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Objective To investigate the predictive value of PCT for postoperative pancreatic fistula (POPF) in advance.Methods Clinical data of 62 consecutive patients who underwent pancreaticoduodenectomy(PD) and 19 consecutive patients who underwent distal pancreatectomy (DP) between Apr 2016 and Apr 2017 in the First Affiliated Hospital of Harbin Medical University and met the inclusion criteria were retrospectively collected and analyzed.Patients with PD and DP were divided into pancreatic fistula group (12 cases,3 cases),and non-pancreatic fistula group (50 cases,16 case).The PCT,CRP and WBC count levels of preoperative and postoperative day 1,3,5 (POD1,POD3,POD5) were compared between two groups.The data were subjected to independent sample t-test,Mann-Whitney rank sum test,x2 test or Fisher exact test.Receiver operating characteristic (ROC) curve was drawn and area under curve (AUC) was calculated to determine the cutoff value,sensitivity and specificity.Results For PD and DP patients,there were no significant difference on age,gender,BMI,diabetes,obstructive jaundice,preoperative laboratory test,operation time,intraoperative blood loss,tumor type between the two groups,which were comparable.For PD patients,postoperative hyperglycemia rate,postoperative ICU admission rate and total hospital stay of pancreatic fistula group were significantly higher than those of non-pancreatic fistula group (P =0.011,P =0.023,P ＜0.001).The PCT levels of POD1,POD3 and POD5 of pancreatic fistula group were significantly higher than those of non-pancreatic fistula group (P ＜ 0.001,P =0.010,P =0.002).PCT of POD1 had the highest sensitivity (100％) and specificity (80％) and PCT ＞0.76 μg/L was the risk factor for POPF.For DP patients,the PCT levels of POD1,POD3 and POD5 had the same predictive value for pancreatic fistula.Conclusion PCT has early predictive value for POPF of PD patients.
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Objective@#To investigate the prognostic factors related to the severity of acute pancreatitis and to establish the multiple predictor models of severe acute pancreatitis(SAP) in elderly patients.@*Methods@#Clinical data of 146 consecutive elderly patients who met the inclusion criteria between January 2014 and May 2017 at Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University were retrospectively collected and analyzed, wherein 88 cases were mild acute pancreatitis, 29 cases were moderately severe acute pancreatitis and 29 cases were SAP. The patients data were subjected to univariate analysis and multiple classified Logistic regression analysis for independent prognostic factors of the severity of acute pancreatitis in elderly patients. Unweighted predictive score(unwScore) and weighted predictive score(wScore)for SAP in elderly patients were established according which the receiver-operating characteristic(ROC) curves of independent prognostic factors and predictor models were produced. The cutoff values of independeut prognostic factors and predictor models were determined. The area under the curve, the sensitivity, the specificity, the positive predictive value and the negative predictive value to verify the predictive efficiency of the independent prognostic factors and predictor models were calculated.@*Results@#Procalcitonin(PCT)(Z=10.564, P=0.000), blood urea nitrogen(BUN)(Z=22.231, P=0.003), serum creatinine(Scr)(Z=14.151, P=0.030), serum calcium(Z=34.979, P=0.032) and pleural effusion(χ2=28.463, P=0.015) were independent prognostic factors of the severity of acute pancreatitis by univariate analysis and multiple classified Logistic regression analysis in elderly patients. Respectively, the area under the curve of PCT, BUN, Scr, serum calcium and pleural effusion were 0.908, 0.737, 0.701, 0.753, 0.712, the sensitivity were 0.828, 0.621, 0.552, 0.690, 0.517, the specificity were 0.915, 0.786, 0.846, 0.966, 0.906, the positive predictive value were 70.6%, 41.9%, 47.1%, 83.3%, 57.7%, the negative predictive value were 95.5%, 89.3%, 88.4%, 92.6%, 88.3%. Respectively, the area under the curve of unwScore and wScore were 0.915 and 0.953, the sensitivity were 0.759 and 0.931, the specificity were 0.889 and 0.915, the positive predictive value were 62.9% and 73.0%, the negative predictive value were 93.7% and 98.2%.@*Conclusions@#PCT, BUN, Scr, serum calcium and pleural effusion were independent prognostic factors of the severity of acute pancreatitis in elderly patients. The multiple predictor models of SAP in elderly patients have a good predictive efficiency, which may provide valuable clinical reference for prediction and treatment.
