Objective Explore the feasibility of the laparoscopy, choledocho-fiberacopy, duodenoscopy for the extrahepatic bile duct stone patients and the scope of application. Methods Sixty-four patients with extract common bile duct stones received the multiple endoscopies. Results Satisfactory outcome was ob-tained, no conversion, residual stones, and other complications were observed. Conclusion With profi-ciency in endoscopic and laparoscopic techniques, and a good grasp of the indications for various methods, minimally invasive treatment for extrahepatic bile duct stones is safe and feasible.

Objective To assess the outcomes of the laparocopic cholecystectomy for complicated gall-stone and to sum up the skills and experiences of the operation. Methods We retrospectively analyzed the clinical data of laparoscopic treatment for the complicated gallstone of 256 patients within three years. Re-sults All patients were cured and discharged, without convention to open surgery and operateive death. Conclusion As long as master the operative indications and the skills to managing complicated problems, LC can be used for the treatment of complicated gallstone.

In order to explore the application of the teaching mode based on WeChat official platform in the teaching of experimental pathology for international students, the students are required to browse the teaching objectives and the general pictures and microscopic pictures of experimental specimens on the public platform before the experimental class, and get in touch with the preliminary diagnosis of pathology at an early stage, contact with the preliminary diagnosis of pathology early, and consolidate and expand their knowledge after class by using the platform. The research shows that the mixed teaching mode based on the official platform can improve the diagnostic thinking of foreign students in pathology, deepen their understanding of pathology, increase the interaction between teachers and students and the supervision of teachers on students, and enhance their interest in learning.

Objective:To investigate the clinical features of preoperative gastric cancer cachexia patients, with the focus on changes of abdominal fat distribution and serum inflammatory factors.Methods:128 gastric cancer patients admitted to General Surgery Department of Zhongshan Hospital, Fudan University from January 2018 to December 2018 were included. Relevant clinical information was collected, including age, gender, height, weight, hematological test results and blood lipid profiles (including free fatty acids ,FFA). Concurrent serum IL-6 and TNF-α levels were examined using enzyme-linked immunosorbent assay. Areas of subcutaneous and visceral fat were both measured at umbilical level on CT. Data mentioned above were compared between gastric cancer patients with cachexia and pre-cachexia.Results:The 128 patients were divided into stable pre-cachexia group (97 patients) and cachexia group (31 patients). Compared with pre-cachexia group, patients in the cachexia group showed significant decline in BMIs (23.4±0.3 vs 21.9±0.6, t=2.359, P=0.019), apparent elevation in serum IL-6 levels [(3.73±0.32) ng/L vs(5.26±0.77) ng/L, t=2.214, P=0.036], significant decrease in lymphocyte counts [(1.67±0.05)×10 9/L vs (1.42±0.12)×10 9/L, t=2.251, P=0.026], as well as predominant decrease in total protein levels, [(64.9 ± 0.8) g/L vs (61.5±1.1) g/L, t=2.208, P=0.029], total cholesterol levels [(4.09±0.09) mmol/L vs (3.74±0.15) mmol/L, t=2.393, P=0.046] and pre-albumin levels [(0.22±0.01) g/L vs (0.19±0.01) g/L, t=1.987, P=0.049]. Additionally, there was a noticeable decrease in subcutaneous fat area [(151.6±8.73) cm 2vs (112.4±15.9) cm 2, t=2.192, P=0.042]. The other markers displayed no remarkable differences. Conclusion:Based on our investigation, it's highly suspected that IL-6 plays a more important role than TNF-α in the fat loss of gastric cancer cachexia patients, and these patients have increased lipid catabolism predominated by subcutaneous fat loss.

Objective: To investigate the effect of oral nutritional supplements(ONS) on body weight loss and life quality in post-discharge patients with gastric and colorectal cancer. Methods: All the enrolled post-operative gastric or colorectal cancer patients were randomly divided into ONS group and control group. Body weight loss, middle arm circumference, triceps skinfold thickness and right-hand grip strength were measured and the Karnofsky score, ECOG score and QOL score were calculated 3 months after the discharge. Results: The body weight loss of gastric cancer patients was lower in ONS group than in control group since 2 months after discharge.(2 months after discharge: 1.65±2.11vs. 2.70±1.90 kg, t=-2.385 3, P=0.019 3; 3 months after discharge: 1.95±2.75vs. 3.67±2.29 kg, t=-3.134 7, P=0.002 4), There was no difference of body weight loss between two groups in colorectal cancer patients. The middle arm circumference, triceps skinfold thicknessand right-hand grip strength showed no statistic difference between two groups both in gastric and colorectal cancer patients. The Karnofsky score(56.82±13.65%vs. 51.71±9.72%, t=2.014 8, P=0.047 2) and QOL score(41.91±6.92 vs. 38.39±8.77, t=2.059 7, P=0.042 6) were higher in ONS group than in control group in gastric cancer patients. While all 3 types of scores had no difference between two groups in colorectal cancer patients. Conclusion ONS can efficiently reduce the body weight loss and improve the performance status and life qualityin post-discharge gastric cancer patients, but not in colorectal cancer patients.

