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1.
Chinese Journal of Surgery ; (12): 461-465, 2022.
Article in Chinese | WPRIM | ID: wpr-935622

ABSTRACT

Objective: To examine the clinical value of routine contrast esophagram (RCE) for the diagnosis of anastomotic leakage (AL) after three-incision esophagectomy with cervical anastomosis. Methods: Clinical data of 1 022 patients with esophageal cancer who underwent McKeown three-incision esophagectomy with cervical anastomosis from January 2015 to December 2019 at Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Hospital and Institute were analyzed retrospectively. There were 876 males and 146 females, aging(M(IQR)) 48(16) years (range: 36 to 84 years). There were 253 patients (24.8%) with neoadjuvant therapy, and 817 patients (79.9%) with minimally invasive esophagectomy. According to the diagnosis and treatment habits of the attending surgeons, 333 patients were included in the RCE group, and RCE was performed on the 7th day postoperative, while 689 patients were included in the non-RCE group, and RCE was performed when the patients had suspicious symptoms. Taking clinical symptoms, RCE, CT, endoscopy and other methods as reference to the diagnosis of AL, the sensitivity and specificity were used to analyze and evaluate the efficacy of RCE for the diagnosis of AL. The data were compared by U test or χ² test between groups. Results: The incidence rate of AL after three-incision esophagectomy was 7.34% (75/1 022), including 30 cases in the RCE group and 45 cases in the non-RCE group (9.0%(30/333) vs. 6.5%(45/689), χ²=2.027, P=0.155). The diagnostic time of AL was 9(5) days postoperative (range: 4 to 30 days). Among them, 23 cases showed cervical leakages, 50 cases showed intro-thoracic leakages, and 2 cases both cervical and intro-thoracic leakages. The diagnostic time of patients with intro-thoracic leakages was longer than that of cervical leakages (10(4) days vs. 6(3) days, Z=-2.517, P=0.012). Among the 333 patients in the RCE group, 16 cases of RCE indicated leakages including 11 cases of true positive and 5 cases determined to be false positive, while 317 cases indicated no abnormalities including 19 cases developed leakages. The sensitivity and specificity of RCE to detect AL were 36.7%(11/30) and 98.3%(298/333), respectively. The Youden-index was 0.35, and the diagnostic accuracy was 92.8%(309/333). The positive and negative predictive value were 11/16 and 94.0%(298/317), respectively. Conclusions: Routine contrast esophagram after three-incision esophagectomy with cervical anastomosis has low sensitivity and high specificity in the diagnosis of AL. The diagnostic time of AL is the 9th day after surgery. It is necessary to prolong the observation time clinically, and combine RCE with CT, endoscopy and other inspection methods for diagnosis.


Subject(s)
Anastomosis, Surgical/adverse effects , Anastomotic Leak/etiology , Esophageal Neoplasms/surgery , Esophagectomy/methods , Female , Humans , Male , Retrospective Studies , Surgical Wound/surgery
2.
Article in Chinese | WPRIM | ID: wpr-427277

ABSTRACT

Ectopic ACTH syndrome caused by adrenal pheochromocytoma is very rare.A case was herewith reported and the domestic and foreign literatures were reviewed.The correct diagnosis of the syndrome depends on clinical,biochemical,hormonal,radiographic,pathological investigations,as well as tumor immunohistochemistry for final comprehensive judgments.

3.
Article in Chinese | WPRIM | ID: wpr-329879

ABSTRACT

<p><b>OBJECTIVE</b>To explore the signal transduction mechanisms of apoptosis in renal tubular epithelial cells in diabetic rats with fluctuant high blood glucose.</p><p><b>METHODS</b>Healthy SD rats were randomly divided into 3 groups: normal control group (A), stable high blood glucose group (B) and fluctuant high blood glucose group (C). Diabetic rats were induced by intraperitoneal injection of streptozotocin (STZ, 65 mg/kg), and the fluctuant high blood glucose animal model was induced by intraperitoneal injection of ordinary insulin and glucose at different time point every day. The superoxide dismutase (SOD) activity and the content of malonaldehyde (MDA) in renal tissue homogenate were detected with colorimetry. The protein expression of Nox4 and JNK were examined by immunohistochemistry and Western blot. Apoptosis was assessed by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling (TUNEL).</p><p><b>RESULTS</b>After 12 experimental weeks, significantly increased cell apoptosis, up-regulation of Nox4 and P-JNK expression in renal tubular epithelial cells were observed in B and C groups compared with those in A group. The MDA content increased and SOD activity decreased in renal tissue in B and C groups. Above effects were more obviously shown in C group.</p><p><b>CONCLUSION</b>Fluctuant high blood glucose induced more apoptosis of renal tubular epithelial cell than stable high blood glucose in diabetic kidney, which might be related to the activation of JNK signal transduction pathway.</p>


