Table of Content

28 September 2012, Volume 1 Issue 1    Next Issue

Reviews

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Surgical therapeutic strategy of thoracic aortic aneurysm —Common understanding increases and controversy remains Zhu Hong-Sheng 2012, 1 (1):  1-3.  Abstract ( 120 )   PDF (706KB) ( 287 )   Save References | Related Articles | Metrics

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Some key problems on improving comprehensive surgical treatment for the patients with gastric cancer Zhu Zheng-Gang 2012, 1 (1):  4-7.  Abstract ( 141 )   PDF (640KB) ( 337 )   Save Related Articles | Metrics

Experts forum

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Minimal invasive endovascular repain for distention of aorta Jing Zai-Ping, Lu Qing-Sheng, Zhang Lei 2012, 1 (1):  8-12.  Abstract ( 149 )   PDF (738KB) ( 657 )   Save Aortic dilated disease is a pathological condition of aortic dilation, including aortic dissection and abdominal aortic aneurysm. Endovascular treatment of aortic dilated disease was usually in the area of descending thoracic aorta and infrarenal abdominal aorta. As the development of technique and appliance, more and more aortic dilated diseases involving aortic arch, abdominal visceral aorta and ascending aorta could be treated by scallop, fenestration, branch technique, multiple bare stents and complete endovascular technique. The purpose of this review was to show the progress of endovascular treatment of aortic dissection and aneurysm. References | Related Articles | Metrics

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Norcantharidin and its anti-cancer effects and mechanisms Fan Yue-Zu, Jing Wei, Sun Jian-Jun 2012, 1 (1):  13-18.  Abstract ( 144 )   PDF (689KB) ( 277 )   Save Norcantharidin (NCTD) is a demethylated derivative of cantharidin which is an anticancer active ingredient of traditional Chinese medicine,and currently used clinically as a routine anti-cancer drug in China.Distinctly,understanding the anticancer effects and molecular mechanisms of NCTD is an important key for NCTD that serves as an anticancer drug in clinic.But,NCTD’s anticancer effects and mechanisms remain to be rarely elucidated.Here,we will review the key anticancer effects of NCTD,such as inducing cell apoptosis,inhibiting cell proliferation,blocking tumor invasion and metastasis,anti-angiogenesis and/or anti-vasculogenic mimicry,and their molecular mechanisms. References | Related Articles | Metrics

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Transumbilical laparoscopic surgery:current state and controversies Zhu Jiang-Fan 2012, 1 (1):  19-22.  Abstract ( 169 )   PDF (644KB) ( 266 )   Save The fundamental idea of transumbilical endoscopic surgery (TUES) or laparo-endoscopic single site (LESS) surgery is to have all of the working ports entering the abdomen through a single incision, which could have better cosmetic results or less trauma. The history, current status and controversies of TUES are introduced in this article. The hotspot in TUES is to overcome difficulty in manipulation caused by external and internal conflict, and lack of triangulation. The range of TUES procedures is expanding rapidly. However, we should not overlook the safety for slightly improved cosmetic value. The multicenter, randomized and clinical trials are necessary to further elucidate the safety and efficiency of this new technique References | Related Articles | Metrics

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Some key points on treatment of symptomatic carotid artery stenosis by carotid endarterectomy Wang Fei 2012, 1 (1):  23-26.  Abstract ( 133 )   PDF (652KB) ( 566 )   Save Stroke is the third leading cause of death recently.Carotid artery stenosis is the leading cause of ischemic stroke events.The carotid endarterectomy(CEA)is a surgical method which removes the plaque in the carotid artery through surgical method,so that the blood flow can be restored and stroke prevented.In the 1990s,there were many randomized controlled trials that proved carotid endarterectomy,compared with medical therapy,had many advantages in the prevention of stroke.This article describes some advances in some key points on treatment of symptomatic carotid artery stenosis by CEA,which will help more clinicians to have a better understanding of the relationship between CEA and ischemic stroke,thus encouraging them to continue to popularize this technology in China. References | Related Articles | Metrics

