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1.
Journal of Medical Biomechanics ; (6): E030-E035, 2021.
Article in Chinese | WPRIM | ID: wpr-904360

ABSTRACT

Objective To study the effect of non-self-similar hierarchy on fracture mechanical properties and crack propagation of the biocomposite. Methods The numerical models were established by using ABAQUS, and the stiffness and crack initiation and propagation in the biocomposite with the inclination angles between the axis of the prism and mineralized collagen fibrils θ=0°,20°,40°,60°,80° were simulated by extended finite element method. Results The inclination angle θ had limited influences on biocomposite stiffness at θ≤40°, while biocomposite stiffness decreased with θ at θ>40°. The ultimate tensile strain also increased at θ>40°. Asymmetry in the crack was also found during propagation of matrix surrounded-enhanced phases at θ>0°. The crack propagatation on one side of the long axis of the mineral crystal was relatively easier than that on the other side at θ>0°. Conclusions The non-uniform distributions of cracks were found in biological hard tissues arisen from the non-self-similar hierarchy. The non-uniform crystal arrangement in the biocomposite would result in local damage rather than catastrophic fracture. The findings of this study can provide theoretical support for material design.

2.
Article in Chinese | WPRIM | ID: wpr-883239

ABSTRACT

Lateral lymphatic drainage is one of the three important directions for low rectal cancer. Radical surgery of rectal cancer requires the dissection of lymph nodes along the drainage route which determines the extent of lymph node dissection. However, controversial arguments exist whether lateral lymph node belonging to the regional lymph node or the distant lymph node. This arguments has also brought the controversy about neoadjuvant chemoradiotherapy and lateral lymph node dissection, as well as the controversy about efficacy of neoadjuvant chemoradiotherapy on lateral metastatic lymph nodes. Combined with the preliminary clinical practices, the authors comprehensively analyze research advances at home and abroad, further elaborate the lateral lymph node metastasis of rectal cancer, the risk factors affecting lateral lymph node metastasis and tumor recurrence, and the evaluation of lateral lymph node by magnetic resonance imaging before and after chemoradiotherapy, et al, in order to investigate the selection and significance of lateral lymph node dissection in advanced low rectal cancer after neoadjuvant chemoradiotherapy.

3.
International Journal of Surgery ; (12): 226-231,封4, 2019.
Article in Chinese | WPRIM | ID: wpr-743026

ABSTRACT

Objective To analyze the risk factors for anastomotic leakage after low anterior resection(LAR) for rectal cancer.Methods The retrospective study of 1 336 patients with rectal cancer who underwent LAR from Jan.2013 to Dec.2017 in the Department of Colorectal Surgery,First Affiliated Hospital of Nanjing Medical University was conducted.There were 838 male and 498 female patients.The median age was 62 (53,70) years.Observation indicators:①intraoperative conditions,including the performance of preventive enterostomy,the preservation of left colic artery,the placement of transanal decompression tube;②postoperative conditions,for example,postoperative clinical symptoms and physical examination,postoperative hospital stay.Anastomotic leakage patients were graded according to the grading system of anastomotic leakage following anterior resection of the rectum proposed by the International Study Group of Rectal Cancer in 2010.Measurement data with non-normal distribution were described as median,and comparison between groups was done using Mann-Whitney U test.Ranked data were compared with rank sum test.Comparison of count data between groups were analyzed using the Chi-square test or Fisher exact test.Potential risk factors for anastomotic leakage were further analyzed with multiple logistic regression.Results Anastomotic leakage was noted in 138 (10.4%) of 1 336 patients with 93 patients (7.0%) of Grade B and 46 patients (3.4%) of Grade C respectively.The occurrence of Grade C anastomotic leakage was on the 3th day postoperatively,which was earlier than Grade B anastomotic leakage [5 (3,7) d,Z =2.746,P =0.006].There were significant differences in sex,BMI,placement of transanal decompression tube and tumor location between anastomotic leakage cases and non-anastomotic leakage cases by Chi-squared test (x2 =10.897,9.033,6.343,6.34,Z =-2.380,P <0.05).On multiple logistic regression analysis,male sex (OR =1.840,95 % CI:1.210-2.799,P =0.004),BMI ≥ 24 kg/m2 (OR =1.573,95 % CI:1.088-2.274,P =0.016),placement of transanal decompression tube(OR =2.418,95% CI:1.196-4.888,P =0.014),middle rectal cancer (OR =1.536,95% CI:O.836-2.822,P =0.167),low rectal cancer(OR =1.989,95% CI:1.068-2.822,P =0.03),ultralow rectal cancer (OR =2.908,95% CI:1.289-6.560,P =0.01) were independent risk factors of anastomotic leakage.Conclusion Male sex,high BMI,placement of transanal decompression tube and low rectal tumor were independent risk factors of anastomotic leakage for patients receiving LAR.

