Clinical efficacy of gastroscopic and sequential laparoscopic therapy in the treatment of gastric variceal bleeding / 中华消化外科杂志

Objective:To investigate the clinical efficacy of gastroscopic 'sandwich’ injection and sequential laparoscopic splenectomy combined with pericardial devascularization in the treatment of gastric variceal bleeding.Methods:The retrospective cohort study was conducted. The clinical data of 52 patients with cirrhotic portal hypertension combined with gastric variceal bleeding who were admitted to Affiliated Hospital of Jiaxing University between March 2011 and October 2019 were collected. There were 33 males and 19 females, aged (63±9)years, with a range of 41-83 years. Of the 52 patients, 31 undergoing gastroscopic 'sandwich’ injection and sequential laparoscopic splenectomy combined with pericardial devascularization and 21 undergoing laparoscopic splenectomy combined with pericardial devascularization were allocated into sequential group and laparoscopic group, respectively. Observation indicators: (1) surgical situations; (2) complications; (3) changes in gastric varices after treatment; (4) follow-up. Follow-up was performed using telephone interview combined with outpatient examination to detect survival of patients up to December 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed by the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed by the Mann-Whitney U test. Count data were expressed as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Ordinal data was analyzed by nonparametric rank sum test. Results:(1) Surgical situations: patients of sequential group and laparoscopic group underwent surgery successfully. The operation time and volume of intraoperative blood loss of the sequential group were (112±16)minutes and (57±11)mL, respectively, versus (103±14)minutes and (55±9)mL of the laparoscopic group, showing no significant difference in the above indicators between the two groups ( t=0.963, 1.052, P>0.05). (2) Complications: 11 patients in the sequential group had postoperative complications including 1 case with perioperative bleeding, 2 cases with postoperative gastrointestinal rebleeding, 4 cases with ascites, 4 cases with portal vein thrombosis. There was no death in the sequential group. Sixteen patients in the laparoscopic group had postoperative complications including 2 cases with perioperative bleeding, 6 cases with postoperative gastrointestinal rebleeding, 4 cases with ascites, 4 cases with portal vein thrombosis. Three patients died in the laparoscopic group. There was no significant difference in the cases with perioperative bleeding or cases with ascites between the two groups ( P>0.05) and no significant difference in the cases with portal vein thrombosis or death between the two groups ( χ2=0.082, 0.082, P>0.05). There was a significant difference in the cases with postoperative gastrointestinal rebleeding between the two groups ( P<0.05). Cases with postoperative gastrointestinal rebleeding, cases with ascites, cases with portal vein thrombosis in the sequential group were cured after the treatment of gastroscopy, low salt diet combined with diuretic or low dose warfarin, respectively. Of the 6 patients with postoperative gastrointestinal rebleeding in the laparoscopic group, 3 were cured after the treatment of gastroscopy and 3 died due to failure to rescue in time. Cases with ascites and cases with portal vein thrombosis in the laparoscopic group were cured after the treatment of low salt diet plus diuretic or low dose warfarin, respectively. (3) Changes in gastric varices after treatment: at postoperative 6 months, 31 patients in the sequential group were diagnosed with negative gastric varices; 15 of 21 patients in the laparoscopic group were diagnosed with negative gastric varices, 3 cases were diagnosed with obvious gastric varices and 3 cases were diagnosed with severe gastric varices. There was a significant difference in the cases with gastric varices between the two groups ( Z=-3.128, P<0.05). At postoperative 12 months, 29 patients in the sequential group and 13 patients in the laparoscopic group were diagnosed with negative gastric variceal. There were 2 patients in the sequential group diagnosed with obvious gastric varices, and 8 patients in the laparoscopic group diagnosed with gastric varices including 3 cases with obvious gastric varices and 5 cases with severe gastric varices. There was a significant difference in the cases with gastric varices between the two groups ( Z=-2.933, P<0.05). Cases with obvious gastric varices in the sequential group were cured after the treatment of gastroscopy. Cases with obvious or severe gastric varices in the laparoscopic group were cured after the treatment of gastroscopy except 1 died due to massive gastrointestinal hemorrhage. (4) Follow-up: 52 patients were followed up for 1-8 years, with a median time of 4 years. All the 31 patients in the sequential group and 18 ptients in the laparoscopic group survived. Conclusion:Gastroscopic 'sandwich’ injection and sequential laparoscopic splenectomy combined with pericardial devascularization in the treatment of gastric variceal bleeding has low recurrence rate of varicosity and low incidence of rebleeding.

