ObjectiveTo study the effect of a fast-track surgery (FTS) program on the clinical outcomes in cirrhotic patients with portal hypertension.Methods42 cirrhotic patients with portal hypertension were randomly allocated into the FTS group (n=21) and the conventional therapy control group (n=21).The postoperative time to first defecation,hospital stay,hospitalization cost,and postoperative complications were compared between the two groups.ResultsCompared with the control group,the postoperative time to first defecation was significantly shorter in the FTS group (P=0.0287).Furthermore,the postoperative hospital stay was significantly shorter in the FTS group than the control group (P=0.002).Additionally,hospitalization cost was significantly lower in the FTS group than the control group (P＜0.001).The postoperative complication was also significantly different between the two groups (7.15 ％ vs 21.5 ％,P=0.001).ConclusionA FTS program contributed to better postoperative rehabilitation in cirrhotic patients with portal hypertension.

Objective To evaluate the effects of electromagnetic irradiation of 2000 μW/cm2 exposure on mRNA and protein expression levels of immunoreactive protein and mRNA of NMDAR1 in rats hippocampal,and to explore the impaired mechanism of electromagnetic irradiation on learning and memory.Methods Rats were randomly divided into normal control group, sham-radiated group, and 1 h/d, 2 h/d, and 3 h/d radiation groups.The rats in the radiation groups were fixed and recieved microwave exposure of 2000 μW/cm2, then their learning and memory abilities were tested by Morris water maze experiment, the change of NR1 protein in hippocampal neurons of each group of rats was measured with immunohistochmistry and western blot techniques, and the expression of NR1 mRNA in hippocampus was determined by RT-PCR.Results In the water maze test,compared with the normal control group (8.8 ± 1.66 ), the escape latency of three radiated groups rats ( 1 h/d ( 12.29 ±1.36) s,2 h/d ( 17.99 ±2.25) s,and 3 h/d (24.66 ±5.56) s) were significantly longer (P＜0.05).In the radiation group,the hippocampal neurons of rats showed evident reduction in the ratio of NR1 positive cells,irregular,and arrayed in disorder.Moreover,compared with the normal control group ( (0.70 ±0.11 ), (0.68 ±0.11 ) ) ,the expession of NR1 protein ( 1 h/d (0.122 ±0.026) ,2 h/d (0.102 ±0.023) ,and 3 h/d (0.060 ± 0.009) ) and its mRNA ( 1 h/d (0.46 ±0.07) ,2 h/d (0.35 ±0.05) ,and 3 h/d (0.12 ±0.02) ) in hippocampal neurons was significantly decreased (P＜0.05).Among the indicators, there was no significant difference between sham-radiated group and normal control group.Conclusions Electromagnetic irradiation of 2000 μW/cm2 exposure can impair the learning and memory abilities of rats possibly through a mechanism correlated with the lower expression of NR1 protein and its mRNA in hippocampus.

ObjectiveTo explore the possible mechanism of adult offspring rats'anxiety-like behavior induced by parents experienced morphine addiction and withdrawal.MethodsEstablishing the model of Sprague-Dawley rats morphine addiction,Male and female rats were mated after morphine withdrawal 21 days.Meaning-while,saline control group was established in the same method.5 female and 5 male offspring's brains were obtained to observe the neuronal morphology of hippocampal CA1 through Golgi staining when they were 8 weeks old,the same number of female and male's hippocampus were derived after deeply anesthetized to perform the whole genome expression profiles analysis.ResultsThe total length and the number of basal dendrites branches on hippocampal CA1 neurons in offspring of morphine groups were significantly decreased compared to the offspring of saline group.Comparison with the offspring of saline group,663 up-regulated genes (ratios ≥2.0) and 499 down-regulated genes ( ratios ≤0.5 ) were detected in the male offspring of morphine groups,and 350 up-regulated genes (ratios ≥2.0) and 188 down-regulated genes (ratios ≤0.5) were done in the female.Furthermore,they included many genes associated with regulation of emotional behavior,such as 5-HT2c receptor up-regulation 7-fold,Igf-2 up-regulation 7.1-fold and reelin down-regulation 3.3-fold were observed.ConclusionExperienced morphine addiction and withdrawal in parents prior to mating leads to dysplasia of dendritic morphology in hippocampal CA1 neurons of adult offspring rats,and 5-HT2c,Igf-2,reelin expressing abnormally,which may be the possible mechanism of anxiety-like behavior in adult offspring rats.

