Application of membrane anatomy in hepatopancreatobiliary and splenic surgery / 中华外科杂志

Understanding of a variety of membranous structures throughout the body,such as the fascia,the serous membrane,is of great importance to surgeons. This is especially valuable in abdominal surgery. With the rise of membrane theory in recent years,membrane anatomy has been widely recognized in the treatment of abdominal tumors,especially of gastrointestinal tumors. In clinical practice. The appropriate choice of intramembranous or extramembranous anatomy is appropriate to achieve precision surgery. Based on the current research results,this article described the application of membrane anatomy in the field of hepatobiliary surgery,pancreatic surgery,and splenic surgery,with the aim of blazed the path from modest beginnings.

Effects of 3D laparoscopic trans-sacrococcygeal and transabdominal perineal in the treatment of low rectal cancer / 中国医师进修杂志

Objective:To investigate the effect of 3D laparoscopic trans-sacrococcygeal and transabdominal perineal in the treatment of low rectal cancer.Methods:The clinical data of 86 patients with low rectal cancer admitted to Qilu Hospital of Shandong University(Qingdao) from January 2017 to January 2020 were collected retrospectively, and they were divided into the control group and the observation group by the different surgical approaches, with 43 cases in each group. The control group was treated with 3D laparoscopic transabdominal perineal resection of rectal cancer, and the observation group was treated with 3D laparoscopic trans-sacrococcygeal resection of rectal cancer. Perioperative indexes in the two groups were recorded. The levels of carbohydrate antigen (CA)242, CA724, and carcinoembryonic antigen (CEA) were compared before and 6 months after the surgery. Follow-up was arranged to record the local recurrence rate and survival rate.Results:The operative time, intraoperative blood loss, exhaust time, hospitalization time in the observation group were lower than those in the control group: (182.04 ± 50.87) min vs. (210.59 ± 61.03) min, (89.18 ± 12.57) ml vs. (116.58 ± 22.09) ml, (2.94 ± 0.58) d vs. (4.56 ± 1.07) d, (10.65 ± 2.03) d vs. (14.06 ± 2.84) d, the differences were statistically significant ( P<0.05). The urination function of the observation group recovered well after the surgery, and there was statistical significance in the grading of urination function between the two groups ( P<0.05). The levels of CEA, CA242 and CA274 in the observation group at 6 months after the surgery were lower than those in the control group: (4.13 ± 0.46) μg/L vs. (5.01 ± 0.72) μg/L, (14.01 ± 5.16) kU/L vs. (16.97 ± 5.76) kU/L, (4.19 ± 0.68) kU/L vs. (4.97 ± 0.87) kU/L, the differences were statistically significant ( P<0.05). The survival rate in the observation group was higher than that in the control group: 88.37%(38/43) vs. 69.77%(30/43); and the recurrence rate was lower than that in the control group: 4.65%(2/43) vs. 27.91%(12/43), the differences were statistically significant ( χ2 = 4.50, 8.53, P<0.05). Conclusions:3D laparoscopic trans-sacrococcygeal resection of rectal cancer can effectively shorten the operation time, reduce the amount of bleeding, but also improve the patient's anal function, and has low local recurrence rate, which is worthy of clinical promotion.

Isoliquiritigenin induces HMOX1 and GPX4-mediated ferroptosis in gallbladder cancer cells / 中华医学杂志(英文版)

