The aim is to report a case of poor wound healing secondary to enterocutaneous fistula wound management after oesophageal hiatal hernia repair and described our treatment experience.Using the stoma chassis decompression tugging to reduce the tension of the abdominal wall,combined with simplified negative pressure wound technology and saline flushing,and applying the negative pressure wound technology combined with the stoma bag to collect the digestive fluid of enterocutaneous fistulas.The negative pressure wound technique and stoma bag could collect the digestive fluid of the fistula,avoid the contamination of the skin around the fistula,reduce the symptoms caused by the dermatitis,alleviate the pain,and eventually promote the wound healing.
Acute pancreatitis,casuing systemic inflammatory response,can lead to intestinal flora disturbance,gut barrier dysfunction and intestinal immune function impairment.The underlying patho-genesis is closely associated with gut microorganisms,which significantly increases the mortality of sever acute pancreatitis(SAP).Recently the imbalance of intestinal flora is being regarded as an critical poten-tial therapeutic target of AP via traditional Chinese medicine,in with Euphorbia kansui has played a im-portant role in the treatment of SAP.This review aims to provide more basic research and clinical applica-tion evidence of Kansui in the cure of AP from the perspective of gut microorganisms,through summariz-ing and analyzing the existed pertinent literature.
Objective To explore the short-term efficacy of Shenling Baizhu San granules combined with training of lifting the anus for anal dysfunction after Dixon operation for middle and low rectal cancer.Methods Forty-fivepatients with rectal cancer undergoing Dixon'soperation were divided into a control group(treated with Montmorillonite powder combined with levator ani muscle training)of 21 cases,and a study group(treated with oral Shenling Baizhu San granules beside of the same as control group)of 24 cases.The recovery of anal function was evaluated using Williams criteria,Wexner scoring system,and defecography at 1,3,6 months after surgery.Results Williams Anal Function Assessment:The fine anal function rate of in the study group was higher than that in the control group at 3 months after surgery,with a statistically significant difference(P=0.042),but there was no statistically significant difference at 1 and 6 months after surgery(P>0.05).Wexner score of anal incontinence:The Wexner score of anal incontinence in the study group was significantly lower than that in the control group at 1,3,6 months after surgery,with a statistically significant difference(P<0.05).Six months after surgery,defecography in ZD patients at the study group patients(20/24)and 15 patients(15/21)at the control group showed fine rectal filling without significant stenosis and no leakage of contrast media.Conclusion Shenling Baizhu San granules combined with training of lifting the anuscan accelerate the recovery of anal dys-function after Dixon's operation for middle and low rectal cancer,and reduce the incidence of postopera-tive anal incontinence.
Pancreatic cancer is a relatively common malignant tumor in hepatobiliary and pancreatic surgery,with insidious onset,atypical early symptoms,easy to metastasize,and a five-year survival rate of less than 6%.Pancreaticoduodenectomy is the standard procedure for pancreatic and peripelvic tumors,and laparoscopic pancreaticoduodenectomy has higher requirements for the operator's luminal technique,and more precise requirements for the assessment of tumor invasion of adjacent organs and vascular varia-tions.Three-dimensional visualization technology integrates digital medicine,computer and artificial intelligence technologies,and the three-dimensional visualization platform can reorganize and integrate two-dimensional image data to construct three-dimensional abdominal anatomical structure images,and the three-dimensional display of the anatomical structure around the pancreas is conducive to improving the accuracy of preoperative assessment,increasing the safety of the operation,accelerating the patient's recovery after the operation,and achieving the purpose of precise treatment,which is in line with the accelerated recovery surgery concept.The concept is in line with the accelerated rehabilitation surgery.
