / 南方医科大学学报

We report a case report of giant thymoma (17 cm×14 cm×4 cm) in a 32-year-old male patient with myasthenia gravis. Examinations revealed that the tumor invaded the mediastinum, blood vessels and pericardium, and was histologically classified as WHO type B1 and Masaoka stage III. The patient developed myasthenia gravis crisis after radical resection of the thymoma and appropriate treatments with tracheotomy were administered. The patient recovered and was discharged after a hospital stay for 252 days with a mechanical ventilation time of 102 days.

Brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique for Stanford type A aortic dissection: analysis of 23 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the clinical outcomes of brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique for treatment of Stanford type A aortic dissection.</p><p><b>METHODS</b>Twenty-three patients with Stanford type A aortic dissection requiring arch replacement underwent brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique. The operations were performed within 72 h (20 cases) or 3-14 days (3 cases) after the onset of aortic dissection.</p><p><b>RESULTS</b>There was no perioperative death in these cases. The mean extracorporeal circulation time was 209∓52 min, the aortic cross clamp time was 85∓21 min, and the mean chest tube output within the first 24 h after the operation was 570∓263 mL; none of the patients required chest reopening for management of bleeding. Postoperative acute renal failure requiring hemodialysis occurred in 3 cases, transient neurologic dysfunction in 2 cases, paraplegia in case and hematosepsis in 1 case. No such complications as permanent neurologic deficit or postoperative visceral malperfusion occurred in these cases. All the patients survived and were discharged from hospital without experiencing severe complications in the follow-up for 6-18 months.</p><p><b>CONCLUSION</b>Brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique is a safe and simple procedure with controllable bleeding and can serve as an optional procedure for aortic arch replacement.</p>

Thoraco laparoscopic esophagectomy versus open esophagectomy: a meta-analysis of outcomes / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the outcomes of thoraco laparoscopic esophagectomy venus open esophagectomy for esophageal cancer.</p><p><b>METHODS</b>Literature search was performed using PubMed, Embase, Cochrane Library, and Google Scholar databases, CBM, and CNKI from inception to July 2011 for comparative studies assessing thoraco laparoscopic esophagectomy and open esophagectomy. Data were extracted and evaluated by two reviewers independently according to the Cochrane Handbook for Systematic Reviews. Meta-analyses were conducted using RevMan 5.1.</p><p><b>RESULTS</b>A total of 10 studies involving 1017 patients were included for the analysis. Four hundred and fifty-five patients underwent thoraco laparoscopic esophagectomy and 562 patients underwent open esophagectomy. There were no significant differences between the two groups in anastomotic leak, 30-day mortality, and number of lymph node retrieved(P>0.05). However, thoraco laparoscopic esophagectomy had lower blood loss, less operative time, and reduced respiratory complications(P<0.05). There were no significant differences between the two groups in overall complications, cardiac complications, anastomotic stricture, recurrent laryngeal nerve injury, length of stay, ICU stay, and 3-year survival(all P>0.05).</p><p><b>CONCLUSION</b>Thoraco laparoscopic esophagectomy for esophageal cancer is feasible and safe as open esophagectomy.</p>

Quality of life in patients with esophageal carcinoma undergoing thoracoscopic and laparoscopic esophagectomy and circular stapled cervical esophagogastric anastomosis via retrosternal route / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the quality of life (QOL) in patients with esophageal carcinoma after thoracoscopic and laparoscopic esophagectomy and circular stapled cervical esophagogastric anastomosis via retrosternal route or three-incision open surgery.</p><p><b>METHODS</b>A total of 63 patients with middle-upper esophageal carcinoma who underwent radical surgical resection from January 2009 to October 2010 were enrolled in this study. Thirty-three patients underwent combined laparoscopic and thoracoscopic surgery and 30 three-incision open surgery. The EORTC questionnaire QLQ-C30 and QLQ-OES18 were used to evaluate the QOL.</p><p><b>RESULTS</b>There were no significant differences in the clinical data between the two groups except for anastomosis method(P>0.05). In the endoscopy group, there was one patient developed anastomotic leakage(3.0%, 1/33), 1 postoperative wound infection in the neck (3.0%, 1/33), and 1 anastomotic stricture(3.0%, 1/33). In the open group, 8 patients had anastomotic leakage (26.7%, 8/30), 2 had anastomotic stricture (6.7%, 2/30), 1 had wound infection in the neck (3.3%, 1/30), and 6 had pulmonary infection (20.0%, 6/30). All the complications were managed by conservative treatment. The two groups differed in dysphagia, food intake, pain, obstruction, dyspnea, anorexia, fatigue, financial condition, physical function, role function, emotional function, cognitive function, social function and global health level and were more favorable in the endoscopy group(P<0.05), while there were no significant differences in the other dimensions.</p><p><b>CONCLUSIONS</b>The postoperative complication rate is low after thoracoscopic and laparoscopic esophagectomy. Stapled anastomosis is associated with lower rate of anastomotic leak. QOL is better in patients following thoracoscopic and laparoscopic esophagectomy as compared to those following three-incision open surgery.</p>

