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【Objective】 To investigate the efficacy of the adjustable "paper clip" techniques in the suture of dorsal vein complex (DVC) and retention of urethral function in robot-assisted laparoscopic radical prostatectomy (RALRP). 【Methods】 A total of 30 cases of prostate cancer treated with RALRP were enrolled, all of which used the adjustable "paper clip" techniques. During operation, the DVC was sewed with barbed suture, and then a reverse suture was made through two sides of the prostatic ligaments. A Hem-o-lock was used to fasten the suture, which would be flexible to control the degree of tightness for the ligature. Perioperative and follow-up data of urinary continence and symptoms were collected and analyzed. 【Results】 All operations were successful. The estimated blood loss was (123.3±80.7) mL, 53.6% patients recovered continence in 1 month, and the continence rate increased to 92.9% and 96.3% at month 3 and 6. 92.9 of patients had no risk of incontinence 3 months after surgery. 【Conclusion】 The adjustable "paper clip" techniques have advantages in reducing blood loss, maintaining clear surgical field, preserving urethral function, and improving urinary continence.
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Objective:To investigate the feasibility and safety of suprapubic bladder puncture and gland fixation in transurethral enucleation of the prostate.Methods:The clinical data of 15 patients with benign prostatic hyperplasia admitted to the First Affiliated Hospital of Guangxi Medical University from January 2020 to June 2020 were retrospectively analyzed. The age was (70.27±5.35) years old, preoperative serum prostate-specific antigen (PSA) level was (3.03±1.37) ng/ml, preoperative total prostate weight was 80.3(70.49, 96.78)g, preoperative postvoid residual urine volume(PVR)was 80 (55, 108)ml, and the maximum urine flow rate (Q max) was (6.13±2.25) ml/s. The international prostate symptom score(IPSS) was 25(22, 27), quality of life (QOL)score was 5(5, 6), international erectile function index-5 (IIEF-5) score was (15.38±5.10). All 15 patients underwent conventional transurethral plasma enucleation of prostate by using the three-lobe method, and the enucleated gland was pushed into the bladder completely. Then a laparoscopic pneumoperitoneum needle was used to perform suprappubic cystipuncture, and ureteral grasping forceps were inserted through the outer sheath. The forceps were used to fix the enencied gland. A rapid harvesting electric resection was performed in the broad space of the bladder, and the Ellick was rinsed to remove the tissue fragments. Surgical indicators and complications were recorded. The improvement of subjective score (IPSS, QOL, IIEF-5) and objective index (Q max, PVR) was compared between preoperative and postoperative. Results:All the 15 operations were completed successfully and there were no complications such as blood transfusion, capsule perforation, transurethral resection syndrome, bladder injury, bladder puncture site laceration and bleeding. The weight of resected prostate tissue was 44(40, 60)g, with blood loss (79.20±18.93)ml.The time of enucleation operation was (54.13±10.88)min, with harvest cutting time (14.67±2.50)min, evisceration efficiency (0.89±0.08)g/min, harvesting efficiency (3.26±0.36)g/min, bladder irrigation time (2.47±0.52) d. The time of indwelling catheter was (3.73±0.80)d.The postoperative hospital stay was (4.40±0.91) d. Temporary urinary incontinence occurred in 1 case after operation. All patients were followed up for 6 months after operation. The IPSS score was 3(2, 3), QOL score was 0(0, 1), IIEF-5 score was (20.12±2.30), Q maxwas (21.80±2.14) ml/s and PVR was 10(5, 15)ml, which were all significantly different compared with those before surgery ( P<0.05). The symptoms of the patients were significantly improved. Conclusions:Transurethral plasma enucleation of prostate combined with suprapubic bladder puncture and fixed gland is effective in the treatment of benign prostatic hyperplasia. The subjective symptoms and objective examination of patients have been significantly improved, and no adverse operation-related complications have occurred. It is a suitable method for enucleation of prostate in units which are not equipped with transurethral tissue planer.
