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Objective To compare the influence of liberal fluid therapy, goal-directed fluid therapy and restrictive fluid therapy on inflammatory factors and postoperative recovery in patients undergoing laparoscopic colectomy, and find an optimal fluid therapy strategy for intestinal surgery. Methods Ninety colon carcinoma patients who had underwent laparoscopic colectomy at Shengjing Hospital Affiliated to China Medical University from April 2018 to February 2019 were selected. The patients were divided into control group (liberal fluid therapy), observation Ⅰgroup (goal-directed fluid group) and observationⅡgroup (restrictive fluid group) according to random digits table method with 30 cases each. The intraoperative liquid intake and output volume, surgery duration, albumin variation, first exhaust time, postoperative hospital stay and complications were recorded; the plasma levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) before surgery and at the time of leaving post-anesthesia care unit (PACU) were measured. Results The intraoperative crystal solution volume, total fluid volume and urine output in control group were significantly higher than those in observationⅠgroup and observationⅡgroup: (3 113.3 ± 535.9) ml vs. (2 443.3 ± 559.7) and (2 065.0 ± 411.3) ml, (3 703.3 ± 656.4) ml vs. (3 120.0 ± 546.9) and (2 546.7 ± 455.2) ml, (1 078.3 ± 475.4) ml vs. (423.3 ± 222.7) and (299.2 ± 203.1) ml, those in observation Ⅰ group were significantly higher than those in observation Ⅱgroup, and there were statistical differences (P＜0.05). There was no statistical difference in blood loss volume among 3 groups (P＞0.05). There were no statistical differences in IL-6, TNF-α and CRP before surgery among 3 groups (P＞0.05). When leaving PACU, the IL-6 and TNF-α in observationⅡgroup were significantly higher than those in control group and observationⅠgroup: (26.2 ± 5.4) ng/L vs. (22.2 ± 4.9) and (21.4 ± 4.5) ng/L, (38.5 ± 2.6) ng/L vs. (32.5 ± 1.9) and (33.2 ± 1.9) ng/L, and there were statistical differences (P＜0.05); there was no statistical difference in CRP among 3 groups (P＞0.05). There were no statistical differences in surgery duration, albumin variation and incidence of complications among 3 groups (P＞0.05). The first exhaust time in observationⅡgroup was significantly longer than that in observationⅠgroup: (75.5 ± 35.7) h vs. (51.1 ± 23.8) h, the postoperative hospital stay in observationⅡgroup was significantly longer than that in control group and observationⅠgroup: (15.1 ± 2.8) d vs. (12.1±2.7) and (12.5 ± 3.5) d, and there were statistical differences (P＜0.05). Conclusions Compared with the restrictive fluid therapy, liberal and goal-directed fluid therapy are able to reduce inflammatory response and the length of postoperative hospital stay in patients undergoing laparoscopic colectomy. While goal-directed fluid therapy has shorter first exhaust time compared with liberal fluid therapy, it prompts early recovery after surgery.
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In China,peritoneal metastasis of gastric cancer has main characteristics of high incidence,late staging and poor prognosis.However,the proposal of conversion therapy has brought hope to patients.Conversion therapy of peritoneal metastasis in gastric cancer is a novel concept,which aims at down-staging of the gastric cancer's primary lesion and effectively controlling the peritoneal metastases at the same time through valid chemotherapy and other means.Then the surgeons strive for performing radical gastrectomy and lymph node dissection (D2) to prolong survival time of the patients with advanced gastriccancer and improve their life quality.Systemic chemotherapy is the core of the methods of conversion therapy,while the local intraperitoneal chemotherapy can be used as a supplement.Neoadjuvant intraperitoneal-systemic chemotherapy (NIPS) is the most promising technique as conversion therapy due to the comprehensive advantages of the systemic chemotherapy and local intraperitoneal chemotherapy.In recent years,there were many clinical studies reporting NIPS for conversion therapy of peritoneal metastasis in gastric cancer.Therefore,this paper systematically reviews experiences of clinical application in order to provide references for clinical practice of conversion therapy in gastric cancer.
