Objective To investigate the efficacy and safety of laparoscopic repair of paraesophageal her-nia. Methods Sixty-one patients underwent laparoscopic repair of paraesophageal hernia, all having laparo-scopic Toupet fundoplication. Results Laparoscopic repair of paraesophageal hernia was completed success-fully in all the 61 patients. The average operation time was 110 min and the blood loss 10～50 ml. Postopera-tive oral feedings were resumed 24～48 h after surgery, and no postoperative complication occurred. The me-dian postoperative hospital stay was 5.7 d. Conclusion Laparoscopic repair of paraesophageal hernia is an effective and safe surgical procedure of minimal invasion.

Gastroenterology ; Humans ; Integrative Medicine

[Objective]To investigate the inhibitory effect and mechanism of the microRNA-320d(miR-320d)on epithelial mesenchymal transition in endometrial carcinoma JEC cells.[Methods]JEC endometrial carcinoma cell lines were transfected with miR-320d mimics or negative control mimic,respectively,as M320d or NCM group. Control group was established with untreated JEC endometrial carcinoma cells. miR-320d content in each group was detected by RT-PCR method. Transwell assay was used to detect the migration and invasion ability of the 3 groups. Western-blot assay was used to detect the expressions ofα-Catenin,E-cad-herin,Vimentin and PBX3 protein in 3 groups. Antagonistic effect of PBX3 overexpression on miR-320d inhibition of EMT was detect-ed by western blot assay. The relationship between miR-320d and PBX3 was detected by dual luciferase assay.[Results]The expres-sion level of miR-320d in M320d group was significantly up-regulated,and the expression level of miR-320d was 808.25 ± 15.58 times higher than that of control group(P<0.05). The number of migrating cells in M320d group was 29.56 ± 0.59,which was signif-icantly lower than that of control group at 94.48 ± 1.02(P < 0.05). The number of invasive cells in M320d group was 7.33 ± 0.84, which was significantly lower than that of group control 86.28 ± 3.51(P < 0.05). Compared with control group ,the expression of α-Catenin and E-cadherin protein was significantly increased ,the expression of Vimentin protein was significantly decreased ,and the expression of PBX3 protein was significantly decreased. After PBX3 overexpression,the expression ofα-Catenin and E-cadherin protein were significantly decreased,the expression of Vimentin protein were significantly increased. Dual luciferase assay showed that PBX3 is a downstream target gene of miR-320d(P<0.05).[Conclusion]miR-320d may inhibit the expression of EMT related protein through the downstream target gene PBX3 and inhibit the epithelial mesenchymal transition function of endometrial carcinoma JEC cells.

ObjectiveTo investigate the association of nonalcoholic fatty liver disease (NAFLD) with insulin resistance and dyslipidemia in patients with type 2 diabetes mellitus,and to analyze the risk factors.Methods A total of 200 patients with type 2 diabetes mellitus including 99 with NAFLD and 101 without NAFLD were recruited.Height,weight,waist circumference,hip circumference,liver enzymes,blood lipids,fasting and postprandial blood glucose,insulin,C-peptide,and HbA1C levels were detected.Body mass index ( BMI),waist-hip ratio( WHR),and improved insulin and C-peptide index(HOMA-C-peptide) were calculated and compared between two groups.ResultsCompared with non-NAFLD group,weight,BMI,waist circumference,hip circumference,alanine aminotransferase ( ALT),aspartate aminotransferase,triglyceride ( TG ),total cholesterol ( TC ),low density lipoprotein-cholesterol(LDL-C) were significantly higher in NAFLD group( all P＜0.01 ),while age,duration,and high density lipoprotein-cholesterol were lower( all P＜0.05 ).The incidence of combined hyperlipidemia,especially hypertriglyceridemia,was significantly higher in NAFLD group( P＜0.01 ).Fasting and postprandial 1 h blood glucose [ ( 2.07 ±0.36 vs 1.83 ±0.43 ) mmol/L,( 14.04 ± 3.96 vs 12.59 ± 3.90 ) mmol/L ],fasting and postprandial 1 h Cpeptide [ (2.79± 1.15 vs 2.08±1.29 ) ng/ml,( 1.33 ±0.45 vs 1.12±0.54) ng/ml ],HbA1C [ (2.09±0.33 vs 1.96±0.28) ％ ],and HOMA-C-peptide index were significantly increased in NAFLD group ( P ＜ 0.05 or P ＜ 0.01 ).Logistic analysis showed that TG,BMI,and ALT were the major risk factors of NAFLD in type 2 diabetes mellitus( P＜0.05 or P＜0.01 ).ConclusionTriglyceridemia,obesity,and raised ALT level were significantly associated with an increased risk of NAFLD in patients with type 2 diabetes mellitus.

