Application value of enhanced recovery after surgery in the laparoscopic surgery for cholecystolithiasis comorbid with choledocholithiasis / 中华消化外科杂志

Objective@#To explore the clinical application value of enhanced recovery after surgery (ERAS) in the laparoscopic surgery for cholecystolithiasis comorbid with choledocholithiasis.@*Methods@#The prospective study was conducted. The clinicopathological data of 52 patients with cholecystolithiasis comorbid with choledocholithiasis who were admitted to the Third Affiliated Hospital of Zunyi Medical University from September 2016 to September 2018 were collected. Patients were divided into 2 groups by random number table: patients in observation group received laparoscopic cholecystectomy + choledocholithotomy + choledochoscopic exploration + T-tube drainage (or primary suture of common bile duct) and perioperative management guided by the concept of enhanced recovery after surgery (ERAS), and patients in control group received traditional perioperative management. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) postoperative complications; (4) postoperative pain scores; (5) changes in hepatic function and blood routine during perioperative period. Follow-up using outpatient examination and telephone interview was performed to detect complications during the postoperative 6 months up to March 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the paired t test or repeated ANOVA. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability.@*Results@#Fifty-two patients were screened for eligibility, including 20 males and 32 females, aged 25-68 years, with an average age of 53 years. There were 30 patients in the observation group and 22 in the control group. (1) Surgical situations: the operation time and volume of intraoperative blood loss were (133±19)minutes and (47±21)mL in the observation group, and (136±22)minutes and (49±23)mL in the control group, respectively, showing no significant difference between the two groups (t=-0.386, -0.211, P>0.05). (2) Postoperative situations: time to out-of-bed activity, time to initial food intake, time to first anal flatus, duration of postoperative hospital stay, and hospital expenses were (18±4)hours, (19±5)hours, (28±2)hours, (4.0±1.0)days, and (1.82±0.22)×104 yuan in the observation group, and (29±7)hours, (46±9)hours, (37±4)hours, (6.6±1.6)days, and (2.25±0.29)×104 yuan in the control group, respectively, showing significant differences between the two groups (t=-7.054, -14.169, -9.426, -6.582, -5.809, P<0.05). (3) Postoperative complications: 1 of 30 patients in the observation group had postoperative biliary leakage, with a postoperative complication rate of 3.3%, and was cured after symptomatic support treatment. Six of 22 patients in the control group had postoperative complication, with a postoperative complication rate of 27.3%, including 2 of biliary leakage, 1 of hemorrhage, 1 of abdominal infection, 1 of pulmonary infection, 1 of urinary infection, and they were cured after symptomatic support treatment. There was a significant difference between the two groups (χ2=4.358, P<0.05). (4) Postoperative pain scores: from postoperative 6 hours to 48 hours, the postoperative pain score changed from 2.4±0.7 to 1.9±0.9 in the observation group, and from 4.1±0.7 to 2.9±0.9 in the control group, respectively, showing a significant difference in the changing trend between the two groups (F=78.053, P<0.05). (5) Changes in hepatic function and blood routine during perioperative period: from preoperation to postoperative 3 days, levels of alamine aminotransferase (ALT), aspartate transaminase (AST), gamma-glutamyltransferase (GGT), total bilirubin (TBil), and count of white blood cells in the observation group changed from (77±20)U/L to (53±12)U/L, from (85±22)U/L to (61±17)U/L, from (166±39)U/L to (55±24)U/L, from (40±13)μmol/L to (29±12)μmol/L, from (7.0±2.0)×109/L to (6.8±1.9)×109/L, and changed from (79±23)U/L to (62±14)U/L, from (88±24)U/L to (64±17)U/L, from (179±34)U/L to (74±29)U/L, from (45±13)μmol/L to (35±12)μmol/L, from (7.9±2.4)×109/L to (7.5±1.9)×109/L in the control group, respectively. The levels of ALT, AST, GGT, TBiL, and count of WBC showed increasing at postoperative 1 day, and decreasing at postoperative 3 days. There was no significant difference in the changing trend between the two groups (F=0.058, 0.471, 3.021, 1.593, 2.172, P>0.05).@*Conclusion@#ERAS is safe and effective in the laparoscopic surgery for choledocholithiasis comorbid with cholecystolithiasis.