Original articles

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Vasculogenic mimicry,HIF-1α and VEGF expression in gallbladder carcinoma:association with clinical outcomes and prognostic implications Sun Wei, Fan Yue-Zu, Zhang Wen-Zhong, Ge Chun-Yan 2012, 1 (1):  27-41.  Abstract ( 130 )   PDF (2000KB) ( 310 )   Save Purpose To explore whether VM exists in human gallbladder carcinoma (GBC) and VM’ correlation with HIF-1α,VEGF and prognosis of GBC patients.Methods HE and CD31-PAS staining were used to observe VM in GBC.Immunohistochemistry (IHC),computer-assisted image and receiver operating characteristic curve were used to analyze expression of HIF-1α and VEGF in GBC,IHC quantitative analysis and selection of the cut-off score for high or low IHC reactivity.Correlation of HIF-1α and VEGF expression with clinicopathologic features and prognosis of GBC patients with VM and non-VM was evaluated simultaneously.Results VM was observed in GBC (21.35%) and associated with adenocarcinoma and liver metastasis (both P<0.01).Over-expression of HIF-1α and reduced-expression of VEGF were observed in GBC patients with VM (both P<0.01).HIF-1α was correlated with serosal invasion,degree of differentiation in VM group (all P<0.01),and VM in the same subset of clinical-pathologic parameters including Nevin stage,negative liver metastasis and serosal invasion,negative and positive lymph node metastasis (all P<0.05).VEGF was associated with liver metastasis,degree of differentiation in VM group (all P<0.01),and VM in the same subset of clinicopathologic parameters including Nevin stage,negative liver metastasis and moderate degree of differentiation (all P<0.01).Multivariate analysis confirmed that VM,Nevin stage and HIF-1α were independent factors for GBC patients.Conclusions VM exists in human GBC.HIF-1α and VEGF expression is significantly associated with VM and advanced stage in GBC patients.VM and HIF-1α is independent factors for GBC patients. References | Related Articles | Metrics

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Inhibitive effect of norcantharidin on vasculogenic mimicry in three-dimensional cultures of gallbladder carcinoma cell lines GBC-SD and SGC-996 in vitro Sun Wei, Fan Yue-Zu, Zhang Wen-Zhong, Ge Chun-Yan, Zhao Feng-Di, Zhou Ting-Ting, Ning Yan-Xia 2012, 1 (1):  42-48.  Abstract ( 108 )   PDF (9943KB) ( 219 )   Save Objective To evaluate inhibitive effect of norcantharidin on vasculogenic mimicry in three-dimensional cultures of gallbladder carcinoma cell lines GBC-SD and SGC-996 in vitro.Methods The different invasive capacity of gallbladder carcinoma cell lines GBC-SD and SGC-996 were detected by Transwell chamber and collagen gel contraction in vitro. Gallbladder carcinoma cell lines GBC-SD and SGC-996 were tested for their ability to form vasculogenic-like networks in three-dimensional cultures containing Matrigel and type Ⅰcollagen.Norcantharidin was dropped into three-dimensional culture model.The structures of vasculogenic-like networks were observed with light and electron microscope in different periods of time.Results ① The gallbladder carcinoma cell lines GBC-SD had higher invasion than SGC-996 (P＝0.0013),the aggressive gallbladder carcinoma cell lines GBC-SD were able to form in vitro vasculogenic-like networks in three-dimensional cultures containing Matrigel and type Ⅰcollagen,whereas the poorly aggressive SGC-996 cell lines were not.② From 1st day to 4th day the collagen contraction index of GBC-SD group containing TIMP2 were significantly lower than that of GBC-SD group (F=353.88,P<0.0001; F=525.80,P<0.0001; F=190.02,P=0.0002; F=196.26,P=0.0002),furthermore.The collagen contraction index of aggressive GBC-SD cell lines was higher than GBC-SD group poorly aggressive SGC-996 cell lines (F=318.73,P<0.0001; F=911.25,P<0.0001; F=268.88,P<0.0001; F=243.14,P<0.0001); the collagen contraction index of GBC-SD group containing TIMP1 was lower than that of GBC-SD group only at the second day (F=52.66,P=0.0019).③ the network formation could be blocked by Norcantharidin by inhibiting cell invasion and promoting cell apoptosis.Conclusion Three-dimensional cultures model can perfectly stimulate tumor cell growing and progressing conditions in vivo,the aggressive GBC-SD cell lines have higher invasive capacity than SGC-996 cell lines and can form in vitro vasculogenic-like networks in three-dimensional cultures containing Matrigel and type Ⅰcollagen,Norcantharidin can completely block the vasculogenic-like networks. References | Related Articles | Metrics

