Table of Content

20 February 2018, Volume 18 Issue 01

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Annual progress on the treatment for HER2 positive early?stage breast cancer

WANG Jingshu, YAO Herui

2018, 18(01):  1-5.  DOI: 10.3969/j.issn.1009-976X.2018.01.001

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［Abstract］ Clinical guidelines recommend trastuzumab as one of the standard adjuvant treatments for early?stage HER2?positive breast cancer. Researchers are continuing to look for new potential breakthroughs based on the previous studies：on one hand, scientists try to reduce the recurrence rate for early?stage HER2?positive breast cancer by adding a second HER2?targeted treatment or extending therapy duration, on the other hand, other researchers attempt to reduce side?effects of unnecessary medical treatment by cutting the dosage of chemotherapy or using shorter course chemotherapy. In this review, we summarize some large clinical study results in recent years and focus on those following topics：1. Is anti?HER2 targeted therapy required for patients with HER2?Low expression breast cancer？2. Can we use short?course anti?HER2 therapy？ 3. Will it improve clinical outcome by using two HER2 Blocker together for the treatment of early?stage HER2?positive breast cancer？ 4. Will it be able to reduce chemotherapy？ This review will provide new insight and recommendations for oncologists and clinicians on HER2?targeted therapy for early?stage HER2?positive breast cancer.

Discussion on the causes and treatment of iatrogenic enterotomy during laparoscopic ventral hernia repair

TANG Fuxin, CHEN Shuang

2018, 18(01):  6-8.  DOI: 10.3969/j.issn.1009-976X.2018.01.002

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［Abstract］ With the development of laparoscopic technique and the popularization of minimally invasive idea, laparoscopic herniorrhaphy is becoming increasingly popular. More and more studies have shown that laparoscopic hernia repair is superior to the open method of hernia repair. However, although excellent surgical skill, vast experience, and careful dissection, laparoscopic incisional and ventral hernia repair carries with it the risk of morbidity and mortality. Few studies have focused on one of its most serious complications?an“enterotomy”. When enterotomy occurs during laparoscopic ventral hernia repair, most surgeons lack of associated literatures and guidelines to guide treatment prescriptively. In this paper, the risk factors and treatment of enterotomy during laparoscopic ventral wall hernia repair were analyzed.

Expression of cadherin6 in renal fibrosis of mice with unilateral ureteral obstruction

LIANG Diefei, CHANG Ruiming, SONG Zijiao, LIANG Weiwen, LIU Shanying, YAN Li, LI Yan

2018, 18(01):  9-13.  DOI: 10.3969/j.issn.1009-976X.2018.01.003

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［Abstract］ Objective To investigate the expression of cadherin6 （CDH6） in renal fibrosis. Methods Mice were subjected to unilateral ureteral obstruction（UUO）and kidneys were harvested at day 21 after operation. Hematoxylin and eosin （HE）staining was used for histopathologic examination. RT?qPCR was used to evaluate mRNA level of FSP?1, TGF?β1 and CDH6. Immunohistochemistry was used to measure protein level of FSP?1 and CDH6. HK?2 human renal proximal tubule epithelial cells were stimulated with TGF?β1. RT?qPCR or Western Blot was used to evaluate mRNA of FSP?1, TGF?β1, CDH6 or protein level of CDH6 respectively. Results Compared with Sham group, HE staining showed renal tubular atrophy and deposition of extracellular matrix in UUO group. mRNA levels of FSP?1, TGF?β1, CDH6 were up?regulated in obstructed kidneys while compared with sham?operated kidneys. Furthermore, immunohistochemistry showed that FSP?1 and CDH6 were lowly expressed in sham?operated kidneys while they were higher in obstructed ones. TGF?β1 facilitated the transition of HK?2 cells into morphology of fibroblast?like cells, up?regulating mRNA level of FN1, PAI?1, CDH6 and protein level of CDH6 in HK?2 cells. Conclusion Expression of cadherin6 and fibrosis?related biomarkers were upregulated in HK?2 cells induced by TGF?β1, accompanied with phenotype transition into mesenchymal cells. This may contribute to renal fibrosis induced by unilateral ureteral obstruction.

Dual effect of different concentrations of isoflurane anesthesia on inflammatory microenvironment

MENG Shiyu, SU Xiangfei, PENG Shuling

2018, 18(01):  14-18.  DOI: 10.3969/j.issn.1009-976X.2018.01.004

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［Abstract］ Objective To investigate the regulation of isoflurane on microglial NLR family pyrin domain containing 3（NLRP3）inflammasome?related inflammatory microenvironment. Methods Microglia cell line（BV2）was pretreated or not with lipopolysaccharides（LPS）for 30 minutes, subsequently exposed to 4% isoflurane for 6 hours. The mRNA of NLRP3 was detected by quantitative reverse transcription?polymerase chain reaction（qRT?PCR）. The protein of NLRP3 and caspase?1 P20 was analyzed by Western?blot. Production of IL?1β in the supernatants was measured by enzyme linked immunosorbent assay（ELISA）. Toxicity of isoflurane were evaluated by CCK8 cell viability assay. Results Isoflurane activated downstream of NLRP3 pathway, increased the secretion of IL?1β. There was no significant impact on BV2 cell viability, when treated with isoflurane at the experimental concentration. Conclusion Isoflurane induced microglial inflammation through the NLRP3 inflammasome pathway. NLRP3 priming is necessary in Isoflurane induced IL?1β production.

