Influence of liver function after laparoscopy-assisted vs totally laparoscopic gastrectomy

BACKGROUND

Previously, some studies have proposed that total laparoscopic gastrectomy (TLG) is superior to laparoscopic-assisted gastrectomy (LAG) in terms of safety and feasibility based on the related intraoperative operative parameters and incidence of postoperative complications. However, there are still few studies on the changes in postoperative liver function in patients undergoing LG. The present study compared the postoperative liver function of patients with TLG and LAG, aiming to explore whether there is a difference in the influence of TLG and LAG on the liver function of patients.

AIM

To investigate whether there is a difference in the influence of TLG and LAG on the liver function of patients.

METHODS

The present study collected 80 patients who underwent LG from 2020 to 2021 at the Digestive Center (including the Department of Gastrointestinal Surgery and the Department of General Surgery) of Zhongshan Hospital affiliated with Xiamen University, including 40 patients who underwent TLG and 40 patients who underwent LAG. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyltransferase (GGLT), total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL), and other liver function-related test indices were compared between the 2 groups before surgery and on the 1^st, 3^rd, and 5^th d after surgery.

RESULTS

The levels of ALT and AST in the 2 groups were significantly increased on the 1^st to 2^nd postoperative days compared with those before the operation. The levels of ALT and AST in the TLG group were within the normal range, while the levels of ALT and AST in the LAG group were twice as high as those in the TLG group (P < 0.05). The levels of ALT and AST in the 2 groups showed a downward trend at 3-4 d and 5-7 d after the operation and gradually decreased to the normal range (P < 0.05). The GGLT level in the LAG group was higher than that in the TLG group on postoperative days 1-2, the ALP level in the TLG group was higher than that in the LAG group on postoperative days 3-4, and the TBIL, DBIL and IBIL levels in the TLG group were higher than those in the LAG group on postoperative days 5-7 (P < 0.05). No significant difference was observed at other time points (P > 0.05).

CONCLUSION

Both TLG and LAG can affect liver function, but the effect of LAG is more serious. The influence of both surgical approaches on liver function is transient and reversible. Although TLG is more difficult to perform, it may be a better choice for patients with gastric cancer combined with liver insufficiency.

Impact of adherence to GOLD guidelines on 6-minute walk distance, MRC dyspnea scale score, lung function decline, quality of life, and quality-adjusted life years in a Shanghai suburb

We performed a 1-year cluster-randomized field trial to assess the effect of standardized management of chronic obstructive pulmonary disease (COPD) on lung function and quality of life (QOL) measures in patients in China. We used the Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment guidelines and assessed indexes including pulmonary function, QOL, quality-adjusted life years (QALY), Medical Research Council (MRC) dyspnea scale, 6-min walk distance (6-MWD), number of emergency visits, and frequency of hospitalization. Of a total of 711 patients with chronic cough and asthma, 132 were diagnosed as having COPD and 102 participated in this study [intervention group (N = 47); control group (N = 55)]. We found that adherence to GOLD guidelines had a perceivable impact on 6-MWD, MRC dyspnea scale score, and QOL. The average QALY increased by 1.42/person/year in the intervention group, but declined by 0.95/person/year in the control group. We conclude that standardized management improves disease severity, QOL, and QALY in COPD patients when treatment protocols adhere to GOLD guidelines.