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A new model of in-situ xenograft lymphangiogennesis of human colonic adenocarcinomas in nude mice Sun Jian-Jun, Ni Yan-Yan, Yuan Xiao-Jian, Zhou Hai-Hua, Fan Yue-Zu* 2012, 1 (1):  49-55.  Abstract ( 120 )   PDF (6718KB) ( 328 )   Save Objective To explore a new model of in-situ xenograft lymphangiogennesis of human colonic adenocarcinomas in nude mice.Method On the basis of establishing subcutaneous xenograft lymphangiogenesis model of human colonic adenocarcinoms,in-situ xenograft lymphangiogenic models of human colonic adenocarcinomas were established through the in situ growth of human colonic adenocarcinoma cell line HT-29 in nude mice.The number of lymphangiogenetic microvessels,the expression of lymphatic endothelial cell markers lymphatic vessel endothelial hyaloronic acid receptor-1 (LYVE-1),D2-40 and lymphatic endothelial growth factors vascular endothelial growth factor-C (VEGF-C),-D (VEGF-D) and receptor-3 (VEGFR-3) were compared by immunohistochemical staining,Western bolt and quantitative RT-PCR in xenograft in-situ models.Results Some microlymphatics with thin walls,large and irregular or collapsed cavities and increased LMVD,with strong positive of LYVE-1,D2-40 in immunohistochemistry,were observed,and identical with the morphological characteristic of the lymphatic vessels and capillaries.And,the expression of LYVE-1 and D2-40 proteins and mRNAs were significantly higher in xenografts in-situ than those of the negative control group (both P<0.01).Moreover,the expression of VEGF-C,VEGF-D and VEGFR-3 proteins and mRNAs were significantly higher in xenografts in-situ (both P<0.01),that was in conformity with the signal regulation of VEGF-C,-D/VEGFR-3 axis of tumor lymphangiogennesis.Conclusions In situ xenografts of human colonic adenocarcinomas there have been tumor lymphangiogenesis.The in-situ model of xenograft lymphangiogenesis may act as an ideal,referential,new animal model for further studying of lymph node metastasis mechanism,drug intervention and anti-metastasis therapy in colorectal cancer. References | Related Articles | Metrics

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Studies of the significance of intercostal arterial infusion in multi-interventional therapy for malignant pleural effusion with pulmonary carcinoma Zhang Jia-Yu, Wang Yong-Wu, Mao Ai-Wu, Zhou Yong-Xin 2012, 1 (1):  56-60.  Abstract ( 100 )   PDF (1381KB) ( 272 )   Save Objective To study the mechanism and of interventional chemotherapy through the intercostal arteries and evaluate multiple treatment plans for malignant pleural effusion with pulmonary carcinoma.Methods 20 MPE cases totally.Pleurectomy are performed on 2 cases of them with trapped lung for pathological study.The rest 18 cases were divided into three groups,6 cases in each group:carboplatin was administrated through bronchial artery in groupⅠ,through intercostal artery in groupⅡ,and through pulmonary artery in groupⅢ.All patients were treated with small-bore catheter drainage system,interventional chemotherapy and HASL.The Pt concentration in pleural effusion of three groups were compared at different time after carboplatin administration and their clinical results,side effects and life quality improvement were observed.Results Pt concentration curves of the three groups were similar to each other,rose quickly after administration of carboplatin,reached a peak 1 hour or so later,and then began to decrease slowly,but still kept certain levels after 12 hours.Pt concentration of group Ⅱwas obviously higher than that of the other two groups (P<0.05).Pt concentration of groupⅠand group Ⅲ were low,and had no difference between the two groups (P>0.05).The side effects of 18 cases were insignificant.The rates of CR+PR for pleural effusion and pulmonary carcinoma were 94.4% and 50% respectively,and life quality improved significantly after the treatment(P<0.05).Pathological study found embolus of tumor cells in lymphatic vessels of parietal pleura.Conclusion MPE with lung cancer mainly caused by parietal pleura metastasis supplied by intercostal artery,thus we may lay particular emphasis on intercostal artery intervention chemotherapy for MPE with pulmonary carcinoma.The combined therapy of small-ball catheter drainage system,local administration of HASL in pleural cavity and multi interventional therapy is safe,effective and deserving of being widely used. References | Related Articles | Metrics

