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Objective:To investigate the correlation between variations in mitochondrial DNA (mtDNA) control region (D-loop) and keloids.Methods:A total of 216 patients with keloids were collected from Department of Dermatology, the First Affiliated Hospital of Kunming Medical University from 2016 to 2019. Total DNA was extracted from peripheral blood samples of all the patients, as well as keloid tissues and perilesional normal skin tissues of 25 patients with keloids. Peripheral blood samples were collected from 299 health checkup examinees without keloids in Health Examination Center, the Affiliated Hospital of Yunnan University, who served as controls. PCR amplification and Sanger sequencing were performed on the mtDNA D-loop region, and mutation sites in each sample were analyzed by comparisons with the revised Cambridge Reference Sequence (rCRS) . Haplogroups were assigned in the 2 groups by using Phylotree-mtDNA tree Build 17. Mutations in the mtDNA D-loop region were compared among keloid tissues, perilesional normal skin tissues and peripheral blood samples. A median-joining network was constructed via network 5.0 software. Binary logistic regression analysis was performed to investigate the correlation between haplogroup frequencies and the occurrence of keloids, and chi-square, t and t′ tests were used to analyze clinical data. Results:Among the 216 patients with keloids, variations in mtDNA D-loop region were classified into 10 haplogroups, including A, B, D, R9, G, M*, M7, M8, M9 and N9, with the haplogroups R9 and M9 showing the highest (21.3%, 46/216) and lowest (0.9%, 2/216) frequencies respectively. The frequencies of haplogroups M7 ( P=0.040, OR=0.248, 95% CI: 0.066 - 0.937) and N9 ( P=0.048, OR=0.191, 95% CI: 0.037-0.986) were significantly lower in the patients with keloids than in the controls. The median-joining network plot showed that the distribution pattern of the haplogroup M7 differed between the patients with keloids and controls. Significantly less number of lesional sites and younger age of onset were observed in the patients with haplogroup M7 compared with those with non-M7 haplogroups ( P=0.000 1, 0.045, respectively) . Conclusion:The haplogroup M7 is correlated with the occurrence of keloids, and may be a potential protective factor for keloid formation.
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HBV A1762T/G1764A double nucleotide substitution (also called TA mutation) is relatively common in liver diseases. Hepatocyte nuclear factor 4 (HNF4) is one of liver-enriched transcription factors, and TA mutation is located in the binding region of HNF4 and HBV and plays an important regulatory role in HBV gene transcription and replication. Several studies have pointed out that TA mutation may aggravate liver diseases after HBV infection and increase the risk of chronic liver failure and liver cancer; however, it is still unclear how TA mutation can aggravate liver disease after HBV infection, and more studies are needed for clarification in the future. This article reviews the association between HBV A1762T/G1764A double nucleotide substitution and liver diseases.
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Hernia and abdominal surgery keeps moving forward rapidly In 2017, lots of progress were achieved in etiology, material, and surgical technique. In etiology, TTN gene missense mutation was found in family members of indirect inguinal hernia. In material, a long-term slow-absorptive patch was present leading to a good choice of hernia therapy; application of 3D print for individual patch repair was expected. In surgical technique, efficacy of laparoscopic minimal invasive procedure or MILOS and eMILOS procedures was satisfactory in the treatment of complicated incisional hernia; tissue separation, patch placement and abdominal wall reconstruction by robotic surgery resulted in bigger operative space, faster postoperative recovery and lower morbidity of infection and seroma at operative site. In addition, there were more and more evidences to support that prophylactic use of patch in enterostomy can prevent the occurrence of postoperative parastomal hernia and incisional hernia. Domestic surgeons contributed mainly to the standardization of hernia surgery in 2017. This article reviews the hotspots of hernia and abdominal wall surgery in 2017, in the meantime, we prospect the progress in the near future.
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Hiatal hernia is a common disease, which is always complicated with gastro-esophageal reflux. However, owing to restriction of diagnosis ability, the finding of hiatal hernia is still at low level in China. How to increase the finding or diagnosis of this disease and improve the life quality of patients, is an important task of radiologists and hernial surgeons. Surgery has been integrated into the therapy of hiatal hernia for a long time, but most surgeons still need to improve their recognition about its essence and the anti-reflux mechanism of lower esophagus. The purpose of surgery of hiatal hernia is not only to repair the defect, but to recover the anatomic structure and function of lower esophagus, as well as to rebuild anti-reflux barrier in stomach at the mean time. The key principle of surgery is to recover structure of GEJ, location of LES and the length of lower esophagus through fundoplication and firm fixation, which prevent it from dislocating to thoracic cavity. By adhering to the principle of this, we can combine the anatomy and function in repair of hiatal hernia, and recover and keep the anti-reflux function of LES utmost. MDT, specialized precision program and standardization will play more and more important roles in hiatal hernia therapy in the future. In this article, we made a review about the diagnosis and therapy history of hiatal hernia, as well as prospected the progress in the near future.
