FOLFIRINOX in treatment of pancreatic cancer: a single-institutional experience / 中华肝胆外科杂志

Objective:To review the clinical efficacy and safety of the FOLFIRINOX (oxaliplatin, irinotecan, leucovorin, fluorouracil) regimen in treatment of pancreatic cancer.Methods:The clinical data of 31 patients with pancreatic cancer who were treated with the FOLFIRINOX regimen from July 2016 to December 2019 at the Department of General Surgery, China-Japan Friendship Hospital were retrospectively analyzed. For the 20 males and 11 females who were enrolled into this study, their age ranged from 29 to 80 years (mean 56.9 years). The FOLFIRINOX regimen was used as neoadjuvant therapy in 12 patients, postoperative therapy in 10 patients with liver-metastases, and postoperative adjuvant therapy in 9 patients (as second-line chemotherapy in 7 patients and as first-line chemotherapy in 2 patients). The clinical efficacy and adverse reactions of chemotherapy were evaluated.Results:In this study, 8 patients received the modified FOLFIRINOX regimen. Of the remaining 23 patients who received the standard FOLFIRINOX regimen, 10 (43.3%) were converted to the modified regimen because of adverse events. On clinical efficacy evaluation after neoadjuvant therapy: 5 patients achieved partial remission (PR), 3 stable disease (SD) and 4 progression disease (PD). The disease control rate (DCR) was 66.7% (8/12). For 10 patients got remission of abdominal pain, 5 patients underwent surgical resection. For the 10 patients with liver-metastases, 6 achieved PR, 1 SD, 3 PD. For 7 patients got disease control. For 8 patients had remission of abdominal pain, 1 patient underwent surgical resection. For the 7 patients who received second-line chemotherapy, 2 achieved PR and 5 PD. No tumor recurrence or metastases were found in the two patients after the first-line chemotherapy. Adverse events above grade three in all the patients included neutropenia in 12 patients (38.7%), leukopenia in 7 patients (22.6%) and thrombocytopenia in 1 patient (3.2%).Conclusions:The FOLFIRINOX regimen was efficacious with a high DCR rate and controllable adverse events. Balancing its efficacy and safety showed this regimen to be beneficial to patients with pancreatic cancer.

Laparoscopic partial splenectomy for splenic solid lesions / 中华普通外科杂志

Objective To analyze the safety and clinical effects of laparoscopic partial splenectomy for splenic solid benign lesions.Methods Retrospective analysis was made on patients with splenic solid benign tumor admitted from Jan 2015 to Feb 2017.Results 6 patients (4 males,2 females) underwent successful partial splenectomy for splenic tumors.Mean patient age was 44.7 years (range,28-58 years).5 patients were diagnosed by wellness examinations,1 patient had abdominal discomfort.The diameter of tumors ranged from 5.0 to 8.3 cm.Tumors were located in the superior lobes in 2 cases and the others were located in the inferior lobes.The operation times were 120-240 min and intraoperative blood loss was 50-1 400 ml (mean,375 ml).Laparoscopic procedure was successful in all patients without major complications.Postoperative pathology showed hemangioma in 5 cases and hemangioendothelioma in one patient.After 3 to 28 months follow-up no patients experienced recurrence.Conclusions Laparoscopic partial splenectomy is safe and effective in patients with focal benign splenic lesion that was located at the edge of the spleen or in the upper or lower pole of the spleen.

Surgical treatment for giant liver hemangioma: an expeience on 119 cases / 中华普通外科杂志

Objective To summarize the experience of surgical treatments for giant liver hemangioma.Methods A retrospective study was made on the clinical data of patients with liver hemangioma larger than 10 cm in diameter,which were divided into two groups (10-＜ 20 cm,88 cases,≥ 20 cm,31 cases).Data included age and gender,presentation,treatment methods,peri-operative indexes,and complications.Results All patients complained symptoms,the average diameter was (16 ± 7) cm.There were 23,7,and 17 cases respectively with anemia,thrombocytopenia and hypofibrinogenemia,all were more often seen in ≥20 cm group (P ＜ 0.001).Five patients were diagnosed as Kasabach-Merritt syndrome in ≥20 cm group.Patients in ≥20 cm group also had greater rates of compression of the porta hepatis (P ＜ 0.001).Patients in ≥ 20 cm group were treated more often by hepatic resections,while enucleations was often done in 10-＜20 cm group.The ≥20 cm group had more blood loss (P ＜0.001)and autologous transfusion (P ＜ 0.001),greater rates of blood transfusion (P ＜ 0.001).There was no significant difference on morbidity between the two groups (P =0.194).Conclusions For giant liver hemangioma both enucleation and hepatic resection could be completed safely in experienced hands.

