Influence of liver function after laparoscopy-assisted vs totally laparoscopic gastrectomy

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 1^st, 3^rd, and 5^th d after surgery.

RESULTS

The levels of ALT and AST in the 2 groups were significantly increased on the 1^st to 2^nd 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.

[Application of computer virtual design to assist the accuracy of socket preparation during tooth autotransplantation]

PURPOSE

It was aimed to apply computer virtual design and digital surgical templates to simulate postoperative position of tooth and guide the accuracy of socket preparation during tooth autotransplantation.

METHODS

The study enrolled 10 patients who underwent tooth autotransplant surgery. Cone-bean CT (CBCT) data were imported into Proplan CMF 3.0 software. The donor tooth was transferred to the recipient site according to the occlusion and space situation. A digital template was designed to guide socket preparation. Computer-aided rapid prototyping (RP) technique was used to print the surgical template and tooth model.

RESULTS

With computer virtual design and digital template, it was possible to accurately guide socket preparation in recipient site. The six-month follow-up results showed the periodontal space in the radiographs was continuous and intact. There was no mobility in all cases and the probing depth of the tooth was <4 mm. The related data showed a favorable survival and success rates of the donor teeth.

CONCLUSIONS

Computer virtual design can successfully simulate postoperative position in tooth autotransplantation while simplifying the surgical procedure, and enhance the accuracy of socket preparation.

[Evaluation of using Proplan virtual software in teaching of orthognathic surgery]

PURPOSE

Using Proplan virtual software to construct a virtual teaching platform for orthognathic surgery, and to explore an effective teaching model for orthognathic surgery.

METHODS

One-hundred grade four students of stomatology in Fujian Medical University were divided into two groups. Traditional orthognathic surgery teaching method and Proplan virtual software teaching method were employed to teach the two groups of students, respectively. Orthognathic-surgery-related paper test was used to evaluate how the two groups of students understand orthognathic surgery; then the students were switched to the other teaching method, respectively. A follow-up questionnaire survey was conducted to further evaluate students' acceptance of the two teaching methods. Finally, a comprehensive statistical analysis was performed for students understanding of orthognathic surgery using SPSS 11.0 software package.

RESULTS

According to the test scores, students in the experimental group scored higher than the control group, the difference was significant (P<0.01). The acceptance of different teaching methods displayed remarkable difference between the two groups. Token together, our finding showed that virtual model surgery teaching was an easier teaching method for students to understand and accept.

CONCLUSIONS

Proplan virtual software teaching improves the teaching efficiency of orthognathic surgery and deserves further promotion.

[Clinical effect of modified alveolar cleft repair with bone grafting]

PURPOSE

To evaluate the clinical effect of improved alveolar cleft repair with bone grafting.

METHODS

Forty one cases with alveolar cleft treated by modified operation between 2008-2016 were included. The modified techniques were as follow: incision design, preparation of bone graft bed, bone removal and bone grafting, etc. The therapeutic effect was analyzed.

RESULTS

The successful rate was 92.8%. After 6-12 months of follow-up, bone graft survived well with no obvious complications.

CONCLUSIONS

Iliac bone is a good source for bone graft. Improvement of tight tension-free suture in bone bed is the key to surgical success.

Transdifferentiation of neoplastic cells

Transdifferentiation is a process in which a stable cell's phenotype changes to that of a distinctly different cell type. It occurs during certain physiological processes and leads to transition of tumor cell phenotypes. The latter process includes neoplastic epithelial-epithelial transition, neoplastic epithelial-mesenchymal transition, neoplastic mesenchymal-epithelial transition and transition between non-neural and neural neoplastic cell. This phonomenon is exemplified in some origin-debated tumors, such as carcinosarcoma, pleomorphic adenoma, synovial sarcoma, Ewing's/pPNET, and malignant fibrohistiocytoma. We propose that differentiation disturbance of cancer cells should include not only undifferentiation and dedifferentiation, but also transdifferentiation as well. Tumor cell transdifferentiation may be influenced or determined by cellular genetic instabilities, proliferation and apoptosis, as well as by extracellular matrix and growth factors.

Transdifferentiation in neoplastic development and its pathological implication

Transdifferentiation is a process in which a cell committed to a particular specialization changes to another quite distinct type. It occurs during embryological development and some pathological processes, and causes the tumor cells to express a phenotype different from that of their normal progenitors. Neoplastic transdifferentiation involves pathogenesis of cancer subtype, transition between neoplastic epithelia and neuroendocrine cell, transition between neoplastic epithelia and mesenchyme, as well as transition between non-neuroectodermal and neuroectodermal cells. We propose that differentiation disturbance of cancer cells should include not only lower-, un-, or de-differentiation, but also transdifferentiation. Tumor cell transdifferentiation results from genetic instabilities. In some type of neoplastic transition, the initiation may be induced by extracellular matrix and growth factors.

The establishment of two cell lines from a mouse uterine cervical carcinoma (U14) and their metastatic phenotype changes

This paper studies the heterogeneity of metastatic potential of murine cervical carcinoma (U14). Two cell lines, P11-90 and L10-90, were established from a pulmonary metastatic substrain (U14AP11) and a lymphatic metastatic substrain (U14AL10), which were selected from U14 in vivo after 11 and 10 passages, respectively. The biologic differences between the two cell lines are as follows. (1) The cells of the P11-90 line grow more rapidly compared with the L10-90 line. From the 40th passage the medium pH was different. (2) The median number of chromosomes in P11-90 and L10-90 was 72 and 64, respectively; the rates of gap aberration were 88% and 78%, respectively. (3) The number of T lymphocytes and T helper lymphocytes in the peripheral blood from hosts with P11-90 were higher than that of hosts transplanted with L10-90, but the number of B lymphocytes in the latter was larger than that in the former. (4) The metastatic potential of each cell line partially decreased compared to the relative tumor substrain, but their organ preference still remained and the transplant locations, axillary or footpad, had a prominent influence on their metastatic behavior. To observe the effects of metastatic target organs on the metastatic phenotypes of tumor cells, as well as to explore a method for the establishment and maintenance of the metastatic organ preference of tumor cells, conditioned medium (CM) from pulmonary or lymphatic node diploid cells was added to the culture medium of P11-90 and L10-90. Two sublines, P + P11-90 and Ln + L10-90, were thus established. Using stereological methods we found that the majority of P + P11-90 cells became larger and their nuclei also increased in size compared with their parental lines, but the majority of Ln + L10-90 cells became smaller in size, though the nuclei were enlarged. The pulmonary metastatic rate and lymphatic metastatic rate of P + P11-90, as well as the lymphatic metastatic rate of Ln + L10-90, were restored dramatically. The results suggest that by taking advantage of the interaction between tumor cells and the CM of host cells the metastatic potential of tumor cell lines can be maintained in vitro. Our work may offer an experimental model for the manipulation of metastasis of cell lines coming from the same parent strain but with different metastatic potentials.(ABSTRACT TRUNCATED AT 400 WORDS)