Table of Content

20 April 2020, Volume 20 Issue 02

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Glioma cells suppress the maturation of dendritic cells by upregulating the level of thrombospodin-1

CHEN Xing-sheng, HE Ming-liang, LIU An-min

2020, 20(02):  133-138.  DOI: 10.3969/j.issn.1009-976X.2020.02.001

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［Abstract］ Objective To investigate the impact and the potential mechanism of glioma cells on the activation of dendritic cells. Methods Differently expressed genes between mature DCs and TCM-exposed DCs were screened by RNA-seq. The expression level of TSP-1 and the maturation of differently treated dendritic cells was detected by western blot and flow cytometry, respectively. The concentrations of several types of cytokines secreted by differently treated dendritic cells were measured by the ELISA kits. Results RNA-seq revealed that TCM-exposed DCs had significantly increased expression of SOCS1 compared to the negative control. The results of western blot, flow cytometry and ELISA suggested that the maturation of DCs was suppressed and the level of IL-10 was elevated and IL-12p70 and TNF-α were both reduced due to the upregulated expression of TSP-1 in DCs through being cultured with TCM or transfecting the TSP-1 expressing plasmid. The maturation of DCs was restored and the secretion of IL-10 was declined and IL-12p70 and TNF-α were both induced by knocking out TSP-1 in DCs. Conclusion Glioma cells suppress the maturation of dendritic cells and induce more secretion of Th2 cytokines and less of Th1 cytokines by upregulating the level of thrombospodin-1.

circDOCK4 promotes the proliferation, migration and invasion of clear cell renal cell carcinoma

CHEN Zhi-liang, XIE Wen-lian

2020, 20(02):  139-145.  DOI: 10.3969/j.issn.1009-976X.2020.02.002

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［Abstract］ Objective To investigate the proliferation, migration and invasion function of the highly-expressed circDOCK4 in clear cell renal cell carcinoma （ccRCC）. Methods The expression of circDOCK4 in ccRCC tissues and cell lines （ACHN, Caki-1） were detected by quantitative real time PCR （qRT-PCR）. Nucleic acid electrophoresis and Rnase R treatment were employed to verify the cyclonicity of circDOCK4. The EdU assay, MTS assay and Colony formation assay were applied to validate the roles of circDOCK4 in proliferation in ACHN and Caki-1. Transwell assay and Wound-healing assay were performed to evaluate the effects of circDOCK4 on cellular migration and invasion ability in ACHN and Caki-1. Nuclear mass separation assay was used to identify the subcellular location of circDOCK4 in ACHN and Caki-1. Results The research results demonstrated that circDOCK4 was highly expressed both in ccRCC tissues and cell lines. Nucleic acid electrophoresis and Rnase R treatment verified the cyclonicity of circDOCK4. Downregulating the expression of circDOCK4 could suppress the proliferation, migration and invasion ability in ACHN and Caki-1. Nuclear mass separation assay confirmed that circDOCK4 was predominantly located in cytoplasm. Conclusion circDOCK4 could promote the proliferation, migration and invasion ability in ccRCC, which may serve as a biomarker or target for ccRCC.

A preliminary study on the transdifferentiation of adipose-derived stem cells into enteric nerve-like stem cells

WU Yao-hao, LIU Bao-ning,CHEN Lu-ping, ZENG Le-xiang, QIU Rong-lin, ZHANG Jie, SU Jian-hang, LIAO Min-yi, ZHOU Jun, DENG Xiao-geng

2020, 20(02):  146-150.  DOI: 10.3969/j.issn.1009-976X.2020.02.003

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［Abstract］ Objective To explore the feasibility of using small molecules SB431542, noggin and LDN1931897 to transdifferentiate rat adipose-derived stem cells （ADSCs） into enteric neural-like stem cells, and to provide a new seed cell for cell therapy of congenital megacolon. Methods ADSCs were isolated and cultured from inguinal adipose tissue of SD rats. When ADSCs were passaged to the third generation, small molecules SB431542, noggin, LDN1931897, and enteric nerve medium were added for transdifferentiation experiment. The morphological changes of cells were observed by optical microscope, and the expression of enteric neural stem cells markers of was detected by immunofluorescence staining. Results ADSCs formed neurosphere-like cell clusters 7 days after transdifferentiation in enteric nerve cell culture medium containing three small molecules. Immunofluorescence staining showed positive expression of neural stem cell-specific marker Nestin and positive expression of intestinal neural stem cell marker Sox2. Conclusion Our preliminary experiments showed that small molecules SB431542, noggin, and LDN1931897 can transdifferentiate ADSCs into enteric neural-like stem cells in enteric nerve medium. ADSCs may serve as a seed cell source for congenital megacolonic stem cell transplantation.

