Table of Content

20 October 2020, Volume 20 Issue 05

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Original Articles and Clinical Research

Analysis of dynamic characteristics of chromatin behaviors in breast cancer cell from dormancy phase to interphase

WANG Yong-qiang, YAO Wei-cheng, DENG Wei-xi, PENG Jiang-yun

2020, 20(05):  545-549.  DOI: 10.3969/j.issn.1009-976X.2020.05.001

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Objective Dysregulation of the cell cycle can lead to genome instability, causing malignant transformation and canceration of cells. By analyzing the dynamic behavior characteristics of chromatin from G0 phase to the interphase of the breast cancercell linesinour study, it provides a certain experimental basis for further research on cancer cell cycle regulation. Methods In mouse breast cancer 4T1 cellline, we applied DNA markers and histone-related fluorescent markers to reflect the chromatin morphology in the cell and its dynamic changes in the cell cycle, recording and analyzing experimental graphicsby laser confocal microscope. Results Our study showed that the DAPI signal and GFP-H2B signal have better co-localization, and both can effectively label chromatin. During the period from the G0 phase to the interphase, a large volume of fluorescently labeled plaques was observed at the beginning, in which there were multiplecentromere satellite DNA in situ hybridization spots. The fluorescent plaques gradually dissociate into small plaques even disappeared but reappearedwith a smaller volume 1 h 40 mins later, whichwas regularly arranged on the periphery of the nucleolus and the inside of the nuclear membrane. Conclusion There is aggregation between chromatin in G0 phase breast cancer cells, and it may be related to the function of centromeric satellite DNA. When entering the interphase under the stimulation of cell proliferation signal, the aggregate will gradually dissociate and disappear, after the chromatin is copied and highly compressed to form a chromosome, it further divides into two cells.

Protective effects of glycineand pyruvate after intestinal ischemia/reperfusion

WANG Meng, FU Gang-lan, YANG Yan-qi

2020, 20(05):  550-556.  DOI: 10.3969/j.issn.1009-976X.2020.05.002

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Objective Superior mesenteric artery （SMA） ischemia/reperfusion （I/R） may cause severe shock and cardiac and lung injury. Pyruvate and glycine have been demonstrated to protect the local tissue after I/R. In this study the effects of these substances on hemodynamics and cardiopulmonary functions are investigated. Methods After anesthesia male SD rats were operated to establish hemodynamic monitoring. Then SMA ischemia was applied for 90 minutes, by reperfusion for 120 minutes. During the reperfusion sufficient Ringer solution was infused for resuscitation. Totally 24 rats were divided into 4 groups： a control group with the sham operation （sham, n=6）; SMA I/R with pyruvate （50 mg/kg, n=6） or glycine （20 mg/kg, n=6） or equal amount of Ringer （1 mL, n=6） given before reperfusion. Mean arterial pressure （MAP）, cardiac index （CI）, pulmonary artery pressure （PAP） etc. were recorded and systemic vascular resistances （SVR） were calculated during the whole operation. Arterial blood samples were taken for gas analysis and myocardial markers. At the end of observation, the rats were sacrificed and the intestine, heart, lung, liver were harvested for histology study. Results Pyruvate and glycine both effectively stabilized the hemodynamic parameters and facilitated the maintenance of CI with less crystal volume for resuscitation than Ringer group. In Pyruvate and glycine groups the pathological score and neutrophil sequestration of the intestine, lung, heart and liver were significantly lower than Ringer group （P<0.01） but still higher than Sham group （P<0.01）. Metabolic acidosis was also inhibited in Pyruvate and Glycine groups than Ringer group （P<0.01）. Creatine kinase-MB and troponin I in Glycine and Pyruvate groups elevated less than the Ringer group but still more than the Sham group （P<0.05）. Conclusion After SMA I/R, pyruvate and glycine could improve the hemodynamic performances, facilitate the resuscitation for circulatory shock, and protect the local tissue against I/R injury and cardiopulmonary functions.

Effects of sevoflurane on right ventricular hypertrophy induced by monocrotaline in rats

YIN Xiao-qing, ZOU Jun, WANG E

2020, 20(05):  557-561.  DOI: 10.3969/j.issn.1009-976X.2020.04.003

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Objective To observe the effects of sevoflurane on right ventricular hypertrophy（RVH） induced by monocrotaline in rats and explore its mechanisms. Methods Thirty male Spague-Dawlay rats were randomly assigned to a control or a monocrotaline group （60 mg·kg^-1）. After 4 weeks,rats were anesthetized,instrumented with an RV conductance catheter,and underwent dose-responses to sevoflurane inhalation （0.5%,1.0%,and 1.5%）. The changes of hemodynamics, right ventricular hypertrophy index （RVHI）, right ventricular myocardial infarction （RVMI）,inducible nitric oxide synthase （iNOS） and soluble guanylate cyclase （sGC） of right ventricular myocardium were analyzed. Results Compared with the control group, rats injected with monocrotaline presented elevated RVSP, RVHI and RVMI. The RVSP and MAP of all rats decreased after sevoflurane inhalation,and RVH rats preserved more dP/dtmax, cardiac output（CO）, stroke volume（SV）, and ejection fraction（EF）. The expression level of iNOS in right ventricle increased significantly while the level of sGC decreased obviously compared to the controls. Conclusion Sevoflurane could inhibit the right ventricular function in rats, but RVH rats were more tolerant to low-dose sevoflurane inhalation, which may be related to the up-regulation of the expression of iNOS and the decrease of sGC in right ventricular myocardium.

