Objectives: To summarize the current status and outlook of pancreatic duct drainage in the learning curve period of laparoscopic pancreaticoduodenectomy (LPD). Methods: By searching the literature related to the effic...Objectives: To summarize the current status and outlook of pancreatic duct drainage in the learning curve period of laparoscopic pancreaticoduodenectomy (LPD). Methods: By searching the literature related to the efficacy analysis of internal versus external pancreatic duct drainage in pancreaticoduodenectomy (OPD) and the learning curve period of laparoscopic pancreaticoduodenectomy in recent years at home and abroad and making a review. Results: Because of the complexity of the LPD surgical procedure, the high technical requirements and the high complication rate, it is necessary for the operator and his/her team to carry out a certain number of cases to pass through the learning curve in order to have a basic mastery of the procedure. In recent years, more and more pancreatic surgeons have begun to promote and use pancreatic duct drains. However, no consensus conclusion has been reached on whether to choose internal or external drainage for pancreatic duct placement and drainage in LPD. Conclusions: Intraoperative application of pancreatic duct drainage reduces the incidence of pancreatic fistula during the learning curve of laparoscopic pancreaticoduodenectomy. However, external pancreatic duct drainage and internal pancreatic duct drainage have both advantages and disadvantages, so when choosing the drainage method, one should choose the appropriate drainage method in conjunction with one’s own conditions, so as to reduce the incidence of complications.展开更多
BACKGROUND Hypertension is a major risk factor for cardiovascular disease and stroke,and its prevalence is increasing worldwide.Health education interventions based on the health belief model(HBM)can improve the knowl...BACKGROUND Hypertension is a major risk factor for cardiovascular disease and stroke,and its prevalence is increasing worldwide.Health education interventions based on the health belief model(HBM)can improve the knowledge,attitudes,and behaviors of patients with hypertension and help them control their blood pressure.AIM To evaluate the effects of health education interventions based on the HBM in patients with hypertension in China.METHODS Between 2021 and 2023,140 patients with hypertension were randomly assigned to either the intervention or control group.The intervention group received health education based on the HBM,including lectures,brochures,videos,and counseling sessions,whereas the control group received routine care.Outcomes were measured at baseline,three months,and six months after the intervention and included blood pressure,medication adherence,self-efficacy,and perceived benefits,barriers,susceptibility,and severity.RESULTS The intervention group had significantly lower systolic blood pressure[mean difference(MD):-8.2 mmHg,P<0.001]and diastolic blood pressure(MD:-5.1 mmHg,P=0.002)compared to the control group at six months.The intervention group also had higher medication adherence(MD:1.8,P<0.001),self-efficacy(MD:12.4,P<0.001),perceived benefits(MD:3.2,P<0.001),lower perceived barriers(MD:-2.6,P=0.001),higher perceived susceptibility(MD:2.8,P=0.002),and higher perceived severity(MD:3.1,P<0.001)than the control group at six months.CONCLUSION Health education interventions based on the HBM effectively improve blood pressure control and health beliefs in patients with hypertension and should be implemented in clinical practice and community settings.展开更多
BACKGROUND： Severe acute pancreatitis（SAP） remains a clinical challenge with considerable morbidity and mortality.An early identification of infected pancreatic necrosis（IPN）, a life-threatening evolution seconda...BACKGROUND： Severe acute pancreatitis（SAP） remains a clinical challenge with considerable morbidity and mortality.An early identification of infected pancreatic necrosis（IPN）, a life-threatening evolution secondary to SAP, is obliged for a more preferable prognosis. Thus, the present study was conducted to identify the risk factors of IPN secondary to SAP. METHODS： The clinical data of patients with SAP were retrospectively analyzed. Univariate and multivariate logistic regression analyses were sequentially performed to assess the associations between the variables and the development of IPN secondary to SAP. A receiver operating characteristic（ROC） curve was created for each of the qualified independent risk factors. RESULTS： Of the 115 eligible patients, 39（33.9%） progressed to IPN, and the overall in-hospital mortality was 11.3%（13/115）.The early enteral nutrition（EEN）（P=0.0092, OR=0.264）, maximum intra-abdominal pressure（IAP）（P=0.0398, OR=1.131）and maximum D-dimer level（P=0.0001, OR=1.006） in the first three consecutive days were independent risk factors associated with IPN secondary to SAP. The area under ROC curve（AUC） was 0.774 for the maximum D-dimer level in the first three consecutive days and the sensitivity was 90% and the specificity was 58% at a cut-off value of 933.5 μg/L; the AUC was 0.831 for the maximum IAP in the first three consecutive days and the sensitivity was 95% and specificity was 58%at a cut-off value of 13.5 mm Hg. CONCLUSIONS： The present study suggested that the maximum D-dimer level and/or maximum IAP in the first three consecutive days after admission were risk factors of IPN secondary to SAP; an EEN might be helpful to prevent the progression of IPN secondary to SAP.展开更多
In order to advance microbiota-based therapies for cold-related diseases,it is crucial to fundamentally understand the intricate connections between cold exposure and the influence on gut microbiota composition.Identi...In order to advance microbiota-based therapies for cold-related diseases,it is crucial to fundamentally understand the intricate connections between cold exposure and the influence on gut microbiota composition.Identifying unique cold-related microbes and understanding their functionalities will be pivotal in developing effective treatments for cold-related diseases.展开更多
Acute pancreatitis(AP)is one of the most common acute abdomen diseases with increasing incidence and substantial healthcare burden.Gut microbiota disturbance,mucosal barrier failure,and bacterial translocation are ide...Acute pancreatitis(AP)is one of the most common acute abdomen diseases with increasing incidence and substantial healthcare burden.Gut microbiota disturbance,mucosal barrier failure,and bacterial translocation are identified as the dominant cause of infected pancreatic necrosis and high mortality.With the advance of high-throughput sequencing,imbalance between beneficial and facultative pathogenic microorganisms with their metabolic activities in the development of AP has been increasingly recognized,whereas it remains unclear whether dysbacteriosis is the dominant cause of aggravating AP,or merely reflecting different epidemiological or environmental factors at the individual level.This review discussed the alterations of the gut microbiota and their metabolites during AP with detailed molecular mechanisms.Importantly,it highlights microbiome-based medical therapies which influence gut barrier function and immune homeostasis to mitigate inflammatory responses in AP.Our review will provide a novel roadmap of gastrointestinal microecology in AP progression,and contribute to the future development of microbiome-based diagnostic and therapeutic strategies in clinical practice.展开更多
