Objective:To construct an inpatient-outpatient-home step swallowing rehabilitation training program for partial laryngectomy patients.Methods:From June 2022 to May 2023, a preliminary program for inpatient-outpatient-home step swallowing rehabilitation training for partial laryngectomy patients was developed through literature search and analysis. Delphi method was used for two rounds of expert inquiry on the inpatient-outpatient-home step swallowing rehabilitation training program for partial laryngectomy patients.Results:A total of 15 experts were included for two rounds of expert inquiry. The effective response rates of the questionnaires from the two rounds of expert inquiries were 100.0% (15/15). The expert authority coefficients for the two rounds of inquiry were 0.885 and 0.855, respectively, and the Kendall harmony coefficients were 0.217 and 0.230, respectively ( P<0.01). The final inpatient-outpatient-home step swallowing rehabilitation training program for partial laryngectomy patients included three primary items (swallowing training step, swallowing training methods, and feeding guidance methods), 21 secondary items, and 35 tertiary items. Conclusions:The inpatient-outpatient-home step swallowing rehabilitation training program for partial laryngectomy patients based on the Delphi method has certain scientific and feasibility and can provide a reference for medical and nursing staff.

Maternal diabetes not only affects the mother′s own health but also has a significant influence on offspring.Adverse prenatal and intrauterine condition can influence fetal kidney development, which may increase the risk of kidney disease in the adulthood.This article reveiws the impact of maternal diabetes on kidney structure and function.Maternal diabetes can increase the risk of congenital anomalies of the kidney and urinary tract(CAKUT)and impair early and long-term renal function of offspring.In addition, this article reveiws the research progress of the potential mechanisms of how maternal diabetes affects kidney development including oxidative stress, key signal pathway changes of kidney development and epigenetic changes.

Objective:To study factors associated with postoperative acute pancreatitis (POAP) in patients following pancreaticoduodenectomy.Methods:This retrospective analysis included 60 patients who underwent pancreaticoduodenectomy at the First Affiliated Hospital of Soochow University from Jan 2020 to Aug 2021. Enhanced computed tomography was used to identify POAP during postoperative period of 4 to 9 days. Univariate analysis and multivariate analysis were used to find out the risk factors of POAP.Results:Of the 60 patients, 13 cases (21.7%) developed POAP. The incidence of clinically related pancreatic fistula with abdominal abscess (76.9% vs.19.1%, χ2=15.71, P<0.000 1), postoperative hospital stay (26 d vs. 18 d, U=141.5, P=0.002 5) and the severity of complications (Clavien-Dindo grade≥Ⅲ: 53.8% vs. 21.3%, χ2=5.32, P=0.02) were significantly higher in the POAP group. But there was no significant deviation between the two groups when it comes to the severe post pancreatectomy delayed hemorrhage (7.7% vs. 0, χ2=3.68, P=0.06) and the delayed gastric emptying (30.8% vs. 21.3%, χ2=0.51, P=0.47). In the univariate analysis, patients with higher body mass index ( P=0.000 3), smaller main pancreatic duct diameter ( P<0.000 1) and softer texture of the pancreas ( P=0.009) were more likely to develop POAP after pancreaticoduodenectomy. In the multivariate analysis, the pancreatic duct diameter≤2 mm ( OR=0.005,95% CI 0.000 06-0.44, P=0.020), the softer texture of pancreas ( OR=0.005, 95% CI 0.000 04-0.47, P=0.023) were risk factors for POAP. Conclusions:Patients with postoperative acute pancreatitis increased the incidence of pancreatic fistula complicating abdominal abscess.Small caliber pancreatic tube, soft texture of pancreas were risk factors of POAP.

Objective:To investigate the clinical characteristics and treatment of the abdominal cocoon.Mehods:The clinical data of 28 patients with abdominal cocoon from Jan 2004 to Dec 2018 were analyzed retrospectively.Results:Intestinal obstruction was the main clinical manifestations (25 cases), recurrent chronic ileus(17 cases) and abdominal mass (7 cases). Preoperative imaging examination showed varying degrees of intestinal obstruction. CT or MRI scan displayed that small intestinal loops were disorganized , clustered and encased in a thickened capsule. All the cases underwent operations, showing that small bowel were encapsulated in a dense gray-white fibrous membrane. Adhesiolysis and fibrous membrane excision were done with segmental enterectomy when it was necessary. Early postoperative intestinal obstruction occured in 6 cases, all were cured by conservative treatment.Conclusions:The combination of clinical symptoms and CT or MRI may facilitate in preoperative diagnosis. Abdominal cocoon is putative diagnosis when recurrent intestinal obstruction with abdominal mass. Surgery is the therapy of choice.

