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Objective:To investigate the clinical value of esophageal-jejunal OrVil TM anas-tomosis and Overlap anastomosis in laparoscopic radical total gastrectomy of adenocarcinoma of esophagogastric junction (AEG). Methods:The retrospective cohort study was conducted. The clinicopathological data of 112 patients with AEG who were admitted to the First Hospital of Jilin University from July 2017 to August 2022 were collected. There were 87 males and 25 females, aged (64±8)years. All 112 patients underwent laparoscopic total gastrectomy and D 2 lymphadenectomy, in which 61 cases with esophageal-jejunal OrVil TM anastomosis were divided into the OrVil TM group, 51 cases with esophageal-jejunal Overlap anastomosis were divided into the Overlap group. Observa-tion indicators: (1) surgical situations; (2) postoperative complications; (3) influencing factors for patients undergoing esophageal-jejunal OrVil TM anastomosis. Measurement data with normal distri-bution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the non-parameter test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Logistic regression model was used for multivariate analysis. Results:(1) Surgical situations. The esophageal invasion length and tumor diameter was 1.0(0.7,2.0)cm and (6.3±2.7)cm in patients of the OrVil TM group, versus 0.2(0.1,0.5)cm and (4.7±2.2)cm, respectively, in patients of the Overlap group, showing significant differences in the above indicators between the two groups ( Z=?6.14, t=3.26, P<0.05). (2) Postoperative complications. Cases with complications ≥Ⅲa grade of Clavien-Dindo classification, cases with respiratory system complications, cases with hydrothorax were 13, 17, 13 in the OrVil TM group, versus 4, 5, 4 in the Overlap group, showing significant differences in the above indicators between the two groups ( χ2=3.91, 5.74, 3.91, P<0.05). Cases underwent readmission within postoperative 30 days were 3 and 1 in the OrVil TM group and the Overlap group, respectively, and all patients recovered after symptomatic treatment. There were 2 cases died after operation in the OrVil TM group and none of patients died after operation in the Overlap group. (3) Influencing factors for patients undergoing esophageal-jejunal OrVil TM anastomosis. Results of multivariate analysis showed that esophageal invasion length was an independent factor influencing for patients undergoing esophageal-jejunal OrVil TM anastomosis ( odds ratio=8.25, 95% confidence interval as 3.41?19.96, P<0.05). Conclusions:Compared with esophageal-jejunal Overlap anastomosis, choosing the esophageal-jejunal Orvil TM anastomosis during laparoscopic radical total gastrectomy can take benefit to the proximal margin of patients with AEG. However, the ratios of complications ≥ Ⅲa grade of Clavien-Dindo classification, respiratory system complications and hydrothorax associated to OrVil TM anastomosis are relatively increased. Esophageal invasion length is an independent influencing factor for patients undergoing esophageal-jejunal OrVil TM anastomosis.
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Objective To investigate the mechanism of action of Huzhang Qingmai decoction (HZQMY) on the improvement of cognitive function in mice with chronic cerebral ischemia from the perspective of intestinal flora. Methods A mouse model of chronic cerebral ischemia was established by placing microcoils around the bilateral common carotid arteries to induce bilateral carotid artery stenosis (BCAS). After 12 weeks of intragastric administration, the cognitive function of the mice was measured by the Morris water maze; the myelin damage was analyzed by LFB staining; The contents of the cecum of the mice in each group were extracted and analyzed by 16S rRNA sequencing. Results The results of the water maze experiment showed that the mice in the HZQMY group had a significantly shorter escape latency, increased the number of crossings platform and the percentage of target quadrants. LFB staining showed that the white matter damage in the model group was severe; the white matter damage in the HZQMY group was milder. The results of 16S rRNA sequencing showed that compared with the model group, the abundance of Verrucomicrobiota, Akkermansia, and ErysiPelatoclostridium capsulatum in the intestinal flora in HZQMY group was significantly reduced (P<0.05), while the abundances of Eubacterium_xylanoPhilum and Allobaculum were significantly increased (P<0.05). Conclusion The protective effect of HZQMY, which has the effect of improving cognitive function in mice with chronic cerebral ischemia, may be related to the regulation of intestinal flora in mice with chronic cerebral ischemia.
