Clinical efficacy of redo rectal resection and coloanal anastomosis / 中华消化外科杂志

Objective:To investigate the clinical efficacy of redo rectal resection and coloanal anastomosis.Methods:The retrospective and descriptive study was conducted. The clinicopatholo-gical data of 49 patients who underwent redo rectal resection and coloanal anastomosis for the treatment of local recurrence of tumors and failure of colorectal or coloanal anastomosis after rectal resection in the Sixth Affiliated Hospital of Sun Yat-sen University from November 2012 to December 2021 were collected. There were 32 males and 17 females, aged 57(range,31-87)years. Redo rectal resection and coloanal anastomosis was performed according to the patient′s situations. Observa-tion indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distri-bution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers or percentages. Results:(1) Surgical situations. All 49 patients underwent redo rectal resection and coloanal anastomosis successfully, with the interval between the initial surgery and the reopera-tion as 14.2(7.1,24.3)months. The operation time and volume of intraoperative bold loss of 49 patients in the redo rectal resection and coloanal anastomosis was 313(251,398)minutes and 125(50,400)mL, respectively. Of the 49 patients, there were 38 cases receiving laparoscopic surgery including 12 cases with transanoscopic laparoscopic assisted surgery, 11 cases receiving open surgery including 2 cases as conversion to open surgery, there were 20 cases undergoing Bacon surgery, 14 cases undergoing Dixon surgery, 12 cases undergoing Parks surgery, 2 cases undergoing intersphincter resection and 1 case undergoing Kraske surgery, there were 20 cases undergoing rectum dragging out excision and secondary colonic anastomosis, 13 cases undergoing dragging out excision single anastomosis, 12 cases undergoing rectum dragging out excision double anastomosis, 4 cases undergoing first-stage manual anastomosis, there were 21 cases with enterostomy before surgery, 16 cases with prophylactic enterostomy after surgery, 12 cases without prophylactic enterostomy after surgery. The duration of postoperative hospital stay of 49 patients was (14±7)days. (2) Postoperative situations. Fifteen of 49 patients underwent postoperative complications, including 8 cases with grade Ⅱ Clevien-Dindo complications and 7 cases with ≥grade Ⅲ Clevien-Dindo complications. None of 49 patient underwent postoperative transferring to intensive care unit and no patient died during hospitalization. Results of postoperative histopathological examination in 23 patients with tumor local recurrence showed negative incision margin of the surgical specimen. (3) Follow-up. All 49 patients underwent post-operative follow-up of 90 days. There were 42 cases undergoing redo rectal resection and coloanal anastomosis successfully and 7 cases failed. Of the 37 patients with enterostomy, 20 cases failed in closing fistula, and 17 cases succeed. There were 46 patients receiving follow-up with the median time as 16.1(7.5,34.6)months. The questionnaire response rate for low anterior resection syndrome (LARS) score was 48.3%(14/29). Of the patients who underwent redo coloanal anastomosis and closure of stoma successfully, there were 9 cases with mild-to-moderate LARS.Conclusion:Redo rectal resection and coloanal anastomosis is safe and feasible for patients undergoing local recurr-ence of tumors and failure of colorectal or coloanal anastomosis after rectal resection, which can successfully restore intestinal continuity in patients and avoid permanent enterostomy.

Distinct mononuclear diploid cardiac subpopulation with minimal cell-cell communications persists in embryonic and adult mammalian heart / 医学前沿

