AIMTo observe the stability of BCG-induced insulin resistance model.

METHODSThe glucose tolerance, serum glucose, FFA, insulin, triglycerides, cholesterol, TNF-alpha and ALT level were measured. The change of GDR was measured by euglycemic clamp in model rats after given i.v. BCG 2, 4 and 8 weeks.

RESULTSAfter 2, 4 and 8 weeks, the GIR and glucose tolerance of the animals deceased significantly. After 2, 4 and 8 weeks, BCG infusion resulted in a pronounced reduction in glucose tolerance and insulin-stimulated glucose disposal rate [GDR = GDR: (29 +/- 6) vs (13 +/- 7) mg.kg-1.min-1 2 weeks; (29 +/- 6) vs (11 +/- 7) mg.kg-1.min-1 4 weeks and (23 +/- 3) vs (16 +/- 3) mg.kg-1.min-1 8 weeks, respectively, P < 0.01]. BCG infusion resulted in a pronounced increase in the weights of the liver [(6.2 +/- 0.9) vs (8.2 +/- 1.3) g, P < 0.05] and spleens [(0.51 +/- 0.11) vs (1.4 +/- 0.4) g, P < 0.01]. The histo-pathological results showed that BCG infusion resulted severe inflammation in the livers and spleens and the ratio of beta/alpha in pancreas increased. The serum levels of triglyceride, FFA and glucose were unchanged, but the level of serum TNF-alpha [543 +/- 60) vs (759 +/- 137) pg.mL-1, P < 0.05] and insulin [(31 +/- 5) vs (36 +/- 5) mu.L-1, P > 0.05] increased.

CONCLUSIONThis novel model of immune insulin resistance is completely and constantly established.

Animals ; Blood Glucose ; metabolism ; Diabetes Mellitus ; metabolism ; Glucose Clamp Technique ; Glucose Tolerance Test ; Injections, Intravenous ; Insulin ; blood ; Insulin Resistance ; immunology ; Male ; Mycobacterium bovis ; Random Allocation ; Rats ; Rats, Wistar ; Spleen ; pathology ; Tumor Necrosis Factor-alpha ; metabolism

OBJECTIVETo measure the diameter and length of infrarenal inferior vena cava (IVC) in Shandong Peninsula adult through digital subtraction angiography (DSA) for better vena cava filter (VCF) choice and placement.

METHODSFrom April 2008 to June 2010, 83 discontinuous patients (49 males and 34 females, mean age 56.4 years) with deep venous thrombosis (DVT) of lower extremity were placed VCF through DSA according to ACCP-8. During operation, diameter and length of infrarenal IVC were measured. At the same time, the renal vein location and the type of the IVC were identified to help the VCF choice.

RESULTSAll the VCFs were placed successfully, no complications occurred. The diameter of infrarenal IVC was 10 to 26 mm with a mean of (19 ± 5) mm. The average length from beginning of IVC to the lower renal vein was (10.6 ± 2.8) cm. The renal vein was located between the first and second lumbar vertebra, the IVC beginning was located between the fourth and fifth lumbar vertebra.

CONCLUSIONSDiameter and length measurement of infrarenal IVC is helpful to the VCF selection and the domestic VCF research. Vena cava angiography is very important to the accurate placement of VCF.

Asian Continental Ancestry Group ; Female ; Humans ; Male ; Middle Aged ; Phlebography ; Vena Cava Filters ; Vena Cava, Inferior ; diagnostic imaging

OBJECTIVESTo explore the clinical features of traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury (CSCI), and to analyze the feasibility, indication and therapeutic effects of anterior-posterior approach in such cases.

METHODSFrom March 2004 to September 2009, 16 cases with this trauma were admitted and surgically treated in our department. Before surgery, skull traction was performed. Posterior atlantoaxial pedicle screw internal fixation and bone graft fusion were conducted to manage traumatic atlantoaxial instability. As for subaxial CSCI, anterior cervical corpectomy or discectomy decompression, bone grafting and internal fixation with steel plates were applied.

RESULTSAll operations were successful. The average operation time was 3 hours and operative blood loss 400 ml. Satisfactory reduction of both the upper and lower cervical spine and complete decompression were achieved. All patients were followed up for 12 to 36 months. Their clinical symptoms were improved by various levels. The Japanese Orthopaedic Association (JOA) scores ranged from 10 to 16 one year postoperatively, 13.95+/-2.06 on average(improvement rate equal to 70.10%). X-rays, spiral CT and MRI confirmed normal cervical alignments, complete decompression and fine implants'position. There was no breakage or loosening of screws, nor exodus of titanium mesh or implanted bone blocks. The grafted bone achieved fusion 3-6 months postoperatively and no atlantoaxial instability was observed.

CONCLUSIONSTraumatic atlantoaxial instability may combine with subaxial CSCI, misdiagnosis of which should be especially alerted and avoided. For severe cases, one stage anterior-posterior approach to decompress the upper and lower cervical spine, together with reposition, bone grafting and fusion, as well as internal fixation can immediately restore the normal alignments and stability of the cervical spine and effectively improve the spinal nervous function, thus being an ideal approach.

