Objective To investigate the efficacy and safety of laparoscopic repair of paraesophageal her-nia. Methods Sixty-one patients underwent laparoscopic repair of paraesophageal hernia, all having laparo-scopic Toupet fundoplication. Results Laparoscopic repair of paraesophageal hernia was completed success-fully in all the 61 patients. The average operation time was 110 min and the blood loss 10～50 ml. Postopera-tive oral feedings were resumed 24～48 h after surgery, and no postoperative complication occurred. The me-dian postoperative hospital stay was 5.7 d. Conclusion Laparoscopic repair of paraesophageal hernia is an effective and safe surgical procedure of minimal invasion.

Gastroenterology ; Humans ; Integrative Medicine

[Objective]To investigate the inhibitory effect and mechanism of the microRNA-320d(miR-320d)on epithelial mesenchymal transition in endometrial carcinoma JEC cells.[Methods]JEC endometrial carcinoma cell lines were transfected with miR-320d mimics or negative control mimic,respectively,as M320d or NCM group. Control group was established with untreated JEC endometrial carcinoma cells. miR-320d content in each group was detected by RT-PCR method. Transwell assay was used to detect the migration and invasion ability of the 3 groups. Western-blot assay was used to detect the expressions ofα-Catenin,E-cad-herin,Vimentin and PBX3 protein in 3 groups. Antagonistic effect of PBX3 overexpression on miR-320d inhibition of EMT was detect-ed by western blot assay. The relationship between miR-320d and PBX3 was detected by dual luciferase assay.[Results]The expres-sion level of miR-320d in M320d group was significantly up-regulated,and the expression level of miR-320d was 808.25 ± 15.58 times higher than that of control group(P<0.05). The number of migrating cells in M320d group was 29.56 ± 0.59,which was signif-icantly lower than that of control group at 94.48 ± 1.02(P < 0.05). The number of invasive cells in M320d group was 7.33 ± 0.84, which was significantly lower than that of group control 86.28 ± 3.51(P < 0.05). Compared with control group ,the expression of α-Catenin and E-cadherin protein was significantly increased ,the expression of Vimentin protein was significantly decreased ,and the expression of PBX3 protein was significantly decreased. After PBX3 overexpression,the expression ofα-Catenin and E-cadherin protein were significantly decreased,the expression of Vimentin protein were significantly increased. Dual luciferase assay showed that PBX3 is a downstream target gene of miR-320d(P<0.05).[Conclusion]miR-320d may inhibit the expression of EMT related protein through the downstream target gene PBX3 and inhibit the epithelial mesenchymal transition function of endometrial carcinoma JEC cells.

Objective To explore the risk factors for clinical anastomotic leakage after resection of rectal cancer in China. Methods By meta-analysis we made a comprehensive analysis of the risk factors for clinical anastomotic leakage after resection of rectal cancer based on 19 articles published in China between January 1999 and January 2009. Results The anastomotic leakage rate was higher in the patients aged 60 years old and above than in those younger, with the combined odds ratio (OR) value being 0.50 (95% CI: 0.33-0.76) (P<0.01). The incidence rate was higher in the male patients than in the female ones, with the combined OR value being 2.17 (95% CI: 1.38-3.42) (P<0.01). The incidence rate in the patients with the distance of tumor from the lower margin to anal verge being 7cm and shorter was higher than that with longer distance, with the combined OR value being 1.79 (95% CI: 1.37-2.35) (P<0.01). The incidence rate in the patients who had received radiotherapy preoperatively was higher than that in those who had not, with the combined OR value of 3.66 (95% CI: 2.19-6.09) (P<0.01). The incidence rate in the patients who had received stapler anastomosis was higher than that in the patients who had received manual anastomosis, with the combined OR value being 0.70 (95% CI: 0.47-1.05), but there was no significant difference between them (P>0.05). The incidence rate was higher in the patients with diabetes mellitus than in the healthy ones, with the combined OR value being 3.16 (95% CI: 2.27-4.39) (P<0.01). The incidence rate was lower in the patients with Dukes A and B stages than in those with Dukes C and D stages, with the combined OR value being 0.61 (95% CI: 0.45-0.83) (P<0.01). The incidence rate in the patients with high malignance degree in clinicopathological types was higher than that with low malignance degree, with the combined OR value being 2.17 (95% CI: 1.38-3.42) (P<0.01). The incidence rate was lower in the patients who had received preventive colostomy than in those who had not, with the combined OR value being 0.39 (95% CI: 0.14-1.05), but there was no significant difference between them (P>0.05). The incidence rate was higher in the patients who had got selective operation than in those who had got emergency operation, with the combined OR value being 0.27 (95% CI: 0.13-0.56). Conclusion The risk factors of anastomotic leakage after resection of rectal cancer are as follows: 60 years old and above, male patients, diabetes mellitus, preoperative neo-adjuvant radiotherapy, the distance of tumor from the lower margin to the anal verge being shorter than 7cm, Dukes C and D stages, high malignance degree in clinicopathological types, and emergency operation.

