Objective:To investigate the clinical significance of intraoperative prepositioning of dual mediastinal drains in elderly patients developing anastomotic leakage(AL)after a total endoscopic Ivor-Lewis procedure.Methods:This retrospective case-control study analyzed the clinical data of 500 elderly patients who underwent total endoscopic Ivor-Lewis surgery for esophageal or cardia cancer from January 2020 to December 2022.In the control group, one mediastinal drainage tube was placed intraoperatively, while in the study group, two mediastinal drainage tubes were placed.Both groups had a chest tube placed conventionally.The study compared the incidence of anastomotic leak(AL)at 1 month postoperatively, inflammatory indexes in patients with AL, grading of AL, rate of nasal fistula placement, incision infection, anastomotic stenosis, and incidence of hoarseness.Additionally, it compared ICU occupancy, ventilator use, and ICU length of stay between the two groups.Results:The analysis included clinical data from 455 elderly patients.Among the patients who developed AL, the study group had significantly lower peak body temperature[(39.58±1.03)℃ vs.(38.05±0.56)℃, t=4.298, P<0.05], white blood cell count[(18.63±3.35)×10 9/L vs.(14.28±2.78)×10 9/L, t=3.450, P<0.05], and C-reactive protein(CRP)levels[(154.66±41.64)mg/L vs.(122.19±31.29)mg/L, t=2.131, P<0.05]. The study group also had a significantly lower grading of AL and rate of nasal fistula placement(82.4% vs.30.0%, P<0.05). In terms of ICU indicators, the study group had a significantly lower ICU admission rate(64.7% vs.10.0%, P<0.05), shorter period of ventilator use[(6.47±8.15)days vs.(0.90±2.23)days, t=2.62, P<0.05], and shorter ICU stay[(11.70±8.89)days vs.(4.70±6.27)days, t=2.184, P<0.05]. Conclusions:Double mediastinal drainage tubes, have been found to significantly alleviate inflammation, decrease the rate of nasal fistula placement and ICU admission, and shorten the length of ICU stay in elderly patients.Therefore, they are considered safe and deserving of clinical promotion.

【Objective】 To analyze the metagenomics and microbiology of voluntary blood donors in China, so as to assess the potential threats of emerging infectious diseases to the safety of blood transfusion. 【Methods】 12 300 plasma samples (10 mL each) collected by central blood stations in Chongqing, Liuzhou, Urumqi, Mianyang, Wuhan, Nanjing, Mudanjiang, and Dehong Prefecture area from 2012 to 2018 were subjected to total DNA extraction after ultracentrifugation (32 000 rpm/min, centrifugal radius 91.9 mm) in minipools of 160 donations. The metagenomic library was constructed, and deep sequencing was conducted by Illumina Hiseq 4 500. By comparing with reference sequences of bacteria, fungi, parasites and viruses, metagenomic data were analyzed, classification of microbes were identified, and potentially harmful pathogens were evaluated. 【Results】 A total of 632 GB clean data were obtained by deep sequencing, and the top three pathogens were Pseudomonas(0.561 1%), Burkholderia(0.468 7%) and Serratia(4.242 0%). Pathogens with potential threat which could be transmitted by blood transfusion or blood products were found, such as human parvovirus B19(0.126 6%), Leishmania spp(1.348 5%) and Toxoplasma gondii(0.615 8%). 【Conclusion】 Our study analyzed metagenomics of voluntary blood donors in parts of China and revealed pathogens that may cause potential harm to blood safety, which were helpful for targeted prevention and control of emerging infectious diseases.

Objective To investigate the application and clinical value of donation after citizens death (DCD) in salvage liver transplantation (SLT).Method The clinical data of 12 recipients who underwent SLT from DCD of 12 donors at the Guangzhou General Hospital of Guangzhou Military Area from October 2010 to December 2013 were retrospectively analyzed.Of the donors,there was one case of type of China-Ⅰ,2 cases of the type of China-Ⅱ and 9 cases of the type of China-Ⅲ.Extracorporeal membrane oxygenation (ECMO) was applied to donation after brain and cardiac death to avoid warm ischemia.Of the recipients,6 met the Milan criteria,3 UCSF(The University of California,San Francisco) criteria and 3 Hangzhou criteria respectively.Orthotopic liver transplantation was performed on recipients.Eleven recipients received end-to-end anastomosis of the bile duct and followed up regularly.Result Liver transplantation was successfully performed on all recipients.No mortality during operation,no recovering delay and non-function of the transplanted liver occurred.Postoperative complications occurred in 4 cases,2 patients died,and 2 patients recovered and discharged after the second surgery.Ten recipients had a long-term survival.Two cases of hepatocellular carcinoma (HCC) recurrence were still alive after active treatment.The longest survival time was 42 months.All of them had no long-term complications such as biliary stricture.Conclusion The role and status of SLT in the treatment of HCC has become increasingly,and there will be more and more use of DCD donor in SLT.To ensure the DCD donors safely and effectively applied in SLT,we should grasp the characteristics of SLT,choose the appropriate DCD donor according to recipients,and rationally use the ECMO to protect the graft quality.

