Objective:To investigate the application value of antegrade splenic superior region dissection first in laparoscopic total gastrectomy of obesity gastric cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 21 obesity patients with gastric cancer who underwent laparoscopic total gastrectomy in Renji Hospital of Shanghai Jiaotong University School of Medicine from July 2018 to October 2023 were collected. There were 16 males and 5 females, aged (58±13)years. All 21 patients underwent laparoscopic total gastrec-tomy with antegrade splenic superior region dissection first. Observation indicators: operation time, volume of intraoperative blood loss, laparotomy conversion, intraoperative splenic hemorrhage or gastric hemorrhage, lymph node dissection, time to postoperative first flatus, time to postoperative initial liquid food intake, duration of postoperative hospital stay, postoperative complication. Measure-ment data with normal distribution were represented as Mean± SD, and count data were expressed as absolute numbers. Results:All 21 patients underwent laparoscopic total gastrectomy success-fully, with the operation time of (283±47)minutes, time for splenogastric ligament and vascular manage-ment of (34±12)minutes, volume of intraoperative blood loss of (143±86)mL, and no laparotomy conversion. There was no intraoperative splenic hemorrhage or gastric haemorrhage. The total number of lymph node dissected in 21 patients was 375, with the number of lymph node dissected as (21±9)per case. Time to postoperative first flatus, time to postoperative initial liquid food intake and duration of postoperative hospital stay in 21 patients were (3.1±0.7)days, (4.0±0.8)days and (10.1±3.0)days, respectively. There were 2 patients with postoperative complications, including 1 case of incision infection and 1 case of lung infection. The 2 patients with postoperative com-plications were recovered and discharged after conservative treatment. There was no death during the postoperative 30 days.Conclusion:The application of antegrade splenic superior region dissec-tion first in laparoscopic total gastrectomy is safe and feasible, which can reduce surgical difficulty.

Objective:To investigate the effect of quality improvement (QI) project on delayed cord clamping (DCC) implementation in very preterm infants.Methods:This study retrospectively collected the clinical data and assessed the QI indices of very preterm infants born in the Women and Children's Hospital of Chongqing Medical University and transferred to the Neonatology Department from January 2017 to January 2021. The indices for QI assessment included three types: (1) process indices: the implementation rate and timing of DCC; (2) outcome indices: hemoglobin level and hematocrit, etc; (3) balancing indices: the proportion of neonates requiring endotracheal intubation in the delivery room and chest compressions, Apgar score body temperature, and blood pH value on admission, etc. There were four phases for the implementation of QI, the pre-QI period (January to December of 2017), the QI period (January to December of 2018), the post-QI period (January to December of 2019), and the sustained-QI period (January 2020 to January 2021). The QI project was performed since August 2018. Control charts or statistical tests were used for statistical analysis.Results:(1) Process indices: After the implementation of the QI project, the practice of DCC increased from 0 to 82.2%, and the timing of umbilical cord clamping was from 0 s to a delay of 47.1 s. (2) Outcome indices: The levels of hemoglobin in the QI period, the post-QI period, and the sustained-QI period were significantly higher than those in the pre-QI period [(202.22±28.84), (210.10±33.52), (210.52±32.27) g/L vs. (187.94±35.29) g/L; F=8.61, P<0.001]. The hematocrit values in the post-QI period and the sustained-QI period were significantly higher than those in the pre-QI period [(58.99±8.71) %, (60.18±8.06)% vs. (55.41±9.17)%; χ2=5.13, P=0.002]. The other indices showed no statistical differences in different phases. (3) Balancing indices: The proportions of neonates receiving endotracheal intubation in the delivery room in the post-QI period and the sustained-QI period were significantly lower than those in the pre-QI period [16.0% (19/119), 13.2% (25/191) vs. 42.3% (30/71); χ2=29.08, P<0.001]. The body temperature on admission increased gradually through the four periods [pre-QI period: 35.3 ℃ (34.5-36.1 ℃); QI period: 36.0 ℃ (34.0-37.7 ℃); post-QI period: 36.0 ℃ (35.6-37.4 ℃); sustained-QI period: 37.0 ℃ (35.9-38.1 ℃); H=277.88, P<0.001]. The blood pH value on admission in the sustained-QI period [7.32 (6.85-7.50)] was significantly higher than those in the other three periods [7.26 (7.07-7.46), 7.26 (7.04-7.43), and 7.25 (6.91-7.49); H=34.46, P<0.001]. Conclusion:The interventions in this QI project significantly increase the practice of DCC and enable a longer DCC in very preterm infants.

The Fibulin family is a kind of secreted glycoprotein,belonging to the extracellular matrix protein.A total of 7 family members are widely distributed in basement membrane,elastic fiber and loose connective tissue.The Fibulin family is widely involved in the regulation of cell morphology,growth and adhesion.When Fibulin is disturbed,it can cause a range of diseases,such as skin laxity,tooth hypoplasia and various tumors.The researches show that Fibulin-1 is expressed abnormally in fibrosarcoma,gastric cancer and liver cancer,and the expression of Fibulin-2 is down-regulated in breast cancer and up-regulated in lung cancer.The other members of the family also show abnormal expression in various tumor tissues,which indicates the members of the Fibulin family play important roles in the genesis and development of tumors.

