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Objective To evaluate the effect of atorvastatin on patients with hepatolithiasis and obstructive jaundice after partial hepatectomy.Methods We retrospectively analyzed the data of 51 patients with hepatolithiasis and obstructive jaundice who were treated with partial hepatectomy from July 2006 to August 2015 at Xishan People's Hospital of Wuxi.Based on whether atorvastatin was used or not,the patients were divided into the treatment group (25 patients) and the control group (26 patients).Liver function tests were determined regularly after operation.The serum liver function on postoperative day 3 (P3d) and postoperative day 5 (P5d),complications (incisional infection,abdominal infection,pleural effusion,peritoneal effusion and bile leakage) and duration of hospital stay in the two groups of patients were compared.Results There was no perioperative death in the two groups.When compared with the control group,liver function data suggested an improvement in the treatment group,as ALT and AST in the treatment group were significantly lower than in the control group on P3d and P5d [ALT (252.6 ± 87.0) U/L vs (385.0 ± 152.9)U/L,(89.9 ±28.2) U/L vs (116.9 ±29.3) U/L;AST(130.7 ±66.9) U/L vs (212.7 ±80.0) U/L,(47.5 ± 16.1) vs (69.2 ± 12.2) U/L,all P ＜ 0.05].When compared with the control group,the serum cholesterol level was lower on P3d and P5d [TC:(6.7 ± 0.3) mmol/L vs (6.2 ± 0.3) mmol/L;(6.1 ± 0.4) mmol/L vs (7.0 ± 0.4) mmol/L,P ＜ 0.05],the serum CRP level was also lower in the treatment group [(56.8 ± 15.7) mg/L vs (98.9 ± 40.3) rg/L,P ＜ 0.05];the duration of hospital stay was (10 ± 1) days in the treatment group,which was significantly different from the control group (12 ± 1) days.Conclusion The use of atorvastatin in patients with hepatolithiasis and obstructive jaundice who were treated with partial hepatectomy improved postoperative liver function and shortened postoperative hospital stay.
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Objective To investigate the clinical efficacy and summarize the experience of treating patients with hepatic injuries in a primary-care hospital.Methods The clinical data of 230 patients with hepatic injuries from January 2002 to December 2014 were retrospectively analyzed.Results 124 patients were treated with surgery and 106 patients (including two patients who were transferred to another hospital) were managed by conservative treatment.Of 230 patients,204 patients recovered well and 26 patients died.63 cases of severe hepatic injuries (grades Ⅲ,Ⅳ,Ⅴ and Ⅵ),the mortality rate reached 25.4％.Concltsions The important points to success in managing these patients are early diagnosis and adequate assessment of liver injury,proper choice of treatment and using the simplest and the most effective means in surgery to control bleeding.
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Objective To clarify the association of pre-existing choledocholithiasis or cholecystolithiasis and the development of intrahepatic cholangiocarcinoma(ICC).Methods A computerized literature search was performed in Pubmed,EmBase and CBM.Cohort and case control studies on the risk of choledocholithiasis or cholecystolithiasis developing ICC was included.Meta-analysis was performed using STATA version 12.0.Either a fix or random effect model was used according to heterogeneity among studies.Egger's test was performed to assess publication bias.Results A total of 6 case control studies fulfilled our inclusion criteria including 123,713 patients,4,753 for ICC and 118,960 for tumor free controls.Bile duct stone contributed to the development of ICC (OR:15.64,95％ CI 9.33-26.23).Apart from hepatolithiasis,there was still a high risk of ICC development for choledocholithiasis (OR:11.05,95 ％ CI:4.02 ～ 30.37).Cholecystolithiasis is also a risk factor for ICC (OR:2.35,95 ％ CI:1.28 ～ 4.31).Conclusion Both choledocholithiasis and cholecystolithiasis are important prognostic factors for ICC.
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Objective To compare the safety and efficiency of laparoscopic cholecystectomy (LC) + laparoscopic common bile duct exploration (LCBDE) with endoscopic retrograde cholangiopancreatography (ERCP) /endoscopic sphincterotomy (EST) +LC for patients with concomitant gallstones and common bile duct stones.Methods The Pubmed,EMBASE and CNKI were searched for randomized controlled trials published from 1990 to March,2012.Revman 5.1 was used to perform the meta-analysis.The main outcomes were stone clearance rate,treatment morbidity,operative time and length of hospital stay.Results 9 studies with 1021 patients were included into the final analysis.Meta-analysis demonstrated that LC+LCBDE was similar to ERCP/EST+LC in the stone clearance rate (OR 1.55,95％CI 0.95～2.52,P=0.08),treatment morbidity (OR 1.12,95％CI 0.75～1.67,P=0.58),operative time (WMD-54.44,95％CI-107.7～-1.17,P=0.05) and length of hospital stay (WMD-0.22,95％CI-2.6～2.16,P=0.86).The P value of the stone clearance rate was approaching 0.05 with increased number of studies in the analysis.There was no significant difference in the operative time,probably because of small sample size.Conclusions LC-LCBDE was equivalent to ERCP/EST+ LC in stone clearance rate,treatment morbidity,operative time and length of hospital stay.There is a possibility that LC+LCBDE can be superior to ERCP/EST+LC in the stone clearance rate and the operative time with increase in sample size.
ABSTRACT
While Choledocholithiasis is concomitant with gallstones in approximately 9.2％ ～ 14.3％ of the patients,and its treatment methods are mainly by surgery,including:(1)Open cholecystectomy and open choledocholithotomy 、T-tube drainage (OC-OCHTD) ; (2) Endoscopic retrograde cholangiopancreatography (ERCP) and Endoscopic sphincterotomy (EST),and followed by Laparoscopic cholecystectomy (LC) second stage (ERCP/EST + LC) ; (3) Laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration (LC +CBDE).These three methods all have their own characteristics.The last two methods are minimally invasive surgery treatment.Practice has proved that LCBDE and ERCP + EST + LC treatment methods are feasible and show certain advantages,compared with OC-OCHTD reflecting the development of minimally invasive surgery.Practice has proved that LCBDE and ERCP + EST + LC treatment methods are feasible and show certain advantages,compared with OCHTD reflecting the development of minimally invasive surgery.But the indications of operation are need to be summarized constantly in clinical practice,while operation skills are also need to be improved.At present,many reports of the two methods of minimally invasive treatment have been published because of the controversy,such as surgical indications,hospitalization expense,operation time,therapy danger,complications and the length of hospital stay.Both LCBDE and ERCP + EST + LC show some advantages and disadvantages compared with each other.On proper indications,LCBDE embodies the superiority of minimally invasive surgery technology as a one-stage operation,which is preferred for patients of choledocholithiasis with concomitant gallstones.For patients,no matter what kind of operation method,less invasion,lower risk and less complications is the key for best treatment choise.
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Streptomycetes are Gram-positive bacteria of Actinomycetales. These organisms can produce many economically important secondary metabolites. With the development of molecular biology, gene sequencing technology and synthetic biology, people gained a better understanding of the Streptomyces family. The means to transform genome on the molecular level is also increasing. By simplifying the Streptomyces genome rationally and efficiently, it will improve the yield and quality of the metabolites as well as reduce the consumption of the substrates. Markerless knockout is an important way to carry out genetic modification. Here we describe novel genome modification techniques developed for Streptomyces in recent years with focus on the markerless knockout technologies.