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OBJECTIVE@#To investigate the effect of vitamin D binding protein (DBP) gene polymorphism on susceptibility and prognosis of severe acute pancreatitis (SAP).@*METHODS@#A prospective study was conducted. Eighty-three patients with SAP who were admitted to the department of general surgery of Tianjin Fifth Central Hospital from March 2018 to March 2021 were selected as the research objects, and 83 healthy people in the same period were selected as controls. Peripheral blood RNA was extracted and reverse transcribed into cDNA, and the genotype and allele frequency of DBP gene rs7041 locus were detected by fluorescence quantitative analyzer. Hardy-Weinberg equilibrium was used to test the genetic balance. On the day of admission, serum C-reactive protein (CRP) level was detected by scattering immunoturbidimetry, serum procalcitonin (PCT) level was detected by electrochemiluminescence, serum DBP level was detected by enzyme-linked immunosorbent assay (ELISA), and neutrophil to lymphocyte ratio (NLR) was calculated automatically by the instrument. The length of intensive care unit (ICU) stay, the length of hospital stay and prognosis during hospitalization of patients were statistically analyzed. Multivariate Logistic regression analysis was used to screen the influencing factors of SAP occurrence.@*RESULTS@#The results of Hardy-Weinberg equilibrium test showed that the distribution of gene polymorphisms in the two groups of subjects conformed to the law of genetic equilibrium. The frequencies of TT genotype and T allele of DBP gene rs7041 locus in the patients of SAP group were significantly higher than those in the healthy control group [TT genotype: 34.94% (29/83) vs. 9.64% (8/83), T allele: 55.42% (92/166) vs. 38.55% (64/166), both P < 0.01], and the frequency of GT genotype was significantly lower than that in the healthy control group [40.96% (34/83) vs. 57.83% (48/83), P < 0.05]. There was no significant difference in the frequency of GG genotype between the healthy control group and SAP group [32.53% (27/83) vs. 24.10% (20/83), P > 0.05]. Further multivariate Logistic regression analysis showed that TT genotype [odds ratio (OR) = 2.831, 95% confidence interval (95%CI) was 1.582-5.067, P < 0.001] and T allele (OR = 2.533, 95%CI was 1.435-4.472, P < 0.001) of DBP gene rs7041 locus were independent risk factors for SAP in healthy people, while GT genotype was a protective factor for SAP (OR = 0.353, 95%CI was 0.143-0.868, P = 0.041). The levels of CRP, PCT, NLR and DBP in patients with TT genotype of DBP gene rs7041 locus were significantly higher than those in patients with GG/GT genotype on the day of admission in SAP group [CRP (mg/L): 43.25±13.25 vs. 31.86±12.83, PCT (μg/L): 1.53±0.24 vs. 1.21±0.20, NLR: 3.15±0.53 vs. 2.71±0.48, DBP (μg/L): 87.78±19.64 vs. 70.58±18.67, all P < 0.01]. The length of ICU stay in patients with TT genotype of DBP gene rs7041 locus in SAP group was significantly longer than that in patients with GG/GT genotype (days: 11.35±1.58 vs. 9.71±1.35, P < 0.01). The length of hospital stay of patients with TT genotype was longer than that of patients with GG/GT genotype (days: 23.41±3.64 vs. 23.17±3.57), and the in-hospital mortality was higher than that of patients with GG/GT genotype [34.48% (10/29) vs. 29.63% (16/54)], but the difference was not statistically significant (both P > 0.05).@*CONCLUSIONS@#The risk of SAP was significantly increased in patients with TT genotype of rs7041 locus of DBP gene, and the mechanism may be related to the increase of DBP expression. And carrying the TT genotype will prolong the ICU hospitalization time of SAP patients, but the effect on prognosis is not obvious.
