Objective To evaluate the combination treatment effects of bisoprolol,perindopril and spirono-lactone on chronic cardiac failure caused by rheumatic heart disease.Methods 92 patients were randomly divided into the control group (n=45) and observation group (n=47).The observation group received combination usage of bisoprolol,perindopril and spironolactone,while the control group was given regular treatment.Cardiac functions were measured in both two groups.Results The left ventricular end diastolic diameter ( LVEDD) and left ventricular end systolic diameter (LVESD) were significantly decreased in the observation group(t=4.217,5.842,P<0.05),while left ventricular ejection fraction (LVEF) was significantly increased compared with the control group (t=3.164,P<0.05).Conclusion The combination treatment effects of bisoprolol,perindopril and spironolactone has the privilege effects on chronic cardiac failure caused by rheumatic heart disease,which mainly improves cardiac remodeling.

Objective To explore the protective measure and the complication of laparoscopic common bile duct primary closure surgery with self-releasing single-J tube. Methods The clinical data of 35 choledocholithiasis patients having underwent selective operation were retrospectively analyzed from January 2009 to November 2014. The operation was laparoscopic choledocholithotomy, a self-releasing single J-tube was placed in the common bile duct, and the common bile duct was primary closure. The postoperative complication was observed. Results All the patients were operated under laparoscope. The operative time was (120 ± 15) min, and the intraoperative bleeding was (50 ± 15) ml. The levels of diastase was normal or increased slightly 1 d after operation. There were no postoperative bile leakage, bleeding and incision infection. The diet was recovered 2-4 d after operation. Postoperative abdominal X-ray result showed that single-J tube position was good. Two-three weeks after operation, the single-J tube was discharged from the intestinal tract, without intestinal obstruction. The length of stay was (9.3 ± 1.8) d. Open operation with T tube drainage was performed in one case with the complication of stone residue and stenosis of common bile duct. Conclusions In laparoscopic common bile duct primary closure surgery, self-releasing single-J tube can provide security guarantees in patients with choledocholithiasis. Although there are some complications, it has less trauma and quicker recovery, and deserves further popularization and application.

Objective To evaluate the safety of laparoscopic cholecystectomy (LC) for patients with hepatic cirrhosis. Methods We retrospectively analyzed the clinical data of 72 patients with hepatic cirrhosis (Child-Pugh’s grads A or B). The patients received LC between July 2002 and March 2007. Under general anesthesia, the operation was preformed with four trocars and an intra-abdominal pressure of 8 to 12 mm Hg. Results LC was completed in 71 of the patients (antegrade in 67 and retrograde in 4), 6 of them received subtotal cholecystectomy. One patient was converted to open procedure because of dense adhesion at the Calot triangle. The operation time was 35 to 105 minutes (mean, 51 minutes); blood loss ranged from 5 to 60 ml with a mean of 12 ml. The patients were discharged 3 to 11 days (mean, 5.6 days) after the operation and were followed up for 3 to 18 months (mean, 12 months). After the operation, 7 patients developed ascites, and 1 had hemorrhage at the puncture site. During the follow-up, all patients were free of biliary symptoms, no residual or recurrent liver stone was found. Conclusions LC is safe for patients with liver cirrhosis, and should be the first choice for Child-Pugh’s grads A or B patients. Proper preoperative preparation and intra-and postoperative treatments are critical for the surgical outcomes.

