Objective To investigate the role of intestinal flora in the development of irritable bowel syndrome with diarrhea(IBS-D).Methods The mice treated with antibiotics were randomly assigned to experimental group or control group.IBS-D mouse feces and normal mouse feces were given to the experimental group and control group for fecal microbiota transplantation,respectively.The fecal water content,intestinal transit time,and intestinal sensitivity were observed.qRT-PCR was used to determine the mRNA expression of nuclear factor kappa-B(NF-κB),Toll like receptor 4(TLR4),myeloid differentiation factor 88(MyD88),interleukin-1β(IL-Iβ),interleukin-6(IL-6),and tumor necrosis factor α(TNF-α)in colon tissue.Western blotting was used to determine the protein levels of the above-mentioned parameters.Results IBS-D related symptoms presented in the mice of the experimental group,such as increased fecal water content and intestinal sensitivity,and shortened intestinal transit time.The expression levels of inflammatory factors(IL-Iβ,IL-6,and TNF-α),NF-κB,TLR4,and MyD88 in the colon tissue of experimental group were significantly higher than those in the control group(P<0.05).Conclusion Intestinal flora inbalance is involved in the development and progression of IBS-D as an initiating important driver.Dysbiosis-induced hypo-inflammation of the intestinal mucosa and abnormal activation of NF-κB-related pathways may play key roles in this process.

Objective:To evaluate the effects of different pacing modes (unipolar/bipolar) under left bundle branch pacing(LBBP) on ventricular mechanical synchrony and myocardial work using the pressure-strain loop technique.Methods:Twenty-nine patients with LBBP due to symptomatic bradycardia were collected as LBBP group in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from December 2018 to July 2020. Another 29 matched patients with right ventricular pacing (RVP) during the same period were also included as a RVP group. Each LBBP patient was programmed to different pacing modes (uni-/bio-polar) within 1 week after the operation.Under each pacing mode, the inter- and intra-ventricular mechanical synchronization were evaluated. Meanwhile, the global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were obtained by the left ventricular pressure-strain loops technique.Results:Compared with the RVP group, the mechanical synchrony in the LBBP group was significantly improved (all P<0.05). GWI, GCW, and GWE increased, while GWW decreased, and the differences were statistically significant (all P<0.05), there were no significant differences in ventricular mechanical synchronization, GWI, GCW, GWE, and GWW between unipolar and bipolar pacing in the LBBP group (all P>0.05), there were no significant differences in these parameters when increasing output voltage (all P>0.05). Conclusions:LBBP induces better mechanical synchronization and higher myocardial work efficiency than RVP. Different LBBP pacing modes do not affect ventricular mechanical synchronization and myocardial work efficiency.

OBJECTIVE: To investigate the expression profile of long non-coding RNAs (lncRNA) and identify potential lncRNA-related competing endogenous RNAs (ceRNA) in placenta accrete spectrum disorders (PAS). METHODS: Five tissue specimens of placental implantation and 5 adjacent normal placental tissues were collected from cesarean section deliveries complicated by PAS in our hospital between December, 2017 and June, 2018. Human microarrays were used to identify the lncRNAs that were differentially expressed in PAS, and 5 of the identified lncRNAs were further validated using qRT-PCR. GO and KEGG pathway analyses were performed to indentify the most significant enrichment functions. A ceRNA network was constructed based on ENST00000511361 (RP5-875H18.4), NR_027457 (LINC00221) and NR_126415 (FOXP4-AS1) to pinpoint the potential lncRNAs-related ceRNA. RESULTS: A total of 329 lncRNAs and 179 mRNAs were identified to have differential expression in PAS. The results of qRT-PCR were consistent with the human microarrays results. Transforming growth factor-β (TGF-β) signaling pathway was the most significantly enriched pathway. The constructed ceRNA network suggested that RP5-875H18.4--miRNA-218--SLIT2 had a potential ceRNA regulatory mechanism in PAS. CONCLUSIONS The differentially expressed lncRNAs are involved in the occurrence and progression of PAS possibly by regulating the TGF-β signaling pathway. The ceRNA network of RP5-875H18.4--miRNA-218--SLIT2 may play a role in the occurrence of PAS.

