Effect of Jianpi Shengxue Tablet on Iron Metabolism and Nutritional Status in Patients with Renal Anemia:A Prospective,Randomized,Open,Parallel Controlled and Multicenter Clinical Study

Objective This study aimed to analyze the clinical efficacy of the Jianpi Shengxue tablet for treating renal anemia.Methods A total of 200 patients with renal anemia from December 2020 to December 2022 were enrolled and randomly divided into two groups.Patients in the control group were treated with polysaccharide-iron complex,and those in the experimental group were administered Jianpi Shengxue tablet.After 8 weeks of continuous treatment,the therapeutic outcomes regarding anemia were compared between the two groups.Results After treatment,the red blood cell(RBC)count,hematocrit(HCT),reticulocyte percentage(RET),ferritin(SF),serum iron(SI),transferrin saturation(TSAT),and serum albumin(ALB)all increased(P<0.01),and the clinical symptom score and total iron binding capacity decreased(P<0.01)in the experimental group.Moreover,the improvements in RBC,HCT,RET,SF,SI,TAST,ALB,and clinical symptoms(fatigue,anorexia,dull skin complexion,numbness of hands and feet)in the experimental group were significantly greater than those in the control group(P<0.05).The total effective rate for treating renal anemia was significantly higher in the experimental group than in the control group(P<0.01).Conclusion The Jianpi Shengxue tablet demonstrates efficacy in treating renal anemia,leading to significant improvements in the laboratory examination results and clinical symptoms of patients with renal anemia.

Corneal subepithelial nerve fibers in type 2 diabetes:potential biomarker of diabetic neuropathy

AIM:To observe the changes in corneal subepithelial nerve fibers(CNFs)and Langerhans cells(LCs)in patients with type 2 diabetes using corneal laser confocal microscopy(CLCM).METHODS:A total of 60 patients(64 eyes),including 40 patients with type 2 diabetes(DM group)and 20 subjects without diabetes(control group)were included with CLCM.Neuron J plugin of Image J software were used for quantitative analysis of CNF length(CNFL),CNF density(CNFD),corneal nerve branch fiber density(CNBD),main branch length density,branch length density,corneal nerve fiber tortuosity(NT)score,and LCs density.An independent samples t-test to analyze the variability between the two groups was performed,and Pearson correlation analysis was used to analyze the relationships between CNF and multiple biochemical indicators in the DM group.The predictive power of CNF for type 2 diabetes was assessed using the receiver operating characteristic(ROC)curve.RESULTS:There were significant differences in the CNFL,CNFD,and main branch length density between two groups.The results of Pearson correlation analysis showed a significant negative correlation between CNFD and the duration of diabetes as well as triglyceride levels and total cholesterol,and a significant positive correlation between CNFD and serum albumin.In addition,the NT score showed a positive correlation and urea nitrogen,similar to the positive correlation observed between LC density and glycosylated hemoglobin(HbA1c)levels.CNFD showed the highest area under the curve(AUC of ROC)value,followed by main branch length density and CNFL.The AUC of the ROC curve under the logistic regression model also demonstrated good predictive values.The cut-off values of CNFD,CNFL,and main branch length density for diabetes showed 31.25,18.85,and 12.56,respectively.CONCLUSION:In patients with type 2 diabetes,there is a notable reduction in both CNFL and CNFD.These measurements can be influenced by various blood biochemical factors.However,the compromised nerve fibers can serve as valuable indicators for predicting the onset of type 2 diabetes and also as biomarkers for detecting diabetic neuropathy and its related complications.

Effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section

BACKGROUND Following cesarean section,a significant number of women encounter moderate to severe pain.Inadequate management of acute pain post-cesarean section can have far-reaching implications,adversely impacting maternal emotional wellbeing,daily activities,breastfeeding,and neonatal care.It may also impede maternal organ function recovery,leading to escalated opioid usage,heightened risk of postpartum depression,and the development of chronic postoperative pain.Both the Chinese Enhanced Recovery After Surgery(ERAS)guidelines and the American ERAS Society guidelines consistently advocate for the adoption of multimodal analgesia protocols in post-cesarean section pain management.Esketamine,functioning as an antagonist of the N-Methyl-D-Aspartate receptor,has been validated for pain management in surgical patients and has exhibited effectiveness in depression treatment.Research has suggested that incorporating esketamine into postoperative pain management via pain pumps can lead to improvements in short-term depression and pain outcomes.This study aims to assess the efficacy and safety of administering a single dose of esketamine during cesarean section.AIM To investigate the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.METHODS A total of 315 women undergoing elective cesarean section under combined spinal-epidural anesthesia were randomized into three groups:low-dose esketamine(0.15 mg/kg),high-dose esketamine(0.25 mg/kg),and control(saline).Postoperative Visual Analog Scale(VAS)scores were recorded at 6 hours,12 hours,24 hours,and 48 hours.Edinburgh Postnatal Depression Scale(EPDS)scores were noted on 2 days,7 days and 42 days.Ramsay sedation scores were assessed at specified intervals post-injection.Postoperative adverse reactions were also recorded.RESULTS Low-dose group and high-dose group compared to control group,had significantly lower postoperative VAS pain scores at 6 hours 12 hours,and 24 hours(P<0.05),with reduced analgesic usage(P<0.05).EPDS scores and postpartum depression rates were significantly lower on 2 days and 7 days(P<0.05).No significant differences in first exhaust and defecation times were observed(P>0.05),but ambulation times were shorter(P<0.05).Ramsay scores were higher at 5 minutes,15 minutes,and upon room exit(P<0.05).Low-dose group and high-dose group had higher incidences of hallucination,lethargy,and diplopia within 2 hours(P<0.05),and with low-dose group had lower incidences of hallucination,lethargy,and diplopia than high-dose group(P<0.05).CONCLUSION Esketamine enhances analgesia and postpartum recovery;a 0.15 mg/kg dose is optimal for cesarean sections,balancing efficacy with minimized adverse effects.

Phenotypic Diversity of Different Populations of Paeonia ludlowii in Nyingchi of Tibet

[Objectives] To study the differences in fruit traits of different populations of Paeonia ludlowii , and to provide basic data for the identification, protection and utilization of germplasm resources of P. ludlowii .[Methods] Nine fruit traits of three different populations of P. ludlowii in Tibet were tested and analyzed.[Results] The mean values of 9 fruit traits of P. ludlowii were different in different populations;the coefficients of variation of different traits of different populations were also different;there were morphological differences of different sizes among individuals in each population;there were significant differences in 8 traits (pod length, pod width, pod thickness, pod weight, seeds per pod, seed length, seed width, and seed weight) among different populations. Among the 9 traits of the three P. ludlowii populations, the variability of the five traits was higher in the fruit pods, the variation degree of five traits including pod weight, pod thickness, seeds per pod, and seed weight was higher. It is of great significance for the screening and preservation of the germplasm resources of P. ludlowii . According to the principal component analysis (PCA), the seed weight, seed width, and seed length, i.e. the seed traits, were the main factors causing differences in fruit traits among populations. There was a certain correlation between different traits of P. ludlowii . Among the 36 Pearson- related combinations of 9 fruit traits, 11 combinations had extremely significant correlations, and 8 combinations had significant correlations, indicating that there was a certain correlation between fruit traits in the growth and development. Through cluster analysis, three populations of P. ludlowii can be divided into two categories. The BV population was a category, which is characterized by long pods, long seeds, wide seeds, thick seeds and large seed weight. Therefore, the BV population is suitable material for breeding excellent varieties.[Conclusions] This study provides basic data for the identification, protection and utilization of germplasm resources of P. ludlowii .