ObjectiveTo investigate the association of nonalcoholic fatty liver disease (NAFLD) with insulin resistance and dyslipidemia in patients with type 2 diabetes mellitus,and to analyze the risk factors.Methods A total of 200 patients with type 2 diabetes mellitus including 99 with NAFLD and 101 without NAFLD were recruited.Height,weight,waist circumference,hip circumference,liver enzymes,blood lipids,fasting and postprandial blood glucose,insulin,C-peptide,and HbA1C levels were detected.Body mass index ( BMI),waist-hip ratio( WHR),and improved insulin and C-peptide index(HOMA-C-peptide) were calculated and compared between two groups.ResultsCompared with non-NAFLD group,weight,BMI,waist circumference,hip circumference,alanine aminotransferase ( ALT),aspartate aminotransferase,triglyceride ( TG ),total cholesterol ( TC ),low density lipoprotein-cholesterol(LDL-C) were significantly higher in NAFLD group( all P＜0.01 ),while age,duration,and high density lipoprotein-cholesterol were lower( all P＜0.05 ).The incidence of combined hyperlipidemia,especially hypertriglyceridemia,was significantly higher in NAFLD group( P＜0.01 ).Fasting and postprandial 1 h blood glucose [ ( 2.07 ±0.36 vs 1.83 ±0.43 ) mmol/L,( 14.04 ± 3.96 vs 12.59 ± 3.90 ) mmol/L ],fasting and postprandial 1 h Cpeptide [ (2.79± 1.15 vs 2.08±1.29 ) ng/ml,( 1.33 ±0.45 vs 1.12±0.54) ng/ml ],HbA1C [ (2.09±0.33 vs 1.96±0.28) ％ ],and HOMA-C-peptide index were significantly increased in NAFLD group ( P ＜ 0.05 or P ＜ 0.01 ).Logistic analysis showed that TG,BMI,and ALT were the major risk factors of NAFLD in type 2 diabetes mellitus( P＜0.05 or P＜0.01 ).ConclusionTriglyceridemia,obesity,and raised ALT level were significantly associated with an increased risk of NAFLD in patients with type 2 diabetes mellitus.

BACKGROUND:Hidden blood loss is an important risk for the intertrochanteric fracture patients, especial y the elderly patients, which can cause anemia in patients after internal fixation and can affect wound healing and patient recovery. OBJECTIVE:To compare the perioperative hidden blood loss and the risk factors of proximal femoral anti-rotation intramedul ary nail internal fixation and dynamic hip screw fixation for the treatment of femoral intertrochanteric fracture. METHODS:We selected 70 cases of femoral intertrochanteric fracture patients who treated with proximal femoral anti-rotation intramedul ary nail and dynamic hip screw fixation, including 21 patients with the age ≥ 80 years and 49 patients with the age<80 years;28 patients with the body mass index>30 kg/m2 and 42 patients with the body mass index ≤ 30 kg/m2;30 patients received anti-rotation intramedul ary nail internal fixation and 40 patients received dynamic hip screw fixation. The perioperative blood loss was calculated with Gross formula according to the changes of height, body mass index and the hematocrit before and after fixation. RESULTS AND CONCLUSION:The mean total blood loss was 936 mL, the mean dominant blood loss was 237 mL and the mean hidden blood loss was 699 mL. The hidden blood loss was accounted for 74.7%in total blood loss. The dominant blood loss in the dynamic hip screw fixation group was higher than that in the anti-rotation intramedul ary nail internal fixation group, and the hidden blood loss was lower than the anti-rotation intramedul ary nail internal fixation group. The total blood loss and the hidden blood loss of the elderly patients were higher than those of the non-elderly patients;there was no significant difference between male and female patients, obesity and normal patients. The results indicate that hidden blood loss is the major reason for total blood loss of femoral intertrochanteric fracture after internal fixation. The hidden blood loss of anti-rotation intramedul ary nail internal fixation is larger than that of dynamic hip screw fixation, and elder is the risk factor for hidden blood loss.