Determination of cerebral oxygen saturation and determination of intestinal necrosis in neonatal necrotizing enterocolitis by near infrared spectroscopy

MAO Jian-xiong, XIAO Dong, LUO Yan, ZHANG Chi, WANG Xiu-liang

2020, 20(05):  562-566.  DOI: 10.3969/j.issn.1009-976X.2020.05.004

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Objective To determine the value of near infrared spectroscopy （NIRS） in the diagnosis of neonatal necrotizing enterocolitis （necrotizing enterocolitis） by measuring the blood oxygen saturation of intestine by near infrared spectroscopy （NIRS） and comparing with the position and volume of necrotic bowel in operation changes of cerebral oxygen saturation in children with neonecrotizing enterocolitis.Methods Thirty cases of neonatal non intestinal diseases were selected as control group, 27 cases of neonatal necrotizing enterocolitis were diagnosed and conservative treatment failed. The intestinal oxygen saturation, cerebral oxygen saturation and peripheral blood oxygen saturation of the upper abdomen, lower abdomen, left abdomen and right abdomen of the control group and the operation group were measured by near-infrared spectroscopy （cerebral oxygen saturation meter）. The intestinal necrosis site and the volume of necrotic bowel were recorded in the operation group. The data of the two groups were compared. The proportion of the lowest value of the four measurement sites in accordance with the site of intestinal necrosis during operation, and the relationship between the measured value of intestinal blood oxygen saturation and the volume of necrotic bowel were calculated in the operation group. T-test was used to compare the two groups. The degree of compliance before and after operation was used as percentage. The relationship between intestinal oxygen saturation and necrotic bowel volume was analyzed by Pearson correlation. Results There were significant differences in intestinal oxygen saturation, cerebral oxygen saturation and blood oxygen saturation between the same part of the control group and the operation group, P<0.05, with significant statistical difference. The lowest value of the four measurement sites in the operation group was 85.2% consistent with the necrotic site during operation, and there was a negative linear correlation between intestinal oxygen saturation and the volume of necrotic bowel. Conclusion Near infrared spectroscopy is an effective method to measure intestinal oxygen saturation and cerebral oxygen saturation, which has a certain evaluation value for the degree of intestinal necrosis, and has certain significance for the early diagnosis of neonatal necrotizing enterocolitis.

Study of mechanism of Prunella vulgaris decoction on thyroid cancer based on network pharmacology and molecular docking technology

TU Xing-qiang, ZHANG Jing-jing, PENG Xiao-bin, DU Guo-neng, XULI Xiao-zi, XU Yong-hui, XIAO Yu-gen

2020, 20(05):  567-572.  DOI: 10.3969/j.issn.1009-976X.2020.05.005

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Objective To analyze the molecular mechanism of Prunella vulgaris in the treatment of thyroid cancer using network pharmacology combined with molecular docking technology. Methods TCMSP database was used to predict the main active components of Prunella vulgaris, and TCMSP and PubChem database were used to obtain the corresponding targets of all active components. Thyroid targets for the treatment of thyroid cancer were collected through GeneCards and OMIM database. The interaction information between proteins was obtained by using STRING database, and the topology analysis and visualization were carried out by using R language. GO and KEGG pathway analysis was conducted on the intersection targets of drugs and diseases obtained above using the clusterProfiler. Cytoscape 3.7.2 was used to construct the active component-target-disease network, and the core compounds were obtained through topological analysis. The core targets and compounds were verified by molecular docking. Results Quercetin, luteolin, kaempferol and sitosterol may be the core components in the treatment of thyroid cancer, while AKTI, VEGFA, CASP3, MYC, JUN, MAPK8, IL6, EGFR, MAPK1 and EGF may be the important therapeutic targets. Conclusion The treatment of thyroid carcinoma by Prunella vulgaris shows the characteristics of multiple components, multiple targets and multiple pathways, which provides a theoretical basis for the screening and further study of the effective components of Prunella vulgaris.

The application and clinical effect of endoscopic assisted placement of decompression tube in acute obstructive induced by colorectal carcinoma

LI Jun, DI Mao-jun, TAN Hua-yong, TANG Qiang

2020, 20(05):  573-576.  DOI: 10.3969/j.issn.1009-976X.2020.05.006

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Objective To investigate the application and clinical effect of endoscopic assisted placement of decompression tube in acute obstructive induced by colorectal carcinoma. Methods Thirteen patients with colorectal cancer complicated with acute obstruction treated with decompression tube and 3~7 days later, all the patients underwent colorectal cancer radical surgery. Results All the 13 patients were successfully placed in the decompression tube; and abdominal pain and abdominal distension were relieved, the symptoms of bloating and vomiting disappeared. Three days later, the abdominal circumference was reduced from （92.7±5.7） to （81.2±4.8） cm （P<0.001）. The intra-abdominal pressure was reduced from （21.00±1.5） to （12.2±0.8） cmH₂O （P<0.001）; the drainage volume of the decompression catheter decreased from （782.3±72.1） to （33.8±15.3） ml （P<0.001）; the maximum transverse diameter of the proximal intestinal tube was reduced from （5.4±0.6） to （2±0.3） cm （P<0.001）. All cases underwent one-stage radical surgery, and there were no postoperative complications such as anastomotic leakage and wound infection occurred. Conclusion Colorectal cancer with acute intestinal obstruction, Endoscopic assisted placement of decompression tube in the colorectal cancer with acute intestinal obstruction can not only relieve the symptoms of intestinal obstruction, but also improve the general condition of the patient and fully complete the preoperative preparation, and win the opportunity for radical surgery. The advantages of safety, economy, and trauma may benefit greatly for these patients.

