Objective:To explore the influencing factors of early postoperative complications after radical resection of congenital choledochal cyst (CCC) in a single center and provide some clinical basis and guidance for reducing postoperative complications.Methods:Case control study.Clinical data of 124 children (29 boys and 95 girls) with CCC diagnosed and radically treated at the Affiliated Hospital of Zunyi Medical University from September 2010 to October 2019 were analyzed.According to postoperative complications (bile leakage, gastrointestinal anastomotic fistula, bleeding, incision dehiscence, cholangitis, abdominal infection, pancreatitis, and lymphatic fistula), these children were divided into the complication group (group A) and non-complication group (group B). Age, laboratory indicators[preoperative white blood cell (WBC) count, hemoglobin, glutamic pyruvic transaminase, prealbumin, and postoperative albumin], and clinical factors, such as operation method, operation time, intraoperative blood loss, cyst type, cyst diameter, hepatic duct diameter, abdominal operation history, biliary sludge and calculus, hepatic duct anatomic variation, and pancreaticobiliary maljunction were statistically analyzed between the two groups.The t-test was performed for normal distribution of the measurement data, and the non-parametric rank sum test for non-normal distribution.Multivariate analysis was made using Logistic regression. Results:Among the 124 children, 25(20.16%) had complications, and 99(79.84%) had no complications.Bile leakage occurred in 14 children (11.29%), of whom 7 received operation again and 7 received conservative treatment.Gastrointestinal anastomotic fistula occurred in 2 children (1.61%), of whom 1 was re-operated and 1 was cured conservatively.One child (0.81%) was complicated with bleeding and cured by re-operation.Two children (1.61%) were complicated with incision dehiscence, of whom 1 was cured by re-operation and 1 was cured by conservative treatment.Cholangitis in 2 children (1.61%), abdominal infection in 2 children (1.61%), pancreatitis in 1 child (0.81%), and lymphatic fistula in 1 child (0.81%) were all conservatively cured.No significant difference was found in non-normal distribution indicators-age and WBC count-between the two groups (all P>0.05). Blood loss volume and cyst diameter were significantly different between the two groups (all P<0.05). Postoperative albumin[(27.84±4.62) g/L vs.(32.45±3.72) g/L] meeting the normal distribution showed a statistically significant difference between the two groups ( t=5.254, P<0.05). Logistic multivariate regression analysis suggested that preoperative anemia ( OR=7.922, 95% CI: 1.468-42.757) and biliary sludge and calculus ( OR=1.295, 95% CI: 1.075-4.359) were independent risk factors for postoperative complications; postoperative albumin ( OR=0.055, 95% CI: 0.012-0.244) was a protective factor for postoperative complications, and the differences were statistically significant (all P<0.05). Conclusions:The larger the cyst diameter, the more the intraoperative bleeding, and the higher the risk of operation.Treating anemia before operation, clearing sludge in the hepatic duct during operation, reducing bleeding, and strengthening the monitoring of albumin and hemoglobin during the perioperative period can prevent and reduce early complications after radical resection of CCC in children.

Objective:To explore the influence of family function and personal characteristics on death anxiety in patients with advanced cancer, providing reference for finding methods and approaches to alleviate death anxiety in advanced cancer patients.Methods:From March to June 2023, convenience sampling was used to select 182 advanced cancer patients admitted to the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University. The Chinese Version of Death and Dying Distress Scale and Family APGAR Index were used to investigate patients' death anxiety and family function. The Numerical Rating Scale and Kamofsky Performance Status were used to assess patients' pain and performance status. Single factor analysis and multiple linear regression were used to analyze the influencing factors of death anxiety in advanced cancer patients.Results:A total of 182 questionnaires were distributed, and 165 valid questionnaires were collected, with a valid response rate of 90.7%. The death anxiety score of advanced cancer patients was (22.52±15.27), and 10.3% (17/165) of patients had moderate or above death anxiety. The patients' total family function score was (8.62±1.97), and 86.7%(143/165) patients self-reported good family function. The death anxiety score was negatively correlated with the family function score ( P<0.05). Multiple linear regression analysis showed that Kamofsky Performance Status score, pre-illness employment, family function, place of residence, and pain score were the influencing factors of death anxiety in advanced cancer patients, and the differences were statistically significant ( R2=0.196, P<0.01) . Conclusions:The advanced cancer patients have low levels of death anxiety in our study. Advanced cancer patients with moderate family dysfunction, living in rural areas, working before illness, and high pain scores have high levels of death anxiety, while patients with good performance status have low levels of death anxiety. It is recommended that clinical workers strengthen the assessment of death anxiety and family function in patients with advanced cancer, take timely and effective measures based on influencing factors, and help alleviate death anxiety in patients with advanced cancer.