Objective:To explore the application effect of the auxiliary teaching mode based on WeChat Official Platform in pathology teaching.Methods:With the help of WeChat Official Platform, the "Pathology Experimental Course Platform of Qiqihar Medical University" (bilingual) was designed and formed. For the international students in the experimental group, teachers designed, developed and generated teaching resources in advance according to the requirements of pathology syllabus for international students and teaching contents, and post them on the platform. At the end of the term, they had pathology examination with the same difficulty as the control group, and their results were comparatively analyzed. Meanwhile, a questionnaire survey was designated to evaluate the teaching process and effects, to find out whether the platform work for the students to obtain more extracurricular knowledge and improve learning efficiency. SPSS 19.0 was used for t test. Results:Compared with the control group [(7.56±0.12) points and (53.20±0.70) points], the experimental group's scores of experimental assessment [(8.59±0.13) points] increased significantly ( P<0.05), and the scores of theoretical assessment [(56.23±0.60) points] also increased significantly ( P<0.05). Conclusion:With the help of the WeChat Official Platform, the auxiliary teaching mode breaks the limitation of time and space, enables foreign students to study and observe more actively, consolidates basic theoretical knowledge, strengthens the ability to observe disease lesions and clinical thinking ability, promotes international students' understanding of the relationship between pathological changes and clinical symptoms and signs, and improves their academic performances.

OBJECTIVE: To investigate the levels of serum inflammatory cytokines and Resolvin D1 (RvD1) and their association with pathological staging of colon cancer. METHODS: Clinical data of 50 colon cancer patients (colon cancer group) admitted to the General Surgery Department of Zhongshan Hospital of Fudan University from January to December 2016 and 5 ml of whole blood specimen were collected at admission. During the same period, 50 healthy volunteers were enrolled (healthy volunteer group). Inclusion criteria for the colon cancer group: colon cancer diagnosed by preoperative colonoscopy and pathology; no recent enteral or parenteral nutrition support treatment or use of oral nutrition preparation; age ≤85 years; no surgical contraindications by preoperative evaluation; no history of taking fish oil-related preparations; no radiotherapy or chemotherapy before surgery. Healthy volunteer group enrollment criteria: no history of malignant tumors; no organ with organic lesions detected by the healthy examination center of our hospital; detection indicators in normal reference range; no administration of fish oil-related preparations; age ≤ 85 years. Serum inflammatory factors(IL-1β, IL-6, IL-10 and TNF-α) concentrations were detected by chemiluminescence immunoassay; serum RvD1 concentration was measured by enzyme-linked immunosorbent assay. The levels of inflammatory factors and RvD1 were compared between the two groups, and their associations with TNM staging of colon cancer patients were analyzed. RESULTS: There were no significant differences in age, gender and nutrition-related indicators between the two groups (all P>0.05). There were 31 males and 19 females in the healthy volunteer group with age of (61.8±11.6) years. There were 23 males and 27 females in the colon cancer group with age of (65.4±12.4) years. According to the 7th edition of the American Cancer Society TNM staging criteria, 10 cases were stage I, 13 cases stage II, 17 cases stage III, and 10 cases stage IV. Compared with healthy volunteer group, colon cancer group had higher serum IL-1β [(3.89±0.24)×10 μg/L vs.(1.55±0.37)×10 μg/L, t=37.52, P<0.01], higher IL-6 [(129.14±3.07)×10 μg/L vs.(51.46±3.14)×10 μg/L, t=125.08, P<0.01], higher IL-10 [(100.59±8.69)×103 μg/L vs.(27.57±4.77)×10 μg/L, t=52.09, P<0.01] and higher TNF-α [(114.31±4.43)×10 μg/L vs.(41.04±5.27)×10 μg/L, t=75.25, P<0.01], while lower RvD1 [(34.19±1.93)×10 μg/L vs.(77.76±1.02)×10 μg/L, t=140.56, P<0.01], all the differences were statistically significant. Subgroup analysis revealed that concentrations of IL-6, IL-1β, IL-10 and TNF-α gradually increased with the advancement of TNM staging (P<0.01). In stage III, concentrations of IL-6, IL-1β, and IL-10 were the highest, TNF-α concentration was the highest in stage IV. RvD1 concentration gradually decreased with the advancement of TNM staging(P<0.01). CONCLUSIONS Compared with healthy volunteers, the levels of serum inflammatory cytokines in colon cancer patients increase significantly while the level of RvD1 decreases significantly. Both are associated with higher TNM stage of colon cancer.
Aged ; Colonic Neoplasms ; blood ; immunology ; pathology ; Cytokines ; blood ; Docosahexaenoic Acids ; blood ; Female ; Humans ; Male ; Middle Aged

