Table of Content

20 February 2023, Volume 23 Issue 01

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Original Articles and Clinical Research

Application of transprepancreatic septotomy combined with modified pancreatic duct stent in ERCP difficult intubation of common bile duct stones

JIAO Yuan-jun, LIN Qi-rui, YIN Yao-xin, LI Gui-xian, LIU Xiao-ping

2023, 23(01):  1-5.  DOI: 10.3969/j.issn.1009-976X.2023.01.001

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Objective To explore transprepancreatic septotomy combined with modified pancreatic duct stent procedure for treatment ofcommon bile duct stones in patients with ERCP difficult intubation. Methods The data of 60 patients with difficult intubation who underwent ERCP for choledocholithiasis from January 2020 to December 2021 in our hospital were retrospectively analyzed, and the effects and postoperative complications in ERCP difficult intubation patients were analyzed and compared between simple transprepancreatic septotomy （TPS） and transprepancreatic septotomy combined with modified pancreatic duct stent technique （TPS+MPs）. Results There was no significant difference in gender, age, height, weight, BMI and liver function between TPS group （n=29） and TPS+MPs group （n=31）. Patients in TPS+MPs group showed lower WBC count, post-ERCP pancreatitis incidence, and total complication incidence, and compared to those in TPS group, there were significant differences （all Ps less than 0.05）. There was no significant difference in the success rate of intubation and the success rate of one-time lithotomy. Two patients were found gastrointestinal bleeding in TPS group and no one in TPS+mPS group. No perforation occurred in both groups. Conclusion It is safe and effective to apply the transprepancreatic septotomy combined with modified pancreatic duct stent for treatment of common bile duct stones in patients with ERCP difficult intubation.

Application of laparoscopic-guided rectus sheath block on single-incision laparoscopic cholecystectomy

ZHANG Xian-guang, ZUO Chao-hai, YU Jie-xiong

2023, 23(01):  6-9.  DOI: 10.3969/j.issn.1009-976X.2023.01.002

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Objective To explore the application effects and safety of Laparoscopic-guided rectus sheath block on single-incision laparoscopic cholecystectomy. Methods Retrospective analysis was performed on 100 patients who were undergone single-incision laparoscopic cholecystectomy from October 2019 to March 2021, of whom 50 patients were performed laparoscopic-guided rectus sheath block, and others were performed local infiltration anesthasia. Postoperative pain score, first ambulation, complications was compared between two groups. Visual analogue scale was applied to evaluate the pain on 2 h, 6 h、12 h and 24 h after operation. Results There was no significant difference in gender, age, weight, operating time between two groups. The observation group had lower VAS scores at the time of 2 h,and 6 h,12 h after operation as compared with the control group, respectively（1.7±1.1 vs 3.1±1.1, P<0.001; 1.7±1.2 vs 2.7±0.9, P<1.9±0.8 vs 2.4±0.8,P=0.001）. And there was no significant difference at the time of 24 h （1.7±1.0 vs 1.9±1.2, P=0.411）. And the observation group shows superior advantage on the first ambulation（8.3±1.1 vs 10.7±1.5 h, P<0.001）. There were no complications on both groups. Conclusion Laparoscopic-guided rectus sheath block on single-incision laparoscopic cholecystectomy is effective and safe. It is a method to release the pain after operation which is performed by surgeon easily.

Functional and mechanistic study of FOXA1 in promoting the proliferation of breast cancer by regulating the transcription of XBP1

