ObjectiveTo present the safety and efficiency of laparoscopic Nissen fundoplication for hiatal hernia in elderly patients. MethodsClinical data of 35 elderly patients with hiatal hernia who underwent laparoscopic Nissen fundoplication in The Affiliated Hospital of Xuzhou Medical College between August 2013 and March 2014 was retrospectively analyzed. ResultsAll patients underwent laparoscopic Nissen fundoplication. The operation time was 72-minute in average (65-105 minutes) and intraoperative blood loss was 30 mL in average (10-120 mL). The mean value of postoperative hospital stay was 5-day (3-23 days). Patients' stomachs and esophagus were restored to normal position after surgery. No complication was noted except 2 patients had mild gastroesophageal reflux after operation, and 1 patient suffered from transient dysphagia after operation, all the symptoms subsided after conservative treatment. Afterwards, 33 of them achieved follow-up for 6 to 12 months (mean of 8.5 months), the other 2 patients were lost to follow-up. During the follow-up period, a questionnaire regarding to the criteria for Reflux Diagnostic Questionnaire (RDQ) score were conducted in the 33 patients, and the results showed that the symptoms including acid reflux, heartburn, chest pain, cough, dyspnea, lump sensation in the pharynx, and hoarseness were improved significantly in 6 months after operation (P<0.05), and no recurrence was found during the follow-up period. ConclusionLaparoscopic Nissen fundoplication is a safe operation for elderly patients with hiatal hernia, and it can achieve good clinical result.
ObjectiveTo observe expre with ssions of insulin receptor substrate 1(IRS-1) and ubiquitin-protein in skeletal muscle of non-obese rats with type 2 diabetes mellitus following gastric bypass operation (GBP), and to investigate possible mechanism of GBP in improving insulin resistance. MethodsMale GK rats were randomly divided into diabetic operation group (DO group), diabetic sham operation group (DSO group), and diabetic control group (DC group), 8 rats in each group; besides 8 male Wistar rats were served as normal control group (NC group). Fasting body weight (FBW), fasting plasma glucose (FPG), and fasting insulin (FINS) were measured respectively before operation and on week 1, 2, 4 and 8 after operation. Homeostasis model-insulin resistant (HOMA-IR) index was calculated respectively before operation and on week 8 after operation. The expressions of IRS-1 protein and ubiquitin-protein in skeletal muscle were detected by using Western blot method on week 8 after operation. Results① Compared with the preoperative levels, the FBWs on week 1, 2, and 4 after operation markedly decreased (P < 0.05), but it recovered to the preoperative level on week 8 after operation (P > 0.05) in the DO group; which in the DSO group decreased on week 1 after operation (P < 0.05) and then increased on week 4 after operation (P < 0.05); which in the DC group or the NC group increased continuously and had a significant difference on week 8 after operation (P < 0.05).② The FPGs in the DO, DSO and DC groups were significantly higher than those of the NC group before operation (P < 0.05), which in the DO group decreased from (9.10±0.98) mmoL/L before operation to (5.70±0.91) mmol/L on week 8 after operation (P < 0.05) and were significantly lower than those of the DSO group or the DC group on week 2, 4, and 8 after operation (P < 0.05); which in the DC group, DSO group and NC group had no obviously changes between before and after operations (P > 0.05). ③ The FINS had no significant differences among these four groups before operation (P > 0.05), which in the DO group obviously increased[(9.64±1.59) mU/L] on week 2 after operation (P < 0.05) and then obviously decreased[(6.58±1.05) mU/L] on week 8 after operation (P < 0.05) and significantly lower than those of the DSO group or the DC group on week 8 after operation (P < 0.05), while which had no significant difference between before and after operations in the DSO group, the DC group, or the NC group (P > 0.05). ④ The HOMA-IR index in the DO, DSO or DC group was significantly higher than that of the NC group before operation (P < 0.05), which in the DO group markedly decreased from 3.18±0.50 before operation to 1.96±0.63 on week 8 after operation (P < 0.05) and significantly lower than that of the DSO group or the DC group on week 8 after operation (P < 0.05), while which had no significant difference between before and after operations in the DSO group, the DC group, or the NC group (P > 0.05). ⑤ The expression of IRS-1 protein in the DO group was significantly higher than that in the DSO group (P < 0.05) or the DC group (P < 0.05) on week 8 after operation. While there was no significant difference between the DSO and the DC group after operation (P > 0.05). ⑥ Compared with the NC group, the expression of ubiquitin-protein was significantly increased in the DO group, the DSO group, or the DC group (P < 0.05). Compared with the DSO group or the DC group, the expression of ubiquitin-protein was significantly decreased in the DO group on week 8 after operation (P < 0.05), especially it was most obvious near the molecular weight of 180×103. While there was no significant difference between the DSO group and the DC group after operation (P > 0.05). ConclusionsExpression of IRS-1 protein in skeletal muscle insulin signaling pathway in type 2 diabetes mellitus rats following GBP is increased, it might be associated with decreasing ubiquitin-protein level in skeletal muscle, thus reduces the IRS-1 ubiquitin-degradation, increase insulin sensitivity, and improve insulin resistance of skeletal muscle.
