Security Assurance for One-stage Resection of Left Colon Cancer with Acute Obstruction—Thorough and Prompt Enteral Decompression without Contamination

Objective: Thorough, prompt enteral decompression technique without contamination was de- veloped to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the “to be resected colon segment” was cut at its lower end, then the proximal cut end was put into a plastic bag which was adhered to one side of the operating table. After releasing the clamp, the content could ?ow into this bag. The operator could squeeze the bowel with two hands by turns, from proximal to farness, and from small bowel to large bowel, until the entire bowel content was fully discharged. Then the upper end of this “to be resected colon segment” was cut, and was removed together with the plastic bag. Results: 31 cases of left colon cancer with acute obstruction were decompressed with this technique. They all recovered smoothly, without anastomosis ?stula. Another 6 cases of hepatic seg- mentectomy with incidental colonectomy were decompressed with this technique and had the same results. This technique was also used in di?erent kinds of acute small intestinal obstruction and gained satisfactory results. Conclusion: This technique could be considered as the preferable choice for intraoperative enteral decompression.

Protective effects of erythropoietin against acute lung injury in a rat model of acute necrotizing pancreatitis

AIM： TO investigate the effect of exogenous erythro- poietin （EPO） administration on acute lung injury （ALI） in an experimental model of sodium taurodeoxycholate- induced acute necrotizing pancreatitis （ANP）. METHODS： Forty-seven male Wistar albino rats were randomly divided into 7 groups： sham group （n = 5）, 3 ANP groups （n = 7 each） and 3 EPO groups （n = 7 each）. ANP was induced by retrograde infusion of 5% sodium taurodeoxycholate into the common bile duct. Rats in EPO groups received 1000 U/kg intramuscular EPO immediately after induction of ANP. Rats in ANP groups were given 1 mL normal saline instead. All animals were sacrificed at postoperative 24 h, 48 h and 72 h. Serum arnilase, IL-2, IL-6 and lung tissue malondialdehyde （MDA） were measured. Pleural effusion volume and lung/body weight （LW/BW） ratios were calculated. Tissue levels of TNF-a, IL-2 and IL-6 were screened immunohistochemically. Additionally, ox-LDL accumulation was assessed with immune-fluorescent staining. Histopathological alterations in the lungs were also scored.RESULTS： The mean pleural effusion volume, calculated LW/BW ratio, serum IL-6 and lung tissue MDA levels were significantly lower in EPO groups than in ANP groups. No statistically significant difference was observed in either serum or tissue values of IL-2 among the groups. The level of tumor necrosis factor-（~ （TNF-（~） and IL-6 and accumulation of ox-LDL were evident in the lung tissues of ANP groups when compared to EPO groups, particularly at 72 h. Histopathological evaluation confirmed the improvement in lung injury parameters a^er exogenous EPO administration, particularly at 48 h and 72 h. CONCLUSION： EPO administration leads to a significant decrease in ALI parameters by inhibiting polymorphonuclear leukocyte （PMNL） accumulation, decreasing the levels of proinflammatory cytokines in circulation, preserving microvascular endothelial cell integrity and reducing oxidative stress-associated lipid peroxidation and therefore, can be regarded as a cytoprotective agent in ANP-induced ALI.

Acute fatty liver of pregnancy:An update on pathogenesis and clinical implications

Acute fatty liver of pregnancy (AFLP) is a serious maternal illness occurring in the third trimester of pregnancy with significant perinatal and maternal mortality. Till recently, it has been considered a mysterious illness. In this editorial, we review the recent advances in understanding the pathogenesis of AFLP and discuss the studies documenting a fetal-maternal interaction with a causative association between carrying a fetus with a defect in mitochondrial fatty acid oxidation and development of AFLP. Further, we discuss the impact of these recent advances on the offspring born to women who develop AFLP, such that screening for a genetic defect can be life saving to the newborn and would allow genetic counseling in subsequent pregnancies. The molecular basis and underlying mechanism for this unique fetal-maternal interaction causing maternal liver disease is discussed.

