1.Fluoroscopically Guided Three-Tube Insertion for the Treatment of Postoperative Gastroesophageal Anastomotic Leakage.
Guowen YIN ; Qingyu XU ; Shixi CHEN ; Xiangjun BAI ; Feng JIANG ; Qin ZHANG ; Lin XU ; Weidong XU
Korean Journal of Radiology 2012;13(2):182-188
OBJECTIVE: To retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL). MATERIALS AND METHODS: From January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients' nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube. RESULTS: The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 +/- 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 +/- 0.40 g/dL) to post-enteral feeding (3.7 +/- 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months). CONCLUSION: Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary procedure to treat postoperative GEAL.
Adult
;
Aged
;
Anastomosis, Surgical
;
Anastomotic Leak/radiography/*therapy
;
Decompression, Surgical/instrumentation
;
Drainage/instrumentation
;
Enteral Nutrition/instrumentation
;
Esophageal Neoplasms/*surgery
;
Esophagectomy
;
Female
;
Fluoroscopy
;
Humans
;
Intubation, Gastrointestinal/*methods
;
Male
;
Middle Aged
;
Postoperative Complications/*radiography/*therapy
;
Radiography, Interventional/*methods
;
Retrospective Studies
;
Stomach Neoplasms/*surgery
2.Fibroblast Growth Factor 21 Protects against Atherosclerosis via Fine-Tuning the Multiorgan Crosstalk.
Leigang JIN ; Zhuofeng LIN ; Aimin XU
Diabetes & Metabolism Journal 2016;40(1):22-31
Fibroblast growth factor 21 (FGF21) is a metabolic hormone with pleiotropic effects on energy metabolism and insulin sensitivity. Besides its antiobese and antidiabetic activity, FGF21 also possesses the protective effects against atherosclerosis. Circulating levels of FGF21 are elevated in patients with atherosclerosis, macrovascular and microvascular complications of diabetes, possibly due to a compensatory upregulation. In apolipoprotein E-deficient mice, formation of atherosclerotic plaques is exacerbated by genetic depletion of FGF21, but is attenuated upon replenishment with recombinant FGF21. However, the blood vessel is not the direct target of FGF21, and the antiatherosclerotic activity of FGF21 is attributed to its actions in adipose tissues and liver. In adipocytes, FGF21 promotes secretion of adiponectin, which in turn acts directly on blood vessels to reduce endothelial dysfunction, inhibit proliferation of smooth muscle cells and block conversion of macrophages to foam cells. Furthermore, FGF21 suppresses cholesterol biosynthesis and attenuates hypercholesterolemia by inhibiting the transcription factor sterol regulatory element-binding protein-2 in hepatocytes. The effects of FGF21 on elevation of adiponectin and reduction of hypercholesterolemia are also observed in a phase-1b clinical trial in patients with obesity and diabetes. Therefore, FGF21 exerts its protection against atherosclerosis by fine-tuning the interorgan crosstalk between liver, brain, adipose tissue, and blood vessels.
Adipocytes
;
Adiponectin
;
Adipose Tissue
;
Animals
;
Apolipoproteins
;
Atherosclerosis*
;
Blood Vessels
;
Brain
;
Cholesterol
;
Energy Metabolism
;
Fibroblast Growth Factors*
;
Fibroblasts*
;
Foam Cells
;
Hepatocytes
;
Humans
;
Hypercholesterolemia
;
Insulin Resistance
;
Liver
;
Macrophages
;
Mice
;
Myocytes, Smooth Muscle
;
Obesity
;
Plaque, Atherosclerotic
;
Transcription Factors
;
Up-Regulation
;
Vascular Diseases
3.Chronic stress accelerates ligature-induced periodontitis by suppressing glucocorticoid receptor-α signaling.