4.
Journal of Medical Biomechanics ; (6): E365-E371, 2019.
Article in Chinese | WPRIM | ID: wpr-802468

ABSTRACT

Objective To explore the effects of the interfacial debonding caused by water environment in the mouth and the interfacial defects between the crown and cement on stress distributions in all-ceramic crowns. Methods The three-dimensional solid model of lithium disilicate CAD/CAM crowns for the first mandibular molar was established. Seven debonding states between inferior surface of the crown and top surface of the cement (Stage 1-7) as well as two interfacial defects (Case I and II) were defined in finite element software ABAQUS. The bottom of nine models was completely constrained. For stress calculation, the 600 N vertical load was applied at occlusal surface via an analytical rigid hemisphere with the diameter of 5 mm. Results Under occlusal vertical load, the stress on interior of the crown and top surface of the cement was mainly distributed at the boundary of the debonding areas and margin of the defects. The first principle stress on interior of the crown did not exceed its ultimate tensile strength, but the maximum tensile stress of the cement exceeded its ultimate tensile strength, leading to cohesive failure in the cement. Conclusions The axial wall played a critical role in maintaining the principal tensile stress of the crown at a lower level. The defects at bonding interface between the crown and cement had a more significantly impact on load capacity of the crown than the increase in debonding areas. In order to improve load bearing capacities of all-ceramic crowns, attention should be paid to avoid defects in clinical prosthodontic practices.

5.
Journal of Medical Biomechanics ; (6): E365-E371, 2019.
Article in Chinese | WPRIM | ID: wpr-802365

ABSTRACT

Objective To explore the effects of the interfacial debonding caused by water environment in the mouth and the interfacial defects between the crown and cement on stress distributions in all-ceramic crowns. Methods The three-dimensional solid model of lithium disilicate CAD/CAM crowns for the first mandibular molar was established. Seven debonding states between inferior surface of the crown and top surface of the cement (Stage 1-7) as well as two interfacial defects (Case I and II) were defined in finite element software ABAQUS. The bottom of nine models was completely constrained. For stress calculation, the 600 N vertical load was applied at occlusal surface via an analytical rigid hemisphere with the diameter of 5 mm. Results Under occlusal vertical load, the stress on interior of the crown and top surface of the cement was mainly distributed at the boundary of the debonding areas and margin of the defects. The first principle stress on interior of the crown did not exceed its ultimate tensile strength, but the maximum tensile stress of the cement exceeded its ultimate tensile strength, leading to cohesive failure in the cement. Conclusions The axial wall played a critical role in maintaining the principal tensile stress of the crown at a lower level. The defects at bonding interface between the crown and cement had a more significantly impact on load capacity of the crown than the increase in debonding areas. In order to improve load bearing capacities of all-ceramic crowns, attention should be paid to avoid defects in clinical prosthodontic practices.

6.
International Journal of Surgery ; (12): 667-673, 2019.
Article in Chinese | WPRIM | ID: wpr-797186

ABSTRACT

Objective@#To investigate the short-term clinical efficacy of laparoscopic common bile duct exploration(LCBDE) with primary suture or T tube drainage in the management of choledocholithiasis.@*Methods@#The retrospective cohort study was conducted from January 2014 to December 2018 with the clinical data of patients with choledocholithiasis being analyzed. A total of 863 patients were enrolled in this study. There were 431 males and 432 females. The median age was 60 (range 11 to 94). These patients had received LCBDE with primary suture (n=287) and T tube drainage (n=576) in the Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University. Observation indicators: (1)Preoperative blood biochemistry, including blood serum levels of total bilirubin, direct bilirubin, ALT, AST, GGT. (2) Intraoperative conditions, including operation time, blood loss, diameter of common bile duct, number of common bile duct stone.(3)Short-term postoperative conditions, including postoperative hospital stay, postoperative complications. Measurement data with non-normal distribution were described as M (P25, P75), and comparison between groups was done using Mann-Whitney U test. Comparison of count data between groups were analyzed using the chi-square test. Univariate analysis and subsequent multivariable logistic regression were used to investigated the factors affecting the selection of surgical methods.@*Results@#(1) Blood serum levels of total bilirubin and direct bilirubin in the T tube drainage group were 17.0(12.2, 36.0) μmol/L, 7.6(4.9, 19.0) μmol/L, which were significantly higher than those of the primary suture group[15.7(11.8, 29.7) μmol/L, 6.7(4.4, 16.5) μmol/L)](Z=-2.023, -2.468, P<0.05). Preoperative blood serum levels of ALT, AST and GGT in the T tube drainage group were 56.7 (26.6, 128.8) U/L, 38.0(24.3, 75.8) U/L and 179.7(50.8, 394.4) U/L, the primary suture group were[68.2(24.8, 165.3) U/L, 35.5(22.8, 96.9) U/L and 235.2(74.9, 459.1) U/L], with no difference between the two groups (Z=-0.985, -0.437, -1.740, P>0.05). (2)The operation time of the primary suture group was 85(70, 100) min, which was significantly shorter than that of the T tube drainage group[97(75, 120) min](Z=-5.532, P<0.05). The diameter of common bile duct in the primary suture and T tube drainage group were 1.0(0.8, 1.2) cm and 1.0(0.8, 1.2) cm, respectively. Significant difference was observed between the two groups(Z=-2.071, P<0.05). The intraoperative blood loss in the primary suture and T tube drainage group were 20(10, 50) ml and 20(20, 50) ml, with no difference between the two groups (Z=-0.477, P>0.05). 61.32%(176/287) and 67.36%(388/576) of patients in the primary suture group and T tube drainage group were found with multiple stones in the common bile duct, with no difference between the two groups (χ2=3.083, P>0.05). (3)The primary suture group showed shorter postoperative hospital stay compared with the T tube drainage group[4(3, 5) d vs 6(5, 6) d, Z=-12.057, P<0.05]. The primary suture group showed more patients with bile leakage (2.09%) compared with that of the T tube drainage group (0.35%). Multivariable logistic regression showed that the number of common bile duct stone, diameter of common bile duct, time period of surgery, surgery group were significant factors affecting the selection of surgical methods(OR=1.687, 2.423, 0.587, 4.632, 95%CI: 1.152-2.470, 1.519-3.865, 0.511-0.675, 3.698-5.802, P<0.05).@*Conclusions@#Although different surgeons showed different opinions with the method of primary suture, laparoscopic common duct exploration with primary suture is safe and reliable in the management of choledocholithiasis with shorter operation time and faster postoperative recovery. T tube drainage is not absolutely necessary in the management of choledocholithiasis. Patients with multiple common bile duct stone or large diameter of common bile duct are likely to receive T tube drainage.