Connective tissue growth factor reacts as an IL-6/STAT3-regulated hepatic negative acute phase protein

AIM:To investigate the mechanisms involved in a possible modulator role of interleukin(IL) -6 signalling on CYR61-CTGF-NOV(CCN) 2/connective tissue growth factor(CTGF) expression in hepatocytes(PC) and to look for a relation between serum concentrations of these two parameters in patients with acute inflammation. METHODS:Expression of CCN2/CTGF,p-STAT3,p-Smad 3/1 and p-Smad2 was examined in primary freshly isolated rat or cryo-preserved human PC exposed to various stimuli by Western blotting,electrophoretic mobility shift assay(EMSA) ,reporter-gene-assays and reversetranscriptase polymerase chain reaction. RESULTS:IL-6 strongly down-regulated CCN2/CTGF protein and mRNA expression in PC,enhanceable by extracellular presence of the soluble IL-6 receptor gp80,and supported by an inverse relation between IL-6 and CCN2/CTGF concentrations in patients'sera.The inhi-bition of TGFβ1 driven CCN2/CTGF expression by IL-6 did not involve a modulation of Smad2(and Smad1/3) signalling.However,the STAT3 SH2 domain binding peptide,a selective inhibitor of STAT3 DNA binding activity,counteracted the inhibitory effect of IL-6 on CCN2/CTGF expression much more pronounced than pyrrolidine-dithiocarbamate,an inhibitor primarily of STAT3 phosphorylation.An EMSA confirmed STAT3 binding to the proposed proximal STAT binding site in the CCN2/CTGF promoter. CONCLUSION:CCN2/CTGF is identified as a hepatocellular negative acute phase protein which is downregulated by IL-6 via the STAT3 pathway through interaction on the DNA binding level.

Nurse-staffing level and quality of acute care services:Evidence from cross-national panel data analysis in OECD countries

Background:Most of previous studies aimed to estimate the effect of nurse staffing on quality of acute hospital care have used stochastic methods and their results are mixed.Objective:To measure the magnitude of effect of nurse-staffing level on increasing quality of acute care services in long-run.Data:The number of practicing nurses'density per 1000 population as the proxy of nurse-staffing level and three Health Care Quality Indicators(HCQI)included 30-day mortality per 100 patients based on acute myocardial infarction(MORTAMIO),hemorrhagic stroke(MORTHSTO)and ischemic stroke(MORTISTO)were collected as a part of ongoing project by OECD.org in panels of 26 OECD countries over 2005-2015 period.Method:Panel data analysis.Results:There were committed relationships from nurse-staffing level to the enhancement of HCQI i.e.1%increase in nurse-staffing level would reduce the rates of patient mortality based on MORTAMIO,MORTHSTO and MORTISTO by 0.65%,0.60%and 0.80%,respectively.Furthermore,the role of nursestaffing level in increasing overall HCQI were simulated at the highest level in Sweden(-3.53),Denmark(-3.31),Canada(-2.59),Netherlands(-2.33),Finland(-2.09),Switzerland(-1.72),Australia(-1.64)and United States(-1.53).Conclusion:A higher proportion of nurses-staffing level is associated with higher quality of acute care services in OECD countries.Also,the nursing characteristics of Sweden,Denmark,Canada,Netherlands,Finland,Switzerland,Australia and United States would be good patterns for other countries to maximize nursing outcomes in the care of patients with acute and life-threatening conditions by reducing the risk of complication,mortality and adverse clinical outcomes.

Infected pancreatic necrosis: Not necessarily a late event in acute pancreatitis

It is widely believed that infection of pancreatic necrosis is a late event in the natural course of acute pancreatitis. This paper discusses the available data on the timing of pancreatic infection. It appears that infected pancreatic necrosis occurs early in almost a quarter of patients. This has practical implications for the type, timing and duration of preventive strategies used in these patients. There are also implications for the classification of severity in patients with acute pancreatitis. Given that the main determinants of severity are both local and systemic complications and that they can occur both early and late in the course of acute pancreatitis, the classification of severity should be based on their presence or absence rather than on when they occur. To do otherwise, and in particular overlook early infected pancreatic necrosis, may lead to a misclassification error and fallacies of clinical studies in patients with acute pancreatitis.