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Objective To explore the influence of goal-directed fluid therapy guided by stroke volume variation (SVV) on the recovery of gastrointestinal function and the length of hospital stay in patients undergoing gastrointestinal surgery, thus provide evidence for clinical application. Methods The studies related to the functional recovery of patients undergoing gastrointestinal surgery, including goal-directed fluid therapy guided by SVV were search in the PubMed, Medline, Google Scholar, Web of Science, CNKI, VIP and Wanfang data from 2008 to 2017. The experiment group was treated with goal-directed fluid therapy, and the control group was treated with open fluid therapy. The key indexes included first time of exhaust time, postoperative first defecation time, postoperative first feeding time, length of postoperative hospital stay or total length of hospital of stay. The Meta-analysis used RevMan 5.3 statistical software. Results A total of 13 randomized controlled trials containing 851 patients was included. The total length of hospitalization was compared in 8 articles, and the results showed that the difference was statistically significant ( MD = -4.12, 95% CI-5.93 to-2.30, P < 0.01). The length of postoperative hospital stay was compared in 6 articles, and the results showed that the difference was statistically significant ( MD=-2.64, 95% CI-3.84 to-1.43, P<0.01). The first time of exhaust time was compared in 12 articles, and the results showed that the difference was statistically significant ( MD=-15.32, 95% CI-19.96 to-10.69, P<0.01). The postoperative first defecation time was compared in 7 articles, and the results showed that the difference was statistically significant ( MD=-13.55, 95% CI-17.86 to -9.24, P < 0.01). The postoperative first feeding time was compared in 7 articles, and the results showed that the difference was statistically significant ( MD=-13.20, 95% CI-17.61 to-8.80, P < 0.01). Conclusions Goal-directed fluid therapy by SVV programs can help patients undergoing gastrointestinal surgery with earlier recovery in gastrointestinal function and shorter length of hospital stay or postoperative hospital stay.
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Objective To investigate the traditional Chinese medicine(TCM) syndromes distribution rule of nonalcoholic fatty liver disease(NAFLD) and its correlation with related clinical indexes.Methods The general condition,TCM four diagnostic methods,biochemical and CT results in 1950 cases of NAFLD in Chongqing City were investigated for analyzing the TCM syndromes distribution rule and its correlation with biochemistry and CT.Results In 1950 cases,the accumulation and binding of damp-heat,congestion of dampness turbidity,stagnation of liver-QI with spleen deficiency,intermin-gled phlegm and blood stasis and yin deficiency of both liver and kidney accounted for 36.62 ％,27.69 ％,19.38 ％,10.10 ％ and 6.21 ％ respectively;there was statistically significant difference in age among different TCM syndromes(P＜0.05);the vin deficiency syndrome of both liver and kidney and intermin-gled phlegm and blood stasis in severe fatty liver were maximal;glutamic-pyruvic transaminase(ALT) and glutamic-oxalacetic transaminase(AST) level was higher in the accumulation and binding of damp-heat;the level of fasting plasma gluco se(FBG) was higher in the yin deficiency syndrome of both liver and kidney;the total cholesterol(TC),triglyceride(TG) and FBG levels were lower in the stagnation of liver-QI with spleen deficiency,the differences were statistically significant(P＜0.05).Conclusion In NAFLD patients,the accumulation and binding of damp-heat distribution is maximal,the proportion of severe fatty liver with vin deficiency syndrome of both liver and kidney is higher.Different dialectical types may play an important role in the clinical indexes and disease development.
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Aim Toexplorewhether1-methylhydan-toin(MH)could inhibit the basal secretion of growth hormone (GH ) and suppress the promoting effect of growth hormone-releasing hormone (GHRH ) in rab-bits.Methods Thirty-sixrabbitswererandomlydi-vided into six experimental groups according to the kind of dosing drugs,namely normal saline group(A), MH group (B ),octreotide group (C ),GHRH group (D),GHRH +MH group(E),GHRH +octreotide group(F),with 6 rabbits in each group.Blood was sampled (1. 0 mL each time)from each rabbit before injecting drugs and 5,15,30,45,60 min after drug administration.Clotting spontaneously,rabbits blood samples were centrifugated for 20 minutes at approxi-mately 1000 ×g and the supernatant was collected. Serum GH concentrations were determined by enzyme linked immunosorbent assay kit(ELISA Kit).Mean-while,the behavior of rabbits in each group after injec-tingdrugswascloselyobserved.Results TheGH level of rabbits in group A at each time point had no significant differences(P>0. 05 ).Group B and group C rabbit GH levels were significantly lower than those of group A (P<0. 05 ),while GH levels in group D were obviously higher than those of group A (P <0. 05 ).Compared with group D,rabbit GH levels in group E and group F decreased markedly(P<0. 05 ). No obvious toxic and side effects had been observed within one week after the experimental rabbits were ad-ministered corresponding drugs by intravenous injec-tion.Conclusions 1-methylhydantoincouldinhibit the basal secretion of GH in rabbits.1-methylhydan-toin could suppress the promoting effect of GHRH in rabbits.
