Table of Content

20 October 2019, Volume 19 Issue 05

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The value of diffusion-weighted magnetic resonance imaging in differential diagnosis of benign and malignant gallbladder lesions

ZHUO Xianhua， WAN Yunle

2019, 19(05):  513-519.  DOI: 10.3969/j.issn.1009-976X.2019.05.007

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Objective To evaluate the value of diffusion-weighted imaging （DWI） in the differential diagnosis of benign and malignant gallbladder lesions. Methods A retrospective analysis of 82 cases of postoperative pathologically diagnosed gallbladder lesions， including 58 cases of gallbladder malignant tumors and 24 benign lesions. The difference between ADC values of benign and malignant gallbladder lesions was analyzed by independent t test， and the diagnostic efficacy of ADC value was evaluated by ROC curve. Results The ADC value of gallbladder carcinoma and benign gallbladder lesions was 1.13±0.32×10-3 mm2/s and 1.58±0.33×10-3 mm2/s， respectively. The ADC value of gallbladder carcinoma was significantly lower than that of benign lesions. The area under the ROC curve for the diagnosis of benign and malignant gallbladder lesions was 0.834. When the ADC value was ≤1.38×10-3 mm2/s， the sensitivity of diagnosis of gallbladder cancer was 81.8%， the specificity was 74.1%， and the accuracy was 91.3%. Conclusion DWI has a good application value in the differential diagnosis of benign and malignant gallbladder lesions.

Effect of small interfering RNA reverse wnt/β-catenin pathway on hepatocellular carcinoma cell line

ZHANG Huayao， TAN Langping， LIU Jianping， SU Zheng， WEI Jinxing， HUANG Yannian

2019, 19(05):  520-524.  DOI: 10.3969/j.issn.1009-976X.2019.05.002

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Objective To investigate the effect of silencing β-catenin gene on HepG2 cells in liver cancer cells. Methods The experiment was divided into 5 groups： normal liver cell （LO2） group， HepG2 group， HepG2/ADM group， SiNC-HepG2/ADM negative transfection group and Siβ-catenin-HepG2/ADM transfection group； The expression of β-catenin was determined； the highest inhibition rate of Siβ-catenin was designed and screened； the mRNA and protein expression levels of β-catenin， P-gp and MRP1 were detected by Western-blot and RT-PCR techniques； MTT assay The sensitivity of each group to doxorubicin （ADM）， fluorouracil （5-FU）， cyclic adenosine monophosphate （VCR） and oxaliplatin （OHP） was observed. The apoptosis of each group was detected by flow cytometry. Results 50 mol/L ctnnb1-001 had the highest inhibition efficiency in HepG2/ADM： 78.86% （P<0.05）， which was selected as Si-β-catenin. Cellular immunofluorescence showed that β-catenin had the strongest fluorescence in HepG2/ADM. After transfection of Si-β-catenin， the fluorescence was significantly attenuated； β-catenin， P-gp and MRP1 mRNA and protein were highly expressed in HepG2/ADM group， and the mRNA expressions were 0.92±0.03， 7.98±0.43 and 4.56±0.12， respectively. P<0.05）， protein expression was 1.128±0.214， 1.678±0.344 and 1.405±0.212 （P<0.05）； transfection of Siβ-catenin to HepG2/ADM， β-catenin， P-gp and MRP1 in mRNA and The expression levels of protein were decreased at different degrees. The mRNA expressions were 0.47±0.03， 0.66±0.054 and 0.74±0.03， respectively （P<0.05）. The protein expressions were 0.787±0.032， 0.797±0.055 and 1.390±0.050， respectively （P<0.05）. The resistance coefficient （RI） of Aβ， 5-FU， VCR and OHP in the Siβ-catenin-HepG2/ADM transfection group was 0.61， 0.55， 0.30 and 0.55， respectively， compared with HepG2/ADM group， and the sensitivity to chemotherapy drugs was significant. The enhancement rate was （P<0.05）. The apoptosis rate of Siβ-catenin-HepG2/ADM transfection group was 28.05±0.35%， which was significantly higher than other groups （P<0.05）. Conclusion The Wnt/β-catenin pathway is aberrantly activated in HepG2. β-catenin may positively regulate the drug resistance genes P-gp and MRP1. Si-β-catenin can block the Wnt pathway to a certain extent and reverse liver cancer to some extent. The drug resistance of the cell line HepG2 enhances chemosensitivity and increases apoptosis.

Optimization of Breath-hold three-dimensional （3D） magnetic resonance cholangiopancreatography using a Gradient and Spin Echo （GRASE） technique at 3.0 T

SU Yun， LI Jixin， LI Jingwen， LI Cheng， HU Huijun， ZHONG Jinglian

2019, 19(05):  525-527.  DOI: 10.3969/j.issn.1009-976X.2019.05.003

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Objective To investigate the most appropriate value of TSE factor and EPI factor for accelerated 3D GRASE-MRCP which is within 15 seconds. Methods Thirty-one patients underwent 3D GRASE-MRCP 5 times with different value of TSE factor and EPI factor at 3T， the acquisition time of each sequence was less than 15 seconds. ANOVA and pairwise comparison were used to compare the contrast-to-noise （CNR） of common bile duct between 5 groups. The images quality of 5 groups were scored by three experienced radiologists. Scoring results were analyzed statistically with the Kruskal-Wallis H test and pairwise comparison. Results The CNR of Group 5 （14*9） was significantly higher than that of Group 1 （14*7）、Group 3 （13*7）、Group 4 （14*5）. The qualitative scores for Group 1 is significantly better than that of Group 4 and 5. Conclusion The acquisition time of accelerated 3D GRASE-MRCP could be less than 15 seconds， which made it more feasible for clinical use. When the value of TSE factor and EPI factor were 14×7， it provided better CNR and image quality.