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Epigenetic alterations include chromosome translocation, polycomb function and non-coding RNA abnormalities, and etc.A study on genome of childhood acute myeloid leukemia(AML)in children has shown that these abnormalities play an important role in the pathogenesis of AML, and epigenetic heterogeneity is associated with poor prognosis and relapse of AML.Presently, the overall survival(OS)for AML in children has been improved, but for the refractory/relapsed acute myeloid leukemia(r/r AML), the prognosis or curative effect remains poor.The curative effect is expected to be improved by epigenetics related therapies.A large number of studies have found that the epigenetic abnormalities of AML in children are different from those in adults.Some drugs targeting epigenetic alternations, such as DNA methyltransferase inhibitor and IDH inhibitor, have been used to treat AML in children.This paper aims to review the epigenetic regulation abnormalities in children with AML and the progress in relevant clinical applications.
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Objective:To assess the impact of kidney damage on the progression and prognosis of coronavirus disease 2019 (COVID-19) patients.Methods:The databases including CNKI, Wanfang Chinese Academic Journal Database, Pubmed, EMBASE and Cochrane databases were searched. The data retrieval period was from December 2019 to June 2020. During this period, RevMan 5.2 was used to extract and analyze data from the literature.Results:In this study, 15 articles, covering 11 448 COVID-19-related cases, were selected from the target databases. Meta-analysis results indicated that, for COVID-19 patients with acute kidney injury (AKI), the proportion of COVID-19 patients with AKI who received intensive care unit (ICU) treatment was significantly higher than that of patients without AKI ( OR=10.83, 95% CI 9.43-12.45, Z=33.53, P<0.001). Among them, the Asian group of COVID-19 patients with AKI accounted for 3.4% of all COVID-19 patients. The Asian group of COVID-19 patients with AKI who received ICU treatment accounted for 74.1% of all COVID-19 patients with AKI. Meta-analysis showed that the proportion of COVID-19 patients with AKI in the Asian group receiving ICU treatment was significantly higher than that of COVID-19 patients without AKI ( OR=18.66, 95% CI 9.85-35.34, Z=8.98, P<0.001). COVID-19 patients with AKI in the European and American groups accounted for 36.5% of all COVID-19 patients, and the European and American groups of COVID-19 patients with AKI who received ICU treatment accounted for 53.3% of all COVID-19 patients with AKI. Meta-analysis showed that the proportion of COVID-19 patients with AKI in the European and American groups receiving ICU treatment was significantly higher than that of COVID-19 patients without AKI ( OR=10.58, 95% CI 9.18-12.21, Z=32.40, P<0.001). The death risk of COVID-19 patients with AKI was significantly higher than that of patients without AKI ( OR=56.46, 95% CI 15.86-200.96, Z=6.23, P<0.001). COVID-19 patients with renal impairment had a higher risk of worsening and death than those without renal impairment ( OR=6.40, 95% CI 4.14-9.90, Z=8.36, P<0.001). Subgroup analysis showed COVID-19 patients with positive urine protein had a higher risk of worsening and death than those without positive urine protein ( OR=6.27, 95% CI 3.88-10.14, Z=7.49, P<0.001), and COVID-19 patients with elevated serum creatinine had a higher risk of worsening and death than those without elevated serum creatinine ( OR=7.13, 95% CI 2.58-19.72, Z=3.79, P<0.001). Conclusions:Patients with COVID-19 combined with AKI or only with positive urine protein and elevated serum creatinine are the risk factors for aggravation and even death. It is recommended that, in the diagnosis and treatment of COVID-19 patients, an optimization plan should be adopted to avoid or reduce the burden on the kidneys, meanwhile the patients' kidney damage should be paid closely attention to for protection and treatment in the early stage to avoid the occurrence of AKI. For patients who already suffered from AKI, replacement therapy, which would prevent these patient's condition from getting worse or even death, should be promptly implemented to alleviate the impact of kidney damage.
