ObjectiveTo summarize the current status and the management and prophylaxis of complications in laparoscopic gastrectomy. MethodsThe literatures on laparoscopic gastrectomy in domestic and abroad were reviewed and analyzed combined with our experiences. ResultsThe complications of laparoscopic gastrectomy primary attributed to surgery itself and pneumoperitoneum. Limited field under laparoscopy, loss of threedimensional space and finger touch, new instrument and technology and working conditions increased the difficulty of operation and the possibility of surgical complications. Clear anatomical layer under laparoscopy, accurate dissection of lymph nodes, and digestive tract reconstruction were the basis to reduce the complications in laparoscopic gastrectomy. ConclusionCorrect surgical procedures may reduce the occurrence of complications in laparoscopic gastrectomy.
【Abstract】Objective To study the effects of nitric oxide (NO) on the growth and metastasis of tumor.Methods The literatures of recent years were reviewed.Results NO had double effects on the growth and metastasis of tumor. NO promoted the growth and metastasis by regulating the expression of tumor proliferation gene and inducing tumor angiogenesis. On the other hand, NO had antitumor effects by interfering with the metabolism of tumor cells, inducing the damage of DNA, forming high toxic free radical, inducing apoptosis of tumor cells and mediating the antitumor action of endothelial cells and macrophages.Conclusion Selective blockage or induction of synthesis of NO may be a new way for tumor therapy.
【Abstract】ObjectiveTo explore the effects of p38 mitogenactivated protein kinase (MAPK) on apoptosis of small intestinal epithelial cells after transplantation in rats. MethodsSmall intestinal transplantation was performed in SD and Wistar rats. The recipients were divided into three groups: isograft group (Wistar→Wistar group), allograft group (SD→Wistar group) and allograft+cyclosporine A group (SD→Wistar+CsA group). The grafts were harvested on day 1, 3, 5 and 7 after operation. All graft samples were subjected to histological examination. The apoptosis of graft epithelial cells was detected by TUNEL method. p38 MAPK was measured by Westernblotting method and serum TNFα was determined by ELISA. ResultsMild, moderate and severe rejection reaction occurred in the SD→Wistar group, it was showed that the number of apoptotic cells increased with the severity of the rejection reaction by TUNEL. In SD→Wistar group, the numbers of apoptotic cells were significantly higher than those of the other two groups （P＜0.01）. The severity of rejection reaction in SD→Wistar+CsA group was less than that of SD→Wistar group and the number of apoptotic cells increased with the severity of the rejection reaction (P＜0.01). The level of serum TNFα varied with the apoptotic degree of small intestinal epithelial cells in SD→Wistar group and SD→Wistar+CsA group （P＜0.01）. The expression of p38 MAPK increased with the number of the apoptotic cells in SD→Wistar group and SD→Wistar+CsA group （P＜0.01）, but there was no evident change in Wistar→Wistar group （Pgt;0.05）. The expression of p38 MAPK and the level of serum TNFα were positively correlated with apoptosis in small intestinal rejection after transplantation （r=0.875， P＜0.01； r=0.837， P＜0.01）. p38 MAPK and TNFα were also positively correlated （r=0.826，P＜0.01）. ConclusionApoptosis plays an important role in small intestinal rejection. p38 MAPK is involved in apoptosis and is an important regulator in signal pathway of cell apoptosis.
Pelvic exenteration has become an important procedure for radical treatment of locally advanced/recurrent rectal cancer, and in recent years, with the advancement of surgical techniques and the improvement of perioperative management ability, the long-term prognosis of patients has been significantly improved. However, the high incidence of perioperative complications seriously impacts the quality of life of patients and the course of postoperative recovery, which remains a major problem for surgeons. Precise surgical levels and appropriate intraoperative position help to fully expose the surgical field, accurately identify major vessels, and reduce the risk of intraoperative bleeding. Biological mesh, myocutaneous flap and omentoplasty are common pelvic floor reconstruction methods, and combined repair of pelvic defects by two of them may further reduce the incidence of empty pelvic syndrome. Iliac revascularization could effectively prevent postoperative thrombosis and ventricular septal syndrome. The application of minimally invasive techniques and the implementation of pre-rehabilitation measures might help to reduce postoperative complications. This article reviews the prevention strategies of complications after pelvic exenteration in order to provide some reference for clinical practice and surgical promotion.
