[Application of Bi's intestinal loop binding in treating patients with critical esophagojejunal anastomosis leakage]

Objective: To assess the safety and feasibility of Bi's intestinal loop binding treatment of esophageal jejunal anastomotic leak after total gastrectomy. Methods: Bi's Intestinal loop binding are suitable for patients who underwent radical total gastrectomy+Roux-en-Y anastomosis and were confirmed by upper gastrointestinal angiography to have esophageal jejunal anastomotic leakage and whose conservative or endoscopic treatment was ineffective. The operation procedure is as follows: take the original central incision of the upper abdomen, remove the abscess around the anastomoses after ventral incision, and place drainage tube inside the abscess, which is convenient to rinse and drain after operation. A double 1-0 VICRYL is applied to the loop of gastrointestinal surrogate 10-15 cm proximal to the jejuno-jejunal anastomosis. The knot tension is tight to prevent regurgitation of digestive juices, but too much force should be avoided to cut the intestinal tract. Nutritional jejunostomy fistula was performed at 10‒15 cm distal to the jejuno-jejunal anastomosis and gastric tube was retained during the operation. The preoperative and postoperative data from 12 patients with jejunal esophageal anastomotic leak after total radical gastrectomy and Roux-en-Y anastomosis were retrospectively analyzed from October 2016 to January 2023 in gastrointestinal surgery and pancreas surgery at Shanxi People's Hospital, and observed the curative effect. Results: 12 patients were managed with Bi's Intestinal loop binding, operative time (60.0±20.8) minutes, median bleeding (50±10.8) ml, median hospital stay 20(12~28) days, and median reviewing upper and mid Gastrointestinal Contrast time postoperatively 61(52~74) days. The results showed that the anastomoses healed well, all the small intestine showed good imaging, the binding wire fell off by itself, and two patients had incision infection. Conclusions: It is safe and feasible for patients with esophageal jejunostomy fistulae after total gastrectomy to use the method of Bi's Intestinal loop binding.

Risk factors for hemodynamic instability during laparoscopic resection of pheochromocytoma

Background

Laparoscopic adrenalectomy for pheochromocytoma is associated with high risk of intraoperative hemodynamic instability. Our study aimed to identify predictive factors for hemodynamic instability during laparoscopic resection of pheochromocytoma.

Methods

Between January 2011 and December 2021, 136 patients underwent unilateral laparoscopic adrenalectomy for pheochromocytoma. The patients were divided into 2 groups depending on the presence or absence of hemodynamic instability during surgery. Intraoperative hemodynamic parameters were compared between the 2 groups. Patient demographic characteristics and preoperative evaluations were assessed for their prognostic relevance with respect to intraoperative hemodynamic instability via both univariate analysis and multivariate logistic regression analysis.

Results

There was greater blood pressure fluctuations and higher maximum blood pressure and heart rate in the hemodynamic instability group. More patients need intraoperative administration of vasoactive drugs in the hemodynamic instability group. In the univariate analysis, presence of coronary artery disease, tumour size, and previous hypertension history were significantly associated with intraoperative hemodynamic instability. The multivariate logistic regression analysis showed that tumour size and previous hypertension history were independent risk factors for intraoperative hemodynamic instability.

Conclusion

Tumour size and previous hypertension history were associated with hemodynamic instability during laparoscopic resection of pheochromocytoma.

[Spatial Distribution and Risk Assessment of Heavy Metals in Sediments of the Ruxi Tributary of the Three Gorges Reservoir]

Sediment column and soil samples collected from 12 sampling sites in four regions of the Ruxi River, a typical tributary of the Three Gorges Reservoir, were analyzed for eight selected heavy metals including Cr, Ni, Cu, Mn, Zn, Cd, Pb, and Hg to evaluate their spatial and vertical distribution, source, and biological toxic effects. The results showed that the average concentrations of heavy metals were (79.60±11.87), (41.340±4.999), (32.69±8.70), (823.34±125.76), (122.11±22.82), (0.393±0.140), and (29.122±6.811) mg·kg^-1 for Cr, Ni, Cu, Mn, Zn, Cd, and Pb, respectively, and (74.84±39.50) μg·kg^-1 for Hg, all of which exceeded the sediment background values of the Yangtze River. A spatial trend of decreasing metal concentrations was observed from the reach influenced by the human activities of Ruxi town to the backwater zone and then to the natural river reach. Moreover, in the backwater zone, the heavy metals in sediments and soil along the river were significantly lower than those in sediments, indicating that the sediments and soil were not one primary source for these metals in backwater zone sediment. From the vertical distribution of sediment, in addition to Pb, the highest level of metals was observed at 8 cm in the reach influenced by human activities, and their concentrations decreased with sediment depth in the backwater zone and natural river beach. Significant correlation was found between all the heavy metals (P<0.01, except Ni), indicating a potential homology of these metals in the Ruxi River. Evaluation results of the geoaccumulation index reveal that there exists light to partial moderate Cd and Zn pollution in the Ruxi River. The evaluation of biotoxicity effects showed that Ni was likely to have toxic effects on organisms with a probability of 10% to 75%, and Cd, Zn, Hg, Cu, Pb, and Cr are likely to have biotoxic effects at<10% probability. The combined effect values of multiple metals indicated that the risk of adverse effects was between low and lower medium in the sediments of the Ruxi River.

