[Application of sutureless integrated stented graft in patients with aortic dissection]

Objective: To preliminarily investigate effectiveness and safety of sutureless integrated stented graft (SIS graft) on aortic dissection patients undergoing surgeries. Methods: In October 2019, 2 patients with aortic dissection were treated by SIS graft in Shenzhen Fuwai Hospital. Data of the operations and follow-up were recorded. Results: Patient 1 (male, 42 years old) was treated with aortic sinus repair, ascending aortic replacement, total arch replacement combined with frozen elephant trunk implantation. Time of cardiopulmonary bypass and circulatory arrest was 81 minutes and 9.5 minutes,respectively. The lowest nasopharynx temperature was 27.3 ℃. This patient was followed up for 10 months and no postoperative complication was found. Six-month postoperative aortic CT angiography (CTA) revealed SIS graft was patent and no anastomosis fistula or stent leakage occurred. True lumen of stented area was full-filled and false lumen disappeared. Incomplete false lumen thrombosis was seen in un-stented thoracic aorta, but no progressive aortic enlargement appeared. Patient 2 (male, 61 years old) was treated with ascending aortic replacement, ascending aorta to right femoral artery bypass graft, total arch replacement combined with frozen elephant trunk implantation. Time of cardiopulmonary bypass and circulatory arrest was 77 minutes and 7 minutes,respectively. The lowest nasopharynx temperature was 27.3 ℃. This patient was also followed up for 10 months and was free of postoperative complications. Six-month postoperative aortic CTA revealed SIS graft was patent and there was no anastomosis fistula or stent leakage. Perfusion of true lumen in thoracic aorta and branches of abdominal aorta improved significantly and complete false lumen thrombosis could be seen in thoracic aorta. Progressive aortic enlargement was not detected. Conclusion: Application of SIS graft can reduce circulatory arrest time and avoid deep hypothermia, which will decrease risks of postoperative complications, and this graft can simplify surgery procedure. However, further clinical trial for effectiveness and safety of SIS graft should be applied.

Laparoscopic intersphincteric resection for low rectal cancer: comparison of stapled and manual coloanal anastomosis

AIM

The study aim was to analyse the safety and feasibility of laparoscopic intersphincteric resection with stapled coloanal anastomosis for low rectal cancer.

METHOD

Between March 2009 and August 2010, 22 patients underwent laparoscopic intersphincteric resection with a stapled coloanal anastomosis without a diverting ileostomy. The results were compared retrospectively with hand-sewn coloanal anastomoses performed between January 2001 and May 2009, which included 55 open and 38 laparoscopic intersphincteric resections. The morbidity comparison only included data relevant to the anastomosis. Function was compared using the Saito function questionnaire and the Wexner score and only involved data relevant to the laparoscopy.

RESULTS

The anastomotic complication rates were similar for fistula, bleeding and neorectal mucosal prolapse (P = 0.526, P = 0.653 and P = 0.411, respectively). Anastomotic leakage and stricture formation of the stapled coloanal anastomosis were significantly lower than those of the hand-sewn coloanal anastomosis (P = 0.037 and P = 0.028, respectively). There were no significant differences in the Saito function questionnaire and the Wexner score between the stapled and hand-sewn coloanal anastomotic groups (all P > 0.05).

CONCLUSION

Laparoscopic intersphincteric resection with a stapled coloanal anastomosis is technically feasible and is less likely to result in anastomotic leakage and stricture formation than a hand-sewn anastomosis.

Up-regulation of human arrest-defective 1 protein is correlated with metastatic phenotype and poor prognosis in breast cancer

BACKGROUND

Human arrest defective 1 protein (ARD1), as a N-terminal acetyltransferase, has been reported to play a crucial role in tumorigenesis, but the results are somewhat controversial. To explore the clinical and pathological significance of ARD1 in breast tumorigenesis, we analyzed ARD1 status in multiple types of breast disease.

METHODS

The expression of ARD1 protein was assessed by immunohistochemistry in 356 cases including 82 invasive ductal carcinomas (IDC), 159 fibroadenomas, 66 hyperplasia of mammary glands, 19 inflammatory breast disease, 30 breast cysts, and in 29 postoperative treatment patients. We assessed the relationship of ARD1 protein with clinical and pathological characteristics using χ2 test.