Combined laparoscopic and gastroscopic treatment of patients with cirrhosis and portal hypertension presenting with bleeding esophageal varices / 中华肝胆外科杂志

Objective:To evaluate the efficacy of laparoscopic splenectomy plus pericardial devascularization combined with gastroscopic (double endoscopy) treatment of patients with cirrhosis and portal hypertension presenting with bleeding esophagogastric varices.Methods:To retrospectively analyze 108 patients who presented with bleeding esophageal and gastric varices at the First Hospital of Jiaxing from March 2013 to March 2018. Of 108 patients, there were 61 males and 47 females, with an average age of 61 years. According to the disease and desires of patients and family members, 28 patients underwent laparoscopic splenectomy plus devascularization (the laparoscopic group), 43 endoscopic treatment (the endoscopic group) and 37 double endoscopic treatment (the double endoscopic group). The liver function, renal function, hemoagglutination and degrees of recurrence of the three groups were compared after operation.Results:The renal function, coagulation function, HbA1c in the double endoscopic group was significantly better than that in the other two groups ( P<0.05). In the laparoscopic group, there were 4 patients who presented with rebleeding within 36 months, compared with 3 in the endoscopic group, and no patients in the combined group. At 36 months after operation, gastroscopy performed in the laparoscopic group showed mild varices in 8(28.6%) patients, moderate in 9(32.1%), and severe in 11(39.3%). In the endoscopic group, there were 7(16.3%) patients with mild, 26(60.5%) with moderate, and 10(23.2%) with severe. In the double endoscopic group, there were 32(86.5%) patients with mild and 5(13.5%) with moderate. The degrees of recurrence and postoperative esophageal and gastric varices rebleeding in the double endoscopic group were significantly better than those in the laparoscopic group and the endoscopic group ( P<0.05). Conclusion:Laparoscopic combined with endoscopic treatment was more effective in patients with cirrhosis and portal hypertension who presented with bleeding esophageal varices.

Resistance of Helicobacter pylori to Commonly Used Antibiotics in Jiaxing Area,Zhejiang Province from 2009 to 2013 / 胃肠病学

Background:Resistance of Helicobacter pylori(Hp)to antibiotics is the primary reason for failure of Hp eradication therapies. It has been reported that there are regional differences in the resistance rate of Hp to commonly used antibiotics. Monitoring the regional Hp resistance status is helpful for improving the eradication rate in local area. Aims:To investigate the resistant spectrum of clinical Hp strains to commonly used antibiotics in Jiaxing Area,Zhejiang Province. Methods:A total of 17 402 patients who underwent gastroscopy from Jan. 2009 to Dec. 2013 at Jiaxing First Hospital were recruited for Hp culturing by using gastric antral biopsies. Then a drug sensitive test was performed for the Hp strains obtained from the culturing. Sensitivity of these Hp strains to metronidazole,amoxicillin,gentamicin,furazolidone,clarithromycin and levofloxacin was determined. Results:Among the 17 402 cases of gastric antral biopsies,5 898(33. 9% )were positive for Hp culturing. Drug sensitive test revealed that the resistance rate of metronidazole was extremely high in all year and age groups;the resistance rates of clarithromycin and levofloxacin were increasing by years;and the resistance rates of furazolidone,amoxicillin and gentamicin were considerably low in all year and age groups. When two antibiotics were combined,amoxicillin and gentamicin accounted for the lowest resistance rate,and the next were amoxicillin and furazolidone,and gentamicin and furazolidone,respectively. Conclusions:The clinical Hp strains isolated from all age groups in Jiaxing Area,Zhejiang Province are highly resistant to metronidazole,therefore it is not recommended to be used in first line eradication regimen. Amoxicillin combined with gentamicin/ furazolidone is an ideal antibiotic combination for patients with Hp infection in all age groups;and combination of gentamicin and furazolidone is recommended to patients who are allergic to penicillin.

