Clinicopathological features and prognostic analysis of primary duodenal adenocarcinoma / 中华普通外科杂志

Objective:By analyzing the clinical data of patients with primary duodenal adenocarcinoma (PDA), the risk factors affecting the postoperative prognosis of PDA patients were discussed.Methods:The clinical data of 191 patients diagnosed with PDA in Peking University First Hospital from Jan 2009 to Dec 2022 were collected. The survival rate was calculated and the survival curve was plotted by Kaplan-Meier method. Univariate analysis was performed by Log-Rank test, and multivariate analysis was performed by COX proportional hazards regression model to obtain independent risk factors.Results:The median age of onset in patients with PDA is 65 years old, and the most common symptoms are abdominal pain and abdominal distension. Prognostic analysis showed that the survival rates at 1, 3 and 5 years were 73.8%, 44.6%, and 23.0%. The analysis of Cox risk proportional regression model showed that preoperative CA19-9 level, depth of tumor invasion, degree of differentiation, TNM stage, and surgical mode were independent risk factors for the prognosis of PDA (all P<0.01). Conclusion:The overall incidence of PDA is low, but the prognosis is rather poor. Multvariable factors are associated with its prognosis and surgery is still the mainstay for hope of cure.

Imaging diagnostic value of lateral lymph node metastasis in middle and low rectal cancer / 中华普通外科杂志

Objective:To evaluate CT and or MRI imaging in the diagnosis of lateral lymph node metastasis in patients of middle and low rectal cancer.Methods:In this study, 112 lateral lymph nodes were harvested in 79 patients with middle and low rectal cancer. The relationship between the preoperative imaging features of the lateral lymph nodes and the postoperative pathology was evaluated.Result:Thirty-eight cases (48%) were pathologically confirmed to have lateral lymph node metastasis. The diameter of metastasis-positive lateral lymph nodes was significantly larger than that of metastasis-negative lateral lymph nodes ( P<0.01). Multivariate analysis of clinical features and imaging features found that, tumors poorly differentiated, mucinous adenocarcinoma, signet ring cell carcinoma ( P=0.006), and the largest short diameter of the lateral lymph node ≥7 mm ( P=0.024), uneven density or signal ( P=0.022) were independent risk factors for lateral lymph node metastasis. Conclusion:Poor tumor differentiation, lateral lymph node maximum short diameter ≥7 mm, density or signal unevenness are independent risk factors for lateral lymph node metastasis in middle and low rectal carcinoma.

Nomogram analysis on the influencing factors of low anterior resection syndrome after anterior resection for rectal cancer / 中华普通外科杂志

Objective:To investigate the risk factors of low anterior resection syndrome (LARS)after low anterior resection of rectal cancer (Dixon).Methods:This retrospective study was conducted in Peking University First Hospital and Traditional Chinese Medicine Hospital of Shanxi Provice from Jan 2012 to Jun 2019. A cohort of 504 patients with rectal cancer was enrolled in the study. All the patients underwent anterior resection. The relationship between clinical-pathological data were analyzed retrospectively. Univariate analysis using χ 2 test. Logistic regression analysis was used to screen the influencing factors of LARS, and the Nomogram method was used to score each factors. Results:Univariate analysis showed that BMI≥28 kg/m 2(χ 2=9.450, P=0.002), the distance from the lower edge of the tumors to the anus <6 cm (χ 2=12.070, P=0.001), high ligation of the inferior mesenteric artery (IMA) (χ 2=8.279, P=0.004), preoperative neoadjuvant therapy (χ 2=11.230, P=0.001), postoperative anastomotic leakage (χ 2=11.840, P=0.001) were associated with severe LARS.Multivariate analysis showed that the distance from the lower edge of the tumors to the anus <6 cm ( OR=1.861, 95% CI: 1.289-2.688, P=0.001), BMI≥28 kg/m 2 ( OR=1.747, 95% CI: 1.022-2.987, P=0.041), high IMA ligation ( OR=1.688, 95% CI: 1.157-2.463, P=0.007), preoperative neoadjuvant therapy ( OR=2.719, 95% CI: 1.343-5.505, P=0.005) were independent risk factors for LARS. Nomogram model showed that the total factor ranged from 2 to 212, and the corresponding risk rate ranged from 30% to 80%. The patients with higher score have greater risk for severe LARS. The area under the predictive power curve of Nomogram model (AUC) was 0.749 (95% CI: 0.705-0.793, P<0.001). Conclusion:Lower tumor location, obesity, preoperative neoadjuvant therapy, high IMA ligation and postoperative anastomotic leakage increase the risk of severe LARS.

