OBJECTIVETo study the application of intraoperative irrigation of the colon in primary resection and anastomosis of left colorectal cancer with intestinal obstruction.

METHODSThe clinical data were analyzed in 58 patients with left colon rectal cancer and intestinal obstruction undergoing intraoperative irrigation of the colon for primary anastomosis, and the results were compared with 58 patients receiving conventional primary tumor resection.

RESULTSThe mean intraoperative blood loss or postoperative hospital stay was comparable between the two groups, but the patients undergoing colon irrigation had significantly delays in the recovery of bowel movement.

CONCLUSIONWith strict control of the surgery indication, intraoperative colon irrigation can be safe and feasible in primary resection and anastomosis of left colorectal cancer with intestinal obstruction.

Adult ; Anastomosis, Surgical ; methods ; Colon ; Colorectal Neoplasms ; complications ; surgery ; Female ; Humans ; Intestinal Obstruction ; etiology ; surgery ; Intraoperative Period ; Male ; Middle Aged ; Therapeutic Irrigation ; methods

OBJECTIVETo explore the relationship between hypoxia-inducible factor-1α (HIF-1α) mRNA levels in the peripheral blood and the metastasis of colorectal cancer.

METHODSHIF-1α mRNA in the peripheral blood was detected by RT-PCR in 40 patients with colorectal cancer and 20 healthy subjects.

RESULTSSeventeen patients with colorectal cancer showed positivity for HIF-1α mRNA, showing a significantly higher positivity rate (42.5%) than the healthy subjects (P<0.05). The expression of HIF-1α mRNA is closely related to the staging of colorectal cancer (CRC).

CONCLUSIONHIF-1α mRNA may serve as a potential marker in the detection of metastasis of colorectal cancer.

Adenocarcinoma ; blood ; pathology ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Colorectal Neoplasms ; blood ; pathology ; Female ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; blood ; genetics ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Metastasis ; RNA, Messenger ; genetics

AIM To explore the effects of Bushen Huoxue Recipe (Fluoritum,Psoraleae Fructus,Cuscutae Semen,etc.) on the protein expressions of transforming growth factor (TGF)-β1,TGF-βRⅡ and Smad2/3 in follicle wall granulosa cells in mice with autoimmune premature ovarian failure (POF).METHODS Balb/c female mice were subcutaneously injected with mouse zona pellucida 3 at multiple points to establish autoimmune POF model.POF mice were divided into model group,positive group (progynova),low-,middle-and high-dose of Bushen Huoxue Recipe groups.After intervention for 30 days,ovarian tissue was stained by hematoxylin-eosin (HE),and the protein expressions of TGF-β1,TGF-βRⅡ and Smad2/3 in follicle wall granulosa cells and ovarian tissue were detected by immunohistochemistry and Western blot,respectively.RESULTS Compared with the model group,the number of mature follicles in the Bushen Huoxue Recipe groups and the positive group was obviously increased,together with the decreased number of atretic follicles.The protein expressions of TGF-β1,TGF-βRⅡ and Smad2/3 in follicle wall granulosa cells and ovarian tissue in the Bushen Huoxue Recipe groups and the positive group were much higher than those in the model group (P ＜ 0.05).CONCLUSION Bushen Huoxue Recipe can improve ovarian function by up-regulating the protein expressions of TGF-β1,TGF-βRⅡ and Smad2/3 in granulosa cells.

OBJECTIVETo evaluate the impact of preoperative three-dimensional visualization and virtual liver surgery planning on hepatic resection.

METHODSAll relevant structures (livers, portal vein, hepatic veins, and tumors) were extracted from multislice CT scans of 142 cases treated from May 2007 to May 2009. By the liver surgery planning system software Liv 1.0, reconstruction and image analysis of the relevant structures was performed and virtual resections of liver were carried out. Data were correlated to intraoperative findings.

