Table of Content

20 December 2019, Volume 19 Issue 06

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Recognition and management of acute tumor lysis syndrome in emergency department

LI Li

2019, 19(06):  653-657.  DOI: 10.3969/j.issn.1009-976X.2019.06.001

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Oncologic emergency may be seen in any emergency department because patients may have malignancy?related emergency manifestation. For many patients, oncologic emergency may be the initial manifestation of tumor. Some oncologic emergencies can be subtle in presentation and may be overlooked, contributing to delay in treatment. Knowledge of malignancy?induced complications in critically ill patients expedites the ability of the intensivist to properly manage them. Effective diagnosis and correct management of life?threatening complications may help to alleviate oncologic emergency and reduce mortality. Tumor lysis syndrome （TLS） is a metabolic disorder caused by tumor cell lysis, including hyperkalemia, hyperphosphatemia, hypocalcemia and acute renal injury （AKI）. Early diagnosis and treatment are very important,and the management of TLS often needs the mutual assistance of oncologists, emergency doctors and critical doctors.In this article we will cover TLS. After reading this article the reader should be much more confident in the diagnosis, evaluation, and management of these oncologic emergencies.

Analysis of factors influencing postoperative recurrence of gastrointestinal stromal tumors and prospects for treatment decision

TIAN Huakai， ZONG Zhen

2019, 19(06):  658-661.  DOI: 10.3969/j.issn.1009-976X.2019.06.002

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The only possible cure for gastrointestinal stromal tumors is surgery， but the risk of recurrence or metastasis cannot be ignored. Targeted treatment based on postoperative risk assessment is the key to preventing recurrence or metastasis. There are many factors affecting the recurrence of gastrointestinal stromal tumors. Tumor size， tumor location， mitotic figures and tumor rupture are considered to be independent risk factors. According to these criteria， risk assessment methods are developed， mainly including F/NIH grading standards. AFIP grading standards， improved NIH grading standards in 2008， and nomogram models. Although these assessment methods have determined prognostic risk factors and risk grades， they are not able to accurately assess the risk of postoperative recurrence and guide clinical accurate treatment. Therefore， we still need to continuously explore the independent risk factors affecting the prognosis of GIST， establish a simple and accurate clinical evaluation method， improve the probability of recurrence risk probability， better guide clinical individualized treatment， and achieve precise treatment.

Comparison of correlation between CD44+/CD24-/low and ALDH1+ with prognosis of early stage breast cancer

LI Fanghua1， ZHANG Xiao2

2019, 19(06):  662-672.  DOI: 10.3969/j.issn.1009-976X.2019.06.003

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Objective to compare the correlation between CD44+/CD24-/low and ALDH1+ with overall survival of early stage breast cancer. Methods 510 cases of patients undergoing surgery for early stage breast cancer from April 2007 to February 2008 in our department were retrospectively selected. Paraffin?embedded tumor specimens were collected after surgery， and the expressions of CD44， CD24 and ALDH1 were detected by immunohistochemistry， and the correlation between CD44+/CD24-/low group and ALDH1+ group with overall survival was compared. Results The proportion of CD44+/CD24-/low was 22.9%， and the proportion of ALDH1+ was 11.1%. After controlling for confounding variables in the multivariate Cox proportional risk model， there was no significant difference in the overall survival between the CD44+/CD24-/low group and the non?CD44+/CD24-/low group （HR=1.335， 95%CI：0.812-2.193， P=0.254）. The overall survival of the ALDH1+ group was lower than that of the ALDH1- group （HR=1.736， 95%CI： 0.385-0.864， P=0.008）. Conclusion ALDH1+ can be used as a marker of poor prognosis in early stage breast cancer， while CD44+/CD24-/low cannot be used as a marker of poor prognosis in early stage breast cancer.

Outcomes of liver resections with preoperative portal vein embolization for hepatobiliary neoplasms

YAN Qing1， CHEN Yaoting2， YU Xianhuan1， FENG Mingbin2， LIU Chao1

2019, 19(06):  668-672.  DOI: 10.3969/j.issn.1009-976X.2019.06.004

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Objective To explore the application value of portal vein embolization technique in hepatobiliary surgery. Methods We retrospectively recalled all patients that have underwent preoperative portal vein embolization and diagnosed as hepatobiliary tumor from January 1st 2017 to May 31st 2019， and collected basic characteristics and perioperative data of them. Through comparing the change of future liver remnant （FLR） and the ratio of future liver remnant to total liver volume （FLR/TLV） before and after the portal vein embolization， we tried to analyze the influence of PVE on surgical indicators and patient prognosis. Results Twelve patient were included. The mean FLR before PVE was 374.96±48.77ml， and the mean FLR after PVE was 518.47±102.98 mL with an increase of 145.70±75.81 mL，P<0.001）. The mean FLR/TLV before PVE was （32.06±4.01）%， and the mean FLR/TLV after the PVE was （44.45±8.54）% with an increase of （12.44±6.3）% （P<0.001）. Nine patients underwent radical surgery， seven patients achieved the R0 resection， and only two patients have experienced obvious postoperative complications. Conclusion Portal vein embolization could significantly improve the future liver remnant， provide surgical opportunity for more patients and improve the radical surgery rate and R0 resection rate. Moreover， it could also reduce the occurrence of postoperative liver failure， decrease the postoperative complication rate and increase the prognosis of patients.