Distribution characteristics of LAP+CD4+T cells in the tumor microenvironment of hepatocellular carcinoma and its significance

CHEN Jingsen， OU Xi， ZHAO Yang， YU Guangyin， LIU Xiaoping

2019, 19(05):  528-532.  DOI: 10.3969/j.issn.1009-976X.2019.05.004

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Objective To study the distribution characteristics of LAP+CD4+T cells in Tumor tissue of hepatocellular carcinoma （HCC） and to explore the role of LAP+CD4+T cells in occurrence and development of HCC. Methods Tumor tissues and peri-tumor tissues from 28 patients with HCC during October 2011 to December 2012， as well as hepatic tissues from 28 HBV-infected patients with benign lesions were subjected to immunohistochemical analysis with double staining for LAP and CD4， and the average number of the LAP+CD4+ T cells in each visual field was quantified. Results The average number of LAP+CD4+T cells underling an individual high magnification vision in HCC tissues were significantly higher than those of control tissues （11.25±3.00 vs 2.61±0.83， P=0.000）. The average number of LAP+CD4+T cells underling an individual high magnification vision in peri-cancer tissues were significantly higher than those of control tissues （5.75±1.00 vs 2.61±0.83， P=0.000）. This significant difference was also viewed in HCC tissues and peri-cancer tissues （11.25±3.00 vs 5.75±1.00， P=0.000）. Conclusions LAP+CD4+T cells accumulate in the tumor microenvironment of HCC. LAP+CD4+T cells could accelerate the immune escape by suppressing the local immune system in the development of HCC. LAP+CD4+T cells would play a role in negatively regulating through cell to cell contact.

Application of enhanced recovery after surgery in extra-hepatic bile duct stone surgery

LI Yong， WU Shaofeng， WANG Fuqiang

2019, 19(05):  533-540.  DOI: 10.3969/j.issn.1009-976X.2019.05.005

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Objective To verify the safety and effectiveness of enhanced recovery after surgery （ERAS） in extra-hepatic bile duct stone surgery. Methods 300 patients with extra-hepatic bile duct stones undergoing laparoscopic common bile duct exploration in our hospital from 2017 to 2019 were selected and divided into ERAS group and control group according to the sequence of operation time. The duration of operation， nausea and vomiting after operation， pain score， first exhaust time of anus， urinary retention after operation， complications （bile fistula， bile duct stricture， abdominal infection， incision infection） and other indicators were observed. Results Compared with the control group， ERAS group had shorter operation time， lower incidence of nausea and vomiting， less pain， earlier anal exhaust time， lower incision infection rate， fewer hospital days after operation all（P<0.05）， and no difference in other surgical complications and urinary retention after operation. Conclusion ERAS in LEBDE is safe and effective， while improve patients′ medical experience.

Non-surgical treatment of severe lymphatic leakage after neck dissections

YU Jiandong， CHEN Zhiping， LIN Zeyu， HUANG Xiaoming， ZHUO Xianhua， CHEN Qin， ZHONG Chuangyue， WAN Yunle

2019, 19(05):  536-540.  DOI: 10.3969/j.issn.1009-976X.2019.05.006

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Objective To evaluate the value of comprehensive non-surgical therapeutic measures in the prevention and treatment of severe lymphoid leakage after neck dissections of thyroid carcinoma. Methods The clinical data and treatment process of two patients with severe lymphoid leakage after neck dissections were analyzed retrospectively. The prevention and treatment methods of severe lymphoid leakage after neck dissections for thyroid carcinoma were discussed in combination with the current literature. Results Through diet control， nutritional support， local pressure bandaging， negative pressure drainage， somatostatin， and local injection of high concentration compound meglumine diatrizoate injection， etc. It can promote the healing of patients with severe lymphoid leakage after neck dissections. Conclusion Non-surgical comprehensive therapeutic measures such as diet control， nutritional support， local pressure drainage， somatostatin， and local injection of high concentration compound meglumine diatrizoate injection， etc. It is safe and effective to prevent and treat severe lymphoid leakage after neck dissections in thyroid carcinoma and can be used as the first choice.

The value of diffusion-weighted magnetic resonance imaging in differential diagnosis of benign and malignant gallbladder lesions

LI Yong， XIE Mingwei， SHI Guangzi， PAN Heng， LI Guozhao， YI Zhilong

2019, 19(05):  541-543.  DOI: 10.3969/j.issn.1009-976X.2019.05.007

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Objective To evaluate the value of diffusion-weighted imaging （DWI） in the differential diagnosis of benign and malignant gallbladder lesions. Methods A retrospective analysis of 82 cases of postoperative pathologically diagnosed gallbladder lesions， including 58 cases of gallbladder malignant tumors and 24 benign lesions. The difference between ADC values of benign and malignant gallbladder lesions was analyzed by independent t test， and the diagnostic efficacy of ADC value was evaluated by ROC curve. Results The ADC value of gallbladder carcinoma and benign gallbladder lesions was 1.13±0.32×10-3 mm2/s and 1.58±0.33×10-3 mm2/s， respectively. The ADC value of gallbladder carcinoma was significantly lower than that of benign lesions. The area under the ROC curve for the diagnosis of benign and malignant gallbladder lesions was 0.834. When the ADC value was ≤1.38×10-3 mm2/s， the sensitivity of diagnosis of gallbladder cancer was 81.8%， the specificity was 74.1%， and the accuracy was 91.3%. Conclusion DWI has a good application value in the differential diagnosis of benign and malignant gallbladder lesions.