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Dual antiplatelet therapy on elderly patients to be treated by off-pump coronary artery bypass grafting does not increase perioperative bleeding complications Zhang Yang-Yang, Xia Yu, Xu Xiao-Han 2012, 1 (1):  61-65.  Abstract ( 130 )   PDF (669KB) ( 355 )   Save Objective To assess whether the dual antiplatelet therapy with aspirin and clopidogrel affects operative bleeding complications in elderly patients (over 65 years of age) to be treated by off-pump coronary artery bypass grafting (OPCABG).Methods Retrospective analysis of related clinical data from 276 patients (65-83 years of age)receiving OPCABG was performed.The patients were divided into 2 groups according to the type of antiplatelet therapy:216 cases were given both clopidogrel and aspirin (group AC),while 60 cases were given aspirin alone (group A).Preoperative basic clinical information,intraoperative and postoperative general data were compared between the two groups,and intraoperative bleeding volume,postoperative pleural drainage volume and consumption of blood products were recorded.Using multiple linear regression model,the factors influencing intraoperative blood loss were further analyzed.Results The average age of group AC was younger than that of group A.The platelet count of group AC was less than group A,and each result of blood coagulation test in group AC was slightly shorter than that in group A.However,that of platelet count and blood coagulation test results were in normal range.Other factors had no statistical difference (P>0.05).The two groups of patients had no serious complications and operative mortality.Compared with group A,the consumption of plasma (P=0.000) during operation was less in group AC,but the platelet consumption in surgery is more (P=0.013).There was no statistical difference in the operative time,number of transplant blood vessels,intraoperative blood loss,and consumption of red blood cells between the two groups.Postoperatively,the total time of chest drainage in group AC was longer than that in group A (P=0.002),but the mean postoperative hospital stay was shorter (P=0.005).There was no statistical difference in the postoperative mechanical ventilation time,consumption of red blood cells,plasma and platelet during the first 24 h after surgery,volume of chest drainage during the first 24 h after surgery,postoperative consumption of plasma and platelet,total volume of postoperative chest drainage and postoperative ICU stay time between the two groups (P>0.05).Combined multiple linear enter regression and stepwise regression model revealed that the type of anti-platelet therapy had no significant correlation to intraoperative blood loss (r=-0.044,P=0.996).And the operative time were slightly related to intraoperative blood loss (r=0.262,P=0.000).Conclusion In patients over 65 years of age to undergo OPCABG,preoperative dual antiplatelet therapy with combined aspirin and clopidogrel does not increase intraoperative blood loss,volume of postoperative drainage and consumption of postoperative blood products,compared to aspirin therapy alone.Also,the dual antiplatelet therapy does not increase the risk of operative bleeding complications. References | Related Articles | Metrics