Comparison of early enteral nutrition in severe acute pancreatitis with prebiotic fiber supplementation versus standard enteral solution:A prospective randomized double-blind study

AIM: To compare the benefi cial effects of early enteral nutrition (EN) with prebiotic fiber supplementation in patients with severe acute pancreatitis (AP).METHODS: Thirty consecutive patients with severe AP, who required stoppage of oral feeding for 48 h, were randomly assigned to nasojejunal EN with or without prebiotics. APACHE Ⅱ score, Balthazar’s CT score and CRP were assessed daily during the study period.RESULTS: The median duration of hospital stay was shorter in the study group [10 ± 4 (8-14) d vs 15 ± 6 (7-26) d] (P < 0.05). The median value of days in intensive care unit was also similar in both groups [6 ± 2 (5-8) d vs 6 ± 2 (5-7) d]. The median duration of EN was 8 ± 4 (6-12) d vs 10 ± 4 (6-13) d in the study and control groups, respectively (P > 0.05). Deaths occurred in 6 patients (20%), 2 in the study group and 4 in the control group. The mean duration of APACHE Ⅱ normalization (APACHE Ⅱ score < 8) was shorter in the study group than in the control group (4 ± 2 d vs 6.5 ± 3 d, P < 0.05). The mean duration of CRP normalization was also shorter in the study group than in the control group (7 ± 2 d vs 10 ± 3 d, P < 0.05).CONCLUSION: Nasojejunal EN with prebiotic fiber supplementation in severe AP improves hospital stay, duration nutrition therapy, acute phase response and overall complications compared to standard EN therapy.

Recent achievements and acute toxicity after TP concurrent chemoradiotherapy for the advanced cervical cancer

Objective： The aim of our study was to investigate the early outcome of the taxotere and cisplatin chemora- diotherapy to the advanced cervical cancer. Methods： Fifty-six cases with cervical cancer （FIGO lib to IVa） were divided randomly into two groups in the oncology hospital of Jingzhou from September 2009 to October 2010, radiotherapy alone （28 cases） and radiation plus chemotherapy （TP） group. There was no difference of radiotherapy between the two groups, the RT ＋ C cases who accepted TP regimen during the radiation, and DDP once weekly injection of vain, according to 20 mg/m2 and taxotere once weekly i.v. according to 35 mg/m2. These regimen were given for 4-5 weeks, and some medicine for vomit- ing was given to the RT ＋ C cases. Two groups were received an oral medicine MA 160 mg every day during the treatment. Results： The early outcome： the complete remission rate was 64.3% and partial remission rate was 35.7% in RT ＋ C. The complete remission rate was 32.1% and partial remission rate was 39.3% in RT. The total response rate and complete remis- sion of RT ＋ C group was higher than that of the RT group. There was significant difference between the two groups. In RT ＋ C group, 1-year survive rate was 100.00% （28/28）; in RT group, 1-year survive rate was 85.71% （24/28）. There was significant difference between the two groups （X2 = 4.31 〉 3.84, P 〈 0.05）. Conclusion： The taxotere and cisplatin chemoradiotherapy can improve the early outcome of the advanced cervical cancer, and the adverse effect are raised, but that can be endured.

Early prediction of myocardial viability after acute myocardial infarction by two-dimensional speckle tracking imaging

Background Identifying the transmural extent of myocardial necrosis and the degree of myocardial viability in acute myocardial infarction （AMI） is important clinically. The aim of this study was to assess myocardial viability using two-dimensional speckle tracking imaging （2D-STI） in patients with AMI. Methods 2D-STI was performed at initial presentation, three days, and six months after primary percutaneous coronary intervention （PCI） in 30 patients with AMI, who had a left anterior descending coronary artery （LAD） culprit lesion. In addition, 20 patients who had minimal stenotic lesions （〈 30% stenosis） on coronary angiography were also included in the control group. At six months dobutamine echocardiography was performed for viability assessment in seven segments of the LAD territory. According to the recovery of wall motion abnormality, segments were classified as viable or non-viable. Results A total of 131 segments were viable, and 44 were nonviable. Multivariate analysis revealed significant differences between the viable and nonviable segments in the peak systolic strain, the peak systolic strain rate at initial presentation, and peak systolic strain rate three days after primary PCI. Among these, the initial peak systolic strain rate had the highest predictive value for myocardial viability （hazard ratio： 31.22, P 〈 0.01）. Conclusions 2D-STI is feasible for assessing myocardial viability, and the peak systolic strain rate might be the most reliable predictor of myocardial viability in patients with AMI.

