The value of superior mesenteric artery preferential approach in the treatment of borderline resectable pancreatic head cancer / 中华普通外科杂志

Objective:To evaluate superior mesenteric artery preferential approach in the borderline resectable pancreatic head cancer.Methods:The clinical and follow-up data of 90 patients with borderline resectable pancreatic head cancer who underwent radical pancreatoduodenectomy at Beijing Chaoyang Hospital,Capital Medical University from Jan 2015 to Dec 2021 were analyzed.Results:After exploring the superior mesenteric artery in the lower colon area to confirm the vascular invasion meet the resection criteria, the blood supply is cut off first, then the tumors were resected en bloc, with the invaded vessels resected and reconstructed or replaced. All 90 patients successfully completed the operation without perioperative death. Pathology established pancreatic ductal adenocarcinoma. The 1-year, 2-year, and 3-year disease-free survival rates of patients in the arterial priority approach group were 68.2%, 60.4%, and 54.3%, while the 1-year, 2-year, and 3-year disease-free survival rates of patients by conventional approach were 58.4%, 26.4%, and 11.7% ( P=0.001). Conclusion:The superior mesenteric artery preferential approach in the inferior colon region can prolong the survival time of patients after surgery, and reduce the recurrence.

Correlation between preoperative CA19-9/GGT ratio and postoperative long-term survival of distal cholangiocarcinoma / 中华肝胆外科杂志

Objective:This research aimed to study the relationship between preoperative CA19-9/GGT ratio and postoperative long-term survival in patients with distal cholangiocarcinoma.Methods:The clinical data of 121 patients with distal cholangiocarcinoma who underwent radical pancreaticoduodenectomy (PD) at the Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2013 to December 2019 were retrospectively analyzed. The ROC curve was drawn based on the preoperative CA19-9/GGT ratio and postoperative 1-year survival. Using the best cut-off value of CA19-9/GGT ratio, the 121 patients were divided into two groups: the low ratio group (CA19-9/GGT≤0.12, n=53) and the high ratio group (CA19-9/GGT>0.12, n=68). The clinical data of the two groups were compared, and the risk factors of long-term survival were analyzed. Results:There were 72 male and 49 female patients, aged (64.9±9.2) years. When compared with the high ratio group, the low ratio group had significantly less requirement for preoperative jaundice reduction, lower CA19-9, higher GGT, better tumor differentiation, and more patients without lymph node metastasis (all P<0.05). The median follow-up time was 26 months. The 1-, 3- and 5-year survival rates of the low vs. high ratio groups were 89.4% vs. 64.7%, 64.4% vs. 14.1%, 48.7% vs. 14.1%, respectively (all P<0.001). Multivariate analysis showed that CA19-9/GGT ratio>0.12 ( RR=2.802, 95% CI: 1.494-5.256), poor differentiation ( RR=1.855, 95% CI: 1.106-3.111) and lymph node metastasis ( RR=1.891, 95% CI: 1.129-3.169) were independent risk factors for long-term survival ( P<0.05). Conclusion:The ratio of CA19-9/GGT could be used as an index to predict long-term survival of patients with distal cholangiocarcinoma after PD. The smaller the ratio, the better was the long-term prognosis.

Research progress on etiology and mechanism of portal vein gas / 中华肝胆外科杂志

Portal vein gas (PVG) is a kind of imaging sign which has been attracting widespread attention in recent years, and its appearance is often accompanied by serious or fatal situation. PVG is not an indication of surgery and the treatments depend on potential diseases. When there are serious potential abdominal diseases, the emergency surgical intervention will be needed. The potential diseases that cause PVG mainly include infectious, ischemic, mechanical and medical. The prognosis is not related with PVG, but is affected by the pathogenesis. Although more and more reports about PVG have been reported in recent years, the research on its pathogenesis is less. Based on the review of the previous literatures, the pathogenesis, risk factors, imaging manifestations, treatment and prognosis of PVG were discussed.

Application of superior mesenteric artery priority approach in infracolic compartment in surgical treatment of resectable pancreatic head cancer / 中华胰腺病杂志

