Hotspots and difficulties of biliary surgery in older patients / 中华医学杂志(英文版)

With the accelerated aging society in China, the incidence of biliary surgical diseases in the elderly has increased significantly. The clinical characteristics of these patients indicate that improving treatment outcomes and realizing healthy aging are worthy of attention. How to effectively improve the treatment effect of geriatric biliary surgical diseases has attracted widespread attention. This paper reviews and comments on the hotspots and difficulties of biliary surgery in older patients from six aspects: (1) higher morbidity associated with an aging society, (2) prevention and control of pre-operative risks, (3) extending the indications of laparoscopic surgery, (4) urgent standardization of minimally invasive surgery, (5) precise technological progress in hepatobiliary surgery, and (6) guarantee of peri-operative safety. It is of great significance to fully understand the focus of controversy, actively make use of its favorable factors, and effectively avoid its unfavorable factors, for further improving the therapeutic effects of geriatric biliary surgical diseases, and thus benefits the vast older patients with biliary surgical diseases. Accordingly, a historical record with the highest age of 93 years for laparoscopic transcystic common bile duct exploration has been created by us recently.

High expression of death-associated protein 5 promotes glucose metabolism in gastric cancer cells and correlates with poor survival outcomes / 南方医科大学学报

OBJECTIVE@#To investigate the prognostic value of death-associated protein 5 (DAP5) in gastric cancer (GC) and its regulatory effect on aerobic glycolysis in GC cells.@*METHODS@#We analyzed DAP5 expression levels in GC and adjacent tissues and its association with survival outcomes of GC patients using public databases. We collected paired samples of GC and adjacent tissues from 102 patients undergoing radical resection of GC in our hospital from June, 2012 to July, 2017, and analyzed the correlation of DAP5 expression level detected immunohistochemically with the clinicopathological parameters of the patients. Cox regression analysis, Kaplan-Meier analysis, and ROC curves were used to explore the independent risk factors and the predictive value of DAP5 expression for 5-year survival of the patients. In the cell experiments, we observed the changes in aerobic glycolysis in MGC-803 cells following lentivirus-mediated DAP5 knockdown or overexpression by measuring glucose uptake and cellular lactate level and using qRT-PCR and Western blotting.@*RESULTS@#Analysis using the public databases showed that DAP5 was highly expressed in GC and correlated with tumor progression and poor survival outcomes of the patients (P < 0.05). In the clinical samples, DAP5 expression was significantly higher in GC than in the adjacent tissues (3.19±0.60 vs 1.00±0.12; t=36.863, P < 0.01), and a high expression of DAP5 was associated with a reduced 5-year survival rate of the patients (17.6% vs 72.5%; χ2=29.921, P < 0.05). A high DAP5 expression, T3-4, N2-3, and CEA≥5 ng/mL were identified as independent risk factors affecting 5-year survival outcomes of GC (P < 0.05), for which DAP5 expression showed a prediction sensitivity, specificity and accuracy of 73.2%, 80.4% and 79.0%, respectively. In MGC-803 cells, DAP5 knockdown significantly reduced glucose uptake, lactate level and the expressions of GLUT1, HK2 and LDHA, and DAP5 overexpression produced the opposite effects (P < 0.05).@*CONCLUSION@#A high expression of DAP5 in GC, which enhances cellular aerobic glycolysis to promote cancer progression, is correlated with a poor survival outcome and may serve as a biomarker for evaluating long-term prognosis of GC patients.

