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Essential thrombocythemia (ET) is a chronic myeloproliferative neoplasm (MPN) featured by clonal proliferation of platelets, thrombosis and hemorrhage. Portal hypertension is a serious complication of ET associated with poor prognosis. We report a patient with ET complicated with acute upper gastrointestinal hemorrhage and intestinal perforation due to portal hypertension. She had an uneventful recovery after surgical and endoscopic treatment.
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Objective:To improve the Rapid Arterial Occlusion Evaluation (RACE) scale and to investigate its value in identifying large vessel occlusion (LVO) in patients with acute anterior circulation ischemic stroke (AIS).Methods:Consecutive patients with AIS treated in Liangxiang Hospital of Fangshan District, Beijing through stroke easy access from January 1, 2016 to December 31, 2018 were enrolled prospectively. The clinical data and multimodal CT examinations required to determine LVO were collected. The existing problems in the RACE score were modified. The patients were evaluated by the modified RACE score, RACE score, and National Institute of Health Stroke Scale (NIHSS). The receiver operator characteristic (ROC) curve was used to evaluate the predictive ability of the modified RACE score for LVO, and it was compared with the RACE score and NIHSS score. The ROC curves of LVO predicted by modified RACE score and NIHSS score in patients with left and right hemispheric lesions were compared.Results:A total of 184 patients were included, of which 66 (35.9%) had LVO. The age (64.8±11.7 vs. 60.5±10.8 years; t=2.483, P=0.014), baseline NIHSS score (13 [6.75-17] vs. 5 [2-9]; Z=-6.361, P<0.001) and the proportion of patients with gaze (37.9% vs. 17.4%; χ2=4.696, P=0.030) in the LVO group were significantly higher than those in the non-LVO group. ROC curve showed that the modified RACE score was more effective in identifying LVO than RACE score (area under the curve: 0.812 vs. 0.770; Z=4.654, P<0.001). The best cutoff value of the modified RACE score in predicting LVO was 5, and its predictive sensitivity and specificity were 75.8% and 75.4%, respectively, and the positive and negative predictive values were 63.3% and 84.8%, respectively. A comparison of patients with left hemispheric lesion and those with right hemispheric lesion showed that the ability of the modified RACE score in predicting LVO was more balanced (area under the curve: 0.826 vs. 0.796; Z=0.454, P=0.650), while there was a significant difference in NIHSS score (area under the curve: 0.856 vs. 0.703; Z=2.149, P=0.031). Conclusions:The modified RACE score is better than the original RACE score in the predictive value of LVO in patients with AIS, and its predictive power of LVO in patients with left and right hemisphere stroke is more balanced than the NIHSS score, which may help clinical discrimination and screening for patients suitable endovascular treatment.
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Objective To investigate the risk factors for short-term residual common bile duct stones after laparoscopic cholecystectomy (LC),and to provide a reference for clinical prevention and treatment.Methods A total of 18 patients with short-term residual common bile duct stones after LC who were admitted to The First Affiliated Hospital of Nanyang Medical College from January 2014 to January 2016 were enrolled as observation group,and 320 patients without short-term residual common bile duct stones after LC who were admitted during the same period of time were enrolled as control group.The two groups were compared in terms of acute pancreatitis,alanine aminotransferase (ALT),aspartate aminotransferase (AST),emergency surgery,results of preoperative magnetic resonance cholangiopancreatography (MRCP),direct bilirubin (DBil),the gallbladder full of stones,number of gallstones,minimum stone diameter,gallbladder volume,cystic duct diameter,cystic duct length,and sand-like stones.The independent-samples t test was used for comparison of continuous data between groups,the chi-square test was used for comparison of categorical data between groups,and a logistic multivariate regression analysis was performed for variables with statistical significance.Results The univariate analysis showed that acute pancreatitis,emergency surgery,sand-like stones,retrograde cholecystectomy,preoperative MRCP,number of gallstones,minimum stone diameter,gallbladder volume,cystic duct diameter,and common bile duct diameter were associated with short-term residual common bile duct stones after LC (x2 =9.801,16.217,5.802,9.865,and 5.145,t =18.314,6.077,7.687,15.678,and 5.512,all P ＜0.05).The multivariate logistic regression analysis showed that acute pancreatitis,retrograde cholecystectomy,common bile duct diameter,and cystic duct diameter were independent risk factors for short-term residual common bile duct stones after LC,while preoperative MRCP was a protective factor.Conclusion Active intervention for risk factors for short-term residual common bile duct stones after LC can reduce the incidence of postoperative residual bile duct stones.
