The study is designed to explore the regulatory network that MALAT1 competitively binds with miR-188-5p to up-regulate PSMD10 to facilitate cholangiocarcinoma cell migration and invasion and suppress apoptosis. qRT-PCR and fluorescence in situ hybridization (FISH) were used to examine the expression and positive signal of MALAT1 and miR-188-5p in cholangiocarcinoma tissues and HIBEC, HCCC-9810, RBE, and QBC939 cells. Western blot, qRT-PCR, and immunohistochemistry were selected to detect PSMD10 expression in cholangiocarcinoma tissues and cell lines. Dual luciferase reporter gene assay was adopted to verify that miR-188-5p targeted MALAT1 and PSMD10. qRT-PCR, pull down, and western blot were used to examine the regulation of MALAT1-miR-188-5p-PSMD10 axis. Transwell, wound healing assay, and Tunel cell apoptosis were adopted to respectively detect the regulatory abilities of MALAT1-miR-188-5p-PSMD10 axis on cell invasion, migration, and apoptosis. Western blot was used to detect the regulation mechanism of MALAT1 on Bax, Bcl-2, and caspase-3 proteins. Nude mice subcutaneous xenograft model of cholangiocarcinoma was established to examine the impacts of MALAT1 on subcutaneous tumor growth. Immunohistochemistry was adopted to examine the positive indicator of Ki67 antibodies and SMD10 antibodies in each group. MALAT1 and PSMD10 were highly expressed in cholangiocarcinoma tissues and cell lines, while miR-188-5p was lowly expressed. MALAT1 could competitively bind to miR-188-5p, and miR-188-5p could negatively regulate PSMD10. MALAT1, In-miR-188-5p, and PSMD10 could facilitate cell invasion and migration and inhibit apoptosis, while siMALAT1, miR-188-5p, and siPSMD10 produced an opposite result. MALAT1-miR-188-5p-PSMD10 axis could promote RBE cell invasion and migration and inhibit apoptosis, whereas siMALAT1-In-miR-188-5p-siPSMD10 axis showed an opposite result. On the other hand, it was verified that up-regulation/down-regulation of MALAT1 can inhibit/promote Bax and caspase-3 proteins and promote/inhibit the expression of Bcl-2 protein. MALAT1 could facilitate subcutaneous tumor growth and enhance cell proliferation and positive signal of PSMD10, while miR-188-5p worked in an opposite direction. MALAT1 competitively binds to miR-188-5p to up-regulate mRNA translation and protein expression of PSMD10, thereby facilitating cholangiocarcinoma cell invasion and migration and inhibiting its apoptosis. However, interfering MALAT1-miR-188-5p-PSMD10 axis could inhibit the occurrence and development of cholangiocarcinoma.

At present, most patients with obesity complicated with obstructive sleep apnea hypopnea syndrome (OSAHS) are treated with single laparoscopic bariatric surgery.However, in the follow-up process, some patients are often found to have poor outcomes, and most of these patients are complicated with pharyngeal stenosis and malformation.Currently, otolaryngologists are promoting the use of cryogenic plasma uvulopalatopharyngoplasty (UPPP) as an important procedure for OSAHS. Therefore, we consider the possibility of using a combination of laparoscopic sleeve gastrectomy (LSG) and UPPP in such patients. We recently performed such a combined procedure on one such patient. By investigating the feasibility, safety, and efficacy of this procedure, this study aims to provide a basis for the expansion of this procedure for the benefit of patients with obesity combined with OSAHS.