7.
Article in Chinese | WPRIM | ID: wpr-753012

ABSTRACT

Objective To investigate the application value of superior mesenteric artery (SMA)-oriented complete mesocolic excision (CME) in the treatment of right colon cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 955 patients with right colon cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2013 to June 2018 were collected.There were 514 males and 441 females,aged from 18 to 96 years,with a median age of 65 years.Of the 955 patients,377 undergoing SMA-oriented CME of right colon with the lymph node dissection along the left boundary of SMA were allocated into SMA-oriented group,and 578 undergoing superior mesenteric vein (SMV)-oriented CME of right colon with the lymph node dissection along the left boundary of SMV were allocated into SMV-oriented group.Observation indicators:(1) intraoperative and postoperative conditions;(2) postoperative complications;(3) postoperative pathological examinations;(4) follow-up and survival situations.Follow-up was performed by telephone interview and outpatient examination once every 3-6 months within 2 years after surgery and once a year after 2 years up to January 2019,using tumor recurrence and metastasis or death as the end point.Follow-up included physical examination and tumor marker test,including carcino embryonic antigen,CA19-9,chest and abdomen CT examination and enteroscopy.Measurement data with skewed distribution were described as M (P25,P75),and comparison between groups was done using the Mann-Whitney U test.Count data were described as absolute numbers or percentages,and comparison between groups was analyzed using the chi square test.Ordinal data were analyzed using the rank sum test.Kaplan-Meier method was used to calculate survival time and rate,and draw survival curve.Log-rank test was used for survival analysis.Patients with loss to follow-up were involved in survival analysis as censored data.Results (1) Intraoperative and postoperative conditions:the operation time,volume of intraoperative blood loss,duration of postoperative hospital stay were 100 minutes (90 minutes,110 minutes),50.0 mL (50.0 mL,70.0 mL),8 days (8 days,10 days) in the SMA-oriented group,and 110 minutes (90 minutes,135 minutes),50.0 mL (50.0 mL,122.5 mL),10 days (8 days,12 days) in the SMV-oriented group,showing significant differences between the two groups (Z=-5.400,-5.799,-7.461,P<0.05).After the exclusion of 47 patients unsuitable for defecation analysis because of postoperative complications,365 in the SMA-oriented group and 543 in the SMV-oriented group were analyzed.The time to first defecation,the maximum number and the median number of daily defecation postoperatively were 5 days (3 days,5 days),2.0 (1.0,2.5),1.0 (1.0,1.0) in the SMA-oriented group,which showed no significant difference from 4 days (3 days,5 days),2.0 (1.0,3.0),1.0 (1.0,1.0) in the SMV-oriented group (Z=-1.622,-1.541,-1.024,P> 0.05).(2) Postoperative complications:cases with postoperative complications,cases with incisional liquefaction or infection,cases with anastomostic leakage,cases with delayed gastric emptying,cases with intra-abdominal bleeding,cases with complete or incomplete ileus,cases with anastomostic bleeding,cases with intra-abdominal infection,cases with disruption of wound,the number of death were 55,10,3,3,2,2,1,1,1,1 in the SMA-oriented group,which showed no significant difference from 83,30,13,4,3,8,3,6,2,3 in the SMV-oriented group,respectively (x2 =0.045,3.662,2.926,0.034,0.001,1.604,0.352,1.873,0.048,0.352,P>0.05).There were 32 of 377 patients in the SMA-oriented group and 14 of 578 in the SMV-oriented group with chylous leakage,showing a significant difference between the two groups (x2 =18.312,P< 0.05).Patients with chylous leakage were improved after conservative treatment,without reoperation.Patients with other complications were improved after anti-infection,fluid infusion,and reoperation.Four of 955 patients died after surgery.(3) Postoperative pathological examinations:patients with stage Ⅰ,stage Ⅱ,and stage Ⅲ (pathological TNM staging),patients with high-differentiation,mid-differentiation,and low-differentiation (tumor differentiation degree),length of intestine specimen,number of positive lymph nodes,maximum tumor diameter,patients with cancer nodules,patients with vascular invasion,patients with perineural invasion were 57,174,146,30,174,173,23 cm (21 cm,26 cm),0 (0,2),5.0 cm (3.0 cm,6.0 cm),37,81,53 in the SMA-oriented group,which showed no difference from 66,280,232,33,303,242,23 cm (21 cm,25 cm),0 (0,2),5.0 cm (3.5 cm,6.0 cm),80,108,82 in the SMV-oriented group (Z=-1.020,-0.216,-0.243,-0.220,-0.814,x2=3.441,1.127,0.003,P>0.05).The number of harvested lymph nodes was 22.0 (17.0,27.0) and 18.0 (15.0,22.0) in the SMA-oriented group and SMV-oriented group,respectively,with a significant difference between the two groups (Z=-7.800,P<0.05).There were 202 patients extracted for further analysis.The number of harvested lymph nodes and harvested central lymph nodes was 25.0 (20.0,31.3),5.0 (3.0,8.0) of 166 patients in the SMA-oriented group,and 21.5 (18.0,28.8),1.5 (0,4.5) of 36 patients in the SMV-oriented group,respectively,showing significant differences between the two groups (Z =-1.995,-4.309,P<0.05).(4) Follow-up and survival situations:840 of 955 patients including 346 in the SMA-oriented group and 494 in the SMV-oriented group were followed up for 1.0-73.2 months,with a median time of 31.5 months.SMA-oriented group had a higher 5-year overall survival rate than SMV-oriented group (91.8% vs.84.9%,x2 =4.384,P<0.05),but had no significant difference in the 5-year tumor-free survival rate compared with the SMV-oriented group (84.4% vs.78.2%,x2=2.158,P>0.05).Conclusion Compared with SMV-oriented CME of right colon,SMA-oriented CME of right colon is safe and feasible,with larger number of harvested lymph nodes,which can achieve complete lymph node dissection.