Objective To compare the efficacy and safety of aspirin and rivaroxaban in the prevention of venous thromboembolism (VTE) after total knee arthroplasty (TKA). Methods Eight databases were searched, including Cochrane Library, Embase, Web of Science, PubMed, SinoMed, Wanfang, Chongqing VIP, and China National Knowledge Infrastructure. The search period was from the establishment of databases to June 2023. All randomized controlled trials of aspirin and rivaroxaban for the prevention of VTE after TKA were collected, and meta-analysis was conducted using RevMan 5.3 software. Results A total of 7 articles were included, with a publication period from 2014 to 2022, including a total of 714 patients, including 356 in the aspirin group and 358 in the rivaroxaban group. The meta-analysis results showed that the incidence of deep venous thrombosis in the lower limbs of the aspirin group was higher than that of the rivasarb group [relative risk (RR)=1.53, 95% confidence interval (CI) (1.09, 2.16), P=0.01], and the incidence of bleeding complications was lower than that of the rivaroxaban group [RR=0.66, 95%CI (0.52, 0.82), P=0.0003]. There was no statistically significant difference in the incidence of wound complications between the two groups (P>0.05). Conclusion The efficacy of rivaroxaban in preventing VTE after TKA is better than that of aspirin, but there is an increased risk of bleeding complications.
Sleep apnea causes cardiac arrest, sleep rhythm disorders, nocturnal hypoxia and abnormal blood pressure fluctuations in patients, which eventually lead to nocturnal target organ damage in hypertensive patients. The incidence of obstructive sleep apnea hypopnea syndrome (OSAHS) is extremely high, which seriously affects the physical and mental health of patients. This study attempts to extract features associated with OSAHS from 24-hour ambulatory blood pressure data and identify OSAHS by machine learning models for the differential diagnosis of this disease. The study data were obtained from ambulatory blood pressure examination data of 339 patients collected in outpatient clinics of the Chinese PLA General Hospital from December 2018 to December 2019, including 115 patients with OSAHS diagnosed by polysomnography (PSG) and 224 patients with non-OSAHS. Based on the characteristics of clinical changes of blood pressure in OSAHS patients, feature extraction rules were defined and algorithms were developed to extract features, while logistic regression and lightGBM models were then used to classify and predict the disease. The results showed that the identification accuracy of the lightGBM model trained in this study was 80.0%, precision was 82.9%, recall was 72.5%, and the area under the working characteristic curve (AUC) of the subjects was 0.906. The defined ambulatory blood pressure features could be effectively used for identifying OSAHS. This study provides a new idea and method for OSAHS screening.
Objective To review the progress and application of peripheral nervous microelectrode. Methods The recent articles on peripheral nervous microelectrode were extensively reviewed. The classification, the progress of the peripheral nervous microelectrode and its utilizable prospect in the control of electronic prosthesis were summarized. Results The microelectrodes had favorable functions of selective stimulation and recording. It provided an information transmitting interface between the electric prosthesis and peripheral nerves. Conclusion Peripheral nervous signal is a feasible signal source to control electronic prosthesis.
Objective To investigate the effect of adenovirus vector mediated transfer of human herpes simplex virus thymidine kinase (HSVtk) gene inhibits intimal hyperplasia of vein grafts. Methods Auto vein graft models of Wistar rats were established. Adenovirus vector dwelled in cervical veins which were transplanted into inferior renal abdominal aorta. The combination of HSVtk (4×109 plaque forming units) and ganciclovir (GCV) was applied to test the inhibition effect. GCV was infused 〔60 mg/(kg·d), IP, Bid〕 from day 3 to day 21 after transplantation. Vein samples were harvested and the existence of HSVtk DNA was measured by PCR and the mRNA of it was studied by in situ hybridization. Van gieson (VG) and proliferating cell nuclear antigen (PCNA) stains were carried out in paraffin sections to study the thickness of neointima and smooth muscle cells (SMCs) proliferation with a computer-assisted analysis system. The apoptosis of SMCs also was detected by TUNEL. Results The existence of HSVtk gene in veins and its transcription were demonstrated. Morphometric analysis demonstrated a reduced intima thickness in the group receiving combination therapy (HSVtk/GCV) compared with HSVtk alone 〔(17.2±3.2) μm versus (31.1±2.5) μm, P＜0.05〕. GCV per se had no effect on intimal hyperplasia after vein transplantation. The apoptosis of SMCs increased significantly and expression of PCNA decreased in HSVtk/GCV gene therapy group versus blank control group 〔(9.1±2.3)% vs (28.7±3.6)%, P＜0.05; (38.7±5.6)%vs (18.5±2.6)%, P＜0.05〕. Conclusion GCV conditions reduction of intimal hyperplasia after intraluminal delivery of HSVtk in transplanting vena veins involving SMCs apoptosis.
