The value of transanal multipoint full-layer puncture biopsy in determining the response degree of rectal cancer following neoadjuvant therapy: a prospective multicenter study / 中华外科杂志

Objective: To verify the feasibility and accuracy of the transanal multipoint full-layer puncture biopsy (TMFP) technique in determining the residual status of cancer foci after neoadjuvant therapy (nCRT) in rectal cancer. Methods: Between April 2020 and November 2022, a total of 78 patients from the Beijing Chaoyang Hospital of Capital Medical University, the Beijing Friendship Hospital of Capital Medical University, the Qilu Hospital of Shandong University, the Zhongnan Hospital of Wuhan University with advanced rectal cancer received TMFP after nCRT participated in this prospective multicenter trial. There were 53 males and 25 females, aged (M(IQR)) 61 (13) years (range: 35 to 77 years). The tumor distance from the anal verge was 5 (3) cm (range: 2 to 10 cm). The waiting time between nCRT and TMFP was 73 (26) days (range: 33 to 330 days). 13-point transanal puncture was performed with a 16 G tissue biopsy needle with the residual lesion as the center. The specimens were submitted for independent examination and the complications of the puncture were recorded. The consistency of TMFP and radical operation specimen was compared. The consistency of TMPF with clinical remission rates for the diagnosis of complete pathological remission was compared by sensitivity, specificity, negative predictive value, positive predictive value and accuracy. Statistical analysis between groups was performed using the χ2 analysis, and a paired χ2 test was used to compare diagnostic validity. Results: Before TMFP, clinical complete response (cCR) was evaluated in 27 cases. Thirty-six cases received in vivo puncture, the number of punctures in each patient was 13 (8) (range: 4 to 20), 24 cases of tumor residue were found in the puncture specimens. The sensitivity to judgment (100% vs. 60%, χ2=17.500, P<0.01) and accuracy (88.5% vs. 74.4%, χ2=5.125, P=0.024) of TMFP for the pathologic complete response (pCR) were significantly higher than those of cCR. Implement TMFP based on cCR judgment, the accuracy increased from 74.4% to 92.6% (χ2=4.026, P=0.045). The accuracy of the in vivo puncture was 94.4%, which was 83.3% of the in vitro puncture (χ2=1.382, P=0.240). Overall, the accuracy of TMFP improved gradually with an increasing number of cases (χ2=7.112, P=0.029). Conclusion: TMFP is safe and feasible, which improves the sensitivity and accuracy of rectal cancer pCR determination after nCRT, provides a pathological basis for cCR determination, and contributes to the safe development of the watch and wait policy.

Risk factors and functional evaluation of recurrence after resection of thigh soft tissue malignant tumor / 中华骨科杂志

Objective:To explore the risk factors of recurrence after resection of thigh soft tissue malignant tumors and the evaluation of the postoperative lower limb function.Methods:A total of 211 patients who underwent thigh soft tissue malignant tumor resection in the Department of Orthopaedics of the second affiliated Hospital of Medical College of Zhejiang University from May 2011 to May 2021 were retrospectively analyzed, including 117 males and 94 females, aged 53 (43, 65) years. There were 59 cases of atypical/well-differentiated liposarcoma, 30 cases of other types of liposarcoma, 33 cases of malignant fibrous histiocytoma, 19 cases of fibrosarcoma, 12 cases of rhabdomyosarcoma, 12 cases of leiomyosarcoma, 9 cases of synovial sarcoma, and 37 cases of others. The tumor involvement of muscle, bone, blood vessel, nerve tissue and intermuscular compartment, postoperative Musculoskeletal Tumor Society (MSTS) functional score and recurrence were recorded. The relationship between anatomical structure and postoperative recurrence was analyzed by Cox logistic regression to determine risk factors; the cumulative recurrence rate of different compartment groups (medial compartment, anterior compartment, and posterior compartment) were compared; The Box plot was used to compare the postoperative function of patients with resection of different anatomical structures (e.g., vastus lateralis, biceps femoris, femur, etc.).Results:A total of 34 out of 211 patients relapsed, with a recurrence rate of 16.1%. The recurrence time ranged from 2.6 months to 91.6 months after operation, with a median recurrence time of 37.0 (18.2, 52.8) months. Three independent risk factors were found to be associated with recurrence, namely: pathological grade [ HR=3.86, 95% CI(1.75, 8.51)], involvement of vastus intermedius [ HR=3.05, 95% CI(1.53, 6.06)], and involvement of vastus medialis [ HR=3.17, 95% CI(1.56, 6.41)]. The recurrence rate of patients with anterior chamber tumor resection was 35.3%, which was higher than that of patients without tumor resection (16.2%), and the difference was statistically significant ( P=0.020). There was no significant difference in recurrence rate between patients with medial chamber tumor resection and patients without tumor resection ( P>0.05). The recurrence rate of patients with posterior compartment tumor resection was 12.3%, which was lower than that of unresectable patients (37.6%), and the difference was statistically significant ( P=0.002).The postoperative MSTS score of 167 patients averaged 26±3.2 points (9-30 points). After intraoperative resection of part of the femur, vastus intermedius, vastus medialis, and rectus femoris, the patient's function was relatively poor [corresponding median MSTS score: 25 (23, 28), 26 (24 28), 26 (24,28), 26(24, 27)]. Conclusion:The risk factors for local recurrence after resection of thigh soft tissue malignant tumors include: pathological grade of the tumor, and whether the vastus intermedius or vastus medialis is involved. Anterior compartment tumors have a higher recurrence rate after surgery. If the tumor involves the above-mentioned anatomical structures, more attention should be paid to the risk of local recurrence after surgery.

