Diagnosis and treatment status of perioperative anemia in patients with gastrointestinal neoplasms: a multi-center study in Hubei Province / 中华外科杂志

Objective: To investigate the incidence and treatment of perioperative anemia in patients with gastrointestinal neoplasms in Hubei Province. Methods: The clinicopathological data of 7 474 patients with gastrointestinal neoplasms in 62 hospitals in 15 cities (state) of Hubei Province in 2019 were collected in the form of network database. There were 4 749 males and 2 725 females. The median age of the patients was 62 years (range: 17 to 96 years). The hemoglobin value of the first time in hospital and the first day after operation was used as the criterion of preoperative anemia and postoperative anemia. Anemia was defined as male hemoglobin <120 g/L and female hemoglobin <110.0 g/L, mild anemia as 90 to normal, moderate anemia as 60 to <90 g/L, severe anemia as <60 g/L. The t test and χ2 test were used for inter-group comparison. Results: The overall incidence of preoperative anemia was 38.60%(2 885/7 474), and the incidences of mild anemia, moderate anemia and severe anemia were 25.09%(1 875/7 474), 11.37%(850/7 474) and 2.14%(160/7 474), respectively. The overall incidence of postoperative anemia was 61.40%(4 589/7 474). The incidence of mild anemia, moderate anemia and severe anemia were 48.73%(3 642/7 474), 12.20%(912/7 474) and 0.47%(35/7 474), respectively. The proportion of preoperative anemia patients receiving treatment was 26.86% (775/2 885), and the proportion of postoperative anemia patients receiving treatment was 14.93% (685/4 589). The proportions of preoperative anemia patients in grade ⅢA, grade ⅢB, and grade ⅡA hospitals receiving treatment were 26.12% (649/2 485), 32.32% (85/263), and 29.93% (41/137), and the proportions of postoperative anemia patients receiving treatment were 14.61% (592/4 052), 22.05% (73/331), and 9.71% (20/206). The proportion of intraoperative blood transfusion (16.74% (483/2 885) vs. 3.05% (140/4 589), χ²=434.555, P<0.01) and the incidence of postoperative complications (17.78% (513/2 885) vs. 14.08% (646/4 589), χ²=18.553, P<0.01) in the preoperative anemia group were higher than those in the non-anemia group, and the postoperative hospital stay in the preoperative anemia group was longer than that in the non-anemia group ((14.1±7.3) days vs. (13.3±6.2) days, t=5.202, P<0.01). Conclusions: The incidence of perioperative anemia in patients with gastrointestinal neoplasms is high. Preoperative anemia can increase the demand for intraoperative blood transfusion and affect the short-term prognosis of patients. At present, the concept of standardized treatment of perioperative anemia among gastrointestinal surgeons in Hubei Province needs to be improved.

Effect comparison of anterograde and reverse digital artery island flap in repairing of fingertip defects / 局解手术学杂志

Objective To evaluate the clinical effect of anterograde and reverse digital artery island flap in treatment of wound repairing for fingertip defects.Methods From January 2015 to December 2016,there were 35 patients with fingertip defects underwent surgical treat-ment in our hospital,including 14 cases underwent surgery with anterograde digital artery island flap(anterograde group)and 21 cases under-went surgery with reverse digital artery island flap(reverse group).The anterograde group used proper palmar digital artery and nerve as the pedicle of flap,then took forward the finger pulp flap to the injured site.The reverse flap from the dorsal of one side of finger was harvested for coverage of the distal phalanx.Results All the flaps of the 35 cases were survived.In the anterograde group,reflux obstacle of vein appeared in 1 case,and it was cured with scarification procedures.In the reverse group,there were 3 cases of vascular crisis.After dressing release and partial remove of the stitching,2 cases of them return to normal.The other 1 case suffered from flap edge necrosis,and then the wound healed after dressing change.The operation time of anterograde group was(107.5 ±18.4)min and it was(139.5 ±18.0)min in the reverse group, which showed significant difference between the two groups(P<0.05).All the 35 cases were followed up for 6 to 12 months,with an average of 8.5 months.At the last follow-up,it showed that patients in both of the two groups had ruddy color,good texture and no significant bloated flap appearance.In the anterograde group,the sensory function of 12 patients restored to S4 and 2 patients restored to S3.Meanwhile,in re-verse group,5 patients restored to S3,12 patients restored to S2, and 4 patients restored to S1.The two-points discrimination of the antero-grade group was(4.22 ±0.67)mm,and it was(7.04 ±1.25)mm in the reverse group,which was significantly different(P<0.05).The in-terphalangeal joint motion was(102.67 ±7.35)°at the distal end and(64.46 ±8.37)°at the proximal end in anterograde group.And it was (100.64 ±10.29)°and(60.81 ±10.80)°respectively in the reverse group,with no significant difference between the two groups (P>0.05).The excellent and good rate was 92.8%in the anterograde group and 80.9%in the reverse group by the criteria for functional evaluation,and there was no statistically significant difference(P>0.05).Conclusion For fingertip defects(IshikawaⅠ~Ⅲ)treated by anterograde digital artery island flap or reverse digital artery island flap both can obtained good clinical efficacy.But it has shorter operation time and better sensory recovery with anterograde digital artery island flap repairing.

