Objective To compare the clinical effect of unarmed cardiopulmonary resuscitationand cardiopulmonary resuscitationmachine in the emergency room.Methods One hundred cases patients with cardiopulmonary arrest in Hainan Agricultural Reclamation General Hospital from February 2014 to February 2016 were analyzed.The control group(n=50) were given unarmed cardiopulmonary resuscitation,while thetest group(n=50) were given ardiopulmonary resuscitation machine.Two groups' before and after cardiopulmonary resuscitation of arterial blood gas index(oxygen saturation (SaO2),C02 partial pressure (PaC02),oxygen partial pressure(Pa02)),cardiopulmonary resuscitation effectiveness and the success rate,and complications were compared.Results Before cardiopulmonary resuscitation,there were no significant differences on arterial blood gas index (SaO2,PaCO2,PaO2) between the two groups (t =0.069,0.097,0.121,P ＞ 0.05).After cardiopulmonary resuscitation,the SaO2,PaO2 of the test group were higher than that of the control group ((98.60± 8.51) ％ vs.(86.37 ± 7.84) ％,(13.84 ± 1.40) kPa vs.(8.69± 1.21) kPa),while PaCO2 of test group was lower than the control group ((3.24 ± 0.56) kPa vs.(6.41 ± 0.87) kPa),the differences were significant(t =7.474,21.665,19.679,P ＜ 0.05).The cardiopulmonary resuscitation of effective rate,success rate of test group were higher than the control group (84.00％ (42/50) vs.62.00％ (31/50),26.00％ (13/50)vs.10.00％(5/50),x2=6.139,4.336,P＜0.05).The total complication rate of the test group was lower than the control group(8.00％ (4/50) vs.28.00％ (14/50)),the difference was significant (x2 =6.775,P ＜0.05).Conclusion The clinical effect of cardiopulmonary resuscitation machine is significantly superior to unarmed cardiopulmonary resuscitation,which can effectively improve the patient's arterial blood gas state,improve the efficiency and success rate of cardiopulmonary resuscitation,and reduce the complications.

BACKGROUND: The super-hydrophobic surface exhibits excellent super-hydrophobic property, which attracts more attention in anti-coagulation property study. However, the test result is differing from the expectation.OBJECTIVE: To summarize the research status of super-hydrophobic effects on anti-coagulation.METHODS: The web of science database was retrieved with key words of "super-hydrophobic surface; blood compatibility; platelet adhesion; protein adsorption" to search papers concerning anti-coagulation property of super-hydrophobic surface. A total of 37 papers were initially searched by computer. According to the inclusive criteria, 20 papers were initially in this review. RESULTS AND CONCLUSION: Through thorough analyzing different test methods of platelet adhesion used by present researchers, including in vitro static platelet adhesion, in vitro blood circulation experiments and in vivo animal experiments, we find that it may be not accurate and objective to obtain the conclusion of the super-hydrophobic surface possessing positive effect on anti-coagulation only by statically testing platelet adhesion in vitro. In order to confirm whether the super-hydrophobic luminal surface has anti-coagulating property, analysis of the blood deposition onto the luminal surface after in vitro circulation experiments and in vivo implantation experiments must be performed.

Objective To investigate the methods of isolation,culture,identification and labeling of mesenchymal stem cells(MSCs) in vitro and lay a foundation for further study on intervention of MSCs on immunologic rejection of organ transplantation. Methods MSCs were isolated and cultivated by adherent methods . The expressions of CD90 and CD45 of cells were analyzed by using flow cytometry in order to identify MSCs.The third generation of MSCs were labeled by DAPI,the labeling efficiency was detected.Results Primary cultured MSCs adhered to plastic surface within 48 h and reached 90% confluence within 7-10 d .Flow cytometry showed that the positive rates of CD90 and CD45 of MSCs at third generation were 99.8% and 6.8%. MSCs expressed CD90 but no CD45.All of the MSCs after labeling by DAPI showed blue fluorescence by immunofluoroscope. DAPI labeling was sensitive and highly efficient to MSCs.Conclusion Adherent method is simple and easy to isolate and cultivate MSCs and it can serve as a routine method.DAPI labeling can be used as a efficient method to label MSCs.

