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Objective:To compare the clinical efficacy of percutaneous transhepatic gallbladder drainage (PTGBD) combined with delayed laparoscopic cholecystectomy (LC) with direct LC in the treatment of acute cholecystitis.Methods:A single-center case-control retrospective study was used. Sixty-three patients with acute cholecystitis with onset time ≥ 72 hours during the period from August 1, 2021 to December 10, 2022 in the Department of Hepatobiliary Surgery of the 900TH Hospital of Joint Logistics Support Force were selected. There were 38 males and 25 females, aged (57.3±15.4) years, with an age range of 28-87 years. According to whether PTGBD treatment was performed before LC, they were divided into experimental group ( n=29) and control group ( n=34). Experimental group was treated with PTGBD combined with delayed LC and control group was treated with LC only.The differences in operative time, intra-operative bleeding, intra-operative transit open rate, post-operative hospital days, total hospital days, hospital costs, short-term post-operative complications of LC and post-operative time to exhaustion were compared and analysed between the two groups. Measurement data with normal distribution were expressed as mean±standard deviation ( ± s), and independent sample t-test was used for comparison between groups.Measurement data with skewed distribution were expressed as M( Q1, Q3), and rank sum test was used for comparison between groups; Chi-square test was used to compare the counting data groups. Results:Intraoperative bleeding, total hospital days, hospital costs and postoperative time to exhaustion were 0(0, 50) mL, 13(11, 18) d, 29 015.0 (22 791.6, 39 000.8) yuan and 1(1, 2) d in the experimental group and 50(0, 88) mL, 7(6, 11) d, 16 015.0 (15 832.1, 22 185.1) yuan, 2(1, 3) d, the difference was statistically significant between the two groups( P<0.05). In the experimental group, the operative time, the intraoperative transit open rate, the number of postoperative hospital days, and the incidence of short-term postoperative complications of LC were 80 (55, 115) min, 13.8%, 5 (3, 7) days, 34.5%, respectively, compared with 98(70, 125) min, 20.6%, 5(3, 6) days, 38.2% in the control group, the difference between the two groups was not statistically significant ( P>0.05). Conclusion:The clinical efficacy of PTGBD combined with delayed LC is better than direct line LC, and it is feasible and effective for patients with cholecystitis whose inflammatory indexes have returned to normal and who have high gallbladder tone.
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Objective:To investigate the diagnostic value of electrocardiographic ST-segment changes for myocardial injury related to percutaneous coronary intervention.Methods:We included 60 patients who received percutaneous coronary intervention in Haining People's Hospital from January 2020 to February 2021 in this study. We detected serum troponin I level before and after treatment and recorded electrocardiographic ST-segment changes. Taking serum troponin I level as a reference, we divided these patients into myocardial injury and non-myocardial injury groups and analyzed the influential factors of myocardial injury.Results:Balloon inflation time and stent length were (85.6 ± 56.2) minutes and (25.2 ± 15.2) mm in the myocardial injury group, and they were (48.5 ± 39.2) minutes and (17.2 ± 8.2) mm in the non-myocardial injury group. There were no significant differences in balloon inflation time and stent length between the two groups ( t = -3.01, -2.42, both P < 0.05). The proportion of patients with electrocardiographic ST-segment changes was significantly higher in the myocardial injury group than in the non-myocardial injury group [(80.77% (21/26) vs. 5.88% (2/34), χ2= 34.95, P < 0.001). Multivariable logistic regression analysis results showed that electrocardiographic ST-segment changes were an influential factor of myocardial injury ( r = 69.25, P < 0.05). Conclusion:Electrocardiographic ST-segment changes are an independent influential factor of myocardial injury related to percutaneous coronary intervention. It can effectively judge the possibility of developing a myocardial injury and increase the safety of percutaneous coronary intervention.
