Objective To investigate the risk factors resulting in the perioperative liver failure and death for the HBV-associated hepatocellular carcinoma (HCC) patients with or without cirrhosis.Methods The method of retrospective case-control study was performed.The clinicopathological data of 1 083 HCC patients with positive HBsAg who received curative liver resection at the Southwest Hospital from January 2008 to December 2012 were collected.According to the absence or presence of cirrhosis,the HCC patients with positive HBsAg were divided into the 2 groups,including the cirrhosis group (633 patients) and the non-cirrhosis group (450patients).The intraoperative conditions (operation time,volume of intraoperative blood loss,rate of blood transfusion,rate of pringle maneuver) and postoperative conditions (incidence of perioperative complications,duration of postoperative hospital stay,perioperative mortality) of HCC patients were observed.The gender,age,alanine transaminase (ALT),aspartate transaminase (AST),albumin (Alb),total bilirubin (TBil),platelet (PLT),Child-Pugh classification,operation time,volume of intraoperative blood loss,blood transfusion,pringle maneuver,extent of liver resection,number of tumors,tumor diameter,tumor thrombus and liver cirrhosis were enrolled and prognostic factors resulting in perioperative liver failure and death for the HCC patients were explored.Measurement data with skewed distribution were presented as M (range) and comparison between the 2 groups was analyzed using Mann-Whitney U test.Count data were presented as counts (percentage) and comparison between the 2 groups was analyzed using chi-square test or Fisher exact probability.Univariate analysis was performed by chi-square test and multivariate analysis was performed by Logistic regression model (forward).Results (1) The intraoperative conditions:the volume of intraoperative blood loss were 500 mL (range,30-7 000 mL) in the cirrhosis group and 400 mL (range,50-8 000 mL) in the non-cirrhosis group,with a statistically significant difference between the 2 groups (Z =-2.209,P ＜ 0.05).The operation time,rate of blood transfusion and rate of pringle maneuver were 250 minutes (range,82-715 minutes),29.86％ (189/633),62.24％ (394/633) in the cirrhosis group and 242 minutes (range,85-738 minutes),27.11％ (122/450),66.67％ (300/450) in the non-cirrhosis group,respectively,with no statistical differences between the 2 groups (Z =-1.212,x2 =0.969,2.236,P ＞0.05).(2) The postoperative conditions:the incidence of perioperative complications was 30.49％(193/633) in the cirrhosis group and 21.11％ (95/450) in the non-cirrhosis group,with a statistically significant difference between the 2 groups (x2 =11.851,P ＜ 0.05).The incidence of lung infection,abdominal infection and liver failure were 6.48％ (41/633),2.69％ (17/633),5.53％ (35/633) in the cirrhosis group and 3.56％ (16/450),0.89％ (4/450),1.33％ (6/450) in the non-cirrhosis group,respectively,with statistically significant differences between the 2 groups (x2 =4.502,4.465,12.713,P ＜ 0.05).The duration of postoperative hospital stay was 15 days (range,0-70 days) in the cirrhosis group and 14 days (range,0-71 days) in the non-cirrhosis group,with a statistically significant difference between the 2 groups (Z =-3.448,P ＜ 0.05).The perioperative mortality was 5.85％ (37/633) in the cirrhosis group and 2.44％ (11/450) in the non-cirrhosis group,with a statistically significant difference between the 2 groups (x2=7.181,P ＜ 0.05).(3)Results of risk factors affecting perioperative liver failure:①results of univariate analysis showed that age,AST,Alb,Child-Pugh classification,operation time,volume of intraoperative blood loss,blood transfusion,extent of liver resection,tumor diameter,liver cirrhosis with positive HBsAg were associated with perioperative liver failure in HCC patients (x2=5.013,7.979,8.855,16.968,14.148,9.764,18.511,11.749,5.534,12.713,P＜0.05);age,AST,Alb,Child-Pugh classification,operation time,blood transfusion,extent of liver resection and tumor diameter were associated with perioperative liver failure in the cirrhosis group (x2=5.877,5.380,11.087,13.672,8.849,13.170,12.418,5.805,P ＜ 0.05);volume of intraoperative blood loss was associated with perioperative liver failure in the non-cirrhosis group (P ＜ 0.05).②Results of multivariate analysis showed that age≥60 years,Child-Pugh class B,operation time ＞ 360 minutes,blood transfusion,extent of liver resection ≥3 segments and liver cirrhosis were independent risk factors affecting perioperative liver failure in HCC patients with positive HBsAg [OR =2.285,2.716,2.315,2.159,2.459,4.322;95％ confidence interval (CI):1.081-4.831,1.100-6.706,1.064-5.038,1.068-4.362,1.264-9.786,1.763-10.598,P＜0.05];Alb ＜38 g/L,Child-Pugh class B,blood transfusion and extent of liver resection ≥ 3 segments were independent risk factors affecting perioperative liver failure in the cirrhosis group (OR =2.231,2.857,2.186,2.927,95％ CI:1.038-4.795,1.095-7.451,1.045-4.576,1.426-6.008,P ＜ 0.05);volume of intraoperative blood loss ＞ 1 200 mL was an independent risk factor affecting perioperative liver failure in the non-cirrhosis group (OR =15.077,95％CI:2.695-84.353,P ＜ 0.05).(4) Risk factors affecting perioperative death:①results of univariate analysis showed that gender,Alb,TBil,Child-Pugh classification,blood transfusion,extent of liver resection,tumor diameter,tumor thrombus and liver cirrhosis were associated with perioperative death in HCC patients with positive H BsAg (x2=4.462,8.783,4.212,4.869,7.189,11.745,6.837,4.323,7.181,P ＜0.05);Alb,extent of liver resection and tumor diameter were associated with perioperative death in the cirrhosis group (x2=12.173,12.793,10.981,P ＜ 0.05);blood transfusion and tumor thrombus were associated with perioperative death in the non-cirrhosis group (x2 =5.836,6.417,P ＜ 0.05).② Results of multivariate analysis showed that Alb ＜38 g/L,extent of liver resection ≥ 3 segments and liver cirrhosis were independent risk factors affecting perioperative death in HCC patients with positive HBsAg (OR =2.560,2.657,2.567,95％ CI:1.382-4.742,1.471-4.800,1.283-5.134,P ＜ 0.05);Alb ＜ 38 g/L,extent of liver resection ≥ 3 segments and tumor diameter≥5 cm were independent risk factors affecting perioperative death in the cirrhosis group (OR =3.003,2.533,3.060,95％ CI:1.495-6.034,1.251-5.128,1.135-8.251,P＜0.05);blood transfusion and tumor thrombus were independent risk factors affecting perioperative death in the non-cirrhosis group (OR =3.755,4.036,95％ CI:1.047-13.467,1.126-14.469,P ＜ 0.05).Conclusions Liver cirrhosis is an independent risk factor for perioperative liver failure and death in HCC patients with positive HBsAg.The risk of perioperative liver failure and death in HCC patients with cirrhosis is significantly higher than that in HCC patients without cirrhosis,and there is a difference in the risk factors for perioperative liver failure and death.

