Education, Nursing, Continuing ; General Surgery ; education ; Humans ; Physicians

Objective To investigate the factors and rate of the forming of the collateral feeding arteries from inferior phrenic artery(IPA) in hepatocellular carinoma(HCC).Methods IPA was demonstrated on angiographs in 137 patients with HCC during transcatheter arterial chemoembolization(TACE),TACE was performed through diaphragmatic inferior artery(DIA) super setectively.Results Of 137 cases,21 cases underwent TACE through DIA(15.3%),of them 2 cases were recurrent after surgical operation(9.5%),3 cases had the tumor receive blood supply from IPA at first TACE(14.3%) and 16 cases were occured after TACE tow and more times(76.2%).Conclusion Collateral branches originated from IPA are important feeding arteries in HCC,TACE of IPA can be performed with a high success rate without major complications.

Objective To investigate the clinical value of pregnancy-associated plasma protein A (PAPP-A) in patients with acute coronary syndrome (ACS).Methods The study subjects comprised of 249 patients with ACS [ 50 patients with ST elevation acute myocardial infarction( STEMI),43 patients with non-ST elevation acute myocardial infarction (NSTEMI), 156 patients with unstable angina pectoris (UAP) ] from July 2008 to December 2009 at Shanghai East Hospital affiliated to Tongji University.The patients were divided into single-vessel lesions group,double-vcssel lesions group and three-vessel lesions group according to the coronary artery stenosis.A group of 205 healthy subjects admitted for health physical examination were used as conuols.Blood samples were collected from ACS patients and control subjects.Serum PAPP-A,creatine kinaseisoenzyme MB (CK-MB),high-sensitivity troponin-T (hs-TnT) were measured by clectrochemiluminesence and high-sensitivity C-reactive protein (hs-CRP) was measured by immune scatter turbidity method.Analysis of variance ANOVA and Kruskal-Wallis H test were used for statistical analysis.Results Serum PAPP-A in the STEMI,NSTEMI,UAP and normal control group were 10.45(5.54 - 16.08),6.56(4.68 - 9.55),5.70(4.12 - 8.50),5.23 (4.00 - 5.88) mIU/L,respectively,and the difference was statistically significant (H =43.94,P ＜ 0.01 ).Pairwise comparison showed that PAPP-A in STEMI,NSTEMI,UAP were significantly higher than the healthy control group and differences were statistically significant ( t =6.80,2.46,1.72,P ＜ 0.05 ).The PAPP-A had a sensitivity of 52.2％ and specificity of 80％ in diagnosis of ACS.The positive rate of PAPP-A was 44.5％ (69/155) in patients with negative hs-TnT.The serum levels of PAPP-A in the three-vessel lesions group [7.72(5.03 -12.46) mIU/L] was higher than that in the single,double groups [ 5.35 ( 4.14 - 8.59 ),6.05 (4.42 -9.58 ) mIU/L ],and the difference had statistical significance( t =2.00,1.57,P ＜ 0.05 ).There was obvious correlation between the level of serum PAPP-A and the level of hs-CRP ( r =0.524,P ＜ 0.05 ),and there was weak correlation between the PAPPA and CK-MB or hs-TnT (r=0.326,0.343,P＜0.05).Conclusions The results shows that PAPP-A is elevated in patients with ACS.It may be used as a serum biomarker for vulnerable plaques in patients with ACS and has a clinical value for ACS diagnosis especially in patients with negative hs-TnT.