BACKGROUND@#Gallbladder cancer (GBC) is the most common malignant tumor of biliary tract. Isoliquiritigenin (ISL) is a natural compound with chalcone structure extracted from the roots of licorice and other plants. Relevant studies have shown that ISL has a strong anti-tumor ability in various types of tumors. However, the research of ISL against GBC has not been reported, which needs to be further investigated.@*METHODS@#The effects of ISL against GBC cells in vitro and in vivo were characterized by cytotoxicity test, RNA-sequencing, quantitative real-time polymerase chain reaction, reactive oxygen species (ROS) detection, lipid peroxidation detection, ferrous ion detection, glutathione disulphide/glutathione (GSSG/GSH) detection, lentivirus transfection, nude mice tumorigenesis experiment and immunohistochemistry.@*RESULTS@#ISL significantly inhibited the proliferation of GBC cells in vitro . The results of transcriptome sequencing and bioinformatics analysis showed that ferroptosis was the main pathway of ISL inhibiting the proliferation of GBC, and HMOX1 and GPX4 were the key molecules of ISL-induced ferroptosis. Knockdown of HMOX1 or overexpression of GPX4 can reduce the sensitivity of GBC cells to ISL-induced ferroptosis and significantly restore the viability of GBC cells. Moreover, ISL significantly reversed the iron content, ROS level, lipid peroxidation level and GSSG/GSH ratio of GBC cells. Finally, ISL significantly inhibited the growth of GBC in vivo and regulated the ferroptosis of GBC by mediating HMOX1 and GPX4 .@*CONCLUSION@#ISL induced ferroptosis in GBC mainly by activating p62-Keap1-Nrf2-HMOX1 signaling pathway and down-regulating GPX4 in vitro and in vivo . This evidence may provide a new direction for the treatment of GBC.

Epidemiological characteristics, diagnosis, treatment and prognosis of gallbladder cancer in China: a report of 6 159 cases / 中华消化外科杂志

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

A Novel DNMT3A R882H Cell Line Generated Using CRISPR/Cas9 Technology as a Universal Quality Control Material for Clinical Testing in Acute Myeloid Leukemia / 中国生物化学与分子生物学报

The pathogenesis and treatment strategies of acute myeloid leukemia (AML) are different for disparate gene mutations. Therefore, precise molecular testing plays a vital role in its diagnosis. However, when clinical laboratories perform molecular testing, internal quality control materials similar to clinical samples for molecular testing are lacking. At the same time, there is no related external quality assessment system to evaluate clinical laboratory test results. In order to improve the accuracy and credibility of molecular testing in clinical laboratories, we used the CRISPR/Cas9 technology to construct the DNMT3A (R882H, 2645G > A) HEK293T cell line for the quality control of AML molecular testing. We replaced the cas9 protein recognition site AGG in the ssODN with AGA to prevent the homologous recombination cell line from being cleaved by the cas9 protein again, thereby increasing the success rate of homologous recombination cell line production. It has been verified that the DNMT3A (R882H, 2645G > A) cell line can be inherited stably. The mutation frequency of the external quality assessment sample made by the DNA extraction of DNMT3A (R882H, 2645G > A) HEK293T cell line was very stable, tested by two Sanger sequencing instruments and three NGS instruments. The results above showed that the DNA extraction of DNMT3A (R882H, 2645G > A) HEK293T cell line can not only be used as internal quality control, but also be used as external quality assurance samples for monitoring different manufacturers and platforms, thereby improving the accuracy and credibility of molecular testing in clinical laboratories.

Problems and strategy in surgical treatment of biliary tract tumors / 中华消化外科杂志

Biliary tract tumor is a high degree malignancy,which presents with early metastasis and poor prognosis.However,the incidence keeps increasing in recent years compared with other digestive system tumors,the clinical and basic research started late.The biliary tract system is very complicated,it starts up to the liver,descending through the pancreas into the duodenum,involving these three organs,beside this,the portal vein and the hepatic artery are in close proximity.Thus,there are many problems to be solved in current surgical treatment,including how to assess accurately before surgery,whether to undergo preoperative biliary drainage,the extent of liver resection,the extent of lymph node dissection,whether venous involvement should be resected and constructed,whether liver transplantation is useful to these tumors,operation scope of early gallbladder carcinoma.

