Application of SpyGlass endoscopic direct visualization system in complicated biliary complications after orthotopic liver transplantation / 器官移植

Objective To evaluate the application efficacy of SpyGlass endoscopic direct visualization system in management of complex biliary complications after orthotopic liver transplantation. Methods Clinical data of 369 adult patients with biliary complications after orthotopic liver transplantation who received endoscopic retrograde cholangiopancreatography (ERCP) for the first time were retrospectively analyzed. Preoperative conditions, intraoperative manifestations, treatment outcomes and complications of patients treated with SpyGlass system were analyzed. Results Fifty-six patients were treated with SpyGlass system. The main preoperative symptoms included abdominal discomfort in 38 cases, fever in 8 cases, jaundice in 6 cases and skin itching in 4 cases. Ultrasound examination in 18 patients indicated common bile duct stenosis and significant intrahepatic bile duct dilatation. Preoperative magnetic resonance cholangiopancreatography (MRCP) of 56 patients revealed that 36 cases were diagnosed with common bile duct stenosis complicated with stones, 16 cases of common bile duct stenosis alone and 4 cases of suspected tumors. All patients had definite indications for SpyGlass system treatment. Among 56 patients treated with SpyGlass system, 34 cases were diagnosed with anastomotic stricture complicated with stones, 12 cases of anastomotic stricture alone, 1 case of biliary stone and 4 cases of tumors. Among 48 cases who were successfully treated, the levels of alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, alkaline phosphatase and total bilirubin at postoperative 48 h were all significantly lower than preoperative levels (all P<0.05). No severe complications occurred in 56 patients treated with SpyGlass system. Conclusions Use of SpyGlass system may significantly increase success rate and guarantee surgical safety in the treatment of complex biliary complications after liver transplantation, which is worthy of promotion and application.

Comparative study of two biliary drainage strategies in perioperative period of cholangiojejunostomy / 国际外科学杂志

Objective:To evaluate the clinical efficacy of PTCD and ERCP combined with T tube in the perioperative period of biliary anastomosis in patients with moderate to severe obstructive jaundice.Methods:The data of 93 patients with moderate obstructive jaundice who met the inclusion criteria and planned to undergo cholangiojejunostomy (including reconstruction after pancreaticoduodenectomy) in Shuguang Hospital Affiliated to Shanghai University of traditional Chinese medicine from March 2015 to December 2021 were collected. According to the perioperative drainage strategy, 54 cases were divided into PTCD group and 39 cases were divided into ERCP combined with intraoperative T-tube drainage group. Retrospective cohort method was used to analyze the bile duct diameter, postoperative hospital stay, operation cost, time of jaundice reduction, degree of jaundice reduction, average postoperative bile loss, postoperative bile leakage, abdominal infection of the two groups. The measurement data were expressed as mean ± standard deviation( ± s), and t test was used for comparison between groups. The data of skewed distribution were represented by M( Q1, Q3), and nonparametric rank sum test was used. Chi-square test was used for counting data. Results:The preoperative yellowing reduction time, operation cost, mean bile loss 7 days after operation, time to remove biliary drainage tube, and postoperative hospital stay in PTCD group were (5.9±3.1) d, (59 846.3±9 129.7) yuan, 210.0(170.0, 325.0) mL/d, (18.4±5.6) d, and(10.7±4.4) d, respectively, while those in ERCP group were (9.5±4.4) d, (77 833.1±12 164.5) yuan, 285.0(225.0, 370.0) mL/d, (41.4±17.2) d and(15.3±5.6) d, respectively. The difference between the two groups was statistically significant ( P<0.05). There was no significant difference between the two groups in general condition before drainage, cholangitis and hemorrhage after drainage, degree of jaundice reduction, bile leakage after surgery, abdominal infection, etc. Conclusions:When performing biliary enterostomy in patients with moderate or above obstructive jaundice, PTCD and ERCP combined with intraoperative T-tube drainage are effective means to improve the safety of perioperative period. PTCD has some advantages in reducing jaundice efficiency, operation cost and rapid postoperative rehabilitation.

