Objective To investigate the features of epileptic seizures and eletroencepalogram (EEG)in patients of mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS). Methods Fifty-five patients with MELAS were selected. EEG and head MRI was performed on all patients.The types of epileptic seizure and EEG changes were compared between patients in and outside stroke-like episodes. Results Epileptic seizures occurred in 49 of 55 patients (89.1%) with MELAS, while multitype epileptic seizures were presented in 33 cases(67.3%). The frequency of partial seizures, generalized tonic-clonic seizures, status epilepticus was 47.3%(26/55), 69.1%(38/55), 38.2%(21/55) in stroke-like episodes and12.7%(7/55), 27.3%(15/55), 5.5%(3/55) in nonstroke-like episodes, which had statistical significance (χ2 = 8.023, 10.647, 11.002; P=0.022, 0.016, 0.005, respectively). Abnormal EEGs appeared in all patients.The rates of slow alpha frequency, diffuseδorθwave, epileptic discharges were 7.3%(4/55), 43.6%(24/55) and 25.5%(14/55) in stroke-like episodes and 30.9%(17/55), 58.2%(32/55) and 23.6%(13/55) in nonstroke-like episodes, respectively.Slow alpha frequency was significantly different between patients in and outside stroke-like episodes (χ2=8.933, P=0.019). Conclusions Epileptic seizures with different types are more common during stroke-like episodes in patients with MELAS.While the rates of epileptic discharges are also common outside the stroke-like episodes.

Objective To investigate the surgical methods and techniques of total laparoscopic resection of primary extraperitoneal pelvic benign neoplasms.Methods The clinical data of 32 patients undergoing laparoscopic resection for primary extraperitoneal pelvic benign neoplasms in Cangzhou Central Hospital from March 2011 to June 2016 were retrospectively analyzed.Results All cases were successfully operated under total laparoscopic resection.The operation time was 95-240 min,with an average of(152 ± 37) min,the amount of blood loss was 30-100 ml,the average was (56 ± 14) ml.Postoperative pathological examination confirmed mature teratoma in 14 cases,lipoma in 6 cases,epidermoid cyst in 7 cases,dermoid cyst in 5 cases.Patients were discharged from hospital 5 to 8 days after surgery,with an average of (6.5 ± 0.7) days.All patients were followed up for 2 to 36 months with no tumor recurrence.Conclusion Laparoscopic surgery is a safe and effective method for primary extraperitoneal pelvic benign neoplasms.

Objective To investigate the application of purse string suture and the end-to-side invagination pancreaticojejunostomy in pancreaticoduodenectomy (PD).Methods Clinical data of 175 cases who were admitted in Cangzhou Central Hospital and underwent pancreaticoduodenectomy because of malignant tumor from December 2012 to December 2016 were retrospectively analyzed.According to the texture of pancreas in the operation,the patients were divided into 2 groups.Purse string suture and the end-to-side invagination pancreaticojejunostomy was performed in study group.Duct-to-mucosa pancreaticojejunostomy was conducted in control group.The operation time,the time of pancreaticojejunostomy,the amount of intraoperative bleeding,the incidence of postoperative pancreatic fistula,postoperative recovery time of gastrointestinal function,the average length of hospital stay and the like were comparative analyzed between the two groups.Results There was no significant difference on gender,age,primary diagnosis,preoperative total serum bilirubin,alanine aminotransferase and serum albumin levels between the two groups.The pancreatic texture of the study group was softer than that of the control group,the pancreatic duct diameter in the study group was significantly smaller than that in the control group [(2.0 ± 0.9) mm vs (3.4 ± 1.3) mm],the time of pancreaticojejunostomy in the study group was significantly shorter than that in the control group [(13 ± 4) min vs (17-± 7) min],the incidence of postoperative pancreatic fistula in the study group was significantly lower than that in the control group(5.88％ vs 15.56％),and the differences were statistically significant (all P ＜0.05).There was no significant difference on mean operative time,mean blood loss,postoperative gastrointestinal recovery time and average hospital stay between the two groups.1 cases with postoperative abdominal bleeding occurred in the study group,and the bleeding was successfully stopped by secondary surgery.Conclusions Purse string suture and the end-to-side invagination pancreaticojejunostomy was simple,safe and effective,which had a advantage of reducing the time of pancreaticojejunostomy and the incidence of postoperative pancreatic fistula.

Objective To compare the short-term efficacy of laparoscopic pancreaticoduodenectomy (LPD) with open pancreatoduodenectomy (OPD).Methods The clinical data of 122 LPD patients and 167 OPD patients at our department from 2015 to 2017 were analyzed retrospectively.Results There was no significant difference in demographic,ASA classification,preoperative liver function between the two groups (P ＞0.05).The operative time was (405 ± 109) min vs.(312 ±57) min,liquid diet intake time postoperatively was (5.4 ± 2.6) d vs.(7.9 ± 3.3) d,postoperative hospital stay was (10.4 ± 6.1) d vs.(14.5 ± 8.6) d,with all the difference statistically significant (P ＜ 0.05).Intraoperative blood loss was (290 ± 102) ml vs.(322 ± 75) ml,the number of lymph node dissection in malignant tumor cases was (14.7 ± 5.6) vs.(13.9 ± 7.3),R0 resection rate in malignant tumor cases was 97.9％ (96/98)vs.96.6％ (143/148),the incidence of postoperative complications was 39.3％ (48/122) vs.35.3％(59/167) (all P ＞0.05).All patients were followed up with a median time m group LPD and group OPD was 9 months and 11 months respectively,and the tumor free survival rate was 93.4％ (114/122) and 90.4％ (151/167) at 6 months (P ＞ 0.05).Conclusion LPD has the same safety and radical effect as the traditional OPD surgery,while of less trauma and quicker postoperative recovery.