ObjectiveTo evaluate clinical feasibility and safety of total laparoscopic pancreaticoduodenectomy (TLPD).MethodThe clinical data of 51 consecutive cases who underwent TLPD, admitted in this department of pancreatic surgery of the Affiliated Hospital of Xuzhou Medical University from August 2016 to August 2018, were analyzed retrospectively.ResultsThe TLPDs were successfully completed in the 51 patients. The operative time was (375.5±75.2) min, the pancreaticojejunostomy time was (45.2±8.3) min and bilioenteric anastomosis time was (25.6±7.5) min. The intraoperative blood loss was (337.8±164.4) mL. The length of surgical incision was (6.0±1.2) cm. The duration of flatulence was (3.5±1.0) d. The time for liquid diet was (5.2±2.1) d, the postoperative first ambulation time was (2.0±1.2) d. The duration of postoperative hospital stay was (14.8±5.3) d. The total postoperative complication rate was 34.3% (17/51), with 19.6% (10/51) of B or C postoperative pancreatic fistula and 9.8% (5/51) of bleeding. The postoperative pathology showed that there were 45 cases of malignant tumor and there was no positive incisal margin. The maximum tumor size was (2.8±1.2) cm and the number of lymph nodes harvested was 12.6±7.8. All the patients were followed up for 2–24 months with a median time of 17 months. The 1-year overall survival rate and progression-free survival rate of the patients with malignant tumors were 84.4% (38/45) and 77.8% (35/45), respectively.ConclusionTLPD is safe and feasible in cases of clinical practice under skilled hand and there are advantages such as faster postoperative recovery and shorter hospital stay.
ObjectiveTo investigate the expressions of glucose transporter-4 (GLUT-4) and secreted protein acidic and rich in cysteine (SPARC) in adipose tissue of Goto-Kakizaki (GK)/Wister rats after gastric bypass operation (GBP), and to explore the possible mechanism of GBP improving insulin resistance.MethodsHealthy male GK rats were randomly divided into diabetic operation group (DO group, underwent GBP), diabetic sham operation group (DS group, underwent sham-operation), and diabetic control group (DC group, received no-treatment), Wister rats were set as normal control group (NC group, received no-treatment). The weight, fasting blood glucose (FPG), fasting serum insulin (Fins), and HbA1c were measured before operation and at the 1st, 2nd, 4th, and 8th week after operation. Quantitative insulin sensitivity check index (QUICKI) was measured in before operation and at the 8th week after operation, and the expressions of GLUT-4 and SPARC protein in adipose tissues were measured by Western Blot method at the 8th week after operative too.Results① Weight: the weight of the DO group was lower than preoperative at the 2nd and 4th week after GBP (P<0.05), but increased to the normal level at the 8th week after GBP (P>0.05). The weight of the DO group was lower than those of the DS group, DC group, and NC group at the same time point of 2nd, 4th, and 8th week (P<0.05). ② FPG: the FPG level of the DO group was lower than preoperative at the 2nd, 4th, and 8th week after GBP (P<0.05), and lower than those of the DS group and the DC group from 2nd to 8th week after GBP (P<0.05). The FPG level between the DS group and the DC group had no statistical significance (P>0.05). ③ Fins: the Fins level of the DO group was higher than preoperative at the 2nd week after GBP (P<0.05), and decreased gradually at 4th and 8th week but not significantly differed from the NC group at the same time point. At the 2nd week after GBP, the Fins level of the DO group was higher than those of the DS group and the DC group (P<0.05), but there was no statistical significance between the DS group and the DC group (P>0.05). ④ HbA1c: the HbA1c level of the DO group started to decrease but there was no statistical significance between preoperative and all time after GBP (P>0.05). There was no statistical significance among the 4 groups at the 8th week after GBP (P>0.05). ⑤ QUICKI: at the 8th week, the QUICKI value of the DO group was higher than preoperative (P<0.05), and at the same time, the QUICKI value of the DO group and the NC group were higher than those of the DS group and the DC group (P<0.05), but there was no statistical significance between the DO group and the NC group (P>0.05), as well as the DS group and the DC group (P>0.05). ⑥ GLUT-4 protein and SPARC protein: the expression of GLUT-4 protein of the DO group was dramatically higher than those of the DC, DS, and NC group (P<0.05), and the expression of SPARC protein of the DO group was dramatically lower than those of the DC, DS, and NC group (P<0.05) at the 8th week. But the expressions of GLUT-4 and SPARC protein had no statistical significance among the DS, DC, and NC group at the 8th week after GBP (P>0.05).ConclusionGBP may improve and increase the sensitivity of insulin resistance by regulating the expressions of GLUT-4 and SPARC protein in adipose tissue of GK rats.