Objective To investigate the clinical effect of unilateral percutaneous kyphoplasty(PKP)in the treatment of vertebral compression fracture in the elderly from the perspective of the injected volume and distribution of bone cement.Methods The clinical data of 60 elderly patients with vertebral compression fracture who were treated in the hospital from September 2019 to September 2022 were retro-spectively analyzed.According to the position of bone cement in vertebral body displayed on postoperative thoracolumbar orthotopic X-ray film,the patients were divided into control group(eccentric distribution,31 cases)and observation group(centric distribution,29 cases).Perioperative parameters of the two groups were compared.Changes in pain scores and imaging data before operation,1 week,6 months and 12 months after operation,activities of daily living and the incidence rates of complications in the two groups were recorded.Results There was no statistically significant difference between the two groups in terms of surgical time,blood loss,length of hospital stay,injected volume of bone cement and the incidence of complications(P>0.05).The Visual Analog Scale(VAS)scores,Oswestry disability index(ODI)scores and kyphosis angles(Cobb angle)of the two groups decreased at 1 week,6 months and 12 months after operation.The VAS score,ODI score and Cobb angle of the observation group were lower than those of the control group at each time point(P<0.05).Conclusion The distribution of bone cement in elderly patients with vertebral compression fracture after unilateral PKP can affect the curative effect.Eccentric distribution can delay pain relief and affect quality of life of the patients.Therefore,centric distribution of bone cement should be maintained as much as possible.
Objective To explore the alterations of spermidine metabolism in breast cancer in response to chemotherapy,and the subsequent impact on immune cell infiltration and lymphocytic activation.Methods The single-cell RNA sequencing data of MMTV-Wnt1 tumor transplants from the online data-base were re-analyzed to identify the adjustments of spermidine metabolism in breast cancer cells after chemotherapy.Additionally,investigations were performed on the single-cell RNA-Seq data on multiple breast samples of various subtypes from GEO:GSE176078 to uncover the heterogeneity of spermidine metabolism in cancer cells.Based on the expression of genes associated with spermidine metabolism,breast cancer samples were divided into two categories:the high-spermidine-metabolism group and the low-spermidine-metabolism group.Then the variations in immune cell infiltration and lymphocytic activa-tion were further evaluated between the two groups.Results A subpopulation of tumor cells with active spermidine metabolism and high levels of ODC1 and SMOX expression,the enzymes related to spermidine metabolism,were significantly enriched in the transplant tumors after chemotherapy with doxorubicin.Moreover,active spermidine metabolism in cancer cells was positively correlated with increased effector T-cell infiltration and enhanced CD8 T-cell functions in breast cancer.Conclusion Chemotherapy potentiated antitumor immunity in breast cancer by activating the spermidine metabolism.
Objective To explore the clinical manifestations,pathological features,immunophenotype,differential diagnosis,treatment and prognosis of primary thyroid follicular lymphoma(PTFL).Methods The clinical data of three patients with PTFL were retrospectively analyzed,and the therapy strategy and follow-up prognosis were sorted out and analyzed.Results All three patients underwent surgery.One of them was confirmed as FL by pathological diagnosis,and regular chemotherapy after surgery.This patient was followed up for more than 3 years and completely remission(CR).The postoperative pathological diagnosis of other one was not clear,for the results didn't support typical FL.However,the Bcl-2-negative PTFL couldn't be exclude.This case was in stable condition after followed up for more than 6 years without any further examination or chemotherapy.The last case had difficulties in pathological diagnosis,and finally diagnosed as FL by pathology specialist consultation.Then the patient was treated with 1 course CD20 monoclonal antibody and followed up for over 1 year,CR.Conclusion PTFL is rare in clinical practice and is prone to misdiagnosed or missed.By collecting 3 cases of PTFL for clinical analysis,the differential diagnosis ideas were provided and the basis for formulating individualized clinical treatment strategies were provided.
