Table of Content

20 December 2016, Volume 16 Issue 06

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Significance of a good comprehension of 'precision medicine' in clinical practice

OU Qingjia， CHEN Yajin

2016, 16(06):  637-641.  DOI: 10.3969/j.issn.1009?976X.2016.06.001

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【Abstract】 To discover the cause of diseases and improve prevention and treatment, a program initiating by the study of genetic sequence alteration was launched in January last year in US. It is named as precision medicine. This definition of precision medicine resulted in certain confusion and frustration among clinicians, which would fundamentally influent the trends and future directions of medicine re-search and practice. In fact, clinicians have already borne their own concept of precision medicine based on the definition of evidence based medicine. These two definitions are relative, but not complete the same. Understanding the meaning of precision medicine is a must or essential for clinical practice. Clini-cians must use all modern methods of treatment precisely for their patients regardless of whether they meet the standards of molecular genetic study or not. The criteria of precision medicine have a much more generalized meaning for clinicians.

Advances in the study of genes associated with papillary thyroid carcinoma

HAO Jing，LIU Sheng.

2016, 16(06):  642-646.  DOI: 10.3969/j.issn.1009?976X.2016.06.002

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【Abstract】 Thyroid carcinoma is the most common malignant tumor of endocrine organs. Papillary thyroid carcinoma accounts for approximately 90% of thyroid cancers. While most tumors can be diag-nosed and treated without much difficulty, a few tumors, sometimes still pose some diagnostic or thera-peutic challenges. Advances in the understanding of the genetic and biologic characteristics of thyroid papillary cancer, coupled with the development of new molecular targeted therapeutics, have led to the improved diagnosis and treatment of patients with this cancer. In the current review, we summarize re-cent research on genetic characteristics of the thyroid papillary cancer and their importance for the devel-opment of tumor.

Therapeutic effect of cyclosporin A on hyaluronidase induced interstitial cystitis/bladder pain sydrome (IC/BPS) in rats.

XIE Weijie，XU Xi，ZHANG Jiapeng，YAO Yousheng

2016, 16(06):  647-651.  DOI: 10.3969/j.issn.1009-976X.2016.06.003

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Objective To evaluate the therapeutic effect of cyclosporin A (CsA) on hyaluronidase induced interstitial cystitis/bladder pain sydrome (IC/BPS) in rats. Methods Forty-five Sprague-Dawley rats were randomly divided into control group (15 rats, intravesical normal saline), model group(15 rats, intravesical hyaluronidase) and CsA-treated group (15 rats, intravesical hyaluronidase+CsA). Voiding patterms were investigated by cystometrography. The changes of pain in urogenital area were detected by Von-Frey Hairs. The NO level of bladder tissue were measured by using nitric acid deoxidize enzyme method. The mRNA 1evels of iNOS, IL-6, IL-10, IL-17 were analyzed with real time reverse transcription polymerase chain reaction. The IL-6, IL-10 and IL-17 level were measured by ELISA. Results Compared with control, the mRNA level of iNOS, IL-6, IL-10, IL-17 increased significantly (all P values<0.001). The CsA-treated group showed decreased mRNA levels of iNOS, IL-6, IL-10, IL-17 (all P values<0.05). In model group, the NO level was (9.73±2.62)μmol/g; the IL-6 level was (125.4±11.25) μg/g；the IL-10 level was（64.05±6.26)μg/g；the IL-17 level was（90.61±10.49)μg/g. The intercontraction intervals was(148.23±40.75)s; The bladder capacity was 0.41±0.06 m1. In control group, the NO level was 1.31±0.55 μmol/g; the IL-6 level was 55.18±5.07 μg/g. The IL-10 level was（32.12±3.82)μg/g; the IL-17 level was（44.45±4.92)μg/g. The intercontraction intervals was 441.90±34.96 s; The bladder capacity was 1.27±0.10 m1. Compared with control, the rats of model group showed high NO, IL-6, IL-10 and IL-17 level, decreased intercontraction intervals and bladder capacity, high pain score (all P<0.05). After administration of CsA, the NO, IL-6, IL-10 and IL-17 level of bladder reduced (P<0.001), which was 3.97±1.71 μmol/g, 62.29±6.68 μg/g, 33.51±5.77 μg/g and 51.88±6.67 μg/g, respectively. Both intercontraction intervals and bladder capacity increased significantly (both P<0.05). And they were 422.06±42.22 s and 1.14±0.15 ml, respectively. The pain score also decreased significantly (P<0.05). Conclusion In the IC/BPS rat model induced by hyaluronidase, intravesical CsA can significantly ameliorate the frequent urination and bladder pain, which may be related to the down-regulation of iNOS, NO, IL-6, IL-10 and IL-17.

Lidocaine inhibits the adhesion of HepG2 to human umbilical vein endothelial cells by modulated endothelial cell adhesion molecules

SU Zegeng，YE Xijiu

2016, 16(06):  652-656.  DOI: 10.3969/j.issn.1009-976X.2016.06.004

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【Abstract】 Objective To explore the effect of lidocaine on endothelial cell adhesion molecules. Methods Human umbilical vein endothelial cells （HUVECs） were preincubated with different concentration of lidocaine prior to tumor necrosis factor（TNFα, 10 ng?ml-1）for different time. Tumour cell adhesion assays were performed. The mRNA of endothelial-selectin （E-Selectin, CD62E）, intercellular adhesion molecule-1（ICAM-1）and vascular cell adhesion molecule-1（VCAM-1）were detected via quantitative reverse-transcriptase polymerase chain reaction（qRT-PCR）. The proteins of p65 were evaluated via western blotting. Results Compared with TNFα, the adhesion of HepG2 was significantly inhibited by lidocaine. CD62E, VCAM-1 and ICAM-1 expression were significantly promoted by TNFα. After pretreatment of lidocaine for 30 min, CD62E, VCAM-1 and ICAM-1 expression were significantly inhibited. Meanwhile, the phosphorylation of p65 were significantly attenuated by lidocaine. Conclusion Our results suggested that lidocaine modulated the expression of endothelial cell adhesion molecules and inhibited the adhesion of cancer cell.

