1.To study the variation of glucose and its management in patients with insulinomas
Hanxiang ZHAN ; Yupei ZHAO ; Taiping ZHANG ; Lin CONG ; Quan LIAO ; Menghua DAI
Chinese Journal of Hepatobiliary Surgery 2011;17(1):13-16
Objective To retrospectively study the variation of glucose in patients with insulinomas. Methods The medical records of patients who underwent operations in the last 20 years at Peking Union Medical College Hospital were reviewed retrospectively. Patients who received repeated operations, or just exploratory laparotomy or liver biopsy were excluded. The clinical data were collected and analyzed. Results There were 245 patients, including 103 males and 142 females. The mean age was (42.2+ 14.6) years old. The mean value of preoperative fasting glucose was (1.47+0. 57) mmol/L, and the ratio of insulin to glucose was greater than 0.3 in 87.4% patients. The glucose level rose gradually after removal of the tumor(s). The blood sugar rising more than 1 time over the baseline value at one hour after resection was observed in 79.6% patients. For all the other patients, the glucose level rose to this level in the morning of the first postoperative Day 1. Rebound hyperglycemia was common after operations, and the glucose gradually returned to normal, with a mean level of 5.56 mmol/L at the time when the patients were discharged home. Conclusions Patients with insulinomas had a serum fluctuation in glucose (low→high→normal) during the perioperative period.Intraoperative glucose test combined with ultrasound and frozen section helped to localize and to remove all the lesions. Rebound hyperglycemia after surgery should be treated with insulin pump actively to minimize the incidence of complications.
2.Affecting factors for diagnosis of benign or malignant pancreatic cystic lesions
Menghua DAI ; Tao XU ; Taiping ZHANG ; Quan LIAO ; Lin CONG ; Junchao GUO ; Ya HU ; Yue CAO ; Yupei ZHAO ; Lixing CAI
Chinese Journal of Hepatobiliary Surgery 2010;16(11):831-834
Objective To determine the effecting factors for diagnosis of binign or malignant in cystic lesions of pancreas(CLP).Methods One hundred twenty-six patients undergoing operations for CLP or suspected CLP in this hospital from January 1984 to June 2008 were reviewed.Patients were divided into two groups according to lesion's histological features after operation.The predictive effect of various preoperative factors on the malignant potential of CLP was evaluated.Results One hundred twenty-six patients underwent operations for suspected pancreatic cystic neoplasms.There were 89 benign and 37 malignant CLPs.The univariate analysis showed that gender, clinical symptoms(jaundice and weight loss), elevated serum CA199, and presence of one or more of three morphologic features such as solid component, nodule or septation were significantly different between benign and malignant cystic neoplasm of pancreas.The multivariate analysis indicated that imaging features and gender were independent predictors of malignancy.Conclusion In patients with suspected pancreatic cystic neoplasms, elevated serum CA199, clinical symptoms(jaundice and weight loss)and presence of suspicious morphologic features on imaging are predictors of malignant potential of CLP.Patients with a high likelihood of a potentially malignant or malignant lesion based on these three factors should undergo operation without additional investigations.
3.Diagnosis and treatment of multiple insulinom
Lin CONG ; Yupei ZHAO ; Taiping ZHANG ; Quan LIAO ; Menghua DAI ; Ge CHEN ; Ziwen LIU ; Ya HU ; Junchao GUO ; Yingchi YANG ; Lixing CAI ; Yu ZHU
Chinese Journal of General Surgery 2008;23(5):336-339
Objective To summarize the diagnostic and therapeutic experiences for multiple insulinoma. Methods Clinical data of 34 cKsefl of multiple insulinoma treated in Peking Union Medical College Hospital between 1984 and 2007 were analyzed retrospectively. Results Multiple insulinoma was identified in these 34 cases for 37 instances.Malignant insulinoma was found in 2 cases.Three cases suffered from postoperative recurrent multipie tumors.35.3% cases belonged to MEN1;13.5% cases were of insulinoma combined with islet hyperplasia;43.2% cases had 3 or more than 3 insulinomas;Fifteen cases (40.5%)had had a misdiagnosis.45.2%tumors were smaller than 1 cm in diameter:88.9%multiple insulinonla located at the body and tail of the pancreas.Enucleation of multiple tumors was performed for 48.7 percent of cases. Conclusions Most multiple insulinomas were small,it was difficult for preoperative examination to locate all the tumors therefore.Being on the alert against multiple insulinoma and such measures as careful exploration,intraoperative blood glucose determination.fine needle aspiration biopsy,frozen sections helps to avoid missing multiple imuhnoma.
