ObjectiveTo summary the treatment of pancreatic neuroendocrine neoplasms (pNENs). MethodsArticles relevant to pNENs at home and abroad were collected and reviewed. ResultsBecause of rare incidence and non-specific clinical syndromes of pNENs, clinician had no enough cognition about it. For pNENs, surgery was still the preferred option, combining other treatments included chemotherapy, somatostatin analogue, α-interferon, molecular targeted therapy, and peptide receptor radionuclide therapy (PRRT). ConclusionSurgery is still considered as the preferred option for controlling the associated biochemical syndromes and curtailing the malignant progression of pNENs.
ObjectiveTo analyze the curative effect of vacuum sealing drainage for early deep infection after posterior spinal internal fixation. MethodsFrom March 2009 to March 2012, 9 patients with early deep infection after posterior spinal internal fixation, including 5 males and 4 females aged between 21 and 64 years, averaging at 44.6, underwent debridement and vacuum sealing drainage (VSD). Original fixtures in all the patients were not taken out. ResultsThe patients were treated by VSD for once to three times with an average of 2.1 times, and VSD continued for 3 to 7 days every time. Two patients underwent one time of VSD, 4 underwent twice, and 3 underwent three times. In these patients, 6 achieved wound healing after VSD, one changed to ordinary dressing and wound suturing two weeks later due to hemorrhage of VSD, one changed to ordinary dressing and wound suturing wound three weeks later due to impeded drainage, one accepted skin-grafting after three times of VSD. All the patients were followed up for 6 to 38 months (18 months on average) and all of them were cured. There was no obvious back pain or signs of incision infection. The X-ray films showed that there were no bone destruction and the white blood cell count, erythrocyte sedimentation rate, and C-reactive protein significantly decreased to normal after surgery. ConclusionOne-stage debridement and vacuum sealing drainage therapy is an effective method for treating early deep infection after posterior spinal internal fixation.
ObjectiveTo investigate the clinical characteristic and treatment of gastrointestinal neuroendocrine neoplasm. MethodsFrom January 2011 to July 2015, the clinical characteristic and treatment of 74 patients with gastrointestinal neuroendocrine neoplasm in The Affiliated Hospital of Xuzhou Medical College were retrospectively analyzed. ResultsCases of gastrointestinal neuroendocrine neoplasm were increasing year by year. This study includes statistics of 74 patients. The number of male and female were 47 and 27, the rate was 1.74:1, the median age was 57.5 years old ranging from 24 up to 82 years. Of all the 74 cases, there were 38 cases (51.4%) in the stomach, 23 cases (31.1%) in rectum, 12 cases (16.2%) in colon, 1 case in duodenum. Of all the 74 cases with clinical symptom information, non-functional symptom accounts for 95.9% (71/74), while functional symptom accounts only for 4.1% (3/74). There were treatment data of 74 cases, including 34 cases in radical surgery, 23 cases in endoscopic excision, 8 cases in local resection, 4 cases in palliative resection, and 5cases in conservative treatment. The lymphatic metastasis was associated with gender, tumor size, tumor depth of invasion and tumor differentiation (P < 0.05). There was no statistically significant between the lymphatic metastasis and tumor location (P > 0.05). Preoperative distant metastasis was associated with tumor size and tumor depth of invasion (P < 0.05). Syn had a higher positive rate than CgA (P < 0.01). The positive rate of Syn and CgA was respectively 96.1% (49/51) and 72.9% (35/48). Conciusions Cases of gastrointestinal neuroendocrine neoplasm are increasing year by year, of which men has a higher morbidity than women. Radical surgery and endoscopic resection are the main treatment methods. The Syn and CgA test are helpful to the diagnosis of gastrointestinal neuroendocrine neoplasm.