Study on the early stoma closure after endoscopic stricturotomy in the treatment of postoperative anastomotic stricture of colorectal cancer

HU Jiancong， LIN Dezheng， LIU Wei， YANG Xiaoyan， YU Zhaoliang， TAN Shuyun

2019, 19(05):  544-547.  DOI: 10.3969/j.issn.1009-976X.2019.05.008

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Objective To analyze the effect of endoscopic stricturotomy of anastomotic stenosis in patients with colorectal cancer and the complications of short-term closure of temporary stoma. Methods Clinical data of 7 colorectal cancer patients with postoperative anastomotic stricture underwent stoma closure after endoscopic stricturotomy in less than 2 weeks at The Sixth Affiliated Hospital of Sun Yat-sen University between January 2014 and December 2016 were retrospectively collected. The short-term and long-term effects of endoscopic stricturotomy and the incidence of surgical complications were analyzed after stoma closure. Results The endoscopic pass rate of 7 patients after endoscopic stricturotomy was 100%. All the cases underwent stoma closure after endoscopic stricturotomy in less than 2 weeks （6.6±2.9 days）. No complication was recorded after stoma closure. 2 cases accepted endoscopic intervention due to stricture recurrence. The long-term efficient rate was 71.4% with 30.2±10.8 months follow up. Conclusion Endoscopic stricturotomy in the treatment of postoperative anastomotic stricture of colorectal cancer is effective. Stoma closure after stricturotomy with short interval is safe.

Clinical analysis of 13 cases of acute mesenteric arterial embolus withatrial fibrillation

ZHANG Meng， ZENG Zhifen， ZHOU Tian′en*

2019, 19(05):  548-551.  DOI: 10.3969/j.issn.1009-976X.2019.05.009

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Objective To investigate clinical manifestation of acute mesenteric arterial embolism（AMAE） in patients with atrial fibrillation. Methods The retrospective study was performed on the clinical data of atrial fibrillation with acute mesenteric arterial embolism admitted into the Sun Yat-sen Memorial hospital of Sun Yat-sen University from January 2009 to January 2019. Results 15006 patients with atrial fibrillation were retrieved， of 13 cases received AMAE and the incidence was 0.087%. 8 cases were males and 5 were females. The ages range from 46 to 87 and the average age was 65.5±5.3 years old. 41 AMAE patientswere retrievedand the incidence of atrial fibrillation was 31.72%（13/41）. Belly pain was all the starting symptom of AMAE， with no characteristic signs and test results. The average time from seeking medical advice to making a definite diagnosis was 47.9 hours. The total mortality was 46.15%（6/13）， with death of 3 for 8 patients received surgery and death of 3 for 5 patients received conservation treatment. Just 2 patients took anticoagulant drugs，one was warfarin and the other was rivaroxaban， but none of the coagulation indicators met the standard. Conclusion AMAE is a rateof atrial fibrillation， while atrial fibrillation is the risk factor for AMAE. Age， lack of specific signs and test indicator result in a long diagnostic period and high mortality. Doing CTA or DAS as a valuable supplementary approach timely to make a definite diagnosis as early as possible， accurate judgment of illness to make a appropriate therapy decision and taking anticoagulant drugs regularly is effective in decrease of morbidity and mortality.

Effect of ERAS on Hs-CRP and PA in elderly patients after laparoscopic colon cancer surgery

TAN Minghua， HU Haitao， OU Xiaowei， LIAO Jiannan， FENG Weiqing， ZHU Jingtao

2019, 19(05):  552-554.  DOI: 10.3969/j.issn.1009-976X.2019.05.010

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Objective To investigate the effect of ERAS on postoperative protein synthesis in elderly colon cancer patients and to investigate its effect on postoperative recovery. Methods 45 elderly colon cancer patients were admitted to our hospital from December 2016 to December 2018， including 22 cases receiving accelerated rehabilitation surgery （experimental group） and 23 cases receiving conventional treatment （control group）. Postoperative anal exhaust time， postoperative hospitalization time， total hospitalization cost， Hs-CRP and PA before and after operation， perioperative complications were compared between the two groups. Results The postoperative exhaust time， postoperative hospitalization time and total hospitalization cost of patients in the experimental group were significantly lower than those in the control group. The levels of Hs-CRP in the experimental group were significantly lower than those in the control group after surgery while PA were significantly higher in the experimental group than those in the control group after surgery. Conclusion ERAS can promote postoperative recovery of senile colon cancer patients.

Analysis of multiple factors in the cause of thyroid nodules

HE Zhijian， TAN Yucan， XU Guojian， ZHU Zhengrong， CAO Jianqiang， XING Yue， WU Jiayu， ZOU Lan， LUO Canhua

2019, 19(05):  555-558.  DOI: 10.3969/j.issn.1009-976X.2019.05.011

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Objective To investigate the risk factors for the risk of thyroid nodules. Methods A total of 240 patients in the health examination department of our hospital were surveyed. The questionnaires were used to analyze the age， sex， family style and living habits of the patients. The age， sex， family history and habits of patients with thyroid nodules and no thyroid nodules were compared. Multivariate logistic regression analysis was used to analyze the risk factors of thyroid nodules. Results The three factors of gender， head and neck irradiation and psychology were related to the disease of thyroid nodules. The results of single factor analysis showed that people with head and neck irradiation history， female patients and personality depression were risk factors for thyroid disease. The final inclusion of the model is the high-risk factors for thyroid nodules， including gender， head and neck exposure and personality. Conclusion Gender， head and neck exposure history and personality may be risk factors for thyroid nodules.

Effect of withdrawal of antiplatelet and anticoagulation therapy for elderly inguinal hernia patients undergoing Lichtenstein tension-free hernia repair

LIU Yexing， ZHANG Donghui，ZHUANG Zhehong, ZHANG Jianbao， LIANG Zhihao

2019, 19(05):  559-562.  DOI: 10.3969/j.issn.1009-976X.2019.05.012

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【Abstract】 Objective To observe the clinical efficacy of Lichtenstein tension-free hernioplasty in the treatment of elderly inguinal hernia patients who withdrawing anticoagulants and antiplatelet. Methods A retrospective analysis was made of the clinical data of 108 elderly male patients with long-term use of anticoagulants treated by Lichtenstein tension-free hernioplasty in gastrointestinal surgery of the Eight Affiliated Hospital of Sun Yat-sen University from January 2015 to December 2017 under local infiltration anesthesia. Results There was no death and no serious complications during the perioperative period. The operation lasted 50 to 105 min with bleeding of 5 to 20 ml and normal oxygen saturation. After operation, patients were given general diet and no urinary retention occurred. There were 8 patients with seroma, which improved after aspiration, and no incision infection. During the operation, blood pressure increased in 12 cases and heart rate increased in 10 cases. There were 16 cases of pain during operation. The pain score (visual analogue score) at 6, 12 and 24 hours after operation was below 3. There were 2 cases of chronic pain and abnormal sensation after operation. Conclusion For elderly patients at high risk of thromboembolism this may be safe way to decrease bleeding risk with no anticoagulants and antiplatelets when undergoing Lichtenstein tension-free hernioplasty.