Pancreaticogastrostomy for the treatment of pancreatojejunostomy stricture after pancreaticoduodenectomy:A report of 3 cases / 中国实用外科杂志

OBJECTIVE: To investigate the clinical value of pancreaticogastrostomy(PG) in the treatment ofpancreatojejunostomy stricture(PJS) after pancreaticoduodenectomy(PD).METHODS: The clinical data of 3 patients withPJS who failed the endoscopic treatment underwent PG followed by resection of pancreatojejunostomy(PJ) from May2010 to December 2017 in Department of General Surgery,Xinhua Hospital,Shanghai Jiaotong University School ofMedicine were analyzed retrospectively. After the pancreatointestinal anastomosis was explored and resected, thedigestive tract of the remnant pancreas was reconstructed by using the single-layer bundle pancreaticogastric mucosaanastomosis. The intraoperative and postoperative conditions were observed.RESULTS: The median time of presentationwas 72,37 and 21 months. Three cases of operation were completed successfully. The operation time was 137, 210, 120 min,and blood loss was 210, 350, 180 m L. No pancreatic fistula,surgical bleeding and other serve complicationoccurred postoperatively. All the 3 patients experienced resolution of symptoms without recurrent acute pancreatitis afterPG during the follow-up of 23, 58 and 15 months.CONCLUSION: PG especially duct-to-mucosa PG followed byresection of PJ could be used in the PJS patients who failed the endoscopic treatment.

The new classifications of biliary tract diseases based on actual anatomy / 中华外科杂志

In order to facilitate the treatment strategies for biliary tract injury, hilar cholangiocarcinoma, bile duct tumor thrombus, cholangiocellular carcinoma and bile duct cystic dilatation, many classifications have been made, even more than 10 types for one disease. Each type is represented by numbers or English alphabet, which are not only confusing but also difficult to remember. The Academician Mengchao Wu divided the liver into five sections and four segments base on its anatomy, this classification is very direct and visual, thus had been using till now. In order to overcome those complicated problems, it is considered to develop a new classification based on actual anatomic location similar to that for liver cancer, which is easy to remember and to directly determine the treatment strategy. All kinds of classifications have their own characteristics and advantages and disadvantages. This practical classifications avoid the complexity and may be useful for clinicians.

Historical review of pancreatico-enteric reconstruction following pancreatoduodenectomy / 中华消化外科杂志

The pancreatico-enteric anastomisis has always been a great concern in pancreatoduodenectomy,even been called "Achilles heel".Pancreatic surgeons are interested in improving the anastomosis technique to prevent the pancreatic fistula rate.More than a hundred of anastomosis techniques were reported,authors reviewed the history of pancreatico-enteric anastomisis and divided it into three historical stages,as well as summarized the characteristics of each stage.At the same time,auhors introduced the most representative anastomotic techniques and conccpts in each period.

Method and significance of specimens standardized pathological treatment in pancreaticoduodenectomy for pancreatic head cancer / 中华外科杂志

Pancreatic ductal adenocarcinoma is a highly aggressive disease with a grim prognosis. Surgical resection offers the best chance for long-term survival. Negative-margin resection still remains the goal, the influence of margin status on outcomes in pancreatic head carcinoma remains controversial, as conflicting data have been plagued by a lack of standardization in R0 resection and margin definitions, pathologic analysis, and reporting. In contrast to common belief, a high rate of R1 resections in pancreatic cancer is not a marker of low-quality surgery but rather of high-quality pathology. The international pathological consensus of pancreatic head carcinoma is still needed to fully understand the prognostic value of margin status in order to optimize treatment strategy for this disease.

Clinical effect of terminal branches portal vein embolization combined with transcatheter arterial chemoembolization on liver neoplasms / 中华外科杂志

