Objective To analyze the diagnostic efficacy and clinical significance of magnifying endoscopy combined with narrow-band imaging(ME-NBI),acetate-indigo rouge staining and multi-slice spiral CT for early gastric cancer and precancerous lesions.Methods 202 patients with suspected early gastric cancer and precancerous lesions from February 2019 to March 2022 were regarded as the subjects of this study,all the patients underwent ME-NBI,acetate-indigo rouge staining,and multi-slice spiral CT examination;The diagnostic value of different examination methods for early gastric cancer and precancerous lesions was analyzed using the receiver operator characteristic curve(ROC curve),using the pathological results of gastric cancer as the gold standard,the diagnostic value of ME-NBI,acetate-indigo rouge staining combined with multi-slice spiral CT and their combination in early gastric cancer and precancerous lesions was analyzed using a four grid table.Results The image quality of ME-NBI and acetate-indigo rouge staining combined examinations was significantly higher than that of their respective independent examinations(P<0.05).There was significant difference in the degree of differentiation in the clinical features of patients with early gastric cancer and precancerous lesions(P<0.05).The area under the curve(AUC)of ME-NBI for the diagnosis of early gastric cancer and precancerous lesions was 0.853,the accuracy was 85.64%,the sensitivity was 88.37%,and the specificity was 83.62%.The AUC of acetate-indigo rouge staining for the diagnosis of early gastric cancer and precancerous lesions was 0.814,the accuracy was 81.68%,the sensitivity was 83.72%,and the specificity was 80.17%.The AUC of multi-slice spiral CT for the diagnosis of early gastric cancer and precancerous lesions was 0.804,with an accuracy of 80.69%,a sensitivity of 82.56%,and a specificity of 79.31%.And the AUC of the three methods combined to diagnose early gastric cancer and precancerous lesions was 0.893,with an accuracy of 89.60%,a sensitivity of 93.02%,and a specificity of 87.07%.Conclusion ME-NBI,acetate-indigo rouge staining combined with multi-slice spiral CT has high diagnostic efficacy in early gastric cancer and precancerous lesions,and can be used in clinical practice.

Background: Brucella infection induces brucellosis, a zoonotic disease. The intracellular circulation process and virulence of Brucella mainly depend on its type IV secretion system (T4SS) expressing secretory effectors. Secreted protein BspJ is a nucleomodulin of Brucella that invades the host cell nucleus. BspJ mediates host energy synthesis and apoptosis through interaction with proteins. However, the mechanism of BspJ as it affects the intracellular survival of Brucella remains to be clarified. Objectives: To verify the functions of nucleomodulin BspJ in Brucella's intracellular infection cycles. Methods: Constructed Brucella abortus BspJ gene deletion strain (B. abortus ΔBspJ) and complement strain (B. abortus pBspJ) and studied their roles in the proliferation of Brucella both in vivo and in vitro. Results: BspJ gene deletion reduced the survival and intracellular proliferation of Brucellaat the replicating Brucella-containing vacuoles (rBCV) stage. Compared with the parent strain, the colonization ability of the bacteria in mice was significantly reduced, causing less inflammatory infiltration and pathological damage. We also found that the knockout of BspJ altered the secretion of cytokines (interleukin [IL]-6, IL-1β, IL-10, tumor necrosis factor-α, interferon-γ) in host cells and in mice to affect the intracellular survival of Brucella. Conclusions BspJ is extremely important for the circulatory proliferation of Brucella in the host, and it may be involved in a previously unknown mechanism of Brucella's intracellular survival.

