Association between perfluoroalkyl and polyfluoroalkyl substances and maternal thyroid-related hormones in pregnant women / 环境与职业医学

Background Exposure to perfluoroalkyl and polyfluoroalkyl substances (PFAS) during pregnancy might affect thyroid-related hormone levels in pregnant women. However, most previous studies focused on the effects of PFAS containing 8-10 carbon atoms, and few studies have estimated the associations between PFAS with longer carbon chain and thyroid-related hormone levels. Objective To examine the associations between PFAS exposure and thyroid-related hormones in pregnant women. Methods The present study was based on the Jiashan Birth Cohort from September 2016 to April 2018. We analyzed 13 PFAS in maternal blood samples (n=781) by high-performance liquid chromatography-tandem mass spectrometry, as well as total triiodothyronine (T3), total thyroxine (T4), free T3 (FT3), free T4 (FT4), thyroid stimulating hormone (TSH), thyroglobulin antibody (TG-Ab), and thyroid peroxidase antibody (TPOAb) by electrochemiluminescence immunoassay. PFAS were divided into three groups:low concentration, medium concentration and high concentration according to the tertile of their concentrations. We estimated the associations between PFAS concentrations and thyroid-related hormones in pregnant women by multiple linear regression. Results In the multiple linear regression models, a change in perfluorododecanoic acid (PFDoA) concentrations from the low concentration group to the high concentration group was associated with a −0.10 (95%CI: −0.20, 0) nmol·L−1 change in T3, −0.15 (95%CI: −0.28, −0.02) pmol·L−1 change in FT3, and −3.02 (95%CI: −5.66, −0.39) pmol·L−1 change in FT4, respectively. A change in perfluorotridecanoic acid (PFTrDA) concentrations from the low concentration group to the high concentration group was associated with a −0.10 (95%CI: −0.20, 0) nmol·L−1 change in T3. Compared with the low concentration group, the concentration of T4 in the medium concentration group of perfluorohexane sulfonate (PFHxS) increased by 6.10 (95%CI: 0.44, 11.75) nmol·L−1. No statistically significant associations were found between PFAS and TSH concentration. The negative associations of PFAS with thyroid-related hormones were more pronounced in pregnant women with positive TG-Ab and/or TPOAb. Conclusion Exposure to PFAS during pregnancy may affect thyroid-related hormone homeostasis in pregnant women, and the effect is stronger in TG-Ab and/or TPOAb-positive pregnant women.

Clinical efficacy of three-dimensional laparoscopic radical resection of rectal cancer with left colic artery preservation and natural orfice specimen extraction surgery / 中华消化外科杂志

Objective:To investigate the clinical efficacy of three-dimensional (3D) laparos-copic radical resection of rectal cancer with left colic artery preservation and natural orfice specimen extraction surgery (NOSES).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 186 patients with rectal cancer who were admitted to Henan Provincial People's Hospital from December 2018 to December 2019 were colleted. There were 120 males and 66 females, aged from 30 to 81 years, with a median age of 59 years. Patients underwent 3D laparoscopic radical resection of rectal cancer. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up using outpatient examination or telephone interview was conducted to detect survival of patients and tumor recurrence up to January 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers and percentages. Result:(1) Surgical situations: 186 patients with rectal cancer under-went 3D laparoscopic radical resection and postoperative with left colic artery preservation and NOSES. The operation time was (123±24)minutes, volume of intraoperative blood loss was (30±20)mL, the numer of lymph nodes dissected was 15±7. The time to postoperative first flatus, time to semiliquid food intake, time to postoperative out-of-bed activities were (2.3±0.7)days, (4.1±1.4)days, (2.9±1.0)days, respectively. The incidence of postoperative complications was 8.06%(15/186). The duration of postoperative hospital stay of 186 patients was (6.6±1.9)days and the treatment cost was (3.8±1.1) ten thousand yuan. Results of postoperative pathological examination showed 54 cases of low differentiated adenocarcinoma, 97 cases of moderate differentiated adenocarcinoma, 19 cases of high differentiated adenocarcinoma and 16 cases of mucinous adenocarcinoma. (2) Follow-up: 186 patients with rectal cancer were followed up for 13 to 24 months, with a median follow-up time of 13 months. During the follow-up, 18 patients had tumor recurrence or metastasis including 6 patients of death, 168 cases recovered well.Conclusion:3D laparoscopic radical resection of rectal cancer with left colic artery preservation and NOSES is safe and feasible.

