Table of Content

20 April 2019, Volume 19 Issue 02

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Angle of inferior mesenteric vein into the portal venous system and its relationship with the distribution of left?sided colorectal liver metastases

LIN Zeyu，LI Wenli， ZHONG Haifeng， MENG Xiaochun， YU Jiandong， CHEN Zhiping， HUANG Congyun， WAN Yunle

2019, 19(02):  125-129.  DOI: 10.3969/j.issn.1009?976X.2019.02.001

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［Abstract］ Objective To investigate the angle of inferior mesenteric vein （IMV） into the portal venous system and its relationship with the distribution of left?sided colorectal liver metastases. Methods Clinical data of 113 cases of colorectal liver metastases were collected from Jan 2012 to Jan 2017， including the site of primary tumor， metastases number and site， and the type of portal venous system based on the three?dimensional images we reconstructed defining “IMV input into superior mesenteric vein （SMV）， IMV input into splenic vein （SV） and IMV input into the venous angle”. Results In 113 cases， 17 are the type of IMV input into the venous angle， 100% metastases are in the left lobe of liver due to the obtuse angle of IMV input into SMV， 75% metastases are in the right lobe of liver and 25% metastases are in the left lobe of liver due to the acute angle of IMV input into SMV. The constituent ratio of liver metastases was statistically different （P<0.05）； none metastases are in the left lobe of liver， 25% metastases are in the right lobe of liver and 75% metastases are in the two lobes of liver due to the obtuse angle of IMV input into SV，80% metastases are in the left lobe of liver， 20% metastases are in the right lobe of liver and none metastases are in the two lobes of liver due to the acute angle of IMV input into SV. The constituent ratio of liver metastases was statistically different （P<0.05）； 31 are the type of IMV input into SMV， 66.7% metastases are in the right lobe of liver， 8.3% metastases are in the left lobe of liver and 25% metastases are in the two lobes of liver due to the obtuse angle of IMV input， 26.3% metastases are in the right lobe of liver， 36.8% metastases are in the left lobe of liver and 36.8% metastases are in the two lobes of liver due to the acute angle of IMV input. The constituent ratio of liver metastases was statistically different （P<0.05）； 65 are the type of IMV input into SV， 50% metastases are in the right lobe of liver， 35.7% metastases are in the left lobe of liver and 14.3% metastases are in the two lobes of liver due to the obtuse angle of IMV input， 21.6% metastases are in the right lobe of liver， 25.5% metastases are in the left lobe of liver and 52.9% metastases are in the two lobes of liver due to the acute angle of IMV input. The constituent ratio of liver metastases was statistically different （P<0.05）. Conclusion The angle of IMV input into the portal venous system is deeply related with the distribution of left?sided colorectal liver metastases， especially to predicting， monitoring the liver metastases， guiding clinic diagnosis and treatment due to the obtuse angle of IMV input.

Correlation analysis of ERAS scheme and postoperative stay for patients with colorectal carcinoma

ZHENG Quan， LI Xiaofeng， LIU Gai， ZENG Xiancheng， YANG Qiaolan， GAO Peng

2019, 19(02):  130-134.  DOI: 10.3969/j.issn.1009?976X.2019.02.002

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［Abstract］ Objective To study the correlative factors which affect postoperative stay after ERAS implementation on patients with colorectal carcinoma. Methods The data were collected from 411 patients with colorectal carcinoma who underwent surgery in our department from May 2015 to September 2018. All patients completed ERAS standard procedure according to Chinese Expert Consensus on Application of Enhanced Recovery Surgery in Colorectal Operation （version 2015）. The correlation between postoperative stay and preoperative bowel preparation， preoperative carbohydrate intake， use of preventive antibiotics， perioperative preventive measures for low body temperature， targeted fluid therapy， epidural catheterization， postoperative early mobilization， postoperative early?stage feeding， use of non?steroidal painkiller， early removal of drainage tube， age， gender， body mass index， anesthesia grading in American Society of Anesthesiologists， anemia， surgical site， surgical mode， surgical time， any postoperative ICU monitoring and incidence of complication were observed. Binary Logistic regression analysis was used to analyze correlation between each variant and postoperative stay. Results There was no obvious correlation among age， gender， diabetes， body mass index， new adjuvant therapy， preoperative anemia and postoperative stay and P value was 0.705， 0.563， 0.078， 0.674， 0.323 and 0.782 respectively. Anesthesia grading in American Society of Anesthesiologists which was over or equal to 3（P=0.000， OR=8.000， 95% CI 4.080-15.686） was the factor for prolonged postoperative stay before surgery. Surgery correlative factors such as surgical approach and over 180 min surgical time were closely related to prolonged postoperative stay （P=0.025， OR=0.464， 95% CI 0.237?0.907； P<0.001， OR=15.370， 95% CI 7.828?30.175）. However， postoperative ICU monitoring treatment posed no effect on postoperative stay （P=0.645， OR=0.791， 95% CI 0.291?2.148）. Delayed postoperative early mobilization was correlated to prolonged postoperative stay （P<0.001， OR=12.149， 95% CI 5.284?27.931）. Preoperative carbohydrate intake affected postoperative stay （P=0.001， OR=0.343， 95% CI 0.179?0.658）. It certainly could shorten postoperative stay of the patients （correlation index was ?1.050）. However， there was no significant correlation between epidural catheterization pain?easing， perioperative fluid balance as well as postoperative early?stage feeding and postoperative complications and postoperative stay. Conclusion More efficient and reasonable perioperative ERAS scheme for colorectal carcinoma could shorten hospital stay and accelerate rehabilitation of patients.

