Table of Content

20 April 2018, Volume 18 Issue 02

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Annual progress of HER2 positive metastatic breast cancer

CHAI Jie, YAO Herui

2018, 18(02):  123-127.  DOI: 10.3969/j.issn.1009?976X.2018.02.001

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Breast cancer is one of the most common malignant disease in China. HER2 positive meta?static breast cancer accounted for 25% to 30%. The prognosis of HER2 positive metastatic breast cancer is poor, how to improve the therapeutic effect of HER2 positive metastatic breast cancer have vital clinical-significance, including optimize targeted therapy, selection of chemotherapy and strategy beyond first-line therapy. This article based on the 2017 breast cancer conference and reviewed the latest progress of HER2 positive metastatic breast cancer.

Identification of differentially expressed genes in Hepatoblastoma using bioinformatics analysis

CHEN Ziyue, WU Yaohao, ZENG Lexiang, QIU Ronglin, ZHOU Jiajia, ZHANG Jie, DENG Xiaogeng

2018, 18(02):  128-132.  DOI: 10.3969/j.issn.1009?976X.2018.02.002

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Objective To screen the differentially expressed genes（DEGs）between hepatoblastoma tissues and normal fetal liver tissues, to explore the mechanism of Hepatoblastoma, and to provide new gene diagnosis and gene therapy methods. Methods Data of hepatoblastoma tissues and the normal controls were extracted from GEO database. The R software RSTUDIO was used to explore the DEGs. DAVID Online （http：// david.ncifcrf.gov/） was used to perform the Gene ontology （GO） analysis. STRING Online （http ：//string-db.org） was used to integrate the protein-protein interaction network. Results A total of 290 DEGs（99 up-regulated genes and 191 down-regulated genes）were identified （P<0.05）. GO analysis indicated that Cell division, Extracellular exosome, as well as Metal ion binding were significantly enriched in up-regulated DEGs. And lipoprotein metabolic process, extracellular exosome, as well as heme binding were enriched in down-regulated DEGs. PPI network identified 12 hub-genes, including IMPDH2、AGXT、ALDH1A1、ALDH2、PFAS、SERPINC1、AGXT2、KNG1、 APOA1 、MAT1A 、APOC3 and HSD17B6. Conclusion With a variety of bioinformatics methods, a series of DEGs between Hepatoblastoma tissues and their normal control were explored. The might functions and expression of these genes in hepatoblastoma tumor were explained in different perspectives, which could provide theoretical basics of gene diagnosis and therapy in hepatoblastoma.

Expression and clinical significance of Polo?like kinase 3 in prostate cancer

LIN Chunhao, LAI Yiming, PENG Shengmeng, HUANG Hai, GUO Zhenghui.

2018, 18(02):  133-136.  DOI: 10.3969/j.issn.1009?976X.2018.02.003

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Objective To investigate the expression of Polo?like kinase 3（Plk3）in prostate cancerand its clinical significance. Methods Immunohistochemistry was performed to detect the expression of Plk3 in the tissues of 68 cases of prostate cancer and 10 cases of prostate. The relationship between the expression of Plk3 and clinicopathological features was analyzed. GSEA analysis was conducted to explore relationship between gene sets of proliferation or metastasis and Plk3 expression in 498 cases of prostate cancer in TCGA database. Results The positive rate of Plk3 in prostate cancer tissues was significantly higher than that in normal prostate tissues（P=0.034）. The expression of Plk3 was correlated with the pathological grade, clinical stage, tumor stage, lymph node metastasis and distant metastasis（P<0.05）but not age and Gleason score（P>0.05）. The results of GSEA analysis showed that Plk3 was associated with the proliferation and metastasis of prostate cancer. Conclusion Plk3 is up?regulated in prostate cancer and promotes the progression of prostate cancer, which may play a role in promoting proliferation and metastasis.

Calcium and phosphorus metabolism in patients with primary aldosteronism and its correlation withfibroblast growth factor 23

LIN Ying, TANG Juying#, ZHANG Shaoling, LI Feng, ZHANG Xiaoyun, MAI Lifang, GUO Ying, YAN Li

2018, 18(02):  137-141.  DOI: 10.3969/j.issn.1009?976X.2018.02.004

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Objective To compare calcium and phosphorus metabolism and fibroblast growth factor 23（FGF23）level in patients with primary aldosteronism（PA）and essential hypertension（EH）, and to explore the correlation between them. Methods A total of 123 cases with PA and 123 cases with EH individually matched1：1 by gender, age, blood pressure and duration of hypertension were recruited from in-hospital patients who were hospitalized because of suspicion of secondary hypertension. The differences in calcium and phosphorus metabolism as well as FGF23 were compared between two groups. Result FGF23, PTH levels were higher in PA patient than that of EH patients, 271.31（173.91, 504.34）pg/mL vs. 160.41（118.08, 235.60）pg/mL, 74.5 pg/mL（46.5, 91.0）vs. 43.60（33.75, 60.25）pg/mL, P<0.001. However the levels of serum calcium and blood phosphorus were decreased in PA group, 2.18±0.17 vs. 2.33±0.17 mmol/L and 1.013±0.204 vs. 1.127±0.190 mmol/L, all P values <0.001. In PA group, FGF23 was negatively correlated with the level of serum phosphorus（r=- 0.502, P=0.001）, which was positively correlated with the PTH level（r=0.349, P=0.030）. With the increase of aldosterone level in PA group, FGF23 showed an upward trend（P<0.05）. Conclusion The level of FGF23 was significantly elevated in PA patients, and FGF23 was correlated with serum phosphorus and PTH levels. FGF23 may be associated with high aldosterone level.

