SURGICAL TREATMENT OF ESOPHAGEAL HIATUS HERNIA BY TRANSTHORACIC HERNIOTOMY: A PRELIMINARY REPORT

In view of the extensive operation required for repair of hiatus hernia by transthoracic or abdominal approach, herniotomy was done in three cases. Objectives were to (a) widen the esophageal hiatus, (b) remove the hernial sac, (c) cut the structures of the omentum and lesser curvature so that the stomach would lie flat in the chest, and (d) fix the stomach at the new level.After the operation, all three patients were free of the symptoms of indigestion of which they had previously complained.     

Gastritis of the Herniated Stomach in Patients with Esophageal Hiatus Hernia

Seven illustrative cases of gastritis of the herniated stomach in patients with sliding esophageal hiatus hernia are reported. Five had superficial gastritis (three mild, one moderate and one severe); two had atrophic gastritis. Gastritis was present in two patients whose mucosa appeared normal at esophagoscopy. Interstitial hemorrhage into the lamina propria was present in four of the seven biopsy specimens. The possibility that interstitial hemorrhage may be related to the development of gastric erosions is considered. The pathogenesis of this form of gastritis is discussed.     

应用电视胸腔镜进行三切口食管癌根治术的手术配合及护理体会

目的：总结应用电视胸腔镜（video,assistedthoracoscopic surgeryVATS）在三切口食管癌根治术中的手术配合过程。方法：回顾2011年5月至2013年5月共38例中上段食管癌患者应用电视胸腔镜进行三切口食管癌根治术,术中胸部采用微创技术,使用胸腔镜器械进行食管游离和淋巴结清扫,腹部小切口进行胃部游离并制作管状胃,最后颈部切口进行食管胃吻合。结果：顺利完成38例中上段食管癌患者的手术配合,手术护士可以通过电视胸腔镜观察手术进程,熟练默契的配合每个手术步骤,术中出血较少,胸部手术时间30．60min,无一例中转开胸病例。结论：电视胸腔镜手术安全,有效,微创,便于操作,手术时间较短。     

Disorganization of stroma alters epithelial differentiation of the glandular stomach in adult mice

Summary The response of adult epithelium in contact with heterologous mesenchymes/stromas was studied in three digestive organs (forestomach, glandular stomach, and duodenum). After various tissues were implanted beneath the epithelial layer of adult mice, the epithelial differentiation was examined after sacrifice of animals at intervals up to 24 weeks. In the forestomach and duodenum, the epithelial differentiation was not affected at all by the tissue implantation. In the glandular stomach, in contrast, epithelial cells exhibited altered differentiation in which chief and parietal cells disappeared and were replaced by columnar epithelial cells with PAS-positive granules. These epithelial cells often formed immature villi. Such differentiation-altered columnar epithelium (DACE) was induced by implanting any type of tissue and even by sham operation, indicating that it was induced by disorganization of the tissue-implanted stroma. The size of DACE was significantly influenced by the stage of implanted tissue; 14.5-day fetal mesenchyme induced the largest DACE, and was followed by 16.5-day fetal mesenchyme, adult stroma, and sham operation. These results suggest the importance of stromal organization in maintaining epithelial differentiation in the glandular stomach.     

