Objective:According to the World Federation of Medical Education,critical thinking should be part of the training of medical and paramedical students.Professionals can improve the quality of care of patients after sur...Objective:According to the World Federation of Medical Education,critical thinking should be part of the training of medical and paramedical students.Professionals can improve the quality of care of patients after surgery by having or acquiring this skill in health care.Also,Emotional intelligence is introduced as an impor tant and effective factor on the professional performance and mental health of healthcare professionals.Thus,the present study was designed and implemented to determine the relationship between emotional intelligence and critical thinking among operating room nursing students of medical sciences universities in Iran.Methods:This cross-sectional study was done on 420 operating room students in 10 top medical sciences universities of Iran in 2022.The sampling method in this research was multistage sampling.The data collection instruments included demographic characteristics,Rickett's critical thinking,and Bradberry-Greaves'emotional intelligence questionnaires.After receiving the ethics code,data collection was done for 2 months.For data analysis,descriptive and inferential analyses including independent t-tests,analysis of variance,and Pearson correlation were used.The collected data were analyzed by SPSS 18(IBM Corporation,Armonk,New York,United States).P-value<0.05 was considered significant.Results:The mean age of the students participating in this study was 23.02±3.70 years,with women constituting 67.4%of them.The results of data analysis indicated that the mean total score of critical thinking and emotional intelligence was 124.10±37.52 and 114.12±43.63,respectively.A direct significant correlation between critical thinking and emotional intelligence(r=0.459,P-value<0.001)and a significant relationship between gender and emotional intelligence(P-value=0.028)were found.Conclusions:Based on the present study results,educational managers in the Ministry of Health are suggested to consider suitable educational programs for improving critical thinking and emotional intelligence to enhance the quality of care provided by students in operating rooms.展开更多
Robotic surgery systems,as emerging minimally invasive approaches,have been increasingly applied for the treatment of esophageal cancer because they provide a high-definition three-dimensional surgical view and mechan...Robotic surgery systems,as emerging minimally invasive approaches,have been increasingly applied for the treatment of esophageal cancer because they provide a high-definition three-dimensional surgical view and mechanical rotating arms that surpass the limitations of human hands,greatly enhancing the accuracy and flexibility of surgical methods.Robot-assisted McKeown esophagectomy(RAME),a common type of robotic esophagectomy,has been gradually implemented with the aim of reducing postoperative complications,improving postoperative recovery and achieving better long-term survival.Multiple centers worldwide have reported and summarized their experiences with the RAME,and some have also discussed and analyzed its perioperative effects and survival prognosis compared with those of video-assisted minimally invasive esophagectomy.Compared to traditional surgery,the RAME has significant advantages in terms of lymph node dissection although there seems to be no difference in overall survival or disease-free survival.With the continuous advancement of technology and the development of robotic technology,further development and innovation are expected in the RAME field.This review elaborates on the prospects of the application and advancement of the RAME to provide a useful reference for clinical practice.展开更多
Objective: To explore the application value of rapid rehabilitation concept in patients with extrahepatic bile duct stones under laparoscopy during perioperative period. Methods: 90 patients with extrahepatic bile duc...Objective: To explore the application value of rapid rehabilitation concept in patients with extrahepatic bile duct stones under laparoscopy during perioperative period. Methods: 90 patients with extrahepatic bile duct stones treated in our hospital from January 2022 to February 2023 were selected as the research object and randomly divided into the study group and the control group. The control group was given routine care, and the observation group was given rapid surgical rehabilitation care. The postoperative anal exhaust time, first meal time, early activity time, pain time, abdominal drainage tube removal time, hospitalization time and complication rate were compared between the two groups. The independent sample T test was used for the measurement data, and the x<sup>2</sup> test was used for the counting data, and the difference was statistically significant (P Results: The postoperative anal exhaust time, first meal time, early activity time, pain time, abdominal drainage tube removal time and hospitalization time in the study group were shorter than those in the control group (all P Conclusion: The concept of rapid rehabilitation can significantly improve the perioperative nursing effect of patients with extrahepatic bile duct stones and accelerate their rehabilitation, which is worth improving and popularizing.展开更多
BACKGROUND The recovery time of hand wounds is long,which can easily result in chronic and refractory wounds,making the wounds unable to be properly repaired.The treatment cycle is long,the cost is high,and it is pron...BACKGROUND The recovery time of hand wounds is long,which can easily result in chronic and refractory wounds,making the wounds unable to be properly repaired.The treatment cycle is long,the cost is high,and it is prone to recurrence and disability.Double layer artificial dermis combined with autologous skin transplantation has been used to repair hypertrophic scars,deep burn wounds,exposed bone and tendon wounds,and post tumor wounds.AIM To investigate the therapeutic efficacy of autologous skin graft transplantation in conjunction with double-layer artificial dermis in treating finger skin wounds that are chronically refractory and soft tissue defects that expose bone and tendon.METHODS Sixty-eight chronic refractory patients with finger skin and soft tissue defects accompanied by bone and tendon exposure who were admitted from July 2021 to June 2022 were included in this study.The observation group was treated with double layer artificial dermis combined with autologous skin graft transplantation(n=49),while the control group was treated with pedicle skin flap transplantation(n=17).The treatment status of the two groups of patients was compared,including the time between surgeries and hospital stay.The survival rate of skin grafts/flaps and postoperative wound infections were evaluated using the Vancouver Scar Scale(VSS)for scar scoring at 6 mo after surgery,as well as the sensory injury grading method and two-point resolution test to assess the recovery of skin sensation at 6 mo.The satisfaction of the two groups of patients was also compared.RESULTS Wound healing time in the observation group was significantly longer than that in the control group(P<0.05,27.92±3.25 d vs 19.68±6.91 d);there was no significant difference in the survival rate of skin grafts/flaps between the two patient groups(P>0.05,95.1±5.0 vs 96.3±5.6).The interval between two surgeries(20.0±4.3 d)and hospital stay(21.0±10.1 d)in the observation group were both significantly shorter than those in the control group(27.5±9.3 d)and(28.4±17.7 d),respectively(P<0.05).In comparison to postoperative infection(23.5%)and subcutaneous hematoma(11.8%)in the control group,these were considerably lower at(10.2%)and(6.1%)in the observation group.When comparing the two patient groups at six months post-surgery,the excellent and good rate of sensory recovery(91.8%)was significantly higher in the observation group than in the control group(76.5%)(P<0.05).There was also no statistically significant difference in two point resolution(P>0.05).The VSS score in the observation group(2.91±1.36)was significantly lower than that in the control group(5.96±1.51),and group satisfaction was significantly higher(P<0.05,90.1±6.3 vs 76.3±5.2).CONCLUSION The combination of artificial dermis and autologous skin grafting for the treatment of hand tendon exposure wounds has a satisfactory therapeutic effect.It is a safe,effective,and easy to operate treatment method,which is worthy of clinical promotion.展开更多
BACKGROUND Colorectal cancer(CRC)is a common life-threatening disease that often requires surgical intervention,such as laparoscopic radical resection.However,despite successful surgeries,some patients experience dise...BACKGROUND Colorectal cancer(CRC)is a common life-threatening disease that often requires surgical intervention,such as laparoscopic radical resection.However,despite successful surgeries,some patients experience disease relapse.Identifying the risk factors for CRC relapse can help guide clinical interventions and improve patient outcomes.AIM To determine the risk factors that may lead to CRC relapse after laparoscopic radical resection.METHODS We performed a retrospective analysis using the baseline data of 140 patients with CRC admitted to our hospital between January 2018 and January 2020.All included participants were followed up until death or for 3 years.The baseline data and laboratory indicators were compared between the patients who experienced relapse and those who did not experienced relapse.RESULTS Among the 140 patients with CRC,30 experienced relapse within 3 years after laparoscopic radical resection and 110 did not experience relapse.The relapse group had a higher frequency of rectal tumors with low differentiation and lymphatic vessel invasion than that of the non-relapse group.The expression of serum markers and the prognostic nutritional index were lower,whereas the neutrophil-to-lymphocyte ratio,expression of cytokeratin 19 fragment antigen 21-1,vascular endothelial growth factor,and Chitinase-3-like protein 1 were significantly higher in the relapse group than those in the non-relapse group.The groups did not differ significantly based on other parameters.Logistic regression analysis revealed that all the above significantly altered factors were independent risk factors for CRC relapse.CONCLUSION We identified multiple risk factors for CRC relapse following surgery,which can be considered for the clinical monitoring of patients to reduce disease recurrence and improve patient survival.展开更多
