Associations of cholecystectomy with the risk of colorectal cancer: a Mendelian randomization study / 中华医学杂志(英文版)

BACKGROUND@#Cholecystectomy is a standard surgery for patients suffering from gallbladder diseases, while the causal effects of cholecystectomy on colorectal cancer (CRC) and other complications are still unknown.@*METHODS@#We obtained genetic variants associated with cholecystectomy at a genome-wide significant level ( P value <5 × 10 -8 ) as instrumental variables (IVs) and performed Mendelian randomization (MR) to identify the complications of cholecystectomy. Furthermore, the cholelithiasis was also treated as the exposure to compare its causal effects to those of cholecystectomy, and multivariable MR analysis was carried out to judge whether the effect of cholecystectomy was independent of cholelithiasis. The study was reported based on Strengthening the Reporting of Observational Studies in Epidemiology Using Mendelian Randomization guidelines.@*RESULTS@#The selected IVs explained 1.76% variance of cholecystectomy. Our MR analysis suggested that cholecystectomy cannot elevate the risk of CRC (odds ratio [OR] =1.543, 95% confidence interval [CI]: 0.607-3.924). Also, it was not significant in either colon or rectum cancer. Intriguingly, cholecystectomy might decrease the risk of Crohn's disease (OR = 0.078, 95% CI: 0.016-0.368) and coronary heart disease (OR = 0.352, 95% CI: 0.164-0.756). However, it might increase the risk of irritable bowel syndrome (IBS) (OR = 7.573, 95% CI: 1.096-52.318). Cholelithiasis could increase the risk of CRC in the largest population (OR = 1.041, 95% CI: 1.010-1.073). The multivariable MR analysis suggested that genetic liability to cholelithiasis could increase the risk of CRC in the largest population (OR = 1.061, 95% CI: 1.002-1.125) after adjustment of cholecystectomy.@*CONCLUSIONS@#The study indicated that cholecystectomy might not increase the risk of CRC, but such a conclusion needs further proving by clinical equivalence. Additionally, it might increase the risk of IBS, which should be paid attention to in clinical practice.

Determining transfusion use in major burn patients: A retrospective review and analysis from 2009 to 2019.

Blood transfusion is an important treatment for patients with major burns. Understanding the predictive factors of blood product usage in major burns can improve effective transfusion therapy. We retrospectively reviewed the medical records of the Burn Center, First Affiliated Hospital of the Chinese Naval Military Medical University, from August 2009 to July 2019 and enrolled all patients with major burns treated in that decade. Basic information, condition, and blood-transfusion details of the patients were analyzed to identify predictive factors for blood use and prognosis. Despite a yearly decreasing trend, the frequency of use of blood-product usage in major burns was high at 57.72%, with 5.39 times and 28.76 units of blood usage per person. Burn area was the most important predictive factor for blood transfusion at different stages. Burn depth, combined with injury, age, and other factors, affected blood use. Blood use or volume correlated with prognosis; especially, platelet and cryoprecipitate use was significantly associated with increased mortality. Blood product usage in major burns patients is related not only to the clinical condition, but also to doctors' experience, which can predict prognosis. Blood use is associated with increased mortality, although we found no evidence of a causal association.

Predictive value of serum CTRP-3 and D-dimer for hyperacute transformation after thrombolysis in patients with cerebral infarction and their correlation with brain injury / 中华全科医师杂志

