Analysis of risk factors for acute pancreatitis complicated with pancreatic sinistral portal hypertension and construction of predictive model.

Objective: Pancreatic sinistral portal hypertension (PSPH) is a common complication of acute pancreatitis (AP) and can cause massive gastrointestinal bleeding, which is one of the causes of AP-related mortality. However, there is currently no predictive model for AP concurrent with PSPH. This study aimed to identify the risk factors for AP concurrent with PSPH and use these factors to build a related predictive model. Materials and methods: We collected clinical data from 282 patients with AP. 192 patients were used as a training group and 90 patients as a validation group. Univariate and multivariate analyses were used to identify independent risk factors for AP complicated with PSPH, and then a nomogram was established. The models are cross verification and Internal verification. The predictive ability and accuracy of the model were evaluated based on the working curve of the subjects and the calibration curve, respectively. The clinical value of the model was evaluated using decision curve analysis (DCA). Results: The univariate analysis revealed significant differences in the occurrence of PSPH with respect to sex, recurrent AP, history of hypertension, smoking history, patency of the splenic vein, pancreatic necrosis or pancreatic pseudocyst formation, the most significant site of pancreatic swelling, presence of a Dmure D polymer, MCTSI, and involvement of lipase and amylase. The logistic multivariate regression analysis showed that male sex, splenic-vein stenosis or occlusion and swelling were located in the body-tail, and MCTSI was an independent risk factor for PSPH. The nomogram and ROC curve were constructed. The area under the working curve of the subjects was 0.91, and the sensitivity and specificity were 82.5% and 89.1%, respectively. In the validation group, the C-index is 0.826. The nomogram was internally validated using 1,000 bootstrap samples, and the c-index was 0.898. The calibration curve demonstrated that the predicted probability was concordant with the observed probability, and the DCA confirmed that the model had robust clinical utility. Conclusion: Male sex, splenic-vein stenosis or occlusion, recurrent AP, and swelling are located in the body-tail, and MCTSI is an independent risk factor for the occurrence of PSPH. The predictive model developed for AP complicated with PSPH may serve toward developing preventive and therapeutic approaches for PSPH.

[Case control study on T-plate combined with suture anchors for the treatment of Neer â ¡b clavicle fractures].

OBJECTIVE: To compare the clinical efficacy of distal radius T-plate combined with suture anchor and distal clavicle anatomical locking plate combined with suture anchor in the treatment of Neer Ⅱb distal clavicle fracture. METHODS: From June 2014 to June 2018, 42 patients with Neer Ⅱb distal clavicle fractures were retrospectively analyzed. According to different surgical methods, they were divided into the observation group (T-shaped plate combined with suture anchor) and the control group (anatomical locking plate combined with suture anchor). There were 22 patients in the observation group and 20 patients in the control group. In the observation group, there were 13 males and 9 females, aged from 22 to 70 (45.78± 14.44) years old, 12 cases on the left side and 10 cases on the right side, 8 cases of traffic accident injury and 14 cases of fall. In the control group, there were 12 males and 8 females, aged from 24 to 66 (44.17±15.58) years, 13 cases on the left side and 7 cases on the right side, 6 cases of traffic accident injuryand 14 cases of fall. The operation time, intraoperative blood loss and fracture healing time were compared between the two groups, and Constant Murley score was used to evaluate shoulder joint function. RESULTS: The patients in both groups were followed up for 18 to 24 (20.96±2.02) months. The incisions of both groups were healed at stageⅠ. The fracture ends of both groups were bony healed at the last follow up. There was no significant difference in operation time, intraoperative blood loss and fracture healing time between two groups (P>0.05);there was no significant difference in shoulder joint function between two groups at 3 months after operation (P>0.05). CONCLUSION: The two methods can obtain satisfactory results in the treatment of Neer Ⅱb distal clavicle fractures, especially suitable for patients with comminuted distal clavicle fractures or osteoporosis; the clinical effect of the treatment of NeerⅡb distal clavicle fractures with T type distal radius plate combined with suture anchor is satisfactory, which provides another feasible treatment scheme for clinic.

Optimal gestational weight gain in Chinese pregnant women by Chinese-specific BMI categories: a multicentre prospective cohort study.

OBJECTIVE: To establish optimal gestational weight gain (GWG) in Chinese pregnant women by Chinese-specific BMI categories and compare the new recommendations with the Institute of Medicine (IOM) 2009 guidelines. DESIGN: Multicentre, prospective cohort study. Unconditional logistic regression analysis was used to evaluate the OR, 95 % CI and the predicted probabilities of adverse pregnancy outcomes. The optimal GWG range was defined as the range that did not exceed a 1 % increase from the lowest predicted probability in each pre-pregnancy BMI group. SETTING: From nine cities in mainland China. PARTICIPANTS: A total of 3731 women with singleton pregnancy were recruited from April 2013 to December 2014. RESULTS: The optimal GWG (ranges) by Chinese-specific BMI was 15·0 (12·8-17·1), 14·2 (12·1-16·4) and 12·6 (10·4-14·9) kg for underweight, normal weight and overweight pregnant women, respectively. Inappropriate GWG was associated with several adverse pregnancy outcomes. Compared with women gaining weight within our proposed recommendations, women with excessive GWG had higher risk for macrosomia, large for gestational age and caesarean section, whereas those with inadequate GWG had higher risk for low birth weight, small for gestational age and preterm delivery. The comparison between our proposed recommendations and IOM 2009 guidelines showed that our recommendations were comparable with the IOM 2009 guidelines and could well predict the risk of several adverse pregnancy outcomes. CONCLUSIONS: Inappropriate GWG was associated with higher risk of several adverse pregnancy outcomes. Optimal GWG recommendations proposed in the present study could be applied to Chinese pregnant women.

