Objective To sum up the experiences of the application of gastric cancer postoperative gastroin-testinal decompression tube.Methods Retrospectively analyzed the implementation of postoperative gastrointestinal decompression tube undergoing elective surgery.The clinical data of 15 cases of gastric cancer,preoperative education communication,preoperative preparation,intraoperative and postoperative treatment were analyzed.Results 14 cases recovered,1 case was not completely correct anastomotic fistula by malnutrition.The average for the first time the anus exhaust time was (48.7 ±16.4)h,for the first time defecation time was (65.1 ±5.7)h,postoperative length of hospi-tal stay was (12.4 ±3.1)d,postoperative nausea and vomiting occurred in 2 cases,diarrhea in 2 cases,sore throat discomfort in 3 cases.Conclusion Postoperative gastric cancer patients with gastrointestinal decompression tube can reduce stress damage,improve postoperative experience,accelerate the postoperative rehabilitation,does not increase the incidence of postoperative complications,it is safe and feasible.

Objective To explore the expression of Her-2 and the effect on the initiation,development,invasion and metastasis of pancreatic carcinoma.Methods A total of 225 patients with pancreatic carcinomafrom January 2000 to December 2007 were analyzed retrospectively.Paraffin sections of surgical specimens from all the patients who underwent standard resection were examined by SP immunohistochemical method staining.The expression of Her-2 in patients with pancreatic carcinoma and the association between Her-2 and other clinical and pathological parameters were examined.Results Her-2 was positive in 87 of all the 225 patients(38.67%).The differentiation of tumors;size of tumors;lymph node metastasis and other organs metastasis were significantly related to Her-2.The surrival time of the Her-2-positive patients[(19.33±8.15)/nonths]Was significantly shorter than that of the Her-2-negative patients [(36.23±15.44)months]in the univariate analysis(P<0.01).At multivariate COX proportional hagards model analysis,the positivity of Her-2 applied to be an independent prognostic factor,which was also influenced by size of tumors;lymph node metastasis and other organs metastasis.Conclusion It suggests the incidence of Her-2 play an important role in evaluation of the prognosis of pancreatic carcinoma,and it could serve as an independent predictor of prognosis of pancreatic carcinoma.

Objective To evaluate the therapeutic effect of different types of biliary tract reconstruction on the post- resection of congenital choledochal cyst (CCC). Methods 106 cases of CCC undergoing resection of CCC with Roux-en-Y hepaticojejunostomy as biliary tract reconstruction were followed up and analysed. Results In this series, three kinds of biliary tract reconstruction were performed, including single Roux-en-Y hepaticojejunostomy in 48 cases, intussusceptive valve and rectangular valve lying on the jejunal segmental of Roux-en-Y hepaticojejunostomy in 37 and 21 cases, respectively. 61 cases were followed up for 4.82 years in average. None of them occurred anastomasis stricture. There were 4 cases with ascending cholangitis after primary operation: of them 3 after single Roux-en-Y hepaticojejunostomy; symptoms of 2 out of the 3 cases disappeared after reoperation to set up an intussusceptive valve plasty on the jejunal segmental of Roux-en-Y hepaticojejunostomy; another one was in rectangular valve group. Occasional abdominal pain tooke place in 8 patients, of them, 5 in single Roux-en-Y hepaticojejunostomy group, 2 and 1 in intussusceptive valve and rectangular valve groups, respectively. No patients suffered from ascending cholangitis in the intussusceptive valve plasty group. Conclusions The postoperative ascending cholangitis and anastomasis stricture can be prevented effectively, if a prophylactic intussusceptive valve on the jejunal segmental of Roux-en-Y hepaticojejunostomy is carried out after resection of CCC for biliary tract reconstruction. This procedure corresponds to the biliary tract physiology.

