Radical pancreaticoduodenectomy is the only effective method for the treatment of malignancies in the pancreatic head and the periampulary region.Early determination of the involvement of the superior mesenteric artery (SMA)is important for the selection of the surgical procedure and judgment of the prognosis.The operation should follow the principle of tumor-free and adequate resection range,safe resection margin and complete lymph node resection.For this purpose,we performed the radical pancreaticoduodenectomy via mesenteric approach.The SMA was dissected first,and then the tumor was en-bloc resected.From December 2011 to December 2012,24 patients with tumors in the pancreatic head or the periampullary region received radical pancreaticoduodenectomy via the mesenteric approach at the Second Affiliated Hospital of Harbin Medical University,and the short-term outcome was satisfactory.

Objective To investigate the direct and indirect MRI manifestations of anterior cruciate ligament(ACL)tears and discuss its mechanism and diagnostic value.Methods The study involved 40 patients with ACL tears including 37 males and three females at age range of 16-49 years(mean age of 33 years).Arthroscopy and operation confirmed 28 patients at acute phase of ACL tears,12 at chronic phase of ACL tears,35 with complete ACL tears and five with partial ACL tears.All patients were examined on 1.5T Siemens MRI scanner,with SE,TSE or Medic sequence in multiple directions.The direct and indirect MRI manifestations of ACL tears were retrospectively and statistically analyzed by employing three experienced doctors.Results Among 28 patients with acute tears,the direct MRI signs included signal interruption or non-consecutive(86%),uneven signal(64%)and swelling and thickening ligament(36%).While in 12 patients with chronic teats,the MRI signs manifested swelling ligament(92%),signal interruption or non-consecutive(75%)and uneven signal(58%).The sign of thickening ligament was mainly seen at chronic phase of ACL tears(P ＜0.01).Of 35 patients with complete ACL tears,80% occurred in the middle part of ACL,with low incidence of upper and lower parts.All five patients with partial ACL tears occurred in the anteriomedialis bundle.The indirect MRI signs of ACL tears included 7-shaped deformity of posterior cruciate ligament(PCL)(34 patients,85%),meniscus exposure(26 patients)including 16 with lateral meniscus exposure(62%),bone injury(15 patients)including segond fracture(8 patients,53%),widened joint space(9 patients)including 78% at chronic phase,and tibia antelocation(23 patients,57%).Among 40 patients,37 patients were diagnosed correctly preoperatively,with accuracy rate of 92%.While three patients with partial ACL tears were missed diagnosis preoperatively,with inaccuracy rate of 8%.Conclusion ACL tear is relatively easy to identify preoperatively according to direct and indirect MRI signs in combination with trauma history.

Objective To explore the expression of frizzled-7 and β-catenin proteins in hepatocellular carcinoma (HCC),and determine their relationship with clinicopathological features and prognosis.Methods Expression levels of frizzled-7 and β-catenin proteins were detected by the SP immunohistochemical technique in 64 cases of HCC and 15 normal liver tissues.Results Frizzled-7 and β-catenin proteins were found in 42 (65.6％) and 45 (70.3％) of tumor specimens respectively,which was significantly higher than that in normal liver tissues.The expression of frizzled-7 protein was significantly positively correlated with that of β-catenin (P ＜ 0.05) in HCC.The high expression of frizzled-7 was closely correlated to tumor size (P =0.014),histologic grade (P =0.020),portal vein tumor thrombus (P =0.034),tumor recurrence (2 years,P =0.030),TNM stage (P =0.022),and HBsAg (P =0.025),and negatively correlated with 5-year postoperative survival (47.6％ vs.13.2％).The expression of β-catenin protein was significantly associated with histologic grade (P =0.012),tumor recurrence (2 years,P =0.010),and TNM stage (P =0.026),and negatively correlated with 5-year postoperative survival (36.8％ vs.20.0％).Conclusions Frizzled-7 is overexpressed in HCC and associated with decreased postoperative survival.Moreover,frizzled-7 may up-regulate the expression of β-catenin and promote β-catenin-mediated tumor invasion and recurrence.

In the original publication the photo of the gregarious adult locust in Fig. 1A is incorrect. The correct photo of adult migratory locust is provided in this correction.

