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Objective To compare the clinical efficacy between traditional laparoscopic surgery and laparoscopic surgery under the guidance of membrane anatomy with complete mesangectomy in the treatment of rectal cancer. Methods A retrospective cohort study was conducted on 60 patients with rectal cancer who were randomly divided into control group (n=30) and observation group (n=30) in accordance with the principle of randomization.The control group received traditional laparoscopic radical resection of rectal cancer, and the observation group received laparoscopic radical resection of rectal cancer under the guidance of membrane anatomy with complete mesangectomy.The different clinical application effects of the two groups were analyzed by comparing the general data, operation time, intraoperative blood loss, and postoperative rehabilitation. Results All the 60 patients underwent the laparoscopic radical resection of rectal cancer.No operation-related complications, conversion to laparotomy, or perioperative death cases were reported.No statistically significant differences in age, gender, operation time, postoperative exhaust time, drainage tube removal time, or postoperative complications were found between the two groups (all P > 0.05).Compared with the control group, the observation group had significantly less intraoperative blood loss and more lymph node dissected (P < 0.05). Conclusion Laparoscopic radical resection of rectal cancer guided by the membrane anatomy with complete mesangectomy can completely remove the mesorectum, enlarge and clear the surgical field, reduce intraoperative bleeding, thoroughly remove lymph nodes, and improve the quality of surgery.
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Objective To observe the effects of amarogentinon liver cancer stem cells (LCSCs) after insufficient thermal ablation and its mechanism. Methods A insufficient thermal ablation model of HepG2 cells was established by water bath method.The percentage of CD133-positive LCSCs and the mRNA and protein levels of CD133 were detected by flow cytometry, qRT-PCR and Western blot.The insufficient thermal ablation model of HepG2 cells was treated with variable doses of amarogentin for 24 h; the percentage of CD133-positive LCSCs, the proliferation and apoptosis of liver cancer cells, and the mRNA and protein levels of CD133, TBC1D15, and p53were detected by flow cytometry, qRT-PCR and Western blot. Results The percentage of CD133-positive HepG2 cells and the mRNA and protein levels of CD133 and TBC1D15in the insufficient thermal ablation model were significantly higher than those in the normal HepG2 cells.Amarogentin then markedly decreased the percentage of CD133-positive LCSCs, the proliferation rate of HepG2 cells, and the mRNA and protein levels of CD133 and TBC1D15 in the insufficient thermal ablationresidual model (all P < 0.05);inversely, the apoptosis rate of HepG2 cells and the phosphorylated levels of p53 in the insufficient thermal ablation model were significantly increased (all P < 0.05). Conclusion Amarogentin could reduce the proportion of LCSCs after insufficient thermal ablation, inhibit the proliferation, and promote the apoptosis of LCSCs, which maybe associated with increasing the phosphorylation of p53 and inhibiting the expression of TBC1D15.
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Objective@#To explore the association between maternal pre pregnancy and pre delivery overweight with overweight and obesity among offspring during adolescence in Guangzhou, and to provide evidence for child obesity prevention.@*Methods@#Based on the routine physical examination of primary and secondary school students in Guangzhou, random sampling was used to 6 middle schools and questionnaire survey was conducted among 3 384 students and their parents. Students with overweight and obesity were included in the case group, and the other students were included in the control group. Propensity Score Matching (PSM) was adopted to reduce selection bias. Logistic regression model and χ 2 test were used to analyze the data before and after PSM.@*Results@#The result of univariate analysis showed that there were statistically significant differences between overweight/obese group and the control group by gender, schooling stage (middle and high schools), picky eater, family history of obesity, family monthly income, delivery mode, high birthweight, and gestational weight gain before PSM( χ 2=42.38, 10.64, 14.47, 26.85, 10.58, 13.59 , 15.53, 20.64, P <0.05). After PSM, results showed that there were no statistically significant differences between overweight/obese group and the control group in middle and high schools, and mother delivery mode( P >0.05). Logistic regression analysis showed that the risk of overweight and obesity of maternal pre pregnancy on adolescent offspring was 1.54 times higher than control group (95% CI =1.01-2.36) before PSM, and the overweight and obesity of maternal predelivery also increased the risk of overweight and obesity of adolescent offspring( OR=2.35, 95%CI =1.67-3.31). After PSM, maternal overweight and obesity pre pregnancy ( OR=2.17, 95%CI =1.41-3.34) and maternal overweight and obesity pre delivery( OR=2.99, 95%CI =2.08-4.31) significantly increased the risk of overweight and obesity in adolescent offspring.@*Conclusion@#Maternal overweight and obesity pre pregnancy and pre delivery are associated with increased risk of overweight and obesity in adolescent offspring.