Many management strategies are available for pancreatic neuroendocrine neoplasms with liver metastases.However,a lack of biological,molecular,and genomic information and an absence of data from rigorous trials limit t...Many management strategies are available for pancreatic neuroendocrine neoplasms with liver metastases.However,a lack of biological,molecular,and genomic information and an absence of data from rigorous trials limit the validity of these strategies.This review presents the viewpoints from an international conference consisting of several expert working groups.The working groups reviewed a series of questions of particular interest to clinicians taking care of patients with pancreatic neuroendocrine neoplasms with liver metastases by reviewing the existing management strategies and literature,evaluating the evidence on which management decisions were based,developing internationally acceptable recommendations for clinical practice,and making recommendations for clinical and research endeavors.The review for each question will be followed by recommendations from the panel.展开更多
BACKGROUND Whether regional lymphadenectomy(RL)should be routinely performed in patients with T1b gallbladder cancer(GBC)remains a subject of debate.AIM To investigate whether RL can improve the prognosis of patients ...BACKGROUND Whether regional lymphadenectomy(RL)should be routinely performed in patients with T1b gallbladder cancer(GBC)remains a subject of debate.AIM To investigate whether RL can improve the prognosis of patients with T1b GBC.METHODS We studied a multicenter cohort of patients with T1b GBC who underwent surgery between 2008 and 2016 at 24 hospitals in 13 provinces in China.The logrank test and Cox proportional hazards model were used to compare the overall survival(OS)of patients who underwent cholecystectomy(Ch)+RL and those who underwent Ch only.To investigate whether combined hepatectomy(Hep)improved OS in T1b patients,we studied patients who underwent Ch+RL to compare the OS of patients who underwent combined Hep and patients who did not.RESULTS Of the 121 patients(aged 61.9±10.1 years),77(63.6%)underwent Ch+RL,and 44(36.4%)underwent Ch only.Seven(9.1%)patients in the Ch+RL group had lymph node metastasis.The 5-year OS rate was significantly higher in the Ch+RL group than in the Ch group(76.3%vs 56.8%,P=0.036).Multivariate analysis showed that Ch+RL was significantly associated with improved OS(hazard ratio:0.51;95%confidence interval:0.26-0.99).Among the 77 patients who underwent Ch+RL,no survival improvement was found in patients who underwent combined Hep(5-year OS rate:79.5%for combined Hep and 76.1%for no Hep;P=0.50).CONCLUSION T1b GBC patients who underwent Ch+RL had a better prognosis than those who underwent Ch.Hep+Ch showed no improvement in prognosis in T1b GBC patients.Although recommended by both the National Comprehensive Cancer Network and Chinese Medical Association guidelines,RL was only performed in 63.6%of T1b GBC patients.Routine Ch+RL should be advised in T1b GBC.展开更多
A consensus statement on the diagnosis and treatment of pancreatic exocrine insufficiency(PEI)after pancreatic surgery was developed based on the latest references,combined with China’s actual situation.More than 20 ...A consensus statement on the diagnosis and treatment of pancreatic exocrine insufficiency(PEI)after pancreatic surgery was developed based on the latest references,combined with China’s actual situation.More than 20 Chinese excellent experts participated in this work and contributed many thorough discussions.This consensus discusses the definition,epidemiology,diagnosis,treatment,and follow-up of PEI after pancreatic surgery.The authors hope this consensus will promote the standard procedure of diagnosis and treatment of PEI in China.展开更多
BACKGROUND Littoral cell angioma(LCA)is a rare benign vascular tumor of the spleen.Given its rarity,standard diagnostic and therapeutic recommendations have yet to be developed for reported cases.Splenectomy is the on...BACKGROUND Littoral cell angioma(LCA)is a rare benign vascular tumor of the spleen.Given its rarity,standard diagnostic and therapeutic recommendations have yet to be developed for reported cases.Splenectomy is the only method of obtaining a pathological diagnosis and providing treatment to obtain a favorable prognosis.CASE SUMMARY A 33-year-old female presented with abdominal pain for one month.Computed tomography and ultrasound revealed splenomegaly with multiple lesions and two accessory spleens.The patient underwent laparoscopic total splenectomy and accessory splenectomy,and splenic LCA was confirmed by pathology.Four months after surgery,the patient presented with acute liver failure,was readmitted,rapidly progressed to multiple organ dysfunction syndrome and died.CONCLUSION Preoperative diagnosis of LCA is challenging.We systematically reviewed online databases to identify the relevant literature and found a close relationship between malignancy and immunodysregulation.When a patient suffers from both splenic tumors and malignancy or immune-related disease,LCA is possible.Due to potential malignancy,total splenectomy(including accessory spleen)and regular follow-up after surgery are recommended.If LCA is diagnosed after surgery,a comprehensive postoperative examination is needed.展开更多
The incidence of pancreatic cancer has been rising worldwide,and its clinical diagnosis and treatment remain a great challenge.To present the update and improvements in the clinical diagnosis and treatment of pancreat...The incidence of pancreatic cancer has been rising worldwide,and its clinical diagnosis and treatment remain a great challenge.To present the update and improvements in the clinical diagnosis and treatment of pancreatic cancer in recent years,Chinese Pancreatic Association,the Chinese Society of Surgery,Chinese Medical Association revised the Guidelines for the Diagnosis and Treatment of Pancreatic Cancer in China(2014)after reviewing evidence-based and problem-oriented literature published during 2015-2021,mainly focusing on highlight issues regarding diagnosis and surgical treatment of pancreatic cancer,conversion strategies for locally advanced pancreatic cancer,treatment of pancreatic cancer with oligo metastasis,adjuvant and neoadjuvant therapy,standardized processing of surgical specimens and evaluation of surgical margin status,systemic treatment for unresectable pancreatic cancer,genetic testing,as well as postoperative follow up of patients with pancreatic cancer.Forty recommendation items were finally proposed based on the above issues,and the quality of evidence and strength of recommendations were graded using the Grades of Recommendation,Assessment,Development,and Evaluation system.This guideline aims to standardize the clinical diagnosis and therapy,especially surgical treatment of pancreatic cancer in China,and further improve the prognosis of patients with pancreatic cancer.展开更多
