BACKGROUND:Previous experiment has confirmed that the nitinol artificial esophagus is an artificial succedaneum which can be used for replacing an esophagus resected and rebuilding esophageal tube.
OBJECTIVE:To observe the tissue reaction of the neo-esophagus and the adjacent organs injury contacted with the nitinol artificial esophagus after replacement.
METHODS:Eight miniature pigs were selected and modeled by resection of a 70 mm segment of the thoracic esophagus. After modeling, the nitinol artificial esophagus was inserted into the proximal and distal end of the thoracic esophagus at an insert distance of about 10 mm. After that, the nitinol artificial esophagus with polyester connecting ring was sewed into the thoracic esophagus in a manner of ful-thickness anastomosis. After operation, the pigs were subjected to feeding regulation measures to control the shedding time of the artificial esophagus. Two model pigs were sacrificed for anatomical observation at 1, 2, 3, 4 months postoperatively, respectively. The tissue reaction during the neo-esophagus formed procedure and adjacent organs injury contacted with the nitinol artificial esophagus were observed.
RESULTS AND CONCLUSION:Al pigs survived without complications such as thoracic hemorrhage, pneumothorax, pyothorax, esophageal perforation and anastomotic leakage. The experimental animals with the nitinol artificial esophagus fixed in situ had no dysphagia for eating semisolids food (Bown’SⅡ). Autopsy findings showed that there was slight membrane-like adhesion between partial pleura and lung. No hydrothorax was found. The nitinol artificial esophagus was wrapped up by the neo-esophagus. There was slight membrane-like adhesion between the neo-esophagus and the adjacent organs such as the lung, aorta and esophageal mucosa. The esophageal mucosa covered the neo-esophageal entocoele from esophageal stumps to intermedius of neo-esophagus until completely covered. Histological findings of the neo-esophagus showed that in imbed cycle of the nitinol artificial esophagus the tissue reaction showed aseprtic inflammation reaction and foreign body reaction around the implant. These tissue reactions were most severe at 1 month after operation and thereafter relieved gradual y.

Objective To investigate the clinical effects of mucosolvan on the respiratory tract in elderly patients with long-time tracheal intubation for upper abdominal operation.Methods A total of 88 elderly patients to receive upper abdominal surgery were randomly divided into 2 groups:the treatment group (n=41,treated with antibiotics and mucosolvan 90 mg,iv,bid,for 7 consecutive days) and the control group (n=39,with the same antibiotics but without mucosolvan).Patients indwelling endotracheal tube≤3 hours were excluded.Lung function [forced vital capacity (FVC),forced expiratory volume in 1 second (FEV1),FEV1/FVC ratios (FEV1％)],blood gas analysis (pH,PaCO2,PaO2) and lung condition changes were compared between the two groups before and after surgery.Results There was a significant difference in blood gas analysis between the two groups 3 days after surgery (P＜0.05).There were differences in FEV1 and FEV1％ between the two groups 5 days after surgery (P＜0.05),but no differences were found in FVC in the two groups before versus after surgery.There were significant differences in the incidences of pulmonary infection and atelectasis between the treatment group and the control group [4.9 ％ vs.23.1％ (2 cases vs.9 cases),0％ vs.10.3％ (0 cases vs.4 cases),respectively,both P＜0.05].Conclusions Mucosolvan has a better protective effect on the respiratory tract in elderly patients undergoing upper abdominal surgery and the synergies can be achieved in combination with antibiotics.

Objective To investigate the application value of MRS in temporal lobe epilepsy (TLE) without hippocampal sclerosis.Methods A retrospective study was conducted in 23 unilateral TLE patients (TLE group) with absence of hippocampal sclerosis and 20 age-matched normal control subjects (control group).All of them underwent conventional MRI and MRS.N-acetyl aspartate (NAA)/creatine (Cr),choline (Cho)/Cr ratios of bilateral hippocampus in 2 groups were analyzed.Eleven of 23 patients underwent surgical treatment,pathological findings and surgical outcomes were evaluated.Results The NAA/Cr ratios of ipsilateral hippocampus significantly decreased compared with that in the contralateral hippocampus (t=-7.97,P＜0.001) and the control group (t=-9.96,P＜0.001).There was no significant difference between the contralateral hippocampus in patients and the control group (t=-1.21,P=0.12).The Cho/Cr ratios of ipsilateral hippocampus in TLE had no significant difference compared with contralateral hippocampus (t=0.50,P=0.31) and the control group (t=-0.59,P=0.28).The pathological findings of the 11 patients who underwent temporal lobe resection indicated small amounts of neuronal loss and unobvious gliosis.Conclusion MRS is helpful in clinical practice to lateralize and localize the epileptogenic foci in the absence of hippocampal sclerosis in patients with TLE.

