Research advances in immune checkpoint inhibitor-related cholangitis / 临床肝胆病杂志

Immune checkpoint inhibitors (ICIs) have ushered in a new era of tumor treatment; however, immunotherapy-related adverse events are critical issues that restrict the clinical application of ICIs and have attracted wide attention. The liver is one of the target organs that is easily affected. With the progress in research, scholars have found that besides hepatocytes, intrahepatic and extrahepatic bile ducts can also be attacked by the immune system, leading to the disease known as immune-related cholangitis. This article reviews the research advances in ICI-related cholangitis by summarizing related articles, in order to preliminarily reveal its clinical, pathological, and imaging features and provide clues for early identification, standard treatment, and subsequent research.

Plasma levels of soluble immune checkpoint molecules and their prognostic significance in patients with primary liver cancer / 中华微生物学和免疫学杂志

Objective:To analyze the plasma levels of soluble immune checkpoint molecules in patients with primary liver cancer and their prognostic significance.Methods:The levels of sCD28, sCD80, sCD137, sCD27, sGITR, sTIM3, sCTLA4, sHVEM, IDO, sLAG3, sBTLA, sPD1, sPDL1 and sPDL2 in plasma samples of 58 patients with primary liver cancer and 30 healthy controls were detected by liquid chip technology and compared between different groups. The relationship between the plasma levels of soluble immune checkpoint molecules and tumor recurrence was analyzed.Results:The levels of sCD28 and sCD80 were higher in patients in Barcelona Clinic Liver Cancer (BCLC) stage 0/A and B than in healthy controls and patients in BCLC-C stage ( P<0.05). However, the levels of sCD27 and sHVEM in BCLC-C patients were significantly lower than those in BCLC-0/A and BCLC-B patients, and even lower than healthy control group. The levels of sCD137, IDO and sPD1 in BCLC-0/A and BCLC-B patients were higher than those in healthy controls. The levels of sPDL1 and sPDL2 in different BCLC stages were all higher than those in healthy controls, and maintained at high level in the three stages, but there was no significant difference between different stages. After 24 months of interventional treatment, the preoperative sCD28 level was lower in patients with recurrent tumor recurrence than in patients without recurrence ( t=2.843, P=0.007). The optimal cut-off value of sCD28 based on the receiver operating characteristic (ROC) curve for predicting tumor recurrence was 101.42 pg/ml and the area under the ROC curve was 0.771 (95%CI: 0.611-0.931) with a sensitivity of 0.889 and a specificity of 0.666. The cumulative recurrence rate in patients with high sCD28 level (≥101.41 pg/ml) was 57.9% at 24 months after surgery, which was lower than the rate (95.5%) in patients with low sCD28 level (<101.41 pg/ml). The difference in the cumulative recurrence rate between the two groups was statistically significant (χ 2=15.777, P=0.000). Conclusions:The expression patterns of soluble immune checkpoint molecules varied in patients at different stages of primary liver cancer, suggesting that there were differences in their immune status and sCD28 could be used as a prognostic marker for postoperative recurrence of liver cancer.

The retrocolonic approach for laparoscopic pancreaticoduodenectomy / 中华肝胆外科杂志

Objective:To study the retrocolonic approach for laparoscopic pancreaticoduodenec-tomy (LPD).Methods:The clinical data of 53 patients who underwent LPD using the retrocolonic approach at the Second Hospital of Hebei Medical University from January 2019 to December 2021 were analyzed retrospectively. There were 36 males and 17 females, aged (61.9±8.8) years old. The operation time, intraoperative bleeding and postoperative complications were analysed.Results:LPD was successfully performed in 53 patients via the retrocolonic approach. The operation time was (285.7±49.8) min, and the resection time for specimens was (120.0±10.5) min. The median intraoperative blood loss was 200 ml and blood loss ranged from 50 to 800 ml. Among the 53 patients, 3 patients underwent combined portal vein resection and reconstruction (end-to-end anastomosis). The operation time was 300, 325 and 385 min, respectively, and the intraoperative blood loss was 400-800 ml. During the operation, 5 patients (9.43%) had transection of the middle colonic artery and underwent resection of part of the transverse mesocolon due to invasion of the transverse mesocolon by tumours. Postoperative complications occurred in 5 patients (9.43%), including 4 patients with pancreatic fistula and 1 patient with hemorrhage and with delayed gastric emptying. The postoperative passage of first flatus was (5.40±1.14) days in 5 patients with transection and (2.92±1.03) days in 48 patients without transection of the middle colonic artery. All patients were discharged home successfully. The postoperative pathological results showed all patients to achieve R 0 resection. Conclusion:Laparoscopic pancreaticoduodenectomy via the retrocolonic approach was safe and feasible for patients with a large duodenal tumor, pancreatic head uncinate process tumor with or without invasion of the portal vein and mesenteric vessels.