The value of dual?energy CT in preoperative diagnosis of regional lymph node metastasis in rectal cancer

LIU Yuanfang， ZENG Weike， DENG Hong， HU Huijun， YANG Zehong， SHEN Jun*

2019, 19(06):  673-678.  DOI: 10.3969/j.issn.1009-976X.2019.06.005

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［Abstract］Objective To evaluate the value of quantitative parameters derived from dual energy CT （DECT） in preoperative diagnosis of regional lymph node metastasis in rectal cancer. Methods In this prospective cohort study， a total of 90 patients with rectal cancer which was confirmed by surgical pathology were included. All patients underwent preoperative tri?phase contrast?enhanced DECT examination. In each patient， the largest regional lymph nodes were selected for evaluation. The shortest diameter， normalized iodine concentration （nIC）， normalized atomic number （nZeff）， and slope of the spectral Hounsfield curve （λHu） of the largest lymph node were measured. A total of 90 largest lymph nodes in 90 patients were selected， including 36 metastatic lymph nodes and 54 non?metastatic lymph nodes. Independent sample t?test was used to compare the differences of the shortest?diameter and three?phase DECT quantitative parameters of nIC， nZeff and λHu between metastatic and non?metastatic lymph nodes. The LASSO regression analysis was used to determine independent quantitative parameters that was predictive of metastatic lymph nodes. The receiver operating curve （ROC） analysis was used to determine the diagnostic performance of the shortest diameter and the independent predictive DECT parameter in discriminating the metastatic from non?metastatic lymph nodes. Results DECT quantitative parameters including hepatic arterial phase， portal venous phase nIC， nZeff and λHu as well as equilibrium phase nIC and nZeff were higher in nonmetastatic lymph nodes than in metastatic lymph nodes. There were statistical differences between the two groups （P<0.05）. No significant different was found in equilibrium phase λHu between the two groups （P>0.05）. LASSO analysis showed that the portal venous phase nZeff was an independent parameter for differential diagnosis of metastatic from non?metastatic lymph nodes. ROC analysis showed that the area under the curve （AUC） was 0.881 and the accuracy was 83.3% for nZeff， which were higher than the counterparts of the shortest diameter （AUC，0.714； accuracy，74.4%）. Conclusion The quantitative parameter， the portal phase nZeff?P DECT is helpful for improving pre?operative diagnostic accuracy for regional lymph node metastasis in rectal cancer.

MRI-DWI differential diagnosis of focal autoimmune pancreatitis and Pancreatic ductal adenocarcinoma

YI Zhilong， LI Yong*， WANG Zhihui， PAN Heng

2019, 19(06):  679-681.  DOI: 10.3969/j.issn.1009-976X.2019.06.006

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Objective To analyze the imaging findings of focal autoimmune pancreatitis （AIP） and pancreatic cancer （PC）， and to explore the value of MRI?DWI in differential diagnosis. Methods Thirty patients which were pathologically diagnosed as pancreatic cancer and 15 patients with mass?type autoimmune pancreatitis with clinical diagnostic criteria were enrolled from Sun Yat?sen Memorial Hospital of Sun Yat?sen University in March 2013 to June 2019. The imaging characteristics of the above patients were retrospectively analyzed. The ADC values on DWI between focal autoimmune pancreatitis and pancreatic cancer werec ompared. Results In patients with focal pancreatitis， most of the lesions showed equal and low signals on T1WI， uneven signals and high signalson T2WI， and was equal or high signalon DWI，with high Inhomogeneity enhancement. Most of the lesions in patients with pancreatic cancer showed low signal， and a small number of lesions showed mixed signals or signalson T1WI， while most lesions showed high signalon T2WI and low signalon DWI，with low enhancement. The both can be accompanied by the expansion of the main pancreatic duct. The interruption of the main pancreatic duct only can be observed in pancreatic ductal adenocarcinoma. When b value=800 s/mm2， the average ADC value of the focal AIP was （1.38±0.11）×10-3 mm2/s （mean ± standard deviation）， and the mean ADC value of pancreatic cancer was （1.03±0.15）×10-3 mm2/s （mean ± standard deviation）， P<0.05， the difference was statistically significant. Conclusion The imaging findings of focal autoimmune pancreatitis （AIP） and pancreaticductal adenocarcinoma （PC） are different. DWI sequence and ADC value are helpful for differential diagnosis.

Experience of laparoscopic ultrasonography combined with choledochoscope in common bile duct exploration with primary suture

CHEN Rongjun， TANG Shilong， LU Qiang， ZHANG Wanyu， CHEN Zhanhui， QI Songxu

2019, 19(06):  682-685.  DOI: 10.3969/j.issn.1009-976X.2019.06.007

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Objective The clinical experience of laparoscopic ultrasound combined with choledochoscope in laparoscopic cholecystectomy， choledocholithotomy and one?stage suture of the common bile duct. Methods Twenty?four cases of gallbladder stones with common bile duct calculi cases clinical data were retrospectively analyzed， and the operation line of laparoscopic gallbladder excision， common bile duct incision， clear bile duct， blood vessels， the application of laparoscopic surgery， joint choledochoscope calculi， ensure stone residue and duodenal papilla function good case to carry on the first phase of the common bile duct suture， T tube drainage set free. Results Twenty four patients were received successful surgery， there were 3 cases（3/24)were diagnosed holedocholithiasis during the operation,the average operation time was 101.3±15.9 min，average blood loss was 13.4±3.4 mL， average removal time was 5.5±1.1 d the drainage tube，the average length of hospital stay was 11.2±4.0 d， and followed up for one to six months after hospital discharge，all patients had not been found associated with gallbladder stones or common bile duct calculi disease of postoperative complications. Conclusion The application of ultrasound combined with choledochoscope in laparoscopic surgery can ensure the safety and effectiveness of primary suture of common bile duct， avoid complications caused by t?tube drainage， and improve the quality of life of these patients.