8.
Article in Chinese | WPRIM | ID: wpr-752967

ABSTRACT

Objective To investigate the clinical effects of laparoscopic left colic artery (LCA) preserving total mesorectal excision (TME) for middle-low rectal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 339 patients with middle-low rectal cancer who underwent laparoscopic TME in the First Affiliated Hospital of Nanjing Medical University from July 2016 to July 2017 were collected.There were 216 males and 123 females,aged from 35 to 89 years,with an average age of 62 years.No lymph node enlargement was detected at the root of inferior mesenteric artery as evaluated by preoperative examination.Of the 339 patients,173 undergoing laparoscopic TME with preservation of LCA and 166 without preservation of LCA were allocated into observation group and control group,respectively.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect complications and survival of patients after hospital discharge up to August 2018.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was analyzed using the Mann-Whitney U test.Count data were represented as absolute number or percentage,and comparison between groups was analyzed using the chi-square test or Fisher exact propability.Comparisons of ordinal data were analyzed by Mann-Whitney U test.Results (1) Surgical situations:339 patients underwent laparoscopic TME successfully,without conversion to open surgery or death.The operation time,volume of intraoperative blood loss and number of lymph nodes dissected at the root of inferior mesenteric artery were (77± 15)minutes,(32±22)mL and 3.5± 1.3 in the observation group,(74± 16)minutes,(30±21) mL and 3.6± 1.3 in the control group,respectively,showing no statistically significant difference between the two groups (t =1.730,0.790,-0.378,P>0.05).There were 21 and 37 patients receiving preventive stoma in the observation group and control group,with a statistically significant difference between the two groups (x2 =6.154,P<0.05).(2) Postoperative situations:no lymphatic metastasis at the root of inferior mesenteric artery was detected in the observation group or control group.The incidence of anastomotic leakage was 8.55% (13/152) and 16.28%(21/129) of patients without preventive stoma in the observation group and control group,with a statistically significant difference between the two groups (x2=3.917,P<0.05).The overall incidence of anastomotic leakage was 7.51% (13/173) and 12.65% (21/166),with no statistically significant difference between the two groups (x2 =2.477,P>0.05).Cases with anastomotic hemorrhage and time to first anal sufflation were 18 and (2.2±0.9) days in the observation group,10 and (2.4±1.0) days in the control group,respectively,showing no statistically significant difference between the two groups (x2 =2.145,t =-1.370,P>0.05).(3) Follow-up:339 patients were followed up for 13-22 months,with a median time of 14 months.During the follow-up,2 patients had postoperative intestinal obstruction,19 had tumor recurrence or metastasis,and 4 died in the observation group.In the control group,1 patient had postoperative intestinal obstruction,17 had tumor recurrence or metastasis,and 3 died.The other patients in the two groups survived well.Conclusion Laparoscopic TME with preservation of LCA can reduce incidence of anastomotic leakage in patients with middle-low rectal cancer who don't undergo preventive stoma.