RESULTS(1) Three-dimensional visualization revealed the spatial relationship of tumors to the intrahepatic vascular system, thus giving impressions how the neoplasms were situated. Virtual tumor resections corresponded to the intraoperative findings. (2) With the planning, an intended resection could be performed virtually and optimal identification of resection margins could be achieved. The ischemia and congestion territory within the remaining liver parenchyma could be calculated. Simulation resections could avoid liver parenchyma over resection and maintain a sufficient amount of liver tissue to sustain hepatic function. Virtual simulations of tumor resection were used successfully to plan of surgical procedures in the hepatic tumors. Hepatectomy was performed in 29 cases after virtual tumor resections but seemed impossible with conventional CT scan. Resection plans of 92 cases were optimized after virtual resections. (3) The mean liver volume of patients with primary hepatocellular carcinoma measured by the software and the real resected was (477 +/- 223) ml and (451 +/- 209) ml respectively. Comparison by means of linear regression analysis between volume measurement on the software and the real resected showed a nearly ideal correlation coefficient (R = 0.922, P < 0.01). The mean error was 6.1%.

CONCLUSIONSThe three-dimensional tumor visualization and virtual simulation of tumor resections of the software Liv 1.0 provide an important reference for a valuable planning of complex hepatic resections. It is not only benefit to improve the predictability and security of hepatectomy but also helpful to improve the success rate of complex hepatic resections.

Adult ; Aged ; Computer Simulation ; Female ; Hepatectomy ; methods ; Humans ; Imaging, Three-Dimensional ; Liver ; diagnostic imaging ; surgery ; Liver Neoplasms ; surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed ; User-Computer Interface ; Young Adult

OBJECTIVETo analyze the effect of different hepatic vascular exclusions for massive hemorrhage in hepatectomy.

METHODSThe clinical data of 2238 cases with hepatectomy treated from January 1995 to August 2009 was analyzed retrospectively in the cause of massive hemorrhage (blood loss ≥ 1000 ml), blood loss during liver resection and massive hemorrhage incidence with different methods of hepatic vascular exclusion.

RESULTSAmong 2238 cases received hepatectomy, 215 cases (9.6%) had massive hemorrhage because of portal vein tumor thrombus extraction (26.0%), extensive adhesions around the tumor (24.7%), section of liver hemorrhage (23.7%), hepatic vascular injury (15.8%), and tumor rupture (9.8%). Among 2182 cases received hepatectomy without portal vein tumor thrombus extraction, 159 cases (7.3%) had massive hemorrhage, 1257 cases (57.6%) which blood loss were less than 400 ml. Hepatectomy with different hepatic vascular exclusion methods had different blood loss and massive hemorrhage incidence.

CONCLUSIONPringle combined with clamping infrahepatic vena cava method and the liver double-hanging maneuver through the retrohepatic avascular tunnel on the right of the inferior vena cava method can reduce blood loss and massive hemorrhage incidence in hepatectomy more effectively, especially for huge liver tumor resection.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Loss, Surgical ; prevention & control ; Female ; Hepatectomy ; methods ; Humans ; Liver ; blood supply ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVETo study changes in the levels of systematic and airway local oxidative stress in patients in different stages of chronic obstructive pulmonary diseases (COPD), and explore the association between oxidative stress and glucocorticoid receptor (GR) level in the peripheral blood leukocytes.

METHODSThe levels of malonaldehyde (MDA), glutathione (GSH), superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) in induced sputum and plasma, as well as GR levels in peripheral blood leukocytes and plasma levels of cortisol and adrenocorticotrophic hormone (ACTH), were examined in 33 patients with acute exacerbations of COPD (AECOPD, group A), 27 with stable COPD (group B), and 28 healthy volunteers (including 15 smokers as group C, and 15 nonsmokers as group D).

