[Risk factors for delayed gastric emptying after laparoscopic pancreaticoduodenectomy: a single-center experience of 1 000 cases]

Objective: To explore the causes and summarize the treatment experience for clinically relevant delayed gastric emptying(DGE) after laparoscopic pancreaticoduodenectomy(LPD). Methods: The clinical data of 1 000 patients who underwent LPD in the Department of Liver Transplantation and Hepatobiliary Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University between March 2017 and September 2022 was retrospectively collected. There were 640 males and 360 females,with an age of (60.1±11.4)years(range: 13 to 93 years),and 590 patients were older than 60 years. Depending on the severity of DGE,patients were divided into a clinically relevant DGE group and a 0/A grade DGE group. The comparison between the two groups was performed by the χ2 test,Fisher's exact probability method,t test or the rank sum test,and the effects of various treatment strategies for clinically relevant DGE were evaluated. Results: LPD was conducted successfully in all 1 000 patients,with a surgical time of (344.8±103.6)minutes(range:160 to 450 minutes) and intraoperative blood loss (M(IQR)) of 100 (150) ml(range:50 to 1 000 ml). A total of 74 patients(7.4%) developed clinically relevant DGE. Compared to those in the 0/A grade DGE group,patients in the clinically relevant DGE group had a higher preoperative body mass index of ((24.9±3.5)kg/m2 vs. (23.9±3.3)kg/m2,t=-2.419,P=0.016),more postoperative bile leakage(51.4%(38/74) vs. 10.8%(100/926)),pancreatic fistula(59.5%(44/74) vs. 22.9%(212/926)),abdominal infection(74.3%(55/74) vs.14.6%(135/926)),and abdominal bleeding(43.2%(32/74) vs. 11.3%(105/926))(all P<0.05). Among these patients,10 cases(13.5%) received enteral nutrition treatment,22 cases(29.7%) received parenteral nutrition treatment,and 42 cases(56.8%) received a combination of enteral and parenteral nutrition treatment. The time for patients to return to a normal diet was 21(14)days (range: 8 to 85 days). Compared to those who received only enteral(23.5(27.0)days) or parenteral nutrition treatment(15.5(11.0)days),patients who received a combination of enteral and parenteral nutrition treatment(25.5(31.0)days) had a longer time to return to a normal diet (Z=20.019,P<0.01). Among the 60 patients who developed secondary DGE,48 cases(80.0%) received ultrasound-guided puncture and drainage treatment,while 12 cases(20.0%) only received anti-infection treatment. The patients in the non-puncture drainage group had a longer time to return to a normal diet than those in the puncture drainage group (26.5(12.5)days vs. 20.0(11.0)days, Z=-2.369,P=0.018). Conclusions: Patients with clinically relevant DGE after LPD had a higher proportion of postoperative complications such as pancreatic fistula,biliary fistula and abdominal infection. A combination of enteral and parenteral nutrition treatment is needed for patients with a long-term course of DGE."Smooth" drainage and ani-infectious therapy could contribute to the recovery of DGE.

[Epidemiological analysis of Plague in Dehong Dai and Jingpo Autonomous Prefecture of Yunnan province, 1950-2019]

Objective: To analyze the epidemic situation and influencing factors of plague in Dehong Dai and Jingpo Autonomous prefectures (Dehong) from 1950 to 2019, for the improvement of strategies on prevention and control of the disease. Methods: The epidemic situation and surveillance data of animal and human plague in Dehong prefecture from 1950 to 2019 were collected and analyzed by descriptive epidemiological methods. Multiple linear regression equations were established by SPSS 20.0 software to analyze the relationship between plague among animals and rat density and flea index, as well as the relationship between human plague and plague among animals. Results: In Dehong prefecture, plague experienced a phenomenon of epidemic-resting-epidemic-resting cycle, between 1950 and 2019. During this period, 614 epidemic spots were identified in 36 townships of five counties/cities,. Human plague had been prevalent for 15 years, with 1 153 human cases and 379 deaths involved. Between 1982 and 2019, 261 319 rodents were captured, of which Rattus flavipectus accounted for 70.95%(185 421/261 319). A total of 70 124 fleas were seized with 76.65%(53 752/70 124), xenopsylla cheopis as fleas. The index of fleas and free fleas were 0.57 and 0.22 respectively. A total of 1 577 strains of Yersinia pestis were isolated from 285 091 animal specimens and 418 strains of Yersinia pestis were isolated from 60 119 groups of fleas, with 255 F1 antibody positive samples were detected from 64 157 sera samples. Neither Yersinia pestis nor the outbreak of plague had been noticed since 2008. Correlations between both animal plagues and rat density, as well as human plague and animals plague were noticed from the regression analysis. Conclusions: The epidemics of plague were with long-term and stable nature, in Dehong prefecture. Affected by many factors, plague seemed in a resting period currently. However, we should be reminded that the fact that outbreak of plague may revive at some uncertaint point. Hence in order to prevent human plague, strategies as careful surveillance programs on animals, need to be strenthened.

