BACKGROUND:In resent year,as the biological materials improving,all kinds of sutures are used widely in clinic. It is an important problem how to select the exact one for surgeon. OBJECTIVE:To compare the effect of antibacterial and poly (p-dioxanone) absorbable sutures (PDS) in abdominal wall incision. DESIGN,TIME AND SETTING:A contrast observation was performed at the Department of General Surgery,the Second Affiliated Hospital of Shantou University Medical College between January 2005 and August 2007. PARTICIPANTS:A total of 450 laparotomy patients,including 230 males and 220 females aging 18-78 years with the mean age of (40?9) years were collected in this study. METHODS:The 450 patients were randomly divided into three groups,including the antibacterial absorbable suture (AAS; abdominal wall incision except the skin was successively sutured with triclosan-coated antibacterial absorbable suture),PDS group (abdominal wall incision except the skin was successively sutured with PDS suture),and control group (abdominal wall incision was treated with common suture),with 150 cases in each group. All patients were followed up for 12-24 months. MAIN OUTCOME MEASURES:The visual analogue scale (VAS; point 0:indolence; point 10:severe pain),the incision heal classification and complications including incisional infection,rejection reaction,scar formation,incisional disruption and incisional hernia. RESULTS:A total of 450 cases were included in the final analysis. The VAS in the AAS group and the PDS group were significantly lower than control group (P

To investigate the influence of recombinant human augmenter of liver regeneration (hALR) on stromelysin 1 gene expression in rats with fibrotic liver. CCl 4 or albumin induced liver fibrosis in rats was established, and different dosages of recombinant human augmenter of liver regeneration were given to rats with liver fibrosis.Liver specimens were obtained at different intervals of treatment , total RNA of liver tissues were isolated and stromelysin 1 gene expression was measured by reverse transcription polymerase chain reaction (RT PCR) . The results showed that in both rat models of experimental liver fibrosis , stromelysin 1 gene expression levels were significantly higher in hALR treated rats than those without the treatment at various intervals. Stromelysin 1 gene expression levels in high dose hALR treatment group were significantly higher than that in low dose hALR treatment group. It suggested that recombinant human augmenter of liver regeneration may enhance stromelysin 1 gene expression in rats with fibrotic liver.

Hepatic stellate cell (HSC-T) was cultured in medium containing different concentrations of recombinant human augmenter of liver regeneration (hALR),and cells were collected at different incubation period. Total RNA of HSC was isolated and collagenⅠ and Ⅲ gene expression levels were measured with reverse transcription polymerase chain reaction. The results showed that, collagen Ⅰ gene expression levels of HSC in high(0 2ng/L),middle (0 02ng/L) and low (0 002ng/L) concentrations of three hALR groups were much lower than those of control group after exposure to hALR at 8h, 24h, 48h and 72h. Collagen Ⅰ gene expression levels of HSC in high dose group were also significantly lower than those of middle and low dose groups . Collagen Ⅲ gene expression levels of HSC in middle and low dose hALR group were much lower than those of control group at 24h,48h and 72h, Collagen Ⅲ gene expression levels in high dose group were significantly lower than those of control group at 8h, 24h, 48h and 72h, and were also much lower than those of middle and low dose groups. It suggested that hALR could inhibit collagen Ⅰ and Ⅲ gene expression in hepatic stellate cells.

Objective To investigate the effect of ketamine injected into the ventral posteromedial nucleus (VPM) of the thalamus on sensory processing of thalamocortical circuits in rats.Methods Twenty-four SpragueDawley rats in which the neurophysiological model was successfully established,aged 2 months,weighing 280-350g,were randomly divided into 4 groups (n=6 each):control group (group C),specific inhibitor of NMDA receptors AP-5 group (group A) and two different concentrations of ketamine groups (K1 and K2 groups).Normal saline 1 μl,AP-5 5 μg/μl and ketamine 12.5 and 25.0 μg/μl were injected into the VPM in A,AP-5,K1 and K2groups,respectively.Somatosensory-evoked potentials (SEPs) in the primary somatosensory cortex (S1) of the rat was recoded at 4 time periods:300 s before administration-immediately after administration (baseline,T0),immediately after administration-300 s after administration (T1),300-600 s after administration (T2),600-900 s after administration (T3).Results Compared with the baseline value at T0,there was no significant difference in the peak amplitude of SEPs at T1-3 in group C (P ＞ 0.05),and the peak amplitude of SEPs was significantly decreased at T1-3 in A,K1 and K2 groups (P ＜ 0.05).Compared with group C,the peak amplitude of SEPs was significantly decreased at T1-3 in A,K1 and K2 groups (P ＜ 0.05).Compared with group A,the peak amplitude of SEPs was significantly increased at T3 in group K1 (P ＜ 0.05).There was no significant difference in the peak amplitude of SEPs between A and K2 groups,K1 and K2 groups (P ＞ 0.05).Conclusion Ketamine results in damage to the integrity of sensory processing of thalamocortical circuits and reduction of incoming sensory information,and the mechanism may be related to blockade of NMDA receptors in VPM of the thalamus.