[Interventional effect of vitamin A supplementation on re-vaccination to hepatitis B virus among rural infants and young children in China].

OBJECTIVE: The objective of this study was to observe the interventional effect of cod liver oil supplementation on re-vaccination to hepatitis B virus (HBV) among infants and young children. METHODS: All 7-36 months old infants and young children, who had been vaccinated with obligatory HBV vaccines routinely by the national technical and administrative procedures for HBV vaccination on children of China, were convened among villages in Linyi, Shandong province, from October 2008 to March 2009. After detection of serum anti-HBV, one hundred children with lower serum anti-HBV were picked out for the randomized, double blinded, placebo controlled vitamin A supplementation study. The children in the intervention group (50 subjects) took 0.5 g condensed cod liver oil (containing 25 000 IU vitamin A and 2500 IU vitamin D(2)) every 15 days for six times. The children in the control group (50 subjects) were given corn oil with same volume. All children were re-vaccinated at the 30th and the 60th day of the experiment. The serum samples were collected from each child at the 90th day of the experiment. Retinol concentration in serum samples was analyzed with HPLC method before and after the intervention. The levels of serum anti-HBs were detected by the electro-chemi-luminescence immunoassay (ECLIA). RESULTS: Total 74 children finished the supplemental experiment and blood collection, 37 subjects in each group, respectively. After intervention, the serum retinol level in the experimental and control group were (404.1 ± 123.1) and (240.8 ± 92.8) µg/L (t = 6.441, P < 0.01), respectively. The serum anti-HBs levels in the experimental and control group were (2737.2 ± 2492.6) and (1199.7 ± 2141.6) U/L (t = 2.846, P < 0.01), respectively. The rate of weak or no-answer case in experimental and control groups was 0.00% (0/37) and 10.81% (4/37) (χ(2) = 4.229, P = 0.040), respectively. CONCLUSION: The results showed that vitamin A supplementation might enhance the re-vaccination reaction against HB vaccine in infants and young children.

[Effect of balanced diet on the nutrition status of schoolchildren in the mountain area].

OBJECTIVE: To study the effect of balanced diet on the nutrition status of primary schoolchildren in the mountain area in November 2004. METHODS: All the subjects aged 7-9 years old were divided into intervention group and control group. The balanced diet was provided for the intervention group and the control group was maintained on their usual diet for 30 days in December. The anthropometric and nutritional status of the subjects were checked before and after the study. RESULTS: The growth and nutritional status of the intervention group improved significantly. However the unbalanced diet in the control group affects the normal growth of the children because the usual diet can not meet the nutrient requirement. CONCLUSION: The nutrition intervention can improve the growth and nutritional status of the primary schoolchildren in the mountain area.

[Evaluation on beta-carotene-vitamin A equivalence of middle-aged subjects in Chinese adults].

OBJECTIVE: As an extended study of beta-Carotene-vitamin A equivalence in Chinese adults, we carried out an experiment on 10 (5 males and 5 females) rural volunteers aged 38 - 49 years, which would be complementary to the early reported study on subjects aged 50 - 60 years. METHODS: Ten healthy Chinese adult volunteers aged 38-49 years were recruited in a 56 days experiment, which included residency in the Metabolic Research Unit (first 10 days and in home (last 46 days). A physiological dose of 2H8 beta-C (11,011 (nmole or 6 mg) in oil was given with a liquid diet (25% energy from fat) to the volunteers in the first day of the experiment. Three days after the 2H8 beta-C, each volunteer took a reference dose of 2H8 retinyl acetate (8,915 nmole or 3 mg) in oil with the same liquid diet. Serum samples were collected at 0, 3, 5, 7, 9, 11 and 13 hours of the first and the fourth days of study, and fasting serum samples were also collected daily in first 10 days and then weekly at morning of 14th, 21st, 28th, 35th, 42nd, 49th and 56th day after a 12-hours overnight fast. Serum retinol and carotenoids concentrations were measured by high performance liquid chromatography (HPLC). Also retinol fraction was extracted from serum and isolated by HPLC. The serum retinal enrichments were determined by using gas chromatograph/mass spectrometry with electron capture negative chemical ionization (GC-MS). RESULTS: The average 52-day area under the serum 2H4 retinol response curve (from the 2H8 beta-C dose) was (1289 +/- 547) nmol/d and the 52-day area under the serum 2H8 retinol response curve (from the 2H8 retinyl acetate dose) was (3560 +/- 1058) nmol/d. By using 2H8 retinyl acetate as the vitamin A reference, the 2H4 retinol formed from 2H8 beta-C (11,011 nmol) was calculated to be equivalent to (3434 +/- 1449) nmol of retinol. The calculated conversion factor of beta-C to retinol ranged from 2.00 - 9.61 to 1 with an average of (3.89 +/- 2.76) to 1 on a molar basis, or 3.76 - 18.05 to 1 with an average of (7.30 +/- 5.18) to 1 on a weight basis. CONCLUSION: The conversion of beta-C to vitamin A in 10 middle-aged Chinese adults had been quantitatively determined by using a stable isotope reference method, and an average conversion ratio of 7.30 : 1 to 1 on a weight basis was found in this study.