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Abstract Objective Nasopharyngeal Carcinoma (NPC) is a malignancy of epithelium of epithelium of the nasopharynx, with the highest incidence of otolaryngeal malignancies. A growing number of studies confirm that Circular RNA (circRNA) plays an important role in tumor development, including Hsa_circ_0013561. This study aims to elucidate the process and mechanism of NPC regulation hsa_circ_0013561. Methods In this study, circRNA expression nodes and subcellular localization in NPC tissues were analyzed by fluorescence in situ hybridization. The expression of hsa_circ_0013561 in NPC cells was further clarified by RT-qPCR. At the same time, the lentivirus vector interfered by hsa_circ_0013561 was constructed and transfected. The cell proliferation was detected by CCK-8 method, EdU assay and plate cloning assay. The cell cycle and apoptosis were detected by flow cytometry, and the cell migration ability was detected by wound healing assay and Transwell assay. Western blotting examined the expression of apoptosis, Epithelial-Mesenchymal Transition (EMT)-associated proteins, and Janus Kinase/Signal Transductor and Activator of Transcription (JAK/STAT) signaling pathway-related proteins. Results The results showed that the expression of hsa_circ_0013561 in NPC samples was significantly upregulated and hsa_circ_0013561 localized in the cytoplasm. After down-regulating hsa_circ_0013561 expression, it significantly inhibited the proliferation and metastasis ability of NPC, inhibited EMT progression, and promoted apoptosis. Further studies showed that interference hsa_circ_0013561 significantly inhibited JAK2/STAT3 signaling pathway activation and induced the expression of apoptosis-related proteins. Conclusion In summary, we found that hsa_circ_0013561 is a pro-tumor circRNA in NPC, which can reduce the activation of JAK2/STAT3 pathway by knocking down hsa_circ_0013561, thereby slowing down the malignant progression of NPC. Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence Level 4.
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Objective:To summarize the clinical features and survival differences between human immunodeficiency virus (HIV)-positive and HIV-negative cervical cancer patients, and to explore the factors influencing the prognosis.Methods:The clinical data of patients with cervical cancer diagnosed and treated in Zhongnan Hospital of Wuhan University from January 2015 to January 2022 were retrospectively analyzed. There were 46 HIV-positive cases and 587 HIV-negative cases; all 46 HIV-positive patients had squamous cell carcinoma, while 504 HIV-negative patients had squamous cell carcinoma. According to age and clinical staging, 230 HIV-negative squamous cell carcinoma patients were screened to match with 46 HIV-positive squamous cell carcinoma patients according to 1∶5. The clinical features of HIV-positive and HIV-negative patients were compared in all matched patients with pathological type of squamous cell carcinoma; the Kaplan-Meire method was used to analyze the overall survival (OS) and the comparison of OS was made by using log-rank test. Multivariate Cox proportional risk model was used to analyze the independent factors affecting the OS of patients with cervical squamous cell carcinoma.Results:The differences in the age, pathological types, clinical staging between 46 HIV-positive patients and 587 HIV-negative patients were statistically significant (all P < 0.05). There were statistically significant differences in age and clinical staging between 46 HIV-positive squamous cell carcinoma patients and 504 HIV-negative squamous cell carcinoma patients (all P < 0.05). After 1∶5 matching, there were no statistically significant differences in the age, clinical staging between 46 patients with HIV-positive squamous cell carcinoma and 230 patients with HIV-negative squamous cell carcinoma. The OS of HIV-positive patients in the entire group,pathological type of squamous cell carcinoma or after pairing was worse than that of HIV-negative patients (all P < 0.001). The median OS time of HIV-positive patients was 63 months (95% CI 61-109 months), while the median OS time of HIV-negative patients was not reached (95% CI 165-178 months, 164-178 months, 143-173 months, respectively). Multivariate Cox regression analysis showed that clinical staging Ⅲ-Ⅳ was an independent risk factor for OS in patients with cervical squamous cell carcinoma (Ⅲ-Ⅳ vs. Ⅰ-Ⅱ: HR = 1.573, 95% CI 1.032-2.397, P = 0.035); HIV infection was an independent protective factor for OS (HIV-positive vs. HIV-negative: HR = 0.087, 95% CI 0.042-0.182, P < 0.001), indicating that HIV-positive patients had an advantage in OS compared to HIV-negative patients at the same age and clinical staging. Age was not an independent influencing factor for OS ( P > 0.05). Conclusions:The onset age of HIV-positive cervical cancer tends to be younger and the clinical staging is late when patients are diagnosed. HIV-positive patients have poor prognosis.