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Objective To explore the impact of early use of renal replacement therapy on the prognosis of severe acute pancreati-tis patients .Methods 60 cases of patients with severe acute pancreatitis were chosen between September 2015 and June 2016 in De-partment of General Surgery in our hospital ,and were randomly divided into treatment group (n=30) and control group (n=30) with the method of number table .The patients in the control group were treated with conventional therapy ,treatment group was given the early use of renal replacement therapy (within 12 h after onset) .The scores of Acute Physiology and Chronic Health E-valuation Ⅱ (APACHE Ⅱ) ,partial pressure of oxygen (PaO2 ) ,oxygenation index (PaO2/FiO2 ) ,lactate (Lac) ,C-reactive protein (CRP) ,interleukin 1 (IL-1 ) ,and interleukin-6 (IL-6) levels before treatment ,12 h ,24 h ,48 h and 72 h after treatment were com-pared between two groups ,and the incidence of abdominal compartment syndrome (ACS) was compared as well .Results The difference of the indicators before treatment between two groups was not significant different (P>0 .05);the scores of APACHEⅡ ,PaO2 ,PaO2/FiO2 and Lac levels at 12 h ,24 h ,48 h and 72 h after treatment in treatment group were all lower than those in con-trol group ,and the difference was statistically significant (P<0 .05);CRP ,IL-1 and IL-6 levels at 24 h ,48 h and 72 h after treat-ment in treatment group were lower than those in control group ,and the difference was statistically significant (P<0 .05) .In the control group ,5 cases had ACS ,the incidence rate was 16 .7% ,and there was no case having ACS in treatment group and the differ-ence was statistically significant (P<0 .05) .Conclusion The early application of renal replacement therapy can effectively improve the physiological indexes of patients with severe acute pancreatitis ,inhibit the inflammatory response rapidly ,reduce damage to the abdominal organs ,and is worthy of promotion and application in clinical practice .
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Objective To summarize our experiences in the diagnosis and prognosis of different subtypes of primary thyroid lymphoma (PTL). Methods The clinical data of 27 PTL patients who were treated in our hospital from January 1998 to December 2014 were retrospectively analyzed. The pathological types of these patients included B cell lymphoma unclassifiable (BCLU) (n=5),mucosa-associated lymphiod tissue lymphoma (MALT) (n=9),diffuse large B cell lymphoma (DLBCL) (n=12),and T cell lymphoma (n=1). Results Of all these 27 cases,the most common clinical symptom was painless swelling of the neck (n=21,77.8%). Of 7 patients who had received preoperative fine needle biopsy,lymphoma was suspected in 2 cases (28.6%). Among these 7 cases,the positive rate of suspicious lymphoma was 66.7% in 3 DLBCL patients,0 in 3 MALT patients,and 0 in 1 BCLU paitent. Also,25 patients underwent intraoperative frozen pathological examination,which revealed lymphoma or suspicious lymphoma in 16 cases (64.0%); in these patients,the positive rate was 66.7% for BCLU,77.8% for MALT,58.3% for DLBCL,and 0 for T-cell lymphomas. The overall survival was (89.3±12.4) months,and the overall 5-year survival rate was 61.6%. The estimated survival in symptomatic group was 31.6 months,which was significantly shorter than that in asymptomatic group (97.9 months) (P=0.032). Other factors including age,sex,tumor size,tumor stage,international prognostic index,tracheal compression,lactate dehydrogenase,residual tumor,and pathological type showed no significant effect on survival(all P>0.05). Conclusions DLBCL has the highest fine needle biopsy positive rate,MALT has the highest frozen pathological positive rate,and intraoperative frozen pathology has more malignant results than the preoperative fine needle biopsy in the diagnosis. The accompanying lymphoma symptoms may be an adverse prognostic factor.
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BACKGROUND:Precancerous lesions are a long-term development process in which many factors are involved. Bone marrow mesenchymal stem cel s can repair tissue injury. OBJECTIVE:To investigate the effect of bone marrow mesenchymal stem cel transplantation on gastric precancerous lesions in the rats. METHODS:Thirty-six Wistar rats were randomly divided into control group, model group and transplantation group. Animal models of gastric precancerous lesions were established in the model and transplantation groups. Rats in the transplantation group were given 1 mL of CM-dil-labeled bone marrow mesenchymal stem cel s (3×106 cel s) via the tail vein, once a week, total y three times. Rats in the model and control group were subjected to the tail vein injection of the same volume of normal saline. Then, rats were sacrificed 1 week after final injection, and pathohistological changes in rat gastric tissue sections were observed. The expression of vascular endothelial growth factor in the gastric mucosa and levels of serum cytokines were detected. RESULTS AND CONCLUSION:The severity of gastric mucosal injury in the transplantation group was lighter than that of the model group. The expression of vascular endothelial growth factor was significantly higher in the transplantation group compared with the model and control groups (P<0.05). The levels of serum interleukin-17 and interferon-γwere significantly higher in the model group than the transplantation group fol owed by the control group (both P<0.05). Therefore, bone marrow mesenchymal stem cel s can increase vascular permeability, reduce inflammation, block or ease the occurrence of precancerous lesions by up-regulating the expression of vascular endothelial growth factor in the gastric mucosa lesions and reducing the expression of interleukin-17 and interferon-γ.
