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Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis

World Journal of Gastroenterology 2019年第34期25卷 5162-5173页

作者： Jiong-Di Lu Feng Cao Yi-Xuan ding Yu-Duo Wu Yu-Lin Guo Fei Li Department of General Surgery Xuanwu HospitalCapital Medical UniversityBeijing 100053China Department of Cardiac Surgery Beijing Anzhen Hospital Affiliated to Capital University of Medical SciencesBeijing 100029China

BACKGROUND Acute pancreatitis(AP)is a common acute abdominal disease worldwide,and its incidence rate has increased annually.Approximately 20%of AP patients develop into necrotizing pancreatitis(NP),and 40%to 70%of NP patients have infectious complications,which usually indicate a worse prognosis.Infection is an important sign of complications in NP patients.AIM To investigate the difference in infection time,infection site,and infectious strain in NP patients with infectious complications.METHODS The clinical data of AP patients visiting the Department of General Surgery of Xuanwu Hospital of Capital Medical University from January 1,2014 to December 31,2018 were collected retrospectively.Enhanced computerized tomography or magnetic resonance imaging findings in patients with NP were included in the study.Statistical analysis of infectious bacteria,infection site,and infection time in NP patients with infectious complications was performed,because knowledge about pathogens and their antibiotic susceptibility patterns is essential for selecting an appropriate antibiotic.In addition,the factors that might influence the prognosis of patients were analyzed.RESULTS In this study,539 strains of pathogenic bacteria were isolated from 162 patients with NP infection,including 212 strains from pancreatic infections and 327 strains from extrapancreatic infections.Gram-negative bacteria were the main infectious species,the most common of which were Escherichia coli and Pseudomonas aeruginosa.The extrapancreatic infection time(9.1±8.8 d)was earlier than the pancreatic infection time(13.9±12.3 d).Among NP patients with early extrapancreatic infection(14 d),bacteremia(15.94%),respiratory tract infection(7.74%),and urinary tract infection(7.71%)were predominant.Drug sensitivity analysis showed that P.aeruginosa was sensitive to enzymatic penicillins,thirdand fourth-generation cephalosporins,and

关键词： Necrotizing pancreatitis Extrapancreatic infection Pathogenic bacteria Drug sensitivity test

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Acinous cell AR42J-derived exosome miR125b-5p promotes acute pancreatitis exacerbation by inhibiting M2 macrophage polarization via PI3K/AKT signaling pathway

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World Journal of Gastrointestinal Surgery 2023年第4期15卷 600-620页

作者： Zhi Zheng Feng Cao Yi-Xuan ding Jiong-Di Lu Yuan-Qiao Fu Lin Liu Yu-Lin Guo Shuang Liu Hai-Chen Sun Ye-Qing Cui Fei Li Department of General Surgery Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China Department of General Surgery Xuanwu HospitalCapital Medical UniversityBeijing 100053China Department of Gastroenterology The Second Affiliated Hospital of Baotou Medical CollegeBaotou 014040Inner Mongolia Autonomous RegionChina

BACKGROUND The incidence rate of acute pancreatitis(AP), which is a pathophysiological process with complex etiology, is increasing globally. miR-125b-5p, a bidirectional regulatory miRNA, is speculated to exhibit anti-tumor activity. However,exosome-derived miR-125b-5p in AP has not been reported.AIM To elucidate the molecular mechanism of exosome-derived miR-125b-5p promoting AP exacerbation from the perspective of the interaction between immune cells and acinar cells.METHODS Exosomes derived from AR42J cells were isolated and extracted in active and inactive states by an exosome extraction kit, and were verified via transmission electron microscopy, nanoparticle tracking analysis, and western blotting. RNA sequencing assay technology was used to screen differentially expressed miRNAs in active and inactive AR42J cell lines, and bioinformatics analysis was used to predict downstream target genes of miR-125b-5p. The expression level of miR-125b-5p and insulin-like growth factor 2(IGF2) in the activated AR42J cell line and AP pancreatic tissue were detected by quantitative real-time polymerase chain reaction and western blots. The changes in the pancreatic inflammatory response in a rat AP model were detected by histopathological methods. Western Blot was used to detect the expression of IGF2, PI3K/AKT signaling pathway proteins, and apoptosis and necrosis related proteins.RESULTS miR-125b-5p expression was upregulated in the activated AR42J cell line and AP pancreatic tissue,while that of IGF2 was downregulated. In vitro experiments confirmed that miR-125b-5p could promote the death of activated AR42J cells by inducing cell cycle arrest and apoptosis. In addition,miR-125b-5p was found to act on macrophages to promote M1 type polarization and inhibit M2type polarization, resulting in a massive release of inflammatory factors and reactive oxygen species accumulation. Further research found that miR-125b-5p could inhibit the expression of IGF2 in the PI3K/AKT signaling pathway. Additionally, in vivo experiments rev

