Recurent spontaneous abortion (RSA) was classified into the primary (1?) and the sec-ondary (2?) according to patients histoty.Occurence of blocking antibodies between them wasinvestigated with mixed lymphocyte reaction—blocking assay and complement dependent cyto-toxicity assay.It was found that the primary abortion had been mainly caused by lack of block-ing antibodies,the secondary abortion without lack of blocking antibodies.Thus,the primaryabortion is different from the secondary abortion in aspects of immune aetiology and immunemechanisms although their clinical manifestations are similar.

Objective To investigate the influence of polyethylene glycol (PEG) on heparin release of heparinloaded polycaprolactone/polyethylene glycol (PCL/PEG) membranes used in artificial vascular peosthesis.Methods Heparin-loaded PCL/PEG membrane samples with different PEG mass contents of 0,0.5％,10％ and 15％ were prepared by blending method and freeze-drying technology.The influence of PEG on heparin release was experimental studied in vitro.The influence of PEG on the structural characteristics of the samples were investigated by X-ray diffraction,Fourier transform infrared spectrum and differential scanning calorimeter.Results The addition of PEG reduced the heparin release resistance.The results showed that the average release rate of heparin in the first day and the release amount for 34 d were improved.Both these parameters increased with the increase of PEG mass content.The X-ray diffraction,Fourier transform infrared spectroscopy and differential scanning calorimetry showed that the crystallinity of PCL membrane was slightly enhanced by the addition of heparin,but the overall effect was not significant.In addition,the addition of heparin could promote the crystalline grain growth of PEG,and a common distribution of heparin and PEG in the matrix was observed.Conclusions The heparin release control can be achieved by adjusting the PEG mass content in heparin-loading PCL/PEG membranes prepared by blending method and freeze-drying technology.The proposed samples may have anticoagulant effect,which can be expected to be used as small-diameter artificial vascular prosthesis material.

Biliary stent has been widely used in the treatment of biliary stricture and obstruction, it can relieve the pain of patients effectively, but bacterial infection and stent obstruction are still troublesome after surgery. We introduce the mechanism of infection and stent blockage caused by bacterial invasion after biliary stent implantation, and expound the formation mechanism of bacterial biofilm and bile sludge in this review. Antibacterial biliary stent is an effective way to inhibit biliary tract infection, the literatures on antibacterial modification of biliary stent with different antibacterial methods in domestic and abroad are reviewed, and the research prospect of antibacterial biliary stent is summarized and prospected.
Anti-Bacterial Agents/pharmacology* ; Bile ; Biliary Tract ; Cholestasis ; Humans ; Stents

Objective    To investigate the impact of thoracic duct ligation (TDL) on metabolism and postoperative complications during esophagectomy in patients with type-2 diabetes mellitus (T2DM). Methods    We conducted a retrospective clinical data analysis of 230 esophageal carcinoma patients with T2DM who underwent esophagectomy in our hospital from January 2003 to December 2018. Patients were divided into a TDL+ group (n=112), including 78 males and 34 females aged 63.47±7.23 years, and a TDL– group (n=118), including 84 males and 34 females aged 64.38±7.57 years. We compared the blood glucose, liver function parameters and lipid metabolic parameters at different time points before and after surgery. In addition, we compared the postoperative major complications between the two groups. Propensity score-matched (PSM) was used to control the observed confounders. Results    Compared with the TDL–group, patients in TDL+ group had higher blood glucose level (P<0.05, except the fourth postoperative day). The total protein and albumin levels on the first and fourth postoperative days in the TDL+ group were lower than those in the TDL– group (P<0.05). The alanine transaminase (P=0.027) and aspartate transaminase (P=0.007) levels on the fourth postoperative day in the TDL+ group were higher than those in the TDL– group. More pulmonary complications (P=0.014) and anastomotic leaks (P=0.047) were found in the TDL+ group. Conclusion    Given that TDL may aggravate metabolic disorders, increase anastomotic leaks and the pulmonary complications, it is cautious to perform TDL, and prophylactic TDL should not be performed routinely for patients with T2DM.

