Postoperative pancreatic leakage remains a persistent problem after pancreaticoduodenectomy.For patients with a soft and nonfibrotic pancreas,double binding continuous hemstitch suture is an optimal method for anastomosis.From January 2011 to June 2012,92 cases of periampullary carcinoma with a soft pancreas underwent pancreaticoduodenectomy,and then a modified technique of pancreaticogastrostomy was performed with 2 continuous hemstitch sutures placed in the mucosal and seromuscular layers of the posterior gastric wall,respectively.The median time for pancreaticogastrostomy was 12 minutes,and only 15 patients had postoperative complications.Two patients developed pancreatic leakage(1 grade A and 1 grade B)postoperatively.Pancreaticogastrostomy with double binding continuous hemstitch sutures is a simple and safe reconstruction procedure for patients with a soft and fragile pancreas who received pancreaticoduodenectomy.

Background There are a lot of studies about the carrier of corneal endothelial transplantation,but the best carrier has not been defined.Objective This study was to investigate the biocompatibility of chitosan carrier with rabbit corneal endothelium in vivo.Methods Fresh eye-balls were obtained from 10 New Zealand white rabbits.Rabbit corneal endothelial cells (CECs) were isolated and cultured on chitosan carrier in vitro.The morphology and density of rabbits CECs were observed every day,and the expressions of fibronectin (FN),collagen-1 (Coil-I) and Zonula occludens 1 (ZO-1) were detected by immunoinfluorescence.The morphology and ultrastructure of CECs were observed under the scanning and transmission electron microscope.Chitosan carrier with CECs was implanted into the anterior chamber of the left eyes in ten healthy New Zealand white rabbits,and only paracentesis of anterior chamber was performed in the right eyes as controls.The inflammation of ocular anterior segment was examined under the slit lamp microscope,and corneal thickness was measured 1 week,4 and 8 weeks after operation.Corneal endothelium cell density and morphology were examined under the corneal endothelial microscope at postoperative 2 weeks.Corneal samples were collected for the regular histopathological examination to observe the inflammatory reaction at postoperative 1 month and 3 months.Paired t test was used for statistical analyses between the control group (left eyes) and the experimental group (right eyes).The use and care of the animals followed the Statement of ARVO.Results CECs formed an intact monolayer of cells with the uniform shape and size on the chitosan membrane after incubated for 5 days.The cells reached confluence of 90％ 7 days after cultured with the 40％ hexagon cells.Under the scanning electron nicroscope,rabbit CECs showed the round or polygon in the shape with the microvillus on the cell surface.The cells connected closely by desmosome.The processes,pseudopodiums and microvillus on the cellular surface,vacuole in the cytoplasm,expanded endoplasmic reticulum with ribosome and abundant chromatin were exhibited under the transmission electron microscope.The immunofluorescence examination revealed the positive expressions of FN,Coll-Ⅰ and ZO-1 in the CECs on the chitosan carrier.In the in vivo experiment,the exudation in the anterior chamber and corneal edema were seen under the slit lamp microscope 3 days after implantation of chitosan carrier with CECs.However,the inflammation was gone 14 days after operation.The differences of the corneal thickness were no significant between the experimental group and the control group 1 week and 4,8 weeks after operation (t =1.377,P=0.265;t =1.795,P=0.165 ; t =0.390,P =0.760).In addition,no significant differences were found in the CECs density and the hexagon cells rate between the two groups(P =0.365,0.062).The histopathological examination showed that the inflammatory cells around the chitosan membrane were disappeared 3 months after operation and showed a good corneal structure.Conclusions Chitosan carrier has a good biocompatibility with rabbit CECs and anterior chamber,and it may be a potentially good carrier for CECs transplantation.

OBJECTIVETo observe the clinical effects of Erhuang Powder (EHP) in promoting the wound healing of cervical columnar epithelium ectopy after physiotherapy.

METHODSSixty-four patients with moderate and severe cervical columnar epithelium ectopy accompanied with contact bleeding were assigned to the treatment group (34 cases) and the control group (30 cases) according to table of random digit. Physiotherapy of the cervix was given to all patients. EHP was externally applied to the affected site of patients in the treatment group once every 3 days. Five times consisted as one therapeutic course, totally for 2 courses. The therapeutic effects, the wound healing time, the vaginal fluid quantity, the vaginal fluid discharge time, the wound infection, and adverse reaction were observed in the two groups.