Risk factors of preoperative hypoxemia in geriatric patients with hip fracture / 中华创伤杂志

Objective:To investigate the risk factors for preoperative hypoxemia in geriatric patients with hip fracture.Methods:A case-control study was used to analyze the clinical data of 99 geriatric patients with hip fracture admitted to Zhongda Hospital affiliated to Southeast University between November 2020 and August 2021. There were 29 males and 70 females, aged 67-96 years [(82.6±6.2)years]. The patients were divided into hypoxemia group ( n=51) and non-hypoxemia group ( n=48) using partial arterial partial pressure of oxygen (PaO 2)<80 mmHg while breathing room air at emergency as the reference standard. The two groups were compared in terms of sex, age, fracture types, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, pulmonary diseases diagnosed by preoperative chest CT [atelectasis, pleural effusion, chronic obstructive pulmonary disease (COPD)], time from injury to visit, New York Heart Association (NYHA) classification, Barthel index, KATZ index, modified Medicine Research Council (mMRC) dyspnea scale, numeric rating scale (NRS), smoking, drinking, comorbidities (hypertension, diabetes mellitus, Parkinson′s disease, Alzheimer′s disease, cerebral infarction, coronary atherosclerotic heart disease), body temperature, blood routine test at first examination (erythrocyte count, leukocyte count, C-reactive protein, hemoglobin), biochemistry (serum albumin, blood glucose, blood creatinine, blood urea nitrogen), electrolyte (serum potassium, serum sodium), and other related examinations [D-dimer, brain natriuretic peptide (BNP), lactic acid]. Univariate analysis was performed to the correlation of those indicators with preoperative hypoxemia. Multivariate Logistic regression analysis was used to identify the independent risk factors for preoperative hypoxemia in geriatric patients with hip fracture. Results:Differences in sex, age, fracture types, BMI, pulmonary diseases diagnosed by preoperative chest CT, time from injury to visit, Barthel index, KATZ index, NRS, smoking, drinking, comorbidities, body temperature, first laboratory results of erythrocyte count, biochemistry, electrolyte and other related examinations were not statistically significant between the two groups (all P>0.05). The two groups showed statistical differences in ASA classification, NYHA classification, mMRC dyspnea scale, leukocyte count at first examination, C-reaction protein and hemoglobin (all P<0.05). Univariate analysis indicated that ASA classification, NYHA classification, mMRC dyspnea scale, leukocyte count at first examination and C-reaction protein were correlated with the occurrence of preoperative hypoxemia in geriatric patients with hip fracture (all P<0.05). Multivariate Logistic regressions analysis indicated that higher mMRC dyspnea scale ( OR=2.30, 95% CI 1.10-4.81, P<0.05), higher leukocyte count at first examination ( OR=1.24, 95% CI 1.05-1.45, P<0.05), higher level of C-reaction protein ( OR=1.02, 95% CI 1.01-1.03, P<0.05) and higher level of hemoglobin ( OR=1.04, 95% CI 1.01-1.07, P<0.05) were significantly correlated with the occurrence of preoperative hypoxemia in geriatric patients with hip fracture. Conclusion:Higher mMRC dyspnea scale, higher leukocyte count, higher level of C-reaction protein and higher level of hemoglobin are independent risk factors for preoperative hypoxemia in geriatric patients with hip fracture.

Hepatocyte growth factor protects pulmonary endothelial barrier against oxidative stress and mitochondria-dependent apoptosis / 中华医学杂志(英文版)

BACKGROUND@#Pulmonary microvascular endothelial cells (PMVECs) were not complex, and the endothelial barrier was destroyed in the pathogenesis progress of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). Previous studies have demonstrated that hepatocyte growth factor (HGF), which was secreted by bone marrow mesenchymal stem cells, could decrease endothelial apoptosis. We investigated whether mTOR/STAT3 signaling acted in HGF protective effects against oxidative stress and mitochondria-dependent apoptosis in lipopolysaccharide (LPS)-induced endothelial barrier dysfunction and ALI mice.@*METHODS@#In our current study, we introduced LPS-induced PMEVCs with HGF treatment. To investigate the effects of mammalian target of rapamycin (mTOR)/signal transducer and activator of transcription 3 (STAT3) pathway in endothelial oxidative stress and mitochondria-dependent apoptosis, mTOR inhibitor rapamycin and STAT3 inhibitor S3I-201 were, respectively, used to inhibit mTOR/STAT3 signaling. Moreover, lentivirus vector-mediated mTORC1 (Raptor) and mTORC2 (Rictor) gene knockdown modifications were introduced to evaluate mTORC1 and mTORC1 pathways. Calcium measurement, reactive oxygen species (ROS) production, mitochondrial membrane potential and protein, cell proliferation, apoptosis, and endothelial junction protein were detected to evaluate HGF effects. Moreover, we used the ALI mouse model to observe the mitochondria pathological changes with an electron microscope in vivo.@*RESULTS@#Our study demonstrated that HGF protected the endothelium via the suppression of ROS production and intracellular calcium uptake, which lead to increased mitochondrial membrane potential (JC-1 and mitochondria tracker green detection) and specific proteins (complex I), raised anti-apoptosis Messenger Ribonucleic Acid level (B-cell lymphoma 2 and Bcl-xL), and increased endothelial junction proteins (VE-cadherin and occludin). Reversely, mTOR inhibitor rapamycin and STAT3 inhibitor S3I-201 could raise oxidative stress and mitochondria-dependent apoptosis even with HGF treatment in LPS-induced endothelial cells. Similarly, mTORC1 as well as mTORC2 have the same protective effects in mitochondria damage and apoptosis. In in vivo experiments of ALI mouse, HGF also increased mitochondria structural integrity via the mTOR/STAT3 pathway.@*CONCLUSION@#In all, these reveal that mTOR/STAT3 signaling mediates the HGF suppression effects to oxidative level, mitochondria-dependent apoptosis, and endothelial junction protein in ARDS, contributing to the pulmonary endothelial survival and barrier integrity.