Objective:To intestigate the clinical efficacy between modified Overlap anastomosis and traditional auxiliary incision anastomosis in laparoscopic total gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 115 patients with gastric cancer who were admitted to the Second Affiliated Hospital of Fujian Medical University from January 2016 to December 2018 were collected. There were 62 males and 53 females, aged from 27 to 83 years, with a median age of 62 years. Of 115 patients, 51 patients undergoing totally laparoscopic total gastrectomy with modified Overlap anastomosis using linear stapler were divided into modified Overlap group and 64 patients undergoing laparoscopic assisted total gastrectomy with traditional auxiliary incision anastomosis using circular stapler were divided into traditional assisted group. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) anastomotic complications; (4) follow-up. Follow-up using outpatient examination or telephone interview was conducted to detected tumor recurrence and survival of patients up to December 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ranked data was analyzed using the rank sum test. Results:(1) Surgical situations: the operation time, time of esophagojejunostomy, volume of intraoperative blood loss, the number of lymph node dissected, length of proximal incisional margin and length of auxiliary incision of the modified Overlap group were (234.0±11.0)minutes, (29.4±2.1)minutes, (53±14)mL, 42±13, (2.0±0.3)cm and (5.1±0.4)cm, respectively. The above indicators of the traditional assisted group were (231.0±11.0)minutes, (29.2±2.2)minutes, (50±13)mL, 40±10, (2.2±0.4)cm and (8.2±0.4)cm, respectively. There was significant difference in the length of auxiliary incision between the two groups ( t=-43.098, P<0.05), and there was no significant difference in the operation time, time of esophagojejunostomy, volume of intraoperative blood loss, the number of lymph node dissected, length of proximal incisional margin between the two groups ( t=1.168, 0.460, 0.990, 1.127, -1.926, P>0.05). (2) Postoperative situations: cases with mild, moderate, severe pain (postoperative pain degree), time to first flatus, time to initial fluid diet intake, duration of postoperative hospital stay of the modified Overlap group were 40, 9, 2, (2.9±1.0)days, (4.8±2.2)days, (11.7±2.8)days, respectively. The above indicators of the traditional assisted group were 31, 27, 6, (3.9±1.4)days, (6.5±2.5)days, (13.0±3.1)days, respectively. There were significant differences in the above indicators between the two groups ( Z=-3.217, t= -4.344, -3.888, -2.261, P<0.05). (3) Anastomotic complications: cases with anastomotic leakage, cases with anastomotic bleeding, cases with anastomotic stenosis of the modified Overlap group were 1, 1, 0, respectively. The above indicators of the traditional assisted group were all 1. There was no significant difference in the above indicators between the two groups ( P>0.05). Cases with anastomotic leakage were cured after the treatment of enteral nutritional support through nasogastric catheterization, which were confirmed by gastroenterography. Cases with anastomotic bleeding were improved by active hemostatic therapy. Cases with anastomotic stenosis were improved after the symptomatic treatment of anti-inflammatory and anti-swelling. (4) Follow-up: 109 of the 115 patients were followed up. Forty-eight of 51 patients in the modified Overlap group were followed up for 15.0-45.0 months, with a median follow-up time of 33.5 months. Sixty-one of 64 patients in the traditional assisted group were followed up for 16.0-46.0 months, with a median follow-up time of 27.0 months. There was no tumor recurrence in the modified Overlap group. One patient in the traditional assisted group had tumor recurrence with liver metastasis and survived with tumor. There was no significant difference in tumor recurrence rate between the two groups ( P>0.05). There was no patient died during the follow-up. Conclusion:Compared with traditional auxiliary incision anastomosis, patients undergoing total laparoscopic total gastrectomy with modified Overlap anastomosis have small incision, good postoperative recovery.

