Objective To investigate efficacy and effect on liver function of the experimental therapy with balloon catheter to block the main artery temporarily and then pressurize chemoembolization to treat hypovascular liver cancer. Methods Eighty patients with hypovascular liver cancer requiring interventional therapy were randomly divided into two groups.The experimental group was treated with the new therapy and the control group was treated with traditional therapy. The lipiodol-filling status and maximum diameter of the tumor was analyzed for a midterm outcome,and the change of AFP and liver function were evaluated.Mann-Whitney test was used for data between two groups,Friedman test was used for data of each group,and Spearman nonparameter relevant analysis was used for efficacy indexes.Results ( 1 ) All Patients have confirmed diagnosis of hypocvascular liver cancer and got balanced baseline. ( 2 ) Lipiodol-filling status:the clinical efficacy and benefit rates of patients from experimental group were higher than that from control group and showed statistically significant difference in 1,3,12 months (Z =-2.135,- 2.939,- 2.686 ; P =0.034,0.004,0.007 ),but no statistically significant difference in 6 month ( Z =- 1.170,P =0.242 ).The status of lipiodol-filling of experimental group ( x2 =2.593,P =0.459 ) was more stable than control group ( x2 =10.886,P =0.012).(3) Maximum diameter of the tumor:the clinical efficacy and benefit rates of patients from experimental group were higher than that from control group and showed statistically significant difference in 3,12 months ( Z =- 2.734,- 2.733 ; P =0.006,0.006),but no statistically significant difference in 1,6 month ( Z =- 1.692,- 1.895 ;P =0.091,0.058). But neither of two groups showed statistically significant difference in change of maximum diameter of the tumor ( x2 =5.500,P =0.139 ; x2 =6.509,P =0.089 ).Relation between lipiodol-filling and maximum diameter showed positive correlation in 3 month ( r =0.257,P =0.035 ). (4) Stratified analysis was used for data of AFP according to AFP value before therapy,and two groups showed no statistically significant difference for patients belonging to 20-1000 μg/L by Pearson Chi-square test. (5)Two groups showed no statistically significant difference for data of liver function before therapy and in 1,3,6months ( Z =- 1.073,- 1.314,-0.518,-0.549;P=0.308,0.189,0.604,0.583).Conclusions According to the midterm result of this experiment,the experimental therapy increased lipiodol-filling and decreased maximum diameter of the tumor significantly in 3 and 12 months correspondingly,but no significant difference was observed in AFP and liver function between groups yet. So the long-term efficacy and its influence to lung metastasis and survival rate need further research.

Objective Evaluation of the effect of manual reduction with small external fixation on the treatment of elderly Barton fractures.Methods A total of 244 elderly patients with Barton fractures were divided into conservative group (n=126) and operation group (n=118) according to random number table. The conservative group was treated by with manual reduction with small external fixation, and the operation group was treated with open reduction and internal fixation. The complications of the patients, the time of fracture healing, hospitalization time and treatment cost were recorded.The wrist function was evaluated by PRWE wrist score system and Wrightington wrist function score system.The clinical efficacy was evaluated by Gartland-Werley Colles fracture evaluation method.Results The excellent and good effect rate was 91.3% (115/126) in the conservative group and 97.5% (115/118) in the operation group. There was no significant difference between the two groups(χ2=0.857,P=0.354). One year, 6 months, 3 months and 6 weeks after treatment, in the conservative group, the PRWE score (10.4 ± 7.9, 19.1 ± 8.0, 40.5 ± 7.8, 55.7 ± 8.1vs. 80.8 ± 8.2,F=113.665), wrightington score (8.2 ± 3.7, 13.2 ± 4.0, 21.4 ± 3.9, 26.3 ± 4.2vs. 30.1 ± 4.2,F=121.348) were significantly lower than those before treatment (P<0.01). And in the operation group, the PRWE score (10.2 ± 7.8, 15.0 ± 8.0, 26.5 ± 8.0, 44.7 ± 8.2vs. 79.6 ± 8.6,F=81.411), Wrightington score (8.1 ± 3.8, 12.1 ± 4.0, 16.5 ± 4.0, 20.6 ± 4.3vs. 29.8 ± 4.6,F=69.113) were significantly lower than those before treatment (P<0.01). But there was no significant difference in PRWE score and Wrightington scores between the two groups after treatment (t=0.149, 0.104,P=0.881, 0.917, respectively). In the conservative group, the hospitalization time (5.28 ± 2.10 dvs. 12.8 ± 2.21d,t=25.260) was significantly shorter than that of the control group (P<0.01), and the treatment cost (3.26 ± 0.93 thousandvs. 28.66 ± 1.04 thousand,t=200.369) was significantly lower than that in the control group (P<0.01). The overall incidence of complication was 8.7% (11/126) in the conservative group and 17.8% in the surgery group (21/118). There was significant difference between the two groups(χ2=4.396,P=0.036).Conclusions The manual reduction with small splint external fixation was simple, low cost, small trauma, short hospitalization time, and less complications.

