Objective:To explore the expressions of long non-coding RNA LINC00673 and ISG15 protein in pancreatic cancer and their clinical significances.Methods:The clinical data of 57 patients diagnosed as pancreatic ductal carcinoma (PDAC) at the Affiliated Cancer Hospital of Xiangya Medical College of Central South University from January 2014 to December 2018 were retrospectively analyzed. The relative expressions of LINC00673 in pancreatic cancer tissues and paracancerous normal tissues (within 3 cm from the edge of cancer tissues) were examined by using quantificational reverse transcription-polymerase chain reaction (qRT-PCR). The ISG15 protein expressions in pancreatic cancer tissues and paracancerous normal tissues were examined by using immunohistochemistry. The difference in LINC00673 expression between ISG15 protein positive and negative patients was compared. The correlation between LINC00673 and ISG15 protein expressions in pancreatic cancer was analyzed by Spearman rank correlation analysis. Moreover, the correlations of LINC00673 and ISG15 protein expressions with clinical stage and pathological classification of pancreatic cancer patients were analyzed.Results:The positive expression of ISG15 protein in pancreatic cancer tissues was 40.4% (23/57), which was higher than that in paracancerous normal tissues [15.8% (9/57)] ( χ2 = 7.90, P = 0.004), and the relative expression of LINC00673 in pancreatic cancer tissues was 0.99±0.36, which was lower than that in paracancerous normal tissues (1.26±0.41) ( t = 4.80, P < 0.001). For 23 (40.4%) ISG15-positive patients and 34 (59.7%) ISG15-negative patients, the relative expression of LINC00673 was 0.77±0.46 and 0.45±0.27 ( P < 0.001). Spearman analysis showed that there was a correlation between LINC00673 and ISG15 protein expressions ( ρ = -0.429, P = 0.001). The relative expression of LINC00673 decreased in patients with low differentiated or undifferentiated tumor, vascular invasion and lymph node metastasis (all P < 0.05), but there was no correlation between LINC00673 expression and patients' age, tumor site, preoperative CA199 level, and TNM stage (all P > 0.05); ISG15 protein expression increased in patients with low differentiated or undifferentiated tumor, TNM stage Ⅲ-Ⅳ, vascular invasion and lymph node metastasis (all P < 0.05), but there was no correlation between ISG15 protein expression and patients' gender, age, tumor site, and preoperative CA199 level (all P > 0.05). Conclusions:The expression of LINC00673 in pancreatic cancer is related to vascular invasion, tumor differentiation degree and lymph node metastasis, and the expression of ISG15 in pancreatic cancer is related to vascular invasion, tumor differentiation degree, lymph node metastasis and TNM stage. The combined detection of LINC00673 and ISG15 protein could be a valuable prognostic indicator for pancreatic cancer. The therapies targeting LINC00673 and ISG15 protein signaling pathways are expected to be a potential option for immunotherapy of pancreatic cancer.

