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【Objective】 To evaluate the underreporting of death cases and related factors in disease surveillance system of Xi’an. 【Methods】 Multi-stage cluster random sampling was used, and 733 villages (neighborhood committees) were selected from 44 townships or streets in Xi’an. All the death cases of the residents in the sampled areas from 2018 to 2020 were collected through a variety of channels and checked with those registered in the Disease Surveillance System. Then the missing cases were investigated and verified. The underreporting rate was calculated, the Excel software was applied for statistical processing and Chi square analysis, and the related factors of underreporting were analyzed by using Logistic regression method. 【Results】 A total of 37650 death cases were investigated from 2018 to 2020; the average mortality was 650.59/105, and 2 901 cases were underreported. From 2018 to 2020, the underreporting rate was 9.89%, 6.95%, and 6.24%, respectively (χ2=133.525, P<0.001), with the average underreporting rate of 7.71%. The underreporting rate in the 44 sampled areas ranged from 0.90% to 42.07%. Multivariate Logistic regression analysis showed that compared with that in rural areas (9.87%), the underreporting rate was lower in urban areas (5.91%, OR=0.567, 95% CI:0.525-0.613), and higher in children under 5 years old (31.20%, OR=5.494, 95% CI:3.732-8.090) and people aged 15-44 years old (11.85%, OR=1.541, 95% CI:1.284-1.846) compared to people over 65 years old (7.44%), and higher in 2018 (9.89%, OR=1.702, 95% CI:1.551-1.869) and 2019 (6.95%, OR=1.148, 95% CI:1.038-1.271) compared to the year 2020 (6.24%). There were 2901 cases reported missing, and the proportion of those who died at home was the highest (81.39%). Underreporting of death more easily occurred in heart diseases (36.80%) and cerebrovascular diseases (27.08%) than others. 【Conclusion】 The reporting completeness of disease surveillance system increased in Xi’an. The overall underreporting rate of death causes decreased with year from 2018 to 2020. The underreporting rates in age group under 5 years old and in rural population were still high. Therefore, the reporting and management of death information should still be strengthened to minimize the underreporting rate.
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Objective:To explore the clinical efficacy and safety of different surgical procedures of Mayo level Ⅳ inferior vena cava tumor thrombus(IVC-TT).Methods:The clinical and pathological data of 36 patients with Mayo level Ⅳ tumor thrombus were collected in three large clinical centers in China, including 18 cases in PLA General Hospital, 7 cases in Nanfang Hospital, and 11 cases in Renji Hospital. There were 25 males and 11 females.The median age was 56.5 years (53-67 years old). The average body mass index was 24.18±2.55 kg/m 2. The average diameter of renal tumors was 8.24±3.25 cm. The average length of inferior vena cava tumor thrombus was 12.89±2.50 cm. Mayo level Ⅳ tumor thrombus were divided into level Ⅳa and level Ⅳb (301 classification) based on the criterion of whether the proximal end of the thrombus has invaded the right atrium. Among them, level Ⅳa patients underwent robot-assisted inferior vena cava thrombectomy without cardiopulmonary bypass(CPB-free group, 6 cases). Level Ⅳb patients underwent robot-assisted inferior vena cava thrombectomy with cardiopulmonary bypass(CPB group, 12 cases) or cardiopulmonary bypass with deep hypothermic circulatory arrest assisted inferior vena cava thrombectomy(CPB/DHCA group, 18 cases). The baseline data of the three groups of patients were comparable. The perioperative results and long-term survival data after surgery were compared with different surgical methods for grade Ⅳcancer thrombosis. Results:All operations were successfully completed. Compared with the CPB group, the CPB-free group had a shorter first portal blocking time[17.5(15-36)min vs. 36.5(12-102)min, P=0.044], less intraoperative bleeding [2 350(1 000-3 000)ml vs. 3 500 (1 500-12 000)ml, P=0.043] and a lower allogeneic blood transfusion [1 250(500-2 000)ml vs. 2 185(700-5 800)ml, P=0.049]. Compared with the CPB/DHCA group, the CPB-free group had an advantage in reducing intraoperative allogeneic blood transfusion [1 250(500-2 000)ml vs. 2 700(1 200-10 000)ml, P=0.003]. There were no significant differences between groups in terms of duration of surgery and postoperative hospital stay. Among the 36 patients in this group, 23(64%) developed major complications (level Ⅲ or above), including 9 (25%) grade Ⅲ, 12 (33%) grade Ⅳ, and 2 (6%) grade Ⅴ. The CPB-free group had a relatively low complication rate of grade Ⅳ or above [ 17% (1/6) vs.42% (5/12) vs.44% (8/18)]. There were no statistical differences in median progression-free survival (16.4 vs.12.3 vs.18.0 months, P=0.695) and overall survival (30.1 vs.30.2 vs.37.7 months, P=0.674) between the groups. Conclusions:Robot-assisted inferior vena cava thrombectomy without cardiopulmonary bypass has the advantages of short ischemia time of organs, less intraoperative bleeding, and low incidence of major complications, which can be used as a safe and feasible surgical strategy for selected level Ⅳ tumor thrombus.
