Safety analysis of definitive surgery for chronic radiation intestinal injury / 中华胃肠外科杂志

Objective: To investigate the safety of definitive surgery for chronic radiation intestinal injury. Methods: A descriptive case series study was performed. Clinical data of 105 patients who were diagnosed as chronic radiation intestinal injury, had complete data and received definitive surgery (the radiation-induced intestinal segment and digestive tract reconstruction) at Department of Gastrointestinal Surgery of Beijing Tsinghua Changgung Hospital from June 2016 to May 2020 were retrospectively analyzed. There were 30 males (28.6%) and 75 females (71.4%) with the median age of 58 years (P25, P75: 52, 64 years). Patients who had tumor recurrence or refused surgical treatment were excluded. According to the preoperative evaluation and clinical manifestations, to select the resection range. Outcome parameters: (1) preoperative evaluation (nutrition risk assessment and status of obstruction or fistula); (2) clinical manifestations and treatment strategies; (3) details of surgical parameters; (4) postoperative complications, and Clavien-Dindo classification III to V was defined as main moderate-severe complication. Results: (1) Preoperative evaluation: Eighty-eight patients (83.8%) developed symptoms of chronic radiation intestinal injury more than 1 year after the end of radiotherapy. Ninety-eight patients (93.3%) had preoperative NRS-2002 score ≥3, 74 patients (70.5%) received preoperative parenteral nutritional support, and the median time of nutritional support was 10.5 (7.0, 16.0) days. Sixteen patients (15.2%) received small intestinal decompression tube implantation due to severe obstruction. (2) Clinical manifestations and treatment strategies: Among 105 patients, 87 (82.9%) presented with obstruction and received definitive resection of the radiation-induced intestinal segment plus one-stage digestive tract reconstruction; 18 (17.1%) presented with intestinal fistula and all of them received definitive resection of the radiation-induced intestinal segment, intestinal fistula plus one-stage digestive tract reconstruction. Among above 18 patients with fistula, 3 patients with ileorectal stump fistula received pedicled pelvic closure of greater omentum at the same time; 4 patients had ileal vesical fistula, of whom 2 patients received cystectomy and bladder repair due to preoperative nephrostomy decompression, and the other 2 patients received transection of the small intestine proximal and distal to the fistula and anastomosis of the intestinal loop without fistula resection, intestinal fistula or bladder fistula repair. (3) The details of surgical parameters: Median operative time and intraoperative blood loss was 230 (180, 300) minutes and 50 (20, 50) ml respectively. Ninety-two patients (92/105, 87.6%) underwent ileocolonic anastomosis, and anastomosis on the hepatic flexure or splenic flexure colon were performed in 88 (83.8%) and 4 (3.8%) patients respectively. Ileoileal anastomosis was performed in 13 patients (12.4%). The anastomotic site of 92 patients (87.6%) was strictly located in the contralateral quadrant of the radiation field, and the anastomotic site of 13 patients (12.4%) was far from the radiation field. Nine patients (8.6%) had more than one anastomosis, 5 patients (4.8%) had less than 180 cm of residual small intestine, 7 patients (6.7%) underwent retrograde intestinal permutation, 4 patients (3.8%) underwent abdominal wall reconstruction surgery due to abdominal wall defects, and 87 patients (82.9%) had severe abdominal pelvic adhesions (grade 3-4 adhesions). Intraoperative complications occurred in 3 patients (2.9%), which were found in time and handled properly. The median postoperative hospital stay was 13.0 (12.0, 24.5) days, and all the patients had resumed oral feeding upon discharge. (4) Postoperative complications: Fourteen patients (13.3%) had 18 major complications (grade III to V). The incidence of postoperative anastomotic leakage was 5.7% (6/105), and the incidence of anastomotic leakage for ileocolon anastomosis and ileoileal anastomosis was 2.2% (2/92) and 4/13, respectively (χ(2)=17.29, P<0.001). The incidence of postoperative anastomotic leakage of intestinal fistula and intestinal obstruction was 3/18 and 3.4% (3/87), respectively (χ(2)=4.84, P=0.028). The mortality at 30 days after operation was 1.0% (1/105), after abdominal infection and septic shock caused by postoperative anastomotic leakage resulting in multiple organ failure. Conclusion: For chronic radiation intestinal injury patients with obstruction or fistula, definitive surgical treatment is feasible and safe with acceptable major complications.

