Splenic vascular flow control in the use of laparoscopic spleen-preserving distal pancreatectomy (Kimura) / 中华普通外科杂志

Objective:To investigate the techniques used in blood flow control of Kimura laparoscopic spleen-preserving pancreatectomy (LSPDP).Methods:Forty·five patients with benign or low-grade malignant pancreatic diseases undergoing LSPDP at Huzhou Central Hospital from May 2014 to Oct 2021 were analyzed retrospectively. Patients were divided into splenic vascular flow control group ( n=22) and routine management group ( n=23). Results:There was no significant difference in gender, age, BMI, accompanying symptoms, hypertension, diabetes, lesion size and pathological diagnosis between the two groups (all P>0.05). A higher overall spleen preservation rate (90.9% vs. 52.2%, χ2=8.213, P=0.004), lower incidence of morbidity with Clavien grade ≥ Ⅱ (22.7% vs. 73.9%, χ2=9.911, P=0.002) and shorter postoperative hospital stay [(9.6±4.5) d vs. (14.3±6.6) d, t=2.447, P=0.008] were achieved in the vascular flow control group compared with those in the routine group. Conclusion:Splenic vascular flow control techniques improve the success rate of spleen preservation in laparoscopic distal pancreatectomy, reduce the postoperative complications and shorten the postoperative hospital stay.

Effect of recombinant adenovirus Ad-mir-22 on glucose uptake in HepG2 cells / 生物工程学报

The recombinant adenoviruses expressing miR-22 (Ad-miR-22) was constructed and the effect of Ad-miR-22 on insulin signal pathway and glucose uptake in HepG2 cells was analyzed. MiR-22 gene was amplified by PCR from human hepatocytes and cloned into the pAdTrack-CMV vector to generate the shuttle plasmid pAdT-22. The positive colonies were confirmed by PCR and sequencing. The resultant shuttle plasmid was linearized with Pme I, followed by co-transformation into competent BJ5183 cells containing an adenoviral backbone plasmid (pAdEasy-1) to create the recombinant plasmid pAd-miR-22. After digested with Pac I, the linearized pAd-miR-22 was transfected into 293A packaging cell line to generate recombinant adenoviruses Ad-miR-22. HepG2 cells were infected with Ad-miR-22 or control Ad-GFP (adenoviruses expressing green fluorescent protein), and then the miR-22 expression levels were analyzed by qPCR. The result shows that adenovirus-mediated overexpression of miR-22 significantly decreased insulin-induced glucose uptake in HepG2 cells. Moreover, overexpression of miR-22 markedly decreased insulin-induced phosphorylation of GSK-3β. miR-22 also increased the mRNA levels of gluconeogenic genes in HepG2 cells. Furthermore, Western blotting results indicate that the protein expression of SIRT1 decreased in Ad-miR-22 infected HepG2 cells as compared with Ad-GFP infected HepG2 cells. In summary, overexpressing of miR-22 significantly increased gluconeogenesis while decreased glucose uptake in HepG2 cells. The effect of miR-22 on glucose metabolism may be mediated by SIRT1.

Laparoscopic cholecystectomy in patients with a history of gastrectomy / 中华普通外科杂志

Objective To investigate the risk factors of laparoscopic cholecystectomy (LC) in patients with previous gastrectomy.Methods This retrospective study reviewed a database of patients who underwent LC at our hospital during the period of Jan 2010 and May 2015.Results Comparesd with those of no history of gastrectomy the average operation time in patients with previous gastrectomy was longer (t =15.608,P ＜ 0.05) the intraoperative blood loss was higher (t =3.061,P ＜ 0.05),and the operation time of patients with a long interval (＞ 5 years) between gastrectomy and LC was shorter (t =6.405,P ＜ 0.01).The conversion rate did not differ between the two groups (P ＞ 0.05),but the conversion rate significantly reduced after a comprehensive preoperative evaluation procedure (x2 =15.282,P ＜ 0.01).Conclusion LC for benign gallbladder diseases is safe,effective and feasible in patients with a history of gastrectomy,if a comprehensive preoperative evaluation is adopted and in experinced hands.