Mini-open excision of osteoid osteoma using burrs with the guidance of O-arm navigation / 中华骨科杂志

Objective:To investigate the surgical method and clinical effect of O-arm navigation mini-open burring for osteoid osteoma.Methods:Eighteen patients with osteoid osteoma were treated with O-arm guided grinding drill from June 2021 to May 2022, including 15 males and 3 females, the age was (18.4 ±10.9) years (range 2 to 44 years), and the course of disease ranged from 1 week to 3 years (mean 14.2 months). The lesions sites included 6 cases of proximal femur, 3 cases of distal femur, 4 cases of proximal tibia, 1 case of distal tibia, 2 cases of proximal fibula and 1 case of distal and proximal humerus. During the operation, the O-arm navigation was used to determine the location of the focus, the muscle and soft tissue was peeled off to the bone surface through a 1-4 cm small incision, the channel retractor was placed, and the burr was registered as a navigation recognition device to gradually remove the bone on the surface of the tumor nest, and the tumor nest was scraped with a curette for pathological examination; according to the navigation image, the focus was enlarged removed with burr and the grinding range was confirmed by the O-arm X-ray machine before the end of the operation. The patients were followed up for 6 to 15 months (mean 9.5 months). CT scans were performed before and after surgery for imaging comparison in order to figure out whether it had residual lesions or recurrence. The visual analogue score (VAS) of pain was used as a parameter for evaluating the clinical efficacy.Results:The operation time of 18 cases was 40-175 min, with an average of 89.3 min. The time required to establish navigation image was 18.0 ±4.1 min (range 13 ~ 22 min). The length of the incision was 2.7±1.1 cm (range 1-4 cm). All patients achieved complete curettage of the lesions, and osteoid osteoma was confirmed by pathology after operation. All the patients could move to the ground 24 hours after operation, and the pain was significantly relieved from 3 to 7 d after operation, and the pain almost disappeared 3 months after operation. The VAS score of 18 cases was 5.33±1.24 before surgery, 2.79±1.32 on the 3rd day, 1.86±1.21 on the 7th day, 0.86±0.93 on the 1st month, 0.33±0.48 on the 3rd month, and 0.09±0.29 on the 6th month after operation, and the difference was statistically significant ( F=58.50, P<0.001). There were no serious complications during and after operation, and the success rate of treatment (no recurrence of symptoms, no residual recurrence of imaging lesions, no serious complications after operation) was 100%. Conclusion:Treatment of osteoid osteoma with mini-open excision using burrs under the navigation of O-arm is a simple, safe, minimally invasive and efficient technique. Intraoperative precise positioning and the use of burr with navigation to remove a larger area than the tumor nest are the keys to successful treatment.

Clinical features and prevention of dislocation after resection and reconstruction of tumors involving pelvic area II / 中华骨科杂志

Objective:To explore the clinical characteristics of dislocation after resection and reconstruction of tumors involving pelvic area II, and to try to propose intraoperative and postoperative techniques to prevent its occurrence.Methods:From March 2011 to March 2021, 122 patients with resection and reconstruction involving pelvic area II were retrospectively analyzed. Among them, 17 had postoperative dislocation, 32 had pelvic area II, and 31 had pelvic area I+II. There were 40 cases in the pelvic area II+III, and 19 cases in the pelvic area I+II+III. There were 49 female patients and 73 male patients; the mean age was 47 years (9-73 years). The Musculoskeletal Tumor Society (MSTS) score of lower extremity patients after reduction was evaluated, and the clinical characteristics of dislocation, such as dislocation direction, dislocation time and reduction method, were counted and analyzed, and feasible prevention measures were analyzed based on the imaging characteristics after resection and reconstruction. dislocation method.Results:Among the 122 patients, there were 17 cases of dislocation, and the dislocation rate was 13.7%. Among them, 12 cases were anterior dislocation, accounting for 70.6% of anterior dislocation; 5 cases were posterior dislocation, and the proportion of posterior dislocation was 29.4%, difference (χ 2=4.52, P=0.033). There were 12 cases of dislocation within 3 months after operation, accounting for 70.6%; 1 case of dislocation occurred in 5 months after operation, and the other 4 cases of dislocation occurred for more than one year. The MSTS score of the dislocation patients after reduction was 56.1±15.6% (20%-80%). Combined with postoperative imaging examinations, the feasible methods for preventing dislocation include: The anteversion angle of the acetabular cup can be appropriately reduced (0°-10°); The acetabular cup can be appropriately shifted to the rear of the rotation center; Appropriately reducing the anteversion angle of the femoral neck prosthesis, the combination of the three can reduce the occurrence of femoral-acetabular prosthesis impingement; at the same time, the affected limb is controlled in a neutral position with strict nail shoes after surgery to avoid the occurrence of external rotation. Conclusion:The dislocation after tumor resection and reconstruction in pelvic area II is mostly anterior dislocation. Postoperative CT scan of the pelvis shows that the space between the neck of the femoral stem prosthesis and the lower edge of the acetabulum is small, which is prone to impingement. If the anteversion angle of the acetabular cup is appropriately reduced, the acetabular prosthesis is appropriately displaced posteriorly, and the anteversion angle of the femoral neck is reduced by 5°, the possibility of femoral-acetabular impingement can be reduced, thereby reducing the risk of postoperative dislocation.

