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Objective: To investigate the safety and learning curve of Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) in the treatment of obesity patients. Methods: A descriptive case series study was performed. Clinical data of obesity patients who were treated with Da Vinci robotic SADI-S in China-Japan Union Hospital of Jilin University from March 2020 to May 2021 were analyzed retrospectively. Case inclusion criteria: (1) uncomplicated obese patients with body mass index (BMI)≥37.5 kg/m(2); (2) patients with BMI of 28 to <37.5 kg/m(2) complicated with type 2 diabetes or two metabolic syndrome components, or obesity comorbidities; (3) patients undergoing SADI-S by Da Vinci robotic surgery system. Those who received other bariatric procedures other than SADI-S or underwent Da Vince robotic SADI-S as revisional operation were excluded. A total of 77 patients were enrolled in the study, including 31 males and 46 females, with median age of 33 (18-59) years, preoperative body weight of (123.0±26.2) kg, BMI of (42.2±7.1) kg/m(2) and waistline of (127.6±16.3) cm. According to the order of operation date, the patients were numbered as 1-77. The textbook outcome (TO) and Clavien-Dindo grading standard were used to analyze the clinical outcome of each patient and to classify surgical complications, respectively. The standard of textbook outcome was as follows: the operative time less than or equal to the 75th percentile of the patient's operation time (210 min); the postoperative hospital stay less than or equal to the 75th percentile of the patient's postoperative hospital stay (7 d); complication grade lower than Clavien grade II; no readmission; no conversion to laparotomy or death. The patient undergoing robotic SADI-S was considered to meet the TO standard when meeting the above 5 criteria. The TO rate was calculated by cumulative sum analysis (CUSUM) method. The curve was drawn by case number as X-axis and CUSUM (TO rate) as Y-axis so as to understand the learning curve of robotic SADI-S. Results: The operative time of 77 robotic SADI-S was (182.9±37.5) minutes, and the length of postoperative hospital stay was 6 (4-55) days. There was no conversion to laparotomy or death. Seven patients suffered from complications (7/77, 9.1%). Four patients had grade II complications (5.2%), including one with duodeno-ileal anastomotic leakage, one with abdominal bleeding, one with peritoneal effusion and one with delayed gastric emptying; two patients were grade IIIb complications (2.6%) and both of them were diagnosed with gastric leakage; one patient was grade IV complication diagnosed with postoperative respiratory failure (1.3%), and all of them were cured successfully. A total of 51 patients met the textbook outcome standard, and the TO rate was positive and was steadily increasing after the number of surgical cases accumulated to the 46th case. Taking the 46th case as the boundary, all the patients were divided into learning stage group (n=46) and mastery stage group (n=31). There were no significant differences between the two groups in terms of gender, age, weight, body mass index, waist circumference, ASA classification, standard liver volume, operative time and morbidity of postoperative complication (all P>0.05). The percent of abdominal drainage tube in learning stage group was higher than that in mastery stage group (54.3% versus 16.1%, P<0.05). The length of postoperative hospital stay in learning stage group was longer than that in mastery stage group [6 (4-22) d versus 6 (5-55) d, P<0.05)]. Conclusion: The Da Vinci robotic SADI-S is safe and feasible with a learning curve of 46 cases.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Anastomosis, Surgical , Diabetes Mellitus, Type 2/surgery , Gastrectomy/methods , Gastric Bypass/adverse effects , Learning Curve , Obesity/surgery , Obesity, Morbid/surgery , Retrospective Studies , Robotic Surgical ProceduresABSTRACT
Purpose@#The aim of this study was to compare the efficacy of liver transplantation (LT) and liver resection (LR) for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) and to investigate risk factors affecting prognosis. @*Materials and Methods@#A total of 94 HCC patients with PVTT type I (segmental PVTT) and PVTT type II (lobar PVTT) were involved and divided into LR (n=47) and LT groups (n=47). Recurrence-free survival (RFS) and overall survival (OS) were compared before and after inverse probability of treatment weighting (IPTW). Prognostic factors for RFS and OS were explored. @*Results@#Two treatment groups were well-balanced using IPTW. In the entire cohort, LT provided a better prognosis than LR. Among patients with PVTT type I, RFS was better with LT (p=0.039); OS was not different significantly between LT and LR (p=0.093). In subgroup analysis of PVTT type I patients with α-fetoprotein (AFP) levels >200 ng/mL, LT elicited significantly longer median RFS (18.0 months vs. 2.1 months, p=0.022) and relatively longer median OS time (23.6 months vs. 9.8 months, p=0.065). Among patients with PVTT type II, no significant differences in RFS and OS were found between LT and LR (p=0.115 and 0.335, respectively). Multivariate analyses showed treatment allocation (LR), tumor size (>5 cm), AFP and aspartate aminotransferase (AST) levels to be risk factors of RFS and treatment allocation (LR), AFP and AST as risk factors for OS. @*Conclusion@#LT appeared to afford a better prognosis for HCC with PVTT type I than LR, especially in patients with AFP levels >200 ng/mL.
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ED is a common male disease, often caused by neurological, vascular or psychological factors, and the diagnostic methods for ED vary widely. The nocturnal penile tumescence test (NPT) by RigiScan is an objective assessment method used mainly to detect ED and has gained a wide clinical application in recent years. This review focuses on the application value of the six RigiScan parameters in the diagnosis of ED, namely, the number of erections, total erection time, event rigidity of tip/base, event tumescence of tip/base, tumescence activated unit and rigidity activated unit, aiming to provide some help to clinicians and researchers with the application of NPT.