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Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.
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Objective:To investigate the pathogen spectrum of acquired immunodeficiency syndrome (AIDS) patients with pulmonary opportunistic infections in the local area, and to evaluate the clinical application of metagenomic next-generation sequencing (mNGS) in these patients.Methods:From January to December 2021, AIDS patients with pulmonary infections admitted to Zhongnan Hospital of Wuhan University were enrolled. Their bronchoalveolar lavage fluid (BALF) was subjected to mNGS and coventional pathogen detection.Routine pathogen detection methods included smear, culture, polymerase chain reaction (PCR), and immunochromatographic colloidal gold. Fisher′s exact probability method was used for statistical analysis.Results:A total of 69 patients were included, and all of them were tested positive for mNGS. Among them, 53 cases (76.8%) were positive for fungi and viruses, 40 cases (58.0%) were positive for bacteria (excluding Mycobacterium tuberculosis (MTB) and nontuberculous mycobacteria (NTM)), six cases were positive for MTB, 11 cases were positive for NTM, and seven cases were positive for other pathogens. Mixed infections with two or more pathogens were found in 89.9%(62/69) of the patients. Among the conventional pathogen detections of BALF, 79.7%(55/69) of the patients were positive for pathogens, including 42 cases positive for Pneumocystis jirovecii PCR, 16 cases positive for BALF culture, nine cases positive for MTB PCR, and five cases positive for Cryptococcus antigen. The total detection rate of mNGS was 100.0%(69/69), which was higher than that of the conventional pathogen detection rate of 79.7%(55/69), and the difference was statistically significant (Fisher′s exact probability method, P<0.001). The specificity of mNGS detection was 88.4%. Combining clinical and two detection methods, the top five pathogens were Pneumocystis jirovecii (62.3%(43/69)), Candida (29.0%(20/69)), MTB (20.3%(14/69)), NTM and Talaromyces marneffei (15.9%(11/69), each). Fifty-three patients (76.8%) had co-infection with virus. Conclusions:The main cause of pulmonary infection in AIDS patients in this area is mixed infection, and Pneumocystis jirovecii is the most common pathogen. mNGS could significantly improve the pathogen detection rate in AIDS patients with pulmonary infections.
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Objective:To investigate the feasibility, efficacy and adverse reactions of programmed death-1(PD-1) inhibitors in patients with acquired immunodeficiency syndrome (AIDS) complicated with malignant tumor.Methods:From September 2020 to August 2021, patients with AIDS complicated with malignant tumor in Zhongnan Hospital of Wuhan University were enrolled. Data including basic information, laboratory test results, CD4 + T cell count, human immunodeficiency virus (HIV) viral load were collected. Patients were continuously administered intravenously PD-1 monoclonal antibody until disease progression or intolerant toxicity reaction occurred. Adverse reactions during treatment were recorded.And treatment outcomes were assessed once every 12 weeks after treatment. HIV viral load was measured after treatment once a week for four consecutive times, then once four weeks for two consecutive times, and then once every 12 weeks. Results:Ten patients were included in the study, including seven males and three females, three cases of Hodgkin′s lymphoma, two cases of cervical cancer and hepatocellular carcinoma respectively, one case of non-Hodgkin′s lymphoma, non-small cell lung cancer and anal cancer respectively. There were four patients with CD4 + T cell count of 100 to 200 cells/μL and two patients with CD4 + T cell count lower than 100 cells/μL. All patients had completed at least three cycles of treatment with PD-1 monoclonal antibody, HIV viral load remained lower than 20 copies /mL. Three cases achieved complete response and three cases achieved partial response. Adverse reactions were cutaneous capillary endothelial proliferation (CCEP) (seven cases), major bleeding (three cases), and hearing impairment (one case). Conclusions:PD-1 inhibitor has no adverse effect on the continuous suppression of HIV viral load and has an effect on tumor control, so it is a viable choice in AIDS patients complicated with tumor. However, due to its considerable adverse reactions, multidisciplinary cooperation is needed to reduce the risk of complications and deal with serious complications.