Analysis of clinicopathological features of 240 cases of pancreatic cancer with liver metastasis and prognostic risk factors

LI Xuan-na, CHEN Shang-xiang, LIAN Guo-da, CHEN Shao-jie, HUANG Kai-hong

2020, 20(02):  151-154.  DOI: 10.3969/j.issn.1009-976X.2020.02.004

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［Abstract］ Objective To analyze the clinical and pathological characteristics of patients with pancreatic ductal adenocarcinoma （PDAC） liver metastasis, and to identify independent prognostic risk factors. Methods A total of 240 cases of PDAC liver metastasis patients from Sun Yat-sen Memorial Hospital, Sun Yat-sen University were included in the study. The patients, who were hospitalized during January 2007 to October 2014, were recorded full clinicopathological data. Kaplan-Meier was used to evaluate the survival of patients. Cox univariate analysis and multivariate regression model were used to identify independent prognostic risk factors. Results At the end of the follow-up, 227 patients died （94.58%）, and the overall median survival time was 5.34 months. The 6-month, 1-year, and 3-year survival rates were 36.50%, 16.36%, and 5.39%, respectively. Univariate survival analysis suggested that age, CA19-9, tumor differentiation, T stage, and chemotherapy were prognosis risk factors. Multivariate analysis implied that T4 stage, poorly differentiated tumor, and not receiving chemotherapy were independent risk factors for prognosis. Conclusion T stage, tumor differentiation, and chemotherapy are independent prognostic risk factors for patients with PDAC liver metastasis

Expression of CXCL10 in papillary thyroid carcinoma and its correlation with clinical features

FENG Wei-lian, HUANG Ren-wei, WANG Xiao-yi, YAN Yue-rong, WU Jia-yun, CHEN Cai-xia, LI Feng, ZHANG Jin, YAN Li, XU Ming-tong

2020, 20(02):  155-160.  DOI: 10.3969/j.issn.1009-976X.2020.02.005

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［Abstract］ Objective The aim was to investigate the expression of chemokine CXCL10 in papillary thyroid carcinoma and explore its correlation with clinical features. Methods The clinical and pathological data of 105 cases of papillary thyroid carcinoma and 40 cases of benign diseases in Sun Yat-sen Memorial Hospital were collected. Immuno-histochemical streptavidin-perosidase （SP） method was used to detect the expression level of CXCL10. Results CXCL10 expression was significantly higher in papillary thyroid carcinoma than that in benign thyroid nodules （P<0.05）. The expression of CXCL10 in the extracapsular infiltration of thyroid carcinoma was significantly higher than that in the case of non-envelope infiltration （P<0.05）. The CXCL10 staining score of AJCC Ⅲ+Ⅳ was significantly higher than that of AJCC Ⅰ+Ⅱ （P<0.05）. However, there was no significant difference in the expression of CXCL10 in papillary thyroid carcinoma with or without lymph node metastasis （P>0.05）. Conclusion CXCL10 is highly expressed in papillary thyroid carcinoma and correlated with extracapsular infiltration and high AJCC satges, but not relevant to lymph node metastasis and ultrasound signs.

Expression level and prognostic significance of TIMP1 and EFEMP1 in rectal cancer

TAN Ying, LIAN Guo-da, CHEN Shao-jie, LI Jia-jia, CHEN Shang-xiang, HUANG Kai-hong, CHEN Yin-ting

2020, 20(02):  161-166.  DOI: 10.3969/j.issn.1009-976X.2020.02.006

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［Abstract］ Objective To analyze the expression of tissue inhibitor of metalloproteinases-1 （TIMP1） in rectal cancer and its relationship with the prognosis of rectal cancer. To analyze the molecular and biological functions of different genes in the high-expression and low-expression groups of TIMP1. To analyze the relationship between TIMP1 and EFEMP1. To analyze the relationship between EFEMP1 and prognosis of rectal cancer. Methods Data related to rectal cancer in TCGA database were downloaded to analyze the expression of TIMP1 in adjacent normal tissues and rectal cancer tissues. The relationship between TIMP1 expression and prognosis of rectal cancer patients was analyzed by Kaplan-Meier curve. According to the expression level of TIMP1, rectal cancer patients were divided into groups with high expression of TIMP1 and low expression of TIMP1. The two groups were screened for different genes. Enrichment analysis and pathway analysis were carried out to explore the function of TIMP1 related genes. Genes closely related to TIMP1 were searched. Their correlation between the gene and TIMP1 was analyzed. The relationship between the gene and prognosis of rectal cancer was analyzed. Results Compared with adjacent normal tissues, TIMP1 was highly expressed in rectal cancer tissues. Patients with stage Ⅰ，Ⅱ, Ⅲ and Ⅳ had higher levels of TIMP1 than the control group. The higher the expression level of TIMP1, the shorter the overall survival time and the tumor-free survival time of the patients. Gene enrichment results showed that most of the different genes in the high-expression and low-expression groups of TIMP1 were involved in biological processes such as cell adhesion and maintenance of extracellular matrix stability. Pathway analysis showed that differential genes were functionally closely related to the epithelial-mesenchymal transition （EMT）. Among them, the gene of Epidermal Growth factor-containing fibulin-like Extracellular Matrix Protein 1 （EFEMP1） was positively correlated with TIMP1. The higher the expression of EFEMP1, the shorter the overall survival time and tumor-free survival time of rectal cancer patients, and the worse the prognosis. Conclusion TIMP1 was highly expressed in rectal cancer and negatively correlated with prognosis. TIMP1 was positively correlated with EFEMP1. EFEMP1 was negatively correlated with prognosis in rectal cancer.

