Clinical efficacy of laparoscopic-assisted intersphincteric resection with different surgical approaches for low rectal cancer / 中华消化外科杂志

Objective:To investigate the clinical efficacy of laparoscopic-assisted inters-phincteric resection (ISR) with different surgical approaches for low rectal cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 90 patients with low rectal cancer who were admitted to the Second Affiliated Hospital of Fujian Medical University from January 2016 to December 2020 were collected. There were 58 males and 32 females, aged (60±9)years. Of 90 patients, 60 cases underwent laparoscopic assisted ISR with transpelvic approach, 30 cases underwent laparoscopic assisted ISR with transabdominal and transanal mixed approach. Observation indicators: (1) clinicopathological characteristics of patients with transpelvic approach and mixed approach; (2) intraoperative and postoperative conditions of patients with transpelvic approach and mixed approach; (3) postoperative complications of patients with transpelvic approach and mixed approach; (4) follow-up. Follow-up was conducted by telephone interview and outpatient examination once every 3 months within postoperative 3 years, once every six months in the postoperative 3 to 5 years and once a year after postoperative 5 years to detect tumor recurrence and metastasis, and survival of patients.Follow-up was up to March 2021 or patient death. Measurement data with normal distribution were represented as Mean± SD, and the t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(range), and comparison between groups was conducted using the non-parametric Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was performed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed by the non-parametric rank sum test. Kaplan-Meier method was used to draw survival curves and calculate survival rates, and survival analysis was performed by the Log-Rank test. Results:(1) Clinicopathological characteristics of patients with transpelvic approach and mixed approach. The sex (males, females), distance from the distal margin of tumor to anal margin were 34, 26, (4.5±0.5)cm for patients with transpelvic approach, versus 24, 6, (3.5±0.5)cm for patients with mixed approach, respectively, showing significant differences between them ( χ2=4.75, t=8.35, P<0.05). (2) Intraoperative and postoperative conditions of patients with transpelvic approach and mixed approach. The operation time, volume of intraoperative blood loss, distance from the postoperative anastomosis to anal margin were (187±9)minutes, 50(range, 20?200)mL, (3.4±0.7)cm for patients with transpelvic approach, versus (256±12)minuets, 100(range, 20?200)mL, (2.6±0.7)cm for patients with mixed approach, showing significant differences between them ( t=?26.99, Z=?2.48, t=4.67, P<0.05). None of the 90 patients had a positive distal margin. The stoma reversal rates of patients with transpelvic and mixed approach were 93.3%(56/60) and 90.0%(27/30), respectively. Of the 60 patients with transpelvic approach, 3 cases had no stoma reversal due to anastomotic complications, and 1 case was not yet to the reversal time. Of the 30 patients with mixed approach, 2 cases had no stoma reversal due to anastomotic complications, and 1 case was not yet to the reversal time. The 1-, 3-month Wexner scores after stoma reversal were 15(range, 12?17), 12(range, 10?14) for patients with transpelvic approach, versus 16(range, 14?18), 14(range, 12?16) for patients with mixed approach, showing significant differences between them ( Z=?4.97, ?5.49, P<0.05). The 6-month Wexner score after stoma reversal was 10(range, 9?12) for patients with transpelvic approach, versus 11(range, 8?12) for patients with mixed approach, showing no significant difference between them ( Z=?1.59, P>0.05). (3) Postoperative complications of patients with transpelvic approach and mixed approach. The complications occurred to 16 patients with transpelvic approach and 9 patients with mixed approach, respectively, showing no significant difference between them ( χ2=0.11, P>0.05). Cases with postoperative anastomotic fistula, cases with anastomotic bleeding, cases with anastomotic stenosis, cases with intestinal obstruction, cases with incision infection, cases with urinary retention, cases with pelvic infection, cases with pulmonary infection, cases with incisional hernia, cases with chylous fistula, cases with abdominal and pelvic abscess were 5, 2, 1, 7, 0, 1, 5, 3, 1, 1, 1 for patients with transpelvic approach, versus 6, 3, 2, 2, 2, 1, 2, 3, 1, 1, 1 for patients with mixed approach, showing no significant difference between them ( P>0.05). The same patient could have multiple postoperative complications. (4) Follow-up. All the 90 patients were followed up for 27(range, 6?62)months. The follow-up time of 60 patients with transpelvic approach was 27(range, 8?62)months. The follow-up time of 30 patients with mixed approach was 28(range, 6?53)months. Of the 60 patients with transpelvic approach, 3 cases had local recurrence, 4 cases had liver metastasis, 3 cases had lung metastasis, and all of them survived with tumor. Of the 30 patients with mixed approach, 1 case had local recurrence, 2 cases had liver metastasis, 1 case had lung metastasis, and all of them survived with tumor. There was no death. The 3-year disease-free survival rates of patients with transpelvic approach and mixed approach were 84.7% and 87.9%, respectively, showing no significant difference between them ( χ2=0.39, P>0.05). Conclusions:Lapa-roscopic assisted ISR via transpelvic approach or mixed approach for low rectal cancer are safe and feasible. Compared with transanal mixed approach, the transpelvic approach of laparoscopic-assisted ISR has shorter operation time, less volume of intraoperative blood loss and longer distance from the postoperative anastomosis to anal margin.

