Background and purpose:The prognosis of advanced esophageal carcinoma is poor,there are no standard regimens for these patients. This study was to observe and evaluate the clinical feasibility and effi cacy of combined esophageal stent insertion with radiotherapy and concurrent chemotherapy in the treatment of locally advanced esophageal carcinoma. Methods:66 patients with esophageal carcinoma who were not suitable for operation were analyzed retrospectively. In the therapy group,stent was placed in order to relieve esophageal stenosis,and then followed by 3D-CRT and concurrent chemotherapy,while patients in the control group were treated with the placement of stent alone. According to the evaluating standards of WHO and Stooler classifi cation,we evaluated the effi cacy. Results:In the study group,72.2% of 36 cases was observed as partial response(PR),and 13.9% with complete response(CR),overall response rate was 86.1%. 6 and 12 months survival rates were 88.9% and 72.2% in the study group,compared to 53.3% and 26.7% in the control group,respectively(P

Hemangioendothelioma ; complications ; Humans ; Infant, Newborn ; Kasabach-Merritt Syndrome ; complications ; Sarcoma, Kaposi ; complications

Inguinal hernia is one of the most common diseases in general surgery. Surgery is the only treatment. In recent years, with the emergence and popularization of tension-free hernia repair, the recurrence rate has been lower than before. Chronic Postoperative Inguinal Pain (CPIP) has gradually become the focus of research. CPIP has now become one of the important efficacy indicators for inguinal hernia surgery. The etiology of CPIP is more complicated, mainly including neuropathic pain, non-neuropathic pain, somatic pain and visceral pain. Female, young, obese, low pain control, preoperative anxiety, preoperative pain, high pain sensitivity and other patient factors, and experience of the surgeon, open hernia repair, weight patch, patch fixation, surgery Surgical factors such as post-acute pain are risk factors for CPIP. CPIP is not only a product of neuropathic and nociceptive pain, but is also affected by various factors such as psychology, emotion, cognition, and genetics. Therefore, detailed medical history, physical examination, and correct pain and quality of life assessment tools are essential for the diagnosis of CPIP is very necessary. The treatment of CPIP should follow certain steps. The first choice is anticipatory treatment, drug treatment, psychological and behavioral treatment, physical therapy and other conservative treatments and interventional treatments, If the pain relief is not obvious after 6 months to 1 year by the above methods, surgical treatment is considered. So far, preventive analgesia and standardized surgery are the most important means to improve the prognosis of patients.

Enhanced recovery after surgery (ERAS) is a systematic approach to care that optimizes perioperative management, improves clinical outcomes, and reduces healthcare costs. ERAS has been introduced into abdominal hernia repair in recent years. Preoperative management was optimized through health education, smoking cessation, weight control, blood glucose and pain management, infection and thrombosis prophylaxis. And prevention of hypothermia, standardized anesthesia management, fluid replacement control, minimally invasive operation, controlled catheter placement and other intraoperative management optimization measures. And multi-mode analgesia, early postoperative activity, recovery of gastrointestinal function and control of blood glucose and other postoperative management optimization measures effectively reduced the incidence of complications such as surgical site infection, alleviated the pain of patients, and shortened the hospital stay. ERAS factors such as perioperative pain management, early postoperative activity, and recovery of gastrointestinal function are the key to shorten hospital stay and improve prognosis during abdominal wall hernia repair. ERAS can be used safely and effectively for abdominal hernia repair.

Abdominal hernia repair is a challenging surgery with high complication rate and recurrence rate, especially in potentially contaminated or contaminated abdominal wall hernias. The application of hernia mesh has significantly reduced the recurrence rate. However, different types of meshes have their own advantages and disadvantages. There are still controversies regarding the selection of mesh in the environment of potential contaminated and contaminated abdominal hernia repair. The biological mesh, which was once considered that have anti-infection advantages and was widely used, has not been found to reduce the infection rate in recent studies, but instead leads to a higher recurrence rate and expensive medical costs. On the contrary, synthetic mesh represented by monofilament and large mesh polypropylene mesh have achieved good results in potentially contaminated or contaminated hernia repairs recently. The emergence of new types of meshes such as absorbable synthetic mesh may be a better choice for potentially contaminated or contaminated abdominal hernia repair. This article reviews the application progress of mesh in the environment of potential contaminated and contaminated abdominal hernia repair, aiming to provide reliable evidence for the selection of mesh for these patients.