Effect of propofol?remifentanil on liver biopsy in children

CHEN Meixian， LU Fuding， LIAO Chaoxia， YE Xijiu， HUANG Haiming

2019, 19(06):  686-693.  DOI: 10.3969/j.issn.1009-976X.2019.06.008

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Objective To investigate the effect and safety of intravenous anesthesia with propofol combined with remifentanil in children undergoing hepatic biopsy. Method We selected 40 children undergoing hepatic biopsy as subjects， aged 3 to 13 years old， ASA Ⅰ-Ⅱ. The patients were randomized divided into two groups， the propofol group （group A， n=20） and the propofol combined with remifentanil group （group B， n=20）. Patients in group A were given 2.5-3.5 mg/kg propofol before abdominal skin disinfection intravenously. Patients in group B were given 1.5-2.5 mg/kg propofol and 0.5 μg/kg remifentanil before abdominal skin disinfection intravenously. 10-30 mg of propofol was added if the child was agitated during the puncture. The following targets were recorded：the mean arterial pressure （MAP）， heart rate （HR）， pulse oximetry （SpO2）； the total amount of propofol； the agitation during the puncture and the time to wake up （t）. Results There were no significant differences in the age， sex， weight， and ASA grade between the two groups （P>0.05）. The MAP of T1 and T2 in group A was lower than that before anesthesia （T0） （P<0.05）. There were no significant changes in HR and SpO2 between the two groups （P>0.05）. The dose of propofol， the incidence of agitation and the waking time were higher in group A than in group B （P<0.05）. There was no significant difference in respiratory inhibition rate between the two groups （P>0.05）. Conclusion Intravenous anesthesia with propofol combined with remifentanil is safe and feasible in children undergoing hepatic biopsy.

Clinicopathological characteristics and prognosis of aged breast cancer

YAN Shanshan1， WANG Yongnan2

2019, 19(06):  689-693.  DOI: 10.3969/j.issn.1009-976X.2019.06.009

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Objective To research the clinicopathological and prognosis of aged breast cancer. Methods The data of 73 patients with breast cancer who were hospitalized for Ⅰ-ⅢA ≥65 years of age from Jan. 2003 to Dec. 2012 were analyzed. The clinicopathological features and prognosis were analyzed. Results Among the 73 cases， there was 42 cases in the 65-69 years of age and 31 cases in ≥70 years of age. The proportion of comorbidities in patients ≥ 70 years of age was higher than that of patients aged 65-69 years （72.4% vs 42.6%， P=0.009）， and the ratio of ER/PR positive in patients ≥70 years of age was higher than that in patients aged 65-69 （80.6% vs 57.1%， P=0.045）. The proportion of patients older than 70 years who did not receive adjuvant chemotherapy was higher than patients aged 65-69 years （58.1 vs 26.2%， P=0.045）. The median follow-up was 85 months. The disease-free survival rate （DFS） was 82.2% and the overall survival rate （OS） was 86.3%. Univariate analysis showed that disease?free survival was associated with tumor size （P=0.020） and lymph node metastasis （P=0.010）. Overall survival was associated with HER2 status （P=0.001）. Multivariable analysis found that the prognosis of breast cancer had no relation with age （P=0.644）， and complications （P=0.314）， tumor size（P=0.363）， lymph node status （P=0.387）， ER/PR （P=0.250）， HER2 （P=0.579）， operation mode （P=0.666）， adjuvant chemotherapy （P=0.787）， radiation therapy （P=0.107） and endocrine therapy（P=0.340）. Univariate analysis and multivariate analysis showed that age， comorbidity， ER/PR， surgical modality， adjuvant chemotherapy， radiotherapy and endocrine therapy were not associated with DFS and OS. Conclusion With ageing， ER/PR positive rate of elderly breast cancer patients increased， accompanied by more medical complications， should be comprehensive and comprehensive evaluation of the patient′s tolerance and the degree of benefit selection of treatment.

Diagnosis and treatment of solitary fibrous tumors?a single?center retrospective study

JIN Shaowen1， HE Maoqin1， SUN Qing2， WANG Kaimei3

2019, 19(06):  694-700.  DOI: 10.3969/j.issn.1009-976X.2019.06.010

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Objective To explore the diagnosis， treatment and follow?up of solitary fibrous tumors （SFT）. Methods The clinical data for seven and a half years in our institution of solitary fibrous tumors， which were surgically resected and pathologically diagnosed， were collected， and epidemiological characteristics， diagnosis， therapies and follow?up of SFT were analyzed and summed up. Results There was no significant difference in the ratio of male to female of 60 SFT patients and the median age was 46 years old. Pelvic and abdominal cavities were the most common site， followed by intracranial space， otolaryngology and oral cavity. About half of patients came to the hospital with specialized symptoms. All cases were surgically resected and confirmed by histopathology and immunohistochemical staining. 45% of the patients were reexamined and followed up postoperatively almost in one year. Recurrence was found in 4 of the 27 patients at follow?up. Conclusion Solitary fibrous tumors are mostly benign or low?grade malignant and grow slowly. Its diagnosis depends on histopathology and immunohistochemical staining. Complete surgical resection is the main treatment， and follow?up should be carried out regularly.