Acute pancreatitis(AP)is a common acute abdominal condition of the digestive system.In recent years,treatment concepts,methods,and strategies for the diagnosis of AP have advanced,and this has played an important role...Acute pancreatitis(AP)is a common acute abdominal condition of the digestive system.In recent years,treatment concepts,methods,and strategies for the diagnosis of AP have advanced,and this has played an important role in promoting the standardization of AP diagnosis and treatment and improving the treatment quality of AP patients.On the basis of previous guidelines and expert consensus,this guideline adopts an evidence-based,problem-based expression;synthesizes important clinical research data at home and abroad in the most recent 5 years;and forms 29 recommendations through multidisciplinary expert discussion,including diagnosis,treatment,and follow-up.It is expected to provide evidence support for the treatment of AP in the clinical setting in China.展开更多
Background Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to inves...Background Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to investigate the current status of digestive tract reconstruction after PD in university hospitals in China.Method A cross-sectional survey was conducted among the members of the Young Elite Pancreatic Surgery Club of China by using the Questionnaire for Digestive Tract Reconstruction after Pancreaticoduodenectomy.The questionnaire was disseminated and collected by point-to-point communication via WeChat public platforms.Results A total of 73 valid questionnaires were returned from 65 university hospitals in 28 provincial divisions of China's Mainland.The respondents who performed PD surgery with an annual volume of over 100 cases accounted for 63%.Generally,laparoscopic PD was performed less often than open PD.Child and Whipple reconstructions accounted for 70%and 26%,respectively.The sequence of pancreatoenteric,biliary-enteric,and gastrointestinal reconstruction accounted for 84%of cases.In pancreatoenteric anastomosis,double-layer anastomosis is the most commonly employed type,accounting for approximately 67%,while single-layer anastomosis accounts for 30%.Of the double-layer anastomoses,duct-to-mucosa/dunking(94%/4%)PJ was performed with duct-mucosa using the Blumgart method(39%)and Cattel-Warren(29%),with continuous/interrupted sutures in the inner layer(69%/31%)and continuous/interrupted sutures in the outer layer(53%/23%).In single-layer anastomosis,continuous/interrupted sutures accounted for 41%/45%.In hepatojejunostomy,single-layer/double-layer suture accounted for 79%/4%,and continuous/interrupted suture accounted for 75%/9%.Forty-six percent of the responding units had not applied double-layer biliary-intestinal anastomosis in the last 3 years,75%of the responding surgeons chose the anastomosis method according to bile duct diameter,with absorbable/non-absorbable suture accounting for 86%/12%.PD/pylorus-preserving PD accounted for 79%/11%of GJ cases,the distance between GJ and HJ<30 cm,30-50 cm and>50 cm were 11%,75%,and 14%,respectively.Antecolic/retrocolic GJ accounted for 71%/23%of cases.Twenty-two percent of GJ cases employed Braun anastomosis,while 55%and 19%of GJ cases used linear cutting staplers/tube-type staplers,respectively;60%/14%were reinforced/not reinforced via manual suturing after stapler anastomosis.Manual anastomosis in GJ surgery employed absorbable/non-absorbable sutures(91%/9%).Significant differences in reconstruction techniques were detected between different volumes of PD procedures(<100/year and>100/year),regions with different economic development levels,and between north and south China.Conclusion Digestive tract reconstruction following PD exists heterogeneity in Chinese university hospitals.Corresponding prospective clinical studies are needed to determine the consensus on pancreatic surgery that meets the clinical reality in China.展开更多
Background:Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to inves...Background:Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to investigate the current status of digestive tract reconstruction after PD in university hospitals in China.Method:A cross-sectional survey was conducted among the members of the Young Elite Pancreatic Surgery Club of China by using the Questionnaire for Digestive Tract Reconstruction after Pancreaticoduodenectomy.The questionnaire was disseminated and collected by point-to-point communication via WeChat public platforms.Results:A total of 73 valid questionnaires were returned from 65 university hospitals in 28 provincial divisions of China's Mainland.The respondents who performed PD surgery with an annual volume of over 100 cases accounted for 63%.Generally,laparoscopic PD was performed less often than open PD.Child and Whipple reconstructions accounted for 70%and 26%,respectively.The sequence of pancreatoenteric,biliary-enteric,and gastrointestinal reconstruction accounted for 84%of cases.In pancreatoenteric anastomosis,double-layer anastomosis is the most commonly employed type,accounting for approximately 67%,while single-layer anastomosis accounts for 30%.Of the double-layer anastomoses,duct-to-mucosa/dunking(94%/4%)pancreatojejunostomy was performed with duct-mucosa using the Blumgart method(39%)and Cattel-Warren(29%),with continuous/interrupted sutures in the inner layer(69%/31%)and continuous/interrupted sutures in the outer layer(53%/23%).In single-layer anastomosis,continuous/interrupted sutures accounted for 41%/45%.In hepatojejunostomy,single-layer/double-layer suture accounted for 79%/4%,and continuous/interrupted suture accounted for 75%/9%.Forty-six percent of the responding units had not applied double-layer biliary-intestinal anastomosis in the last 3 years,75%of the responding surgeons chose the anastomosis method according to bile duct diameter,with absorbable/non-absorbable suture accounting for 86%/12%.PD/pylorus-preserving PD accounted for 79%/11%of gastrojejunostomy(GJ)cases,the distance between GJ and hepaticojejunostomy<30,30-50,and>50 cm were 11%,75%,and 14%,respectively.Antecolic/retrocolic GJ accounted for 71%/23%of cases.Twenty-two percent of GJ cases employed Braun anastomosis,while 55%and 19%of GJ cases used linear cutting staplers/tube-type staplers,respectively;60%/14%were reinforced/not reinforced via manual suturing after stapler anastomosis.Manual anastomosis in GJ surgery employed absorbable/non-absorbable sutures(91%/9%).Significant differences in reconstruction techniques were detected between different volumes of PD procedures(<100/year and>100/year),regions with different economic development levels,and between north and south China.Conclusion:Digestive tract reconstruction following PD exists heterogeneity in Chinese university hospitals.Corresponding prospective clinical studies are needed to determine the consensus on pancreatic surgery that meets the clinical reality in China.展开更多