FJX1 overexpression is associated with poor prognosis and promotes gastric cancer proliferation via the PI3K/AKT signaling pathway / 南方医科大学学报

OBJECTIVE@#To investigate the expression of four-jointed box kinase 1 (FJX1) in gastric cancer (GC), its correlation with survival outcomes of the patients, and its role in GC progression.@*METHODS@#The expression level of FJX1 in GC tissues and normal gastric mucosal tissues and its correlation with the survival outcomes of GC patients were analyzed using TCGA and GEO database GC cohort. Immunohistochemistry was used to detect FJX1 expression level in clinical specimens of GC tissue, and its correlations with the patients' clinicopathological parameters and prognosis were analyzed. Bioinformatic analysis was performed to identify the potential pathways of FJX1 in GC. The effects of FJX1 overexpression or FJX1 silencing on GC cell proliferation and expressions of proliferation-related proteins, PI3K, AKT, p-PI3K, and p-AKT were evaluated using CCK-8 assay and Western blotting. The effect of FJX1 overexpression on GC cell tumorigenicity was evaluated in nude mice.@*RESULTS@#GC tissues showed significantly higher expressions of FJX1 mRNA and protein compared with normal gastric mucosa tissues (P < 0.05). The high expression of FJX1 was associated with poor prognosis of GC patients (P < 0.05) and served as an independent risk factor for poor survival outcomes in GC (P < 0.05). FJX1 was expressed mainly in the cytoplasm of GC cells in positive correlation with Ki67 expression (R=0.34, P < 0.05), and was correlated with CA199 levels, depth of tumor infiltration and lymph node metastasis of GC (P < 0.05). In the cell experiment, FJX1 level was shown to regulate the expressions of Ki67 and PCNA and GC cell proliferation (P < 0.05). Gene set enrichment analysis indicated that the PI3K/AKT pathway potentially mediated the effect of FJX1, which regulated the expressions of PI3K and AKT and their phosphorylated proteins. In nude mice, FJX1 overexpression in GC cells significantly promoted the growth of the transplanted tumors (P < 0.05).@*CONCLUSION@#FJX1 is highly expressed in GC tissues and is correlated with poor prognosis of GC patients. FJX1 overexpression promotes GC cell proliferation through the PI3K/AKT signaling pathway, and may serve as a potential prognostic biomarker and therapeutic target for GC.

Correlation between clinicopathologic features and BRAF V600E gene mutation abundance in papillary thyroid carcinoma / 中华普通外科杂志

Objective:To investigate the correlation between cervical lymph node metastasis,extra thyroidal extension and other clinicopathologic features and BRAF V600E gene mutation abundance in papillary thyroid carcinoma. Methods:The clinicopathologic data of 123 PTC patients admitted from Jan 2018 to Oct 2020 in Peking University People's Hospital were analyzed retrospectively. All the PTC cases were examined by next generation sequencing technology. BRAF V600E gene mutation abundances were detected and analyzed with different clinicopathologic features, and differences between groups were compared. Results:There were statistical differences compared to control group in BRAF V600E gene mutation abundances in lymph node metastasized group and extra thyroidal extended group(all P<0.05). BRAF V600E gene mutation abundances were positively related with severity of extra thyroidal extension( P<0.05). Conclusion:BRAF V600E gene mutation abundance was related with cervical lymph node metastasis and extra thyroidal extension in PTC patients.

Clinical practice and development in minimally invasive functional surgery of digestive tract / 中华消化外科杂志

Digestival functional surgery refers to surgical treatment for patients with functional diseases of the digestive tract. With the continuous development of minimally invasive surgery, most of surgical procedures for digestive functional diseases have been conducted by minimal invasive approach. Based on decades of clinical practice, the authors focus on minimally invasive surgeries for a group of digestive functional diseases such as achalasia of cardia, gastroesophageal reflux disease, volvulus of stomach, gastroptosis, dolichocolon, refractory constipation, rectocele and rectal prolapse, and make ageneral summary on current status and prospects of its clinical application combined with literatures.

Clinical practice and development in minimally invasive functional surgery of digestive tract / 中华消化外科杂志

Digestival functional surgery refers to surgical treatment for patients with functional diseases of the digestive tract. With the continuous development of minimally invasive surgery, most of surgical procedures for digestive functional diseases have been conducted by minimal invasive approach. Based on decades of clinical practice, the authors focus on minimally invasive surgeries for a group of digestive functional diseases such as achalasia of cardia, gastroesophageal reflux disease, volvulus of stomach, gastroptosis, dolichocolon, refractory constipation, rectocele and rectal prolapse, and make ageneral summary on current status and prospects of its clinical application combined with literatures.