Application value of enhanced recovery after surgery in the laparoscopic surgery for cholecystolithiasis comorbid with choledocholithiasis / 中华消化外科杂志

Objective To explore the clinical application value of enhanced recovery after surgery (ERAS) in the laparoscopic surgery for cholecystolithiasis comorbid with choledocholithiasis.Methods The prospective study was conducted.The clinicopathological data of 52 patients with cholecystolithiasis comorbid with choledocholithiasis who were admitted to the Third Affiliated Hospital of Zunyi Medical University from September 2016 to September 2018 were collected.Patients were divided into 2 groups by random number table:patients in observation group received laparoscopic cholecystectomy + choledocholithotomy + choledochoscopic exploration +T-tube drainage (or primary suture of common bile duct) and perioperative management guided by the concept of enhanced recovery after surgery (ERAS),and patients in control group received traditional perioperative management.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) postoperative complications;(4) postoperative pain scores;(5) changes in hepatic function and blood routine during perioperative period.Follow-up using outpatient examination and telephone interview was performed to detect complications during the postoperative 6 months up to March 2019.Measurement data with normal distribution were represented as Mean ± SD,and comparison between groups was analyzed using the paired t test or repeated ANOVA.Count data were described as absolute numbers and percentages,and comparison between groups was analyzed using the chi-square test or Fisher exact probability.Results Fifty-two patients were screened for eligibility,including 20 males and 32 females,aged 25-68 years,with an average age of 53 years.There were 30 patients in the observation group and 22 in the control group.(1) Surgical situations:the operation time and volume of intraoperative blood loss were (133± 19) minutes and (47 ± 21) mL in the observation group,and (136±22) minutes and (49±23)mL in the control group,respectively,showing no significant difference between the two groups (t=-0.386,-0.211,P＞0.05).(2) Postoperative situations:time to out-of-bed activity,time to initial food intake,time to first anal flatus,duration of postoperative hospital stay,and hospital expenses were (18±4) hours,(19±5) hours,(28±2)hours,(4.0± 1.0)days,and (1.82±0.22) × 104 yuan in the observation group,and (29±7)hours,(46±9)hours,(37±4)hours,(6.6±1.6)days,and (2.25±0.29) ×104 yuan in the control group,respectively,showing significant differences between the two groups (t =-7.054,-14.169,-9.426,-6.582,-5.809,P＜0.05).(3) Postoperative complications:1 of 30 patients in the observation group had postoperative biliary leakage,with a postoperative complication rate of 3.3％,and was cured after symptomatic support treatment.Six of 22 patients in the control group had postoperative complication,with a postoperative complication rate of 27.3％,including 2 of biliary leakage,1 of hemorrhage,1 of abdominal infection,1 of pulmonary infection,1 of urinary infection,and they were cured after symptomatic support treatment.There was a significant difference between the two groups (x2 =4.358,P ＜ 0.05).(4) Postoperative pain scores:from postoperative 6 hours to 48 hours,the postoperative pain score changed from 2.4 ± 0.7 to 1.9± 0.9 in the observation group,and from 4.1 ± 0.7 to 2.9 ± 0.9 in the control group,respectively,showing a significant difference in the changing trend between the two groups (F=78.053,P＜0.05).(5) Changes in hepatic function and blood routine during perioperative period:from preoperation to postoperative 3 days,levels of alamine aminotransferase (ALT),aspartate transaminase (AST),gamma-glutamyltransferase (GGT),total bilirubin (TBil),and count of white blood cells in the observation group changed from (77±20)U/L to (53± 12)U/L,from (85±22)U/L to (61± 17) U/L,from (166±39) U/L to (55±24) U/L,from (40± 13) μmol/L to (29±12) μmol/L,from (7.0±2.0) × 109/L to (6.8± 1.9) × 109/L,and changed from (79±23) U/L to (62± 14) U/L,from (88±24)U/L to (64± 17) U/L,from (179±34) U/L to (74±29) U/L,from (45± 13) μmol/L to (35±12) μmol/L,from (7.9±2.4)× 109/L to (7.5± 1.9)× 109/L in the control group,respectively.The levels of ALT,AST,GGT,TBiL,and count of WBC showed increasing at postoperative 1 day,and decreasing at postoperative 3 days.There was no significant difference in the changing trend between the two groups (F=0.058,0.471,3.021,1.593,2.172,P＞0.05).Conclusion ERAS is safe and effective in the laparoscopic surgery for choledocholithiasis comorbid with cholecystolithiasis.

