Objective To investigate the safety, feasibility and results of laparoscopic assisted distal radical gastrectomy for gastric cancer. Methods Twenty-three cases of gastric cancer were subjected to laparoscopic assisted distal radical gastrectomy, D_(1+α)/D_(1+β) lymphadenectomy on 3 cases and D_2 lymphadenectomy on 20 cases. All cases received Billroth I reconstruction. Results Laparoscopic assisted distal radical gastrectomy was carried out in all cases successfully. The mean operative time was (205 ±38 )min, mean blood loss was (105 ± 66) ml and mean number of lymph nodes dissected was 19.7 ± 6.2 each case. The mean postoperative time of recovery of bowel function was (3.5 ±1.2) d,mean postoperative time of liquid intake was (4.9 ±0.9) d and mean hospitalization was (10.2 ± 2.7) d. No postoperative death or anastomotic fistula was found. Postoperative upper gastrointestinal bleeding occurred in 1 case and was cured by conservative treatment. Follow-up for 1-12 months revealed no recurrence or metastasis. Conclusions Laparoscopic assisted distal radical gastrectomy is a safe and feasible procedure with satisfactory short-term outcomes.Moreover,the short-term outcomes may be improved if the patients are treated under the notion of fast track surgery.

Right colon cancer is a kind of clinically common colorectal cancer.Surgical resection is the main treatment and the only curative method for patients.Improvement of surgical methods in recent years is one of the hotspots in the surgical treatment of colorectal cancer.There are controversies in laparoscopic surgery or traditional open surgery,intestine resection extent,D3 radical surgery or complete mesocolic excision,selective arterial guidance or venous guidance,pyloric lymph nodes (No.6 group lymph nodes) dissection,and most of the issues are currently lacking of prospectively randomized controlled trials.Therefore,this article discusses the above problems.At the same time,in view of the complicated operation of right hemicolectomy,and the greater risk of surgery,the author consulted the relevant literature and combined his clinical experience to introduce the key techniques of the operation.

By constructing the genomic DNA library of Meiothermus ruber CBS-01, the genes of trehalose phosphate synthase (TPS) and trehalose phosphate phosphatase (TPP) involved in trehalose synthesis were cloned. The genes were cloned into the plasmid pET21a, and expressed in Escherichia coli Rosetta gami (DE3). The activities of these two purified enzymes were confirmed by thin layer chromatography (TLC). Meanwhile, we tested the cellular compatible solutes of M. ruber CBS-01 under different environmental pressure, and found that under hyperosmotic pressure, this strain can accumulate trhalose-6-phosphate, but not trehalose. These results can give more insight to future research in the roles of TPS/TPP and TreS pathway.
Bacterial Proteins ; genetics ; metabolism ; Cloning, Molecular ; Escherichia coli ; genetics ; metabolism ; Glucosyltransferases ; genetics ; metabolism ; Phosphoric Monoester Hydrolases ; genetics ; metabolism ; Recombinant Fusion Proteins ; genetics ; isolation & purification ; metabolism ; Thermus ; enzymology ; genetics ; Trehalose ; biosynthesis

Objective To establish a method for measuring blood phosphatidylethanol by liquid chromatography coupled with tandem mass spectrometry(LC-MS/MS), which can be applied for objective and quantitative of alcohol intake.Methods Whole blood samples were treated with isopropanol to precipitate protein,and phosphopropanol(16:0/16:0)was used as the standard.After centrifugation, the supernatants were transferred and evaporated under a stream of nitrogen until dryness.Then the residuals were analyzed by LC-MS/MS.Various methodological parameters, including linearity, limit of detection (LOD), limit of quantitation(LOQ), recovery, and precision, were investigated.Finally, blood samples from 40 Chinese individuals with more than one year of regular drinking habits were analyzed, and distributions of phosphatidylethanol were evaluated.Results The correlation coefficients were higher than 0.9992.The LOD and LOQ were lower than 0.74 and 2.48 ng/ml, respectively.The inter-and total assay coefficient of variations were 0.77%-3.18% and 2.30%-6.95%, respectively, with recoveries ranged from 96.88% to 102.99%.The relationship between phosphatidylethanol level and self-reported alcohol consumption was significantly and positively correlated(r =0.769, P <0.001).Furthermore, Kruskal-Wallis analysis showed a significant difference in total phosphatidylethanol levels among individuals with different levels of alcohol intake(χ2=18.850,P<0.001).Conclusions An LC-MS/MS method for whole blood phosphatidylethanol detection has been developed.This method is simple,sensitive and accurate and can effectively reflect light,moderate and heavy alcohol intake.The method will be applied to the assessment of alcohol consumption and its association with the risks of drinking related diseases.