Laparoscopic partial splenectomy for benign splenic neoplasms / 中华普通外科杂志

Objective To evaluate laparoscopic partial splenectomy (LPS) for benign splenic neoplasms.Methods From Sep 2016 to Aug 2017,7 patents with splenic benign lesions underwent laparoscopic partial splenectomy,results were compared with 15 cases receiving total splenectomy.Results All the patients underwent laparoscopic total or partial splenectomy successfully without conversion.There was no statistic difference in operative time,intra-operative blood loss and transfusion between the two groups.However,the morbidity of LPS group was significant lower (x2 =17.679,P =0.000),and no thrombocytosis occurred in LPS patients.Additionally,the patients received LPS recovered quicker and the postoperative hospital stay was shorter (5.7 ± 2.3) d vs.(15.3 ± 3.4) d (t =6.741,P =0.000 1) with a lower medical expenditure (19 288 ± 2 760) Yuan vs.(27 737 ± 4 626) Yuan (t =4.442,P =0.000 3).No thrombocytosis and recurrence were observed during follow up.Conclusions LPS is safe and effective to cure spleen benign lesions with quicker recovery and lower expenditure.

Serum levels of fatty cytokines in hepatitis B patients with liver fibrosis / 中华全科医师杂志

Objective To investigate the serum levels of fatty cytokines in hepatitis B patients with liver fibrosis.Methods Fifty six hepatitis B patients with liver fibrosis admitted in Wenzhou Central Hospital from April 2014 to March 2016 were recruited as case group and 65 healthy subjects as control group.Serum cytokines including omentin,leptin,adiponectin and visfatin were detected in both two groups and glutamyl endopeptidase (ALT),aspartate aminotransferase (AST) and hepatitis B virus DNA were detected in the case group.Liver biopsy was performed in the case group and histologic activity (HA) and histologic fibrosis (HF) stage were evaluated.Results The level of omentin in the case group was significantly higher than that in the control group [(358-119) vs.(305 ± 108) μg/L,t =2.236,P =0.037].Serum omentin,visceral fat hormone,leptin and adiponectin were not associated with liver function and HBV-DNA (P ＞0.05).There was no significant difference in adipocytokines levels between the low and high HA group (P ＞ 0.05).The level of omentin in high HF stage group was significantly higher than that in low HF stage group [(398 ± 130) vs.(292 ± 120) μg/L,t =2.648,P =0.009],while the other fatty cytokines did not show significantly differences between high and low HF groups (P ＞ 0.05).Conclusion Serum omentin level is elevated in hepatitis B patients with liver fibrosis and is associated with liver fibrosis severity.

The impact of antiviral therapy on postoperative intrahepatic recurrence of hepatitis B related hepatocellular carcinoma / 中华肝胆外科杂志

Objective To study the impact of antiviral therapy on patients with postoperative intrahepatic recurrence of hepatitis B related hepatocellular carcinoma (HCC).Methods According to the inclusion and exclusion criteria,65 patients with HCC who were managed in our hospital from January 2004 to December 2011 for intrahepatic recurrence and had indications for antiviral treatment were included into this study.The patients were divided into two groups ; the antiviral and the control groups.Relevant data between these two groups such as cumulative survival after recurrence,Child-Pugh grade,HBV-DNA,HBeAg,AFP at the time of recurrence and 6 months later were studied.An analysis on multiple-factors was carried for survival after recurrence at 2 years.Results When compared with the control group,the antiviral group had better cumulative survival in all the cases and in the TACE cases (P ＜ 0.05 respectively).The cumulative survival in the RFA cases was not significantly different between the two groups (P ＞ 0.05).A comparison was carried out in patients who received antiviral therapy which was combined with one or more other therapies (TACE,RFA,reoperation):(a) antiviral therapy only (8 patients) ; (b) combined with one therapy (22 patients) ; (c) combined with two therapies (10 patients) ; (d) combined with three therapies (2 patients).All P values of a:b,a:c,a:d,b:c,b:d were less than 0.05.The blood HBV-DNA of the two groups was significantly different at the time 6 months after recurrence (P ＜ 0.05).The results of multivariate analysis showed the 2-year survival was significantly correlated with recurrent tumor size,primary tumor class,antiviral therapy or not after recurrence,presence of absence of cirrhosis.All P values were less than 0.05.Conclusions Antiviral therapy had remarkable clinical impact on HCC patients with postoperative intrahepatic recurrence and with indication for antiviral treatment.Patients had better prognosis if antiviral therapy was combined with one or more other therapies.

