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Objective:To investigate the influencing factors of operation time for laparos-copic sleeve gastrectomy (LSG) and analyze the learning curve of LSG in sarcopenic obesity (SO) and non-sarcopenic obesity (NSO).Methods:The retrospective cohort study was conducted. The clinical data of 240 obesity patients who underwent LSG in the Fujian Medical University Union Hospital from January 2018 to June 2022 were collected. There were 52 males and 188 females, aged (30±8)years. Patients underwent L3 vertebral body horizontal axial computer tomography (CT) scanning before and after receiving LSG to accurately segment muscles and fats. Observation indicators: (1) treatment and follow-up; (2) influencing factors of operation time for LSG; (3) cumulative sum (CUSUM) of learning curve; (4) comparison of clinical data between patients in the initial and profi-cient stages. Measurement data with normal distribution were represent as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(IQR), and comparison between groups was conducted using the non-parameter test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Univariate and multivariate analyses were conducted using the Logistic regression model. The CUSUM of learning curve was calculated and the fitting process was conducted on scatter plot of learning curves. Results:(1) Treatment and follow-up. Of the 240 patients, there were 97 cases of SO and 143 cases of NSO. All 240 patients underwent LSG successfully, without conversion to open surgery. The operation time of 240 patients was (108±23)minutes. None of patient died during the perioperative period and all patients underwent follow-up during the postoperative 6 months. (2) Influencing factors of operation time for LSG. Results of multivariate analysis showed that SO was an independent factor influencing operation time for LSG ( odds ratio=2.207, 95% confidence interval as 1.207-4.038, P<0.05). (3) CUSUM of learning curve. Results of CUSUM of operation time in patients of SO and NSO showed that the best fit equation of patients of SO was y=-4E-08x 6+1E-05x 5-0.001 1x 4+0.063 1x 3-1.89x 2+28.126x-48.671 (x means the number of surgical cases), with goodness-of-fit R 2 as 0.833, and the best fit equation of patients of NSO was y=3E-09x 6-1E-06x 5+0.000 2x 4-0.010 9x 3+0.063 8x 2+12.053x-65.025 (x means the number of surgical cases), with goodness-of-fit R 2 as 0.716. Based on the trend of CUSUM of learning curve of operation time, the peak value of number of surgical cases in patients of SO and NSO was 81 and 36, respec-tively, which was used to divide the learning curve as two stages of the initial stage and the proficient stage. (4) Comparison of clinical data between patients in the initial and proficient stages. ① Of the 97 patients of SO, there were 81 cases and 16 cases in the initial stage and the proficient stage of LSG, with the operation time, postoperative duration of hospital stay as (119±23)minutes, (5.9±2.3)days and (106±21)minutes, (4.7±0.5)days, showing significant differences between them ( t=2.074, 2.147, P<0.05). ②Of the 143 patients of NSO, there were 36 cases and 107 cases in the initial stage and the proficient stage of LSG, with gender (female), height, preoperative body mass, defatted body mass, operation time, postoperative duration of hospital stay, body mass at postoperative 6 month, body mass index (BMI) at postoperative 6 month, percentage of excess weight loss (EWL%) at postoperative 6 month, cases with EWL% >100% at postoperative 6 month, excess BMI at post-operative 6 month as 20, (170±10)cm, (110±25)kg, (57±12)kg, (108±22)minutes, (6.1±1.6)days, (80±16)kg, (27.63±4.22)kg/m2, 83%±35%, 9, 1.99(6.03)kg/m2 and 87, (164±8)cm, (99±20)kg, (52±12)kg, (100±19)minutes, (4.7±1.1)days, (71±16)kg, (25.89±4.48)kg/m2, 103%±42%, 48, 0.31(5.82)kg/m2, showing significant differences between them ( χ2=9.484, t=3.266, 2.424, 2.141, 2.137, 5.821, 2.740, 1.993, -2.524, χ2=4.432, Z=-2.300, P<0.05). Conclusions:SO is an independent factor influencing operation time for LSG. It is suggested that the surgeons need to finish 81 cases and 36 cases master LSG in patients of SO and NSO.
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As intelligent outpatient service comes into being, it is significant to enable the elderlies to leverage such benefits and improve their outpatient experience. A hospital explored an " Orange" heart-to-heart service mode for the elderlies in its outpatient clinics since November 2020. Covering the whole process of elderly outpatients visits in the mode, the following measures were taken, namely the age-appropriate transformation of outpatient self-service equipments, a one-stop medical center for the elderlies to optimize the outpatient flow, and a smart outpatient service station for the elderlies to help them immediately complete or gradually learn related operations on mobile phones and self-service machines. The " Orange" elderly assistance school provides elderlies with popular science education on disease knowledge, and how to use information equipment and medical procedures, effectively improving the experience of elderly outpatients.For example, their waiting time was shortened from(22.56±5.25) minutes before to(13.66±3.65) minutes after, and their overall satisfaction scoring for outpatient experience rose from 3.63 to 4.32 points, and satisfaction rate increased from 78.00% to 93.00%. It can provide reference for improving the outpatient experience of elderlies in the context of smart outpatient visits.
