A case of laparoscopic assisted ileostomy reduction after multiple abdominal injuries / 中国综合临床

Patients with abdominal surgery history always present different degrees of abdominal adhesion. In the past, it was regarded as a relative contraindication of laparoscopic surgery. With the development of minimally invasive concept, reoperative minimally invasive surgery is proposed in clinic to avoid huge trauma caused by multiple open surgeries. In June 2022, a laparoscopic assisted ileostomy reduction was performed for a patient with history of multiple abdominal injuries in Shanghai Changzheng Hospital. Minimally invasive achieved after huge trauma, and it maximized the benefit to the patient.

Influencing factors of anastomotic leakage after laparoscopic intersphincter resection for extremely low rectal cancer and construction of nomogram prediction model / 中华消化外科杂志

Objective:To investigate the influencing factors of anastomotic leakage after laparoscopic intersphincter resection (ISR) for extremely low rectal cancer and construction of nomogram prediction model.Methods:The retrospective case-control study was conducted. The clinicopathological data of 812 patients who underwent laparoscopic ISR for extremely low rectal cancer in the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) from February 2012 to February 2022 were collected. There were 459 males and 353 females, aged (51±11)years. Observation indicators: (1) surgical situations; (2) follow-up; (3) influencing factors of postoperative anastomotic leakage; (4) construction and evaluation of nomogram prediction model for postoperative anastomotic leakage. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. The COX proportional hazard model was used for univariate and multivariate analyses. The R software(3.5.1 version) was used to construct nomogram prediction model. The receiver operating characteristic (ROC) curve was drawn and the area under curve (AUC) was used to evaluate the efficacy of the nomogram prediction model. The Bootstrap method was used for internal verification and to calculate the average consistency index (C-index). Results:(1) Surgical situations. All 812 patients underwent laparoscopic ISR for extremely low rectal cancer, including 388 cases undergoing partial ISR, 218 cases undergoing subtotal ISR and 206 cases undergoing complete ISR. All 812 patients underwent ileal protective ostomy, and there were 306 cases with double anastomosis and 203 cases with left colic artery preserved, respectively. The operation time and volume of intraoperative blood loss of 812 patients was (179±33)minutes and (33±13)mL, respectively. (2) Follow-up. All 812 patients were followed up for (13.5±0.9)months. Of the 812 patients, there were 62 cases with postoperative anastomotic leakage and the healing time of these cases was (33±6)days. (3) Influencing factors of postoperative anastomotic leakage. Results of multivariate analysis showed that male, neoadjuvant chemoradiotherapy, failure of reser-ving left colic artery were independent risk factors of anastomotic leakage after laparoscopic ISR for extremely low rectal cancer ( hazard ratio=5.98, 4.00, 16.26, 95% confidence interval as 1.66-24.12, 1.30-12.42, 3.00-90.89, P<0.05). (4) Construction and evaluation of nomogram prediction model for postoperative anastomotic leakage. According to the results of multivariate analysis, male, neoadju-vant chemoradiotherapy and failure of reserving left colic artery were used to construct the nomogram prediction model for anastomotic leakage after laparoscopic ISR for extremely low rectal cancer, and the score of these indexes in the nomogram prediction model was 50, 49, 93, respectively. The total score of these index corresponded to the incidence rate of anastomotic leakage. Results of ROC curve showed that the AUC of nomogram prediction model of anastomotic leakage after laparoscopic ISR for extremely low rectal cancer was 0.87 (95% confidence interval as 0.80-0.93, P<0.05), with sensi-tivity and specificity 0.96 and 0.60, respectively. Results of internal verification showed that the C-index of nomogram prediction model was 0.87. Conclusion:Male, neoadjuvant chemoradiotherapy, failure of reserving left colic artery are independent risk factors of anastomotic leakage after laparo-scopic ISR for extremely low rectal cancer, and the nomogram prediction model based on these indexes can predict the incidence rate of postoperative anastomotic leakage.

