OBJECTIVE: To explore the application of the"five-line division method "in selecting the surgical approach for occupying lesions in the saddle area and its adjacent areas. METHODS: Based on the natural anatomic structures, 5 lines (alpha, beta, theta line and lambda, epsilon line) were drawn on the images of the craniocerebral axial plane crossing the middle of the saddle area and the craniocerebral median sagittal plane, thus dividing the saddle area and its adjacent areas into 6 regions in the axial plane (1, 2, 3, 1', 2', and 3' regions) and into 4 regions in the sagittal plane (I, II, III, and IV regions). Based on these divisions, the large space-occupying lesions in the saddle area and adjacent areas were classified and their respective surgical approaches were determined after reviewing the commonly used approaches in the saddle area and clinical experiences. We collected the data of 116 patients undergoing surgeries for space-occupying lesions involving the saddle and the adjacent areas in our hospital between September, 2014 and August, 2017, and analyzed their classifications and the corresponding surgical approaches based on the "five- line division method " to compare the consistency between the hypothetic approaches and the approaches adopted in the actual surgeries. RESULTS: The actual surgical approaches adopted in the 116 cases were all selected under the guidance of experts in our hospital. The hypothetic surgical approaches selected based on the"five- line division method "showed a good consistency with the actually adopted approaches. CONCLUSIONS The"five-line division method "can spatially classify the commonly seen space-occupying lesions involving the saddle area and its adjacent area to provide assistance in the selection of surgical approaches for such lesions.
General Surgery/methods* ; Humans

Objective To investigate the effect of oral nutritional supplementation on the nutritional status and quality of life in patients with gastric cancer after operation.Methods In this prospective,single blind,randomized,controlled clinical study,25 postoperative patients with gastric cancer received neoadjuvant chemotherapy in outpatient clinic were enrolled.All patients received dietary guidance.In the intervention group,in addition to standard diet,oral nutritional supplements with 2 090 kJ/d of Intacted Protein Enteral Nutrition Powder were added,which lasted 90 days.The changes of body mass,body mass index(BMI),hemoglobin,prealbumin,albumin,gastrointestinal function score,and life quality score 30,60,and 90 days after discharge were recorded.Patients on standard diets were used as the control group.Results In the intervention group,the body mass increased by(0.66 ±1.47)kg 60 d after discharge and(-0.90±1.82)kg on 90 d after discharge,which were [60 d:(-5.13±1.79)kg,90 d:(-9.56±2.44)kg] in the control group,and the difference was statistically significant(P=0.027,P=0.015).The BMI of intervention group increased by(0.20 ±0.55)kg/m2 on 60 d and(-0.32±0.55)kg/m2 on 90 d after discharge,which were(-2.06±0.67)kg/m2 on 60d and(-3.21± 0.73)kg/m2 on 90 d in the control group(P=0.014,P=0.003).There was no significant difference in terms of serum albumin,prealbumin and other laboratory indicators.Intestinal functional status and quality of life also showed no significant difference between these two groups.ConclusionOral nutrition supplementation can reduce the body mass loss and improve the nutritional status in patients with gastric cancer during chemotherapy after operation.

Objective Long-chain triacylglycerol (LCT) by three producers,each mixed with the same medium-chain triacylglycerol (MCT),were compared with the brand MCT/LCT in causing focal necrosis of hepatocytes in beagle dogs (a bioequivalence evaluation).Methods 21 beagle dogs (male,0.7-1.5 years old,10-15 kg) were used in this study.According to the sources of the LCT,the animals were divided into Group A (LCT made in China),Group B (LCT made in Japan),Group C (LCT made in Germany),and the control group (the brand 10％ MCT/LCT).Central venous port was placed via the lumber vein of the animals under general anesthesia.After 2 weeks of rehabilitation,MCT/LCT was administered through this port for 28 days at 9 g/ (kg · d) [while the routine dose used clinically was 1 g/ (kg · d)].The laboratory indexes and the pathomorphism of the liver and kidney were studied single blindly.Results Laboratory tests,including liver and kidney function,blood coagulation function and lipid metabolism,did not identify differences among emulsions with different sources of LCT.Liver biopsy at day 28 showed no focal necrosis in Group C and the control group;there was minor damage in Group B;and Group A had obvious liver necrosis.and the pathological findings of other organs are similar.No significant difference was observed in biopsies of other organs.Conclusions Emulsions with different sources of LCT varied in their damage to the liver.Generics with LCT of higher quality were equivalent to the brand MCT/LCT in terms of safety.

