Effect of neoadjuvant chemotherapy on the safety of laparoscopic D 2 radical resection and prognosis of patients with locally advanced gastric cancer / 中华消化外科杂志

Objective:To investigate the effect of neoadjuvant chemotherapy on the safety of laparoscopic D 2 radical resection and prognosis of patients with locally advanced gastric cancer. Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 351 patients with locally advanced gastric cancer who underwent laparos-copic D 2 radical resection in the Second Affiliated Hospital of Air Force Medical University from December 2016 to December 2021 were collected. There were 256 males and 95 females, aged (58±9)years. Of the 351 patients, 124 cases undergoing neoadjuvant chemotherapy were divided into the neoadjuvant chemotherapy group, 227 patients undergoing postoperative adjuvant chemotherapy were divided into the adjuvant chemotherapy group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) effect evaluation of neoadjuvant chemotherapy; (3) intraoperative and postoperative situations; (4) postoperative histopathological examinations; (5) follow-up. Propensity score matching was done by the 1∶1 nearest neighbor matching method. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measure-ment data with skewed distribution were represented as M(range) or M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. The Kaplan-Meier method was used to draw survival curves, and the Log-Rank test was used for survival analysis. Results:(1) Propensity score matching conditions and comparison of general data of patients between the two groups of patients after matching. Of 351 patients, 154 cases were successfully matched, including 77 cases in the neoadjuvant chemotherapy group and 77 cases in the adjuvant chemotherapy group. The elimination of gender, age, preoperative body mass index, clinical T staging and clinical N staging confounding bias ensured comparability between the two groups after propensity score matching. (2) Effect evaluation of neoadjuvant chemotherapy. Of the 77 patients receiving neoadjuvant chemotherapy, none of patient achieved complete response, 26 patients achieved partial response, 46 patients showed stable disease, 5 patients had progression of disease, showing the objective response rate as 33.8%(26/77) and the disease control rate as 93.5%(72/77). There were 15 males and 11 females sensitive to neoadjuvant chemotherapy, while 46 males and 5 females not sensitive, showing a significant difference between them ( χ2=11.05, P<0.05). (3) Intra-operative and postoperative situations. The operation time, volume of intraoperative blood loss, cases with intraoperative blood transfusion, time to postoperative first flatus, time to postoperative first liquid food intake, duration of postoperative hospital stay, cases with postoperative immediate complications, cost of hospital stay were (308±71)minutes, 100(range, 20?600)mL, 5, 3.0(range, 2.0?10.0)days, 4.0(range, 2.0?12.0)days, 9.0(range, 4.0?31.0)days, 7, 7.96(7.37,8.58) ten thousand yuan in patients of the neoadjuvant chemotherapy group, versus (296±67)minutes, 100(range, 20?500)mL, 4, 3.5(range, 1.0?14.0)days, 4.0(range, 2.0?15.0)days, 8.0(range, 5.0?45.0)days, 11, 8.18(7.52,9.19) ten thousand yuan in patients of the adjuvant chemotherapy group, showing no signifi-cant difference in the above indicators between the two groups ( t=1.13, Z=?0.37, χ2=0.12, Z=?1.26, ?0.33, ?0.70, χ2=1.01, Z=?1.04, P>0.05). (4) Postoperative histopathological examinations. Results of postoperative histopatho-logical examinations showed that all 154 patients achieving R 0 resection. Cases with pathological T staging as stage T1, stage T2, stage T3, stage T4, cases with pathological N staging as stage N0, stage N1, stage N2, stage N3, number of positive lymph nodes, cases with human epidermal growth factor receptor 2 (negative, positive) were 3, 7, 5, 62, 27, 19, 19, 12, 1(range, 0?28), 59, 18 in patients of the neoadjuvant chemotherapy group, versus 0, 0, 2, 75, 17, 15, 21, 24, 3(range, 0?31), 44, 33 in patients of the adjuvant chemotherapy group, showing significant differences in the above indicators between the two groups ( Z=?3.39, ?2.55, ?3.12, χ2=6.60, P<0.05). (5) Follow-up. Of the 154 patients, 143 patients were followed up for 37(range, 5?69)months. The 3-year overall survival rate and 3-year disease-free survival rate was 72.1% and 70.0%, respectively, in patients of the neoadjuvant chemotherapy group, versus 74.8% and 76.6% in patients of the adjuvant chemo-therapy group, showing no significant difference in the above indicators between the two groups ( χ2=0.14, 0.60, P>0.05). Conclusions:Compared to postoperative adjuvant chemotherapy, neoadjuvant chemotherapy does not bring additional surgical risks, but can reduce the tumor stage of patients who underwent laparoscopic D 2 radical resection for locally advanced gastric cancer. However, it does not show any advantage in improving survival of patients.

