Hedysari Radix Polysaccharide Regulates Apoptosis of Smooth Muscle Cells in Gastric Antrum of Rat Model of Diabetic Gastroparesis via IGF-1/PI3K/Akt Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo observe the effects of Hedysari Radix polysaccharide on the apoptosis of gastric sinus smooth muscle cells and explore the underlying mechanism via the insulin-like growth factor-1 （IGF-1）/phosphatidylinositol 3-kinase （PI3K）/serine-threonine kinase （Akt） pathway in the rat model of diabetic gastroparesis （DGP）. MethodSixty-two Wistar male rats were randomized into a blank group （n=12） and a modelling group （n=50）. The rat model of DGP was established by small-dose multiple intraperitoneal injections of streptozotocin combined with an irregular high-fat and high-sugar diet for 4 weeks. The modeled rats were randomized into model group， mosapride citrate （1.35 mg·kg-1）， and high-， medium-， and low-dose （200， 100， and 50 mg·kg-1， respectively） Hedysari Radix polysaccharide groups. The rats were administrated with corresponding drugs by gavage， and those in the blank and model groups with equal volumes of pure water by gavage once a day for 8 consecutive weeks. The random blood glucose and body mass were measured every 2 weeks， and gastric emptying rate was calculated. Hematoxylin-eosin （HE） staining was used to observe the pathological changes of smooth muscle in gastric antrum， and terminal deoxynucleoitidyl transferase-mediated nick-end labeling （TUNEL） was employed to detect the apoptosis of smooth muscle cells in the gastric antrum. The expression of IGF-1， phosphorylated （p）-PI3K， and p-Akt in the smooth muscle of gastric sinus tissue was detected by immunohistochemistry. Western blot was employed to determine the protein levels of IGF-1， p-PI3K/PI3K， p-Akt/Akt， B-cell lymphoma-2 （Bcl-2）， and Bcl-2-associated X protein （Bax） in the smooth muscle of the gastric antrum. ResultCompared with the blank group， the model group showed elevated random blood glucose at all time points （P<0.01）， decreased body mass and gastric emptying rate （P<0.01）， increased apoptotic index of smooth muscle cells in the gastric antrum （P<0.01）， down-regulated protein levels of IGF-1， p-PI3K/PI3K， p-Akt/Akt， and Bcl-2， and up-regulated protein level of Bax （P<0.01）. Compared with the model group， the 8 weeks of drug administration lowered the random blood glucose， increased the body mass and gastric emptying rate （P<0.05， P<0.01）， decreased the apoptotic index of smooth muscle cells in the gastric antrum （P<0.05， P<0.01）， up-regulated the protein levels of IGF-1， p-PI3K/PI3K， p-Akt/Akt， and Bcl-2， and down-regulated the protein level of Bax （P<0.05， P<0.01）. Compared with the mosapride citrate group，the administration of low-dose Hedysari Radix polysaccharide for 6 and 8 weeks lowered the random blood glucose and decreased the body mass （P<0.05， P<0.01），low and medium-dose Hedysari Radix polysaccharide decreased the gastric emptying rate and the apoptotic index of smooth muscle cells in the astragaloside low-dose group decreased （P<0.05）. The protein levels of IGF-1，p-PI3K/PI3K，p-Akt/Akt and Bcl-2（low dose）were down-regulated and the protein level of Bax was up-regulated by low doses of Hedysari Radix polysaccharide （P<0.05， P<0.01）. Compared with high-dose Hedysari Radix polysaccharide， low-dose Hedysari Radix polysaccharide elevated random blood glucose and reduced body mass after 6 and 8 weeks of administration （P<0.05， P<0.01）， and the low and medium doses decreased the gastric emptying rate， increased the apoptotic index of smooth muscle cells in the gastric antrum （P<0.05， P<0.01）， down-regulated the protein levels of IGF-1， p-PI3K/PI3K， p-Akt/Akt， and Bcl-2， and up-regulated the protein level of Bax （P<0.05， P<0.01）. Compared with the medium-dose group，the low-dose group of Hedysari Radix polysaccharide had lower body mass，lower gastric emptying rate in rats，higher apoptotic index of smooth muscle cells in gastric sinus tissue after 6 and 8 weeks of administration （P<0.05， P<0.01）， and lower protein expression of IGF-1，p-PI3K/PI3K，p-Akt/Akt. ConclusionHedysari Radix polysaccharide protects the smooth muscle cells in gastric antrum against apoptotic injury and promotes gastric motility by activating the IGF-1/PI3K/Akt signaling pathway， as manifested by the up-regulated expression of IGF-1， p-PI3K， p-Akt， and Bcl-2 and down-regulated expression of Bax.