Preliminary experience with Campath 1H induction combined with low-dose monotherapy of tacrolimus in small bowel transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To report preliminary experience of the protocol of combining Campath 1H induction with low-dose monotherapy of tacrolimus and no steroid in two cases of small bowel transplantation.</p><p><b>METHODS</b>Campath 1H 30 mg was infused during the small bowel transplantation, and the patients were given 1 gram of methylprednisolone followed by the Campath 1H and another gram of methylprednisolone before reperfusion. Tacrolimus was infused just after the reperfusion. The tacrolimus was administered from vein first and then from gut tract, the blood tacrolimus level was controlled at 10 to 15 microg/L within the first 3 months after the operation, and reduced to 5 microg/L thereafter.</p><p><b>RESULTS</b>The two recipients have survived more than 1 year, one received surgical closure of intestinal graft terminal stoma 13 months after the transplantation. One episode of indeterminate to mild acute rejection was verified by pathology through routine ileoscopical biopsy in each cases, and one episode of mild to moderate acute rejection occurred 8 months after the transplantation, and the patients recovered after low dose or bolus steroid therapy. The peripheral lymphocyte counts and monocyte counts decreased greatly after Campath 1H was given, and recovered very slowly thereafter. No sign of infection and graft versus host disease (GVHD) was found, and the grafted intestine achieved excellent function. The total parenteral nutrition was ceased on the day 21 and 14 after the operation, respectively, and the patients lived on oral intake to maintain nutrition status.</p><p><b>CONCLUSIONS</b>It's showed that the protocol combining Campath 1H induction with low-dose monotherapy of tacrolimus without steroid in small bowel transplantation can control graft rejection effectively without increasing the opportunity of infection, no sign of GVHD is found, and the grafted intestine could achieve excellent function.</p>

Ablation of the orifices of the pulmonary veins under direct vision by using the transballoon ultrasound ablation catheter for permanent atrial fibrillation with rheumatic valve disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the effect and possibility of surgical ablation of the pulmonary vein orifices under direct vision with transballoon ultrasound ablation catheter for patients with permanent atrial fibrillation and rheumatic valve disease.</p><p><b>METHODS</b>21 consecutive patients with rheumatic valve disease and permanent atrial fibrillation undergoing mitral valve replacement surgery were enrolled for this study from December 2002 to September 2003. All the cases were divided into 2 groups by whether or not receiving an additive pulmonary vein ablation procedure. The test group [6 male, 5 female, aged (51.55 +/- 7.83) years, atrial fibrillation duration (5.50 +/- 5.40) years, left atrial diameter (7.27 +/- 1.39) cm, LVEF (53.95 +/- 4.54)% and NYHA class II - IV] undertook a surgical isolation of the pulmonary vein orifices by using a transballoon ultrasound ablation catheter addition to routine mitral valve replacement. The control group [3 male, 7 female, aged (53.30 +/- 7.86) years, atrial fibrillation duration (4.50 +/- 3.47) years, left atrial diameter (6.74 +/- 0.62) cm, LVEF (56.91 +/- 3.78)% and NYHA class II - IV] received the valve replacement surgery alone.</p><p><b>RESULTS</b>There were not any complications in both groups. With an electrical cardioversion 3 months after the surgery, 73% patients in the ultrasound ablation group were free from AF over 1 year while only 10% patients in control group (P=0.003). During an average follow-up duration of (45.92 +/- 4.61) months, 63.6% were in sinus rhythm in ultrasound ablation group while none in the control group. Left atrial volume decreased significantly at 1 year after surgery compared to that at 3 months after surgery in the test group [(97.83 +/- 32.39) cm(3) vs. (150.78 +/- 52.32) cm(3), P<0.05], and the end systolic diameter (LAESD) and end diastolic diameter (LAEDD) also decreased [(4.12 +/- 0.39) cm vs. (5.09 +/- 0.98) cm, P<0.05, respectively], while there were no apparently changes in the control group.</p><p><b>CONCLUSIONS</b>Ablation of the orifices of the pulmonary veins under direct vision with transballoon ultrasound ablation catheter during mitral valve surgery seems effective to maintain sinus rhythm after electrical cardioversion and could be performed safely. The function of left atrial and cardiac output improved during long term follow-up of 46 months.</p>

