Objective To investigate the application value of the modified Overlap method in digestive tract reconstruction of totally laparoscopic total gastrectomy (TLTG).Methods The retrospective cohort study was conducted.The clinicopathological data of 50 patients with gastric cancer who underwent TLTG with Overlap anastomosis between January 2016 and December 2016 in the Tangdu Hospital of the Fourth Military Medical University were collected.Twenty-six patients using classic Overlap method and 24 patients using modified Overlap method were respectively allocated into the classic Overlap group and modified Overlap group.All the patients underwent D2 lymph node dissection.Patients in the classic Overlap group underwent totally laparoscopic catastalsis side-to-side esophagojejunostomy.During digestive tract reconstruction in the modified Overlap group,there was no esophageal transection before anastomosis,and gastric fundus traction fully exposed to the lower esophagus.Esophagus was spun anticlockwise,and a hole was opened at the left posterior esophageal wall.Transection of jejunum was 25 cm away from Treitz ligment,and opening a hole at mesenteric margin was 6 cm away from distal jejunum to transected end of jejunum.Esophagus-distal jejunum side-to-side anastomosis was done using 60 mm linear stapler,and then laterally closing openings and transecting esophagus.Observation indicators:(1) intra-and post-operative recovery:total operation time,time of esophagus-jejunum anastomosis,volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation,cases with complications and duration of postoperative hospital stay;(2) follow-up and survival.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative tumor-free survival and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the independent-sample t test.Comparison of count data was analyzed using the chi-square test or Fisher exact probability.Results (1) Intra-and post-operative recovery:all the 50 patients underwent successful TLTG using Overlap method,without conversion to open surgery.Total operation time and time of esophagus-jejunum anastomosis were respectively (278.6± 14.9) minutes,(46.5 ± 4.4) minutes in the classic Overlap group and (253.3 ± 12.8) minutes,(20.4 ± 2.3) minutes in the modified Overlap group,with statistically significant differences between the 2 groups (t =5.459,22.482,P＜0.05).Volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation,cases with complications and duration of postoperative hospital stay were respectively (73±25) mL,34±6,(2.7± 1.0) days,2,(9.7± 1.6) days in the classic Overlap group and (71 ± 22) mL,35± 5,(2.6± 1.3) days,2,(9.8± 1.5) days in the modified Overlap group,with no statistically significant difference between the 2 groups (t =0.175,-0.616,0.293,-0.217,P＞ 0.05).Two patients in the classic Overlap group were respectively complicated with esophagus-jejunum anastomotic fistula and pancreatic leakage,2 patients in the modified Overlap group were respectively complicated with pulmonary infection and subcutaneous emphysema,and they were improved by symptomatic treatment.(2) Follow-up and survival:41 of 50 patients were followed up for 3-15 months,with a median time of 7 months,including 20 in the classic Overlap group and 21 in the modified Overlap group.During follow-up,patients had tumor-free survival,without tumor recurrence and metastasis.Conclusion Compared with classic Overlap method,the modified Overlap method can simplify the anastomotic procedures,shorten operation time and achieve similar efficacy,and it is also a simple and effective method for digestive tract reconstruction after TLTG.

Gastrectomy ; Humans ; Laparoscopy ; Stomach Neoplasms/surgery*

OBJECTIVETo study the effects of huai qi huang, a traditional Chinese medicine, on cytokines Th1, Th2 and Th17 levels and alveolar macrophage phagocytosis in asthmatic rats sensitized by ovalbumin (OVA).

METHODSForty male Sprague-Dawley rats were randomly divided into five groups: normal control, untreated asthma, budesonide-treated, huai qi huang-treated and budesonide+huai qi huang-treated asthma (n=8 each). Asthma was induced by OVA sensitization and challenge. The levels of IL-4, IFN-γ and IL-17 in plasma and bronchoalveolar lavage fluid (BALF) were measured using ELISA. The phagocytosis of alveolar macrophages which were isolated and purified from BALF was evaluated by the colorimetric assay.

RESULTSThe levels of IL-4 and IL-17 increased, in contrast, the IFN-γ level decreased in plasma and BALF in the untreated asthma group compared with those in the normal control group. The IFN-γ level in the huai qi huang-treated asthma group was higher than that in the untreated asthma group. The IFN-γ level increased and the IL-17 level decreased more significantly in the budesonide+huai qi huang-treated asthma group when compared with the budesonide and huai qi huang alone treatment groups. The phagocytosis of alveolar macrophages in the untreated asthma group was lower than that in the normal control group. Huai qi huang alone or combined with budesonide increased the phagocytosis of alveolar macrophages compared with the normal control, untreated asthma and budesonid-treated asthma groups. The levels of IFN-γ in plasma and BALF were positively correlated with the phagocytosis of alveolar macrophages.