目的 对外科完成经内镜胰胆管造影术(ERCP)规范化培训后的独立术者成长期所有病例进行回顾性研究,分析术后并发症发生情况,并绘制其学习曲线.方法 确定ERCP操作过程中的可量化评价标准包括乳头插管时间、手术并发症(急性胰腺炎、出血、穿孔、急性胆管炎)发生率、尝试插管次数等六项,采集自2018年7月至2020年12月全部的ERCP手术操作记录中以上参数的具体值进行统计分析,学习曲线评价指标计算公式为:δ=Xi-X0,计算每一次操作的6个评价指标的累积和值即该次ERCP操作水平量化值的总和(∑=δ1+δ2+δ3+δ4+δ5+δ6),量化后绘制学习曲线并分析学习期术后并发症发生率.结果 该术者总体插管成功率为99.4％,高于一般文献报道的独立ERCP操作术者的插管成功率要求.取前100例ERCP操作病例绘制CUSUM控制图并拟合学习曲线.拟合曲线公式:y=10.7001+0.1020x+0.008372x2-0.000089x3,决定系数R2=0.899,曲线拟合效果较好.68例ERCP手术后,曲线k值为负,故68例ERCP手术后,该术者跨越学习曲线.结论 外科术者即使没有内镜基础直接进行ERCP操作培训完全可以胜任ERCP手术,其插管成功率及手术并发症发生情况较文献报道的无明显升高.

Hepatocellular carcinoma (HCC) is an angiogenesis-dependent tumor, and angiogenesis plays pivotal roles in progression and hematogenous metastasis. Upregulating NDRG2 expression could inhibit endothelial cell proliferation and tumor angiogenesis. However, the development of angiogenesis is a complicated and dynamic process, and the specific mechanisms that NDRG2 influences its progression are largely unknown. Conditioned media (CM) was collected from HCC cells. Cell viability, migration assay, tube formation, and western blot were used to evaluate the effect of NDRG2 on angiogenesis in HCC cells. ELISA assay was used to measure the level of VEGFA in CM. CM from NDRG2 knockdown cells significantly promoted HUVECs proliferation, migration, and tube formation compared with control cells. The level of VEGFA in CM was increased by NDRG2 knockdown relative to the control group. The expression of VEGFA, HIF-1α, and p-Akt was significantly increased in NDRG2 knockdown cells. CM from NDRG2 knockdown cells with VEGFA antibody failed to induce HUVEC proliferation, migration, and tube formation. YC-1 significantly inhibited the level of VEGFA in CM from NDRG2 knockdown cells. YC-1 also inhibited the expression of VEGFA and HIF-1α. Therefore, NDRG2 inhibition promoted the angiogenesis of HCC via VEGFA and may be used to be an anti-angiogenesis target.

目的 探讨代谢综合征患者行腹腔镜减重与代谢手术后的效果及影响.方法 回顾性分析行腹腔镜减重与代谢手术的代谢综合征患者100例的临床资料,记录术前及术后1年间的体重、体重指数(body mass index BMI)、多余体重百分比(percentage of excess body weight,EWI％)、三酰甘油(triglyceride,TC)、高密度脂蛋白(high density lipoprotein,HDL)、空腹血糖(fasting plasma glucose,FPG)、糖化血红蛋白(glycosylated hemoglobin,HbA1 c)、胰岛素抵抗指数(homeostasis model assessment insulin resistance index,HOMA-IR)、Epworth嗜睡量表(epworth sleepiness scale,ESS)评分、最低血氧饱和度(lowest arterial O2 saturation,LSaO2)及2型糖尿病、高血压、脂肪肝、关节退行性改变的改善情况.结果 100例患者均顺利完成手术,患者术后体重、BMI、TC、FPG、HbA1 c、HOMA-IR、ESS评分逐渐降低,术后3个月、6个月、12个月体重、BMI明显低于术前,术后6个月、12个月TC明显低于术前,术后1个月、3个月、6个月、12个月FPG、HbA1 c、HOMA-IR均明显低于术前,术后3个月、6个月、12个月ESS评分明显低于术前,差异有统计学意义(P<0.05).患者术后HDL、LSaO2逐渐升高,术后6个月、12个月HDL明显高于术前,术后3个月、6个月、12个月LSaO2明显高于术前,差异有统计学意义(P<0.05).术后12个月,2型糖尿病、高血压、脂肪肝、关节退行性改变发生率均明显低于术前,差异有统计学意义(P<0.05).结论 腹腔镜减重与代谢手术治疗以肥胖为基础的代谢综合征安全可靠、疗效显著.