MUC1抑制COPD中烟草烟雾诱导的黏液高分泌

目的:探究黏蛋白1(MUC1)对烟草烟雾(CS)暴露诱导的慢性阻塞性肺疾病(COPD)中MUC5AC和MUC5B的表达影响。方法:(1)动物实验:健康SPF级雄性C57BL/6小鼠20只,随机分为空白对照组(n=10)和CS暴露组(n=10),采用CS暴露24周的方法建立COPD小鼠模型。建模结束后,检测小鼠肺功能;肺组织切片进行HE和PAS染色评估肺组织病理改变及气道杯状细胞增生情况;Western blot法检测肺组织MUC1蛋白水平;ELISA法检测支气管肺泡灌洗液中白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、MUC5AC和MUC5B的表达水平,以评估小鼠肺部炎症及黏液分泌情况。(2)细胞实验:用烟草烟雾提取物(CSE)处理人支气管上皮细胞系16HBE,通过Western blot、RT-qPCR和免疫荧光染色检测MUC1、MUC5AC和MUC5B的表达。用MUC1小干扰RNA(siRNA)和MUC1过表达质粒转染16HBE细胞以沉默和过表达MUC1,确定MUC1对MUC5AC和MUC5B表达的影响。结果:(1)CS组小鼠表现为类似COPD的病变,包括肺气肿、肺功能下降及气道炎症(P<0.05);(2)CS组小鼠气道杯状细胞增生显著增加(P<0.01),肺组织中MUC1及支气管肺泡灌洗液中MUC5AC和MUC5B的水平显著升高(P<0.05);(3)与对照组相比,CSE处理组的16HBE细胞中MUC1、MUC5AC和MUC5B表达水平显著升高(P<0.01);(4)通过siRNA沉默MUC1显著促进了CSE诱导的MUC5AC和MUC5B表达水平升高(P<0.05);而过表达MUC1则显著降低了CSE诱导的MUC5AC和MUC5B表达水平升高(P<0.05)。结论:CS诱导小鼠COPD发病过程中,MUC1表达增加并可抑制CSE诱导的黏液高分泌。

An Electrochromic Nickel Phosphate Film for Large-Area Smart Window with Ultra-Large Optical Modulation

Exploring materials with high electrochemical activity is of keen interest for electrochemistry-controlled optical and energy storage devices.However,it remains a great challenge for transition metal oxides to meet this feature due to their low electron conductivity and insufficient reaction sites.Here,we propose a type of transition metal phosphate(NiHPO_(4)·3H_(2)O,NHP)by a facile and scalable electrodeposition method,which can achieve the capability of efficient ion accommodation and injection/extraction for electrochromic energy storage applications.Specifically,the NHP film with an ultra-high transmittance(approach to 100%)achieves a large optical modulation(90.8%at 500 nm),high coloration efficiency(75.4 cm^(2)C^(-1)at 500 nm),and a high specific capacity of 47.8 mAh g^(-1)at 0.4 A g^(-1).Furthermore,the transformation mechanism of NHP upon electrochemical reaction is systematically elucidated using in situ and ex situ techniques.Ultimately,a large-area electrochromic smart window with 100 cm^(2)is constructed based on the NHP electrode,displaying superior electrochromic energy storage performance in regulating natural light and storing electrical charges.Our findings may open up new strategies for developing advanced electrochromic energy storage materials and smart windows.

Magnetic compression anastomosis for sigmoid stenosis treatment:A case report

BACKGROUND Endoscopic balloon dilation is a minimally invasive treatment for colorectal stenosis.Magnetic compression anastomosis can be applied against gastrointestinal anastomosis.When combined with endoscopy,it offers a unique approach to the recanalization of colorectal stenosis.CASE SUMMARY We have reported here the case of a 53-year-old female patient who underwent a descending colostomy due to sigmoid obstruction.Postoperative fistula restoration was not possible in her due to sigmoid stenosis.Accordingly,endoscopicassisted magnetic compression anastomosis for sigmoid stenosis was performed,and the sigmoid stenosis was recanalized 15 d after the surgery.Subsequently,a reduction colostomy was successfully performed after 10 d.CONCLUSION This case report proposes a novel minimally invasive treatment approach for colorectal stenosis.

A bioartificial transgenic porcine whole liver expressing human proteins alleviates acute liver failure in pigs

Background:Preventing heterologous protein influx in patients is important when using xenogeneic bioartificial livers(BALs)to treat liver failure.The development of transgenic porcine livers synthesizing human proteins is a promising approach in this regard.Here,we evaluated the safety and efficacy of a transgenic porcine liver synthesizing human albumin(h ALB)and coagulation factor VII(h FVII)within a bioartificial system.Methods:Tibetan miniature pigs were randomly subjected to different interventions after surgeryinduced partially ischemic liver failure.Group A(n=4)was subjected to basic treatment;group B(n=4)was to standard medical treatment and wild-type porcine BAL perfusion,and group C(n=2)was to standard medical treatment and transgenic BAL perfusion.Biochemical parameters,coagulation status,survival time,and pathological changes were determined.Expressions of h ALB and h FVII were detected using immunohistochemistry and enzyme-linked immunosorbent assays.Results:The survival time in group A was 9.75±1.26 days;this was shorter than that in both perfused groups,in which all animals reached an endpoint of 12 days(P=0.006).Ammonia,bilirubin,and lactate levels were significantly decreased,whereas albumin and fibrinogen levels were increased after perfusion(all P<0.05).h ALB and h FVII were detected in transgenic BAL-perfused pig serum and ex vivo in the liver tissues.Conclusions:The humanized transgenic pig livers could synthesize and secrete h ALB and h FVII ex vivo in a whole organ-based bioartificial system,while maintaining their metabolism,detoxification,transformation,and excretion functions,which were comparable to those observed in wild-type porcine livers.Therefore,the use of transgenic bioartificial whole livers is expected to become a new approach in treating acute liver failure.

