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By summarizing and analyzing the clinical diagnosis and treatment experience of 17 cases of adrenal lymphangioma, the imaging characteristics and pathological types of the disease were discussed. The results showed that the imaging of adrenal lymphangioma was non-specific, and the appearance was similar to that of general cysts.Howerer, the density of the cyst was slightly higher than that of simple cysts. Some cases showed calcification on the cyst wall, and a few showed adenoma-like appearance. The diagnosis mainly depends on pathological examination. For those patients with tumors ≥4.0 cm, endocrine function, suspected malignancy, or obvious clinical symptoms, surgery is recommended.
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Objective:To investigate the diagnosis and treatment for intra-abdominal fistula in China, and to explore the prognostic factors.Methods:A multi-center cross-sectional study was conducted based on the Registration System of Chinese Gastrointestinal Fistula and Intra-Abdominal Infections to collect the clinical data of patients with intra-abdominal fistula from 18 medical centers from January 1, 2018 to December 31, 2018, including basic information, medical records and prognosis.Results:A total of 106 patients were enrolled in this study, including 57 males and 49 females, with an average age of (48.0±17.8)years. The most common type of intra-abdominal fistula was entero-vesical fistula (34.0%), followed by entero-vaginal fistula (31.1%), entero-enteric fistula (26.4%) and multiple fistula (8.5%). The direct causes of intra-abdominal fistula were mainly surgical operation (66.0%), followed by spontaneous fistula due to Crohn′s disease (18.9%), radiation intestinal injury (11.3%), and 4 cases (3.8%) of unknown reasons. During the whole treatment, 95 patients received nutritional support therapy, mainly EN+ PN (75.8%). Finally, 86 patients (81.1%) received surgical treatment, with a healing rate of 95.3%. After surgery, 8.1% of patients developed surgical site infections (SSI), and 10.5% had a relapse of fistula. 20 patients (18.9%) were treated conservatively, with a self-healing rate of 80.0%. The overall mortality rate was 8.5%, and the highest mortality (15.2%) was found in entero-enteric fistula. Statistical analysis showed that the age ( t=-4.664, P<0.001), leucocyte level ( U=663.000, P=0.010), sepsis ( P=0.002) and multiple organ dysfunction syndrome (MODS) ( P=0.019) were higher in the death group than those in the healing group. Multivariate analysis suggested that advanced age ( OR=1.073, 95% CI: 1.008-1.141, P=0.026) and complications of sepsis ( OR=11.806, 95% CI: 1.064-131.048, P=0.044) were independent risk factors of the death for patients with intra-abdominal fistula. Conclusions:The overall mortality rate of intra-abdominal fistula is still high, and malignant tumor is the most common primary disease. Advanced age and sepsis are independent risk factors for death in patients with intra-abdominal fistula.
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A patient with adrenal enteric cyst was reported. The patient was admitted to the hospital for physical examination and found adrenal glands. The preoperative diagnosis considered simple adrenal cysts and underwent complete surgical resection. Postoperative pathological returns were adrenal enteric cysts. There was no recurrence at 1 year postoperative follow-up and recovery was good. The clinical symptoms of the disease are not typical. The imaging and laboratory indicators are not specific. Pathological diagnosis is required, and surgical resection is the best treatment plan.