Thoracoscopic thoracic duct ligation for refractory lymphatic leakage after thyroidectomy

LI Peng， LIANG Qingzhuang， WANG Donglai， HAN Bin， YI Xin， WEI Wei

2019, 19(06):  697-700.  DOI: 10.3969/j.issn.1009-976X.2019.06.011

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Objective To explore the safety and feasibility of thoracic duct ligation under thoracoscope in the treatment of refractory lymphatic leakage after thyroidectomy. Methods Two cases of lymphatic leakage after thyroidectomy， the first case was invalid conservative treatment and failed neck exploration， the second case was invalid conservative treatment after total areola endoscopic thyroidectomy. All patients were underwent thoracoscopic thoracic duct ligation. Results The cervical drainage fluid decreased dramatically in 2 patients， and the cervical drainage tube was removed 48 hours after operation. There were no clinical manifestations of gastrointestinal digestive and absorption dysfunction and low immunity after 3 months of follow?up. Conclusion Thoracoscopic thoracic duct ligation is safe and effective， and is suitable for the treatment of intractable lymphatic leakage after thyroid surgery.

The role of lncRNA PANDAR in tongue squamous cell carcinoma

FANG Songcheng1， XIU Xia2， MAI Lianxi3， XIE Shule3， LIN Zhaoyu3， JIAO Jiuyang3

2019, 19(06):  701-705.  DOI: 10.3969/j.issn.1009-976X.2019.06.012

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Objective To investigate the expression of lncRNA PANDAR in tongue squamous cell carcinoma （TSCC） and explore its function and mechanism. Methods The expression of PANDAR was determined by qRT?PCR in tongue squamous cell carcinoma specimens and cell lines. The CCK8 assays and flow cytometry were used to detect cell proliferation and apoptosis of tongue squamous cell carcinoma cells with or without PANDAR deletion. The expression of Bax in Cal27 and SCC25 cells was detected by qRT?PCR and Western blot. Results LncRNA PANDAR was significantly upregulated in TSCC tissues and cell lines. PANDAR knockdown improved cell proliferation， but suppressed cell apoptosis. PANDAR deletion was beneficial to the expression of Bax in Cal27 and SCC25 cells. Conclusion PANDAR is highly expressed in TSCC tissues and cells. PANDAR downregulation in TSCC cells promotes cell proliferation， but inhibits cell apoptosis through inhibiting Bax expression.

The surgical treatment for left ventricular rupture after mitral valve replacement

LIANG Xiangyuan， CHENG Xiangjun， LI Lunming， ZHANG Zhigang， DENG Yiquan

2019, 19(06):  706-713.  DOI: 10.3969/j.issn.1009-976X.2019.06.013

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Objective To investigate the cause and surgical treatment of left ventricular rupture after mitral valve replacement （MVR）. Methods We retrospectively analyzed clinical data of 6 patients who had left ventricular rupture after MVR，among a total of 765 MVR patients，between January 2007 and December 2018. Four patients who had early ruptures were sutured with extracorporeal circulation，two patients who had delayed ruptures were sutured without extracorporeal circulation. Results Five patients died， one patients was successfully healed. The survival patient was repaired rupture in the heart early. Conclusion Left ventricular rupture is difficult to repair with a high mortality. Once left ventricular rupture occurs during the surgery，extracorporeal circulation should be quickly established，and it′s possible to save patients′ life. The best strategy is to prevent its happening based on risk factors analysis.

The expression of miR-155， miR-208 and miR-499 in children with Kawasaki disease

YE Jiayun， CHEN Xuezhen， LIAO Xiongyu， LIANG Huanxin， ZHONG Yi， QIN Lijun

2019, 19(06):  709-713.  DOI: 10.3969/j.issn.1009-976X.2019.06.014

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Objective To investigate the expression and clinical significance of cardiovascular disease?related miR?155， miR?208 and miR?499 in patients with Kawasaki disease. Methods Fifty children with Kawasaki disease were enrolled and 20 normal children were included as controls. Peripheral blood was collected and plasma RNA was extracted. The expression of these three miRNAs was detected by real?time fluorescent quantitative PCR and analyzed with RNU6B as the internal reference gene. Results Compared with the control group， the expression level of miR?155 was significantly increased in children with Kawasaki disease （P=0.018）， and the expression level of miR?155 was positively correlated with the degree of coronary artery damage. The expression of miR?208 and miR?499 in Kawasaki disease was increased， but there was no significant difference between them. Conclusion The high expression of miR?155 is associated with Kawasaki disease in children， suggesting that it can be used as a potential biomarker for the diagnosis of Kawasaki disease。

Comparison of dural patch repair and common dural suture in postoperative complications of posterior fossa surgery

ZHANG Haihong， CHEN Xiaochen， HE Shan， SHI Minggang

2019, 19(06):  714-716.  DOI: 10.3969/j.issn.1009-976X.2019.06.015

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Objective To explore the advantages of dural patch repair and common dural suture in preventing subcutaneous effusion， cerebrospinal fluid leakage and intracranial infection after posterior fossa surgery. Methods From October 2016 to April 2019， 40 patients with defect dura mater were repaired with dural patch repair method and 60 patients with conventional repairing method to repair defect dura mater were analyzed. Results Among the 40 cases with dural patch repair， 2 cases （5%） had subcutaneous effusion， 1 （2.5%） had cerebrospinal fluid leakage， and 1 case （2.5%） had intracranial infection. Of the 60 patients with common dural suture， 15（25%） had subcutaneous effusion， 7（11.6%） had cerebrospinal fluid leakage， and 4 （6.6%） had intracranial infection. Conclusion The dural patch method is superior to the conventional repair method in preventing subcutaneous effusion after posterior fossa surgery.