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Humans , Polymorphism, Single Nucleotide , Prospective Studies , Vitamin D-Binding Protein/genetics , Acute Disease , Pancreatitis/genetics , Genotype , PrognosisABSTRACT
Objective:To investigate the therapeutic effect of exosomes divided from bone marrow mesenchymal stem cell (BMSC) on pancreatic cancer in vivo through regulation of tumor-associated macrophages (TAM) polarization.Methods:Ten male C57BL/6 mice weighing approximately 20 g, ages 4 weeks, were used for BMSC exosomes extraction and PKH26 labelling. Thirty female SPF BALB/c-nu/nu nude mice weighing approximately (18.56±0.85) g, ages 4-6 weeks, were adopted for pancreatic carcinoma models. The models were randomly divided into 3 groups with 10 in each: control group (injected with PBS through tail vein), portal vein treatment group (injected with exosomes in PBS through portal vein), tail vein treatment group (injected with exosomes in PBS through tail vein). After the models were executive 8 weeks later, the percentage of PKH26 positive-exosomes in pancreas tissue was quantified by flow cytometry technique. The volume of the primary pancreatic tumor, the tumor volume of inhibitory rate, the number of metastatic nodule, and the ascitic fluid were assess. Also, the weight of liver and the tumor weight were evaluated. The expression of M1 and M2 macrophage-activate biomarkers and the content of pancreatic cancer marker B7-H4 tumor carbohydrate antigen 199 in peripheral blood was detected. Moreover, the expression of Survivin and matrix metalloproteinase-9 (MMP-9) in pancreatic cancer tissue cells was also detected.Results:There was no significant difference for the tumor volume of inhibitory rate between portal vein treatment group (72.4±21.6)% and tail vein treatment group (70.1±20.7)% ( t=0.24, P=0.811). Compared with control group, the volume of the primary pancreatic tumor, the weight of liver, the tumor weight, the number and rate of liver metastatic nodule, the ascitic fluid, and the number of other metastatic nodule were totally lower in the 2 treatment groups with significant difference (all P<0.05). Compared with the control group, iNOS and CD68 in portal vein treatment group and tail vein treatment group were increased, while Arginase, CD206, B7-H4, tumor carbohydrate antigen 199, Survivin and matrix metalloprotein-9 were decreased, with statistically significant differences (all P<0.05). Conclusion:Exosomes derived from BMSC can inhibit the polarization of TAM to the M2 phenotype and induce their polarization to the M1 phenotype, thereby suppressing the proliferation, invasion and migration of pancreatic cancer.
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Objective To compare the clinical effect of laparoscopic and open umbilical hernia repair for adult umbilicalhernia.Methods Eighty-threepatients with adult umbilical hernia admitted to People's Hospital of Beijing Daxing District from Feb.2008 to Jan.2017 were randomly divided into laparoscopic umbilical hernia repair group (n =38) and open umbilical hernia repair group (n =45).Patients in laparoscopic umbilical hernia repair group accepted laparoscopic umbilical hernia repair with intraperitoneal onlay mesh (n =38),while patients in open umbilical hernia repair group accepted traditional umbilical hernia repairtreatment.Operation time,hospital stay,blood loss,seroma/hematoma formation,wound infection,incomplete bowel obstruction and recurrence were compared between the two groups with the software of SPSS 22.0.The outpatient consultation was performed at 2 weeks,1 month,3 months,and 6 months after operation.The follow-up contents were wound condition,pain,and whether there were any masses in the umbilicus.After every 3 months of telephone follow-up or outpatient review,whether there were any masses in the umbilicus,the average follow-up time was 14 months.Results All operations were successfully completed.The operation time of laparoscopic umbilical hernia repair group was shorter than open umbilical hernia repair group [(31 ± 8) min vs (48 ± 10) min,P ＜ 0.01],and hospital stay were significantly shortened in laparoscopic umbilical hernia repair group (P ＜ 0.05).The amount of bleeding of the laparoscopic umbilical hernia repair group decreased significantly than open umbilical hernia repair group [(40 ± 18) ml vs (62 ± 25) ml,P ＜ 0.01].The postoperative painof the laparoscopic umbilical hernia repair group was mild than open umbilical hernia repair group (P ＜ 0.05).The postoperative complications include seroma,wound infection and incomplete bowel obstruction.There were no significant differences between the two groups of seroma,incision infection and recurrence (P ＞ 0.05).The difference of the incidence of incomplete bowel obstruction between the two groups was statistically significant (P =0.019) . The total postoperative complication rate was significantly lower in laparoscopic umbilical hernia repair group than in open umbilical hernia repair group(x2 =5.328,P =0.021).Conclusions Laparoscopic umbilical hernia repair has short operation time,less bleeding,and satisfactory postoperative pain.It is worthy of advocacy for umbilical hernia patients who can tolerate general anesthesia.
