ABSTRACT
Aldehyde dehydrogenase 2 (ALDH2) is one of important factors against from the damage under oxidative stress in human body. A high proportion of East Asians carry ALDH2 inactive mutation gene. There are many diseases closely related to ALDH2, such as cardiovascular diseases, neurodegenerative diseases and liver diseases. Recent studies also have found that ALDH2 is associated with ferroptosis. Therefore, ALDH2 has becoming a potential target for the treatment of the above related diseases. Several types of small molecule activators with potential value of clinical application have been reported. The research progress on the structure and function of ALDH2 , the relationship with human diseases and its activators were summarized in this paper.
ABSTRACT
Compared with the pediatric femoral neck fracture described by the Delbet-Colonna classification, femoral neck fracture with a comminuted posteromedial column is characterized by a more special fracture location. Therefore, it is more difficult to deal with, leading to higher incidences of avascular necrosis of femoral head, coxa vara deformity, and delayed union postoperatively. This paper reviews recent progress in diagnosis and treatment of this specific kind of fracture in the aspects of anatomy and function of the posteromedial column of the femoral neck, and special features, surgical treatment and complication avoidance concerning this fracture, hoping to arouse interest from pediatric surgeons in this specific fracture which has not been described by the Delbet-Colonna classification.
ABSTRACT
@#Objective To study the biocompatibility of bioprosthetic heart valve material with a non-glutaraldehyde-based treatment, and to provide the safety data for the clinical application. Methods All the tests were conducted according to GB/T16886 standards. The in vitro cytotoxicity was determined by methyl thiazolyl tetrazolium assay. Fifteen guinea pigs were divided into a test group (n=10) and a control group (n=5) in the skin sensitization test. Three New Zealand white rabbits were used in the intradermal reactivity test. Five sites on both sides of the rabbit back were set as test sites and control sites, respectively. In the acute systemic toxicity test, a total of 20 ICR mice were randomly assigned to 4 groups: a test group (polar medium), a control group (polar medium), a test group (non-polar medium) and a control group (non-polar medium), 5 in each group. Forty SD rats were divided into a test group (n=20) and a control group (n=20) in the subchronic systemic toxicity test. Results The viability of the 100% extracts of the bioprosthetic heart valve material with a non-glutaraldehyde-based treatment was 75.2%. The rate of positive reaction was 0.0%. The total intradermal reactivity test score was 0. There was no statistical difference in the body weight between the test group and control group in the acute systemic toxicity test. There was no statistical difference in the body weight, organ weight, organ weight/body weight ratio, blood routine test or blood biochemistry between the test group and control group in the subchronic systemic toxicity test. Conclusion The bioprosthetic heart valve material with a non-glutaraldehyde-based treatment has satisfying biocompatibility, which conforms to relevant national standards. The material might be a promising material for application in valve replacement.
ABSTRACT
Objective:To evaluate the long-term prognosis and recurrence of young liver transplant recipients with hepatocellular carcinoma(HCC).Methods:Based upon the database of liver transplantation center, clinical data were retrospectively reviewed for 39 young recipients(18~40 years)and 158 middle-aged and elderly recipients(over 40 years)from 2013 to 2017. The parameters of overall survival(OS), recurrence-free survival(RFS)and disease-specific survival(DSS)were compared between two groups.Cox's proportional hazard model was utilized for evaluating the prognostic factors.Results:Significant inter-group difference existed in recurrence rate of HCC. Kaplan-Meier analysis revealed no significant difference in OS rate(1/3-year OS, 82.1%, 66.7% and 86.1%, 74.7%, P>0.05)and DSS rate(1/3-year DSS, 94.9%, 82.1% and 99.4%, 91.1%, P=0.053); RFS rate(1/3-year RFS, 51.3%, 41.0% and 73.0%, 62.7%, P=0.008)showed significant differences; Cox multivariate analysis revealed that AFP>400 μg/L was an independent risk factor for OS, DSS and RFS; poorly differentiated tumors and positive micro-vascular invasion(MVI)were independent risk factor for DSS; poorly differentiated tumors and total tumor size >5 cm were independent risk factors for RFS. Conclusions:Although RFS of young adult group is worse than that in middle-aged and elderly group after LT, no significant inter-group difference exists in OS or DSS. And LT is still a quite effective treatment for young HCC patients.
ABSTRACT
Apoptosis is particularly important for the body to inhibit or eliminate Mycobacterium tuberculosis ( Mtb) infection. A series of mechanisms to regulate macrophage apoptosis are triggered after macrophages are infected by Mtb. In Mtb-infected macrophages, there are differentially expressed microRNAs (miRNAs), which can directly bind to the binding sites in the 3′-untranslated region (3′ UTR) of apoptotic genes to regulate the expression of apoptotic genes and the apoptosis of macrophages through the mitochondrial or death receptor pathway. This paper reviewed the miRNAs associated with the apoptosis of Mtb-infected macrophages and the major mechanisms.