Clinical significance of the elevation of serum CK and MYO in critically ill patients in ICU

WANG Jiwen， QIU Yuru， ZHANG Zhixian， CHANG Jianxing

2019, 19(06):  717-720.  DOI: 10.3969/j.issn.1009-976X.2019.06.016

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Objective To investigate the epidemiological characteristics and clinical significance of the elevation of serum creatine phosphokinase （CK） and myoglobin （MYO） in critically ill patients in ICU. Methods Retrospective analysis of 3282 critically ill patients in ICU， we analyzed the incidence of elevation of serum CK and MYO in patients for different gender， age， operation site and different diseases. Results The total incidence of CK and MYO were 55.7% and 29.8% respectively. In gender， the incidence of CK and MYO elevation in men was higher than that in women （P<0.001）. The incidence of CK elevation was higher in the 21?year?old group than in the 20?year?old group， and higher in the myo 41?60?year?old group than in the 20?year?old group （P<0.05）. The increased incidence of CK and MYO in the operation of heart， brain， blood vessel， lung， esophagus and mediastinum was the higher （96.3% and 64.9%， respectively）， and that of the heart operation is the highest.The increased incidence of CK in MODS， cerebrovascular accident and sepsis were higher in non?surgical patients， while MODS， sepsis and cerebrovascular accident were higher in that of MYO. Conclusion The incidence of muscle injury is high in critically ill patients in ICU. The monitoring of serum CK and MYO should be strengthened for postoperative and critically ill patients.

Discussion on anticoagulation treatment of central venous catheter with thrombosis in non?chemotherapy patients

CHEN Zhibo， WU Jiayi， CHEN Qinchang， CHEN Zhenhong， SHEN Runnan， WU Guitao， LI Yonghui

2019, 19(06):  721-724.  DOI: 10.3969/j.issn.1009-976X.2019.06.017

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Objective To study the effect of enoxaparin sodium and rivaroxaban on the prevention and treatment of central venous catheter thrombosis and safety of extubation. Methods Forty?two patients who received central venous catheterization and catheter thrombosis in our hospital were selected in this research. The patients treated with enoxaparin sodium anticoagulation therapy were included in the enoxaparin sodium group （n=24）， and the patients with elivaroxaban anticoagulation were included in the rivaroxaban group （n=18）， and the anticoagulation was performed for 5 consecutive days. The changes of dimer D in the patients were monitored， and the blood vessel color doppler ultrasound was used to determine the size of the thrombus before extubation. Results After continuous anticoagulation for 5 days， D dimer decreased in 40 patients（95.2%）. There were 23 cases in enoxaparin sodium group and 17 cases in rivaroxaban group. After adjusting the anticoagulation dose， D dimer also decreased in the other 2 patients after 5 days of continued anticoagulation（4.8%）. No significant increase in the thrombus range was observed in all patients compared with that before anticoagulation Catheters were removed successfully in all patients without complications of pulmonary embolism or hemorrhage affecting vital aigns. Conclusion Enoxaparin sodium and rivaroxaban have inhibitory effects on catheter thrombosis， and the application of enoxaparin sodium and rivaroxaban anticoagulation therapy before extubation in patients with catheter thrombosis is safe and effective.

Correlation between the composition of urinary calculi and blood lipid

ZHOU Zhihua， LIANG Wen， YANG Liuqing， TAN Jun

2019, 19(06):  725-728.  DOI: 10.3969/j.issn.1009-976X.2019.06.018

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Objective To analyze the composition of urinary calculus， and to determine its correlation with blood lipid related indicators ［triglycerides （TG）， total cholesterol （TC）， low density lipoprotein cholesterol （LDL?C）， high density lipoprotein cholesterol （HDL?C）］. Methods 349 cases of urinary calculus （stone group） and 349 healthy individuals （control group） in our hospital from October 2014 to October 2018 were retrospectively analyzed. Serum TG， HDL?C， TC， LDL?C levels were compared between groups， and the components of urinary stones in 349 patients were also analyzed. The composition of stones in patients with normal and abnormal blood lipid was compared. Spearman correlation was used to analyze the correlation between urinary calculus components and dyslipidemia， and multivariate Logistic regression was used to analyze the influencing factors of urinary calculus. Results The results of composition analysis of urinary stones in 349 patients showed that there were 270 cases of calcium stones， 51 cases of infectious stones and 28 cases of uric acid stones. The stone group had higher serum TG and TC levels as well as lower serum HDL?C level than those in the control group （P<0.05）， while no difference was found in the LDL?C levels between groups （P>0.05）. The proportion of uric acid stones in urinary stone patients with dyslipidemia was significantly higher than that in urinary stone patients with normal lipids （P<0.05）， while no difference was found in the proportion of infectious stones and calcium stones between patients with normal and abnormal blood lipid （P>0.05）. Uric acid stones were positively correlated with dyslipidemia （P<0.05）. There was no correlation between infectious stones， calcium stones and dyslipidemia （P>0.05）. TG was a risk factor for urinary calculi （P<0.05）. Conclusion The formation of urinary calculi is closely related to the level of blood lipid. Dyslipidemia， especially hypertriglyceridemia， can easily lead to the formation of uric acid calculi. Therefore， the control of blood lipid is of great clinical significance for the prevention of urinary calculi.