ObjectiveTo explore the feasibility and application value of laparoscopic pancreaticoduodenectomy (LPD) in elderly patients.MethodsThe clinical data of patients who underwent LPD from August 2016 to July 2019 were retrospectively analyzed. The patients were allocated into the elderly group (≥65 years old) and non-elderly group (<65 years old). The early surgical outcomes and postoperative complications of the two groups were compared.ResultsIn this study, 69 cases of LPD were collected, including 42 cases in the elderly group and 27 cases in the non-elderly group. Compared with the non-elderly group, the proportion of patients complicated comorbidities was higher (P<0.05), albumin level was lower (P<0.05), and American Society of Anesthesiologists classification was higher (P<0.05) in the elderly group. There were no significant differences in the intraoperative conditions, postoperative recovery, and postoperative complications between the two groups (P>0.05), and there were no significant differences in the pathological results of postoperative malignant tumor between the two groups (P>0.05).ConclusionsFor elderly patients with over 65 years old, LPD is a safe and feasible surgical procedure for clinical practice. Meanwhile, early surgical outcomes are satisfactory, postoperative complications are not increased, and tumor cure effect can be achieved.
ObjectiveTo observe expressions of E3 ubiquitin ligase—mitsugmin53 (MG53) protein, MG53 mRNA, and insulin receptor substrate 1 (IRS-1) mRNA in skeletal muscle of non-obese type 2 diabetic mellitus (T2DM) rats after gastric bypass operation (GBP), and to investigate possible mechanism of GBP in improving insulin resistance.MethodsTwenty-four healthy male GK rats were randomly divided into diabetic operation group, diabetic sham operation group, and diabetic control group, 8 rats in each group; besides, 8 male Wistar rats were served as normal control group. The expressions of MG53 protein in skeletal muscle tissue were detected by using Western blot method on week8 after operation. The mRNA levels of IRS-1 and MG53 in skeletal muscles tissue were measured by RT-PCR methods on week 8 after operation.Results① The expressions of MG53 protein and MG53 mRNA in the diabetic sham operation group and diabetic control group were significantly higher than those in the diabetic operation group and the normal control group on week 8 after operation (P<0.05), respectively, which had no significant differences between the diabetic operation group and the normal control group (P>0.05), and between the diabetic sham operation group and the diabetic control group (P>0.05) on week 8 after surgery. ② Compared with the normal control group, the expression of IRS-1 mRNA was significantly decreased in the diabetic operation group, the diabetic sham operation group, and the diabetic control group (P<0.05), while there were no significant differences between the diabetic operation group, diabetic sham operation group, and the diabetic control group on week 8 after operation (P>0.05).ConclusionExpression of E3 ubiquitin ligase—MG53 protein in skeletal muscle tissue in T2DM rats following GBP is decreased, thus reduces the IRS-1 ubiquitin-degradation, increase the expression of IRS-1 protein in insulin signaling pathway of skeletal muscle tissue, and improve insulin resistance of skeletal muscle.
ObjectiveTo explore the risk factors of lymph node metastasis (LNM) in patients with early gastric cancer (EGC), and try to establish a risk prediction model for LNM of EGC.MethodsThe clinicopathologic data of EGC patients who underwent radical gastrectomy and lymph node dissection from January 1, 2015 to December 31, 2019 in this hospital were retrospectively analyzed. Univariate analysis and logistic regression analysis were used to determine the risk factors for LNM of EGC, and the risk prediction model for LNM of EGC was established based on the multivariate results.ResultsA total of 311 cases of EGC were included in this study, and 60 (19.3%) cases had LNM. Univariate and multivariate analysis showed that age (younger), depth of tumor invasion (submucosa), vascular invasion, and undifferentiated carcinoma were the risk factors for LNM of EGC (P<0.05). The optimal threshold for predicting LNM of EGC was 0.158 (area under the receiver operating characteristic curve was 0.864), the sensitivity was 80.0%, and the specificity was 79.3%.ConclusionsFrom results of this study, risk factors for LNM of EGC have age, depth of invasion, vascular invasion, and differentiation degree. Risk prediction model for LNM of EGC established on this results has high sensitivity and specificity, which could provide some references for treatment strategy of EGC.