ObjectiveTo systematically evaluate the efficacy and safety of omental wrapping technique for pancreaticojejunal anastomosis in preventing complications after pancreaticoduodenectomy. MethodsThis study was conducted according to the PRISMA guideline. English and Chinese databases including CNKI， Wanfang Data， VIP， CBM， the Cochrane Library， PubMed， Embase， and Web of Science were searched for clinical studies on omental wrapping technique for pancreaticojejunal anastomosis in preventing complications after pancreaticoduodenectomy published up to November 2022， and Stata 16 and Review Manager 5.4 were used to perform the meta-analysis. ResultsA total of 15 studies with 1 830 patients were included in this study. The meta-analysis showed that the omental wrapping group had a significantly lower overall incidence rate of postoperative pancreatic fistula （POPF） than the non-omental wrapping group （odds ratio ［OR］=0.30， 95% confidence interval ［CI］： 0.22‍ ‍—‍ ‍0.41， P<0.001）， and the subgroup analysis showed that the omental wrapping group had a significantly lower incidence rate of grade B/C POPF than the non-omental wrapping group （OR=0.29， 95%CI： 0.21‍ ‍—‍ ‍0.39， P<0.001）. Compared with the non-omental wrapping group， the omental wrapping group had significantly lower incidence rates of postoperative bile leakage （OR=0.30， 95%CI： 0.16‍ ‍—‍ ‍0.56， P<0.001）， postoperative hemorrhage （OR=0.35， 95%CI： 0.24‍ ‍—‍ ‍0.53， P<0.001）， delayed gastric emptying （OR=0.45， 95%CI： 0.31‍ ‍—‍ ‍0.64， P<0.001）， abdominal infection （OR=0.55， 95%CI： 0.40‍ ‍—‍ ‍0.75， P<0.001）， reoperation （OR=0.31， 95%CI： 0.18‍ ‍—‍ ‍0.54， P<0.001）， and death within 30 days after surgery （OR=0.42， 95%CI： 0.22‍ ‍—‍ ‍0.80， P=0.009）， a significantly earlier time to diet （mean difference ［MD］=-0.98， 95%CI： -1.84 to -0.11， P=0.03）， and a significantly shorter length of postoperative hospital stay （MD=-2.44， 95%CI： -4.10 to -0.77， P=0.004）. There were no significant differences between the two groups in the time of operation （MD=-13.68， 95%CI： -28.31 to -0.95， P=0.07） and intraoperative blood loss （MD=-17.26， 95%CI： -57.55 to -23.03， P=0.40）. ConclusionOmental wrapping can reduce the incidence rates of postoperative complications such as pancreatic fistula， bile leakage， postoperative hemorrhage， abdominal infection， and delayed gastric emptying， improve the prognosis of patients， and shorten the length of hospital stay， without increasing surgical difficulty or time of operation.

Bacterial biofilms have been demonstrated to be closely related to clinical infections and contribute to drug resistance. Berberine, which is the main component of Coptis chinensis, has been reported to have efficient antibacterial activity. This study aimed to investigate the potential effect of a combination of berberine with ciprofloxacin (CIP) to inhibit Salmonella biofilm formation and its effect on expressions of related genes (rpoE, luxS, and ompR). The fractional inhibitory concentration (FIC) index of the combination of berberine with CIP is 0.75 showing a synergistic antibacterial effect. The biofilm's adhesion rate and growth curve showed that the multi-resistant Salmonella strain had the potential to form a biofilm relative to that of strain CVCC528, and the antibiofilm effects were in a dose-dependent manner. Biofilm microstructures were rarely observed at 1/2 × MIC/FIC concentrations (MIC, minimal inhibition concentration), and the combination had a stronger antibiofilm effect than each of the antimicrobial agents used alone at 1/4 × FIC concentration. LuxS, rpoE, and ompR mRNA expressions were significantly repressed (p < 0.01) at 1/2 × MIC/FIC concentrations, and the berberine and CIP combination repressed mRNA expressions more strongly at the 1/4 × FIC concentration. The results indicate that the combination of berberine and CIP has a synergistic effect and is effective in inhibiting Salmonella biofilm formation via repression of luxS, rpoE, and ompR mRNA expressions.
Anti-Infective Agents ; Berberine ; Biofilms ; Ciprofloxacin ; Coptis ; Drug Combinations ; Drug Resistance ; Drug Resistance, Multiple ; Repression, Psychology ; RNA, Messenger ; Salmonella