Objective To explore the effects of acupuncture and individualized occupational therapy on the rehabilitation of patients with unilateral spatial neglect ( USN ) after stroke.Methods Stroke patients with hemiplegia were evaluated by neuropsychological tests,including line bisection,a cancellation test,clock drawing,and figure and shape copying.Sixty-nine right hemispheric stroke patients identified with USN were randomly assigned to 3 groups:20 patients as a control group received conventional rehabilitation therapy ; another 22 patients as an occupational group received type-specific individualized occupational therapy combined with conventional rehabilitation therapy; the remaining 23 patients as an acupuncture combined with occupational therapy group received acupuncture in addition to both conventional rehabilitation therapy and occupational therapy.These three groups were evaluated with neuropsychological tests and the modified Barthel index (MBI) before and after treatment.Results ①MBI scores in the occupational therapy group and the combined group were significantly higher after treatment,but no significant difference was observed in the control group.②The increased MBI scores in the combined and occupational groups were higher than those in the control group.At the same time the increase in MBI scores in the combined group was significantly greater than in the occupational therapy group.③The assessment results with both line bisection and cancellation tests in all three groups were significantly different after treatment.The line bisection results in the occupational therapy group and the combined group were significantly better than in the control group.The cancellation test results in the combined group were significantly better than in the control group.Conclusion These findings show that acupuncture combined with occupational therapy can have a positive effect on neglect recovery and greatly improve the daily life of USN patients.

Objective To comparatively analyze the clinical characteristics of thyrotropin-secreting pituitary adenomas (TSH-omas).Methods The clinical features, laboratory variables, imaging and pathological Results were retrospectively compared and analyzed of 26 cases with TSH-omas admitted in Chinese PLA General Hospital from Feb. 2006 to Oct. 2016 and 20 cases with TSH-omas admitted in Shanghai Huashan Hospital from Apr. 2006 to Apr. 2013.Results The female ratio was slightly higher in patients of Chinese PLA General Hospital than in Huashan Hospital [(57.7%(15/26)vs. 45.0%(9/20)], while the mean age was similar [39.5±14.1(18-67 years)vs. 40.0±14.5(17-74 years)]. The most common chief complaint was thyrotoxicosis [73.1%(19/26)vs. 55.0%(11/20)], and mild-to-moderate goiter was the most common symptom. The mean serum TSH levels in Chinese PLA General Hospital and in Huashan Hospital were 5.06(2.97-6.27)mU/L and 6.16(3.76-10.91)mU/L respectively, and patients with normal serum TSH levels were more common in Chinese PLA General Hospital than in Huashan Hospital [57.7%(15/26)vs. 40.0%(8/20)]. Microadenoma was more common in Chinese PLA General Hospital than in Huashan Hospital [34.62%(9/26)vs. 20.0%(4/20)], while macroadenoma was more common in Huashan Hospital than in Chinese PLA General Hospital [20.0%(4/20)vs. 7.7%(2/26)]. Microadenoma was more common in female patients of the both groups [66.7%(6/9)vs. 75.0%(3/4)], while macroadenoma was all found in male patients. Tumor invasion of surrounding tissue and structure was often found in macroadenoma. In terms of octreotide inhibition test, the range of 24h TSH inhibition rate was roughly the same in the two groups (37.4%-91.8% and 46.5%-94.1%, respectively). Mixed adenoma was rare among all the pathologically confirmed cases. In Chinese PLA General Hospitals, TSH immunoreactive negative neoplastic cells were found in 3 of 8 cases, and octreotide scanning showed negative in 2 of 12 cases.Conclusions Patients with TSH-omas in the two hospitals show similarities but also some significant differences in the clinical features. Overall, the domestic patients with TSH-omas are diagnosed without gender difference according to the reports in China. The mean age at diagnosis is significantly younger than that in foreign data. Microadenoma is more common in females, while macroadenoma is more common in males. Serum TSH levels can be normal in patients with TSH-omas. Immunostaining and/or octreotide scanning for TSH can be negative.

OBJECTIVETo evaluate the safety and efficacy of hand-assisted laparoscopic surgery (HALS) in colorectal tumors.

METHODSClinical data of 70 patients with colorectal tumors were retrospectively analyzed. All the patients had received HALS colectomy in the Beijing Cancer Hospital. Lapdisc was used for the hand port at the umbilicus. Two additional trocars were used.