A Case Report of Mucormycosis in a Patient with a Recent History of COVID-19 Infection in India

Introduction: Mucormycosis is an angio-invasive fungal infection that increased significantly during the 2nd wave of the Covid-19 pandemic in India. The rise of cases was attributed to inflammatory changes, poor quality oxygen, immune suppression, and corticosteroid therapy. Case Presentation: This case study reports the history, treatment, and rehabilitation of a case of post-Covid-19 mucormycosis infection. The patient was admitted to the hospital following respiratory distress, at the beginning of the 2nd Covid-19 wave in India. Intravenous antibiotics, steroids, and moist O2 were administered, intensive support was provided and the patient was discharged after 13 days. Following extraction of 17, the patient reported signs of oro-antral communication which was managed by performing antral lavage and buccal advanced flap closure. Histopathological investigation of tissue salvaged during the procedure revealed the presence of fungal hyphae. Management and Prognosis: Following diagnosis, anti-fungal medication was prescribed, and a maxillectomy was performed to remove the affected tissue. On follow-up, the tissue healed with no further complications or symptoms, and rehabilitation was performed using an obturators and are movable complete denture. Histopathological investigations were carried out on the tissue salvaged during maxillectomy which confirmed Mucormycosis infection. Conclusion: The importance of histopathological investigation in the diagnosis of any infectious disease is enumerated in this paper

Reinforcing the valuable role of gastric ultrasound for volume and content assessment: an observational study

Abstract Background Pulmonary aspiration is one of the most important complications in anesthesiology. Assessment of gastric content by ultrasound is a good method to quantify gastric volume and to determine the risk of intraoperative pulmonary aspiration. The aim of this study is to determine the accuracy of the gastric ultrasonography in the qualitative analysis of gastric content, mainly in the analysis of small amounts of liquid content. Methods Gastric ultrasound was performed to 36 patients before upper gastrointestinal endoscopy (UGI), making two longitudinal scans at the epigastric level, one in supine position and the other in right lateral decubitus position, measuring two diameters and the area of the gastric antrum and assessing the content characteristics determining whether it was an empty stomach or contained fluid or solid content. Subsequently, the ultrasound findings were compared with UGI findings. Results Gastric areas were analyzed by the trace and the lengths of the craniocaudal and anteroposterior axes concluding that there are no significant differences between the two methods. No statistically significant difference was found between UGI and US assessment technics. No statistically significant difference was found between the estimated volume by UGI and US. Conclusions Though our study has some limitations, qualitative analysis of gastric content using ultrasound followed by endoscopy enabled the conclusion that there are no differences in the qualitative assessment regarding these two techniques, supporting the important role of point-of-care gastric ultrasound (POCGUS) in the assessment of pulmonary aspiration risk by the anesthesiologist in the perioperative period.

A Clinical Study Of Gastric Outlet Obstruction

Background:Diagnosis of Gastric outlet obstruction (GOO) is a challenge in 3rd world countries. Gastric outlet obstruction occurs because of impeding emptying of stomach mechanically, and it has varied causes. This study was taken up to know the etiological factors and management. Material And Methods:This was a descriptive prospective study done at Smt. NHL Municipal Medical College for a period of 2years from June 2019 to May 2021. A set of inclusion and exclusion criteria were defined and followed. Upper gastrointestinal endoscopy (OGD) was done in all cases w hile Barium meal study was done in a few cases to make the diagnosis. Relevant operative procedure was done, and patients were managed post operatively. Result:Cicatrised Duodenal ulcer (DU) was the commonest cause followed by Carcinoma Pyloric antrum (Ca PA). Majority of the patients were males (68%) with male to female ratio of 2.13:1. Vomiting was one of the major presenting symptoms in all the patients. Conclusion:Cicatrised DU was the commonest cause for GOO in present study. Present study highlights the increasing incidence of Ca PA. This could be due to better management of DU at an early stage.

