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Objective To investigate the clinical value of arterial first approach in laparoscopic pancreaticoduodenectomy (LPD).Methods The retrospective cohort study was conducted.The clinicopathological data of 181 patients with pancreatic head and periampullay tumors who underwent LPD in the Affiliated Tongji Hospital of Huazhong University of Science and Technology between October 2014 and December 2016 were collected.Among 181 patients,96 using arterial first approach and 85 using traditional approach were respectively allocated into the experimental group and the control group.Surgery was applied to patients in the same doctors' team,and there were the same extent of surgical resection,range of lymph node dissection and digestive tract reconstruction.Observation indicators:(1) intraoperative situation;(2) postoperative situation;(3) followup and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect the tumor-free survival up to February 2017.Measurement data with normal distribution were represented as x±s,and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range).Comparison of count data were analyzed using the chi-square test or Fisher exact probability.Results (1) Intraoperative situation:all the patients underwent successful LPD.Overall operation time and time of digestive tract reconstruction were respectively (268 ± 20) minutes,(33 ± 10) minutes in the experimental group and (285±25)minutes,(30± 17)minutes in the control group,with no statistically significant difference between 2 groups (t =8.529,2.741,P＞ 0.05).Time of tumor resection with superior mesenteric venous invasion were respectively (216± 13)minutes and (264±22)minutes in the experimental and control groups,with a statistically significant difference between the 2 groups (t=41.826,P＜0.05).Time of tumor resection without superior mesenteric venous invasion were respectively (224± 14) minutes and (215±21) minutes in the experimental and control groups,with no statistically significant difference between the 2 groups (t =7.423,P＞ 0.05).Volumes of intraoperative blood loss and blood transfusion were respectively (99± 16)mL,(1.3±0.8)U in the experimental group and (131±27)mL,(2.8±1.2)U in the control group,with statistically significant differences between the 2 groups (t =3.670,0.562,P＜ 0.05).Five and 8 patients had intraoperative blood transfusion in the experimental and control groups,showing no statistically significant difference between the 2 groups (x2=1.195,P＞0.05).(2) Postoperative situation:time of drainage tube removal and duration of hospital stay were respectively (5.8±2.4)days,(18.3±6.3) days in the experimental group and (6.3±3.6)days,(19.6±7.1) days in the control group,with no statistically significant difference between the 2 groups (t =0.498,1.305,P＞0.05).Eleven patients in the experimental group had postoperative early complications,including 8with grade A pancreatic fistula (4 combined with diarrhea,2 combined with biliary fistula,1 combined with delayed gastric emptying and 1 with single pancreatic fistula),3 with grade B pancreatic fistula (2 combined with intra-abdominal hemorrhage and 1 combined with intra-abdominal infection).One patient with intra-abdominal hemorrhage in the experimental group died after treatment failure.Twelve patients in the control group had postoperative early complications,including 6 with grade A pancreatic fistula (2 combined with biliary fistula,2 combined with delayed gastric emptying,1 combined with diarrhea,1 combined with digestive tract hemorrhage),3 with grade B pancreatic fistula and intra-abdominal hemorrhage (2 combined with infection,including 1 death) and 3 with diarrhea.Other patients with complications were cured by symptomatic and supportive treatment.There was no statistically significant difference in overall complications between the 2 groups (x2 =0.287,P＞0.05).Results of postoperative pathological examination showed that case with R0 resection was 93 and 76 in the experimental and control groups,with a statistically significant difference between the 2 groups (x2 =4.057,P＜0.05).(3) Follow-up and survival situations:179 patients were followed up for 2-28 months,with a median time of 14 months.Postoperative 6-month tumor-free survival rate was 92.7％ (89/96) and 88.2％(75/85) in the experimental and control groups,with no statistically significant difference between the 2 groups (x2=1.060,P＞0.05).Conclusion Arterial first approach in LPD could significantly shorten the time of tumor resection of patients with superior mesenteric artery invading pancreatic head and periampullay region,significantly reduce the volumes of intraoperative blood loss and blood transfusion,and increase the rate of R0 resection.