Advances in tissue state recognition in spinal surgery: a review / 医学前沿

Spinal disease is an important cause of cervical discomfort, low back pain, radiating pain in the limbs, and neurogenic intermittent claudication, and its incidence is increasing annually. From the etiological viewpoint, these symptoms are directly caused by the compression of the spinal cord, nerve roots, and blood vessels and are most effectively treated with surgery. Spinal surgeries are primarily performed using two different techniques: spinal canal decompression and internal fixation. In the past, tactile sensation was the primary method used by surgeons to understand the state of the tissue within the operating area. However, this method has several disadvantages because of its subjectivity. Therefore, it has become the focus of spinal surgery research so as to strengthen the objectivity of tissue state recognition, improve the accuracy of safe area location, and avoid surgical injury to tissues. Aside from traditional imaging methods, surgical sensing techniques based on force, bioelectrical impedance, and other methods have been gradually developed and tested in the clinical setting. This article reviews the progress of different tissue state recognition methods in spinal surgery and summarizes their advantages and disadvantages.

3D printed hemipelvic prosthesis for treatment of pelvic malignant tumors resected via sacroiliac joint / 中华骨科杂志

Objective:To analyze the surgical techniques, surgical indications and early clinical effects of 3D printed hemipelvic prostheses in the reconstruction of pelvic malignant tumors resected by the sacroiliac joint.Methods:From January 2016 to March 2020, a retrospective analysis of 9 patients with malignant tumors involving pelvis I+II or I+II+III region were treated with sacroiliac joint osteotomy and 3D printed pelvic prosthesis reconstruction. There were 7 males and 2 females; their age was 51.1±10.5 years (range 27-66 years). Among them, 5 cases were chondrosarcoma, 1 case was pleomorphic undifferentiated sarcoma, 2 cases were metastatic renal cell carcinoma, and 1 case was metastatic primitive neuroectodermal tumor. Resection of pelvic area I+II or I+II+III were according to the extent of tumor involvement. During the resection of pelvic I region, osteotomy was done through sacroiliac joint surface, and 3D printed hemipelvic prosthesis that fits the sacral auricular surface was used for reconstruction. Postoperative imaging examination was used to evaluate the acetabular rotation center deviation of the pelvic prosthesis; the International Bone Tumor Society (Musculoskeletal Tumor Society, MSTS) function score was used for functional evaluation; the patient's oncology outcome and postoperative complications were evaluated.Results:All 9 patients successfully completed the operation. The operation time was 3.5-6 hours, with an average of 4.5 hours. The intraoperative blood loss was 800-3 000 ml, with an average of 1 400 ml. 3 patients underwent resection and reconstruction of pelvis I+II area, 4 patients underwent pelvic resection and reconstruction of I+II+III area, 2 patients underwent pelvic I+II+III area combined with proximal femur resection and reconstruction; all patients were followed up. The follow-up time was 6-50 months, with an average of 16 months. At the last follow-up of 9 patients, the MSTS score was 12-26, with an average of 20.2; the postoperative rotation center horizontal displacement distance was 10.67±7.12 mm, and the vertical displacement was 8.56±4.22 mm. One case of metastatic cancer was found to have multiple metastases throughout the body during chemotherapy 3 months after surgery, and died in 7 months after surgery; 1 case of pelvic metastatic renal cell carcinoma developed multiple metastases within one and a half years after surgery, controlled by targeted drugs, and survived with the tumor; the rest seven cases had no recurrence at the surgical site and no distant metastasis was found.Conclusion:The semipelvic prosthesis with 3D printed auricular surface has potential advantages in reconstructing the bone defect of the pelvis I+II or I+II+III area after the sacroiliac joint osteotomy. The short-term efficacy is relatively satisfactory, and the long-term efficacy remains to be further observed.