Objective:To evaluate the clinical efficacy and prognostic factors in patients with stage Ⅲb/c or Ⅳ inoperable advanced gastric cancer.Methods:The clinical data of 33 patients with unresectable locally advanced (stage Ⅲb/c) or unresectable stage Ⅳ gastric cancer were collected from May 2017 to may 2019 in the Department of Surgical Oncology, Anqing Hospital affiliated to Anhui Medical University, Among them, there were 25 males and 8 females with an average age of 65.48±9.00 years. According to the data of patients with conversion therapy efficacy and postoperative pathology and other factors for statistics, using univariate and multivariate analysis method to evaluate its correlation with the prognosis of patients.Results:Of 33 patients, 2 patients were complete remission, 18 patients were partial remission, the objective response rate(ORR) was 60.6%. 20 patients recevied surgical treatment, 17 patients achieved R0 resection. The median overall survival(mOS) of all 33 patients was (18.6±4.5) months. The mOS of patients who underwent surgical treatment was (25.7±10.99) months, which in patients without surgical treatment was (11.2±2.5) months( P=0.004). The mOS of stage Ⅲb/c patients Was (18.9±10.99) months, and of stage Ⅳ patients was (11.3±0.35) months( P=0.568). Univariate analysis showed that preoperative chemotherapy cycle ≥4 weeks had a better prognosis than patients with less than 4 cycles ( P=0.003), TRG score 1/2 patients had a better prognosis ( P=0.001), and positive lymph nodes ≥7 was risk factor. Multivariate analysis showed that positive lymph nodes ≥7 was the only independent prognostic factor ( P=0.013). Conclusion:For patients with stage Ⅲb/c or Ⅳ inoperable advanced gastric cancer, surgical resection after conversion therapy can improve patient survival, adequate preoperative chemotherapy can improve the prognosis of patients with at least 4 cycles of chemotherapy.

Objective To explore a promising system for tumor CD 44 receptor-targeted imaging and to investigate their physic-chemical properties and targeting effect on CD 44 abundant cancer cells in vitro.Methods The superparamagnetic iron oxide ( SPIO) nanoparticles were prepared by a coprecipitation in alkaline media starting from a mixed of the ferrous and ferric solution.And then the surface of the SPIO nanoparticles were modified with APTMS by a reaction with the hydroxyl groups.Finally, the hyaluronan-modified SPIO ( SPIO-HA) nanoparticles were prepared.Control and experimental groups were established after adding SPIO or SPIO-HA as agents respectively.Transmission electron microscopy ( TEM) and particle size analyzer were used to measure these nanoparticle sizes and the hydrodynamic diameters.Thermogravimetric analysis ( TGA) was carried out to evaluate the HA-content on the surface of SPIO-HA.The MRI T2 ralaxivities (1/T2 ) of the two groups at different Fe concentrations (0.09, 0.18, 0.27, 0.36, 0.45 mmol/L ) were measured on a 3.0T MR system.HepG2 cells and HL7702 cells were used for assessment of cells viability by methyl thiazolyl tetrazolium ( MTT ) assay.Prussian blue staining , immunoassay fluorescence image and flow cytometry were carried out to determine the targeted cellular uptake of SPIO-HA nanoparticles.MRI were performed to show the MR T 2 value changes after incubating with HepG2 cancer cells by using T 2 WI sequences at a clinical 3.0 T MR system.One-way analysis of variance was performed to determine significant changes in MR T 2 values of blank control , SPIO-HA and SPIO groups.Results The SPIO-HA and SPIO NPs were fairly homogeneous with an average core size of 18.2 and 22.4 nm, hydrodynamic diameter of 91.1 and 103.2 nm, Zeta potential of (-45.00 ±0.86) mV and (-18.50 ±0.73) mV, and magnetic relaxivity of 0.212 ×106 M-1 · s-1 and 0.191 ×106 M-1 · s-1.Based on the TGA data , HA accounted for 24%weight of each SPIO-HA.The internalization of the SPIO-HA was confirmed by prussian blue staining , while the cells showed no obvious blue stains with SPIO , incubation of SPIO-HA with tumor cells led to blue color inside the cells.After that, we examined cancer cell binding of FITC-SPIO-HA by immunoassay fluorescence image and flow cytometry.The green fluorescence resulting from FITC-SPIO-HA was observed inside the cells in both the cytoplasm and the plasmalemma.Tumor cells treated with SPIO-HA exhibited higher fluorescence signals with 7.97-fold enhancement observed for HepG 2 cells over control particles.In vitro MR, mean T2 values of blank control , SPIO and SPIO-HA groups were ( 115.20 ±0.36 ), ( 115.07 ±0.81 ) and ( 21.67 ±0.21 ) ms, respectively.There was significant difference among those three groups (F=31 703.339,P<0.01), MR T2 values of HepG2 cells treated with the SPIO-HA NPs were lower than blank and SPIO group.In comparison, SPIO did not generate any MRI signal changes compared with blank group.Conclusion The tumor CD44 receptor-targeted MR molecular probe SPIO-HA had a good physic-chemical property and well targeted HepG2 cells.