Experimental study on the effect of PIP controlled-release stents specifically silencing TGF-β1 on prevention of ureteral stricture recurrence

XU Guibin ZHU Jixiang SU Yantian HE Yongzhong ZHAO Haibo SU Zhengming XU Yuyu YUAN Yaoji PENG Ye LI Xun

2016, 16(06):  657-660.  DOI: 10.3969/j.issn.1009-976X.2016.06.005

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【Abstract】 Objective To determine the effect of PIP controlled-release stents which specific silencing of TGF-β1 in prevention of ureteral stricture. Methods A rabbit model of ureteral stricture was constructed in 20 New Zealand rabbits and was randomzed into four groups, each group was 5 rabbits. Control group（group A）, general stent group（group B）, PIP targeting TGF-β1 controlled release stent （group C） and the mismatching PIP group （group D）. Animals were killed at 30 days and defined segments of ureteral were sectioned and observed about ureteral stricture degree, the expression level of TGF-β1 and a-SMA. Results There was different degree of stenosis in all four groups of ureteral lumen, however, group C was the lowest degree of stenosis（P<0.01）. The average thickness of narrow segment ureteral was 2.4±0.6 nm in group A, 2.1±0.7 nm in group B, 1.5±0.4 nm in group C and 2.2±0.4 nm in group D. Compared with the other groups, the expression levels of TGF-β1 and a-SMA were significantly lower in group C（P<0.01）. Conclusion PIP controlled-release stents which specific silencing of TGF-β1 can effectively reduce the degree of ureteral stricture occurred.

EGFL7 regulates invasion and migration of tongue squamous carcinoma via targeting FAK signal pathway

LIN Zhili，LIANG Jianping，HUANG Lei，BAI Zhibao

2016, 16(06):  660-663.  DOI: 10.3969/j.issn.1009-976X.2016.06.006

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【Abstract】 Objective To investigate the function of EGFL7 in the research of cell invasion and migration in tongue squamous carcinoma. Methods EGFL7 and TSCC cell line expression levels were examined by qRT-PCR in cancer tissue and normal tissue. The changes about cell invasion and migration were detected by Transwell assays. Western blotting was performed to study the expression of EGFL7. Results After transfection with EGFL7-siR, the expression of EGFL7 was significantly down-regulated （P<0.001）. The invasion and migration ability of SCC-9 was substantially inhibited by EGFL7-siR. Western blotting showed that EGFL7 was found with positive expression in SCC-9. With downregulation of EGFL7，the expression of p-FAK was up-regulated substantially in SCC-9. Conclusion Overexpression of EGFL7 played an important role in the process of invasion and migration in SCC-9. Downregulation of EGFL7 in SCC-9 could substantially suppress its ability of cell invasion and migration. EGFL7 may exert its role by regulating the expression of p-FAK.

Establishment of a nomogram for predicting the drainage time prolong of postcardiac surgery

LI Hongmu，LIN Xifeng，MA Xun，TAO Jun，HUA Ping

2016, 16(06):  664-668.  DOI: 10.3969/j.issn.1009-976X.2016.06.007

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【Abstract】 Objective To establish a nomogram to predict prolonged drainage time of postoperative cardiac, and get better clinical management. Methods Data on 152 consecutive patients who underwent open cardiac surgery in Sun Yat-sen memorial hospital of Sun Yat-sen University between January 2014, and January 2016. Data collect include the patient's general information, past medical history, perioperative related information and postoperative drainage time etc. Logistic regression analysis was used to identify the independent risk factors associated with postoperative drainage time that then were incorporated into the nomogram. Results Univariate logistic regression found that gender, CPB time （cardiopulmonary bypass time）, smoking, white blood cell count, creatinine preoperatively, left atrial diameter, Left ventricular ejection fraction （EF） significant influence cardiac postoperative drainage time；Multivariate logistic regression showed that smoking history, preoperative creatinine, white blood cell count, CPB time, and PT-INR（Prothrombin time-International Normalized Ratio） were an independent prognostic factor, and were incorporated into nomogram. Nomogram initial concordance index （C-idex） 0.78. After 1 000 times of internal model validation, C-idex was 0.76. The sensitivity of nomogram prediction was 80.0% （95% CI, 95%-69.2%）, and the area under the curve of the ROC analysis was 0.78（95% CI，0.74-0.82）. Positive odds ratio（PLR）was 2.43，negative odds ratio（NLR）of 0.30. Conclusion Cardiac postoperative drainage time related to many factors, the prediction modelbased on the related factors can predict postoperative drainage time accurately.