Objective:To investigate the characteristics of No.253 lymph node metastasis in middle and low rectal cancer and its influencing factors.Methods:The retrospective case-control study was conducted. The clinicopathological data of 2 316 patients with middle and low rectal cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2013 to October 2021 were collected. There were 1 339 males and 977 females, aged (61±12)years. All patients underwent D 3 radical surgery for rectal cancer. Observation indicators: (1) No.253 lymph node metastasis in patients with middle and low rectal cancer; (2) analysis of influencing factors for No.253 lymph node metastasis in patients with middle and low rectal cancer. Measurement data with normal distribution were represented as Mean± SD. Count data were expressed as absolute numbers and percentages, and comparison between groups was performed by the chi-square test. Logistic regression model was used for multivariate analysis. Results:(1) No.253 lymph node metastasis in patients with middle and low rectal cancer. There were 128 of 2 316 patients with positive No.253 lymph node and 2 188 cases with negative No.253 lymph node. The No.253 lymph node metastasis rate was 5.527%(128/2 316). There were 568 of 2 316 patients with the distance from distal margin of tumor to anal margin as 8?10 cm, 766 cases as ≥6 cm and<8 cm, 982 cases as <6 cm. Of the 568 patients with the distance from distal margin of tumor to anal margin as 8?10 cm, 57 cases had positive No.253 lymph node, including 3 cases(5.263%) of high differentiated tumor, 9 cases(15.789%) of moderate differentiated tumor, 45 cases(78.948%) of low differentiated tumor, respectively. There was 0 case of the above 57 patients with positive No.253 lymph node in TNM stage Ⅰ, 0 case in TNM stage Ⅱ, 20 cases(35.088%) in TNM stage Ⅲ, 37 cases(64.912%) in TNM stage Ⅳ, respectively. Of the 766 patients with the distance from distal margin of tumor to anal margin as ≥6 cm and <8 cm, 42 cases had positive No.253 lymph node, including 4 cases(9.524%) of high differentiated tumor, 11 cases(26.190%) of moderate differentiated tumor, 27 cases(64.286%) of low differentiated tumor, respectively. There was 0 case of the above 42 patients with positive No.253 lymph node in TNM stage Ⅰ, 0 case in TNM stage Ⅱ, 19 cases(45.238%) in TNM stage Ⅲ, 23 cases(54.762%) in TNM stage Ⅳ, respectively. Of the 982 patients with the distance from distal margin of tumor to anal margin as <6 cm, 29 cases had positive No.253 lymph node, including 1 case (3.448%) of high differentiated tumor, 3 cases (10.345%) of moderate differentiated tumor, 25 cases (86.207%) of low differentiated tumor, respectively. There was 0 case of the above 29 patients with positive No.253 lymph node in TNM stage Ⅰ, 0 case in TNM stage Ⅱ, 12 cases(41.379%) in TNM stage Ⅲ, 17 cases(58.621%) in TNM stage Ⅳ, respectively. (2) Analysis of influencing factors for No.253 lymph node metastasis in patients with middle and low rectal cancer. Results of univariate analysis showed that tumor T staging, tumor N staging, tumor TNM staging, tumor differentiation degree, the distance from distal margin of tumor to anal margin were related factors for No.253 lymph node metastasis in patients with middle and low rectal cancer ( χ2=28.48, 44.58, 172.62, 227.67, 34.57, P<0.05). Results of multivariate analysis showed that tumor T staging as stage T4, tumor N staging as stage N2, tumor TNM staging as stage Ⅳ, low differentiated tumor, the distance from distal margin of tumor to anal margin as ≥6 cm and <8 cm, 8?10 cm were independent risk factors for No.253 lymph node metastasis in patients with middle and low rectal cancer ( odds ratio=2.74, 3.48, 10.72, 21.47, 1.92, 3.67, 95% confidence intervals as 1.91?3.92, 2.42?4.98, 7.36?15.62, 10.33?44.60, 1.27?2.91, 2.31?5.81, P<0.05). Conclusions:The risk of No.253 lymph node metastasis is relatively high in middle and low rectal cancer patients with long distance from distal margin of tumor to anal margin, low differentiated tumor, and in high TNM stages. Tumor T staging as stage T4, tumor N staging as stage N2, tumor TNM staging as stage Ⅳ, low differentiated tumor, the distance from distal margin of tumor to anal margin as ≥6 cm and <8 cm, 8?10 cm are independent risk factors for No.253 lymph node metastasis in patients with middle and low rectal cancer.