Objective To evaluate the effect of clopidogrel premedication on in-hospital major adverse cardiovascular and cerebral events (MACCE) and bleeding outcomes before coronary artery bypass graft surgery (CABG). Method A total of 2021 patients who underwent CABG from July 2003 to September 2005 were divided into either clopidogrel ( n = 479) or no clopidogrel (1542) group before CABG. Patients with clopidogrel administration ( n = 479) were subdivided into < 5 d ( n = 154) ,5～7d(n = 183)and >7d(n = 142) group according to timing of clopidogrel withdrawal before surgery. In-hospital MACCE and perioperative bleeding outcomes were analyzed among groups. Results Patients who took clopidogrel before surgery had nonsignificantly rates of bleeding and in-hospital MACCE compared with those patients not administered clopidogrel. No differences were found about the incidence of total bleeding,minor bleeding,transfusions of red blood cells,fresh frozen plasma,whole blood and in-hosptial MACCE among three subgroups.The < 5 d group had higher incidence of major bleeding and more platelets transfusions than 5 ～ 7 d [47.8% vs. 31.9%,P < 0.017; (0.08 ±0.38) U vs. (0.00±0.00) U,P <0.017,respectively]and >7 d group [47.8% vs. 20.3%,P <0.017; (0.08±0.38) U vs. (0.00±0.00) U,P <0.017,respectively). However,there were no significant differences between 5 ～ 7 d and > 7 d group ( P > 0.05). Conclusions Gopidogrel administration before CABG does not increase the incidence of in-hospital MACCE events. However,the perioperative risk of bleeding will rise if the patients withhold clopidogrel less than five days before surgery.

Objective:To study serum procalcitonin (PCT), C-reactive protein (CRP) and platelet count (PLT) in evaluation of severity of acute cholangitis (AC).Methods:Ninety patients with AC who were treated at the General Surgery Department, Guangming Hospital, Liaocheng, Shandong Province from January 2016 to December 2018 entered into the observation group, while 60 patients with bile duct stones but without infection treated at the hospital during the study period entered into the control group. Using the " Guidelines for the Diagnosis and Treatment of Acute Biliary Tract Infections" , the study group of patient was further divided into the mild infection, moderate infection, and severe infection groups. The PCT, CRP and PLT levels of all the subjects were checked. Spearman correlation was used to analyze the relationship between PCT, CRP, PLT indexes with severity of infection. The receiver operating characteristic curve was used to analyze the sensitivity and specificity of PCT, CRP and PLT in the diagnosis of patients with different degrees of infection.Results:In the observation group, there were 46 males and 44 females with a Mean±SD age of (45.6±21.1) years. In the control group, there were 30 males and 30 females, with a Mean±SD age of (45.0±19.3) years. The levels of PLT in the observation group and the control group were (8.2±1.1) ng/ml and (0.4±0.1) ng/ml, respectively. The corresponding CRP were (92.7±21.1) mg/L and (6.1±1.0) mg/L, respectively. The observation group had higher levels than the control group. The PLT counts were (62.6±17.6)×10 9/L and (156.3±35.3)×10 9/L for the two groups, with the observation group having lower platelet count than the control group (both P<0.05). The severity of infection was positively correlated with blood PCT levels and CRP indicators ( r=0.427, r=0.584, all P<0.05), and negatively correlated with the PLT ( r=-0.429, P<0.05). The sensitivity and specificity of PCT using a cut-off value of 9.4 μg/L were 84.0% and 65.0%, respectively, which were higher than the CRP using a cut-off value of 145.7 mg/L. The sensitivity and specificity were 67.0% and 48.0%, respectively. When PLT using a cut-off value of 52.8×10 9/L, the sensitivity and specificity were 71.0% and 52.0%, respectively. Conclusions:Changes in serum PCT, CRP and PLT reflected the severity of infection in patients with AC; PCT had a higher sensitivity and specificity, and it can be used to guide treatment.

