Objective To identify the risk factors for surgical site infections after operation of laparoscopic cholecystectomy (LC), so as to provide warning signs for preventing such incidents. Methods The data of 4042 LC patients from January 2003 to December 2015 were analyzed retrospectively. The risk factors for surgical site infections were identified among demographic data, preoperative patients′history, and operative data using multivariate Logistic regression analysis. Results Surgical site infections after LC was seen in 7.2% (291/4042) of the patients. Multivariate analysis identified the following parameters as risk factors for surgical site infections: additional surgical procedure ( OR 4.011, 95%CI 2.149-7.486), age over 55 years (OR 2.398, 95%CI 1.777-3.235), conversion to open procedure (OR 2.647, 95%CI 1.935-3.621), postoperative hematoma (OR 1.910, 95%CI 1.192-3.060), duration of operation >60 min (OR 2.493, 95%CI 1.710-3.635), cystic stump insufficiency (OR 12.451, 95%CI 4.169-37.189), gallbladder perforation (OR 6.161, 95%CI 2.365-16.047), gallbladder empyema (OR 1.704, 95%CI 1.080-2.689), and surgical revision (OR 15.725, 95%CI 10.439-23.686). Surgical site infections were associated with a significantly prolonged hospital stay (P<0.01), higher postoperative mortality (P<0.01), and increased rate of surgical revision (P<0.01). Conclusions Additional surgical procedure is identified as a strong risk factor for surgical site infections after LC. Furthermore, operation time >60 min, age >55 years, conversion to open procedure, cystic stump insufficiency, postoperative hematoma, gallbladder perforation, gallbladder empyema, or surgical revision were identified as specific risk factors for surgical site infections after LC.

Objective To construct the lentiviral vector Lenti-miR-210-Luciferase, and to detect angiogenic factors HIF-1α and VEGF expression in hPDLSCs transduced by Lenti-miR-210-Luciferase. Methods hPDLSCs were iso-lated and cultured, and according to human miR-210 gene sequence(NC_000011. 9), its primer was designed and amplified through PCR. The PCR products of the target gene were connected to the vector pLVX-EGFP-3FLAG-EF1-Luc. To identify the plasmid, target gene PCR product and the purpose vector were digested by EcoRⅠand XbaⅠ. Lenti-miR-210-Luciferase ( the control group was Lenti-LacZ-Luciferase) was constructed using the LR re-combination system. After hPDLSCs was transduced by Lenti-miR-210-Luciferase, the analysis of HIF-1α and VEGF expression was done with qPCR and the immunohistochemistry examination. Results The results of plasmid sequencing and digestion confirmed that the vector Lenti-miR-210-Luciferase was successfully constructed. After Lenti-miR-210-Luciferase was transduced to hPDLSCs on 0, 1, 4, 7 and 14 d, the results of qPCR showed that the over-expression of HIF-1αand VEGF was detected on 4 d, and continued until 21 d. Immunohistochemical results showed that after hPDLSCs were transduced by Lenti-miR-210-Luciferase, hPDLSCs were positive for HIF-1α and VEGF antibody, and the control group was negative. Conclusion The Lenti-miR-210-Luciferase is successfully constructed, and miR-210 can promote hPDLSCs the differentiation of angiogenesis.

Objective To screen genotypes of small body in Tibet minipigs by single nucleotide polymorphism analysis (SNP) of growth hormone (GH) gene.Methods The PCR products are sequenced.According to the results, SNP analysis are applied in GH gene 5′fragment of 108 Tibet minipigs .Results Five mutation points were found by comparison.The polymorphism information content of the T45C locus is highest.The results of growth traits of different genotypes showed that the abdomen of 6~8 month old Tibet minipigs of TC genotype at T 45C mutation site is small; the weight and height of 3~5 month old Tibet minipigs of AA genotype at G 84A mutation site is small; the body length and height of 6~8month old Tibet minipigs of GG genotype at G 93A mutation site is small.Conclusion The AA TC, GG genotypes of T45C, G84A, G93A mutation sites in GH gene may be associated with small body .We also found that genetic mutations always occur in the above sites with high heterozygosity and genetic diversity , which can provide rich material for breeding research .