RESULTSThe healing rate of the treatment group was 85.29% (29/34), higher than that of the control group (50%, 15/30) after 8 weeks of treatment, showing statistical difference (P < 0.1). The average wound healing time of the treatment group (3.2 - 0.8 weeks) was shorter than that of the control group (5.3 +/- 0.9 weeks), showing statistical difference (P < 0.5). The vaginal fluid quantity and the vaginal fluid discharge time in the treatment group were superior to those in the control group, showing statistical difference (P < 0.5, P < 0.1). Increased vaginal secretion accompanied with foreign odor or infection occurred in 2 patients of the control group. No adverse reaction or infection occurred in the treatment group.

CONCLUSIONSLocal application of EHP could promote the wound healing of cervical columnar epithelium ectopy after physiotherapy. It could improve its healing rate. Therefore, it was one ideal and reliable method, and worthy of clinical spreading.

Adult ; Cervix Uteri ; pathology ; Drugs, Chinese Herbal ; therapeutic use ; Endometriosis ; therapy ; Epithelium ; drug effects ; pathology ; Female ; Humans ; Middle Aged ; Physical Therapy Modalities ; Wound Healing

Objective:To analyze the clinical characteristics of patients suffering from acute ischemic stroke (AIS) complicated with obstructive sleep apnea-hypopnea syndrome (OSAHS).Methods:Data of patients with AIS who visited the Second Affiliated Hospital of Soochow University from January 2015 to June 2020 and underwent polysomnography monitoring (PSG) in the sleep center were collected retrospectively. Patients were divided into OSAHS group and AIS only group. Demographic information of patients, general clinical data, hematological indicators of glucose and lipid metabolism and inflammatory markers, PSG parameters and neurological function scores were collected, including the National Institutes of Health Stroke Scale (NIHSS) on admission and the modified Rankin Scale (mRS) on discharge. We compared the differences between the two groups. In addition, OSAHS group were divided into good prognosis and poor prognosis subgroups according to mRS score. The differences between the two subgroups were compared.Results:A total of 112 AIS patients combined with OSAHS and 89 AIS only patients were included. The proportion of non-rapid eye movement stages 1+2 [(N1+N2) %], arousal index, the oxygen desaturation index (ODI), percentage of total sleep time with oxygen saturation<90% (TS90) in the OSAHS group were higher than those in the AIS only group, while N3%, lowest nocturnal oxygen saturation (LSaO 2) were lower (all P<0.05). There was no statistical difference in the distribution of cerebral apoplexy lesions (cortex, subcortical, brainstem, cerebellum) between the two groups, but the proportion of patients with multifocal cerebral apoplexy in the OSAHS group was higher ( P=0.032). There was no statistical difference in NIHSS score on admission between the two groups, but the neutrophil/lymphocyte ratio (NLR) score ( P=0.004) and mRS score on discharge ( P=0.010) of the OSAHS group were significantly higher than those in the AIS only group. There were 74 patients in the good prognosis group and 38 in the poor prognosis group. The analysis showed that the NIHSS and NLR scores of the poor prognosis group were higher than the good prognosis group, admission NIHSS score was a risk factor for poor prognosis, all P<0.01. Conclusions:AIS patients complicated with OSAHS are characterized by disordered sleep structure, more severe nocturnal hypoxia, higher risk of developing multiple lesions, poor neurological function recovery at discharge, and high inflammatory index of NLR. Among them, patients with poor prognosis have poorer sleep efficiency, and high admission NIHSS score is a risk factor for poor prognosis.

OBJECTIVE: To assess the image quality and effective radiation dose of prospectively electrocardiogram (ECG)-gated high-pitch spiral acquisition mode (flash mode) of dual-source CT (DSCT) coronary angiography (CTCA) in patients with high heart rates (HRs) as compared with retrospectively ECG-gated spiral acquisition mode. MATERIALS AND METHODS: Two hundred and sixty-eight consecutive patients (132 female, mean age: 55 +/- 11 years) with mean HR > 65 beats per minute (bpm) were prospectively included in this study. The patients were divided into two groups. Collection was performed in group A CTCA using flash mode setting at 20-30% of the R-R interval, and retrospectively ECG-gated spiral acquisition mode in group B. The image noise, contrast-to-noise ratio (CNR), image quality scores, effective radiation dose and influencing factors on image quality between the two groups were assessed. RESULTS: There were no significant differences in image quality scores and proportions of non-diagnostic coronary artery segments between two groups (image quality scores: 1.064 +/- 0.306 [group A] vs. 1.084 +/- 0.327 [group B], p = 0.063; proportion of non-diagnostic coronary artery segments: segment-based analysis 1.52% (group A) vs. 1.74% (group B), p = 0.345; patient-based analysis 7.5% (group A) vs. 6.7% (group B), p = 0.812). The estimated radiation dose was 1.0 +/- 0.16 mSv in group A and 7.1 +/- 1.05 mSv in group B (p = 0.001). CONCLUSION: In conclusion, in patients with HRs > 65 bpm without cardiac arrhythmia, the prospectively high-pitch spiral-acquisition mode with image-acquired timing set at 20-30% of the R-R interval provides a similar image quality and low rate of non-diagnostic coronary segments to the retrospectively ECG-gated low-pitch spiral acquisition mode, with significant reduction of radiation exposure.
Arrhythmias, Cardiac/*diagnosis ; Artifacts ; *Cardiac-Gated Imaging Techniques ; *Coronary Angiography ; *Electrocardiography ; Female ; *Heart Rate ; Humans ; Male ; Middle Aged ; *Tomography, Spiral Computed