A Retrospective Study Comparing Surgical and Early Oncological Outcomes between Intracorporeal and Extracorporeal Ileal Conduit after Laparoscopic Radical Cystectomy from a Single Center / 中华医学杂志(英文版)

<p><b>Background</b>Robot-assisted/laparoscopic intracorporeal ileal conduit (ICIC) has been reported in many experienced centers. Whether laparoscopic ICIC is superior to extracorporeal ileal conduit (ECIC) and whether laparoscopic ICIC should be promoted is still controversial. The aim of the study was to compare surgical and early oncological outcomes between patients undergoing laparoscopic radical cystectomy (LRC) with ICIC and ECIC.</p><p><b>Methods</b>From January 2011 to June 2016, a total of 45 patients with bladder cancer underwent LRC with ileal conduit at our department, of whom 20 patients underwent LRC with ECIC and 25 patients underwent LRC with ICIC. Data of each patient's characteristics, surgical outcomes, and short-term oncological outcomes were collected and analyzed.</p><p><b>Results</b>LRC with ileal conduit was performed successfully on all 45 patients. There were no significant differences in patients' characteristics, mean total operative time, and mean estimated blood loss between the ICIC and ECIC groups. Median time of flatus and oral intake was shorter in the ICIC group compared with the ECIC group (3 vs. 5 days, P = 0.035; 4 vs. 5 days, P = 0.002). The complications rates did not show significant difference between the two groups within the first 90 days postoperatively (P = 0.538). Cancer staging showed 45% of patients in the ECIC group and 36% in the ICIC group had a pathologic stage of T3 or T4, and 50% of patients in the ECIC group and 44% in the ICIC group had a pathologic stage of N1 or N1+. Kaplan-Meier analysis showed no significant difference in overall survival at 24 months (60% vs. 62%, P = 0.857) between the ECIC and ICIC groups.</p><p><b>Conclusions</b>ICIC after LRC may be successful with the benefits of faster recovery time. No significant difference was found in complications and oncological outcomes between ICIC and ECIC. However, larger series with longer follow-up are needed to validate this procedure.</p>

Laparoscopic radical cystectomy with novel orthotopic neobladder with bilateral isoperistaltic afferent limbs: initial experience

ABSTRACT Purpose To introduce a new method of constructing an orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs, and to describe its clinical outcomes. Materials and Methods From January 2012 to December 2013, 16 patients underwent a new method of orthotopic ileal neobladder after laparoscopic radical cystectomy for bladder cancer. To construct the neobladder, an ileal segment 60cm long was isolated approximately 25cm proximally to the ileocecum. The proximal 20cm of the ileal segment was divided into two parts for bilateral isoperistaltic afferent limbs. The proximal 10cm of the ileal segment was moved to the distal end of the ileal segment for the right isoperistaltic afferent limb, and the remaining proximal 10cm ileal segment was reserved for the left isoperistaltic afferent limb. The remaining length of the 40cm ileal segment was detubularized along its antimesenteric border to form a reservoir. The neobladder was sutured to achieve a spherical configuration. Results All procedures were carried out successfully. The mean operative time was 330 min, mean blood loss was 328mL, and mean hospital stay was 12.5 days. The mean neobladder capacity 6 and 12 months after surgery was 300mL and 401mL, respectively. With a mean follow-up of 22.8 months, all patients achieved daytime continence and 15 achieved nighttime continence. The mean peak urinary flow rate was 11.9mL/s and 12.8mL/s at 6 and 12 months postoperatively, respectively. Conclusions This novel procedure is feasible, safe, simple to perform, and provides encouraging functional outcomes. However, comparative studies with long-term follow-up are required to prove its superiority.