Application of small intestinal submucosa mesh for inguinal hernia repair in adolescent patients aged from 14 to 18 years

ZHANG Tao, WANG Liang, LIU Meibao, Li Yingru

2018, 18(02):  142-145.  DOI: 10.3969/j.issn.1009-976X.2018.02.005

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Objective To evaluate the efficacy of hernioplasty using small intestinal submucosa mesh to repair inguinal hernia in adolescent patients aged from 14 to 18 years. Methods Forty-seven cases of adolescent patients were divided into two groups, the treatment group and the control group. The patients in treatment group were treated with small intestinal submucosa mesh, while the patients in control group underent high ligation of hernia sac. The operation time, the amount of bleeding, the time of hospitalization, postoperative complications and recurrence were observed and analyzed. Results The average operative time in the treatment group（51.6 ± 12.7 min）was higher than that in the control group （38.2 ± 7.5 min）（P<0.05）, and the average hospitalization time（3.4 ± 1.1 d）was lower than that in the control group（5.1±1.3 d）（P<0.05）. There was no significant difference in the amount of bleeding between the treatment group（14.4±6.5）ml and the control group（13±5.9）ml（P>0.05）. There were no significant differences in the incidence of postoperative complications, recurrence rate and postoperative pain score between two groups. Conclusion For adolescent patients with inguinal hernia aged from 14 to 18 years, the use of small intestinal submucosal mesh for tension-free hernia repair is effective, which could shorten the length of hospital stay, and would not increase the incidence of postoperative pain and complications.

Sonographic and mammographic features to distinguish DCIS and DCIS with microinvasion

WANG Hongli, LIN Jinjiang, LAI Jianguo, GU Ran, YANG Yaping, TAN Cui, LIU Fengtao, JI-ANG Xiaofang, HU Yue, SHEN Shiyu, MEI Jingsi, SU Fengxi

2018, 18(02):  146-149.  DOI: 10.3969/j.issn.1009-976X.2018.02.006

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Objective To compare the sonographic and mammographic features in patients with ductal carcinoma in situ（DCIS）and DCIS with microinvasion（DCISM）. Methods A total of 147 women （94 DCIS and 53 DCISM） were retrospectively included. The sonographic lesions were classified as either masses or non-mass abnormalities. The lesions on mammography were classified as calcifications only, mass, asymmetry or architectural distortion. Statistical comparisons were made using Mann?Whitney U test, χ2 test, Fisher′s exact test and multiple logistic regression analysis. Results Univariate and multivariate analyses showed that the presence of microcalcifications and vascularity on sonography were associated with DCISM（P=0.038, P=0.025）. Moreover, a greater range of calcification distribution were associated with a higher likelihood of DCISM（P=0.002）. Conclusion The presence of microcal-cifications and vascularity on sonography or a great range of microcalcification distribution on mammo-graphy may suggest DCISM.

Diagnosis and treatment of acute mesenteric vein thrombosis ：a report of 36 cases

LI Bo, ZHANG Chengsheng, REN Wei

2018, 18(02):  150-154.  DOI: 10.3969/j.issn.1009?976X.2018.02.007

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Objective To summarize the experience in treatment of acute superior mesenteric vein thrombosis（SMVT）and explore the better treatment approach. Methods A retrospective analysis were conducted in 36 patients with SMVT admitted to the Department of Vascular Surgery of the First Affiliated Hospital of Chongqing Medical University from January 2006 to December 2014. Results Of 36 cases, 5（13.9%）were dead, 31（31.6%）got improved, 7（19.4%）were re-operated. Conservative treatment was in 15 cases and 14 were cured. Surgical approach was in 15 cases and 12 discharged. Five cases got re- operated in 30 cases of conservative treatment and surgical procedure, in which 2 patients died of severe systemic infection with acute renal failure after reoperation because of abdominal pain and abdomi-nal distension after primary surgery, one case died of MODS within 48 hours after emergency necrolytic bowel resection. Interventional treatment was performed in 6 cases, 5 cases discharged, 2 cases were re- operated, and one case of SMA catheterized thrombolysis for 6 days died of severe intracranial hemorrhage. In addition, one case of DVT occurred 40 days after treatment, and did of pulmonary embolism, pulmonary infection and ARDS. Conclusion The preoperative diagnosis of SMVT is not easy. For patients with unexplained acute abdominal pain, this disease should be suspected in time. Early detection and treatment can improve the outcomes of this disease. Thrombolysis and thrombectomy can be used early in the course of the disease. Patients with signs of intestinal necrosis should undergo surgery in time and be treated with anticoagulation.

The implantation of ADM to which ADSCs adhere promote the dermal reparation of expander flap

LIU Zhihan, XIAO Xiaolian, LIANG Weiqiang, ZHANG Jinming

2018, 18(02):  155-161.  DOI: 10.3969/j.issn.1009?976X.2018.02.008

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Objective To investigate the effect of adipose?derived stem cells （ADSCs） on the expanded flaps. Methods Expander model was established by using the adult female SD rats. Between skin and the expander, theAcellular dermis matrix（ADM）to which ADSCs adhere is held under skin. The expanded skin flaps were harvested after three weeks. Immunohistochemically stainingwas performed to characterize the form of organization.Western blot was performed to explore the change of Col Ⅰ and fibronectin protein expression. Transforming growth factor-β 1 （TGF-β 1） was measured by QPCR. Results The histologic sections demonstrated that ADSCs promote TGF-β1. On the first week and the second week postoperatively, the ColⅠand fibronectin significantly increased with ADSCs, but reduced remarkably in the third week. QPCR demonstrated high expression of TGF-β 1 in the first week after operation, then it declined with time. Conclusion ADM loaded with ADSCs provided a new experimen-tal basis to promote reconstruction of dermis of expander flap in expander operation.