Objective:To evaluate the effects of weight-bearing area compression injury of the femoral head on the prognosis of elderly acetabular fractures after open reduction and internal fixation.Methods:A retrospective analysis of 36 elderly patients with acetabular fractures treated with open reduction and internal fixation during January 2014 to January 2018 were conducted. All patients with compression injury of the weight-bearing area of the femoral head, including 22 males and 14 females with 73.2±6.5 years old (range 60-87 years old), were included. The compression injury of weight-bearing area of the femoral head was not treated. According to the Letournel-Judet classification of acetabular fractures, there were 14 cases with both-column, 12 cases with anterior column and posterior hemitransverse, 4 cases with T type, 4 cases with transverse, and 2 cases with posterior column+ posterior wall. A total of 14 cases were accompanied by acetabular joint surface compression, while 29 cases were accompanied by joint dislocation. The Merle d'Aubigné score was used to evaluate the hip function during follow-up. The Matta classification method was used to evaluate the results of acetabular fracture reduction. The Kellgren-Lawrence classification standard and Ficat-Alert staging method were used to evaluate the traumatic arthritis of the hip and femoral head necrosis, respectively. During the follow-up, the femoral head necrosis with stage III, IV, or traumatic arthritis III, IV, or with indications for joint replacement was defined as surgery failure. CT scans of the pelvis were performed before and at 2-5 days after operation. The compression size of the femoral head on the coronal and axial planes of the CT scan was calculated for the compression volume. The compression severity was divided into small (<1 cm 3), medium (1-2 cm 3) and large (>2 cm 3) according to the volume. Binary Logistic regression analysis was used to analyze whether the postoperative measurement of the femoral head compression volume was associated with the risk of surgical failure. Results:All patients were followed up for 34.7±8.9 months (range 25-54 months). There were 7 cases with large compression of femoral head, 14 cases with medium, and 15 cases with small pre-operatively. However, there were 12 cases, 10 cases and 14 cases with large, medium and small at 2-5 days after operation, respectively. Six cases were excellent reduction, 22 cases were good, and 8 cases were poor. Thus, the excellent and good rate was 78% (28/36). At the last follow-up, Merle d'Aubigné score was excellent in 2 cases, good in 8 cases, fair in 5 cases, and poor in 21 cases. The excellent and good rate was 28% (10/36). There were 20 cases with surgery failure with 56% (20/36) failure rate. There were no statistically significant differences in the patient's age, body mass index, operation duration, blood volume, fracture type, fracture reduction, combined acetabular joint surface compression, and combined joint dislocation between the two groups. However, there was a statistically significant difference in the frequency distribution of compression volume in the weight-bearing area of the femoral head after surgery (χ 2=22.047, P<0.001). In patients with large, medium, and small-volume compression of the femoral head weight-bearing area, the surgery failure rates were 92%, 80%, and 7%, respectively. The large and medium-volume compression of the femoral head weight-bearing area were independent risk factors for surgical failure. Conclusion:Open reduction and internal fixation can be used to treat elderly patients with acetabular fractures combined with femoral head compression injury. Despite satisfactory reduction for acetabular fractures, the larger volume of femoral head compression affects the clinical outcomes with extremely high rate of surgical failure within 2 years.

Results: All patients were followed up 4-13 months, with an average of 5.7 months. During the treatment, there was no complication such as loosening or breaking of the external fixator, fracture displacement, or re-fracture in 2 groups. The using time of external fixator in group A was (24.77±1.42) weeks and the fracture healing time was (23.04±1.30) weeks, which were all significantly reduced when compared with those in group B [(34.38±1.71) weeks and (32.46±1.66) weeks] ( t=16.10, P=0.00; t=15.58, P=0.00). In group A, there were 2 cases of needle tract infection and 1 case of muscle weakness, the incidence of complication was 23.1%; in group B, there were 3 cases of needle tract infection, 1 case of muscle weakness, and 1 case of delayed union of fracture, the incidence of complication was 38.5%; there was no significant difference in the incidence of complication between 2 groups ( P=1.000).