Three?dimensional versus two?dimensional laparoscopy for hepatectomy in patients with hepatocellular carcinoma

LI Shaoming， TANG Wanrong， LI Wei， YANG Rongbin

2019, 19(02):  135-138.  DOI: 10.3969/j.issn.1009?976X.2019.02.003

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［Abstract］ Objective To explore the advantages of three?dimensional laparoscopic hepatectomy， and to provide experience and skills for surgery procedure. Methods Forty?six cases of laparoscopic hepatectomy for hepatocellular carcinoma from January 2016 to July 2018 were retrospectively analyzed. According surgical procedure， the patients were divided into three?dimensional group （22 cases） and two?dimensional group （24 cases）. The operative time， intraoperative bleeding， postoperative drainage volume， indwelling time of drainage tube and complications were compared between the two groups. Results Compared with the two?dimensional group， the three?dimensional group showed better clinical outcomes， such as lower postoperative complications， shorter operative time， less blood loss， less postoperative drainage volume and time in both hepatic and non?hepatic anatomical resections. （all P values were less than 0.05）. Conclusion Three?dimensional laparoscopy has clearer operative field and smoother operation， especially in hepatic anatomic resection， and is conducive to the overall improvement of the surgeon's surgical level.

Expression and function of circular RNA circPRDM5 in esophageal squamous cell carcinoma

HU Xueting， JIANG Ming， ZHENG Zehua， LIN Meixian， WU Duoguang， WANG Minghui

2019, 19(02):  139-144.  DOI: 10.3969/j.issn.1009?976X.2019.02.004

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［Abstract］ Objective To investigate the expression level of circular RNA circPRDM5 in esophageal squamous cell carcinoma （ESCC） cells and tissues， and its effect on ESCC cell function. Methods qRT?PCR was used to detect the relative expression of circPRDM5 in normal esophageal epithelial cells （HEEC）， ESCC cell line， and 44 ESCC tissues and corresponding adjacent normal tissues； Transwell and CCK8 assays were performed to detect the effects on cell migration， invasion and proliferation after siRNA silencing circPRDM5； a nude mouse model was established to examine the effect of circPRDM5 on the tumorigenic ability of ESCC cells in animals. Results Compared with HEEC， circPRDM5 was highly expressed in ESCC cell lines KYSE150 and ECA109 （P<0.05）， and the expression in ESCC tissues （2.90±0.18） was higher than that in adjacent normal tissues （2.01±0.15）（P<0.001）； Transwell assay and CCK8 assay demonstrated that silencing of circPRDM5 significantly inhibited the migration， invasion and proliferation of ESCC cells （P<0.05）. The results of tumor formation in nude mice showed that the volume and weight of ESCC cells after silencing circPRDM5 were significantly lower than those of the control group （P<0.01）. Conclusion circPRDM5 is highly expressed in the cells and tissues of ESCC. Silencing circPRDM5 in ESCC cells reduced the proliferation， migration and invasion of ESCC cells， and the vivo tumorigenesis abilities. It is suggested that circPRDM5 may become a new target for ESCC treatment.

Screening of circ?0080229 binding proteins and their pivotal role in regulating glioma

ZHOU Zhiwei， LEI Bingxi， HUANG Yutao， LI Wenpeng， CHEN Qinbiao， DENG Yuefei

2019, 19(02):  145-149.  DOI: 10.3969/j.issn.1009?976X.2019.02.005

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［Abstract］ Objectives Glioma was the most common primary brain tumor whose molecular mechanism was unclear. In this study， we tried to assess the role of a circular RNA circ?0080229， derived from EGFR， as a critical biomarker in glioma， through the analysis of RNA binding proteins of circ?0080229. Methods At the beginning， qPCR analysis was carried out to verify the expression of circ?0080229 in glioma. Then， the tagged RNA affinity purification assay and the mass spectrum analysis were performed which figured out RNA binding proteins of circ?0080229. Moreover， we analyzed the differential expression of the genes of the RNA binding proteins and carried out the survival analysis based on TCGA data. Finally， the most valuable biomarker among all the RNA binding proteins was screened out， which was identified to regulate proliferation， migration and invasion in vitro in U251 glioma cell line. Results The expression of circ?0080229 was significantly increased in glioma compared to normal brain tissue. Circ?0080229 would physically bind to 33 RNA binding proteins and the bioinformatics analysis among the 33 genes indicated that two of the RNA binding proteins called ANXA2 and SIL1 were the most significant biomarkers in glioma. We further proved that ANXA2 could promote proliferation， migration and invasion in glioma cell line U251 in vitro. Conclusion The circ?0080229 would physically bind to ANXA2， which might promote the proliferation， migration and invasion in glioma.

Role and mechanism of exosomal hsa?miR?609 isolated from postoperative drainage in the development of papillary thyroid carcinoma

LIU Jing， CHEN Hongxing， XU Mi， WU Yuxi， LIU Xingzhou， YANG Chuan， YAN Li， REN Meng

2019, 19(02):  150-153.  DOI: 10.3969/j.issn.1009?976X.2019.02.006

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［Abstract］ Objective To investigate the exosomal microRNAs （miRNAs） expression in the postoperative drainage of papillary thyroid carcinoma （PTC） and nodular goiter and explore their role and mechanism in the development of PTC. Methods Exosomes were isolated from the postoperative drainage fluid of patients with PTC and nodular goiter on the first morning of thyroidectomy. Transmission electron microscope， particle size analysis and western blotting were used to characterize exosomes. And exosomal RNA was extracted and applied to miRNA microarray. The differently expressed miRNA was further analyzed by bioinformatics. Results Exosomes was identified in the perspective of morphology， size and protein markers. Exosomal miRNA profiles were significantly different between two groups and hsa?miR?609 had the greatest difference. Then the results of bioinformatics indicated that the genes predicted to be targeted by hsa?miR?609 were tied to the tumorgenesis of PTC. Conclusion The dysregulated exosomal miRNAs extracted from the postoperative drainage of PTC may play a regulatory role in the progress and development of PTC.

