Delayed gastric emptying after laparoscopic versus open pancreaticoduodenectomy: a comparative study / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect on postoperative delayed gastric emptying (DGE) after laparoscopic versus open pancreaticoduodenectomy (PD).</p><p><b>METHODS</b>Data from 67 consecutive PD procedures performed between October 2010 and October 2012 were retrospectively analyzed. Among them, 20 patients underwent laparoscopic PD (LPD group), and 47 patients underwent open PD (OPD group; 22 patients underwent pylorus-preserving PD, 25 patients underwent standard PD).</p><p><b>RESULTS</b>The LPD group had significantly longer operative times ((494 ± 46) minutes vs. (391 ± 70) minutes, t = -4.40, P = 0.000), reduced blood loss ((294 ± 158) ml. vs. (399 ± 68) ml, t = 2.73, P = 0.008) and shorter postoperative hospital stay (13.0 days vs. 16.3 days, t = 3.01, P = 0.009) compared to the OPD group. However, there was no difference in terms of DGE occurrence and postoperative complication rates. There was one postoperative death in the OPD group and none in the LPD group. Multivariate analysis by Logistic regression showed that DGE was significantly more frequent among patients with longer operative times (OR = 1.01, 95%CI: 1.000 - 1.024, P = 0.048), increased intraoperative blood loss (OR = 1.01, 95%CI: 1.000 - 1.022, P = 0.040) and postoperative intraabdominal complications (OR = 6.22, 95%CI: 1.400 - 27.700, P = 0.017). Mean postoperative hospital stay was longer among patients who developed DGE (19.7 days vs. 13.6 days, t = -6.50, P = 0.000) than those without DGE.</p><p><b>CONCLUSIONS</b>Longer operative time, increased intraoperative blood loss and postoperative intraabdominal complications appear to be risk factors for DGE development. Meanwhile, the laparoscopic approach PD is safe and feasible, and outcomes appears comparable with those undergoing an open approach.</p>

Synthesis of a supermolecular nanoparticle γ-hy-PC/Ada-Dox and its antitumor activity / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To synthesize a (2-Hydroxypropyl)-γ-cyclodextrin-polyethylenimine/adamantane-conjugated doxorubicin (γ-hy-PC/Ada-Dox) based supramolecular nanoparticle with host-guest interaction and to identify its physicochemical characterizations and antitumor effect.</p><p><b>METHODS</b>A novel non-viral gene delivery vector γ-hy-PC/Ada-Dox was synthesized based on host-guest interaction. 1H-NMR, NOESY, UV-Vis, XRD and TGA were used to confirm the structure of the vector. The DNA condensing ability of complexes was investigated by particle size, zeta potential and gel retardation assay. Cytotoxicity of complexes was determined by MTT assay in BEL-7402 and SMMC-7721 cells. Cell wound healing assay was performed in HEK293 and BEL-7404 cells. The transfection efficiency was investigated in HEK293 cells. H/E staining and cell uptake assay was performed in BEL-7402 cells.</p><p><b>RESULTS</b>The structure of γ-hy-PC/Ada-Dox was characterized by 1H-NMR, NOESY, UV-Vis, XRD, TGA. The drug loading was 0.5% and 5.5%. Gel retardation assay showed that γ-hy-PC was able to completely condense DNA at N/P ratio of 2; 0.5% and 5.5% γ-hy-PC/Ada-Dox was able to completely condense DNA at N/P ratio of 3 and 4,respectively. The cytotoxicity of polymers was lower than that of PEI25KDa. The transfection efficiency of γ-hy-PC was higher than that of γ-hy-PC/Ada-Dox at N/P ratio of 30 in HEK293 cells; and the transfection efficiency was decreasing when Ada-Dox loading was increasing. Cell uptake assay showed that γ-hy-PC/Ada-Dox was able to carry drug and FAM-siRNA into cells.</p><p><b>CONCLUSION</b>The novel vector γ-hy-PC/Ada-Dox has been developed successfully, which has certain transfection efficiency and antitumor activity.</p>

Predictive factors of recurrent angina after acute coronary syndrome: the global registry acute coronary events from China (Sino-GRACE) / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Many patients with acute coronary syndrome (ACS) develop recurrent angina (RA) during hospitalization. The aim of this non-randomized, prospective study was to investigate the predictive factors of RA in unselected patients with ACS enrolled in the global registry acute coronary events (GRACE) during hospitalization in China.</p><p><b>METHODS</b>Between March 2001 and October 2004, enrolled were 1433 patients with ACS, including ST segment elevation myocardial infarction (662, 46.2%), non-ST segment elevation myocardial infarction (239, 16.7%) and unstable angina (532, 37.1%). The demographic distribution, medical history and clinical data were collected to investigate the predictive factors of RA by Logistic regression.</p><p><b>RESULTS</b>During hospitalization 275 (19.2%) patients were documented with RA including unstable angina (53.2%), non-ST segment elevation myocardial infarction (27.5%), ST segment elevation myocardial infarction (19.3%). A comorbidity of dyslipidemia, prior angina, percutaneous coronary intervention (PCI) within 6 months was more common in patients with RA, P < 0.05. In the patients with RA, a significantly higher proportion of patients with acute pulmonary edema was observed, 23 (8.4%) versus 43 (3.7%), P = 0.001. Acute renal failure was present in 8 (2.9%) of patients with RA versus 19 (1.6%) of patients without RA, P = 0.165. Hemorrhagic events were present in 6 (2.2%) of patients with RA versus 8 (0.7%) of patients without RA, ventricular tachycardia/ventricular fibrillation events in 12 patients (4.3%) versus 22 patients (1.9%), congestive heart failure in 69 patients (25.0%) versus 94 patients (8.1%), myocardial re-infarction in 28 patients (10.1%) versus 15 patients (1.3%), P < 0.05, respectively. A lower proportion of patients with RA underwent in-hospital PCI, 687 (59.3%) versus 114 (41.5%), P = 0.000. A higher proportion of patients with RA received heparin, 260 (94.5%) versus 1035 (89.4%), P = 0.006; and beta-blockers 176 (64.0%) versus 864 (74.5%), P = 0.000. Multivarible regression analysis showed that RA was associated with prior angina (OR 2.086, 95% CI 1.466 - 2.967), in-hospital PCI (OR 0.579, 95% CI 0.431 - 0.778), in-hospital congestive heart failure (OR 2.410, 95% CI 1.634 - 3.555), myocardial re-infarction (OR 7.695, 95% CI 3.701 - 15.999), beta-blocker (OR 0.626, 95% CI 0.458 - 0.855), and heparin (OR 3.411, 95% CI 1.604 - 7.382).</p><p><b>CONCLUSIONS</b>In-hospital congestive heart failure, myocardial re-infarction, prior angina history and use of heparin are stronger independent predictors of RA; beta-blockers and PCI are also important predictive factors for RA.</p>