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Treatment of ARDS caused by multiple injuries with pulmonary contusion Zhang Lei, Zhao Ye-Na, Zhang Hong, Qian Zhen-Yu 2012, 1 (1):  66-68.  Abstract ( 115 )   PDF (641KB) ( 421 )   Save Objective To enhance the clinical understanding of the diagnosis and treatment of acute respiratory distress syndrome (ARDS) caused by severe pulmonary contusion in multiple trauma patients.Method 18 cases of severe pulmonary contusion complicated with ARDS were retrospectively reviewed.All the patients underwent mechanical ventilation with SIMV+PSV+PEEP mode and clinical data such as SpO2,PaO2,PaCO2,PaO2/FiO2 and vital signs were collected and analyzed.Result Of them,18 cases of severe pulmonary contusion,15 were fully recovered and 3 died; pulmonary infection was seen in 8 cases.Our data showed a significantly improvement of patients’ clinical status after initiation of the mechanical ventilation,with increased PaO2,PaCO2,PaO2/FiO2 (P<0.01) and SpO2 (P<0.05) and reduced HR (P<0.01).Conclusion Mechanical ventilation with appropriate PEEP is an effective therapeutic method for severe pulmonary contusion complicated with ARDS. References | Related Articles | Metrics

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Terrible triad injury of the elbow:classification with special reference to medial collateral ligament Zhang Shi-Min, Zhu Xiao-Zhong, Huang Yi-Gang, Wang Xin 2012, 1 (1):  69-75.  Abstract ( 186 )   PDF (3498KB) ( 278 )   Save Objective Besides radial head and coronoid fractures,terrible triad injury of the elbow involves a wide range of soft-tissue ruptures.The paper proposes a classification of the terrible triad injury with special reference to the status of medial collateral ligament (MCL).Methods From 2004 to 2009,seven patients with terrible triad injury were treated consecutively.There were 2 in type Ⅰ (MCL-intact) managed conservatively and 5 in type Ⅱ (MCL-ruptured) managed surgically.The operation involved lateral and medial double approaches.The fractures were screw or suture fixed.The lateral collateral ligament (LCL) was repaired by sutures through drilled holes or bone anchors.The elbow was not concentric reduced during intraoperative forearm weight test,and then the MCL was further repaired.Results All 7 patients were followed up for 1-4 years (average 2 years),with healed fracture,stable elbow and no pain movement.The average range of motion was 120 degrees in flexion-extension,100 degrees in pronation-supination.The functional outcome was excellent in 5 and good in 2 according to Mayo Elbow Performance Score.Conclusion Terrible triad injury with MCL-intact was related with minor radial head and coronoid fractures and displacement and may be managed conservatively,while with MCL-ruptured,relevant to major fractures and displacement,and should be treated surgically.Further MCL repair enhances the stability greatly in terrible triad of the elbow. References | Related Articles | Metrics

Summaries

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ST-segment elevation myocardial infarction; reperfusion treatment; percutaneous coronary intervention Jongo S.A, Xu Ya-Wei 2012, 1 (1):  76-80.  Abstract ( 153 )   PDF (667KB) ( 320 )   Save ST segment elevation myocardial infarction (STEMI) is a major health concern even with the current improvements in diagnosing and managing acute MI.STEMI is still a fatal event in approximately 33% of patients.STEMI is only the second most severe form of acute coronary syndrome (ACS) after sudden cardiac death.About 29% of patients with myocardial infarction experience a STEMI (1),whereas 47% of acute coronary syndrome (ACS) patients present with STEMI (2).STEMI is one of the three components which constitute a spectrum of conditions known as acute coronary syndrome (ACS),the other two being unstable angina and Non-ST segment elevation myocardial infarction (NSTEMI).Acute coronary syndrome is characterized by a specific pattern of acute ischemic chest pain (either rest pain or minimal exertion),associated with ECG changes of ischemia (ST elevation or depression or T inversion).The presence of persistent ST elevation distinguishes STEMI from other forms of acute coronary syndrome.NSTEMI and unstable angina are distinguished by the presence or absence of a rise in cardiac injury markers[3-6].Fibrinolysis and percutaneous coronary intervention (PCI),are the definitive therapies for reperfusion in STEMI.These strategies have been on a frontline to improve patency of the infarct-related artery,reduce infarct size,and lower mortality rates.The time sensitivity nature of STEMI prompts for a quick implementation of one or the other of these two strategies[4-7].Surveys showed that many patients with STEMI from western countries remain “untreated” with limited access to reperfusion therapy and suboptimal utilization of proven pharmacotherapies in clinical practices.Up to one-third of patients presenting with STEMI within 12 h of symptom onset still receive no reperfusion therapy acutely,despite improvements in care[7-8].However,a recent study has shown that,80.9% of patients with STEMI in Beijing received reperfusion treatment (81% primary PCI; 19% thrombolysis).Meanwhile,the study implies that primary PCI was the predominant reperfusion strategy in Beijing[9]. References | Related Articles | Metrics

