Table of Content

20 October 2014, Volume 14 Issue 05

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论文

Construction and identification of the human hepatocyte nuclear factor4α recombinant lentivirus

Deng Jiemin, Deng Xiaogeng, Jiang Wenli, Qiu Ronglin, Wu Yaohao, Zen Lexiang,

2014, 14(05):  499-505.  DOI: j.issn.1009-976X.2014.05.001

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【Abstract】〓Objective〓To construct, package and identify the recombinant lentivirus overexpressing hepatocyte nuclear factor 4 alpha, HNF4A, and to lay the foundation for further study the functions and mechanism of action of HNF4A. Methods〓The human HNF4A cDNA was amplified from the human genomic DNA by polymerase chain reaction (PCR), which was constructed to the lentiviral expression vector PCDH-CMV-MCS-EF1a-GFP-puro. After enzymatic digestion and sequencing,the positive recombinant PCDH-CMV-HNF4A-EF1a-GFP- puro expression vector, pCMV-VSV-G and pCMV-dR8.91, three plasmids were cotransfected into HEK-293T cells, next the supernatants were harvested. After getting the virus suspension concentrated, we make the gradient dilution to infect HEK-293T cells and determine the virus titer by the green fluorescence protein. Finally the expression of HNF4A in primary cultured human skin fibroblasts HFFs infected with recombinant lentivirus was analyzed by real-time quantitative PCR. Results〓Enzymatic digestion and DNA sequencing demonstrated that the recombinant lentiviral expression vector PCDH-CMV- HNF4A-EF1a-GFP-puro was successfully constructed. The lentivirus, with the concentration of 1×108 TU/ml, can significantly increased the level of HNF4A expression in HFFs which was infected. Conclusion〓The recombinant lentivirus with PCDH-CMV- HNF4A-EF1a-GFP-puro was successfully constructed and highly overexpresses HNF4A in HFFs, what make a contribution to the better carrier for HNF4A with high efficiency and stability.

Clinical research on treating advanced stage hepatocarcinoma with DC-CIK immunotherapy combined with TACE interventional therapy

ZuYuqi, Xue Ping, Jiang Xiaofeng, Wen Zilong, Zhang Dawei

2014, 14(05):  505-508.  DOI: j.issn.1009-976X.2014.05.002

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【Abstract】〓Objective〓To investigate the clinical effectiveness of transcatheter arterial chemoem-bolization (TACE) combined with DC-CIK in treating advanced stage hepatocarcinoma. Methods〓112 patients with advanced stage hepatocarcinoma were included in the study..Among them,64 cases received TACE combined with DC-CIK (group A) and 48 cases underwent TACE alone (group B). Blood routine, tumor makers, immune function were detected, analyzed in all patients and compared between two groups. Results〓The serum CD3+, CD4+, CD8+, CD19+, NK, CD3+/CD4+, CD3+/CD8+ cells in A group were increased than that in B group (P<0.05). The number of patients who were demonstrated remission and partial remission was increased in A group than that in B group(P<0.05). The death mumber in A group was less than in group at 6 months and 12 months of follow-up and no difference was found at 18 months of follow-up. Conclusion〓To a certain degree, TACE combined with DC-CIK would improve the immune function,increase in the near future curative effect for patients with advanced stage hepatocarcinoma.

Postoperative neutrophil to lymphocyte ratio predicts the prognosis of patients with hepatocellular carcinoma after curative hepatectomy

Chen Jie, Ye Yibiao, Luo Xingxi, Zhang Jindai, Lu Zhenhuan, Wu Xiao, Chen Tao

2014, 14(05):  509-512.  DOI: j.issn.1009-976X.2014.05.003

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【Abstract】〓Objective〓To investigate the postoperative neutrophil to lymphocyte ratio (NLR) change in predicting the prognosis of patients after radical resection of hepatocellular carcinoma. Methods〓Clinical data of 155 patients with hepatocellular carcinoma (HCC) who underwent radical hepatectomy in Depart ment of Hepatobiliary Surgery, the Sun Yat-sen Memorial Hospital from January 2007 to December 2009 were analyzed retrospectively. NLR changes were calculated based on the routine examination results of peripheral blood within one week before and one month after surgery. Patients were divided into the NLR decreased group and the NLR increased group according to NLR change. Kaplan-Meier method was used to analyze survival curve and Cox proportional hazard model was used to evaluate theprognostic factors of overall survival. Results〓The 5-year overall survival rates were 91.2%, 80.4%, 49.5% in NLR decreased group (108 cases) and 80.2%, 71.6%, 42.5% in NLR increased group (47 cases) (P<0.05). The median time to recurrence (TTR) was 19.9 months in NLR decreased group, and 15.2 months in NLR increased group(P<0.05). Cox multivariate analysis showed NLR change, tumor size, tumor stage were independent prognostic factors of overall survival. Conclusion〓The postoperative NLR change was an independent prognostic factor for HCC patient underwent radical hepatectomy, and patients with increased NLR indicated poor survival.

