Treatment strategy for gastrointestinal tumor under the outbreak of novel coronavirus pneumonia in China / 中华胃肠外科杂志

The outbreak of the novel coronavirus pneumonia (NCP) has become a public health emergency in China. Chinese authorities and health agencies had devoted great efforts to control this disease. As surgeons specialized in the treatment of gastrointestinal tumors, we should always be aware of the prevention for NCP and incorporate this awareness into every detail of clinical practice. For the patients with gastrointestinal tumors, pre-admission screening should be done in order to rule out NCP. Real-time RT-PCR panel and chest CT scan should be conducted for patients with fever (>37.3℃), travel history to Hubei Province within 14 days, or contact history with residents from Wuhan district within 14 days. Prevention measures for both medical staffs and the screen-negative admitted patients should also be enhanced because false negative is possible. Medical instruments should be properly discarded or disinfected according to standardized procedures established by the local center for disease control and prevention (CDC). Surgical operation should be reduced at a minimal level to prevent cross infection in this special period.Surgical intervention for benign tumor should be postponed. For malignant tumor, multidisciplinary therapy (MDT) is recommended and non-surgical anti-tumor therapy should be selected with higher priority. Neoadjuvant therapy is highly recommended for gastrointestinal cancer at advanced stages that meet the indications of NCCN guideline (gastric cancer T stage ≥ 2/rectal cancer T stage ≥ 3/unresectable colon cancer). Gastric or esophagogastricjunction (EGJ) malignant tumor with obstruction can be managed with gastric tube decompression or stent placement to relieve the symptoms. Transnasal enteral feeding tube intubation/percutaneous endoscopic gastrostomy could be adopted to ensure enteral nutrition supply. For colorectal malignancy with simple intestinal obstruction, stent placement can achieve a high success rate, which not only helps avoid emergency surgery, but also creates a better condition for subsequent surgery. Transcatheter arterial embolization for hemostasis is an alternative choice for gastrointestinal tumor with bleeding. However, emergency operation still must be performed for patients with acute uncontrolled bleeding, obstruction or after other alternative treatment measures fail. All cases with suspicious or confirmed with NCP must be reported to the local CDC department. All invasive intervention must be performed in a designated isolation area. Tertiary prevention measure must be adopted for all anesthetists with additional face mask or medical goggle protection to prevent respiratory droplet transmission. Preventive enterostomy is preferable in lower digestive tract surgery. Thoroughly disinfecting the operating room after surgery is necessary. Fever after surgery must be carefully differentiated whether it's caused by post-surgery abdominal infection/inflammation or NCP. Single-room isolation and related examinations should be performed according to the standard procedures. We believe that with the unprecedentedly joint efforts of doctors and patients, we will eventually win this war against NCP.

Diagnostic value of P2X7 receptor and its role in inflammatory reaction in rheumatoid arthritis / 南方医科大学学报

OBJECTIVE@#To study the diagnostic value of P2X7 receptor for rheumatoid arthritis (RA) and its role in the inflammatory response.@*METHODS@#With the synovial tissues from 25 patients with bone and joint replacement as the control,the synovial tissues of 25 RA patients were examined for the relative expression of P2X7 receptor mRNA using qRT-PCR.In an immortalized RA synovial cell line (MH7A),the effect of P2X7 receptor knockdown via a small interfering RNA were examined on the productions of the inflammatory cytokines including interleukin-1β(IL-1β),IL-6,and IL-8 using ELISA.@*RESULTS@#The RA patients showed significantly higher levels of P2X7 receptor mRNA expression in the synovial tissue than the control patients.P2X7 receptor had a good diagnostic value for RA.The expression levels of IL-1β,IL-6,and IL-8 were positively correlated with the levels of P2X7 receptor in the synovial tissues of RA patients (<0.001).In MH7A cells,P2X7 receptor knockdown obviously reduced the secretion of IL-1β and IL-6.@*CONCLUSIONS@#RA patients show elevated P2X7 receptor level in the synovial tissue, which has a good diagnostic value for RA.Blocking P2X7 receptor can inhibit inflammatory factor secretion and suppress inflammatory reactions.