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Traumatic spinal cord injury (SCI) has devastating effects on patients′ physical and mental health. Autophagy is widely involved in various physiological and pathological processes of the body and plays a key role in spinal cord injury. The mammalian target of rapamycin (mTOR) is the main regulator of autophagy. mTOR regulation of autophagy is closely related to the pathological process of spinal cord injury, and can effectively promote the recovery of spinal cord injury. Therefore, mTOR is a promising target for treatment of spinal cord injury. This article reviews the role of mTOR signal transduction pathway in the regulation of autophagy in spinal cord injury, in order to provide reference for follow-up research.
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Objective To investigate the effect of micro-ribonucleic acid-21(miR-21) on the malignant biological behavior of human cholangiocarcinoma cell line QBC939 by targeting the protein tyrosine phosphatase (PTEN)/inositol phosphate 3-kinase (PI3K)/protein kinase B (Akt) pathway. Methods The cholangiocarcinoma cell line QBC939 in the logarithmic growth phase was divided into empty vector group, blank control group, overexpression group, and silencing group.An inverted fluorescence microscope was used to observe transfection efficiency; MTT assay, flow cytometry, Transwell assay, and wound healing assay were used to measure cell proliferative activity, apoptosis rate, invasion activity, and migration activity.Quantitative reverse transcription PCR was used to measure the mRNA expression levels of miR-21, PTEN, PI3K, Akt, and mammalian target of rapamycin (mTOR); Western blotting was used to measure the protein expression levels of PTEN, PI3K, Akt, phosphorylated Akt (p-Akt), and mTOR; dual-luciferase reporter assay was used to verify the effect of miR-21 on PTEN.A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the SNK- q test was used for further comparison between two groups. Results Transfection efficiency was 90.27%±18.03% in the overexpression group, 91.43%±18.26% in the silencing group, and 92.16%±18.41% in the empty vector group.Compared with the blank control group and the empty vector group, the overexpression group had a significant increase in the proliferative activity of QBC939 cells (both P < 0.05) and a significant reduction in apoptosis rate (both P < 0.01);compared with the blank control group, the empty vector group, and the overexpression group, the silencing group had a significant reduction in proliferative activity ( P < 0.01) and a significant increase in apoptosis rate ( P < 0.01).Compared with the blank control group and the empty vector group, the overexpression group had significant increases in the migration rate of QBC939 cells and number of cells penetrating the membrane (all P < 0.01);compared with the blank control group, the empty vector group, and the overexpression group, the silencing group had significant reductions in migration rate and number of cells penetrating the membrane (all P < 0.01).Compared with the blank control group and the empty vector group, the overexpression group had significant increases in the mRNA expression levels of miR-21, PI3K, Akt, and mTOR and a significant reduction in the mRNA expression level of PTEN (all P < 0.05);compared with the blank control group, the empty vector group, and the overexpression group, the silencing group had significant reductions in the mRNA expression levels of miR-21, PI3K, Akt, and mTOR and a significant increase in the mRNA expression level of PTEN (all P < 0.05).Compared with the blank control group and the empty vector group, the overexpression group had significant increases in the protein expression levels of PI3K, Akt, p-Akt, and mTOR and a significant reduction in the protein expression level of PTEN (all P < 0.01);compared with the blank control group, the empty vector group, and the overexpression group, the silencing group had significant reductions in the protein expression levels of PI3K, Akt, p-Akt, and mTOR and a significant increase in the protein expression level of PTEN (all P < 0.01).Furthermore, miR-21 showed targeted regulation of PTEN expression. Conclusion MiR-21 silencing may inhibit the malignant biological behavior of human cholangiocarcinoma cell line QBC939 by targeting the PTEN/PI3K/Akt signaling pathway to upregulate the expression of PTEN and downregulate the expression of PI3K, Akt, mTOR, and p-Akt.