CONCLUSIONSThe levels of IL-4 and IL-17 increase and the IFN-γ level decreases in plasma and BALF, and the phagocytosis of alveolar macrophages decreases in asthmatic rats. Huai qi huang treatment may increase the IFN-γ expression in plasma and BALF and the phagocytosis of alveolar macrophages in asthmatic rats. There is a synergistic effect between huai qi huang and glucocorticoids.

Animals ; Asthma ; drug therapy ; immunology ; Cytokines ; biosynthesis ; Macrophages, Alveolar ; drug effects ; immunology ; Male ; Medicine, Chinese Traditional ; Phagocytosis ; drug effects ; Rats ; Rats, Sprague-Dawley ; T-Lymphocytes, Helper-Inducer ; immunology ; Th1 Cells ; immunology ; Th17 Cells ; immunology ; Th2 Cells ; immunology

Background:Esophagogastric variceal bleeding is a severe and commonly seen complication of portal hypertension in patients with liver cirrhosis. Prevention of rebleeding remains an important issue in the management of patients suffered from the disease. Aims:To evaluate the efficacy and safety of percutaneous transhepatic variceal embolization(PTVE) combined with partial splenic embolization(PSE)for treatment of esophagogastric variceal bleeding in patients with liver cirrhosis. Methods:Ten liver cirrhosis patients with esophagogastric variceal bleeding were prospectively selected and treated by PTVE combined with PSE. The blood flow of portal system was measured by Doppler ultrasonography pre- and post-operatively;meanwhile peripheral blood cells were counted. A 1-2-year follow-up was carried out and the rebleeding and procedure-related complications were recorded. Results:The postoperative inner diameter of main portal vein,as well as the blood flow velocity of main portal vein and splenic vein were significantly reduced as compared with those before operation(P < 0. 05). Three months after operation,the peripheral white blood cell and platelet were still significantly higher than those before operation(P < 0. 05). During 1-year follow-up,rebleeding appeared in 2 patients,one of them was found having main portal vein thrombosis developed,and was treated by endoscopic esophageal variceal ligation because the gastric varices was not as evident as ever. The rebleeding rate and incidence of portal system thrombosis after the PTVE-PSE procedure was 20. 0% and 10. 0%,respectively. Conclusions:PTVE combined with PSE seemed efficient for alleviating portal hypertension,and might be recommended as a safe and effective interventional therapy for liver cirrhosis patients with esophagogastric variceal bleeding.

Objective To observe the effect of Yang-warming and Qi-tonifying Recipe (YQP)on aquaporin 3(AQP3) and AQP8 in rats with slow transit constipation,and to explore its therapeutic mechanism. Methods Forty rats were randomly divided into modeling group(N=30)and normal control group(N = 10). After successful modeling by gastric gavage of loperamide,the modeled rats were randomly divided into model group,YQP group and Mosapride group,10 rats in each group,and were separately treated with corresponding medicine for 2 weeks. After treatment, the colonic transit function was measured by carbon propelling test. The protein levels of AQP3 and AQP8 were detected by immunohistochemistry and their mRNA expression levels were detected with real-time fluorescence polymerase chain reaction (qPCR). Results Compared with the normal control group,the propelling rate of carbon particle in the model group was decreased,and the protein and mRNA expression levels of AQP3 and AQP8 were significantly increased(P<0.05 or P<0.01). Compared with the model group,the propelling rate of carbon particle of YQP group and mosapride group was significantly increased, and the protein and mRNA expression levels of AQP3 and AQP8 were significantly decreased (P<0.05),but there was no significant difference between YQP group and mosapride group (P >0.05). Conclusion YQP had therapeutic effects on loperamide-induced constipation through decreasing the expression of AQP3 and AQP8 in the intestine,reducing the reabsorption of intestinal fluid, and increasing the fecal water content.

OBJECTIVETo explore the technical feasibility, safety, and clinical efficacy of β-shaped Roux-en-Y reconstruction(β reconstruction) in totally laparoscopic distal gastrectomy (TLDG).

METHODSClinical data of 21 patients with gastric cancer undergoing TLDG with β reconstruction from January 2014 to May 2014 were retrospectively analyzed.

RESULTSTLDG with β reconstruction was successfully performed in all the patients. The mean time of operation and β reconstruction was (229.0±18.7) min and (27.5±4.2) min. The blood loss was (91.0±38.3) ml and number of dissected lymph node was 33.2±4.6 per patient. The length of upper and lower segment of resection from lesion was (5.9±0.4) cm and (3.2±0.8) cm. The average time to resume fluid diet, time to restore flatus and hospital stay were (2.1±0.8) d, (3.1±0.9) d and (5.9±2.4) d, respectively.

CONCLUSIONThe β reconstruction is a safe and feasible procedure for TLDG and provides satisfactory short-term efficacy.