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Pancreatic cancer is one of the most malignant digestive cancer with high morbidity and mortality. Surgical treatment is considered the only way to cure pancreatic cancer. For resectable pancreatic cancer, the principles of "artery-frst approach" and "systematic mesopancreas dissection" have improved the increase the local radicality and reduce the local recurrence rate. For borderline resectable pancreatic cancer and locally advanced pancreatic cancer, neoadjuvant chemotherapy can be used before surgical resection. Although there are no targeted and immunotherapeutic drugs for pancreatic cancer, clinical studies on monoclonal antibodies are ongoing. Chimeric antigen receptor T cell therapy and irreversible electroporation are emerging therapies in the treatment of pancreatic cancer. In the present study, the status and progress of comprehensive treatment for pancreatic cancer are reviewed.
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Pancreatic duct stones are closely related to chronic pancreatitis. Although the incidence is low, they can cause intractable abdominal pain and may lead to pancreatic cancer. Changes in the composition of pancreatic juice are the essential causes for the formation of pancreatic duct stones, while local inflammation and pancreatic ductal stenosis are the direct causes of the progression of stones and the recurrence of the symptoms, and they are also the main targets of treatment. Endoscopic treatment combined with extracorporeal shock-wave lithotripsy has a good therapeutic effect on most pancreatic duct stones. More complex stones require surgical intervention. The choice of specific surgical methods is related to the size and distribution of the stones. Treatment schemes should aim at reducing long-term stones or pain recurrence, and preserving more endocrine and exocrine functions of the pancreas, in order to bring greater benefits to patients.
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Pancreatic cancer is highly malignant, and surgical resection is the only cure method at present. In recent years, neoadjuvant therapy has enabled some patients to be successfully downgraded with surgical treatment, which increased the R0 surgical resection rate and prolonged the survival time of patients, has become an important part in the treatment of pancreatic cancer. However, the applicability and standardization of neoadjuvant therapy for pancreatic cancer still need more advanced evidence. This article reviews whether neoadjuvant therapy should be used for resectable pancreatic cancer, the choice of neoadjuvant chemotherapy, and the progress, advantages and disadvantages of neoadjuvant chemoradiotherapy.
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Purpose@#Pancreatic duct decompression relieves pancreatic duct stone (PDS)-associated abdominal pain, though a consensus indication for the drainage procedure of the main pancreatic duct (MPD) is lacking. Moreover, major prognostic factors for postsurgical long-term pain relief and recurrence are largely unknown. @*Methods@#The clinical outcomes of 65 consecutive PDS patients undergoing surgery from 2008–2012 with 3+ years of follow-up were assessed. @*Results@#At postsurgical follow-up (median, 4.5 years; range, 3–7 years; procedure: Partington, n = 32; Frey, n = 27; pancreatoduodenectomy, n = 3; distal pancreatectomy, n = 3), the early complication and complete stone clearance rates were 29.2% and 97%, respectively. Long-term, complete and partial pain relief were 93.9%, 83.1%, and 10.8%, respectively. The risk of pancreatic fistula was higher in the 8 mm group (P < 0.05), and 80% of the pancreatic fistula cases occurred in the <8 mm group. A shorter pain duration (P = 0.007), smaller MPD diameter (P = 0.04), and lower Izbicki pain score (P < 0.001) predicted long-term pain relief. Pain recurrence after initial remission occurred in 5 patients and was only related to pain duration (P = 0.02). Stone recurrence and pancreatic exocrine functional and endocrine functional deterioration occurred in 2, 5, and 11 patients, respectively. @*Conclusion@#Surgery provides excellent stone clearance, long-term pain relief, and acceptable postoperative morbidity. Using 8 mm as the criterion for drainage surgery can minimize the postoperative pancreatic fistula risk. Individualized and timely surgical treatment may improve the effect of surgery.