Efficacy and safety of different surgical approaches for early cervical cancer in patients / 中国基层医药

Objective:To investigate the efficacy and safety of laparoscopic versus open surgery for early cervical cancer and analyze the factors that influence laparoscopic surgery for early cervical cancer. Methods:The clinical data of 411 patients with International Federation of Gynecology and Obstetrics (FIGO)stage IA1-IIA2 cervical cancer who received treatment in Liuzhou Worker's Hospital, China between January 1, 2000 and August 31, 2016 were retrospectively analyzed. The clinical data were divided into laparoscopic surgery ( n = 320) and open surgery ( n = 91) groups according to surgical approaches. The operation time, intraoperative injury, intraoperative blood loss, time to first postoperative anal exhaust, postoperative complications, time to extubation, and postoperative recurrence rate were compared between laparoscopic surgery and open surgery groups. Multivariable COX regression analysis was performed to analyze the recurrence of cervical cancer after laparoscopic surgery. Results:The operation time in the laparoscopic surgery group was significantly shorter than that in the open surgery [(223.4 ± 53.2) min vs. (251.0 ± 50.0) min, t = 20.200, P < 0.05]. The intraoperative blood loss, time to extubation and the time to first postoperative anal exhaust in the laparoscopic surgery group were less or shorter than those in the open surgery group (all P < 0.05). Under the premise that there were no significant differences in vascular and lymphatic space invasion, tumor size, parametrial invasion, depth of muscle invasion, lymph node metastasis, and vaginal margin between the laparoscopic surgery and open surgery groups, the 1-year and 3-year recurrence rate of cervical cancer was 9.4% (30/320) and 15.9% (51/320), respectively and the 1-year and 3-year tumor-free survival rate was 90.6% and 84.1%, respectively in the laparoscopic surgery group; the 1-year and 3-year recurrence rate of cervical cancer was 4.4% (4/91) and 9.9% (9/91), respectively and the 1-year and 3-year tumor-free survival rate was 95.6% and 89.6%, respectively in the open surgery group. There were no significant differences in 1-year and 3-year recurrence rate of cervical cancer and 1-year and 3-year tumor-free survival rate between laparoscopic surgery and open surgery groups (all P > 0.05). During the 5-year follow-up, there were no significant differences in the recurrence rate of cervical cancer (18.7% vs. 12.2%) and the tumor-free survival rate (81.9% vs. 86.8%) between the laparoscopic surgery and open surgery groups (both P > 0.05). Univariate and multivariate analysis showed that positive lymph node metastasis, tumor size ≥ 2 cm, FIGO stage > IB1 and non-squamous cell carcinoma pathological type are the risk factors for the recurrence of cervical cancer. Conclusion:Laparoscopic surgery for early cervical cancer can reduce the intraoperative and postoperative complications. Positive lymph node metastasis, tumor size ≥ 2 cm, FIGO stage > IB1, and non-squamous cell carcinoma pathological type are the risk factors of recurrence of cervical cancer after laparoscopic surgery.

Observation on resistance of adult Aedes albopictus to commonly used insecticides in Xiamen City / 中华地方病学杂志

Objective:To investigate the resistance of adult Aedes albopictus to commonly used insecticides, in order to scientifically select and use insecticides. Methods:In Siming, Jimei and Haicang districts of Xiamen City in September 2018, and in Siming, Jimei and Xiang'an districts of Xiamen City in August 2019, larvae and egg blocks of Aedes albopictus in the field were collected by ladle method, and then raised to adult mosquitoes in the laboratory. The resistance of adult Aedes albopictus to 7 commonly used insecticides was determined by the contact tube method, and the knockdown rate of 1 h and mortality rate of 24 h recovery were calculated. The resistance level was determined according to the mortality rate: ≥98% was the sensitive group (S); 80% - < 98% was potential resistant group (M); < 80% was resistant group (R). Results:In 2018 and 2019, adult Aedes albopictus were exposed to 0.1% deltamethrin, 0.4% beta-cypermethrin, 0.5% lambda-cyhalothrin, 1.4% alpha-cypermethrin, 3% permethrin, 0.5% malathion and 0.05% propoxur, the knockdown rates of 1 h were 95.1% (117/123), 98.3% (115/117), 100.0% (116/116), 99.2% (120/121), 98.4% (123/125), 97.5% (119/122), 100.0% (127/127) and 96.7% (118/122), 98.6% (143/145), 100.0% (139/139), 100.0% (149/149), 98.0% (146/149), 96.8% (121/125), and 100.0% (126/126), respectively. In 2018, the mortality rates of 24 h recovery were 91.1% (112/123), 78.6% (92/117), 75.0% (87/116), 88.4% (107/121), 96.0% (120/125), 99.2% (121/122), and 100.0% (127/127), respectively. In 2019, the adjusted mortality rates of 24 h recovery were 74.9%, 76.9%, 79.5%, 91.4%, 92.3%, 100.0%, and 100.0%, respectively. Conclusions:Adult Aedes albopictus in Xiamen City is sensitive to malathion and propoxur, and it has a high resistance to pyrethroids insecticides such as deltamethrin, beta-cypermethrin and lambda-cyhalothrin. Therefore, it is necessary to strengthen resistance monitoring and use different insecticides in turn to reduce and delay the development of resistance.