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Background@#In our previous paper, we demonstrated that Connexin 43 (CX43) was highly expressed in bladder cancer (BC) tissues. But the molecular mechanism about microRNAs (miRNAs) regulation upstream of CX43 in BC has not been well elucidated and remains to be further studied. MicroRNA-139-5p (miR-139-5p) is a tumor suppressor in progression of multifarious cancers including BC. Nevertheless, the underlying mechanisms of CX43/miR-139-5p in tumorigenesis of BC are still not well illustrated. The specific objective of our study was to inquiry the effect of CX43/miR-139-5p on BC progression and its underlying mechanism.@*Methods@#The bioinformatics analysis softwares were applied to predict the miRNAs in the upstream of CX43. First, the expression levels of miR-139-5p in BC tissues (tumor) and paracancer tissues (normal) were investigated using the data from The Cancer Genome Atlas database. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was used to detect the mRNA expression level of miR-139-5p in three human BC cell lines 5637, T24, ECV-304 and a human bladder epithelial immortalized cell line SV-HUC-1 (normal control). Then si-CX43, si-control, miR-139-5p mimic, and its negative control (NC) were transfected into BC cell line ECV-304. The relationship of miR-139-5p and CX43 was analyzed by dual-luciferase reporter assay. The qRT-PCR and Western blotting were used to test the mRNA and protein expression level of CX43. The proliferation of ECV-304 and T24 cells were examined by cell counting kit-8. The migration and invasion of ECV-304 cells were tested by transwell assay. To determine whether miR-139-5p would affect cell proliferation, migration and invasion by targeting CX43, we executed the rescue assay. The comparison between two groups was analyzed by Student’s t test, and comparisons among multiple samples were performed by oneway analysis of variance and a Bonferroni post hoc test.@*Results@#The expression of miR-139-5p was remarkably down-regulated in BC tissues (tumor vs. normal, 2.286 ± 0.017 vs. 3.211 ± 0.034, t= 11.540, P < 0.0001) and cell lines (P < 0.01 in all BC cell lines). Besides, we also indicated that over-expression of miR-139-5p reduced the proliferation of ECV-304 (P = 0.001) and T24 cells (P = 0.005). Moreover, miR-139-5p over-expression weakened the invasion (P = 0.001) and migration (P = 0.001) of ECV-304 cells. Furthermore, the relative luciferase activity of CX43-wild type construct was distinctly lessened by up-regulation of miR-139-5p (miR-139-5p mimic NC vs. miR-139-5p mimic, 0.916 ± 0.063 vs. 0.356 ± 0.048, t = 7.085, P = 0.002), nevertheless the activity of CX43-mutant type construct was untouched (miR-139-5p mimic NC vs. miR-139-5p mimic, 0.918 ± 0.057 vs. 0.878 ± 0.039, t= 0.577, P = 0.595). Finally, the rescue assay revealed that CX43 deletion enhanced the depressor effect of miR-139-5p on ECV-304 cell proliferation (P < 0.01), invasion (P = 0.028), and migration (P = 0.014).@*Conclusion@#MiR-139-5p, as a tumor-suppressor, repressed cell proliferation, invasion, and migration in BC, which might be achieved by regulating CX43.
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Objective@#To investigate the diagnosis and treatment for enterocutaneous fistula (ECF) in China, and to explore the prognostic factors of ECF.@*Methods@#A multi-center cross-sectional study was conducted based on the Registration System of Chinese Gastrointestinal Fistula and Intra-Abdominal Infections to collect the clinical data of ECF patients from 54 medical centers in 22 provinces/municipalities from January 1, 2018 to December 31, 2018. The clinical data included patient gender, age, length of hospital stay, intensive care unit (ICU) admission, underlying diseases, primary diseases, direct causes of ECF, location and type of ECF, complications, treatment and outcomes. All medical records were carefully filled in by the attending physicians, and then re-examined by more than two specialists. The diagnosis of ECF was based on the clinical manifestations, laboratory/imaging findings and intraoperative exploration.@*Results@#A total of 1521 patients with ECF were enrolled, including 1099 males and 422 females, with a median age of 55 years. The top three primary diseases of ECF were malignant tumors in 626 cases (41.2%, including 540 gastrointestinal tumors, accounting for 86.3% of malignant tumors), gastrointestinal ulcers and perforations in 202 cases (13.3%), and trauma in 157 cases (10.3%). The direct causes of ECF were mainly surgical operation in 1194 cases (78.5%), followed by trauma in 156 (10.3%), spontaneous fistula due to Crohn′s disease in 92 (6.0%), radiation intestinal injury in 41 (2.7%), severe pancreatitis in 20 (1.3%), endoscopic treatment in 13 (0.9%) and 5 cases (0.3%) of unknown reasons. All the patients were divided into three groups: 1350 cases (88.7%) with simple ECF, 150 (9.9%) with multiple ECF, and 21 (1.4%) with combined internal fistula. Among the patients with simple ECF, 438 cases (28.8%) were jejuno-ileal