Objective To compare the safety and feasibility of laparoscopic splenectomy and esophagogastric devascularization (LS + ED) versus open splenectomy and esophagogastric devascularization (OS + ED) in treating portal hypertension using Meta-analysis.Methods Controlled trials comparing LS + ED and OS + ED in treating portal hypertension were electronically searched from Wan Fang Data Knowledge Service Platform,Medalink,CNKI,PubMed,Elsevier,SpringerLink and CBM disc.The most recent search was conducted in April 2015.All the relevant data and references were retrieved and screened.RevMan 5.2 was used for data analysis.Results Eventually,7 randomized controlled trials (RCTs) or high-quality case-controlled studies involving 468 patients were included into this study.Meta-analysis showed LS reduced blood loss [WMD =214.67,95％ CI 198.74-230.60,P ＜ 0.01],shortened flatus time [WMD =17.72,95％ CI 12.39-23.04,P ＜ 0.01] and postoperative hospital stay [WMD =3.75,95％ CI 3.28-4.23,P ＜ 0.01],while the duration of surgery was shorter in OS (P ＞ 0.05).However,OS was comparable with LS in complication rates.Conclusions Comparing with OS,LS had the advantages of reducing intraoperative blood loss and shortening recovery time after operation.In patients with cirrhosis,portal hypertension and esophageal varices,laparoscopic splenectomy was safe and effective.

OBJECTIVETo evaluate the response rate and adverse reactions of xeloda, an analogue of 5-fluorouracil, in the treatment of relapsed and metastatic breast cancer.

METHODSTwenty-two breast cancer patients who had recurrent and metastatic measurable foci were treated from Dec. 1999 to Feb. 2000. Xeloda was given, as a single drug, at a dose of or 2,510 mg/m2/d, bid, for two weeks followed by one week rest as one cycle, at least for one cycle in each patient.

RESULTSAmong these 22 patients, there was no complete response. Rates of partial response 8(36.4%), stable disease 10(45.5%), progressive disease 4(18.2%), and clinical benefit response (CR + PR + SD) 18(81.8%). The response rate in patients who had failed in previous chemotherapy of taxanes and/or anthracycline was 30.0%-33.3%. The common adverse reactions were hand-foot syndrome, skin pigmentation, nausea, vomiting, anorexia and fatigue. Mild-moderate anemia and leukopenia were observed in 36.4% of patients. Stomatitis, dizziness, diarrhea and chest distress were present in some. One patient developed degree IV myelosuppression. Total bilirubin and alanine transaminase (ALAT) mild elevation occurred in a few patients.

CONCLUSIONXeloda is an effective drug in the treatment of patients with relapsed and metastatic breast cancer, especially for those who have failed in chemotherapy with taxanes and/or anthracycline. Xeloda is well tolerated but has mild adverse reactions.

Adult ; Aged ; Antimetabolites, Antineoplastic ; adverse effects ; therapeutic use ; Breast Neoplasms ; drug therapy ; pathology ; Capecitabine ; Deoxycytidine ; adverse effects ; analogs & derivatives ; therapeutic use ; Female ; Fluorouracil ; analogs & derivatives ; Humans ; Middle Aged ; Neoplasm Metastasis ; Recurrence

Objective To evaluate the accuracy of simulated operation before the left atrial appendage ( LAA ) occlusion by filed LAA model with soft materials ,which is based on transesophageal three-dimensional echocardiography ( 3D-TEE) . Methods Silica and hydrogel were mixed to imitate cardiac tissue . Silica and hydrogel mixed materials ,silica and Tangoplus were subjected to mechanical detection and ultrasonic shear wave elastography ( SWE) . The preoperative and postoperative 3D-TEE image processing was performed on 21 patients undergoing LAA occlusion . The silica and hydrogel LAA 3D model ,silicone model and Tangoplus model were acquired to evaluate the accuracy of 3D model . LAA closure was simulated using the 3D models and the compression ratio of the device in models was compared with the value measured in operation . Results The silica and hydrogel mixed materials were successfully prepared . The elastic modulus and stress-strain curve were closer to the myocardial tissue . Twenty-one 3D printing models of three materials were obtained in 21 patients based on 3D-TEE images .There was no significant difference in the anchor zone between the 3D model and 3D-TEE ( P > 0 .05) .The 3D model measurements were consistent with the 3D-TEE measurements .The compression ratios of the decive in the 3D models of all three materials were greater than those measured in operation ,and the compression ratio of the device in the 3D model of silica and hydrogel materials had a better correlation with that measured in operation ( r =0 .900 ,P < 0 .01) .Conclusions The 3D model of LAA made of silica and hydrogel material based on 3D-TEE can improve the accuracy of the LAA occlusion simulation ,also can optimize the preparation of LAA occlusion .