The gallbladder is extremely rare involved by metastatic carcinoma from other organs.To our knowledge,there is no case of matastasis to gallbladder from cervical carcinoma being reported and no systemic diagnosis and treatment standards.A 49-year-old woman presented pain in her upper abdo-men for more than 20 days with a previous history of radical hysterectomy.A computed tomography(CT)scan of upper abdomen revealed an acute cholecystitis.Laparoscopic exploration was performed,swollen lymph nodes in portal area were seen during the operation.A lymph node metastasis was suggested by rapid frozen section examination.Radical resection of gallbladder caner was performed and the final path-ological examination showed the metastatic cervical squamous carcinoma to the gallbladder.The patient was treated with hyperthermic intraperitoneal chemotherapy(HIPEC)effectively.In conlusion,the diagno-sis of metastatic gallbladder malignant tumor is difficult without systematic diagnosis and treatment standards.For patients with cholecystitis with a history of previous malignant tumors and poor response to long-term conservative treatment,clinicians need to pay more attention to avoid missed diagnosis and misdiagnosis.
For abdominal surgery,especially digestive system(hepatobiliary,pancreatic,gastroin-testinal)surgery,prophylactic placing abdominal drainage tube abdominal closure is a significant treat-ment.Among all the existing abdominal drainage tube fixation methods,suture fixation and enhanced fixation methods based on it are the most mainstream one.However,the suture fixation often causes skin traction and cutting pain,delays the patient's early movement out of bed,which is not in line with the concept of Enhanced Recovery after Surgery(ERAS).Also,suture fixation has a high risk of decannula-tion.In this study,we designed a novel abdominal drainage tube fixation device,which innovatively uses suture-free skin tape,connecting hose,half-ring buckle triple fixation structure.Therefore,it avoided damage to the skin around the drainage tube wound and reduces skin pain.The flexibility of the detach-able components and the plasticity of the air bag provide high compatibility,making our device suitable for most wounds and various types of abdominal drainage tubes.In general,our abdominal drainage tube fixation device has certain clinical value and application prospects.
Objective To construct a prognostic model for glioma patients based on cuproptosis related genes.Methods The transcriptome expression profiles of normal brain tissues were downloaded from GTEx database.The transcriptome expression profiles and corresponding clinical data of glioma patients were downloaded from TCGA and GEO databases.Differential expression analysis and prognostic analysis were performed on the 12 CRGs.Firstly,according to the expression profile of prognostic CRGs,the glio-ma samples were classified into different cuproptosis subtypes by consensus clustering algorithm.Prognos-tic DEGs between different cuproptosis subtypeswere obtained.Then,Lasso Cox regression analysis was used to construct the prognostic risk score model,and ROC curve was used to evaluate the predictive per-formance of this model.Finally,nomogram was constructed to improve the clinical applicability of the prognosis model.Results A total of 720 glioma samples were obtained.Using the consensus cluster-ing algorithm,glioma samples were classified into two cuproptosis subtypes,CRGcluster A and CRGclus-ter B.A total of 1831 differentially expressed genes related to prognosis were identifiedbetween the two cuproptosis subtypes.A prognostic risk score model with eight genes was constructed in the train set and validated in the test set.ROC curve analysis showed that the AUC of the model in predicting the 1-,3-and 5-year survival rates of glioma patients in the test set were 0.881,0.894 and 0.874.According to the prognosis model,glioma samples were classified into high-risk group and low-risk group,and patients in the high-risk group had lower survival rate and shorter survival time(P<0.05).Conclusion In this study,a prognostic risk score model for glioma was constructed based on cuproptosis related genes.This model can accurately predict the prognosis of patients with glioma,which provides a new way to evaluate the prognosis of patients with glioma.
Glycosylation is the process by which monosaccharides or glycans are attached to proteins or lipids under the control of glycosyltransferases and glycosidases.Glycosylation is crucial for pathogen infection,intercellular signaling,cell migration,proliferation,and differentiation.Extensive research has demonstrated the significant role of glycosylation in chronic inflammatory diseases,such as inflammatory bowel disease,chronic kidney disease,autoimmune diseases,and cancer.This article provides an over-view of glycosylation and its structural diversity,focusing on the role of glycosylation in the inflammatory microenvironment and its potential feasibility as a diagnostic and therapeutic target for chronic inflamma-tory diseases.It provides theoretical basis and new ideas for the prevention,diagnosis,and treatment of chronic inflammatory diseases based on glycosylation.
