AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality ...AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.展开更多
BACKGROUND Plexiform fibromyxoma(PF)is a rare mesenchymal tumor of the stomach.The clinical features of PF frequently include upper abdominal pain,abdominal discomfort,hematemesis,melena,pyloric obstruction and an upp...BACKGROUND Plexiform fibromyxoma(PF)is a rare mesenchymal tumor of the stomach.The clinical features of PF frequently include upper abdominal pain,abdominal discomfort,hematemesis,melena,pyloric obstruction and an upper abdominal mass.We herein report a case of PF resected by laparoscopic radical distal gastrectomy plus Roux-en-Y gastrojejunostomy.CASE SUMMARY The patient was admitted to hospital,due to a 1-wk history of an abdominal space-occupying lesion identified during a health examination.He underwent complete resection by laparoscopic radical distal gastrectomy plus Roux-en-Y gastrojejunostomy.During the operation,the tumor was located in the anterior wall of the gastric antrum(approximately 7 cm×6 cm×5.5 cm)and did not show evidence of invasion of the serosa.Histology showed that the tumor cells were oval fibroblast-like and spindle-shaped cells,with numerous thin-walled blood vessels and abundant myxoid stroma.Cellular atypia and mitosis were both rare.Immunohistochemistry showed that the tumor cells were immunoreactive for smooth muscle actin,S-100 and CD-10,but were negative for CD-117,CD-34,DOG-1,and ALK.In this case,S-100 was positive and no significant disease was observed during the follow-up period.CONCLUSION The fact that PF is a rare tumor with only a few cases in this region can lead to misdiagnosis of this entity and pose a real diagnostic challenge for general surgeons and pathologists when encountering such patients and differentiating PF from other primary tumors of gastric mesenchymal origin.Our report may help increase awareness of this rare,but important new disease entity.展开更多
Background：Alemtuzumab has been used in organ transplantation and a variety of hematologic malignancies （especially for the treatment of B-cell chronic lymphocytic leukemia）.However,serious infectious complications...Background：Alemtuzumab has been used in organ transplantation and a variety of hematologic malignancies （especially for the treatment of B-cell chronic lymphocytic leukemia）.However,serious infectious complications frequently occur after treatment.The reason for increased infections postalemtuzumab treatment is unknown at this stage.We explore the effect ofalemtuzumab on intestinal intraepithelial lymphocytes （IELs） and intestinal barrier function in cynomolgus model to explain the reason of infection following alemtuzumab treatment.Methods：Twelve male cynomolguses were randomly assigned to either a treatment or control group.The treatment group received alemtuzumab （3 mg/kg,intravenous injection） while the control group received the same volume of physiological saline.Intestinal IELs were isolated from the control group and the treatment group （on day 9,35,and 70 after treatment） for counting and flow cytometric analysis.Moreover,intestinal permeability was monitored by enzymatic spectrophotometric technique and enzyme-linked immunosorbent assay.Results：The numbers of IELs were decreased significantly on day 9 after treatment compared with the control group （0.35 ± 0.07 × 10^8 and 1.35 ± 0.09 × 10^8,respectively; P 〈 0.05） and were not fully restored until day 70 after treatment.There were significant differences among four groups considering IELs subtypes.In addition,the proportion ofapoptotic IELs after alemtuzumab treatment was significantly higher than in the control group （22.01 ± 3.67 and 6.01 ± 1.42,respectively; P 〈 0.05）.Moreover,the concentration of D-lactate and endotoxin was also increased significantly on day 9 after treatment.Conclusions：Alemtuzumab treatment depletes lymphocytes in the peripheral blood and intestine of cynomolgus model.The induction of apoptosis is an important mechanism of lymphocyte depletion after alemtuzumab treatment.Notably,intestinal barrier function may be disrupted after alemtuzumab treatment.展开更多
文摘AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.