Stage-wise treatment of large or multiple common bile duct stones through small-incision endoscopic sphincterotomy plus plastic biliary stenting

WANG Zhonghui，ZHANG Yingfei，SU Shuying

2016, 16(06):  669-673.  DOI: 10.3969/j.issn.1009-976X.2016.06.008

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【Abstract】 Objective To investigate the clinical efficacy and safety of stage-wise treatment with small-incision endoscopic sphincterotomy plus plastic biliary stenting on large or multiple common bile duct stones. Methods A total of 72 Patients were recruited and treated by ERCP with large（≥20 mm）or multiple（≥3）CBD stones from January 2010 to December 2015. The patients were assign to observation group （n=36） and control group （n=36）, and the former were treated with small-incision endoscopic sphincterotomy and placement of plastic stents in the bile duct without stone extraction at the initial ERCP, then a month later, the second ERCP was carried out and stone removal was attempted. The patients in control group were performed with small-incision endoscopic sphincterotomy, stone removal and nasobiliary drainage in one stage ERCP. The stone clearance, post-ERCP pancreatitis（PEP）, severe post-ERCP pancreatitis, bleeding and biliary tract infection were compared between two groups. ResultsThe total stone clearance at second ERCP was 94.4% in observation group and the total stone clearance was 91.2% in control group. The post-ERCP complications in observation group included one case of PEP and one case of postoperative hemorrhage. However, 8 cases of PEP（22.2%）, 6 cases of postoperative hemorrhage （16.7%） were recorded in control group （all P values less than 0.05, as compared with observation）. No biliary tract infection were occurred in observation group, when compared with five cases biliary tract infection（13.9%）in control group. Conclusion Stage-wise treatment of large or multiple common bile duct stones through small-incision endoscopic sphincterotomy and plastic biliary stenting is a safe, effective and feasible method.

Clinical significance of serum amylase in post-operative patients in the ICU

WANG Jiwen, QIU Yuru, CHEN Liang, HUANG Dan, CHANG Jianxing

2016, 16(06):  674-677.  DOI: 10.3969/j.issn.1009-976X.2016.06.09

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【Abstract】 Objective To investigate the epidemiological characteristics and clinical significance of serum amylase in postoperative patients with ICU. Methods A retrospective analysis of 395 cases of eligible postoperative patients in ICU, we observed underlying disease, operative site, blood and urine amylase, blood lipase and imaging changes, and compared the change of blood amylase in patients with increased amylase. Results serum amylase was elevated in 43.3% postoperative patients in ICU, began by 1-3 days, peaked by 2-3 days, increased 1-2 times, kept 1-3 days. The percentage was respectively 5.3%, 7.6%, 1.8% and 1.8% with urine amylase, lipase, imaging changes and diagnosis of pancreatitis. The incidence rate was significantly lower in patients with elevated serum amylase with diabetes mellitus (P< 0.05), and was high in upper abdomen, head and neck surgery (P<0.05). Conclusion The serum amylase was elevated during 3 days in 43.3% postoperative patients in ICU. The incidence rate was the highest in upper abdominal, head and neck surgery. The incidence rate was reduced in the patient with diabetes mellitus. But the urine amylase and lipase rarely increased, the patient was very few with diagnosis of acute pancreatitis.

Laparoscopic common bile duct exploration with primary closure for management of choledocholithiasis：experience of 54 cases

LI Shufan，ZHANG Caiyun

2016, 16(06):  678-680.  DOI: 10.3969/j.issn.1009-976X.2016.06.010

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【Abstract】 Objective To investigate the feasibility and introduce the experience of primary suture of common bile duct after bile duct exploration. Methods Fifty-four cases with choledocholithiasis were presented and underwent laparoscopic common bile duct exploration with primary closure from December 2010 to June 2015. The clinical effect and our experience were discussed and analyzed. Results The operation time ranged from 68 min to 137 min（average 92 min）. Operative bleeding was from 20 mL to 150 mL（average 82 mL）. Postoperative hospital stay was 5~14 days（average 6.8 days）. Postoperative bile leakage occurred in three cases and was healed by abdominal drainage for 7 days to 12 days. All the patients were followed for one months to 3 years, and the residual stones and biliary stricture were not found. Conclusions The management of laparoscopic common bile duct exploration in one stage suture showed less trauma, short hospital stay and less complications. Suggestion is the grasp of the indications and surgical skills before operation.

Experience and problem of rigid choledochoscope combined with fibrous sheath through T-tube sinus in the treatment of residual bile duct stones

ZHANG Shengmin，CHEN Hao，WANG Jian， JIANG Zizhuo，LIN Bo，CAO Tiansheng

2016, 16(06):  681-683.  DOI: 10.3969/j.issn.1009-976X.2016.06.011

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【Abstract】 Objective To summarize the experience and problems of rigid choledochoscope combined with fibrous sheath through T-tube sinus for treatment of complex residual bile duct stones. Methods The clinical data of 34 patients of residual bile duct stones treated by rigid choledochoscope combined with fibrous sheath through T-tube sinus were analyzed. The clinical efficacy and complications were recorded. Results All surgical procedures were completed smoothly. The time of calculus removed was ranged from 45 to135 minutes and 80 minutes on average. Stones were completely removed in 33 cases and stone was residue in one case. No bleeding, acute cholangitis, injury of bile duct wall and T-tube sinus were found during operation. And none had fever, abdominal pain, jaundice and recurrence in followed-up from 4 to 30 months. Conclusion Rigid choledochoscope combined with fibrous sheath through T-tube sinus existed a good efficiency in the treatment of residual bile duct stones. However, it relied on the experience and skills of the surgeon.

