Objective:To employ body weight as a reference index for nutritional risk screening to assess the nutritional status of hospitalized children with Hirschsprung disease (HSCR) and provide evidence-based rationales for clinical nutritional management.Methods:From January 2006 to December 2019, clinical data were reviewed for 472 hospitalized HSCR children. There were 386 boys and 86 girls with a median age of 10(0-120) months. Weight-for-age z score (WAZ) was calculated as an evaluation index of nutritional status using a standardized growth curve of height and weight of WHO 2006 as a reference. And WAZ < -2 was defined as moderate-to-severe malnutrition. To assess the overall nutritional status of HSCR children and compare the nutritional risk differences in children with different age of onset, different clinical types of HSCR and whether or not receiving conservative treatment.Results:The overall WAZ was (-0.81±1.56) and moderate-to-severe malnutrition accounted for 18.2%(86/472). According to diagnostic age, they were divided into 5 groups of ≤6 months, 6 months < age ≤12 months, 12 months < age≤24 months, 24 months < age ≤60 months and >60 months. The median body weight was 6.0, 8.0, 10.0, 13.7 and 21.7 kg. And WAZ of five groups were (-0.68±1.47), (-0.70±1.45), (-0.92±1.67), (-1.15±1.79) and (-1.29±1.51) respectively and there was no significant inter-group difference ( P=0.15). WAZ of children with different clinical types, namely short-segment, common, long-segment and pancolonic, were (-0.62±1.53), (-0.81±1.47), (-1.06±1.75), and (-2.20±1.79) respectively and the difference was statistically significant ( P=0.001). No significant differences existed in the incidence of WAZ or moderate-to-severe malnutrition between recipients and non-recipients of conservative treatment ( P>0.05). The results of correlation analysis hinted at a significant weak correlation between WAZ and whether or not postoperative enteritis occurring (r=0.21, P=0.001). Conclusions:Malnutrition is a prevalent condition among HSCR children. And clinical classification of HSCR is a influencing factor of malnutrition risk. Moderate-to-severe malnutrition is a significant influencing factor of occurrence of postoperative complications. Weight-for-age Z score may be employed as a simple and easy screening tool. Nutritional assessment should be performed and appropriate and timely nutritional intervention offered to children at a risk of malnutrition.

Objective:The expression and clinical significance of achaete scute homolog 2 (ASCL2) gene in gastrointestinal cancer were analyzed by data mining of Oncomine, tumor immune estimation resource (TIMER), cBioportal and gene expression profiling interactive analysis (GEPIA).Methods:By searching GEPIA database from January 2017 to January 2021, ASCL2 gene with significant changes in both gastric and colorectal cancer was screened. The expression level of ASCL2 in various tumors was analyzed by the TIMER database. GEPIA database was used to evaluate the effect of ASCL2 on the clinical prognosis of gastrointestinal cancer, and the correlation between ASCL2 and cancer cell immune invasion was studied by the TIMER database. In addition, the correlation of mismatch repair genes co-expressed by ASCL2 was analyzed by cBioportal.Results:NPSRL, NOTUM, RP11-400N13.2 and ASCL2 were the four genes with the most significant difference in gastric cancer, colon cancer and rectal cancer. ASCL2 was significantly higher in most tumors such as colon adenocarcinoma, esophageal adenocarcinoma, rectal adenocarcinoma and gastric adenocarcinoma (0.61±0.03, 0.56±0.02, 0.67±0.04, 0.59±0.03 vs. 0.14±0.01, respectively) with statistically significances (all P<0.05). Patients with esophageal adenocarcinoma with high ASCL2 expression had poor prognosis [total survival: hazard ratio ( HR)=1.6, P<0.05; disease-free survival: HR=1.6, P<0.05]. The expression of ASCL2 gene was significantly correlated with the expression of MLH1 ( rs=0.17, P<0.05) and PMS2 ( rs=0.30, P<0.05). The expression of ASCL2 was positively correlated with tumor purity in colorectal adenocarcinoma ( r=0.237, P<0.05), and negatively correlated with the infiltration of B cells ( r=-0.159, P<0.05), CD8 + T cells ( r=-0.468, P<0.05), macrophages ( r=-0.115, P<0.05), neutrophils ( r=-0.34, P<0.05) and dendritic cells ( r=-0.351, P<0.05) in colorectal adenocarcinoma. And there was a negative association with CD8 + T cell, neutrophil and dendritic cell infiltration in rectal adenocarcinoma. Conclusion:ASCL2 is highly expressed in gastrointestinal tumor tissues and inhibits the immune system of patients with gastrointestinal tumors, which is closely related to its prognosis.