IFN-γ secretion in gut of Ob/Ob mice after vertical sleeve gastrectomy and its function in weight loss mechanism / 华中科技大学学报（医学）（英德文版）

Vertical sleeve gastrectomy (VSG) is becoming more and more popular among the world. Despite its dramatic efficacy, however, the mechanism of VSG remains largely undetermined. This study aimed to test interferon (IFN)-γ secretion n of mesenteric lymph nodes in obese mice (ob/ob mice), a model of VSG, and its relationship with farnesoid X receptor (FXR) expression in the liver and small intestine, and to investigate the weight loss mechanism of VSG. The wild type (WT) mice and ob/ob mice were divided into four groups: A (WT+Sham), B (WT+VSG), C (ob/ob+Sham), and D (ob/ob+VSG). Body weight values were monitored. The IFN-γ expression in mesenteric lymph nodes of ob/ob mice pre- and post-operation was detected by flow cytometry (FCM). The FXR expression in the liver and small intestine was detected by Western blotting. The mouse AML-12 liver cells were stimulated with IFN-γ at different concentrations in vitro. The changes of FXR expression were also examined. The results showed that the body weight of ob/ob mice was significantly declined from (40.6±2.7) g to (27.5±3.8) g on the 30th day after VSG (P<0.05). At the same time, VSG induced a higher level secretion of IFN-γ in mesenteric lymph nodes of ob/ob mice than that pre-operation (P<0.05). The FXR expression levels in the liver and small intestine after VSG were respectively 0.97±0.07 and 0.84±0.07 fold of GAPDH, which were significantly higher than pre-operative levels of 0.50±0.06 and 0.48±0.06 respectively (P<0.05). After the stimulation of AML-12 liver cells in vitro by different concentrations of IFN-γ (0, 10, 25, 50, 100, and 200 ng/mL), the relative FXR expression levels were 0.22±0.04, 0.31±0.04, 0.39±0.05, 0.38±0.05, 0.56±0.06, and 0.35±0.05, respectively, suggesting IFN-γ could distinctly promote the FXR expression in a dose-dependent manner in comparison to those cells without IFN-γ stimulation (P<0.05). It was concluded that VSG induces a weight loss in ob/ob mice by increasing IFN-γ secretion of mesenteric lymph nodes, which then increases the FXR expression of the liver and small intestine.

Longbishu Capsule combined with mesylate doxazosin: an efficacious therapy for benign prostatic hyperplasia / 中华男科学杂志

<p><b>OBJECTIVE</b>To assess the clinical effect and safety of the Chinese medicine Longbishu Capsule combined with mesylate doxazosin in the treatment of benign prostatic hyperplasia (BPH) of the kidney deficiency and blood stagnation type.</p><p><b>METHODS</b>This was a randomized, double-blind, double-simulation control study. We equally assigned 60 men diagnosed with BPH of the kidney deficiency and blood stagnation type to an experimental and a control group, the former treated with mesylate doxazosin plus Longbishu Capsule and the latter with mesylate doxazosin plus placebo. We compared the International Prostate Symptom Score (IPSS), quality of life (QOL), Chinese symptom score (CSS), maximal urinary flow rate (Qmax), and prostate volume between the two groups of patients before and after 6 months of medication.</p><p><b>RESULTS</b>After treatment, there were 5 cured cases, 13 markedly effective cases, 9 effective cases, 1 ineffective case, and 2 eliminated cases in the experimental group, as compared with 2 cured cases, 8 markedly effective cases, 10 effective cases, 7 ineffective cases, and 3 eliminated cases in the control group. The total effectiveness rate was obviously higher in the former (96.4%) than in the latter (74.1%). IPSS, Qmax, and CSS were improved in both of the groups after medication, even more significantly in the experimental than in the control group (IPSS: 15.22 ± 2.98 vs 18.15 ± 5.88, P <0.05; Qmax: [13.56 ± 2.26] ml/s vs [11.78 ± 2.97] ml/s, P <0.05; CSS: 6.18 ± 2.13 vs 9.52 ± 3.15, P <0.05). Because of the difference in the QOL score between the two groups at the baseline (P = 0.038 <0.05), no more comparison was made in this aspect after treatment.</p><p><b>CONCLUSION</b>The combination of Longbishu Capsule with mesylate doxazosin is safe and effective for the treatment of BPH.</p>

Standardized treatment of mid-low rectal cancer / 中华胃肠外科杂志

In recent years, the treatment strategy of mid-low rectal cancer has changed from surgical resection alone to multidisciplinary treatment. In order to offer the greatest benefits to the mid-low rectal cancer patients, it is necessary to carry out the preoperative TNM staging for appropriate therapeutic strategies. Total mesorectal excision (TME), preoperative TNM staging and neoadjuvant chemoradiotherapy together may achieve a breakthrough in the therapeutic outcome of mid-low rectal cancer.

