Study on the sensitivity of multi-slice spiral CT in diagnosis of lymph node metastasis in different lymph node stations of gastric cancer / 中华胃肠外科杂志

Objective@#To study the sensitivity of multi-slice spiral CT in the diagnosis of lymph node metastasis in different lymph node stations of gastric cancer.@*Methods@#A retrospective series of case study was employed in the research. Inclusion criteria: (1) patients undergoing preoperative abdominal CT scan plus enhanced examination, and data in the image archiving and communication system of Sun Yat-sen University Cancer Center; (2) patients undergoing total or subtotal gastrectomy plus D2 or D1+ lymphadenectomy, with more than 15 harvested lymph nodes and more than 1 metastatic lymph node confirmed by postoperative pathology; (3) WHO pathological classification defined as gastric adenocarcinoma; (4) no history of lymph node tuberculosis, giant lymph node hyperplasia, lymphoma or other diseases resulting in enlarged lymph nodes; (5) no history of gastrectomy; (6) no preoperative neoadjuvant therapy. Clinicopathologic data of gastric cancer patients at the Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center from January 2009 to December 2012 were retrospectively analyzed. Using the pathologically positive lymph nodes as a reference, the sensitivity of CT-positive lymph nodes was calculated (total number of positive image lymph nodes/total number of positive pathological lymph nodes) and complete coincidence rate (number of case defined as complete coincidence/number of case with positive pathologic lymph nodes; complete coincidence indicated that the number of positive image lymph nodes was consistent with the number of positive pathologic lymph nodes in each lymph node station). The χ2 test was used to compare the sensitivity of CT in the diagnosis of lymph node metastasis in each lymph node station.@*Results@#A total of 228 patients with pathology-proven gastric cancer were enrolled in the study, including 147 male and 81 female. The overall sensitivity of CT in diagnosis of metastatic lymph nodes in gastric cancer was 68.7% (1769/2576). The sensitivity of CT in diagnosis of lymph node metastasis of groups 1 to 8 from high to low was group 3 [81.1% (506/624)], group 7 [73.9% (246/333)], group 2 [70.3% (111/158)], group 6 [68.7% (248/361)], group 4 [68.1% (262/385)], group 8 [60.4% (116/192)], group 1 [53.8% (155/288)], group 5 [47.1% (82/174)]. The CT diagnostic sensitivity of group 3 was significantly higher than the overall level (χ2=37.689, P<0.001). The CT diagnostic sensitivity of group 5 was significantly lower than the overall level (χ2=34.387, P<0.001). The CT diagnostic sensitivity of group 1 was also significantly lower than the overall level (χ2=25.918, P<0.001). Significant differences were not found in the CT diagnostic sensitivity of group 2, 4, 6, 7, 8 compared with the overall level (all P>0.05). The complete coincidence rate was 56.9% (536/942) between pathological positive lymph nodes and CT positive lymph nodes. The highest complete coincidence rate was observed in group 3 (68.0%, 123/181) and the lowest was in group 1 (41.4%, 46/111), whose difference was statistically significant (χ2=9.673, P=0.002).@*Conclusion@#The sensitivity of CT in diagnosis of lymph nodes in different lymph node stations of gastric cancer is different.

Expression of NKCC1 and Na-K-ATPase in C57BL/6J mice with age-related hearing loss / 中国耳鼻咽喉头颈外科