Objective To develop a high performance liquid chromatographic method (HPLC) for the analysis of of cholesterol in erythrocyte membranes.Methods The study included 167 consecutive chest pain patients who underwent coronary artery angiography in the Department of Cardiology,Nanjing General Hospital of Nanjing Command between September 2012 and February 2013.According to the clinical symptoms and t angiographic results,patients were divided into three groups:acute coronary syndrome (ACS) group (n =46),stable angina pectoris (SAP) group (n =76) and the control group (n =45).After the erythrocyte sample was hypotonically lysed and washed,saponification was carried out in a polassium hydroxide solution at 70 ℃.After extraction by Hexane/isopropanol mixture,the sample was separated on a Lichrospher column and detected by ultraviolet absorbance at 208 nm.A mobile phase composed of acetonitrile-isopropyl alcohol was found to be the most suitable for this separation.Concentrations of cholesterol in erythrocyte membranes were tested.Analysis of variance with covariates (ANOVA) was used to evaluate differences in CEM levels among groups.The relationship between continuous variables was evaluated by Spearman's correlation coefficient.Results Under the chromatographic conditions described,retention time of the cholesterol was approximately 6.1 min.Good separation and detectability of cholesterol in erythrocyte membranes were obtained.The method proved to be linear in the injection range of cholesterol from 0.05 g to 2.00 g.Cholesterol content in erythrocyte membranes were (87.0 μg/mg,75.4-98.9 μg/mg),(92.9 μg/mg,83.8-109.0 μg/mg) and (173.9 μg/mg,140.0-188.8 μ g/mg) in the control,SAP and ACS groups,respectively.Cholesterol content in erythrocyte membranes was significantly higher in ACS group than that in SAP and control groups (P ＜ 0.01).Conclusion We have successfully developed a method for the determination of cholesterol in erythrocyte membranes with good sensitivity,specificity and repeatability.

Objective To explore the risk factors for clinical anastomotic leakage after resection of rectal cancer in China. Methods By meta-analysis we made a comprehensive analysis of the risk factors for clinical anastomotic leakage after resection of rectal cancer based on 19 articles published in China between January 1999 and January 2009. Results The anastomotic leakage rate was higher in the patients aged 60 years old and above than in those younger, with the combined odds ratio (OR) value being 0.50 (95% CI: 0.33-0.76) (P<0.01). The incidence rate was higher in the male patients than in the female ones, with the combined OR value being 2.17 (95% CI: 1.38-3.42) (P<0.01). The incidence rate in the patients with the distance of tumor from the lower margin to anal verge being 7cm and shorter was higher than that with longer distance, with the combined OR value being 1.79 (95% CI: 1.37-2.35) (P<0.01). The incidence rate in the patients who had received radiotherapy preoperatively was higher than that in those who had not, with the combined OR value of 3.66 (95% CI: 2.19-6.09) (P<0.01). The incidence rate in the patients who had received stapler anastomosis was higher than that in the patients who had received manual anastomosis, with the combined OR value being 0.70 (95% CI: 0.47-1.05), but there was no significant difference between them (P>0.05). The incidence rate was higher in the patients with diabetes mellitus than in the healthy ones, with the combined OR value being 3.16 (95% CI: 2.27-4.39) (P<0.01). The incidence rate was lower in the patients with Dukes A and B stages than in those with Dukes C and D stages, with the combined OR value being 0.61 (95% CI: 0.45-0.83) (P<0.01). The incidence rate in the patients with high malignance degree in clinicopathological types was higher than that with low malignance degree, with the combined OR value being 2.17 (95% CI: 1.38-3.42) (P<0.01). The incidence rate was lower in the patients who had received preventive colostomy than in those who had not, with the combined OR value being 0.39 (95% CI: 0.14-1.05), but there was no significant difference between them (P>0.05). The incidence rate was higher in the patients who had got selective operation than in those who had got emergency operation, with the combined OR value being 0.27 (95% CI: 0.13-0.56). Conclusion The risk factors of anastomotic leakage after resection of rectal cancer are as follows: 60 years old and above, male patients, diabetes mellitus, preoperative neo-adjuvant radiotherapy, the distance of tumor from the lower margin to the anal verge being shorter than 7cm, Dukes C and D stages, high malignance degree in clinicopathological types, and emergency operation.

To providing evidence about nitrogen adequate application of Platycodon grandiflorum, the pot culture experiment was conducted to study the effect of nitrogen on the growth, physiological metabolism and the quality of P. grandiflorum. The activity of NR, GS and SOD, POD and CAT were determined. And the nitrate and ammonium nitrogen content, photosynthetic characteristics, active components of P. grandiflorum were determined. The results showed that the nitrate nitrogen content and P. biomass reached its maximum value, when NH4(+)-N/NO3(-) -N was 0: 100, the activity of NR. The activity of GS was the highest at the NH4(+) -N/NO3(-) -N ratio of 25:75 and ammonium nitrogen content was the highest at 75:25. The activity of SOD decreased and then increased with the increasing of NO3(-) -N. At the NH4(+) -N/NO3(-) -N ratio of 25: 75, the activity of CAT had its maximum value and the content of MDA had the minimum value. At the same time, the content of platycodon D was the highest at this treatment. The studies had shown that different nitrogen forms and ratio had a significant effect on the characteristics of photosynthetic physiology, nitrogen metabolism and resistance adjustment, growth and the quality of P. grandiflorum. The NH4(+) -N/NO3(-) -N ratio of 25: 75 was a suitable ratio of nitrogen forms for the growth of P. Grandiflorum and accumulating the content of platycodon D.
Ammonium Compounds ; metabolism ; Biomass ; Drugs, Chinese Herbal ; analysis ; metabolism ; Nitrates ; metabolism ; Photosynthesis ; Plant Leaves ; chemistry ; growth & development ; metabolism ; Platycodon ; chemistry ; growth & development ; metabolism