Objective To explore the experimental methods and conditions of 131I-labeled anti-epidermal growth factor receptor (EGFR) vⅢ preparation,and to evaluate the targeting distribution of 131I-Anti-EGFRvⅢ in malignant glioma-loading nude mice.Methods The 131I labeling on anti-EGFRvⅢ was performed by Iodogen method.The labeling rate was determined after separation and purification and paper chromatography was used for the determination of radioactive chemical purity.Twenty-eight U87-EGFRvⅢ malignant glioma-loading nude mice with glioma average diameter of 10-15 mm were chosen and randomly divided into group of 131I-Anti-EGFRvⅢ intravenous injection,group of Na131I intravenous injection,group of 131I-Anti-EGFRvⅢ intratumor injection and group of Na131I intratumor injection;7.5 MBq/0.1 mL labeled products with 131I-Anti-EGFRvⅢ or Na131I were injected in the veins or the tumors to observe the changes of the radioactivity distribution of malignant glioma-loading nude mice with SPECT imaging.Results The rate of 131I-labeled anti-EGFRvⅢ was (68.12±6.19)％,and the immediate rate of radiochemieal purity was (95.12±0.59)％,and (87.78 ±5.35)％ in room temperature and (85.12±3.58)％ in 37 ℃ serum placed for 24 h.SPECT scan showed that the tumor site had significantly stronger imaging than the thyroid gland with the labeled products either by intravenous or intratumor injection.Conclusions It is applicable to the 131I-labeled Anti-EGFRvⅢ with Iodogen method.131I-Anti-EGFRvⅢ has good radiation chemical purity and stability in vitro and in vivo,and could be combined with tumor tissue specificity.

Objective To evaluate a relationship between the nutritional risk and nutritional support in elderly hospitalized patients (aged ≥ 65 years) with gastrointestinal cancer,and to analyze the relationship between nutrition support and clinical outcomes.Methods Elderly hospitalized patients with gastrointestinal cancer were recruited from September 2009 to November 2011.Patients were screened using Nutritional Risk Screening 2002 (NRS 2002) on admission.Data were collected on the application of nutrition support,including complication rate,length of hospital stay and medical care costs.Results In 592 recruited patients,the malnutrition rate was 14.0％ (83/592) and the rate of a validated nutrition risk was 43.7％ (259/592).79.2％ of patients with nutritional risk received nutritional support while 62.2％of non-risk patients received nutritional support.The case numbers of paraenteral nutrition (PN),enteral nutrition(EN) and paraenteral nutrition + enteral nutrition(PN + EN) were 141,64 and 49 respectively,with the PN:EN ratio of 2.2 ∶ 1.The rate of postoperative complications,lengths of hospital stay and medical care cost were higher in patients with nutritional risk than without nutritional risk[complications 39.8 ％ (103/259) vs.20.4 ％ (68/333),lengths of hospital stay (17.1±4.8) d vs.(12.6±3.6) d,medical care cost(62 191.5 ±4 251.2) RMB vs.(46 792.3±3 115.4) RMB,x2 =26.55 or t=13.03,50.84 respectively,all P＜ 0.01].The average of the rate of postoperative complication [36.8 ％ (75/205) vs.45.9％ (20/44),x2 =19.38,P＜0.01],length of hospital stay [(15.6±3.5) d vs.(18.1±5.4) d,(12.1±4.8) d vs.(15.6±3.5) d,P＜0.05 or 0.01] and medical care cost[62843.3±3491.7) RMB vs.(68925.1± 4633.2) RMB,(53410.5±1954.3) RMBvs.(59857.3±3221.6) RMB,allP＜0.05 or0.01] were lower or shorter in elderly gastric cancer or colorectal cancer patients with nutritional support than in patients without nutritional support.Conclusions A considerable numbers of elderly hospitalized patients with gastrointestinal cancer are at nutritional risk.There is significant relationship between the nutritional risk and clinical outcome.Nutritional support for elderly hospitalized patients with nutritional risk may improve the clinical outcome.