Analysis of COL4A1 gene expression and significance in colorectal cancer based on database mining

YAO Qi, HE Lan-zhen

2020, 20(02):  167-171.  DOI: 10.3969/j.issn.1009-976X.2020.02.007

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［Abstract］ Objective To explore the expression level and clinical significant of collagen type Ⅳ alpha 1（COL4A1） in colorectal cancer by mining the public bioinformatic databases. Methods Oncomine and GEPIA database were used to analyze the mRNA expression of COL4A1 in colorectal cancer. The clinical stage and survival data were analyzed by mining the GEPIA database. The relationship between the COL4A1 mRNA expression and DNA methylation was evaluated using the MethHC database. Further, String online tools were applied to analyze the possible regulatory signaling pathways of COL4A1 and to construct a protein interaction network. Results The Oncomine and GEPIA databases showed that the COL4A1 gene was significantly higher in colorectal cancer tissues than in the normal colorectal tissues. Survival analysis from the GEPIA showed that no significantly difference was observed （P<0.05）. A positive correlation between COL4A1 mRNA and DNA methylation was found using the MethHC database. The functional enrichment analysis predicted that COL4A1 and its network play significant roles in ECM receptor interaction, and COL4A1 gene might be enriched in pathways, such as. Bioinformatics analysis identified 5 genes, namely COL16A1, SERPINH1, COL5A2, COL6A1, COL5A2, that were significantly correlated with COL4A1. Conclusion COL4A1 was highly expressed in colorectal cancer tissues. Future researches are needed to find out the function and mechanism of COL4A1 in colorectal cancer.

Short-term clinical results of hand-assisted laparoscopic radical resection of left colon cancer

LIU Yu-feng, LIU Shao-jie, LIU Dan

2020, 20(02):  172-175.  DOI: 10.3969/j.issn.1009-976X.2020.02.008

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［Abstract］ Objective To introduce the experience, investigate the feasibility, minimally invasive and safety of hand-assisted laparoscopy in radical resection of left colon cancer. Methods This is a retrospective study which collected the clinical data from January 2013 to December 2018 in Guangzhou Red Cross Hospital. And the patients with left half colon cancer were included in the study. According to the operation method, patients were divided into HALS group （81 cases） and LAC group （93 cases）. Surgery-associated parameters were recorded, analyzed, as well as compared between two groups. Results Age, gender, body mass index （BMI）, history of abdominal surgery, complications, preoperative stage of tumor and other clinical parameters between the HALS group and the LAC group showed no statistically significant differences （P>0.05）. HALS group had shorter operative time and lower conversion to laparotomy than LAC group （P<0.05）. Blood loss, lymph node dissection, length of the incision, collateral injury, postoperative complications, unplanned secondary surgery and postoperative length of hospital stay were not statistically significant （P>0.05）. Conclusion In the present study, HALS technology and LAC have similar effects in safety and postoperative recovery, while HALS showed less conversion to laparotomy in a limited cases.

Evaluation of contrast-enhanced ultrasound in the diagnosis of focal hepatic lesions

LI Xiong, LAN Si-rong, LI Jia, XU Jian-hui

2020, 20(02):  176-179.  DOI: 10.3969/j.issn.1009-976X.2020.02.009

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［Abstract］ Objective To explore the value of contrast-enhanced ultrasound （CEUS） in the differential diagnosis of benign and malignant liver lesions. Methods From May 2018 to October 2019, 30 patients with focal hepatic lesions were performed contrast-enhanced ultrasound （CEUS） examination in our hospital. After SonoVue （a contrast agent） was injected into the peripheral elbow vein, time-to-peak, wash-in time, wash-out time were recorded and made the differential diagnosis of benign and malignant lesions, and the data were statistically analyzed. Results Pathological results from operation or fine-needle aspiration biopsy, 21cases with malignant lesions （including 14 HCC, 1 cholangiocarcinoma and 6 metastatic HCC）, 11 cases of benign lesions （9 hemangiomas, 1 focal nodular hyperplasia, 1 cirrhosis）. 21 malignant lesions and 10 benign lesions were correctly diagnosed by CEUS. The wash-in time was 12.76 ± 2.68 s vs. 16.12±3.82 s, time-to-peak 23.18±3.57 s vs. 42.78±10.46 s, wash-out time 40.69±8.42 s vs. 78.35±14.63 s between malignant lesions and benign lesions, and in which most of the malignant lesions were earlier than the benign ones. Conclusion CEUS is a very reliable technique with a high sensitivity for the differential diagnosis of benign and Malignant local hepatic lesions.

Risk factors of early allograft dysfunction after liver transplantation

WANG Ze-liang, HU Ze-ming, HE Yong-zhu, YE Shao-wei

2020, 20(02):  180-183.  DOI: 10.3969/j.issn.1009-976X.2020.02.010

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［Abstract］ Objective To analyze the risk factors of early allograft dysfunction EAD after liver transplantation, and to explore its prevention methods. Methods A retrospective analysis was performed on 112 cases of liver transplantation patients in Zhongshan People??s Hospital from January 1, 2015 to June 31, 2019. Incomplete data were excluded, and 109 patient data were included for research. The occurrence factors were analyzed by single factor and multi-factor logistic regression, and the results of multi-factor logistic regression analysis were analyzed by ROC curve. Results Donor Lactic acid （LAC） before operation, donor age, recipient body mass index （BMI）, recipient white blood cells （WBC） before operation, lymphocyte percentage （LYMPH%）, post-neutrophil/lymphocyte ratio （Neutrophil-to-Lymphocyte Ratio, NLR） after recipient surgery, liver cold ischemia time. There were differences between the EAD group and non-EAD group （P<0.05）. Recipient BMI, LAC before operation and cold ischemia time is an independent risk factor for EAD after liver transplantation （P<0.05）. Conclusion The risk factors affecting EAD after liver transplantation include cold ischemic time of donor liver （>313.50 min）, LAC before donor operation, donor age, recipient BMI, WBC before operation|recipient LYMPH% after operation, Recipient postoperative NLR. Recipient BMI, LAC before donor operation and donor cold ischemia time （>313.50 min） were independent risk factors.

