ObjectiveTo evaluate the safety and feasibility of non-nasogastric tube throughout the perioperative period of classical Whipple pancreaticoduodenectomy. MethodsA retrospective analysis was conducted on the clinical data of 63 patients who underwent Whipple pancreaticoduodenectomy at West China Hospital of Sichuan University from June 2020 to August 2023. According to whether nasogastric tube was placed throughout the perioperative period, the patients were divided into nasogastric tube group (NGT group, n=32) and no nasogastric tube group (no NGT group, n=31). The intraoperative indicators such as gastrointestinal anastomosis mode and outcome measures such as postoperative hospital stay were compared between the two groups. Results① Preoperative baseline data: the proportion of benign diseases (P=0.005) and preoperative pancreatitis (P=0.003) of the no NGT group were higher than those of the NGT group, and other preoperative baseline data, such as age and sex, were not statistically significant (P>0.05). ② Intraoperative index: the proportion of circular stapler (P=0.009) was smaller and the operation time was shorter (P<0.001), but there was no significant difference in the anastomosis, intraoperative blood transfusion and intraoperative bleeding (P>0.05). ③ Postoperative outcome measures: the postoperative length of hospital stay (P<0.001) and the incidence of delayed gastric emptying (P<0.001) of the no NGT group were lower than those in the NGT group, but the postoperative time of food intake, incidence of pancreatic fistula, incidence of postoperative bleeding, and Clavien-Dindo grade of complications were not significant (P>0.05), and on one died within 30 d after operation. ConclusionsThe results of this study preliminarily show that, it is safe and feasible not to place nasogastric tubes throughout the perioperativeperiod in patients undergoing classical Whipple pancreaticoduodenectomy. Compared with placing nasogastric tube, it can shorten the postoperative hospital stay, reduce the incidence of postoperative delayed gastric emptying.
Diagnosis and surgical procedures were studied in this paper. Twentyfive cases of insulinoma were treated surgically from 1970 to 1997, in which 10 patients had Whipple′s triad so that the early diagnosis could be made. The sites of tumours were found in 10 out of 12 undergoing. Selective celiac angiongraphy with the accuracy rate of 83%, but B-ultrasonography and CT gave only 10% (4 out of 25) and 40%(8 out of 20) respectively. In this series, 5 cases underwent bodytail pancreatectomy and 20 cases enucleation of insulinoma. Blood glucose levels were tested during operation in 15 cases, and they all reached the normal level one hour after the tumours were completely removed. The authors consider that Whipple′s triad is the main basis in diagnosis of insulinoma. The selective celiac angiongraphy play an important role in detecting and locating the tumour. If diagnosis is made, surgical operation should be taken. The blood glucose monitoring during operation is the hallmark for complete resection of insulinomas.
ObjectiveTo compare the clinical effects of enteral nutrition via stoma of jejunum or nasal-jejunum tube after Whipple procedure. MethodsEighty-seven patients performed Whipple procedure were divided into nasaljejunum tube group(n=47)and stoma of jejunum group(n=40)according to the different enteral nutrition methods. The adverse reactions such as vomiting, abdominal distension, pharyngeal pain, and hypostatic pneumonia, anastomotic leakage, hospital stay, hospitalization expenses, and serum glucose and electrolyte(CL-, Na+, K+)on day 1, 3, 5 after operation were compared between two groups. ResultsCompared with the nasal-jejunum tube group, the rates of adverse reactions and hypostatic pneumonia were more lower(P < 0.05), the hospitalization expense was more less (P < 0.05) in the nasal-jejunum tube group. The rate of anastomotic leakage and hospital stay had no significant differences between the nasal-jejunum tube group and stoma of jejunum group(P > 0.05). The differences of serum glucose and electrolyte(CL-, Na+, K+)on day 1, 3, 5 after operation were not statistically significant between two groups(P > 0.05). ConclusionsEnteral nutrition via the stoma of jejunum after Whipple procedure has some better clinical effects in reducing adverse reactions such as vomiting, abdominal distension, pharyngeal pain, hypostatic pneumonia. The hospitalization expenses are decreased. There are no obvious effects on the hospital stay, blood glucose and electrolyte concentration on day 1, 3, 5 after operation.
