Research progress in clinical management of nonalcoholic fatty liver disease / 重庆医学

Nonalcoholic fatty liver disease(NAFLD),also known as metabolic associated fatty liver disease(MAFLD),is one of the most common chronic liver diseases characterized by the fat accumulation in the liver and hepatocellular damage.Patients with NAFLD can manifest as simple fatty liver or non-alcoholic steatohepatitis(NASH)in the early stage,and can progress to hepatic fibrosis,hepatic cirrhosis,hepatic fail-ure,and hepatic carcinoma in the late stage.NAFLD has become the most common chronic liver disease,af-fecting more than 30%of the population worldwide,posing a threat to human health that cannot be ignored.However,the current research on NAFLD is still incomplete,and there is no ideal medication for the treat-ment of NAFLD.The clinical management of NAFLD lacks unified standards and evidence-based evidence,and the multiple comorbidities bring challenges to the clinical management of NAFLD.This article was aimed to review the research progress in the clinical management of NAFLD,including the diagnosis and non-invasive examination methods,evaluation and commonly used tools,treatments methods,advantages and disadvanta-ges,so as to provide a reference for the clinical management of NAFLD.

Effects of Amarogentin on Residual Liver Cancer Stem Cells After Insufficient Thermal Ablation and Related Mechanism / 肿瘤防治研究

Objective To observe the effects of amarogentinon liver cancer stem cells (LCSCs) after insufficient thermal ablation and its mechanism. Methods A insufficient thermal ablation model of HepG2 cells was established by water bath method.The percentage of CD133-positive LCSCs and the mRNA and protein levels of CD133 were detected by flow cytometry, qRT-PCR and Western blot.The insufficient thermal ablation model of HepG2 cells was treated with variable doses of amarogentin for 24 h; the percentage of CD133-positive LCSCs, the proliferation and apoptosis of liver cancer cells, and the mRNA and protein levels of CD133, TBC1D15, and p53were detected by flow cytometry, qRT-PCR and Western blot. Results The percentage of CD133-positive HepG2 cells and the mRNA and protein levels of CD133 and TBC1D15in the insufficient thermal ablation model were significantly higher than those in the normal HepG2 cells.Amarogentin then markedly decreased the percentage of CD133-positive LCSCs, the proliferation rate of HepG2 cells, and the mRNA and protein levels of CD133 and TBC1D15 in the insufficient thermal ablationresidual model (all P < 0.05);inversely, the apoptosis rate of HepG2 cells and the phosphorylated levels of p53 in the insufficient thermal ablation model were significantly increased (all P < 0.05). Conclusion Amarogentin could reduce the proportion of LCSCs after insufficient thermal ablation, inhibit the proliferation, and promote the apoptosis of LCSCs, which maybe associated with increasing the phosphorylation of p53 and inhibiting the expression of TBC1D15.

Clinical Efficacy of Concept of Membrane Anatomy with Complete Mesangectomy in Radical Resection of Rectal Cancer / 肿瘤防治研究

Objective To compare the clinical efficacy between traditional laparoscopic surgery and laparoscopic surgery under the guidance of membrane anatomy with complete mesangectomy in the treatment of rectal cancer. Methods A retrospective cohort study was conducted on 60 patients with rectal cancer who were randomly divided into control group (n=30) and observation group (n=30) in accordance with the principle of randomization.The control group received traditional laparoscopic radical resection of rectal cancer, and the observation group received laparoscopic radical resection of rectal cancer under the guidance of membrane anatomy with complete mesangectomy.The different clinical application effects of the two groups were analyzed by comparing the general data, operation time, intraoperative blood loss, and postoperative rehabilitation. Results All the 60 patients underwent the laparoscopic radical resection of rectal cancer.No operation-related complications, conversion to laparotomy, or perioperative death cases were reported.No statistically significant differences in age, gender, operation time, postoperative exhaust time, drainage tube removal time, or postoperative complications were found between the two groups (all P > 0.05).Compared with the control group, the observation group had significantly less intraoperative blood loss and more lymph node dissected (P < 0.05). Conclusion Laparoscopic radical resection of rectal cancer guided by the membrane anatomy with complete mesangectomy can completely remove the mesorectum, enlarge and clear the surgical field, reduce intraoperative bleeding, thoroughly remove lymph nodes, and improve the quality of surgery.