Objective To investigate the effects of inhaled low dose nitric oxide(NO)on lung ischemia-reperfusion injury during flush and delayed 10 min after reperfusion.Methods Sixty health a- dult male Sprague-Dawley rats were randomly allocated to the control and the NO group.Before the donor lung was harvested,the right hilus was clipped for 5 min(clipping test),then blood sample was collected from carotid artery for arterial blood gas analysis as baseline.Lung transplantation was per- formed in a“cuff-like”vessel anastomosis technique.Dynamic compliance(Cdyn)and resistance of airway(Raw)were monitored before operation(baseline)and after 2-h reperfusion.The graft's gas exchange and oxygenation were assessed by“clipping test”after 2-h reperfusion.The lung graft was harvested for measuring wet/dry weight ratio(W/D),the activity of myeloperoxidase(MPO)and in- ducible nitric oxide synthase(iNOS),the content of malonyldialdehyde(MDA),and the expression of iNOS gene and protein.Results After 2-h reperfusion,compared to the control group,PaO_2/FiO_2, OI,and Qs/Qt were improved significantly in the NO group(277?91 vs.157?47,P＜0.01;2.67?0.89 vs.4.72?1.48,P＜0.01;21.1?4.57 vs.27.1?2.37,P＜0.01,respectively).The activi- ties of MPO were significantly reduced in NO group(1.80?0.46 vs 3.08?0.65 U/g tissue,P＜0.01).The content of MDA in the lung tissue of NO group was significantly higher than that of the control group(34.8?7.9 vs.20.0?11.2 nmol/mg protein,P＜0.05).Inflammatory cell infiltration was also significantly reduced(P＜0.05).The expression of iNOS gene and protein in the lung tissue of NO group was significantly lower than that of the control group.The activities of iNOS were also significantly reduced in NO group(10.6?10.2 vs 97.8?82.2 nmol?g~(-1)?min~(-1),P＜0.05).The im- munohistochemical positive staining of iNOS was localized in the alveolar epithelial cells and the in- flammatory cells infiltrated in the alveolar spaces and mesenchymal tissue.But there were no signifi- cant differences between two groups in Cdyn,Raw and W/D ratio.Conclusion Inhaled low dose NO might mitigate the intrapulmonary shunt,prevent neutrophil sequestration,inhibit the expression of iNOS gene and protein in isograft,thereby ameliorate ischemia-reperfusion injury and improve the ox- ygenation of the graft.

ObjectiveTo investigate the recent treatment result and the toxic responses of chemoradiotherapy with lobaplatin and paclitaxel in advanced esophageal carcinoma. MethodsFrom April 2010 to May 2011, 26 initial treatment patients withadvanced esophageal carcinoma were enrolled. The chemotherapy consisted of paclitaxel (135 mg/m2) on day 1 and lobaplatin (35 mg/m2) on day 2,and one cycle continued 21 days. Radiotherapy started on the second day after the fist cycle of chemotherapy. The median total dose was 60 Gy (2 Gy/Fraction,30 fractions,completed in 6 weeks).ResultsThere were 52 cycles in all and mean 2 cycles per patient.CR occurred in 7 patients (26.9 ％),PR in 17 patients (65.4 ％) and SD in 2 patients (7.7 ％).The total effective rate was 92.3 ％ (CR+PR).The toxic responses mainly represented as following,myelotoxicity principally showed leucopenia at grade Ⅰ - Ⅱ occurred 46.1％ (12/26) and at grade Ⅲ-Ⅳ 46.1％ (12/26),thrombopenia at grade Ⅰ - Ⅱ occurred 30.8 ％ (8/26) and at grade Ⅲ-Ⅳ 7.7 ％ (2/26),hypohemoglobinemia at grade Ⅰ - Ⅱ occurred 42.3 ％ (11/26) and at grade Ⅲ 15.4 ％ (4/26).Baldness occurred 84.6 ％(22/26). Pain of muscles or arthralgia occurred 69.2 ％(18/26). Responses of gastrointestinal tract at grade Ⅰ - Ⅱ occurred 11.5 ％ (3/26).Radiation induced esophagitis occurred 88.5 ％ (23/26) and tracheitis 19.2 ％ (5/26).ConclusionThe toxic responses of concurrent chemoradiaotherapy with lobaplatin and paclitaxel in advanced esophageal carcinoma are tolerant, and the recent treatment result is good.Further study is needed.

OBJECTIVETo compare the perioperative complications between Ivor-Lewis approach and McKeown approach in minimally invasive esophagectomy and gastric tube reconstruction for the treatment of middle and lower thoracic esophageal cancer.

METHODSRetrospective analysis of clinical data was performed on 288 patients with middle and lower thoracic esophageal cancer who underwent completely minimally invasive esophagectomy by one surgical team in Fujian Medical University Union Hospital from December 2010 to March 2014. Among the 288 patients, 103 patients underwent combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis using a transoral anvil(Orvil)(Ivor-Lewis group, 2-incision) and 185 patients underwent combined laparoscopic and thoracoscopic esophagectomy and cervical anastomosis(McKeown group, 3-incision). Patients were stratified by surgical approach and perioperative outcomes were compared between the two groups.