In the post-genomic era,with the advancement of molecular pathological detection techniques,the mode of tumor prevention,diagnosis and treatment has changed dramatically.Molecular pathological detection techniques has been more and more used in the whole course management of solid tumors,and has become critical for promoting the overall survival of patients with solid tumors.In recently years,molecular pathological testing represented by next generation sequencing(NGS)has played key roles in identification of genetic susceptibility genes,early detection of solid tumors and development of personalized therapeutic strategies for malignant solid tumors.This review briefly introduces the real world application of different molecular pathological testing platforms in different stages of tumor prevention and management as well as the potential problems.

OBJECTIVE: To explore the clinical characteristics and genetic etiology of three children with Menkes disease. METHODS: Three children who had presented at the Children's Medical Center, the Affiliated Hospital of Guangdong Medical University from January 2020 to July 2022 were selected as the study subjects. Clinical data of the children were reviewed. Genomic DNA was extracted from peripheral blood samples of the children, their parents and sister of child 1. Whole exome sequencing (WES) was carried out. Candidate variants were verified by Sanger sequencing, copy number variation sequencing (CNV-seq), and bioinformatic analysis. RESULTS: Child 1 was a 1-year-and-4-month male, and children 2 and 3 were monozygotic twin males aged 1-year-and-10-month. The clinical manifestations of the three children have included developmental delay and seizures. WES showed that child 1 has harbored a c.3294+1G>A variant of the ATP7A gene. Sanger sequencing confirmed that his parents and sister did not carry the same variant, suggesting that it was de novo. Children 2 and 3 had carried a c.77266650_77267178del copy number variation. CNV-seq results showed that their mother has carried the same variant. By searching the HGMD, OMIM and ClinVar databases, the c.3294+1G>A was known to be pathogenic. No carrier frequency has been recorded in the 1000 Genomes, ESP, ExAC and gnomAD databases. Based on the Standards and Guidelines for the Interpretation of Sequence Variants: A Joint Consensus Recommendation of the American College of Medical Genetics and Genomics (ACMG), the ATP7A gene c.3294+1G>A variant was predicted to be pathogenic. The c.77266650_77267178del variant has involved exons 8 to 9 of the ATP7A gene. ClinGen online system score for it was 1.8, which was also considered to be pathogenic. CONCLUSION The c.3294+1G>A and c.77266650_ 77267178del variants of the ATP7A gene probably underlay the Menkes disease in the three children. Above finding has enriched the mutational spectrum of Menkes disease and provided a basis for clinical diagnosis and genetic counseling.
Humans ; Male ; Computational Biology ; Copper-Transporting ATPases/genetics* ; DNA Copy Number Variations ; Exons ; Menkes Kinky Hair Syndrome/genetics* ; Mutation ; Peptide Fragments ; Seizures ; Infant

To explore the feasibility and efficacy of isolated caudate lobe resection for caudate lobe in huge hepatocellular carcinoma(10 cm or larger in diameter).
 Methods: Clinical data of 27 patients with hepatocellular carcinoma larger than 10 cm who underwent isolated caudate lobe resection from January 2001 to December 2011 were retrospectively analyzed.
 Results: All the patients successfully completed the operation. There was no postoperative death. Median operative time was 288 min, and the estimated intraoperative blood loss was 2 260 mL. Postoperative morbidity rate was 44.4%. The patients were discharged successfully after active treatment. Overall survival rates at 1, 3, and 5 years were 80.2%, 52.1%, and 27.1%, respectively.
 Conclusion: Isolated caudate lobe resection is safe and effective for caudate lobe huge hepatocellular carcinoma.
Carcinoma, Hepatocellular ; mortality ; surgery ; Hepatectomy ; Humans ; Liver Neoplasms ; mortality ; surgery ; Retrospective Studies ; Survival Analysis ; Treatment Outcome