Expression and diagnostic efficacy of LINC01151 in tumor tissues of ovarian cancer patients with chemotherapy resistance

LEI Ruilin， ZHANG Meng， JIANG Xiaoyan， CHEN Siqi， LIN Rongchun

2019, 19(05):  563-566.  DOI: 10.3969/j.issn.1009-976X.2019.05.013

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Objective To finding lncRNAs associated with ovarian cancer progression and platinum-based chemoresistance， and provide novel detection markers for early screening and treatment options for ovarian cancer. Methods Differentially expressed lncRNAs were screened from cisplatin-resistant ovarian cancer cell lines. The ovarian cancer sequencing data in the TCGA and GTEx databases were analyzed to compare the expression of LINC01151 in ovarian cancer tissues， paracancerous tissues， metastatic tumor tissues， and the overall life cycle of patients. The expression levels of LINC01151 were detected in 25 clinical samples of ovarian cancer tumor tissues and adjacent tissues， and the expression of LINC01151 in normal ovarian epithelial cells and different ovarian cancer cell lines was compared， as well as cisplatin-sensitive ovarian cancer cells and cisplatin-induced ovarian cells. The expression of LINC01151 in cancer cells was analyzed for the association of LINC01151 with tumorigenesis and drug resistance. Results Differentially expressed lncRNAs were screened from cisplatin-resistant ovarian cancer cell lines， and the expression of LINC01151 was significantly different. The relevant data in the chip showed that LINC01151 was highly expressed in cisplatin-resistant ovarian cancer cell lines. It was found by qPCR that LINC01151 was highly expressed in ovarian cancer tissues and cells， and LINC01151 was highly expressed in cisplatin-induced cell lines compared with cisplatin-sensitive cells. Conclusion LINC01151 may be a marker of chemotherapy resistance in ovarian cancer. It is of great significance to reduce the cost of over-treatment and to take timely interventions to avoid the missed optimal cure time and improve the prognosis of cancer patients.

Application of an improved lymph node detection method in postoperative pathological examination of colorectal cancer

LI Zhaoyang， LIN Yiban， CHEN Huaxian， GUO Xiaoxi， ZHNAG Zilang， DENG Jianzhong

2019, 19(05):  567-570.  DOI: 10.3969/j.issn.1009-976X.2019.05.014

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Objective To investigate the effect of an improved lymph node detection method in pathological examination of colorectal cancer after operation. Methods A modified method of lymph node detection was used to detect lymph nodes in 100 patients undergoing radical operation for colorectal cancer from November 2016 to February 2019 in the Anorectal Surgery Department of First People′s Hospital of Foshan. Results A total of 2303 lymph nodes were detected in 100 colorectal cancer surgical specimens by modified method， with an average of （23.03±10.94） lymph nodes per case， 178 positive lymph nodes （1.78±2.99） per case， 1138 lymph nodes （21.47±8.37） per case， 91 positive lymph nodes （1.72±2.82） per case， and 23 sigmoid colorectal cancer. There were 442 nodules with an average of （19.22±7.67） in each case； 43 positive lymph nodes with an average of （1.87±2.60） in each case； 130 lymph nodes with an average of （16.25±5.44） in 8 cases of descending colon cancer； 13 positive lymph nodes with an average of （1.63±1.77） in each case； 593 lymph nodes were detected in 16 cases of right colon cancer， with an average of （37.06±13.19） in each case； and 31 positive lymph nodes with an average of （37.06±13.19） in each case. Each case （1.94±4.42）. There were less than 12 lymph nodes detected in 7 cases of colorectal cancer after operation， which were 0/8 and 4/10 lymph nodes detected in 2 cases of descending colon cancer， 1/8， 1/9 and 0/10 lymph nodes detected in 3 cases of sigmoid colon cancer， and 0/6 and 1/11 lymph nodes detected in 2 cases of rectal cancer. Conclusion The improved lymph node de tection method， the high light direct vision method， was a feasible method for lymph node detection. It has the advantages of simple operation， no additional cost and easy popularization. It could meet the requirements of pathological staging.

Comparison of different epidural infusion modes in labor analgesia

ZHANG Yuan， LIU Zhiheng

2019, 19(05):  571-575.  DOI: 10.3969/j.issn.1009-976X.2019.05.015

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Objective To compare the effects of regularintermittent epidural bolus （RIEB） and continuous epidural infusion （CEI） combined with patient-controlled epidural analgesia （PCEA） on labor analgesia. Methods 225 parturients who voluntarily received labor analgesia were randomly divided into three groups： A， B and C， 75 cases in each. Epidural analgesia was used for all the paturients， through L2-3 intervertebral space with 0.08% ropivacaine and 0.4 μg/ml sufentanil as epidural analgesic solution. In group A， CEI mode of analgesia was applied with 8 ml/h continuous infusion of analgesic solution. In the other two groups， RIEB mode of analgesia were used and after the first dose， 8 mL analgesic solution was injected epidural every one hour， on the speed of 2 ml/min in group B and 6 ml/min in group C respectively. Mean arterial pressure （MAP）， heart rate （HR） ， the visual analogue scale （VAS）， modified Bromage score were recorded at the following time points： before analgesia （T1）， 30 min after labor anesthesia （T2）， 60 min after labor anesthesia （T3）， datively cervix to 7-8 cm （T4）， full dilatation of cervix （T5）， at labor （T6）. Frequency of PCEA request， ropivacaine consumption， sufentanil consumption， total delivery duration，analgesic time，delivery mode， neonatal Apgar score， adverse reactions and parturients satisfaction score were observed. Results There was no significant difference in VAS score at T1， T2 and T3 among the three groups （P>0.05）. The VAS score at T4，T5 and T6，frequency of PCEA request， ropivacaine consumption， sufentanil consumption group C Group B > Group A （P<0.05）. There was no significant difference in MAP ， HR， modified Bromage score， total delivery time，analgesic time， delivery mode，adverse reactions，neonatal Apgar score， adverse reactions among the three groups（P>0.05）. Conclusion RIEB combined with PCEA is effective in labor analgesia， and the pump speed of 6ml/min is the best， which effectively decrease the need of PCEA and the dosage of analgesics and improve maternal satisfaction， without additional adverse reactions.

