Kyphoplasty versus vertebroplasty for the treatment of malignant vertebral compression fractures caused by metastases: a retrospective study

Background There are few comparative studies regarding kyphoplasty (KP) and vertebroplasty (VP) for the treatment of painful vertebral compression fractures (VCF) in patients with cancer. The purpose of this study is to retrospectively compare KP with VP in pain improvement, cement leakage incidence, and the cost of treatment of malignant VCF.

Methods We performed a retrospective study of clinical data for 80 patients with multiple spinal metastases, treated with KP in 42 cases and VP in 38. Visual analog scale (VAS) scores were collected pre-operatively, post-operatively, at 1 month, 6 months, and 1 year after treatment. Cement leakage was identified using fluoroscopy and CT scan. Total cost per patient was also collected.

Results There was a significant difference between the pre- and post-operative VAS scores (7.4±2.0 to 3.8±1.6, P <0.001 in the KP group; 6.7±2.4 to 3.7±1.4, P <0.001 in the VP group), and was maintained at 1-year follow-up (3.2±1.4 in the KP group, 3.1±1.3 in the VP group). However, the difference in VAS score between these two groups was insignificant at baseline and every follow-up assessment post-operatively (P >0.05). The incidence of cement leakage in the KP group was lower than that of the VP group (16.9% (14/83) vs 30.3% (23/76), P <0.05). However, none of the patients developed any symptoms. The length of postoperative hospital stay in the VP group was shorter than that of the KP group ((2.4±1.3) vs (5.3±1.9) days, P <0.05). Total hospital cost in the KP group was much higher than that of the VP group (RMB Yuan 8 492±3 332 vs RMB Yuan 3 173±1 341, P <0.01).

Conclusions VP and KP are both effective in providing pain relief for patients with cancer-related VCF. KP provides no greater degree of pain improvement. KP is associated with a lower rate of cement leakage compared with VP. VP is associated with lower cost and shorter postoperative hospital stay in China.

     

Efficacy of multimodal cocktail periarticular injection with or without steroid in total knee arthroplasty

Background Multimodal cocktail periarticular injection （MCPI） with a large volume of low concentration local anesthetics, adrenaline, and anti-inflammatory agents such as non-steroidal anti-inflammatory drug or steroids have shown good pain control and improvement in range of motion after surgery. This study compares the efficacy of pain control after total knee arthroplasty, using multimodal cocktail periarticular injection with steroid or without steroid.     

Cigarette smoking contributes to idiopathic pulmonary fibrosis associated with emphysema

Background Combined emphysema and pulmonary fibrosis,including idiopathic pulmonary fibrosis （IPF）,is a distinct disorder described with upper-lobe emphysema and lower-lobe fibrosis on chest computed tomography.Smoking appears to be the predominant risk factor for this disorder.We aimed to compare clinical features,smoking history,physiological and radiological findings between IPF with and without emphysema.Methods A sample of 125 IPF patients over a period of 48 months were evaluated.High resolution CT scans were reviewed blinded to clinical data.The IPF patients with or without emphysema were classified accordingly.Results The prevalence of emphysema in this IPF sample was 70/125.IPF with emphysema was significantly associated with smoking status （OR 63; 95％ CI 4.4 to 915; P=0.002） and smoking pack year （OR 1.1; 95％ CI 1.05 to 1.13; P=-0.000）.The patients with IPF and emphysema had a higher decrease in carbon monoxide diffusing capacity adjusted for alveolar volume （（58±19）％ pred vs.（66：±：21）％ pred; P=-0.021） and a higher prevalence of pulmonary hypertension （24/70 vs.7/55; P=0.006）.The two groups of patients had similar forced and residual volumes.No significant differences were found in cell differentials of bronchoalveolar lavage or the scores of fibrosis on chest CT.Survival of the patients with emphysema was significantly less than that of patients with IPF alone.Conclusions Cigarette smoking induces IPF combined with emphysema.Emphysema further impairs physiological function and increases the prevalence of pulmonary hypertension that leads to poor prognosis.The inclusion of the patients with combined pulmonary fibrosis and emphysema in IPF clinical trials may lead to under evaluation of the effect of treatment in patients.     