Application of PCOA + NOSES with 3D high-resolution laparoscopic radical operation for left sided colon cancer / 中华普通外科杂志

Objective To evaluate PCOA + NOSES with 3D laparoscopy in the left colon cancer radical resection.Methods In this study 64 patients underwent PCOA + NOSES with 3D laparoscopic radical operation of the left colon cancer in He'nan Provincial People's Hospital from June 2016 to June 2019.Result The operation time was(146 ±53)min,time for anastomosis of PCOA was(30.3 ±2.5)min,intraoperative blood loss was (51 ±26)ml,the bowel function recovered in (2.1 ± 1.3)d,the time to semiliquid diet was (4.1 ± 1.4) d,time to being up and about was (1.3 ±0.6) d,the mean postoperative hospital stay was (5.4 ± 1.4) d,the number of lymph nodes dissection was (22 ± 9.5),the inhospital cost was (4.1 ± 1.2) ten thousand yuan.Complications developed in 4 patients (6％),one of intestinal obstruction,one of anastomotic leakage,one patient had ascites and infection,one suffred from pulmonary infection.Conclusion The PCOA + NOSES with 3D laparoscope in the left colon cancer radical resection was safe and feasible.

Application value of parallel and cross-to-overlap anastomosis method in three-dimensional laparoscopic radical resection of right hemicolon cancer / 中华消化外科杂志

Objective@#To investigate the application value of parallel and cross-to-overlap anastomosis method (PCOA) in three-dimensional (3D) laparoscopic radical resection of right hemicolon cancer.@*Methods@#The retrospective cross-sectional study was conducted. The clinicopathological data of 138 patients who underwent 3D laparoscopic radical resection of right hemicolon cancer at Henan Provincial People′s Hospital between July 2016 and July 2019 were collected. There were 83 males and 55 females, aged from 30 to 76 years, with a median age of 64 years. All the 138 patients with right hemicolon tumors were diagnosed as malignant tumors by enteroscopy and pathological examination before operation. The lymph node dissection and radical resection of right hemicolon cancer were performed according to the 9th edition of Japanese General Rules for Cancer of Colon, Rectum and Anus of the Japanese Colorectal Cancer Association. Observation indicators: (1) surgical situations; (2) postoperative conditions; (3) follow-up. Follow-up was conducted by outpatient examination or telephone interview to detect survival of patients and tumor recurrence and metastasis up to September 2019. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were represented as M (range). Count data were represented as percentages or absolute numbers.@*Results@#(1) Surgical situations: all the 138 patients underwent 3D laparoscopic radical resection of right hemicolon cancer using PCOA to reconstruct digestive tracts, without conversion to open surgery. The operation time, time for PCOA, and volume of intraoperative blood loss was (151.0±54.0)minutes, (20.1±2.0)minutes, and (60±21)mL. (2) Postoperative situations: the time to first flatus, time to semi-liquid food intake, length of auxiliary incision, and incidence rate of postoperative complications were (2.5±0.4)days, (4.0±1.3)days, (3.0±0.2)cm, and 3.62%(5/138), respectively. Of the 5 patients with postoperative complications, 1 patient with intestinal obstruction was cured after conservative treatment including gastrointestinal decompression and nutritional support, 1 patient with anastomotic leakage was cured after conservative treatment including gastrointestinal decompression, local patency drainage, infection control and nutritional support, 1 patient with ascites and abdominal infection was cured after computed tomography-guided percutaneous catheter drainage, 1 patient with incisional infection was cured by controlling infection, strengthening dressing changes, local irrigation and drainage, 1 patient with pulmonary infection was cured after anti-infective treatment.The number of lymph nodes dissected after surgery, duration of postoperative hospital stay, and hospital expenses were 19±8, (7.2±4.1)days, and (4.8±1.4)×104 yuan. All the 138 patients were confirmed as colonic adenocarcinoma by postoperative pathological examination, including 27 cases of poorly differentiated adenocarcinoma, 92 cases of moderately differentiated adenocarcinoma, 10 cases of highly differentiated adenocarcinoma, and 9 cases of mucinous adenocarcinoma. (3) Follow-up: 133 of 138 patients were followed up for 2-38 months, with a median follow-up time of 18 months. During the follow-up, 2 patients died, 1 of which was detected multiple liver metastases at postoperative 16 months and died at postoperative 21 months, and the other was detected multiple liver metastases at postoperative 20 months and died at postoperative 24 months. Eight patients had distant metastasis, including 5 cases of liver metastasis, 1 case of lung metastasis, and 2 cases of abdominal metastasis. The 10 patients with death and tumor metastasis were confirmed as stage Ⅲ by postoperative pathological examination, and the other 123 patients were generally in good condition.@*Conclusion@#PCOA is safe and effective for 3D laparoscopic radical resection of right hemicolon cancer.