A small proportion of mononuclear diploid cardiomyocytes (MNDCMs), with regeneration potential, could persist in adult mammalian heart. However, the heterogeneity of MNDCMs and changes during development remains to be illuminated. To this end, 12 645 cardiac cells were generated from embryonic day 17.5 and postnatal days 2 and 8 mice by single-cell RNA sequencing. Three cardiac developmental paths were identified: two switching to cardiomyocytes (CM) maturation with close CM-fibroblast (FB) communications and one maintaining MNDCM status with least CM-FB communications. Proliferative MNDCMs having interactions with macrophages and non-proliferative MNDCMs (non-pMNDCMs) with minimal cell-cell communications were identified in the third path. The non-pMNDCMs possessed distinct properties: the lowest mitochondrial metabolisms, the highest glycolysis, and high expression of Myl4 and Tnni1. Single-nucleus RNA sequencing and immunohistochemical staining further proved that the Myl4+Tnni1+ MNDCMs persisted in embryonic and adult hearts. These MNDCMs were mapped to the heart by integrating the spatial and single-cell transcriptomic data. In conclusion, a novel non-pMNDCM subpopulation with minimal cell-cell communications was unveiled, highlighting the importance of microenvironment contribution to CM fate during maturation. These findings could improve the understanding of MNDCM heterogeneity and cardiac development, thus providing new clues for approaches to effective cardiac regeneration.

Analysis on operational safety of chronic radiation intestinal injury / 中华胃肠外科杂志

Objective@#To investigate the safety and efficacy of surgical treatment for chronic radiation intestinal injury.@*Methods@#A descriptive cohort study was performed. Clinical data of 73 patients with definite radiation history and diagnosed clinically as chronic radiation intestinal injury, undergoing operation at Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University from January 1, 2012 to February 28, 2019, were reviewed and analyzed retrospectively. Patients did not undergo operation or only received adhesiolysis were excluded. All the patients had preoperative examination and overall evaluation of the disease. According to severity of intestinal obstruction and patients′ diet, corresponding nutritional support and conservative treatment were given. Surgical methods: The one-stage bowel resection and anastomosis was the first choice for surgical treatment of chronic radiation intestinal injury. Patients with poor nutritional condition were given enterostomy and postoperative enteral nutrition and second-stage stoma closure and intestinal anastomosis if nutritional condition improved. For those who were unable to perform stoma closure, a permanent stoma should be performed. Patients with severe abdominal adhesion which was difficult to separate, enterostomy or bypass surgery after adhesiolysis would be the surgical choice. For patients with tumor metastasis or recurrence, enterostomy or bypass surgery should be selected. Observation parameters: the overall and major (Clavien-Dindo grades III to V) postoperative complication within 30 days after surgery or during hospitalization; mortality within postoperative 30 days; postoperative hospital stay; time to postoperative recovery of enteral nutrition; time to removal of drainage tube.@*Results@#Of the 73 patients who had been enrolled in this study, 10 were male and 63 were female with median age of 54 (range, 34-80) years. Preoperative evaluation showed that 61 patients had intestinal stenosis, 63 had intestinal obstruction, 11 had intestinal perforation, 20 had intestinal fistula, 3 had intestinal bleeding, and 6 had abdominal abscess, of whom 64(87.7%) patients had multiple complications. Tumor recurrence or metastasis was found in 15 patients. A total of 65(89.0%) patients received preoperative nutritional support, of whom 35 received total parenteral nutrition and 30 received partial parenteral nutrition. The median preoperative nutritional support duration was 8.5 (range, 6.0-16.2) days. The rate of one-stage intestine resection was 69.9% (51/73), and one-stage enterostomy was 23.3% (17/73). In the 51 patients undergoing bowel resection, the average length of resected bowel was (50.3±49.1) cm. Among the 45 patients with intestinal anastomosis, 4 underwent manual anastomosis and 41 underwent stapled anastomosis; 36 underwent side-to-side anastomosis, 5 underwent end-to-side anastomosis, and 4 underwent end-to-end anastomosis. Eighty postoperative complications occurred in 39 patients and the overall postoperative complication rate was 53.4% (39/73), including 39 moderate to severe complications (Clavien-Dindo grade III-V) in 20 patients (27.4%, 20/73) and postoperative anastomotic leakage in 2 patients (2.7%, 2/73). The mortality within postoperative 30 days was 2.7% (2/73); both patients died of abdominal infection, septic shock, and multiple organ failure caused by anastomotic leakage. The median postoperative hospital stay was 13 (11, 23) days, the postoperative enteral nutrition time was (7.2±6.9) days and the postoperative drainage tube removal time was (6.3±4.2) days.@*Conclusions@#Surgical treatment, especially one-stage anastomosis, is safe and feasible for chronic radiation intestine injury. Defining the extent of bowel resection, rational selection of the anatomic position of the anastomosis and perioperative nutritional support treatment are the key to reduce postoperative complications.