Efficacy and safety of selective transumbilical single-port laparoscopic cholecystectomy for elderly patients with acute cholecystitis after percutaneous hepatic and gallbladder puncture and drainage

AI Zhi-guo, CHEN Yu, ZHANG Xu

2020, 20(02):  184-187.  DOI: 10.3969/j.issn.1009-976X.2020.02.011

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［Abstract］ Objective To explore the effect of transumbilical single-port laparoscopic cholecystectomy （TUSLC） in elderly patients with acute cholecystitis （AC） after percutaneous transhepatic gallbladder drainage （PTGD）. Methods Eighty elderly patients with AC in our hospital （from December 2017 to December 2018） were divided into control group （n=40） and experimental group （n=40） according to the operation plan. PTGD+traditional laparoscopic cholecystectomy （LC） and PTGD+TUSLC were performed respectively. The bleeding volume, operation time, recovery time of white blood cells, recovery time of gastrointestinal function, hospitalization time and complications of the two groups were observed, and the pain degree （VAS） of 1, 3 and 7 days after operation was compared. Results Compared with the control group, the recovery time of white blood cells, hospital stay and gastrointestinal function in the experimental group were shorter, and the amount of bleeding during operation was less （P<0.05）|compared with the control group, the VAS score of the experimental group was lower on the 1st, 3rd and 7th day after operation （P<0.05）|compared with the control group, the incidence of complications in the experimental group was lower （P<0.05）. Conclusion Selective TUSLC after PTGD is helpful to reduce the blood loss, relieve the pain, reduce the risk of complications and shorten the rehabilitation process of elderly AC patients.

Comparison of short-term clinical effects between patients undergoing MIS-TLIF and PLIF in the treatment of degenerative lumbar diseases

HE Xu-hui, ZHENG Chao-shun, HU Zheng, GUO Yue-yue

2020, 20(02):  188-192.  DOI: 10.3969/j.issn.1009-976X.2020.02.012

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［Abstract］ Objective To compare short-term clinical effects between patients undergoing MIS-TLIF and PLIF in the treatment of degenerative lumbar diseases. Methods A retrospective study was performed in 60 patients of degenerative lumbar diseases from June 2017 to December 2018 in our hospital. Thirty patients underwent MIS-TLIF, while 30 patients underwent PLIF. The surgery time, intraoperative blood loss, drainage volume postoperative, bed time, hospital time postoperative, VAS score, ODI score, fusion rate and reduction rate among spondylolisthesis patients were compared between the 2 groups. Results The patients in the MIS-TLIF group had better VAS and ODI scores 1month and 6 months postoperative （P<0.05）. The intraoperative blood loss, drainage volume postoperative, bed time, hospital time postoperative in MIS-TLIF group were better （P<0.05）, while the surgery time longer and reduction rate among spondylolisthesis patients lower （P<0.05）. There were no significant differences in VAS, ODI scores and fusion rate between 2 groups （P>0.05）. One pulmonary infection and one dura cyst injury occur in PLIF group, which could be cured conservatively. One malposition of pedicle screw and one contralateral radiculopathy occur in MIS-TLIF group, which could be cured conservatively. There were no wrong intervertebral location, neural injuries, surgery site infection and internal fixation loosening in both groups. Conclusion MIS-TLIF can achieve same short-term clinical effects with PLIF in the treatment of degenerative lumbar diseases, while could had better clinical effects in 6 months postoperative and the recovery time were shorter.

A clinical study of modified minimally invasive incision in maxillary sinus floor elevation with simultaneous placement of dental implants for 5 years

ZHANG Wen, ZHANG Qing-yuan, LU Jie, CHENG Jie-li

2020, 20(02):  193-199.  DOI: 10.3969/j.issn.1009-976X.2020.02.013

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［Abstract］ Objective To discuss the long clinical effect of modified minimally invasive incision in maxillary sinus floor elevation with simultaneous placement of dental implants of patients. Methods Between January 2012 and January 2014, a total of 27 patients with maxillary posterior teeth missing were enrolled in this study. The residual alveolar bone height （RBH） was less than 7 mm, with an average of （4.03±1.87） mm. A modified minimally invasive fenestration was performed on the lateral wall of the maxillary sinus, and a total of 42 implants were implanted at the same time. The upper part was repaired half a year later, and all cases were observed for 5 years （that is more than 60 months）. Results The 5-year survival rate of 42 implants was 100%, and a total of 31 sides of the maxillary sinus were elevated. One case had small perforation of the sinus membrane, and the perforation rate was 3.23%. RBH measured immediately after the operation, six months, one year and five years after the operation were significantly higher than that before the operation, and gradually decreased with the extension of postoperative time （P<0.001）. Further, according to the preoperative RBH level, the patients were divided into two groups （RBH≤4 mm group and RBH>4 mm group）. There was no statistically significant difference in postoperative RBH change between the two groups （P=0.124）. The bone resorption was 0.97 mm six months after the operation compared with that immediately after the operation. Compared with half a year after the operation, the bone resorption was 1.15 mm at 1 year. Compared with 1 year after surgery, the bone resorption was 0.66 mm at 5 years after surgery. It can be seen that after 1 year, the elevated bone mass of maxillary sinus gradually decreases and tends to stabilize. Conclusion Modified minimally invasive incision in maxillary sinus floor elevation with simultaneous placement of dental implants can achieve ideal elevation, reduce trauma in patients, and achieve stable long-term clinical effect.