Hyper-osmotic stress is one of the key factors that decrease the efficiency of biological succinic acid production. To increase the osmotic stress tolerance of succinate-producing Escherichia coli, we studied the influence of IrrE, an exogenous global regulator, on cell osmotic stress resistance. Fermentation results showed that cell growth and succinic acid production by the recombinant increased under different Na+ concentrations. Meanwhile, the maximum dry cell mass, glucose consumption and succinic acid concentration increased 15.6%, 22% and 23%, respectively, when fermented in a 5-L bioreactor. Expressing IrrE improved cell resistance to hyper-osmotic stress. Further comparison of intracellular osmoprotectants (trehalose and glycerol) concentrations showed that trehalose and glycerol concentrations in the recombinant increased. This suggested that introduction of IrrE could enhance intracellular osmoprotectants accumulation which conferred cell with improved resistance to osmotic stress.

Objective To detect the changes of microbial community functional diversity of corpses with different postmortem interval(PMI)and to evaluate forensic application value for estimating PMI. Methods The cultivation of microbial community from the anal swabs of aSusscrofaand a human corpse placed in field environment from 0 to 240 h after death was performed using the Biolog-Eco Mi-croplate and the variations of the absorbance values were also monitored. Combined with the technology of forensic pathology and flies succession, the metabolic characteristics and changes of microbial commu-nity on the decomposed corpse under natural environment were also observed.Results The diversity of microbial metabolism function was found to be negatively correlated with the number of maggots in the corpses. The freezing processing had the greatest impact on average well color development value at 0 h and the impact almost disappeared after 48 h. The diversity of microbial metabolism of the samples be-came relatively unstable after 192 h. The principal component analysis showed that 31 carbon sources could be consolidated for 5 principal components(accumulative contribution ratio >90%). The carbon source tsquare-analysis showed thatN-acetyl-D-glucosamine andL-serine were the dominant carbon sources for estimating the PMI(0=240 h)of theSusscrofaand human corpse.Conclusion The Biolog-Eco method can be used to reveal the metabolic differences of the carbon resources utilization of the microbial community on the corpses during 0-240 h after death, which could provide a new basis for estimating the PMI.

Objective To explore the implementation of multi-disciplinary healthcare teamwork in Fast Track Surgery( FTS). Methods A total of 500 patients,who would have laparoscopic radical resection of gastric cancer during January 2011 to December 2013,were averagely divided into control group( traditional nursing model and routine perioperative nursing) and experimental group ( multi-disciplinary healthcare teamwork)by random number table. The patients of experimental group received fast recovery process by careful design,strict work procedure,effective quality control and were assessed the effect of recovery,satisfaction of medical staffs and observed the application effect of multi-disciplinary healthcare teamwork. Results The satisfaction of experimental group for intervention was 97. 05% ,and the first time of fart(2. 13 ± 0. 69)d,first time to get out of bed(1. 33 ± 1. 13)d,length of gastric tube indwelling time(2. 00 ± 1. 56)d,first time to feeding time(5. 00 ±1. 42)d,post-hospitalization time(13. 24 ± 3. 12),that all were better than those of the control group(t = -16. 889 6,-25. 068 0,-14. 705 9,-14. 190 1,-5. 693 4;P <0. 05). Conclusions The multi-disciplinary healthcare team is an effective approach to promote patients' recovery in Fast Track Surgery, and is a effective way in the clinical.

Objective To investigate the most appropriate surgical methods,different surgical modes of osmidrosis and their clinical effi-cacy were observed. Methods Clinical data was collected from 200 cases of axillary osmidrosis from January 2011 to July 2013. These cases were divided into four groups of the traditional group,minimally invasive group,RF pen-frequency electric cautery group and improved curet-tage group. Results The traditional group(80 cases) has an average healing period of 18. 7 days for operative incision including 78 cured cases(97. 5%)and 2 significant improved cases(2. 5%). The minimally invasive group(60 cases)has an average healing time of 8. 6 days, among which there are 3 cured cases(5%),8 significant improved cases(13. 3%),16 improved cases(26. 7%),4 cases(6. 7%)with weak curative effect and 29 failed cases(48. 3%). In the RF pen-frequency electric cautery group(30 cases),there are 5 significant improved ca-ses(16.7%),8improvedcases(26.7%)and17failedcases(56.6%).Theimprovedcurettagegroup(30cases)withanaverageincision healingtimeof9.8dayscontains28curedcases(93.3%)and2significantimprovedcases(6.7%). Conclusion Thetraditionalgroup shows the best curative effect,nevertheless the incision needs a considerably amount of time to recover. The patients under the treatment of minimally invasive surgery or RF pen-frequency electric cautery can recover in short time but recrudescence always occur. The improved cu-rettage method,which is effective and safe,combines the advantages of traditional surgery and minimally invasive surgery. However,large scar left from this method still remains as its major disadvantage but the overall curative effect is satisfactory. The improved curettage is proved to be the most appropriate method for axillary osmidrosis.