Objective:To systematically evaluate the safety and efficacy of laparoscopic versus open surgery for palliative resection of the primary tumor in stage IV colorectal cancer.Methods:The databases of CNKI, Wanfang, VIP, PubMed, EMBASE and Cochrane Library were searched to retrieve randomized controlled trials (RCT) or clinical controlled trials (CCT) comparing laparoscopic surgery with open surgery for palliative resection of the primary tumor in stage IV colorectal cancer published from January 1991 to May 2019. Chinese search terms included "colorectum/colon/rectum" , "cancer/malignant tumor" , "laparoscopy" , "metastasis" , " IV" ; English search terms included "laparoscop*" , "colo*" , "rect*" , "cancer/tumor/carcinoma/neoplasm" , " IV" , "metasta*" . Inclusion criteria: (1) RCT or CCT, with or without allocation concealment or blinding; (2) patients with stage IV colorectal cancer that was diagnosed preoperatively and would receive resection of the primary tumor; (3) the primary tumor that was palliatively resected by laparoscopic or open procedure. Exclusion criteria: (1) no valid data available in the literature; (2) single study sample size ≤20; (3) subjects with colorectal benign disease; (4) metastatic resection or lymph node dissection was performed intraoperatively in an attempt to perform radical surgery; (5) duplicate publication of the literature. Two researchers independently evaluated the quality of the included studies. In case of disagreement, the evaluation was performed by discussion or a third researcher was invited to participate. The data were extracted from the included studies, and the Cochrane Collaboration RevMan 5.1.0 version software was used for this meta-analysis.Results:Four CCTs with a total of 864 patients were included in this study, including 216 patients in the laparoscopic group and 648 patients in the open group. Compared with the open group, except for longer operation time (WMD=37.60, 95% CI: 26.11 to 49.08, P<0.05), laparoscopic group had less intraoperative blood loss (WMD=-74.89, 95% CI: -144.78 to -5.00, P<0.05), earlier first flatus and food intake after surgery (WMD=-1.00, 95% CI: -1.12 to -0.87, P<0.05; WMD=-1.61, 95%CI: -2.16 to -1.06, P<0.05), shorter hospital stay (WMD=-2.01, 95% CI: -2.21 to -1.80, P<0.05) and lower morbidity of postoperative complication (OR=0.52, 95% CI: 0.35 to 0.77, P<0.05). However, no significant differences were found in time to start postoperative chemotherapy, postoperative chemotherapy rate, and mortality ( P > all 0.05). Conclusion:Laparoscopic surgery for palliative resection of the primary tumor is safe and feasible to enhance recovery after surgery by promoting postoperative bowel function recovery, shortening hospital stay and reducing postoperative complication in stage IV colorectal cancer.