Objective To investigate the efficacy of medial plantar flaps with cutaneous nerves on fixing palm skin defects for patients injured while working.Methods All cases with palm skin defects who received medial plantar flaps grafting from June 2003 to January 2013,were analyzed retrospectively.The data included 13 males and 10 females,with the mean age of 36 years old (range,18-61 years old).There were 16 cases with right hand injury and 7 cases with left,whose skin defects ranged from 3.6 cm×2.8 cm to 7.0 cru×5.5 cm.All cases had skin and soft tissue injury while 5 cases with vascular and nerve injury,3 cases with tendon involvement and being exposed,6 cases with open metacarpal fractures.15 patients were treated with emergency surgery within 8 hours after injury,while 8 patients were treated 10 days after debridement surgery.Results Altogether,23 patients who received medial plantar flaps grafting operations,with palm skin defects,were included in this study.All cases were followed up for 3 to 36 months with a average period of 18 month.The grafted flaps range from 4.6 cm×3.8 cm to 8.0 cm×6.5 cm.Among the patients,19 of them recovered excellently with healing by first intention,with 7-14 d healing time,fully-retained hand functions and palm appearance,and 4-8 mm for between two points distinguish test.Flaps survived fairly well in 3 patients because partial necrosis happened at plantar skin graft donor site.After being debrided and dressed,the wound healed at second phase with a healing time of 12-21 d and 5-9 mm for between two points distinguish test.The operated hands could flex and extend functionally in the follow-up period.Only one patient did not recovered from medial plantar flap grafting and the flap did not survive operationally.The patient recovered after another operation with groin skin grafting later.According to Gu Yudong et al' evaluation criteria,such as improved hand function,19 cases were scored as excellent recovery,3 cases as good,and 1 as poor.The excellent rate was 95.7％ (22/23).Conclusion Medial plantar flaps with cutaneous nerves are ideal flaps for palm skin defects restoration,which characterized by the advantages of fixed anatomical position,high survival rate and being good to the functional recovery and palm appearance.

Objective To explore the leaves water extract on the liver human hepatocellular carcinoma xenografts and protein expression of Bcl-2 and HSP70 .Methods From cell morphology and DNA agarose gel electrophoresis the observation leaves water extract the characteristics of the material role in human hepatoma cells ,further use of immunocytochemistry agent Western blotting analysis method oncogene Bcl-2 and tumor suppressor genes HSP70expression .Results After the processing of the the 60 mg/mL leaves water extract of liver cancer cells after 12 h ,liver cells showed severe shrinkage ,pyknosis ,highlight the cell plasma mem-brane ,immunohistochemistry and Western blotting analysis showed that during the experiment along with the oncogene Bcl-2 ex-pression weakened(P<0 .05) ,while the expression of tumor suppressor genes HSP70 had no obvious change(P<0 .05) .Conclusion Water extract of the leaves can be induced in vitro human liver cancer cell apoptosis ,and the apoptotic process may be followed by the oncogene Bcl-2 ,tumor suppressor gene expression of HSP70 relationship .

Objective To summarize the clinical experiences in liver transplantation from donation after cardiac death donors. Methods The clinical data of 20 recipients who underwent liver transplantation from donation after cardiac death of 20 donors at the Guangzhou General Hospital of Guangzhou Military Area from July 2006 to May 2011 were retrospectively analyzed.Extracorporeal membrane oxygenation (ECMO) was applied to donors with brain and cardiac death to avoid warm ischemia.Donors in type Ⅲ according to the Maastricht classification did not receive ECMO.Liver grafts were obtained 5 minutes after the stop of heartbeat of the donors.Orthotopic liver transplantation was performed on recipients.Seventeen recipients received end-to-end bile duct anastomosis and 3 received cholangioenterostomy.All the recipients were followed up regularly.The survival curve was drawn by Kaplan-Meier method.Results Of the 20 donors,2 ( 10％ ) were in the type of Maastricht Ⅲ and 18 (90％) were donation after brain and cardiac death donors.Liver transplantation was successfully performed on all recipients,and the mean operation time,duration of anhepatic phase,mean volume of blood loss and duration of postoperative intensive care unit stay were (6.2 ± 2.7 ) hours,( 54 ± 13 ) minutes,( 2305 ± 1311 ) ml and (44 ±35) hours,respectively.There was no mortality during operation,and no recovering delay and non-function of the transplanted liver occurred.One recipient died of sepsis and 1 died of pulmonary infection at 1 month after operation,the other 18 recipients all survived.The longest survival time was 58 months.Conclusions Donation after cardiac death is the main source of liver grafts in China currently,and donation after brain and cardiac death is the main type.Establishment of rational flow-sheets of the donation after cardiac death and liver transplantation,rational application of ECMO for protecting the liver grafts are helpful for the work of organ donation after brain and cardiac death.