Objective To investigate the prevalence of feeding intolerance (FI),and to explore the FI within 7 days of ICU admission in association with clinical outcome in critically ill patients.Methods The adult patients from 14 general ICUs in Zhejiang Province with an expected admission to ICU for at least 24h were recruited from March 2014 to August 2014,and all clinical,laboratory,and survival data were prospectively collected.The AGI (acute gastrointestinal injury) grade was daily assessed based on gastrointestinal (GI) symptoms,feeding details and organ dysfunction within the first week of ICU stay.The intra-abdominal pressures (IAP) was measured using AbViser device.Results Of 550 patients enrolled,418 were assessed in GI symptoms and feeding details within 7 days of ICU stay.The mean age and SOFA score were (65.1 ± 18.3) years and (8.96 ±4.10),respectively.Of them,355 patients (84.9％) were under mechanical ventilation support,and 37 (8.85％) received renal replacement therapy.The mean length of time for enteral feeding was (30.8 ±26.2) h,and the prevalence of FI on the 3rd and 7th day of ICU stay accounted for 39.2％ and 25.4％,respectively.Compared to those with FI within 7 days of ICU stay,the patients without FI had higher rate of successively weaning from mechanical ventilation (21.3％ vs.5.7％,P =0.003) and higher rate of withdrawal of vasoactive medication (45.5％ vs.20.0％,P =0.037),as well as lower mortality rate of 28-day (24.4％ vs.38.7％,P =0.004) and 60-day (29.6％ vs.44.3％,P =0.005).In multivariate Cox regression model with adjustment for age,sex,participant center,serum creatinine and lactate,AGI grade on the first day of ICU stay,and comorbidities,the FI within 7 days of ICU stay (x2 ≥ 7.24,P ＜ 0.01) remained to be independent predictors for 60-day mortality.After further adjusted for SOFA score,the FI within 7 days of ICU stay (HR =1.71,95％ CI:1.18-2.49;P =0.006) and AGI grade on the first day of ICU stay (HR =1.33,95 ％ CI:1.07-1.65;P =0.009) could provide independent prognostic values of 60-day mortality.Conclusions There is high rate of FI occurred within 7 days of ICU stay,and is significantly associated with worse outcome.In addition,this study also provides evidence to further support that measurement of gastrointestinal dysfunction could increase value of SOFA score in outcome prediction for the risk of 60-day mortality.

Objective To investigate and evaluate the clinical signiifcance of lfexible ureteroscopy in computed tomography urography negative patients with upper urinary tract hematuria. To improve the diagnostic rate of patients with upper urinary tract hematuria. Methods We retrospectively reviewed the cases of 10 computed tomography urography negative patients with upper urinary tract hematuria. The age ranges from 38 to 75 years old, and the average of them is 45.2 years old. The patients consist of 7 male patients and 3 female patients. Among them, 4 cases were on the left upper urinary tract cases, 6 cases were right upper urinary tract. All patients received lfexible ureteroscopy to conifrm the diagnosis and take the relevant treatment. Results In the total of 10 patients, 3 patients (30%) were diagnosed with tumors of renal pelvis, a renal arteriovenous ifstula was found in 1 case (10%), 3 patients (30%) were considered non-specific inflammation, other 3 patients (30%) had no obvious abnormalities. Conclusions Flexible ureteroscopy has significantly clinical diagnosis in computed tomography urography negative patients with upper urinary tract hematuria.