Clinical experience in the diagnosis and treatment of traumatic splenic rupture:analysis of 216 cases

Gao Jinting, Miao Dingding, Cheng Xinsheng, Wang Fuyu, Zheng Yongbin, Suo Zhijun

2014, 14(05):  512-515.  DOI: j.issn.1009-976X.2014.05.004

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【Abstract】〓Objective〓To report the 10 years experience in diagnosis and treatment for traumatic splenic rupture. Methods〓The clinical data of trauma splenic rupture were retrospectively analyzed. A total of 216 cases admitted to our hospital in recent 10 years were included in the study. Patients in the first five years were served as group A, and those in the second 5 years were group B. The clinical data were compared between two groups. Results〓In 216 patients, 81 cases underwent conservative treatment, and 135 cases were performed surgical treatment, including 5 cases of delayed splenic rupture. The rate in A group treated with conservative approach was significantly increased than that in B group (P<0.05), and the incidence of complications, blood transfusion and hospitalization time had no significant difference between two group. Conclusion〓Non operative treatment gradually increases in patients with traumatic splenic rupture. Splenectomy and spleen preserving should take into account the splenic injury degree and the hemodynamics in patients for individualized treatment.

Experience in the surgical treatment for pancreatic head mass of chronic pancreatitis in 18 cases

Li Liuzheng, Peng Lianfang, Xiang Chunming, Xu Leisheng, Feng Jiawei,

2014, 14(05):  516-519.  DOI: j.issn.1009-976X.2014.05.005

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【Abstract】〓Objective〓To investigate the effect of surgical treatment of chronic pancreatitis with mass in the head of pancreas. Methods〓The clinical data of 18 cases of chronic pancreatitis with mass in head between January 1999 and December 2013 were retrospectively analyzed..Of 18 cases,.4 cases were associated with pancreatic duct stones, 5 cases with pancreatic cyst, and pancreatoduodene-ctomy was performed in 10 cases,.pancreato-jejunal Roux-y anastomosis in 4 cases,.pancreatic cyst jejunum Roux-y anastomosis in 2 cases,.bile duct jejunum Roux-y anastomosis in one cases,.pancreaticojejunostomy combined with gastrojejunostomy was in one case. Results〓Seventeen patients were completed the operation, one case died from superior mesenteric venous bleeding. Pleural effusion after operation occurred in 2 cases,.wound dehiscence was in one cases. 13 cases were followed up for 6 months to 10 years..The pain completely disappeared in 8 cases with pancreatoduodenectomy. The pain eased obviously in 4 cases with intestine and pancreas or biliary enteric anastomosis. Pain in one cases failed to relieve and had to repeated hospitalization due to intractable pain. Conclusion〓In our study, surgical operation was the effective treatment of chronic pancreatitis with mass in head, especially pancreatic resection.

Analysis of factors on influencing factors in the occurrence of incisional hernia after the operation of necrotizing pancreatitis

Cui Kai, Jiang Bolun

2014, 14(05):  519-522.  DOI: j.issn.1009-976X.2014.05.006

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【Abstract】〓Objective〓Necrotizing pancreatitis (NP) patients frequently underwent pancreatic debr-idement with risk factors for incisional hernia (IH). However, no published data exist the regarding incidence of IH in NP. The aim of the current study was to define the incidence of and identify risk factors for developing IH after pancreatic debridement. Methods〓Hernia presence was determined by clinical examination and patient interview. Technical and clinical considerations were noted: type of incision, closure, suture material, age, body mass index (BMI), diabetes mellitus (DM), preoperative albumin, and number of operations. Results〓Sixty-three (42%) of 149 debrided patients with NP developed IH. IH patients were older than those without IH(P<0.05). No differences in surgical technique or clinical risk factors were seen between groups. Conclusion〓The incidence of IH in NP patients requiring operative debridement is substantially higher than that in patients undergoing routine laparotomy. Innovative fascial closure techniques such as primary fascial buttress with nonsynthetic mesh should be considered.

Hepatic angiomyolipoma was misdiagnosed as hepatic carcinoma (A case report and literature review)

2014, 14(05):  523-526.  DOI: j.issn.1009-976X.2014.05.007

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【Abstract】〓Objective〓To investigate clinical characteristic, pathological and immunohistochme-ical features, diagnosis and treatment of hepatic angiomyolipoma (HAML). Methods〓One case misdiagn-osed as hepatic carcinoma was retrospectively analyzed and confirmed by pathological examination for huge hepatic angiomyolipoma in our hospital. The clinical presentation, imaging performance, pathological and immunohistochmeical features combining with the knowledge were reviewed. Results〓Most patients with HAML were asymptomatic, and occur commonly in female. HAML are composed of varying amounts of smooth muscle cells, adipose tissue, and vessels. Immunohistochemeical staining showed the tumor cells were positive for HMB45, Melan-A and SMA. Conclusion〓HAML lacks typical clinical presentation, its imaging appearance varies widely, easily misdiagnosed as other tumors. Liver biopsy is proposed when it is difficult to get a clear diagnosis. The reliable way to diagnose HAML is depend on pathology and immunohistochemical technique.