OBJECTIVE: To discuss management of chylous leakage after retroperitoneoscopic upper-pole heminephrectomy for duplex kidney. METHODS: Between November 2004 and Februar y 2011, 39 patients underwent retroperitoneoscopic upper-pole heminephrectomy for duplex kidney, of these 5 patients had chylous leakage. The ages of the patients ranged from 32 to 60 years (mean 42). All the patients were treated conservatively, and the therapeutic effects were observed. RESULTS: Delayed chylous leakage in 5 patients occurred 5-31 days after surgery, and leakage occurred in 4 of the same 5 patients during the first 2 post-operative years. Chylous leakage after retroperitoneoscopic upper-pole heminephrectomy for duplex kidney preferentially occurred at the left side of duplex kidney. All the patients healed under conservative treatment. CONCLUSION Chylous leakage typically occurs after left retroperitoneoscopic upper-pole heminephrectomy for duplex kidney, and can be prevented by improving surgical technique; it can be completely relieved by conservative management with satisfactory results.
Adult ; Chylous Ascites ; etiology ; prevention & control ; therapy ; Female ; Humans ; Kidney ; abnormalities ; surgery ; Laparoscopy ; adverse effects ; methods ; Male ; Middle Aged ; Nephrectomy ; adverse effects ; methods ; Retroperitoneal Space

Objective:To investigate the value of nomogram constructed by CT-based radiomics for differentiating benign and malignant thyroid follicular neoplasms.Methods:Totally 200 post-surgery patients with pathologically confirmed thyroid follicular neoplasms in Fudan University Shanghai Cancer Center from January 2016 to December 2018 were retrospectively analyzed. Among the patients, 46 were follicular thyroid carcinoma (FTC) and 154 patients were follicular thyroid adenoma (FTA). The patients were randomly divided into a training set ( n=140) and validation set ( n=60) using a random number table. CT signs and radiomics features of each patient were analyzed within the LIFEx package. A predictive model was developed by the least absolute shrinkage and selection operator regression to build a nomogram based on selected parameters. The predictive effectiveness of differentiating benign and malignant thyroid follicular neoplasms was evaluated by the area under receiver operating characteristic curve (AUC). Calibration plots were formulated to evaluate the reliability and accuracy of the nomogram based on internal (training set) and external (validation set) validity. The clinical value of the nomogram was estimated through the decision curve analysis. Results:The prediction nomogram was built with 4 selected parameters, including grey level zone length matrix (GLZLM)-gray-level zone length matrix_zone length non-uniformity, GLZLM-gray-level zone length matrix_low gray-level zone emphasis, CONVENTIONAL_HUQ3, CONVENTIONAL_HUmean. In training and validation sets, the AUCs for differentiating FTC and FTA were 0.863 (95%CI 0.746-0.932), 0.792 (95%CI 0.658-0.917), accuracy were 87.9% and 75.0%, sensitivity were 67.9% and 66.7%, specificity were 91.1% and 90.5%, respectively. The calibration curves indicated good consistency between actual observation and prediction for differentiating the malignancy. Decision curve analysis demonstrated the nomogram was clinically useful.Conclusions:The CT radiomics mode shows the certain value and great potential to identify benign or malignant thyroid follicular neoplasms and the nomogram can accurately and intuitively predict the malignancy potential in patients with thyroid follicular neoplasms.

