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Objective:To construct a model of early neurological deterioration (END) in acute ischemic stroke (AIS), and to evaluate the predictive value of this model.Methods:From February 2018 to December 2020, 263 cases of AIS patients admitted to Response General Hospital were selected as research objects. According to whether END occurs, they were divided into END group (80 cases) and non-END group (183 cases). Logistic regression was used to analyze the independent risk factors of AIS concurrent END, and the predictive model of the above factors was constructed. The value of the model was evaluated by receiver operating characteristic (ROC) curve, correction curve and decision curve analysis (DCA).Results:Systolic blood pressure, diastolic blood pressure, fasting plasma glucose, total cholesterol, National Institutes of Health Stroke Scale (NIHSS) and door to needle time (DNT) in the END group were (144.66 ± 18.08) mmHg(1 mmHg=0.133 kPa), (84.04 ± 8.47) mmHg, (6.15 ± 1.00) mmol/L, (4.82 ± 1.08) mmol/L, (14.90 ± 4.95) points, (4.58 ± 1.02) h, all higher than those in the non-END group (132.32 ± 15.53) mmHg, (81.19 ± 11.00) mmHg, (5.53 ± 0.98) mmol/L, (4.51 ± 1.15) mmol/L, (11.37 ± 3.32) points, (3.22 ± 1.08) h, and the level of high density lipoprotein cholesterol was (1.09 ± 0.07) mmol/L in the END group,lower than that in the non-END group (1.15 ± 0.08) mmol/L, the differences were statistically significant ( t values were 2.07-9.53, all P<0.05). Logistic regression analysis showed that fasting plasma glucose ( OR=2.25, 95% CI 1.50-3.40, P<0.05), systolic blood pressure ( OR=1.04, 95% CI 1.02-1.07, P<0.05), NIHSS score ( OR=1.26, 95% CI 1.14-1.39, P<0.05) and DNT ( OR=3.44, 95% CI 2.30-5.14, P<0.05) were independent risk factors for AIS concurrent END. The area under ROC curve, sensitivity and specificity of the model X composed of fasting plasma glucose, systolic blood pressure, NIHSS scores and DNT for diagnosing AIS concurrent END were 0.90 (95% CI 0.87-0.94), 90.00% and 77.60% respectively. The calibration curve of model X had a high coincidence with the ideal curve. Conclusions:The model X composed of fasting plasma glucose, systolic blood pressure, NIHSS score and DNT has high application value for the prediction of END, which can assist the clinic to make better decision.
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Liver cirrhosis is a common kind of chronic liver diseases, with the development of diseases; some patients may gradually develop precancerous lesions, or even progress to hepatocellular carcinoma (HCC). Precancerous lesions of the liver mainly include dysplastic foci (DF) and dysplastic nodules (DN), and most of it occurs on the basis of liver cirrhosis. Thus, recognition of precancerous lesions and liver cirrhosis through screening, combined with imaging and pathological features will identity the nature of nodules in early stage cirrhosis and HCC, and thereby will help to improve the diagnosis rate and clinical prognosis.
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Liver pathological examination plays an important role in guiding clinical treatment and evaluating disease prognosis, especially in the diagnosis of difficult liver diseases. The application of liver biopsy and proper pathological techniques helps pathologists to observe the morphological changes of the liver and thus provides a reference for disease diagnosis, differential diagnosis, and clarification of etiology. This article introduces the commonly used techniques for liver biopsy, in order to improve the understanding of liver pathological changes among clinicians, strengthen the association between clinical practice and pathology, and provide help to the diagnosis of liver diseases, especially difficult liver diseases.
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AIM: To explore whether exogenous hydrogen sulfide (H2S) depresses high glucose (HG)-in-duced injury by modulating the Janus kinase/signal transducer and activator of transcription ( JAK/STAT) pathway in hu-man umbilical vein endothelial cells (HUVECs).METHODS:The protein levels of JAK2, STAT3 and cleaved caspase-3 were determined by Western blot.The cell viability was measured by CCK-8 assay.Mitochondrial membrane potential ( MMP) was detected by rhodamine 123 staining followed by photofluorography.The intracellular level of reactive oxygen species (ROS) was analyzed by DCFH-DA staining followed by photofluorography.The activity of superoxide dismutase (SOD) was also measured.RESULTS:Pretreatment of the HUVECs with 400 μmol/L NaHS (a donor of H2S) for 30 min prior to exposure to 40 mmol/L glucose ( HG) markedly attenuated HG-induced upregulation of the phosphorylation of JAK2 and STAT3.Pretreatment with 400μmol/L NaHS for 30 min or with 20μmol/L AG490 (inhibitor of the JAK/STAT pathway) for 30 min attenuated the injury of HUVECs induced by HG, as indicated by the increases in cell viability and SOD activity, and decreases in the protein level of cleaved caspase-3, ROS generation and dissipation of MMP.CONCLU-SION:Exogenous H2 S protects HUVECs against HG-induced injury by inhibiting JAK/STAT pathway.