Sentinel lymph node biopsy in breast cancer: our experience

LI Yipeng, LIN Wen, QIU Yanping

2016, 16(06):  684-687.  DOI: 10.3969/j.issn.1009-976X.2016.06.012

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【Abstract】 Objective To summarize the surgical experience of sentinel lymph node biopsy in early staged breast cancer. Methods Retrospectively analyzed the clinical data of 78 patients with early stage breast cancer undergone sentinel lymph node biopsy in our hospital from January 2013 to December 2015. Results A total of 78 patients suffering from breast cancer were enrolled. Mean age was 54 years （range 32-75）. Of 78 cases, the lesion was localized on the right breast in 48（62%）, while was localized on the left breast in 30（38%）. Also, the tumor involved the upper-outer quadrant in 46（59%）patients, the lower external quadrant in 13（17%）, the upper-inner quadrant in 11（14%）and the inferior-internal quadrant in the remaining 8（10%）. All removed breast lesions were histologically malignant: 55（70%） patients diagnosed as infitrating ductal carcinoma（IDC）, 16（21%）ductal carcinoma in situ（DCIS）, 5（6%） infiltrating lobular carcinoma（ILC）and 2（3%）as mixed invasive cancer. The successful rate of SLNB is 90%（70）, in which pathological positive rate of SLNB was 34%（24）, while pathological negative rate of SLNB was 66%（46）. Medium follow-up was 12 months, and only one case developed axillary recurrence. Conclusion Sentinel lymph node biopsy is a safe and effective way to evaluate the status of axillary and the good results are obtained when undertaken by an experienced surgeon.

An observational study of therapeutic effect of preoperative arterial infusion chemotherapy on locally advanced breast cancer

ZHANG Xiao，YE Yifeng

2016, 16(06):  688-690.  DOI: 10.3969/j.issn.1009-976X.2016.06.013

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【Abstract】 Objective To investigate the effect of preoperative arterial infusion chemotherapy with embolism on locally advanced breast cancer. Methods Thirteen patients with locally advanced breast cancer diagnosed by the core needle biopsy from February 2010 to March 2015 in this hospital were selected. Seldinger procedure was used to perform angiography by arterial femoralis. Super-selective arterial catheterization was performed to ensure the locally infusion of Epirubicin 100 mg, Mitomycin 10 mg, 5-FU 1 g plus Oxaliplatin 1 g, finally the tumor blood supply artery war embolizated. Results Of 13 cases, two patients achieved CR, ten patients achieved PR, one patient achieved SD. The rate of CR+PR was 92.3% and CR + PR + SD was 100% . All the 13 patients received radical mastectomy. Conclusion Preoperative arterial infusion chemotherapy is effective and safe in the treatment of locally advanced breast cancer.

Effect of central neck lymph node dissection on papillary thyroid microcarcinoma metastasis

LIN Dong

2016, 16(06):  691-693.  DOI: 10.3969/j.issn.1009-976X.2016.06.014

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【Abstract】 Objective To summarize the clinical effect of central neck lymph node dissection in patients with papillary thyroid microcarcinoma（PTMC）. Methods Fifth-eighty patients with PTMC from April 2008 to May 2011 were included in the study, in which 30 cases were subjected to central neck dissection（observation group）and 28 cases underwent thyroidectomy alone. The lymph node metastasis was analyzed. Results Observation group and control group with ipsilateral neck lymph node metastasis were 3.33%, 17.86%, respectively（P<0.05）, and the complications in observation and control groups were 23.33%, 21.43%, and there was no significant difference between groups. Conclusion Central neck dissection for PTMC surgery effectively reduces the lymph node metastasis and does not increase com-plications.

Comparison of two different ways of radical resection of bursa omentalis above the pancreas for advanced proximal gastric cancer

ZHANG Hongzhi，YAO Guozhong，WU Xing

2016, 16(06):  694-697.  DOI: 10.3969/j.issn.1009-976X.2016.06.01

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【Abstract】 Objective To compare the perioperative safety and efficacy between left initial pathway and right initial pathway of radical resection of bursa omentalis above the pancreas for advanced proximal gastric cancer. Methods The clinical data of 102 patients who underwent D2 lymphadenectomy for advanced proximal gastric cancer at People’s Hospital of Liyang Jiangsu from March 2009 to November 2015 were retrospectively analyzed. Fifity cases were performed radical resection by left initial pathway and 49 by right initial pathway. The intraoperative outcomes between the two groups were compared. Results Compared with right initial pathway, left initial pathway had shorter operation time, less intraoperative blood loss, and lower morbidity of postoperative lymphatic fistulas. There were no significant differences in the number of lymph node removed, time to anal exsufflation, time for fluid diet intake and time duration of hospital stay between the two groups. Conclusion Radical resection of bursa omentalis is very important for D2 lymphadenectomy for advanced proximal gastric cancer. Left initial pathway has advantage in the shorter operation time, less intraoperative blood loss, and lower morbidity of postoperative lymphatic fistulas. the pathway is safe、convenient and could be popularized.

