Practice of bar code management for implanted high-value consumables in operating room / 中华护理杂志

Objective To establish standardized traceable management procedure for implanted high-value consumables in operating room.Methods The management model combining information-based system operation process and quality control process was designed,and management results before and after implementation were compared.Results There were statistically significant differences in error rates of information recording,bar code sticking and charging of implantable high-value consumables after the implementation of the process management mode (P＜0.05).At the same time,there were statistically significant differences in improvement of traceability of high-value consumables,adverse event reporting and patient satisfaction(P＜0.05).Conclusion Establishment of management model in operating room for implanted high-value consumables can ensure medical safety and increase medical quality.It was proved to improve the level of hospital management.

The application of failure mode and effect analysis in the retrospective management of high-value consumables in implant operation / 中国实用护理杂志

Objective The failure mode and effect analysis (FMEA) were used to monitor the managerial process of high-value consumables in the implantation surgery, and establish the traceable management process for high-value consumables of the implantation surgery. Methods FMEA was used to carry out risk assessment process, formulate specific measures for improvement. The risk priority number(RPN),the qualified rate of the management index of implant surgical consumables,the patients satisfaction, and the number of adverse events reported were compared before and after the implementation of this process management. Results After FMEA was used to conduct management over implant surgery consumables,the RPN value decreased dramatically due to difficulty of traceability, information recording, and imperfect management system, thereby showing that the difference was statistically significant (t=16.655, 10.664, 9.321, P<0.01). Quality management measures: the access to consumables meets the requirements,complete information record,quality of stock consumables,paste bar code standard, charge accurate, return visits and records on time, consumables traceability, patient satisfaction rate were 99.2%(373/376),96.7%(363/376),99.5%(374/376),95.6%(361/376),98.6%(371/376), 95.7% (360/376), 100.0% (376/376), 97.1% (365/376), respectively after the implementation of this process management, which were higher than 90.9% (355/390), 81.8% (319/390), 94.2% (367/390), 91.3% (356/390),84.7%(330/390),87.3%(341/390),87.5%(342/390),91.8%(358/390)before the implementation of this process management, thereby showing that the difference was statistically significant (χ2=7.149-49.371, P<0.01).The number of adverse consumables event reports increased from 0 up to 5. Conclusions It was feasible and effective to improve the level of hospital management and ensure the safety of patients by using the FMEA model in the implantation surgical high-value consumables.

Establishment of dual liver transplantation rat model / 中华肝胆外科杂志

Objective To establish a dual liver transplantation rat model,which could benefit the future clinical practice.Methods Y type vein derived from the crossover segment of vena cava and two iliac veins in donor and Y type bile duct prosthesis were employed to recanalize portal vein and bile duct from dual liver grafts to recipient liver.The dual right upper lobes with about 45％ ～ 50％ of the recipient liver volume were taken as donor.One was orthotopically implanted at its original position,while the other was rotated 180° sagittally and heterotopically positioned in the left upper quadrant.Survival rate was analyzed to evaluate the function of dual liver grafts.Results A total of 7 rats which underwent dual liver transplantation survived more than 7 days and the survival rate was 58.3％.5 rats died due to abdominal hemorrhage,bile leakage and liver abscess.Conclusion Using Y type vein and bile duct prosthesis,we successfully established a novel rat model of dual right upper liver lobe transplantation.

Establishment and preliminary application of the McA-RH7777/Buffalo hepatoma rat model with bioluminescence imaging / 中华肝胆外科杂志

Objective To establish a luciferase labeled McA-RH7777 hepatoma rat model,which could be used for gross observation to further observe the effect of selective ligation of the portal vein and bile duct on tumor growth and metastasis.Methods The luciferase gene was transfected into rat McA-RH7777 hepatoma cells with pCDH-puromycin-CMV as the carrier,which were subcutaneously inoculated into Buffalo rats.Tumor pieces were then heterotransplanted into the left lateral lobe of the allogenic rat liver to observe the tumor growth in vivo.After the successful hepatoma modeling,the rats were randomly divided into three groups,namely the implanted portal vein group with combined portal vein and bile duct ligation,the implanted portal vein group with single portal vein ligation and sham operation group.The rats were executed at the 1 st week and 2nd week after ligation,and the livers were dissected to record the tumor growth and metastasis inside and outside the liver,respectively.Results The tumor formation rates of Buffalo rats after subcutaneous and intrahepatic implantation were both 100％.The fluorescence signal implanted into the liver lobe could be observed in vivo after the intrahepatic implantation of luciferase transfected Luc-McA-RH7777 at 2nd week,the range and intensity of which increased over time.Only local tumor growth could be found at the 4th week,without obvious intrahepatic and lung metastasis.However,both an increased in situ tumor volume and the pulmonary metastasis could be observed in the implanted portal vein group with combined portal vein and bile duct ligation at 2nd week after the ligation.Immunohistochemistry showed AFP positive immunoreactions in the vast majority of intrahepatic tumor cells and Luc positive immunoreactions in part of tumor cells.Conclusion Luc-McA-RH7777 cells could be used to establish the heptoma rat model and the in vivo analysis within the Buffalo rat liver demonstrated that the combined ligation of the portal vein and bile duct can accelerate the development and metastasis of liver cancer.