Objective To observe the effect of Chinese herbal fumigation combined with CPM promote the function recovery after Postoperative Patellar Fracture. Methods Eighty patients with patellar fracture were randomly divided into treatment group (40 cases) and control group (40 cases). The control group was treated with CPM. The treatment group was treated with Chinese Herbal Fumigation and CPM. After 8th weeks, the clinical curative effect, knee range of motion and KSS knee score were observed and compared. Results The effect rate of the treatment group was 87.5% (35/40), and the control group was 65.0% (26/40). The difference was statistically significant (χ2=5.591, P<0.01). After treatment, the range of motion of knee joint (138.38°± 7.82°vs. 0.29°± 7.83°, t=10.338), KSS knee function score (88.38 ± 9.52 vs. 3.46 ± 9.36, t=2.330) of the treatment group were higher than those in the control group (P<0.01 or P<0.05). Conclusions The Chinese medicine fumigation combined with CPM functional exercise could accelerate the recovery of knee function and reduce the complications of fracture after patellar fracture.

Objective To determine the half-effective target effect-site concentration (Ce) (EC50) of sufentanil required to inhibit the body movement during insertion of ureteroscopes when combined with propofol in patients undergoing transureteroscopic holmium laser lithotripsy. Methods Fifty ASA Ⅰ or Ⅱ patients of both sexes, aged 20-60 yr, BMI ＜ 30 kg/m2 , undergoing transureteroscopic holmium laser lithotripsy were randomly divided into 5 groups according to the different C es of sufentanil ( n = 10 each): group S1 (Ce 0.21 ng/ml), group S2(Ce 0.14 ng/ml), group S3(Ce 0.09 ng/ml), group S4(Ce 0.06 ng/ml), group S5(Ce 0.04 ng/ml). TCI of propofol with target plasma concentration set at 2.5-3.0 μg/ml was given. Sufentanil with the corresponding Ce was infused in each group. The ureteroscopes were inserted as soon as the patients lost consciousness and the effect-site concentration of sunfentanil was achieved. The response was defined as positive when body movement occurred within 1 min after insertion of ureteroscopes. The EC50 of sufentanil required to inhibit the body movement during insertion of ureteroscopes when combined with propofol and 95% confidence interval (CI) were calculated. Results The EC50 of sufentanil required to inhibit the body movement during insertion of ureteroscopes when combined with propofol was 0.084 ng/ml and 95% CI was 0.066-0.107 ng/ml. Conclusion The EC50 of sufentanil required to inhibit the body movement during insertion of ureteroscopes was 0.084 ng/ml when combined with propofol.