Impact of heart failure on outcomes in patients with sepsis:A systematic review and meta-analysis

BACKGROUND Heart failure(HF)often affects the progress of sepsis patients,although its impact on outcomes is inconsistent and inconclusive.AIM To conduct a systematic review and meta-analysis of the impact of HF on mortality in patients with sepsis.METHODS PubMed,Embase,Web of Science,and the Cochrane Library databases were searched to compare the outcomes of sepsis patients with HF.A random effect model was used to summarize the mortality data,and the odds ratio(OR)and 95%confidence interval(CI)were calculated as effect indicators.RESULTS Among 18001 records retrieved in the literature search,35712 patients from 10 separate studies were included.The results showed that sepsis patients with HF were associated with increased total mortality(OR=1.80,95%CI:1.34-2.43;I2=92.1%),with high heterogeneity between studies.Significant subgroup differences according to age,geographical location,and HF patient sample were observed.HF did not increase the 1-year mortality of patients(OR=1.11,95%CI:0.75-1.62;I2=93.2%),and the mortality of patients with isolated right ventricular dysfunction(OR=2.32,95%CI:1.29-4.14;I2=91.5%)increased significantly.CONCLUSION In patients with sepsis,HF is often associated with adverse outcomes and mortality.Our results call for more high-quality research and strategies to improve outcomes for sepsis patients with HF.

Sensory nerves directly promote osteoclastogenesis by secreting peptidyl-prolyl cis-trans isomerase D(Cyp40)

Given afferent functions,sensory nerves have recently been found to exert efferent effects and directly alter organ physiology.Additionally,several studies have highlighted the indirect but crucial role of sensory nerves in the regulation of the physiological function of osteoclasts.Nonetheless,evidence regarding the direct sensory nerve efferent influence on osteoclasts is lacking.In the current study,we found that high levels of efferent signals were transported directly from the sensory nerves into osteoclasts.Furthermore,sensory hypersensitivity significantly increased osteoclastic bone resorption,and sensory neurons(SNs)directly promoted osteoclastogenesis in an in vitro coculture system.Moreover,we screened a novel neuropeptide,Cyp40,using an isobaric tag for relative and absolute quantitation(iTRAQ).We observed that Cyp40 is the efferent signal from sensory nerves,and it plays a critical role in osteoclastogenesis via the aryl hydrocarbon receptor(AhR)-Ras/Raf-p-Erk-NFATc1 pathway.These findings revealed a novel mechanism regarding the influence of sensory nerves on bone regulation,i.e.,a direct promoting effect on osteoclastogenesis by the secretion of Cyp40.Therefore,inhibiting Cyp40 could serve as a strategy to improve bone quality in osteoporosis and promote bone repair after bone injury.

纤维素纳米晶的改性对其晶体结构及性能的影响

采用硫酸水解法制备纤维素纳米晶(CNC),并对CNC进行乙酰化改性(A-CNC)、TEMPO氧化(T-CNC)、阳离子疏水改性(C-CNC)、阳离子亲水改性(E-CNC)、烷基化改性(S-CNC)、聚丙烯酸接枝改性(P-CNC),之后采用红外光谱、固态碳谱、X射线衍射分析、透射电镜、原子力显微镜、热重分析、分散性分析等表征方法研究了不同改性方法对CNC晶体结构及性能的影响。结果表明,这些改性不会对CNC晶体结构产生严重影响,依然保持棒状结构和纳米尺寸;改性后的纤维素纳米晶结晶度有不同程度的下降,其中A-CNC下降最大,达21.2%;改性后的纤维素纳米晶基本在250~350℃发生降解,而未改性的在200℃就已开始降解;不同的改性可以改变CNC在不同溶剂中的分散性,阳离子亲水改性可以显著提高纤维素纳米晶的热稳定性。