Hepatitis B virus X protein induces epithelial-mesenchymal transition through c-Src activation in liver cancer cells / 中华肝胆外科杂志

Objective To examine the role of c-Src activation in hepatitis B virus X (HBx) protein induced epithelial-mesenchymal transition (EMT) in liver cancer.Methods SMMC-7721 liver cancer cells were transfected with HBx gene to induce EMT and the activated c-Src expression was evaluated by Western blot.Both the morphological changes and the epithelial and mesenchymal markers expression (real-time PCR,western blot and immunocytochemistry) of HBx-transfected SMMC-7721 cell treated by c-Src kinase inhibitor PP2 and negative control PP3 were observed and compared,respectively.Results The activated c-Src expression in HBx gene transfected SMMC-7721 cells was significantly increased compared to that in mock transfected cells,c-Src kinase inhibitor PP2 could enable the HBx-transfected SMMC-7721 cells to transmit from spindle-like shape to original epithelial morphology.Western blot and immunocytochemistry confirmed that the expression of epithelial markers and mesenchymal markers almost returned to the levels of parental cells,indicating the mesenchymal-epithelial transition.Conclusions c-Src activation plays a key role in the process of EMT induced by HBx protein in SMMC-7721 cells.

Surgical management of incidental gallbladder cancer discovered during or after laparoscopic cholecystectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the surgical management of incidental gallbladder cancer (IGBC) discovered during or after laparoscopic cholecystectomy (LC) and to evaluate the associated factors of survival.</p><p><b>METHODS</b>A retrospective analysis of patients with IGBC between January 2002 and December 2013 was performed. A total of 10 080 consecutive patients underwent LC operation for presumed gallbladder benign disease in Chinese People's Liberation Army General hospital. And among them, 83 patients were histologically diagnosed as IGBC. Data covering clinical characteristics, surgery records, local pathological stage, histological features and factors for long term survival were reviewed. The survival analysis was performed using Kaplan-Meier method, and the results were examined using the log-rank test.For multivariate statistical analyses of prognostic factors, a Cox proportional hazards model was carried out.</p><p><b>RESULTS</b>A total of 83 patients with IGBC:68.7% females (57/83), median age of 61 years (range 34-83 years). There were 47 cases accepted the initial simple LC, 18 cases converted to open extended radical cholecystectomy, 16 cases with radical second resection, and 2 cases with re-laparotomy; the 5-year survival rates for each group were 89.4%, 38.9%, 87.5%, and 0, respectively. The 5-year survival rates in T1a, T1b, T2, and T3 stage patients were 95.7% (22/23), 90.0% (18/20), 75.0% (15/20), and 40.0% (8/20), respectively. Univariate analysis for prognostic factors associated with cancer-specific death showed that depth of invasion, lymph-node status, vascular or neural invasion, tumor differentiation, extent of resection, bile spillage during prior LC and type of surgery were statistically significant.In multivariate analysis, depth of invasion, extent of resection and bile spillage were the most important prognostic factors related to both cancer-specific mortality and disease relapse (P < 0.05).</p><p><b>CONCLUSIONS</b>Simple LC is appropriate for T1a patients with clear margin and unbroken gallbladder. An extended radical resection in patients with T1b or more is highly recommended, and provided as a potentially curative R0 resection only if it is necessary.</p>

Effects of the expression of adhesion molecules on the metastasis of cirrhotic liver cancer in mice / 中华肝胆外科杂志