OBJECTIVE Disturbance of K+ ion balance in inner ear is associated in age-related hearing loss. Our study is to investigate the role of NKCC1 and Na-K-ATPase in cochlea and auditory function regulated by with different expression of NKCC1 and Na-K-ATPase. METHODS Auditory threshold of young or old C57BL/6J mice was measured by auditory brainstem response(ABR). The expression of NKCC1 and Na-K-ATPase in mice cochlea were evaluated by reverse transcription polymerase chain reaction(RT-PCR) and western blotting. Furosemide and Ouabain were applied in vivo to inhibit NKCC1 and Na-K-ATPase in C57BL/6J mice. RESULTS C57BL/6J mice developed hearing loss at 12M by ABR threshold shifting to (75±10), (78±26) and (81±14)dB SPL at frequencies of 8, 16 and 32 kHz; PCR showed that the relative expression of NKCC1 and Na-K-ATPase mRNA in the aged group decreased, which were 0.52±0.06 and 0.35±0.04 times higher than those in the young control group, the difference was statistically significant(t =7.466 and 16.11, all P＜0.05). WB showed that relative expression of NKCC1 and Na-K-ATPase protein level in the aged group decreased by 0.79±0.02 and 0.68±0.05 times as much as that of the young control group, the difference was statistically significant(t =8.857 and 6.771, P all＜0.05). After applied with Furosemide and Ouabain to suppress the two ion transporters, the ABR threshold increased to (50±17), (53±21), (55±17)dB SPL and (56±6), (70±17), (73±6)dB SPL at frequencies of 8, 16 and 32 kHz. CONCLUSION In vivo experiment of C57BL/6J suggested that NKCC1 and Na-K-ATPase might be related to age related hearing loss.

Changes in clinicopathological features and survival after surgical resection for gastric cancer over a 20-year period at a single institution / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate changes in clinicopathological features and survival of patients with gastrectomy at a single institution in China.</p><p><b>METHODS</b>From January 1990 to December 2009, clinicopathological data of 2518 cases of gastric cancer patients who underwent surgical resection in the Sun Yat-sen University Cancer Center were analyzed retrospectively. The overall survival rate was determined using Kaplan-Meier method and log-rank test was used to determine significance. The prognosis was analyzed using univariate analysis and multivariate analysis by Cox proportional hazards model. Clinical features, pathological findings and survival differences were compared in this cohort between two consecutive periods(1990-1999 and 2000-2009).</p><p><b>RESULTS</b>The 5-year survival rates for the whole cohort and those undergoing radical resection was 48.1% and 53.7%, respectively. In the first period, the 5-year survival rate for the whole cohort and for patients undergoing radical resection was 40.1% and 45.7%. In the second period, the 5-year survival rates for whole cohort and for patients undergoing radical resection was 51.5% and 57.1%, respectively. For those who underwent radical resection, the mean number of lymph node dissection was significantly higher in the recent period (20.1±8.3 vs. 9.5±6.0, P<0.01). On multivariate analysis by means of the Cox proportional hazard model, age, location, tumor size, histological type, radical resection, lymphatic/venous invasion, depth of invasion, nodal status, number of retrieved lymph nodes, and treatment period were independent factors (P<0.05). The constitution, number of retrieved lymph nodes, and survival rate were all improved between the two intervals (P<0.05).</p><p><b>CONCLUSION</b>The overall survival rate has gradually increased in gastric cancer patients over the past 20 years.</p>

The difference of phonation patterns in vocal fold polyps and vocal nodules / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the difference of phonation patterns by dividing patients with vocal fold polyps and vocal nodules into two groups according to muscle tension patterns (MTP).@*METHOD@#Fifty-six patients with vocal fold polyps and vocal nodules were divided into two groups according to phonation with MTP or not by video strobolaryngoscopy.@*RESULT@#MTP could be found in 85% patients with vocal nodules and in 55.56% patients with vocal fold polyps. Significant difference was found in patients with/without MTP, and difference was also found in every type of MTP.@*CONCLUSION@#MTP lies in most patients with vocal nodules while only part of patients with vocal fold polyps, which indicated that vocal fold polyps and vocal nodules may demonstrate different phona

Correlation of VEGF expression with microvessel and microlymphatic density in sinonasal squamous cell carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the expression of VEGF in sinonasal squamous cell carcinoma and its correlations with microvessel density (MVD), microlymphatic vessel density (MLVD).@*METHOD@#The expression of VEGF, MVD and MLVD in 41 cases of sinonasal squamous cell carcinoma were detected by immunohistochemical technique.@*RESULT@#In the sinonasal squamous cell carcinoma, the positive rate of VEGF was 82.9% (34/41). The over expression of VEGF was related with tumor invasion, histological grading and lymphatic metastasis (P 0.05).@*CONCLUSION@#VEGF may participate in the metastasis of sinonasal squamous cell carcinoma through promoting vascularization in the tumors, but not promoting MLVD.