Research in the function of arresten and its mechanism in vascular smooth muscle

LU Penghui, LONG Miaoyun, LI Honghao

2018, 18(01):  19-22.  DOI: 10.3969/j.issn.1009-976X.2018.01.005

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［Abstract］ Objective To explore the function of arresten and its mechanism in vascular smooth muscle cell. Methods The proliferation of vascular smooth muscle cells affected by arresten was monitored by using live cell dynamic imaging. The angiogensis?related molecules in vascular smooth muscle cells were detected by protein microarray. The significant differential expression of associated molecules caused by arresten were detected by RT?PCR. Results Arresten inhibited the proliferation of vascular smooth muscle cells. Angiogenin, Endoglin and TIMP?1 were significantly regulated by arresten in vascular smooth muscle cells, but only the Angiogenin mRNA showed significant differential expression. Conclusion Arresten can inhibit the proliferation of vascular smooth muscle cells and its underlying mechanism possibly correlate with Angiogenin participating in the signal pathways.

Effects of LY354740 on neurocognitive impairment and Hippocampal inflammatory response after ketamine anesthesia in juvenile mice

HONG Yu, LIU Jiayi, PENG Shuling, WANG Shouping

2018, 18(01):  23-26.  DOI: 10.3969/j.issn.1009-976X.2018.01.006

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［Abstract］ Objective To investigate the effects of LY354740 pretreatment on the learning and memory impairment induced by chronic ketamine exposure in juvenile mice. Methods Forty?eight healthy male C57BL/6 mice（weighed 22?32 g）were randomized into three groups：normal saline group （group NS）, ketamine group（group Ket）, LY354740 pretreatment group（group LY）. In group Ket and group LY, ketamine（per 30 mg/kg）was injected intraperitoneally three times a day at 30?minute intervals for 5 consecutive days, while in Group LY, LY354740 was injected intraperitoneally（per 15 mg/kg）30 minutes before the first injection of ketamine every day. While in group NS inject same normal saline. Cognitive test including Morris water maze and Openfield test was carried out 24 hours after the last administration of ketamine. Mice in each group were sacrificed immediately after the test and hippocampi were harvested to determine the expression of inflammatory cytokines including IL?6, IL?1 and TNF?α using ELISA. Results Compared to group NS, the escape latency was prolonged；the time in the original platform and central area in Openfield were decreased, the frequency of crossing the original platform was decreased；the levels of hippocampal IL?1, IL?6, TNF?α were increased in group Ket（P<0.05）. While in group LY, there were no significant differences of above indexes（P>0.05）. Compared to group Ket, in group LY the escape latency was significantly shortened；the time in the original platform and central area in Openfield were prolonged；the frequency of crossing the original platform was increased；the levels of hippocampal IL?1, IL?6, TNF?α were decreased（P<0.05）. Conclusion Cognitive dysfunction induced by chronic ketamine exposure can be reversed by LY354740 pretreatment in juvenile mice, which may be associated with the down?regulation of the excessive release of hippocampal cytokines.

The expression of PPIB in papilary thyroid carcinoma and its correlation with prognosis

WANG Jue, OUYANG Nengtai

2018, 18(01):  27-31.  DOI: 10.3969/j.issn.1009-976X.2018.01.007

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［Abstract］ Objective To investigate the expression of Cyclophillin B （PPIB） protein in Thyroid papillary carcinoma（PTC）and their correlation with clinicopathological factors and prognosis. Methods Tissue samples from 98 cases of PTC and 58 cases adjacent normal tissues were surgically resected at the Sun Yat?Sen Memorial Hospital of Sun Yat?sen University from 2011 to 2014. The expression of PPIB protein were carried out by immunohistochemistry, the correlation of PPIB protein and clinicopathological features and prognosis were statistical analyzed. Results PPIB protein expression was significantly higher than normal thyroid tissue, PPIB tended to significantly correlated with age （P=0.025）, lymph node metastasis（P=0.046）, Capsular invasion （P=0.034） and TNM stage （P=0.036）. The Kaplan?Meier survival analysis suggested that PPIB overexpression was significantly associated with lymph node recurrence?free survival （LN?RFS）. Multivariate analysis confirmed the PPIB expression was an independent prognostic factor for LN?RFS in PTC patients. Conclusion In conclusion, high PPIB expression correlates with poor survival in PTC patients, which is expected to become an important indicator for clinical treatment and prognosis.

Clinical study of laparoscopic primary suture of common bile duct

ZUO Chaohai

2018, 18(01):  32-35.  DOI: 10.3969/j.issn.1009-976X.2018.01.008

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［Abstract］ Objective To study the clinical effect of laparoscopic common bile duct exploration （LCBDE） with primary closure in the treatment of choledocholithiasis and summarize experience. Methods A retrospective analysis of 41 patients from 2013 to 2017 in our hospital underwent LCBDE with primary closure（LCBDE with primary closure group）were analyzed. Another 43 patients during the same period received laparotomy choledocholithotomy with T tube drainage were assigned to control group （T tube group）. Results In LCBDE with primary closure group, hospitalization days and exhaust time were less than those in T?tube group, the difference was statistically significant（P<0.05）. There was no statistically significant difference in operative time, bleeding volume, bile leakage, wound infection rate and biliary tract stenosis between two groups（P>0.05）. Bile leakage occurred in one case in LCBDE with primary closure group and two cases in T?tube group, which were all cured by conservative treatment. Conclusion On the basis of strict assurance of indications, laparoscopic common bile duct primary suture is safe and effective for patients with common bile duct stones. But it should be operated by an experienced doctor.

