[Preliminary analysis of the promotion effect of laparoscopic standardized surgical treatment for gastric cancer in regional medical centers in Shanghai].

Objective: To explore the promotion effect of laparoscopic standardized surgery for gastric cancer observational in some regional medical centers in Shanghai. Methods: A retrospective cohort study was carried out. Eleven regional medical centers in Shanghai received the promotion program of laparoscopic standardized surgery for gastric cancer, which was led by Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Shanghai Minimally Invasive Surgery Center) from January to December 2020. Clinicopathological data of gastric cancer patients treated at these 11 regional medical centers before and after the promotion program were collected. Inclusion criteria were as follows: patients undergoing laparoscopic distal gastrectomy or total gastrectomy; gastric cancer confirmed by pathology; without distant metastasis or peritoneal metastasis. Patients who did not undergo laparoscopic D2 radical resection, or received neoadjuvant chemotherapy before surgery, or without complete clinical data were excluded. Patients undergoing laparoscopic surgery from January to December 2019 were included in the pre-promotion group (46 cases). Patients undergoing laparoscopic surgery from January to December 2021 were included in the post-promotion group (102 cases). In addition, patients undergoing laparoscopic surgery at Ruijin Hospital from January 2021 to December were included in the control group (138 cases). The baseline data, perioperative measurements postoperative complications, and pathological results of the three groups were analyzed and compared. Results: There were no significant differences in baseline characteristics among the three groups (all P>0.05). Compared with the pre-promotion group, the operation time in post-promotion group was significantly shorter [(207.3±36.0) minutes vs. (254.2±47.1) minutes, t=7.038,P<0.001], and the number of harvested lymph node was significantly more (24.4±12.2 vs. 18.9±5.5, t=2.900, P=0.004). However, there were no significant differences in the extent of resection, time to fluid intake, and postoperative hospital stay between the two groups (all P>0.05). Compared with the control group, the operation time [(207.3±36.0) minutes vs (172.6±26.0) minutes, t=8.281, P<0.001], time to fluid intake [(6.3±3.2) days than (5.5±3.0) days, t=2.029, P=0.044], and the postoperative hospital stay [(14.3±5.6) days vs. (10.1±4.8) days, t=6.036, P<0.001] in the post- promotion group were still longer. Total gastrectomy was less common in the post-promotion group compared with the control group [18 cases (17.6%) vs. 41 cases (29.7%), χ2=7.380, P=0.007]. However, there was no significant difference in the number of harvested lymph node between the two groups (P>0.05). The morbidity of postoperative complication in the post-promotion group (9.8%, 10/102) was significantly lower than that in the pre-promotion group (23.9%, 11/46) (χ2=5.183, P=0.023), while above morbidity was not significantly different between the post-promotion group and the control group [9.8% vs. 6.5% (9/138), χ2=0.867, P=0.352]. Conclusion: After the promotion of laparoscopic standardized surgery for gastric cancer in regional medical centers, the standardization degree of surgery has been improved, and the morbidity of postoperative complication decreases. Laparoscopic standardized surgery for gastric cancer can be promoted to more regional medical centers.

[Clinicopathologic characteristics and causes of difficulty in locating the "difficult to locate" intractable epilepsy].

Objective: To summarize the clinicopathological characteristics of "difficult to locate" intractable epilepsy patients, and investigate the causes of difficulty in their location. Method: Retrospective analysis was performed on the clinical data of 58 patients who underwent resection of the epileptogenic zones after intracranial electroencephalography (iEEG) detection at the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University from January 2010 to December 2018. Clinicopathological characteristics and lesion lobes of "difficult to locate" intractable epilepsy were summarized. The prognosis of patients was assessed according to Engel grading.Univariate and multivariate logistic regression analysis were used to investigate the relevant factors affecting the prognosis of patients with "difficult to locate" intractable epilepsy related to malformation of cortical development(MCD). Results: Among the 58 patients, there were 47 cases of MCD (12 cases with mild malformation of cortical development (mMCD), 35 cases with focal cortical dysplasia (FCD)), and 11 cases of other types. Among the 47 MCD cases, univariate analysis showed that patients with preoperative magnetic resonance imaging(MRI) positive and completed resection of the epileptogenic zones had better prognosis (P<0.05). Multivariate analysis indicated that completed resection of epileptogenic zones was an independent factor affecting the postoperative efficacy of MCD (P=0.013,Wald χ(2)=6.149, 95%CI: 0.07-0.56). And among the 47 MCD cases, 18 cases were with mono-lobar lesions and 29 cases were with multi-lobar lesions, however, there was no significant difference of the efficacy between the two groups (P=0.511). Conclusions: MCD, especially FCD, is the main pathological types of patients with "difficult to locate" intractable epilepsy. Multi-lobar pathological changes, especially multi-lobar MCD, are the main reasons of being difficult to locate, however, accurate locating of epileptogenic zones and functional areas via effective use of iEEG can achieve satisfactory efficacy in these patients after resection of the epileptogenic zones.