Application value of parallel and cross-to-overlap anastomosis method in three-dimensional laparoscopic radical resection of right hemicolon cancer / 中华消化外科杂志

Objective To investigate the application value of parallel and cross-to-overlap anastomosis method (PCOA) in three-dimensional (3D) laparoscopic radical resection of right hemicolon cancer.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 138 patients who underwent 3D laparoscopic radical resection of right hemicolon cancer at Henan Provincial People's Hospital between July 2016 and July 2019 were collected.There were 83 males and 55 females,aged from 30 to 76 years,with a median age of 64 years.All the 138 patients with right hemicolon tumors were diagnosed as malignant tumors by enteroscopy and pathological examination before operation.The lymph node dissection and radical resection of right hemicolon cancer were performed according to the 9th edition of Japanese General Rules for Cancer of Colon,Rectum and Anus of the Japanese Colorectal Cancer Association.Observation indicators:(1) surgical situations;(2) postoperative conditions;(3) follow-up.Follow-up was conducted by outpatient examination or telephone interview to detect survival of patients and tumor recurrence and metastasis up to September 2019.Measurement data with normal distribution were represented as Mean ± SD.Measurement data with skewed distribution were represented as M (range).Count data were represented as percentages or absolute numbers.Results (1) Surgical situations:all the 138 patients underwent 3D laparoscopic radical resection of right hemicolon cancer using PCOA to reconstruct digestive tracts,without conversion to open surgery.The operation time,time for PCOA,and volume of intraoperative blood loss was (151.0±54.0)minutes,(20.1±2.0)minutes,and (60±21) mL.(2) Postoperative situations:the time to first flatus,time to semi-liquid food intake,length of auxiliary incision,and incidence rate of postoperative complications were (2.5±0.4)days,(4.0± 1.3)days,(3.0±0.2) cm,and 3.62％ (5/138),respectively.Of the 5 patients with postoperative complications,1 patient with intestinal obstruction was cured after conservative treatment including gastrointestinal decompression and nutritional support,1 patient with anastomotic leakage was cured after conservative treatment including gastrointestinal decompression,local patency drainage,infection control and nutritional support,1 patient with ascites and abdominal infection was cured after computed tomography-guided percutaneous catheter drainage,1 patient with incisional infection was cured by controlling infection,strengthening dressing changes,local irrigation and drainage,1 patient with pulmonary infection was cured after anti-infective treatment.The number of lymph nodes dissected after surgery,duration of postoperative hospital stay,and hospital expenses were 19±8,(7.2±4.1) days,and (4.8± 1.4) × 104 yuan.All the 138 patients were confirmed as colonic adenocarcinoma by postoperative pathological examination,including 27 cases of poorly differentiated adenocarcinoma,92 cases of moderately differentiated adenocarcinoma,10 cases of highly differentiated adenocarcinoma,and 9 cases of mucinous adenocarcinoma.(3) Follow-up:133 of 138 patients were followed up for 2-38 months,with a median follow-up time of 18 months.During the follow-up,2 patients died,1 of which was detected multiple liver metastases at postoperative 16 months and died at postoperative 21 months,and the other was detected multiple liver metastases at postoperative 20 months and died at postoperative 24 months.Eight patients had distant metastasis,including 5 cases of liver metastasis,1 case of lung metastasis,and 2 cases of abdominal metastasis.The 10 patients with death and tumor metastasis were confirmed as stage Ⅲ by postoperative pathological examination,and the other 123 patients were generally in good condition.Conclusion PCOA is safe and effective for 3D laparoscopic radical resection of right hemicolon cancer.

Clinical efficacy of laparoscopic gastric stump cancer resection / 中华普通外科杂志

Objective To investigate the clinical value of laparoscopic resection techniques in patients with gastric stump cancer.Methods From Oct 2012 to Oct 2015,the clinical data of 30 patients who had undergone laparoscopic resection for gastric stump cancer in the Department of Gastrointestinal Surgery of He'nan Province People's Hospital were analyzed retrospectively.Results Among the 30 patients,22 cases underwent laparoscopic radical gastrectomy,five cases did palliative gastrectomy and three cases were converted to open palliative resection.The average operation time of laparoscopic surgery was (200 ±55) min,average intraoperative blood loss was (110 ± 80) ml,average number of harvested lymph node was(19 ±7).The average time of first flatus was (3.0 ± 1.0) d.The average first time of semi liquid diet intake was (5.3 ±1.6) d.The average hospital stay was (8.0 ±2.8) d (7-15 d),and the cost of hospitalization was (5.9 ± 1.3) × 104 RMB.Postoperative complications occurred in 2 patients (7％),one with ascites and infection,one with pulmonary infection,all were cured.28 patients (93％) were followed up for a median time of 18 months (2-36 months).During the follow-up period,2 patients died of liver metastasis and 6 patients died of peritoneal metastasis.Conclusions Laparoscopic gastrectomy for gastric stump cancer is safe and feasible with satisfactory short-term outcome.