Efficacy of different nutritional therapentic methods on nutritional improvement for pancreatitis patients intolerant to oral feeding / 中华肝胆外科杂志

Objective:To compare the efficacy and safety of providing nasogastric (NG), nasojejunal (NJ), and parenteral nutrition (PN) support to pancreatitis patients who were intolerant to oral feeding.Methods:One hundred pancreatitis patients who were intolerant to oral feeding treated at the Xuanwu Hospital of the Capital Medical University from October 2018 to September 2020 were retrospectively studied. They were divided into three groups based on the nutritional support given to them: the NG group, NJ group, and PN group. The acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), nutritional risk screening 2002 (NRS2002), hemoglobin, albumin, pre-albumin and other clinical data were recorded and compared among the three groups.Results:After nutrition support treatments, the hemoglobin, albumin and pre-albumin levels were significantly better than before giving nutrition support, and the APACHE Ⅱ scores were significantly improved in all the groups. The NRS2002 scores were significantly better in the NJ group ( Z=2.28, P=0.023) and the NG group ( Z=1.99, P=0.046). With compared to the PN group, the albumin and pre-albumin levels were significantly higher in the NG and NJ groups, and the NRS2002 score after giving nutrition support treatment was significantly lower ( P<0.05). Compared with the PN group, the APACHE Ⅱ score ( t=2.18) and the hemoglobin levels ( t=2.04) were significantly better in the NJ group ( P<0.05). The overall incidence of complications in the NJ group was 41.2% (14/34), which was significantly lower than the NG group [78.8%(26/33), χ 2=5.41, P=0.020] and the PN group [66.7% (22/33), χ 2=4.35, P=0.037]. Conclusion:Enteral nutrition support through NG and NJ are better than PN in acute pancreatitis patients who were intolerant to oral feeding.

Roles of neutrophil reactive oxygen species (ROS) generation in organ function impairment in sepsis / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Sepsis is a condition of severe organ failure caused by the maladaptive response of the host to an infection. It is a severe complication affecting critically ill patients, which can progress to severe sepsis, septic shock, and ultimately death. As a vital part of the human innate immune system, neutrophils are essential in resisting pathogen invasion, infection, and immune surveillance. Neutrophil-produced reactive oxygen species (ROS) play a pivotal role in organ dysfunction related to sepsis. In recent years, ROS have received a lot of attention as a major cause of sepsis, which can progress to severe sepsis and septic shock. This paper reviews the existing knowledge on the production mechanism of neutrophil ROS in human organ function impairment because of sepsis.

Progress on surgical treatment in gastric cancer / 国际外科学杂志

There are high burden of disease including a high incidence, relatively high proportion of late stage when diagnosed and poor overall prognosis in China regarding to the diagnosis and treatment of gastric cancer. Surgery remains as the major treatment for gastric cancer. Based on the latest guidelines, endoscopic surgery or gastrectomy is performed for early gastric cancer, and the standard surgery for locally advanced gastric cancer is D2 lymphadenectomy. Besides, this article will discuss about other research hotspots, such as expansion of lymph node dissection in selected patients, construction methods of adenocarcinoma of esophagogastric junction, especially Siewert type Ⅱ, minimally invasive techniques (laparoscopic gastrectomy and robotic gastrectomy), the surgical treatment for elderly patients with gastric cancer will be discussed also.

Targeting PFKL with penfluridol inhibits glycolysis and suppresses esophageal cancer tumorigenesis in an AMPK/FOXO3a/BIM-dependent manner

As one of the hallmarks of cancer, metabolic reprogramming leads to cancer progression, and targeting glycolytic enzymes could be useful strategies for cancer therapy. By screening a small molecule library consisting of 1320 FDA-approved drugs, we found that penfluridol, an antipsychotic drug used to treat schizophrenia, could inhibit glycolysis and induce apoptosis in esophageal squamous cell carcinoma (ESCC). Gene profiling and Ingenuity Pathway Analysis suggested the important role of AMPK in action mechanism of penfluridol. By using drug affinity responsive target stability (DARTS) technology and proteomics, we identified phosphofructokinase, liver type (PFKL), a key enzyme in glycolysis, as a direct target of penfluridol. Penfluridol could not exhibit its anticancer property in PFKL-deficient cancer cells, illustrating that PFKL is essential for the bioactivity of penfluridol. High PFKL expression is correlated with advanced stages and poor survival of ESCC patients, and silencing of PFKL significantly suppressed tumor growth. Mechanistically, direct binding of penfluridol and PFKL inhibits glucose consumption, lactate and ATP production, leads to nuclear translocation of FOXO3a and subsequent transcriptional activation of BIM in an AMPK-dependent manner. Taken together, PFKL is a potential prognostic biomarker and therapeutic target in ESCC, and penfluridol may be a new therapeutic option for management of this lethal disease.