ABSTRACT
Osteonecrosis is the most common disorder in femoral head and scaphoid. However, avascular necrosis (AVN) in metacarpal head is a rare disease. In the present study, a 14-year-old male patient complained of right-hand pain with a limited range of motion for one month. Physical examination showed that the active flexion was 70° and the extension was limited to 30° of the metacarpophalangeal (MCP) joints. The grip strength decreased to 60% of the contralateral hand. X-rays demonstrated flattening and sclerotic changes in the long finger and ring finger of metacarpal head. CT scanning indicated cystic, osteochondral defects and sclerotic changes in metacarpal head. Imaging examination further confirmed the diagnosis of AVN in the long metacarpal finger and ring finger. After conservative treatments including splint immobilization, non-steroidal anti-inflammatory drugs (NSAIDs) and physiotherapy, the local pain symptoms of the MCP joint gradually disappeared. The range of motion of MCP joint returned to normal with the grip strength score as 105% of the contralateral hand. MRI confirmed excellent remodeling and regeneration in the metacarpal head at two years later. The clinical characteristics, diagnosis and treatments of AVN of metacarpal head were reviewed. Although radiograph examination is commonly used, early-stage osteonecrosis of the metacarpal head should be confirmed by MRI. Given the rarity of this disorder, there is no consensus on the treatments. Metacarpal necrosis is the more common disorder in adolescent patients with a history of trauma. Considering the potential of bone remodeling, juveniles with metacarpal head necrosis could recover by conservative treatments.
ABSTRACT
Objective:To identify the risk factors for premature proximal femur physeal closure (PPC) in children treated surgically for femoral neck fractures.Methods:Data of 106 children with an open triradiate cartilage who were treated surgically for a femoral neck fracture were retrospectively analyzed. Age, gender, laterality, mechanism of injury, the type of fracture, initial displacement, time to reduction, fixation method, whether the implant crossed the physeal plate, reduction method, reduction quality and development of femoral head avascular necrosis (AVN) were collected. PPC of the proximal femur was assessed through postoperative 6-12 months radiographs.Results:A total of 106 patients with an open triradiate cartilage were followed up, with an average duration of 20.4±13.3 months (range, 6-86 months). The overall rate of PPC following paediatric femoral neck fractures treated surgically was 36.8% (39/106). Among the 39 patients with PPC, 25 were males and 14 were females; the average age at the time of injury was 9.7±3.6 years (range, 3-15 years); 23 patients were involved in left hips and 16 were in right; the mechanisms of injury included motor vehicle accident in 5 fractures, falling injury in 21, sports-related injury in 12 and other causes in 1 fracture; two hips were Delbet type I, and 26 hips and 11 hips were Delbet type II and III, separately; type II and III of initial displacement were involved in 26 and 13 patients, separately; the mean duration from injury to surgery was 3.3±2.8 d (range, 1-14 d); 2 hips were treated with Kirschner wires, 35 hips with screw fixation, and the remaining 2 hips underwent screw and plate fixation; 2 hips had the hardware crossing the proximal femoral growth plate, and the remaining 37 hips didn’t; 15 hips were treated by closed reduction and internal fixation, and the other 24 hips underwent open reduction and internal fixation; anatomical reduction was achieved in 14 patients, acceptable reduction in 24 hips and unacceptable reduction in 1 hip; 24 hips developed AVN at the latest follow-up and the remaining 15 hips didn’t. Statistical analysis indicated that age ( t=3.875, P< 0.001), the severity of initial displacement ( Z=-2.118, P=0.034) and the rate of AVN ( χ2=42.280, P< 0.001) in patients with PPC were significantly higher than those in patients without; Logistic regression analysis confirmed age ( OR=1.288, P=0.011) and AVN ( OR=40.336, P< 0.001) as risk factors for PPC. ROC curve analysis indicated 10 years was the cut off age to significantly increase the rate of PPC. The rate of PPC in patients aged over 10 years (63.6%, 21/33) was significantly higher than that (24.7%, 18/73) in those aged less than 10 years ( χ2=14.848, P< 0.001). Conclusion:Age over 10 years and AVN are risk factors for PPC in children with femoral neck fractures treated surgically.
