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Objective:To evaluate the application efficacy of enhanced recovery after surgery(ERAS)in laparoscopic colorectal cancer surgery in primary hospitals.Methods:A total of 116 patients who underwent laparoscopic colorectal cancer surgery from January 2017 to December 2018 at our hospital were enrolled in this study.According to the perioperative rehabilitation program, 116 patients were divided into the group A(n=67, receiving enhanced recovery after surgery)and the group B(n=49, receiving traditional recovery after surgery).Results:The incidences of preoperative thirst and hunger were lower in the group A than in the group B(11.9% vs.53.1%, 16.4% vs.51.0%, χ2=23.10 and 15.83, respectively, P<0.001). The levels of CRP and blood glucose in the two groups were significantly higher after operation than before operation, and reached the peak values on the 3rd day after the operation.At different time points after operation, CRP levels and blood glucose levels were higher in the group B than in the group A(all P<0.05). On the 7th day after operation, blood glucose level was recovered to the preoperative level in the group A, while it was not so in the group B. The incidence of complication in the group A was similar to the group B(7.46% vs.12.2%, χ2=0.75, P>0.05). The hospitalization period was shorter and the hospitalization cost was less in the group A than in the group B(8.16±1.33)d vs.(15.39±2.81)d, (46100±1800)yuan vs.(56900±5600)yuan, t=10.98 and 9.96, P=0.000). Conclusions:The application of enhanced recovery after surgery is beneficial for perioperative safety, can reduce surgical stress response, promote postoperative recovery, shorten hospitalization time after surgery and reduce hospitalization costs in laparoscopic colorectal cancer surgery.
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Objective@#To investigate the significance of Twist2 in glioma and whether it is involved in the malignant transformation of glioma by epithelial-mesenchymal transition (EMT).@*Methods@#Using immunohistochemical method detected the expression level of Twist2 in 60 cases of gliomas (including WHO grades Ⅱ, Ⅲ and Ⅳ, each for 20 cases) and 20 cases of non-tumor brain tissues. Real-time fluorescence quantitative PCR and Western blot were used to detect the expression level of Twist2 mRNA and protein in 61 cases of fresh glioma tissue (WHO grade Ⅱ 16 cases, Ⅲ 21 cases, Ⅳ 24 cases) and 12 cases of adjacent tissues, and the expression levels of E-cadherin, N-cadherin and vimentin were also investigated in fresh glioma tissue.@*Results@#Immunohistochemistry results showed that the percentages of Twist2 expression in glioma was 90%(54/60) compared with 30%(6/20) in non-tumor brain tissues(P<0.01). The percentages of Twist2 expression were 75% (15/20), 95% (19/20), and 100% (20/20) in the WHO gradesⅡ, Ⅲ and Ⅳ gliomas, respectively. WHO grades Ⅳ and Ⅲ were significantly higher than that of WHO grade Ⅱ (P<0.01). There was no significant difference between WHO grade Ⅳand WHO Ⅲ glioma (P>0.05). Real-time fluorescence quantitative PCR and Western blot showed that the expression level of Twist 2 in gliomas was significantly higher than that in para-cancerous tissues (P<0.01), and those in WHO grades Ⅳ and Ⅲ gliomas were significantly higher than that in WHO grade Ⅱ glioma (P<0.01). There was no significant difference between WHO grade Ⅳand grade Ⅲ glioma (P>0.05). Detection of key protein expression in EMT by Western blot displayed that the expression of E-cadherin was negatively associated with Twist2 in glioma (r=-0.972, P<0.01). The expression of N-cadherin and vimentin was positively associated with Twist2 in glioma(r=0.971, P<0.01; r=0.968, P<0.01).@*Conclusions@#The expression of Twist2 in human glioma is positively correlated with the malignant grade of glioma, which may be involved in the malignant progression of glioma by EMT.