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Objective:To observe the clinical effect of Traditional Chinese Medicine (TCM) collapsibility combined with pressure therapy in the treatment of eczema.Methods:From January 2021 to August 2021, 60 patients with lower extremity venous ulcers who were treated in Wangjing Hospital, China Academy of Chinese Medical Sciences were selected and randomly divided into the control group (30 patients) and observation group (30 patients). The control group was treated by the routine pressure therapy, and the observation group was by the TCM nursing intervention on the basis of the control group. Both groups were treated for 2 weeks. The visual analogy scale (VAS),chronic Venous Insufficiency Questionnaire (CIVIQ), Self-rating Anxiety Acale (SAS), and Self-rating Depression Scale (SDS) were measured and evaluated at baseline and after treatment.Results:The total response rate was 100.0% (30/30) in the observation group and 86.7% (26/30) in the control group, and the difference was statistically significant ( χ2=4.29, P=0.038). The VAS (2.47±0.68 vs. 2.97±0.14, t=3.95), SAS (40.31±11.93 vs. 55.87±4.53, t=4.73), SDS (44.30±5.38 vs. 47.61±5.33, t=2.39) scores were significantly lower than those in the control group ( P<0.05), CIVIQ score (86.63±2.74 vs. 84.67±3.23, t=2.54) was significantly higher than that of the control group ( P<0.05). Conclusion:TCM combined with pressure therapy can promote the healing of ulcers in patients with eczema, relieve pain, and improve the quality of life of patients.
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Objective:To clarify the anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava during laparoscopic surgery.Methods:In December 2018, two frozen and two fresh adult cadavers were dissected. The chest of the frozen cadavers was opened along the bilateral midline of the clavicle, the anterior pericardial wall was opened, and the superior vena cava and the inferior vena cava was dissected. The abdominal cavity was opened along the midline of the abdomen, the left and right hepatic lobes were turned over, the inferior vena cava and the second hilum of the posterior segment of the liver were exposed, and the hiatus of the inferior vena cava was opened and entered the pericardium.The anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava were observed, and the length of the superior segment of the inferior vena cava was measured. The fresh frozen cadaver patients underwent laparoscopic surgery.Five 12 mm trocars were placed at the side of umbilicus, right rectus abdominis about 4 cm from umbilicus, midline of abdomen about 6 cm above umbilicus, right axillary front about 2 cm below inferior edge of liver, left midline of clavicle about 2 cm below inferior edge of liver. Laparoscopic-assisted turning of the left and right hepatic lobes, exposing the posterior inferior vena cava and the second hilum of the liver, opening of the vena cava hiatus into the pericardium.The anatomical characteristics and adjacent relationship of the upper diaphragmatic segment of the inferior vena cava were observed.Results:In two autopsies, the inferior vena cava entered the chest through the cava sulcus of the liver and the phrenic foramen cava, and then through the fibrous pericardium into the right atrium. The length from the diaphragm of inferior vena cava to the right atrium was 1.67 cm, 2.57 cm. In laparoscopic operation, the diaphragm entrance of the posterior segment of the liver inferior vena cava, the second hepatic portal and the inferior vena cava could be well exposed.The diaphragm could be opened along the hole of the vena cava with a relatively non vascular anatomical layer of adipose tissue.There was a large anatomical gap between the pericardium and the right atrium, and the inferior vena cava, the superior vena cava and the right atrium could be well exposed, and the whole diaphragm could be completely and continuously exposed from the bottom to the inferior vena cava at the entrance segment of the right atrium.Conclusions:There was a relatively avascular anatomical layer beside the inferior vena cava. During laparoscopic operation, opening the diaphragm through the abdominal cavity could safely enter the pericardium and expose the inferior vena cava, the superior vena cava and the right atrium, which provides a possibility for the removal of Mayo Ⅳ grade inferior vena cava tumor thrombus through this approach.