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Acetaminophen (APAP) overdose is the leading cause of drug-induced liver injury, and its prognosis depends on the balance between hepatocyte death and regeneration. Sirtuin 6 (SIRT6) has been reported to protect against oxidative stress-associated DNA damage. But whether SIRT6 regulates APAP-induced hepatotoxicity remains unclear. In this study, the protein expression of nuclear and total SIRT6 was up-regulated in mice liver at 6 and 48 h following APAP treatment, respectively.
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The constitutive androstane receptor (CAR, NR3I1) belongs to nuclear receptor superfamily. It was reported that CAR agonist TCPOBOP induces hepatomegaly but the underlying mechanism remains largely unknown. Yes-associated protein (YAP) is a potent regulator of organ size. The aim of this study is to explore the role of YAP in CAR activation-induced hepatomegaly and liver regeneration. TCPOBOP-induced CAR activation on hepatomegaly and liver regeneration was evaluated in wild-type (WT) mice, liver-specific YAP-deficient mice, and partial hepatectomy (PHx) mice. The results demonstrate that TCPOBOP can increase the liver-to-body weight ratio in wild-type mice and PHx mice. Hepatocytes enlargement around central vein (CV) area was observed, meanwhile hepatocytes proliferation was promoted as evidenced by the increased number of KI67
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Objective To observe the abnormality of lipid metabolism and renal function change in elderly patients with hypertension,and to evaluate the relationship between atherogenic index of plasma(AIP) and glomerular filtration rate(GFR).Methods From July 2015 to June 2017,in Quzhou People's Hospital,182 elderly patients with hypertension were selected as observation group,and 192 elderly healthy people with normal blood pressure were selected as control group.The total cholesterol(TC),triglyeride(TG),high density lipoprotein cholesterol (HDL-C) were detected,and the AIP =1og [TG/HDL-C] was calculated.The GFR was estimated by Cockcroft-Gault equation.The relationship between the estimated GFR (eGFR) and the blood lipid parameters was analyzed.Results The eGFR of the observation group and control group were (84.94 ± 19.49) mL · min-1 · (1.73m2)-1,(154.91 ± 20.44) mL· min-1 · (1.73m2)-1,respectively,the difference between the two groups was statistically significant (t =11.27,P ＜ 0.01).The AIP of the observation group and control group were (0.68 ± 0.03),(-0.22 ± 0.02),respectively,the difference between the two groups was statistically significant (t =3.43,P ＜ 0.01).There was a negative correlation between AIP and eGFR in the elderly patients with hypertension (r =-0.845,P ＜ 0.01).Conclusion The fact shows that abnormality of lipid metabolism in the elderly patients with hypertension is present.AIP can be used as a plasma marker of atherosclerosis and could be used as a useful and important parameter for clinical observation in the elderly hypertensive patients with renal impairment.
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Objective To investigate the therapeutic effect of Jianpi Yiqi, Bushen Fenjing combined with oxaliplatin+CF/5-FU on colorectal cancer.MethodsEighty patients with colorectal cancer who were treated in our hospital from January 2014 to December 2015 were randomly divided into observation group(40cases) and control group (40cases).The control group was given oxaliplatin+CF/5-FU treatment, the observation group in the control group based on the application of Spleen Qi, Bushen fill essence treatment, observed before and after treatment of two groups of serum tumor markers, clinical symptoms and living conditions, changes, record adverse reactions.ResultsThe observation effect of 82.50% was significantly higher than that of the control group (62.50%).The QOL score (37.8±5.6) was significantly higher than that of the control group (33.5±3.1) and the adverse reaction rate was 30.00% (P<0.05).The difference between the two groups was significant (P<0.05).ConclusionThe effect of invigorating spleen qi and tonifying siren solution combined with oxaliplatin+CF/5-FU on colorectal cancer can improve the clinical symptoms and improve the quality of life of patients.