Objective:To evaluate serum complement C1q tumor necrosis factor related proteins-3 (CTRP-3) and D-dimer (D-D) in predicting hyperacute transformation after thrombolysis in patients with cerebral infarction, and their correlation with brain injury.Methods:One hundred and sixty patients with cerebral infarction admitted in our hospital from August 2016 to August 2019 were enrolled in the study. The hyperacute transformation occurred in 29 cases after intravenous thrombolysis (occurrence group) and did not occur in 131 cases (non-occurrence group). The serum CTRP-3, D-D levels and other factors that may cause hyperacute transformation were compared between the occurrence group and the non-occurrence group. Logistic regression analysis was used to analyze the risk factors of cerebral hemorrhage. The predictive values of serum CTRP-3 and D-D for hyperacute transformation in patients with cerebral infarction were analyzed with receiver operating characteristic (ROC)curve. The correlation between serum CTRP-3, D-D and brain injury was analyzed by Pearson correlation coefficient method.Results:The National Institute of Health stroke scale (NIHSS) score [(18.6±2.2) points vs. (14.0±2.1) points, t=10.62, P<0.01], proportion of infarct diameter >5 cm [69.0%(20/29) vs. 39.7%(52/131), χ 2=8.22, P<0.01], trial fibrillation rate[72.4%(21/29) vs. 44.3%(59/131), χ 2=7.52, P<0.01], and serum D-D levels [(3.02±0.31) mg/L vs. (2.24±0.23) mg/L, t=15.44, P<0.01] of the occurrence group were significantly higher than those of the non-occurrence group; while the serum CTRP-3 levels were lower than those of the non-occurrence group [(251.3±26.9) μg/L vs. (285.7±29.2) μg/L, t=5.82, P<0.01], the onset-to-needle time (OTN) was longer than that of the non-onset group [(4.61±0.43) h vs. (2.96±0.52) h, t=15.91, P<0.01]. Logistic regression analysis showed that pre-thrombosis NIHSS ( OR=1.69, 95 %CI: 1.02-2.15, P<0.01), proportion of infarct diamete r>5 cm ( OR=3.73, 95 %CI: 1.96-5.10, P=0.001), atrial fibrillation ( OR=2.14, 95 %CI: 1.25-2.96, P<0.01), OTN ( OR=3.44, 95 %CI: 1.85-5.02, P<0.01), serum DD ( OR=2.37, 95 %CI: 1.56-3.30, P<0.01) and serum CTRP-3 ( OR=2.9 d, 95 %CI: 1.91-4.25, P<0.01) were risk factors for hyperacute transformation in patients with cerebral infarction. ROC results showed that the area under the curve (AUC) of CTRP-3 and D-D for predicting hyperacute transformation in patients with cerebral infarction were 0.723 and 0.796, respectively; and the AUC of the combination of two indicators was 0.823. The anterior cerebral infarction occurred in 28 cases, the posterior cerebral infarction occured in 132 cases. The NIHSS score were(18.7±2.1)points and (14.0±1.9)points,respectively,and the modified Rankin Scale(mRS) score were(3.8±0.5)points and(3.2±0.6) points. Pearson correlation analysis showed that the serum CTRP-3 was negatively correlated with the NIHSS score of brain damage in patients with anterior circulation cerebral infarction ( r=-0.72, P<0.01), and the correlation was less strong with the NIHSS score in patients with posterior circulation cerebral infarction ( r=-0.35, P<0.01). The serum D-D was strongly positively correlated with NIHSS score of brain damage in patients with anterior circulation cerebral infarction ( r=0.88, P<0.01), and it was less strong with NIHSS score in patients with posterior circulation cerebral infarction ( r=0.24, P<0.01). The serum CTRP-3 was strongly positively correlated with brain injury mRS score ( r=0.80, P<0.01), and serum D-D was strongly negatively correlated with brain injury mRS score ( r=-0.76, P<0.01). Conclusion:The combined detection of serum CTRP-3 and D-D has a high predictive value for the occurrence of cerebral hemorrhage in hyperacute transformation after thrombolysis in patients with cerebral infarction, and two indicators have a certain correlation with brain injury of patients.

Clinical analysis of mini-invasive treatment for gallstone with non-dilated extrahepatic choledocholithiasis, experiences in 230 patients / 中华普通外科杂志

Objective:To evaluate the methods and effects of mini-invasive treatment of non-dilated common bile duct stones.Methods:From Oct 2015 to Dec 2018, clinical data of 230 cases of cholecystolithiasis combined with non-dilated common bile duct stones (choledochal diameter ≤8 mm) at our hospital were analyzed. The treatment methods included endoscopic retrograde cholangiopancreatography (ERCP)+ synchronous LC, ERCP+ nonsynchronous LC, laparoscopic transcyctic duct common bile duct exploration(LTCBDE).Results:In 69 out of 70 patients in the ERCP+ synchronous LC group stones were successfully extracted. In 118(118/120) cases out of the ERCP+ nonsynchronous LC group common bile duct stones were successfully removed, LTCBDE was performed in 38(38/40) cases and stones were successfully removed. There was no significant difference in the success rate among the three methods ( P>0.05), while patients in LTCBDE group had the shortest mean postoperative hospitalization time ( F=243.22, P=0.000) , the least average hospitalization cost ( F=300.40, P=0.000) and with lower incidence of complications (10.00%, P<0.05). Conclusions:It is of great importance to adopt the appropriate procedures for the mini-invasive treatment of non-dilated extrahepatic common bile duct stones. LTCBDE is the most suitable procedures for this purpose.

Research progress of lipolipomics in primary hepatocellular carcinoma / 中华肝脏病杂志

Presently, nonalcoholic fatty liver disease has become the most common pathogenic factor of chronic liver disease worldwide that can lead to the occurrence of hepatocellular carcinoma (HCC). Lipid metabolism in cancer cells is closely related to tumorgenesis, invasion and metastasis, and thus acts as one of the hallmark of cancer cells. Lipolipomics is an important branch of metabolomics, which has been adapted recently in the study of HCC for analysis of the structure and function of lipid components by chromatography and mass spectrometry. Fatty acids, glycerides, glycerophospholipids, sphingolipids, and sterol are significantly different in HCC tissues or serum. Therefore, it contributes to the diagnosis, determination of prognosis, mechanistic study and targeted therapy of HCC.

Bioinformatic analysis reveals CYP2C9 as a potential prognostic marker for HCC and liver cancer cell lines suitable for its mechanism study.