Preparation and identification of multi single chain antibodies modified immune nanoparticles

ZOU Jinmao， LI Ruomeng， LIAN Guoda， CHEN Shaojie, CHEN Yinting, HUANG Kaihong

2019, 19(02):  154-161.  DOI: 10.3969/j.issn.1009?976X.2019.02.007

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【Abstract】 Objective To establish a method for conjugating multi single chain antibodies to iron oxide nanoparticles. Methods Iron Oxide Nanoparticles （IONPs） coated with polyethylene glycol （PEG） and carboxyl functional group （COOH group） was conjugated with anti?MUC4， anti?CEACAM6 and anti?CD44v6 single chain antibodies （scAbMUC4， scAbCEACAM6， scAbCD44v6） under the action of cross?linking agents of EDC/Sulfo?NHS. After the construction of IONPs?PEG?multi scAbs complex， dynamic light scattering （DLS） and transmission electron microscopy （TEM） were used to characterize the complex. Besides， by coupling fluorescein labeled monoclonal antibody to the surface of IONPs?PEG， the fluorescence intensity of the IONPs?mAbs complex was measured， and the coupling efficiency was calculated. Cellular immunofluorescence assays were used to identify the specificity of IONPs?multi scAbs complex， and the aqueous solution stability of the complex was also evaluated by DLS， TEM and cellular immunofluorescence experiments at the timepoint of one month and six month after construction. Results After coupling three kinds of scAbs to IONPs?PEG， the hydrodynamic particle size of IONPs?PEG?multi scAbs complex was （23.6±0.5） nm， and the particle size distribution was concentrated， zeta potential was （?17.3±0.6） mV. TEM showed that the average particle size of IONPs?PEG?multi scAbs complex was about 10 nm. The results showed that the antibody coupling efficiency was about 75.5%. The results of cellular immunofluorescence showed that the IONPs?PEG?multi scAbs complex had specific recognition ability for BxPC?3 cells with high expression of MUC4， CEACAM6 and CD44v6. After storage for 1 and 6 months in aqueous solution， the hydrodynamic particle size， zeta potential， TEM photograph and cellular immunofluorescence of the complex were not significantly different from those obtained immediately after preparation. Conclusion In this study， the EDC/Sulfo?NHS crosslinker combination was used to conjugate the three kinds of scAbs to the surface IONPs?PEG to construct IONPs?PEG?multi scAbs complex. This coupling method has high conjugation efficiency and formed a complex with ultra?small particle size， uniform distribution and excellent antigen recognition specificity， as well as good aqueous solution stability.

The mechanism of Wnt?activated colorectal cancer cells inhibiting the maturation of tumor infiltrating dendritic cells

LI Weiyu， HUANG Yuanyuan， JIANG Zhimin， XIE Derong， BI Zhuofei， YANG Qiong

2019, 19(02):  162-168.  DOI: 10.3969/j.issn.1009?976X.2019.02.008

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［Abstract］ Objective Wnt pathway activation exists in most colorectal cancer. Basic research has found that Wnt pathway can affect tumor immunity， but its role in colon cancer is unknown. This study focused on the effects of Wnt pathway activation on the immune microenvironment of colon cancer in order to find new targets for immunotherapy of colorectal cancer. Methods Immunofluorescence was used to verify the Wnt pathway status of SW480 and NCM460.The expressions of IL?1β in Wnt?activated colon cancer cell line SW480 and normal intestinal epithelial cell line NCM460 were compared by qPCR and Western blot. Human peripheral blood mononuclear cells were isolated and induced to form immature dendritic cells （iDC） by colony stimulating factor （GM?CSF） and IL?4， and then stimulated to induce mature dendritic cells （mDC） by using IL?1β. Expression of mature molecules on the surface of mDC cells was detected by flow cytometry. Results SW480 cells expressed beta?catenin in the nucleus， suggesting activation of the Wnt pathway. IL?1β mRNA and protein expressions increased after treatment with SW480 using Wnt pathway inhibitor （ICG?001） and increased with increasing concentration， IL?1β mRNA and protein expressions were lower in the NCM460 treated with wnt pathway activator （Licl）， and decreased with increasing concentration， and the expressions of IL?1β protein were negatively correlated with the expressions of non?phosphorylated β?catenin protein. IL?1β can promote iDC maturation， and the expression rates of HLA?DR and CD86 in IL?1β 50 ng/ml group were （69±3.62）% and （84.3±4.7）%， respectively， and the expression was significantly up?regulated compared to the RPMI group and the TNF?a 10 ng/ml group （P<0.001）. Conclusion Wnt pathway activation in colorectal cancer may inhibit the maturation of DC in tumor microenvironmentby reducing the expression of IL?1β.

Effects of different doses of euthyrox suppressive therapy on glucolipid metabolism and bone metabolism after radical resection of thyroid carcinoma