The effects of fondaparinux sodium on microcirculation and inflammatory factors in hyperlipidemic rats with acute necrotizing pancreatitis

GU Xin, SANG Yunhua, WU Caisheng, LONG Hongjie

2018, 18(01):  36-40.  DOI: 10.3969/j.issn.1009-976X.2018.01.009

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［Abstract］ Objective To investigate the effects of fondaparinux sodium on microcirculation and inflammatory factors in hyperlipidemic rats with acute necrotizing pancreatitis. Methods Thirty healthy male SD rats were taken as the research objects , and randomly divided into fondaparinux group（n=15） and hyperlipidemia group （n=15）. Both of the two groups were fed with high fat diet to establish hyperlipidemia rat model. In additional, fondaparinux group had 0.1 ml/100 g weight of 5% sodium taurocholate solution injected into pancreatic duct to make acute necrotizing pancreatitis model. 0 h, 6 h, 12 h and 18 h after model making, the animals in fondaparinux group had 0.2 ml/100 g fondaparinux sodium injection. After two groups model making , the rats were prohibited food taking and drinking , and given 2 ml/100 g NS rehydration injection. Before treatment and 24 h after treatment, both of the two groups had venous blood taken for detection of serum IFN?γ, TNF?α, IL?6 and IL?10. And before treatment and after treated for 6 h, 12 h and 24 h, pancreatic head and tail micro?blood flow in the two groups were examined and compared. Rats in two groups were killed of 24 h after model making. Laparotomy was performed for obaervation of intra?abdominal tissue and pancreas , and Removal of duodenal pancreatic tissue for pathological examination. Results Compared with the hyperlipidemia group, the levels of serum IFN?γ, TNF?α, IL?6 and IL?10 before treatment in fondaparinux group were increased（all P values <0.05）. Compared with before treatment, 24 h after treatment, levels of serum inflammatory factors in fondaparinux group was decreased （all P values <0.05）. The micro?blood flow volume of pancreas head and tail in fondaparinux group was significantly increased , when compared with the hyperlipidemia group and before fondaparinux treatment（all P values <0.05）. Pathological scores of edema, necrosis and inflammatory cell infiltration in the fondaparinux group were higher than those in the hyperlipidemia group （P<0.05）. ConclusionFondaparinux sodium can improve the microcirculation and inflammatory state of rats , so as to achieve the purpose of disease treatment.

Transanal endoscopic microsurgery for patients with rectal tumors：experience with 45 patients

GUO Xiaoxi，DENG Jianzhong，LIN Yiban，LI Chaoyang，LIANG Shanshan，FENG Jielan，WU Qiaoling

2018, 18(01):  41-44.  DOI: 10.3969/j.issn.1009-976X.2018.01.010

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［Abstract］ Objective To investigate the clinical value of transanal endoscopic microsurgery（TEM） and review literature. Methods The clinical data of 45 patients with rectal lesions treated using TEM between Aug. 2014 and Feb. 2017 were summarized retrospectively. Results All 45 patients were performed TEM successfully. The lesions were 1.8 ± 0.8 cm（range, 1.0?4.0 cm）in diameter, and the distance of the anastomosis from the anal verge was 7.6 ± 2.8 cm（range, 6?17 cm）. Surgical procedures included the full?thickness excision（18 cases）and the submucosal excision with partial muscular layer excision（27 cases）. The average operating time was 72.7 ± 18.1 min（40?120 min）. The mean operative blood loss was 16.6 mL（range, 5?200 mL）. The average postoperative stay was 4.9 ± 1.7 d（4?7 d）. The postoperative pathological examination identified rectal adenomas in 18 cases, villous adenoma in 13, high grade intraepithelial neoplasia in 7, early rectal adenocarcinomas（Tis?T1）in 5, rectal carcinoid in 2. Surgical margins of all specimens were clear. Postoperative complications included wound hemorrhage in 3 cases who were cured conservatively, anal hemorrhage of internal hemorrhoids and anal canal injury in 5 who were sutured. No patient was encopresis and enterobrosis. The incidence of complications was 6.7%（3/45）. With a mean follow?up period of 15 months（2?30 months）, no abnormal defecation, no tumor recurrence and metastasis was observed. Conclusion Our outcomes are in line with the literature. The localized rectal neoplasms suitable for local excision are the main indications of TEM. TEM is a safe and effective procedure to treat rectal cancer in selected patients such as Tis?T1, and T2 is not recommended because of a higher recurrence rate. As a kind of minimally invasive surgery with fewer complications, TEM is now considered as the first choice of procedure for rectal local excision.

Surgical selection and patient reported outcomes in the elderly patients with inguinal hernia

ZHU Ruichang, LI Yunfu, DENG Donghai

2018, 18(01):  45-48.  DOI: 10.3969/j.issn.1009-976X.2018.01.011

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［Abstract］ Objective To compare open and laparoscopic hernia repair in patients ≧ 60 years old and those <60 years old with respect to patient reported outcomes. Methods A total of 137 cases of inguinal hernia surgery from January 2015 to May 2016 were included in this study, in which 72 cases were less than 60 years old（<60 group）, 65 were more than and equal to 60 years old（≧60 group）. In <60 group, 29 patients underwent laparoscopic hernia repair（TEP）and 43 open hernia repair（open）. The patient?reported outcomes（PROMS）was carried out in all patients 24 hour after surgical procedure. The PROMS included an optional survey with questions to quantify pain, general feeling, nausea, dizziness, drowsiness, satisfaction and vomiting since the operation. Results Data was presented from patients 6 months after operation by a follow?up for 137 cases. There were 8 cases reported severe pain, in which 6 patients were <60 and only 2 cases reported severe pain. This was significantly lower （P<0.05）. One patient reported moderate pain in the ≧65 TEP group and 3 in <60 TEP group. Patient satisfaction with the surgery was satisfied or very satisfied in almost all patients in all groups. Only 2 patient complained their surgical scars and post?operative pain. Conclusion The patients over 60 can expect the same high levels of satisfaction and low levels of pain following either technique for inguinal hernia repair as younger patients.