Hepatocellular carcinoma (HCC) is a common cancer and the sixth most lethal malignancy in the world. We chose gene expression profile of GSE14520 from GEO database aiming to find key genes that affect HCC progression. 22 paired tumor and non-tumor samples were included in this analysis. Differentially expressed genes (DEGs) between tumor and non-tumor were selected using GEO2R. Gene ontology (GO) enrichment and protein-protein interaction (PPI) of the DEGs were done using Metascape. There were 357 DEGs, including 70 up-regulated genes and 287 down-regulated genes. These DEGs were enriched in drug metabolic process, organic acid catabolic process, monocarboxylic metabolic process and etc. Three important modules were detected from PPI network using Molecular Complex Detection (MCODE) algorithm. Moreover, the Kaplan-Meier analysis for overall survival and disease-free survival were applied to those genes in top PPI group. In conclusion, this bioinformatic analysis demonstrated that DEGs, such as CYP2C9, might promote the development of HCC, especially in drug metabolism. It could also be used as a new biomarker for diagnosis.

Relating pancreatic ductal adenocarcinoma tumor samples and cell lines using gene expression data in translational research.

Cancer cell lines are useful tools to study cancer biology. Choosing proper cell lines based on experimental design for different experiments is vital. Relating tumors and cell lines, and recognizing their similarities and differences are thus very important for translational research. Abundant online databases with genomic and expression profile are suitable resources for conducting the assessment. Pancreatic ductal adenocarcinoma (PDAC) is a severe cancer with grim prognosis. Current effective treatments of PDAC remain limited. In this study, we compared the gene expression profile of 178 PDAC tumor samples from The Cancer Genome Atlas and 44 pancreatic cancer cell lines from Cancer Cell Line Encyclopedia. We showed that all pancreatic cancer cell lines resemble PDAC tumors but the correlation is different. Our study will be used to guide the selection of PDAC cell lines.

Antiseptic effect of compound lysostaphin disinfectant and its preventive effect on infection of artificial dermis after graft on full-thickness skin defect wound in rats / 中华烧伤杂志

Objective@#To study the antiseptic effect of compound lysostaphin disinfectant and its preventive effect on infection of artificial dermis after graft on full-thickness skin defect wound in rats.@*Methods@#(1) Each one standard strain of Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus were selected. Each 20 clinical strains of Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus were collected from those isolated from wound exudates of burn patients hospitalized in our wards from January 2014 to December 2016 according to the random number table. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of compound lysostaphin disinfectant to above-mentioned strains were detected. The experiment was repeated 3 times. Compared with the corresponding standard strain, the clinical strain with higher MIC and/or MBC was considered as having decreased sensitivity to the disinfectant. The percentage of strains of each of the three kinds of bacteria with decreased sensitivity was calculated. (2) Artificial dermis pieces were soaked in compound lysostaphin disinfectant for 5 min, 1 h, 2 h, and 4 h, respectively, with 21 pieces at each time point. After standing for 0 (immediately), 12, 24, 36, 48, 60, 72 h (with 3 pieces at each time point), respectively, the diameters of their inhibition zones to standard strains of Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus were measured. The experiment was repeated 3 times. The shortest soaking time corresponding to the longest standing time, after which the disinfectant-soaked artificial dermis could form an effective inhibition zone (with diameter more than 7 mm), was the sufficient soaking time of the disinfectant to the artificial dermis. (3) Forty Sprague-Dawley rats were divided into post injury day (PID) 3, 7, 14, and 21 sampling groups according to the random number table, with 10 rats in each group. A full-thickness skin defect wound with a diameter of 20 mm was made on both sides of the spine on the back of each rat. Immediately after injury, the artificial dermis without any treatment was grafted on the wound on left side of the spine (hereinafter referred to as control wound), while the sufficiently soaked artificial dermis with compound lysostaphin disinfectant was grafted on the wound on right side of the spine (hereinafter referred to as disinfectant wound). On PID 3, 7, 14, and 21, the gross condition of wounds of all the surviving rats was observed, and the new infection rates of control wounds and disinfectant wounds were calculated. Then, the rats in the sampling group with corresponding time were killed, and the full-thickness wound tissue containing artificial dermis was collected for quantitative analysis of bacteria. Bacteria content of the uninfected control wounds and that of the uninfected disinfectant wounds were compared. Data were processed with chi-square test and Wilcoxon rank sum test.@*Results@#(1) The MIC of compound lysostaphin disinfectant to standard strains of Staphylococcus aureus, Klebsiella pneumoniae, and Acinetobacter baumannii were 1/32, 1/32, and 1/512 of the original concentration of the disinfectant, respectively, and the MBC were 1/32, 1/16, and 1/512 of the original concentration of the disinfectant, respectively. The percentages of clinical strains of Klebsiella pneumoniae, Acinetobacter baumannii and Staphylococcus aureus with decreased sensitivity to compound lysostaphin disinfectant were 15% (3/20), 20% (4/20), and 10% (2/20), respectively. (2) After being soaked in compound lysostaphin disinfectant for 2 and 4 h, the longest standing time, after which the artificial dermis could form an effective inhibition zone against Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus, were 24, 36, and 48 h respectively, longer than 12, 24, and 24 h of soaking for 5 min and 24, 24, and 36 h of soaking for 1 h. The sufficient soaking time of compound lysostaphin disinfectant to artificial dermis was 2 h. (3) On PID 3, no infection symptom was observed in all the wounds, and so both the new infection rate of control wounds and that of disinfectant wounds were 0. The artificial dermis was transparent but not well connected with the wound. On PID 7, the new infection rate of control wounds was 20.00% (6/30), which was obviously higher than 3.33% (1/30) of disinfectant wounds, χ2=4.043, P<0.05. On the infected wound, a large amount of purulent exudates were observed, and the artificial dermis was not connected with the wound and degraded partially. On the uninfected wound, artificial dermis was transparent and had a partial connection with the wound. On PID 14 and 21, no new infected wound was observed, and so both the new infection rate of control wounds and that of disinfectant wounds were 0. There was no obvious improvement on the infected wounds. The collagen layers of artificial dermis in the uninfected wound established a good connection with the wound and were separating from the silica gel layer gradually. Infection occurred in 2, 3, 1 control wound (s) in PID 7, 14, and 21 sampling groups, respectively, and in 1 disinfectant wound in PID 14 sampling group. The bacteria content of the infected wounds tissue was 0.79×106 to 7.22×109 colony-forming unit (CFU)/g. The bacteria content of uninfected control wounds tissue in PID 3, 7, and 14 sampling groups were (3.43±1.88)×102, (2.37±0.43)×103, and (8.40±1.03)×103 CFU/g, respectively, which were significantly higher than (0.33±0.12)×102, (0.43±0.17)×103, (2.16±0.52)×103 CFU/g of uninfected disinfectant wounds tissue (Z=-3.780, -3.554, -3.334, P<0.05). The bacteria content of uninfected control wounds tissue and that of uninfected disinfectant wounds tissue in PID 21 sampling group were similar (Z=-0.490, P>0.05).@*Conclusions@#Compound lysostaphin disinfectant has quite strong antibacterial ability against Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus. Clinical strains of the three kinds of bacteria were highly sensitive to compound lysostaphin disinfectant. Saturation of absorption of compound lysostaphin disinfectant achieves in artificial dermis after 2 hours′ soaking. After 24, 36, and 48 hours′ standing, the soaked artificial dermis still has the antibacterial effect on Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus, respectively. The infection rate and the bacteria content of full-thickness skin defect wound in rats are all decreased when grafted with soaked artificial dermis.