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Objective To study the iodine deficiency disorders (IDD) situation in Wenzhou City during 1995-2014.Method According to National IDD Surveillance Project,IDD surveillance had been consecutively carried out during the past 20 years,which consisted of goiter rate in 8-10 years old children,iodized salt and urinary iodine levels.Results The goiter rate of 8-10 years old children was decreased from the highest of 31.09％ (2 190/7 043) in 1995 to the lowest of 2.28％ (77/3 378) in 2014;the highest level of median urinary iodine was 214.78 μg/L,and the lowest level was 74.48 μg/L,and which was increased from 74.48 μg/L in 1995 to 187.00 μg/L in 1996,and then had been maintained at the appropriate level recommended by World Health Organiation (WHO),except that in 1998,2003,2004 and 2006.The qualified rate of iodized salt was increased from 54.95％ (1 471/2 677) in 1996 to 95.52％ (2 548/2 754) in 1999,but decreased to 62.75％ (768/1 224) in 2003,however it was fluctuated from 78.61％ (2 503/3 184) to 92.48％ (2 989/3 232) from 2004 to 2013,and it was 90.43％ in 2014 (2 983/3 300).Conclusions The comprehensive measures for controlling IDD,with universal salt iodization,has been gradually achieved remarkable effect in Wenzhou City,but the non-iodization salt existing in the market is still a problem,and people have misunderstandings about iodization salt.Iodine supplementation had better be conducted according to local conditions and based on scientific policy.
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Objective To explore the relationship of sevoflurane neurotoxicity with the expres-sion of Bid,Bim,Puma.Methods The cortical neuron from newborn SD rat (within 24 h)were see-ded in 6 or 12 well plate,and then randomly divided into 4 groups.Rat culture cortical neurons in vitro exposed in 1%,2%,4% and 0% sevoflurane for 6h were divided into A,B,C and D group. The effect of neuron viability,death and apoptosis were assessed using CCK-8,LDH and caspase-3 cleavage 1 7kDa expression assay.The expressions of Bid,Bim and Puma were assessed by western blot.Results Compared with group D, there were significant increases of neuron death and apoptosis,but a decrease of neuron viability,and upregulated expressions of Bid,Bim and Puma in group B (P <0.05);Compared with group B,Group C had increased death and apoptosis and de-creased viability of neurons,as well as upregulated expressions of Bid,Bim and Puma (P <0.05 ). Conclusion Along with the increase of the concentration,sevoflurane neurotoxicity was increased by upregulation of Bid,Bim,Puma expression.
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Objective To understand the dynamic conditions after reaching the stage goal of elimination of iodine deficiency disorders (IDD) in Wenzhou, and to provide a scientific basis for prevention and treatment of IDD. Methods Three counties that the annual consumption rate of qualified iodized salt < 80% in 2014 and had the prevalence of endemic cretinism in history, Cangnan, Taishun and Yongjia, were selected as high risk monitoring areas. Three townships were selected in each area, and two primary schools were selected from each township, and 40 children urine samples were collected in each school (half male and half female) and the age of children were 8-10 years old. And near the location of these primary schools, we randomly selected 10 pregnant women in each village, and estimated the urinary iodine level and salt iodine concentration, respectively. The examination of thyroid by B ultrasound was performed in children by provincial professionals. Urinary iodine was determined using the arsenic cerium catalytic spectrophotometric method (GB/T 13025.7-2012). Salt iodine was determined by direct titration. Results Endemic cretinism case was not found in this survey, total goiter rate of 8-10 years old children was 2.04%(16/783). The median of urinary iodine was 116.1 and 108.2 μg/L, respectively, in 8 - 10 years old children and pregnant women. Iodized salt coverage rate was 90.48%(171/189), the intaking rate of qualified iodized salt was 84.66% (160/189). The concentration of pregnant women urinary iodine and salt iodine was positively correlated (r=0.54, P< 0.05). Conclusions Children's iodine nutrition is in the appropriate level, but pregnant women are in iodine definciency in Wenzhou City.