Discussion on monitoring and application of near infrared spectroscopy in hypertensive cerebral hemorrhage

FENG Jiaqiang， YU Ruiqi， LUO Jiangbing， LI Lifeng

2019, 19(05):  576-579.  DOI: 10.3969/j.issn.1009-976X.2019.05.016

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Objective To investigate the effects of near-infrared spectroscopy on intracranial pressure （ICP）， cerebral perfusion pressure （CPP） and vital signs in patients with hypertensive intracerebral hemorrhage before， during and after surgery. Methods Twenty patients with hypertensive intracerebral hemorrhage were monitored for ICP， CPP， brain tissue oxygen saturation （rScO2） and vital signs before and during operation and after operation. Correlation analysis was performed. Results With the progress of the operation， the CPP value of the patients gradually increased， and the ICP value decreased gradually. The difference between the groups was statistically significant （P<0.05）. Preoperative， intraoperative， and postoperative comparisons showed that the ICP of the affected side was lower than that of the healthy side before， during， and after surgery （P<0.05）. ICP was lower than that during surgery and postoperatively. Before （P<0.05）； the postoperative CPP was higher than the healthy side （P<0.05）. There were no significant differences in rScO2， pulse oximetry， heart rate， systolic blood pressure， diastolic blood pressure， mean arterial pressure and body temperature between preoperative， intraoperative and postoperative patients （P>0.05）. Preoperative， intraoperative， postoperative， rScO2 in patients with hypertensive cerebral hemorrhage was negatively correlated with CPP （P<0.05）， and positively correlated with ICP and mean arterial pressure （P<0.05）. Conclusion Near-infrared spectroscopy can timely obtain bleeding in patients with hypertensive intracerebral hemorrhage before， during and after surgery， which is helpful for early diagnosis and treatment.

Evaluation of laparoscopic ureterolithotomy for treatment of upper ureteral calculi

LI Hang， XIE Jiaodi， CHEN Zebo， YANG Shangqi

2019, 19(05):  580-583.  DOI: 10.3969/j.issn.1009-976X.2019.05.017

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Objective To evaluate the clinical value of laparoscopic ureterolithotomy for upper ureteral calculi. Methods All the surgical-treated upper ureteral calculi cases from January 2013 to December 2018 in Peking University Shenzhen hospital were reviewed. The 121 laparoscopic ureterolithotomy （LUL） cases were divided into the study group， while 152 ureteroscopic lithotripsy （USL） cases were in the control group. Then we compared the stone-free rate， surgical complications and some other clinical data between the two groups. Results The LUL group had a higher stone-free rate （97.5% vs 84.2%， P<0.001） and a lower surgical complication rate （8.3% vs 18.4%， P=0.012） than the USL group. However， the LUL cases had more intraoperative bleeding （P<0.001）， longer operation time （P<0.001） and longer postoperative hospitalization time （P<0.001）. Conclusion For the surgical treatment of upper ureteral calculi， laparoscopic ureterolithotomy provides higher stone-free rate and leads to less surgical complications， but has more intraoperative bleeding， longer operation time and longer postoperative hospitalization time， and demands higher technical level. A surgeon should choose the appropriate way of operation according to his technical condition， feature of the case and patient′s requests.

A case report of pseudomyogenic hemangioendothelioma and review of literature

LI Jixin， ZHANG Fan， YANG Qihua

2019, 19(05):  584-588.  DOI: 10.3969/j.issn.1009-976X.2019.05.018

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Objective To investigate the clinical and imaging features of pseudomyogenic hemangioendothelioma. Methods A case of pseudomyogenic hemangioendothelioma in our hospital was analyzed， including clinical features， laboratory test results， image findings and pathological features. Results After laboratory test and imageological examinations， the patient underwent right iliac bone mass and right hip subcutaneous mass resection， he recovered well thereafter. Conclusion Pseudomyogenic hemangioendothelioma is rare， andit manifest as intermediate malignancy or low malignancy. It has the characteristics of soft tissue tumor on imaging and should be differentiated in diagnosis. Familiarity with clinical manifestations， relative imaging features and pathological features is conducive to diagnosis and differential diagnosis of this disease.

Effect of small window craniotomy via lateral fissure-insular approach and traditional craniotomy in the treatment of cerebral hemorrhage in basal ganglia region

CHEN Shengyong， LIU Guanghuang， WU Fenlang， GUAN Zejian

2019, 19(05):  589-591.  DOI: 10.3969/j.issn.1009-976X.2019.05.019

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Objective To investigate the effect of small bone window craniotomy via lateral fissure-insular approach and traditional bone flap craniotomy on cerebral hemorrhage in basal ganglia. Methods From October 2017 to October 2018， 60 patients with cerebral hemorrhage in basal ganglia were selected and divided into different groups according to the treatment plan， 30 cases in each group. The traditional group was treated with traditional craniotomy， while the small bone window group was treated with microsurgery via translateral fissure-insular approach. The operation conditions， Glasgow Coma Score （GCS） （before operation， 1 week after operation and 2 weeks after operation）， Pap index （BI） （1 month， 3 months and 6 months after operation）， and complications were compared between the two groups. Results Compared with the traditional group， the small bone window group had lower bleeding volume， shorter operation time and higher clearance rate of hematoma （P<0.05）； the GCS score of the small bone window group was higher than that of the traditional group one week after operation （P<0.05）； the BI of the small bone window group was higher than that of the traditional group one month and three months after operation （P<0.05）； the complication rate of the small bone window group was 3.33% lower than that of the traditional group 26.67% （P<0.05）. Conclusion Compared with traditional craniotomy， microsurgery via small bone window craniotomy via lateral Fissure-Insula approach has the advantages of less trauma， less bleeding， shorter operation time， higher clearance rate of hematoma and fewer complications， and which can also promote coma recovery and improve activities of daily life.