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Background and purpose:Pathological lymph node metastasis (LNM) is not rare in clinical lymph node negative (cN0) papillary thyroid carcinoma (PTC). The aim of this study was to investigate the risk factors of LNM, especially of high volume LNM (more than 5 metastatic lymph nodes) and contralateral central compartment LNM, in cN0 PTC.Methods:Medical records of 350 PTC patients (265 female, 85 male, 212 patients with solitary lesion in unilateral lobe) were reviewed. All operations of these patients were performed by one surgical team. The clinical pathological data were collected, and univariate and multivariate analysis was performed.Results:LNM was conifrmed in 138 patients (39.4%) and 20 patients had high volume LNM. In 169 patients with solitary lesion in unilateral lobe with total thyroidectomy and bilateral central neck dissection, 24 patients had contralateral metastasis (14.2%). In univariate analysis, tumor size (58.5% in >1 cmvs 33.6% in≤1 cm) and tumor with calcification in preoperational ultrasonography (43.7% withvs 31.7% without) showed signiifcant difference in prevelance of LNM. In multivariate analysis, tumor size >1 cm (OR=2.792) was the independent risk factor of LNM. Gender (3.8% in male vs 11.8% in female), age (10.7% 1 cmvs 3.4% in≤1 cm) and tumor with low echo in preoperational ultrasonography (13.9% withvs 4.8% without) showed signiifcant difference in univariate analysis of high volume LNM. Male (OR=5.152), tumor size >1 cm (OR=5.712) and age 1 cm (OR=3.863) were also demonstrated as independent risk factors of contralateral LNM in patients with solitary lesion in unilateral lobe, the prevalence of LNM were 26.5% in male and 26.1% in tumor size >1 cm, respectively.Conclusion:LNM was not “rare” in cN0 PTC patients. Prophylactic central neck dissection should be performed in cN0 patients with tumor size >1 cm. For cN0 microcarcinoma, more active surgical treatment may be considered in male and young patients.
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BACKGROUND:Bone marrow mesenchymal stem cels have good proliferation and paracrine functions, which have irreplaceable advantages in the treatment of intestinal diseases. OBJECTIVE:To explore the effects of bone marrow mesenchymal stem cel transplantation on intestinal ischemia-reperfusion injury in rats. METHODS:Forty-eight Sprague-Dawley rats were enroled to make animal models of ischemic reperfusion injury of the intestine, and then model rats were randomized into experimental and control groups. After modeling, 1 mL bone marrow mesenchymal stem cels or the same volume of normal saline were injected into the intestinal mucosa of rats in the two groups, respectively. At hours 0, 2, 6, 24, 72, 120 after injection, serum diamine oxidase,tumor necrosis factor α, and D-lactic acid levels were detected by ELISA method. At 24 hours after injection, rat intestinal tissues were taken and observed pathologicaly under light microscopy, and their close connections were observed under transmission electron microscope. ZO-1 protein levels were detected by immunohistochemistry method. RESULTS AND CONCLUSION:Compared with the control group, the serum diamine oxidase, tumor necrosis factor α, and D-lactic acid levels were significantly lower in the experimental group at hours 6 and 24 after injection (P < 0.05). Intestinal necrosis, vilous edema, intestinal congestion and inflammatory cel infiltration in the experimental group were milder than those in the control group. In addition, the ZO-1 protein expression in the experimental group was higher than that in the control group. Experimental results show that bone marrow mesenchymal stem cel transplantation into the intestinal mucosa can improve the intestinal mucosal permeability in rats with intestinal ischemia-reperfusion injury.
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BACKGROUND:In esophageal cancer chemotherapy, inhibiting proliferation of tumor cels and tumor stem cels can be effectively improved by using appropriate sensitive agents. OBJECTIVE:To explore the effect of molybdenum on ECA-109 cel chemosensitivity and p75NTR cel inhibition in esophageal carcinoma cels. METHODS:ECA-109 cels at logarithmic phase were selected and randomly divided into blank control group, cisplatin group, molybdenum group and molybdenum+cisplatin group (combination group). Molybdenum and cisplatin at different concentrations were used in the three groups. MTT assay was used to detect ECA-109 cel proliferation and growth; flow cytometry was used to detect the proportion of P75NTR cels. RESULTS AND CONCLUSION:Cisplatin at different concentrations showed a certain inhibitory role in ECA-109 cels, which had an increasing kiling effect on esophageal carcinoma stem cels at dose- and time-dependent manner. Molybdenum alone had no remarkable kiling effects on inhibiting ECA-109 proliferation and esophageal carcinoma stem cels. Combination of molybdenum and cisplatin was found to have an enhanced effect to inhibit ECA-109 cels and to kil esophageal carcinoma stem cels in a dose- and time-dependent manner, which was significantly different from the cisplatin group and blank control group (P < 0.05). These findings indicate that molybdenum can promote and enhance the inhibitory effect of cisplatin on ECA-109 and p75NTR cels, which can be used as a chemosensitizer.