Laparoscopic surgery for giant liver hemangiomas: a report of 40 patients / 中华肝胆外科杂志

Objective To analyze the clinical experience of laparoscopic surgery for giant liver hemangiomas.Methods The clinical data of 40 patients who underwent laparoscopic surgery for giant liver hemangiomas from August 2012 to January 2018 in the China-Japan Friendship Hospital were retrospectively analyzed.The diameters of the liver hemangiomas were more than 10 cm for all the patients.The liver functions of all the patients were Child-Pugh class A.The follow-up was up to the end of February 2018.Results Laparoscopic treatment of giant liver hemangioma was successfully performed in 37 patients.Three patients were converted to open hepatectomy.The mean diameter of the giant liver hemangiomas was (10.8± 1.3) cm (ranged 10.0～15.0 cm).The mean operative time for laparoscopic therapy was (154.7±68.0) min (range 70～ 390 min).The mean intraoperative blood loss was 200 (100 ～ 400) ml.20 patients received autologous blood transfusion.Of these 2 patients received in addition allogeneic blood transfusion.The postoperative hospital stay was (6.9t2.0) days (range 4～14 days).Postoperative complications occurred in 3 patients (8.1％).Two patients developed postoperative pleural effusion and one pelvic effusion.Two patients responded well to puncture drainage and one to conservation management.There was no postoperative hemorrhage,bile leakage or air embolism.All patients were followed-up and no liver hemangioma recurrence was detected.Conclusion Laparoscopic surgery was a safe and efficacious procedure in selected patients with giant liver hemangioma.

Risk factors of massive blood loss during resection of giant liver hemangioma / 中华肝胆外科杂志

Objective To evaluate the risk factors of massive blood loss in resection of giant liver hemangioma.Method The clinical data of 141 patients who underwent giant liver hemangioma resection were retrospectively studied.These data included general physical condition,laboratory tests,radiologic findings,and various surgical parameters.The patients were divided into the massive blood loss group (＞ 1 000 ml,n =27) and the minor blood loss group (≤1 000 ml,n =114).Logistic regression was performed to determine the risk factors of intraoperative massive blood loss.Results The average diameter of the liver hemangioma was significantly greater in the massive blood loss group than that in the minor blood loss group [(21.7 ± 8.5) cm vs.(14.1 ± 5.3) cm,P ＜ 0.05].The incidences of preoperative leukopenia,anemia,thrombocytopenia and prolonged prothrombin time were higher in the massive blood loss group than that in the minor blood loss group (48.1％ vs.16.7％,37.0％ vs.11.4％,25.9％ vs.3.5％,22.2％ vs.3.5％,respectively,all P ＜ 0.05).Hepatic hemangioma with compressed hepatic veins,inferior vena cava and porta hepatis were more frequently found in the massive blood loss group than in the minor blood group (55.6％ vs.14.9％,44.4％ vs.14.0％,55.6％ vs.12.3％,respectively,all P＜0.05).Logistic regression analysis demonstrated a diameter of hemangioma greater than 15 cm was a risk factor of intraoperative massive blood loss during surgical resection.Conclusions Giant hepatic hemangioma may cause disorders in the hematological and coagulation systems.Compression of major hepatic vessels raised technical difficulty and risks in surgery.Hemangioma with a diameter greater than 15 cm was recognized as a high-risk factor of intraoperative massive blood loss.

Differential diagnosis of asymptomatic patients with pancreatic small cystic lesions / 中华普通外科杂志

Objective To analyze the differences between benign and potential malignant small pancreatic cystic lesions.Methods We retrospectively analyzed the clinical and pathological data of asymptomatic patients with pancreatic small cystic lesions and divided them into benign group (including serous cystic neoplasms,lymphoepithelial cyst and pseudocyst) and potential malignant group (including mucinous cystic neoplasms,intraductal papillary mucinous neoplasms and solid pseudopapillary neoplasms).Comparison of clinical data was made between the two groups.Results 46 patients with pathological results were included (22 cases in benign group and 24 cases in potential malignant group).No difference was detected on demographic data and lab results between the two groups.Compared with benign patients,patients in the potential malignant group were more likely to show thicken wall (P =0.000),mural nodule (P =0.000),solid constituents inside the cyst (P =0.001),wall enhancement (P =0.003) and uneven wall on CT scan (P =0.024).The diagnostic sensitivity,specificity and accuracy of the combination of above mentioned CT features for potential malignant diseases were 91.7％,77.3％ and 84.8％,respectively.Conclusions Pancreatic cystic lesions with thicken wall,mural nodule,wall enhancement,solid parts inside the cyst and uneven wall on CT were more likely of potential malignant entities.

