Clinical study on endoscopic closure of gastrointestinal fistula using the over-the-scope-clip system / 医学研究生学报

Objective Gastrointestinal fistula is a serious complication after operation. It is reported that the over-the-scope-clip(OTSC) can close intestinal full-thickness wall and treat gastrointestinal fistula effectively. This study was to investigate the efficacy of OTSC in the treatment of gastrointestinal fistula.Methods We analyzed the clinical data of 28 postoperative patients with gastrointestinal fistula who underwent endoscopic closure using OTSC in Endoscopy Center of Research Institute of General Surgery in our hospital from October 2014 to October 2017, and recorded the course of disease, the site of gastrointestinal fistula, the diameter of fistula and the efficacy of OTSC. Patients with successful closure were followed up for half a year after hospital discharge to observe the recurrence of fistula.Results Endoscopic closure with OTSC was successful in all the 28 patients without complications like bleeding and falling off. In the sinus tract or digestive tract radiography at 1-2 weeks after OTSC closure, 23 patients were successful in endoscopic closure(82.14%). In the six months′ follow-up of 23 patients with successful treatment, 4 patients were lost to follow-up and 19 patients were successful without recurrence of fistula.Conclusion The endoscopic closure of gastrointestinal fistula using OTSC is safe and effective, avoiding reoperation and reducing trauma.

Effect of inositol requiring enzyme 1-mediated endoplasmic reticulum stress in liver cell apoptosis of experimental fulminant hepatic failure and its significance / 中华传染病杂志

Objective To study the role of inositol requiring enzyme 1 (IRE1)-mediated endoplasmic reticulum stress on hepatocyte apoptosis of experimental fulminant hepatic failure (FHF).Methods Thirty male depuratory Wistar rats were manufactured to be FHF model by peritoneal injection of D-galactosamine (D-GalN) and lipopolysaccharide (LPS),and 30 rats were injected peritoneally with 0.9％ sodium chloride solution as controls.The apoptosis of liver cells was detected by flow cytometry.The protein and mRNA expressions of Caspase-12 and IRE1 in liver tissues were detected by immunohistochemistry and reverse transcriptation-polymerase chain reaction (RT-PCR).The independent samples were compared by Kruskal-Wallis H test.The comparison between two groups at the same time point was done by Mann-Whitney U test.The correlation analysis was done by rank correlation.Results The apoptotic rates of liver cells at 2,4,8 and 12 hours were increased over time in model group (x2 =25.475,P=0.01),which were higher than control group (U=0,P＜0.01).The expressions of Caspase-12 and IRE1 proteins in liver tissues were upregulated in model group,while the expressions were not detected in control group.The expressions of Caspase-12 and IRE1 mRNA in model group were also increased over time and peaked at 8 h,then gradually decreased; the differences among different time points were statistically significant (x2 =23.983,x2 =24.820; both P＜0.01),and all higher than control group (U=0,P＜0.01).IRE1 was positively correlated with both Caspase-12 and hepatocellular apoptotic rate (r=0.733 and 0.715,respectively;both P＜0.01).Caspase-12 was positively correlated with hepatocellular apoptotic rate (r=0.586,P＜0.01).Conclusions IRE1 mediated endoplasmic reticulum stress on hepatocyte apoptosis is closely related to the development of FHF.The earlier intervention on endoplasmic reticulum stress pathway,the more protective effect in liver failure.

Clinical application of percutaneous endoscopic gastrostomy/jejunostomy / 中国医学科学院学报

<p><b>OBJECTIVE</b>To summarize the clinical experiences in percutaneous endoscopic gastrostomy (PEG)/percutaneous endoscopic jejunostomy (PEJ).</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 578 patients who received either PEG or PEJ from July 2001 to December 2007 in our hospital. The data analyzed included the type, aim, duration, success rate, and complications of these procedures.</p><p><b>RESULTS</b>Of 578 patients, 247 patients underwent PEG, 293 patients underwent percutaneous endoscopic gastrojejunostomy (PEGJ), 4 patients received percutaneous endoscopic duodenostomy (PED), 4 patients underwent direct percutaneous endoscopic jejunostomy (DPEJ), 4 patients underwent percutaneous endoscopic colostomy (PEC), and 26 patients received PEG/J combined stents. These procedures were performed in different clinical conditions, including enteral nutrition (n = 329), decompression combined enteral nutrition (n = 133), decompression of the gastrointestinal tract (n = 103), enteral nutrition combined bile refeeding (n = 5), perioperative applications (n = 4), and coloclysis (n = 4). Tubes were successfully placed in 578 patients (98.0%) in an average time of (7.5 +/- 1.9) min in PEG, (17.7 +/- 4.2) min in PEGJ, (14.8 +/- 2.1) min in DPEJ, (12.3 +/- 2.5) min in PED, (11.3 +/- 2.6) min in PEC, and (30.2 +/- 5.2) min in PEG/J combined stent, respectively. No procedure-related complications were observed. Major complications were found in 6 patients (1.04%) and minor complications in 36 patients (6.23%). The duration of tube functioning was (168.37 +/- 198.64) d.</p><p><b>CONCLUSIONS</b>PEG/PEJ are easy to handle, effective, safe, and convenient for nursing. The endoscopic method of tube placement can be performed at the bedside and allow for enteral feeding, gastrointestinal decompression, and internal biliary drainage to be rapidly and efficiently achieved.</p>

The safety and efficiency of fast track surgery in gastric cancer patients undergoing D2 gastrectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the safety and efficacy of fast track surgery (FTS) management in gastric cancer undergoing D2 gastrectomy.</p><p><b>METHODS</b>Eighty gastric cancer patients undergoing D2 gastrectomy were recruited prospectively. Patients were assigned to receive FTS management (n = 40) or conventional perioperative care (n = 40). The FTS care included shorten preoperative fasting time, no nasogastric decompressing tubes and abdominal drainage placed, early postoperative oral feeding, multimodal analgesia, and early mobilisation. The length of postoperative hospital stay, medical cost, nutritional status, gut function, and postoperative complications in the two groups were recorded and compared.</p><p><b>RESULTS</b>FTS group was associated with a significantly shorter postoperative hospital stay compared with conventional care group [(5.6 +/- 1.3) d vs. (9.4 +/- 1.9) d, P < 0.05]. Medical cost was less [(18 620 +/- 2360) Yuan vs. (20 370 +/- 2440) Yuan, P < 0.05] and duration of intravenous infusion [(3.5 +/- 1.4) d vs. (5.8 +/- 1.9) d, P < 0.05] was also shorter. First passage of flatus was earlier in FTS group than in conventional care group [(4.3 +/- 0.4) d vs. (5.5 +/- 0.9) d, P < 0.05]. Loss of body weight in the postoperative period was less in FTS group [(3.2 +/- 0.8) kg vs. (4.3 +/- 1.6) kg, P < 0.05]. There was no difference in morbidity or mortality between the two groups.</p><p><b>CONCLUSION</b>FTS in D2 gastrectomy is safe and efficient, and it can shorten postoperative hospital stay and hasten return of gut function.</p>