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@#An innovative approach to quantitatively analyze the histamine and its precursor histidine simultaneously in biological matrices was established for the first time based on double adsorption combined with high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS).The internal standard was 2-dihydroxybenzoic acid (DHB).The plasma and brain tissue homogenate was protein precipitated with 3-fold acetonitrile, and the supernatant was then sampled for injection analysis.The chromatographic separation of the target components was achieved on an amino chromatography column (ODS-SPXBridge? Amide).Gradient elution was carried out with the mobile phase consisting of solvent A (0.1% formic acid and 1mmol/L ammonium formate in water) and solvent B (acetonitrile).Mass spectrometry was employed for quantitative analysis with ESI ion source in multiple reaction monitoring (MRM) mode.In order to improve the specificity and accuracy, activated carbon and calcite were used for the double adsorption of biological matrices for the first time.The adsorbed matrix was then used for methodology validation.The results showed that histamine and histidine were linear in the quantitative range (correlation coefficient r ≥ 0.999).Accuracy, precision, extraction recovery, matrix effect and stability all met the requirements of biological sample analysis.All results suggested that the present method could not only be efficiently and reliably used for simultaneous quantitative analysis of histamine and histidine in biological samples, but also provide reference for the detection of other endogenous substances.
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Objective To explore the values of serological markers in the phenotype diagnosis of Crohn's disease (CD).Methods From January 2015 to December 2016,100 patients diagnosed as CD were enrolled.The levels of human anti-Saccharomyces cerevisiae antibody (ASCA) IgG,ASCA IgA,anti-mannobioside carbohydrate antibody (AMCA),anti-chitobioside carbohydrate antibody (ACCA),antibody against outer membrane porin C of Escherichia coli (anti-OmpC),antibody against pseudomonas fluorescens (anti-I2),flagella protein antibody,perinuclear anti-neutrophil cytoplasmic antibodies (pANCA) and antibodies to proteinase-3 (anti-PR3) were detected by indirect enzyme-linked immunosorbent assay (ELISA).Binary Logistic regression analysis was used to analyze the correlation between the serological markers and the phenotype of CD.The diagnosis values were evaluated by receiver operating characteristic (ROC) curve.Results The level of anti-I2 was significantly correlated with the narrow type of patients with CD (odd ratios (OR) =34.304,P=0.011);ACCA and flagella protein antibody were significantly correlated with the penetrating type of patients with CD (OR =1.024,P=0.027;OR=2.702,P=0.021).ASCA IgA and AMCA were significantly correlated with the lesion involved gastric,duodenum and small intestine in CD patients (OR =1.146,P=0.044;OR=1.035,P=0.013).In the diagnosis of narrow type CD,the diagnostic accuracy of anti-I2 was the highest (area under curve (AUC) =0.631,P=0.043),and according to this result,its best cutoff value was 0.650,and then the sensitivity increased to 28.6％ (8/28).In the diagnosis of penetrating type CD,the diagnostic accuracy of flagella protein antibody was the highest (AUC=0.725,P＜0.01).Anti-OmpC (AUC =0.677,P=0.006) and ACCA (AUC=0.644,P=0.025) also had higher diagnostic accuracy.According to these results,the best cutoff values of flagella protein antibody,anti-OmpC and ACCA were 0.395,0.225 and 59.500,respectively,and then their sensitivity improved after correcting the cutoff values.The AUC of any one item positive in the combination of flagella protein antibody,anti-OmpC and ACCA in the diagnosis of penetrating type CD was 0.761 (P＜0.01),which was significantly higher than the diagnostic accuracy of single antibody detection.In the diagnosis of the lesions involved gastric,duodenum and small intestine,the diagnostic accuracy of AMCA was the highest,and its AUC was 0.817 (P＜0.01).ASCA IgA (AUC=0.772,P=0.001) and ACCA (AUC=0.752,P=0.001) also had higher diagnostic accuracy.The AUC of any one item positive of ASCA IgA and AMCA in the diagnosis of CD lesions involved gastric,duodenum and small intestine was 0.905 (P＜0.01),which was significantly higher than the diagnostic accuracy of single antibody detection.The best cutoff values of ASCA IgA,AMCA and ACCA were 21.500,55.000 and 29.500,respectively.And their sensitivity improved after correcting the cutoff values.The sensitivity of any one item positive in the three items also improved.Conclusion The detection of serological markers has great clinical values in the hierarchical management of phenotypes in Chinese CD population.
