目的 探究下调XRCC6对人结直肠癌细胞凋亡、侵袭的影响及其与ATM/CHK1/p53信号通路的相关性.方法 将人结直肠癌细胞SW620分为对照组、si-NC组和si-XRCC6组.MTT法检测各组细胞活力;流式细胞法检测各组细胞凋亡水平;细胞划痕实验检测各组细胞迁移能力;Transwell检测各组细胞侵袭能力;定量聚合酶链反应(qPCR)检测ATM、CHK2、p53的转录水平;免疫印迹(Western blot)检测ATM、CHK2、p53的蛋白表达和磷酸化(p-ATM、p-CHK2、p-p53)水平.结果 MTT实验结果表明,与对照组和si-NC组相比,si-XRCC6组细胞活力显著降低(P＜0.05);流式细胞实验结果表明,与对照组和si-NC组相比,si-XRCC6组细胞存活比例降低(P＜0.01),早期凋亡比例增加(P＜0.01),晚期凋亡细胞比例显著增加(P＜0.01),si-NC组和si-XRCC6组差异无统计学意义(P＞0.05);细胞划痕及Transwell实验结果表明,与对照组和si-NC组相比,si-XRCC6组细胞迁移能力降低(P＜0.01),侵袭能力降低(P＜0.01).qPCR及Western blot结果表明,与对照组和si-NC组相比,si-XRCC6组细胞ATM、CHK2、p53的转录和蛋白表达水平有上升的趋势,其磷酸化蛋白p-ATM、p-CHK2、p-p53表达水平也具有上升的趋势.结论 下调XRCC6可以抑制人结直肠癌细胞活性,诱导细胞早期凋亡,其机制可能与ATM、CHK2、p53信号通路的调控及其磷酸化水平的调控相关.

目的:探讨内镜逆行胰胆管造影(ERCP)相关围十二指肠穿孔的临床特点及诊治方法.方法:回顾收治的5例ERCP相关围十二指肠穿孔病例,并分析近十年此类病例的中英文文献.结果:5例患者中StapferⅡ病3例,StapferⅠ、Ⅲ各1例.1例StapferⅡ型患者保守治疗,4例行2次手术.3例良性疾病患者经再次手术治疗痊愈出院,2例恶性疾病患者均死亡.结论:及时果断的外科手术可能是ERCP相关围十二指肠穿孔的合理选择.

目的 探讨肿瘤免疫营养指标预测胰腺癌可切除性的价值.方法 回顾性分析2015年1月至2018年12期间就诊于首都医科大学宣武医院、经病理学检查确诊的55例胰腺癌患者的临床资料,收集指标包括:中性粒细胞计数、淋巴细胞计数、单核细胞计数、血小板计数、血红蛋白、白蛋白、前白蛋白、胆固醇和血清肿瘤标志物(CEA和CA19-9),计算中性粒细胞计数/淋巴细胞计数比(NLR)、血小板计数/淋巴细胞计数比(PLR)、淋巴细胞计数/单核细胞计数比(LMR)、预后营养指数(PNI)、老年营养风险评分(GNIR)和控制营养状况评分(COUNT),采用受试者工作特征曲线(ROC曲线)评价各种指标对胰腺癌根治性切除的预测价值.结果 55例胰腺癌患者中,22例接受了根治性手术,33例未接受根治性手术.根治性手术组与非根治性手术组患者的性别、BMI、中性粒细胞计数、单核细胞计数、血小板计数、血红蛋白水平、白蛋白水平、前白蛋白水平、胆固醇水平和肿瘤部位比较差异均无统计学意义(P＞0.05),但2组患者的年龄、淋巴细胞计数、CEA和CA19-9水平比较差异均有统计学意义(P＜0.05).中性粒细胞计数、淋巴细胞计数、单核细胞计数、血小板计数、血红蛋白、白蛋白、前白蛋白、胆固醇、NLR、PLR、LMR、PNI和GNIR预测胰腺癌可切除性的曲线下面积(AUC)均无统计学意义(P＞0.05),而COUNT、CEA和CA19-9的AUC值均有统计学意义,具有一定的诊断效能.COUNT、CEA水平和CA19-9水平的AUC值分别为0.700、0.705和0.739,最佳临界点对应的灵敏度分别为59.09％、80.00％和100％,特异度分别为87.88％、66.67％和42.42％.COUNT的特异度比较高,而灵敏度差;血清肿瘤标志物CEA水平和CA19-9水平的灵敏度比较高,但特异度差.结论 COUNT可以作为预测胰腺癌可切除性的一项临床参考指标.COUNT、CEA及CA19-9的综合应用,可以帮助临床更好地判断胰腺癌的手术指征.

