Comparison of safety of total laparoscopic versus laparoscopic-assisted radical gastrectomy for distal gastric cancer in older patients / 中华胃肠外科杂志

Objective: To compare the effectiveness of total laparoscopic versus laparoscopic-assisted distal gastrectomy and investigate the safety and replicability of total laparoscopic distal gastrectomy in older patients. Methods: This was a retrospective cohort study. The inclusion criteria were as follows: (1) age ≥65 years; (2) malignant gastric tumor diagnosed pathologically preoperatively; (3) Eastern Cooperative Oncology Group performance status score 0-1; (4) Grade I-III American Society of Anesthesiologists physical status; (5) preoperative clinical tumor stage I-III; (6) total laparoscopic or laparoscopic-assisted distal gastrectomy performed; and (7) gastrointestinal tract reconstruction using uncut Roux-en-Y or Billroth-II+Braun procedure. Patients who had received neoadjuvant therapy, undergone conversion to open surgery, or had serious comorbidities or incomplete data were excluded. The clinical data of 129 patients who met the above criteria and had undergone laparoscopic surgery for gastric cancer from January 2012 to December 2021 in the Gastrointestinal Cancer Center in the Beijing Cancer Hospital were analyzed. According to the operation method, the patients were divided into total laparoscopic group and laparoscopic-assisted group. Variables studied comprised: (1) surgical procedure and postoperative recovery; (2) postoperative pathological findings; and (3) postoperative complications. Measurement data with skewed distribution are represented as mean(quartile 1, quartile 3). Comparisons between groups were evaluated using the Mann-Whitney U test. Results: After propensity score matching in a 1:1 ratio, there were 40 patients in the total laparoscopic distal gastrectomy group and 40 in the laparoscopic-assisted distal gastrectomy group. Baseline characteristics did not differ significantly between the two groups (all P>0.05).Compared with the laparoscopic-assisted group, the total laparoscopic group had shorter main incisions (4.1±1.0 cm vs. 8.5±2.8 cm, t=9.375, P<0.001), time to fluid intake [4.0 (3.0, 4.8) days vs. 5.0 (4.0, 6.0) days, Z=2.167, P=0.030], and duration of indwelling abdominal drainage catheter [6.0 (6.0, 7.0) days vs. 7.0 (6.0, 8.0) days, Z=2.323, P=0.020]. Numerical Rating Scale scores on postoperative days 1 and 2 were higher in the total laparoscopic than the laparoscopic-assisted group [2.5 (1.0, 3.0) vs. 1.5 (1.0, 2.0), Z=1.980, P=0.048; 2.0 (1.0, 3.0) vs. 1.0 (1.0, 2.0), Z=2.334, P=0.020, respectively]. However, there were no significant differences between the groups in operation time, intraoperative blood loss, white blood cell count, hemoglobin concentration, or albumin concentration on postoperative day 1, time to ambulation, mean time to bowel movement, postoperative admission to the intensive care unit, length of postoperative hospital stay, or Numerical Rating Scale scores on postoperative day 3 (all P>0.05). There were also no significant differences between the two groups in maximum tumor diameter, pathological tumor type, total number of lymph nodes dissected, or total number of positive lymph nodes (all P>0.05). The incidence of postoperative complications was 15.0% (6/40) in the total laparoscopic group and the laparoscopic-assisted group; these differences are not significant (χ2<0.001, P>0.999). Conclusions: Compared with laparoscopic-assisted radical gastrectomy for distal gastric cancer, total laparoscopic surgery has the advantages of shorter incision, shorter time to fluid intake, and shorter duration of indwelling abdominal drainage catheter in older patients (age ≥65 years). Total laparoscopic radical gastrectomy for distal gastric cancer does not increase the risk of postoperative complications and could therefore be performed more frequently.