Application of active peritoneal incision in the maintenance of round ligament of uterus in laparoscopic total extraperitoneal hernia repair

LIANG Wen-feng, ZHOU Jian-ping, LIAO Zi-cong, TANG Zhi-ping

2020, 20(05):  577-581.  DOI: 10.3969/j.issn.1009-976X.2020.05.007

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Objective To explore the application value of active peritoneal incision in the preservation of round ligament of uterus in laparoscopic total extraperitoneal hernia repair （TEP）. Methods From January 2014 to October 2019, 41 cases of TEP in general surgery department of Zhongshan Boai hospital were analyzed retrospectively, and the clinical and surgical data of them were compared. The time of operation, the amount of bleeding and the incidence of postoperative complications were compared. Results There were no significant differences in operation time, bleeding volume, hospitalization days and hospitalization expenses among the groups. The postoperative pain, seroma formation, and foreign body sensation in the groin area were not statistically significant in the two groups （P<0.05）. There was no intraoperative side injury in each group. The incidence of postoperative complications was 0. Conclusion The technique of active peritoneal incision is safe and reliable in the application of TEP, which can not increase the recurrence of inguinal hernia and complications during and after operation, and can protect the original anatomical relationship and function of the ligament.

Effect of atrial septal defect occluder in the treatment of tuberculous bronchopleural fistula

LIU Jia-jie, XIAO Ze-lin, GAO Jian-qi, LIAN Gui-yong

2020, 20(05):  582-587.  DOI: 10.3969/j.issn.1009-976X.2020.05.008

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Objective To summarize and analyze the experience of treating tuberculous bronchopleural fistula with atrial septal defect closure device. Methods A retrospective analysis was conducted on the treatment of 20 cases of tuberculous empyema with bronchopleural fistula in our department from 2018 to 2019 using atrial septal defect closure device to block tuberculous bronchopleural fistula. In this group, patients with effective control of residual cavity infection chose fibre-optic subtracheal septum closure device to block the bronchial pleural fistula after fenestration and drainage for 2~4 weeks. Results After effective control of chest infection in the whole group of patients, the efficacy of closure of fistula was evaluated according to clinical symptoms, control of chest and lung infection and closure of fistula. All 20 cases achieved the cure （CR） standard after closure： the fistula healed and the clinical symptoms were completely relieved for 1 month; the patients were followed up for 6~12 months, and 8 patients underwent simple thoracic window closure （OWT） 3~6 months after closure, seven patients had improved systemic symptoms and could tolerate elective surgery. Three patients had partial remission （PR）. The fistula was not closed and partially blocked by stents. The clinical symptoms were partially relieved in 2 patients. The occluder was removed under bronchoscope 8 months and 12 months after operation. There were no death cases in this group, and there were no adverse events in perioperative period, including occluder falling off, airway stenosis and other complications. Conclusion Characterized by minimally invasive and cost-effective, also due to the special anatomy of the fistula of bronchopleural fistula, which is similar to the fistula structure of atrial septal defect. Under the condition that the routine treatment is ineffective, the use of atrial septal defect closure device in the treatment of tuberculosis empyema with bronchopleura fistula can be used as a special treatment technique under tracheoscopy, which can block the fistula quickly and effectively, reduce the risk of re-infection and respiratory failure, and provide an effective treatment for patients with tuberculosis empyema with bronchopleura fistula.

Comparative analysis of clinical effect of extracorporeal shock wave therapy and surgery in treatment of delayed union of fractures

HUANG Kai-yue, CHANG Ji-yang, LI Jian, XU Chuang, CAO Heng, WANG Lin-wei, ZHENG Li-chao, LIU Ming-ting

2020, 20(05):  588-592.  DOI: 10.3969/j.issn.1009-976X.2020.05.009

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Objective To compare the clinical effect between extracorporeal shock wave therapy（ESWT） and surgery in treatment of delayed union of fractures. Methods Thirty patients who visited our hospital from Jan. 2017 to Jan. 2018 with delayed union of fracture diagnoses were randomly divided into surgical group and ESWT group. Each group has 15 patients. In the clinical trial, the surgical group received surgical treatment, and X-rays were re-examined regularly every month. By comparison, the ESWT group was treated with extracorporeal shock wave. Besides, X-rays were re-examined after each course of treatment. X-ray callus growth at the fracture site was observed before treatment and at the 1^st, 2^nd and 3^rd courses of treatment. The formation of callus was scored. The clinical efficacy of extracorporeal shock wave therapy for delayed fracture healing was explored by measuring callus status, the period of healing time for fractured bones, the evaluation of fracture healing criteria, and treatment costs. Results Patients were followed up after at least 18 months of treatment. The X-ray scores of callus in both groups were higher than those before treatment. In the ESWT group, 13 patients totally recovered, while 1 partly recovered. Moreover, the average time of fracture healing was 8.267 months, and 1 had no radiological healing sign at the fracture site until the end of follow-up. In the surgical group, 14 patients totally recovered, using 8.714 months on average. One patient didn't show radiological signs of union at the fracture site until the end of follow-up. Additionally, there were no significant complications （such as vascular nerve injury, internal fixation） fracture observed in either group bythe end of follow-up. Conclusion Extracorporeal shock wave therapy has significant clinical efficacy in the treatment of delayed union of fractures, and it is worthy of clinical application because of itis non-invasive, simple, safe and effective, without complications and relatively low cost.

Efficacy of closed reduction and internal fixation with hollow tension nail for intertrochanteric fracture of femur under C-arm： experience report of 88 cases of primary hospital