Objective@#To analyze the efficacy of branches portal vein embolization (TBPVE) combined with transcatheter arterial chemoembolization (TACE) on liver neoplasms.@*Methods@#From August 2016 to May 2017, there were 13 patients including 11 males and 2 females with primary hepatocellular carcinoma who underwent TBPVE+ TACE , among whom there were 11 cases with a history of HBV infection.Average age of the 13 patients was (60.8±6.2)years. The live function of all patients were Child-Pugh A classification.The CT or MRI images of each patient was reconstructed and the standard liver volume(SLV) before TBPVE+ TACE was (1 181.2±49.3)ml, estimated future liver remnant(FLR) was (326.1±72.1)ml and FLR/SLV was (27.6±6.0)%.The puncture site for TBPVE was determined by the three-dimensional reconstruction of portal vein.CT scan or MRI, AFP and liver function test were repeated after one and two weeks after TBPVE+ TACE.FLR and FLR/SLV were calculated respectively.Hepatectomy would be performed if the patients agreed.The postoperative complications were analyzed.@*Results@#On the 7thday after TBPVE+ TACE, the FLR/SLV was(42.6±8.0)% and the FLR increasement was(56.0±24.6)%.The level of AFP decreased from(87.9±81.8)μg/L to (29.7±20.9)μg/L.On the 14thday after TBPVE+ TACE, the FLR/SLV was(45.8±6.2)% and the FLR increasement was(71.8±29.0)%.Four patients underwent surgery which including 2 right hepatectomies and 2 right trisegmentectomies in 2 weeks after TBPVE+ TACE.Nine patients were performed with targeting intratumoral lactic acidosis TACE (TILA-TACE). No severe complication occurred in all patients.@*Conclusions@#TBPVE could induce a rapid growth of the liver remnant but still with the concern of inducing the growth of neoplasms at the same time.To combine TACE in TBPVE therapy not also can the growth of neoplasms be prevented but also inducing its shrinking.This method might be a new mode for the treatment of hepatocellular carcinoma.

Effect of Shuwel Decoction on Enteric Nervous System-Interstitial Cells of Cajal-Smooth Muscle Network Structure Injury in Deep Muscle Nerve Plexus of Functional Dyspepsia Rats / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe morphological changes of enteric nervous system (ENS)-interstitial cells of Cajal (ICC)-smooth muscle cell (SMC) structure injury in deep muscle nerve plexus offunctional dyspepsia (FD) rats, and the repair of Shuwei Decoction (SD) on it, and to explore its effecton FD.</p><p><b>METHODS</b>Totally 72 rats were randomly divided into the control group, the model group, the lowdose SD group, the medium dose SD group, and the high dose SD group, the Mosapride group, 12 ineach group. Rats in the low dose SD group, the medium dose SD group, and the high dose SD group were intragastrically fed with SD at 0.767, 1.534, 3.068 g/mL, respectively. Rats in the Mosapride group were intragastrically fed with Mosapride (1.37 mg/kg). FD rat model with Gan depression Pi deficiency syndrome (GDPDS) was established using complex pathogenic factors. Corresponding liquors were respectively administered to rats in corresponding groups from the 3rd day after modeling. Distilled water(10 mL/kg) was administered to rats in the control group and the model group, once per day for 14 successive days. Rats were sacrificed and small intestine tissues collected for observing ENS-ICC-SMC structure injury using immunofluorescence double labeling, laser scanning confocal microscope, and transmission electron microscope at day 15. Repair of SD on it was also observed.</p><p><b>RESULTS</b>ENS-ICC SMC structure was incomplete, with obvious injury in mutual link of ICC, ICC, SMC, and connecting structure. ENS-ICC-SMC structure was more complete in high, medium, and low dose SD groups, with close link of ICC and SMO. Their connecting structures were in good conditions.</p><p><b>CONCLUSION</b>SD could keep the integrity of ENS-ICC-SMC structure by promoting regeneration and morphology of ICC, thereby, improving gastrointestinal movement disorder and showing therapeutic effect on FD.</p>

Therapeutic efficacy of Voriconazole on invasive fungal infections in very elderly patients / 中华老年医学杂志