Short-term safety and efficacy of the biodegradable iron stent in mini-swine coronary arteries

Background To overcome the drawbacks of permanent years. The bioabsorbable polymer vascular scaffold （BVS） stents, biodegradable stents have been studied in recent was the first bioabsorbable stent to undergo clinical trials, demonstrating safety and feasibility in the ABSORB studies. Iron can potentially serve as the biomatedal for biodegradable stents. This study aimed to assess the short4erm safety and efficacy of a biodegradable iron stent in mini-swine coronary arteries. Methods Eight iron stents and eight cobalt chromium alloy （VISION） control stents were randomly implanted into the LAD and RCA of eight healthy mini-swine, respectively. Two stents of the same metal base were implanted into one animal. At 28 days the animals were sacrificed after coronary angiography, and histopathological examinations were performed. Results Histomorphometric measurements showed that mean neointimal thickness （（0.46±0.17） mm vs. （0.45±0.18） mm, P=0.878）, neointimal area （（2.55±0.91） mm2 vs. （3.04±1.15） mm2, P=0.360） and percentage of area stenosis （（44.50±11.40）% vs. （46.00±17.95）%, P=0.845） were not significantly different between the iron stents and VISION stents. There was no inflammation, thrombosis or necrosis in either group. The scanning electron microscopy （SEM） intimal injury scores （0.75±1.04 vs. 0.88±0.99, P=0.809） and number of proliferating cell nuclear antigen （PCNA） positive staining cells were not significantly different between the two groups. The percentage of neointimal coverage by SEM examination was numerically higher in iron stents than in VISION stents （（84.38±14.50）% vs. （65.00±22.04）%, P=0.057）, but the difference was not statistically significant. Iron staining in the tissue surrounding the iron stents at 28 days was positive and the vascular wall adjacent to the iron stent had a brownish tinge, consistent with iron degradation. No abnormal histopathological changes were detected in coronary arteries or major organs. Conclusions The biodegradable iron stent has good biocompatibility and short-term safety and efficacy in the mini- swine coronary artery. Corrosion of iron stents is observed at four weeks and no signs of organ toxicity related to iron degradation were noted.     

Distinct properties and metabolic mechanisms of postresuscitation myocardial injuries in ventricular fibrillation cardiac arrest versus asphyxiation cardiac arrest in a porcine model

Background The two most prevalent causes of sudden cardiac death are ventricular fibrillation cardiac arrest （VFCA） and asphyxiation cardiac arrest （ACA）. Profound postresuscitation myocardial dysfunction has been demonstrated in both VFCA and ACA animal models. Our study aimed to characterize the two porcine models of cardiac arrest and postresuscitation myocardial metabolism dysfunction. Methods Thirty-two pigs were randomized into two groups. The VFCA group （n=16） were subject to programmed electrical stimulation and the ACA group （n=16） underwent endotracheal tube clamping to induce cardiac arrest （CA）. Once induced, CA remained untreated for a period of 8 minutes. Two minutes following initiation of cardiopulmonary resuscitation （CPR）, defibrillation was attempted until return of spontaneous circulation （ROSC） was achieved or animals died. To assess myocardial metabolism, 18F-FluoroDeoxyGlucose Positron Emission Tomography was performed at baseline and 4 hours after ROSC. Results ROSC was 100% successful in VFCA and 50% successful in ACA. VFCA had better mean arterial pressure and cardiac output after ROSC than ACA. Arterial blood gas analysis indicated more detrimental metabolic disturbances in ACA compared with VFCA after ROSC （ROSC 0.5 hours, pH： 7.01±0.06 vs. 7.21±0.03, P〈0.01; HCO3： （15.83±2.31 vs. 20.11±1.83） mmol/L, P〈0.01; lactate： （16.22±1.76 vs. 5.84±1.44） mmol/L, P〈0.01）. Myocardial metabolism imaging using Positron Emission Tomography demonstrated that myocardial injuries after ACA were more severe and widespread than after VFCA at 4 hours after ROSC （the maximum standardized uptake value of the whole left ventricular： 1.00±0.17 vs. 1.93±0.27, P〈0.01）. Lower contents of myocardial energy metabolism enzymes （Na＊-K＊-ATPase enzyme activity, Ca2＊- ATPase enzyme activity, superoxide dismutase and phosphodiesterase） were found in ACA relative to VFCA. Conclusions Compared with VFCA, ACA causes more severe myocardium injury an     

Long term follow up of clinical outcome between patellar resurfacing and nonresurfacing in total knee arthroplasty: Chinese experience