Laparoscopic splenectomy plus selective pericardial devascularization for the treatment of portal hypertension / 中华普通外科杂志

Objective To summarize the efficacy and feasibility of laparoscopic splenectomy combined with selective pericardial devascularization for cirrhotic portal hypertension.Methods From January 2015 to January 2017,the clinical data of 29 cases of cirrhotic portal hypertension treated by laparoscopic splenectomy combined with selective pericardial devascularization were analyzed retrospectively.Results Laparoscopic surgery was successful in all but one cases,who was converted to open surgery.Theoperation time was (235 ± 54) min,intraoperative blood loss was (384 ± 262) ml.The spleen fever syndrome and splenic vein thrombosis were found in 1,2 patients respectively after operation.No serious complications of abdominal hemorrhage,pancreatic fistula and intra-abdominal infection were found.The postoperative hospital stay was (9.6 ± 1.9) d,patients were followed up for 3-6 months,and 3 cases had portal vein thrombosis.The liver function was well maintained.Conclusion Laparoscopic splenectomy combined with selective pericardial devascularization for treatment of portal hypertension is with high success rate and lower incidence of postoperative complications.

Short- and long-term outcomes of small auto- and cryopreserved allograft skin grafting in those with >60%TBSA deep burn wounds.

BACKGROUND: The shortage of autologous skin sources not only adds difficulty to the repair of extremely large-area deep burn wounds but affects the healing quality. The aim of the present study is to explore an ideal method for repairing large-areas burn wounds with low scar formation. METHODS: Between 2002 and 2014, we used grafting of small auto- and cryopreserved allo-skin to repair large-area residual burn wounds in wounds after 21 days 21 patients, and after early excision in 17 patients. The wound healing rate and quality were observed. RESULTS: The skin expansion rate was 1:9-1:16, and the mean area of wounds repaired after three weeks was 64.8±7.3%TBSA, the wound healing rate was 91.8±3.7%. The mean area of the early excision group was 65.9±9.8 TBSA, where the healing rate was 94.5±5.6%. After small auto- and cryopreserved allograft skin grafting, the epidermis of the auto-skin gradually replaced the allo-epidermis, and the allo-dermis persisted for a prolonged period. The dermal collagen fibers at the allo-skin grafting sites were well arranged. At 1-2-year follow-up, observation showed that the Vancouver Scar Scale total score was 4·304±2·363, and we did not discern significant contracture and dysfunction in the large joints of the four extremities. CONCLUSIONS: Small auto- and cryopreserved allograft skin grafting of small auto- and allo-skin not only raised the graft expansion rate but offers a stable wound healing rate. This new technique may provide an option for repair of large-area deep burn wounds.

