BACKGROUND: Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting. METHODS: To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks. RESULTS: A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor. CONCLUSIONS Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.
Humans ; Male ; Retrospective Studies ; Diabetes Mellitus, Type 2/complications* ; Obesity, Morbid ; Anastomotic Leak/epidemiology* ; Gastrectomy/methods* ; Reoperation/methods* ; Registries ; Laparoscopy/methods* ; Treatment Outcome

Inhibitor of nuclear factor kappa-B kinase subunit beta (IKKβ) is one of important kinases in inflammation to phosphorylate inhibitor of nuclear factor kappa-B (IκBα) and then activate nuclear factor kappa-B (NF-κB). Inhibition of IKKβ has been a therapeutic strategy for inflammatory and autoimmune diseases. Here we report that IKKβ is constitutively activated in healthy donors and healthy Ikkβ ^C46A (cysteine 46 mutated to alanine) knock-in mice although they possess intensive IKKβ-IκBα-NF-κB signaling activation. These indicate that IKKβ activation probably plays homeostatic role instead of causing inflammation. Compared to Ikkβ ^WT littermates, lipopolysaccharides (LPS) could induce high mortality rate in Ikkβ ^C46A mice which is correlated to breaking the homeostasis by intensively activating p-IκBα-NF-κB signaling and inhibiting phosphorylation of 5' adenosine monophosphate-activated protein kinase (p-AMPK) expression. We then demonstrated that IKKβ kinase domain (KD) phosphorylates AMPKα1 via interacting with residues Thr183, Ser184, and Thr388, while IKKβ helix-loop-helix motifs is essential to phosphorylate IκBα according to the previous reports. Kinase assay further demonstrated that IKKβ simultaneously catalyzes phosphorylation of AMPK and IκBα to mediate homeostasis. Accordingly, activation of AMPK rather than inhibition of IKKβ could substantially rescue LPS-induced mortality in Ikkβ ^C46A mice by rebuilding the homeostasis. We conclude that IKKβ activates AMPK to restrict inflammation and IKKβ mediates homeostatic function in inflammation via competitively phosphorylating AMPK and IκBα.

As a new technology for screening carotid plaques, three-dimensional ultrasound plays an important role in clinical and scientific research. Recent studies have shown that three-dimensional ultrasound combined with various new algorithms can effectively evaluate carotid plaque load and vulnerability. However, due to the high cost of volumetric probes and the large volume affecting the detection angle, three-dimensional ultrasound has not been widely used in China. This article reviews the advantages of three-dimensional ultrasound in evaluating vulnerable plaques and plaque load, in order to provide reference for clinical work in the future.

Objective To investigate the clinical features and prognostic characteristics of head and neck cancer in patients with esophagus cancer and triple primary carcinoma(TPC).Methods A total of 30 patients with head and neck cancer with esophagus cancer TPC were collected in Zhejiang Cancer Hospital from January 2007 to December 2016.The distribution of cancer kinds and the incidence of synchronous and metachronous cancer were described.The clinical characteristics and prognosis were also compared in synchronous and metachronous cancer.The influence of number of hospitalization and different treatments on the survival time were analyzed.Results The TPC of "laryngeal pharynx + esophagus + lung" and "laryngeal pharynx + esophagus + oropharynx" had the highest incidence,that was 20.0％ in 30 patients (6/30).The second type was "laryngeal pharynx + esophagus + larynx".Fifteen cases were synchronous cancer and other 15 cases were metachronous cancer.The rate of surgery was 73.3％ (11/15),and the number of hospitalization who more or equal than 5 was 73.3％ (11/15) in the synchronous cancer.While the rate of surgery was 33.3％ (5/15),and the number of hospitalization who more or equal than 5 was 33.3％ (5/15) in the metachronous cancer.There were significant differences between synchronous and metachronous cancer (x2 =4.661,4.661,all P ＜ 0.05).The 1-year,3-year and 5-year survival rates were 39.9％,19.9％ and 0.0％ in patients with synchronous cancer.The mean survival time was (18.4 ± 6.2)months.In contrast,the survival rates were 78.7％,77.8％ and 59.1％ in metachronous cancer.The mean survival time was (122.2 ± 17.2) months.There were significant differences between the two groups (survival rate:x2 =10.934,P =0.001;mean survival time:t =3.201,P =0.003).The survival rate of the number of hospitalization more than or equal to 5 times had significant difference compared with those less than 5 times (x2 =10.574,P =0.001).There was no statistically significant difference in the improvement of OS between single operation,chemotherapy and target treatment (P ＞ 0.05).Conclusion Head and neck cancer in patients with esophagus cancer TPC can still has a high survival rate through active combined modality therapies,especially in metachronous carcinoma.