ABSTRACT
OBJECTIVE@#To investigate the effects of blocking the activation of ERK pathway on the expression of matrix metalloproteinase-9 (MMP-9) and the formation of cerebral edema in SD rats after brain injury.@*METHODS@#Ninety SD rats were randomly divided into 3 equal groups, including a sham-operated group, modified Feeney's traumatic brain injury model group, and ERK inhibition group where the ERK inhibitor SCH772984 (500 μg/kg) was injected via the femoral vein 15 min before brain trauma. At 2 h and 2 days after brain trauma, the permeability of blood-brain barrier was assessed by Evans blue method, the water content of the brain tissue was determined, and the phosphorylation level of ERK and the expression level of MMP-9 mRNA and protein were measured by RT-PCR and Western blotting.@*RESULTS@#Compared with the sham-operated group, the rats with brain trauma exhibited significantly increased level of ERK phosphorylation at 2 h and significantly increased expression of MMP-9 mRNA and protein 2 days after the injury ( < 0.01). Treatment with the ERK inhibitor significantly decreased the phosphorylation level of ERK after the injury ( < 0.01), suppressed over-expression of MMP-9 mRNA and protein 2 days after the injury ( < 0.01). The permeability of blood-brain barrier increased significantly 2 h after brain trauma ( < 0.05) and increased further at 2 days ( < 0.01); the water content of the brain did not change significantly at 2 h ( > 0.05) but increased significantly 2 d after the injury ( < 0.01). Treatment with the ERK inhibitor significantly lowered the permeability of blood-brain barrier and brain water content after brain trauma ( < 0.01).@*CONCLUSIONS@#Blocking the activation of ERK pathway significantly reduced the over-expression of MMP-9 and alleviates the damage of blood-brain barrier and traumatic brain edema, suggesting that ERK signaling pathway plays an important role in traumatic brain edema by regulating the expression of MMP-9.
Subject(s)
Animals , Rats , Blood-Brain Barrier , Brain Edema , Brain Injuries, Traumatic , MAP Kinase Signaling System , Matrix Metalloproteinase 9 , Rats, Sprague-DawleyABSTRACT
Objective To analyze the risk factors of bile leakage after operation of hepatic alveolar echinococcosis.Methods The clinical manifestations,laboratory examination,imaging features and operative data of 137 patients with hepatic alveolar echinococcosis were retrospectively analyzed.The clinical characteristics of bile leakage group (n =22) and non-bile leakage group (n =115) were compared and analyzed,and the Logistic regression model was used to explore the related factors of bile leakage.Results Preoperative liver function (AST,ALP,LDH),blood loss,blood transfusion,hepatic hilum invasion,preoperative PTCD,and regular resection were significantly different between the two groups.Logistic regression analysis showed that regular hepatectomy was a protective factor to avoid bile leakage.Hepatic hilum invasion was a risk factor for bile leakage.Conclusion The invasion of the hepatic hilum is an important factor of postoperative bile leakage.Regular hepatectomy can reduce the incidence of postoperative bile leakage.
ABSTRACT
Objective To investigate the value of gadoxetic acid-enhanced magnetic resonance imaging (MRI) on oxaliplatin-induced liver function injury in C57BL/6 mice.Metbods Forty male and six weeks old C57BL/6 mice without specific pathogens were included and the body weght ranged from 19 to 23 g.They were randomly assigned into control group,experimental group A,experimental group B and experimental group C (10 mice/group).The mice in the control group was intraperitoneally injected with saline solution.The mice in the experimental groups were intraperitoneally injected with oxaliplatin twice a week.The experimental group A,B and C were administered for 2 weeks,4 weeks and 6 weeks,respectively.The T1 relaxation time on the hepatobiliary phase and the first rapid enhancement slope percentage (ESP) in liver parenchyma were measured and calculated.Serum albumin and bilirubin values were measured and albumin and bilirubin (ALBI) scores were calculated.Pathological staining was used to observe liver tissue damage and fibrosis.The receiver operating characteristic (ROC) curve evaluated the ALBI score,ESP and T1 relaxation time on hepatobiliary phase for the diagnosis of liver function.Results Sixteen mice in the experimental groups (including group A,B and C) were included in the hepatic degeneration group (hepatocyte degeneration without fibrosis).Fourteen mice were included in the hepatic fibrosis group.T1 relaxation time on hepatobiliary phase in the hepatic fibrosis group was higher than that in the control group and in the hepatic degeneration group.The differences were statistically significant (P ＜ 0.05).The ESP of the control group,the hepatic degeneration group and the hepatic fibrosis group was increased,with statistically significant differences (all P ＜ 0.05).Compared with the control group,ALBI scores of the hepatic degeneration group and the hepatic fibrosis group were both decreased,with statistically significant differences (P ＜ 0.05).In the hepatic fibrosis group,the areas under the curve of ALBI scores,the T1 relaxation time on hepatobiliary phase and the ESP were 0.734,0.962 and 0.989,respectively.Conclusion The T1 relaxation time on hepatobiliary phase and the ESP of gadoxetic acid-enhanced MRI can effectively evaluate the hepatic function reduction induced by oxaliplatin-induced hepatic tissue injury in C57BL/6 mice.
