DNA double-strand break repair (DSBR) pathways are important repair pathways in human. DSBR pathways repair damaged DNA, maintain the integrity of the genetic information and therefore suppress cancer. More and more researches have indicated important roles of DSBR pathway genes in the development and treatment of ovarian cancer.

Objective To investigate the application of permissive hypercapnia in the thoraco-scopic surgery of neonates with congenital esophageal atresia.Methods Thirty newborns with con-genital esophageal atresia,seventeen males,thirteen females,aged 1-5 days,weighing 1.42-3.28 kg, ASA physical status Ⅱ or Ⅲ,undergoing the thoracoscopic surgery,were randomly divided into group P and group C,n =1 5 in each group.The newborns were intratracheally intubated and adopted intravenous anesthesia combining inhalational anesthesia.FiO 2 100%,fresh gas flow 2 L/min,then adjusted the respirator parameters according to the results of airway pressure and arterial blood gas a-nalysis.Group P maintained PaCO 2 ranging at 60-80 mm Hg,group C maintained PaCO 2 ranging at 35-45 mm Hg.Arterial blood gas analysis was conducted respectively before artificial pneumothorax (T0 ),1 5 min after foundation of artificial pneumothorax (T1 ),30 min after foundation of artificial pneumothorax (T2 ),60 min after foundation of artificial pneumothorax (T3 )and 1 5 min after artifi-cial pneumothorax (T4 ).Two hours after surgery,a chest X ray photograph was taken to observe pneumothorax.The time from the end of the surgery to the ventilator weaning was recorded. Results At T1-T3 ,the PET CO 2 [(73.93 ± 3.53 )mm Hg vs.(41.53 ± 1.59 )mm Hg,(73.46 ± 3.04)mm Hg vs.(41.30±1.29)mm Hg,(74.13±2.85)mm Hg vs.(41.67 ±1.35)mm Hg]in group P were greatly higher than those in group C (P <0.05);the arterial blood pH value of group P (7.25±0.02 vs.7.38 ± 0.03,7.24 ± 0.01 vs.7.37 ± 0.03,7.25 ± 0.01 vs.7.38 ± 0.02 )were greatly lower than those in group C (P <0.05);PaCO 2 [(74.80±2.45)mm Hg vs.(41.93±1.39) mm Hg,(75.33±2.1 9)mm Hg vs.(42.01±1.31)mm Hg,(75.20±2.08)mm Hg vs.(42.13± 1.1 9)mm Hg ] were greatly higher than those in group C (P < 0.05 ).The incidence of pneumothorax of group P was obviously lower than that of group C (6.7% vs.40.0%,P <0.05 ). There was no statistically significant difference of the time from the end of surgery to the ventilator weaning [(3.6±0.6)d vs.(3.5 ±0.6)d]between the two groups.Conclusion Permissive hyper-capnia significantly reduces the incidence of pneumothorax in the thoracoscopic surgery of neonates with congenital esophageal atresia.Permissive hypercapnia (PaCO 2 60-80 mm Hg)can be safely ap-plied to the thoracoscopic surgery of neonates with congenital esophageal atresia.

Objective To define the correlation between the proliferating cell nuclear antigen (PCNA) and metastasis-related gene nm-23-H 1, and to correlate their espressions with clinical features,radiosensitivity and prognostic variables in exophageal squamous cell carcinoma (ESCC), to establish some biological parameters obtained prior to therapy though which we can predict radiosensitivity and outcome.Methods PCNA and nm-23-H 1 expression protein were determined by immunohistochemical technique with formalin-fixed paraffin-embedded specimens from 59 patients with ESCC who had received definitive radical radiation and had been followed up for more than 3 years. The values were assessed by distributions of patients , disease factors, including age,sex,lesion site,legth ,histological grade and prognosis.Results The findings showed that the mean labelling indices of PCNA and nm-23-H 1 were significantly higher in ESCC than in the normal esophageal tissue (P0.05).Conclusions PCNA and nm-23-H 1 indices can be taken as biological endpoints to predicting therapeutic response, local and systemic control of disease.

