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Objective:To study ApoE gene polymorphism in patients with intracerebral hemorrhage at different ages and its relationship with blood lipid level.Methods:From December 2017 to December 2019, 360 inpatients with cerebral hemorrhage received by neurosurgery department of Weihai Central Hospital were selected as the cerebral hemorrhage group.According to the age of patients, patients with cerebral hemorrhage were divided into low age group (age<30 years), middle age group (30 years≤age≤60 years) and high age group (age>60 years), with 120 cases in each group.Another 120 healthy persons who received health examination during the same period were selected as control group.The levels of high density lipoprotein (HDL), low density lipoprotein (LDL), triglyceride (TG) and total cholesterol (TC) in peripheral blood were measured.ApoE gene polymorphism was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).Results:There were no statistically significant differences in sex, age, body mass index between the cerebral hemorrhage group and the control group (χ 2=0.045, t=0.459, t=0.655, P=0.832, 0.323, 0.256). The systolic blood pressure, diastolic blood pressure, history of hypertension, history of diabetes, smoking and drinking in the cerebral hemorrhage group were significantly higher than those in the control group ( t=12.598, t=13.003, χ 2=49.308, χ 2=10.246, χ 2=45.562, χ 2=8.602, P=0.000, 0.000, 0.000, 0.000, 0.000, 0.003). There were statistically significant differences in TC, TG, LDL and HDL among the control group, the younger group, the middle-aged group and the older group ( F=36.893, 131.263, 808.908, 143.188, all P=0.000). The highest genotype frequency was E3/3 in the control group, the younger group, the middle-aged group and the older group(70.00%, 68.33%, 68.33% and 66.67%). There was no statistically significant difference in genotype frequencies of ApoE among the groups (χ 2=2.025, 1.524, 0.693, 0.308, 0.815, 2.025, P=0.567, 0.677, 0.875, 0.959, 0.856, 0.567). The highest allele frequencies of ApoE in the control group, the younger group, the middle-aged group and the older group were epsilon 3 (81.66%, 81.66%, 79.99%, 80.83%). There was no statistically significant difference in the allele frequencies of ApoE among the groups (χ 2=0.061, 0.125, 0.241, P=0.996, 0.989, 0.971). For patients with E3/3 genotype cerebral hemorrhage, the levels of TC, TG, LDL and HDL in the younger age group were (4.43±0.33)mmol/L, (1.50±0.37)mmol/L, (2.58±0.32)mmol/L and (1.53±0.32)mmol/L, respectively.The TC, TG, LDL and HDL levels in middle-aged group were (4.22±0.34)mmol/L, (1.87±0.32)mmol/L, (3.30±0.31)mmol/L and (1.85±0.35)mmol/L, respectively.The TC, TG, LDL and HDL levels in the elderly group were (3.85±0.35)mmol/L, (2.09±0.35)mmol/L, (3.60±0.33)mmol/L and (2.13±0.34)mmol/L, respectively.There were statistically significant differences in TC, TG, LDL and HDL among all groups ( F=60.289, 59.844, 218.120, 64.364, all P=0.000). Conclusion:There is no significant correlation between ApoE gene polymorphism and the occurrence of widespread intracerebral hemorrhage in different age groups.There is no correlation between E3/3 genotype and blood lipid level in patients with intracerebral hemorrhage in different age groups.