目的:评估机器人辅助腹腔镜下前列腺癌根治术加扩大盆腔淋巴结清扫术治疗局部进展期前列腺癌的安全性及其疗效.方法:回顾性分析2015年12月-2019年12月我院收治的112例局部进展期前列腺癌患者的临床资料,放射性核素骨扫描排除骨转移后,行机器人辅助腹腔镜下前列腺癌根治术加扩大盆腔淋巴结清扫术,统计患者手术时间、术中出血量、清扫淋巴结个数、术后病理、住院时间等.结果:112例患者均顺利完成手术,平均手术时间(217.60±30.19)min,平均术中出血量(192.00±138.30) mL,常规术后2周拔除导尿管,平均术后住院时间(9.36±3.42)d.平均检出淋巴结(17.94±4.38)枚,淋巴结转移患者29例,检出阳性淋巴结共107枚,切缘阳性28例,术后淋巴漏21例,平均随访时间(34.69±11.25)个月.术后辅助内分泌治疗61例,放疗32例,出现生化复发44例.结论:局部进展期前列腺癌患者行机器人辅助腹腔镜下前列腺癌根治术加扩大盆腔淋巴结清扫术安全可行,临床疗效满意,并能清除潜在的转移淋巴结,提供精确的肿瘤病理分期,有望改善患者预后.

Objective To summarize the preliminary experience of extraperitoneal laparoscopic radical prostatectomy (C.R.P.C.four-step) for localized prostate cancer and the outcomes based on early follow-up.Methods A total of 102 prostate cancer patients were screened by prostate specific antigen (PSA) and diagnosed by prostate magnetic resonance imaging and prostatic puncture biopsy with cT1c-cT3b,with average age of (67 ±5) years old,average preoperative total PSA value of (45.32 ± 18.33) ng/ml,and average prostate volume was (42 ± 12)cm3.All these patients underwent extraperitoneal laparoscopic radical prostatectomy by the four-step technique,abbreviating as C.R.P.C.[C:control DVC (dorsal deep venous complex).R:recognize three anatomical layers (prostate and bladder junction,seminal vesicle,and Denonvilliers' fascia surface).P:preserve urethral sphincter and bladder neck.C:continuous anastomosis between urethra and bladder neck (4 key needles at 3,5,7 and 9 o'clock)].The operative time,estimated blood loss,length of hospital stay and postoperative complications were recorded,and the postoperative PSA was followed up.Results All the 102 cases were successfully treated by iaparoscopic radical prostatectomy.The operative time was from 55 to 156 min (mean 92 min),and the estimated blood loss was from 55 to 185 ml (mean 105 ml).There was no case converted of open surgery,only one case received blood transfusion for postoperative hemorrhage (0.98％),and positive surgical margin was found in 15 case (14.70％) by pathological examination.Postoperative urinary extravasation within one week occurred in 2 (1.96％) cases,and resolved after tensioning the catheter and prolonging the indwelling time.During the follow-up period of 12 to 45 months,2 cases were incontinent (grade I-II),and the other cases(98.04％) had no incontinence or dysuria.However,11 cases (10.78％) developed to biochemical recurrence within 6 months after the operation.Conclusions The C.R.P.C.four-step technique of lparoscopic radical prostatectomy is easily to be grasped and performed by the greenhand urologists,and was efficient and safe.

目的 评价全息影像技术引导机器人辅助腹腔镜下肾部分切除术(RAPN)治疗肾门部肿瘤的可行性与有效性.方法 回顾性分析该院2019年6月-2019年10月收治的11例肾门部肿瘤患者的临床资料.其中,男3例,女8例;左侧4例,右侧7例;患者年龄32～75岁,平均62.6岁,体质指数19.45～28.12 kg/m2,平均23.75 kg/m2,肿瘤直径1.1～6.7 cm,平均2.76 cm,R.E.N.A.L.评分8～12分,平均10.7分,患肾肾小球滤过率(GFR)22～51 mL/min,平均35 mL/min.患者术前行全腹部增强CT,利用CT数据进行全息影像重建.术中应用该技术结合达芬奇机器人辅助系统,精准分离、剜除肿瘤,并记录手术持续时间、出血量、肾脏热缺血时间、有无并发症及切缘阳性率等.结果 根据全息影像引导,11例患者均顺利剜除肿瘤,完成手术,无中转开放.手术时间60～130 min,平均90 min.术中出血量50～180 mL,平均100 mL,热缺血时间18～25 min,平均21 min,无术后发热、继发出血或漏尿等并发症.术后病理诊断肾透明细胞癌9例(FuhrmanⅠ和Ⅱ级),乳头状细胞癌1例,血管平滑肌脂肪瘤1例,无切缘阳性病例.术后随访3～7个月,平均4.3个月,患肾GFR 18～43 mL/min,平均31 mL/min.术后3个月复查肾脏CT平扫及增强,全部患者未出现复发.结论 全息影像技术引导RAPN治疗肾门部肿瘤,围手术期并发症少,安全有效.