Effect of Milligan-morgan combined with Ruiyun procedure for hemorrhoids on treatment of hemorrhoids：Experience report

CHEN Zhanpeng，GUAN Zhenzhong

2016, 16(06):  698-702.  DOI: 10.3969/j.issn.1009-976X.2016.06.016

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【Abstract】 Objective To investigate the effect of Milligan-morgan combined with Ruiyun procedure on hemorrhoids and summarize the experience. Methods 169 patients with hemorrhoids were included in the study from Jul. 2014 to Dec. 2015 in our hospital. Of them, 91 cases were performed Milligan-morgan combined with Ruiyun procedure on hemorrhoids （M-M-R group）, and 78 cases underwent procedure for prolapse and hemorrhoids（PPH group）. The operation duration, hemorrhage during operation, hospital charge, emergency, postoperative anal pain and edema, postoperative bleeding, postoperative inconvenience, and anorectal dynamics of post operation were observed, recorded and compared between two groups. Results The operation time was 42.7±28.6 minand 28.5±15.3 min in M-M-R group and PPH group, respectively（P<0.05）. Intraoperative blood loss was less than 10 ml in each group. The patients in M-M-R group had higher visual analogue scale（VAS）than in PPH group. There were more patients presented postoperative inconvenience in M-M-R group, including anal complaints, anal edema, mild fecal incontinence and those got recovery in a few days after operation. M-M-R group had the lower hospital inpatient expenses than PPH group. There were no statistical significant differences in the postoperative prolapse, bleeding, urination, and the satisfactory degree between two groups. There were not archostenosis, stool bleeding, recurrence recorded in 3 months of follow-up. Conclusion The effect of M-M-R procedure was comparable with PPH on treatment of hemorrhoids at least in the short time. M-M-R is especially suitable for the implementation of the basic hospital due to its lower cost.

Treatment experience of elderly patients with asymptomatic meningiomas

SUN Shuanghua

2016, 16(06):  703-705.  DOI: 10.3969/j.issn.1009-976X.2016.06.017

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【Abstract】 Objective To summarize the clinical features and treatment experience in elderly patients with asymptomatic meningiomas. Methods The data of 58 elderly patients with asymptomatic meningiomas from March 2009 to March 2016 were retrospectively analyzed. Results Fifty-eight patients were included in the study and were followed up for ranging from 18 to 36 months. Of them, Twenty-one patients accepted surgery at the first diagnosis, 10 patients accepted γ radiosurgery, 12 patients accepted surgery in the follow-up period. The tumor body was not found to increase rapidly in all patients, including 15 patients without any therapy during follow-up. The tumor growth was not more than 10 mm. The patients did not leave long-term neurological dysfunction except 3 cases died of postoperative complications. Conclusions With regard to as asymptomatic meningioma of elderly patients, conservative treatment with close follow-up review for three to six months may be the best therapeutic strategy before surgery, lessening surgery-related complications and ensuring the quality of life.

Clinical application of the minimal preauricularand retroauricular incisions in parotidectomy of benign tumor

ZHANG Zhili, DENG Zhang, ZENG Wei, LU Wenhui

2016, 16(06):  706-709.  DOI: 10.3969/j.issn.1009-976X.2016.06.18

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【Abstract】 Objective To evaluate the clinical effect of the minimal preauricular and retroauricular incisions in parotidectomy of benign tumor. Methods Thirty patients with benign parotid tumor were reviewed in this study. Parotidectomy was designed as follows: a minimal preauricular and retroauricular incision was used, partial-superficial parotideceomy was applied, the preservation of facial nerve as well as great auricular nerve was carried out in parotidectomy of benign tumor. Follow-up study for3 to 24 months included the cosmetic effect of this incision and the clinical effect. Results The minimal preauricular and retroauricular incision healed uneventfully in all patients without salivary fistulae. After a follow-up, all the patients showed results with no obvious scar and sunken deformity left in face and parotid region. Two patients had temporary facial paralysis but recovered in 3 months with the treatment of cortical hormone and neurotrophic drugs. Four patients felt numb in ear lobe and the symptom was disappeared in 3-10 months post-operation. No patient had presented with clinical Frey's syndrome, as well as no tumor recurrence. Conclusion This minimal preauricular and retroauricular incisionsis a feasible technique, providing excellent cosmetic outcome in the treatment of benign parotid neoplasms.

The evaluation of postoperative analgesic effect of parecoxib following free-tension inguinal hemioplasty combined with incision infiltration by local anesthetics

CHEN Jianxin，LI Ruiping，LI Libo

2016, 16(06):  710-713.  DOI: 10.3969/j.issn.1009-976X.2016.06.019

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【Abstract】 Objective To investigate the postoperative analgesic effect of parecoxib following free -tension inguinal hemioplasty when local anesthetics was infiltrated at incision site. Methods Two hundred patients undergoing free-tension inguinal hemioplasty under spinal anesthesia were assigned to four groups, each group of 50 cases. The patients in the group A received intravenous 4 ml saline and incision infiltration with saline in ten minutes before the end of operation. The patients in group B received intravenous parecoxib 40 mg and incision infiltration with saline. Those in group C received intravenous 4 ml saline and incision infiltration with 0.75% ropivacaine. And those in group D received intravenous parecoxib 40 mg and incision infiltration with 0.75% ropivacaine. The observation time points included T1（6 hours after operation）, T2（24 hours after operation）. VAS values, additional requirement of opioids analgesia 24 hours after the operation, the rate of satisfactory with analgesia quality were compared between four groups. Results There was no significant difference between group A and group B of the VAS scores at time point T1, while the VAS values of group D was significantly lower than other three groups（all P values < 0.05）. Group C was also significantly lower than group A and group B（all P values <0.05）. There was no significant difference among the three groups（group A, B and C）of the VAS values at time point T2（P>0.05）, while the VAS values of group D was significantly lower than others（P<0.05）. Three patients（6%）received additional analgesics in the group D and significantly lower than other three groups（all P values <0.05），while there was no significant difference among the other three groups. The rate of satisfactory with analgesia in group D（86%）was significantly higher than other three groups（P<0.05），while there was no significant difference among the other three groups. Conclusion Paricoxib combined with local anesthetics infiltration can significantly relieve the pain of early stage after operation in the patients receiving free-tension inguinal hemioplasty.