Effects of timing of enteral nutrition in the severe acute pancreatitis / 中华消化外科杂志

Objective To explore the effects of timing of enteral nutrition (EN) in the severe acute pancreatitis (SAP).Methods The rabbit model of SAP was constructed,and 40 experimental rabbits were divided randomly into the experimental group (20 rabbits) and the control group(20 rabbits).(1) The parenteral nutrition (PN) was administered to rabbits in the experimental group,and then EN was administered after bowel sound restoration.(2) EN was administered to the rabbits in the control group at hour 12 after PN.The values of TNF-α,IL-6 and IL-8 on post-modeling day 1,3 and 7 and intra-abdominal pressures at hour 1 before EN and on post-modeling day 1 and 3 were respectively examined.The experimental animals were sacrificed on post-modeling day 7 and 10.The expression of nuclear factor-kappa B (NF-κB) was detected by immunohistochemistry and bacteria from mesenteric lymph nodes were cultured.The measurement data with normal distribution were presented as (x) ± s.The trend comparison between groups and pairwise comparison were analyzed using the repeated measures ANOVA and t test.Results The 40 rabbit models of SAP were constructed successfully.(1) The results of serum test showed that the values of TNF-α,IL-6 and IL-8 in the experimental group on post-modeling day 1,3and 7 were (6.9 ±2.1)ng/L,(5.9 ± 1.8) ng/L,(5.3 ± 1.8) ng/L and (109 ± 17) ng/L,(96 ± 16) ng/L,(83 ± 17)ng/L and (89 ±20)ng/L,(78 ±21)ng/L,(70 ± 19)ng/L,respectively.The values of TNF-α,IL-6 and IL-8 in the control group on post-modeling day 1,3 and 7 were (7.4 ± 1.5) ng/L,(7.1 ± 1.6) ng/L (6.8 ±1.7) ng/L and (101 ± 19) ng/L,(98 ± 18) ng/L,(93 ±20) ng/L and (91 ± 14) ng/L,(91 ± 16) ng/L,(83 ±19)ng/L,respectively.There were significant differences in the changing trends of TNF-α and IL-6 between the 2 groups (F =7.947,19.386,P ＜ 0.05),with no significant difference in the changing trend of IL-8 between the 2 groups (F =2.756,P ＞ 0.05).(2)The intra-abdominal pressures in the experimental group at hour 1 before EEN and on post-modeling day 1 and 3 were (3.5 ± 1.6) cmH2O (1 cmH2O =0.098 kPa),(4.3 ± 1.7) cmH2Oand (3.6 ± 1.8) cmH2O,which were significantly different from (4.9 ± 1.9) cmH2O,(5.7 ± 2.2) cmH2O and (4.5 ± 1.6)cmH2O in the control group (F =7.042,P ＜0.05).(3) The expression of NF-κB in the tissues of pancreas was localized mainly in the cell nucleus.The expression of NF-κB in the experimental group on postmodeling day 7 was 5.0 ± 2.7,which was significantly different from 7.0 ± 2.9 in the control group (t =2.236,P ＜ 0.05).(4) The amount of bacteria culture from mesenteric lymph nodes in the experimental group on postmodeling day 7 and 10 were (4.7 ±0.9) × 103 cfu/g and (4.1 ±0.7) × 103 cfu/g,which were significantly different from (5.5 ± 1.0) × 103 cfu/g and (4.6 ± 0.7) × 103 cfu/g in the control group (t =2.382,2.126,P ＜0.05).Conclusion The selective timing of EN can effectively improve the recovery of rabbits with SAP,and the efficacy of EN administering based on the recovery of bowel function may be better than immediate EN administering.

Therapeutic effect of Shenmai injection on acute pancreatitis and mechanism / 中华胰腺病杂志

Objective To observe the therapeutic effect of Shenmai injection on rats with acute edematous pancreatitis (AEP) and its mechanism.Methods The model of AEP in rats was induced by intraperitoneal injection of caerulein every one hour for 7 times.One hour after last injection,intravenous Shenmai injection (5 ml · kg-1 · d-1) was given to rats in Shenmai injection treatment (SI) group,while same amount of normal saline was given to rats in control (AEP) group.One hour and 1,3,5,7 d after AEP induction,the blood was taken,and the method of double antibody sandwich enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of amylase,platelet activating factor (PAF),vascular endothelial growth factor (VEGF).The rats were sacrificed at 7 and 14 d,and pancreatic tissue samples were harvested.RT-PCR and Western Blot were used to determine the expression of NF-κB mRNA and protein,and normal pancreatic tissue samples were used as control.The positive expression of CD31 in pancreatic tissue was determined by immunohistochemical method to calculate microvascular density (MVD).Results The serum levels of amylase and PAF in both groups were increased and gradually decreased 3 days later,while the decrement in SI group was greater than that of AEP group.At the 5th day after AEP induction,the serum levels of amylase in SI group and AEP group were (4569 ± 158),(5056 ± 198) U/L,and the serum levels of PAF were (25.30 ± 4.76),(36.06 ± 5.57)μg/L,and the difference between the two groups was statistically significant (P ＜ 0.05).The serum levels of VEGF were increased 1 d after AEP induction,and the increase in SI group was greater than that of AEP group 3 d later,and the serum levels of VEGF were (139.78 ±24.30),(118.51 ±21.70)pg/ml at 5th day,and the difference between the two groups was statistically significant (P ＜ 0.05).The expression levels of NF-κB mRNA and protein of pancreatic tissue in SI group were O.834 ±0.031 and 0.49±0.24,and MVD was 6.41 ± 1.14,while the corresponding values in AEP group were 1.000 ± 0.059,0.93 ± 0.45,3.62 ± 0.89,and the difference between the two groups was statistically significant (P ＜ 0.05 or P ＜ 0.01).Conclusions In the course of acute pancreatitis,Shenmai injection has the therapeutic effects of promoting new angiogenesis,improving the microcirculation,reducing the inflammatory cascade.