ObjectiveTo study the feasibility and technique in liver transplantation (LT) in an adult with situs inversus (SI) and reviewed the medical literature on this subject.MethodsA 45-year-old male with complete SI,suffered from progressive hepatic failure secondary to hepatolithiasis,obstructive jaundice,portal hypertension and liver cirrhosis.He underwent liver transplantation in July 2004.His anatomy was studied by preoperative CT scan and three-dimensional liver reconstruction imaging and angiography.LT was performed using the modified piggyback technique.The donor right liver was rotated 45 degree to the left,making the donor left liver pointing to the left paracolic sulcus and the donor right liver was in the recipient hepatic fossa.The donor suprahepatic vena cava was anastomosed end-to-side to the recipient vena cava,and the infrahepatic vena cava was closed by oversewing.ResultThe patient recovered uneventfully.His liver function was stable during a follow-up of 75 months.ConclusionLT in patients with SI is safe and feasible.Exact determination of the anatomy,comprehensive preoperative planning,and good technique in liver transplantation play important roles in LT for patients with SI.

Objective To investigate the age-associated changes of ultrastructure,mRNA and protein expressions of H+-K+-ATPase in elderly gastric parietal cell. Methods Fifty patients with relative normal stomach without gastroduodenal diseases were enrolled,including younger group (aged 20-59 years,n=19) and elderly group (aged≥60 years,n=31).Furthermore,the elderly group was divided into 3 subgroups:60-69 years old (n =11 ),70-79 years old (n=10 ),above 80 years old (n =10).The ultrastructure of gastric parietal cell was observed under electron microscope.The expression of H+-K+-ATPase α subunit mRNA and H+-K+-ATPase β subunit protein were assessed by quantitative real-time PCR and Western-blot,respectively.The ageing-associated changes of all these data were respectively compared. Results No significant difference was showed in the morphology of gastric parietal cell and acid-secretion-associated organelles among all the groups.The average ratio Am to Ac (Am means the area of mitochondria,Ac means the area of cytoplasm) of gastric parietal cell and the average At to Ac ratio (At means the area of secretory canaliculi and tubulovesicular system )between younger group and elderly group had no significant difference[(48.4±7.5) ％ vs.(50.6±7.6) ％,t=-0.775,P=0.444; (13.8±4.1) ％ vs.(12.2±4.7) ％,t=0.984,P=0.332].Meanwhile,there were no distinctions in the expression of H+-K+ -ATPase α subunit mRNA and H+-K+-ATPase protein among all elderly subgroups(F=1.522,2.32,P=0.24,0.114).However,the mRNA expression of H+-K+-ATPase a subunit was higher in the elderly group than in the younger group(t=-3.682,P=0.001).Furthermore,the expression of H+ -K+ -ATPase protein in the elderly group was increased as compared with younger group(t=-3.389,P=0.004). Conclusions Acidsecretion-associated organelles of human gastric parietal cell have no degeneration and the expression of H + -K+-ATPase is in trend of increase with aging,indicating that healthy elderly people have the basis of ultrastructure and molecular biology to maintain well function of acid secretion.