Clinical value of stylized laparoscopic hemicolectomy for left colon cancer / 中华消化外科杂志

Objective:To investigate the clinical value of stylized laparoscopic hemicolec-tomy for left colon cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 174 patients who underwent laparoscopic hemicolectomy for left colon cancer in the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2020 were collected. There were 106 males and 68 females, aged 59(range, 17?86)years. All patients underwent stylized laparoscopic hemicolectomy for left colon cancer. Observation indicators: (1) surgical situations; (2) postoperative complications; (3) postoperative histopathological examinations; (4) follow-up. Follow-up was conducted using outpatient examination or telephone interview to detect tumor recurrence and metastasis and survival of patients up to October 2021. Follow-up was performed once every 3 months within postoperative 2 years, once every 6 months within postoperative 2 to 5 years and once a year after postoperative 5 years, with the end point as tumor recurrence and metastasis or death of patients. Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were represented as M(range) or M( Q1, Q3). Count data were described as absolute numbers or percentages. Kaplan-Meier method was used to draw survival curve and calculate survival rate. Results:(1) Surgical situations. All the 174 patients underwent stylized laparoscopic hemicolectomy for left colon cancer successfully, including 6 cases receiving preoperative enteral stent placement due to bowel obstruc-tion, 3 cases receiving defunctioning ileostomy and 1 case receiving Hartmann procedure. The operation time, volume of intraoperative blood loss, time to postoperative initial defecation and duration of postoperative hospital stay of the 174 patients were 97(80,106)minutes, 45(25,60)mL, 5(3,6)days and 7(6,8)days, respectively. (2) Postoperative complications. Twelve of the 174 patients had complications, including 4 cases with incision infection or fat liquefaction, 3 cases with anastomotic leakage, 2 cases with incomplete bowel obstruction, 1 case with abdominal hemo-rrhage, 1 case with chylous leakage and 1 case with pulmonary infection. The 2 cases with anastomotic leakage underwent ileostomy. The patient with abdominal hemorrhage underwent laparotomy to stop bleeding. One elder patient died of postoperative pulmonary infection. The other patients with complications recovered with conservative treatment. (3) Postoperative histopatho-logical examinations. Of the 174 patients, there were 27 cases in stage Ⅰ of TNM staging, 68 cases in stage Ⅱ, 77 cases in stage Ⅲ and 2 cases in stage Ⅳ. There were 9 cases with well differentiated tumor, 107 cases with moderately differentiated tumor and 58 cases with poorly differentiated tumor. The number of lymph node detected, the number of positive lymph node and tumor diameter of the 174 patients were 19(15,23), 0(0,2) and 4(3,5)cm, respectively. Of the 174 patients, there were 79 cases with lymph node metastases, 21 cases with cancerous nodules, 35 cases with vascular invasion and 29 cases with nerve invasion. (4) Follow-up. Of the 174 patients, 157 cases were followed up for 27(range, 1?70)months. Of the 157 patients who conducted follow-up, 20 cases had tumor metastasis, including 9 cases with multiple metastasis, 5 cases with liver metastasis, 4 cases with lung metastasis, 1 case with bone metastasis and 1 case with spleen metastasis. The 5-year overall survival rate and tumor free survival rate of the 157 patients were 90.9% and 80.8%, respectively.Conclusion:The stylized laparoscopic hemicolectomy for left colon cancer is safe and feasible.

Clinical efficacy of pancreaticoduodenectomy for periampullary diseases: a report of 2 019 cases / 中华消化外科杂志