Correlation analysis of quality,origin and phenotypic characters of Paris polyphylla var. yunnanensis / 中国中药杂志

In order to provide guidance for the protection and utilization of resources,quality control and breeding of improved varieties,we compared the main phenotypic characters and quality of wild and transplanted Paris polyphylla var. yunnanensis collected from different producing areas. Seven phenotypic characters of 33 samples of P. polyphylla var. yunnanensis collected from Yunnan,Guizhou and Sichuan were determined by conventional methods,and the principal component analysis and cluster analysis were used to analyze the diversity of the samples. The parissaponin( polyphyllin Ⅰ,Ⅱ,Ⅵ,Ⅶ) content of the samples were detected by HPLC,and analyzed by cluster analysis. Correlation analysis of the phenotypic characters and the parissaponin content was performed. There were significant differences in seven phenotypic characters between wild and transplanted samples of P. polyphylla var. yunnanensis from different habitats,with high phenotypic diversity and abundant genetic variation. The results of principal component analysis showed that leaf shape index was the main factor of morphological variation of P. polyphylla var. yunnanensis. Cluster analysis showed that the phenotypic characters of wild and transplanted P. polyphylla var. yunnanensis could not be completely separated. The content of saponins in wild and transplanted samples from different habitats was quite different. Saponins content of 93. 94% samples met the criterion of Chinese Pharmacopoeia 2015 edition,and the overall quality was relatively steady. The results of independent sample t-test showed that there was no significant difference of all the active ingredient between wild and transplanted samples,and it couldn't be used to distinguish between wild and transplanted samples. It is the same as the results of cluster analysis. The results of correlation analysis showed that the phenotypic traits of P. polyphylla var. yunnanensis were correlated with its medicine quality,and the total content of saponins was positively correlated with leaf length and leaf shape index( r = 0. 389,0. 441; P<0. 05). Yunnan,Guizhou and Sichuan are suitable for the growth of P. polyphylla var. yunnanensis. And the transplaned P. polyphylla var. yunnanensis can be used as the same as the wild ones completely. The results provide reference for the protection and selective breeding of P. polyphylla var. yunnanensis.

Advance in hemofiltration for severe acute pancreatitis / 国际外科学杂志

The treatment of severe acute pancreatitis (SAP) is a difficult clinical problem.Hemofiltration has been used in the treatment of SAP for more than 20 years.Hemofiltration can clear excessively activated inflammatory factors of blood and block systemic inflammatory response syndrome (SIRS),while maintaining water-electrolyte balance.It plays an more and more important role in the treatment of SAP.At the same time,the application of hemofiltration in the treatment of SAP is also controversial and requires further study.This paper will summarize recent advances in hemofiltration for SAP so as to achieve better application of hemofiltration in clinical practice.

Isolation of Carbapenems-resistant Gram-negative Bacillus and Analysis of Producing Metallo-β-lactamase / 中国药房

OBJECTIVE:To provide reference for rational use of antibiotics in the clinic of our hospital. METHODS:Drug re-sistance of Gram-negative bacillus in the inpatients of our hospital were analyzed retrospectively during May 2013-Dec. 2015 as well as the situation of producing metallo-β-lactamase(MBLs). RESTUTS:A total of 2089 strains of Gram-negative bacillus were detected in our hospital during 2013-2015,among which there were 1456 strains of enterobacteria (69.70%) and 633 strains of non-fermentative bacteria,mainly involving Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter bau-mannii and Enterobacter cloacae. A total of 406 strains of carbapenems-resistant bacteria were detected (19.44%),including 367 strains of non-fermentative bacteria and 39 strains of enterobacteria. The resistant rates of carbapenems-resistant strains to 16 antibi-otics were all higher than 50%,but those of non-carbapenems-resistant strains were in relative low level. Except for aztreonam,re-sistant rates of carbapenems-resistant strains to other 15 antbiotics were all higher than those of non-carbapenems-resistant strains, with statistical significance(P<0.05). A total of 36 strains of producing MBLs were detected(8.87%),including 13 strains of pro-ducing MBLs drug-resistant P. aeruginosa and 23 strains of producing MBLs drug-resistant A. baumannii;producing MBLs drug re-sistant enterobacteria had not been found. CONCLUSIONS:Gram-negative bacillus are mainly enterobacteria in our hospital;car-bapenems-resistant strains are mainly non-fermentative bacteria,resistant rate of them are commonly higher than that of non-drug-re-sistant strain. The situation of producing MBLs is serious,and enzyme producing strains are mainly non-fermentative bacteria. It is necessary to strengthen drug resistance of pathogen and enzyme producing strain monitoring,avoid the generation and spreading of drug-resistant strains due to irrational use of antibiotics.