ZHANG Zhijian， MO Yanping， CHEN Chao， LI Dexiang， FU Jiyong， WU Lixuan

2019, 19(02):  169-173.  DOI: 10.3969/j.issn.1009?976X.2019.02.009

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［Abstract］ Objective To study the effects of different doses of levothyroxine （LT4） suppressive therapy on glucolipid metabolism and bone metabolism after radical resection of differentiated thyroid carcinoma （DTC）. Methods Eighty patients with DTC radical resection in our hospital from April 2017 to April 2018 were randomly divided into two groups with 40 cases in each group. 131I was used to clear residual thyroid tissues at 1 month after DTC radical resection and LT4 suppressive therapy was given to patients， and the dose was 2.5 μg/kg in load group and 2.0 μg/kg in routine group， and the course of treatment was 6 months. The changes of thyroid function， glucolipid metabolism， bone metabolism and bone mineral density were compared between the two groups before and after treatment. Results After treatment， the levels of serum FT3 and FT4 were significantly increased （P<0.05） while the serum TSH level was significantly decreased （P<0.05）， and the levels of serum FT3 and FT4 in load group were higher than those in routine group while the serum TSH level was lower than that in routine group （P<0.05）. The levels of FBG， HbA1c and serum TC， TG and LDL?C in the two groups were significantly decreased （P<0.05）， and the levels of FBG， HbA1c and serum TC， TG and LDL?C in load group were lower than those in routine group （P<0.05）. The levels of serum BGP， BALP and ICTP were significantly increased in the two groups （P<0.05）， and the levels of serum BGP， BALP and ICTP in load group were higher than those in routine group （P<0.05）. The BMD values of lumbar vertebrae L2~4， femoral neck and Ward’ s triangle were significantly decreased （P<0.05）， and there were no significant differences between the two groups （P>0.05）. Conclusions LT4 suppressive therapy after DTC radical resection can promote glucolipid metabolism and bone metabolism. The decrease of blood glucose and blood lipids levels in patients will increase with the increase of dose. And there is no obvious relationship between the decrease of bone mineral density and the dose in the short term.

Effect of enhanced recovery after surgery combined with probiotics on the changes of intestinal microflora in patients with colorectal cancer after operation

WU Yingjun， LI Chao， SU Yaorong， HE Dongtian， JIANG Wenchuan， ZHAO Jinbiao

2019, 19(02):  174-181.  DOI: 10.3969/j.issn.1009?976X.2019.02.010

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［Abstract］ Objective To investigate the effect of enhanced recovery after surgery combined with probiotics on intestinal microflora in patients with colorectal cancer after operation. Methods From May 2016 to May 2018， 126 patients with colorectal cancer were prospectively enrolled in the gastrointestinal surgery department of Jiangmen Central Hospital. According to the random number table method， the patients were divided into control group （59 cases， ERAS group） and experimental group （67 cases， ERAS combined with probiotics treatment group）. The changes of intestinal floras in different genus and the grading of intestinal floras disorder were compared between the two groups. The incidence of complications related to intestinal infection was compared between the two groups. Results Dysbacteriosis were happened before operation in both groups （P>0.05）. The majority of patients in the control group were Ⅱ° dysbacteriosis after operation， while those in the experimental group were mainly I°dysbacteriosis after operation （P=0.014）. The total number of bifidobacteria and lactobacillus in the experimental group was higher than that in the control group （P<0.001）. The incidence of diarrhea， abdominal infection and anastomotic leakage in the control group was higher than that in the experimental group， but only the incidence of diarrhea had significant difference between the two groups， while the incidence of abdominal infection and anastomotic leakage had no significant difference. There was no sepsis after operation in both groups. Conclusions Perioperative probiotic therapy for colorectal cancer patients can improve the intestinal microecological environment， protect the intestinal mucosal barrier and accelerate the recovery of patients.

Clinical research of oncoplastic breast?conserving surgery in the treatment of Granulomatous lobular mastitis patients

ZHANG Kai， LUO Zhihui， HUANG Zhan， GONG Xumeng

2019, 19(02):  177-181.  DOI: 10.3969/j.issn.1009?976X.2019.02.011

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［Abstract］ Objective To assess the feasibility and cosmetic effect of oncoplastic breast?conserving surgery （OBCS） in the treatment of Granulomatous lobular mastitis. Methods Patients with Granulomatous lobular mastitis who received traditional surgery and OBCS in Yuebei People??s Hospital of Shaoguan from January 2013 to December 2017 were collected. The recurrence rate and postoperative breast cosmetic effect of the two groups were compared. Results The recurrence rate was not statistically significant between the two groups （P>0.05）.The postoperative breast cosmetic effect of OBCS was superior to that of the traditional operation group， and the difference was statistically significant （P<0.05）. Conclusion OBCS is a safe and effective procedure for Granulomatous lobular mastitis patients.

Prognosis and influencing factors of diabetic foot patients in Huaiji People??s Hospital of Zhaoqing City

LEI Guoda， CHEN Liyan， LI Li， MO Shike， LI Yongjie， YANG Chuan

2019, 19(02):  182-186.  DOI: 10.3969/j.issn.1009?976X.2019.02.012

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［Abstract］ Objective To describe the situation of the prognosis and analyze the risk factors of diabetic foot patients in Huaiji People??s Hospital in order to provide reference for target intervention in grass?roots hospitals. Methods By cluster sampling， 154 inpatients with diabetic foot in Huaiji People??s Hospital were selected. Relevant cases and follow?up data were collected. The healing， mortality and influencing factors of rural patients with diabetic foot after discharge were analyzed retrospectively. Results Among 154 cases of diabetic foot， 121 cases healed， the healing rate was 78.6%. The cumulative mortality rates of 1，3 and 5 years were 9.1%， 11.0% and 11.7%， respectively. Hypoproteinemia （OR=3.467）， high density lipoprotein （OR=3.478）， number of ulcers （OR=5.182） were independent risk factors affecting the healing of ulcers in rural diabetic foot patients （P<0.05）； high density lipoprotein （RR=0.246）， glycosuria. Disease nephropathy （RR=0.209） and number of ulcers （RR=0.226） were independent predictors of death in patients with diabetic foot， and high density lipoprotein was a protective factor（P<0.05）. Conclusion For patients with diabetic foot in grass?roots hospitals， the prognosis is affected by many factors， including hypoproteinemia， diabetic nephropathy， non?single ulcer number and high density lipoprotein. Targeted interventions should be given to promote the healing of foot ulcer and prolong survival time.