The effect of different positive end expiratory pressure on oxygen delivery after recruitment maneuvers in dogs with acute respiratory distress syndrome / 中华急诊医学杂志

Objective To explore the effect of different positive end expiratory pressures (PEEP) on oxygen delivery (DO2) after recruitment maneuvers (RM) in dogs with acute respiratory distress syndrome (ARDS). Method After ARDS models established in 15 dogs by oleic acid, static P-V (pressure-volume) curves were determined by low flow technique. Lower inflection point (LIP) was set by two-way linear regression methods. RM was operated with the pressure control method. ARDS dog models were randomly divided into three groups, namely PEEP 8 cmH2O group (group A), 12 cmH2O group (group B) and 16cmH2O group (group C) after RM (equivalent to pressure at4 cmH2O under LIP, 4 cmH2O near LIP, and 4 cmH2O above LIP, respectively). Hemodynamics and arterial blood gas analysis were monitored before RM, 0, 5, 10 and 15 min after RM. The recruited volume was measured by P-V curve method 15 min after RM and respiratory mechanics was also observed at the same time. Then DO2 was calculated. The quantitative variables were summarized as the mean and SD. The t-test was used to compare continuous variables between the two independent samples. One-way analysis of variance was used to compare variables among three groups. The level of significance was set at P＜0.05 for all the tests. Results In group A, the levels of PaO2 were significantly reduced 5 min, 10 min and 15 min after RM[(257 ± 23 )mmHg, (253±21)mmHg, and (255±19)mmHg] compared with PaO2 at 0 min [(322 ± 20) mmHg] (P＜0.05).But in group B and group C, the levels of PaO2 5 min, 10 min and 15 min after RM were not lower than level of PaO2 at 0 min after RM (P＞0.05 ). The levels of PaO2 in groups B and C were higher than that in group A at the same time (P＜0.05). The recruited volume distinctly increased with PEEP levels escalated [(50±12 ) mL, (124 ±15) mL, and ( 157 ±10)mL](P＜0.05). However, the increment in the recruited volume from PEEP 8 cmH2O to 12 cmH2O was dramatically greater than that from PEEP 12 cmH2O to 16 cmH2O.There was no significant difference in static compliance between group A and B [(14.3 ± 2.2) mL/cmH2O vs. (17.2±1.4)mL/cmH2O] (P ＞ 0.05 ). But compared with groups A and B, the static compliance in the group C significantly reduced(10.5 ± 0.9) mL/cmH2O ( P ＜ 0.05 ). The ratios of DO2 after RM to DO2 before RM were different at different levels of PEEP. The levels of DO2 after RM[( 1.15 ± 0. 11 ),( 1. 14 ± 0.12), ( 1.14 ± 0. 12) and ( 1.16 ± 0.11 )] increased more greatly than that before RM ( 1.00 ±0.09) in the group B (P ＜ 0.05 ). It did not occurred in the groups A and C. Conclusions The PEEP 12 cmH2O set at near the LIP after RM could be the optimal PEEP. Not only can it improve DO2 and the static compliance, but also maintain oxygenation and the recruited volume after RM.

Effects of low dose of hydrocortisone on circulating thymus-dependent lymphocyte apoptosis in patients with septic shock / 中华急诊医学杂志