Objective:To evaluate the precise guidance of intraoperative ultrasound for closed reduction and fixation with intramedullary titanium elastic nail (TEN) in the treatment of clavicle fractures.Methods:The data of 40 patients with fresh clavicle fracture were retrospectively analyzed who had undergone closed reduction and TEN fixation under precise guidance of intraoperative ultrasound at Department of Emergency Trauma, Shandong Wendeng Osteopathic Hospital from January 2017 to March 2019. They were 25 males and 15 females, aged from 25 to 68 years (average, 52.1 years), with 27 cases on the left side and 13 on the right. Reduction and fixation of the fracture was monitored during operation to avoid iatrogenic injuries to the subclavian brachial plexus nerve, subclavian artery and vein and thoracic cavity. The Neer scoring was used at the last follow-up to assess shoulder joint function and complications were recorded.Results:Closed reduction and TEN fixation was completed uneventfully in all the 40 patients under precise guidance of intraoperative ultrasound. The operation time ranged from 20 to 56 min, averaging 36 min; the blood loss from 10 to 35 mL, averaging 22 mL. No injury occurred to the subclavian brachial plexus, subclavian artery or vein, or thoracic cavity. The 40 patients were followed up for 4 to 6 months (average, 4.8 months). All fractures achieved bony union, with no displacement or breakage of internal fixation, or fracture malunion. At the last follow-up, the shoulder joint function was good, with Neer scores ranging from 85 to 95 points (average, 93.1 points).Conclusion:The precise guidance of intraoperative ultrasound improves surgical accuracy and safety, making the closed reduction and TEN fixation a safe and minimally invasive treatment for clavicle fractures.

Objective:To investigate the features of common bile duct adenoma under endoscopic ultrasonography (EUS).Methods:Clinical data of 15 patients with common bile duct adenomas confirmed by pathology from January 2015 to January 2020 in Tianjin Nankai Hospital were analyzed retrospectively. The patients′ EUS features were summarized.Results:The common bile duct adenoma was characterized by homogeneous soft tissue mass with medium or low echo and clear boundary, floating in the bile duct with no movement under EUS. EUS diagnosis of 14 out of 15 patients was consitent with the pathology, and the diagnostic consistency was 93.3%. One patient with a movable lesion was misdiagnosed as cholestasis by EUS. One patient had two solitary adenomas, located in the middle and lower part of the common bile duct, and 14 others had single adenoma. There were 9 adenomas in the lower part, 4 in the ampulla, 2 in the upper part, and 1 in the middle of the common bile duct. The pathological findings were 7 cases of villous adenoma with high-grade intraepithelial neoplasia, 4 cases of local malignant changes; 6 villous tubular adenoma with high-grade intraepithelial neoplasia, 3 local malignant changes; 2 villous tubular adenoma with low-grade intraepithelial neoplasia; and 1 papillary adenoma.Conclusion:EUS, helpful for the qualitative diagnosis, can be used as an important technique to improve the diagnosis of common bile duct adenoma.

Objective To evaluate the clinical effect of the application of simultaneous metal stents for treatment of biliary and duodenal obstruction. Methods A retrospective review of clinical data in 32 patients underwent simultaneous placement of biliary and duodenal metal stent was performed. Changes of bilirubin and liver function indexes were observed before and after treatment in patients. Results The biliary stent placement and duodenal stent placement were successively performed in all patients. The indexes of liver function were improved, and the symptoms were relieved. Conclusion The combined self-expandable metal stenting for biliary and duodenal obstruction is a safe and effective treatment method.

Objective To compare the clinical effects of closed reduction and intramedullary nailing versus open reduction and plate fixation in the treatment of displaced midshaft clavicular fractures.Methods A prospective,randomized,controlled trial was performed between July 2012 and May 2014 in 194 patients with acute displaced midshaft clavicular fracture.They were 136 males and 58 females,from 16 to 65 years of age.They were randomly divided into 2 groups to received either closed reduction and intramedullary nailing (n =98) or open reduction and plate fixation (n =96).We recorded operation time,intraoperative blood loss,hospitalization expenses,fracture healing time and complication rate.Functional assessments were conducted at 3,6 and 12 months using the Disabilities of the Arm,Shoulder and Hand (DASH) and Constant-Murley scores.The preoperative general data showed no statistical significance between the 2 groups (P ＞ O.05).Results All the 194 patients were followed up for 12 to 27 months (average,15.6 ±3.1 months).The operation time (27.7 ± 16.3 min),intraoperative blood loss (18.6 ± 14.4 mL),hospitalization expenses (12,462.0 ±3,263.4 yuan),and fracture healing time (12.1 ± 3.0 weeks) in the intramedullary nailing group were significantly better than those(62.3 ± 19.4 min,40.3 ± 17.4 mL,24,760.0 ± 3,320.4 yuan,and 16.9 ± 2.8 weeks) in the plate fixation group (P ＜ 0.05).At 3 months after surgery,the DASH (13.4 ± 3.5) and Constant-Murley (88.5 ±5.9) scores in the plate fixation group were significantly better than those (24.8 ± 6.7 and 69.1 ± 6.2,respectively) in the intramedullary nailing group (P ＜ 0.05).At 6 and 12 months after surgery,there were no significant differences in the Constant-Murley scores or DASH scores between the 2 groups (P ＞ 0.05).The complication rate in the intramedullary nailing group (25.5％,25/98) was significantly higher than in the plate fixation group (9.4％,9/96) (P ＜ 0.05).Conclusions In the treatment of displaced midshaft clavicular fractures,compared with open reduction and plate fixation,closed reduction and intramedullary nailing has advantages of less invasion,lower cost and faster fracture healing,but a disadvantage of higher complication rate.The 2 treatments may lead to similar functional recovery of the shoulder.