Objective To evaluate the safety and efficacy of Voriconazole on invasive fungal infections in very elderly patients.Methods Clinical data of 24 very elderly patients with invasive fungal infections who had sought treatment at the Department of Geriatrics of our hospital from April 2013 to April 2014 were retrospectively investigated.The classifications and quantities of fungi,accompanying symptoms,adverse reactions,blood tests,and liver and kidney function indicators were recorded and analyzed before and after treatment.Results Each of the 24 cases was found to have been infected with one or more of 17 fungal strains belonging to the genus of Candida.The rate of complete fungal elimination after treatment was 70％ (12/17).Of the 24 cases,5 achieved a full recovery(20.8 ％),10 (41.7 ％) had significant improvement,5 (20.8 ％) had some improvement,and 4 cases(16.7％)showed no therapeutic benefits,with a total effectiveness rate of 62.5 ％.There was no significant difference in liver and kidney function before and after treatment(P＞0.05).A transient increase in serum creatinine occurred in 1 case and defective vision in another patient during Voriconazole treatment.Conclusions The incidence of invasive fungal infections is high in very elderly patients,with Candida as the main pathogen.Voriconazole is effective in treating invasive fungal infections in very elderly patients,and close monitoring of liver and kidney function is required during voriconazole treatment.

Comparative study on the developmental characteristics of mathematical cognitive between ADHD and nor-mal children / 中华行为医学与脑科学杂志

Objective To compare the differences of the development of mathematical cognitive characteristics between ADHD children and normal children aged from 7 to 12 years old with event?related potentials ( ERP ) in the mathematical tasks, and to explore the neural mechanisms and characteristics. Methods ERP and behavioral data of 72 ADHD children and 88 normal children in three groups( 7?8 years old,9?10 years old,11?12 years old) were recorded,and analyzed N1,P2 and N2 components'amplitude and latency of Fz by judging the answers to simple calculation within 20. Results ( 1) Vertical comparative a?nalysis( the three age groups were compared):the differences of N1,P2 and N2 amplitudes in normal groups were considered to be statistically significant (right answer:N1(-3.8±2.1)μV,(-4.3±3.4)μV,(-2.2± 2.4)μV;P2(10.6±4.3)μV,(12.6±5.1)μV,(8.5±2.4)μV;N2(-6.5±3.1)μV,(-10.2±4.2)μV,(-6.8± 3.4)μV;error answer:N1(-2.8±2.7)μV,(-4.5±3.0)μV,(-2.9±2.5)μV;P2(9.3±5.9)μV,(12.1±5.0)μV,(8.2±3.6)μV;N2(-7.4±3.7)μV,(-11.4±5.5)μV,(-7.7±3.7)μV;all P0.05). (2)Horizontal comparative analysis(ADHD group and normal group were compared):N1 amplitude of ADHD group aged from 7 to 8 years old was higher than normal group’ s while judging the right answer((-5.3±2.4)μV,(-3.8±2.1)μV, P0.05) . The latent period of the wrong answers was longer than that of the right ones among normal groups aged from 11?12 while the difference of ADHD group had no statistical significance ((312.9±42.3)ms,(292.2±21.2)ms, P<0.05). Conclusion The development trend of mathematical ERP component in ADHD children is different from normal ones,and it is closely related to the maldevelopment of frontal lobe.The characteristics of cognitive deficit differ from ages.ADHD children in low and intermediate level were damaged primarily with inhibition function,while the senior were damaged mainly in collision de?tection function.

Progress on the research of acupuncture for smoking cessation in foreign and domestic / 中国针灸

Up to December of 2011, the domestic and overseas literatures of acupuncture for smoking cessation are searched and collected through Pubmed, CNKI, Wanfang and Chongqing VIP databases, which are analyzed from treatment method, action mechanism, influencing factors of efficacy and efficacy evaluation research and so on. The result shows that (1) acupuncture has positive effect on smoking cessation, and large clinical trials has been carried out. However, most of them are needling methods and the short-term effect observation, which lack of long-term efficacy research of withdrawal symptoms, especially continuous withdrawal symptoms and index of life quality. (2) Because of unified clinical treatment, manipulation standard and curative effect criteria, it is difficult to make comparison among them. (3) The study of mechanism on acupuncture for smoking cessation is not of in-depth. In future, clinical research project of acupuncture on smoking cessation should be optimized and regulated, including the unified treatment, manipulation standard and curative effect criteria, also long-term researches with large-scale samples should be launched to confirm effect ofacupuncture for smoking cessation to further discuss its action mechanism.