Expression profiling and immunofluorescence localization of the major egg antigen p40 of Schistosoma japonicum in the liver of infected New Zealand white rabbits / 南方医科大学学报

<p><b>OBJECTIVE</b>To examine the expression profile and immunofluorescence localization of the major egg antigen p40 of Schistosoma japonicum (Sjp40) during granuloma formation in the liver of infected New Zealand white rabbits.</p><p><b>METHODS</b>New Zealand white rabbits were infected with S. japonicum cercariae, and the livers were harvested at 29 and 45 days post-infection (dpi). The total RNA of the liver tissues was extracted for expression profiling of Sjp40 by quantitative reverse transcription-PCR (qRT-PCR) with GAPDH of S. japonicum as the endogenous reference gene. The expression of Sjp40 in the liver were detected by Western blotting using anti-Sjp40 monoclonal antibody (mAb) 9G7 or anti-Toxoplasma gondii tSAG1 mAb Y3A8 (control) as the primary antibody. Paraffin sections of the liver were prepared for observing egg granuloma formation using HE staining and for indirect immunofluorescence assay of Sjp40 location in the trapped eggs and egg granulomas.</p><p><b>RESULTS</b>The level of Sjp40 mRNA in the eggs trapped in rabbit livers was significantly higher at 45 dpi than that at 29 dpi (P<0.05), and Western blotting confirmed the presence of Sjp40 protein in the rabbit livers at both 29 and 45 dpi. Immunofluorescence assay demonstrated localized expression of Sjp40 in the immature eggs in the rabbit liver at 29 dpi, but at 45 dpi fluorescence was detected in clusters of mature eggs containing miracidium and in the surrounding egg granulomas.</p><p><b>CONCLUSIONS</b>The transcriptional levels of Sjp40 significantly increased with the maturation of eggs trapped in the rabbit livers. Sjp40 protein spread from the eggs to the surrounding egg granuloma at 45 dpi when acute liver granulomatous lesions occur, suggesting that Sjp40 plays a key role in egg granulomas formation in the livers of infected New Zealand white rabbits.</p>

Discussions on the business strategy against total reimbursement control of medical insurance for large public hospitals / 中华医院管理杂志

To address such challenges as the rapid rise in health care costs,insufficient constraints on supply-side behavior by medical insurance,and rising risk exposure of the insurance foundation,the Ministry of Human Resources and Social Security has proposed a payment mode reform featuring total reimbursement control.Such a total control policy will affect significantly the business operation of urban public hospitals.To adapt to the impacts so incurred,a three-level transformation strategy is recommended as follows.A development strategy calling for a new growth model,greater role of hospital-health alliances for greater service coverage; a business management strategy to ensure quality of care and safety,clinical pathways in place and optimize service processes; an administrative strategy to enhance cost control,strengthen information technology,and transform the management functions.

Analysis of multiple drug resistance of 2311 strains of Helicobacter pylori isolated from patients of different ages / 中华消化杂志