Study on the water-soluble composition release of compound Danshen sustained-release tablet / 中国中药杂志

<p><b>OBJECTIVE</b>To study on the release of compound Danshen sustained-release tablet and the evaluate method of Chinese material medica compound sustained-release preparation.</p><p><b>METHOD</b>Rotating basket method and HPLC were employed.</p><p><b>RESULT</b>Through the determination of 6 time-point samples, the water-soluble compositions of compound Danshen sustained-release tablet had a Well-balanced release behavior with a zero-grade release model or Higuchi release model.</p><p><b>CONCLUSION</b>Compound Danshen sustained-release tablet had a zero-grade release model. The method was rapid and stable and could be applied to evaluate the water-soluble composition release of compound Danshen sustained-release Tablet.</p>

Surgical management of chronic radiation enteritis / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the surgical methods and the clinical results of chronic radiation enteritis.</p><p><b>METHODS</b>Treatments were applied to forty-nine cases of chronic radiation enteritis complicated with intestinal obstruction, enterocutaneous fistula, intestinal stenosis, intestinal bleeding, severe proctocolitis and intestinal perforation, among whom 47 cases received an average of 2.8 +/- 2.1 operations. Twenty-six cases received resection of the injured segment with primary anastomosis, fourteen cases received intestinal resection and proximal enterostomy, among whom 6 ostomies were permanent, and another 8 cases received secondary ostomy closure. The injured intestinal segments were spared in 7 cases.</p><p><b>RESULTS</b>Forty-seven among 49 cases were cured (success rate, 96%) with no anastomotic leakage. Two patients died.</p><p><b>CONCLUSIONS</b>Surgical complications of chronic radiation enteritis should be managed operatively. The operative method should be chosen according to the general condition of the patients and the complexity of the abdomen. Perioperative management and proper selection of intestinal segments for anastomosis are essential for the success.</p>

Non-composite combined liver and intestinal allotransplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To report the first case of non-composite combined liver and intestinal allotransplantation in China. The technical aspects of the case and pros and cons of such an approach versus composite technique were discussed.</p><p><b>METHODS</b>The patient suffered from short bowel syndrome and TPN-related liver damage. A non-composite technique was used in this case. During operation, the whole 380 cm intestine was transplanted with systemic drainage and aortic inflow, while the liver graft was placed in a piggyback fashion. Warm ischemic time of donor graft was 2 min and 30 seconds, and cold ischemic duration for intestinal and liver graft was 6 hours and 40 and 8 hours and 7 utes respectively. Postoperative immunosuppression management includes tacrolimus, methylprednisolone, MMF and Zenapax.</p><p><b>RESULTS</b>The recipient recovered smoothly with no evidence of rejection on days' follow up. Now he is maintained well on enteral nutrition.</p><p><b>CONCLUSION</b>Non-composite technique should be considered in adult recipients, especially those with a history of abdominal infections or multiple laparotomies.</p>