Effect on improved extension tube for endotracheal tube on the pediatric patients undergoing spinal surgery under prone position

LONG Jiaqi，CHEN Jianting，LI Yunfan，MO Jian

2016, 16(06):  714-717.  DOI: 10.3969/j.issn.1009-976X.2016.06.020

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【Abstract】 Objective To observe the effect of improved extension tube for endotracheal tube （IETET）on the pediatric patients undergoing spinal surgery under prone position. Methods Thirty-two subjects, aged from 4 to 14 years old and with the ASA of Ⅰ or Ⅱ, were enrolled and assigned to the observation group and control group（n=16 for each）. All the children underwent operation under the mode of pressure controlled ventilation, and children in the observation group were given the IETET while the control ones were given the traditional ET. The differences in tidal volume （VT）, minute ventilation（MV）, dynamic lung compliance（Cdyn）, blood oxygen saturation（SpO2）, and end-tidal carbon dioxide partial pressure （PETCO2） between the two groups were compared, so were the indexes of blood gas analysis, as well as the slipping percentages. Results There was no statistically difference in VT, SpO2, PETCO2, duration of anesthesia and operation between the two groups（P>0.05）, but MV and Cdyn in theobservation group were significantly greater than those in the control one（P=0.028 and 0.021）. There were also no statistically differences in pH value, PaO2, and PaCO2 between the two groups before anesthesia and after the awakening （P>0.05）. There were one case in observation group and two cases in control group encountering slipping, respectively, but the slipping rates between the two groups were not statistically significant. Meanwhile, the lasting time of solid contact between the ET and ventilator circuits was significantly longer in the observation group when compared with the control one. Conclusion The IETET can help increase MV and Cdyn，and strengthen the fastness between ET and ventilator circuits for the pediatric patients undergoing spinal surgery under prone position.

The optimal depth of endotracheal tube in intraoperative neuro-montoring for recurrent laryngeal nerve during thyroid surgery

FANG Jianqin，TANG Qunjie，HUANG Guangyong，HE Haifeng， PENG Jun

2016, 16(06):  718-722.  DOI: 10.3969/j.issn.1009-976X.2016.06.021

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【Abstract】 Objective To investigate the optimal depth of endotracheal tube （ETT） which is closely related with the effectiveness of intraoperative neuromonitoring （IONM） for recurrent laryngeal nerve（RLN）during thyroid surgery in order to guarantee the accuracy of IONM for LRN especially when visible intubation devices are not available. Methods This clinical study involved two phases. In phase 1 study, 133 patients whose heights ranging from 145 cm to 180 cm were enrolled. Height and body weight were recorded；video intubation devices were utilized for intubation and observation；while the midline of the probe reaching the vocal cords opening level, the depth of ETT（Optimal depth） was also recorded and corresponding mean values for male and female were calculated separately. In phase 2 study, 35 patients with same inclusion criteria as in phase 1 study were intubated without any visible intubation devices and the ETTs were fixed in male or female to the depth according to the mean values of optimal depth obtained from phase 1 study, respectively；the success rate of electromyography （EMG） for laryngeal recurrent nerve monitoring was examined and compared to that in phase 1 study. Results Based on this certain study sample, the optimal depth of ETT in IONM for RLN shows positive correlation with patient height, the mean values are 21.7 cm and 19.7 cm in male and female, respectively. Fixing the ETT to the mean value of optimal depth either in male or in female can provide similar success rate of IONM for RLN when compared to direct localization with visible intubation devices. Conclusion In certain population，the mean value of optimal depth of ETT in IONM for RLN is 21.7 cm for male while 19.7 cm for female，one may fix the ETT to this mean value to achieve effective and satisfied IONM without the help of visible intubation devices.

Comparison of efficacy between the locking plate fixation and the plaster external fixation for treatment of distal radial fractures in aged patients with osteoporosis

ZHANG Shengrui WANG Yi-jun, LIU Mingjun

2016, 16(06):  722-726.  DOI: 10.3969/j.issn.1009-976X.2016.06.022

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【Abstract】 Objective To analyze the clinical effect of the treatment of osteoporotic distal radius fractures with the locking compression plate fixation and plaster immobilization. Methods 103 cases of osteoporotic distal radius fractures were recruited from June 2013 to June 2014 and assigned to two groups, observation group（n=52）and control group（n=51）. The patients in control group were treated with closed reduction and cast immobilization, and those in observation group were given locked volar plate and screws fixation. The wrist-hand functional improvement and fracture healing were observed in one year after treatment in two groups. Results The total effective rates of observation group and control group were 96.15% and 80.39%, having significant difference （P<0.05）. The back strength, cock waist, radial deviation, forearm rotation angle in observation were ameliorated much better than that in control group（P<0.05）. Conclusion The surgical procedure of palm side locking plate has more advan-tage of the closed reduce for intra-articular fractures of the distal radius combined with osteoporosis.