Huaixiu LU ; Minguang XU ; Feng WANG ; Shisen LIU ; Jing GU ; Songshan LIN ; Lisheng ZHAO
Experimental & Molecular Medicine 2016;48(3):e223-
Periodontitis is a common chronic inflammatory disease. Recent studies have shown that chronic stress (CS) might modulate periodontal disease, but there are few models of CS-induced periodontitis, and the underlying mechanisms are unclear. The present study established a rat model of periodontitis associated with CS induced by nylon thread ligatures. The severity of periodontitis was evaluated in this model by radiographic and pathological examination. The inflammatory reaction indicated by the elevated serum levels of interleukin (IL)-1β, IL-6 and IL-8 was assessed by enzyme-linked immunosorbent assay. Toll-like receptor-4 (TLR4) and glucocorticoid receptor-α (GR-α) expressions were detected by reverse transcriptase-PCR and western blotting. Open-field tests and serum corticosterone were used to evaluate CS. The results showed that CS induced behavioral changes and increased corticosterone levels of the animals with periodontitis. CS stimulation markedly increased alveolar bone loss, periodontal pocket depth and the number of plaques. It also enhanced the inflammatory reaction. These results suggest that CS accelerated the ligature-induced pathological changes associated with periodontitis. Further analysis of the mechanisms involved showed that GR-α expression was significantly downregulated in periodontal tissues of the animals undergoing CS. Blocking GR-α signaling in lipopolysaccharide and corticosteroid-treated human periodontal ligament fibroblast cells in vitro significantly upregulated the expression of p-Akt (protein kinase B) and TLR4, promoted nuclear factor-κB activity and increased levels of IL-1β, IL-6 and IL-8. This research suggests that CS might accelerate the pathological progression of periodontitis by a GR-α signaling-mediated inflammatory response and that this may be a potential therapeutic target for the treatment of periodontal disease, particularly in patients with CS.
Alveolar Bone Loss
;
Animals
;
Blotting, Western
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Corticosterone
;
Enzyme-Linked Immunosorbent Assay
;
Fibroblasts
;
Humans
;
In Vitro Techniques
;
Interleukin-6
;
Interleukin-8
;
Interleukins
;
Ligation
;
Models, Animal
;
Nylons
;
Periodontal Diseases
;
Periodontal Ligament
;
Periodontal Pocket
;
Periodontitis*
;
Phosphotransferases
4.Is There a Correlation between the Presence of a Spiculated Mass on Mammogram and Luminal A Subtype Breast Cancer?.
Song LIU ; Xiao Dong WU ; Wen Jian XU ; Qing LIN ; Xue Jun LIU ; Ying LI
Korean Journal of Radiology 2016;17(6):846-852
OBJECTIVE: To determine whether the appearance of a spiculated mass on a mammogram is associated with luminal A subtype breast cancer and the factors that may influence the presence or absence of the spiculated mass. MATERIALS AND METHODS: Three hundred seventeen (317) patients who underwent image-guided or surgical biopsy between December 2014 and April 2015 were included in the study. Radiologists conducted retrospective assessments of the presence of spiculated masses according to the criteria of Breast Imaging Reporting and Data System. We used combinations of estrogen receptor (ER), progesterone receptor (PR), human epithelial growth factor receptor 2 (HER2), and Ki67 as surrogate markers to identify molecular subtypes of breast cancer. Pearson chi-square test was employed to measure statistical significance of correlations. Furthermore, we built a bi-variate logistic regression model to quantify the relative contribution of the factors that may influence the presence or absence of the spiculated mass. RESULTS: Seventy-one percent (71%) of the spiculated masses were classified as luminal A. Masses classified as luminal A were 10.3 times more likely to be presented as spiculated mass on a mammogram than all other subtypes. Patients with low Ki67 index (< 14%) and HER2 negative were most likely to present with a spiculated mass on their mammograms (p <0.001) than others. The hormone receptor status (ER and PR), pathology grade, overall breast composition, were all associated with the presence of a spiculated mass, but with less weight in contribution than Ki67 and HER2. CONCLUSION: We observed an association between the luminal A subtype of invasive breast cancer and the presence of a spiculated mass on a mammogram. It is hypothesized that lower Ki67 index and HER2 negativity may be the most significant factors in the presence of a spiculated mass.
