Objective To investigate the application value of enhanced recovery after surgery(ERAS) in laparoscopic pancreaticoduodenectomy (LPD).Methods The retrospective cohort study was adopted.The clinical data of 64 patients who underwent LPD from January 2014 to January 2016 in the Shangjin Hospital of West China Hospital of Sichuan University were collected.Of the 64 patients,41 patients managed with ERAS program between March 2015 and January 2016 were allocated into the ERAS group,23 patients managed with traditional perioperative treatment between January 2014 and Febuary 2015 were allocated into the traditional group.The following indexes were observed:(l) intraoperative status:operation time,volume of intraoperative blood loss,conversion to open surgery,pylorus preservation.(2) Postoperative status:the time to out-of-bed activity,time to postoperative flatus,time of drainage tube removal,postoperative complications (pancreatic leakage,bile leakage,hemorrhage,delayed gastric emptying,abdominal infection,cardiovascular complications),duration of postoperative hospital stay,death within the postoperative 30 days.(3) Follow-up status:incidence of complications after discharge and survival of patients.The follow-up including incidence of complications after discharge and survival of patients was conducted by outpatient examination and telephone interview up to March 2016.Measurement data with normal distribution were presented as (x) ± s and analyzed by t test.Count data were analyzed using the chi-square test or Fisher exact probability.Results (1) Intraoperative status:the operation time,volume of intraoperative blood loss,number of patients with conversion to open surgery and pylorus preservation were (377 ± 38) minutes,(164 ± 48) mL,1,40 in the ERAS group and (392 ± 53) minutes,(152 ±31)mL,2,21 in the traditional group,showing no statistically significant difference between the 2 groups (t =5.02,8.43,x2=1.29,1.29,P ＞ 0.05).(2) Postoperative status:the time to out-of-bed activity,time to postoperative flatus,time of drainage tube removal and duration of postoperative hospital stay were (1.7 ± 0.6)days,(2.5 ± 0.6) days,(5.3 ± 1.7) days,(9.1 ± 1.3) days in the ERAS group and (2.1 ± 0.9) days,(3.8 ±1.2) days,(8.2 ± 2.6) days,(11.9 ± 1.8) days in the traditional group,showing statistically significant differences between the 2 groups(t =-5.28,-7.01,-16.20,-10.67,P ＜ 0.05).The numbers of patients with pancreatic leakage in stage A,B and C,bile leakage,hemorrhage,delayed gastric emptying,abdominal inflection,cardiovascular complications and death in the postoperative 30 days were 8,0,0,0,1,3,0,1,1 in the ERAS group and 5,1,0,1,1,3,2,1,0 in the traditional group,respectively,showing no significant difference between the 2 groups (x2=0.37,1.81,0.18,0.57,3.68,0.18,P ＞0.05).(3) Follow-up status:the 64 patients were followed up for a median time of 11 months (range,1-25 months).During the follow-up,number of patients complicated with diabetes,local tumor recurrence,liver metastasis and death were 5,4,1,0in the ERAS group and 2,5,2,3 (2 died of tumor recurrence and 1 died of myocardial infarction) in the traditonal group.Conclusion Application of ERAS in the perioperative management of LPD is safe and effective,meanwhile,it can accelerate the recovery of patients who underwent LPD and shorten the duration of hospital stay.

AIM:To explore the effect of the pretreatment of hypertonic saline(HTS) in hepatic ischemia reperfusion(I/R) injury.METHODS:The rats were divided into sham group(sham group),ischemia reperfusion group(IR group) and pretreatment of hypertonic saline group(HTS group).Partial hepatic ischemia reperfusion model was used.The rats were sacrificed at the time of 1 h,3 h,6 h,12 h and 24 h after reperfusion in each group,respectively.Blood samples were obtained to examine ALT.The expression of the CD11b/CD18(Mac-1) on the neutrophils was analyzed by flow cytometry.RT-PCR and Western blotting were used to examine the expression of intercellular adhesion molecule-1(ICAM-1) in livers and chromatometry was performed to detect the activity of myeloperoxidase(MPO) in livers.The morphology of hepatocytes and the structure of sinusoid were observed by histological examinations.RESULTS:① HTS pretreatment decreased the level of ALT at the time points of 3 h,6 h and 12 h after reperfusion(P