BACKGROUND As the perioperative risk of elderly patients with extremely unstable hip fractures(EUHFs)is relatively high and therapeutic effect is not satisfactory,new therapeutic strategies need to be proposed urgentl...BACKGROUND As the perioperative risk of elderly patients with extremely unstable hip fractures(EUHFs)is relatively high and therapeutic effect is not satisfactory,new therapeutic strategies need to be proposed urgently to improve the efficacy and clinical outcomes of such patients.AIM To determine the influence of two surgical treatment modalities on postoperative cognitive function(CF)and delirium in elderly patients with EUHFs.METHODS A total of 60 elderly patients consecutively diagnosed with EUHF between September 2020 and January 2022 in the Chongqing University Three Gorges Hospital were included.Of them,30 patients received conventional treatment(control group;general consultation+fracture type-guided internal fixation),and the other 30 received novel treatment(research group;perioperative multidisciplinary treatment diagnosis and treatment+individualized surgical plan+risk prediction).Information on hip function[Harris hip score(HHS)],perioperative risk of orthopedic surgery[Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity(POSSUM)],CF[Montreal cognitive assessment scale(MoCA)],postoperative delirium[mini-cognitive(Mini-Cog)],adverse events(AEs;internal fixation failure,infection,nonunion,malunion,and postoperative delirium),and clinical indicators[operation time(OT),postoperative hospital length of stay(HLOS),ambulation time,and intraoperative blood loss(IBL)]were collected from both groups for comparative analyses.RESULTS The HHS scores were similar between both groups.The POSSUM score at 6 mo after surgery was significantly lower in the research group compared with the control group,and MoCA and Mini-Cog scores were statistically higher.In addition,the overall postoperative complication rate was significantly lower in the research than in the control group,including reduced OT,postoperative HLOS,ambulation time,and IBL.CONCLUSION The new treatment modality has more clinical advantages over the conventional treatment,such as less IBL,faster functional recovery,more effectively optimized perioperative quality control,improved postoperative CF,mitigated postoperative delirium,and reduced operation-related AEs.展开更多
BACKGROUND Prohibitin 1(PHB1)has been identified as an antiproliferative protein that is highly conserved and ubiquitously expressed,and it participates in a variety of essential cellular functions,including apoptosis...BACKGROUND Prohibitin 1(PHB1)has been identified as an antiproliferative protein that is highly conserved and ubiquitously expressed,and it participates in a variety of essential cellular functions,including apoptosis,cell cycle regulation,prolifera-tion,and survival.Emerging evidence indicates that PHB1 may play an important role in the progression of hepatocellular carcinoma(HCC).However,the role of PHB1 in HCC is controversial.AIM To investigate the effects of PHB1 on the proliferation and apoptosis of human HCC cells and the relevant mechanisms in vitro.METHODS HCC patients and healthy individuals were enrolled in this study according to the inclusion and exclusion criteria;then,PHB1 levels in the sera and liver tissues of these participates were determined using ELISA,RT-PCR,and immunohistoche-mistry.Human HepG2 and SMMC-7721 cells were transfected with the pEGFP-PHB1 plasmid and PHB1-specific shRNA(shRNA-PHB1)for 24-72 h.Cell prolif-eration was analysed with an MTT assay.Cell cycle progression and apoptosis were analysed using flow cytometry(FACS).The mRNA and protein expression levels of the cell cycle-related molecules p21,Cyclin A2,Cyclin E1,and CDK2 and the cell apoptosis-related molecules cytochrome C(Cyt C),p53,Bcl-2,Bax,caspase 3,and caspase 9 were measured by real-time PCR and Western blot,respectively.RESULTS Decreased levels of PHB1 were found in the sera and liver tissues of HCC patients compared to those of healthy individuals,and decreased PHB1 was positively correlated with low differentiation,TNM stage III-IV,and alpha-fetoprotein≥400μg/L.Overexpression of PHB1 significantly inhibited human HCC cell proliferation in a time-dependent manner.FACS revealed that the overexpression of PHB1 arrested HCC cells in the G0/G1 phase of the cell cycle and induced apoptosis.The proportion of cells in the G0/G1 phase was significantly increased and the proportion of cells in the S phase was decreased in HepG2 cells that were transfected with pEGFP-PHB1 compared with untreated control and empty vector-transfected cells.The percentage of apoptotic HepG2 cells that were transfected with pEGFP-PHB1 was 15.41%±1.06%,which was significantly greater than that of apoptotic control cells(3.65%±0.85%,P<0.01)and empty vector-transfected cells(4.21%±0.52%,P<0.01).Similar results were obtained with SMMC-7721 cells.Furthermore,the mRNA and protein expression levels of p53,p21,Bax,caspase 3,and caspase 9 were increased while the mRNA and protein expression levels of Cyclin A2,Cy-clin E1,CDK2,and Bcl-2 were decreased when PHB1 was overexpressed in human HCC cells.However,when PHB1 was upregulated in human HCC cells,Cyt C expression levels were increased in the cytosol and decreased in the mitochondria,which indicated that Cyt C had been released into the cytosol.Conversely,these effects were reversed when PHB1 was knocked down.CONCLUSION PHB1 inhibits human HCC cell viability by arresting the cell cycle and inducing cell apoptosis via activation of the p53-mediated mitochondrial pathway.展开更多
BACKGROUND Gastric cancer(GC)is the most commonly diagnosed malignancy worldwide.Increasing evidence suggests that it is necessary to further explore genetic and immunological characteristics of GC.AIM To construct an...BACKGROUND Gastric cancer(GC)is the most commonly diagnosed malignancy worldwide.Increasing evidence suggests that it is necessary to further explore genetic and immunological characteristics of GC.AIM To construct an immune-related gene(IRG)signature for accurately predicting the prognosis of patients with GC.METHODS Differentially expressed genes(DEGs)between 375 gastric cancer tissues and 32 normal adjacent tissues were obtained from The Cancer Genome Atlas(TCGA)GDC data portal.Then,differentially expressed IRGs from the ImmPort database were identified for GC.Cox univariate survival analysis was used to screen survival-related IRGs.Differentially expressed survival-related IRGs were considered as hub IRGs.Genetic mutations of hub IRGs were analyzed.Then,hub IRGs were selected to conduct a prognostic signature.Receiver operating characteristic(ROC)curve analysis was used to evaluate the prognostic performance of the signature.The correlation of the signature with clinical features and tumor-infiltrating immune cells was analyzed.RESULTS Among all DEGs,70 hub IRGs were obtained for GC.The deletions and amplifications were the two most common types of genetic mutations of hub IRGs.A prognostic signature was identified,consisting of ten hub IRGs(including S100A12,DEFB126,KAL1,APOH,CGB5,GRP,GLP2R,LGR6,PTGER3,and CTLA4).This prognostic signature could accurately distinguish patients into highand low-risk groups,and overall survival analysis showed that high risk patients had shortened survival time than low risk patients(P<0.0001).The area under curve of the ROC of the signature was 0.761,suggesting that the prognostic signature had a high sensitivity and accuracy.Multivariate regression analysis demonstrated that the prognostic signature could become an independent prognostic predictor for GC after adjustment for other clinical features.Furthermore,we found that the prognostic signature was significantly correlated with macrophage infiltration.CONCLUSION Our study proposed an immune-related prognostic signature for GC,which could help develop treatment strategies for patients with GC in the future.展开更多
Solid pseudopapillary neoplasms(SPNs)of the pancreas are rare,low-grade,malignant neoplasms that are mostly seen in young women in the second and third decades of life and are quite uncommon in children.Standard resec...Solid pseudopapillary neoplasms(SPNs)of the pancreas are rare,low-grade,malignant neoplasms that are mostly seen in young women in the second and third decades of life and are quite uncommon in children.Standard resection for benign and borderline neoplasms of the pancreas is associated with a substantial risk of postoperative morbidity and long-term functional impairment,whereas enucleation leads to less morbidity and preserves healthy parenchyma as well as exocrine and endocrine function.Enucleation of SPNs has been increasingly reported to be feasible and safe for preserving the normal physiological function of the pancreas,especially in teenagers and children.This review summarizes findings published in recent years on the enucleation of SPNs as well as potential future developments and directions.Enucleation has undoubtedly come to stay as an alternative surgical procedure for SPNs.However,many questions remain unresolved,and future directions toward the best surgical indication,the prevention and intervention of complications,especially pancreatic fistula,intraoperative resection margin safety assessment,and long-term oncology prognosis remain to be evaluated and should be explored in future clinical trials.展开更多