Influence of P27RF-RhO mRNA gene silencing in drug sensitivity of 5-fluorouracil in liver cancer SMMC7721 cell line / 吉林大学学报(医学版)

Objective:To investigate the influence of P27RF-Rho mRNA gene silencing in the drug sensitivity of 5-fluorouracil(5-Fu)to the liver cancer SMMC cell line,and to provide theoretical basis for the treatment of advanced liver cancer.Methods:The P27RF-Rho RNAi vector was constructed and the P27RF-Rho gene silencing lentivirus were used to infect the SMMC7721 cells.Western blotting method was used to detect the gene silencing effect.The SMMC7721 cells were divided into Scramble-siRNA group, 5-Fu group, P27RF-Rho siRNA group and P27RF-Rho siRNA + 5-Fu group.Western blotting was used to detect the transfection efficiency of RNAi.MTT method was used to detect the cell growth in various groups.Scratching test was used to detect the migration ability of cells in various groups.Transwell experiment were used to detect the invasion ability of cells in various groups.The expressions of P27 and RhoC protein were detected by Western blotting method.Results:P27RF-Rho RNAi lentiviral vector was successfully constructed.The Western blotting results showed that the expression of P27RF-Rho protein in P27RF-Rho siRNA group was decreased compared with 5-Fu group and Scramble-siRNA group(P<0.05).Compared with other three groups, the growth speed of the cells in P27RF-Rho siRNA + 5-Fu group was significantly decreased(P<0.05).The migration ability of the cells in P27RF-Rho siRNA + 5-Fu group was significantly lower than those in other three groups (P<0.01);the average number of cells passing through the Transwell microporous membrane was significantly less than those in other three groups (P<0.01).The Western blotting analysis results showed that the expression level of P27 protein in the cells in P27RF-Rho siRNA + 5-Fu group was significantly higher than those in other three groups(P<0.05);the expression level of RhoC protein was significantly lower than those in other three groups(P<0.05).Conclusion:P27RF-Rho gene silencing can significantly enhance the drug sensitivity of 5-Fu to SMMC7721 cells.

Emergency laparoscopic splenectomy for the treatment of traumatic splenic rupture / 中华普通外科杂志

Objective To investigate the indications and clinical effect of emergency laparoscopic splenectomy for traumatic splenic rupture.Me,ods Clinical data of 30 traumatic splenic rupture patients undergoing emergency laparoscopic splenectomy from Aug 2011 to Mar 2016 in our hospital were analyzed retrospectively.Results.All patients were of simple traumatic spleen rupture without combined injuries.There were 2 cases of grade Ⅱ (6.7％),17 cases of grade Ⅲ (56.7％),10 cases of grade Ⅳ (33.3％),1 case of grade Ⅴ (3.3％).28 cases underwent successful laparoscopic splenectomy and 2 cases were converted to open surgery.22 cases used intraoperative autologous blood transfusion (73.3％),19 cases received blood transfusion (63.3 ％),average perioperative blood loss were (1 791 ± 643) ml,operation time were (135 ± 51) min,postoperative fasting time was (2.7 ± 1.8) d,postoperative hospital stay was (8 ± 5) d.The overall postoperative morbidity rate was 20％ (6/30),including pancreatic leakage in one,pleural effusions in 2,infections in 3.There were no operative mortality and other serious complications.Conclusions Emergency laparoscopic splenectomy is minimally invasive with faster recovery,less complication and shorter hospital stay.

Associating liver partition and portal vein ligation for staged hepatectomy in the treatment of hepatocellular carcinoma with cirrhosis / 中华消化外科杂志

Objective To investigate the safety and clinical effect of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in the treatment of hepatocellular carcinoma (HCC) with cirrhosis.Methods The retrospective cohort study was adopted.The clinical data of 5 patients with primary HCC with cirrhosis who underwent ALPPS at the First Bethune Hospital of Jilin University between October 2014 and August 2015 were collected.The surgical plan was determined according to preoperative liver function and liver functional reserve.The patients underwent portal vein (PV) ligation and liver partition in the first staged surgery.The second staged surgery was performed when growing future live remnant (FLR) came up to the standard of safe section by rescan of computed tomography (CT) at 10,14,18 days after the first staged surgery,and hemihepatectomy and hepatic segmentectomy were applied to patients.(1) The intraoperative situations were observed,including the severity of liver cirrhosis,first staged surgery time,volume of intraoperative blood loss and FLR in the first staged surgery,interval time of surgery,growth rate of liver volume,ratio of FLR and standard liver volume (SLV),time and volume of intraoperative blood loss in the second staged surgery.(2) Pre-and postoperative biochemical indicators in the first and second staged surgeries were detected,including total bilirubin (TBil) and alanine phosphatase (ALT).(3) Postoperative situations were observed,including occurrence of complications,results of pathological examination and duration of hospital stay.(4) The follow-up using telephone reservation and outpatient examination was performed to detect tumors recurrence and metastasis and survival of patients by imaging examination and tumor marker test up to November 2015.Count data were represented as mean (range).Results (1) Intraoperative situations:of 5 patients,there were 1 patient with F3 of liver cirrhosis and 4 with F4 of liver cirrhosis.One patient was complicated with lots of peritoneal effusion,followed by acute renal failure,and didn't receive the second staged surgery.Four patients underwent successful ALPPS.The first staged surgery of 5 patients:average operation time,volume of intraoperative blood loss,FLR,interval time of surgery,growth rate of liver volume,ratio of FLR and SLV were 282 minutes (range,240-320 minutes),500 mL (range,300-700 mL),457 em3(range,338-697 cm3),15 days (range,14-18 days),58％ (range,46％-67％) and 42％ (range,32％-44％),respectively.Average operation time and volume of intraoperative blood loss in second staged surgery were 220 minutes (range,200-260 minutes) and 412 mL (range,300-600 mL).(2) Pre-and post-operative biochemical indicators:levels of TBil and ALT of 5 patients from pre-operation to postoperative day 12 in the first staged surgery were from 4.9-30.4 μmol/L to 9.8-56.1 μmol/L and from 12.9-156.1 U/L to 46.3-207.3 U/L,respectively.Levels of TBil and ALT of 4 patients from pre-operation to postoperative day 10 in the second staged surgery were from 10.1-21.2μmol/L to 6.9-38.0 μmol/L and from 30.8-55.5 U/L to 19.8-72.8 U/L,respectively.(3) Postoperative situations:there were no perioperative death and postoperative complications of liver failure and intraperitoneal infection.One patient complicated with bile leakage was cured by non-operative treatment for 30 days.Results of pathological examination:5 patients were confirmed as Ⅱ-Ⅲ stage HCC,and 4 tumors had vascular tumor thrombi and negative resection margin with tumor size of 8-13 cm.Duration of hospital stay of 5 patients was 36 days (range,28-48 days).(4) Results of follow-up:4 patients undergoing successful ALPPS were followed up for 4-12 months.One patient was emerged with a new lesion of 2 cm in left half liver at postoperative month 7,level of AFP of which was 512 μg/L before the first staged surgery reduced to normal level at postoperative month 2,and then the patient received transcatheter arterial chemoembolization (TACE) and radio frequency ablation (RFA) treatments without tumor recurrence up to postoperative month 12.No tumor recurrence and new lesions in liver were detected in other 3 patients by abdominal enhanced scan of CT,with a normal level of AFP.Conclusion ALPPS is safe and feasible for HCC with cirrhosis,with a satisfactory short-term outcome.

