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Gastric cancer is the most prevalent gastrointestinal tumor in China， threatening the life and health of patients. Surgery is one of the available therapies， which， however， induces postoperative gastrointestinal dysfunction （PGD） and other common complications. The pathogenesis of PGD is still unclear and no efficient targeted drug is available. In addition， the limited treatment measures fail to effectively improve gastrointestinal function. As a result， patients generally suffer from low quality of life and poor prognosis. In Chinese medicine， PGD belongs to the categories of "vomiting"， "stuffiness and fullness"， "regurgitation"， "abdominal distension"， "intestinal impediment"， and "intestinal accumulation". In recent years， there has been an explosion of research on the PGD of gastric cancer in Chinese medicine， and many research results have been obtained. On this basis， this study introduced PGD in modern medicine， and causes and pathogenesis， syndrome differentiation-based treatment， and clinical studies of PGD. It was found that diverse internal and external treatments are available in Chinese medicine for PGD such as internal use of Chinese medicine， Chinese medicine enema， auricular point seed-embedding， acupuncture， and moxibustion， which feature ease of implementation， small side effects， definite efficacy， and significant effect in combination with other therapies. This paper summarized the ideas and measures for treatment of PGD of gastric cancer by Chinese medicine， the research outcomes， limitations， and research directions， which can serve as a reference for further research on treatment of PGD of gastric cancer by Chinese medicine.
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Objective:To evaluate the surgical effect of repairing soft tissue defect of hand and foot with medial gastrocnemius fascia flap combined with skin graft.Methods:From January, 2018 to June, 2019, 10 patients were treated with transfers of free medial gastrocnemius fascia flaps combined with skin graft to repair soft tissue defect of hand and foot. The size of free fascial flap was 5.0 cm×8.0 cm-12.0 cm×15.0 cm. After successful transfer on the wound, the skin was grafted onto the fascial flap, and the donor site was sutured directly. The appearance and function of the recipient and donor sites were observed and the effect of the operation was evaluated. Sensory recovery was assessed by the standard set by British Medical Research Council (BMRC) at the last follow-up.Results:All the free medial gastrocnemius fascia flap survived. After 6-10 days of granulation tissue growing, the skin grafts were transferred and all survived. All patients entered follow-up for 3-9 months, with an average of 7.5 months. The tissue at the recipient sites were soft and wear-resistant without swelling or ulceration. According to the self-designed evaluation system of soft tissue defect reconstruction, 10 patients had score from 68 to 92 (average, 75.2) . At the last follow-up, sensory recovery was assessed by BMRC, 7 cases were excellent and 3 cases were good.Conclusion:The repair of hand and foot soft tissue defect by the free medial gastrocnemius fascia flap combined with skin graft has advantages in constancy of vascular anatomy of free fascia tissue, long vascular pedicle and for repair of various types of hand and foot defects. Skin of the recipient area is soft with good appearance without swelling after the reconstruction of fascia flap. It is a method of treatment in repair of soft tissue defect of hand and foot by avoiding the thinning of a flap in the second procedure.
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Objective To analyze the influencing factors for residual lesions after radiofrequency ablation in elderly patients with liver cancer.Methods Clinical data of 65 elderly patients with liver cancer treated by radiofrequency ablation in our hospital from January 2014 to December 2016 were retrospectively analyzed.The influencing factors on residual lesions after radiofrequency ablation were analyzed by univariate analysis and multivariate logistic regression.Results Of 102 lesions in 65 elderly patients with liver cancer,87 lesions were completely ablated at the first time,and the first complete ablation rate of lesion was 85.29 ％ (87/102).All visible lesions were completely ablated in 56 patients at the first time,and the first complete ablation rate of cases was 86.15％ (56/65).Fifteen lesions in 9 patients were incompletely ablated.Univariate analysis showed that gender(x2 =0.740,P =0.390),cirrhosis (x2 =0.745,P =0.388),hepatitis B (x2 =0.057,P =0.812) and type of liver cancer(x2=0.171,P =0.682)had no significant effect on the residual lesions after radiofrequency ablation,but the number of lesions(x2 =6.694,P =0.010),the lesion size(x2 =14.382,P =0.000) and liver function classification(x2 =5.359,P =0.030) had statistically significant effects on residual lesions after radiofrequency ablation.Further multivariate logistic regression analysis showed that the number of lesions ≥ 3(OR =1.916,95 ％CI:1.326～2.571,P=0.029),the size of lesions≥3 cm(OR =2.362,95 ％ CI:2.180 ～ 2.923,P =0.000) were risk factors for residual lesions after radiofrequency ablation.Conclusions Radiofrequency ablation has a better therapeutic effect on liver cancer in elderly patients.The number and size of lesions have a certain impact on the residual lesions after radiofrequency ablation.