Aged ; Atlanto-Axial Joint ; injuries ; surgery ; Female ; Humans ; Joint Instability ; diagnosis ; surgery ; Male ; Middle Aged ; Spinal Cord Injuries ; diagnosis ; surgery

Total mesorectal excision (TME) is being established as the gold standard for rectal cancer surgery, however sexual and urinary dysfunction is an established risk after TME. By cadaver dissections, we clarify the correct surgical plane for TME and further determine the relation between the surgical plane and pelvic autonomic nerves. It must be noted that the pelvic plexus can be divided into 2 categories: aggregated shape and diffused shape. The latter is in tight contact with visceral fascia, which seems to be inseparable from each other by sharp dissection. Therefore, it is necessary to study the function of different units in pelvic plexus.
Humans ; Hypogastric Plexus ; anatomy & histology ; injuries ; Rectal Neoplasms ; surgery

OBJECTIVESTo study the value of enteroscopy in determining bleeding lesion of small intestine.

METHODSClinical data of ten cases with small intestinal bleeding diagnosed by enteroscopy were analyzed retrospectively from June 2003 to June 2004.

RESULTSBleeding sites disclosed by enteroscopy were consistent with those confirmed by operation in 10 patients,but qualitative diagnosis was not consistent in 2 patients.

CONCLUSIONSEnteroscopy is a safe,reliable and valuable modality for diagnosing bleeding lesion of small intestine.

Adolescent ; Adult ; Aged ; Endoscopy, Gastrointestinal ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; Humans ; Intestine, Small ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVETo study the relationship of mesorectum with fasciae and nerves in the pelvic cavity and to specify the proper planes of dissection in total mesorectal excision.

METHODSTwenty-four pelvises (12 males and 12 females) harvested from cadavers were studied by dissection.

RESULTSThere were three planes surrounding the rectum as the visceral fascia, vesicohypogastric fascia and parietal fascia. The pelvic plexus and its branches situated between the visceral fascia and the vesicohypogastric fascia. Pelvic splanchnic nerves and hypogastric nerves were observed between the visceral fascia and the parietal fascia.

CONCLUSIONSThe posterior plane of total mesorectal excision lies between the visceral fascia and the parietal fascia. The lateral dissection should be conducted in a plane between the visceral fascia and the vesicohypogastric fascia. The proper planes for posterior and lateral resection can be identified by the hypogastric nerve and the pelvic plexus respectively.

Fascia ; anatomy & histology ; Fasciotomy ; Female ; Humans ; Male ; Mesentery ; anatomy & histology ; surgery ; Pelvis ; anatomy & histology ; surgery

OBJECTIVETo study clinic character of liver failure complicated with bacterium and fungous infection.

METHODSThe patients with liver failure complicated with bacterial and fungous infection who were treated in our hospital from January 1986 to June 2006 were studied. All patients had clinical manifestation and positive of bacterium. The data were statistical analysis.

RESULTS507 patients diagnosed with fungous infection were found from January 1986 to June 2006 in which 132 patients were diagnosed with bacterial and fungous infection. There were 85 patients (64.39%) with chronic severe hepatitis and 40 patients (30.3%) with decompensation cirrhosis. Bacterial infection happened in 153 cases in which the rate of nosocomial infections was 54.90%. 204 bacterial strains were separated in which 143 strains (70.10%) were gram-negative bacterium and 61 (29.90%) strains were gram-positive bacterium. The main sites of bacterial infection were abdominal cavity (122 cases) and lung (30 cases). Fungous infection happened in 143 cases in which the rate of nosocomial infections was 86.71%. 155 fungous strains were separated in which 90 strains (58.06%) were Candida albicans, 17 strains (10.97%) were Aspergillus fumigatus and 25 (16.13%) strains were non-Candida albicans. The main sites of fouguns infection were lung (94 cases) and mouth (53 cases). 84 patients (63.64%) were ineffective and died after treatment.

CONCLUSIONThe patients with decompensation cirrhosis and chronic severe liver hepatitis were easy to be infected by bacterial and fungous. the rate of fungous nosocomial infections is higher than that of bacterium. The prognosis is bad in patients who had secondary fungous infection.

Adolescent ; Adult ; Aged ; Bacteria ; isolation & purification ; Bacterial Infections ; complications ; microbiology ; Cross Infection ; microbiology ; Female ; Fungi ; isolation & purification ; Humans ; Liver Failure ; complications ; pathology ; Male ; Middle Aged ; Mycoses ; complications ; microbiology ; Retrospective Studies ; Young Adult

OBJECTIVETo investigate the feasibility and short-term outcomes of total laparoscopic sigmoid and rectal surgery combined with transanal endoscopic microsurgery(TEM).

METHODSThe clinical data of 26 patients with colorectal carcinoma treated by total laparoscopic surgery with TEM between May 2010 and May 2011 in the Shanghai Ruijin Hospital were retrospectively analyzed.