4.Imaging anatomy and clinical significance of the inferior pancreaticoduodenal veins
Qiang XU ; Wenming WU ; Quan LIAO ; Menghua DAI ; Taiping ZHANG ; Junchao GUO ; Lin CONG ; Yupei ZHAO
Chinese Journal of Digestive Surgery 2019;18(6):575-580
Objective To investigate the imaging anatomy and clinical significance of the inferior pancreaticoduodenal veins (IPDVs).Methods The retrospective and descriptive study was conducted.The clinicopathological data of 42 patients with pancreatic head ductal adenocarcinoma who were admitted to Peking Union Medical College Hospital from January to June 2018 were collected.There were 24 males and 18 females,aged from 41 to 78 years,with an average age of 61 years.Patients received preoperative contrast-enhanced computed tomography (CT) examination with 1 mm slice thickness,and underwent corresponding surgery according to the preoperative evaluation.Observation indicators:(1) results of preoperative CT examination;(2) surgical situations.Normality of measurement data was analyzed using Shapiro-Wilk test.Measurement data with skewed distribution were described as M (QR) or M (range),and comparison between groups was analyzed by the Mann-Whitney U test.Count data were described as absolute number or percentage,and comparison between groups was analyzed by the chi-square test.Results (1) Results of preoperative CT examination:42 patients received preoperative contrast-enhanced CT examination with 1 mm slice thickness.① The first jejunal venous trunk was identified in all the 42 patients.The first jejunal venous trunk crossed dorsal to the superior mesenteric artery (SMA) in 34 patients and ventral to the SMA in 8 patients.② Of 42 patients,2 showed no IPDV,and 40 showed IPDV including 23 with 1 IPDV,13 with 2 IPDVs,3 with 3 IPDVs,and 1 with 4 IPDVs.A total of 62 IPDVs were identified in the 42 patients,with an average IPDV number of 1 (range,0-4).There were 43 IPDVs drained into first or second jejunal venous trunks and 19 IPDVs drained into superior mesenteric vein (SMV).③ Of 42 patients,type Ⅰ IPDV was identified in 32 patients including 20 with 1 IPDV drained into jejunal venous trunk at dorsal side of SMA,7 with 2 IPDVs drained into jejunal venous trunk at dorsal side of SMA,2 with 3 IPDVs drained into jejunal venous trunk at dorsal side of SMA,and 3 with 1 IPDV drained into jejunal venous trunk at ventral side of SMA,and non-type Ⅰ IPDV was identified in 10 patients;type Ⅱ IPDV was identified in 18 patients including 17 with 1 IPDV drained into SMV and 1 with 2 IPDVs drained into SMV,and non-type Ⅱ IPDV was identified in 24 patients.Some patients can simultaneously had type Ⅰ and type Ⅱ IPDV.(2) Surgical situations:42 patients underwent pancreatoduodenectomy,14 of which underwent laparoscopic surgery and 28 underwent open surgery.There were 5 cases with SMV or portal vein reconstruction,and 18 with intraoperative blood transfusion.All the 42 patients were diagnosed as pancreatic ductal adenocarcinoma by postoperative pathological examination,including 30 of R0 resection and 12 of R1 resection.The volume of intraoperative blood loss,cases with intraoperative blood transfusion,cases with R0 and R1 resection (situation of surgical margin),cases with SMV or portal vein reconstruction were 650 mL(853 mL),15,20,12,4 in the 32 patients with type Ⅰ IPDV,aod 475 mL (480 mL),3,10,0,1 in the 10 patients with non-type Ⅰ IPDV;there were significant differences in the volume of intraoperative blood loss and situation of surgical margin (Z=94.000,x2=5.250,P< 0.05).There was no significant difference in the cases with intraoperative blood transfusion,cases with SMV or portal vein reconstruction between patients with type Ⅰ and non-type Ⅰ IPDV (x2 =0.045,0.886,P>0.05).Conclusions IPDVs can be distinguished on the contrast-enhanced CT with slice thickness,and classified as IPDVs drained into SMV or jejunal venous trunk.It is necessary to carefully deal with IPDVs drained into jejunal venous trunk in the pancreaticoduodenectomy due to its more volume of intraoperative blood loss and lower R0 resection rate.
5.Research progress on the correlation between sarcopenia and chronic pain
Taiping LIN ; Tingting JIANG ; Jirong YUE
Chinese Journal of Geriatrics 2022;41(4):379-382
Sarcopenia is a geriatric syndrome associated with aging, accompaning with decreased skeletal muscle mass and muscle hypofunction, which will contribute to many adverse outcomes and seriously threaten the health status of the elderly.There are many studies concerning its risk factors and adverse outcomes of sarcopenia, but the correlation between sarcopenia and chronic pain is not fully clarified.This article will review the association between sarcopenia and chronic pain so as to provide a theoretical reference for future research on the risk factors and early prevention of sarcopenia.