Cloud of cotton inside the maxillary sinus: A unique case report worth sharing

The maxillary sinus is one of the most important structures present in the vicinity of the oral cavity. Unknowingly, it often gets involved when the environment of dentoalveolar structures of the maxillary unit jeopardize. There are lots of reasons such as trauma, forceful extraction which may change the internal environment of the maxillary sinus, and the balance of its microbial flora. Among them, oroantral communication and oroantral fistula cause chronic sinusitis inevitably. However, this case is unique by virtue due to the formation of chronic sinusitis by the intrusion of a foreign body by the patient himself and followed by the formation of an oroantral fistula after the extraction of an offending tooth.

Is pre-oxygenation with high-flow nasal oxygen safe? randomized control trial of 56 cases of elderly patients during induction of general anesthesia with endotracheal intubation / 南方医科大学学报

OBJECTIVE@#To evaluate the safety of preoxygenation with high-flow nasal oxygenation in elderly patients during induction of general anesthesia with endotracheal intubation.@*METHODS@#Fifty-six elderly patients without difficult airway were randomized equally into high-flow nasal oxygen group (HF group) and conventional mask oxygen group (M group). Preoxygenation was performed for 5 min before induction of general anesthesia and endotracheal intubation. Oxygenation was maintained during laryngoscopy in HF group, and ventilation lasted until laryngoscopy in M group. For all the patients, the general data, cross-sectional area (CSA) of the gastric antrum measured by ultrasonography, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and arterial oxygen saturation (cSO2) were recorded before preoxygenation (T1), at 5 min of preoxygenation (T2) and immediately after intubation (T3). The safety time of asphyxia, intubation time, times of mask ventilation and postoperative complications were compared between the two groups.@*RESULTS@#The general data were comparable between the two groups. After 5 min of preoxygenation, PaO2 and cSO2 were significantly increased in both groups, and PaO2 was significantly higher in HF group than in M group (F=118.108 vs 9.511, P < 0.05). Both PaO2 and cSO2 decreased after intubation, but PaO2 decreased more slowly in HF group and still remained higher than that at T1; cSO2 decreased significantly in M group to a lower level than that at T1. Compared with those in M group, the patients in HF group showed a significantly longer safety time of asphyxia (t=5.305, P < 0.05) with fewer times of mask ventilation (χ2= 6.720, P < 0.05). PaCO2 increased after intubation in both groups but was comparable between the two groups (F=3.138, P > 0.05).@*CONCLUSION@#High-flow nasal oxygen is safe, simple and effective for pre-oxygenation, which, as compared with the conventional oxygen mask, improves arterial oxygen partial pressure and prolongs the safety time of asphyxia to ensure the safety of airway management during induction of general anesthesia in elderly patients with endotracheal intubation.

Remoção de fresa odontológica alojada em seio maxilar: relato de caso / Removal of dental burr localized in the maxillary sinus: case report

Introdução: O seio maxilar é um dos seios paranasais, constituído por cavidade óssea preenchida de ar, localizado bilateralmente na maxila, próximo a região dos dentes posteriores. Dada sua localização, morfologia e fisiologia, o assoalho desse seio possui íntima relação com as raízes dos dentes posteriores. Essa estrutura possui uma membrana de revestimento e que pode ser acometida em processos de exodontia de dentes posteriores no qual existe uma relação de proximidade muito evidenciada. O alvéolo pode tornar-se uma via de comunicação entre cavidade oral e seio maxilar. Relato de Caso: O objetivo desse trabalho é descrever o relato de caso de um paciente que foi encaminhado à clínica de cirurgia Bucomaxilofacial para remoção de um fresa alojada no interior do seio maxilar direito que se deslocou durante ato de odontossecção do dente 26. A remoção do fragmento foi realizada pelo alvéolo onde, inicialmente, foi realizada a cirurgia de exodontia. O paciente em questão apresentou evolução satisfatória com ausências de sinais e sintomas de complicações relacionadas ao corpo estranho. Considerações Finais: conhecer a história é fundamental na conduta de tais casos, assim como investigar as possíveis queixas relacionadas ao quadro, por exemplo, os sinais e sintomas de uma sinusite maxilar... (AU)