Objective A retrospective analysis was conducted on standardized laparoscopic left lateral sectionectomy in liver resection (LLLR) using the "Two Step Two Endo-GIA" procedure.The aim of the study was to improve safety and efficacy of the operation.Methods All patients who underwent LLLR in Department of General Surgery,the First Affiliated Hospital of Soochow University from May 2014 to July 2018 were included in the study.All patients were divided into laparoscopic group (n=56) and open group (n=44).The operative plan followed the standardized procedure used in our department.Results Of 56 patients,there were 28 males and 28 females.No hepatic hilar occlusion was required and no case was converted to laparotomy.The average age was (55.7± 13.0),tumor diameter (6.3±3.7) cm,liver dissection time (30.0± 10.9) min,intraoperative blood loss (142.3±22.8) ml,and postoperative length of hospital stay (6.1±2.4) d.The average follow-up was (36.6± 10.1) months.One patient developed mild bile leakage and recovered after drainage.The other patients had no serious postoperative complications.The laparoscopic group was superior to the open group in operation time (90.0±17.0 vs.129.3±38.8) min,fasting time (1.5±1.0 vs.2.1±1.1) d,TBil (13.0±2.6 vs.19.0±3.1) μmol/L and ALT (80.0±19.3 vs.200.0±32.1) U/L.Conclusion A standardized LLLR has the advantages of short operation time,good reproducibility and short learning curve.It can be used as a standard procedure at all hospital levels.

Objective: To investigate the effect of long-chain non-coding RNA Fez family zinc finger protein 1 antisense RNA1 (lncRNA FEZF1-AS1) on the biological function of hepatocellular carcinoma (HCC). Methods: SMMC771 and BEL-7402 cells were transfected with sh-FEZF1-AS1 and OE-FEZF1-AS1, respectively. The expression of lncRNA FEZF1-AS1 was detected by real-time quantitative PCR. Cell proliferation was detected by Cell Counting Kit-8 (CCK-8), and apoptosis was detected by flow cytometry. The effects of lncRNA FEZF1-AS1 on invasion and migration were detected by Transwell and wound healing assays. The expression levels of adhesion molecules were detected by Western blot. The effect of lncRNA FEZF1-AS1 on the in vivo growth was verified by nude mice xenograft experiments. Results: The silencing or ectopic expression of lncRNA FEZF1-AS1 inhibited or promoted the proliferation of hepatocellular carcinoma cells. CCK-8 assay showed that the proliferation abilities of SMMC7721 and BEL-7402 cells in sh-FEZF1-AS1 transfection group significantly decreased, achieving (35.43±4.06)% and (34.68±3.97)%, respectively, on the fifth day. There were significant differences between sh-FEZF1-AS1 group and sh-NC group [52.21±8.46)% and (53.76±7.64)%] (all P<0.05). In contrast, the proliferation ability of SMMC7721 and BEL-7402 cells transfected with OE-FEZF1-AS1 was significantly increased, achieving (83.49±6.92)% and (80.31±3.13)%, respectively, on the fifth day. There were significant differences between OE-FEZF1-AS1 and OE-NC group [53.03±8.84)% and (55.11±7.09)%] (all P<0.05). The subsequent flow cytometry results showed that cell apoptotic rates of SMMC7721 and BEL-7402 cells transfected with sh-FEZF1-AS1 were (13.02±1.38)% and (11.88±1.29)%, respectively, which were significantly higher than those in sh-NC groups [(5.57±1.46)% and (8.06±1.42)%, respectively, all P<0.05]. In contrast, the apoptotic rates of SMMC7721 and BEL-7402 cells transfected with OE-FEZF1-AS1 were (3.01±0.39)% and (3.22±0.43)%, which were significantly lower than those in OE-NC groups [(6.68±0.96)% and (6.63±0.45)%, all P<0.05]. In addition, knockdown or overexpression of lncRNA FEZF1-AS1 expression inhibited or enhanced the migration and invasion abilities as well as the levels of adhesion molecules in hepatocellular carcinoma cells. After 30 days of feeding under the same conditions, the tumor volumes of sh-FEZF1-AS1 and sh-NC SMMC7721 cells xenograft mice models were (0.26±0.03) cm³ and (0.63±0.06) cm³, respectively, showing significant difference (P<0.05). The tumor volumes of sh-FEZF1-AS1 and sh-NC BEL-7402 cells were (0.31±0.02) cm³ and (0.72±0.08) cm³, and the difference was statistically significant (P<0.05). Conclusion lncRNA FEZF1-AS1 may strengthen the growth, migration and invasion of hepatocellular carcinoma cells.