BACKGROUND Bilioenteric Roux-en-Y anastomosis is one of the most complicated approaches for reconstructing the gastrointestinal tract, and endoscopic retrograde cholangiopancreatography (ERCP) is technically challengi...BACKGROUND Bilioenteric Roux-en-Y anastomosis is one of the most complicated approaches for reconstructing the gastrointestinal tract, and endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients after bilioenteric Roux-en-Y anastomosis. The optimal endoscopic strategies for such cases remain unknown. AIM To explore the feasibility and effectiveness of single balloon enteroscopy-assisted (SBE-assisted) therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis based on multi-disciplinary collaboration between endoscopists and surgeons as well as report the experience from China. METHODS This is a single center retrospective study. All of the SBE-assisted therapeutic ERCP procedures were performed by the collaboration between endoscopists and surgeons. The operation time, success rate, and complication rate were calculated. RESULTS Forty-six patients received a total of 64 SBE-assisted therapeutic ERCP procedures, with successful scope intubation in 60 (93.8%) cases and successful diagnosis in 59 (92.2%). All successfully diagnosed cases received successful therapy. None of the cases had perforation or bleeding during or after operation, and no post-ERCP pancreatitis occurred. CONCLUSION Based on multi-disciplinary collaboration, SBE-assisted therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis is relatively safe and effective and has a high success rate.展开更多
Glial cell line-derived neurotrophic factor(GDNF)plays an important role in the protection of dopaminergic neurons,but there are few reports of the relationship between GDNF and its precursors(α-pro-GDNF andβ-pro-GD...Glial cell line-derived neurotrophic factor(GDNF)plays an important role in the protection of dopaminergic neurons,but there are few reports of the relationship between GDNF and its precursors(α-pro-GDNF andβ-pro-GDNF)and cognitive impairment in Parkinson’s disease.This study aimed to investigate the relationship between the serum levels of GDNF and its precursors and cognitive impairment in Parkinson’s disease,and to assess their potential as a diagnostic marker.Fifty-three primary outpatients and hospitalized patients with Parkinson’s disease(23 men and 30 women)with an average age of 66.58 years were enrolled from the Affiliated Hospital of Xuzhou Medical University of China in this case-control study.The patients were divided into the Parkinson’s disease with cognitive impairment group(n=27)and the Parkinson’s disease with normal cognitive function group(n=26)based on their Mini-Mental State Examination,Montreal Cognitive Assessment,and Clinical Dementia Rating scores.In addition,26 age-and sex-matched healthy subjects were included as the healthy control group.Results demonstrated that serum GDNF levels were significantly higher in the Parkinson’s disease with normal cognitive function group than in the other two groups.There were no significant differences in GDNF precursor levels among the three groups.Correlation analysis revealed that serum GDNF levels,GDNF/α-pro-GDNF ratios,and GDNF/β-pro-GDNF ratios were moderately or highly correlated with the Mini-Mental State Examination,Montreal Cognitive Assessment,and Clinical Dementia Rating scores.To explore the risk factors for cognitive impairment in patients with Parkinson’s disease,logistic regression analysis and stepwise linear regression analysis were performed.Both GDNF levels and Hoehn-Yahr stage were risk factors for cognitive impairment in Parkinson’s disease,and were the common influencing factors for cognitive scale scores.Neitherα-pro-GDNF norβ-pro-GDNF was risk factors for cognitive impairment in Parkinson’s disease.A receiver operating characteristic curve of GDNF was generated to predict cognitive function in Parkinson’s disease(area under the curve=0.859).This result indicates that the possibility that serum GDNF can correctly distinguish whether patients with Parkinson’s disease have cognitive impairment is 0.859.Together,these results suggest that serum GDNF may be an effective diagnostic marker for cognitive impairment in Parkinson’s disease.However,α-pro-GDNF andβ-pro-GDNF are not useful for predicting cognitive impairment in this disease.This study was approved by Ethics Committee of the Affiliated Hospital of Xuzhou Medical University,China(approval No.XYFY2017-KL047-01)on November 30,2017.展开更多
BACKGROUND Kras mutant colon cancer shows abnormal activation of the nuclear factor kappa-B(NF-κB)pathway,resulting in the proliferation of tumor cells.Treatment with fluorouracil(5-FU)might not achieve the expected ...BACKGROUND Kras mutant colon cancer shows abnormal activation of the nuclear factor kappa-B(NF-κB)pathway,resulting in the proliferation of tumor cells.Treatment with fluorouracil(5-FU)might not achieve the expected inhibition of proliferation of malignant cells based on the fluorouracil-induced activation of the NF-κB pathway.AIM To detect whether interleukin(IL)-1 receptor antagonist(IL-1RA)could increase the chemosensitivity to 5-FU by decreasing the activation of the NF-κB pathway and reducing the proliferation of colon cancer cells.METHODS Western blot analysis was performed to detect the persistent activation of the NF-κB pathway in colon cancer cell lines.Reverse transcription-polymerase chain reaction was used to detect the IL-1RA-reduced expression levels of IL-6,IL-8,IL-17,IL-21 and TLR4 in colon cancer cell lines.We used a xenograft nude mouse model to demonstrate the downregulation of the NF-κB pathway by blocking the NF-κB-regulated IL-1αfeedforward loop,which could increase the efficacy of chemotherapeutic agents in inhibiting tumor cell growth.RESULTS IL-1 receptor antagonist could decrease the expression of IL-1αand IL-1βand downregulate the activity of the NF-κB pathway in Kras mutant colon cancer cells.Treatment with 5-FU combined with IL-1RA could increase the chemosensitivity of the SW620 cell line,and decreased expression of the TAK1/NF-κB and MEK pathways resulted in limited proliferation in the SW620 cell line.CONCLUSION Adjuvant chemotherapy with IL-1RA and 5-FU has a stronger effect than single chemotherapeutic drugs.IL-1RA combined with fluorouracil could be a potential neoadjuvant chemotherapy in the clinic.展开更多
Background Anosmia is one of the symptoms in individuals with SARS-CoV-2 infection.In anosmic patients,SARS-CoV-2 temporarily alters the signaling process in olfactory nerve cells and olfactory bulb(OB),which eventual...Background Anosmia is one of the symptoms in individuals with SARS-CoV-2 infection.In anosmic patients,SARS-CoV-2 temporarily alters the signaling process in olfactory nerve cells and olfactory bulb(OB),which eventually damages the structure of the olfactory epithelium,leading to a permanent disorder in the olfactory pathway that this damaged structure is showed in MRI imaging Method Two investigators independently searched four databases consisting of PubMed,ProQuest,Scopus,and Web of Science for relevant records as of November 11,2020 with no time,space,and language restrictions.Google Scholar was also searched for the related resources within the time limit of 2020.All the found articles were reviewed based on the PRISMA flow diagram.Qualitative studies,case reports,editorials,letters,and other non-original studies were excluded from this systematic analysis.Results Initial search yielded 434 records.After reviewing the titles and abstracts,we selected 74 articles;finally,8 articles were depicted to be investigated and read in full text.The obtained results showed an increase in the width and volume of the olfactory cleft(OC),complete or partial destruction of OC,and complete occlusion of OC in COVID-19 patients.Deformation and degeneration as well as a subtle asymmetry were evident in the OBs.Computed tomography(CT),meganetic resonance imaging(MRI),and positron emission tomography(PET)were used to detect the outcomes of anosmia in these studies.Conclusions The changes in OC are greater than those in OB in patients with COVID-19,mainly due to the inflammatory and immune responses in OC.However,fewer changes in OB are due to neurological or vascular disorders.Topical steroid therapy and topical saline can be helpful.展开更多
BACKGROUND Sebaceous lymphadenoma is a benign tumor that occurs rarely in the salivary glands,most commonly in the parotid glands or periparotid lymph nodes,and even more rarely undergoes malignant transformation into...BACKGROUND Sebaceous lymphadenoma is a benign tumor that occurs rarely in the salivary glands,most commonly in the parotid glands or periparotid lymph nodes,and even more rarely undergoes malignant transformation into a sebaceous lymphadenocarcinoma.CASE SUMMARY We report an 82-year-old woman who presented with a painless mass in the right parotid region.We performed extended surgical resection of the parotid gland mass.Intraoperative pathology revealed a sebaceous lymphadenocarcinoma with metastasis into the periparotid cervical lymph nodes,so we also performed neck dissection and lymph node resection.Postoperative pathology confirmed the diagnosis.The literature review revealed that this was the seventh reported case of sebaceous lymphadenocarcinoma and the second reported case of cervical lymph node metastasis and infiltration of the skin of the parotid gland.CONCLUSION Treatment of sebaceous lymphadenocarcinoma depends on the typing and clinical staging of the cancer.Extensive resection is the first choice,and adjuvant radiotherapy should be given to patients with high-grade tumors or those at an advanced clinical stage.展开更多