Enteric nervous system (ENS), originating predominantly from neural crest cells (NCCs), is one of the largest component of peripheral nervous system. Although it operates along with central nervous system (CNS) to control numerous gastrointestinal functions, ENS may function independently from CNS. The development of ENS involves invasion of foregut by NCCs and their coordinated proliferation, directional movement and differentiation into neurons and glia. This review summarizes our current understanding of ENS development, focusing on the regulatory mechanisms of migration of NCCs along gut.

Objective To employ an animal model of Ednrb knockout mice for exploring the efficacy of the treatment using dental pulp stem cells (DPSCs) in Hirschsprung's disease associated enterocolitis (HAEC).Methods The experiment group received an intraperitoneal injection of DPSCs with a cell count of 0.5 × 106/kg.The control group received an injection of the same amount of PBS buffer and the normal group included wild-type mice with the same age but without any treatment.Changes in body weight of each group of mice and 4-week survival were recorded.For each group,gross macroscopic intestinal changes were observed and the pathogenesis of enteritis was evaluated.The expressions of such proinflammatory factors as TNF-α,TGF-β,IFN-γ,TGF-β and IL-10 and such immune cell surface markers as CD4,CD20,CD56 and CD68 in intestinal tract were detected by immunofluorescence.Results The lifespan of experiment group was significantly longer than that of control group [(26.2 ± 2.5) vs.(22.0 ± 3.0) days] and 4-week survival rate was significantly higher than that of control group (62.50％ vs.16.70％).When the above parameters were compared,the between-group differences were statistically significant (P＜0.05).At an age of 2 weeks,the plasma levels of TNF-α and IFN-γ were 35.21 ± 2.08 and 32.31 ± 7.41 in control group and both were significantly higher than those in normal group 29.52 ± 0.19 and 18.94 ± 0.49 (P＜0.05).The levels of TGF-β and IL-10 were 41.38 ± 2.39 and 53.89 ± 4.90 in control group and both were significantly lower than 14.84 ± 0.02 and 43.56 ± 0.97 in normal group respectively.And the differences were statistically significant (P＜0.05).After transplanting DPSCs,the contents of TNFα and IFN-γ were 31.31 ± 0.63 and 24.75 ± 2.76 in experiment group versus 35.21 ± 2.08 and 32.31 ± 7.41 in control group.The contents decreased significantly and the difference was statistically significant (P＜0.05).The contents of TGF-β and IL-10 were 122.97 ± 0.90 and 69.00 ± 0.28 in experiment group and both were significantly higher than 14.84 ± 0.20 and 41.38 ± 2.39 respectively in control group.Statistically significant differences existed between two groups (P ＜ 0.05).Furthermore,the expressions of CD4,CD20,CD56 and CD68 decreased in experiment group as compared with control group.Conclusions With the functions of immunoregulation,dental pulp stem cells may suppress the release of tissue inflammatory mediators,reduce tissue inflammation,and alleviate the symptoms of HAEC.Thus it provides a new clinical therapy for HAEC.

目的:探讨多房囊性肾细胞癌的临床特征和手术治疗策略,为临床诊治提供依据.方法:回顾性研究2013年3月-2018年3月华中科技大学同济医学院附属同济医院泌尿外科收治的17例多房囊性肾细胞癌患者资料.所有患者均行腹腔镜(或机器人辅助腹腔镜)下多房囊性肾细胞癌保留肾单位部分切除术,分析患者的临床表现及影像学特征、组织病理学特征、手术治疗及随访情况.结果:17例患者均行保留肾单位的肾部分切除术.术后病理检查均为多房囊性肾细胞癌.随访时间3～52个月,平均(35.0±13.7)个月.术后患者肾功能均正常,16例患者术后复查未见复发,临床症状消失;1例患者术后9个月行CT检查提示术后复发并再次行肾癌根治术及腹膜后脂肪淋巴结清扫,病理检查提示肾透明细胞癌伴腹膜后淋巴结转移.结论:多房囊性肾细胞癌患者多由体检发现,影像学表现相对特殊,需要慎重鉴别.手术治疗策略推荐经腹腔镜下保留肾单位部分切除术,具有创伤小,并发症少等优点,值得临床推广.