Association between maternal pre pregnancy and pre delivery overweight with overweight and obesity of middle school students:a case control study / 中国学校卫生

Objective@#To explore the association between maternal pre pregnancy and pre delivery overweight with overweight and obesity among offspring during adolescence in Guangzhou, and to provide evidence for child obesity prevention.@*Methods@#Based on the routine physical examination of primary and secondary school students in Guangzhou, random sampling was used to 6 middle schools and questionnaire survey was conducted among 3 384 students and their parents. Students with overweight and obesity were included in the case group, and the other students were included in the control group. Propensity Score Matching (PSM) was adopted to reduce selection bias. Logistic regression model and χ 2 test were used to analyze the data before and after PSM.@*Results@#The result of univariate analysis showed that there were statistically significant differences between overweight/obese group and the control group by gender, schooling stage (middle and high schools), picky eater, family history of obesity, family monthly income, delivery mode, high birthweight, and gestational weight gain before PSM( χ 2=42.38, 10.64, 14.47, 26.85, 10.58, 13.59 , 15.53, 20.64, P <0.05). After PSM, results showed that there were no statistically significant differences between overweight/obese group and the control group in middle and high schools, and mother delivery mode( P >0.05). Logistic regression analysis showed that the risk of overweight and obesity of maternal pre pregnancy on adolescent offspring was 1.54 times higher than control group (95% CI =1.01-2.36) before PSM, and the overweight and obesity of maternal predelivery also increased the risk of overweight and obesity of adolescent offspring( OR=2.35, 95%CI =1.67-3.31). After PSM, maternal overweight and obesity pre pregnancy ( OR=2.17, 95%CI =1.41-3.34) and maternal overweight and obesity pre delivery( OR=2.99, 95%CI =2.08-4.31) significantly increased the risk of overweight and obesity in adolescent offspring.@*Conclusion@#Maternal overweight and obesity pre pregnancy and pre delivery are associated with increased risk of overweight and obesity in adolescent offspring.

Research advances in neoadjuvant therapy for resectable pancreatic cancer / 国际外科学杂志

Pancreatic cancer is highly malignant, and surgical resection is the only cure method at present. In recent years, neoadjuvant therapy has enabled some patients to be successfully downgraded with surgical treatment, which increased the R0 surgical resection rate and prolonged the survival time of patients, has become an important part in the treatment of pancreatic cancer. However, the applicability and standardization of neoadjuvant therapy for pancreatic cancer still need more advanced evidence. This article reviews whether neoadjuvant therapy should be used for resectable pancreatic cancer, the choice of neoadjuvant chemotherapy, and the progress, advantages and disadvantages of neoadjuvant chemoradiotherapy.

Diagnosis and treatment of pancreatic duct stone / 国际外科学杂志

Pancreatic duct stones are closely related to chronic pancreatitis. Although the incidence is low, they can cause intractable abdominal pain and may lead to pancreatic cancer. Changes in the composition of pancreatic juice are the essential causes for the formation of pancreatic duct stones, while local inflammation and pancreatic ductal stenosis are the direct causes of the progression of stones and the recurrence of the symptoms, and they are also the main targets of treatment. Endoscopic treatment combined with extracorporeal shock-wave lithotripsy has a good therapeutic effect on most pancreatic duct stones. More complex stones require surgical intervention. The choice of specific surgical methods is related to the size and distribution of the stones. Treatment schemes should aim at reducing long-term stones or pain recurrence, and preserving more endocrine and exocrine functions of the pancreas, in order to bring greater benefits to patients.

Advances in the comprehensive treatment of pancreatic cancer / 国际外科学杂志

Pancreatic cancer is one of the most malignant digestive cancer with high morbidity and mortality. Surgical treatment is considered the only way to cure pancreatic cancer. For resectable pancreatic cancer, the principles of "artery-frst approach" and "systematic mesopancreas dissection" have improved the increase the local radicality and reduce the local recurrence rate. For borderline resectable pancreatic cancer and locally advanced pancreatic cancer, neoadjuvant chemotherapy can be used before surgical resection. Although there are no targeted and immunotherapeutic drugs for pancreatic cancer, clinical studies on monoclonal antibodies are ongoing. Chimeric antigen receptor T cell therapy and irreversible electroporation are emerging therapies in the treatment of pancreatic cancer. In the present study, the status and progress of comprehensive treatment for pancreatic cancer are reviewed.