随着人民生活水平的不断提高,以肥胖为基础的代谢综合征发病率呈显著上升趋势,减重与代谢手术被认为是治疗该疾病最有效的措施[1,2].目前腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)因操作简单、治疗代谢综合征疗效显著,逐步成为主流术式[3],但腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass, LRYGB)在治疗肥胖患者合并2型糖尿病方面仍然有着不可替代的价值,有报道显示,LRYGB对2型糖尿病的治愈率达到84％,因此,LRYGB在国内外都得到很大的推广和应用[4,5].然而随着国内开展减重与代谢手术的医院越来越多、手术例数也不断增多,因术式不规范而引起严重并发症的问题就逐步受到关注,减重与代谢手术术后的修正手术也就成了解决该问题的最优选择.我中心曾收治两例不规范开腹胃旁路术后患者,行修正手术后均取得满意的疗效,现就案例中首次手术的不规范操作、并发症的处理及术后修正手术的选择等方面进行探讨,为标准化减重与代谢手术的推广提高实践依据.

To determine whether sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) should be the optimal choice in patients stratified by diabetes duration and body mass index (BMI) level. Classification tree analysis was performed to identify the influential factors for surgical procedure selection in real setting. Meta-analyses stratified by influential factors were conducted to compare the complete diabetes remission rates between SG and RYGB. The cost-effectiveness analysis was performed when results from meta-analysis remain uncertain. Among 3198 bariatric procedures in China, 824 (73%) SGs and 191 (17%) RYGBs were performed in patients with T2DM. Diabetes duration with a cutoff value of 5 years and BMI level with 35.5 kg/m2 were identified as the influential factors. For patients with diabetes duration > 5 years, RYGB showed a significant higher complete diabetes remission rate than SG at 1 year: 0.52 (95% confidence interval (CI): 0.46–0.58) versus 0.36 (95% CI: 0.30–0.42). For patients with diabetes duration ≤ 5 years and BMI ≥ 35.5 kg/m2, there was no significant difference between 2 procedures: 0.57 (95% CI: 0.43–0.71) for SG versus 0.66 (95% CI: 0.62–0.70) for RYGB. The cost-effectiveness ratios of SG and RYGB were 244.58 and 276.97 dollars per QALY, respectively. For patients with diabetes duration > 5 years, RYGB was the optimal choice with regard to achieving complete diabetes remission at 1 year after surgery. However, for patients with diabetes duration ≤ 5 years and BMI ≥ 35.5 kg/m2, SG appeared to provide a cost-effective choice.

BackgroundLncRNAs have proven to be involved in the initiation and progression of cholangiocarcinoma (CCA), although the mechanism by which this occurs remains unknown.MethodsThe current study reveals that RHPN1-AS1 was overexpressed in CCA patient samples, which predicted poor outcome of CCA patients. RHPN1-AS1 increased in vitro pancreatic carcinoma cell proliferation as well as promoted xenograft growth in vivo. Mechanistically, DANCR upregulated expression of YAP1 by competitively binding to miR-345-5p. Importantly, RHPN1-AS1 level was positively correlated with YAP1 expression level in CCA tissues. Moreover, YAP1 overexpression could predicted a poor outcome of CCA patients.ResultsTaken together, our results suggested that RHPN1-AS1 might be a remarkable biomarker to evaluate prognosis in CCA.ConclusionThe RHPN1-AS1/YAP1 axis may provide new strategies for CCA clinical practice.

Background Outcomes of gastroesophageal reflux disease (GERD) using Toupet fundoplication (TF) and Stretta radiofrequency (SRF) have not been compared and this study was conducted to compare therapeutic efficacy of the two methods. Methods This retrospective study analyzed a total of 230 patients undergoing TF or SRF at our hospital. Baseline data, reflux symptoms, the DeMeester scores, lower esophageal sphincter (LES) pressure and adverse events were compared over 1 year period. Results A total of 226 patients were included in the study. The time and frequency of reflux and percentage of reflux time before and 12 months after therapy were not significantly different. There were significantly interactions between the therapy method and follow-up time on the DeMeester score and LES pressure. Twelve months post therapy, the DeMeester score was significantly higher in SRF than in TF group, while the LES pressure was lower. At 12 months after therapy, multivariate Cox proportional regression analysis showed that reflux frequency, the DeMeester score and LES pressure were risk factors for poor prognosis in TF group, while reflux frequency and the DeMeester score, and LES pressure were risk factors for poor prognosis in SFR group. Conclusions Compared with TF, SFR can significantly improve the esophageal pH and pressure in GERD patients without increasing the risk of poor prognosis.