The role of hiatus hernia in GERD

Increased esophageal acid exposure in gastroesophageal reflux disease has several potential causes, some related primarily to physiological dysfunction of the LES and others related to anatomic distortion of the gastroesophageal junction as occurs with hiatus hernia. One attractive feature of implicating hiatal hernias in the pathogenesis of reflux disease is that, like reflux disease, axial hernias become more common with age and obesity. However, the importance of hiatus hernia is obscured by imprecise definition and an all-or-none conceptualization that has led to wide variation in estimates of prevalence among normal or diseased populations. There are at least three potentially significant radiographic features of a hiatus hernia: axial length during distention, axial length at rest, and competence of the diaphragmatic hiatus. Although any or all of these features may be abnormal in a particular instance of hiatus hernia, each is of different functional significance. Grouping all abnormalities of the gastroesophageal junction as "hiatus hernia" without detailing the specifics of each case defies logic. Mechanistically, the gastroesophageal junction must protect against reflux both in static and dynamic conditions. During abrupt increases in intra-abdominal pressure, the crural diaphragm normally serves as a "second sphincter," and this mechanism is substantially impaired in individuals with a gaping hiatus. Large, non-reducing hernias also impair the process of esophageal emptying, thereby prolonging acid clearance time following a reflux event (especially while in the supine posture). These anatomically-determined functional impairments of the gastroesophageal junction lead to increased esophageal acid exposure. Thus, although hiatus hernia may or may not be an initiating factor at the inception of reflux disease, it clearly can act as a sustaining factor accounting for the frequently observed chronicity of the disease.     

基于经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效

摘要 目的：探讨经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效。方法：选择2020年9月至2022年9月我院收治的96例产后盆底功能障碍患者,根据随机数字表法将患者分为两组,对照组（48例）采用盆底肌锻炼治疗,研究组（48例）采用生物反馈电刺激联合盆底肌锻炼治疗。治疗前后采用经会阴实时三维超声检查,对比两组治疗前后的盆底功能障碍调查表（PFDI-20）、盆底障碍影响简易问卷7（PFIQ-7）评分、静息和Valsalva动作状态下的肛提肌超声参数。分析肛提肌超声参数与PFDI-20、PFIQ-7评分的相关性。结果：两组治疗后PFDI-20、PFIQ-7评分,静息和Valsalva动作状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积较治疗前降低（P＜0.05）,静息时肛提肌厚度较治疗前增加（P＜0.05）。研究组治疗后PFDI-20、PFIQ-7评分,静息和Valsalva动作状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积低于对照组（P＜0.05）,静息时肛提肌厚度大于对照组（P＜0.05）。静息和Valsalva状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积与PFDI-20、PFIQ-7评分呈正相关（P＜0.05）,静息状态肛提肌厚度与PFDI-20、PFIQ-7评分呈负相关（P＜0.05）。结论：经生物反馈电刺激联合盆底肌锻炼治疗后肛提肌裂孔大小较治疗前降低,肛提肌厚度较治疗前增加,且与PFDI-20、PFIQ-7评分改善有关,经会阴实时三维超声可客观、有效评价产后盆底功能障碍患者的治疗效果。     

Effect of experimental conditions on the stomach evacuation of Coregonus lavaretus L.

The gastric evacuation of juveniles of Coregonus lavaretus L. fed on living Daphnia pulicaria was investigated. Three successive stages of stomach evacuation were observed when one meal per day was given: (i) a lag phase between the end of food intake and the beginning of stomach evacuation, (ii) a linear reduction of stomach content, (iii) a long residence time for food relics in the stomach. The initial stomach content and the stomach evacuation time are correlated positively. The stomach content increased during feeding when three meals day ⁻¹ were provided and it decreased when no food was available. During the course of an experiment the highest stomach content found increased with increasing daly ration. Excess feeding resulted in a low stomach content similar to that found with rations about 30–50% of the maximum daily food intake. Therefore the daily food intake cannot be determined by the single parameter of stomach content alone. Identical initial stomach contents showed significantly higher stomach evacuation rates under three meals day⁻¹ conditions than under one meal day⁻¹ conditions.     

Some Aspects of Abdominal Surgery in the Elderly Patient

Most operations on elderly patients are of an urgent nature. If time permits, measures to improve cardiac, respiratory and renal functions in the appropriate ways should be undertaken. During recovery from anesthesia careful but adequate sedation will reduce the risk of myocardial ischemia. Throughout the postoperative period constant encouragement of the older patient is particularly helpful.Transverse abdominal incisions and the frequent use of temporary gastrostomy are advocated.External hernia, hiatus hernia, peptic ulcer, carcinoma of the stomach, biliary disease, appendicits, intestinal obstruction, and carcinoma of the large intestine are discussed specifically, with special reference to the practical details of management in the elderly patient.     

