OBJECTIVETo explore the radicality, safety, feasibility and indication of right colectomy by laparoscopy-assisted surgery using three ports.

METHODSClinical data of 109 patients undergoing laparoscopy-assisted right colectomy in the Ruijin Hospital from 2013 to 2014 were retrospectively reviewed. Patients were divided into triple-port group(n=65, 3 ports) and traditional group(n=44, 4 or 5 ports). In the triple-port group, 21 cases were converted, including 14 cases added an additional port, 4 cases added 2 ports and 3 cases converted to laparotomy. The radicality, safety and feasibility were compared between the two groups. Difficulty of the triple-port procedure was summarized and the indication was concluded.

RESULTSNo significant differences were observed in specimen length, number of harvested lymph node, CME rate, time to resume fluids, postoperative hospital stay, morbidity of complication, reoperation rate, operation time, blood loss and incidental bowel damage between the two groups (all P>0.05). Among triple-port group, body mass index(BMI) and history of previous surgery were significantly different between those succeed and failed in the procedure [(22.4±2.9) kg/m(2) vs. (25.4±3.8) kg/m(2), P=0.001; 22.7%(10/44) vs. 47.6%(10/21), P=0.017], while other factors were not significantly different(all P>0.05).

CONCLUSIONSFor right-colectomy, triple-port and traditional laparoscopic procedures are comparable in terms of oncologic clearance, safety and feasibility. In selection of suitable patients for the triple-port procedure, BMI and history of previeus surgery should be considered.

Body Mass Index ; Colectomy ; methods ; Feasibility Studies ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Operative Time ; Reoperation ; Retrospective Studies

Objective T o analyze the influence of high flow nasal cannula (HFNC) on trespiratory mechanical parameters of the patient with acute respiratory distress syndrome (ARDS) based on ventilation experiment, and investigate the therapeutic and side effects of the HFNC. Methods The HFNC ventilation system model based on MATLAB and the physical experiment platform based on active simulated lung ASL5000 were developed to simulate the respiratory movement of ARDS patients with different lung compliance, and a series of the HFNC ventilation experiments were carried out. Both experimental results in MATLAB and physical platform were compared and analyzed. Results The results from the Matlab model-based simulation experiment and physical platform based-physical experiment uniformly showed that increasing the output flow of HFNC would decrease the relevant respiratory mechanical parameters of respiratory flow and tidal volume, but increase the intrapulmonary pressure and the functional residual capacity (FRC). Under the condition of small flow, the output flow from HFNC might be smaller than the inspiratory flow required by the patient, and an inspiratory compensation flow was necessary to make up for the inspiratory flow. Conclusions The necessary reliable compensation flow in inspiration will promote the security of HFNC. Understanding the changes in respiratory mechanical parameters of ARDS patient will be beneficial to pre-evaluate the HFNC, improve the ventilation effect and reduce the ventilation risks.

We reported the discovery of six novel coumarins, toddasirins A-F (1-6), each endowed with modified isoprenyl or geranyl side chains, derived from the roots of Toddalia asiatica. Comprehensive structural elucidation was achieved through multispectroscopic analyses, single-crystal X-ray diffraction experiments, and advanced quantum mechanical electronic circular dichroism (ECD) calculations. Furthermore, the anti-inflammatory activity of these compounds was assessed. Notably, compounds 1-3 and 6 demonstrated notable inhibitory effects on nitric oxide (NO) production in lipopolysaccharide (LPS)-induced RAW 264.7 cells, with 50% inhibitory concentration (IC₅₀) values of 3.22, 4.78, 8.90, and 4.31 μmol·L^-1, respectively.
Mice ; Animals ; Coumarins/chemistry* ; Rutaceae/chemistry* ; Anti-Inflammatory Agents/pharmacology* ; Plant Extracts/chemistry* ; RAW 264.7 Cells ; Nitric Oxide ; Molecular Structure

OBJECTIVETo explore the factors affecting the operative difficulty of triple-port laparoscopic surgery (TLS) in anterior resection.