QIAN Jun, LIN Jian, SU Shu-yuan

2020, 20(05):  593-596.  DOI: 10.3969/j.issn.1009-976X.2020.05.010

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Objective To investigate the clinical effect of closed reduction and internal fixation with hollow tension nails for intertrochanteric fractures （IF） under C-arm perspective. Methods From January 2014 to January 2018, 176 patients with IF in our hospital were selected and divided into observation group （n=88） and control group （n=88） according to different treatment schemes. The control group underwent traditional nail plate internal fixation, and the observation group underwent closed reduction and internal fixation with hollow tension nails under C-arm fluoroscopy. The surgical conditions （time of operation, blood loss during operation, time of osseous healing）, fracture healing at 6 months after surgery, incidence of complications, hip function （Harris score）, and motor function （FMA score） before and after 6 months were compared between the two groups. Results The observation group had shorter operation time and bone healing time than the control group, and the blood loss during the operation was less than that of the control group, the difference was statistically significant （P<0.05）; the Harris and FMA scores of the two groups increased after 6 months, and the observation group was higher than the control group, and the difference was statistically significant （P<0.05）; the excellent healing rate of fracture healing in the observation group at 6 months after operation was 97.73% （86/88） higher than that in the control group at 79.55% （70/88）, and the difference was statistically significant （P<0.05）; the incidence of complications in the observation group was 2.27% （2/88） compared with 6.82% （6/88） in the control group, and the difference was not statistically significant （P>0.05）. Conclusion Closed reduction hollow cannula internal fixation under C-arm fluoroscopy has a significant effect on IF, can further promote fracture healing, restore hip joint function and motor function, and has fewer complications.

Clinical research of the volume ratio of bone cement on the therapeutic results in percutaneous vertebroplast

CHEN Jia-yu, LIU Zhan-liang, ZHANG Hui-cheng, YANG Yong-qian, HUANG Ling-zhi, YANG Zhi-fa

2020, 20(05):  597-600.  DOI: 10.3969/j.issn.1009-976X.2020.05.011

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Objective To assess the volume ratio of bone cement on the therapeutic results in percutaneous vertebroplasty. Methods From January 2016 to May 2018, 43 patients suffered from osteoporotic vertebral compression fracture were performed percutaneous vertebroplast. CT scans of pre-operative and post-operative were imported into Mimics software and the diffusion volume of bone cement in vertebral body was calculated. Bone cement diffusion volume ratio = bone cement diffusion volume / wound cone volume. Bone cement diffusion volume ratio was divided into three grades, grade 1 <25%, 25<grade 2<50%, grade 3>50%. The VAS scores and Oswestry Disability Index scores were compared at preoperation, 12 months after operation. Results Thirty-seven vertebral bodies were operated in percutaneous vertebroplast. They were followed up for 12 to 27 months （average 16.8 months）. The back pain of the patients was alleviated or disappeared. There was no significant difference in pain relief between the groups with cement diffusion volume ratio of grade 1, grade 2 and grade 3（P<0.05）. Conclusion In the present study, cement volume ratio less than 25% was an effective therapy for osteoporotic vertebralcompression fractures in vertebroplasty. Increasing the diffusion volume ratio of bone cement couldn't achieve better curative effect.

Effect of the vertebroplasty for vertebral compression fractures of screw-setting segment after thoracolumbar internal fixation

XIAO Jin-yu, YE Ji-chao, WANG Zhen

2020, 20(05):  601-604.  DOI: 10.3969/j.issn.1009-976X.2020.05.012

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Objective To investigate the clinical effect of vertebroplasty in the treatment of vertebral compression fracture of screw-setting level after thoracolumbar pedicle screw fixation. Methods From June 2016 to June 2019, a total of 12 patients with vertebral compression fractures of screw-setting segment after thoracolumbar internal fixation were treated with vertebroplasty in Zengcheng People's Hospital, Guangzhou. Postoperative observation included bone cement leakage, re-fracture and instrumental loosen and failure. Visual analogue scale （VAS）, vertebral compression rate and Cobb Angle were collected before vertebroplasty and 3 days, 1 month, 3 months, 6 months and 12 months after vertebroplasty. Results All patients were followed up for 12 months. There was only 1 case of bone cement leakage, no re-fracture, instrumental loosen and failure. There were statistically significant differences between before and after vertebroplasty in lumbar VAS score, vertebral compression rate and Cobb Angle （P<0.05）. Compared with 1 month after vertebroplasty, 3 months, 6 months and 12 months after vertebroplasty had no statistically significant differences in lumbar VAS score, vertebral compression rate and Cobb Angle （P>0.05）. Conclusion Vertebroplasty is an effective treatment for thoracolumbar vertebral compression fracture of screw-setting segment after thoracolumbar internal fixation, which could significantly relieve the lower back pain, prevent the re-fracture and instrumental loosen and failure.

MRI manifestations of Sacrococcygeal Pilonidal Sinus

WANG Zhi-hui, LAI Bing-jia, MAO Jia-yi, HU Hui-jun, YANG Qi-hua

2020, 20(05):  605-609.  DOI: 10.3969/j.issn.1009-976X.2020.05.013

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Objective To summarize the clinical and magnetic resonance imaging （MRI） characteristics of sacrococcygeal pilose sinus. Methods Five patients with pathologically confirmed sacrococcygeal pilose sinus were retrospectively analyzed, including clinical data and MR images. Results Sacrococcygeal subcutaneous sinus could be found in all 5 cases, with the ostium located in internatal cleft skin at the level between the 5^th sacral and 3^rd coccygeal vertebrae. The sinus extended upward subcutaneously from sacrococcygeal region, with tortuous or irregular shape. The wall of sinus was thick, hyperintense on T2WI-FS and hypointense on T1WI. The lumen was hypointense on both T2WI-FS and T1WI when there is no pus or fluid and intralumen pus and fluid were hyperintense on T2WI-FS and hypointense to slight hyperintense on T1WI. Edema was seen in surrounding soft tissue. The wall and surrounding soft tissue of the sinus showed significant enhancement in the case of infection. No sacrococcygeal bone or anal canal was involved. Conclusion MRI can accurately show the position, scope of sinus and surrounding tissues, so it has important clinical value in the diagnosis of sacrococcygeal pilose sinus.