Objective:To investigate the clinical efficacy of pancreaticoduodenectomy (PD) for periampullary diseases.Methods:The retrospective cohort study was conducted. The clinico-pathological data of 2 019 patients with periampullary diseases who underwent PD in the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2020 were collected. There were 1 193 males and 826 females, aged 63(15) years. Observation indicators: (1) surgical situations; (2) postoperative conditions; (3) postoperative pathological examinations; (4) prognosis of patients with periampullary carcinoma. Regular follow-up was conducted by telephone interview and outpatient examination once every 3 months within the postoperative first year and once every 6 months thereafter to detect the survival of patients with periampullary carcinoma. The follow-up was up to December 2021. Measurement data with skewed distribution were represented as M(IQR) or M(range), and comparison between groups was analyzed using the rank sum test. Count data were described as absolute numbers and (or) percentages, and comparison between groups was analyzed by the chi-square test or Fisher exact probability. Kaplan-Meier method was used to draw survival curves and calculate survival rates, and Log-Rank test was used to conduct survival analysis. Results:(1) Surgical situations: of 2 019 patients, 1 116 cases were admitted from 2016-2018 and 903 cases were admitted from 2019-2020. There were 1 866 cases undergoing open PD and 153 cases undergoing laparoscopic or robot-assisted PD. There were 1 049 cases under-going standard PD and 970 cases undergoing pylorus-preserved PD. There were 215 cases combined with portal mesenteric vein resection, 3 cases combined with arterial resection. The operation time of 2 019 patients was 255(104)minutes and the volume of intraoperative blood loss was 250(200)mL. The intraoperative blood transfusion rate was 31.401%(623/1 984), with the blood transfusion data of 35 cases missing. The proportions of pylorus-preservation, combination with portal mesenteric vein resection, intraoperative blood transfusion were 585 cases(52.419%), 97cases(8.692%), 384 cases(34.941%) for patients admitted in 2016-2018, versus 385 cases(42.636%), 118 cases(13.068%), 239 cases(27.006%) for patients admitted in 2019-2020, showing significant differences between them ( χ2=19.14,10.05,14.33, P<0.05). (2) Postoperative conditions: the duration of postoperative hospital stay of 2 019 patients was 13 (10) days. One of 2 019 patients lacked the data of postopera-tive complications. The overall postoperative complication rate was 45.292%(914/2 018), of which the incidence rate of grade B or C pancreatic fistula was 23.439%(473/2 018), the rate of grade B or C hemorrhage was 8.127%(164/2 018), the rate of grade B or C delayed gastric emptying was 15.312%(309/2 018), the rate of biliary fistula was 2.428%(49/2 018) and the rate of abdominal infection was 12.884%(260/2 018). The reoperation rate of 2 019 patients was 1.932%(39/2 019), the in-hospital mortality was 0.644%(13/2 019), the postoperative 30-day mortality was 1.238%(25/2 019), and the postoperative 90-day mortality was 2.675%(54/2 019). There were 541 cases(48.477%) with overall postoperative complications, 109 cases(9.767%) with grade B or C hemorr-hage, 208 cases(18.638%) with grade B or C delayed gastric emptying , 172 cases(15.412%) with abdominal infection, 39 cases(3.495%) with postoperative 90-day mortality of 1 116 patients admitted in 2016-2018. The above indicators were 373 cases(41.353%), 55 cases(6.098%), 101 cases(11.197%), 88 cases(9.756%), 15 cases(1.661%) of 902 patients admitted in 2019-2020, respectively. There were significant differences in the above indicators between them( χ2=10.22, 9.00, 21.30, 14.22, 6.45 , P<0.05). The in-hospital mortality occurred to 11 patients(0.986%) of 1 116 patients admitted in 2016-2018 and to 2 cases(0.221%) of 903 patients admitted in 2019-2020, showing a significant difference between them ( P<0.05). (3) Postoperative pathological examinations. Disease area of 2 019 patients reported in postoperative pathological examinations: there were 1 346 cases(66.667%) with lesions in pancreas, including 1 023 cases of carcinoma (76.003%) and 323 cases(23.997%) of benign diseases or low potential malignancy. There were 250 cases(12.382%) with lesions in duodenal papilla, including 225 cases of carcinoma (90.000%) and 25 cases(10.000%) of benign diseases or low potential malignancy. There were 174 cases(8.618%) with lesions in bile duct, including 156 cases of carcinoma (89.655%) and 18 cases(10.345%) of benign diseases or low potential malignancy. There were 140 cases(6.934%) with lesions in ampulla, including 134 cases of carcinoma (95.714%) and 6 cases(4.286%) of benign diseases or low potential malignancy. There were 91 cases(4.507%) with lesions in duodenum, including 52 cases of carcinoma (57.143%) and 39 cases(42.857%) of benign diseases or low potential malignancy. There were 18 cases(0.892%) with carcinoma in other sites. Postoperative pathological examination showed carcinoma in 1 608 cases(79.643%), benign diseases or low potential malignancy in 411 cases(20.357%). The histological types of 1 608 patients with carcinoma included adenocarcinoma in 1 447 cases (89.988%), intra-ductal papillary mucinous carcinoma in 37 cases(2.301%), adenosquamous carcinoma in 35 cases(2.177%), adenocarcinoma with other cancerous components in 29 cases(1.803%), neuroendocrine carcinoma in 18 cases(1.119%), squamous carcinoma in 1 case (0.062%), and other histological malignancies in 41 cases(2.550%). The histological types of 411 patients with benign or low poten-tial malignancy included intraductal papillary mucinous neoplasm in 107 cases (26.034%), chronic or autoimmune inflammatory disease in 62 cases(15.085%), neuroendocrine tumor in 58 cases(14.112%), pancreatic serous cystadenoma in 52 cases(12.652%), pancreatic solid pseudopapillary tumor in 36 cases(8.759%), gastrointestinal stromal tumor in 29 cases(7.056%), villous ductal adenoma in 20 cases(4.866%), pancreatic mucinous cystadenoma in 2 cases(0.487%), pancreatic or duodenal trauma in 2 cases(0.487%) and other histological types in 43 cases(10.462%). (4) Prognosis of patients with periampullary carcinoma. Results of survival analysis of 1 590 patients with main locations of periampullary carcinoma showed that of 1 023 patients with pancreatic cancer, 969 cases were followed up for 3.0-69.6 months, with a median follow-up time of 30.9 months. The median overall survival time, 1-year, 3-year and 5-year survival rates of pancreatic cancer patients were 19.5 months [95% confidence interval ( CI) as 18.0-21.2 months], 74.28%, 29.22% and 17.92%. Of 225 patients with duodenal papillary cancer, 185 cases were followed up for 3.0-68.9 months, with a median follow-up time of 36.7 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were unreached, 94.92%, 78.87% and 66.94%. Of 156 patients with distal bile duct cancer, 110 cases were followed up for 3.0-69.5 months, with a median follow-up time of 25.9 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were 50.6 months (95% CI as 31.4 to not reached), 90.37%, 56.11% and 48.84%. Of 134 patients with ampullary cancer, 100 cases were followed up for 3.0-67.8 months, with a median follow-up time of 28.1 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were 62.4 months (95% CI as 37.8 months to not reached), 90.57%, 64.98% and 62.22%. Of 52 patients with duodenal cancer, 38 cases were followed up for 3.0-69.5 months, with a median follow-up time of 26.2 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were 52.0 months (95% CI as 30.6 months to not reached), 93.75%, 62.24% and 40.01%.There was a significant difference in overall survival after PD between patients with different locations of periampullary malignancies ( χ2=163.76, P<0.05). Conclusions:PD is safe and feasible in a high-volume pancreas center, but the incidence of overall postoperative complications remains high. With the increase of PD volume, the incidence of overall postoperative complications has significantly decreased. There is a significant difference in overall survival time after PD among patients with different locations of periampullary malignancies. The 5-year survival rate after PD for duodenal papillary cancer, ampullary cancer, duodenal cancer and distal bile duct cancer is relatively high, whereas for pancreatic cancer is low.

Prepartum anionic diet induces hyperchloremic acidosis in high-producing dairy cows without preventing subclinical hypocalcemia / Dieta aniônica pré-parto provoca acidose hiperclorêmica em vacas leiteiras de alta produção mas não evita a hipocalcemia subclínica

In this study we evaluated the effects of the prepartum anionic diet on the electrolyte balance and calcemia of high producing dairy cows in the first days of lactation, and investigated the impact on the frequency of subclinical hypocalcemia (SCH). Sixty healthy Holstein cows, producing 30 kg of milk/day, handled in intensive system (compost barn), were distributed in groups (n=15) according to lactation order: first, second, third, and fourth to sixth. In the last three weeks before calving they received a diet with negative DCAD (-6mEq/100g DM) and high chloride content. After calving, they received a diet with positive DCAD (18mEq/100g DM). Urine pH was measured before calving. Serum Na+, Cl-, K+, and total Ca concentrations, and the strong ion difference (SID3) were determined in samples taken soon after calving (0h), 24, 48, 72 and 96h after. The frequencies of SCH were determined considering the critical value of 2.125mmol/L (8.5mg/dL). Two-way repeated measures ANOVA and chi-square test were used for comparisons. The cows eliminated acidic urine before calving. Na+, K+, Cl-, and SID3 values did not differ between groups. Na+ and K+ did not vary between days; Cl- was elevated at calving and decreased until 72h; and SID3 was reduced at calving and increased up to 48h. The Ca levels were reduced until 24h and increased up to 72h. Cows of third and fourth to sixth lactations presented lower values up to 24h. SCH was observed in almost half of the cows (43.3% to 55%) until 48h. The maintenance of hypocalcemia for three or more consecutive days occurred in 53.3% of third and fourth to sixth lactations cows. Ingestion of a high chloride prepartum anionic diet led to hyperchloremic acidosis and this imbalance was reversed on the second postpartum day. The induced effects on electrolyte and acid-base balances were not able to prevent the occurrence of SCH in the first days of lactation.(AU)