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Objective:To compare the difference between the combined diagnostic effect of plasma Septin9(SEPT9) and polyligand Syndecan-2(SDC2) methylation with four serum tumor markers in the diagnosis of colorectal cancer.Methods:In this study, 128 patients who were treated in the affiliated Hospital of Xuzhou Medical University from March to December in 2019 were selected for a case-control study.All the subjects were examined by gastroenteroscopy.According to the pathological results, they were divided into three groups: colorectal cancer group( n=74) and colorectal adenoma group( n=7). The patients with no abnormal or inflammatory polyps or proliferative polyps examined by gastroenteroscopy were taken as the control group( n=47). The methylation levels of SEPT9 gene and SDC2 gene were detected by Roche Lightcycler 480 II real-time fluorescence quantitative polymerase chain reaction, and the concentrations of alpha-fetoprotein, carcinoembryonic antigen, carbohydrate antigen 125 and carbohydrate antigen 199 were detected by Roche Cobas 8000 electrochemiluminescence instrument.Chi-square test was used to compare the positive rate of each marker in the three groups.Medcalc was used to draw the receiver operating characteristic curve (ROC) curve of the subjects′ working characteristic curve, and the value of each index in the diagnosis of colorectal cancer was analyzed. Results:The positive rates of SEPT9 gene and SDC2 gene methylation were 81.1%(60/74) and 67.6%(50/74) respectively in colorectal cancer group, and increased to 85.1%(63/74) after combined detection.The positive detection rates of alpha-fetoprotein, carcinoembryonic antigen, carbohydrate antigen 125 and carbohydrate antigen 199 in colorectal cancer group were 1.4%(1/74), 33.8%(25/74), 6.8%(5/74) and 13.5%(10/74), respectively.When the four tumor markers were detected together, the positive detection rates were only increased to 43.2%(32/74), except for AFP and carbohydrate antigen 125(χ 2=3.847, 2.430, all P>0.05). The differences were statistically significant (χ 2=48.230, 30.487, 43.285, 3.847, 8.788, 6.988, 8.722, all P<0.05). The area under the curve (AUC) of SEPT9 methylation, SDC2 methylation, alpha fetoprotein, carcinoembryonic antigen, carbohydrate antigen 125 and carbohydrate antigen 199 were 0.854 (0.781, 0.910), 0.795 (0.715, 0.861), 0.575 (0.485, 0.662), 0.685 (0.597, 0.764), 0.603 (0.513, 0.689) and 0.631 (0.541, 0.715), respectively.The AUC of combined detection of two DNA methylation markers was better than that of alpha fetoprotein, carcinoembryonic antigen, carbohydrate antigen 125 and carbohydrate antigen 199, and the differences were statistically significant (alpha fetoprotein: Z=4.990, P<0.001; carcinoembryonic antigen: Z=3.743, P<0.001; carbohydrate antigen 125: Z=4.951, P<0.001; carbohydrate antigen 199: Z=3.983, P<0.001). The combined detection of two kinds of gene methylation was better than the combined detection of four kinds of serum markers in the diagnosis of colorectal cancer, and the difference was statistically significant ( Z=3.334, P<0.001). Conclusion:The combined detection of SEPT9 gene and SDC2 gene methylation in plasma is more suitable for non-invasive diagnosis of colorectal cancer than the combined detection of 4 serum tumor markers.
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Objective:To explore the feasibility and safty of robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy in treatment of Ⅳa grade tumor thrombus without cardiopulmonary bypass and thoracotomy.Methods:The clinical data of 4 patients with renal cell carcinoma and Ⅳa grade tumor thrombus by robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy from January 2013 to June 2019 were retrospectively analyzed. The median age was 53.5 (53-70) years. The average body mass index was 23.25 (20.7-26.3) kg/m 2. The tumors were located on the right side in 2 cases. The average maximum diameter of the tumor was 8.1 (3.6-11.2) cm.Preoperative tumor thrombus of all patients was classified as Ⅳa. The average preoperative length of tumor thrombus in vena cava was 12.3 (11.8-18.0) cm. All the operations were performed under multidisciplinary cooperation of urology, hepatobiliary, cardiovascular, ultrasound and anesthesiologist team. Surgical procedure: Robot assisted liver mobilization was used to expose the inferior vena cava. Under the guidance of intraoperative ultrasound, the central tendon and pericardium of diaphragm were dissected until the inferior vena cava and right atrium in the superior pericardium were exposed. The first porta hepatis and inferior vena cava were blocked in turn.The vena cava thrombectomy and inferior vena cava reconstruction were performed. Results:All the operations were completed without conversion. The median operation time was 553.5 (338-642) minutes, and the median time of the first porta hepatis occlusion was 18.1 (14-32)minutes. The median blood loss was 1 900(1 000-2 600)ml. All patients were transferred to ICU after operation. The median length of stay in ICU was 7(4-8) days, and the median time of indwelling drainage tube was 8(4-12) days. The average postoperative hospital stay was 13(11-20) days. There were 1 case of grade Ⅱ and 3 cases of grade Ⅲ complications (Clavien classification). One case had paroxysmal supraventricular tachycardia, one case had lymphatic fistula, one case had pleural effusion with atelectasis, and one case had hepatic and renal insufficiency and lymphatic fistula. The complications were improved after treatment. There was no perioperative death.Conclusions:Robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy is an alternative method for the treatment of Ⅳa grade inferior vena cava tumor thrombus. Using this method, Ⅳa grade tumor thrombus can be treated without cardiopulmonary bypass and thoracotomy, with controllable complications and zero perioperative mortality.