Risk factors affecting the rehabilitation of patients with distal radius fracture after operation

LI Jingwei， WANG Wenzhi

2019, 19(02):  187-191.  DOI: 10.3969/j.issn.1009?976X.2019.02.013

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［Abstract］ Objective To explore the influencing factors of rehabilitation effect of patients with distal radius fracture after operation. Methods Ninety patients with distal radius fracture treated in our hospital from July 2012 to July 2016 were included in the study. The wrist motion， hand grip strength and Michigan functional score at 3， 6 and 12 months after operation were recorded as strain variables to characterize the rehabilitation effect of patients after operation. The wrist motion， hand grip strength and Michigan Hand Outcome Questionnaire （MHQ） at 3， 6 and 12 months after operation were recorded as strain variables to characterize the rehabilitation effect of patients after operation. One?way linear regression was used to determine the relationship between the possible influencing factors. The independent variables of P<0.05 were included in the multivariate logistic regression analysis to determine the risk factors of rehabilitation effect. Results During the 12?month follow?up， 2 patients had screw infection， 2 patients mild screw loosening at 1 month， and 1 patient developed carpal tunnel syndrome at later stage. The grip strength， range of motion and MHQ improved continuously at 3， 6 and 12 months after operation. Univariate analysis showed that trauma energy， fracture type， age， bone mineral density and fixation time of external fixator were closely related to the rehabilitation effect after operation in 3 months after operation （P<0.05）； Fracture type， traumatic energy and fixation time of external fixator were closely related to the rehabilitation effect after operation in 6 months after operation （P<0.05）； Age， bone mineral density and fracture type are closely related to the rehabilitation effect after operation in 12 months （P<0.05）. Multivariate logistic regression showed that severe fracture type， high energy trauma and long external fixator fixation time were risk factors affecting the recovery of patients with distal radius fracture after 3 months （P<0.05）； Severe fracture types and high energy trauma were risk factors affecting the recovery of patients with distal radius fracture after 6 months （P<0.05）. Decreased bone mineral density and increased age were risk factors affecting the recovery of patients with distal radius fracture after 12 months （P<0.05）. Conclusion In the tresent study， severe fracture types， high?energy trauma and long external fixator fixation time were risk factors affecting the rehabilitation of patients with distal radius fracture after 3 months of operation， and fracture types and high energy trauma were the risk factors at 6 months， while decreased bone mineral density and increased age were risk factors at 12 months. Whether distal radius fracture was complicated with ulnar styloid process fracture and the length of fixation were not closely related to the rehabilitation effect.

The experimental study of the effect of ischemia on the proximal epiphyseal plate of the fibula

李远辉1， 吴宝杰1， 曾勉东1， 尹德龙1， 胡汉生1， 余升华1， 黄玉莲2*

2019, 19(02):  192-194.  DOI: 10.3969/j.issn.1009?976X.2019.02.014

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［Abstract］ Objective To investigate the effect of ischemia on epiphyseal plate of proximal fibula. Methods Twelve young rabbits of 8 weeks old were randomly divided into 3 groups. The proximal blood vessels of the fibula were carefully exposed according to the cutting method of transplantation of fibula with epiphysis. The blood supply to the proximal epiphysis of the fibula was blocked by 0， 1 and 1.5 hours by blocking the right common iliac vessels. X-ray examination was performed every week after operation to observe and record the time of epiphyseal closure of fibula. Statistical analysis was used to compare the closure time of fibula epiphysis in each group. Results the closure time of epiphysis in 0 hour ischemia group was 8.25±0.71 weeks， the closure time of epiphysis in 1 hour group was 8.13+0.99 weeks， and the closure time of epiphysis in 1.5 hour ischemia group was 8.13±0.99 weeks. There was no significant difference in the closure time between the three groups （P>0.05）. Conclusion In the process of epiphyseal fibula transplantation， if the time of epiphyseal ischemia is controlled within a certain time， the short term epiphyseal ischemia would not lead to premature closure of epiphysis.

The value of transrectal real?time elastography?targeted biopsy in the detection and diagnosis of prostate lesion

YE Xiuqin， DING Zhimin， DONG Fajin， WEI Zhanghong， LIU Huiyu， WU Huaiyu， XU Jinfeng

2019, 19(02):  195-198.  DOI: 10.3969/j.issn.1009?976X.2019.02.015

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［Abstract］ Objective To explore predictive value of transrectal real?time elastography （TRTE） targeted biopsy in the detection and diagnosis of prostate lesion. Methods 112 patients with suspected prostate cancer included in this study were examined with transrectal ultrasound， two needles targeted biopsy for suspicious lesions and traditional 12?needles systemic biopsy were performed under TRTE guidance. Moreover， we evaluated the diagnostic value of TRTE for prostate disease and compared accuracy of targeted biopsy and systemic biopsy. Results In this study， 54 cases of prostate cancer and 58 cases of benign prostatelesions were diagnosed with TRTE. 70 cases were diagnosed as benign prostate lesions and 42 were diagnosed as prostate cancer according to pathological examination. The sensitivity， specificity， accuracy， positive predictive value and negative predictive value were 88.1%， 75.7%， 80.3%， 0.68， 0.91， respectively. TRTE guided targeted biopsy to diagnose prostate cancer with 84 needles， the positive rate was 37.5% （84/224）， and the systematic biopsy for prostate cancer diagnosis with 313 needles， the positive rate was 23.3% （313/1344）， showing a statistically significant difference （χ2=4.08， P<0.05）. Additionally， the number of needle used for the diagnosis of prostate cancer by targeted and systematic biopsy was 397， and the positive rate was 25.3% （397/1568）. Conclusion TRTE has higher sensitivity， specificity and accuracy in the diagnosis of prostate lesions， and TRTE guided targeted biopsy has higher accuracy than systematic biopsy in diagnosing prostate cancer. However， targeted biopsy have not completely replaced systematic biopsy， and combination of them is currently the main way to reduce the false negative rate of prostate cancer.