Os objetivos do estudo foram avaliar os efeitos que a dieta aniônica pré-parto provoca sobre o equilíbrio eletrolítico e sobre a calcemia de vacas leiteiras de alta produção nos primeiros dias de lactação, e verificar o impacto sobre a frequência da hipocalcemia subclínica (HSC). Sessenta fêmeas hígidas HPB, com produção de 30 kg de leite/dia, manejadas em sistema intensivo (compost barn), foram distribuídas por grupos (n=15) de acordo com a ordem de lactação: primeira, segunda, terceira e quarta a sexta. Nas três semanas pré-parto receberam dieta com DCAD negativa (-6mEq/100g MS) e teor de cloreto elevado. Após o parto receberam dieta com DCAD positiva (18mEq/100g MS). O pH da urina foi mensurado antes do parto. As concentrações séricas de Na+, Cl-, K+ e Ca total e a diferença de íons fortes (SID3) foram determinadas em amostras colhidas ao parto (0h), 24, 48, 72 e 96h após. As frequências de HSC foram determinadas considerando-se o valor crítico de 2,125mmol/L (8,5mg/dL). ANOVA de medidas repetidas e teste de qui-quadrado foram empregados para as comparações. As vacas eliminavam urina ácida antes do parto. Os valores de Na+, K+, Cl- e SID3 não diferiram entre os grupos. Na+ e K+ não variaram entre os dias; Cl- era elevado ao parto e diminuiu até 72h; e SID3 era reduzida ao parto e aumentou até 48h. A calcemia era reduzida até 24h e se elevou até 72h. Vacas de terceira e de quarta a sexta lactações apresentaram valores mais baixos até 24h. A HSC foi observada em quase metade das vacas (43,3% a 55%) até 48h. A manutenção de hipocalcemia por três ou mais dias seguidos ocorreu em 53,3% das vacas de terceira e de quarta a sexta lactações. A ingestão de dieta aniônica pré-parto com alto teor de cloreto provocou acidose hiperclorêmica e este desequilíbrio se reverteu no segundo dia pós-parto. Os efeitos induzidos sobre os equilíbrios eletrolítico e ácido base não foram capazes de prevenir a ocorrência de HSC nos primeiros dias da lactação.(AU)

Study of the changes in the growth, protein, and bioactive profile of Chlorella emersonii KJ725233 in response to sodium and ammonium nitrate

India. The alterations in its chlorophyll, protein, and antioxidant content in response to cationic stress were studied.Chlorella emersonii KJ725233 (CEK) was subjected to NaNO3 and NH4 (NO3)2 at concentrations equivalent to0.9 g/l (1×) and 1.8 g/l (2×) in the cultivation media. Qualitative alterations in the bioactives of the microalgawere identified by gas chromatography–high-resolution mass spectrometry (GC-HRMS), while the protein,chlorophyll, and antioxidant manipulations were spectrophotometrically quantified. Doubling of the proteincontent was observed when CEK was grown in 1× NH4+, whereas in 2× NH4+, chlorosis was significant. 2× NH4+also induced oxidative stress on CEK as evident from the 85.72% ± 6.72%, 197.47% ± 7.01%, 22.24% ± 1.78%,and 187.37% ± 1.88% increase in antioxidant potential, ferric reducing capacity, radical scavenging potential, andtotal phenolic content, respectively, as compsared to CEK grown in 1× Na+. These alterations as indicated fromthe GC-HRMS data correlate to the bioactive inductions/variations of/in Vitamin E, phytol, and its isomer in CEKgrown in 2× NH4+. The study thus indicates that manipulations of nitrate salts in the media significantly induce, aswell as alter the concentrations of commercially significant compounds like Vitamin E, phytol, etc.

Preoperative evaluation value of carotid and cerebral arteries by CT angiography in acute type A aortic dissection / 医疗卫生装备

Objective To investigate the feasibility of combined CT angiography(CTA)of head,neck and aorta in acute type A aortic dissection (ATAAD) and whether the incremental craniocervical information benefits the surgeon and leads to improved clinical outcomes.Methods One hundred and twenty ATAAD patients in a CAC group underwent combined aortic CTA and 123 ATAAD patients in a control group underwent conventional aortic CTA.In the CAC group,the image quality was analyzed and critical CTA findings in craniocervical arteries were determined for further surgery procedure.The radiation dose,intraoperative cerebral protection method,and postoperative intensive care units(ICU)time,in-hospital time,neurologic dysfunction(ND)and all-cause mortality were compared between the two groups.Results The CAC group had all the carotid and cerebral arteries diagnosed successfully. There were 13 patients replaced conventional unilateral antegrade selective cerebral perfusion with bilateral one according to the head and neck CTA images in the CAC group. The CAC group had effective radiation dose,postoperative ND,ICU time and in-hospital time significantly lower than those of the control group (P<0.05).There were no statistical differences between the all-cause morbidities of the two groups (P>0.05).Conclusion A combined CTA of head, neck and aorta in ATAAD is feasible. The incremental craniocervical information may lead to improved clinical outcomes.