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Objective:To compare the clinical efficacy between the pressing tendon suture with a lateral anchor and the knotted suture with a lateral anchor in the treatment of severe rotator cuff tear under shoulder arthroscopy.Methods:A retrospective study was conducted of the 42 patients who had been treated at Department of Orthopedic Sports Medicine, Affiliated Hospital to Qingdao University from December 2018 to December 2019 for severe rotator cuff tear. They were 13 males and 29 females, with an age of (58.3±10.1) years (from 32 to 74 years). The injury was on the right side in 26 cases and on the left side in 16 cases. Of them, 22 received pressing tendon suture with a lateral anchor under shoulder arthroscopy and 20 knotted suture with a lateral anchor under shoulder arthroscopy. The flexion, abduction and external rotation of the shoulder, Visual Analog Scale (VAS) pain score, University of California-Los Angeles (UCLA) score, Constant-Murley shoulder score, American Shoulder and Elbow Surgeons (ASES) score and imaging MRI Sugaya grading were compared between the 2 groups 12 months after operation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability between them ( P>0.05). At 12 months after operation, the pressing tendon suture group had better abduction and flexion of the shoulder, a lower VAS pain score and a higher ASES score than the knotted suture group, but the differences were insignificant ( P>0.05). At 12 months after operation, the pressing tendon suture group achieved significantly better external rotation (39.2°±11.7°) and significantly higher UCLA score (28.1±4.7) and Constant-Murley shoulder score (77.0±9.3) than the knotted suture group (29.8°±14.6°, 22.1±5.7 and 66.4±11.0) ( P<0.05). At 12 months after operation, the imaging MRI Sugaya grading was significantly lower for the pressing tendon suture group than that for the knotted suture group ( P<0.05). Conclusion:In the treatment of patients with severe rotator cuff tear under shoulder arthroscopy, the pressing tendon suture with a lateral anchor may lead to better clinical prognosis than the knotted suture with a lateral anchor.
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Tendon injuries often need surgical treatment, which enables to repair the structure and stability of the tendons to a certain extent, whereas it is difficult to restore to their normal strength. The primary reason is that the natural healing ability of tendons is limited and the functions of the repaired tendons cannot be restored completely. As further researches on tendon healing are conducted, biological technology provides a novel orientation for tendon repair. One of the research hotspots of tendon repair currently is to facilitate tendon healing using biological auxiliaries, including tendon stem /progenitor cells(TSPCs) and growth factors. The authors review the research progress in mechanism of TSPCs and growth factors accelerating tendon healing in order to provide a reference for the biological treatment of tendon injuries.
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Hepatocellular carcinoma (HCC) is one of the most common malignant cancers and has high incidence and mortality rates and poor prognosis. Forkhead box (FOX) transcription factor family can regulate cell growth, differentiation, and tissue development and plays an important role in tumor. This article reviews the association of the molecular expression of the FOX family with the development, progression, and prognosis of HCC and analyzes the mechanism of action of FOX in the progression of HCC. It is pointed out that FOX family is expected to become a new target for HCC treatment.
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Objective@#To summarize the technical experience of extracorporeal membrane oxygenation(ECMO)catheterization in children.@*Methods@#Data of patients that received ECMO treatment in the pediatric intensive care unit between October 2016 and October 2018 were analyzed retrospectively.The age, weight, diagnosis, complications and the final outcomes of the patients, as well as the working mode, catheterization mode and duration of ECMO were collected.@*Results@#A total of 15 children were treated with ECMO, including 5 males and 10 females.The median age(range) was 4.9 (1.0-11.0)years and the median weight(range) was 21.5(8.5-49.0)kg.There were 5 cases of fulminant myocarditis, 7 cases of severe pneumonia, 3 cases of septic shock, 8 cases of venous-arterial bypass(VA mode), and 7 cases of venous-venous bypass(VV mode). All the 15 patients underwent percutaneous catheterization.Two patients that experienced difficulty in percutaneous catheterization turned to open catheterization.None abandoned ECMO due to the difficulty in catheterization.The position and depth of the catheter, and the flow rate required no further adjustment.The mean ECMO duration was 96.8(1-366)h.Weaning was successful in 8 cases(53%). One case was transferred and 8 cases were dismissed, and the survival rate was 60%.There were 2 cases of bleeding at the site of catheter entrance, one treated with local compression and the other with suture.There was 1 case of femoral artery thrombosis that was relieved by percutaneous femoral artery angiography and intracavitary formation.Another case developed carotid artery thrombosis and had been undergoing antithrombotic therapy and following-up.One case had nerve injury in the left lower extremity that was relieved by oral vitamin Bs and low frequency electrical stimulation.@*Conclusion@#Catheterization is the basis of ECMO execution.Catheterization method should be individualized.Percutaneous catheterization is the choice of thumb due to its safety and simplicity.In case of failure, or during the extra-cardiac compression, the surgical method should be taken quickly, and the catheter should be placed in an open or partly-open manner.Proficient catheterization technique ensures the smooth application of ECMO in children.