Background The long term outcome of patellar resurfacing in Chinese has not been well described.This study evaluated more than 10-year clinical outcomes and survivorship of patellar resurfacing or nonresurfacing in total knee arthroplasty.Methods From January 1993 to December 2002,265 patients accepted total knee arthroplasty in Department of Orthopaedic Surgery,Peking Union Medical College Hospital.Among them,226 patients （246 knees） were successfully followed up,with 176 knees for patellar resurfacing and 70 knees for nonresurfacing.The survivorship of total knee arthroplasty between two groups and the hospital for special surgery knee score （HSS）,patellar score,patellar related complication and radiological results were studied at the latest follow-up.Results The HSS knee score increased from 55.9±12.2 preoperatively to 92.0±10.9 postoperatively for patellar resurfacing group and from 56.6±9.9 to 94.2±11.4 for nonresurfacing group after average 11.4-year follow-up.Patellar score increased from 13.93±2.42 preoperatively to 28.33±2.20 for resurfacing group and from 13.55±2.73 to 27.8±2.37 for nonresurfacing group.There was no statistically significant difference for both HSS score,patellar score between the two groups with higher rate of anterior knee pain for nonresurfacing group.Patellar nonresurfacing had higher lateral subluxation than resurfacing group according to radiological evaluation.Patients with rheumatoid arthritis had 5.5 fold patellar related complication than patients with osteoarthritis.The 10-year survival rate was not statistically significant different between the two groups （P=0.12）.Conclusions There was no significant difference of long-term clinical outcome and survivorship between patellar resurfacing and nonresurfacing.Patellar nonresurfacing can be advisable during primary total knee arthroplasty especially in Chinese patients with osteoarthritis.Selective patellar resurfacing for patients with rheumatoid arthritis can achieve lower patella related complication.     

Effect of short-term high-dose atorvastatin on systemic inflammatory response and myocardial ischemic injury in patients with unstable angina pectoris undergoing percutaneous coronary intervention

Background Percutaneous coronary intervention （PCI） could develop periprocedural myocardial infarction and inflammatory response and statins can modify inflammatory responses property.The aim of this study was to evaluate whether short-term high-dose atorvastatin therapy can reduce inflammatory response and myocardial ischemic injury elicited by PCI.Methods From March 2012 to May 2014,one hundred and sixty-five statin-naive patients with unstable angina referred for PCI at Department of Cardiology of the 306th Hospital,were enrolled and randomized to 7-day pretreatment with atorvastatin 80 mg/d as high dose group （HD group,n=56） or 20 mg/d as normal dose group （ND group,n=57） or an additional single high loading dose （80 mg） followed 6-day atorvastatin 20 mg/d as loading dose group （LD group,n=52）.Plasma C-reactive protein （CRP） and interleukin-6 （IL-6） levels were determined before intervention and at 5 minutes,24 hours,48 hours,72 hours,and 7 days after intervention.Creatine kinase-myocardial isoenzyme （CK-MB） and cardiac troponin I （cTnl） were measured at baseline and then 24 hours following PCI.Results Plasma CRP and IL-6 levels increased from baseline after PCI in all groups.CRP reached a maximum at 48 hours and IL-6 level reached a maximum at 24 hours after PCI.Plasma CRP levels at 24 hours after PCI were significantly lower in the HD group （（9.14±3.02） mg/L） than in the LD group （（11.06±3.06） mg/L） and ND group （（12.36±3.08） mg/L,P ＜0.01）; this effect persisted for 72 hours.IL-6 levels at 24 hours and 48 hours showed a statistically significant decrease in the HD group （（16.19±5.39） ng/L and （14.26±4.12） ng/L,respectively）） than in the LD group （（19.26±6.34） ng/L and （16.03±4.08） ng/L,respectively,both P ＜0.05） and ND group （（22.24±6.98） ng/L and （17.24±4.84） ng/L,respectively）.IL-6 levels at 72 hours and 7 days showed no statistically significant difference among the study groups.Although PCI cau     

宫-腹腔镜检查患者联合应用帕瑞昔布钠和罗哌卡因对术后疼痛的影响

目的：评估宫 腹腔镜检查患者术前应用帕瑞昔布钠并联合应用切口周围注射罗哌卡因对术后肩痛和切口疼痛的影响。方法：60例择期全身麻醉下行宫-腹腔镜检查的患者随机分为两组,一组患者(组1,n=30)麻醉诱导前静脉注射帕瑞昔布钠40 mg（生理盐水2 mL稀释）,建立气腹前切口注射0.5%（体积分数）罗哌卡因20 mL;另一组患者(组2,n=30)麻醉诱导前静脉注射生理盐水2 mL,建立气腹前切口注射0.5%罗哌卡因20 mL。术后记录停药后患者的苏醒时间和睁眼时间,患者在恢复室内（0 h）和术后2 h、4 h、8 h、12 h、24 h、48 h的切口疼痛和肩痛的评分,以及术后患者应用曲马多的次数和剂量。结果：与组2患者相比,组1患者的术后肩痛发生率较低（37% vs. 67%,P=0.020）,术后48 h内重度疼痛的发生患者较少（4 vs. 11,P=0.037）;术后12 h,组1患者的右侧肩痛数字评分法（numerical rating scales, NRS）评分为0（0,2）,而组2患者为0（0,8）,两组差异有统计学意义（P=0.012);组1患者的左侧肩痛的NRS评分在术后12 h和24 h分别为0（0,1）和0（0,4）,也低于组2患者的0（0,8）和2（0,9）,差异有统计学意义（P=0.026,P=0.014）。术后即刻,组1患者腹部切口疼痛的动态和静态NRS评分均低于组2患者（P=0.001,P=0.005）;术后12 h和24 h,组1患者的腹部切口疼痛的静态NRS评分也低于组2患者（P=0.042,P=0.029）。组2患者术后24 h内需应用曲马多的例数多于组1 (8 vs. 0,P=0.002)。结论：术前应用帕瑞昔布钠并切口周围注射罗哌卡因可显著改善宫 腹腔镜检查术后的肩痛和切口疼痛。     