An investigation of iodine nutritional status of children aged from 8 - 10 and pregnant women before and after adjustment of salt iodine concentration in Xiamen City / 中华地方病学杂志

Objective:To investigate the iodine nutritional status among children aged from 8 - 10 and pregnant women in Xiamen City before and after adjustment of salt iodine concentration, and scientifically evaluate the suitability of the new standard iodized salt adjustment policy for Xiamen City.Methods:In the pre-adjustment period (2011) and the post-adjustment period (2018), cross-sectional research methods and stratified cluster sampling methods were adopted in six districts of Xiamen City. The salt samples of residents and pregnant women, urine samples of children aged from 8 - 10 and pregnant women were collected to determine the iodine level; thyroid of children aged from 8 - 10 was examined. Changes in salt iodine, urine iodine and goiter prevalence before and after adjusting iodine content of salt were compared.Results:The median of salt iodine in residents after the adjustment (23.5 mg/kg) was significantly lower than that of before (28.9 mg/kg, Z = - 10.512, P < 0.05), the median of salt iodine in pregnant women after the adjustment (23.7 mg/kg) was significantly lower than that of before (29.2 mg/kg, Z = - 12.622, P < 0.05); the consumption rate of qualified iodized salt in residents after the adjustment (95.7%, 1 196/1 250) was significantly lower than that of before (97.1%, 1 608/1 656; χ 2 = 4.250, P < 0.05); before and after adjustment of salt iodine concentration, the consumption rate of qualified iodized salt in pregnant women was 94.7% (124/131) and 95.9% (579/604), respectively. No significant difference was found when comparing the consumption rate of qualified iodized salt in pregnant women (χ 2 = 0.015, P > 0.05). There was significant difference in median urinary iodine (from 204.2 to 183.9 μg/L, detected in 652, 1 250 urine samples, respectively) of children aged 8 - 10 years ( Z = - 3.583, P < 0.05); the difference of iodine nutritional status in pregnant women before and after adjustment of salt iodine concentration(130.2, 130.8 μg/L, detected in 132, 604 urine samples, respectively) was not significant ( Z = - 1.715, P > 0.05). The thyroid goiter rate of children aged 8 - 10 years had reduced from 1.1% (14/1 239) to 0.2% (2/1 253), the difference was statistically significant (χ 2 = 9.195, P < 0.05). Conclusions:As a whole, the measure of control and prevention of iodine deficiency disorders through iodized salt is implemented well in Xiamen City. After adjustment of salt iodine concentration, the iodine status of children aged from 8 to 10 is adequate, but the pregnant women has showed iodine deficiency.

Exploration and application of occupational disease risk assessment model based on information diffusion theory / 中华劳动卫生职业病杂志

Objective@#To research build a kind of occupational disease risk assessment model which provides scientific basis for prevention and control of occupational diseases.@*Methods@#Based on the principle of information diffusion, this paper uses spread function to extend the incomplete gathered information, establishes the mapping relationship between observation samples and risk probability distributions, and constructs the occupational disease risk assessment model, to analyzes the risk data of occupational disease reported cases in Guangdong Province in the past five years.@*Results@#Through evaluation analysis, every year, 200-300 cases of pneumoconiosis probability is 67.77%, 100-200 cases of occupational poisoning probability is 68.52%, 20-40 cases of occupational cancers probability is 71.62%, each year, the incidence of occupation otorhinolaryngology and oral diseases in 200 cases was 62.23%.@*Conclusion@#A model of occupational disease risk assessment based on information diffusion theory is constructed, the evaluation result is basically consistent with the actual situation of occupational disease, which can provide reference for occupational disease prevention and control.

Efficacy analysis of neoadjuvant chemoradiotherapy combined with total pelvic exenteration in the treatment of primary T4b rectal cancer / 中华胃肠外科杂志

OBJECTIVE@#To investigate the value of neoadjuvant chemoradiotherapy (nCRT) combined with total pelvic exenteration (TPE) in the treatment of primary T4b rectal cancer.@*METHODS@#A retrospective cohort study was conducted to analyze the clinicopathological data of 31 patients with primary T4b rectal cancer who underwent TPE from January 2008 to December 2015 at Peking University First Hospital.@*INCLUSION CRITERIA@#preoperative clinical stage (cTNM) was defined as cT4b primary rectal cancer with only front wall Invasion; the lower edge of tumor was within 10 cm from the anal margin; TPE was performed; R0 resection was confirmed by pathology. Patients with recurrent rectal cancer, distant metastasis, and undergoing TPE for non-rectal tumors were excluded. Patients were divided into nCRT group and non-nCRT group according to whether receiving nCRT before surgery. The nCRT group received long course radiotherapy (total dose 50 Gy in 25 daily fractions) with concomitant chemotherapy (Capecitabine), and the surgery was performed 6-8 weeks after the neoadjuvant chemoradiation, while the non-nCRT group received surgery directly. The intraoperative, postoperative and pathological conditions and local recurrence were compared between the two groups. The survival curves were drawn by Kaplan-Meier method and the survival of two groups were compared.@*RESULTS@#A total of 31 patients were enrolled, including 13 patients in the nCRT group and 18 patients in the non-nCRT group. The baseline data, such as age, duration of disease, preoperative basic disease, body mass index, smoking rate, and tumor distance from the anal margin, were not significantly different between the two groups (all P>0.05). In the nCRT group and non-nCRT group respectively, the ratio of anal preservation was 30.8%(4/13) and 38.9%(7/18) (P=0.468), the median intraoperative blood loss was 1 000 ml and 800 ml (P=0.644), the operation time was (531.7±137.2) minutes and (498.0±90.1) minutes (P=0.703), the median hospital stay was 18 days and 14 days (P=0.400), the morbidity of complications within 30 days after surgery was 23.1%(3/13) and 38.9%(7/18)(P=0.452), the incidence of postoperative abdominal abscess was 15.4%(2/13) and 0 (P=0.168), the proportion of secondary surgery was 7.7%(1/13) and 11.1%(2/18)(P=1.000), whose differences were not significantly different. The proportion of postoperative pathological pT4b in whole group was 58.1%(18/31), including 53.8%(7/13) in nCRT group and 61.1%(11/18) in non-nCRT group, which was not significantly different between the two groups (P=0.691). The number of harvested lymph node in nCRT group was 13.5±5.9, which was significantly less than 23.0±11.8 in non-nCRT group (P=0.013). There was no pathological complete remission (ypCR) case in nCRT group, and among 13 patients, tumor regression grade (TRG) of 2, 3, 4, and 5 was in 1 case (7.7%), 6 cases (46.2%), 5 cases(38.5%), and 1 case (7.7%), respectively. The median follow-up time was 33 (2 to 115) months, and the follow-up rate was 93.5%(29/31). One case was lost in both the nCRT group and non-nCRT group. The 3-year disease-free survival rate was 43.5% in pooled data, and was 43.6% and 43.3% in nCRT group and non-CRT group respectively without significant difference (P=0.833). The 3-year overall survival rate was 51.1% in pooled data, and was 45.7% and 54.7% in nCRT group and non-nCRT group respectively without significant difference (P=0.653).The local recurrence rate of nCRT and non-nCRT groups was 8.3%(1/12) and 5.9%(1/17) respectively, and the distant metastasis rate was 50.0%(6/12) and 41.2%(7/17) respectively, whose differences were not statistically significant as well (P=1.000 and P=0.865, respectively).@*CONCLUSION@#For primary T4b rectal cancer which can achieve R0 resection through total pelvic exenteration, neoadjuvant chemoradiotherapy has not been demonstrated any advantage in tumor regression, reducing local recurrence, or improving survival, and may increase postoperative complications.