A comparative study of the effects of different treatment strategies on postoperative anal function and quality of life in patients with complete obstructive left hemicolon cancer / 中华胃肠外科杂志

Objective: To compare the effects of 3 treatment strategies (emergent surgery, self-expanding metallic stents, self-expanding metallic stents plus neoadjuvant chemotherapy) on postoperative anal function and quality of life in patients with complete obstructive left hemicolon cancer. Methods: A retrospective cohort study was conducted. Clinical data of patients with complete obstructive left hemicolon cancer admitted to General Surgery Department of Beijing Chaoyang Hospital between January 2017 and October 2019 were retrospectively collected. Patient inclusion criteria: (1) complete obstructive left hemicolon cancer was confirmed through clinical manifestation and abdominal computed tomography; (2) adenocarcinoma was confirmed by postoperative pathology; (3) emergent radical resection of primary tumor was performed with temporary stoma, or radical resection of primary tumor and primary anastomosis was performed without stoma, 7 to 14 days after completion of insertion of self-expanding metallic stents. Patients who did not receive stoma reversion after emergent operation were excluded. According to different therapies, patients were divided into three groups: emergent surgery (ES) group, self-expanding metallic stents (SEMS) group and self-expanding metallic stents plus neoadjuvant chemotherapy (SEMS+NAC) group. Wexner score for incotinence (higher score indicates the worse anal function), Vaizey score (>10 indicates fecal incontinence) and low anterior resection syndrome (LARS) scale (higher score indicates the worse anal function) were applied to evaluate anal function of patients among groups at postoperative 1-, 6- and 12-month. EORTC QLQ-C30 questionnaire was used to assess the quality of life. Risk factors of decreased anal function were identified by logistic regression analysis. Results: A total of 72 patients were enrolled, including 27 (37.5%) patients in ES group, 23 (31.9%) in SEMS group and 22 (30.6%) in SEME+NAC group. The baseline characteristics including age, gender, tumor location, comorbidities, total blood loss, operation time and postoperative complications, were comparable among groups, except that the proportion of laparoscopic surgery was significantly lower in ES group (4/27, 14.9%) than that in SEMS (15/23, 65.2%) and SEMS+NAC group (16/22, 72.7%) with significant difference (P<0.001). The follow-up ended up to October 2020, and the overall follow-up rate was 79.2% (57/72). No significant differences existed in the Wexner score of patients among groups at postoperative 1-, 6- and 12-month (all P>0.05). The Vaizey scores at postoperative 1-month in ES, SEMS and SEMS+NAC group were 7 (0-17), 3 (0-7) and 4 (0-8) respectively with significant difference (H=18.415, P=0.001), and the scores in SEMS and SEMS+NAC groups were significantly lower than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC group (P>0.05). Vaizey scores at postoperative 6- and 12-month among 3 groups were not significantly different (both P>0.05). The LARS scores at postoperative 1-month in ES, SEMS and SEMS+NAC groups were 20 (0-37), 15 (0-24) and 16 (0-28) respectively with significant difference (H=3.660, P=0.036), and the scores in SEMS and SEMS+NAC groups were significantly lower than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC groups (P>0.05). LARS scores at postoperative 6- and 12-month among 3 groups were not significantly different (both P>0.05). The QLQ-C30 score revealed that the social function of patients in SEMS group and SEMS+NAC group was significantly better than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC group (P>0.05). The logistic regression analysis revealed that only ES was an independent risk factor of decreased anal function (OR=2.264, 95% CI: 1.098-4.667, P=0.027). Conclusion: Compared to ES, SEMS may improve quality of life and short-term anal function of patients with complete obstructive left hemicolon cancer.

Prosthesis-preserving sequential method for treatment of peripheral prosthesis infection after bone tumor limb salvage / 中华骨科杂志

Objective:To explore the curative effect of the "domino" sequential method with prosthesis preservation in the treatment of infection around the prosthesis after limb salvage surgery for bone tumors.Methods:A retrospective analysis of 11 patients with peripheral prosthetic infections after limb salvage surgery with prosthesis preserving "domino" from January 2016 to January 2020 was retrospectively analyzed, including 8 males and 3 females; age 21-74 years old, with an average of 51.8 years old. There were 6 cases of knee prosthesis for distal femoral tumor, 2 cases of proximal tibia knee prosthesis, 2 cases of pelvic prosthesis infection, and 1 case of middle femoral prosthesis. Before the operation, 8 cases had fever, and 2 cases had sinus. Sequential treatment failure is defined as: recurrence of infection. The treatment method is the debridement and lavage of the prosthesis and the systemic combined local application of drug-sensitive antibiotics to evaluate the patient's blood routine, C-reflective protein, erythrocyte sedimentation rate and other indicators, X-ray and CT of the surgical site, and the Musculoskeletal Tumor Society (MSTS) score.Results:The positive rate of microorganism culture was 72.7% (8/11), including 2 cases of Staphylococcus aureus, 1 case of Staphylococcus epidermidis, 1 case of methicillin-resistant Staphylococcus epidermidis, 1 case of methicillin-resistant Staphylococcus aureus, abalone There were 2 cases of Acinetobacter mannifolia and 1 case of Streptococcus degalactiae. The MSTS score before treatment and at the last follow-up after treatment increased from 10.91±2.31 points to 20.73±3.52 points, the difference was statistically significant ( t=7.162, P<0.05). A total of 3 cases of sequential treatment failed to control infection, and the operation success rate was 72.7% (8/11). One case was amputation, one case was long-term replacement of wound dressing, and one case was switched to antibiotic bone cement combined with intramedullary nail reverse double insertion technique to control infection. Conclusion:For bone tumors with clinical infection symptoms less than one month after limb salvage surgery, the use of prosthesis-preserving "domino" sequential method for treatment of prosthetic infections is desirable for early and mid-term clinical efficacy.