Objective:To investigate the clinical efficacy of laparoscopic-assisted inters-phincteric resection (ISR) with different surgical approaches for low rectal cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 90 patients with low rectal cancer who were admitted to the Second Affiliated Hospital of Fujian Medical University from January 2016 to December 2020 were collected. There were 58 males and 32 females, aged (60±9)years. Of 90 patients, 60 cases underwent laparoscopic assisted ISR with transpelvic approach, 30 cases underwent laparoscopic assisted ISR with transabdominal and transanal mixed approach. Observation indicators: (1) clinicopathological characteristics of patients with transpelvic approach and mixed approach; (2) intraoperative and postoperative conditions of patients with transpelvic approach and mixed approach; (3) postoperative complications of patients with transpelvic approach and mixed approach; (4) follow-up. Follow-up was conducted by telephone interview and outpatient examination once every 3 months within postoperative 3 years, once every six months in the postoperative 3 to 5 years and once a year after postoperative 5 years to detect tumor recurrence and metastasis, and survival of patients.Follow-up was up to March 2021 or patient death. Measurement data with normal distribution were represented as Mean± SD, and the t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(range), and comparison between groups was conducted using the non-parametric Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was performed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed by the non-parametric rank sum test. Kaplan-Meier method was used to draw survival curves and calculate survival rates, and survival analysis was performed by the Log-Rank test. Results:(1) Clinicopathological characteristics of patients with transpelvic approach and mixed approach. The sex (males, females), distance from the distal margin of tumor to anal margin were 34, 26, (4.5±0.5)cm for patients with transpelvic approach, versus 24, 6, (3.5±0.5)cm for patients with mixed approach, respectively, showing significant differences between them ( χ2=4.75, t=8.35, P<0.05). (2) Intraoperative and postoperative conditions of patients with transpelvic approach and mixed approach. The operation time, volume of intraoperative blood loss, distance from the postoperative anastomosis to anal margin were (187±9)minutes, 50(range, 20?200)mL, (3.4±0.7)cm for patients with transpelvic approach, versus (256±12)minuets, 100(range, 20?200)mL, (2.6±0.7)cm for patients with mixed approach, showing significant differences between them ( t=?26.99, Z=?2.48, t=4.67, P<0.05). None of the 90 patients had a positive distal margin. The stoma reversal rates of patients with transpelvic and mixed approach were 93.3%(56/60) and 90.0%(27/30), respectively. Of the 60 patients with transpelvic approach, 3 cases had no stoma reversal due to anastomotic complications, and 1 case was not yet to the reversal time. Of the 30 patients with mixed approach, 2 cases had no stoma reversal due to anastomotic complications, and 1 case was not yet to the reversal time. The 1-, 3-month Wexner scores after stoma reversal were 15(range, 12?17), 12(range, 10?14) for patients with transpelvic approach, versus 16(range, 14?18), 14(range, 12?16) for patients with mixed approach, showing significant differences between them ( Z=?4.97, ?5.49, P<0.05). The 6-month Wexner score after stoma reversal was 10(range, 9?12) for patients with transpelvic approach, versus 11(range, 8?12) for patients with mixed approach, showing no significant difference between them ( Z=?1.59, P>0.05). (3) Postoperative complications of patients with transpelvic approach and mixed approach. The complications occurred to 16 patients with transpelvic approach and 9 patients with mixed approach, respectively, showing no significant difference between them ( χ2=0.11, P>0.05). Cases with postoperative anastomotic fistula, cases with anastomotic bleeding, cases with anastomotic stenosis, cases with intestinal obstruction, cases with incision infection, cases with urinary retention, cases with pelvic infection, cases with pulmonary infection, cases with incisional hernia, cases with chylous fistula, cases with abdominal and pelvic abscess were 5, 2, 1, 7, 0, 1, 5, 3, 1, 1, 1 for patients with transpelvic approach, versus 6, 3, 2, 2, 2, 1, 2, 3, 1, 1, 1 for patients with mixed approach, showing no significant difference between them ( P>0.05). The same patient could have multiple postoperative complications. (4) Follow-up. All the 90 patients were followed up for 27(range, 6?62)months. The follow-up time of 60 patients with transpelvic approach was 27(range, 8?62)months. The follow-up time of 30 patients with mixed approach was 28(range, 6?53)months. Of the 60 patients with transpelvic approach, 3 cases had local recurrence, 4 cases had liver metastasis, 3 cases had lung metastasis, and all of them survived with tumor. Of the 30 patients with mixed approach, 1 case had local recurrence, 2 cases had liver metastasis, 1 case had lung metastasis, and all of them survived with tumor. There was no death. The 3-year disease-free survival rates of patients with transpelvic approach and mixed approach were 84.7% and 87.9%, respectively, showing no significant difference between them ( χ2=0.39, P>0.05). Conclusions:Lapa-roscopic assisted ISR via transpelvic approach or mixed approach for low rectal cancer are safe and feasible. Compared with transanal mixed approach, the transpelvic approach of laparoscopic-assisted ISR has shorter operation time, less volume of intraoperative blood loss and longer distance from the postoperative anastomosis to anal margin.