[Effect and mechanism of miR-223 on fibrosis-related signaling pathway in rat cardiomyocytes]

Objective: To investigate the protective effect of microRNA 223 (miR-223) on cardiac fibrosis-related signaling pathway and its regulation on expression of Twist family basic helix-loop-helix transcription factor 1 (Twist1) and transforming growth factor-β1 receptor 2 (TGFBR2) in rat cardiomyocytes. Methods: Rat cardiomyocytes (H9c2) were cultured in vitro and treated with TGF-β to induce myocardial fibrosis. The miR-223 group was transfected with miR-223 lentivirus and miR-223-NC group was transfected with miR-223-NC lentivirus. Model group and blank control group had no transfection. Immunocytochemistry staining of alpha-smooth muscle actin (α-SMA) was used to calculate myocardial fibrosis. The mRNA level of miR-223, collagen Ⅰ, collagen Ⅲ, Twist1 and TGFBR2 were detected by real-time PCR. The protein level of Twist1, TGFBR2, collagen Ⅰ, collagen Ⅲ and α-SMA were detected by Western blot. Target regulation of miR-223 on Twist1 and TGFBR2 3'UTR was verified by double luciferase reporter gene system. Results: The average optical density of α-SMA-positive cardiomyocytes in miR-223 group (0.089±0.013) was significantly lower than that in model group and miR-223-NC group (0.134±0.018, 0.132±0.016, respectively). The mRNA level of collagen Ⅰ, collagen Ⅲ, Twist1 and TGFBR2 in miR-223 group were significantly lower than that in model group and miR-223-NC group (all P<0.05). The protein level of Twist1, TGFBR2, collagen Ⅰ, collagen Ⅲ and α-SMA in miR-223 group was significantly lower than model group and miR-223-NC group (all P<0.05). Twist1, TGFBR2 3'UTR wild-type double luciferase reporter plasmids and miR-223 mimics were co-transfected in 293T cells, and luciferase activity was significantly reduced (0.48±0.06 vs 0.92±0.17 and 0.51±0.07 vs 0.94±0.12). Conclusion: MiR-223 may inhibit the activation of fibrosis-related signaling pathway in cardiomyocytes by down-regulating the expression of Twist1 andTGFBR2 genes.

Clinical effect of balloon kyphoplasty in elderly patients with multiple osteoporotic vertebral fracture

Objective

This study aims to discuss the clinical effect of balloon kyphoplasty on elderly patients with multiple osteoporotic vertebral fractures.

Methods

The observation group was treated with balloon kyphoplasty, and the control group was managed with conservative treatment. Image indices, pain degree, daily life disturbance, and occurrences of complications were compared between the two groups.

Results

In total, 116 elderly patients with multiple osteoporotic vertebral fracture admitted in our hospital from January 2016 to June 2017 were chosen and divided randomly into observation (n = 58) and control groups (n = 58). The observation group showed a significantly higher trailing edge, leading edge, and midcourt line and larger upper thoracic kyphosis compared with the control group (P < 0.05). Before the treatment, no statistically significant differences were observed between the two groups in terms of visual analog scale (VAS) score and daily life disturbance score (P > 0.05). However, the VAS score and the daily life disturbance score of the two groups decreased sharply after the treatment (P < 0.05). Moreover, the VAS score and the daily life disturbance score of the observation group were significantly lower than those of the control group (P < 0.05). The observation group showed lower occurrence rate of complications compared with the control group (P < 0.05).