Objective To study the effects of 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) on experimental allergic encephalomyelitis (EAE) and its immune-modulating mechanisms. Methods 1,25-(OH)2D3 were given to Lewis rats immunized with myelin basic protein (MBP) in complete Freud’s adjuvant (CFA) respectively on the same day of immunization (the prevented group) and the presenting day of symptoms (the treated group). Then clinical symptoms were scored until the 13th day after immunization, when rats were sacrificed. Mononuclear cells (MNC) in draining lymph nodes were collected for the following studies: (1)Total number of MNC in the lymph nodes were counted. (2) Numbers of CD~+4CD~+ 25 cells and CD~+ 86 cells were determinated by flow cytometry. (3) The concentrations of interferon(IFN)-? and interleukin(IL)-4 in cell culture supernatant were measured by enzyme-linked immuno sorbent assay (ELISA). Results 1,25-(OH)2D3 could delay the peak EAE severity in the prevented group while it could relieve the progression of EAE and lower the peak score in the treated group (3.3?0.6 vs 4.0?0.3, P

Objective:To investigate the short-term efficacy of totally laparoscopic distal gastrectomy (TLDG) after endoscopic submucosal dissection (ESD) versus direct TLDG for early gastric cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 623 patients with early gastric cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University from March 2014 to December 2019 were collected. There were 405 males and 218 females, aged from 26 to 86 years, with a median age of 62 years. Of 623 patients, 25 cases undergoing TLDG after ESD were divided into ESD+TLDG group and 598 cases undergoing TLDG directly were divided into TLDG group. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after propensity score matching; (2) intraoperative and postoperative situations of TLDG; (3) stratification analysis of the ESD+TLDG group. The propensity score matching was conducted by 1∶2 matching using the nearest neighbor method. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range) and comparison between groups was done using the Mann-Whitney U test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. Results:(1) The propensity score matching conditions and comparison of general data between the two groups after propensity score matching: 75 of 623 patients had successful matching, including 25 in the ESD+TLDG group and 50 in the TLDG group. Before propensity score matching, the body mass index (BMI), cases with tumor diameter ≤20 mm, 21 to 30 mm or>30 mm, cases with tumor classified as stage Ⅰ, stage Ⅱ or stage Ⅲ of clinical staging were (22.3±3.6)kg/m 2, 16, 6, 3, 24, 1, 0 of the ESD+TLDG group, respectively, versus (24.3±2.7)kg/m 2, 238, 125, 235, 312, 126, 160 of the TLDG group, showing significant differences in the above indicators between the two groups ( t=2.744, Z=?2.834, ?4.209, P<0.05). After propensity score matching, the BMI, cases with tumor diameter ≤20 mm, 21 to 30 mm or >30 mm, cases with tumor classified as stage Ⅰ or stage Ⅱ of clinical staging were (22.3±3.6)kg/m 2, 16, 6, 3, 24, 1 of the ESD+TLDG group, versus (23.6±2.9)kg/m 2, 29, 12, 9, 48, 2 of the TLDG group, showing no significant difference between the two groups ( t=1.542, Z=?0.597, 0.000, P>0.05). (2) Intraoperative and postoperative situations of TLDG: after propensity score matching, the operation time and time to postoperative drainage tube removal were 180 minutes(range, 124 to 289 minutes) and 6 days(range, 4 to 13 days) of the ESD+TLDG group,respectively,versus 170 minutes(range, 106 to 250 minutes) and 6 days (range, 4 to 9 days) of the TLDG group, showing significant differences between the two groups ( Z=-2.396, -3.039, P<0.05). Cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL, the number of lymph node dissected, duration of postoperative hospital stay, cases with perioperative complications as incision fat liquefaction, delayed gastric emptying, anastomotic bleeding or pulmonary infection were 7, 9, 9,34(range, 16 to 58), 8 days(range, 6 to 31 days), 1, 1, 0, 0 of the ESD+TLDG group,respectively,versus 18, 26, 6, 39 (range, 22 to 68), 8 days (range, 6 to 29 days), 0, 0, 1, 1 of the TLDG group, showing no significant difference between the two groups ( Z=-1.703, -1.958, -1.139, χ2=0.033, P>0.05). Cases with anastomotic bleeding were recovered after hemostasis under