Objective To explore the empathy deficits of adolescents with different types of conduct disorder. Methods The participants included 65 adolescents ( who met the DSM-Ⅳ criteria for conduct disorder)ranging from 13 ～ 18 in age,and 195 normal adolescents ranging from 13 ～ 18 in age. All participants were assessed by revised Basic Empathy Scale. 65 patients were divided into 4 subgroups according to symptoms: destructive-nondestructive subgroups and overt-covert subgroups. Results (1) Scores of cognitive empathy were lower in patients than normal controls ( (29.86 ± 4.72) vs ( 32.09 ± 4.94), P ＜ 0. 01 ). (2) There were significant differences in the levels of cognitive empathy between patients and controls (P＜0. 01 ). Scores of cognitive empathy were lower in destructive subgroup than controls ( (29.76 ± 4.46) vs ( 32.09 ± 4.94) , P ＜ 0.01 ). (3) There were significant differences in the levels of two dimensions and total scores of empathy between patients and controls (F=3.10 ～5.36, P ＜ 0.05 ). Scores of cognitive empathy were lower in overt subgroup ( 29.22 ± 3.77 ) and covert subgroup (30.21 ± 5.17 ) than controls (32.09 ± 4.94) (P＜ 0.05, P＜0.01 );and scores of affective empathy were lower in overt subgroup than covert subgroup ( (26.13 ±5.05) vs (29.50 ±4.16), P＜0.05 ). Total scores of empathy were lower in overt subgroup (55.35 ±7.09) than covert subgroup (59.71 ±7.58) and controls (60.04 ±8.50 ) (P＜0.05). (4) Logistic regression analysis showed that cognitive empathy was a protective factor for conduct disorders( OR = 0.43 ). Conclusion The cognitive empathy level of patients is significantly lower than normal students;and boys with different types of conduct disorder possess different empathic abilities when compared with healthy controls;and cognitive empathy is a protective factor for conduct disorder.

Objective To compare the diagnostic value of DWI and ultrasound elastography(UE) in staging hepatic fibrosis in patients with chronic viral hepatitis B(CHB). Methods Fifteen healthy volunteers (control group) and 69 patients with CHB (disease duration more than 1 year) (patient group) were prospectively recruited. All of the subjects underwent DWI and UE experiments twice with the interval of less than 3 days. Liver ADC and shear wave velocity(SWV) values were obtained for subsequent analysis. Sixty?nine patients who had biopsy were grouped according to their pathological grading of fibrosis, from S0 to S4. One?way ANOVA was used to compare the ADC and SWV values between the five different fibrosis groups and control group. Spearman correlation analysis was used to analyze the correlations between the ADC and SWV values and those staging factors. Finally, receiver operating characteristic (ROC) curve analysis was performed to compare the diagnostic performance of ADC and SWV values in discriminating different stages of hepatic fibrosis. Results Based on the pathological results, the 69 patients were reclassified to five subgroups with 11, 13, 12, 15 and 18 patients in the S0, S1, S2, S3 and S4 groups respectively. ADC values were(1.39±0.09)×10-3,(1.39±0.08)×10-3,(1.38±0.10)×10-3,(1.20±0.06)×10-3,(1.12±0.07)×10-3 and(1.01±0.07)×10-3mm2/s for the control group and stages S0 to S4 respectively.SWV values were(1.17±0.07),(1.16±0.08),(1.23±0.10),(1.48±0.14),(1.85±0.14)and(1.97±0.12)m/s for stages S0 to S4 and the control group respectively. Statistically significant differences were observed among them (P<0.01). Both ADC (r=-0.894,P<0.01) and SWV (r=0.904,P<0.01) values were highly correlated with the stages of liver fibrosis. The area under ROC(AUC) for predicting fibrosis stages (≥S1, ≥S2, ≥S3 and S4) with ADC values was 0.893, 0.991, 0.966 and 0.952 respectively. Accordingly, the AUC for SWV values were 0.937, 0.993, 0.994 and 0.914. Conclusions The two imaging methods of DWI and UE showed good and similar diagnostic performance in discriminating the different stages of hepatic fibrosis.