病人,女性,63岁.因间断上腹部疼痛伴皮肤黄染8个月余,加重5个月余于2019年5月6日入院.腹部计算机断层扫描(CT)和磁共振胰胆管成像(MRCP)检查诊断为胆总管结石.实验室检查:血红蛋白127 g/L,红细胞压积为37.6％,白细胞4.26×109/L,丙氨酸氨基转氨酶(ALT) 175IU/L,γ-谷氨酰转肽酶(GGT)558 IU/L.于2019年5月9日行胆道支架植入术+内窥镜十二指肠乳头切开(EST)+内窥镜逆行胰胆管造影(ERCP)手术,手术使用0.035英寸直径,450 cm长度的斑马导丝.用取石网篮成功取出所有胆总管结石,并放置6cm×10 F胆道支架,术中失血量为10ml.ERCP术后返回病房.查血常规显示血红蛋白118 g/L,红细胞压积为35.0％,白细胞计数8.03×109/L,血流动力学稳定,给予外周输注抗生素预防感染、微量泵泵入胰酶抑制剂预防术后胰腺炎的发生.术后6小时,病人突发腹部剧痛伴大汗及血流动力学变化(血压53/32 mmHg,心率105次/分).

Objective To observe the effects of proximal gastric electrical stimulation (GES) on body weight and gastrointestinal motility in SD rats,and investigate the regulation of gastric nerve stimulation and serum gastrointestinal hormones by neuro-humoral regulation.Methods 12 SD rats were divided into experimental group (n =6) and control group (n =6),with gastric electrical stimulator implanted,and in experimental group dual-channel GES was activated.General status was observed for 4 weeks after GES activation,including body weight,feeding and water intake,urine and stool volumes,the resting gastric volume and gastric emptying were monitored via the establishment of intestinal fistula,and serum gastrointestinal hormones change was detected.Results During 4-week GES process,one rat had gastric retention and died at 1 week after GES activated.Compared with the control group,body weight,food intake,urine and stool volumes levels of the rats in experimental group decreased significantly (t =4.005,2.530,3.350,all P＜0.05).Resting gastric volume was significantly lower than that in the control group [(2.93 ± 0.50) ml vs.(5.10 ± 0.53) ml,Z =2.460,P =0.014],and the intestinal juice drainage was lower than the control group [(0.18 ±0.15)ml vs.(0.44 ±0.05)ml,Z =2.513,P =0.012],while serum GLP-1 levels were similar between the two groups [(0.44 ± 0.05) ml vs.(0.18 ± 0.15) ml,Z =1.026,P =0.305],but Ghrelin was significantly higher than that in the control group [(1.65 ± 0.58) vs.(0.65 ±0.36),Z =2.380,P =0.017].Conclusion The proximal GES may lead to the change of the body weight,food intake,gastrointestinal function and motility,possibly by stimulating nerve reflex inducing gastrointestinal hormones secretion and affect gastrointestinal function.

