Clinical efficacy of laparoscopic closed hernia ring combined with a patch repair for Gilbert type III indirect inguinal hernia.

Purpose: The incidence of seroma and postoperative pain after Gilbert type III inguinal hernia repair is high. To reduce postoperative complications, this study investigated the clinical efficacy of laparoscopic closed hernia ring combined with a patch repair for Gilbert type III indirect inguinal hernia. Methods: Through a prospective randomized controlled study, a total of 193 patients with Gilbert type III indirect inguinal hernia admitted to Nanchong Central Hospital affiliated with Chuanbei Medical College from May 2020 to December 2021 were selected and randomly divided into the inner ring closed group (85 patients) and the inner ring non-closed group (95 patients). The patients in both groups underwent laparoscopic tension-free repair of their inguinal hernias. General information such as operative time, postoperative hospital stay, and hospital cost were compared between the two groups, and the patients were followed up at 1, 7, 14, 21, and 28 days and then 3, 6, and 12 months after surgery to compare complications such as incidence of seroma, volume of the seroma fluid, incidence of pain, and visual analogue scale (VAS) pain score. Results: There was no conversion to open procedures in any of the patients. The operation time of the closed group was significantly longer than that of the non-closed group (64.2 ± 12.2 vs. 55.3 ± 9.5 min, P < 0.01). The proportion of patients with postoperative pain in the two groups was 39 (46%) vs. 59 (62%), P = 0.029 on 7 days; 17 (20%) vs. 33 (35%), P = 0.028 on 14 days; and 6 (7%) vs. 22 (23%), P = 0.003 on 21 days in the postoperative closed group and was significantly lower than that in the non-closed group, while we found that the non-closed group had a higher VAS pain score than that of the closed group (2.36 ± 0.61 vs. 1.95 ± 0.71, P = 0.003 on 7 days and 2.12 ± 0.49 vs. 1.65 ± 0.49, P = 0.002 on 14 days) after surgery according to the statistical results of the VAS pain score. The incidence of postoperative seroma and the amount of seroma fluid decreased gradually in both groups, but when comparing the two groups, the proportion of cases of seroma in the closed group on 7 days [45 (53%) vs. 79 (83%), P < 0.01]; 14 days [23 (27%) vs. 43 (45%), P = 0.011]; and 21 days [10 (12%) vs. 29 (31%), P = 0.002] after the operation were significantly less than that in the non-closed group. For the comparison of the amount of seroma fluid between the groups, the seroma fluid volume in the non-closed group was greater than that in the closed group (34.48 ± 20.40 vs. 43.87 ± 16.40 ml, P = 0.006, 7 days) and (21.79 ± 8.42 vs. 30.74 ± 10.39 ml, P = 0.002, 14 days) after surgery. There were no differences in the length of stay, total hospital costs, or postoperative complications (urinary retention, intestinal obstruction, nausea, vomiting, bleeding, and infection) between the two groups, and the differences were not statistically significant (P > 0.05). The postoperative follow-up period was 3-20 months, and no chronic pain or recurrence occurred during the postoperative follow-up period in either group. Conclusions: Closure of the hernia ring is safe and effective for laparoscopic hernia repair for Gilbert type III inguinal hernia, and it significantly reduces the incidence of postoperative seroma and further reduces the postoperative pain without increasing the risk of postoperative infection and recurrence.

Circular RNA circ0025847 supresses colorectal cancer proliferation by promoting of RNA-binding protein QK1 expression / 中华内分泌外科杂志

Objective:To uncover the effect of circ0025847 on the proliferation of colorectal cancer cells and its molecular mechanisms.Methods:qRT-PCR was utilized to analyze the expression of circ0025847 and QK1 in human colorectal cancer cells (HCT116, SW480) and normal mucosa cells (NCM460) .CCK-8 was used to analyze the effect of circ0025847 and QK1 on proliferation in colorectal cancer cells. Bioinformatics method was used to screen RBP which could bind to circ0025847. RNA pulldown and RIP was utilized to confirm whether QK1 binds to circ0025847.Effects of circ0025847 over-expression on QK1 expression was analyzed by Western blot.NC group, circ0025847 overexpression group and circ0025847 overexpression+ QK1 inhibitor group were established and the proliferation effect was determined by CCK8.Results:circ0025847 (the expression levels in NCM460, HCT116 and SW480 cells were 1.01±0.05, 0.49±0.08, 0.45±0.10) and QK1 (the expression levels in NCM460, HCT116 and SW480 cells were 0.98±0.07, 0.50±0.07, 0.47±0.09) expression was significantly downregulated in colorectal cancer cells. Overpression of circ0025847 and QK1 suppressed colorectal cancer cells growth.RNA pull-down and RIP clarified that circ0025847 bind to QK1 and circ0025847 positively regulate QK1 expression (7 199.20±12.44 VS 3 889.80±11.03) . circ0025847 inhibiting the proliferation of colorectal cancer cells by promoting the expression of QK1 was confirmed by rescue experiment.Conclusion:circ0025847 inhibits colorectal cancer cells proliferation via positively regulating QK1 expression, indicating that circ0025847 may be potential therapeutic target of colorectal cancer.