Effect of fast acupuncture at Zusanli (ST36) on the recovery of gastrointestinal function after ;abdominal non-gastrointestinal surgery / 国际中医中药杂志

Objective To observe the effect of fast acupuncture at Zusanli(ST36) on the recovery of gastrointestinal function after abdominal non-gastrointestinal surgery. Methods In this randomised placebo-controlled single-blind clinical trial, patients received abdominal non-gastrointestinal surgery were assigned to a treatment group and a control group. The treatment group received fast acupuncture and the control group received superficial conciliative acupuncture. The acupuncture was taken at both sides of Zusanli (ST36) for 1 minute respectively during 7-8 a.m. and 7-8 p.m..We began from the first postoperative day and stopped when the patients got initial postoperative flatus or stool, or at the end of the fifth postoperative day. Results 37 controlled patients were assigned to the treatment group (18 patients) and the control group (19 patients) randomly. There were no differences on general information between the two groups. The treatment group had stronger feeling than the control group on the comparison of the acupuncture sensation level (5.7 ± 3.0 vs. 2.7 ± 2.2;t=-3.471, P=0.001). For the treatment group, the initial postoperative flatus or stool time is 19 hours earlier than the control group (65.9 ± 18.1 h vs. 85.0 ± 24.5 h; t=2.682, P=0.011). And the treatment group patients’ postoperative abdominal distension is lesser than the control group (P=0.006). Conclusion Fast acupuncture at Zusanli(ST36) can promote the recovery of gastrointestinal function after abdominal non-gastrointestinal surgery, and can also lighten the patients’ postoperative abdominal distension.

Localized primary sclerosing cholangitis mimicking as a Klatskin tumour: report of three cases / 中华肝胆外科杂志

Objective To report three cases of localized primary sclerosing cholangitis (PSC) mimicking a hilar cholangiocarcinoma (Klatskin tumor) and to summarize their clinical characteristics and the ways to differentiate them through a literature review.Method The clinical data of three patients with localized PSC mimicking a hilar cholangiocarcinoma were retrospectively analyzed.The characteristics of laboratory tests and imaging examination were reviewed,and therapy and prognosis were discussed.Results The three patients were all diagnosed to have a hilar cholangiocarcinoma preoperatively,but the diagnosis of PSC was confirmed by histopathology post-operatively.All the three patients had elevated CA19-9,2 patients had elevated anti-nuclear antibody (ANA) and 2 patients had elevated IgG.All the three patients underwent surgical resection and histopathological study showed chronic inflammation of the hilar bile ducts and cholangitis of the intrahepatic portal area.The three patients were followed up from 7 months to 8 years with no symptoms.Conclusions Localized PSC is rare and it can casily be misdiagnosed as a hilar cholangiocarcinoma.Biopsy before surgery is helpful for the differential diagnosis but it is difficult to get a good biopsy sample.Surgical resection is an effective treatment.

Mechanism of DNA transformation based on mineral nanofibers and method improvement / 生物工程学报

Sepiolite--an inexpensive, resourceful, fibrous yet inoffensive mineral--made DNA transformation rapid, simple and efficient but the mechanism for DNA transformation was still unclear. Through RNA competition test, we proposed the different transforming mechanisms from the previous report. Meanwhile, we optimized the transforming method and could transfer a colony stored at 4 degrees C for a month with plasmid through sepiolite fibers. The cells could be transformed well without competent cells preparation or incubation process. In sum, this was a novel potential transforming method, which could be explored further if the chemical method and electroporation could not be used.

Microbial lipid production by Rhodosporidium toruloides in a two-stage culture mode / 生物工程学报

To shorten the cultivation time and reduce the consumption of raw materials for microbial lipid production, oleaginous yeast Rhodosporidium toruloides AS 2.1389 was cultivated using a two-stage culture mode, in which the cell propagation and lipid accumulation were separated. The yeast cells recovered from the propagation culture were re-suspended in glucose solution for lipid accumulation, through which lipid content over 55% of the dry cell weight was achieved, the longer the propagation stage was, the higher the lipid content. Analysis of the lipid indicated that the long-chain fatty acids with 16 and 18 carbon atoms were major components, suggesting that the lipid can be an alternative feedstock for biodiesel production.