Objective: To analyze the clinical application of the open supraclavicular approach in thyroidectomy. Methods: The clinical practicability of open supraclavicular thyroidectomy was explored by comparing the traditional anterior low arc incision thyroidectomy procedure with open supraclavicular thyroidectomy in terms of patients'aesthetic satisfaction, effectiveness of the operation, operation time, and so on. Result: Twenty-two cases of open supraclavicular thyroidectomy (group B) had better aesthetic satisfaction than 29 cases of traditional incision thyroidectomy (group A)(P<0.05), and had the same operative effect with traditional incision. Open supraclavicular thyroidectomy is associated with good aesthetic satisfaction, and has the same effect as the traditional incision does. Conclusions: Open supraclavicular thyroidectomy has good clinical value for benign thyroid tumors and some malignant tumors that require unilateral lobectomy, and even for tumors larger than the incision diameter. It has good aesthetic value while ensuring the curative effect of surgery.

OBJECTIVE: To explore the safety, feasibility and short-term efficacy of intracavitary uncut Roux-en-Y (URY) anastomosis in digestive tract reconstruction following laparoscopic total gastrectomy (LTG). METHODS: From November 2015 to January 2018, 67 gastric cancer patients underwent intracavitary URY following LTG to reconstruct the digestive tract at Oncological Surgery Department of Fujian Provincial Hospital. There were 41 males and 26 females with age of 50 to 81 (61.9±7.4) years and body mass index (BMI) of (23.4±3.2) kg/m². Among 67 patients, 19 were gastric cardia carcinomas, 33 were gastric body carcinomas, and 15 were gastric fundus carcinomas; tumor size was (3.4±2.3) cm; 22 were Borrmann type I, 15 were type II, 21 were type III, and 19 were type IV; 29 were highly or moderately differentiated adenocarcinoma, 23 were lowly differentiated adenocarcinoma, and 15 were signet-ring cell carcinoma. After conventional laparoscopic D2 radical gastrectomy, the duodenum was closed and dissociated at 2 cm below the pyloric ring using the Echelon-flex endoscopic articulated linear Endo-GIA stapler, and the esophagus was dissociated above the esophagogastric junction (EGJ).URY and digestive tract reconstruction were performed under the direct vision of laparoscope: (1) Side-to-side esophagojejunostomy: An incision of 0.5 cm was made in the left lower edge of the esophageal closed end; jejunum about 25 cm distal away from the Treitz ligament was elevated to the lower end of esophagus; another incision of 0.5 cm was made in the contralateral of mesenteric side; both arms of the linear Endo-GIA stapler were inserted into the windows opened through esophagus and jejunum respectively to complete side-to-side anastomosis. The common opening of esophagus and jejunum was closed to complete esophagojejunostomy, forming the chyme outflow tract. (2) Side-to-side Braun jejunojejunostomy: Incisions of 0.5 cm were made in the proximal jejunum about 10 cm away from the esophagojejunal anastomosis and 35-40 cm away from the contralateral of mesenteric side of distal jejunum respectively for proximal-distal side-to-side jejunojejunostomy. The common opening was closed to form the biliopancreatic duodenal juice outflow tract. (3) Closure of the input loop jejunum in the esophagojejunal anastomosis: The input loop jejunum 2-3 cm away from the esophagojejunal anastomosis was closed using the non-blade linear stapler (ATS45NK), and the biliopancreatic duodenal juice reflux was blocked. Clinical data of these patients were collected for retrospective case series study. Surgical and digestive tract functional recovery, perioperative complications, as well as postoperative nutritional status were observed. Moreover, related indexes, such as anastomosis function and tumor recurrence were evaluated through endoscopic and imaging examinations during postoperative follows-up. RESULTS: All the 67 patients completed the surgery successfully. The mean operative time was (259.4±38.5) minutes, digestive tract reconstruction time was (38.2±13.2) minutes, intraoperative blood loss was (73.4±38.4) ml, and number of harvested lymph node was 36.2±14.2. The mean distance from upper resection margin to upper tumor edge was (3.3±1.2) cm, distance from upper resection margin to dentate line was (1.2±0.7) cm, and 1 case had positive upper incisal margin, which became negative after the second resection. Moreover, the average length of the auxiliary incision was (3.2±0.4) cm. The mean postoperative intestinal exhaust time was (52.8±26.4) hours, time to liquid diet was (64.8±28.8) hours, and postoperative hospital stay was (8.4±2.5) days. The morbidity of postoperative complication was 10.4%(7/67). Among these 7 cases, 4 cases were grade IIIa of Clavien-Dindo classification, including 2 with esophagojejunal anastomosis leakage, 1 with duodenal stump leakage, and 1 with abdominal infection, and all these patients were recovered after conservative treatment. All the 67 patients were followed up. The mean nutrition index 12 months after surgery was 53.4±4.2, diameter of esophagojejunal anastomosis was (3.9±0.6) cm, the incidence of Roux-en-Y stasis syndrome was 3.0% (2/67), and the incidence of reflux esophagitis was 4.5% (3/67). No patient had recanalization of the closed input loop of esophagojejunal anastomosis, anastomotic stenosis, obstruction, or tumor recurrence at anastomosis. CONCLUSION Intracavitary URY anastomosis following LTG for digestive tract reconstruction is safe and feasible, leading to fast postoperative recovery of digestive tract function and favorable short-term efficacy.
Anastomosis, Roux-en-Y ; methods ; Anastomosis, Surgical ; Female ; Gastrectomy ; methods ; Humans ; Jejunum ; Laparoscopy ; Male ; Retrospective Studies ; Stomach Neoplasms ; surgery