Hirschsprung's disease (HD) is one of the most common gastrointestinal malformations in pediatric surgery.HD may be one complex disease due to interaction of multiple genes with the environment,which is a disease closely related to intestinal neural crest cell migration disorders,but the actual pathogenesis was not yet clear.Even if the surgical resection of intestinal lesions,but the postoperative complications still occur in different degrees.In recent years,with the continuous improvement of surgical methods,the radical resection techniques of HD has made great progress,and the vast majority of children can get better results after operation.However,part of the distal internal sphincter has been retained by all the existing radical resection technology,which may result in postoperative constipation,abdominal distension and enterocolitis,seriously affect the quality of life in children.Most of these complications are related to the residual of rectal muscle sheath,therefore,how to improve the therapeutic effect of HD,more accurate treatment of rectal muscle sheath,is the goal of pediatric surgeons to pursue.

Objective To understand the distribution and antimicrobial resistance of pathogenic bacteria isolated from patients in the department of infectious diseases in Xiangya Hospital.Methods The distribution and antimicrobial susceptibility testing results of pathogenic bacteria isolated from patients in this department in 2011 -2015 were analyzed retrospectively.Results A total of 560 strains were isolated during 5 years,of which gram-posi-tive bacteria and gram-negative bacteria accounted for 44.1 % (n =247)and 55.9%(n =313)respectively.69.8%(81/116)of coagulase-negative staphylococcus and 24.3%(9/37)of Staphylococcus aureus were methicillin-resistant (MRCNS,MRSA)respectively.Enterococcus was highly susceptible to vancomycin,linezolid,and phosphonomy-cin (>81 %).Enterobacteriaceae remained highly susceptible to carbapenems (88.9%-100.0%),and was suscep-tible to amikacin,cefoperazone/sulbactam,and piperacillin/tazobactam (>84%).Acinetobacter baumannii was the major isolated multidrug-resistant organism (MDRO),isolation rate of imipenem-resistant Acinetobacter baumannii increased from 50.0% in 2011 to 77.8% in 2015,its resistance rate to imipenem was 64.9%.Conclusion The majority of clinically isolated pathogenic bacteria from this department is gram-negative bacilli,and detection rate of MDROs showed an upward trend;antimicrobial agents should be chosen according to distribution and antimicrobial resistance of pathogenic bacteria.

Objective Through detecting the expression of chemokine CCL21 and its receptor CCR7 in thyroiditis of NOD mice induced by excessive iodine and thyroglobulin (Tg) immunization,to explore the mechanism of lymphocytic infiltration.Methods Seven to eight weeks old female NOD (non-obese diabetic) mice were used,the mice were divided into four groups by random number table,7 mice for each group.Control group:intoke distilled water;,Tg group:intoke'distilled water,use pig Tg emulsified in Freund's complete adjuvant subcutaneous injection to immunization,0.10 mg Tg for each mouse at 8 weeks old,strengthened immunity at 11 and 15 weeks old (0.05 mg Tg for each mouse,and emulsified by Freund's incomplete adjuvant); iodine excess (HI) group:intoke 0.05％ NaI water; iodine excess combined with Tg (HI + Tg) group:intoke 0.05％ NaI water,Tg immunization method was same to Tg group; all mice were raised in specific pathogen free (SPF) environment.All mice were executed at 16 weeks old,and removed the thyroid tissue.Morphologic change in thyroid was observed by HE staining.Immunofluorescence (IF) staining was used to observe CD3,CD22,CCL21 and CCR7 expression in thyroid.Real-time PCR was used to detect CCL21 mRNA expression in thyroid.Results The morphologic change of thyroid was observed under the light microscope,in HI group,thyroid follicle distended,colloid accumulation,lymphocytes accumulate together and disorganization was seen; Tg group thyroid had scatted lymphocytes; HI + Tg group enhanced inflammation response and disorganization.IF staining showed that lymphocytes infiltrated in thyroid were almost CD3+ T cells,only few scatted CD22+ B cells; CCL21 and CCR7 were negative in control group,CCR7 positive cells were scatted in Tg group but no CCL21 expression,in HI and HI + Tg groups,we could see CCL21 strong positive expression in inflammation area and also had CCR7 positive cells there.CCL21 mRNA relative expression in thyroid:Tg group (3.20 ± 0.18),HI group (1.72 ± 0.31),and HI ± Tg group (9.94 ± 0.32) increased compared to control group (1.00 ± 0.17,all P ＜ 0.01).Conclusion CCL21 and its receptor CCR7 have improved lymphocytic infiltration in autoimmune thyroiditis