Objective: To explore therapeutic effect of recombinant human brain natriuretic peptide (rhBNP) in aged patients with acute decompensated heart failure (ADHF).Methods: A total of 98 aged ADHF patients treated in our hospital were selected and randomly divided into routine treatment group (n=50) and rhBNP group (n=48, received intravenous injection of rhBNP based on routine treatment group).After 72h treatment, cardiac function indexes, total effective rate and incidence of adverse drug reactions (ADR) were measured and compared between two groups.Results: Compared with before treatment, after 72h treatment, there were significant rise in left ventricular ejection fraction (LVEF) and 24h urine volume in both groups(P=0.001 all);compared with routine treatment group after treatment, there were significant rise in LVEF [(45.9±7.8)% vs.(57.4±7.9)%] and 24h urine volume [(1637.5±103.2)ml vs.(1836.4±118.4)ml], P=0.001 all.On 7d after treatment, total effective rate of rhBNP group was significantly higher than that of routine treatment group (93.75% vs.82.00%, P=0.033).There was no significant difference in incidence rate of ADR between two groups, P=0.898.Conclusion: Recombinant human brain natriuretic peptide can significantly improve heart function, and the therapeutic effect is significant in aged patients with acute decompensated heart failure.

Objective Conclusion thoracoscope surgery clinical data and correcting Ⅲ esophageal atresia(EA) and discuss the feasibility and clinical effect.Methods 24 cases confirmed the third type of esophageal atresia were retrospectively analyzed.There were 12 male and 12 female.9 cases were type Ⅲa EA and 15 cases were type Ⅲb EA.The weights were from 1.9 kg to 3.6 kg,mean weight was 2.56 kg.The age were from born to 8 days,the mean age was 2.5 days.Before operation esophageal contrast study was carried out,also ultrasonography was routinely used to evaluate heart and abdominal viscera.Results The diagnosis of third type EA was confirmed by esophageal contrast study with a blind proximal end of the esophagus and air inflation in the gut.There were 3 cases with proximal blind pouch at the 2nd vertebrate level and the other 21 cases at the 3rd to 4th vertebrate level.All the cases except one just beginning transferred to open operation because hypo-SpO2 was corrected by thoracoscopic operation.The operation time was from 110 min to 280 min,and the mean time was 120 min.The azygos vein in the former 14 cases divided and was preserved in the latter 10 cases.So the stump of the tracheoesophageal fistula (TEF) of the latter 10 cases were covered by the preserved azygos vein or plus the parietal pleura.One Ⅲa type EA could not be repaired by the radical operation and abandoned.5 cases with anastomotic leakage were cured by conserved tactics.2 cases with early TEF recurrence were initially supported by enteral nutrition by putting nasogastric jejunal tube and corrected by the 2nd stage operation.5 cases with anastomotic stricture were dilated by two times.Conclusion It is feasible to correct the Ⅲ type EA by thoracoscopic operation with good results and nice appearances.The preserved azygos vein to cover the stump of the TEF may contribute to reduce the recurrence of TEF.

BACKGROUND:Resveratrol is a natural antioxidant extracted from plants.Its mechanism of improving exercise-induced fatigue mainly focuses on the protective effect against oxidative stress and inflammation.In this study,the protective mechanism of resveratrol on exercise-induced fatigue was mainly discussed from the perspective of gluconeogenesis. OBJECTIVE:To investigate the effect of resveratrol on gluconeogenesis in exercise-induced fatigue rats. METHODS:After 1 week of adaptive training,male Sprague-Dawley rats were randomly divided into 4 groups with 12 rats in each group:blank control group,resveratrol group,exercise group,resveratrol + exercise group.Weight-bearing swimming training was used to simulate long-term medium-high intensity exercise.After swimming with a weight of 5%for 1 hour every day,50 mg/kg resveratrol solution or the same volume of dimethyl sulfoxide solvent were given orally,6 days a week,for a total of 6 weeks.Samples were collected 24 hours after the last exercise,and the levels of urea nitrogen,creatine kinase,blood glucose,liver glycogen and lactic acid and pyruvate in liver tissue were detected by the kit.The activity of phosphoenolpyruvate carboxykinase was detected by microassay,and the activity of glucose-6-phosphatase was detected by enzyme-linked immunosorbent assay.Real-time fluorescence quantitative PCR was used to detect the gene expression of silent information regulator 1,cAMP-response element binding protein and peroxisome proliferator-activated receptor-γ coactivator-1α. RESULTS AND CONCLUSION:In the exercise group,plasma urea nitrogen and creatine kinase levels of rats were significantly increased(both P<0.05),liver lactate and pyruvate levels and lactate/pyruvate ratio were significantly increased(all P<0.01),and blood glucose and liver glycogen contents were significantly decreased(both P<0.01).Resveratrol supplementation could effectively improve the above conditions.Exercise significantly decreased the activities of phosphoenolpyruvate carboxykinase and glucose-6-phosphatase(P<0.01,P<0.05),and resveratrol supplementation significantly increased the activity of phosphoenolpyruvate carboxykinase in liver tissue(P<0.01).The mRNA expression levels of silent information regulator 1,cAMP-response element binding protein and peroxisome proliferator-activated receptor-γ coactivator-1α in liver tissue of the exercise group were significantly decreased(all P<0.01),while resveratrol supplementation could significantly increase the gene expression levels of this pathway.To conclude,resveratrol can relieve exercise-induced fatigue caused by long-term medium-high intensity exercise,and its mechanism may be related to up-regulating the gluconeogenesis regulatory pathway,improving rate-limiting enzyme activity,promoting liver gluconeogenesis,and increasing blood glucose and liver glycogen levels.