Effect of potassium iodate on the cell cycle of human thyroid cancer cells / 基础医学与临床

Objective To explore the effects of potassium iodate (KIO3) on the proliferation, cell cycle, and the mRNA/protein levels of cyclin D 1 and Ki67 of SW579 cells, a human thyroid squamous carcinoma cell line . Methods The effects of different doses of KIO3(0,10-6,10-5,10-4,10-3,10-2,10-1 mol/L)on SW579 cell prolifer-ation were assessed by CCK8 method.SW579 cells were then treated with 0 (control), 10-6 or 10-2 mol/L KIO3 for 48 h.The cell cycle was measured by flow cytometry .The mRNA and protein levels of cyclinD 1 and Ki67 were re-spectivelyanalyzedbyreal-timePCRandWesternblot.Results 10-6and10-2mol/LofKIO3respectivelyexhibi-ted the most promoting and suppressive effect on SW579 cell proliferation.G1 phase of cells in 10-6 group short-ened significantly( P<0.05) , and S phase prolonged significantly( P<0.05); while each phase of cells in 10-2 mol/L group changed in the opposite way( P<0.05) .KIO3 at the dose of 10-6 mol/L significantly up-regulated the mRNA levels of cyclin D1 and ki67 in cells( P<0.05) ;whereas, the mRNA and protein levels of cyclin D1 and Ki67 were significantly down-regulated in cells treated with 10-2 mol/L KIO3( P<0.05) .Conclusions Different doses of KIO3 affect the proliferation and cell cycle of SW579 cells probably by regulating the levels of cyclin D1and Ki67 .

Clinical application of preoperative imaging evaluation in the anterolateral thigh flap transplantation: comparison of computed tomography angiography, digital subtract angiography and magnetic resonance angiography / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of three preoperative imaging methods in the anterolateral thigh flap (ALT) transplantation.</p><p><b>METHODS</b>According to preoperative imaging, patients who underwent the ALT flap transplantation were divided into three groups: computed tomography angiography (CTA) group, digital subtract angiography ( DSA) group and magnetic resonance angiography (MRA) group. There were fifteen cases in each group. We compared the imaging quality of the ALT artery among these groups and recorded the parameters of lateral femoral circumflex artery, descending branches and perforators including type, course and size. The results from images were compared with intraoperative findings. The success rate and complications were also recorded.</p><p><b>RESULTS</b>The preoperative imaging accuracy of the types of the lateral femoral circumflex artery and descending branch was more than 92.3%, with no significant different between any two of three groups (P > 0.05). The difference in diameters of descending branches and perforators from preoperative measurement and from intraoperative measurement was also not significant between any two of the three groups; the success rate and complications were not also obviously different (P > 0.05 , P > 0.05, respectively).</p><p><b>CONCLUSIONS</b>Preoperative mapping using CTA, DSA and MRA is a feasible and reliable method for the flap design in ALT transplantation. As a preoperative evaluation means, CTA and MRA may replace DSA in the ALT transplantation.</p>

Computer simulation-based study of emergency medical rescue strategy / 第二军医大学学报

Objective To apply computer simulation technology for simulating the emergency medical rescue of different conditions and optimizing the rescue strategy and resource allocation. Methods Firstly, according to the characteristics of the arrival of the wounded and the state of injury, four alternative strategies were formulated and simulated. Secondly, the optimal strategy was determined by waiting time of the wounded and the working intensities of rescue unit. Finally, the reasonable suggestions for the rescue strategy and rescue force allocation were put forward by simulation analysis of the relationship between the arrival rate of wounded and the number of rescue units. Results First-leave-first-served and the select-units strategy could effectively reduce the waiting time of the wounded and the working intensity of the rescue unit. When the arrival rate of class A(B) of the wounded increased, the total number of rescue units increased at the same time under the premise of meeting the requirements of the medical rescue, with the number of A(B) rescue units increasing more rapidly. Conclusion By simulating the emergency medical rescue process using different strategies, the optimal rescue strategy can be determined; the number of the rescue units is closely related to the arrival rate of the wounded; estimating the arrival rate of the wounded and the average treatment time can provide reference for rescue force allocation.