RESULTSAll the 26 operations were successfully accomplished laparoscopically. There was no conversion to open procedure. No diverting ileostomy was made. The mean operative time was (151.6±25.9) min. The mean blood loss was (200.2±114.7) ml. The mean time to first flatus was (2.0±0.5) d. The mean tumor size was (3.0±0.7) cm and all resection margins were negative. The mean number of lymph nodes harvested was (12.9±2.2). Six patients developed postoperative anastomotic leakage, all of who had tumors in the lower rectum. There were no ureteral injury, intestinal obstruction, or pulmonary infection.

CONCLUSIONSTotal laparoscopic sigmoid and rectal surgery combined with TEM is a safe and feasible minimally invasive surgery. It is an improvement by combining laparoscopic skills with the concept of natural orifice transluminal endoscopic surgery.

Adult ; Aged ; Anal Canal ; surgery ; Colorectal Neoplasms ; surgery ; Endoscopy, Gastrointestinal ; methods ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo evaluate the safety and outcomes after transanal endoscopic microsurgery (TEM)for rectal adenoma.

METHODSData of 32 patients undergoing TEM for rectal adenoma between September 2006 and February 2010 in the Ruijin Hospital were reviewed.

RESULTSThe adenoma diameter ranged from 0.6 to 10.0(2.3±1.2) cm. The mean operative time was 70(range,20-180) min. The estimated blood loss was less than 10 ml. There were no conversions to transabdominal procedure. Twenty-two(68.8%) patients underwent suturing of the wound, of whom 14 had full-thickness resection. Two patients had perforation into peritoneal cavity during full-thickness resection, which were repaired by continuous suturing and no postoperative leak occurred. R0 resection was achieved in 31(96.9%) patients. Postoperative pathology showed 12 simple adenomas, 10 adenomas with low grade intraepithelial neoplasia, 5 adenomas with high grade intraepithelial neoplasia, and 5 T1 focal carcinomas. Complications included rectal bleeding in 1 patient, acute urinary retention in 1 patient, and pulmonary infection in 1 patient. The postoperative stay was 4.5(3-8) days. The patients were followed-up for a period of 23 months(range, 2-43 months). There were 2 tumors recurred.

CONCLUSIONTEM is a safe and effective minimally invasive surgical technique for large rectal adenomas.

Adenoma ; surgery ; Aged ; Anal Canal ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Proctoscopy ; methods ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome

Objective To explore the embolization effect of new platinum coils coated with [4COOH-P (DLLA-co-TMC)] biodegradable polymer and released vascular endothelial growth factor (VEGF) into intracranial aneurysms on rat intracranial aneurysms. Methods A total of 54 adult healthy female SD rats were randomly divided into Group Ⅰ with general platinum coils, Group Ⅱ with polymer-coated platinum coils and Group Ⅲ with platinum coils modified with VEGF (n=18).The right common carotid arteries (CCA) of rats in each group were exposed; and the 8 mm lengths of platinum coil segments were inserted into the ligated right CCA of rats. The distal right CCA was performed ligation and restored the blood flow; 6 rats each time at 15,30 and 90 d after the surgery were chosen;and the distal right CCA was used as aneurysm models,and the left CCA without the coil placement or surgical disruption in Group I with general platinum coil was chosen as normal control.The proliferation and fibrosis of endothelial cells were observed by HE staining; von Willebrand Factor (vWF) expression was detected by immunohistochemical staining; and VEGF expression was examined by Western blotting. Results Cellular proliferation and fibrosis in Group Ⅲ with platinum coils modified with VEGF enjoyed significantly higher grade than those in Group Ⅰ with general platinum coils 10,60 and 90d after the surgery (P＜0.05); Cellular proliferation and fibrosis in Group Ⅲ with platinum coils modified with VEGF enjoyed significantly higher grades than those in Group Ⅱ with polymer-coated platinum coils 30 d after the surgery (P＜0.05).Pathological observations showed that the massive intimal hyperplasia and substantial clot completely occluded the aneurysm lumen in Group Ⅲ with platinum coils modified with VEGF; New small blood vessels having vwf-positive expression were noted in the fiberized tissues;the thrombosis in Group Ⅰ with general platinum coils and Group Ⅱ with polymer-coat platinum coils were not fully organized and showed loose hyperplasia structure with a large number of internal spaces.Western blotting indicated that the VEGF level in Group Ⅲ with platinum coils modified with VEGF were significantly higher than that in other groups 15 and 30 d after the operation,however,the VEGF level in Group Ⅲ with platinum coils modified with VEGF 90 d after the surgery was decreased because the lumen completed fibration and degradation of 4COOH-P (DLLA-co-TMC). Conclusion The VEGF-eontaining biodegradable polymer,by slowly releasing VEGF to modify the surface of platinum coils, could enhance the cellular proliferation, thrombosis and formation of dense fibrous tissue in aneurysm lumen; as compared with general platinum coils,these new platinum coils could occlude the rat aneurysm faster and more completely.