Three Points on Laparoscope Operation to Gallbladder Neck Incarceration Stone(with A Clinical Report of 81 Cases) / 浙江中医药大学学报

[Objective] To discuss the reasonable treatment and skil of gal bladder calculus.[Method] Select 81 cases of such patients, take their clinical data as examples for analysis foundation;and choose relative documents for evidence of theoretic analysis.[Result] 77 cases were successively operated of laparo-scope, 3 transferred for laparotomy owing to difficult anatomy of Colot triangle, 1 made probe of choledoch because of choledocholithiasis;compared with documents results, the incision length, bleeding, operaiotn time, in-hospital time and complications of laparoscope operation, transferred laparotomy in the study were similar to relative documentary reports, the differences had no statistical meaning;the intranperative bleeding, operation period, in-hopital time, complications were better than documents, the differences had statistical meaning. [Conclusion] The correct pre-operation evaluation of disease condition, operation chance and methods selection, 3 operation points were the key of successful operaiton.

Expression of FHIT, FN and PTEN in hepatocellular carcinomas / 中华普通外科杂志

Objective To investigate the expression of fragile histidine triad(FHIT),fibronectin (FN) and phosphatase and tensin homology deleted on chromosome ten( PTEN )in human hepatocellular carcinomas (HCC) and their relationship with pathological characteristics and prognosis of HCC.Methods Immunohistochemistry was used to detect expression of FHIT,FN and PTEN in cancerous tissues from 138 HCC patients.The correlation between their expression and clinicpathological features and prognosis were analyzed.Results FHIT,FN,PTEN protein expressed differently between HCC and adjacent mucosa ( respectively x2 =5.968,7.380,4.962,all P ＜ 0.05 ),and the expression level was different with tumor size,tumor number,grades and tumor lymph node metastasis( P ＜ 0.05 ).In FHIT and FN positive group,the recurrence free survival rates were lower than those in negative groups( respectively x2 =4.443,9.867,all P ＜0.05),while in PTEN positive group patients' recurrence free survival rates were higher than those with PTEN negative expression ( x2 =4.199,P ＜ 0.05 ).Conclusions FHIT,FN,PTEN were abnormally expressed in HCC.Positive expression of FHIT and FN predicts poor prognosis,while positive PTEN indicates fair prognosis.

Effects of anti-viral therapy in combination with transcatheter arteria chemoembolization on recurrence of HBVrelated hepatocellular carcinoma after operation / 中华肝胆外科杂志

Objective To investigate the preventive effects of anti-viral therapy in combination with transcatheter arteria chemoembolization (TACE) on recurrence of HBV-related hepatocellular carcinoma (HCC) after operation. Methods According to selection standards, 49 patients treated in this hospital from January 2003 to June 2009 were enrolled in this study and divided into a control group and combined group.The cumulative tumor-free survival rate, cumulative survival rate, the 1-, 2- and 3-year recurrence rates and cumulative recurrence rates were determined in all the patients and compared between the 2 groups. Results The cumulative tumor-free survival rate and cumulative survival rate were significantly higher in the combined group than in the control group (P=0. 019, 0. 008). The 1-, 2-, and 3-recurrence rates were 24% vs. 38.9%, 28% vs. 33.3%, and 28% vs. 22.2% in the combined group and control group, respectively. The 1-, 2-, and 3-year cumulative recurrence rates were 24% vs. 38. 9%, 52% vs. 72. 2%, and 80% vs.94. 4% in the combined group and control group, respectively. Conclusion Anti-viral therapy in combination with TACE can exert significant preventive effects on recurrence of HBV-related HCC after operation.