Subject(s)
Animals , Apoptosis , Blood Glucose , Metabolism , Diabetes Mellitus, Experimental , Metabolism , Pathology , Epithelial Cells , Metabolism , Kidney Tubules , Cell Biology , MAP Kinase Kinase 4 , Metabolism , MAP Kinase Signaling System , Male , Malondialdehyde , Metabolism , NADPH Oxidase 4 , NADPH Oxidases , Metabolism , Rats , Rats, Sprague-Dawley , Superoxide Dismutase , Metabolism
4.
Article in Chinese | WPRIM | ID: wpr-390678

ABSTRACT

Objective To investigate the effect of matrix metalloproteinas-9 (MMP-9) and high sensitive C-reactive protein (hs-CRP) in type 2 diabetes mellitus (T2DM) combined with coronary heart disease(CHD). Methods Thirty-one patients with T2DM combined with CHD(T2DM combined with CHD group) ,50 patients with CHD (CHD group) and 30 healthy volunteers (control group) were studied. Serum MMP-9 was measured by ELISA, and serum hs-CRP was measured by scattering immunoturbidimetric assay. Results The level of MMP-9 in T2DM combined with CHD group (409.62 μg/L) was significantly higher than that in CHD group (263.40 μg/L) and control group [(196.15 ±44.89) μg/L] (P < 0.05).The level of hs-CRP in T2DM combined with CHD group (17.20 mg/L) was significantly higher than that in CHD group (4.57 mg/L) and control group [(1.52±0.78) mg/L] (P <0.01). MMP-9 wa significantly related with hs-CRP in T2DM combined with C HD group (r = 0.482,P < 0.01). Conclusion The serum M MP-9 and hs-CRP levels are closely associated with the occurrence and development of diabetes related coronary atherosclerosis.

5.
Chinese Journal of Geriatrics ; (12): 462-465, 2009.
Article in Chinese | WPRIM | ID: wpr-394147

ABSTRACT

Objective To explore the effect of repaglinide intensive treatment on islet β-cell function and long-term control of blood glucose in newly diagnosed type 2 diabetic patients. Methods Self-control and inter-group control prospective study was conducted in 80 newly diagnosed type 2 diabetic patients who were treated with short-term repaglinide intensive treatment and islet β-cell function was assessed by 75 g oral glucose tolerance test (OGTT) before and after repaglinide treatment. The changes of △I30/△G30 ratio, blood lipid, HOMA A and HOMA B were examined. Results After treatment, in successful group, middle group and defeat group, the fasting plasma glucose levels were decreased from 8.9±1.5, 8.6±1.6,9.0±2.0 to 5.0±1.4,6.3±0. 7,6.5±0. 9 mmol/L, 0. 5 h postprandial glucose levels were decreased from (12.6±1.6, 12.6±1.5, 12.4±1.3 to 8.4±1.0, 6.8±0. 7, 8. 6±0. 9)mmol/L,and 2 h postprandial glucose levels were decreased from (13.0±1.2, 13. 1±1.3, 13. 3±1.4 to 9.2±0.9, 6.6±0. 7, 9.2±0. 9)mmol/L,respectively (all P <0. 005). The ratio of △I30/△G30 was increased froml. 69±0. 31, 1.72±0. 33, 1.79±0. 36 to 4. 47±0. 62, 4. 42±0.46,12. 00±0.46 in the three groups, respectively (P<0.05). HOMA B was significantly improved (P<0. 05), while triglycerides and HOMA A were decreased(P<0. 05). The levels of fasting blood glucose and postprandial blood glucose in 21 patients were maintained within normal range for more than six months. There were significant differences in the ratio of △I30/△G30, age, repaglinide dosage and the time of reaching target of glucose [4.47±0.62 vs. 2. 0± 0.46; 39±8 vs. 56±9; 2.0±1.5 vs. 5.0±2.5; 32.4±8.0 vs. 53.3±7.6; all P<0.05] between successful group and defeat group. Conclusions The short-term intensive treatment with repaglinide can significantly improve the early secretion phase of insulin and the islet β-cell function, reconstruct of the physiological model of insulin secretion and relieve the disease.