Serum inter-cellular adhesion molecule 1 is an early marker of diagnosis and prediction of severe acute pancreatitis

AIM:To determine if serum inter-cellular adhesion molecule 1(ICAM-1)is an early marker of the diagnosis and prediction of severe acute pancreatitis(SAP) within 24 h of onset of pain,and to compare the sensitivity,specificity and prognostic value of this test with those of acute physiology and chronic health evaluation(APACHE)Ⅱscore and interleukin-6(IL-6). METHODS:Patients with acute pancreatitis(AP)were divided into two groups according to the Ranson's criteria:mild acute pancreatitis(MAP)group and SAP group.Serum ICAM-1,APACHEⅡand IL-6 levels were detected in all the patients.The sensitivity,specificity and prognostic value of the ICAM-1,APACHEⅡscore and IL-6 were evaluated. RESULTS:The ICAM-1 level in 36 patients with SAP within 24 h of onset of pain was increased and was significantly higher than that in the 50 patients with MAP and the 15 healthy volunteers(P<0.01).The ICAM-1 level(25 ng/mL)was chosen as the optimum cutoff to distinguish SAP from MAP,and the sensitivity,specificity,positive predictive value,negative predictive value(NPV),positive likelihood ratio and negative likelihood ratio were 61.11%,71.42%,0.6111,0.7142, 2.1382 and 0.5445,respectively.The area under the curve demonstrated that the prognostic accuracy of ICAM-1(0.712)was similar to the APACHE-Ⅱscoring system(0.770)and superior to IL-6(0.508)in distinguishing SAP from MAP. CONCLUSION:ICAM-1 test is a simple,rapid and reliable method in clinical practice.It is an early marker of diagnosis and prediction of SAP within the first 24 h after onset of pain or on admission.As it has a relatively low NPV and does not allow it to be a stand-alone test for the diagnosis of AP,other conventional diagnostic tests are required.

An exceptional cause of left lower quadrant abdominal pain

Acute appendidtis is an exceptional cause of left lower quadrant abdominal pain. Computed tomography scan is the key to its diagnosis and helps to establish its early treatment. We present a case of a 35-year-old male patient who presented acute appendicitis with redundant and loosely attached cecum which was diagnosed based on his left lower quadrant abdominal pain.

Liver disease in pregnancy

Liver diseases in pregnancy may be categorized into liver disorders that occur only in the setting of pregnancy and liver diseases that occur coincidentally with pregnancy. Hyperemesis gravidarum, preeclampsia/eclampsia, syndrome of hemolysis, elevated liver tests and low platelets (HELLP), acute fatty liver of pregnancy, and intrahepatic cholestasis of pregnancy are pregnancy-specific disorders that may cause elevations in liver tests and hepatic dysfunction. Chronic liver diseases, including cholestatic liver disease, autoimmune hepatitis, Wilson disease, and viral hepatitis may also be seen in pregnancy. Management of liver disease in pregnancy requires collaboration between obstetricians and gastroenterologists/hepatologists. Treatment of pregnancy-specific liver disorders usually involves delivery of the fetus and supportive care, whereas management of chronic liver disease in pregnancy is directed toward optimizing control of the liver disorder. Cirrhosis in the setting of pregnancy is less commonly observed but offers unique challenges for patients and practitioners. This article reviews the epidemiology, pathophysiology, diagnosis, and management of liver diseases seen in pregnancy.

Short- and long-term effect of complete versus culprit-only revascularization in patients undergoing primary PCI for multivessel disease： a meta-analysis

