A single-team experience with robotic pancreatic surgery in 1010 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the safety and advantages of robotic pancreatic surgery (RPS) based on the single-team experience with 1010 cases.</p><p><b>METHODS</b>The clinical data of 1010 cases of RPS performed by a single team from November, 2011 to September, 2017 in our hospital were collected prospectively and analyzed. In most of cases the surgeries were performed using the third-generation da Vinci robotic surgical system.</p><p><b>RESULTS</b>The 1010 cases receiving RPS included 417 cases of robotic pancreatoduodenectomy (RPD), 428 cases of robotic distal pancreatectomy, 60 cases of robotic central pancreatectomy, 53 cases of robotic pancreatic tumor enucleation, 3 cases of Appleby procedure, and 49 cases of other operations (including 4 cases of innovative robotic retroperitoneal laparoscopic surgery, 4 cases of robotic pancreatic tumor enucleation combined with main pancreatic duct bridging repair, 1 case of single incision robotic pancreatic tumor enucleation, and 2 cases of robotic central pancreatectomy combined with end-to-end anastomosis reconstruction). The median operative time was 210 min (30-720 min) with a median intraoperative blood loss of 80 mL (10-2000 mL), a conversion rate of 4.06% (41/1010), a blood transfusion rate of 6.7% (68/1010), a mean post-operative stay of 10.87∓6.70 days, a complication rate (beyond grade III according to Clavien-Dindo scoring system) of 8.0% (81/1010), and a pancreatic fistula rate (beyond) grade B of 9.21% (93/1010). The mortality rate of the patients was 0.69% (7/1010) in 30 days and 1.31% (12//934) in 90 days. The application of RPS in total pancreatectomy increased steadily from the rate of 10.44% in 2012 to 72.06% in 2017.</p><p><b>CONCLUSION</b>This represents to our knowledge the world largest series of robotic pancreatic resections. RPS is expected to gradually replace open procedure and laparoscopic procedure to become the primary choice of approach for pancreatectomy. After the learning curve, RPS procedure including distal pancreatectomy, robotic Appleby procedure and other operations can be safely performed, and the experiences from other centers can be beneficial to reduce severe complications in the early stage of learning.</p>

Monoclonal antibody OX26-modified ginsenoside Rg1 nano drug delivery system for promoting angiogenesis and neurogenesis after cerebral infarction / 医学研究生学报

Objective Blood-brain barrier(BBB)may stop over 95%of the drugs delivered from entering the brain.This study aimed to establish a BBB model in vitro,detect the ability of the nano drug delivery system to penetrate the BBB,and observe its effect on angiogenesis and neuron cell proliferation after cerebral infarction. Methods A BBB model was established in vitro and the penetrability of PHRO through the BBB was detected by transwell assay.PBS,Rg1,and PHRO were placed in the upper chamber,and the content of Rg1 in the lower chamber was measured by HPLC.The effect of PHRO on angiogenesis was assessed with the in vitro tube formation model and the expression levels of the angiogenesis -related genes VEGFA and Dll4 determined by real time fluorescence quantitative PCR.Brain endothelial cells were incubated with 10 μL PBS(the control group),10 μmol/L Rg1(the Rg1 group),and PHRO(containing 10 μmol/L Rg1,the PHRO group)for 24 hours,and the SH5Y cells incubated the same way in the three groups for 72 hours.The effects of PHRO on the proliferation and apoptosis of the SH5Y cells were detected by MTT assay and flow cytometry respectively.The SH5Y cells were treated with 10 μL PBS(the PBS con-trol group),1 mmol/L Na2S2O4(the hypoxia-induction group),1 mmol/L Na2S2O4plus 10 μmol/L Rg1(the hypoxia-induction +Rg1 group),and 1 mmol/LNa2S2O4plus PHRO(including10 μmol/L Rg1,the hypoxia-induction +PHRO group), respectively. Results The content of Rg1 was 3.18%in the Rg1 group,28.8%in the PHRO group,and 0 in the control group.The angiogenesis of endothelial cells was markedly increased in the Rg 1 group as compared with the control(P<0.05), and even more significantly in the PHRO than in the Rg1 group(P<0.05).In comparison with the control group,the expressions of VEGFA and Dll 4 and the prolif-eration of the SH5Y cells were remarkably elevated in the Rg 1 group(P<0.05)and even more significantly in the PHRO than in the Rg1 group(P<0.05).The apoptosis rate of neurons was the lowest in PBS control(1.2%)and the highest in the hypoxia-induction group(21.6%),decreased to 13.14%and 8.25%in the hypoxia-induction +Rg1 and hypoxia-induction +PHRO group,respectively. Conclusion PHRO nanomedicine could penetrate the blood-brain barrier in vitro, promote angiogenesis and neuronal proliferation, reduce the apoptosis of neurons under hypoxia,and up-regulate the expressions of angiogenesis-related genes.