OBJECTIVE: To explore the role of phosphorylation of cAMP response element binding protein (CREB) in the incision-induced pain hypersensitivity. METHODS: A longitudinal incision was made in one plantar hind paw of isoflurane-anesthetized rats. Spinal cords were removed at various postoperative time after behavior test. Phosphorylation of CREB was determined by immunohistochemistry and double-labeling immunofluorescence. Morphine and gabapentin were intraperitoneally injected before the behavior test and were used to determine the interaction between phosphorylation of CREB and morphine and gabapentin. RESULTS: After the hind-paw incision, phosphorylation of CREB was enhanced in the ipsilateral lumbar spinal cord (P<0.05). The enhancement of p-CREB was mainly in the neurons in the dorsal horn of the spinal cord. All these were shown by double-labeling technique and p-CREB was mainly in the neurons. Intraperitoneal injection of morphine prevented the increased phosphorylation of CREB in the spinal cord and inhibited the mechanical allodynia induced by the incision (P>0.05). Gabapentin didn't inhibit the phosphorylation of CREB (P<0.05) but partly inhibited the mechanical allodynia. CONCLUSION Incision induces the phosphorylation of CREB in the spinal cord, and the increase of p-CREB is mainly in the neurons. Phosphorylation of CREB in the spinal cord contributes to the pain hypersensitivity induced by surgical incision.
Animals ; Cyclic AMP Response Element-Binding Protein ; metabolism ; Female ; Foot ; surgery ; Neurons ; metabolism ; Pain Threshold ; Pain, Postoperative ; metabolism ; Phosphorylation ; Rats ; Rats, Sprague-Dawley ; Spinal Cord ; metabolism

Objective: To investigate the effect of non-vitamin K antagonist oral anticoagulants (NOAC) on left atrial or atrial appendage (LA/LAA) thrombi in patients with nonvalvular atrial fibrillation (NVAF). Method: Data from 3 042 patients with atrial fibrillation(AF), who underwent transesophageal echocardiography (TEE) examination before cardioversion or catheter ablation for the detection of LA/LAA thrombus in our department from March 2016 to January 2018 were prospectively analyzed. Among these patients, LA/LAA thrombus was detected by TEE in 57 patients. A total of 19 patients who received dabigatran or rivaroxaban for ≥3 weeks and underwent repeated TEE were included, 38 patients were excluded (7 patients with rheumatic heart disease, 1 patient treated with pericardial decortication, 1 patient treated with surgical repair of endocardial cushion defect, 1 patient with LA thrombus associated with the atrial septal occluder device, 14 patients received warfarin therapy, 14 patients did not receive repeated TEE). Results: First repeated TEE results showed that LA/LAA thrombus was not completely resolved in 4 out of 4 patients treated with dabigatran (110 mg bid) for a median time of 119 (47, 258) days, whereas LA/LAA thrombus was completely resolved in 5 out of 11 patients treated with dabigatran (150 mg bid) for a median time of 80 (58, 147) days. Thrombus was completely resolved in 2 out of 2 patients treated with rivaroxaban (15 mg qd) for 110 days and 95 days respectively, and in 1 out of 2 patients treated with rivaroxaban (20 mg qd) for 91 days. Second repeated TEE was performed in 8 patients. Thrombus was resolved completely in 2 out of 3 patients with undissolved thrombus treated by dabigatran (110 mg bid) after increasing the dabigatran dosage (150 mg bid). Thrombus was resolved in 3 (1 patient prolonged treatment with dabigatran 150 mg bid and 2 patients switched to rivaroxaban 20 mg qd) out of 4 patients with undissolved thrombus under the dabigatran 150 mg bid regimen, whereas the thrombus remained unresolved in 1 patient switched to rivaroxaban (15 mg qd). After receiving rivaroxaban 15 mg bid treatment, the thrombus was finally resolved in 1 patient with undissolved thrombus treated by rivaroxaban 20 mg qd. There was no clinical thromboembolism or major bleeding events during the median follow up time of 462 (305, 558) days. Conclusions Our data show that NOAC is an effective therapeutic option for the treatment of LA/LAA thrombi. When eligible, a higher NOAC dosage may be preferred due to the higher efficacy on thrombus resolvement.

