Proposal of the Surgical Options for Primary Tumor Control During Sentinel Node Navigation Surgery Based on the Discrepancy Between Preoperative and Postoperative Early Gastric Cancer Diagnoses

Background

There is no consensus on the optimal method of primary tumor control, determined by preoperative clinical factors, during sentinel node (SN) navigation surgery for early gastric cancer (EGC). In this study, we investigated the accuracy of clinical diagnosis based on preoperative examination in patients with EGC and proposed surgical options for primary tumor control during SN navigation surgery.

Methods

We analyzed 815 patients with clinical stage IA gastric cancer who underwent gastrectomy at the National Cancer Center in Korea between March 2001 and February 2011. The clinical stage was determined by endoscopy, endoscopic ultrasonography, and abdominal computed tomography.

Results

The preoperative assessment of tumor depth and tumor size was accurate in 57.5 and 70.8 % of patients, respectively. Tumor depth and size were underestimated in 8 and 25.3 % of patients. The overall accuracy of histologic diagnosis by endoscopic biopsy was 87.2 %. Of those tumors diagnosed preoperatively as differentiated, 20.5 % revealed mixed histology of undifferentiated type.

Conclusions

The recommendation for SN biopsy may be limited to tumors sized 3 cm or smaller to avoid positive lateral margins and to minimize the risk of skip metastases. Endoscopic resection may safely be applied to small mucosal cancers, but other surgical options should be employed for undifferentiated large mucosal lesions, given their tendency for diffuse invasion. Full-thickness resection is preferable for submucosal cancers, to secure clear vertical margins.     

Pulsed 808-nm infrared laser stimulation of the auditory nerve in guinea pig cochlea

Pulsed near-infrared radiation has been proposed as an alternative stimulus for auditory nerve stimulation and could be potentially used in the design of cochlear implant. Although the infrared with high absorption coefficient of water (i.e., wavelength ranged from 1.8 to 2.2 μm) has been widely investigated, the lymph in the cochlea absorbs most of the infrared energies, and only a small part can arrive at the target auditory nerves. The present study is aimed to test whether the short-wavelength near-infrared irradiation with lower absorption coefficients can penetrate the lymph fluid to stimulate the auditory nerves. An 808-nm near-infrared laser was chosen to stimulate the auditory nerve in the guinea pig cochlea. The infrared pulse was delivered by an optical fiber that was surgically inserted near the round window membrane and oriented toward the spiral ganglion cells in the basal turn of the cochlea. The 2-Hz infrared pulses were used to stimulate the cochlea before and after the deafness with different pulse durations (100–1,000 μs). Optically evoked compound action potentials (oCAPs) were recorded during the infrared radiation. We successfully recorded oCAPs from both normal hearing animals and deafened animals. The oCAP amplitude increased with the infrared radiation energy. The preliminary experiment suggests that the near-infrared with lower absorption coefficients can effectively pass through the lymph filled in the cochlea and stimulate the auditory nerve. Further studies will optimize the deafness animal model and determine the optimal stimulation parameters.     

Prognostic Impact of Microscopic Tumor Involved Resection Margin in Advanced Gastric Cancer Patients after Gastric Resection

Background

The prognosis of patients with positive surgical resection margins is dismal in gastric cancer. However, the influence of positive margin itself on prognosis is still uncertain, especially in advanced gastric cancer (AGC). The aims of the present study were to evaluate the prognostic impact of microscopic tumor involved resection margins in stage III–IV AGC after gastric resection in comparison with other well-known factors.

Methods

Among 1,536 consecutive gastric cancer patients who received intentional curative resection for stage III–IV AGC between April 2001 and December 2011 at the National Cancer Center, 35 patients (2.28 %) had positive resection margins on their final histology. A comparison of clinicopathologic characteristics, recurrence pattern, overall survival (OS), and disease-free survival (DFS) was made between positive margin (PM) patients and negative margin (NM) patients.

Results

Among the 35 PM patients, 15 (42.9 %) had proximal involved margins, 21 (60.0 %) had distal involved margins, and one (2.9 %) had both involved margins. Twenty-eight PM patients (80.0 %) were stage III, and 7 (20.0 %) were stage IV. Recurrence was significantly higher in PM than NM (63.6 % vs. 39.7 %, respectively; p = 0.005). The OS and DFS rates were significantly lower in the PM group than in the NM group (14.9 vs. 36.3 months, p < 0.001 and 11.6 vs. 27.1 months, p = 0.005, respectively). The presence of PM was an independent risk factor for both OS and DFS.

Conclusions

The presence of PM is an independent risk factor for OS and DFS. Considering the prognostic impact of PM, a sufficient resection margin should be ensured when determining the resection line in gastrectomy with curative intent. The reoperation to secure clear resection margins should be considered as a treatment of choice in the case of PM.     