6.Selected CD34+ cell autologous transplantation for advanced malignant tumors.
Lu-jia DONG ; Hu CHEN ; Min JIANG ; Liang-ding HU ; Mao-quan QIN ; Wei-jing ZHANG ; Zhi-yong YU ; Shi-kai WU ; Xi-lin CHEN ; Yun-hua BAO ; San-tai SONG ; Duan-qi LIU
Chinese Journal of Oncology 2003;25(2):183-185
OBJECTIVETo determine the clinical results of selected CD34(+) cell autologous transplantation in advanced malignant tumors.
METHODSAfter pretreatment, fifteen patients aged 12 - 70 (49.5) years with various Stage III or IV malignant tumors were given the sorted CD34(+) cells collected by magnetic-activated cell sorting (Clini MACS, Milteny Biotech, Germany).
RESULTSPeripheral blood progenitor cells (PBPC) from the patients were mobilized by chemotherapy and G-CSF 5 micro g/kg per day. CD34(+) cells gave 2.0 - 5 log depletion after cell sorting, with a median yield of CD34(+) selected cells of 2.4 (0.15 - 12.03) x 10(6)/kg. It gave a median recovery of 64 (52 - 81.4)% and median purity of 98.2 (83.2 - 99.7)%. The median time of neutrophil recovery > 1.0 x 10(9)/L and platelet recovery > 20 x 10(9)/L post-transplantation were 14 (8 - 26) days and 13 (11 - 35) days, respectively. On follow-up of 2 - 33 (11) months, the event-free survival rate was 53.3% (8/15) and the overall survival rate was 66.7% (10/15).
CONCLUSIONTransplantation of autologous selected PBPC CD34(+) cells gives prompt and stable engraftment. Selected CD34(+) cell transplantation, being a safe approach, may improve the clinical outcome even in patients with advanced malignant tumors.
Adolescent ; Adult ; Aged ; Antigens, CD34 ; analysis ; Child ; Female ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Male ; Middle Aged ; Neoplasms ; mortality ; therapy ; Survival Rate ; Transplantation, Autologous
7. Impact of the 2016 new definition and classification system of pancreatic fistula on the evaluation of pancreatic fistula after pancreatic surgery
Xianlin HAN ; Jing XU ; Wenming WU ; Menghua DAI ; Taiping ZHANG ; Quan LIAO ; Ge CHEN ; Junchao GUO ; Weibin WANG ; Lin CONG ; Yupei ZHAO
Chinese Journal of Surgery 2017;55(7):528-531
Objective:
To discuss the impact of updated definition and classification system of pancreatic fistula published in 2016 on the postoperative classification of pancreatic fistula.
Methods:
Retrospective analysis was made on patients who underwent pancreatic surgery at ward 1 in Department of General Surgery, Peking Union Medical College Hospital from January 2015 to December 2016.A total of 408 patients were included in this retrospective study, male/female was 184/224, aged from 9 to 81 years with mean age of 51.6 years.One hundred and fifty-two cases were performed pancreaticoduodenectomy, 125 cases for distal pancreatectomy, 43 cases for spleen preservation distal pancreatectomy, 61 cases for partital pancreatectomy or enucleation, 8 cases for middle pancreatectomy, 6 cases for pancreaticojejunostomy and 13 cases for other procedures.Clinical data including postoperative drainage fluid volume, amylase concentration, duration of hospitalization and drainage were obtained, revaluated and re-analyzed, classified grounded on 2005 edition and 2016 edition, respectively.