RESULTSThere were 38 males and 32 females. The median age was 61(29-89) years. Diagnoses included sigmoid cancer(n=48), sigmoid adenoma(n=4), descending colon cancer (n=3), ascending colon cancer (n=1), rectal cancer (n=13), total colectomy(n=1). The operative time was (126.0±22.5) minutes. The intraoperative blood loss was (75.0±18.8) ml. The mean number of lymph node dissection was(16.8±4.2). The median postoperative hospital stay was 9.4 days. There were no perioperative deaths. One patient developed anastomotic stricture and two anastomotic leak, all of which were successfully managed with conservative treatment.

CONCLUSIONHALS is a safe and effective technique for colectomy.

Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms ; surgery ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo compare the safety and efficacy perioperatively between hand-assisted laparoscopic surgery (HALS) and conventional open sigmoidectomy.

METHODSProspectively collected data on 115 patients with sigmoid colon cancer between January 2009 to June 2010 were analyzed. There were 62 patients in the HALS group and 53 in the conventional sigmoidectomy group (CS). Patient characteristics, operative parameters, and perioperative outcomes were compared.

RESULTSHALS patients were similar to CS patients in age(60.2 yrs vs. 63.4 yrs, P=0.163), gender (53.2% vs. 60.4% male, P=0.441), tumor size (4.7 cm vs. 5.3 cm, P=0.114) and tumor stage. The two groups were comparable in operative time [(122.4±32.0) min vs.(126.7±37.4) min, P=0.510], lymph node harvest (15.1±4.6 vs. 16.8±6.4, P=0.163), free margin length [(4.1±1.8) cm vs.(4.3±1.7) cm, P=0.601], and postoperative complications. However, HALS group had less intraoperative bleeding [(62.6±35.4) ml vs. (168.9±137.1) ml, P=0.000], shorter time to flatus [(2.3±0.8) d vs. (3.3±1.1) d, P=0.000], and shorter hospital stay [(8.8±2.7) d vs.(12.6±8.0) d, P=0.001].

CONCLUSIONSHALS results in similar short-term outcomes compared to conventional surgery. HALS is safe and minimally invasive.

Colectomy ; methods ; Female ; Humans ; Laparoscopy ; methods ; Laparotomy ; Male ; Middle Aged ; Retrospective Studies ; Sigmoid Neoplasms ; surgery ; Treatment Outcome

Human tumstatin(hTumstatin)cDNA was amplified from recombinant plasmid pET-3c-tum, cloned in frame with the signal sequence in yeast vector pPICZalphaA and transformed into Pichia pastoris GS115 by electroporation. The expression of hTumstatin in GS115(pPICZalpha-tum)was then induced by methanol and secreted into the culture medium, with a yield of 25mg/L as shown by SDS-PAGE and Western blotting. The expressed hTumstatin was purified to more than 85% purity using a simple one-step SP-Sepharose cation exchange chromatography. The MTT and chick chorioallantoic membrane assay showed that the yeast produced hTumstatin could inhibit the proliferation of human umbilical vein endothelial cells and the neovascularization induced by bFGF. Hoechst 33258 fluorescent staining also demonstrated the apoptotic change in endothelial cellular nuclear morphology.
Angiogenesis Inhibitors ; metabolism ; Autoantigens ; genetics ; metabolism ; Cell Proliferation ; Cells, Cultured ; Collagen Type IV ; genetics ; metabolism ; DNA, Complementary ; genetics ; Electroporation ; Endothelial Cells ; cytology ; Humans ; Pichia ; genetics ; metabolism ; Recombinant Proteins ; genetics ; metabolism ; Umbilical Cord ; cytology

