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@#Objective To evaluate the data of preoperative aortic root CT angiography (CTA), compare it with two-dimensional transthoracic echocardiography and investigate the correlation of the two measurements with the actual intraoperative measurement data. Methods Clinical data of 53 patients with aortic valve diseases who underwent aortic valve repair in our hospital from January 2018 to August 2020 were retrospectively analyzed, including 38 males and 15 females with an average age of 42.9±18.3 years ranging from 10 to 77 years. Preoperative two-dimensional transthoracic echocardiography (TTE) and aortic root CTA measurements were collected, including aortic valve annulus (AVA), aortic sinus (Sinus) and sino-tubular junction (STJ). In comparison with the intraoperative measurements during the aortic valve repair surgery, the consistency analysis was performed. Results Both the preoperative echocardiography AVA measurements and the CT AVA measurements were positively correlated with the intraoperative AVA measurements (P<0.001). Compared with the echocardiography AVA data [correlation coefficient (ρ)=0.74, mean squared error (MSE)=12.78], the CT AVA data were more accurate and consistent with the intraoperative AVA measurements (ρ=0.95, MSE=2.72). CT AVA data had a higher correlation coefficient with the intraoperative measurements, compared to that of the echocardiography AVA data (P<0.001). Conclusion In comparison with two-dimensional transthoracic echocardiography, preoperative morphological evaluation of aortic root CTA is more consistent with the actual intraoperative measurements during aortic valve repair surgery.
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@#Objective To evaluate the short and mid-term outcomes of valve repair in patients with insufficient bicuspid aortic valves (BAV). Methods The clinical data of 27 consecutive patients with insufficient BAV undergoing valve repair in Shanghai Chest Hospital from September 2016 to January 2020 were retrospectively reviewed. There were 24 males and 3 females with a mean age of 38.5±14.6 years (range: 20-68 years). BAV of all patients was type 1 in Seviers' classification. There were 23 patients with left-right fusion and 4 patients with right-noncoronary fusion. There was aortic regurgitation in the patients measured by the echocardiogram, including moderate regurgitation in 3 patients, moderate-severe in 18 patients, and severe in 6 patients. The diameter of aortic annular base was 27.9±3.4 mm, and the largest diameter of aortic sinus was 39.9±7.6 mm. Left ventricular end diastolic diameter was 62.7±6.5 mm, and the volume was 197.9±53.6 mL. Results All 27 patients completed the follow-up, and the mean time was 24.2±12.5 months (range: 12-51 months). No patient died or required aortic valve-related reoperation during the follow-up. The cardiac function of the patients significantly improved postoperatively (P<0.05). By echocardiography, 11 patients had no aortic regurgitation, 13 had mild aortic regurgitation, and 3 had moderate aortic regurgitation, and no patient had severe aortic regurgitation. Postoperative left ventricular end diastolic diameter and volume decreased, compared to preoperative ones (P<0.05). Conclusion In patients with insufficient BAV, valve repair is safe and effective, and has excellent short and mid-term outcomes.