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Objective@#To investigate the short-term clinical efficacy of laparoscopic common bile duct exploration(LCBDE) with primary suture or T tube drainage in the management of choledocholithiasis.@*Methods@#The retrospective cohort study was conducted from January 2014 to December 2018 with the clinical data of patients with choledocholithiasis being analyzed. A total of 863 patients were enrolled in this study. There were 431 males and 432 females. The median age was 60 (range 11 to 94). These patients had received LCBDE with primary suture (n=287) and T tube drainage (n=576) in the Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University. Observation indicators: (1)Preoperative blood biochemistry, including blood serum levels of total bilirubin, direct bilirubin, ALT, AST, GGT. (2) Intraoperative conditions, including operation time, blood loss, diameter of common bile duct, number of common bile duct stone.(3)Short-term postoperative conditions, including postoperative hospital stay, postoperative complications. Measurement data with non-normal distribution were described as M (P25, P75), and comparison between groups was done using Mann-Whitney U test. Comparison of count data between groups were analyzed using the chi-square test. Univariate analysis and subsequent multivariable logistic regression were used to investigated the factors affecting the selection of surgical methods.@*Results@#(1) Blood serum levels of total bilirubin and direct bilirubin in the T tube drainage group were 17.0(12.2, 36.0) μmol/L, 7.6(4.9, 19.0) μmol/L, which were significantly higher than those of the primary suture group[15.7(11.8, 29.7) μmol/L, 6.7(4.4, 16.5) μmol/L)](Z=-2.023, -2.468, P<0.05). Preoperative blood serum levels of ALT, AST and GGT in the T tube drainage group were 56.7 (26.6, 128.8) U/L, 38.0(24.3, 75.8) U/L and 179.7(50.8, 394.4) U/L, the primary suture group were[68.2(24.8, 165.3) U/L, 35.5(22.8, 96.9) U/L and 235.2(74.9, 459.1) U/L], with no difference between the two groups (Z=-0.985, -0.437, -1.740, P>0.05). (2)The operation time of the primary suture group was 85(70, 100) min, which was significantly shorter than that of the T tube drainage group[97(75, 120) min](Z=-5.532, P<0.05). The diameter of common bile duct in the primary suture and T tube drainage group were 1.0(0.8, 1.2) cm and 1.0(0.8, 1.2) cm, respectively. Significant difference was observed between the two groups(Z=-2.071, P<0.05). The intraoperative blood loss in the primary suture and T tube drainage group were 20(10, 50) ml and 20(20, 50) ml, with no difference between the two groups (Z=-0.477, P>0.05). 61.32%(176/287) and 67.36%(388/576) of patients in the primary suture group and T tube drainage group were found with multiple stones in the common bile duct, with no difference between the two groups (χ2=3.083, P>0.05). (3)The primary suture group showed shorter postoperative hospital stay compared with the T tube drainage group[4(3, 5) d vs 6(5, 6) d, Z=-12.057, P<0.05]. The primary suture group showed more patients with bile leakage (2.09%) compared with that of the T tube drainage group (0.35%). Multivariable logistic regression showed that the number of common bile duct stone, diameter of common bile duct, time period of surgery, surgery group were significant factors affecting the selection of surgical methods(OR=1.687, 2.423, 0.587, 4.632, 95%CI: 1.152-2.470, 1.519-3.865, 0.511-0.675, 3.698-5.802, P<0.05).@*Conclusions@#Although different surgeons showed different opinions with the method of primary suture, laparoscopic common duct exploration with primary suture is safe and reliable in the management of choledocholithiasis with shorter operation time and faster postoperative recovery. T tube drainage is not absolutely necessary in the management of choledocholithiasis. Patients with multiple common bile duct stone or large diameter of common bile duct are likely to receive T tube drainage.
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Objective To investigate the short-term clinical efficacy of laparoscopic common bile duct exploration(LCBDE) with primary suture or T tube drainage in the management of choledocholithiasis.Methods The retrospective cohort study was conducted from January 2014 to December 2018 with the clinical data of patients with choledocholithiasis being analyzed.A total of 863 patients were enrolled in this study.There were 431 males and 432 females.The median age was 60 (range 11 to 94).These patients had received LCBDE with primary suture (n =287) and T tube drainage (n =576) in the Department of General Surgery,the First Affiliated Hospital of Nanjing Medical University.Observation indicators:(1) Preoperative blood biochemistry,including blood serum levels of total bilirubin,direct bilirubin,ALT,AST,GGT.(2) Intraoperative conditions,including operation time,blood loss,diameter of common bile duct,number of common bile duct stone.