Efficacy and Safety of Allogeneic Hematopoietic Stem Cell Transplantation with Decitabine-containing Regimen in Myelodysplastic Syndromes and Myelodysplastic Syndromes Transformed Acute Myeloid Leukemia / 中国实验血液学杂志

OBJECTIVE@#To evaluate the efficacy and safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT) with decitabine (Dec)-conditioning regimen in the treatment of myelodysplastic syndrome (MDS) and MDS transformed acute myeloid leukemia (MDS-AML).@*METHODS@#The characteristics and efficacy data of 93 patients with MDS and MDS-AML who received allo-HSCT in our center from April 2013 to November 2021 were retrospectively analyzed. All patients were administered by myeloablative conditioning regimen containing Dec (25 mg/m2 /d×3 d).@*RESULTS@#Among the 93 patients, 63 males and 30 females, were diagnosed as MDS（n ＝77）, MDS-AML（n ＝16）. The incidence of I/II grade regimen-related toxicity (RRT) was 39.8%, and III grade RRT was only found in 1 patient (1%). Neutrophil engraftment was successful in 91 (97.8%) patients after a median neutrophil engraftment time of 14 (9-27) days; Successful platelet engraftment was achieved in 87 (93.5%) patients, with a median engraftment time of 18 (9-290) days. The incidence of acute graft versus host disease（aGVHD） and grade III-IV aGVHD was 44.2% and 16.2%, respectively. The incidence of chronic graft versus host disease（cGVHD） and moderate-to-severe cGVHD was 59.5% and 37.1%, respectively. Of the 93 patients, 54 (58%) developed posttransplant infections, among which lung infection (32.3%) and bloodstream infection (12.9%) were the most common. The median follow-up after transplantation was 45 (0.1-108) months. The 5-year overall survival (OS) rate, disease-free survival (DFS) rate, treatment-related mortality, and cumulative incidence of relapse were 72.7%, 68.4%, 25.1%, and 6.5%, respectively. And the 1-year graft-versus-host disease/relapse-free survival rate was 49.3%. The patients in different group of relative high-risk prognostic scoring or low-risk prognostic scoring, with or without poor-risk mutation(s), with mutations number ≥3 or <3 had similar 5-year OS rate (more than 70%). Multivariate analysis showed that the incidence of grade III-IV aGVHD was the independent risk factor affecting OS（P =0.008）and DFS (P =0.019).@*CONCLUSION@#Allo-HSCT with Dec-conditioning regimen is feasible and effective in the treatment of patients with MDS and MDS-AML, especially those in high prognostic risk and with poor-risk mutations.

A new diterpenoid acid from the rosin of Pinus kesiya var. langbianensis (A.Chev.) Gaussen ex Bui / 药学学报

One undescribed diterpenoid acid and six compounds were isolated from the 95% ethanol fraction of Pinus kesiya var. langbianensis (A.Chev.) Gaussen ex Bui resin by using various chromatographic methods, including MCI Gel, Sephadex LH-20, ODS, silica gel and semi-preparative HPLC. The planar structures were identified by spectroscopy methods (1D, 2D NMR, UV, IR, MS, etc.), and the absolute configuration of the new compound was determined by ECD calculation. Compound 1 is a new compound, and compounds 2, 5-7 were isolated from Pinus kesiya var. langbianensis (A.Chev.) Gaussen ex Bui for the first time.

A Network Pharmacology-Based Study on Antidepressant Effect of Salicornia europaea L. Extract with Experimental Support in Chronic Unpredictable Mild Stress Model Mice / 中国结合医学杂志

OBJECTIVE@#To investigate the pharmacodynamic material basis, mechanism of actions and targeted diseases of Salicornia europaea L. (SE) based on the network pharmacology method, and to verify the antidepressant-like effect of the SE extract by pharmacological experiments.@*METHODS@#Retrieval tools including Chinese medicine (CM), PubMed, PharmMapper, MAS 3.0 and Cytoscape were used to search the components of SE, predict its targets and related therapeutic diseases, and construct the "Component-Target-Pathway" network of SE for central nervous system (CNS) diseases. Further, protein-protein interaction (PPI) network, Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) function annotation of depression-related targets were analyzed to predict the antidepressant mechanism of SE. Chronic unpredictable mild stress (CUMS) model was used to construct a mouse model with depression-like symptoms. And the animals were randomly divided into 6 groups (n=10) including the normal group (nonstressed mice administered with distilled water), the CUMS group (CUMS mice administered with distilled water), the venlafaxine group (CUMS mice administered with venlafaxine 9.38 mg/kg), SE high-, medium-, and low-dose groups (CUMS mice administered with SE 1.8, 1.35 and 0.9 g/kg, respectively). Then some relevant indicators were determined for experimental verification by the forced swim test (FST), the tail suspension test (TST) and open-field test (OFT). Dopamine (DA) concentration in hippocampus and cerebral cortex, IL-2 and corticosterone (CORT) levels in blood, and nuclear factor E2 related factor 2 (Nrf2), kelch-like epichlorohydrin related protein 1 (Keap1), NAD(P) H dehydrogenase [quinone] 1 (NQO1) and heme oxygenase-1 (HO-1) levels in mice were measured by enzyme linked immunosorbent assay (ELISA) and Western blot respectively to explore the possible mechanisms.@*RESULTS@#The "target-disease" network diagram predicted by network pharmacology, showed that the potential target of SE involves a variety of CNS diseases, among which depression accounts for the majority. The experimental results showed that SE (1.8, 1.35 g/kg) significantly decreased the immobility period, compared with the CUMS group in FST and TST in mice after 3-week treatment, while SE exhibited no significant effect on exploratory behavior in OFT in mice. Compared with CUMS group, the SE group (0.9 g/kg) showed significant differences (P<0.05) in DA levels in the hippocampus and cerebral cortex. In addition, compared with CUMS control group, SE (1.8 g/kg) group showed a significant effect on decreasing the activities of CORT (P<0.05), and serum IL-2 level with no statistical significance. Finally, Western blot results showed that compared with the model group, Nrf2, Keap1, NQO1 and HO-1 protein expressions in SE group (1.8 g/kg) were up-regulated (all P<0.01).@*CONCLUSION@#The SE extract may have an antidepressant effect, which appeared to regulate Nrf2-ARE pathway and increased levels of DA and CORT in the hippocampus and cortex.