Laboratory study of surface electromyography and electrocardiogram in assessing dynamic workload / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To investigate the use of surface electromyography (sEMG) and electrocardiogram (ECG) in evaluation of dynamic workload.</p><p><b>METHODS</b>Through controlling the speed and gradient, 8 subjects ran on the treadmill power machine to simulate the dynamic work. The sEMG signal of anterior tibial muscle (AT) and gastrocnemius muscle (GC) of right lower limb and ECG signal were recorded. The root mean square value (RMS), median frequency (MF), mean power frequency (MPF), heart rate (HR), standard deviation of all normal to normal intervals (SDNN) and Borg scores were analyzed.</p><p><b>RESULTS</b>In the five sports, with the speed increasing, all the values of RMS increased in the AT and GC (P < 0.01). With the gradient increasing, the values of RMS increased in the GC (P < 0.01) while the values of RMS of AT had a trend of decrease (P > 0.05). In all five sports, both the values of MF and MPF in AT and GC were lowest in B sports. Compared to A sport, most of the values of MF and MPF increased in C, D, E sports (P < 0.01), with a highest value in the D sport. Compared with A sport, the HR of B, C, D, E sports significantly increased (P < 0.01), and the highest heart rate was found in B sport, however, the values of SDNN significantly decreased. With the increased speed and gradient, the scores of Borg scale significantly increased.</p><p><b>CONCLUSION</b>In the evaluation of dynamic workload, RMS and HR appear to be good indexes. However, in terms of stress reaction to dynamic workload, MF and MPF are more sensitive.</p>

Role of dissection of secondary branches of splenic pedicle in portal hypertension cases undergoing splenectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It is well known that conventional splenectomy, which requires careful handling and ligation of tissue of the splenic hilum, can easily cause complications such as splenic fever and pancreatic fistula. Here, we use the technique of dissection of the secondary branches of the splenic pedicle to handle the hilum in the portal hypertension patients who are subjected to splenectomy.</p><p><b>METHODS</b>We retrospectively compared and analyzed the complications, postoperative hospital stay, operative time, and occurrence of hemorrhage in 121 patients with portal hypertension undergoing splenectomy and devascularization of the gastric cardia from January 1999 to December 2007. The selected cases consisted of 51 patients undergoing conventional splenectomy and 70 patients undergoing dissection of secondary branches of the splenic pedicle. In addition, we analyzed the relationship between size of the spleen and occurrence of complications.</p><p><b>RESULTS</b>The incidence of pancreatic fistula and splenic fever (0/70 and 9/70) was lower in patients undergoing dissection of secondary branches of the splenic pedicle as compared with that of the conventional group (5/51 and 18/51 respectively). In addition, there was no significant difference in operative time and volume of blood loss between two groups. The spleen thickness of those patients who had pancreatic fistula and splenic fever was significantly greater than those without complications.</p><p><b>CONCLUSIONS</b>These results indicate that dissection of secondary branches of the splenic pedicle in portal hypertension patients undergoing splenectomy can decrease the incidence of splenic fever and pancreatic fistula, and shorten the postoperative hospital stay, especially in the patients with a large spleen. So dissection of secondary branches of the splenic pedicle is a valuable technique for splenectomy.</p>