Clinical observation and application experience of percutaneous nephrolithotomy in semi?supine position

LIN Yaobin， HUANG Jiantuan， HUANG Jianmou

2019, 19(02):  199-202.  DOI: 10.3969/j.issn.1009?976X.2019.02.016

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［Abstract］ Objective To evaluate the safety of percutaneous nephrolithotomy （PCNL） in semi?supine position and summarize the practical experience. Methods According to the different operation positions， 68 patients who received PCNL in our hospital from October 2016 to December 2018 were divided into observation group （34 cases） and control group （34 cases）. The former group used semi?supine position in PCNL， while the control group chose traditional position （prone position）. Hemodynamic changes， clinical effects and complications were observed and compared between the two groups. Results The blood oxygen saturation， pulse and blood pressure in the observation group were relatively stable during the perioperative period. There were significant changes in the related indicators in the control group from the posture to the end of the operation， including the decrease of blood pressure and the increase of heart rate， and the incidence of intraoperative restlessness. The complications and hospitalization time of the two groups were similar. Conclusion In PCNL， the use of semi?supine position is conducive to reducing the changes of blood pressure and heart rate， reducing the agitation of patients during the operation， and the operation is safe.

Acute pulmonary edema and septic shock during percutaneous nephrolithotomy: a case report and review of literature

CHEN Ruixia， PENG Yuxuan， DU Sujuan， YE Xijiu

2019, 19(02):  203-206.  DOI: 10.3969/j.issn.1009?976X.2019.01.017

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［Abstract］ Percutaneous nephrolithotomy（PCNL） is a modern and minimally invasive treatment for urinary calculi disease， but a variety of related complications can appear in the process of the surgery. Now we reported an ASA 47?year?old woman with calculi in both kidneys and urinary infection， she was scheduled for elective percutaneous nephrolithotomy under combined spinal?epidural anesthesia. During the operation， the patient developed the symptoms of hypoxia and acute pulmonary edema， and later septic shock. After reviewing the literature， we explore the prevention and treatment of acute pulmonary edema and septic shock that appear in PCNL， and anesthesiologists should be actively involved in the perioperative medicine， play an important role in the prevention and cure of complications of PCNL， which is of great importance on the prognosis of patients.

Effect of urokinase on early coagulated hemothorax after pleural exfoliation

GUO Jingjing， CHEN Sui， HUANG Xiaoqiang

2019, 19(02):  207-210.  DOI: 10.3969/j.issn.1009?976X.2019.02.018

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［Abstract］ Objective To evaluate the efficacy of urokinase intrathoracic perfusion therapy for early coagulated hemothorax after pleural dissection surgery. Methods Sixty?three patients with coagulated hemothorax after pleural exfoliation from March 2014 to December 2016 underwent urokinase intrathoracic perfusion. The thoracic drainage， X?ray examination results were recorded and comprehensively analyzed therapeutic effect. Results The perfusion process was smooth in all 63 patients， in which 48 cases were cured， 13 cases were effective and 2 cases were ineffective. The cure rate was 84.1% and the total effective rate was 96.8%. The patients were well tolerated during the whole treatment. Three cases had low fever， 8 had mild chest pain， 7 had shortness of breath and one case had massive hemorrhage， without other serious adverse reactions. Conclusion Treatment of early coagulated hemothorax with intrapleural perfusion of urokinase is a simple， safe， minimally invasive procedure， with definite efficacy， low incidence of adverse reactions.

Advantages and clinical experience of day?surgery for breast cancer

黄健东1， 吴祖培1， 陈宇宁1， 冯瑞卿2

2019, 19(02):  211-213.  DOI: 10.3969/j.issn.1009?976X.2019.02.019

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［Abstract］ Objective To determine whether there was a difference in complications among breast cancer patients undergoing day?surgery versus overnight or inpatient stay. Methods 108 patients with breast cancer undergoing mastectomy and axillary lymph node dissection between Dec 2016 and Feb 2019 were included in this study. Among them， 24 cased underwent daytime surgery （day?surgery group）， 32 stayed in hospital overnight （overnight group） and 52 stayed in hospital longer than 2 day postoperatively （normal group）. The clinical data were analyzed and compared between three groups. Results The operation time of the three groups was close， and the use of analgesics in the day?surgery group was more than that in the other two groups， but the differences were not statistically significant. The number of community medical and outpatient visits increased in the day?surgery group after leaving hospital， and there was a significant difference between the two groups after more than two days of admission. The total medical expenses in the daytime operation group were significantly lower than those in the other two groups. There was no significant difference in incision bleeding， hematoma， surgical site infection and pain among the three groups. Conclusion Day? surgery of breast cancer with less cost， no severe complications occurred in outpatients， can be safely and comfortably performed on an outpatient basis.

A case report of primary mediastinal atypical meningioma and review of literature

LI Jixin， ZHANG Fan， YANG Qihua

2019, 19(02):  214-218.  DOI: 10.3969/j.issn.1009?976X.2019.01.020

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［Abstract］ Objective To investigate the clinical and imaging features of primary mediastinal atypical meningioma. Methods A case of primary mediastinal atypical meningioma in our hospital was analyzed， including clinical features， laboratory test results， image findings and pathological features. Results After laboratory test and CT scan， the patient underwent mediastinal mass resection and recovered well thereafter.ConclusionThe tissue source and structure of primary mediastinal atypical meningioma is in consistent with intracranial calcified meningioma， thusthe imaging features are similar to intracranial meningioma. Familiarity with relative imaging features and pathological changes is conducive to diagnosis and differential diagnosis of this disease.