Objective The optimal strategy during primary percutaneous coronary intervention （PCI） in patients with acute myocardial infarction and multivessel disease is still controversial. Therefore, the aim of our study is to evaluate the short- and long-term effect of complete revas- cularization （CR） versus infarct-related artery revascularization （IR） following primary PCI. Methods We identified randomized controlled studies （RCTs） by systematic search of PubMed, EMBASE, Web of Science, ClinicalTrials.gov Website, Cochrane Library and Google scholar Database. Primary outcome was major adverse cardiac events （MACE）. Result Nine RCTs （2198 patients） with mean follow-up of 21.1 months were retrieved. Overall, CR was associated with significantly lower risk of MACE compared with IR therapy when followed by long-term duration （≥ 12 months） （RR： 0.56; 95% Ch 0.47-0.68; I^2 = 58.5%）. Additionally, CR was associated with equivalent rates of all-cause mortality （RR： 0.76; 95% CI： 0.53-1.08; I^2= 0.0%） and myocardial infarction （RR： 0.81; 95% CI： 0.57-1.16; I^2= 26.4%） compared with control. Meanwhile, risk of stroke was similar between groups （RR： 0.73; 95% CI： 0.24-2.19; I^2= 0.0%）. However, rates of cardiac death and target vessel revascularization were significantly decreased in the CR group （RR： 0.41; 95% CI： 0.23-0.72; I^2 = 0.0% and RR： 0.46; 95% CI： 0.37-0.57; I^2= 47.4%）. Conclusion Complete revascularization appears to have long-term clinical benefit with regard to adverse cardiac events following primary PCI. However, more studies are needed to confirm these findings.

Analyses of therapeutic effects using rludarabine and cytarabine on acute myeloid leukemia at different stages during treatment

Objective: To evaluate the therapeutic effect of the fludarabine and cytarabine (FA) regimen on acute myeloid leukemia (AML) at different phases during treatment. Methods: A total of 185 patients with AML were divided into 4 groups based on the outcome of previous treatments. Patients in Group 1 had no remission after the first course of induction chemotherapy (n = 55). Patients in Group 2 had no remission after no less than two courses of induction chemotherapy (n = 41). Patients in Group 3 had early relapse (n = 40). Patients in Group 4 had late relapse (n = 49). Patients in groups 2, 3 and 4 had refractory AML or AML with relapse. We assessed the efficacy and toxicity of FA combination chemotherapy in each of these 4 groups. Results: The complete remission (CR) rates of Groups 1, 2, 3 and 4 were 74.5% (41/55), 45.9% (19/41), 17.5% (7/40) and 38.8% (19/49), respectively. The CR rate was higher in Group 1 than in the other 3 groups (34.6%, 45/130) (P = 0.000). A significant correlation was found between CR rate and the number of chemotherapeutic courses (P = 0.023). The main adverse reactions included bone marrow suppression and secondary infection. Conclusion: FA regimen is a good choice for patients with AML, especially those who have failed to achieve CR after the first course of induction chemotherapy.

DNA-guided hepatitis B treatment:Viral load is insufficient with few exceptions

In DNA-guided hepatitis B treatment, viral load is insufficient, and requires other viral markers for treatment of hepatitis B patients as in patients with acute exacerbation of chronic hepatitis B, end-stage renal disease on dialysis, human immunodeficiency virus co-infected patients. There are exceptions to this rule： a residual level hepatitis B virus （HBV） DNA at 24 wk predicts beneficial outcome and reduced resistance at i year. The genotypic viral resistance to antiviral agents and occult HBV infection can be determined by HBV-DNA levels.

Maternal alcohol consumption during pregnancy and the risk of childhood acute leukemia:a meta-analysis

Objective： The authors used a meta-analytic technique to quantify the evidence of an association between ma- ternal alcohol consumption during pregnancy and childhood acute leukemia （AL）, which provided a basis for the prevention of childhood AL. Methods： Relevant literatures of maternal alcohol consumption during pregnancy were comprehensively searched and screened. Subgroup meta-analysis was conducted according to the type of leukemia. Results of research data of maternal alcohol consumption during pregnancy were tested for heterogeneity. Combined OR values and 95% CIs were statistically calculated with RevMan 4.2 software; Funnel plots were applied to conduct bias analysis for those included litera- tures. Results： Ten related literatures were included after data screening, 4593 cases in AL group and 6157 cases in control group respectively. According to heterogeneity test result （X2 = 16.26, P 〈 0.05）, the combined OR values and 95% CI were calculated with random effects model, which were 1.02 （0.92-1.14）, Z = 0.41, P = 0.68 〉 0.05, indicating that there was no significant difference between maternal alcohol consumption during pregnancy and the risk of childhood acute leukemia （AL）. Subgroup analysis： for the association between maternal alcohol consumption during pregnancy and childhood acute lympho- blastic leukemia （ALL）, the combined OR value and 95% CI were 0.92 （0.84-1.00）, Z = 1.92, P = 0.05, indicating that there was significant difference between two groups; for the association between maternal alcohol consumption during pregnancy and childhood acute non-lymphoblastic leukemia （ANLL）, the combined OR values and 95% CI were 0.82 （0.61-1.11）, Z = 1.30, P = 0.19 〉 0.05, indicating that there was no significant difference between two groups. Conclusion： Maternal alcohol consumption during pregnancy is a risk factor in childhood ALL, but not in childhood ANLL.