YAO Xin-yi, XU Bao-hong, ZHANG Meng-ting, HUANG Yong-xin

2023, 23(01):  10-18.  DOI: 10.3969/j.issn.1009-976X.2023.01.003

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Objective To explore the function and molecular mechanism of FOXA1 in breast cancer. Methods Thec BioPortal and TCGA databases were used to analyze the mutation of FOXA1 in tumors, the mRNA expression level of FOXA1 in breast cancer, and its correlation with the patient′s prognosis. The effects of FOXA1 and XBP1 on the proliferation of ERα-positive breast cancer cells were investigated by CCK-8 and colony formation assay. The effect of FOXA1 on the cell cycle was analyzed by flow cytometry. Transcriptome analysis and the GEO database were used to analyze the genes and pathways regulated by FOXA1. Western blot and RT-qPCR were used to verify the expression levels of genes regulated by FOXA1. Results FOXA1 is mutated in multiple tumors. The expression levels of FOXA1 in breast cancer tissues are significantly higher than in normal tissues, and breast cancer patients with high expression levels of FOXA1 are associated with poor prognosis. FOXA1 was significantly overexpressed in the Luminal subtype compared with other breast cancer subtypes. Transcriptome and chromatin immunoprecipitation analysis identified 177 genes directly regulated by FOXA1, including XBP1. Pathway enrichment analysis showed that the genes regulated by FOXA1 were significantly enriched in cell cycle and DNA replication pathways. In ER-positive breast cancer cell lines, knockdown of FOXA1 or XBP1 significantly inhibited cell proliferation, and silencing of FOXA1 increased the number of G1 phase cells. Conclusion The pioneer transcription factor FOXA1 is highly expressed in ER-positive breast cancer and is associated with poor prognosis. FOXA1 promotes the proliferation of breast cancer cells by regulating the expression of a series of oncogenes, including XBP1.

The expression and clinical significance of aldehyde dehydrogenase 1 in sentinel lymph nodes of breast cancer

SHEN Mei-ying, PAN Hua-wen, ZHAO Li, HU Bo-tao, XU Bo, WEI Wei, CUI Jun-wei

2023, 23(01):  19-25.  DOI: 10.3969/j.issn.1009-976X.2023.01.004

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Objective To investigate the expression of aldehyde dehydrogenase 1 （ALDH1） in sentinel lymph nodes of breast cancer and its clinical significance. Methods The clinical data of patients who underwent breast cancer surgery in Maoming People′s Hospital between May 2021 and May 2022 were collected. The expression of ALDH1 in sentinel lymph nodes with metastasis （n = 26） and without metastasis n = 29） of breast cancer was detected by immunohistochemical staining. Results The positive expression rate of ALDH1 in breast cancer metastatic sentinel lymph nodes and non metastatic sentinel lymph nodes was 76.9% （20/26） and 17.2% （5/29）, respectively. The positive expression rate of ALDH1 in metastatic sentinel lymph nodes was significantly higher than that in non metastatic sentinel lymph nodes （P<0.01）. It was found that there was no statistical significance between the expression of ALDH1 in sentinel lymph nodes with histological grading, clinical stage, tumor diameter, expression of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, Ki-67 and molecular types （P>0.05）, but it was related to patient′s age （P<0.05）, the difference between the expression of ALDH1 and axillary lymph node metastasis, as well as the accuracy of sentinel lymph nodes with clear pathological characteristics after surgery, was statistically significant （P<0.01）. Conclusion The expression of ALDH1 in sentinel lymph nodes of breast cancer is not related to clinical stage, tumor diameter, histological grade, ER, PR, HER-2, Ki-67 and molecular types, but related to the patient′s age, axillary lymph node metastasis and postoperative pathological state of sentinel lymph node.

Analysis of the effects of different sites and surgical approaches on thoracoscopic radical lung cancer surgery complicated by celiac disease

HAN Le-yang, ZENG Chao, ZHAO Long

2023, 23(01):  26-30.  DOI: 10.3969/j.issn.1009-976X.2023.01.005

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Objective To investigate the effects of different parts and surgical methods of thoracoscopic lung cancer （segment group and lobe group, left and right group） on the incidence, treatment and prognosis of chylothorax. Methods The clinical data of 38 cases of chylothorax after radical resection of lung cancer in Ningbo Huamei Hospital of Chinese Academy of Sciences from January 2015 to December 2021 were retrospectively analyzed, including 1236 cases of segmental resection and 1236 cases of lobectomy, 952 cases of left thoracoscopic radical resection of lung cancer, 1520 cases of right thoracoscopic radical resection of lung cancer, 16 cases of chylothorax after segmental resection and systemic lymph node radical resection, 22 cases of chylothorax after lobectomy and systemic lymph node radical resection, 8 cases of chylothorax after left thoracoscopic radical resection of lung cancer, and 30 cases of chylothorax after right thoracoscopic radical resection of lung cancer. Results The total incidence of chylothorax after thoracoscopic lung cancer surgery was 1.54 %, the incidence of chylothorax in the lung segment group was 1.29 %, and the lung lobe group was 1.78 %. There was no significant difference between the two groups （P = 0.32）. The incidence of chylothorax after left thoracoscopic lung cancer was 0.63%, and the incidence of chylothorax after right thoracoscopic lung cancer was 2.11%, with significant difference （P <0.001）. All cases were successfully treated with conservative treatment, no deaths. Conclusion The incidence of chylothorax after lung cancer surgery was significantly correlated with the surgical site of lung cancer, but not with the surgical method of lung cancer. Treatment outcome： nutritional support for postoperative chylothorax of lung cancer improves the efficiency of conservative treatment.

