Lymphorrhea and lymphocele are the common complications after urological pelvic lymph node dissection, which are difficult to diagnose and treat. Up to now, a few studies of lymphorrhea and lymphocele were reported, and there is no relevant diagnosis and treatment guideline. The pathogenesis, treatment and prevention of lymphorrhea and lymphocele formation after urological pelvic lymphadenectomy were reviewed in this article.The mechanism of occurrence includes leakage and exudation of lymph-vessels. The high risk factors are old age, open surgery and perioperative use of anticoagulants. Most patients can be cured by nutrition management and percutaneous catheter sclerotherapy. Closing lymph-vessels and stumps may paly an important role in prevetion of lymphorrhea and lymphocele.

BACKGROUND: Different derivatives of chitosan with different molecular weights or degrees of deacetylation show different anti-tumor effects.OBJECTIVE: To study the inhibition effect of water-soluble chitosan and its derivatives, such as sulfonated chitosan, carboxymethyl chitosan and chitooligosaccharides for the growth of hepatocellular carcinoma cell line SMMC7721.DESIGN, TIME AND SETTING: Controlled experiments based on observation were carried out in Jiangxi Institute of Digestive Disease (Nanchang, Jiangxi, China) from January 2004 to December 2006.MATERIALS: Hepatoma cell line SMMC7721 was provided by Jiangxi Institute of Digestive Disease (China). 85.5% deacetylated chitooligosaccharides and 85% deacetylated water-soluble chitosan were produced by Jinan Haidebei Ocean Biological Engineering Co., Ltd (China); Carboxymethyl chitosan and 88.5% deacetylated chitosan were the products of Shanghai Qisheng Biological Products Co., Ltd (China).METHODS: Sulfonated chitosan was prepared using 88.5% deacetylated chitosan and chlorosulfonic acid-formamide, and then was detected with infrared spectroscopy in the Detection Analysis and Test Center, East China University of Science and Technology. SMMC7721 cells in the log phase were inoculated into 96-well culture plates, which were then added with water-soluble chitosan, sulfonated chitosan, carboxymethyl chitosan and chitooligosaccharides with the final concentrations of 25, 50, 100, 200, 400 and 800mg/L. This test was repeated for 3 times, while the control group was also set each time. After 72 hours of routine culture, MTT solution was added into each well and inoculated for another 4 hours. After the culture was terminated, dimethyl sulfoxid was added. The absorbance value of each well was measured at 490nm wavelength on a microplate reader. Three tests were measured to obtain the mean value. Also the inhibition rate was calculated.MAIN OUTCOME MEASURES: Growth inhibition effect of chitosan and its derivatives on the hepatoma cell line SMMC7721.RESULTS: Among the chitosan and its derivates at four kinds of concentrations, water-soluble chitosan and sulfonated chitosan could significantly inhibit the growth of SMMC7721 cells (P<0.001), and the effect was the most significant in the case of sulfonated chitosan. Treatment with water-soluble chitosan and sulfonated chitosan at the concentration of 50mg/L could inhibit the growth of SMMC7721 cells in a dose-dependent manner, and reached a peak at the concentration of 400mg/L and 800mg/L, respectively. Carboxymethyl chitosan and chitooligosaccharides showed no growth inhibition effect (P>0.05).CONCLUSION: Water-soluble chitosan and sulfonated chitosan have significant antigrowth effects on hepatoma carcinoma cells, while carboxymethyl chitosan and chitooligosaccharides are ineffective.

Pregnancy ; Female ; Humans ; Milk, Human ; Overweight/genetics* ; Fatty Acids, Unsaturated ; Fatty Acids ; Adiponectin/genetics*

Objective To observe the incidence of severe acute pancreatitis (SAP) in obese acute pancreatitis (AP) patients with medical treatment, and evaluate the impact of obesity in AP progression.Methods A multicenter prospective controlled study was conducted. APACHE Ⅱ scoring system was used to evaluate the severity of AP. Results 161 patients with mild AP(MAP) were enrolled, according to the cut-off point of 25 kg/m2, these patient were divided into obese group (79 patients) and non-obese group (82patients). The levels of CRP, hypertriacylglycerolemia, complication rate, incidence of SAP and mortality were observed under the circumstance of identical medical treatment. The levels of CRP in obese group and non-obese group were (117±109 ) mg/L and (35±36 ) mg/L(P<0.01). The number of obese patients with hypertriacylglycerolemia was two times as many as that in non-obese patients, but there was no significantly difference. There was no local complication in both groups, but the incidence of systematic complication in obese patients (20.3%) was significantly higher than that in non-obese group (6.1%, P<0.01). 16patients (20.3%) in obese group progressed into SAP, which was significantly higher than that in non-obese group (5 patients, 6.1%, P<0.01). One patient(1.3%) died in obese group, but no one died in non-obese group. In MAP patients with APACHE Ⅱ 4～7 points, the incidence of SAP (43.3%) in obese group was significantly higher than that in non-obese group (18.5%, P<0.05). Conclusions Obese MAP patients with APACHE Ⅱ 4～7 points were prone to develop into SAP. More aggressive interventions are needed.