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Patients with chronic thromboembolic pulmonary arterial hypertension,aged＞ 18 yr,scheduled for primary pulmonary thromboendarterectomy from May 2014 to October 2016 in our hospital,were selected.The site and degree of thrombus obstruction,pulmonary hypertension and degree of right heart insufficiency were assessed on 1 day before surgery.Anesthesia was induced with midazolam,etomidate,rocuronium or cisatracurium,and the Swan-Ganz catheter was placed.Anesthesia was maintained with Ⅳ propofol,dexmedetomidine,cisatracurium or rocuronium,and intermittent Ⅳ large boluses of sufentanil.Deep hypothermia circulatory arrest was used for cardiopulmonary bypass.The bispectral index value was maintained between 40 and 60 during surgery.The systemic blood pressure was maintained above 90/60 mmHg during the non-cardiopulmonary bypass period,and pulmonary arterial pressure was maintained not higher than the preoperative baseline level.The vasoactive drugs such as lyophilized recombinant human brain natriuretic peptide,norepinephrine and dopamine were intravenously injected after cardiopulmonary bypass.A total of 53 patients were included in the study and completed surgery successfully,vital signs were stable during surgery,and the patients returned to the recovery room safely.The mean pulmonary arterial pressure was reduced from the preoperative (38±13) mmHg to (26±12) mmHg at the end of the operation,the incidence of reperfusion pulmonary edema after surgery was 8％,incidence of pulmonary hypertensive crisis was 4％,and no patients died in the perioperative period.There were two improvements in the method of anesthetic management of pulmonary thromboendarterectomy in the perioperative period:(1) Lyophilized recombinant human brain natriuretic peptide in combination with norepinephrine was used;(2) The aortic pressure was guaranteed to ensure oxygen supply for the heart and body.This method can maintain the intraoperative circulation stable and reduce postoperative complications and is a suitable anesthetic management method for pulmonary thromboendarterectomy.
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Objective To investigate the effect of propofol on autophagy in SD rat heart during myocar-dial ischemia-reperfusion (I/R) injury. Methods Twenty-one male SD rats were randomly divided into three groups as follows (n = 7): the sham operation group, in which rats underwent sham operation without tightening of the coronary artery sutures; the myocardial ischemia-reperfusion group , in which rats were induced by occlud-ing the left anterior descending coronary artery for 30 min , followed by 120 min reperfusion and 0.9% NaCl in-fusion at 3 mL/(kg·h) at 10 min before occluding the left anterior descending coronary artery; the myocardial ischemia- reperfusion- propofol group, in which rats underwent I/R and propofol infusion at 6 mg/(kg·h) at 10 min before occluding the left anterior descending coronary artery. Before tightening of the coronary artery, at 30 min post-tightening of the coronary artery and at 120 min post-reperfusion, HR、 LVSP and ± dp/dtmax of rats were recordedin each group. Atter 120 min post-reperfusion, the serum concentrations of cTnT was measured. The in-jured cardiac tissue was collected to investigate the ultrastructure change under the TEM and to determine the levels of mTOR and p-mTOR. Results No signifcant differences in HR, LVSP and ± dp/dtmax before tighten-ing of the coronary artery. But, at 30 min post- tightening of the coronary artery, compared with groupⅠ, the HR, LVSP and ±dp/dtmax were significantly decresed in groupⅡ and Ⅲ(P < 0.05). Then, at 2 h post-reper-fusion, compared with groupⅠ, the HR, LVSP, ±dp/dtmax and the level of p-mTOR were significantly de-creased, but the serum concentration of cTnT was significantly increased in groupⅡ(P < 0.05); but, compared with groupⅡ, the HR, LVSP, ± dp/dtmax and the level of p-mTOR were significantly increased, the serum concentration of cTnT and the level of mTOR were significantly decreased in group Ⅲ(P < 0.05). Conclusions These data suggest that propofol could heighten the level of p-mTOR, and attenuate the expression of mTOR dur-ing the myocardial ischemia-reperfusion injury in SD rats.
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Objective To investigate the orientation relationship between the infarct related artery (IRA)and the change of the electrocardiogram (ECG)of the patients with anterior wall and extensive anterior wall acute myocardial infarction (AMI) .Methods ECG and coronary artery angiography (CAG)were compared and analyzed retrospectively through 171 patients(selected from January 1 ,2008 to March 31 ,2013)who were divided into anterior wall of LAD group and extensive anterior wall of LAD group .Re‐sults It was prompted that the IRA of the extensive anterior was the proximal occlusion of the left anterior descending (LAD) rather than distal occlusion (P<0 .05)if ST‐segment elevated in lead I ,aVL and aVR or ST‐segment depressed in lead Ⅱ ,Ⅲ and aVF in case of anterior wall and extensive anterior wall AMI .Conclusion Analyzing valuable ECG index could help us to prelimina‐rily infer IRA and the occlusion site in anterior wall and extensive anterior wall AMI .