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Objective To summarize the technical experience of extracorporeal membrane oxygena-tion(ECMO)catheterization in children. Methods Data of patients that received ECMO treatment in the pe-diatric intensive care unit between October 2016 and October 2018 were analyzed retrospectively. The age, weight,diagnosis,complications and the final outcomes of the patients,as well as the working mode,catheter-ization mode and duration of ECMO were collected. Results A total of 15 children were treated with ECMO,including 5 males and 10 females. The median age(range) was 4. 9 (1. 0-11. 0)years and the median weight(range) was 21. 5(8. 5-49. 0)kg. There were 5 cases of fulminant myocarditis,7 cases of severe pneu-monia,3 cases of septic shock,8 cases of venous-arterial bypass( VA mode),and 7 cases of venous-venous bypass(VV mode). All the 15 patients underwent percutaneous catheterization. Two patients that experienced difficulty in percutaneous catheterization turned to open catheterization. None abandoned ECMO due to the difficulty in catheterization. The position and depth of the catheter,and the flow rate required no further ad-justment. The mean ECMO duration was 96. 8(1-366)h. Weaning was successful in 8 cases(53%). One case was transferred and 8 cases were dismissed,and the survival rate was 60%. There were 2 cases of bleeding at the site of catheter entrance,one treated with local compression and the other with suture. There was 1 case of femoral artery thrombosis that was relieved by percutaneous femoral artery angiography and intracavitary for-mation. Another case developed carotid artery thrombosis and had been undergoing antithrombotic therapy and following-up. One case had nerve injury in the left lower extremity that was relieved by oral vitamin Bs and low frequency electrical stimulation. Conclusion Catheterization is the basis of ECMO execution. Catheter-ization method should be individualized. Percutaneous catheterization is the choice of thumb due to its safety and simplicity. In case of failure,or during the extra-cardiac compression,the surgical method should be taken quickly,and the catheter should be placed in an open or partly-open manner. Proficient catheterization tech-nique ensures the smooth application of ECMO in children.
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Objective To retrospectively analyze the injury characteristics of victims and treatment strategies in the explosion accident on the 17th May 2018 in Xixia county (Xixia "May 17th" explosion accident). Methods Based on the practice featured in pre-hospital emergency of Henan province and Nanyang city Emergency Center in the explosion accident, a retrospective analysis for the Level Three medical rescue was conducted, where a total of thirteen survived victims in Xixia "May 17" explosion accident were studied retrospectively. The data included the gender, age, burned extent and depth of the patients, burns complicated by trauma, complication of burn, respiratory function maintenance, resuscitation during shock stage, skin grafting with excision and scab. Furthermore, the data of organ function and the effect of the 90-day comprehensive treatment for the burned victims wereanalyzed. Results completion the Level Three treatment on time, which was depended on the leading role played by the regional trauma centers was the main rescuing mode of the work in Xixia county, where the primary and secondary treatments were the key parts. The three-level treatment model includes: the local hospital acts as a level-one emergency medical institution, county hospitals function as secondary emergency medical institutions, and other higher medical institutions are the tertiary first aid medical institutions. The pre-hospital and in-hospital emergency procedures were initiated immediately after the large-scale explosive burn being identified, the key to the successfully rescue was to set up a comprehensive treatment team for burns and trauma. Rescue team should involve burn department and other related departments, including the departments of emergency, general surgery, orthopedic, thoracic surgery, neurosurgery, plastic surgery, intensive care unit, blood transfusion unit, anesthesiology, and interventional radiology, etc. All the thirteen burned patients were male, with inhalation injury, blast injury, hemopneumothorax, brain injury, bone fractures, and etc. Eight of them (61.54%) had multiple organ dysfunction syndrome (MODS). MODS mainly involved respiratory, circulatory, liver, gastrointestinal tract, kidney and coagulation function. With the multi-discipline treatment, the wound of 6 severely-burned patients started healing and can be discharged after keeping the patency of airway, applying resuscitation fluid and comprehensive treatments such as debridement and dressing change. Among 7 patients with extensive deep burns, one case with skull-based fracture, open craniocerebral, extensive intracranial hemorrhage and hemopneumothorax, died 9 hours later. Another case died within 24 hours after injury due to obvious exudation on the site of early incision and relaxation of wound. The escharotomy, micro-dermis and allograft skin transplantation were carried out for five cases with extensive deep burns from the 4th day after the recovery of shock. One week later, the second stage of microsphere skin transplantation was performed. But all died of sepsis or fungal infection. Conclusions MODS and infection often occur during the course especially for patients with extensive and deep burns due to the great explosion in Xixia county, most of whom were accompanied with MODS and infection. Therefore, assembling multi-discipline team for treating the group of explosively-burned patients can increase the survival rate and reduce the possibility of disability.