Construction of a RFP-lacZα bicistronic reporter system and its application in lead biosensing.

The combination of a fluorescent reporter and enzymatic reporter provides a flexible and versatile way for the study of diverse biological processes, such as the detection of transcription and translation. Thus, there is an urgent need to develop this novel bifunctional reporter system. This study reports the design, construction, and validation of a new dicistronic mCherry-lacZα reporter system by artificial lac operon and pbr operon models in lacZM15-producing E. coli. It allows two reporter genes to be co-transcribed into a dicistronic mRNA strand, followed by coupled expression of mCherry and lacZα. In artificial lac operons, expression of the downstream lacZα was demonstrated to be positively related to expression of the upstream ORF. In artificial pbr operons, compared with the insertion of downstream full-length lacZ, the insertion of downstream lacZα exerted a slight effect on the response from the upstream mCherry. Furthermore, the downstream lacZα reporter showed stronger response to Pb(II) than the downstream full-length lacZ. Importantly, the response sensitivity of downstream lacZα was still higher than that of upstream mCherry in a dual RFP-lacZα reporter construct. The highly efficient expression profile of the reporter lacZα peptide makes it a preferred downstream reporter in polycistronic constructs. This novel bifunctional reporter system offers a robust tool for biological studies.

Inhibition of the PD-1/PD-L1 signaling pathway enhances innate immune response of alveolar macrophages to mycobacterium tuberculosis in mice.

BACKGROUND: Mycobacterium tuberculosis (TB) is a pathogen that consequently leads to TB infection, which remains a significant global health concern. Programmed death 1 (PD-1)/programmed death-ligand 1 (PD-L1) signaling pathway is critical for terminating immune responses. The present study aimed to elucidate the regulatory role of the PD-1/PD-L1 signaling pathway in alveolar macrophages against Mycobacterium TB in mice. METHODS: Specific pathogen free mice were initially prepared for Mycobacterium TB model establishment. The alveolar macrophages of the successfully modeled rats were evaluated to determine the levels of PD-1, PD-L1, AKT, mTOR, TNF-α, NF-κB, IL-2, IL-4, IL-6, IL-10, IL-17, IL-17A, and IFN-γ. The surface makers of macrophages (CD11c, CD16, CD86, CD163, CD206, CX3CR-1 and CSF-1R), level of ROS, apoptosis and cell cycle, were all assessed. RESULTS: Elevated levels of PD-1 and PD-L1, decreased levels of AKT and mTOR, along with elevated levels of TNF-α, NF-κB, IL-17, IL-2, IL-6, IL-17A and IFN-γ were identified in the alveolar macrophages infected with Mycobacterium TB, while an opposite trend was observed when PD-1/PD-L1 signaling pathway was inhibited. Additionally, elevated protein levels of CD11c, CD16 and CD86, as well as an increased rate of positive ROS and cell apoptosis, levels of Bax, and a diminished percentage of alveolar macrophages at the S and G2/M stages were detected in the event of Mycobacterium TB infection. A contrasting trend to the aforementioned findings was detected when the PD-1/PD-L1 signaling pathway was inhibited. CONCLUSION: Taken together, these results suggested that inhibition of the PD-1/PD-L1 signaling pathway enhanced the innate immune response of alveolar macrophages to Mycobacterium TB in mice.

Improved Monitoring of Low-Level Transcription in Escherichia coli by a ß-Galactosidase α-Complementation System.

Genetically encoded reporter proteins are important and widely used tools for the identification and capture of a promoter, tracking the dynamic behavior of transcription, and the quantification of promoter activity. The sensitivity of the reporter gene is a critical factor for an ideal reporter system because weak transcriptional signal has usually failed to be detected using classical reporters. In this study, we present a novel reporter system for improved monitoring of transcription in E. coli based on ß-galactosidase α-complementation. In this reporter system, the ß-galactosidase activity resulting from the assembly of a reporter lacZα and an existing α-acceptor in advance serves as a measure of transcriptional activity in vivo. To validate the potential of the lacZα-derived reporter system, a series of artificial operons were constructed, and the moderately strong lac promoter, ara promoter, and weak pbr promoter were chosen as the detection promoters. The response profiles of lacZα was similar to that of wild type lacZ in artificial lac operons. Due to its small size and efficient expression profile, the detection sensitivity of a lacZα-derived reporter system was significantly higher than that of the traditional full-length ß-galactosidase and the fluorescent protein mCherry reporter system in artificial ara operons. As expected, the response sensitivity of the lacZα-derived reporter system was also demonstrated to be significantly higher than that of the ß-galactosidase and mCherry reporter systems in lead-sensitive artificial pbr operons. The lacZα-derived reporter system may prove to be a valuable tool for detecting promoter activity, especially low-level transcription in vivo.

