Objective This study describes the protective effect of myocardial isehemic post- conditioning on ischemic-reperfused myocardium (I/ R) of diabetic rat and its Signaling mechanism. Methods Healthy SD rats weighing 25O-30Og were divided into 6 groups; (1) Blank control; (2) Ischemia-reperfusion; (3) Post conditioning; (4) Diabetic postconditioning ; (5) Diabetic ischemia-reperfusion; ( 6) Diabetic blank control group. Ten rats in each group were randomly selected. Introduction of diabetic rat model: 65 mg/kg STZ was injected into the intraperitoneal cavity, until 2 consecutive blood glucose measurements≥ 16.65 mmol/L were reached after48h. The diabetic model was successful when rats had following symptoms, such as more drinking, more eating, polyuria, weight loss and epilation. Langendorff isolated rat heart perfusion was used for the experiment. Following parameters were measured and compared: Coronary perfusion flow, myocardial infarct size, western blot for measurement of P-Akt, changes in myocardium and mitochondrian observed by Electron microscopy. Results Blood glucose concentration in diabetic group was (23. 15±2. 16) mmol/L and (4. 16±0. 31) mmol/L in non-diabetic group. There was a significant difference (P <0. 01) between the two groups. There were more coronary flow in post-conditioning groups (Post group and Dpost group) than ischemia-reperfusion groups (IR group and DIR group) (6.5±1.2、5.6±1.0 vs. 3.4±1.0、2.0±1.3). The myocardial infarction size was smaller in post-conditioning groups than in ischemia-reperfusion groups (25.2±2.1、34.2±3.6 vs. 47.5±3.5 、65.2±4.5). There was more expression of P-Akt and the myocardial fibers and mitochondrian in post-conditioning groups were better preserved. Conclusion Postconditioning has protective effects in diabetic rat hearts. The mechanism may be associated with Akt activation.

Objective To investigate the protective effect of the myocaidial ischemic postconditioning on ischemic-reperfused myocardium of rat and its signaling mechanism.Methods Healthy SD rats weighing 250 to 300 g were divided into blank control(N) group,ischemiareperfusion(IR) group and postconditioning(Post) group.We measured heart coronary perfusion flow and myocardial infarct size of the rats in each group.The expression of phosphorylated protein kinase B(P-Akt) was detected by Western blot.The morphological changes of myocardial fibers and mitochondrial were observed under the transmission electron microscopy.Results More coronary flow and less myocardial infarction were found in Post group than those in IR group.The expression level of P-Akt was higher in Post group.The integrity of myocardial fibers and mitochondrial was better in Post group than IR group.Conclusion Postconditioning had a protective effect for the ischemic isolated rat heart.Akt activation might play an important role in its mechinism.

AIM: To observe the tear film changes after phacoemulsification combined with intraocular lens implantation in age - related cataract patients and to compare the therapeutic effect of hydroxyl-glucoside and sodium hyaluronate on the postoperative dry eye.
METHODS:A total of 49 patients ( 70 eyes ) with age-related cataract suffering from dry eye after phacoemulsification combined with IOL implantation were divided into treatment group 1 ( group A, 23 eyes with conventional therapy and hydroxyl - glucoside at 7d postoperatively) , treatment group 2 ( group B, 22 eyes with conventional therapy and sodium hyaluronate at 7d postoperatively) and control group ( group C, 25 eyes with conventional therapy only ) . Questionnaire score of dry eye symptoms, SchirmerⅠtest ( SⅠt) , tearfilm break up time ( BUT ) and corneal fluoresce in staining ( CFS ) were measured at 2d preoperatively and 7, 14, 30, 90d postoperatively.
RESULTS: No statistical differences existed among the three groups of preoperative 2d ( P > 0. 05 ). At 2d preoperatively and 90d postoperatively, the results of questionnaire score of dry eye symptoms, SⅠt, BUT, and CFS displayed no statistical differences in the patients of three groups (P>0. 05). While there was statistical significance among preoperatively and 7, 14, 30d postoperatively of the three groups (P<0. 05). At 14, 30d postoperatively, the questionnaire score of dry eye symptoms, SⅠt, BUT, CFS in group A and B were better than in group C, which displayed statistical differences ( P<0. 05). At 30d postoperatively the questionnaire score of dry eye symptoms , SⅠt, BUT in group B were better than in group A, which displayed statistical differences ( P<0. 05).
CONCLUSION: At the early stage after phacoemulsification combined with IOL implantation, the tear film stability is decreased, which may promote eyesymptoms. Management with hydroxyl-glucoside or sodium hyaluronate plays a role in relief of the structure and stability of the tear film and improves dry eye symptoms, while sodium hyaluronate eye drops is more effective.