Diagnosis and treatment of liver fibrosarcoma: a case report and review of the literature

Lin Shuwen, Ouyang Hongfei, Ji Chenggang

2014, 14(05):  527-529.  DOI: j.issn.1009-976X.2014.05.008

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【Abstract】〓Objective〓To discuss the diagnosis and treatment for malignant fibrous histiocytoma of the liver. Methods〓One case of primary hepatic malignant fibrous histiocytoma, treated in Dongguan Taiping People's Hospital,.misdignosed as liver abscess before operation and confirmed by the pathology after operation in 2014,.was analyzed retrospectively. Results〓The case showed liver abscess by history and imaging data preoperatively,but liver tumor intraoperatively..The patient received complete surgical resection,.confirmed for malignant fibrous histiocytoma of the liver by the pathology postoperatively,.and survived for about two months. Conclusion〓Primary hepatic malignant fibrous histiocytoma of the liver,.highly malignant,.with nonspecific clinical manifestation and a poor prognosis,.is easy to be misdiagnosed,.and confirmed by the pathology mainly..Surgical resection is the only effective treatment for malignant fibrous histiocytoma of the liver,.which is not sensitive to chemotherapy or radiotherapy.

Experience in the diagnosis and treatment of hyperlipidemic acute pancreatitis (46 cases report)

Du Anping, Li Ping

2014, 14(05):  530-532.  DOI: j.issn.1009-976X.2014.05.009

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【Abstract】〓Objective〓To investigate the clinical features and the treatment of hyperlipidemic pancreatitis(HLP). Methods〓A total of 46 patients with hyperlipidemic pancreatitis who were admitted to our hospital from June 2005 to October 2013 were retrospectively analyzed..Results〓Forty-five patients were cured, and one case died from MSOF. Thirty-eight patients were followed for 6 to 12 months. Three patients developed recurrence. Conclusion〓Hyperlipidemia can trigger acute pancreatitis attacks,.and even leads to severe pancreatitis..In early periods,.reducing quickly triglyceride and promoting the recovery of gastrointestinal function can help alleviate the condition..The treatment for hyperlipidemic pancreatitis is dominated by non-operative management..The key of treatment is reducing triglyceride.

Effect of dexmetomidine and parecoxib on remifentanil-induced hyperalgesia in elderly patients

Huang Haiming, Wang Shouping

2014, 14(05):  533-536.  DOI: j.issn.1009-976X.2014.05.010

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【Abstract】〓Objective〓To investigate the impact of pre-treatment or post-treatment with dexmet-omidine and parecoxib on remifentanil-induced hyperalgesia in elderly patients. Methods〓Sixty elderly patients(ASA Ⅱ or Ⅲ) scheduled for elective laparoscopic cholecystectomy were randomized into three groups(n=20), pre-treatment group (group A), post-treatment group (group B) and control group (group C). Intravenous infusions of 0.2 μg/kg dexmedetomidine and 40 mg parecoxib were given 30 min before induction in patients of group A or 30 min after remifentanil infusion in group B, while patients in group C were injected with saline, respectively. Surgery and anesthesia duration, time to extubation, sedation score, VAS pain score, usage of analgesics, and the incidences of adverse effects were recorded. Results〓The VAS scores both in group A and group B were significantly lower than that of group C after surgery (P<0.05). The postoperative usages of fentanyl in group A, B and C were 246.25±17.09 μg,.326.20±19.78 μg and 479.50±18.84 μg,.with any two groups differentiating significantly.(P<0.01). The need for additional analgesic in group A was later than that of group B and C,.and faster pain relief was obtained in group A after using analgesics. Additionally, administration of dexmedetomidine combined with parecoxib also decreased the incidences of postoperative nausea and vomiting,.with no significance between group A and B. Conclusion Preoperative or intraoperative injection of dexmedetomidine and parecoxib can significantly alleviate remifentanil-induced hyperalgesia in elderly patients and can reduce the incidence of postoperative nausea and vomiting, better outcome gained when managing preoperatively.