Objective To investigate the effect of long?chain non?coding RNA Fez family zinc finger protein 1 antisense RNA1 ( lncRNA FEZF1?AS1) on the biological function of hepatocellular carcinoma (HCC). Methods SMMC771 and BEL?7402 cells were transfected with sh?FEZF1?AS1 and OE?FEZF1?AS1, respectively. The expression of lncRNA FEZF1?AS1 was detected by real?time quantitative PCR. Cell proliferation was detected by Cell Counting Kit?8 ( CCK?8), and apoptosis was detected by flow cytometry. The effects of lncRNA FEZF1?AS1 on invasion and migration were detected by Transwell and wound healing assays. The expression levels of adhesion molecules were detected by Western blot. The effect of lncRNA FEZF1?AS1 on the in vivo growth was verified by nude mice xenograft experiments. Results The silencing or ectopic expression of lncRNA FEZF1?AS1 inhibited or promoted the proliferation of hepatocellular carcinoma cells. CCK?8 assay showed that the proliferation abilities of SMMC7721 and BEL?7402 cells in sh?FEZF1?AS1 transfection group significantly decreased, achieving (35.43± 4.06)% and ( 34.68± 3.97)%, respectively, on the fifth day. There were significant differences between sh?FEZF1?AS1 group and sh?NC group [52.21 ± 8.46)% and (53.76 ± 7.64)%] ( all P＜0.05). In contrast, the proliferation ability of SMMC7721 and BEL?7402 cells transfected with OE?FEZF1?AS1 was significantly increased, achieving (83.49±6.92)% and (80.31 ± 3.13)%, respectively, on the fifth day. There were significant differences between OE?FEZF1?AS1 and OE?NC group [53.03 ± 8.84)% and ( 55.11 ± 7.09)%] ( all P＜0.05). The subsequent flow cytometry results showed that cell apoptotic rates of SMMC7721 and BEL?7402 cells transfected with sh?FEZF1?AS1 were ( 13.02 ± 1.38)% and ( 11.88 ± 1.29)%, respectively, which were significantly higher than those in sh?NC groups [(5.57±1.46)% and (8.06±1.42)%, respectively, all P＜0.05]. In contrast, the apoptotic rates of SMMC7721 and BEL?7402 cells transfected with OE?FEZF1?AS1 were (3.01 ± 0.39)% and ( 3.22 ± 0.43)%, which were significantly lower than those in OE?NC groups [(6.68±0.96)% and (6.63±0.45)%, all P＜0.05]. In addition, knockdown or overexpression of lncRNA FEZF1?AS1 expression inhibited or enhanced the migration and invasion abilities as well as the levels of adhesion molecules in hepatocellular carcinoma cells.After 30 days of feeding under the same conditions, the tumor volumes of sh?FEZF1?AS1 and sh?NC SMMC7721 cells xenograft mice models were (0.26±0.03) cm3 and (0.63±0.06) cm3, respectively, showing significant difference (P＜0.05). The tumor volumes of sh?FEZF1?AS1 and sh?NC BEL?7402 cells were (0.31±0.02) cm3 and (0.72±0.08) cm3, and the difference was statistically significant ( P＜0.05). Conclusion lncRNA FEZF1?AS1 may strengthen the growth, migration and invasion of hepatocellular carcinoma cells.