Objective:To investigate the clinical efficacy of superior mesenteric artery priority approach in infracolic compartment in the surgical treatment of resectable pancreatic head cancer.Methods:The clinical data of 79 patients with resectable pancreatic head cancer who underwent radical pancreaticoduodenectomy (PD) in the Department of Hepatobiliary Surgery of Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2016 to December 2019 were analyzed retrospectively. According to the surgical approach, they were divided into arterial priority approach group (arterial priority group, 48 cases) and conventional approach group (conventional approach group, 31 cases). The arterial priority group was to first explore the superior mesenteric artery in the subcolone, then cut off the tumor blood supply after ascertaining that the tumor can be removed, and finally remove the tumor and anastomose it routinely. The conventional approach group underwent traditional radical PD. The operation time, intraoperative bleeding, intraoperative blood transfusion, lymph node metastasis, number of lymph node dissections, resection criteria, tumor length diameter, degree of tumor differentiation, occurrence of postoperative complications (pancreatic fistula, impaired gastric emptying, abdominal bleeding, biliary fistula and diarrhea), postoperative hospital stay and postoperative chemotherapy were observed. The patients were followed up by the way of outpatient and/or telephone. The follow-up time was up to March 2021. The survival rate was calculated by Kaplan Meier method.Results:Compared with the conventional approach group, the amount of intraoperative bleeding in the arterial priority group was significantly reduced (400 ml vs 600 ml, P=0.005), the intraoperative blood transfusion rate was significantly reduced (39.6% vs 64.5%, P=0.030), the number of lymph node dissections was significantly increased (19 vs 13, P=0.024), the R 0 resection rate was significantly increased (83.3% vs 58.1%, P=0.013), but the incidence of diarrhea was significantly increased (39.6% vs 16.1%, P=0.027). The differences were statistically significant. The median survival time of arterial priority group and conventional approach group was both 19 months. The overall survival rates of 1, 2 and 3 years were 72.0%, 39.5%, 28.5% and 64.1%, 33.7% and 15.4% respectively. The median tumor free survival time was 15 months and 12 months. There was no significant difference. However, the 1, 2 and 3-year tumor free survival rate of patients in arterial priority group was significantly improved (61.2%, 39.5% and 25.9% vs 46.0%, 21.3% and 7.1%, P=0.042) , and the difference was statistically significant. Conclusions:Superior mesenteric artery priority approach in infracolic compartment can improve R 0 resection rate, prolong postoperative survival time, reduce recurrence and improve prognosis.

Preliminary research of B10 cell infiltration in the anastomotic tissue of the choledochojejunostomy rat model / 国际外科学杂志

Objective:To investigate the infiltration of B10 cells in the anastomotic tissue after choledochojejunostomy by establishing a rat model of choledochojejunostomy.Methods:24 male SPF SD rats aged 6 weeks and weighing 180-200 g were randomly divided into control group, 1-week group, 2-week group and 4-week group, with 6 samples in each group. The rats were killed at different time after operation to obtain the anastomotic tissue and peripheral blood. The changes of anastomotic diameter were measured. The changes of inflammatory factors in peripheral blood were determined by ELISA. Flow cytometry was used to detect the proportion of B10 cells in peripheral blood and tissues around the anastomotic site. The formation of anastomotic scar was evaluated by histopathological section. IL-10 and TGF-β1 gene expression were detected by qPCR. The measurement data with normal distribution were expressed as ( Mean± SD). Analysis of variance was used to compare the measurement data of multiple groups. T test was used to compare the measurement data between the two groups. Results:The diameter of anastomotic stoma gradually narrowed with time after choledochojejunostomy, which was(2.7± 0.3) mm at the 4st week after operation; However, liver function and inflammation index reached the peak at the 2st week after operation, and then gradually returned to normal level; The proportion of B10 cells in peripheral blood did not change significantly in each period after operation, but the infiltration of B10 cells in anastomotic tissue increased significantly, which was significantly higher than that in the control group at the first week after operation [(16.6±4.0)% vs (1.1±0.3)%, P<0.05], and it was still higher than that of the control group at the 4st week after operation [(7.5±1.3)% vs (1.1±0.3)%, P<0.05]; The pathological staining of anastomotic tissue showed that with the passage of time, the infiltration of inflammatory cells in the bile duct wall increased, the proliferation of collagen fibers, the thickening of bile duct wall, and then led to scar formation; Expression of IL-10 and TGF-1β in anastomotic tissue after operation. At the 4st week after operation, IL-10 gene expression was still higher than that of the control group [(1.4±0.6) vs (0.5±0.2), P<0.05], the gene expression of TGF-1β was increased continuously and was higher than that of the control group [(3.9±0.9) vs (0.3±0.2), P<0.05]. Conclusion:The content of B10 cells in the anastomotic tissue of rats after choledochojejunostomy is significantly increased, and the expression of IL-10 gene is high, which may play a role in regulating local scar formation.