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Objective@#To systematically evaluate the surgical effect in duct-to-mucosa and invagination groups of pancreaticojejunostomy after pancreaticoduodenectomy.@*Methods@#The Cochrane Library, PubMed, EMbase and CBM data bases were searched to identify randomized controlled trials that compared the postoperative pancreatic fistula, mortality, incidence of complications, delayed gastric emptying, postoperative haemorrhage, infection, reoperate rate, postoperative hospital stay of duct-to-mucosa and invagination for pancreaticcoduodenectomy. Meta-analysis was performed using the software RevMan 5.3.@*Results@#Nine trials with 1 163 patients comparing the duct-to-mucosa group with invagination group were included, the duct-to-mucosa group with 579 patients and the invagination group with 584 patients. The meta-analysis revealed that, compared the duct-to-mucosa group with the invagination group, the rate of postoperative pancreatic fistula was not significantly reduced (RR=1.13, 95%CI: 0.88-1.45, P=0.34), there was no significant difference between the two group. To systematically evaluate the total mortality (RR=0.80, 95%CI: 0.42-1.52, P=0.49), incidence of complications (RR=1.04, 95%CI: 0.88-1.24, P=0.63), delayed gastric emptying (RR=1.26, 95%CI: 0.90-1.76, P=0.18), postoperative haemorrhage (RR=0.86, 95%CI: 0.51-1.44, P=0.57), postoperative infection (RR=1.20, 95%CI: 0.86-1.69, P=0.29), reoperate rate (RR=1.05, 95%CI: 0.62-1.78, P=0.84), postoperative hospital stay (WMD=-1.36, 95%CI: -2.91-0.20, P=0.09) in duct-to-mucosa and invagination groups. There was no significant difference between the two group.@*Conclusions@#There was no significant difference of postoperative pancreatic fistul and mortality, incidence of complications, delayed gastric emptying, postoperative haemorrhage, postoperative infection, reoperate rate, postoperative hospital stay in duct-to-mucosa and invagination groups of pancreaticojejunostomy after pancreaticoduodenectomy.
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Acute liver failure (ALF) is commonly used to describe the emergence or development of an acute attack of abnormal liver function. It is a rare but severely life-threatening clinical syndrome that often causes jaundice, coagulopathy and hepatic encephalopathy. Encephalopathy(HE) and multiple organ failure. ALF has a wide range of etiological factors. In the global scope, different regions often show different epidemiological characteristics. With the gradual improvement of specialized diagnosis and intensive care, the prognosis of ALF has improved significantly. The current clinical treatment methods of ALF include etiology treatment, symptomatic supportive treatment, immunotherapy, artificial liver and liver transplantation. This article will summarize the causes of ALF and discuss the latest treatment progresses of ALF.
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The global disease burden of hepatocellular carcinoma (HCC) is increasing gradually. HCC can be categorized into proliferation and non-proliferation classes. The occurrence and development of HCC are closely associated with both genetic and epigenetic changes. However, the underlying mechanisms remain unclear. CT/MRI is the most commonly used imaging modality for diagnosis of HCC. Barcelona clinic liver cancer staging system is widely used to stage HCC worldwide. The treatment options of HCC include surgery, liver transplantation, radiofrequency ablation, transcatheter arterial chemoembolization and systematic therapy. This review will focus on the progress in mechanisms and treatments of HCC.
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Hepatic ischemia-reperfusion injury is the most common complication after liver transplantation. Oxidative stress, autophagy, and inflammatory response caused by excessive reactive oxygen species production are significant steps that cause liver ischemia-reperfusion injury. What′s more, nuclear factor erythroid 2-related factor 2 is considered to be a major regulator of the antioxidant response, the PI3K-Akt-mTOR signaling pathway is considered to be an important pathway of autophagy, and the HMGB1-TLR4-NF-κB signaling pathway is considered to be a key signaling pathway which leads to inflammation. Based on the above signaling pathways and regulatory factor, this article shows that the antioxidant, anti-inflammatory and autophagy regulation effects of genes, molecules and drugs on hepatic ischemia-reperfusion cells, to explore the protective effects on hepatic ischemia-reperfusion cells.