Technical points of total laparoscopic choledochal cyst excision / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Choledochal cyst excision and biliary enteric reconstruction constitute the best therapy for choledochal cyst. And laparoscopy is currently used to cure this disease now.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 34 cases of total laparoscopic choledochal cyst excision between January 2007 and August 2011. All patients underwent in vitro Roux-en-Y hepatoenterostomy.</p><p><b>RESULTS</b>All 34 patients underwent successful total laparoscopic choledochal cyst excision. The operation time was 200 - 360 minutes. The duration of hospital stay was 3 - 7 days. Follow-up observations lasted 1 - 56 months. One patient developed an anastomotic stoma stricture, but no other cases had postoperative complications. No patients died.</p><p><b>CONCLUSION</b>Total laparoscopic choledochal cyst excision is safe and feasible.</p>

Follicular fluid levels of prostaglandin E2 and the effect of prostaglandin E2 on steroidogenesis in granulosa-lutein cells in women with moderate and severe endometriosis undergoing in vitro fertilization and embryo transfer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The mechanisms of endometriosis with infertility have not been fully studied. The present study aimed to assess the follicular fluid (FF) levels of prostaglandin E2 (PGE2), which plays a critical role within the ovary, and to investigate the effect of PGE2 on steroidogenesis in granulosa-lutein cells (GLCs) from women with and without endometriosis.</p><p><b>METHODS</b>Thirty-three women with laparoscopically documented endometriosis and 40 controls undergoing in vitro fertilization (IVF) were studied. We assayed the concentrations of PGE2 in FF, the production of E2 and progesterone in FF and in culture medium, and the expression of steroidogenic acute regulatory protein (StAR) and CYP19A1 in GLCs with the intervention of PGE2.</p><p><b>RESULTS</b>PGE2 and progesterone concentrations were increased and displayed positive correlation in endometriotic FF. PGE2 induced the expression of StAR and the production of progesterone in GLCs from women with endometriosis, and the expression of StAR and the production of progesterone were increased in GLCs from women with endometriosis. However, there were no significant effects of PGE2 on promoting the production of E2 or the expression of CYP19A1 in GLCs. Moreover, the production of E2 and the expression of CYP19A1 in GLCs from women with endometriosis were significantly decreased compared to the controls.</p><p><b>CONCLUSIONS</b>PGE2 concentrations are increased in endometriotic FF, along with concomitant increases in progesterone and StAR. In contrast, the E2 and CYP19A1 are decreased in GLCs, which may delay the development of the follicles and cause an imbalance in the follicular steroid hormone levels. These changes may have close relationship with endometriosis-associated infertility.</p>

Diagnosis and treatment of fungal infection after liver transplantation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Liver transplantation is the most effective treatment for end-stage liver diseases; however, infections after transplantation can seriously affect the patient's health. The aim of this research was to investigate the diagnosis and treatment of fungal infection following liver transplantation.</p><p><b>METHODS</b>Clinical data for 232 liver transplant patients at risk of fungal infection were examined for the presence of fungus in the blood, fluid, sputum, urine and stools of patients and by chest or abdominal CT scans. Patients diagnosed with a fungal infection were treated with Fluconazole or, if this was not effective, Voriconazole or Amphotericin B. Immunosuppressive therapy was also reviewed.</p><p><b>RESULTS</b>Thirty-seven of 232 (15.9%) patients were diagnosed with a fungal infection, which occurred 4 to 34 days post-transplantation. Candida infections were diagnosed in 23 cases (62.2%) and Aspergillus infections in 12 cases (32.4%). Twenty-one cases were effectively treated with Fluconazole, 11 cases with Voriconazole, and two cases with Amphotericin B; however, three cases were not effectively treated with any of the antifungal agents. Overall, treatment was effective in 91.9% of patients.</p><p><b>CONCLUSIONS</b>Fungal infection has a significant influence on survival rate after liver transplantation. Imaging studies, and pathogenic and biopsy examinations can diagnose fungal infections, which can be effectively treated with antifungal agents such as Fluconazole, Voriconazole or Amphotericin B.</p>

Semen biochemical markers and their significance in the patients with premature ejaculation / 中华男科学杂志