松辽黑猪、雷香猪、杜长大白猪肉质性状及肌肉营养成分比较研究

为了比较松辽黑猪、雷香猪、杜长大白猪肉质性状及肌肉营养成分,选取松辽黑猪、雷香猪、杜长大白猪进行屠宰,对肉质性状、肌肉氨基酸及脂肪酸含量进行测定,结果表明:松辽黑猪剪切力、肌内脂肪含量显著高于杜长大白猪(P<0.05),熟肉率显著高于雷香猪(P<0.05),雷香猪剪切力、肌内脂肪含量极显著高于杜长大白猪(P<0.01);松辽黑猪和雷香猪肌肉中丙氨酸含量极显著高于杜长大白猪(P<0.01),甘氨酸含量松辽黑猪显著高于雷香猪(P<0.05),极显著高于杜长大白猪(P<0.01);雷香猪亚油酸含量显著低于杜长大白猪(P<0.05)。文章对优质高端黑猪肉生产群体的选择提供了参考。

优质黑猪育种30年工作体会

品种是影响养猪生产中的最重要因素,猪育种是一项复杂且系统的工程,文章从育种素材筛选、育种方案设计、育种方法选择、品种审定以及扩群产业化推广等方面进行详细的阐述,并结合育种经验提出相应猪育种建议。

干眼的免疫机制研究进展

干眼是一种由多因素所致,发病机制众多的常见眼表疾病。随着我国干眼发病率逐年升高,干眼逐渐引起人们的重视。干眼的发病机制较为复杂,其中炎症、角结膜上皮细胞改变、泪膜成分改变、角膜神经改变、睑板腺功能异常改变等均为重要因素。泪膜高渗导致眼表上皮细胞高渗,刺激炎症发生级联反应,眼表炎症反应为干眼发病机制中最为关键的环节。该过程中有多种炎症介质和免疫细胞参与,越来越多的人认为干眼是一种抗原特异性自身免疫性炎症疾病且二者存在联系。临床治疗中,各类抗炎药物及促进泪液分泌药物在一定程度上标志着干眼药物治疗的快速发展,但干眼治疗并非仅仅为了改善症状,而要根据具体病因展开治疗。近年关于干眼免疫机制的研究日益增多,据此本文就干眼的免疫机制研究进展进行综述,希望系统性了解免疫在干眼发生发展过程中的作用及临床意义。

Novel magnetic compression technique for establishment of a canine model of tracheoesophageal fistula

BACKGROUND Clinically,tracheoesophageal fistula(TEF)is lack of effective surgical strategies.One reason is due to the lack of appropriate animal models of acquired TEF,which is usually complex and difficult.Recently,the magnetic compression technique has been applied for digestive tract anastomosis or vascular anastomosis in animals.In this study,an animal model of TEF in dogs was developed by using the magnetic compression technique,hoping to provide a new method for mimicking TEF.AIM To establish a TEF model in dogs by using the magnetic compression technique.METHODS Six male beagles were used as models with two Nd-Fe-B permanent magnets for TEF.The parent magnet and the daughter magnet were placed in the cervical esophagus and trachea,respectively.The anterior wall of the esophagus and the posterior wall of the trachea were compressed when the two magnets coupled.After 4-6 d,the necrotic tissue between the two magnets fell off and the parent and daughter magnets disengaged from the target location,leaving a fistula.Gastroscopy/bronchoscopy,upper gastrointestinal contrast study,and histological analysis were performed.RESULTS The establishment of the TEF model in all six beagles was successful.The average time of magnet placement was 4.33±1.11 min(range,3-7 min).Mean time for the magnets to disengage from the target location was 4.67±0.75 d(range,4-6 d).TEFs were observed by gastroscopy/bronchoscopy and esophageal angiography.The gross anatomical structure of the esophagus and the trachea was in good condition.There was no esophageal mucosa or pseudostratified ciliated columnar epithelium at the site of the fistula according to histological analysis.CONCLUSION It is simple,feasible,and minimally invasive to use the magnetic compression technique for the establishment of the TEF model in dogs.