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Objective To explore the clinical application value of carbon nanoparticles labeled lymph node staining combined with artery approach in radical resection of sigmoid colon cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 40 patients with sigmoid colon cancer who were admitted to the Tumor Hospital of Zhengzhou University (Henan Cancer Hospital) from December 2015 to June 2016 were collected.Among 40 patients undergoing radical resection of sigmoid colon cancer,20 using nanometer carbon lymph node staining combined with artery approach and 20 using the traditional lymph node sorting were respectively allocated into the observation group and control group.Observation indicators:(1) detection of the lymph node and pathological examination;(2) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect adjuvant chemotherapy,tumor recurrence or metastasis and surgery-related complications up to June,2017.Measurement data with normal distribution were represented as (x)±s,and comparisons between groups were evaluated with the t test.Comparisons of count data were analyzed using the chi-square test.The comparisons of ordinal data were analyzed using the nonparametric test.Results (1) Detection of the lymph node and pathological examination:40 patients underwent successful radical resection of sigmoid colon cancer.The lymph node sorting time,total and average numbers of lymph node sorting,total and average numbers of lymph node with diameter ＜ 5 mm,cases with lymph node number ＜ 12 and numbers of the first,second and third stations lymph nodes were respectively (13.1±2.4) minutes,522,28.0±7.0,152,8.6±2.5,0,13.7±3.6,9.5±2.5,4.7±1.2 in the observation group and (18.4±3.5) minutes,239,13.0±3.0,64,3.9± 1.7,6,6.1 ± 1.6,6.6± 2.2,2.5± 1.0 in the control group,with statistically significant differences between groups (t =14.562,24.872,19.256,x2 =4.902,t =14.368,10.026,8.210,P＜0.05).The total number of positive lymph node,positive rate of lymph node,metastasis rate of patients,total and average numbers of positive lymph node with diameter ＜ 5 mm and numbers of the first,second and third stations positive lymph nodes were respectively 82,0.22％±0.13％,17/20,51,3.9± 1.9,4.2± 1.8,1.9±0.6,2.3± 1.2 in the observation group and 43,0.48％±0.18％,7/20,38,2.7±1.5,2.1±0.6,2.6±0.7,1.4±0.5 in the control group,showing no statistically significant difference in the positive rate of lymph node and number of the third station positive lymph nodes between groups (t =1.462,1.759,P＞0.05).There were statistically significant differences in the metastasis rate of patients,average number of positive lymph nodes with diameter ＜ 5 mm and numbers of the first and second stations positive lymph nodes between groups (x2 =10.417,t =7.264,4.682,3.410,P＜0.05).(2) Follow-up situations:40 patients were followed up for 12-18 months,with a median time of 16 months.Eighteen and 10 patients in the observation group and control group received postoperative adjuvant chemotherapy,showing a statistically significant difference between groups (x2=5.833,P＜ 0.05).Tumor recurrence or metastasis was respectively detected in 0 and 2 patients (1 with local recurrence and 1 with liver metastasis) in the observation group and control group,with no statistically significant difference between groups (x2=2.105,P＞ 0.05).During the follow-up,there was no surgery-related complication.Conclusion The carbon nanoparticles labeled lymph node staining combined with artery approach in radical resection of sigmoid colon cancer can increase the sorting rate and number of lymph node,and improve the accuracy of postoperative pathological staging.
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Objective: To investigate the expression of HSP-27,-60 and -90 in gastric cancer and its clinical significance. Methods:66 cases of gastric carcinoma was detected by immunohistochemistry HSP-27,60 and 90 of the expression and clinical significance of combined with clinical and pathological characteristics, tumor cell proliferation and survival analysis of three kinds of heat shock protein expression. Results: HSP-27,-60 and -90 were highly expressed in gastric cancer tissues. HSP-27 expression and tumor size (pT,P=0. 026),organ metastasis (pM,P=0. 046) and pathological staging (P=0. 041),HSP-27 staining intensity and lymph node status were significantly correlated ( pN, P=0. 042 ) . HSP-60 expression was associated with gender ( P=0. 011),and HSP-60 staining intensity was associated with age (P=0. 027) and tumor grade (P=0. 031). There was no correlation between HSP-90 expression and the clinical pathological parameters of this study; however, the intensity of HSP-90 staining was significantly correlated with tumor size (P=0. 020,pT). Single factor analysis showed that HSP-90 was significantly associated with longer survival (P=0. 033). Multivariate analysis demonstrated that HSP-90 was highly expressed as an independent prognostic factor for gastric cancer (P=0. 026). Conclusion: the HSP-27,-60 and -90 and some clinical pathological parameters. These parameters is very important for the treatment of patients with gastric cancer. The high expression of HSP-90 in patients with gastric cancer were inde-pendent prognostic indicators.