fistula, 313 (20.6%) colon fistula, 170 (11.2%) rectal fistula, 111 (7.3%) duodenal fistula, 76 (5.0%) ileocecal fistula, 65 (4.3%) ileocolic anastomotic fistula, 55 (3.6%) duodenal stump fistula, 36 (2.4%) gastrointestinal anastomotic fistula, 36 (2.4%) esophagogastric/esophagojejunal anastomotic fistula, 29 (1.9%) gastric fistula and 21 (1.4%) cholangiopancreatiointestinal. Among all the simple ECF patients, 991 were tubular fistula and 359 were labial fistula. A total of 1146 patients finished the treatment, of whom 1061 (92.6%) were healed (586 by surgery and 475 self-healing) and 85 (7.4%) died. A total of 1043 patients (91.0%) received nutritional support therapy, and 77 (6.7%) received fistuloclysis. Infectious source control procedures were applied to 1042 patients, including 711 (62.0%) with active lavage and drainage and 331 (28.9%) with passive drainage. Among them, 841 patients (73.4%) underwent minimally invasive procedures of infectious source control (replacement of drainage tube through sinus tract, puncture drainage, etc.), 201 (17.5%) underwent laparotomy drainage, while 104 (9.1%) did not undergo any drainage measures. A total of 610 patients (53.2%) received definitive operation, 24 patients died within postoperative 30-day with mortality of 3.9% (24/610), 69 (11.3%) developed surgical site infection (SSI), and 24 (3.9%) had a relapse of fistula. The highest cure rate was achieved in ileocecal fistula (100%), followed by rectal fistula (96.2%, 128/133) and duodenal stump fistula (95.7%,44/46). The highest mortality was found in combined internal fistula (3/12) and no death in ileocecal fistula. Univariate prognostic analysis showed that primary diseases as Crohn′s disease (χ2=6.570, P=0.010) and appendicitis/appendiceal abscess (P=0.012), intestinal fistula combining with internal fistula (χ2=5.460, P=0.019), multiple ECF (χ2=7.135, P=0.008), esophagogastric / esophagojejunal anastomotic fistula (χ2=9.501, P=0.002), ECF at ileocecal junction (P=0.012), non-drainage/passive drainage before the diagnosis of intestinal fistula (χ2=9.688, P=0.008), non-drainage/passive drainage after the diagnosis of intestinal fistula (χ2=9.711, P=0.008), complicating with multiple organ dysfunction syndrome (MODS) (χ2=179.699, P<0.001), sepsis (χ2=211.851, P<0.001), hemorrhage (χ2=85.300, P<0.001), pulmonary infection (χ2=60.096, P<0.001), catheter-associated infection (χ2=10.617, P=0.001) and malnutrition (χ2=21.199, P<0.001) were associated with mortality. Multivariate prognostic analysis cofirmed that sepsis (OR=7.103, 95%CI:3.694-13.657, P<0.001), complicating with MODS (OR=5.018, 95%CI:2.170-11.604, P<0.001), and hemorrhage (OR=4.703, 95%CI: 2.300-9.618, P<0.001) were independent risk factors of the death for ECF patients. Meanwhile, active lavage and drainage after the definite ECF diagnosis was the protective factor (OR=0.223, 95%CI: 0.067-0.745, P=0.015).@*Conclusions@#The overall mortality of ECF is still high. Surgical operation is the most common cause of ECF. Complications e.g. sepsis, MODS, hemorrhage, and catheter-associated infection, are the main causes of death. Active lavage and drainage is important to improve the prognosis of ECF.
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BACKGROUND@#In our previous paper, we demonstrated that Connexin 43 (CX43) was highly expressed in bladder cancer (BC) tissues. But the molecular mechanism about microRNAs (miRNAs) regulation upstream of CX43 in BC has not been well elucidated and remains to be further studied. MicroRNA-139-5p (miR-139-5p) is a tumor suppressor in progression of multifarious cancers including BC. Nevertheless, the underlying mechanisms of CX43/miR-139-5p in tumorigenesis of BC are still not well illustrated. The specific objective of our study was to inquiry the effect of CX43/miR-139-5p on BC progression and its underlying mechanism.@*METHODS@#The bioinformatics analysis softwares were applied to predict the miRNAs in the upstream of CX43. First, the expression levels of miR-139-5p in BC tissues (tumor) and paracancer tissues (normal) were investigated using the data from The Cancer Genome Atlas database. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was used to detect the mRNA expression level of miR-139-5p in three human BC cell lines 5637, T24, ECV-304 and a human bladder epithelial immortalized cell line SV-HUC-1 (normal control). Then si-CX43, si-control, miR-139-5p mimic, and its negative control (NC) were transfected into BC cell line ECV-304. The relationship of miR-139-5p and CX43 was analyzed by dual-luciferase reporter assay. The qRT-PCR and Western blotting were used to test the mRNA and protein expression level of CX43. The proliferation of ECV-304 and T24 cells were examined by cell counting kit-8. The migration and invasion of ECV-304 cells were tested by transwell assay. To determine whether miR-139-5p would affect cell proliferation, migration and invasion by targeting CX43, we executed the rescue assay. The comparison between two groups was analyzed by Student's t test, and comparisons among multiple samples were performed by one-way analysis of variance and a Bonferroni post hoc test.