An increasing number of studies have recently indicated the important effects of gut microbes on various functions of the central nervous system.However, the underlying mechanisms by which gut microbiota regulate brain functions and behavioral phenotypes remain largely unknown. We therefore used isobaric tags for relative and absolute quantitation (iTRAQ)-based quantitative proteomic analysis to obtain proteomic profiles of the hippocampus in germ-free (GF), colonized GF, and specific pathogen-free (SPF) mice. We then integrated the resulting proteomic data with previously reported mRNA microarray data, to further explore the effects of gut microbes on host brain functions. We identified that 61 proteins were upregulated and 242 proteins were downregulated in GF mice compared with SPF mice. Of these, 124 proteins were significantly restored following gut microbiota colonization. Bioinformatic analysis of these significant proteins indicated that the glucocorticoid receptor signaling pathway and inflammation-related pathways were the most enriched disrupted pathways. This study provides new insights into the pathological mechanisms of gut microbiota-regulated diseases.

Objective:To investigate the application value of multi-slice spiral CT (MSCT) in Borrmann classification of advanced gastric cancer.Methods:The clinical data of 80 patients with advanced gastric cancer who received treatment in Cixi Integrated Traditional Chinese and Western Medicine and Health Group from January 2016 to January 2020 were analyzed. Clinical results were compared with MSCT imaging findings.Results:Postoperative specimens of 80 patients with gastric cancer showed that a single cancer occurred in cardiac fundus of 13 (16.25%) patients, in gastric body of 21 (26.25%) patients, in gastric antrum of 46 (57.50%) patients. Advanced gastric cancer involved gastric fundus and gastric body in 21(26.25%) patients, gastric antrum and gastric body in 34 (42.50%) patients, and gastric fundus, gastric body and gastric antrum in 13 (16.25%) patients. Pathological results of gastric cancer showed Borrmann type I in 12 (15.00%) patients, Borrmann type II in 28 (35.00%) patients, Borrmann type III in 27 (33.75%) patients and Borrmann type IV in 13 (16.25%) patients. The accuracy rate of preoperative MSCT in the identification of Borrmann type I, II, III and IV gastric cancer was 83.33%, 78.57%, 77.78%, and 84.62%, respectively, with the total preoperative MSCT accuracy rate of 80.00%. Preoperative MSCT has good intra-observer consistency and inter-observer consistency in the Borrmann classification of advanced gastric cancer, with the kappa values of 0.883 and 0.853, respectively ( P < 0.001). Conclusion:MSCT has a high accuracy rate and good repeatability in Borrmann typing of advanced gastric cancer.

OBJECTIVETo perform a prospective,multicenter,open,randomized study to determine a treatment regimen for treatment-naive patients with refractory chronic hepatitis C (RHC) using the predictive value (PV) of early virological response (EVR).

METHODSA total of 438 patients from 18 hospitals were recruited between December 2008 and December 2010 and administered peg-interferon/ribavirin treatment for 12 weeks. Patients who achieved complete EVR (cEVR) were assigned to group A for a 48-week course of treatment, while patients without cEVR were randomly allocated to either group B 1 for a 72-week course of treatment or to group B2 for a 96-week course of treatment. Serum hepatitis C virus RNA levels at baseline,treatment weeks 4, 12 and 24, end of treatment, and post-treatment week 24 were measured and used to evaluate the efficiency of therapy.

RESULTSThe overall sustained virological response (SVR) rate was 85.1%. In all, 91.0% of patients achieved cEVR and were assigned to group A, which had an SVR rate of 90.8%. There was no statistically significant difference in the SVR rates of groups B1 and B2 (29.4% vs. 25.0%, P more than 0.05). The positive PV of rapid virological response (RVR), cEVR and delayed virological response (DVR) for SVR was 93.4%, 90.8% and 77.8% respectively, and the negative PV of RVR, EVR and DVR for SVR was 28.0%, 93.3% and 100% respectively. Overall, 66.9% of the patients experienced adverse events (AEs), but only 1.9% of patients experienced sevcre AEs.

CONCLUSIONThe majority of Chinese RHC treatmentna(i)ve patients (91.0%) can achieve cEVR and a high SVR rate with a low rate of severe AEs using the cEVR guided personal treatment regimen.

Aortic graft infections(AGI) are uncommon complications of aortic surgery, although they carry a high mortality. Due to its special anatomical location, the thoracic aorta has less surrounding covered tissue. Once the graft infection occurs, the condition is often more dangerous. Therefore, the treatment of AGI of thoracic aorta is particularly important. This article reviews the surgical treatment of thoracic aorta graft infections.