The application of Percutaneous continuous intravenous analgesia with naproxen sodium combined with sufentanil after upper extremity surgery

Hu Zhiqiang, Wu Bing, Wu Shuhui, Huang Yonghui

2014, 14(05):  537-539.  DOI: j.issn.1009-976X.2014.05.011

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【Abstract】〓Objective〓To evaluate the analgesia effect of patient controlled intravenous analgesia (PCIA) with naproxen sodium and sufentanil in upper extremity surgery. Methods〓Ninety patients with ASA Ⅰ-Ⅱ that were scheduled for clavicular and upper extremity surgery under brachial plexus retardation, and treated with PCIA after the surgery. The patients were randomized into three group, fentanyl group (Group F, n=30), sufentanil group (group SF,n=30) and naproxen sodium+sufentanil group (group SF+N, n=30). PCIA gradients used for each group are as follow: fentanyl 20 μg/kg+ondansetron hydrochloride 0.15 mg/kg for group F, sufentanil 2.0 μg/kg+naproxen sodium 0.15 mg/kg for group SF; Sufentanil 1.5 μg/kg+ naproxen sodium 10 mg/kg+ondansetron hydrochloride 0.15 mg/kg for group SF+N,which were diluted to be 100 ml by adding saline. VAS, Ramesy scores and pressing times of PCA equipment,side effects as well as patient's satisfactory degree were recorded and compared among 3 groups. Results〓There was no significant difference in pressing times of PCA equipment..And SF+N group showed no significant different outcome regarding to the VAS score, Ramesy score and when compared with group F and group SF (P>0.05). Group SF+N showed significantly higher satisfactory degree as compared to group F and group SF (P<0.05). Conclusion〓Naproxen sodium combining with sufentanil in PCIA exhibits better clinical effect with less side effects and higher satisfactory degree for patients.

Effects of Narcotrend monitor on preventing early cognitive disorder in postoperative elderly patients undergoing laparoscopic cholecystectomy

Zhou Mao, Peng Yuxuan, Wu Qiang, Ye Xijiu

2014, 14(05):  540-542.  DOI: j.issn.1009-976X.2014.05.012

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【Abstract】〓Objective〓To investigate the role of Narcotrend (NT) monitor on postoperative cognitive impairment in elderly patients with laparoscopic chloecystectomy (LC). Methods〓Sixty cases of elderly patients under general anesthesia for laparoscopic chloecystectomy were randomized into two groups, the control group (n=30) and the NT group (n=30) according to the patients with or without NT monitor. The dosage of remifentanil and sevoflurane during anesthesia, operative time, extubation time, recovery time and incidence of postoperative dysfunction were recorded and analyzed. Results〓The dosage of remifentanil and sevoflurane in NT group were significantly lower than that of the control group, the difference was statistically significant (P<0.05). The incidence of Postoperative cognitive dysfunction in 24 h after surgery in NT patients was significantly lower than that of the control group (P<0.05), but not in the seventh day after surgery (P>0.05). Conclusion〓Narcotrend monitor during general anesthesia is instrumental to accurately judge the depth of sedation and effectively reduce the incidence of postoperative dysfunction in elderly patients undergoing LC.

Effect of dexmedetomidine on postoperative cognitive function of elderly patients: a systematic review

Chen Weiqiang, Zheng Chunqin, Huang Shengxing, Cao Minghui

2014, 14(05):  543-549.  DOI: j.issn.1009-976X.2014.05.013

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【Abstract】〓Objective〓To systematically evaluate the effect of dexmedetomidine on the incidence of early postoperative cognitive function in elderly patients undergoing noncardiac surgeries,so as to provide evidence for prevention and treatment of postoperative cognitive dysfunction (POCD) in elderly patients. Methods〓Databases including the Cochrane Library, PubMed, CNKI, and WanFang Data (by April 2014) were searched for randomized controlled trials (RCTs) on effect of dexmedetomidine on early postoperative cognitive function in elderly patients undergoing noncardiac surgeries. According to the modified Jadad quality scale, literature was screened, data were extracted, and quality of the included studies was critically evaluated. The meta-analysis was performed using STATE 12.0 software. Results〓A total of 19 RCTs involving 1202 patients were included. The results of meta-analyses showed that: compared with the control group, the scores on the Minimum Mental State Examination (MMSE)at the 1st and the 7th day after surgery were significantly higher in the dexmedetomidine group,and the ratio of early POCD incidence at the 1st and the seventh day after surgery in the dexmedetomidine group were significantly lower than those in the control group. Conclusion Dexmedetomidine might benefit postoperative cognitive function and might be effective for ameliorating POCD in elderly patients.

Evaluation of complete internal suture FasT-fix technique combined with outside-in suture device in the treatment of meniscus tears underarthroscope

2014, 14(05):  549-553.  DOI: j.issn.1009-976X.2014.05.014

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【Abstract】〓Objective〓To assess the effect of the surgical method of repairing the meniscus tear by all-inside suture technique FasT-fix unite outside-in device.(Smith & Nephew Endoscopy, Andover, MA). Methods〓From Feb 2011 to Feb2014, 83 knees were diagnosed as meniscus tear and underwent meniscal repair using arthroscopic FasT-Fix and out-inside device with concomitant other injuries restoration. For all patients, MRI was performed for evaluating meniscal healing capacity postoperatively..Preoperative and postoperative Lysholm scores was evaluated comparatively for joint function. Results〓Eighty-three patients were followed up for an average of 16 months (range 6-26 months),.and normal joint function was found in all patients..MRI showed that 59 patients got complete healing,.16 patients got incomplete healing,.and 8 patients failed to heal..The Lysholm scores from 46.3±20.8 Preoperatively to 93.5±4.6 postoperatively had improvedwith statistical significance(t=19.28, P<0.01). Conclusion〓Using all-inside suture technique FasT-fix and outside-in device for meniscus tear under arthroscope had excellent effect.