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Objective To compara the postoperative pain and foreign body sensation in patients with inguinal hernia treated by laparoscopic transabdominal preperitoneal (TAPP) and open transinguinal preperitoneal (TIPP).Methods Retrospective analysis of clinical data of 180 patients with inguinal hernia admitted to the Daxing District People's Hospital of Capital Medical University from January 2016 to January 2018,male 158 cases,female 22 cases,average age 56 years old,age range 23-80 years old.Including 110 patients in the TAPP group and 70 patients in the TIPP group,patients in the TAPP group were treated with laparoscopic TAPP,and patients in the TIPP group were treated with open TIPP.Pain degree was assessed with pain visual analogue scale (VAS) postoperatively at 3 weeks,3 months and 6 months.The incidence of chronic pain was measured at 3 weeks,3 months,and 6 months after surgery,and the incidence of foreign body sensation at 3 months was recorded.Measurement data were expressed as mean ± standard deviation (Mean ± SD),t test was used for comparison between groups;Chi-square test was used for compare the count data between groups.Results At 3 weeks,3 months,and 6 months after surgery,the mean value of pain VAS in the TAPP group was lowerthan in the TIPP group [(0.07 ± 0.40) scores vs (0.37 ± 0.94) scores,(0.03 ± 0.16) scores vs (0.24 ± 0.69) scores,(0.01 ± 0.10) scores vs (0.14 ± 046) scores],and the difference was statistically significant (P =0.004,0.002,0.004).The incidence of pain in the TAPP group was 3.6％,2.7％,and 0.9％ at 3 weeks,3 months,and 6 months after surgery,respectively.The incidence of pain in the TIPP group was 14.3％,11.4％,and 10.0％,respectively.The difference was statistically significant (P =0.021,0.040,0.012).At 3 months postoperatively,there were 2 cases (1.8％) in the TAPP group and 12 cases (17.1％) in the TIPP group with the foreign body sensation.The difference between the two groups was statistically significant (x2 =14.006,P =0.000).Conclusion Compared with the open TIPP,the laparoscopic TAPP is used to repair the inguinal hemia,The postoperative pain is milder,and the incidence of chronic pain and foreign body sensation was lower.
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Objective To explore the difference between laparoscopic transabdominal preperitoneal hernia repair (TAPP) and open preperitoneal hernia repair for the treatment of inguinal hernia under local anesthesia.Methods A total of 64 cases with inguinal hernia underwent hernia repair in Beijing Daxing District Hospital of Capital Medical University from January 2014 to January 2015 were retrospectively analyzed.Thirty-four cases in test group were applied with TAPP and used D(9 * 13) mesh to repair for inguinal hernia,and 30 cases in traditional group with open preperitoneal hernia repair which used D10 mesh to repair for inguinal hernia.Results All operations were successfully completed.There was statistically significant difference in operation time(P =0.000),postoperative activity time(P =0.000),postoperative hospitalization time (P =0.003) and pass flatus time (P =0.000) between these two groups.There was no statistically significant difference in wound seroma(P =0.216),hematoma (P =1.000),analgesics (P =0.090) and recurrence rate of the first year (P =1.000).Conclusions Both TAPP and tension free repair of inguinal hernia under regional anesthesia are safe and effective methods for the treatment of inguinal hernia,which has its advantages.Surgeon should choose the suitable procedure according to patient's condition reasonably.