Background and purpose:Anastomotic leakage and low anterior resection syndrome(LARS) are both common complications in dual-anastomosis for patients with low rectal cancer. The aim of this study was to observe and explore the signiifcance and role of vertical cutting of the closed distal rectum in dual-anastomosis for patients with low rectal cancer.Methods:A total number of 120 patients with mid-low rectal cancer who admitted to and completed laparoscopic rectal cancer resection in the Department of General Surgery, the First Afifliated Hospital of Soochow University from Feb. 2010 to Jun. 2014 were pair-matched into Groups A and B based on their gender,age, tumor size, the distance of lower edge to the dentate line and tumor staging, etc. For the 55 patients in Group A (observation group), the rectum distal end was closed vertically instead of horizontally while disposing “the ifrst intestinal anastomosis”, intestine-intestine anastomosis was conducted in an “end-corner” approach when dealing with “the second intestinal anastomosis”, upper corner (“dog ear”) of the closed line in the distal end of the rectum was removed, the lower corner (“dog ear”) of the closed line in the distal end of the rectum was removed using vascular occlusion clamp method, and the T-shaped interchanges (“dangerous triangle”) of stapled sutures formed after anastomosis were strengthened with absorbable suture. For the 65 patients in Group B (control group), laparoscopic dual anastomosis was conducted using conventional method, and the two “dog-ears” and “dangerous triangles” were kept without any treatment. The clinical outcomes of the two groups of patients were analyzed retrospectively. Results:In group A, It was convenient to complete the operation when the “dog ears” and “dangerous triangle” on the vertical line after cutting the closed distal rectum vertically by “end-corner” anastomosis. The axis of intestine formed a certain angle making the closed distal rectum into “ampulla” sample without “dog ears”. the “dangerous triangle” were strengthened with absorbable suture. In group B, The distal and proximal intestine located on the same axis after intestine-intestine anastomosis leaving two “dog ears” and a “dangerous triangle”. The general clinical data of patients in the two groups were comparable and not signiifcantly different (P>0.05). The two groups of patients showed no signiifcant differences in blood loss, postoperative drainage, postoperative anastomotic bleeding, anal exhaust time, and length of hospital stay (P>0.05). However, the operation time as well as the numbers of anastomotic ifstula occurrence, defecation, tenesmus and post-operation re-ostomy differed significantly (P<0.05).Conclusion:Vertical cutting of the closed distal rectum with dual anastomosis made the “new” intestine closer to the physiological bending and morphology of the rectum, meanwhile, it simpliifed the approach of removing “dog ear” and strengthening “dangerous triangle”, ifnally it signiifcantly reduced the incidence of post-surgical complications.

OBJECTIVETo explore a new procedure of laparoscopic dual anastomosis for mid-low rectal cancer to reduce postoperative complications.

METHODSClinical data of 56 patients with mid-low rectal cancer undergoing laparoscopic rectal cancer resection(modified double-stapling technique, MDST, modification group) in the Department of General Surgery, the First Affiliated Hospital of Soochow University from February 2010 to June 2014 were compared with the data of 64 patients with mid-low rectal cancer (conventional double-stapling technique, DST, convention group) in the same period based on gender, age, tumor size, the distance from lower edge to the dentate line and tumor staging, etc. Patients in the modification group received operation as follows: (1) the rectum distal end was closed vertically instead of horizontally. (2) the anastomosis was conducted in an "end-corner" approach. (3) upper corner of the closed line in the distal end of rectum was removed. (4) the lower corner of closed line in the distal end of rectum was removed using vascular occlusion clamp method. (5) two T-shaped interchanges ("dangerous triangle") of stapled sutures formed after anastomosis were strengthened with absorbable suture. Patients in the convention group received laparoscopic dual anastomosis using conventional method: two corners and "dangerous triangles" were kept without any treatment. The clinical outcomes of two groups were analyzed retrospectively.