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Objective To investigate the efficacy and safety of combination of transcatheter arterial chemoembolization (TACE)and percutaneous radiofrequency ablation (RFA)in treatment of hepatocellular carcinoma (PHC).Methods 70 cases of PHC were divided into combined group (TACE +RFA,n =37) and control group (only TACE,n =33).Patients were followed up for1 to 2 years,and the therapeutic effects and side effects were compared between the two groups.Results The patients with tumor completely necrosis and AFP level lower than >50% in combined group were significantly more than those in control group (P <0.05);the half of year,one year and two years survival rate in combined group were greatly higher than those of control group;no severe side effect was observed in two groups.Conclusions TACE+RFA is effective and safe in treatment of PHC of more than 5 cm in diameter.
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The eukaryotic expression of human arresten gene and its effect on the proliferation of in vitro cultured vascular smooth cells (VSMCs) in vitro were investigated. COS-7 cells were transfected with recombinant eukaryotic expression plasmid pSecTag2-AT or control plasmid pSecTag2 mediated by liposome. Forty-eight h after transfection, reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expression of arresten mRNA in the cells, while Western blot assay was applied to detect the expression of arresten protein in concentrated supernatant. Primary VSMCs from thoracic aorta of male Sprague-Dawley rats were cultured using the tissue explant method, and identified by immunohistochemical staining with a smooth muscle-specific anti-alpha-actin monoclonal antibody before serial subcultivation. VSMCs were then co-cultured with the concentrated supernatant and their proliferation was detected using Cell Counting Kit-8 (CCK-8) in vitro. The results showed that RT-PCR revealed that the genome of arresten-transfected cells contained a 449 bp specific fragment of arresten gene, suggesting the successful transfection. Successful protein expression in supernatants was confirmed by Western blot. CCK-8 assay showed that the proliferation of VSMCs were inhibited significantly by arresten protein as compared with control cells (F=40.154, P<0.01). It was concluded that arresten protein expressed in eukaryotic cells can inhibit proliferation of VSMCs effectively in vitro, which would provide possibility to the animal experiments.
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The eukaryotic expression of human arresten geneand its effect on the proliferation of in vitro cultured vascular smooth cells (VSMCs) in vitro were investigated. COS-7 cells were transfected with recombinant eukaryotic expression plasmid pSecTag2-AT or control plasmid pSecTag2 mediated by liposome. Forty-eight h after transfection, reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expression of arresten mRNA in the cells,while Western blot assay was applied to detect the expression of arresten protein in concentrated supernatant. Primary VSMCs from thoracic aorta of male Sprague-Dawley rats were cultured using the tissue explant method, and identified by immunohistochemical staining with a smooth muscle-specific anti-αactin monoclonal antibody before serial subcultivation. VSMCs were then co-cultured with the concentrated supernatant and their proliferation was detected using Cell Counting Kit-8 (CCK-8) in vitro. The results showed that RT-PCR revealed that the genome of arresten-transfected cells contained a 449 bp specific fragment of arresten gene, suggesting the successful transfection. Successful protein expression in supernatants was confirmed by Western blot. CCK-8 assay showed that the proliferation of VSMCs were inhibited significantly by arresten protein as compared with control cells (F=40.154, P＜0.01). It was concluded that arresten protein expressed in eukaryotic cells can inhibit proliferation of VSMCs effectively in vitro, which would provide possibility to the animal experiments.