Therapeutic effect of tracheal anastomosis versus interventional bronchoscopy in the treatment of airway stenosis / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the therapeutic effects of tracheal anastomosis and interventional bronchoscopy in the treatment of airway stenosis.</p><p><b>METHODS</b>From February, 1990 to February 2008, 53 patients with airway stenosis including 32 male and 21 female patients aged 2 to 80 years (mean 38 years) received end-to-end anastomosis or bronchoscopic stent-graft treatment in our hospital. End-to-end anastomosis of the narrow sleeves resected was performed in 26 cases, balloon dilatation in 14 cases, and stent implantation in 13 cases. The clinical and follow-up data of the patients were analyzed retrospectively and the surgical outcomes were evaluated.</p><p><b>RESULTS</b>No perioperative deaths occurred in these cases. Eight patients (5 with anastomosis, 2 with balloon dilation, and 1 with stent implantation) were lost to the follow-up ranging from 1 to 204 (mean 44.94-/+54.56) months. Of the patients available to the follow-up, 12 had airway restenosis, including 2 receiving end-to-end anastomosis (9.5%), 6 (50%) receiving balloon angioplasty, and 6 with granulation hyperplasia following stent implantation (50%). Of the 3 treatment, end-to-end anastomosis was associated with the lowest restenosis rate (Chi2=8.869, P=0.012).</p><p><b>CONCLUSION</b>End-to-end anastomosis, with a low postoperative restenosis rate and better prognosis, should be the primary choice for treatment of tracheal airway stenosis.</p>

Clinical analysis of primary thymic lymphoma: a report of 27 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate clinicopathologic features and optimal treatment of primary thymic lymphoma.</p><p><b>METHODS</b>Clinical records of 27 primary thymic lymphoma patients treated from 1990 to 2007 were reviewed.</p><p><b>RESULTS</b>Of the 27 patients, 8 received mastectomy and chemotherapy, 12 received excision of the thymic lesion and chemotherapy, 5 received chemotherapy alone, and 2 received lesion excision alone. 24 achieved complete remission after scheduled treatment, 1 achieved partial remission, and 2 patients had progressive disease. With a follow-up of 10 years and median 38 months, the 5-year overall and disease-free survival rates of the 27 patients were 47% and 23% respectively.</p><p><b>CONCLUSION</b>The main subtypes of primary thymic lymphoma are diffuse large B-cell lymphoma and peripheral T-cell lymphoma. The optimal sequence is radical operation followed by standard anthracycline-based regimens and radiotherapy.</p>

Validation of the non-cellular metastasis hypothesis of malignant tumors in mice / 南方医科大学学报

<p><b>OBJECTIVE</b>To test the hypothesis that malignant tumor metastasis is mediated also through a non-cellular, essentially molecular, mechanism in addition to the cellular pathway.</p><p><b>METHODS</b>The sex-determining region on the Y chromosome was detected as the marker of the primary tumors using PCR in Lewis lung carcinoma (LLC) in vitro and in female C57BL/6 mice bearing LLC with spontaneous metastasis. The macroscopic and microscopic metastases in the tumor-bearing mice were examined for SRY expression by PCR and in situ hybridization, using the tissues from male and female mice as the positive or negative controls.</p><p><b>RESULTS AND CONCLUSION</b>Positive SRY gene expression was detected in the metastatic foci in the LLC-bearing female mice, suggesting the origination of these tumor cells from the primary tumor foci. We have failed to verify the non-cellular metastasis hypothesis in this animal experiment, but given the limitations of this experiment, we consider further investigation still necessary for verification of this hypothesis using other methods.</p>