Objective To investigate the diagnostic value of High-Sensitive Troponin T(hs-TnT)in acute myocardial infarction(AMI). Methods One hundred and sixty nine patients with serum hs-TnT concentration≥0.014 μg/L in early hospitalization were enrolled in this study.The ROC curve was used to compare the concentra-tion of hs-TnT with four heart enzyme(CK,CK-MB,LDH,AST)on the diagnostic efficacy to AMI. The differ-ence of hs-TnT in different clinical data groups were investigated using Mann-Whitney U rank test.Then the correla-tion between hs-TnT and Gensini score of Coronary angiography was investigated using the Spearman rank correla-tion test.Results The concentration of hs-TnT in patients with chest pain was significantly higher than that in non-AMI group(P<0.05).The AUC of each ROC curve was hs-TnT(0.806)>CK-MB(0.792)>CK(0.780)>AST (0.704)> LDH(0.684). The optimal diagnostic point of hs-TnT was 0.152 ug/L(sensitivity 0.659,specificity 0.894,Yuden index 0.553).There was a positive correlation between hs-TnT and Gensini scores in men,age>65 years old and the chest tightness group(P < 0.05). Conclusion The hs-TnT is better than four heart enzyme in early diagnosis of AMI and benefit early treatment of AMI.

Objective To observe the effects of adenosine preconditioning on the intestinal inflammatory response,the damaged mucosal tissue and apoptosis of intestinal epithelial cells in rats with abdominal open injury coupled with seawater immersion.Methods Sixty male Wistar rats with abdominal open injury were randomly divided into 3 groups,each consisting of 20 animals.The animals in group A had 0.9％ sodium chloride solution immersion + caudal vein injection of sterilization water (3 mg/kg).The animals in group B received seawater immersion + caudal vein injection of sterile water (3 mg/kg) and the animals in group C were given seawater immersion + caudal vein injection of adenosine pretreatment (3 mg/kg).All animals were sacrificed 6 hours after immersion.Pathological changes in intestinal mucosa were closely observed by histopathology.Levels of TNF-α and IL-6 were detected by enzyme-linked immunosorbent assay (ELISA).Caspase-3 protein was detected by immunohistochemistry.Apoptosis of the cells in intestinal mucosa were monitored by TUNEL method.Results The intestinal pathological scores of TNF-α and IL-6 for the animals in group B(3.98 ±0.41)were significantly higher than those in group A (2.46 ±0.39) (P ＜0.01).The TNF-α and IL-6 levels for the animals in group B [(2.38 ±0.39) μg/L and(883.11 ±34.22) ng/L] were significantly increased,as compared with those in group A [(1.01 ± 0.06) μg/L and (258.09 ± 6.52) ng/L] (P ＜ 0.01).The TNF-α and IL-6 levels for the animals in group C[(1.88 ± 0.21)pg/L and (582.13 ±19.44)ng/L] were significantly decreased,as compared with those in group B (P ＜ 0.01).The level of Caspase-3 and percentage of apoptotic cells in the intestinal mucosa