9.
Article in Chinese | WPRIM | ID: wpr-752958

ABSTRACT

Right colon cancer is a kind of clinically common colorectal cancer.Surgical resection is the main treatment and the only curative method for patients.Improvement of surgical methods in recent years is one of the hotspots in the surgical treatment of colorectal cancer.There are controversies in laparoscopic surgery or traditional open surgery,intestine resection extent,D3 radical surgery or complete mesocolic excision,selective arterial guidance or venous guidance,pyloric lymph nodes (No.6 group lymph nodes) dissection,and most of the issues are currently lacking of prospectively randomized controlled trials.Therefore,this article discusses the above problems.At the same time,in view of the complicated operation of right hemicolectomy,and the greater risk of surgery,the author consulted the relevant literature and combined his clinical experience to introduce the key techniques of the operation.

10.
International Journal of Surgery ; (12): 667-673, 2019.
Article in Chinese | WPRIM | ID: wpr-789131

ABSTRACT

Objective To investigate the short-term clinical efficacy of laparoscopic common bile duct exploration(LCBDE) with primary suture or T tube drainage in the management of choledocholithiasis.Methods The retrospective cohort study was conducted from January 2014 to December 2018 with the clinical data of patients with choledocholithiasis being analyzed.A total of 863 patients were enrolled in this study.There were 431 males and 432 females.The median age was 60 (range 11 to 94).These patients had received LCBDE with primary suture (n =287) and T tube drainage (n =576) in the Department of General Surgery,the First Affiliated Hospital of Nanjing Medical University.Observation indicators:(1) Preoperative blood biochemistry,including blood serum levels of total bilirubin,direct bilirubin,ALT,AST,GGT.(2) Intraoperative conditions,including operation time,blood loss,diameter of common bile duct,number of common bile duct stone.(3) Short-term postoperativeconditions,including postoperative hospital stay,postoperative complications.Measurement data with non-normal distribution were described as M (P25,P75),and comparison between groups was done using Mann-Whitney U test.Comparison of count data between groups were analyzed using the chi-square test.Univariate analysis and subsequent multivariable logistic regression were used to investigated the factors affecting the selection of surgical methods.Results (1) Blood serum levels of total bilirubin and direct bilirubin in the T tube drainage group were 17.0(12.2,36.0) μmol/L,7.6 (4.9,19.0) μmol/L,which were significantly higher than those of the primary suture group[15.7 (11.8,29.7) μmol/L,6.7 (4.4,16.5) μmol/L)] (Z =-2.023,-2.468,P < 0.05).Preoperative blood serum levels of ALT,AST and GGT in the T tube drainage group were 56.7 (26.6,128.8) U/L,38.0 (24.3,75.8) U/L and 179.7 (50.8,394.4) U/L,the primary suture group were [68.2 (24.8,165.3) U/L,35.5(22.8,96.9) U/L and 235.2(74.9,459.1) U/L],with no difference between the two groups (Z =-0.985,-0.437,-1.740,P > 0.05).(2) The operation time of the primary suture group was 85 (70,100) min,which was significantly shorter than that of the T tube drainage group [97 (75,120) min] (Z =-5.532,P < 0.05).The diameter of common bile duct in the primary suture and T tube drainage group were 1.0(0.8,1.2) cm and 1.0 (0.8,1.2) cm,respectively.Significant difference was observed between the two groups(Z =-2.071,P < 0.05).The intraoperative blood loss in the primary suture and T tube drainage group were 20(10,50) ml and 20(20,50) ml,with no difference between the two groups (Z =-0.477,P >0.05).61.32% (176/287) and 67.36% (388/576) of patients in the primary suture group and T tube drainage group were found with multiple stones in the common bile duct,with no difference between the two groups (x2 =3.083,P > 0.05).(3)The primary suture group showed shorter postoperative hospital stay compared with the T tube drainage group [4 (3,5) d vs 6 (5,6) d,Z =-12.057,P < 0.05].The primary suture group showed more patients with bile leakage (2.09%) compared with that of the T tube drainage group (0.35%).Multivariable logistic regression showed that the number of common bile duct stone,diameter of common bile duct,time period of surgery,surgery group were significant factors affecting the selection of surgical methods (OR =1.687,2.423,0.587,4.632,95%CI:1.152-2.470,1.519-3.865,0.511-0.675,3.698-5.802,P<0.05).Conclusions Although different surgeons showed different opinions with the method of primary suture,laparoscopic common duct exploration with primary suture is safe and reliable in the management of choledocholithiasis with shorter operation time and faster postoperative recovery.T tube drainage is not absolutely necessary in the management of choledocholithiasis.Patients with multiple common bile duct stone or large diameter of common bile duct are likely to receive T tube drainage.