Central Nervous System Diseases ; Epstein-Barr Virus Infections ; Hematopoietic Stem Cell Transplantation ; Herpesvirus 4, Human ; Humans ; Lymphocytes ; Lymphoproliferative Disorders

Objective To prospectively investigate the diagnostic accuracy for coronary artery stenosis of prospectively electrocardiogram-triggered spiral acquisition mode (high pitch mode) dual-source computed tomography coronary angiography (CTCA) in patients with relatively higher heart rates (HR) compared with catheter coronary angiography (CCA). Methods Forty-seven consecutive patients with relatively higher HR (>65 and <100 bpm) (20 male, 27 female; age 55±10 years) who both underwent dual-source CTCA and CCA were prospectively included in this study. All patients were performed CTCA using high pitch mode setting at 20%-30% of the R-R interval for the image acquisition. All coronary segments were evaluated by two blinded and independent observers with regard to image quality on a three-point scale (1: excellent to 3: non-diagnostic) and for the presence of significant coronary stenoses (defined as diameter narrowing exceeding 50%). Considered CCA as the standard of reference, the sensitivity, specificity, positive predictive value and negative predictive value were calculated. Radiation dose values were calculated using the dose-length product. Results Image quality was rated as being score 1 in 92.4% of segments, score 2 in 6.1% of segmentsand score 3 in 1.5% of segments. The average image quality score per segment was 1.064±0.306. The HR variability of patients with image score 1, 2 and 3 were 2.29±1.06 bpm, 5.17±1.37 bpm, 8.88±1.53 bpm, respectively. The average HR variability of patients with different image scores were significantly different (F=170.402, P=0.001). The sensitivity, specificity, positive and negative predictive values were 92.6%, 97.0%, 87.6%, 98.3%, respectively, per segment and 90.0%, 95.2%, 85.3%, 96.9%, respectively, per vessel and 100%, 63.6%, 90.0%, 100%, respectively, per patient. The effective radiation dose was on average 0.86±0.16 mSv. Conclusion In patients with HR more than 65 bpm and below 100 bpm without cardiac arrhythmia, the prospectively electrocardiogram-gated high-pitch spiral acquisition mode with image acquired timing set at 20%-30% of the R-R interval provides a high diagnostic accuracy for the assessment of coronary stenoses combined with a 1.5% of non-diagnostic coronary segments and a radiation dose below 1 mSv.
Coronary Angiography ; Coronary Stenosis ; Electrocardiography ; Heart Rate ; Humans ; Radiation Dosage

The objective of this study was to investigate the efficacy and toxicity of standard-dose idarubicin in combination with continuous infusion of cytarabine as induction therapy in patients with acute myeloid leukemia (AML). A total of 38 AML patients were enrolled, including 30 new diagnosed patients, 8 relapsed and refractory patients. Cytogenetic analysis was performed in all patients, 15 patients had cytogenetic aberrations including 4 complex abnormalities. All patients were treated with standard-dose idarubicin [12 mg/(m(2).d), days 1 to 3] and continuous infusion of cytarabine [100 mg/(m(2).d), days 1 to 7]. The results showed that after one course of induction therapy, the overall response rate was 89.5% (34/38), and 32 out of 38 (84.2%) patients achieved complete remission (CR), including 27 of 30 (90.0%) new diagnosed AML patients, 5 (62.5%) refractory and relapsed AML patients, all 4 patients with complex cytogenetic aberrations achieved cytogenetic CR. Out of 6 relapsed patients 2 showed as extramedullary relapse, 4 showed as bone marrow relapse. The median survival duration was > 22 months and median disease-free survival time was > 16 months. Myelosuppression and infections due to neutropenia were the most frequent adverse effects, severe nonhematologic toxicity and the early death were not observed in the patients. It is concluded that standard-dose of idarubicin combined with continuous infusions of cytarabine as the induction therapy is highly effective and well tolerated approach in patients with AML, this regimen provides an opportune moment for hematopoietic stem cell transplantation.
Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Cytarabine ; administration & dosage ; therapeutic use ; Female ; Humans ; Idarubicin ; administration & dosage ; therapeutic use ; Leukemia, Myeloid, Acute ; drug therapy ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the quality of life (QOL) in patients with esophageal carcinoma after thoracoscopic and laparoscopic esophagectomy and circular stapled cervical esophagogastric anastomosis via retrosternal route or three-incision open surgery.