Utility and safety of procalcitonin in an antimicrobial stewardship program (ASP) in patients with malignancies

As data on procalcitonin utility in antibiotics discontinuation [under an antimicrobial stewardship program (ASP)] in patients with malignancies are lacking, we aimed to evaluate the utility of procalcitonin in an ASP in patients with malignancies. We conducted a retrospective review of the ASP database of all patients with malignancies in whom at least one procalcitonin level was taken and our ASP had recommended changes in carbapenem regimen, from January to December 2011. We compared clinical outcomes between two groups of patients: patients whose physicians accepted and those whose physicians rejected ASP interventions. There were 749 carbapenem cases reviewed. Ninety-nine were suggested to either de-escalate, discontinue antibiotics, or narrow the spectrum of empiric treatment, based on procalcitonin trends. While there was no statistical difference in the mortality within 30 days post-ASP intervention (accepted: 8/65 patients vs. rejected: 9/34 patients; p = 0.076), the median duration of carbapenem therapy was significantly shorter (5 vs. 7 days; p = 0.002). Procalcitonin use safely facilitates decisions on antibiotics discontinuation and de-escalation in patients with malignancies in the ASP.

Adaptive-weighted cubic B-spline using lookup tables for fast and efficient axial resampling of 3D confocal microscopy images

Confocal laser scanning microscopy has become a most powerful tool to visualize and analyze the dynamic behavior of cellular molecules. Photobleaching of fluorochromes is a major problem with confocal image acquisition that will lead to intensity attenuation. Photobleaching effect can be reduced by optimizing the collection efficiency of the confocal image by fast z-scanning. However, such images suffer from distortions, particularly in the z dimension, which causes disparities in the x, y, and z directions of the voxels with the original image stacks. As a result, reliable segmentation and feature extraction of these images may be difficult or even impossible. Image interpolation is especially needed for the correction of undersampling artifact in the axial plane of three-dimensional images generated by a confocal microscope to obtain cubic voxels. In this work, we present an adaptive cubic B-spline-based interpolation with the aid of lookup tables by deriving adaptive weights based on local gradients for the sampling nodes in the interpolation formulae. Thus, the proposed method enhances the axial resolution of confocal images by improving the accuracy of the interpolated value simultaneously with great reduction in computational cost. Numerical experimental results confirm the effectiveness of the proposed interpolation approach and demonstrate its superiority both in terms of accuracy and speed compared to other interpolation algorithms.

An automatic segmentation algorithm for 3D cell cluster splitting using volumetric confocal images

With the rapid advance of three-dimensional (3D) confocal imaging technology, more and more 3D cellular images will be available. Segmentation of intact cells is a critical task in automated image analysis and quantification of cellular microscopic images. One of the major complications in the automatic segmentation of cellular images arises due to the fact that cells are often closely clustered. Several algorithms are proposed for segmenting cell clusters but most of them are 2D based. In other words, these algorithms are designed to segment 2D cell clusters from a single image. Given 2D segmentation methods developed, they can certainly be applied to each image slice with the 3D cellular volume to obtain the segmented cell clusters. Apparently, in such case, the 3D depth information with the volumetric images is not really used. Often, 3D reconstruction is conducted after the individualized segmentation to build the 3D cellular models from segmented 2D cellular contours. Such 2D native process is not appropriate as stacking of individually segmented 2D cells or nuclei do not necessarily form the correct and complete 3D cells or nuclei in 3D. This paper proposes a novel and efficient 3D cluster splitting algorithm based on concavity analysis and interslice spatial coherence. We have taken the advantage of using the 3D boundary points detected using higher order statistics as an input contour for performing the 3D cluster splitting algorithm. The idea is to separate the touching or overlapping cells or nuclei in a 3D native way. Experimental results show the efficiency of our algorithm for 3D microscopic cellular images.

Study on the relationship between meteorological conditions and acid rain in mid-eastern Fujian

Based on the acid rain observation data and the contemporaneous historical synoptic charts of Mid-Eastern Fujian during the period of 1991 to 2003, we analyzed the distribution characteristics of acid rain in different seasons, weather types, precipitation grades and wind directions. The results showed that the acid pollution in Mid-Eastern Fujian was still serious. In winter, the precipitation pH value was 4.79, and the acid rain frequency was 60.62% which was twice higher than that in summer. The pH value of warm shear-type precipitation at 850 hPa was 4.79. Nearly half of these precipitations had the problems of acid rain pollution. The acid rain frequency of the inverted trough type was only 26.11% which was the lowest one in all types. There was no marked difference of the acid rain distribution characteristics between ahead-of-trough and behind-the-trough. The precipitation pH values of the five grades were lower than 5.30 and the acid rain frequency changed as an inverted U shape with the increasing of the rainfall. The pH values of precipitations in the eight wind directions were generally below 5.20, and the acid rain frequencies were about 40%.