6.
Article in Chinese | WPRIM | ID: wpr-397908

ABSTRACT

Objective To determine the serum level of Visfatin, and observe the effect of short-term treatment of rosiglitazone on it in the patients with type 2 diabetes mellitus. Methods Thirty-three patients with type 2 diahetes mellitus(diabetic group) who were inadequately controlled by suffonylureas were treated with rosiglitazone (4 mg/d) for 12 weeks. Twenty-seven sex-, age- and BMI-matehed non-diabetic subjects (control group) were studied. Determined blood pressure, Visfatin, triglyceride (TG), high density lipopro-tein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG),2-hoar postprandial glucose (2 h PPG), fasting insulin (FINS)in all subjects and free fatty acid (FFA), high sensitive C-reactlve protein (hs-CRP) and glyeosylated hemoglobin (GHbA1c), abdominal fat distribution before and after treatment with rosiglitazone in diabetic group respectively. Results The level of serum Visfatin was lower in diabetic group than that in control group [(24.53±9.22) μg/L vs (53.10±27.00)μg/L, P<0.01 ], and it was higher after treatment with rosiglitazone for 12 weeks, but there was no significant difference [(24.53±9.22)μg/L vs (32.62±24.89) μg/L, P>0.05]. Visfatin was correlated significantly with systolic pressure (r =-0.29, P=0.02), FPG (r=-0.40, P=0.001 ), 2 h PPG (r=-0.34, P=0.009 ),LDL-C (r=0.26,P=0.049) and FFA (r=0.44,P=0.009) respectively. In a linear stepwise regression analysis, FFA showed significant correlation with serum Visfatin levels (r2=0.30,f=7.707, P=0.009).Conclusions The level of serum Visfatin is lower in type 2 diabetes mellitus, and it is related significantly with glucose and lipid metabolic factors. The short-term treatment with rosiglitazone can't increase the serum concentration of Visfatin in the type 2 diabetes mellitua.

7.
Article in Chinese | WPRIM | ID: wpr-247361

ABSTRACT

<p><b>OBJECTIVE</b>To explore the relationship between type 2 diabetes mellitus (T2DM) and the mutations in the fragment of mitochondrial DNA (mtDNA) from nucleotides 3153 to 3551, which have shown high frequency of point mutation.</p><p><b>METHODS</b>One hundred and ninety-one normal controls and 222 patients with T2DM were screened by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), T-A cloning sequencing and denatured high performance liquid chromatography (DHPLC) techniques.</p><p><b>RESULTS</b>The prevalence of mtDNA mutations in the patient group (24.32%) was significantly higher than that in the control group (7.33%) (P < 0.05). Three novel mutations of A3209T, T3253G and A3467C were found, and C3497T was first reported in DM. Onset age, body mass index, fasting blood glucose, HbA1C, high density lipoprotein-cholesterol and diabetic nephropathy could be related to occurrence of mtDNA mutations (P < 0.05).</p><p><b>CONCLUSION</b>Mitochondrial DNA mutations might implicate T2DM in Wenzhou population, which should play an important role in the pathogenesis of T2DM.</p>


Subject(s)
Adult , Aged , Chromatography, High Pressure Liquid , DNA Mutational Analysis , DNA, Mitochondrial , Genetics , Diabetes Mellitus, Type 2 , Genetics , Female , Humans , Male , Middle Aged , Mutation , Polymerase Chain Reaction , Polymorphism, Restriction Fragment Length
8.
Article in Chinese | WPRIM | ID: wpr-592596

ABSTRACT

The rennin angiotensin system has been recognized for many years as a key regulator in systemic blood pressure and the metabolism of water and salt. Angiotensin converting enzyme 2(ACE2) is the first human homolog of angiotensin converting enzyme which efficiently hydrolyze the angiotensin Ⅱ to vasodilator angiotensin 1-7.ACE2 is now implicated in cardiovascular,renal, lung disease and serves as a receptor for Severe Acute Respiratory Syndrome coronavirus.

9.
Article in Chinese | WPRIM | ID: wpr-591655

ABSTRACT

OBJECTIVE To explore the risk factors and preventive measures of nosocomial infection among the diabetes mellitus patients with cerebrovascular accident.METHODS A retrospective survey on 574 diabetes mellitus patients with cerebrovascular accident was conducted.RESULTS The result showed that 126 of the 574 patients had nosocomial infection,the rate of infection was 22%.The risk factors of nosocomial infection included: age,hospitalized days,invasive treatment procedures and operation,application of antibiotics,course of diabetes mellitus,fasting plasma glucose(FPG),glycosylated hemoglobinA1C(HbA1C),clinical type of cerebrovascular accident,consciousness and bulbar palsy. The main infection sites were at lungs,urinary tract and intestines.The chief pathogens were Gram-negative bacteria.CONCLUSIONS Nosocomial infection is a high frequent complication in diabetes mellitus with cerebrovascular accident.Preventing and controlling the risk factors can reduce the rate of nosocomial infection among the diabetes mellitus patients with cerebrovascular accident.