Objective:To summarize the clinical features, diagnosis and treatment experience of esophageal hamartoma in children.Methods:From December 2013 to December 2019, 3 cases of esophageal hamartoma were admitted to our hospital, and a retrospective analysis was conducted.Results:There were 1 male and 2 females, with an average age of 6.4 years old. The clinical manifestations were vomiting in 2 cases and dysphagia with esophageal foreign body sensation in 1 case. Esophagography, chest contrast-enhanced CT, and esophagoscopy showed esophageal stenosis or esophageal mass effectg, and esophageal dilatation above the affected segment. The tumor was found in upper esophagus in 1 case and lower esophagus in 2 cases. Tumors were complete resection in all 3 cases and the patients were discharged smoothly. All the 3 cases were followed up after surgery for 10-74 months(average 37 months), and 1 case had gastroesophageal reflux. No stenosis or recurrence was found in all the cases, and all the patients could eat normal diet.Conclusion:The main manifestations of esophageal hamartoma in children are vomiting and choking. Complete surgical resection is the main treatment method, and the prognosis is good.

Objective:Gasless laparoscopic surgery using lifting device was first introduced in 1993 mainly for general surgery and gynecology. Here we report its application in bifid rib treatment and explore the feasibility and safety of the surgery.Methods:From July 2008 to December 2019, according to the enrollment criteria, 278 patients of bifid ribs were treated at the Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, including 183 males and 95 females, the mean age was(5.7±2.5) years old. There were 242 cases of single bifid rib and 36 cases of multiple bifid ribs. The bifid ribs were more common on the right side, as 184 cases had bifid ribs on right side, while only 68 cases on the left side and 26 cases on both sides. Patients’ clinical data were retrospectively summarized and analyzed, including the patients’ gender, age, location and type of bifid rib, perioperative outcome, and follow-up.Results:All the 278 patients successfully completed the operation. The abnormality was most frequently found in the fifth rib(incidence ranking: fifth > fourth > third > sixth). The mean operation time was(64.5±16.1)min, and the mean blood loss was(4.8±2.1)ml. No serious complications occurred during the surgery. Follow-up was done for 7 to 120 months, and no recurrent patients were observed.Conclusion:Gasless endoscopy with lifting device has been used as a safe and effective method to treat bifid ribs in our hospital. This surgery leads to less injury, smaller incision, and no scars on the front chest. Gasless endoscopic surgery with lifting device can be one of the options for correcting bifid ribs.

Objective To explore the establishment of 3D thoracic model by finite element methods,and study the mechanical mechanism of minimally invasive surgery for correcting the chest wall deformity,and provide personalized surgery solution in the future.Methods According to admission and exclusion criteria,we selected 10 cases of pectus carinatum that received chest CT scan.The finite element model of pectus carinatum was established and analyzed by Mimics,ABAQUS,etc.The validity of finite element method for chest wall was verified by comparing the sternal displacement between the simulated values and actual values with the same force.Results The 3D finite element model of pectus carinatum was successfully established and analyzed.The stress distribution of the 10 cases in the posterior ribs was mainly in the 1-6 ribs on both sides,mostly concentrated in the 4th to 6th ribs,and the stress was symmetrical on both sides.Statistical analysis showed that the displacement value of the sternum was correlated,and the validity of the model was verified.Conclusion Mimics,ABAQUS and other finite element modeling and analysis software can effectively establish the thoracic 3D finite element model and mechanical analysis,which can help the further development of personalized minimally invasive surgery for correcting chest wall deformities.