ABSTRACT
OBJECTIVE@#To investigate the effects of blocking the activation of ERK pathway on the expression of matrix metalloproteinase-9 (MMP-9) and the formation of cerebral edema in SD rats after brain injury.@*METHODS@#Ninety SD rats were randomly divided into 3 equal groups, including a sham-operated group, modified Feeney's traumatic brain injury model group, and ERK inhibition group where the ERK inhibitor SCH772984 (500 μg/kg) was injected via the femoral vein 15 min before brain trauma. At 2 h and 2 days after brain trauma, the permeability of blood-brain barrier was assessed by Evans blue method, the water content of the brain tissue was determined, and the phosphorylation level of ERK and the expression level of MMP-9 mRNA and protein were measured by RT-PCR and Western blotting.@*RESULTS@#Compared with the sham-operated group, the rats with brain trauma exhibited significantly increased level of ERK phosphorylation at 2 h and significantly increased expression of MMP-9 mRNA and protein 2 days after the injury ( < 0.01). Treatment with the ERK inhibitor significantly decreased the phosphorylation level of ERK after the injury ( < 0.01), suppressed over-expression of MMP-9 mRNA and protein 2 days after the injury ( < 0.01). The permeability of blood-brain barrier increased significantly 2 h after brain trauma ( < 0.05) and increased further at 2 days ( < 0.01); the water content of the brain did not change significantly at 2 h ( > 0.05) but increased significantly 2 d after the injury ( < 0.01). Treatment with the ERK inhibitor significantly lowered the permeability of blood-brain barrier and brain water content after brain trauma ( < 0.01).@*CONCLUSIONS@#Blocking the activation of ERK pathway significantly reduced the over-expression of MMP-9 and alleviates the damage of blood-brain barrier and traumatic brain edema, suggesting that ERK signaling pathway plays an important role in traumatic brain edema by regulating the expression of MMP-9.
Subject(s)
Animals , Rats , Brain Edema , Drug Therapy , Brain Injuries, Traumatic , Drug Therapy , Gene Expression Regulation, Enzymologic , Indazoles , Pharmacology , Therapeutic Uses , MAP Kinase Signaling System , Matrix Metalloproteinase 9 , Genetics , Piperazines , Pharmacology , Therapeutic Uses , Protein Kinase Inhibitors , Pharmacology , Therapeutic Uses , Random Allocation , Rats, Sprague-DawleyABSTRACT
Objective@#To investigate the effects of definitive repair surgery on health-related quality of life (HRQOL) in patients with bile duct injury after laparoscopic cholecystectomy (LC).@*Methods@#The retrospective case-control study was conducted. The clinicopathological data of 181 patients with bile duct injury caused by LC for benign gallbladder diseases who underwent definitive repair surgery and 50 patients without complications after LC for benign gallbladder diseases in the Mianyang Central Hospital from January 2000 to December 2017 were collected. There were 82 males and 99 females of 181 patients with bile duct injury, aged from 31 to 68 years, with an average age of 47 years. Definitive repair surgery was performed according to different types of bile duct injury, and questionnaire of HRQOL was conducted preoperatively and one year after operation. There were 18 males and 32 females of 50 patients without complications after LC, aged from 35 to 69 years, with an average age of 41 years. Questionnaire of HRQOL was conducted on LC patients without complications one year after operation. Observation indicators: (1) classification of bile duct injury; (2) intraoperative situations of definitive repair surgery; (3) postoperative situations of definitive repair surgery; (4) follow-up; (5) results of the SF-36 scale assessment. Follow-up was conducted by outpatient examination and telephone interview up to December 2018. Patients were reexamined liver function and color Doppler ultrasonography once every 6-12 months, and further magnetic resonance cholangiopancreatography (MRCP) or computed tomography examination to detect recurrence of anastomotic biliary stricture and cholangitis. Measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was analyzed by the paired t test. Measurement data with skewed distribution were described as M (range), and count data were described as absolute numbers.