8.Mechanism of Yiyuan Qiwei Pills in Treatment of Diabetes Mellitus-induced Erectile Dysfunction
Ding WANG ; Shaofeng ZHANG ; Xue JIANG ; Xiang LYU ; Taiping ZHU ; Jiakun LIN
Chinese Journal of Experimental Traditional Medical Formulae 2022;28(18):77-84
ObjectiveTo observe the therapeutic effect of Yiyuan Qiwei pills (YYQW) on diabetes mellitus-induced induced erectile dysfunction (DMED) in rats and explore its regulation on the nitric oxide (NO)-cyclic guanosine monophosphate (cGMP) signaling pathway. MethodFifty-five healthy SD male rats of clean grade aged 2-3 months underwent intraperitoneal injection of streptozotocin (STZ) to induce the DMED model, and another 10 healthy SD male rats of clean grade aged 2-3 months were assigned to the control group. The model rats were randomly divided into a model group, a sildenafil group (5 mg·kg-1, ig), and low-, medium-, and high-dose YYQW groups (1.5, 3.0, 6.0 g·kg-1, ig). The rats in the model group and the control group were given normal saline by gavage at 10 mL·kg-1, once a day for two months. After intervention, the penile erectile function of rats in each group was measured by a pressure detection system. The pathological changes and ultrastructure of penile corpus cavernosum were observed by hematoxylin-eosin (HE) staining and transmission electron microscopy, respectively. The level of NO in the corpus cavernosum was detected by nitrate reductase. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of cGMP and advanced glycation end products (AGEs). Real-time quantitative polymerase chain reaction (Real-time PCR) was used to detect the mRNA expression of endothelial nitric oxide synthase (eNOS), neurogenic nitric oxide synthase (nNOS), total nitric oxide synthase (NOS), and phosphodiesterase type5 (PDE5) in rat penile tissues. The expression of above proteins was detected by Western blot. ResultCompared with the control group, the model group showed decreased intracavernous pressure (ICP), NO, and cGMP levels, reduced mRNA and protein expression of nNOS and NOS, and increased PDE5 mRNA and protein expression (P<0.05). Compared with the model group, the sildenafil group and the YYQW groups displayed increased ICP, NO, and cGMP levels, elevated mRNA and protein expression levels of nNOS and NOS, and reduced PDE5 mRNA and protein expression levels (P<0.05). There were no pathological changes in the tissues and cell ultrastructure of the corpus cavernosum in the control group, while serious pathological changes were observed in the model group. Additionally, the sildenafil group and the YYQW groups were superior to the model group, the optimal effect was observed in the high-dose YYQW group. ConclusionYYQW can improve the penile erectile function of DMED rats and reduce the pathological damage of corpus cavernosum. The mechanism may be related to the promotion of nNOS and NOS expression, the inhibition of PDE5 expression, and the activation of the NO/cGMP signaling pathway.
9.Research of relationship between frailty and gut microbiota on middle-aged and the aged patients with diabetes.
Xuchao PENG ; Yanli ZHAO ; Taiping LIN ; Xiaoyu SHU ; Lisha HOU ; Langli GAO ; Hui WANG ; Ning GE ; Jirong YUE
Journal of Biomedical Engineering 2021;38(6):1126-1133
Gut microbiota plays an important role in development of diabetes with frailty. Therefore, it is of great significance to study the structural and functional characteristics of gut microbiota in Chinese with frailty. Totally 30 middle-aged and the aged participants in communities with diabetes were enrolled in this study, and their feces were collected. At the same time, we developed a metagenome analysis to explore the different of the structural and functional characteristics between diabetes with frailty and diabetes without frailty. The results showed the alpha diversity of intestinal microbiota in diabetes with frailty was lower.
Aged
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Diabetes Mellitus
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Epstein-Barr Virus Infections
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Frailty
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Gastrointestinal Microbiome
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Herpesvirus 4, Human
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Humans
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Middle Aged
10.Metformin inhibits pancreatic cancer metastasis caused by SMAD4 deficiency and consequent HNF4G upregulation.
Chengcheng WANG ; Taiping ZHANG ; Quan LIAO ; Menghua DAI ; Junchao GUO ; Xinyu YANG ; Wen TAN ; Dongxin LIN ; Chen WU ; Yupei ZHAO
Protein & Cell 2021;12(2):128-144
Pancreatic ductal adenocarcinoma (PDAC) has poor prognosis due to limited therapeutic options. This study examines the roles of genome-wide association study identified PDAC-associated genes as therapeutic targets. We have identified HNF4G gene whose silencing most effectively repressed PDAC cell invasiveness. HNF4G overexpression is induced by the deficiency of transcriptional factor and tumor suppressor SMAD4. Increased HNF4G are correlated with SMAD4 deficiency in PDAC tumor samples and associated with metastasis and poor survival time in xenograft animal model and in patients with PDAC (log-rank P = 0.036; HR = 1.60, 95% CI = 1.03-2.47). We have found that Metformin suppresses HNF4G activity via AMPK-mediated phosphorylation-coupled ubiquitination degradation and inhibits in vitro invasion and in vivo metastasis of PDAC cells with SMAD4 deficiency. Furthermore, Metformin treatment significantly improve clinical outcomes and survival in patients with SMAD4-deficient PDAC (log-rank P = 0.022; HR = 0.31, 95% CI = 0.14-0.68) but not in patients with SMAD4-normal PDAC. Pathway analysis shows that HNF4G may act in PDAC through the cell-cell junction pathway. These results indicate that SMAD4 deficiency-induced overexpression of HNF4G plays a critical oncogenic role in PDAC progression and metastasis but may form a druggable target for Metformin treatment.