OBJECTIVE To investigate and analyze the application of prophylactic antibiotics in perioperative period in hospital and offer the scientific basis for reasonable usage and management of antibiotics through surveying the situation.METHODS Totally 120 cases under operation were investigated prospectively from Jan to Aug in 2007.RESULTS The rate of antibiotics usage was 100% among the 120 cases.40% of the patients received single antibiotic treatment,56% and 4% received 2 or 3 kinds of antibiotics combined therapy respectively.The rate of prophylactic usage was 80.3%,the rate of therapeutic one was 19.7%;50% of the patients treated with antibiotics had the duration of postoperative prophylaxis of 7 days or more,the longest one was 30 days.the antibacterials used in turns were cephalosporins,penicillins,lincomycin,macrolides and nitroimidazole.CONCLUSIONS The duration of antibiotic used after operation is too long and the rate of combined anti-infective drugs is too high.It means that their are some problems existed in prophylactic use of antibiotics during cardiovascular surgery at perioperative period in condition of extracorporeal circulation,it is necessary that the antibiotic administration should be standardized.

Objective To evaluate the short-term effectiveness of Amplatzer device closure for congenital heart diseases.Methods Under X-ray fluoroscopy or/and transthoracic echocardiography(TTE),percutaneous puncture of the femoral artery or vein was conducted and the Amplatzer occluder was passed through the catheter.Effectiveness evaluation by transthoracic echocardiography,electrocardiography(ECG),and X-ray examination was applied at 24 hours,1 month,6 months,and every 1 year after the procedure.Results In 1 case of perimembranous ventricular septal defect(VSD),the detachment of the Amplatzer occluder to the arch of aorta was due to an inadequate small size.This patient was immediately operated with successful removal of the device through the femoral artery and later underwent a re-deployment of a larger-sized Amplatzer occluder closure successfully.The remaining 29 patients with atrial septal defect(ASD),patent ductus arteriosus(PDA),or perimembranous ventricular septal defect underwent a successful deployment of the Amplatzer occluder on one session without complications.The operation time was 20~90 min (38?16 min),the X-ray exposure time was 5~45 min(18?10 min),and the length of hospital stay was 3~7 days(4?2 days).Conclusions Amplatzer occluder transcatheter closure of congenital heart diseases has advantages of simplicity of deployment,good safety,and high success rate.This procedure is suitable for patients with secundum ASD,membranous VSD,and PDA.

AIM: In vitro isolation and culture of esophageal epithelial cells are basic component of tissue-engineered esophagus. This study explored the method to culture esophageal epithelial cells for research on tissue-engineered esophagus. METHODS: The experiment was performed at experimental center of Lanzhou University from May to November 2007. Normal esophagus tissues, 2.0-3.0 cm, were harvested from patient with esophagus cancer by surgery. The informed consent was obtained from the patient. Esophageal epithelial cells for tissue engineering were obtained and passaged. The cells cultured by DMEM+F12 (1∶1) after 20 minutes, 1-4 days were observed by immunohistochemistry staining and inverted phase contrast microscope. The growth curve of cells was drawn by MTT method. RESULTS: The immunohistochemistry staining results showed that 90% of the cells were positive, which indicated the cultured cells were esophageal epithelial cells. Normal cells were big and globular, floating in the culture-medium. Cells began to adhere after 20 minutes, and most cells were polygon-like or irregular globular and adherent after 1 day; the cells began to cluster after 2 days; the cells grew at peak after about 3-4 days with abundant endochylema and large and spherical nuclear. Cells growth reached the peak after about 3 days of culture and its absorbance was significantly different compared with that on the 1st, 2nd, 5th, and 6th days (P