LncRNAs have been reported to be involved in the initiation and progression of cholangiocarcinoma (CCA), although the mechanisms by which this occurs remains unknown. The current study aimed to reveal the clinico-pathological relationship of RHPN1-AS1 expressed with CCA, and also investigate the functions of RHPN1-AS1 both in vivo and in vitro. RHPN1-AS1 was overexpressed in CCA cell proliferation as well as promoted xenograft growth in vivo. Mechanistically, DANCR upregulated the expression of YAP1 by competitively binding to miR-345-5p. Importantly, RHPN1-AS1 level was positively correlated with YAP1 expression level in CCA tissues (P<0.05). Moreover, Kaplan-Meier curves showed that YAP1 overexpression predicted a poor outcome of CCA patients (P=0.004). Taken together, our results suggested that RHPN1-AS1 might be a remarkable biomarker to evaluate prognosis in CCA. The RHPN1-AS1/YAP1 axis may provide new strategies for CCA clinical practice.

目的 统计分析大华北地区2018年减重与代谢手术开展情况.方法 基于大华北减重与代谢手术临床资料数据库数据登记数据,统计分析大华北地区2018年开展减重与代谢手术情况,并对病人人口学信息、肥胖相关疾病、手术信息等进行统计学描述和分析.结果 2018年来自大华北7个省市及自治区、17家中心提交数据,登记数据728例.有效数据来自16家中心.病人术前BMI为38.4(24.7,95.2).女性病人542例(74.7％),平均年龄为(32.5±8.29)岁;男性病人183例(25.3％),平均年龄为(32.7±9.90)岁.腹腔镜袖状胃切除术(LSG)占93.9％,腹腔镜胃转流术(LRYGB)占4.4％,其他术式占1.7％.29.2％的病人在术前合并2型糖尿病,69.4％的病人术前合并阻塞性睡眠呼吸暂停综合征,22.6％的病人术前合并多囊卵巢综合征.结论 大华北减重与代谢手术临床资料数据库的搭建为大华北地区减重与代谢手术的大数据登记工作奠定了坚实基础.基于目前数据,LSG是本年度大华北地区减重与代谢手术的主流术式.

目前胆管癌仍是胆道系统最常见的恶性肿瘤[1?2] ,其起病隐匿,患者就诊的首要症状多为渐进性黄疸,发现时往往已属晚期,失去了手术切除机会,根治性手术五年生存率仅10%,预后极差[3] .对于无法行根治性手术或者不愿意行根治性手术的患者,内镜下胆道引流术可以有效解除阻塞性胆汁淤积,减轻黄疸?皮肤瘙痒?腹痛等相关并发症,预防胆管炎并避免渐进性胆道梗阻引起的肝衰竭等,是解除恶性胆道梗阻的一种有效的姑息性治疗手段.

目的 分析腹腔镜下修补手术对胃十二指肠溃疡穿孔(PGDU)患者临床疗效影响.方法 选取2011年3月~2014年5月间我院行穿孔修补手术的PGDU患者68例,根据患者意愿按手术方式不同将其分成两组,观察组(34例)行腹腔镜下修补手术,对照组(34例)行开腹修补手术.观察患者手术时间、术后VAS评分、术中出血量、住院时间、术后胃肠功能恢复、术后使用抗生素时间及并发症情况,观察患者白细胞计数、中性粒细胞百分比、血清C反应蛋白(CRP)、IL-6、TNF-α含量改变情况.结果 观察组患者手术时间、术后VAS评分、术中出血量、住院时间、术后恢复胃肠功能、术后使用抗生素时间及并发症发生率优于对照组,差异有统计学意义(P<0.05);术后第1、3、5天观察组白细胞计数、中性粒细胞百分比、血清CRP、TNF-α及IL-6含量均比对照组低,差异有统计学意义(P<0.05).结论 腹腔镜下进行PGDU修补手术对患者创伤小,手术后并发症少,机体炎症反应轻,恢复较快.