L-arginine pretreatment lowers cerebral metabolism for cerebral protection during deep hypothermic circulatory arrest / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the effect of L-arginine pretreatment on cerebral metabolism for cerebral protection during deep hypothermic circulatory arrest (DHCA).</p><p><b>METHODS</b>Fifteen healthy adult canines of either sex weighing 14.7-/+2.4 kg were randomly divided into 3 groups (n=5), namely the normal saline group, L-arginine pretreatment group (pretreated with 100 mg/kg L-arginine 60 min before DHCA), and L-arginine combined with 7- nitroindazole treatment group (pretreated with 100 mg/kg L-arginine and 25 mg/kg7-Ni 60 min before DHCA). For all the canines, extracorporeal circulation was established routinely to allow nasopharyngeal temperature reduction to 18 degrees celsius;, at which point DHCA commenced followed 90 min later by reperfusion. At 30 min before DHCA and 0, 45 and 90 min after DHCA as well as at 60 min after reperfusion initiation, blood samples were collected from the jugular vein and arterial to measure the plasma lactic acid, and the cerebral cortex of the parietal lobe was sampled determine the activity of Na(+)-K(+)ATPase. The cerebral water content was also determined after execution of the canines.</p><p><b>RESULTS</b>In the two pretreatment groups, the level of lactic acid production (shown by the difference in lactic acid levels between the jugular venous and arterial blood) and the cerebral ATP consumption were similar (P>0.05), but both were significantly lower than those of the control group (P<0.05). The cerebral water content was the lowest in the combined treatment group, followed by exclusive L-arginine group, and the highest in the control group (P<0.05), with significant difference between the 3 groups (P<0.05).</p><p><b>CONCLUSION</b>L-arginine pretreatment can lower cerebral metabolism during DHCA to offer protective effect on the brain.</p>

Design and experimental application of a device for direct vision intracardiac operation without cardiopulmonary bypass / 南方医科大学学报

<p><b>OBJECTIVE</b>To design a device for direct vision intracardiac operation without cardiopulmonary bypass, and assess its applicability preliminarily.</p><p><b>METHODS</b>The device was designed according to the clinical needs of intracardiac operation and used in operations for repairing atrial septal defect in 5 ex vivo porcine heart models. The practical applicability of this device was thoroughly tested and the results of the operations were evaluated.</p><p><b>RESULTS AND CONCLUSION</b>Direct vision operation for repairing atrial septal defect was successfully performed using this device, which can be a well applicable in some intracardiac operations, but its clinical effects need further evaluation.</p>

Preparation and dose-effect analysis of ecdysterone cream for promoting wound healing / 南方医科大学学报

<p><b>OBJECTIVE</b>To prepare ecdysterone cream for promoting wound healing and conduct the dose-effect analysis to determine the optimal concentration.</p><p><b>METHODS</b>The cream substrate containing 4 concentrations (0.625%, 1.25%, 2.5% and 5%) of ecdysterone was prepared. Full-thickness skin defect was induced in 9 New Zealand rabbits at 5 sites on the dorsal skin, and the wounds were treated with blank cream substrate and ecdysterone cream at the 4 concentrations, respectively. On days 4, 8 and 12 after the injury, the healing area and the healing rate for each wound were determined, and in one rabbit, the tissues around the wounds were sampled for pathological examination.</p><p><b>RESULTS</b>The ecdysterone cream significantly promoted wound healing as shown by increased percentage of the healing area (P<0.01), and the optimal concentration was 2.5%. Pathologically, the wounds treated with 2.5% ecdysterone cream exhibited more obvious granulation tissue formation and proliferation of the epithelial cells, endothelial cells and fibroblasts than those treated with the cream of the other concentrations.</p><p><b>CONCLUSION</b>The ecdysterone cream can obviously promote wound healing in rabbits at the optimal concentration of 2.5%, which may offer a clinical alternative for promoting wound healing.</p>

Screening of differentially expressed proteins from human esophageal cancer and esophageal tissues by two-dimensional difference gel electrophoresis and mass spectrometry / 南方医科大学学报

<p><b>OBJECTIVE</b>To establish two-dimensional electrophoresis profiles from human esophageal cancer tissue and paired normal esophageal tissue and identify differentially expressed proteins to identify the molecular markers for early-stage diagnosis.</p><p><b>METHODS</b>The total proteins of human esophageal cancer tissue and paired normal esophageal tissue were separated by immobilized pH gradient-based two-dimensional gel electrophoresis (2-DE). The 6 differentially expressed proteins were analyzed by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS). The peptide mass fingerprintings (PMF) were identified by database searching. Six differentially expressed proteins were validated by RT-PCR.</p><p><b>RESULTS</b>The well-resolved, reproducible 2-DE patterns of esophageal cancer tissue and esophageal normal tissue were established. Using MALDI-TOF-MS technology, 6 differential protein spots were identified. Among them, the expressions of squamous cell carcinoma antigen 1 (SCCA1b), KRT4 and annexin A1 were downregulated and triosephosphate isomerase (TPI1), heat shock protein 27 (HSP27) and manganese superoxide dismutase (MnSOD) were upregulated in esophageal cancer tissues.</p><p><b>CONCLUSION</b>The identification of differential expressed proteins in human esophageal cancer and normal tissue will be helpful for screening the biomarker for early-stage diagnosis.</p>