Analysis of causes of left ventricular rupture after mitral valve replacement by autopsy

GAO Xiaotian， LI Wei

2019, 19(06):  729-731.  DOI: 10.3969/j.issn.1009-976X.2019.06.019

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Objective To analyze the causes of left ventricular rupture after mitral valve replacement in two cases. Methods Two patients with left ventricular rupture after mitral valve replacement were reported. One of them underwent autopsy and the other underwent intraoperative exploration. The causes of left ventricular rupture were analyzed according to the results of autopsy and intraoperative exploration， as well as the changes of cardiac anatomy after mitral valve replacement. Results The two patients with left ventricular rupture excluded direct surgical injury， and preoperative anatomical structure changes led to left ventricular rupture. Conclusion In the present report， the cause of left ventricular rupture after mitral valve replacement was closely related to the changes of left ventricular structure.

The efficacy of two operative methods in patients with medial tibial plateau fracture and fracture dislocation

SUN Xiaoxu

2019, 19(06):  732-741.  DOI: 10.3969/j.issn.1009-976X.2019.06.020

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［Abstract］ Objective To analyze and compare the effect of two kinds of surgical approach in the treatment of tibial medial plateau fracture with dislocation. Methods The clinical data of 54 patients with medial tibial plateau fractures and fracture dislocation admitted to our hospital from August 2009 to August 2016 were retrospectively analyzed. According to the type of operation， the patients were divided into two groups， 29 cases in the double?plate group and 25 cases in the single?plate group. Patients in the double?plate group were treated withdouble plate internal fixation through the medial knee approach and patients in the single?plate group underwent anterior and posterior lag screw internal fixation through the medial knee approach. The effects of the two groups were compared. Results HarrisFunctional Outcome Score：there was no significant difference between the two groups on preoperative and first day after operation （P>0.05）， however the statistical difference between the two groups was demonstrated on 3 months of operation （P<0.05）. Radiological Rasmussen score： preoperative data had no difference between two groups （P>0.05）. There were significant differences between different time points （first day after operation and three months after operation） （P<0.05）， and the score of the double plate group was significantly higher than that of the single plate group （P<0.05）. In the double?plate group， the recovery of posterior slop and tibial plateau angle of tibial plateau in the first day and three months after the operation was better than that in the single plate group， and the differenceswere statistically significant （P<0.05）. There was no significant difference in hospitalization time， operation time， intraoperative hemorrhage and postoperative complications between the two groups （all P values > 0.05）. Conclusion It is better approach for treatment of medial tibial plateau fracture with fracture dislocation by using double plate medial approach internal fixation.

Clinical therapeutic evaluation of arthroscopy?assisted internal fixation for posterolateral tibial plateau fractures

ZHAO Yong， XU Shengquan， XU Xiulei

2019, 19(06):  736-741.  DOI: 10.3969/j.issn.1009-976X.2019.06.021

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Objective To explore the clinical effect and application value of arthroscopic assisted internal fixation for posterolateral tibial plateau fractures. Methods From April 2016 to November 2018， 98 patients with posterolateral tibial plateau fractures admitted to our hospital were selected and divided into observation group and control group according to random number table method. 52 patients in the observation group were treated with reduction and internal fixation under arthroscopy， while 46 patients in the control group were treated with traditional open reduction and internal fixation. The intraoperative bleeding volume， operation time， incision length， time to get out of bed， fracture healing time and pain grade scores were observed and compared between the two groups. Relevant complications during perioperative period were recorded and Rasmussen knee function scale was used to evaluate the clinical recovery effect. Results There was no significant difference in operation time between the observation group and the control group （P>0.05）； the length of incision and the average amount of bleeding in the observation group were lower than those in the control group （P<0.05）. Perioperative complications in the observation group were mainly arthritis and traumatic arthritis， and the incidence of complications was lower than that in the control group （P<0.05）. There was no significant difference in pain level between the two groups before treatment （P>0.05）. After 5 days of treatment， the pain level of the observation group and the control group decreased compared with that before treatment （P<0.01）， and the pain relief ability of the observation group was better than that of the control group （P<0.05）. The average time of getting out of bed and healing in the observation group was earlier than that in the control group （P<0.05）. In Rasmussen knee joint evaluation， the effective rate of knee joint treatment in the observation group was 78.8%， while that in the control group was 52.2%. There was significant difference between the two groups （P<0.05）. Conclusion Arthroscopy?assisted reduction and internal fixation can effectively reduce surgical stress and reduce the risk of complications in the treatment of posterolateral tibial plateau fractures. The clinical effect is better than that of open surgery.