ObjectiveTo compare the outcome between two nutrition support methods, total enteral nutrition (TEN) and enteral nutrition combined with parenteral nutrition, in infants after ventricular septal defect (VSD) repair operation. MethodsWe retrospectively analyzed the clinical data of 76 infants who underwent VSD repair operation in Xinhua Hospital in 2012 year. There were 46 males and 35 females aged 1.6-11.9 (5.5±2.5) months. Nutrition support was started from the first day after operation. There were 35 patients in the group A with TEN 60 kcal/(kg·d), and 41 patients in the group B with both enteral nutrition at 30 kcal/(kg·d) and parenteral nutrition at 30 kcal/(kg·d). ResultsThere was no statistical difference between two groups in demography data and preoperative clinical indicators. The number of patients suffered abdominal distension and gastric retention was more in the group A (22.9% vs. 4.9%, 68.6% vs. 2.4%, P<0.05). There was no difference in diarrhea. The completion of nutrition support in the group A was worse than that in the group B. In the group A, only 40% of the goal calorie was finished on the first and the second day after operation. It was improved until the third day, and the goal calorie could be finished on the seventh day. In the group B, the nutrition support method could be finished on the first day. The prealbumin level in the group B was significantly higher on the third, fifth and seventh day (P<0.05). The blood urea nitrogen (BUN) level in the two groups on the first day after operation was higher than that before operation (P<0.05), and persisted in the group A, while decreased to the normal level gradually in the group B. Following up to discharge, the weight was higher and the length of stay was shorter in the group B (P<0.05). There was no statistical difference in the cost of hospitalization between the two groups (P>0.05). ConclusionThe nutrition support method, enteral nutrition combined with parenteral nutrition, is better than TEN for infants after VSD repair operation.
ObjectiveTo explore the effects on osteogenic differentiation of adipose derived stem cells (ADSCs) by simultaneously down-regulating Noggin combined with up-regulating bone morphogenetic protein 14 (BMP-14) in vitro. MethodsPrimary ADSCs were isolated and expanded in vitro from 5 Sprague Dawley rats (weighing, 250-300 g). ADSCs were transfected with lentiviral (Lv)-enhanced green fluorescent protein in group A (control group), with Lv-BMP-14 in group B, and with Lv-BMP-14 and Lv-Noggin shRNA in group C. BMP-14 and osteogenesis-related genes[collagen type I, alkaline phosphatase (ALP), and osteocalcin (OCN)] mRNA expression levels were detected by real time fluorescence quantitative PCR at 3, 7, and 14 days after transfection. Alizarin red staining for calcium nodules was also employed to assess the osteogenic ability of co-transfected ADSCs. ResultsAt 3 days after transfection, no significant difference was found in BMP-14 mRNA expression among groups P>0.05). At 7 and 14 days after transfection, BMP-14 mRNA expression was significantly higher in group C than groups A and B, and in group B than group A (P<0.05). At 3 days after transfection, collagen type I, ALP, and OCN mRNA expressions of group C were significantly higher than those of groups A and B (P<0.05), but no significant difference was shown between groups A and B P>0.05). At 7 and 14 days, collagen type I, ALP, and OCN mRNA expressions were higher in group C than groups A and B, and in group B than group A, showing significant difference (P<0.05) except collagen type I mRNA expression at 7 days between groups A and B P>0.05). The results of alizarin red staining showed that the amount of calcium nodules presented an increased tendency in the order of group A, group B, and group C. ConclusionBMP-14 is capable of enhancing osteogenic differentiation of ADSCs. A combination of inhibiting Noggin gene expression and enhancing BMP-14 gene expression in ADSCs can significantly strengthen osteogenic differentiation capability, showing significant synergistic effect.
ObjectiveTo summarize our experience of emergency coronary artery bypass grafting (CABG) for the treatment of coronary accidents during percutaneous coronary intervention (PCI). MethodsFrom January 2011 to January 2013, 30 patients with coronary accidents during PCI from our hospital and other hospitals received surgical treatment in Xinhua Hospital, Medical School of Shanghai Jiaotong University. There were 21 male and 9 female patients with their age of 68±11 (54-84) years. Coronary accidents included coronary artery dissection in 12 patients, coronary artery perforation in 12 patients, acute in-stent thrombosis in 2 patients, dilation balloon rupture in 1 patient and balloon retention in 1 patient, and PCI guidewire retention in 2 patients. Among the 30 patients, 8 patients received intra-aortic balloon pump (IABP) implantation preoperatively. All the patients underwent emergency CABG, including 29 patients undergoing off-pump CABG and 1 patient undergoing CABG on pump with heart beating. The patients' medical history, PCI and surgical records were retrospectively reviewed, and surgical treatment strategies, clinical outcomes and prognosis were summarized. ResultsThe average number of grafts was 2.8±0.4. Postoperative length of ICU stay was 8.3±4.8 days, and mean hospital stay was 20.3±15.2 days. Postoperative complications included low cardiac output syndrome (LCOS) in 3 patients, tracheotomy in 2 patients, acute renal failure requiring continuous renal replacement therapy in 2 patients, and reexploration for bleeding in 1 patient. Twenty-eight were discharged, 1 patient died of multiple organ dysfunction syndrome caused by LCOS, and another patient died of refractory ventricular fibrillation. A total of 26 patients were followed up for 10.2±8.3 months and 1 patient died of stroke during the following up. ConclusionEmergency CABG can restore coronary artery blood flow quickly and provide good results for coronary accidents during PCI.
