Objective To investigate the feasibility,safety and efficacy of laparoscopic and endoscopic cooperative surgery (LECS) for elderly patients with gastric gastrointestinal stromal tumor (GIST).Methods 54 cases with GIST aged 65 years and over in Department of Gastrointestinal Surgery in Beijing Hospital from Dec.2008 to Dec.2012 were selected.31 cases underwent LECS and 23 cases underwent open surgery.Clinical data including operation time,intraoperative blood loss,complications,tumor size,length of incision,postoperative gastrointestinal function recovery time,postoperative in hospitalization and follow up data were retrospectively analyzed in patients.Results There were 17 males and 14 females in the LECS group,and the mean age was (72.8±5.9)years.29 patients underwent laparoscopic-assisted partial gastrectomy,and 2 cases underwent laparoscopicassisted endoscopic dissection in LECS group.All operations were successful with no conversion to open surgery and death.There were 13 males and 10 females in the open surgery group,and the mean age was(73.3±6.1)years.The mean operation time was longer in LECS group than in open surgery group [(120.6±32.8) min vs.(86.3±33.5) min].The mean intraoperative blood loss,mean tumor size,mean length of incision,mean time of gastrointestinal function recovery,mean postoperative hospitalization were less or smaller in LECS group than in open surgery group [(40±23.4) ml vs.(130±65.6) ml,(2.3±1.2)cm vs.(3.6 ±1.8)cm,(3.6±1.1) cm vs.(14.4±3.5) cm,(47.7± 10.4)h vs.(61.4±11.9)h,(5.1±2.3)d vs.(7.2±2.5)d,respectively,t=3.192,1.831,5.212,2.014,3.519,P=0.002,0.012,0.000,0.015,0.001].According postoperative tumor risk assessment,13 cases were at very low risk,15 cases at low risk and 3 cases at middle risk in LECS group; 4 cases were at very low risk,14 cases at low risk and 5 cases at middle risk in open surgery group.The risk degree was lower in LECS group than in open surgery group (x2 =5.63,P=0.017).During a follow-up of 5 53 months,death without GIST was found in 5 patients in LECS group and 4 cases in open surgery group.Hepatic metastasis was found in 1 case in open surgery group.Conclusions LECS is a safe and feasibility alternative approach for elderly patients with gastric GISTs.It has more minimal invasion,fast recovery and satisfaction with short term outcomes as compared with conventional open surgery.

Objective To study the nutritional evaluation and clinical effects of perioperative enteral nutrition (EN) versus parenteral nutrition support (PN) in elderly patients undergoing gastrectomy for gastric carcinoma.The safety,feasibility and superiority were also compared between EN and PN.Methods Totally 50 cases (aged 65 years and over) undergoing gastrectomy for gastric carcinoma in Department of Gastrointestinal Surgery of Beijing Hospital were recruited and divided randomly into two groups of EN and PN (25 cases for each).NRS2002 nutritional assessment scoring system was used to evaluate the patients.The patients in EN group were given Rui Su at 2 d before surgery,then Wei wo,Bai pu li and Rui su were sequentially given from 12 h after the surgery.The patients in PN group were received total parenteral nutrition (TPN) via central venous for 7 days.Results The average absolute lymphocytes[(1.22±0.23) ×109/L and (1.31±0.27) ×109/L vs.(1.02±0.21) × 109/ L and (1.14 ± 0.23 × 10)9/L],pre-albumin[(151.442± 48.15) mg/ L and (167.38± 46.23) mg/ L vs.(115.22 ± 47.34) mg/L and (131.27 ± 43.58) mg/L] and transferring [(1.71±0.33)g /L and (1.83±0.31)g/L vs.(1.50±0.32)g/L and (1.65±0.32)g/L,all P＜0.05] levels after surgery of 3 d and 7 d in EN group were higher than those of PN group (P＜0.05).The CRP levels at 3 d and 7 d after surgery were increased in PN group compared with EN group [(63.71±35.26)mg/L and (41.58 ± 22.55)mg/L vs.(54.26±29.13)mg/L and (18.12 ±14.35)mg/L,P＜0.05].The blood sugar and insulin levels of EN group at 3 d and 7 d after surgery were (5.93±1.12) mmol/L and (5.61± 1.03)mmol/L,(6.72±5.14) U/L and (6.21±2.63) U/L,which were decreased compared to PN group (8.31 ± 2.62) mmol/L and (8.85 ± 2.92) mmol/L,(12.81±7.26) U/L and (15.21±8.24) U/L (P＜0.05).ALT in the PN group was (38.43±18.37) U/L at 7 d after surgery,higher than EN group (23.91± 14.82) U/L(P＜0.05).The perioperative average costs of EN group was (2714.5± 1391.7) yuan,lower than PN group (5041.6± 3007.7) yuan (P＜0.05).For the patients complicated with delayed gastric emptying after surgery,nutrition cost reduction was more evident.There were no significant difference between the two groups of patients in the liver and kidney function changes and postoperative complications.Conclusions It is safe and feasible for elderly gastric cancer patients with perioperative EN sequential therapy in view of its reduced stress response of surgical trauma and insulin resistance,improvement of hyperglycemia,reduction of medical costs compared with PN for elderly gastric cancer patients.