关键词： Acute pancreatitis Exosome miR-125b-5p Macrophage Mechanism

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胰腺切除术后胰腺炎预防及诊治策略

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中国实用外科杂志 2023年第7期43卷 816-818,822页

作者：曹锋卢炯地李非首都医科大学宣武医院普通外科、首都医科大学急性胰腺炎临床诊疗与研究中心北京100053

胰腺手术后急性胰腺炎(PPAP)是胰腺切除术后的独立并发症。国际胰腺外科研究小组在2022年制定了PPAP的定义和分级标准,由临床、生化和影像三部分组成,并根据PPAP的严重程度将其分为A、B、C 3个等级。PPAP将导致胰腺切除术后病人的住院... 详细信息

胰腺手术后急性胰腺炎(PPAP)是胰腺切除术后的独立并发症。国际胰腺外科研究小组在2022年制定了PPAP的定义和分级标准,由临床、生化和影像三部分组成,并根据PPAP的严重程度将其分为A、B、C 3个等级。PPAP将导致胰腺切除术后病人的住院时间延长、并发症发生率和病死率增高。术后血清生物学标记物(C反应蛋白、白细胞介素6、淀粉酶及脂肪酶等)水平可预测PPAP的发生。胰腺质地软、主胰管直径≤3 mm、残胰血供差是发生PPAP的独立危险因素。PPAP治疗尚无统一规范,目前以使用生长抑素类似物和充分引流为主。对出现胰腺坏死、器官衰竭、严重腹腔感染的PPAP病人,可行挽救性全胰腺切除术。

关键词：急性胰腺炎术后并发症胰十二指肠切除术

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KLF16 promotes pancreatic adenocarcinoma cell proliferation and migration by positively regulating SMAD6

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World Journal of Gastrointestinal Oncology 2022年第11期14卷 2157-2169页

作者： Wei Mi Zhi Zheng Jiong-Di Lu Shu-Quan Duan Jie Zhang Hai-Qiao Zhang Yi-Xuan ding Jie Yin Feng Cao Jun Zhang Fei Li Department of General Surgery Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China Department of General Surgery Xuanwu HospitalCapital Medical UniversityBeijing 100053China Department of digestive Minimally Invasive Surgery The Second Affiliated Hospital of Baotou Medical CollegeBaotou 014030Inner Mongolia Autonomous RegionChina Department of Radiology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

BACKGROUND Pancreatic adenocarcinoma(PAAD)is a cancerous tumor with an extremely poor 5-year survival rate.The exploration of biomarkers for the diagnosis and treatment of PAAD is crucial in clinical practice.Krüppel-like factors(KLFs)are involved in a variety of biological functions in cells.According to multiple studies,KLF16 behave as an oncogene in prostate,breast and gastric cancers.However,no research has been done on the significance of KLF16 in PAAD.AIM To explore the molecular mechanisms of KLF16 in PAAD.METHODS KLF16 was identified in the tumor specimens and normal tissues by GEPIA database and verified by quantitative real-time PCR(qRT-PCR).Knockdown or exogenous expression of KLF16,combined with in vitro and in vivo assays,was performed to show the functional significance of KLF16.The molecular mechanism of KLF16 was demonstrated by qRT-PCR,western blotting,immunoprecipitation assay and flow cytometry.RESULTS We showed that KLF16 was highly expressed in PAAD patients based on the GEPIA database.KLF16 silencing suppressed while KLF16 overexpression promoted the malignant function of PAAD cells.Based on RNA sequencing,we discovered that KLF16 potentiated the expression of SMAD6 in PAAD cells.SMAD6 transcript abundance was increased and positively correlated with KLF16 expression in PAAD samples.In addition,inhibiting SMAD6 was able to mitigate the effects of KLF16 overexpression on PAAD cell processes,suggesting the importance of SMAD6 in the development of KLF16-triggered PAAD.CONCluSION KLF16/SMAD6 axis might be explored as a therapeutic target for PAAD therapy.