胃癌术后早期肠内营养支持的临床观察

目的:观察胃癌术后早期肠内营养支持的临床效果。方法:将76例患者随机分成早期肠内营养(EEN)组和未施行肠内营养(N-EEN)组(n=38),EEN组于胃癌术后24h经术中放置的鼻空肠管应用能全力进行早期肠内营养,N-EEN为术后静脉营养,术前、术后7天测定血清白蛋白、前白蛋白和体重、记录术后肠蠕动、排气时间和术后并发症。结果:两组肠鸣音恢复时间差异无统计学意义,EEN组术后肛门排气时间明显早于N-EEN组(P<0.05);两组术后体重均低于术前,但N-EEN组体重下降更明显,差异有统计学意义(P<0.05);术后第7天,两组患者血清白蛋白、前白蛋白均较术前下降,差异有统计学意义(P<0.05),但两组白蛋白下降的差异无统计学意义,而N-EEN组前清蛋白下降明显,差异有统计学意义(P<0.05)。结论:胃癌术后EEN安全、可靠,具有维护机体代谢平衡、促进肠蠕动的作用,并可减少术后并发症。     

大熊猫胃内纤毛虫检测初报

Twenty three captive giant pandas, fecal specimens and stomach juice from five captive giant pandas(Ailuropoda melanoleuca)were tested for ciliate in 2004. Of them, ciliates of Epdinium spp.and Entodinium spp.were found in the stomach of five giant panda. Density of ciliates in each stomach of giant pandas were 4.21×10 4 ind./ml, 6.98×10 4 ind./ml, 3.05×10 4 ind./ml, 4.46×10 4 ind./ml and 4.38×10 4 ind./ml respectively. But all the fecal specimens were negative.     

实时三维盆底超声对产后压力性尿失禁患者疗效评估作用及与尿动力学的相关性分析

摘要 目的：探讨实时三维盆底超声对产后压力性尿失禁（SUI）患者疗效评估作用及与尿动力学的相关性。方法：选择2020年4月至2022年12月石家庄市人民医院收治的139例产后SUI患者,均接受盆底生物反馈电刺激联合盆底肌锻炼治疗。治疗前后分别进行实时三维盆底超声检查和尿动力学检查。比较治疗前后实时三维盆底超声参数、尿动力学指标差异。Pearson法分析实时三维盆底超声参数与尿动力学指标的相关性。结果：实时三维盆底超声图像特征显示：治疗前盆膈裂孔内的结构疏松,回声变弱,盆腔器官结缔组织疏松,间隙增宽,盆膈裂孔面积、尿道旋转角、膀胱尿道后角以及膀胱颈移动度较大;治疗后盆膈裂孔两侧耻骨直肠肌对称,耻骨内脏肌呈带状高回声,盆膈裂孔面积、尿道旋转角、膀胱尿道后角以及膀胱颈移动度较治疗前降低。产后SUI患者治疗后静息状态和Valsalva状态下盆膈裂孔面积、尿道旋转角、膀胱尿道后角、膀胱颈移动度均较治疗前降低（P＜0.05）,腹压漏尿点压、最大逼尿肌压力均较治疗前增加（P＜0.05）。产后SUI患者静息状态和Valsalva状态下盆膈裂孔面积、尿道旋转角、膀胱尿道后角、膀胱颈移动度与最大逼尿肌压力、腹压漏尿点压呈负相关（P＜0.05）,与最大膀胱容量和残余尿量无关（P＞0.05）。结论：产后SUI患者经盆底生物反馈电刺激联合盆底肌锻炼治疗后实时三维盆底超声参数较治疗前降低,与尿动力学改善有关。临床可通过实时三维盆底超声检查,对产后SUI患者进行临床疗效评价,以指导临床治疗。     