Objective To study the immunophenotype and clinical pathological significance of pulmo-nary sclerosing pneumocytoma(PSP)/sclerosing hemangioma(PSH)with atypical clinical and pathological features.Method Cases were selected according to enrollment requirements,and clinical and pathological data of 15 PSP/PSH patients with atypical clinical and pathological features were collected.The gross and microscopic changes,immunohistochemical expression characteristics,clinical and imaging manifesta-tions of the patients were retrospectively analyzed.High throughput sequencing was performed to detect gene mutations in one case of pulmonary sclerosing pneumocytoma withsimultaneous regional lymph node metastasis.Results PSP with atypical clinical and pathological features was more common in middle-aged women,ranging from 33 to 73 years old,with a median age of 54 years old.It was mostly found in the left upper and right lower lungs,and most patients were asymptomatic.During physical examination,it was found that the imaging findings were mostly solitary circular or quasi circular masses with clear boundaries.The characteristic manifestation of HE is composed of four organizational structures(papillary area,sclerotic area,solid area,and hemangioma like area)and two types of cells(surface cells,interstitial cells).Both types of IHC cells express EMA and TTF-1,while surface cells express CK7,NapsinA,interstitial cells express Vim,without CK7,NapsinA.Among the 15 cases,1 case experienced simultaneous regional lymph node metastasis and was followed up for 10 months.Currently,the patient has survived well without recurrence or distant metastasis.Conclusion The clinical manifes-tations and imaging features of PSP with atypical clinical and pathological features are not significantly specific,and the histological morphology is diverse.The misdiagnosis or delayed diagnosis rate during surgery is high.When diagnosing,it is not only necessary to grasp the characteristic HE manifestations and IHC expression characteristics,but also to pay attention to whether it has malignant biological behavior.In addition,1 out of 15 cases had simultaneous regional lymph node metastasis,but there was no AKT1 E17K somatic mutation and TP53 C176Y germline mutation.The reason why this patient develop malig-nant progression needs further research.
Thrombophilia refers to a pathological condition where the risk of thrombosis is increased due to various genetic or acquired factors.The main clinical outcome of thrombophilia is venous thrombo-embolism(VTE),which can manifest in various forms such as deep vein thrombosis(DVT),pulmonary embolism(PE),cerebral venous thrombosis(CVT),portal vein thrombosis(PVT),and mesenteric vein thrombosis(MVT).Moreover,thrombophilia also can cause arterial thrombotic events like early-onset acute coronary syndrome and ischemic stroke.Thrombophilia is typically categorized into two main types,genetic and acquired type.Genetic thrombophilia results from inherent defects in the body's anticoagula-tion or coagulation system,leading to a hypercoagulable state.Patients with thrombophilia often develop thrombotic condition at a young age,and once it occurs,it can lead to severe consequences.In order to enhance the diagnostic and treatment capabilities of clinical doctors in Guangdong Province and provide guidance and standardization for the diagnosis and treatment of thrombophilia at various levels of hospi-tals,a multidisciplinary team(MDT)of experts in the field of thrombosis was formed.After extensive discussions and seeking opinions from various sources,this consensus document was developed.It primarily focuses on the diagnosis and treatment of genetic thrombophilia and special population prone to clot forma-tion,aiming to provide guidance for clinical decision-making in the management of thrombophilia.This consensus will be regularly revised and updated based on advances in domestic and international research.