Clinical immune tolerance after healing of acute graft-versus-host disease following liver transplantation:one case report / 中华器官移植杂志

Objective A successful salvage treatment of acute graft-versus-host disease (GVHD) after liver transplantation(OLT) with prognosis of immune tolerance was reported and the treatment experience was summed up.Methods A 46-year-old man with hepatic carcinoma recurrence after resection underwent OLT from an ABO-identical male donor after cardiac death due to brain death.Post-transplant immunosuppression regimens consisted of induction with anti-interleukin-2 receptor monoclonal antibody (basiliximab) followed by maintenance with tacrolimus,mycophenolate mofetil and low dose of steroids.On the postoperative day (POD) 20,the patient developed skin rashes on his limbs and trunk,and skin biopsy showed histological features consistent with acute GHVD.Donor-recipient dominant HLA was matched at 6 loci,with donor CD3 + T-cell chimerism positive Results Immunosuppressants were withdrawn.Basilixirnab combined with high dose of steroids was used,and the dosage was quickly reduced.Anti-irnfection treatment was strengthened.The skin rash recovered quickly,while the hemogram was significantly decreased,which was insensitive to colony stimulating factor.The fever came back with the skin rash on the POD 46.The modified hormone regimen was used,low dose of steroids with slowly reduction,and the patient recovered with the normal hepatic function.Conclsion With the untypical clinical presentation,pathological examination,HLA-matching and chimerisms,aGVHD could be early detected and diagnosed,with a therapy of low dose of steroids with slow reduction combined with basiliximab.Recipient achieved immune tolerance,which may result from the high match of HLA and chimerisms.

Clinical efficacy of combined three-endoscopic minimally invasive surgical treatment of extrahepatic cholangiolithiasis in 2 364 patients / 中华消化外科杂志