Objective To study the effects of a cirrhotic environment on the metastasis of liver cancer in mice.Methods Male BALB/c mice were randomly assigned to two groups:cirrhosis group and control group.The cirrhosis group was treated by an injection of carbon tetrachloride intraperitoneally.H22 liver cancer cells were directly implanted under the capsule of each group after cirrhosis was established.The animals were sacrificed at 1,2,and 3 weeks after the operation.The metastatic behavior of the cancer cells was observed by the naked eye and microscopically.Additionally,the adhesion ability of the liver was assessed by measuring the expression of vascular cell adhesion molecule 1 (VCAM-1),E-selectin,and E-cadherin.Results After the operation,the cirrhosis group showed an obvious metastatic tendency in both intrahepatic (14/19) and extrahepatic ways (4/19),compared with the control group's intrahepatic (5/17) and extrahepatic ways (1/17) (P＜0.05).Immunohistochemisty for VCAM-1 and E-selectin showed a significant increase in the cirrhosis (P＜0.05).However,there was no difference observed in the E-cadherin between the cirrhosis and control group.Conclusion A cirrhotic liver environment may promote the metastasis of liver cancer cells by increasing the ability of liver adhesion.

Influences of congestion/reperfusion injury on remnant liver in rats after hepatectomy / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the effect of congestion/reperfusion injury (CRI) and ischemia/reperfusion injury (IRI) on remnant liver in rats after hepatectomy.</p><p><b>METHODS</b>Male SD rats were divided into IRI, CRI, and control groups. In the former two groups, the left lateral lobe of the rats were subjected to IRI or CRI for 30 min with the rest lobes (about 70% of the total liver weight) resected; the rats in the control group received hepatectomy preserving only the left lateral lobe. The mortality rate of the rats was recorded, and the surviving rats were sacrificed at 1, 3 and 7 days after operation for analyses of ICG plasma disappearance rate (ICG-PDR), ALT, AST, liver regeneration rate, and Ki-67 labeling index.</p><p><b>RESULTS</b>The mortality rate was significantly higher in CRI group (34.3%) than in IRI group (8%, P<0.05) and control group (4%, P<0.01). On day 1 following hepatectomy, CRI group showed significantly higher liver enzyme levels and poorer liver functions than the control group (P<0.05) without significant differences from those in IRI group (P<0.05); Ki-67 labeling index in CRI group was significantly lower than that in the control group (P<0.01) and IRI group (P<0.01). Compared with the control group, CRI group showed a significantly lowered maximum Ki-67 labeling index with also a delayed occurrence (P<0.01); CRI resulted in poorer liver regeneration rate on day 3 after hepatectomy compared to the control group (P<0.01) and IRI (P<0.05).</p><p><b>CONCLUSION</b>Compared with IRI, CRI can result in severer liver damage and lowered liver regenerative capacity in rats early after hepatectomy.</p>

Influence of nursing intervention on anxiety and pains of out-patients who had accepted operation / 中国实用护理杂志

Objective To know the correlation of anxiety and pains of out-patients who had accept-ed operation and the effect of nursing intervention. Methods Divided 173 out-patients with operation in-to the intervention group(83 cases) and the control group(90 cases) randomly. Routine nursing cares was used in the control group, preoperative health education was used in the intervention group in addition. Us-ing the Me-Gill and SF-MPQ to evaluate pains between the 2 groups. Using the S-AI and the T-AI to evaluate the emotional condition between the 2 groups. Results The indexes which can indicated the pains and emotional condition in the intervention group after the health education were significant better than those of in the control group and themselves before the nursing intervention. Conclusions Preoperative pains and emotional condition should be evaluated among out-patients, and then carry out certain counter nursing measures to release patients' pain and negative emotion.

A survey of surgical treatment of hepatic cavernous hemangioma during 20 years / 中华消化外科杂志

Objective To summarize the experience in surgical treatment of hepatic cavernous hemangioma (HCH). Methods The clinical data of 345 patients who received HCH resection in General Hospital of PLA from 1986 to 2005 were retrospectively analyzed. Results The ratio between male and female patients was 1/1.8. Eighteen patients (5.2%) were incidentally found with HCH during or after operation. Most of the HCH were located in the right lobe, with the proportion of 16.2% (56/345). Ninety-one patients (26.5%) had small HCH (diameter<5.0 cm), 173 (50.3%) had large HCH (diameter ranging from 5.0-10.0 cm), and 80 (23.2%) had giant HCH (diameter>10.0 cm). The mean diameter of the HCH was (8.0±5.0) cm. Three hundred and twenty-three (99.7%) patients were with Child pugh A. Right subcostal incision and enucleation were performed on all patients. The incidence of postoperative complications and mortality were 11.3% (39/345) and 0.3% (1/345), respectively. Caudate lobe resection was performed on 9 of 11 patients with the tumor located in caudate lobe. Conclusions Some HCHs may be easy to be misdiagnosed as hepatic solid tumor. HCH resection (inclu-ding hepatic caudate lobectomy) is safe for patients with HCH, and the most severe operative complication is massive bleeding during hepatectomy.