Clinical significance of LINC0047 in renal cell carcinoma and its effect on 786?O cells

CHEN Haicheng, CAI Yuhong, ZHENG Zaosong, CHEN Zhiliang, XIE Wenlian*

2018, 18(02):  162-166.  DOI: 10.3969/j.issn.1009?976X.2018.02.009

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Objective To investigate the expression and clinical significance of long non-coding RNA（lncRNA）LINC00475 in renal cell carcinoma（RCC）, and analyze the effect of LINC00475 on the proliferation and migration of 786?O cells. Methods The expression of LINC00475 in RCC and adjacent normal tissues was detected by qRT-PCR. The clinical significance and prognostic value of LINC00475 in RCC was analyzed using TCGA data.LINC00475 expression was down?regulated by trans-fecting siRNA into 786-O cells. Later, the proliferation and migration of 786-O cells were detected by MTS and transwell assays. Finally, the potential molecular mechanism of LINC00475 involved in RCC was analyzed by gene enrichment analysis （GSEA）. Results The expression of LINC00475 in RCC tissues was significantly higher than in normal tissues. The expression of LINC00475 was positively asso-ciated with tumor stage（P=0.010）and M stage（P=0.022）. Meanwhile, patients with higher LINC00475 expression had a shorter survival time than patients with lower LINC00475 expression. Moreover, knock-down LINC00475 could significantly inhibit the proliferation and migration of 786-O cells. Finally, GSEA revealed that the gene sets associated with cyclin D1, VEGFA, WNT signaling pathway were signif?icantly up-regulated in LINC00475 high expression group（NOM P<0.01, FDR Q<0.05）. Conclusion LINC00475 was overexpressed in RCC and knockdown LINC00475 could inhibited the proliferation and migration of 786?O cells. LINC00475 might be an important biomarker in RCC.

The mechanism of hyperglycemia promoting the formation of renal calcium oxalate stone under hyperoxaluria

SHENG Yiyu，LI Zhuohang，HUANG Xin，XU Kewei

2018, 18(02):  167-171.  DOI: 10.3969/j.issn.1009?976X.2018.02.010

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Objective To explorethe mechanism of hyperglycemia promoting the formation of calcium oxalate stones through cell and animal experiments. Methods Eight?week?old Wistar male rats （40 rats in total）were randomized into 4 groups：negative control group，hyperoxaluria model group， hyperglycemic model group，hyperglycemia group with high oxalic acid urine model group；10 rats in each group. The mRNA levels of the OPN，MCP?1，Cbfa1 and BMP?2 were analyzed with real?time reverse transcription polymerase chain reaction. The protein levels of OPN and MCP?1 in culture medium of renal tubular epithelial cells were detected by enzyme ? linked immunosorbent adsorption assay. Detecting calcium oxalate stones in renal tissue of rats from each group by calcium salt staining. Detecting the apoptosis of renal tubular epithelial cells in each group by apoptosis test. Detecting the expression of OPNin rat kidney tissues from each groupby immunohistochemistry. Detecting the expression ofkidney tissues from each groupby immunohistochemistry. Detecting the expression of MCP?1 in rats 24 hours urine from each group by enzyme linked immunosorbent adsorption assay. Results PCR and enzyme linked immunosorbent assay showed that OPN and MCP?1 were up?regulated in both mRNA and protein levels in high concentrations of glucose medium. Therewere large amounts of calcium salt deposition in renal tubules，large number of renal tubular epithelial cell apoptosis and OPN increased significantly in kidney tissues in hyperglycemia combined with hyperoxaluria model group，MCP?1 was increased in 24 hours urine from hyperglycemia combined with hyperoxaluria model group compare to other groups. Conclusion Hyperglycemia can induce the expression of chemokine，OPN and MCP?1，in renal tubular epithelial cells. Underhyperoxaluria，hyperglycemia can lead to the increase of apoptosis of renal tubular epithelial cells，and the formation of calcium oxalate stone increases. Hyperglycemia may contribute to the formation of calcium oxalate stones by increasing the local inflammatory response.

Observation of elastic wire ligation stapler on treatment of mixed hemorrhoids in 48 patients（39 cases of RPH controls）

WANG Yong, ZHONG Jiantao, LIU Shuiping, YAO Jinwang, DENG Qun, HUANG Weixiang, YANG Liu′e

2018, 18(02):  172-178.  DOI: 10.3969/j.issn.1009?976X.2018.02.011

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Objective To observe the clinical effects of elastic thread ligation stapler in the treatment of mixed hemorrhoids. Methods Eighty- seven patients with mixed hemorrhoids were divided into treatment group（48 cases）and control group（39 cases）. The treatment group was treated with elastic thread ligation stapler, while the control group was treated with Rubber ring ligation stapler. The clinical curative effects, pain degree, healing time, postoperative hemorrhage, edema, anal stenosis and other complications were observed and analyzed. Results The cure rate was 93.75%（45/48）in the treatment group, while the control group was 89.74%（35/39）. There was no significant difference in the overall efficacy between the two groups（P>0.05）. However, postoperative pain, postoperative edema, postoperative bleeding and wound healing time in the treatment group were significantly lower than those in the control group（P<0.05）. Moderate anal stenosis occurred in 3 patients in the treatment group at the third week of follow- up and 4 in control group, and the symptoms were improved after 3 to 5 anal expansions. Conclusion Elastic thread ligation treatment is superior to the rubber ring ligation stapler.