Comparison of the influence of putting T tube drainage or not on surgery effect of laparoscopic choledocho－lithotomy / 中国基层医药

Objective To compare the influence of putting T tube drainage or not on surgery effect of laparo －scopic choledocholithotomy .Methods From January 2014 to December 2017,76 patients with laparoscopic choledo－cholithiasis in the People's Hospital of Houma were selected in the research .All patients underwent laparoscopic choledocholithotomy.According to the random number table method,the patients were randomly divided into observation group(without T tube drainage ) and control group(with T tube drainage),with 38 cases in each group.The operation time,postoperative hospital stay ,anal exhaust time,hospitalization expenses ,bile leakage and postoperative satisfaction between the two groups were compared .Results There was no statistically significant difference in the operation time between the two groups(t＝0.39,P＞0.05).The hospitalization days,hospitalization expense and anus exhaust time in the observation group were significantly lower than those in the control group ( t＝12.54,5.05,11.32,all P＜0.01).The incidence rate of bile leakage of the observation group was 2.63%,which was significantly lower than 28.95%of the control group (χ2＝8.02,P ＝0.01).The postoperative satisfaction of the observation group was 97.37%,which was significantly higher than 63.16%of the control group(χ2＝11.96,P＜0.01).Conclusion The non－T tube drainage in laparoscopic choledochotomy can reduce the hospitalization time , hospitalization cost, incidence rate of postoperative bile leakage and improve the patients 'satisfaction.Therefore,it has good safety and feasibility,which is worthy of clinical application and promotion .

Importância da detecção de mutações do gene ATP7B para o diagnóstico da doença de Wilson / The importance of detecting ATP7B gene mutations for the diagnosis of Wilson's disease

O diagnóstico da doença de Wilson (DW) é realizado por exames clínicos, laboratoriais, anatomopatológicos e de imagem. Mais de 500 mutações no gene ATP7B foram descritas como causadoras da DW. Para avaliar a importância da detecção de mutações no diagnóstico da DW em nosso meio, analisamos 35 pacientes com DW, 20 familiares de wilsonianos a partir de rastreamento familiar, 18 com hepatite crônica criptogênica e sete com insuficiência hepática aguda grave. Para o diagnóstico da DW foi utilizado o sistema de escore sugerido pela Sociedade Europeia para o Estudo do Fígado de 2012. Os dados demográficos, clínicos, laboratoriais e histológicos foram obtidos retrospectivamente. Obteve-se o DNA genômico de cada paciente a partir de sangue periférico e realizou-se o sequenciamento direto dos 21 éxons e suas bordas intrônicas do gene ATP7B. Todos os pacientes com DW apresentavam no mínimo quatro pontos. No grupo de rastreamento familiar o sequenciamento foi importante para o diagnóstico de DW em 14 familiares; no grupo de hepatite crônica criptogênica em oito pacientes e no grupo de insuficiência hepática aguda grave em três pacientes. Foi caracterizada uma família com cinco genótipos diferentes (dois homozigotos p.A1135Qfs/p.A1135Qfs e p.M645R/p.M645R), um heterozigoto composto (p.A1135Qfs/p.M645R) e dois heterozigotos simples (p.A1135Qfs/0 e p.M645R/0) com fenótipos variados. Foram detectadas duas mutações em heterozigose simples em pacientes com insuficiência hepática aguda grave. A mutação p.A1135Qfs e p.L708P foram as mais frequentes em todos os grupos. Foi identificada pela primeira vez a mutação p.M645R em homozigose. Concluímos que os resultados confirmaram que o sequenciamento do gene ATP7B foi útil: 1) para confirmar que as mutações p.A1135Qfs e p.L708P são as mais importantes na população brasileira; 2) para demonstrar que a mutação tida como a mais frequente na Europa, a p.H1069Q, tem bem menor importância em nosso meio, embora mais...

Wilson's disease (WD) is an autosomal recessive disorder secondary to mutations in the ATP7B gene resulting in toxic accumulation of copper in various tissues. The diagnosis of WD is made by the analysis of clinical, laboratory, histological findings and imaging tests. More than 500 mutations have been described in the ATP7B gene as the cause of WD. In order to expand the knowledge of the importance of mutation detection in the diagnosis of WD, we analyzed 36 patients with WD, 20 individuals from family screening, 18 with cryptogenic chronic hepatitis and seven with severe acute liver failure. For the diagnosis of WD the International Scoring System suggested by the European Association for the Study of the Liver (EASL) in 2012 was used. Demographic, clinical, laboratory and histological data were obtained retrospectively. Direct sequencing of 21 exons and intron boundaries of ATP7B gene was performed in genomic DNA extracted from peripheral blood leucocytes of all subjects. All patients with WD have at least four points of the scoring system without considering the DPA challenge test. In the family screening group, sequencing was important for the diagnosis of DW in fourteen patients; eight patients in the group of cryptogenic chronic hepatitis, and three patients in the group of severe acute liver failure. Five different genotypes were identified in one family (two homozygous, p.A1135Qfs/p.A1135Qfs and p.M645R/p.M645R, one compound heterozygous p.A1135Qfs/p.M645R, and two simple heterozygous p.A1135Qfs/0 and p.M645R/0). Two patients with acute liver failure were detected as simple heterozygous. The p.A1135Qfs and p.L708P were the most frequent mutations in all groups. It is the first time p.M645R mutation was detected in homozygosity. The ATP7B gene sequencing was useful: 1) to confirm that p.A1135Qfs and p.L708P mutations are the most frequent in the Brazilian population; 2) to confirm that the most common mutation in Europe, p.H1069Q has lower frequency...

Simultaneous Determination of Anions and Cations by Multimodal Liquid Chromatography / 分析化学

A new method has been established for simultaneous determination of anions and cations in fertilizer sample by multimodal liquid chromatography with direct conductivity detection. An Acclaim Trinity P1 column based on nanopolymer silica hybrid technology with multimodal separation functional groups reversed-phase/anion-exchange/cation-exchange was used for the analysis. The chromatographic conditions were optimized and the effect ion of eluent on retention was discussed. Eight ions ( Li+, NH+4 , K+, HCOO-, NO-2 , Cl-, NO-3 and Br-) were separated and determined simultaneously by using 25 mmol/L CH3 COONa solution containing 50% acetonitrile at pH=5. 0 as mobile phase. The flow rate was 0. 50 mL/min and the temperature was 30 ℃. Under the optimum conditions, the linear ranges of the method were in the range of 0 . 5-200 mg/L for all the ions with correlation coefficient of 0 . 9997-0 . 9999 . Whereas the detection limits (S/N=3) were in the range of 0. 16-1. 72 mg/L and the relative standard deviations (RSD, n=9) were in the range of 1 . 3-2 . 5%. The method was applied to the determination of anions and cations in the fertilizer samples with satisfied results and the recoveries were in the range of 95 . 8%-103 . 8%.