Objective:To explore the effect of subpressure on the bonding strength of resin to polycrystalline particulates modified zirconia ceramic.Methods:One hundred and twenty pre-sintered zirconia discs were prepared and divided into the control group, the sandblasting group and the 30, 50, 70 s acid etching group (24 per group) by the random number table method. There was no additional treatment in the control group and sandblasting group before sinering. The 30, 50, and 70 s acid etching groups were immersed in HF for 30, 50, 70 s, respectively, and then they were placed into CaCl 2 solution for 90 s and dipped in NaOH solution at 80 ℃ for 2 h. After sintering, the sandblasting group was subjected to sandblasting. The surface tomography and roughness were tested. According to whether subpressure was applied or not after the adhesives were applied, each group was randomly divided into two subgroups with a random number table: a subpressure subgroup and a normal pressure subgroup (12 per subgroup). Resin columns were bonded to these specimens. Shear bonding strength (SBS) test was conducted and the bonding interface, fracture surface and failure mode were analyzed. Results:The surface of control group was smooth, and its roughness was (0.24±0.11) μm. The rough surface was formed after sandblasting in the sandblasting group, and its roughness was (0.95±0.12) μm. The surface roughness of 30, 50, 70 s acid etching groups [(0.60±0.15), (1.04±0.11), (1.57±0.16) μm] increased as the HF immersion time prolonged, and the difference in surface roughness of zirconia specimens among each group was statistically significant ( P<0.05). The SBS values between zirconia and resin of all the subpressure subgroups, namely: the control group, the sandblasting group, and the 30, 50, 70 s acid etching group [(13.56±1.19), (20.98±2.11), (17.37±2.44), (24.19±2.97), (21.36±2.16) MPa] were significantly stronger than those in the normal pressure subgroups, namely: the control group, sandblasting group, 30, 50, 70 s acid etching group [(10.74±0.93), (18.47±2.14), (14.81±1.54), (20.74±2.56), (17.75±2.54) MPa] ( P<0.05). No obvious gaps and bubbles were observed in the bonding interfaces in subpressure subgroups. The proportion of mixed failure was significantly increased after applying subpressure ( P<0.05). Conclusions:The subpressure can effectively enhance the bonding strength between the resin and polycrystalline particulates modified zirconia ceramic and improve the bonding effect.