Regularity and predictors of weight loss during concurrent chemoradiotherapy for nasopharyngeal carcino- ma patients / 实用医学杂志

Objective To investigate the regularity and predictors of weight loss during concurrent chemo-radiotherapy for nasopharyngeal carcinoma patients. Methods A retrospective study was carried out on 82 patients with nasopharyngeal carcinoma ,with average age of 45 years ,who received concurrent chemoradiotherapy at the Affiliated Cancer Hospital of Guangzhou Medical University. Paired t-test was used to analyze the weight loss pattern during chemoradiotherapy. The Spearman′s rank correlation analysis was used to investigate the correlation between high weight loss(HWL)and the clinical factors. Results The paired t-test showed that the weight of the patients decreased continuously every week during chemoradiotherapy(P 10%). Spearman′s rank correlation analysis showed that HWL was associated with older age,female,higher T and TNM stage,3D-CRT technology,the higher dose of radiotherapy in nasopharynx and in neck lymph node,and decreases of leukopenia and hemoglobin over degree Ⅱ(P<0.05). Conlousions Weight may decrease continuously every week during chemoradiotherapy for nasopharyngeal carcinoma patients. Age,gender,T stage,TNM stage,radio-therapy dose,and leukopenia and hemoglobin decreases may be predictors for weight loss degree during concurrent chemoradiotherapy for nasopharyngeal carcinoma patients.

Study on relation between junctional adhesion molecule family A expression level and radiosensitivity of nasopharyngeal carcinoma cell line / 重庆医学

Objective The radiotherapy resistance is one of important causes for nasopharyngeal carcinoma(NPC) treatment failure.Junctional adhesion molecule A(JAMA)is closely correlated with the tumor poor prognosis.Thus this experiment is to in vestigate the relationship between JAMA expression and the radiosensitivity of NPC.Methods To overexpress or interfere the JAMA expression in CNE2 and HONE1 cell lines.Then different doses of X-ray were adopted to conduct irradiation.The cell clone formation capacity and cellular apoptosis change were detected after 24 h.The role of JAMA in the NPC radiotherapy was understand.The related signal pathway protein in cell lines with different JAMA expression was detected by Western blot.Results The cell lines with low JAMA expression were more sensitive to radiotherapy:After low JAMA expression,the D0 value in the CNE2 cell line was decreased from 3.26 ±0.78 to 1.92 ± 0.23;the Dq value was decreased from 46.51 ± 4.27 to 32.12 ± 3.19.The radio therapy induced apoptosis was significantly increased in the cell lines with low JAMA expression,after low JAMA expressing,thcellular apoptosis was elevated from 6.9 ％ ± 0.9 ％ to 13.7 ％ ± 1.3 ％;the HONE1 cellular apoptosis was elevated from 6.5 ％ + 1.1 ％ to 12.3 ％ ± 1.7％;JAMA overexpression cell lines were significantly decreased.The preliminary mechanism research results showed that JAMA played the effect via Akt signal pathway.Conclusion This research results verifiy that JAMA expression level is closely correlated with the radiosensitivity of NPC cell line:JAMA can increase the radiotherapy resistance of NPC cell lines,which provides a new feasible research direction for NPC enhancing radiosensitivity.

Effect of miR-124 on the epithelial-mesenchymal transition and radio-resistance of nasopharyngeal carci-noma / 实用医学杂志

Objective To identify the role of miR-124 in regulating the radiosensitivity and the epithelial-mesenchymal transition (EMT) of nasopharyngeal carcinoma (NPC). Methods Transient transfection of cells with miR-124 mimic or inhibitor was performed and wound-healing assay was used to investigate the role of miR-124 in the EMT of NPC. The apoptosis affected by miR-124 was also measured after irradiation , followed by investigating the cell proliferation by EdU assay. Finally , proteins of Akt and ERK associated with EMT and radiosensitivity, were measured by western blot. Results The migration index from NPC cell line indicated that miR-124 repressed the EMT. The results from caspase-3 activity assay showed that caspase-3 activity after irradiation significantly increased in miR-124 mimic group compared with the control group (P < 0.01). It was also confirmed that irradiation led to a higher percentage of apoptosis in miR-124 group compared with the control group in NPC cells. Cell proliferation after irradiation was significantly decreased in MiR-124 group as compared with control group . MiR-124 inhibited the protein expression of p-Akt . Conclusion MiR-124 may repress the EMT and decrease radio-resistance of NPC via p-Akt signaling pathway , which may provide a new insight into radio-resistance in NPC.

