Efficacy of infliximab combined with surgery in the treatment of perianal fistulizing Crohn disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of infliximab combined with surgery in the treatment of perianal fistulizing Crohn disease (CD).</p><p><b>METHODS</b>Clinical data of 15 patients with perianal fistulizing CD receiving infliximab combined with surgery in the Affiliated Hospital of Nanjing University of Chinese Medicine from March 2010 to June 2011 were analyzed retrospectively. One week after operation, all the patients received infliximab infusion thrice at weeks 0, 2, and 6. Crohn disease activity index (CDAI), perianal Crohn disease activity index (PDAI), body mass index (BMI), routine blood test and endoscopy were evaluated at week 0, 14. Adverse reactions and healing time were recorded.</p><p><b>RESULTS</b>At week 14, the response rate was 100% with 86.7% (13/15) complete responders. One patient had local improvement and one developed recurrent fistula. The mean healing time was 32.5 (20-45) d. Anorectal stenosis in 4 patients was significantly improved. At week 14, CDAI decreased to 114.0±90.3 from 230.5±97.5 after IFX treatment. PCDAI decreased to 2.8±3.2 from 9.9±3.4, and BMI increased to (21.5±3.0)kg/m(2) from (19.1±3.1)kg/m(2). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), platelet and neutrophil were significantly decreased from baseline (all P<0.01). Intestinal mucosa healed completely in one patient. There were no serious adverse events except hypokalemia in one patient and severe infusion reaction in another.</p><p><b>CONCLUSION</b>Infliximab combined with surgery is effective and safe for perianal fistulizing CD.</p>

Effects of Baicalin on an orthotopic transplantation mouse model of mismatch repair gene deficient colorectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To study the anticancer effects of Baicalin on an orthotopic transplantation mouse model of mismatch repair gene deficient colorectal cancer.</p><p><b>METHODS</b>Sixty orthotopic transplantation mice model of human colon cancer cell line HCT-116 expressing eGFP were established, which were divided randomly into negative controlled group (5% NaHCO3) and 50, 100, 200 mg/kg Baicalin groups. The nude mice were treated with intragastric infusion twice a day. Nude mice growth state, average weigh, inhibition rate of transplanted tumor, tumor metastasis and survival state were observed.</p><p><b>RESULTS</b>At 14, 21 and 28 days after treatment with different dose of Baicalin, tumor growth velocity was significantly slower in the treatment groups, and tumor volume was significantly smaller than the controlled group (there were (832 ± 637), (2012 ± 1566) and (2494 ± 1557) mm(3) respectively in 14, 21 and 28 days) (F = 4.433, P < 0.05). At the end point of study, survival state of 100 mg/kg group (13/15) was superior to controlled group (8/15) and 200 mg/kg group (8/15) (χ(2) = 4.665 and 3.980, P < 0.05).However, there were no significant differences in tumor metastasis and tumor surface vessel density.</p><p><b>CONCLUSIONS</b>Baicalin has statistically significant effects in inhibiting tumor growth in an orthotopic transplantation mouse model of mismatch repair gene deficient colorectal cancer, and 100 mg/kg may be an ideal treatment dose.</p>

Defibrillation efficacy of a newly developed automated external defibrillator in a swine ventricular tachycardia/fibrillation model / 中华心血管病杂志

<p><b>OBJECTIVE</b>The aim of this study was to evaluate the recognition and defibrillation efficiency of a newly developed automated external defibrillator (AED).</p><p><b>METHOD</b>Ventricular tachycardia (VT)/ventricular fibrillation (VF) was induced by alternating current (50 Hz) through an electrode placed on apex of right ventricle in 23 anesthetized swine and recorded, recognized and defibrillated by a newly developed AED.</p><p><b>RESULTS</b>A total of 96 VF was induced and 145 defibrillations were recorded. We analyzed available 167 electrocardiosignal with a total length of 103,740 seconds. The accuracy, sensitivity and the specificity of the AED on VT/VF recognition are 99.5%, 98.2% and 99.6%, respectively. The success rate of defibrillation was 33.4% which increased in proportion to defibrillation energy. The defibrillation threshold of energy is 29.10-116.91 (78.75 +/- 35.64) J, the defibrillation threshold of electric quantity is (0.11 +/- 0.04) C and the defibrillation threshold of voltage is (1216.67 +/- 260.87) V.</p><p><b>CONCLUSIONS</b>This newly developed AED has high sensitivity and the specificity on recognizing VT/VF. The lower success rate of defibrillation of this AED is associated with the low defibrillation energy during defibrillation which needs to be improved on further development.</p>

Diagnosis on the preoperative staging of rectal cancer by magnetic resonance imaging with water-bag in rectum / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the accuracy of preoperative magnetic resonance imaging (MRI) with water-bag in rectum in prediction of pathological staging of rectal cancer.</p><p><b>METHODS</b>Clinical data of 19 patients with rectal carcinoma assessed by MRI with water-bag in rectum for tumour (T) and mesorectal nodal (N) staging were analyzed retrospectively. Preoperative MRI assessment was compared with postoperative histopathological findings.</p><p><b>RESULTS</b>The tumors were correctly staged by MRI in 15 patients, understaged in 2 and overstaged in 2. The accuracy of T stage was 78.9% (15/19). Mesorectal node were correctly staged in 11 patients, overstaged in 2 and understaged in 6. The accuracy of node staging was 57.9% (11/19), sensitivity was 3/9, and specificity was 80%(8/10).</p><p><b>CONCLUSION</b>Preoperative MRI with water-bag in rectum can not provide correct predictive data on mesorectal node stage, but has certain value in the T staging of rectal carcinoma.</p>

Application of magnetic resonance imaging in the diagnosis of complex anal fistula / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of magnetic resonance imaging (MRI) in the diagnosis of complex anal fistula.</p><p><b>METHODS</b>The preoperative digital examination and MRI with the phased-array coil were implemented for 28 patients who were clinically suspected with complex anal fistula. The final diagnosis were based on surgical findings. Outcomes of MRI and digital examination were compared with surgical results.</p><p><b>RESULTS</b>Twenty-five patients were diagnosed as complex anal fistula, 1 presacral cyst and 2 chronic anorectal fistula combined with perianal mucinous adenocarcinoma. All the patients were correctly diagnosed by MRI,while the patients with presacral cyst and perianal mucinous adenocarcinoma could not be diagnosed correctly by digital examination. According to the Parks classification, 3 patients were suffered from trans-sphincteric fistula, 10 intersphincteric, 5 supra- sphincteric and 7 extra-sphincteric. The diagnosis rates of the internal opening with digital examination and MRI were 48% and 84%, the rates of the primary tract were 76% and 100%, and the rates of the secondary extensions were 57.9% and 94.7% respectively. The differences in detection of internal opening, primary tract and secondary extensions between MRI and digital examination were significant (P<0.01).</p><p><b>CONCLUSION</b>MRI with the phased-array coil can correctly orient the internal opening and direction of the complex anal fistula, and find the relationship between anorectal sphincters and the complex fistula.</p>