11.
Journal of Breast Cancer ; : 371-381, 2018.
Article in English | WPRIM | ID: wpr-718896

ABSTRACT

PURPOSE: Immune suppression is common in patients with advanced breast cancer but the mechanisms underlying this phenomenon have not been sufficiently studied. In this study, we aimed to identify B7 family members that were able to predict the immune status of patients, and which may serve as potential targets for the treatment of breast cancer. We also aimed to identify microRNAs that may regulate the expression of B7 family members. METHODS: The Cancer Genome Atlas data from 1,092 patients with breast cancer, including gene expression, microRNA expression and survival data, were used for statistical and survival analyses. Polymerase chain reaction and Western blot were used to measure messenger RNA and protein expression, respectively. Luciferase assay was used to investigate direct microRNA target. RESULTS: Bioinformatic analysis predicted that microRNA (miR)-93, miR-195, miR-497, and miR-340 are potential regulators of the immune evasion of breast cancer cells, and that they exert this function by targeting CD274, PDCD1LG2, and NCR3LG1. We chose CD274 for further investigations. We found that miR-195, miR-497, and CD274 expression levels were inversely correlated in MDA-MB-231 cells, and miR-195 and miR-497 expressions mimic inhibited CD274 expression in vitro. Mechanistic investigations demonstrated that miR-195 and miR-497 directly target CD274 3′ untranslated region. CONCLUSION: Our data indicated that the level of B7 family members can predict the prognosis of breast cancer patients, and miR-195/miR-497 regulate CD274 expression in triple negative breast cancer. This regulation may further influence tumor progression and the immune tolerance mechanism in breast cancer and may be able to predict the effect of immunotherapy on patients.


Subject(s)
B7-H1 Antigen , B7 Antigens , Blotting, Western , Breast Neoplasms , Computational Biology , Gene Expression , Genome , Humans , Immune Evasion , Immune Tolerance , Immunotherapy , In Vitro Techniques , Ligands , Luciferases , MicroRNAs , Polymerase Chain Reaction , Prognosis , RNA, Messenger , Triple Negative Breast Neoplasms , Untranslated Regions
12.
Journal of Practical Radiology ; (12): 329-333, 2018.
Article in Chinese | WPRIM | ID: wpr-696808

ABSTRACT

Objective To explore the difference in inhibitory control ability between DRD2 gene subtype of heroin addicts with fMRI.Methods Thirty-seven heroin-dependent patients were divided into DRD2 Taq IA+ group (A+,22)and matched DRD2 Taq IA-group (A-,15).Functional MRI was performed in all patients while they were executing an event-related go/nogo task at 3.0T MR scanner.The differences of brain activated images and behavioral data between the two groups were analyzed with SPM8 and SPSS1 6.0 software,respectively.Results There were no significant differences in reaction time,accuracy and false alarm rates between the two groups (P>0.05).Compared with A-group,weaker activation in the medial prefrontal cortex,dorsal anterior cingulate,middle cingulate,supplementary motor area,temporal lobe,fusiform gyrus,lingual gyrus,hippocampus and parahippocampal gyrus in response inhibition condition were demonstrated in A+ group (voxel number>228,t=2.11,Alphasim correction,P<0.05).There was no corrlation between the intensity within the activated brain regions and the usage of heroin,morphine urine test positive number(P>0.05).Conclusion DRD2 Taq IA+ group exist deactivation of the brain area on memory,inhibitory control,visual spatial attention. It may be the neural basis that contribute to easy addiction and relapse for A+ carriers.

13.
Article in Chinese | WPRIM | ID: wpr-696748

ABSTRACT

Objective To study the effects of the different phases of breast dynamic contrast enhanced MR with 3D MIP in reconstruction of breast vascular.To explore the reconstruction parameters of breast vascular in benign and malignant breast lesions.Methods All of 132 female patients with pathologically confirmed breast disease were enrolled,including 50 cases of benign lesions and 82 malignant cases.All of them underwent high temporal resolution dynamic enhanced MR scanning,with each phase of 20 s.All of the images were reconstructed by 3D MIP and analyzed.Results In both of benign and malignant lesions,the display rate of the internal thoracic artery was higher than that of the lateral thoracic artery and intercostal artery.The display rate of grade Ⅱ vessels of internal thoracic artery and intercostal artery were higher in malignant lesion(P=0.035,0.000).The grade Ⅰ and Ⅱ vessels of the internal thoracic artery and the lateral thoracic artery increased gradually with time delay.The vascular branches were showed in malignant lesions earlier than those in benign lesions,in the 20th seconds in which grade Ⅰ vessels could be displayed,and in the 60th seconds,internal thoracic artery in malignant lesions(96.3%)can be clearly displayed.For benign lesions,grade Ⅰ branch of the internal thoracic artery in patients(80%)could be displayed in the 120th seconds.Conclusion Breast dynamic contrast enhanced MR with 3D MIP can be used to display the blood vessels of the breast,which is of great value in the diagnosis of breast diseases.To achieve the best display effect,different enhanced phases should be selected to reconstruct the blood vessels based on the different enhancement patterns in benign and malignant lesions.

14.
Chinese Journal of Radiology ; (12): 241-246, 2018.
Article in Chinese | WPRIM | ID: wpr-707923

ABSTRACT

Objective This meta-analysis aims to identify consistent results of vulnerable brain regions through the existing resting-state fMRI studies, thus exploring the changes of neural spontaneous brain activity in type 2 diabetes mellitus (T2DM) patients. Methods A systematic analysis of studies on brain resting-state changes in T2DM patients using ALFF, fALFF and ReHo analysis. The meta-analysis was based on the activation likelihood estimation method, using the software of Ginger ALE 2.3. Results Ten studies from 7 references (188 T2DM patients and 170 healthy controls) were included. Based on the analysis of ALFF and ReHo data, this meta-analysis identi fied the robust reduction of resting-state spontaneous brain activity in T2DM patients, including the left lingual gyrus of occipital lobe, right cerebellum posterior lobe,left postcentral gyrus and right insula(cluster size= 800,488,368,256 mm3,P<0.05 after FDR correction),while no increased spontaneous brain activation was found in any regions.The meta-analysis from ReHo studies showed reduced resting-state spontaneous brain activity in the left lingual gyrus of occipital lobe,left postcentral gyrus,right insula and posterior cingulum/lingual gyrus(cluster size=832,368,280,232 mm3,P<0.05 after FDR correction),while no increased spontaneous brain activation was found in any regions. Conclusion This meta-analysis study using the activation likelihood estimation method demonstrated that the resting-state spontaneous brain anomalies in T2DM patients might contribute to exploring machenism underlying diabetic encephalopathy.