Objective:To evaluate the efficacy and safety of modified mushroom-shaped occluder in the treatment of refractory thoracogastric-airway fistulas.Methods:From March 1, 2022 to June 30, 2023, 12 patients with refractory thoracogastric-airway fistulas underwent the placement of modified mushroom-shaped occluder at the Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University were enrolled. The baseline clinical data of patients such as gender, age, course of disease, and fistula diameter were recorded. The data of operation and follow-up, such as operation time and method, intraoperative and postoperative complications were also collected. The occlusion efficacy at 1 month and 6 months after surgery, as well as the improvement of body mass index (BMI) and scores of the short form 36 (SF-36) were analyzed. Paired t test and non-parametric test were used for statistical analysis. Results:There were 10 males and 2 females among the 12 patients. The median age was 66.5 years old (ranged from 53.0 to 69.0 years old), the median course of disease was 7.5 months (ranged from 3.0 to 39.0 months), and the diameter of fistula was (9.3±3.4) mm. The occluder placements were successful in all the 12 patients, with 6 cases intracavitary release and 6 extracavitary release. The operation time was (30.9±9.9) min and the time of occluder placement was (3.5±1.3) min. One patient had minor (<2 mL) bleeding during the operation and 2 patients reported mild foreign body sensation but tolerable after operation. All patients resumed oral feeding and nasojejunal tubes were removed before discharge. The follow-up time of 12 patients was (11.3±1.7) months. The initial effective occlusion rate was 11/12, and the complete occlusion rate was 9/12. Two patients died but neither were related to the procedure or instruments. The BMI of 12 patients at 1 month after surgery was (18.5±1.9) kg/m 2, which was higher than that before operation ((17.6±2.3) kg/m 2), the BMI at 6 months after operation was (20.3±2.5) kg/m 2, which was higher than that at 1 month after operation, and the differences were statistically significant ( t=-4.15 and -4.45, P=0.002 and 0.001). The scores of 8 domains of SF-36 including physical functioning, general health, vitality, mental health, role-physical, bodily pain, social functioning and role-emotional of 12 patients before operation, at 1 month after operation and 6 months after operation were 49.6±13.6, 63.3±13.5 and 75.4±8.6, 17.1±11.2, 33.2±14.5 and 56.0±12.2, 30.0±12.6, 45.0±13.5 and 67.5±8.7, 41.3±18.7, 52.0±15.4 and 68.0±8.2, 0.0 (0.0 to 75.0), 25.0 (0.0 to 100.0) and 50.0 (25.0 to 100.0), 87.8 (44.0 to 100.0), 90.8 (57.0 to 100.0) and 100.0 (94.0 to 100.0), 12.5 (0.0 to 50.0), 50.0 (37.5 to 75.0) and 81.3 (50.0 to 87.5), 0.0 (0.0 to 100.0), 66.7 (33.3 to 100.0) and 100.0 (33.3 to 100.0), respectively. The scores of 8 domains at 1 month after operation were all higher than those before operation, and the differences were statistically significant ( t=-5.25, -5.32, -4.87 and -2.51, Z=-2.97, -2.20, -3.11 and -3.00; all P<0.05). The scores of 8 domains at 6 months after operation were all higher than those at 1 month after operation, and the differences were statistically significant ( t=-4.34, -7.48, -7.10 and -4.64, Z=-2.49, -2.20, -2.97 and -2.07; all P<0.05). Conclusion:The clinical application of the improved mushroom-shaped occluder in the treatment of refractory thoracogastric-airway fistulas is effective and relatively safe.

Objective:To evaluate the safety and efficacy of endoscopic injection of autologous platelet rich plasma(PRP)in the treatment of refractory upper gastrointestinal fistula(RUGF).Methods:From June 1, 2022 to March 1, 2023, at the Department of Gastroenterology of the First Affiliated Hospital of Nanjing Medical University, 8 RUGF patients who received PRP treatment were enrolled. The baseline data such as gender, age, course of disease, and body mass index, etc. as well as the PRP treatment-related data such as the time of first treatment, length of hospital stay after the first treatment, and adverse events were recorded. The postoperative follow-up lasted till 6 months after the first treatment to assess fistula healing, and to record body mass index and health survey short form. Paired t-test and non-parametric test were used for statistical analysis. Results:Among the 8 RUGF patients, there were 7 males and 1 female. The median age was 58.5 years old (ranged from 27.0 to 75.0 years old), and the median duration of the disease was 14 months (ranged from 4 to 120 months). The maximum diameter of the fistula was(4.50±2.62) mm, the concentration multiple of PRP was (4.02±0.48) times. The operation time of the first endoscopic PRP treatment was (21.88±4.52) min; the median length of the first postoperative hospital stay was 2 days (ranged from 1 to 2 days), and the median total number of treatment was 4 (ranged from 1 to 5). The healing time was (2.57±1.72) months, 7 RUGF patients healed within 6 months after the first treatment, and the fistula was narrowed in 1 patient. There were no adverse events during or after the operation. After 6 months of treatment, the body mass index and the scores of 8 dimensions of the health survey short form which included physical functioning, physical role functioning, body pain, general health, vitality, social functioning, emotional role functioning and mental health were all higher than those before treatment ((20.91±2.15) kg/m 2 vs. (18.67±3.21) kg/m 2, 86.88±13.35 vs. 58.13±20.34, 100 (0 to 100) vs. 0(0 to 100), 83.06±11.74 vs. 56.94±28.86, 67.88±26.77 vs. 31.88±13.08, 81.88±13.87 vs. 46.25±24.02, 76.56±22.60 vs. 37.50±26.73, 100 (0 to 100) vs. 0 (0 to 100), 78.00±17.37 vs. 51.50±22.77), and the differences were statistically significant ( t=-3.40 and -3.87, Z=2.06, t=-3.03, -4.26, -4.73 and -6.06, Z=-2.06, t=-4.32; P=0.012, 0.006, 0.039, 0.019, 0.004, 0.002, 0.001, 0.039 and 0.003). Conclusion:Endoscopic injection of autologous PRP for the treatment of RUGF is safe and effective, and has a significant promotion effect on the healing of small (maximum diameter ≤ 6 mm) fistula.