Objective To compare the clinical outcome of 3D and 2D laparoscopic distal gastrectomy for patients with gastric cancer, and to explore the feasibility and safety of 3D laparoscopy. Methods From January 2015 and June 2017, 68 patients diagnosed with advanced stomach cancer were enrolled in our hospital,including 34 cases in 3D group and 34 cases in 2D group.were compared between the two groups.Statistical analysis were performed by using SPSS 18.0 software.Intraoperative and postoperative clinical indicators and quality of life score were presented as mean ±standard deviation, and were examined by using t test; The postoperative survival and complication rate were compared with χ2or Fisher test.P<0.05 was thought to be statistically significant. Results Compared with 2D group,there were less intraoperative bleeding and more harvested lymph nodes in 3D group, with significant differences (P<0.05).There were no significant differences between 2 groups in terms of exhaust time and liquid nurtrion recovery time, proximal and distal dissection margin, the postoperative hospital stay, and postoperative complications,as well as the EORTC QLQST022 score 6 month after surgery and 1-and 2-year survival rate(P>0.05). Conclusions 3D laparoscopic assisted D2 gastric cancer radical surgery is convenient to the surgeons, which could reduce the intraoperative blood loss and increase the number of removed lymph nodes.Besides,it does not increase postoperative complications as well as reduce life quality and survival rate,which is worth popularizing in clinical use.

Objective:To investigate the combined effects of docosahexaenoic acid(DHA)and Cucurbitacin B on cells proliferation and apoptosis of human gastric cancer BGC - 823 cells. Methods:BGC - 823 cells were stained with NADH enzyme and Giemsa to observe their morphological changes under the microscope before and after treated with DHA and Cucurbitacin B. MTT assay and flow cytometry were used to measure proliferation,cycle and apoptosis of BGC - 823 cells respectively. Results:According to the MTT assay,compared with the effects of DHA and Cucurb-itacin B respectively,the cell viability was reduced more effectively with the combined treatment on cell proliferation inhibition of gastric cancer cells,and the reduction effect improved as the drug concentration increased. With NADH enzyme and Giemsa staining,apoptosis phenomenon could be observed visibly by microscope. When flow cytometry was employed on the tumor cells with drugs joint intervention,G0 / G1 cells increased significantly while G2 / M and S phase cells decreased significantly. Conclusion:The combined treatment of DHA and Cucurbitacin B can inhibit the growth and induce the apoptosis of human gastric cancer BGC - 823 cells,and has synergistic effect.

目的 探讨MK-801对梗阻性黄疸大鼠中枢神经抗氧化应激系统的影响.方法 20只大鼠随机均分为假手术组、对照组、MK-801低剂量组和MK-801高剂量组4组,后3组为梗阻性黄疸模型组.MK-801低剂量组和MK-801高剂量于梗阻性黄疸模型建模术后第2天起分别腹腔注射0.025 mg/(kg·d)和0.25 mg/(kg·d)的MK-801,共10d;假手术组和对照组则以等容量生理盐水同时点注射.4组大鼠于术后3d采尾部静脉血检查直接胆红素(DBIL)和总胆汁酸(TBA)以确定模型制作是否成功,术后10d处死大鼠并取大脑皮质按试剂盒要求行丙二醛(MDA)、过氧化氢酶(CAT)、总超氧化物歧化酶(T-SOD)及总抗氧化能力(T-AOC)含量或活性测定.结果①建模术后3d,对照组、MK-801低剂量组和MK-801高剂量组大鼠的DBIL和TBA水平明显升高,且出现全身皮肤黄染,提示梗阻性黄疸模型建模成功.②对照组、MK-801低剂量组和MK-801高剂量组的MDA含量均明显高于假手术组(P＜0.05),MK-801低剂量组和MK-801高剂量组MDA含量则明显低于对照组(P＜0.05),MK-801低剂量组和MK-801高剂量组间MDA含量的差异无统计学意义(P＞0.05).③对照组CAT活性低于假手术组(P＜0.05),MK-801低剂量组和MK-801高剂量组的CAT活性明显高于假手术组及对照组(P＜0.05),MK-801低剂量组和MK-801高剂量组之间CAT活性差异无统计学意义(p＞0.05).④对照组T-SOD活性明显低于假手术组(P＜0.05),MK-801低剂量组T-SOD活性则明显高于对照组(P＜0.05),MK-801高剂量组T-SOD活性高于对照组但低于MK-801低剂量组(P＜0.05).⑤对照组、MK-801低剂量组和MK-801高剂量组的T-AOC明显高于假手术组(P＜0.05).MK-801低剂量组和MK-801高剂量组的T-AOC又明显高于对照组(P＜0.05),但MK-801低剂量组和MK-801高剂量组间T-AOC的差异无统计学意义(P＞0.05).结论 梗阻性黄疸时机体中枢神经系统存在氧化应激反应,机体通过增加CAT等抗氧化应激损伤酶类的表达使抗氧化应激损伤能力增强.MK-801使梗阻性黄疸所致大鼠中枢神经系统氧化应激损伤过程中脂质过氧化程度降低,并可提高SOD及CAT的活性及机体总抗氧化应激能力;高剂量的MK-801与低剂量的MK-801相比其效果并未明显增加,反而使T-SOD活性比低剂量组降低.具体机理需要进一步研究.