Animals ; Dependovirus ; genetics ; immunology ; Gene Transfer Techniques ; instrumentation ; Genetic Therapy ; instrumentation ; Genetic Vectors ; genetics ; immunology ; Humans

Objective:To evaluate the effect of gtfB specific antisense phosphorothioate-modified oligodeoxyribonucleotides(PS-ODNs) on S.mutans sucrose-dependent adherence.Methods:Antisense oligodeoxyribonucleotide targeted to gtfB sequence 709~726 bp(PS-ODN1) and 3 479~3 497 bp(PS-ODN2) were synthesized.Natural genetic transformation of S.mutans with PS-ODN1 and PS-ODN2 was respectively performed.Adhesion of S.mutans to saliva coated hydroxyapatite was examined by crystal violet staining and destain with absolute ethanol.The absorbance at 620 nm was measured by plate reader(the absorbance value derived from the wells without sucrose was used as background and was subtracted).Results:The adhesion ability of the strains treated with antisense PS-ODN was significantly lower than that of the control(P

Objective To investigate the safety and feasibility of laparoscopic ELAPE for elderly patients with low advanced rectal cancer.Methods Totally 48 cases patients with low advanced rectal cancer surgery aged over 65 years old were analyzed retrospectively,who come from Beijing Hospital between Jan 2012 and Jan 2015.A total of 26 cases underwent Laparoscopic extralevator abdominoperineal excision (L-ELAPE) and 22 cases underwent Laparoscopic abdominoperineal excision(L-APE).Clinical data including general data,operation time,intraoperative blood loss,complications,pathological data,postoperative in hospitalization were retrospectively analyzed in patients.Results The mean operation time between L-ELAPE and APE group was (312±46)min vs.(245±62)min,mean intraoperative blood loss was(170±74)ml vs.(250± 109)ml,Operative complications was 26.9％ vs.27.3％,harvested lymph node was (16.0 ± 5.8)cm vs.(15.0±7.2)cm,intraoperative bowel perforation(IOP)rate was 0％ vs.18.2％,CRM involvement was 3.8 ％ vs.13.6 ％,mean postoperative hospital stay (days) was (13.1 ± 4.6) d vs.(13.7 ± 6.1) d.The mean operating time of L-ELAPE group was longer and mean intraoperative blood loss was much less than APE group,IOP rate and circumferential resection margin(CRM)involvement were higher in APE group(P＜0.05).Conclusions L-ELAPE is a safe and feasibility alternative approach for elder patients with rectal cancer.It is related with less intraoperative blood loss,IOP rate,CRM involvement and longer operating time contrast with L-APE.

OBJECTIVE:To study the ex vivo adsorption of montmorillonite powder to ofloxacin.METHODS:Different dosages of ofloxacin and montmorillonite powder were mixed with artificial gastric juice and artificial intestinal juice,respec?tively,which were filtrated after warmed at(37?0.5)℃in water bath for1hour,the content changes of ofloxacin were de?termined by ultraviolet spectrometry.RESULTS:The adsorption rates of montmorillonite powder to ofloxacin in artificial gastric juice and in artificial intestinal juice were(99.76?0.01)%and(99.55?0.02)%,respectively.CONCLUSIONS:Montmorillonite powder has strong adsorption to ofloxacin in both artificial gastric juice and artificial intestinal juice,there?fore,which should not be administered simultaneously in the clinic.