Objective To investigate the effects of low-dose of hydrocortisone on circulating thymus-dependent lymphocyte (T lymphocyte) apoptosis in patients with septic shock. Method fifty-seven patients with septic shock admitted into ICU from January 2006 to January 2009 were prospectively randomized (random number) to treatment group and control group. Another 20 healthy volunteers and 18 patients with sepsis alone were included as external control groups.The patients of treatment group and control group were treated with low-dose of hydrocortisone and placebo,respectively. Samples of peripheral blood were taken from healthy volunteers and patients 0 hr,24 hrs,48 hrs,72 hrs and 168 hrs after onset of the disease to determine the circulating T lymphocyte apoptosis by using the assays of Annexin V and flow cytometry. Least significant difference t -test was used for multiple comparisons. Results The percentage of Annexin V-positive CD4+ T lymphocytes in the primary stage was (11.01 +4.52)% in septic shock patients, (4.41 + 1.45)% in healthy volunteers, and (7.87 + 3. 82)% in patients with sepsis alone. And in the initial setting, the percentage of Annexin V-positive CD4+ T lymphocytes in the septic shock patients was higher than that in healthy volunteers ( P < 0.05) and in patients with sepsis alone ( P < 0.05). The percentage of Annexin V-positive CD8 + T lymphocytes at the beginning was (11.33+19.62)% in septic shock patients, (9.62+8.32)% in healthy volunteers, and (13.09+ 15.84)% in patients with sepsis alone (P > 0.05 between three groups). The percentages of Annexin V-positive CD4+ T lymphocytes in control group after 24 his, 48 hrs and 72 hrs were(13.51+6.85)%, (19.39 + 6.63)% and (15.33+ 6.21)%, respectively. And the percentages of Annexin V-positive CD4+ T lymphocytes in treatment patients after 24 hrs, 48 hrs and 72 hrs were (17.4 + 7.21)%, (22.61 + 5.64)%, and (25.73 + 6.91)%, respectively. The percentage of Annexin V-positive CD4+ T lymphocytes in septic shock patients was higher than that in control groups ( P < 0.05). The percentages of Annexin V-positive CD8+ T lymphocytes in control group after 24 hrs, 48 hrs and 72 hrs were (11.49+ 11.73)%, (12.74+ 10.39)% and (13.28+ 16.6)%, respectively, and in the treatment group, those were (9.49 + 8.9)%, (15.32+18.17)% and (13.68+16.84)%, respectively (P >0.05 between two groups). In the meantime, the percentages of Annexin V-positive CDS'1' T lymphocytes in control group and in treatment group were (12.72+ 19.69)% and (13.88 + 13.28)%, respectively (P >0.05). Conclusions Low-dose of hydrocortisone could induce CD4+ T lymphocyte apoptosis and has no effects on CD8+ T lymphocyte apoptosis when it is used to treat septic shock.

The effect of lipopoly-saccharide on glutamine metabolism in the rat Kupffer cells / 肠外与肠内营养

Objectives:To observe the metabolism of glutamine in the rat Kupffer cells and the effect of endotoxin. Methods:The changes of glutamine concentrations were measured before and 24 h after the in vitro cultures of the rat Kupffer cells with or without the stimulations of lipopoly saccharide. Results:Consumption and utilization rate of Gln in Kupffer cells with no LPS were (225?24)?mol/L and (9 33?0 99)% repectively.When the concention of LPS was 10.00 mg/L,consumptoin and utilization of Gln were (4 937?289)?mol/L and (73.29? 4.72 )%. Conclusions:Glutamine is an important substrate of Kupffer cell metabolism in the rest and LPS activated conditions.

An experimental study of metabolic intervention of anti-TNF antibody in intra-abdominal infection complicated by multiple organ dysfunction syndrome / 肠外与肠内营养

Objectives:To observe the effect of metabolic intervention of anti TNF antibody on the hypermetabolism occurred in intra abdominal infection(IAI) complicated by multiple organ dysfunction syndrome(MODS). Methods:Twenty rabbits were operated on with cecal ligation plus puncture(CLP) inducing IAI and MODS and were randomly divided into two groups, one receiving the anti TNF serum raised against TNF ?(anti TNF group) at 0.5?h after CLP and another receiving the non specific serum (control group). All animals were placed in metabolic cages and maintained with intravenous infusion for the observation period of one week. Serum levels of cytokines(TNF, IL 6), hormones (cortisol, insulin, glucagon), biochemical indexes (glucose, cholesterol, triglyceride, albumin) and daily excretions of urea nitrogen (UN),creatinine (Cr) and 3 methylhistidine (3 MH) were dynamically determined for 7 days. The death of animals was also recorded. Results:Compared with the control group, the levels of serum TNF, IL 6 and cortisol were significantly decreased and the levels of insulin and glucagon were kept normal after the injection of immune serum in anti TNF group, with significant improvements of biochemical indexes and decreased excretions of UN, Cr and 3 MH in urine. The survival rate was significantly increased in the anti TNF group. Conclusions:The anti TNF antibody can attenuate the metabolic abnormalities of IAI and MODS, being of the metabolic intervention on the hypermetabolism.