Background:Our previous study demonstrated that aldolase A(ALDOA)is overexpressed in clinical human lung squamous cell carcinoma and that ALDOA promotes epithelial-mesenchymal transition and tumorigenesis.The pre-sent...Background:Our previous study demonstrated that aldolase A(ALDOA)is overexpressed in clinical human lung squamous cell carcinoma and that ALDOA promotes epithelial-mesenchymal transition and tumorigenesis.The pre-sent study aimed to explore the function of ALDOA in the modulation of non-small cell lung cancer(NSCLC)prolifera-tion and cell cycle progression and the potential mechanism.Methods:ALDOA was knocked down by short hairpin RNA in H520 and H1299 cells.ALDOA was overexpressed with vectors carrying the full-length ALDOA sequence in H1299 and H157 cells.The proliferation capacities were assessed with immunohistochemical staining,Cell Counting Kit-8 and colony formation assays.The cell cycle distribution was examined by flow cytometry,and molecular alterations were determined by western blotting.Cell synchronization was induced with nocodazole.The stability of cyclin D1 mRNA was tested.The pyruvate kinase M2 and ALDOA protein distributions were examined.Aerobic glycolysis was evaluated with Cell Titer-Glo assay,glucose colorimetric assay and lactate colorimetric assay.Results:ALDOA knockdown inhibited the proliferation and G1/S transition in H520 cells.Conversely,ALDOA over-expression promoted the proliferation and G1/S transition in H157 cells.The cell cycle synchronization assay showed that ALDOA expression increased in the G1 phase and G1/S transition.Furthermore,ALDOA knockdown reduced cyclin D1 expression by regulating epidermal growth factor receptor/mitogen-activated protein kinase(EGFR/MAPK)pathway.Similar results were found in H1299 and H157 cells.The inhibition of mitogen-activated protein kinase kinase 1/2 prompted the nuclear distribution of ALDOA.Additionally,ALDOA knockdown reduced nuclear distribution of PKM2,the extracellular lactate and intracellular adenosine triphosphate concentrations and elevated the extracellular glucose concentration.Conclusions:ALDOA contributed to activation of the EGFR/MAPK pathway,thus promoting cyclin D1 expression and enhancing proliferation and G1/S transition in NSCLC.Additionally,ALDOA facilitated NSCLC aerobic glycolysis.展开更多
Acute pancreatitis(AP)is a complicated disease with rising incidence over the years.Twenty percent of AP will develop into acute necrotizing pancreatitis(ANP).Interventions for ANP have evolved from traditional open s...Acute pancreatitis(AP)is a complicated disease with rising incidence over the years.Twenty percent of AP will develop into acute necrotizing pancreatitis(ANP).Interventions for ANP have evolved from traditional open surgery to minimally invasive step-up approaches.Infected pancreatic necrosis(IPN)is the most serious event of ANP and associated with extremely poor prognosis.The contrast-enhanced computed tomography(CECT)-based classification of IPN describes various types of IPN and will help to carry out surgical interventions for each subtype.Nevertheless,many challenges are still remaining during the treatment of ANP.Including the balance between endoscopic and surgical approaches,and the selection of optimal timing of surgical intervention for infected necrosis.In nowadays treatment scenario of ANP,the necessity for open surgery remains to be debated.Despite of the development of advanced interventional techniques,postoperative residual infection(PRI)remains thorny,and effective prevention and treatment of PRI is of significance.展开更多
Acute pancreatitis(AP)is a complicated disease with rising incidence over the years.20%of AP will develop into acute necrotizing pancreatitis(ANP).Interventions for ANP have evolved from traditional open surgery to mi...Acute pancreatitis(AP)is a complicated disease with rising incidence over the years.20%of AP will develop into acute necrotizing pancreatitis(ANP).Interventions for ANP have evolved from traditional open surgery to minimally invasive step-up approaches.Infected pancreatic necrosis(IPN)is the most serious event of ANP and associated with extremely poor prognosis.The CT-based classification of IPN describes various types of IPN and will help to carry out surgical interventions for each subtype.Nevertheless,many challenges are still remaining during the treatment of ANP.Including the balance between endoscopic and surgical approaches,and the selection of optimal timing of surgical intervention for infected necrosis.In nowadays treatment scenario of ANP,the necessity for open surgery remains to be debated.Despite of the development of advanced interventional techniques,postoperative residual infection(PRI)remains thorny,and effective prevention and treatment of PRI is of significance.展开更多
文摘Objectives: To summarize the current status and outlook of pancreatic duct drainage in the learning curve period of laparoscopic pancreaticoduodenectomy (LPD). Methods: By searching the literature related to the efficacy analysis of internal versus external pancreatic duct drainage in pancreaticoduodenectomy (OPD) and the learning curve period of laparoscopic pancreaticoduodenectomy in recent years at home and abroad and making a review. Results: Because of the complexity of the LPD surgical procedure, the high technical requirements and the high complication rate, it is necessary for the operator and his/her team to carry out a certain number of cases to pass through the learning curve in order to have a basic mastery of the procedure. In recent years, more and more pancreatic surgeons have begun to promote and use pancreatic duct drains. However, no consensus conclusion has been reached on whether to choose internal or external drainage for pancreatic duct placement and drainage in LPD. Conclusions: Intraoperative application of pancreatic duct drainage reduces the incidence of pancreatic fistula during the learning curve of laparoscopic pancreaticoduodenectomy. However, external pancreatic duct drainage and internal pancreatic duct drainage have both advantages and disadvantages, so when choosing the drainage method, one should choose the appropriate drainage method in conjunction with one’s own conditions, so as to reduce the incidence of complications.