A clinical case of mycobacterium fortuitum infectionin in orthopedics

HAN Jiaoling， WANG Leiming， ZHENG Yan， YU Yali， ZHANG Ying， LI Fei， XU Linlin， YE Jing

2019, 19(02):  219-222.  DOI: 10.3969/j.issn.1009?976X.2019.02.021

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［Abstract］ Objective Mycobacterium fortuitum belongs to the rapidly growing mycobacteria， which is widely distributed in nature， but the clinical cases of mycobacterium fortuitum infectionin in orthopedics rarely reported. Now， we shared a clinical case of our hospital to provide reference for clinical treatment. Methods The process of laboratory examination， clinical features and treatment were analyzed retrospectively. Results Non?tuberculous mycobacterium infection can be easily misdiagnosed with mycobacterium tuberculosis infection， or missed during diagnose. The conventional bacterial culture is difficult to find the infection caused by Mycobacterium fortuitum， and its treatment has a loug-term process. Conclusion More and more non?tuberculosis mycobacterium infection are reported， the isolation， culture and identification of non?tuberculous Mycobacteria are of great significance to clinical practice.

The effect of facial rejuvenation at different surgical anatomical levels under endoscopy

QIU Huanbiao， LI Bing

2019, 19(02):  223-227.  DOI: 10.3969/j.issn.1009?976X.2019.02.022

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［Abstract］ Objective To evaluate the effect of different surgical anatomical levels of upper and middle facial rejuvenation under endoscopy. Methods 192 patients undergoing endoscopic facial lift from November 5， 2015 to November 5， 2018 were divided into control group and observation group， 96 in each group. In the control group， the fascia ligament of orbicularis oculi was dissected under the frontal periosteum， the orbicularis oculi retaining ligament and the lateral orbital thickening were dissected under the periosteum， and the zygomatic supporting ligament was dissected under the periosteum of the anterior auricular incision， and the zygomatic and buccal ligament was dissected under the periosteum of the auxiliary intraoral incision， and then lifted up the face. The fascia ligament of orbicularis oculi and orbicularis oculi retaining ligament were dissected under galea aponeurotics in the observation group， and the lateral orbital thickening was cut off from the surface of deep temporal fascia. The zygomatic support ligament and zygomatic buccal support ligament were dissected at the same level， and the zygolabial sulcus was broken along the suborbicularis oculi （SOOF）. The effect and satisfaction of the two groups were compared and analyzed. Results The satisfaction rate of cosmetic effect was 95.6% in the study group and 60.9% in the control group. There was significant difference between the two groups（P<0.05）. Conclusion Endoscopic treatment of orbicularis oculi supporting ligament， orbital ligament， zygomatic supporting ligament， lateral orbital thickening， zygomatic buccal ligament and buccal lip ligament disruption on deep fascia is a new and meaningful surgical method with high satisfaction and quick recovery.

Application of modified expanded cutaneous branch flap pedicled by cervical transverse artery in treatment of faciocervical cicatricial contracture

QIN Wangchi， LIANG Zhi， YANG Weiguo， LIN Haibo， GUO Zhengdong， LIU Fei

2019, 19(02):  228-230.  DOI: 10.3969/j.issn.1009?976X.2019.02.023

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［Abstraction］ Objective To improve the effects of treatment of faciocervical cicatricial contracture by a modified expanded cutaneous flap pedicled by cervical transverse artery. Methods Nine cases with faciocervical cicatricial contracture received flap transfer from Feb 2014 to Oct 2018. Besides routine imbedment of soft tissue expander， we applied buried stitches to block cutaneous branches from thoracoacromial and internal thoracic vessels firstly. Secondly， the delay procedure was used before one week of flap transfer. Results There was no surgical complications existed postoperatively including necrosis， circulation disturbance and infection. The texture of receipt area was similar with surrounding skin and faciocervical appearance was improved obviously. Donor site could be closed firstly and no need for free skin graft. Conclusion The survival rate and postoperative effect of cutaneous branch flap pedicled by cervical transverse artery can be notably improved by some modifications including buried stitches and delay procedure.

The muscle biopsy features of primary dermatomyositis and the influence of lymphocyte subsets with treatment

TANG Ying， ZENG Huasong

2019, 19(02):  231-234.  DOI: 10.3969/j.issn.1009?976X.2019.02.024

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［Abstract］ Objective To investigate the clinical and muscle biopsy features of primary dermatomyositis （DM） and the influence of lymphocyte subsets with treatment. Methods Twenty?seven cases of primary dermatomyositis were retrospectively analyzed in terms of clinical features， electromyogram and MRI results. All the patients underwent quadriceps femoris muscle biopsy on the right thigh. Histochemical （HE， COX， SDH） staining was used to observe the morphology of muscle fibers， electron microscopy and the characteristics of myofibrillar membrane after immunohistochemical staining； PLT， CRP， WBC， IgG， IgA， IgM and IgE were observed before and after 12 weeks of treatment. Changes of CD3+， CD4+， CD8+， CD19+B， CD16+56?NK cells were detected. Results After 12 weeks of treatment， the proportion of CD19+B cells was lower than that of baseline （P<0.05）. The proportion of CD8 and CD3+T cells was higher than that of baseline. The change of CD16+56?NK cells was not significant before and after treatment（P>0.05）. Levels of IgG， IgM and IgA of immunoglobulin were lower than that of baseline（P<0.05）. Diffuse abnormal signal shadows in muscle space and subcutaneous adipose layer and electromyogram showed progressive muscle damage. In 25 cases， myofibrillar necrosis， perifascicular atrophy， no intracytoplasmic lipid droplets or glycogen vacuoles， no broken red fibers or edge vacuoles， no obvious proliferation of fibrous adipose tissue in perimyofibrillar membrane and endomyofibril， no obvious inflammatory cells， normal COX activity were observed. Dystrophin indicated that the myofibrillar membrane was expressed uniformly and continuously. Under electron microscopy， muscle cells showed atrophy， degeneration and necrosis. Among them， 2 （7.4%） had normal muscle enzymes， the expression of Dystrophin in muscle fibers was suspected to be decreased， COX staining of one （3.7%） case showing a decrease with a few muscle fibers， and SDH/COX showed a few blue fibers， one （3.7%） case had no typical perifascicular atrophy under light microscopy， while the electron microscopy showed an increase in lipid droplets. Conclusion Light microscopy of dermatomyositis showed necrosis of individual muscle fibers and perifascicular atrophy locally. MRI can show muscle lesions of JDM patients sensitively and noninvasively. Immune disorders of B and T cells are involved in the pathogenesis of dermatomyositis， and can also be used as indicators of therapeutic efficacy of dermatomyositis.