@*RESULTS@#The expression of miR-139-5p was remarkably down-regulated in BC tissues (tumor vs. normal, 2.286 ± 0.017 vs. 3.211 ± 0.034, t = 11.540, P < 0.0001) and cell lines (P < 0.01 in all BC cell lines). Besides, we also indicated that over-expression of miR-139-5p reduced the proliferation of ECV-304 (P = 0.001) and T24 cells (P = 0.005). Moreover, miR-139-5p over-expression weakened the invasion (P = 0.001) and migration (P = 0.001) of ECV-304 cells. Furthermore, the relative luciferase activity of CX43-wild type construct was distinctly lessened by up-regulation of miR-139-5p (miR-139-5p mimic NC vs. miR-139-5p mimic, 0.916 ± 0.063 vs. 0.356 ± 0.048, t = 7.085, P = 0.002), nevertheless the activity of CX43-mutant type construct was untouched (miR-139-5p mimic NC vs. miR-139-5p mimic, 0.918 ± 0.057 vs. 0.878 ± 0.039, t = 0.577, P = 0.595). Finally, the rescue assay revealed that CX43 deletion enhanced the depressor effect of miR-139-5p on ECV-304 cell proliferation (P < 0.01), invasion (P = 0.028), and migration (P = 0.014).@*CONCLUSION@#MiR-139-5p, as a tumor-suppressor, repressed cell proliferation, invasion, and migration in BC, which might be achieved by regulating CX43.
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Objective To investigate the variation of renal pelvic pressure during percutaneous nephrolithotomy (PCNL) via standard nephrostomy tract and explore its influence on renal function. Methods 156 patients with renal calculi were selected for PCNL in standard-tract. The patients were divided into normal, mild hydronephrosis, moderate hydronephrosis groups according to the image by color Doppler ultrasonograph. A transurethral 6F ureteral catheter was inserted into renal pelvis and connected to the pressure monitering system before PCNL. During the operations, all the nephrostomy tracts were dilated to F24 size after successful puncture. Energy used was pneumatic and ultrasound lithotripsy. Renal function of the patients was evaluated with glomerular filtration rate (GFR) determined by 99mTc-DTPA dynamic renal imaging before and one week after PCNL. Data were analyzed by SPSS 19.0 software. Results The stone clearance rate was 75.0％ in one-session procedure. Severe complications did not occur during the operation, such as hemorrhage needing nephrectomy and abdominal organ injury or pneumothorax. There were no statistically significant differences between normal and mild hydronephrosis groups for the variation of renal pelvic pressure during preoperative versus intraoperative PCNL (P > 0.05). The renal pelvic pressure was significantly higher during operation than those of preoperation in moderate hydronephrosis group (P < 0.05), and it was greater than those of normal and mild hydronephrosis groups during operation (P < 0.05). Renal pelvic pressure generally remained lower than a level to 30.00 mmHg. There were no significant differences of preoperative and postoperative glomerular filtration rate in all the groups (P > 0.05). Conclusions There were no significant differences on the renal pelvic pressure in normal group and mild hydronephrosis group during operation via standard nephrostomy tract. It should be careful to maintain the lower intrapelvic pressure in order to avoid reflux and infection in moderate hydronephrosis group. Percutaneous nephrolithotomy via standard- tract does not cause significant effects on glomerular filtration rate during the perioperative period of PCNL .
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BACKGROUND/AIMS: Methylation status plays a causal role in carcinogenesis in targeted tissues. However, the relationship between the DNA methylation status of multiple genes in blood leukocytes and colorectal cancer (CRC) susceptibility as well as interactions between dietary factors and CRC risks are unclear. METHODS: We performed a case-control study with 466 CRC patients and 507 cancer-free controls to investigate the association among the methylation status of individual genes, multiple CpG site methylation (MCSM), multiple CpG site heterogeneous methylation and CRC susceptibility. Peripheral blood DNA methylation levels were detected by performing methylation-sensitive high-resolution melting. RESULTS: Total heterogeneous methylation of CA10 and WT1 conferred a significantly higher risk of CRC (adjusted odds ratio [OR(adjusted)], 5.445; 95% confidence interval [CI], 3.075 to 9.643; OR(adjusted), 1.831; 95% CI, 1.100 to 3.047; respectively). Subjects with high-level MCSM (MCSM-H) status demonstrated a higher risk of CRC (OR(adjusted), 4.318; 95% CI, 1.529 to 12.197). Additionally, interactions between the high-level intake of fruit and CRH, WT1, and MCSM on CRC were statistically significant. CONCLUSIONS: The gene methylation status of blood leukocytes may be associated with CRC risk. MCSM-H of blood leukocytes was associated with CRC, especially in younger people. Some dietary factors may affect hypermethylation status and influence susceptibility to CRC.