关键词： KLF16 Pancreatic adenocarcinoma SMAD6 Tumorigenesis Therapeutic target

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Comparison of safety,efficacy,and long-term follow-up between“one-step”and“step-up”approaches for infected pancreatic necrosis

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World Journal of Gastrointestinal Surgery 2021年第11期13卷 1372-1389页

作者： Zhi Zheng Jiong-Di Lu Yi-Xuan ding Yu-Lin Guo Wen-Tong Mei Yuan-Xu Qu Feng Cao Fei Li Department of General Surgery Xuanwu HospitalCapital Medical UniversityBeijing 100053China

BACKGROUND Although the“Step-up”strategy is the primary surgical treatment for infected pancreatic necrosis,it is not suitable for all such patients.The“One-step”strategy represents a novel treatment,but the safety,efficacy,and long-term follow-up have not yet been compared between these two approaches.AIM To compare the safety,efficacy,and long-term follow-up of two surgical approaches to provide a reference for infected pancreatic necrosis treatment.METHODS This was a retrospective analysis of infectious pancreatic necrosis patients who underwent“One-step”or“Step-up”necrosectomy at Xuan Wu Hospital,Capital Medical University,from May 2014 to December 2020.The primary outcome was the composite endpoint of severe complications or death.Patients were followed up every 6 mo after discharge until death or June 30,2021.Statistical analysis was performed using SPSS 21.0 and GraphPad Prism 8.0,and statistical significance was set at Pdisease onset to hospital admission(53.69±38.14 vs 32.20±20.75,Pdicator levels were significantly lower than preoperative levels in each group.Although the incisional hernia incidence was higher in the“One-step”group,no significant difference was found in the composite outcomes of severe complications or death,new-onset organ failure,postoperative complications,inflammatory indicators,long-term complications,quality of life,and medical costs between the groups(P>0.05).CONCluS

关键词： Acute pancreatitis Follow-up Infectious pancreatic necrosis Safety and efficacy Surgical approach

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Risk factors for postoperative seromas in Chinese breast cancer patients

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Chinese Medical Journal 2011年第9期124卷 1300-1304页

作者： LIN Yan-ping YIN Wen-jin YAN Ting-ting ZHOU Li-heng di Geng-hong WU jiong SHEN Zhen-zhou SHAO Zhi-min lu Jin-song Department of Breast Surgery Cancer Hospital/Cancer Institute Fudan University Department of Oncology Shanghai Medical College Fudan University Shanghai 200032 China Department of General Surgery Shanghai Sixth People's Hospital of Shanghai Jiao Tong University Shanghai 200233 China

Background Seroma formation is one of the most common complications after breast cancer surgery. Various risk factors have been evaluated for their associations with the development of seromas in Western populations. However, similar data are not available in Chinese series. Therefore, we sought to investigate the potential risk factors for Chinese breast cancer patients. Methods A prospective study of female breast cancer patients undergoing surgery was carried out in Cancer Hospital of Fudan Unversity, Shanghai, China. Univariate analyses were performed by chi-square test or Student＇s t test or Mann-Whitney test and multivariate analyses by stepwise Logistic regression. The logistic model included age （years）, total serum protein concentration （g/L）, drainage volume on postoperative day 3 （POD 3; ml） and time to daily drainage volume not more than 30 ml （TTV30; days）. Results A total of 158 patients with breast cancer were studied. The mean age at diagnosis was （52.14±10.77） years （range 25-92）. During the follow-up period, 24 （15.2%） patients developed seromas. Calculated as continuous variables in the stepwise Logistic regression, age （0R=1.090, 95% CI 1.028-1.155, P=0.004）, total serum protein concentration （OR=0.886, 95% Cl 0.791-0.992, P=0.036）, drainage volume on POD3 （OR=1.013, 95% Cl 1.002-1.023, P=0.017） and TTV30 （OR=1.273, 95% CI 1.039-1.561, P=0.020） were independent risk factors for seroma formation. Additionally, significant difference in daily drainage volume was substantiated in the analysis by seroma formation （P=0.034） rather than by type of surgery （P=0.713）. Conclusions Although the pathogenesis of seroma remains controversial, such risk factors as age, nutritional status, drainage volume on POD3 and TTV30 should be considered for prediction and prevention of seroma formation in Chinese breast cancer patients.