OBJECTIVETo compare the short-term efficacy between totally laparoscopic distal gastrectomy(TLDG) with delta-shaped anastomosis (DS) and laparoscopic-assisted distal gastrectomy (LADG) with BrillrothI ( anastomosis (BI(), and to evaluate the application of DS.

METHODSBetween March 2013 and February 2014, 50 patients underwent TLDG with DS using linear staplers, and 43 patients underwent LADG with BI( using circular staplers. Clinical features and short-term efficacy of the two groups were analyzed retrospectively.

RESULTSThere were no significant differences between the two groups in terms of demographic indicators, operation time, intraoperative blood loss, number of removal lymph node, time to first flatus, incidence of complication and postoperative discharge day(all P>0.05). First-day postoperative pain was milder (3.1 ± 1.0 vs. 4.6 ± 1.4), and operative incision was shorter [(3.4 ± 0.4) cm vs. (6.9 ± 0.8) cm] significantly in TLDG with DS group(P<0.05).

CONCLUSIONTLDG with DS is safe and feasible for patients with gastric cancer, and has more advantages in cosmetic and comfort level than LADG with BI.

Anastomosis, Surgical ; Gastrectomy ; Humans ; Laparoscopy ; Lymph Node Excision ; Operative Time ; Postoperative Period ; Retrospective Studies ; Stomach ; surgery ; Stomach Neoplasms

OBJECTIVETo compare the short-term efficacy of modified medial (M-M) with traditional medial(T-M) approach in laparoscopic right hemicolectomy(LRHC)/or extended laparoscopic right hemicolectomy(ELRHC) for right or hepatic flexure colon cancer.

METHODSA comparative, retrospective study was performed that included all the patients scheduled for LRHC or ELRHC for right or hepatic flexure colon cancer between June 2013 and August 2014. The following factors of two groups were assessed: patient characteristics, operative details, pathology, and surgical outcomes.

RESULTSA total of 99 patients were evaluated, including 52 patients in the M-M group and 47 patients in the T-M group. Age, gender, body mass index, American Society of Anesthesiology(ASA) class, tumor location, diameter of tumor were not significantly different between the two groups. As compared to the T-M group, M-M group was associated with a significantly shorter operative time [(105.6±38.8) min vs. (138.2±39.5) min, P<0.05], less estimated mean blood loss[(38.4±12.4) ml vs. (87.2±24.6) ml, P<0.05] and lower intraoperative vascular damage rate [5.8%(3/52) vs. 25.5%(12/47), P<0.05]. There were no significant differences between these two groups in terms of intraoperative complications, CME, conversion rate, number of harvested lymph node, postoperative ileus, hospital stay, wound, lung and urinary system infections.

CONCLUSIONThe use of M-M approach in laparoscopic right hemicolectomy provides short-term benefits in operative time and estimated blood loss compared with traditional medial approach.

Case-Control Studies ; Colectomy ; Colon, Ascending ; Colonic Neoplasms ; Humans ; Ileus ; Intraoperative Complications ; Laparoscopy ; Length of Stay ; Operative Time ; Postoperative Complications ; Retrospective Studies

OBJECTIVETo determine the correlation of the CYP1A1 (rs4646422) gene polymorphisms with male infertility in the Chinese Han population.

METHODSUsing the Mass ARRAY iPLEX GOLD technique, we conducted a case-control study on theCYPlA1 (rs4646422) gene polymorphisms in 636 infertile males aged 21-49 years (case group) and 442 normal healthy men aged 23-47 years (control group) of the Chinese Han population. We analyzed the genotypes and allele frequencies in the two groups ofsubjects with the SPSS 20.0 software.

RESULTSCompared with the wild homozygous genotype GG, the heterozygous genotype AG (OR = 1.06, 95% CI 0.81-1.38) and homozygous genotype AA (OR = 1.11, 95% CI 0.56-2.21) showed no correlation with male infertility, nor did the mutant allele A (OR = 1.06, 95% CI 0.85-1.32) in comparison with the wild allele G.

CONCLUSIONThe CYP1A1 (rs4646422) gene polymorphisms might not be correlated with male infertility in the Chinese Han population.

Adult ; Alleles ; Case-Control Studies ; China ; Cytochrome P-450 CYP1A1 ; genetics ; Gene Frequency ; Genotype ; Homozygote ; Humans ; Infertility, Male ; genetics ; Male ; Middle Aged ; Polymorphism, Genetic ; Young Adult

Microneedle is a painless and minimally invasive transdermal drug delivery. It can enhance the permeability of skin for macromolecular drugs by puncturing and creating a micron-level drug delivery channel in the skin. The biodegradable microneedles aim to solve the problem that nondegradable-material microneedles may break under skin and cause adverse reaction. This article pro?vides an overview of the characteristics of biodegradable microneedles,the biodegradable materials used,its recent research progress, the development status and the tendency.