pIRES2-EGFP-NT3 transfected mouse cochlea fibroblast by lipofectamineTM 2000 / 中国医师杂志

Objective To detect the transfection of pIRES 2-EGFP-NT3 in mouse cochlea fibroblast by cationic liposome . Methods After pIRES2-EGFP-NT3 had been abstracted successfully , it was transfected into mouse cochlea fibroblast by lipofectami-neTM2000.Twenty four hours later, the efficiency of the transfection was analyzed by confocal microscope .Results The pIRES2-EG-FP-NT3 was effectively transfected into mouse cochlea fibroblast by cationic liposome .The transfected fibroblasts displaying green fluo-rescence were observed under fluorescence microscope .Conclusions The effective transfection of pIRES 2-EGFP-NT3 into mouse cochlea fibroblast by lipofectamine TM 2000 laid the basis for the following experiments , such as NT3 gene transfection in deaf or normal cochlea and so on .

Geoquímica de rios de água preta do sudeste do Amazonas: origem, fluxo dos elementos e consumo de CO2 / Geochemistry of black water rivers from the southeastern of the Amazonas State: source, element fluxes and consumption of CO2

This work examined the chemical composition of waters from tributaries of the right bank of the Madeira River which drain silicaterocks of the Brazilian Craton. The study was conducted at the municipalityof Apui, in the southeastern of the Amazonas State, Brazil. There were analyzed pH, conductivity, SiO2 and dissolved ions (Na+, K+, Mg2+ e Ca2+, HCO3-, Cl-, NO3- and SO4(2-)) in the four pluviometric seasons of the Amazon region: rainy, transition to the dry, dry and transition to the rainy. The waters are diluted, have high HCO3-and SiO2 concentration and represent the typical environment of intense leaching that affects the rocks in the Amazon. Although the chemical composition reveals seasonal influences, it was identified variation due to lithological composition. The rate of exportation of cations and the chemical erosion are low in consequence of the tectonic stability of the region and the weathering mantle, which hinders the interaction of water with the bedrock.

Neste trabalho foi examinada a composição química das águas dos afluentes da margem direita do rio Madeira que drenam as rochas do Escudo Brasileiro. O estudo foi realizado no município de Apuí no sudeste do estado do Amazonas, Brasil. Foram analisados pH, condutividade, as concentrações de SiO2 e de íons dissolvidos (Na+, K+, Mg2+, Ca2+, HCO3-, Cl-, NO3- e SO4(2-)) em quatro épocas do ano segundo o índice pluviométrico: chuvosa, transição para a estiagem, estiagem e transição para a chuvosa. As águas são diluídas, mais concentradas em HCO3- e SiO2 e representam o típico ambiente de intensa lixiviação que afeta as rochas na Amazônia. Apesar da química das águas terem influência da sazonalidade, foram identificadas variações em função da litologia. As taxas de exportação de cátions e de erosão química das rochas são baixas e refletem a estabilidade tectônica da região e o manto intempérico que dificulta a interação da água com o substrato rochoso.

Effect of zinc and calcium ions on the rat kidney membrane-bound form of dipeptidyl peptidase IV.

Dipeptidyl peptidase IV (DPP-IV) is an ectopeptidase with many roles, and a target of therapies for different pathologies. Zinc and calcium produce mixed inhibition of porcine DPP-IV activity. To investigate whether these results may be generalized to mammalian DPP-IV orthologues, we purified the intact membrane-bound form from rat kidney. Rat DPP-IV hydrolysed Gly-Pro-p-nitroanilide with an average Vmax of 0.86±0.01 μmol min–1mL–1 and KM of 76±6 μM. The enzyme was inhibited by the DPP-IV family inhibitor L-threo-Ile-thiazolidide (Ki=64.0±0.53 nM), competitively inhibited by bacitracin (Ki=0.16±0.01 mM) and bestatin (Ki=0.23±0.02 mM), and irreversibly inhibited by TLCK (IC50 value of 1.20±0.11 mM). The enzyme was also inhibited by divalent ions like Zn2+ and Ca2+, for which a mixed inhibition mechanism was observed (Ki values of the competitive component: 0.15±0.01 mM and 50.0±1.05 mM, respectively). According to bioinformatic tools, Ca2+ ions preferentially bound to the β-propeller domain of the rat and human enzymes, while Zn2+ ions to the α-β hydrolase domain; the binding sites were essentially the same that were previously reported for the porcine DPP-IV. These data suggest that the cationic susceptibility of mammalian DPP-IV orthologues involves conserved mechanisms.

Significance of Bioelectrical Impedance Change after Ischemia and Reperfusion Injury in Liver and What it Causes? / 한양의대학술지

PURPOSE: Ischemia and reperfusion (I/R) injury is a major cause of hepatic failure after liver surgery, but there is no direct method to monitor it in real-time (like an ECG in heart disease) during surgery. Recently we found the possible role of bioelectrical impedance (BEI) to monitor I/R injury in liver, but the mechanism responsible for ischemia-related BEI changes has not been clearly determined. METHODS: The authors used a LCR meter to quantify BEI changes at 0.12 KHz. Livers were subjected to 70% partial ischemia for 120 minutes, and ATP content, cation changes in extracellular fluid (ECF; determined using an in vivo intracellular microdialysis technique), hepatocyte sizes, and histological changes were then examined. RESULTS: Liver tissue BEI was found to increase gradually during the first 60 minutes of ischemia and then tended to plateau. During the same period, intracellular ATP content decreased to below 20% of the baseline level, [Na+] in ECF decreased from 150.4+/-3.8 to 97.8+/-10.6 mmol/L, and [K+] in ECF increased from 7.5+/-0.3 to 34.3+/-5.5 mmol/L during the first 60 minutes of ischemia. Hepatocyte diameter increased by approximately 20% during the first 60 minutes of ischemia. CONCLUSION: This study suggests that BEI changes during hepatic ischemia are probably caused by sodium and potassium concentration changes in the ECF due to reduced intracellular ATP content.