Gastrectomy ; Humans ; Laparoscopy ; Stomach Neoplasms/surgery*

OBJECTIVE: Vertebral compression fractures (VCFs) are common complications of osteoporosis. The expansion of VCFs with a Sky Bone Expander is a new procedure which improves kyphotic deformities and decreases pain associated with VCFs. The purpose of this study was to investigate the preliminary results for the treatment of painful osteoporotic VCFs with a Sky Bone Expander. MATERIALS AND METHODS: Twenty-six patients with pain-causing VCFs were treated with a Sky Bone Expander. This operation involved the percutaneous insertion of the Sky Bone Expander into a fractured vertebral body transpedicularly. Following the expansion, the Sky Bone Expander was contracted and removed, resulting in a cavity to be filled with bone cement. All fractures were analyzed for improvement in sagittal alignment. Clinical complications, pain relief and ambulation status were evaluated 1 day, 1 week, 1 month, and 3 months after the operation. RESULTS: Twenty-four hours after the operation, all the patients treated experienced some degree of pain relief. In addition, no postoperative neurologic complications were noted. The average operative time was 42.4 +/- 15.5 min per vertebra. Moreover, an average cement volume of 3.5 mL (range, 2.5 +/- 5.0 mL) was injected per vertebra. The average anterior height was 18.4 +/- 5.1 mm preoperatively and 20.5 +/- 5.3 mm postoperatively (p < 0.01). Furthermore, the average midline height was 15.5 +/- 5.2 mm preoperatively and 18.9 +/- 4.0 mm postoperatively (p < 0.01). The Cobb angle improved from 18.5 +/- 8.2 degrees preoperatively to 9.2 +/- 4.0 degrees postoperatively (p < 0.01). The Visual Anabog Scale scores decreased from 7.7 +/- 1.8 points preoperatively to 3.1 +/- 2.0, 2.9 +/- 1.7, 2.6 +/- 1.5 and 2.9 +/- 11.3 after 1 day, 1 week, 1 month and 3 months after the operation, respectively. Cement extrusion was observed in four patients without any neurologic symptoms. CONCLUSION: As a result of this study, we can postulate that the expansion of compressed vetrebra with a Sky Bone Expander is a safe and minimally invasive procedure resulting in the restoration of vertebral body height and the relief of pain associated with VCFs.
Aged ; Aged, 80 and over ; Bone Cements ; Female ; Fractures, Compression/etiology/radiography/*surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Osteoporosis/*complications ; Pain/etiology/*surgery ; Postoperative Complications ; Prospective Studies ; Radiography, Thoracic ; Spinal Fractures/etiology/radiography/*surgery ; *Tissue Expansion Devices ; Treatment Outcome

Adult ; Female ; Follow-Up Studies ; Hepatitis B Surface Antigens ; blood ; Humans ; Liver Transplantation ; Male ; Middle Aged ; Tissue Donors

OBJECTIVETo describe the experience with surgical treatment of pituitary adenomas via a fully transnasal endoscopic approach.

METHODSClinical records of 375 cases with pituitary adenomas underwent pure endoscopic operations between December 2006 and December 2009 were carefully assembled. Among 375 pure endoscopic operations of pituitary adenomas, 201 cases were nonfunctional adenomas and 174 cases were functional adenomas. There were 27 giant pituitary adenomas (7.2%) and 41 pituitary adenoma invaded cavernous sinus (10.9%). Intraoperative 1.5 T MRI and neuro-navigation system were used during some operations. The postoperative and follow-up data of patients were analyzed.

RESULTSThere were 234 (79.3%) cases of total resection, 56 (19.0%) cases of subtotal resection, 5 (1.7%) cases of partial resection. Sixty-eight patients had vision improved in 73 patients with vision decreasing before operation. Sixty-eight (77.3%) patients got normal endocrine in 88 hyper-prolactin patient. Fifty-five (84.1%) patients got normal growth hormone in 63 patients with somatotrophinomas. Eighteen (78.2%) patients got normal in 23 patients with corticotrophinoma. These was no death case in this group. One case (0.3%) suffered post-operative coma. Transient decreasing of vision occurred in 2 cases (0.5%). Transient palsy of oculomotor nerve or abducens nerve occurred in 7 cases of operations involved cavernous sinus. Three (0.8%) patients had cerebral meningitis. Two patients (0.5%) suffered from cerebrospinal fluid leak but none underwent operation to repair. Fourteen patients (3.7%) had transient diabetes insipidus. Six patients (1.6%) had nose bleeding.