Objective To investigate condition of single drug or multiple drug resistance and sensitivities of different combinations of antibiotics in Helicobacter pylori (H.pylori) infected patients of different ages in Jiaxing City,Zhejiang Province.Methods From January 2007 to December 2011,a total of 6280 patients underwent gastroendoscopy examination were enrolled,the average age of them was 50.8 years old.Among them,129 cases were less than 20 years old,1802 cases were between 20 and 40,3016 cases were between 40 and 60,and 1333 cases were over 60.The mucosa of gastric antrum was collected for H.pylori culture.Drug sensitivity of isolated H.pylori strains was tested with metronidazole,amoxicillin and gentamycin,furazolidone,clarithromycin and levofloxacin.x2 test was performed for the comparison of drug resistance among different age groups.Results Among 6280 specimens,H.pylori culture of 2311 cases was positive (positive rate 36.80％).The positive rate of patients aged between 40 and 60 was the highest (38.43％,1159/3016),and that of patients over 60 was the lowest (33.76％,450/1333).The drug resistance rate of metronidazole in patients between 20 and 40 years reached 98.02％ (644/657) and was the highest.The drug resistance rate of clarithromycin in patents over 60 years old was the highest,which was 22.67％(102/450).The drug resistance rates of the levofloxacin,furazolidone,amoxicillin and gentamicin were low of all ages.Mixed resistance of two antibiotic appeared in 586 strains,mixed resistance rate of metronidazole and clarithromycin was the highest (259 strains,15.23 ％).Mixed resistance of three drugs appeared in 49 strains,mixed resistance rate of metronidazole,clarithromycin and levofloxacin was the highest (32 strains,12.88％).A total of 1691 strains were sensitive to the combination of amoxicillin and gentamycin,the sensitive was rate 99.41％.The sensitive rate of the combination of amoxicillin and furazolidone,gentamycin and furazolidone was both 94.24％.Conclusions Metronidazole presented high drug resistance of all ages,and should not be chosen.The combination use of amoxicillin and gentamicin is the ideal antibiotic combination for different ages.The combination of gentamycin and furazolidone is recommended for patients who are allergic to penicillin.

A hydroponic cultivation system for rapid high-yield transient protein expression in Nicotiana plants under laboratory conditions / 南方医科大学学报

<p><b>OBJECTIVE</b>To develop a hydroponic Nicotiana cultivation system for rapid and high-yield transient expression of recombinant proteins under laboratory conditions.</p><p><b>METHODS</b>To establish the hydroponic cultivation system, several parameters were examined to define the optimal conditions for the expression of recombinant proteins in plants. We used the green fluorescent protein (GFP) and the geminiviral plant transient expression vector as the model protein/expression vector. We examined the impact of Nicotiana species, the density and time of Agrobacterium infiltration, and the post-infiltration growth period on the accumulation of GFP. The expression levels of GFP in Nicotiana leaves were then examined by Western blotting and ELISA.</p><p><b>RESULTS</b>Our data indicated that a hydroponic Nicotiana cultivation system with a light intensity of 9000 LX/layer, a light cycle of 16 h day/8 h night, a temperature regime of 28 degrees celsius; day/21 degrees celsius; night, and a relative humidity of 80% could support the optimal plant growth and protein expression. After agroinfiltration with pBYGFPDsRed.R/LBA4404, high levels of GFP expression were observed in both N. benthamiana and N. tobaccum (cv. Yuyan No.5) plants cultured with this hydroponic cultivation system. An optimal GFP expression was achieved in both Nicotiana species leaves 4 days after infiltration by Agrobacterium with an OD(600) of 0.8. At a given time point, the average biomass of N. tobaccum (cv. Yuyan No.5) was significantly higher than that of N. benthamiana. The leaves from 6-week-old N. benthamiana plants and 5-week-old N. tobaccum (cv. Yuyan No.5) plants could be the optimal material for agroinfiltration.</p><p><b>CONCLUSION</b>We have established a hydroponic cultivation system that allows robust growth of N. benthamiana and N. tobaccum (cv. Yuyan No.5) plants and the optimal GFP expression in the artificial climate box.</p>