Objective To investigate the effect of long?chain non?coding RNA Fez family zinc finger protein 1 antisense RNA1 ( lncRNA FEZF1?AS1) on the biological function of hepatocellular carcinoma (HCC). Methods SMMC771 and BEL?7402 cells were transfected with sh?FEZF1?AS1 and OE?FEZF1?AS1, respectively. The expression of lncRNA FEZF1?AS1 was detected by real?time quantitative PCR. Cell proliferation was detected by Cell Counting Kit?8 ( CCK?8), and apoptosis was detected by flow cytometry. The effects of lncRNA FEZF1?AS1 on invasion and migration were detected by Transwell and wound healing assays. The expression levels of adhesion molecules were detected by Western blot. The effect of lncRNA FEZF1?AS1 on the in vivo growth was verified by nude mice xenograft experiments. Results The silencing or ectopic expression of lncRNA FEZF1?AS1 inhibited or promoted the proliferation of hepatocellular carcinoma cells. CCK?8 assay showed that the proliferation abilities of SMMC7721 and BEL?7402 cells in sh?FEZF1?AS1 transfection group significantly decreased, achieving (35.43± 4.06)% and ( 34.68± 3.97)%, respectively, on the fifth day. There were significant differences between sh?FEZF1?AS1 group and sh?NC group [52.21 ± 8.46)% and (53.76 ± 7.64)%] ( all P＜0.05). In contrast, the proliferation ability of SMMC7721 and BEL?7402 cells transfected with OE?FEZF1?AS1 was significantly increased, achieving (83.49±6.92)% and (80.31 ± 3.13)%, respectively, on the fifth day. There were significant differences between OE?FEZF1?AS1 and OE?NC group [53.03 ± 8.84)% and ( 55.11 ± 7.09)%] ( all P＜0.05). The subsequent flow cytometry results showed that cell apoptotic rates of SMMC7721 and BEL?7402 cells transfected with sh?FEZF1?AS1 were ( 13.02 ± 1.38)% and ( 11.88 ± 1.29)%, respectively, which were significantly higher than those in sh?NC groups [(5.57±1.46)% and (8.06±1.42)%, respectively, all P＜0.05]. In contrast, the apoptotic rates of SMMC7721 and BEL?7402 cells transfected with OE?FEZF1?AS1 were (3.01 ± 0.39)% and ( 3.22 ± 0.43)%, which were significantly lower than those in OE?NC groups [(6.68±0.96)% and (6.63±0.45)%, all P＜0.05]. In addition, knockdown or overexpression of lncRNA FEZF1?AS1 expression inhibited or enhanced the migration and invasion abilities as well as the levels of adhesion molecules in hepatocellular carcinoma cells.After 30 days of feeding under the same conditions, the tumor volumes of sh?FEZF1?AS1 and sh?NC SMMC7721 cells xenograft mice models were (0.26±0.03) cm3 and (0.63±0.06) cm3, respectively, showing significant difference (P＜0.05). The tumor volumes of sh?FEZF1?AS1 and sh?NC BEL?7402 cells were (0.31±0.02) cm3 and (0.72±0.08) cm3, and the difference was statistically significant ( P＜0.05). Conclusion lncRNA FEZF1?AS1 may strengthen the growth, migration and invasion of hepatocellular carcinoma cells.