Objective To evaluate the application effect of 3D Vane-XD-mDixon sequence in thoracic spine enhanced MRI.Methods Sixty-three patients with suspected thoracic spine diseases are collected to scan 3D-T1WI-mDixon-TSE and 3D-Vane-XD-mDixon sequence after routine thoracic spine MRI.The SNR and CNR of thoracic spine were calculated and measured.The images were scored subjectively with 5-point method to compare the diagnostic value of the two sequences.Results In terms of objective evalution,the SNR of 3D-Vane-XD-mDixon and T1WI-mDixon-TSE sequences are 258.30(41.63,1982.67)and 133.05(18.90,584.34);CNR are 114.67(22.32,740.17)and 23.44(6.44,224.77).SNR and CNR of 3D-Vane-XD-mDixon sequence are higher than those of T1WI-mDixon-TSE sequence(Z=-4.042,P<0.001);(Z=-4.107,P<0.001).In terms of subjective evalution,T1WI-mDixon-TSE and 3D-Vane-XD-mDixon images subjective scores are 3.03±0.53,3.09±0.47;4.17±0.50,3.96±0.69,which are consistent between the 2 diagnosticians(kappa=0.723,0.685>0.61).Besides,the overall quality score of 3D-Vane-XD-mDixon image is significantly better than that of T1WI-mDixon-images,and the difference is statistically significant(P<0.001).Conclusion By using 3D-Vane-XD-mDixon sequence can obviously improve the quality of enhanced images of thoracic spine,and provide accurate images infor-mation for disease diagnosis.
目的 构建和验证预测结肠癌根治术后并发症的列线图.方法 从电子病历系统提取2019年1月～2021年6月在中山大学孙逸仙纪念医院行结肠癌根治术的患者相关资料进行回顾性分析.研究的主要结局指标是术后是否发生并发症.将符合入选标准的病例按照7:3的比例随机分为模型训练集和内部验证集,首先采用最小绝对收缩和选择算子回归即LASSO回归筛选出回归系数不为零的潜在影响因素,然后对筛选出的潜在影响因素进行多因素逐步回归,选择P<0.05的变量进一步构建预测模型并用列线图进行可视化展示.通过ROC曲线、校准曲线和决策曲线分析(DCA)分别评价模型的区分度、校准度和临床应用价值.结果 最终的列线图模型包括年龄、手术时间、术后是否入ICU和术前D-二聚体水平4个变量.训练集与内部验证集的受试者操作特征曲线下面积(AUC)分别为0.791(95%CI:0.771～0.801)和0.889(95%CI:0.873～0.899).校准曲线和DCA曲线表明该模型具有良好的校准度和临床适用性.结论 本研究开发并验证了一种新的结肠癌根治术后并发症的预测模型,该模型只有4个预测因子,但预测性能较好.这种新型工具应用可能有助于减少术后并发症并加速患者康复.
胆总管结石是肝胆外科最常见的良性疾病之一,多以外科手术治疗为主,术后的复发率为4%～25%.近年来,复发率有上涨的趋势,因此,防止胆总管结石术后复发并了解其危险因素就成为了临床医师必须要解决的问题.经内镜逆行胰胆管造影胆管取石术(ERCP)以及腹腔镜下胆总管探查取石术(LCBDE)已经成为胆总管结石的最常用外科治疗手段.两种术式的结石复发危险因素存在相同点,也存在不同点,同时影响结石复发的原因并不是单一因素所致,而是多因素共同作用导致的.本文通过综合分析国内外有关两种术式术后结石复发危险因素的不同,旨在从外科医师的角度上探究如何最大程度上降低结石复发的概率,为临床医师提供参考.