CONCLUSIONSTrans-nasal endoscopy provides a new device for operation of pituitary adenomas which is effective and safe. Comparing with microscope, endoscopic visual field is clearer, closer and wider.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Hypophysectomy ; methods ; Male ; Middle Aged ; Nose ; surgery ; Pituitary Neoplasms ; surgery ; Retrospective Studies ; Sphenoid Sinus ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the emergency therapeutic effects of intertrochanteric fractures in elderly patients.

METHODSA retrospective study was designed. From March 2006 to March 2012, 254 patients with intertrochanteric fractures treated in Mianyang Central Hospital were reviewed. The patients with old fractures, pathological fractures, multiple trauma and severe medical comorbidities of admission were excluded. So 127 patients with intertrochanteric fractures over 70 years old were included in the study, including 38 males and 89 females, and the patients were divided into 2 groups: 56 patients underwent emergency operation within 24 h after injury (emergency operation group), 71 patients underwent an operation more than 24 h after injury (not emergency operation group). The following data were collected retrospectively for all patients: (1) in-hospitalcomplications, including electrolyte disturbance, hidden blood loss, delirium, deep vein thrombosis, upper gastrointestinal hemorrhage, pulmonary infection, urinary tract infection, cardiovascular and cerebrovascular disease, bedsore. (2) prognosis, ineluding in-hospital mortality, mortality in the 1st year, length of hospital stay, fracture healing times, hip score. Comparisons between the two groups were made using SPSS13.0. The quantitative data and categorical data were analyzed by t test and chi2 test, respectively.

RESULTSThe main medical complications in emergency operation group were hidden blood loss, delirium, pulmonary infection, electrolyte disturbances, urinary tract infections, and in not emergency operation group followed respectively by hidden blood loss, lung infection, electrolyte disturbances, delirium, and pulmonary infection. In-hospital mortality was zero, and 1 in the 1st year in emergency operation group; while in not emergency operation group were 4 and 7 respectively. An average length of hospital stay with (9 +/- 3) d in emergency operation group was lower than (17 +/- 8) d in not emergency operation group. Fracture healing time was (12 +/- 2) weeks in both groups. The significant variables with P < 0.05 between the two groups were electrolyte disorders, delirium, deep venous thrombosis, pulmonary infection, urinary tract infection, bedsore, in-hospital mortality, mortality in the 1st year, and length of hospital stay. The differences of hidden blood loss, upper gastrointestinal hemorrhage, cardiovascular and cerebrovascular disease, fracture healing times, hip score between the two groups had no significant differences (P > 0.05).

CONCLUSIONThe emergency surgery (within 24 h after injury) reduces length of hospital stay, and may also reduce complications and mortality.

Aged ; Aged, 80 and over ; Case-Control Studies ; Female ; Hip Fractures ; mortality ; surgery ; Humans ; Male ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome

Objective:To investigate the effect of neoadjuvant chemotherapy on the safety of laparoscopic D 2 radical resection and prognosis of patients with locally advanced gastric cancer. Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 351 patients with locally advanced gastric cancer who underwent laparos-copic D 2 radical resection in the Second Affiliated Hospital of Air Force Medical University from December 2016 to December 2021 were collected. There were 256 males and 95 females, aged (58±9)years. Of the 351 patients, 124 cases undergoing neoadjuvant chemotherapy were divided into the neoadjuvant chemotherapy group, 227 patients undergoing postoperative adjuvant chemotherapy were divided into the adjuvant chemotherapy group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) effect evaluation of neoadjuvant chemotherapy; (3) intraoperative and postoperative situations; (4) postoperative histopathological examinations; (5) follow-up. Propensity score matching was done by the 1∶1 nearest neighbor matching method. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measure-ment data with skewed distribution were represented as M(range) or M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. The Kaplan-Meier method was used to draw survival curves, and the Log-Rank test was used for survival analysis. Results:(1) Propensity score matching conditions and comparison of general data of patients between the two groups of patients after matching. Of 351 patients, 154 cases were successfully matched, including 77 cases in the neoadjuvant chemotherapy group and 77 cases in the adjuvant chemotherapy group. The elimination of gender, age, preoperative body mass index, clinical T staging and clinical N staging confounding bias ensured comparability between the two groups after propensity score matching. (2) Effect evaluation of neoadjuvant chemotherapy. Of the 77 patients receiving neoadjuvant chemotherapy, none of patient achieved complete response, 26 patients achieved partial response, 46 patients showed stable disease, 5 patients had progression of disease, showing the objective response rate as 33.8%(26/77) and the disease control rate as 93.5%(72/77). There were 15 males and 11 females sensitive to neoadjuvant chemotherapy, while 46 males and 5 females not sensitive, showing a significant difference between them ( χ2=11.05, P<0.05). (3) Intra-operative and postoperative situations. The operation time, volume of intraoperative blood loss, cases with intraoperative blood transfusion, time to postoperative first flatus, time to postoperative first liquid food intake, duration of postoperative hospital stay, cases with postoperative immediate complications, cost of hospital stay were (308±71)minutes, 100(range, 20?600)mL, 5, 3.0(range, 2.0?10.0)days, 4.0(range, 2.0?12.0)days, 9.0(range, 4.0?31.0)days, 7, 7.96(7.37,8.58) ten thousand yuan in patients of the neoadjuvant chemotherapy group, versus (296±67)minutes, 100(range, 20?500)mL, 4, 3.5(range, 1.0?14.0)days, 4.0(range, 2.0?15.0)days, 8.0(range, 5.0?45.0)days, 11, 8.18(7.52,9.19) ten thousand yuan in patients of the adjuvant chemotherapy group, showing no signifi-cant difference in the above indicators between the two groups ( t=1.13, Z=?0.37, χ2=0.12, Z=?1.26, ?0.33, ?0.70, χ2=1.01, Z=?1.04, P>0.05). (4) Postoperative histopathological examinations. Results of postoperative histopatho-logical examinations showed that all 154 patients achieving R 0 resection. Cases with pathological T staging as stage T1, stage T2, stage T3, stage T4, cases with pathological N staging as stage N0, stage N1, stage N2, stage N3, number of positive lymph nodes, cases with human epidermal growth factor receptor 2 (negative, positive) were 3, 7, 5, 62, 27, 19, 19, 12, 1(range, 0?28), 59, 18 in patients of the neoadjuvant chemotherapy group, versus 0, 0, 2, 75, 17, 15, 21, 24, 3(range, 0?31), 44, 33 in patients of the adjuvant chemotherapy group, showing significant differences in the above indicators between the two groups ( Z=?3.39, ?2.55, ?3.12, χ2=6.60, P<0.05). (5) Follow-up. Of the 154 patients, 143 patients were followed up for 37(range, 5?69)months. The 3-year overall survival rate and 3-year disease-free survival rate was 72.1% and 70.0%, respectively, in patients of the neoadjuvant chemotherapy group, versus 74.8% and 76.6% in patients of the adjuvant chemo-therapy group, showing no significant difference in the above indicators between the two groups ( χ2=0.14, 0.60, P>0.05). Conclusions:Compared to postoperative adjuvant chemotherapy, neoadjuvant chemotherapy does not bring additional surgical risks, but can reduce the tumor stage of patients who underwent laparoscopic D 2 radical resection for locally advanced gastric cancer. However, it does not show any advantage in improving survival of patients.

OBJECTIVESTo review the preliminary clinical experience with high-field-strength intraoperative magnetic resonance imaging (iMRI) suite with neuronavigation system in the pituitary adenoma operation with transsphenoidal approach.

METHODSFrom March 2009 to December 2010, 31 patients [range, 29 - 76 years, mean age (47 ± 11) years]of pituitary adenoma were operated with transsphenoidal approach and intraoperatively with a movable 1.5 T high-field-strength iMRI suite in combination with neuronavigation system. Tumor size was 1.8 - 7.3 cm, mean (3.5 ± 1.2) cm. Twenty-five cases were non-functional pituitary adenoma, 4 cases were prolactin-secreting pituitary adenoma, 2 cases were growth hormone-secreting pituitary adenoma. Thirty patients' resection with transnasal transsphenoidal approach were performed, one patient with transoral transsphenoidal approach was performed.

RESULTSIn 12 cases of 30 patients who planed to totally remove tumor, iMRI had revealed residual lesions and resulted in the change of the surgical strategy, 2 invasive cavernous sinus cases no further resection of the tumor because of internal carotid artery encasement, the other 10 cases resected further, eventually. Finally, 8 cases were totally removed. The ratio of total removal tumor was enhanced to 86.7% (26/30) from 60.0% (18/30). There was no perioperative mortality.

CONCLUSIONSHigh-field-strength iMRI suite with neuronavigation system provides valuable information of tumor resection that allows intraoperative modification of the surgical strategy. It could be very helpful to maximize the resection of the pituitary adenoma and minimize the injury to neurological function.

Adenoma ; surgery ; Adult ; Aged ; Cavernous Sinus ; surgery ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Monitoring, Intraoperative ; methods ; Neuronavigation ; methods ; Pituitary Neoplasms ; surgery