Development of a novel bacterial surface display system using truncated OmpT as an anchoring motif.

OBJECTIVES: An efficient bacterial surface display system based on the anchoring motif derived from Escherichia coli (E. coli) outer membrane protease OmpT was developed in this study. RESULTS: Referring to the classical Lpp-OmpA (LOA) display system, the signal peptide and nine amino acids of mature Lpp were fused to the transmembrane domain comprising five ß-strands of truncated OmpT to generate a novel Lpp-OmpT (LOT) display system. The C-terminal fusion strategy was used to fuse a small peptide (His tag) and red fluorescent protein (mCherry) to the C-terminus of LOT. Cell surface exposure of His tag and mCherry were compared between the LOA and LOT display systems. E. coli expressing LOT-His tag adsorbed more Cu2+ than E. coli expressing LOA-His tag. E. coli expressing both LOT-mCherry-His tag and LOA-mCherry-His tag adhered to Cu2+ chelating sepharose beads, and adhered cells could be dissociated from the beads after excess Cu2+ treatment. More importantly, compared with the LOA system, a higher amount of LOT-mCherry-His tag hybrid protein was demonstrated to be localized at the outer membrane by both fluorescence spectrophotometric determination of cell fractions and cell-surface immunofluorescence assay. CONCLUSIONS: These results suggest that genetically modified OmpT can be used as a potential anchoring motif to efficiently and stably display polypeptides and proteins, and that the LOT system could be used in a variety of biotechnological and industrial processes.

Carriage prevalence and drug resistance profile of MRSA and MSSA strains isolated from newborns / 中华疾病控制杂志

Objective To determine the carriage prevalence and antibiotics resistance profile of methicillin-resistant staphylococcus aureus(MRSA) and methicillin-sensitive staphylococcus aureus(MSSA) strains isolated from newborns. Methods A cross-sectional study was conducted in two hospitals in Shenzhen from August to November 2015. Cotton swab samples were collected from 1834 newborns. Staphylococcus aureus was identified by general laboratory tests, and antimicrobial-susceptibility profiles was tested. Results In total, 3.27% (60/1 834) Staphylococcus aureus (SA) strains were isolated, including 0.82% (15/1 834) MRSA and 2.45% (45/1 834) MSSA. Most MRSA and MSSA strains were resistant to penicillin and erythromycin but less than 10% strains resistant to linezolid. Drugs resistance rates of MRSA to erythromycin, moxifloxacin and clindamycin were all higher than that of MSSA (all P<0.05). The multidrug-resistant risk of MRSA (80.00%) was 12.36 times higher than that of MSSA (24.44%). Conclusions Multidrug-resistant SA especially MRSA strains isolated from newborns had the higher prevalence, the drugs resistance rate of MRSA strains was more serious than that of MSSA.

Long-term outcomes of laparoscopic low anterior resection of rectal carcinoma with preservation of the left colic artery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the long-term outcomes of laparoscopic low anterior resection of rectal carcinoma with preservation of the left colic artery(LCA).</p><p><b>METHODS</b>Clinicopathological and follow-up data of 322 cases with rectal carcinoma undergoing laparoscopic low anterior resection in Department of General Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2007 to December 2011 were retrospectively analyzed. According to the different surgical methods of inferior mesenteric artery (IMA), cases were divided into the trial group (LCA preservation plus lymph nodes around IMA root dissection, 168 cases) and the control group(origin of IMA ligation, 154 cases). The 5-year rates of disease-free survival(DFS) and overall survival(OS) were compared between two groups.</p><p><b>RESULTS</b>There were no statistically significant differences in the baseline data between the two groups. The follow-up rate was 91.1%(153/168) during 5-60 months in the trial group, and 90.3%(139/154) during 6-60 months in the control group. The number of patients who developed death, local recurrence and metastasis were 49(32.0%), 9(5.9%) and 62(40.5%) in the trial group, and 44(31.7%), 9(6.5%) and 52(37.4%) in the control group, respectively, without significant differences(all P>0.05). The 5-year DFS and OS rates were 57.2% and 69.5% in the trial group, and 59.7% and 70.1% in the control group, and the differences were not significant between the two groups(all P>0.05). After stratification by TNM stage, the 5-year DFS rates of I( stage, II( stage and III( stage were 80.4%, 62.5% and 45.1% in the trial group, and 82.6%, 66.0% and 48.8% in the control group; the 5-year OS rates of I( stage, II( stage and III( stage were 90.2%, 76.2% and 56.7% in the trial group, and 94.4%, 74.3% and 60.5% in the control group, respectively, and the differences were not significant as well (all P>0.05).</p><p><b>CONCLUSION</b>The long-term outcomes after laparoscopic low anterior resection of rectal carcinoma with preservation of LCA and dissection of lymph nodes around root of IMA are comparable with ligation at origin of IMA.</p>

