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Xiao F, Qiu XF, You CW, Xie FP, Cai YY. Influence of liver function after laparoscopy-assisted vs totally laparoscopic gastrectomy. World J Gastrointest Surg 2023; 15:859-870. [PMID: 37342845 PMCID: PMC10277945 DOI: 10.4240/wjgs.v15.i5.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/11/2023] [Accepted: 04/04/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Previously, some studies have proposed that total laparoscopic gastrectomy (TLG) is superior to laparoscopic-assisted gastrectomy (LAG) in terms of safety and feasibility based on the related intraoperative operative parameters and incidence of postoperative complications. However, there are still few studies on the changes in postoperative liver function in patients undergoing LG. The present study compared the postoperative liver function of patients with TLG and LAG, aiming to explore whether there is a difference in the influence of TLG and LAG on the liver function of patients.
AIM To investigate whether there is a difference in the influence of TLG and LAG on the liver function of patients.
METHODS The present study collected 80 patients who underwent LG from 2020 to 2021 at the Digestive Center (including the Department of Gastrointestinal Surgery and the Department of General Surgery) of Zhongshan Hospital affiliated with Xiamen University, including 40 patients who underwent TLG and 40 patients who underwent LAG. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyltransferase (GGLT), total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL), and other liver function-related test indices were compared between the 2 groups before surgery and on the 1st, 3rd, and 5th d after surgery.
RESULTS The levels of ALT and AST in the 2 groups were significantly increased on the 1st to 2nd postoperative days compared with those before the operation. The levels of ALT and AST in the TLG group were within the normal range, while the levels of ALT and AST in the LAG group were twice as high as those in the TLG group (P < 0.05). The levels of ALT and AST in the 2 groups showed a downward trend at 3-4 d and 5-7 d after the operation and gradually decreased to the normal range (P < 0.05). The GGLT level in the LAG group was higher than that in the TLG group on postoperative days 1-2, the ALP level in the TLG group was higher than that in the LAG group on postoperative days 3-4, and the TBIL, DBIL and IBIL levels in the TLG group were higher than those in the LAG group on postoperative days 5-7 (P < 0.05). No significant difference was observed at other time points (P > 0.05).
CONCLUSION Both TLG and LAG can affect liver function, but the effect of LAG is more serious. The influence of both surgical approaches on liver function is transient and reversible. Although TLG is more difficult to perform, it may be a better choice for patients with gastric cancer combined with liver insufficiency.
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Affiliation(s)
- Fan Xiao
- The School of Clinical Medicine, Fujian Medical University, Fuzhou 350000, Fujian Province, China
- Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Xing-Feng Qiu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou 350000, Fujian Province, China
- Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Cai-Wen You
- The School of Clinical Medicine, Fujian Medical University, Fuzhou 350000, Fujian Province, China
- Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Fu-Ping Xie
- The School of Clinical Medicine, Fujian Medical University, Fuzhou 350000, Fujian Province, China
- Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Yao-Yuan Cai
- The School of Clinical Medicine, Fujian Medical University, Fuzhou 350000, Fujian Province, China
- Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
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Wei J, Qian XP, Zou ZY, Wang LF, Yu LX, You CW, Song Y, Lu HY, Hu WJ, Yan J, Xu XX, Chen XF, Li XY, Wu QF, Zhou Y, Zhang FL, Liu BR. [Chinese multicenter randomized trial of customized chemotherapy based on BRCA1 (breast cancer susceptibility gene 1)-RAP80 (receptor-associated protein 80) mRNA expression in advanced non-small cell lung cancer (NSCLC) patients]. Zhonghua Zhong Liu Za Zhi 2016; 38:868-873. [PMID: 27998448 DOI: 10.3760/cma.j.issn.0253-3766.2016.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: BRCA1 (breast cancer susceptibility gene 1) and RAP80 (receptor-associated protein 80) play key roles in predicting chemosensitivity of platinum and taxanes. A randomized trial was carried out to compare non-selected cisplatin-based chemotherapy with therapy customized according to BRCA1 and RAP80 expression. Methods: Advanced stage NSCLC patients whose tumor specimen was sufficient for molecular analysis were randomized (1∶3) to the control or experimental arm. Patients in the control arm received docetaxel/cisplatin; in the experimental arm, patients with low RAP80 expression received gemcitabine/cisplatin (Arm 1), those with intermediate/high RAP80 expression and low/intermediate BRCA1expression received docetaxel/cisplatin (Arm 2), and those with intermediate/high RAP80 expression and high BRCA1 expression received docetaxel alone (Arm 3). The primary end point was progression-free survival (PFS). Results: 226 patients were screened and 124 were randomized in this trial. ORR in the four subgroups was 22.6%, 48.4%, 30.3% and 19.2%, respectively (P=0.08); PFS was 4.74, 5.59, 3.78 and 2.73 months, respectively (P=0.55); and OS was 10.82, 14.44, 10.86 and 10.86 months, respectively (P=0.84). The common adverse effects included neutropenia, nausea, anemia and fatigue. Conclusions: No statistically significant difference of ORR, PFS or OS is observed in the experimental arms compared with the control arm. Patients with low RAP80 mRNA levels have a trend of better survival and higher response rate to gemcitabine/cisplatin chemotherapy.
