Doppler-guided hemorrhoidal artery ligation with suture mucopexy compared with LigaSure™-assisted pile excision for the treatment of grade III hemorrhoids: a prospective randomized controlled trial.

BACKGROUND: Doppler-guided hemorrhoid artery ligation and stapled hemorrhoidopexy have been used in surgical practices to avoid post-hemorrhoidectomy pain. Our study compared Doppler-guided hemorrhoid artery ligation with suture mucopexy (DGHAL-SM) and ligature-assisted pile excision (LAP) for greater than three grades of internal hemorrhoids. METHODS: Eighty patients with greater than 3 grades of internal hemorrhoids were selected (age range: 20-28 years; average age: 23 years) between January and June 2015. The patients were randomly divided into group A (DGHAL-SM) and group B (LAP); each group had 40 patients. RESULTS: With respect to the postoperative cure rate and anal skin tags, group A was inferior to group B, but the postoperative pain assessment and satisfaction were better than group B (P<0.001). CONCLUSIONS: The DGHAL-SM cure rate was high; the postoperative pain was mild; 97.5% of the patients did not return to hospital because of pain. LAP has a higher cure rate than DGHAL-SM, but the postoperative pain and return rate within 6 h was as high as 65%, and the postoperative satisfaction assessment was lower than DGHAL-SM. Therefore, we recommend that DGHAL-SM for outpatient surgery in patients with greater than three grades of internal hemorrhoids.

Elevated Plasma Levels of Gas6 Are Associated with Acute Lung Injury in Patients with Severe Sepsis.

Acute lung injury (ALI) is one of the complications of severe sepsis, causing sudden deaths. However, information regarding predictive factors for the onset of ALI in severe sepsis is limited. Growth arrest-specific gene 6 (Gas6) is secreted by endothelial cells and is important for the activation of endothelium during inflammation. This study aimed to investigate the predictive effect of plasma Gas6 in patients with severe sepsis. Collection of plasma samples was carried out from 129 participants with severe sepsis following with or without ALI development. We found that the elevated levels of Gas6, interleukin-6 and -8 (IL-6 and IL-8) in plasma were associated with the ALI development (P = 0.003, 0.002, and 0.004, respectively). We also observed the robust correlation between the plasma level of Gas6 and the following ALI development to adjustment for sepsis and administration of vasopressor. Between patients with ALI (n = 18) and those without ALI (n = 111), Gas6 and the Lung Injury Prediction Score (LIPS) showed promising discrimination (AUROC, 0.74 and 0.68, respectively), and in combination with these two indexes, the AUROC was increased to 0.86 (vs. 0.74, P = 0.05), while soluble receptor for advanced glycation end products (sRAGE) and Willebrand factor (vWF) in plasma showed no predictive value for of ALI. Collectively, our findings indicate that higher levels of Gas6 in plasma are obviously correlated with ALI development. An early increase in the plasma Gas6 level suggests that endothelial injury is a key link in the pathogenesis of ALI.

Nasogastric tube placement with video-guided laryngoscope: A manikin simulator study.

BACKGROUND: This study aimed to investigate video-guided laryngoscopy for nasogastric tube placement. METHODS: This was an observational comparative study performed in a hospital. The participants included volunteers from the medical staff (physicians and nurses) experienced with nasogastric intubation, and non-medical staff (medical students, pharmacists and emergent medical technicians) with knowledge of nasogastric intubation but lacking procedural experience. Medical and non-medical hospital staff performed manual, laryngoscope-assisted and video-guided laryngoscope nasogastric intubation both in the presence and in the absence of an endotracheal tube, using a manikin. Nasogastric intubation times were compared between groups and methods. RESULTS: Using the video-guided laryngoscope resulted in a significantly shorter intubation time compared to the other 2 methods, both with and without an endotracheal tube, for the medical and non-medical staff alike (all p < 0.05). For the medical staff, mean nasogastric intubation time was significantly shorter using video-guided laryngoscope without endotracheal intubation, direct laryngoscope with endotracheal intubation and video-guided laryngoscope with endotracheal intubation compared to manual intubation without endotracheal intubation (0.49, 0.63 and 0.72 vs. 5.63, respectively, p ≤ 0.008). For non-medical staff, nasogastric intubation time was significantly shorter using video-guided laryngoscope without endotracheal intubation, direct laryngoscope with endotracheal intubation and video-guided laryngoscope with endotracheal intubation compared to manual intubation without endotracheal intubation (1.67, 1.58 and 0.95 vs. 6.9, respectively, p ≤ 0.002). And mean nasogastric intubation time for video-guided laryngoscope endotracheal intubation was significantly shorter for medical staff than for non-medical staff (0.49 vs. 1.67 min, respectively, p = 0.041). CONCLUSION: Video-guided laryngoscope reduces nasogastric intubation time compared to manual and direct laryngoscope intubation, which promotes a consistent technique when performed by experienced medical and previously untrained non-medical staff.

Absolute Quantitative Evaluation of 67Ga Scintigraphy in Lupus Nephritis.