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Objective:To discuss the surgical efficacy of neuroendoscopic transsphenoidal approach for the removal of pituitary cystic lesion.Methods:Clinical data and efficacy of 32 patients with neuroendoscopic transsphenoidal surgery and pathological diagnosis of pituitary cystic lesion in the Affiliated Hospital of Jining Medical University from March 2013 to May 2019 were retrospectively analyzed.Results:Of the 32 patients, 29 patients were pathologically diagnosed with Rathke cysts and 3 patients with pituitary arachnoid cysts. The content of cyst could be completely removed and the relationship between cyst and sellarseptum and subarachnoid space could be clearly observed by using endoscopy. After followed-up for 0.5-1.0 year, headic, dizziness and visual impairment were improved. One patient relapsed, without serious complications or death.Conclusions:Transsphenoidal neuroendoscopic surgery is a safe and effective treatment for pituitary cystic lesion.
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Non-functioning pituitary adenoma (NFPA), lack of the clinical and biochemical characteristics of hormone overexpression, is a common type of pituitary adenoma. It could bring enormous suffering to the patients on account of the tendentiousness of being invasive macroadenoma and oppressing surrounding tissue. At present, the pathogenesis of NFPA is still unclear, thus there is no effective medical management for the disease. Although transsphenoidal surgery is the first-line treatment for NFPA, it is very difficult to achieve a cure effect. It has been found that the abnormal expression of cyclooxygenase-2 (COX-2) affects the survival and progression of cancer. Recent studies have detected the expression of COX-2 in pituitary tumors, and the expression of COX-2 in NFPA is stronger, suggesting that COX-2 may be involved in the occurrence and development of NFPA. This article reviews the pathogenesis of NFPA and the tumorigenicity of COX-2, and provides new ideas for clinical drug treatment of NFPA.
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Objective To observe the clinical effect of "palace bone-setting" Dieda-Wanying cream combined with Yuan Shu Zhi Pai Zi fixation in the treatment of acute ankle sprain.Methods A total of 60 patients with acute ankle sprain were collected and randomly divided into observation group and control group according to the random number table method,with 30 cases in each group.The observation group was treated with "Palace Bone-setting" Dieda-Wanying cream combined with Yuan Shu Zhi Pai Zi for fixation.The control group was treated with external application of diclofenac diethylamine emulsion and fixation of elastic bandage.Two groups were treated for 14 days.The patients pain disappeared time and the swelling subsided,the VAS scale for assessment of ankle pain observed.The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-after scoring system was used to assess the Ankle function,evaluation of clinical curative effect.Results The pain disappear time (9.7 ± 1.6 d vs.13.4 ± 3.5 d,t=5.638),regression and time (3.5 ± 1.3 d vs.6.7 ± 1.1 d,t=10.292) in the observation group were significantly earlier than those in the control group (P＜0.01).After treatment,VAS score (1.9 ± 1.1 vs.3.3 ± 1.3,t=4.503) of the observation group significantly lower than that of the control group (P＜0.01);AOFAS score (93.6 ± 3.9 vs.84.2 ± 5.1,t=8.019) significantly higher than the control group (P＜0.01).Total effective rate in the observation group was 96.7％ (29/30),and the control group was 80.0％ (24/30),which the difference was statistically significant (x2=4.043,P=0.044).Conclusions The "Palace Bone-setting" Dieda-Wanying cream combined with Yuan Shu Zhi Pai Zi fixation has definite curative effect on acute ankle sprain,relieve pain,swelling and promote the ankle function.