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Journal of Medical Biomechanics ; (6): E423-E428, 2018.
Article in Chinese | WPRIM | ID: wpr-803731

ABSTRACT

Objective To compare the biomechanical stability of different fixation methods for unstable pelvic fractures, so as to provide references for clinical treatment. Methods An unstable pelvic fracture model (Tile C) with the sacroiliac joint dislocation at one side and the pubic rami fracture was constructed via three-dimensional finite element method. In the front of the pelvis, the fracture models were fixed with anterior pelvic Stoppa approach (ASA),subcutaneous anterior pelvic approach (APA), anterior pelvic ilioinguinal approach (AIA) and anterior pelvic external fixation (AEF),and the rear was fixed with sacroiliac joint screw (SIJS)and posterior tension-band plate (PTP). The Von Mises stress and strain distributions of fracture models fixed by different combinations of fixation approaches were analyzed under simulated standing conditions. Results After the models were applied with 500 N vertical load, the maximum stresses at the fracture sites were all reduced, which were smaller than 10 MPa in the front of the pelvis. The maximum stress at the anterior and posterior part of implants in sequence was ASA<AIA<AEF<APA, and the average displacement under the same stress in sequence was ASA<AIA<AEF<APA. Meanwhile, the maximum stresses at the sacroiliac joint and the posterior part of implants in PTP group were significant smaller than those in SIJS group, and the maximum total displacement and vertical displacement in PTP group were also smaller than those in SIJS group. Conclusions Unstable pelvic fractures could be significantly improved when the fracture was fixed by implants in eight combined methods. However, the overall biomechanical properties of the AIA groups were superior to those of the AEF groups and the APA groups. The stability of PTP groups in the treatment of posterior injury was better than that of SIJS groups.

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Article in Chinese | WPRIM | ID: wpr-317535

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the clinical efficacy of superior mesenteric artery (SMA)-oriented laparoscopic complete mesocolic excision (CME) with a medial-to-lateral approach in the treatment of right colonic cancer.</p><p><b>METHODS</b>A total of 166 patients with right colonic cancer who were admitted to The First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2016 underwent SMA-oriented laparoscopic CME by the same surgical team. Clinical data of these patients were retrospectively analyzed.</p><p><b>RESULTS</b>All the 166 cases were enrolled in this study, including 96 male and 70 female patients. Right colon adenocarcinoma was diagnosed by preoperative colonoscopy, enhanced computerized tomography(CT) and pathological examination, and the tumor was resectable. There were no emergency surgery patients for bowel obstruction or perforation, no patients with multiple primary cancers, and no stage IIII( patients with liver or lung metastasis. All the patients underwent SMA-oriented laparoscopic CME successfully, without conversion to laparotomy. No ureteral injury, duodenal injury, and superior mesenteric vein injury occurred during the operation. R0 resections were performed in all the cases. The average operation time was (102.4±28.3) min, blood loss was (67.2±26.3) ml, number of lymph nodes retrieved was 20.5±7.6, postoperative anal exhaust time was (2.1±1.1) d, postoperative hospital stay was (7.9±1.4) d. There was no perioperative death or anastomotic leakage. Two patients with small bowel obstruction were readmitted within 30 days after operation. The postoperative complications occurred in 15.1%(25/166) of the patients, including wound infection (2 cases), chylous fistula (20 cases), anastomotic bleeding (1 case), small bowel obstruction (2 cases). A total of 161 patients (97.0%) were followed up for 1 to 24 months, and 10 patients had distant metastasis during the follow-up period. The 2-year overall survival (OS) rate was 96.4%.</p><p><b>CONCLUSION</b>Superior mesenteric artery-oriented laparoscopic complete mesocolic excision with a medial-to-lateral approach for right colonic cancer has good short-term efficacy.</p>

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Article in Chinese | WPRIM | ID: wpr-707413

ABSTRACT

Objective To report the clinical effects of a 3D-printed metal drilling template used in surgery for complex upper cervical disorders.Methods Between August 2015 and June 2017,5 patients with upper cervical disorder complicated with complex cranial cervical junction deformity underwent instrumentation and fusion.They were 4 males and one female,aged from 3 to 36 years.All the patients underwent thin slice CT scan before operation.The CT image data were imported into a computer workstation for three dimensional reconstruction of individualized models of the upper cervical spine on which individualized drilling templates were designed.Guided by each of the individualized metal drilling templates manufactured by 3D printing,surgery via the posterior approach was performed in 2 cases and surgery via the combined anterior and posterior approach in 3 cases.After surgery,the screw trajectory was evaluated by CT scan.Results Surgery succeeded in all the 5 patients.A total of 5 pedicle screws and 5 laminar screws were drilled.Postoperative CT scan showed accurate placement of all the 10 screws.The patients recovered with no neurovascular complications.Conclusion Since an individualized 3D-printed metal drilling template can improve the accuracy and safety of screw placement,it can reduce surgical risks and enhance surgical success in the surgery for complex upper cervical disorders.