Objective To investigate the application value of MRS in temporal lobe epilepsy (TLE) without hippocampal sclerosis.Methods A retrospective study was conducted in 23 unilateral TLE patients (TLE group) with absence of hippocampal sclerosis and 20 age-matched normal control subjects (control group).All of them underwent conventional MRI and MRS.N-acetyl aspartate (NAA)/creatine (Cr),choline (Cho)/Cr ratios of bilateral hippocampus in 2 groups were analyzed.Eleven of 23 patients underwent surgical treatment,pathological findings and surgical outcomes were evaluated.Results The NAA/Cr ratios of ipsilateral hippocampus significantly decreased compared with that in the contralateral hippocampus (t=-7.97,P＜0.001) and the control group (t=-9.96,P＜0.001).There was no significant difference between the contralateral hippocampus in patients and the control group (t=-1.21,P=0.12).The Cho/Cr ratios of ipsilateral hippocampus in TLE had no significant difference compared with contralateral hippocampus (t=0.50,P=0.31) and the control group (t=-0.59,P=0.28).The pathological findings of the 11 patients who underwent temporal lobe resection indicated small amounts of neuronal loss and unobvious gliosis.Conclusion MRS is helpful in clinical practice to lateralize and localize the epileptogenic foci in the absence of hippocampal sclerosis in patients with TLE.

Objective:To prepare for mAb of progesterone receptor. It would provide support for the immunohistochemistry behind. Methods:Target gene connected together with a carrier by seamless cloning method. The target protein that expression by inducing was collected. And with cell fusion method , the monoclonal antibodies were preparation. Then the mAb were detected by IHC. Results: The mAb ( clone 7C7 ) was detected and it found positive for the breast, uterine fibroid tissue, showed negative in colorectal cancer tissue, smooth muscle tissue, the goal of the claim were achieve. Conclusion: Finally, we found the method that prepare for mAb was far beyond our imagination. The result of IHC on different samples about mAb(7C7)obtained compliance with an-ticipation. Study on the difference between the PR-A and PR-B had significance.

Objective To observe the short-term,long-term clinical results and complications in refractory juvenile idiopathic arthritis (JIA) treating with TNF-α inhibitors,and to compare 2 evaluation systems.Methods A retrospective review of 52 cases of patients with refractory JIA in Shenzhen Children's Hospital was performed.With reference to International Leagne of Associations for Rheumatology(ILAR)2001 diagnostic criteria,the patients were divided into 4 groups:26 polyarticular JIA patients,14 systemic JIA patients,9 oligoarticular JIA patients and 3 other types of patients.The children with JIA were based on the conventional treatment such as Methotrexate,combination of TNF-α inhibitors treatment.The short-term and long-term clinical outcomes were evaluated and compared with American College of Rheumatology (ACR) and Juvenile Arthritis Disease Activity Score (JADAS).Complications in each group were recorded.Results (1) Short-term outcome assessment:ACR 50 were achieved in 69.2％ of the polyarticular JIA,66.7％ in oligoarticular and 35.7％ in systemic JIA patients on the third month;and by the time of the sixth month it reached to 73.0％ in polyarticular JIA,77.7％ in oligoarticular JIA and 14.3％ in systemic JIA patients on the sixth month.Significant improvement of JADAS after the treatment was observed in each type of JIA,and the differences were statistically significant(all P ＜ 0.05).(2) Long-term outcome assessment:except for the cases missing follow-ups and withdrawal cases,46 patients were able to complete 2 years assessments:according to ACR,effective rate was 84.0％ in polyarticular JIA (21/25 cases),50.0％ in oligoarticular JIA (4/8 cases) and 7.7％ in systemic (1/13 cases) JIA patients;JADAS was significantly decreased in polyarticular JIA patients (76.0％,19/25cases) (P ＜ 0.05),while significant improvement was not observed in oligoarticular JIA and systemic JIA patients(P ＞ 0.05).(3) Complications of upper respiratory tract infection (23.0％,12 cases) and local reaction in injection site (7.6％,4 cases) were noticed.Higher risks of tuberculosis infection and malignancy were not observed.Conclusions (1) TNF-α inhibitors treatment showed a better short-term and long-term outcome in polyarticular and oligoarticular JIA patients,and it may also improve short-term outcome in systemic JIA but with poorer long-term outcome.(2)Two evaluated systems (ACR and JADAS) were well relative,but ACR was capable to compare clinical course between different types of JIA.(3) TNF-α inhibitors treatment was relatively safe with unremarkable adverse reactions.

OBJECTIVETo investigate the cause and the management of treatment and prevention of reoperation following esophagectomy.