Drainage procedure for pancreatolithiasis: re-examination of the pancreatic duct diameter standard

Purpose@#Pancreatic duct decompression relieves pancreatic duct stone (PDS)-associated abdominal pain, though a consensus indication for the drainage procedure of the main pancreatic duct (MPD) is lacking. Moreover, major prognostic factors for postsurgical long-term pain relief and recurrence are largely unknown. @*Methods@#The clinical outcomes of 65 consecutive PDS patients undergoing surgery from 2008–2012 with 3+ years of follow-up were assessed. @*Results@#At postsurgical follow-up (median, 4.5 years; range, 3–7 years; procedure: Partington, n = 32; Frey, n = 27; pancreatoduodenectomy, n = 3; distal pancreatectomy, n = 3), the early complication and complete stone clearance rates were 29.2% and 97%, respectively. Long-term, complete and partial pain relief were 93.9%, 83.1%, and 10.8%, respectively. The risk of pancreatic fistula was higher in the 8 mm group (P < 0.05), and 80% of the pancreatic fistula cases occurred in the <8 mm group. A shorter pain duration (P = 0.007), smaller MPD diameter (P = 0.04), and lower Izbicki pain score (P < 0.001) predicted long-term pain relief. Pain recurrence after initial remission occurred in 5 patients and was only related to pain duration (P = 0.02). Stone recurrence and pancreatic exocrine functional and endocrine functional deterioration occurred in 2, 5, and 11 patients, respectively. @*Conclusion@#Surgery provides excellent stone clearance, long-term pain relief, and acceptable postoperative morbidity. Using 8 mm as the criterion for drainage surgery can minimize the postoperative pancreatic fistula risk. Individualized and timely surgical treatment may improve the effect of surgery.

Swirl sign and black hole sign on CT scanning in predicting early hematoma expansion in intracerebral hemorrhage: a comparative study / 中华神经医学杂志

Objective To compare the predictive values of swirl sign and black hole sign on CT scanning in early hematoma expansion in spontaneous intracerebral hemorrhage (SICH) patients.Methods Two hundred and ten firstly diagnosed SICH patients,admitted to our hospital from January 2012 to December 2018,were enrolled in the study.All patients were divided into hematoma expansion and non-hematoma expansion group according to whether early hematoma expansion appeared;and they were also divided into positive imaging sign group and negative imaging sign group according to whether imaging signs appeared;the clinical and imaging data were compared between these groups,respectively.The accuracies of swirl sign and black hole sign in predicting early hematoma expansion were analyzed using receiver operator characteristic (ROC) curve.Multivariate Logistic regression analysis was performed to determine the independent risk factors for early hematoma expansion.Results (1) In the 57 patients with early hematoma expansion,21 (36.8％) had swirl sign,and 17 (29.8％) had black hole sign;in the 153 patients without hematoma expansion,12 (7.8％) had swirl sign and 22 (14.4％) had black hole sign;the differences between the two groups were statistically significant (P＜0.05).As compared with those in the non-hematoma expansion group,the admission systolic blood pressure increased significantly and number of patients with intraventricular hemorrhage was significantly larger in the hematoma expansion group (P＜0.05).(2) There were no statistical differences in clinical and imaging data between the patients with swirl sign (n=33) and patients without swirl sign (n=177,P＞0.05);the hematoma volume in patients with black hole sign (n=39) was significantly increased as compared with that in patients without black hole sign (n=171,P＜0.05),and there were no statistical differences in other clinical and imaging data between patients with and without black hole sign (P＞0.05).(3) The areas under ROC curve of swirl sign,black hole sign,and "swirl sign combined with black hole sign" were 0.645,0.577,and 0.570,respectively.(4) Multivariate Logistic regression analysis showed that admission systolic blood pressure,swirl sign and black hole sign were independent risk factors for early hematoma expansion (P＜0.05).Conclusion In comparison to black hole sign and "swirl sign combined with black hole sign",the swirl sign has higher predictive value in early hematoma expansion in ICH patients.