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Objective To evaluate the value of systematic simulation training program in the training of flexible ureteroscopy. Methods The training course was divided into three parts: shifting and positioning of flexible ureteroscope, stone-grasping with basket and lithotripsy by holmium laser. Thirty trainees in the flexible ureteroscopy training class in our hospital in March 2017 were prospectively selected and divided into 2 groups: standardized systematic training group and autonomous training group, with 15 trainees in each group. The trainees in the standardized systematic training group gradually completed the training contents of the three parts in strict accordance with the contents and forms of the training courses using in vitro training dry simulator, spending 60 min in each course, while the trainees in the autonomous training group completed the training by self-study using in vitro training dry simulator for 180 min. After completing the training, the trainees in the two groups were assessed by the in vitro training dry simulator and pig animal surgery, and the examination items included the shifting and positioning of the flexible ureteroscope in the animal surgery system or the dry simulator, stone-grasping with basket, and lithotripsy by holmium laser. The operating time and global rating scale (GRS) score for the operation by tutor were compared between the two groups. Results The operating time for the shifting and positioning of the flexible ureteroscope in the animal surgery system or the dry simulator, stone-grasping with basket, and lithotripsy by holmium laser in the standardized systematic training group were significantly shorter than those in the autonomous training group (all P<0.05). The GRS scores for the above operations in the standardized systematic training group were higher than those in the autonomous training group (all P<0.05). Conclusion The systematic simulation training program divides the flexible ureteroscopy training course into three separate parts, improves the learning efficiency and enthusiasm of the trainees, helps the trainees quickly mastering the operation skills of flexible ureteroscopy, and shortens the learning curve.
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In the last several year, the bromodomain and extra-terminal domain(BET) subfamily has been an extensively researched target. The bromodomain-containing protein 4(BRD4) belongs to this subfamily. It can regulate transcription, mark the mitosis of mammals, and regulate cell cycle so that it plays a quite significant role in the development and progression of cancer as well as the production of fibrosis and inflammation. Therefore BRD4 inhibitors have been widely studied for the treatment of solid tumors, leukemia, and fibrosis. Based on vast literature, this paper mainly described the structure and function of BRD4 as well as the latest progress in the research of the structure-activity relationship of BRD4 inhibitors.
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Cyclin-dependent kinase-5 (Cdk5) is a kind of Ser/Thr kinases in the signaling pathway, which regulates the neural development. The recent studies have confirmed that hyperactivation of Cdk5 is closely associated with the evolution, progression and apoptosis of tumors. The Cdk5 inhibitors have been extensively studied in the drug discovery against cancer. The structure features of these inhibitors and molecular mechanisms of their activities have provided clues for the drug development. In the second generation Cdk5 inhibitors, the ATP-binding pocket, a highly conserved site, has been targeted in the drug design in most cases. In addition, a growing number of peptides has been generated by targeting the protein/protein interfaces of Cdk5.
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The total RNA was extracted from ginseng leaves of Panax ginseng. The Cu/Zn-SOD gene was amplified via RT-PCR and the pET-28(a)-Cu/Zn-SOD expression vector was constructed. The pET-28 (a)-Cu/Zn-SOD recombinant plasmid was transformed into Escherichia coli BL21 (DE3) competent cells and was induced by IPTG in order to select optimal induction of expression conditions. The target protein was purified by the nickel ions (Ni ) affinity chromatography and the target protein enzyme activity was determinated by the xanthine oxidase method. The similarity of the Cu/Zn-SOD gene sequences and the Cu/Zn-SOD gene sequences of Korean ginseng in NCBI was 99. 00%. The target protein expression level was about 44.42%, and the molecular weight was 16.30 kDa after the pET-28(a)-Cu/Zn-SOD recombinants were induced by IPTG. The purified Cu/Zn-SOD protease activity reached 10,596.69 U x mg(-1). The P. ginseng pET-28(a)-Cu/Zn-SOD prokaryotic expression vector was built by the method of molecular biology, which provided the foundation for studying the Cu/Zn-SOD biology function.
Subject(s)
Cloning, Molecular , Escherichia coli , Genetics , Gene Expression , Genetic Engineering , Methods , Genetic Vectors , Genetics , Panax , Genetics , Sequence Analysis , Superoxide Dismutase , Genetics , MetabolismABSTRACT
Cancer cell vaccine-based immunotherapy has received increasing interest in many clinical trials involving patients with breast cancer. Combining with appropriate adjuvants can enhance the weak immunogenic properties of tumor cell lysates (TCL). In this study, diphtheria toxin (DT) and two tandem repeats of mycobacterial heat shock protein 70 (mHSP70) fragment 407-426 (M2) were conjugated to TCL with glutaraldehyde, and the constructed cancer cell vaccine was named DT-TCL-M2. Subcutaneous injection of DT-TCL-M2 in mice effectively elicited tumor-specific polyclonal immune responses, including humoral and cellular immune responses. High levels of antibodies against TCL were detected in the serum of immunized mice with ELISA and verified with Western blot analyses. The splenocytes from immunized mice showed potent cytotoxicity on Ehrlich ascites carcinoma cells. Moreover, the protective antitumor immunity induced by DT-TCL-M2 inhibited tumor growth in a mouse breast tumor model. DT-TCL-M2 also attenuated tumor-induced angiogenesis and slowed tumor growth in a mouse intradermal tumor model. These findings demonstrate that TCL conjugated with appropriate adjuvants induced effective antitumor immunity in vivo. Improvements in potency could further make cancer cell vaccines a useful and safe method for preventing cancer recurrence after resection.