Dynamic changes of serum cholinesterase activity after severe trauma

Objective： The aim of the present study was to examine dynamic changes in serum cholinesterase （ChE） activity during early-stage severe trauma and the clinical significance of these changes. Methods： This prospective, observational study included 81 patients with severe trauma who were treated between October 2011 and April 2013 in the emergency intensive care unit （EICU） of a university-affiliated, tertiary-care, grade A general hospital in China. Serum ChE activity was measured on Days 1, 3, and 7 post-injury. The correlation of dynamic changes in serum ChE activity with trauma severity and prognosis was assessed. Correlations between changes in serum ChE activity after injury and albumin （ALB）, prealbumin （PAB）, transferrin （TRF）, and C-reactive protein （CRP） levels were also analyzed Results： Serum ChE activity in trauma patients was 42.3%-50.2% lower on Days 1, 3, and 7 compared with the control （P〈0.001 for all time points）, and it continued to decrease after Day 7 in both the survival and death subgroups. In the subgroup with an injury severity score （ISS） of 〈25, serum ChE activity initially decreased, but eventually increased. However, activity decreased continuously in the ISS〉25 subgroup. ChE activity was significantly lower in both the death and the ISS〉25 subgroups than in the survival and ISS〈25 subgroups on Days 1, 3, and 7 after injury. Activity was negatively correlated with ISS and acute physiology and chronic health evaluation Ill （APACHE III） at all time points. When comparing the receiver operating characteristic （ROC） curves for predicting prognosis, the area under the curve （AUC） in the dot of serum ChE was similar to the AUCs in plots of ISS and APACHE Ⅲ, but significantly smaller than the AUC in the plot of the trauma and injury severity score （TRISS）. Serum ChE activity was positively correlated with ALB, PAB, and TRF at all time points post-injury. Activity was not significantly correlated with CRP on Day 1, but was significantly and negatively correlated with CRP on Days 3 and 7. Conclusions： There is a significant decrease in serum ChE activity after severe trauma. Serum ChE may be regarded as a negative acute phase protein （APP） and the dynamic changes in serum ChE may be useful as an auxiliary indicator for evaluating trauma severity and predicting prognosis.

Study on changes of partial pressure of brain tissue oxygen and brain temperature in acute phase of severe head injury during mild hypothermia therapy

Objective: To study the changes of partial pressure of brain tissue oxygen (PbtO 2) and brain temperature in acute phase of severe head injury during mild hypothermia therapy and the clinical significance. Methods: One hundred and sixteen patients with severe head injury were selected and divided into a mild hypothermia group (n=58), and a control group (n=58) according to odd and even numbers of hospitalization. While mild hypothermia therapy was performed PbtO 2 and brain temperature were monitored for 1 7 days (mean=86 hours), simultaneously, the intracranial pressure, rectum temperature, cerebral perfusion pressure, PaO 2 and PaCO 2 were also monitored. The patients were followed up for 6 months and the prognosis was evaluated with GOS (Glasgow outcome scale). Results: The mean value of PbtO 2 within 24 hour monitoring in the 116 patients was 13.7 mm Hg ± 4.94 mm Hg , lower than the normal value (16 mm Hg ± 40 mm Hg ) The time of PbtO 2 recovering to the normal value in the mild hypothermia group was shortened by 10± 4.15 hours compared with the control group (P< 0.05 ). The survival rate of the mild hypothermia group was 60.43 %, higher than that of the control group ( 46.55 %). After the recovery of the brain temperature, PbtO 2 increased with the rise of the brain temperature. Conclusions: Mild hypothermia can improve the survival rate of severe head injury. The technique of monitoring PbtO 2 and the brain temperature is safe and reliable, and has important clinical significance in judging disease condition and instructing clinical therapy.