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Objective To investigate the clinical value of 64-slice spiral computed tomography(64-MSCT)triple-phase enhanced scan in diagnosis of lymphatic metastasis of gastric cancer.Methods Thirty patients with gastric cancer underwent plain and triple-phase enhanced scan by using 64-MSCT to analyze the relevant parameters of lymphatic metastasis.Results The four parameters de-termined metastatic perigastric lymph node as follows:①the short diameter ≥6 mm,②the ratio of short-to-long diameter ≥0.6,③the CT value in the portal venous phase≥ 65 HU,④the difference of CT values between portal venous phase and plain scan≥35 HU.The sensitivity and specificity of combining two parameters (①+②)in diagnosing metastatic lymph node were 90.5% and 29.0%,respectively.The sensitivity and specificity of combining three parameters (①+②+③)were 98.2% and 1 9.4%,respec-tively.The sensitivity and specificity of combining four parameters (①+②+③+④)were 99.7% and 13.2%,respectively.In ad-dition,metastatic lymph nodes were considered if they were ring-enhancement,or adhesions of several lymph nodes.Conclusion The use of 64-MSCT triple-phase enhanced scan and synthesis of various parameters of lymph nodes could lead to reliable diagnosis of lymphatic metastasis in gastric cancer with rapid,non-invasive,high sensitive and specific features.
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Objective To investigate management strategy of minimally invasive surgery for common bile duct stones. Methods Three hundred and four cases of common bile duct stones were divided into 3 groups receiving respectively endoscopic papillary balloon delation plus laparoscopic cholecystectomy ( EPBD group, 35 cases ), endoscopic sphincterotomy plus LC ( EST group, 138 cases), and Laparoscopic common bile duct exploration plus LC (LCBDE group, 131 cases). Results There was no significant difference in treatment success rate, short-term complications and bile duct retained stones among these three group ( x2 = 1. 930, 0. 038, and 0. 427 respectively, P > 0. 05 ). There was significant difference among these three groups in operation time ( F = 17.941, P = 0. 000 ), and the operation time in LCBDE group was shorter than that in other two groups( EPBD-EST: P = 0. 122, EST-LCBDE:P = 0. 000, EPBD-LCBDE:P = 0. 020 ). There was significant difference among these three groups in postoperative hospital stay (F =24. 016,P =0. 000) ,and the postoperative hospital stay in EPBD group was shorter than that in other two groups ( EPBD-EST: P = 0. 000, EST-LCBDE : P = 0. 198, EPBD-LCBDE : P = 0. 000 ). In EPBD group,bile duct recurrent stones was found in 2 cases(6. 7% ) and cholangitis in 1 case(33% ) and no duodenal papilla stenosis was encountered; In LCBDE group, bile duct recurrent stones were found in 7 cases (6. 0% ), cholangitis in 3 cases ( 2. 6% ), and there was no duodenal papilla stenosis; In EST group, bile duct recurrent stones were complicated in 18 cases ( 15.8% ), duodenal papilla stenosis in 9 cases (7.9%), and cholangitis in 14 cases( 12. 3% ). There were significant differences among these three groups for these three complications( x2 = 6. 482, 9. 160, and 12. 020 respectively,P < 0. 05 ), and the rate of complications in EST group was higher than that in other two groups. Conclusion For common bile duct stones, EPBD is the first choice followed by LCBDE while EST is only indicated for very few cases.
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Objective To study the value of three-dimensional (3D) visualization and virtual surgery system in piggyback liver transplantation. Methods Two patients who suffered from choledocholithiasis were scanned by 64-slice spiral CT and the data were collected. The segmentation of the hepatic CT images was carried out. The 3D model of the liver and the intrahepatic vessels was reconstructed, and was imported to the FreeForm Modeling System in STL format for smoothing and modifying. Piggyback liver transplantation was simulated with the force-feedback equipment (PHANToM). Results The reconstructed 3D model of the liver was vivid, and the process of the virtual piggyback liver transplantation was verisimilar. Conclusions The 3D model of the liver enables the simulation of piggyback liver transplantation. It can reduce the risk and complications of the surgery, and enhance the communication between doctor and patient through designing surgical plan and demonstrating visualized operation before surgery. Virtual liver transplantation is also helpful during the training of medical workers.
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Objective To study the application of ultrasonically activated scalpel in laparoscopic intestinal adhesion release.Methods Intestinal adhesion release with ultrasonically activated scalpel under laparoscope was performed in 29 patients suffered from intestinal adhesive obstruction after gynecological operation. Results All operations were successfully performed, and none of them converted into open surgery. Intestinal disruption occurred durring operation in 2 patients with extensive intestinal denseadhesion which were mended successfully under laparoscope. The operative duration was 30-150 min (mean 45 min). Postoperative complications such as bowel leak age, bleeding, abdominal infection were not experienced. Postoperative hospital stay was 3-7 days (mean 4 days). No case had relapse symptom such as abdominal distention or pain after 1-24 months of follow up. Conclusion Compared with electric scalpel, ultrasonically activated scalpel can improve the operative safety, lessen tissue damage, shorten operative time, and reduce the chance of relapse in laparoscopic operation in gynecology.
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0.05).The operation time was longer,volume of bleeding was less,and postoperative time of bowel gas passage and hospital stay were shorter in laparoscopic group compared to those in open group(P0.05).Conclusions This study reveals that totally laparoscopic D2 gastrectomy is safe and feasible for advanced gastric cancer,and it presents the superior character of minimal invasion.