PURPOSE: Renal biopsy is crucial for management of lupus nephritis. However, it is invasive and can cause bleeding and infection. In our previous study, we developed a semiquantitative method for gallium renal imaging and demonstrated a good correlation between the left kidney-to-spine ratio (K/S ratio) and the results of renal biopsy. However, the accuracy of left K/S ratio is compromised by the variation of spinal gallium uptake, especially in patients with extraordinarily high or low gallium uptakes in the spine. In this study, we developed an absolute quantitative method and compared the results of quantitative gallium images, semiquantitative gallium images, visual methods, and renal biopsies. METHODS: Thirty-four patients with lupus nephritis were enrolled and underwent renal biopsy to determine activity index (AI) and chronicity index. A delayed 48-hour gallium scan was also performed and interpreted by visual, semiquantitative, and absolute quantitative methods. For absolute quantitative analysis, a standard solution with activities of approximately 555 KBq (15 µCi) was prepared and poured into a 5-mL tube, which was placed close to the patient. ROIs were drawn around the outer edge of the left kidney as well as around the outer edges of the standard. A kidney uptake index (KUI) was calculated, and the results were compared with K/S ratio, visual grading, and renal biopsies. RESULTS: Kidney uptake index had the best correlation with AI among the 3 methods using Spearman rank correlation test. The Spearman R values were 0.78, 0.71, and 0.61 for KUI, K/S ratio and visual grading, respectively. Chronicity index did not correlate well with the results of any of the 3 methods. In addition, AI was significantly higher in patients with a KUI equal to or greater than 1.5, when compared with patients with a KUI lower than 1.5 (P = 0.00001 by Mann-Whitney U test). Using a K/S ratio of 0.95 as a cutoff value, AI also showed a statistically significant difference with P = 0.0001. When a visual grading of 2 was used as a cutoff value, P = 0.0008. The difference in AI was most significant when the statistical value was based on the KUI. CONCLUSIONS: The KUI showed better correlation with the results of renal biopsy than the K/S ratio and the visual grading. We suggest that the KUI from the absolute quantitative renal gallium scintigraphy may be a useful parameter for evaluating the disease activity in lupus nephritis.

Therapeutic efficacy of 188Re-MN-16ET lipiodol in an animal model of hepatocellular carcinoma.

OBJECTIVE: In our recent study, we developed a new radiopharmaceutical (Re-188 MN-16ET lipiodol) with encouraging results for the treatment of liver malignancy. In this study, we further evaluated the therapeutic efficacy of this radiopharmaceutical by measuring tumor response and survival times in rats with liver tumors after intra-hepatic arterial injection of Re-188 MN-16ET lipiodol. METHODS: Twelve male rats bearing hepatic tumors were divided into three groups. Group 1 received an intra-hepatic arterial injection of 18.5 MBq Re-188 MN-16ET lipiodol; Group 2 received lipiodol and Group 3 received normal saline. Tumor size was measured by liver sonography before injection, at 2, 4, and 8 weeks after injection. Survival time and response rate were calculated. RESULTS: All rats showed good response and survived over 60 days in Group 1 while all rats showed poor response in Group 2 and Group 3 with only 25 % of rats in Group 2 and none (0 %) in Group 3 survived over 60 days. The p value was 0.0067 between Group 1 and Group 3; 0.04 between Group 1 and Group 2; and 0.034 between Group 2 and Group 3. CONCLUSION: Re-188 MN-16ET lipiodol has good potential for the treatment of hepatoma.

A comparison of Re-188-MN-16ET-lipiodol and transcatheter arterial chemoembolization in the treatment of hepatoma: an animal study.

INTRODUCTION: In patients with unresectable HCC, transcatheter arterial chemoembolization (TACE) is a widely used treatment. Recently, as an alternative treatment modality for HCC, transcatheter arterial embolization with radioisotopes has been investigated. In this study, we compared the therapeutic efficacy of an intra-hepatic arterial injection of Re-188-MN-16ET-lipiodol and the TACE method in rats with liver tumors. METHODS: Twelve male rats bearing hepatic tumors were divided into three groups to evaluate the efficacy of treatment (four in each group). Group 1 received an intra-hepatic arterial injection of 0.2mCi of Re-188-MN-16ET-lipiodol; group 2 received epirubicin (0.5mg/kg) and 0.1ml of lipiodol emulsion; group 3 received 0.1ml of normal saline and served as the control group. Tumor size was measured by liver sonography before injection, at two weeks, four weeks and eight weeks after injection. Survival time was calculated from the day of treatment to 56days after treatment by the life-table method. The response to treatment and the survival time in each group were evaluated and compared. RESULTS: All rats treated with Re-188 MN-16ET-lipiodol showed good response to the therapy. Their tumor size decreased and all rats survived over eight weeks. All rats treated with epirubicin plus lipiodol survived over 8weeks; however, two rats (50%) showed increased tumor size in the 8th week. As for the control group (rats treated with normal saline), all rats survived less than 37days with continuous tumor growth. CONCLUSION: Results showed that Re-188-MN-16ET-lipiodol can be a potential therapeutic pharmaceutical for the treatment of liver tumors.