Objective:To evaluate the feasibility, safety and efficacy of robotic-assisted lateral lymph node dissection for mid-low advanced rectal cancer.Methods:A retrospective cohort study was performed. Inclusion criteria: (1) age between 18 and 80 years old; (2) rectal adenocarcinoma diagnosed by pathology; (3) without distant metastasis by preoperative CT or MRI; (4) patients underwent robotic-assisted total mesorectal resection (TME). Exclusion criteria: (1) conversion to open surgery; (2) multiple primary tumors; (3) patients underwent combined multiple organ resection. According to the above criteria, 137 patients undergoing robotic-assisted mid-low rectal cancer resection in the First Affiliated Hospital of Xi′an Jiaotong University from December 2016 to April 2019 were enrolled. Ninety-seven cases underwent robotic-assisted total mesorectal excision (TME group) and 40 underwent robotic-assisted total mesorectal resection with lateral lymph node dissection (LLND) (TME+LLND group, pelvic LLND was performed with neurovascular guidance to retain pelvic autonomic nerves in the order of the left side the first and then the right side). The propensity score matching of 1:1 was performed with R software, based on age, sex, BMI, ASA classification, distance from tumor to the anal verge, preoperative chemoradiotherapy history, preoperative abdominal surgery history, the size of tumors and TNM stage. The operative indicators, postoperative recovery, pathology and postoperative complications within 30 days were compared between the two groups.Results:A total of 72 cases were successfully matched (36 in each group), and there were no statistically significant differences in baseline data between the two groups (all P>0.05). The operation time of TME+LLND group was significantly longer than that of TME group [275.0 (180-405) minutes vs. 220.0 (140-320) minutes, Z=-3.680, P<0.001], while there were no statistically significant differences in blood loss during operation, time to postoperative first flatus, postoperative hospital stay, total hospital cost, tumor differentiation, and distal resection length of margin (all P>0.05). Circumferential resection margin was all negative in both groups. The number of harvested lymph modes in the TME+LLND groups was higher than that in the TME group [26 (18-37) vs. 14 (9-36), Z=-6.407, P<0.001]. In addition, there were no statistically significant differences in postoperative morbidity and Clavien-Dindo classification of complication within 30 days between the two groups (both P>0.05). Conclusions:Although robotic lateral lymph node dissection requires longer operation time, it is a feasible, safe and effective procedure.

Objective:To evaluate the feasibility, safety and efficacy of robotic-assisted lateral lymph node dissection for mid-low advanced rectal cancer.Methods:A retrospective cohort study was performed. Inclusion criteria: (1) age between 18 and 80 years old; (2) rectal adenocarcinoma diagnosed by pathology; (3) without distant metastasis by preoperative CT or MRI; (4) patients underwent robotic-assisted total mesorectal resection (TME). Exclusion criteria: (1) conversion to open surgery; (2) multiple primary tumors; (3) patients underwent combined multiple organ resection. According to the above criteria, 137 patients undergoing robotic-assisted mid-low rectal cancer resection in the First Affiliated Hospital of Xi′an Jiaotong University from December 2016 to April 2019 were enrolled. Ninety-seven cases underwent robotic-assisted total mesorectal excision (TME group) and 40 underwent robotic-assisted total mesorectal resection with lateral lymph node dissection (LLND) (TME+LLND group, pelvic LLND was performed with neurovascular guidance to retain pelvic autonomic nerves in the order of the left side the first and then the right side). The propensity score matching of 1:1 was performed with R software, based on age, sex, BMI, ASA classification, distance from tumor to the anal verge, preoperative chemoradiotherapy history, preoperative abdominal surgery history, the size of tumors and TNM stage. The operative indicators, postoperative recovery, pathology and postoperative complications within 30 days were compared between the two groups.Results:A total of 72 cases were successfully matched (36 in each group), and there were no statistically significant differences in baseline data between the two groups (all P>0.05). The operation time of TME+LLND group was significantly longer than that of TME group [275.0 (180-405) minutes vs. 220.0 (140-320) minutes, Z=-3.680, P<0.001], while there were no statistically significant differences in blood loss during operation, time to postoperative first flatus, postoperative hospital stay, total hospital cost, tumor differentiation, and distal resection length of margin (all P>0.05). Circumferential resection margin was all negative in both groups. The number of harvested lymph modes in the TME+LLND groups was higher than that in the TME group [26 (18-37) vs. 14 (9-36), Z=-6.407, P<0.001]. In addition, there were no statistically significant differences in postoperative morbidity and Clavien-Dindo classification of complication within 30 days between the two groups (both P>0.05). Conclusions:Although robotic lateral lymph node dissection requires longer operation time, it is a feasible, safe and effective procedure.