Single-incision vs three-port laparoscopic cholecystectomy:Prospective randomized study

AIM:To compare the clinical outcome of single-inci-sion laparoscopic cholecystectomy(SILC)with threeport laparoscopic cholecystectomy(TPLC). METHODS:Between 2009 and 2011,one hundred and two patients with symptomatic benign gallbladder diseases were randomized to SILC(n=49)or TPLC (n=53).The primary end point was post operative pain score(at 6 h and 7 d).Secondary end points were blood loss,operation duration,overall complications,postoperative analgesic requirements,length of hospital stay,cosmetic result and total cost.Surgical techniques were standardized and all operations were performed by one experienced surgeon,who had performed more than 500 laparoscopic cholecystectomies. RESULTS:One patient in the SILC group required conversion to two-port LC.There were no open conversions or major complications in either treatment groups.There were no differences in terms of esti-mated blood loss(mean±SD,14±6.0 mL vs 15±4.0 mL),operation duration(mean±SD,41.8±17.0 min vs 38.5±22.0 min),port-site complications(contusion at incision:5 cases vs 4 cases and hematoma at inci- sion:2 cases vs 1 case),total cost(mean±SD,12 075 ±1047 RMB vs 11 982±1153 RMB)and hospital stay (mean±SD,1.0±0.5 d vs 1.0±0.2 d),respectively. TPLC had a significantly worse visual analogue pain score at 8 h after surgery(mean±SD,3.5±1.6 vs 2.0 ±1.5),however,the scores were similar on day 7(mean ±SD,2.5±1.4 vs 2.0±1.3).Cosmetic satisfaction, as determined by a survey at 2 mo follow-up favored SILC(mean±SD,8±0.4 vs 6±0.2). CONCLUSION:SILC is a safe and feasible approach in selected patients.The main advantages are a better cosmetic result and less pain.

Learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy

AIM: To investigate the learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy (SILC). METHODS: The clinical data of 180 consecutive transumbilical suture-suspension SILCs performed by a team in our department during the period from August 2009 to March 2011 were retrospectively analyzed. Patients were divided into nine groups according to operation dates, and each group included 20 patients operated on consecutively in each time period. The surgical outcome was assessed by comparing operation time, blood loss during operation, and complications between groups in order to evaluate the improvement in technique.RESULTS: A total of 180 SILCs were successfully performed by five doctors. The average operation time was 53.58 ± 30.08 min (range: 20.00-160.00 min) and average blood loss was 12.70 ± 11.60 mL (range: 0.00-100.00 mL). None of the patients were converted to laparotomy or multi-port laparoscopic cholecystectomy. There were no major complications such as hemorrhage or biliary system injury during surgery. Eight postoperative complications occurred mainly in the first three groups (n = 6), and included ecchymosis around the umbilical incision (n = 7) which resolved without special treatment, and one case of delayed bile leakage in group 8, which was treated by ultrasound-guided puncture and drainage. There were no differences in intraoperative blood loss, postoperative complications and length of postoperative hospital stay among the groups. Bonferroni's test showed that the operation time in group 1 was significantly longer than that in the other groups (F = 7.257, P = 0.000). The majority of patients in each group were discharged within 2 d, with an average postoperative hospital stay of 1.9 ± 1.2 d. CONCLUSION: Following scientific principles and standard procedures, a team experienced in multi-port laparoscopic cholecystectomy can master the technique of SILC after 20 cases.

Hybrid bioartificial liver support in cynomolgus monkeys with D-galactosamine-induced acute liver failure

AIM: To evaluate a hybrid bioartificial liver support system (HBALSS) in cynomolgus monkeys with acute liver failure.