Clinical analysis of 63 cases undergoing laparoscopic splenectomy for splenic traumatic rupture by the ligation of splenic pedicle by snare

KONG Lianguang, WANG Danchuan, ZHENG Xiangzhen, MAI Weijin, CAO Jiezhi, WEI yisheng

2018, 18(02):  175-178.  DOI: 10.3969/j.issn.1009?976X.2018.02.012

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Objective To investigate the safety and feasibility of laparoscopic splenectomy（LS）for splenic traumatic rupture. Methods The clinical data of 63 cases with splenic traumatic rupture from March 2009 to August 2017 were analyzed retrospectively. Forty-eight cases underwent splenic artery ligation followed by the ligation of splenic pedicle by snare, 15 cases underwent secondary splenic pedicle dissection. Results Sixty cases underwent successfully LS, 3 cases required the conversion to laparotomy due to the splenic bleeding or the serious adhesion. The operative time was 60- 170 min with a mean time of 120 min, whilst the mean volume of blood loss was 100-800 ml with a mean volume of 400 ml. No complication such as hemorrhea, pancreatic fistula or thrombosis occurred following LS. Conclusion Splenic artery ligation followed by the ligation of splenic pedicle by snare or secondary splenic pedicle dissection in LS for splenic traumatic rupture is safe and feasible with the satisfactory effect, the minimal invasion, the rapid recovery, the short hospitalizing time, which is worth spreading in clinically.

Analysis of postoperative analgesic efficacy of continuous and single- shot transversus abdominis plane block after laparoscopic cholecystectomy

DENG Huajun, XU Peng

2018, 18(02):  179-182.  DOI: 10.3969/j.issn.1009?976X.2018.02.013

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Objective To analyze the postoperative analgesic efficacy of continuous transversus transversus abdominis plane block（CTAPB）and single- shot transversus transversus abdominis plane block（SCTAPB） after laparoscopic cholecystectomy. Methods Ninety patients scheduled for laparoscopic cholecystectomy were divided to three groups（n=30, each）：the control group, STAPB group（group S） and CTAPB（group C）. In group S and group C, STAPB and CTAPB were performed after the tracheal intubation respectively, and patient- controlled intravenous analgesia（PCIA）were performed in all the patients in three groups postoperatively. Visual Analog Scale（VAS）scores of the superficial incisional site and deep abdominal pain at 1, 6, 12, 24, 48, 72 h, total pressing times of PICA pumps, adverse effects and patients′ satisfaction degrees for postoperative analgesia of all the postoperative patients were recorded. Results VAS scores of the superficial incisional site and deep abdominal pain at 1, 6 and 12 h were significantly lower in group S and group C than that in the control group（P<0.05）. There was no significant difference in the VAS scores of the superficial incisional site and deep abdominal pain at 24, 48 and 72 h between group S and the control group（P>0.05）, however, it was lower in group C than that in group S and control group（P<0.05）. Total pressing times of PICA pumps in group S and group C were significantly less than that in the control group（P<0.05）, and it was less in group C than that in group S significantly（P<0.05）. Incidence rates of nausea were lower in group S and group C than that in the control group（P<0.05）. Patients′ satisfaction degrees for postoperative analgesia were higher in group C than that in group S, and it was also higher in group C than that in group S（P<0.05）. Conclusions Ultrasound-guided CTAPB could enhance postoperative analgesic efficacy, reduce opioid con-sumptions and improve patients′ satisfaction degrees for postoperative analgesia, which might become an ideal analgesic method after laparoscopic cholecystectomy.

Ultrasound?guided quadratus lumborum block for analgesia after total hysterectomy

WANG Jian, YE Xijiu

2018, 18(02):  183-187.  DOI: 10.3969/j.issn.1009?976X.2018.02.014

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Objective To observe the effect and adverse reaction of the quadratus lumborum block after total hysterectomy. Methods A randomized, double-blind, controlled trial was performed. Forty patients who were age 43 to 55 years old and ASA class Ⅰ~Ⅱwas randomly divided into two groups and received bilateral ultrasound-guided quadratus lumborum block with either 0.4 mL/kg（2.5 mg/mL） ropivacaine or saline after total hysterectomy. All the patients received a postoperative analgesic regimen of sufentanil, dezocine administered by a patient?controlled pump. Then we recorded the visual analogue scores（VAS）of 2, 12, 24, 48 hours after operation, the times pressing the analgesic pump button, the times and the dosage of oxycodone used in ward, the time getting out of bed, the first time of exhaust after operation and the side effects. Results The observation group has a lower visual analogue scores for resting at 2, 12, 24 hours after operation, a lower moving VAS at 2, 12, 24, 48 hours after operation, the less times of pressing the analgesic pump button, the less times and the dosage of oxycodone used in ward. There were no more significant difference found in two groups. Conclusion Ultrasound-guided quadratus lumborum block can reduce postoperative pain for patients after total hysterectomy.