西藏高原鳅、细尾高原鳅和异尾高原鳅消化道结构的比较

运用解剖学、组织学方法比较研究西藏高原鳅(Triplophysa tibetana)、细尾高原鳅(Triplophysa stenura)和异尾高原鳅(Triplophysastewarti) 3种高原鳅的消化道结构。结果表明: (1)3种高原鳅的消化道均由口咽腔、食道、胃、肠组成。胃“U”型, 无幽门盲囊, 肠道短, 可分为前、中、后三个部分。异尾高原鳅胃长与消化道长比值最大, 比肠长最短, 为0.51±0.07, 与西藏高原鳅比肠长0.64±0.08和细尾高原鳅比肠长0.70±0.06, 差异显著。(2)异尾高原鳅胃黏膜层相对高度大于西藏高原鳅和细尾高原鳅, 肌肉层相对厚度也比其他2种鱼厚。前肠黏膜层为异尾高原鳅相对高度最大, 肌肉层为西藏高原鳅相对最厚。中肠与后肠黏膜层相对厚度由大到小为异尾高原鳅>细尾高原鳅>西藏高原鳅。综上所述, 3种高原鳅的消化道结构均符合肉食性鱼类特征, 推测异尾高原鳅的结构特征适于消化更多的动物性饵料。     

Difference between the effect of acute and chronic surgical vagotomy on the cytoprotective action of atropine against indomethacin-induced mucosal lesions on the gastrointestinal tract in rats

The cytoprotective effect of a small dose of atropine was proved against the indomethacin (IND)-caused gastrointestinal (GI) mucosal damage. This protective effect of atropine disappeared in the acute phase of surgical vagotomy (ASV) on the vagally-innervated parts of GI tract. The aims of our observations were: 1) to examine the effect of chronic surgical vagotomy (CSV) on the cytoprotective action of atropine in the GI tract; and 2) to compare the effects of ASV and CSV on the GI cytoprotection caused by atropine against IND-induced mucosal damage and vascular permeability in rats. The IND was given s.c. 24 h prior to the killing of the animals in a dose of 20 mg x kg(-1). Bilateral surgical vagotomy or sham operation were carried out 24 h (ASV) or 14 d (CSV) before IND-application. Atropine was given i.p. every 5 h after IND-treatment in a dose of 0.1 mg x kg(-1). The number of macroscopical mucosal ulcerations was noted and its severity was calculated by semiquantitative scale in the stomach, small intestine and three equal parts of colon. Vascular permeability was measured by Evans-blue leakage into the mucosal tissue. It has been found that: 1) Tte small dose of atropine significantly decreased the IND-induced mucosal damage and vascular permeability on the stomach, small intestine and the vascular permeability on the proximal colon; 2) the small dose of atropine did not cause any changes in the appearance of IND-induced mucosal lesions and in Evans blue concentration in the mucosa after ASV, but it significantly decreased the IND-caused mucosal damage and Evans blue concentration in the mucosa of stomach, small intestine and proximal colon after CSV; 3) the IND-induced mucosal damage and vascular permeability treated with atropine (given in cytoprotective dose) were significantly smaller after CSV than that after ASV on the stomach, small intestine and proximal colon. It has been concluded that the intact vagal nerve has an essential role in the appearance of cytoprotective mechanisms of atropine in GI tract.     

Satellite observed reversal in trends of spring phenology in the middle-high latitudes of the Northern Hemisphere during the global warming hiatus

The start of the growing season (SOS) is essential to track the responses of vegetation to climate change. However, recent findings on whether the SOS in the middle-high latitudes of the Northern Hemisphere (NH) continued to advance or reversed during the global warming hiatus were not consistent. It is necessary to investigate the causes of this controversy and to examine the relationship between the SOS and preseason temperature trends. To this end, we first applied four widely used phenology extraction methods to derive the SOS from the GIMMS NDVI3g dataset and then used the ensemble empirical modal decomposition (EEMD) method to extract the nonlinear trends of the SOS and preseason temperature. Our results clarify, for the first time, that the limitations of the linear assumption-based trend analysis methods are an important but overlooked cause of the discrepancies among existing studies on whether the SOS was advanced or delayed in the NH (>30° N) during the global warming hiatus. We further revealed the range of the mismatches between the SOS and preseason temperature trends at the latitude, altitude and biome levels. Specifically, we discovered that the SOS in the NH (>30° N) obtained by the four phenology extraction methods showed a significant reversal from advance to delay during the global warming hiatus, and the corresponding average rate of change was very small. The area showing increasing preseason temperatures decreased during the global warming hiatus, but it always occupied most of the NH (>30° N). However, delayed SOS trends were dominant in the NH from 50° N to 60° N, above 3000 m and in biomes other than TBMF and BF. Accordingly, using an EEMD-like approach to evaluate the changes in the SOS and preseason temperature is necessary for improving our understanding of the changes in the SOS and their association with climate.     