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Objective:To explore the perioperative safety and oncological results of laparoscopic assisted transanal total mesorectal excision (TaTME) and robot assisted total mesorectal excision (TME) in radical resection of low rectal cancer.Methods:A single center retrospective study was conducted. Analyzed the clinical data of 54 patients with low rectal cancer who received robot assisted TME or laparoscopic assisted TaTME in the first hospital of Jilin University from January 2020 to July 2022, including 39 males and 15 females, with a median age of 61 years old. They were divided into robot assisted TME group ( n=29) and laparoscope assisted TaTME group ( n=25) according to the surgical methods. Follow-up was carried out through outpatient, telephone and wechat. The follow-up time was 30 days after operation. The quality of mesorectal excision was divided into high quality and low quality according to the evaluation of the integrity of the mesentery of the specimen after total mesorectal excision and the circumferential cutting edge. The primary outcome was the quality of mesorectal excision, and the secondary end points were surgery related information, postoperative pathological information, and postoperative complications. SPSS25.0 software was used for statistical analysis. The measurement data of skew distribution were expressed by M( Q1, Q3), and the Mann Whitney U test was used for comparison between groups. The counting data were expressed by n(%), and the comparison between groups was conducted by χ2 test or Fisher exact probability method. Results:The high-quality mesorectal excision rate in TaTME group was 88% (22 cases), and the high-quality mesorectal excision rate in robot group was 100%, with no statistical difference( χ2=3.69, P=0.093). The operation time of TaTME group and robot assisted TME group was [180 (165, 220)] min and [140 (117, 168)] min, respectively, with statistical significance ( U=125.00, P<0.001). The preventive ileostomy rate was 100% in the TaTME group and 37.9% in the robot group( χ2=23.27, P<0.001). Compared with TaTME group, robot assisted TME had a longer distance from the lower tumor to the distal cutting edge [10 (5, 25) mm vs 35 (21, 41) mm, U=117.00, P<0.001], a longer distance from the deepest tumor to the circumferential cutting edge [15 (10, 25) mm vs 25 (20, 34) mm, U=165.50, P=0.003], and a larger tumor maximum meridian [20 (4, 52) mm vs 42 (30, 48) mm, U=202.50, P=0.005]. The total incidence of complications within 30 days after operation was 16.7%, of which the incidence of Clavien-Dindo Ⅰ to Ⅱ complications was 11.1%, and the incidence of Clavien-Dindo ⅢA complications was 5.6%. The overall complication rate of TaTME group was higher, but there was no significant difference (20.0% vs 13.8%, χ2=0.37, P=0.718). Conclusion:Both TaTME and robot assisted TME can ensure good quality of TME operation and can be used as an effective and safe treatment for low rectal cancer. When performing TaTME surgery for low rectal cancer, it is more necessary to ensure sufficient distal margin distance.
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Objective To explore the mechanism of motherwort in the treatment of nerve injury. Methods The active components of motherwort were obtained by searching TCMSP and BATMAN-TCM databases. The action targets of candidate compounds were collected and predicted from TCMSP and SwissTargetPrediction (STP) databases. The target genes corresponding to the active components of motherwort were obtained by using the standardized database of disease targets (Uniprot). The potential targets of motherwort in the treatment of nerve injury were obtained by mapping the disease genes of nerve injury with the three databases of Genecards, DisGenet and OMIM. The network topology analysis software Cytoscape 3.6.0 was used to construct the action target network of motherwort active components. The protein interaction platform database (STRING) was used to construct the interaction relationship between action targets. The target protein interaction (PPI) network was constructed by introducing Cytoscape 3.6.0 software. Through STRING database, GO enrichment analysis and KEGG pathway enrichment analysis were carried out to analyze the target points of motherwort in the treatment of nerve injury. Results 19 active components were screened from motherwort, involving 654 action targets, including 426 action targets related to nerve injury and 6 key targets. These target genes were mainly involved in biological regulation, oxidative stress response and cell communication and other biological processes. Molecular functions were mainly related to protein binding, ion binding and catalytic reduction. They were enriched outside the cell membrane. Its mechanism was related to signal pathways such as MAPK, Toll-like receptor, PI3K-Akt, TNF, IL-17, and apoptosis. Conclusion The active components of motherwort may play a protective role on nerve injury through anti-inflammation, anti-apoptosis and promoting cell growth.
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Tooth root morphogenesis involves two biological processes, root elongation and dentinogenesis, which are guaranteed by downgrowth of Hertwig's epithelial root sheath (HERS) and normal odontoblast differentiation. Ubiquitin-dependent protein degradation has been reported to precisely regulate various physiological processes, while its role in tooth development is still elusive. Here we show ubiquitin-specific protease 34 (USP34) plays a pivotal role in root formation. Deletion of Usp34 in dental mesenchymal cells leads to short root anomaly, characterized by truncated roots and thin root dentin. The USP34-deficient dental pulp cells (DPCs) exhibit decreased odontogenic differentiation with downregulation of nuclear factor I/C (NFIC). Overexpression of NFIC partially restores the impaired odontogenic potential of DPCs. These findings indicate that USP34-dependent deubiquitination is critical for root morphogenesis by stabilizing NFIC.