Application of unidirectional barbed suture in laparoscopic repair of gastroduodenal huge ulcer perforation

ZHENG Yifeng, LI Wei, WANG Huaiming

2018, 18(01):  49-51.  DOI: 10.3969/j.issn.1009-976X.2018.01.012

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［Abstract］ Objective To explore the safety and effectivity of unidirectional barbed suture for laparoscopic repair of the gastroduodenal ulcer perforation cases with the diameter of perforation greater than or equal to 1.0 cm. Methods From February 2014 to June 2017, 32 cases with gastroduodenal huge ulcer perforation who underwent laparoscopic repair by using unidirectional barbed suture were retrospectively reviewed, and the ulcer perforation was closed with a way of unidirectional barbed suture of full?thickness. The duration of surgery , intraoperative blood loss, flatus time after operation, hospital stay and complications were collected and analyzed. Results All of 32 cases underwent successful operations without conversion to open surgery and without perioperative complications. There were 24 cases with anterior wall of duodenal bulb ulcer perforation , and 8 cases with gastric antrum mastoideum ulcer perforation. There were 18 cases with the diameter of perforation greater than or equal to 1.0 cm and less than 1.5 cm, 10 with the diameter of perforation greater than or equal to 1.5 cm and less than 2.0 cm, and 4 with the diameter of perforation greater than or equal to 2.0 cm. The average operation duration was 43.06 ± 5.29 min. The intra?operative blood loss was 9.25 ± 3.47 ml. The flatus time after operation was 34.31 ± 7.85 h The hospital stay was 7.53 ± 1.02 d. Conclusion It is safe and effective to perform laparoscopic repair for the gastroduodenal ulcer perforation patients with the diameter of perforation greater than or equal to 1.0 cm by using unidirectional barbed suture, which This method reduces the difficulty of laparoscopic suture and beneficial to the recovery of patients.

A retrospective study of the correlation between smoking and male colorectal carcinogenesis by location

WANG Huizhong, YANG Qiong, LI Weiyu, XIE Derong, JIANG Zhimin

2018, 18(01):  52-56.  DOI: 10.3969/j.issn.1009-976X.2018.01.013

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［Abstract］ Objective To investigate the association between smoking and lesion sites of colorectal cancer in male patients. Methods Clinical data of male patients with colorectal cancer who were admitted into our hospital from 2010 to 2016 were collected and retrospectively analyzed. Patients were divided into smoking group and non?smoking group. Results There were significant differences in the age composition ratio between left?and right?sided colon cancer smoking and non?smoking group（P<0.05）. More patients with left?sided colon cancer in non?smoking group suffered from hematochezia（35.4%）, while abdominal pain seems more common in the smoking group（33.0%）（P<0.05）. The proportion of patients with high differentiation adenocarcinoma in smoking group was higher than that in non?smoking group（P<0.05）；when it comes to the smoking index, the proportion of heavy smokers in rectal cancer were higher than the right?and left?sided colon cancer patients （P<0.05）. Conclusion Smoking and location are independent factors for colorectal cancer, different parts of colorectal cancer between smoking and non?smoking groups have differences in the diagnosis of sensitivity, clinical pathology and prognosis.

Observation and experience of single?step nephrostomy access establishment by B?ultrasound guidance in percutaneous nephrolithotripsy

JIANG Maolin, CAO Zhengguo, LI Jianxin, ZHANG Chaosheng, TIAN Chao, HAN Qingjie, PENG Lian

2018, 18(01):  57-60.  DOI: 10.3969/j.issn.1009-976X.2018.01.014

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［Abstract］ Objective To explore the safety and effectiveness of establishing a percutaneous renal access by one?step expansion. Methods 368 cases who underwent percutaneous nephrolithotomy from January 2014 to October 2017 in our hospital were retrospectively analyzed. According to the different ways of channel establishment, 188 cases were treated by F6?F18 fascia dilator for standard tract percutaneous nephrolithotomy procedure（control group）, and another 180 cases were treated by F18 or F20 fascia dilator by one?step renal access establishment （one?step group）. The establishment time of channel, operation time, blood loss, average length of stay, complications, one?time rate of clear stone were recorded in two groups and were compared between the two groups. Results 368 patients were successfully established channel to complete the operation. The patients in one?step expansion group had shorter establishment time of the channel, higher primary stone clearance rate, less bleeding, as compared to those in control group（all P values were less than 0.05）. There was no significant differences in average length of stay and complication between the two groups （P>0.05）. Conclusion One?step expansion method to establish percutaneous renal access to the treatment of upper urinary tract stones is safe and reliable, which can significantly shorten the non?lithotripsy time of the surgical procedure, and increase the one?time clear stone ratio.