Clinical effect and possible mechanism of intravenous thrombolysis combined with mild hypothermia on acute cerebral infarction / 中国神经精神疾病杂志

Objective To examine the effects of intravenous thrombolysis with Tissue-type plasminogen activator (rt-PA) combined with mild hypothermia therapy on patients with acute cerebral infarction and further investigate under?lying mechanism for the treatment of cerebral infarction. Methods Sixty cases of cerebral infarction patients were random?ly divided into three groups with 20 patients in each group:①The control group was given rt-PA intravenous thromboly?sis;②The treatment group 1:intravenous thrombolytic therapy combined with local mild hypothermia treatment for 12 h;③The treatment group 2:intravenous thrombolytic therapy and local mild hypothermia in the treatment of 24 h. We col?lected NIHSS score before and after thrombolytic therapy, patient monitoring (ICP) changes during thrombolytic therapy, March (MRS) score and complications during follow-up after thrombolysis, The serum levels of SOD and MDA were as? sessed before and after thrombolytic therapy. Results NIHSS score was lower in both treatment group 1 and treatment group 2 than in the control group (P0.05). Conclusion Rt-PA intravenous thrombolysis combined with mild hypothermia treatment can improve the prognosis of patients with cerebral infarction without increasing the inci?dence of adverse reactions. In addition, thrombolysis combined with mild hypothermia 24 h has better effect than with mild hypothermia 12 h. The beneficial effects may be accomplished by reducing oxidative stress reaction.

Clinical application of curved cutter stapler in laparoscopic anterior resection of low rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To make a preliminary assessment of the feasibility of Endo GIATM Radial Reload with Tri-StapleTM Technology(Radial Reload) in laparoscopic anterior resection of low rectal cancer.</p><p><b>METHODS</b>Clinical data of 21 low rectal cancer patients undergoing laparoscopic anterior resection with the Radial Reload in our department between July 2014 and July 2015 were retrospectively analyzed.</p><p><b>RESULTS</b>All the rectums were achieved complete transection by the first stapler device firing and all the operations were performed successfully. No patient were converted to open surgery. The operative time ranged from 110.0 to 180.0(140.5±16.6) minutes, the blood loss ranged from 50.0 to 100.0(66.8±11.4) ml, and the distal resection margin ranged from 1.0 to 3.0(1.8±0.7) cm. Tumor cells were not discovered in all the postoperative pathological samples of distal resection margin. Among 21 cases, stage I( was found in 14 cases, stage II( in 4 cases and stage III( in 3 cases. There were no anastomotic bleeding and anastomotic leakage. There was no local recurrence and distant metastasis during a median follow-up of 6 months(1 to 13 months) postoperatively.</p><p><b>CONCLUSION</b>The application of Radial Reload in laparoscopic anterior resection of low rectal cancer is feasible with satisfactory efficacy.</p>

Laparoscopy combined with transperineal extralevator abdominoperineal excision for locally advanced low rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the laparoscopy combined with transperineal extralevator abdominoperineal excision (TP-ELAPE) for locally advanced low rectal caner.</p><p><b>METHODS</b>Clinical data of 12 patients with locally advanced low rectal cancer undergoing laparoscopy combined with TP-ELAPE in our department from May 2013 to March 2015 were retrospectively analyzed. There were 8 male and 4 female patients with median aged of 63 (46 to 72) years. The median distance from tumor lower margin to anal verge was 3.5(2.0 to 4.0) cm. A self-made transanal suit for minimally invasive operation was used to make a sealed lacuna outside the sphincter, thus laparoscope can be applied to perform transperineal operation.</p><p><b>RESULTS</b>All the patients underwent operations successfully without conversion to open abdominal operation. The median operating time was 206 (180 to 280) minutes with perineal operating time 95(80 to 120) minutes. The median intraoperative blood loss was 120(50 to 200) ml. The median postoperative hospital stay was 12(9 to 18 ) days. Postoperative pathology revealed that all circumferential margins (CRM) were negative. The area of sample horizontal section was (2 824±463) mm(2), and of outer muscularis propria was(2 190±476) mm(2). Postoperative complications included chronic sacrococcygeal region pain in 2 cases, urinary retention in 3 cases, perineal wound infection in 1 case. No perineal seroma, perineal hernia, wound dehiscence and sinus tract formation were observed. Among 8 patients with preoperative normal sexual function, sexual dysfunction occurred in 2 patients. There was no local recurrence and metastasis during a median follow-up of 21(12 to 34) months.</p><p><b>CONCLUSION</b>Laparoscopy combined with TP-ELAPE has the potential to simplify the operation procedure for low rectal cancer, can ensure the radical treatment and safety of operation, and may be carried out in experienced centers.</p>

