Abstract： Objective To investigate the clinical application of tubular stomach in cervical esophageal reconstruction after esophagectomy for esophageal cancer. Methods A total of 850 patients with esophageal cancer who underwent esophagectomy through cervico-thoraco-abdominal（3-field）approach between January 2007 and January 2009 in North Jiangsu Hospital were allocated into the tubular stomach group（group A, n=425） and the whole stomach group （group B, n=425）by operation order. Group A included 287 male and 138 female patients with their average age of 58.2±11.5 years. Among them, 27 patients had upper esophageal cancer, 346 patients had middle esophageal cancer and 52 patients had lower esophageal cancer. Group B included 298 male and 127 female patients with their average age of 58.5±12.8 years. Among them, 33 patients had upper esophageal cancer, 338 patients had middle esophageal cancer, and 54 patients had lower esophageal cancer. Operation time, postoperative length of hospital stay and the incidence of anastomotic leakage, anastomotic stricture, intra-thoracic stomach syndrome and reflux esophagitis of the two groups were compared. Results All the patients recovered uneventfully with no in-hospital death. There was no statistical difference in operation time （175.0±12.8 min vs.171.0±10.5 min，t=1.702，P＞ 0.05）and postoperative length of hospital stay （16.0±8.5 d vs.16.3±8.8 d，t=1.773，P＞ 0.05） between the two groups. During follow-up of six months, the rates of anastomotic leakage（χ2=5.550，P＜ 0.05）, intra-thoracic stomach syndrome （χ2=10.500，P＜ 0.05）and reflux esophagitis（χ2=9.150，P＜ 0.05） of group A were significantly lower than those of group B. There was no significant difference in the incidence of anastomotic stricture （χ2=0.120，P＞ 0.05） between the two groups. Conclusion Tubular stomach is better than whole stomach for cervical esophageal reconstruction after esophagectomy for esophageal cancer since it is more physiologically and anatomically complied. It can decrease the incidence of anastomotic leakage, intra-thoracic stomach syndrome, reflux esophagitis and improve the postoperative quality of life.
ObjectiveTo investigate the correlation between abnormal thyroid function and benign or malignant breast tumors. MethodsThe contents of free iodine three original acid (FT3), three iodine original acid (T3), thyroxine (T4), free thyroxine (FT4), thyroid-stimulating hormone (TSH), anti-thyroglobulin antibodies (Anti-TG), and antithyroid peroxidase antibody (Anti-TPO) were detected by chemiluminescence method in 563 patients with benign breast neoplasms, 87 patients with breast cancer, and 123 health examination population. ResultsT3 and T4 levels in patients with breast cancer were lower than those of normal control group and benign tumor group (P < 0.05). However, there were no significant difference in the levels of FT3, FT4, and TSH between the 3 groups (P > 0.05). The positive rates of Anti-TPO and Anti-TG were higher than those of benign group and normal group (P < 0.001). T3 and T4 levels in patients with breast cancer were not related to the expression of ER and PR, in Her-2 negative expression and lymph node metastasis were relatively low (P < 0.05). ConclusionThe decrease of contents of T3 and T4, and the positive expressions of Anti-TPO and Anti-TG may provide a basis for predicting the incidence of breast cancer.
ObjectiveTo investigate the effectiveness of reversed arthroscopic subacromial decompression in the treatment of rotator cuff tears. MethodsBetween November 2012 and January 2015, 53 patients with rotator cuff tears were treated with reversed arthroscopic subacromial decompression and rotator cuff repair. Of 53 patients, 38 were male and 15 were female, with the age of 47-61 years (mean, 53.4 years). The injury was caused by falling in 36 cases and other in 17 cases without an obvious history of trauma. All patients had shoulder pain and limited shoulder movement before operation. Visual analogue scale (VAS) was 6.4±0.9, and University of California at Los Angeles (UCLA) score was 16.3±1.9. MRI showed that distal supraspinatus tear was observed in 41 cases and distal infraspinatus tear in 12 cases; partial-thickness rotator cuff tear was observed in 9 cases and full-thickness tear in 44 cases. And the tear size was from 1 to 3 cm (mean, 1.9 cm). Combined injuries included tendinitis of long head of biceps brachii in 31 cases, Bankart lesion in 5 cases, and superior labrum anterior and posterior lesion in 2 cases. ResultsIncision healed by first intention in all patients; no infection or nerve injury occurred. Forty-nine cases were followed up from 12 to 35 months (mean, 22.8 months). After operation, shoulder pain relief was achieved in 42 cases; 7 cases had anterior shoulder pain at 3 months after operation, which was relieved after symptomatic treatment. At last follow-up, VAS score was significantly decreased to 0.5±0.6 (t=40.565, P=0.000). UCLA score was significantly increased to 33.8±1.7 (t=-79.799, P=0.000). The results were excellent in 42 cases, good in 6 cases, and fair in 1 case; the excellent and good rate was 98.0%. ConclusionReversed arthroscopic subacromial decompression can avoid coracoacromial arch injury and achieve good recovery of joint function, so it can be used in rotator cuff tears procedure.