Lymph node dissection and key technical points in 4K laparoscopic radical resection of mid-distal sigmoid colon cancer / 中华消化外科杂志

Colon cancer is a commonly malignant tumor with high morbidity and mortality in China, which seriously threatens human health and lives. Surgery plays a key role in the treatment of colorectal cancer so far. The sigmoid colon is the predilection site of colon cancer. Laparoscopic surgery has been gradually applied in radical operation of sigmoid colon cancer. 4K laparoscopy belongs to a kind of high-imaging technology, of which the information volume is more than 4 times that of conventional high-definition televisions. It can improve the operator's sense of control on the surgical field of view. Combined with team practical experience, the author introduces and interprets the excision extent and operative procedures in radical resection of mid-distal sigmoid colon cancer from the perspective of the 4K laparoscopy.

The clinical effect of hydromorphone combined with ropivacaine in abdominal transverse plane block after laparoscopic myomectomy and its effect on stress response / 中国医师进修杂志

Objective:To investigate the clinical effect of hydromorphone combined with ropivacaine and its effect on stress response after laparoscopic myomectomy.Methods:From March 2017 to March 2020 in Shangyu Hospital of Traditional Chinese Medicine, Zhejiang Province, 100 patients who were performed laparoscopic hysteromyoma were randomly divided into observation group (50 cases) and control group (50 cases). Both groups were treated with plane block of transverse abdominal muscle after anesthesia induction. The control group was injected with ropivacaine, and the observation group was injected with hydromorphone and ropivacaine. The changes of hemodynamics at the time of entering operation room (T 0), 1 h after operation (T 1) and after surgery (T 2) were compared between two groups. The visual analogue scale (VAS) score at postoperative 3 h, 12 h and 24 h, Ramsay sedation score during operation, and serum stress level at preoperative and postoperative 24 h were compared between two groups. Results:The levels of heart rate, systolic and diastolic blood pressure between the two groups at different times had no significant differences ( P>0.05). The VAS scores of the observation group at postoperative 3 h, 12 h and 24 h were lower than those in control group [(3.05 ± 0.32) scores vs. (3.42 ± 0.39) scores, (2.16 ± 0.38) scores vs. (2.73 ± 0.43) scores, (1.43 ± 0.29) scores vs. (2.28 ± 0.35) scores], and there were significant differences ( t = 5.186, 7.024, 13.223, P<0.05). The scores of Ramsay sedation score in observation group was higher than that in control group [(3.79 ± 0.45) scores vs. (2.54 ± 0.39) scores], and there was significant difference ( t = 14.843, P<0.05). The levels of noradrenaline, interleukin-6, and cortisol in observation group at postoperative 24 h were lower than those in control group [(254.18 ± 14.35) pmol/L vs. (328.73 ± 18.69) pmol/L, (26.89 ± 4.10) ng/L vs. (35.27 ± 5.46) ng/L, (214.30 ± 21.28) pmol/L vs. (296.53 ± 32.19) pmol/L], and there were significant differences ( t = 22.371, 8.678, 15.068, P<0.05). Conclusions:The combination of hydromorphone and ropivacaine in abdominal transverse plane block after laparoscopic myomectomy has good analgesic and sedative effects and can reduce stress response.

Prevalence of chronic kidney disease and its comorbidity analysis among the elderly in community of Suzhou / 中华老年医学杂志