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Objective@#To analyze the influencing factors for residual lesions after radiofrequency ablation in elderly patients with liver cancer.@*Methods@#Clinical data of 65 elderly patients with liver cancer treated by radiofrequency ablation in our hospital from January 2014 to December 2016 were retrospectively analyzed.The influencing factors on residual lesions after radiofrequency ablation were analyzed by univariate analysis and multivariate logistic regression.@*Results@#Of 102 lesions in 65 elderly patients with liver cancer, 87 lesions were completely ablated at the first time, and the first complete ablation rate of lesion was 85.29%(87/102). All visible lesions were completely ablated in 56 patients at the first time, and the first complete ablation rate of cases was 86.15%(56/65). Fifteen lesions in 9 patients were incompletely ablated.Univariate analysis showed that gender(χ2=0.740, P=0.390), cirrhosis(χ2=0.745, P=0.388), hepatitis B(χ2=0.057, P=0.812)and type of liver cancer(χ2=0.171, P=0.682)had no significant effect on the residual lesions after radiofrequency ablation, but the number of lesions(χ2=6.694, P=0.010), the lesion size(χ2=14.382, P=0.000)and liver function classification(χ2=5.359, P=0.030)had statistically significant effects on residual lesions after radiofrequency ablation.Further multivariate logistic regression analysis showed that the number of lesions ≥ 3(OR=1.916, 95%CI: 1.326~2.571, P=0.029), the size of lesions≥3 cm(OR=2.362, 95%CI: 2.180~2.923, P=0.000)were risk factors for residual lesions after radiofrequency ablation.@*Conclusions@#Radiofrequency ablation has a better therapeutic effect on liver cancer in elderly patients.The number and size of lesions have a certain impact on the residual lesions after radiofrequency ablation.
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Objective To investigate the risk factors of laparoscopic cholecystectomy (LC) in patients with previous gastrectomy.Methods This retrospective study reviewed a database of patients who underwent LC at our hospital during the period of Jan 2010 and May 2015.Results Comparesd with those of no history of gastrectomy the average operation time in patients with previous gastrectomy was longer (t =15.608,P ＜ 0.05) the intraoperative blood loss was higher (t =3.061,P ＜ 0.05),and the operation time of patients with a long interval (＞ 5 years) between gastrectomy and LC was shorter (t =6.405,P ＜ 0.01).The conversion rate did not differ between the two groups (P ＞ 0.05),but the conversion rate significantly reduced after a comprehensive preoperative evaluation procedure (x2 =15.282,P ＜ 0.01).Conclusion LC for benign gallbladder diseases is safe,effective and feasible in patients with a history of gastrectomy,if a comprehensive preoperative evaluation is adopted and in experinced hands.