Objective To review progress of clinical application ofmorselized bone and to investigate relative exploration on it.Methods The recent articles on morselized bone in the field of clinicand experimental research were extensively reviewed, and relative examination of morselized bone referring to method and mechanism were investigated carefully.Results Morselized bone worked well clinically, especially inrevision ofartificial total hip joint, and it was proved effective with lots of advantages.Conclusion Morselized bone functions well clinically. Although its mechanism requires a further research, it still has a promising value in clinical application.
Objective To explore the relationship between the gut microbiome (GM) and psoriasis using a two-sample two-way Mendelian randomization (MR) approach. Methods The forward analysis uses the gut microbiota as the exposure factor, and its genetic data are derived from the genome-wide association study dataset published by the MiBioGen consortium. Psoriasis was used as the outcome variable, and its genetic data were obtained from the UK Biobank. The reverse MR analysis, on the other hand, took psoriasis as the exposure and the specific gut microbiota taxonomic units identified in the forward analysis as the outcome variable. MR analysis was conducted using maximum likelihood, MR Egger regression, weighted median, inverse variance weighting (IVW), and weighted models to study the causal relationship between the gut microbiota and psoriasis. Then, sensitivity analyses including horizontal pleiotropy test, Cochran’s Q test, and leave-one-out analysis were used to evaluate the reliability of the results. Results A total of 51 single nucleotide polymorphisms from 5 fungi were included in the forward study. The forward IVW analysis results showed that, the class Mollicutes [odds ratio (OR)=1.003, 95% confidence interval (CI) (1.001, 1.006), P=0.004], genus Lachnospiraceae FCS020 group [OR=1.003, 95%CI (1.000, 1.006), P=0.041], and phylum Tenericutes [OR=1.003, 95%CI (1.001, 1.006), P=0.004] were causally associated with an increased risk of psoriasis. The family Victivallaceae [OR=0.998, 95%CI (0.997, 1.000), P=0.005] and order Pasteurellales [OR=0.998, 95%CI (0.996, 1.000), P=0.047] were also linked to a decreased risk of psoriasis. The results of the sensitivity analysis were robust. There was no evidence of a reverse causal relationship from psoriasis to the identified bacterial taxa found in the results of reverse MR analysis results. Conclusions The abundance of three species, class Mollicutes, genus Lachnospiraceae and phylum Tenericutes, may increase the risk of psoriasis. The abundance of two species, family Victivallaceae and order Pasteurellales may reduce the risk of psoriasis. These results provide new directions for the prevention and treatment of psoriasis in the future, but further research is needed to explore how the aforementioned microbiome affects the progression of psoriasis.
ObjectiveTo summarize the research progress of constitutive photomorphogenesis 9 signalosome (CSN) in malignant tumor in recent years. MethodsLiteratures about the relationship between CSN and maglinant tumor which were published in recent years were collected to make a review. ResultsMany malignant tumors were found to have high expression level of CSN, and CSN could degrade various tumor suppressor genes, such as p53 gene, mainly through regulating the ubiquitin protein degradation pathway, which played an role in promoting tumor growth. CSN5 was the deneddylation active center of CSN, and the activity of CSN was based on the integrity of CSN, which meant CSN6 (CSN core scaffold structure) have to exist. Current study found that CSN6 could promote tumorigenesis and development through a variety of signaling pathways, and CSN5 was mainly involved in cell cycle regulation and DNA damage repair to promote tumor growth. ConclusionsThe research of CSN in malignant tumors has lay a foundation of targeted therapies for cancer. However, the specific function of each of its subunit still remains unclear, and its upstream regulatory factors also need to be further explored.