ObjectiveTo investigation the requirement of patients for occupational therapy, and find a better manner for occupational therapy practices.MethodsThe questionnaire survey of expectation for occupational therapy was performed for sixty-nine patients. Questions were as below: how much does each patient expect through their occupational therapy for the goal, such as physical function recovery, psychological stability, vocational reinstate and so on.ResultsMore than ninety percent subject responded to questions about physical function recovery, re-acquiring roles in own family, decreasing care volume, psychological stability and pastime activity as expected. About the question of condition after discharge, thirty-two percents wanted to live in own home without care; while reinstate, continue to hospitalization, and live in care facilities were twenty-five percents respectively.ConclusionThere is a remarkable higher requirement for physical function recovery, however through the explanation about occupational therapy, another aspects of it are to be recognized.

Objective To investigate the effects of enalapril on tachycardia induced acute atrial electrical remodeling in human.Methods 27 patients with paroxysmal supraventricular tachycardia undergoing radiofrequency catheter ablation were randomly divided into control group (16 patients) and enalapril group (11 patients). After autonomic blockade, atrial effective refractory period (AERP) in multiple sites, AERP rate adapting feature, AERP dispersion (AERPd) and inducibility of atrial fibrillation were measured before and after rapid atrial pacing with maximal atrial capture rate(349?37bpm)in both groups. Results ①In control group, AERP shortened significantly after rapid atrial pacing, but it did not change dramatically in enalapril group; ② Before and after rapid atrial pacing, curve estimation showed that the slope values were 0 062 and 0 018 in control group. In enalapril group the slope values were 0 059 and 0 053 respectively; ③After rapid atrial pacing, the inducibility and duration of atrial fibrillation increased significantly in control group, which did not change dramatically in enalapril group. Conclusion Enalapril can prevent acute atrial electrical remodeling and reduce the inducibility of atrial fibrillation after rapid atrial pacing.

Objective:To evaluate the impact of laparotomy pancreatoduodenectomy (OPD), laparoscopic pancreatoduodenectomy (LPD) and Da Vinci robot assisted pancreatoduodenectomy (RPD) on the risk of pancreatic fistula in postoperative patients.Methods:The key words were laparoscopic, pancreaticoduodenectomy, robot, DaVinci, Whipple, complication, fistula, pancreaticoduodenectomy, laparoscopy, robot, postoperative complications and pancreatic fistula, and the databases of CNKI, Wanfang, VIP, CBM, Cochrane Library, PubMed, EMBASE and web of science were searched until August 1, 2020 for retrospective cohort studies and randomized controlled trials comparing the efficacy of OPD, LPD and RPD. The articles were screened according to the pre-set inclusion and exclusion criteria, and the quality of the articles was evaluated and the data were extracted. Based on Bayesian framework, R4.0.2, Revman 5.3 and Stata 16.0 software were used to analyze the extracted data for mesh meta analysis.Results:Thirty articles involving 3 428 patients were included, including 26 retrospective cohort studies and 4 randomized controlled studies. Mesh meta-analysis showed that in the incidence of pancreatic fistula, there was no significant difference between LPD and OPD, between LPD and RPD ( OR=0.93, 95% CI 0.63-1.4; OR=1.4, 95% CI 0.87-2.2, P<0.05), but the incidence of postoperative pancreatic fistula was significantly lower than that of OPD ( OR=1.5, 95% CI 1.1-2.1, P<0.05), 95% CI 1.12.1; P>0.05). The risk probability of pancreatic fistula was ranked as RPD (0.00), LPD(0.34) and OPD(0.65), that is, for the risk of postoperative pancreatic fistula, the advantages and disadvantages of the three surgical methods were ranked as RPD, LPD and OPD. Conclusions:Compared with OPD, RPD can significantly reduce the risk of pancreatic fistula after PD and improve the quality of operation; there was no significant difference between LPD and RPD in the incidence of postoperative pancreatic fistula, and both of them were safe and feasible.