Observation and characteristics of Narcotrend guided sevoflurane combined with propofol anesthesia in laparoscopic gynecological operation

LIU Chungui, SU Yahai, WANG Haiyang, ZHANG Jiale, QUAN Shoubo

2018, 18(02):  188-191.  DOI: 10.3969/j.issn.1009?976X.2018.02.015

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Objective To study the effects of Narcotrend guided sevoflurane combined with propofol anesthesia in patients undergoing gynecological laparoscopic operation and the influence on hemodynam-ics, cognitive function and dosage of sevoflurane. Methods Eighty patients who underwent elective gynecological laparoscopic operation in the hospital from January 2016 to March 2017 were selected as the subjects. The patients were assigned to Narcotrend group and control group, 40 cases in each group. All patients were given intravenous- inhalation combined anesthesia. Narcotrend group was given Narco-trend-guided anesthesia while the control group was given anesthesia according to the clinical experience of anesthesiologists. According to patient′s vital signs, the appropriate depth of anesthesia was maintained. The heart rate and mean arterial pressure of patients were recorded on entering（T0）, at 2 min after in-duction of anesthesia （T1）, at tracheal intubation （T2）, at the establishment of pneumoperitoneum （T3）, at 15 min after establishing pneumoperitoneum（T4）and at extubation（T5）. The dosage of sevoflurane and remifentanil and spontaneous breathing recovery time were compared between the two groups. The cognitive function was assessed. Results The heart rate and mean arterial pressure of Narcotrend group at T2, T3 and T5 were significantly lower than those of the control group（P<0.05）. The dosage of sevoflurane and propofol and spontaneous breathing recovery time in Narcotrend group（10.82±1.95 ml/h, 0.16±0.03 μg/kg · min, 9.31±1.68 min）were significantly less or shorter than those in the control group（13.15±2.36 ml/h, 0.20±0.04 μg/kg·min, 10.65±1.92 min）（all P values<0.05）. Scores of mini?mental state examination （MMSE） and Montreal cognitive assessment （MoCA） in Narcotrend group at 1 d after operation were significantly higher than those in the control group（P<0.05）. Conclusion The Narcotrend- guided gynecological laparoscopic operation can make anesthesia closer to the ideal state, reduce the dosage of anesthetics, stabilize hemodynamics and reduce the impact on cognitive function.

Clinical application of brachial plexus block by ultrasound-guided in limb surgery

ZHANG Xiaoyi, WANG Jinchang, YANG Weixiong

2018, 18(02):  192-194.  DOI: 10.3969/j.issn.1009?976X.2018.02.016

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Department of Anesthesiology, Lufeng People′s Hospital, Guangdong 516500, China. Objective To observe the safety and superiority of ultrasound-guided interscalene brachial plexus blockade in limb surgery and summarize experience. Methods Eighty patients with limb sur-gery were included in this study. Of them, 20 cases underwent surgical procedure by ultrasound-guided interscalene brachial plexus blockade way, while another 20 were treated with an anesthetic method by blind approach to brachial plexus block. The vital signs, effects of nerve block, complications between two groups were recorded and compared. Results The time of anesthesia initiation, the duration of anal-gesia and the success rate of the patients in the ultrasound-guided group were all superior to those of the blind brachial plexus block group, and the difference between the two groups was statistically significant （P<0.05）. The number of complications in blind approach-brachial plexus block group was higher than that in the ultrasound guided group, but the difference was not statistically significant（P>0.05）. There was no significant difference in the MAP, HR and RR between the two groups（P>0.05）. Conclusion Ultrasound-guided brachial plexus block can help to the anesthetic to the accurate position and improve the quality of anesthesia.

Expression and clinical significance of SATB-1 and α-SMA in pancreatic cancer

WEI Lusheng, LU Yuanting, YE Huilin, ZHOU Quanbo, CHEN Rufu

2018, 18(02):  195-200.  DOI: 10.3969/j.issn.1009?976X.2018.02.017

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Objective To investigate the expression level and clinical significance of special AT-rich sequence binding protein 1（SATB-1）and α-smooth muscle actin（α-SMA）in pancreatic cancer. Methods Immunohistochemical staining was performed to analyze the expression of SATB- 1 and α- SMA in 71 pancreatic cancer tissue, the clinicopathological features were collected, and the clinical relationship between the SATB-1 and α-SMA expression and clinicopathological features. Results The positive expression rate of SATB- 1 and α- SMA was 70.4% and 77.5%, respectively. Kaplan- Meier analysis showed that the expression levels of SATB-1 and α-SMA was relative with overall survival time of pancreatic cancer patients. Cox regression analysis showed that differentiation and SATB- 1 expression were independent prognosis factors of pancreatic cancer patients. Chi- square test showed that SATB- 1 expression was relative with the expression of α- SMA（P<0.05）. Conclusion SATB- 1 and α- SMA was over- expressed in pancreatic cancer, and SATB- 1 deserved as an independent prognosis factor of pancreatic cancer.

The causes and prevention measures of early postoperative complications of unstable intertro?chanteric fracture patients

YIN Wanle

2018, 18(02):  200-203.  DOI: 10.3969/j.issn.1009?976X.2018.02.018

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Objective To explore the causes and prevention measures of early postoperative compli-cations of unstable intertrochanteric fracture patients. Methods Atotal of 120 patients with unstable intertrochanteric fracture were assigned to two groups, the proximal femoral nail antirotation group （group A, n=60）and the locking plate internal fixation operation group（group B, n=60）. The postoper-ative recovery and complications were compared between the two groups. Results Group A was signifi-cantly better than group B in the operation, fracture healing and daily living ability, and the differences between the two groups were statistically significant（all P values <0.05）. The complications of group A were associated with delayed union, coxa vara and femoral head cuttingout of dynamic hip screw. Group B was mainly focused on the delayed healing of fracture. In the two groups, there were a small number of patients with the complications of pressure sores, urinary tract infection, pulmonary infection, and deep venous thrombosis in the lower extremity. There was no significant difference in the total incidence of the two groups（P<0.05）. Conclusion Complications can occur early in patients with unstable intertrochan-teric fracture after proximal femoral nail antirotation and locking plate internal fixation operation, and the corresponding preventive measures should be taken into account.