The short-term efficacy of different surgical approaches on thoracolumbar fracture without nerve injury

2014, 14(05):  553-556.  DOI: j.issn.1009-976X.2014.05.015

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【Abstract】〓Objective〓To compare the short term efficacy of pedicle screw fixation with intra-sacrospinal muscular approach and conventional approach for treating thoracolumbar fractures without nerve injury..Methods〓Fifty cases with thoracolumbar fractures without nerve injury undergoing fractured vertebral pedicle screw fixation and bone grafting from April 2009 to April 2013 were randomized into the observation group (paraspinal muscle approach) and the control group (conventional approach) with 25 cases in each group..Blood loss,.operative time,.postoperative drainage and hospitalization time were recorded in two groups,.and preoperative VAS scores and postoperative VAS scores after one year,.vertebral compression ratio and Cobb angle were compared in two groups. Results〓Blood loss, operative time, postoperative drainage, and hospital stay in the observation group were significantly less than those in the control group (P<0.05). There were no significant difference in preoperative VAS score, vertebral compression ratio and Cobb angle between two groups (P>0.05), and these were decreased one year after operation in two groups..VAS score in observation group was significantly decreased than that in control group,.but the difference of vertebral compression ratio and Cobb angle between the two groups was no statistically significant(P>0.05). Conclusion〓In treating thoracolumbar fractures without injured nerve,.the paraspinal muscle pedicle screw fixation plus vertebral bone grafting was less injury, faster postoperative recovery and better short term efficacy.

Ilizarove external fixator appatatus combined with focal cleaning and bone grafting in the treatment of infected bone nonunion and chronic osteomyelitis

2014, 14(05):  557-560.  DOI: j.issn.1009-976X.2014.05.016

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【Abstract】〓Objective〓To investigate the clinical effect of Ilizarov device in treating infected bone nonunion and osteomyelitis. Methods〓From 2012 to 2013, 18 cases with infected bone nonunion with osteomyelitis were operated in our hospital...Twelve of them were infected nonunion and 6 cases were osteomyelitis..All patients underwent one-stage of truncation for bone-extension and fixed with Ilizarov device after debridement in injury part. Results〓Sixteen cases were healed both in fracture and infection. Two cases were infected again one month after operation,..then the same method was performed and the patients got well healed...After 10 to 18 months of follow-up,..no recurrence was found. Conclusion〓Application of Ilizarov device has good efficacy in treatment of infected bone nonunion and osteomyelitis by one-stage of truncation for bone-extension.

Lumboiliac external fixation for the treatment of Denis-II sacral fracture with anterior pelvic ring fracture

Zhang Qiang, Zhang Xiangfeng, Zheng Qiang

2014, 14(05):  561-564.  DOI: j.issn.1009-976X.2014.05.017

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【Abstract】〓Objective〓To explore the efficacy of the lumbar iliac fixation combined with external fixation for the treatment of the Denis-II sacral fractures involved with anterior rings. Methods〓Eleven cases consecutively enrolled, with Tile-c type pelvic fracture (Tile-c1 8 cases, Tile-c2 2 cases and Tile-c3 1 case) concurrently accompanied with Denis-Ⅱtype sacral fracture. The posterior lumbopelvic fixation together with anterior external fixation were adopted to stabilize the fractures. Results〓All the patients had been followed up with the average period of 34 months (from 11 months to 64 months). The bone healing was observed in 4-11 months. The excellent rate was achieved 90.9% according to the Majeed score. One case of incision infection and one case of pinholes infection were occurred, and were with debridement and removing of the external fixation. Conclusion〓Stable pelvic ring could be achieved by posterior lumbopelvic fixation in combination with the anterior external fixation. This procedure is relatively simple yet a safe and effective technique in the treatment of the anterior pelvic ring fracture with sacral fracture.

Clinical observation of three approaches for treatment of femoral intertrochanteric fractures in senile patients

2014, 14(05):  564-567.  DOI: j.issn.1009-976X.2014.05.018

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【Abstract】〓Objective〓To evaluate the curative effect of dynamic hip screw(DHS), proximal femoral nail antirotation (PFNA) and femoral head replacement (FHR) in the treatment of senile patients with intertrochanteric fractures. Methods〓Fifty-eight senile patient with intertrochanteric fractures in our hospital from March 2008 to January 2013 were divided into three groups: DHS group (n=25, treated with DHS), PFNA group (n=11, treated with PFNA), FHR (n=22, treated with FHR). The operation time,mean intraoperative blood loss,function exercise time and the Harris hip function scores were observed. Results〓In follow-up period of 8-18 months,mean intraoperative blood loss of PFNA group was less than any other groups. The operation time,functional exercise time, the Harris hip function scores of PFNA group and FHR group was superior to the DHS group (P<0.05). Conclusion Both PFNA and FHR have good clinic efficacy in the treatment of intertrochanteric fractures. Compared FHR with PFNA which have advantage of less mean intraoperative blood loss and lower trauma.