Introduction: The maxillary sinus is one of the paranasal sinuses, constituted by a bone cavity filled with air, located bilaterally in the maxilla, close to the region of the posterior teeth. Given its location, morphology and physiology, the floor of this sinus is closely related to the roots of the posterior teeth. This structure has a lining membrane and can be affected in processes of extraction of posterior teeth in which there is a very evident relationship of proximity. The alveolus can become a communication route between the oral cavity and the maxillary sinus. Case Report: The purpose of this paper is to describe the case report of a patient who was referred to oral and maxillofacial surgery clinic for removal of a dental burr located inside the right maxillary sinus that was displaced during the tooth 26 extraction. Removal of the fragment was performed through the socket where, initially, extraction surgery was performed. The patient in question presented a satisfactory evolution with no signs and symptoms of complications related. Final considerations: knowing the history is important in management of these cases, as well as investigating possible complaints related to the condition, for example the signs and symptoms of a maxillary sinusitis... (AU)

Mathematical model construction and analysis of the effect of estradiol on the electrical activity of gastric antrum in female rabbits / 解剖学报

Objective To investigate the expression of estrogen receptor in gastric antrum and the effect of estrogen on electrical activity of gastric antrum smooth muscle in female rabbits in virtue of the constructed mathematical model in order to explore the regulation of estrogen on gastric motility. Methods Using immunofluorescence to observe the expression of estrogen receptor in gastric antrum. Using BL-420F bio monitor to monitor: Comparing the difference of antral electromyography index between rabbits in ovariectomized group and rabbits in sham operating group; Observing the dose-response relationship between doses of estradiol (0,0. 1,0. 15,0. 2,0. 25 and 0. 3 mg/ kg). To construct the mathematical model, and to analyze the dose-response relationship and mechanism of action. Rresult The expression of estrogen receptor in the antral wall of the stomach was negative. The activity index of gastric antrum myoelectric activity was significantly decreased after ovarian ablation (P<0. 01). With the increase of estradiol dose, the activity index of gastric antrum muscle increased and then decreased. Analysis of variance showed that the difference of antral electromyographic activity index between adjacent groups was significant (P<0. 05) or extremely significant (P<0. 01). Taking the estradiol dose as the independent variable x, the antral electromyography activity index was the dependent variable y, and the fitting wass obtained: y= 2. 80 + 5. 65 × exp{ -0. 5 × [(x-0. 159) / 0. 038 ]

Ultrasound assessment of gastric insufflation in obese patients receiving transnasal humidified rapid-insufflation ventilatory exchange during general anesthesia induction / 南方医科大学学报

OBJECTIVE@#To assess the effect of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) on gastric insufflation during general anesthesia induction in obese patients.@*METHODS@#Ninety obese patients (BMI 30-39.9 kg/m@*RESULTS@#The incidence of gastric insufflation was significantly higher in Group M and Group M+T than in Group T (@*CONCLUSIONS@#Ultrasound monitoring of the comet tail sign and the changes of CSA-GA in the gastric antrum is feasible and reliable for detecting gastrointestinal airflow, and in obese patients, the application of THRIVE for induction of anesthesia can ensure the oxygenation level without further increasing gastric insufflation.