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Humans , Carcinogenesis , Case-Control Studies , China , Colorectal Neoplasms , DNA Methylation , Freezing , Fruit , Leukocytes , Methylation , Odds RatioABSTRACT
Objective To study the early renal function assessment value of urine kidney injury molecule-1(KIM-1)level in patients with unilateral obstruction renal diseases.Methods Seventy-eight patients with unilateral obstruction renal diseases were selected,and the glomerular filtration rate(GFR) was detected by 99Tcm-diethylene triaminepentaacetic acid (DTPA) renal dynamic imaging method. The patients were divided into 4 groups according to the GFR: normal renal function group with GFR>40 ml/(min·1.73 m2)25 cases(A group),low-injury renal function group with 20 ml/(min·1.73 m2)<GFR≤40 ml/(min·1.73 m2) 22 cases (B group), mid-injury renal function group with 10 ml/(min·1.73 m2) <GFR ≤ 20 ml/(min·1.73 m2) 16 cases (C group), serious-injury renal function group with GFR ≤ 10 ml/(min·1.73 m2) 15 cases (D group). Twenty-five healthy people were selected as control group (E group). The urine KIM-1 and serum creatinine and blood urea nitrogen levels were detected. The correlation among urine KIM-1, serum creatinine and blood urea nitrogen was analyzed. Results The urine KIM-1 in A group, B group, C group and D group was significantly higher than that in E group:(49.70 ± 9.23),(57.84 ± 10.06),(67.71 ± 7.36)and(65.84 ± 22.48)ng/L vs.(39.17 ± 3.28)ng/L,in A group and B group was significantly higher than that in C group and D group,in A group was significantly higher than that in B group, and there were statistical differences (P<0.05). There was no statistical difference in urine KIM-1 between C group and D group(P>0.05).There was no statistical difference in serum creatinine and blood urea nitrogen among 5 groups (P>0.05). The KIM-1 was negatively correlated with GFR(r=-0.441,P<0.01),and the serum creatinine and blood urea nitrogen were not correlated with GFR (r = -0.115 and 0.019, P>0.05). The receiver operating characteristic curve analysis result showed that the area under curve of urine KIM-1 in the diagnosis of kidney injury was significantly higher than that in serum creatinine and blood urea nitrogen(0.804 vs.0.441 and 0.567);the sensitivity and specificity were 82.6% and 66.7%,56.5% and 53.3%,66.9% and 66.7%.Conclusions The expression level of urine KIM-1 of unilateral obstructive nephropathy with different degree of kidney injury is a higher sensitivity marker compared with serum creatinine and blood urea nitrogen, which is helpful for diagnosing kidney injury early in clinic.
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Objective To study the impacts of lipopolysaccharide on expressions of Cx43 and TLR4 proteins in bladder cancer cell lines and on cell proliferation and apoptosis. Methods 5637 cells were cultured in vitro. After stimulation with LPS,expressions of Cx43 and TLR4 proteins were detected by Western blot in bladder cancer 5637 cell. The proliferation and apoptosis in the 5637?control group,5637?LPS group,and 5637?LPS +cisplatin group were detected by CCK?8(cell counting kit)and flow cytometry. Results The gene expression of Cx43 in the 5637?LPS group was significantly higher than that in the 5637?control group(t=3.892,P=0.012). The expressions of TLR4 and Cx43 in 5637?LPS group were significantly higher than those in the 5637?control group(t=7.029,P=0.019;and t=18.17,P=0.003). The proliferation was significantly decreased in the 5637?control group as compared with the 5637?LPS group (t = 8.756,P = 0.018). The apoptotic rate was (8.3 ± 1.58)% in the 5637?control group and (7.8 ± 2.03)% in the 5637?LPS group,with no significant statistical difference(t = 2.935,P = 0.099). However,the rate of the 5637?cisplatin group(60 ± 4.35)%was higher than that in 5637?cisplatin + LPS group(52 ± 6.25)%,the difference was statistically significant(t = 6.992,P =0.019). Conclusions Under the stimulation of LPS,bladder tumor cells may induce tumor cells to escape immune surveillance by increasing the expressions of TLR4 and Cx43.