Objective To investigate the application value of laparoscopic sleeve gastrectomy (LSG) in treating morbid obesity.Methods Clinical data of 10 morbidly obese patients undergoing LSG in the Second Hospital of Hebei Medical University from May 2011 to March 2014 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 10 patients, 6 were males and 4 were females with an average age of (27±5) years old and an average body mass index (BMI) of (49±7) kg/m2. BMI, percentage of excess body weight loss (EWL%) and improvement situation of obesity- related comorbidities were observed at 3, 6 and 12 months after operation. Clinical indexes before and after operation were compared usingt test.Results Ten patients received LSG successfully. BMI and EWL% levels decreased and increased respectively during the follow-up time after operation. At 3 months, BMI was (38.3±4.9) kg/m2, which was significantly lower than (48.8±6.8) kg/m2 before operation (t=3.962,P<0.05); the related comorbidities, including type 2 diabetes mellitus, hypertension, sleep apnea syndrome, fatty liver, polycystic ovarian syndrome and joint degeneration, all got remission or improvement in different degrees postoperatively.Conclusions LSG has a significantly short-term curative effect on losing weight and improving obesity-related comorbidities, however, and the long-term effect remains to be observed further.

BACKGROUND:A variety of factors contribute to biliary injury that is difficult to be repaired. Stent implantation is extensively used for bile duct injury, but either scaffolds made by metal or plastics can lead to certain adverse reactions. OBJECTIVE:To explore the biological characteristics of a novel biodegradable scaffold and its repair effects on bile duct injury. METHODS:The biological characteristics of the novel biodegradable scaffold were detected by fresh bile, and its degradation was observed at different time points. Thirty Bama mini pigs were included and were randomly divided into observation group (n=15) and control group (n=15). After bile duct injury models were prepared, the control group was subjected to the bile duct interrupted suture, while the observation group was subjected to the novel biodegradable scaffold combined with omentum majus. The biological properties of the scaffolds were observed. Hepatic enzymes and serum total bilirubin levels were detected, as wel as hematoxylin-eosin staining, Masson staining and immunohistochemistry detection ofα-smooth muscle actin were performed. RESULTS AND CONCLUSION:Before and 1, 3 and 6 months after surgery, hepatic enzymes and total bilirubin of two groups were detected, and neither intra-group nor intergroup comparisons had significant differences (P>0.05). Hematoxylin-eosin staining and Masson staining revealed that inflammatory reactions and fiber hyperplasia at the anastomotic site in the observation group were lighter than those in the control group at different time points after surgery. Theα-smooth muscle actin-positive scores in both two groups were in a rise at 1 and 3 months after surgery, and peaked at the 3rd month, and then began to decline. Moreover, theα-smooth muscle actin-positive scores in the observation group were significantly lower than those in the control group at 3 and 6 months after surgery (P<0.05). These results show that the novel biodegradable scaffold has good biological characteristics and can obtain ideal repair effects in the bile duct injury.