Foreign body inlaid in the glottis developed to tracheal foreign body： a case report and review of the literature

ZOU Tuanming， CHEN Junming， YU Youjun， LIU Zhen

2019, 19(05):  592-595.  DOI: 10.3969/j.issn.1009-976X.2019.05.020

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Objective To explore the clinical manifestations， diagnosis and treatment of the subglottic foreign body. Methods A case report and review of the literature. from a retrospective analysis of 12 June 2018， a case of the insinuated sound portal developed into a trachea foreign body. The patient， female， 1 year 3 months old， was admitted to the hospital for “10 days after eating fish bones.” Before the admission， the treatment of anti-inflammatory and atomizer was not effective， and the fiber laryngoscopy showed a foreign object. During general anesthesia downlink bronchoscope surgical exploration， laryngospasm and oxygen desaturation occurred， emergency tracheal intubation and evolution of trachea was applied with the bronchoscope under general anesthesia. The foreign body was removed successfully. Results The procedure went well the first postoperative day and 13 days after tracheal intubation. The patient had no fever， cough and expectoration， without shortness of breath or rosy. The lung auscultation breath sounds was clear. Review of X-ray suggests basic healing and no foreign body residual or pneumonia. She discharged from hospital. Conclusion Laryngeal foreign body and tracheal foreign body are common， but it is rare to develop into the endotracheal foreign body. A history of foreign body ingestion of children should be considered the possibility of laryngeal eyewinker and needs relevant examination and further diagnosis. Suitable operation and anesthesia method should be chosen.

Treatment of Schatzker Ⅰ-Ⅳ tibial plateau fracture with arthroscopic assisted minimally invasive internal fixation

CHEN Shuai， ZHANG Xiaohai， ZHANG Hongyi， QU Yongliang

2019, 19(05):  596-599.  DOI: 10.3969/j.issn.1009-976X.2019.05.021

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Objective to investigate the clinical effect of arthroscopic-assisted minimally invasive internal fixation in the treatment of Shatzker Ⅰ-Ⅳ Tibial plateau fracture. Methods The clinical data of 42 cases of tibial plateau fracture were analyzed retrospectively from February 2015 to August 2018 which were divided into observation group and control group， each group 21 cases. The observation group was treated with percutaneous minimally invasive fixation assisted by Arthroscopic techniques. The control group was treated with traditional open operation. The effects were evaluated by Rasmussen Score. Results The follow-up time was 6 to 24 months （10.3 months on average）. After 6 months and 12 months， Rasmussen score was better than that of control group （P<0.05）. In the observation group， the different grades of Rasmussen were better than those of the control group （P<0.05）. Compared with control group and observation group， the superiority rate was 57.1% and 90.5% respectively， the difference was statistically significant （z=3.921， P=0.044）. There were no complications such as infection， osteofascial compartment syndrome and deep vein thrombosis. control group infected 1 case， after treatment of the disease， recovered. There was no statistically significant difference in the incidence of complications between the two groups. Conclusion the treatment of Scharzker Ⅰ-Ⅳ Tibial plateau fracture with percutaneous minimally invasive fixation with arthroscopic technique is less traumatic， less complication and more effective.

Anesthesia management of Sturge-Werber syndrome： a case report and review of literatures

DU Sujuan， CHEN Ruixia， YE Xijiu

2019, 19(05):  600-603.  DOI: 10.3969/j.issn.1009-976X.2019.05.022

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Objective To investigate the anesthesia management of Sturge-Werber syndrome. Methods The anesthesia management of a child with Sturge-Werber syndrome （type Ⅲ） was retrospectively analyzed， and the related literatures were reviewed. Result After sufficient preoperative evaluation， knowing the patient′s history of antiepilepsy and excluding the risks such as difficult airway and high intraocular pressure， the operation was successfully completed under combined intravenous and inhalation anesthesia， and the patient recovered well after operation. Conclusion Difficult airway， oral and upper respiratory angiomata， central nervous system lesions and glaucoma are the main problems in SWS anesthesia management. Anesthesiologists should fully understand these problems and make appropriate preoperative evaluation of SWS patients so as to formulate appropriate anesthesia management plan.

Application of modified medial skin removal method during double blepharoplasty

ZAHNG Ting， JI Chenyang， ZHANG Jinming， GE Jun， RAO Xiangting

2019, 19(05):  604-607.  DOI: 10.3969/j.issn.1009-976X.2019.05.023

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Objective To improve the incision design of double blepharoplasty， enlarge the removal of medial skin， and observe the degree of skin fluency below the double eyelid line after operation. Methods From January 2017 to April 2018， 78 patients were treated with modified medial skin removal method for double blepharoplasty. They were divided into observation group. In the supine position， the amount of skin removal was evaluated. The tightness of skin in the eyelid was assessed at different stages after surgery. At the same time， 89 patients who underwent conventional double blepharoplasty from January 2016 to December 2016 were selected as the control group， and the probability of occurrence of folds on the medial double eyelid line was counted. Results The wounds of 78 patients in the observation group healed in one stage， and 4 patients had skin folds on the medial side， with a probability of 6.4%. In the control group， there were 17 cases of skin folds on the medial side of double eyelid line， with a probability of 19.1%. Conclusion Modified medial skin removal method during double blepharoplasty can effectively avoid the appearance of skin folds on the medial side of the double eyelid line and improve patient satisfaction.