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Objective To establish a small liver cancer biobank with a standard operating procedure and the function of informationized management. Methods According to the inclusion and exclusion criteria, blood, tissue, and stool samples were collected from the patients with liver cancer who attended Liver Surgery Center, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, from August 2012 to December 2020 and signed the informed consent. In-and-out-of-storage management was performed based on the standard procedure for whole blood, serum, frozen tissue, paraffin-embedded tissue, and stool samples, and related clinical and follow-up data were collected. The frozen samples of liver cancer tissue and adjacent tissue in different years were randomly selected, and the concentration and completeness of total RNA were examined to ensure the quality of frozen samples stored in the biobank. Results The samples were collected from 4190 liver cancer patients who underwent surgery within a period of 101 natural months, and there were 41718 frozen tissue samples, 18950 paraffin-embedded tissue samples, 24389 whole blood samples, 20060 serum samples, and 5392 stool samples. The liver cancer patients had an age range of 13-88 years, and male patients accounted for 85.1%. The patients with hepatitis B accounted for 83.3%, and those with liver cirrhosis accounted for 73.5%. A standard operating procedure and an electronic data capture system were developed according to the collection, processing, storage, application, and informationized management of samples. Among the 18 frozen tissue samples randomly selected from the biobank, 16 samples had high RNA quality, which could meet the requirements of subsequent experiments. Conclusion A standardized and informationized biobank has been established for liver cancer, which provides high-quality samples for the basic research on liver cancer and helps to explore the research value of samples.
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Objective:To systematically review and evaluate the safety and efficacy of high-flow nasal oxygen (HFNO) for pre-oxygenation before anesthesia induction.Methods:Pubmed, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database and China Biomedical Literature Database were searched from inception to March 2022.All randomized controlled trials comparing HFNO and facemask ventilation for pre-oxygenation before anesthesia induction were collected.Two researchers independently assessed the quality of trials and extracted data.The primary outcome was the safe apnea time, the secondary outcomes were the lowest SpO 2 during intubation, oxygenation-related complications, patient comfort, PaO 2 and PaCO 2 before and after pre-oxygenation and after intubation.Meta-analysis was performed using RevMan 5.4 software. Results:Seventeen randomized controlled trials involving 843 patients were included in this meta-analysis.The results of meta-analysis showed that the safe apnea time was significantly longer ( MD=67.61, 95% CI 5.94-129.28, P=0.03), the lowest SpO 2 was higher during tracheal intubation ( MD=3.27, 95% CI 2.25-4.29, P<0.01), and PaO 2 was higher after pre-oxygenation ( MD=54.39, 95% CI 9.32-99.46, P=0.02) in the patients using HFNO than those using facemask ventilation.There were no statistically significant differences in the other outcomes ( P>0.05). Conclusions:HFNO for pre-oxygenation before anesthesia induction can significantly prolong the safe apnea time, increase the lowest SpO 2 during tracheal intubation, and improve the levels of PaO 2 after pre-oxygenation, and HFNO does not affect the patient′s comfort or increase the development of preoxygenation-related complications when compared with facemask ventilation.