Objective To investigate the effects of schistosomiasis on malignant bio-behaviors including histological types,differentiation grade,inasie depth,lymphnode metastasis and prognosis of colorectal carcinoma among elderly people in the district of petrochemical industry,Shanghai.Methods A total of 184 cases (aged 60 years and over) with specimens of colorectal cancer were collected from January 2004 to December 2010.These specimens were divided into colorectal carcinoma with schistosomiasis (CRCS) group (102 cases) and simple colorectal carcinoma (CRC) as control group (82 cases).The prognostic data of 40 elderly cases with colorectal carcinoma from January 2004 to December 2006 were simultaneously selected and analysed Results Totally 55.4％ (102/184) cases exhibited coexistent schistosomiasis with colorectal carcinoma.lesion site(x2=16.53),growth pattern(x2 =10.81 ),differentiation degree(x2 =10.46),infiltration degree(x2 =6.71),lymph node metastasis(x2 =3.90),and TNM staging(x2=5.73) in CRCS group were closely related to schistosomiasis compared with CRC group (P＜0.05).Survival curve analysis showed that there was no significant effect of schistosomiasis on the survival time of elderly patients with colorectal carcinoma (x2 =0.14,P＞0.05).Conclusions The coexistent schistosomiasis may be associated with the malignant bio-behaviors of colorectal carcinoma among the elderly,but have no significant influence on the survival time after operation.

AIM: To investigate the effects of poly (I:C) as virus mimics on iodine excess-induced chronic lymphocytic thyroiditis in NOD mouse. METHODS: Female, 32 NOD mice were randomly divided into 4 groups: (1) control;(2) high iodine;(3) poly (I:C);(4) high iodine+poly (I:C). Nine weeks after administration, mice were sacrificed. The following parameters were determined: body weight, thyroid weight and anatomic form. Thyroid hormone (T_4) in serum was measured by radioimmunoassay, the thyroid morphology was observed through HE staining, apoptosis was detected by TUNEL, the mRNA expression levels of TRAIL, TRAIL-sR1, ICAM-1 and CXCL10 were determined by the method of real time RT-PCR. RESULTS: Compared to control group and poly (I:C) group, the thyroid absolute weight and relative weight in high iodine group were increased (P<0.01), the level of total T_4 in serum was decreased (P<0.05), inflammation and apoptosis were obviously observed, the mRNA expressions of TRAIL, TRAIL-sR1, CXCL10 and ICAM-1 were upregulated (P<0.05). Compared to high iodine group, thyroid absolute weight and relative weight in high iodine+poly (I:C) group were further increased, the level of total T_4 in serum was further decreased (P<0.05), the ratio of inflammatory degree Ⅳ increased to 50.0%, the numbers of apoptosis cells were further enhanced, the mRNA expressions of TRAIL, TRAIL-sR1, ICAM-1 and CXCL10 were further upregulated (P<0.05). Otherwise, the tendency of all parameters in poly (I:C) group was similar to that in control group (P>0.05). CONCLUSION: Poly (I:C) aggravates chronic lymphocytic thyroiditis induced by excess of iodine associated with increase in infiltration of lymphocytes and induction of apoptosis.