Value of Lp (a) in risk assessment of patients with non ST-elevation acute coronary syndrome / 中华老年心脑血管病杂志

Objective To study the value of Lp (a) in risk assessment of patients with NSTE-ACS.Methods Eighty NSTE-ACS patients were divided into elderly NSTE-ACS group (n=58) and non elderly NSTE-ACS group (n=22) with 22 elderly patients with their coronary artery stenosis ＜ 50％ served as a control group.The relationship of serum Lp (a) level with Gensini score and GRACE risk score was analyzed.Results The incidence of hypertension and DM was significantly higher,the smoking history was significantly longer,the serum LDL-C and FBG level,Gensini score and GRACE risk score were significantly higher in elderly NSTE-ACS group than in control group (P＜0.05).The age was significantly older and the GRACE risk score was significantly higher in elderly NSTE-ACS group than in non elderly NSTE-ACS group (P＜0.05).The Gensini score and GRACE risk score were positively related wtih the serum Lp (a) level (r=0.494,P＜ 0.01;r=0.432,P＜0.01).Serum Lp (a) level was an independent risk factor for NSTE-ACS (P＜0.01).Conclusion Serum Lp (a) level is closely related with the severity and outcome of NSTE-ACS,indicating that serum Lp (a) level can be used as a predictor of risk assessment in NSTE-ACS patients.

Effect of different atorvastatin doses on contrast-induced nephropathy after PCI / 中华老年心脑血管病杂志

Objective To study the effect of different atorvastatin doses on contrast-induced nephropathy (CIN) and the role of neutrophil gelatinase-associated lipocalin (NGAL) in early diagnosis of CIN after PCI.Methods Two hundred and twelve patients admitted to our hospital for PCI from June 2015 to January 2017 were divided into high atorvastatin dose treatment group as group A (n=108) and conventional atorvastatin dose treatment group as group B (n=104).They underwent coronary arteriography and PCI.Their serum creatinine and urinary NGAL levels were measured before and at 4,24,48,72 h respectively after coronary arteriography and PCI.The role of urinary NGAL level in early diagnosis of CIN was analyzed according to its ROC curve.Results CIN occurred in 6 patients of group A and in 19 patients of group B with an incidence of 5.6％ and 18.3％ respectively (P=0.012).The urinary NGAL level was significantly higher in two groups at 4,24,48,72 h respectively after coronary arteriography and PCI than before coronary arteriography and PCI,reached its peak at 72 h,and was significantly higher in group B than in group A (P＜0.05).The area under the ROC curve was 0.917,0.919,0.928,0.953 respectively at 4,24,48,72 h after coronary arteriography and PCI.The sensitivity and specificity of urinary NGAL in early diagnosis of CIN were 92.10％ and 100.00％ respectively.Conclusion High atorvastatin dose treatment can reduce the occurrence of CIN.Urinary NGAL level can indicate the change of renal function earlier than serum creatinine level after PCI,and can thus be used as an early predictor of CIN.

Clinical application of ERCP in the treatment of bile duct stenosis after liver transplantation / 中华器官移植杂志

Objective To discuss the clinical application of individualized strategy of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of bile duct stenosis after liver transplantation (LT).Methods Fifty-two patients,including 40 men and 12 women,aged 54.3 ± 9.1 years old,who suffered from bile duct stenosis and accepted 88 times of ERCP from June 2014 to May 2016 in our department were investigated.The procedures,clinical features and biochemical criteria were analyzed retrospectively.Results According to the treating occasions and clinical symptoms,single plastic stent,dilatation combined with single plastic stent,and dilatation combined with multiple plastic stents were chosen to use.ERCP in 8 patients out of 52 patients failed technically,and the therapeutic efficacy was 82.7％.The treatment duration was 8.2 ± 2.9 months.The recurrence rate was 4.7％ (2 cases) during the follow-up period.The most common complications were postERCP pancreatitis (2.3％) and cholangitis (3.4％),which would be cured by conservative treatment in most cases.Conclusion ERCP,as an effective and safe method,could be used as the first choice or bridge treatment for bile duct stricture after LT.We recommend individualization strategy,including step by step mode and different combinations of PTC or endoscopic procedures,in order to improve clinical efficacy of all kinds of stricture.