Clinical application of laparoscopic proctocolectomy / 中华胃肠外科杂志

Laparoscopic proctocolectomy is a safe and feasible but complicated procedure, which is widely used clinically. Fully understanding of surgical plane and vascular anatomy is important for operation. The anastomosis methods, the type of ileal reservoir pouch and whether or not performing protective ileostomy should be considered preoperatively. Many details should be paid attention to.

Treatment of linguiform calcaneus fracture by close nail-pry reduction and internal fixation with hollow screws / 中国骨伤

<p><b>OBJECTIVE</b>To study the curative effects of close nail-pry reduction and internal fixation with hollow screws for treatment of linguiform calcaneus fracture.</p><p><b>METHODS</b>From May 2006 to October 2009,32 patients (35 feet) with linguiform calcaneus fracture were treated by close nail-pry reduction and internal fixation with hollow screws, including 23 males and 9 females ranging in age from 25 to 46 years, with a mean of 37.6 years. According to Paley classification, 3 cases were Paley II a, and 29 cases were Paley II b. All cases were close fractures. The time from injury to operation was 3 to 10 days after most swelling subsided. Böhler angle and Gissane angle were measured by X-ray before and after operation. The therapeutic effect was assessed according to ZHANG Tie-liang's foot score.</p><p><b>RESULTS</b>All the patients were followed-up for 6 to 18 months, with a mean of 12 months. All fractures gained bone healing. The time of fracture healing averaged 12 months. The fractures healed completely and no infection occurred. According to ZHANG Tie-liang's foot scale, the postoperative function was excellent in 18 feet, good in 10 feet, moderate in 5 feet and poor in 2 feet. The Böhler angle and Gissane angle were significant improved after treatment (P < 0.01).</p><p><b>CONCLUSION</b>The surgical method of close nail-pry reduction and internal fixation with hollow screws for treatment of linguiform calcaneus fracture can regain the foot function, with minimal injury, fewer complications, earlier recovery and lower costs.</p>

Clinical analysis of 217 patients with gastrointestinal stromal tumor / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics, diagnosis, treatment and prognostic factors of gastrointestinal stromal tumor(GIST).</p><p><b>METHODS</b>Clinicopathological data of 217 GIST patients from January 2005 to September 2010 in Wuhan Union Hospital were analyzed retrospectively and the prognostic factors were evaluated.</p><p><b>RESULTS</b>There were 103 males and 114 females with a median age of 55 years old. Two hundred and thirteen patients underwent R0 resection and 4 R1 resection due to extensive invasion. Thirty-five patients underwent laparoscopic resection. Forty-eight patients received imatinib mesylate therapy after surgery. A total of 178 patients(82.0%) were followed up for 3 to 74 months. Sixteen patients(9.0%) developed recurrence or metastasis. Logistic regression analysis showed that tumor location (OR=2.547, 95% CI:1.466-4.424) and mitotic count(OR=6.556, 95% CI:2.974-14.449) were independent factors for post-operative recurrence or metastasis. Five patients survived with tumor, and 11 patients(6.2%) died of GIST including intestinal GIST(n=7) and extraintestinal GIST(n=4). Cox regression analysis showed that the mitotic count (RR=2.654, 95% CI:1.094-6.438) and post-operative recurrence or metastasis (RR=32.988, 95% CI:3.879-280.529) were independent prognostic factors.</p><p><b>CONCLUSIONS</b>Tumor location and mitotic count are independent risk factors for post-operative recurrence or metastasis in GIST. Mitotic count and post-operative recurrence or metastasis are independent indicators of poor prognosis. Surgical radical resection combined with targeted therapy can achieve satisfactory outcomes in patients with GIST.</p>

Laparoscopic-assisted modified Soave procedures for adult Hirschsprung disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical value of laparoscopy-assisted modified Soave procedure for Hirschsprung disease in adults.</p><p><b>METHODS</b>Twenty-eight patients with a preoperative diagnosis of Hirschsprung disease underwent laparoscopy-assisted modified Soave procedure between March 2005 and December 2009. Clinical data were retrospectively analyzed.</p><p><b>RESULTS</b>There were no conversions to open surgery. The mean operative time was (165±12) minutes (range: 135-185 minutes). Estimated blood loss ranged from 50 to 250 ml, and no patients required intraoperative blood transfusion. Postoperative pathologic examination showed Hirschsprung diseases in 19 patients and Hirschsprung allied diseases in 9. Only two patients developed rectal cuff infection and three mild seepage. Other patients had no postoperative complications. The mean hospital stay was (17.5±1.0) days. No fecal incontinence or recurrent constipation occurred during follow-up.</p><p><b>CONCLUSION</b>Laparoscopy- assisted modified Soave procedure is safe and effective for Hirschsprung disease.</p>