RESULTS

ARD1 protein was observed at 61.0% (50/82), 54.7% (87/159), 37.9% (25/66), 36.8% (7/19) in IDC, fibroadenoma, hyperplasia, and inflammation, respectively, and less than 30.0% for breast cyst. Thus, high ARD1 expression correlated with breast cancer (relative risk = 1.32, P < 0.005). Moreover, the level of ARD1 protein in carcinoma patients was distinctly related to lymph node metastasis and ER status, with 94.0% (47/50) as copmpared to 6.0% (3/50) in metastatic and non-metastatic (P < 0.001), and 84.0% (42/50) and 16.0% (8/50) for ER + and ER - (P < 0.01), respectively. In addition, the level of ARD1 appeared to have potential for evaluation of prognosis in breast cancer patients after postoperative therapy.

CONCLUSIONS

These results suggest that ARD1 expression may be as a potential target for exploring the mechanism of breast cancer metastasic to lymph nodes and hormone-responsive regulation.

Effects of morphine and its withdrawal on Y-maze spatial recognition memory in mice

Effects of morphine on acquisition and retrieval of memory have been proven in the avoidance paradigms. In present study, we used a two-trial recognition Y-maze to test the effects of acute morphine and morphine withdrawal on spatial recognition memory. The Y-maze is based on the innate tendency of rodents to explore novel environments and therefore avoid punishment and reward.

RESULTS

1) Pre-training morphine 10 mg/kg impaired the recognition spatial memory of acquisition after a 1 h inter-trial interval (ITI), whereas morphine 2.5, 5 and 10 mg/kg showed impairment after 2 h ITI. 2) Pre-retention morphine 5, 10 mg/kg disrupted the retrieval of memory after 1 h ITI. 3) Morphine 5 and 10 mg/kg caused hyper-locomotor activity depending on the state. 4) Mice withdrawn from morphine 40 mg/kg but not 10 mg/kg for 3 days showed amnesia in Y-maze. Our data suggested that acute morphine impaired the acquisition and retrieval of spatial recognition memory and increased the locomotor activity in the Y-maze depending on the dose and state. Moreover, withdrawal from chronic morphine also impaired acquisition in the Y-maze depending on the dose and state.

[Treatment of refractory multiple myeloma with vincristine, adriamycin, and dexamethasone]

Ten patients with multiple myeloma (two refractory and eight relapsing) received vincristine and adriamycin infusion therapy with oral high-dose dexamethasone (VAD regimen). Reduction in monoclonal immunoglobulin in serum exceeding 75 per cent was noted in three patients and reduction from 50 per cent to 75 per cent in four patients. Total response rate was 70 per cent. It was as high as the results reported in other countries. The responses to VAD regimen occurred rapidly. Most of them needed only one course. The side effects of VAD were not severe and were mainly reversible depression of leukocyte and infection of various kinds. All patients tolerated well. The probable mechanisms for increased response to VAD regimen are as follows. 1. Instead of administration as a bolus, vincristine and adriamycin were infused continuously and were given several times; therefore there was a prolonged unchanged concentration of the drugs in blood and exerting a possibly superior antitumor effect. 2. high-dose dexamethasone.

[Clinical analysis of 36 cases of coexistent hyperthyroidism with idiopathic thrombocytopenic purpura]

36 cases of coexistent hyperthyroidism and idiopathic thrombocytopenic purpura (ITP) were reported. There were 33 cases of overt hyperthyroidism with ITP. After treatment with antithyroid drugs the platelet count returned to normal in 29 and somewhat increased in the remaining four cases. The other three cases had ITP accompanied by hyperthyroidism. In 2 cases the platelet count decreased when they had accompanying hyperthyroidism. When the thyroid function returned to normal after antithyroid treatment, the platelet count returned to normal in one and increased in another. The authors discussed the association between hyperthyroidism and ITP and treatment of coexistent hyperthyroidism and ITP. Probable mechanisms causing thrombocytopenia in hyperthyroidism were discussed also.