文摘BACKGROUND Plexiform fibromyxoma(PF)is a rare mesenchymal tumor of the stomach.The clinical features of PF frequently include upper abdominal pain,abdominal discomfort,hematemesis,melena,pyloric obstruction and an upper abdominal mass.We herein report a case of PF resected by laparoscopic radical distal gastrectomy plus Roux-en-Y gastrojejunostomy.CASE SUMMARY The patient was admitted to hospital,due to a 1-wk history of an abdominal space-occupying lesion identified during a health examination.He underwent complete resection by laparoscopic radical distal gastrectomy plus Roux-en-Y gastrojejunostomy.During the operation,the tumor was located in the anterior wall of the gastric antrum(approximately 7 cm×6 cm×5.5 cm)and did not show evidence of invasion of the serosa.Histology showed that the tumor cells were oval fibroblast-like and spindle-shaped cells,with numerous thin-walled blood vessels and abundant myxoid stroma.Cellular atypia and mitosis were both rare.Immunohistochemistry showed that the tumor cells were immunoreactive for smooth muscle actin,S-100 and CD-10,but were negative for CD-117,CD-34,DOG-1,and ALK.In this case,S-100 was positive and no significant disease was observed during the follow-up period.CONCLUSION The fact that PF is a rare tumor with only a few cases in this region can lead to misdiagnosis of this entity and pose a real diagnostic challenge for general surgeons and pathologists when encountering such patients and differentiating PF from other primary tumors of gastric mesenchymal origin.Our report may help increase awareness of this rare,but important new disease entity.
基金This work was supported by grants from the National Basic Research Program （973 Program） in China （No. 2007CB513005 and 2009CB522405）, Shangdong Province Young and Middle-Aged Scientists Research Awards Fund （No. BS2011YY004）, the Key Project of National Natural Science Foundation in China （No. 30830098）, National Key Project of Scientific and Technical Supporting Programs Funded by Ministry of Science and Technology of China （No. 2008BAI60B06）, the National Natural Science Foundation in China （No. 3067206t）, the Military Scientitle Research Fund （No. 0603AM 117） and the Gut Barrier Foundation of Jie-Shou Li Academician.
文摘Background：Alemtuzumab has been used in organ transplantation and a variety of hematologic malignancies （especially for the treatment of B-cell chronic lymphocytic leukemia）.However,serious infectious complications frequently occur after treatment.The reason for increased infections postalemtuzumab treatment is unknown at this stage.We explore the effect ofalemtuzumab on intestinal intraepithelial lymphocytes （IELs） and intestinal barrier function in cynomolgus model to explain the reason of infection following alemtuzumab treatment.Methods：Twelve male cynomolguses were randomly assigned to either a treatment or control group.The treatment group received alemtuzumab （3 mg/kg,intravenous injection） while the control group received the same volume of physiological saline.Intestinal IELs were isolated from the control group and the treatment group （on day 9,35,and 70 after treatment） for counting and flow cytometric analysis.Moreover,intestinal permeability was monitored by enzymatic spectrophotometric technique and enzyme-linked immunosorbent assay.Results：The numbers of IELs were decreased significantly on day 9 after treatment compared with the control group （0.35 ± 0.07 × 10^8 and 1.35 ± 0.09 × 10^8,respectively; P 〈 0.05） and were not fully restored until day 70 after treatment.There were significant differences among four groups considering IELs subtypes.In addition,the proportion ofapoptotic IELs after alemtuzumab treatment was significantly higher than in the control group （22.01 ± 3.67 and 6.01 ± 1.42,respectively; P 〈 0.05）.Moreover,the concentration of D-lactate and endotoxin was also increased significantly on day 9 after treatment.Conclusions：Alemtuzumab treatment depletes lymphocytes in the peripheral blood and intestine of cynomolgus model.The induction of apoptosis is an important mechanism of lymphocyte depletion after alemtuzumab treatment.Notably,intestinal barrier function may be disrupted after alemtuzumab treatment.