Evaluation of ultramicroporous expanded polytetrafluoroethylene mitral valve under pulsatile flow condition in vitro / 南方医科大学学报

<p><b>OBJECTIVE</b>To test 25# and 27# ultramicroporous expanded polytetrafluo-roethylene mitral valve (UPMV) under pulsatile flow condition in vitro.</p><p><b>METHODS</b>Six 25# and six 27#UPMV were tested using TH-1200 HV Prosthesis Pulsatile Flow Tester in vitro at the cycling rate of 70 cycle/min, with the systolic pressure maintained at about 16 kPa (120 mmHg), diastolic pressure at 10.7 kPa (80 mmHg), and the percentage of mean forward flow at 35%. The stimulant cardiac output was maintained at 2, 3, 4, 5 and 6 L/min, respectively, for the testing.</p><p><b>RESULTS</b>The mean pressure difference for the 25#UPMV under stimulant cardiac output of 2, 3, 4, 5 and 6 L/min was 2.488-/+0.378, 4.427-/+0.240, 5.460-/+0.449, 6.776-/+0.391 and 8.327-/+0.490 mmHg, and its effective valvular orifice was 1.430-/+0.333, 1.993-/+0.208, 2.260-/+0.477, 3.204-/+0.174 and 3.652-/+0.158 cm(2), respectively. The regurgitant fraction of the 25#UPMV under each stimulant cardiac output was (5.731-/+0.643) %, (5.431-/+0.312) %, (5.059-/+0.708) %, (3.545-/+0.097) % and (2.615-/+0.125) %, respectively. The mean pressure difference of the 27#UPMV under each stimulant cardiac output was 1.618-/+0.497, 3.448-/+0.440, 4.825-/+0.434, 5.494-/+0.446 and 7.482-/+0.455 mmHg, effective valvular orifice was 1.773-/+0.364, 2.113-/+0.305, 2.409-/+0.295, 3.326-/+0.417 and 4.522-/+0.445 cm(2), and regurgitant fraction was (5.357-/+0.509) %, (5.407-/+0.110) %, (4.999-/+0.182) %, (4.010-/+0.254) % and (2.584-/+0.114)%, respectively.</p><p><b>CONCLUSION</b>The mean pressure difference, effective valvular orifice and regurgitant fraction of the UPMVs can measure up to the national criteria for artificial heart valve prosthesis of China.</p>

Ecdysterone promotes wound healing in rabbits / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the efficacy of ecdysterone in promoting wound healing in rabbits.</p><p><b>METHODS</b>Twenty-one New Zealand rabbits were randomized equally into 3 groups and in each rabbit, 4 separate full-thickness skin wounds were induced and treated with dexamethasone, ecdysterone and Yunnan white powder, or untreated, respectively. On day 3, 6, and 9, respectively, one group of rabbits were sacrificed and the local wound tissue was obtained for pathological examination.</p><p><b>RESULTS</b>Three days after the operation, the 4 wounds in each rabbit did not show significant difference in the healing rate (P>0.05). On day 6, as was similar to day 9, ecdysterone and Yunnan white powder showed better efficacy in promoting wound healing than dexamethasone (P<0.01), the latter having similar effect with the control management (P>0.05), and that of ecdysterone was similar to Yunnan white powder (P>0.05). Pathologically, early stage of wound healing was characterized by exudation and hyperemia, and on days 6 and 9, ecdysterone and Yunnan white powder exhibited similar strong effect for shaping the granulation tissue and stimulating epithelial cell proliferation.</p><p><b>CONCLUSION</b>Ecdysterone can obviously promote wound healing in rabbits, which may offer a clinical alternative for promoting wound healing.</p>