Background/Aims: Four-week treatment of linvencorvir (RO7049389) was generally safe and well tolerated, and showed anti-viral activity in chronic hepatitis B (CHB) patients. This study evaluated the efficacy, safety, and pharmacokinetics of 48-week treatment with linvencorvir plus standard of care (SoC) in CHB patients. Methods: This was a multicentre, non-randomized, non-controlled, open-label phase 2 study enrolling three cohorts: nucleos(t)ide analogue (NUC)-suppressed patients received linvencorvir plus NUC (Cohort A, n=32); treatment-naïve patients received linvencorvir plus NUC without (Cohort B, n=10) or with (Cohort C, n=30) pegylated interferon-α (Peg-IFN-α). Treatment duration was 48 weeks, followed by NUC alone for 24 weeks. Results: 68 patients completed the study. No patient achieved functional cure (sustained HBsAg loss and unquantifiable HBV DNA). By Week 48, 89% of treatment-naïve patients (10/10 Cohort B; 24/28 Cohort C) reached unquantifiable HBV DNA. Unquantifiable HBV RNA was achieved in 92% of patients with quantifiable baseline HBV RNA (14/15 Cohort A, 8/8 Cohort B, 22/25 Cohort C) at Week 48 along with partially sustained HBV RNA responses in treatment-naïve patients during follow-up period. Pronounced reductions in HBeAg and HBcrAg were observed in treatment-naïve patients, while HBsAg decline was only observed in Cohort C. Most adverse events were grade 1–2, and no linvencorvir-related serious adverse events were reported. Conclusions 48-week linvencorvir plus SoC was generally safe and well tolerated, and resulted in potent HBV DNA and RNA suppression. However, 48-week linvencorvir plus NUC with or without Peg-IFN did not result in the achievement of functional cure in any patient.

Objective To assess the efficacy and safety of 100 mg or 200 mg yimitasvir phosphate combined with sofosbuvir in patients with non-cirrhotic chronic hepatitis C virus ( HCV) genotype 1 infection who were treatment-na?ve or had a virologic failure to prior interferon-based treatment.Methods A multicenter, randomized, open-label, phase 2 clinical trial was conducted.The patients were randomly assigned to yimitasvir phosphate 100 mg+sofosbuvir 400 mg group (Group 100 mg) and yimitasvir phosphate 200 mg+sofosbuvir 400 mg group ( Group 200 mg) in a 1∶1 ratio with the stratified factors of " treatment-naive" or"treatment-experienced" for 12 weeks and followed up for 24 weeks after the end of treatment.During the clinical trial, HCV RNA was tested in all patients.Resistance of virus in patients who didn′t achieved sustained virological response (SVR) was monitored.Safety and tolerability were assessed by monitoring adverse events , physical examination , laboratory examination, electrocardiogram, and vital signs during the study.The primary end point was SVR12 after the end of therapy.Descriptive statistics were used for categorical variables and eight descriptive statistics were used for continuous variables.Descriptive statistics were used and summarized according to HCV genotypes and treatment groups.Safety data were presented using descriptive statistics and summarized according to treatment groups.Results A total of 174 subjects were screened from July 31, 2017 to September 26, 2018.One hundred and twenty-nine patients were successfully enrolled and received treatment , and 127 completed the study.There were 64 patients and 65 patients assigned to Group 100 mg and Group 200 mg, respectively.Among the 129 patients who underwent randomization and were treated , 18.6% were treatment-experienced and: 100%were HCV genotype 1b infection.The total SVR rate was 98.4%(127／129), with 98.4%(63／64, 95%confidence interval [CI]: 91.60%-99.96%) in the Group 100 mg, and 98.50%(64／65, 95%CI: 91.72%-99.96%) in the Group 200 mg.There was no significant difference between the two groups (χ2 ＝0.000 2, P＝0.989 2).The SVR rates in treatment-naive group and treatment-experienced group were 98.10%(95%CI: 93.29%-99.77%) and 100.00%(24／24, 95%CI: 85.75%-100.00%), respectively.Virological failure during treatment ( including breakthrough , rebound and poor efficacy) and relapse after treatment did not occur during the trial.By Sanger sequencing , 11.6%(15／129) patients had baseline NS5A Y93H／Y or Y93H resistance-associated substitutions ( RAS), 1.6%( 2／129) patients had baseline NS5A L31M RAS.No mutation was observed in NS5B S282 at baseline.There was no S282 mutation in HCV NS5B.A total of 100 (77.5%) subjects had adverse events.No adverse events ≥Grade 3 or severe adverse events related to the study treatment.No patient prematurely discontinued study treatment owing to an adverse event.No life-threatening adverse event was reported.Conclusion Twelve weeks of yimitasvir phosphate 100 mg or 200 mg combined with sofosbuvir 400 mg daily is a highly effective and safe regimen for patients without cirrhosis with HCV genotype 1b infection who had not been treated previously or had a virologic failure to prior interferon-based treatment.