ObjectiveTo evaluate the results of a novel operative procedure of spleen and pancreas preserving clearance of lymph nodes on spleen hillus and along the splenic artery in gastric resection for gastric carcinoma.Methods The postoperative complications and survival rates were observed in 61 patients of gastric carcinoma undergoing gastrectomy with preservation of the spleen and pancreas (PSP) and clearance of lymph nodes on spleen hillus and along splenic artery.Results were compared with those undergoing traditional operations. Results The postoperative complications and mortality were lower and survival rates higher in patients with preservation of spleen and pancreas than those with spleen and a portion of the pancreas resected.Conclusions Spleno-pancreas preserving lymph node clearance on the splenic hillus and along pancreatic artery is safe and effective procedure in radical gastrectomy for patients with gastric carcinoma.

OBJECTIVETo study the clinical value of radical resection of gastric carcinoma with pancreas and spleen preservation (PSP) and functional cleaning of lymph nodes (LNs) of the spleen hillus and along the splenic artery.

METHODSPancreas and spleen involvement was retrospectively reviewed among 439 cases of resectable carcinoma of the gastric cardia, gastric corpus and total stomach. During gastric surgery, 2 ml of methylene blue was injected into the subserosal space of the gastric cardia or corpus to observe the spread of lymphatic flow in 54 cases of gastric carcinoma. The metastatic rate of LNs in splenic hillus and along the trunk of the splenic artery (No10, No11), postoperative complications and survival rates were investigated in 63 gastric carcinoma patients that had received gastrectomy with pancreas and spleen preservation (PSP). These were compared with the pancreas preservation (PP) group and pancreas and spleen combined resection (PSR) group.

RESULTSAmong these 439 cases, only 25 cases were observed with direct invasion to the pancreas (5.7%), and 10 cases with direct invasion to the spleen (2.3%). After pathological examination of the pancreatic body and tail, we found 22 cases with pancreas and spleen combined resection, 4 cases (18.2%, 4/22) with direct invasion of the capsule and 2 with invasion to the superficial parenchyma (9.1%, 2/22), without metastasis to the lymph nodes within the pancreas and spleen. The metastatic rate of No10, No11 lymph nodes were 17.5% (11/63) and 19.1% (12/63) in the PSP group, 20.8% (45/216) and 25% (54/216) in the PP group, and 20% (6/30) and 23.3% (7/30) in the PSR group. There were no statistically significant differences (P > 0.05). Injection of methylene blue into the subserosal space of the stomach did not diffuse into the spleen or pancreatic parenchyma. Postoperative complications, diabetes and mortality in PSP (0%, 0%, 0%) were lower than in PP (4.2%, 0.9%, 0.9%) or PSR (40%, 10%, 3.3%). The 5-year survival rate (5-YSR) and 10-YSR in PSP (57.5%, 52.0%) were higher than in PSR (37.5%, 30.0%). Those patients with stage II and III(a) treated by PSP, improved markedly.

CONCLUSIONSThe surgical procedure of pancreas and spleen preservation for gastric cancer is a safe and organ function protected method. Postoperative complications were lower and survival rates were higher, the radicality was not reduced. These results indicate that PSP is preferred in patients with gastric carcinoma of stage II or III(a).

Adult ; Aged ; Female ; Humans ; Lymph Nodes ; pathology ; surgery ; Lymphatic Metastasis ; Lymphatic System ; physiopathology ; Male ; Methylene Blue ; Middle Aged ; Neoplasm Staging ; Pancreatic Neoplasms ; secondary ; surgery ; Postoperative Complications ; Splenic Neoplasms ; secondary ; surgery ; Stomach Neoplasms ; mortality ; pathology ; surgery ; Survival Rate ; Treatment Outcome