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Objective To explore the feasibility of robot-assisted laparoscopic inferior vena cava (IVC) thrombectomy in treating renal tumor with Mayo level Ⅲ-Ⅳ inferior vena cava thrombus.Methods From November 2014 to January 2017,5 cases of renal tumor with Mayo level Ⅲ-Ⅳ inferior vena cava tumor thrombus were treated with robot-assisted surgery.There were 4 males and 1 female with the median age of 59 years (range 54-71 years).Four cases had the renal tumor on the right side and one on the left side.The mean tumor size was 6.8 cm (range 5-9 cm) with 3 cases of T3b and 2 cases of T3c.There were 4 cases of level Ⅲ and 1 case of level Ⅳ inferior vena cava thrombus with the median length of 9 cm (range 7-11 cm).The surgical procedure for Mayo level Ⅲ inferior vena cava thrombus included mobilization of both left and right robes of liver,subsequently controlling the suprahepatic infradiaphramatic IVC and first porta hepatis simultaneously.The surgical procedure for Mayo level Ⅳ inferior vena cava thrombus included cardiopulmonary bypass by multi-disciplinary cooperation among urologists,hepatobiliary and cardiovascular surgeons.The procedures included live mobilization,control of the superior vena cava and first porta hepatis and remove thrombus in the atrium and IVC respectively.Results All operations were completed successfully.The median operative time was 440 min (320-630 min).The blood recovery device was used and the intraoperative estimated blood loss was 2 500 ml (500-6 000 ml) and all cases required intraoperative blood transfusion.The median time of intraoperative occlusion of IVC was 35 min (25-50 min).All patients were transferred to the intensive care unit for median of 4 days (2-8 days) after surgery.The median time to remove the postoperative drainage tube was 9 days (7-12 days).Postoperative pathological diagnosis revealed 5 cases of clear cell carcinoma.Postoperative renal dysfunction occurred in 3 patients and liver dysfunction occurred in 2 patients who improved after medical therapy.During median 19.6 months (12-48 months) of follow-up,1 patient died and 1 patient progressed.Conclusions Despite the high risk of surgery,robot-assisted laparoscopic IVC thrombectomy for renal tumor with Mayo level Ⅲ-Ⅳ thrombus is feasible for experienced surgeons in selected patients.However,the oncological outcomes need further investigation.
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Objective To explore the effect of Kruppel like factor 4 (KLF4) on epithelial-to-mesenchymal transition and invasion ability of pancreatic cancer.Methods The expression of KLF4 in 70 pancreatic cancer tissues and 10 normal pancreatic tissues was detected by immunohistochemistry,and the correlations between KLF4 expression and pathological characteristics were analyzed.Small hairpin RNA targeting KLF4 (sh-KLF4) and negative control shRNA were constructed.After the transfection of shRNA,qRT-PCR and western blot were used to detect the mRNA and protein expression of KLF4,E-cadherin and vimentin,and cell scratch-wound assay and transwell assay were utilized to determine the ability of invasion and metastasis.Results KLF4 expression (47.1％) was lower in pancreatic cancer tissues compared with normal pancreatic tissues (80.0％),and negatively correlated with cell differentiation,tumor stage and distant metastasis.Down-regulated KLF4 expression in PANC1 cell caused decreased mRNA and protein expression of E-cadherin (F =25.71,P =0.0011) and increased mRNA and protein expression of vimentin (F =24.95,P=0.0012).Knockdown of KLF4 in PANC1 cell promoted the transition from epithelial morphology to mesenchymal morphology,and enhanced the healing ability (F =47.82,P ＜ 0.001),migration (F =53.68,P=0.0001) and invasion (F=27.65,P=0.0009).Conclusions Knockdown of KLF4 can promote EMT and enhance the invasion ability of pancreatic cancer.
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Objective To investigate the effectiveness and safety of the slender external biliary drainage tube (F5 ureter catheter) inserted into the common bile duct via the cystic duct in laparoscopic choledochotomy with primary closure.Methods Clinical data of 59 patients with cholecystolithiasis and choledocholithiasis treated in our hospital between Feburary 2013 and March 2016 were retrospectively analyzed.The patients were treated with laparoscopic common bile duct exploration followed by primary duct closure,and bile duct drainage with a slender catheter through cystic duct after closure of the choledochotomy.Results All the cases underwent surgery successfully.The postoperative output of bile drainage was 30-570 ml/d.There were no complications such as biliary leakage,cholangitis or biliary pancreatitis.The catheter was withdrawn in 6-8 d in 57 patients after the operation,and was withdrawn in 10-11 d in 2 patients after the operation.There was no discomfort after removing the catheter.Postoperative hospitalization time was (9.1 ± 2.0) d.All patients were followed up for 5 months to 3 years,with an average of 16 months.The B ultrasound examinations showed no residual bile duct stones and liver functions were normal.Conclusions External biliary drainage using a slender ureter catheter via the cystic duct is safe,effective and easy to perform.It may reduce postoperative potential complications,especially bile leakage.