Objective To investigate the role and potential mechanism of interleukin-17A (IL-17A) in the inflammatory response to traumatic brain injury (TBI) in rats.Methods The adult male Wistar rats were randomly (random number) divided into seven groups:control group (n =6),sham operation group (n =6),TBI group (n =24),sham operation + normal saline group (n =6),sham operation + Y320 (an immunomodulator acts as an inhibitor of IL-17A) group (n =6),TBI + normal saline group (n =6) and TBI + Y320 group (n =6).The TBI model of rat was established by using free-falling-body impact device.The levels of IL-17A and nuclear transcription factor kappa B p65 (NF-κB p65) in the cerebral cortex were assayed by using Western Blot.The capability of leaming and memory of rats was assessed by Morris water maze.The beam balance test was employed to evaluating the neurological motor performance and the capability of balance.Results Compared with the sham operation group,the levels of IL-17A and NF-κB p65 in the cerebral cortex of TBI,TBI + saline and TBI + Y320 groups increased significantly (P ＜0.05) and peaked at the 3rd day after TBI.Compared with TBI + normal saline group,the level of NF-κB p65 was significantly down regulated by Y-320 (P ＜ 0.05) at the 3rd day after TBI in TBI + Y320 group.The lengths of latency time required for rats to escape to the platform area in TBI + normal saline group were (57.72±3.29) s,(55.63±3.85) s,and (55.02±3.92) sat the3rd,5th and7th days after TBI,respectively;while those in TBI + Y320 group were (35.45 ± 3.04) s,(30.98 ± 2.92) s,and (23.90 ±2.51) s at the 3rd,5th and 7th days after TBI,respectively.Thus,the capability of learning and memory of rats in TBI + Y320 group was improved significantly 3d,5d and 7 days after TBI (all P ＜ 0.01).Conclusions This study shows IL-17A is involved in the process of secondary brain injury after TBI,and associated with inflammation by activating the NF-κB p65 signaling pathway.

Objective: To explore the clinical features and prognosis in patients with Takayasu arteritis (TA) combining neurological symptoms. Methods: We retrospectively studied 274 TA patients combining neurological symptoms who admitted to our hospital from 2002-01 to 2013-10 for their clinical and imaging features with prognosis. Results: The ratio of male to female was 1:4.3 and the mean age of disease onset was at (28.2±11.2) years. The most common neurological symptom was dizziness (214/274 cases, 78.1%), most frequent type was type III TA (112 cases, 40.9%), most common affected artery was left subclavian artery (147 cases, 53.6%), and there were 77 cases (28.1%) with (3-4) branches of the aortic arch involvement. For stroke conditions, ischemic stroke was more frequently observed in patients with steno-occlusive lesions in subclavian artery and common carotid artery, while hemorrhagic stroke was more frequently found in patients with steno-occlusive lesions in descending aorta, abdominal aorta and/or renal artery. Heart failure was the most common cause of death, it was also the most common cardiovascular event in surviving cohorts. Conclusion: TA patients could have many neurological symptoms, which were related to the number and site of artery involvement.

OBJECTIVE:To establish the method for rapid determination of ginsenoside Rg1,Re,Rb1 in Panax quinquefolius crude slices.METHODS:HPLC method was adopted to determine the total contents of ginsenoside Rg1,Re,Rb1 (as reference value).NIRS combined PLS algorithm were adopted to establish total quantitative correction model of ginsenoside Rg1,Re,Rb1.According to the reference,62 samples were collected.The spectrum was pretreated with multivariate scattering correction method combined with first order derivative method.The optimal ranges of wave band for ginsenoside Rg1,Re,Rb1 were 7 664.23-5 236.05 cm-1.RESULTS:Methodology validation for total content determination of ginsenoside Rg1,Re,Rb1 was in line with the requirements.For total quantitative correction model of ginsenoside Rg1,Re,Rb1,related correction set coefficient was 0.991 03,corrected mean square deviation 0.010 26.CONCLUSIONS:The method is rapid,accurate,simple and free of contamination.It can be used for rapid determination of ginsenoside Rg1,Re,Rb1 in P quinquefolius crude slices.