A preliminary study of imaging paclitaxel-induced tumor apoptosis with 99Tcm-His10-Annexin V

Backgroud In tumors the process of apoptosis occurs over an interval of time after chemotherapy. It is important to determine the best time for detecting apoptosis by in vivo imaging. In this study, we evaluated the dynamics and feasibility of imaging non-small cell lung cancer (NSCLC) apoptosis induced by paclitaxel treatment using a 99Tcm-labeled Annexin V recombinant with ten consecutive histidines (His10-Annexin V) in a mouse model.

Methods 99Tcm-His10-Annexin V was prepared by one step direct labeling; radio-chemical purity (RCP) and radio-stability was tested. The binding of 99Tcm-His10-Annexin V to apoptotic cells was validated in vitro using camptothecin-induced Jurkat cells. In vivo bio-distribution was determined in mice by dissection. The human H460 NSCLC tumor cell line (H460) tumor-bearing mice were treated with intravenous paclitaxel 24, 48 and 72 hours later. 99Tcm-His10-Annexin V was injected intravenously, and planar images were acquired at 2, 4 and 6 hours post-injection on a dual-head gamma camera fitted with a pinhole collimator. Tumor-to-normal tissue ratios (T/NT) were calculated by ROI analysis and they reflected specific binding of 99Tcm-His10-Annexin V. Mice were sacrificed after imaging. Caspase-3, as the apoptosis detector, was determined by flow cytometry, and DNA fragmentation was analyzed by the terminal deoxynucleotidytransferase mediated dUTP nick-end labeling (TUNEL) assay. Nonspecific accumulation of protein was estimated using bovine serum albumin (BSA). The imaging data were correlated with TUNEL-positive nuclei and caspase-3 activity.

Results 99Tcm-His10-Annexin V had a RCP >98% and high stability 2 hours after radio-labeling, and it could bind to apoptotic cells with high affinity. Bio-distribution of 99Tcm-His10-Annexin V showed predominant uptake in kidney, relatively low uptake in myocardium, liver and gastrointestinal tract, and rapid clearance from blood and kidney was observed. The T/NT was significantly increased after paclitaxel treatment, whereas it was low in untreated tumors (T/NT=1.43±0.18). The %ID/g activity in Group 2 (24 hours), Group 3 (48 hours) and Group 4 (72 hours) after treatment was 2.55±0.73, 3.35±1.10, and 3.4±0.96, respectively. Whereas in the non-treated group, Group 1, %ID/g was 1.10±0.18. The radiotracer uptake was positively correlated to the apoptotic index (r=0.852, P<0.01), as well as caspase-3 activity (r=0.816, P<0.01).

Conclusion This study addresses the dynamics and feasibility of imaging non-small cell lung tumor apoptosis using 99Tcm-His10-Annexin V.

     

Ibutilide decreases defibrillation threshold by the reduction of activation pattern complexity during ventricular fibrillation in canine hearts

Background  Ibutilide has been commonly used for pharmacologic cardioversion of atrial fibrillation and flutter in clinical settings. The objective of this study was to investigate the effects of ibutilide on the defibrillation threshold (DFT), restitution properties, dispersion of refractoriness and activation patterns during ventricular fibrillation (VF).

Methods  Ibutilide was administrated intravenously in six open-chest beagles. Before and after the drug administration, 20-second episodes of VF were electrically induced and recorded with a 10×10 unipolar electrode plaque sutured on the lateral epicardium of the left ventricle. DFT and VF activation patterns, including type of epicardial activation maps, VF cycle length (VF-CL), conduction velocity, wavelength (WL) and reentry incidence, were measured. Restitution properties and dispersion of refractoriness were estimated from activation recovery intervals (ARI) during pacing.