Effectiveness and safety of clinical use of stem cells and its implications for regulations / 上海预防医学

ObjectiveTo analyze the effectiveness and safety of clinical use of different types of stem cells to provide evidence for governmental supervision of key issues in clinical utilization of stem cells. MethodsSix literature databases in China and abroad were searched for relevant literature published from January 2010 to July 2020， and a systematic review was conducted. ResultsThe study showed 72 studies concerning the effectiveness and safety of different types of stem cells in clinical utilization. Although clinical utilization of stem cells had some therapeutic effects for certain diseases， their long-term effect and safety need to be further evaluated， especially their potential risk of tumorigenicity. ConclusionTo protect the patients’ interest， physicians should fully weigh the benefits against the risks of clinical utilization of stem cells， and relevant governmental departments should strengthen supervision of ethics of clinical research and therapies involving stem cells as well as supervision of stem cell products.

Effects of 5-Aza-dC combined with chemotherapy regimens on the apoptosis of lung adenocarcinoma cells / 中国综合临床

Objective:To investigate the effect of different chemotherapy drugs combined with DNA methylase inhibitor 5-Aza-2'-deoxycytidine (5-Aza-dC) on the apoptosis of lung adenocarcinoma cells.Methods:In the prospective randomized controlled study, lung adenocarcinoma A549 cells were treated with cisplatin plus paclitaxel (TP) or gemcitabine (GP) with or without 5-Aza-dC. According to different drug intervention methods, they were divided into control group, cisplatin combined with paclitaxel (TP) group, cisplatin combined with gemcitabine (GP) group, and 5-Aza-dC combined with TP group, 5-Aza-dC combined with GP group. CCK-8 assay was used to detect the proliferation of A549 cells. Transwell migration and invasion assay were used to detect the effect that each group of drugs on the migration and invasion ability of A549 cells. Quantitative Real-time Polymerase Chain Reaction was used to evaluate the effect of each treatment on the expression of apoptotic genes. One-way analysis of variance was used to compare the degree of cell proliferation in different drug treatment groups, and LSD- t method was used for pairwise comparison within groups. Results:The inhibition rates of lung adenocarcinoma cells in the TP regimen at different time points at 24, 48, and 72 h were as follows (20.00±4.23) %, (35.00±2.80) %, and (56.00±3.11) %. The inhibition rate of 5-Aza-dC combined with TP regimen on lung adenocarcinoma cells was significantly increased, at different time points of 24, 48 and 72 h, respectively (38.00±3.80) %, (50.00±3.25) %, (93.00±4.33) %. The inhibition rates of cells at different time points at 24, 48, and 72 h in the GP regimen were (33.00±5.10) %, (54.00±3.80) %, and (74.00±2.82) %, respectively; while 5-Aza-dC combined with GP regimen could significantly reduce the rate of cell growth, the inhibition rates of cells at 24, 48, and 72 h different time points were as follows (54.00±3.00) %, (67.00±5.30) %, and (95.00±1.13) %. The inhibitory effect of the same drug on lung adenocarcinoma cells increased with time (TP group: F=35.93, P<0.001; 5-Aza-dC combined with TP group: F=97.33, P<0.001; GP group: F =41.73, P<0.001; 5-Aza-dC combined with GP group: F=79.00, P<0.001), and at different time points, the differences were statistically different (all P<0.05). 5-Aza-dC combined with TP and GP chemotherapy regimens can inhibit the migration and invasion of lung adenocarcinoma cell A549, and the inhibitory effect is stronger than that of TP or GP regimens alone. The expression of Caspase 8 was significantly elevated ( t=5.87, P=0.004) in cells treated with 5-Aza-dC combined with GP when compared with GP regimen alone. The expression of Caspase 8 ( t=3.94, P=0.017), Caspase 6 ( t=5.81, P=0.004) and BBC3 (BCL-2 binding component 3) ( t=6.53, P=0.003) were increased when drugged with 5-Aza-dC combined TP regimen compared with TP regimen alone. Conclusion:5-Aza-dC might serve as a chemotherapeutic sensitizer to increase the sensitivity of lung adenocarcinoma cells.