of the animals in group B [(27.9 ± 4.3) ％ and (24.5 ± 3.1) ％]were significantly higher than those of the animals in group A [(13.8 ± 2.6) ％ and (16.4 ± 2.3) ％] (P ＜0.01),and the expression level of Caspase-3 and percentage of apoptotic cells of the animals in group C [(20.2 ± 3.4) ％ and (19.9 ± 2.9) ％] were significantly lower than those of the animals in group B (P ＜ 0.01).Conclusions Adenosine pretreatment could significantly improve intestinal mucosal inflammatory response in seawater immersion rats coupled with open abdominal open injury,alleviate the destruction of intestinal epithelial structure,and reduce apoptosis of intestinal mucosal epithelial cells.

Objective To observe the effects of adenosine preconditioning on gastric mucosal tissue destruction,inflammatory response and apoptosis of epithelial cells in rats with abdominal open injury coupled with seawater immersion.Methods Sixty male Wistar rats with abdominal open injury were randomly divided into 3 groups,each consisting of 20 animals.The animals in group A were treated with abdominal open injury + caudal vein injection of sterile water (3 mg/kg).The animals with abdominal open injury in group B received seawater immersion + caudal vein injection of sterile water (3 mg/kg),and the animals with abdominal open injury in group C were given seawater immersion + caudal vein injection of adenosine (3 mg/kg).All the animals were treated either with caudal vein injection of sterile water or adenosine at a dosage of 3 mg/kg 60 minutes before surgery,and were sacrificed 6 hours after immersion.Gastric mucosal ulcer index (UI) was calculated in the animals of all the groups.Pathological changes in gastric mucosa were closely observed under light microscopy.The levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in the gastric mucosa of various groups were detected by enzyme-linked immunosorbent assay (ELISA),the expression levels of Caspase-3 in gastric mucosa were detected by immunohistochemistry,and apoptosis of the cells in intestinal mucosa were monitored by TUNEL method.Results The UI,the levels of TNF-α and IL-6,and the pathological damage of gastric mucosa in group B were all significantly higher than those in group A (P＜0.01) and group C (P ＜0.05).The expression level of Caspase-3 (25.2％ ±3.6％) and the percentage of apoptosis cells (27.3％ ± 2.4％) in group B were significantly higher than those in group A (10.3％ ±1.4％ and 9.4％ ± 1.8％) (P ＜0.01),and the expression level of Caspase-3 of group C (19.4％ ±2.6％ and 21.9％ ± 2.6％) were signficantly lower than those of group B (P ＜0.05).Conclusions Adenosine pretreatment could effectively protect gastric mucosal epithelial inflammatory response in seawater immersion rats coupled with open abdominal injury,inhibit the secretion of inflammatory factors,alleviate gastric mucosal inflammatory response and reduce apoptosis of gastric mucosal epithelial cells.