Efficacy of Equilibrium Radionuclide Angiography in Evaluating Acute Response of Right Ventricle After Cardiac Resynchronization Therapy / 中国医学影像学杂志

Purpose To assess right ventricular function and synchronous acute response in patients with chronic cardiac failure after cardiac resynchronization therapy (CRT) using equilibrium radionuclide angiography (ERNA).Materials and Methods Twenty-four chronic cardiac failure patients who accepted CRT were included (CRT group) and twenty healthy participants were also selected as the control group.ERNA was performed before and within 48 h after pacemaker implantation to calculate both right ventricular ejection fraction (RVEF) and RV dyssynchrony.RV dyssynchrony was defined as the standard right ventricular phase shift and right ventricular phase standard deviation (RVPS and RVPSD).Results The postoperative RVEF,RVPS and RVPSD in CRT group were significantly improved (P＜0.05).Fifteen patients (62.5％) were classified as acute responders,based on a reduction of at least 15％ in LV end-systolic volume immediately after CRT.The baseline RVEF in responders was higher than that in nonresponders (P＜0.05),while the RVPS and RVPSD were lower (P＜0.05).The postoperative RVPS and RVPSD decreased (P＜0.05),and the RVEF increased (P＜0.05) in both responders and nonresponders after pacemaker implantation,indicating that the right ventricular function and dyssynchrony in CRT group were both improved.Conclusion This study showed a significant improvement in RV ventricular systolic function and synchrony immediately after CRT.ERNA allows assessment of changes in RVEF and RV dyssynchrony before and after CRT implantation.

Effects of nitric oxide and cholecystokinin on the sphincter of Oddi of dogs / 中华消化外科杂志

Objective To investigate the effects of nitric oxide (NO) and cholecystokinin (CCK) on the regulation of the motility of sphincter of Oddi (SO).Methods The basal pressure,action rate and contraction range of the SO were examined before and after the injection of CCK,sodium nitroprusside (SNP) and NG-nitroL-argininemethyl ester hydrochloride (L-NAME).The expression of neurons with positive expression of NO synthase was detected by immunohistochemical staining.The measurement data were analyzed by using the t test.Results The basal pressure,contraction rate and contraction range of the SO were (27 + 10)mm Hg (1 mm Hg =0.133 kPa),( 10 ± 3 ) times/minute and (32 + 8 ) mm Hg before injection of CCK,and (61 + 14) mm Hg,(64 +21 ) times/minute,(44 ± 15 ) mm Hg after injection of CCK of 20 ng/kg.After injection of CCK of 100 ng/kg,the basal pressure,contraction range and contraction rate of the SO were (77 ± 31 )mm Hg,(69 ± 18 ) times/minutes,(79 + 14) mm Hg when the inhibition effect of CCK reached peak,and were ( 140 ± 21 ) mm Hg,( 129 ± 25 )times/minutes,( 173 ± 63 ) mm Hg when the excitatory effect of CCK reached peak.After injection of SNP into the common bile duct,the basal pressure,contraction range and contraction rate of the SO decreased significantly ( t =3.706,5.183,P ＜ 0.05),while the 3 indexes increased significantly after injection of SNP (t =5.859,3.588,P ＜O.05).Conclusion Different from physiological dose (20 ng/kg) of CCK,large dose of CCK enhances motility of SO intensively.NO relaxes SO,which may play an important role in the inhibitor pathway of CCK.

Reasons and prevention of residual stones after choledo-choscopic treatment of cholelithiasis / 中国现代普通外科进展

Objective: To study the reasons and prevention of residual stones after choledo- choscopic treatment of cholelithiasis. Methods:The clinical data of 219 patients who had under- gone choledochoscopic treatment were analyzed retrospectively. Results: 21 cases were found with residual stones in the bile duct after the operations. Residual stone rate was to 9.58% . Bile duct stones of 8 patients could not be removed completely during operations. 13 patients were proved that stones still remain in their bile ducts by T-tube cholangiography and choledochoscope after opera- tions. There were 5 patients with acute obstructive suppurative cholangitis accompanying septic shock, 5 patients with stenosis in intrahepatic bile ducts, 4 patients with stones of in trahepatic bile duct and variation of bile duct, 2 patients with stones in sphincter of duodenal papilla,2 patients withstones and stenosis at the inferior segment of choledochus,3 patients were founded residual stones in bile duct obviously after the operations. Conclusions: B-type ultrasonic scanning and T-tube cholangiog- raphy are useful to reduce the rate of residual stones.