Exploring the detection of MYD88 mutation in patients with Waldenström macroglobulinemia by different methods and specimens / 中华血液学杂志

Objective: To improve the positivity rate and accuracy of MYD88 mutation detection in patients with Waldenström macroglobulinemia (WM) . Methods: MYD88 mutation status was retrospectively evaluated in 66 patients diagnosed with WM in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2017 to June 2021. The positivity rate and accuracy of the different methods and specimens for MYD88 mutation detection were analyzed. Results: MYD88 mutations were detected in 51 of 66 patients with WM, with an overall positivity rate of 77%. The positivity rate of the next-generation sequencing (NGS) or allele-specific polymerase chain reaction (AS-PCR) was significantly higher than that of the first-generation Sanger sequencing (84% vs 71% vs 46%, P<0.05) . For the different specimens, the positivity rate for the lymph nodes or bone marrow was significantly higher than that of peripheral blood (79% vs 84% vs 52%, P<0.05) . The positivity rate of the MYD88 mutation in the lymph nodes, bone marrow, and peripheral blood determined by NGS was 86%, 90%, and 67%, respectively. The positivity rate in the lymph nodes, bone marrow, and peripheral blood detected by AS-PCR was 78%, 81%, and 53%, respectively. Thirty-nine patients with WM underwent ≥ 2 MYD88 mutation detections. The final MYD88 mutational status for each patient was used as the standard to determine the accuracy of the different methods and in different specimens. The accuracy of MYD88 mutation detection in the lymph nodes (n=18) and bone marrow (n=13) by NGS was significantly higher than that in the peripheral blood (n=4) (100% vs 100% vs 75%, P<0.05) . There was no statistically significant difference in the accuracy of MYD88 mutation detection by AS-PCR in the lymph nodes (n=15) , bone marrow (n=11) , or peripheral blood (n=16) (93% vs 91% vs 88%, P>0.05) . Conclusions: In the detection of the MYD88 mutation in patients diagnosed with WM, NGS or AS-PCR is more sensitive than Sanger sequencing. Lymph nodes and bone marrow specimens are better than peripheral blood specimens.

Status of thyroid function and intelligence quotient of children in areas with different iodine nutrition levels in Xinjiang Uygur Autonomous Region / 中华地方病学杂志

Objective:To learn about the status of thyroid function and intelligence quotient (IQ) of children in areas with different iodine nutrition levels in Xinjiang Uygur Autonomous Region, and to explore the health risk of children with median urinary iodine of 200 - 299 μg/L, and to provide a basis for scientific iodine supplementation.Methods:In May 2019, in Xinjiang Uygur Autonomous Region, Altay Prefecture and Kashgar Prefecture were selected, where the median urinary iodine of children aged 8 to 10 years were 100 - 199 and 200 - 299 μg/L for three consecutive years (2017 - 2019). A stratified random sampling method was used to select 400 children aged 8 to 10 years in each of the two regions, urine and blood samples were collected to detect urinary iodine and thyroid function [thyrotropin stimulating hormone (TSH), free thyroxine (FT 4), free triiodothyronine (FT 3), anti-thyroglobulin antibody (TgAb), and anti-thyroperoxidase antibody (TPOAb)]. At the same time, children's IQ was measured and determined by Second Revision of Combined Raven's Test (CRT-C2) in China and Second Revision of Combined Raven's Test for Children-the Rural, in China (CRT-RC2). Results:The median urinary iodine of children aged 8 to 10 years in Altay Prefecture and Kashgar Prefecture was 188.6 and 250.1 μg/L, respectively. There was no statistically significant difference in thyroid function indexes TSH and FT 3 levels between the two regions ( Z = - 0.58, t = 0.49, P > 0.05), while there was statistically significant difference in FT 4 level ( t = 60.08, P < 0.001). There was no statistically significant difference in TgAb positive rate [3.6% (14/394), 4.0% (16/399)] between the two regions (χ 2 = 0.11, P = 0.736), but the difference of TPOAb positive rate [9.6% (38/394), 30.6% (122/399)] was statistically significant (χ 2 = 53.93, P < 0.001), while the difference of dual antibody positive rate [0.8% (3/394), 2.0% (8/399)] was not statistically significant ( P = 0.134). There was no statistically significant difference in the detection rates of subclinical hypothyroidism [8.9% (35/394), 11.0% (44/399)], subclinical hyperthyroidism [1.0% (4/394), 1.3% (5/399)] and hyperthyroidism [0.3% (1/394), 0.8% (3/399)] in children between the two regions ( P > 0.05). The IQ results of children in the two regions were 96.55 ± 11.36 and 89.57 ± 12.35, respectively, and there was no significant difference between them ( t = 2.79, P = 0.095). Conclusions:The thyroid function status of children is similar in the two regions with median urinary iodine of 100 - 199 μg/L and 200 - 299 μg/L in children aged 8 to 10 years, but the TPOAb positive rate is significantly different. Children whose iodine nutritional level is at or above the appropriate level have no obvious changes in intelligence. It is suggested that median urinary iodine at 200 - 299 μg/L is a relatively safe iodine nutrition state.