文摘BACKGROUND Hypertension is a major risk factor for cardiovascular disease and stroke,and its prevalence is increasing worldwide.Health education interventions based on the health belief model(HBM)can improve the knowledge,attitudes,and behaviors of patients with hypertension and help them control their blood pressure.AIM To evaluate the effects of health education interventions based on the HBM in patients with hypertension in China.METHODS Between 2021 and 2023,140 patients with hypertension were randomly assigned to either the intervention or control group.The intervention group received health education based on the HBM,including lectures,brochures,videos,and counseling sessions,whereas the control group received routine care.Outcomes were measured at baseline,three months,and six months after the intervention and included blood pressure,medication adherence,self-efficacy,and perceived benefits,barriers,susceptibility,and severity.RESULTS The intervention group had significantly lower systolic blood pressure[mean difference(MD):-8.2 mmHg,P<0.001]and diastolic blood pressure(MD:-5.1 mmHg,P=0.002)compared to the control group at six months.The intervention group also had higher medication adherence(MD:1.8,P<0.001),self-efficacy(MD:12.4,P<0.001),perceived benefits(MD:3.2,P<0.001),lower perceived barriers(MD:-2.6,P=0.001),higher perceived susceptibility(MD:2.8,P=0.002),and higher perceived severity(MD:3.1,P<0.001)than the control group at six months.CONCLUSION Health education interventions based on the HBM effectively improve blood pressure control and health beliefs in patients with hypertension and should be implemented in clinical practice and community settings.
基金supported by grants from the National Natural Science Foundation of China(81372613 and 81170431)Doctoral Fund of Ministry of Education of China(21022307110012)Special Fund of Ministry of Public Health of China(210202007)
文摘BACKGROUND： Severe acute pancreatitis（SAP） remains a clinical challenge with considerable morbidity and mortality.An early identification of infected pancreatic necrosis（IPN）, a life-threatening evolution secondary to SAP, is obliged for a more preferable prognosis. Thus, the present study was conducted to identify the risk factors of IPN secondary to SAP. METHODS： The clinical data of patients with SAP were retrospectively analyzed. Univariate and multivariate logistic regression analyses were sequentially performed to assess the associations between the variables and the development of IPN secondary to SAP. A receiver operating characteristic（ROC） curve was created for each of the qualified independent risk factors. RESULTS： Of the 115 eligible patients, 39（33.9%） progressed to IPN, and the overall in-hospital mortality was 11.3%（13/115）.The early enteral nutrition（EEN）（P=0.0092, OR=0.264）, maximum intra-abdominal pressure（IAP）（P=0.0398, OR=1.131）and maximum D-dimer level（P=0.0001, OR=1.006） in the first three consecutive days were independent risk factors associated with IPN secondary to SAP. The area under ROC curve（AUC） was 0.774 for the maximum D-dimer level in the first three consecutive days and the sensitivity was 90% and the specificity was 58% at a cut-off value of 933.5 μg/L; the AUC was 0.831 for the maximum IAP in the first three consecutive days and the sensitivity was 95% and specificity was 58%at a cut-off value of 13.5 mm Hg. CONCLUSIONS： The present study suggested that the maximum D-dimer level and/or maximum IAP in the first three consecutive days after admission were risk factors of IPN secondary to SAP; an EEN might be helpful to prevent the progression of IPN secondary to SAP.
文摘In order to advance microbiota-based therapies for cold-related diseases,it is crucial to fundamentally understand the intricate connections between cold exposure and the influence on gut microbiota composition.Identifying unique cold-related microbes and understanding their functionalities will be pivotal in developing effective treatments for cold-related diseases.
基金supported by the National Natural Science Foundation of China(82270665,82070658,81871974)the Natural Science Foundation of Heilongjiang Province(TD2021H001)the Open Fund of Key Laboratory of Hepatoaplenic Surgery,Ministry of Education,Harbin,China(GPKF202201).