Effects of percutaneous nephrolithotomy combined with ureteroscopy on the treatment of complex renal calculi in the elderly

SONG Shengsheng, GU Zhiwen, ZHENG Bin, ZHAN Hejuan, CHEN Yue

2018, 18(01):  61-65.  DOI: 10.3969/j.issn.1009-976X.2018.01.015

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［Abstract］ Objective To evaluate the clinical efficacy of percutaneous nephrolithotomy （PCNL） combined with flexible ureteroscope on complex renal calculi in the elderly. Methods Eighty?eight elderly patients with complex renal calculi in our hospital from January 2015 to December 2016, were divided into control group and observation group in accordance with the admission number and even order, 44 cases in each group. The control group was given PCNL treatment, and the observation group were treated with PCNL combined with flexible ureteroscopic. The levels of serum urea nitrogen（SUN）, serum creatinine（ScR）, cystain C（CysC）, β2?MG, uric acid（UA）of the two groups were tested and compared. Serum norepinephrine（NE）, cortisol（Cor）and dopamine（DA）levels were measured preoperatively, postoperatively 6 h and postoperatively 24 h. The stone clearance rate, postoperative bleeding and infection complications were compared between the two groups. Results The stone clearance rates at postoperative 3 d and 30 d of the observation group were 93.94% , 97.73% , and both were significantly higher than those of the control group （P<0.05）. The levels of SUN, ScR, UA, β2?MG and CysC at postoperative 3 d and 30 d of the observation group were significantly lower than those of the control group （P<0.05）. The levels of NE, Cor, DA of the observation group at postoperative 6h and postoperative 24h were lower than those of the control group（P<0.05）. The length of stay and total complication rate of the observation group were 4.13 ± 1.28 d, 6.82% , and were also significantly lower than those of the control group （P<0.05）. Conclusion Compared with PCNL, percutaneous nephrolithotomy combined with flexible ureteroscopy has higher rate of stone removal, faster recovery of renal function and less complications in the treatment of complex renal calculi.

Clinical observation of treating female stress urinary incontinence with TVT?Abbrevo and TVT?Obturator

HUANG Rihuan, LIN Liguo

2018, 18(01):  66-69.  DOI: 10.3969/j.issn.1009-976X.2018.01.016

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［Abstract］ Objectives To compare the effectiveness and complications of TVT?A and TVT?O for the treatment of female stress urinary incontinence. Methods From July 2006 to December 2015, 65 patients suffering from FSUI were treated with TVT?O（n=39）or TVT?A（n=26）procedure. The clinical efficacy and operation?correlated complications were observed. Results There were no significant differences in perioperative data including operating time, intraoperative bleeding, days of indwelling catheter, length of stay between the two groups（P>0.05）. Of 65 cases in two groups, 59 cases of urinary incontinence symptoms disappeared completely, 6 cases were improved. Twenty?four cases（92.3%）were cured and 2 cases（7.7%）were improved in TVT?A group. Thirty?five cases（89.7%）were cured and 4 cases（10.3%）were improved in TVT?O group. No significant differences could be found for the curing rates between two groups （P>0.05）. Compared with the TVT?O group, the TVT?A group had lower incidence and more insignificant degree of inner thigh pain at 24 h, l W and 1 month after surgery（P<0.05）. No significant differences were observed for the incidence and degree of inner thigh pain at 3 month, 6 month and 1 year after surgery between TVT?O and TVT?O group（P>0.05）. Two cases in TVT?A group and 4 cases in TVT?O group suffered from postoperative dysuria, and given the indwelling catheter for 3 days. Two cases in TVT?A group and 3 cases in TVT?O group were found urinary frequency, and treated with Tolterodine Tartrate Tablets 2mg twice a day for two weeks. No significant differences were observed for the incidence of postoperative dysuria and urinary frequency between TVT?O and TVT?O group （P>0.05）. No intraoperative complications such as blood vessel, nerve, bladder damage were recorded and no postoperative retropubic hematoma, tape adjustment and other complications occurred in two groups. No recurrence after l year follow?up. Conclusion The study shows that TVT?A procedure is safe and efficacy in treatment of FSUI, but associated with low incidence of recent postoperative inner thigh pain.

Comparison of clinical efficacy of disposable circumcision suture device，conventional and sleeve circumcision

XU Kai，WU Zhe

2018, 18(01):  70-74.  DOI: 10.3969/j.issn.1009-976X.2018.01.017

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［Abstract］ Objective To summarize the experience of disposable circumcision suture device, conventional and sleeve circumcision and literature review. Methods Clinical data of patients receiving circumcision in our hospital （112 patients with disposable circumcision suture device, 123 with conventional circumcision and 108 with sleeve circumcision） between July 2014 and July 2016 was analyzed retrospectively. The operation time, blood loss, pain score, postoperative complication rate and postoperative penile appearance satisfaction rate were compared among these methods. Results The operation time for disposable circumcision suture device, conventional and sleeve was 5.6±3.5 min, 25.6±6.7 min and 34.3±5.4 min（P<0.001）；blood loss for these methods was 2.0±0.7 m, 12.3±5.8 ml and 4.1±2.3 mL（P<0.001）. The pain score 24 hours postoperatively was 3.1±1.1, 5.4±1.2 and 3.5±0.9（P<0.001）. The postoperative rate was 9.8% （11/112）, 16.3%（20/123） and 11.1% （12/108）（P=0.286）, and postoperative penile appearance satisfaction rate was 97.3% （109/112）、85.4% （105/123） and 95.4% （103/108） （P=0.001）. Conclusion All the surgical procedures have its own advantage and disadvantage. The disposable circumcision suture device is simple with short operation time, few blood loss and high postoperative penile appearance satisfaction rate, while the cost is high. The sleeve circumcision has longer operation time compared with conventional circumcision, with fewer blood loss, lower pain score and postoperative complication rate, higher penile appearance satisfaction. Therefore, sleeve circumcision could be considered in older boys and adults as recommendation.