Hepatectomy for huge liver neoplasm / 中华普通外科杂志

Objective To summarize experiences associated with hepatectomy of huge liver neoplasm.Methods Two hundred and sixty six consecutive cases of huge liver neoplasm undergoing hepatectomy from January 1987 to December 2005 at Chinese PLA General Hospital were analized retrospectively based on the clinical data.Results There were 174 males and 92 females with the average age of(44.8 ± 12.2)years(range 7-76 yrs).Among them,93 cases were with benign neoplasms.The maximum diameter of tumors was 30 cm and hemangioma accounted for 86.0%(80 cases).The other 173 cases were huge liver malignant neoplasms with the maximum diameter of 33 cm,hepatocellular carcinoma accounted for 73.4%(127 cases).The average diameter of all tumors was(14.7 ±4.0)cm(range 10.2-33.0 cm).HBsAg(+)was found in 40.49% of cases.Numbers of resected segments averaged(3.3 ±1.2)in benign cases and(3.1 ±1.2)in malignant ones without significant difference between the two groups(t=1.710,P=0.310).Postoperative complications occurred in 17.29% of cases and the hospital mortality was 0.75%.The postoperative 1-,3-and 5-year survival rates in patients with malignant liver tumors were 58.3%,39.7% and 27.5%,respectively.Conclusions Hepatectomy of huge liver benign and malignant neoplasms can be performed safely with low morbidity and mortality,provided that it is carried out with skillful surgical expertise and optimized perioperative management.

Expression of caspase-3 in rodent and monkey brain: a species- and age-related study / 中国组织工程研究

BACKGROUND: Caspase-3 is well recognized as the key caspase carrying out apoptosis in animal and human brain. To date, a few studies revealed the expression of caspase-3 protein in brains of normal persons and Alzheimer patients but data obtained from rodents exhibited much discrepancy.OBJECTIVE: To investigate the different expression patterns of caspase-3in rodent and monkey brain, and the different expression of caspase-3 in different brain regions and during aging in monkeys.DESIGN: Parallel comparison between means of single variable.SETTING: Institute of Hepatobiliary Surgery, Chinese PLA General Hospital and Department of Anatomy, the Chinese University of Hong Kong.MATERIALS: The experiment was carried out from August, 2003 to February, 2005 in Institute of Hepatobiliary Surgery, Chinese PLA General Hospital and Department of Anatomy, the Chinese University of Hong Kong. Sprague Dawley rats, ICR mice and senescence-accelerated mice (SAM) with ages ranging from postnatal 2, 12, 24 to 48 weeks(n=5 for each age group of different rodents) were included in the present study. All of these animals were supplied by Laboratory Animal Services Center, the hinese University of Hong Kong. Totally 8 rhesus monkeys aged 4 years (n=4) or 20 years (n=4) were selected from the Laboratory Animal Center in Chinese PLA General Hospital [SCXK-(Beijing)2003-002]. Both ro dents and monkeys were female and were raised under standard conditions without any experimental interventions. METHODS: ①Brain tissue samples were taken freshly from both rodents and monkeys and made into homogenate. The expression of caspase-3 pro tein in brains of both rodents and monkeys was investigated with im munoblot. ② The expression levels in monkey brains were exhibited quantitatively with the same method in three brain regions, such as the frontal cortex, hippocampus and cerebellar cortex, for the two age-groups. In vivo distribution patterns of caspase-3-immunoreactive cells were further presented in 3 brain regions of monkeys through immunohistochemistry. MAIN OUTCOME MEATURES: ①Detection of caspase-3 protein with immunoblot in the brain of rodents and monkeys; ② Distribution patterns of caspase-3-immunoreactive cells in 3 brain regions of monkeys. RESULTS: ① Result of detection with immunoblot: The same pattern of caspase-3 protein expression in brain of three kinds of 2-week-old rodents. But the expression was not seen in any other brains of older ages. Caspase 3 was expressed in a relatively high level inboth adult and aged monkey brains, and the amount did not attain to the level in 2-week-old rodents. Caspase-3 Was expressed in the pattern of zymogen (Mr 32 000). The ex pressions of caspase-3 in brains of monkey were not different in ages and brain regions. ②Result of Immunohistochemistry: It was showed that most neurons in the frontal cortex lack detectable caspase-3 immunoreactivity, whereas low to moderate caspase-3 immunostaining be found mainly in pyramidal cells in CA1, CA3 and CA4 subfields of hippocampus. And in the cerebellum, a small number of Purkinje cells were strongly stained in their cytosol and dendrites. Age-related expression pattern of caspase-3 were not found except that in the motor cortex of aged monkeys in which there were a limited number of large pyramidal cells in layer Ⅴ that were strongly stained with caspase-3 antibody.③ Immunoblot procedure revealed that the caspase-3 protein expressed in monkey brains is in the form of zymogen (Mr 32 000) and there is no significant difference in caspase-3 expression level as a function of either brain region or age of animals.CONCLUSION: Unlike rodents in which caspase-3 protein rapidly drops to an undetectable level since animals grow up, the primate expresses caspase-3 constitutively in brain until the late period of lifetime. But there are no significant brain region- or age-related differences in the protein levels in monkey brain.