<p><b>OBJECTIVE</b>To detect the changes of biochemical markers in the semen of premature ejaculation patients and investigate the correlation of the markers with premature ejaculation.</p><p><b>METHODS</b>Fifty-six premature ejaculation patients and 60 males with normal sexual behavior were enrolled in this experiment. Acid phosphatase, alpha- glucosidase and fructose were assayed by the methods of glucose oxidase, disodium phenyl phosphate and disodium phenyl phosphate respectively.</p><p><b>RESULTS</b>The contents of acid phosphatase, alpha-glucosidase and fructose were (36.37 +/- 31.33) U/ml, (39.97 +/- 22. 09) U/ml and (3.40 +/- 1.92) mg/ml in the premature ejaculation patients and (54. 27 +/- 20. 96) U/ml, (55.71 +/- 16.19) U/ml and (2.55 +/- 1.12) mg/ml in the normal control, respectively, with significant differences in the former two markers between the two groups. The rate of the abnormal content of both acid phosphatase and alpha- glucosidase was 31% and 13% (P < 0.05) , while that of the normal content of the three markers was 10% and 33% in premature ejaculation group and the control, respectively (P < 0. 05 ).</p><p><b>CONCLUSION</b>The abnormality of both acid phosphatase and alpha-glucosidase is one of the causes of premature ejaculation. Because acid phosphatase and alpha- glucosidase reflect the functions of the prostate and epididymis, we should pay attention to the status of these two organs in the treatment of premature ejaculation.</p>

Retrospective analysis of 47 cases with hilar cholangiocarcinoma using T-staging system / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical value of T-staging system for hilar cholangiocarcinoma which was adopted in memorial Sloan-Kettering cancer center of New York.</p><p><b>METHODS</b>The image data of these 47 patients were analyzed retrospectively from December 1997 to December 2002 whose data were according with our demand, and they were staged into three-stage according to the criteria of the T-staging system. The difference of respectability, ratio of tumor-free resection margin and actuarial survival rate were analyzed for different T-staging. And the coincident ratio of three different kinds of imaging methods was also analyzed.</p><p><b>RESULTS</b>Twenty patients had T(1) tumors, twenty three had T(2) tumors and four had T(3) tumors. The resectability of the three stage was 60%, 39% and 0% respectively, and the difference was significant (P = 0.013). The likelihood of achieving tumor-free margin decreased progressively with increasing T stage (P = 0.018). The cumulative 1-year survival rates of T(1), T(2) and T(3) patients were 60%, 39% and 0% respectively, and the cumulative 3-year survival rate was 35%, 9% and 0% respectively, the survival of different stage patients differed markedly (P = 0.0103). The coincident ratio of combined using MRCP and color Doppler-ultrasonography was higher than that of combined using MRCP and B-ultrasonography or combined using CT/SCT and color Doppler-ultrasonography (P = 0.007).</p><p><b>CONCLUSIONS</b>The T-staging system has a better value for preoperative assessment, and can be used to judge resectability and survival of hilar cholangiocarcinoma. It will be helpful to use MRCP and color Doppler-Ultrasonography combined to verdict the coverage of the tumor and the T-staging preoperatively.</p>

Study on the interface of human hepatocyte L-02 polypropylene:simple culture method of human hepatocyte with spheroidal aggregate culture / 中华外科杂志

<p><b>OBJECTIVE</b>To found new interface of human hepatocyte/poly propylene with good cytocompatibility for made polypropylene hollow fibers bioreactor of bioartificial liver in future.</p><p><b>METHODS</b>Using the macromolecular hydroperoxide groups on the polypropylene membrane surface as initiators, acrylamides were polymerized on the polypropylene membranes, under induction by both UV irradiation and Fe2+ reduction. Growth characteristics of human hepatocyte L-02 were detected when it was cultured on polystyrene, polypropylene and modified polypropylene membrane surface.</p><p><b>RESULTS</b>Water contact angle measurement of the polypropylene and the modified polypropylene membranes decreased from (72 +/- 5) degrees to (30 +/- 4) degrees , which indicated that the hydrophilicity of the membrane was improved obviously after the grafting modification. Human hepatocyte L-02 could not adhere and spread on modified polypropylene membrane surface, and grown in spheroidal aggregate with higher density and higher proliferation ratio measured by MTT method.</p><p><b>CONCLUSIONS</b>Acrylamide polymerized on the polypropylene membranes is a good method which not only improved human hepatocytes cytocompatibility but also found a new simple culture method with spheroidal aggregate culture of human hepatocyte.</p>