Effect of oral iodized oil pills on thyroid function of pregnant women / 中华地方病学杂志

Objective:To evaluate the effect of oral iodized oil pills on iodine nutrition and thyroid function of pregnant women in Xinjiang Uygur Autonomous Region (Xinjiang).Methods:From May to July 2017, one county was selected from Ili Prefecture without taking iodized oil pills, Aksu Prefecture taking iodized oil pills once a year, and Kashgar Prefecture taking iodized oil pills twice a year in Xinjiang as survey sites, respectively; 100 pregnant women (evenly distributed in early, middle and late pregnancy) were selected from each survey county, the general data, urine and blood samples were collected, and urinary iodine and thyroid function indicators [free triiodothyronine (FT 3), free thyroxine (FT 4), thyrotropin (TSH), anti thyroglobulin antibody (TgAb), and anti thyroid peroxidase antibody (TPOAb)] were tested. Results:A total of 308 pregnant women were investigated, and 289 were finally included in the analysis, with an average age of 25 years; the body mass index (BMI) was (22.69 ± 3.07) kg/m 2. The occupation distribution was mainly farmer, accounting for 93.77% (271/289); most of them had junior high school education or below, accounting for 71.97% (208/289). The median urinary iodine of early, middle and late pregnant women in Kashgar Prefecture was 712.87, 604.50 and 656.23 μg/L, respectively, which were in iodine excess state. The iodine nutrition level of early pregnant women in Ili Prefecture and Aksu Prefecture was in iodine super suitability state, and the iodine nutrition level of middle and late pregnant women was in the iodine suitability state. The difference of median urinary iodine in early, middle and late pregnancy women between different regions was statistically significant ( Z = 53.02, 49.60, 44.66, P < 0.001). In addition, the urinary iodine of women in Kashgar Prefecture during each pregnancy period was significantly higher than that in Ili Prefecture and Aksu Prefecture ( P < 0.05). There were statistically significant differences in the levels of FT 3 among women in early pregnancy, FT 4 and TSH among women in middle pregnancy between different regions ( F = 4.59, 10.92, Z = 8.61, P < 0.05 or < 0.001). Among them, the level of FT 3 in early pregnancy in Kashgar Prefecture was lower than that in Ili Prefecture ( P < 0.05); the level of FT 4 in Kashgar Prefecture during middle pregnancy was higher than that in Ili Prefecture, and the level of TSH was lower than that in Ili Prefecture ( P < 0.05). There was no significant difference in TgAb positive rate, TPOAb positive rate and double antibody positive rate of early, middle and late pregnant women between different regions ( P > 0.05). The detection rates of hypothyroxinemia in early pregnant women in Ili Prefecture, Aksu Prefecture and Kashgar Prefecture were 13.9% (5/36), 3.2% (1/31) and 0 (0/33), respectively, and there was a statistically significant difference between different regions ( P = 0.036). The detection rates of subclinical hyperthyroidism in middle pregnant women were 0 (0/35), 0 (0/40), 17.6% (6/34), respectively, and there was a statistically significant difference between different regions ( P = 0.001). Conclusions:The results of urinary iodine in the three regions are in line with the iodine nutrition distribution under their respective iodine supplement strategies. Pregnant women in Kashgar Prefecture present iodine excess status after taking iodized oil pills; at the same time, the serum FT 3, FT 4 and TSH levels of pregnant women in Kashgar Prefecture are affected by iodine nutrition levels. Although it is scientific and effective to implement the intensified iodine supplement measures for pregnant women, it is still necessary to further study the suitability of oral iodine oil pills to ensure that pregnant women are at an suitability iodine nutrition level.