Effects of rumen-protected betaine supplementation on meat quality and the composition of fatty and amino acids in growing lambs.

Rumen-protected betaine (RPB) can enhance betaine absorption in the small intestine of ruminants, while betaine can alter fat distribution and has the potential to affect the meat quality of livestock. Hence, we hypothesized that RPB might also affect the meat quality of lambs. Sixty male Hu sheep of similar weight (30.47 ± 2.04 kg) were selected and randomly subjected to five different treatments. The sheep were fed a control diet (control treatment, CTL); 1.1 g/day unprotected-betaine supplemented diet (UPB); or doses of 1.1 g/day (low RPB treatment; L-PB), 2.2 g/day (middle RPB treatment; M-PB) or 3.3 g/day (high RPB treatment; H-PB) RPB-supplemented diet for 70 days. Slaughter performance, meat quality, fatty acid and amino acid content in the longissimus dorsi (LD) muscle, shoulder muscle (SM) and gluteus muscle (GM) were measured. Compared with CTL, betaine (including UPB and RPB) supplementation increased the average daily weight gain (ADG) (P < 0.05) and average daily feed intake (P < 0.01) of lambs. Rumen-protected betaine increased ADG (P < 0.05) compared with UPB. With increasing RPB doses, the eye muscle area of the lambs linearly increased (P < 0.05). Compared with CTL, betaine supplementation decreased water loss (P < 0.05) in SM and increased pH24 in the SM (P < 0.05) and GM (P < 0.05). Compared with UPB, RPB decreased water loss in the GM (P < 0.01), decreased shear force (P < 0.05) in the LD and SM and increased the pH of the meat 24 h after slaughter (pH24). With increasing RPB doses, the shear force and b* value in the LD linearly decreased (P < 0.05), and the pH24 of the meat quadratically increased (P < 0.05). Compared with CTL, betaine supplementation increased the polyunsaturated fatty acid in the GM (P < 0.05). Compared with UPB, RPB supplementation decreased the saturated fatty acid (SFA) content in the LD (P < 0.05) and increased the unsaturated fatty acids (UFA), mono-unsaturated fatty acids and UFA/SFA ratio in the LD (P < 0.05). Compared with CTL, the content of histidine in the LD increased with betaine supplementation. Compared with UPB, RPB supplementation increased the content of total free amino acids and flavor amino acids in the LD of lambs (P < 0.05). With increasing RPB, the isoleucine and phenylalanine contents in the LD linearly increased (P < 0.05). Overall, the data collected indicated that the meat quality of lambs (especially in the LD) improved as a result of betaine supplementation, and RPB showed better effects than those of UPB.

[Discussion on pT3 staging in TNM staging of AJCC 8(th) edition gallbladder carcinoma].