[Icaritin Reverses Multidrug Resistance of Multiple Myeloma Cell Line KM3/BTZ]

OBJECTIVE

To investigate the reversing effect of icaritin on multidrug resistance of multiple myeloma cell lines KM3/BTZ and its underlying mechanism.

METHODS

KM3/BTZ cells were established by a gradually ascending gradient induction of bortezomib (BTZ). The sensitivities of KM3 and KM3/BTZ cells to 7 chemotherapeutic drugs, the inhibition and reversal effects of icaritin on proliferation and drug-resistance of KM3/BTZ cells were analyzed by MTT. The apoptosis was analyzed by flow cytometry, and the expression of Par-4, HSP27 and P-gp were detected by Western blot.

RESULTS

KM3/BTZ cells were not only resistant to BTZ, but also to other 6 chemotherapeutic drugs. The resistance index (RI) to BTZ was 17.84, and higher than that of other chemotherapeutic drugs. Icaritin inhibited the proliferation and induced the apoptosis of KM3/BTZ cells. The IC₅₀ value of BTZ decreased from 0.345 µg/ml to 0.149 µg/ml, and the reversal index was 2.38 (P<0.05). The expression of Par-4 protein increased in a concentration-dependent manner, while the expression of HSP27 and P-gp were down-regulated.

CONCLUSION

Icaritin can inhibit cell proliferation and induce apoptosis of KM3/BTZ cells, moreover, can effectively reverse the multidrug resistance of KM3/BTZ cells. The mechanism may be related with down-regulation of HSP27 and P-gp expression, and up-regulation of Par-4 expression.

[Distribution Characteristics and Risk Assessment of Heavy Metals in the Sediments of the Estuary of the Tributaries in the Three Gorges Reservoir, SW China]

To investigate the pollution status of sediments at the junction of the Three Gorges Reservoir area, sediment samples were collected over four seasons from the junction of the estuary located at a tributary of the Ruxi River and the Yangtze River. The content of eight heavy metals (HMs), including Cr, Zn, Mn, Ni, Cu, As, Cd, and Pb, in sediments was determined by ICP-MS. The results showed the average levels of investigated HMs (in mg·kg^-1) were Cr (45.24), Zn (46.46), Mn (406.14), Ni (20.885), Cu (12.49), As (7.02), Cd (0.253), and Pb (11.042). The distribution analysis indicated that the levels of HMs at the river mouth were higher than that of the tributaries of the middle reaches and the two sections nearby. The seasonal distribution shows that the heavy metal content in the spring sediment is higher than in summer, autumn and winter. In addition, the correlation analysis indicated that the eight HMs possessed similar homologous characteristics and had common exogenous inputs. The assessment of the Geo Accumulation Index showed slight Cd pollution in the estuary of Ruxi River, and the Potential Ecological Risk index showed that Cd presented moderate ecological risks. The toxic effect of benthonic organisms was possibly correlated to Ni contamination at the intersection of the tributary and main stream, which was supported by the evidence from the sediment quality criteria. In conclusion, the rating of ecological risk at the mouth of the Ruxi River tributary is slight.

[Strategy for wound repair of skin and soft tissue defect and systematic rehabilitation treatment for functional reconstruction of patients with severe burn or trauma on knees]