Biomarkers
;
Biopsy
;
Breast Neoplasms*
;
Breast*
;
Estrogens
;
Humans
;
Information Systems
;
Logistic Models
;
Pathology
;
Phenobarbital*
;
Receptors, Progesterone
;
Retrospective Studies
5.Serum calcium is a novel parameter to assess metabolic syndrome in endometrial carcinoma.
Yanying LIN ; Jingyi ZHOU ; Linlin CAO ; Qi XU ; Juan HAO ; Lijun ZHAO ; Jianliu WANG
Journal of Gynecologic Oncology 2019;30(1):e12-
OBJECTIVES: To investigate the distribution of serum calcium and the relationship between serum calcium and serum metabolic parameters in endometrial carcinoma (EC) patients. METHODS: Retrospective assessment of patients diagnosed with endometrial cancer from Peking University People's Hospital from 2004 to 2009. Clinical characteristics as well as pretreatment serum calcium, albumin, fasting plasma glucose (FPG), serum triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol (TC) value were extracted from patient records. Serum calcium was corrected for albumin. Unpaired t test and analysis of covariance were used to compare serum calcium among categorical variables. Simple correlation analyses and partial correlation analyses were used to assess the associations between serum calcium and continuous variables. RESULTS: Two-hundred twenty patients were included in this study. After adjusting for confounders, postmenopausal patients had higher total serum calcium (p=0.002) and albumin-corrected serum calcium (p=0.012) than premenopausal patients, endometrioid endometrial carcinoma (EEC) patients had higher total serum calcium than non-endometrioid endometrial carcinoma (NEEC) patients (p=0.037). Significant positive correlations were found between total serum calcium and FPG (p=0.017), TG (p=0.043), HDL (p=0.042), LDL (p < 0.001), and TC (p < 0.001) after adjusting for multiple variables, and the corrected serum calcium showed no significant correlation with metabolic parameters. CONCLUSION: Total serum calcium might be a more sensitive parameter for metabolic syndrome in endometrioid endometrial cancer patients than lipids.
Beijing
;
Blood Glucose
;
Calcium*
;
Cholesterol
;
Endometrial Neoplasms*
;
Fasting
;
Female
;
Humans
;
Lipoproteins
;
Retrospective Studies
;
Triglycerides
6.Chronic stress enhances progression of periodontitis via alpha1-adrenergic signaling: a potential target for periodontal disease therapy.
Huaixiu LU ; Minguang XU ; Feng WANG ; Shisen LIU ; Jing GU ; Songshan LIN
Experimental & Molecular Medicine 2014;46(10):e118-
This study assessed the roles of chronic stress (CS) in the stimulation of the sympathetic nervous system and explored the underlying mechanisms of periodontitis. Using an animal model of periodontitis and CS, the expression of tyrosine hydroxylase (TH) and the protein levels of the alpha1-adrenergic receptor (alpha1-AR) and beta2-adrenergic receptor (beta2-AR) were assessed. Furthermore, human periodontal ligament fibroblasts (HPDLFs) were stimulated with lipopolysaccharide (LPS) to mimic the process of inflammation. The proliferation of the HPDLFs and the expression of alpha1-AR and beta2-AR were assessed. The inflammatory-related cytokines interleukin (IL)-1beta, IL-6 and IL-8 were detected after pretreatment with the alpha1/beta2-AR blockers phentolamine/propranolol, both in vitro and in vivo. Results show that periodontitis under CS conditions enhanced the expression of TH, alpha1-AR and beta2-AR. Phentolamine significantly reduced the inflammatory cytokine levels. Furthermore, we observed a marked decrease in HPDLF proliferation and the increased expression of alpha1-ARfollowing LPS pretreatment. Pretreatment with phentolamine dramatically ameliorated LPS-inhibited cell proliferation. In addition, the blocking of alpha1-ARsignaling also hindered the upregulation of the inflammatory-related cytokines IL-1beta, IL-6 and IL-8. These results suggest that CS can significantly enhance the pathological progression of periodontitis by an alpha1-adrenergic signaling-mediated inflammatory response. We have identified a potential therapeutic target for the treatment of periodontal disease, particularly in those patients suffering from concurrent CS.