Observation on the efficacy of combination propofol with nabulphine on central venus catheterization in children with hematologic diseases

ZHANG Xue-rong, YANG Xue-ying

2020, 20(05):  610-613.  DOI: 10.3969/j.issn.1009-976X.2020.05.014

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Objective To evaluate the value of propofol combined with nabulphineanesthesia on central venus catheterization in children with hematologic diseases. Methods A total of 60 children with hematologic diseases underwent central venus catheterization in the operating room were randomly divided into the observation group （propofol combined with nabophine） and the control group （propofol alone）, with 30 patients in each group. Children in the observation group were anesthetized with propofol combined with nalbuphine, while children in the control group were anesthetized with propofol alone. Propofol dosage, the incidence of body movement during puncture, the incidence of respiratory depression, operative time and waking time were compared between the two groups. Restlessness and sedation scores were recorded immediately after wakefulness （T₁）, 30 min （T₂）, 2 h （T₃） and 6 h （T₄） postoperatively. The occurrence of postoperative adverse reactions in the two groups was recorded. Results The dosage of propofol, the incidence of body movement and the operation time of the patients in the control group were significantly higher than those in the observation group. There were no significant difference in the incidence of respiratory depression and waking time between the two groups. The restlessness and sedation scores of the observation group at T₁ and T₂ were better than those of the control group, and there was no statistically significant difference between the two groups at T₃ and T₄. There was no significant difference in postoperative adverse reactions between the two groups. Conclusion Propofol combined with nabulphine intravenous anesthesia is safe and feasible in central venus catheterization of children with hematologic diseases, which reduces the amount of intraoperative propofol, decreasesthe incidence of postoperative agitation, and does not affect the awake time of children.

Evaluation of clinical outcome of TAP block by adding dexmedetomidine as an adjuvant in patients with liver cancer surgery

HUANG Hai-ming, CHEN Rui-xia, YUAN Yuan, YE Xi-jiu

2020, 20(05):  614-618.  DOI: 10.3969/j.issn.1009-976X.2020.05.015

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Objective To evaluate the clinical outcome of TAP block by adding dexmedetomidine as an adjuvant in patients with liver cancer surgery. Methods A total of 60 patients undergoing elective open liver carcinoma resection were enrolled, and were randomly divided into three groups （20 cases in each）, including group R, group D0.5 and group D1.0, according to the dose of dexmedetomidine mixed into local anesthetic solution used for TAP block. All patients underwent bilateral subcostal TAP block under local anesthesia guided by ultrasound. 40 mL 0.5% ropivacaine was injected into the TAP in group R; 40 mL 0.5% ropivacaine mixed with 0.5 μg/kg dexmedetomidine was injected in group D0.5; 40 mL 0.5% ropivacaine mixed with 1.0 μg/kg dexmedetomidine was injected in group D1.0. After TAP block completion, the onset time, duration, Narcotrend Index and hemodynamics were recorded. Recovery time, dosage of analgesic and incidence of complications were compared between groups. Results The onset time of TAP block in group R, group D0.5 and group D1.0 was 13.1±2.9 min,11.6±2.3 min,7.7±2.1 min, respectively, with significant difference between any two groups （P<0.05）. The duration of TAP block in group R, group D0.5 and group D1.0 was 10.7±3.0 h, 13.6±3.1 h,17.3±4.2 h, respectively, with significant difference between any two groups （P<0.05）. Narcotrend Index, arterial pressure and heart rate in group D0.5 or group D1.0 were lower than those of group R （P<0.05）, with those of group D1.0 lower than those of group D0.5 （P<0.05）. The recovery time was not significantly different among the three groups. The dosage of postoperative analgesic within 48 h in group D1.0 was lower than that of group R or group D0.5 （P<0.05）, with no difference between group R and group D0.5. All patients enrolled didn't suffer any complications related to TAP block. Conclusion Mixed with local anesthetic, dexmetomidine can accelerate the onset time and prolong the duration of TAP block, and also play the role of sedation and stabling circulation through it's absorption into blood.

Application of norepinephrine combined with butorphanol tartrate in the rapid induction of elderly patients with hypertension

CHEN Mei-xian, LU Fu-ding, LIAO Zhao-xia, YE Xi-jiu

2020, 20(05):  619-623.  DOI: 10.3969/j.issn.1009-976X.2020.05.016

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Objective To investigate the effects of norepinephrine combined with butorphanol tartrate on the macrocirculation and microperfusion in elderly patients with hypertension during rapid induction of propofol. Methods Sixty elderly patients with hypertension who underwent elective upper abdominal surgery, age 65~79 years, ASAⅡ~Ⅲ, were randomly divided into 3 groups： Norepinephrine （groupⅠ）, saline + butorphanoltartrate （groupⅡ） and norepinephrine + butorphanoltartrate （group Ⅲ）. Norepinephrine was continuously pumped in groupⅠand group Ⅲ during induction and maintained the MAP within 60-130 mmHg, while in group Ⅱ and groupⅢ, butorphanoltartrate 0.02 mg/kg iv was administered two minutes before induction. All groups were induced by propofol 2.5~3.5 μg/mL TCI, sufentanil 0.4 μg/kg iv and homeopathic atracurium 0.2 mg/kg iv. And after 3 min, tracheal intubation and mechanical ventilation were performed. The MAP and HR of each group before induction （T₀）, after induction （T₁）, before intubation （T₂）, after intubation （T₃）, and before surgery （T₄） were recorded, and at the moment of T₀, T₃ as well as T₄, blood gas analysis was performed to measure the values of blood glucose （cGlu） and lactic acid （cLac）. Results Compared with group I, the incidence of injection pain, cough and muscle twitch was lower in groupⅡand group Ⅲ （P<0.05）. Compared with T₀, MAP and HR in all three groups were lower after induction. Compared with group Ⅱ, the MAP fluctuations were smaller in groupⅠand group Ⅲ （P<0.05）. Compared with T₀, lactic acid level in group Ⅲ at T4 was the most significantly improved, and the difference was statistically significant compared with the other two groups （P<0.05）. As well, there was no significant difference in blood glucose in each group （P>0.05）. Conclusion Norepinephrine combined with butorphanol tartrate can greatly prevent macrocirculation fluctuation, improve microscopic perfusionduring rapid induction, reduce cough and other adverse reactions in elderly hypertensive patients.

