The phenomenon of perineural invasion in pancreatic cancer occurs more easily.It can cause pain and tumor recurrence,and result in poor prognosis.The perineural invasion of pancreas cancer is closely related to the anatomical basis of pancreas and nerve tissue as well as the changes in the tumor microenvironment.Multiple factors in the microenvironment take part in the development of perineural invasion,meanwhile,the tumor tissue itself can also change the microenvironment.This article is to overview the research on the anatomy and molecular biology of perineural invasion of pancreas cancer.

Objective:To explore the feasibility and precautions of laparoscopic pyeloplasty for children with hydronephrosis combined with renal trauma.Methods:The clinical data of 6 cases with hydronephrosis and renal trauma admitted to the Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University from August 2016 to August 2019, aged from 5 to 11 years old (average age 7 years old) were reviewed.These patients had suffered renal trauma for 1 to 4 days.All patients had the symptoms of pain in the affected kidney, and 4 patients had hematuria.The renal pelvis diameter of all patients was more than 25 mm.The patients underwent laparoscopic pyeloplasty and renal rupture repairment, with the ureteral stent, perirenal drainage tube and catheter placed inside the body during the operation.Results:All operations were completed successfully without any blood transfusion and open surgery.Intrao-perative time was from 2.5 to 3.5 hours.Two cases had renal parenchymal contusion in the front lower pole of kidneys and 4 cases in the lateral lower pole.Five cases had renal cortex and pelvis rupture, and 1 case had renal cortical fracture and subcapsular hematoncus.After the operation, the perinephric drainage tube was pulled out in 3 to 5 days, the catheter was pulled out in 7 to 10 days, and the ureteral stent was removed in 6 to 8 weeks.All children recovered well and hydronephrosis was ameliorated.The glomerular filtration rates and fractional renal function were all improved.Conclusions:One stage laparoscopic pyeloplasty is safe and effective for the treatment of hydronephrosis with renal trauma in children.Renal trauma in children usually occurs at the lower pole of the kidney.Early operation is needed if hydronephrosis is aggravated and symptoms are not relieved after the trauma.Intraoperative impairment of renal parenchymal rupture can be conducted.For intraoperative bleeding in grade 3 renal injury, renal parenchyma suturation and removal of necrotic renal tissue should be adopted to arrest bleeding.

Objective To explore the curative effect of knee flexion deformity on spastic cerebral palsy treatment method.Methods All of 30 patients with spastic cerebral and knee flexion deformity were randomly divided into two groups:traditional operation group and modified operation group,using the commonly used operation (In 15 cases,with traditional hamstring post surgery) and) modified operation (In 15 cases,with modified hamstring post surgery),two groups of patients were treated with Ilizarov external fixation drafting device in the correction of knee flexion deformity after soft tissue release.Adjustment began 7 days after the soft tissue release operation of external fixation,and stretched approximately 0.2 degrees each time,3 times/d,until knee flexion deformity was corrected to hyperextension for 10 degree and maintained for 3 weeks,and the flexion contracture degree of knee joint was measured every 2 weeks;then the Ilizarov external fixation drafting device was removed.Then wear a walking straight leg brace for more than 3 months,until the knee walking function is good.Clinical evaluation included the joint pain index,walking function index,knee flexion deformity degree and range of joint motion score of Dimeglio standard.Results Flexion contracture deformity of knee joint in 30 cases (60 knees) was corrected when Ilizarov external fixator was removed,knee extension to 0 degrees-5 degrees.The two groups of patients had the knee flexion angle range of-1.2 degrees to 13.3 degrees,with an average of (7.32°±3.41°) after removed of the walking straight leg brace,in which 4 cases (8 joints) got recurrent deformity of 10°-15° at the time of removing of the walking straight leg brace.Knee activity significantly was improved at the end of treatment.60 cases of knee joint activity were close to normal,with flexion of 100 degrees to 135 degrees,extension of 0 degrees to 10 degrees.Two groups of patients were statistically significantly improved before and after surgery.Curative effect comparison:The walking function index of the modified operation group was obviously superior to that of the traditional operation group,there was significant statistical difference.There were no statistically significant differences in pain index,knee flexion,and range of joint motion.Conclusion For the treatment of flexion deformity of the knee joint in spastic cerebral palsy,traditional surgery using the semitendinosus and gracilis,post and semimembranosus lysis,combined with the Ilizarov draft external fixation could improve the walking function of the patients,simplify the surgical incision and reduce trauma.As a result,modified hamstring post surgery is an ideal,effective treatment method.