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Objective To investigate the risk factors of death and to establish an early multi-index predictive model for mortality moderately of severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) in elderly patients.Methods Clinical data of 58 digible elderly patients of MSAP and SAP between January 2014 and May 2017 in First Affiliated Hospital of Harbin Medical University were analyzed retrospectively,including 18 cases (31.0％) in the death group and 40 cases in the control group (69.0％).Univariate analysis and logistic regression analysis were used to screen out the independent risk factors related to death,combined with these independent risk factors,the unweighted predictive model (unwScore) and weighted predictive model (wScore) for mortality were established.The receiver-operating characteristic (ROC) curves of independent risk factors and predictive models were drawn to determine the cut-off value,to calculate the area under the curve (AUC),sensitivity,specificity,positive predictive value and negative predictive value and to observe the clinical predictive effectiveness.Student's t-test was used to analyze continuous variables that complied with a normal distribution expressed as ((x) ± s).Mann-Whitney U test was used to analyze abnormally distributed variables expressed as median (quartile range) [M(P25,P75)].chi-square test or Fisher's exact test was used to analyze categorical data expressed by rate (％).Univariate analysis was used to screen out data with statistically significant difference,and then Logistic regression analysis was performed to determine independent predictors.Results Univariate analysis showed that there were statistically significant differences in pro-calcitonin,serum albumin (ALB),serum calcium,D-dimers,mean arterial pressure,pleural effusion and peritoneal effusion between the two groups (P ＜0.05);multivariate analysis showed that ALB,pleural effusion and peritoneal effusion were independent risk factors for mortality of MSAP,SAP in early patients,which AUC were 0.815,0.678,0.696,sensitivity were 0.611,0.556,0.667,specificity were 0.825,0.800,0.725,the positive predictive values were 61.1％,55.6％,52.2％,and the negative predictive values were 82.5％,80.0％,89.9％,respectively.The AUC of unwScore and wScore were 0.852 and 0.863,the sensitivity were 0.667 and 0.778,the specificity were O.875 and 0.800,the positive predictive values were 70.6％ and 63.6％,and the negative predictive values were 85.4％ and 88.9％,respectively.Conclusion ALB,pleural effusion and peritoneal effusion were independent risk factors for mortality of MSAP,SAP in elderly patients.The multi-index predictive model had good clinical predictive effectiveness,which could provide clinical references for the treatment of MSAP and SAP in elderly patients.
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Objective The purpose of the retrospective study was to introduce a treatment option for atypical Hangman fractures (AHF) based on a new classification.Methods Sixty-seven patients with Hangman fractures were treated with a comprehensive treatment strategy.Firstly,Hangman fractures were classified as typical or atypical (AHF) lesions using computed tomography scans of the cervical spine.Secondly,AHF was divided into 1 of 4 types (type A1,A2,B1,and B2) devised by us to clarify the feature of injury.Thirdly,the injury status of disco-ligamentous complex (intact/indeterminate/ruptured) was evaluated using magnetic resonance imaging.If it was a stable lesion,conservative treatment was recommended.If not surgical treatment using anterior or/and posterior stabilization and fusion at C2-C3 level was used.Results Fifty-one patients were identified with AHF.According to our classification,thirty patients were classified as type A1,14 cases as typeA2,5 cases as type B1,and 2 cases as type B2 lesions.Thirteen AHF without C2-C3 instability (12 as type A1 and 1 as type B1) were treated with non-operative treatment,and 38 AHF with C2-C3 instability (18 as type A1,14 