Objective To investigate the function of JAK2-STAT3 signaling pathway in pancreatic injury and systematic inflammatory response in rats with acute necrotizing pancreatitis ( ANP) . Methods SD rats were randomly divided into the ANP group (n=48), ANP+JAK2 inhibitor Ruxolitinib group (ANP+R group, n=48), ANP+STAT3 inhibitot Stattic group (ANP+S group, n=48), ANP+Ruxolitinib+Stattic group (ANP+R+S group, n=48), and sham operation group (SO group, n=48). 5％ sodium taurocholate injection via retrograde pancreatobiliary duct was used to establish ANP model. Blood samples from abdominal aorta and pancreatic tissue were collected after 3 h, 6 h, 12 h and 18 h after modeling. Serum amylase (AMY) and tumor necrosis factor-α(TNF-α) and interleukin-4 (IL-4) were tested. JAK2 and STAT3 mRNA expression and protein expression of p-JAK2 and p-STAT3 in pancreas were examined by RT qPCR and western blot, respectively. Results AMY, TNF-α and IL-4 in plasma, and JAK2 mRNA, STAT3 mRNA, p-JAK2 protein and p-STAT3 protein at different time points in ANP group were all obviously higher than those in SO group(P<0. 05). Serum AMY, TNF-αand IL-4 in ANP+R group, ANP+S group and ANP+R+S group at different time points were lower than those in ANP group [12 h (5391 ± 1009),(6130 ± 1227),(4818 ± 992)U/L vs (8524 ± 1360) U/L;(147.25 ± 27.85),(156.25 ± 23.17),(127.87 ± 21.39) ng/L vs (187.58 ±20.09)ng/L;(45.89 ±16.95),(50.19 ±15.87),(38.87 ±14.03)ng/L vs (58.85 ±9.34)ng/L] . JAK2 mRNA and p-JAK2 protein,STAT3 mRNA and p-STAT3 protein in ANP+R group and ANP+R+S group at different time points were obviously lower than those in ANP group (12 h 0. 357 ± 0. 091 vs 0. 597 ± 0. 121,1. 115 ± 0. 203 vs 1. 217 ± 0. 213,0. 361 ± 0. 089 vs 0. 489 ± 0. 097,0. 965 ± 0. 189 vs 1. 128 ± 0. 217, 0. 362 ± 0. 092 vs 0. 597 ± 0. 121,1. 107 ± 0. 212 vs 1. 217 ± 0. 213,0. 297 ± 0. 087 vs 0. 489 ± 0. 097,0. 713 ± 0. 184 vs 1. 128 ± 0. 217). STAT3 mRNA and p-STAT3 protein in ANP+S group were obviously lower than those in ANP group(0. 319 ± 0. 107 vs 0. 489 ± 0. 097,0. 849 ± 0. 177 vs 1. 128 ± 0. 217), and the difference was statistically different (P<0.05). Conclusions The activation of JAK2-STAT3 signaling pathway in pancreas may play a key role in the pathogenesis of systematic inflammatory response in ANP.

Heterotopic ossification is a rare complication of burns, and its incidence and risk factors are still unclear. Through summarizing the literature on heterotopic ossification caused by burns at home and abroad, the author searched for the risk factors of heterotopic ossification after burn and the new progress of its prevention and treatment. It was realized that the size, depth and healing time of burn wounds were related to heterotopic ossification; the nonsteroidal anti-inflammatory drugs, radiation therapy, and their combination therapy can be used for the prevention of heterotopic ossification; surgery is an effective means of treating heterotopic ossification.