Objective: To discuss the rationality of stage pT3 in the AJCC 8(th) TNM criteria of gallbladder carcinoma. Methods: A retrospective study was performed to analyze the clinical and pathological data of 88 patients with pT3 gallbladder carcinoma admitted to Department of Second Biliary Surgery of Eastern Hepatobiliary Surgery Hospital, affiliated to Naval Medical University from May 2013 to September 2018.pT3 stage tumors were divided into two groups: (1) pT3a stage: tumors had penetrated serosa but not directly invaded liver and/or an adjacent organ or structure; (2) pT3b stage: tumor penetrating serosa and directly invaded liver and/or an adjacent organ or structure. There were 45 patients with pT3a stage, including 15 males and 30 females, aged 36 to 80 years, with a median age of 59 years; 43 patients with pT3b, including 24 males and 19 females, aged 41 to 78 years old, median aged 63 years old.Patients with pT3a and pT3b were further divided into two groups respectively: radical resection group and extended radical resection group according to surgical radicalization. Independent sample t-test was used for comparison between two groups with normal distribution measurement data. Wilcoxon rank sum test was used between groups of non-normally distributed measurement data.The comparison of the count data was performed by χ(2) test or Fisher exact probability method. Survival analysis was performed using Kaplan-Meier method, and survival rate was compared using Log-rank test. Results: (1)Serum total bilirubin(15.6(90.3)mmol/L), albumin(40.2(4.8)mmol/L), and CA19-9(132.90(455.78)U/ml) levels in pT3b patients were higher than that in pT3a patients(10.2(6.8)mmol/L, 41.8(4.9)mmol/L, 14.35(36.27)U/ml), respectively(Z=-3.816, -1.966, -3.739, all P<0.05),postoperative complication rate in pT3b patients(24.4%) was higher than that in pT3a patients(8.9%)(P<0.05),postoperative hospital stay(12(7)days) and overall hospital stay((26±17)days) of pT3b patients were longer than that of pT3a patients((10±5) days and (19±7)days) (P<0.05). (2) The 1-, 3-, 5-year survival rates of pT3b and pT3a patients were 53%,22%,22% and 69%, 46%,38%,and the median survival time was 13 months and 26 months, respectively. The difference in survival rates between the two groups was statistically significant(χ(2)=5.117, P=0.024). (3)The 1-, 3-year survival rates of extended radical resection group(n=19) and radical resection group(n=24) in the pT3b stage were 73%, 36% and 28%, 7%, respectively.The survival time was 20 months and 9 months,respectively,and the difference in survival rates between the two groups was statistically significant(χ(2)=4.976, P=0.026). Conclusions: pT3 gallbladder carcinoma could be further subdivided into pT3a stage and pT3b stage based on the TNM criteria of AJCC 8(th) gallbladder carcinoma. Extended radical resection for pT3b gallbladder carcinoma should be further considered after comprehensive assessment of the patient's basic condition and surgical tolerance.

[Applicational value of modified pancreaticojejunostomy and risk factors of pancreatic fistula following pancreaticoduodenectomy].

Objective: To compare the efficacy of modified pancreaticojejunostomy with traditional pancreaticojejunostomy following pancreaticoduodenectomy, and to investigate the risk factors of postoperative pancreatic fistula. Methods: Clinical data of 68 patients who underwent pancreaticoduodenectomy between October 2017 and October 2018 at the Second Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital was retrospectively collected and analyzed.According to the method of pancreaticojejunostomy, the patients were divided into two groups: modified pancreaticojejunostomy group (34 patients) and traditional pancreaticojejunostomy group (34 patients). There were 18 males and 16 females, aged (60.4±9.6) years of modified pancreaticojejunostomy groups; there were 17 males and 18 females, aged (58.9±10.9) years of traditional pancreaticojejunostomy group. The major postoperative complications such as pancreatic fistula were compared between the two groups, and the risk factors of postoperative pancreatic fistula were analyzed by univariate and multivariate analyses. Results: All of the 68 operations were successfully completed. The overall incidence of postoperative complications was 51.5% (35/68). The incidence of postoperative pancreatic fistula was 13.2% (9/68), of which all were cases of grade B.There were 16 patients (23.5%) occurred with abdominal infection, and 11 patients (16.2%) occurred with delayed gastric emptying, including 1 case of grade A, 1 case of grade B and 9 cases of grade C.And 9 patients (13.2%) occurred with postoperative bleeding was, including 2 cases of mild bleeding, 5 cases of moderate bleeding, and 2 cases of severe bleeding.Biliary leakage occurred in one patient (1.5%) and chylous leakage occurred in two patients (2.9%). The modified pancreaticojejunostomy could significantly reduce the incidence of postoperative bleeding compared with control group (χ(2)=4.610, P=0.032). And there were no significant differences for other postoperative complications between the two groups (all P>0.05). According to the results of univariate analysis: age, intraoperative bleeding and diameter of pancreatic tube were related factors affecting postoperative pancreatic fistula (P=0.025, 0.019, 0.017, respectively). The results of multivariate analysis showed that intraoperative bleeding>400 ml and diameter of pancreatic tube <3 mm were independent risk factors of pancreatic fistula following pancreaticoduodenectomy (P=0.025, 0.008, respectively). Conclusion: The modified pancreaticojejunostomy is feasible with advantages of reducing postoperative bleeding following pancreaticoduodenectomy.