Analysis of complications after Burr-hole craniostomy and drainage in 242 cases of hypertensive intracerebral hemorrhage

ZHUO Shaowei，SHI Shaochun， HUANG Liujun， LIN Xiaoyi， QIN Kangwei， ZHANGZhunyi，CAIShujia， ZHANG Shujia

2019, 19(05):  608-613.  DOI: 10.3969/j.issn.1009-976X.2019.05.024

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Objective To analyze the causes and related factors of complications after operation of hypertensive intracerebral hemorrhage. Methods This was a retrospective analysis of 242 patients with hypertensive intracerebral hemorrhage who received minimally invasive burr-holecraniostomy and closed-system drainage （BCD） from August 2015 to September 2018. The efficacy， accuracy of catheter placement and the causes of complications such as catheter-related bleeding and infection were analyzed. Results Of the 242 patients， 114 had complications （47.1%）. Among 16 patients with rebleeding and requiring intervention， 7 cases were treated with re-catheterization， 9 cases were treated with conservative medical treatment， and 3 cases died. The cause of rebleeding was associated with the use of aspirin and anticoagulants， but not with age， sex， emergency operation and Kakarla classification. There were 8 cases of catheter-drainage infection in this group， 6 of which caused focal intracerebral abscess， and the other 2 cases were scalp redness and abscess caused by pericatheter infection， which were cured after dressing change and anti-infection.Among all the patients， 28 were completely recovered， 175 were significantly improved and 16 were not improved. According to ADL classification， there were 147 cases Ⅰ~Ⅱ， 67 cases Ⅲ~Ⅳ， and 5 cases Ⅴ， and 11 cases died during admission and 12 cases died during follow-up to 6 months. Conclusion Patients with hypertensive intracerebral hemorrhage have a high incidence of complications after cranial trepanation and drainage. Rehaemorrhage and infection are important risk factors to be dealt with.

Beneficial effect of fluid warming in elderly patients with bladder cancer undergoing Da Vinci robotic-assisted laparoscopic radical cystectomy

LUO Jianwei， ZENG Jianfeng

2019, 19(05):  614-618.  DOI: 10.3969/j.issn.1009-976X.2019.05.025

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Objective To investigate the efficacy of fluid warming nursing in elderly patientsundergoing Da Vinci robotic-assisted laparoscopic radical cystectomy. Methods A total of 108 patients with bladder cancer scheduled to DaVinci robotic-assisted laparoscopic radical cystectomy were recruited and randomly divided into the control group （n=55） receiving a warming blanket （41℃） during intraoperative period and the warming group （n=53） in which all intraoperative fluids were administered via a fluid warmer （41℃）. The surgical data， body temperature， coagulation function indexes and postoperative complications were compared between the two groups. Results Compared to the control group， the warming group had significantly less intraoperative transfusion （P=0.028） and shorter hospitalization days （P<0.05）. During the entire intraoperative period （from 1 to 6 h）， body temperature was significantly higher in the warming group than in the control group. There were significant differences in preoperative fibrinogen， white blood cell， total bilirubin，intraoperative lactose， and postoperative thrombin time （TT） and platelet between the control and warming groups. Multivariate linear regression analysis demonstrated that TT was the only significant factor，suggesting that the warming group had lower TT level than the control group. Conclusion Fluid warming nursing can effectively reduce transfusion requirement and hospitalization days， maintain intraoperative normothermia and promote postoperative coagulation function.

Progress in treatment of cricopharyngeal dysfunction with ultrasound-guided botulinum toxin

ZHOU Mengting， YANG Haiyun， YAO Jiyi， HE Shaoyun， LUO Baoming， WU Jiayi

2019, 19(05):  619-622.  DOI: 10.3969/j.issn.1009-976X.2019.05.026

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Cricopharyngeal dysfunction is a common disease which can lead to dysphagia， for pharyngeal muscles are not completely relaxed. There are numerous etiologies including the general categories of neuromuscular， iatrogenic， inflammatory， neoplastic， and idiopathic disease. Current options for treatment include cricopharyngeal myotomy， esophageal dilatation， and botulinum toxin injection. Minimally invasive treatment gradually replaces traditional surgical treatment with its advantages of safety， convenience， minimally invasive and cosmetically appealing appearance. Among them， ultrasound-guided botulinum toxin injection therapy has attracted much attention as a hot treatment in recent years， and has become the first choice for clinical treatment of pharyngeal muscle dysfunction. This article compares the botulinum toxin injection under ultrasound guidance with other treatments of pharyngeal muscle dysfunction.

Current situation and prospect of imaging examination of early breast cancer

LIU Li， CHI Yuerui

2019, 19(05):  623-627.  DOI: 10.3969/j.issn.1009-976X.2019.05.027

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Breast cancer is a malignant tumor that seriously threatens the physical and mental health of women. In China， the incidence of breast cancer is the first of the female malignant tumors in big cities， and the incidence of the disease is increasing year by year. Many imaging methods are currently used for early screening of breast， such as clinical breast palpation （CBP）， mammography （mammography）， ultrasound imaging （ultrasonography， US）， computed tomography （CT）， magnetic resonance imaging （magnetic resonance imaging， MRI）， and positron emission. Tomographic imaging （PET）， and breast thermal tomography，especially the application of breast biopsy are aimed at improving the detection rate of early breast cancer.

The research progress of extracorporeal shock wave therapy for the treatment of delayed union and nonunion

ZHANG Chengnian， LIU Mingting， LI Jian， XU Chuang， DU Changling

2019, 19(05):  628-631.  DOI: 10.3969/j.issn.1009-976X.2019.05.028

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5%-10% of all fractures evolve into a delayed union or nonunion. Surgery is still considered as the “golden standard” for the treatment of fracture nonunion and usually requires debriding the non-union gap， reopeningthe bone marrow cavity and bone grafting. However， surgery has the problems of large trauma， infection and implant related problems requiring an additional surgery. In recent years， extracorporeal shock wave therapy （ESWT） ，because of its advantages of non-invasive， high efficiency and low cost，as been widely used in the treatment of bone and muscle diseases， especially in the treatment of delayed union and nonunion of fracture. This article reviews the progress of extracorporeal shock wave therapy in the treatment of fracture nonunion， hoping to be useful in clinical practice.