Purpose To investigate the relationship between maximum standardized uptake value (SUVmax) of 18F-FDG PET/CT and clinical features of tongue squamous cell carcinoma (TSCC),in order to provide better PET/CT results for clinical guide.Materials and Methods Fifty-two patients with pathologically confirmed TSCC who accepting PET/CT examination before surgery were retrospectively analyzed.Single-factor analysis and multiple regression analysis were conducted on possible factors influencing primary tumor SUVmax,including gender,age,smoking history,tumor location,tumor size,TNM stage,T stage and N stage.Results Single-analysis showed that SUVmax was correlated with gender,tumor location,tumor size,TNM stage,T stage and N stage (P＜0.05),and was not correlated with tumor differentiation,smoking history and age (P＞0.05).Multivariate linear regression analysis showed that gender,tumor location,tumor size,T stage and N stage were independent influencing factors of primary tumor SUVmax (P＜0.05).Primary tumor SUVmax had predictive value for lymph node metastasis.When the cutoff value was 6.57,the diagnostic efficiency was the highest,the sensitivity was 79.2％ and the specificity was 85.7％.Conclusion TSCC 18F-FDG PET/CT SUVmax is higher among male patients with tongue base tumor location,larger tumor size and lymph node metastasis.Primary tumor SUVmax is of important significance in predicting lymph node metastasis.

Purpose To investigate the application value of 18F-FDG PET/CT in the diagnosis and staging of tongue cancer,in order to improve the accuracy of preoperative staging.Materials and Methods The 18F-FDG PET/CT findings of 52 patients with pathologically confirmed tongue cancer were retrospectively analyzed.The tumor location,size,FDG metabolic characteristics and tumor staging were observed,and compared with postoperative pathology.Results PET/CT showed that most patients were at middle or late stage when initially diagnosed (28/52).The lesions were mostly located on middle or middle-back region of tongues,and the average SUVmax was 6.81 ± 3.81.The sensitivity of PET/CT diagnosing tongue cancer was 94.2％.There was no significant difference in SUVmax between high,medium-high and medium differentiated tongue cancer primary lesions (P＞0.05).The SUVmax of tongue cancer at stage Ⅲ and Ⅳ was obviously higher than that at stage Ⅰ and Ⅱ,and the difference was statistically significant (P＜0.008).The diagnose and staging of tongue cancer using preoperative PET/CT and postoperative pathology were in excellent consistence (Kappa=0.859,P＜0.01).The staging accuracy reached 90.4％ (47/52).Conclusion Higher SUVmax value indicates worse tongue cancer staging,but it is of little significance in predicting differentiation.PET/CT can provide an objective imaging basis for preoperative diagnosis and accurate staging of tongue cancer.

Objective To assess the clinical significance of the application of computer assisted navigation technology in excision for sacrum tumor.Methods From December 2007 to June 2009,13 patients with sacrum tumor were treated with computer navigation assisted aggressive curettage.There were 5 males and 8 females.aged 21 to 69 years,with the mean age of 44 years,10 cases were over the level of sacrum3 and 3 cases under the sacrum3.Pathologic diagnosis was chordoma in 7 cases.giant cell tumor in 4 cases and neurofibroma in 2 cases.Five cases were recurrence.The preoperative data of CT and MRI were input into the computer navigation workstation.CT images determined the scope of the invasion of tumor in bone tissue.MRI determined the scope of the invasion of tumor in soft tissue.The CT and MRI image fusion identified the precise boundaries of the tumor in CT images and made markers for navigation guidance in the operative in 10 cases.The Iso-c scan had been made for another 3 cases and fused the Iso-c images with preoperation CT images for improving the images quality.According to preoperative marker in CT images,the aggressive curettage were completed with the real time computer navigation for 7 cases,marginal resection in 4 cases and wide resection in 2.The precise surgical removal of the lesions boundary were verified by computer navigation according to the preoperative planning.Results Thirteen patients were followed up for 7 to 37 months,an average of 18 months,no recurrence cases with marginal resection and wide resection.Two cases with aggressive curettage had recurrence.Conclusion Computer navigation technology helps to precise excision the sacrum tumors,to reduce the recurrence rate.