Objective To evaluate the safety and efficacy of precise hepatectomy in treatment of hepatolithiasis. Methods Clinical data of 93 patients with hepatolithiasis who underwent hepatectomy in Anhui Provincial Hospital between January 2013 and January 2017 were analyzed retrospectively. The patients were divided into precise hepatectomy group (precise group, n=59) and conventional resection group (conventional group, n=34) according to different surgical procedures. There were 28 males and 31 females in precise group, with an average age of (56±5) years old. There were 18 males and 16 females in conventional group, with an average age of (56±4) years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The operation time, intraoperative blood loss, postoperative length of stay, postoperative ALT, AST level between two groups were compared by t test or Kruskal-Wallis rank sum test. The incidence of postoperative complication was compared by Chi-square test. Results The operation time was (210±61) min in precise group, significantly longer than (157±60) min in conventional group (t=1.586, P<0.05). The intraoperative blood loss was (386±99) ml in precise group, significantly less than (518±153) ml in conventional group (t=-1.421, P<0.05). The median postoperative length of stay was 8(6-10) d in precise group, significantly shorter than 10(8-15) d in conventional group (Z=-2.018, P<0.05).The ALT and AST level at postoperative 1 d was respectively (214±87) and (368±106) U/L in precise group, significantly lower than (594±133) and (625±165) U/L in conventional group, (t=-3.395, -2.047; P<0.05). The incidence of postoperative complication was 8.5% (5/59) in precise group, significantly lower than 23.5%(8/34) in conventional group (χ2=4.066, P<0.05). Conclusions Compared with conventional hepatectomy, precise hepatectomy possesses advantages of smaller surgical trauma, less intraoperative blood loss and lower incidence of postoperative complication. It has better clinical application value.

Objective To evaluate the application of three-dimensional visualization technique in precise hepatectomy for patients with massive hepatocellular carcinoma (HCC). Methods 64 patients with massive HCC who underwent hepatectomy in Anhui Provincial Hospital Affiliated to Anhui Medical University between January 2014 and January 2016 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the will of patients and their families, these patients were divided into precise group and conventional group. There were 34 cases in precise group, including 28 males and 6 females, with an average age of (54±6) years old. There were 30 cases in conventional group, including 26 males and 4 females, with an average age of(56±7) years old. In precise group, liver volume, tumor location and size and relation with the adjacent vessels were assessed precisely, and surgical protocol was planned and simulated using CT three-dimensional visualization technique before operation. Precise hepatectomy was performed using cavitron ultrasound surgical aspirator (CUSA) or ultrasonic scalpel with the guidance of color Doppler ultrasound. Patients were treated according to the concept of enhanced recovery after surgery after operation. Patients in conventional group received routine CT or MRI before operation, liver resection with clamping method was performed and the porta hepatis was occluded using Pringle maneuver during the operation. Patients received routine nursing and rehabilitation treatments after operation. Intraoperative situation and postoperative liver function of patients between both groups were compared by t test, and the rates were compared by Chi-square test. Results The median length of operation was 229(57-352) min in precise group, significantly more than 138(61-282) min in conventional group (Z=1.752, P<0.05). The postoperative 1 d ALT and AST was respectively 425(24-1 299) and 390(15-1 484) U/L in precise group, significantly lower than 574(42-3 533) and 670(76-3 795) U/L in conventional group (Z=-2.099, -2.677; P<0.05). The postoperative length of hospital stay was 6.2(3.0-19.0) d in precise group, significantly less than 9.5(5.0-30.0) d in conventional group (Z=-2.387, P<0.05). Postoperative complications occurred in 3 patients in precise group and 9 patients in conventional group, where significant difference was observed (χ2=4.691, P<0.05). No death case was observed in precise group, while 1 case died of postoperative liver failure in conventional group. Conclusions Compared with conventional liver resection, three-dimensional visualization technique can be used in precise hepatectomy for patients with massive HCC. It has the advantages of less trauma, higher safety and faster postoperative recovery.