Efficacy analysis of laparoscopic curve resection for gastric gastrointestinal stromal tumor / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of curved cutter stapler in laparoscopic curve resection for gastric gastrointestinal stromal tumor(GIST).</p><p><b>METHODS</b>A retrospective clinical study was carried out with the clinical data of 19 cases of gastric GIST, who received laparoscopic curve resection with the curved cutter stapler during the period between January 2015 and December 2015 in Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University. Curved cutter stapler was used intraoperatively to run curve resection for stomach, at least 0.5 cm away from the tumor outer margin. If the curved cutter stapler could not completely cut off the gastric wall at first time, the linear cutter stapler would be used secondly to cut off the remaining gastric wall.</p><p><b>RESULTS</b>All the cases were successfully performed under laparoscopy, without conversion to open surgery and the occurrence of severe complications. Fourteen(73.7%) patients received complete transection by the first curved cutter stapler, the other 5(26.3%) cases accepted complete transection by the second linear cutter stapler. The operative time ranged from 50 to 100(71.8±12.7) minutes, the blood loss ranged from 20 to 50 (33.6±7.4) ml, the postoperative exhaust time ranged from 1 to 4 (2.4±0.9) days, the postoperative hospital stay ranged from 5 to 9(6.8±1.1) days. There was no patient suffered from incision infection, delayed gastric emptying, anastomotic leakage and anastomotic bleeding. The postoperative pathological examination confirmed that all the cases were GIST. The tumor length ranged from 1.5 to 5.5(2.9±1.1) cm, the resection margin ranged from 0.5 to 2.0(1.2±0.4) cm and all the patients had negative resection margins. Of the 19 cases, 8(42.1%) were classified as very low risk, 5(26.3%) as low risk, 5(26.3%) as moderate risk and 1(5.3%) as high risk according to the National Institute of Health classification. Six patients with moderate and high risk were treated with imatinib. In the follow-up time of 5 to 16 months(mean 10 months) after operation, no distant metastasis and local recurrence occurred in all the cases.</p><p><b>CONCLUSION</b>The application of curved cutter stapler in laparoscopic curve resection for GIST is safe and feasible with good short-term efficacy.</p>

Prevalence of Helicobacter pylori infection in 125 patients with type 2 diabetes and its effects on diabetic gastroparesis / 中华消化杂志

Objective To investigate the prevalence of Helicobacter pylori (H .pylori)infection in type 2 diabetic patients and its effects on diabetic gastroparesis.Methods Prospective clinical case-control study was applied.From January 2011 to December 2013,125 hospitalized patients with type 2 diabetes and 142 healthy controls without dyspeptic symptoms were enrolled.The prevalence of H .pylori infection and the incidence of gastroparesis in 125 patients with diabetes were investigated in both two groups.The patients with type 2 diabetes were divided into groups according to the course of the disease,and the prevalence of gastroparesis and H .pylori infection of each group were analyzed.The patients with type 2 diabetes and healthy controls confirmed with H .pylori infection were treated with eradication therapy,the rate of eradication of two groups was compared.The improved symptoms of gastroparesis before and after eradication therapy of patients with type 2 diabetes were compared.The chi-square test was performed for statistical analysis.Results The prevalence of H .pylori infection in type 2 diabetic patients was 66.4%(83/125),which was significantly higher than that of healthy control group (51 .4%,73/142 )(χ2 =5 .549,P <0.05).The prevalence of gastroparesis in diabetic patients with the disease course less than 10 years,10 to 20 years and more than 20 years was 33.8% (27/80 ),47.1 % (16/34 )and 8/11 , respectively.The difference was statistically significant (χ2 = 6.554,P < 0.05).The prevalence of H .pylori infection in patients with gastroparesis was 78.4% (40/51 ),which was significantly higher than that of patients without gastroparesis (58.1 %,43/74)(χ2 =4.716,P <0.05).The eradication rate of H .pylori infection in patients with type 2 diabetes was 68.7% (57/83),which was lower than that of healthy control group (87.8%,36/41),and the difference was statistically significant (χ2 =4.385 ,P <0.05).The incidence of epigastric pain and distension,early satiety and apocleisis before H .pylori eradication in type 2 diabetes patients was 75 .9% (63/83 ),66.3% (55/83 )and 67.5 % (56/83 ), respectively,while after eradication which was 44.6%(37/83),37.3%(31/83)and 39.8%(33/83)after eradication,respectively.The differences were statistically significant (χ2 =15 .720,12.764 and 11 .724;all P <0.01).Conclusions The prevalence of H .pylori infection is significantly higher in type 2 diabetic patients,and gastroparesis in type 2 diabetic patients may be correlated with H .pylori infection.The eradication rate in type 2 diabetic patients was lower,and H .pylori eradication therapy can efficiently improve the symptoms of dyspepsia in diabetic patients with gastroparesis.