RESULTSMDA level in induced sputum and plasma decreased, whereas the levels of GSH, SOD and GSH-PX increased significantly in the order of groups A, B, C, and D (P<0.05). The activity of SOD in induced sputum and plasma were significantly lower in group C than in group D. No significant difference was noted in the other oxidative stress indices between groups C and D (P>0.05). The plasma levels of cortisol and ACTH showed no significant difference between the 4 groups, while the GR level in peripheral blood leukocytes increased significantly in the order of groups A, B, C and D (1565-/+719, 2069-/+488, 2739-/+926, and 4793 -/+1415 U, respectively, P<0.05). After controlling for the factor of smoking status, the plasma and sputum SOD activity were both positively correlated to GR, with the partial correlation coefficient of 0.512 and 0.564, respectively (P<0.001).

CONCLUSIONPatients in different stages of COPD, especially those with AECOPD, may sustain systematic and local oxidation and anti-oxidation imbalance. Decreased SOD activity may contribute to GR level decrement in peripheral blood leukocytes in these patients.

Aged ; Female ; Glutathione Peroxidase ; metabolism ; Humans ; Leukocytes ; metabolism ; Male ; Middle Aged ; Oxidative Stress ; Pulmonary Disease, Chronic Obstructive ; metabolism ; Receptors, Glucocorticoid ; metabolism ; Superoxide Dismutase ; metabolism

OBJECTIVETo study the value of ultrasound, abdominal X-ray, and dual-source CT (DSCT) in the diagnosis of colon tumor obstruction.

METHODSA retrospective analysis was conducted among 45 patients who were admitted to our department between October 2010 and August 2011 for abdominal pain. All the patients underwent ultrasound, abdominal X-ray and DSCT examinations and subsequent surgical interventions, which confirmed the diagnosis of colon tumor obstruction.

RESULTSDSCT diagnosis was obviously more efficient than ultrasound and X-ray in detecting colon obstruction by neoplasms, and could better predict the position of the obstruction. Complete information of the vessels in the surgical field could be obtained by DSCT imaging three-dimensional reconstruction.

CONCLUSIONSCompared with ultrasound and X-ray, DSCT is more effective in the diagnosis of colon tumor obstruction by acquiring more thorough information by imaging reconstruction and should be considered for a rapid and accurate diagnosis.

Adult ; Aged ; Colonic Neoplasms ; complications ; Female ; Humans ; Intestinal Obstruction ; diagnostic imaging ; etiology ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVETo evaluate the clinical outcomes between extreme lateral interbody fusion and conventional posterior operation in the treatment of upper lumbar disc herniation.

METHODSAmong 60 patients with upper lumbar disc herniation were treated with extreme lateral interbody fusion(XLIF) or conventional posterior operation from June 2010 to December 2014, 30 patients(19 males and 11 females) were treated with XLIF (XLIF group); and the other 30 patients(17 males and 13 females) were treated with conventional posterior operation (conventional group). In XLIF group, the lesions occurred at T₁₂L₁ segments in 2 patients, at L₁,₂ segments in 6 patients, at L₂,₃ segments in 10 patients, and at L₃,₄ segment in 12 patients. In conventional group, the lesions occurred at T₁₂L₁ segments in 1 patient, at L₁,₂ segments in 6 patients, at L₂,₃ segments in 8 patients, and at L₃,₄ segment in 15 patients. Operative incision lengths, time, blood loss, postoperative draining volume, hospital stays were recorded. Pre-and post-operative visual analogue score(VAS) and Japanese Orthopedic Association(JOA) were compared between two groups. According to the image data, the intervertebral fusion device was observed to be displaced and the rate of interbody fusion was analyzed.

RESULTSAll the patients were followed up, and the duration ranged from 12 to 48 months, with an average of 29 months. The complications included 2 femoral nerve damage in XLIF group (postoperative recovery within 3 months) and superficial incision infection in conventional group(cured by anti-infection). There were no patients with cerebrospinal fluid leakage(CSFL), cauda equina injuries or functional deterioration in the nerve root of lower limbs. In the XLIF group: the operative time was (65.6±20.5) minutes, blood loss was (48.8±15.3) ml, postoperative draining volume was 0 ml. In the conventional group: the operative time was (135.2±33.9) minutes, blood loss was (260.3±125.7) ml, postoperative draining volume was (207.1±50.2) ml. The operative time, blood loss, postoperative draining volume in XLIF group were less than those in the conventional group(<0.05). The JOA and VAS score were significantly improved in both groups during the follow-up period compared with those before operation(<0.05). But the difference of the JOA and VAS score between the two groups 1, 6, and 24 months after surgery had not significant differences(>0.05). There were no significant differences in the fusion rate between the two groups 6 and 12 months after operation(>0.05).