Surveillance of bacterial resistance in Tongling People's Hospital during 2016 / 中国感染与化疗杂志

Objective To investigate the bacterial distribution and antibiotic resistance profile in Tongling People's Hospital during 2016.Methods All the clinically isolated bacterial strains in Tongling People's Hospital during 2016 were identified and tested for their susceptibility to antimicrobial agents.The results were analyzed with WHONET 5.6 software.Results A total of 2 949 strains of bacteria were collected,including 2 134 strains of gram-negative bacteria and 815 strains of gram-positive bacteria.The top five gram-negative bacteria were E.coli,4.baumannii,K.pneumoniae,P.aeruginosa and Enterobacter.The top five gram positive bacteria were coagulase-negative Staphylococcus,S.aureus,E.faecalis,E.faecium and Streptococcus.The prevalence of ESBLs-producing strains was 42.3％ in E.coli and 31.1％ in K.pneumoniae,The prevalence of carbapenem-resistant strains was 1.2％ (8/640) in E.coli isolates and 29.4％ (108/367) in K.pneumoniae isolates.Majority (94.3％) ofA.baumannii strains were susceptible to tigecycline.However,74.3％ and 74.9％ of these strains were resistant to imipenem and meropenem,respectively.Most P aeruginosa strains (78.2％) were resistant to piperacillin,but about 70％ were susceptible to carbapenem antibiotics.The prevalence of methicillin-resistant strains was 32.0％ (74/231) in S.aureus and 65.6％ (170/259) in coagulase-negative Staphylococcus.No staphylococcal strains were found resistant to teicoplanin or vancomycin.No enterococcal isolates were resistant to teicoplanin or linezolid.Conclusions The number of bacterial isolates in this hospital is increasing year by year.The prevalence of multidrug-resistant bacteria is also on rise,especially the pandrug-resistant Enterobacteriaceae and A.baumannii.It is urgently required to strengthen the control of hospital infections.

Application value analysis of the method cut-open performing umbilicus abdominal access during laparoscopy / 局解手术学杂志

Objective To introduce a new method performing umbilicus abdominal access during laparoscopy. Methods In a prospec-tive,362 patients received laparoscopic appendectomy in October 2012 to October 2014 were oberserved in this study. The clinical data,the time of the progress of making umbilicus abdominal access,complications and the state of the wound were recorded. Results The performing time of the trocar in umbilicus was (42. 3 ± 27. 1)s. Conclusion The method Cut-open,is simple,fast and save,which is worth to promoting in laparoscopic surgery.

Evaluation methods of angiogenesis in experimental liver fibrosis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the methods for assessing angiogenesis in experimental liver fibrosis.</p><p><b>METHODS</b>Male C57BL/6 mice were randomly divided into a normal (unmodeled) group and a liver fibrosis model group.The model was established by a 4-week course of 10% CCl4 solution (in olive oil) intraperitoneal injection. Liver vasculature was observed by magnetic resonance (MR),computed tomography (CT),synchrotron radiation X-ray,and von Willibrand factor(vWF) immunofluorescence staining. Liver inflammation and fibrosis were observed by staining with hematoxylin-eosin and Sirius red.The t-test and Pearson's correlation analysis were used for statistical analyses.</p><p><b>RESULTS</b>Compared with the normal group,the model group had more robust inflammation and fibrosis in liver tissue.The liver tissue in the modeled mice showed significant deceases in MR signal intensity on T2WI before and after enhancement (386.67+/-69.04 vs.492.67+/-112.50,t =-2.456, P=0.026).The liver tissue in the modeled mice also showed significantly decreased enhancement CT values (P < 0.01).Synchrotron radiation X-ray imaging showed that the small vessels in the liver tissues of the modeled mice were significantly increased compared to that in the normal mice (P < 0.01).The MR T2W enhanced signal value (439.67+/-104.80, Pearson's r=0.714, P=0.009) and microvascular relative length (676.53+/-122.75, Pearson's r=0.791, P=0.002) were positive correlated with microvessel density (MVD) (14.50+/-5.95),as shown by detection of labeled vWF.The before and after CT enhancement difference (132.60+/-57.02, Pearson's r=-0.612, P=0.034) was negatively correlated with MVD.</p><p><b>CONCLUSION</b>s MR,CT and synchrotron radiation X-ray imaging can be used for assessing angiogenesis in liver fibrosis,and the findings from each are correlated with the traditional MVD detection method. The two-dimensional imaging of synchrotron radiation X-ray is more intuitive,and has been confirmed as an effective evaluation method for liver angiogenesis.</p>