ObjectiveTo summarize surgical strategies, early and long-term outcomes of concomitant surgical treatment for patients with both coronary artery disease (CAD) and lung cancer (LC). MethodsWe retrospectively analyzed clinical data of 15 patients who underwent concomitant surgical treatment for both CAD and LC in Xinhua Hospital, School of Medicine of Shanghai Jiaotong University from January 2006 to January 2014. There were 11 male and 4 female patients with their age of 52-73 years. Preoperative clinical staging of LC was stageⅠtoⅡb (TNM), and postoperative pathological result of most patients (11 patients) was adenocarcinoma. All the patients had normal heart and pulmonary function. All the 15 patients received off-pump coronary artery bypass grafting (OPCAB) via median sternotomy. After OPCAB, 9 patients underwent radical LC resection via median sternotomy, and 6 patients underwent radical LC resection with video-assisted thoracoscopic surgery (VATS). ResultsThere was no in-hospital death or newonset myocardial infarction. Pathological diagnosis included squamous LC in 4 patients and adenocarcinoma in 11 patients. Pathological TNM staging wasⅠb in 4 patients, Ⅱa in 6 patients, andⅡb in 5 patients. Postoperative complications included arrhythmias, atelectasis, and pulmonary infection. All the patients were followed up for 6 months to 5 years. Three patients died during follow-up. None of the patients received redo revascularization or LC resection. ConclusionConcomitant OPCAB and LC resection is a safe and efficacious treatment choice for patients with both CAD and LC.
ObjectiveTo explore the midterm therapeutic effect of modified Blalock-Taussing shunts (MBTs) in the treatment of tetralogy of Fallot. MethodsWe retrospectively analyzed the clinical data of 69 children with tetralogy of Fallot undergoing MBTs in Shanghai Xinhua Hospital between July 2006 and January 2013. There were 44 males and 25 females with mean age of 17.97±24.73 months (ranged from 2 months to 10 years). The patients weighted from 4 to 24 (9.00±4.03) kg. All the MBTs between subclavian artery and pulmonary artery were performed through right or left posterior lateral incision. ResultsThe patients were followed up for 6-36 months including 57 patients with 6 months following-up, 33 patients with 6 months and 12 months following-up, 16 patients with 12 months and 24 months following-up, and 11 patients with 24 months and 36 months following-up. There was significant growth in McGoon ratio during the first 12 months follow-up (preoperative vs. 6 months:1.09 ±0.33 vs. 1.40 ±0.40, P=0.00; 6 months vs. 12 months:1.29±0.31 vs. 1.36±0.33, P=0.00). There was no obvious growth in McGoon ratio after 12 months (12 months vs. 24 month:1.22±0.31 vs. 1.19±0.32, P=0.14; 24 months vs. 36 months:1.22±0.23 vs. 1.23±0.20, P=0.45). The left ventricular end diastolic volume index (LVEDVI) increased significantly in 6 months after MBTs (preoperative vs. 6 months:29.60±10.12 ml/m2 vs. 49.18±11.57 ml/m2, P=0.00), but there was no significant growth after 6 months. There was no significant decline in left ventricular ejection fraction (LVEF) after MBTs. ConclusionThe MBTs can significantly promote the growth of McGoon ratio in 12 months of patients with tetralogy of Fallot, but there is no obvious growth of McGoon ratio after 12 months. MBTs can significantly improve left ventricular development within 6 months, and it won't lead to excessive expansion of the left ventricle when we extend follow-up time. The MBTs affects little on cardiac function of patients with tetralogy of Fallot.