ObjectiveTo explore the application value of individualized surgical treatment based on the CT portal venograpy (CTPV) classiifcation in cirrhotic portal hypertension.MethodsOne hundred and iffty-six patients with cirrhotic portal hypertension who received surgical treatment in Anhui Province Hospital between June 2010 and December 2014 were enrolled in this prospective study. According to different surgical procedures, the patients were divided into two groups: the individualized surgery based on CTPV classiifcation group (classification group) and traditional surgery group (traditional group). Among the 84 patients in the classiifcation group, 56 were males and 28 were females with the age ranging from 19 to 67 years old and the median of 45 years old. Among the 72 patients in the traditional group, 47 were males and 25 were females with the age ranging from 23 to 62 years old and the median of 43 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients in the classiifcation group underwent individualized surgery according to the pre-operative CTPV classiifcation, while the patients in the traditional group underwent splenectomy + pericardial devascularization. The effects of two surgical procedures on the portal hypertension, intraoperative and postoperative conditions and postoperative survival rate of the patients were observed. The observation indexes of two groups were compared usingt test and survival analysis was conducted using Kaplan-Meier method and Log-rank test.ResultsThe postoperative free portal pressure (FPP) in the classiifcation group was (27±3) cmH2O (1 cmH2O=0.098 kPa), signiifcantly lower than (33±8) cmH2O in the traditional group (t=-3.355,P<0.05). The FPP decrease range before and after surgery in the classiifcation group was (13±6) cmH2O, signiifcantly higher than (9±5) cmH2O in the traditional group (t=3.016,P<0.05). The length of surgery and intraoperative blood loss in the classiifcation group were respectively (188±84) min and (378±49) ml, significantly less than (240±76) min and (463±57) ml in the traditional group (t=-2.687,-3.015;P<0.05). The postoperative length of stay and hospitalization expense in the classiifcation group were respectively (12±4) d and (31 000 ± 15 000) yuan, signiifcantly lower than (15±5) d and (36 000±15 000) yuan in the traditional group (t=-2.061,-2.104;P<0.05). The 1, 3-year accumulative survival rate were respectively 94.05% and 85.71% in the classiifcation group, and were respectively 87.50% and 68.05% in the traditional group. The overall survival rate in the classiifcation group was signiifcantly higher than that in the traditional group (χ2=7.000,P<0.05).ConclusionsPre-operative CTPV classification and individualized surgical treatment for patients with cirrhotic portal hypertension can effectively reduce the portal vein pressure and has the advantages of smaller injury and better prognosis.

Objective To investigate the occurrence of postoperative pain of hepatectomy and its possible related factors.Methods The clinical data of 555 cases undergoing hepatectomy was analyzed retrospectively,and the related influencing factors on postoperative pain of hepatectomy were analyzed by univariate analysis and multivariate logistic regression.Results Moderate postoperative pain was reported in 255 cases among 555 patients who underwent hepatic resection (with an incidence of 45.95％).Incision pain which was often sharp was most common,followed by postoperative complication caused pain.According to whether the postoperative pain occurred or not,all cases were divided into postoperative pain group (n =255) and non-postoperative pain group (n =300),univariate analysis showed that age (P ＜0.01),surgical history (P ＜ 0.01),surgical approach (P ＜ 0.01),incision length (P ＜ 0.01),xiphoid removal(P ＜ 0.01),the final outcome of incision (P ＜ 0.01),complications (P ＜ 0.01) were significantly different between the two groups.Logistic multiple regression analysis showed that the independent influencing factors of postoperative pain included surgical history (P =0.001),surgical approach (P =0.005),incision length (P =0.000),xiphoid process removal (P =0.001),complications (P =0.000).Conclusions The postoperative pain of hepatectomy has a high incidence.Surgical history,surgical approach,incision length,xiphoid process,removal and postoperative complications are the independent impact factors of postoperative pain.

Objective To determine efficacy of selective devascularization in management of portal hypertension. Methods The clini-cal data of 86 patients of portal hypertension in our hospital from Jan. 2010 to Aug. 2013 were retrospectively analyzed. The patients were divided into the selective group and the nonselectove devascularization group according to the different devascularization ways. The postopera-tive liver function index and complications were analyzed. Results In selective devascularization group, the surgery time was prolonged (P<0. 05), the postoperative FPP was reduced (P<0. 05), and there was no difference in bleeding volume and blood transfusion cases (P>0. 05). The postoperative peak value of ALT and AST and postoperative pomplications in the selective devascularization group were low-er than those in the nonselectove devascularization group (P<0. 05). And patients in the selective devascularization group have a shorter hospital stay compared to the nonselectove devascularization group (P<0. 05). Conclusion Selective devascularization can lower free portal pressure more effectively, reduce incidence rates of postoperative early complications, and it is worthy of clinical promotion.

Ischemia reperfusion injury is an important factor which has been affected the recuperation of hepatic function after hepatectomy and liver transplantation,and is a complex course in pathophysiology with many factors.With the development of research on ischemia reperfusion injury,effective prevention measures of ischemia reperfusion injury also have made new progress.And this will greatly improve the prognosis of hepatic surgery.The mechanism and its prevention measure of hepatic ischemia reperfusion injury were reviewed in this paper.