BACKGROUND:Studies have shown that resveratrol can relieve exercise-induced fatigue and protect the heart,but its action mechanism needs further study. OBJECTIVE:To explore the protective effect and regulatory mechanism of resveratrol on ventricular remodeling in exercise-induced fatigue rats. METHODS:Totally 48 male Sprague-Dawley rats were randomly divided into four groups,with 12 rats in each group.Rats in the blank control group were fed conventionally.After one week of adaptive training,rats in the exercise-related fatigue group and exercise-related fatigue with resveratrol supplement group were trained by 6-week weight-bearing swimming(5%body mass lead block fixed in the tail,70%-80%maximal oxygen uptake intensity),6 days a week,60 minutes a day.Rats in the resveratrol supplement group and exercise-related fatigue with resveratrol supplement group were given resveratrol(50 mg/kg per day)by gavage one hour after exercise intervention.Blank control group and exercise-related fatigue group were given the same volume of 2%dimethyl sulfoxide,6 days a week,once a day for 6 weeks.The body mass and heart mass of the rats were measured 24 hours after the last intervention.Plasma creatine kinase isoenzyme,cardiac troponin 1,pyruvate dehydrogenase and uncoupling protein 1 levels in myocardial tissue were determined by ELISA.The mRNA expression levels of ventricular remodeling-related factor Foxp1,transforming growth factor β1 and endothelin 1 were detected by RT-PCR. RESULTS AND CONCLUSION:Compared with the blank control group,the body mass of rats decreased and the heart mass increased in the exercise-related fatigue group(P＜0.05).Compared with the exercise-related fatigue group,the body mass and heart mass of the rats reduced in the exercise-related fatigue with resveratrol supplement group(P＜0.05).Compared with the blank control group,the levels of creatine kinase isoenzyme,cardiac troponin 1 and uncoupling protein 1 increased(P＜0.01),and the level of pyruvate dehydrogenase decreased(P＜0.01)in the exercise-related fatigue group.Compared with the exercise-related fatigue group,the levels of creatine kinase isoenzyme,myocardial troponin 1 and uncoupling protein 1 decreased(P＜0.05),and the level of pyruvate dehydrogenase increased(P＜0.05)in the exercise-related fatigue with resveratrol supplement group.Compared with the blank control group,the expression of the Foxp1 gene decreased(P＜0.01),and the expression of transforming growth factor β1 and endothelin 1 gene increased(P＜0.01)in the myocardium of the exercise-related fatigue group.Compared with the exercise-related fatigue group,the expression of the Foxp1 gene in the myocardium of the exercise-related fatigue with resveratrol supplement group increased(P＜0.01),while the expression of the transforming growth factor β1 and endothelin 1 gene decreased(P＜0.05).It is suggested that exercise-induced fatigue can promote myocardial adaptability and cause compensatory hypertrophy.Resveratrol can improve myocardial injury and energy metabolism and delay ventricular energy remodeling in rats.This effect may be related to the regulation of Foxp1/transforming growth factor β1/endothelin 1 signaling pathway.