Objective To investigate the value of multi-modal neuroendoscopy combined with microscopy in the treatment of solid cystic brain tumors. Methods Fifty patients with cystic solid tumors admitted to Wuzhou Worker′s Hospital(the Seventh Affiliated Hospital of Guangxi Medical University) from February 2016 to February 2019 were enrolled. The patients were divided into two groups by random number table method. The patients in control group (25 cases) received microsurgery, and the patients in observation group (25 cases) received microsurgery combined with neuroendoscopy. All patients underwent CT or MRI. The differences in tumor resection rate between the two groups were observed and compared. The postoperative complications and Glasgow Outcome Scale (GOS) scores were compared between the two groups. All patients were followed up for 12 months after surgery. The tumor recurrence rate and mortality rate of the two groups were compared. Results The total resection rate of the tumor in observation group was 80.00%(20/25), and in control group was 48.00%(12/25), and there was significant difference (P<0.05). The postoperative GOS score of observation group was higher than that of control group: (4.52 ± 1.73) scores vs. (3.65 ± 1.15) scores, t=2.094, P=0.041. The incidence of postoperative complications, tumor recurrence rate and the mortality rate between two groups had no significant difference (P>0.05). Conclusions Multi-modal neuroendoscopy combined with microscopy can significantly improve the total resection rate of cystic brain tumors and improve the prognosis without increasing the risk of surgery.

Objective To investigate the application value of artery approach in the lower colon region combined with portal vein (PV) resection and allograft vascular grafts in radical pancreaticoduodenectomy for pancreatic cancer combined with vascular invasion.Methods The retrospective descriptive study was conducted.The clinicopathological data of 13 patients with pancreatic cancer involving in PV,splenic vein or junction who were admitted to the Beijing Chao Yang Hospital of Capital Medical University from March 2014 to June 2015 were collected.The superior mesenteric artery (SMA),tumors and soft tissues (including involved vessels) in the right of the celiac trunk were resected after exploring SMA and evaluating resectability of tumors.Patients underwent PV-splenic vein resection and reconstruction with allogenic vein.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor recurrence and metastasis up to April 2016.Measurement data with normal distribution were represented as (x)±s.Results (1) Surgical situations:13 patients successfully underwent radical pancreaticoduodenectomy via artery approach in the lower colon region combined with PV,splenic vein resection and allograft vascular grafts.Operation time and volume of intraoperative blood loss were respectively (489 ± 31) minutes and (407 ± 96) mL,without intra-and post-operative deaths.(2)Postoperative situations:of 13 patients,3 and 1 patients were respectively complicated with pancreatic fistula (2 in grade A and 1 in grade B) and gastroplegia,and cured by conservative treatment.There was no occurrence of bleeding,intraperitoneal infection,diarrhea,anastomotic stenosis and thrombus.The median duration of postoperative hospital stay was 12 days.Results of postoperative pathological examination:of 13 patients,high-,moderate-and low-differentiated adenocarcinoma was detected in 2,7 and 4 patients respectively.Three patients had negative vascular margin,2 had tunica intima invasion and 8 had tumor cell invasion in vascular adventitia.One,2,6,4 patients were detected in Ⅰ B,Ⅱ A,Ⅱ B and Ⅲ staging,respectively.The negative margin rate by postoperative pathological examination was 11/13.(3) Follow-up situation:13 patients were followed up 10 months postoperatively,with good survival and without tumor recurrence or metastasis.Conclusion The radical pancreaticoduodenectomy via artery approach in the lower colon region combined with PV/SMV resection and allograft vascular grafts is safe and feasible for pancreatic cancer involving in PV,splenic vein or junction,it can also evaluate early resectability of tumors,with good operative efficacy.