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Objective To establish the methodology of combining BOLD and 1H-MRS for investigating correlation between the deactivation in medial prefrontal cortex (MPFC) and gamma-aminobutyric acid (GABA) concentration by acupuncture at LI4 (Point Hegu),and to optimize the experimental technique and procedure.Methods Twenty healthy adult volunteers were enrolled.During fMRI-BOLD scanning,each subject received acupuncture at right LI4 (Point Hegu).MRS scanning was based on MEGA-PRESS sequence,and ROIs were located at bilateral MPFC.The task BOLD fMRI was block design,including 3 stimulations (30 s) with 2 intervals (2 min).Then MRS scanning was performed before and after BOLD.The quantitative values of the BOLD positive and negative activations (Pm) and GABA concentrations were calculated.Results All 20 subjects completed BOLD fMRI scanning,and met the postprocessing requirements.MRS images of 9 subjects with good image quality were included in analysis.Among all 20 subjects,positive activation (Pm=1.17± 0.16) was observed in 9,while negative activation (Pm =-1.31 ± 0.17) was observed in 11 subjects.The GABA average values before and after the acupuncture were (19.93 ±1.04) nmol/L and (20.04±0.81)nmol/L,respectively,and the average amplitude between post-and pre-acupuncture was (0.11 ± 1.60)nmol/L.Conclusion The success rate of this method for quantitative study of brain function established multimodal-functional (BOLD-fMRI and MRS) was acceptable,and the multimodal brain function changes as well as the quantitative values were observed in the brain region during acupuncture.Combined BOLD and MRS quantitative method is feasible for testing acupuncture response in the brain.
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Objective To study the effect of enhanced MK gene expression in hepatic carcinoma cells.Methods The recombinant plasmid pIRES2-EGFP-MK was transfected into SMMC 7721 cells.The mRNA and protein expression levels of MK gene in these cells were determined by real-time PCR,Western blotting and flow cytometry.The intracellular DNR accumulation of these cells was measured by flow cytometry.To investigate the effect of MK gene mediated multidrug resistance,MTT assay was employed to determine the cellular sensitivity of different chemotherapeutic drugs in MK-overexpressed SMMC 7721 cells.Results The mRNA and protein expression levels of MK gene significantly increased after the recombinant plasmid pIRES2-EGFP-MK transfected into SMMC 7721 cells,suggesting that the recombinant plasmid pIRES2-EGFP-MK can enhance the transcription of MK effectively.The DNR accumulation of MK transfected cells decreased significantly (4.06 ± 0.88,P ＜ 0.05),and IC50 of MK transfected cells to ADM/5-FU increased significantly (15 ± 3,27 ± 4,P ＜ 0.05).Conclusions After the recombinant plasmid pIRES2-EGFP-MK transfected into hepatic carcinoma cells,expression of midkine increased,enhancing the resistance of hepatic carcinoma cells to chemotherapeutic drugs.
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Objective To study the impact of antiviral therapy on patients with postoperative intrahepatic recurrence of hepatitis B related hepatocellular carcinoma (HCC).Methods According to the inclusion and exclusion criteria,65 patients with HCC who were managed in our hospital from January 2004 to December 2011 for intrahepatic recurrence and had indications for antiviral treatment were included into this study.The patients were divided into two groups ; the antiviral and the control groups.Relevant data between these two groups such as cumulative survival after recurrence,Child-Pugh grade,HBV-DNA,HBeAg,AFP at the time of recurrence and 6 months later were studied.An analysis on multiple-factors was carried for survival after recurrence at 2 years.Results When compared with the control group,the antiviral group had better cumulative survival in all the cases and in the TACE cases (P ＜ 0.05 respectively).The cumulative survival in the RFA cases was not significantly different between the two groups (P ＞ 0.05).A comparison was carried out in patients who received antiviral therapy which was combined with one or more other therapies (TACE,RFA,reoperation):(a) antiviral therapy only (8 patients) ; (b) combined with one therapy (22 patients) ; (c) combined with two therapies (10 patients) ; (d) combined with three therapies (2 patients).All P values of a:b,a:c,a:d,b:c,b:d were less than 0.05.The blood HBV-DNA of the two groups was significantly different at the time 6 months after recurrence (P ＜ 0.05).The results of multivariate analysis showed the 2-year survival was significantly correlated with recurrent tumor size,primary tumor class,antiviral therapy or not after recurrence,presence of absence of cirrhosis.All P values were less than 0.05.Conclusions Antiviral therapy had remarkable clinical impact on HCC patients with postoperative intrahepatic recurrence and with indication for antiviral treatment.Patients had better prognosis if antiviral therapy was combined with one or more other therapies.