Percutaneous endoscopic lumbar discectomy as day surgery： a retrospective study with 6-month follow-up

ZHENG Pei-zhong, ZHANG Wei-qiong, ZHENG Xiang

2020, 20(02):  200-204.  DOI: 10.3969/j.issn.1009-976X.2020.02.014

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［Abstract］ Objective To observe the effect of day surgery of percutaneous endoscopic lumbar discectomy. Methods A retrospective clinical data of percutaneous endoscopic lumbar discectomy （PELD） from August 2016 to October 2018 were analyzed, involving patients who received PELD under normal hospitalization procedure （control group, n=153） and patients who underwent PELD as day surgery （day surgery group, n=217）. The patients were followed up for 6 months. Clinical data, length of stay, complications, recurrence, VAS assessment of leg pain and back pain, Oswestry disability index （ODI）, Mac-Nab assessment were recorded and analyzed. Results All patients successfully completed PELD, and the patients in the two groups had significant relief of low back pain or leg pain. The hospitalization time of control group was 2-6 days, and that of day surgery group was 5.1 ± 3.5 hours. In the day surgery group, 19 patients were delayed in discharge, 6 of them were in psychological factors and asked to stay in hospital. There were 26 cases lost in the day surgery group and 13 lost in control group. In the day surgery group, the incidence of complications was 5.53% （12 cases）, while 8.7.84% （12 cases） in the control group, mainly including skin sensory disorders, temporary motor disorders and recurrence. There was no significant difference in the incidence of complications between the two groups （P=0.930）. Twelve patients of the day surgery group and 9 of control group were readmitted to the hospital within 6 months after surgery because of recurrent disc herniation, free nucleus pulposus and neuralgia, and recovered after operation again. According to the Mac-Nab standard, there were 109 excellent cases, 98 good cases, 4 fair cases and 6 poor cases in the day surgery group|71 excellent cases, 70 good cases, 7 fair cases and 5 poor cases in the control group, and there was no significant difference between the two groups （P=0.457）. The VAS score and ODI score of the two groups were significantly improved before and after surgery （both P<0.001）, and there was no significant difference between the groups. Conclusion As a day surgery, PELD has the same safety and effectiveness as normal hospitalization procedure.

Analysis of the efficacy and safety of interlocking intramedullary nail closed and nailing combined with blocking screw for treatment of patients with unilateral tibial fracture

SANG Jing-wei, WEI Zhong-yang

2020, 20(02):  205-209.  DOI: 10.3969/j.issn.1009-976X.2020.02.015

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［Abstract］ Objective To investigate the effect of interlocking intramedullary nailing and screwing combined with blocking screws on patients with unilateral tibial shaft fractures. Methods A total of 178 patients with unilateral and lower tibial shaft fractures in our hospital （April 2017 to June 2019） were selected, 88 patients treated with minimally invasive percutaneous plate internal fixation （MIPPO） were used as the control group, and 90 patients treated with interlocking intramedullary nails and perforating screws combined with blocking screws were used as the observation group. The excellent and good rates, surgical and postoperative indicators （intraoperative blood loss, surgical time, postoperative recovery time, fracture healing time）, Johner-Wruhs score of tibial shaft, Kofoed score of ankle joint, Baily score of knee joint before and after 3 months, and incidence of postoperative complications were compared between the two groups. Results The excellent rate in the observation group was 96.67% higher than the control group 84.09%, and the incidence of postoperative complications was 3.33% lower than the control group 19.32% （P<0.05）|the intraoperative blood loss of the observation group was more than that of the control group, and the operation time was longer than that of the control group, the postoperative recovery time and fracture healing time were shorter than the control group （P<0.05）|three months after operation, the Johner-Wruhs score of the tibial shaft, Kofoed score of the ankle joint, and Baily score of the knee joint in the observation group were higher than those in the control group （P<0.05）. Conclusion Interlocking intramedullary nails combined with blocking screws for the treatment of unilateral tibial shaft fractures can improve the excellent rate, improve the function of tibial shaft, ankle and knee joints, reduce the incidence of complications and promote rehabilitation.