The percutaneous vertebroplasty on osteoporotic vertebral compression fracture：an experience of 36 cases

SHI Quanfeng， Lü Houzhong， HUANG Wendong， CHEN Jupeng， HUANG Haiyang

2016, 16(06):  727-730.  DOI: 10.3969/j.issn.1009-976X.2016.06.023

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【Abstract】 Objective To evaluate the effect of percutaneous vertebroplasty （PVP） on osteoporotic vertebral compression fracture （OVCF）. Methods Thirty-six patients with OVCF（single vertebral fracture） from Jan 2011 to June 2014 in our hospital undergoing PVP were retrospectively analyzed. The average age of the patients was 74 years. The extent of pain was measured with visual analog scale, and the compression ratio, the kyphotic angle and the complications were also investigated. Results A remarkable pain relief was achieved within 24 hours postoperatively in all cases. Postoperative VAS values declined markedly and were statistically significantly different from preoperative values （P<0.001）. No statistically significant differences were recorded between preoperative and postoperative values of compression ratio or kyphotic angle （P>0.05）. Asymptomatic cement leakage was found on postoperative radiographs in four cases. All cases were followed from 24 to 42 months, 33 months at average. Adjacent vertebral fractures were confirmed by X-ray in four cases within 2 years and lumbar back pain were manifested. No pain exacerbation or fresh onset of neural compression took place in the rest of patients. The form of neither the responsible vertebrae nor their adjacent vertebrae had changed. Conclusion PVP is a safe and effective method for treating OVCF.

A clinical study of establishing percutaneous renal access guided by different methods for the treatment of kidney stones without uronephrosis

HUANG Tao，LONG Zhaolin，WU Shihao，HUA Qingsheng，LIU Zhile，CHEN Yuanyang，ZHANG Xinji，ZENG Renchuang

2016, 16(06):  731-735.  DOI: 10.3969/j.issn.1009-976X.2016.06.024

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【Abstract】 Objective To compare the success rate and effectiveness of C-arm X-ray, B-convex array probe and probe B-guided percutaneous renal puncture. Methods A clinical data of 138 patients suffering from kidney stones and undergoing percutaneous nephrolithotomy lithotripsy were retrospectively analyzed. The patients were assigned to the X-ray-guided puncture group（n=46）, B ultrasound convex array probe-guided group （n=46） and B-ultrasound-guided puncture group （n=46） according to the different puncture methods to the kidneys. The success rate and effectiveness were compared between the three different methods of percutaneous puncture. Results All patients were successfully established a channel within the kidneys. One-time success rate of probe B-guided puncture group was 67.39%, ≤2 puncture success rate was 89.13%, and they were higher than that of either the B-convex array probe-guided puncture group or X-ray-guided puncture group. The differences were statistically significant（P<0.05）and the average number of puncture done by B-guided puncture probe was less than the other two groups. Forty-one（89.13%）of cases in the probe B-guided puncture group performed the procedure by calyx into the fornix and the puncture effectiveness was better than the other two groups （P<0.05）. Conclusion B-puncture probe used by the real-time guided percutaneous renal puncture shows better efficacy than X ray-guided, B-convex array probe-guided percutaneous renal puncture.

Comparison of the effects of circumcision using a novel disposable suture device vs traditional procedure

HE Jiahui，PENG Shuiqing

2016, 16(06):  736-739.  DOI: 10.3969/j.issn.1009-976X.2016.06.025

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【Abstract】 Objective To compare the effects of circumcision using a novel disposable suture device and traditional procedure. Methods A total of 203 cases between July 2015 and July 2016 that underwent circumcision with traditional procedure（114 cases）or using a novel disposable suture device （89 cases）were documented, The main surgical outcomes including surgical time, intraoperative blood loss, pain score, incision healing time, postoperative complications and patients ‘satisfaction rate of postoperative penile cosmetic appearance were collected and analyzed. Results The suture device group had shorter operation time, less blood lose, lower VAS, shorter wound healing time and higher satisfac-tion rate of penile cosmetic appearance than the traditional group（P<0.05）；Besides, the incidence of postoperative complications such as incision bleeding and infection, wound dehiscence was significantly lower in the suture device group than in the traditional group（P<0.05）, however, the incidence of ede-ma was no different between two groups. Conclusion Application of a novel disposable suture device in circumcision represents convenient, efficient and minimal invasive, and has better cosmetic outcome and less complications. It is worth promoting clinically.

Effect of inclined plane incision combined with compression dressing on wound healing

LONG Qing，WU Zupei，ZHANG Caiming，CHEN Yuning，SU Qunshan

2016, 16(06):  740-742.  DOI: 10.3969/j.issn.1009-976X.2016.06.26

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【Abstract］】 Objective To observe the clinical effect of skin incision by inclined plane incision combined with compression dressing to prevent the formation of skin incision scar. Methods 124 cases in our hospital undergoing elective surgical with class I incision, were assigned to observation group （inclined plane incision combined with compression dressing, n=68）and control group（traditional skin incision and suture of the skin, n=68）, and the effect of different skin incisions on the healing of incision were analyzed in two groups. The width of the average incision scar was measured in two months after operation in two groups. Results After operation, all of 124 cases were followed up for two months. Patients with stage I incision healing rate was 99.4% in the observation group, the control group was 98.8%, and there was no significant difference between the two groups. The width of the average incision scar was 0.7 mm in the observation group, and 1. 3 mm in the control group, the difference was statistically significant. Conclusion In our study, the treatment of by using inclined plane incision combined with pressure dressing abbreviated the formation of skin scar, and showed the cosmetic effect.