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Objective Dynorphins have advantages in powerful analgesic effect, high safety, no respiratory depression and no addiction, which is the emphasis of analgesic research at present. The aim of the article was to explore the expression of lentivirus-mediated rat prodynorphin gene in bone marrow mesenchymal stem cells( BM-MSCs) and contribute to the subsequent studies on bio-logical analgesia in cancer pain of rat model. Methods BM-MSCs were isolated and proliferated using the adherence screening meth-od, and further identified by flow cytometry, adipogenic and osteogenic differentiation experiments. The PDYN lentiviral vectors in rats were transfected into BM-MSCs after construction. The expression of green fluorescent protein (GFP) was detected under inversion fluo-rescence microscope and the best multiplicity of infection ( MOI ) of virus was screened by western blot. There are three groups in the ex-periment: blank group, experimental group ( PCDH-CMV-PDYN-EF1-copGFP ) and empty vector group ( PCDH-CMV-MCS-EF1-copGFP). PYDN gene was determined by qPCR and western blot, while DYN protein was detected by immunochemical method.Results BM-SMCs were in longspindle-shape and fibrocyte-like adherent growth, most in expression of CD29, CD44 and CD90, and a few in CD45. The oil red-O staining of the induced cells by adipogenic differentiation was positive. The mineralized nodules formed in the induced cells by osteogenic differentiation were orange after alizarin red staining. Flow cytometry detection showed the positive rates of CD29, CD90, CD44 and CD45 were respectively (99.80±0.19)%, (99.62±0.24)%, (96.86±1.27)%, (0.82±0.06)%, while after transfection the positive rates were (99.59±0.34)%, (98.06±1.27)%, (95.23±0.71)%, (10.23±0.59)%, representing no sig-nificant difference before and after PDYN transfection. Lentiviral vector of PCDH-CMV-PDYN-EF1-copGFP was successfully construc-ted after the identification of PCR amplification, cloning and sequencing. The titer of recombined lentiviruses was 5×106IU/mL. The best MOI of lentiviruses was 100 according to the results of GFP and western blot. Western blot and qPCR suggested PDYN gene signif-icantly increased in BM-MSCs after lentiviral transfection ( P<0.05) , and immunohistochemical staining indicated DYN protein also in-creased greatly. Conclusion BM-MSCs are successfully cultured and the overexpressed rat PDYN gene lentivirus vector is also suc-cessfully constructed;PDYN gene is highly and stably expressed and DYN protein is secreted in BM-MSCs.
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Objective To assess the clinical outcomes in patients who underwent laparoscopic primary closure of common bile duct (CBD) with or without transcystic cholangiography and transcystic biliary drainage.Methods From June 2013 to March 2016,we operated on 46 patients who underwent primary closure of common bile duct after laparoscopic choledochotomy (group A).The results were compared with 51 patients who underwent primary closure of common bile duct after laparoscopic choledochotomy together with transcystic biliary drainage (group B) during the same study period.Results There was a significant difference in the incidence of postoperative bile leakage between the two groups.The risk in group A was sig nificantly higher than group B (8.7％ vs 0％,P ＜0.05).The duration of operation in group A was significantly shorter than in group B [(125.3 ± 28.3) min vs (131.3 ± 20.5) min].There were no significant differences in the duration of hospital stay between the two groups [(7.3 ± 2.4) days vs (7.8 ± 1.9) days,P ＞ 0.05].All patients were followed up (range 3 months to 29 months,average 8.4 months).B-ultrasound examination showed no residual bile duct stones and the liver functions were normal.Conclusions Laparoscopic primary closure of common bile duct was possible after choledochotomy.Transcystic cholangiography and transcystic biliary drainage after primary closure of common bile duct were safer and more reli able.
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Objective@#To evaluate the feasibility and strategy of the lesser omentum approach for laparoscopic pancreatic enucleation.@*Methods@#Between June 2011 and October 2013, 6 laparoscopic pancreatic enucleations were performed by lesser omentum approach.The average age was 42 years, including 1 male and 5 female.The preoperation diagnosis of 6 cases were pancreatic islet cell tumors determined by abdominal CT/MRI, ultrasound and digital subtraction angiography.The tumors of 3 cases located in pancreatic neck, 2 tumors located in neck and body of pancreas, and 1 tumor located in pancreatic body.Their biggest tumor diameter were 0.8-2.5 cm.@*Results@#Among the 6 cases, all laparoscopic pancreatic enucleations were successfully performed.None of the patients were converted to open operation.Eestimated blood loss was (26.7±18.6)ml, operating time was (82.5±19.4)minutes, and postoperative length of stay was (5.17±1.17)days.Additionally, postoperative complication included grade A pancreatic fistula in 1 case.After 36-64 months followed-up, there was no tumor recurrence and clinical symptom disappeared.@*Conclusion@#For the islet cell tumors located in pancreatic neck and body, the lesser omentumapproach may contribute to good surgical view and operative space, which can make pancreatectomy safer and easier for clinical application.