目的 研究腹腔镜辅助经腹经膈肌裂孔治疗进展期贲门癌的疗效.方法 2013年6月至2017年12月于我科诊治的符合纳入标准的进展期贲门癌为研究对象,均行腹腔镜辅助经腹经膈肌裂孔根治术,统计手术时间、术中出血量、淋巴结切除数目、肠通气时间、住院时间及术后并发症等.结果 本组行腹腔镜辅助经腹经膈肌裂孔治疗进展期贲门癌病人手术时间为(3.8±0.5)h;术中出血量为(218.6±13.2) ml;淋巴结切除数目为(32.5±4.7)枚/例;肠通气时间为(5.5±1.2)d;住院时间为(9.8±1.5)d.术中未见任何并发症,术后出现吻合口瘘1例,胃癌术后胃瘫1例,经留置鼻空肠营养管支持对症治疗后出院,术后病理未见切缘阳性或肿瘤残留病例.结论 进展期贲门癌行腹腔镜辅助经腹经膈肌裂孔根治术,手术短期疗效确切且安全性高,但应严格把握手术适应证.

家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)是一组以结直肠多发腺瘤为特征的常染色体显性遗传的综合征,FAP大肠内表现主要为结肠腺瘤样息肉,大肠外表现主要为胃小肠腺瘤样息肉、腹壁及肠系膜侵袭性纤维瘤病(aggressive fibromatosis,AF)等[1].AF为FAP最常见及病死率最高的肠外相关并发疾病,呈浸润性生长,局部易复发但无远处转移,治疗以手术根治为主[2].发生于肠系膜的AF常侵犯肠系膜上动静脉,导致手术难度及风险极高.笔者对1例FAP并发侵犯肠系膜上血管的AF病人行肿瘤离体切除及小肠自体移植手术,术后恢复良好.现报告如下.

Objective To identify the effect and mechanism of small-molecule RNA-199a-3p on the proliferation in bladder carcinoma cells. Methods Firstly,the expression of miR-199a-3p and CDK7 in the fresh tissue of bladder tumor were detected by reverse transcriptional Real-time PCR and analyzed.Before the experiment,the transfection system was proved to be effective by u-sing reverse transcriptional Real-time PCR,and the effect of miR-199a-3p on bladder tumor cells was clearly determined by the proliferation experiment.Fluorescein enzyme reporting system was used to determine the regulatory role of miR-199a-3p by targeting CDK7 3′UTR,and further immune-im-printing was used to verify the effect of miR-199a-3p on CDK7 protein levels. Results The ex-pression of miR-199a-3p in the fresh tissue of bladder tumor was significantly decreased compared with normal control,while the expression of CDK7 was significantly increased.The negative correla-tion was found after correlation analysis.The expression of miR-199a-3p was significantly up or down regulated after miR-199a-3p mimics and inhibitor transfection.MiR-199a-3p can significantly inhibit the proliferation of bladder carcinoma cells,while miR-199a-3p inhibitor can promote its pro-liferation.Fluorescein report system clarified the binding of miR-199a-3p to 3′UTR of CDK7,and miR-199a-3p could significantly inhibit the expression of CDK7 in bladder carcinoma cells.CDK7 can respond to or partially respond to the proliferation inhibition effect of miR-199a-3p on proliferation of bladder carcinoma cells. Conclusions Small-molecule RNA-199a-3p inhibit the cell growth by tar-geting CDK7 in bladder cancer.

Objective To establish a mouse model by transplanting subcutaneously human pancreatic cancer tissue fragments.Methods Surgically resected pancreatic cancer tissue fragments from patients were transplanted into NOD/SCID mice subcutaneously,and then the growth of the tumor and transplanting it into the next generation were observed.The growth rate,HE staining and immunohistochemistry staining of Ki67 and VEGF were compared.Results We have obtained 13 cases ofpancreatic cancer tissues and 6 cases of biopsy specimens.In 5 cases transplantation was successful,in onemouse model passing to fourth generation,in 4 models to second generation.With the increase of generaions,tumor growth accelerated.HE staining showed later passage cells behavior in an identical manner as the primary cells.Immunohistochemistry staining showed that expressions of Ki67 and VEGF are increasing.Conclusions Through transplanting human pancreatic cancer tissue fragments directly,we have constructed mouse model of pancreatic cancer successfully.With the passage of subculture,the malignant degree and invasiveness may increase.