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Objective To investigate the fetal management of prenatally diagnosed fetal mediastinal masses and the initial experience of neonatal thoracoscopic minimally invasive treatment. Methods We per-formed a retrospective study from November 2015 to November 2016 of all newborns affected by mediastinal masses and treated by thoracoscopic surgery. This group of cases were found with mediastinal masses by pre-natal ultrasound. The earliest detection of abnormal time was 16 to 31 weeks of pregnancy,with an average of 25 weeks. In the fetal period,the patients were treated with multidisciplinary consultation and individual man-agement. Prenatal examinations helped us except for chromosomal abnormalities and other organ abnormali-ties. After birth,the patients underwent CT and MRI examination. The diameter of the tumor was 1. 7 to 5. 7 cm,with an average of 3. 2 cm. The operative age was 4 to 29 days,with an average of 12. 4 days. This group of newborns were performed thoracoscopic mass resection and confirmed by intraoperative pathological exam-ination. Results After individualized precise prenatal management,all children were born successfully and confirmed that prenatal diagnosis was accurate. All mediastinal masses were completely excised in the neo-natal period. Five mediastinal masses were completely excised. One posterior mediastinum immature teratoma was converted to open thoracotomy. The mean operative duration was 112 min(100 to 150 min). There was no operative complication with a minimal amount of blood loss. With a smooth recovery,the hospital stay was 11-17 days. Pathological results included:1 esophageal duplication,2 bronchogenic cysts,1 lymphangioma, 1 cystic teratoma of anterior mediastinum,1 immature teratoma of posterior mediastinum. During a mean fol-low-up period of 8-14 months,neither complication nor recurrence occurred. Conclusion These are the pre-conditions for early treatment of neonatal patients with mediastinal masses,including definite prenatal diagno-sis,multidisciplinary consultation system and individualized and accurate fetal management. Throcoscopic ex-cision of mediastinal masses is both feasible and safe in neonates. Proper preoperative case selection may pre-vent a conversion into thoracotomy due to huge solid mass.
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Aim To examine the role and uderlying mechanisms of Lin28 /let-7d axis in the proliferation of lung fibrobalsts and fibroblasts-into-myfibroblasts tran-sition,and provide novel strategy for the treatment of idiopathic pulmonary fibrosis (IPF).Methods We induced experimental lung fibrosis in mice by intratra-cheally injection of bleomycin (BLM).Ang Ⅱ and TGF-β1 were used to induce fibrogenesis in cultured MRC-5 cells;qRT-PCR and Western blot were applied to determine the changes of Lin28B,collagen 1 α1 and collagen 3α1 ;MTT assay,Edu satining and immun-ofluoresence were used to examine the cell viability, proliferation and fibroblasts-into-myofibroblasts transi-tion in MRC-5 cells.Results Lin28B was increased in the lung of mice with experimental lung fibrosis and in MRC-5 cells treated with AngⅡ or TGF-β1 .Moreo-ver,Lin28B enhanced collagen deposition via inhibi-ting expression of let-7d,which maybe contribute to the progression of IPF.In addition,further studies showed that Lin28B promoted proliferation and fibro-blasts-into-myofibroblasts in MRC-5 cells.Conclusion Lin28B /let-7d axis contributes to fibrogenesis via promotes fibroblasts-into-myofibroblasts transition, which may provide novel approaches for lung fibrosis treatment.
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In recent years, chemotherapy is an important treatment for colorectal cancer, but the therapeutic effect of chemotherapy drugs is still poor, adverse reactions, and there are individual differences, studies have found that chemotherapy sensitizer in colorectal cancer is important, it is not only can improve the efficacy of chemotherapy drugs can reduce the toxicity of the neoadjuvant chemotherapy is to becomne a research focus in recent vears.Chemotherapy sensitizer will lead people to explore various combinations of different drugs and chemotherapy for the treatment of diseases and bring better outcomes, it will usher in a new era.The efficacy, mechanism, research status and safety of the colorectal cancer for enhancing its chemotherapy sensitivity of these representative drugs were reviewed in these article.