Effect of omental flap wrapping of pancreaticoduodenectomy on postoperative pancreatic fistula and intra-abdominal bleeding: a meta-analysis / 中华内分泌外科杂志

Objective To determine the effect of omental flap wrapping of pancreaticoduodenectomy on postoperative pancreatic fistula and intra-abdominal bleeding in patients undergoing pancreaticiduodenectomy through meta-analysis of published studies.Methods Articles about whether omental flap wrapping could prevent postoperative pancreatic fistula and intra-abdominal bleeding were searched in databases of MEDLINE,PUBMED and EMBASE.14 English article were found and according to including and excluding criteria,4 eligible articles with a total of 2971 patients were selected.Random effects model was used to analyze odds ratios and 95％ confidence intervals (CIs).Results 1129 patients were in omental wrapping group,and 1842 patients in nonomental wrapping group.Omental roll-up during pancreaticoduodenectomy could not prevent postoperative pancreatic fistula (OR =0.81,95 ％ CI 0.40～1.63,P＞0.05) or postoperative abdominal bleeding (OR=0.67,95％ CI 0.28～1.59,P＞0.05).The sensitivity analysis showed the pancreatic fistula rate was lower in the nonomental roll-up group than that in the omental roll-up group (OR=1.24,95％ CI 1.03～1.50,P＜0.05).Conclusions Omental wrapping can not decrease the risk of pancreatic fistula and abdominal bleeding after pancreaticoduodenectomy.Further randomized controlled trials are needed to identify the effect of omental wrapping technique for pancreaticoduodenectomy.

The analysis of the present status of early diagnosis and misdiagnosis of nasopharyngeal carcinoma in ;Guangdong province / 实用医学杂志

Objective To investigate the present status of early diagnosis and misdiagnosis of nasopharyngeal carcinoma (NPC). Methods A total of 50 patients diagnosed as NPC were recruited at the department of nasopharyngeal carcinoma in our hospital. The time from that patients felt discomfort to be diagnosed of NPC was determined bydifferent symptoms and signs. Furthermore , the status of misdiagnosis were also investigated. The spearmans rank correlation was used to analyze the correlation between the cancer stage and the time of confirmeddiagnosis , and the relationship between the rate of misdiagnosed and the rank of the hospital they visited. The χ2 test was then used to analyze the cancer stage with the time when they were diagnosed. Results Results indicated that the time when patients were diagnosed significantly correlated with pTNM stage (P < 0.05). Patients diagnosed in one month were most at stage Ⅱ, diagnosed in six months were stage III, and diagnosed after twelve months were stage Ⅳ(P < 0.05). Furthermore, we found that the rate of misdiagnosis of NPC was 12%. Moreover,the misdiagnosed rate was associated with the rank of the hospital patients visited. Discussion In conclusion , the present status of the early diagnosis of NPC is not optimistic. Most of the patients with NPC were misdiagnosed in basic medical institutions , especially in town or village health center. Thus, it is important to popularize the health knowledge about the secondary prevention of NPC and train the doctor in basic medical institutions.

Anatomic resection for hepatoceilular carcinoma ≤ 5 cm: a Meta analysis / 中华普通外科杂志

ObjectiveTo evaluate the impact of anatomic and non-anatomic liver resection on prognosisofpatientswithsmallhepatocellularcarcinoma( HCC ) usingaMeta-analysis.MethodsLiterature on anatomic versus non-anatomic liver resection for the treatment of small HCC ( ≤5 cm) was retrieved. ResultsFour nonrandomized controlled trials were included consisting of 776 patients:484 undergoing anatomic liver resection and 292 non-anatomic resection.The age ranged from 53.4 to 63.0 years.Male ∶ female ratio was 3.56 ∶ 1.87.1％ patients were Child-Pugh class A.Most patients (94.5％ ) had a single tumor.No significant differences were found conceming the 1,3,and 5 year disease-free survival rate between the two groups.There was no significant difference in overall survival and disease-free survival between the two groups at 1,3,and 5 years.Sensitivity analysis found anatomic resection was superior to non-anatomic resection in 3 year disease free survival rate (OR =0.72,95％ CI:0.52 - 0.99,P =0.04). ConclusionsAnatomic liver resection elevated the 3 year disease free survival rate of patients with small hepatocellular carcinoma when compared with non-anatomic hepatectomy but failed to further elevate long-term disease free survival and overall survival.