Meta-analysis of duct-to-mucosa and invagination of pancreaticoduodenectomy / 国际外科学杂志

Objective To systematically evaluate the surgical effect in duct-to-mucosa and invagination groups of pancreaticojejunostomy after pancreaticoduodenectomy.Methods The Cochrane Library,PubMed,EMbase and CBM data bases were searched to identify randomized controlled trials that compared the postoperative pancreatic fistula,mortality,incidence of complications,delayed gastric emptying,postoperative haemorrhage,infection,reoperate rate,postoperative hospital stay of duct-to-mucosa and invagination for pancreaticcoduodenectomy.Meta-analysis was performed using the software RevMan 5.3.Results Nine trials with 1 163 patients comparing the duct-to-mucosa group with invagination group were included,the duct-to-mucosa group with 579 patients and the invagination group with 584 patients.The meta-analysis revealed that,compared the duct-to-mucosa group with the invagination group,the rate of postoperative pancreatic fistula was not significantly reduced (RR =1.13,95 ％ CI:0.88-1.45,P =0.34),there was no significa nt difference between the two group.To systematically evaluate the total mortality (RR =0.80,95 ％ CI:0.42-1.52,P =0.49),incidence of complications (RR =1.04,95 ％ CI:0.88-1.24,P =0.63),delayed gastric emptying (RR =1.26,95 ％ CI:0.90-1.76,P =0.18),postoperative haemorrhage (RR =0.86,95 ％ CI:0.51-1.44,P =0.57),postoperative infection (RR =1.20,95％ CI:0.86-1.69,P =0.29),reoperate rate (RR =1.05,95％ CI:0.62-1.78,P =0.84),postoperative hospital stay (WMD =-1.36,95％ CI:-2.91-0.20,P =0.09) in duct-to-mucosa and invagination groups.There was no significant difference between the two group.Conclusions There was no significant difference of postoperative pancreatic fistul and mortality,incidence of complications,delayed gastric emptying,postoperative haemorrhage,postoperative infection,reoperate rate,postoperative hospital stay in duct-to-mucosa and invagination groups of pancreaticojejunostomy after pancreaticoduodenectomy.

Research progress on protective effect of liver ischemia-reperfusion injury after liver transplantation / 国际外科学杂志

Hepatic ischemia-reperfusion injury is the most common complication after liver transplantation. Oxidative stress, autophagy, and inflammatory response caused by excessive reactive oxygen species production are significant steps that cause liver ischemia-reperfusion injury. What′s more, nuclear factor erythroid 2-related factor 2 is considered to be a major regulator of the antioxidant response, the PI3K-Akt-mTOR signaling pathway is considered to be an important pathway of autophagy, and the HMGB1-TLR4-NF-κB signaling pathway is considered to be a key signaling pathway which leads to inflammation. Based on the above signaling pathways and regulatory factor, this article shows that the antioxidant, anti-inflammatory and autophagy regulation effects of genes, molecules and drugs on hepatic ischemia-reperfusion cells, to explore the protective effects on hepatic ischemia-reperfusion cells.

Pathogenesis and treatment progress of hepatocellular carcinoma / 国际外科学杂志

The global disease burden of hepatocellular carcinoma (HCC) is increasing gradually. HCC can be categorized into proliferation and non-proliferation classes. The occurrence and development of HCC are closely associated with both genetic and epigenetic changes. However, the underlying mechanisms remain unclear. CT/MRI is the most commonly used imaging modality for diagnosis of HCC. Barcelona clinic liver cancer staging system is widely used to stage HCC worldwide. The treatment options of HCC include surgery, liver transplantation, radiofrequency ablation, transcatheter arterial chemoembolization and systematic therapy. This review will focus on the progress in mechanisms and treatments of HCC.

Etiology and recent treatment progress of acute liver failure / 国际外科学杂志

Acute liver failure (ALF) is commonly used to describe the emergence or development of an acute attack of abnormal liver function. It is a rare but severely life-threatening clinical syndrome that often causes jaundice, coagulopathy and hepatic encephalopathy. Encephalopathy(HE) and multiple organ failure. ALF has a wide range of etiological factors. In the global scope, different regions often show different epidemiological characteristics. With the gradual improvement of specialized diagnosis and intensive care, the prognosis of ALF has improved significantly. The current clinical treatment methods of ALF include etiology treatment, symptomatic supportive treatment, immunotherapy, artificial liver and liver transplantation. This article will summarize the causes of ALF and discuss the latest treatment progresses of ALF.