CONCLUSIONSThe XLIF fusion for the treatment of upper lumbar disc herniation has several advantages such as minimal invasive, stable vertebral plate, less complications and postoperative fusion rate, which has a better clinical effect.

OBJECTIVEThe purpose of this study was to investigate the clinical characteristics of lymph node metastasis in the contralateral mediastinum and scalene in patients with potentially operable nonsmall cell lung cancer (NSCLC).

METHODSCervical mediastinoscopy was performed for 89 patients with clinical stage I-III A non-small cell lung cancer prior to thoracotomy. Of these, 12 underwent cervical medistinoscopy combined with right scalene lymph node biopsy and 10 with anterior para-mediastinal small incision.

RESULTSA total of 9 patients were found have N3 disease on mediastinosopy, with cancer-cell-positive lymph nodes in the contralateral mediastinum in 6 and 3 in the right scalene. Statistical analysis revealed that the incidence of N3 disease in adenocarcinoma group was higher than that in patients with nonadenocarcinoma (P < 0.05), which was also higher in the patients with serum CEA >5 ng/ml than that in the patients with CEA <5 ng/ml (P < 0.05), and it was higher in the patients with ipsilateral mediastinal multi-station lymph node metastasis than that in the patients with uni-station lymph node metastasis (P < 0.05).

CONCLUSIONBiopsy of contralateral mediastinal lymph nodes or scalene lymph node should be performed in order to exclude N3 disease for potentially operable NSCLC patients with adenocarcinoma, serum CEA >5 ng/ml or ipsilateral multi-station mediastinal lymph node metastasis.

Adenocarcinoma ; blood ; pathology ; therapy ; Adult ; Aged ; Biopsy ; Carcinoembryonic Antigen ; blood ; Carcinoma, Non-Small-Cell Lung ; blood ; pathology ; therapy ; Carcinoma, Squamous Cell ; blood ; pathology ; therapy ; Chemotherapy, Adjuvant ; Female ; Humans ; Lung Neoplasms ; blood ; pathology ; therapy ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Mediastinoscopy ; Mediastinum ; Middle Aged ; Neck Muscles ; Neoplasm Staging ; Pneumonectomy

【Objective】 To investigate the clinicopathological characteristics and prognosis of T2DM patients with renal involvement. 【Methods】 We conducted a retrospective analysis of clinical and pathologic data from T2DM patients who received renal biopsy(n = 120), and these patients were followed up. Renal outcome is defined as receiving renal replacement therapy or progression to ESRD. 【Results】 Among the 120 patients with T2DM, 57(47.5%) were diagnosed as DN, and 63(52.5%) as non diabetic renal disease(NDRD). The most common subtype of NDRD is membranous nephropathy. Compared with the NDRD group, the DN group had longer course of diabetes, worse renal function and higher proportion of diabetic retinopathy. Kaplan-Meier analysis showed that the renal survival rate in DN group was significantly lower than that in NDRD group. The 1-year, 5-year renal survival rate of DN group was only 81%, 41% Vs NDRD group 95, 84%. After multivariate adjustment, the risk of ESRD in DN patients was 3.81 times higher than that of NDRD patients(95%CI 1.61-9.01, P=0.002) . 【Conclusions】 There is a risk of misdiagnosis DN by clinical manifestations, and accurate diagnosis depends on renal biopsy. The prognosis of DN patients is significantly worse than NDRD, so it is of great clinical significance to distinguish the pathological types of diabetic patients with kidney disease.