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AIM: To express human Arresten gene in eukaryotic cell,and to investigate its effect on the proliferation and migration in vitro of rat primary cultured thoracic aortic vascular smooth cells (VSMCs).METHODS: COS-7 cells were transfected with recombinant eukaryotic expression plasmid pSecTag2-AT or control plasmid pSecTag2 mediated by liposome.48 hours after transfection,polymerase chain reaction(RT-PCR) was used to detect the expression of Arresten mRNA in the cells,while Western blotting assay was applied to detect expressed Arresten protein in concentrated supernatants.VSMCs were then co-cultured with the concentrated supernatants;and its proliferation was detected using cell counting kit-8(CCK-8) in vitro.Migration of VSMCs was assayed by a microchemotaxis chamber and a polycarbonate filter (Transwell's chamber) with pores of 8 ?m in diameter.RESULTS: RT-PCR revealed that the genome of Arresten-transferred cells contained a 449bp specific fragment of Arresten gene.Successful protein expression in supernatants was confirmed by Western blotting.CCK-8 assay showed that the proliferation of VSMCs was inhibited significantly by Arresten protein as compared with control group(P
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Objective To elucidate the clinical features,and the principles in diagnosis and treatment of hyperlipidemic pancreatitis.Methods The clinical data of 262 cases with acute pancreatitis from January,2004 to April,2006,were studied.Results Among 262 cases,46 cases were diagnosed as hyperlipidemic pancreatitis(17.5%,46/262),that included 32 cases with mild acute pancreatitis(69.0%) and 14 cases with severe acute pancreatitis(31.0%).Depending on the severity of pancreatitis,different treatments were adopted.Among the 46 cases,10 were treated operatively.As a result,43 cases were cured,accounting for 93.5% of all cases,and 3 cases died,accounting for 21.4% of cases with severe acute pancreatitis.Conclusions Hyperlipidemia can induce acute pancreatitis,and many may have severe pancreatitis.Treatment is mainly by nonoperative management but different therapeutic measures should be adopted according to the severity of pancreatitis.
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Objective To investigate the changes of Toll-like receptor 2 and 4 gene expression in lungs with acute injury induced by acute hemorrhagic necrotizing pancreatitis(AHNP) in rats.Methods Forty SD male rats were randomly divided into sham-operated group(n=10),and AHNP group(n=30).Of all the rats,the lungs were dissected for lung histological scores and bronchoalveolar lavages were harvested for lung injury index.TLR2,4mRNA expression in the lungs was measured by RT-PCR at different time points.(Results) TLR2,4mRNA could be detected in lungs with low values in sham-operated group;but they were markedly increased at 3 hours in AHNP group,peaking at 6~12 hours(P
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AIM:To investigate the depressant effect and mechanism of atorvastatin on the chronic rejection of aortic allograft in rats.METHODS:The models of abdominal aorta transplantation were made with micro-surgery in rats.The recipients were divided into three groups:allograft control group,atorvastatin-treated group and isograft control group.Vascular intimal thickness in all of the groups was observed by histological examination.The expression of proliferation cell nuclear antigenl(PCNA)and ?-smooth muscle actin(?-SMA)were determined by immunohistochemistry.The content of nitric oxide was measured by nitrate reductase chromatometry.RESULTS:The vascular intimal thickness in atorvastatin-treated group(11.60%?2.40%)was lower than that in allograft control group(34.60%?6.40%,P
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Objective To explore the etiology,mechanism and treatment of diarrhea after(pancreatoduodenectomy).Methods Based on the clinical data of 159 cases of pancreatoduodenectomy(performed) in the recent one and half years,the pathogenesis of post-pancreatoduodenectomy diarrhea was(analyzed) and the effect of different treatments was observed.Results Seventy-one cases had diarrhea,with an incidence of 44.7%.Tweenty-two cases had bacterial infection of the intestinal tract and 4 cases had fungus infection.The incidence of infection was 36.6%.In 64 cases diarrhea was relieved with effective treatment,accounting for 90.1% of all cases.Seven cases with chronic diarrhea had additional treatment with oral pancreatic enzyme and symptoms were relieved 2 weeks after treatment.Conclusions Diarrhea is frequently observed in patients after pancreatoduodenectomy,and the majority of them can be cured with(treatment) selected according to the pathogenesis.
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Objective To study the depressant effect of atorvastatin on arteriosclerosis of aortic allograft in rats.Methods The models of abdominal aorta transplantation were established in rats with the use of(micro-surgery).The recipients were divided into three groups:allograft control group,allograft experimental group and isograft control group.After 60 days of transplant,vascular intimal thickness(VIT) in all of the groups was observed by histological examination.The expression of PCNA and ?-SMA was determined by(immunohistochemistry).Results The degree of VIT in rats of the allograft experimental group was lower than that in the allograft control group;the VIT area ratio in the allograft control group,allograft experimental group and isograft control group was(12.40?2.65)%,(5.20?6.35)%,and(1.2?1.10)%,respectively,A statistical difference between these groups was observed(P