Observation on the curative effect of pathological anal fissure tissue resection in the treatment of chronic anal fissure

CAI Can-feng, LI Jin-hong, CHEN Qing-qun, HUANG Wen-dong, XIN Hai-yang, CHENG Guang-hui, SUN Ming-kun, TANG Chao-ming, ZENG jun

2023, 23(01):  31-34.  DOI: 10.3969/j.issn.1009-976X.2023.01.006

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Objective To investigate the therapeutic effect of pathological anal fissure tissue resection on chronic anal fissure. Methods The clinical and follow-up data of 46 patients with chronic anal fissure who underwent pathological anal fissure tissue resection in our hospital from September 2019 to April 2020 were retrospectively analyzed. The operation time, intraoperative blood loss, postoperative complications, postoperative pain score, changes of anal canal resting pressure before and after surgery and clinical efficacy were observed. Results The operation time was （35.91±12.35） min, and the intraoperative blood loss was （7.33±3.48） ml. Postoperative urinary retention occurred in four cases （8.70%）, incision infection in one case （2.17%）, no incision bleeding, anal incontinence and other complications. Postoperative pain score： 24 h after operation （3.43±0.91）, 48 h after operation （3.00±0.73）, 72 h after operation （2.22±0.76）, one week after operation （0.67±0.63）. The resting pressure of anal canal was （19.86±2.24） kPa before operation and （10.396±1.97） kPa one week after operation, and the difference was statistically significant （P=0.000）. The wound healing time was （24.26±5.14） days. In this group, 42 cases （91.30%） were cured, 4 cases （8.70%） were improved, and the effective rate was 100%. The median follow-up time was 8 months, and no recurrence was found. Conclusion Pathological anal fissure tissue resection for chronic anal fissure is safe and effective.

Analysis of the characteristics and risk factors of chronic lower extremity venous diseases in diabetes

ZHU Tian-xin, CHEN Hong-xing, HUANG Kai, YOU Li-li, YANG Chuan, LIU Dan, YAN Li, REN Meng

2023, 23(01):  35-41.  DOI: 10.3969/j.issn.1009-976X.2023.01.007

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Objective To observe the clinical characteristics of diabetic patients with venous disease （VD）. Methods A total of 44 VD patients with （DM group） or without （NC group） diabetes hospitalized in the department of vascular surgery, Sun Yat-sen Memorial hospital, Sun Yat-sen University from September 2018 to January 2019 were enrolled in this study, and the clinical manifestations of VD patients in these two groups were compared. The patients were further divided into 4 groups according to the degree of VD. The baseline data of each group were compared, and the orderly multivariate logistic regression was conducted to analysis the risk factors related to the severity of VD. Results DM Patients presented to have more severe VD. The complication of DM and high level of creatine kinase isoenzyme （CM-KB） were clarified to be risk factors related to the severity of venous lesions. Conclusion Patients with diabetes presented to have more severe venous lesions than those without; the combination of DM and high level of CK-MB are evaluation factors for the high risk of exacerbation of chronic venous disease.

A study on the effect of comprehensive management on the balance disorder of Parkinson′s disease patients after deep brain stimulation