文摘Acute pancreatitis(AP)is one of the most common acute abdomen diseases with increasing incidence and substantial healthcare burden.Gut microbiota disturbance,mucosal barrier failure,and bacterial translocation are identified as the dominant cause of infected pancreatic necrosis and high mortality.With the advance of high-throughput sequencing,imbalance between beneficial and facultative pathogenic microorganisms with their metabolic activities in the development of AP has been increasingly recognized,whereas it remains unclear whether dysbacteriosis is the dominant cause of aggravating AP,or merely reflecting different epidemiological or environmental factors at the individual level.This review discussed the alterations of the gut microbiota and their metabolites during AP with detailed molecular mechanisms.Importantly,it highlights microbiome-based medical therapies which influence gut barrier function and immune homeostasis to mitigate inflammatory responses in AP.Our review will provide a novel roadmap of gastrointestinal microecology in AP progression,and contribute to the future development of microbiome-based diagnostic and therapeutic strategies in clinical practice.
基金supported by the National Natural Science Foundation of China(Grant number,82141127).
文摘Many management strategies are available for pancreatic neuroendocrine neoplasms with liver metastases.However,a lack of biological,molecular,and genomic information and an absence of data from rigorous trials limit the validity of these strategies.This review presents the viewpoints from an international conference consisting of several expert working groups.The working groups reviewed a series of questions of particular interest to clinicians taking care of patients with pancreatic neuroendocrine neoplasms with liver metastases by reviewing the existing management strategies and literature,evaluating the evidence on which management decisions were based,developing internationally acceptable recommendations for clinical practice,and making recommendations for clinical and research endeavors.The review for each question will be followed by recommendations from the panel.
基金National Natural Science Foundation of China(General Program),No.31620103910National Natural Science Foundation of China(Key Program),No.81874181+3 种基金National Health Commission of China,No.2019ZX09301158Shanghai Municipal Commission of Economy and Informatization,No.2019RGZN01096Shanghai Shenkang Hospital Development Center,No.12018107and Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,No.19XHCR13D.
文摘BACKGROUND Whether regional lymphadenectomy(RL)should be routinely performed in patients with T1b gallbladder cancer(GBC)remains a subject of debate.AIM To investigate whether RL can improve the prognosis of patients with T1b GBC.METHODS We studied a multicenter cohort of patients with T1b GBC who underwent surgery between 2008 and 2016 at 24 hospitals in 13 provinces in China.The logrank test and Cox proportional hazards model were used to compare the overall survival(OS)of patients who underwent cholecystectomy(Ch)+RL and those who underwent Ch only.To investigate whether combined hepatectomy(Hep)improved OS in T1b patients,we studied patients who underwent Ch+RL to compare the OS of patients who underwent combined Hep and patients who did not.RESULTS Of the 121 patients(aged 61.9±10.1 years),77(63.6%)underwent Ch+RL,and 44(36.4%)underwent Ch only.Seven(9.1%)patients in the Ch+RL group had lymph node metastasis.The 5-year OS rate was significantly higher in the Ch+RL group than in the Ch group(76.3%vs 56.8%,P=0.036).Multivariate analysis showed that Ch+RL was significantly associated with improved OS(hazard ratio:0.51;95%confidence interval:0.26-0.99).Among the 77 patients who underwent Ch+RL,no survival improvement was found in patients who underwent combined Hep(5-year OS rate:79.5%for combined Hep and 76.1%for no Hep;P=0.50).CONCLUSION T1b GBC patients who underwent Ch+RL had a better prognosis than those who underwent Ch.Hep+Ch showed no improvement in prognosis in T1b GBC patients.Although recommended by both the National Comprehensive Cancer Network and Chinese Medical Association guidelines,RL was only performed in 63.6%of T1b GBC patients.Routine Ch+RL should be advised in T1b GBC.
文摘A consensus statement on the diagnosis and treatment of pancreatic exocrine insufficiency(PEI)after pancreatic surgery was developed based on the latest references,combined with China’s actual situation.More than 20 Chinese excellent experts participated in this work and contributed many thorough discussions.This consensus discusses the definition,epidemiology,diagnosis,treatment,and follow-up of PEI after pancreatic surgery.The authors hope this consensus will promote the standard procedure of diagnosis and treatment of PEI in China.
基金Supported by the National Natural Science Foundation of China,No.81972230Hubei Technological Innovation Special Fund(CN),No.CXPJJH11800004-004,No.CXPJJH122002-063,and No.CXPJJH122002-092+6 种基金University Nursing Program for Young Scholar with Creative Talents in Heilongjiang Province,No.UNPYSCT-2017064Postdoctoral Foundation of Hei Long Jiang Province,No.LBH-Z20196 and No.LBH-Z20178China Postdoctoral Science Foundation,No.2021MD703835Wu Jie-Ping Medical Foundation,No.320.6750.2021-23-22Open Fund of Key Laboratory of Hepatosplenic Surgery,Ministery of Education,Harbin,China,No.GPKF202204Excellent Youth Science Fund of the First Hopital of Harbin Medical University,No.2021Y01Scientifc Foundation of the First Afliated Hospital of Harbin Medical University,No.2021B03。
文摘BACKGROUND Littoral cell angioma(LCA)is a rare benign vascular tumor of the spleen.Given its rarity,standard diagnostic and therapeutic recommendations have yet to be developed for reported cases.Splenectomy is the only method of obtaining a pathological diagnosis and providing treatment to obtain a favorable prognosis.CASE SUMMARY A 33-year-old female presented with abdominal pain for one month.Computed tomography and ultrasound revealed splenomegaly with multiple lesions and two accessory spleens.The patient underwent laparoscopic total splenectomy and accessory splenectomy,and splenic LCA was confirmed by pathology.Four months after surgery,the patient presented with acute liver failure,was readmitted,rapidly progressed to multiple organ dysfunction syndrome and died.CONCLUSION Preoperative diagnosis of LCA is challenging.We systematically reviewed online databases to identify the relevant literature and found a close relationship between malignancy and immunodysregulation.When a patient suffers from both splenic tumors and malignancy or immune-related disease,LCA is possible.Due to potential malignancy,total splenectomy(including accessory spleen)and regular follow-up after surgery are recommended.If LCA is diagnosed after surgery,a comprehensive postoperative examination is needed.