Effects of femoral anteversion measurement by c-arm on antetorsion control deringintramedullary nai fixation in treatment of femoral proximal and middle fractures

MO Huagui, LUO Yuqiang, HUANG Yuanqiao, CHEN Yuanzhuang, MA Gunshao, XU Qin, WU Liping

2018, 18(02):  204-208.  DOI: 10.3969/j.issn.1009?976X.2018.02.019

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Objective To evaluate the feasibility and effectiveness of adjusting mal?rotation based on measurement of femoral neck anteversion using C?arm in intramedullary nail fixation for femoral proximal and middle fractures. Methods A total of 46 patients with femoral proximal and middle fractures were treated with closed reduction and intramedullary nail fixation from June 2015 to June 2017. Twenty?five cases of experimental group were developed according to Brunner method （rotation of femur adjusted based on femoral neck anteversion measurement using C-arm）, and conventional methods are adminis-tered in 21 cases of control group for rotation control. All cases were unilateral closed fractures. Bilateral femur CT scan was performed before operation, and femoral neck anteversion of the normal side was measured, which was used to adjust the proximal rotation in the standard position of distal femur in experimental group. CT scan was performed post?operation in all cases and the femoral neck anteversion of affected side was measured. Results All cases were successfully completed. There was no significant difference in operative time, bleeding volume and fracture healing time between the two groups. The absolute difference of femoral neck anteversion between the normal sand affected side was significantly different（experimental group 4.62°±2.35° vs control group 7.28°±2.93°, P<0.001）. Following up 6 to 24 months with an average of 16.8 months, no bone nonunion, screw cut and other complications were recorded. The St.Michael hip score of 6 months post?operation was statistically significant（experimental group 22.2+1.8 vs control group 20.6±2.0, P=0.01）. Conclusion Measurement of femoral neck antever-sion based on C?arm in intramedullary nail for femoral proximal and middle fractures improves the reduc-tion effect during operation, and significantly reduces the incidence of rotational mal?alignment.

XRF and FTIR analysis of stain deposition on betel tooth

SHEN Yang, CAI Xinjie, JIANG Tao, WANG Yining

2018, 18(02):  209-214.  DOI: 10.3969/j.issn.1009?976X.2018.02.020

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Objective To explore the possible reasons for betel tooth discolouration by composition analysis. Methods Analyze chemical elements in the stained deposition by XRF. Analyze possible organic ingredients in the stain deposition by FTIR. Results The stained area contains O, C, Ca, P, S, 3 2- 2- Cl, Fe, Mn, Na, protein, PO4, HPO4 Fe, Mn, S and protein., and CO3. Conclusion Betel tooth iscolouration is due to Fe，Mn，S and protein.

Treatment of comminuted femoral fractures bridging internal fixation system ：the experience in basic hospital

ZENG Zhanpeng, DAI Caifeng, ZHENG Weijie, HE Xian, TAN Benqian

2018, 18(02):  211-214.  DOI: 10.3969/j.issn.1009?976X.2018.02.021

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Objective To explore the clinical effect of bridge combined internal fixation system in the treatment of comminuted femoral fractures in basic hospital. Methods From January 2015 to January 2017, 40 patients in our hospital with comminuted femoral fractures were treated by bridge combined fracture internal fixation system（bridge combined internal fixation group, n=20）and locking plate（locking plate group, n=20）. The clinical data were compared between the two groups, including the time before operation, the amount of bleeding during operation, the time of operation, the length of stay, the complications, the union of the fracture and the evaluation of the limb function. Results The clinical outcomes of bridge combined internal fixation system were better than that of the locking plate group without complications. Conclusion Bridge combined internal fixation system is easy to operate, can be used in any combination and widely used in the basic hospital for comminuted femoral fractures. It has a good application prospect.

Effect and safety of local medication of tranexamic acid on reducing postoperation blood loss in posterior lumbar fusion

XU Fei, YANG Pibin, LIU Sibo, ZHEN Tao, HE Zhongbao, LI Hongjian

2018, 18(02):  215-217.  DOI: R681.5

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Objective To investigate the effect and safety of local medication of tranexamic acid into wounds on reducing postoperation blood loss in posterior lumbar fusion for degenerative lumbar stenosis. Methods A retrospective study from January 2015 to February 2017 were performed for 81 patients with degenerative lumbar stenosis who first underwent posterior lumbar fusion surgery of one or two segments. The patients were divided into tranexamic acid group （group A, n=39） and control group （group B, n=42）according to whether using tranexamic acid, The operation of pedicle screw fixation, posterior laminectomy, bone plantation and lumbar interbody fusion were performed for all patients, the patients of group A were injected tranexamic acid（100 ml）into incision locally at the end of operation, while the group B did not receive that drug, then the drainage pipe will be clamped for 2 hours. Volume of the first 24 h and general drainage postoperative was compared and observed the morbidity of pulmonary embolism and deep vein thrombosis. Results It showed no statistically significant difference in age, gender, count of fusional segments, preoperative hematological result, duration of operation and intraoperative blood loss between the two groups（P>0.05）, both volume of the first 24 h drainage and general drainage of group A was significantly lower than that in the group B （P<0.05）. The pulmonary embolism and deep vein thrombosis were not found in the two groups. Conclusion The local medication of tranexamic acid at the end of posterior lumbar surgery, could reduce the postoperative blood loss significantly and not increase the risk of pulmonary embolism or deep vein thrombosis.