LI Hai-tao, YU Yang, WU Jing-chao, WU Fan, WANG Yue, LIANG Si-quan

2023, 23(01):  42-48.  DOI: 10.3969/j.issn.1009-976X.2023.01.008

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Objective To investigate the effect of multi-disciplinary teamwork on balance performance in Parkinson′s disease （PD） with bilateral STN-Deep Brain Stimulation. Methods 16 primary Parkinson′s disease（8 male,8 female） treated with bilateral subthalamic nucleus deep brain stimulation（STN-DBS） were included in the study. The median age of patients was 60.5 years; all patients were in H&Y 3 stage; the median PD duration of the disease was 9 years. For each patient, multi-disciplinary teamwork treatment including DBS, medication, physical therapy and psychotherapy was proceeded. LEDD, Motor disability（MDS-UPDRSIII）, life quality （PDQ-39） and balance performance（MDS-UPDRS 3.12, Berg Balance Scale, BBS Limits of Stability, LoS） were assessed in different time and status respectively： pre-operation （Med-off,Med-on）, post-operation （Stim-Off/Med-Off, Stim-On/ Med-Off, Stim-On/Med-On）, 6 months postoperation （Stim-On/ Med-Off, Stim-On/ Med-On） and 12 months postoperation （Stim-On/Med-Off, Stim-On/Med-On）. Results The LEDD of the 16 patients was significantly decreased during the follow-up （P<0.05）. The life quality （PDQ-39） score was significantly improved during the follow-up （P<0.05）. The Motor disability （MDS-UPDRSIII） was significantly improved in the postoperation Stim on/Med off state（P<0.05）, the MDS-UPDRS III score was optimal at 12 months postoperation （P<0.05）. Balance-related scores （MDS-UPDRS, item 3.12 and BBS） showed no significant improvement （P>0.05） compared with preoperation Med-off,postoperation Stim on/Med off, and Stim on/Med off state at 6 months postoperation. The scores were statistically different （P<0.05）, and the scores of Stim on/Med off state continued to improve at 12 months postoperation （P<0.05）. The limit of stability assessment of postoperation Stim on/Med off state （target acquisition percentage, body swing angle standard deviation, time） were significantly improved （P<0.05） compared with the preoperation Med off, preoperative Med on and postoperation Stim-off/Med-off. Conclusion Multi-disciplinary teamwork for PD patients with STN-DBS could improve balance performance.

ARH3 promotes the proliferation of glioblastoma by stabilizing MCM2-7 expression

XIE Xiao-juan, HU Kai-shun

2023, 23(01):  49-57.  DOI: 10.3969/j.issn.1009-976X.2023.01.009

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Objective To explore the mechanism of ARH3 promoting cell proliferation in glioblastoma. Methods The mRNA and protein expression levels of ARH3 in glioblastoma were analyzed by GEPIA2 and CPTAC databases. Two siRNA were designed and transferred either into glioblastoma cell lines U87 and LN229 to silence the expression of ARH3. Western Blot was employed to verify the knockdown efficiency of ARH3. Cell proliferation was detected by clonal formation. Flow cytometry was used to detect the proportion of cells at different periods. EdU assay was used to detect the proportion of cells in S phase. The overexpression vector of Flag-tag ARH3 was constructed and transfected into cells. The interaction proteomics of ARH3 was analyzed by co-immunoprecipitation combined with mass spectrometry and the enrichment analysis of related pathway network was performed. The effect of ARH3 on the stability of cycle-related proteins was verified by cell transfection siRNA combined with Western Blot. The changes of signal pathway network in glioblastoma cells after ARH3 silencing were analyzed by cell transfection siRNA combined mass spectrometry. Results The results of GEPIA2 and CPTAC databases showed that glioblastoma significantly overexpressed ARH3 （P<0.05）; after knocking down endogenous ARH3 in glioblastoma U87 and LN229, the number of colony formation decreased （P<0.05）; the result of flow cytometry showed that the proportion of ARH3 knockdown cells in G1 phase increased （P<0.05）, and the proportion of cells in S phase decreased （P<0.05）; the results of EdU assay showed that the proportion of cells in S phase decreased （P<0.05）; Co-immunoprecipitation combined with mass spectrometry showed the interaction between cell cycle associated proteins and ARH3. Western Blot results showed that the silencing of ARH3 decreased the protein expression level of MCMs and inhibited the expression level of cyclins in S phase. Mass spectrometry showed that ARH3 depression down-regulated the expression of cell cycle-related pathway proteins. Conclusion ARH3 is highly expressed in glioblastoma; ARH3 promotes the transition of glioblastoma in G1/S phase, thereby maintaining the normal progress of cell cycle and promoting the proliferation ability of glioblastoma cells.