METHODSClinical data of 946 cases with esophageal cancer undergoing esophagectomy from January 2000 to December 2012 by the same surgical team in the Beijing Cancer Hospital were retrospectively analyzed. Among them, 19 patients underwent reoperation after esophagectomy because of serious complications. Clinical features and treatment course of these 19 cases were summarized.

RESULTSThe indications and procedures of reoperation included thoracotomy for hemorrhage (n=4), diaphragmatic hernia repair (n=4), thoracic duct ligation for chylothorax (n= 4), re-suturing for incision dehiscence (n=4), re-laparotomy and re-thoracotomy for drainage of traumatic pancreatitis (n=1), re-laparotomy for intestinal obstruction (n=1), and tracheotomy for bilateral recurrent laryngeal nerve paralysis (n=1). All the 19 patients were successfully cured without perioperative deaths and further complications.

CONCLUSIONSThe indications of reoperation following esophagectomy include postoperative bleeding, diaphragmatic hernia, chylothorax and abdominal incision dehiscence.

Adult ; Aged ; Aged, 80 and over ; Esophageal Neoplasms ; surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Reoperation ; Retrospective Studies

Objective: To discuss the effect and safety of continuous pumping for home enteral nutrition after esophagectomy. Methods: The current study retrospectively analyzed the esophageal cancer patients who underwent transthoracic esophagectomy between January 2017 and November 2017 at First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute. There were totally 108 cases, including 88 males and 20 females, with an average age of 62 years. The patients were divided into pump feeding group (n=56) and traditional tube feeding group (n=52). The postoperative short-term safety, weight maintenance, enteral nutrition tolerance and nutritional support complete rate of the 2 groups were compared by χ² test, Fisher exact test and t test, respectively. Results: Compared with traditional tube feeding group, the patient safety in pumping feeding group was significantly better, with complications within 2 months after discharge were 11/52 and 4/56 respectively (χ²=2.393, P=0.035); the weight maintenance was significantly better, the weight loss within 4 weeks after discharge were 3.90 kg and 0.13 kg, respectively (t=7.720, P=0.000); the general enteral complications were significantly lower (26/52 vs. 5/56, χ²=22.225, P=0.000), the nutritional support complete rate was significantly higher (23/52 vs. 55/56, χ²=39.167, P=0.000). Conclusions Continuous pump feeding enteral nutrition support after discharge postoperatively could help improve patient safety after discharge, which is better for weight maintenance of the patients. Pump feeding could also enhance tolerability of tube feeding and ensure the effective accomplishment of nutritional support.

OBJECTIVETo summarize the mortality of esophagectomy in our series and compare the different mortalities based on 30-day deaths and 90-day deaths postoperatively.

METHODSA total of 954 patients undergoing esophagectomy by single-surgeon-team between January 2000 and December 2012 from our prospective database were enrolled. The mortalities based on 30-day and 90-day deaths postoperatively were compared, and the causes of deaths within 30 days and 90 days were analyzed.

RESULTSAmong all these 954 patients, a total of 20 postoperative deaths(2.1%) were observed: 11 within 30 days(1.1%) and 9 between 30 and 90 days after surgery(1.0%). The reasons for deaths within 30 days were as follows: 3 for respiratory failure related to anastomotic leakage,1 for bleeding after stenting due to anastomotic fistula, 1 for sepsis, 3 for respiratory failure from presenting preoperative respiratory morbidities, 2 for cardiac arrest caused by preoperative heart disorder, and 1 for multiple organ failure caused by early adjuvant chemotoxicity. The reasons for deaths between 30 and 90 days were as follows: 1 for respiratory failure related to anastomotic leakage, 1 for cardiac arrest from preoperative heart disorder, 1 for cerebrovascular accident, 1 for liver failure from liver cirrhosis presenting preoperatively, 1 for renal failure after operation, 1 for tumor progression and 2 for unknown reasons.

CONCLUSIONSince postoperative mortality calculated based on 30 days deaths postoperatively may underestimate the risk of esophagectomy, mortality calculated based on 90 days may be a better option.

Anastomotic Leak ; Cause of Death ; Esophageal Neoplasms ; surgery ; Esophagectomy ; mortality ; Humans ; Postoperative Period ; Prospective Studies ; Risk Factors ; Stents