Ultrasound assessment of gastric antrum in term pregnant women before elective cesarean section / Ultrassom de antro gástrico em gestantes a termo antes de cesariana eletiva

Abstract Background and objectives: Pregnant women are considered patients at risk for pulmonary aspiration of gastric contents. The study aim was to evaluate the gastric antral cross-sectional area using ultrasound. Method: In this prospective study, 85 scheduled term pregnant women underwent gastric ultrasound. The outcomes were the measurement of the gastric antral cross-sectional area (main outcome), the estimated gastric volume, the incidence of pregnant women at risk for pulmonary aspiration, and the association between gastric antral cross-sectional area and clinical-demographic characteristics. Gastric antral cross-sectional area and gastric volume were compared according to body mass index <30 or ≥30. Results: The median (IIQ) for gastric antral cross-sectional area was 4 cm2 (2.8-6.3), for the estimated gastric volume it was 49.8 mL (33.7-87.2), and for the gastric volume estimated in mL.kg-1 it was 0.62 mL.kg-1 (0.39-0.95). The 95th percentile [95% confidence interval (CI)] of the gastric antral cross-sectional area and the estimated gastric volume were ≤10.3 cm2 (95% CI: 7.6-15.6) and 1.42 mL.kg-1 (95% CI: 1.20-2.64), respectively. The incidence of pregnant women at risk for pulmonary aspiration was 3.5% (CI: 3.5 (1.2-9.8)). There was a positive correlation between gastric antral cross-sectional area and weight, p < 0.001 and body mass index <0.001. Patients with a body mass index ≥30 had a gastric antral cross-sectional area and an estimated gastric volume greater than those with a body mass index <30, respectively, p < 0.01 and p < 0.02. Conclusion: Measuring the gastric antral cross-sectional area of pregnant women is feasible and easy. There was positive correlation between gastric antral cross-sectional area, body weight and body mass index. The estimation of gastric volume by measuring the gastric antral cross-sectional area can identify patients at risk for pulmonary aspiration. Obese patients had a gastric antral cross-sectional area and an estimated gastric volume greater than non-obese patients.

Resumo Justificativa e objetivos: As gestantes são consideradas pacientes de risco para aspiração pulmonar do conteúdo gástrico. O objetivo foi avaliar a área transversal do antro gástrico por meio de ultrassonografia. Método: Neste estudo prospectivo, 85 gestantes a termo agendadas foram submetidas à ultrassonografia do antro gástrico. Os desfechos foram a mensuração da área transversal do antro gástrico (desfecho principal), a estimativa do volume gástrico, a incidência de gestantes sob risco de aspiração pulmonar, a associação entre a área transversal do antro gástrico e características clínico-demográficas. A área transversal do antro gástrico e do volume gástrico foi comparada de acordo com o índice de massa corporal < 30 ou ≥ 30. Resultados: A mediana (IIQ) da área transversal do antro gástrico foi 4 cm2 (2,8-6,3), do volume gástrico estimado 49,8 mL (33,7-87,2) e do volume gástrico estimado em mL.kg-1 de 0,62 mL.kg-1 (0,39-0,95). O percentil 95 [intervalo de confiança (IC) 95%] da área transversal do antro gástrico e do volume gástrico estimado foi ≤ 10,3 cm2 (IC 95%: 7,6-15,6) e 1,42 mL.kg-1 (IC 95%: 1,20-2,64), respectivamente. A incidência de gestantes sob risco de aspiração pulmonar foi de 3,5% (IC: 3,5 (1,2-9,8). Houve correlação positiva entre a área transversal do antro gástrico e peso, p < 0,001 e índice de massa corporal p < 0,001. As pacientes com índice de massa corporal ≥ 30 apresentaram maior área transversal do antro gástrico, e do volume gástrico estimado, do que as com índice de massa corporal < 30, respectivamente p < 0,01 e p < 0,02. Conclusão: A mensuração da área transversal do antro gástrico de gestantes é factível e fácil. A área transversal do antro gástrico correlacionou-se positivamente com peso e índice de massa corporal. A estimativa do volume gástrico através da mensuração da área transversal do antro gástrico pode identificar pacientes sob risco de aspiração pulmonar. As pacientes obesas apresentaram área transversal do antro gástrico e volume gástrico estimado maior do que as não obesas.