Application value of ultrasound-guided anterior serratus and erector spinae block in surgery of minimally invasive lobectomy

WANG Dao-meng, GU Xiang-sen, PAN Zhong, QIAN Bin

2020, 20(05):  624-627.  DOI: 10.3969/j.issn.1009-976X.2020.05.017

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Objective To explore the value of ultrasound-guided anterior serratus and erector spinae block in the rapid rehabilitation of minimally invasive lung cancer radical surgery. Methods Retrospective data were analyzed in 120 patients with minimally invasive radical resection of lung cance in Jiangdu People's Hospital from May 2017 to November 2019. According to the different anaesthetic and postoperative analgesia program, the patients were randomized into two groups, 60 cases in each group. The anaesthetic mode of control group was double lumen endotracheal catheter intubation and analgesic method was in the form of patient-controlled intravenous analgesia pump. The anaesthetic mode of observation group was double lumen endotracheal catheter intubation and analgesic method was ultrasound-guided serratus anterior muscle and erector spinae plane block + intravenous self-controlled analgesic pump analgesia. The intraoperative index, postoperative analgesic effect and clinical related index were observed in two groups of patients. Results All 120 patients successfully completed the operation. There was no significant difference in heart rate, blood pressure and oxygen saturation during operation between the two groups （P>0.05）. There were statistically significant differences in postoperative pain score, incidence of postoperative dizziness, postoperative nausea and vomiting, incidence of postoperative pulmonary infection and postoperative ambulation time between the two groups （P<0.05）. Conclusion Ultrasound-guided serratus anterior muscle and erector spinae plane block has good analgesic effect, can achieve the goal of rapid recovery after surgery.

Application of sevoflurane inhalation induction and UE glidescope under spontaneous breathing in patients with anticipated difficult intubation

YIN Xiao-qing, ZOU Jun, YE Xi-jiu

2020, 20(05):  628-630.  DOI: 10.3969/j.issn.1009-976X.2020.05.018

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Objective To investigate the clinical effect of sevoflurane inhalation induction and UE glidescope under spontaneous breathing in patients with anticipated difficult airway. Methods Fifty ASA Ⅰ-Ⅲ patients with difficult airway scheduled for tracheal intubation anesthesia were selected. All patients were induced with inhalation of 8% sevoflrane and oxygen 6 litre min^-1 under spontaneous breathing via face masks, and then intubated by UE glidescope. The mean arteriablood pressure （MAP）, heart rate （HR） and O₂ saturation （SpO₂） were recorded at the time points of T₁ （before anesthesia）, T₂ （before intubation） and T3 （after intubation）. The intubation times, the first-attempt success rate of intubation and the related adverse events were recorded. Results During the whole procedure of induction and intubation, SpO₂ was more than 96% in all patients. Fourty-three cases （86%） were intubated successfully at first attempt, 4 cases with re-intubated, no case with respiratory suppression, laryngospasm, and bucking, 2 cases with mild teeth bleeding. No significant difference in HR, MAP and SpO₂ at three time points. Conclusion sApplication of sevoflurane inhalation induction combined with UE glidescope intubationin patients with difficult airway not only provides high rate of successful intubation, but also has relative stable hemodynamics and low occurrence rate of adverse events, therefore, which is a safe and feasible induction scheme.

Emphysema pyelonephritis： report of 4 cases and literatures review

ZHOU Yu, TAO Jiong-hua, LI Yuan

2020, 20(05):  631-634.  DOI: 10.3969/j.issn.1009-976X.2020.04.019

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Objective Emphysema pyelonephritis （EPN） is a severe acute necrotizing renal parenchymal and perirenal infection that was characterized by the production of gas, with a high mortality rate. There is no guideline to provide a reference for treatment standard. Our treatment plan of DJ stenting combined with antibiotic treatment were used to treat the class 1-2 EPN and results could provide clinical evidence for therapeutic method. Methods The clinical data of 4 cases of class 1-2 EPN in our hospital and the latest relevant literatures were retrospectively analyzed and the clinical efficacy of the scheme was comprehensively analyzed. Results Four patients were cured by drainage of DJ stenting combined with antibiotic treatment. Conclusion Drainage of DJ stenting combined with antibiotic treatment of class 1-2 EPN was safe and effective.

Case Report

Disease-free survival over 3 years after surgery for anaplastic thyroid carcinoma： a case report

MIN Lei, HUANG Zhi-heng

2020, 20(05):  635-638.  DOI: 10.3969/j.issn.1009-976X.2020.05.020

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Anaplastic thyroid carcinoma is quite an aggressive cancer from thyroid follicular epithelial cells. For low morbidity, surgical indication and extent are still controversial currently. This article not only reported an ATC case of which disease-free survival was over 3 years after surgery, but also reviewed clinical pathological characteristics and treatment approach.

HELLP syndrome complicated by subcapsular hepatic hematoma： A case report

HUANG Kang-hua, LIN Ze-wei

2020, 20(05):  639-641.  DOI: 10.3969/j.issn.1009-976X.2020.05.021

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HELLP syndrome, the full name of hemolysis-liver transaminase elevation-thrombocytopenia syndrome, refers to pregnancy induced hypertension syndrome with hemolysis, elevated liver function and low platelet count. Gynecology, hepatobiliary surgery and imaging doctors should be familiar with the characteristics of its pathological changes so as to avoid missed diagnosis and misdiagnosis in clinical work. We clinically diagnosed and treated a 36-year-old woman developed HELLP syndrome complicated with hepatic subcapsular hematoma after delivery. In multidisciplinary diagnosis and treatment, close observation of hepatic subcapsular hematoma, conservative treatment was adopted under the condition of stable hemodynamics, and finally the patient's condition improved gradually. The patient is reported as follows.