BACKGROUNDThoracic endovascular aortic repair (TEVAR) is an emerging treatment modality, which has been rapidly embraced by clinicians treating thoracic aortic disease. However, the clinical manifestations of systemic inflammatory response after TEVAR as post-implantation syndrome (PIS) resemble the perioperative infection. This study aimed to evaluate changes and diagnostic value of procalcitonin (PCT) and other traditional inflammatory markers for infections after TEVAR.

METHODSWe conducted a prospective clinical study that enrolled 162 consecutive aortic dissection cases, who underwent TEVAR in our institution between July 2011 and November 2012. The PCT, C-response protein (CRP), erythrocyte sedimentation rate (ESR) and blood routine examination were monitored before the operation and on days 1, 2, 3 and 5 after the operation. The diagnosis of infection was confirmed by the infection control committee with reference to Hospital Acquired Infection Diagnostic Criteria Assessment, released by the Ministry of Health of the People's Republic of China.

RESULTSPost endovascular repair of thoracic aorta, PCT changes significantly at different time points (χ(2) = 13.225, P = 0.021), without significant difference between the PIS group and the control group (0.24 ± 0.04 vs.0.26 ± 0.10, P = 0.804). PCT values were significantly higher in the first day after TEVAR than the preoperative levels (0.18 ± 0.03 vs. 0.11 ± 0.02, P < 0.001). Compared with PIS patients, the level of PCT, CRP, White blood cell (WBC) and neutrophil (NEU) in the infection patients elevated significantly (relatively χ(2) = 6.062, P = 0.048; χ(2) = 6.081, P = 0.048; χ(2) = 11.030, P = 0.004; χ(2) = 14.632, P = 0.001). According to the ROC analysis, the PCT levels in the first day after TEVAR (AUC = 0.785, P = 0.012) had better predictive values of infection than WBC, NEU CRP and ESR (AUC = 0.720, P = 0.040; AUC = 0.715, P = 0.045; AUC = 0.663, P = 0.274; AUC = 0.502, P = 0.991). The best predictive index was the changes of PCT between preoperative and postoperative (PCT), which possess AUC as 0.803 (P = 0.014). And PCT = 0.055 could be considered as an infection diagnosis cutoff value with a sensitivity of 83.3% and specificity 69.0%.

CONCLUSIONSPCT provides better diagnostic value of infection compared with other inflammatory markers. The potential applications of PCT in differential diagnosis of PIS and infection after percutaneous TEVAR deserve further studies.

Adult ; Aged ; Blood Sedimentation ; C-Reactive Protein ; metabolism ; Calcitonin ; metabolism ; Calcitonin Gene-Related Peptide ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Protein Precursors ; metabolism ; Vascular Surgical Procedures

The fall armyworm (FAW), Spodoptera frugiperda, is a destructive pest native to America and has recently become an invasive insect pest in China. Because of its rapid spread and great risks in China, understanding of FAW genetic background and pesticide resistance is urgent and essential to develop effective management strategies. Here, we assembled a chromosome-level genome of a male FAW (SFynMstLFR) and compared re-sequencing results of the populations from America, Africa, and China. Strain identification of 163 individuals collected from America, Africa and China showed that both C and R strains were found in the American populations, while only C strain was found in the Chinese and African populations. Moreover, population genomics analysis showed that populations from Africa and China have close relationship with significantly genetic differentiation from American populations. Taken together, FAWs invaded into China were most likely originated from Africa. Comparative genomics analysis displayed that the cytochrome p450 gene family is extremely expanded to 425 members in FAW, of which 283 genes are specific to FAW. Treatments of Chinese populations with twenty-three pesticides showed the variant patterns of transcriptome profiles, and several detoxification genes such as AOX, UGT and GST specially responded to the pesticides. These findings will be useful in developing effective strategies for management of FAW in China and other invaded areas.
Animals ; China ; Genomics ; Humans ; Male ; Pesticides ; Spodoptera/genetics* ; Transcriptome