Computer-assisted pelvic osteotomy and 3D printing guide plate for developmental dislocation of hip surgery / 中华骨科杂志

Objective:To explore the scheme of accurate pelvic osteotomy parameters and to analyze the feasibility and efficacy of 3D printing navigation plate in developmental dysplasia of the hip surgery.Methods:From January 2015 to December 2017, a total of 18 children with DDH underwent computer-assisted Salter pelvic osteotomy (computer-assisted osteotomy group) and 25 children with DDH who underwent conventional Salter pelvic osteotomy (conventional osteotomy group) were selected for retrospective analysis. There were 11 males and 32 females with an average age of 3.2±2.5 (range 1-11) years. According to International Hip Dysplasia Institute (IHDI) classification, there were 20 cases of type 1, 9 of type 2, 12 of type 3 and 2 of type 4. All patients were unilateral dislocation, including 18 cases on the left and 25 on the right. All children underwent pelvic CT examination before operation. Further, the proximal femur was surgically corrected during the operation. According to the acetabular rotation angle (ATA) and bony acetabular index (BAI), the computer-assisted osteotomy group simulated the operation with Mimics software made 3D printing navigation plate through which an accurate osteotomy scheme was developed. The two groups were compared in operative duration, intraoperative blood loss, Japanese Orthopaedic Association (JOA) hip joint score. Acetabular index (AI), central edge (CE) angle, and acetabulum head index (AHI) were compared between the two groups by using postoperative X-ray. The acetabular tilt angle (ATA) changes before and after operation in the computer-assisted osteotomy group were compared through 3D CT.Results:The follow-up duration was 2.3±0.2 (2.0 to 2.5) years in the computer-assisted osteotomy group and 2.8±0.15 (2.5 to 3.0) years in the conventional osteotomy group. The operative duration in the computer-assisted osteotomy group was 127±20.6 min, which was significantly longer ( t=4.657, P<0.001) than that in the conventional osteotomy group (103±13.2 min). Intraoperative bleeding was 157±17.5 ml in the computer-assisted osteotomy group and 151±15.3 ml in the conventional osteotomy group without significant difference between the two groups ( t=1.195, P=0.239). At 2 years after surgery, the JOA score of the hip joint in the computer-assisted osteotomy group (86.7±8.5 points) was like that (84.8±10.0 points) in the conventional osteotomy group ( t=0.628, P=0.533). At the last follow-up, the CE angle in the computer-assisted osteotomy group (36.8°±5.2°) was significantly larger than that (31.8°±4.4°) in the conventional osteotomy group ( t=3.414, P<0.001). There was statistically significant difference in term of AHI between the computer-assisted osteotomy group (85.8%±6.6%) and the conventional osteotomy group (80.4%±8.3%, t=2.284, P=0.028). AI was 23.5°±5.5° in the computer-assisted osteotomy group and 25.2°±4.2° in the conventional osteotomy group without significant difference ( t=-1.150, P=0.257). The ATA of the affected side was 12.3°±1.4° in the computer-assisted osteotomy group which was similar ( t=0.614, P=0.547) to that of the healthy side (11.8°±2.8°). Conclusion:Based on specific anatomical parameters, computer-assisted preoperative planning can not only directly simulate the process of osteotomy, but also produce individualized 3D printed guide plates. Compared with conventional Salter pelvic osteotomy, computer-assisted osteotomy can achieve accurate radiographic correction of the hip joint in children with DDH, resulting in a better matching relationship between the femoral head and acetabulum.

Clinical application of " variable diameter measurable pancreatic duct" in laparoscopic pancreaticoduodenectomy / 中华肝胆外科杂志

Objective:To evaluate the safety and effectiveness of clinical application of " variable diameter measurable pancreatic duct" in laparoscopic pancreaticoduodenectomy (LPD).Methods:A retrospective study was conducted at the Second Hospital, Hebei Medical University Liver Surgical Team from July 2019 to July 2020 using the " HongShi single stitch" method of pancreatic duct to jejunum anastomosis on 147 patients who underwent LPD. According to the type of pancreatic duct, the patients were divided into having normal pancreatic ducts (the normal group, n=61) and those having " variable diameter measuring pancreatic duct" (the variable diameter group, n=86). The perioperative data and postoperative complications were compared and analyzed. Results:There were 89 males and 58 females, aged (56.7±1.5) years. There were no significant differences in age, gender and body mass index between groups ( P>0.05). For the variable diameter group, the diameter of the divided pancreatic stump was (3.2±0.1) mm, and the depth of internal pancreatic duct stenting was (4.7±0.2) cm. However, it could not be measured accurately in the normal group. The incidence of postoperative pancreatic fistula rate was significantly lower in the variable diameter group than the normal group [2.32% (2/61) vs. 11.47% (7/86), P=0.023]. Conclusion:The variable diameter measurement of pancreatic duct was safe and effective in choosing patients to undergo LPD.