Objective To investigate the inhibiting effect of interleukin (IL)‐24 combined with targeted attenuated Salmonella typhimurium vector SL7207/pBud‐VP3 on the growth of gastric cancer cells .Methods The co‐expression eukaryotic expression plasmid pBud‐VP3‐IL‐24 was constructed .The plasmid pBud‐VP3‐IL‐24 was transformed into attenuated Salmonella typhimurium SL7207 by using the high voltage electroporation for constructing the SL 7207/pBud‐VP3‐IL‐24 strain .The mouse gastric cancer transplantation tumor model was established and randomly divided into the normal saline control group ,SL7207/pBud group , SL7207/pBud‐VP3 group and SL7207/pBud‐VP3‐IL‐24 group .The tumor‐bearing mice were fed by oral administration of bacterial strain .The tumor volume was measured and the tumor inhibition rate was calculated .The expression of IL‐24 was detected by Western blotting .The levels of IFN‐γ,IL‐6 and TNF‐αin tumor tissue were detected by using RT‐PCR .The expression of Caspase‐3 and VEGF were detected by using immunohistochemistry .Results The plasmids attenuated Salmonella typhimurium vector carrying the gene IL‐24 was successfully constructed .The IL‐24 protein expression was detected in gastric cancer tissue after 14 d treatment .The tumor volume after 28 d treatment in the SL7207/pBud‐VP3‐IL‐24 group was reduced compared with the other groups ,moreover the tumor growth was significantly inhibited ,and the differences were statistically significant (P<0 .05) .RT‐PCR and immunohistochemistry results showed that IL‐24 combined with SL7207/bBud‐VP3 could significantly increase the expression levels of immune factor IL‐6 ,IFN‐γ and TNF‐αin tumor tissue ,.in addition ,up‐regulated the expression of Caspase‐3 and down‐regulated the VEGF expression(P<0 .05) .Conclu‐sion IL‐24 combined with SL7207/pBud‐VP3 can synergically play the inhibitory effect on the growth of gastric cancer cells ,its mecha‐nism is related with the tumor apoptosis promotion ,tumor vessel inhibition and immune regulation .

Objective To evaluate the efficacy of biofeedback combined with swallowing function training at different times on post-stroke dysphagia. Methods 124 patients with post-stroke dysphagia were randomly divided into observation group and control group. The observation group was given biofeedback combined with swallowing function training for 2 weeks and 4 weeks of treatment. The control group was given routine swallowing function training for 2 weeks and 4 weeks of treatment. Kubota drinking water test was used to evaluate the swallowing function before treatment, 2 weeks and 4 weeks after treatment in both groups. Results There was no statistically significant difference in the scores of swallowing function between the two groups before treatment (P=0. 401). After 2 weeks of treatment, there was also no statistically significant difference in the evaluation of swallowing function between the observation group and the control group (P=0. 138). After 4 weeks of treatment, the evaluation of swallowing function in the observation group was significantly better than that in the control group(P=0. 003). Conclusion Biofeedback combined with swallowing function training is better than the routine swallowing function training. After 4 weeks of treatment, the efficacy of biofeedback combined with swallowing function training is better than the biofeedback combined with swallowing function training after 2 weeks, indicating that there is a correlation between the treatment effect and the length of treatment time.

Objective To explore the prediction of comprehensive geriatric assessment (CGA) on postoperative delirium (POD) in elderly patients after cardiac surgery. Methods A total of 276 patients from cardiac surgery department were selected from January 2015 to December 2016 by convenience sampling method. The general clinical data of the subjects were recorded and the CGA was conducted. POD assessment was performed on the 1st to the 7th day postoperatively using Confusion Assessment Method-Intensive Care Unit (CAM-ICU) or Confusion Assessment Method (CAM). Single factor analysis and multiple Logistic regression analysis were applied to analyze the factors influencing the incidence of POD after cardiac surgery in elderly patients. Results A total of 98 cases showed POD, with the incidence of 35.5%. Compared with the non-POD patients, the patients with POD were older; the proportion of history of cerebrovascular disease, atrial fibrillation, cardiopulmonary bypass, intraoperative blood transfusion was higher; the mechanical ventilation duration was longer; the score of Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ), the postoperative pain score, the level of serum creatinine and C-reactive protein (CRP) were higher; the proportion of patients with CGA score over 15 was significantly higher, and all the differences were statistically significant (P< 0.05). Logistic multivariate regression analysis showed that the history of cerebrovascular disease, cardiopulmonary bypass, APACHE Ⅱ score, postoperative pain score and CGA score over 15 were independent risk factors for POD. Conclusions CGA can predict patients with cardiac surgery with high risk of postoperative delirium, which has a certain significance for the prevention and treatment of postoperative delirium and improve the prognosis.