This study aimed to investigate the efficacy and safety of apatinib plus programmed cell death protein 1 (PD-1) blockades for patients with metastatic colorectal cancer (CRC) who were refractory to the standard regimens. In this retrospective study, patients with metastatic CRC who received apatinib plus PD-1 blockades in clinical practice were included. The initial dosage of apatinib was 250 mg or 500 mg, and PD-1 blockades were comprised of camrelizumab, sintilimab and pembrolizumab. Efficacy and safety data were collected through the hospital’s electronic medical record system. From October 2018 to March 2022, a total of 43 patients with metastatic CRC were evaluated for efficacy and safety. The results showed an objective response rate of 25.6% (95% CI, 13.5%-41.2%) and a disease control rate of 72.1% (95% CI, 56.3%-84.7%). The median progression-free survival (PFS) of the cohort was 5.8 months (95% CI, 3.81-7.79), and the median overall survival (OS) was 10.3 months (95% CI, 5.75-14.85). The most common adverse reactions were fatigue (76.7%), hypertension (72.1%), diarrhea (62.8%), and hand-foot syndrome (51.2%).Multivariate Cox regression analysis revealed that Eastern Cooperative Oncology Group (ECOG) performance status and location of CRC (left or right-side) were independent factors to predict PFS of patients with metastatic CRC treated with the combination regimen. Consequently, the combination of apatinib and PD-1 blockades demonstrated potential efficacy and acceptable safety for patients with treatment-refractory metastatic CRC. This conclusion should be confirmed in prospective clinical trials subsequently.

Bovine adenovirus type 3 (BAdV3) is being used in the development of potential vehicles for gene therapy and vectored vaccine. To that end, a more comprehensive description of BAdV3 biology is essential. In this study, we focused on the role of pIX in BAdV3 virion rescue after full-length BAdV3 genome transfection. Initially, pIX deletion or initiation codon mutation abolished the production of progeny virions, which suggested that pIX was essential for the rescue of BAdV3 containing a full-length genome. Moreover, through transfection of a panel of pIX mutant BAdV3 genomes, we observed that the conserved N-terminus and the putative leucine zipper element (PLZP) were essential for virion rescue, whereas the C-terminus following the coiled-coil domain was non-essential. In addition, swap of the PLZP element and its following region of BAdV3 pIX to corresponding domains of human adenovirus type 5 (HAdV5) did not affect virion production, whereas swap of the entire pIX abolished production of progeny virions. We suggest that failure of the full-length BAdV3 pIX swap might be due to species specificity of its N-terminus region before the PLZP element.
Adenoviridae* ; Adenoviruses, Human ; Biology ; Codon, Initiator ; Genetic Therapy ; Genome ; Genome, Viral* ; Leucine Zippers ; Species Specificity ; Transfection* ; Virion*

Objective:To investigate the effect of albumin to fibrinogen ratio on the prognosis of patients undergoing radical resection for colorectal cancer.Methods:Clinical and pathological data of 216 patients who underwent laparoscopic radical resection of colorectal cancer at the General Surgery Department of Taizhou People's Hospital from Aug 2015 to Jul 2017 were retrospectively analyzed. Albumin and fibrinogen results within 7 days before surgery was collected. The optimal cut-off point of AFR was determined by Youden index of ROC curve. Kaplan-Meier analysis, univariate and multivariate COX regression models were used to analyze the prognostic factors of OS and DFS.Results:The best postoperative OS threshold of AFR for patients undergoing laparoscopic radical resection of colorectal cancer was 9.43. Univariate analysis and multivariate COX regression analysis showed that age ≤65 years, TNM stage Ⅰ-Ⅱ, and AFR≥9.43 had better OS and DFS (all P<0.05). Conclusions:Preoperative AFR level had a good predictive value on postoperative survival of patients undergoing laparoscopic radical resection of colorectal cancer, and AFR<9.43 was an independent risk factor for postoperative OS and DFS.