关键词： breast neoplasms surgery seroma risk factors

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An attempt to treat Hoffa fractures under arthroscopy： A case report

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Chinese Journal of Traumatology 2018年第5期21卷 308-310页

作者： Kun Xiao Chun Chen Jie Yang di Yang jiong Liu Department of Orthopaedics The Fourth People's Hospital of Guiyang Guizhou China

我们与大腿骨的髁和骨头在膝前面转移了的 lateral 以后的骨折对待一个 15 岁的女病人。认为传统的外科的途径有重要损伤和差的预后的缺点，我们设计了 arthroscopic 过程，它完成了令人满意的短期的功效，有效地减少了并且修理，避免... 详细信息

我们与大腿骨的髁和骨头在膝前面转移了的 lateral 以后的骨折对待一个 15 岁的女病人。认为传统的外科的途径有重要损伤和差的预后的缺点，我们设计了 arthroscopic 过程，它完成了令人满意的短期的功效，有效地减少了并且修理，避免了损坏到脉管的神经，并且最大地减少了损伤破裂自己由外科引起了。

关键词：案例断裂损伤外科

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Carbon dioxide insufflation for endoscopic retrograde cholangiopancreatography:A meta-analysis and systematic review

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World Journal of Gastroenterology 2012年第39期18卷 5622-5631页

作者： Yao Cheng Xian-Ze Xiong Si-Jia Wu jiong lu Yi-Xin Lin Nan-Sheng Cheng Tai-Xiang Wu Department of Bile Duct Surgery West China Hospital Sichuan University Chengdu 610041 Sichuan Province China Chinese Cochrane Centre Chinese Clinical Trial Registry Chinese Evidence-Based Medicine Centre INCLEN Resource and Training Centre West China Hospital Sichuan University Chengdu 610041 Sichuan Province China

AIM:To assess the safety and efficacy of carbon dioxide (CO2) insufflation during endoscopic retrograde cholangiopancreatography (ERCP). METHODS:The Cochrane Library, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Science Citation Index Expanded, Chinese Biomedical Literature Database, and references in relevant publications were searched up to December 2011 to identify randomized controlled trials (RCTs) comparing CO2 insufflation with air insufflation during ERCP. The trials were included in the review irrespec-tive of sample size, publication status, or language. Study selection and data extraction were performed by two independent authors. The meta-analysis was performed using Review Manager 5.1.6. A random-effects model was used to analyze various outcomes.Sensitivity and subgroup analyses were performed if necessary. R ESULTS:Seven double-blind RCTs involving a total of 818 patients were identified that compared CO2 insufflation (n = 404) with air insufflation (n = 401) during ERCP. There were a total of 13 post-random- ization dropouts in four RCTs. Six RCTs had a high risk of bias and one had a low risk of bias. None of the RCTs reported any severe gas-related adverse events in either group. A meta-analysis of 5 RCTs (n = 459) indicated that patients in the CO2 insufflation group had less post-ERCP abdominal pain and distension for at least 1 h compared with patients in the air insuf-flation group. There were no significant differences in mild cardiopulmonary complications [risk ratio (RR) = 0.43, 95% CI:0.07-2.66, P = 0.36], cardiopulmonary (e.g., blood CO2 level) changes [standardized mean difference (SMD) = -0.97, 95% CI: -2.58-0.63, P = 0.23], cost analysis (mean difference = 3.14, 95% CI:-14.57-20.85, P = 0.73), and total procedure time (SMD = -0.05, 95% CI:-0.26-0.17, P = 0.67) between the two groups. C ONCluSION:CO2 insufflation during ERCP appears to be safe and reduces post-ERCP abdominal pain and discomfort.