Influencing factors for early clinical deterioration in patients with mild posterior circulation infarction / 中华行为医学与脑科学杂志

Objective:To study the incidence and influencing factors for clinical deterioration at an early stage in patients with mild posterior circulation infarction (PCI).Methods:Totally 291 patients with mild PCI from January 1, 2016 to January 1, 2020 were retrospectively included. Clinical deterioration within 24 h (CD 24h) and clinical deterioration between 2 d and 14 d (CD 14d) were the endpoint events. IBM SPSS Statistics 19.0 software was used for statistical analysis. Pearson chi-square test or Mann-Whitney U test were used to compare the group differences of corresponding variables. Multivariate logistic regression model was used to analyze the influencing factors of the primary endpoint events. Results:The incidences of CD 24h and CD 14d were 21.6% (63/291) and 30.6% (89/291) respectively, with the reperfusion therapy rate of 13.4% (39/291). The results of multivariate logistic regression analysis with CD 24h as the endpoint event showed that the baseline NIHSS was a positive independent factor increasing the risk of CD 24h ( OR=1.184, 95% CI=1.078-1.300, P<0.01). Cerebellar infarction (compared with brainstem infarction) ( OR=0.250, 95% CI=0.082-0.757, P=0.014)and non-macroatherosclerosis (compared with major atherosclerosis) ( OR=0.026, 95% CI=0.002-0.325, P=0.005) had negative predictive effects on CD 24h. The results of multivariate logistic regression analysis with CD 14d as the endpoint event showed that pulmonary infection complications after stroke ( OR=28.085, 95% CI=6.863-114.927, P<0.01) and baseline NIHSS ( OR=1.114, 95% CI=1.001-1.240, P=0.048) were independent factors of CD 14d. Reperfusion therapy ( OR=0.089, 95% CI=0.013-0.613, P=0.014) could reduce the risk of CD 14d.Top of basilar syndrome(compared with single brainstem infarction) ( OR=7.526, 95% CI=1.565-36.188, P=0.012) increased the risk of CD 14d, while the non-macroatherosclerotic (compared with the macroatherosclerotic subtype) ( OR=0.076, 95% CI=0.009-0.683, P=0.021) negatively predicted the risk of CD 14d. Baseline NIHSS ( OR=0.834, 95% CI=0.758-0.918, P<0.01), CD 14d ( OR=0.048, 95% CI=0.018-0.130, P<0.01) and pulmonary infection complications ( OR=0.045, 95% CI=0.012-0.167, P<0.01) were negatively predicted the good clinical prognosis (modified Rankin score 14 days after onset ≤2). Conclusion:Early clinical deterioration has a negative predictive effect on clinical prognosis improvement of patients with mild PCI. Large artery atherosclerotic stenosis subtype and basilar apex syndrome are the risk factors of CD 24h and CD 14d of patients with mild PCI, and pulmonary infection is the risk factor of CD 14d. Reperfusion therapy in acute phase is helpful to reduce the risk of early clinical deterioration and improve clinical prognosis in patients with mild PCI.

Application of 3D printing combined with CBL in the teaching of loose teeth fixation of severe periodontal disease / 中华医学教育探索杂志

Objective:To explore the effect of 3D printing periodontal bone defect model of anterior teeth combined with case-based learning (CBL) teaching mode in the standardized residency training of loose teeth fixation.Methods:Sixty general practitioner of stomatology students were equally divided into two groups, with one group receiving CBL teaching (CBL group) and the other group receiving 3D printing model combined CBL teaching (3D+CBL group). After the teaching, the teacher evaluated the overall practice effects, tested the residents' theory and practice scores, and designed a questionnaire to evaluate the teaching effect. SPSS 16.0 software was used for statistical analysis, and t test was used for comparison between the two groups. Results:The theoretical score (89.0±3.2) and the practical score (90.0±2.5) in the 3D+CBL group were significantly higher than the theoretical score (83.3±3.6) and the practical score (84.2±3.5) in the CBL group ( P<0.05). The questionnaire showed that the students of the 3D+CBL group performed significantly better than those in CBL group in the following eight aspects, including mastery of basic periodontal knowledge, professional knowledge of loose teeth fixation, ability to diagnose cases and formulate treatment plans, clinical operation ability, interesting teaching content, willingness to communicate with teachers, awareness of actively receiving patients, and satisfaction of standardized residency training ( P<0.05). Conclusion:The 3D printing periodontal bone defect model of anterior teeth combined with the CBL teaching mode has achieved good results in the teaching of loose teeth fixation, and it provides a reference for the application of 3D printing in clinical teaching for periodontology.