Clinical effect analysis on fracture of lower limb involved joint

Guo Kunying

2014, 14(05):  568-571.  DOI: j.issn.1009-976X.2014.05.019

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【Abstract】〓Objective〓To summarize the clinical treatment and rehabilitation procedure of intra-articular fractures of the lower limbs. Methods〓Fifty-five cases with intra-articular fractures of the lower limb were included. The incision was chosen according to the type of fracture and main site of the fracture fragments and collapse. Bone graft from iliac and allogeneic bone were applied to fill the bone defect site caused by compression fractures. C-arm and intra-operative measurement of lower-extremity-alignment were applied to evaluated the reduction of fracture. Effective internal fixation was according to the type of fracture. Joint exercise schedule was decided according to repair of ligament injury, stepwise loading exercise was applied and according to fracture healing. Results〓Forty-nine cases were followed up for 3 to 18 months, an average of six months. Fractures were healed at 16 weeks, involving the knee fracture. Rasmussen scoring criteria used to evaluate the efficacy of intra-articular fracture of knee showed excellent in 26 cases, good in 2 cases, and the excellent and good efficacy reached 90.3%. Mazur scoring criteria used to evaluate the efficacy of intra-articular fracture of ankle showed excellent in 13 cases, good in 3 cases, the excellent and good rate reached 88.9%. Conclusion〓Bone allograft to fill bone defect site, restoring the articular surface, and reduction of limb alignment were necessary during the operation of the lower extremity intra-articular fractures. Ligament repairing, effective internal fixation and early functional exercise leads to a good therapeutic effect.

Experiences with complete endoscopic thyroidectomy in 328 cases

Li Xiang, Liu Xueyi, Shi Zhenchao

2014, 14(05):  572-574.  DOI: j.issn.1009-976X.2014.05.020

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【Abstract】〓Objective〓To report the experience of thyroid surgery under complete endoscope. Methods〓From Nov. 2008 to Feb. 2010, 328 patients underwent thyroidectomy with the single-incision complete endoscopic surgery technique via the anterior chest wall approach,cleavage and areola of mammary gland incision. An experience of operation was summarized and reported. Results 328 surgical performances were successfully completed,without transferring and open surgery. Five cases hand transient recurrent laryngeal nerve paralysis,recovering after 1 to 4 months. Parathyroid injury occurred in two cases with transient numb and mild tetany. Incision hematoma happened in one case. No additional surgery was performed. The patients were followed up for 1 to 30 months with satisfactory results. All patients were satisfied with the cosmetic effects of the operation. Conclusion Complete endoscopic thyroidectomy is feasible and practicable.

Intra-abdominal inflammatory myofibroblastoma: analysis of 5 cases and literature review

Ye Junwen, Li Zhengyu, Liang Jinglin, Cai Yonghua, Zhou Jiaming, Wang Puning,

2014, 14(05):  575-578.  DOI: j.issn.1009-976X.2014.05.021

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【Abstract】〓Objective〓To investigate the clinical features, pathological features, treatment options and prognosis of intra-abdominal inflammatory myofibroblastic tumor (IMT). Methods〓Five cases of intra-abdominal inflammatory myofibroblastic tumor from our hospital during June 2008 to May 2013 were analyzed and followed-up with the clinical features,pathological morphology, immunohisto-chemistry and treatment programs. Results〓The patients were included in 2 males and, 3 females, aged from 31 to 74 years old, and the mean age was 53.4 years old. The main symptoms are abdominal mass. All cases underwent surgical resection and the diagnosis was confirmed by pathological examination. The follow-up ranged from 6 months to 5 years, including one case of local recurrence. 3 cases of tumors derived from omentum, and 2 from mesentery. Immunohistochemistry showed that Actin, Vimentin and SMA were positive, while S-100, CD117 and, CD34 were negative. Conclusion〓The pathogenesis of IMT is not clear. The symptoms tend to disappear after surgical resection. Surgical resection is the primary approach in treatment of IMT. Considering the biological feature of the intermediate type of neoplasm in IMT, it needs to be followed-up closely.