Objective:To evaluate the effect of esketamine on acute kidney injury (AKI) in the rats with sepsis and the role of autophagy.Methods:Forty SPF healthy adult male Sprague-Dawley rats, weighing 200-240 g, were divided into 5 groups ( n=8 each) by a random number table method: control group (Con group), esketamine group (Con+ Ket group), sepsis group (lipopolysaccharide [LPS] group), sepsis plus esketamine group (LPS+ Ket group), and sepsis plus esketamine plus 3-methyladenine (3MA) group (LPS+ Ket+ 3MA group). The model of AKI was established by intraperitoneal injection of LPS in anesthetized rats.Normal saline 10 ml/kg was intraperitoneally injected in Con group.In Con+ Ket group, normal saline 10 ml/kg was intraperitoneally injected, and 30 min later esketamine 10 mg/kg was injected via the tail vein.LPS 10 mg/kg was intraperitoneally injected in LPS group.In LPS+ Ket group, LPS 10 mg/kg was intraperitoneally injected, and 30 min later esketamine 10 mg/kg was injected via the tail vein.In LPS+ Ket+ 3MA group, LPS 10 mg/kg was intraperitoneally injected, and 30 min later esketamine 10 mg/kg and 3-MA 15 mg/kg were injected via the tail vein.The rats were anesthetized at 24 h after intraperitoneal injection of LPS and then sacrificed, and renal tissues were removed for microscopic examination of the pathological changes which were scored and for determination of contents of nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3), apoptosis-associated speck-like protein containing a CARD (ASC), caspase-1, interleukin-1beta (IL-1β) and IL-18 (by enzyme-linked immunosorbent assay) and expression of LC3, P62 and Beclin-1 (by Western blot). Results:Compared with Con group, the score for pathological damage to renal tissues and contents of NLRP3, ASC, caspase-1, IL-1β and IL-18 were significantly increased, LC3-Ⅱ/LC3-Ⅰ ratio was decreased, the expression of Beclin-1 was down-regulated, and the expression of P62 was up-regulated in LPS group ( P<0.05). Compared with LPS group, the score for pathological damage to renal tissues and contents of NLRP3, ASC, caspase-1, IL-1β and IL-18 were significantly decreased, LC3-Ⅱ/LC3-Ⅰ ratio was increased, the expression of Beclin-1 was up-regulated, and the expression of P62 was down-regulated in LPS+ Ket group ( P<0.05). Compared with LPS+ Ket group, the score for pathological damage to renal tissues and contents of NLRP3, ASC, caspase-1, IL-1β and IL-18 were significantly increased, LC3-Ⅱ/LC3-Ⅰ ratio was decreased, the expression of Beclin-1 was down-regulated, and the expression of P62 was up-regulated in LPS+ Ket+ 3MA group ( P<0.05). Conclusion:Esketamine can reduce AKI and autophagy is involved in the process, which is related to inhibiting the activation of NLRP3 inflammasomes and decreasing inflammatory responses in rats with sepsis.

