Objective: To investigate the changes of sTNFR in rats with MODS and its clinical implication. Methods: Rat delayed two phase models of MODS were replicated, then serum sTNFR were measured respectively pre and post MODS by ELISA method. Results: Serum sTNFRⅠ pre and post MODS was (112.15?24.95) pg/ml and (438.06? 67.06) pg/ml ( P

Objective A retrospective study to evaluate the feasibility of the sequential treatment of extrahepatic bile duct calculus and acute gallstone pancreatitis using the technique of combination of duodenoscope, laparoscope and choledochoscope in one anesthetic session. Methods 112 patients with extrahepatic bile duct calculus (including 23 patients associated with acute gallstone pancreatitis) were treated using this technique. The data were analyzed. Results The technique was successfully carried out in 102 patients but 10 patients had to be treated by conventional open operation.For the patients treated by this technique, 16 patients were treated by endoscopic sphincterotomy (EST) plus choledochotomy. The stones were removed through a choledochoscope, and the bile duct was drained by a T-tube (LCTD). 18 patients were treated by endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy (LC). The choledocholiths were removed by a choledochoscope through the cystic duct. 22 patients were treated by choledochotomy, and the calculus was removed through a choledochoscope and the bile duct was primarily sutured. 46 patients were treated by endoscopic nasobiliary drainage (ENBD) plus LC, choledochotomy. The calculi were through a choledochoscope and followed by primary suture of the bile duct. The mean time of endoscopic treatment, LC and postoperative hospital day were 35 min, 110 min and 6.5 d respectively. None of the 102 patients died after operation. 9 patients developed complications of ERCP or EST including acute pancreatitis (n=6), hemorrhage of papilla duodeni (n=2) and duodenal perforation (n= 1). 11 patients developed biliary fistula after primary suturing of the choledochus and they recovered with drainage; 2 patients developed residual or recurrent biliary fistula after the T tube was removed and they recovered after drainage via a [aparoscope. During follow-up for 1 to 3 years using ultrasonic or MRCP examinations, 3 cases of stones were found and they were removed by EST. There was no stenosis of common bile duct. Conclusions Our results suggested that the three-endoscope-combination in one anesthetic session for the treatment of extrahepatic bile duct calculi and acute gallstone pancreatitis was safe and efficacious. Moreover, this technique reduced the complications of EST. This technique increased the success rate using minimal invasive surgery.

OBJECTIVE: To explore the application value of intraoperative ultrasound (IU) in laparoscopic lymphadenectomy of gastric cancer. METHODS: Patients with gastric cancer undergoing laparoscopic radical D2 gastrectomy at General Surgery of the Second Affiliated Hospital of Anhui Medical University between August 2016 and May 2018 were prospectively enrolled and were randomly divided into IU group (n=78) and conventional group (n=91). The conventional group underwent laparoscopy only. In IU group, the laparoscopy examination was followed with intraoperative ultrasound by ultrasound specialist. The lesser curvature, peripheral gastric organs and gastric lymph nodes were scanned. Lymph nodes were considered positive if maximum diameter was greater than 10 mm or internal hyperechoic features and normal oval shape were lost. The postoperative pathological results were used as the gold standard to analyze the sensitivity of positive lymph nodes by IU detection [true positive lymph nodes/(true positive lymph node+false negative lymph nodes)×100%], specificity [true negative lymph nodes/(true negative lymph nodes+false positive lymph nodes)×100%] and the accuracy rate[(true positive lymph nodes+ true negative lymph nodes/total lymph nodes)×100%]. A consistency check between N staging diagnosed by IU and by postoperative pathology was performed with Kappa test(Kappa>0.75 indicating good consistency). Number of dissected lymph node, number of positive lymph node detected by pathology and the operation time were compared between the IU group and the conventional group. RESULTS: Among 169 gastric cancer patients, 95 were males and 74 were females with age of (63±8) years. Among 1 794 lymph nodes detected by IU from 78 patients in IU group, predicted positive lymph nodes were 832 and 740 positive nodes were confirmed by postoperative pathology. True positive lymph nodes were 679 and true negative lymph nodes were 901 by IU, and a total of 1 580 lymph nodes were accurately diagnosed by IU. The sensitivity and specificity of IU for N staging of gastric cancer were 91.8%(679/740) and 85.5%(901/1 054), respectively. Overall accuracy was 88.1%(1 580/1 794), which was in good accordance with postoperative N staging(Kappa=0.758). There was no significant difference in number of lymph node detected between the IU group and conventional group during laparoscopic gastric cancer surgery(23.0±6.9 vs. 22.0±7.7, t=0.880, P=0.380). However, the numbers of lymph nodes in the third station (No.10, No.11, No.12) in the IU group were significantly higher than those in the conventional group [No.10: median 1 (0-1) vs. 0 (0-1), Z=-6.307, P<0.001; No.11: median 1(0-2) vs. 0(0-1), Z=-5.895, P<0.001; No.12: median 1 (0-1) vs. 0 (0-1), Z=-6.693, P<0.001]. There was no significant difference in the number of positive lymph node between IU group and the conventional group(P>0.05), but the number of positive lymph nodes dissected in stage III patients of IU group was significantly higher than that in stage III patients of conventional group (14.6±4.8 vs. 14.0±3.6, t=2.531, P=0.011). The operative time of IU group was(272.0±12.0) minutes, which was significantly longer than (249.0±7.0) minutes of conventional group (t=14.638, P<0.001). However, with the increase of patients undergoing IU, the operation time of IU showed a downward trend. The average operation time of the last 20 patients was 264 minutes, and the average IU time was 15 minutes. CONCLUSIONS Intraoperative ultrasound is more accurate N-staging of gastric cancer. Although increasing operation time, it is helpful for lymph node dissection in laparoscopic gastric cancer surgery, especially by providing good support for laparoscopic No.10, No.11 and No.12 lymph nodes dissection.
Aged ; Female ; Humans ; Intraoperative Period ; Laparoscopy ; Lymph Node Excision ; Lymph Nodes ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; diagnostic imaging ; surgery ; Ultrasonography

