ObjectiveTo analyze the factors influencing the total number of harvested lymph nodes in laparoscopic radical gastrectomy for advanced gastric cancer.MethodsThe clinicopathologic data of patients who underwent laparoscopic D2 radical resection of gastric cancer in this hospital for advanced gastric cancer from January 2018 to July 2020 were retrospectively analyzed. The statistical analysis was conducted to analyze the influence factors (age, gender, tumor size, tumor site, body mass index, infiltration depth, lymph node metastasis, HER-2 gene amplification status, presence or absence of vascular tumor thrombus, presence or absence of nerve infiltration, differentiation type, pTNM, Borrmann type, and type of gastrectomy) on the number of harvested lymph nodes.ResultsA total of 536 patients met the inclusion and exclusion criteria were included. The results of univariate analysis showed that the total number of harvested lymph nodes during laparoscopic radical gastrectomy for advanced gastric cancer was correlated with age, tumor size, tumor infiltration depth, lymph node metastasis, pTNM stage, Borrmann type, and type of gastrectomy. That was, the younger the patient was (≤ 54 years old), the larger the tumor was (long diameter >3.5 cm), the later the Borrmann classification was (type Ⅲ, Ⅳ), the deeper the tumor invasion was, the more the number of lymph node metastasis was, the later the pTNM stage was, and the more the number of lymph nodes was detected in patients undergoing total gastrectomy (all P<0.05). The multiple linear regression analysis showed that the age, lymph node metastasis, and PTNM stage had significant effects on the number of harvested lymph nodes. The multiple linear regression model was statistically significant (F=6.754, P<0.001). 11.2% of the variation in the number of harvested lymph nodes could be explained by the age, lymph node metastasis, and pTNM stage (adjusted R2=11.2%). ConclusionsNumber of harvested lymph nodes in laparoscopic radical gastrectomy for advanced gastric cancer is greatly affected by the age of patients, lymph node metastasis, and pTNM stage. So patients should be evaluated objectively and individually according to their age so as to harvest sufficient number of lymph nodes, which is conducive to accurately judge pTNM stage, formulate accurate adjuvant treatment scheme, and improve prognosis of patients.
ObjectiveTo analyze the effect of anal fistula clip (AFC) in the treatment of anal fistula, and to evaluate its safety. MethodsA historical cohort study method was conducted. Eighty-three patients with glandular transsphincteric anal fistula in the Xuzhou Central Hospital from September 2018 to May 2021 were collected, of which 42 patients underwent the AFC treatment (AFC group), 41 patients underwent the endorectal advancement flap (ERAF) treatment (ERAF group). The operation time, intraoperative blood loss, visual analogue scale (VAS) score of anus pain on postoperative day 1, 3, and 7, wound healing time, Wexner incontinence score of anal function on postoperative month 6, and clinical efficacy (healing and failure) were compared between the two groups. ResultsThe operation was successfully completed in both groups. The operation time and intraoperative blood loss in the AFC group were shorter or less than those in the ERAF group (P<0.05). No complications such as internal opening infection and bleeding occurred in the two groups. There were no statistical differences in the VAS score of postoperative anus pain at all time point between the two groups (P>0.05). The median follow-up time was 22 months. There was no statistical difference in the wound healing time between the two groups (P>0.05). The Wexner score of anal function in the AFC group was lower than that in the ERAF group (P<0.05), and there was no statistical difference between after operation and before operation (Z=–1.751, P=0.089) in the AFC group, while that in the ERAF group after operation was higher than before operation (Z=–1.859, P=0.014). The healing rate had no statistical difference between the AFC group and ERAF group (85.7% versus 77.5%, χ2=0.925, P=0.336). Conclusion From the results of this study, the AFC is safe and effective in treatment of anal fistula, with the advantages of relatively simple operation, less bleeding during operation, lighter postoperative pain, and good protection of anal function.