Objective This study was to evaluate the clinical outcomes of orbital blowout fracture repair using the individual titanium mesh bent by computer-aided rapid prototyping . Methods The CT imaging data of 11 cases of orbital blowout fracture were analyzed.The subciliary approach was used for the exposure of the fractures .An appropriate 3D-printed titanium mesh pre-bent by computer-aided rapid prototyping was selected and implanted according to the characteristics of a given defect .The surgical results were analyzed by evaluating diplopia , eyeball movement , enophthalmos , and the position of the titanium mesh and comparing the orbital vol-ume before and after surgery . Results All the operations were successfully accomplished .No remolding or trimming was needed for the pre-bent titanium mesh and implanted titanium mesh was tightly fixed to the orbital wall .The patients were followed up for 3 -12 months, which revealed no symptoms of diplopia in any of the patients . Volumetric analysis showed a significantly reduced orbital volume difference from (2.60 ±0.43) mL preoperatively to (-0.07 ±0.62) mL postoperatively (P<0.01).Enophthalmos was desirably correc-ted, with the enophthalmos difference decreased from (2.35 ±0.81)mm preoperatively to (-0.10 ±0.52) mm postoperatively (P<0.01).No extra-ocular muscle limitation was observed . Conclusion The individual titanium mesh bent with computer-aided rapid prototyping technology can be applied to orbital blowout fracture repair , which may achieve a high success rate of anatomic restoration of the orbital volume and effective prevention of enophthalmos .

Objective:To explore the practical effect of goal-oriented hierarchical responsibility system in the teaching of emergency standardized training.Methods:A total of 43 residents who rotated in the Emergency Department of Huashan Hospital Affiliated to Fudan University from March 2019 to August 2019 were selected as the control group, and traditional teaching was implemented. Another 41 residents who rotated from September 2019 to March 2020 were selected as the research group, and the goal-oriented hierarchical responsibility system of teaching was implemented. They were all taught for 3 months, and the scores of theoretical and clinical skills, clinical comprehensive ability and teaching recognition before and after teaching were compared between the two groups. SPSS 24.0 was used for t-test and Chi-square test. Results:After teaching, the scores of theoretical knowledge questions, question and answer questions and case analysis in the two groups were higher than those before teaching ( P<0.05), and the scores of the research group were higher than those in the control group ( P<0.05). After teaching, the scores of 8 items in the study group on understanding of skill indications, anatomy and operation, preparation before operation, aseptic operation, operation ability, post-operation treatment, communication ability, humanistic care and overall performance were higher than those in the control group ( P<0.05). The recognition rates of teaching management, teaching methods, teaching content and teaching effect in the research group were higher than those in the control group ( P<0.05). Conclusion:The application of goal-oriented hierarchical responsibility system in the teaching of standardized training of emergency residents is helpful to improve their theoretical and clinical skill examination results and clinical ability, with high degree of teaching recognition.