Results  Compared to baseline, ibutilide markedly decreased the DFT by 31% ((491±14) V vs. (337±59) V, P <0.01). The drug significantly reduced the maximal slope of the restitution curve (1.34±0.08 vs. 0.76±0.06, P <0.01) and its epicardial dispersion (0.36±0.09 vs. 0.21±0.06, coefficient of variation, P=0.03). The dispersion of refractoriness was enhanced at the pacing cycle length of 300 ms to 160 ms by ibutilide. The drug significantly increased the VF-CL ((96±19) ms vs. (112±20) ms, P <0.01) and the WL ((41±9) mm vs. (52±14) mm, P=0.02) during VF, and reduced the reentry incidence by 25% (0.08±0.02 vs. 0.06±0.02, P <0.01). In the epicardial activation maps, ibutilide significantly reduced the percentage of more complex activation maps during VF.

Conclusions  Intravenous ibutilide significantly decreased the DFT. It might be due to reduction of activation pattern complexity during VF.

     

Effect of chronic intermittent hypoxia on theophylline metabolism in mouse liver

Background Chronic intermittent hypoxia (CIH) has been associated with abnormalities in the liver,which is the most important organ for drug metabolism.This study aimed to investigate the effect of CIH...     

Comparison on colonoscopic parameters according to length of adult-colonoscope

Background High success rate of intubation and short intubation time have been needed to endoscopists for a complete and comfortable coolonoscopy,if possible.The purpose of present study was to compare procedure efficiencies according to adult-colonoscope length.Methods This was a prospective,randomized,single-blinded controlled trial.A total of 239 healthy Korean subjects were randomly assigned to two groups：one group receiving intermediate-length adult-colonoscope （n=119）,and the other group receiving long-length adult-colonoscope （n=120）.Cecal intubation time and rate,and terminal ileal intubation time and rate as well as other procedure-related outcomes （adenoma detection rate,withdrawal time,and total procedure time） were evaluated.Results There were significant differences in cecal intubation time and terminal ileal intubation rate according to colonoscope length.The time of cecal intubation was shorter in the intermediate-scope group than that in the long-scope group （（222.13±101.67） s vs.（253.85±109.40） s,P=-0.014）.However,the rate of terminal ileal intubation was higher in the long-scope group than that in the intermediate-scope group （94.2％ vs.83.2％,P=-0.007）.In addition,terminal ileal intubation time was also shorter in the long-scope group than that in the intermediate-scope group （（35.21±38.89） s vs.（44.09±33.87） s,P ＜0.001）.There were no significant differences in other procedure-related outcomes between the two groups.Conclusions The intermediate-length adult-colonoscope had an advantage over the long-length adult-colonoscope regarding cecal intubation time,whereas the long-scope had an advantage over the intermediate-scope regarding the rate and time of terminal ileal intubation.These results suggest that it is rational to prepare and use these two types of colonoscope properly,instead of employing only one type of colonoscope.     

Comparison of loading with maintenance dose of clopidogrel on platelet reactivity in Chinese with different CYP2C19 genotypes prior to percutaneous coronary intervention

Background Whether two clopidogrel pretreatment strategies prior to elective percutaneous coronary intervention （PCI）： a 300 mg loading dose （LD） in clopidogrel naive patients and a 75 mg maintenance dose （MD） once daily in patients on chronic clopidogrel therapy play the same role in the platelet inhibition in Chinese with different CYP2C19 genotypes remains unknown. We aim to evaluate the impact on platelet inhibition by clopidogrel pretreatment strategy and its interaction effect with CYP2C19 genotype. Methods Chinese patients undergoing PCI （n=840） were assigned to 2x2 groups in the trial according to different clopidogrel pretreatment strategies （470 patients in LD, 370 patients in MD） and CYP2C19 genotypes （494 carriers of any CYP2C19 ＊2 or ＊3 loss-of-function allele, 346 non-carriers）. The primary outcome was platelet aggregation （PA） as measured by the 10 umol/L adenosine diphosphate induced light transmission aggregation. Results Compared with MD group, LD strategy showed a significantly higher PA-（（59.22＋11.67）% vs. （52.83±12.17）%, P 〈0.01）, similar PA difference was observed in CYP2C19 loss-of-function carriers compared with non-carriers （（59.41±10.91）% vs. （52.10±12.90）%, P 〈0.01）. LD patients in either the CYP2C19 loss-of-function allele carrier or non- carrier group showed a significantly higher PA compared with MD group （（61.50±10.61）% vs. （56.84±10.74）%, P 〈0.01; （56.06±12.34）% vs. （46.88±11.78）%, P 〈0.01, respectively）. A quantitative interaction effect was observed between clopidogrel pretreatment strategy and CYP2C19 genotype （P=0.001）. Conclusion The 300 mg LD strategy results in a decreased effect on platelet inhibition compared with the 75 mg MD in Chinese patients receiving clopidogrel prior to PCI, especially in the CYP2C19 ＊2 or ＊3 loss-of-function allele non-carriers. （ClinicalTrials.gov number NCT01710436） Chin tided J 2014;127 （14）： 2571-2577     