Loop-mediated isothermal amplification for rapid detection of acute viral necrobiotic virus in scallop Chlamys farreri

Loop-mediated isothermal amplification (LAMP) assay for rapid and sensitive detection of Acute viral necrobiotic virus (AVNV) in scallop Chlamys farreri was developed and evaluated. Four primers recognizing six targets on distinct AVNV DNA sequences were designed and the LAMP reaction was carried out in a water bath. Reaction temperature and time were optimized at 64 degrees C for 60 mins and LAMP products were detected using agarose gel electrophoresis and visual assessment. Confirmation of the expected LAMP products was performed with MboI restriction enzyme analysis. The detection limit of LAMP assay was as low as 1 fg AVNV DNA and accordingly, this assay was 100 times more sensitive than conventional PCR technique. A comparative evaluation of 20 samples using the LAMP and PCR assays revealed a complete accord in positivity or negativity for AVNV. These results indicate that the LAMP assay is simple, sensitive, specific, and has a great potential for detection of AVNV in the laboratory and field.

An automatic method for identifying appropriate gradient magnitude for 3D boundary detection of confocal image stacks

Gradients play an important role in 2D image processing. Many edge detection algorithms are gradient-based. We are interested in 3D boundary detection which can be considered as an extension of 2D edge detection in 3D space. In this paper, an algorithm to automatically and quantitatively measure the suitability of gradient magnitudes in detection of 3D boundary points of confocal image stacks is presented. A Measurement Function is defined to evaluate the suitability of each gradient magnitude chosen to be the threshold for 3D boundary detection. The application of Gauss's Divergence Theorem provides a solution to calculate the Measurement Function numerically. The gradient magnitude at which the maximum of the Measurement Function is achieved can be utilized as the most appropriate threshold for gradient-based boundary detection and other operations like volume visualization.

Tactile VR for hand-eye coordination in simulated PTCA

Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive image-guided technique for treatment of coronary diseases. PTCA procedure requires physicians to have good skills of hand-eye coordination in performing the operation. Training of PTCA thus very much emphasizes skill building for hand-eye coordination. We have been developing virtual reality (VR) technology for medical simulation. In this paper, we will address the issue of VR-based simulation for the enhancement of hand-eye coordination for PTCA operation. Starting from the characterization of PTCA procedure, we examine what roles VR can play in training of PTCA physicians. We then describe a computerized PTCA training system we have developed which is composed of a tactile interface and a visual interface. The system is designed in such a way that real PTCA devices (including catheters and guide-wires) can be used to mimic the requirements of the CathLab. The backend computational engine supporting the real-time and realistic PTCA simulation is also presented.

[Chromosomal mapping of ld gene which causes congenital limb deformity syndrome in KM-ld mouse]

Fourteen biochemical marker loci and 61 SSLP loci in congenic strain C57BL/6.KM-ld were screened to determine the loci linkage to ld gene, an autosomal recessive mutant gene in KM mouse which causes congenital limb deformity in mouse by means of electrophoresis and PCR amplification. The result showed that ld gene linked to D2Mit30, D2Mit62 and D2Mit63. To locate ld gene more accurately on chromosome 2, 86 backcross offsprings (C57BL/6 x KM-ld) F1 x KM-ld were produced for linkage analysis. From the backcross progeny genomic DNAs were amplified for D2Mit13, D2Mit30, D2Mit62 and D2Mit63 loci in vitro. According to phenotypes, the linkage between the four SSLP loci and ld gene was analysed by calculating genetic distance, ld gene was located exactly on Chr. 2, 76cM, with distances of 25.58cM to D2Mit30, D2Mit62 and D2Mit63, of 31.39cM to D2Mit13.