Objective To explore the impact of nutritional risk on short-term clinical outcomes after laparoscope-assisted radical gastrectomy for gastric cancer.Methods The retrospective case-control study was conducted.The clinical data of 150 patients who underwent laparoscopic gastrectomy at the First Affiliated Hospital of Wenzhou Medical University between June 2014 and April 2016 were collected.According to nutritional risk screening 2002 (NRS 2002),42 and 108 patients were respectively divided into the nutritional risk group (NRS 2002 score ≥3) and non-nutritional risk group (NRS 2002 score ＜3).Laparoscope-assisted radical subtotal gastrectomy or total gastrectomy was performed based on tumor location.Observation indicators:(1) postoperative short-term clinical outcomes:postoperative complications,duration of postoperative hospital stay,hospital expenses,unplanned readmission within 30 days after discharging.Postoperative complications meant total complications within 30 days postoperatively,grade Ⅰ-Ⅴ of Clavien-Dindo grade was complication classification.Grade Ⅱ and above of Clavien-Dindo grade were analyzed in this research.(2) Risk factors analysis affecting occurrence of postoperative complications of patients.Measurement data with normal distribution were represented as x±s and analyzed using the independent-sample t test.Measurement data with skewed distribution were described as M (Qn) and analyzed using the Mann-Whitney U test.Categorical variables were described as number and percentage and analyzed by the chisquare test.Ranked data were analyzed by the Mann-Whitney U test.Univariate analysis was done by the chi-square test.P＜0.1 of univariate analysis was used to multivariate analysis.COX regression model in multivariate analysis was built using progressive condition method.Results (1) Postoperative short-term clinical outcomes:number of patients with total complications,number of patients with severe complications,duration of postoperative hospital stay,hospital expenses and number of patients with unplanned readmission within 30 days after discharging were 9,2,11 days (9 days,16 days),57 825 yuan (51 894 yuan,66 908 yuan),2 in the nutritional risk group and 16,3,11 days (9 days,13 days),55 067 yuan (49 395 yuan,62 423 yuan),8 in the non-nutritional risk group,respectively,with no statistically significant difference between the 2 groups (X2=0.952,0.010,Z=-1.133,-1.691,X2 =0.048,P＞0.05).Results of univariate analysis showed that age was a risk factor affecting incidence of complications after laparoscope-assisted radical gastrectomy for gastric cancer (X2 =4.468,P＜ 0.05).Results of multivariate analysis showed that preoperative hypoproteinemia was an independent risk factor affecting incidence of complications after laparoscope-assisted radical gastrectomy for gastric cancer (OR =2.797,95％ confidence interval:1.053-7.435,P＜0.05).Conclusion There is little poor impact of nutritional risk on short-term outcomes after laparoscope-assisted radical gastrectomy for gastric cancer,preoperative hypoproteinemia is an independent risk factor affecting occurrence of grade Ⅱ and above of postoperative complications.

Background and purpose: Multidrug resistance of tumor cells is the main factor for the failure of chemotherapy. It is found that the apigenin has the anti-tumor effect, but its role in multidrug resistant cells was rarely reported. This study aimed to investigate the effect of apigenin on multidrug resistant breast cancer cell line MCF-7/ADR, and to explore the role of apigenin in reversing multidrug resistance. Methods: The MCF-7/ADR cells were cultured with different concentrations of apigenin, and the same cells were cultured with ADR in the control group. Thecell proliferation was detected by MTT, the cell cycle distribution was detected by PI, and the cell apoptosis was detect-ed by Annexin V/PI. The drug sensitivity in vitro was detected by the method of MTT, and the drug retention rate was detected by rhodamine 123 accumulation. The expression of P-gp protein was measured by Western blot, the RT-PCR method was used to detect the transcription of multidrug resistance gene MDR1. Results: The MCF-7/ADR cell prolif-eration was inhibited by the apigenin, the cell cycle progression was blocked by the apigenin, and the cell apoptosis was induced by the apigenin. There were significant differences between the apigenin group and the ADR group (P<0.05). The IC50 of ADR on MCF-7/ADR cell was (12.37±0.18) μg/mL with the apigenin effect, while the IC50 of ADR on MCF-7/ADR cell was (39.83±0.29) μg/mL without the apigenin effect (P<0.05). The reversal index was 3.22. The retention rate of rhodamine 123 in MCF-7/ADR cells in the apigenin group was higher than that in the ADR group. The MDR1 gene transcription level in MCF-7/ADR cells was higher than that in the MCF-7 cells, and the P-gp expression in MCF-7/ADR cells was higher than that in the MCF-7 cells. However, the level of MDR1 gene transcription and P-gp expression were down-regulated by the apigenin in the MCF-7/ADR cells. Conclusion: The apigenin had anti-MCF-7/ADR effect, and played the role of reversing multidrug resistance in the MCF-7/ADR cells. The mechanism may be related to down-regulation of the MDR1 gene transcription and the P-gp mediated drug e?ux function.