Effects of irrigation of insulin solution combined with VSD in chronic wounds

YU Menglei， PENG Jicai， CAO Yi， HUANG Duping， YANG Tao， ZHU Jie

2019, 19(06):  742-745.  DOI: 10.3969/j.issn.1009-976X.2019.06.022

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Objective To investigate the effects of irrigation of insulin solution combined with vacuum sealing drainage （VSD） in chronic wounds. Methods Between January 2012 and December 2018， 60 patients with chronic wounds were treated with VSD （group A， n=20）， with VSD combining irrigation of normal saline （group B， n=20）， and with VSD combining irrigation of insulin solution （group C， n=20） after debridement. There was no significant difference in gender， age， course of ulcers， area and depth of wound among 3 groups （P>0.05）， and the data were comparable. The contents of fibroblast growth factors 2 （FGF?2）， tumor growth factor α （TNF?α）， and a?smooth muscle actin （α?SMA） in drainage of fluid were determined. The coverage rate and thickness of granulation tissue and clearance rate of bacteria in wound were calculated， the granulation tissue in the center of the wound was harvested for pathological observation with HE and Masson staining after 6 days of treatment. Results The coverage rate and thickness of granulation tissue and clearance rate of bacteria in group C were significantly higher than those in groups A and B after treatment （P<0.05）. The contents of FGF?2 and α?SMA were significantly increased and TNF?α was significantly decreased in group B when compared with those in group A（P<0.05）. Compared with group B， FGF?2 and Α?SMA contents were significantly increased and TNF?α content was significantly decreased in group C（P<0.05）. The pathological staining showed that there were fewer new capillaries， fibroblasts and collagen in group A after treatment，many new capillaries， fibroblasts and collagen in group B and a large number of new capillaries， fibroblasts and collagens were found in group C. Conclusion VSD combined with local irrigation of insulin solution in the treatment of chronic wounds can promote the growth of granulation tissue， enhance tissue repair function， and significantly improve wound healing rate and speed.

Application study of continuous infusion of glauconite solution combined with vacuum sealing drainage （VSD） in the treatment of infected abdominal wounds

TIAN Huakai1， ZHOU Taicheng2， MA Ning2， YU Zhuomin2， TANG Fuxin2， LIU Jian1， ZONG Zhen1

2019, 19(06):  746-750.  DOI: 10.3969/j.issn.1009-976X.2019.06.023

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Objective In order to promote the healing of infectious abdominal wounds and reduce the incidence of drug resistance， continuous drip infusion of glauconite solution on the basis of negative pressure closed drainage technique （VSD） was conducted to compare with traditional normal saline drip and evaluate its efficacy， so as to provide a more effective and economical new method for the treatment of abdominal surgical site infection. Methods From January 2018 to December 2018， 80 patients who underwent negative pressure closure and drainage after wound debridement were collected from the department of general surgery of the second affiliated hospital of nanchang university and the department of gastrointestinal and hernia surgery，the Sixth Affiliated Hospital of Sun Yat?sen University. It can be divided into two groups at random， the experimental group 40 cases， continuous drip mirabilite solution with closed negative pressure drainage technology， the control group， 40 cases of continuous drip saline combined with closed negative pressure drainage technology， compare two groups of patients with wound granulation tissue growth after debridement， improve postoperative pain， wound up to second stage suture time， wound healing after suture time， treatment cost， etc. Results The score of wound granulation tissue growth in the experimental group was （3.97±0.42）， significantly better than the control group （2.25±0.44）， and the wound healing time was （11.75±1.69）d， significantly shorter than the control group （16.4±2.74） d. The postoperative pain score of the experimental group was （2.87±0.36）， which was significantly lower than that of the control group （4.05±0.85）. The healing time of the experimental group was （7.15±1.63） d significantly shorter than that of the control group （10.27±2.89 d）. The frequency and cost of dressing change in the experimental group were significantly lower than those in the control group， and the above differences were statistically significant （P<0.05）. Conclusion Continuous drip of Glauber′s salt solution combined with negative pressure closed drainage technology can significantly promote the rapid recovery of abdominal infectious wounds， reduce the burden on patients， save medical resources， and provide a more cost?effective solution for clinical treatment of abdominal infectious wounds.

Cost?effectiveness analysis of mimic bioelectrical stimulation in promoting intestinal function recovery after minimally invasive gynecology surgery

LEI Ruilin1， LONG Tengfei1， FAN Kui2， XIE Xiaoqian1， CHEN Yaxiao1， DING Miao1， XIE Meiqing1， ZHU Yuye1

2019, 19(06):  751-754.  DOI: 10.3969/j.issn.1009-976X.2019.06.024

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Objective Exploring the cost effect of bioelectrical stimulation on promoting postoperative intestinal function recovery. Methods A total of 100 patients with minimally invasive gynecological laparoscopic surgery were enrolled at Sun Yat?Sen Memorial Hospital of Sun Yat?Sen University from August 20 to March 2019. They were randomly divided into control group （n=49） according to routine nursing after gynecological laparoscopic surgery； 51 patients in the experimental group were using the bioelectrical stimulation on the basis of routine nursing. The cost?effectiveness analysis of the first exhaust time， postoperative hospital stay and total hospitalization cost of the two groups of patients was carried out. Results The exhaust time of the patients in the experimental group was 4h earlier than that of the control group. The total effective rates of the treatments in the two groups were 96.1% and 69.4% with significant difference （P<0.001）. The hospitalization time and total hospitalization cost were significantly lower than that of the control group， and the cost?effect ratio were 36.38 RMB and 38.53 RMB， respectively， with significant difference （P<0.05）. Conclusion Mimic bioelectrical stimulation of intestinal peristalsis can effectively accelerate intestinal peristalsis and promote intestinal function recovery， which is with a high cost?effective. It is a promising clinical treatment for Enhanced Recovery after surgery.