RESULTSThe intraoperational blood loss, postoperative drainage volume, postoperative anastomotic stoma bleeding, bowel function return and hospital stay were not significantly different between the two groups (all P>0.05). As compared to the convention group, the modification group had longer operation time [(211 ± 91) min vs. (174 ± 57) min, P<0.05], lower incidence of postoperative anastomotic leakage [1.8%(1/56) vs. 12.5% (8/64), P=0.030], lower tenesmus rate [3.6% (2/56) vs. 14.1% (9/64), P<0.05], less postoperative stoma re-creation [0 vs. 9.4% (6/64), P<0.05].

CONCLUSIONModified laparoscopic dual anastomosis for mid-low rectal cancer can significantly reduce the incidence of post-surgical complications such as anastomotic leakage.

Anastomosis, Surgical ; Anastomotic Leak ; Humans ; Laparoscopy ; Neoplasm Staging ; Operative Time ; Postoperative Complications ; Rectal Neoplasms ; surgery ; Retrospective Studies

Objective: To investigate a mass incident of bromadiolone poisoning and analyze related clinical data. Methods: An investigation was performed for a mass incident of bromadiolone poisoning in a place in Shandong, China in December 2015, and related clinical data were analyzed and summarized. Results: This incident was a mass incident of bromadiolone poisoning caused by spreading poison. The poisoned patients had major clinical manifestations of bleeding and coagulation disorder and all of them were cured after comprehensive rescue, especially after intravenous drip of vitamin K1. Conclusion Bromadiolone poisoning can cause severe visceral hemorrhage and coagulation disorder, and intravenous drip of vitamin K1 has a good therapeutic effect.

Objective To explore a new procedure of laparoscopic dual anastomosis for mid-low rectal cancer to reduce postoperative complications. Methods Clinical data of 56 patients with mid-low rectal cancer undergoing laparoscopic rectal cancer resection (modified double-stapling technique, MDST, modification group) in the Department of General Surgery, the First Affiliated Hospital of Soochow University from February 2010 to June 2014 were compared with the data of 64 patients with mid-low rectal cancer (conventional double-stapling technique, DST, convention group) in the same period based on gender, age, tumor size, the distance from lower edge to the dentate line and tumor staging, etc. Patients in the modification group received operation as follows: (1) the rectum distal end was closed vertically instead of horizontally. (2) the anastomosis was conducted in an “end-corner”approach. (3) upper corner of the closed line in the distal end of rectum was removed. (4) the lower corner of closed line in the distal end of rectum was removed using vascular occlusion clamp method. (5) two T-shaped interchanges (“dangerous triangle”) of stapled sutures formed after anastomosis were strengthened with absorbable suture. Patients in the convention group received laparoscopic dual anastomosis using conventional method: two corners and “dangerous triangles” were kept without any treatment. The clinical outcomes of two groups were analyzed retrospectively. Results The intraoperational blood loss, postoperative drainage volume, postoperative anastomotic stoma bleeding, bowel function return and hospital stay were not significantly different between the two groups (all P>0.05). As compared to the convention group, the modification group had longer operation time [(211± 91) min vs. (174±57) min, P<0.05], lower incidence of postoperative anastomotic leakage [1.8%(1/56) vs. 12.5%(8/64), P=0.030], lower tenesmus rate [3.6%(2/56) vs. 14.1%(9/64), P<0.05], less postoperative stoma re-creation [0 vs. 9.4%(6/64), P<0.05]. Conclusion Modified laparoscopic dual anastomosis for mid-low rectal cancer can significantly reduce the incidence of post-surgical complications such as anastomotic leakage.