Combined surfactant therapy and inhaled nitric oxide in rabbits with oleic acid-induced acute respiratory distress syndrome

Intratracheal administration of surfactant and inhaled nitric oxide (INO) have had variable effects in clinical trials on patients with acute respiratory distress syndrome (ARDS). We hypothesized that combined treatment with exogenous surfactant and INO may have effects in experimental ARDS. After intravenous infusion of oleic acid in adult rabbits and 4-6 h of ventilation, there was more than a 40% reduction in both dynamic compliance (Cdyn) of the respiratory system and functional residual capacity (FRC), a 50% increment of respiratory resistance (Rrs), a 70% reduction in PaO2 /FIO2, and an increase in intrapulmonary shunting (Q S/Q T) from 4.4 to 33.5%. The animals were then allocated to groups receiving (1) neither surfactant nor INO (control), (2) 100 mg/kg of surfactant (S) administered intratracheally, (3) 20 ppm INO (NO), or (4) 100 mg/kg of surfactant and 20 ppm INO (SNO), and subsequently ventilated for 6 h. After the period of ventilation, the animal lungs were used for analysis of disaturated phosphatidylcholine (DSPC) and total proteins (TP) in bronchoalveolar lavage fluid (BALF), and for determination of alveolar volume density (VV). The animals in the control group had the lowest survival rate, and no improvement in lung mechanics and blood oxygenation, whereas those in the S group had a modest but statistically significant improvement in Cdyn, Rrs, PaO2 and FRC, reduced Q S/Q T, lowered minimum surface tension (gammamin) of BALF, and increased DSPC/ TP and alveolar VV. The NO group had increased PaO2 and reduced Q S/Q T. The SNO group showed improved Cdyn, Rrs, FRC, DSPC/TP, alveolar VV, and gammamin of BALF comparable to the S group, but there was a further increase in survival rate and PaO2, and additional reduction in Q S/Q T and TP in BALF. These results indicate that, in this animal model of ARDS, a combination of surfactant therapy and INO is more effective than either treatment alone.

[An investigation on anxiety and coping patterns of patients under cancer chemotherapy and the strategies]

100 cases of patients under cancer chemotherapy were investigated by using Self-Rating Anxiety Scale (SAS) and questionnaire on coping patterns. The results showed that scores of SAS were significantly higher than that of the normal population. The state of the anxiety reached 45% among the patients. The patients' coping patterns tended to be passive. Linear analysis revealed a negative correlation between the coping patterns and the scores of SAS. It is recommended that cognitive behavioral therapy can be used to relieve the anxiety of patients under cancer chemotherapy.

[Drive-time constant (DTC): a new index of respiratory muscle endurance]

Mouth occlusion pressure (P0.1) and the function of respiratory muscle were measured in 6 unsuccessful weaning patients (group I), 15 successful weaning patients (group II) and 9 normal subjects (group III). The results showed that PImax in the three groups was 4.36 +/- 1.67kPa, 6.19 +/- 2.38kPa and 9.20 +/- 3.51kPa respectively. Pdimax was 5.39 +/- 1.62kPa, 6.90 +/- 2.41kPa and 11.46 +/- 3.16kPa respectively. TTdi was 0.24 +/- 0.07, 0.12 +/- 0.04 and 0.05 +/- 0.02 respectively. DTC, the product of P0.1/PImax and Ti/Ttot, was 0.06 +/- 0.01, 0.03 +/- 0.01 and 0.01 +/- 0.003 respectively. Both group I and group II had lower PImax and Pdimax but higher TTdi and DTC other than group III. Both PImax and Pdimax between group I and group II showed no significant difference, but TTdi and DTC of group I were higher than those of group II. If DTC 0.04 and TTdi 0.15 were used as the criteria for predicting whether or not the patients could perform a successful weaning trial, the values of sensitivity were 83% and 100%, and the values of specificity 93% and 87% respectively. We conclude that DTC as a noninvasive and convenient measurement is of clinical value in evaluating the endurance of respiratory muscles.