METHODSA retrospective case-control study was carried out. Clinical and MRI imaging data of 106 colorectal cancer cases undergoing TLS anterior resection at Department of Colorectal Surgery of Ruijin Hospital between 2013 and 2016 were retrospectively analyzed.

INCLUSION CRITERIA(1) patients receiving TLS anterior resection (Dixon operation); (2) preoperative stageI( to III( malignant tumor;(3) distance of 5-15 cm from inferior margin of tumor to anal verge; and (4) available preoperative rectal MRI.

EXCLUSION CRITERIA(1) patients receiving preoperative adjuvant therapy; (2) patients with low rectal cancer or with local advanced disease; (3) T4b tumor. Rectal MRI was introduced to measure the structure of pelvis. In sagittal view, superior margin of the first sacral vertebrae, superior margin of the third sacral vertebrae, apex of coccyx, and the line of superior margin of pubic symphysis were used to form a pentagon. The 5 lines were marked as N, O, P, Q, R, and the 5 included angles were marked as angle 1, 2, 3, 4, 5. Organs (uterus and prostate) and tumor (transverse diameter, longitudinal diameter, section area, lesion length, distance to circumference cutting edge) were also measured on MRI. The operative time was applied to be the indicator of operative difficulty and patients were divided into 2 groups according to median operative time. Baseline information (age, gender, BMI, distance from inferior margin of tumor to anal verge, operative history, length of tumor), preoperative tumor staging, and MRI measurements (pelvis, tumor, uterus, prostate), etc were compared between two groups. Factors affecting operative difficulty of TLS were analyzed with logistic regression model.

RESULTSOf 106 enrolled patients, 73 were male and 33 female with mean age of (59.8±12.2) years and mean BMI of (22.8±3.3) kg/m; 25 patients had previous abdominal surgery; distance from inferior margin of tumor to anal verge was (7.4±2.0) cm and the tumor diameter was (3.7±1.4) cm; 24, 36 and 46 patients were in stage I(, II( and III( respectively. All operations were completed successfully. The median number of harvested lymph node was 13(11-16); the median length of distal resection margin was 2.5(2.0-3.1) cm; the median operative time was 2.0(1.5-2.6) hours; the median intraoperative blood loss was 50(0-100) ml; the median time to liquid diet was 4(3-5) days; the median hospital stay was 7(6-10) days. Ten cases (9.4%) developed complications within 30 days after surgery. Patients were divided into ≤2 h group and > 2 h group according to median operative time, and both groups had 53 patients. As compared to ≤2 h group, >2 h group had shorter distance from inferior margin of tumor to anal verge [(6.8 ± 1.5) cm vs. (8.0 ± 2.4) cm, t = 3.174, P = 0.004], lower ratio of (R+N)/(O+P)(1.61±0.27 vs. 1.73±0.19, t = 2.494, P = 0.014), larger transverse distance of tumor [(3.45±0.72) cm vs. (3.05±0.89) cm, t = 0.224, P = 0.027]. Multivariate logistic regression analysis showed the distance from inferior margin of tumor to anal verge was the independent factor affecting operative difficulty(OR=0.584, 95%CI:0.429-0.796, P = 0.001).

CONCLUSIONSSurgeons may have less difficulty in performing TLS anterior resection for patients with longer distance from inferior margin of tumor to anal verge. In preoperative assessment of operative difficulty of TLS, comprehensive evaluation should be performed. Distance from inferior margin of tumor to anal verge should be regarded as the main factor, and MRI (R+N)/(O+P) and transverse diameter of tumor should be used as important reference, leading to reasonable choice of cases for TLS and smooth pass of study curve.

Aged ; Anal Canal ; Case-Control Studies ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Rectal Neoplasms ; diagnostic imaging ; surgery ; Retrospective Studies ; Treatment Outcome