China experts' consensus on preventive and interceptive orthodontic treatments of malocclusions of children / 华西口腔医学杂志

Malocclusion is one of the three most common oral diseases reported by World Health Organization(WHO). In China, its incidence rate is rising. Malocclusion seriously affects the dental and maxillofacial function, facial appearance and growth development of nearly 260 million children in China, and what is more, it affects their physical and mental health development. Malocclusion occurrence is related to genetic and environmental factors. Early treatment of malocclusion can create a good dental and maxillofacial development environment, correct abnormal growth and control the adverse effects of abnormal genetic factors. It can effectively reduce the prevalence of children's malocclusion and enhance their physical and mental health. This is an urgent need from the economic perspective of our society, so it has great practical and social significance. Experts from the project group "standard diagnose and treatment protocols for early orthodontic intervention of malocclusions of children" which initiated by China National Health Institute of Hospital Administration wrote the "China Experts' Consensus on Preventive and Interceptive Orthodontic Treatments of Malocclusions of Children", which aims to guide and popularize the clinical practice, improve the clinical theory and practice level, and accelerate the disciplinary development of early treatment of children's malocclusion in China. The consensus elaborates the harmfulness of malocclusion and the necessity of early treatment, and brings up the principles and fundamental contents. Based on the law of dental and maxillofacial development, this paper puts forward the guiding suggestions of preventive and interceptive treatments in different stages of dental development ranging from fetus to early permanent dentition. It is a systematic project to promote and standardize the early treatment of malocclusion. Through scientific and comprehensive stratified clinical practice and professional training, the clinical system of early treatment of malocclusion in China will eventually be perfected, so as to comprehensively care for children's dental and maxillofacial health, and improve their oral and physical health in China.

Use of transnasal ileus catheter in elderly patients with mechanical intestinal obstruction / 中华普通外科杂志

Objective:To evaluate the treatment efficiency using transnasal ileus catheter in elderly patients with mechanical small intestinal obstruction.Method:Ninety geriatric patients with mechanical small intestinal obstruction admitted to Xuanwu Hospital of Capital Medical University from Jan 2018 to Dec 2019 were divided into intestinal obstruction catheter group with transnasal ileus catheter insertion ( n=40) and nasogastric tube group ( n=50). Results:The transnasal ileus catheter retained for (91.0±33.5) h significantly shorter than that in nasogastric tube group ((149.3±82.3) h, t=3.323, P=0.002). Compared to nasogastric tube group, the exhaust time, defecation time, feeding time, time to gas-liquid level disappearance and time to contrast agent appearance in the colon in intestinal obstruction catheter group were significantly shorter [(55.9±40.9) h vs. (127.6±59.1) h, t=5.149; (69.8±42.3) h vs. (134.9±48.4) h, t=5.371; (104.3±35.1) h vs. (178.3±79.8) h, t=4.297; (106.2±36.6) h vs. (175.8±79.1) h, t=4.050 and (101.4±37.3) h vs.(172.4±72.9) h, t=4.407, all P<0.05]. In addition, the length of hospital stay was shorter and in hospital expenses were lower [(8.1±3.8) d vs. (11.6±6.7) d, t=2.248; (8 236±5 451)￥ vs. (15 320±9 582)￥, t=3.293, all P<0.05]. Conclusion:The use of transnasal ileus catheter was safe and effective to relieve the symptoms of mechanical small intestinal obstruction, hence improving the success rate of conservative treatment.

Effects of continuous light exposure on muscle fiber remodeling and lipid metabolism in mice / 中华内分泌代谢杂志