Stateflow and queuing theory-based design of emergency medical rescue simulation system / 第二军医大学学报

Objective To design an emergency medical rescue-simulation system,and to provide reference for optimizing rescue strategy and medical resource allocation by simulating different rescue conditions. Methods Firstly，Stateflow was used to build the main simulation unit，which included arrival of the wounded, classification of the wounded (emergent [type A] and non-emergent [type B])，and medical treatment modules， and then the related event and response function were appended. Secondly，the system parameter input unit and character display unit were set up in Simulmk. Finally two different medical treatment strategies (strategy 1:type B wounded waiting for treatment in the rescue module with least waiting patients strategy 2 :type B wounded waiting for treatment in the rescue module with least workload) were simulated and the corresponding rescue strategies were analyzed. Results The system could simulate the medical rescue process of different strategies. The type A wounded could be rescued in a timely manner in both strategies. Type B wounded had a shorter waiting time in strategy 1，but the rescuers had a heavy work load; while they had a longer waiting time in strategy 2，and the rescuers had a lighter work load. Conclusion We have successfully designed a simulation system for emergency medical rescue and its feasibility and effectiveness are verified. Different rescue strategies have their respective advantages and disadvantages in the waiting time and work load, and the two strategies can be combined in practice in order to achieve a dynamic balance between the waiting time of the wounded and the work load of the rescuers.

Orthogonal design based optimization of a mouse model of acute liver failure induced by D-galactosamine and lipopolysaccharide / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To apply an orthogonal design optimization strategy to a mouse model of acute liver failure induced by D-galactosamine (D-GalN) and lipopolysaccharide (LPS) exposure.</p><p><b>METHODS</b>A four-level orthogonal array design (L16(45)) was constructed to test factors with potential impact on successful establishment of the model (D-GalN and LPS dosages, and dilution rate of the D-GalN/LPS mixture). The mortality rate of mice within 24 hours of D-GalN/LPS administration was determined by the Kaplan-Meier method. The model outcome was verified by changes in serum alanine transferase level, liver histology, and hepatocyte apoptosis.</p><p><b>RESULTS</b>The orthogonal array identified the optimal model technique as intraperitoneal injection of a combination of D-GalN and LPS at dosages of 350 mg/kg and 30 mug/kg, respectively, and using a dilution rate of 3. The dosages tested had no effect on survival. The typical signs of liver failure appeared at 6 hrs after administration of the D-GalN/LPS combination.</p><p><b>CONCLUSION</b>The orthogonal design optimization strategy provided a procedure for establishing a mouse model of acute liver failure induced by D-GalN and LPS that showed appropriate disease outcome and survival, and which will serve to improve future experimental research of acute liver failure.</p>

Protective effects of a c-jun N-terminal kinase inhibitor, SP600125, against D-galactosamine/lipopolysaccharide induced acute liver failure in mice / 中华传染病杂志

Objective To investigate the protective effect of c-jun N-terminal kinase (JNK)inhibitor SP600125 against acute liver failure in mice.Methods Fifty-five male C57/BL6 mice were divided into control group (n =30) and SP600125 group (n =25).The animals were given an intraperitoneal injection of D-galactosamine (D-GalN,400 mg/kg body weight)/lipopolysaccharide (LPS,30 μg/kg body weight).The control group and SP600125 group were given 10％ dimethyl sulfoxide (15 mL/kg body weight) or SP600125 (75 mg/kg body weight) subcutaneously 12 h and 1 h before D-GalN/LPS administration,respectively.D GalN/LPS induced mouse JNK activation was detected by immunohistochemistry for phospho JNK (p-JNK).D-GalN/LPS induced mouse liver cell apoptosis was detected by immunohistochemistry for Caspase-3 and TdT-mediated-dUTP nick endlabeling (TUNEL).Serum alanine transaminase (ALT) level was tested to assess liver injury.Survival rate of mice within 24 h after D-GalN/LPS administration was observed.The comparison between groups was done by t test and survival rate was analyzed by Kaplan-Meier method.Results JNK activity in liver tissues,as indicated by observation of p-JNK positive cells by immunohistochemistry,was diminished 4 h after D-GalN/LPS administration in SP600125 group.Reduced Caspase-3 activity was observed 6 h after D-GalN/LPS administration in SP600125 group (as indicated in immunohistochemistry by Caspase-3 positive cells).Mice in SP600125 group showed significantly lower TUNEL-positive cell count than control group (43.0±24.5 vs 194.7±73.8; t=9.743,P=0.000).Serum ALT level 6 h after D-GalN/LPS administration was (24.0±54.7) U/L in SP600125 group,which was significantly lower than that in control group [(1234.4±478.4) U/L; t=4.734,P=0.0015].SP600125 also significantly improved the survival rate within 24 h after D-GalN/LPS administration (4/5 vs 1/10； x2=5.225,P=0.0223).Conclusions JNK inhibitor SP600125 exerts protective effects against D-GalN/LPS induced acute liver failure in mice by suppressing JNK activation and hepatocyte apoptosis.