Objective:To investigate the prevalence of chronic kidney disease(CKD)in community of Suzhou and explore the comorbid health conditions.Methods:The population over 60 years old undergoing health physical examination in community of Suzhou were selected as screening subjects for CKD.Examination data were collected, and other health data were obtained through residents' health records and chronic disease management systems.A total of 7 387 participants were enrolled.Results:In the population of 7 387 individuals, detected cases with CKD were 2 771, with detection rate of 37.5%, awareness rate of 13.9%.The 2 521 patients(91.0%=2 521/2 771 of total CKD patients)with CKD 1-2 stage, and 2222 patients(80.2%=2 222/2 771)with low and medium risk were detected out.The detection rates of CKD were significantly higher in group with hypertension, diabetes, hyperuricemia, hyperlipidemia, obesity and stroke than in the group without those diseases(all P<0.05). With the increase of the number of comorbidity in patients with CKD, the detection rate of CKD was increased( χ2=74.658, P<0.001). In a total of 2771 CKD patients, 33.6% had 1 comorbid condition, 23.4% had two comorbid conditions, and 19.8% had 3 or more comorbid conditions.In the declined-eGFR group, patients with three or more comorbid conditions accounted for 34.0%, which was significantly higher than that in the normal-eGFR group(18.4%)( χ2=35.042, P<0.001). Multivariate Logistic regression analysis revealed that women, advanced age, hypertension and having 3 or more comorbid conditions were independent influencing factors for the CKD detection rate.People with three or more comorbid conditions had a 1.58-fold increased risk for developing CKD as compared with those without comorbid condition(95% CI: 1.30-1.91, P<0.001). Conclusions:The prevalence of CKD in Suzhou community elderly population is high, but the awareness rate is low.A large number of early and low-and moderate-risk of CKD patients have been detected out.Comorbid conditions are prevalent in older patients with CKD.With the decrease of renal function, the number of comorbidity in CKD patients significantly increased.Early screening for CKD in the elderly population is very necessary, especially in those with hypertension and 3 or more comorbid conditions.

Efficacy of ultrasound-guided serratus anterior plane block for postoperative analgesia in patients undergoing thorascopic surgery / 中华麻醉学杂志

Objective To evaluate the efficacy of ultrasound-guided serratus anterior plane block (SAPB) for postoperative analgesia in patients undergoing thoracoscopic surgery.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index of 18-24 kg/m2,scheduled for elective thoracoscopic surgery under general anesthesia,were divided into 3 groups (n=20 each) using a random number table method:control group (group C),thoracic paravertebral block (PVB) group (group PVB) and group SAPB.After the patients were turned to contralateral position,thoracic PVB was performed at T4.6 thoracic vertebrae on the affected side under ultrasound guidance,and 0.25％ ropivacaine 20 ml was injected in group PVB.In group SAPB,ultrasoundguided SAPB was performed on the affected side,and 0.33％ ropivacaine 30 ml was injected.Patient-controlled intravenous analgesia (PCIA) was performed at the end of surgery.PCIA pump was pressed when numerical rating scale scores＞3 after surgery and flurbiprofen axetil 2 mg/kg was intravenously injected when the efficacy was inadequate.The requirement for PCIA pressing,total consumption of drugs during PCIA and requirement for flurbiprofen axetil were recorded at day 3 after surgery.The consumption of sufentanil during operation was recorded,the dose was calculated,and the total amount of sufentanil consumed was recorded.The development of postoperative nausea and vomiting,pulmonary infection and chronic pain was also recorded.Results Compared with group C,the consumption,dose and total consumption of sufentanil were significantly decreased,the number of pressing times of PCIA and total consumption of drugs during PCIA were decreased,and the incidence of postoperative nausea and vomiting was decreased in PVB and SAPB groups (P＜0.05).Compared with group PVB,no significant change was found in the parameters in group SAPB (P＞0.05).There was no significant difference in the incidence of chronic pain among the three groups (P＞0.05),and no patients required additional flurbiprofen axetil.Conclusion Ultrasound-guided SAPB provides good efficacy for postoperative analgesia in the patients undergoing thoracoscopic surgery with fewer adverse effects.

The training strategy of laparoscopic skills for surgeons in the era of laparoscopy / 中华医学教育探索杂志

At present, Laparoscopy has become a professional skill that surgeons have to master. In cultivating surgeons in laparoscopy in our country, there are some deficiencies such as unbalanced regional development, technical difficulties, long learning curve, lack of standardized training mode and so on. Based on the original foundations, the Department of Gastrointestinal Surgery, Tangdu Hospital, the Air Force Military Medical University, has been constructing and improving the cultivating system by modifying the course contents, improving the training of endoscopic simulator, endoscopic surgery training on animal and endoscopic clinical practice, and managing the processes. Based on the above measures, certain results have been achieved.

Research on relationship of FGF-23 and sKL with cardiac valve calcification in CAPD patients / 上海交通大学学报（医学版）

Objective· To explore the relationship of fibroblast growth factor-23 (FGF-23) and soluble klotho (sKL) with cardiac valve calcification in patients with continuous ambulatory peritoneal dialysis (CAPD).Methods· 147 CAPD patients from the dialysis center of the First Affiliated Hospital of Soochow University were enrolled.The concentrations of FGF-23 and sKL were measured by enzyme-linked immunosorbent assays (ELISA).Echocardiography was applied to evaluate cardiac valve calcification.The patients were divided into normal cardiac valve group (group A) and cardiac valve calcification group (group B).SPSS 23.0 software was used for data analysis.Results· The incidence of cardiac valve calcification in CAPD patients was 54.42％.The risk of cardiac valve calcification showed positive correlation with age,dialysis age,serum creatinine,corrected calcium,serum phosphorus,serum alkaline phosphatase,parathyroid hormone,and the level of FGF-23 (P=0.045,P=0.022,P=0.006,P=0.024,P=0.000,P=0.017,P=0.022,P=0.000),and negative correlation with urea clearance index,the level of sKL and residual renal function (P=0.045,P=0.000,P=0.011).Multivariate Logistic regression analysis showed that the increase of FGF-23 (OR=5.007,95％ CI 1.446-17.339,P=0.011) and serum phosphorus (OR=7.433,95％ CI 1.558-35.470,P=0.012) were two independent risk factors for cardiac valve calcification in CAPD patients,and the decrease of sKL (OR=0.310,95％ CI 0.108-0.891,P=0.030) was another independent risk factor as well.Receiver operator characteristic curves (ROC) indicated that to predict cardiac valve calcification in patients with CAPD,the optimal cut off points of FGF-23 and sKL were 2 172.64 pg/mL (sensitivity was 91.3％,specificity was 91％) and 231.88 pg/mL (sensitivity was 88.8％,specificity was 92.5％),respectively.Conclusion· The high level of FGF-23 and low level of sKL are two independent risk factors for cardiac valve calcification in CAPD patients.FGF-23 and sKL can be used to diagnose cardiac valve calcification in CAPD patients.