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Revascularization of coronary artery disease in diabetic patients Mbarak,Zainab Abdulaziz, Li Wei-Ming 2012, 1 (1):  81-86.  Abstract ( 136 )   PDF (683KB) ( 258 )   Save Morbidity and mortality related to CAD remain a great challenge in patients with DM.Platelet function is abnormal in diabetes,expression of both glycoprotein Ib and Ⅱb/ Ⅲa is increased,augmenting both platelet-von Willebrand factor and platelet-fibrin interaction which leads to an increased risk of death and thrombotic complications in diabetics compared with nondiabetic patients.Multiple studies have shown that DM is a strong risk factor for restenosis following successful percutaneous coronary intervention (PCI) with greater need for repeat revascularization and inferior clinical outcomes though early data available suggest that drug eluting stents (DES) reduce restenosis rates and the need for repeat revascularization irrespective of the diabetic state and with no significant reduction in hard clinical endpoints such as myocardial infarction and mortality.However,there are so many other randomized trials comparing multivessel PCI using DES or bare metal stent (BMS) to coronary artery bypass grafting (CABG) which consistently demonstrated the superiority of CABG in patients with DM.Selection of the optimal myocardial revascularization strategy for patients with DM and multivessel coronary artery disease is crucial.Strategies for revascularization must take into account the higher risk for restenosis and graft occlusion,as well as the comorbid sequelae that complicate interventions in diabetic patients.When opting for PCI,the use of DES and potent platelet inhibitors should be favoured.And when opting for CABG,reduction in perioperative stroke,wound infection,and optimization of post-operative medical management will be of benefit to diabetic patients.Glycaemic control is beneficial to both strategies. References | Related Articles | Metrics

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Clinical progression of diagnosis and treatment for juxtapapillary duodenal diverticulum Lu Ke-Xiang, Fan Yan-Zu, Zhang Jing-Tan 2012, 1 (1):  87-90.  Abstract ( 346 )   PDF (640KB) ( 685 )   Save Juxtapapillary duodenal diverticulum (JPDD) refers to the bursiform apophysis formed from the outward expansion of the part of intestinal wall caused by the defect of mucosal or submucosal muscular layer at in the paries medialis of the descendant duodenum juxtapapillary about 2~3 cm.With the endoscopic techniques especially endoscopic retrograde cholangiopancreatography (ERCP) launched extensively in recent years,JPDD cases increased gradually.JPDD such as its epidemiology,pathogenesis,clinical classification,relationship of biliary-pancreatic diseases,diagnosis and treatment are reviewed in this paper. References | Related Articles | Metrics

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Advance of study on approach of transcatheter aortic valve implantation (TAVI) Huang Hai-Tao, Wang Yong-Wu 2012, 1 (1):  91-95.  Abstract ( 133 )   PDF (649KB) ( 507 )   Save TAVI is a new technology for the patients who cannot receive the routine surgical aortic valve replacement under cardiopulmonary bypass.Vascular access is also a key point to success of TAVI,beside the selection of indication.Presently,the available vascular access mainly includes:antegrade approach,retrograde approach,transapical approach,trans-subclavian approach,and direct trans-aortic approach.Trans-femoral approach is the dominant TAVI route; however,each of them has their advantages and disadvantages.Selection of vascular approach depends on the conditions of patient’s arteries and aortic root.In this study,selective principle,complications,surgical methods and the latest clinical research of each vascular approach are reviewed,in order to develop this technology in China. References | Related Articles | Metrics