RESULTSThere were no statistical differences between two groups in intra-operative blood loss, conversion to open, extubation time, time to resume oral intake, postoperative hospital stay, the median number of lymph nodes resected. The operation time of Ivor-Lewis group was significantly shorter than that of McKeown group [(283.4±32.0) min vs. (303.6±43.7) min, P=0.003). The hospital cost of Ivor-Lewis group was significantly higher than that of McKeown group [(76 492±18 553) yuan vs. (68 923±17 331) yuan, P<0.01]. There were no statistical differences between two groups in chylothorax, delayed gastric emptying, atrial fibrillation, postoperative bleeding, admission to ICU, short-term postoperative mortality (P>0.05). The total postoperative complication morbidity of Ivor-Lewis group was significantly lower than that of McKeown group(16.5% vs. 31.4%, P<0.01). Ivor-Lewis group had lower pulmonary complication(8.7% vs. 25.9%, P<0.01), anastomotic leakage(1.9% vs. 13.0%, P<0.01), anastomotic stricture (0% vs. 4.9%, P<0.05), recurrent laryngeal nerve injury(1.0% vs. 7.0%, P<0.05).

CONCLUSIONIvor-Lewis approach is associated with less postoperative complications, but higher cost as compared to McKeown approach in the treatment of middle and lower thoracic esophageal cancer.

Anastomosis, Surgical ; Anastomotic Leak ; Blood Loss, Surgical ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Laparoscopy ; Length of Stay ; Minimally Invasive Surgical Procedures ; methods ; Operative Time ; Postoperative Complications ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies

OBJECTIVETo study the mechanism of delayed emptying indigestible solids in thoracic stomach after the resection of esophageal cancer by monitoring the variety of antropyloroduodenal migrating motor complex (MMC) during interdigestion.

METHODSEsophagectomy and gastroesophagostomy in the neck was performed in 5 men with esophageal cancer. An eight-lumen manometric sleeve assembly was passed through a nostril into the duodenum during operation. The sleeve was astride the pylorus. Antropyloroduodenal manometry was performed for at least 300 min with a polygraphic system (PC POLYGRAF HR) 7 - 11 days after operation.

RESULTSTwenty-eight MMCs were recorded in the pylorus and duodenum, 12 MMC(s) in the antrum, and 33% (4/12) of the motility frequency of antral phases III started after that of pyloroduodenal phases III. The number of MMC in the antrum was lower than that in the duodenum after the operation. The mean duration of MMC of the antrum, pylorus and duodenum was (49.2 +/- 10.5) min, (46.5 +/- 10.4) min and (45.9 +/- 10.0) min respectively. The mean duration of phases III was respectively (6.7 +/- 3.5) min in the antrum, (10.0 +/- 3.5) min in pylorus, and (8.0 +/- 3.9) min in duodenum. The mean wave amplitude of phases III was respectively (83 +/- 30) mm Hg in the antrum, (60 +/- 12) mm Hg in pylorus, and (55 +/- 4) mm Hg in duodenum. The mean duration of MMC of the antrum and duodenum was shorter in patients than that in healthy volunteers, and the mean wave amplitude of phases III of the antrum was lower in patients than that in healthy volunteers.

CONCLUSIONSDiminution of the number of MMC and the mean wave amplitude of phases III in the antrum, incoordination of the antropyloroduodenal phases III should be the most important one of the mechanisms of delayed emptying of indigestible solids in thoracic stomach after the resection of esophageal cancer.

Duodenum ; Esophageal Neoplasms ; Gastric Emptying ; Gastrointestinal Motility ; Humans ; Manometry ; Pylorus

OBJECTIVETo explore the application of mesoesophagus suspension technique to improve the upper mediastinal lymph node dissection during thoracoscopic esophagectomy in the treatment of esophageal cancer.

METHODSClinical data of 164 thoracic esophageal cancer patients who underwent combined thoracoscopic and laparoscopic esophagectomy with two-field lymph node dissection in the Union Hospital of Fujian Medical University between October 2012 and June 2015 were retrospectively analyzed. Among 164 patients, 80 cases underwent upper mediastinal lymph node dissection by traditional method (traditional group), and the remaining 84 cases underwent upper mediastinal lymph node dissection by mesoesophagus suspension technique (suspension group). The operation time, estimated blood loss, number of excised lymph nodes and postoperative complications were compared between the two groups.

RESULTSThere were no significant differences in gender, age, location of tumor and pathology stage between the two groups. The operation time in the two groups was similar. The suspension group had significantly less thoracic blood loss than traditional group [(85±5) ml vs.(140±7) ml, P=0.000]. The number of dissected lymph nodes of bilateral recurrent laryngeal nerve was more in suspension group [median (interquartile range): left: 3 (2 to 4) vs. 2 (1 to 3), P=0.013; right: 3(2 to 6) vs. 2(1 to 3), P=0.007]. There was no significant difference in metastatic rate of lymph node in different sites between the two groups. The highest metastatic rate of suspension and traditional group was found at paracardia lymph nodes[22.6%(19/84) and 22.5%(18/80)], the next was at right laryngeal nerve lymph nodes [17.9%(15/84) and 15.0%(12/80)] and left laryngeal nerve lymph nodes [16.7%(14/84) and 12.5%(10/80)]. There were no significant differences with regard to the incidence of major postoperative complications between two groups, including respiratory complication, anastomotic leakage, vocal cord palsy.