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Parenteral & Enteral Nutrition ; (6): 138-142, 2017.
Article in Chinese | WPRIM | ID: wpr-618459

ABSTRACT

Objective:To compare three nutritional screening tools in predicting dialysis-related pro tein-energy wasting(PEW) among maintenance hemodialysis(MHD) patients and to find a more rapid,accurate,and feasible screening tool.Methods:The nutrtional risk screening 62002 (NRS 2002),7-point subjective global assessment(SGA) and malnutrition inflammation scores (MIS) were compared among 205 MHD patients.Correlations between the serum biochemistry,anthropometry and different screening tools were analyzed,and comparisons were made with established guidelines by International Society of Renal Nutrition and Metabolism (ISRNM) for PEW.Results:A total of 31.2% of HD patients had PEW by ISRNM criteria,whilst using NRS 2002,7-point SGA and MIS,58%,40.8% and 46.8% of MHD patients exhibited PEW respectively.The results of three screening tools were closely related to those by serum biochemistry and anthropometry (P < 0.05),but the composite correlation coefficient between the screening tools for PEW and the objective nutritional index commonly used was higher in NRS 2002(r =0.787,P < 0.001) than in 7-Point SGA or MIS.NRS 2002 had higher sensitivity and accuracy values (87.5% and 59.1%,respectively) in MHD Patients.Conclusion:MIS,7-PointSGA and NRS 2002 are valid tools for nutrition screening of dialysis patients,and NRS 2002 may be the best one.

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Article in Chinese | WPRIM | ID: wpr-498053

ABSTRACT

The three-in-one immunoaffinity column ( IAC ) for the determination of aflatoxin B1 ( AFB1 )-zearalenone (ZEN)-deoxynivalenol (DON) was prepared with rProtein A-sepharose 4B as the column matrix. The comprehensive performance ( such as nonspecific adsorption, column blank, column capacity, column efficiency and sample standard addition recovery rate) was evaluated and investigated. The results showed that, the column capacities of AFB1 , ZEN, DON were 295 ng per 0. 25 mL gel, 905 ng per 0. 25 mL gel, 2342 ng per 0. 25 mL gel, respectively, and the column blank was 0. The average recoveries of AFB1 , ZEN and DON were 97. 4%, 98. 0% and 98. 4%, respectively. By optimizing conditions, the samples were extracted using the mixture of methanol and water (80:20, V/V), and diluted with phosphate buffered saline (contain 0. 1% Tween-20, PBST). The detection results of FAPAS (Food Analysis Performance Assessment Scheme) by different batch three-in-one columns were close to the target value. The prepared three-in-one immunoaffinity column which could take the place of conventional single immunoaffinity column was able to meet the requirement for treatment of food and feed samples, and lay a foundation for one step enrichment, purification and detection of multi-mycotoxins.

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Article in Chinese | WPRIM | ID: wpr-489929

ABSTRACT

Objective To study the effects of Rhodiolae Crenulatae Radix ET Rhizoma extracts on sexual behavior of male mice.Methods 50 healthy male mice were randomly divided into the low dose, middle dose and the high dose Rhodiola group, theNanbao capsules group and the normal control group, 10 mice per group. The low dose, middle dose and high dose group were drenched with 0.05, 0.20 and 0.80 g/kg Rhodiola diluent respectively. TheNanbao capsules group mice were drenched with 2.00 g/kg turbid liquid. The normal control group were drenched with saline in the same volume. Liquid is drenched two times each day for 21 days. After 21 days, 50 female mice were matched with to the ratio of 1:1. The number of free movement and swimming test were observed before execution. After the execution, the organ indexes were calculated, and then the contents of SOD and MDA in the testis and liver were measured.Results Compared with the normal control group, capturing latency period of low dose group and middle dose group (20.88 ± 19.94 s, 35.40 ± 22.02 svs.78.11 ± 43.33 s) significantly decreased (P<0.05 orP<0.01). Testicular coefficient of the middle dose group (0.72% ± 0.10 %vs. 0.64% ± 0.08%) was significantly increased (P<0.05); the content of SOD in testicular of the middle dose group, the high dose groups and theNanbao capsules group (152.71 ± 38.10 U/mg, 122.32 ± 52.76 U/mg, 94.38 ± 22.20 U/mgvs. 25.30 ± 14.21 U/mg) increased (P<0.01); the content of SOD in liver of the middle dose group and theNanbaocapsules group (77.71 ± 26.35 U/mg, 74.10 ± 26.04 U/mgvs. 57.92 ± 17.17 U/mg) significantly increased (P<0.05).Conclusion Rhodiola extract can improve the ability of sexual behavior of male mice, and improve the antioxidant capacity of testis and liver.

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