(3) Short-term postoperativeconditions,including postoperative hospital stay,postoperative complications.Measurement data with non-normal distribution were described as M (P25,P75),and comparison between groups was done using Mann-Whitney U test.Comparison of count data between groups were analyzed using the chi-square test.Univariate analysis and subsequent multivariable logistic regression were used to investigated the factors affecting the selection of surgical methods.Results (1) Blood serum levels of total bilirubin and direct bilirubin in the T tube drainage group were 17.0(12.2,36.0) μmol/L,7.6 (4.9,19.0) μmol/L,which were significantly higher than those of the primary suture group[15.7 (11.8,29.7) μmol/L,6.7 (4.4,16.5) μmol/L)] (Z =-2.023,-2.468,P ＜ 0.05).Preoperative blood serum levels of ALT,AST and GGT in the T tube drainage group were 56.7 (26.6,128.8) U/L,38.0 (24.3,75.8) U/L and 179.7 (50.8,394.4) U/L,the primary suture group were [68.2 (24.8,165.3) U/L,35.5(22.8,96.9) U/L and 235.2(74.9,459.1) U/L],with no difference between the two groups (Z =-0.985,-0.437,-1.740,P ＞ 0.05).(2) The operation time of the primary suture group was 85 (70,100) min,which was significantly shorter than that of the T tube drainage group [97 (75,120) min] (Z =-5.532,P ＜ 0.05).The diameter of common bile duct in the primary suture and T tube drainage group were 1.0(0.8,1.2) cm and 1.0 (0.8,1.2) cm,respectively.Significant difference was observed between the two groups(Z =-2.071,P ＜ 0.05).The intraoperative blood loss in the primary suture and T tube drainage group were 20(10,50) ml and 20(20,50) ml,with no difference between the two groups (Z =-0.477,P ＞0.05).61.32％ (176/287) and 67.36％ (388/576) of patients in the primary suture group and T tube drainage group were found with multiple stones in the common bile duct,with no difference between the two groups (x2 =3.083,P ＞ 0.05).(3)The primary suture group showed shorter postoperative hospital stay compared with the T tube drainage group [4 (3,5) d vs 6 (5,6) d,Z =-12.057,P ＜ 0.05].The primary suture group showed more patients with bile leakage (2.09％) compared with that of the T tube drainage group (0.35％).Multivariable logistic regression showed that the number of common bile duct stone,diameter of common bile duct,time period of surgery,surgery group were significant factors affecting the selection of surgical methods (OR =1.687,2.423,0.587,4.632,95％CI:1.152-2.470,1.519-3.865,0.511-0.675,3.698-5.802,P＜0.05).Conclusions Although different surgeons showed different opinions with the method of primary suture,laparoscopic common duct exploration with primary suture is safe and reliable in the management of choledocholithiasis with shorter operation time and faster postoperative recovery.T tube drainage is not absolutely necessary in the management of choledocholithiasis.Patients with multiple common bile duct stone or large diameter of common bile duct are likely to receive T tube drainage.
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Objective To investigate the expression of pSTAT5 in 7 pancreatic carcinoma cell lines,and the change of expression of pSTAT5 in pancreatic carcinoma cells SW1990 after growth hormone (GH) treatment, and explore its molecular mechanism. Methods Human pancreatic carcinoma cell lines (SW1990, Cap-1, Colo, Mia, AsPc, P3, PANC1) were cultured in vitro, and Western blotting was used to detect the expression of pSTAT5 in these cell lines. SW1990 in exponential growth phase was collected and nude Balb/c mice were inoculated with SW1990 cells. When tumors became palpable after inoculation, mice (normal saline group). 1 h, 2 h and 24 h after the last dose of GH treatment, the mice were sacrificed.Western blotting was used to detect the expression of pSTAT5 in SW1990 and inoculation tumor cells after GH injection. Results Positive expression of pSTAT5 was observed in all human pancreatic carcinoma cell lines (SW1990, Cap-1, Colo, Mia, Aspc, P3, PANC1). 5 minutes after GH (50 ng/ml) stimulation, the expression of pSTAT5 in SW1990 was 0.57 ±0.05, which was significantly increased; and it reached 0.64 ±0.04 at 10 minutes, then decreased to 0.39 ±0.03 at 15 minutes, however, it remained higher than that in the control group at 1 h (0.33 ± 0.02 vs 0.25 ± 0.06), and its expression at 2 h was 0.26 ± 0.03 and returned to the normal level. The expression of pSTAT5 in xenograft was not significantly changed. Conclusions GH could rapidly up-regulate the expression of pSTAT5 in SW1990 but the effect lasted for a relatively short period. GH had no significant effect on the expression of pSTAT5 in xenograft.
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ObjectiveTo explore the feasibility, safety and clinical value of laparoscopic Rouxen-Y cystojejunostomy in the treatment of pancreatic pseudocyst. Method Four patients with pancreatic pseudocyst received totally laparoscopic pancreatic pseudocystojejunostomy. The data on intraoperative bleeding, operative time, postoperative time to get out of bed, time of first flatus/bowel motion, complication and duration of hospital stay were collected and analyzed retrospectively. ResultsAll operations were carried out successfully with laparoscopic surgery. The mean operative time was 90 min. The average intraoperative blood loss was 40 ml. The mean postoperative time to get out of bed was 1.5 d, and the mean time of first flatus/bowel motion was 2. 3 d. All patients recovered smoothly without any pancreatic fistula. The average hospital stay was 7 days. Fever, pancreatitis,adhesive intestinal obstruction and other complications did not occur. ConclusionsTotally laparoscopic Roux-en-Y pancreatic pseudocystojejunostomy was an efficacious, safe, and minimally invasive procedure.