OBJECTIVE:To analyze one case of pericardial pain induced by drug combination of omeprazole so as to provide reference for drug combination in the clinic. METHODS:A 79-year-old male patient was admitted because of stage Ⅲ hypertension,coronary heart disease,acute attack of chronic bronchitis in Dec. 2 of 2009. He was treated with omeprazole and pericardial pain was observed during treatment. ADR caused by omeprazole were put forward in the clinic. RESULTS & CONCLUSION: Omeprazole combined with other drugs can easily cause ADR for example,pericardial pain. The universality of ADR induced by drug combination of omeprazole should be further confirmed because of limited sample.

Objective To induce adipose-derived mesenchymal stem cells (ADMSCs) differentiation into cardiomyocytes, so as to provide stem cells for myocardial regeneration.Method ADMSCs were isolated and cultured from adult adipose tissue in vitro.They were induced with 10μmol/L 5-azacytidine (5Aza) for 24h.At the 7th, 14th, 21st days after induction, the expression of α-sarcomeric actin, and myosin heavy chain were repeatedly detected by immunocytochemistry.The expression of ANP was detected by RT-PCR.Results At the 7th day after induction, there was no expression of α-sarcomeric actin and MHC.At the 14th day, there was a little expression of α-sarcomeric actin and MHC that could be seen in cells.At the 21st day, there was increased expression of α-sarcomeric and MHC, and the expression of ANP was positive results detected by RT-PCR.Conclusions 5-Aza can induced ADMSCs to differentiate into cardiomyocytes.ADMSCs might be a potential source of cell transplantation for myocardial.

PcoI-PcoR is a quorum-sensing (QS) system influencing the biofilm formation and rhizosphere colonization in Pseudomonas fluorescens 2P24. The expression of the pcoI, a N-acyl-homoserne lactone (AHL) biosynthase gene, is under the regulation of a number of chromosomal factors, such as the GacS-GacA two-component system. In this paper, we investigated the upstream regulators that influence the transcription of pcoI gene using a chromosomal pcoI-lacZ fusion reporter strain PM203. Cosmids containing genomic DNA of the wild-type strain 2P24 were introduced into the reporter strain PM203 (gacA—, pcoI-lacZ) to screen positive transcriptional regulators of pcoI gene. One of them named pP32-24, which contained a 5-kb Pst I functional fragment was selected. Further analysis identified that the pcoI was the gene responsible for the increase of the pcoI-lacZ expression. The expression of pcoI-lacZ reporter was alsoimproved in both PM101 (pcoI-lacZ) and its gacAmutant PM203 after addition of exogenous AHL, indicating that the expression of pcoI is positively regulated by AHL (autoinduction) in strain 2P24. In addition, deletion mutagenesis and complementation experiments demonstrated that the transcriptional regulator PcoR positively controlled the expression of pcoI and the formation of biofilm. These results suggest that, in strain 2P24, the expression of PcoI-PcoR QS system is auto-inducted, and the transcriptional factor PcoR is involved in the regulation of pcoI transcription and the biofilm formation.

Objective The aim of this study is to address learning curve and clinical outcomes of totally robotic atrial septal defect repair on the basis of a single - center experience.Methods 54 cases of atrial septal defect (ASD) were repaired using “da Vinic S surgical system on arrested ( group Ⅰ,54 cases) or beating heart ( group Ⅱ,40 cases) from January 2007 to December 2010.Learning curves were assessed by means of regression analysis with logarithmic curve fit.The effect of operative variables on clinical outcome was analyzed by linear by regression using the Spearman's rho coefficient.Results All cases were accomplished successfully without complications.No residual shunt was detected at intraoperative or postoperative echocardiography.Significant learning curves were noted for corss clamp time in group Ⅰ:y (min) =68.741 -8.283 (n) (x)( r2 =0.489 ; P ＜ 0.01 ) ; the operation time in group Ⅱ:y (min) =355.51 - 56.29 (n) (x) ( r2 =0.581 ; P ＜ 0.01 ).No correlation was detected between operation time,cardiopulmonary bypass time,or cross clamp time and intubation time,intensive care unit stay,or total length of stay.Conclusion The robotic atrial septal defect repair can be performed safely.The learning curves is steep and the longer cardiopulmonary bypass times,operation time or cross clamp time had no negative impact on intraoperative and postoperative outcome.