Clinical application of preoperative CT angiography in anterolateral thigh perforator flap transplantation / 中华放射学杂志

Objective To investigate the accuracy and utility of preoperative CTA in the anterolateral thigh perforator flap (ALTPF) transplantation.MethodsPreoperative CTA was performed in 15 consecutive patients,who underwent the ALTPF transplantation. The suitable perforators were found through measuring and estimating the perforator parameters including size,course and origin location by reviewing preoperative angiogram.These parameters were compared with the actual intraoperative findings.ResultsOne patient was transferred to abdominal flap transplantation,because no perforator could be found by both CTA and intraoperative observation.In 14 patients,the sizes and origin locations ( perpendicular and horizontal length from the origin of the perforator to both patella and lateral of thigh) of all selected perforators on CTA were no significantly different from the operative findings( P ＞ 0.05 ),and the types were consistent with the operative findings.The rate of septocutaneous perforator was 28.6％ (4/14),and the rate of musculocutaneous perforator was 71.4％ (10/14).The utilization rate of perforator flap was 93.3％ ( 14/15),and the accuracy of preoperative CTA was 100％.All of these ALTP flaps survived,and there was no donor site morbidity. Conclusions Preoperative mapping using CTA provides fairly accurate information about the size,type (course) and location of the perforators.Preoperative CTA in the ALTPF transplantation is an accurate and useful method and leads to safer and successful operation with optimal outcome.

Transportal variceal sclerotherapy with n-butyl-2-cyanoacrylate for gastric fundal varices / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate the technique, safety and clinical efficacy of transportal variceal sclerotherapy with n-butyl-2-cyanoacrylate (NBCA) for gastric fundal varices.</p><p><b>METHODS</b>Twenty-one patients with gastric fundal varices confirmed by endoscopy were enrolled in this study. The causes of the gastric varices were cirrhosis caused by hepatitis virus B or C (n = 16) and hepatocellular carcinoma with portal venous obstruction (n = 5). Percutaneous transhepatic or transplenic portography were performed on all 21 patients. The gastric varices were treated with NBCA-lipiodol mixture injected via a microcatheter introduced into the varices. For 8 patients who had large gastrorenal shunts (GRS), a balloon-occluded catheter was introduced into the GRS via the right femoral and left renal veins before injecting the NBCA-lipiodol. During the NBCA-lipiodol injection, the balloon was inflated to block the flow of GRS. Follow-up evaluations included findings of the laboratory liver function tests, upper intestinal endoscopies, and the occurrences of rebleeding.</p><p><b>RESULTS</b>In 20 patients (95.2%), the gastric varices were successfully obliterated with 2-8 ml of NBCA-lipiodol. In one patient with a large GRS, sclerotherapy was not successfully performed because a balloon-occluded catheter was not available during the procedure. In five patients, small amounts of NBCA-lipiodol entered into the distal pulmonary artery branches. Two of them suffered from transient irritable coughs; no patient developed severe pulmonary embolism. Embolization of portal venous branches occurred in two patients, which were not treated specifically. In comparison with the findings before the treatments, the serum alanine aminotransferase levels decreased at both 3 and 6 months after treatments (P less than 0.05); serum albumin levels increased at 6 months (P less than 0.05); the prothrombin times decreased at 6 months (P less than 0.05); but no significant changes were seen in the serum bilirubin levels. Fifteen patients were followed-up endoscopically for 3 months after the treatment. Gastric varices were completely resolved in 10 patients (66.7%) and were markedly smaller in 4 patients (26.6%). Worsening of the esophageal varices occurred in 3 patients (20%). All the patients were followed-up from 1 to 30 months [(16.7+/-8.8) months]. Rebleeding was observed in 4 patients, and the cumulative rebleeding rate at 1 year was 9.52%.</p><p><b>CONCLUSION</b>Transportal variceal sclerotherapy with NBCA is a safe and effective method for treating gastric varices. Microcatheter technique and occlusion of the large gastrorenal shunt with a balloon-occluded catheter are necessary to ensure obliteration of gastric varices and prevent pulmonary embolism.</p>