ObjectiveTo observe the clinical efficacy and relative mechanism of the Modified Wenshen Yixin Formula （温肾益心方加减， MWYF） as an auxiliary treatment of coronary heart disease （CHD） complicated with hypothyroidism of spleen-kidney yang deficiency. MethodsA total of 135 CHD patients complicated with hypothyroidism and spleen-kidney yang deficiency were included and divided into control group （67 cases） and experimental group （68 cases） according to the patients' wishes of herbal medicine administration. The control group was given conventional western medicine， while the treatment group was additionally given MWYF， 1 dose per day； both groups were treated for 8 weeks. The traditional Chinese medicine （TCM） syndrome scores， angina scores， SF-36 scores， thyroid function indicators including thyroid stimulating hormone （TSH）， thyroxine （T4） and triiodothyronine （T3）， as well as serum cyclic adenosine monophosphate （cAMP）， cyclic guanosine monophosphate （cGMP）， monocyte chemoattractant ligand 2 （CCL2）， and tumor necrosis factor-related activator protein （CD40L） levels before and after treatment were compared between the two groups. The dosage and reduction and discontinuation rate of thyroid hormone preparations after treatment were compared between the two groups. The effectiveness regarding TCM syndrome and angina pectoris was evaluated， and the safety was assessed. ResultsBias was adjusted by matching on propensity score， and 102 cases were finally included in the statistical analysis， with 51 cases in each group. The total effective rate regarding TCM syndrome ［94.12% （48/51） versus 64.71% （33/51）］， the total effective rate regarding angina pectoris ［80.39% （41/51） versus 62.75% （32/51）］， and the reduction and discontinuation rate of thyroid hormone preparation ［39.21% （20/51） versus 5.88% （3/51）］ were significantly higher in the experimental group than those in the control group （P＜0.05 or P＜0.01）. After treatment， the total TCM syndrome score， individual scores of major symptoms ， the major symptoms score， the secondary symptoms score， angina pectoris score， and TSH level were significantly reduced （P＜0.01）， while all dimensions of SF-36 scores， T4， T3， and cAMP levels significantly increased in both groups （P＜0.05 or P＜0.01）. The dosage of thyroid hormone preparations and the levels of cGMP， CCL2， and CD40L in the experimental group significantly decreased after treatment （P＜0.01）. When compared between the two groups after treatment， the total TCM syndrome score， the major symptoms score， the scores of individual major symptom （chest tightness， chest pain， fear of cold， cold limbs， waist and kness soreness and weakness）， the secondary symptoms score， angina pectoris score， TSH， cGMP， CCL2， and CD40L levels of the experimental group were significantly lower than those of the control group （P＜0.05 or P＜0.01）， while all dimension scores of SF-36， T4， T3， and cAMP levels were significantly higher （P＜0.01）. A total of three adverse events occurred during treatment， none of which were judged to be related to the interventions of this study. ConclusionMWYF can significantly ameliorate the TCM syndrome， angina pectoris， quality of life and thyroid function in CHD patients complicated with hypothyroidism and spleen-kidney yang deficiency， and can promote the reduction and disconti-nuation of thyroid hormone preparations. The mechanism may be related to the regulation of cAMP/cGMP balance， the regulation of hypothalamic-pituitary-thyroid metabolic axis and the reduction of immune inflammation.