The application of inguinal lymph node dissection in penile neoplasms′ treatment

WU Shangchao， LI Zaishang， ZHANG Xueqi

2019, 19(02):  235-240.  DOI: 10.3969/j.issn.1009?976X.2019.01.025

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［Abstract］ Penile neoplasms is a rare malignant tumor in clinical， its incidence is obvious differently in different regions on the world， it′s with a low incidence for the developed countries， such as Europe and the United States. But， the penile neoplasms′ incidence is higher in Africa， South America， parts of Asia such as India because of the poor health condition. The current treatment methods for penile neoplasms mainly include： Phallic preserving surgery. Partial phallic resection； Radical resection of the penis. Regional lymph node invaded or not for the penile neoplasms patients， and a radical inguinal lymph node dissection is the decisive factor that affect the patient′s survival rate. The inguinal lymph nodes are the earliest and most common regional lymph node metastases of penile carcinoma.This paper has reviewed the application of the open inguinal lymph node dissection， modified inguinal lymphadenectomy， video endoscopic inguinal lymphadenectomy， robotic?assisted inguinal lymphadenectomy in penile neoplasms patients，and the major complications of each surgery method.

An analysis report of patients falling in hospital

ZHANG Chunqiong， LI Zhuohui， XIE Jingmei， LIANG Donghua

2019, 19(02):  241-243.  DOI: 10.3969/j.issn.1009?976X.2019.02.026

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[Abstract］ Objective To investigate the occurrence and characteristics of falls in hospitalized patients. Methods A retrospective analysis was performed about the incidence and characteristics of hospitalized falls in hospitals from January to June 2017. Results A total of 141 falls occurred in 127 patients， two of which resulted in a fracture. The average age of patients who fell was 63.9 years （range 0 to 91）. Most falls occur at the bedside （68.2%）. About half of the falls were related to activities （46.6%）， and the most common time to find falls was 2：00?3：59 and （38/201， 18.9%） and 6：00?7：59 （28/201， 13.9%）， which followed by the morning when the patient was active. The fall rate in our hospital was 1.37 falls per 1，000 patient ?days. The Internal Medical in hospital departments had the highest fall rate （3.08 times/1000 patient?days）， followed by the Emergency Dept. and Pediatrics Dept. （2.98 times/1000 patient?days and 2.56 times/1000 patient?days）. Conclusion This study demonstrates the characteristics of falls in hospitals in general hospitals and suggests that increased care or publicity for some time periods may help reduce the incidence of falls in hospitalized patients.

The influence of staged health education on knowledge， attitude， and practice toward patients taking warfarin after valve replacement

LV Linhua， CHEN Biqiao， ZHANG Ying， QING Xiaomin， YANG He， WU Shuting， ZHENG Cuiyu

2019, 19(02):  244-247.  DOI: 10.3969/j.issn.1009?976X.2019.02.027

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［Abstract］ Objective To observe the influence of health education by stage on knowledge， attitude， and practice of patients taking Warfarin after valve replacement. Methods 130 patients undergoing valve replacement surgery in our hospital from April 2017 to April 2018 were chosen and divided into two groups： intervention group （65 cases） and control group （65 cases）. The control group was given routine health education on warfarin， the intervention group received health education on warfarin by stage， statistical analysis were made between the two groups. According to clinical statistics， the patients in the observation group were significantly better than in the control group in awareness of their knowledge of warfarin. Their attitudes and beliefs about taking warfarin， their compliance on taking warfarin and their satisfaction with the health education on Warfarin. The differences between the two groups were obvious， all of them have statistical significance （P<0.05）. Results The adoption of staged health education showed a good effect on patients with valve replacement surgery， which can effectively improve the awareness of their knowledge on warfarin and their compliance on taking warfarin for reducing the occurrence of anticoagulant， complications， improving the satisfaction and life quality of the patients. Conclusion The health education by stage on warfarin is a scientific， effective and ideal nursing method.

Effect of nursing peer review combined with performance check on promoting nursing pathway for laparoscopic appendectomy

HUANG Wanyun， LI Xinmei， HUANG Jieying

2019, 19(02):  248-250.  DOI: 10.3969/j.issn.1009?976X.2019.02.028

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［Abstract］ Objective To explore the effect of nursing by peer review combined with performance check on enhancing nursing pathway in operation room. Methods 104 patients underwent laparoscopic appendectomy in Maoming People??s Hospital from January to June 2017 were selected and divided into observation group and control group， 52 cases in each group. The patients in the control group were given routine nursing intervention， while those in the observation group were performed a new operating room nursing protocol （on the basis of the control group， strengthening and emphasizing the execution of each procedure， quantifying nursing details according to different weights）. The effects of nursing during appendectomy procedure were scored by peer review and performance examination. The clinical indicators， complications， nursing errors or problems， and doctor?patient satisfaction were compared between the two groups. Results The time from entering the operating room to returning to the ward and the total hospitalization time of the patients in the observation group were shorter than those in the control group （P<0.01， P<0.001， respectively）. The incidences of potential safety incidents in the observation group were lower than those in the control group （P<0.05）. There was no significant difference between the two groups in the occurrence of anesthesia accidents， organ injuries and postoperative infections. Conclusions Nursing peer review combined with performance check can promote participants activity to implement the operating room nursing， shorten the operating room time， reduce errors， and improve patients’ satisfaction with the nursing work in the operating room.