Advances in anti-angiogenic therapeutic drugs for malignant glioma

WANG Bin， SI Tongguo

2019, 19(05):  632-636.  DOI: 10.3969/j.issn.1009-976X.2019.05.029

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Malignant glioma is the most common and invasive primary brain tumor in adults， and its significant neurological and incurable properties bring great pain and serious medical burden to patients and their families. The median survival of patients is less than 15 months due to the current standard treatment regimen that is difficult to achieve. Angiogenesis is a hallmark of malignant glioma and has become an important new therapeutic target. This article reviews the mechanism of anti-angiopathy and the clinical application of anti-angiogenic drugs in the treatment of malignant glioma， and briefly discusses the research progress of anti-angiogenic drugs for malignant glioma.

Screening and analysis of nutritional risk of inpatients based on information system

XIANG Meihuan， CHEN Junyi， LIN Xiuhong， FENG Xiaoling， LU Jiahui， HE Fengyi， Jiang Yingman， CHEN Chaogang

2019, 19(05):  637-641.  DOI: 10.3969/j.issn.1009-976X.2019.05.030

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Objective To investigate the incidence of nutritional risk in inpatients and analyze the status of nutritional risk in inpatients. Methods Nutritional risk screening was conducted on 14954 hospitalized patients hospitalized at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from December 2017 to March 2018 through nutrition information screening （NRS 2002）. Situation and intervention for screening for patients at risk of nutrition. Results Among the 14954 inpatients， the prevalence of nutritional risk was 16.4%. The age of ≥70 years old， bed rest， diet reduction ≥25%， the incidence of nutritional risk was higher and the difference was statistically significant （P<0.05）. Conclusion Inpatients have certain nutritional risks. In addition to BMI <18.5， diet reduction ≥ 75% is the nutritional risk should be nutritional support， elderly patients， bed rest， diet reduction ≥25%， patients should also focus on， in order to timely identify nutritional risks， develop nutritional support Program.

Application of evidence-based nursing to explore the effect of 3M liquid dressing on reducing contact dermatitis of patients with PICC catheter

MU Dan， WANG Caifang， LI Fangmei， ZHANG Yinyan， HUANG Rongfang， XU Dongmei

2019, 19(05):  642-645.  DOI: 10.3969/j.issn.1009-976X.2019.05.031

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［Abstract］Objective To explore the effect of 3M liquid dressing on prevention of contact dermatitis in PICC patients with evidence-based nursing. Methods Forty PICC patients admitted to hospital from January to June 2018 were selected as control group， and routine PICC maintenance was performed. 40 PICC patients admitted to hospital from July to December 2018 as observation group.After disinfection by routine method， we apply a layer of 3M liquid dressing. After drying， apply aseptic transparent dressing， maintain it every seven days， and replace the bleeding fluid in time. The incidence of contact dermatitis， the frequency of dressing change and the maintenance cost were compared between the two groups. Results There were 1 case of dermatitis （mild） in the observation group and 11 cases of dermatitis in the control group （8 cases of mild dermatitis， 2 cases of moderate dermatitis and 1 case of severe dermatitis）. There was a significant difference in the incidence of mild and moderate dermatitis （P < 0.05）. The maintenance times and total maintenance cost of PICC in the observation group were lower than those in the control group （P < 0.05）. Conclusion The use of 3M liquid dressing can reduce the incidence of contact dermatitis， improve the comfort of patients with PICC， reduce the expense， reduce the workload of nurses changing dressing， and effectively improve the clinical outcome of patients.

The summary of total laparoscopic duodenum-preserving total pancreatic head resection: nursing experience

LIANG Sihua， HUANG Zehua， WANG Jiezheng， ZHENG Xiaoxia， ZHAO Jingdan

2019, 19(05):  646-648.  DOI: 10.3969/j.issn.1009-976X.2019.05.032

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Objective To investigate comprehension of surgical nursing cooperation in the 12 cases of total laparoscopic duodenum-preserving pancreatic head resection. Methods Through preoperative nursing assessment for the 12 cases of total laparoscopic duodenum-preserving pancreatic head resection, we summarized preparation content of relative instruments, equipment and items, and key procedures of adept coordination between touring nurses and instrument nurses. Results Through close coordination of the medical team, all of the 12 cases completed successfully, none of them turned to laparotomy. Conclusion In order to complete the operation successfully, it is important and helpful to conduct specialized management on operation room nurses, optimize operation coordination team and standardize nursing cooperation in operations, with adequate preoperative preparation of instruments and professional experience.

Predictive nursing to reduce the incidence of postoperative breast cancer tension blisters in the use of management

WU Yuesong， ZHOU Jie， YANG Mengke， LIAO Yanhua

2019, 19(05):  649.  DOI: 10.3969/j.issn.1009-976X.2019.05.033

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Objective To explore the effect of the predictive nursing on reducing the incidence of skin blisters in patients with breast cancer after operation. Methods 274 cases of breast cancer patients were divided into observation group （136 cases） and control group （138 cases） from January 2018 to December 2018. Both groups were treated with elastic bras for 7 days after radical mastectomy. The control group received routine nursing care， while the observation group underwent predictive nursing intervention and pre painted Sanyrene skin moist. In addition to the conventional suction blisters， the skin that has undergone tension blisters is coated with a therapeutic of Hirudoidand povidone iodine cream. The incidence of tonic vesicles after wearing the elastic corset was compared between the two groups. Results After the predictive nursing intervention in the observation group， the incidence of blisters was 15.29% in the observation group and 28.35% in the control group. In the average number of days of blister elimination， the average elimination days in the observation group was 4 days， and the control group was 8 days. The difference was statistically significant （P<0.05）. Conclusion The application of predictive skin care in patients with breast cancer after radical resection can effectively reduce the occurrence of tension blisters.