Objective Taking nurses relative number prediction for example,this paper discussed the application of Information Renewal GM (1,1)—Linear Regression Coupling Model in the prediction of health personnel resources,so as to provide methodology reference for forecasting health personnel.Methods The information renewal GM(1,1) and linear regression coupling model was built and explored to predict and fit analyzing.Results The error between the predictive value that calculated by information renewal GM(1,1) and the actual value was small,and the prediction accuracy of coupling model was high.Conclusion The coupling model not only remedied the defect that grey system model did not including linear factors,but also improved the fact that linear forecasting model could not express exponential growth.Therefore the coupling model was reasonable and feasible.

Objective To summarize clinical experience in removal of residual metallic foreign body in the soft tissue.Methods Clinical data of 742 cases with residual metallic foreign body in the soft tissue were analyzed.All the patients were forward from other hospitals with failed removal of the foreign body.Second surgery was performed in our hospital by grasping forceps using 3D-locator under the guidance of the C-shaped arm X-ray machine.Results Foreign body,such as scrap-iron,broken needle,nails,wine and so on located at different regions of soft tissues including neck,chest and abdomen,pelvis,and the four limbs were all successfully taken out.Removal rate of the foreign body was 100％.No complications such as bleeding,infection and nerve damage was occurred.The mean time of the procedures and radiation exposure for the removal surgery was 5 minutes.Conclusion Using 3D-locator and grasping forceps under the guidance of the X-ray,the residual metallic foreign bodies can be removed safely and efficiently.

ObjectiveTo evaluate the past 5 years' clinic experience of diagnosis and treatment of the pediatric soft-tissue foreign body (STFB),and to probe new strategies for its clinical management.MethodsTotally 165 consecutive children with small radiopaque STFB were involved.All the children were diagnosed with X-rays.CT (enhanced CT in 9 children)and virtual anatomy imaging (VAI) were performed in 40 children.Percutaneous foreign body forceps removal guided with C-arm video-fluoroscopy was performed and the effect was evaluated.ResultsThe longest dimension of STFB ranged from 1 mm to 40 mm,and the shortest dimension ranged from 1 mm to 5 mm,including scrap-iron,broken iron nails and needles,and glass pieces embedded in soft tissues under surface of the limbs,neck,chest,abdomen and pelvis.Seventy-six (76/165,46.06 ％) children received interventional therapy,and 73 were completely cured (73/76,96.05 ％),2 were partially cured (2/76,2.63 ％),and 1 was failed (1/76,1.32 ％).VAI accurately depicted STFB closely to large vessels even associated vascular complication with local large hematomas or pseudoaneurysms,helped to select the treatment methods and the forceps removal roads.Hematoma,infection,neural damages and other serious complications did not occur during and after operation.ConclusionVideo-fluoroscopy-guided percutaneous foreign body forceps removal is minimally invasive,safe and effective for small radiopaque STFBs,but may not suitable for the one very close to large blood vessels with or without vascular injuries complications.Preoperative CT VAI is helpful to locate STFB within complicated anatomic structures,selecting optimal intervention pathway and assessing the risk of intervention.

Objective To evaluate the feasibility and clinical effect of Argon plasma coagulator in simple enucleation for small renal cell carcinoma. Methods On the basis of successful performing the animal experience of coagulating therapy on the wound tissue during partial nephrectomy with Argon plasma coagulator in rabbit models, 10 cases of simple enucleation for small renal cell carcinoma with Argon plasma coagulator were accomplished. Results Both with the standard of stopping bleeding of wound tissue by Argon plasma coagulator and with the standard of re-spraying the wound tissue for 2 s after stopping bleeding using Argon plasma coagulator, the depth of wound tissue necrosis without blocking the renal pedicle is deeper than that with blocking the renal pedicle(P=0. 012 and P=0. 002, respectively).If the wound tissue was re-sprayed for 2 s after stopping bleeding by Argon plasma coagulator, the depth of the wound tissue necrosis without blocking the renal pedicle was deeper than that just with blocking the renal pedicle(P=0. 007 and P=0. 002,respectively). In the part of application in clinical, all procedures were successfully completed. The mean operative time was 163 min (range, 100-210 min) and mean blood loss was 230 ml (range, 100-400 ml). Drainage tube was pulled out 1 month after operation in 1 case for being allergic to absorbable hemostatic gauze, and the mean pulling drainage tube out time in others was 4. 2 d (range, 3-5 d). During a mean follow-up of 22 months (range, 10-38 months), no local tumor recurrence and distant metastasis was found. Conclusion Argon plasma coagulator can be used in simple enucleation for small renal cell carcinoma, and the clinical effectiveness is ideal.