Surveillance of bacterial resistance in Tongling People′s Hospital during 2013 / 中国感染与化疗杂志

Objective To investigate the antimicrobial resistance of clinical isolates in Tongling People′s Hospital during 2013. Methods A total of 2 281 nonduplicate clinical isolates were collected.Kirby-Bauer disc diffusion method was employed to study the antimicrobial susceptibility.The data were analyzed with WHONET 5.6 software according to CLSI 2012 breakpoints. Results The top 5 most frequently isolated microorganisms were E.coli (479,21.0%),K.pneumoniae (360,15.8%),A. baumannii (271,11.9%),P .aeruginosa (240,10.5%),S.aureus (171,7.5%).Gram negative and gram positive microorganisms accounted for 76.5% and 23.5%,respectively.The prevalence of methicillin-resistant strains in S.aureus (MRSA)and coagulase negative Staphylococcus (MRCNS)was 38.6% and 73.1%,respectively.The resistance rates of MR strains to beta-lactams and other antimicrobial agents were much higher than those of MS strains.No staphylococcal strain was found resistant to vancomycin or teicoplanin.E.faecalis showed relatively lower resistance to penicillin,ampicillin and nitrofurantoin.E.faecium strains were more resistant than E.faecalis to most of the antibiotics tested.Approximately 50.5% of E.coli and 44.5% of Klebsiella isolates produced extended-spectrum beta-lactamases (ESBLs).The ESBLs-respectively.And 29.8% and 23.4% of the P .aeruginosa strains were resistant to imipenem and meropenem.Nearly all (94.0%)P .aeruginosa isolates were susceptible to amikacin.Conclusions There appears a trend of increasing resistance in the clinical bacterial isolates in this hospital,especially the carbapenem-resistant Enterobacteriaceae,which is of great concern.It is mandatory to take effective antibiotic policy and infection control measures.

Cool-tip Radiofrequency Ablation Therapy Instrument Based on Impedance Control Algorithm / 生物医学工程学杂志

A new cool-tip radiofrequency (RF) ablation therapeutic instrument based on impedance control algorithm is introduced in this paper. The equipment is composed of hardware system and software system. The RF power output and real time data acquisition are completed by the hardware system, while the software is used mainly to finish the control of the ablation range, the core of which is impedance control algorithm, and it also used to complete the display of the real time data in the course of the experiment. The impedance algorithm has solved the problem of impedance increased rapidly during the RF ablation, which has also expanded the scope of ablation. The pig liver experiments showed that the impedance control algorithm had strong adaptability. It also obtained a result of ablation range up to 3.5-4.5 cm single needle. It has the high clinical practical value of one-time inactivation of 3-5 cm tumor.

Measures to anatomic variations of the colonic vessels in laparoscopic operations / 中华胃肠外科杂志

In laparoscopic colorectal resection, the poor blood supply of the anastomosis after tumor excision is difficult to be determined during the operations sometimes. The change in blood supply of the bowel is mainly due to the mesenteric anatomy and the operative techniques. The direct blood supply of colon is the marginal vessels in the mesentery. The integrity and patency of the marginal vessels determine the vitality of the bowel. However, the marginal vessels are different in diameter, pulsation or even discontinue in various areas, affecting the excision of the colon and following anastomosis. The most common three dangerous areas to anastomosis include:(1)area between ileocolic artery and right colonic artery; (2)area between middle colonic artery and left colonic artery-the Griffiths point. (3)area between the terminal branch of sigmoid colonic artery and superior rectal artery-Sudeck dangerous area. In laparoscopic colorectal resection, one should pay attention to protect the blood supply of the bowel and the marginal blood vessels, and be vigilant to the three vascular variations above mentioned. The vessels should be ligated accurately to ensure sufficient blood supply to the anastomosis and consequent normal healing of the rectal and colonic anastomosis. More attention should be paid to the elderly, morbid, and diabetic patients. If the safety of the anastomosis is unsure, prophylactic ileostomy should be performed.