Objective To summarize research progress on application of Cup-cage reconstruction in revision of chronic pelvic discontinuity (CPD) in patients undergoing total hip arthroplasty (THA). Methods Relevant literature at home and abroad in recent years was reviewed to summarize the principles of the Cup-cage reconstruction, preoperative patient assessment, intraoperative skills, clinical and radiological effectiveness, limitations, and postoperative complications. Results For the treatment of CPD, the Cup-cage reconstruction achieved long-term acetabular cup bone ingrowth, CPD healing, and biologic fixation of the prosthesis by restoring pelvic continuity. Preoperative evaluation of the surgical site and general condition is necessary. The main intraoperative objectives are to reconstruct pelvic continuity, restore the center of rotation of the hip, and avoid neurovascular injury. Current studies have demonstrated significant clinical and radiological effectiveness as well as acceptable prosthesis survival rates after operation. Nevertheless, there is a lack of evidence regarding the staging of CPD, the optimal surgical approach and internal fixation, and the factors influencing postoperative prosthesis survival remain undefined. Conclusion Cup-cage reconstruction can be an effective treatment for CPD after THA, but there is still a need to explore CPD staging, Cup-cage approach and internal fixation, and influencing factors on prosthesis survival.
It is clear that that bloody bone graft is better than tranditional nobloody bone graft. The autherdesigned the shelf oporation of gluteus minimus muscle pedicle ilinc graft in hip joint. Since 1986 , 14patients were operated. Follow-wp survey lasted 24 to 49 monthes. It was improved evidently forhip joint unsteadiness and clandicatory gait and bad complication did not hiappon. The operation wassimple and make use of materials nearby and union fastly. It didn t destroy myedynamia of ...
ObjectiveTo explore the effectiveness of problem-based learning (PBL) during the internship process for undergraduates in general medical colleges and universities. MethodsFrom September 2011 to September 2012, PBL mode teaching was carried for the five-year undergraduates, in which students were encouraged to explore, innovate, and put forward questions by themselves, and teachers were responsible for guiding. Based on entrance theoretical examination results and the comprehensive evaluation results, the grade 2008 undergraduate interns who received "3+2" two-phase teaching were divided into experimental group and control group with 50 students in each. Students in the experimental group were given the PBL teaching method, while the control group continued to receive traditional teaching mode. Finally, we adopted questionnaire survey, theory exam, and skill evaluation to compare the two groups of students. ResultsFor the questionnaire survey, students in the experimental group got significantly higher marks in such items as "mutual assessment between teachers and students" and "skill operation knowledge mastery" than the control group (P<0.05), but in items like "medical ethics" and "social cultivation", the differences were not significant (P>0.05). For the theory exam results, the average score for students in the experimental group (84.98±9.78) was not significantly different from that in the control group (81.86±10.04) (P>0.05). For the skill operation, the average score for the experimental group was 8.87±0.89, which was significantly higher than that for the control group (6.80±1.46) (P<0.05). ConclusionPBL mode is worth popularizing for its function of improving students' practical operation ability and thinking ability. However, the improvement of theoretical knowledge learning needs to be further solved.
Under the current situation of the rapid development of brain-like artificial intelligence and the increasingly complex electromagnetic environment, the most bionic and anti-interference spiking neural network has shown great potential in computing speed, real-time information processing, and spatiotemporal data processing. Spiking neural network is the core part of brain-like artificial intelligence, which realizes brain-like computing by simulating the structure of biological neural network and the way of information transmission. This article first summarizes the advantages and disadvantages of the five models, and analyzes the characteristics of several network topologies. Then, it summarizes the spiking neural network algorithms. The unsupervised learning based on spike timing dependent plasticity (STDP) rules and four types of supervised learning algorithms are analyzed. Finally, the research on brain-like neuromorphic chips at home and abroad are reviewed. This paper aims to provide learning ideas and research directions for new colleagues in the field of spiking neural network.