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Objective To investigate effects of two doses of dexmedetomidine (Dex) on the recovery quality from general anesthesia undergoing thyroidectomy.Methods A prospective randomized controlled double-blind trial was conducted in 90 patients admitted to Shengjing Hospital of China Medical University who were scheduled for thyroidectomy.They were randomly divided into three groups:group D0.4 received Dex 0.4 μg/kg intravenously,group D0.8 received Dex 0.8 μg/kg intravenously,and control group with same volume of normal saline.There were 30 patients in each group,and all the patients received the above drug or saline 30 minutes after intubation.The heart rate (HR),systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded before Dex administration,at the end of surgery,time of eye opening and extubation,and 10 minutes after extubation.Time of eye opening after surgery and time of extubation after eye opening were recorded.End-tidal partial pressure of carbon dioxide (PETCO2) before and after operation as well as restlessness score (RS),Ramsay sedative score,and visual analogue pain scale (VAS) scores at 10 minutes after extubation were recorded.Events during extubation including cough,nausea and vomiting,respiratory depression were also recorded.Results ① Compared with control group,in D0.4 and D0.8 groups incidence of lowering of HR,SBP and DBP was lower at time of eye opening and extubation,and 10 minutes after extubation.Compared with D0.4 group,D0.8 group had lower HR at the time of extubation and 10 minutes after extubation,SBP was lower at the time of eye opening and extubation,and lower DBP at the time of eye opening.② D0.4 and D0.8 groups showed lower RS and VAS scores than those of control group,Ramsay sedative score in groups D0.4 and D0.8 was higher than that in control group (RS:1.40±0.51,1.20±0.42 vs.1.90±0.56; VAS:1.50±0.52,0.80±0.63 vs.2.50 ± 0.52; Ramsay:2.10 ± 0.56,2.40 ± 0.51 vs.1.60 ± 0.51,P＜0.05 or P＜0.01),and VAS score in group D0.8 was lower than that in D0.4 group (P＜0.01).The time of eye opening and extubation were longer in group D0.8 as compared with those in control and D0.4 groups (minutes:12.50 ± 1.08 vs.10.50 ± 1.58,10.40 ± 1.26; 15.00 ± 0.94 vs.13.00 ± 1.63,12.80 ± 1.13,P＜0.05 or P＜0.01),but there was no significant difference between the latter two groups.No significant difference in PETCO2 was found among three groups before and after surgery.③ The incidence rate of cough,nausea and vomiting in control group (16.7％,13.3％) were significantly higher than those in groups D0.4 (3.3％,0) and D0.8 (0,0).There was no respiratory depression in the three groups.Conclusion Adjunctive infusion of Dex 0.4 μg/kg at 30 minutes after anesthesia induction was recommended as it may result in more steady hemodynamics,with shorter recovery time and extubation time after thyroidectomy.
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Objective To evaluate the feasibility, methods and effectiveness of using a mechani-cal stapler for choledochojejunostomy.Methods The authors have operated on 118 patients in the management of carcinoma of head of pancreas, or periampullary tumor, or cholelithiasis.In the opera-tion, the bilio-enteric end-to-side, or end-to-end and side-to-side anastomosis was made by a circular stapler device, and then a Roux-en-Y or Brown's loop was formed for the preeedure.Results All the surgery of using stapler was done successfully.No postoperative complications such as stomal leak, bleeding and narrow were found.Meanwhile, no harmful consequences were observed through long-time follow-up.Conclusion Using mechanical stapler for bilio-intestinal anastomosis is time-saving, simple and reliable.It can be a choice for some diseases.