The modified BCLC staging system improves predictability of early intrahepatic recurrence for hepatocellular carcinoma following curative hepatectomy / 中华肝胆外科杂志

ObjectiveTo evaluate the modified Barcelona Clinic Liver Cancer (BCLC) staging system for predictability of intrahepatic recurrence for patients with hepatocellular carcinoma (HCC) following curative hepatectomy.MethodsA retrospective study was conducted on 197 consecutive patients with HCC who underwent curative hepatectomy in our department from Jan.2008 to Jan.2011.Univariate and multivariate analyses using Cox proportional hazard model were used to evaluate possible association between clinicopathologic factors and early postoperative intrahepatic recurrence (ER).Receiver operating characteristics (ROC) analysis with calculation of the area under the curve (AUC),sensitivity,and specificity were applied to define the cutoff point values for possible meaningful continuous variables where appropriate.A comparison between the differences in AUC was used to assess BCLC and a modified BCLC (M-BCLC) staging system for their predictive ability of ER.Risk stratification according to calculated M-BCLC was applied to find differences of ER at various time points after curative hepatectomy.ResultsDuring follow-up,111 patients developed ER.The 6-,9-,12-,18- and 24-month cumulative recurrent rates were 26.9％ (53/197),37.6％ (74/197),45.2％(89/197),53.8％ (106/197) and 56.3％ (111/197),respectively.Multivariate analysis revealed thatthe severity of concomitant cirrhosis,elevated AFP≥185.6 μg/L and BCLC staging were risk factors of ER.A M-BCLC was proposed based on the results of multivariate analysis.The severity of cirrhosis and elevated AFP values were included in the BCLC staging.This M-BCLC exhibited better performance.It predicted at different time points of ER at postoperative 9,12,18 and 24 months to be significantly better with M-BCLC than BCLC using AUC drawn from ROC.No significant difference was found with ER prediction at 6 months.The M-BCLC also demonstrated a ER prediction with AUC of 0.710 (95％ CI,0.630-0.790) and achieved a sensitivity of 83.0％,a specificity of 51.9％as calculated from ROC with M-BCLC≥2.913.Further risk stratification according to the M-BCLC at various cutoff point values revealed the ER occurrence rates amongst the different risk groups to be significantly different when compared with the median ER time (17.9 mons,9.9 mons vs 5.7 mons,x2=25.770,P=0.000,Log-Rank test).ConclusionA modified BCLC staging system based on multivariate analysis improved the predictability of ER following curative hepatectomy for HCC.

Evaluation of currently used staging systems for survival predictability in HBsAg-positive hepatocellular carcinoma patients / 中华普通外科杂志

Objective Basing on overall survival(OS)of HBsAg-positive hepatocellular carcinoma(HCC)patients we evaluate several currently used HCC staging systems for OS predictivity.Methods This retrospective study included 775 patients with HBsAg-positive HCC treated in our department during 11-year period from Jan.2000 to Feb.2010.Clinicopathologic factors were evaluated for their possible association with OS in univariate and multivariate analysis using Cox proportional hazard model.Receiver operating characteristics(ROC)analysis with calculation of the area under the curve (AUC),sensitivity,and specificity was applied to define cutoff point values where appropriated and to assess HCC staging systems for their predictive ability of OS.Results The 1-,2-,3-and 5-year OS rates were 21.3％(165/775),9.4％(73/775),4.9％(38/775)and 1.7％(13/775),respectively.Multivariate analysis identified that severity of concomitant liver cirrhosis(B =4.519),treatment modality (B =4.888),ALT≥2N(B =4.068),portal vein tumor thrombi(B =0.537),spontaneous rupture(B =5.033)and inferior vena cava tumor thrombi(B =7.049)as independent risk factors influencing OS.NSMCS(North Sichuan Medical College Score)exhibited best performance predicting OS with AUC 0.801 (95％ CI 0.761-0.840),sensitivity of 78.8％,specificity of 69.3％ at NSMCS ≥-2.Median survival time reached statistically significant difference(13.6 mons,3.4 mons vs.1.3 mons,x2 =467.636,P =0.000).Conclusions Multiple factors determine OS in patients with HBsAg-positive HCC.NSMCS staging system demonstrates better predictability for the survival of HBsAg positive HCC patients.