Meta-analysis of duct-to-mucosa and invagination of pancreaticoduodenectomy / 国际外科学杂志

Objective@#To systematically evaluate the surgical effect in duct-to-mucosa and invagination groups of pancreaticojejunostomy after pancreaticoduodenectomy.@*Methods@#The Cochrane Library, PubMed, EMbase and CBM data bases were searched to identify randomized controlled trials that compared the postoperative pancreatic fistula, mortality, incidence of complications, delayed gastric emptying, postoperative haemorrhage, infection, reoperate rate, postoperative hospital stay of duct-to-mucosa and invagination for pancreaticcoduodenectomy. Meta-analysis was performed using the software RevMan 5.3.@*Results@#Nine trials with 1 163 patients comparing the duct-to-mucosa group with invagination group were included, the duct-to-mucosa group with 579 patients and the invagination group with 584 patients. The meta-analysis revealed that, compared the duct-to-mucosa group with the invagination group, the rate of postoperative pancreatic fistula was not significantly reduced (RR=1.13, 95%CI: 0.88-1.45, P=0.34), there was no significant difference between the two group. To systematically evaluate the total mortality (RR=0.80, 95%CI: 0.42-1.52, P=0.49), incidence of complications (RR=1.04, 95%CI: 0.88-1.24, P=0.63), delayed gastric emptying (RR=1.26, 95%CI: 0.90-1.76, P=0.18), postoperative haemorrhage (RR=0.86, 95%CI: 0.51-1.44, P=0.57), postoperative infection (RR=1.20, 95%CI: 0.86-1.69, P=0.29), reoperate rate (RR=1.05, 95%CI: 0.62-1.78, P=0.84), postoperative hospital stay (WMD=-1.36, 95%CI: -2.91-0.20, P=0.09) in duct-to-mucosa and invagination groups. There was no significant difference between the two group.@*Conclusions@#There was no significant difference of postoperative pancreatic fistul and mortality, incidence of complications, delayed gastric emptying, postoperative haemorrhage, postoperative infection, reoperate rate, postoperative hospital stay in duct-to-mucosa and invagination groups of pancreaticojejunostomy after pancreaticoduodenectomy.

Progress in surgical treatment for severe acute pancreatitis complicated with abdominal compartment syndrome / 国际外科学杂志

Acute pancreatitis is a clinically common acute abdomen,mild acute pancreatitis is a self-limiting disease,while severe acute pancreatitis (SAP) requires multidisciplinary treatment and the mortality rate remains high.A special complication of SAP is intra-abdominal hypertension,as the disease progresses,the intraabdominal pressure is further increased,leading to abdominal compartment syndrome (ACS),which eventually leads to multiple organ dysfunction syndrome.This current surgical intervention for SAP combined with ACS has gradually replaced the conventional medical treatment program.This article reviews the various options for surgical treatment of SAP with ACS.

Minimally invasive therapies for hepatocellular carcinoma / 中华肝脏病杂志

Over 70% of hepatocellular carcinoma patients have not received traditional surgery because of their own disease characteristics and the limitations of traditional surgical methods. With the advancement of medical technology and the development of minimally invasive concepts, minimally invasive surgery, transcatheter arterial chemoembolization, and local ablation have received increasing attention. The combination of various treatment methods can help to strengthen the characteristics of each treatment, but the guiding standard of comprehensive treatment still needs further exploration and research.

Monoacylglycerol lipase high expression as an independent indicator of survival for patients with hepatocellular carcinoma / 中华肝脏病杂志