Subject(s)
Humans , China , Esophagus , Fundoplication , Gastroesophageal Reflux , Hernia, Hiatal , Diagnosis , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To investigate the efficacy of single-hand four-needle suture with sled-shaped needle three-tail fixed stitch in closure of pesudohernia sac of direct hernia under transabdominal preperitoneal (TAPP) inguinal hernia repair.</p><p><b>METHODS</b>A randomized controlled trail was conducted on adult patients with unilateral direct inguinal hernia undergoing laparoscopic TAPP repair from January 2014 to January 2018 at the Sixth Affiliated Hospital of Sun Yat-sen University. A total of 156 patients were enrolled prospectively in the study and were randomly divided into single-hand four-needle suture group (trial group, 76 cases) and traditional tacking group (control group, 80 cases). In trial group, sled-shaped needle three-tail knot-free stitch was applied to the continuous four-needle suture. The sled-shaped needle three-tail fixed stitch was made as follows: straighten the tail of a 3-0, 1/2-circle looper VICRYL Rapide into a sled shape; use suture overlap method to make and tighten a single knot; thread the end of the needle into the single knot loop;knot two ends of the thread next to the first knot; tighten the second knot, leaving about 12 cm to the end of the needle;cut the end of the loop (leaving about 0.6 cm) and the other end of the thread(leaving about 1.5 cm). In the control group, a hernia repair tack was used to fix the pseudohernia sac on pectineal ligament. This study was approved by the Hospital Ethics Committee(approval number: L2014ZSLYEC-016). Operation time, pseudoherina sac closure time, hospitalization cost, morbidity of postoperative complication, VAS score and postoperative recurrence were compared between two groups.</p><p><b>RESULTS</b>All the patients completed operations successfully. There were no significant differences between trial group and control group in age [(60.2±0.4) years vs. (61.1±0.7) years)], gender (male ratio 93.4% vs. 92.5%), BMI [(25.1±0.2) kg/m vs. (24.9±0.2) kg/m ], defection area [(16.1±0.4) cm vs. (15.7±0.7) cm ] (all P > 0.05). As compared to control group, trial group had longer operative time[(34.2±1.9) minutes vs. (30.3±1.1) minutes, t=5.484, P=0.045], longer closure time of psudohernia sac [(4.2±0.5) minutes vs. (1.8±0.7) minutes, t=7.423, P=0.031], but lower VAS score (3.2±0.1 vs. 5.3±0.6, t=-3.186, P=0.015) and lower total cost [(9 897.3±104.4) yuan vs. (12 325.6±169.7) yuan, t=-3.972, P=0.023]. No severe complication and death were found in either groups intra-operatively and postoperatively. No mesh infection and relapse occurred during postoperative follow-up of 1-24 (12.0±1.2) months. During follow-up, seroma occurred in 2 cases (2.6%) of trial group and 3 cases (3.8%) of control group without significant difference (χ =1.284, P=0.799), and all were absorbed and disappeared within 30 days after local application of mirabilite.</p><p><b>CONCLUSION</b>Compared to tack fix method, single-hand four-needle suture with sled-shaped needle three-tail fixed stitch can effectively close pseudohernia sac, reduce hospitalization cost and ameliorate postoperative pain in TAPP repair, which is worth promotion.</p>
Subject(s)
Humans , Male , Middle Aged , Hernia, Inguinal , General Surgery , Herniorrhaphy , Methods , Laparoscopy , Surgical Mesh , Suture Techniques , Sutures , Treatment OutcomeABSTRACT
Laparoscopic and robotic techniques change the view of groin anatomy from inside to outside.The amplification view of laparoscopy extends surgeons' visual field,with clear and precise anatomy,less bleeding and certain outcome.Robotic flexible joints increase angle of suture to abdominal wall.In this background,hernia surgeons pay close attention to closure of abdominal wall defect,choice and fix of mesh as well as status of robotic technique in hernia filed.