Objective To discuss the necessity of D3 dissection in right colon cancer patients without lymph node metastasis in preoperative CT study. Method Retrospective analyses the clinical data of right colon cancer patients who received surgical therapy in our hospital between Jan 2006 and Dec 2014. The criterion of lymph node metastasis in CT study including short/long axis diameter ratio was greater than 0.8, clusters of different lymph nodes and irregular enhancement after introducing contrast. D3 dissection in right hemicolectomy was defined dissecting the lymph node at root of ileocolic artery, right colic artery (if present) and right branch or trunk of middle colic artery (extended right colectomy). Result Between Jan 2006 and Dec 2014, there were 1278 colon cancer patients received surgery in our department. Two hundred and seventy-five right colon cancer patients without lymph node metastasis in preoperative CT study were included in our study. D2 and D3 dissection were performed in 77 and 198 patients, respectively with apical lymph node metastasis rate 3.5%(7/198). Overall complication rate was 15.6%(43/275). Morbidity in D2 and D3 group was 13.0%(10/77) and 16.7%(33/198), respectively with no statistical difference. Elderly patients, emergency operation, open surgery and high T stage of tumor were the risk factors for postoperative complications in logistic regression analysis. Conclusion In right colon cancer patients without lymph node metastasis in preoperative study, despite D3 dissection did not increase the complication rate, the apical lymph node metastasis rate was extremely low. The impact of such surgery on prognosis needs further investigated.

Objective To explore the short-term outcomes and safety of laparoscopic complete mesocolic excision(CME) in patients with colon cancer. Method The clinical pathological factors of 96 patients with colon cancer who were in general surgery Xuanwu Hospital from February 2012 to March 2016 were analyzed retrospectivly. These patients were divided into laparoscopic CME surgery groups (n=52) and laparoscopic traditional surgery groups (n=44). The number of lymph node dissection, operation time, blood loss, postoperative feeding time and postoperative complications were compared between the two groups. Result More number of lymph nodes were removed in the CME group than that in the control group(18.38±2.73 vs 16.48±1.72, P<0.01). In patients with right colon cancer, CME group was associated with higher lymph node counts (19.18±2.73 vs 16.96±1.68, P<0.01). In patients with stage Ⅲ cancer,CME group was associated with great harvest of lymph node (19.50±2.96 vs 17.09±1.35, P<0.01). There were no differences in operation time, intraoperative blood loss, time to eating and postoperative hospital stay(P>0.05). There were some acceptable postoperative complications in each groups,such as pulmonary infection, deep venous thrombosis and incomplete intestinal obstruction, but showed no statistical significances (P>0.05). Conclusion Laparoscopic CME procedure is so safe that will not affect postoperative recovery. It also does not increase the risk of postoperative complications.More important, patients can achieve better oncologic clearance effects than the control group.

A 64-year-old male patient received clozapine 125 mg twice daily for 6 years because of paranoid schizophrenia. The dose of clozapine was increased to 250 mg twice daily by doctor due to his symptoms occurred repeatedly. About one month after increase of drug dosage,the patient developed abdominal pain,distention,nausea,vomiting,and oliguria. Then the drug was stopped by the patient. Two days after the drug withdrawal, the patient visited emergency department in our hospital. Physical examination showed that the patient had abdominal swelling,abdomen tenderness,hypoactive bowel sounds. Laboratory tests showed serum creatinine( scr)106 μmol/L,blood urea nitrogen( BUN)11. 2 mmol/L. Abdominal X-ray showed dilatation of the small intestine with multiple ladder-like fluid level. Paralytic ileus was considered. Fasting,fluid supplement,anti-inflammatory,and gastrointestinal decompression were given. The next day,the renal function deteriorated,scr and BUN levels were 606 μmol/L and 27. 2 mmol/L, respectively;and his clozapine plasma concentration was 630 μg/L. Then it was considered that paralytic ileus combined with acute renal insufficiency was induced by clozapine. The patient was admitted to hospital and symptomatic treatments were given continuously. On day 3 after admission,the patient's urine volume increased markedly. On day 5 after admission,abdominal pain and distention disappeared and day 8,his renal function returned to normal.