Objective To observe the effects of adenosine preconditioning on the intestinal inflammatory response,the damaged mucosal tissue and apoptosis of intestinal epithelial cells in rats with abdominal open injury coupled with seawater immersion.Methods Sixty male Wistar rats with abdominal open injury were randomly divided into 3 groups,each consisting of 20 animals.The animals in group A had 0.9％ sodium chloride solution immersion + caudal vein injection of sterilization water (3 mg/kg).The animals in group B received seawater immersion + caudal vein injection of sterile water (3 mg/kg) and the animals in group C were given seawater immersion + caudal vein injection of adenosine pretreatment (3 mg/kg).All animals were sacrificed 6 hours after immersion.Pathological changes in intestinal mucosa were closely observed by histopathology.Levels of TNF-α and IL-6 were detected by enzyme-linked immunosorbent assay (ELISA).Caspase-3 protein was detected by immunohistochemistry.Apoptosis of the cells in intestinal mucosa were monitored by TUNEL method.Results The intestinal pathological scores of TNF-α and IL-6 for the animals in group B(3.98 ±0.41)were significantly higher than those in group A (2.46 ±0.39) (P ＜0.01).The TNF-α and IL-6 levels for the animals in group B [(2.38 ±0.39) μg/L and(883.11 ±34.22) ng/L] were significantly increased,as compared with those in group A [(1.01 ± 0.06) μg/L and (258.09 ± 6.52) ng/L] (P ＜ 0.01).The TNF-α and IL-6 levels for the animals in group C[(1.88 ± 0.21)pg/L and (582.13 ±19.44)ng/L] were significantly decreased,as compared with those in group B (P ＜ 0.01).The level of Caspase-3 and percentage of apoptotic cells in the intestinal mucosa of the animals in group B [(27.9 ± 4.3) ％ and (24.5 ± 3.1) ％]were significantly higher than those of the animals in group A [(13.8 ± 2.6) ％ and (16.4 ± 2.3) ％] (P ＜0.01),and the expression level of Caspase-3 and percentage of apoptotic cells of the animals in group C [(20.2 ± 3.4) ％ and (19.9 ± 2.9) ％] were significantly lower than those of the animals in group B (P ＜ 0.01).Conclusions Adenosine pretreatment could significantly improve intestinal mucosal inflammatory response in seawater immersion rats coupled with open abdominal open injury,alleviate the destruction of intestinal epithelial structure,and reduce apoptosis of intestinal mucosal epithelial cells.

Objective To observe the effects of adenosine preconditioning on gastric mucosal tissue destruction,inflammatory response and apoptosis of epithelial cells in rats with abdominal open injury coupled with seawater immersion.Methods Sixty male Wistar rats with abdominal open injury were randomly divided into 3 groups,each consisting of 20 animals.The animals in group A were treated with abdominal open injury + caudal vein injection of sterile water (3 mg/kg).The animals with abdominal open injury in group B received seawater immersion + caudal vein injection of sterile water (3 mg/kg),and the animals with abdominal open injury in group C were given seawater immersion + caudal vein injection of adenosine (3 mg/kg).All the animals were treated either with caudal vein injection of sterile water or adenosine at a dosage of 3 mg/kg 60 minutes before surgery,and were sacrificed 6 hours after immersion.Gastric mucosal ulcer index (UI) was calculated in the animals of all the groups.Pathological changes in gastric mucosa were closely observed under light microscopy.The levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in the gastric mucosa of various groups were detected by enzyme-linked immunosorbent assay (ELISA),the expression levels of Caspase-3 in gastric mucosa were detected by immunohistochemistry,and apoptosis of the cells in intestinal mucosa were monitored by TUNEL method.Results The UI,the levels of TNF-α and IL-6,and the pathological damage of gastric mucosa in group B were all significantly higher than those in group A (P＜0.01) and group C (P ＜0.05).The expression level of Caspase-3 (25.2％ ±3.6％) and the percentage of apoptosis cells (27.3％ ± 2.4％) in group B were significantly higher than those in group A (10.3％ ±1.4％ and 9.4％ ± 1.8％) (P ＜0.01),and the expression level of Caspase-3 of group C (19.4％ ±2.6％ and 21.9％ ± 2.6％) were signficantly lower than those of group B (P ＜0.05).Conclusions Adenosine pretreatment could effectively protect gastric mucosal epithelial inflammatory response in seawater immersion rats coupled with open abdominal injury,inhibit the secretion of inflammatory factors,alleviate gastric mucosal inflammatory response and reduce apoptosis of gastric mucosal epithelial cells.