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Objective To investigate the clinical application value of the laparoscopic intraoperative cholan-giography in laparoscopic cholecystectomy,and summarize the experience.Methods The clinical data of 169 cases of laparoscopic cholecystectomy intraoperative cholangiography were analyzed retrospectively.Results 169 patients were successfully completed,131 cases recovered well and no complications occurred after operation.29 patients showed hyperamylasemia,of which 3 patients had intractable hyperamylasemia,8 patients complicated with secondary acute pancreatitis,with fasting,gastrointestinal decompression,enzyme inhibition(plus somatostatin)and acid,analgesic, anti infection,rehydration treatment after remission.Conclusion Laparoscopic cholecystectomy intraoperative cholan-giography is a safe and reliable diagnostic technique,on the occurrence of biliary residual stones in prevention of post-operative prevention and timely detection of bile duct injury during operation and improves the success rate of repair of bile duct injury has important clinical value;control adaptation of intraoperative cholangiography has important clinical significance of reasonable application license.
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Objective To explore the effects of timing of enteral nutrition (EN) in the severe acute pancreatitis (SAP).Methods The rabbit model of SAP was constructed,and 40 experimental rabbits were divided randomly into the experimental group (20 rabbits) and the control group(20 rabbits).(1) The parenteral nutrition (PN) was administered to rabbits in the experimental group,and then EN was administered after bowel sound restoration.(2) EN was administered to the rabbits in the control group at hour 12 after PN.The values of TNF-α,IL-6 and IL-8 on post-modeling day 1,3 and 7 and intra-abdominal pressures at hour 1 before EN and on post-modeling day 1 and 3 were respectively examined.The experimental animals were sacrificed on post-modeling day 7 and 10.The expression of nuclear factor-kappa B (NF-κB) was detected by immunohistochemistry and bacteria from mesenteric lymph nodes were cultured.The measurement data with normal distribution were presented as (x) ± s.The trend comparison between groups and pairwise comparison were analyzed using the repeated measures ANOVA and t test.Results The 40 rabbit models of SAP were constructed successfully.(1) The results of serum test showed that the values of TNF-α,IL-6 and IL-8 in the experimental group on post-modeling day 1,3and 7 were (6.9 ±2.1)ng/L,(5.9 ± 1.8) ng/L,(5.3 ± 1.8) ng/L and (109 ± 17) ng/L,(96 ± 16) ng/L,(83 ± 17)ng/L and (89 ±20)ng/L,(78 ±21)ng/L,(70 ± 19)ng/L,respectively.The values of TNF-α,IL-6 and IL-8 in the control group on post-modeling day 1,3 and 7 were (7.4 ± 1.5) ng/L,(7.1 ± 1.6) ng/L (6.8 ±1.7) ng/L and (101 ± 19) ng/L,(98 ± 18) ng/L,(93 ±20) ng/L and (91 ± 14) ng/L,(91 ± 16) ng/L,(83 ±19)ng/L,respectively.There were significant differences in the changing trends of TNF-α and IL-6 between the 2 groups (F =7.947,19.386,P ＜ 0.05),with no significant difference in the changing trend of IL-8 between the 2 groups (F =2.756,P ＞ 0.05).(2)The intra-abdominal pressures in the experimental group at hour 1 before EEN and on post-modeling day 1 and 3 were (3.5 ± 1.6) cmH2O (1 cmH2O =0.098 kPa),(4.3 ± 1.7) cmH2Oand (3.6 ± 1.8) cmH2O,which were significantly different from (4.9 ± 1.9) cmH2O,(5.7 ± 2.2) cmH2O and (4.5 ± 1.6)cmH2O in the control group (F =7.042,P ＜0.05).(3) The expression of NF-κB in the tissues of pancreas was localized mainly in the cell nucleus.The expression of NF-κB in the experimental group on postmodeling day 7 was 5.0 ± 2.7,which was significantly different from 7.0 ± 2.9 in the control group (t =2.236,P ＜ 0.05).(4) The amount of bacteria culture from mesenteric lymph nodes in the experimental group on postmodeling day 7 and 10 were (4.7 ±0.9) × 103 cfu/g and (4.1 ±0.7) × 103 cfu/g,which were significantly different from (5.5 ± 1.0) × 103 cfu/g and (4.6 ± 0.7) × 103 cfu/g in the control group (t =2.382,2.126,P ＜0.05).Conclusion The selective timing of EN can effectively improve the recovery of rabbits with SAP,and the efficacy of EN administering based on the recovery of bowel function may be better than immediate EN administering.