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Objective To evaluate the efficacy of different doses of ulinastatin for prevention of insulin resistance in the patients undergoing partial hepatectomy.Methods Sixty patients of both sexes,aged 33-71 yr,weighing 44-70 kg,of ASA physical status Ⅰ or Ⅱ,scheduled for electivepartial hepatectomy,were randomly assigned into 3 groups (n =20 each) using a random number table:control group (group C),low dose of ulinastatin group (group UL) and high dose of ulinastatin group (group UH).Before induction of anesthesia and at the beginning of operation,ulinastatin 2 500 U/kg and 5 000 U/kg (in 20 ml of normal saline) were injected intravenously in UL and UH groups,respectively.The equal volume of normalsaline was given instead of ulinastatin in group C.Before skin incision,before removal of the liver,after removal of the liver,and after closure of the abdominal cavity,blood samples were taken from the right internal jugular vein for determination of plasma glucose,insulin and glucagon concentrations.Insulin sensitivity index was calculated.Results Compared with group C,insulin sensitivity index was significantly increased,and the plasma glucose and insulin concentrations were decreased in UL and UH groups.Conclusion Ulinastatin 2 500 U/kg injected intravenously before induction of anesthesia and at beginning of operation can effectively prevent insulin resistance in the patients undergoing partial hepatectomy.
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Objective To evaluate bile duct drainage with ureteral catheter through cystic duct in laparoscopic common bile duct exploration followed by primary duct closure (LCBDEPDC) and posto laparoscopic endoscopic stone extraction treatment of extrahepatic bile duct stones.Methods The clinical data of 116 cases of extrahepatic bile duct stones were retrospectively analyzed.Patients were divided into 2 groups: 57 patients with dilated common bile duct were in group A treated with laparoscopic common bile duct exploration followed by primary duct closure and via cystic duct ureteral catheter biliary drainage.While in group B (59 patients) with normal calibre of the common bile duct, the procedures was laparoscopic cholecystectomy + via cystic duct ureteral catheter biliary drainage and postoperative endoscopic stone extraction.Results Procedures were successful in both the two groups.There was no postoperative pancreatitis and biliary leakage complications.The catheter was withdrawn in 6-9 d in group A postoperative hospitalization time was (8.5 ± 2) d.The catheter was withdrawn in 2-8 d in group B after endoscopic stone extraction.Postoperative hospitalization time was (7.6 ± 3) d.No complications occurred in both two groups relating extubation.Conclusions Bile duct drainage using the ureteral catheter via cyst duct after LCBDEPDC and endoscopic stone extraction treatment of extrahepatic bile duct stones effectively prevent postoperative pancreatitis, biliary leakage and bile duct stricture.
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Objective To investigate the clinical curative effect of“Qing Dynasty Palace manipulation” in combination with plaster immobilization and foot bath with traditional Chinese medicine for acute soft tissue sprain of the ankle.Method A total of 90 patients with acute soft tissue sprain of the ankle from emergency department of WangJing Hospital, CACMS were recruited from July 2013 to April 2014 and randomly divided into two groups with 45 patients in each. The patients in the treatment group were treated with the court manipulation, plaster and Chinese herbs washing, and those in the control group were only treated with cast immobilization. The clinical curative effect was evaluated using Baird-Jackson score system(excellent: 96-100; good: 91-95; fair: 81-90; poor: 0-80).Result At the second, third week after treatment, the excellent/good rates in the treatment group were significantly higher than those in the control group(at week 2: 73.3%vs. 44.4%;χ2=11.468,P<0.01; at week 3: 86.7%vs.60.0%;χ2=6.875,P<0.05). At week 2 and 3, Baird-Jackson scores in the treatment group(87.41±14.12, 93.16±9.51)and in the control group(76.32±11.41, 82.54±9.22)were significantly higher than those before treatment(treatment group: 72.11±12.61; control group: 71.67±13.12, allP<0.05); at week 3, Baird-Jackson score in the treatment group were significantly higher than that in the control group(P<0.05).Conclusion“Qing Dynasty Palace manipulation” in combination with plaster immobilization and foot bath with traditional Chinese medicine can increase Baird-Jackson score and aid recovery of the ankle function in patients with acute soft tissue sprain of the ankle.