Preoperative evaluation using multi-slice spiral CT angiography of right-side colon vascular in laparoscopic radical operation for right colon cancer / 中华外科杂志

Objectives@#To examine the value of multi-slice spiral CT angiography (MSCTA) in the analysis of anatomical variation and structural classification of right colon vessels.@*Methods@#From August 2015 to August 2017, 198 patients (96 of whom underwent laparoscopic radical resection of right colon cancer) at Department of General surgery of Peking University First Hospital were retrospectively collected, and the results of abdominal enhanced CT scan were collected and three-dimensional reconstruction of blood vessels was performed. There were 104 males and 94 females. The age was 64(27) years (M(QR), range: 19 to 87 years). Right gastroepiploic vein, anterior superior pancreaticoduodenal vein, right colonic vein (RCV), superior right colonic vein, ileocolon artery or vein (ICA or ICV), middle colon artery or vein (MCA or MCV) and Henle trunk were observed and recorded respectively. The anatomical relationship between the positions of blood vessels, the length of Henle trunk and surgical trunk were measured.@*Results@#ICV and ICA were the most constant anatomic structures. The ICV/ICA of all patients came directly from SMV/SMA, 36.9% (73/198) ICV going in front of SMV and 63.1% (125/198) behind SMV. 72.2% (143/198) of the patients had RCV imported into Henle trunk and the rest into SMV. Middle colonic vein (MCV) could be observed in 81.3% (161/198) of the cases. 81.4% (131/161) of MCV were imported into SMV, 16.8% (27/161) into Henle trunk, 1.2% (2/161) into the first jejunal vein and 0.6% (1/161) into the splenic vein. Henle trunk was divided into 4 types, among which the occurrence probability of gastric node and pancreatic trunk was the highest. The dry length of Henle trunk was (0.82±0.39) cm (range: 0.37 to 1.68 cm). The length of surgical trunk was (2.54±0.83) cm (range: 1.57 to 3.95 cm). Accuracy of MSCTA results was 96.9%(93/96).@*Conclusions@#Anatomical variation of blood vessels in the right colon is common. Abdominal CT angiography can accurately determine the anatomical structure of the blood vessels in the right colon.

An investigation of iodine status of 6 target populations in both urban and rural areas in Xiamen City 3 years after promotion of new standard iodized salt / 中华地方病学杂志