Reduction of population levels of some indigenous bacteria by lactobacilli in the gastrointestinal tract of gnotobiotic rats.

Effects of each of three indigenous Lactobacillus groups on other bacterial populations were separately investigated in gnotobiotic rats. In the wall of the non-glandular part of the stomach, contents of the stomach and contents of the upper part of the small intestine, some pre-associated indigenous bacteria were reduced to conventional population levels by introducing three groups of lactobacilli: Group I (Lactobacillus acidophilus and related strains), Group II (L. fermentum) and the groups mixed. However, no obvious reduction in cell numbers of the pre-associated bacteria occurred in the case of Group III (L. murini).     

Diagnosis of Superficial or Very Small Gastric Ulcers

Thirteen superficial or very small gastric cancers are described, 10 of which were diagnosed preoperatively. Five patients presented with gastric ulcer, five with radiological deformities of uncertain nature and two with polypoid lesions; one cancer was an incidental finding at emergency operation. Two of the patients had a family history of gastric cancer, two had pernicious anemia and three were born in countries where gastric cancer is common. Gastric cytology was positive in eight of the nine patients examined. A follow-up study of patients investigated for stomach cancer three to five years previously suggests that suspected gastric cancer is seldom missed for long periods if the diagnostic workup is thorough.     

Comparison of stomach microRNA transcriptomes of Tibetan and Yorkshire pigs by deep sequencing

MiRNAs regulate the expression of target genes in diverse cellular processes and hence play important roles in different physiological processes, yet little is known about the stomach microRNAome (miRNAome) of the Tibetan pig. The objective of this experiment was to investigate differentially expressed stomach miRNAs participating in digestion. Firstly, we isolated total RNA by Trizol reagent from three Tibetan and three Yorkshire purebred pigs stomach samples at 90-day-old. Secondly, a comprehensive analysis of Tibetan and Yorkshire pig stomach miRNAomes was performed by small RNA sequencing in the Illumina HiSeq 2000 system. Finally, SYBR Green Real-time RT-PCR was performed to validate the differentially expressed miRNAs. We identified 318 unique miRNAs, 260 were co-expressed in both libraries, 17 and 31 miRNAs were specifically expressed in Tibetan and Yorkshire pigs respectively. Fifty six differentially expressed miRNAs were identified by the identifying differentially expressed genes 6 (IDEG6). Kyoto encyclopedia of genes and genomes analysis revealed that some of the differentially expressed miRNAs were associated with protein and fat digestion. Two differentially expressed miRNAs (miR-214-3p and ssc-un39) participating in the digestion of lipid were identified. Additionally, qRT-PCR results suggested that a higher expression of miR-214-3p in the Tibetan pig stomach could lead to relatively lower expression of calcium-dependent phospholipase A2, which is an enzyme important for the digestion of glycerol phospholipid. This study has delineated the different stomach miRNAs expression patterns of Tibetan and Yorkshire pigs, which would help explain the regulatory mechanisms of miRNAs in digestion of Tibetan pigs, and contribute to utilize a the unique digestion merits of Tibetan pig in future porcine hybridization breeding.     