Objective To investigate the clinical effects and safety differences of open surgery and laparoscopy primary lesion resection combined with D2 lymph node dissection in the treatment of elderly patients with advanced gastric cancer. Methods One hundred and forty elderly patients with advanced gastric cancer were chosen and randomly divided into two group including open operative group (70 patients) with primary lesion resection combined with D2 lymph node dissection by open operation and laparoscopic surgery group (70 patients) with primary lesion resection combined with D2 lymph node dissection by laparoscopy; and the operative time, intraoperative bleeding amount, the levels of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of haemoglobin (Hb) after operation, the hospitalization time, the number of lymph node dissection, the survival rate with followed-up and postoperative complication incidence of both groups were compared. Results There was no significant difference in the operative time between 2 groups (P>0.05). The intraoperative bleeding amount, the level of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of Hb after operation and the hospitalization time of laparoscopic surgery group were significantly better than open operative group (P<0.05). The level of PaCO2 in operation of laparoscopic surgery group was significantly higher than open operative group (P<0.05). There were no significant difference in the gastric lymph node dissection number and the peripheral lymph node dissection number of gastric artery between 2 groups (P>0.05). There were no significant difference in the survival rates between the 2 groups after 3-year followed-up (P>0.05). The complication incidence after operation of laparoscopic surgery group was significantly lower than open operative group (P<0.05). The quality of life scores of patients in laparoscopic surgery group were significantly higher than those in open operative group on 7 days and in 3 months after operation, and the difference were statistically significant (P<0.05). Conclusion Compared with open operation, primary lesion resection combined with D2 lymph node dissection by laparoscopy in the treatment of elderly patients with advanced gastric cancer can efficiently possess the advantages including minimally invasive, shorter recovery time and less postoperative complications.
In 2014, the new concept of embolic stroke of undetermined source (ESUS) was first proposed by cryptogenic stroke/ESUS International Working Group. In the past 5 years, related clinical researches of ESUS have been deepened, and the results of many large clinical studies have been published. However, the guiding significance of this new concept to clinical practice is still controversial. By reviewing the background, diagnostic criteria, assessment, common emboli sources, anticoagulant therapy research advances and related limitations of ESUS, and analyzing the possible causes of negative anticoagulant therapy results, we explored the clinical value of this new classification.
Objective To review researches of the role of inhibitorof differentiation 2(Id2) in skeletal muscle regeneration. Methods The latest original literature concerning Id2 and its role in skeletal muscle regeneration was extensively reviewed. Results Id2 could form heterodimers by combining with E protein to prevent myogenic regulatory factors (MRFs) forming heterodimers by combining with E protein, to inhibit the transcription activity of MRFs anddifferentiation of skeletal muscle cell. Conclusion Id2 plays an important role in skeletal muscle regeneration.
Objective To explore the effect of “in situ first” ex vivo liver resection and autologous liver transplantation (ELRA) for end stage hepatic alveolar echinococcosis (HAE). Methods The clinicopathologic data of 85 end stage HAE cases were initially scheduled underwent ELRA from June 2019 to May 2022 in the Sichuan Provincial People’s Hospital were collected retrospectively. The included cases were operated under “in situ first” ERLA principle. The analyzed data included the final surgical style, operative time, time of anhepatic phase and intraoperative blood transfusion volume for ELRA cases. Results All the included 85 cases underwent radical HAE lesions resection and without perioperative death occurred. According to the principle of “in situ first”, 57 cases underwent HAE lesions resection combined vascular reconstruction without ex vivo liver resection (in situ resection group); 1 case underwent auxiliary partial autologous liver transplantation, and 27 cases underwent ERLA procedures (ELRA group). In the in situ resection group, the operative time was 210–750 min, （380±134）min, and the intraoperative blood transfusion was 0–3 250 mL with a median of 0 mL. In the ELRA group, the operative time was 450–1 445 min, (852±203) min, and the intraoperative blood transfusion was 0–6 800 mL with a median of 1 960 mL. The operative time and the amount of blood transfusion in the ELRA group were longer or more than those in the in situ resection group. The time of anhepatic phase for the ELRA group was 60–480 min, (231±83) min. On the 5th day after operation, except that the total bilirubin and direct bilirubin in the ELRA group were higher than those in the in situ resection group, the other indexes of liver function were similar between the two groups. The postoperative stay in ICU and the total postoperative hospital stay in the ELRA group were longer than those in the in situ resection group. Conclusions The advantage of “in situ first” ERLA principle for end stage HAE patients include resecting the HAE lesions radically without ex vivo liver resection and alleviating the hepatic ischemia and reperfusion injury. For the inevasible ELRA cases, “in situ first” principle could shorten the anhepatic phase and reduce intraoperative blood loss, and turn some cases to auxiliary partial autologous liver transplantation, which will reduce the risk of postoperative hepatic failure.