@*Results@#(1) Classification of bile duct injury: of the 181 patients with bile duct injury, there were 64 cases of E1 type, 70 cases of E2 type, 35 cases of E3 type, 9 cases of E4 type, and 3 cases of E5 type. (2) Intraoperative situations of definitive repair surgery: all the 181 patinets with bile duct injury underwent definitive repair surgery successfully, including 61 undergoing end-to-end biliary anastomosis, 109 undergoing Roux-en-Y choledojejunostomy, 11 undergoing hemi-hepatectomy combined with Roux-en-Y anastomosis. There were 52 patients combined with hilar cholangioplasty. The operation time and volume of intraoperative blood loss of 181 patients were (190±126) minutes and 601.5 mL (range, 150.0-2 100.0 mL). There were 24 cases with blood transfusion and 18 cases with T-tube stent. (3) Postoperative situations of definitive repair surgery: 40 of 181 patients had complications, including 14 cases of incisional infection, 10 cases of bile leakage, 8 cases of perihepatic effusion, 7 cases of pulmonary infection, and 1 case of abdominal hemorrhage. The patient with postoperative abdominal hemorrhage underwent reoperation for hemostasis, and other patients with complications were cured after ultrasound-guided puncture and drainage or conservative treatment. Duration of postoperative hospital stay of 181 patients with bile duct injury was 12.6 days (range, 6.0-34.0 days). There was no perioperative death occurred. (4) Follow-up: 157 of 181 patients were followed up for 8.2-201.3 months, with a median follow-up time of 92.7 months. Twenty-eight patients had anastomotic stricture recurred, 16 of which were treated with reoperation, 10 were treated with endoscopic stent implantation, and 2 cases were treated with balloon dilatation in interventional department; the stricture was repaired again in all cases. Thirteen patients had recurrent cholangitis, showing no obvious anastomotic stricture on MRCP, and symptoms can be effectively controlled after conservative treatment. (5) Results of the SF-36 scale assessment: 181 patients with bile duct injury completed the SF-36 scales before definitive repair surgery, and 157 completed one year after definitive repair surgery. All the 50 patients without complications completed SF-36 scales one year after LC. The scores of HRQOL in physiological function, role functioning, somatic pain, general health, vitality, social function, emotional function, mental health, the scores of physical component summary, and mental component summary of 181 patients with bile duct injury before surgery were 79±15, 65±12, 40±17, 42±14, 59±20, 27±15, 48±23, 56±22, 60±11, and 56±11, respectively. The above indices one year after definitive repair surgery were 87±10, 78±15, 71±20, 64±20、68±19, 70±25, 67±21, 69±23, 71±13, 68±15, respectively. The above indices of 50 patients without complications one year after LC were 90±13, 81±20, 87±16, 72±20, 73±15, 86±17, 79±22, 77±19, 82±18, 79±18, respectively. The 181 patients with bile duct injury had significant elevation in above indices one year after definitive repair surgery (t=2.051, 2.016, 3.875, 3.014, 2.563, 3.225, 2.964, 2.357, 2.150, 2.203, P<0.05). The 50 patients without complications also had significant elevation in above indices one year after definitive repair surgery (t=2.817, 2.206, 3.641, 3.112, 3.202, 3.310, 3.011, 2.899, 2.150, 2.118, P<0.05). There were significant differences in the general health and mental health one year after definitive repair surgery between 181 patients with bile duct injury and 50 patients without complications (t=2.014, 2.011, P<0.05), and no significant difference in the physiological function, role functioning, somatic pain, vitality, social function, or emotional function between the two groups (t=0.852, 0.915, 0.907, 1.102, 1.284, 1.120, 0.863, 1.109, P>0.05).@*Conclusion@#Definitive repair surgery can significantly improve HRQOL in patients with bile duct injury caused by LC.
ABSTRACT
Objective@#To study hemihepatectomy combined with a circular-stretching suturing technique in bile duct anastomosis in treatment of high level bile duct injuries (BDI).@*Methods@#From January 2000 to January 2018, eleven patients with high level BDI caused by laparoscopic cholecystectomy (LC) were treated in Mianyang Central Hospital with hemihepatectomy combined with a circular-stretching suturing technique in the bile duct anastomosis. The hilar confluence was involved in all these patients. A total of six patients had combined right hepatic artery injury with 1 having associated right portal vein injury. A total of five patients had developed right liver atrophy. The median time interval from LC to hepatectomy was 17.0(2.0~61.0) months. The number of previously attempted biliary repairs was 1~4 times (median 2 times). The bile duct anastomosis was performed by the circular-stretching suturing technique.@*Results@#There was no perioperative death. One patient underwent left hemihepatectomy and 10 patients right hemihepatectomy. Roux-en-Y hepaticojejunostomy was carried out in 9 patients, and bile duct end-to-end anastomosis in 2 patients. The operation time was (245.9±87.4) min, intraoperative blood loss (655.7±413.6) ml, and the median postoperative hospital stay 12.0(7.0~29.0) days. Five patients developed complications. The median follow-up was 47.0(15.0~89.0) months. One patient developed anastomotic stenosis and 1 patient had cholangitis. The remaining 9 patients were well.@*Conclusion@#After adequate preoperative preparation, patients who were treated with hemihepatectomy combined with the circular-stretching suturing technique for bile duct anastomosis to treat high level BDI achieved good results.