Objective:To explore the reasons for the retention of long time testicular torsion and the surgical selections of contralateral testis in children.Methods:The data of children with acute scrotal emergencies treated by the First Affiliated Hospital of Zhengzhou University from August 2016 to August 2019 were retrospectively analyzed.All the testicular torsion was included in the study sequence to summarize the clinical characteristics of the testicle that could be saved and different treatment methods adopted in the contrary side according to the anatomy of testes.Results:A total of 80 children with testicular torsion were included in the study.The onset time ranged from 2 hours to 15 days.All patients came to the hospital with unilateral scrotal pain or inguinal pain, including 74 cases of unilateral testicular torsion and 6 cases of cryptorchidical testicular torsion.All the children were treated with surgery.Orchiectomy was performed in 69 cases of testicular necrosis, and 11 cases were saved, among which 4 cases took a long time for testicular torsion, the main reason for the retention was the longer spermatic cord in the tunica vaginalis.Of the 80 healthy testes, the adhesion of the testis to tunica vaginalis was normal in 63 cases and abnormal in 17 cases.There were 20 children (including 5 children with abnormal anatomy) were routinely treated with partial removal of the tunica vaginalis and orchiopexy.Among the remaining 60 cases, 12 cases with abnormal adhesion of the testis to tunica vaginalis underwent partial removal of the tunica vaginalis and orchiopexy, and the other 48 cases with normal anatomy received the testis examination and the original incision closure.During the follow-up of 80 cases, 5 cases of the 11 children with the testis preserved returned to normal, 6 cases of them showed atrophy to varying degrees, and no discomfort such as torsion or pain was found in all the healthy testes.Conclusions:The long spermatic cord in the tunica vaginalis is the reason for long time testicular torsion in children with the testis saved.It buys time for the rescue of their testes.Orchiopexy is not necessary for those who have normal anatomy of the healthy testes, while partial removal of the tunica vaginalis and orchiopexy are recommended for patients with bell clapper anomaly.

Objective:To evaluate the therapeutic characteristics of laparoscopic repair in children with ure-terovesical junction malformation through internal or external bladder.Methods:From February 2018 to August 2019, 29 cases of hydronephrosis combined with ureter expansion treated in the First Affiliated Hospital of Zhengzhou University, with 17 boys and 12 girls confirmed through the preoperative examinations.Inspection results revealed 15 cases of ureteropelvic junction obstruction, 12 cases of vesicoureteral reflux, and 2 cases of single ectopic ureter.Totally, 21 cases were treated by pneumovesical laparoscopic Cohen means, including 17 unilateral cases and 4 bilateral cases, 5 cases of ureterocele, and 8 cases of ureteral clipping.A total of 8 cases were treated by laparoscopic Lich -Gregoir surgical treatment, including 7 unilateral cases and 1 bilateral case.Meanwhile, 4 cases of ureteral clipping were performed among them.There was 1 case of duplex kidney with the ectopic upper ureter outside iliac blood vessels, 1 case of bilateral cryptorchidism and 1 case of unilateral cryptorchidism.Ureteral stents were implanted for those with ureteral tailoring.The catheters were removed 7 days after operation, and the indwelling ureteral stents were removed by cystoscope under general anesthesia after about 6 weeks.Results:All the cases with hydronephrosis and ureteral dilatation were completed in laparoscopic surgery, without open surgery or blood transfusion, 21 cases were treated by pneumovesical laparoscopic Cohen means, with the average time being 1.8 hours in unilateral side and 2.8 hours in bilateral sides.At the same time, 8 cases were treated by laparoscopic Lich-Gregoir means, with the unilateral average time being 1.7 hours and bilateral time being 3.0 hours.All cases were followed up at an average month of 9 (4-20 months), and all children underwent voiding cystourethrography 4 months after the operations.The voiding cystourethrogram(VCUG) of all the cases was confirmed successfully, with only 1 case of vesicoureteral reflux in level Ⅲ, and their hydronephrosis were relieved.There was no vesicoureteral reflux in the others.The short-term urinary retention occurred in 1 patient with bilateral ureteral reimplantation in Lich-Gregoir group, and the symptom disappeared after 1 week of indwelling catheterization.Among them, 1 patient in Cohen group had hematuria that disappeared gradually for 4 days after surgery.There were no significant differences in operation time and postoperative recovery between the two groups.The length of hospital stay in laparoscopic Lich -Gregoir group was slightly longer than that in pneumovesical laparoscopic Cohen group.Conclusions:As for children with ureterovesical junction malformation, laparoscopic Lich-Gregoir surgery is suitable for the ectopia of ureter opening, overexpansion of ureter, and other abdominal malformation complicated and expansive ureter without tortuosity.Pneumovesical laparoscopic Cohen surgery is suitable for hydronephrosis and ureteral expansion with ureterocele, especially with the symptom of dysuria, and ureteral tortuosity obviously.The two ways are safe and reliable, and the advantages and disadvantages should be weighed before being chosen.