Study on the role of dexosome from dendritic cells treated with hyperthermic CO₂ on proliferation regulation of human gastric cancer cells

2014, 14(05):  579-582.  DOI: j.issn.1009-976X.2014.05.022

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【Abstract】〓Objective〓To explore the role of dendritic cells (DC)-derived dexosome (DEX) in proliferation regulation of human gastric adenocarcinoma cells after treated with hyperthermic CO₂. Methods〓Based on an in vitro hyperthermic CO₂ pneumoperitoneum experimental model,the DC-derived DEX was isolated and identified through TEM after treatment by hyperthermic CO₂. AGS cells were co-cultured with DEX in vitro. And the cell proliferation was detected by CCK-8 assay,the expression of p-AKT and bcl-2 in AGS cells was examined by Western blot, and relative activity of p-AKT and bcl-2 was determined by colorimetric assay. Results〓DEX was successfully isolated. The proliferation rate of AGS cells was 54.73%±2.04% in hyperthermic CO₂ treated group, lower than that of heat treated group and control group (P<0.05). Significantly lower expression of p-AKT and bcl-2 in AGS cells treated with hyperthermic CO₂-DEX was observed by Western blot. And the relative activity of p-AKT and bcl-2 in AGS cells treated with hyperthermic CO₂-DEX were 41.28%±2.31% and 36.49%±1.92%. Conclusions〓DC-derived DEX treated by hyperthermic CO₂ could significantly inhibit proliferation of AGS cells, which may be related to the inhibition of AKT pathway activation and the decrease of expression of bcl-2.

Retroperitoneal laparoscopic partial nephrectomy with segmental renal artery blocking for small renal cancer (Report of 39 cases)

Chen Nanhui, Chen Zhiling, Huang Zhicheng, Peng Dong

2014, 14(05):  583-586.  DOI: j.issn.1009-976X.2014.05.023

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【Abstract】〓Objective〓To evaluate the curative effect and the safety of retroperitoneal laparoscopic partial nephrectomy with segmental renal artery clamping for small renal cancer. Methods〓Thirty-nine cases were selected, at the age of 39-86, the average age 58±3.20. Tumor occurred in the left kidney and right kidney had 20 cases and 19 cases, and all were solitary. Tumor located in the upper pole,lower pole arid middle kidney had 18,12,9 case,respectively. The maximum diameter of the tumor ranged from 2 to 5 cm, with an average of 3.5±0.6 cm. All the cases were underwent retroperitoneal laparoscopic partial nephrectomy with segmental renal artery clamping. Statistical data of operational duration, blood loss, renal segmentary artery blockage duration and pre-operative complications were gathered. Results〓Thirty-nine cases were completed smoothly under retroperitoneal laparoscope. The operation duration ranged 65-110 min, and the average duration was 85±16 min. The time of segmental renal artery occlusion ranged 20-42 min, and the average time was 26±5 min. The blood loss was 10-50 ml, and the average loss was 25 ml. The preliminary follow-up showed no secondary bleeding, urinous infiltration and implantation. No significant changes in renal function after surgery. Conclusion Retroperitoneal laparoscopic partial nephrectomy with segmental renal artery clamping for small renal cancer possesses the advantages of security, exact effect, maximum protection of renal function, with a clear surgical field, and small trauma.

Retroperitoneal laparoscopic surgery in the application of urology:a primary hospital experience

Wu Xuli

2014, 14(05):  586-589.  DOI: j.issn.1009-976X.2014.05.024

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【Abstract】〓Objective〓To evaluate the applicability and experience of retroperitoneal laparoscopic operation in primary hospital. Methods〓The clinical data of 81 patients that underwent urologic surgery by retroperitoneal laparoscopy were retrospectively collected and analyzed. Results〓The surgeries were successful in 79 cases. One case of adrenal neoplasm was converted to open surgery because of heavy bleeding during operation. Another case of renal cyst was converted to open surgery due to active bleeding post operation. The average time for operation was 2.5 h (ranged 0.5-7.5 h). No severe complication was observed after operation. The average hospitalized time post-operation was 5.5 d (ranged 2-14 d). Conclusion〓Retroperitoneal laparoscopy is a suitable choice for urologic operations in primary hospitals, with the advantages of minimal invasion, rapid recovery, less complication and short hospitalization days. The step-wise progression from basic to advanced techniques, the optimal screening of candidate through indications and contraindications, and pro-active problem solving is essential at the initial stage.

Experience in modified circumcision by Shang ring for children in 800 cases

2014, 14(05):  590-592.  DOI: j.issn.1009-976X.2014.05.025

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【Abstract】〓Objective〓To explore the clinical effect of modified by Shang Ring Circumcision. Methods〓800 cases were included in this study. We used 3 vascular clamps to lift preputial orifice, inserted the inner ring between the balanus and the inner prepuce, then the outer ring was sleeved on the outer prepuce and clamping. The operation time, blood loss, doffing ring time, complications, appearance satisfaction were analyzed. Results〓The operation time was 4.65±1.25 min, the amount of bleeding 0.80±0.65 ml, the postoperative complications included infection 0.50% (4/800), foreskin edema 3.12% (25/800), wound dehiscence 0.25% (2/800), wound bleeding 0.25% (2/800), the doffing time was 14±5 d, the rate of postoperative adhesions was 2.25%(18/800), 99.38% (795/800) were satisfied with the appearance and 98.13% (785/800) parents feel for reasonable expenses. Conclusion〓The application of modified by Shang Ring Circumcision has a series of advantages, such as short operation time, less bleeding, less complications and the high satisfaction rate of appearance, is a good method for the treatment of phimosis and redundant prepuce in children.