Treatment of Blowout fracture with video-assisted surgery / Tratamento de fratura Blowout com auxílio de vídeo-cirurgia

ABSTRACT Posterior fractures of the orbital floor are challenging, since an incomplete visualization of the defect through conventional surgical accesses may compromise the surgical outcome. The use of the endoscope as an auxiliary method during orbital reconstructions may be considered as a tool of considerable importance, mainly due to the visualization of the whole extension of fracture and adaptation of meshes or bone grafts. This study aims to report a clinical case of a patient diagnosed with extensive blowout fracture showing diplopy, enophthalmos, and ophthalmoplegia in supraversion, who underwent a subciliary approach combined with transantral video assisted surgery. There were no intercurrences on the procedure. Currently, patient has 1 year of follow up, with reestablished orbital function and architecture.

RESUMO As fraturas posteriores do assoalho orbital são desafiadoras, visto que a incompleta visualização do defeito por meio dos acessos cirúrgicos convencionais poderá comprometer o resultado cirúrgico. O uso do endoscópio como método auxiliar durante as reconstruções orbitais pode ser considerado uma ferramenta de grande importância principalmente para visualização de toda a extensão da fratura e adaptação das malhas ou enxertos ósseos. Este trabalho tem como objetivo relatar um caso clínico de um paciente diagnosticado com uma extensa fratura blowout apresentando clinicamente diplopia, enoftalmo e oftalmoplegia em supraversão, o qual foi submetido a tratamento através da abordagem subciliar combinada com a cirurgia vídeo-assistida transantral. O procedimento foi realizado sem intercorrências, estando o paciente com 1 ano de acompanhamento, com função e arquitetura orbital restabelecidos.

Comparative study of different anastomosis methods in laparoscopic distal gastrectomy for gastric cancer / 中国基层医药

Objective@#To explore the value of different anastomosis methods in laparoscopic distal gastrectomy.@*Methods@#From January 2014 to January 2016, 120 patients with distal gastric cancer in Weihai Central Hospital were selected and divided into the observation group and the control group according to the random digital table method, with 60 cases in each group.Triangular anastomosis was used in the observation group, while tubular anastomosis was used in the control group.The operative conditions, pain and complications were compared between the two groups.After 1-4 years of follow-up, the prognosis of the two groups was compared.@*Results@#Compared with the control group, the operation time of the observation group was shorter[(165.2±55.2)min vs.(188.2±59.3)min], the time of anastomosis was shorter[(22.6±8.1)min vs.(29.6±9.1)min], and the amount of bleeding was less[(88.6±29.2)mL vs.(107.5±49.1)mL], the differences were statistically significant (t=2.199, 4.451, 2.563, all P<0.05). Compared with the control group, the VAS scores of 1d[(3.5±1.1)points vs.(5.2±1.9)points]and 3d[(1.9±0.7)points vs.(3.0±1.5)points] were lower in the observation group, and the differences were statistically significant (t=5.998, 5.148, all P<0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P>0.05). After 1-4 years of follow-up, the overall survival rates in the observation group and the control group were 72.0% and 66.0%, respectively, and the median survival time was 42.4 months and 42.9 months, respectively.There was no statistically significant difference in survival between the two groups (χ2=0.310, P>0.05).@*Conclusion@#The trigonometric anastomosis is reliable in laparoscopic distal gastrectomy for gastric cancer, and it can shorten the time of anastomosis, reduce the amount of bleeding, and improve the postoperative pain of the patients.