Objective To evaluate the clinical outcome of bleeding control by preoperative embolization of internal iliac artery with DSA and intra?operative presetting abdominal aorta balloon, combine with the operation techniques of exposure, reduc?tion and internal fixation of pelvic fracture through lateral?rectus approach. Methods From March 2012 to May 2015, 7 patients with type C3 pelvic fractures admitted to our department from March 2012 to May 2015, treated with preoperative embolization of internal iliac artery under digital subtraction angiography 2 h before surgery and presetting abdominal aorta balloon were retrospec?tively reviewed. There were 3 males and 4 females, with an average age of 34 years (range, 16 to 61 years). According to AO classi?fication, all 7 cases belonged to type C3 (3.2:5 cases;C3.3:2 cases), including 5 cases with limb fracture, 2 cases with craniocere?bral trauma, 4 cases with pulmonary contusion, 2 cases with injury of abdominsal organs. Time from injury to operation was 19 days on average (10 to 33 days). Patients received damage control surgery treatment including bleeding control and temporary ex?ternal fixation, and ipsilateral tractions with heavy weight, intensive care and corrections of general situation before operation. The fracture model was manufactured by 3D printing and fracture reduction was simulated on computer preoperatively. Embolization of internal iliac artery was performed in the side of severe displaced sacroiliac joint with DSA 2 hours preoperatively. Reduction was performed to stabilize anterior-posterior pelvic ring and acetabular fractures via the intraoperative lateral?rectus approach. And 2 cases were performed by temporary balloon occlusion of abdominal aorta (≤60 min) for bleeding control in reduction of in the side of sacroiliac joint fractures. Results All the 7 cases had undergone the operations successfully, and the operating time was from 135-320 min with blood loss from 440-3 350 ml. According to Matta radiological evaluation postoperatively, reduction of pelvic fracture was rated as anatomic in 5 cases, satisfactory in 2, without complications. All 7 cases were complicated with lumbosacral plexus injury or lumbosacral trunk injury at different degrees (M0 2 cases, M1 2 cases, M2 2 cases, M3 1 case). According to the BMRC scoring system, 5 cases had well recovered and the other 2 cases had no improvement after three months (M4 2 cases, M5 3 cases). Conclusion Surgical management of pelvic fracture through preoperative internal iliac artery embolization and intra?oper?ative occlusion of abdominal aorta could effective control bleeding and achieve favorable conditions for reduction. Lateral?rectus approach can provide adequate exposure of the anterior and posterior ring, and this approach could also provide excellent visual control of reduction and fixation.

OBJECTIVETo study the clinical data and surgical treatment strategy of rectal neuroendocrine carcinoma (NEC).

METHODSSixteen cases of rectal NEC and 222 cases of rectal carcinomas receiving surgical treatment in Beijing Cancer Hospital from 2003 to 2007, were analyzed retrospectively.

RESULTSAmong the 16 rectal NEC patients, 4(25%) received Miles surgery, 7(43.8%) Dixon surgery, 2 combined multiple organ resection and 3 local resection. Lymph note metastases occurred in 11 cases(68.8%) and distant metastases in 7 cases (43.8%). Among the 222 rectal carcinoma patients, 43(19.4%) received Miles surgery, 152(68.5%) Dixon surgery, 12 palliative operation, 6 colostomy and 9 just received laparotomy. Lymph note metastases occurred in 125 cases (56.3%). In rectal NEC group, postoperative 1-, 2- and 3-year survival rates were 62.5%, 25.0% and 0.63% respectively, which were significantly lower than 83.1%, 61.7% and 46.1% in rectal carcinoma group(all P<0.01).

CONCLUSIONSRectal NEC is a rare disease. More vascular invasion, lymph node and distant organ metastases are found in rectal NEC than rectal carcinoma, and the prognosis of rectal NEC is worse than rectal cancer.

Adult ; Aged ; Carcinoma, Neuroendocrine ; drug therapy ; pathology ; surgery ; Chemotherapy, Adjuvant ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Rectal Neoplasms ; drug therapy ; pathology ; surgery ; Retrospective Studies ; Survival Rate ; Young Adult