Objective To report a new approach of splenic hilar lymph nodes dissection in radical gastrectomy for gastric cancer. Methods 193 cases of gastric cancer patient receiving radical resection of gastric cancer between May 2008 and October 2008 were studied. The tail and body of spleen and pancreas were thoroughly freed with retroperitoneal way retrogressively and extruded out of abdominal cavity in 80 cases. The other 113 cases received operation with routine way. Results In 80 cases who received operation with retroperitoneal approach retrogressively, the total splenic hilar lymph nodes were 519, the positive ones were 65, the positive rate was 12.5 %; In the other 113 cases the total splenic hilar lymph nodes were 565, the positive ones were 58, the positive rate was 10.3 %. The positive rate had statistic significance between these two groups. Conclusion Extruded splenic hilar lymph nodes dissection with retroperitoneal approach retrogressively is safe and has the same effect with splenectomy in gastric cancer operation.

Adolescent ; Adult ; Age Factors ; Child ; Child, Preschool ; Electroencephalography ; Epilepsy, Temporal Lobe ; diagnosis ; etiology ; Humans ; Infant ; Male ; Middle Aged

Objective To investigate the efficacy of wrapping and suturing of pancreatic stump with the avascular zone of the transverse mesocolon for preventing pancreatic leakage after distal pancreatectomy.Methods The clinical data of 69 patients who received distal pancreatectomy at the Affiliated Tumor Hospital of Zhengzhou University from May 2011 to March 2014 were retrospectively analyzed.The pancreatic stump was wrapped with the avascular zone of the transverse mesocolon after suturing the pancreatic stump in 34 patients (the modified group),and the pancreatic stump of 34 patients was sutured without any other treatment (the control group).The time for pancreatic stump management,complications,time for drainage tube placement and duration of postoperative hospital stay of the 2 groups were compared.Patients were followed-up through outpatient examination and telephone interview till June 2014.The measurement data and the count data were analyzed using the t test and the chi-square test,respectively.Results The time for pancreatic stump management of the modified group and the control group were (15.2 ± 2.1) minutes and (13.2 ± 3.2) minutes,with no significant difference between the 2 groups (t =1.565,P ＞ 0.05).No patient was complicated with other diseases in the modified group,while 9 patients in the control group was complicated with pancreatic fistula,with significant differences between the 2 groups (x2=9.399,P ＜0.05).The time for drainage tube placement of the modified group and the control group were (6.1 ± 2.2) days and (16.6 ± 3.5) days,the duration of postoperative hospital stay were (12.5 ± 2.5) days and (21.5 ± 3.5) days,with significant difference between the 2 groups (t =-11.902,-9.853,P ＜ 0.05).Sixty-three patients were followed up from 1 to 35 months with a mean time of 15 months.Fifteen patients died,and the condition of other patients was normal.Conclusion Wrapping and suturing of the pancreatic stump with the avascular zone of the transverse mesocolon is effective for preventing the pancreatic leakage after distal pancreatectomy and shortens the time of postoperative hospital stay.

Objective To study the trans-bladder operative approach in resection of the complicated pelvic tumors with bladder invasion.Methods Twelve patients with complicated pelvic tumors were analyzed from Oct.2007 to Oct.2010.There were 8 males and 4 females.Patient's age was ranging from 35 to 65 years.There were 3 patients with tumor diameter from 10 to 16 cm and 9 patients with tumor diameter greater than 16 cm.All the tumors were located in the pelvic and the stage of all tumors was T4N0M0.The technology of trans-bladder to approach the lower edge of the pelvic tumor and then retrograde up to remove the tumor out of the presacral tissue,pelvic wall,and pelvic organ was applied.The length of hospital stay,operative time,blood loss,death during peri-operative period and the post-operative survival were analyzed retrospectively.Results The median operative time was 126 (110-150) min.The median blood loss was 521 (300-1200) ml.The median hospital stay was 22 (14-28) d.No patient died after surgery.Ten patients were followed up for 6 to 48 months.Three cases died of metastasis or recurrence.Conclusion With the trans-bladder operative approach,the resection of pelvic retroperitoneal tumors is effective and safe.