Correlation analysis of the clinical and sonographic characteristics of papillary thyroid microcarcinomas with its aggressiveness / 中华超声影像学杂志

Objective To compare the clinical and sonographic characteristics of aggressive and nonaggressive papillary thyroid microcarcinomas(PTMC)in order to improve the preoperative predictive value of aggressive PTMC.Methods A total of 309 patients with PTMC from January 2014 to December 2016 were included in this study.Patients with lymphatic metastasis,extrathyroidal invasion,reccurence, distant metastasis and death were classified into aggressive PTMC group,and patients without above characteristics were classified into nonaggressive group.Clinical and sonographic features were reviewed and compared between the two groups.Results Among the 309 patients,76 cases(24.6%)were aggressive PTMC,and 233 cases(75.4%)were nonaggressive.Patients were younger and larger cancerous nodules, microcalcification,capsular inconnection and multifocality were seen more frequently in aggressive PTMC group compared with nonaggressive group.The best cut-off value of age and diameter were 44.5 years and 0.66 cm respectively.Advanced age was the protective factor and larger tumor size and multifocality were independent risk factors for PTMC aggressiveness.The capsular invasion was related with the lateral cervical lymph node metastasis while other features were not.Conclusions Extra attention should be paid to patients with age<44.5 years,tumor size>0.66 cm and multifocal cancerous nodules because their PTMCs are more likely to be aggressive.Thyroid capsule adjacent to the cancerous nodule should be observed carefully.If there is interruption in the capsule,lateral cervical lymph nodes should be carefully examed.

Periostitis and squamous cellcarcinoma induced by long-term use of voriconazole / 中国药理学通报

Voriconazole is a broad spectrum triazole antifungal agent, widely used in the prevention and treatment of invasive fungal diseases.Long-term use of voriconazole can induce periostitis and cutaneous squamous cell carcinoma, accounting for serious adverse effects on patients, which has been reported in increasing clinical cases.This review is to characterize the epidemiological and clinical manifestations of periostitis and squamous cell carcinoma induced by voriconazole, and to analyze the mechanisms of triggering periostitis and squamous cell carcinoma, so as to promote the rational use of voriconazole in clinics.

Analysis of Perioperative Prophylactic Application of Antibacterials in Type Ⅰ Incision Operation in a Class A Grade Three Hospital / 中国药房

OBJECTIVE:To provide reference for perioperative rational prophylactic application of antibacterials in type Ⅰ in-cision operation. METHODS:4 201 patients underwent type Ⅰ incision operation were collected from a class A grade three hospi-tal during Mar. 2013-Feb. 2015. The perioperative prophylactic application of antibacterials in type Ⅰ incision operation were ana-lyzed statistically. RESULTS:Of 4 201 patients underwent type Ⅰ incision operation,there were 2 399 cases of prophylactic appli-cation of antibiotics(accounting for 57.10%). Cephalosporins andβ-lactam/β-lactamase inhibitor were the main classes of antibacte-rials for preventive use,accounting for 45.60%and 19.76%,respectively. The frequency of using cefazolin,ceftriaxone and amoxi-cillin-clavulanic acid ranked the top 3 places, among which there was 823 cases of unsuitable prophylactic medication time (34.31%),and 855 cases of prophylactic medication time >48 h(accounting for 35.64%). CONCLUSIONS:There still is unrea-sonable perioperative prophylactic application of antibacterials in type Ⅰ incision operation in this hospital. It is necessary to strengthen the supervision of antibacterials and conduct regular rational antibacterials use seminars in order to promote rational use of antibacterials.