Rotational Alignment in Total Knee Arthroplasty: Nonimage-based Navigation System Versus Conventional Technique

Background  Proper rotational alignment during total knee arthroplasty (TKA) is important for adequate postoperative patellofemoral and tibiofemoral kinematics, as well as for achieving balanced flexion space at 90º. The effects of computer navigation-assisted total knee replacement and conventional total knee arthroplasty on rotational alignment, mechanical axis, component position and clinical outcomes were compared.

Methods  Two methods were used in 82 patients and the rotation of the femoral and tibial components in the transverse plane, the combined rotation of the two components, the mismatch between them, and the mechanical axis of the lower limb were analyzed. All of these parameters were measured from postoperative radiographs and computed tomography images. Functional outcomes were compared at 6 weeks and 6 months postoperatively.

Results  Significant differences were found between the two techniques (P <0.05) in the following parameters: average rotation of the femoral component ((1.51±3.55)º vs. (−0.63±3.04)º); combined rotation of the femoral and tibial components (2.85±4.07)º vs. (0.28±3.43)º); and mismatch between the femoral and tibial components ((1.44±4.55)º vs. (−0.43±2.86)º). Differences in the rotation of the tibial component were not statistically significant. The prevalence of outliers (malalignment >±3° internal/external rotation) of the femoral component (31.7% vs. 12.5%) and the tibial component (36.6% vs. 15%) were significantly reduced when the navigation system was used (P <0.05). In addition, while patients in the navigation group had significantly better mechanical axis and functional outcomes at 6 weeks after surgery (P <0.05), there was no significant difference between the two groups (P >0.05) with respect to functional outcomes at 6 months.

Conclusion  The navigation system exhibited higher accuracy than the conventional technique in the transverse and coronal plane, and provided better early functional outcomes.

     

Effects of partial portal vein arterialization on liver regeneration after hepatectomy in minipigs with obstructive jaundice

Background  Hilar cholangiocarcinoma is a malignant tumor that is difficult to cure. BACKGROUNDThe aim of this study was to observe the effects of flow-controlled partial portal vein arterializations (PPVA) on liver regeneration after hepatectomy in minipigs with chronic obstructive jaundice.

Methods  Eight minipigs were made into chronic obstructive jaundice models. United semi-hepatectomy, which imitates extended radical surgery for treatment of hilar cholangiocarcinoma, was then performed. The eight minipigs were randomly divided into groups A and B (n=4 minipigs each). PPVA was performed in Group A but not in Group B. The effects of flow-controlled PPVA on live regeneration after hepatectomy were observed for 30 days after hepatectomy.

Results  The portal vein PO₂ at the immediate time point and on postoperative day 30 was higher in Group A ((47.33±2.43) and (48.50±4.44) mmHg) than in Group B ((35.38±4.06) and (35.55±2.55) mmHg respectively, all P <0.01). The mitotic index of liver cells on postoperative days 14 and 21 was higher in Group A (12.55%±2.85% and 15.25%±1.99% respectively) than in Group B (6.85%±2.10% and 11.88%±1.15% respectively, all P <0.05). The regeneration rate of residual liver on postoperative days 14 and 21 was higher in Group A (24.56%±6.15% and 70.63%±9.83% respectively) than in Group B (11.96%±5.43% and 44.92%±7.42% respectively, P <0.05 and P <0.01 respectively).

Conclusion  Flow-controlled PPVA can promote liver regeneration after hepatectomy and prevent liver failure in minipigs with chronic obstructive jaundice.

     

Role of paxillin in colorectal carcinoma and its relationship to clinicopathological features