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Background:Oryz-Aspergillus Enzyme and Pancreatin Tablet is a double-deck digestive enzyme pellet containing Oryz-Aspergillus enzyme and pancreatin that has been widely used for treatment of functional dyspepsia (FD)in clinical practice. However,there is no randomized controlled trial focusing on the efficacy of this agent versus other drugs used for treatment of FD such as prokinetics and proton pump inhibitors (PPI). Aims:To compare the efficacy and safety among Oryz-Aspergillus Enzyme and Pancreatin Tablet,Domperidone Tablet and Esomeprazole Magnesium Enteric-coated Tablet, three drugs with different mechanisms of action on FD,in Chinese population. Methods:A total of 82 Helicobacter pylori-negative outpatients fulfilling the diagnostic criteria of FD in Rome Ⅲ were recruited from Nov. 2015 to Jun. 2016 at the First Affiliated Hospital of Zhejiang Chinese Medical University. These patients were randomly allocated into 3 groups,and received Oryz-Aspergillus Enzyme and Pancreatin Tablet (group A),Domperidone Tablet (group B)and Esomeprazole Magnesium Enteric-coated Tablet (group C)orally for 4 weeks,respectively. The improvement of dyspeptic symptoms and adverse events were observed and recorded. Results:After 4 weeks treatment,the overall efficacies for global symptoms in group A,group B and group C were 93. 1%,88. 9% and 69. 2%,respectively,statistically significant difference was existed among the three groups (P < 0. 05). Domperidone Tablet was effective for postprandial fullness and early satiety;Esomeprazole Magnesium Enteric-coated Tablet was sensitive for epigastric pain,epigastric burning,and belching and regurgitation;the efficacies of Oryz-Aspergillus Enzyme and Pancreatin Tablet for all five dyspeptic symptoms were in between. No adverse events were observed during treatment course. Conclusions:Digestive enzymes,prokinetics and PPI have different sensitive symptoms and optimal indications for treatment of FD. The overall efficacy of Oryz-Aspergillus Enzyme and Pancreatin Tablet is superior to that of prokinetics and PPI.
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Recently the lysine succinylation was discovered in vivo, and it was demonstrated to be widely involved in cell dif-ferentiation, cell metabolism and other important physiological activities.Lysine succinylation has become the forefront of life science research.Scientists have provided a lot of evidences that proteins in prokaryotes and eukaryotes are widely succinylated, without which the central metabolism and intermediary metabolism of many metabolic enzymes are disrupted.To better understand the importance of Succinylation in vivo, protein-succinyl modification of the current research and the latest developments are reviewed, which summarize succinylated protein lysine sites in the center of important physiological metabolic pathways, diseases and other pathological conditions.
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Objective To investigate the clinical effect of cryosurgery in the preoperative preparation of liver transplantation in treating liver cancer.Method This study reviewed retrospectively clinical data from 74 patients who underwent cryosurgery of liver cancer before liver transplantation.According to the differences between transplantation programs,74 patients were divided into 2 groups:26 patients in Argon-helium cryoablation group (AHC group) and 48 patients in transcatheter arterial chemoembolization group (TACE group).Whether the patients in two groups met the standard of Milan after treatment,as well as the incidence rate of complication,waiting time for transplantation and MELD score before transplantation were compared between two groups after preoperative therapy.What's more,operation time,no liver time,amount of bleeding,PT and serum level of aminotransferase at 1st,3rd,and 5th day after transplantation were analyzed.Abdominal drainage fluid volume,the incidence of infection,acute rejection,kidney failure,biliary complication,and vascular complication in two groups were also compared.Disease free survival rate was counted after two years by outpatient follow-up.Result Only 3 cases in two groups exceeded Milan standard after treatment,one in AHC group and two in TACE group.The complication incidence and waiting time in two groups had no statistically significant differences.The MELD score in AHC group was significantly lower than in TACE group before transplantation.The operation time,amount of bleeding and transfusion requirements in AHC group were also significantly lower than in TACE group.The time without liver in two groups had no statistically significant difference.The speed of liver function recover was faster in ACH group,and the abdominal drainage fluid volume was less.There were no significant differences in incidence of postoperative complications between two groups (P＞0.05).Conclusion Cryosurgery therapy has little effect on liver functions after treatment.It is a good therapy for liver cancer patients before liver transplantation.