Changes in Erythrocytic Membrane Free Energy of Albino Rabbits Administered Ethanol Leaf Extract of Spondias mombin Linn.

Aims: To determine the effect of ethanol extract of Spondias mombin Linn on membrane potential energy, the intracellular and extracellular concentrations of Na+, K+, Ca2+ and Mg2+ in an easily accessible model cell, erythrocyte, was studied. The effect on the first approximation estimates of erythrocytic free energy changes (ΔG) was calculated. Study Design: Randomized study. Place and Duration of Study: Department of Biochemistry, Federal University of Technology, Owerri, Nigeria between January 2010 and February 2011). Methodology: Twenty-five female albino rabbits (1.47 ± 0.17 kg) of the same age set were divided into 5 groups of 5 animals. The first group served as the baseline control, the groups II and III animals were intraperitoneally administered 1ml of 750 mg/kg body weight of S. mombin extract daily for 7 and 14 days respectively, while groups IV and V animals were intraperitoneally administered 1ml of 0.14 IU/kg body weight of oxytocin drug ((Pitocin®, USA) daily for 7 and 14 days respectively. Plasma and lyzed red blood cells obtained were analyzed for extracellular and intracellular erythrocyte concentrations of sodium, potassium, calcium and magnesium using standard methods. Results: The study showed that both the extract and oxytocin administrations significantly (p<0.05) reduced intracellular [Mg2+] and extracellular [K+] and [Ca2+], with a concomitant increase in intracellular [Ca2+]. Both treatment with the extract and oxytocin, did not significantly (p>0.05) alter [Na+] and extracellular [Mg2+]. On the other hand, while the extract did not affect intracellular [K+], oxytocin significantly (p<0.05) reduced it. The results also indicated that while the extract significantly (p<0.05) increased the [K+]-based estimated ΔG, oxytocin treatment reduced it. On the other hand, both the extract and oxytocin caused a non-significant (p>0.05) drop in the Ca2+ based ΔG, with no significant (p>0.05) alteration of the [Na+] and [Mg2+] based estimated ΔG. The pole reversa observed with the study of the Ca2+-based ΔG indicates depressive effect of both the extract and oxytocin on Ca2+ ATPase pump. Conclusion: The observations above indicate that, while the use of the extract might enhance energy generation and conservation, the use of oxytocin might elicit exhaustive utilization of energy.

Environmental variables and Piper assemblage composition: a mesoscale study in the Madeira-Purus interfluve, Central Amazonia / Efeitos de variáveis ambientais na composição da assembléia de Piper em mesoescala, no interflúvio Madeira-Purus, Amazônia Central

This study aimed to determine the effects of canopy openness, litter depth, soil cation content and texture on Piper assemblage composition at a mesoscale. Piper assemblage composition and environmental variables were inventoried in 41 0.125 ha (250 × 5 m) plots placed in a terra firme forest located in the Madeira-Purus interfluve, Central Amazonia. Ordination of the 41 plots by Non-metric Multidimensional Scaling (NMDS) in one dimension captured 58 percent of the floristic variation and was used as the response variable in multiple regression models. Environmental variables explained 39 percent of the variation in Piper assemblage composition, which was significantly related to litter depth, soil texture and canopy openness, but not to the cation content. Effects of edaphic components on plant assemblage structure have been reported for different plant groups, however the strong effect of litter depth at a mesoscale had not yet been demonstrated. We suggest that litter depth variation not only influences the structure of Piper assemblages, but also of other plant groups at a mesoscale, as this environmental variable has a direct or indirect effect on species germination and establishment.

Este estudo visou determinar o efeito da abertura de dossel, profundidade da serapilheira, cátions e textura do solo sobre a composição da assembléia de Piper em mesoescala. A composição da assembléia de Piper e as variáveis ambientais foram amostradas em 41 parcelas de 0,125 ha ( 250 × 5 m) localizadas em áreas de floresta de terra firme no interflúvio Madeira-Purus, Amazônia Central. A ordenação das 41 parcelas por NMDS em uma dimensão capturou 58 por cento da variação florística e foi usada com a variável resposta nos modelos de regressão múltipla. As variáveis ambientais explicaram 39 por cento da variação na composição da assembléia de Piper, que esteve significativamente relacionada com profundidade da serapilheira, textura do solo e abertura de dossel. O efeito de fatores edáficos sobre a estrutura de comunidades vegetais foi reportado para diferentes grupos de plantas, entretanto o forte efeito da profundidade da serapilheira em mesoescala ainda não tinha sido demonstrado. Sugerimos que a variação da profundidade da serapilheira, por ter um efeito direto ou indireto na germinação e consequente estabelecimento dos indivíduos, influencia a distribuição das espécies de Piper e provavelmente de outros grupos de plantas em mesoescala espacial.

A survey of soil fertility status of cashew nut gardens of South Goa, India.

Characterization of surface soil for fertility was studied by taking ten representative samples of traditional cashew nut gardens in south Goa. Study revealed that soils are acidic (slight to moderate) in nature with non saline low cation exchange capacity. The available nitrogen content varied from 108 (low) to 945kg/ha (high). The data on available phosphorus ( P2O5 ) indicate low 16.13 to high 18.82 kg/ha indicating low nutrient indices. Potassium status was from 44.8 to 291.2 kg/ha. The exchangeable cation is in the ratio of 1:3 with high fertility rating.

Effects of varying dilutions, pH, temperature and cations on spermatozoa motility in fish Larimichthys polyactis.

The objectives of this present study were to assess the effects of varying dilutions, pH, temperature and cations on spermatozoa motile parameters (SMPs) in fish Larimichthys polyactis. Optimal SMPs were observed when semen was diluted in artificial seawater (ASW) at a ratio of 1 to 100, with temperature of 10oC and pH 8.0. The spermatozoa of L. polyactis were immotile in distilled water and motile in solution containing different cations. Maximum SMPs were obtained in each solution containing 0.4 mol NaCl, 0.4 mol KCl, 0.2 mol CaCl2 and 0.2 mol MgCl2. This study provides baseline knowledge of L. polyactis spermatozoa sensitivity of pH, temperature and cationic effects.