ObjectiveTo summarize the early clinical experience of the extracorporeal membrane oxygenation (ECMO) for protecting the liver donation after cardiac death (DCD).Methods Review and analysis the clinical data of 17 cases of liver transplantation with the donors from Chinese citizen after cardiac death from July 2009 to May 2011 in our liver transplantation center,and comprehend the primary diseases and the relevant index of the donors,the flow-sheet of donation and obtain of the organs from the donation after cardiac death,and the apply methods of extracorporeal membrane oxygenation during those processes.ResultsAll 17 cases had been diagnosed as brain death before,and waited for cardiac death,so all were clearly the donation of brain death plus cardiac death(DBCD).During the processes waiting for cardiac death,extracorporeal membrane oxygenation were introducted in every case,and the using time were 51-380 (mean 187)min.The donation after brain death plus cardiac death (DBCD) were all harvested liver donors and were transplanted to 17 receivers respectively.In our center,there was no operational death in liver transplantation in this series.The post-operation liver function recovered satisfactory,without transplant liver non-function or recovering delay.One case died of the pulmonary infection one month later after operation,and the other 16 cases all survived and were followed up to now.The longest survival time was 29 months.ConclusionThe donation after brain death plus cardiac death (DBCD) was the special donation type for citizen in China.The extracorporeal membrane oxygenation (ECMO) could well control the warm ischemia for protecting the liver donor just without ethics dispute.So,the using of the extracorporeal membrane oxygenation (ECMO) for the liver donation after cardiac death(DCD)of citizen in our China have very important contribution.

Objective To investigate the laparoscopic treatment for giant intraabdominal cysts with postoperative lower body edema. Methods Five cases of giant intraabdominal cysts were given an aspiration of 1 500 ~ 2 000 ml (mean, 1 800 ml) of fluid. The aspiration was performed percutaneously in 2 cases of hepatic cyst, and under direct vision through a 1.5~2.5 cm incision around the umbilics in 3 cases of lower intraabdominal cyst. After aspiration the cysts were excised (3 cases) or fenestrated (2 cases) laparoscopically. Postoperative lower body edema was treated with diuretics either orally (2 cases) or intravenously (3 cases). Results Symptoms completely disappeared after operation in 4 cases and were significantly improved in 1 case of polycystic liver. Follow-up for 3~12 months found no recurrence. The lower body edema subsided in 5~7 days after operation. Conclusions Aspiration of cystic fluid before laparoscopic operation and postoperative administration of diuretics could get good results for patients with giant intraabdominal cysts.

Objective To discuss the prevention and treatment of bile duct injures io the gallbladder bed during laparoscopic cholecystectomy(LC).Methods A retrospective analysis was made on clinical features,treatment,and curative effects of 15 cases of bile duct injures in the gallbladder bed out of 2 032 cases of LC from January 1997 to December 2004.Results There were 5 cases of acute attack of chronic calculous cholecystitis and 10 cases of chronic atrophic calculous cholecystitis.The location of injury was at the branches of the right hepatic ducts in 8 cases and at aberrant bile ducts in 7 cases.The injury was treated with titanium clipping in 8 cases,primary suture in 5 cases,and open surgery of bile duct repair in 2 cases because the injury was relativly large and the site of injury was near the trunk of the right hepatic duct.Postoperatively,bile leakage happened in 1 case and was cured by drainage for 5 days.Follow-up surveys for 6~36 months (mean,23 months) showed free of symptoms and no jaundice or cholangitis.Conclusions Surgical dissection closely near the gallbladder wall when mobilizing the gallbladder is the key to preventing bile duct injuries in the gallbladder bed during laparoscopic cholecystectomy.Prompt detection and proper management of the injury have satisfactory curative effects.

Objective To explore difficulties and countermeasures of laparoscopic cholecystectomy (LC) for treating huge gallstones. Methods Fifty-six cases of huge gallstones with a diameter of 2.0~5.3 cm (3.4?0.6 cm) were reviewed in respect of their clinical features and operative difficulties and countermeasures during laparoscopic cholecystectomy. Results The laparoscopic cholecystectomy was completed smoothly in 54 cases, with an operation time of 30~130 min (94.3?40.7 min). Conversions to open surgery were required in 2 cases because of acute suppurative cholecystitis. Moderate-to-severe adhesion was found in 41 cases (73%). White bile or absence of bile secretion was found in 23 cases (41%). There were 2 cases (4%) of small bile duct injuries in the gallbladder bed, 15 cases (27%) of liver tissue injures in the gallbladder bed, and 19 cases (34%) of intraoperative gallbladder leakage. No major bile duct injury or massive hemorrhage occurred. The postoperative hospitalization time was 3.6?1.5 days. Follow-up observations for 6~12 months (mean, 11 months) found that the symptoms disappeared and no complications were noted. Conclusions The difficulties during LC for huge gallstones lie in the thickening of the gallbladder wall that causes injuries of the liver tissue and small bile ducts in the gallbladder bed. Careful dissection and reservation of part of the gallbladder wall are effective methods to lower the incidence of complications.