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Objective To investigate the expression and clinical significance of apoptosis inhibitory protein, Livin and Smac,in pancreatic carcinoma. Methods The expressions of Livin and Smac protein in 46 cases of pancreatic carcinoma tissues and 15 cases of insulinoma tissues and 14 cases of normal pancreatic tissues were examined by using immunohistochemical SP staining, and its relationship with clinicopathological parameters was analyzed. Results The positive expression rates of Llivin protein were 73.9％ ( 34/46),73.3％ (11/15) and 14.3％ (2/14) in pancreatic carcinoma, insulinoma and normal pancreatic tissue. Livin was highly expressed in pancreatic carcinoma and insulinoma, but there was no significant difference between the two groups, however, both were significantly higher than that in normal pancreatic tissues group ( P ＜ 0.05 ). The expression of Livin was significantly correlated with lymph node metastasis, histopathological grading and clinical staging (P ＜ 0.05 or P ＜0.01 ). The positive expression rates of Smac protein were 39.1％ (18/46), 100％ ( 15/15 ) and 92.9％ (13/14) in pancreatic carcinoma, insulinoma and normal pancreatic tissue. Smac was highly expressed in normal pancreatic tissues and insulinoma, but there was no significant difference between the two groups, however, both were significantly higher than that in pancreatic cancer group (P ＜ 0.05 ). The expression rote of Smac protein was significantly correlated with lymph node metastasis, histopathological grading, chnical staging and patients' age (P ＜0.05 or P ＜0.01 ).Conclusions Livin protein may play an important role in genesis and development of pancreatic carcinoma,but Smac protein may play a role in preventing the development of pancreatic carcinoma.
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OBJECTIVE To take effective disinfection and isolation measures to prevent and control infection after blood sampling and to ensure the safety of the blood donors and the health of the recepients.METHODS Effectively and strictly sterilize and isolate the blood sampling environment,the materials,the donors arms,the medical staff fingers etc;and strictly obey the aseptic technique regulations;and strict sense of disinfection.RESULTS No single case of infection occurred since October,2000.CONCLUSIONS Our measures have prevented and controlled infection after blood sampling;and have ensured the safety of donors.An increasing satisfaction is found from among the donors.More and more citizens are becoming active voluntary blood donors.
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Objective To investigate the method and effect of laparoscopic splenectomy(LS) using the Endo-Cutter and the LapDisc.Methods Laparoscopic splenectomy(LS) using the Endo-Cutter and the LapDisc was performed in 12 patients,including 7 patients with hematopathy and 5 patients with benign tumors.The laparoscopic procedure was performed with the surgeon's left hand through the LapDisc.With the left hand providing safe retraction,a harmonic scalpel was used to incise the splenorenal ligament and the splenogastric ligament.After the spleen was mobilized,a vascular stapler(Endo-Cutter) was used to divide the splenic hilum.The spleen was delivered out of the abdominal cavity through the hand-assisted incision.Results All the LS were successfully completed and no conversion to open surgery was needed.The operating time was 35~120 min(mean,80 min),the blood loss during operation was 40~200 ml(mean,127 ml),and the hospital stay,3~6 d(mean,4.5 d).Follow-up in the 12 patients for 6 months found no complications. Conclusions Laparoscopic splenectomy using the Endo-Cutter and the LapDisc is safe and effective.
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Objective To clarify if estrogen increases gastric mucosal injury in portal hypertensive rats and its role in the pathogenesis of portal hypertensive gastropathy. Methods Forty SD rats were divided into 4 groups:P + E, P, S + E and S groups. P + E and P groups received portal vein ligation and the S + E and S groups underwent sham operation. P + E and S + E groups were given estrogen intramascularly. All rats were maintained on their indiuidual treatment for 14 days. One hour before the sacrifice rats were orally lavaged with 2 ml 99% ethanol. Gastric mucosal blood flow, degree of gastric mucosal injury and mucosal NO production were determined. Results The P + E group had the highest gastric blood flow of (103?14) U compared with the other 3 groups (P