Review

Research of pathophysiological and biochemical markers in traumatic brain injury

YAO Qing-hai, LIU Bao-long

2020, 20(05):  642-649.  DOI: 10.3969/j.issn.1009-976X.2020.04.022

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Traumatic brain injury is a multifaceted condition that encompasses a spectrum of injuries： contusions, axonal injuries in specific brain regions, edema, and hemorrhage. Brain injury determines a broad clinical and disability spectrum due to the implication of various cellular pathways, genetic phenotypes, and environmental factors. It is challenging to predict patient outcomes, to appropriately evaluate the patients, to determine a suitable treatment strategy and rehabilitation program, and to communicate with patient relatives. Biomarkers detected from body fluids are potential evaluation tools for traumatic brain injury patients. These may serve as internal indicators of cerebral damage, delivering valuable information about the dynamic cellular, biochemical, and molecular environments. The diagnostic and prognostic value of biomarkers tested both in animal models of traumatic brain injury is still under question, despite a considerable scientific literature. Recent publications emphasize that a more realistic approach involves combining multiple types of biomarkers with other investigative tools （imaging, outcome scales, and genetic polymorphisms）. Additionally, there is increasing interest in the use of biomarkers as tools for treatment monitoring and as surrogate outcome variables to facilitate the design of distinct randomized controlled trials. This review highlights the latest available evidence regarding biomarkers in adults after traumatic brain injury and discusses new approaches in the evaluation of this patient group.

Individual treatment for adult patient with inguinal hernia underwent the surgery

YE Wei-heng, LIANG Jun-jie, LUO Jia-yao, HU You-zhu

2020, 20(05):  650-653.  DOI: 10.3969/j.issn.1009-976X.2020.05.023

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At present, the effective surgical treatment of adult patient with inguinal hernia is including the open hernia repair and the laparoscopic hernia repair. Although there are many treatment methods, they have their indications and disadvantages. The surgeons should make a surgical plan according to the patient's gender, previous history, culture, income level and other conditions. Thus, the individualized surgical treatment of adult patient with inguinal hernia was discussed. The objective was to make the surgeons learn to choose the right surgical method to treat different patients with inguinal hernia, reduce the complication rate and reduce the financial burden of patients, maximizing the benefit of patients.

Reconstruction methods and research progress of abdominal wall defects

TIAN Hua-kai, ZONG Zhen

2020, 20(05):  654-658.  DOI: 10.3969/j.issn.1009-976X.2020.05.024

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The only possible cure for abdominal wall defects is surgical operation, mainly through a variety of surgical techniques for the effective repair and reconstruction of abdominal wall defects, so as to achieve the purpose of covering and protecting abdominal organs, providing adequate mechanical strength support for abdominal wall, and then restoring the anatomy, function and appearance of abdominal wall. At present, there are various methods for reconstruction of abdominal wall defects, but there are some limitations, and clinical research evidence is still lacking. Therefore, it is necessary to summarize the existing surgical repair technology and clinical experience, and to explore new and innovative surgical techniques.

Research progess of tubeless percutaneous nephrolithotomy for the treatment of renal calculi

CHEN Bin, HU Hong-xing, ZHANG Yu, DENG Jun-hong

2020, 20(05):  659-663.  DOI: 10.3969/j.issn.1009-976X.2020.05.025

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The urolithiasis is one of the common urology diseases, and percutaneous nephrolithotomy is the main choice for the treatment of renal calculi. Traditionally, standard PCNL needs the nephrostomy tube and ureteral stent for drainage and to prevent bleeding. However, the operation also brings many disadvantages such as bleeding, postoperative pain, long hospital stay, high hospitalization costs. Tubeless percutaneous nephrolithotomy can lessen the above shortcomings. The author reviews the recent development and clinical practice of tubeless percutaneous nephrolithotomy.

Study on pharmacological effects of glutamine on intestinal injury

LIN Jie-ru, CHANG Hui-li, FENG Zheng-fu, TANG Rui-ming, WANG Xin, FENG Gu

2020, 20(05):  664-667.  DOI: 10.3969/j.issn.1009-976X.2020.05.026

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Delicate and complex interactions between epithelial cells, immune cells, and luminal microbiota determine mucosal homeostasis. The stimulation of the intestine may lead to intestinal damage （intestinal barrier damage）, such as chemotherapy and radiotherapy of abdominal tumors, inflammatory bowel disease, and intestinal stress, the latter such as trauma, shock, inflammation. The damaged intestinal epithelial barrier and the accompanying excessive immune response to the intestinal microbiota lead to inflammatory bowel disease and enteritis. At the same time, the increased intestinal permeability （bacterial translocation） caused by the intestinal barrier damage may result ininjury in extraintestinal tissues and organs. Glutamine （Gln） is a truly functional amino acid in nutrition. Dietary Gln has been shown to be important formaintenance of the intestinal mucosal barrier by regulatingexpression of genes and proteins involved in cellproliferation, differentiation and apoptosis, protein turnover,anti-oxidative property, and immunity responses. However, the underlying mechanism of Gln is still largely unknown. Therefore, the important role of glutamine continues to motivate researchers in experimental animal, basic and clinical research. This article reviews the mechanism of intestinal barrier damage and the pharmacological effects of glutamine on intestinal injury. It is necessary to better understand the role of glutamine and improve the nutritional utilization of glutamine in organisms.