Effect of bone marrow mesenchymal stem cells on expression OPG and RANKL in the bone tis? sue in diabetic rats with peripheral neuropathy

CHANG Ruiming, CHEN Jinwu, YANG Tao, WANG Peng, CHANG Jianxing

2018, 18(01):  75-78.  DOI: 10.3969/j.issn.1009-976X.2018.01.018

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［Abstract］ Objective To determine the levels of OPG and RANKL in the bone tissue of GK diabetic rats after local injection of bone marrow mesenchymal stem cells. Methods The diabetic model on GK rats was established by feeding high?fat diet（random blood sugar≥11.1 mmol/L）. The fracture was fixed with kirschner wire after the thigh?bone of rats were exploded and sawed off , then the concentrated stem cells were injected into the local area of the fracture. Bone tissue specimen were collected for detection of the expression of OPG and RANKL by immumohistochemical staining and western blot in the twelfth week, sixteenth week and twentieth week after fracture fixation. Results The expression levels of OPG was much higher in the experimental group than those in the control group , however the results of RANKL were adverse. Conclusion In the present study, our findings demonstrated that the local trans?plantation of bone marrow mesenchymal stem cells increased the expression of OPG and inhibited the expression of RANKL, which can promote fracture healing in diabetic GK rats.

A preliminary analysis of the fracture characteristics in 2003 elderly people

WANG Jianjun, LI Jianfeng, LI Xiaodong, Guo Qundi

2018, 18(01):  79-82.  DOI: 10.3969/j.issn.1009-976X.2018.01.019

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［Abstract］ Objective To investigate the fracture characteristics of 2003 elderly people （age≥50）. Methods 2003 cases of elderly people （age≥50） in our hospital from Jan. 2012 to Dec. 2016 were selected, and their clinical data were statistically analyzed. Results The incidence of fractures in male and female over the age of 60 increased with age. The incidence in female from 60 old to 80 years old was higher than that in men, and the incidence of 50 years old group and 90 year old was quite similar, and that in male was slightly higher than that in female. The male operative rates in all age groups were significantly reduced, the differences were statistically significant, while the female operative rate was not significant decreased. Incidence of female with diabetes in all ages was increased significantly, the difference was statistically significant, while male with diabetes were not increased in different age group. Compared with male diabetic patients in the 60?79 age, incidence of fractures in female diabetic patients had statistically significant differences. The incidence of hip fracture, vertebral fracture and distal radius fracture were the top three incidence sites. In addition to vertebral fractures, the incidence of other parts was significantly higher in women than that in men. In the past 5 years, the incidence of total fracture of the people in our hospital has been increasing year by year, with significant difference in statistics. Conclusion In our survey, age, sex, and diabetes in the elderly population were closely related to the occurrence of fracture in our hospital；female, diabetes, age were important risk factor of fracture.

Clinical analysis in total hip arthroplasty versus hemiarthroplasty in the management of geriatric femoral neck fractures

HUANG Jianbin, YAN Chaoyi, CHEN Yuanzhuang

2018, 18(01):  79-82.  DOI: 10.3969/j.issn.1009-976X.2018.01.020

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［Abstract］ Objective To analyze the clinical effect of the treatment of senile femoral neck fracture after total hip arthroplasty and semiarthroplasty. Methods A retrospective analysis of the clinical data of 71 cases of elderly patients with femoral neck fracture was conducted. Of 71 cases, 35 were performed total hip arthroplasty therapy （A group）, and 36 underwent hemiarthroplasty therapy （B group）. The clinical efficacy of the two group was assessed and compared. Results The operation time, hospitalization time in A group were longer than that in B group. Intraoperative blood loss, postoperative drainage volume in A group were greater than that in B group. The complications in A group was less than in B group. The postoperative Harris hip score in A group was higher than in B group. The curative rate of A group was higher than of B group. Conclusion The total hip arthroplasty and semiarthroplasty for femoral neck fracture have their own advantage and disadvantage. The results of the study are in accordance with the literature.

Effects of dexmedetomidine on inflammation factors and lung injury in ARDS patients during ventilation