Adrenergic alpha-1 Receptor Antagonists/*therapeutic use
;
Animals
;
Cells, Cultured
;
Cytokines/immunology
;
Fibroblasts/immunology/pathology
;
Humans
;
Lipopolysaccharides/administration & dosage/immunology
;
Male
;
Periodontal Ligament/cytology/immunology/pathology
;
Periodontitis/*drug therapy/*etiology/immunology/pathology
;
Phentolamine/*therapeutic use
;
Rats
;
Rats, Wistar
;
Receptors, Adrenergic, alpha-1/analysis/*immunology
;
Signal Transduction/drug effects
;
*Stress, Physiological/drug effects
;
Tyrosine 3-Monooxygenase/analysis/immunology
7.Cutaneous metastasis: a rare phenomenon of colorectal cancer.
Dan Yang WANG ; Feng YE ; Jian Jiang LIN ; Xiao XU
Annals of Surgical Treatment and Research 2017;93(5):277-280
Cutaneous metastases from colorectal cancer are extremely rare and generally appear several years after diagnosis or resection of the primary tumor. Although this phenomenon is uncommon, it is very important and often indicates a poor prognosis. We present a case of a 76-year-old female patient with multiple cutaneous metastatic nodules on the back, just 1 month after resection of rectal cancer. Unfortunately, the patient gave up the follow-up treatment due to her age and poor physical condition; she died 3 months later. In view of its rarity of occurrence and lack of experience in treatment, we reviewed the literature and report as follows.
Aged
;
Colorectal Neoplasms*
;
Diagnosis
;
Female
;
Follow-Up Studies
;
Humans
;
Neoplasm Metastasis*
;
Prognosis
;
Rectal Neoplasms
8.Outcomes of Secondary Laminoplasty for Patients with Unsatisfactory Results after Anterior Multilevel Cervical Surgery
Hong Wei LIU ; Liang CHEN ; Nan Wei XU ; Hui Lin YANG ; Yong GU
Journal of Korean Neurosurgical Society 2015;57(1):36-41
OBJECTIVE: To investigate the causes for failed anterior cervical surgery and the outcomes of secondary laminoplasty. METHODS: Seventeen patients failed anterior multilevel cervical surgery and the following conservative treatments between Feb 2003 and May 2011 underwent secondary laminoplasty. Outcomes were evaluated by the Japanese Orthopaedic Association (JOA) Scale and visual analogue scale (VAS) before the secondary surgery, at 1 week, 2 months, 6 months, and the final visit. Cervical alignment, causes for revision and complications were also assessed. RESULTS: With a mean follow-up of 29.7+/-12.1 months, JOA score, recovery rate and excellent to good rate improved significantly at 2 months (p<0.05) and maintained thereafter (p>0.05). Mean VAS score decreased postoperatively (p<0.05). Lordotic angle maintained during the entire follow up (p>0.05). The causes for secondary surgery were inappropriate approach in 3 patients, insufficient decompression in 4 patients, adjacent degeneration in 2 patients, and disease progression in 8 patients. Complications included one case of C5 palsy, axial pain and cerebrospinal fluid leakage, respectively. CONCLUSION: Laminoplasty has satisfactory results in failed multilevel anterior surgery, with a low incidence of complications.