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Objective To study the application value of microvascular density (MVD)in determination of transrectal ultrasound hemodgynamics in the differential diagnosis of prostate cancer and chronic prostatitis, and to provide imageological basis for their differential diagnosis.Methods A total of 6 1 patients suspected of prostate cancer underwent transrectal ultrasound scan and ultrasound guided biopsy.38 cases of prostate cancer and 23 cases of chronic prostatitis were confirmed by pathology and retrospectively analyzed.The peak systolic blood flow velocity (Vs)and blood flow classification of the suspicious lesions were compared and analyzed.The MVD was observed by Weidner method with monoclonal antibody CD34 immunohisochemistry staning. Results The Vs and the blood flow classification of the suspicious lesions in prostate cancer group were significant higher than those in chronic prostatitis group (P<0.05).The MVD in prostate cancer group and chronic prostatitis group were 46.70±13.87 and 34.38±7.28,respectively(P<0.05);the MVD in prostate cancer (C+D)stage and (A+B)stage were 56.99±12.85 and 39.97±10.21,respectively(P<0.05);the MVD in prostate cancer with high Gleason score group and low Gleason score group were 53.79±13.30 and 36.96±7.24,respectively(P<0.05).The Vs and the blood flow classification of the suspicious lesions of prostate cancer had a significantly positive correlation with the MVD (r=0.793,P<0.05;r=0.723,P<0.05).Conclusion The Vs and the blood flow classification of prostate cancer by ultrasound can well reflect the changes of the micrangium in tumor tissue. The Vs and blood supply grade of suspicious lesions in the patients with prostate cancer are significantly higher than those in the patients with chronic prostatitis.They may be useful for the identification of prostate cancer and chronic prostatitis.
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Objective: To investigate the effect of Trichostatin A (TSA) on histone acetylation and expression of ING1b mRNA in Colo205 human colon cancer cell line. Methods: Human colon cancer Colo205 cells were cultured and divided into 4 groups. Cells in the control group (group A) was treated without TSA. In the other three groups, cells were treated with 3 different concentrations of TSA: 50μg/L (group B), 100μg/L (group C), and 200μg/L (group D). At 24 hours after treatment, the level of histone H3 acetylation was analyzed by chromatin immunoprecipitation (CHIP) and the expression of ING1b mRNA was detected by RT-PCR with qPCR. The growth of Colo205 human colon cancer cells in group C and D was obviously inhibited compared with that in group A and B. Results: The Ct value of histone H3 acetylation and mRNA expression of ING1b in group A were 23.25± 0.08 and 23.32±0.05, respectively. After treatment with TSA, the 2~(-△△Ct) value of histone H3 acetylation in group B, C, and D were 1.12, 4.21 and 4.38, respectively. The level of histone H3 acetylation in group C and D was increased more compared with that in group A (P<0.05) and there was no difference between group B and group A (P>0.05). The 2~(-△△Ct) value of the expression of ING1b mRNA in group B, C and D were 1.33, 4.52 and 4.62, respectively. The expression of ING1b mRNA in group C and D were more than that in group A (P<0.05). Group B and group A had a similar level of ING1b mRNA expression (P>0.05). Conclusion: The histone acetylation is probably responsible for ING1b expression silencing in Colo205 human colon cell line. TSA at 100μg/L can increase the level of acetylation and activate the gene transcription which is silenced by low level of acetylation and induce the expression of gene, inhibiting the growth of tumor cells.
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Objective To explore the surgical management of chronic pancreatitis complicated with pancreatolithiasis (CPPL). Methods The clinical data of 66 patients with CPPL were retrospectively analyzed. Pancreatolithiasis was classified into 4 types according to the location of stones: stones located in the head of the pancreas (type Ⅰ, n=28), stones located in the body of the pancreas (type Ⅱ, n=30), stones located in the tail of the pancreas (type Ⅲ, n=1) and stones located from the head to tail of the main duct of pancreas (type Ⅳ, n=7). Ten patients (including 4 with type Ⅰpancreatolithiasis, 5 with type Ⅱ and 1 with type Ⅳ) received conservative treatment; 10 patients with type Ⅰ pancreatolithiasis underwent lithotomy under endoscope; pancreaticoduodenectomy and Beger procedure were carried out on 14 patients with type Ⅰ pancreatolithiasis, pancreatolithotomy+pancreaticojejunostomy on 25 patients with type Ⅱ pancreatolithiasis, resection of pancreatic tail and spleen on 1 patient with type Ⅲ pancreatolithiasis, and Puestow-Gillesby procedure, dividing of the neck of pancreas+removing stones from both ends of pancreatic duct+Roux-en-Y pancreatojejunostomy on 6 patients with type Ⅳ pancreatolithiasis. Results Sixty-two patients were followed up for 2 months to 15 years, and the number of patients with recurrence for type Ⅰ, Ⅱ, Ⅲ and Ⅳ pancreatolithiasis was 4, 2, 0 and 3, respectively. Conclusions Early surgical management according to the location of stones should be carried out after confirmed diagnosis of CPPL. Individualized management based on correct diagnosis and classification plays an important role in the prevention of pancreatolithiasis recurrence.
