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Effect of small incision versus traditional incision thoracotomy for aortic valve replacement: A case control study

ObjectiveTo compare the clinical efficacy of small incision with traditional thoractomy for aortic valve replacement.MethodsWe retrospectively analyzed the clinical data of 78 patients with heart valve replacement in our hospital between May 2014 and June 2016. The patients were divided into a small incision group and an open chest group with 39 patients in each group. In the small incision group, 18 males and 21 females, aged 56.4±10.8 years, underwent cardiac surgery with a small incision. And in the open chest group, 17 males and 22 females, aged 57.1±9.7 years, underwent cardiac surgery by thoracotomy.ResultsThe extracorporeal circulation time, aortic cross clamping time of the small incision group were longer than those of the open chest group (P<0.05). But the amount of intraoperative blood transfusion and postoperative 24 h drainage volume of the small incision group were significantly less than those of the open chest group (P<0.05). Postoperative mechanical ventilation time, and postoperative hospitalization time of the small incision group were significantly shorter than those of the open chest group (P<0.05). Pain score of the small incision group was significantly lower than that of the open chest group significantly (P<0.05). There was no statistical difference in complications rate between the two groups after 6 months (P>0.05).ConclusionCompared with traditional open chest cardiac surgery, small incision cardiac surgery is effective and safe, and is worth popularizing in clinic.

封閉式負壓引流技術聯合腓腸神經營養血管皮瓣治療跟腱部軟組織缺損

目的 總結封閉式負壓引流技術（vacuum sealing drainage，VSD）聯合腓腸神經營養血管皮瓣治療跟腱部軟組織缺損的臨床療效。 方法 2008 年1 月－ 2010 年6 月，收治14 例跟腱中下部軟組織缺損患者。男9 例，女5 例；年齡18 ～ 67 歲，平均46 歲。交通事故傷6 例，重物砸傷4 例，炸傷2 例。受傷至入院時間為2 ～ 6 h，平均3.5 h；外院清創縫合后感染致皮膚壞死2 例。軟組織缺損部位：跟腱部軟組織缺損11 例，其中4 例伴跟腱斷裂；跟腱及跟骨結節處軟組織缺損3 例。創面范圍為3 cm × 3 cm ～ 8 cm × 6 cm。入院后先行VSD 治療，待創面有新鮮肉芽組織后，采用大小為4.5 cm × 4.0 cm ～ 10 cm × 8 cm 的腓腸神經營養血管皮瓣修復創面。供區直接縫合或植皮修復。 結果 采用VSD 治療1 次11 例，2 次2 例，3 次1 例。術后第8 天1 例發生皮瓣遠端周緣壞死，經換藥后10 d 愈合；其余皮瓣及植皮均順利成活，創面Ⅰ期愈合。患者術后均獲隨訪，隨訪時間6 ～ 20 個月，平均12 個月。皮瓣外形、質地良好，無臃腫，局部無明顯瘢痕攣縮，耐磨性良好。術后6 個月踝關節功能采用美國足踝外科學會（AOFAS）評分系統，獲優9 例，良3 例，可1 例，差1 例，優良率為85.7%。 結論 VSD 能有效預防和控制感染，促進肉芽生長，為皮瓣修復提供良好條件；腓腸神經營養血管皮瓣是修復跟腱中下部軟組織缺損的有效方法。

非體外循環雙向Glenn分流術治療

目的 總結非體外循環下行雙向Glenn分流術治療紫紺型復雜先天性心臟病的臨床經驗，以提高手術療效。 方法 2001年5月至2007年5月，56例患者在非體外循環下行雙向Glenn分流術，術后采用電話和信件問卷方式對患者進行隨訪。 結果 術后早期死亡3例，死于低心排血量綜合征。術后肺動脈壓較術前增高(16.3±3.2 mm Hg vs. 12.4±2.1 mm Hg，Plt;0.05);術后動脈血氧飽和度較術前提高（91％±5％ vs. 74％±10％，Plt;0.05)。隨訪39例，隨訪時間3個月～6年，失訪14例。隨訪期間死亡2例，其中1例出院后即死于心力衰竭，1例于3年后死于肺氣腫。37例生存患者的5年生存率為95% (37/39)，32例紫紺有所減輕，21例患者于術后3～6個月行心電圖、彩色超聲心動圖檢查，腔靜脈肺動脈吻合口均通暢，肺動脈壓為17.3±1.8 mm Hg。 2例患者于術后2年行全腔靜脈肺動脈連接術，二期手術后效果滿意。 結論 非體外循環下雙向Glenn手術安全、可靠，是一種治療難以解剖根治或一期生理矯治的紫紺型復雜先天性心臟病患者的較好術式。

Research Progress of Pancreatic Fistula Following Pancreaticoduodenectomy

ObjectiveTo summarize the prevention method for pancreatic fistula following pancreaticoduodenec-tomy. MethodLiteratures related to the prevention methods for postoperative pancreatic fistula at home and abroad in recent years were retrieved and summarized. ResultsThe pancreatic fistula was a common complication following pancreaticoduodenectomy. It was mainly caused by preoperative continuous high jaundice, selection of intraoperative anastomosis, and early postoperative pancreatic juice secretion. Trypsinogen was activated by alkaline intestinal juice and then the nearby tissue was digested. Pancreatic juice flowed into abdominal cavity to digest the tissue, then caused serious complications or even death. Through the prevention of drugs, preoperative biliary drainage and intraoperative anastomosis, etc., the incidence of postoperative pancreatic fistula was slightly decreased. ConclusionThe prevention for postoperative pancreatic fistula is an integrated process, and it needs to be ran through the whole perioperative period.