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Objective To investigate the effect of celecoxib on the cell cycle and cell autophagy of HepG2 cell line and its possible molecular mechanism. Methods HepG2 cells were treated with celecoxib at different concentrations (0, 50, 100, 200, 500μM), then MTT was used to detect the cell proliferation, cell cycle and apoptosis were detected by flow cytometry, the cell autophagy was observed by transmission electron microscopy, and the expressions of cyclin and autophagy protein were determined using Western blot. Results Celecoxib inhibited the proliferation of HepG2 cells in a concentration dependent manner (0, 50, 100, 200 and 500 μM) and time-dependent manner (24,48h)(P<0.05). There was no significant change in necrocytosis and apoptosis after ttreated by different concentrations of (0, 50, 100, 200 and 500 μM). The celecoxib inhibited cell cycle arrest at G1 phase, the cell rate of G1 phase increased, while the cell rate of S phase decreased in a concentration dependent manner (0, 50, 100, 200 and 500 μM) and time-dependent manner (0, 8, 16, 24h)(P<0.05). The protein expressions of cyclin D1,cyclin D3, cyclin E2, CDK2 and CDK4 significantly decreased by 500 μM celecoxib (P<0.05). The celecoxib induced autophagy in HepG2 cells, and transformed autophagy protein LC3-Ⅰto LC3-Ⅱ in a concentration dependent manner. Conclusion Celecoxib can effectively inhibit the proliferation of human malignant hepatocellular carcinoma cell line HepG2, which provides a new idea for the clinical application of celecoxib.
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Objective To explore the associations between polymorphisms in CYP24A1 gene and the risk and prognosis of colorectal cancer ( CRC) .Methods A case-control study consisting of 528 CRC patients and 605 cancer free controls and a follow up study with 317 cases were conducted to explore the associations be-tween two polymorphisms in CYP24A1 and the risk and prognosis of CRC,as well as the combinations and inter-actions of polymorphisms with dietary factors on CRC risk.Results Although there was no association between polymorphisms in CYP24A1 and the risk of CRC,significant combinative effects between polymorphisms and diet-ary factors on CRC risk were observed.For Rs4809957 polymorphism,the prognosis of AA genotype carriers was worse than GG/GA carriers in CRC,colon cancer and rectal cancer(Log-rank test P=0.01,P=0.01,P=0.02,respectively).Compared with GG genotype,AA genotype carriers of Rs4809957 polymorphism had worse prognosis in CRC(HR =2.35,95%CI =1.28~4.30),colon caner(HR =2.37,95% CI =1.09~5.14) and rectal cancer(HR =2.11,95% CI =1.11~4.01).Conclusion The combinations of the polymorphisms in CYP24A1 gene with dietary factors are associated with the susceptibility of CRC,and Rs4809957 polymorphism may lead to a worse prognosis of CRC.
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Objective To study the local recurrence,distant recurrence and survival rate of anastomotic leak after surgery in patients with colorectal cancer.Methods Chinese and English related studies published from January 1970 to June 2011 were searched in PubMed/Medline,Excerpta medica database (EMBASE),Springger,Google scholar,China national knowledge infrastructure (CNKI),China biomedical literature database (CBM),Wanfang data.All controlled trials related to anastomotic leak after surgery in patients with colorectal cancer were retrieved.Outcomes were evaluated including local recurrence,distant recurrence and survival rate,then Mate-analysis was performed using RevMan 5.0 software provided by the Cochrane network.Results Fifteen studies were included,including a total of 18 225 patients.There were 1 425 patients with anastomotic leak and 16 800 patients without anastomotic leak.The patients with anastomotic leak were compared with patients without anastomotic leak.The OR value of local recurrence was 2.47 (95％ CI 1.72-3.55,P ＜ 0.01),the OR value of distant recurrence was 1.18 (95％ CI 0.98-1.43,P =0.08),and the OR value of 5-year survival rate was 1.68 (95％ CI 1.36-2.07,P ＜ 0.01).Conclusions Anastomotic leak after surgery is a bad prognosis factor in patients with colorectal cancer.It can increase the local recurrence rate,and decrease survival rate.
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Objective To investigate the relationship between preoperative anemia,low albumin,low body mass index and the prognosis of advanced gastric cancer.Methods Three hundred and seventeen patients diagnosed with advanced gastric cancer as well as complete clinical pathology data from January 2006 to January 2008 were retrospectively analyzed.The clinical pathologic factors including age,gender,tumor size,type of Borrmann,hemoglobin,serum albumin,body mass index,type of histology,blood vessels and lymphatic invasion,infiltration depth,lymph nodes metastasis.The single factor and multiple factors were analyzed.Results Tumor size,type of Borrmann,hemoglobin,serum albumin,body mass index,type of histology,blood vessels and lymphatic invasion,infiltration depth and lymph node metastasis were identified as influencing factors of the prognosis,while independent factors associated with the prognosis of gastric cancer were serum albumin (OR =1.546,95％ CI:1.069-2.237),infiltration depth (OR =1.933,95％ CI:1.182-3.162) and lymph nodes metastasis (OR =1.586,95％ CI:1.358-1.853).Conclusion Anemia and low body mass index are the influence factors but not the independent factors in the prognosis of gastric cancer,while low albumin concentration is the independent factor in the prognosis of gastric cancer.