[A comparison between nasotracheal and orotracheal intubation in treating chronic obstructive pulmonary disease complicated by respiratory failure]

Endotracheal intubation and mechanical ventilation were given to 100 COPD patients complicated by respiratory failure from Dec. 1977 to May 1990. Among them 42 were intubated through mouth. The tubes were kept from 1 to 6 days. In only 8 cases (19.0%) the tubes could be withdrawn according to the criterion, and 25 patients (59.0%) were tracheostomized. Nasotracheal intubation were given to 58 patients. The tubes were kept from 1 to 220 days and could be withdrawn in 39 cases (81.0%), with an incidence higher than that in patients intubated orotracheally (P < 0.01). Tracheostomy mas given to 6 patients intubated nasotracheally (10.3%), being fewer than in patients intubated through mouth (P < 0.01). Although the tubes have been kept for longer time, the duration of hospitalization was not prolonged.

[Pathological changes in the trachea after tracheostomy in patients with respiratory failure]

A variety of pathological changes in trachea were observed in 7 cases with tracheostomy. The common lesions were inflammation, necrosis and ulcer, and squamous metaplasia or granuloma were seen in those with tracheal tube for longer time. The dilatation of trachea was manifested by dislocating of the tube and not sealing of the cuff. Cuff-radiography could show the site and degree of the dilatation of trachea. In order to alleviate the lesions, the tubes made of plastic or silica gel with lower pressure cuff were recommended. The prevention of local infection and improvement of nutritional status were also important.

[A clinical trial of treating asthma of moderate severity with beclomethasone dipropionate aerosol]

In order to investigate the efficacy of steroid inhalation in treating asthma of moderate severity, a single-blind, randomized short-term (3-4 weeks) trial was performed in 25 asthmatics uncontrolled by salbutamol inhalation, oral aminophylline and beta 2-agonist. 22 patients finished the trial. Among them, twelve received beclomethasone dipropionate 300 mcg/day and ten received placebo. There was significant improvement in asthmatic symptoms and pulmonary function (FEV1.0, V50, V25) in the group treated with steroid inhalation at the end of this trial, whereas no significant changes were observed in the placebo group. The results demonstrated that steroid inhalation could effectively control asthma of moderate severity.

[Effects of external diaphragm pacing on transdiaphragmatic pressure, ventilation and arterial blood gases in healthy volunteers]

The effects of external diaphragm pacing (EDP) were studied in seven healthy volunteers. During EDP the movement of both left and right hemidiaphragms increased on average 1.28 and 1.30 cm respectively. The transdiaphragmatic pressure also increased from 8.63 +/- 1.576 cm H2O to 15.18 +/- 1.946 cm H2O (P less than 0.01). Inductive plethysmography showed that with EDP the mean inspiratory flow rate increased from 308 +/- 28.6 ml/sec. to 454 +/- 36.6 ml/sec. (P less than 0.01), but there was no change in respiratory rate, inspiratory time and the ratio of inspiratory time to respiratory cycle. Both tidal volume and minute volume of ventilation increased from 419 +/- 33.9 ml to 691 +/- 71.5 ml (P less than 0.01) and from 7.02 +/- 0.74 l/min. to 10.14 +/- 0.73 l/min. (P less than 0.01) respectively. Accompanied with the change of ventilation, the consumption of oxygen and the production of CO2 also increased from 258 +/- 14.9 ml/min. to 310 +/- 15.0 ml/min. (P less than 0.05) and from 228 +/- 11.4 ml/min. to 299 +/- 25.9 ml/min. (P less than 0.05) respectively. Consequently PaCO2 reduced from 5.24 +/- 0.22 kPa to 4.27 +/- 0.25 kPa (P less than 0.05), whereas PaO2 increased from 12.7 +/- 0.32 kPa to 14.5 +/- 0.42 kPa (P less than 0.01).

