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1.
World J Gastroenterol ; 25(8): 1002-1011, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30833805

RESUMO

BACKGROUND: A clinical pathway (CP) is a standardized approach for disease management. However, big data-based evidence is rarely involved in CP for related common bile duct (CBD) stones, let alone outcome comparisons before and after CP implementation. AIM: To investigate the value of CP implementation in patients with CBD stones undergoing endoscopic retrograde cholangiopancreatography (ERCP). METHODS: This retrospective study was conducted at Nanjing Drum Tower Hospital in patients with CBD stones undergoing ERCP from January 2007 to December 2017. The data and outcomes were compared by using univariate and multivariable regression/linear models between the patients who received conventional care (non-pathway group, n = 467) and CP care (pathway group, n = 2196). RESULTS: At baseline, the main differences observed between the two groups were the percentage of patients with multiple stones (P < 0.001) and incidence of cholangitis complication (P < 0.05). The percentage of antibiotic use and complications in the CP group were significantly less than those in the non-pathway group [adjusted odds ratio (OR) = 0.72, 95% confidence interval (CI): 0.55-0.93, P = 0.012, adjusted OR = 0.44, 95%CI: 0.33-0.59, P < 0.001, respectively]. Patients spent lower costs on hospitalization, operation, nursing, medication, and medical consumable materials (P < 0.001 for all), and even experienced shorter length of hospital stay (LOHS) (P < 0.001) after the CP implementation. No significant differences in clinical outcomes, readmission rate, or secondary surgery rate were presented between the patients in the non-pathway and CP groups. CONCLUSION: Implementing a CP for patients with CBD stones is a safe mode to reduce the LOHS, hospital costs, antibiotic use, and complication rate.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Coledocolitíase/cirurgia , Procedimentos Clínicos/estatística & dados numéricos , Análise de Dados , Complicações Pós-Operatórias/epidemiologia , Idoso , Big Data , Colangiopancreatografia Retrógrada Endoscópica/economia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Coledocolitíase/economia , Ducto Colédoco/cirurgia , Procedimentos Clínicos/economia , Feminino , Gastos em Saúde/estatística & dados numéricos , Preços Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Resultado do Tratamento
2.
J Ultrasound Med ; 38(8): 2039-2046, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30561767

RESUMO

OBJECTIVES: To investigate the value of liver stiffness in rats with various degrees of hepatic sinusoidal obstruction syndrome (HSOS) induced by monocrotaline by comparing liver histopathologic findings. METHODS: Seventy rats were randomly divided into a control group (n = 10), a low-dose monocrotaline group (n = 30), and a high-dose monocrotaline group (n = 30). After successful modeling, the liver shear wave velocity (SWV) by Virtual Touch tissue imaging quantification (Siemens Medical Solutions, Mountain View, CA) and the alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin levels of the groups were obtained on days 3 and 5, and the intergroup differences were compared. Liver histopathologic characteristics were analyzed to evaluate the degrees of HSOS, and the scores were recorded. RESULTS: On days 3 and 5, the total bilirubin, AST, and ALT, levels and liver SWV in the low- and high-dose groups were elevated; the portal vein velocity (PVV) of these groups was decreased compared with the control group; and the high-dose rats showed higher serum AST and ALT levels than the low-dose rats. The high-dose rats had a lower PVV than the low-dose rats at day 3. The liver SWV values had significant correlations with the histologic score and PVV. In a multivariate analysis, the liver SWV (ß = 0.813; P < .001) was independently associated with the histopathologic score. CONCLUSIONS: Liver stiffness as measured by Virtual Touch tissue imaging quantification increases with the severity of HSOS and can be recommended as a marker for diagnosis and assessment of HSOS.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Hepatopatia Veno-Oclusiva/diagnóstico por imagem , Hepatopatia Veno-Oclusiva/patologia , Animais , Modelos Animais de Doenças , Fígado/diagnóstico por imagem , Fígado/patologia , Masculino , Ratos , Reprodutibilidade dos Testes
3.
Ultrasound Med Biol ; 43(6): 1134-1140, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28335998

RESUMO

This study evaluated whether the stiffness of the liver and spleen, measured using the point shear wave elastography (pSWE) technique, correlates with portal venous pressure (PVP) and whether the result extends to estimate the diminishing change in PVP (ΔPVP) in patients with decompensated cirrhosis. We evaluated the data of 67 prospectively enrolled patients who underwent both transjugular intrahepatic portosystemic shunt (TIPS) and pSWE. The stiffness of liver and spleen were evaluated by measuring shear wave velocity (SWV) to determine the statistical correlation with PVP. We also analyzed whether change in SWV (ΔSWV) correlates with ΔPVP. The correlations were assessed with Spearman's rank correlation coefficients. Furthermore, receiver operating characteristic (ROC) curves were constructed to evaluate diagnostic capacity of ΔSWV. Spleen stiffness (SS) was positively correlated with PVP before and after TIPS (p < 0.002), although no correlation between liver stiffness and PVP was detected. A strong relationship between ΔSWV in SS and ΔPVP change in portal hypertension (r = 0.871) was also found in the overall population. The area under the ROC curve for the diagnosis of TIPS technical success was 0.869 and at a ΔSWV cut-off value of 0.36 m/s sensitivity was 77%. Measurement of SS can be used for non-invasive assessment and monitoring of PVP in patients with decompensated cirrhosis.