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Affiliation(s)
- J Wei
- The Comprehensive Cancer Center, Affiliated Drum Tower Hospital to Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing 210008, China
| | - X P Qian
- The Comprehensive Cancer Center, Affiliated Drum Tower Hospital to Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing 210008, China
| | - Z Y Zou
- The Comprehensive Cancer Center, Affiliated Drum Tower Hospital to Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing 210008, China
| | - L F Wang
- The Comprehensive Cancer Center, Affiliated Drum Tower Hospital to Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing 210008, China
| | - L X Yu
- The Comprehensive Cancer Center, Affiliated Drum Tower Hospital to Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing 210008, China
| | - C W You
- Department of Oncology, Suqian General Hospital, Suqian 223800, China
| | - Y Song
- Department of Respiratory Medicine, Jinlin Hospital, Nanjing 210002, China
| | - H Y Lu
- Department of Oncology, Taizhou General Hospital, Taizhou 225300, China
| | - W J Hu
- The Comprehensive Cancer Center, Affiliated Drum Tower Hospital to Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing 210008, China
| | - J Yan
- The Comprehensive Cancer Center, Affiliated Drum Tower Hospital to Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing 210008, China
| | - X X Xu
- Department of Respiratory Medicine, Northern Jiangsu People's Hospital, Yangzhou 225001, China
| | - X F Chen
- Department of Oncology, Huaian General Hospital, Huaian 223300, China
| | - X Y Li
- Department of Oncology, Affiliated Hospital to Zhengzhou University, Zhengzhou 450052 , China
| | - Q F Wu
- Department of Oncology, Yixing General Hospital, Yixing 214200, China
| | - Y Zhou
- Department of Oncology, Yixing General Hospital, Yixing 214200, China
| | - F L Zhang
- Department of Oncology, Maanshan General Hospital, Maanshan 243000, China
| | - B R Liu
- The Comprehensive Cancer Center, Affiliated Drum Tower Hospital to Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing 210008, China
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You CW. The impact of haemarthropathy on the QoL of Korean severe haemophilia A patients: the critical level of haemarthropathy for the QoL. Haemophilia 2013; 19:637-41. [PMID: 23574382 DOI: 10.1111/hae.12131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2013] [Indexed: 11/26/2022]
Abstract
The minimum goal of secondary prophylaxis may be to delay the progression of haemarthropathy below a critical level over which it has a great impact on the QoL of haemophilia patients. However, the critical level of haemarthropathy may be different across countries. For these reasons, the impact of haemarthropathy on the QoL in Korean haemophilia A patients was investigated. Depending on observed Pettersson scores of 27 severe haemophilia A patients, they were divided into three groups, P (Pettersson score) ≤ 10, P11~19 and P ≥ 20 groups. The QoL of each patient, assessed by the SF36, was compared between the groups. In addition, the changes in the QoL of the patients were observed according to the changes of Pettersson scores to find out the critical level of arthropathy. None of the scores of the SF36 scales were different between the P ≤ 10 and P11~19 groups. In contrast, the scores of PF and MH scales were significantly different between the P11~19 and P ≥ 20 groups. When changes in the scores of each scale in the SF36 were observed according to changes in Pettersson scores, the average P score of 13.0 ± 2.7 was thought to be the critical level of haemarthropathy because above that level, haemarthropathy and physical and mental health of the patients rapidly deteriorated. The progression of haemarthropathy to the critical level should be delayed as long as possible to prevent or to delay a rapid deterioration of the QoL of Korean patients with haemophilia.