Objective    To investigate the risk factors for lymph node metastasis (LNM) and prognosis of T1-stage esophageal squamous carcinoma (ESC). Methods    Clinical data of 387 patients with T1-stage ESC who underwent surgical treatment in our hospital from March 2013 to March 2018 were collected. There were 281 males and 106 females aged 60 (41-80) years. The patients were divided into a lymph node metastasis group (n=77) and a non-metastasis group (n=310). The risk factors for LNM and prognosis were analyzed. Results    Among 387 patients with T1-stage ESC, 77 (19.9%) patients had LNM. The incidence of LNM was 8.4% (8/95) in T1a-stage patients and 23.6% (69/292) in T1b-stage patients. Univariate analysis showed that tumor size, differentiation degree, depth of invasion and vascular tumor thrombus were associated with LNM (P<0.05). Multivariate logistic regression analysis showed that invasion depth of tumor [OR=2.456, 95%CI (1.104, 5.463), P<0.05] and vascular tumor thrombus [OR=15.766, 95%CI (4.880, 50.938), P<0.05] were independent risk factors for LNM. The follow-up time was 41 (12, 66) months. The 1-year, 3-year and 5-year survival rates were 98.71%, 89.67% and 86.82%, respectively. Univariate analysis showed statistically significant differences in tumor invasion depth, vascular tumor thrombus and LNM between the survival group and the death group. Cox analysis showed that LNM [OR=3.794, 95%CI (2.109, 6.824), P<0.05] was an independent risk factor for prognosis. Conclusion    T1-stage ESC patients with deeper invasion or vascular tumor thrombus have a higher risk of LNM. The prognosis of T1-stage ESC with LNM is relatively poor.

Objective    To investigate the clinical efficacy of minimally invasive Ivor-Lewis esophagectomy (MIILE) with reverse-puncture anastomosis. Methods    Clinical data of the patients with lower esophageal carcinoma who underwent MIILE with reverse-puncture anastomosis in our department from May 2015 to December 2020 were collected. Modified MIILE consisted of several key steps: (1) pylorus fully dissociated; (2) making gastric tube under laparoscope; (3) dissection of esophagus and thoracic lymph nodes under artificial pneumothorax with single-lumen endotracheal tube intubation in semi-prone position; (4) left lung ventilation with bronchial blocker; (5) intrathoracic anastomosis with reverse-puncture anastomosis technique. Results     Finally 248 patients were collected, including 206 males and 42 females, with a mean age of 63.3±7.4 years. All 248 patients underwent MIILE with reverse-puncture anastomosis successfully. The mean operation time was 176±35 min and estimated blood loss was 110±70 mL. The mean number of lymph nodes harvested from each patient was 24±8. The rate of lymph node metastasis was 43.1% (107/248). The pulmonary complication rate was 13.7% (34/248), including 6 patients of acute respiratory distress syndrome. Among the 6 patients, 2 patients needed endotracheal intubation-assisted respiration. Postoperative hemorrhage was observed in 5 patients and 2 of them needed hemostasis under thoracoscopy. Thoracoscopic thoracic duct ligation was performed in 1 patient due to the type Ⅲ chylothorax. TypeⅡ anastomotic leakage was found in 3 patients and 1 of them died of acute respiratory distress syndrome. One patient of delayed broncho-gastric fistula was cured after secondary operation. Ten patients with type Ⅰ recurrent laryngeal nerve injury were cured after conservative treatment. All patients were followe up for at least 16 months. The median follow-up time was 44 months. The 3-year survival rate was 71.8%, and the 5-year survival rate was 57.8%. Conclusion    The optimized MIILE with reverse-puncture anastomosis for the treatment of lower esophageal cancer is safe and feasible, and the long-term survival is satisfactory.