Machine learning model predicts the occurrence of acute kidney injury after open surgery for abdominal aortic aneurysm repair / 中南大学学报(医学版)

OBJECTIVES@#Abdominal aortic aneurysm is a pathological condition in which the abdominal aorta is dilated beyond 3.0 cm. The surgical options include open surgical repair (OSR) and endovascular aneurysm repair (EVAR). Prediction of acute kidney injury (AKI) after OSR is helpful for decision-making during the postoperative phase. To find a more efficient method for making a prediction, this study aims to perform tests on the efficacy of different machine learning models.@*METHODS@#Perioperative data of 80 OSR patients were retrospectively collected from January 2009 to December 2021 at Xiangya Hospital, Central South University. The vascular surgeon performed the surgical operation. Four commonly used machine learning classification models (logistic regression, linear kernel support vector machine, Gaussian kernel support vector machine, and random forest) were chosen to predict AKI. The efficacy of the models was validated by five-fold cross-validation.@*RESULTS@#AKI was identified in 33 patients. Five-fold cross-validation showed that among the 4 classification models, random forest was the most precise model for predicting AKI, with an area under the curve of 0.90±0.12.@*CONCLUSIONS@#Machine learning models can precisely predict AKI during early stages after surgery, which allows vascular surgeons to address complications earlier and may help improve the clinical outcomes of OSR.

Research progression of endoscopic anastomosis technique and digestive tract reconstruction after totally laparoscopic gastrectomy for gastric cancer / 中华胃肠外科杂志

With the development of laparoscopic skills and instruments,totally laparoscopic gastrectomy for gastric cancer has become widely used in the clinic,mainly including totally laparoscopic proximal gastric reconstruction,distal gastrectomy for gastric cancer and total gastrectomy. Digestive tract reconstruction is the key procedure of totally laparoscopic gastrectomy for gastric cancer. Totally laparoscopic surgery has less trauma and better visualization than reconstruction in a small incision. At present,feasibility and safety of totally laparoscopic gastrectomy for gastric cancer have been preliminarily confirmed. However,higher level of evidence is needed for the evaluation of long-term oncologic efficacy. In the future,it is possible for patients to best benefit from totally laparoscopic surgery with minimal trauma,safe anastomosis under the principle of radical resection of gastric cancer. The digestive tract reconstruction includes Delta anastomosis (Billroth I),Billroth II anastomosis,and gastrojejunal Roux-en-Y anastomosis in totally laparoscopic distal gastrectomy (TLDG). Billroth I with delta anastomosis has strict indications in TLDG. Gastrojejunal Roux-en-Y anastomosis is now more popular. Billroth II with Braun anastomosis and uncut Roux-en-Y anastomosis is technically easier to carry out in TLDG than Roux-en-Y. Totally laparoscopic proximal gastric reconstruction includes esophagogastric stump anastomosis,esophagogastric tubular anastomosis and interposition jejunostomy. The digestive tract reconstruction includes anastomosis using linear stapler and circular stapler in totally laparoscopic total gastrectomy (TLTG). In order to better serve the clinic,we review the progress of different endoscopic anastomotic techniques and digestive tract reconstruction.

Biomechanical properties of PDO-SIS patch and its effect on repairing the abdominal wall defect of rats / 解放军医学杂志

Objective To explore the mechanical properties of the hybrid patch made of porcine acellular small intestinal submucosa (P-SIS) and polydioxanone (PDO) and its effect on repairing the abdominal wall defects of rats.Methods The PDOSIS patch and 8SIS patch were constructed by weaving and vacuum lamination and the mechanical properties were measured.In the both sides of abdomen of 36 healthy female SD rats,a partially defect (lcm × lcm) was created by surgery and repaired with a same area of PDO-SIS patch or 8SIS patch,each 12 rats were randomly sacrificed at 2,4 and 8 weeks after surgery,respectively,and tissue regeneration was evaluated.Results The bending length and tensile strength of the PDO-SIS patch were stronger than the 8SIS patch (P＜0.05) with the increase of diameter.No acute inflammation occurred at the repaired sites of the two groups,but a moderate chronic inflammation was observed 2 weeks after surgery,and the inflammatory response reduced gradually over time,no obvious chronic inflammation was found in the 8th week after surgery,with no statistical differences between the two groups (P＞0.05).Two patch materials were degraded gradually in the repaired area,and the regenerated collagen tissues were deposited continuously,but no significant differences existed between the two groups in the collagen content and collagen arrangement (P＞0.05).Conclusion The PDO-SIS patch has better mechanical properties than the 8SIS patch,and does not cause strong immune rejection when used to repair abdominal partially defect of SD rats.