Objective To explore a new procedure of laparoscopic dual anastomosis for mid-low rectal cancer to reduce postoperative complications. Methods Clinical data of 56 patients with mid-low rectal cancer undergoing laparoscopic rectal cancer resection (modified double-stapling technique, MDST, modification group) in the Department of General Surgery, the First Affiliated Hospital of Soochow University from February 2010 to June 2014 were compared with the data of 64 patients with mid-low rectal cancer (conventional double-stapling technique, DST, convention group) in the same period based on gender, age, tumor size, the distance from lower edge to the dentate line and tumor staging, etc. Patients in the modification group received operation as follows: (1) the rectum distal end was closed vertically instead of horizontally. (2) the anastomosis was conducted in an “end-corner”approach. (3) upper corner of the closed line in the distal end of rectum was removed. (4) the lower corner of closed line in the distal end of rectum was removed using vascular occlusion clamp method. (5) two T-shaped interchanges (“dangerous triangle”) of stapled sutures formed after anastomosis were strengthened with absorbable suture. Patients in the convention group received laparoscopic dual anastomosis using conventional method: two corners and “dangerous triangles” were kept without any treatment. The clinical outcomes of two groups were analyzed retrospectively. Results The intraoperational blood loss, postoperative drainage volume, postoperative anastomotic stoma bleeding, bowel function return and hospital stay were not significantly different between the two groups (all P>0.05). As compared to the convention group, the modification group had longer operation time [(211± 91) min vs. (174±57) min, P<0.05], lower incidence of postoperative anastomotic leakage [1.8%(1/56) vs. 12.5%(8/64), P=0.030], lower tenesmus rate [3.6%(2/56) vs. 14.1%(9/64), P<0.05], less postoperative stoma re-creation [0 vs. 9.4%(6/64), P<0.05]. Conclusion Modified laparoscopic dual anastomosis for mid-low rectal cancer can significantly reduce the incidence of post-surgical complications such as anastomotic leakage.

Objective To explore the intervention effect and molecular mechanism of Xinkang Granules on inflammatory factors in rats with chronic heart failure based on cGAS/STING signaling pathway.Methods SD rats were randomly divided into normal group and modeling group.The chronic heart failure model was established by intraperitoneal injection of Doxorubicin Hydrochloride.After successfully modeling,the rats were further divided into model group,Valsartan group and Xinkang Granules group.The model group was treated with distilled water every day,the Valsartan group was treated with Valsartan solution every day,and the Xinkang Granules group was treated with Xinkang Granules every day,all given for 4 consecutive weeks.Echocardiography was used to detect cardiac function,the pathological changes of myocardium were detected by hematoxylin-eosin staining(HE),the ultrastructural changes of myocardium in each group were observed by transmission electron microscope,and the contents of interleukin-1β(IL-1β)and interleukin-6(IL-6)in serum were detected by enzyme-linked immunosorbent assay(ELISA).The mRNA expression levels of mitochondrial transcription factor A(TFAM),cyclic guanosine monophosphate-adenylate synthase(cGAS),interferon-stimulated gene(STING)and IL-6 in myocardial tissue of rats in each group were detected by real-time fluorescence quantitative method(qPCR).The protein expressions of cGAS and STING in rat myocardial tissue were detected by immunohistochemical method.Results Compared with the blank group,the rats in the model group had significant inflammatory cell infiltration and inflammatory edema in myocardial tissue,their cardiac function was significantly reduced(P＜0.05,P＜0.01),and serum inflammatory factors were significantly increased(P＜0.01).The mRNA expression of TFAM in myocardial tissue was significantly reduced(P＜0.01),the mRNA expressions of IL-6,cGAS,and STING were significantly increased(P＜0.01),and the protein expressions of cGAS and STING in the myocardial tissue were significantly increased(P＜0.01).Compared with the model group,the cardiac function of the rats in the Xinkang Granules group was significantly improved(P＜0.05,P＜0.01),the inflammatory infiltration of myocardial cells was reduced,the expression of serum inflammatory factors was significantly reduced(P＜0.01),the mRNA expression of TFAM in myocardial tissue was significantly increased(P＜0.05),and the mRNA expressions of IL-6,cGAS,and STING were significantly decreased(P＜0.01),the protein expressions of cGAS and STING in myocardial tissue were significantly decreased(P＜0.01).Conclusion Xinkang Granules can reduce the expression of inflammatory factors and improve cardiac function in rats with chronic heart failure.Its mechanism may be related to inhibiting the cGAS/STING signaling pathway.