Application value of the clearance of No.253 lymph nodes with priority to fascial space and preserving left colic artery in laparoscopic radical proctectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the application value of the clearance of No.253 lymph nodes with priority to fascial space and preserving left colic artery (LCA) in patients undergoing laparoscopic radical proctectomy.</p><p><b>METHODS</b>From August 2015 to August 2016, 97 consecutive middle-low rectal cancer patients underwent laparoscopic radical proctectomy using the clearance of No.253 lymph nodes with priority to fascial space and preserving LCA at Department of General Surgery, Tangdu Hospital. Among 97 patients, 45 were females , 52 were males, mean age was (64.3±5.5) years and mean BMI was (22.4±1.8) kg/m. Brief steps of this clearance: traditional medial approach was the commencement of the dissection at the membrane bridge line in front of iliac vascular bifurcation, then entering into the Toldt's space; superior rectal artery served as the top of the tent and the Toldt's space was extended as far as possible; blunt separation was developed caudally (reaching 2 cm below the sacral promontory), cephalad (reaching the lower part of the pancreas), left laterally (reaching Toldt's line), dextrally (reaching abdominal aorta); after giving priority to fascias space, from the root of inferior mesenteric artery, LCA was exposed and No.253 lymph nodes were dissected. This regimen was suitable for the rectal adenocarcinoma patients without distant metastasis.</p><p><b>RESULTS</b>There was no tension in the intestine and mesenteria after anastomosis in all the 97 patients. One patient received LCA ligation during the clearance, because of thinner LCA resulting in bleeding. The other 96 cases completed the clearance and operation successfully. The mean No.253 lymphadenectomy time was 11-27(17.1±5.3) minutes. The mean number of harvested No.253 lymph node was 0-6(4±2). The No.253 lymph nodes of 6 patients were positive. No.253 regional mesentery was complete in 95 patients. The total harvested number of lymph node was 11-26(17.3±5.3). Six patients with positive lymph nodes aged from 68 to 72 years old and all of them underwent TME operation 6-8 weeks after neoadjuvant chemoradiotherapy. The mean operative time was 89-189(125±35) minutes. The mean estimated blood loss was 10.5-38.6(22.4±10.5) ml. The first exhaust time was 3.0-6.0(5.6±2.1) days. The mean time to extracting the drainage tube was 3.0-5.0(4.5±2.5) days. Anastomotic fistula appeared in 1 case and hemorrhage appeared in 1 case, and these 2 cases were cured by conservative treatment. No perioperative death occurred. The mean postoperative hospital stay was 3.0-10.0(3.6±2.6) days.</p><p><b>CONCLUSION</b>The clearance of No.253 lymph nodes with priority to fascial space and preserving LCA in laparoscopic radical proctectomy is safe and feasible.</p>