Background Colorectal carcinoma is one of the most common malignant tumors.Despite advances in therapy,mortality is still very high.The aim of this study was to evaluate the expression of paxillin in the human colon adenocarcinoma cell line SW480 and its role in cell cycle and apoptosis.We also investigated the expression of paxillin in colorectal carcinoma tissues and its relationship to clinicopathological features and survival.Methods Paxillin short hairpin RNA （shRNA） was constructed and transfected into the colon adenocarcinoma cell line SW480.The influence of paxillin shRNA on the cell cycle and cell apoptosis was analyzed by flow cytometry.Immunohistochemistry staining was used to assess the expression of paxillin and its association with the expression of carcinoembryonic antigen （CEA）,carbohydrate antigen （CA） 19-9,p53 and Bcl-2 in 102 patients with primary colorectal carcinoma.Western blotting was also used to investigate the expression of paxillin.Medical records were reviewed and a clinicopathological analysis was performed.Results In vitro,the percentage of cells in S phase was （45.23±1.05）％,（43.53±1.23）％,and （36.13±0.57）％ in the blank control group,negative control group,and paxillin shRNA group respectively.It was significantly decreased in the paxillin shRNA group （P=0.000）.The early apoptosis index of the paxillin shRNA group （17.2±1.18％） was significantly increased compared to the control shRNA group （（13.17±1.15）％,P=0.013）.Paxillin was positive in 71 （69.6％） patients,and it was found to be overexpressed in tumor tissues compared with normal adjacent tissues.Paxillin positive rate was higher in patients who are less than 50-years old （100.0％ vs.65.6％,P=0.016）.Paxillin expression was associated with a high histologic grade of carcinoma （81.4％ vs.61.0％,P=0.031）,a high rate of regional lymph node metastasis （22.5％ vs.13.0％,P=0.031）,mesenteric artery lymph node metastasis （100.0％ vs.64.8％,P=0.008）,distant metastasis （94.1％ vs.64.7％,P=-0.016） and a high Tumor Node Metastasis （TNM） stage （94.1％,73.2％,60.0％,and 50％,P=0.030）.Multivariate analyses revealed that recurrence was associated with the rate of regional lymph node metastasis （P=0.001） and paxillin expression （P=0.024）.Multivariate analysis indicated that the overall survival is related to the TNM stage （P=0.000）.Conclusions In vitro,paxillin may promote cell proliferation and inhibit apoptosis in SW480 cells.Paxillin may be a potential metastasis predictor,and an independent prognosis factor of recurrence.It may also be related to poor patient outcomes,but was not an independent predictor of survival.     

Impairment of recovery of muscle function by residual rocuronium after re-transfusion of intraoperative salvaged blood

Background Recurarization has previously been described in the context of acute normovolemic hemodilution.The aim of this study was to investigate the impairment of recovery of neuromuscular function after re-transfusion of intraoperative salvaged blood in patients treated with rocuronium.Methods We enrolled 50 patients undergoing general anesthesia for lumbar surgery.Intraoperative blood salvage （IBS） was used in 30 patients （group Ⅰ）; the remaining 20 comprised a control group （group C）.Anesthesia was induced with fentanyl,midazolam,propofol and rocuronium.Rocuronium was infused to maintain neuromuscular blockade during surgery.Blood was collected from the operative field and re-transfused in the post-anesthesia care unit （PACU）.Neuromuscular function was monitored using the train-of-four ratio （TOFr）.Once the train-of-four ratio exceeded 90 in the PACU,neuromuscular function was evaluated every 5 minutes for 30 minutes.The TOFr and incremental recovery of TOFr from baseline were recorded.Salvaged blood was re-transfused at the beginning of the evaluation for patients in group Ⅰ,and afterwards for patients in group C.Blood gas analysis was assessed before anesthesia and in the PACU.Results Incremental recovery of TOFr from baseline was significantly less in group Ⅰ than controls at 25 minutes （6.1±3.2vs.9.1±3.2,respectively; P=0.001） and 30 minutes （7.1±3.2 vs.10.0±2.2,respectively; P=-0.001）.There were no significant differences in gas exchange between the groups.Conclusions In patients who had received a rocuronium infusion during anesthesia,re-transfusion of salvaged blood significantly impaired recovery of neuromuscular function recovery in the PACU,but without significant impairment of respiratory function.     

Hydrogen sulfide defends against the cardiovascular risk of Nw-nitro-L-argininemethyl ester-induced hypertension in rats via the nitric oxide/endothelial nitric oxide synthase pathway

