Fluoroscopically Guided Three-Tube Insertion for the Treatment of Postoperative Gastroesophageal Anastomotic Leakage

Guowen Yin,Qingyu Xu,Shixi Chen,Xiangjun Bai,Feng Jiang,Qin Zhang,Lin Xu,Weidong Xu 대한영상의학회 2012 Korean Journal of Radiology Vol.13 No.2

Objective: To retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL). Materials and Methods: From January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients’ nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube. Results: The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 ± 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 ± 0.40 g/dL) to post-enteral feeding (3.7 ± 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months). Conclusion: Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary procedure to treat postoperative GEAL. Objective: To retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL). Materials and Methods: From January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients’ nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube. Results: The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 ± 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 ± 0.40 g/dL) to post-enteral feeding (3.7 ± 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months). Conclusion: Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary procedure to treat postoperative GEAL.

Metabolic Characteristic of the Liver of Dairy Cows during Ketosis Based on Comparative Proteomics

Xu, Chuang,Wang, Zhe,Liu, Guowen,Li, Xiaobing,Xie, Guanghong,Xia, Cheng,Zhang, Hong You Asian Australasian Association of Animal Productio 2008 Animal Bioscience Vol.21 No.7

The objective of the present study was to identify differences in the expression levels of liver proteins between healthy and ketotic cows, establish a liver metabolic interrelationship of ketosis and elucidate the metabolic characteristics of the liver during ketosis. Liver samples from 8 healthy multiparous Hostein cows and 8 ketotic cows were pooled by health status and the proteins were separated by two-dimensional-electrophoresis (2D-E). Statistical analysis of gels was performed using PDQuest software 8.0. The differences in the expression levels of liver proteins (p<0.05) between ketotic and healthy cows were identified by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF-TOF) tandem mass spectrometry. Five enzymes/proteins were identified as being differentially expressed in the livers of ketotic cows: expression of 3-hydroxyacyl-CoA dehydrogenase type-2 (HCDH), acetyl-coenzyme A acetyltransferase 2 (ACAT) and elongation factor Tu (EF-Tu) were down-regulated, whereas that of alpha-enolase and creatine kinase were up-regulated. On the basis of this evidence, it could be presumed that the decreased expression of HCDH, which is caused by high concentrations of acetyl-CoA in hepatic cells, in the livers of ketotic cows, implies reduced fatty acid ??oxidation. The resultant high concentrations of acetyl-CoA and acetoacetyl CoA would depress the level of ACAT and generate more ??hydroxybutyric acid; high concentrations of acetyl-CoA would also accelerate the Krebs Cycle and produce more ATP, which is stored as phosphocreatine, as a consequence of increased expression of creatine kinase. The low expression level of elongation factor Tu in the livers of ketotic cows indicates decreased levels of protein synthesis due to the limited availability of amino acids, because the most glucogenic amino acids sustain the glyconeogenesis pathway; thus increasing the level of alpha-enolase. Decreased protein synthesis also promotes the conversion of amino acids to oxaloacetate, which drives the Krebs Cycle under conditions of high levels of acetyl-CoA. It is concluded that the livers of ketotic cows possess high concentrations of acetyl-CoA, which through negative feedback inhibited fatty acid oxidation; show decreased fatty acid oxidation, ketogenesis and protein synthesis; and increased gluconeogenesis and energy production.

New Failure Mechanism for Evaluating the Static and Seismic Ultimate Bearing Capacity of Strip Footings Adjacent to Slope

Hongwei Fang,Yixiang Xu,Guowen Xu 대한토목학회 2023 KSCE Journal of Civil Engineering Vol.27 No.5

The seismic slip line field theory (SLFT) is derived based on the method of characteristic, and the critical slope contour calculated by the SLFT is a convex shape when a high surcharge is imposed on the slope top surface. A simple and robustness failure mechanism is proposed to calculate the static and seismic ultimate bearing capacity of strip footing adjacent to the cohesion-frictional slopes where the critical slope contour shifts from the inside of the slope to the outside of the slope with the increase of the boundary load, and the slope is at the limit state when the critical slope contour is tangent to the slope surface. The influence of slope and footing geometric features, soil parameters, and the seismic load on the bearing capacity is analyzed. The ultimate bearing capacity decreases as the strength parameters decreases, and the slope angle and the seismic coefficient increases. The static and seismic bearing capacity calculated by the proposed method does not require the failure models to be initially assumed, and the results are consistent with those of the other methods.

Evaluation of thermal comfort in air-conditioned rooms based on structure/control-related parameters and data-mining method

Zhao Shunan,He Lin,Wu Xin,Xu Guowen,Xie Junlong,Cai Shanshan 대한설비공학회 2023 International Journal of Air-Conditioning and Refr Vol.31 No.1

Evaluating the thermal environment and thermal comfort in an air-conditioned room is an essential for estimating the performance of air-conditioning systems. However, multiple component structures and control-related parameters often lead to a long test cycle and large number of tests, significantly affecting the testing efficiency and speed. To address these problems, in this study, a data-mining method was proposed to predict and evaluate the thermal environment of an air-conditioned room. Owing to the limited amount of experimental data, the sample data were expanded by the simulation data of a collaborative platform between the air-conditioning system and air-conditioned room. Data-mining models, including the support vector regression (SVR), backpropagation (BP), and multiple linear regression (MLR) models, were developed and achieved good accuracy in evaluating the thermal environment by considering air-conditioning systems with various structures and control parameters. In the multiple-input single-output evaluation method, the prediction accuracy of the SVR model was higher than those of the BP and MLR models with respect to the vertical air temperature difference, temperature uniformity, temperature drop rate, and draft rate, while the result was the opposite in terms of the predicted mean vote indices. In the multiple-input multiple-output evaluation method, there was a decline in prediction accuracy and an increase in efficiency prediction compared with multiple-input single-output evaluation.