Expression of caspase-3 in rhesus monkey brains at different ages / 中华老年医学杂志

Objective To study the in vivo expression patterns of caspase-3 in normally aged primate brain. Methods Fresh brain tissue was taken from 4-year-old and 20-year-old female rhesus monkeys,4 for each age group. In vivo distribution of caspase-3-positive cells and its protein levels in different brain regions were investigated by immunohistochemical and immunoblot means,respectively. Results In the frontal cortex,most neurons lacked detectable caspase-3 immunoreactivity,whereas low to moderate caspase-3 immunostaining was found mainly in pyramidal cells in CA1,CA3 and CA4 subdivisions of hippocampus. And in the cerebellum,a small number of Purkinje cells were strongly stained in their cytosol and dendrites,while their nuclei lacked staining. Age-related changes in caspase-3 expression pattern were not found. Immunostaining of motor cortex in aged monkeys localized strong caspase-3 immunoreactivity to a limited number of large pyramidal cells in layer V. Immunoblotting revealed the 32 000 caspase-3 progenitor in all three brain regions. There were no differences in caspase-3 expression levels as a function of either brain region or age of animals. Conclusions These results suggest that caspase-3 is constitutively expressed in matured primate brain and there is no significant age-related change in its expression.

Reproduction and evaluation of abdominal multiple organ trauma model / 解放军医学杂志

Objective To establish a reproducible and controllable experimental swine model of abdominal multiple organ trauma.Method Fifteen pigs were included in the present study,and the method adopted conformed to the animal ethics.With the self-made explosive device,the electric firecrackers consisting of 0.3g,0.2g and 0.2g black powder were put respectively onto the surface of left lateral lobe of liver,lower pole of spleen and tail of pancreas to produce injuries by explosion.The operation time of exploratory laparotomy and isolation of the organs,blood loss,the maximum diameter and area of injury to the liver and spleen due to explosion,the length and extent of the pancreas that was injured in explosion,as well as the changes in mean arterial pressure(MAP) during the operation were detected and recorded.Finally,the injury severity score(ISS) was calculated.Results The damaged liver area was 9.2?0.3cm2,the maximum diameter of damaged liver was 5.4?0.2cm,the damaged spleen area was 5.2?0.1cm2,the maximum diameter of damaged spleen was 5.6?0.2cm,the damaged pancreas length was 6.3?0.2cm,the time for MAP's to lower by half was 8.8?0.5min,the blood loss for depression of MAP by half was 704.7?14.6ml,the time from injury to death in the first 5 pigs was 25.4?1.8min,ISS was 28.0?0.8.The experimental swine model of abdominal multiple organ trauma was reproduced successfully.Conclusions By using the self-made explosion device and electric firecrackers,the abdominal multiple organ trauma model is reproducible,controllable and stable.It can be generally used in the research of war trauma and traffic accident trauma.

Analysis of 120 Cases of Trial of Labor with Borderline Oligohydramnios Assessed by Ultrasound / 中华围产医学杂志

0.05). The incidence of emergency cesarean section in borderline oligohydramnios group was significantly higher than that of the control group. Conclusions Patients with borderline oligohydramnios may have a trial of labor under intensive monitor.

Long-term effect of flow-restricted portal vein arterialization on rat's liver structure and function / 中国普通外科杂志

Objective To explore long-term effects of flow-restricted portal vein arterialization on hepatic function and structure in a rat model. Methods SD rats were divided into three groups to undergo respectively total portal vein arterialization ( PVA) , arterial inflow restricted portal vein arterialization (RPVA) ,and sham operation (SO). Postoperative portal blood flow and cross section after one month and six months, portal vein pressure, liver function and structure after six months were observed. Results The cross section and blood flow of the portal vein in PVA group consistently increased, serum ALT level was elevated after six months(F=7. 72,P