Objective To assess the accuracy of preoperative serum CA19-9 levels in predicting the resectability of pancreatic adenocarcinoma.Methods Patients with biopsy-proven pancreatic adenocarcinoma who had preoperative seru...Objective To assess the accuracy of preoperative serum CA19-9 levels in predicting the resectability of pancreatic adenocarcinoma.Methods Patients with biopsy-proven pancreatic adenocarcinoma who had preoperative serum CA19-9 level data were enrolled in the present retrospective analysis. Receiver operating characteristics(ROC) curve analysis was used to determine the optimal cut-off value of CA19-9. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated at this cut-off point.Results Seventy-six patients with pancreatic adenocarcinoma that was considered potentially resectable according to radiological imaging were included. Of all 76 patients, 44 received complete resection of the pancreatic adenocarcinoma. The preoperative serum CA19-9 level was significantly higher in the unresectable tumor group than in the resectable tumor group(P = 0.0036). The area under the ROC curve was 0.749(95% confidence interval [CI]: 0.637–0.842). When the cut-off value of CA19-9 was set to 359.1 U/m L, the sensitivity, specificity, positive and negative predictive values were 71.9%(95% CI: 53.3%–86.3%), 70.5%(95% CI: 54.8%–83.2%), 63.9%(95% CI: 46.0%–79.4%), and 77.5%(95% CI: 61.5%–89.2%), respectively.Conclusion The preoperative serum CA19-9 level is useful for predicting the resectability of pancreatic adenocarcinoma.展开更多
Objective:Chemotherapy significantly improved the survival of breast cancer,but also brings various symptoms and psychological distresses.Cognitive dysfunction was usually ignored.This study aimed to investigate the c...Objective:Chemotherapy significantly improved the survival of breast cancer,but also brings various symptoms and psychological distresses.Cognitive dysfunction was usually ignored.This study aimed to investigate the changes in cognitive function during chemotherapy and its influence on the quality of life in breast cancer patients.Methods:Female patients with newly diagnosed breast cancer have prospectively enrolled in this study.Participants investigated and completed questionnaires at four-time points:pre-chemotherapy(T1),post-chemotherapy(T2),6 months(T3)and 12 months(T4)after the completion of chemotherapy.The Functional Assessment of Cancer Therapy-Cognitive scale and the Functional Assessment of Cancer Therapy-Breast Cancer scale used was to assess the cognitive function and the quality of life,respectively.Data were analyzed using descriptive and repeated-measures analysis of variance statistics.Results:One hundred and eighty-three patients participated in the study and completed questionnaires at least 2 times.The mean score of cognitive function and the quality of life were significantly different at a different time point(P<0.05 for all).The trends of cognitive scores shown that the most serious damage of cognitive function appeared after beginning chemotherapy and followed by a slowly turn back after the completion of chemotherapy.The trend of the mean score of the quality of life after chemotherapy was similar to that of the cognitive score.The degree of cognitive dysfunction was significantly associated with the score of the quality of life at each time point after chemotherapy(P<0.05).Conclusion:Chemotherapy is closely associated with a cognitive impairment,which contributes to a significant decrease in the quality of life of patients with breast cancer.展开更多
Malignant tumors are one of the serious public health problems that threaten the survival time of human beings.They are prone to metastasis to distant organs and the central nervous system is one of the common target ...Malignant tumors are one of the serious public health problems that threaten the survival time of human beings.They are prone to metastasis to distant organs and the central nervous system is one of the common target organs.As it is difficult for chemotherapeutics,targeted drugs and other macromolecules to pass through the blood brain barrier(BBB),local radiation therapy is often used for treating intracranial primary or metastatic tumors.However,whether it is whole brain radiation therapy(WBRT)or stereotactic body radiation therapy(SBRT),the choice of radiation dose is limited by the side effects of radiation therapy on the surrounding normal brain tissues.Radiation-induced brain injury(RBI)can further develop into radiation necrosis(RN)in the late stage.Bevacizumab is often effective against RBI by antagonizing vascular endothelial growth factor(VEGF),but it still cannot completely reverse RN.Emerging treatment options such as human pluripotent stem-cell transplantation have made it possible to reverse the process of RN.展开更多
Objective:The prognostic value of circulating tumor cells(CTCs)in metastatic breast cancer(MBC)patients was contentious.A meta-analysis was conducted to evaluate whether MBC patients’clinical outcomes could be predic...Objective:The prognostic value of circulating tumor cells(CTCs)in metastatic breast cancer(MBC)patients was contentious.A meta-analysis was conducted to evaluate whether MBC patients’clinical outcomes could be predicted by CTCs detection.Methods:Relevant published studies were searched through electronic databases from January 1990 to February 2018,among which,those investigated the correlation between CTCs and clinical outcomes of progression-free survival and overall survival in MBC patients were involved.The hazard ratios(HR)and confidence intervals(CI)in the studies were extracted from the study using random or fixed effects model,and the meta-analysis was conducted.The prognostic value of tumor cells in patients with different subtypes was estimated by subgroup analysis.Results:Twenty-one eligible studies enrolling 3,837 patients were appropriate for pooled analysis.Progression-free survival(HR,1.66;95%CI,1.47–1.87;P=0.000)and overall survival(HR,2.51;95%CI,2.13–2.96;P=0.000)were worse in patients with CTCs-positive.Subtypes of hormone receptor(HorR)positive,human epidermal growth factor receptor-2(HER2)negative and triple negative with presence of CTCs showed a statistically significant worse PFS and OS.However,CTCs detection presented no prognostic value in patients with HorR-negative or HER2-positive subtypes.Conclusion:The enumeration of CTCs at baseline in patients with MBC subtypes of HorR-positive,HER2-negative and triple negative is connected with disease progression and poor survival,but inappropriate for HorR-negative and HER2-positive subtypes.展开更多
Objective:To investigate the prevention and management of perioperative nausea and vomiting and reflux aspiration in painless hysteroscopy patients.Methods:The clinical datum of one patient with reflux and postoperati...Objective:To investigate the prevention and management of perioperative nausea and vomiting and reflux aspiration in painless hysteroscopy patients.Methods:The clinical datum of one patient with reflux and postoperative vomiting and another one with a history of multiple postoperative nausea and vomiting during painless hysteroscopy were retrospectively analyzed.Results:In case 1,despite the occurrence of reflux,no significant aspiration or other serious consequences occurred through positive attraction,ondansetron,dexamethasone,droperidol and other drugs and candy treatment,then nausea and vomiting gradually eased.In case 2,due to the reduction of preoperative dosage of sufentanil,prophylactic application of ondansetron,psychological intervention and postoperative candy,no nausea and vomiting occurred during the painless hysteroscopy.The patient recovered quickly with high satisfaction.Conclusion:Patients with a high risk of nausea and vomiting may be ameliorated by positive psychological and drug intervention.Even if patients have intraoperative reflux and postoperative nausea and vomiting,it can be relieved by psychological and drug treatment,and the occurrence of serious complications such as aspiration can be prevented.展开更多
BACKGROUND The frequency and content of follow-up strategies remain controversial for colorectal cancer(CRC),and scheduled follow-ups have limited value.AIM To compare intensive and conventional follow-up strategies f...BACKGROUND The frequency and content of follow-up strategies remain controversial for colorectal cancer(CRC),and scheduled follow-ups have limited value.AIM To compare intensive and conventional follow-up strategies for the prognosis of non-metastatic CRC treated with curative intent using a meta-analysis.METHODS PubMed,Embase,and the Cochrane Library databases were systematically searched for potentially eligible randomized controlled trials(RCTs)from inception until April 2023.The Cochrane risk of bias was used to assess the methodological quality of the included studies.The hazard ratio,relative risk,and 95%confidence interval were used to calculate survival and categorical data,and pooled analyses were performed using the random-effects model.Additional exploratory analyses were performed for sensitivity,subgroups,and publication bias.RESULTS Eighteen RCTs involving 8533 patients with CRC were selected for the final analysis.Intensive follow-up may be superior to conventional follow-up in improving overall survival,but this difference was not statistically significant.Moreover,intensive follow-up was associated with an increased incidence of salvage surgery compared to conventional follow-up.In addition,there was no significant difference in the risk of recurrence between intensive and conventional follow-up strategies,whereas intensive follow-up was associated with a reduced risk of interval recurrence compared to conventional follow-up.Finally,the effects of intensive and conventional follow-up strategies differed when stratified by tumor location and follow-up duration.CONCLUSION Intensive follow-up may have a beneficial effect on the overall survival of patients with non-metastatic CRC treated with curative intent.展开更多