Objective To validate the accuracy of the determinant-based classification (DBC) for the severity of acute pancreatitis (AP).Methods Retrospective analysis the clinical data of 243 patients with acute pancreatitis who admitted to our hospital between January 2012 and December 2013.Length of total parenteral nutrition,length of ICU and hospital stay,operation rate and mortality was assessed,respectively in subgroup of mild,moderate,severe and critical acute pancreatitis according to DBC.Results Pancreatic or peripancreatic necrosis was present in 65 of the patients (26.7％).Transient and persistent organ failures were present in 26 patients (10.7％) and 9 patients (3.7％),respectively.On the basis of the DBC,178 (73.3％),35 (14.4％),21 (8.6％),and 9 (3.7％) patients were determined to have mild,moderate,severe,or critical AP,respectively.The different categories of severity for DBC system were associated with statistically significant and clinically relevant differences in length of total parenteral nutrition,length of ICU and hospital stay,operation rate and mortality.Conclusions The DBC accurately classify the severity of AP in subgroups of patients.

Objective To explore the short-term outcomes and safety of laparoscopic complete mesocolic excision ( CME) in elderly patients with colon cancer. Method The clinical pathological factors of 54 patients with colon cancer who were over 70 years old in department of general surgery of Xuan Wu Hospital from January 2012 to Feb-ruary 2015 were analyzed retrospectivly. These patients were divided into laparoscopic CME surgery groups (n=23) and laparoscopic traditional surgery groups (n=31). Short-term outcomes, safety and complications were compared between the patients of two groups. Result More number of lymph nodes were removed in the CME group than that in the control group(18. 21±2. 70 vs 15. 76±1. 35,P<0. 01). In patients with stageⅢcancer,CME group was associated with gratifying harvest of lymph node (19. 79±2. 33 vs 16. 12±1. 41,P<0. 01). In patients with right co-lon cancer,CME group was associated with higher lymph node counts(22. 92±2. 76 vs 19. 45±2. 24,P<0. 01). There were no differences in operation time,intraoperative blood loss, time to eating and postoperative hospital stay (P>0. 05). There were some acceptable postoperative complications in each groups,but showed no statistical signifi-cance(P>0. 05). Conclusion Elderly patients undergoing laparoscopic are safe and this surgical proceduredoes not affect postoperative recovery. It also does not increase the risk of postoperative complications. More important,laparo-scopic CME surgery can achieve better oncologic clearance effects than the control group.

Objective To evaluate the surgery timing for adhesive small bowel obstruction (ASBO).Methods A retrospective analysis was made on the clinical data of ASBO patients admitted to our hospital between January 2003 and December 2012 who received surgical treatment.According to surgery timing,patients were divided into three groups,early surgery group (＜ 36 h),mid-term surgery group (36-72 h) and late surgery group (≥ 72 h).The mortality,surgical site infection (SSI) rate and systemic infection rate were compared between groups.Result In this study,33,56 and 27 patients received early,middle and late surgery,respectively.The SSI rate in early surgery group was significantly lower than that in middle (6％ vs.25％,x2 =5.05,P =0.025) and late surgery group(6％ vs.30％,x2 =5.94,P =0.015).Though of not significant difference,the mortality and systemic infection rate in early surgery group were also lower than both middle and late surgery groups.Conclusions Early surgery might reduce the postoperative infectious complications and improve the outcome of patients with ASBO.

Objective To determine the effect of video-assisted retroperitoneal debridement in treatment of infected necrotizing pancreatitis.Methods The clinical data of patients with infected necrotizing pancreatitis was retrospectively analyzed.Heart rate,mean arterial pressure,body temperature and indicators for inflammatory response including level of WBC,CRP and procalcitonin before and after VARD treatment were compared.Results After VARD treatment,the heart rate (preoperative vs.postoperative 8 h,108 ± 22/min vs.95 ± 17/min),mean arterial pressure (preoperative vs.postoperative 12 h,66 ± 18 mmHg vs.79 ± 19 mmHg) and body temperature(preoperative vs.postoperative 24 h,38.3 ± 1.7 ℃ vs.37.3 ± 1.3 ℃) improved significantly (all P ＜ 0.05).Level of WBC [preoperative vs.postoperative 48 h,(13.8 ±6.6) × 109/L vs.(10.1 ±5.2) × 109/L],CRP(preoperative vs.postoperative 48 h,145 ± 88 mg/L vs.95 ± 4 mg/L) and procalcitonin (preoperative vs.postoperative 48 h,1.4 ± 0.7 μg/L vs.0.9 ± 0.4 μg/L) also decreased significantly(all P ＜ 0.05).Conclusions VARD therapy can significantly reduce systemic inflammation and improve the general condition of infected necrotizing pancreatitis patients.