Clinical application of G-lipopolysaccharides detection in patients with traumatic brain injury / 国际检验医学杂志

Objective To study the application value of G-lipopolysaccharides(G-LPS) detection in patients with traumatic brain injury(TBI).Methods From Jan.2013 to Jun.2014,plasma G-LPS of TBI-patients and non-patients in this hospital were detected by using MB-80 microbiology analyzer and compared.Results of pathogenic microbiological detection of G-LPS positive TBI patients were analyzed,and G-LPS levels,detected before and after treatment,were also analyzed.Results G-LPS positive rate of TBI patients(33.33%) was higher than the 13.34% of non-TBI patients(P<0.05).After treatment,G-LPS level in G-LPS positive TBI patients significantly decreased(P<0.05).The common pathogenic bacteria,causing infection in TBI patients,included Acinetobacter bauman,Klebsiella pneumoniae and Escherichia coli,and the most common infection diseases included respiratory tract infections and urinary tract infections.Conclusion G-LPS detection could be used for the early detection of secondary infection in TIB patients,with significance for guiding clinical treatment.

Enhancement of Gastric Ulcer Healing and Angiogenesis by Hepatocyte Growth Factor Gene Mediated by Attenuated Salmonella in Rats

The present study developed an oral hepatocyte growth factor (HGF) gene therapy strategy for gastric ulcers treatment. An attenuated Salmonella typhimurium that stably expressed high HGF (named as TPH) was constructed, and the antiulcerogenic effect of TPH was evaluated in a rat model of gastric ulcers that created by acetic acid subserosal injection. From day 5 after injection, TPH (1 × 10⁹ cfu), vehicle (TP, 1 × 10⁹ cfu), or sodium bicarbonate (model control) was administered orally every alternate day for three times. Then ulcer size was measured at day 21 after ulcer induction. The ulcer area in TPH-treated group was 10.56 ± 3.30 mm², which was smaller when compared with those in the TP-treated and model control groups (43.47 ± 4.18 and 56.25 ± 6.38 mm², respectively). A higher level of reepithelialization was found in TPH-treated group and the crawling length of gastric epithelial cells was significantly longer than in the other two groups (P < 0.05). The microvessel density in the ulcer granulation tissues of the TPH-treated rats was 39.9 vessels/mm², which was greater than in the TP-treated and model control rats, with a significant statistical difference. These results suggest that TPH treatment significantly accelerates the healing of gastric ulcers via stimulating proliferation of gastric epithelial cells and enhancing angiogenesis on gastric ulcer site.

Investigation of telomere length in buccal cells in longevity families in Bama area of Guangxi / 中华老年医学杂志

Objective To explore the telomere length (TL) in buccal cells and its possible implications for long-lived families of Zhuang nationality in Bama area of Guangxi.Methods Relative TL in buccal cells from Bama long-lived families (BLF,n=1250) was determined by real time PCR and compared between Bama non-long-lived families (BNLF,n=556) and Pingguo longlived families (PLF,n=630).All participants were Zhuang ethnic.Results The TL in buccal cells was negatively correlated with age (R=-0.215,P=0.000) and was independent of sex in all subjects (n=2436).There were no significant differences in TL between males and females in different of ages in BLF (all P＞0.05).Similar tendency was observed in most but not all age groups in the two other families.The TL was significantly longer in BLF aged over 65 years (the first offspring of the longlived individual) than in BNLF aged over 65 years (1.969 vs.1.622,P=0.004) and the TL of BLF aged over 90 years was comparable to that of BNLF aged over 65 years (1.662 vs.1.622,P=0.955),which indicating that the offspring of long-lived individuals inherited longer TL from their parental generation.Conclusions Telomere length is shorten with aging in long-lived families in Bama area.The TL of BLF has a tendency of inheritance,which may be one of the mechanisms of longevity in Bama area.