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BACKGROUND:Slow growth of peripheral nerve, muscle denervation atrophy and fossilization of motor end plate fol owing sciatic nerve injury cause irreversible limb function disorders. Umbilical cord mesenchymal stem cells have been widely used in multi-disciplinary research, but studies concerning umbilical cord mesenchymal stem cells delaying denervated muscle atrophy in rats fol owing peripheral nerve injury are rarely reported. OBJECTIVE:To observe the value of human umbilical cord mesenchymal stem cells transplantation to delay denervated muscle atrophy of rats after sciatic nerve injury. METHODS:Umbilical cord blood was col ected from healthy parturient woman after ful-term delivery. In the experimental group, the rat’s Sunderland IV degree sciatic nerve injury model was established by 5 mm denervation, epineurial repair, and 5 mm smal gap transplantation of umbilical cord mesenchymal stem cells. In the control group, after modeling, the same volume of normal saline was injected into the smal gap. The main outcome measures included the sciatic nerve function index, the wet weight of triceps surae,sciatic nerve latency, action potential conduction velocity and amplitude,and skeletal muscle fiber cross section area maintenance rate. RESULTS AND CONCLUSION:After 4, 8 and 12 weeks of modeling, the sciatic nerve function index values, the wet weight of triceps surae and skeletal muscle fiber cross section area maintenance rates in the experimental group were significantly higher than those in the control group (P<0.05). After 12 weeks of modeling, electromyography results showed sciatic nerve latency was significantly lower, but action potential conduction velocity and amplitude were dramatical y higher in the experimental group than the control group (P<0.05, P<0.001). Human umbilical cord mesenchymal stem cells transplantation in denervated muscle atrophy rats after sciatic nerve promotes nerve growth, delays denervated muscle atrophy, maintains the denervatied neuromusle’s morphology and function.
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Objective To observe the therapeutic effect of Shenmai injection on rats with acute edematous pancreatitis (AEP) and its mechanism.Methods The model of AEP in rats was induced by intraperitoneal injection of caerulein every one hour for 7 times.One hour after last injection,intravenous Shenmai injection (5 ml · kg-1 · d-1) was given to rats in Shenmai injection treatment (SI) group,while same amount of normal saline was given to rats in control (AEP) group.One hour and 1,3,5,7 d after AEP induction,the blood was taken,and the method of double antibody sandwich enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of amylase,platelet activating factor (PAF),vascular endothelial growth factor (VEGF).The rats were sacrificed at 7 and 14 d,and pancreatic tissue samples were harvested.RT-PCR and Western Blot were used to determine the expression of NF-κB mRNA and protein,and normal pancreatic tissue samples were used as control.The positive expression of CD31 in pancreatic tissue was determined by immunohistochemical method to calculate microvascular density (MVD).Results The serum levels of amylase and PAF in both groups were increased and gradually decreased 3 days later,while the decrement in SI group was greater than that of AEP group.At the 5th day after AEP induction,the serum levels of amylase in SI group and AEP group were (4569 ± 158),(5056 ± 198) U/L,and the serum levels of PAF were (25.30 ± 4.76),(36.06 ± 5.57)μg/L,and the difference between the two groups was statistically significant (P ＜ 0.05).The serum levels of VEGF were increased 1 d after AEP induction,and the increase in SI group was greater than that of AEP group 3 d later,and the serum levels of VEGF were (139.78 ±24.30),(118.51 ±21.70)pg/ml at 5th day,and the difference between the two groups was statistically significant (P ＜ 0.05).The expression levels of NF-κB mRNA and protein of pancreatic tissue in SI group were O.834 ±0.031 and 0.49±0.24,and MVD was 6.41 ± 1.14,while the corresponding values in AEP group were 1.000 ± 0.059,0.93 ± 0.45,3.62 ± 0.89,and the difference between the two groups was statistically significant (P ＜ 0.05 or P ＜ 0.01).Conclusions In the course of acute pancreatitis,Shenmai injection has the therapeutic effects of promoting new angiogenesis,improving the microcirculation,reducing the inflammatory cascade.