ObjectiveTo investigate the expression of miR-195 and the underlying molecular mechanisms of miR-195 regulating HMGB1 in diabetic retinopathy (DR). MethodsExtract 5 ml venous blood from DR patients, diabetes mellitus (DM) patients and normal subjects, then extract and perificate plasma total RNA. MicroRNA array and real time polymerase chain reaction (RT-PCR) was used to screen out miRNAs which were expressed with significant differences in the serum of patients with DR. Bioinformatics was employed to predict the miR-195 related to high mobility group box 1 (HMGB1) regulation. Next, miR-195 was down-regulated or up-regulated in umbilical vein endothelial cells through transfection of miR-195 inhibitor and miR-29b mimics respectively.Then we analyzed expression of HMGB1 mRNA and protein by RT-PCR and Western blot. ResultsMicroRNA array results showed the expression of miR-195 in DR group is decreased by 8.34 times and 11.47 times compared with DM group and the normal group. RT-PCR verification results conforms to the microRNA array results. Compared with the DM group (F=0.034, t=8.057) and the normal group (F=0.370, t=9.522), the expression of miR-195 in DR group were significantly reduced, the differences were statistically significant (P < 0.05). RT-PCR showed that the expression of HMGB1 mRNA was significantly decreased in up-regulation group, compared with blank (F=0.023, t=11.287) and negative control group (F=0.365, t=7.471), the difference was statistically significant (P < 0.05). The expression of HMGB1 mRNA was significantly increased in down-regulation group, compared with blank (F=0.053, t=10.871) and negative control group (F=0.492, t=6.883), the difference was statistically significant (P < 0.05). Western blot showed that the expression of HMGB1 protein was significantly decreased in up-regulation group, compared with blank (F=0.021, t=8.820) and negative control group (F=0.039, t=7.401), the difference was statistically significant (P < 0.05); and significantly increased in down-regulation group, compared with blank (F=0.186, t=10.092) and negative control group (F=0.017, t=12.923), the difference was statistically significant (P < 0.05). ConclusionMiR-195 can inhibit the expression of HMGB1, reduce the inflammation and angiogenesis, thereby delaying or inhibiting the occurrence and development of DR.
ObjectiveTo investigate the mechanism of early vascularization of the tissue engineered bone in the treatment of rabbit radial bone defect by local injection of angiopoietin 2 (Ang-2).MethodsForty-eight New Zealand white rabbits were established unilateral 1.5 cm long radius defect models. After implantation of hydroxyapatite/collagen scaffolds in bone defects, the rabbits were randomly divided into 2 groups: control group (group A) and Ang-2 group (group B) were daily injected with 1 mL normal saline and 1 mL saline-soluble 400 ng/mL Ang-2 at the bone defect within 2 weeks after operation, respectively. Western blot was used to detect the expressions of autophagy related protein [microtubule associated protein 1 light chain 3 (LC3), Beclin-1], angiogenesis related protein [vascular endothelial growth factor (VEGF)], and autophagy degradable substrate protein (SQSTMl/p62) in callus. X-ray films examination and Lane-Sandhu X-ray scoring were performed to evaluate the bone defect repair at 4, 8, and 12 weeks after operation. The rabbits were sacrificed at 12 weeks after operation for gross observation, and the angiogenesis of bone defect area was observed by HE staining.ResultsWestern blot assay showed that the relative expressions of LC3-Ⅱ/LC3-Ⅰ, Beclin-1, and VEGF in group B were significantly higher than those in group A, and the relative expression of SQSTMl/p62 was significantly lower than that in group A (P<0.05). Radiographic and gross observation of specimens showed that only a few callus were formed in group A, the bone defect was not repaired; more callus were formed and complete repair of bone defect was observed in group B. The Lane-Sandhu scores in group B were significantly higher than those in group A at 4, 8, and 12 weeks after operation (P<0.05). HE staining showed that the Harvard tubes in group B were well arranged and the number of new vessels was significantly higher than that in group A (t=–11.879, P=0.000).ConclusionLocal injection of appropriate concentration of Ang-2 may promote early vascularization and bone defect repair of tissue engineered bone in rabbits by enhancing autophagy.