Construction of recombinant adenovirus vector pAdxsi-GFP-HIF containing hypoxia inducible factor gene and its expression in endothelial cells / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To construct a recombinant adenovirus (pAdxsi-GFP-HIF) encoding human hypoxia inducible factor 1 α gene (HIF-1 α) and to express it in endothelial cells.</p><p><b>METHODS</b>HIF-1 α gene was obtained from human lung cancer cell line A549, which was cultured in hypoxia condition, by RT-PCR. The HIF-1 α gene was subcloned into shuttle vector p Shuttle-CMV-EGFP at KpnI and BamHI sites. After identified with restriction enzymes, plasmid p Shuttle-GFP-HIF was linearized by digestion with restriction endonuclease I-CeuI and I-SceI, and subsequently cotransformed into E.coli DH5a with adenoviral backbone plasmid pAdxsi to make homologous recombination. After linearized by PacI, the homologous recombinant adenovirus plasmid was transfected into 293 cells to package and amplify. The recombinant adenovirus was infected with human umbilical vein endothelial cells (ECV304), and the expression level of HIF-1 α protein was evaluated by ELISA.</p><p><b>RESULTS</b>The recombinant adenovirus vector containing HIF-1 α gene (pAdxsi-GFP-HIF) was successfully constructed and amplified with titer of 3.38 X 10(10) pfu/mL. The green fluorescence protein was detected under fluorescent microscope in ECV304 at 24h after transfection and with a stronger degree after 48h. The concentration of HIF-1 protein was (48.93 ±3.86)ng/mL in supernatant at 48 h after transfection.</p><p><b>CONCLUSION</b>A recombinant adenovirus vector pAdxsi-GFP-HIF, encoding human hypoxia inducible factor 1 α gene, has been constructed in vitro and expressed successfully in ECV304 cells.</p>

Research advances in treatment of cerebral ischemic injury by acupuncture of conception and governor vessels to promote nerve regeneration / 中西医结合学报

Cerebral ischemia is one of the most common diseases treated by acupuncture therapeutics. Recent studies indicated that acupuncture treatment by needling the conception and governor vessels had positive effects in promoting neural regeneration in patients after cerebral ischemia injury. Acupuncture intervention could continuously promote the proliferation and differentiation of the neural stem cells in the brain, obviously up-regulate expression of growth factors, accelerate angiogenesis and inhibit apoptosis. Hence, it is necessary to present an exhaustive review on the mechanisms. The present review gives a detailed description of pathological changes of cerebral ischemia and acupuncture intervention applied to the conception and governor vessels, and proposes research prospects in the future.

The expression of P16、Ki-67 gene protein in esophageal carcinoma and its significance / 中国基层医药