Expression of SIRT1 gene in human lung cancer lines enhances their sensitivity to the anticancer effects of cisplatin.

OBJECTIVE: Lung cancer is one of the lethal cancers and one of the major causes of cancer-related mortalities across the globe. SIRT1 gene has been reported to be involved in the progression and tumorigenesis of several types of cancers. However, the role of SIRT1 gene is in the progression of lung cancer is poorly understood. Against this backdrop, the present study was designed to investigate the expression of SIRT1 gene in different lung cancer cell lines. Moreover, the relation between the expression of this gene and the sensitivity of lung cancer cell lines to the anticancer effects of cisplatin was also investigated. MATERIALS AND METHODS: Expression of SIRT1 gene was determined by quantitative RT-PCR. Protein expression was examined by Western blotting. Anti-proliferative activity was determined by MTT and colony formation assay. Apoptotic populations were determined by annexin V/IP staining and flow cytometry. RESULTS: The results revealed that NCI-H125 showed lowest, NCI-H226 showed moderate, while as NCI-H358 exhibited the highest expression of SIRT1. The three differentially SIRT1 expressing cancer cell lines were subjected to cisplatin treatment. It was observed that cisplatin exhibited the highest anticancer activity against NCI-H125 (IC50, 1.25 µM) and lowest against NCI-H358 (IC50, 4.5 µM). Moreover, cisplatin leads to highest inhibition of colony formation and apoptosis in NCI-H125 and lowest against NCI-H358. CONCLUSIONS: Expression of SIRT1 gene determines the sensitivity of lung cancer cells to anticancer effects of cisplatin. This work will pave for understanding the role of SIRT1 gene in cancer progression.

[Investigation of short-term resolution as a predictor of long-term cure of microvascular decompression in hemifacial spasm].

Objective: To investigate whether the short-term relief of spasm (within 7 days) after microvascular decompression (MVD) for hemifacial spasm (HFS) can be used as a prognostic factor of long-term outcome (>6 months). Methods: The clinical characteristics and follow-up data (completely recorded) of 159 patients who had HFS and underwent microvascular decompression surgery in the first Affiliated Hospital of Fujian Medical University from August 2008 to May 2016 were analyzed retrospectively. The collected data focus on symptom relief in a time course: immediately after MVD, 7 days after MVD and the last follow-up (>6 months) by using Cohen-Albert grading. Results: In a total of 159 patients underwent MVD were followed up for more than 6 months.Compared to persist spasm group within 7 days after MVD, the cure rate was significantly higher in the spasm symptom relief group within 7 days after MVD (P<0.05). The cure rate of MVD (y) and the number of days within 7 days of relief (x) were highly relevant, y=-0.707x(2)+ 9.724x+ 67.442 (P<0.05). By using univariate Logistic regression analysis, we found that the prognostic factors of long-term curative effect were the symptom scale immediately after MVD and the average symptom scale in the 7 days after MVD (P<0.001). The incidence of delayed cure was 41.5%(66/159). Conclusion: In the 7 days after MVD, at least 1 day of symptom remission can predict the cure of HFS.

[Factors associated with the surgical efficacy and prognosis of seizures in patients with low-grade glioma].