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According to the Organ Injury Scale Grading System of the American Association for the Surgery of Trauma (AAST-OIS),grade Ⅴ liver trauma is always complicated with retrohepatic inferior vena cava injury and less bile duct injury,and it is extremely severe and difficult to be treated.Timely and fast judgment,emergent exploration and effective repair of the injured bile duct are the key points for the treatment of bile duct injury.One patient with grade Ⅴ liver trauma combined with hilar bile duct transection injury was admitted to the Fuzhou General Hospital of Nanjing Military Command on August 30,2013.The rupture of left and right liver junction was detected by preoperative multidisciplinary consultation and emergency open surgery at admission hour 4.There was left and right hepatic duct bifurcation rupture at the first hepatic hilum.Non-functional liver tissues were excised.Breakage left and middle hepatic vein were sutured by polymer suture line.Liver traumatic bleeding and bile duct were sutured and ligatured individually.Left and right hepatic duct laceration was sutured by 6-0 PDS suture line.A hole in the stomach wall was opened fist,and then most part of the gastric contents was removed and the gastric wall was reparied by stapler.Patient received the postoperative symptomatic treatment with gradual recovery,and was discharged from hospital at admission day 26.The patient was readmitted to the hospital at 31 days of discharge due to outflow of purulent fluid from abdominal cavity drainage tube,and was treated by ceftriaxone sodium and tazobactam sodium according to the results of drug sensitive test and continuous peritoneal lavage.The abdominal cavity drainage tube and left and right hepatic duct drainage tube were removed at postoperative day 83.The patient was discharged from hospital at readmission day 28,and was followed up till December 2014 with good recovery and without complication.
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Objective To investigate the effects of intracavity double pipe suction in the duodenal rupture repair.Methods The clinical data of 56 patients with duodenal rupture repair who were admitted to Fuzhou General Hospital from January 2003 to January 2014 were retrospectively analyzed.Thirty-one patients and 25 patients received the simple drainage (simple drainage group) and intracavity double pipe suction (intracavity double pipe suction group) for duodenal rupture repair.Quantitative data were presented by $ ± s,repeated measures analysis of variance and the t-test were used to evaluate quantitative data,respectively.Count data were analyzed using Chi-square test or Fisher's exact test.Results Volume of drainage of patients in the intracavity double pipe suction group at day 1,2,3,4,5,6,7 were (220 ± 54) mL,(284 ± 65) mL,(368 ± 35) mL,(413 ± 41) mL,(454 ± 62) mL,(714 ± 96) mL and (852 ± 121) mL,compared with (102 ± 30) mL,(124 ± 29)mL,(186 ±26)mL,(110 ±21)mL,(167 ±31)mL,(193 ±35)mL and (182 ±44)mL in the simple drainage group,with a significant difference between the 2 groups (F =65.214,P ＜ 0.05).The volumes of drainage of the 2 patterns were compared at postoperative day 1 to 7,with a significant difference (t =9.532,11.624,13.421,15.257,14.147,18.311,20.135,P ＜0.05).The incidence of duodenal fistula,intraperitoneal infection and wound infection in the simple drainage group were 29.0％ (9/31),41.9％ (13/31) and 51.6％ (16/31),compared with 4.0％ (1/25),12.0％ (3/25) and 16.0％ (4/25) in the intracavity double pipe suction group,showing a significant difference between the 2 groups (x2 =4.460,6.077,7.645,P ＜ 0.05).The incidence of pancreatic fistula and pulmonary infection in the sample drainage group and intracavity double pipe suction group were 16.1％ (5/31) and 29.0％ (9/31),8.0％ (2/25) and 12.0％ (3/25),with no significant difference between the 2 groups (x2 =0.836,2.385,P ＞ 0.05).The duration of hospital stay and hospital expenses in the simple drainage group and the intracavity double pipe suction group were (30 ± 14) days and(12 ± 6) x 104 yuan,(21 ± 7) days and (7 ± 5) x 104 yuan,respectively,with significant difference between the 2 groups (t =3.161,2.913,P ＜ 0.05).Conclusion The intracavity double pipe suction for duodenal rupture repair is simple and effective for significantly improving the prognosis of patients and reducing the duration of hospital stay and hospital expenses.