Assuntos
Determinação da Pressão Arterial/métodos , Técnicas de Imagem por Elasticidade/métodos , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/fisiopatologia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/fisiopatologia , Pressão na Veia Porta , Adulto , Idoso , Módulo de Elasticidade , Feminino , Humanos , Hipertensão Portal/etiologia , Interpretação de Imagem Assistida por Computador/métodos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Resistência ao Cisalhamento , Estresse Mecânico
4.
Oncol Lett ; 12(4): 2696-2701, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27698845

RESUMO

Gallbladder carcinoma (GBC) is a rare and highly aggressive disease. The diagnosis of this cancer is difficult due to its occult onset. Hence, GBC is often detected late and at an advanced stage. Although physicians and researchers are continually working to improve the treatment for advanced-stage disease, GBC is usually associated with short survival times. The present study describes a case of GBC that was first diagnosed with accompanying cholecystolithiasis at the time of cholecystectomy. Cancer relapse occurred 1.5 years after the cholecystectomy. Multidisciplinary collaboration was involved in the decision-making process for the treatment of this aggressive recurrence, and the survival time was successfully extended to 26 months. Importantly, high-grade intraepithelial neoplasia and positive margins had previously been detected post-cholecystectomy at a different institution, but were ignored. Relapse may have been preventable had the cancer been diagnosed when it was initially observed. Taken together, these findings suggest that multidisciplinary collaboration should be considered for the management of advanced GBC, whereby patients will benefit from improved survival times. Furthermore, it is recommended that samples obtained from patients undergoing cholecystectomy should more carefully analyzed for evidence of cancerous or precancerous tissues.

5.
Int Immunopharmacol ; 19(2): 193-200, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24495518

RESUMO

OBJECTIVE: To investigate the effects of S-adenosylmethionine (SAM) on the proliferation, adhesion, migration, invasion and apoptosis of activated human hepatic stellate cells (HSCs) and to explore the relevant potential mechanisms. METHODS: Human HSCs LX-2 were cultured with SAM. The proliferation and adhesion were detected by CCK-8. Cell apoptosis rate were analyzed by flow cytometry, and cell migration and invasion were tested by the transwell assay. The expression of Rac1 and MMP-2 was identified by real-time PCR or Western blotting, and activated Rac1 was detected by GST pull-down assay. The activity of MMP-2 and MMP-9 was analyzed by substrate zymography. RESULTS: The proliferation of LX-2 cells was inhibited by SAM, exhibiting a dose-dependent manner. Cell apoptosis rate induced by SAM was remarkably increased. SAM decreased the adhesion, migration and invasion of LX-2 cells. The expression and activation of Rac1 in LX-2 cells were significantly suppressed by SAM. In contrast, the activity of MMP-2 and MMP-9 was enhanced by SAM. SAM attenuated the up-regulated expression of Smad3/4 and Rac1 induced by TGF-ß1. CONCLUSION: SAM inhibits the proliferation, adhesion, migration and invasion of LX-2 cells in vitro probably via attenuating the expression and activation of Rac1 and up-regulating MMP-2 and MMP-9 expression, which possibly provide a molecular basis for potential application of SAM in the therapy of liver fibrosis.


Assuntos
Células Estreladas do Fígado/efeitos dos fármacos , Metaloproteinase 9 da Matriz/metabolismo , S-Adenosilmetionina/farmacologia , Proteínas rac1 de Ligação ao GTP/metabolismo , Apoptose/efeitos dos fármacos , Adesão Celular/efeitos dos fármacos , Linhagem Celular , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Células Cultivadas , Células Estreladas do Fígado/metabolismo , Células Estreladas do Fígado/fisiologia , Humanos , Metaloproteinase 2 da Matriz/genética , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinases da Matriz , Fenótipo , Proteína Smad3/metabolismo , Proteína Smad4/metabolismo , Proteínas rac1 de Ligação ao GTP/genética
6.
World J Gastroenterol ; 19(30): 4984-91, 2013 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-23946605

RESUMO

AIM: To investigate the prevalence of minimal hepatic encephalopathy (MHE) and to assess corresponding health-related quality of life (HRQoL) in hospitalized cirrhotic patients in China. METHODS: This multi-center cross-sectional study included 16 teaching hospitals, which were members of "Hepatobiliary Cooperation Group, Society of Gastroenterology, Chinese Medical Association", from different areas of China carried out between June and October in 2011. All the eligible hospitalized cirrhotic patients (n = 538) were required to complete triplicate number connection tests combined with one digit symbol test for diagnosing MHE. Patients' clinical examination data were complemented by a modified questionnaire assessing HRQoL. Written informed consent was obtained from each patient. RESULTS: Male was predominant (68.6%) in 519 patients who met the criteria of the study, with a mean age of 49.17 ± 11.02 years. The most common cause of liver cirrhosis was chronic hepatitis B (55.9%). The prevalence of MHE was 39.9% and varied by Child-Pugh-Classification score (CPC-A: 24.8%, CPC-B: 39.4% and CPC-C: 56.1%, P < 0.01). MHE (P < 0.01) and higher CPC scores (P < 0.01) were associated with a high HRQoL scores (reflecting poorer quality of life). The prevalence of MHE was proportionate to CPC (P = 0.01) and high quality of life scores (P = 0.01). CONCLUSION: Hospitalized cirrhotic patients have a high prevalence of MHE that is proportionate to the degree of liver function and HRQoL impairment.


