Abstract： Objective To investigate the influence of vasoactive intestinal peptide （VIP) on the sling fibers and the clasp fibers of the lower esophageal sphincter （LES） and the difference， and explore whether VIP belongs to a nonadrenergic and noncholinergic （NANC） neurotransmitter. Methods Thirty LES specimens were obtained from 30 patients with high-position carcinoma of the middle thoracic esophagus who underwent esophagectomy from March to August 2010 in Fourth Affiliated Hospital of Hebei Medical University. There were 14 male patients and 16 female patients with their average age of 58.0±6.1 years. The clasp fibers and sling fibers were isolated and suspended in perfusion. Exogenous VIP was added to the two kinds of strips to draw a concentration-effect curve. Electric field stimulation （EFS） or exogenous VIP was applied to clasp fibers and sling fibers， and the influence of VIP （10-28） on LES was compared. Results ExogenousVIP in different concentration caused concentration-dependent relaxation of the sling fibers and clasp fibers of LES in vitro. There was statistical difference in relaxation between the sling fibers and clasp fibers under same VIP concentration （P＜0.05）， and the relaxation of sling fibers was more significant than that of clasp fibers. VIP （10-28） transiently inhibited the relaxationof the sling fibers and clasp fibers caused by exogenous VIP. VIP （10-28） also transiently inhibited the relaxation of the sling fibers and clasp fibers after the activation of EFS. Conclusion The relaxation of sling fibers and clasp fibers induced by EFS is related to VIP. VIP is a kind of NANC neurotransmitter in human LES.
Objective To evaluate the results of arthroscopically-assisted closed reduction and percutaneous screw fixation by posterior approach to subtalar joint for calcaneal fractures of Essex-Lopresti tongue type, Sanders IIA, IIB, and IIIAB. Methods Sixteen patients with unilateral calcaneal fracture were treated with arthroscopically-assisted closed reduction and percutaneous screw fixation by posterior approach to subtalar joint between June 2012 and June 2015. There were 13 males and 3 females with an average age of 37.8 years (range, 18-65 years). The injury causes included falling from height in 10 cases and traffic accident in 6 cases. Of 16 cases, 4 were classified as Essex-Lopresti tongue type, 5 as Sanders IIA, 4 as Sanders IIB, and 3 as Sanders IIIAB. The interval of injury and operation was 4-8 days (mean, 5.94 days). The Böhler angle, Gissane angle, and width of calcaneus were measured before and after operation. American Orthopaedic Foot and Ankle Society (AOFAS) score was used to evaluate the ankle function at 12 months after operation. Results Primary healing of incision was obtained in all cases, and no complications of infection, necrosis, and osseous fascia compartment syndrome occurred. The patients were followed up 12-15 months (mean, 13.63 months). The X-ray films showed that fracture line disappeared at 6 months after operation; the patients had no tenderness or percussion pain, no breakage or loosening of internal fixation, no varus calcaneus tuberosity, no subtalar joint fusion, and no compression symptoms of peroneal tendons. Achilles tendon irritation occurred in 2 cases, and disappeared after removal of internal fixation; traumatic arthritis occurred in 2 cases, and was relieved after removal of internal fixation. The Böhler angle, Gissane angle, and calcaneal width were significantly improved at 3 days and 6 months after operation when compared with preoperative ones (P<0.05). The loss of the above indexes was observed at 6 months, showing no significant difference between at 3 days and 6 months (P>0.05). The AOFAS score results were excellent in 11 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 87.5%. Conclusion It has the advantages of little trauma, less complication, and good function recovery to use arthroscopically-assited closed reduction and percutaneous screw fixation by posterior approach to subtalar joint for calcaneal fractures of Essex-Lopresti tongue type, Sanders IIA, Sanders IIB, and Sanders IIIAB.
ObjectiveTo systematically evaluate the effects of biological mesh (BM) and non-absorbable synthetic mesh (SM) on the risks of recurrence, complications, and cost-effectiveness after ventral hernia repair. MethodsThe publicly published related researches of BM versus SM for ventral hernia repair were searched in the PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP, CBM databases from the establishment of the databases to August 1, 2021. According to the inclusion and exclusion criteria, the literatures were screened and the data were extracted, and the data that met the conditions were merged and analyzed. The meta-analysis was performed by RevMan5.4.1 software. ResultsA total of 26 studies with 3 259 patients were included, including 1 388 patients in the BM group and 1 871 in the SM group. The results of meta-analysis showed that the recurrence, surgical site infection, surgical site occurrence, reoperation rates, and medical costs in the BM group were higher than those in the SM group (P<0.05). There were no significant differences in the patch infection, seroma, hematoma, wound dehiscence, and readmission rates between the two groups (P>0.05). ConclusionsSM during ventral hernia repair is better than BM on postoperative recurrence, surgical site infection, surgical site occurrence, reoperation, etc., and could reduce medical costs. In the future, it is tried to use more SM in patients with complicated ventral hernia such as cleaning pollution and contaminated environment.