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Objective To investigate the clinical efficacies of the conservative and surgical treatment of grade m and Ⅳ traumatic hepatic rapture.Methods The clinical data of 77 patients with traumatic hepatic rapture were analyzed.All the patients were admitted to the Fuzhou General Hospital of Nanjing Military Command from January 2004 to June 2014.According to the Organ Injury Scale grading system of the American Association for the Surgery of Trauma (AAST-OIS) and the Becker classification,there were 44 patients and 33 patients had grade Ⅲ and grade Ⅳ traumatic hepatic rapture,respectively.The vital signs,condition of the wound and the resuhs of imaging examination were comprehensively analyzed,and the conservative and surgical treatment methods were selected accordingly.Patients were followed up via outpatient examination or telephone interview till September 2014.Results There were 19 patients received conservative treatment and 25 received surgical treatment among the 44 patients with grade m traumatic hepatic rapture,and 5 received conservative treatment and 28 received surgical treatment among the 33 patients with type Ⅳ traumatic hepatic rapture.Thirty-one patients received suture of the liver,18 received partial hepatectomy and 4 received damage control surgery.All the 77 patients were cured without perioperative death.For patients with grade m traumatic hepatic rapture,the duration of hospital stay were (12 ± 9)days and (20 ± 15)days for patients received conservative and surgical treatment,respectively; and for patients with grade Ⅳ traumatic hepatic rapture,the duration of hospital stay were (17 ± 3) days and (34 ± 25) days for patients received conservative and surgical treatment,respectively.Nineteen patients had complications,including 10 with hepatic abscess,5 with bile leakage (cured by puncture and drainage),2 with pseudoaneurysm (cured by interventional therapy with digital subtraction angiography),1 with adhesive intestinal obstruction and delayed hemorrhage (cured by operation for 2 times).Seventy-one patients were followed up,with the rate of 92.2％ (71/77).The median time of follow-up was 7 months (range,3-15 months).Only 1 patient was complicated with hepatic abscess at postoperative month 13,and was cured by puncture and drainage,and the other patients were live and well.Conclusions The success rate of operation for patients with grade m traumatic hepatic rapture is relatively high with short hospital stay and quick recovery of patients.The indication of conservative treatment for patients with grade Ⅳ traumatic hepatic rapture should be strictly controlled,and the surgical treatment is the main means of therapy.Hepatic abscess,bile leakage and pseudoaneurysm are the common complications for patients with traumatic hepatic rapture.
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Objective To investigate the association between glucose metabolism status and brachial-ankle pulse wave velocity(baPWV)in Chinese patients with coronary artery disease(CAD).Methods baPWV values were measured in 198 CAD patients.Plasma glncose,serum lipids,hsCRP and other baseline data were obtained in all the patients.According to the glucose level,the participants were divided into 3 groups:normal glucose tolerance(NGT)group,impaired glucose regulation(IGR)group and diabetes mellitus(DM)group.ResultsbaPWV values in the DM group(1807±381)cm/s were significantly higher than those in the NGT group[(1615±248)cm/s,P=0.000]and IGR group[(1674±277)cm/s.P=0.035].Multiple stepwise linear regression analyses indicated that higher baPWv values were associated with aging and hsCRP levels in 198 patients.In DM group,higher baPWV values were independently associated with aging and HbA1 C levels.Conclusions In patients with coronary artery disease.baPWV values increase with different glucose metabolism status from NGT to IGR then DM.baPWV values in the patients with DM were significantly higher than those in the other two groups.Glycemic control may ameliorate arterial stiffness.