Since the development of tension-free hernia repair, the choice of mesh type and fixation mode has become a problem that surgeons must consider in operation. The selection of appropriate mesh fixation mode is of great significance to the prognosis of patients. In recent years, with the development of laparoscopic technology and hernia repair materials, new mesh types and mesh fixation techniques have been popularized in clinical practice, tack fixation and suture fixation have been less used in trans-abdominal preperitoneal hernia repair, and medical glue and self-gripping mesh have become the mainstream choice. Some scholars believe that in addition to large direct hernia, vacuum suction fixation is also a safe and effective fixation method. The best method of mesh fixation is still controversial, and the choice of intraoperative fixation methods is also to reach a unified standard. This paper reviews the advantages and disadvantages of different mesh fixation methods in trans-abdominal preperitoneal hernia repair, as well as the selection of intraoperative fixation methods, in order to provide basis for clinicians' intraoperative selection.

Objective:To explore the risk factors of chronic postoperative inguinal pain for laparoscopic trans-abdominal preperitoneal hernia repair and establish a nomogram prediction model for it.Methods:The clinical data of 576 patients who underwent laparoscopic trans-abdominal preperitoneal hernia repair for inguinal pain at the First Hospital of Lanzhou University from January 2015 to December 2020 were analyzed retrospectively. According to different postoperative outcomes, patients were divided into chronic pain group ( n=54) and non-chronic pain group ( n=522), compared two groups of patients in the material, including gender, age, BMI, smoking history, history of drinking, hypertension, diabetes, chronic bronchitis, abdominal surgery history, history of inguinal hernia, hernia type, the hernial sac size, prophylactic use of antibiotics, VAS score, mesh fixation techniques, operation time, length of stay. Measurement data with normal distribution were expressed as ( ± s) and independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M( Q1, Q3), and the Mann-Whitney U test was used for comparision between groups. Chi-square test was used to compare the measurement data of counting data.Multivariate logistic regression was used to analyze the independent risk factors for chronic postoperative inguinal pain. R software was used to establish the drawing of the nomogram prediction model, and the consistency index, calibration chart and area under the receiver operating characteristic curve was used to evaluate the predictive ability of the nomogram prediction model. Results:According to the results of the Logistic regression analysis, age≤45 years ( OR=2.202, 95% CI: 1.080-4.491), BMI≥24 kg/m 2 ( OR=2.231, 95% CI: 1.204-4.134), hernial sac≤5 cm ( OR=2.623, 95% CI: 1.309-5.257), recurrent hernia ( OR=2.769, 95% CI: 1.118-6.860), preoperative pain ( OR=4.121, 95% CI: 2.004-8.476), suture fixation ( OR=2.204, 95% CI: 1.151-4.219)and Postoperative acute pain (VAS>3) ( OR=5.814, 95% CI: 2.532-13.350) were independent risk factors for chronic postoperative inguinal pain ( P<0.05). Based upon the above independent risk factors, the nomogram prediction model was established and verified. The area under the curve of the nomogram prediction model was 0.779 (95% CI: 0.718-0.840, P<0.01). After internal verification, the concordance index value of the prediction model was 0.779. Conclusion:age≤45 years, BMI ≥24 kg/m 2, hernial sac≤5 cm, recurrent hernia, preoperative pain, suture fixation and Postoperative acute pain (VAS>3) are independent risk factors for chronic postoperative inguinal pain for laparoscopic trans-abdominal preperitoneal hernia repair, the nomogram prediction model has a good accuracy and discrimination with a high value of clinical application.

