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Objective:To investigate the feasibility and clinical efficacy of laparoscopic radical cholecystectomy(LRC) for gallbladder cancer.Methods:The clinical data of 247 patients with gallbladder cancer who underwent radical resection from Jan 2013 to Dec 2019 at Department of General Surgery, Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine was analyzed retrospectively. After propensity score matching, 54 patients were included in laparoscopic group and 103 in laparotomy group. The clinicopathological characteristics and the short- and long-term outcomes were compared.Results:Compared to the laparotomy group, patients in the laparoscopic group had less intraoperative blood loss [100(50,200)ml vs. 200(100,300) ml, Z=4.105, P<0.001], earlier postoperative oral diet[1.0(1.0,2.0) d vs. 2.0(1.0,4.0) d, Z=4.157, P<0.001]and drainage removal[6.5(4.0,12.5) d vs. 9.0(6.0,16.0) d, Z=2.769, P=0.006], shorter hospital stay[7.0(5.0,9.3) d vs. 9.0(8.0,14.0) d, Z=3.923, P<0.001]. The number of lymph node dissection in laparoscopic group was significantly lesser than that in open group [6(4,9) vs. 8(5,12), Z=2.639, P=0.008]. There were no significant differences between the two groups in postoperative complications, short-term and long-term survival outcomes. Conclusions:Laparoscopic radical surgery for gallbladder cancer is as safe and feasible, and identical survival prognosis as open surgery, and moreover a less traumatic procedure.
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Objective To compare the value among three hilar cholangiocarcinoma (HCC) staging systems,Bismuth-Corlette classification,TNM staging system and MSKCC classification,in predicting the resection rate and prognosis of HCC patients.Methods The clinical and histopathological data of 154 HCC cases were analyzed retrospectively.Three different staging methods were performed respectively to analyze the correlations with respectability and survival.Chi-square test and Kaplan-Meier analysis were applied to find clinical and histopathological factors related to prognosis.Results There was no significant difference in resectability between Bismuth-Corlette classification or TNM stage Ⅰ,Ⅱ,Ⅲ and Ⅳ.The resection rates of MSKCC T1,T2 and T3 were 68.6％,44.8％,19.2％respectively (x2 =20.03,P =0.000).With higher T stage,resection rate obviously declined.The survival predicted by TNM staging and MSKCC classification was better than Bismuth-Corlette classification.Tumor differentiation,LN involvement,distant metastasis,margin status,TNM stage and MSKCC classification were significantly correlated with survival.Conclusions The MSKCC classification predicted resectability better than Bismuth-Corlette classification and TNM staging system,while both MSKCC classification and TNM staging system predicted survival better than Bismuth-Corlette classification.Clinical and histopathological factors such as tumor differentiation,LN involvement,metastasis,margin status,TNM staging,MSKCC classification were correlated with survival.
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Objective To investigate the risk factors of gallbladder neoplastic polyps,to determine the proper surgical indications,and to understand more about the clinical characteristics of gallbladder adenoma.Methods The clinical data of 748 patients diagnosed to have polypoid lesion of gallbladder (PLG) and underwent cholecystectomy from January 1998 to December 2012 in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively reviewed.Results Among 748 patients,340 had abdominal symptoms.Postoperative histopathology showed non-neoplastic polyps (n =659),gallbladder adenoma (n =68),gallbladder cancer (n =15) and no polyps (n =6).The mean diameters of the nonneoplastic lesions and the neoplastic polyps were (9.38 ± 3.44) mm and (14.55 ± 5.71) mm,respectively (P ＜ 0.01).The average age of the patients with non-neoplastic lesions was (44.14 ± 11.42) years and (47.39 ± 12.82) years in those with neoplastic polyps (P ＜ 0.05).The proportion of solitary PLG was 41.4％ (253/611) and 59.59％ (47/79) for the non-neoplastic lesions and the neoplastic polyps respec tively (P ＜ 0.01).The size of PLG (13.34 ± 4.18 mm vs.20.07 ± 8.19 mm,P ＜ 0.05) and the age of the patient (45.78 ± 11.66 years vs.54.13 ± 15.82 years,P ＜0.05) between the gallbladder adenoma and gallbladder cancer groups were significantly different.Gallbladder adenoma or dysplasia was identified in 66.7％ (10/15) of gal1bladder cancer specimens.Conclusions Patients with PLG and with abdominal symptoms,large size (≥ 10 mm),old age (≥50 y) and solitary polyp are indications for cholecystectomy.Gallbladder adenoma may develop to gallbladder cancer within 10 years.
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<p><b>OBJECTIVE</b>To test the effects of 7 virus-encoded RNA silencing suppressors (RSSs) for enhancement of a plant virus-based vector system-mediated heterologous expression of green fluorescence protein (GFP) in Nicotiana benthamiana.</p><p><b>METHODS</b>Seven transient expression vectors for the 7 RSSs were constructed and co-inoculated on the leaves of Nicotiana benthamiana with PVXdt-GFP vector, a novel Potato virus X-based plant expression vector, through agroinfiltration. The protein and mRNA expression levels of the reporter gene GFP in the co-inoculated Nicotiana leaves were examined by Western blotting, ELISA and RT-qPCR to assess the effect of the RSSs for GFP expression enhancement.</p><p><b>RESULTS</b>The 7 RSSs differed in the degree and duration of enhancement of heterologous GFP expression, and the p19 protein of Tomato bushy stunt virus (TBSV) induced the highest expression of GFP. African cassava mosaic virus AC2 protein and Rice yellow mettle virus P1 protein produced no obvious enhancement GFP expression.</p><p><b>CONCLUSION</b>Transient co-expression of RSSs suppresses host silencing response to allow high-level and long-term expression of heterologous genes in plant, but the optimal RSS has to be identified for each plant virus-based expression vector system.</p>
Subject(s)
Genetic Vectors , Green Fluorescent Proteins , Genetics , Plant Viruses , Genetics , Plants, Genetically Modified , Genetics , Metabolism , Potexvirus , Genetics , RNA Interference , Tobacco , Genetics , MetabolismABSTRACT
Objective To explore a method to improve the nutritional state and immune function of patients after radical gastrectomy,and to decrease postoperative complication rate and accelerate recovery from operation.Methods In line with the concept of fast tract surgery (FTS),a new perioperative nutritional schedule was made for patients prior to radical gastrectomy,ehich included preoperative nutritional risk screen and prophylactic enteral nutrition,early postoperative light enteral nutrition,early ambulation and perioperative nursing care.Patients with gastric cancer were randomly assigned into fast track group or a simple control group.New perioperative schedule was executed in the patients of fast track group and traditional nutrition support in control group.After operation,serum albumen was measured to evaluate the patient's nutritional state and serum IgA to evaluate gastrointestinal immune function.In addition,the time to passage of flatus,postoperative recovery time and complication rate after operation were compared.Results Patiens in FTS group (n=35) showed higher serum albumin and serum IgA on d1 and d3 after operation than those in the control group (n=25) (P