Objective:To observe the effects of continuous light exposure on skeletal muscle fiber type transformation and lipid metabolism, and to explore its internal relationship.Methods:Mice were randomly divided into normal light group and 24-hour continuous light group by random number table. The serum and skeletal muscle lipid content and urine 6-sulfatoxymelatonin(6-SML)level were detected by ELISA. The expression of circadian clock and lipid metabolism related genes mRNA were observed by realtime PCR. The muscle fiber type and lipid deposition were evaluated by tissue immunofluorescence as well as oil red O staining.Results:Compared with the normal light group, the level of 6-SML in urine at night decreased( P<0.05), and the expression level and rhythm of brain and muscle ARNT-like protein 1(Bmal1), circadian locomotor output cycles protein kaput(Clock), and period 2(Per2)mRNA in the skeletal muscle changed in continuous light group. In addition, the body weight, blood lipid, free fatty acid, and triglyceride contents of skeletal muscle in continuous light group increased significantly( P<0.05 or P<0.01), the expression of carnitine palmitoyltransferase 1b (Cpt1b)mRNA, the key enzyme of fatty acid oxidation, decreased significantly( P<0.05), while the expression of stearoyl-CoA desaturase(Scd1)mRNA, a lipid synthesis related gene, increased significantly( P<0.01). Further immunofluorescence analysis showed that the proportion of slow muscle fibers decreased and that of fast muscle fibers increased in continuous light group(both P<0.05). Conclusion:The process of ectopic deposition of lipid in skeletal muscle in mice induced by continuous light exposure may be related to the remodeling of skeletal muscle fibers.

Laparoscopic combined with multi-video debridement in treatment of complicated infectious pancreatic necrosis / 中华肝胆外科杂志

Objective:To study the clinical application of laparoscopic combined with multi-video debridement in treatment of complicated infectious pancreatic necrosis (CIPN).Methods:The clinical data of 34 patients with CIPN who were treated at the Department of General Surgery, Xuanwu Hospital, Capital Medical University from August 2017 to December 2019 were retrospectively studied. Based on the different video methods used, these patients were divided into 3 groups: the laparoscopic combined with intraoperative ultrasound group, the laparoscopic combined with choledochoscopy group and the laparoscopic group. The number of operations, operation time, blood loss, postoperative complication rates, mortality rates and total length of hospital stay were compared.Results:There were 13 patients in the laparoscopic combined with intraoperative ultrasound group, with age of (56.4±13.4) years. There were 7 patients in the laparoscopic combined with choledochoscopy group, with age of (48.0±8.4) years. There were 14 patients in the laparoscopic group with age of (51.4±15.6) years. The number of operations of the laparoscopic combined with intraoperative ultrasound group, the laparoscopic combined with choledochoscopy group and the laparoscopic group were (2.2±1.1), (1.6±0.8), (2.9±1.4), respectively. The number of operations of the laparoscopic combined with choledochoscopy group were significantly less than that of the laparoscopic group ( P<0.05), but there were no significant differences among the other groups ( P>0.05). The operation time of the laparoscopic combined with intraoperative ultrasound group, the laparoscopic combined with choledochoscopy group and the laparoscopic group were (70.5±22.9) min, (65.7±19.9) min, (51.5±15.4) min, respectively. The operation time of the laparoscopic combined with intraoperative ultrasound group was significantly longer than that of the laparoscopic group ( P<0.05), but there were no significant differences among the other groups ( P>0.05). There were no differences in blood loss, postoperative complication rate, mortality rates and total lengths of hospital stay among the three groups ( P>0.05). Conclusion:Laparoscopic combined with multi-video debridement after making full use of the advantages of each of the video methods, can be used to improve treatment outcomes of patients with CIPN.

Application value of laparoscopic duodenum-preserving pancreatic head resection / 中华消化外科杂志