应用富血小板血浆混合透明质酸钠治疗膝骨关节炎

目的比较富血小板血浆＋透明质酸钠(PRP＋HA)混合物与单纯使用PRP关节腔内注射治疗Ⅱ期和Ⅲ期膝骨关节炎患者的疗效。 方法选择2014年2月至2014年5月,山东大学附属省立医院和威海市立医院门诊收治的126例Ⅱ、Ⅲ期(Keligren Lawrence分级)膝关节骨关节炎的患者,随机分为PRP＋HA混合物组(63例,63膝)和PRP组(63例,63膝),两组患者性别、年龄、身体质量指数、Keligren Lawrence分级、疼痛视觉模拟评分(VAS)、美国西部安大略与麦克马斯特大学骨关节炎指数(WOMAC)评分分别采用t检验和χ²检验比较。患者接受每周1次的HA＋PRP混合物(2 ml HA＋3.5 ml PRP)关节腔内注射或只注射PRP(3.5 ml)治疗持续3周。在第1、3、6和12个月记录VAS评分和WOMAC评分,采用t检验比较治疗后不同时间点的疗效。 结果两组患者性别、年龄、BMI的差异均无统计学意义(P >0.05),具有可比性。在使用PRP＋HA混合物和单纯PRP治疗的患者中,相比治疗前患者的状态,VAS评分明显降低,膝关节的功能(WOMAC)明显改善。就VAS和WOMAC而言,两组之间差异没有统计学意义(VAS：t＝0.862,P>0.05;WOMAC：t＝1.765,P>0.05);然而,PRP＋HA混合物组有1种能获得更好的功能评分的趋势。两组中没有发现重大不良反应或并发症。 结论PRP＋HA混合物治疗Ⅱ、Ⅲ期膝骨关节炎的患者是安全有效的。     

食管癌Ivor-Lewis术中营养管置入新方法的评价

目的评价食管癌Ivor-Lewis术中新的鼻十二指肠营养管置入方法的临床效果。 方法收集内蒙古医科大学附属医院胸外科2013年1月—2016年12月期间单一手术组同一术者开展的食管中下段癌Ivor-Lewis术共117例,其中2015年3月前采用空肠造瘘术行肠内营养49例;2015年3月后采用新方法放置鼻十二指肠营养管68例,比较两组患者术中营养管置入所需时间、带管的舒适性,以及吻合口瘘、肺部感染、与营养管相关并发症的发生率。 结果117例患者均顺利置入营养管,1例采用鼻十二指肠管组患者置入失败。两组均无住院死亡病例。鼻十二指肠管组比空肠造瘘组操作时间明显缩短,差异有统计学意义[(6.2±1.8)min vs(18.2±8.2)min,P<0.05]。鼻十二指肠管组患者的咽喉部不适发生率明显高于空肠造瘘组,差异有统计学意义(36.8% vs 16.3%,P<0.05)。两组患者在肺部感染、恶心呕吐、吻合口瘘发生率等方面比较,差异均无统计学意义(P>0.05),且均未发生术后胃排空障碍和急性胃扩张。空肠造瘘组术后2例患者出现腹壁造瘘口渗液(1例最终因渗液多而拔除),2例患者出现不全肠梗阻;鼻十二指肠管组术后1例患者因烦躁自己拔除了胃管、十二指肠营养管。 结论在食管癌Ivor-Lewis术中,应用鼻十二指肠营养管置入方法简便、创伤小、时间短、并发症少,具有良好的临床效果。     

中药经皮给药脂质体的研究与展望

中药经皮给药有悠久的应用历史,脂质体作为新型载体用于中药活性成分的经皮给药可以提升药物在局部的皮内滞留或（和）透皮吸收效果,从而显著改善药效。该文从皮肤屏障的特点、中药经皮给药概况、脂质体促进经皮吸收的机制与影响因素、中药经皮给药脂质体的皮内滞留、中药经皮给药脂质体的透皮吸收等5个方面对相关研究进展进行了综述,涉及常规脂质体以及传递体、醇质体、萜质体、甘油体、表面修饰脂质体等新型脂质体的应用,并提出了坚持正确的研究方向、提升制剂技术水平和提高研究技术水平三方面的展望。      

乳腺手术患者胸椎旁神经阻滞与胸神经阻滞效果比较的Meta分析

目的 采用系统评价和Meta分析方法比较乳腺手术患者行胸椎旁神经阻滞（TPVB）和胸神经阻滞（Pecs阻滞）的镇痛效果。方法 检索PubMed、Web of Science、Embase、Ovid、Cochrane图书馆、CNKI、维普数据库、万方数据库和中国生物医学全文数据库,收集比较TPVB和PECS阻滞在乳腺手术麻醉镇痛效果的随机对照试验（RCT）。应用RevMan 5.2软件进行统计学分析。结果 获得符合标准的6个RCT研究,共计323例,其中PECS阻滞组161例,TPVB组162例。Meta分析结果显示：PECS阻滞组术后镇痛药物使用量少于TPVB组[MD=1.350,95% CI（-2.240,-0.460）],TPVB组术后疼痛评分高于PECS阻滞组[MD=1.350,95% CI（-2.110,-0.590）],两组术后恶心呕吐发生率差异无统计学意义[RlR=0.930,95% CI（0.560,1.320）]。结论 现有证据表明对于乳腺手术患者,PECS阻滞镇痛效果优于TPVB镇痛。