Objective To study the expression of P16、Ki-67 gene protein in esophageal squamous cell carcinoma,and its relation with lymph node metastasis、 prognostis.Methods The SP immunohistochemical method was used to detect the expression of P16 、Ki-67 gene protein in 56 cases with esophageal squamous cell carcinoma,and its normal paraneoplastic rectal mucous tissues.Results The positive expression rate of P16 in normal paraneoplastic rectal mucous tissues was 89.29%(50/56),and 42.86%(24/56) in esophageal squamous cell carcinoma,there was significant difference between the two groups(all P＜0.05);the positive expression rate of Ki-67 in normal paraneoplastic rectal mucous tissues was 8.93%(5/56),and 33.93%(19/56) in esophageal squamous cell carcinoma,there was also significant difference between the two groups(all P＜0.05).In well differentiated groups of esophageal carcinoma the positive expression rate of P16 was significantly higher than that in moderately differentiated group、poorly differentiated group(P＜0.05);in bad progressed group of esophageal carcinoma the positive expression rate of Ki-67 was higher than that in good progressed group(P＞0.05);The positive expression rate of P16、Ki-67 in lymph node metastasis was significantly higher than that in without lymph node metastasis(P＞0.05).In the exist period after operation over three years groups,the positive expression rate of P16 57.69%(15/26) was significantly higher than that in the groups of the exist period after operation non-over three years 30.00%(9/30)(χ2 =4.36,P＜0.05),in the exist period after operation non-over three years groups the positive expression rate of Ki-67 46.67%(14/30) was higher than that in the exist period after operation over three years group 19.23%(5/26)(χ2 =4.68,P＜0.05).Conclusion P16、Ki-67 were objective markers to estimate the behaviors of esophageal squamous cell carcinoma and to evaluate the development and predict the mettastasis of tumors of patiens.

Effect of octylphenol or/and genistein on proliferation of MCF-7 cells / 第三军医大学学报

Objective To observe the effect of genistein,octylphenol,and their combination on proliferation of MCF-7 cells and explore the molecular mechanisms.Methods The MCF-7 cells were divided into four groups: control,5?10~(-5)mol/L genistein treated,8?10~(-6)mol/L octylphenol treated,genistein and octylphenol treated.The cell proliferation,cell cycle,phospho-L-tyrosine protein(PTPr),ER?,ER? mRNA and AIB1 mRNA expression of MCF-7 cells was observed by MTT test,flow cytometry,immunocytochemistry and RT-PCR.Results When MCF-7 cells were treated with 8?10~(-6) mol/L octylphenol or 5?10~(-5) mol/L genistein,or both for 72 h,the proliferation ratio was 12.98%,46.16% and 36.44% respectively;the percentage of MCF-7 cells at G_(2)/M were 12.98%,46.16% and 36.44% respectively;the apoptosis ratio of MCF-7 cells were 3.57%,11.41% and 8.24% respectively;the expression of PTPr was(62.84?9.80),(26.75?5.09),(39.15?7.83) respectively.Octylphenol increased the expression of AIB1 mRNA,but genistein and its combination with octylphenol inhibited the expression of ER? and decreased the expression of AIB1 mRNA in nucleus.Conclusion Octylphenol can promote the proliferation of MCF-7 cells,while genistein and its combination with octylphenol inhibit,which mechanism may be related to regulation of PTPr,AIB1 and ER expression.

EFFECTS OF OCTYLPHENOL AND GENISTEIN ON ER,AIB1,AND PCNA EXPRESSIONS IN RAT BREAST CANCER / 营养学报

Objective: To study the effects of octylpheno(lOP)and genistein(GEN)on the expressions of estrogen receptors(ER),amplified in breast cancer 1(AIB1) and proliferating cell nuclear antigen(PCNA) in rat breast cancer.Method:Female SD rats were randomly divided into control,model,GEN treated,OP treated,GEN and OP combined treated groups.RT-PCR and immunohistochemical methods were used to detect the expressions of AIB1,ER,PCNA on normal mammary gland and mammary cancer.Results: Compared with control mammary gland,AIB1 mRNA,ER mRNA,PCNA and ER expressions were up-regulated in mammary cancer.Compared with mammary cancer in model group,the level of AIB1mRNA,ER mRNA and ER expressions were significantly decreased in GEN treated group,while they were significantly increased in OP treated group and PCNA expression was significantly increased too.Compared with OP treated group,the level of AIB1mRNA,ER mRNA,ER and PCNA expressions were partly decreased in GEN and OP combined treated group.Conclusion: Octylphenol can up-regulate the levels of AIB1,ER and PCNA expressions in mammary cancer and may increase the incidence of 7,12-dinmethylbenz[a]anthracene(DMBA)-induced mammary cancer.Genistin or genistein combined with octylphenol can downregulate the levels of AIB1,ER and PCNA expressions in mammary cancer,and inhibit theiincidences.