Objective To investigate the effect and the mechanism of up-regulating histone acetylizad level with a selective inhibitor of HDACs-Valproate acid sodium (VPA) on breast cancer cell proliferation. Methods MCF-7 cells were cultured with 0.75-4.0 mmol/L valproic acid (VPA) for 24, 48, 72, 96 hours in vitro, the inhibiting rate was tested by MTT assay. Cell cycle was analyzed by flow eytome- try with PI assay, and the protein and mRNA expressions of Cyelin A, Cyclin DI, Cyclin E, P21Waf/cipl of MCF-7 cells after 1.5, 3.0 mmol/ L VPA treated were analyzed by indirect immunofluorescence technique and RT-PCR respectively. Results After cultured with 0.75 -4.0 mmol/L valproic acid (VPA) for 24, 48, 72, 96 hours, the inhibiting rate of experimental groups increased significantly(P<0.01) and a dose and acting time dependent manner was found. As to cell cycle, the percentages of GI, S, M phrase in control groups remained the same. Contrary to control groups, 0. 75 -4.0 mmo]/L VPA induced a significant arrest in G1 phrase ( P<0.01), and a total of 55.4% -82.8% G1 phrase ratio were found. P21Waf/cipl was up-regulated both at the mRNA and protein level while Cyclin D1 was down-regulated ( P<0.001). Conversely, neither mRNA nor protein expression of Cyclin A, Cyclin E showed difference ( P>0.05). Conclusions Up- regulating histone acetylizad level can inhibit breast cancer cell proliferation, induce cell cycle arrest in G1 phrase. VPA, as a I class of histone deaeetylase inhibitor, can be used as an option in the treatment of breast cancer. The mechanism may include up-regulating P21Waf/cipl mRNA and protein expression and down-regulating Cyclin D1 mRNA and protein expression.

Objective To investigate whether antisense integrin αV and β3 gene therapy has antitumor activity for hepatocellular carcinoma.Methods In this study,120 male nude mice at the age of 4 weeks old were devided into 4 groups randomly.The antisense integrin αV and β3 expression vectors were iniected into HepG2 hepatomas established in nude mice to monitor tumor growth after 6 weeks.Tumot inhibit rate was calculated.Tunor microvessel density(MVD)was determined by immunohistochemical staining,and tumor apoptosis by TUNEL. Results The tumor weight of the control group,αV group,β3 group and αVβ3 group was(1.38±0.92)g、(1.28±0.27)g、(1.30±0.34)g、(1.08±0.16)g respectively.The difference between each two groups was significant(q12=4.76,q13=3.73,q14=14.28,P＜0.05);The MVD was(17.53±1.88)、(16.06±1.92)、(15.83±2.00)、(14.86±1.69)respectively,(q12=3.91,q13=4.55,q14=7.13,P＜0.01);The AI of the control group,αV group,β3 group and αVβ3 group was 10.53%±3.29%,19.80%±4.06%,21.93%±3.26%,24.03%±4.45%respectively,with the difference being significant among groups(q12=29.41,q13=33.52,q14=39.7,P＜0.01).Conclusions Antisense gene therapy targeting αV and β3 integrins exerts dramatic inhibition on the growth of the tumor.