Analysis of implantable vascular access devices through the internal jugular vein and guided by ultrasound in 1856 cases

2014, 14(05):  593-596.  DOI: j.issn.1009-976X.2014.05.026

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【Abstract】〓Objective〓To investigate the surgical method of implantable vascular access devices through the internal jugular vein and guided by ultrasound. Methods〓A retrospective analysis of 1856 cases of implantable vascular access devices were carried out, through the internal jugular vein and guided by ultrasound from the medical department of breast oncology, Sun Yat-sen University Memorial Hospital between 2011 January and 2014 March. Results〓The success rate of 1856 cases of implantable vascular access devices were 100%, through the internal jugular vein and guided by ultrasound. The right internal jugular vein were implanted in 1838 patients (99.03%), the left internal jugular vein were implanted in 18 patients (0.97%). Intraoperative complications were occurred in 5 cases (0.3%); 25 cases had post-operative complications (1.3%), no death case happened. Conclusion〓The method of implantable vascular access devices through the internal jugular vein and guided by ultrasound has a higher success rate, and a lower rate of serious complications.

Application of medical glue in the treatment of emergency surgical facial wound

2014, 14(05):  596-599.  DOI: j.issn.1009-976X.2014.05.027

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【Abstract】〓Objective〓To investigate the efficacy of surgical glue in treatment of facial wounds in emergency surgery. Methods〓One hundred patients with facial wounds whom were treated in our Emergency Department from 2012 Jan to 2013 Dec were chosen in this study. They were randomly divided into two groups (50 patients each group), surgical glue treatment group and the conventional surgical debridement group. The clinical efficacy was compared between two groups. Results〓Compared with conventional surgical debridement group, surgical glue showed advantages in safety, convenience and debridement time, and cosmetic effect in treatment with small facial wounds. Conclusion〓Surgical glue is more effective than conventional debridement in treating facial wound, but is used in eligible patients.

Clinical observation of effect of hirudoid on thrombosed external hemorrhoid

2014, 14(05):  600-601.  DOI: j.issn.1009-976X.2014.05.028

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【Abstract】〓Objective〓To observe the clinical effect of hirudoid on thrombosed hemorrhoid. Methods〓Seventy-three patients with thrombosed hemorrhoid were randomized into two groups, therapeutic group (n=38) and control group (n=35). The patients in the therapeutic group were treated with potassium hypermanganate and hirudoid and those in the control group were treated with potassium hypermanganate and compound carraghenates. The difference in effective rate between two groups was compared. Results〓The effective rate of therapeutic group was 86.8%, control group was 65.7%. The difference between two groups was significant. Conclusion〓Hirudoid is effective in treatment thrombosed hemorrhoids.

Effects of endovascular embolization combined with craniotomy decompression and evacuation of hematoma on treating rupture of intracranial aneurysm(Analysis of 12 cases)

2014, 14(05):  602-604.  DOI: j.issn.1009-976X.2014.05.029

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【Abstract】〓Objective〓To explore the feasibility and clinical value of endovascular embolization combined with craniectomy for hematoma elimination and decompression in treating Hunt-Hess Ⅲ- Ⅳ merger intracranial hematoma in patients with intracranial aneurysm rupture. Methods〓Twelve cases with intracranial aneurysm rupture admitted in our hospital from March 2009 to February 2014 and underwent above endovascular embolization and surgical treatment. The patients need meet following conditions for operation indication,firstly,the patients were with spontaneous subarachnoid hemorrhage along with intracranial hematoma and with Hunt-Hess classification in Ⅲ-grade Ⅳ at the onset. Secondly,the head CT scan showed the brain shift of the midline >0.5 cm but <1.0 cm. Thirdly,cerebral angiogram found intracranial aneurysm and successful embolization and decompression craniectomy. Results〓No case was dead. GOS scores at 3 months of follow-up were 5 points in 7 cases, 4 points in 2 case, 3 points in 2 cases, 2 points one case. Conclusion〓For the patients suffered from intracranial aneurysm rupture, endovascular embolization combined with craniectomy for hematoma elimination and decompression may be a good treatment choice.

Endovascular interventional therapy of middle cerebral artery aneurysms

2014, 14(05):  606-608.  DOI: j.issn.1009-976X.2014.05.031

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【Abstract】〓Middle cerebral artery aneurysm is one of common intracranial aneurysms. Because of the special anatomy of the middle cerebral artery, the symptoms and prognosis of patient with ruptured aneurysm at this location are worse than the other supratentorial aneurysms. With the continuous development of interventional treatment technology,..endovascular detachable coil embolization has increasingly become the preferred treatment modality for intracranial aneurysms in many medical centers of the world. However, the treatment of middle cerebral artery aneurysm remains controversial, the selection of the appropriate patients for treatment is the primary problem.