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Objective:To compare the effects of different fractions of inspired O 2 (FiO 2) during general anesthesia induction on perioperative pulmonary function in patients undergoing gynecological laparoscopic surgery. Methods:A total of 100 patients, aged 30-64 yr, with body mass index<30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective total laparoscopic hysterectomy, were divided into 4 groups ( n=25 each) using a random number table method: group A, group B, group C and group D. In A, B, C and D groups, FiO 2 was 40%, 60%, 80% and 100%, respectively.Immediately after the establishment of electrocardiogram monitoring after entering the operation room (T 0), immediately after tracheal intubation (T 1), immediately after creation of pneumoperitoneum (T 2), at 30 min of pneumoperitoneum (T 3), immediately before tracheal intubation (T 4) and at 15 min after tracheal intubation (T 5), ventral (ROIⅠ), middle ventral (ROIⅡ), middle dorsal (ROIⅢ) and dorsal (ROI Ⅳ) lung ventilation were recorded using electrical impedance tomography.The impedance ratio (IR) was calculated and the safety time without ventilation was recorded.Blood samples were collected from the radial artery at T 0-2 and T 5 for blood gas analysis, arterial oxygen partial pressure (PaO 2) and arterial carbon dioxide partial pressure (PaCO 2) were recorded, and oxygenation index (OI) was calculated.The occurrence of pulmonary complications within 3 days after operation was recorded. Results:Compared with group D, the ventilation in ROIⅠ and ROIⅡwas significantly increased, the ventilation in ROIⅢ and ROIⅣ was decreased, and IR was increased at T 1 and T 2 in A, B and C groups, PaO 2 and OI were decreased at T 1, and the safety time without ventilation was prolonged in A and B groups, and PaO 2 was decreased, OI was increased at T 1 ( P<0.05), and no significant was change in the safety time without ventilation in group C ( P>0.05). There was no significant difference in the incidence of pneumoperitoneum among the 4 groups ( P>0.05). Conclusion:During general anesthesia induction, 80% FiO 2 has the least effect on lung function in the patients undergoing gynecological laparoscopic surgery.
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Due to the problems of language barriers and cultural differences existing in the current clinical practice teaching activities of overseas students, this study proposes to divide the oversea students and Chinese students into bilingual mixed groups in the ward rounds teaching. Through the selection of typical cases and the application of flipped classroom, the Chinese and English versions of learning materials related to disease are provided to the interns for learning in advance, and the oversea students and Chinese students are requested to complete the history and auxiliary examination data collection in Chinese and English in cooperation, and then the teacher leads the group to carry out ward rounds teaching, including bedside English history report, physical examination, case analysis, discussion and summary, so as to improve the participation enthusiasm of overseas students and also improve the teaching effects.
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We designed and fabricated a novel high throughput brain-on-chip with three dimensional structure with the aim to simulate the in vivo three-dimensional growth environment for brain tissues. The chip consists of a porous filter and 3D brain cell particles, and is loaded into a conventional 96-well plate for use. The filter and the particle molds were fabricated by using computer modeling, 3D printing of positive mold and agarose-PDMS double reversal mold. The 3D cell particles were made by pouring and solidifying a suspension of mouse embryonic brain cells with sodium alginate into a cell particle mold, and then cutting the resulting hydrogel into pieces. The loaded brain-on-chip was used to determine the neurotoxicity of pesticides. The cell particles were exposed to 0, 10, 30, 50, 100 and 200 µmol/L of chlorpyrifos or imidacloprid, separated conveniently from the medium by removing the porous filter after cultivation. Subsequently, cell proliferation, acetylcholinesterase activity and lactate dehydrogenase release were determined for toxicity evaluation. The embryonic brain cells were able to grow and proliferate normally in the hydrogel particles loaded into the filter in a 96-well plate. Pesticide neurotoxicity test showed that both chlorpyrifos and imidacloprid presented dose-dependent inhibition on cell growth and proliferation. Moreover, the pesticides showed inhibition on acetylcholinesterase activity and increase release of lactate dehydrogenase. However, the effect of imidacloprid was significantly weaker than that of chlorpyrifos. In conclusion, a novel brain-on-chip was developed in this study, which can be used to efficiently assess the drug neurotoxicity, pharmacodynamics, and disease mechanism by combining with a microtiterplate reader.