Doctor-patient communication ability is a basic skill of medical interns, Clinical doctors play a key role in the training process of doctor-patient communication skills for interns. This article discusses the importance of cultivation of active doctor-patient communication skills in interns' training and proposes strategies on how to improve doctor-patient communication skills.

目的 分析腹腔镜下肛提肌外腹会阴联合切除术(ELAPE)与腹腔镜下传统Miles手术治疗低位直肠癌近期疗效的异同以及腹腔镜下ELAPE手术的可行性.方法 回顾性分析2012年1月至2013年12月间37例腹腔镜腹会阴联合切除术治疗的低位直肠癌病例,其中腹腔镜下ELAPE手术者21例(L-ELAPE组),腹腔镜下传统Miles手术16例(L-Miles组).比较两组患者一般资料、手术时间、术中出血量、术后会阴部切口局部并发症、术后住院时间.结果 L-ELAPE组21例,L-Miles组16例,两组一般资料差异无统计学意义(P＞0.05).L-ELAPE组手术总时间为(294±53) min,术中出血量为(162±72) ml,会阴部切口局部并发症发生率为28.6％,术后住院天数为(18.9±6.6)d.L-Miles组手术总时间为(239±58) min,术中出血量为(144±89) ml,会阴切口并发症发生率为25％,术后住院日为(20.5±5.2)d.L ELAPE组总手术花费时间较L-Miles组长(P＜0.05),而两组患者术中出血量、术后会阴部切口局部并发症及术后住院天数差异均无统计学意义(P＞0.05).结论 腹腔镜ELAPE手术安全可行,手术时间较腹腔镜传统Miles手术有所延长.

Objective To explore the clinical outcomes of fluid accumulation for acute pancreati-tis(AP)under new Atlanta definition.Methods The clinical data from 522 AP patients who admitted to our hospital between September 2009 and December 2013 were retrospectively analyzed.The fluid accumu-lation was classified according to the new Atlanta definition.Risk factors for fluid accumulation and absorp-tion were analyzed with logistic regression analysis.Results The incidence of fluid accumulation in AP patients was 45.6%(238 /522).Among patients with fluid accumulation,self-absorbtion happened in 145 patients(60.9%,145 /238)and subsequent infection occurred in 31.9% of the patients.Logistic regres-sion analysis revealed that alcoholic etiology(OR 1.16,95%CI 1.02 ~1.93),APACHEⅡscore≥8(OR 3.21,95%CI 2.82 ~5.91),level of serum sodium ≥145mmol/L(OR 2.14,95%CI 1.88 ~2.91),pan-creatic necrosis revealed by CT(OR 15.30,95%CI 11.35 ~33.18)and sepsis(OR 13.5,95%CI 10.22~18.95)were the independent predictors of fluid accumulation.Conclusion Fluid accumulation is still a common complication of acute pancreatitis even under the new definition.The clinical outcomes of fluid ac-cumulation are related to the cause and severity of acute pancreatitis.

Objective To determine risk factors for postoperative infectious complications for small bowel obstruction.Methods Retrospective analysis the clinical data from small bowel obstruction patients who admittedto our hospital between January 2006 and December 2012 who receiving surgical treatment.The independent risk factors for infective complications were detected by logistic analysis.Results One hundred and fifty-four patients received surgery for small bowel obstruction with infection rate 27.9％.Logistic analysis revealed that older people(≥65 years) (OR 6.71,95％ CI 3.15-16.33),intraoperative bowel rupture (OR 2.71,95％ CI 1.19-7.25),delay surgery(≥72 h)(OR 11.33,95％CI4.62-20.20) and operation time(≥180 min) (OR 2.90,95％ CI 1.26-9.83) were the independent risk factors for postoperative infective complications.Conclusions Postoperative infections were the common complications after surgery for small bowel obstruction.Early surgery,intraoperative soft operation to prevent bowel rupture may be effective measures to reduce postoperative infection.