Fertility and acidity status of latossolos (oxisols) under pasture in the Brazilian Cerrado

The Cerrado region, with over 50 million hectares of cultivated pasture, provides 55 percent of Brazilian beef production. Previous investigations have shown that about 70-80 percent of this pasture is affected by some kind of degradation, leading to low productivity. However, until now, few surveys have been carried out on a regional scale. The aim of the present work is both to assess the fertility and acidity levels of Cerrado soils under pasture and compare the variability of the soils characteristics on a regional scale. Two soil depths were sampled in different places within the studied area: (1) a surface horizon (0.0-0.2 m) in order to evaluate its fertility and acidity status for pasture, and (2) a subsurface horizon (0.6-0.8 m), used for classification. Most of soils had levels of nutrients below the reference values for adequate pasture development. Whatever the texture, about 90 percent of soils had low or very low availability of phosphorus. Only 7 to 14 percent of soils had low pH, high exchangeable aluminum, and aluminum saturation above the critical acidity level. Except for nitrogen, no significant difference was found between Latossolos Vermelhos and Latossolos Vermelho-Amarelos.

A região do Cerrado, com 50 milhões de hectares de pastagens cultivadas, responde por 55 por cento da carne bovina produzida no Brasil. Há estimativas indicando que entre 70 e 80 por cento destas pastagens apresentam algum grau de degradação, o que leva a baixa produtividade. No entanto, até o presente, poucos trabalhos foram desenvolvidos em escala regional. O objetivo deste trabalho foi avaliar a fertilidade e a acidez de Latossolos sob pastagens na região do Cerrado e comparar a variabilidade das características dos solos em escala regional. A amostragem foi realizada em duas profundidades, superficial (0,0-0,2 m) para avaliação da fertilidade e acidez e subsuperficial (0,60,8 m), utilizada para classificar os solos. A maioria dos solos apresentou teores de nutrientes abaixo do recomendado para o adequado desenvolviento das pastagens. Independentemente da textura, aproximadamente 90 por cento dos solos apresentaram baixa ou muito baixa disponibilidade de P. Apenas 7-14 por cento dos solos apresentaram baixo pH, alta saturação por Al e acidez acima do nível crítico. Exceto para o N, não houve diferença significativa nos níveis de fertilidade e acidez entre os Latossolos Vermelhos e os Latossolos Vermelho-Amarelos.

Doses de potássio e cálcio no crescimento da planta, na produção e na qualidade de frutas do morangueiro em cultivo sem solo / Potassium and calcium doses on plant growth, fruit yield and quality of strawberries in soilless cultivation

Com o objetivo de avaliar o efeito de doses de potássio fornecido pela fertirrigação e de cálcio na parte aérea sobre o crescimento da planta, a produção e a qualidade de frutas do morangueiro em cultivo sem solo, plantas de morangueiro foram cultivadas com solução nutritiva contendo 9 (T1), 6 (T2, testemunha) e 4,28mmol L-1 (T3) de K+ e com a solução testemunha (T2) suplementada uma vez por semana por pulverizações foliares de cálcio nas concentrações de 2,5 (T4) e 5g L-1 de CaCl2 (T5). O crescimento da planta foi reduzido no tratamento com a concentração de potássio mais elevada (T1), e o maior IAF foi obtido na dose mais elevada de CaCl2 (T5). A maior produção de frutas foi obtida em T2 e T3, a acidez (AT) foi maior em T1, enquanto o teor de sólidos solúveis (SST) e a relação SST/AT não diferiram significativamente entre os tratamentos. Concluiu-se que o aumento da concentração de potássio na solução nutritiva diminui o crescimento, a produção e a qualidade das frutas de morango e que a aplicação de cálcio na parte aérea das plantas por meio do CaCl2 reduz a produção de frutas.

In order to evaluate the effect of potassium doses supplied by fertigation and of calcium by foliar spray on plant growth, fruit yield and quality of soilless grown strawberries, plants were supplied with nutrient solutions at K+ concentrations of 9 (T1); 6 (T2, control) and 4.28mmol L-1 (T3) and with the control nutrient solution (T2) supplemented once a week by spraying CaCl2 on shoot at concentrations of 2.5 (T4) and 5g L- 1 (T5). Plant growth was lower in the higher potassium concentration (T1) and the highest LAI was recorded in the higher CaCl2 dose (T5). Fruit yield was higher in T2 and T3, the titratable acidity (TA) was higher in T1, while total soluble solids (TSS) and the ratio TTS/TA did not differ among treatments. It was concluded that high potasium concentration in the nutrient solution reduces plant growth, fruit yield and quality and that calcium supplied on shoot by CaCl2 reduces fruit production.

Re-engineering the mitochondrial genomes in mammalian cells / 대한해부학회지

Mitochondria are subcellular organelles composed of two discrete membranes in the cytoplasm of eukaryotic cells. They have long been recognized as the generators of energy for the cell and also have been known to associate with several metabolic pathways that are crucial for cellular function. Mitochondria have their own genome, mitochondrial DNA (mtDNA), that is completely separated and independent from the much larger nuclear genome, and even have their own system for making proteins from the genes in this mtDNA genome. The human mtDNA is a small (~16.5 kb) circular DNA and defects in this genome can cause a wide range of inherited human diseases. Despite of the significant advances in discovering the mtDNA defects, however, there are currently no effective therapies for these clinically devastating diseases due to the lack of technology for introducing specific modifications into the mitochondrial genomes and for generating accurate mtDNA disease models. The ability to engineer the mitochondrial genomes would provide a powerful tool to create mutants with which many crucial experiments can be performed in the basic mammalian mitochondrial genetic studies as well as in the treatment of human mtDNA diseases. In this review we summarize the current approaches associated with the correction of mtDNA mutations in cells and describe our own efforts for introducing engineered mtDNA constructs into the mitochondria of living cells through bacterial conjugation.