An empirical study on medical selection of flying cadets with hernia disease between PLAAF and USAF / 军事医学

Objective To analyze the disease spectrum of abdominal external hernia during medical selection of flying cadets and compare the medical standards between US Air Force and Chinese PLA Air Force in order to improve the system of medical selection.Methods The data about abdominal external hernia among flying cadets during Chinese PLAAF medical selection between 2012 and 2015 were retrospectively analyzed and compared with the medical standards of the USAF flying cadets.Results Twenty-nine candidates were eliminated because of hernia,including 4 cases of hiatal hernia,3 cases of umbilical hernia and 22 cases of inguinal hernia.4.70% of the candidates were eliminated because of hernia disease.Empirical research showed difference in hernia standards between China and the USA.Conclusion Compared with Chinese medical selection standards,the USAF standards give more weight to whether the symptoms of disease impact air safety and efficiency.Our medical selection standards need to be improved by learning from foreign practices.

An empirical study on medical selection of flying cadets with anal diseases between PLAAF and USAF / 军事医学

Objective To analyze the spectrum of anus disease during the medical selection of flying cadets and com-pare the medical standard between US Air Force and Chinese Air Force in order to improve the system of medical selection. Methods The data on flying cadets of Chinese Air Force medical selection from 2012 to 2015 were retrospectively analyzed and these data were re-analyzed by medical standards for US Air Force flying cadets.Results Ninety students were elimi-nated because of anal disease,including 65 hemorrhoids,14 fistula and 11 fissure.The rate of disqualification from 2012 to 2015 was 48.28%, 33.33%, 31.37%, 39.69%and there was no significant statistical difference between each two years (x2 =2.6154,P=0.4548).There was statistically significant difference(P=0<0.05)in hemorrhoids standards between CAF and USAF,and significant difference in fistula and fissure standards.Conclusion Compared with Chinese medical se-lection standards,the US Air Force standards focus on whether the symptoms of disease have effect on air safety and effi-ciency.To improve our medical selection standards,we need to learn from foreign air forces and take our own conditions into account.

Three-dimensional finite element analysis of artificial femoral head replacement for unstable femoral intertrochanteric fractures / 中国组织工程研究

BACKGROUND:Artificial femoral head replacement provides a new idea for the repair of unstable intertrochanteric fracture. Artificial prosthesis replacement may affect original femoral biomechanical stability and lead to a variety of adverse consequences. OBJECTIVE:To analyze the stress distribution of femoral head replacement in the treatment of unstable femoral intertrochanteric fractures with three-dimensional finite element analysis. METHODS:One male old volunteer was randomly selected from population who underwent health examination. The left femur was scanned with spiral CT, and the three-dimensional finite element models of the human femur and prosthesis were established. The three-dimensional finite element model was used to simulate the actual working conditions of human climbing stairs, and the stress distribution of the bone channels around the surface of the femur and the prosthesis was analyzed with three-dimensional finite element analysis. RESULTS AND CONCLUSION: Under normal condition, the stress of the human femur was in a consistent state. Stress changed gradualy from the proximal end to the distal end. The stress of the prosthesis was concentrated in the middle section. The prosthesis of inner stress distribution was analyzed to obtain stress distribution of prosthesis and femur cancelous bone interface. The analysis found that stress change trend was consistent. The results suggest that artificial femoral head replacement does not have a significant effect on the overal stress distribution of the human femur, and the overal stress distribution does not change, and the maximum stress region is located in the middle of the whole femur. After the reconstruction, the stress concentration of the femur is not observed.