BACKGROUND: Thyroid transcription factor-1 (TTF-1) has been widely studied in non-small cell lung cancer, which is considered as an independent prognostic factor in patiens with non-small cell lung cancer. However, there are few studies on the prognostic value of TTF-1 in small cell lung cancer (SCLC). The purpose of this study was to explore the relationship between the expression state of TTF-1 and the sensitivity to first-line chemotherapy and prognosis in patients with SCLC. METHODS: A retrospective analysis was made on 234 patients with SCLC who were diagnosed and treated in The Affiliated Hospital of Qingdao University and received platinum-based chemotherapy. The clinical characteristics, treatment and survival of the patients were followed up. Chi χ² test and Logistic regression model were used to analyze the relationship between TTF-1 expression and chemotherapy response rate. Kaplan-Meier method and Cox proportional hazard regression model were used to analyze the effect of TTF-1 expression on survival time of patients. RESULTS: Among the 234 patients, the positive expression of TTF-1 was 188 cases (80.3%), and the negative expression of TTF-1 was 46 cases (19.7%). The objective response rate (ORR) of first-line chemotherapy in patients with positive expression of TTF-1 was higher than that in patients with negative expression of TTF-1 (70.7% vs 47.8%) (χ²=8.681, P=0.003). Logistic regression multivariate analysis showed that the expression state of TTF-1 was an independent predictor of ORR in first-line chemotherapy (OR=0.216, 95%CI: 0.076-0.615, P=0.004), however this difference was only reflected in LS-SCLC. The median progression free survival (PFS) of patients with negative expression of TTF-1 was shorter than that of patients with positive expression (6.9 months vs 9.0 months) (χ²=9.357, P=0.002). The median OS in TTF-1 negative group was shorter than that in TTF-1 positive group (13.3 months vs 20.1 months)(χ²=12.082, P=0.001). CONCLUSIONS TTF-1 expression is an independent predictor of first-line chemotherapy response rate and survival in patients with SCLC, and may become a biomarker to predict the efficacy and prognosis of SCLC.

Preoperative sleep loss can amplify post-operative mechanical hyperalgesia. However, the underlying mechanisms are still largely unknown. In the current study, rats were randomly allocated to a control group and an acute sleep deprivation (ASD) group which experienced 6 h ASD before surgery. Then the variations in cerebral function and activity were investigated with multi-modal techniques, such as nuclear magnetic resonance, functional magnetic resonance imaging, c-Fos immunofluorescence, and electrophysiology. The results indicated that ASD induced hyperalgesia, and the metabolic kinetics were remarkably decreased in the striatum and midbrain. The functional connectivity (FC) between the nucleus accumbens (NAc, a subregion of the ventral striatum) and the ventrolateral periaqueductal gray (vLPAG) was significantly reduced, and the c-Fos expression in the NAc and the vLPAG was suppressed. Furthermore, the electrophysiological recordings demonstrated that both the neuronal activity in the NAc and the vLPAG, and the coherence of the NAc-vLPAG were suppressed in both resting and task states. This study showed that neuronal activity in the NAc and the vLPAG were weakened and the FC between the NAc and the vLPAG was also suppressed in rats with ASD-induced hyperalgesia. This study highlights the importance of preoperative sleep management for surgical patients.
Rats ; Animals ; Hyperalgesia/metabolism* ; Sleep Deprivation/metabolism* ; Rats, Sprague-Dawley ; Periaqueductal Gray/pathology* ; Proto-Oncogene Proteins c-fos/metabolism* ; Pain, Postoperative/pathology*