OBJECTIVETo explore the genetic etiology of a patient with classic maple syrup urine disease (MSUD).

METHODSNext-generation sequencing (NGS) was used to screen the exons of BCKDHA, BCKDHB, DBT and DLD genes. Suspected mutations were verified by Sanger sequencing. Bioinformatic analysis was carried out to predict the influence of mutations on the protein structure and function.

RESULTSNGS and Sanger sequencing have detected a c.550delT mutation in exon 5 of the BCKDHB gene in the mother and a c.1046G>A mutation in exon 10 of the BCKDHB gene in the father, while no mutation was found with BCKDHA, DBT and DLD genes. Among these, the c.550delT is a novel mutation. Bioinformatic analysis suggested that the two mutations both located in a highly conserved region and may decrease the activity of branched-chain α-ketoacid dehydrogenase complex through alternation of its structure.

CONCLUSIONThe compound heterozygous mutations c.550delT and c.1046G>A of the BCKDHB gene probably underlie the clinical manifestations of the patient with classic MSUD.

Objective To evaluate the clinical value of maternal serum 25(OH)D level and bilateral uterine artery S/D mean in early prediction of pre-eclampsia(PE). Methods Sixty normal pregnancy women(normal group),40 mild preeclampsia women(MPE group)and 60 severe preeclampsia women(SPE group)who were examined in Changzhou First People′s Hospital and Changzhou Maternal and Child Health Care Hospital between January 2016 and June 2018 were included. The mean value of S/D of bilateral uterine artery was measured from 15th to 20th weeks in all the 3 groups,and serum 25(OH)D level of the mother was measured at 24th week. Meanwhile, the ROC curves of S/D mean value,serum 25(OH)D level and combined detection were drawn to compare the area under each curve(AUC),and the diagnostic efficiency of S/D mean value,serum 25(OH)D level and combined detection PE were also calculated. Results The incidence of adverse pregnancy outcome in SPE group was significantly higher than that in MPE group,and that in MPE group was significantly higher than that in normal group(P < 0.05). The mean value of S/D of bilateral uterine artery in SPE group was(4.09 ± 0.62),which was higher than that in MPE group(3.26 + 0.55)and in normal group(2.62 ± 0.51),while the mean value of S/D in MPE group was significantly higher than that in normal group and the difference was statistically significant(P < 0.05). The level of serum 25(OH)D in SPE group was(32.44 ± 5.84),which was significantly lower than that in MPE group(37.15 ± 5.90)and in normal group(42.57 ± 7.44),while the serum 25(OH)D level in MPE group was significantly lower than that in normal group,and the difference was statistically significant(P < 0.05). The mean value of S/D of bilateral uterine artery in the pre-eclampsia group was negatively correlated with 25(OH)D level(r = -0.66,P < 0.01). The area under the ROC curve separately detected by S/D mean value and 25(OH)D level was 0.787 and 0.719 respectively,both of which were lower than that by jointly detection(0.908)and the difference was statistically significant(P < 0.001). Conclusion Both the mean S/D value of bilateral uterine arteries and serum 25(OH)D level can be used for the diagnosis and monitoring of pre-eclampsia,and the diagnostic efficacy of the combined detection is superior to that of single detection.