Asian Continental Ancestry Group
;
Cerebrospinal Fluid
;
Decompression
;
Disease Progression
;
Follow-Up Studies
;
Humans
;
Incidence
;
Paralysis
;
Spondylosis
9.The role of hand-assisted laparoscopic surgery in total colectomy for colonic inertia: a retrospective study
Dan Yang WANG ; Jian Jiang LIN ; Xiang Ming XU ; Fan Long LIU
Journal of the Korean Surgical Society 2013;85(3):123-127
PURPOSE: To compare and assess the efficacy, safety and utility of hand-assisted laparoscopic surgery (HALS) with open surgery (OS) in total colectomy with ileorectal for colonic inertia. METHODS: From January 2001 to February 2012, 56 patients diagnosed with colonic inertia who failed to respond to medical treatments underwent hand-assisted laparoscopic total colectomy with ileorectal anastomosis. Another 68 patients underwent laparotomy. Main parameters such as clinical manifestations, conversion to open procedure, operative time, incision length, pain score, intraoperative blood loss, time to first flatus and hospitalization, early postoperative complications and hospitalization cost were retrospectively analyzed. Postoperative defecating frequencies were followed up in both groups. RESULTS: All patients received successful operation, no surgical mortality happened and none of the patients required conversion to an exploratory laparotomy in HALS group. The clinical features, the estimated blood loss, incision length, pain score, first passing flatus time, and postoperative hospitalization time were superior in HALS group (P < 0.05). The early postoperative complications and frequency of defecation were similar. However, the mean operative time was longer and hospitalization cost was higher in HALS group than those in OS group (P < 0.05). CONCLUSION: HALS total colectomy can be a safe and efficient technique in the treatment of colonic inertia. HALS can result in a better cosmetic result and a quicker postoperative recovery, but requires higher direct cost.
Colectomy
;
Colon
;
Constipation
;
Cosmetics
;
Defecation
;
Flatulence
;
Hand-Assisted Laparoscopy
;
Hospitalization
;
Humans
;
Laparotomy
;
Operative Time
;
Postoperative Complications
;
Retrospective Studies
;
Surgical Procedures, Operative
10.The role of hand-assisted laparoscopic surgery in total colectomy for colonic inertia: a retrospective study
Dan Yang WANG ; Jian Jiang LIN ; Xiang Ming XU ; Fan Long LIU
Journal of the Korean Surgical Society 2013;85(3):123-127
PURPOSE: To compare and assess the efficacy, safety and utility of hand-assisted laparoscopic surgery (HALS) with open surgery (OS) in total colectomy with ileorectal for colonic inertia. METHODS: From January 2001 to February 2012, 56 patients diagnosed with colonic inertia who failed to respond to medical treatments underwent hand-assisted laparoscopic total colectomy with ileorectal anastomosis. Another 68 patients underwent laparotomy. Main parameters such as clinical manifestations, conversion to open procedure, operative time, incision length, pain score, intraoperative blood loss, time to first flatus and hospitalization, early postoperative complications and hospitalization cost were retrospectively analyzed. Postoperative defecating frequencies were followed up in both groups. RESULTS: All patients received successful operation, no surgical mortality happened and none of the patients required conversion to an exploratory laparotomy in HALS group. The clinical features, the estimated blood loss, incision length, pain score, first passing flatus time, and postoperative hospitalization time were superior in HALS group (P < 0.05). The early postoperative complications and frequency of defecation were similar. However, the mean operative time was longer and hospitalization cost was higher in HALS group than those in OS group (P < 0.05). CONCLUSION: HALS total colectomy can be a safe and efficient technique in the treatment of colonic inertia. HALS can result in a better cosmetic result and a quicker postoperative recovery, but requires higher direct cost.
Colectomy
;
Colon
;
Constipation
;
Cosmetics
;
Defecation
;
Flatulence
;
Hand-Assisted Laparoscopy
;
Hospitalization
;
Humans
;
Laparotomy
;
Operative Time
;
Postoperative Complications
;
Retrospective Studies
;
Surgical Procedures, Operative