Predictive value of quantitative contrast-enhanced ultrasound in hepatocellular carcinoma recurrence after ablation

AIM: To investigate the relationship between contrastenhanced ultrasound(CEUS),basic fibroblast growth factor(b FGF),endothelin-1(ET-1),and hepatocellular carcinoma(HCC) recurrence after ablation. METHODS: A total of 51 HCC patients(38 males and 13 females) who received radiofrequency ablation in our hospital from June 2012 to July 2014 were enrolled in this study. The patients were divided into two groups: recurrence group and non-recurrence group. Routine abdominal examination was first performed in the horizontal position. Then the patients underwent CEUS and immunohistochemical staining before receiving radiofrequency ablation. All patients were followed-up every three months for one year.The results of CEUS and serum tumor marker levels were evaluated and combined together to estimate HCC recurrence and metastasis. Patients were divided into two groups: recurrence group and non-recurrence group. Quantitative parameters of CEUS and tumor expression levels of b FGF and ET-1 were compared between the two groups,respectively. Binary logistic regression analysis was used to analyze the relationship between CEUS quantitative parameters,expression levels of ET-1 and b FGF,and HCC recurrence after ablation. RESULTS: Based on the quantitative parameters of CEUS before patients received radiofrequency ablation,the levels of tumor rise time(t RT),tumor time to peak(t TTP),tumor peak intensity(t PI) and tumorparenchymal peak intensity(t-p PI) in the recurrence group were significantly lower than those in the nonrecurrence group(16.6 ± 6.1 vs 23.2 ± 7.0,P = 0.000; 41.2 ± 10.2 vs 59.6 ± 14.2,P = 0.000; 23.8 ± 6.7 vs 31.4 ± 6.4,P = 0.000; 7.1 ± 3.4 vs 14.6 ± 7.4,P = 0.000; respectively). The expression levels of b FGF in the recurrence group were significantly higher than those in the non-recurrence group(P < 0.05). Levels of t TTP showed a significant inverse correlation with the level of b FGF in tumors(r =-0.312,P = 0.037). The Binary logistic regression analysis results revealed that the levels of t RT,t TTP,t PI and the level of b FGF were associated with HCC recurrence after radiofrequency ablation(P < 0.05). CONCLUSION: CEUS is a noninvasive and effective method for evaluating the angiogenesis of HCC,and predicting its recurrence and prognosis.

Laparoendoscopic single-site cholecystectomy vs three-port laparoscopic cholecystectomy: A large-scale retrospective study

AIM: To perform a large-scale retrospective comparison of laparoendoscopic single-site cholecystectomy (LESSC) and three-port laparoscopic cholecystectomy (TPLC) in a single institution. METHODS: Data were collected from 366 patients undergoing LESSC between January 2005 and July 2008 and were compared with the data from 355 patients undergoing TPLC between August 2008 and November 2011 in our department. Patients with body mass index greater than 35 kg/m2 , a history of major upper abdominal surgery, signs of acute cholecystitis, such as fever, right upper quadrant tenderness with or without Murphy's sign, elevated white blood cell count, imaging findings suggestive of pericholecystic fluid, gallbladder wall thickening > 4 mm, and gallstones > 3 cm, were excluded to avoid bias. RESULTS: Altogether, 298 LESSC and 315 TPLC patients met the inclusion criteria. The groups were well matched with regard to demographic data. There were no significant differences in terms of postoperative complications (contusion: 19 vs 25 and hematoma at incision: 11 vs 19), hospital stay (mean ± SD, 1.4 ± 0.2 d vs 1.4 ± 0.7 d) and visual analogue pain score (mean ± SD, 8 h after surgery: 2.3 ± 1.4 vs 2.3 ± 1.3 and at day 1: 1.2 ± 0.4 vs 1.3 ± 1.2) between the LESSC and TPLC patients. Four patients required the addition of extra ports and 2 patients were converted to open surgery in the LESSC group, which was not significantly different when compared with TPLC patients converted to laparotomy (2 vs 2). LESSC resulted in a longer operating time (mean ± SD, 54.8 ± 11.0 min vs 33.5 ± 9.0 min), a higher incidence of intraoperative gallbladder perforation (56 vs 6) and higher operating cost (mean ± SD, 1933.7 ± 64.4 USD vs 1874.7 ± 46.2 USD) than TPLC. No significant differences in operating time (mean ± SD, 34.3 ± 6.0 min vs 32.7 ± 8.7 min) and total cost (mean ± SD, 1881.3 ± 32.8 USD vs 1876.2 ± 33.4 USD) were found when the last 100 cases in the two groups were compared. A correlation was observed between reduced operating time of LESSC and increased experience (Spearman rank correlation coefficient, -0.28). More patients in the LESSC group expressed satisfaction with the cosmetic result (98% vs 85%). CONCLUSION: LESSC is a safe and feasible procedure in selected patients with benign gallbladder diseases, with the significant advantage of cosmesis.