Differential diagnosis of thyroid nodules by multivariate analysis / 中华普通外科杂志

Objective To discuss the feasibility and value of routine clinical preoperative examination predicting benign and malignant thyroid nodules. Methods The clinical data of 1630 patients undergoing thyroidectomy for nodular thyroid disease were analyzed retrospectively.The relationship between pathological diagnosis and physical examination,ultrasonographic parameters,the results of laboratory test and nuclear medicine test were examined to build a risk prediction model.The sensitivity,specificity and accuracy of the formula were tested. Results In 387 cystic nodules 0.78％ were malignant; In 1243 solid nodules 17.2％ were malignant.Among the 1243 cases,characters significantly related to malignancy were:age younger than 40 years,solitary lobe involvement,hypoechoic nodule,irregular margins,solid nodule,microcalcification,macrocalcification,max diameter ≤ 2 cm. The prediction formula was: malignancy indicator =0.80 × age + 0.59 × solitary lobe + 0.72 × hypoechoic + 0.82 × irregular margin + 1.32 × solid nodule + 1.90 × microcalcification + 0.70 × macrocalcification + 0.71 × max diameter.The threshold limit value was 2.8,and the sensitivity,specificity and accuracy of which were 74.4％,80.4％ and 75.2％,respectively. Conclusions Benign and malignant thyroid nodules could be differentiated roughly with the combination of patients' general information and the results of routine examination before operation.

Efficacy of radiofrequency thermocoagulation in relieving refractory pain of knee osteoarthritis in midde and older patients / 中华老年医学杂志

Objective To investigate the effects of radiofrequency thermocoagulation in relieving refractory pain of knee osteoarthritis in older patients.Methods A total of 18 patients with refractory pain of knee osteoarthritis were under treatment of radiofrequency thermocoagulation to denervation and compared to 20 patients with refractory pain of knee osteoarthritis which were under treatment of arthroscopy combined with compound betamethasone (control group).The Oxford knee score and visual analogue scale were used to evaluate the clinical effects before operation,at 1 week,4 weeks and 12 weeks after operation.Results There were significant decreases in both groups after operation than before operation(Foxford ＝4.12,3.98,FVAS ＝3.98,4.11,both P＜0.05),but there were no statistics differences between radiofrequency thermocoagulation group and control group at 1 week,4 weeks and 12 weeks after operation(toxford ＝ 1.215,1.426; tVAS＝1.319,1.123,0.867,P＞0.05).Conclusions The treatment of radiofrequency thermocoagulation is a minimally invasive method,which can relieve refractory pain of knee osteoarthritis in middle and older patients and recover knee function effectively.

Clinical application of domestic harmonic scalpel in laparoscopic cholecystectomy / 中国微创外科杂志

Objective To explore the clinical value of domestic harmonic scalpel in laparoscopic cholecystectomy. Methods Modified laparoscopic cholecystectomy (LC) was performed in 36 cases under general anesthesia. The operation was completed by using domestic USI harmonic scalpel in 21 cases (USI Group) and by using imported harmonic scalpel in 15 cases (GEN Group). Results The operation was laparoscopically accomplished in both of the groups, without conversions to open surgery. Of the USI Group, the operating time was 42.6?7.5 min, the postoperative drainage was 34.3?14.0 ml, the length of postoperative hospitalization was 4.9?0.9 d, the speed for cutting cystic duct was 335.1?180.3 ?m/s, the speed for cutting cystic artery was 524.2?127.8 ?m/s, and the denaturalization width of cystic duct was 2 047.6?376.3 ?m. Of the GEN Group, the operating time was 47.0?9.0 min, the postoperative drainage was 38.0?3.9 ml, the length of postoperative hospitalization was 4.3?0.9 d, the speed for cutting cystic duct was 403.5?120.1 ?m/s, the speed for cutting cystic artery was 513.5?125.9 ?m/s, and the denaturalization width of cystic duct was 2 266.7?306.3 ?m. There was no differences in these parameters between the two groups ( P