CT Diagnosis and Treatment of Retroperitoneal Cystic Lymphangioma(Report of 5 Cases)

目的 探討腹膜后囊性淋巴管瘤的CT診斷價值和治療方法。方法 回顧性分析2004年6月至2010年5月期間我院收治的5例經病理檢查證實的腹膜后囊性淋巴管瘤患者的臨床表現、CT影像特征、手術治療及術后隨訪的資料。結果 5例患者術前CT均診斷為囊性淋巴管瘤，均行手術完整切除腫瘤，術后病理結果均證實為囊性淋巴管瘤。術后7 d順利出院，隨訪3個月～6年均無復發。結論 CT對腹膜后囊性淋巴管瘤的診斷具有重要意義，手術完整切除整個囊壁是治療及預防術后復發的最好方法。

THE EXAMINATION OF APOPTOSIS AND EXPRESSION OF PROLIFERATING CELL NUCLEAR ANTIGEN IN HEPATOCELLULAR CARCINOMA

Objective To examine the relationship between ratio of proliferating cell nuclear antigen (PCNA)/apoptosis and biology of hepatocellular carcinoma. Methods Thirty five cases of hepatocellular carcinoma were studied with TUNEL and immunohistochemistry. Results Positive rate of apoptosis in grade Ⅰ, Ⅱ, Ⅲand Ⅳ was 1.37%,0.70%, 0.67% and 0.25% respectively. Positive rate of PCNA in grade Ⅰ, Ⅱ, Ⅲ and Ⅳ was 17%, 19%, 75% and 80%. Ratio of PCNA/apoptosis in grade Ⅰ,Ⅱ,Ⅲ and Ⅳ was 19.04, 75.51, 138.01 and 345.52. Conclusion Ratio of PCNA/apoptosis is correlated with histological classification.

支氣管擴張癥138例

目的 總結支氣管擴張癥外科治療的臨床診斷和治療經驗. 方法 回顧性分析1985～ 1999年手術治療138例支氣管擴張癥患者的診斷和治療情況. 結果 全組無1例手術死亡,94例單葉或雙葉支氣管擴張患者癥狀消失;13例雙側或廣泛支氣管擴張患者,癥狀均改善. 結論 把握好手術適應證和肺的切除范圍,可降低手術死亡率和并發癥發生率,提高治療效果.肺切除術對治療單葉或雙葉支氣管擴張療效十分顯著,盡可能完全切除病灶是獲得最佳治療效果的前提.

Dubin-Jonhson綜合征合并膽囊結石1例報道

Study on adsorption of microRNA-124 by long chain non-coding RNA MALAT1 regulates osteogenic differentiation of mesenchymal stem cells

ObjectiveTo investigate the regulatory effect of long chain non-coding RNA (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) adsorbing microRNA-124 (miR-124) on osteogenic differentiation of mesenchymal stem cells (MSCs).MethodsC3H10T1/2 cells derived from mouse embryos were cultured in vitro, then randomly divided into control group (group A), lncRNA MALAT1 no-load plasmid group (group B), lncRNA MALAT1 overexpression plasmid group (group C), lncRNA MALAT1 small interfering RNA (siRNA) group (group D), and lncRNA MALAT1 siRNA negative control group (group E). The cells were transfected into plasmids and siRNA, then induced to differentiate into osteoblasts. Alkaline phosphatase (ALP) and alizarin red staining were used to detect the osteogenic differentiation of cells in each group, real-time fluorescence quantitative (qRT-PCR) analysis was used to detect the expressions of lncRNA MALAT, miR-124, and osteogenesis-related genes such as Runt-related transcription factor 2 (Runx2), osteopontin (OPN), and osteocalcin (OCN) in each group. Double luciferase reporter gene was used to detect the targeting regulation of lncRNA MALAT1 to miR-124.ResultsThe relative contents of ALP positive cells, mineralized nodule, and the relative mRNA expressions of lncRNA MALAT1, Runx2, OPN, and OCN in group C were significantly higher than those in other groups (P<0.05), while in group D significantly lower than in other groups (P<0.05); the relative expression of miR-124 in group C was significantly lower than that in other groups(P<0.05), while in group D significantly higher than in other groups (P<0.05). There was no significant difference in these indexes between groups A, B, and E (P>0.05). The results of double luciferase reporter gene assay showed that lncRNA MALAT1 targeting down-regulated the expression of miR-124.ConclusionLncRNA MALAT1 can targeting down-regulate the expression of miR-124 and promote the osteogenic differentiation of MSCs.

Investigation of Cognition Degree and Clinical Use of 2011 GOLD New COPD Classification System in Respiratory Specialist from Chongqing

Objective To investigate the cognition degree and clinical use of new COPD classification system of 2011 GOLD in respiratory specialists, and further analyze the reasons of failing to clinical use. Methods Respiratory specialists from 42 hospitals in Chongqing were investigated through questionnaire survey. The questionnaire contains two parts. The first part contains nine questions about the knowledge of 2011 GOLD new COPD classification system and its clinical use. The second part contains six questions about the reasons of failing to clinical use of the COPD classification system. Results A total of 204 valid questionnaires were recovered. More than 90% respiratory specialists had understood the new COPD classification system with different degree, and believed it is suitable for clinical use. More than twothirds respiratory specialists knew well the ways about CAT and mMRC, but only 24% specialists were using these ways. The main reasons of failing to clinical use were as follows: 60% specialists believed the pulmonary function test can evaluate the COPD classification, and 66. 7% specialists were limited by short visit time. The cognition degree and clinical use of the new COPD classification systemin the specialists from third grade A class hospitals was better than those from the other hospitals. But the difference was not significant among specialists with different professional title.Conclusion Respiratory specialists in Chongqing knew well about the new COPD classification systemin 2011 GOLD, but did not use it widely in clinical works due to the complicated operation of the new COPD classification system.