目的 探讨急性肠系膜血管闭塞(AMVO)的早期诊断及治疗.方法 回顾性分析51例AMVO的临床特点.结果 肠系膜上动脉栓塞(SMAE) 33例,肠系膜上动脉血栓形成(SMAT)7例,肠系膜上静脉血栓形成(SMVT) 11例.入院即诊断为SMAE的仅有16例;手术27例,非手术治疗6例;死亡20例,治愈13例.入院即诊断为SMAT的仅有4例;手术4例,介入治疗1例,非手术治疗2例;死亡4例,存活3例.入院即诊断为SMVT的有8例;手术3例,介入治疗2例,非手术治疗6例;死亡3例,存活8例.结论 早期诊断、积极行介入治疗与剖腹探查为主的外科治疗是提高AMVO疗效的关键.

Objective: To investigate the common mistakes in clinical practice of medical students,which helps to improve the clinical teaching level and quality.Methods: We concluded the common surgical clinical basic operation of clinical medicine students in our hospital,then made a statistical result and put forward certain measurements.Results: A total of 90 students were investigated.There were 22 person-time(24.4%) met mistakes in the management of surgical dressing,24 person-time met mistakes in surgery disinfection(26.6%),32 person-time met mistakes in suture(35.5%),38 person-time met mistakes in knot(42.2%),and 19 person-time met mistakes in taking out stitches.Conclusion: It is an important link of the clinical teaching that strengthen the surgical practice during the period of aseptic concept training and basic operation in medical students.

Objective:To investigate whether AQP3 expression in the human colon carcinoma cell lines enhances cell migration.Methods: The AQP3 expression level of colon cancer cell line HCT116 under different EGF conditions was analyzed by Western blot.Scratch assay test colon cancer cell migration under different AQP3 expression levels.Results: Western blot analysis showed that EGF increased the expression of AQP3 and was dependent on time and does.Scratch test showed AQP3 expression in different groups migration of colon cancer cell line HCT116 were significant differences(P0.05).High expression of AQP3 can promote migration of colon cancer cells and this effect was blocked by AQP3 inhibitors CuSO4.Conclusion: After binding with EGFR,EGF up-regulated the expression of AQP3.Over expression of AQP3 increase migration of colon cancer cells.

Objective To evaluate the efficacy of preoperative concurrent chemoradiotherapy combined with total mesorectal excision(TME)in treatment for locally advanced lower rectal cancer.Methods The clinical data of 31 patients with locally advanced lower rectal cancer received concurrent chemoradiotherapy from January 2009 to December 2011 in this hospital were analyzed retrospectively.Conventional fraction radiotherapy with total dose 50 Gy and chemotherapy with mFOLFOX6 or CapeOX regimen were taken.The efficacy was assessed by recording results of clinical and pathological examination.The function of sphincter was also recorded.Results All 31 patients underwent TME operation.The complication morbidity and mortality was 12.9%(4/31)and 3.2%(1/31),respectively.As a result of the preoperative management,the tumor was reduced by an average of 21.9%,down-regulation of T stage was observed in 48.4%(15/31)patients,the frequency of lymph node metastasis decreased from 83.9%(26/31)to 38.7%(12/31).Pathological complete response was observed in 5 patients(16.1%)and the total response rate was 74.2%(23/31),grade 3/4 toxicity was occurred in 2(6.5%)patients.84.6%(22/26)of patients underwent sphincter preservation surgery reserved good function of sphincter.Conclusions Preoperative concurrent chemoradiotherapy combined with TME in treatment for locally advanced lower rectal cancer is effective and safe,which can lead to pathological complete response,decrease the tumor stage and the rate of lymph node metastasis,and can also increase the efficacy of operation.