Laparoscopy combined with esophagogastroscopy for achalasia of the cardia:Report of 25 cases / 中国微创外科杂志

Objective To investigate the value of laparoscopy combined with esophagogastroscopy in the treatment of achalasia of the cardia. Methods Twenty-five patients with achalasia of the cardia between October 2003 and April 2006 in this department underwent the HellerDor operation under laparoscopy combined with esophagogastroscopy.Results A1l the operations were successfully accomplished.The operating time was 60~240 min(mean,107 min) and the intraoperative blood loss,5~60 ml(mean,22 ml).Intraoperative mucosal perforation was encountered in 4 patients.All the patients got out of bed for activities at 8 hours after operation,with first passage of flatus,removal of the gastric tube,and liquid diet intake at 1~3 days after operation(mean,1.5 days).The esophageal manometry showed the lower esophageal sphincter(LES) pressure had decreased to normal levels at 7 days after operation.The 24-hour ambulatory pH studies showed a high reflex index in 3 patients,but without symptoms.Upper gastrointestinal barium swallow showed the dilated esophagus had a 8~26 mm(mean,18 mm) decrease in diameter at 8 days after operation.The length of postoperative hospitalization was 8~11 days(mean,8.5 days).Follow-up for 1~30 months(mean,5.4 months) in all the patients showed 23 patients were asymptomatic and 2 had intermittent dysphagia.Conclusions Heller-Dor operation under laparoscopy combined with esophagogastroscopy has advantages of precise positioning,little invasion,less pain,and good effects,increasing the quality of operation as well as decreasing the incidence of complications.

Laparoscopic radical resection of colorectal carcinoma / 中国微创外科杂志

Objective To summarize the clinical experience of laparoscopic radical resection of colorectal carcinoma.Methods Clinical data of 13 cases of colorectal carcinoma treated by laparoscopic radical resection from November 2002 to April 2006 in this department were retrospectively analyzed.There were 10 cases of colon cancer(Duke's A,4 cases;Duke's B,6 cases) and 3 cases of rectal cancer(all Duke's A).Results According to the size of the tumor,the 13 patients were treated with either laparoscopic-assisted operation(10 cases) or hand-assisted laparoscopic surgery(3 cases).All the operations were performed successfully.No conversions to open surgery were needed and no mortality occurred.Follow-up checkups for 1~36 months(mean,17 months) showed no recurrence.Conclusions In patients with colorectal carcinoma,the selection of laparoscopic-assisted procedure or hand-assisted laparoscopic surgery can not only provide the operative safety and effectiveness,but also enable the operation minimally invasive.

Development of gasless laparoscopic devices and clinical application of gasless laparoscopic surgery / 中国微创外科杂志

Objective To research the clinical safety and feasibility of self-made devices in gasless laparoscopic surgery. Methods A total of 5 generations of gasless laparoscopic devices (8 models) were designed and manufactured by ourselves from April 1993 to September 2004. After animal experiments, 15 types of different gasless laparoscopic operations were carried out in 87 patients. Results Out of the 87 cases, conversions to open surgery were required in 7 cases (conversion rate, 8.0%). The other 80 cases of gasless laparoscopic operations were successfully performed, involving cholecystectomy, colorectal resection, partial cecectomy, subtotal gastrectomy, inguinal herniorrhaphy, abdominal wall contraction, radical resection for carcinoma of renal pelvis, haital herniorrhaphy with Toupet’s fundoplication and total hysterectomy. Conclusions Our self-made gasless laparoscopic devices may be applied safely and effectively in clinical cases. Gasless laparoscopic surgery has been reflecting the complementary advantages of modern laparoscopic surgery and traditional open surgery. It is of supplementary significance in patients contraindicated to pneumoperitoneum and of distinctive importance for laparoscopic gastrointestinal surgery requiring abdominal fistulization or prolonged incision, as well as hand-assisted hepatobiliary or pancreatic laparoscopic surgery.