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BACKGROUND: One unit of umbilical cord blood does not have a sufficient number of peripheral blood stem cells to meet the requirements of transplantation in adults. One solution of this problem is their ex vivo expansion, which requires not only a longer time and higher culture conditions, but also easily leads to the differentiation of stern cells, thus affecting the effects of transplantation. OBJECTIVE: To transduce human interleukin-3(IL-3) gene into umbilical cord blood CD34" cells and to observe IL-3 expression. DESIGN, TIME AND SETTING: A cell-genomics in vitro experiment was performed in the Chengde Medical College in 2008. MATERIALS: Human peripheral blood mononuclear cells (PBMC) of healthy adult were provided by Chengde Blood Center, and umbilical cord blood was provided by Chengde Maternal and Child Care Hospital. Written informed consent was obtained from each donor. METHODS: Peripheral blood mononuclear cells were isolated by Ficoll gradient centrifugation and umbilical blood CD34+ cells were isolated using immunomagnetic beads method. IL-3 mRNA was extracted. IL-3 cDNA was synthesized by RT-PCR, and IL-3 cDNA was subcloned into eukaryotic expressing vector pcDNA3. In the experimental group, pcDNA3/IL-3 vectors were transduced into umbilical cord blood CD34+ cells, while in the control group, transfection was not performed. MAIN OUTCOME MEASURES: Detection of IL-3 level in umbilical cord blood CD34" cells suspension using ELISA kits. RESULTS: Theoretically, the amplified IL-3 cDNA was 616 bp, and actually, after agarose gel electrophoresis, the PCR products exhibited a strip with expected size under ultraviolet ray. Extraction of IL-3mRNA was successful and reversely transcripted cDNA was complete. A 616-bp inserted fragment was observed by agarose gel electrophoresis after double digestion with BamH Ⅰ and Xba Ⅰ, and it was the same as IL-3 sequence. Within 1-7 days after transfection, IL-3 level in the umbilical cord CD34+ cells suspension was significantly higher in the experimental group than in the control group (t = 3.46, P < 0.05). CONCLUSION: IL-3 cDNA was successfully cloned, and eukaryotic expressing plasmid pcDNA3/IL-3 that could be effectively expressed within short term in umbilical cord CD34+ cells was successfully constructed.
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The clinical medical work is accompanied with high risk .The medical treatment risk exists everywhere at anytime, but the graduate students of the Medical colleges lack the understanding of the hygiene laws. Therefore it is necessary for them to accept the education of hygiene law.
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Objective Because of local infiltrated growth and spread,the operative resection of hilar (cholangiocacinoma) is very difficult. Recently,combined extended hepatectomy and vascular resection had been performed for treatment of hilar cholangiocarcinoma and has greatly increased the resection rate and survival rate.However, it is associated with high operative morbidity and mortality. The aim of this study is to explore a reasonable hepatic resection strategy, that is safe and beneficial for the patient. Method Sixteen (consecutive) cases of hilar cholangiocarcinoma with involvement of hilar vessels have been treated in our hospital since 1977. En bloc resection of the hilar tumor that included hepatic segment I,IV and involved blood (vessel), as well as hepato-duodenal ligament skeletonization was performed in 15 patients. Results All 15 cases were successfully operated on with a resection rate of 93.8%, and 12 cases with R_0 resection. The operative mortality and in-hospital mortality rate were 0. Temporary bile leak and abdominal infection (respectively) developed in 1 patienteach,with an overall morbidity of 13.3%,and both were cured by non-(operative) therapy. No case of liver failure occurred. Follow up showed the median survival was 22 months and 7 are still alive. Conclusions (1)The resection rate and survival rate for hilar cholangiocarcinoma could be improved by combination of liver and hilar vascular resection.(2)Hilar cholangiocarcinoma mainly spreads to the medial segment(S4) and caudate(S1), and these segments need to be resected in the combined (operation).(3)Although resection of the middle part of liver takes little more time than hemi-hepatectomy and trisegmentectomy, it could preserve more liver parenchyma and reduce postoperative morbidity (such as liver failure) and mortality rates.(4)The resection of the hilar blood vessel involved by tumor was necessary to improve the resection rate and cure rate. Reconstruction of the blood vessel was made selectively by taking the circumstances into consideration.
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Aim To investigate the effects of bradykinin preconditioning on the damage produced by focal cerebral ischemia-reperfusion in rats.Methods Rats were scheduled to undergo middle cerebral artery ischemia-reperfusion by intraluminal suture.Prior to ischemia,bradykinin was pumped into the brain via extra carotid artery and control group was given the same amount of normal saline.The infarct volume、brain water content、permeability of blood brain barrier and histological neuronal changes were evaluated after 2 h ischemia and 24 h reperfusion.Results Compared with other groups, bradykinin preconditioning 15min before ischemia reduced infarct volume、brain edema、permeability of blood brain barrier and histological neuronal damage.Conclusion Bradykinin preconditioning may provide protective effects against cerebral ischemic injury.This protection may be due to the protection of cerebral vasculature and the decrease of infarct volume.