Minimally invasive percutaneous plate osteosynthesis combined with Non-Contact-Bridging for the treatment of elderly femoral intertrochanteric fracture

GE Tao, XIAO Xuejun, ZHANG Guangming, KUANG Jiongxiang, WANG Jianwei

2018, 18(02):  218-221.  DOI: 10.3969/j.issn.1009?976X.2018.02.023

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Objective To explore the effects of minimally invasive percutaneous plate osteosynthesis （MIPPO）combined with Non?Contact?Bridging（NCB）universal in the treatment of femoral intertrochan-teric fractures in the elderly. Methods A total of 35 patients with femoral intertrochanteric fractures were included in this paper from Jul. 2013 to Oct. 2015. Of them, there were 21 males and 14 females；16 right hips, 19 left hips；aged 68 to 92 years with a mean age of 83.5 years, Evans type Ⅰ type in 2 cases, type Ⅱ in 5 cases, typeⅢ in 11 cases, typeⅣ in 10 and type Ⅴ in 7. All patients underwent X-ray pelvic radiographs and CT scans before operation. The operative time, intraoperative blood loss, complications, fracture healing time, Harris hip score at the final follow-up were recorded, and the results were analyzed. Results The average operation time was 50.2 minutes（40~65）, and the average intraoperative blood loss was 180 ml（150~230）. All the 35 patients were followed up for an average of 15.6 months（12 to 39 months）after surgery. One patient developed postoperative internal fixation and then hemiarthroplasty. Another 34 patients received bony union after operation. The average healing time was 7.8 months（6 to 9）. At the final follow-up, 34 patients had an average Harris hip score of 84.5 points（75 to 90 points）. Conclusion Surgical procedure of MIPPO combined with NCB is an effective and reliable treatment for intertrochanteric fractures in the elderly, especially for osteoporotic intertro?chanteric fractures, which can achieve better reset and early stability.

Efficacy of locking plate combined with autologous cancellous bone and BMP in treatment of postoperative nonunion of femoral shaft fractures in children

CAO Zhong

2018, 18(02):  222-225.  DOI: 10.3969/j.issn.1009?976X.2018.02.024

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Objective To investigate the clinical effect of morphogenetic protein bone（BMP）in the treatment of femoral shaft fractures in children. Methods Twenty-eight cases of pediatric femoral shaft fractures were treated with cases of pediatric femoral shaft fractures from January 2012 to June 2016 in our hospital, and 16 cases were treated with locking plate and BMP, and 12 cases were treated with elastic intramedullary nailing. The amount of blood loss, operation time, hospitalization time, hospitalization expenses and postoperative exercise time were observed in the two groups. After 1 year follow-up, X-ray film was observed. Results all cases achieved bony union, and no loosening was found in X- ray findings. The average healing time of the observation group was 3.89±0.28 months, the control group was 3.82±0.25 months, the difference was not statistically significant（P>0.05）in the two groups. There was no fracture nonunion or delayed union in the follow- up period. There were no complications such as infection, necrosis of the femoral head, hip, and hypotension in the two groups. There was no significant difference in the amount of bleeding, hospitalization time, hospitalization expenses and postoperative exercise time in the two groups（P>0.05）；the control group was significantly different from the control group （P<0.05）. Conclusion The locking plate combined with autologous cancellous bone, bone morphogenetic protein in the treatment of femoral shaft fractures in children can improve the fracture healing rate, reliable fixation, less complications, and can be used in clinical application.

Effects of ulinastatin pretreatment on cognitive function after ketamine anesthesia in juvenile mice

HONG Yu, DU Sujuan, LIU Jiayi, PENG Shuling, LIU Ting, WANG Shouping

2018, 18(02):  226-229.  DOI: 10.3969/j.issn.1009?976X.2018.02.025

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Objective To investigate the effects of ulinastatin pretreatment on the learning and memory impairment induced by chronic ketamine exposure in juvenile mice. Methods Thirty-six healthy male C57BL/6 mice （weighed 20~30 g） were randomized into three groups：Control group （group C）, ketamine group（group K）, ulinastatin pretreatment group（group S）. In group K and group S, ketamine（per 30 mg/kg）was injected intraperitoneally three times a day at 30-minute intervals for 7 consecutive days, while in Group S, ulinastatin was injected intraperitoneally（per 50000 U/kg）30 minutes before the first injection of ketamine every day. Cognitive test including Morris water maze 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 tau protein and A β protein using Western blot. Results Compared to group C, the escape latency was prolonged, the time in the original platform were decreased, the frequency of crossing the original platform was decreased, the levels of hippocampal tau protein and Aβ protein were increased in group K（P<0.05）, while in group S, there were no significant differences of above indexes （P>0.05）. Compared to group K, in group S the escape latency was significantly shortened, the time in the original platform were prolonged, the frequency of crossing the original platform was increased, the levels of hippocampal tau protein and Aβprotein were decreased（P<0.05）. Conclusion Cognitive dysfunction induced by chronic ketamine exposure can be reversed by ulinastatin pretreatment in juvenile mice, which may be associated with the down?regulation of the excessive express of hippocampal tau protein and A β protein.