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Animals , Mice , Brain , Chlorpyrifos/toxicity , Culture Media , Oligonucleotide Array Sequence Analysis , Pesticides/toxicityABSTRACT
The robotic surgical system can provide a stable, clear and magnified three-dimensional view, filter the surgeon's hand tremor, and hold robotic arms with multiple degrees of freedom to ensure flexible and stable operations, which overcomes the shortcomings of traditional laparoscopy. Although the robotic surgical system has been widely used in surgical fields such as urology, obstetrics and gynecology, its role in hepatic surgery has not been fully recognized. In this article, based on the relevant literatures and their own experience, the authors briefly discuss the indications of the application of robotic surgical system in liver surgery, safety and efficacy of robotic liver resection, learning curve of robotic hepatectomy, difficult robotic hepatectomy, the cost of robotic liver resection and other issues.
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Objective:To investigate the risk factors associated with death among patients with coronavirus disease 2019 (COVID-19).Methods:A total of 217 COVID-19 patients admitted to Zhongnan Hospital, Wuhan University from December 29, 2019 to January 31, 2020 were enrolled. The general conditions, clinical symptoms, comorbidities, laboratory test indicators and clinical outcomes of the COVID-19 patients were analyzed. According to prognosis, the COVID-19 patients were divided into the death group and the survival group, and the clinical manifestations and laboratory examination results of the two groups were compared by t test and chi-square test. The binary logistics regression model was used to analyze the risk factors related to death. Results:Among the 217 COVID-19 cases, 124 were males and 93 were females, as of March 4, 2020, 25 died and 192 survived, with the mortality of 11.5%. Eighty-nine patients (41.0%) had confirmed history of exposure to the Huanan seafood market or had close contact with another patient with confirmed COVID-19. Among the patients who died, 21(84.0%) were male, 21(84.0%) had comorbidities, 15(60.0%) had more than three types of clinical symptoms, 14(56.0%) had alaine aminotransferase or aspartate aminotransferase>1.5 upper limit of normal (ULN), 13(52.0%) had creatinine (Cr) >104 μmol/L, and 18(72.0%) had procalcitonin (PCT) >0.05 μg/L, whereas the above indicators among the survival patients were 103(53.6%), 95(49.5%), 92(47.9%), 23(12.0%), 14(7.3%) and 47(24.5%), respectively. The differences of the above indicators between the two groups were all statistically significant ( χ2=11.506, 7.889, 14.897, 30.307, 40.585 and 23.807, respectively, all P<0.01). The multivariate analysis results showed that age≥65 years old (odds ratio ( OR)=5.968, 95% confidence interval ( CI)1.991-17.888, P=0.001), male ( OR=6.009, 95% CI 2.504-14.422, P<0.01), comorbidities ( OR=7.152, 95% CI 2.058-24.851, P=0.002), having more than three types of clinical symptoms ( OR=7.944, 95% CI 2.280-27.676, P=0.001), alanine aminotransferase or aspartate aminotransferase>1.5×ULN ( OR=9.552, 95% CI 3.760-24.269, P<0.01), Cr>104 μmol/L ( OR=11.458, 95% CI 4.289-30.613, P<0.01), lactic acid dehydrogenase (LDH)>243 U/L ( OR=7.591, 95% CI 1.683-34.249, P=0.008) and PCT>0.05 μg/L( OR=12.410, 95% CI 4.433-34.744, P<0.01) were risk factors for death among COVID-19 infection patients. Conclusion:For elderly male COVID-19 patients with comorbidities, impaired liver and kidney functions, elevated LDH and PCT are early warning signs for disease deterioration.