endoscopy and cases with other perioperative complications were recovered after conservative treatment. (3) Stratification analysis of the ESD+TLDG group. ① For 5 cases undergoing TLDG ≤14 days after ESD and 20 cases undergoing TLDG >14 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 200 minutes(range, 170 to 289 minutes), 0, 3, 2, 36(range, 9 to 57), 7 days(range, 5 to 9 days), 8 days(range, 7 to 9 days), 1 and 180 minutes (range, 124 to 253 minutes), 8, 6, 6, 34(range, 8 to 78), 6 days(range, 4 to 13 days), 8 days(range, 6 to 31 days), 1, respectively, showing no significant difference in the operation time of TLDG, volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative tube removal and duration of postoperative hospital stay between the two groups ( Z=?1.536, ?1.993, ?0.238, ?0.932, ?0.589, P>0.05), and no significant difference in cases with perioperative complications between the two groups ( P>0.05). ② For 13 cases undergoing TLDG ≤21 days after ESD and cases undergoing TLDG >21 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss as <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 200 minutes(range, 145 to 289 minutes), 2, 6, 5, 34(range, 8 to 57), 6 days(range, 4 to 11 days), 8 days(range, 6 to 11 days), 1 and 179 minutes(range, 124 to 240 minutes), 6, 3, 3, 34(range, 16 to 78), 6 days(range, 5 to 13 days), 8 days(range, 6 to 31 days), 1, respectively, showing a significant difference in the operation time of TLDG between the two groups ( Z=?2.241, P<0.05), while showing no significant difference in the volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay between the two groups ( Z=?1.471, ?0.163, ?0.084, ?0.194, P>0.05) and no significant difference in cases with perioperative complications between the two groups ( P>0.05). ③ For 15 cases undergoing TLDG ≤28 days after ESD and 10 cases undergoing TLDG >28 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 190 minutes (range, 145 to 289 minutes), 2, 7, 6, 33(range, 8 to 57), 6 days(range, 4 to 11 days), 8 days(range, 6 to 31 days), 1 and 179 minutes(range, 124 to 240 minutes), 6, 2, 2, 37(range, 16 to 78), 6 days (range, 5 to 13 days), 8 days(range, 6 to 14 days), 1, respectively, showing no significant difference in the operation time of TLDG, volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative tube removal and duration of postoperative hospital stay between the two groups ( Z=?1.619, ?2.000, ?0.667, ?0.370, ?0.057, P>0.05), and no significant difference in cases with perioperative complications between the two groups ( P>0.05). Conclusions:Compared with cases undergoing TLDG directly, the operation time to TLDG and time to drainage tube removal after TLDG for cases undergoing ESD+TLDG are prolonged, but there is no difference in the short-term efficacy. For cases undergoing TLDG ≤21 days after ESD and cases undergoing TLDG >21 days after ESD, there is a significant difference in the operation time of TLDG.

OBJECTIVE: To evaluate the impact of Down syndrome (DS) on surgical management in patients with congenital heart defects (CHD). METHODS: We retrospectively analyzed the clinical data from 35 children with DS and CHD, who underwent cardiac surgery between 2004 and 2009. The data on surgical mortality, complications and follow-up results are emphasized. RESULTS: All of the patients underwent primary repair. One child (2.9%) with DS and complete atrioventricular septal defect (CAVSD) died early postoperatively because of pulmonary hypertension. Two patients (5.7%) had low cardiac output syndrome, and 15 (42.9%) suffered pulmonary complications. III degree atrioventricular block (AVB) occurred in 4 patients (11.5%). Thirty children who were followed up 10 months to 6 years [(3.8±1.1) years] are in NYHA class I or II. There were no reoperations or later death. CONCLUSION CHD in DS children can be repaired with a low risk of mortality, although a high incidence of severe infections and III degree AVB can result in a complicated postoperative course. The results of mid-term follow up are satisfactory.
Child ; Child, Preschool ; Down Syndrome ; complications ; Female ; Heart Defects, Congenital ; complications ; mortality ; surgery ; Heart Septal Defects, Ventricular ; complications ; mortality ; surgery ; Humans ; Infant ; Male ; Postoperative Complications ; etiology ; Retrospective Studies ; Survival Analysis ; Treatment Outcome