OBJECTIVE To analyze the new features in diagnosis and treatment of parathyroid tumor co-existent with thyroid disease. METHODS The clinical data of 98 patients with parathyroid tumors from Jan.2007 to Dec.2016, in Zhejiang Cancer Hospital were retrospective analyzed. RESULTS In all 98 cases, there were 22 cases mistaken as thyroid disease before surgery. The misdiagnosis rate was higher(36.2％), when combined with thyroid disease. When co-existent with thyroid disease, the qualitative diagnosis rate of the ultrasound and CT will be decreased, it was easy to misdiagnosis. Logistic regression analysis showed that parathyroid tumor location, hyperparathyroidism, cystic parathyroid tumor affected the accuracy of the qualitative diagnosis of ultrasound. The size of the parathyroid tumor affected the accuracy of the qualitative diagnosis of CT. Three of 9 patients underwent bilateral thyroid cancer and parathyroid tumor resection presented permanent hypoparathyroidism(33％). CONCLUSION When combined with thyroid disease, parathyroid tumor is easy to be misdiagnosed, the qualitative diagnosis rate of the ultrasound and CT will also decreased. When combined with thyroid cancer, these will be a higher risk of hypoparathyroidism after bilateral thyroid cancer and parathyroid tumor resection.

Objective: To investigate the value of detecting circulating tumor cells (CTCs) in patients with local advanced head and neck squamous cell carcinoma (LAHNSCC). Methods: Twenty cases of LAHNSCC and eight healthy cases as the negative control were collected. The clinicopathological factors were evaluated. The LAHNSCC CTCs were enriched by specific antibody nanofluidic chip immunoassay using CytoSorter CTCs sorting system. LAHNSCC CTCs were identified by immunofluorescence staining. The relationships between CTCs and the clinicopathological features of LAHNSCC were analyzed. The numbers of CTCs were monitored and compared two weeks after inductive chemotherapy and at the end of the treatment. Results: CTCs were detect in 15 (75%) 20 patients with LASHNCC, with an average number of 22.4 CTCs. There was a correlation between the numbers of CTCs and age or N staging (P<0.05). Among the 15 cases with CTCs, 13 cases received inductive chemotherapy, for whom CTCs were detected again after inductive chemotherapy in all of these 13 patients, with an average number of 9.5 CTCs. Ten of the fourteen cases (71.4%) were still CTCs detected After whole treatments CTCs were detected in 14 patients, of them, 10 (71.4%) patients showed positive CTCs, with an average 1.6 CTCs. The numbers of CTCs decreased after either inductive chemotherapy or the whole treatment. The number of detected CTCs after whole treatment decreased nearly to background levels. Conclusions CTCs have a high detection rate in the peripheral blood of patients with LAHNSCC, especially in patients ≥60 years old and with ≥ N2 stage before treatment. Real-time detection of dynamic change of CTCs may assist to evaluate therapeutic effect.

Objective To investigate the expression of sodium iodide symporter (NIS ) mRNA in differentiated thyroid Carcinoma (DTC)and further explore its value in clinical diagnosis and therapy of DTC. Methods The expression of NIS mRNA was detected and analyzed in 21 nodular goiter and 45 cases of DTC (including 35 cases of papillary thyroid carcinoma and 10 cases of follicular thyroid carcinoma)by using real-time fluorescent quantitative reverse transcription polymerase chain reaction (real-time RT-PCR).Results Compared with that in nodular goiter,the mRNA expression of NIS in DTC tissue was significantly decreased (P < 0.05 ). Moreover,the mRNA expression of NIS was significantly correlated with lymph node metastasis and AJCC stage, respectively.The expression of NIS mRNA in DTC with lymph node metastasis was significantly decreased compared with that in DTC without lymph node metastasis (P <0.05).In addition,the expression of NIS mRNA in Ⅱ-Ⅳstage DTC was significantly decreased compared with that in Ⅰ - Ⅱ stage DTC (P < 0.05 ).Conclusion Differential expression of NIS can provide evidence for individual 1 3 1 I therapy for DTC.