OBJECTIVE: To explore the relevant factors associated with the surgical efficacy and prognosis of seizures in patients with low-grade glioma (LGG). METHODS: The clinical cases of seizures in patients with LGG admitted to our department were retrospectively collected from January 2010 to December 2014. A total of 45 cases were studied to analyze the relevant factors associated with the surgical efficacy and prognosis. RESULTS: During a follow-up period of 1 to 5 years after surgery, Engel classⅠ to Ⅱ were achieved in 36 patients (80%) and Engel class Ⅲ to Ⅳ in 9 cases (20%). The preoperative epilepsy frequency and the use of intraoperative electrocardiograph (ECoG) were correlated with the surgical efficacy and prognosis (P<0.05). The other factors, such as age, gender, duration of epilepsy, and tumor characteristics, had no significant statistical difference. CONCLUSIONS: The surgical efficacy of seizures in patients with LGG is favorable. Our results suggest that preoperative epilepsy frequency and intraoperative ECoG are important factors for surgical efficacy and prognosis. Consequently, based on gross total resection for seizures in patients with LGG, epileptogenic zones should be considered and dealt with by use of ECoG.

PI3K-AKT pathway polymerase chain reaction (PCR) array analysis of epilepsy induced by type II focal cortical dysplasia.

The aims of this study were to observe the differential expression of PI3K-AKT pathway-related genes in seizure-inducing brain lesions in type II focal cortical dysplasia, and to explore the relationship between gene expression and histological changes in dysplastic foci and their epileptogenic mechanism. Typical lesions in brain tissue from three patients with epilepsy induced by type II focal cortical dysplasia were selected for analysis, along with normal brain tissue from two control group individuals. Following quantitative expression analysis using the RT2 Profiler(TM) PI3K-AKT PCR Array, differential expression of the pathway related genes was detected in the focal brain tissue lesions, and gene function queries were performed. Compared with the control group, thirteen related genes appeared to exhibit marked differences in expression in epileptic lesions from patients with type II focal cortical dysplasia; those genes were found to be involved in regulation of cell size, morphology, adhesion, migration, and apoptosis, and in immunity, inflammation, and many other domains. The differential expression of multiple genes in the PI3K-AKT signaling pathway in type II focal cortical dysplasia may be an important molecular mechanism underlying histological changes and recurrent seizures.

The Arabidopsis thaliana ethylene-responsive element binding protein (AtEBP) can function as a dominant suppressor of Bax-induced cell death of yeast.

We identified genes based on screening of an Arabidopsis cDNA library for functional suppressors of mouse Bax-induced cell death of yeast cells. Interestingly, the cDNA encoding AtEBP, known as Arabidopsis thaliana ethylene-responsive element binding protein, was isolated numerous times in the functional screen (82% of all suppressors). Full-length AtEBP and its localization to the nucleus were essential for the suppression of Bax-induced cell death. Morphological abnormality of intracellular network that is a hallmark of Bax-induced cell death was attenuated by expression of AtEBP.

Inverted papilloma.

BACKGROUND: Inverted papilloma, a benign sinonasal lesion, constitutes 0.5% to 4% of all nasal tumors. Its local aggressiveness, high recurrence rate, association with malignancy or malignant transformation, and tendency toward multicentricity lead most physicians to advocate radical surgery. Nonetheless, conservative surgery is effective for selected patients with limited disease. This study was done to reassess the efficacy of both radical and conservative surgery. METHODS: The records of all patients with the diagnosis of inverted papilloma treated at the Taipei Veterans General Hospital between January 1986 and October 1998 were collected. A minimal follow-up period of 12 months was required for inclusion in the study. Clinical manifestations, radiologic findings, methods of treatment, pathology reports and recurrence rates were all retrospectively reviewed. RESULTS: Sixty patients with an average age at diagnosis of 58 years were studied. The follow-up period ranged from 12 to 195 months, with a mean of 43 months. The most common presenting symptom was unilateral nasal obstruction. The duration of symptoms ranged from one month to 30 years, with a mean of 36 months. The lateral wall and middle meatus were the most commonly involved sites. Bone erosion and intracranial or intraorbital extension were observed in some patients. Medial maxillectomy was the most common surgical treatment, followed by functional endoscopic sinus surgery and the Caldwell-Luc operation. The overall recurrence rate was 23%, with an average interval from initial treatment to recurrence of 42 months (range, 2-93 months). The recurrence rates for the two groups undergoing medial maxillectomy and conservative surgery were 16% and 27%, respectively. CONCLUSIONS: Early diagnosis relies on high suspicion and biopsy. The treatment modality is related to the location and extent of the disease, which is assessed by preoperative imaging studies. Any tumor with extensive involvement of the sinuses or inaccessibility to the endoscope should be treated with traditional medial maxillectomy for best control. The endoscopic technique is good for preoperative biopsy and follow-up.