ObjectiveTo explore the effectiveness of the modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer (LABC) patients.MethodsBetween January 2016 and June 2019, 64 unilateral LABC patients were admitted. All patients were female with an average age of 41.3 years (range, 34-50 years). The disease duration ranged from 6 to 32 months (mean, 12.3 months). The diameter of primary tumor ranged from 4.8 to 14.2 cm (mean, 8.59 cm). The size of chest wall defect ranged from 16 cm×15 cm to 20 cm×20 cm after modified radical mastectomy/radical mastectomy. All defects were reconstructed with the modified designed bilobed latissimus dorsi myocutaneous flaps, including 34 cases with antegrade method and 30 cases with retrograde method. The size of skin paddle ranged from 13 cm×5 cm to 17 cm×6 cm. All the donor sites were closed directly.ResultsIn antegrade group, 2 flaps (5.8%, 2/34) showed partial necrosis; in retrograde group, 6 flaps (20%, 6/30) showed partial necrosis, 5 donor sites (16.7%, 5/30) showed partial necrosis; and all of them healed after dressing treatment. The other flaps survived successfully and incisions in donor sites healed by first intention. There was no significant difference in the incidence of partial necrosis between antegrade and retrograde groups (χ2=2.904, P=0.091). The difference in delayed healing rate of donor site between the two groups was significant (P=0.013). The patients were followed up 15-30 months, with an average of 23.1 months. The appearance and texture of the flaps were satisfactory, and only linear scar left in the donor site. No local recurrence was found in all patients. Four patients died of distant metastasis, including 2 cases of liver metastasis, 1 case of brain metastasis, and 1 case of lung metastasis. The average survival time was 22.6 months (range, 20-28 months).ConclusionThe modified designed bilobed latissimus dorsi myocutaneous flap can repair chest wall defect after LABC surgery. Antegrade design of the flap can ensure the blood supply of the flap and reduce the tension of the donor site, decrease the incidence of complications.
ObjectiveTo observe the effect of polypyramidine tract binding protein-associated splicing factor (PSF) towards advanced glycation end products (AGEs) induced the apoptosis of Müller cells in vitro.MethodsExperimental study. Müller cells were cultured and divided into groups according to the project design, plasmid enhanced green fluorescent protein-PSF were transfected into the cells to achieve the overexpression of PSF Müller cells in vitro, then cells were exposed to AGEs and the Morphological changes were observed by HE staining and Hoechst 33258 staining while the survival rate of cells were detected by MTT assay. The effects of PSF on AGEs-induced Müller apoptosis was measured by Cell Death Detection ELISA kit. Meanwhile, 2′,7′-dichlorofluorescin diacetate staining was performed to monitor the protective effects of PSF on AGEs-induced Müller cells ROS.ResultsThe morphology of cells in normal group was full and the cytoplasm staining was uniform. In N+AGEs group and Vec+AGEs group, cell volume decreased, cytoplasm was dense and concentrated, and eosinophilic staining was enhanced. The cell morphology of PSF+AGEs group was still full, with uniform cytoplasm staining and uniform nucleus staining. The viability of N+AGEs group, Vec+AGEs group and PSF+AGEs group were 0.42±0.11, 0.35±0.12 and 0.68±0.12. The apoptosis values were 1.08±0.16, 0.96±0.20 and 0.44±0.08. The intracellular ROS levels were 28 833.67±3 550.06, 28 356.67±4 854.81, 186 163.00±382.54. Compared with N+AGEs group and Vec+AGEs group, the cell viability of PSF+AGEs group was significantly improved (F=20.65, P=0.000), cell apoptosis value (F=43.43, P=0.000) and intracellular ROS level (F=18.86, P=0.000).ConclusionPSF overexpression play a protective role in AGEs-induced apoptosis by inhibiting the production of ROS in Müller cells.