[The effects of almitrine bismesylate in chronic obstructive pulmonary disease with CO2 retention]

Ten cases of chronic obstructive pulmonary disease (COPD) were examined before and 2 hours after oral administration of 150 mg of almitrine bismesylate while breathing 31% oxygen. The agent induced a rise in mouth occlusion pressure (P 0.1) from 2.67 +/- 0.64 cmH2O to 3.74 +/- 1.02 cmH2O (P less than 0.01). However the central inspiratory drive and ventilation response to hypercapnia did not change after taking almitrine. VT/Ti increased from 0.32 +/- 0.06 L/sec. to 0.40 +/- 0.08 L/sec. (P less than 0.01) and RR, Ti, Ti/Ttot were not changed, so VT and VE increased from 0.37 +/- 0.10 L to 0.42 +/- 0.16 L (P less than 0.05) and from 7.70 +/- 1.72 L to 8.85 +/- 2.28 L (P less than 0.05) respectively. VA also increased from 3.34 +/- 0.06 L to 4.14 +/- 0.86 L (P less than 0.01). Analysis of blood gases showed a marked increase in PaO2 from 88.70 +/- 16.19 mmHg to 109.10 +/- 25.57 mmHg (P less than 0.05) and a decrease in PaCO2 from 61.73 +/- 12.15 mmHg to 54.01 +/- 10.37 mmHg (P less than 0.05). Our results suggested that almitrine bismesylate could improve the blood gases in COPD patients with CO2 retention as it is a respiratory stimulant which might act through a peripheral mechanism.

Establishment and characterization of a continuous murine uterine cervix cancer cell line metastatic to lymph nodes and lungs

The murine uterine cervix cancer (MUCC) cell line was derived from a chemically induced Kunming mouse uterine cervix cancer (U27) and maintained in culture on solid substrates for over 100 passages. Cultures were morphotypically heterogeneous and heteroploid, with a modal number of chromosomes = 80. Each cell showed at least two abnormal chromosomes. Immunogold-silver staining was positive for keratin, vimentin, and laminin but not for desmin. The population doubling time was 27.8 h with a saturation density of 3.2 X 10(5) cells/cm2 and a peak mitotic index of about 6%. MUCC cells produced colonies on tissue culture plastic (68%) and in soft agar (8%). MUCC cells were fully malignant inasmuch as they produced in syngeneic mice invasive tumors that reproducibly were metastatic to lymph nodes and lungs. The MUCC cell line is the first mouse cervix cancer cell line useful for the study of invasion and metastasis.

[Establishment and biologic properties of a mouse uterine cervix cancer cell line (MUCC) with lymphatic and hematogenous metastatic capacities]

For study of tumor metastatic mechanism, a mouse uterine cervix cancer cell line (MUCC), as derived from a transplantable mouse uterine cervix cancer No. 27 (U 27) with metastatic capacities through lymphatics and blood, was established in vitro. It has been successfully maintained for more than 24 months through more than 100 passages. MUCC cells are epithelioid with definite malignant morphological features. The doubling time of the cell population is 27.8 hours. The average mitotic index is 30.6%, with a maximum of 58.9%. Chromosomes show aberration in number and structure. The homotransplant rate is 75% (9/12). The solid tumor, produced by homotransplant, is similar to the tumor U 27. Metastases are present in the lymph nodes and lungs in these 9 animal models. It is evident that this cell line retains the capacity of inducing daughter tumor lines with spontaneous lymphatic and blood metastases. MUCC cell line might be very useful in isolating subpopulations which possess the different metastatic abilities and the study of metastatic mechanism.