Objective To study the CT features of peripheral lung cancer with thin-walled cavity, and to improve the understanding and diagnostic accuracy of this type of lung cancer. Methods Thirty-one patients (male:18, female:13, average age(56 ± 12)years old) with surgically proven peripheral lung cancer with thin-walled cavity were studied retrospectively. There were 28 cases of adenocarcinoma, 2 cases of squamous cell carcinoma and 1 case of sarcomatoid carcinoma. All patients had MSCT examination, and the CT features of the solid lesion and thin-walled cavity of the lung cancer were analyzed. The relationship between solid lesion and thin-walled cavity location, cavity wall thickness and uniformity, wall nodules, vascularstructures close to the outer wall, septum or air-fluid level inside the cavity, and dynamic changes of the lesions were all evaluated. Results (1) Solid lesion:mostly located in both upper and middle lobes of the lung in 21cases (67.7%). Lobulation, speculation and vessel convergence sign were observed in 27 cases (87.1%), 21 cases(67.7% )and 16 cases(51.6%) respectively. Twenty cases showed as ground glass nodule (GGN) (64.5%), with pure GGN in 11 cases(35.5%). (2) Cavitary lesion: The average diameter was (2.7 ± 1.3) cm, the cavity located in the periphery of the solid lesions in 26 cases (83.9%),and in 20 cases (64.5%) located in the lateral or superior and inferior lateral aspect of the solid lesion;The cavity wall was uniform in17 cases (54.8%) and the wall thickness<2 mm were seen in 16 cases (51.6%), 2-3 mm were observed in 10 cases (32.3%);Wall nodules were seen in five cases (16.1%);Blood vessels adjacent to outer wall were found in 12 cases (38.7%);There was no air-fluid level in the cavity in all the cases;But septum with uneven thickness or small vessels were seen in the cavity in 27 cases (87.1%). Conclusions The majority of peripheral lung cancer with thin-walled cavity was adenocarcinoma, characteristic CT features of thin-walled cavitary lesions may be helpful in the diagnosis of this type of lung cancer.

Objective To analyze the mammographic findings of ductal carcinoma in situ,and to improve DCIS diagnosis.Methods 1 58 cases of infiltrating ductal carcinomas,27 cases of DCIS and 14 cases of DCIS with microinvasion identified by postoperative pathological were collected,and their mammographic data were analyzed etrospectively.Results There were significantly more calci-fication and pure calcification in DCIS group than in IDC group(both P <0.05 ).And have no statistically significant difference be-tween those two diseases for the shap of calcification(P >0.05),both of them mostly showed granula and punctate calcification.There were statistically significant difference those two diseases for the distribution of calcification (P <0.05),the linearity and V-shaped segmental distribution occupies a relatively high percentage in DCIS while the cluster-like calcification occupies a relatively high percentage in IDC.Conclusion Pure calcification is mainly mammographic feature of DCIS.The characteristic of calcification is distribute along duct.

Objective To learn the various clinic characteristics of newly T tuberculosis (TB) patients ,investigating the preven-tion and treatment knowledge of TB patients ,in an effort to provide scientific evidence for targeted prevention and control meas-ures .Methods Retrospectively analyzing the common demographic characteristics of 648 newly and 434 old TB patients from Sep-tember 2011 to September 2012 ,diagnostic information ,the awareness on the prevention and treantment ,drug use situation and so on .Results Among these patients ,most of them were males(60 .2% ) ,the middle age and the young were the majority (77 .8% ) , the disease areas were mainly rural ones (61 .6% ) ,and manual workers (65 .4% ) ,secondary pulmonary TB was in the majority (72 .8% ) ,40 .0% (52/130) of the patients with TB pleuritis were accompanied by pulmonary TB .TB patients usually combined with pneumonoconiosis(8 .0% ) ,diabetes(3 .6% ) ,asthma(4 .3% ) and some other fundamental diseases .The old TB patients had more prevention and treatment knowledge about TB than those newly patients (P<0 .05) .The major source of newly patients about the knowledge were mainly from their relatives and friends (30 .3% ) ,whereas the old patients from teaching of medical care (36 .9% ) .The main reasons for irregular usage of medicine came from the lack of knowledge about the course period of treatment (45 .3% ) ,and the disappearing of TB symptoms (30 .8% ) .Conclusion In the less developed rural areas ,the young and middle aged males who mainly done physical work were the majority patients .These newly patients have little prevention and treatment knowledge about TB .Comprehensive hospitals played an important role in transmission of TB knowledge .In the process of educa-tion ,we should pay special attention on the following less known but essential points :mode of transmission ,protective measures , course period of treatment ,monitoring side effect ,giving out free medicine ,and the prognosis of TB .