Conclusions

Balloon kyphoplasty can significantly improve the image indices of patients with multiple osteoporotic vertebral fractures and relieve their pain degree and daily life disturbance. Balloon kyphoplasty exhibited a low occurrence rate of complications and high safety and is, thus, worthy of clinical applications.

Genetic association of sequence variation in exon 3 of the swine leukocyte antigen-DQA gene with piglet diarrhea in Large White, Landrace, and Duroc piglets

Piglet diarrhea is one of the primary factors that affects the benefits of the swine industry. Recent studies have shown that exon 2 of the swine leukocyte antigen-DQA gene is associated with piglet resistance to diarrhea; however, the contributions of additional exon coding regions of this gene remain unclear. Here, we detected and sequenced variants in the exon 3 region and examined their associations with diarrhea infection in 425 suckling piglets using the polymerase chain reaction-single-strand conformational polymorphism and sequencing analysis. The results revealed that exon 3 of the swine leukocyte antigen-DQA gene is highly polymorphic and pivotal to both diarrhea susceptibility and resistance in piglets. We identified 14 genotypes (AA, AB, BB, BC, CC, EE, EF, BE, BF, CF, DD, DH, GG, and GF) and eight alleles (A-H) that were generated by 14 nucleotide variants, eight of which were novel, and three nucleotide deletions. Statistical analyses revealed that the genotypes AB and EF were associated with resistance to diarrheal disease (P < 0.05), and the genotype DD may contribute to diarrhea susceptibility but was unique to Large White pigs (P > 0.05). These results elucidate the genetic and immunological background to piglet diarrhea, and provide useful information for resistance breeding programs.

Swine Leukocyte Antigen-DQA Gene Variation and Its Association with Piglet Diarrhea in Large White, Landrace and Duroc

The swine leukocyte antigen class II molecules are possibly associated with the induction of protective immunity. The study described here was to investigate the relationship between polymorphisms in exon 2 of the swine DQA gene and piglet diarrhea. This study was carried out on 425 suckling piglets from three purebred pig strains (Large White, Landrace and Duroc). The genetic diversity of exon 2 in swine DQA was detected by PCR-SSCP and sequencing analysis, eight unique SSCP patterns (AB, BB, BC, CC, CD, BD, BE and DD) representing five specific allele (A to E) sequences were detected. Sequence analysis revealed 21 nucleotide variable sites and resulting in 12 amino acid substitutions in the populations. A moderate level polymorphism and significant deviations from Hardy-Weinberg equilibrium of the genotypes distribution were observed in the populations (p<0.01). The association analysis indicated that there was a statistically significant difference in the score of piglet diarrhea between different genotypes, individuals with genotype CC showed a lower diarrhea score than genotypes AB (0.98±0.09), BB (0.85±0.77) and BC (1.25±0.23) (p<0.05), and significantly low than genotype BE (1.19±0.19) (p<0.01), CC genotype may be a most resistance genotype for piglet diarrhea.

Liver cancer stem cells are selectively enriched by low-dose cisplatin

Accumulating evidence has indicated the importance of cancer stem cells in carcinogenesis. The goal of the present study was to determine the effect of low-dose cisplatin on enriched liver cancer stem cells (LCSCs). Human hepatoblastoma HepG2 cells were treated with concentrations of cisplatin ranging from 1 to 5 μg/mL. Cell survival and proliferation were evaluated using a tetrazolium dye (MTT) assay. LCSCs were identified using specific markers, namely aldehyde dehydrogenase-1 (ALDH1) and CD133. The percentage of ALDH1+ or CD133+ cells was examined by flow cytometric analysis. The expression of ALDH1 and/or CD133 in HepG2 cells was determined by immunocytochemical analysis. Low-dose cisplatin treatment significantly decreased cell survival in HepG2 cells after 24 or 72 h. However, the percentage of LCSCs in the surviving cells was greatly increased. The percentage of ALDH1+ or CD133+ cells was increased in a time- and dose-dependent manner after treatment with 1-4 μg/mL cisplatin, whereas 5 μg/mL cisplatin exposure slightly reduced the number of positive cells. These findings indicate that low-dose cisplatin treatment may efficiently enrich the LCSC population in HepG2 cells.