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Affiliation(s)
- C W You
- Department of Pediatrics, Eulji University School of Medicine, Daejeon, Korea.
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Hwang SH, Lim JA, Kim MJ, Kim HC, Lee HW, Yoo KY, You CW, Lee KS, Kim HS. Profiling of differentially expressed genes in haemophilia A with inhibitor. Haemophilia 2011; 18:e247-53. [PMID: 22176207 DOI: 10.1111/j.1365-2516.2011.02702.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Inhibitor development is the most significant complication in the therapy of haemophilia A (HA) patients. In spite of many studies, not much is known regarding the mechanism underlying inhibitor development. To understand the mechanism, we analysed profiles of differentially expressed genes (DEGs) between inhibitor and non-inhibitor HA via a microarray technique. Twenty unrelated Korean HAs were studied: 11 were non-inhibitor and nine were HA with inhibitor (≥5 BU mL(-1)). Microarray analysis was conducted using a Human Ref-8 expression Beadchip system (Illumina) and the data were analysed using Beadstudio software. We identified 545 DEGs in inhibitor HA as compared with the non-inhibitor patients; 384 genes were up-regulated and 161 genes were down-regulated. Among them, 75 genes whose expressions were altered by at least two-fold (>+2 or <-2) were selected and classified via the PANTHER classification method. The expressions of signal transduction and immunity-related genes differed significantly in the two groups. For validation of the DEGs, semi-quantitative RT-PCR (semi-qRT-PCR) was conducted with the six selected DEGs. The results corresponded to the microarray data, with the exception of one gene. We also examined the expression of the genes associated with the antigen presentation process via real-time PCR. The average levels of IL10, CTLA4 and TNFα slightly reduced, whereas that of IFNγ increased in the inhibitor HA group. We are currently unable to explain whether this phenomenon is a function of the inhibitor-inducing factor or is an epiphenomenon of antibody production. Nevertheless, our results provide a possible explanation for inhibitor development.
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Affiliation(s)
- S H Hwang
- Department of Biological Science, College of Natural Sciences, Ajou University, Suwon, Korea
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You CW, Lee SY, Park SK. Cost and effectiveness of treatments for mild-to-moderate bleeding episodes in haemophilia patients with inhibitors in Korea. Haemophilia 2008; 15:217-26. [PMID: 18754800 DOI: 10.1111/j.1365-2516.2008.01862.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
First-line treatment for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in Korea is currently activated prothrombin complex concentrate (aPCC) with recombinant activated factor VII (rFVIIa) as second-line therapy or as a last resort. The aim of this study was to estimate the cost and effectiveness of aPCC vs. rFVIIa for treating mild-to-moderate bleeds in inhibitor patients from the Korean reimbursement authorities' perspective. Clinical outcomes and resource utilization data (number of doses, average dose, number of outpatient visits, inpatient stays, ambulance transport and concomitant medications) were collected from an observational study involving four Korean paediatric haemophilia centres. Cost-effectiveness was modelled using a decision analysis approach and sensitivity analyses undertaken. rFVIIa was a more effective haemostatic therapy (87.1% efficacy in bleed resolution) than aPCC (64.0%). rFVIIa effected more rapid haemostasis, resolving bleeding in a mean of 6.6 h vs. 25.2 h for aPCC. Fewer rFVIIa doses were required per bleed vs. aPCC (means 1.7 and 2.3). Mean total direct medical costs from bleed initiation to cessation were estimated at Korean Won (KRW)12 460 thousand (US$12 311) for rFVIIa given as first-line therapy and KRW18 304 thousand (US$18 085) for aPCC given as first-line therapy. Sensitivity analyses confirmed the cost-effectiveness of rFVIIa vs. aPCC given as first-line therapy. In Korea, use of rFVIIa as first-line therapy for treatment of mild-to-moderate bleeding episodes in inhibitor patients is both clinically effective and cost-effective compared with initial aPCC treatment. rFVIIa should be considered as the first-line treatment for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in Korea.
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Affiliation(s)
- C W You
- Department of Pediatrics, College of Medicine, Eulji University, Daejeon, Korea.
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