ObjectiveTo investigate the prevalence of nutritional risk and malnutrition,and nutritional support in elderly hospitalized patients.Methods2386 elderly hospitalized patents (aged ≥65 years) in Beijing Hospital from April 2007 to June 2009 were consecutively enrolled.Nutritional Risk Screening 2002 (NRS 2002) was performed on the next morning after admission.Body mass index (BMI)lower than 18.5 kg/m2 or serum albumin lower than 35 g/L was diagnosed as malnutrition.Results Among 2517 enrolled patients,NRS 2002 was completed by 94.8％,including 466 cases in Department of Respiratory,580 cases in Department of General surgery,549 cases in Department of Neurology,180 cases in Department of Nephrology,301 cases in Department of Gastroenterology and 310 cases in Department of Thoracic Surgery in Beijing Hospital.The prevalence of nutrition risk was 28.2％ (673/2 386),and the ratioes of nutrition risk in Department of Respiratory,General Surgery,Neurology,Nephrology,Gastroenterology and Thoracic Surgery were 27.5％,30.3％,28.5％,29.4％,25.9％ and 25.4％,respectively.The prevalence of malnutrition was 26.4％,and the ratios of malnutrition in Department of Respiratory,General surgery,Neurology,Nephrology,Gastroenterology and Thoracic Surgery were 26.2％,29.8％,26.9 ％,28.3％,22.3％ and 22.9％,respectively.Among 48.1％ of patients with nutrition risk who received nutritional support,the proportions of nutritional support in Department of Respiratory,General Surgery,Neurology,Nephrology,Gastroenterology and Thoracic Surgery were 30.1％,85.2％,26.1％,18.2％ 73.8％ and 64.9％,respectively.Among 15.1％ of patients without nutrition risk (NRS＜3) who received nutritional support,the proportions of nutritional support in Department of Respiratory,General Surgery,Neurology,Nephrology,Gastroenterology and Thoracic Surgery were 10.6％,25.2％,6.3％,3.8 ％,34.2％ and 17.4 ％,respectively.The ratio of parenteral nutrition (PN) over enteral nutrition(EN) was more than 4:1.ConclusionsA large proportion of elderly hospitalized patients are at nutrition risk and malnutrition.And nutritional support is somehow inappropriately applied.Evidence-based guideline of PN or EN is needed to improve this situation.

ObjectiveTo investigate the prevalence of nutritional risk and malnutrition among hospitalized elderly abdominal surgical patients with malignant tumors.MethodsTotally 269 elderly patents ( ≥ 65 years) with malignant tumor who were hospitalized in our department of abdominal surgery from December 2009 to November 2010 were consecutively enrolled.Nutritional Risk Screening 2002 ( NRS 2002 ) was performed on the next morning after admission.Body mass index (BMI) lower than 18.5 kg/m2 was considered as malnutrition.Results The NRS 2002 was completed in all the 269 enrolled patients.The overall prevalence of malnutrition was 30.1％ (81/269) ; more specifically,37.5％ (21/56) among geriatric patients ( ≥80 years) and 17.6％ (43/245) among the other age groups (P =0.001 ).The overall rate of nutrition risk was 38.3％ (103/269) ; more specifically,57.1％ (32/56) among the geriatric patients and 29.3％ (72/245) among the other age groups (P ＜0.001 ).The rate of nutrition risk in patients with pancreas cancer was 58.3％,which was higher than other elderly patients; on the contrary,and the rate of nutrition risk in the patients with colorectal cancer was relatively lower.ConclusionThe rates of nutrition risk and malnutrition in hospitalized elderly abdominal surgical patients ( ≥ 65years) with malignant tumor are relatively higher than other age groups,especially among the geriatric patients.

ObjectiveTo explore the clinical outcome of the combined nutrition support for colorectal cancer patients.MethodsTwo research arms were obtained using a cohort sampling method.Ann A ( the study group): from 2009 to 2010,30 colorectal cancer patients were enrolled.They received nutritional risk screening (NRS) 2002 after admission.Nutritional risk was defined as NRS 2002 score ≥3 three days before operation.Patients with nutritional risk received enteral nutrition (EN) for bowel preparation without laxative drug and enema.After operation,they received EN combined with parenteral nutrition (PN) supports provided.Arm B (control group): 30 cases with historically confirmed colorectal cancer were enrolled from 2007 to 2008.They received routine bowel preparation (diet control,laxative drug,and enema) and PN supports after operation.Nutritional parameters,the rate of infectious complications,the rate of systemic inflammatory response syndrome,and the duration of hospital stay were analyzed.ResultsThere were no significant difference in body weight and plasma albumin between these two arms ( P ＞ 0.05 ). The incidence of systemic inflammatory response syndrome (13.3 ％ ),infectious complications (10.0％ ),and the duration of hospital stay [ (12.3 ± 6.5 ) d ] in arm A were significantly lowerthan those in arm B [33％,30％,and (15.0 ±7.2) d,respectively] (P =0.038,P =0.042,P =0.045).Conclusion For the colorectal cancer patients,nutritional risk screening on admission,bowel preparation with eneral nutrition before operation,and combined nutritional support after operation can improve the clinical outcome.