10.
Article in Chinese | WPRIM | ID: wpr-538627

ABSTRACT

Urinary excretions of transforming grow th factor-? 1 (TGF-? 1), laminin (LN) and type Ⅳ collagen were determined i n 182 type 2 diabetic patients. Urinary excretions of TGF-? 1, LN and type Ⅳ collagen were increased in type 2 diabetic patients, and these findings were fa irly well correlated with severity of diabetic nephropathy (DN). Urinary TGF-? 1 seems to be the early index of DN, urinary LN and type Ⅳ collagen appear to be the indices of DN severity.

11.
Article in Chinese | WPRIM | ID: wpr-554011

ABSTRACT

Objective To study the relationship between u rinary,serum laminin (LN) and urinary albumin (Alb) in type 2 diabetes mellitus.Methods Urinary,serum LN and urinary creatinine (Cr) were measure d in 116 patients with type 2 diabeties mellitus and 31 normal controls .Results ①Urinary LN/Cr in DM microalbumi nuria (DMMA) group was higher than control group (group C) (P

12.
Article in Chinese | WPRIM | ID: wpr-676619

ABSTRACT

Diabetic rats were induced by intraperitoneal injection of streptozotocin.TUNEL and immunohistochemistry results showed that the renal tubular cell apoptosis index(AI)and Bax protein expression were significantly reduced,and the Bcl-2 protein expression in glomeruli was significantly increased in diabetic rats with stable hyperglycemia treated by benazepril compared with diabetic rats with stable hyperglycemia treated by vehicle(all P

13.
Article in Chinese | WPRIM | ID: wpr-558185

ABSTRACT

AIM: To investigate the effect of losartan on the mRNA expression of type 2 angiotensin II receptor and cytokines in diabetic rat kidney.METHODS: SD rats were randomly divided by following groups: control rats(group C),diabetic rats(group D) and diabetic rats treated with losartan (30(mg?kg~(-1)?d~(-1)),by gavage,group DT).At the end of 8-weeks study,mRNA expressions of the type 2 angiotensin II receptor(AT_2),transforming growth factor-?_1(TGF-?_1),platelet-derived growth factor-B(PDGF-B),tumor necrosis factor-?(TNF-?) and collagen Ⅳ in rats renal cortex were measured by RT-PCR,respectively.In addition,angiotensin Ⅱ level in renal cortex was determined by the radioimmunoassay.RESULTS: In group D,urine protein excretion(P

14.
Article in Chinese | WPRIM | ID: wpr-528974

ABSTRACT

AIM: To explore the effects of fluctuant high blood glucose and stable high blood glucose on apoptosis and the expression of Bax and Bcl-2 in glomerular endothelial cells and renal tubular epithelial cells in diabetic rats. METHODS: 24 SD rats were divided into 3 groups: control group, stable high blood glucose group and fluctuant high blood glucose group. Diabetic rats were induced by intraperitoneal injection of STZ, and the fluctuant high blood glucose animal model was induced by intraperitoneal injection of aspart and glucose at different time points every day. Apoptosis was assessed by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling (TUNEL), and immunohistochemistry was used to detect apoptosis associated gene bax and bcl-2 expression in kidney. RESULTS: After 4 experimental weeks, a significant increase in cell apoptosis, up-regulation of Bax protein expression in kidney tubular epithelial cell and down-regulation of Bcl-2 in glomerular endothelial cell in fluctuant high blood glucose rats were observed compared with stable high blood glucose rats.CONCLUSION: Fluctuant high blood glucose induces more apoptosis in renal tubular epithelial cells than that in stable high blood glucose diabetic rats.

15.
Article in Chinese | WPRIM | ID: wpr-524445

ABSTRACT

AIM: To investigate the molecular mechanism of amylin in inducing apoptosis of human pancreatic islet ?-cells. METHODS: Human pancreatic islet cells were isolated and cultured. The cells were treated with amylin or amylin and aminoguanidine (AG group) for 24 h, respectively. Apoptosis of pancreatic islet ?-cells was studied by in situ TUNEL method combined with double staining for insulin and ELISA. The levels of insulin, NO 2 -/NO 3 - and glutathione (GSH), p53 mRNA and bcl-2 mRNA were also detected. RESULTS: (1) The enrichment factor and the apoptosis rate of pancreatic islet ?-cells in amylin group were markedly higher than that in control group and AG group ( P

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