Objective To assess the value of endovascular management in treating long segment occlusion of femoral-popliteal artery by using retrograde puncture path.Methods The clinical data of a total of 46 patients with long segment occlusion of femoral-popliteal artery,who were admitted to authors' hospital during the period from June 2009 to January 2017 to receive endovascular treatment,were retrospectively analyzed.The patients included 27 males and 19 females,with a mean age of (69±8) years old.Grade Ⅲ of Rutherford classification was seen in 32 patients,grade ⅣV in 8 patients,and grade V in 6 patients.On CT angiography,the mean length of occluded lesion was (17±5) cm.Results In 46 patients of this series,the technical success rate was 100％.The average time used for making the small skin incision and puncturing the artery was (5.2±2.3) min.A 4-F artery sheath was employed in 7 patients,endovascular management with no use of artery sheath was carried out in 39 patients.The guide wire smoothly passed through the occluded segment of femoral-popliteal artery and entered the proximal true lumen in 41 patients.Subintimal arterial flossing with antegrade-retregrade intervention (SAFARI) technique was adopted to establish guide wire working track in 5 patients.On the third postoperative day,the ankle brachial index (ABI) was (0.71±0.12),which was significantly different from preoperative (0.33±0.11),and the difference was statistically significant (t=12.483,P＜0.001).The overall incidence of operation-related complications was 23.9％ (11/46),the incidence of distal arterial puncture-related complications was 4.3％ (2/46).No death occurred in perioperative period.Forty-three patients (93.5％) were followed up for 3-24 months.CTA reexamination performed at 3,6 and 12 months after treatment showed that the primary patency rate of the stent were 91.3％ (4/46),78.3％ (10/46) and 58.7％(19/46) respectively,and the one-year limb salvage rate was 95.7％ (44/46).Conclusion For the treatment of long segment occlusion of femoral-popliteal artery,endovascular management by using retrograde puncture path is technically simple and clinically safe and effective,this technique has certain clinical application value.

Objective:We aimed to develop a novel visualized model based on nomogram to predict postoperative overall survival.Methods:This was a multicenter, retrospective, observational cohort study, including participants with histologically confirmed gastric and colorectal cancer who underwent radical surgery from 11 medical centers in China from August 1, 2015 to June 30, 2018. Baseline characteristics, histopathological data and nutritional status, as assessed using Nutrition Risk Screening 2002 (NRS 2002) score and the scored Patient-Generated Subjective Global Assessment, were collected. The least absolute shrinkage and selection operator regression and Cox regression were used to identify variables to be included in the predictive model. Internal and external validations were performed.Results:There were 681 and 127 patients in the training and validation cohorts, respectively. A total of 188 deaths were observed over a median follow-up period of 59 (range: 58 to 60) months. Two independent predictors of NRS 2002 and Tumor-Node-Metastasis (TNM) stage were identified and incorporated into the prediction nomogram model together with the factor of age. The model's concordance index for 1-, 3- and 5-year overall survival was 0.696, 0.724, and 0.738 in the training cohort and 0.801, 0.812, and 0.793 in the validation cohort, respectively.Conclusions:In this study, a new nomogram prediction model based on NRS 2002 score was developed and validated for predicting the overall postoperative survival of patients with gastric colorectal cancer. This model has good differentiation, calibration and clinical practicability in predicting the long-term survival rate of patients with gastrointestinal cancer after radical surgery.

Nowadays potential preclinical drugs for the treatment of nonalcoholic steatohepatitis (NASH) have failed to achieve expected therapeutic efficacy because the pathogenic mechanisms are underestimated. Inactive rhomboid protein 2 (IRHOM2), a promising target for treatment of inflammation-related diseases, contributes to deregulated hepatocyte metabolism-associated nonalcoholic steatohepatitis (NASH) progression. However, the molecular mechanism underlying Irhom2 regulation is still not completely understood. In this work, we identify the ubiquitin-specific protease 13 (USP13) as a critical and novel endogenous blocker of IRHOM2, and we also indicate that USP13 is an IRHOM2-interacting protein that catalyzes deubiquitination of Irhom2 in hepatocytes. Hepatocyte-specific loss of the Usp13 disrupts liver metabolic homeostasis, followed by glycometabolic disorder, lipid deposition, increased inflammation, and markedly promotes NASH development. Conversely, transgenic mice with Usp13 overexpression, lentivirus (LV)- or adeno-associated virus (AAV)-driven Usp13 gene therapeutics mitigates NASH in 3 models of rodent. Mechanistically, in response to metabolic stresses, USP13 directly interacts with IRHOM2 and removes its K63-linked ubiquitination induced by ubiquitin-conjugating enzyme E2N (UBC13), a ubiquitin E2 conjugating enzyme, and thus prevents its activation of downstream cascade pathway. USP13 is a potential treatment target for NASH therapy by targeting the Irhom2 signaling pathway.