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Objective To study effect of bufalin on invasion and metastasis of gastric cancer cells and related mechanism.Methods AGS human gastric cancer cell line was used for in vitro experiments.Cultured cells were treated by negative control group,bufalin group and oxaliplatin group.Cell proliferation was determined by MTT.Invasion and metastasis were observed by Wound-Healing Assay and Transwell Assay.Expression levels of E-cadherin,matrix metalloproteinases (MMP)-2,MMP-9 were detected by Western blotting.Results Bufalin was found to significantly inhibit the proliferation of AGS cells in a dose and time dependent manner.Wound-Healing Assay and Transwell Assay showed that as compared with the blank control group,bufalin inhibited invasion and metastasis of AGS cells (P＜ 0.05),but there was no statistically significant difference between bufalin group and oxaliplatin group (P＞0.05).Western blotting showed the expression of E-cadherin was increased in bufalin group as compared with the blank control group while the expression levels of MMP-9 and MMP-2 were down-regulated (P＜0.05),but there was no statistically significant difference between bufalin group and oxaliplatin group (P＞ 0.05).Conclusion Bufalin has anti-cancer activity on gastric cancer cells,and it has the ability of inhibiting cancer cell invasion and metastasis,and regulating the expression of some related gene.
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Alcohol abuse leads to alcoholic liver disease and no effective therapy is currently available. Wuzhi Tablet (WZ), a preparation of extract fromthat is a traditional hepato-protective herb, exerted a significant protective effect against acetaminophen-induced liver injury in our recent studies, but whether WZ can alleviate alcohol-induced toxicity remains unclear. This study aimed to investigate the contribution of WZ to alcohol-induced liver injury by using chronic-binge and acute models of alcohol feeding. The activities of ALT and AST in serum were assessed as well as the level of GSH and the activity of SOD in the liver. The expression of CYP2E1 and proteins in the NRF2-ARE signaling pathway including NRF2, GCLC, GCLM, HO-1 were measured, and the effect of WZ on NRF2 transcriptional activity was determined. We found that both models resulted in liver steatosis accompanied by increased transaminase activities, but that liver injury was significantly attenuated by WZ. WZ administration also inhibited CYP2E1 expression induced by alcohol, and elevated the level of GSH and the activity of SOD in the liver. Moreover, the NRF2-ARE signaling pathway was activated by WZ and the target genes were all upregulated. Furthermore, WZ significantly activated NRF2 transcriptional activity. Collectively, our study demonstrates that WZ protected against alcohol-induced liver injury by reducing oxidative stress and improving antioxidant defense, possibly by activating the NRF2-ARE pathway.
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Objective To investigate the clinical efficacy of electroacupuncture in treating mild and moderate female stress incontinence.Methods One hundred and eighty female patients with mild or moderate stress incontinence were randomly allocated to treatment and control groups, 90 cases each. The treatment group received electroacupuncture and the control group took midodrine hydrochloride tablets. The International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) score was recorded and 1-hour pad test leakage was measured in the two groups before and after treatment. The clinical therapeutic effects were compared between the two groups.Results There were statistically significant pre-/post-treatment differences in the ICIQ-UI SF score and pad test leakage in both groups (P<0.01). There were statistically significant post-treatment differences in the ICIQ-UI SF score and pad test leakage between the treatment and control groups (P<0.01). The total efficacy rate was 86.7% in the treatment group and 68.9% in the control group; there was a statistically significant difference between the two groups (P<0.05).Conclusions Electroacupuncture is an effective way to treat mild and moderate female stress incontinence. It can improve urinary continence and reduce urine leakage in the patients.
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Objective To investigate the effects ofZhenqi-Fuzheng capsule combined with highly active antiretroviral therapy (HAART) the Thl/Th2, Tcl/Tc2, and CD4+ T lymphocytes in patients with advanced AIDS.Methods A total of 70 patients with advanced AIDS were randomly divided into a treatment group and a control group, with 35 patients in each group. The treatment group was treated withZhenqi-Fuzheng capsule combined with HAART, while the control group was treated with HAART only. The patients in both groups were treated for 24 weeks. The Thl, Th2, Tcl, Tc2 and CD4+ T lymphocytes in peripheral blood were detected by flow cytometer.Results After treatment, the ratios of Th1/Th2 (6.27 ± 0.70vs. 5.39 ± 0.64;P<0.05) and Tcl/Tc2 (10.70 ± 0.68vs. 10.16 ± 0.85;P<0.05) in the treatment group showed significantly higher than those in the control group. The CD4+T lymphocytes after the treatment in both groups showed significantly increased than that before the treatment (treatment group: 289.2 ± 101.5/mlvs. 121.1 ± 77.5/ml,P<0.01; control group: 231.6 ± 97.6/mlvs. 118.9 ± 76.2/ml,P<0.01). The CD4+T lymphocytes in the treatment group showed significantly increased than that in the control group after the treatment (P<0.05).ConclusionsZhenqi-Fuzhengcapsule combined with HAART may regulate the Thl/Th2 and Tcl/Tc2, and increase the CD4+ T lymphocytes in patients with advanced AIDS.