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Objective To systematically evaluate the surgical effect in duct-to-mucosa and invagination groups of pancreaticojejunostomy after pancreaticoduodenectomy.Methods The Cochrane Library,PubMed,EMbase and CBM data bases were searched to identify randomized controlled trials that compared the postoperative pancreatic fistula,mortality,incidence of complications,delayed gastric emptying,postoperative haemorrhage,infection,reoperate rate,postoperative hospital stay of duct-to-mucosa and invagination for pancreaticcoduodenectomy.Meta-analysis was performed using the software RevMan 5.3.Results Nine trials with 1 163 patients comparing the duct-to-mucosa group with invagination group were included,the duct-to-mucosa group with 579 patients and the invagination group with 584 patients.The meta-analysis revealed that,compared the duct-to-mucosa group with the invagination group,the rate of postoperative pancreatic fistula was not significantly reduced (RR =1.13,95 ％ CI:0.88-1.45,P =0.34),there was no significa nt difference between the two group.To systematically evaluate the total mortality (RR =0.80,95 ％ CI:0.42-1.52,P =0.49),incidence of complications (RR =1.04,95 ％ CI:0.88-1.24,P =0.63),delayed gastric emptying (RR =1.26,95 ％ CI:0.90-1.76,P =0.18),postoperative haemorrhage (RR =0.86,95 ％ CI:0.51-1.44,P =0.57),postoperative infection (RR =1.20,95％ CI:0.86-1.69,P =0.29),reoperate rate (RR =1.05,95％ CI:0.62-1.78,P =0.84),postoperative hospital stay (WMD =-1.36,95％ CI:-2.91-0.20,P =0.09) in duct-to-mucosa and invagination groups.There was no significant difference between the two group.Conclusions There was no significant difference of postoperative pancreatic fistul and mortality,incidence of complications,delayed gastric emptying,postoperative haemorrhage,postoperative infection,reoperate rate,postoperative hospital stay in duct-to-mucosa and invagination groups of pancreaticojejunostomy after pancreaticoduodenectomy.
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Hepatic ischemia-reperfusion injury has always been a difficult problem in liver transplantation and liver tumor resection. The involvement of multiple mechanisms makes it particularly complex, among which energy expenditure during ischemia and oxidative stress induced by reperfusion are the main mechanisms leading to hepatic ischemia-reperfusion injury and may cause cell death and even liver failure. Silent information regulators are a class of nicotinamide adenine dinucleotide-dependent deacetylases which can lead to deacetylation of transcription factors including histones and nonhistones, and they are playing an important regulatory role in cell apoptosis, inflammatory response, energy balance, and oxidative stress. There are 7 types of silent information regulators in mammals, i.e., Sirt1-Sirt7, among which Sirt1 can reduce hepatocyte stress, regulate cell metabolic pathways, and thus alleviate the degree of hepatic ischemia-reperfusion injury through various signaling pathways. This article reviews the role of Sirt1-related signaling pathways in hepatic ischemia-reperfusion injury.
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Hepatolithiasis is a common benign biliary disease in China. It is a challenge to treat hepatolithiasis. Some patients with complicated hepatolithiasis fail to achieve satisfactory outcomes after several biliary operations, and therefore, how to improve the treatment outcome of hepatolithiasis is a major problem for biliary surgeons. At present, surgery is still the main treatment method for hepatolithiasis. Percutaneous transhepatic choledochoscopic lithotripsy (PTCSL), as a minimally invasive surgical treatment for hepatolithiasis, has been accepted by many biliary surgeons and patients with hepatolithiasis and gradually gains a place in the treatment of hepatolithiasis. This article reviews the research advances in PTCSL in the treatment of hepatolithiasis.
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Decompensated liver cirrhosis has various life-threatening complications such as spontaneous bacterial peritonitis, hepatic encephalopathy, and sepsis, and the development of such complications is closely associated with bacterial translocation. Pathological bacterial translocation in patients with liver cirrhosis is caused by the impairment of intestinal barrier function, and thus bacteria can cross the intestinal barrier and enter the mesenteric lymph nodes or other sites. Therefore, a better understanding of the association between intestinal barrier and bacterial translocation in liver cirrhosis can provide new theoretical support for the treatment of liver cirrhosis. This article discusses the four major components of the intestinal barrier, namely the mechanical barrier, the immune barrier, the chemical barrier, and the biological barrier, as well as their changes during bacterial translocation.
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Membrane anatomy is in broad sense the anatomy of the mesentery and its bed, both of which are consisted of fascia membrane or/and serous membrane. Although the traditional mesentery has the definition of mesentery, people unconsciously identify them according to their "fan-shaped" and "free" characteristics. The "generalized mesentery" we propose refers to the fascia and/or serosa, envelope-like organs and their blood vessels, suspending to the posterior wall of the body, regardless of its shape, free or not. So the main points of the anatomy are as follows.(1) Organs or tissues with their feeding structures are enveloped by the fascia membrane or/and serous membrane, suspending to posterior wall of the body, to form different shapes of the mesentery in broad sense, and most of them are buried in the mesentery bed. (2) Cancer metastasis type V of in the gut moves in the envelop of the mesentery in broad sense.(3) Intraoperative breach of the envelop membrane not only results in intraoperative bleeding, but also cancer cell leakage from the mesentery. (4) The cancer of gut can be divided into cancer in the mesentery, cancer out of the mesentery and cancer at edge of the mesentery based on this anatomy. Radical tumor resection is effective for cancer in the mesentery, which should not be artificially breached into those of cancer out of the mesentery. The essence of neoadjuvant chemoradiation is to push cancer at edge of the mesentery back inside the mesentery.(5) Based on such anatomy, radical gut tumor operations are divided into D2/D3 procedure, without emphasizing the integrity of the mesentery during lymphatic dissection; CME procedure, which emphasizes the integrity of the mesentery but does not strictly define the extent of lymphatic dissection; D2/D3 + CME procedure, which strictly defines the integrity of the mesentery and the extent of lymphatic dissection.(6)For gastrointestinal tumors of the same T stage, shorter mesentery indicates worse prognosis.(7) For gastrointestinal tumors with the same T stage and the same length of mesentery, the more mesentery buried in the mesentery bed, the worse prognosis. (8) The above seven principles are universal in the organs of the body cavity (and even all internal organs).Membrane anatomy, unlike traditional "plane surgery" , is completely different from the "anatomy of the membrane..." described by Japanese scholars, but mainly bases on generalized mesentery and mesentery bed, meanwhile inherent life events can be accurately defined and confirmed.