Value of bedside ultrasound-measured antral cross-sectional area in diagnosing an empty stomach in patients with chronic hepatitis B / 中华麻醉学杂志

Objective To evaluate the value of bedside ultrasound-measured antral cross-sectional area (CSA) in diagnosing an empty stomach in patients with chronic hepatitis B.Methods One hundred and fifty-nine patients with chronic hepatitis B,aged 18-64 yr,with body height＞150 cm,weighing 45-110 kg,were enrolled in this study.The antero-posterior diameter and craniocaudal diameter of the gastric antrumn were measured by bedside ultrasound when patients were in the supine position,and CSA was calculated.Gastroscope negative pressure was used to suction fluid from stomach at the end of gastroscopy,and the fluid volume was recorded,and gastric fluid volume ≤0.8 ml/kg was defined as the standard for empty stomach.Results The cut-off value of CSA measured by bedside ultrasound in diagnosing an empty stomach was 440 mm2,with sensitivity 85.07％,specificity 80.95％,positive predictive value 96.61％,negative predictive value 45.95％,coincidence rate 84.52％.Conclusion The cut-off value of bedside ultrasound-measured CSA in diagnosing an empty stomach is 440 mm2 for the patients with chronic hepatitis B.

Comparative study of different anastomosis methods in laparoscopic distal gastrectomy for gastric cancer / 中国基层医药

Objective To explore the value of different anastomosis methods in laparoscopic distal gastrectomy.Methods From January 2014 to January 2016,120 patients with distal gastric cancer in Weihai Central Hospital were selected and divided into the observation group and the control group according to the random digital table method,with 60 cases in each group.Triangular anastomosis was used in the observation group,while tubular anastomosis was used in the control group.The operative conditions,pain and complications were compared between the two groups.After 1-4 years of follow-up,the prognosis of the two groups was compared.Results Compared with the control group,the operation time of the observation group was shorter[(165.2 ± 55.2)min vs.(188.2 ± 59.3)min],the time of anastomosis was shorter[(22.6 ± 8.1) min vs.(29.6 ± 9.1) min],and the amount of bleeding was less [(88.6 ± 29.2) mL vs.(107.5 ± 49.1) mL],the differences were statistically significant (t =2.199,4.451,2.563,all P ＜ 0.05).Compared with the control group,the VAS scores of 1d[(3.5 ± 1.1) points vs.(5.2 ± 1.9) points] and 3d [(1.9 ± 0.7) points vs.(3.0 ± 1.5) points] were lower in the observation group,and the differences were statistically significant (t =5.998,5.148,all P ＜ 0.05).There was no statistically significant difference in the incidence of postoperative complications between the two groups (P ＞ 0.05).After 1-4 years of follow-up,the overall survival rates in the observation group and the control group were 72.0％ and 66.0％,respectively,and the median survival time was 42.4 months and 42.9 months,respectively.There was no statistically significant difference in survival between the two groups (x2 =0.310,P ＞ 0.05).Conclusion The trigonometric anastomosis is reliable in laparoscopic distal gastrectomy for gastric cancer,and it can shorten the time of anastomosis,reduce the amount of bleeding,and improve the postoperative pain of the patients.

Bedside ultrasound measurement of gastric content and volume / 基础医学与临床

Perioperative pulmonary aspiration is a serious complication during general anesthesia .For patients with un-known gastric condition , there is no effective method for the noninvasive evaluation of gastric content and volume preop-eratively.Because of the portable and real-time detection, bedside ultrasound can significantly reduce the risk of periop-erative reflux and pulmonary aspiration , which makes preoperative gastric contents visualized and accurate .

Impact of Catgut Embedding Intervention on JAK 2-STAT 3 Signaling in Gastric Mucosa of Chronic Atrophic Gastritis Rats / 针刺研究