Application of Overlap method to digestive tract reconstruction of totally laparoscopic left colectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the application value of the Overlap method in digestive tract reconstruction of totally laparoscopic left colectomy(TLLC) and its potential advantage.</p><p><b>METHODS</b>The retrospective cohort study was adopted. Clinicopathological data of 16 patients with left colon cancer who underwent TLLC and Overlap anastomosis between August 2016 and August 2017 at Tangdu Hospital were retrospectively collected as Overlap group. Twenty-one patients who underwent laparoscopic assisted left colectomy (LALC) between January 2015 and July 2016 at Tangdu Hospital were used as control (traditional group). The intraoperative and postoperative data were compared between the two groups. During digestive tract reconstruction in the Overlap group, the proximal colon and distal colon were lined up side by side; a side-to-side anastomosis was conducted on colic band with a 60 mm linear stapler; and the common entry hole was closed using running suture. While in traditional group, the bowel was pulled out of abdominal wall through the assisted incision; the sample was resected and a proximal and distal end-to-end anastomosis was performed.</p><p><b>RESULTS</b>In Overlap group, 10 cases were male and 6 cases were female, with a mean age of (66.4±4.8) years and a BMI of (23.6±2.3) kg/m; the tumor located in distal transverse colon in 1 case, in splenic flexure in 2 cases, in descending colon in 4 cases, in upper sigmoid colon in 9 cases. TLLC was successfully completed in all the cases without conversion to laparotomy. In traditional group, 12 cases were male and 9 cases were female, with mean age of (65.9±5.8) years and BMI of (22.7±2.8) kg/m; the tumor located in the distal transverse colon in 1 case, in the splenic flexure in 3 cases, in the descending colon in 6 cases, in the upper sigmoid colon in 11 cases. No statistically significant differences in baseline data were found between the two groups (all P>0.05). Compared to the traditional group, the total operation time was shorter [(143.4±11.1) minutes vs. (166.4±16.5) minutes, t=4.792, P=0.000], the anastomosis time was prolonged [(44.3±3.3) minutes vs. (22.4±3.0) minutes, t=-20.948, P=0.000], the amount of bleeding was reduced [(46.6±13.6) ml vs. (70.5±20.0) ml, t=4.106, P=0.000], and the incision length was shorter [(3.9±0.9) cm vs. (6.7±1.3) cm, t=7.056, P=0.000] in the Overlap group. There were no significant differences in lymph nodes harvested (17.3±2.9 vs. 15.5±3.0), time to flatus [(2.8±1.3) days vs. (2.6±1.0)days], postoperative complications [6.2%(1/16) vs. 9.5%(2/21)] and postoperative hospitalization [(4.6±1.4) days vs.(4.7±1.2) days] between the two groups (all P>0.05).</p><p><b>CONCLUSION</b>The Overlap reconstruction method in totally laparoscopic left colectomy is a safe and feasible procedure, and provides less injury and better cosmetic outcome of abdominal wall.</p>

Application value of the modified Overlap method in digestive tract reconstruction of totally laparoscopic total gastrectomy / 中华消化外科杂志

Objective To investigate the application value of the modified Overlap method in digestive tract reconstruction of totally laparoscopic total gastrectomy (TLTG).Methods The retrospective cohort study was conducted.The clinicopathological data of 50 patients with gastric cancer who underwent TLTG with Overlap anastomosis between January 2016 and December 2016 in the Tangdu Hospital of the Fourth Military Medical University were collected.Twenty-six patients using classic Overlap method and 24 patients using modified Overlap method were respectively allocated into the classic Overlap group and modified Overlap group.All the patients underwent D2 lymph node dissection.Patients in the classic Overlap group underwent totally laparoscopic catastalsis side-to-side esophagojejunostomy.During digestive tract reconstruction in the modified Overlap group,there was no esophageal transection before anastomosis,and gastric fundus traction fully exposed to the lower esophagus.Esophagus was spun anticlockwise,and a hole was opened at the left posterior esophageal wall.Transection of jejunum was 25 cm away from Treitz ligment,and opening a hole at mesenteric margin was 6 cm away from distal jejunum to transected end of jejunum.Esophagus-distal jejunum side-to-side anastomosis was done using 60 mm linear stapler,and then laterally closing openings and transecting esophagus.Observation indicators:(1) intra-and post-operative recovery:total operation time,time of esophagus-jejunum anastomosis,volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation,cases with complications and duration of postoperative hospital stay;(2) follow-up and survival.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative tumor-free survival and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the independent-sample t test.Comparison of count data was analyzed using the chi-square test or Fisher exact probability.Results (1) Intra-and post-operative recovery:all the 50 patients underwent successful TLTG using Overlap method,without conversion to open surgery.Total operation time and time of esophagus-jejunum anastomosis were respectively (278.6± 14.9) minutes,(46.5 ± 4.4) minutes in the classic Overlap group and (253.3 ± 12.8) minutes,(20.4 ± 2.3) minutes in the modified Overlap group,with statistically significant differences between the 2 groups (t =5.459,22.482,P＜0.05).Volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation,cases with complications and duration of postoperative hospital stay were respectively (73±25) mL,34±6,(2.7± 1.0) days,2,(9.7± 1.6) days in the classic Overlap group and (71 ± 22) mL,35± 5,(2.6± 1.3) days,2,(9.8± 1.5) days in the modified Overlap group,with no statistically significant difference between the 2 groups (t =0.175,-0.616,0.293,-0.217,P＞ 0.05).Two patients in the classic Overlap group were respectively complicated with esophagus-jejunum anastomotic fistula and pancreatic leakage,2 patients in the modified Overlap group were respectively complicated with pulmonary infection and subcutaneous emphysema,and they were improved by symptomatic treatment.(2) Follow-up and survival:41 of 50 patients were followed up for 3-15 months,with a median time of 7 months,including 20 in the classic Overlap group and 21 in the modified Overlap group.During follow-up,patients had tumor-free survival,without tumor recurrence and metastasis.Conclusion Compared with classic Overlap method,the modified Overlap method can simplify the anastomotic procedures,shorten operation time and achieve similar efficacy,and it is also a simple and effective method for digestive tract reconstruction after TLTG.