ObjectiveTo evaluate the effectiveness of the single segmental cervical disc replacement with ProDisc-C, and to explore the location change of the flexion/extension center of rotation (COR) of the target level as well as its clinical significance. MethodsBetween June 2010 and February 2012, 23 patients underwent single segmental cervical disc replacement with ProDisc-C, and the clinical data were retrospectively analyzed. Of 23 patients, 9 were male, and 14 were female with the age range from 27 to 65 years (mean, 45 years), and the disease duration ranged from 10 to 84 months (mean, 25 months). There were 15 patients with radiculopathy, 5 patients with myelopathy, and 3 patients with mixed cervical spondylosis. The involved segments were C4,5 in 5 cases, C5,6 in 14 cases, and C6,7 in 4 cases. Japanese Orthopaedic Association (JOA) score and neck disability index (NDI) were adopted to evaluate the effectiveness. Preoperative and Postoperative radiographic parameters, such as cervical overall range of motion (ROM), target segmental ROM, the adjacent segmental ROM, and intervertebral height were compared. Besides, the location changes of the COR of the target level were further analyzed by the alteration of its coordinates (COR-X,COR-Y), and the relationships between the location changes of the COR and the effectiveness or the radiographic results were analyzed. ResultsAll the operations were completed successfully; 1 case had hoarseness after operation, which disappeared at 3 months after operation. All cases were followed up 18.3 months on average (range, 6-36 months). There was no device migration, loosening, subsidence, or fracture at last follow-up. The JOA score increased significantly and the NDI score decreased significantly at last follow-up when compared with preoperative scores (P<0.05). No difference was found in the cervical overall ROM, target segmental ROM, the adjacent segmental ROM, and the COR-Y of the target level between pre-operation and last follow-up (P>0.05); while the intervertebral height and the COR-X increased significantly (P<0.05). The change of the COR-X had no obvious correlation with the postoperative JOA, NDI, and target segmental ROM (P>0.05). According to whether the difference of the COR-X between pre- and post-operation was less than the average value 1.86 mm or not, the patients were divided into 2 groups; significant difference was shown in the postoperative target segmental ROM between 2 groups (P<0.05), but no significant difference was found in the postoperative JOA、NDI, cervical overall ROM, adjacent segmental ROM, and the intervertebral height between 2 groups (P>0.05). ConclusionSingle segmental cervical disc replacement with ProDisc-C can obtain satisfactory outcomes. The cervical overall ROM, target segmental ROM, and adjacent segmental ROM can be effectively maintained, and the intervertebral height is increased. The location of the flexion/extension COR of the target segment shifts forward after insertion of the ProDisc-C prosthesis, and the postoperative target segmental ROM becomes smaller as the distance of the displacement of the COR becomes greater.
ObjectiveTo analyze the clinical effects of staged repair for severe tetralogy of Fallot (TOF), and to investigate a better individual treatment of TOF. MethodsWe retrospectively analyzed the clinical data of 110 children with TOF in our hospital from January 2009 through December 2014. The patients were divided into a severe TOF group (Group A, n=23) and a mild TOF group (Group B, n=87). In the group A, all 23 patients underwent staged surgery (modified Blalock-Taussig and radical operation of TOF). In the Group B, all 87 patients only received a radical operation of TOF. The patients' preoperative and postoperative arterial oxygen saturation, McGoon ratio, left ventricular end-diastolic volume index (LVEDVI), the results of perioperation and follow-up were compared. ResultsIn the group A, there was no death after modified Blalock-Taussig (MBT). The median interval time between MBTs and radical operation was 9 months (ranged from 6.3 to 25.3 months). Compared with that before MBTs, the McGoon ratio and LVEDVI were significantly increased at the time of radical operation. And the pulmonary artery development and left ventricle volume reached the standard of radical operation of TOF (P < 0.01). After the radical operation, one patient died for pneumonia in the early postoperation period. In the group B, three patients died for low cardiac output syndrome during perioperation. There was no significant difference between the group A and the group B in in-hospital mortality, length of hospital stay, intensive care unit (ICU) stay, ventilation time, cardiopulmonary bypass time, aortic cross-clamp time, rate of using trans-annular repair path, or drainage of pleural fluid. ConclusionStaged repair of severe TOF is safe and effective for children, who are not suitable for one-stage radical operation. Severe TOF received staged repair can achieve the similar outcomes with that of mild TOF underwent one-stage radical operation.