Effects of endovenous laser ablation technique for large saphenous varicose veins： an analysis in 248 cases

PENG Yan-bin, CHU Yun-feng, CHEN Zhong, WAN Shen-xiang, XIAO Ying-feng

2020, 20(02):  210-213.  DOI: 10.3969/j.issn.1009-976X.2020.02.016

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［Abstract］ Objective To investigate the clinical effect of intracavitary laser minimally invasive treatment of varicose veins of lower extremities. Methods From July 2012 to December 2019, 248 patients （laser ablation group） with varicose great saphenous vein of lower extremities were treated by endovenous laser ablation in our hospital, and another 248 patients （traditional operation group） were treated by traditional high ligation of great saphenous vein plus extraction at the same time in our hospital. The clinical effects were compared between the two groups. Results The incision length, operation time, first day postoperative pain degree, duration and hospitalization time of laser ablation group were better than those of conventional operation group （all P values <0.05）. The complications mainly included delayed healing of incision, hematoma of wound, numbness of skin, subcutaneous induration and thrombosis caused by heat in vena cava. The incidence of laser ablation group was significantly lower than that of conventional operation group （all P values < 0.05）. After 12 months follow-up, 14 cases （5.6%） recurred in the laser ablation group and 8 cases （3.2%） recurred in the conventional operation group. There was no significant difference between the two groups （P>0.05）. The quality of life score （SF-36） in the laser ablation group was significantly better than that in the conventional operation group （P<0.05）. Conclusion Intraluminal laser minimally invasive treatment can play an active role in improving the condition of patients with varicose veins of lower extremities, which is worthy of popularization and application.

The clinical experience of Asahi guidewire applied to completely occluded femoral artery

GAO Yi-jing, LI Pang, YE Xue-mei, PENG Meng-miao

2020, 20(02):  214-218.  DOI: 10.3969/j.issn.1009-976X.2020.02.017

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［Abstract］ Objective How to penetrate chronic superficial femoral artery occlusion （CTO） is now still in front great challenge. We summarize the surgical experience of chronic complete femoral arterial occlusion with Asahi guide wire crossing device. Methods From January, 2018 to December 2019, 64 patients （64 limbs） with severe superficial femoral artery stenosis or occlusion were admitted to Guangzhou Red Cross society hospital. All the patients were treated with Asahi guide wire to penetrate the occlusive superficial femoral artery, and the usage amount of Asahi guide wire, arterial injury, and time of penetrating were recorded. Results The superficial femoral artery was successfully penetrated in all cases, the technical success rate was 100%, and no serious arterial injury and other complications occurred. The success rate of primary penetrating was 92.19% （59/64）, and the duration of primary penetrating was 15.3±4.7 minutes. Conclusion It is safe and effective to use Asahi series guide wire to penetrate the superficial femoral artery occlusion, and the opening success rate is high, so it can be worth promoting.

Safety and efficacy of intravenous tirofiban and loading dose of clopidogrel in stent-assisted embolization of acute ruptured aneurysms

DONG An-shi, LIAO Xu-xing, ZHONG Wei-jian, LIU Xin-xin, ZHOU Si-jie, LIANG Ming-qin, LIN Hai-bo, LUO Jie, DENG Qi-jun

2020, 20(02):  219-224.  DOI: 10.3969/j.issn.1009-976X.2020.02.018

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［Abstract］ Objective To evaluate the safety and efficacy of intravenous tirofiban and loading dose of clopidogrel in stent-assisted coil embolization of acute ruptured aneurysms. Methods A retrospective analysis was made of the patients with ruptured intracranial aneurysms treated continuously from January 2012 to October 2018. All patients were treated with stent-assisted coil embolization in acute stage. Tirofiban was injected intravenously 15 minutes before stent release in tirofiban group, and clopidogrel was given a load dose of clopidogrel （300 mg） 2 hours before stent release in clopidogrel group. The hemorrhage and thromboembolism events of two kinds of antiplatelet aggregation drugs were observed and analyzed. Results Thirty-eight ruptured aneurysms of 36 patients in tirofiban group were treated. Two patients （5.6%） had new thrombosis during operation, three patients （8.3%） had acute cerebral infarction after operation, two patients?? （5.6%） aneurysms had ruptured during operation, and two patients had late hemorrhage after ventricular drilling and drainage. There was no significant difference in platelet count （P=0.136）. Thirty cases with GOS score （≥4）. In clopidogrel group, 41 ruptured aneurysms were treated in 37 patients, 2 patients （4.9%） had acute cerebral infarction after operation, 2 patients?? （4.9%）aneurysms had ruptured during operation, 3 patients?? （7.3%）aneurysms had ruptured after operation, and 1 patient had puncture bleeding after ventricular drilling and drainage. Platelet count decreased significantly （P=0.000）. 26 cases with GOS score （≥4）. Conclusion Intravenous application of tirofiban during stent-assisted coil embolization of ruptured aneurysms in acute phase showed lower ischemia and hemorrhage events. In particular, tirofiban can dissolve newly generated thrombus during operation, and can be used as an alternative drug for anti-platelet aggregation in perioperative period.

Management strategy of acute abdomen disease during the outbreak of novel coronavirus pneumonia

TAN Hua-yong, LIU Hui, DI Zi-yang, HAN Sheng-bo, DI Mao-jun, TANG Qiang

2020, 20(02):  225-228.  DOI: 10.3969/j.issn.1009-976X.2020.02.019

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［Abstract］ Since Dec. 2019, the cases of novel coronavirus pneumonia （COVID-19）have reported in Wuhan，Hubei Province. This infectious disease has been classified as Category B infectious disease and managed Category A infectious disease in China. Academic studies have established that COVID-2019 can be transmitted from human to human rapidly. The main clinical manifestations of COVID-19 are fever, dry cough, dyspnea and other respiratory symptoms. And some patients also have digestive system symptoms and have the possibility of gastrointestinal transmission. Under the new situation of COVID-19 outbreak, how to deal with the acute abdomen patients safely and efficiently, especially the confirmed and suspected patients, is the key to overcome the epidemic situation. This article described the latest prevention and control guidelines, literature reports and shared the clinical experience of our hospital, which may be of value in the diagnosis and treatment for acute abdomen during the outbreak of COVID-19.