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Objective:To analyze the clinical data of 203 discharged patients with corona virus disease 2019(COVID-19), and to investigate the predictors for the severe cases.Methods:Confirmed COVID-19 cases hospitalized at Zhongnan Hospital of Wuhan University from January 1 to February 1, 2020 were consecutively enrolled, who were divided into severe group and non-severe group.The clinical data of enrolled patients were collected and the clinical manifestations, laboratory results, imaging, treatments and prognosis of patients in the two groups were analyzed. Mann-Whitney U rank sum test and chi-square test were used for statistical analysis. Results:A total of 203 discharged patients with COVID-19 were enrolled. The common clinical manifestations included fever (89.2%, 181/203), dry cough (60.1%, 122/203), chest distress (35.5%, 72/203), shortness of breath(29.1%, 59/203)and myalgia or arthralgia (26.6%, 54/203). The time from disease onset to hospital admission was 5.8 days (1.0 to 20.0 days). Among 203 enrolled patients, 107(52.7%) were divided into severe group and 96(47.3%) were non-severe group. The age in severe group was 60 years (23 to 91 years), which was significantly older than non-severe group (47 years (20 to 86 years)), the difference was statistically significant ( Z=-6.12, P<0.01). There were 63.6%(68/107) patients in severe group with at least one underlying disease, which was significantly more than non-severe group (20.8% (20/96)), the difference was statistically significant ( χ2=37.60, P<0.01). The proportions of patients with increased white blood cells, decreased lymphocytes and albumin, elevated alanine aminotransferase, aspartate aminotransferase, creatinine, lactic acid dehydrogenase, creatine kinase, fasting blood glucose, D-dimer, erythrocyte sedimentation rate, C-reactive protein, interleukin-6, and procalcitonin in severe group were all higher. On admission, 172 patients (84.7%) had bilateral patchy shadows or ground glass opacity in the lungs on chest imaging study, 20(9.9%) presented pleural effusion. Fifty-five cases (27.1%) showed progressions of lung lesions on computed tomography (CT) rescan at an average interval of five days. Among 203 patients, 123(60.6%) were given oxygen therapy upon admission, 107(52.7%) were given short-term glucocorticoid therapy, and 131(64.5%) received antiviral therapy; and 26(12.8%) died. The hospital stay was 11.0 days (1.0 to 45.0 days). Conclusions:Fever is the most common symptoms in COVID-19 patients.Elderly and patients with underlying diseases are risk factors for progression to severe cases. The elderly patients should be strengthened early monitoring, paid attention to the control of underlying diseases, and reduce the occurrence of critical diseases.
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Surgeons need high sensitivity to the epidemic of Corona Virus Disease 2019 (COVID-19) and take preventive measures in hospital as early as possible. They need to totally play their roles in anti-epidemic to treat patients with acute and critical diseases as well as overall arrangement under the condition of adapting to epidemic situation.
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Postoperative pancreatic fistula (POPF) is the most common and critical complication after pancreatic body and tail resection. How to effectively reduce the occurrence of pancreatic fistula and conduct timely treatment thereafter is an urgent clinical issue to be solved. Recent research standardized the definition of pancreatic fistula and stressed the correlation between POPF classification and patient prognosis. According to the literature, identification of the risk factors for pancreatic fistula contributed to lowering the rate of the complication. Appropriate management of the pancreatic stump and perioperative treatment are of great significance to reduce the rate of POPF in clinical practice. After the occurrence of POPF, the treatment of choice should be determined according to the classification of the pancreatic fistula. However, despite the progress and promising treatment approaches, POPF remains to be a clinical issue that warrants further studies in the future.