Progress in research of occult pancreaticobiliary reflux

WEI Yunping，XU Junyao，CHEN Jie，YE Yibiao，CHEN Tao

2016, 16(06):  743-746.  DOI: 10.3969/j.issn.1009-976X.2016.06.027

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【Abstract】 Occult pancreaticobiliary reflux（OPR/OPBR）is defined as pancreaticobiliary reflux （PBR）occurs in individuals with a normal pancreaticobiliary junction （NPBJ）. Studies have shown that many diseases of biliary system, especially gallbladder cancer, are closely associated with OPR. However, these cases present no clinical symptoms and is also impossible to accurately detected by using conventional imaging examinations. Understanding and further research of OPR have great importance of significance for clinical guiding. In this article, we review the progress in research of OPR.

Advance in study of microRNA in invasion and metastasis of thyroid carcinoma

LIN Zaikai，MA Baojin

2016, 16(06):  747-750.  DOI: 10.3969/j.issn.1009-976X.2016.06.028

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【Abstract】 To summarize the relationship of microRNA（miRNA）to metastasis and invasion of thyroid cancer. Domestic and international publications involving the relationship of miRNA to thyroid cancer were screened and reviewed. miRNA played a key role in the process of thyroid cancer metastasis. According to its function, it could be distinguished from cancer-promoting gene（such as miR-221, miR-222, miR-146b, etc. ）to suppressor gene（such as miR-199a, miR-204, etc. ）. The more detailed experimental studies about the relationship of miRNA to metastasis and invasion of thyroid cancer need to be researched in order to provide a new method for the diagno sis and treatment of thyroid cancer metastasis and invasion.

Development of surgery on thoracolumbar burst fracture

MENG De，YANG Rui

2016, 16(06):  751-754.  DOI: 10.3969/j.issn.1009-976X.2016.06.029

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【Abstract】 Thoracolumbar burst fractures accounts for more than half of the spine fractures. It concerns about the stability of the spine and the damage to the nerve function, and the surgical treatment is often established in terms of personalization, skills and even experience of surgeon. Accordingly, the best treatment for thoracolumbar burst fractures is controversial, and the node is the choice between surgical treatment and conservative treatment, especially the fracture combined with nerve injury. At presence, open surgery has been the main way of surgical treatment, both through different approaches to spinal decompression, bone fracture reduction and fixation, achieving vertebral body fusion and recovery of nervous function. Minimally invasive treatment of thoracolumbar burst fracture is not a lot, due to a lack of high level of evidence. However, with the development of minimally invasive techniques and new types of fixation materials, minimally invasive treatment of thoracolumbar fractures is increasing, such as by the use of endoscopic anterolateral pedicle screw fixation or by percutaneous vertebroplasty.

Comparison of clinical effect between two different vacuum-assisted breast biopsy systems

ZENG Minhua，SU Linhong，HE Haiyan

2016, 16(06):  755-757.  DOI: 10.3969/j.issn.1009-976X.2016.06.030

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【Abstract】 Objective To compare the operation time and adverse reactions between two vacuum-assisted breast biopsy system. Methods 100 cases were chosen in outpatient patients and were per-formed ultrasound-guided and vacuum-assisted needle biopsy（VANB）in our hospital from March 2015 to June 2015. Fifty cases were performed surgery by VANB system A and another 50 patients by VANB system B. The operation time（from lesion position to the end of the operation）, blood loss, preoperative and postoperative D-value of highest heart rate and systolic blood pressure, hematoma volume and postop-erative breast profile were observed and compared between two groups. Results Systolic blood pres-sure, heart rate changing, postoperative hematoma of magnitude breast appearance between system A and B had no significant difference. The operation time of the system A was 8.7+5.39 min, and was sig-nificantly less than that of the system B group（17.56+8.63 min, P<0.05）。 Amount of bleeding system A was 3.7±2.6 ml significantly and was less than that of system B（6.1±3.9 ml, P<0.01）. Conclusion System A showed shorter operation time and less bleeding amount in the breast biopsy.

The impotance of nursing?related risk management in primary care units

YANG Qiuping

2016, 16(06):  758-759.  DOI: 10.3969/j.issn.1009-976X.2016.06.031

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Analysis of the application effect of two kinds of naso-intestinal feeding tube in ICU patients

LUO Yuzhen，LI Runhua，XIAN XiaoLan，LI Yantong

2016, 16(06):  760-762.  DOI: 10.3969/j.issn.1009-976X.2016.06.032

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【Abstract】Objective To analysis the effect and feature of The Flocare Bengmark- Naso -Intestinal tube and CORTRAK- polyurethane tubes. Methods A total of 80 cases with naso-intestinal tube for enteral nutrition were selected and assigned to Locare Bengmark group （using The Flocare Bengmark-Naso-Intestinal tube，n=40）and CORTRAK group（using CORTRAK polyurethane tube，n=40）. The effect and feature were analyzed. Results The patients in CORTRAK group showed a high success rate（75%）and operate time was 31.26±10.94 min（P<0.05）. Conclusion ICU patients are often accompanied by gastric motility dysfunction. The enteral tube feeding，dependent of normal gastric motility function such as the Flocare Bengmark- Naso-Intestinal tube，should be replaced with CORTRAK polyurethane tube.