OBJECTIVE: To observe the impact of catgut embedding on histopathological changes and expression of phosphorylated-Janus kinase-2 (p-JAK 2), phosphorylated-signal transducer and activator of transcription 3 (p-STAT 3), Cyclin D 1, Bcl-2, and suppressor of cytokine signaling (SOCS) of the gastric mucosa in chronic atrophic gastritis (CAG) rats, so as to explore its mechanisms underlying improving CAG. METHODS: Forty-one SD rats were randomly divided into normal (n＝12), model (n＝9), natural recovery (n＝10) and catgut embedding (n＝10) groups. The CAG model was established by free drinking of N-methyl-N'-nitro-N-nitroso-guanidine (MNNG) solution (100µg/mL) and irregular diet for 24 weeks. Catgut embedding was applied at bilateral "Zusanli" (ST 36), "Pishu" (BL 20) and "Zhongwan" (CV 12), once every 10 days, 6 times altogether. The histopathological changes of the gastric mucosa were observed by naked eye and light microscope after H．E. staining. Wes-tern blot was used to detect the expression of p-JAK 2, p-STAT 3, CyclinD 1, Bcl-2 and SOCS 3 proteins in the gastric antrum tissue. RESULTS: After modeling, the regional gastric tissue showed pale thinner gastric wall, and poorer elasticity with fewer plica, congestion of blood vessels, reduction of regional glands with necrosis and disordered arrangement as well as evident hyperplasia of the connective tissue, which was evidently milder in the catgut embedding group. Compared with the normal group, the expression levels of p-JAK 2, p-STAT 3, CyclinD 1, Bcl-2, SOCS 3 proteins were significantly up-regulated in both model group and natural recovery group (P0.05). After catgut embedding intervention, the expression levels of p-JAK 2, p-STAT 3, Cyclin D 1, Bcl-2 proteins were considerably down-regulated (P<0.01), and that of SOCS 3 protein was notably further increased relevant to the natural recovery group (P<0.01)．. CONCLUSION: Catgut embedding may improve pathological changes of gastric mucosa in CAG rats, which possibly associated with its effects in up-regulating gastric SOCS 3 protein expression and in inhibiting the activation of JAK 2-STAT 3 signaling pathway to reduce the expression of CyclinD 1 and Bcl-2 proteins.

Adenoid cystic carcinoma in maxillary antrum – A rare presentation

Adenoid Cystic Carcinoma is a rare malignant salivary gland tumor comprising <1% of all malignancies of head and neck and 10-15 % of the malignant tumors of salivary glands. Most of it arises in minor salivary glands nearly about 60%. Intraorally, about 50% of adenoid cystic carcinomas occur in the palate. Here by, we present a case of adenoid cystic carcinoma affecting the left maxillary antrum and palate on the same side in 30 years old male along with a brief review of literature.

Effects of gastrin 17 and pepsinogen on anastomotic ulcer after gastric bypass surgery for resection of pyloric antrum / 天津医药

Objective To study the changes of gastrin 17 (G17) and pepsinogen (PG) after gastric bypass surgery in gastric antrum resection, and the influences of different surgical methods on postoperative peptic ulcer. Methods Clinical data of 63 patients with gastric bypass surgery in our hospital from October 2013 to October 2015 were divided into resection of pyloric antrum group (n=33) and preserved pyloric antrum group (n=30). The values of G17, PGⅠ, PGⅡand PGⅠ/PGⅡwere detected by enzyme linked immunosorbent assay at 1 month, 6 months and 12 months after operation. The correlation between the different surgical methods and the incidence of peptic ulcer was analyzed between two groups. Results The G17 levels were significantly decreased in resection of pyloric antrum group 6 and 12 months after operation than those in preserved pyloric antrum group (P0.05). There was no significant difference in postoperative peptic ulcer between two groups (P>0.05). Conclusion Gastric bypass after resection of the pyloric antrum can reduce the postoperative secretion of G17, PGⅠ and PGⅡ, but which can not reduce the incidence of postoperative anastomotic ulcer.

Application of ultrasonography guided water injection for insertion of naso-jejunal tubes / 中华护理杂志

Objective To examine the effects of application of ultrasonography guided water injection for inser-tion of naso-jejunal tubes. Methods Hospitalized patients in ICU who needed naso-jejunal tubes were recruited from one tertiary hospital in Beijing from November 2016 to April 2017. Ultrasonography guided water injection was used to assist insertion of naso-jejunal tubes. Meanwhile,we conducted semi-structured interviews to learn feel-ings and suggestions from the patients. Results A total of 40 patients were included in this study,37 patients (92.5%) were successfully inserted with the tubes at the first attempt. The duration of insertion of naso-jejunal tubes was 25 (20,38.75) min. Conclusion Ultrasonography guided water injection is a simple and convenient method to guide the placement of naso-jejunal tubes for critical ill patients,which provides guarantee for early en-teral nutrition.