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Objective There have been many techniques proposed for the reconstruction of pancreatic digestive continuity to prevent fistula (PF) formation, but this is still highly debated. We carried out a systematic review and meta- analysis to determine the effectiveness of methods of anastomosis after pancreaticoduodenectomy (PD). Methods A full literature search was conducted in the Cochrane Controlled Trials Register Databases, Medline, et al.Randomized controlled trials(RCTs) were considered for inclusion. Analysis was carried out using Revman software. Results In all, 10 RCTs including a total of 1 408 patients were included, the pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) groups, duct to mucosa PJ and PJ, binding PJ and PJ, pancreatic duct without anastomosis PJ and PJ. The meta-analysis showed that the PF, postoperative complications, biliary fistula, mortality, re-operation and hospital stay were not statistically different among four methods(P>0.05).Conclusions No ideal technique of pancreatic reconstruction after PD is found to be applicable to all kinds of pancreatic remnants in this systematic review and meta-analysis.
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Objective To explore central lymph node metastasis (CLNM) of cN0 papillary thyroid carcinoma(PTC).Methods We evaluate the clinical data of 245 patients with cN0 unilateral TPC undergoing total thyroidectomy and bilateral central lymph node dissection.Results Central lymph node metastasis of cN0 TPC was 36.8％ (91/245),significantly related to gender(x2 =5.626,P =0.018),age (x2 =6.255,P =0.012),tumor size (x2 =20.063,P ＜ 0.001) and capsule invasion (x2 =15.024,P ＜ 0.001).The central lymph node metastasis was 51.7％ (60/116) in 116 patients with tumor size ＞ 1 cm,and the contralateral CLNM was 22.4％ (26/116) which was related to capsule invasion (x2 =9.737,P =0.002) and delphian LNM(x2 =10.982,P =0.001) There were 6 cases (2.4％) suffering from temporary unilateral recurrent laryngeal nerve injury.96 cases (39.2％) suffered from temporary hypoparathyroidism and 3 cases (1.2％) from permanent hypoparathyroidism.The median follow-up time was 40 months.6 cases were found regional lymph node recurrence on the ipsilateral side.Tumor size ＞ 1 cm was significantly related with recurrence (P =0.008),as CLNM with higher recurrence rate (P =0.001).Conclusions CLNM is common in cN0 PTC patients,and central lymph node metastases increase the risk of recurrence.Prophylactic bilateral central lymph node dissection is suggested for tumor size ＞ 1 cm cases.
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Objective To study the clinical significance of recognizing Zuckerkandl tubercle (ZT) during thyroid surgery. Methods One hundred and sixty-one patients (218 sides) having underwent thyroid lobectomy or thyroidectomy were retrospectively analyzed. The presence of ZT, the position and size of ZT, and the relationship between ZT and recurrent laryngeal nerve (RLN), superior parathyroid (SP) were observed. Results In 218 sides, 179 sides (82.1%) found ZT, with right side in 93 cases and left side in 86 cases. The main relationship between ZT and RLN was A type, accounting for 90.5%(162/179). There were no statistical differences in ZT grade and the relationship type between ZT and RLN between left side and right side (P>0.05). There was negative correlation in ZT grade and the relationship type between ZT and RLN (r=-0.269, P<0.01). In right side, 92.3%(72/78) of SP located on the top of ZT at 10-11 o′clock position;in left side, 94.6%(70/74) of SP located on the top of ZT at 1-2 o′clock position. Conclusions ZT is an important anatomical mark in the thyroid surgery, which helps to identify and protect the RLN and SP, so as to reduce surgical complications.