Objective To analyze the effect of monitoring and modulating the portal vein pressure and blood flow during living donor liver transplantation （LDLT） on preventing small-for-size-syndrome (SFSS). Methods Data of forty-four LDLT recipients between Oct.2007 and Oct.2008 were reviewed. Actual graft-to-recipient weight ratio（GRWR）, portal vein flow and pressure during operation and syndrome of SFSS after operation were recorded. The patients received splenectomy or splenic artery ligation according to actual GRWR, portal vein flow and pressure and WBC. Relationships between patients’ GRWR, portal vein flow, portal vein pressure and occurrence of SFSS were analyzed. Results Six patients received splenectomy and 7 patients received splenic artery ligation to decrease the portal vein flow and pressure during the operation. The portal vein flow and pressure decreased after splenectomy （Plt;0.05）. The portal vein pressure decreased （Plt;0.05） and the portal vein flow had no significant change after splenic artery ligation （P＞0.05）. No SFSS occurred after operation. Conclusion Modulation of portal vein flow and pressure by splenectomy or splenic artery ligation during LDLT operation can decrease the portal vein flow and pressure, and which can prevent the incidence of SFSS.
ObjectiveTo explore the effects of volume mechanical ventilation with different tidal on the diaphragm discharge in rats. MethodsTwenty-four SD rats were randomly divided into three groups, namely a high tidal volume group, a low tidal volume group, and a control group. The rats in the high tidal volume group and the low tidal volume group underwent volume controlled ventilation with tidal volume of 10 mL/kg and 5 mL/kg, respectively. The rats in the control group breath spontaneously after anesthetization. The EMGdi frequency, diaphragm discharge area, product of diaphragm discharge amplitude and diaphragm discharge rate (A×R) were measured every 2 hours to analyze the characteristics of diaphragm of rats under different duration of ventilation. ResultsCompared with the control group, there was no statistical difference of A×R in the high tidal volume group, but the frequency of the diaphragm discharge reduced and the discharge diaphragm area increased. When compared the low tidal volume group with the control group, only the A×R increased significantly. The transcutaneous oxygen saturation (SpO2) and end-tidal CO2 pressure (PetCO2) in the high tidal volume group decreased significantly compared to the control group while the other indexes had no difference. ConclusionsThe effects of mechanical ventilation with different tidal volume on the rat diaphragm discharge are different. The low tidal volume mechanical ventilation can excite the respiratory center and strengthen the diaphragm discharge with the stabilization of physiological index while the high tide volume inhibits diaphragm function and damages the oxygenation.
ObjectiveTo investigate the clinical value of 3D CT combined with CT-guided Hookwire for localizing small pulmonary nodules in thoracoscopic pulmonary segmentectomy.MethodsFrom December 2017 to February 2019, 39 patients received thoracoscopic pulmonary segmentectomy in our hospital, including 14 males and 25 females with a mean age of 51.33±11.17 years. Before operation, we used Mimics Medical 20.0 to re-establish the anatomy of lung and locate the small pulmonary nodules with Hookwire guided by CT. Based on the position of Hookwire needle, 3D CT images and simulated surgical methods, thoracoscopic pulmonary segmentectomy was performed accurately.ResultsThe surgery was successfully completed in 39 patients without a transfer to open procedure. The mean operation time, mean intraoperative blood loss, mean postoperative hospital stay, mean thoracic tube drainage time were 148.97±28.56 min, 27.95±17.57 mL, 6.95±1.68 d, 4.21±1.95 d, respectively. Postoperative complications occurred in 5 patients (12.82%), including atrial fibrillation in 1, pulmonary infection in 1, chylothorax in 1, intrathoracic hemorrhage in 1 and pneumothorax in 1. All actual surgical margins were larger than 3.0 cm.ConclusionThe application of preoperative 3D CT combined with CT-guided Hookwire to localize small pulmonary nodules is helpful for accurate anatomical segmental resection of the lung, making the operation safe .