Efficacy and side-effects of docetaxel combined with cisplatin on the treatment of local advanced esophageal cancer with concomitant radiation therapy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the therapeutical effect and side-effect of docetaxel combined with cisplatin (DDP) on the treatment of local advanced esophageal cancer with concomitant radiation therapy.</p><p><b>METHODS</b>Ninety patients with LOCAL advanced esophageal squamous cell carcinoma were divided into two groups: (DDP + 5-Fu) group and (docetaxel + DDP) group. Chemotherapy was carried out every 4 weeks for a total of 4 courses. The radiation dose was 50.4 Gy/28FX.</p><p><b>RESULTS</b>The median survival time of patients in the (DDP + 5-Fu) group was 16 months and that in (docetaxel + DDP) group was 21 months (P = 0.0278). The 3-year survival rate in the (docetaxel + DDP) group was obviously higher than that in the (DDP + 5-Fu) group (23.9% vs. 12.1%). The ORR in (docetaxel + DDP) group (84.5%) was significantly higher than that in the (DDP + 5-Fu) group (71.1%) (P = 0.025). No significant differences were observed in the incidence of side-effects in the two groups.</p><p><b>CONCLUSIONS</b>The conventional dose chemotherapy of docetaxel + DDP with concomitant radiation therapy showed a better partial remission rate and long-term survival rate for the treatment of local advanced esophageal cancer than the traditional chemotherapy (DDP + 5-Fu) with concomitant radiation therapy and the side-effects are not increased.</p>

Preoperative chemoradiotherapy with FOLFOX in low rectal cancer: a multicenter study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the toxicity and safety of FOLFOX regimen concurrent with radiotherapy in neoadjuvant setting in patients with low rectal cancer.</p><p><b>METHODS</b>Fifty-six patients with stage T(3-4)N(0)M(0) and T(1-4)N(1-2)M(0) were eligible from Aug. 2004 to Jul. 2007. Upon entry the study, they received 4 cycles of chemotherapy with FOLFOX regimen. Radiotherapy was added from the second cycle of chemotherapy (CT). The total dose of radiotherapy (RT) was 46 Gy (2 Gy x 23). Total mesorectal excision (TME) was performed 4-8 weeks after RT.</p><p><b>RESULTS</b>Among them, 54 cases received 4 cycles of CT, 1 patient stopped CT after the second cycle of CT because of unrecovery from neutropenia. One patient stopped chemoradiotherapy(CRT) because of complicating with active pulmonary tuberculosis after 2 cycles of CT and 10 times of RT. Two occurred liver, lung and bone metastases after CT. Totally 220 cycles of CT were administrated. Fifty-two patients received operation after CRT, 50 with anal interior sphincter reservation, 19 with prophylactic ileac stoma. Anastomotic leakage occurred in 2 patients after operation, and rectal vaginal fistula in 2 patients 1 month after operation. According to the pathologic results, 7 patients achieved complete response, 41 partial response, 4 stable disease, and the objective response rate was 85.7%.</p><p><b>CONCLUSION</b>Concomitant treatment of FOLFOX regimen and RT in neoadjuvant setting of rectal cancer was safe and tolerable, and it suggests that protective ileostomy for anastomotic leakage following anus-preserving operation should be performed.</p>

Analysis of Technical Keypoints of The Second-Phase Diaplasis Treatment after Hartmann Operation / 中国普外基础与临床杂志

Objective To discuss the technical keypoints of the second-phase diaplasis treatment after Hartmann operation. Methods Twenty-one cases of the second-phase diaplasis operation of Hartmann operation in this hospital from January 2003 to December 2007 were analysed retrospectively. Results In this group, stapler technique was used in 15 cases, anastomotic ring was used in 3 cases, and one-layer suture was used in 3 cases. The time of these operations was between 118 min and 240 min (mean 164 min). Neither stomal leak nor stomal stenosis occurred, acute ileus occurred in 2 cases, and both recovered after the treatments of gastrointestinal decompression, inhibition of secretion digestive juice and reoperation. Acute retension of urine occurred in 1 case after urine catheter removed. The symptoms disappeared after excises of bladder function. These cases were followed up for 3-36 months (mean 20 months). All the patients recovered to normal function of defecation. Conclusion The technical keypoints of the second-phase diaplasis treatment after Hartmann operation are how to find and liberate the end of the distal colon. It will affect the prognosis and the occurrence of complications after this operation.