Retrograde changes in the dorsal motor nuclei of rat vagus nerve after vagotomy / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the retrograde changes in the dorsal motor nuclei (DMV) of the vagus nerve after vagotomy in rats.</p><p><b>METHODS</b>Nissl staining and immunohistochemistry were used to observe the morphological and quantitative changes of the DMV and alterations of the expression of iNOS and NADPH after severing of the vagus nerve in adult male Wistar rats.</p><p><b>RESULTS</b>Compared with the control group, the rats with right vagotomy showed obvious morphological changes and a significantly decreased number of neurons in the right DMV (P<0.05). Numerous iNOS- and NADPH-immunopositive cells were detected in the right DMV 5 and 10 days after right vagotomy.</p><p><b>CONCLUSION</b>Vagotomy causes obvious retrograde changes in rat DMV shown by a significantly decreased number and obvious morphological changes of the neurons in the DMV.</p>

Clinicial analysis of 69 patients with acute hyperthyroid myopathy and its treatment / 中华内分泌代谢杂志

Sixty-nine cases of acute hyperthyroid myopathy admitted from 1990 to 2011 were retrospectively analyzed.Hoarseness was the most common symptom; 17.39％ of the patients had difficulty in breathing; respiratory muscle paralysis and aspiration pneumonia were the main causes of death.Efficient treatment lasting for two weeks was carried out in 81.16％ of the cases.Patients with severe bulbar palsy were often complicated with aspiration pneumonia and thus had high mortality rate.The main treatments in cluded anti-hyperthyroid drugs,corticosteroids,energy supports,and symptomatic management,which usually resulted in good clinical improvement.

Effect of α-melanocyte stimulating hormone on human dermal fibroblasts: preliminary identification of protein expression / 中华医学美学美容杂志

Objective To evaluate the effect of this neuroendocrine hormone on protein expression by treating the human dermal fibroblasts with a-melanocyte stimulating hormone (α-MSH ).Methods Thehuman dermal fibroblasts was cultured, and the total protein of the fibroblasts were separated with immobilized pH gradient-based two-dimensional gel electrophoresis (2-DE). After Coomassie bright blue staining, gel images were acquired by Image-scanner and then analyzed with the PDQuest software. 2-DE maps of fibroblasts were established. Partial differently expressed protein spots were incised from gels and digested by trypsin in-gel. Matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS) and MSDB database searching by Mascot? software were used for protein identification. Results Well-resolved, reproducible 2-DE patterns of dermal fibroblasts treated with and without crMSH were obtained. 8 differently expressed protein spots were detected, among which 8 obtained peptide mass fingerprints (PMF) by MALDI-TOF-MS analysis. Among these proteins, of particular interest were five proteins annexin I, HSP27 and lamin A, etc. Conclusions Proteins expressed by human dermal fibroblasts treated with or without crMSH are different, and some of the differently expressed proteins involve apoptosis, intracellular signal transduction and framework construction and so on, which may be associated with anti-fibrosis effects of (a)-MSH on human dermal fibroblasts.

Protective effect of nicorandil on myocardial ischemia reperfusion injury in patients undergoing cardiac valve replacement / 中国临床药理学与治疗学

AIM:To observe the protective effect of nicorandil on myocardial ischemia reperfusion injury in patients undergoing valve replacement.METHODS:Sixty patients undergoing valve repalacement were randomly divided into 3 groups:control(Ⅰ)group,nicorandil delayed precondictioning(Ⅱ)group and nicorandil preconditioning(Ⅲ)group.20 mg nicorandil was given i.v.24 h before operation in group Ⅱ,whereas in group Ⅲ,20 mg nicorandil was given i.v.after induction of anesthesia.Blood samples were taken from coronary venous for determination of cTnI,TNF-?,IL-6 levels at aortic clamping(T0),15 min(T1),30 min(T2),60 min(T3),90 min(T4)after aortic declamping.Right atria myocardium tissue were taken at T0 and T2 to observe the histopathological changes with electron microscopy.RESULTS:The levels of cTnI,TNF-?and IL-6 in group Ⅱand Ⅲ were significantly lower than those in group I.Myocardium injury was obviously lighter in groupⅡand Ⅲ than that in group Ⅰ,whereas the levels of cTnI,TNF-?,IL-6 and myocardium injury were lower in group Ⅱ than those in group Ⅲ.CONCLUSION:Nicorandil is effcetive in decreasing myocardial ischemia repefusion injury in patients undergoing valve replacement,The protective effect of nicorandil delayed preconditioning is more obvious than precondictioning.