as type A2,4 as type B1,and 2 as type B2) were treated with operative treatment.Three patients (all with type A1 lesions) with slightly displacement of C2-3 underwent isolated direct screw osteosynthesis.The remaining 35 underwent posterior stabilization and fusion at C2-C3 level:24 patients with posterior approach with C2 lag screws and C3 non-lag screws fixation and fusion (11 as type A1,10 as type A2,2 as type B1,and 1 as type B2);3 patients with posterior approach with C1 and C3 screw-rod fixation and fusion (1 as type A1 and 1 as type B1);7 with anterior approach by C2-3 discectomy and fusion (3 as type A1 and 4 as type A2);and 2 with anterior and posterior approach (1 as type B1 and 1 as type B2).The average follow-up period was 26 months (range,12-86 months).Neck pain improved significantly at 3-month follow-up,and neurologic status improved at least 1 grade in 12 patients with neurologic deficits at final follow-up.Radiological evaluation showed bony fusion in all patients at 12-month follow-up.Radiological evaluation showed that all 13 AHF without C2-C3 instability treated with non-operative treatment gained fractures fusion at 3-6 month follow-up.Posterior approaches with C1 or C2 and C3 screw-rod fixation and fusion were found to obtain a better alignment of C2-C3 and satisfactory fusion of C2 pedicle factures than anterior approach.Conclusion The treatment option for AHF based on a new classification is helpful in managing such fractures,resulting in good clinical and radiological outcomes.C2 lag screws with or without C3 pedicle screws fixation via posterior approach may not only reduce fractures but also obtain alignment of C2-C3 effectively.
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Objective To evaluate the early predictive and diagnostic value of procalcitonin (PCT) in abdominal infection after pancreatoduodenectomy(PD).Methods The clinical data of 62 patients with PD in the First Affiliated Hospital of Harbin Medical University from April 2016 to April 2017 were retrospectively analyzed.The general data and postoperative conditions of the patients were recorded.Serum PCT,C-reactive protein (CRP) levels and WBC counts were measured before and 1,3,and 5 days after surgery.According to the postoperative abdominal infection,the patients were divided into abdominal infection group (n =10) and control group(n =52).The area under the ROC curve (AUC) was calculated by plotting the receiver operating characteristic (ROC) curve,and the cut-off value was determined to compare the sensitivity and specificity of the two groups of patients.Results There were no significant difference between two groups on age,gender,BMI,diabetes mellitus,preoperative laboratory indicators,anesthetic time,operation time,intraoperative bleeding and blood transfusion,surgical procedures and Braun anastomosis,which were comparable.The incidence of postoperative hyperglycemia,surgical incision infection,pancreatic fistula,biliary fistula,mortality,postoperative hospital stay and total medical costs of abdominal infection group were significantly higher than those of control group (P ＜ 0.05).There were no significant differences on PCT,CRP,and WBC between the two groups before surgery.The PCT level of the abdominal infection group was significantly higher than that of the control group at the 1st postoperative day and the difference was statistically significant (P ＜0.05).The sensitivity of predicting abdominal infection was 90％ and the specificity was 75％,which was significantly higher than those of CRP and WBC.There were no significant differences on the sensitivity and specificity of PCT,CRP and WBC for postoperative abdominal infection at 3 and 5 days after surgery,but the sensitivity of the combined diagnosis was as high as 100％ and 90％,significantly higher than 3 indicators alone,respectively.Conclusions Serum PCT level may predict in advance or diagnose early abdominal infection after PD.The combination of PCT,CRP and WBC might be more valuable for the diagnosis of abdominal infection after PD.