Effects of Ginkgo biloba tablet on MPA, CD11 b and MCP-1 levels in patients with unstable angina pectoris / 中国临床药理学与治疗学

AIM:To observe the levels of monocyte-platelet aggregates (MPA) and markers of activated monocytes in patients with unstable angina pectoris (UAP) accepting Ginkgo biloba tablet treatments,and to explore its mechanisms for cardiovascular disease treatments.METHODS:The levels of MPA,CD11b,and MCP-1 were measured in 92 unstable angina pectoris (UAP) and 42 stable angina pectoris (SAP).The UAP patients were randomly assigned into routine treatment group (control group) and combined tablet treatment group (Ginkgo biloba group).The efficacy was assessed,and the levels of MPA,CD11b,and MCP-1 were measured after 28 days of treatment,respectively.RESULTS:The levels of MPA,CD11b,and MCP-1 in UAP group were higher than those in SAP group (P＜0.001).The levels of MPA and CD11b were positively correlated with MCP-1 level (P ＜ 0.01).The total rate of effective Ginkgo biloba tablet treatment was higher than that of non-Ginkgo biloba tablet treatment (P ＜ 0.05).After 28 days of treatments,the levels of MPA,CD11b,and MCP-1 in Ginkgo biloba group were significantly lower than those in control group (P ＜ 0.001).In total effective treatment group,the levels of MPA,CD11b,and MCP-1 were significantly lower after treatment than those before treatment (P ＜ 0.001),and the decreased rates of these markers after treatment were also much higher (P ＜ 0.01).CONCLUSION:There is an obvious efficacy of Ginkgo biloba tablet on unstable angina pectoris by down-regulating the levels of MPA,CD11b and MCP-1.

Relationship between NK Cell Reconstitution and aGVHD after Allo-HSCT / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the relationship between NK cell count/activity and acute graft-versus-host disease (aGVHD) in patients receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT).</p><p><b>METHODS</b>A total of 26 patients who had undergone allo-HSCT from January to July 2015 were enrolled in this study. The NK cell count/activity in the peripheral blood of recipients on day 30 after allo-HSCT were monitored by using 4-color flow cytometry. The incidence of aGVHD in patients was evaluated by clinical manifestation combinating with related pathologic indicators, and the relationship between NK cell count/activity and aGVHD were analyzed.</p><p><b>RESULTS</b>In the aGVHD group and the no-aGVHD group, the NK cell count and activity on days 30 after allo-HSCT were 655±216 cells/µl vs 1169±372 cells/µl(P=0.002) and 7.3±3.6% vs 9.0±3.6% (P=0.008). In the II-IV grade aGVHD group and the 0-I grade aGVHD group, the NK cell count/activity were 617±220 cells/µl vs 1081±399 cells/µl (P=0.001) and 4.2±1.7% vs 8.3±3.5%(P=0.001). As compared with the 0-I grade aGVHD group, patients in the II-IV grade aGVHD group had higher relapse rate (57% vs 5%)(P=0.010) , lower 1-year progression-free survival(PFS) rate (43% vs 84%)(P=0.010).</p><p><b>CONCLUSION</b>NK cell count/activity on day 30 after allo-HSCT were closely relates with aGVHD, which may be a potential marker for aGVHD and can provide a new target for aGVHD therapy.</p>

Clinical and CT identification between preinvasive and invasive lung adenocarcinoma presented as pure ground-glass opacity / 重庆医学

Objective To investigate the diffevential diagnostic value of preinvasive and invasive lung adenocarcinoma (including minimally invasive adenocarcinoma and invasive adenocarcinoma) presented as pure ground-glass nodules(pGGN) by CT.Methods One hundred and fifty-six cases of pGGN verified by operative pathology were retrospectively analyzed,including 58 ca ses of preinvasive adenocarcinoma and 98 cases of invasive adenocarcinoma(TNM staging were T1N0M0).The CT features and sex were statistically processed.The difference between the CT features and sex were performed by thex2 test.The ROC curve of lesion focus size was drawn.Results Statistically significant differences were found in the lesion shape,vacuole sign,air bronchogram,blood vessel through,tumor-lung interface and vascular cluster sign between the two groups(all P＜0.05).The ROC curve showed that the accuracy rate of invasive adenocarcinoma was 75.0％ when the size of the pGGN lesions was larger than 15.35 mm.Conclusion The lesion size,shape,vacuole sign,air bronchogram,blood vessels through and vascular cluster sign have some predictive value.

Comparison of thin sectional anatomy based on the Chinese Visible Human with MRI of biceps reflection pulley / 局解手术学杂志