【Abstract】 Objective To investigate the feasibil ity of applying enzymatic method to prepare decellularizedporcine aorta and to evaluate its biomechanical properties, immunogenicity and cell compatibil ity. Methods 0.1% trypsin- 0.01% EDTA was appl ied to extract cells from porcine aorta under 37 continuously vibrating condition and its histology and microstructure were observed. The thickness, stress-strain curve, ultimate tension stress (UTS) and strain of failure (SOF) were compared before and after decellularization for 48, 96 and 120 hours under uniaxial tensile tests, respectively. The histological change was observed at 1, 3 and 6 weeks after the decellularized tissue was implanted subcutaneously in 3 dogs. According to the HE stains and a semi-quantitative Wakitani grading method, gross changes, category and amounts of infiltrated cells and neo-capillaries were compared between pre- and post-decellularization of porcine aortae. Endothel ial cells from canine external jugular vein were seeded onto the decellularized patches to observe the cell compatibil ity. Results Microscopy and electron microscopies examination identified that cell components was completely removed from the fresh porcine aorta and Masson’ strichrome showed that the structure of matrix (fibrins) was maintained intact at 96 hours using the decellularization method. There were no significant differences in the thickness, UTS and SOF between before and after decellularization (P gt; 0.05). However, The UTS values showed a decrease tendency and SOF showed an increase tendency. The stress-strain curve also verified a decrease tendency in mechanical intensity and an increase one in ductil ity after decellularization. After implanting the acellularized matrix subcutaneously in canine, moderately lymphocyte infiltration was seen at the 1st week and the infiltration was replaced by fibroblasts accompanied by neocapillary formation at the 6th week. A semi-quantity histological evaluation showed that there were differences in gross observation, category and the numbers of the infiltrated cells between decellularized and non-decellularized tissues（P lt; 0.05). A cell monolayer was identified by HE staining and scanning electron microscopywhen the endothel ial cells were seeded onto the inner luminal surface of the scaffold, al igned at the same direction on the whole. Conclusion The decellularized porcine aortic scaffold, prepared by trypsin-EDTA extraction under continuously vibrating condition, could meet the requirements of tissue-engineering graft in biomechanical properties, immunogenicity and cell compatibil ity.
Objective To explore the correlations of plasma D-dimer and fibrinogen levels with carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) in patients with non-small cell lung cancer (NSCLC). Methods The clinical data of 196 patients with NSCLC diagnosed for the first time in the Department of Respiratory and Critical Care Medicine, the 416 Hospital of Nuclear Indusry between July 2017 and December 2019 were analyzed retrospectively. There were 57 cases in early stage (stage Ⅰ-Ⅱ), 57 cases in medium stage (stage Ⅲ), and 82 cases in advanced stage (stage Ⅳ) according to TNM staging, 108 cases of adenocarcinoma, 87 cases of squamous cell carcinoma, and 1 case of unclassified type according to pathological classification, and 19 deaths and 177 survivals according to outcome. The levels of D-dimer and fibrinogen were determined by immunoturbidimetry and coagulation method, and the levels of CEA and CFYRA21-1 were determined by electro-chemiluminescence method. The non-normally distributed data were presented as median (lower quartile, upper quartile), and Spearman correlation analyses were performed. Results Among the early, middle and advanced stage patients, the levels of D-dimer [198.00 (133.00, 390.87), 279.00 (170.93, 520.89), 389.00 (196.25, 931.00) μg/L], CEA [3.20 (2.60, 5.17), 13.53 (5.07, 70.63), 15.69 (4.07, 123.46) μg/L], and CFYRA21-1 [4.79 (3.15, 8.84), 8.60 (4.83, 19.32), 7.19 (3.09, 15.05) μg/L] were significantly different (P<0.05); however, there was no statistical difference in the level of fibrinogen among the three stages (P>0.05). The level of CYFRA21-1 in the adenocarcinoma group was lower than that in the squamous cell carcinoma group [(5.39 (2.81, 12.71) vs. 6.86 (4.18, 12.29) μg/L, P<0.05], while there was no statistically significant difference in D-dimer, CEA, or fibrinogen between the two groups (P>0.05). The levels of D-dimer, CEA, and CFYRA21-1 in the death group [1176.00 (382.00, 2848.00), 135.34 (24.85, 403.50), 10.82 (7.41, 23.41) μg/L] were significantly higher than those in the survival group [270.00 (146.00, 481.50), 5.62 (3.05, 26.53), 6.28 (3.37, 12.30) μg/L], and the differences were statistically significant (P<0.01); but there was no statistical difference in the level of fibrinogen between the two groups (P>0.05). D-dimer was positively correlated with CEA and CFYRA21-1 (rs=0.450, 0.291; P<0.001), but fibrinogen was not correlated with CEA or CFYRA21-1 (P>0.05). Conclusion D-dimer was more valuable than fibrinogen in predicting the clinical stage and prognosis of NSCLC.