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Objective To investigate the application value of the preoperative progressive pneumoperitoneum (PPP) in parastomal hernia repair.Methods The retrospective cross-sectional study was conducted.The clinical data of 28 patients who underwent parastomal hernia repair using PPP in the Sixth Affiliated Hospital of Sun Yat-sen University from December 2014 to February 2017 were collected.Patients received abdominal computed tomography (CT) scan after admission,and volumes of the hernia sac and abdominal cavity and (volume of the hernia sac / total volume of the abdominal cavity)× 100.0％ were respectively calculated.Open or laparoscopic parastomal hernia repair was selected based on the effects of artificial pneumoperitoneum.Observation indicators:(1) PPP situations:① completion;② changes of volumes of the hernia sac and abdominal cavity before and after PPP;③ adhesion and retraction of parastomal hernia contents after PPP;(2) surgical and postoperative recovery situations;(3) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative long-term complications and recurrence of parastomal hernia up to May 2017.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Repeated measurement data were evaluated with the repeated measures ANOVA.Results (1) PPP situations:① completion:28 patients received successful ultrasound-guided indwelling catcher.Twenty-four patients completed PPP,with a completion rate of 85.7％ (24/28) and an air injection volume of (3 995±531) mL,and 4 stopped PPP.Eighteen patients had varying degrees of abdominal pain,abdominal distension and scapular pain,including 17 with tolerance and 1 with disappearing of symptoms at day 6.Of 5 patients with shortness of breath,3 were improved or well tolerated through breathing exercises,and symptoms of 2 disappeared at day 7 and 9.Three patients had mild subcutaneous emphysema.The arterial CO2 tension of 1 patient was high and then returned to normal at day 7.Some patients had simultaneously multiple adverse reactions.② Changes of volumes of the hernia sac and abdominal cavity before and after PPP:volumes of the hernia sac before and after PPP were (699± 231) mL and (993 ± 332) mL,with a statistically significant difference (F=129.29,P＜0.05),and increasing volume of the hernia sac was (294± 167) mL,with an increasing rate of 43％±15％.Volumes of the abdominal cavity before and after PPP were (6 520±745)mL and (9 196± 909) mL,with a statistically significant difference (F=429.42,P＜0.05),and increasing volume of the abdominal cavity was (2 715±709)mL,with an increasing rate of 42％± 12％.(Volume of the hernia sac / total volume of the abdominal cavity) × 100.0％ before and after PPP were 9.6％ ± 2.7％ (less than or equal to 10.0％ in 20 patients,more than 10.0％ and less than or equal to 15.0％ in 6 patients,and more than 15.0％ in 2 patients) and 9.7％± 2.8％,with no statistically significant difference (F =0.44,P＞0.05).③ Adhesion and retraction of parastomal hernia contents after PPP:results of abdominal CT showed anterior abdominal bulging,abdominal contents prostrated at the base of the abdominal cavity due to gravity,and gas was full of gaps.Abdominal adhesion signs:adhesions of banded fibrous connective tissue established a connection between the base of the abdominal cavity and anterior abdominal wall,and intestinal canals were found inside the adhesions.Parastomal hernia contents of 28 patients had varying degrees of retraction to abdominal cavity,including 9 with complete retraction,13 with a great amount of retraction (retraction volume ＞50％) and 6 with a small amount of retraction (retraction volume ＜50％).Four patients were accompanied by incomplete stoma obstruction,and then obstruction disappeared or relieved after PPP.(2) Surgical and postoperative recovery situations:all the 28 patients underwent successful operations,without intestinal canal injury.Three patients received open parastomal hernia repair,including 2 receiving preperitoneal mesh repair using 8 layers Biodesign meshes (deep venous catheter for local drainage was placed and then removed at postoperative day 2 and 3) and 1 receiving Sugarbaker surgery using PCOPM mesh (peritoneal drainage-tube was placed and then removed at postoperative day 2).Other 25 patients received laparoscopic parastomal hernia repair and Sugarbaker surgery using PCOPM and Sepramesh meshes (no drainage-tube was placed).Bladder pressure of 28 patients at postoperative day 3 was (13±6)cmH2O (1 cmH2O =0.098 kPa),without an abnormal high pressure.Nine patients with postoperative complications were improved by conservative treatment,including 3 with seroma,3 with delayed stoma defecation or incomplete intestinal obstruction,2 with pulmonary infection and 1 with urinary tract infection.There were no occurrences of abdominal compartment syndrome,cardiac failure,lung failure,renal failure,other severe complications and perioperative death.Duration of postoperative hospital stay was (7.2± 1.5) days.(3) Follow-up situations:25 of 28 patients were followed up for 3-25 months,with a median time of 11 months.During follow-up,2 patients had chronic pain around the operation and a sense of discomfort and then were improved by symptomatic treatment,and 1 with parastomal hernia recurrence at postoperative month 6 after open preperitoneal mesh repair underwent again open preperitoneal mesh repair,without recurrence.There were no occurrence of tardive mesh infection and other longterm complications.Conclusion PPP in the treatment of parastomal hernia repair is safe and feasible.
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Xihuang pill,a famous anticancer traditional Chinese medicine formula,has curative effect in clinical application. It can inhibit the growth and invasion of tumor cells and cancer stem cells,prevent angiogenesis,and reverse the tumor immunosup-pressive microenvironment. This review summarizes the reported Xihuang pill' s anticancer mechanism and clinical application on colorectal cancer,breast cancer,liver cancer,so as to provide a reference for the further research and development on anticancer ap-plication of Xihuang pill.