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Objective To investigate the predictive values of P-selectin (P-sel),thrombus precursor protein (TpP) and D-dimer (D-D) in the early diagnosis of portal vein thrombosis (PVT) in patients submitted to splenectomy (or to devascularization).Methods The clinical data of 48 patients with portal hypertension (the PVT group,n=26; and the non-PVT group,n=22) who received operation in our hospital from 2009 to 2011 were retrospectively analyzed.Detecting the P-sel,TpP and D-D levels in the two groups of patients were done on preoperative day 1 and postoperative day 1,3,5,7,14.The SPSS software was used for statistic analysis.Results There were no significant differences on the preoperative day 1 levels of P-sel,TpP and D-D in the two groups (P＞0.05).The postoperative day1 levels of the three indicators in the PVT group were significantly higher than the non-PVT group (P＜0.05).Receiver operating characteristic (ROC) curves showed the area under curve (AUC) of P-sel was largest (0.893),followed by D-D,and TpP.The combined detection of the 3 indicators was highest,with the AUC up to 0.977.Conclusions Combined detection of P-sel,D-D and TpP levels were useful in the early diagnosis of PVT after splenectomy in patients with portal hypertension.
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Objective To investigate the expression of fragile histidine triad(FHIT),fibronectin (FN) and phosphatase and tensin homology deleted on chromosome ten( PTEN )in human hepatocellular carcinomas (HCC) and their relationship with pathological characteristics and prognosis of HCC.Methods Immunohistochemistry was used to detect expression of FHIT,FN and PTEN in cancerous tissues from 138 HCC patients.The correlation between their expression and clinicpathological features and prognosis were analyzed.Results FHIT,FN,PTEN protein expressed differently between HCC and adjacent mucosa ( respectively x2 =5.968,7.380,4.962,all P ＜ 0.05 ),and the expression level was different with tumor size,tumor number,grades and tumor lymph node metastasis( P ＜ 0.05 ).In FHIT and FN positive group,the recurrence free survival rates were lower than those in negative groups( respectively x2 =4.443,9.867,all P ＜0.05),while in PTEN positive group patients' recurrence free survival rates were higher than those with PTEN negative expression ( x2 =4.199,P ＜ 0.05 ).Conclusions FHIT,FN,PTEN were abnormally expressed in HCC.Positive expression of FHIT and FN predicts poor prognosis,while positive PTEN indicates fair prognosis.
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Objective To investigate the preventive effects of anti-viral therapy in combination with transcatheter arteria chemoembolization (TACE) on recurrence of HBV-related hepatocellular carcinoma (HCC) after operation. Methods According to selection standards, 49 patients treated in this hospital from January 2003 to June 2009 were enrolled in this study and divided into a control group and combined group.The cumulative tumor-free survival rate, cumulative survival rate, the 1-, 2- and 3-year recurrence rates and cumulative recurrence rates were determined in all the patients and compared between the 2 groups. Results The cumulative tumor-free survival rate and cumulative survival rate were significantly higher in the combined group than in the control group (P=0. 019, 0. 008). The 1-, 2-, and 3-recurrence rates were 24% vs. 38.9%, 28% vs. 33.3%, and 28% vs. 22.2% in the combined group and control group, respectively. The 1-, 2-, and 3-year cumulative recurrence rates were 24% vs. 38. 9%, 52% vs. 72. 2%, and 80% vs.94. 4% in the combined group and control group, respectively. Conclusion Anti-viral therapy in combination with TACE can exert significant preventive effects on recurrence of HBV-related HCC after operation.