Progress in diagnosis and treatment of portal vein gas in adult acute abdomen patient / 国际外科学杂志

Portal vein gas refers to the accumulation of gas in the main portal vein and its tributaries caused by various reasons. It is often found in acute abdomen patients caused by intestinal obstruction and ischemia. CT is an important examination for the definite diagnosis. In recent years, with the deepening understanding of the pathogenesis of portal vein gas and the development of radiological imaging technology, portal vein gas is no longer considered as the indication of surgical exploration in acute abdomen patients. However, once it is found, intestinal ischemia and necrosis should been evaluated carefully in patients. According to the etiology, vital signs and auxiliary examination, the treatment decision can be made to avoid improper selection of treatment plan and delay the treatment opportunity. For patients with intestinal necrosis, surgical treatment should be active. This paper reviews the current situation of diagnosis and treatment of portal vein gas in adult acute abdomen patients.

Research status of immune tolerance after liver transplantation / 国际外科学杂志

Liver transplantation has been developed for nearly 60 years, and the operation technology has been improved day by day. However, the rejection is still one of the key factors that restrict the long-term survival of the graft and patients. Immune tolerance refers to the state of specific immune non response or low response after the immune system contacts the antigen, which is the most ideal state after organ transplantation, and the liver, as an immune immunity organ, is also the most easy to induce immune tolerance state. At present, a large number of experimental studies have confirmed that immune tolerance is related to a variety of cellular and molecular mechanisms after liver transplantation, but the realization of clinical transformation remains to be further studied. In this paper, the current research status of immune tolerance after liver transplantation was reviewed to explain its possible mechanism and induction methods.

Relationship between impaired myocardial untwisting and left ventricular diastolic dysfunction in patients with autoimmune diseases / 中华心血管病杂志

Objective@#To observe the relationship between impaired myocardial untwisting and left ventricular diastolic dysfunction in patients with autoimmune diseases (AD).@*Methods@#In this retrospective study, 95 AD patients (27 males, (38.6±14.2) years old) were enrolled as AD group and 71 gender and age matched healthy subjects (24 males, (37.6±12.2) years old) were enrolled as control group, all underwent transthoracic echocardiography and two-dimensional speckle-tracking echocardiography (STE) in our hospital between January 2014 and June 2018. Left ventricular untwisting and diastolic function parameters were measured. Multiple logistic regression analysis was used to identify related factors of left ventricular diastolic dysfunction in AD patients. Receiver operating characteristic (ROC) curve was used to identify the diagnosis value of untwisting parameters for left ventricular diastolic dysfunction in AD patients.@*Results@#Compared with control group, left ventricular ejection fraction was lower (58(47, 66)% vs. 67 (62, 71) %, P<0.001), E/e′ was higher (10.78 (7.28, 13.65) vs. 6.30 (5.55, 7.25) , P<0.001), isovolumic relaxation time was longer (73.5 (56.5, 88.0) ms vs. 62.0 (58.0, 68.5) ms, P<0.001),and untwist slope during isovolumic relaxation period (USIR) was lower (31.92 (14.09, 54.92) °/s vs. 59.90 (40.09, 87.18) °/s, P<0.001) in AD group than in control group. Multiple logistic regression analysis showed heart rate (OR=0.885, 95%CI 0.840-0.931, P<0.001), E/e′ (OR=0.655, 95%CI 0.537-0.798, P<0.001) and USIR (OR=0.986, 95%CI 0.974-0.998, P=0.020) were independently related with left ventricular diastolic dysfunction in AD patients. ROC curve showed that area under the curve (AUC) was 0.919 (P<0.001), sensitivity was 87.6%, and specificity was 88.7%, when combining the heart rate, E/e′, and USIR as assessment parameters for the diagnosis of left ventricular diastolic dysfunction in AD patients at a cutoff of 0.51.@*Conclusions@#Impairment of myocardial untwisting indicates the presence of early stage left ventricular diastolic dysfunction in AD patients. USIR may be a sensitive parameter to evaluate early stage left ventricular diastolic dysfunction in AD patients.

Chemical constituents of Dendrobium candidum / 中国中药杂志

The column chromatography on silica gel, sephadex LH-20 preparative HPLC were used to separate and purify the compounds from the stems of Dendrobium candidum. Twenty compounds were isolated and identified as 3,4'-dihydroxy-5-methoxybibenzyl(1), dihydroresveratrol(2), dendromoniliside E(3), denbinobin(4),2,4,7-trihydroxy-9, 10-dihydrophenanthrene(5), aduncin(6), (-)-loliolide(7), adenosine(8), uridine(9), guanosine(10), sucrose(11), 5-hydroxymethyl-furaldehyde(12), n-octacostyl ferulate(13), defuscin(14), n-triacontyl cis-p-coumarate(15), daucosterol(16), beta-sitosterol(17), hexadecanoic acid(18), hentriacontane(19), and heptadecanoic acid(20). Their structures were elucidated on the basis of spectroscopic data and physicochemical properties. All of the compounds were isolated from this plant for the first time.