Objective To discuss the perioperative complications of self-expanding Wingspan stent angioplasty for symptomatic basilar atherosclerotic stenosis.Methods A total of 91 consecutive patients with severe basilar atherosclerotic stenosis, who were admitted to the Interventional Radiology Department of Zhengzhou University People’s Hospital during the period from July 2007 to April 2013 to receive Wingspan stent angioplasty, were included in this study.The clinical data were retrospectively analyzed.Based on the operator’s experience, 30 patients who received treatment in the early stage of the period were defined as group A, 30 patients who received treatment in the middle stage of the period were defined as group B, and 31 patients who received treatment in the recent stage of the period were defined as group C.The incidence of perioperative complications, the risk factors and the prevention measures were analyzed.Results Wingspan stent angioplasty was successfully accomplished in all patients.The mean basilar atherosclerotic stenosis ratio was reduced from preoperative (82.2±5.8)%to postoperative (15.9±5.7)%.During the perioperative period of 30 days, strokes occurred in 13 patients (14.3%, 13/91), including perforating branch strokes in 8 patients (8.8%, 8/91); thrombosis occurred in 4 patients (4.4%, 4/91) and subarachnoid hemorrhage in 1 patient (1.1%, 1/91).Lethal and disabling stroke was seen in 2 patients (2.2%, 2/91), resulting in death (n=1) and severe disability (n=1).No other non-stroke-related complications occurred.Statistical analysis indicated that the incidence of ischemic strokes bore a parallel correlation with the following factors: involvement of the middle segment of basilar artery (P=0.049), the longer affected arterial segment (P=0.002) and severe degree of stenosis(P=0.001); while the incidence of ischemic strokes showed no definite correlation with the operator’s experience (P=1.000).Conclusion In treating symptomatic severe basilar atherosclerotic stenosis, self-expanding Wingspan stent angioplasty carries a relatively higher incidence of perioperative complications.Patients with the middle segment stenosis of basilar artery and severe longer segmental stenosis are more prone to develop complications, but the incidence of lethal and disabling stroke is rather lower.

Objective To assess the safety and efficacy of the treatment for symptomatic atherosclerotic high-grade stenosis in middle cerebral artery with Wingspan stent.Methods The medical records of Wingspan stenting for 102 cases with symptomatic middle cerebral artery high-grade stenosis from February 2008 to May 2012 in our hospital were reviewed retrospectively.All of the patients suffered from ischemic stroke or transient ischemic attack ( TIA ) attributed to the atherosclerotic high-grade stenosis in middle cerebral artery and the stenosis of 70%to 99%was confirmed by DSA before the stenting procedure.All the stroke, death, TIA within 30 days after the stenting procedure or during the follow-up beyond 30 days were observed and recorded.In-stent restenosis were recorded after DSA or CTA was performed 6 months later.χ2 test or Fisher exact test was used to compare in-stent restenosis rate among patients with different clinical and pathological conditions.Results Stenting procedure were successfully performed in 100 patients (98.0%,100/102).The mean degree of stenosis was reduced from (81.0 ±8.4)% to (15.3 ±6.7)%right after surgery.Eight adverse cardiovascular events (7.8 %, 8/102) occured within 30 days ,including seven stroke or death ( 6.9%, 7/102 ) and 1 TIA.The mean clinical follow-up duration was ( 29 ± 15) months in 82 patients, and 9 ischemic events were documented (4 cases of ipsilateral recurrent stroke , 3 cases of ipsilateral TIA, and 2 cases of contralateral ischemic stroke ).The mean radiological follow-up duration was (11 ±9) months in 55 patients.Among them, 8 patients (14.3%) had in-stent restenosis and 3 patients had symptomatic restenosis.The restenosis rate in patients with age ≤49 years.(25.0%,7/28) was higher than those with age >49 years ( 3.7%,1/27 ) ( P>0.05 ).The restenosis rate in patients with lesion size>7.5 mm(25.0%,7/28) was higher than those with lesion size ≤7.5 mm (3.7%,1/27)(P>0.05).Conclusions The treatment of symptomatic middle cerebral artery high-grade stenosis with Wingspan system was relatively safe and associated with a low perioperative complication rate.The long-term efficacy of the treatment for symptomatic atherosclerotic high-grade stenosis in middle cerebral artery with Wingspan stent is prominent.

Objective To compare the perioperative complications of prophylactic use of three antiplatelet strategies in unruptured intracranial aneurysms treated by stent assisted coiling. Methods A total of 203 consecutive patients were brought into this retrospective study including the following three groups:the loading group (n=54), with a loading dose of 300 mg to 600 mg clopidogrel at 2 h to 24h before the stenting; tirofiban group (n=50), a loading dosage of tirofiban (8 μg/kg/min over 3 min) followed by a 0.1μg/kg/min maintenance dosage; dual antiplatelet group (n=99), dual oral antiplatelet drugs (clopidogrel 75 mg + aspirin 100 mg) pretreated for 3-5 days before the operation. Events of hemorrhage and thromboembolism were recorded and the complications were compared to assess the safety and efficacy of various antiplatelet strategies. Chi-square or Fisher exact tests were used for categorical variables. Results The hemorrhagic rates were 11.1% in loading group, 2.0% in dual antiplatelet group, and 0% in tirofiban group, respectively, while the thromboembolic rates were 7.4% in loading group, 4.0% in dual antiplatelet group, and 0% in tirofiban group, respectively. For total complications, significant difference (P<0.05) existed among the three groups, and the complication rate in loading group was significantly higher than that of the dual group (P=0.016) and tirofiban group (P=0.001), while there was no significant difference between tirofiban group and dual antiplatelet group(P>0.05). The hemorrhagic rate in loading group was significantly higher than that of the dual group (P=0.023) and tirofiban group (P=0.027), while there was no significant difference between tirofiban group and dual antiplatelet group (P>0.05). In subgroup analysis of the loading group, the postoperative thromboembolic rate was significantly higher in those exposed to low molecular weight heparin than those not (P=0.039) with no increase of hemorrhagic events (P>0.05). Conclusions When compared with the dual antiplatelet strategy, tirofiban strategy may be used as a new prophylactic protocol in unruptured intracranial aneurysms treated by stent assisted coiling. Those treated by low molecular weight heparin postoperatively after receiving dual antiplatelet therapy may increase the hemorrhagic risk, although there was a significant decrease in thromboembolic events postoperatively.