Hand-assisted gasless laparoscopic nephroureterectomy for renal pelvis transitional cell carcinoma / 中国微创外科杂志

Objective To investigate the technical skill of hand-assisted gasless laparoscopic nephroureterectomy for patients with transitional cell carcinoma in renal pelvis. Methods 4 patients underwent hand-assisted gasless laparoscopic nephroureterectomy for transitional cell carcinoma in renal pelvis with homemade gasless laparoscopic device from July to November 2001. Results The average operative time was 170 minutes, and the average blood lose was 195 ml. No analgesic was prescribed postoperatively. The interval to resume normal oral intake 2 8 days. All patients had been followed up for 1 to 4 months, there was no tumor recurrence in bladder. Conclusions Hand-assisted gasless laparoscopic nephroureterectomy has the advantages of easy to learn, safer and faster to operate, less blood loss, less interference to cardiopulmonary system, as well as quicker postoperative recovery.

The Application of Modern Laparoscopy to the Diagnosis and Treatment in Chronic Abdominal Pain / 中国微创外科杂志

Objective To evaluate the role of laparoscopic exploration in patients with chronic abdominal pain. Methods Sixty patients with chronic abdominal pain were selected for laparoscopic evaluation. Results of 60 patients, 35 cases were operated on by laparoscopic appendectomy and lysis of adhesion,20 cases by lysis of ad- hesion simply, and 5 cases by simple irrigation of the pelvis. Forty five patients were followed up from 0.5 to 5 years, complete pain relief rate was 53 % (24/45), partial pain relief rate was 29% (13/45), the other 18% (8/45)got no im- provement of their addominal pain. Conclusions Laparoscopic diagnosis and treatment in patients with chronic ab- dominal pain have the following advantages: extensive exploration, multidisciplinary diagnosis and treatment in combi- nation, as well as accuracy and effectiveness.

MODIFIED LAPAROSCOPIC CHOLECYSTECTOMY / 中国内镜杂志

To furtherly reduce the subxiphoid port site pain,improve the cosmetic result and patient satisfaction,and increase the safety for patients underwent laparoscopic cholecystectomy by advanced laparoscopic knotting skill.Methods:Among our 1500 patients underwent laparoscopic cholecystectomy since 1991,120 cases of modified laparoscopic cholecystectomy (MLC) were performed with three 5-mm ports and one 10-mm port(for laparoscope and sepcien withdrawn).There were 25 male and 95 female patients with an average age of 55 years (24～77years).The indications for MLC included polypoid lesions of gallbladder (21),simple cholecystitis(3),cholecystolithiasisi with chronic cholecystitis(84),with acute suppurative cholecystitis(7),with atrophic cholecystitis(5).Results:There were 5 patients underwent combined laparoscopic appendectomy(3),fenestration of hepatic cyst(1),and drainge for liver abscess(1).The average operative time for MLC was 55 minutes(30～150min),blood loss was 10ml(3～50ml),and postoperative stay was 3 days(1～5days).There were no conversion from MLC to either LC or open surgery,without mortality.Complications were limited to two patients(1.7%).One was retained common bile duct stone and another was port site bleeding after operation.They were treated by transduodenal endoscopic stone retrieval and simple suture ligation,respecrtively.Conclusions:The advantages of MLC conducted mainly by advanced laparoscopic knotting techniques were no more laparoscope (either 2-mm or 5-mm)needed,no sacrifice of good illumination and laproscopic image.Most of all,its costeffective and operative safety were all improved furtherly.