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Novel coronavirus pneumonia (NCP) is a highly infectious disease, has a long incubation period and a variety of clinical manifestations, which has a significant impact on public health and life. Afterwards, scientific and standardized work processing during the epidemic is of great significance for prevention and control. In order to implement the central government's decision-making deployment and defeat the NCP as soon as possible, we had focused on the key points in the clinical work of general surgery according to latest relevant guidelines, literature and experience in epidemic prevention. Finally, we drafted the prevention and control strategies and recommendations to make a reference for medical staff of general surgery to fight NCP.
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Objective@#To investigate the safety and feasibility of longitudinal transpancreatic U-sutures invaginated pancreatojejunostomy (Chen′s pancreaticojejunostomy technique) in laparoscopic pancreaticoduodenectomy (LPD) .@*Methods@#Clinical data of 116 consecutive patients who underwent LPD using Chen′s pancreaticojejunostomy technique in Hunan Provincial People′s Hospital from May 2017 to December 2018 were retrospectively analyzed. Among these patients, 66 were males and 50 were females. The median age was 58 years old (32-84 yeas old). All 116 patients underwent pure laparoscopic whipple procedure with Child reconstruction method, using Chen′s pancreaticojejunostomy technique. The intraoperative and postoperative data of patients were analyzed.@*Results@#All 116 patients underwent LPD successfully. The mean operative time was (260.3±33.5) minutes (200-620 minutes). The mean time of pancreaticojejunostomy was (18.2±7.6) minutes (14-35 minutes) . The mean time of hepaticojejunostomy was (14.6±6.3) minutes (10-25 minutes). The mean time of gastrojejunostomy was (12.0±5.5) minutes (8-20 minutes). The mean estimated blood loss was (106.0±87.6) ml (20-800 ml). Postoperative complications were: 11.2% (13/116) of cases had postoperative pancreatic fistula (POPF) , including 10.3% (12/116) of biochemical fistula and 0.9% (1/116) of grade B POPF, no grade C POPF occurred; 10.3% (12/116) had gastrojejunal anastomotic bleeding; 3.4% (4/116) had hepaticojejunal anastomotic fistula; 3.4% (4/116) had delayed gastric emptying; 4.3% (5/116) had localized abdominal infection; 12.1% (14/116) had pulmonary infection; postoperative mortality were 0(0/116) and 1.7% (2/116) within 30 days and 90 days, respectively. One patient died of massive abdominal bleeding secondary to Gastroduodenal artery pseudoaneurysm rupture, the other patient died of extensive tumor recurrence and metastasis after surgery.@*Conclusions@#Chen′s pancreaticojejunostomy technique is safe and feasible for LPD.It is an option especially for surgeons who have not completed the learning curve of LPD.
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Objective@#To investigate the safety and feasibility of longitudinal transpancreatic U-sutures invaginated pancreatojejunostomy (Chen′s pancreaticojejunostomy technique) in laparoscopic pancreaticoduodenectomy (LPD).@*Methods@#Clinical data of 116 consecutive patients who underwent LPD using Chen′s pancreaticojejunostomy technique in Hunan Provincial People′s Hospital from May 2017 to December 2018 were retrospectively analyzed. Among these patients, 66 were males and 50 were females. The median age was 58 years old (32-84 yeas old). All 116 patients underwent pure laparoscopic whipple procedure with Child reconstruction method, using Chen′s pancreaticojejunostomy technique. The intraoperative and postoperative data of patients were analyzed.@*Results@#All 116 patients underwent LPD successfully. The mean operative time was (260.3±33.5) minutes (200-620 minutes). The mean time of pancreaticojejunostomy was (18.2±7.6) minutes (14-35 minutes). The mean time of hepaticojejunostomy was (14.6±6.3) minutes (10-25 minutes). The mean time of gastrojejunostomy was (12.0±5.5) minutes (8-20 minutes). The mean estimated blood loss was (106.0±87.6) ml (20-800 ml). Postoperative complications were: 11.2%(13/116) of cases had postoperative pancreatic fistula (POPF), including 10.3% (12/116) of biochemical fistula and 0.9%(1/116) of grade B POPF, no grade C POPF occurred; 10.3%(12/116) had gastrojejunal anastomotic bleeding; 3.4%(4/116) had hepaticojejunal anastomotic fistula; 3.4%(4/116) had delayed gastric emptying; 4.3% (5/116) had localized abdominal infection; 12.1%(14/116) had pulmonary infection; postoperative mortality were 0(0/116) and 1.7%(2/116) within 30 days and 90 days, respectively. One patient died of massive abdominal bleeding secondary to Gastroduodenal artery pseudoaneurysm rupture, the other patient died of extensive tumor recurrence and metastasis after surgery.@*Conclusions@#Chen′s pancreaticojejunostomy technique is safe and feasible for LPD.It is an option especially for surgeons who have not completed the learning curve of LPD.