Background and objective hTe fusion (rearrangement) of anaplastic lymphoma kinase (ALK) gene has been identiifed as an import factor to the tumorigenesis and development of lung cancer. ALK tyrosine kinase inhibitors (ALK-TKIs) have been proved to have good effects to ALK positive lung cancers. hTe increasement of the relevance ratio of ALK will be very important to patients. hTe aim of this study is to investigate the clinical pathological features of ALK positive lung cancer, and the roles of immunohistochemistry (IHC) and lfuorescence in situ hybridization (FISH) in screening and conifrm-ing the ALK positive cases in the testing lfow of ALK. Methods IHC analysis of ALK in tumor specimens was performed on 525 lung cancer patients. 34 cases among them were conifrmed by FISH. Results hTe positive incidence of ALK by IHC was 5.14%(27/525). hTe ALK positive patients were signiifcantly younger than ALK negative patients (P<0.05), and femal was predominant (P<0.05). hTe proportion of solid predominant adenocarcinoma was signiifcantly higher in ALK positive patients (P<0.05). While acinar and lepidic predominant adenocarcinoma were signiifcantly lower in ALK positive patients (P<0.05). FISH was applied in 34 cases. hTe coincidence rate was increased with the increasement of positive intensity of IHC staining. All the IHC positive cases with or without EGFR mutation must be conifrmed by FISH. Conclusion IHC is a reliable detec-tion method to screening the ALK in lung cancer, and then enhance the relevance ration. To make a deifnite diagnosis of ALK positive lung cancer, FISH is a signiifcant detection method.

Succinic acid production was inhibited by high osmotic pressure caused by the accumulation of sodium ions in the process of two-stage fermentation by Escherichia coli using Na2CO3 as the pH regulator. To enhance the resistance of this strain to osmotic stress, the possibility to isolate high NaCl-tolerant mutant strain of Escherichia coli for succinic acid production by metabolic evolution was investigated. The metabolic evolution system was used as a mutant-generating system, allowing the cells to be continuously cultured at the maximum specific growth rate. The mutant strain can grow at maximum rate in the condition of high osmotic by gradually improving the concentration of NaCl in a continuous culture. Then the high osmotic-tolerant mutant strain of E. coli XB4 was selected with NaCl as the osmo-regulator. When using Na2CO3 as the pH regulator, E. coli XB4 was used in a 7.0 L fermenter during two-stage fermentation. After 60 h anaerobic fermentation, the mutant strain XB4 produced 69.5 g/L succinic acid with a productivity of 1.18 g/(L x h), which were increased by 18.6% and 20% compared with that of the parent strain.
Drug Tolerance ; genetics ; Escherichia coli ; genetics ; isolation & purification ; metabolism ; Industrial Microbiology ; Metabolic Engineering ; methods ; Mutation ; Osmotic Pressure ; Sodium Chloride ; pharmacology ; Succinic Acid ; metabolism

Escherichia coli NZN111 is a promising strain with ldhA and pflB genes inactivated for the production of succinic acid. However, with these mutations, NAD+ could not be regenerated from NADH, and an unbalanced NADH/NAD+ ratio eliminated cell growth and glucose utilization under anaerobic conditions. Nicotinic acid mononucleotide adenylyltransferase (NAMNAT), encoded by the nadD gene, catalyzes the reaction from nicotinic acid mononucleotide (NaMN) to nicotinic acid adenine dinucleotide (NaAD) during the synthetic pathway of NAD(H). Overexpression of the nadD gene could enhance the concentration of NAD(H) and maintain a suitable NADH/NAD+ ratio. In this study, we constructed a recombinant strain E. coli NZN111/pTrc99a-nadD, and overexpressed NAMNAT with 1.0 mmol/L of IPTG under anaerobic conditions in sealed bottles. Compared to E. coli NZN111, the concentrations of NAD+ and NADH in the recombinant strain increased by 3.21-fold and 1.67-fold, respectively. The total concentration of NAD(H) was increased by 2.63-fold, and the ratio of NADH/NAD+ decreased from 0.64 to 0.42. The recombinant strain restored the cell growth and glucose utilization under anaerobic conditions. After 72 h, the recombinant strain could consume 14.0 g/L of glucose to produce 6.23 g/L of succinic acid, and the concentration of succinic acid was 19-fold higher than in E. coli NZN111.
Anaerobiosis ; Escherichia coli ; genetics ; metabolism ; Glucose ; metabolism ; Mutation ; NAD ; metabolism ; Nicotinamide-Nucleotide Adenylyltransferase ; genetics ; metabolism ; Recombinant Proteins ; genetics ; metabolism ; Succinic Acid ; metabolism