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Objective To explore the effects of silencing DDR2 expression by siRNA on CCl4-induced liver fibrosis and its mechanism in rats. Methods Liver fibrosis model was induced by intraperitoneal injection of CCl4 twice a week for 6 consecutive weeks. Some rats were administered siRNA targeting DDR2 (0. 3 mg/kg), saline or control siRNA every three days from the beginning of CCl4 injection via tail vein injection, while other rats were treated in the same pattern after 2-week CCl4 injection. Quantitative real-time polymerase chain reaction (QRT-PCR) and Western blot were used to detect the mRNA and protein expressions of DDR2, MMP-2 and COL Ⅰ . Meanwhile, the pathological changes of liver tissues and the levels of liver function were also observed. Results QRT-PCR showed that the DDR2, MMP-2 and COL Ⅰ mRNA in the chemically synthetic cholesterol-modified siRNADDR2 group were significantly decreased as compared with those in the control group (P＜0.01) ,and the protein expressions of DDR2, MMP-2 and COL Ⅰ were also significantly decreased (P＜0. 01,4 wand 6w). In addition, in comparison with those in the control group, the pathological changes of liver tissues in the siRNA-DDR2 treated group were markedly attenuated, and the levels of ALT(1356.17 ±83.80 nkat/L vs 2532. 70±145.11 nkat/L,4w,1367. 60±321.76 nkat/L vs 2604.37±255.02 nkat/L,6w,P＜0. 01 ) and AST (2460. 80 ± 207. 58 nkat/L vs 3983. 70 ± 253. 08 nkat/L, 4w, P＜ 0. 01,2383.27±290.16 nkat/L vs 3227.70±353. 34 nkat/L,6w,P＜0. 05)were also significantly lowered,while the level of TBIL (7. 97 ± 1.60 μmol/L vs 3.80± 0.60 μmol/L, 4w, 10.40±1.61 μmol/L vs 6.10±0.79 μmol/L,6w,P＜0. 01)was markedly increased. Conclusion Systemic administration of cholesterol-modified siRNA targeting DDR2 could significantly suppress the expression of DDR2, decrease the contents of the extracellular matrix,and thus has a potential antifibrotic effect.
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Hepatic fibrosis is a wound-healing re-sponse to all kinds of chronic liver injury, which if persistent can lead to cirrhosis. Once develops to cirrhosis, the only ef-fective therapy will be liver transplantation. In recent years,many scholars have taken all kinds of methods to try to pre-vent liver fibrosis developing to cirrhosis. As auto adult stem cell possesses multi-directional differentiation and none reject reaction advantages, it has become the study hotspot of nu-merous researches for hepatic fibrosis therapy and acquired significant progression.
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Objective To explore the effects of inhibiting DDR2 expression by siRNA on hepatic stellate cells and evaluate the role of DDR2 gene in hepatic fibrogenesis. Methods (1) Three pairs of chemically synthesized siRNAs targeting DDR2 were respectively transfected into HSC-T6 cells for evaluation of silence efficacy, and the most effective siRNA was used. (2) HSC-T6 cells were divided into three groups, group A served as normal controls, group B served as negative control and group C was RNA interference DDR2 (siRNA-DDR2) expression of HSC. The most effective RNA interference sequences targeting DDR2 gene was chosen to transfect HSC-T6 cells by plasmid transfection. The tendency of DDR2, α-smooth muscle actin(α-SMA) and collagen-Ⅰ mRNA expression were estimated using RT-PCR, and the protein expression of DDR2 was evaluated by Western blot. Meanwhile, MTT assay was employed to analyze the proliferation of HSC. Results (1) DDR2 siRNA, which began at nt 868, inhibited DDR2 gone expression stronger than the other two siRNAs. (2) After transfection of siRNA-DDR2, the mRNA expression of DDR2 (P<0.01) and α-SMA (P<0.01) significantly decreased compared with the normal group, and the protein expression of DDR2 also significantly decreased (P<0.01). In addition, the proliferation of HSC was also markedly suppressed as compared with the normal group (P<0.01). However, compared with the negative control group, none of them was markedly suppressed. Conclusion SiRNA targeting DDR2 significantly suppresses the activation, proliferation of HSC, and thus attenuates hepatic fibrogonesis in vitro.