Transabdominal pre-peritoneal versus transabdominal pre-peritoneal laparoscopic techniques for inguinal incarcerated hernia repair

ZHANG Zi-tong, MO Wei-feng, YANG Hui, NIU Jing-zhi

2020, 20(02):  229-232.  DOI: 10.3969/j.issn.1009-976X.2020.02.020

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［Abstract］ Objective To explore the safety and effect of laparoscopic preperitoneal （TAPP） and total extraperitoneal repair （TEP） in the treatment of inguinal incarcerated hernia. Methods Fifty patients with inguinal incarcerated hernia treated with TAPP and TEP from July 2017 to July 2019 were divided into TAPP group （n=25） and TEP group （n=25）. The effects and complications were compared between two groups, including operative time, bleeding volume, bladder injury, spermatic cord vascular injury and vas deferens injury, postoperative swelling, postoperative infection, postoperative chronic pain, recurrence and postoperative urinary retention. Results There was no significant difference in operation time, intraoperative blood loss, and postoperative seroma between the two groups （P>0.05）. TAPP may have more advantages in detecting the blood circulation of embedded content. Conclusion There is no difference between TAPP and TEP in short-term efficacy. TAPP has more advantages in treating peritoneum, which is suitable for beginners.

Evaluation of the clinical effect of enhanced recovery after surgery in the treatment of pelvic fractures

ZHAO Yong, XU Sheng-quan, XU Xiu-lei

2020, 20(02):  233-237.  DOI: 10.3969/j.issn.1009-976X.2020.02.021

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［Abstract］ Objective To explore the clinical effect of perioperative treatment of pelvic fracture with the concept of rapid rehabilitation surgery. Methods From February 2017 to January 2019, 97 patients with pelvic fracture treated in our hospital were randomly divided into observation group （n=52） and control group （n=45）. The observation group was treated with pelvic fracture reduction and fixation during perioperative period under the guidance of rapid rehabilitation surgery concept, while the control group was treated with routine perioperative management scheme. The changes of analog pain score before and after treatment were observed. The amount of bleeding during operation, the time of awakening after operation, the time of getting out of bed, the time of exhaust, the time of hospitalization and the time of fracture healing in the two groups were compared. The perioperative complications and the recovery of pelvic function in the two groups were analyzed to evaluate their prognosis. Results There was no significant difference in analogue pain scores between the two groups before each treatment （P>0.05）|the pain level in the observation group was lower than that in the control group 12 hours after anesthesia recovery （P<0.05）. There was significant difference in pain score between the observation group before treatment and 12 hours after anesthesia recovery （P<0.05）, but there was no significant difference between the two monitoring points in the control group （P>0.05）. There was no significant difference in blood loss between the observation group and the control group （P>0.05）|the recovery time, exhaust time, out of bed time and hospitalization time of the observation group were earlier than those of the control group （P<0.05）|there was no significant difference in fracture healing time between the two groups after treatment （P>0.05）. In the course of treatment, the perioperative complications in the control group were significantly higher than those in the observation group （P<0.05）, while there was no significant difference in the number of cases of deep venous thrombosis in the lower extremities （P>0.05）. Three months after treatment, the recovery rate of pelvic function was 82.7% in the observation group and 80.0% in the control group. There was no significant difference between the two groups （P>0.05）. Conclusion Under the guidance of the concept of rapid rehabilitation surgery, it can effectively alleviate the stress reaction of pelvic fracture patients during reduction and internal fixation, reduce the risk of perioperative complications, and promote the early functional recovery of patients.

Characteristics of polymorphism of CPY2A6 gene in patients associated with acute exacerbations of chronic obstructive pulmonary disorder

LIU Lin-sheng, YAO Wei-ping, ZENG Bo-wen, ZHAO Song-li, LUO Wei, LU Guo-ying, LI Li-wen, LIU Xiao-li

2020, 20(02):  238-242.  DOI: 10.3969/j.issn.1009-976X.2020.02.022

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［Abstract］ Objective To observe the characteristics of CPY2A6 gene polymorphism in patients with acute exacerbations of chronic obstructive pulmonary disorder （AECOPD）. Methods This is a prospective cohort study. Patients with AECOPD who were treated in our hospital from April 2016 to April 2019 were divided into CYP2A6 wild type group and CYP2A6 deletion （or variant） type group by detecting CYP2A6 genotype. Finally, 133 patients were enrolled, including 108 cases of CYP2A6 wild type and 25 cases of CYP2A6 deletion type. CYP2A6 gene was detected by real-time PCR combined with the restriction enzyme fragment length polymorphism analysis. Results In the CYP2A6 wild type group, the number of smoking cases and emergency admission cases was more than that of the CYP2A6 deletion type group （P<0.001）. There was no significant difference between the two groups in the number of admission in a year, mortality, length of stay, APACHE Ⅱ score, the number of cases of mechanical ventilation, renal replacement therapy on the first day, and comorbidities （P>0.05）. CYP2A6 wild-type group greatly fluctuated biochemical indexes of blood gas analysis. The patients with CYP2A6 wild-type had lower PaO2, higher PaCO2, HCO3-, hypercreatinine, and larger heart rate changes when compared those with CYP2A6 deletion type （P<0.05）. Conclusion CYP2A6 wild-type patients may have more disordered blood gas biochemical indexes and physiological changes in AECOPD. Meanwhile, the patients with smoking history in CYP2A6 wild-type group are more than CYP2A6 deletion type group, and the type of admission is more urgent hospitalization in CYP2A6 deletion type groups.