Objective To study the effect of postoperative anticoagulant therapy after splenectomy in patients with cirrhosis and portal hypertension.Methods One hundred and forty patients with cirrhosis and portal hypertension receiving splenectomy and periesophagastric devascularization were divided into anticoagulant group (76 cases) and control group (64 cases) by random number table,patients in anticoagulant group received postoperative anticoagulant therapy,principally according to the platelet count,gave ligustrazine,aspirin,low molecular heparin after operation; patients in control group without postoperative anticoagulant therapy.Postoperative monitoring platelet count and D-dimer,ultrasound or CT check the presence of portal vein thrombosis.Results Platelet count,D-dimer levels in anticoagulant group and control group in 2 days after operation were significantly increased,the difference was significant compared with preoperative [anticoagulant group:(95.73 ± 28.06) × 109/L vs.(38.41 ± 11.96) × 109/L,(3.61 ± 0.18) mg/L vs.(0.42 ± 0.09) mg/L;control group:(92.56 ± 27.75) × 109/L vs.(35.13 ± 11.38) × 109/L,(3.26 ± 0.16) mg/L vs.(0.37 ± 0.09) mg/L,P ＜ 0.05].Platelet count and D-dimer levels between two groups at preoperative and postoperative in 2 days had no statistical significance (P ＞ 0.05).Ten cases of control group occurred postoperative portal vein thrombosis,anticoagulant group were 3 cases,portal vein thrombosis incidence of anticoagulant group [3.95％ (3/76)] compared with control group [15.62％(10/64)] was statistically significant (P ＜ 0.05).Conclusion Postoperative anticoagulant therapy after splenectomy in patients with cirrhosis and portal hypertension is an effective method to prevent portal vein thrombosis.

OBJECTIVETo explore the feasibility of laparoscopic-assisted natural orifice specimen extraction radical left colectomy.

METHODSRetrospective analysis was performed on clinicopathological dada of 15 colorectal patients who were treated by laparoscopic-assisted anal specimen extraction radical left colectomy with self-developed surgical instrument Cai tube between January and September in 2014. Tumor location included descending colon (n=3), the junction of descending colon and sigmoid colon (n=2), the sigmoid colon (n=6) and upper rectum (n=4). Clinical efficacy of patients was observed.

RESULTSThere were no perioperative deaths or postoperative complications, such as anastomotic bleeding or leakage. The median operation time was 257 (range 103-337) min, median blood loss was 50(range 20-200) ml, median time to first flatus was 3 (range 1-5) d and median hospital stay was 14 (range 11-21) d. All the patients had good quality of life and normal defecation function without tumor recurrence or metastasis after 1-8 months of follow-up.

CONCLUSIONLaparoscopic-assisted anal specimen extraction radical left colectomy is safe and feasible.

Colectomy ; Colon, Sigmoid ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Postoperative Complications ; Quality of Life ; Rectum ; Retrospective Studies

The morbidity and mortality of stroke caused by large vessel occlusion are high,and its outcome is closely associated with emergency treatment.In order to receive treatment within the time window,the effective prehospital assessment is very important.The prehospital stroke scale simplifies emergency screening and assessment of such patients.Although the predictive value is good,its role remains controversial.This article reviews some of the prehospital stroke scales used to identify large vessel occlusions and analyzed the characteristics of different scales.

Objective:To investigate the regression of regional lymph nodes after administering neoadjuvant short-course chemoradiother-apy combined with immunotherapy in patients with locally advanced rectal cancer(LARC).Methods:This retrospective study analyzed the clinical data of 40 patients with LARC admitted to Zhongshan Hospital Affiliated to Xiamen University(32 cases)and the Union Hospital,Tongji Medical College,Huazhong University of Science and Technology(8 cases)between January 2021 and December 2022.The control and experimental groups consisted of 20 patients who underwent direct laparoscopic surgery and neoadjuvant short-course chemoradio-therapy combined with immunotherapy prior to the laparoscopic surgery,respectively.The detection of the postoperative lymph node was compared between the two groups.In addition,the pathologic complete response(pCR)rate of the primary tumor and regional lymph nodes in the experimental group was assessed.Results:The number of patients with N downstaging(18 vs.7,P<0.001)significantly in-creased,whereas the positive lymph node metastasis rate(1.4%vs.19.1%,P<0.001)and number of patients with positive lymph nodes(4 vs.16,P<0.001)significantly decreased in the experimental group compared to those in the control group.Although the number of detected lymph nodes in the experimental group was slightly lower compared to that in the control group(18.3±8.7 vs.20.4±6.5,P=0.392),it was not statistically different.Furthermore,the pCR rate of the regional lymph nodes was significantly higher than that of the primary tumor in the experimental group(80%vs.30%,P=0.001).Conclusions:Neoadjuvant short-course chemoradiotherapy combined with immunotherapy caused significant pathological remission of positive lymph nodes in patients with LARC.This study hypothesizes that a"spatial effect"con-tributes to the pathological remission of regional lymph nodes in rectal tumors.