Application of hyperthermic intraoperative intraperitoneal chemotherapy in patients with gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the effect of hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) on the postoperative metastatic rate and survival rate of advanced gastric cancer (AGC).</p><p><b>METHODS</b>In HIIC group, patients received HIIC (mitomycin C 30 mg and cisplatin 100 mg were added into 2000 ml distilled water, heated to 42 approximately 45 degrees C, perfused to abdominal cavity for 30 min and then sucked) and intravenous chemotherapy after operation (5- FU 10 approximately 15 mg/kg, mitomycin C 0.1 approximately 0.15 mg/kg, adriamycin 0.5 approximately 1 mg/kg i.v drip, once a week for 2 approximately 3 weeks). In control group, patients received intravenous chemotherapy only. The postoperative metastatic rate and survival rate (1- , 3- and 5- year) of patients were compared between 92 cases of AGC undergone HIIC and 120 cases of AGC without HIIC (control group).</p><p><b>RESULTS</b>The peritoneal recurrence rates after operations occurred within two years were 14.1% and 37.5% in HIIC group and control group respectively (P < 0.01). The 1- , 3- , and 5- year survival rates in HIIC group were 98.9%, 68.5%, and 52.2% and in control group 95.0%, 56.7% and 37.5% respectively. The 3- , and 5- year survival rates were significantly different between the two the groups (P < 0.05).</p><p><b>CONCLUSION</b>HIIC can kill isolated intraperitoneal cancer cells, reduce peritoneal recurrence rate after operations, raise significantly survival rate of patient, and improve the prognosis of AGC.</p>

Application of Ligasure vessel sealing system in haemorrhoidectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical value of Ligasure vessel sealing system (LVSS) in haemorrhoidectomy.</p><p><b>METHODS</b>From December 2002 to November 2003, clinical data of 36 cases undergoing haemorrhoidectomy with LVSS were compared with those of 30 cases undergoing traditional operation,considering visual analogue scale(VAS), hospital time,operation time,hospital expenses,postoperative complication.</p><p><b>RESULTS</b>There were no significant differences in hospital expenses,postoperative complications between the two groups,but the postoperative pain scores of Ligasure haemorrhoidectomy was better than that of traditional operation. The hospital stay and operation time of Ligasure haemorrhoidectomy were shorter than those of the traditional operation.</p><p><b>CONCLUSION</b>Ligasure vessel sealing system has more advantages such as less pain, safety, facility to perform, and a shorter operation time.</p>

Diagnosis and treatment of mesenteric venous thrombosis early after operation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics diagnosis and treatment of patients with mesenteric venous thrombosis early after operation.</p><p><b>METHODS</b>A retrospective study was performed on the clinical data of 7 patients with mesenteric venous thrombosis early after operation from 1990 to 2004.</p><p><b>RESULTS</b>Patients had main clinical manifestations of severe abdominal pain and vomiting, but abdominal signs were slight. The systemic toxic symptoms occurred in 2 cases at late course. The examination of abdominal X- ray showed intestinal obstruction of all patients. Four patients received abdominal CT- scanning, of whom 3 patients were diagnosed as mesenteric venous thrombosis. Seven patients received exploratory operation. The necrotic intestinal segments were resected. Two patients had short intestinal syndromes after operation, one of them died of serious malnutrition. Four patients who had recurrence of portal, mesenteric and iliac venous thrombosis needed a long-term therapy of warfarin and aspirin after discharge.</p><p><b>CONCLUSION</b>It is easy to make a mistake in diagnosis because of the lacking of characteristic clinical manifestations. Exploratory operation immediately plus anticoagulant therapy is strongly recommended.</p>

Comparison of postoperative hepatic functions between laparoscopic and open colorectal surgery / 中国微创外科杂志

Objective To investigate the difference on postoperative hepatic functions between laparoscopic and conventional surgery for colorectal cancers. Methods In this prospective study, a laparoscopic group ( n =20) was compared with an open group ( n =20). Blood samples were obtained at 1, 24, 48, and 72 hours postoperation respectively to perform liver function tests, including total bilirubin (TBil), albumin (Alb), gamma-glutamyl transpeptidase (?-GT), alkaline phosphatase (ALP), aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Results Of the both groups, serum Alb and ALP levels decreased, and TBil and GGT levels remained unchanged. Postoperative ALT and AST levels transiently increased by threefold and returned to near baseline levels at 72 hours. There was no postoperative liver failure or mortality in both groups. Conclusions Laparoscopic colorectal surgery results in postoperative elevation of hepatic transaminases but does not adversely alter hepatic functions to any greater extent than open colorectal surgery.