Objective To investigate the impact of an infant formula supplemented with 1.34 g/L oligosaccharides mixture (galactooligosaccharides and fructooligosaccharides,GOS+FOS) on growth,stool characteristics and fecal beneficial bacteria content in healthy infants.Methods 25 formula-fed (FF) infants and 29 breast-fed (BF) infants within 3 weeks after birth were included and followed up.FF infants were exclusively fed with GOS+FOS supplemented formula at the median age of 13d (1-27d).Body weight and head circumference at 6 and 12 weeks were measured.The frequency,consistency,and color of the infant's stool,and occurrences of spit-up or vomiting during the study period were recorded daily by the parents.Stool samples were collected at 6 and 12 weeks of age,and then subjected to quantitative real-time polymerase chain reaction assays for the enumeration of lactobacillus,bifidobacteria,Bifidobacterium longum,Bifidobacterium breve and Bifidobacterium adolescentis.Results No difference in daily weight gain was detected between the two groups (33.56 ± 7.03g vs.31.18 + 6.91g,P=0.22)during the observation phase from 6 to 12 weeks.FF infants had less frequent and firmer stools at 6 weeks than BF infants,and they both had similar stool frequency,color and consistency at the end of study.FF infants had less fecal Bifidobacterium,B.longum and B.breve at 6 weeks,but those differences became less significant at 12 weeks with more increase in fecal B.longum and B.breve levels in FF infants during the follow up.Conclusions The GOS+FOS supplemented formula provides adequate nutrition for growth,and promotes soft stools and intestinal bifidogenic effects in healthy infants.

Objective To observe the effect of astragalus polysaccharide on motor function and pathology after spinal cord injury in rats. Methods Seventy adult Sprague-Dawley rats were selected as normal group (n=10), injury group (n=30) and treatment group (n=30), and the injury group and the treatment group were divided into 7 days, 14 days, 28 days subgroups. The injury group and the treatment group were modeled with Allen's mode at T10 (10 g×25 mm). The treatment group was injected with astragalus polysaccharide 10 mg/kg per day after injury. They were rated with Basso-Beattie-Bresnahan (BBB) scores 7 days, 14 days and 28 days after injury, while the morphology was observed with HE staining, Nylon body was observed with Nissl staining, and myelin sheath was observed with eriochrome cyanine staining. Results The BBB score was significantly higher in the treatment group than in the injury group at each time point (P<0.05). There was a large number of necrotic tissue in the injured cords and cystic cavity began to form 7 and 14 days after injury. Cystic cavity formed basically and surrounded with dense scar 28 days after injury. The necrosis and cystic cavity alleviated in the treatment group at each time point. Demyelination and myelin sheaths loose were found 7 days after injury, and aggravated with the time. There was a cystic cavity in trauma center 28 days after injury. The demyelination and myelin sheaths loose relieved at each time point in the treatment group. Nissl bodies began to coalesce 7 days after injury, and aggravated 14 days after injury, coalesced completely 28 days after injury. Nissl body coalesced alleviatively in the treatment group at each time point. Conclusion Astragalus polysaccharide may reduce the damage and promote the recovery of motor function after spinal cord injury in rats.

OBJECTIVE: To detect variants of IVD gene among 4 neonates with suspected isovalerate acidemia in order to provide a guidance for clinical treatment. METHODS: 111 986 newborns and 7461 hospitalized children with suspected metabolic disorders were screened for acyl carnitine by tandem mass spectrometry. Those showing a significant increase in serum isovaleryl carnitine (C5) were analyzed for urinary organic acid and variants of the IVD gene. RESULTS: Four cases of isovalerate acidemia were detected, which included 2 asymptomatic newborns (0.018‰, 2/111 986) and 2 children suspected for metabolic genetic diseases (0.268‰, 2/7461). The formers had no obvious clinical symptoms. Analysis of acyl carnitine has suggested a significant increase in C5, and urinary organic acid analysis has shown an increase in isovaleryl glycine and 3-hydroxyisovalerate. Laboratory tests of the two hospitalized children revealed high blood ammonia, hyperglycemia, decreased red blood cells, white blood cells, platelets and metabolic acidosis. The main clinical manifestations have included sweaty foot-like odor, feeding difficulty, confusion, drowsiness, and coma. Eight variants (5 types) were detected, which included c.158G>A (p.Arg53His), c.214G>A (p.Asp72Asn), c.548C>T (p.Ala183Val), c.757A>G (p.Thr253Ala) and 1208A>G (p.Tyr403Cys). Among these, c.548C>T and c.757A>G were unreported previously. None of the variants was detected by next generation sequencing of 2095 healthy newborns, and all variants were predicted to be likely pathogenic based on the guidelines from the American College of Medical Genetics and Genomics. CONCLUSION The incidence of isovalerate acidemia in Liuzhou area is quite high. Screening of metabolic genetic diseases is therefore recommended for newborns with abnormal metabolism. The discovery of novel variants has enriched the mutational spectrum of the IVD gene.
Infant, Newborn ; Child ; Humans ; Acidosis ; Carnitine ; Erythrocytes ; High-Throughput Nucleotide Sequencing