Objective To investigate the clinical effects of laparoscopic left colic artery (LCA) preserving total mesorectal excision (TME) for middle-low rectal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 339 patients with middle-low rectal cancer who underwent laparoscopic TME in the First Affiliated Hospital of Nanjing Medical University from July 2016 to July 2017 were collected.There were 216 males and 123 females,aged from 35 to 89 years,with an average age of 62 years.No lymph node enlargement was detected at the root of inferior mesenteric artery as evaluated by preoperative examination.Of the 339 patients,173 undergoing laparoscopic TME with preservation of LCA and 166 without preservation of LCA were allocated into observation group and control group,respectively.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect complications and survival of patients after hospital discharge up to August 2018.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was analyzed using the Mann-Whitney U test.Count data were represented as absolute number or percentage,and comparison between groups was analyzed using the chi-square test or Fisher exact propability.Comparisons of ordinal data were analyzed by Mann-Whitney U test.Results (1) Surgical situations:339 patients underwent laparoscopic TME successfully,without conversion to open surgery or death.The operation time,volume of intraoperative blood loss and number of lymph nodes dissected at the root of inferior mesenteric artery were (77± 15)minutes,(32±22)mL and 3.5± 1.3 in the observation group,(74± 16)minutes,(30±21) mL and 3.6± 1.3 in the control group,respectively,showing no statistically significant difference between the two groups (t =1.730,0.790,-0.378,P＞0.05).There were 21 and 37 patients receiving preventive stoma in the observation group and control group,with a statistically significant difference between the two groups (x2 =6.154,P＜0.05).(2) Postoperative situations:no lymphatic metastasis at the root of inferior mesenteric artery was detected in the observation group or control group.The incidence of anastomotic leakage was 8.55％ (13/152) and 16.28％(21/129) of patients without preventive stoma in the observation group and control group,with a statistically significant difference between the two groups (x2=3.917,P＜0.05).The overall incidence of anastomotic leakage was 7.51％ (13/173) and 12.65％ (21/166),with no statistically significant difference between the two groups (x2 =2.477,P＞0.05).Cases with anastomotic hemorrhage and time to first anal sufflation were 18 and (2.2±0.9) days in the observation group,10 and (2.4±1.0) days in the control group,respectively,showing no statistically significant difference between the two groups (x2 =2.145,t =-1.370,P＞0.05).(3) Follow-up:339 patients were followed up for 13-22 months,with a median time of 14 months.During the follow-up,2 patients had postoperative intestinal obstruction,19 had tumor recurrence or metastasis,and 4 died in the observation group.In the control group,1 patient had postoperative intestinal obstruction,17 had tumor recurrence or metastasis,and 3 died.The other patients in the two groups survived well.Conclusion Laparoscopic TME with preservation of LCA can reduce incidence of anastomotic leakage in patients with middle-low rectal cancer who don't undergo preventive stoma.

Objective To investigate the application value of superior mesenteric artery (SMA)-oriented complete mesocolic excision (CME) in the treatment of right colon cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 955 patients with right colon cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2013 to June 2018 were collected.There were 514 males and 441 females,aged from 18 to 96 years,with a median age of 65 years.Of the 955 patients,377 undergoing SMA-oriented CME of right colon with the lymph node dissection along the left boundary of SMA were allocated into SMA-oriented group,and 578 undergoing superior mesenteric vein (SMV)-oriented CME of right colon with the lymph node dissection along the left boundary of SMV were allocated into SMV-oriented group.Observation indicators:(1) intraoperative and postoperative conditions;(2) postoperative complications;(3) postoperative pathological examinations;(4) follow-up and survival situations.Follow-up was performed by telephone interview and outpatient examination once every 3-6 months within 2 years after surgery and once a year after 2 years up to January 2019,using tumor recurrence and metastasis or death as the end point.Follow-up included physical examination and tumor marker test,including carcino