Assuntos
Encefalopatia Hepática/epidemiologia , Encefalopatia Hepática/psicologia , Hospitalização , Cirrose Hepática/epidemiologia , Cirrose Hepática/psicologia , Qualidade de Vida , Adulto , Análise de Variância , Distribuição de Qui-Quadrado , China/epidemiologia , Estudos Transversais , Feminino , Encefalopatia Hepática/diagnóstico , Humanos , Cirrose Hepática/diagnóstico , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários
7.
J Clin Endocrinol Metab ; 97(5): 1729-36, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22419704

RESUMO

CONTEXT: Autologous hematopoietic stem cell transplantation (AHSCT) has the potential to induce clinical remission in patients with newly diagnosed type 1 diabetes. OBJECTIVE: The objective of the study was to examine the impact of AHSCT on lymphocytes and pancreatic ß-cell function. DESIGN: This was a nonrandomized, open-label prospective study. PATIENTS AND INTERVENTIONS: Thirteen patients with new onset of type 1 diabetes, 10 of them with diabetic ketoacidosis, were subjected to AHSCT with cryopreserved CD34(+) progenitor cells and followed up for 31-54 months. MAIN OUTCOME MEASURES: The numbers of different subsets of lymphocytes and the levels of serum cytokines, islet antibodies, C-peptide, and plasma glycosylated hemoglobin were longitudinally measured. RESULTS: The numbers of different subsets of lymphocytes, except for CD8(+) T cells, in the patients before AHSCT were significantly lower than those in controls. However, all lymphocytes gradually recovered after AHSCT, accompanied by decreased levels of serum autoantibodies, IL-1, IL-17, and TNF-α. After AHSCT, 11 of 13 patients required significantly reduced doses of insulin for adequate glycemic control, accompanied by reduced levels of glycosylated hemoglobin but increased C-peptide concentrations. Three patients achieved exogenous insulin independence for 7-54 months. The survival of remaining ß-cells was associated positively with the preexisting ß-cell function but negatively with preexisting autoantibodies (P < 0.05). The numbers of infused CD34(+) cells were positively correlated with the concentrations of serum IL-10, IL-4, TGF-ß, and fasting C-peptide but negatively correlated with the levels of serum TNF-α and insulin doses after AHSCT (P < 0.05). CONCLUSION: AHSCT modulated lymphocytes and preserved ß-cell function in Chinese patients with new onset of type 1 diabetes and diabetic ketoacidosis.


Assuntos
Diabetes Mellitus Tipo 1/cirurgia , Transplante de Células-Tronco Hematopoéticas , Células Secretoras de Insulina/fisiologia , Adolescente , Grupo com Ancestrais do Continente Asiático , Glicemia/metabolismo , Criança , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/fisiopatologia , Feminino , Humanos , Insulina/sangue , Masculino , Estudos Prospectivos , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
8.
Zhonghua Gan Zang Bing Za Zhi ; 15(4): 273-5, 2007 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-17456314

RESUMO

OBJECTIVES: To investigate the efficacy of interventional obstructive therapy for patients with liver cancer complicated with intrahepatic arteriovenous fistula. METHODS: Forty-eight of 56 patients with liver cancer complicated with intrahepatic arteriovenous fistula, confirmed by angiography, were treated with interventional obstructive therapy. The manifestations of the angiography, abdominal distention, ascites, and 24 hour urine output of the patients were retrospectively analyzed. RESULTS: (1) The arteriovenous fistula connected with the main branches of hepatic artery were embolized effectively by interventional method. (2) After the treatment, the abdominal distention alleviated remarkably (x2 =13.59, P < 0.01), the amount of ascites decreased, 24 hour urine output increased significantly (t = 13.57, P < 0.01) and quality of life improved. (3) The lifespan of the treated patients was prolonged after the embolization therapy. CONCLUSION: Interventional embolization is an effective palliative therapy for patients with liver cancer complicated with severe ascites and intrahepatic arteriovenous fistula. The good results of this therapy were associated with its effect in decreasing portal hypertension of the patients.


Assuntos
Fístula Arteriovenosa/terapia , Embolização Terapêutica , Neoplasias Hepáticas/terapia , Fístula Arteriovenosa/complicações , Embolização Terapêutica/métodos , Feminino , Artéria Hepática , Humanos , Neoplasias Hepáticas/complicações , Masculino , Pessoa de Meia-Idade , Veia Porta , Estudos Retrospectivos , Resultado do Tratamento
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