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The five-year overall survival rate with liver cancer currently ranks the second lowest among seventeen common malignant tumors in China. The occurrence and development of liver cancer is a process of progressive exacerbation. Nowadays, the clinical research is mainly aimed at the intermediate stage, that is, the exploration of the principle and method of diagnosis and treatment in the hospital. Notably, the research on the precancerous stage and the recovery stage after treatment of liver cancer are still seriously inadequate. We put forward a stepwise strategy to emphasize that only the full course of prevention and treatment study on liver cancer patients can significantly improve the overall efficacy of liver cancer in China.
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Objective:To evaluate the effect of dexmedetomidine on the activity of nucleotide-binding oligomerization domain-like receptor containing pyrin domain (NLRP3) inflammasome in ventilator-induced lung injury (VILI) in mice.Methods:Eighty-four male SPF C57BL/6J mice, weighing 25-30 g, aged 2-3 months, were divided into 3 groups ( n=28 each) using a random number table method: control group (C group), VILI group and dexmedetomidine group (D group). The mice were tracheostomized and spontaneous breathing was maintained in group C, while the other mice were tracheostomized and mechanically ventilated for 4 h in VILI and D groups.Dexmedetomidine was infused in a loading dose of 1.0μg/kg for 20 min before intubation followed by continuous infusion of 1.0 μg·kg -1·h -1 for 4 h in group D. Blood samples were taken from the femoral artery for blood gas analysis before intubation and at 1, 2 and 4 h of mechanical ventilation (T 1-4), and PaO 2 was recorded for detection of PaO 2.Eight mice were selected at T 4 and sacrificed, and the broncho-alveolar lavage fluid (BALF) was collected for determination of the concentration of total protein, interleukin-1β (IL-1β) and interleukin-18 (IL-18). The lung tissues were removed for microscopic examination of pathologic changes which were scored and for determination of the wet to dry weight (W/D) ratio, expression of IL-1β and IL-18 mRNA (by real-time polymerase chain reaction), and expression of NLRP3, apoptosis-associated speck-like protein containing CARD (ASC), and caspase-1 (by Western blot). The other 20 mice in each group were observed for the 24-h survival rate. Results:Compared with group C, PaO 2 at T 3 and T 4 and 24-h survival rate were significantly decreased, and the lung injury score, W/D ratio, and concentrations of total protein, IL-1β, and IL-18 in BALF were increased, and the expression of NLRP3, ASC, caspase-1, IL-1β mRNA and IL-18 mRNA was up-regulated in VILI and D groups ( P<0.05). Compared with group VILI, the 24-h survival rate was significantly increased, the lung injury score, W/D ratio, and concentrations of total protein, IL-1β, and IL-18 in BALF were decreased, and the expression of NLRP3, ASC, caspase-1, IL-1β mRNA and IL-18 mRNA was down-regulated in group D ( P<0.05). Conclusion:The mechanism by which dexmedetomidine attenuates VILI may be related to inhibiting NLRP3 inflammasome activity in mice.