Use of dibunol in pharmacological correction of post-vagotomy hypoxia of digestive organs in rats

1, 7, 14, 30 and 60 days after bilateral sub-diaphragmatic truncal vagotomy tension of oxygen (pO2) in liver, stomach and small intestine (jejunum) was determined. It was demonstrated that vagotomy leads to a decrease of pO2 in all investigated organs 1 day after the operation (such changes were observed in sham-operated rats) and 30 days, in jejunum--after 7 days, in liver--after 14 days, in stomach--after 60 days. Dibunol introduction in vagotomized rats during 29 days (starting from the second day after operation) results in pO2 normalization in all investigated organs.     

腹腔镜与开腹胃楔形切除术对GIST患者营养状况、T细胞亚群和预后的影响

摘要 目的：探讨腹腔镜与开腹胃楔形切除术对胃间质瘤（GIST）患者营养状况、T细胞亚群和预后的影响。方法：回顾性分析2013年1月~2014年2月期间我院收治的GIST患者97例的临床资料,根据手术方式的不同将患者分为对照组（n=47,开腹胃楔形切除术）和研究组（n=50,腹腔镜胃楔形切除术）,对比两组患者手术相关指标、营养状况、T细胞亚群、预后情况。结果：研究组住院时间、肛门排气时间、切口长度、手术时间短于对照组,术中出血量少于对照组（P<0.05）。两组患者术后7 d前白蛋白、转铁蛋白、白蛋白均降低,但研究组高于对照组（P<0.05）。两组术后7 d的 CD4⁺/CD8⁺、CD3⁺、CD4⁺较术前下降,CD8+较术前升高（P<0.05）;研究组术后7 d 的CD4⁺/CD8⁺、CD3⁺、CD4⁺高于对照组,CD8⁺则低于对照组（P<0.05）。研究组并发症总发生率低于对照组（P<0.05）;两组术后复发率、5年生存率比较无统计学差异（P>0.05）。结论：与开腹胃楔形切除术相比,GIST患者采用腹腔镜胃楔形切除术治疗的远期预后效果相当,可有效改善围术期相关指标,对患者营养状况、T细胞亚群的影响较轻,且可减少术后并发症的发生率。     

Stomach stress and strain depend on location, direction and the layered structure

The stomach is as other parts of the gastrointestinal tract functionally subjected to dimensional change. Hence, the biomechanical properties are of functional importance. Our group has previously demonstrated that the stress–strain properties of the rat and rabbit stomach wall were species-, location- and direction-dependent. We further wanted to study the anisotropic biomechanical properties of the stomach wall in pigs. Furthermore, we made an in-depth biomechanical test on the layered wall of the stomach in different regions. Two stomach strips were cut both in longitudinal direction (parallel with the greater curvature) and circumferential direction (perpendicular to the greater curvature) from the gastric fundus, corpus and antrum. One strip was used for the non-separated (intact) wall test and the other one was separated for the test on the mucosa–submucosa and muscle layers individually. The length, thickness and width of each strip were measured from digital images. The uni-axial stress and strain were computed from the force generation and the tissue strip deformation during stretching. The muscle layer was the thickest in the antrum whereas the mucosal–submucosal layer was the thickest in the corpus of the stomach (P<0.01). The strips from the corpus were stiffest among the three regions in both longitudinal and circumferential directions (P<0.001). The longitudinal strips was stiffer than the circumferential strips in all three regions (P<0.001) and the mucosa–submucosa strips was stiffer than the intact wall and the muscle layer in both directions for the fundus and the corpus (P<0.001). The constant a of the intact wall and mucosa–submucosa layer was in both directions linearly associated with the mucosa–submucosa thickness. In conclusion, the uni-axial stress–strain curves of pig stomach were location-, direction- and layer-dependent. The stiffer wall in the corpus is likely due to its thicker mucosa, i.e., the stiffness of the mucosa–submucosa layer seems can explain the intact wall stiffness. Since the structure and function of the pig stomach are similar to the human stomach, we believe that the data obtained from this study can be extended to humans. Detailed biomechanical mapping of the stomach will likely help us to understand physiological functions of the different parts of the human stomach, such as gastric accommodation and mechanosensation.