Bioinformatics exploration of immunoregulatory mechanism of glucocorticoids in the treatment of sepsis

GU Yang1， ZHANG Wenda2， SHI Yini1， LI Li1

2019, 19(06):  755-759.  DOI: 10.3969/j.issn.1009-976X.2019.06.025

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Objective To explore the differential expressed genes（DEGs） in sepsis patients treated by glucocorticoids. Methods The gene chip datasets were obtained from the Gene Expression Omnibus （GEO） database. Then the common differential genes were carried out for later analyses according to the glucocorticoid treatment. The genes were analyzed by Gene ontology （GO）， pathway enrichment analysis （KEGG， GSEA） and Protein?protein interaction （PPI） network forscreening out key genes. Results A total of 685 genes in the two groups were identified as DEGs （P<0.05）， and GO， KEGG， GSEA and PPI were mainly enriched into granulocyte activation and immune response pathways. The genes of FPR2， RETN， HMA1， UBB， TFRC and RUMX1 were involved in a wide range of intergenic regulation.Conclusion Bioinformatics technology contributes to the understanding of the mechanisms of immunotherapy for sepsis.

Delayed diagnosis of extradural meningioma: a case report

LU Dongyan，YANG Bo，YIN Biao，JIANG Qi

2019, 19(06):  760-762.  DOI: 10.3969/j.issn.1009-976X.2019.06.026

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Progress in the application of circulating tumor cells in neoadjuvant chemotherapy for breast cancer

WANG Yongnan1， YAN Shanshan2

2019, 19(06):  763-766.  DOI: 10.3969/j.issn.1009-976X.2019.06.027

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Pathologic complete response （pCR） is an indicator of survival benefit in patients with neoadjuvant chemotherapy for breast cancer， and serves as a surrogate endpoint for accelerating the approval of neoadjuvant chemotherapy. However， there are currently common methods for evaluating the efficacy of neoadjuvant chemotherapy， such as clinical palpation and imaging （mammography， mammography， mammography， etc.）， so it is necessary to look for new biological indicators to predict neoadjuvant chemotherapy for breast cancer. Efficacy and prognosis can be used as a reference for the next step of accurate treatment. Circulating tumor cells （CTC） is a tumor cell that detaches from the primary tumor tissue into the blood circulation and is a new type of “liquid biopsy” tumor biomarker. At present， CTC can replace tissue samples by non?invasive methods for pathological diagnosis， disease monitoring， molecular sequencing， etc.， which can be used for dynamic monitoring and prognosis. Using CTC to establish a personalized cancer treatment program is an important and reliable way to achieve accurate treatment of breast cancer. This article reviews the progress in the application of circulating tumor cells in neoadjuvant chemotherapy for breast cancer.

Incidence， risk factors and progress in prevention of incisional hernia after stoma reversal

HUANG Canbin1， RONG Zhenxiang1,2

2019, 19(06):  767-775.  DOI: 10.3969/j.issn.1009-976X.2019.06.028

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Stoma site incisional hernia （SSIH） is one of the common long?term complications after stoma reversal， which is also one of the main reasons for the patient′s second operation. It not only brings the pain of the second operation to the patients， but also has a certain recurrence rate after repair. However， domestic clinicians have not paid much attention to the high incidence of SSIH after stoma reversal， and failed to analyze the risk factors from the characteristics of stoma reversal. This article reviews the incidence， risk factors and prevention of SSIH after stoma. reversal， with a view to improving clinicians′ understanding and attention to SSIH.

Clinical application of non?invasive indocyanine green clearance experiment in liver surgery

CHEN Minqiang， LI Wentao， CHEN Nianping

2019, 19(06):  771-775.  DOI: 10.3969/j.issn.1009-976X.2019.06.029

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Non?invasive indocyanine green clearance experiment has gradually been accepted as an important method for perioperative assessment of liver function and evaluation of surgical outcome in liver surgery. This article summarizes the clinical application of non?invasive ICG clearance experiment from the aspects of pharmacokinetics， clinical safety， detection principle and clinical value of ICG.

Investigation on improvement of spinal surgical instruments sort and count

ZHANG Chunyan， LI Ying， FENG Lijun

2019, 19(06):  776.  DOI: 10.3969/j.issn.1009-976X.2019.06.030

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Objective To explore the standardized measures to reduce the mistake in spinal surgical instruments sort and count， and also shorten the time?consuming of them. Methods From July to September 2016， 158 cases of spinal internal fixation were performed in our hospital， and 3 cases of sort and count errors were found. Fishbone diagram was made to analyze the causes of the errors. On the one hand， according to the analysis of causes， improvement measures were designed； on the other hand， 20 spine internal fixation operations were randomly selected to measure the sort and count time?consuming. Improvement measures?including establishment of standard operating procedure for surgical items sort and count， simplification of surgical instruments， to formulate “Guidelines for Classification and Packaging of Foreign Instruments for Spinal Surgery”， standardization of foreign instruments delivery inventory， and standardizing the items positioning on operation instrument table?? had been taken during the period from October 15， 2016 to March 31， 2017. In the same period， the occurrence of sort and count errors in all spinal internal fixation operations were observed. And from November 2016 to March 2017， 20 operations were randomly selected for surgical instruments sort and count time?consuming. From the observations above， the effectiveness of the improvement measures was evaluated. Results Both the occurrence of errors （1.9% vs 0%，before and after improvements） and the time?consuming （187±17 seconds vs 138±12 seconds，before and after improvements） of surgical items sort and count are significantly reduced， after the implementation of the improvement measures. Conclusion Improvement measures on surgical items sort and count，as mentioned above， improved the sort and count reliability and efficiency.