Objective To analyze the iodine nutritional status among pregnant women,breasffeeding women,0-2 years old infants,8-10 years old children,18-45 years old women and men in both urban and rural areas of Xiamen 3 years after promotion of new standard iodized salt.Methods The Huli and Xiang'an were selected as the urban and rural study sites in Xiamen City,from March 2015 to March 2016.Each study site was further divided into five geographic locations (east,south,west,north and center).In each location,one township was randomly selected.In each town,2 tap water samples,60 salt samples of residents,and urine samples of 40 children aged from 8-10 years old,20 pregnant women,12 breastfeeding women,0-2 years old infants,18-45 years old women and men were collected to determine the iodine level.The water iodine and urinary iodine were detected by arsenic cerium catalytic spectrophotometry;salt iodine was detected by direct titration.Results The medians of salt iodine in urban and rural were 23.0 and 25.3 μg/L,respectively.The coverage rates of iodized salt in urban and rural area were 99.3％ (298/300) and 94.0％ (282/300),respectively.The consumption rates of qualified iodized salt were 93.7％ (281/300) and 90.7％ (272/300),respectively.The medians of tap water iodine in urban and rural were 4.1 and 4.4 μg/L,respectively.In urban and rural areas,the medians of urinary iodine of pregnant women were 167.6 and 119.6 μg/L,respectively.The medians of urinary iodine of breastfeeding women were 121.6 and 101.2 μg/L,respectively.The medians of urinary iodine of infants were 165.9 and 110.5 μg/L,respectively.The medians of urinary iodine of children were 208.9 and 167.2 μg/L,respectively.The medians of urinary iodine of women aged 18-45 were 132.5 and 154.5 μg/L,respectively.The medians of urinary iodine of men aged 18-45 were 131.7 and 154.5 μg/L,respectively.Conclusions After 3 year promotion of new standard iodized salt,the iodine status of pregnant women in urban,breastfeeding women,0-2 years old infants,children aged 8 to 10 and adults aged 18 to 45 is adequate,but the pregnant women in rural has showed iodine deficiency.So surveillance and health education should be continuously strengthened in the future.Scientific salt iodization should continue to ensure the amount of iodine intake.

Risk factors of anastomotic leakage after anterior resection for rectal cancer and the diagnostic value of computed tomography signs in anastomotic leakage / 中华胃肠外科杂志

Objective@#To investigate the risk factors and computed tomography (CT) diagnostic accuracy of anastomotic leakage after resection of rectal cancer (Dixon) .@*Methods@#This retrospective study was conducted in Peking University First Hospital from January 2013 to June 2015. A cohort of 452 patients with rectal cancer was enrolled in the study. All the patients underwent anterior resection. The relationship between clinical-pathological data (including sex, age, body mass index (BMI) , presence of diabetes, hypohemoglobin (Hb < 90 g/L) , hypoalbuminemia (Alb < 35 g/L) , the distance from the lower edge of the tumors to the anus, tumor diameter, tumor differentiation, tumor TNM stage, neoadjuvant therapy status, ligation of the left colonic artery (LCA) , preventive colostomy, and anastomotic leakage was analyzed retrospectively. Univariate analysis using χ2 test and multivariate analysis by using the Ordered Classification Arguments Logistic regression model.@*Results@#Of all the cases, 281 and 171 patients were men and women, respectively. The median age was 64 years (range, 18-88 years) . Forty-seven patients (10.4%) were diagnosed with anastomotic leakage, and the median diagnostic time of anastomotic leakage was 6.5 days (range, 3-31 days) . One patient with anastomotic leakage died because of respiratory failure within 1 month postoperatively; 11 patients underwent salvage colostomy performed 2-34 days (median, 7 days) after the first surgery. All the 11 patients underwent colostomy closure within 2 years. The other 35 patients recovered by antibiotic and peritoneal lavage treatment. The mean length of postoperative hospital stay in patients without anastomotic leakage was 8.4±2.4 days, which was significantly shorter than that in patients with anastomotic leakage (34.6±15.7 days) , and the difference was statistically significant (t = 24.127, P = 0.008) . The results of the univariate analysis showed that BMI≥28 kg/m2 (χ2 = 7.550, P = 0.000) , diabetes mellitus (χ2 = 5.055, P = 0.025) , Hb < 90 g/L preoperatively (χ2 = 5.718, P = 0.017) , Alb < 35 g/L preoperatively (χ2 = 8.096, P = 0.004) , distance of < 6 cm from the lower edge of the tumors to the anus (χ2 = 8.205, P = 0.004) and LCA ligation (χ2 = 16.540, P = 0.000) were risk factors for the occurrence of anastomotic leakage. Multivariate analysis showed that BMI≥28 kg/m2 (OR = 1.758, 95%CI: 1.265-2.454, P = 0.021) , distance of < 6 cm from the lower edge of the tumors to the anus (OR=1.530, 95%CI: 1.035-2.117, P = 0.037) , LCA ligation (OR = 1.551, 95%CI: 1.035-2.131, P = 0.042) were independent risk factors for anastomotic leakage. The CT diagnostic sensitivity of anastomotic leakage was 91.2% (31/34) . The false positive rate of CT for diagnosing anastomotic leakage was zero 7 days after the Dixon procedure.@*Conclusion@#Important factors, including BMI of patients, LCA ligation, and the distance from the lower edge of the tumors to the anus are related with anastomotic leakage. The individual treatments should be considered based on the patient′s clinical condition. CT was recommended 7 days postoperatively when anastomotic leakage was highly suspected.