Objective To obtain abundant anatomical information using fusion of ultrasonic valve images and CT heart images and provide new methods of image processing for 3D heart printing . Methods Cardiac examinations of three-dimensional transesophageal echocardiography ( 3D-TEE) and DICOM images of 41 patients who had atrial fibrillation without structural cardiac diseases were analyzed retrospectively and the data afterward were processed by using Mimics software . For the single-mode image group ,only the heart CT were invoked as the data sources . For the multimodel image group ,CT and ultrasound images were invoked as the data sources . Valve structures of the 3D reconstructions were graded and the circumferences ,areas and other parameters of the two groups were measured . The images of two groups were overlapped ,and the angles between the two valve planes of each heart were evaluated and analysed . Results Score of valves reconstructed by ultrasound 3D construction was higher than those by CT reconstruction . Measurements of correlated parameters between the 3D-TEE group and the CT group showed no significant statistical difference ( P ＞ 0 .05 ) , and the consistency was well . Ultrasound measurements of 3D reconstructed valves were well concordant with CT reconstructed valves by Bland-Altman analysis . Mean value and standard deviation of the angles between mitral valve annulus and aortic valve ring plane of each heart in the two group were ( 3 .15 ± 0 .88)°,( 2 .87 ± 0 .76)°,respectively . Conclusions Ultrasonic valve images can fuse precisely with CT images and it provides a better displayed morphology . This will help improving simulation quality of the 3D printed hearts .

Objective:To study the use of different assessment methods in predicting perioperative outcomes in patients with acute cholecystitis and decompensated cirrhosis.Methods:A retrospective study was performed on 28 patients with acute cholecystitis and decompensated cirrhosis (MELD ≥ 15) who underwent laparoscopic surgical intervention from January 2016 to August 2020 at the Third People Hospital of Xinjiang Uygur Autonomous Region. These patients were divided into 2 groups according to the severity of acute cholecystitis grading in the Tokyo Guidelines 2018 (TG18): TG18 grade Ⅰ for the mild cholecystitis group ( n=15) and TG18 grade Ⅱ and grade Ⅲ for the moderate and severe cholecystitis group ( n=13). 16 patients with a MELD score ranging from 5 to 15 and with TG18 grade Ⅰ were used as the control group. The operation-related conditions, surgical injuries and surgical complications were compared among the three groups. Results:Of 44 patients with acute cholecystitis and decompensated cirrhosis included in this study, there were 28 males and 16 females, aged (57.3±5.9) years. Significantly more patients in the moderate and severe cholecystitis group (13/13) suffered from cholecystitis due to stone impaction than the control group (11/16) and the mild cholecystitis group (10/15) ( P<0.05). When compared to the control group, patients in the mild cholecystitis group and the moderate and severe cholecystitis group had significant increases in operative time, intraoperative bleeding, amount of abdominal drainage, abdominal drainage time, delayed feeding time and hospital stay ( P<0.05). These perioperative outcomes were further and significantly increased in the moderate and severe cholecystitis group when compared to the mild cholecystitis group ( P<0.05). The blood bilirubin levels, blood creatinine levels and MELD scores after surgery were significantly better in both the mild cholecystitis group and the moderate and severe cholecystitis group on postoperative day 3 when compared to those before treatment ( P<0.05). The Child score was significantly better in the control group after surgery than that before surgery ( P<0.05). The grade Ⅰ-Ⅱ surgical complication rate was significantly higher in the moderate and severe cholecystitis group (11/13) than the mild cholecystitis group (5/15, χ 2=7.479), and the control group (4/16, χ 2=10.208) ( P<0.05). There were no significant differences in the grade Ⅲ-Ⅴ surgical complication rates among the three groups (all P>0.05). The overall surgical complication rate was significantly higher in the moderate and severe cholecystitis group (12/13) than the mild cholecystitis group (7/15, χ 2=7.385), and the control group (5/16, χ 2=11.023), (all P<0.05). Conclusions:The MELD score when combined with the severity grading for acute cholecystitis of the TG18 was effective to evaluate the perioperative risks of patients with acute cholecystitis and decompensated cirrhosis. Patients with a MELD score ≥ 15 and TG18 Ⅱ or Ⅲ had significantly higher risks after minimally invasive surgery.

Objective To evaluate the feasibility and accuracy of mitral valve prolapse( M VP) model made by three‐dimensional( 3D) printing based on three‐dimensional transesophageal echocardiography ( 3D‐T EE) data and the application value for mitral valvuloplasty . Methods 3D‐T EE volumetric data of 28 patients with M VP were acquired and postprocessed ,13 patients underwent mitral valve replacement and 15 patients underwent mitral valvuloplasty . A flexible material was used to made the valve 3D model by molding . T he areas of M VP identified by models were compared with surgical findings ,the circumference and the length and thickness of anterior and posterior mitral leaflets obtained from the valve specimens and the models were compared in the mitral valve replacement group . T he diameter between anterior and posterior ,the diameter between anterolaterior and posteromedial ,annulus area ,height of prolapsed leaflet and area of prolapsed leaflet were measured from 3D models and 3D‐T EE images in mitral valvuloplasty group . Surgical simulations were performed on the 3D models of the mitral valvuloplasty group ,and the water injection test was used to evaluate the surgical results and compared with the surgical results . Results 3D‐T EE volumetric data were successfully postprocessed and made as 3D M VP models in all patients . T he consistency of M VP location based on 3D models and surgical findings was 0 .92 . T he differences between the mitral valve replacement group and mitral valvuloplasty group were not significant ( P＞ 0 .05 ) . A simulation valvuloplasty was successfully performed on the 3D model in mitral valvuloplasty group ,2 patients underwent mitral valve replacement after water injection test . T he remaining 3D models successfully simulated the operation . Conclusions The M VP model made by 3D‐T EE and 3D printing technique has high feasibility and accuracy ,w hich may be promising for the mitral valvuloplasty of M VP .