Objective To compare the clinical effectiveness of transcatheter domestic occluder with those of surgical closure of atrial septal defect (ASD) , and to evaluate the feasibility of transcatheter ASD closure using domestic occluder. Methods From January 2002 to December 2007,69 patients underwent transcatheter ASD closure using domestic occluder, and 123 patients underwent surgical closure were observed. The technical success rate,residual shunt rate,total complication rate,operative time,blood transfusion volume,length of hospital stay and clinical long-term results were compared. Results The technical success rate was 98. 6% in domestic occluder group,and the one unsuccessful patients underwent surgical closure in the other day. Complication included cardiac tamponade in 1 patient (1. 4%) , residual shunt in 1 patient (1.4%). All patients in surgical group were treated successfully, residual shunt in 2 patient (1. 6%), total complications were progressive hemothorax in 1, cerebral embolism in 1,pulmonitis in 2 patient,pulmonary atelectasis in 1 patient,hydrothorax in 2,and incisional infection in 5, the total complication rate were 9.8% . Long-term follow up shows that both groups had good clinical results. Conclusions Transcatheter closure of ASD using domestic occluder is an ideal procedure owing to its reliability and safety, with less complication than and same long-term results with the surgical group. It is an alternative to surgery within acceptable limits.

10.3969/j.issn.2095-4344.2013.23.016

Objective To evaluate the short-term outcomes and postoperative inflammatory cytokine changes in patients with lung cancer treated with robot-assisted thoracoscopic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS). Methods A total of 270 patients with lung cancer treated by minimally invasive surgery were selected for the study, and the surgical procedures were selected according to the patients' economic conditions and preferences. Among them, 132 patients completed the operation through RATS, and 138 patients completed the operation through VATS. The clinical data of the two groups were compared. Results All patients successfully completed radical lung cancer surgery, and no perioperative deaths were reported. Intraoperative bleeding, postoperative drainage time, postoperative hospital stay, number of lymph nodes dissected, and number of lymph nodes dissected groups were more advantageous in the RATS group compared with the VATS group (P < 0.05). In terms of operative time, total postoperative chest drainage, and hospitalization cost, the VATS group had an advantage (P < 0.05). The postoperative levels of CRP, PCT, IL-6, IL-8, IL-10, and TNF-α increased in both groups, compared with preoperative levels, and the increases in the RATS group were lower than those in the VATS group. Conclusion RATS offers technical and short-term efficacy advantages for the treatment of lung cancer but comes with the disadvantage of high cost. Post-operative inflammatory cytokine elevation is lower in the RATS group, and inflammatory response to the organism is less severe.

BACKGROUNDTo investigate the expression of vascular endothelial growth factor (VEGF) and its relation to clinical characteristics and prognosis of non-small cell lung cancer (NSCLC), and to study the possible mechanism of VEGF.

METHODSThe expression of VEGF and intratumoral microvascular density (MVD) were determined in 96 NSCLC tissues by SP immunohistochemical method.

RESULTSVEGF was mainly stained in the cytoplasm of tumor cells. The positive rate of VEGF expression was 64.6% in 96 patients. The positive rate of VEGF expression was related to stages (P=0.041), but not to other clinical characteristics of NSCLC (P > 0.05). The expression of VEGF in high MVD group (80.4%) was significantly higher than that in low MVD group (46.7%) (P=0.001). The patients with positive VEGF expression had a significantly shorter survival duration than those with negative VEGF expression (P < 0.01). By Cox proportional hazard model analysis, the expression of VEGF and clinical stage were considered the independent predictors for the prognosis of NSCLC.

CONCLUSIONSThe results suggest that VEGF plays an important role in the angiogenesis of NSCLC, and that detection of VEGF expression may be helpful to predict prognosis of NSCLC.

BACKGROUND AND OBJECTIVEWhether gemcitabine plus platinum chemotherapy is superior to gemcitabine or platinum single-agent chemotherapy for patients with non-small cell lung cancer (NSCLC) is still in dispute, and the aim of this study is to evaluate the efficacy and safety of gemcitabine combining platinum chemotherapy for patients with NSCLC.

METHODSWe searched relevant randomized controlled trials (RCTs) from VIP, CBM, CNKI, the Cochrane library, PUBMED and EMBASE. We traced the related references and experts in this field and communicated with other authors to obtain the information that has not been found. We made quality assessment of qualified RCTs assessed by the exclusion and inclusion criteria and used RevMan 5.0 provided by the Cochrane Collaboration to perform meta-analysis.