Effect of RNA interference on small heat shock protein Sjp40 of Schistosoma japonicum / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the effect of RNA interference (RNAi) on small heat shock protein (sHSP) Sjp40 of Schistosoma japonicum and its synergistic effect on the expression of SjHSP60, SjHSP70, and SjHSP90 mRNA, and observe the mRNA expression levels of Sjp40, SjHSP60, SjHSP70, and SjHSP90 in different stages of S.japonicum.</p><p><b>METHODS</b>Double-stranded RNA (dsRNA) of Sjp40 (dsSjp40) and a control dsRNA of green fluorescent protein (dsGFP) were generated by in vitro transcription and transfected into adult worm by immersing the worm in dsRNA solution. The total RNA and proteins were isolated simultaneously from the adult worms using TRIzol reagent 7 days after transfection. The expression levels of Sjp40, SjHSP60, SjHSP70, and SjHSP90 mRNA and the expression level of Sjp40 protein were determined by quantitative real-time PCR (qPCR) and Western blotting, respectively. The mRNA expression of HSPs of S. japonicum in different stages was evaluated by qPCR.</p><p><b>RESULTS</b>Compared with those in the control worms transfected with dsGFP, Sjp40 mRNA level was decreased by 80% in the worms transfected with dsSjp40, and the level of Sjp40 protein showed also a significant decrease. The mRNA expression levels of SjHSP60, SjHSP70, and SjHSP90 did not show an obvious synergism after Sjp40 RNAi. The expression profiles of Sjp40, SjHSP60, SjHSP70, and SjHSP90 showed significant differences in different stages of S. japonicum, and the expression level of Sjp40 mRNA in the egg stage was much higher than that of other HSP genes.</p><p><b>CONCLUSION</b>dsSjp40-RNAi can induce effective suppression of Sjp40 gene expression at both mRNA and protein levels, but no obvious synergism occurs in the mRNA expressions of SjHSP60, SjHSP70, and SjHSP90.</p>

In vitro and in vivo biocompatibility of nano-hydroxyapatite/polyamide 66 as bone repair material / 中国组织工程研究

BACKGROUND: Nanohydroxyapatite reinforced polyamide 66 (n-HA/PA66) prepared using the novel process based on nanohydroxyapatite (n-HA) sol may promote the biocompatibility due to the well distribution of n-HA in the polyamide66 (PA66) matrix and chemical bond at organic-inorganic interface, n-HA/PA66 composite has been proposed as a premising bone repair biomaterial.OBJECTIVE: To investigate the biocompatibility of the novel material both in vitro and in vivo.METHODS: Primarily cultured osteoblasts were co-cultured with n-HA/PA66 and PA66. The cell attachment and morphology were studied using phase contrast light microscope (PCLM) and field-emission scanning electron microscope (FE-SEM).Moreover, n-HA/PA66 pins, with PA66 pins as control, were implanted into the right and left (control group) shinbone shafts of the rabbits, respectively. Materials were harvested at weeks 2, 8 and tissue sections were observed.RESULTS AND CONCLUSION- n-HA/PA66 and PA66 exhibited no cytotoxicity with osteoblasts, while the cellular morphology near the samples was better in the test group than in the control one. Moreover, the cell density attached on n-HA/PA66 was higher than that on PA66 and the cell number were especially different after co-culturing for 3 days (P < 0.01 ). The osteoblasts at the interface between the host bone and n-HA/PA66 also had a higher activity during the earlier period after implantation.Meanwhile the bone formation process was faster and effective in the experimental group. Results suggested that n-HA/PA66 prepared base on the n-HA sol has a better biocompatibility as compared with PA66.

Treatment and restoration of residual dental root and crown in the elderly / 中华老年医学杂志

Objective To investigate the effect of treatment and restoration of residual dental root and crown in the elderly. Methods A total of 68 elderly patients with 202 residual roots and 47 residual crowns was treated.Radiography was taken to find out the length of residual roots and the status of treatment. A comprehensive treatment plan was made for each case, including restoration, extraction and endodontic treatment, etc. The restoration and the periodontal health of abutment teeth were followed up for 1 5 to 3 years consecutively. Results In endodontically treated teeth, the success rates of anterior 109, bicuspid 74, molar 26, were 92 3% 94 5%. In 87 post core crowns, 1 root cracked, 7 teeth mobility was 2 0 3 0 , all of which were the abutment teeth of removable dentures and single tooth. Maybe it was the impact of load heavy and occlusal trauma. In 64 post core fixed bridges, 6 ceramic broken was the impact of occlusal trauma. The function of restorations was good, with no root caries. Periodontitis was mainly in the abutment teeth and single tooth. Failure rate of restorative was 5 5% 7 7%. Conclusions Comprehensive treatments and restorations for residual root and crowns in the elderly would improve periodontal health and chewing function.