embryonic antigen,CA19-9,chest and abdomen CT examination and enteroscopy.Measurement data with skewed distribution were described as M (P25,P75),and comparison between groups was done using the Mann-Whitney U test.Count data were described as absolute numbers or percentages,and comparison between groups was analyzed using the chi square test.Ordinal data were analyzed using the rank sum test.Kaplan-Meier method was used to calculate survival time and rate,and draw survival curve.Log-rank test was used for survival analysis.Patients with loss to follow-up were involved in survival analysis as censored data.Results (1) Intraoperative and postoperative conditions:the operation time,volume of intraoperative blood loss,duration of postoperative hospital stay were 100 minutes (90 minutes,110 minutes),50.0 mL (50.0 mL,70.0 mL),8 days (8 days,10 days) in the SMA-oriented group,and 110 minutes (90 minutes,135 minutes),50.0 mL (50.0 mL,122.5 mL),10 days (8 days,12 days) in the SMV-oriented group,showing significant differences between the two groups (Z=-5.400,-5.799,-7.461,P＜0.05).After the exclusion of 47 patients unsuitable for defecation analysis because of postoperative complications,365 in the SMA-oriented group and 543 in the SMV-oriented group were analyzed.The time to first defecation,the maximum number and the median number of daily defecation postoperatively were 5 days (3 days,5 days),2.0 (1.0,2.5),1.0 (1.0,1.0) in the SMA-oriented group,which showed no significant difference from 4 days (3 days,5 days),2.0 (1.0,3.0),1.0 (1.0,1.0) in the SMV-oriented group (Z=-1.622,-1.541,-1.024,P＞ 0.05).(2) Postoperative complications:cases with postoperative complications,cases with incisional liquefaction or infection,cases with anastomostic leakage,cases with delayed gastric emptying,cases with intra-abdominal bleeding,cases with complete or incomplete ileus,cases with anastomostic bleeding,cases with intra-abdominal infection,cases with disruption of wound,the number of death were 55,10,3,3,2,2,1,1,1,1 in the SMA-oriented group,which showed no significant difference from 83,30,13,4,3,8,3,6,2,3 in the SMV-oriented group,respectively (x2 =0.045,3.662,2.926,0.034,0.001,1.604,0.352,1.873,0.048,0.352,P＞0.05).There were 32 of 377 patients in the SMA-oriented group and 14 of 578 in the SMV-oriented group with chylous leakage,showing a significant difference between the two groups (x2 =18.312,P＜ 0.05).Patients with chylous leakage were improved after conservative treatment,without reoperation.Patients with other complications were improved after anti-infection,fluid infusion,and reoperation.Four of 955 patients died after surgery.(3) Postoperative pathological examinations:patients with stage Ⅰ,stage Ⅱ,and stage Ⅲ (pathological TNM staging),patients with high-differentiation,mid-differentiation,and low-differentiation (tumor differentiation degree),length of intestine specimen,number of positive lymph nodes,maximum tumor diameter,patients with cancer nodules,patients with vascular invasion,patients with perineural invasion were 57,174,146,30,174,173,23 cm (21 cm,26 cm),0 (0,2),5.0 cm (3.0 cm,6.0 cm),37,81,53 in the SMA-oriented group,which showed no difference from 66,280,232,33,303,242,23 cm (21 cm,25 cm),0 (0,2),5.0 cm (3.5 cm,6.0 cm),80,108,82 in the SMV-oriented group (Z=-1.020,-0.216,-0.243,-0.220,-0.814,x2=3.441,1.127,0.003,P＞0.05).The number of harvested lymph nodes was 22.0 (17.0,27.0) and 18.0 (15.0,22.0) in the SMA-oriented group and SMV-oriented group,respectively,with a significant difference between the two groups (Z=-7.800,P＜0.05).There were 202 patients extracted for further analysis.The number of harvested lymph nodes and harvested central lymph nodes was 25.0 (20.0,31.3),5.0 (3.0,8.0) of 166 patients in the SMA-oriented group,and 21.5 (18.0,28.8),1.5 (0,4.5) of 36 patients in the SMV-oriented group,respectively,showing significant differences between the two groups (Z =-1.995,-4.309,P＜0.05).(4) Follow-up and survival situations:840 of 955 patients including 346 in the SMA-oriented group and 494 in the SMV-oriented group were followed up for 1.0-73.2 months,with a median time of 31.5 months.SMA-oriented group had a higher 5-year overall survival rate than SMV-oriented group (91.8％ vs.84.9％,x2 =4.384,P＜0.05),but had no significant difference in the 5-year tumor-free survival rate compared with the SMV-oriented group (84.4％ vs.78.2％,x2=2.158,P＞0.05).Conclusion Compared with SMV-oriented CME of right colon,SMA-oriented CME of right colon is safe and feasible,with larger number of harvested lymph nodes,which can achieve complete lymph node dissection.