文摘Objective:According to the World Federation of Medical Education,critical thinking should be part of the training of medical and paramedical students.Professionals can improve the quality of care of patients after surgery by having or acquiring this skill in health care.Also,Emotional intelligence is introduced as an impor tant and effective factor on the professional performance and mental health of healthcare professionals.Thus,the present study was designed and implemented to determine the relationship between emotional intelligence and critical thinking among operating room nursing students of medical sciences universities in Iran.Methods:This cross-sectional study was done on 420 operating room students in 10 top medical sciences universities of Iran in 2022.The sampling method in this research was multistage sampling.The data collection instruments included demographic characteristics,Rickett's critical thinking,and Bradberry-Greaves'emotional intelligence questionnaires.After receiving the ethics code,data collection was done for 2 months.For data analysis,descriptive and inferential analyses including independent t-tests,analysis of variance,and Pearson correlation were used.The collected data were analyzed by SPSS 18(IBM Corporation,Armonk,New York,United States).P-value<0.05 was considered significant.Results:The mean age of the students participating in this study was 23.02±3.70 years,with women constituting 67.4%of them.The results of data analysis indicated that the mean total score of critical thinking and emotional intelligence was 124.10±37.52 and 114.12±43.63,respectively.A direct significant correlation between critical thinking and emotional intelligence(r=0.459,P-value<0.001)and a significant relationship between gender and emotional intelligence(P-value=0.028)were found.Conclusions:Based on the present study results,educational managers in the Ministry of Health are suggested to consider suitable educational programs for improving critical thinking and emotional intelligence to enhance the quality of care provided by students in operating rooms.
文摘Robotic surgery systems,as emerging minimally invasive approaches,have been increasingly applied for the treatment of esophageal cancer because they provide a high-definition three-dimensional surgical view and mechanical rotating arms that surpass the limitations of human hands,greatly enhancing the accuracy and flexibility of surgical methods.Robot-assisted McKeown esophagectomy(RAME),a common type of robotic esophagectomy,has been gradually implemented with the aim of reducing postoperative complications,improving postoperative recovery and achieving better long-term survival.Multiple centers worldwide have reported and summarized their experiences with the RAME,and some have also discussed and analyzed its perioperative effects and survival prognosis compared with those of video-assisted minimally invasive esophagectomy.Compared to traditional surgery,the RAME has significant advantages in terms of lymph node dissection although there seems to be no difference in overall survival or disease-free survival.With the continuous advancement of technology and the development of robotic technology,further development and innovation are expected in the RAME field.This review elaborates on the prospects of the application and advancement of the RAME to provide a useful reference for clinical practice.
文摘Objective: To explore the application value of rapid rehabilitation concept in patients with extrahepatic bile duct stones under laparoscopy during perioperative period. Methods: 90 patients with extrahepatic bile duct stones treated in our hospital from January 2022 to February 2023 were selected as the research object and randomly divided into the study group and the control group. The control group was given routine care, and the observation group was given rapid surgical rehabilitation care. The postoperative anal exhaust time, first meal time, early activity time, pain time, abdominal drainage tube removal time, hospitalization time and complication rate were compared between the two groups. The independent sample T test was used for the measurement data, and the x<sup>2</sup> test was used for the counting data, and the difference was statistically significant (P Results: The postoperative anal exhaust time, first meal time, early activity time, pain time, abdominal drainage tube removal time and hospitalization time in the study group were shorter than those in the control group (all P Conclusion: The concept of rapid rehabilitation can significantly improve the perioperative nursing effect of patients with extrahepatic bile duct stones and accelerate their rehabilitation, which is worth improving and popularizing.
基金Clinical Study of Artificial Dermis Combined with Skin Flap Replacement Flap in Limb Wound Repair,No.WX21C27.
文摘BACKGROUND The recovery time of hand wounds is long,which can easily result in chronic and refractory wounds,making the wounds unable to be properly repaired.The treatment cycle is long,the cost is high,and it is prone to recurrence and disability.Double layer artificial dermis combined with autologous skin transplantation has been used to repair hypertrophic scars,deep burn wounds,exposed bone and tendon wounds,and post tumor wounds.AIM To investigate the therapeutic efficacy of autologous skin graft transplantation in conjunction with double-layer artificial dermis in treating finger skin wounds that are chronically refractory and soft tissue defects that expose bone and tendon.METHODS Sixty-eight chronic refractory patients with finger skin and soft tissue defects accompanied by bone and tendon exposure who were admitted from July 2021 to June 2022 were included in this study.The observation group was treated with double layer artificial dermis combined with autologous skin graft transplantation(n=49),while the control group was treated with pedicle skin flap transplantation(n=17).The treatment status of the two groups of patients was compared,including the time between surgeries and hospital stay.The survival rate of skin grafts/flaps and postoperative wound infections were evaluated using the Vancouver Scar Scale(VSS)for scar scoring at 6 mo after surgery,as well as the sensory injury grading method and two-point resolution test to assess the recovery of skin sensation at 6 mo.The satisfaction of the two groups of patients was also compared.RESULTS Wound healing time in the observation group was significantly longer than that in the control group(P<0.05,27.92±3.25 d vs 19.68±6.91 d);there was no significant difference in the survival rate of skin grafts/flaps between the two patient groups(P>0.05,95.1±5.0 vs 96.3±5.6).The interval between two surgeries(20.0±4.3 d)and hospital stay(21.0±10.1 d)in the observation group were both significantly shorter than those in the control group(27.5±9.3 d)and(28.4±17.7 d),respectively(P<0.05).In comparison to postoperative infection(23.5%)and subcutaneous hematoma(11.8%)in the control group,these were considerably lower at(10.2%)and(6.1%)in the observation group.When comparing the two patient groups at six months post-surgery,the excellent and good rate of sensory recovery(91.8%)was significantly higher in the observation group than in the control group(76.5%)(P<0.05).There was also no statistically significant difference in two point resolution(P>0.05).The VSS score in the observation group(2.91±1.36)was significantly lower than that in the control group(5.96±1.51),and group satisfaction was significantly higher(P<0.05,90.1±6.3 vs 76.3±5.2).CONCLUSION The combination of artificial dermis and autologous skin grafting for the treatment of hand tendon exposure wounds has a satisfactory therapeutic effect.It is a safe,effective,and easy to operate treatment method,which is worthy of clinical promotion.
文摘BACKGROUND Colorectal cancer(CRC)is a common life-threatening disease that often requires surgical intervention,such as laparoscopic radical resection.However,despite successful surgeries,some patients experience disease relapse.Identifying the risk factors for CRC relapse can help guide clinical interventions and improve patient outcomes.AIM To determine the risk factors that may lead to CRC relapse after laparoscopic radical resection.METHODS We performed a retrospective analysis using the baseline data of 140 patients with CRC admitted to our hospital between January 2018 and January 2020.All included participants were followed up until death or for 3 years.The baseline data and laboratory indicators were compared between the patients who experienced relapse and those who did not experienced relapse.RESULTS Among the 140 patients with CRC,30 experienced relapse within 3 years after laparoscopic radical resection and 110 did not experience relapse.The relapse group had a higher frequency of rectal tumors with low differentiation and lymphatic vessel invasion than that of the non-relapse group.The expression of serum markers and the prognostic nutritional index were lower,whereas the neutrophil-to-lymphocyte ratio,expression of cytokeratin 19 fragment antigen 21-1,vascular endothelial growth factor,and Chitinase-3-like protein 1 were significantly higher in the relapse group than those in the non-relapse group.The groups did not differ significantly based on other parameters.Logistic regression analysis revealed that all the above significantly altered factors were independent risk factors for CRC relapse.CONCLUSION We identified multiple risk factors for CRC relapse following surgery,which can be considered for the clinical monitoring of patients to reduce disease recurrence and improve patient survival.