Objective: Strategy for wound repair of skin and soft tissue defect and systematic rehabilitation treatment for functional reconstruction of patients with severe burn or trauma on knees. Methods: From January 2015 to October 2016, 26 patients with skin and soft tissue defect on knees after severe burn or trauma were hospitalized in our unit. Among these patients, 14 patients had patellar ligament defect, and 16 patients had knee joint capsule defect. Wound debridement was operated on 1 to 3 days after admission. After debridement, the area of skin and soft tissue defect ranged from 10 cm×7 cm to 42 cm×18 cm. Vacuum sealing drainage (VSD) treatment was performed after debridement, and flap transplantation operation was performed after VSD treatment for 5 to 7 days. Defects of nine patients were treated with local rotation flaps. Seven patients with skin and soft tissue defects on knees and knee joint capsule defects of 5 cm×3 cm to 9 cm×7 cm were treated with free anterolateral femoral flaps combined with fascia lata. Ten patients with skin and soft tissue defects on knees and patellar ligament defects of 6 cm×3 cm to 12 cm×4 cm were treated with free anterolateral femoral flaps combined with iliotibial tract. The area of flaps ranged from 11 cm×9 cm to 22 cm×15 cm. After flap transplantation operation, functional reconstruction of knee joint was carried out according to early, continuous, and sequential systematic rehabilitation treatment strategy. The pain degree and function of knee joint of patients were scored by the International Knee Documentation Committee (IKDC) Knee Evaluation Form before operation and 12 months after operation. The knee joint flexion and extension degrees of patients were measured by joint protractor in 2 weeks and 12 months after operation. The color Doppler ultrasound was used to evaluate integrity of knee joint capsule and continuity of patellar ligament of patients in 6 and 12 months after operation. Results: All flaps of 26 patients survived well, and wounds healed completely after the operation. Distal parts of flaps of 2 patients treated with free anterolateral femoral flaps had local necrosis after the operation, and their wounds healed after debridement and transplantation of autologous intermediate split-thickness skin graft of thigh. The IKDC Knee Evaluation Form score of patients was (79±8) points in 12 months after operation, which was significantly higher than (64±7) points before operation (t=7.20, P<0.05). The flexion degree of knee joint of patients was (117±10)° in 12 months after operation, which was significantly larger than (35±8)° in 2 weeks after operation (t=32.65, P<0.05). The extension degree of knee joint of patients was (12±9)° in 12 months after operation, which was significantly smaller than (61±9)° in 2 weeks after operation (t=19.63, P<0.05). In 6 and 12 months after operation, 9 patients treated with local rotation flaps had good integrity of knee joint capsule and continuity of patellar ligament; 7 patients treated with free anterolateral femoral flaps and fascia lata had good integrity of knee joint capsule; 10 patients treated with free anterolateral femoral flaps and iliotibial tract had good continuity of patellar ligament. During follow-up of 12 months, all flaps survived well; knees of all patients had good appearance; knee joints functioned normally. Conclusions: Good appearance and function of knees can be achieved by repairing wound of skin and soft tissue defect on knees after severe burn or trauma with local rotation flaps or free anterolateral femoral flaps with fascia lata or iliotibial tract plus systematic rehabilitation treatment of knee joint in early stage after flap transplantation operation.

Heavy metal concentrations in edible bivalves and gastropods available in major markets of the Pearl River Delta

Molluscs are able to accumulate heavy metals and impose health hazard to consumers. The main objective of the present study is to investigate the heavy metal concentrations in edible bivalves and gastropods available in major markets of the Pearl River Delta. Fourteen species of edible molluscs were purchased from six markets in Hong Kong and Guangdong Province. The fresh of these biota were tested for their cadmium (Cd), copper (Cu), zinc (Zn), lead (Pb), nickel (Ni), chromium (Cr), antimony (Sb) and tin (Sn) concentrations (based on wet weight). The results indicated that amongst the 14 edible molluscs, only Cd, Pb, Ni, Cr, Sb and Sn concentrations in three species (Ruditapes philippinarum, Perna viridis and Hemifusus tuba) were within the local regulatory limits. Over 60% of bivalve species exceeded maximum permitted levels of Cd (2 micrograms/g) and Cr (1 microgram/g), while over 40% of gastropod species exceeded the maximum levels of Sb (1 microgram/g) and Cr (1 microgram/g). Most of the samples collected from Hong Kong had significantly higher contents of Pb and Sb, but similar levels of Cd, Cu and Zn when compared with samples collected across the border (p < 0.05; p < 0.01; p < 0.001 respectively). In general, the molluscs purchased in Guangdong markets had higher metal contents than those purchased from the Hong Kong markets. When compared with the Provisional Tolerable Weekly Intake or Maximum Acceptable Daily Load recommended by FAO/WHO Expert Committee on Food Additives, Cd levels of five species (Anadara ferruginea, Pinna pectinata, Chlamys nobilis, Babylonia lutosa and Hemifusus terntanus) and Cr levels of seven species (Anadara ferruginea, Paphia undulata, Pinna pectinata, Babylonia lutosa, Hemifusus terntanus, Cymbium melo and Cipangopaludina chinensis) were higher than both the human daily acceptable limits (for Cd and Cr respectively) and the local regulatory levels (for Cd and Cr respectively).

[Effect of er-xian decoction and its disassembled prescription on enzyme activities and their gene expression of antioxidant enzymes in aging rat]

In order to study the mechanism of aging, this experiment adopted molecular biological techniques to observe the effect of Er-Xian decoction (EXD)and its disassembled prescription on the enzyme activities and their gene expression of superoxide dismutase (SOD)and catalase (CAT). The results showed that in old rat, the amount of lipid peroxide (LPO) increased significantly; the enzyme activities such as SOD, CAT decreased significantly; and the lowering of these activities had a direct bearing on the gene expression level of their enzyme protein. After treatment by EXD and its disassembled prescription in aging rat, the amounts of LPO reduced significantly, the activities of SOD, CAT enhanced significantly. Moreover, it was observed that the increasing of these enzyme activities was related to the enhancing of their gene expression. It was suggested that EXD had the effect of anti-aging in that it could raise the activities of antioxidant enzymes and reduce the product of free radicals by means of regulating and enhancing the gene expression levels of their enzyme protein.