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Objective To develop a scale of assessing inpatient′s risk factors of chemotherapy drugs permeability. Methods Designed a questionnaire for expert information collecting based on literature review,and employed the Delphi method to develop a set of indicators to measure inpatient′s effective store seepage risk factors. Fifteen experts finished the 2-round survey. Results Expert's enthusiasm was high, the two rounds of enquiry for effective questionnaire recovery rate was 100%. Expert's authority was very high, the average duration of clinical practice was 23.8 years, the average duration of nursing management was 13.1 years, the rate of familiarity about this kind of research was 100%, the recognition degree in the accumulation of theoretical knowledge, the clinical practice and the home or abroad research degree was 93%, 100%and 73%respectively. Two rounds of enquiry for expert advice of Cronbach's alpha coefficient was 0.96 and 0.98 respectively, experts tend to agree that the scale had good consistency, high credibility, delivery system eventually formed contains, vein, the static drop time (static) chemotherapy, more routine chemotherapy, liquid type, drug factors, social support, cooperation degree, liquid volume, mission 11 dimensions such as level of understanding, the nurse puncture store effective seepage risk factors assessment of 42 items. Conclusion The inpatient′s effective store seepage risk factor assessment scale developed by using the Delphi method is reliable for assessing effective store seepage risk factor of hospitalized patients .
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Objective To analyse the effect of irinotecan hydrochloride injection on serum glutathione peroxidase 3 (GPX3), and WNT1 induced signaling pathway protein 2 (WISP2) and fibroblast growth factor binding protein 1 (FGFBP1) in tumor tissue fluid of patients with advanced rectal cancer.Methods 90 patients who were diagnosed with advanced rectal cancer in the hospital were collected.All patients were randomly divided into experimental group and control group,control group were treated with oxaliplatin +calcium folinate +fluorouracil chemotherapy, and experimental group were treated with oxaliplatin +calcium folinate +irinotecan hydrochloride injection chemotherapy.The treatment were repeated every four weeks, a total of six times.The serum GPX3 content, and WISP2, FGFBP1 levels in tumor tissue fluid were detected in two groups pre-and post treatment.The clinical efficacy was evaluated.ResuIts Compared with control group, the serum level of GPX3 in experimental group increased significantly (P<0.05);WISP2 level in tumor tissue fluid of experimental group increased significantly (P<0.05);FGFBP1 level in tumor tissue fluid of experimental group decreased significantly ( P<0.05 ) .The total efficiency of experimental group was higher than that of control group ( 64.44%vs.42.22%;χ2 =4.46,P<0.05), and the clinical benefit rate of experimental group was significantly higher than that of control group(93.33%vs.75.56%;χ2 =5.41,P<0.05).ConcIusion The irinotecan hydrochloride injection could increased levels of serum GPX3 and WISP2 in tumor tissue fluid, reduce FGFBP1 level in tumor tissue fluid, which has good clinical curative effect.
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<p><b>OBJECTIVE</b>To investigate the ideal digestive tract reconstruction methods among three different surgical methods after radical gastrectomy of gastric cancer patients.</p><p><b>METHODS</b>A total of 123 patients who received elective radical gastrectomy for gastric cancer from February 2010 to August 2011 were prospectively enrolled and randomly divided into radical proximal gastrectomy and jejunal interposition group, radical proximal gastrectomy and esophageal with the posterior of residual-stomach group, and radical total gastrectomy and Roux-en-Y esophagojejunostomy group. Patients were followed up for 12 months. Symptoms of reflux esophagitis were observed, gastric emptying tests were done, liver and kidney function was also monitored. The quality of life was documented before operation, and one and twelve months after operation.