基金Supported by the Chongqing Medical Scientific Research Project(Joint Project of Chongqing Health Commission and Science and Technology Bureau),No.2020FYYX211Medical Research Project of Wanzhou District(Joint Project of Health Commission and Science and Technology Bureau),No.wzstc-kw2020023.
文摘BACKGROUND As the perioperative risk of elderly patients with extremely unstable hip fractures(EUHFs)is relatively high and therapeutic effect is not satisfactory,new therapeutic strategies need to be proposed urgently to improve the efficacy and clinical outcomes of such patients.AIM To determine the influence of two surgical treatment modalities on postoperative cognitive function(CF)and delirium in elderly patients with EUHFs.METHODS A total of 60 elderly patients consecutively diagnosed with EUHF between September 2020 and January 2022 in the Chongqing University Three Gorges Hospital were included.Of them,30 patients received conventional treatment(control group;general consultation+fracture type-guided internal fixation),and the other 30 received novel treatment(research group;perioperative multidisciplinary treatment diagnosis and treatment+individualized surgical plan+risk prediction).Information on hip function[Harris hip score(HHS)],perioperative risk of orthopedic surgery[Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity(POSSUM)],CF[Montreal cognitive assessment scale(MoCA)],postoperative delirium[mini-cognitive(Mini-Cog)],adverse events(AEs;internal fixation failure,infection,nonunion,malunion,and postoperative delirium),and clinical indicators[operation time(OT),postoperative hospital length of stay(HLOS),ambulation time,and intraoperative blood loss(IBL)]were collected from both groups for comparative analyses.RESULTS The HHS scores were similar between both groups.The POSSUM score at 6 mo after surgery was significantly lower in the research group compared with the control group,and MoCA and Mini-Cog scores were statistically higher.In addition,the overall postoperative complication rate was significantly lower in the research than in the control group,including reduced OT,postoperative HLOS,ambulation time,and IBL.CONCLUSION The new treatment modality has more clinical advantages over the conventional treatment,such as less IBL,faster functional recovery,more effectively optimized perioperative quality control,improved postoperative CF,mitigated postoperative delirium,and reduced operation-related AEs.
基金the Key Research and Development Program of Shaanxi,No.2021SF-227 and No.2020SF-297the Natural Science Basic Research Program of Shaanxi,No.2023-JC-YB-770。
文摘BACKGROUND Prohibitin 1(PHB1)has been identified as an antiproliferative protein that is highly conserved and ubiquitously expressed,and it participates in a variety of essential cellular functions,including apoptosis,cell cycle regulation,prolifera-tion,and survival.Emerging evidence indicates that PHB1 may play an important role in the progression of hepatocellular carcinoma(HCC).However,the role of PHB1 in HCC is controversial.AIM To investigate the effects of PHB1 on the proliferation and apoptosis of human HCC cells and the relevant mechanisms in vitro.METHODS HCC patients and healthy individuals were enrolled in this study according to the inclusion and exclusion criteria;then,PHB1 levels in the sera and liver tissues of these participates were determined using ELISA,RT-PCR,and immunohistoche-mistry.Human HepG2 and SMMC-7721 cells were transfected with the pEGFP-PHB1 plasmid and PHB1-specific shRNA(shRNA-PHB1)for 24-72 h.Cell prolif-eration was analysed with an MTT assay.Cell cycle progression and apoptosis were analysed using flow cytometry(FACS).The mRNA and protein expression levels of the cell cycle-related molecules p21,Cyclin A2,Cyclin E1,and CDK2 and the cell apoptosis-related molecules cytochrome C(Cyt C),p53,Bcl-2,Bax,caspase 3,and caspase 9 were measured by real-time PCR and Western blot,respectively.RESULTS Decreased levels of PHB1 were found in the sera and liver tissues of HCC patients compared to those of healthy individuals,and decreased PHB1 was positively correlated with low differentiation,TNM stage III-IV,and alpha-fetoprotein≥400μg/L.Overexpression of PHB1 significantly inhibited human HCC cell proliferation in a time-dependent manner.FACS revealed that the overexpression of PHB1 arrested HCC cells in the G0/G1 phase of the cell cycle and induced apoptosis.The proportion of cells in the G0/G1 phase was significantly increased and the proportion of cells in the S phase was decreased in HepG2 cells that were transfected with pEGFP-PHB1 compared with untreated control and empty vector-transfected cells.The percentage of apoptotic HepG2 cells that were transfected with pEGFP-PHB1 was 15.41%±1.06%,which was significantly greater than that of apoptotic control cells(3.65%±0.85%,P<0.01)and empty vector-transfected cells(4.21%±0.52%,P<0.01).Similar results were obtained with SMMC-7721 cells.Furthermore,the mRNA and protein expression levels of p53,p21,Bax,caspase 3,and caspase 9 were increased while the mRNA and protein expression levels of Cyclin A2,Cy-clin E1,CDK2,and Bcl-2 were decreased when PHB1 was overexpressed in human HCC cells.However,when PHB1 was upregulated in human HCC cells,Cyt C expression levels were increased in the cytosol and decreased in the mitochondria,which indicated that Cyt C had been released into the cytosol.Conversely,these effects were reversed when PHB1 was knocked down.CONCLUSION PHB1 inhibits human HCC cell viability by arresting the cell cycle and inducing cell apoptosis via activation of the p53-mediated mitochondrial pathway.
文摘BACKGROUND Gastric cancer(GC)is the most commonly diagnosed malignancy worldwide.Increasing evidence suggests that it is necessary to further explore genetic and immunological characteristics of GC.AIM To construct an immune-related gene(IRG)signature for accurately predicting the prognosis of patients with GC.METHODS Differentially expressed genes(DEGs)between 375 gastric cancer tissues and 32 normal adjacent tissues were obtained from The Cancer Genome Atlas(TCGA)GDC data portal.Then,differentially expressed IRGs from the ImmPort database were identified for GC.Cox univariate survival analysis was used to screen survival-related IRGs.Differentially expressed survival-related IRGs were considered as hub IRGs.Genetic mutations of hub IRGs were analyzed.Then,hub IRGs were selected to conduct a prognostic signature.Receiver operating characteristic(ROC)curve analysis was used to evaluate the prognostic performance of the signature.The correlation of the signature with clinical features and tumor-infiltrating immune cells was analyzed.RESULTS Among all DEGs,70 hub IRGs were obtained for GC.The deletions and amplifications were the two most common types of genetic mutations of hub IRGs.A prognostic signature was identified,consisting of ten hub IRGs(including S100A12,DEFB126,KAL1,APOH,CGB5,GRP,GLP2R,LGR6,PTGER3,and CTLA4).This prognostic signature could accurately distinguish patients into highand low-risk groups,and overall survival analysis showed that high risk patients had shortened survival time than low risk patients(P<0.0001).The area under curve of the ROC of the signature was 0.761,suggesting that the prognostic signature had a high sensitivity and accuracy.Multivariate regression analysis demonstrated that the prognostic signature could become an independent prognostic predictor for GC after adjustment for other clinical features.Furthermore,we found that the prognostic signature was significantly correlated with macrophage infiltration.CONCLUSION Our study proposed an immune-related prognostic signature for GC,which could help develop treatment strategies for patients with GC in the future.
基金Supported by the Key Research and Development Projects in Sichuan Province,No.2019YFS0043the 1·3·5 Project for Disciplines of Excellence,West China Hospital,Sichuan University,No.ZY2017302-1.3.5.
文摘Solid pseudopapillary neoplasms(SPNs)of the pancreas are rare,low-grade,malignant neoplasms that are mostly seen in young women in the second and third decades of life and are quite uncommon in children.Standard resection for benign and borderline neoplasms of the pancreas is associated with a substantial risk of postoperative morbidity and long-term functional impairment,whereas enucleation leads to less morbidity and preserves healthy parenchyma as well as exocrine and endocrine function.Enucleation of SPNs has been increasingly reported to be feasible and safe for preserving the normal physiological function of the pancreas,especially in teenagers and children.This review summarizes findings published in recent years on the enucleation of SPNs as well as potential future developments and directions.Enucleation has undoubtedly come to stay as an alternative surgical procedure for SPNs.However,many questions remain unresolved,and future directions toward the best surgical indication,the prevention and intervention of complications,especially pancreatic fistula,intraoperative resection margin safety assessment,and long-term oncology prognosis remain to be evaluated and should be explored in future clinical trials.