Experimental study of cerebral protection by retrograde vs selective antegrade cerebral perfusion during deep hypothermic circulatory arrest / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the effect of cerebral protection between retrograde cerebral perfusion (RCP) and selective antegrade cerebral perfusion (SACP) during deep hypothermic circulatory arrest (DHCA) in canine models.</p><p><b>METHODS</b>Fifteen healthy adult dogs were randomly divided into 3 groups (n=5), namely the simple DHCA group (group I), DHCA+RCP group (group II) and DHCA+SACP group (group III). Extrocorporeal circulatory was established routinely in the dogs, and DHCA commenced when the nasopharyngeal temperature was reduced to 18 degrees C. During DHCA, RCP and SACP were applied in groups II and III, respectively. All the models were rewarmed after 90 min of DHCA and the cerebral reperfusion continued for 90 min. Cerebral oxygenous metabolic function, cerebral temperature and ultrastructural changes of the neurons were observed in the 3 groups at different time points during the operation.</p><p><b>RESULTS</b>The jugular venous oxygen saturation (SjvO(2)) increased with the temperature reduction, and then decreased after DHCA commencement, showing significant changes at different time points in groups I and II. SjvO(2) in group III were significantly higher than that in the other two groups after 90 min of DHCA (P=0.000). Brain temperature significantly increased in group I during DHCA as compared with that in groups II and III (P=0.000), but showed no significant difference between the latter two groups (P=0.195). The ultrastructure of the neurons underwent obvious changes after reperfusion for 30 min in group I. In group II the neuronal ultrastructure was basically normal at 60 min during DHCA and changed slightly at 90 min, but in group III no obvious changes were seen at 90 min during DHCA and only slight changes occurred at 30 min of reperfusion.</p><p><b>CONCLUSIONS</b>RCP can not supply enough oxygen but can maintain low cerebral temperature, and provide short-term brain protection. DHCA+SACP provides better brain protection than simple DHCA and DHCA+RCP, and has a promising prospect in cardiac surgery.</p>

Comparative study of video-assisted thoracoscopic surgery vs thoracic tube drainage in synthetic therapy for malignant pleural effusion secondary to non-small cell lung cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the value of video-assisted thoracoscopic surgery (VATS) and identify its indications in synthetic therapy for malignant pleural effusion secondary to non-small cell lung cancer.</p><p><b>METHODS</b>A prospective randomized single-blinded controlled clinical trial was conducted. Fifty-three patients with moderate or large amount of ipsilateral malignant pleural effusion (MPE) secondary to non-small cell lung cancer (NSCLC) were randomly divided into VATS group and tube drainage group (TD group). All patients received chemotherapy with the regimen of paclitaxel combined with paraplatin, and the response rate of MPE after therapy, difference of Karnofsky performance status (KPS) grades before and after therapy and the survival rate of the patients were compared.</p><p><b>RESULTS</b>The response rate of MPE after therapy in VATS group and TD group was 92.3% and 59.3%, and the complete remission rate was 88.5% and 44.4% (P<0.05), respectively. The difference of KPS grades before and after therapy in VATS group and TD group were 30 and 20, with a mean of 33.5-/+11.3 and 24.07-/+10.5 (P<0.05), respectively. Till August of 2005 years, all patients were available for followed-up, whose median survival time was 20 months in VATS group and 15 months in TD group. The 1-, 2- and 3-year survival rate were 65.4%, 38.5% and 22.4% in VATS group and 59.3%, 25.9% and 14.8% in TD group (P>0.05), respectively.</p><p><b>CONCLUSION</b>Video-assisted thoracoscopic pleurectomy can effectively control MPE and improve the quality of life for NSCLC patients with MPE, but failed to significantly improve the patients' survival rate in comparison with tube drainage. Except for grade IV, grades I, II and III according to CT findings all can be indications of VATS.</p>

Accelerated fatigue test in vitro of expanded polytetrafluoroethylene artificial heart valve / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the durability of expanded polytetrafluoroethylene artificial heart valve (ePTFE AHV).</p><p><b>METHODS</b>Six ePTFE AHVs were tested for 400 million times against accelerated fatigue using TH-2200 artificial heart valve exosomatic accelerated fatigue instrument. Hydromechanical parameters of fore-and-aft accelerated fatigue test of the 6 AHVs were obtained by TH-1200 artificial heart valve exosomatic pulsatile stream instrument.</p><p><b>RESULTS AND CONCLUSION</b>The mean gradient pressure spanning the valve and the effective orific area of ePTFE AHVs did not undergo significant changes after fore-and-aft the fatigue test, but the regurgitation volume and regurgitation rate of ePTFE AHVs were reduced after the accelerated fatigue test, suggesting good durability of ePTFE AHV.</p>

Development study on model WY multi-functional thoracic cavity closed drainage system / 中国医疗器械杂志

Based on the improved design of the existing thoracic cavity closed drainage system, a new multi-functional device is developed and is described here in detail. The device is more convenient and more efficient than the existing system. Besides, it has a function of autotransfusion. Animal experimental results show that it has attained the goal of the improved design.