目的 探讨肝细胞癌(HCC)术后严重并发症发生的高危因素,并构建线上预测模型以帮助临床医务工作者快速识别高危人群并予以干预措施,从而促进患者术后早期康复.方法 回顾性分析中山大学孙逸仙纪念医院2009年12月至2017年12月347例接受肝癌切除术的HCC患者的临床病历资料,基于Logistic回归分析明确术后出现严重并发症的高危因素,并以此为基础构建线上预测模型,通过一致性指数(C指数)及校正曲线等验证模型预测效能.结果 共39例患者术后出现严重并发症,其术后平均住院时长(19±10)天.经过多因素回归分析提示伴发慢性病,吸烟酗酒史,术前血清ALT及GGT水平,癌灶数目与手术时间是HCC术后出现严重并发症的危险因素(P<0.05).以多因素分析结果为基础构建线上预测模型.经内部验证,该预测模型C指数为0.845,且校正曲线提示该模型具有良好的预测性能.结论 HCC术后严重并发症的发生是围术期死亡的重要原因,通过本研究所建立的线上预测模型,临床医务工作者可快速简便识别高危人群并予以干预措施,可有效缩短术后康复时间.
瘘管型肛周克罗恩病(PFCD)的治疗仍然是炎性肠病中最大的挑战之一.尽管研发了一些新的治疗,例如引入生物疗法,包括最有前景的骨髓间充质干细胞领域,但仍然缺乏最有效的治愈的方法.外科手术仍然是PFCD的最主要方法,且每个治疗方案均根据不同患者采用的个性化治疗.内窥镜治疗技术的应用、经验丰富的外科医生、多学科的合作有望为患者带来更光明的未来.
目的 观察加速康复外科理念与技术(FTS)在胃肠外科中的应用效果.方法 选取2021年1月至2022年6月期间在我院接受胃癌、结直肠癌根治术的患者共计110例,对患者采用电脑随机分组,每组各55例,对照组行传统临床路径治疗,加速康复外科组(FTS组)行加速康复外科程序进行围手术期治疗.记录两组患者术前及术后7d的血常规、胰岛素抵抗指数、皮质醇、C反应蛋白(CRP)的水平,采用数字评价表(NRS)评估患者腹痛、腹胀等相关临床指标,观察患者术后并发症的发生情况.结果 术前两组患者的血红蛋白、血清白蛋白、胰岛素抵抗指数、皮质醇、CRP水平比较差异不明显,无统计学意义(P>0.05),但与对照组相比较,FTS组患者的血红蛋白、血清白蛋白水平更高,胰岛素抵抗指数、皮质醇、CRP水平更低,差异具有统计学意义(P<0.05).两组患者术前NRS评分比较差异无统计学意义(P>0.05),术后FTS组患者的NRS较对照组明显降低,差异有统计学意义(P<0.05).加速康复外科组患者中吻合口瘘1例、尿路感染2例,并发症发生率为5.45%,对照组中吻合口瘘2例,3例尿路感染,2例肺部感染,3例切口感染,并发症发生率为18.18%,两组间比较差异具有统计学意义(P<0.05).结论 对进行胃癌、结直肠癌根治术患者采用FTS与技术,可促进患者恢复,降低并发症发生.
目的 初步评估mFOLFOX系统性化疗联合靶向免疫方案应用于不可切除肝细胞癌(uHCC)的真实世界疗效和安全性.方法 回顾性收集并分析2022年7月至2023年7月期间中山大学孙逸仙纪念医院肝胆外科收治的51例应用mFOLFOX联合免疫靶向方案治疗uHCC患者的真实世界数据.结果 初步统计mRECIST标准下客观缓解率(ORR)为47.1%,疾病控制率(DCR)为96.1%;其中21例(41.2%)成功转化手术,术后5例达到pCR(23.8%).Logistic回归分析显示肿瘤数量是达到转化的独立影响因素(OR=11.6,95%CI:1.28～105.41,P=0.029),而治疗时机可能是临床上影响缓解的独立因素,但未达到统计学差异(P=0.054).平均随访时间为6.76个月,中位OS及PFS均未达到.治疗相关不良事件(TRAE)总体发生率为92.1%.其中3～4级TRAE发生率为33.3%.结论 mFOLFOX系统性化疗联合靶向免疫方案可安全有效地应用于不可切除肝癌的治疗,并有可观的转化手术率.