Objective To explore the morphologic features of the biceps reflection pulley through the comparative study of the thin sec -tional anatomy based on the Chinese Visible Human ( CVH) and MRI sectional anatomy of the biceps reflection pulley ,and to provide ima-ging anatomic data for the diagnosis of lesions .Methods The thin slices of sagittal oblique plane and coronal oblique plane by visualization -al reconstruction based on 5 data set of the Chinese visible human ( CVH) were compared with the corresponding MR images from 20 shoulder joints of the normal volunteer individuals with routine MRI ,5 shoulders without abnormalities with MR arthrography .The detailed sectional a-natomy structure of the the biceps reflection pulley was marked from the CVH ,routine MRI and MR arthrography one by one with Photoshop CS2 software.Results The main three components of the biceps reflection pulley including the coracohumeral ligament (CHL),the superior glenohumeral ligament ( SGHL) ,and the long head of the biceps tendon ( LBT) were markedly displayed on the CVH and MRI .The CHL was markedly displayed on the sagittal oblique , using plain MRI .The SGHL was markedly displayed on the CVH , especially in the transverse plane.The LBT was markedly displayed on the CVH ,especially in the coronal oblique plane parallel to the LBT .The biceps reflection pulley was markedly displayed on the sagittal oblique plane with CVH and MR arthrography .The SGHL was perpendicular to the CHL , with T-shaped link anterior to the LBT on the sagittal oblique plane .Conclusion It is complementary for MRI and CVH displaying the components of the biceps reflection pulley .The sagittal oblique plane is the best position for displaying the components and adjacent structures of the bi -ceps reflection pulley ,which provide helpful position mark for the diagnosis of the lesions in the rotator interval .

Analysis of Risk Factors for Cytomegalovirus Infection after Allogeneic Hematopoietic Stem Cell Transplantation / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To analyze the incidence of cytomegalovirus infection and related risk factors after allogeneic hematopoietic cell transplantation and to develop a rational strategy for the preemptive treatment of CMV infection.</p><p><b>METHODS</b>The clinical data of 398 patients undergoing allogeneic hematopoietic cell transplantation from December 2011 to December 2014 were analyzed retrospectively by using a Kaplan Meier analysis and Logistics model.</p><p><b>RESULTS</b>Out of 398 patients 233 developed post-transplant CMV infection (58.5%). Univariate analysis showed that HLA mismatch, ATG administration, acute graft versus host disease (aGVHD), using prednisone ≥ 1 mg/kg body weight or equivalent were associated with increase of CMV infection. Multivariate analysis showed that HLA mismatch (HR = 2.765, P = 0.000), ATG administration (HR = 3.866, P = 0.000), using prednisone ≥ 1 mg/kg body weight or equivalent (HR = 4.767, P = 0.000) also were associated with increase of CMV infection.</p><p><b>CONCLUSION</b>HLA mismatch, ATG administration, using prednisone ≥ 1 mg/kg are risk factors for CMV reaction.</p>

Diagnosis of frozen shoulder with the coracohumeral ligament on the coronal oblique plane by MRI / 局解手术学杂志

Objective To evaluate the diagnosis of frozen shoulder with the coracohumeral ligament on the coronal oblique plane with MRI.Methods There were 60 patients(120 shoulder joints)in control group,with 30 males and 30 females,the mean age was 50.5 years old.There were 72 shoulder joints in 72 patients of frozen shoulder group(50 femles and 22 males with a mean age of 53.5 years)with clini-cal evidence and MR imaging evidence of frozen shoulder.These were prospectively analyzed to identify the CHL visualization rate and meas-ure the maximum thickness of the CHL.Results The CHL visualization rate on the coronal oblique plane in the control group was 86.7%(104 /120),and the frozen shoulder group was 87.5%(63 /72),the difference was not significant(P >0.05).The CHL visualization rate on the axial view in the frozen shoulder group was 19.4%(14 /72)and the control group was 24.2%(29 /120),the difference was not signifi-cant(P >0.05).The CHL thickness on the coronal oblique plane (n =63)in the patients with frozen shoulder was (4.37 ±1.71)mm, which was significantly greater than (2.84 ±0.79)mm ofpatients in the control group(n =104),the difference was significant(P <0.001). The CHL thickness on the axial plane(n =14)in the patients with frozen shoulder was (3.93 ±1.49)mm,which was significantly greater than (2.29 ±0.65)mm of patients in the control group(n =29),the difference was significant(P <0.001).Conclusion A thickened CHL is highly suggestive of frozen shoulder,which is 4.37 mm on the coronal oblique plane.

Diagnostic value of tri-phase dynamic enhancement scan with CT for acute renal infarction / 局解手术学杂志

Objective To investigate the imaging characteristics and diagnostic value of tri-phase dynamic enhancement scan with CT for acute renal infarction. Methods The image features of CT plain scan and tri-phase dynamic enhancement scan of 10 patients (19 sides) with acute renal infarction were retrospectively analyzed, and the CTA expression of 6 patients were observed. Results Fourteen acute renal infarction lesions of 10 cases were diagnosed. The CT scan showed there were 4 cases with enlargement of kidney, and the other 6 cases were of no abnormality. The tri-phase enhancement CT scan showed there were 6 cases of unilateral renal infarction and 4 cases of bilateral renal infarction, which totally involving 14 sides. The acute renal infarction lesions lacked of high density region in the corticomedullary in cortical phase, and there were wedge-shaped hypodense area, even low density of full kidney in parenchymal phase and pyelographic phase. The a-cute renal infarction lesions were revealed better in parenchymal phase and pyelographic phase than in cortical phase. Six cases of CTA re-vealed the responsible vessels of renal infarction lesions and the other vascular diseases. Conclusion CT tri-phase dynamic enhancement scan has important value in the diagnosis of acute renal infarction, and CTA can identify the responsible vessels of renal infarction lesions.