Objective@#To study the expression level of monoacylglycerol lipase (MAGL) in liver tissues of patients with hepatocellular carcinoma (HCC), and its clinical correlation.@*Methods@#Immunohistochemistry was employed to detect MAGL protein in 353 cases with hepatocellular carcinoma (HCC) and tissue microarray (TMA) for paracancerous liver tissues. The expression levels of MAGL in TMA were quantitatively analyzed using Image-Pro plus 6.0. The difference in MAGL expression between liver cancer tissues and paracancerous liver tissues was compared. Combined with the clinical follow-up data of TMA patients, the correlation between the expression of MAGL in TMA and the degree of HCC tumors differentiation and the survival rate of 1-year and 3-year were analyzed using Logistic regression analysis. The survival curves of patients with different levels of MAGL protein was plotted and analyzed using Kaplan-Meier method. The expression of MAGL protein was analyzed by multiple linear regression analysis. COX regression was used to analyze the correlation between MAGL protein expression level and the risk of HCC death in the included patients.@*Results@#The expression of MAGL in HCC tissues was significantly higher than paracancerous liver tissues. The expression level of MAGL was correlated to the degrees of HCC tumors differentiation (P < 0.001) and 1-year survival rate (P = 0.01), but not with 3-year survival rate (P = 0.91). Survival curve showed that the expression level of MAGL was negatively correlated with prognosis and survival of HCC patients (P = 0.001). Multiple linear regressions showed a negative correlation between MAGL expression level and overall survival time of HCC patients (P=0.010, R2=0.166, Durbin-Watson value: 1.989). COX regression showed that the expression of MAGL was a risk factor for death of patients with HCC [P = 0.004, Exp (B) = 1.000].@*Conclusion@#The expression level of MAGL has positive correlation with the malignant degree in HCC patients, and negative correlation with its prognosis. Therefore, MAGL may serve as a new prognostic indicator for HCC patients.

Progress in surgical treatment for severe acute pancreatitis complicated with abdominal compartment syndrome / 国际外科学杂志

Acute pancreatitis is a clinically common acute abdomen, mild acute pancreatitis is a self-limiting disease, while severe acute pancreatitis (SAP) requires multidisciplinary treatment and the mortality rate remains high. A special complication of SAP is intra-abdominal hypertension, as the disease progresses, the intra-abdominal pressure is further increased, leading to abdominal compartment syndrome (ACS), which eventually leads to multiple organ dysfunction syndrome. This current surgical intervention for SAP combined with ACS has gradually replaced the conventional medical treatment program. This article reviews the various options for surgical treatment of SAP with ACS.

Progress in precise treatment of liver surgery / 国际外科学杂志

After more than a hundred years of development,hepatic surgery has gradually developed from a traditional rough model to a precise model in the 21st century.The era of precision liver surgery,and even precision medicine has come.Under the guidance of precise concept,the therapeutic effect of all liver diseases,especially liver malignant tumors,has been significantly improved,and the quality of life of patients has been significantly improved.Precise hepatectomy,precise radiofrequency ablation and precise transcatheter arterial chemoembolization are the three magic weapons of precise treatment in liver surgery.The precise concept will be the future development direction of medicine.This article reviews the research progress of precise treatment in liver surgery in order to further promote the concept of precise treatment in liver surgery.

Meta-analysis of the clinical effect and safety of early oral feeding in patients with acute pancreatitis / 国际外科学杂志

Objective To evaluate the clinical effect and safety of early oral feeding versus delayed feeding in patients with acute pancreatitis using Meta-analysis.Methods An electronic search of PubMed,Cochrane Library,Embase,Web of Science,CNKI,Wanfang database and VIP database were retrieved from their inception to March 2019 to identify relevant literatures,by taking'acute pancreatitis,oral,food intake,refeeding,feeding,diet'as the keywords for retrieval.The evaluation indexes included hospitalization time,incidence of abdominal pain after feeding,incidence of nausea and vomiting after feeding,incidence of hyperglycemia and leucocyte level after feeding.To select literatures and extractdata strictly according to inclusion and exclusion criteria,then conducted data analysis by Revman 5.3 provided by Cochrane collaboration.Results A total of 9 articles,involving 856 patients,were included with 425 in the early feeding group and 431 in the delayed feeding group.The length of hospitalization in early feeding group was shorter than that in delayed feeding group (MD =-2.37,95％ CI:-3.45--1.28,P ＜ 0.000 1).The incidence of abdominal pain (P =0.67),nausea and vomiting (P =0.77),hyperglycemia (P =0.54),and leukocyte level (P =0.26) were not significantly different between two groups.Conclusion Early oral feeding is safe and effective for patients with acute pancreatitis,which can significantly shorten the hospital stay without increasing the incidence of adverse reactions.