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Feminino , Diferenciação Celular , Morfogênese , Fatores de Transcrição NFI , Odontogênese , Raiz DentáriaRESUMO
<p><b>OBJECTIVE</b>To preliminarily discuss the anatomical ideas on infrapyloric lymphadenectomy in the sagittal view of laparoscopic radical gastrectomy for gastric cancer.</p><p><b>METHODS</b>A retrospective review was performed on the clinical data of 98 patients of lower-middle stomach cancer who underwent D2 radical gastrectomy in Department of Gastrointestinal Surgery of The First Hospital of Jilin University from June 2015 to December 2016. There were 56 males and 42 females with an average age of 59 years. TNM staging of gastric cancer revealed 22 cases of stage I, 37 cases of stage II, and 39 cases of stage III. All the patients underwent standardized No.6 lymph node dissection. Patients in stage II and above also received dissection of No.14v lymph nodes. During operation, sub-regional lymph node dissection was performed in the infrapyloric region according to sagittal anatomy. The dissection of each sub-region was to expose the corresponding anatomical landmarks as quality control standards. The region under the stomach pylorus was divided into the upper and lower parts by the pancreatic anterior plane and the gastroduodenal artery. The lower part was 6v region, and the upper part was 6a and 6i region. The lower part was further divided into front region and rear region by right vein of gastric omentum. The upper part was further divided into front, middle and posterior parts by right vein of gastric omentum and inferior pyloric artery. A total of 5 regions were established. Lymph node dissection in the lower pyloric region was performed at these five regions. Photographs were taken during operation and statistics was carried out in operation time and harvested lymph nodes from infrapyloric lymphadenectomy.</p><p><b>RESULTS</b>The time to complete No.6 lymph node dissection was (38±6) minutes for the 22 patients with stage I gastric cancer, and to finish No.6 and No.14v lymph node dissection was (49±8) minutes for the 76 patients with stage II and stage III gastric cancer. The mean number of harvested No.6 lymph nodes was 5.4±2.9, including 2.9±1.8 in No.6a,1.3±0.9 in No.6v, and 1.2±0.7 in No.6i. No.6 lymph node metastasis was found in 29 cases (29.6%), and No.14v lymph node metastasis in 19 patients (9.2%).</p><p><b>CONCLUSION</b>Sub-regional lymphadenectomy for infrapyloric region based on embryology and membrane anatomy may achieve complete dissection of No.6 lymph nodes.</p>
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Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gastrectomia , Métodos , Laparoscopia , Excisão de Linfonodo , Estudos Retrospectivos , Neoplasias Gástricas , Cirurgia GeralRESUMO
<p><b>OBJECTIVE</b>The aim of this study is to discuss the curative effect of introperitoneal hyperthermic perfusion chemotherapy(IHPC) combined with systemic neoadjuvant chemotherapy on the gastric cancer patients with peritoneal carcinomatosis.</p><p><b>METHODS</b>Sixty-four patients with gastric cancer and peritoneal carcinomatosis who were hospitalized in the Department of Gastrointestinal Surgery of First Hospital of Jilin University from December 2006 to December 2013. After peritoneal carcinomatosis was confirmed during laparoscopic exploration, FOLFOX6 (oxaliplatin and calcium folinate and 5-Fu) was performed for systemic chemotherapy. One course was 14 days and a complete treatment includes four courses. At the same time, patients underwent peritoneal catheter insertion and received IHPC(5-Fu 1 500 mg/m(2) and Cisplatin 35 mg/m(2) were added into 0.9% NaCl solution 2 000 ml, the infusion velocity was 35-45 ml/min, infusion time was 45-60 minutes, the temperature was controlled to 41°C). A comprehensive evaluation was taken after the fourth course of treatment before operation. Further surgical therapy was performed according to the assessment result.</p><p><b>RESULTS</b>Sixty-four patients received IHPC combined with systemic chemotherapy. Thirty-two patients(50.0%) had partial response, 18(28.1%) stable disease, and 14(21.9%) progressive disease after chemotherapy. No severe complications or death occurred during the neoadjuvant chemotherapy. Thirty-two patients(50.0%) received radical resection, 10(15.6%) palliative operation, and another 22 patients(37.4%) didn't comply with inclusion criteria of operation. Patients receiving operation had a median survival time of 678 days, which was significantly longer than patients without operation, with a median survival time of 251(χ(2)=23.34, P=0.02).</p><p><b>CONCLUSIONS</b>IHPC combined with systemic chemotherapy is an effective therapeutic method for gastric cancer patients with peritoneal carcinomatosis in terms of reducing preoperative tumor load and achieving radical resection.</p>