YE Qiang, HUANG Jiaxing, ZHAO Qihong

2018, 18(01):  87-89.  DOI: 10.3969/j.issn.1009-976X.2018.01.021

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［Abstract］ Objective To analyze the effects of dexmedetomidine on inflammation factors and lung injury in ARDS patients during ventilation. Methods This article consisted of forty patients with acute respiratory distress syndrome（ARDS）who had been hospitalized in our hospital from. The patients were divided into two groups according to using dexmedetomidin（dexmedetomidine group, n=20）or without using dexmedetomidine （control group, n=20）. The patients of dexmedetomidine group received the management of intravenously infused with dexmedetomidine 1 μg/kg to 15 min, and followed by 0.2?0.7 μg（/kg·h）. Propofol was given intravenously the ratio of 3?5 mg（/kg·h） until 48 h later in control group. All patients were administrated with sufentanil 0.1?0.2 μg（/kg·h）in both groups. Blood was draw from vein to detect IL?6, IL?8, IL?10, and PaO2/FiO2 was recorded respectively at pre?intubation（T0）, 6 h（T1）, 12 h（T2）, 24 h（T3）and 48 h after intubation（T4）. Results Compared with T0 , the levels of IL?6, IL?8 and IL?10 were higher at T1 ?T4 in two groups（P<0.05）. PaO2/FiO2 was higher at T2 ?T4 in dexmedetomidine group and were lower at T1 ?T4 than in control group（P<0.05）. HR were higher at T1 ?T4 in dexmedetomidine group and lower in control group （P<0.05）. Compared with control group, the patients in dexmedetomidine group showed lower levels of IL?6, IL?8 and higher levels of IL?10 and PaO2/ FiO2 at T2?T4 （P<0.05）. Conclusion Administration of dexmedetomidine for the ARDS patients with mechanical ventilation reduces the release of inflammatory factors and may reduce lung injury.

Surgical intervention for acute thrombophlebitis of the great saphenous vein intact

LI Hui, DENG Donghai, HUANG Yaofeng

2018, 18(01):  90-92.  DOI: 10.3969/j.issn.1009-976X.2018.01.022

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［Abstract］ Objective To summarize the characteristics of surgical procedure for acute thrombophlebitis of the great saphenous vein intact. Methods Forty patients were enrolled in the present study and retrospectively analyzed the surgical approach in the patients with intact saphenous vein thrombophlebitis from Dongguan Qiaotou Hospital from January 2010 to December 2016. Results All 40 cases underwent high ligation of great saphenous vein and intact saphenous vein stripping surgery. Anticoagulant and anti?infection treatment were given to the patients before and after operation. No new deep vein thrombosis was found in the patients. There was no case of pulmonary embolism caused by venous thrombosis. Conclusion The high ligation of great saphenous vein and intact saphenous vein stripping surgery is a safe and effective treatment of intact saphenous vein thrombophlebitis. Preoperative appropriate anticoagulation, avoidance of compression of the lesion during operation, are important steps for prevention of serious consequences caused by venous thrombosis.

Study on the role of thromboelastography in evaluating the condition of patients with sepsis

ZHU Jianhong, ZOU Zijun, ZHI Yaowei, HUANG Canxia, LI Mu, ZHENG Yongyi, HE Zhijie

2018, 18(01):  93-96.  DOI: 10.3969/j.issn.1009-976X.2018.01.023

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［Abstract］ Objective To study the value of thromboelastography（TEG）in the evaluation of sepsis. Methods Fifty?five patients with sepsis from April 2017 to November 2017 in the Department of Critical Care Medicine of Sun Yat?sen Memorial Hospital, Sun Yat?sen University were analyzed retrospectively. According to the SOFA score, the patients were divided into Group A（SOFA score≥ 10）（26 cases）and Group B （10>SOFA score≥2）（31 cases）. Another 43 cases with non?sepsis and normal coagulation function were selected as a control group（Group C）. The venous blood was collected for TEG, and then analysis and comparison of various TEG indicators between groups. Results The time of coagulation reaction（R value）and thrombin formation（K value）were compared in each group：Group A > Group C > Group B, the results were statistically significant （P<0.05）, the rate of fibrin clot formation and reinforcement（α Angle）and the maximum strength and hardness of blood clot（MA value）：Group A < Group C < Group B, the results were statistically significant （P<0.05）. R and K value were positively correlated with the SOFA score （All P values <0.05）, and α Angle, MA value were significantly negatively correlated with the SOFA score（All P values <0.05）. The 28?day mortality rate of Group B was 12.9% and with the increase of SOFA score, the 28?day mortality rate of Group A was 46.1%. Conclusion Thromboelastography can analyze the coagulation status of sepsis patients comprehensively and accurately, and there is a significant correlation with SOFA score. Monitoring the thromboelastography is of great significance to evaluate the severity of sepsis patients and guide the treatment.

Multislice spiral CT angiography and clinical experience of surgical treatment for guidance of cerebral aneurysm subarachnoid hemorrhage

ZENG Weijin, PAN Heng, LIN Xizhou, PENG Cuilan, LV Xiujin

2018, 18(01):  97-100.  DOI: 10.3969/j.issn.1009-976X.2018.01.024

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［Abstract］ Objective Research and sum up of clinical application of MSCTA in diagnosis of cerebral aneurysms. Methods The clinical data of 60 patients with suspected subarachnoid hemorrhage who underwent MSCTA in our hospital from October 2014 to January 2017 were selected, Among them, 15 cases underwent conservative treatment, and the remaining 45 cases underwent MSCTA got surgical treatment, which including 41 cases underwent DSA endovascular treatment and 4 cases underwent craniotomy. The diagnostic accuracy, application value and the author’s experience of CTA were analyzed. Results A total of 47 cerebral aneurysms were diagnosed by MSCTA in 45 patients, while 49 cerebral aneurysms were detected by DSA and craniotomy. The diagnostic coincidence rate was 95.9%. There was no significant difference between CTA and DSA that used to analyze the long axis of the tumor, the short axis of the tumor, and the neck of the tumor, P>0.05. Conclusion For patients with intracranial aneurysms, the detection of MSCTA has important clinical significance. It is helpful, safe and reliable to show the tumor size and neck of the patients intracranial aneurysm.