Objective:To evaluate the effects of propofol on glucose-regulated protein 78 (GRP78)-activating transcription factor-4 (ATF4)-CCAAT/enhancer binding protein (C/EBP) homologous protein (CHOP) signaling pathway during apoptosis in gastric cancer cells.Methods:MGC-803 cells were cultured to the logarithmic phase and divided into 2 groups ( n=15 each) using the random number table method: control group (group C) and propofol group (group P). The cells in group C were cultured under normal conditions of 37 ℃ and 5% CO 2. In group P, propofol (final concentration 5 μg/ml) was added when the cells were attached to the wall and grown to 70%-90% confluence.At 24 h after propofol was added, the apoptosis rate of cells was determined by flow cytometry, the expression of GRP78, ATF4 and CHOP mRNA was detected by quantitative polymerase chain reaction, and the expression of GRP78, ATF4 and CHOP was determined by Wester blot, respectively. Results:Compared with group C, the apoptosis rate was significantly increased, and expression of GRP78, ATF4, CHOP and its mRNA was up-regulated in group P ( P<0.05). Conclusion:The mechanism by which propofol accelerates apoptosis is related to activating GRP78-ATF4-CHOP signaling pathway in gastric cancer cells.

Objective To evaluate the value of different methods of hormone measurement and image study before surgery.Methods We retro spectively reviewed 99 patients with insulinoma confirmed by pathological report after surgery in the PUMC Hospital from December 1989 to August 2005.Results The main clinical manifestations were hypoglycemia coma,weight gain,perspiration,disorientation,hypomnesis,and dizziness.The sensitivity of diagnosis of insulinoma with fasting blood-glucose less than 2.78 mmol/L was 66.6%.The ratio of serum insulin to blood-glucose greater than 0.3 when hypoglycemia attacks was 90% sensitive.The sensitivity of perfusion CT was highest which was 100%.Conclusion Typical “Whipple's triad” and the ratio of serum insulin to blood-glucose greater than 0.3 when hypoglycemia attacks are best for the qualitative diagnosis of insulinoma.Perfusion CT has the best sensitivity and specificity among image studies currently used.

Objective To systematically review the preventive efficacy of N-methyl-D-aspartate (NMDA) receptor antagonists on remifentanil-induced postoperative hyperalgesia.Methods Pubmed,EMBase,Springer and Cochrane Controlled Trials Register were searched to identify all randomized controlled trials(RCTs) about efficacy of NMDA receptor antagonists for preventing remifentanil-induced postoperative hyperalgesia.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.The data was extracted,including postoperative analgesic consumption,pain scores,time for first analgesic request and the incidence of adverse effects.Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.0 software.Results Fourteen RCTs involving 623 patients were included in our Meta-analysis.NMDA receptor antagonists significantly decreased pain scores at 4 h after operation ( P ＜ 0.05),and had no effect on postoperative analgesic consumption,time for first analgesic request and the incidence of adverse effects ( P ＞ 0.05).Conclusion NMDA receptor antagonists (ketamine and magnesium)can not prevent the occurrence of postoperative hyperalgesia induced by remifentanil.

Background and purpose:Breast invasive ductal carcinoma (IDC) is the most common breast carci-noma, and the ultrasonographic features of its molecular subtypes has great clinical value. The purpose of this study was to discuss the correlation between ultrasonographic features of IDC and its molecular subtypes.Methods:Ultrasonographic features of 112 patients with preoperative integrated ultrasonographic information and pathologically confirmed IDC from Sep. 2012 to Feb. 2015 were retrospectively analyzed. Based on the immunohistochemistry results of ER (estrogen receptor), PR (progesterone receptor), HER-2 (human epidermal growth factor receptor-2) and Ki-67, these cases were categorized into 4 molecular subtypes: Luminal A group, Luminal B group, ERBB2 positive group and Basal-like group. Results:There were 14 cases (12.5%) in Luminal A group, 62 cases (55.4%) in Luminal B group, 21 cases (18.7%) in ERBB2 positive group and 15 cases (13.4%) in Basal-like group. The 4 molecular subtypes differed in tumor length, lymph node involvement, tumor boundary, tumor shape and internal blood flow on ultrasonography (P<0.05). There were no sig-nificant differences in tumor internal echo, posterior echo, micro-calcification and elastrography between subtypes (P>0.05).Luminal A group and Luminal B group had less lymph node involvement, more obscure boundary and irregular shape. More internal blood flow, bigger tumor size and lymph node involvement were observed in ERBB2 positive group of this study. Patients in Basal-like group were more likely to have clear tumor boundary, regular tumor shape, bigger tumor size and lymph node involvement on ultrasonogram.Conclusion:Correlation exists between ultrasonographic features and molec-ular subtypes of IDC. This has tremendous clinical significance in the early diagnosis of IDC, preoperative, intraoperative and prognosis evaluation of IDC patients.