RESULTSFour RCTs were eligible and included 984 patients. Meta analysis results suggested that: compared with gecitabine single-agent chemotherapy, the combination had a statistically significant benefit in increasing the response rate (OR = 3.29, 95% CI: 1.79-6.05, P = 0.000 1) and 2-year survival rate (OR = 3.22, 95% CI: 1.45-7.12, P = 0.004) while increased the risk of the incidence of adverse reactions, especially the grade 3-4 thrombocytopenia (RR = 8.16, 95% CI: 1.71-39.07, P = 0.009); compared with cisplatin single-agent chemotherapy, the combination had a statistically significant benefit in increasing the response rate (OR = 3.51, 95% CI: 2.20-5.60, P < 0.01) and 1-year survival rate (OR = 1.67, 95% CI: 1.16-2.41, P = 0.006) while increased the risk of the incidence of adverse reactions, especially the grade 3-4 thrombocytopenia (OR = 28.55, 95% CI: 14.06-57.04, P < 0.01).

CONCLUSIONCompared with single-agent chemotherapy, the combining can significantly improve the efficiency and survival rate while increase the toxicity rare. The results still need to be proved by high quality RCTs.

Antineoplastic Agents ; adverse effects ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; mortality ; Deoxycytidine ; adverse effects ; analogs & derivatives ; therapeutic use ; Humans ; Lung Neoplasms ; drug therapy ; mortality ; Platinum ; adverse effects ; therapeutic use ; Treatment Outcome

Objective To systematically evaluate the effect of sequence of pulmonary artery and vein transection in thoracoscopic lobectomy on the efficacy and safety of patients with non-small cell lung cancer. Methods PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP and CBM databases were searched for the researches on The post-operative efficacy of pulmonary arteriovenous and pulmonary vein resection sequence in thoracoscopic lobectomy for non-small cell lung cancer. The retrieval time is from the database construction to May 2022. Meta-analysis was performed using RevMan 5.4 software. Results Eight articles were included, including 3 randomized controlled studies and 5 cohort studies, with a total of 1810 patients. Meta-analysis results showed that: The operative time (MD=13.34, 95%CI(7.36, 19.32), P < 0.0001) and intraoperative blood loss (MD=45.29, 95%CI(40.24, 50.35), P < 0.0001) in the group with priority pulmonary vein resection were significantly higher than those in the group with priority pulmonary vein resection. The difference was statistically significant. However, the benefits of OS (HR=1.34, 95%CI (1.12, 1.60), P=0.001) and DFS (HR=1.44, 95%CI(1.18, 1.76), P=0.0003) in the group of priority pulmonary vein transection were significantly better than those in the group of priority pulmonary artery transection, with statistically significant differences. Conclusion Priority pulmonary vein transection during thoracoscopic lobectomy effectively improved patients' OS and DFS, resulting in higher survival benefit for patients with non-small cell lung cancer, but intraoperative bleeding and operation time are more than those with priority pulmonary artery transection.

Objective:To investigate the safety and feasibility of endoscopic cholecystolithotomy after endoscopic ultrasonography (EUS)-guided lumen-apposing metal stent (LAMS) implantation in animals.Methods:Six miniature pigs of 30-35 kg were selected to laparotomy under intravenous anesthesia. Two to four sterile human stones with diameter of 0.8-2.0 cm were implanted in their gallbladder. After successful modeling, LAMS was implanted between the stomach and gallbladder under the guidance of EUS. Ultrafine endoscope was used to search and remove stones after passing the gastric stent into the gallbladder. Endoscopic sphincterotomy (EST) and endoscopic retrograde biliary drainage (ERBD) was performed to prevent bile leakage. And then ordinary endoscope was used to remove LAMS and close the wound. The success rate, operation time, and incidence of complications were analyzed.Results:Five pigs were successfully implanted with LAMS, and the ultrafine endoscope entered the gallbladder smoothly. Small stones were removed from the stone basket, and large stones were completely removed after laser lithotripsy. The total operation time was 87-128 min. No postoperative complications such as bleeding, perforation, infection, or biliary fistula were observed. Failure in 1 pig was due to the first EST plus ERBD, resulting in rapid reduction of gallbladder volume and away from the gastric cavity leading to puncture difficulties.Conclusion:Endoscopic cholecystolithotomy after EUS-guided LAMS implantation is safe and feasible, and may provide animal experimental evidence for potential therapeutic approach for patients with difficulty in cholecystectomy.