Surgical Nursing

Tailored preoperative family rectal irrigation care guide for neonatal with Hirschsprung's disease

LI Rui-qiong, OUYANG Run-xian, YAN Jing-hua, DAI Ying

2020, 20(05):  668-671.  DOI: 10.3969/j.issn.1009-976X.2020.05.027

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Objective To explore a more suitable method for preoperative family rectal irrigation care for neonates with Hirschsprung's disease （HSCR）. Methods A randomized block design method was used to divide 100 neonates with HSCR who were <3 months old into 50 cases each in the routine group and the intervention group. Parents in the routine group received regular rectal irrigation guidance. Parents in the intervention group receive guidance of implementing rectal irrigation according to the indicators of good practice of family rectal irrigation. Tailored family rectal irrigation was performed to their child. The incidences of abdominal distension, abdominal drum sound, stool traits, enterocolitis, and intestinal perforation were compared between the two groups before and after intervention. The chi-square test was used to compare the results of the two groups. Results There were no significant differences in neonates' age, diagnosis of HSCR and parental education level between the two groups. There were 15 cases and 4 cases in the abdomen with drum sounds in the routine and intervention group respectively, χ²=6.50, P=0.01. Stool color was not fresh with stench odor was shown in 8 cases in the routine group and 1 in the intervention group respectively, χ²=4.40, P=0.03. There were no enterocolitis, intestinal perforation or decreased milk intake after family rectal irrigation in both groups. Conclusion Tailored family rectal irrigation care for neonates with HSCR is recommended as a new standard of guidance for family rectal irrigation care. It is safe and effective, and is easily accepted by parents who do not have medical expertise. It can be used in families with HSCR neonates.

Nursing experience of 46 patients undergoing pancreaticoduodenectomy

LIN Miao, ZHONG Wei-guo, CAI Xiao-ling

2020, 20(05):  672-676.  DOI: 10.3969/j.issn.1009-976X.2020.05.028

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Objective To summarize the nursing of 46 patients after pancreaticoduodenectomy. Methods a descriptive method to record and report peri-operative nursing care of 46 patients with pancreaticoduodenectomy （Whipple procedure） in our department from September 2014 to January 2017 were collected, including general nursing, abdominal symptoms and signs, pipeline nursing, observation and nursing of complications, psychological nursing. Results Of 46 patients underwent pancreaticoduodenectomy, 33 had no severe complications and were discharged from hospital. The other 12 patients had complications after operation and discharged after intervention. One patient gave up treatment because of multiple organ diseases. Conclusion Standardized nursing, early detection of problems, unblocked communication between doctors and nurses, three-point treatment and seven-point nursing, attaching importance to the perioperative nursing management of Whipple procedure can help reduce the incidence of complications, and is an important node to promote early recovery and discharge of patients.

Application of health education based on micro-video in nursing of patients undergoing catheter indwelling after laparoscopic radical prostatectomy

YUAN Hong, HU Xiao-fang, CHEN Ye-hui, LI Shu-xia

2020, 20(05):  677-680.  DOI: 10.3969/j.issn.1009-976X.2020.05.029

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Objective To study application effect of health education based on micro-video in nursing of patients undergoing catheter indwelling after laparoscopic radical prostatectomy （LRP）. Methods Sixty patients undergoing catheter indwelling after LRP who were diagnosed and treated in the hospital from January 2017 to December 2019 were divided into control group and study group by random number table method, 30 cases in each group. The former was given routine health education, while the latter was additionally given health education based on micro-video. The complications, self-efficacy and self-care ability before and after intervention were compared between the two groups. The quality of life in patients after intervention was evaluated. Results The total incidence of complications in study group was significantly lower than that in control group （6.67% vs 26.67%） （P<0.05）. Before intervention, there were no significant differences in scores of General Self Efficacy Scale （GSES） and self-care ability between the two groups （P>0.05）. After intervention, all scores of study group were significantly higher than those of control group （P<0.05）. The scores of quality of life in study group were significantly higher than those in control group （P<0.05）. Conclusion The application of health education based on micro-video in nursing of patients undergoing catheter indwelling after LRP is to beneficial to improve their self-efficacy and self-care ability, prevent complications, thus improving quality of life.

Application of face to face teaching combined with video viewing mode in clinical teaching of central sterile supply department

HE Hui-yan, WU Li-xiang, HUANG Feng-yu, LI Xiang-ying, PENG Cai-ying

2020, 20(05):  681-684.  DOI: 10.3969/j.issn.1009-976X.2020.05.030

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Objective To explore a teaching mode of face-to-face teaching combined with video viewing in disinfection and supply center. Methods Sixty-eight nursing students were divided into two groups according to the rotation order of practice, in which 34 nursing students from July 2019 to September 2019 were selected as the control group, and 34 nursing students from October 2019 to December 2019 were assignedto the observation group. The control group adopted the traditional single face-to-face teaching mode to carry out theoretical teaching and practical demonstration, while the experimental group adopted face-to-face teaching combined with video viewing mode to carry out theoretical teaching and practical demonstration. The clinical teaching effect of the two groups was compared. Results The results of the observation group were higher than those of the control group （P<0.01）; the more times the nursing students watched the teaching video, the better the results of the examination; the experimental group nursing students were satisfied with the teaching mode of face-to-face teaching combined with video watching; the teaching teacher thought that the teaching effect of face-to-face teaching combined with video watching teaching mode was better than that of single face-to-face teaching mode （P<0.05）. Conclusion Face to face teaching combined with video viewing mode was applied in clinical teaching of disinfection and supply center, and the effect was good.

Work experience in medical observation point of close contacts of COVID-19

YU Hong-yan, CHENG Jing, LIU Fang, LI Hui-jing, XUE Jian-sheng, JIANG Zhi-peng

2020, 20(05):  685-688.  DOI: 10.3969/j.issn.1009-976X.2020.05.031

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To explore the problems and treatment methods in the medical observation points of close contacts of COVID 19, so as to provide experience for medical observation points in other areas, and contribute to cutting off the transmission route of the virus, preventing the virus from spreading and ending the epidemic as soon as possible.