Objective To investigate the indications and clinical efficacy of combined application of laparoscope,choledochoscope and duodenoscope in the treatment of extrahepatic cholangiolithiasis.Methods The retrospective cohort study was adopted.The chnical data of 2 364 patients with extrahepatic cholangiolithiasis who were admitted to the First Hospital of Jilin University from January 2008 to December 2015 were collected.Of the 2 364 patients,861 patients had cholecystolithiasis combined with extrahepatic cholangiolithiasis and the diameter of common bile duct ≥ 8 mm,720 patients had cholecystolithiasis combine with extrahepatic cholangiolithiasis and the diameter of common bile duct ＜ 8 mm,783 patients had only extarhepatic cholangiolithiasis.In the patients diagnosed as cholecystolithiasis combined with extrahepatic changiolithiasis,laparoscopic cholecystectomy (LC) + laparoscopic common bile duct exploration (LCBDE) were applied to patients with the diameter of common bile duct≥8 mm,and the T-tube placement or primary suture was used intraoperatively according to the status of individualized patients;endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilation (EPBD) + LC were applied to patients with the diameter of common bile duct ＜ 8 mm.For patients with only extrahepatic cholangiolithiasis or recurrent stones after cholecystectomy,EST or EPBD was applied,and LCBDE was applied to patients with multiple stones and maximum diameter ＞ 2 cm and unsuitable for EST or EPBD.If residual stones were found after operation in patients with T-tube placement,choledochoscope was used to extract stone;otherwise,EST or EPBD was used.Treatment outcomes including treatment method,success rate of minimally invasive lithotomy,operation time,incidence of complication,duration of postoperative hospital stay and treatment expenses,and the results of follow-up including 1-,3-year recurrence rate of stones were recorded.The follow-up was done by outpatient examination and telephone interview till January 2016.All the patients were reexamined blood routine,liver function and color doppler ultrasonography of the abdomen at 1 month,3 months,6 months,1 year and 3 years after operation.Suspected residual cholangiolithiasis found by ultrasound was varified by computer tomography (CT) or magnetic resonanced cholangiopancreatography (MRCP) imaging examination.For patients with T-tube placement,CT scan and biliary photography were performed at 2-3 months postoperatively to determine whether residual stones existed and T tube could be pulled out.Measurement data were presented as mean (range).Results Of 2 364 patients,2 271 patients received minimally invasive lithotomy successfully.Of 861 patients of cholecystolithiasis combined with extrahepatic cholangiolithiasis and the diameter of common bile duct≥8 mm,836 succeeded in minimally invasive lithotomy,with a success rate of 97.10％ (836/861),the other 25 patients were converted to open surgery.Seven hundred and three patients of 836 patients received T-tube placement in LCBDE,and the mean operation time,incidence of complications,duration of postoperative hospital stay and treatment expenses were 97 minutes (range,41-167 minutes),3.70％ (26/703),6.7 days (range,3.0-32.0 days) and 3.4 × 104 yuan (range,1.5 × 104-6.7 × 104 yuan),respectively.One hundred and thirtythree patients of 836 patients received primary suture,and the mean operation time,incidence of complications,duration of postoperative hospital stay and treatment expenses were 89 minutes (range,39-123 minutes),3.01％ (4/133),4.1 days (range,2.0-17.0 days),2.1 × 104 yuan (range,1.6 × 104-3.4 × 104 yuan),respectively.Of 720 patients with the diameter of common bile duct ＜ 8 mm who underwent EST or EPBD + LC,687 succeeded in minimally invasive lithotomy,with a success rate of 95.42％ (687/720),the other 33 patients were converted to open surgery.The mean operation time,incidence of complications,duration of postoperative hospital stay and treatment expenses of 687 patients were 101 minutes (range,69-163 minutes),2.91％ (20/687),5.6 days (range,2.0-15.0 days) and 2.8 × 104 yuan (range,2.0 × 104-6.4 × 104 yuan),respectively.In 783 patients with only extrahepatic cholangiolithiasis or recurrent stones after cholecystectomy,701 of 725 patients who were treated with EST or EPBD succeeded in minimally invasive lithotomy,with a success rate of 96.69％ (701/ 725),and the mean operation time,incidence of complications,duration of postoperative hospital stay and treatment expenses of 701 patients were 47 minutes (range,11-79 minutes),2.28％ (16/701),3.7 days (range,2.0-19.0 days),1.7 × 104 yuan (range,1.3 × 104-5.5 × 104 yuan),respectively;47 of 58 patients who were treated with LCBDE succeeded in lithotomy,with a success rate of 81.03％ (47/58),and the mean operation time,incidence of complications,duration of postoperative hospital stay and treatment expenses were 124 minutes (range,94-170 minutes),8.51％ (4/47),7.9 days (range,5.0-21.0 days) and 3.8 × 104 yuan (range,2.3 × 104-7.9 × 104 yuan),respectively.Of 2 364 patients,2 207 were followed up for a mean time of 38 months (range,1-72 months).The 1-,3-year recurrence rates were 2.74％ (19/693) and 5.08％ (24/472) in patients receiving LC + LCBDE,3.10％ (21/677) and 5.69％ (30/527)in patients receiving EST or EPBD +LC for cholecystolithiasis combined with extrahepatic cholangiolithiasis.The 1-,3-year recurrence rates were 3.22％ (20/621) and 6.11％ (25/409) in patients receiving EST or EPBD + LC,7.32％ (3/41) and 11.11％(2/18) in patients receiving LCBDE for only extrahepatic cholangiolithiasis or recurrent stones after cholecystectomy.Conclusions It is safe and effective to treat extrahepatic cholangiolithiasis based on combined application of laparoscope,choledochoscope and duodenoscope,with choosing appropriate indications as the key to improve the therapeutic effect.Primary suture in the LCBDE is recommended because it can protect patients from T-tube placement.

Assessment of interventional therapy for acute myocardial infarction patients complicated with acute ventricular septal rupture / 中国介入心脏病学杂志

Objective To evaluate the clinical efficacy of interventional occlusion of ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI). Methods Six patients with VSR complicated after AMI underwent transcatheter interventional occlusion in Chinese PLA General Hospital between May 2009 to May 2015 were retrospectively analyzed. Their clinical features, interventional treatment protocols, and occurance of postoperative complications were studied. Results Among the 6 patients, VSR were successfully occluded in 5 patients. One patient failed the operation due to instability of occluder after it was deployed and the occluder was retrieved. The paitents died of heart failure 6 months later. Among the 5 patients with successful closure, 4 patients presented mild residual shunt after occlusion and acute left heart failure occurred in 1 patient after operation. Two patients died during hospital stay after operation. Between them, one patient died 3 hours after operation because of cardiac tamponade and the other patient died of cardiogenic shock after withdrawal from IABP. Three patients were followed up until now and follow up echocardiography showed satisfactory cardiac function without heart failure. Conclusions Transcatheter occlusion was a reliable therapy for patients with ventricular septal rupture complicated in acute myocardial infarction which could improve cardiac function and reduce mortality.