Objective To assess the clinical significance of the application of computer assisted navigation technology in excision for sacrum tumor.Methods From December 2007 to June 2009,13 patients with sacrum tumor were treated with computer navigation assisted aggressive curettage.There were 5 males and 8 females.aged 21 to 69 years,with the mean age of 44 years,10 cases were over the level of sacrum3 and 3 cases under the sacrum3.Pathologic diagnosis was chordoma in 7 cases.giant cell tumor in 4 cases and neurofibroma in 2 cases.Five cases were recurrence.The preoperative data of CT and MRI were input into the computer navigation workstation.CT images determined the scope of the invasion of tumor in bone tissue.MRI determined the scope of the invasion of tumor in soft tissue.The CT and MRI image fusion identified the precise boundaries of the tumor in CT images and made markers for navigation guidance in the operative in 10 cases.The Iso-c scan had been made for another 3 cases and fused the Iso-c images with preoperation CT images for improving the images quality.According to preoperative marker in CT images,the aggressive curettage were completed with the real time computer navigation for 7 cases,marginal resection in 4 cases and wide resection in 2.The precise surgical removal of the lesions boundary were verified by computer navigation according to the preoperative planning.Results Thirteen patients were followed up for 7 to 37 months,an average of 18 months,no recurrence cases with marginal resection and wide resection.Two cases with aggressive curettage had recurrence.Conclusion Computer navigation technology helps to precise excision the sacrum tumors,to reduce the recurrence rate.

Purpose To investigate the relationship between maximum standardized uptake value (SUVmax) of 18F-FDG PET/CT and clinical features of tongue squamous cell carcinoma (TSCC),in order to provide better PET/CT results for clinical guide.Materials and Methods Fifty-two patients with pathologically confirmed TSCC who accepting PET/CT examination before surgery were retrospectively analyzed.Single-factor analysis and multiple regression analysis were conducted on possible factors influencing primary tumor SUVmax,including gender,age,smoking history,tumor location,tumor size,TNM stage,T stage and N stage.Results Single-analysis showed that SUVmax was correlated with gender,tumor location,tumor size,TNM stage,T stage and N stage (P＜0.05),and was not correlated with tumor differentiation,smoking history and age (P＞0.05).Multivariate linear regression analysis showed that gender,tumor location,tumor size,T stage and N stage were independent influencing factors of primary tumor SUVmax (P＜0.05).Primary tumor SUVmax had predictive value for lymph node metastasis.When the cutoff value was 6.57,the diagnostic efficiency was the highest,the sensitivity was 79.2％ and the specificity was 85.7％.Conclusion TSCC 18F-FDG PET/CT SUVmax is higher among male patients with tongue base tumor location,larger tumor size and lymph node metastasis.Primary tumor SUVmax is of important significance in predicting lymph node metastasis.

Purpose To investigate the application value of 18F-FDG PET/CT in the diagnosis and staging of tongue cancer,in order to improve the accuracy of preoperative staging.Materials and Methods The 18F-FDG PET/CT findings of 52 patients with pathologically confirmed tongue cancer were retrospectively analyzed.The tumor location,size,FDG metabolic characteristics and tumor staging were observed,and compared with postoperative pathology.Results PET/CT showed that most patients were at middle or late stage when initially diagnosed (28/52).The lesions were mostly located on middle or middle-back region of tongues,and the average SUVmax was 6.81 ± 3.81.The sensitivity of PET/CT diagnosing tongue cancer was 94.2％.There was no significant difference in SUVmax between high,medium-high and medium differentiated tongue cancer primary lesions (P＞0.05).The SUVmax of tongue cancer at stage Ⅲ and Ⅳ was obviously higher than that at stage Ⅰ and Ⅱ,and the difference was statistically significant (P＜0.008).The diagnose and staging of tongue cancer using preoperative PET/CT and postoperative pathology were in excellent consistence (Kappa=0.859,P＜0.01).The staging accuracy reached 90.4％ (47/52).Conclusion Higher SUVmax value indicates worse tongue cancer staging,but it is of little significance in predicting differentiation.PET/CT can provide an objective imaging basis for preoperative diagnosis and accurate staging of tongue cancer.

Objective To investigate the effect of acute myocardium ischemic on heart function of pregnancy rat.Methods 13 female SD rats and 6 early pregnancy rats were divided into normal group, unpregnant group with acute myocardial infarction and early pregnant group with acute myocardial infarction. The anterior branch of the left coronary artery was ligated. 3 weeks later, Image 1.31 software was used to measure areas of myocardial infarction,and to evaluate hemodynamics of heart with powerLAB4.12, and cardiac tissues were stained with Massion. Results Compared with unpregnant group with acute myocardial infarction , the early pregnant group with acute myocardial infarction had less myocardial infarction area (28. 86% vs. 36. 8%), and had a higher left ventricle end systolic pressure, ±dp/dt max, and lower left ventricle end diastolic pressure. Massion stain showed the amount of collagen of the lesion was less in the early pregnant group with acute myocardial infarction than that in unpregnant group.Conclusion The early pregnant group with acute myocardial infarction had better heart contractive and diastolic function.