Objective To compare the curative effect of fixation of adolescent tibial intercondylar emi-nence fracture among suture anchor,hollow screw and wire. Methods Forty-six adolescent cases of the tibial intercondylar eminence fracture treated with surgical treatment were selected from January 2010 to June 2016 and divided into three groups refer to intra-operative fixation suture anchor group(Group A),hollow screw group (Group B)and wire group(Group C).Duration of treatment,total operation time,hospital stay and surgery times were recorded. All patient condition was assessed with the Lysholm,Tegner,IKDC and VAS score. Results All patients received an average of 13(11~14)months follow-up visit. No blood-vessel,nerve and osteoepiphysis injured,infection and fracture displacement occurred.Before receiving treatment,difference in Lysholm,Tegner, IKDC and VAS score of group A,B and C showed no statistical difference.When it comes to hospitalization condi-tion,data were as follows.Group A/B/C:operation time(80.67 ± 16.68/114.00 ± 20.28/111.88 ± 20.07)min, hospital stay(8.40 ± 1.12/ 15.47 ± 1.25/ 15.19 ± 1.17)d,surgery times(1/2/2)times. Moreover,compared with those before operation and after operation in both of groups,the Lysholm,Tegner,IKDC and VAS score were improved(P < 0.05). Besides,the Lysholm,Tegner,IKDC and VAS score of group A,B and C did not have statistically significant difference yet after post treatment(P>0.05).Conclusions The curative effect of fixation of adolescent tibial intercondylar eminence fracture among suture anchor,hollow screw and wire was similar. By contrast,the fixation of fracture by use of suture anchor can decrease operation time and hospital stay to some extent. It had advantage of need not to have a second operation to remove the internal fixation and can be used in preference.

Objective To compare and analyze the curative effects of mediopatellar plica syndrome under different therapies. Methods 147 patients with mediopatellar plica syndrome were enrolled in the study from January 2011 to January 2015 and divided into three groups refer to treatment: Group A, B and C. Each group was also divided in the youth group and the mid-age group. Different treatments were used in the three groups. Group A: drug therapy and physicotherapeutics; Group B: intraarticular injection regularly; Group C: arthroscopic surgical treatment. All patient conditions were assessed with Lysholm score. Results All patients received an average of 11 (9 ~ 13) months follow-up. No blood-vessel and nerve injured and infection occurred. Before receiving treatment, difference in Lysholm score of the three groups showed no statistical difference (F = 0.08, P = 0.926); after treatment, difference revealed significant difference (F = 15.48, P = 0.001). Compared with those before operation and after operation among the three groups, the Lysholm score was improved (tA = 3.43, tB = 6.74, tC = 7.99, P = 0.001). In the rangeability of Lysholm score, the Group C > B > A (F = 66.43, tAB = 5.97, tAC = 11.52, tBC = 5.55, P = 0.001);The general youth group > the general mid-age (t = 7.91, P = 0.001). Conclusion The best therapeutic method for mediopatellar plica syndrome is the arthroscopy. As for mid-age patients, it is necessary to inform them of possibility that prognosis is not well in preoperative planning.

Objective To investigate gender differences in the curative effects of allograft and autologous hamstring tendon in anterior cruciate ligament reconstruction. Methods One hundred and forty-eight patients with the anterior cruciate ligament injury received surgical treatment were enrolled from January 2011 to January 2015 and divided into two groups,including group M(Men)and group W(Women). Patients in each group were also divided in the allograft group (Group A) and the autologous hamstring tendon group (Group B). The patient condition was separately assessed with the Lysholm,Tegner,VAS score and the value of KT-1000 before and after surgery. Results All patients received an average of 16(13-18)-month follow-up visit. No severe complication , such as blood-vessel and nerve injury ,infection and rupture of graft ,occurred in patients after operations. Compared with those before operation,the Lysholm,Tegner,VAS score and the value of KT-1000 after operation in four groups were significantly improved (P < 0.05,respectively). However,no significant differences were found in the Lysholm,Tegner,VAS score and the value of KT-1000 improvement among group MA,MB,WA and WB post treatment(P>0.05). Conclusions The curative effect of ACL reconstruction between allograft ligament and autologous hamstring tendon has no significant difference in gender. The selection of graft should be considered in more aspects.