Effect of diode laser coagulation treatment on grade III internal hemorrhoids / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the curative effects of diode laser coagulation on grade III internal hemorrhoids.</p><p><b>METHODS</b>From March 2004 to December 2004, 86 patients with grade III internal hemorrhoids were divided into two groups, received laser coagulation (laser group, n=46) or received hemorrhoidectomy (control group, n=40). Complications, symptom relief, pain scores and satisfaction scores were compared between the two groups six months after operation.</p><p><b>RESULTS</b>Pain scores were lower in laser group than that of the control group on the first day and seventh day after operation. Small amount of bleeding occurred in the laser group (12 cases) and control group (35 cases), however, non of them required special hemostasis. Laser coagulation and closed hemorrhoidectomy were equally effective in controlling symptomatic prolapse. There was no difference in terms of continence scores and patients satisfaction between the two groups (P> 0.05).</p><p><b>CONCLUSIONS</b>Diode laser coagulation can be considered as a safe and effective procedure for the treatment of grade III hemorrhoids.</p>

A Study on Surgical Treatment of Early-stage Breast Cancer with Breast-conserving Operation / 中国医师杂志

Objective To explore the effect of breast-conserving operation for the treatment of early-stage breast cancer. Methods From November 1999 to Octorber 2001, the patients with early-stage breast cancer were treated with breast-conserving surgery followed by radical irradiation according to the patients' will. The cosmetic results and quality of life were analyzed after surgery and radiation. Results In all the patients received operation treatment from 1999 to 2001, eighteen patients were treated with breast-conserving surgery with breast conservation rate of 10.2%, of which 7 cases with quadrantetomy plus axillary lymph node dissection (ALND), 8 cases with lumpectomy plus ALND and 3 cases with lumpectomy. Pathological staging was as follow: 4 cases in stage 0, 12 cases in stage Ⅰ, and 2 cases in stage Ⅱ. All cases were followed-up. The cosmetic results were good in 94%(17/18) and fair in 6%(1/18). All the patients had not local recurrence and distant metastasis. Conclusions Breast-conserving surgery followed by radiation therapy is superior to mastectomy in terms of improving breast cosmesis and quality of life. Postoperative radiation therapy does not affect the cosmetic result.

Technical Improvement of the Gastrointestinal Anastomosis After Gastrectomy / 中国医师杂志

Objective To summarize the experience of using anastomotic apparatus and ring in the reconstruction of alimentary tract after gastrectomy. Methods Anastomotic apparatus or anastomotic ring was used to reconstruct alimentary tract after total or partial gastrectomy including esophagojejunostomy, esophagogastrostomy, gastroduodenostomy, gastrojejunostomy and jejunojejunostomy. Results The reconstruction of alimentary tract after gastrectomy using anastomotic apparatus and ring was successfully completed once in 182 cases. There were not anastomotic leakage, bleeding and infection after operation. During the follow-up period of 3～12 months, gastroscope or barium meal examinations showed that only 3 cases had the stricture of anastomotic entrance, and the other patients recovered well. Conclusion Compared with using traditional manual anastomosis to reconstruct alimentary tract after gastrectomy, anastomotic apparatus and ring had the advantages of convenience, simplicity, rapidity and reliability, and could raise operative efficiency greatly, shorten operative time and prevent the complications of post-operation such as the leakage and striture of anastomotic entrance. Using anastomotic apparatus and ring was recommended in the reconstruction of alimentary tract.

Circular Stapling Procedure for the Treatment of Internal Rectal Mucosal Prolapse / 中国医师杂志

Objective To explore the new approach of operatively treating internal rectal mucosal prolapse. Methods 42 patients with internal rectal mucosal prolapse were treated with circular stapling procedure, and followed-up for 2～24 months after operation. Results Mean operative time circular stapling procedure was 18 minutes, and mean hospitalization time of the patients was 3 days. The clinical symptoms were obviously improved after operation. Anastomotic stoma bleeding was found in 9 patients (21.4 %) during operation. Urinary retension was found in 17 patients (40.5%), who needed catheterization. Sensation of rectal tenesmus occurred in 6 patients(14.3%). Infection, anal incontinence and rectovaginal fistula were not found in all the patients. Conclusion Circular stapling procedure is safe, simple and effective technique for treating internal rectal mucosal prolapse with the advantages of minimal invasion.