Influence of lentiviral-mediated P27RF-Rho gene silence in invasion of liver cancer cells / 吉林大学学报(医学版)

Objective:To investigate the silencing of P27RF-Rho gene with lenvirus targeting mediated technique,and to clarify its influence in the invasion of liver cancer cells.Methods:The P27RF-Rho RNAi lentivirus was constructed. The liver cancer BEL7402 cells were infected with lentivirus. The experiment was divided into P27RF Rho-siRNA group, scramble-siRNA group and BEL7402 group.The effect of silencing P27RF-Rho gene and the expression levels of hepatocellular carcinoma (HCC)associated proteins RhoA,RhoC, VEGF,P53 and PTEN were detected;the activities of matrix metalloproteinase (MMPs)associated with tumor invasion were analyzed by Gelatin zymography;the variation of transfer ability and invasion abilities were compared by Wound healing assay experiment and Transwell experiment.Results:The Western blotting results showed the expression levels of P27RF-Rho,RhoA,RhoC,and VEGF proteins in the BEL7402 cells in experiment group were significantly lower than those in two control groups (P<0.05),and the expression levels of P53 and PTEN were higher than those in two control groups (P<0.05).The results of Gelatin zymography showed the activities of MMPs in experiment group were significantly lower than those in two control groups (P<0.01 );Wound healing assay showed that the migration ability of the BEL7402 cells in experiment group was significantly inhibited (P<0.01);the number of cells passed through the Transwell Chambers in experiment group was significantly less than those in two control groups (P<0.01).Conclusion:Silenceing P27RF-Rho can weaken the invasion ability and migration ability of human HCC BEL7402 cells.

Effect of Acupuncture and Rehabilitation Training on the Quality of Survival and Cognitive Function of Patients with Brain Injuries / 沈阳医学院学报

Objective:To explore the effect of acupuncture and rehabilitation training on the quality of survival and cognitive function of patients with brain injuries. Methods:A total of 76 patients with brain injuries treated in our department from Jan 2014 to Apr 2015 were selected as the research object (n=76) . They were randomly divided into two groups, observation group and control group, 38 in each group. The patients in control group were treated by acupuncture and routine care. The patients in observation group were treated by acupuncture and rehabilitation training. The patients' cognitive function, life quality, ability of daily life were observed. Results:Before the treatment,the LOTCA and ADL scores of both groups had no significance for statistics (P>0.05) but improved after the treatment. At 4,8 weeks after treatment,the LOTCA and ADL scores in observation group were higher than those in control group (P<0.05) WHOQOL-BREF was used to survey the quality of survival,and the scores of mental health, psychological health, interpersonal relationship and social relationship in observation group were also higher than those in control group (P<0.05) . Conclusion:Brain injury patients treated with acupuncture and rehabilitation training can improve the patients' cognitive function,ability of daily life and quality of survival,and would be conducive to the long-term prognosis,which is worthy of promotion.

Research advances in 125I radioactive seed implantation for treatment of unresectable pancreatic cancer / 临床肝胆病杂志

In recent years, 125I radioactive seed implantation has been greatly developed for the treatment of unresectable pancreatic cancer, and clinical practice shows that it has good therapeutic effects in relieving pain, controlling local tumor progression, and prolonging patients′ survival time. This article introduces the physical and biological features of 125I radioactive seeds and the advantages and disadvantages of implantation, as well as the therapeutic method, surgical safety, and clinical effects of 125I radioactive seed implantation in the treatment of unresectable pancreatic cancer. This article points out that it is an effective therapeutic method and should be widely applied in well-equipped hospitals.

Chinical experience of laparoscopic spleen-preserving distal pancreatectomy / 临床肝胆病杂志

Due to the limitations of laparoscopic surgery, the lack of special instrument, and the particular location, structure, and function of the pancreas, laparoscopic pancreatic surgery develops slowly and is used only for diagnosis. With the innovation of laparoscopic instruments, the increases in operative experience, and the improvement in laparoscopic technology, laparoscopic distal pancreatectomy is safe and effective for the appropriate cases. In order to avoid the splenectomy-associated complications, laparoscopic spleen-preserving distal pancreatectomy is preferable. There are mainly two methods to preserve the spleen: Kimura′s method and Warshaw′s method. The Kimura′s method is a difficult technology and has a high risk, but it can preserve all functions of the spleen and has few complications. The Warshaw′s method has a narrow indication, a low risk of bleeding, and a short operation time, but it has a high incidence of complications and can hardly preserve all functions of the spleen. Therefore, the Kimura′s method is the first choice to preserve the spleen and the Warshaw′s method is a replacement technology.