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BACKGROUND:It has been reported that human aerobic endurance, cardiovascular system, blood constituent, immune system, neuroendocrine system, free radical antioxidant system, and acid-base balance system can be influenced under hypoxic conditions. However, very little is known regarding bone metabolism under hypoxic conditions and the underlying mechanisms. OBJECTIVE:To summarize the effects of hypoxic conditions on bone metabolism from the views of hypoxia inducible factors, osteblasts and osteoclasts, and the effects of exercise training under hypoxic conditions on the skeleton, contributing to understanding the theoretical advantages and disadvantages of altitude training. METHODS:A computer-based online search was conducted in CNKI and PubMed databases from January 2000 to September 2015 using the keywords“hypoxia environment, hypoxia inducible factors, bone metabolism, exercise, altitude training”to screen the relevant English and Chinese literatures. A total of 233 literatures were screened and final y 46 eligible literatures were included. RESLUTS AND CONCLUSION:The effects of hypoxic conditions on bone metabolism are complex, which are mainly linked to hypoxia inducible factors, osteblasts and osteoclasts. Hypoxia-inducible factor 1 is considered to influence the skeleton by promoting the bone growth induced by vascular endothelial growth factor and directly affecting the osteblasts and osteoclasts. Additional y, hypoxia-inducible factor 1 has been shown to enhance osteoclast-mediated bone resorption. The balance between osteoblast-mediated bone formation and osteoclast-mediated bone resorption is disturbed under hypoxic conditions. We need to pay attention to the training period and intensity at altitude because altitude training may not benefit the bone metabolism.
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Objective To study whether osteoblast is necessary for IGF-Ⅰ to promote bone resorption by osteoclast.Methods Mouse MC3T3 osteoblast cells and mature osteoclasts induced by RANKL were cultured in vitro.These osteoblasts and osteoclasts were subjected to treatment with recombinant human insulin-like growth factor-1 (rhIGF-Ⅰ),and the activation of IGF-Ⅰ receptor was verified by Western blotting.Thereafter,osteoclasts were cultured individually or co-cultured with osteoblast,in the absence or presence of rhIGF-Ⅰ.Osteoclast proliferation and apoptosis were observed by MTT colorimetric assay and flow cytometry.Cathepsin K gene expression was detected by real-time PCR; bone adsorption activity of osteoclast was determined by resorption pits formation on calf cortex slice with toluidine blue staining.Results Western blotting result confirmed that rhIGF-Ⅰ could effectively activate IGF-Ⅰ receptors either in osteoblast or osteoclast.In co-cultured group,in the presence of rhIGF-Ⅰ osteoclast showed inhibited apoptosis,enhanced proliferation and up-regulated cathepsin K expression (P ＜ 0.05).The functional experiment revealed that osteoclasts collected from IGF-Ⅰ treated co-cultured group resulted in more resorption pits formation (P ＜ 0.05); rhIGF-Ⅰ did not show any significant effect on the individually cultured osteoclasts.Conclusion Osteoblast is necessary for osteoclast induced bone resorption resulting from IGF-Ⅰ treatment.
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BACKGROUND: An ideal repairing material characterizes by both great biocompatibility and osteogenesis ability. Any biomaterials should meet excellent biological security and biocompatibility prior to clinical application.OBJECTIVE: To evaluate the biocompatibility and the biological security of the TiO_2-Ag-nano-hydroxyapatite/polyamide66 (TiO_2-Ag-nHA/PA66) composite.DESIGN, TIME AND SETTING: A randomized controlled duplicated design was performed in Chongqing Medical University from July 2008 to July 2009.MATERIALS: A total of 40 Kunming mice aged 3 weeks and of clean grade and 32 healthy adult New Zealand rabbits were provided by Experimental Animal Center of Chongqing Medical University. TiO_2-Ag-nHA/PA66 composite powder (10 g),TiO_2-Ag-nHA/PA66 composites (n=32, 5 mm ×25 mm), and TiO_2-Ag-nHA/PA66 composites (n=32, 3 mm × 5 mm) were provided by Research Center of Nano-Biomaterials of Sichuan University.METHODS: General toxicity test: Forty mice were randomly divided into experimental and control groups. Composite powder was used to prepare leaching liquor which was treated on experimental mice by an intraperitoneal injection. While, an equal amount saline was inserted into the control mice. Intramuscular implanting