METHODSA total of 63 patients with middle-upper esophageal carcinoma who underwent radical surgical resection from January 2009 to October 2010 were enrolled in this study. Thirty-three patients underwent combined laparoscopic and thoracoscopic surgery and 30 three-incision open surgery. The EORTC questionnaire QLQ-C30 and QLQ-OES18 were used to evaluate the QOL.

RESULTSThere were no significant differences in the clinical data between the two groups except for anastomosis method(P>0.05). In the endoscopy group, there was one patient developed anastomotic leakage(3.0%, 1/33), 1 postoperative wound infection in the neck (3.0%, 1/33), and 1 anastomotic stricture(3.0%, 1/33). In the open group, 8 patients had anastomotic leakage (26.7%, 8/30), 2 had anastomotic stricture (6.7%, 2/30), 1 had wound infection in the neck (3.3%, 1/30), and 6 had pulmonary infection (20.0%, 6/30). All the complications were managed by conservative treatment. The two groups differed in dysphagia, food intake, pain, obstruction, dyspnea, anorexia, fatigue, financial condition, physical function, role function, emotional function, cognitive function, social function and global health level and were more favorable in the endoscopy group(P<0.05), while there were no significant differences in the other dimensions.

CONCLUSIONSThe postoperative complication rate is low after thoracoscopic and laparoscopic esophagectomy. Stapled anastomosis is associated with lower rate of anastomotic leak. QOL is better in patients following thoracoscopic and laparoscopic esophagectomy as compared to those following three-incision open surgery.

Aged ; Anastomosis, Surgical ; methods ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Esophagus ; surgery ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Male ; Middle Aged ; Quality of Life ; Stomach ; surgery ; Thoracoscopy

OBJECTIVEThe determination of skeletal maturity has an important role in pediatric clinical practice, especially in relation to endocrinological problems and growth disorders, and it is frequently useful in diagnosis and monitoring treatment. It has been suggested that the difference between radius, ulna and short bonse (RUS) and carpal may be of differential diagnostic significance. However, no data on comparison among bone ages of Chinese children are available. The differences between TW3-Chinese RUS (TW3-C RUS) and TW3-Chinese Carpal (TW3-C Carpal) bone age of Chinese children were observed in this study to provide references for skeletal development estimation.

METHODSTotally 9408 Han healthy children (5066 boys, 4302 girls) aged 1.5 - 13.5 years from 5 cities of China were enrolled in this study. The bone ages of the children were estimated by TW3-C RUS and TW3-C Carpal. The Z score curves of the differences between them were fitted by BCPE distribution and the goodness-of-fit of Box-Cox power exponential distribution (BCPE) models were assessed by Q-test and percents of cases of sample below the fitted percentile curves.

RESULTSThe means of the differences between TW3-C RUS and TW3-C Carpal were -0.19 - 0.17 over the age 2.0 - 13.5 years in boys and -0.12 - 0.13 from age 1.5 - 11.5 years in girls. The standard deviations were respectively 0.47 - 1.01 years for boys and 0.49 - 0.82 years for girls. The degrees of freedom, with respect to the parameter curves from BCPE distribution, were selected and the percentile curves were fitted by BCPE. The differences between percents of cases below the fitted percentile curves and expected values were all under 0.66%, exception of difference for 90th percentile in girls.

CONCLUSIONSThe differences between TW3-C RUS and TW3-C Carpal varied with age, the standard deviations increased gradually before 4.5 years of age in boys and 4 years of age in girls, and afterwards the variations decreased steadily until the TW3-C Carpal has reached full maturity. However, there was sex diversity in the extent of the variations. The differences between TW3-C RUS and TW3-C Carpal for boys were evidently greater than that for girls. The sex difference decreased progressively after 10 years. The proposed Z scores curves charts should provide reference for clinical practice.

Adolescent ; Age Determination by Skeleton ; statistics & numerical data ; Asian Continental Ancestry Group ; Bone Development ; Carpal Bones ; anatomy & histology ; Child ; Child, Preschool ; China ; Female ; Humans ; Infant ; Male ; Radius ; Reference Values ; Ulna ; Urban Population