Clinical efficacy of three-dimensional laparoscopic resection for gastric stump cancer / 中华消化外科杂志

Objective To investigate the clinical efficacy of three-dimensional (3D) laparoscopic resection for gastric stump cancer.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 20 patients who underwent 3D laparoscopic resection for gastric stump cancer in the Henan Provincial People's Hospital between January 2015 and January 2018 were collected.All patients were diagnosed as malignant tumors through gastroscopy and pathological examination before operation,and underwent 3D laparoscopic resection for gastric stump cancer and lymph node dissection according to Japanese Classification of Gastric Carcinoma (ver.14).Observation indicators:(1) intra-and post-operative recovery situations;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival and tumor recurrence up to March 2018.Measurement data with normal distribution were represented as (-x)±s.Measurement data with skewed distribution were described as M (range).Results (1) Intra-and post-operative recovery situations:of 20 patients with gastric stump cancer,14 underwent 3D laparoscopic radical resection for gastric stump cancer (R0 resection and negative resection margin),4 underwent 3D laparoscopic palliative resection for gastric stump cancer and 2 were converted to open palliative resection for gastric stump cancer.Operation time,volume of intraoperative blood loss,number of lymph node dissected,time for postoperative out-of-bed activity,time to initial anal exsufflation,time for postoperative semi-fluid diet intake,duration of hospital stay and treatment expenses in 18 patients were (195±60) minutes,(105±85) mL,20±8,(1.6±0.8) days,(3.0±1.0) days,(5.5±1.8)days,(8.0±2.8) days and (5.5± 1.5) ×104 yuan,respectively.There was no surgery-related complication.(2) Follow-up and survival situations:of 20 patients,18 were followed up for 2-36 months,with a median time of 18 months.During the follow-up,6 patients died,including 2 dying of liver metastases and 4 dying of peritoneal metastases,12 had good conditions.Conclusion 3D laparoscopic resection for gastric stump cancer is safe and effective.

The effects of inhibiting AKT2 by siRNA on the proliferation and invasion of liver cancer cells / 中华肝胆外科杂志

Objective To study the effects of inhibing AKT2 by siRNA on SMMC7721 liver cancer cells proliferation,apoptosis,migration and invasion.Methods The siRNA targeting AKT2 was designedandthe SMMC7721AKT2- siRNAplasmidwasconstructed andtransfected into SMMC7721 cells.The stable cell lines were screened by G418.The effects of AKT2 by siRNA on SMMC7721 liver cancer cells,growth inhibition was evaluated by MTT assay.Cell cycle was analyzed by flowcytometry (FCM).Protein of P27 and CyclinD1 was evaluated by Western-blot.The ability of migration and invasion was evaluated by wound healing and Transwell assay.ResultsThe growth of SMMC7721 cells was significantly inhibited by siRNA (P＜0.05).Flow cytometry display that AKT2 by siRNA can induce G1 phase arrest,the ratio of G1 phase increased homologously and S phase declined homologously.The protein of CyclinD1 was declined and the protein of P27 was increased by Western-blot.Wound healing and Transwell assay show that the ability of cells,migration and invasion was inhibited by AKT2 by siRNA.Conclusion AKT2 by siRNA can significantly inhibit the growth of SMMC7721 cells,arrest cell cycle.AKT2 by siRNA can inhibit the ability of invasion and migration of SMMC7721 cells.

Laparoscopy assisted subtotal colectomy with antiperistalsis cecorectal anastomosis for slow transit constipation / 中华消化内镜杂志

Objective To investigate the clinical application value of laparoscopy-assisted subtotal colectomy with antiperistalsis cecorectal anastomosis for slow transit constipation (STC).Methods From September 2007 to October 2010,a total of 31 patients with STC underwent laparoscopic-assisted subtotal colectomy with antiperistalsis cecorectal anastomosis.A follow-up survey was completed at 3 and 12 months after the operation.Results No death or conversions to open operation occurred.The mean operation time,mean intraoperative blood loss and mean post-operative hospitalization were 260 min (180-310 min),60 ml (30-120 ml) and 8d (6-11 d),respectively.No postoperative infection,anastomotic stoma,adhesive intestinal obstruction or other perioperative complications occurred.In 3-month follow-up,constipation was significantly alleviated in 23 patients,mild diarrhea occurred in 5,diarrhea in 2 and mild recurrence in 1.Constipation was significantly alleviated in 25 patients,mild diarrhea occurred in 5 and mild recurrence in 1 at 12-month follow-up.Conclusion Laparoscopy-assisted subtotal colectomy with antiperistalsis cecorectal anastomosis is safe,effective and less invasive for STC.