Relationship between the level of serum CA125, prealbumin, cholinesterase and cirrhosis degree by Child-Pugh score / 中华老年医学杂志

Objective To evaluate the relationship between cirrhosis degree and the level of serum CA125,pre-albumin (PA) and cholinesterase (CHE) in aged patients with cirrhosis.Methods One hundred and fifty-five patients with liver cirrhosis admitted to the Second People's Hospital of Tongxiang from December 1st 2013 to December 1st 2015 were selected as the observation group.The age of the patient was 61～81 years,with an average age of (65.5±6.2) years.The degree of patient liver cirrhosis was graded by Child-Pugh (CP) score.Fifty healthy individuals from 60 to 79 years old,average (67.3±5.2) years were selected as the control group.Four indicators were detected in all research objects,including CA125,PA and CHE.Spearman correlation analysis was carried out between liver cirrhosis grading and each index changes.Results Compared to the healthy groups,the patients with liver cirrhosis had a higher levels of CA125,which was a positively correlated with cirrhosis degree.Patients with CP score A,B,C liver function had significantly different levels of CA125 [(43.55± 23.71) μg/L,(157.22 ± 57.18) μg/L,(261.28 ± 131.98) μg/L,respectively,F=102.33,P=0.000],PA [(176.81±55.18) mg/L,(135.23 ± 39.98) mg/L,(89.27 ±49.11) mg/L,respectively,F=177.61,P=0.000] and CHE [(4 727.46±998.10) U/L,(2 451.016±528.81) U/L,(1 962.58±439.14) U/L respectively,F=208.95,P=0.000].Patients with liver cirrhosis were associated with lower levels of PA and CHE than those in the healthy participants,which were negatively correlated with cirrhosis degree.Conclusions The CA125,PA and CHE have an important clinical significance in diagnosis,conditions' evaluation and prognosis' assessment for cirrhosis.

Construction of vibrio vaccine strain and expression of antigen gene:attenuated Listeria monocytogenes as vaccine vector / 中国免疫学杂志

Objective:To provide a potential platform for transferring specific antigen against fish bacterial diseases based on attenuated Lm (EGDe-ΔactA/ΔinlB).Methods: Attenuated Lm (EGDe-ΔactA/ΔinlB) was used to express outer membrane protein K (Ompk),a conserved and effective vaccine candidate in vibrio.The identification of recombinant strains and detection of antigen genes were operated with PCR and RT-PCR,respectively.Results: The results of PCR showed that Lm-Ompk (L-O),Lm-Lmo0576-Ompk (L-L-O) and Lm-P-Ompk (L-P-O) were constructed successfully.The identity of foreign gene was 100％ compared with sequence of NCBI.The analysis of transcription showed that the expressions of Ompk in L-O,L-L-O and L-P-O were significant (P<0.001).Moreover,the expression of Ompk in the condition of antibiotic was higher than that in the BHI without antibiotic (P<0.05).Conclusion: Lm-Ompk (L-O),Lm-Lmo0576-Ompk (L-L-O) and Lm-P-Ompk (L-P-O) were constructed successfully.

Olfactory function in children with adenoid hypertrophy who underwent adenotonsillectomy during pre- and post-operative period / 中华耳鼻咽喉头颈外科杂志

Objective@#To assess the olfactory function in children with adenoid hypertrophy and investigate the changes of both olfactory function and appetite in children with adenoid hypertrophy before and after adenoidectomy.@*Methods@#Forty-four children with adenoid hypertrophy admitted for adenoidectomy, aged 7-12 years, mean age (10.0±2.0) years were tested by Sniffin′ Sticks test and visual analog scale(VAS) of the children′s appetite preoperatively between March and August 2015.In a appointment 6 months after operation, all of them returned and were tested again. The control group consisted of 40 healthy children, aged 7-12 years, mean age (11.2±0.8) years.SPSS 13.0 software was used for statistical analysis@*Results@#The olfactory function of the study group TDI scores (32.4±3.5) preoperatively were significantly lower in comparison with the results of the control group TDI scores (37.3±2.8)(t=7.057, P<0.001). Significant improvement of olfaction TDI scores (36.8±1.9) was observed in the follow-up appointment(t=13.573, P<0.001). The VAS of the children′s appetite during post-adenoidectomy was higher compared to pre-adenoidectomy(t=16.765, P<0.001). There was a strong correlation between the increase in appetite of children and the change of TDI score (r=0.59, P<0.01).@*Conclusions@#Children with adenoid hypertrophy have a reduced ability of both olfactory function and appetite. Surgery had a greater impact on olfaction and appetite.