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Digestive tract fistulas are abnormal connections between gastrointestinal tract and other organs that most commonly occur after surgery. Morbidity and mortality associated with postoperative fistulas are substantial as they are highly associated with nutritional deficits, hypermetabolism, septic complications and concomitant diseases that may appear during prolonged hospital stay. Digestive tract fistula is a challenging condition that involves a multidisciplinary approach to management. The main treatment includes intestinal rest,correction of electrolytic disturbances, parenteral nutrition,protection of the skin surrounding the fistula, and treatment and prophylaxis of any related local or systemic septic complications. Nutritional support, which is an effective and promising treatment for patients with digestive tract fistulas, can promote the closure of the fistula and decrease the duration of hospital stay.
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Humans , Digestive System Fistula , Metabolism , Therapeutics , Nutritional SupportABSTRACT
In recent years, it has been realized that intestinal function plays an increasingly important role in the treatment of critically ill patients. Awareness of intestinal dysfunction becomes more and more important. Enteral nutrition is an effective method for the recovery of intestinal function, and enteral nutrition is closely related to reliable administration route. Percutaneous endoscopic gastrostomy(PEG) is a minimally invasive, simple, safe and effective enteral nutrition route.
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Humans , Critical Illness , Enteral Nutrition , Intestinal Diseases , TherapeuticsABSTRACT
Objective To summarize the etiology,pathological mechanism, and the experience of diagnosis and treatment of bronchobiliary fistula (BBF). Methods Clinical data of 29 BBF patients admitted and operated on from 1976 to 2009 were analyzed retrospectively. Results Clinical menifestation included abdominal pain, chill and high fever,jaundice, hepatomegaly, chest distress, cough, hemoptysis,bilious cough, moist rale in the lower right lung or decreased or disapeared breath sound. Abdominal radiograph, chest X-ray, BUS, CT, PTC, MRCP and ERCP are helpful for localizing diagnosis. All the 29patients were surgically treated. 19 patients were treated by choledochotomy to extract common bile duct stones, T-tube drainage, liver abscess drainage, fistula excision and diaphragmatic repair. Three patients were treated by cholecystectomy, choledocholithotomy, and T-tube drainage. One patient underwent cholecystectomy, choledocholithotomy, and Roux-en-Y hepatojejunostomy. Three patients received liver abscess drainage, choledochotomy, T-tube drainage. 2 patients did subphrenic abscess drainage,choledochotomy, T-tube drainage. One patient complicating Oddi sphincter stenosis received liver abscess drainage, diaphragmatic repair, and Roux-en-Y hepatojejunostomy. 26 patients were cured. 3 patients died.Conclusions The etiology of BBF is obstruction related bilious tract infection leading to liver abcess and lung abscess. In the process of surgical treatment, relief of bilious tract obstruction, clearance of focal lesion and effective drainage of biliary tract are the mainstay of management.
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Objective To summarize the diagnosis and surgical treatment of the cavernous transformation of portal vein (CTPV). Methods Clinical data of 63 patients with adult CTPV trea-ted in our hospital from 1976 to 2006 were retrospectively analyzed. Results The diagnosis of CT-PV was comfirmed according to (1) The main symptoms were repeated haematemesis, hemafecia, hy-persplenotrophy, hypersplenia and normal hepatic function. (2) B uhrasonography or ultrasonic Doppler manifested that portal vein thinning or obstruction or embolism, honeycomb appearance con-duit can be seen around. Portal vein frequency spectrum can be seen in the honeycomb appearance con-duit. (3) CT and MR scan materials were exhibited that the main portal vein and its branches lost the normal shape and had the shaggy edge. (4) percutaneous splenoportography or selective arteriography of superior mesenteric artery showed that occlusion of the main branch of portal vein at the porta hepa-tis was revealed, and a masslike network of tortuose veins around the porta hepatis and many small ir-regular veins radiating from the network to the liver were demonst rated. Splenectomy and devaseu-larization was performed in 23, spleneetomy and splenorenal shunt in 32, portal systemic shunt plus porta-azygous devascularization in 8. Portal hypertension was treated first in CTPV with disease of biliary tract. No death happened. The rascult of haemogram recovered in a short period of time.Conclusion Once the patients are diagnosed to suffer from adult CTPV, they should receive explora-tory laparotomy. It is important to choose the most effective treating method for the disease.