Objective:To observe the effect of noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula oxygen therapy (HFNC) on the prognosis of patients with coronavirus disease 2019 (COVID-19) accompanied with acute respiratory distress syndrome (ARDS).Methods:A retrospective study was conducted in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology when authors worked as medical team members for treating COVID-19. COVID-19 patients with pulse oxygen saturation/fraction of inspiration oxygen (SpO 2/FiO 2, S/F) ratio < 235, managed by medical teams [using S/F ratio instead of oxygenation index (PaO 2/FiO 2) to diagnose ARDS] from February to April 2020 were included. The patients were divided into NIPPV group and HFNC group according to their oxygen therapy modes. Clinical data of patients were collected, including general characteristics, respiratory rate (RR), fraction of FiO 2, SpO 2, heart rate (HR), mean arterial pressure (MAP), S/F ratio in the first 72 hours, lymphocyte count (LYM), percentage of lymphocyte (LYM%) and white blood cell count (WBC) at admission and discharge or death, the duration of dyspnea before NIPPV and HFNC, and the length from onset to admission. The differences of intubation rate, all-cause mortality, S/F ratio and RR were analyzed, and single factor analysis and generalized estimation equation (GEE) were used to analyze the risk factors affecting S/F ratio. Results:Among the 41 patients, the proportion of males was high (68.3%, 28 cases), the median age was 68 (58-74) years old, 28 cases had complications (68.3%), and 34 cases had multiple organ dysfunction syndrome (MODS, 82.9%). Compared with HFNC group, the proportion of complications in NIPPV group was higher [87.5% (21/24) vs. 41.2% (7/17), P < 0.05], and the value of LYM% was lower [5.3% (3.4%-7.8%) vs. 10.0% (3.9%-19.7%), P < 0.05], the need of blood purification was also significantly lower [0% (0/24) vs. 29.4% (5/17), P < 0.05]. The S/F ratio of NIPPV group gradually increased after 2 hours treatment and RR gradually decreased with over time, S/F ratio decreased and RR increased in HFNC group compared with baseline, but there was no significant difference in S/F ratio between the two groups at each time point. RR in NIPPV group was significantly higher than that in HFNC group after 2 hours treatment [time/min: 30 (27-33) vs. 24 (21-27), P < 0.05]. There was no significant difference in rate need intubation and hospital mortality between NIPPV group and HFNC group [66.7% (16/24) vs. 70.6% (12/17), 58.3% (14/24) vs. 52.9% (9/17), both P > 0.05]. Analysis of the factors affecting the S/Fratio in the course of oxygen therapy showed that the oxygen therapy mode and the course of illness at admission were the factors affecting the S/F ratio of patients [ β values were -15.827, 1.202, 95% confidence interval (95% CI) were -29.102 to -2.552 and 0.247-2.156, P values were 0.019 and 0.014, respectively]. Conclusion:Compared with HFNC, NIPPV doesn't significantly reduce the intubation rate and mortality of patients with COVID-19 accompanied with ARDS, but it significantly increases the S/F ratio of those patients.

Objective:To systematically evaluate the safety and efficacy of laparoscopic versus open surgery for palliative resection of the primary tumor in stage IV colorectal cancer.Methods:The databases of CNKI, Wanfang, VIP, PubMed, EMBASE and Cochrane Library were searched to retrieve randomized controlled trials (RCT) or clinical controlled trials (CCT) comparing laparoscopic surgery with open surgery for palliative resection of the primary tumor in stage IV colorectal cancer published from January 1991 to May 2019. Chinese search terms included "colorectum/colon/rectum" , "cancer/malignant tumor" , "laparoscopy" , "metastasis" , " IV" ; English search terms included "laparoscop*" , "colo*" , "rect*" , "cancer/tumor/carcinoma/neoplasm" , " IV" , "metasta*" . Inclusion criteria: (1) RCT or CCT, with or without allocation concealment or blinding; (2) patients with stage IV colorectal cancer that was diagnosed preoperatively and would receive resection of the primary tumor; (3) the primary tumor that was palliatively resected by laparoscopic or open procedure. Exclusion criteria: (1) no valid data available in the literature; (2) single study sample size ≤20; (3) subjects with colorectal benign disease; (4) metastatic resection or lymph node dissection was performed intraoperatively in an attempt to perform radical surgery; (5) duplicate publication of the literature. Two researchers independently evaluated the quality of the included studies. In case of disagreement, the evaluation was performed by discussion or a third researcher was invited to participate. The data were extracted from the included studies, and the Cochrane Collaboration RevMan 5.1.0 version software was used for this meta-analysis.Results:Four CCTs with a total of 864 patients were included in this study, including 216 patients in the laparoscopic group and 648 patients in the open group. Compared with the open group, except for longer operation time (WMD=37.60, 95% CI: 26.11 to 49.08, P<0.05), laparoscopic group had less intraoperative blood loss (WMD=-74.89, 95% CI: -144.78 to -5.00, P<0.05), earlier first flatus and food intake after surgery (WMD=-1.00, 95% CI: -1.12 to -0.87, P<0.05; WMD=-1.61, 95%CI: -2.16 to -1.06, P<0.05), shorter hospital stay (WMD=-2.01, 95% CI: -2.21 to -1.80, P<0.05) and lower morbidity of postoperative complication (OR=0.52, 95% CI: 0.35 to 0.77, P<0.05). However, no significant differences were found in time to start postoperative chemotherapy, postoperative chemotherapy rate, and mortality ( P > all 0.05). Conclusion:Laparoscopic surgery for palliative resection of the primary tumor is safe and feasible to enhance recovery after surgery by promoting postoperative bowel function recovery, shortening hospital stay and reducing postoperative complication in stage IV colorectal cancer.