CONCLUSIONSUpper mediastinal bilateral recurrent laryngeal nerve lymph node is the predilection site of lymphatic metastasis of thoracic esophageal cancer. Application of mesoesophagus suspension technique in thoracoscopic esophagectomy can improve the clearance quality of bilateral recurrent laryngeal nerve lymph nodes.

Anastomotic Leak ; Blood Loss, Surgical ; Esophageal Neoplasms ; surgery ; Esophagectomy ; adverse effects ; methods ; Female ; Humans ; Laparoscopy ; Lymph Node Excision ; adverse effects ; methods ; Lymph Nodes ; anatomy & histology ; pathology ; surgery ; Lymphatic Metastasis ; physiopathology ; Male ; Mediastinum ; surgery ; Operative Time ; Postoperative Complications ; Recurrent Laryngeal Nerve ; physiopathology ; Retrospective Studies ; Treatment Outcome

Objective: To investigate the changes of perioperative immune index in patients with breast cancer and its clinical significance. Methods: Th1 cells, Th2 cells, Th1/Th2 ratio and regulatory T cells (Treg) were detected in peripheral blood of 103 patients with primary breast cancer and 116 patients with breast fibroma before surgery and on the 1st, 3rd and 5th day following operation. The relationship of changes in T lymphocyte subsets and clinicopathological characteristics, as well as tumor-free survival of breast cancer patients, was analyzed. Results: The levels of Th1 cells in breast cancer group on the 1st, 3rd and 5th day following operation were (12.20±0.45)%, (13.89±0.47)%, (14.04±0.49)%, which were significantly lower than those before operation [(15.82 + 0.51)%, all P<0.05 ]. Treg cells, however, with the number of (3.82±0.13)%, (3.25±0.11)%, (2.95 ±0.11)%, were remarkably higher than those before operation [(2.53 ±0.11)%, all P<0.05]. With respect to breast fibroma patients, there was no significant difference compared with those before operation of Th1 cells, Th2 cells and Treg cells (all P>0.05). The changes of Th1 cells were associated with the degree of differentiation, T stage, N stage, TNM stage, HER-2 status and Ki-67 (all P<0.05). Treg cells were related to T stage, N stage and HER-2 status (all P<0.05). Tumor-free survival in the Th1-cell-increasing group was significantly better than that in the Th1-cell-decreasing group (P=0.045), while cell-decreasing group of Treg showed the improved outcomes (P=0.012). Conclusions The levels of Th1 cells and Treg cells are important indicators of cellular immune function in patients with breast cancer. Moreover, the perioperative changes of Th1 cells and Treg cells are associated with the size of tumors, pathological parameters, clinical stages and tumor-free survival outcomes.

Objective: To explore the safety and effectiveness of 3D reconstruction in thoracoscopic posterior basal segmentectomy (S10). Methods: Between March 2018 to September 2018, 14 patients underwent thoracoscopic anatomical resection of the posterior basal segment of the lung (S10). Results: Of the 14 patients, including 5 males and 9 females, age (52.2±5.3)years, size (1.1±0.6)cm, 6 left S10 and 8 right S10. The number of pathological type of microinvasive adenocarcinoma, benign nodule, and metastatic carcinoma was 12, 1, and 1 cases. The average preoperative planning time was (44.9±5.7)min, and the average operation time was (134.8±26.3)min. The blood loss was (25.5±4.1)ml, with (8.1±2.7) lymphadenectomy, no positive metastasis. The coincidence rate of 3D reconstruction and intraoperative anastomosis in the tumor location, B10, A10, and V10 were 100%(14/14), 100%(14/14), 93%(13/14) and 71%(10/14). The median duration of chest tube insertion was (2.3±2.1)day. The incidence of postoperative complications was 21%(3/14), including 7%(1/14) of air leakage, 7%(1/14) of arrhythmia, 14%(2/14) of pulmonary infection, and 14%(2/14) of operation. All the cutting edge was >2 cm. There was no perioperative death, no conversion to thoracotomy or lobectomy. The mean follow-up time was (8.1±2.2)months. There were no recurrence, metastasis or death in the 14 patients. One patient had chronic cough and no hemoptysis. Conclusions Preoperative 3D reconstruction make the anatomic thoracoscopic posterior basal segmentectomy (S10) safer and more effective.