Objective:To investigate the diagnosis and treatment of abdominal cocoon (AC).Methods:The clinical manifestations, findings during surgery, treatments, and follow-up results of 26 cases of AC were retrospectively studied from Jan 2001 to Jan 2019.Results:All of 26 cases were diagnosed as AC definitely by laparotomy, and were categorized into 2 types: type Ⅰ is of absence of second enterocoelia (18 cases, 69%) while type Ⅱ shows second enterocoelia (8cases, 31%). Twenty cases (12 type Ⅰ, 8 type Ⅱ) underwent membrane excision and careful enterodialysis to release the small intestine entirely or partially, while the other 6 cases (all were type Ⅰ) did not. All the patients recovered smoothly.Conclusions:AC can be categorized into two types, Surgery is recommended for type Ⅱ and part of type Ⅰ with severe complications.

Objective:To explore the image quality and its evaluation method using virtual grid under different tube voltages in the clinical chest X-ray exam.Methods:According to the conditions of chest X-ray photography commonly used in clinical practice, the corresponding thickness of plexiglass (20 cm, including CDRAD phantom) was determined as the experimental object. With a fixed tube loading of 4 mAs and the tube voltage from 60 to 125 kV, the experimental object was imaged in three ways: physical grid, none grid and virtual grid. The common physical parameters (CNR, σ, C, SNR), texture analysis (Angular second moment, texture Contrast, Correlation, Inverse difference moment, Entropy) and CDRAD phantom score (IQF inv) were evaluated. Two-way ANOVA test was used for each group of common physical parameters, and further pairwise comparisons were made. At the same time, applying virtual grids on the obtained images with chest anthropomorphic model and texture indexing the images with and without virtual grids, then rank sum test of paired sample can be conducted. Results:There were differences in image quality among the three groups of grid mode( P<0.05), and the physical grid delivered the best image quality. The tube voltage had an impact on all image quality evaluation indexes ( P<0.05). The tube voltage was positively correlated with CNR, SNR, angular second moment, inverse difference moment and IQF inv ( P<0.05), and negatively correlated with σ, C, texture contrast and entropy ( P<0.05). There was no significant correlation between the tube voltage and Correlation ( P>0.05). The chest anthropomorphic model images were used to evaluate the virtual grids, and the texture indexes (Angle second moment, Contrast, Correlation, Inverse difference moment, Entropy) were statistically significant (P<0.05). Conclusions:The virtual grid can improve the image quality of chest X-ray photography, and the image texture analysis method can be a useful supplement to the image quality evaluation parameters.

Objective To verify the feasibility and safety of stomach tumor marker localization based on magnetic tracer technique in dogs.Methods Six male Beagle dogs were examined by gastroscopy.Then tracer magnets were sent to the "tumor" locations assumed in advance and fixed near the "tumors" by endoscopic soft tissue clamp.Laparoscopic gastric tumor localization was performed under general anesthesia 24 hours later.The tracer magnet was placed near the tumor on the surface of the stomach through the operating hole after the conventional establishment of laparoscope puncture parallel mirror to explore the tracer magnet.After the two magnets were attracted,the location of the tracer magnet seen under the laparoscope was the location of the gastric tumor,so as to complete the labeling and positioning of the lesion.Results All the 6 Beagle dogs were successfully implanted with tracer magnets under gastroscopy.Twenty-four hours after the gastroscopy,the pursuit magnet was successfully implanted during laparoscopic surgery.The two magnets automatically attracted each other and formed a sandwich structure of "tracer magnet-gastric wall-pursuit magnet ",which completed the location and identification of gastric tumor under the laparoscopy.Conclusion Gastroscopy combined with laparoscopy based on magnetic tracer technique is simple,accurate,safe and feasible.