Clinicopathologic characteristics and prognosis of rectal neuroendocrine neoplasms / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic characteristics and prognosis of rectal neuroendocrine neoplasms (NENs).</p><p><b>METHODS</b>From January 2000 to May 2017, 84 patients were diagnosed as NENs by pathology and underwent surgical treatment in Peking University First Hospital. Their clinicopathological characteristics, surgial options and prognosis were analyzed retrospectively.</p><p><b>RESULT</b>Among these 84 cases, 67 cases were NET G1, 6 cases were NET G2, 10 cases were NEC G3 and 1 case was MANEC G3. The median size was 0.8 (0.2 to 18.0) cm. There were 60 cases of stage I(, 2 cases of stage II(, 12 cases of stage III(, 10 cases of stage IIII(. Forty-nine patients accepted examinations because of non-specific symptoms, including altered bowel habits(22/49), bloody stool (19/49) and abdominal pain(10/49); the other 35 cases including 2 patients with liver metastasis were diagnosed by endoscopy or CT during routine physical examination. Forty-four patients received endoscopic ultrasonography(EUS) with 100% of sensitivity and 90.9% of accuracy. Among 20 cases (23.8%) with lymph node metastasis (all ≥T2 stage), 12 cases were NET G1 and G2 (1 case of multiple NET G1) and 8 cases were NEC G3 and MANEC G3. The lymph node metastasis rate of stage T1 NET G1 and G2 was lower than that of stage T2 to T4 NET G1 and G2, also lower than that of NEC G3 and MANEC G3 (all P=0.000), however, stage T2 to T4 NET G1 and G2 showed the similar rate of lymph node metastasis with NEC G3 and MANCE G3(P>0.05). Synchronously distant metastasis was found in 10 (11.9%) patients at the first diagnosis, and ovarian metastasis was found in 1 case 9 years after curative resection of rectal NEN. Among 81 patients receiving operation, 57 patients underwent endoscopic mucosal resection (56 patients of stage T1 NET G1 and G2); 3 patients local excision without lymph node dissection; 13 patients curative resection; 1 patient curative resection with liver metastasis resection; 6 patients palliative surgery and 1 patient metastatic lesion resection only. Overall follw-up time was 1 month to 169 months, and the 3- and 5-year survival rates were 87.7% and 79.7% respectively. No recurrence or metastasis was observed in all the 62 patients with T1 G1 and G2, including 56 cases of ESD, 3 cases of local excision, 3 cases of curative resection, whose 3-year and 5-year survival rates were both 96%. The prognosis was closely associated with grade and stage of NENs (all P=0.000).</p><p><b>CONCLUSIONS</b>The early symptoms of rectal NENs are insidious and atypical, therefore some patients are diagnosed as stage II( or higher at their first consultation. ESD is safe and effective for NET G1 and G2. The prognosis depends on grade and stage of NENs.</p>

Surgical procedure selection for chronic pancreatitis / 中华消化外科杂志

Objective To investigate the surgical procedure selection for chronic pancreatitis.Methods The clinical data of 80 patients with chronic pancreatitis who were admitted to the Peking University First Hospital from January 2000 to August 2013 were retrospectively analyzed.Thirty-eight patients were with or without pancreatic duct stone,and the dilation of the pancreatic duct was above 7 mm,44 patients were with common bile duct dilation,32 patients were with inflammatory mass in the head of the pancreas,and 3 patients were with splenomegaly and esophagogastric varices.Surgical procedures were selected according to the symptoms and results of imaging examination.The remission or recurrence of pain was judged according to the visual analog scales.Patients were followed up via out-patient examination,mail or phone call till December 2013.Results Choledochojejunostomy was done on 27 patients,Partington-Rochelle pancreaticojejunostomy on 24 patients,PartingtonRochelle pancreaticojejunostomy + choledochojejunostomy on 6 patients,pancreaticoduodenectomy on 7 patients,resection of the body and tail of the pancreas on 4 patients,Beger's procedure on 3 patients,splenectomy on 3 patients,Frey's procedure + fenestration of bile duct in the head of the pancreas on 3 patients,Frey's procedure on 2 patients,common bile duct exploration + T tube drainage on 1 patient.The remission rate of abdominal pain was 95.2％ (60/63).One patient died of abdominal infection and multiple organ dysfunction syndrome perioperatively.Three patients were complicated with abdominal infection,2 with pancreatic fistula,1 with biliary fistula and 1 with abdominal bleeding.All the complications were cured by conservative treatment.Seventy-nine patients were followed up,and the mean time of follow-up was 58.6 months (range,4-156 months).Thirty patients had recurrence or new onset of abdominal pain,and the recurrence rate was 38.0％ (30/79).Of the 32 patients with inflammatory mass in the head of the pancreas,17 received choledochojejunostomy,and the recurrence rate of abdominal pain was 9/17 ; the other 15 patients received pancreatoduodenectomy,Beger' procedure or Frey's procedure,and the recurrence rate of abdominal pain was 1/15.Of the 41 patients without inflammatory mass,10 received choledochojejunostomy,and the recurrence rate of abdominal pain was 7/10; 30 received PartingtonRochelle pancreaticojejunostomy,and the recurrence rate of abdominal pain was 33.3％ (10/30).Conclusions Complete drainage could relieve the symptoms for patients with pancreatic duct dilation.Surgical resection or combined surgical procedure is effective for the treatment of patients with inflammatory mass in the head of the pancreas.

Clinical value of NHL detection in the differential diagnosis of bacterial and viral infections of elderly patients with acute respiratory infection / 国际检验医学杂志

Objective Toinvestigatetheclinicalvalueofhumanneutrophillipocalin(HNL)detectioninthedifferentialdiagnosis of bacterial and viral infections of elderly patients with acute respiratory infection .Methods 142 elderly patients with respiratory infection were divided the bacteria group (96 cases) and the virus group (46 cases) according to their infections ,42 healthy people in the corresponding period were enrolled as the control group .Enzyme-linked immunosorbent assay and highly sensitive dry chemi-cal particles enhanced immune turbidity assay were employed to detect their blood HNL and C-reactive protein(CRP) ,respectively , and virus-specific antibodies detection were performed simultaneously .Results Compared the blood HNL ,CRP levels and their positive rates of patients in bacteria group with those in the virus group ,control group ,respectively ,differences showed statistically significant(P0 .05) .Antibiotic treatment before and 24 ,48 and 72 hours after ,the concentrations of HNL were (216 .8 ± 64 .1) , (192 .0 ± 41 .2) ,(158 .0 ± 54 .5) and (87 .0 ± 12 .4)μg/L ,respectively ,while those of CRP were (50 .9 ± 40 .9) ,(46 .2 ± 18 .3) , (39 .6 ± 9 .6) and (12 .6 ± 9 .8) mg/L ,respectively .Sensitivity ,specificity ,positive predictive value and negative predictive value of HNL detection were 90 .6% ,90 .9% ,91 .5% and 89 .9% ,respectively ,which were higher than those of CRP (88 .5% ,85 .2% , 86 .7% and 87 .2% ,respectively) ,with statistically significant difference(P<0 .05) .Conclusion NHL detection possesses impor-tant significance in differential diagnosis between bacterial and viral infections of elderly patients with acute respiratory infection .