ABSTRACT
Objective To study hemihepatectomy combined with a circular-stretching suturing technique in bile duct anastomosis in treatment of high level bile duct injuries (BDI).Methods From January 2000 to January 2018,eleven patients with high level BDI caused by laparoscopic cholecystectomy (LC) were treated in Mianyang Central Hospital with hemihepatectomy combined with a circular-stretching suturing technique in the bile duct anastomosis.The hilar confluence was involved in all these patients.A total of six patients had combined right hepatic artery injury with 1 having associated right portal vein injury.A total of five patients had developed right liver atrophy.The median time interval from LC to hepatectomy was 17.0 (2.0 ～ 61.0) months.The number of previously attempted biliary repairs was 1 ～ 4 times (median 2 times).The bile duct anastomosis was performed by the circular-stretching suturing technique.Results There was no perioperative death.One patient underwent left hemihepatectomy and 10 patients right hemihepatectomy.Roux-en-Y hepaticojejunostomy was carried out in 9 patients,and bile duct end-to-end anastomosis in 2 patients.The operation time was (245.9 ± 87.4) min,intraoperative blood loss (655.7 ±413.6) ml,and the median postoperative hospital stay 12.0(7.0 ～29.0) days.Five patients developed complications.The median follow-up was 47.0(15.0 ～ 89.0) months.One patient developed anastomotic stenosis and 1 patient had cholangitis.The remaining 9 patients were well.Conclusion After adequate preoperative preparation,patients who were treated with hemihepatectomy combined with the circularstretching suturing technique for bile duct anastomosis to treat high level BDI achieved good results.
ABSTRACT
Objective To identify the risk factors of early post-surgical recurrence of hepatocellular carcinoma (HCC) within 2 years.Methods This retrospective study included 178 consecutive patients with HCC who underwent curative resection between January 2009 to December 2012 at Zhongshan Hospital,Fudan University.There were 151 males and 27 females,with a mean age of (58±11) years.The CT features including rim enhancement,satellite nodule,two-trait predictor of venous invasion (TTPVI),and nonsmooth tumor margins were reviewed.After hospital discharge,the patients were followed-up regularly for at least 2 years to detect tumor recurrence.The primary end point was recurrence of HCC.Results On univariate analyses AFP ≥ 200 μg/L,rim enhancement,TTPVI,non-smooth tumor margins and largest diameter ＞5 cm were correlated with early post-surgical recurrence of HCC.On multivariate analyses,AFP≥200 pg/L (HR=2.144,95％CI:1.350～ 3.406),rim enhancement (HR =2.196,95％ CI:1.345 ～ 3.587),TTPVI (HR=1.735,95％CI:1.086～2.772),and non-smooth tumor margins (HR=2.065,95％CI:1.242～3.432) were independent risk factors of early post-surgical recurrence of HCC.Conclusion AFP≥200 μg/L,rim enhancement,TTPVI,and non-smooth tumor margins were independent risk factors of early post-surgical recurrence of HCC.
ABSTRACT
Objective To study the clinical manifestations,imaging and pathological features of,and to analyse our experience in diagnosing and treatment of,hepatic angiomyolipoma.Methods The clinical manifestations,imaging features,pathological morphology and immunohistochemical characteristics of hepatic angiomyolipoma from 81 patients were analyzed retrospectively.Results Twenty patients had clinical symptoms.A preoperative imaging diagnosis was made in 20 patients.Radical liver resection was performed in 61 patients,liver biopsy in 2 patients,and radiofrequency ablation after liver biopsy in 18 patients.All tumor cells expressed the markers of melanoma cells (HMB 45,mart-1) and smooth muscle cells.Recurrence of tumor was found in one patient after operation (1.2％,1/81).No patients died on follow-up.Conclusions The imaging manifestations of hepatic angiomyolipoma were varied,and the diagnosis depended on pathological findings and immunohistochemistry staining.The treatment strategy should be selected according to tumor size,location and clinical symptoms.Patients should be followed-up closely after surgery because of the malignant potential of hepatic angiomyolipoma.