Knockdown of PSMA expression promoted cell migration, invasion and EMT in prostate cancer LNCAP cells

LI Jin, LAI Yi-min, ZENG Le-xiang

2023, 23(01):  58-63.  DOI: 10.3969/j.issn.1009-976X.2023.01.010

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Objective To investigate the PSMA expression, migration, invasion and expression of EMT associated proteins in LNCAP cells after transfection of PSMA siRNA. Methods LNCAP cells were cultured and divided into si-PSMA group, negative control siRNA group, inhibitor LY294002 group and LY294002+si-PSMA group. The expressions of PSMA mRNA and protein were detected respectively by qRT-PCR and Western blot. Transwell assay were used to detect migration and invasion in LNCAP cells.Western blot was used to detect the effect of PSMA inhibitionon the protein expression of p-Akt （ser473） and epithelial mesenchymal transformation marker proteins such as E-cadherin, β-cadherin, vimentin and snail. Results Compared with negative control group, the mRNA and protein expression of PSMAin LNCAP cells was downregulated by transfection of PSMAsiRNA（P<0.05）. Transwell results showed that the migration and invasion rates were increased in si-PSMA group（P<0.05） and decreased in LY294002 group,but was rescued combined with siRNA（P<0.05）. Western blot results displayed higher expression of vimentin, snail and p-Akt（ser473） while lower expression of E-cadherin and β-cadherin in si-PSMA group. Conclusion Knockdown of PSMA may promote the migration and invasion of LNCAP cells by activating epithelial mesenchymal transformation pathway.

Analysis of the function and potential inhibitors of 5-methylcytosine modification regulators in cancer

LAI Zheng-hao, LIANG Guo-run, LUO Man-li

2023, 23(01):  64-70.  DOI: 10.3969/j.issn.1009-976X.2023.01.011

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Objective 5-methylcytosine （m5C） modification of RNA is involved in a variety of physiological and pathological processes, especially in the occurrence and development of tumors. In this study, the relationship between the level of m5C in pan-cancer and prognosis was analyzed by m5C modified regulatory genes, and the potential m5C inhibitory were explored. Methods the RNA-Seq data of 33 cancers were downloaded from the cancer gene map （TCGA） database, and the expression levels of M5C regulatory genes in cancer and paracancerous tissues were analyzed by R software. Then, we predicted the potential drugs that might inhibit m5C modification in pan-cancer by The Connectivity Map （CMap）, and verified their inhibitory effects by the m5C dot blot and cell viability assay. Results In most tumor types, Writers and Readers of m5C were significantly overexpressed. The overall survival times （OS） of patients with high level of m5C was significantly shorter than that of patients with low level of m5C. Importantly, the predicted m5C inhibiting drugs can effectively inhibit the total m5C level and proliferation of cancer cells. Conclusion Our study shows that in many types of cancers, the high level of m5C modification and the abnormal expression of m5C regulatory molecules are closely related to malignant tumors, indicating that m5C modification regulators may be promising biomarkers for prognosis. and can be used as valuable targets for cancer treatment.

Analysis of diagnostic efficacy of CTA+CDFI in cerebral aneurysm

HU Shao-yu, ZHENG Zhang-zeng, CHEN Xin-yan

2023, 23(01):  71-74.  DOI: 10.3969/j.issn.1009-976X.2023.01.012

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Objective To explore the diagnostic efficacy of CT angiography （CTA） and color Doppler flow imaging （CDFI） in cerebral aneurysm （CA）. Methods 221 patients with suspected CA admitted to our hospital from March 2019 to September 2021 were selected. CTA and CDFI were performed. Three-dimensional digital subtraction angiography （3D-DSA） was used as the gold standard. The results of CTA and CDFI were observed, and the diagnostic efficacy of the two methods were analyzed. The number of tumors detected by CTA and CDFI, the coincidence rate of specific tumor location, the maximum diameter of tumor body and the diameter of tumor neck were compared. Results Among 221 suspected CA patients, 134 cases were positive by 3D-DSA, 122 cases by CDFI, 124 cases by CTA and 140 cases by CTA+CDFI. The sensitivity （97.76%）, accuracy （94.57%） and negative predictive value （96.30%） of CTA+CDFI were higher than those of CDFI （85.07%, 87.33%, 79.80%）, CTA （85.82%, 87.33%, 80.41%） alone （P<0.05）; The miss diagnosis rate of CTA+CDFI （2.24%） was lower than that of CDFI （14.93%） and CTA （14.18%） （P<0.05）; There was no significant difference between CTA+CDFI and 3D-DSA （P>0.05）. Conclusion the diagnostic efficacy of CTA+CDFI in the diagnosis of Ca is significantly higher than that of CTA and CDFI alone, which can improve the rate of tumor detection and the coincidence rate of lesion location, and is conducive to the development of clinical targeted treatment and the improvement of the prognosis of CA patients.