Background Dyslipidemia caused by liver injury is a significant risk factor for cardiovascular complications.Previous studies have shown that hydrogen sulfide （H2S） protects against multiple cardiovascular disease states in a similar manner as nitric oxide （NO）,and NO/endothelial nitric oxide synthase （eNOS） pathway is the key route of NO production.The purpose of this study was to investigate whether H2S can ameliorate the high blood pressure and plasma lipid profile in Nw-nitro-L-argininemethyl ester （L-NAME）-induced hypertensive rats by NO/eNOS pathway.Methods Thirty-six 4-week old Sprague-Dawley （SD） male rats were randomly assigned to 6 groups （n=6）：control group,L-NAME group,control ＋ glibenclamide group,control ＋ NaHS group,L-NAME ＋ NaHS group,and L-NAME ＋ NaHS ＋ glibenclamide group.Measurements were made of plasma triglycerides （TG）,low-density lipoprotein （LDL）,high-density lipoprotein （HDL）,total cholesterol （CHO）,glutamic-pyruvic transaminase （ALT） levels after 5 weeks.Then measurements of NO level and proteins expression of eNOS,P-eNOS,AKT,P-AKT were made in liver tissue.Results After 5 weeks of L-NAME treatment,the blood pressure,plasma TG （（1.22±0.12） mmol/L in L-NAME group vs.（0.68±0.09） mmol/L in control group; P ＜0.05） and LDL （（0.54±0.04） mmol/L in L-NAME group vs.（0.28±0.02） mmol/L in control group; P ＜0.05） concentration were significantly increased,and the plasma HDL （（0.26±0.02） mmol/L in L-NAME group vs.（0.69±0.07） mmol/L in control group; P ＜0.05） concentration significantly decreased.Meanwhile the rats treated with L-NAME exhibit dysfunctional eNOS,diminished NO levels （（1.36±0.09） mmol/g protein in L-NAME group vs.（2.34±0.06） mmol/g protein in control group; P ＜0.05） and pathological changes of the liver.H2S therapy can markedly decrease the blood pressure （（37.25±4.46） mmHg at the fifth week; P ＜0.05）,and ameliorate the plasma TG （（0.59±0.06） mmHg）,     

Retroperitoneal laparoendoscopic single-site ureterolithotomy versus conventional laparoscopic ureterolithotomy

Background Laparoendoscopic single-site （LESS） surgery through the retroperitoneal approach has been seldom reported.We aimed to evaluate the outcomes of LESS and conventional laparoscopic surgery via the retroperitoneal approach in the management of large,impacted ureteral calculi.Methods Between November 2011 and July 2013,retroperitoneal LESS ureterolithotomy was performed in 12 patients using a homemade single-port device comprising a surgical glove and several strips of tape.Another 16 patients underwent conventional retroperitoneal laparoscopic ureterolithotomy.We compared the operative time,complications,and surgical outcomes,retrospectively.Results All patients were completed without conversion to conventional laparoscopic or open surgery.The operative time of the LESS group and of the conventional laparoscopic group were （125.3±12.8） minutes and （116.9±14.4）minutes,respectively （P=0.119）.The intraoperative blood loss was （42.9±8.9） and （43.4±14.7） ml,respectively （P=0.914）.Postoperative radiologic evaluation revealed that the stones had been removed completely.Cosmetic results were superior in the LESS group （P=0.001）.Conclusion Retroperitoneal LESS ureterolithotomy using a homemade single-port device can be considered a feasible and safe alternative to conventional laparoscopic ureterolithotomy.     

Nine-month angiographic and two-year clinical follow-up of polymer-free sirolimus-eluting stent versus durable-polymer sirolimus-eluting stent for coronary artery disease: the Nano randomized trial

Background First generation drug-eluting stents （DES） were associated with a high incidence of late stent thrombosis （ST）,mainly due to delayed healing and re-endothelization by the durable polymer coating.This study sought to assess the safety and efficacy of the Nano polymer-free sirolimus-eluting stent （SES） in the treatment of patients with de novo coronary artery lesions.Methods The Nano trial is the first randomized trial designed to compare the safety and efficacy of the Nano polymer-free SES and Partner durable-polymer SES （Lepu Medical Technology,Beijing,China） in the treatment of patients with de novo native coronary lesions.The primary endpoint was in-stent late lumen loss （LLL） at 9-month follow-up.The secondary endpoint was major adverse cardiac events （MACE）,a composite of cardiac death,myocardial infarction or target lesion revascularization.Results A total of 291 patients （Nano group：n=143,Partner group：n=148） were enrolled in this trial from 19 Chinese centers.The Nano polymer-free SES was non-inferior to the Partner durable-polymer DES at the primary endpoint of 9 months （P 〈0.001）.The 9-month in-segment LLL of the polymer-free Nano SES was comparable to the Partner SES （0.34±0.42） mm vs.（0.30±0.48） mm,P=0.21）.The incidence of MACE in the Nano group were 7.6% compared to the Partner group of 5.9% （P=0.75） at 2 years follow-up.The frequency of cardiac death and stent thrombosis was low for both Nano and Partner SES （0.8% vs.0.7%,0.8% vs.1.5%,both P=1.00）.Conclusions In this multicenter randomized Nano trial,the Nano polymer-free SES showed similar safety and efficacy compared with the Partner SES in the treatment of patients with de novo coronary artery lesions.Trials in patients with complex lesions and longer term follow-up are necessary to confirm the clinical performance of this novel Nano polymer-free SES.