Common early complications after cardiac transplantation and management progress

CHEN Liu, CHEN Yinghua, ZENG Kuan

2018, 18(01):  101-104.  DOI: 10.3969/j.issn.1009-976X.2018.01.025

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［Abstract］ Cardiac transplantation is the best treatment for end?stage heart failure. However , heart transplant surgery is still developing slowly, and one of the major causes of complications is postoperative complications. Therefore, timely intervention of complications is the key to improve the effect of transplantation. By referring to a large number of domestic and foreign literature, the article reviewed the possible complications and treatment after heart transplantation.

Status of circulating tumor cell research and clinical application in hepatocellular carcinoma patients

LIU Yunqiang, HU Zemin

2018, 18(01):  105-109.  DOI: 10.3969/j.issn.1009-976X.2018.01.026

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［Abstract］ Hepatocellular carcinoma（HCC）is one of the common malignant tumors in China. In recent years, the incidence of liver cancer and mortality have increased year by year, and postoperative recurrence and metastasis are considered to be the leading cause of death in patients with liver cancer. As a research hotspot of liver cancer in recent years, circulating tumor cells（CTCs）have been proposed as real?time and noninvasive monitoring of the changes of liver cancer patient s condition, which can be better assessment of postoperative prognosis of liver cancer and develop individualized treatment options. This article reviews the current status of circulating tumor cells in hepatocellular carcinoma in recent years.

Analysis of the relative factors in the postoperative chronic pain after inguinal hernia tension?free herniorraphy

CHEN Yuhang, LIU Xiaoming, LI Haibo, LIANG Lingling, WANG Lingling

2018, 18(01):  110-113.  DOI: 10.3969/j.issn.1009-976X.2018.01.027

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［Abstract］ Over the past hundred years, the main focus in inguinal hernia was how to implement a flawless surgery and how to reduce postoperative recurrence, while the existence and hazard of postoperative chronic pain were always ignored. Until the 1980s, the problem of postoperative chronic pain has emerged after the effective control over the recurrence rate after herniorraphy. How to reduce its incident rate has become a hot research area at present. By literature reviewing, good understanding of neuroanatomy in inguinal area and proficiency of surgical treatment and intraoperative standard operation were able to lower the incident rate of postoperative chronic pain after inguinal hernia tension?free herniorraphy.

Investigation and analysis of nurses transfer of ICU out patients in general wards

MO Hongping, WANG Yucui, CAI Min, HUANG Chunrong, HUANG Yuehua, FENG Xiaoling

2018, 18(01):  114-120.  DOI: 10.3969/j.issn.1009-976X.2018.01.028

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［Abstract］ Objective To investigate the cognition status of ICU nurses and general ward nurses on ICU shift out patients, and to provide evidence for effective implementation of continuing nursing services and related knowledge training for ICU out patients. Methods A self?designed questionnaire was used to investigate the status of cognition, attitude and implementation of 107 ICU nurses and 373 general ward nurses in Guangzhou 3A hospital. Results The study found that the nurse ICU and general ward in shift for patients with general information, vital signs, disease specialist transfer, mental status, hospital infection, drug delivery, transfer of goods with transfer and other aspects, cognition are different；that is very important for nurses in general wards and ICU nurses on drugs, transfer of ICU roll out with pipeline and skin transfer. Conclusion The different systematic and standardized training should be provided for the different training needs of ICU nurses and general ward nurses.

Case management care model improves initial re?examination rate of breast cancer patients

CHEN Lin, WANG Lizhen, XU Tai, LI Lu, SONG Junfeng, ZHOU Lanlan

2018, 18(01):  117-120.  DOI: 10.3969/j.issn.1009-976X.2018.01.029

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［Abstract］ Objective To investigate the effect of case?management care model on initial reexamination rate of breast cancer patients. Methods 145 cases with breast cancer were included in the study. Of them, 64 cases who received routine medical treatment and nursing care were assigned to the routine medical care group in our hospital from January to March 2015, 81 cases who were performed a case?management care model and conventional medical treatment were as the case?management mode group from January to March 2016. The patients in two groups were told to be reexamined 3 months after the completion of the operation (or end of adjuvant therapy). The patient s initial reexamination rates were compared before and after administration of case management care model between two groups. Results In the patients in outine medical care group, the initial reexamination rates were in 65.63%, and case?management care model group, the initial reexamination rates were in 87.65%. The difference between two group was statistically significant（P<0.05）. Conclusion Case management care model would effectively improves initial reexamination rate of breast cancer patients.

Nursing of allogeneic orthotopic heart transplantation application of standardized nursing in cardiac transplantation

CHEN Shuhong, TAN Shufang, CHEN Zhaolun, CHEN Jin, CHEN Chunling, LAI Cuiping, CHEN Zhaolun

2018, 18(01):  121.  DOI: 10.3969/j.issn.1009-976X.2018.01.030

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［Abstract］ Objectives To summarize the experience of the nursing cooperation of allograft in situ heart transplantation. Methods Orthotopic heart transplantation surgery was performed in 10 patients with dilated heart disease. The brief surgical prodedure, nursing cooperation and experience were introduced and discussed. Results All cardiac transplants were successfully completed. One patient died of gastrointestinal bleeding and hemorrhagic shock. One case was filled the gauze strips in anastomotic site and pulled out after 24 hours. Hospitalization time was 14?30 days after operation, and the ICU monitoring time was 7?12 days. Conclusion Adequate preoperative preparation, effective warm keeping measures during operation, skilled nursing coordination, personnel deployment, and good myocardial protection are effective guarantee for successful cardiac transplantation.