Clinical value of intrafascial hysterectomy with intact ascending uterine artery / 中国医师进修杂志

ObjectiveTo investigate the clinical value of intrafascial hysterectomy with intact ascending uterine artery.MethodsA total of 78 cases of simple hysterectomy patients were divided into group A (underwent intrafascial hysterectomy with intact ascending uterine artery) and group B(underwent modified intrafascial hysterectomy) with 39 cases each by random digits table.The operation time,the amount of hemorrhage,the postoperative complications,the ovarian function and the quality of sexuality were studied and compared.ResultsThree cases were lost in group B.There were no statistical differences in operation time,the amount of hemorrhage,postoperative hemorrhage,postoperative pyrexia,the quality of sexuality between two groups(P ＞0.05).There were significant differences in follicule-stimulating hormone and estradiol level in group B compared with those before operation (P＜ 0.05).There was significant difference in climacteric symptom between two groups [ 5.13％ (2/39) vs.22.22％ (8/36) ](P ＜ 0.01 ).The ascending uterine arteries and the ovarian branch of both sides were showed 100％ in group A.ConclusionsIntrafascial hysterectomy with intact ascending uterine artery has less influences on the blood flow of the ascending uterine arteries and the ovarian branch,there is slight influence on ovarian function and has no obvious influence on the quality of sexuality.The forward clinical effects should be studied further.

Regulation of pancreatic cancer cells by fibroblast growth factor receptor-1 / 中华普通外科杂志

Objective To investigate the expression and regulation of FGFR1 protein and mRNA in human pancreatic cancer cell lines.Methods The expressions of FGFR1 protein and mRNA in pancreatic cancer cells were tested by Western blot,Northern blot and RT-PCR.The effects of exogenous growth factors and tyrosine kinase inhibitors on expression of FGFR1 protein and mRNA was observed.Results FGFR1 protein and mRNA expressed in 7 pancreatic cancer cell lines in different levels.After stimulation of several exogenous growth factors,we found that IGF-1,EGF and FGF2 up-regulated the expression of FGFR1 in Mia PaCa-2 significantly;EGF and FGF2 up-regulated the expression of FGFR1 in PANC-1 significantly (P＜0.05).The effect of FGF2 on the expression of FGFR1 was in time-dependent manner.ERK1/2 special inhibitor UO126 and p38 MAPK special inhibitor SB203580 down-regulated the expression of FGFR1.Conclusion Expression of FGFR1 is up-regulated by growth factors and may be modulated through ERK1/2 and p38 MAPK signal transduction pathway.

Effects of long-term enhanced external counterpulsation on endothelium-dependent and endothelium-independent vasorelaxation of the carotid arteries in atherosclerotic pigs / 中华急诊医学杂志

Objective To explore the effect of long-term enhanced external counterpulsation(EECP)on endothelium-dependent and endothelium-independent vasorelaxation in the carotid arteries of atherosclerotic piss. Method Totally 18 20-day-old male infant pigs were randomly divided into 3 groups according to feeding given: the normal[control group(n=6),the hypercholesterolemic control group(n=6)and the hypereholesterolemic +EECP group(n=6).Porcine model of hypercholesterolemia was made by feeding high-cholesterol diet.After EECP for 36 hours in the hypercholesterolemic+EECP group(n=6),carotid arterial rings were harvested from all animals and their vaso-relaxation response to different dose of Acetylchofine(Ach)and Sodium nitroprusside (SNP)were detected,respectively.Results As the dose of Ach varying between 10-8 mol/L and 10-5mol/L, endothelium-dependent vasorelaxation ratio of hypereholesterolemic piss with or without EECP treatment was significantly lower than that of the normal control group(P＜0.05),however,endothehum-dependent vasorelax- ation ratio in pigs with EECP treatment was obviously higher compared with hypereholesterolemic pigs without EECP treatment(P＜0.05)as the Ach ranged from 10-7 mol/L to 10-5mol/L.Similarly,as the concentration of SNP ranged fiun 10-8 mol/L to 10-5 mol/L.endothelium-independent vasorelaxafion ratio of both the hypercholesterolemic control group and the hypercholesterolemic+EECP group were significantly lower than that of the normal control group(P＜0.05),and end othelium-independent vasorelaxation ratio of the hypercholesterolemic+EECP group was significantly higher than that of the hypercholesterolemic control group (P＜0.05).Condusions Long-term EECP improves the impaired endothelium-dependent and endothelium independent vasorelaxalion function resulting from atherosclerosis.