Malignant otitis externa.

BACKGROUND: Malignant otitis externa is an infrequent but severe infection of the external auditory canal, most often affecting elderly diabetic patients. Early diagnosis is necessary due to its high morbidity and mortality. METHODS: From 1990 to 1997, all patients with malignant otitis externa at the Veterans General Hospital-Taipei were reviewed retrospectively. The clinical features and the strategy of diagnosis and treatment are discussed. RESULTS: Twelve patients with an average age of 65.3 years were included. Eleven of these patients were diabetic. All had the presenting symptoms of otalgia and otorrhea at diagnosis. Bacterial cultures grew Pseudomonas aeruginosa in eight patients and methicillin-resistant Staphylococcus aureus in four patients. The mean duration of admission was 82 days. Appropriate antibiotics were given according to the results of bacterial culture and sensitivity test. 99Technetium scans and 67gallium scans were performed to evaluate the extent of involvement and monitor the effects of treatment. Eventually, four patients died due to renal failure, meningitis, pneumonia and upper gastrointestinal bleeding, respectively. CONCLUSIONS: Malignant otitis externa is a life-threatening infection arising from the external auditory canal. A high degree of suspicion for malignant otitis externa is mandatory. Vigorous local and systemic antimicrobial treatment should be initiated early in the course of the disease to achieve a satisfactory outcome. 99Technetium and 67gallium scans are important for the diagnosis and evaluation of the treatment results.

Tympanoplasty for pars flaccida.

BACKGROUND: The formation of a retraction pocket of the pars flaccida remains a difficult problem for otologists to treat. It may lead to ossicular erosion and the development of a cholesteatoma, especially when the pocket is adherent to the malleus neck. We designed a new method of surgery for the treatment of small attic cholesteatomas. METHODS: From 1986 to 1996, 20 patients with a retraction pocket of the pars flaccida or a small attic cholesteatoma underwent surgery as described below. The complete lesion was removed after widening the posterior-superior bony external ear canal wall and placing pieces of conchal cartilage (usually less than 10 pieces, according to their scutum defect) lateral to the malleus neck or incus. The temporalis fascia was then laid. RESULTS: The average follow-up period was 32 months. The paired t-test was used to compare the results of preoperative and postoperative air conduction and air-bone gap. The preoperative average air conduction was 31.17 dB and the air-bone gap was 15.09 dB. The postoperative average air conduction was 20.66 dB and the air-bone gap was 3.09 dB. The difference between preoperative and postoperative measurements was considered significant (p < 0.05). No recurrent retraction pockets or cholesteatomas were noted during follow-up. CONCLUSIONS: Tympanoplasty for correction of a retraction pocket of the pars flaccida can prevent further attic retraction and the development of cholesteatomas. Postoperative hearing results were also encouraging.

A novel MT gene of rice plants is strongly expressed in the node portion of the stem.

We identified a cDNA encoding a metallothionein (MT)-like protein from a cDNA library of rice endosperm. This cDNA (ricMT) encoded an open reading frame of 80 amino acids, with two cysteine-rich domains at the amino-terminus and carboxy-terminus, respectively. The deduced amino acid sequence was homologous to those of class I MT-like proteins. Southern blot analysis revealed that the gene exists at one locus in the rice genome. Northern blot analysis with rice seedlings showed that the transcript level in shoots was elevated by the addition of metal ions, such as Cu, Zn, Cd, Fe, Pb and A1, whereas in roots it was reduced in the presence of metal ions other than copper. The expression level of ricMT in mature rice plants was extremely high in stems relative to leaf blades, leaf sheaths, endosperm and roots. In the first nodes, the yield of the transcript was 150-times higher than that in leaf blades. These results suggest that ricMT protein may play an important role in the metabolism of metal elements in the stem.