Effects of perioperative general anesthetic sevoflurane on long-term memory impairment and neuronal pyroptosis in neonatal rats

YU Shuai-long, CAO Dong, MA Lin-yun, LI Yu-juan

2023, 23(01):  75-79.  DOI: 10.3969/j.issn.1009-976X.2023.01.013

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Objective This paper investigates the effects of anesthetic sevoflurane on pyroptosis and cognitive function in the hippocampus of neonatal rats. Methods Sprague-Dawley rat pups at postnatal day 7 were randomly assigned to a control group and an experimental group. Under same conditions, the experimental group was treated with 2.8% sevoflurane for 4 hours, while the control group was exposed to air for the same time. Hippocampal tissue was extracted after 6 h. Western blot was used to detect the change of NLPR3, GSDMD, GSDMD-N, IL-18, and IL-1β pyroptotic protein（n=6）. The other rats after exposure were kept with their mothers. The open field test was performed on postnatal days 30 and the fear conditioning test was performed on postnatal days 33-34 （n=10）. Results Compared with the control group, the pyroptotic protein of NLPR3, GSDMD, GSDMD-N, IL-1β, and IL-18 in hippocampal tissues of the experimental group significantly increased（P<0.001）, the fear conditioning test showed a decreased percentage（P<0.001） of freezing time, the open field test showed no difference（P>0.05）in locomotor activity by the total distance and time spent in the center. Conclusion The sevoflurane-induced long-term memory impairment in neonatal rats may be caused by pyroptotic neuron death.

Review

The clinical significance of cholangiography in extrahepatic cholangioscopy

WU Jin-xiang, CHEN Hai-min, ZHAO Jia-feng, MIAO Hui-lai, WU Qing-song

2023, 23(01):  80-83.  DOI: 10.3969/j.issn.1009-976X.2023.01.014

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With the continuous development and improvement of laparoscopic minimally invasive technology, the technical system of laparoscopic biliary tract surgery has entered the era of precision medicine and is developing towards a safer, more efficient and minimally invasive direction. However, how to prevent its occurrence is the key. At present, intraoperative cholangiography and indocyanine green fluorescence cholangiography are often used in laparoscopic biliary surgery to prevent bile duct injury; to determine whether there is stone omission and bile duct variation during surgery and to understand the intraoperative patency of the common bile duct and the functional status of Oddis sphincter.

Research progress of surgical approach for laparoscopic pancreatoduodenectomy

ZHOU Xiao-bo

2023, 23(01):  84-87.  DOI: 10.3969/j.issn.1009-976X.2023.01.015

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Laparoscopic pancreaticoduodenectomy is the operation with characteristics of “endoscopic surgery”. Multiple fascia spaces should be seperated to aim the target area during the operation. The corresponding surgical approach is selected according to the location and size of the tumor and relationship between the tumor and blood vessels.This review combined with the latest data analyzed the advantages and disadvantages of different surgical approaches of laparoscopic pancreatoduodenectomy in order to provide directions for the selection of surgical approaches.

Characteristics and clinical problems of colorectal serrated lesions

XIE Xuan-yu, LI En

2023, 23(01):  88-94.  DOI: 10.3969/j.issn.1009-976X.2023.01.016

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Serrated polyps （SP） were once considered benign lesions. However, it is now recognized that about 15% to 30% of SPs eventually develop into colorectal cancer through the serrated neoplasia pathway （SNP）. Serrated polyps are divided into hyperplastic polyps, sessile serrated lesions, sessile serrated lesions with dysplasia, traditional serrated adenomas and unclassified serrated adenomas, each with different morphological and molecular characteristics. Although the understanding of SP has been improved, due to frequent pathological error classification, insufficient detection of colonoscopy and high rate of incomplete resection, SP is still a lot of clinical challenges faced by endoscopy and pathologists. This article summarizes the new understanding and diagnosis of serrated polyps.