文摘The incidence of pancreatic cancer has been rising worldwide,and its clinical diagnosis and treatment remain a great challenge.To present the update and improvements in the clinical diagnosis and treatment of pancreatic cancer in recent years,Chinese Pancreatic Association,the Chinese Society of Surgery,Chinese Medical Association revised the Guidelines for the Diagnosis and Treatment of Pancreatic Cancer in China(2014)after reviewing evidence-based and problem-oriented literature published during 2015-2021,mainly focusing on highlight issues regarding diagnosis and surgical treatment of pancreatic cancer,conversion strategies for locally advanced pancreatic cancer,treatment of pancreatic cancer with oligo metastasis,adjuvant and neoadjuvant therapy,standardized processing of surgical specimens and evaluation of surgical margin status,systemic treatment for unresectable pancreatic cancer,genetic testing,as well as postoperative follow up of patients with pancreatic cancer.Forty recommendation items were finally proposed based on the above issues,and the quality of evidence and strength of recommendations were graded using the Grades of Recommendation,Assessment,Development,and Evaluation system.This guideline aims to standardize the clinical diagnosis and therapy,especially surgical treatment of pancreatic cancer in China,and further improve the prognosis of patients with pancreatic cancer.
文摘Acute pancreatitis(AP)is a common acute abdominal condition of the digestive system.In recent years,treatment concepts,methods,and strategies for the diagnosis of AP have advanced,and this has played an important role in promoting the standardization of AP diagnosis and treatment and improving the treatment quality of AP patients.On the basis of previous guidelines and expert consensus,this guideline adopts an evidence-based,problem-based expression;synthesizes important clinical research data at home and abroad in the most recent 5 years;and forms 29 recommendations through multidisciplinary expert discussion,including diagnosis,treatment,and follow-up.It is expected to provide evidence support for the treatment of AP in the clinical setting in China.
文摘Background Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to investigate the current status of digestive tract reconstruction after PD in university hospitals in China.Method A cross-sectional survey was conducted among the members of the Young Elite Pancreatic Surgery Club of China by using the Questionnaire for Digestive Tract Reconstruction after Pancreaticoduodenectomy.The questionnaire was disseminated and collected by point-to-point communication via WeChat public platforms.Results A total of 73 valid questionnaires were returned from 65 university hospitals in 28 provincial divisions of China's Mainland.The respondents who performed PD surgery with an annual volume of over 100 cases accounted for 63%.Generally,laparoscopic PD was performed less often than open PD.Child and Whipple reconstructions accounted for 70%and 26%,respectively.The sequence of pancreatoenteric,biliary-enteric,and gastrointestinal reconstruction accounted for 84%of cases.In pancreatoenteric anastomosis,double-layer anastomosis is the most commonly employed type,accounting for approximately 67%,while single-layer anastomosis accounts for 30%.Of the double-layer anastomoses,duct-to-mucosa/dunking(94%/4%)PJ was performed with duct-mucosa using the Blumgart method(39%)and Cattel-Warren(29%),with continuous/interrupted sutures in the inner layer(69%/31%)and continuous/interrupted sutures in the outer layer(53%/23%).In single-layer anastomosis,continuous/interrupted sutures accounted for 41%/45%.In hepatojejunostomy,single-layer/double-layer suture accounted for 79%/4%,and continuous/interrupted suture accounted for 75%/9%.Forty-six percent of the responding units had not applied double-layer biliary-intestinal anastomosis in the last 3 years,75%of the responding surgeons chose the anastomosis method according to bile duct diameter,with absorbable/non-absorbable suture accounting for 86%/12%.PD/pylorus-preserving PD accounted for 79%/11%of GJ cases,the distance between GJ and HJ<30 cm,30-50 cm and>50 cm were 11%,75%,and 14%,respectively.Antecolic/retrocolic GJ accounted for 71%/23%of cases.Twenty-two percent of GJ cases employed Braun anastomosis,while 55%and 19%of GJ cases used linear cutting staplers/tube-type staplers,respectively;60%/14%were reinforced/not reinforced via manual suturing after stapler anastomosis.Manual anastomosis in GJ surgery employed absorbable/non-absorbable sutures(91%/9%).Significant differences in reconstruction techniques were detected between different volumes of PD procedures(<100/year and>100/year),regions with different economic development levels,and between north and south China.Conclusion Digestive tract reconstruction following PD exists heterogeneity in Chinese university hospitals.Corresponding prospective clinical studies are needed to determine the consensus on pancreatic surgery that meets the clinical reality in China.