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<p><b>OBJECTIVE</b>To investigate the inhibitory effect of the Hedgehog signal pathway blocker (cyclopamine) on DU145 cells.</p><p><b>METHODS</b>We interfered DU145 cells with cyclopamine at the concentrations of 1, 10, 50 and 100 micromol/L and detected its inhibitory effect on the cells by MTT colorimetry assay at 24, 48 and 72 hours, as well as its effect on the cell cycle by flow cytometry. We also determined the difference in the mRNA expression of cyclin E between the experimental and control groups by RT-PCR at 48 hours after 50 +/- micromol/L cyclopamine intervention.</p><p><b>RESULTS</b>Cyclopamine inhibited the DU145 cells in a time- and dose-dependent manner, with inhibition rates of 7.42, 12.70 and 59.15% in the 10, 50 and 100 micromol/L groups respectively at 24 hours, significantly different from that of the blank control group (P < 0.05). It markedly suppressed the proliferation of the DU145 cells at >10 micromol/L at 24 hours. Flow cytometry showed an obviously increased proportion of stage G1 cells at the concentration of >10 micromol/L after 48-hour intervention, with statistically significant differences from the G1 cell proportions in the control, 10 micromol/L and 50 micromol/ L groups, which were (52.17 +/- 2.21)%, (60.13 +/- 2.75)% and (74.30 +/- 3.52)% respectively (P < 0.01). The apoptotic peak was elevated with the increased concentration of cyclopamine. The cyclin E mRNA expression of the DU145 cells was decreased by 61.90% at 48 hours after 50 micromol/L cyclopamine intervention as compared with the blank control group (P < 0.01).</p><p><b>CONCLUSION</b>Cyclopamine can inhibit the proliferation of DU145 cells, and the mechanism may be related with its effect of down-regulating the cyclin E mRNA expression of DU145 cells and blocking them in stage G1. Cyclopamine can also induce the apoptosis of DU145 cells.</p>
Subject(s)
Humans , Male , Apoptosis , Cell Cycle , Cell Line, Tumor , Cell Proliferation , Cyclin E , Metabolism , Down-Regulation , Flow Cytometry , Signal Transduction , Veratrum Alkaloids , PharmacologyABSTRACT
Objective To summarize diagnosis and surgical treatment of insulinoma. Methods Clinical data of 64 patients with insulinoma from 1980 to 2006 were analyzed retrospectively. Results All patients had Whipple's triad. Accurate preoperative localization rate of B ultrasonography, CT and enhanced CT, MRI, DSA was 46.9% (30/64), 58.2 %(23/39) and 91.7%(11/12), respectively. Localization rate of intraoperative ultrasonography (IOUS) was 92% (23/25). The tumors were single in 58 cases, and multiple in 6 cases. In the location of single tumor, 19 of them were in the head, 17 in the body, and 22 in the tail;while for multiple tumors, 2 tumors were both located in the body in 4 patient, and 2 tumors were separately located in the body and tail respectively in 2 patients. Treatment Local enucleation was performed in 39 cases, resection of pancreatic body and tail in 13 cases, resection of pancreatic body and tail plus splenectomy in 6 cases, resection of pancreatic tail in 8 cases, resection of pancreatic tail plus splenectomy in 4 cases, laparoscopic resection of insulinoma in 1 case, piecewise resection of pancreas from left to right (blind resection) in 2 cases, pancreaticoduodenectomy in 1 case. The tumor was benign in 62 cases, and malignant in 2 cases. Pancreatic fistula developed after operation in 3 cases, acute pancreatitis in 4 cases, and in these cases, they healed after non-operative treatment. All patients had no symptoms of hypoglycemia after operation. At follow-up visit in 62 cases, 2 case of benign tumor recurred 4 years after operation, and was cured by resection of the pancreas body with tumor, 2 malignant tumors cases, recurred and died of hepatic metastasis in 3 years and 4 years after operation. Conclusions Whipple's triad and IRI/G>0.3 are the bases for qualitative diagnosis of insulinoma. Meticulously palpating the gland combined with IOUS during operation is the most effective method for accurate tumor localization. Resection of insulinoma is the best mode of surgical treatment of insulinoma.