Congenital choledochal cysts in adults: twenty-five-year experience / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Choledochal cyst is rare in western countries. The relatively high incidence of coexistent hepatobiliary disease increases the difficulty of the surgical management of choledochal cyst. Here we analyze the diagnosis and treatment of congenital bile duct cyst in 122 Chinese adults.</p><p><b>METHODS</b>The clinical data of 122 patients with congenital choledochal cysts admitted from 1981 to 2006 were analyzed.</p><p><b>RESULTS</b>Clinical symptoms in most cases were nonspecific, resulting in delayed diagnosis. Sixty-one patients (50%) had coexistent pancreatobiliary disease. Among the 122 patients, 119 patients underwent ultrasonic examination; ERCP/MRCP was performed in 63 cases and CT in 102 cases. Abnormal pancreatobiliary duct junction was found in 48 patients. Sixteen patients had malignant lesions in the bile duct, arising in 11 of them from incomplete choledochal cyst that underwent various operations including cystenterostomy or cystojejunostomy. There was significant difference between the patients who underwent incomplete cyst resection and complete cyst resection in malignancy rate of bile duct (Chi square test, P = 0.000; odds ratio, 7.800; 95% confidence interval, 2.450 to 24.836).</p><p><b>CONCLUSIONS</b>ERCP, CT and MRCP had proved their great values in the classification of the disease. Cyst excision with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice for patients with type I or type IV cysts. For type V cyst (Caroli's disease) with recurrent cholangitis, liver transplantation should be considered.</p>

Comparison of wound healing after pancreaticojejunostomy with three anastomotic methods in piglets / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate wound healing after pancreaticojejunostomy of three anastomotic methods.</p><p><b>METHODS</b>Fifty-four domestic piglets were divided into three groups according to the types of anastomoses: group of end-to-end pancreaticojejunal invagination (EE group), group of binding pancreaticojejunostomy (BP group) and group of inkwell pancreaticojejunostomy (IP group). Bursting pressure, breaking strength and histopathological findings of anastomosis were assessed on operative day and on the 5th and 10th day after operation.</p><p><b>RESULTS</b>Bursting pressure was (67+/-8) mm Hg, (96+/-11) mm Hg and (131+/-9) mm Hg in EE group on day 0, 5 and 10; and (140+/-8) mm Hg, (179+/-10) mm Hg and (269+/-13) mm Hg in BP group; and (102+/-10) mm Hg, (171+/-18) mm Hg and (254+/-24) mm Hg in IP group. Compare to EE group, bursting pressure of BP group and IP group were all increased with significant differences (P<0.05). Another significant difference was observed between BP group and IP group after anastomoses on operative day. Breaking strength was (4.6+/-0.6) N, (5.8+/-0.5) N and (7.1+/-0.6) N in EE group on 0 d, 5 d and 10 d; and (4.5+/-0.4) N, (6.6+/-0.4) N and (10.0+/-0.6) N in BP group; and (4.6+/-0.3) N, (6.5+/-0.4) N and (9.1+/-0.9) N in IP group. A similar value of anastomoses was shown in BP group and IP group on day 0, day 5 and day 10, but significant increase was demonstrated compared to EE group on day 5 and 10. Anastomotic site was well repaired by connective tissue and the cut surface of pancreatic stump was covered by mucosal epithelium in BP group and IP group on day 10, but the cut surface was incompletely repaired by granulation tissue and no regeneration of the epithelium was found in EE group.</p><p><b>CONCLUSIONS</b>Wound healing of binding pancreaticojejunostomy and inkwell pancreaticojejunostomy is more rapid and better than end-to-end pancreaticojejunal invagination, but breaking strength of inkwell pancreaticojejunostomy is weaker than binding pancreaticojejunostomy.</p>

Comparison of base substitutions in response to nitrogen ion implantation and 60Co-gamma ray irradiation in Escherichia coli

To identify the specificity of base substitutions, a novel experimental system was established based on rifampicin-resistant (Rif r) mutant screening and sequencing of the defined region of the rpoB gene in E. coli. We focused on comparing mutational spectra of base substitutions induced by either low energy nitrogen ion beam implantation or 60Co-gamma rays. The most significant difference in the frequency of specific kinds of mutations induced by low energy nitrogen ion beam was that CG -> TA transitions were significantly increased from 32 to 46, AT -> TA transversions were doubled from 7 to 15 in 50 mutants, respectively. The preferential base substitutions induced by nitrogen ion beam implantation were CG -> TA transitions, AT -> GC transitions, AT -> TA transversions, which account for 92.13 percent (82/89) of the total. The mutations induced by 60Co-gamma rays were preferentially GC -> AT and AT -> GC transitions, which totaled 84.31 percent (43/51).