基金Supported by the National Natural Science Foundation of China,No.31600075
文摘BACKGROUND Bilioenteric Roux-en-Y anastomosis is one of the most complicated approaches for reconstructing the gastrointestinal tract, and endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients after bilioenteric Roux-en-Y anastomosis. The optimal endoscopic strategies for such cases remain unknown. AIM To explore the feasibility and effectiveness of single balloon enteroscopy-assisted (SBE-assisted) therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis based on multi-disciplinary collaboration between endoscopists and surgeons as well as report the experience from China. METHODS This is a single center retrospective study. All of the SBE-assisted therapeutic ERCP procedures were performed by the collaboration between endoscopists and surgeons. The operation time, success rate, and complication rate were calculated. RESULTS Forty-six patients received a total of 64 SBE-assisted therapeutic ERCP procedures, with successful scope intubation in 60 (93.8%) cases and successful diagnosis in 59 (92.2%). All successfully diagnosed cases received successful therapy. None of the cases had perforation or bleeding during or after operation, and no post-ERCP pancreatitis occurred. CONCLUSION Based on multi-disciplinary collaboration, SBE-assisted therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis is relatively safe and effective and has a high success rate.
基金This work was funded by the National Natural Science Foundation of China,No.81971006(to DSG)the Postgraduate Research and Practice Innovation Program of Jiangsu Province of China,Nos.KYCX18_2193(to MYS),KYCX18_2171(to CXT).
文摘Glial cell line-derived neurotrophic factor(GDNF)plays an important role in the protection of dopaminergic neurons,but there are few reports of the relationship between GDNF and its precursors(α-pro-GDNF andβ-pro-GDNF)and cognitive impairment in Parkinson’s disease.This study aimed to investigate the relationship between the serum levels of GDNF and its precursors and cognitive impairment in Parkinson’s disease,and to assess their potential as a diagnostic marker.Fifty-three primary outpatients and hospitalized patients with Parkinson’s disease(23 men and 30 women)with an average age of 66.58 years were enrolled from the Affiliated Hospital of Xuzhou Medical University of China in this case-control study.The patients were divided into the Parkinson’s disease with cognitive impairment group(n=27)and the Parkinson’s disease with normal cognitive function group(n=26)based on their Mini-Mental State Examination,Montreal Cognitive Assessment,and Clinical Dementia Rating scores.In addition,26 age-and sex-matched healthy subjects were included as the healthy control group.Results demonstrated that serum GDNF levels were significantly higher in the Parkinson’s disease with normal cognitive function group than in the other two groups.There were no significant differences in GDNF precursor levels among the three groups.Correlation analysis revealed that serum GDNF levels,GDNF/α-pro-GDNF ratios,and GDNF/β-pro-GDNF ratios were moderately or highly correlated with the Mini-Mental State Examination,Montreal Cognitive Assessment,and Clinical Dementia Rating scores.To explore the risk factors for cognitive impairment in patients with Parkinson’s disease,logistic regression analysis and stepwise linear regression analysis were performed.Both GDNF levels and Hoehn-Yahr stage were risk factors for cognitive impairment in Parkinson’s disease,and were the common influencing factors for cognitive scale scores.Neitherα-pro-GDNF norβ-pro-GDNF was risk factors for cognitive impairment in Parkinson’s disease.A receiver operating characteristic curve of GDNF was generated to predict cognitive function in Parkinson’s disease(area under the curve=0.859).This result indicates that the possibility that serum GDNF can correctly distinguish whether patients with Parkinson’s disease have cognitive impairment is 0.859.Together,these results suggest that serum GDNF may be an effective diagnostic marker for cognitive impairment in Parkinson’s disease.However,α-pro-GDNF andβ-pro-GDNF are not useful for predicting cognitive impairment in this disease.This study was approved by Ethics Committee of the Affiliated Hospital of Xuzhou Medical University,China(approval No.XYFY2017-KL047-01)on November 30,2017.
基金Supported by Beijing Tsinghua Changgung Hospital Fund,No.12015C1042Bethune-Excellent Surgery Fund,No.HZB-20181119-13and Chen Xiaoping Science and Technology Development Fund,No.CXPJH11800004-021.
文摘BACKGROUND Kras mutant colon cancer shows abnormal activation of the nuclear factor kappa-B(NF-κB)pathway,resulting in the proliferation of tumor cells.Treatment with fluorouracil(5-FU)might not achieve the expected inhibition of proliferation of malignant cells based on the fluorouracil-induced activation of the NF-κB pathway.AIM To detect whether interleukin(IL)-1 receptor antagonist(IL-1RA)could increase the chemosensitivity to 5-FU by decreasing the activation of the NF-κB pathway and reducing the proliferation of colon cancer cells.METHODS Western blot analysis was performed to detect the persistent activation of the NF-κB pathway in colon cancer cell lines.Reverse transcription-polymerase chain reaction was used to detect the IL-1RA-reduced expression levels of IL-6,IL-8,IL-17,IL-21 and TLR4 in colon cancer cell lines.We used a xenograft nude mouse model to demonstrate the downregulation of the NF-κB pathway by blocking the NF-κB-regulated IL-1αfeedforward loop,which could increase the efficacy of chemotherapeutic agents in inhibiting tumor cell growth.RESULTS IL-1 receptor antagonist could decrease the expression of IL-1αand IL-1βand downregulate the activity of the NF-κB pathway in Kras mutant colon cancer cells.Treatment with 5-FU combined with IL-1RA could increase the chemosensitivity of the SW620 cell line,and decreased expression of the TAK1/NF-κB and MEK pathways resulted in limited proliferation in the SW620 cell line.CONCLUSION Adjuvant chemotherapy with IL-1RA and 5-FU has a stronger effect than single chemotherapeutic drugs.IL-1RA combined with fluorouracil could be a potential neoadjuvant chemotherapy in the clinic.
文摘Background Anosmia is one of the symptoms in individuals with SARS-CoV-2 infection.In anosmic patients,SARS-CoV-2 temporarily alters the signaling process in olfactory nerve cells and olfactory bulb(OB),which eventually damages the structure of the olfactory epithelium,leading to a permanent disorder in the olfactory pathway that this damaged structure is showed in MRI imaging Method Two investigators independently searched four databases consisting of PubMed,ProQuest,Scopus,and Web of Science for relevant records as of November 11,2020 with no time,space,and language restrictions.Google Scholar was also searched for the related resources within the time limit of 2020.All the found articles were reviewed based on the PRISMA flow diagram.Qualitative studies,case reports,editorials,letters,and other non-original studies were excluded from this systematic analysis.Results Initial search yielded 434 records.After reviewing the titles and abstracts,we selected 74 articles;finally,8 articles were depicted to be investigated and read in full text.The obtained results showed an increase in the width and volume of the olfactory cleft(OC),complete or partial destruction of OC,and complete occlusion of OC in COVID-19 patients.Deformation and degeneration as well as a subtle asymmetry were evident in the OBs.Computed tomography(CT),meganetic resonance imaging(MRI),and positron emission tomography(PET)were used to detect the outcomes of anosmia in these studies.Conclusions The changes in OC are greater than those in OB in patients with COVID-19,mainly due to the inflammatory and immune responses in OC.However,fewer changes in OB are due to neurological or vascular disorders.Topical steroid therapy and topical saline can be helpful.
文摘BACKGROUND Sebaceous lymphadenoma is a benign tumor that occurs rarely in the salivary glands,most commonly in the parotid glands or periparotid lymph nodes,and even more rarely undergoes malignant transformation into a sebaceous lymphadenocarcinoma.CASE SUMMARY We report an 82-year-old woman who presented with a painless mass in the right parotid region.We performed extended surgical resection of the parotid gland mass.Intraoperative pathology revealed a sebaceous lymphadenocarcinoma with metastasis into the periparotid cervical lymph nodes,so we also performed neck dissection and lymph node resection.Postoperative pathology confirmed the diagnosis.The literature review revealed that this was the seventh reported case of sebaceous lymphadenocarcinoma and the second reported case of cervical lymph node metastasis and infiltration of the skin of the parotid gland.CONCLUSION Treatment of sebaceous lymphadenocarcinoma depends on the typing and clinical staging of the cancer.Extensive resection is the first choice,and adjuvant radiotherapy should be given to patients with high-grade tumors or those at an advanced clinical stage.