Objective:To design magnets to locate colorectal neoplasms based on magnetic tracer technology, and to test its feasibility and safety by animal experiments.Methods:The magnets used for endoscopic localization of colorectal tumors consist of a tracer magnet and a pursuit magnet, both of which are ring-shaped Nd-Fe-B magnets. Eight healthy Beagle dogs were used as animal models. Tumor locations were assumed in the different parts of the colon and rectum under colonoscopy. The tracer magnet was sent to the hypothetical tumors by endoscopic soft tissue clamp and fixed near the tumors. After 24 hours, laparoscopic surgery was performed under general anesthesia. The pursuit magnet was inserted near the resected colon or rectum through the main operating hole. The tracer magnet was absorbed to the pursuit magnet to identify the location of tumors.Results:The tracer magnet and pursuit magnet were successfully designed and processed. The suction force between the tracer magnet and the pursuit magnet at zero distance was 16 N. All the 8 Beagle dogs successfully received indwelling of magnets under colonoscopy, and no magnets fell off after 24 hours. After the placement of pursuit magnet under laparoscopy, the two magnets attracted each other rapidly and accurately, and successfully completed localization of tumor site without any damage during the operation.Conclusion:Colonoscopy combined with laparoscopy for colorectal neoplasms localization based on magnetic tracer technique is simple, accurate, safe and feasible.

Objective:To study the feasibility of establishing gastrointestinal anastomosis by magnetic compression technique in rabbits.Methods:Ten healthy New Zealand rabbits were selected as models for gastrointestinal anastomosis by magnetic compression technique. Daughter and parent magnets suitable for gastrointestinal anastomosis in rabbits were designed and manufactured. A daughter magnet was inserted into the stomach through the purse fistula in the lack of blood vessel area of gastric body, and was pushed into the duodenum along the intestinal tract. And then a parent magnet was inserted through the stomach fistula. The daughter and parent magnets were automatically attracted and pressed the gastric and intestinal walls after they were adjusted in the proper position. The stomach fistula was closed with purse string suture. After ischemia, necrosis, detachment of the tissues between magnets, gastrointestinal anastomosis was established, and the magnets and necrotic tissues were expelled together from the body through the digestive tract. Survival of experimental animals was observed. Anastomotic specimens were obtained one month after operation. The blasting pressure of anastomotic stoma was measured, and the healing of anastomotic stoma was observed with naked eyes.Results:According to the pre-designed operative route, 10 New Zealand rabbits all successfully completed the operation and survived one month after surgery. No complications occurred during perioperative period. The operation time was 35.80±4.71 min (range 28.00-43.00 min), and the magnet discharge time was 11.40±1.56 days (range 9.00-14.00 days). Anastomotic specimens were obtained one month after the operation. Gross observation showed that the anastomotic stoma of gastrointestinal bypass anastomosis healed well, and the surrounding tissues adhered slightly. The anastomotic bursting pressure was 103.00±7.95 mmHg (range 94.00-113.00 mmHg) (1 mmHg=0.133 kPa).Conclusion:The establishment of gastrointestinal anastomosis by magnetic compression technique in rabbits is simple and effective.

OBJECTIVE: To explore the role of miR-593 in regulating the proliferation of colon cancer cells and the molecular mechanism. METHODS: Bioinformatics analysis identified PLK1 as the possible target gene of miR-593. Luciferase assay was employed to verify the binding between miR-593 and PLK1, and qRT-PCR and Western blotting were used to verify that PLK1 was the direct target gene of miR-593. CCK-8 assay was performed to test the hypothesis that miR-593 inhibited the proliferation of colon cancer cells by targeting PLK1. RESULTS: Luciferase assay identified the specific site of miR-593 binding with PLK1. Western blotting showed a significantly decreased expression of PLK1 in the colon cancer cells transfected with miR-593 mimics and an increased PLK1 expression in the cells transfected with the miR-593 inhibitor as compared with the control cells ( < 0.05). The results of qRT-PCR showed no significant differences in the expression levels of PLK1 among the cells with different treatments ( > 0.05). The cell proliferation assay showed opposite effects of miR-593 and PLK1 on the proliferation of colon cancer cells, and the effect of co-transfection with miR-593 mimic and a PLK1-overexpressing plasmid on the cell proliferation was between those in PLK1 over-expressing group and miR-593 mimic group. CONCLUSIONS miR-593 inhibits the proliferation of colon cancer cells by down-regulating PLK1 and plays the role as a tumor suppressor in colon cancer.
Binding Sites ; Cell Cycle Proteins ; genetics ; metabolism ; Cell Line, Tumor ; Cell Proliferation ; Colonic Neoplasms ; metabolism ; pathology ; Down-Regulation ; Gene Expression Regulation, Neoplastic ; Genes, Tumor Suppressor ; Humans ; In Vitro Techniques ; MicroRNAs ; genetics ; metabolism ; Protein-Serine-Threonine Kinases ; genetics ; metabolism ; Proto-Oncogene Proteins ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Sincalide ; metabolism ; Transfection