Allograft transplantation with compound tissue of two ears and skin of head and neck: A report of 1 case, China / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the possibility and efficacy of allograft transplantation in treating patient with huge tissue defect after radical giant malignant melanoma resection.</p><p><b>METHODS</b>A male person received blood type matching was chosen as donor. Immediately after the donor's brain death, allograft was excised with the depth to the layer intervenient between periosteum and epicranial fascia in calvaria, the superficial layer of deep temporal fascia in both sides of temporal regions, close to zygomatic bones and mandibles including masseter and auricles upon in face, and cervical soft tissues including sternocleidomastoid muscles, cervical and external jugular vessels of both sides were excised simultaneously. After being perfused with 4 degrees C UW solution through both common carotid arteries, the homograft was sheared and radiated with X-ray before being preserved in UW solution for further use. During the operation, both sides of external auditory meatus were anastomosed with ears firstly, and vessels were anastomosed end-to-end sequently, at last, the border of skin flap was sutured intermittently. Combined use of MMF, FK506, Prednisone and Zenopax was performed as post-operation immunosuppressive treatment. Clinical observations were made on the signs and symptoms of graft survival or rejection as well as blood FK506 concentrations and immunological indexes were tested in laboratory. Biopsies of graft were also made at 1 h, 4 h, 8 h, 7 d, 14 d and 30 d after operation.</p><p><b>RESULTS</b>The circulation of the graft was satisfactory, and the temperature and color of skin were normal. Primary healing of suture and hair growth about 0.8 cm in a month were observed. Skin Biopsies of every time had no found of hyperacute or acute rejection. The concentration of FK506 was maintained 20 mg/ml 1 month after the operation.</p><p><b>CONCLUSION</b>Allograft transplantation with compound tissue of head skin flap and ears is a kind of effective and safe treatment in repairing huge tissue defect. Good tissue matching and combined use of currently available immunosuppressants can prevent hyperacute and acute rejection efficiently.</p>

Insulin stimulates translocation of GLUT4 and glucose uptake in ischemic myocar dium in dog / 第二军医大学学报

Objective: To investigate whether insulin stimulates the translocation of glucose transporter-4 (GLUT4) and glucose uptak e in ischemic myocardium. Methods: Plasma concentration of gluc ose, lactate, free fatty acid and insulin were determined by autoanalyser, and G LUT4 was studied by Western blotting analysis. Results: Insulin increased GLUT4 significantly in sarcolemma of ischemic myocardium ［(25±4)% vs (40±6)%］, and GLUT4 content in intracellular membrane decreased proporti onally. The glucose uptake increased significantly in insulin-ischemic myocardi um. The uptake of insulin-ischemic myocardium was almost 2 times that of ischem ic myocardium. Conclusion: Insulin stimulation results in GLUT4 translocation and increases glucose uptake in ischemic myocardium. When myocardi al ischemia occurs, insulin is helpful in increasing myocardial glucose uptake a nd utilization.

Insulin stimulates translocation of GLUT4 and glucose uptake in ischemic myocar dium in dog / 第二军医大学学报

Objective: To investigate whether insulin stimulates the translocation of glucose transporter-4 (GLUT4) and glucose uptak e in ischemic myocardium. Methods: Plasma concentration of gluc ose, lactate, free fatty acid and insulin were determined by autoanalyser, and G LUT4 was studied by Western blotting analysis. Results: Insulin increased GLUT4 significantly in sarcolemma of ischemic myocardium ［(25±4)% vs (40±6)%］, and GLUT4 content in intracellular membrane decreased proporti onally. The glucose uptake increased significantly in insulin-ischemic myocardi um. The uptake of insulin-ischemic myocardium was almost 2 times that of ischem ic myocardium. Conclusion: Insulin stimulation results in GLUT4 translocation and increases glucose uptake in ischemic myocardium. When myocardi al ischemia occurs, insulin is helpful in increasing myocardial glucose uptake a nd utilization.