Complications analysis of subcutaneous venous access port for chemotherapy in patients with gastrointestinal malignancy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To describe and analyze the complications of subcutaneous venous access port for patients with gastrointestinal malignancy.</p><p><b>METHODS</b>Data of 1 912 patients with gastrointestinal malignancy who accepted chemotherapy in our department via subcutaneous venous access ports, including 127 cases in upper arm, 865 cases in subclavicular vein and 920 cases in internal jugular vein, from June 2007 to April 2016 were analyzed retrospectively. Associated complications and risk factors were emphatically investigated.</p><p><b>RESULTS</b>Postoperative complications were confirmed in 233 patients(12.2%), and complication morbidity was 37.0%(47/127), 15.5%(134/865), 6.7%(62/920) in upper arm group, subclavicular vein group, internal jugular vein group respectively, whose difference was statistically significant (χ=71.060, P=0.000). Sixty-one(3.2%) patients developed early complications (in the day of insertion, including catheter dislocation, pneumothorax, arterial damage). Early complication morbidity of upper arm group (14.2%, 18/127) was higher as compared to subclavicular vein group (3.4%, 29/865) and internal jugular vein group(1.5%, 14/920) with significant difference (χ=57.867, P=0.000). Postoperative long-term complications (catheter dislocation, thrombosis, pinch-off syndrome, infusion base exposure, catheter detachment) were found in 182(9.5%) patients. Morbidity of long-term complication was 5.2%(48/920) in internal jugular vein group, which was significantly lower than 22.8% (29/127) in upper arm group and 12.1% (105/865) in subclavicular vein group with statistically significant difference (χ=50.828, P=0.000). Multivariate analysis indicated that subclavicular vein intubation (OR=0.536, 95%CI: 0.341 to 0.843; P=0.007 OR=0.156, 95%CI: 0.096 to 0.253, P=0.000), internal jugular vein intubation (OR=0.156, 95%CI: 0.096 to 0.253, P=0.000), operation time <40 minutes (OR=0.458, 95%CI: 0.342 to 0.613, P=0.000) and standardized training (OR=0.233,95%CI: 0.171 to 0.318, P=0.000) were protective factors of postoperative complication; besides, subclavicular vein intubation (OR=0.458, 95%CI: 0.342 to 0.613, P=0.000), internal jugular vein intubation (OR=0.233, 95%CI: 0.171 to 0.318, P=0.000) and standardized training (OR=0.313, 95%CI: 0.173 to 0.568, P=0.000) were protective factors of thrombosis.</p><p><b>CONCLUSIONS</b>Subcutaneous venous access port implantation is a preferable access to central vein. Appropriate intubation approach and standardized training may reduce postoperative complications effectively. Internal jugular vein approach is safer and more reliable than upper arm vein and subclavian vein approach.</p>

Minimally invasive percutaneous plate osteosynthesis for Neer three-part fractures of proximal humerus in young adults / 中华创伤骨科杂志

Objective To evaluate the efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of Neer three-part fractures of the proximal humerus in young adults. Methods A retrospective analysis was performed of the 46 patients aged 0. 05 ) . The MIPPO group reported significantly shorter operation time ( 105 ± 15 min ) , significantly less intraoperative bleeding ( 140 ± 50 mL ) , significantly shorter fracture healing time ( 4. 2 ± 0. 6 months ) , and significantly higher shoulder Neer scores ( 88. 6 ± 3. 4 ) than the ORIF group ( 120 ± 20 min, 320 ± 40 mL, 5. 4 ± 1. 2 months, and 81. 6 ± 2. 2, respectively ) ( P 0. 05 ) . Conclusion MIPPO with LPHP may be obviously advantageous over ORIF with LPHP in the treatment of proximal humeral fractures in young adults.

Analysis of disease spectrum of village clinics patients in rural areas of Jiangsu Province / 中华医学科研管理杂志

We investigated the common diseases in patients from village clinics and compared them to those of the general population in rural areas of Jiangsu Province.We found that the treatment rates of chronic diseases such as hypertension and diabetes mellitus were quite low.Village clinics should play a more active role in health record management,healthcare education,and management of chronic diseases for the farmers.

Pathological characteristics of carcinoid tumors of the urinary bladder and its treatment (report of 4 cases) / 中华泌尿外科杂志

Objective To study the clinicopathological features,diagnosis and treatment of carcinoid tumors of the urinary bladder. Methods The clinical,histopathologic data of 4 carcinoid tumors of the urinary bladder were retrospectively analysed.The bladder carcinoid was diagnosed in 3 male patients and 1 female patient with age from 54 to 79 years.All patients were presented with gross hematuria,but with no clinical manifestations of the carcinoid syndrome such as flush,tachycardia,diarrhea.Cystoscopies showed 5 mm?5 mm to 25 mm?30 mm sessile polypoid masses. Results One patient received radical cystectomy followed by radiotherapy,3 patients received partial cystectomy.Two patients died of the tumor metastasis at survival interval 5 years and 3 months,respectively;other 2 patients were still alive 19 years and 8 months following the surgical treatment.Two cases were stage Ⅱ,and other 2 cases were stage Ⅲ.Histologically,tumor cells exhibited strong argyrophilia and electron microscopy revealed characteristic dense-core granules. Immunohistochemical testing showed the cancer cell was positive for chromogranin A and keratin. Conclusions Carcinoid of the urinary bladder is uncommon,the diagnosis depends on histopathological and immunohistochemical tests.Based on the degree of infiltration,size,location,lymph node metastasis,different surgical intervention can be choosed.