test: The 16 rabbits were randomly divided into experimental and control groups. Two TiO_2-Ag-nHA/PA66 composite (5 mm × 25 mm) were implanted into left and right erector spinae, respectively. A similar surgery with the exception of implantation was performed on the control rabbits. Intrabony implanting test: The resting 16 rabbits were implanted one TiO_2-Ag-nHA/PA66 composite (3 mm × 5 mm) into left and right lateral epicondyle, respectively. Hemolytic test: A 8-mL anti-coagulation blood was obtained and added with composite powder (0.1,0.15, and 0.2 g).MAIN OUTCOME MEASURES: Biocompatibility and biological security of TiO_2-Ag-nHA/PA66 composite.RESULTS: General toxicity test demonstrated that mice in the two groups had good activity and eating, normal breathing, stable body mass, no paralysis, convulsion, and death. Intramuscular implanting test and intrabony implanting test showed that there was no significant difference in levels of alanine aminotransferase, aspartate transaminase, urea nitrogen, and creatinine and leukocyte numbers between the two groups before implantation and at day 4,1 week, and 2 weeks after implantation (P> 0.05).In particular, there was no significant difference in the experimental group at varying time points (P> 0.05). Intramuscular implanting test indicated that tissue sections in the experimental group displayed coated tissue of materials. The inflammatory variation in the experimental group was generally similar to that in the control group. Intrabony implanting test indicated that tissue sections in the experimental group displayed new bone formation. Hemolytic test suggested that hemolytic ratio of three varying concentrations of TiOrAg-nHA/PA66 composites was less than 5%, which met the normal criterion.CONCLUSION: TiO_2-Ag-nHA/PA66 composite has a good biocompatibility and biological security.
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Aim To study the effects of Metformin (MF) on endocrine function of pituitary-gonad axis in rats. Methods The serum hormone concentration was measured with radioimmunoassay (RIA) and the morphology of gonad endocrine cells was observed with electron microscope. Results MF(135 mg?kg-1?d-1,ig,14 d)decreased serum T concentration in male rats and serum LH concentrations in female rats significantly(P
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AIM To study whether cyproheptadine(Cyp) affects endocrine functions in reproductive system with gender difference. METHODS Sixty SD rats were randomly distributed into 3 groups according to gender, respectively, and they were administered NS(5 mL*kg-1*d-1), Cyp 2.4, 4.8 mg*kg-1*d-1 accordingly by ig for 14 d or 21 d. The serum levels of luteinizing hormone(LH), follicle stimulating hormone(FSH), testosterone(T), progesterone(P), estrodiol(E2) were measured by radio-immunoassay and the ultrastructure of gonadotropin-releasing hormone(GnRH) cells, gonadotropin cells, Leydig cells, Sertoli cells, luteal cells, granulocytes and so on were observed by electronmicroscopy and microscopy. The calmodulin(CaM) mRNA expression in hypothalamus-pituitary-testis axis(HPTA) was detected by reverse transcriptase-polymerase chain reaction. RESULTS Cyp(2.4 mg*kg-1*d-1×14 d, ig) increased serum LH concentration while decreased serum FSH, P concentrations in female rats. Cyp(4.8 mg*kg-1*d-1×14 d, ig)increased serum LH, T concentrations in males, and increased serum LH concentration while decreased serum FSH, E2 and P concentrations significantly in females. The retrograde changes of ultrastructure were observed in part of gonadotropin and ovary endocrine cells, while a stimulating one in testis endocrine cells. CaM mRNA expression levels were elevated in testis but not in hypothalamus and pituitary in male rats. CONCLUSIONCyp had a negative effect on endocrine function in females, but a positive one in males. The ultrastructure showed relevant changes in target gland. Cyp promoted CaM mRNA expression in testis,which had close connections with Cyp′s stimulative effect in HPTA.
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AIM To study the effects of cyproheptadine (Cyp) on endocrine functions and pituitary adrenalcortex axid in rats and its mechanism METHODS Radioimmunoassay(RIA)was used to measure the serum levels of ACTH and cortisone Ultramicrostructure of the ACTH cells and adrenalcortex and the calmodulin(CaM) mRNA expression of the pituitary and adrenalcortex were observed by electron microscope and the quantity PCR technique RESULTS Cyp 2 3 and 4 6 mg?kg -1 ?d -1 , ig for 14 d had significantly reduced the serum levels of ACTH and cortisone ( P