Objective:To explore the prognostic factors that may affect the postoperative survival of gastric cancer by analyzing patients with radical gastrectomy.Methods:The data of 525 patients with radical gastrectomy, including 387 male and 138 female with average age (62.5±10.7) years old (ranged from 16 to 89 years), were analyzed retrospectively in Anqing Municipal Hospital between October 2010 to July 2015. The relationship between 33 variables and prognosis was analyzed by a Cox proportionalhazards regression model, meanwhile ROC curve was established in order to explore the risk factor of postopertive survival.Results:The over survival(OS) rate of all patients was 89.3% at 1 year, 68.4% at 3 years and 59.6% at 5 years. The 5-year OS rate was 81.9% at stage Ⅰ, 71.4% at stage Ⅱ and 44.1% at stage Ⅲ. In the multivariate analysis that included these factors, preoperative comorbidity ( HR=1.595, P=0.001), hemoglobin( HR=1.377, P=0.017), CA199( HR=1.618, P=0.004), tumor distribution( HR=1.943, P=0.032), pT stage( HR=1.731, P=0.012), pN stage( HR=2.118, P=0.000), signet ring cell( HR=1.642, P=0.038)and intravascular tumor thrombus( HR=1.391, P=0.039) were independent risk factors associating with postopertive survival.According to ROC curve, the following area (AUC value) could predict survival after radical gastrectomy, including CA199 (AUC=0.568), hemoglobin(AUC=0.586), preoperative comorbidity(AUC=0.554), pT stage(AUC=0.636), pN stage(AUC=0.670)and intravascular tumor thrombus(AUC=0.626)( P<0.05). Conclusion:According to ROC curve analysis, preoperative comorbidity, anemia, CA199, pN stage, pT stage and intravascular tumor thrombus played an role in predicting long-term survival after radical resection of gastric cancer.

Objective:Clavien-Dindo grading system was used to explore the occurrence and related risk factors of early severe complications after radical resection of gastric cancer, and the effect of severe complications on long-term prognosis was analyzed.Methods:The clinical data of 525 patients who underwent radical resection of gastric cancer, including 387 male and 138 female with average age(62.5±10.7)years old (range from 16 to 89 years), were analyzed retrospectively in Department of Surgical Oncology of Anqing Municipal Hospital from October 2010 to July 2015. The occurrence of postoperative severe complications was analyzed according the Clavien-Dindo grade system.The relationship between 18 variables and severe complications was analyzed by univariate and multivariate analysis in order to explore the risk factors of severe postoperative complications, and the relationship between severe complications and long-term prognosis was analyzed by COX survival model. The software of SPSS 17.0 was used to conduct statistic analysis.Results:Five hundred and twenty-five patients with radical gastrectomy, 114 cases had early postoperative complications, including 20 cases of severe complications, 4 cases were performed second surgery under general anesthesia. The results of univariate analysis showed gender( χ2=4.86, P=0.027), the amount of bleeding( χ2=11.11, P=0.001), opertive time( χ2=4.77, P=0.029), the mode of operation( χ2=9.20, P=0.002) and pTNM stage( χ2=4.86, P=0.027) had significant statistical difference. Multivariate analysis showed that the amount of bleeding ( OR=13.05, P=0.013) and the mode of operation ( OR=7.97, P=0.047) were independent risk factors for early and severe complications after radical resection of gastric cancer. The 5-year survival rates of severe complication and non-severe complication were 35.0% and 61.8% respectively, and the difference was statistically significant ( P=0.004). Severe postoperative complications ( HR=1.595, P=0.107) were not independent risk factors affecting the 5-year survival rate. Conclusions:Early severe complications after radical resection of gastric cancer are closely related to intraoperative blood loss and total gastrectomy. Although the 5-year survival rate in severe complication group is significantly lower than that in non-severe complication group, severe complication is not an independent risk factor for long-term survival.