Objective: Metastases in the supragastric lesser sac (SGLS) are not only occult but are also barriers to complete resection of ovarian cancer. We describe a cohort of patients with SGLS disease undergoing debulking surgery. Methods: We identified all patients who underwent evaluation and eventual resection of SGLS disease as part of cytoreductive surgery for stage IIIC–IVB high-grade epithelial ovarian cancer at our institution from January 2018 to August 2022. Results: Thirty-three of 286 patients (11.5%) underwent resection of SGLS disease.Metastases in the SGLS were identified by preoperative imaging in 4 of 33 patients (12.1%). The median peritoneal cancer index score was 22 (range, 9–33). Through surgical exploration, metastases were frequently seen in the right diaphragm (100%), hepatorenal recess (97%), lesser omentum (81.8%), left diaphragm (78.8%), supracolic omentum (75.8%), anterior transverse mesocolon (72.7%), splenic hilum (63.6%), ligamentum teres hepatis (60.6%), and gallbladder fossa (51.5%). The lesser omentum was normal in 6 of 33 (18.2%) patients, despite metastases within the SGLS. A total of 54.5% of patients underwent complex surgery (surgical complexity scores; median, 8; range, 3–14). Complete resections were achieved in 19 (57.6%) patients. No complications were related to the resection of SGLS disease. The median length of progression-free survival was 24.8 months (95% confidence interval=16.6–32.9). Conclusion Metastases to the SGLS are not uncommon in advanced ovarian cancer, particularly those with widely disseminated disease. Disease in this recess is rarely identified by preoperative imaging and deserves systematic surgical exploration to attain complete cytoreduction.

Objective: Metastases in the supragastric lesser sac (SGLS) are not only occult but are also barriers to complete resection of ovarian cancer. We describe a cohort of patients with SGLS disease undergoing debulking surgery. Methods: We identified all patients who underwent evaluation and eventual resection of SGLS disease as part of cytoreductive surgery for stage IIIC–IVB high-grade epithelial ovarian cancer at our institution from January 2018 to August 2022. Results: Thirty-three of 286 patients (11.5%) underwent resection of SGLS disease.Metastases in the SGLS were identified by preoperative imaging in 4 of 33 patients (12.1%). The median peritoneal cancer index score was 22 (range, 9–33). Through surgical exploration, metastases were frequently seen in the right diaphragm (100%), hepatorenal recess (97%), lesser omentum (81.8%), left diaphragm (78.8%), supracolic omentum (75.8%), anterior transverse mesocolon (72.7%), splenic hilum (63.6%), ligamentum teres hepatis (60.6%), and gallbladder fossa (51.5%). The lesser omentum was normal in 6 of 33 (18.2%) patients, despite metastases within the SGLS. A total of 54.5% of patients underwent complex surgery (surgical complexity scores; median, 8; range, 3–14). Complete resections were achieved in 19 (57.6%) patients. No complications were related to the resection of SGLS disease. The median length of progression-free survival was 24.8 months (95% confidence interval=16.6–32.9). Conclusion Metastases to the SGLS are not uncommon in advanced ovarian cancer, particularly those with widely disseminated disease. Disease in this recess is rarely identified by preoperative imaging and deserves systematic surgical exploration to attain complete cytoreduction.

Objective: Metastases in the supragastric lesser sac (SGLS) are not only occult but are also barriers to complete resection of ovarian cancer. We describe a cohort of patients with SGLS disease undergoing debulking surgery. Methods: We identified all patients who underwent evaluation and eventual resection of SGLS disease as part of cytoreductive surgery for stage IIIC–IVB high-grade epithelial ovarian cancer at our institution from January 2018 to August 2022. Results: Thirty-three of 286 patients (11.5%) underwent resection of SGLS disease.Metastases in the SGLS were identified by preoperative imaging in 4 of 33 patients (12.1%). The median peritoneal cancer index score was 22 (range, 9–33). Through surgical exploration, metastases were frequently seen in the right diaphragm (100%), hepatorenal recess (97%), lesser omentum (81.8%), left diaphragm (78.8%), supracolic omentum (75.8%), anterior transverse mesocolon (72.7%), splenic hilum (63.6%), ligamentum teres hepatis (60.6%), and gallbladder fossa (51.5%). The lesser omentum was normal in 6 of 33 (18.2%) patients, despite metastases within the SGLS. A total of 54.5% of patients underwent complex surgery (surgical complexity scores; median, 8; range, 3–14). Complete resections were achieved in 19 (57.6%) patients. No complications were related to the resection of SGLS disease. The median length of progression-free survival was 24.8 months (95% confidence interval=16.6–32.9). Conclusion Metastases to the SGLS are not uncommon in advanced ovarian cancer, particularly those with widely disseminated disease. Disease in this recess is rarely identified by preoperative imaging and deserves systematic surgical exploration to attain complete cytoreduction.