文摘Background:Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to investigate the current status of digestive tract reconstruction after PD in university hospitals in China.Method:A cross-sectional survey was conducted among the members of the Young Elite Pancreatic Surgery Club of China by using the Questionnaire for Digestive Tract Reconstruction after Pancreaticoduodenectomy.The questionnaire was disseminated and collected by point-to-point communication via WeChat public platforms.Results:A total of 73 valid questionnaires were returned from 65 university hospitals in 28 provincial divisions of China's Mainland.The respondents who performed PD surgery with an annual volume of over 100 cases accounted for 63%.Generally,laparoscopic PD was performed less often than open PD.Child and Whipple reconstructions accounted for 70%and 26%,respectively.The sequence of pancreatoenteric,biliary-enteric,and gastrointestinal reconstruction accounted for 84%of cases.In pancreatoenteric anastomosis,double-layer anastomosis is the most commonly employed type,accounting for approximately 67%,while single-layer anastomosis accounts for 30%.Of the double-layer anastomoses,duct-to-mucosa/dunking(94%/4%)pancreatojejunostomy was performed with duct-mucosa using the Blumgart method(39%)and Cattel-Warren(29%),with continuous/interrupted sutures in the inner layer(69%/31%)and continuous/interrupted sutures in the outer layer(53%/23%).In single-layer anastomosis,continuous/interrupted sutures accounted for 41%/45%.In hepatojejunostomy,single-layer/double-layer suture accounted for 79%/4%,and continuous/interrupted suture accounted for 75%/9%.Forty-six percent of the responding units had not applied double-layer biliary-intestinal anastomosis in the last 3 years,75%of the responding surgeons chose the anastomosis method according to bile duct diameter,with absorbable/non-absorbable suture accounting for 86%/12%.PD/pylorus-preserving PD accounted for 79%/11%of gastrojejunostomy(GJ)cases,the distance between GJ and hepaticojejunostomy<30,30-50,and>50 cm were 11%,75%,and 14%,respectively.Antecolic/retrocolic GJ accounted for 71%/23%of cases.Twenty-two percent of GJ cases employed Braun anastomosis,while 55%and 19%of GJ cases used linear cutting staplers/tube-type staplers,respectively;60%/14%were reinforced/not reinforced via manual suturing after stapler anastomosis.Manual anastomosis in GJ surgery employed absorbable/non-absorbable sutures(91%/9%).Significant differences in reconstruction techniques were detected between different volumes of PD procedures(<100/year and>100/year),regions with different economic development levels,and between north and south China.Conclusion:Digestive tract reconstruction following PD exists heterogeneity in Chinese university hospitals.Corresponding prospective clinical studies are needed to determine the consensus on pancreatic surgery that meets the clinical reality in China.
基金supported by the National Natural Science Foundation of China(Nos.81470367,81773122 and 81702290).
文摘Background:Our previous study demonstrated that aldolase A(ALDOA)is overexpressed in clinical human lung squamous cell carcinoma and that ALDOA promotes epithelial-mesenchymal transition and tumorigenesis.The pre-sent study aimed to explore the function of ALDOA in the modulation of non-small cell lung cancer(NSCLC)prolifera-tion and cell cycle progression and the potential mechanism.Methods:ALDOA was knocked down by short hairpin RNA in H520 and H1299 cells.ALDOA was overexpressed with vectors carrying the full-length ALDOA sequence in H1299 and H157 cells.The proliferation capacities were assessed with immunohistochemical staining,Cell Counting Kit-8 and colony formation assays.The cell cycle distribution was examined by flow cytometry,and molecular alterations were determined by western blotting.Cell synchronization was induced with nocodazole.The stability of cyclin D1 mRNA was tested.The pyruvate kinase M2 and ALDOA protein distributions were examined.Aerobic glycolysis was evaluated with Cell Titer-Glo assay,glucose colorimetric assay and lactate colorimetric assay.Results:ALDOA knockdown inhibited the proliferation and G1/S transition in H520 cells.Conversely,ALDOA over-expression promoted the proliferation and G1/S transition in H157 cells.The cell cycle synchronization assay showed that ALDOA expression increased in the G1 phase and G1/S transition.Furthermore,ALDOA knockdown reduced cyclin D1 expression by regulating epidermal growth factor receptor/mitogen-activated protein kinase(EGFR/MAPK)pathway.Similar results were found in H1299 and H157 cells.The inhibition of mitogen-activated protein kinase kinase 1/2 prompted the nuclear distribution of ALDOA.Additionally,ALDOA knockdown reduced nuclear distribution of PKM2,the extracellular lactate and intracellular adenosine triphosphate concentrations and elevated the extracellular glucose concentration.Conclusions:ALDOA contributed to activation of the EGFR/MAPK pathway,thus promoting cyclin D1 expression and enhancing proliferation and G1/S transition in NSCLC.Additionally,ALDOA facilitated NSCLC aerobic glycolysis.
基金National Natural Science Foundation of China(82270665,81871974,82070658)Natural Science Foundation of Heilongjiang Province(TD2021H001)
文摘Acute pancreatitis(AP)is a complicated disease with rising incidence over the years.Twenty percent of AP will develop into acute necrotizing pancreatitis(ANP).Interventions for ANP have evolved from traditional open surgery to minimally invasive step-up approaches.Infected pancreatic necrosis(IPN)is the most serious event of ANP and associated with extremely poor prognosis.The contrast-enhanced computed tomography(CECT)-based classification of IPN describes various types of IPN and will help to carry out surgical interventions for each subtype.Nevertheless,many challenges are still remaining during the treatment of ANP.Including the balance between endoscopic and surgical approaches,and the selection of optimal timing of surgical intervention for infected necrosis.In nowadays treatment scenario of ANP,the necessity for open surgery remains to be debated.Despite of the development of advanced interventional techniques,postoperative residual infection(PRI)remains thorny,and effective prevention and treatment of PRI is of significance.
基金This work was supported by the National Natural Science Foundation of China(82270665,81871974,82070658)the Natural Science Foundation of Heilongjiang Province(TD2021H001).
文摘Acute pancreatitis(AP)is a complicated disease with rising incidence over the years.20%of AP will develop into acute necrotizing pancreatitis(ANP).Interventions for ANP have evolved from traditional open surgery to minimally invasive step-up approaches.Infected pancreatic necrosis(IPN)is the most serious event of ANP and associated with extremely poor prognosis.The CT-based classification of IPN describes various types of IPN and will help to carry out surgical interventions for each subtype.Nevertheless,many challenges are still remaining during the treatment of ANP.Including the balance between endoscopic and surgical approaches,and the selection of optimal timing of surgical intervention for infected necrosis.In nowadays treatment scenario of ANP,the necessity for open surgery remains to be debated.Despite of the development of advanced interventional techniques,postoperative residual infection(PRI)remains thorny,and effective prevention and treatment of PRI is of significance.