Progress in the treatment and resistance of HER2-positive breast cancer

PENG Jiang-yun, YAO Wei-cheng, WANG Yong-qiang, DENG Wei-xi

2020, 20(02):  243-253.  DOI: 10.3969/j.issn.1009-976X.2020.02.023

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［Abstract］ HER2 positivity is defined as evidence of HER2 protein overexpression as HER2 gene copy number of six or more or a HER2/CEP17 ratio of 2.0 or greater, which is measured by immunohistochemistry status （IHC3+） or by fluorescence in-situ hybridization （FISH） measurement. HER2-positive breast cancer with high invasiveness and poor prognosis accounts for 15%~20% of breast cancer. With survival rates of almost five years in women with metastatic HER2-positive breast cancer and 75% of patients achieving a complete pathological response, the emergence and widespread application of new anti-HER2 treatments have improved the prognosis of HER2-positive breast cancer. Despite these achievements, however, the persisting high death toll of HER2-positive breast cancer remains due to resistance and heterogeneity in anti-HER2 therapy, as well as brain metastases in up to 40%~50% of HER2-positive advanced breast cancer patients. So it calls for continued, intensive clinical research of newer therapies and combinations.

Current study and management of chronic total occlusion of the internal carotid artery

MA Lin, LIU Bao-long, YIN Long

2020, 20(02):  254-260.  DOI: 10.3969/j.issn.1009-976X.2020.02.024

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［Abstract］ There is a limited understanding on the treatment of chronic carotid artery chronic total occlusion （ICACTO） in clinical work. In this article we reviewed the studies including pathology, pathogenesis, clinical symptoms, imaging features and treatment of ICACTO. Cerebral vessels may form collateral circulation immediately or gradually following CTO of the ICA. The pathological of ICACTO include cerebral hypoperfusion, emboli detachment and cognitive dysfunction, which ultimately lead to a variety of outcomes. Therefore most ICACTO require treatment. The early studies of external-ICA bypass were unsatisfactory in treatment of ICACTO. Recently, recanalization is considered the only viable option. The current treatment indications mainly depend on the degree of injury to the cerebrovascular reserve and the extent to which the oxygen extraction fraction is increased. The length, height and duration of ICA occlusion are also relevant, though more frequently, the condition depends on multiple factors. Revascularization can be performed by intravascular intervention, carotid endarterectomy （CEA） or hybrid surgery for selected patients. With the development of biomaterials, the simple re-transmission success rate will gradually increase. However, hybrid surgery may be more representative of the current trend, as CEA can remove carotid atherosclerotic plaques and provide conditions for further endovascular intervention. If the revascularization successful, it is usually possible to improve the patient??s condition steadily in the long term. Although the existing research has yielded certain research results, further research and studies are needed to improve the current understanding of ICACTO.

Research status of commonality between cancerous and precancerous lesions of the biliary tract and the pancreas

PENG Ning-fu, ZHONG Jian-hong, ZHU Shao-liang, LIAO Ying-yang, LI Le-qun

2020, 20(02):  261-266.  DOI: 10.3969/j.issn.1009-976X.2020.02.025

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［Abstract］ Neoplastic and preneoplastic lesions of the biliary tract and the pancreas share analogies in terms of molecular, histopathological and clinical features due to their anatomical proximity and common embryological origin. This review systematically illustrates similarities and differences between cancerous and precancerous lesions of the biliary tract and the pancreas with potential implications on a common origin from similar stem/progenitor cells, which will provides the theoretical basis for learning from each other on the related research, joint monitoring, common prevention and treatment, and individualized strategy under the comprehensive concept for the two types of diseases.

The effect of fingers pain score model in pain evaluation of acute abdomen patients

WEI Li, QING Ping-ping

2020, 20(02):  267.  DOI: 10.3969/j.issn.1009-976X.2020.02.026

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［Abstract］ Objective To analyze the effect of fingers pain score model in pain evaluation of acute abdomen patients. Methods Eighty-two acute abdomen patients in our hospital from January 2018 to December 2018 and 41 nurses were selected. The valuation of fingers pain score model and VAS pain score model of acute abdomen patients and nurses were compared. Results The Completion time of fingers pain score model was 43.25±10.23 s, significantly lower than 68.42±15.18 s of VAS pain score model, P<0.05|The evaluation results of fingers pain score model and VAS pain score model were 5.58±1.12 and 5.92±1.31, and there was no significant difference, P>0.05|The evaluation of fingers pain score model of acute abdomen patients and nurses were were significantly higher than those of VAS pain score model, P<0.05. Conclusions Fingers pain score model is simple and practicable, could meet the requests of acute abdomen patients and nurses.