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Acute pancreatitis is a clinically common acute abdomen, mild acute pancreatitis is a self-limiting disease, while severe acute pancreatitis (SAP) requires multidisciplinary treatment and the mortality rate remains high. A special complication of SAP is intra-abdominal hypertension, as the disease progresses, the intra-abdominal pressure is further increased, leading to abdominal compartment syndrome (ACS), which eventually leads to multiple organ dysfunction syndrome. This current surgical intervention for SAP combined with ACS has gradually replaced the conventional medical treatment program. This article reviews the various options for surgical treatment of SAP with ACS.
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Objective@#To study the expression level of monoacylglycerol lipase (MAGL) in liver tissues of patients with hepatocellular carcinoma (HCC), and its clinical correlation.@*Methods@#Immunohistochemistry was employed to detect MAGL protein in 353 cases with hepatocellular carcinoma (HCC) and tissue microarray (TMA) for paracancerous liver tissues. The expression levels of MAGL in TMA were quantitatively analyzed using Image-Pro plus 6.0. The difference in MAGL expression between liver cancer tissues and paracancerous liver tissues was compared. Combined with the clinical follow-up data of TMA patients, the correlation between the expression of MAGL in TMA and the degree of HCC tumors differentiation and the survival rate of 1-year and 3-year were analyzed using Logistic regression analysis. The survival curves of patients with different levels of MAGL protein was plotted and analyzed using Kaplan-Meier method. The expression of MAGL protein was analyzed by multiple linear regression analysis. COX regression was used to analyze the correlation between MAGL protein expression level and the risk of HCC death in the included patients.@*Results@#The expression of MAGL in HCC tissues was significantly higher than paracancerous liver tissues. The expression level of MAGL was correlated to the degrees of HCC tumors differentiation (P < 0.001) and 1-year survival rate (P = 0.01), but not with 3-year survival rate (P = 0.91). Survival curve showed that the expression level of MAGL was negatively correlated with prognosis and survival of HCC patients (P = 0.001). Multiple linear regressions showed a negative correlation between MAGL expression level and overall survival time of HCC patients (P=0.010, R2=0.166, Durbin-Watson value: 1.989). COX regression showed that the expression of MAGL was a risk factor for death of patients with HCC [P = 0.004, Exp (B) = 1.000].@*Conclusion@#The expression level of MAGL has positive correlation with the malignant degree in HCC patients, and negative correlation with its prognosis. Therefore, MAGL may serve as a new prognostic indicator for HCC patients.
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Over 70% of hepatocellular carcinoma patients have not received traditional surgery because of their own disease characteristics and the limitations of traditional surgical methods. With the advancement of medical technology and the development of minimally invasive concepts, minimally invasive surgery, transcatheter arterial chemoembolization, and local ablation have received increasing attention. The combination of various treatment methods can help to strengthen the characteristics of each treatment, but the guiding standard of comprehensive treatment still needs further exploration and research.
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Acute pancreatitis is a clinically common acute abdomen,mild acute pancreatitis is a self-limiting disease,while severe acute pancreatitis (SAP) requires multidisciplinary treatment and the mortality rate remains high.A special complication of SAP is intra-abdominal hypertension,as the disease progresses,the intraabdominal pressure is further increased,leading to abdominal compartment syndrome (ACS),which eventually leads to multiple organ dysfunction syndrome.This current surgical intervention for SAP combined with ACS has gradually replaced the conventional medical treatment program.This article reviews the various options for surgical treatment of SAP with ACS.