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Objective To investigate the correlation of the expression of KAI1/CD82 and laminin receptor (LNR) in cholangiocarcinoma, and study its role in the invasion and metastasis of cholangiocarcinoma. Methods The expressions of KAI1/CD82 and LNR in 48 cholangiocarcinoma tissue samples were detected by SP immunohistochemistry, and their relationships with clinicopathological factors were analyzed. Results The positive expression rates of KAI1/CD82 and LNR in cholangiocarcinoma were 31% (15/48) and 54% (26/48), respectively. In highly differentiated cholangiocarcinoma, the positive expression rate of KAI1/CD82 was high (χ2=3.911, P<0.05), while that of the LNR was low (χ2=6.970, P<0.05). The positive expression rate of KAI1/CD82 in cholangiocarcinoma with metastasis was significantly lower than that in cholangiocarcinoma without metastasis (χ2=5.765, P<0.05), while the positive expression rate of LNR in cholangiocarcinoma with metastasis was significantly higher than that in cholangiocarcinoma without metastasis (χ2= 9.952, P<0.05). The expression level of KAI1/CD82 was negatively correlated with that of the LNR ( r = -0.462, P < 0.01 ). Conclusions The up-regulated expression of LNR in cholangiocarcinoma correlates with the decreased expression of KAI1/CD82, and plays an important role in the invasion and metastasis of cholangio-carcinoma.
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Objective To investigate the expression of LOXL2 protein (lysyl oxidase like-2 protein) and epithelial-mesenchymal transition (EMT) related markers in cholangiocarcinoma tissues and its relation with the malignant features. Methods The expression of LOXL2、E-cadherin and Vimentin protein in 48 cases of cholangiocarcinoma tissues was detected by immunohistochemistry and compared with the clinicopathological data of cholangiocarcinoma. Results The positive expression rate in cholangiocarcinoma was 71% ( 34/48 ) for LOXL2 and 46% ( 22/48 ) for Vimentin, the absent expression rate was 52% (25/48) for E-cadherin. The positive expression rate of LOXL2 was significantly associated with the absent expression of epithelium markers E-cadherin ( r = 0. 394, P < 0. 05 ) and the positive expression of fibroblast markers Vimentin ( r = 0. 406, P < 0. 05 ). There was no correlation between the expression of LOXL2 and patients gender, age, and cancer differentiation, but a significant correlation with tumor metastasis was found ( P < 0. 05 ). Conclusions LOXL2 protein overexpression in cholangiocarcinoma may accelerate invasion of cholangiocarcinoma through induced EMT.
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Objective To evaluate the treatment of postoperative bile-duct residual stones with rigid cholangioscopy. Methods Three hundred and twenty-seven cases of bile duct residual stones were treated with rigid cholangioscopy. As a route for the rigid cholangioscopy, the T-tube tract (315 cases), the U-tube tract (5 cases) and the jejunostomy tube tract of efferent limb (7 cases) were used. Results Four hundred and eighty-six rigid cholangioscopic sessions were carried out, 1.5 sessions on the average for each patient. Treatment was successful in all but one patient in whom rigid cholangioscopic access to bile duct was difficult since the T-tube tract was too long. The rate of complete removal of the stones was 95.4%. There were no serious complications. Conclusions It′s possible to pass the instrument into the common bile duct and the majority of the intrahepatic bile duct. Many of the problems associated with residual stones can be overcome by this method and good results achieved. This technique seems to be a useful new alternative in patients with difficult retained bile duct stones.