</p><p><b>RESULTS</b>No significant differences were found among these three groups in the pH value of lower part of esophagus, the blood regular test results and the functional parameters of kidney and liver before and after operation(all P>0.05). Symptoms of reflux esophagitis was reported in 1(2.4%) patients in the jejunal interposition group, 10(24.4%) in esophageal with the posterial of residual-stomach group, and 7(17.1%) in the Roux-en-Y esophagojejunostomy group(P=0.017). There was 1(2.4%), 10(17.1%), and 8(19.5%) patients presented reflux of barium meal in these three groups, respectively (P=0.046). There were no statistically significant difference in PH at the distal esophagus(6.9±0.2 vs. 6.8±0.1 vs. 6.9±0.1, P=0.196). The quality of life was significantly improved one year after surgery in terms of general status, physical function, emotional function, fatigue, nausea/vomiting, pain, constipation, and diarrhea (all P<0.05), with the jejunal interposition superior than the other two methods.</p><p><b>CONCLUSION</b>Three methods of digestive tract reconstruction in radical gastrectomy of gastric cancer patients can improve the health status and the quality of life in gastric cancer patients. Radical proximal gastrectomy and jejunal interposition is the preferred method.</p>
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Humans , Anastomosis, Roux-en-Y , Anastomosis, Surgical , Digestive System Surgical Procedures , Esophagus , Gastrectomy , Gastric Emptying , Gastric Stump , Jejunum , Quality of Life , Plastic Surgery Procedures , Methods , Stomach Neoplasms , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To determine whether the prosthesis-patient mismatch has a deleterious impact on survival after mitral valve replacement.</p><p><b>DATA SOURCES</b>A comprehensive literature search of PubMed, Embase, and ScienceDirect was carried out. References and cited papers of relevant articles were also checked.</p><p><b>STUDY SELECTION</b>All articles published after January 1980 was initially considered. Non-English and non-human studies, case reports, and reviews were excluded from the initial search. References and cited papers of relevant articles were also checked.</p><p><b>RESULTS</b>A total of 8 retrospective cohort studies were identified for this review. The overall incidence of prosthesis-patient mismatch (<1.3 to <1.2 cm(2)/m(2)) after mitral valve replacement ranged from 3.7% to 85.9% (moderate prosthesis-patient mismatch (0.9 to 1.2 cm(2)/m(2)) in 37.4% to 69.5%, severe prosthesis-patient mismatch (<0.9 cm(2)/m(2)) in 8.7% to 16.4%). Four studies demonstrated an association of prosthesis-patient mismatch with reduced long-term survival, but the other four studies found no significant deleterious impact of prosthesis-patient mismatch after mitral valve replacement. No definite conclusion could be derived from these conflicting results.</p><p><b>CONCLUSIONS</b>Current evidence is insufficient to derive a definite conclusion whether mitral prosthesis-patient mismatch affects long-term survival because of the biases and confounding factors that interfere with late clinical outcomes. Goodquality prospective studies are warranted to evaluate the impact of mitral prosthesis-patient mismatch after mitral valve replacement in the future.</p>
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Humans , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation , Mortality , Mitral Valve , General SurgeryABSTRACT
ObjectiveTo practice second-level prevention of breast cancer, conduct serial experiments on blocking precancerous change of breast cancer thus reduce its incidence rate. MethodsAfter the segment resection of primary lesions the breast precancerous lesions with ductal hyporplasia (DH) atypical ductal hyperplasia (ADH) and ductal intraepithelial neoplasia (DCIS), lobular intraepithelial neoplasia (LCIS) ,detected hormone receptors ER, PR and c-erbB-2, P53 were detected. With individualized comprehensive treatment, the positive patients with ER and PR was treated with tamoxifen; the postmenopausal patients took anastrozole to reduce the levels of estrogen; the positive patients with c-erbB-2 were treated with chemotherapy and the combined treatment; the patients with preoperative diagnosis of malignant cells were taken with the ipsilateral axillary lymph node dissection; all patients were observed and followed up.ResultsThere were 126 cases of the breast precancerous lesions from 1992 to 2008, including 75 cases of ADH with the positive rates of ER and PR 86.6％, c-erbB-2 1.33％, P53 0; 51 cases of DCIS and LCIS with the positive rates of ER and PR 84.6％, c-erbB-2 4％ ,P53 4％ ; Axillary lymph node reactive hyperplasia were 0/9 - 0/18. ConclusionsBreast precancerous lesions of ADH, DCIS, LCIS are local symptoms of the systemic disease, the segment resection of primary lesions and comprehensive treatment ( endocrine, chemotherapy, radiotherapy) based on immunohistochemical expression are effective through which the incidence rate of breast cancer could be largely controlled or suppressed.