Objective To investigate the prognostic value of preoperative plasma fibrinogen (FIB) combined with lymphocyte-to-monocyte ratio (LMR) in predicting the prognosis of patients with esophageal squamous cell carcinoma. Methods A retrospective analysis was conducted on patients who underwent esophagectomy in our hospital from January 2015 to December 2018. Based on the cut-off values of preoperative FIB and LMR, The F-LMR scoring system was constructed, and patients were divided into three groups. Kaplan-Meier analysis was used to assess 5-year overall survival and 5-year progression free survival, and univariate and multivariate Cox regression analyses were performed to identify prognostic factors. Results Finally 260 patients were collected, including 237 males and 23 females, with a median age of 64 years (ranging from 59 to 70 years). The 5-year OS rates for patients with F-LMR score of 0, 1, and 2 were 24.44%, 51.69%, and 67.31%, respectively, and the 5-year PFS rates were 15.56%, 42.37%, and 57.62%, respectively. Lower preoperative F-LMR scores were associated with worse prognosis. Multivariate analysis showed that deeper tumor invasion, presence of lymph node metastasis, larger tumor maximum diameter, and lower preoperative F-LMR score were independent prognostic factors for OS. Conclusion The F-LMR score system based on the preoperative FIB and LMR can serve as an effective tool for predicting the prognosis of patients with esophageal squamous cell carcinoma.
Objective To compare the clinical effectiveness of different skin closure techniques in stoma reversal using network meta-analysis. Methods CNKI, WanFang Data, VIP, CBM, Cochrane Library, PubMed, Embase, and Web of Science databases were searched until February 1, 2021, and randomized controlled trials (RCTs) comparing outcomes between different skin closure techniques were included. Data were processed using Stata MP16.0 and R 3.6.1. Results The results demonstrated that 16 RCTs (n=2 139) were eligible for pooling. Six types of skin closure techniques were used: linear closure, purse-string closure, gunsight closure, linear closure and drainage, purse-string closure and drainage, and linear closure and biological mesh. Network meta-analysis indicated that the incidence of postoperative infection with linear closure was higher than that with purse-string closure [RR=6.04, 95%CI (3.11, 16.89), P<0.0001], gunsight closure [RR=10.75, 95%CI (1.12, 152.12), P=0.04], and linear closure and drainage [RR=3.18, 95%CI (1.24, 10.20), P=0.03]. The purse-string closure was superior to linear closure and biological mesh [RR=0.15, 95%CI (0.01, 0.88), P=0.03] in reducing postoperative infection. The length of hospital stay after linear suture was longer than that after linear suture and drainage [MD=1.16, 95%CI (0.29, 2.20), P=0.02]. Conclusions This network meta-analysis suggests that purse-string closure and gunsight closure might be best for reducing postoperative infection, and the addition of drainage could not further reduce the incidence of postoperative infection. In addition, implantation of the biological mesh does not increase the risk of postoperative infection. However, a large-scale RCT is warranted to confirm the results.
ObjectiveTo investigate the safety and feasibility of fluorescent guided laparoscopic central hepatic tumor resection via anterior transhepatic approach. MethodWe retrospectively analyzed the clinical data of three patients who underwent fluorescent guided laparoscopic central hepatic tumor resection via anterior transhepatic approach in Department of Hepatobiliary and Pancreas Minimally Invasive Surgery of Hunan Provincial People’s Hospital from April 2017 to April 2020.ResultsAll the three patients completed the operation pure laparoscopically. Pathology results showed one case of hepatocellular carcinoma and two cases of focal nodular hyperplasia, the tumor size range from 4–7 cm. The operation time was 240–320 min, and the blood loss was 150–500 mL. There was no intraoperative blood transfusion. The postoperative hospital stay was 10–30 days. Postoperative bile leakage occurred in one patient, which was cured by laparoscopic hepatectomy. Three patients were followed up for 8, 36, and 25 months, respectively, and all the patients survived and there was no tumor recurrence up to november 2020.ConclusionsLaparoscopic resection of central hepatic tumor is difficult and risky. Anterior transhepatic approach can maximize the preservation of liver parenchyma. In hepatobiliary and pancreatic centers with high volume of laparoscopic hepatectomy, this method is safe and feasible after strict patient selection, accurate preoperative evaluation, and fine intraoperative skills. Indocyanine green fluorescence navigation technology is helpful to accurately locate tumor during operation.