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Objective To investigate the effect of GH on proliferation of pancreatic cancer cells and observe the features of IGF-IGFBP3 pathway in the host after GH administration. Methods Pancreatic cancer cells (SW-1990,PANC-1 and P3) during exponential growth stage were harvested and cultured in medium containing growth hormone (50 ng/ml). After 24, 48 and 72 hours, cells were counted using a Coulter Counter. Thirty-five Athymic nude Balb/c mice were inoculated with SW-1990cells. When tumors became palpable after inoculation, animals were randomized to receive GH points (1 h, 2 h, 6 h, 24 after the last injection), plasma samples were gathered for subsequent ELISA determination and liver was rapidly incised for immune blotting analysis. Results The results revealed that GH stimulated cell growth in vitro. GH elevated levels of IGF-Ⅰ , Ⅱ at the 1st , 2nd , 6th hour after the last injection. GH augmented the expression of IGFBP3 in the liver of the host in vivo (1 h, 2 h, 6 h, 24 h, respectively). Conclusion Such proteins as IGF- Ⅰ and Ⅱ might be associated with mechanism of last effect of GH on tumor host. The up-regulation of IGFBP3 by GH administration in the host may help to explain the phenomena that GH doesn't accelerate growth of pancreatic tumor in vivo.
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Objective To study the impact of exogenous growth hormone (GH) on the levels of insulin-like growth factor-Ⅰ and -Ⅱ (IGF-Ⅰ, -Ⅱ) of the pancreatic cancer tissue and the small intestine mucosa of the host. Methods In situ hybridization was performed on pancreatic cancer cell lines (SW-1990) and inoculation tumor of the host to determine the location of the mRNA transcript encoding IGF R-Ⅰ,-Ⅱ. Athymic nude Balb/c mice were inoculated with SW-1990 cells. After inoculated tumors have become palpable, animals were randomized to receive GH (4 mg/kg once daily for 2 weeks) versus saline control. After the animals were killed at time point, tissues (tumor and small intestine) were rapidly incised for subsequent immune blotting analysis. Results Strong IGF R-Ⅰ,-Ⅱ mRNA hybridization signal could be detected in pancreatic cancer cell. There was no statistically significant difference between the level of IGF-Ⅰ, Ⅱ in the tumor of the GH and NS groups after 1 hours of GH injection (P>0.05). GH augmented the expression of IGF-Ⅰ(1 h : 0.33±0.05, P<0.05 ; 2 h : 0.34±0.04, P<0.05 ; 6 h:0.34±0.05, P<0.05), -Ⅱ(1 h : 0.36±0.05, P<0.05) in the small intestine mucosa of the host. Conclusions The expression of IGF-Ⅰ, Ⅱ in the small intestine mucosa of the host was elevated by GH, but not in the inoculation tumor in vivo. The discrepancy of GH-IGF pathway between inoculation tumor and small intestine of the host may help to explain the phenomena that GH doesn't accelerate growth of pancreatic tumor in vivo.
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Objective To discuss the efficacy and cosmetic effect of laparoscopic thyroidectomy for patients with thyroid diseases. Methods The clinical data of 160 patients who underwent laparoscopic thyroidectomy through the anterior chest approach were analyzed. The operation was performed under a pressure of 8 mm Hg within the surgical space at the neck. After the thyroid was separated completely, the lesions were resected using an ultrasound knife. Results Laparoscopic thyroidectomy was completed in 157 of the patients including 6 cases of papillary adenocarcinoma. The other 3 patients were converted to open surgery because of hyperthyroidisms complicated with intraoperative hemorrhage (1) or thyroid carcinoma complicated with lymph node metastasis (2). No severe complications involving the trachea and parathyroid occurred in this series. One patient with thyroid carcinoma developed transient hoarseness after the operation; one patient with nodular goiter had postoperative subcutaneous hemorrhage and hydrops; both of them were cured spontaneously. Postoperative hospital stay ranged from 3 to 5 days (mean, 4 days). The patients were followed up for 3 to 24 months with a mean of 6.8 months, during which none of them had recurrence. All the patients were satisfied with cosmetic outcomes of the surgery. Conclusion Laparoscopic thyroidectomy via the anterior chest approach is safe and feasible for patients with thyroid diseases with good cosmetic results.