Objective:To investigate the application value of laparoscopic duodenum-preserving pancreatic head resection (LDPPHR).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 25 patients undergoing LDPPHR in the Second Hospital of Hebei Medical University from November 2016 to November 2020 were collected. There were 7 males and 18 females, aged from 14 to 66 years, with a median age of 29 years. All the 25 patients underwent LDPPHR. Observation indicators: (1) surgical situations; (2) postoperative histopathological examination; (3) follow-up. Follow-up was conducted using outpatient examination or telephone interview to detect the recovery of patients up to March 2021. Measurement data with skewed distribution were represented as M (range) and count data were descripted as absolute numbers. Results:(1) Surgical situations: all the 25 patients underwent LDPPHR successfully, including 23 cases undergoing total pancreatic head resection and 2 cases undergoing subtotal pancreatic head resection. The operation time and volume of intraoperative blood loss of 25 patients were 310 minutes (range, 207 to 540 minutes) and 200 mL (range, 50 to 800 mL), respectively. Of the 25 patients, 1 case was infused with 4 U of red blood cells and 400 mL of plasma, 1 case was infused with 500 mL of plasma, 1 case was infused with 600 mL of plasma and the remaining 22 cases were not infused with red blood cells or plasma. Of the 25 patients, 3 cases with pancreatic fistula of class B were discharged after drainage, 4 cases had biliary fistula including 2 cases undergoing symptoms disappeared after implantation of common bile duct stent by endoscopic retrograde cholangiopancreatography, 1 case recovering well with drainage, 1 case with postoperative perihepatic effusion undergoing symptoms disappeared after the treatment of drainage and common bile duct stent implantation, and the remaining 18 cases had no complications. The duration of postoperative hospital stay was 17 days (range, 9 to 27 days) of the 25 patients. (2) Postoperative histopathological examination: the tumor volume of the 25 patients was 6.0 cm×5.0 cm×2.0 cm (range, 1.0 cm×2.0 cm×1.5 cm to 10.0 cm×9.0 cm×8.0 cm). Results of the postoperative histopathological examination showed that there were 12 cases with pancreatic solid pseudopaillary neoplasm, 4 cases with intraductal papillary mucinous neoplasm, 3 cases with serous cystadenoma, 2 cases with mucinous cystadenoma, 1 case with neuroendocrine neoplasm, 1 case with pancreatic true cyst, 1 case with cholesterol crystals combined with calcification in the center of pancreatic nodules and 1 case with cavernous hemangioma of pancreas. (3) Follow-up: all the 25 patients were followed up for 4 months to 48 months, with a median follow-up time of 27 months. During the follow-up, 1 case of the 25 patients with postoperative diabetes controlled blood glucose in the normal range after regular injection of insulin, 1 case with fatty diarrhea had symptoms improved after oral supplement of pancreatic enzyme preparation, 1 case with preoperative intermittent dizziness, weakness of both lower limbs and hypoglycemia had the level of blood glucose returned to normal without any special treatment after operation, and the remaining 23 cases had no metabolic complications. None of the 25 patients had tumor malignant transformation, recurrence or death. No long-term complications such as delayed gastric emptying, bile duct stones or stricture occurred to the 25 patients.Conclusion:LDPPHR is safe and feasible for the treatment of benign or low-grade malignant tumors of the pancreatic head, with the advantage of preserving the integrity of digestive tract.

The angiographic anatomy of the inferior mesenteric artery in elder / 中华外科杂志

To examine the characteristics of the digital subtraction angiography of inferior mesenteric artery (IMA) in elderly Chinese patients over 65 years old. Totally 64 cases who underwent angiography of IMA were selected from the Department of General Surgery, Xuanwu Hospital of Capital Medical University, including 42 males and 22 females, aging (70.9±5.1) years (range: 60 to 88 years). The origin, diameter and trunk length of IMA were analyzed. The distribution of IMA branching and the relationship between LCA and IMV at the level of IMA opening position were revealed. Also, the range of IMA perfusion, Riolan arch and IMA occlusion were observed. All 64 patients underwent IMA angiography successfully. The diameter of IMA was (3.2±0.5) mm (range: 2.6 to 4.4 mm), and the trunk length was (3.8±1.0) cm (range: 1.1 to 7.0 mm). According to IMA classification standard, there were 26 patients with type Ⅰ (40.6%), 24 patients with type Ⅱ (37.5%), 12 patients with type Ⅲ (18.8%), 2 patients with type Ⅳ(3.1%). The horizontal distance between IMV and LCA was less than 0.5 cm in 58 cases (90.6%) and more than 0.5 cm in 6 cases (9.4%). IMA perfusion was interrupted at the splenic flexure in elderly patients in 14 cases (21.9%), including 11 cases terminated at splenic flexure and 3 cases terminated at descending colon. Riolan arch was found in only 4 of 64 patients (6.2%). Two patients (3.1%) had IMA or its branch occlusion, the arterial perfusion were compensated by Drummond arch without Riolan arch. The anatomy of IMA should be taken attention seriously in laparoscopic left-colorectal cancer radical resection. IMA shape, type, blood supply range and the relationship between LCA and IMV could be considered by the angiography or other examination, which can help to determine the ligation position of blood vessels, which could optimize the operation strategy.

Lymph node dissection along the left gastroepiploic vessels region in 4K laparoscopic radical gastrectomy with the surgeon on left position / 中华消化外科杂志

Minimally invasive surgery experienced a rapid development in the past thirty years, of which the laparoscopy has been widely used in gastrointestinal surgery. Lymph node dissection is one of the difficulties of laparoscopic radical resection of gastric cancer. The lymph node dissection along the left gastroepiploic vessels is a difficult part, which usually causes bleeding and splenic injury. This article mainly introduce the indications, contraindications, surgical preparations, the difficulties and techniques during the lymph nodes dissection when the operator stood on the left side of the patients, and perioperative complications of lymph nodes dissection along the left gastroepiploic vessels.