ABSTRACT
Objective To investigate the effects of definitive repair surgery on health-related quality of life (HRQOL) in patients with bile duct injury after laparoscopic cholecystectomy (LC).Methods The retrospective case-control study was conducted.The clinicopathological data of 181 patients with bile duct injury caused by LC for benign gallbladder diseases who underwent definitive repair surgery and 50 patients without complications after LC for benign gallbladder diseases in the Mianyang Central Hospital from January 2000 to December 2017 were collected.There were 82 males and 99 females of 181 patients with bile duct injury,aged from 31 to 68 years,with an average age of 47 years.Definitive repair surgery was performed according to different types of bile duct injury,and questionnaire of HRQOL was conducted preoperatively and one year after operation.There were 18 males and 32 females of 50 patients without complications after LC,aged from 35 to 69 years,with an average age of 41 years.Questionnaire of HRQOL was conducted on LC patients without complications one year after operation.Observation indicators:(1) classification of bile duct injury;(2) intraoperative situations of definitive repair surgery;(3) postoperative situations of definitive repair surgery;(4) follow-up;(5) results of the SF-36 scale assessment.Follow-up was conducted by outpatient examination and telephone interview up to December 2018.Patients were reexamined liver function and color Doppler ultrasonography once every 6-12 months,and further magnetic resonance cholangiopancreatography (MRCP) or computed tomography examination to detect recurrence of anastomotic biliary stricture and cholangitis.Measurement data with normal distribution were expressed as Mean±SD,and comparison between groups was analyzed by the paired t test.Measurement data with skewed distribution were described as M (range),and count data were described as absolute numbers.Results (1) Classification of bile duct injury:of the 181 patients with bile duct injury,there were 64 cases of E1 type,70 cases of E2 type,35 cases of E3 type,9 cases of E4 type,and 3 cases of E5 type.(2) Intraoperative situations of definitive repair surgery:all the 181 patinets with bile duct injury underwent definitive repair surgery successfully,including 61 undergoing end-to-end biliary anastomosis,109 undergoing Roux-en-Y choledojejunostomy,11 undergoing hemi-hepatectomy combined with Roux-en-Y anastomosis.There were 52 patients combined with hilar cholangioplasty.The operation time and volume of intraoperative blood loss of 181 patients were (190±126) minutes and 601.5 mL (range,150.0-2 100.0 mL).There were 24 cases with blood transfusion and 18 cases with T-tube stent.(3) Postoperative situations of definitive repair surgery:40 of 181 patients had complications,including 14 cases of incisional infection,10 cases of bile leakage,8 cases of perihepatic effusion,7 cases of pulmonary infection,and 1 case of abdominal hemorrhage.The patient with postoperative abdominal hemorrhage underwent reoperation for hemostasis,and other patients with complications were cured after ultrasound-guided puncture and drainage or conservative treatment.Duration of postoperative hospital stay of 181 patients with bile duct injury was 12.6 days (range,6.0-34.0 days).There was uo perioperative death occurred.(4) Follow-up:157 of 181 patients were followed up for 8.2-201.3 months,with a median follow-up time of 92.7 months.Twenty-eight patients had anastomotic stricture recurred,16 of which were treated with reoperation,10 were treated with endoscopic stent implantation,and 2 cases were treated with balloon dilatation in interventional department;the stricture was repaired again in all cases.Thirteen patients had recurrent cholangitis,showing no obvious anastomotic stricture on MRCP,and symptoms can be effectively controlled after conservative treatment.(5) Results of the SF-36 scale assessment:181 patients with bile duct injury completed the SF-36 scales before definitive repair surgery,and 157 completed one year after definitive repair surgery.All the 50 patients without complications completed SF-36 scales one year after LC.The scores of HRQOL in physiological function,role functioning,somatic pain,general health,vitality,social function,emotional function,mental health,the scores of physical component summary,and mental component summary of 181 patients with bile duct injury before surgery were 79±15,65±12,40±17,42±14,59±20,27±15,48±23,56±22,60±11,and 56±11,respectively.The above indices one year after definitive repair surgery were 87±10,78±15,71±20,64±20、68± 19,70 ± 25,67 ± 21,69 ± 23,71 ± 13,68 ± 15,respectively.The above indices of 50 patients without complications one year after LC were 90±13,81±20,87±16,72±20,73±15,86±17,79±22,77±19,82±18,79 ± 18,respectively.The 181 patients with bile duct injury had significant elevation in above indices one year after definitive repair surgery (t=2.051,2.016,3.875,3.014,2.563,3.225,2.964,2.357,2.150,2.203,P＜0.05).The 50 patients without complications also had significant elevation in above indices one year after definitive repair surgery (t=2.817,2.206,3.641,3.112,3.202,3.310,3.011,2.899,2.150,2.118,P＜0.05).There were significant differences in the general health and mental health one year after definitive repair surgery between 181 patients with bile duct injury and 50 patients without complications (t =2.014,2.011,P＜0.05),and no significant difference in the physiological function,role functioning,somatic pain,vitality,social function,or emotional function between the two groups (t=0.852,0.915,0.907,1.102,1.284,1.120,0.863,1.109,P＞0.05).Conclusion Definitive repair surgery can significantly improve HRQOL in patients with bile duct injury caused by LC.