Objective:To investigate the value and molecular mechanism of gastric cancer stem cells in invasion and metastasis of gastric cancer.Methods:Gastric cancer stem cells were isolated by spheroid culture method, and the biological characteristics were identified. The role of gastric cancer stem cells in multidrug resistance, invasion and metastasis was analyzed. The important molecules involved in the biological behavior of gastric cancer stem cells were identified by gene chip. Screening of the signaling pathway revealed that anthrax toxin receptor 2 (ANTXR2)plays an important role in invasion, metastasis, glomerization and tumor formation.Results:Sox2 and Bmi1 expression in SGC7901 and MGC803 cells were significantly higher than monolayer culture cells (15.39±3.23). Oct4 express increased to (4.19±0.62). The expression levels of the dry-related genes Bmi1, Sox2 and Oct4 in SGC7901-SC cells were (3.29±0.52), (3.12±0.49), (2.58±0.35), respectively, which were higher than those of SGC7901-MN cells, Bmi1, Sox2 and Oct4, respectively. The differences were statistically significant ( t=5.392, 7.316, 6.449, all P<0.05) for (1.41±0.39), (2.04±0.33), (1.39±0.32); in primary cells XN0422-SC and in SGC7901-SC cells, miR-638 was in high expression (0.69±0.11), and miR-181b and miR-181a in low expression (0.12±0.05) and (0.15±0.07). ANTXR2 expression in SGC7901-SC cells was higher than that in SGC7901-MN cells ( t=6.216, P<0.05). The ANTXR2 positive cells in SGC7901-SC was 85.48%. The proportion of ANTXR2 positive cells in SGC7901 was 4.98%. Gastric cancer cells XN0422 and SGC7901 were affected by PLVT713, and ANTXR2 expression protein decreased. Conclusion:ANTXR effects a regulatory role by activating the Src/ERk signaling pathway, which can be used to predict the biological beharious of gastric cancer.

Objective To evaluate the complications of the Pipeline embolization device in treating complex cerebral aneurysm. Methods Consecutive data of 53 patients who suffered from complex cerebral aneurysm and underwent Pipeline device treatment were retrospectively collected and analyzed. Clinical and imaging data including aneurysm location, type, size and the using of coils, were recorded to investigate the complications. Results Pipeline embolization device was successfully implanted, and 27 patients were combined with coils. Five complications occurred in the 1-month perioperative stage, of which, 1 was disable and 1 was fatal. Two non-disability complications occurred in the later stage beyond 1 month, of which, 1 was cerebral infraction and 1 was intraparenchymal hemorrhage. The Logistic regression analysis demonstrated that the posterior circulation location, types, large size and the using of coils were not statistically significant risk factors for complications. The median imaging follow-up for 43 patients with 58 aneurysms was 6 months, the complete and sub-complete occlusion rate of aneurysms was 74.1％ (43 / 58) and 3 non-symptomatic stenosis occurred in the patients with Pipeline embolization device. Conclusions The occlusion rate of Pipeline embolization device in treating Chinese complex cerebral aneurysm is high , but another further research should be done for the mechanism and the prevention methods of the complications.

Objective To quantitative evaluate the myocardial microcirculation dysfunction in patients with end-stage renal disease (ESRD),and to provide the imaging characteristic for early detection myocardial dysfunction and microcirculation damage in the ESRD patients after dialysis therapy.Methods Sixty-seven patients with ESRD and 1 9 healthy subj ects were enrolled in our study, and the ESRD patients were divided into two groups including patients with preserved systolic function (n=51,EF≥50%)and patients with impaired systolic function (n=16,EF＜50%).The LV regional myocardial perfusion parameters were analyzed including upslope, time to maximum signal intensity (TTM)and max signal intensity (Max SI).Those continuous variables were compared using one-way analysis of variance (A N OVA )in all three groups.Results Compared with the controls and the ESRD patients with preserved EF,the ESRD patients with impaired EF had a significantly lower SV and markedly increased LV mass (all P＜0.001).For the fist-pass perfusion analysis,first-pass perfusion Max SI of all segments were significantly reduced in the ESRD patients with preserved/impaired EF compared with the normal subjects (all P＜0.05).Compared with the ESRD patients with preserved EF and controls,the ESRD patients with impaired EF had lower upslope in the basal segment (P＜0.05).And the ESRD patients with preserved/impaired EF had shorter TTM in the apical segment than that in normal controls (P＜0.01).Conclusion The CMR first-pass perfusion can detect the myocardial deformation and dysfunction in ESRD patients,the Max SI may be more valuable to early detect myocardial microcirculation dysfunction.