ObjectiveTo investigate the protection and the corresponding molecular mechanisms of polypyramidine tract binding protein-associated splicing factor (PSF) overexpression on human retinal microvascular endothelial cells (hRMECs) induced by advanced glycation end-products (AGEs).MethodsThe hRMECs were divided into the normal group, the vector group, PSF group, zinc protoporphyrin (ZnPP) group and PSF+ZnPP group for experiment. Cells in the normal group were cultured in a DMEM medium containing 10% fetal calf serum, penicillin/streptomycin, and placed in a closed constant temperature incubator at 37 °C, 95% air, and 5% CO2. Cells in the vector group were infected with empty lentivirus. The cells in the PSF group were infected with overexpressing PSF lentivirus. Cells in the ZnPP group were treated with ZnPP (10 mol/L) for 2 h. The PSF+ZnPP group cells were infected with overexpressing PSF lentivirus, and then pretreated with ZnPP (10 mol/L) for 2 h. With the last four groups of cells stimulated with AGEs, HE, Hoechst33258 staining and flow cytometry were used to observe the protective effect of high expression of PSF on cell damage and the antagonistic effect of ZnPP on PSF. Western blot was used to detect the protein expression of heme oxygenase-1 (HO-1), phosphorylated (p) extracellular regulatory protein kinase (ERK), and Nrf2 in the cells. U0126, a specific antagonist of ERK pathway, was introduced, and Western blot verified the reversal effect of U0126 on the expression of HO-1 induced by PSF protein.ResultsHE staining and Hoechst33258 staining showed that the number of nuclei of damaged cells of PSF group were significantly increased compared with control group, while decreased compared with PSF+ZnPP group (F=27.5, 38.7; P＜0.05). The results of flow cytometry showed that the ROS produced by cells in the PSF group was significantly increased compared to the normal group, and significantly decreased compared to the PSF+ZnPP group, the difference was statistically significant (F=126.4, P＜0.05). Western blot results showed that HO-1 expression of PSF group was significantly increased compared with control and the vector group (F=70.1, P＜0.05). AGEs inducement of 30, 60, 120 and 240 min could significantly improve pERK expression compared with 15 min (F=474.0, P＜0.05). The expression of HO-1 and Nrf2 proteins in the PSF+/U0126－ group was significantly more than those in the PSF－/U0126－ group, the expression of HO-1 and Nrf2 proteins in the PSF+/U0126+ group was significantly lower than that in the PSF+/U0126－ group, and the differences were statistically significant (F=30.2, 489.4; P＜0.05).ConclusionOver expression of PSF can promote the HO-1 expression by activating ERK pathway and promoting the Nrf2 to the nucleus, thus protect hRMECs against AGEs-induced oxidative damage.
【Abstract】 Objective To research the method and effectiveness of V-Y advancement of skin flap pedicled with the upper limb lateral branch in the treatment of small skin defect in the dorsal elbow. Methods Between March 2008 and August 2010, 6 cases of skin defect in the dorsal elbow were treated by V-Y advancement of skin flap pedicled with the upper limb lateral branch, including 4 males and 2 females with a mean age of 53 years (range, 16-76 years). Defects were caused by crushing in 3 cases, by punching in 2 cases, and the disease duration was 4 hours 30 minutes to 7 days (mean, 29.5 hours); and by chronic infection in 1 case, and the disease duration was 12 months. The defect size ranged from 4.0 cm × 2.5 cm to 9.5 cm × 3.5 cm, all complicating by bone or tendon exposure. The flap size ranged from 6.0 cm × 4.0 cm to 12.5 cm × 9.5 cm; the donor sites were sutured directly. Results All flaps survived completely, wounds and incisions at donor sites healed by first intention. Six cases were followed up 6-12 months after operation. The flaps had good texture and color. Two-point discrimination of the skin flap was 12-16 mm. The function of limb was normal, and elbow flexion and extension activity averaged 105° (range, 95-125°). Conclusion It is ideal to treat small skin defect in the dorsal elbow with V-Y advancement of skin flap pedicled with the upper limb lateral branch because of easier operation and less injury at donor site.