ABSTRACT
OBJECTIVE To identify the mental state of laryngopharyngeal reflux disease (LPRD) patients by analyzing anxiety scale and depression scale. METHODS The LPRD patients who received treatment in Fuzhou General Hospital were studied. The healthy volunteers were recruited as control group. Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to get the individual scores. Mental states of LPRD patients were finally studied through statistical analysis. RESULTS The scores of anxiety and depression in patients with LPRD were significantly higher than those in control group (anxiety score 50.59±7.24 vs 38.76±7.70, depression score 52.90±7.14 vs 40.63±8.17). The incidence of anxiety and depression in patients with LPRD were significantly higher than that in control group (anxiety rate 56.68％ vs 9.80％, depression rate 50.98％ vs 11.76％). Significant association was detected between ref lux symptom index score and anxiety or depression score in patients with LPRD(r =0.786, r =0.736, P ＜0.05). Significant association between LPRD and anxiety and depression were concluded. CONCLUSION The results showed that the patients with LPRD are more prone to be anxiety and depression mental state than healthy control group, and the severity of LPRD symptoms is significantly correlated with the anxiety and depression. This suggests that the patient's mental state should also be emphasized as well as antacids treatment.
ABSTRACT
Objective@#To estimate future excess mortality attributable to cold spells in Guangzhou, China.@*Methods@#We collected the mortality data and metrological data from 2009-2013 of Guangzhou to calculated the association between cold spell days and non-accidental mortality with GLM model. Then we projected future daily average temperatures (2020-2039 (2020s) , 2050-2069 (2050s) , 2080-2099 (2080s) ) with 5 GCMs models and 2 RCPs (RCP4.5 and RCP8.5) to identify cold spell days. The baseline period was the 1980s (1980-1999). Finally, calculated the yearly cold spells related excess death of 1980s, 2020s, 2050s, and 2080s with average daily death count of non-cold spell days, exposure-response relationship, and yearly number of cold spell days.@*Results@#The average of daily non-accidental mortality in Guangzhou from 2009 to 2013 was 96, and the average of daily average was 22.0 ℃. Cold spell days were associated with 3.3% (95%CI: 0.4%-6.2%) increase in non-accidental mortality. In 1980s, yearly cold spells related deaths were 34 (95%CI: 4-64). In 2020s, the number will increase by 0-10; in 2050s, the number will increase by 1-9; and in 2080s, will increase by 1-9 under the RCP4.5 scenario. In 2020s, the number will increase by 0-9; in 2050s, the number will increase by 1-6; and in 2080s, will increase by 0-11 under the RCP8.5 scenario.@*Conclusion@#The cold spells related non-accidental deaths in Guangzhou will increase in future under climate change.
ABSTRACT
Objective To construct the air quality health index (AQHI) by inclusion of air pollutants PM2.5 and O3 in Guangzhou,Shanghai,Xi'an,Beijing,Shenyang,and explore scientificity and feasibility of its application in China.Methods The daily average concentrations of PM2.5 and O3 in air,and daily average mortality from 2013 to 2015 in the 5 cities in China,the exposure-response coefficients of PM2.5 and O3 and total mortality from Meta studies in China were used to construct local AQHI.The health risk levels of air pollution in the 5 cities were calculated and compared with the characteristics of single pollutant concentrationof PM2.5 or O3.Results In the 5 cities,the average concentration of PM2.5 was highest in Beijing (82 μg/m3) and lowest in Guangzhou (46 μg/m3).And the average concentration of O3 was highest in Shanghai (72 μg/m3) and lowest in Xi'an (45 μg/m3).In all the cities,the average concentration of PM2.5 was highest in winter and lowest in summer.In summer,the average concentration of O3 was lowest.But the health risk level of AQHI showed that the 5 cities had higher frequency of low or medium risk averagely.And Beijing had the highest frequency of high risk in summer (5.69％).Xi'an had the highest frequency of extremely high risk in winter (1.63％).Conclusions In this study,AQHI could be constructed by using air PM2.5 and O3 concentration data which can be obtained in many areas in China.The application of this index is scientific and feasible in China.