文摘Objective To assess the accuracy of preoperative serum CA19-9 levels in predicting the resectability of pancreatic adenocarcinoma.Methods Patients with biopsy-proven pancreatic adenocarcinoma who had preoperative serum CA19-9 level data were enrolled in the present retrospective analysis. Receiver operating characteristics(ROC) curve analysis was used to determine the optimal cut-off value of CA19-9. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated at this cut-off point.Results Seventy-six patients with pancreatic adenocarcinoma that was considered potentially resectable according to radiological imaging were included. Of all 76 patients, 44 received complete resection of the pancreatic adenocarcinoma. The preoperative serum CA19-9 level was significantly higher in the unresectable tumor group than in the resectable tumor group(P = 0.0036). The area under the ROC curve was 0.749(95% confidence interval [CI]: 0.637–0.842). When the cut-off value of CA19-9 was set to 359.1 U/m L, the sensitivity, specificity, positive and negative predictive values were 71.9%(95% CI: 53.3%–86.3%), 70.5%(95% CI: 54.8%–83.2%), 63.9%(95% CI: 46.0%–79.4%), and 77.5%(95% CI: 61.5%–89.2%), respectively.Conclusion The preoperative serum CA19-9 level is useful for predicting the resectability of pancreatic adenocarcinoma.
基金supported by the Foundation of the Health and Planning Committee of Sichuan Province(No.17PJ599).
文摘Objective:Chemotherapy significantly improved the survival of breast cancer,but also brings various symptoms and psychological distresses.Cognitive dysfunction was usually ignored.This study aimed to investigate the changes in cognitive function during chemotherapy and its influence on the quality of life in breast cancer patients.Methods:Female patients with newly diagnosed breast cancer have prospectively enrolled in this study.Participants investigated and completed questionnaires at four-time points:pre-chemotherapy(T1),post-chemotherapy(T2),6 months(T3)and 12 months(T4)after the completion of chemotherapy.The Functional Assessment of Cancer Therapy-Cognitive scale and the Functional Assessment of Cancer Therapy-Breast Cancer scale used was to assess the cognitive function and the quality of life,respectively.Data were analyzed using descriptive and repeated-measures analysis of variance statistics.Results:One hundred and eighty-three patients participated in the study and completed questionnaires at least 2 times.The mean score of cognitive function and the quality of life were significantly different at a different time point(P<0.05 for all).The trends of cognitive scores shown that the most serious damage of cognitive function appeared after beginning chemotherapy and followed by a slowly turn back after the completion of chemotherapy.The trend of the mean score of the quality of life after chemotherapy was similar to that of the cognitive score.The degree of cognitive dysfunction was significantly associated with the score of the quality of life at each time point after chemotherapy(P<0.05).Conclusion:Chemotherapy is closely associated with a cognitive impairment,which contributes to a significant decrease in the quality of life of patients with breast cancer.
文摘Malignant tumors are one of the serious public health problems that threaten the survival time of human beings.They are prone to metastasis to distant organs and the central nervous system is one of the common target organs.As it is difficult for chemotherapeutics,targeted drugs and other macromolecules to pass through the blood brain barrier(BBB),local radiation therapy is often used for treating intracranial primary or metastatic tumors.However,whether it is whole brain radiation therapy(WBRT)or stereotactic body radiation therapy(SBRT),the choice of radiation dose is limited by the side effects of radiation therapy on the surrounding normal brain tissues.Radiation-induced brain injury(RBI)can further develop into radiation necrosis(RN)in the late stage.Bevacizumab is often effective against RBI by antagonizing vascular endothelial growth factor(VEGF),but it still cannot completely reverse RN.Emerging treatment options such as human pluripotent stem-cell transplantation have made it possible to reverse the process of RN.
基金This work was supported by grants from the Project Sichuan Science and Technology Department(19YYJC0384)grants from the Project of Nanchong Municipal Research Coorperation with University(18SXHZ0388)Key project of Affiliated Hospital of North Sichuan Medical College(Number:2019ZD006).
文摘Objective:The prognostic value of circulating tumor cells(CTCs)in metastatic breast cancer(MBC)patients was contentious.A meta-analysis was conducted to evaluate whether MBC patients’clinical outcomes could be predicted by CTCs detection.Methods:Relevant published studies were searched through electronic databases from January 1990 to February 2018,among which,those investigated the correlation between CTCs and clinical outcomes of progression-free survival and overall survival in MBC patients were involved.The hazard ratios(HR)and confidence intervals(CI)in the studies were extracted from the study using random or fixed effects model,and the meta-analysis was conducted.The prognostic value of tumor cells in patients with different subtypes was estimated by subgroup analysis.Results:Twenty-one eligible studies enrolling 3,837 patients were appropriate for pooled analysis.Progression-free survival(HR,1.66;95%CI,1.47–1.87;P=0.000)and overall survival(HR,2.51;95%CI,2.13–2.96;P=0.000)were worse in patients with CTCs-positive.Subtypes of hormone receptor(HorR)positive,human epidermal growth factor receptor-2(HER2)negative and triple negative with presence of CTCs showed a statistically significant worse PFS and OS.However,CTCs detection presented no prognostic value in patients with HorR-negative or HER2-positive subtypes.Conclusion:The enumeration of CTCs at baseline in patients with MBC subtypes of HorR-positive,HER2-negative and triple negative is connected with disease progression and poor survival,but inappropriate for HorR-negative and HER2-positive subtypes.
基金supported by grants from the National Natural Science Foundation of China(No.81801175 to Chaoliang Tang)the China Postdoctoral Science Foundation(No.2019M662179)the Anhui Province Postdoctoral Science Foundation(No.2019B324).
文摘Objective:To investigate the prevention and management of perioperative nausea and vomiting and reflux aspiration in painless hysteroscopy patients.Methods:The clinical datum of one patient with reflux and postoperative vomiting and another one with a history of multiple postoperative nausea and vomiting during painless hysteroscopy were retrospectively analyzed.Results:In case 1,despite the occurrence of reflux,no significant aspiration or other serious consequences occurred through positive attraction,ondansetron,dexamethasone,droperidol and other drugs and candy treatment,then nausea and vomiting gradually eased.In case 2,due to the reduction of preoperative dosage of sufentanil,prophylactic application of ondansetron,psychological intervention and postoperative candy,no nausea and vomiting occurred during the painless hysteroscopy.The patient recovered quickly with high satisfaction.Conclusion:Patients with a high risk of nausea and vomiting may be ameliorated by positive psychological and drug intervention.Even if patients have intraoperative reflux and postoperative nausea and vomiting,it can be relieved by psychological and drug treatment,and the occurrence of serious complications such as aspiration can be prevented.
文摘BACKGROUND The frequency and content of follow-up strategies remain controversial for colorectal cancer(CRC),and scheduled follow-ups have limited value.AIM To compare intensive and conventional follow-up strategies for the prognosis of non-metastatic CRC treated with curative intent using a meta-analysis.METHODS PubMed,Embase,and the Cochrane Library databases were systematically searched for potentially eligible randomized controlled trials(RCTs)from inception until April 2023.The Cochrane risk of bias was used to assess the methodological quality of the included studies.The hazard ratio,relative risk,and 95%confidence interval were used to calculate survival and categorical data,and pooled analyses were performed using the random-effects model.Additional exploratory analyses were performed for sensitivity,subgroups,and publication bias.RESULTS Eighteen RCTs involving 8533 patients with CRC were selected for the final analysis.Intensive follow-up may be superior to conventional follow-up in improving overall survival,but this difference was not statistically significant.Moreover,intensive follow-up was associated with an increased incidence of salvage surgery compared to conventional follow-up.In addition,there was no significant difference in the risk of recurrence between intensive and conventional follow-up strategies,whereas intensive follow-up was associated with a reduced risk of interval recurrence compared to conventional follow-up.Finally,the effects of intensive and conventional follow-up strategies differed when stratified by tumor location and follow-up duration.CONCLUSION Intensive follow-up may have a beneficial effect on the overall survival of patients with non-metastatic CRC treated with curative intent.