Treatment of mesh infection and sinus formation after inguinal hernia （an experience of one case）

TANG Fuxingxin, GAN Wenchang, WU Huiying, CHEN Shuang

2018, 18(02):  230-232.  DOI: 10.3969/j.issn.1009?976X.2018.02.026

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Objective The clinical data of one case of mesh infection and the formation of the sinus tract was summarizedand to analyze the reasons of the sinus tract formation and surgical treatment tech-niques. The sinus tract was excised completely through methylthionine chloride stainingguiding. Drainage was placed 7 days postoperativelyand daily dressing change. Wound healed in 11 days after operation.In this case, chronic infection is a major cause of the sinus tract formation. The experience to success sug-gests that complete removal of the sinus tract, methylthionine chloride staining and proper drainage are the key to treat chronic wound and sinus.

Evaluation of the effect of clinical nursing pathway in the perioperative period of tension-free inguinal hernia repair in adult males

LIU Junqing, QIU Huaiyu, HU Mindie, ZHANG Meihong

2018, 18(02):  233-236.  DOI: 10.3969/j.issn.1009?976X.2018.02.027

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Objective To explore the effects of clinical nursing path in the perioperative period of adult male laparoscopic inguinal hernia repair. Methods From March 2015 to February 2017, 149 cases of inguinal hernia in adult men were treated by laparoscopic surgery （totally extraperitoneal inguinal hernia without tension repair, TEP）. According to the nursing procedure, the patients were randomly divided into two groups：the path group （72 cases） and the control group （77 cases）. The observation group adopted the clinical nursing path of inguinal hernia for the patients to carry out comprehensive education and intervention, and the control group adopted general nursing education and intervention. The total length of hospital stay, postoperative hospitalization days, postoperative 6 h, 24 h pain score, total hospitalization expenses, health knowledge and nursing satisfaction of two nursing methods were compared. Results Compared with the control group, the patients in the path group had shorter hospitalization time, 6 h and 24 h postoperative pain score, and the nursing satisfaction was significantly higher than that in the control group （P<0.05）. Conclusion The application of clinical nursing path has reduced the time of hospitalization, alleviated the pain of the patients, and improved the satisfaction of nursing. It is worth popularizing.

Effects of Allevyn Life dressings combined with povidone iodine cream on treatment of phase II pressure score

KUANG Xiumei, RONG Yingxuan, HUANG Junming, LI Zhengyu

2018, 18(02):  237-239.  DOI: 10.3969/j.issn.1009?976X.2018.02.028

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Objective To observe the effects of Allevyn Life dressings combined with povidone iodine cream on treatment of phase II stress scores. Methods A prospective study was conducted to evaluate the efficacy of three different treatments for patients with stage Ⅱ stress score admitted to our hospital from October 2015 to October 2017. A total of 78 cases were assigned to three groups：Allevyn Life dressings + povidone iodine cream group（A group）, Allevyn Life dressings alone group（B group） and povidone iodine cream group（C group）. Observation and recording time is 1 month. Results All patients in group A were treated effectively and the healing time was shorter than that in the other two groups（B and C group）. The differences were statistically significant（all P values < 0.05）. The effective rates of group A, group B, and group C were similar, and the differences were not statistically significant （P>0.05）. The cure time of group A was not superior to group B. There was no statistical difference between the two groups. Conclusion Allevyn Life dressings combined with povidone iodine cream have better efficacy and faster cure time in the treatment of stage Ⅱ stress score.

Application of discharge nursing guidance in implantable venous access port for patients with tumor

LI Qiaoji, DENG Ying, PENG Xiaoyan, GU Jinyan

2018, 18(02):  240-242.  DOI: 10.3969/j.issn.1009?976X.2018.02.029

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Objective To observe the effect of a post?discharge care guidance mode in patients with implanted venous transfusion port. Methods 100 tumor patients with implantable venous port were selected in our hospital and assigned to observation group （50 cases） and routine nursing care group according to the different nursing procedures. The patients in routine nursing care group were treated with routine nursing approach, those in observation received a post?discharge care guidance mode. The nurs-ing effects were compared between the two groups. Results The routine nursing group the incidence was 14.0%, the observation group was 6.0%, the observation group is lower than that of the conventional group, had significant differences（P<0.05）；routine nursing satisfaction group was 86.0%, the observa-tion group was 98%, observation group than in the conventional group, had significant differences（P<0.05）. Conclusion the application effect of nursing instruction in patients with implantable venous port tumor significantly, can effectively reduce the catheter obstruction, infection, local swelling and other complications, improve nursing satisfaction, is worthy to be carried out in clinical nursing work.

The effect of respiratory function training on lung function in patients with lung cancer after operation

LUO Qiuping, ZHONG Haiying, CHEN Shufang, LIAO Yaqin, ZHANG Yanqin

2018, 18(02):  243.  DOI: 10.3969/j.issn.1009?976X.2018.02.030

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Objective To explore the influence of respiratory function training on postoperative lung function in patients with lung cancer. Methods Eighty cases of lung cancer after operation were divided into observation group and control group, 40 cases in each group. The control group was treated with traditional routine nursing. The observation group was given nursing intervention on respiratory function training during perioperative period on the basis of the control group, and the lung function was mea-sured on the first day after admission and the first week after operation. Results there was no significant difference in blood gas index and pulmonary function index between the two groups before operation （P>0.05）. The oxygen saturation, oxygen partial pressure, FEV1% and FEV1/FVC% values in the obser-vation group were better than those in the control group one week after operation, the difference was statistically significant （P<0.05）. The quality of lung function in the observation group was better than that of the control group, and the patient′s expected value of life quality after the operation was obviously improved. Conclusion Respiratory function training on the basis of conventional nursing after lung cancer can improve the respiratory function of lung cancer patients and promote the recovery of lung function.