关键词：二氧化碳气检索系统 Meta分析医学文献数据库造影胆管内镜审查

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感染性胰腺坏死病人多重耐药菌感染危险因素分析

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中国实用外科杂志 2022年第4期42卷 412-416页

作者：卢炯地丁乙轩郑智曲元旭梅文通曹锋李非首都医科大学急性胰腺炎诊疗中心首都医科大学宣武医院普通外科北京100053

目的探讨影响感染性胰腺坏死(IPN)病人发生多重耐药菌(MDRB)感染的相关危险因素。方法回顾性分析2014-01-01至2020-12-31首都医科大学宣武医院普通外科收治的215例IPN病人的临床资料。根据病人有无MDRB感染,分为MDRB感染组(107例)和非M... 详细信息

目的探讨影响感染性胰腺坏死(IPN)病人发生多重耐药菌(MDRB)感染的相关危险因素。方法回顾性分析2014-01-01至2020-12-31首都医科大学宣武医院普通外科收治的215例IPN病人的临床资料。根据病人有无MDRB感染,分为MDRB感染组(107例)和非MDRB感染组(108例),比较两组病人的临床转归。结果MDRB感染组病人入院时CT严重指数(CTSI)评分[8(6~10)vs.6(4~8),P=0.001]和降钙素原(PCT)水平[(1.7±1.4)μg/L vs.(0.8±0.7)μg/L,P=0.001]高于非MDRB感染组病人。在临床治疗过程中,MDRB感染组病人更需要营养支持(80.4%vs.50.9%,P=0.001)、微创手术干预(88.8%vs.64.8%,P=0.001)等治疗措施。在临床转归方面,MDRB感染组病人更易发生术后并发症(23.4%vs.12.1%,P=0.029)和新发器官衰竭(11.2%vs.0.9%,P=0.002),导致重症监护室(ICU)住院时间[(30.1±28.7)d vs.(17.9±13.7)d,P=0.001]和总住院时间[(50.0±31.1)d vs.(29.0±21.5)d,P=0.001]延长。经多因素分析发现,合并胰腺外感染(OR=4.116,95%CI 1.381-12.271,P=0.011)、入院时PCT水平(OR=2.728,95%CI 1.502-4.954,P=0.001)、胰腺坏死程度(OR=2.728,95%CI 1.502-4.954,P=0.001)是影响IPN病人出现MDRB感染的独立危险因素。结论根据IPN病人是否出现胰腺外感染、胰腺坏死严重程度、入院时PCT水平可评估其发生MDRB感染的风险。

关键词：感染性胰腺坏死胰腺外感染病原菌多重耐药菌感染

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In vivo RNAi screen identifies candidate signaling genes required for collective cell migration in Drosophila ovary

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Science China(Life Sciences) 2015年第4期58卷 379-389页

作者： luO Jun ZUO JunTao WU Jing WAN Ping KANG di XIANG Cong ZHU Hong CHEN jiong Model Animal Research Center and MOE Key Laboratory of Model Animals for Disease Study Nanjing University

Collective migration of loosely or closely associated cell groups is prevalent in animal development, physiological events, and cancer metastasis. However, our understanding of the mechanisms of collective cell migration is incomplete. Drosophila border cells provide a powerful in vivo genetic model to study collective migration and identify essential genes for this process. Using border cell-specific RNAi-silencing in Drosophila, we knocked down 360 conserved signaling transduction genes in adult flies to identify essential pathways and genes for border cell migration. We uncovered a plethora of signaling genes, a large proportion of which had not been reported for border cells, including Rack1(Receptor of activated C kinase) and brk(brinker), mad(mother against dpp), and sax(saxophone), which encode three components of TGF-β signaling. The RNAi knock down phenotype was validated by clonal analysis of Rack1 mutants. Our data suggest that inhibition of Src activity by Rack1 may be important for border cell migration and cluster cohesion maintenance. Lastly, results from our screen not only would shed light on signaling pathways involved in collective migration during embryogenesis and organogenesis in general, but also could help our understanding for the functions of conserved human genes involved in cancer metastasis.

关键词：细胞迁移候选基因信号转导 RNAi 集体果蝇体内蛋白激酶C

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