Changes in serum levels of Hcy and MMP-9 and risk factor analysis in patients with coronary heart disease complicating Helicobacter pylori infection in Chengdu area / 公共卫生与预防医学

Objective To study the changes in serum homocysteine (Hcy) and matrix metalloproteinase-9 (MMP-9) levels and risk factors in patients with coronary heart disease (CHD) complicated with Helicobacter pylori (HP) infection in Chengdu area, and to provide a theoretical basis for the prevention of HP infection in patients with coronary heart disease. Methods A total of 348 CHD patients admitted to our hospital in Chengdu from 2019 to 2021 were selected. Hp infection status was detected by C14 urea breath test. Patients were classified into control group (n=197) and HP infection group (n=151) according to the detection results. Data including gender, age, body mass index and peptic ulcer history were collected, and univariate analysis and logistic regression were used to screen the risk factors affecting the occurrence of HP infection in patients with CHD. Results The prevalence rate of HP infection was 43.39% (151/348) among the selected CHD patients. Serum levels of Hcy and MMP-9 were notably elevated in HP infection group compared with control group (P<0.05). The proportion of patients with age ≥60 years old, hyperlipidemia, proton pump inhibitor use history, and frequent consumption of out-of-home food and spicy food in HP infection group was obviously larger than that in control group (P<0.05). Hyperlipidemia (OR=3.719), history of proton pump inhibitor use (OR=3.254) and frequent consumption of out-of-home food (OR=2.721) were independent risk factors for HP infection in CHD patients (P<0.05). Conclusion CHD patients in Chengdu suffer a prevalence rate of HP infection, and have elevated levels of serum Hcy and MMP-9. Furthermore, the intervention measures for patients with hyperlipidemia, proton pump inhibitor drug use history and frequent consumption of out-of-home food are of vital importance for decreasing the risk of HP infection.

Effect and Safety of Guanxinning Tablet () for Stable Angina Pectoris Patients with Xin (Heart)-Blood Stagnation Syndrome: A Randomized, Multicenter, Placebo-Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To investigate the effect and safety of Guanxinning Tablet (, GXN) for the treatment of stable angina pectoris patients with Xin (Heart)-blood stagnation syndrome (XBSS).@*METHODS@#One hundred and sixty stable angina pectoris patients with XBSS were randomly assigned to receive GXN (80 cases) or placebo (80 cases, Guanxinning simulation tablets, mainly composed of lactose), 4 tablets (0.38 g/tablet), thrice daily for 12 weeks. After treatment, an exercise stress test (treadmill protocol), Chinese medicine (CM) syndrome score, electrocardiogram (ECG), and nitroglycerin withdrawal rate were evaluated and compared in the patients between the two groups. Meanwhile, adverse events (AEs) were evaluated during the whole clinical trial.@*RESULTS@#Compared with the control group, the time extension of exercise duration in the GXN group increased 29.28 ±17.67 s after treatment (P>0.05); moreover, the change of exercise duration in the GXN group increased 63.10 ±96.96 s in subgroup analysis (P<0.05). The effective rates of angina pectoris, CM syndrome and ECG as well as nitroglycerin withdrawal rate were 81.33%, 90.67%, 45.76%, and 70.73%, respectively in the GXN group, which were all significantly higher than those in the control group (40.58%, 75.36%, 26.92%, 28.21%, respectively, P<0.05).@*CONCLUSION@#GXN was a safe and effective treatment for stable angina pectoris patients with XBSS at a dose of 4 tablets, thrice daily.

Liver transplantation in end-stage liver disease with portal vein thrombosis / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience in the managements of portal vein thrombosis (PVT) and to evaluate the impact of PVT on intraoperative course and postoperative outcome in liver transplantation.</p><p><b>METHODS</b>Between May 1995 and September 2007, 194 orthotopic liver transplantations were performed, of which 24 cases presented portal vein thrombosis. There were 12 patients with grade I, 9 with grade II, 2 with grade III and 1 with grade IV. The management of PVT depended mainly on its extent. Ligation of the collateral circulation, especially spontaneous or surgical splenorenal shunt, was made as approaches to improve portal flow.Heparin or low-molecule-weight heparin as a prophylactic anticoagulation therapy was maintained during and after operation if prothrombin time is less than eighteen seconds. Follow-up Doppler ultrasonography was used daily in the early postoperative period. Risk factors and variables associated with the transplant and the post-transplant period were analyzed and compared with 170 patients transplanted without PVT.</p><p><b>RESULTS</b>Surgical techniques were eversion thromboendovenectomy in 21 patients with PVT grades I and II, extra-anatomic mesenteric graft in 2 with grade III, and anastomosis to a collateral vein in 1 with grade IV. The study demonstrated more RBC transfusions [(15.2 +/- 11.8) U vs. (8.6 +/- 6.6) U, P = 0.006], longer surgery procedures [(492 +/- 89) min vs. (403 +/- 105) min, P = 0.001] and hospital stay [(32.4 +/- 13.5) d vs. (22.1 +/- 9.1) d, P = 0.001] in the PVT group. However, there were no differences in overall morbidity (58.3% vs. 50.6%, P = 0.478), hospital mortality (8.3% vs.6.5%, P = 0.73) and 1-year survival (87.5% vs. 89.4%, P = 0.778). The incidence of rethrombosis was higher in the PVT group (8.3% vs.1.2%, P = 0.021). Two cases rethrombosis were successfully cured by percutaneous thrombolysis, balloon angioplasty, and stent placement.</p><p><b>CONCLUSION</b>Portal thrombosis is associated with greater operative complexity and rethrombosis, but has no influence on overall morbidity and mortality in liver transplantation.</p>

Prevention and treatment of biliary complications following orthotopic liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To study the prevention and treatment of biliary complications after orthotopic liver transplantation.</p><p><b>METHODS</b>Clinical data of 183 recipients who had received liver transplantation between May 1995 and December 2006 were retrospectively analyzed.</p><p><b>RESULTS</b>Biliary complications occurred in 15 patients (15/183, 8.2%). The incidence for short-term and long-term complication were 6.0% (11/183) and 2.2% (4/183) respectively. No biliary complications was due to hepatic artery thrombosis(HAT). Four cases who received PTC(percutaneous transhepatic cholangiography) with stent insertion,8 cases who received ERCP( endoscopic retrograde cholangiopancreatography) with stent insertion and 1 who received Roux-en-Y choledochojejunostomy for anastomotic stricture were successfully cured. Two cases required relaparotomy died for fungus infection eventually. The mortality due to biliary complications was 1.1%.</p><p><b>CONCLUSIONS</b>The rapid combined abdominal organ harvesting technique could shorten the ischemia time and ameliorate the injury due to vascular and bile duct variances, which could reduce the incidence of biliary complication. PTC and (or) ERCP combined with stent insertion were main procedure for biliary complications not related to HAT after liver transplantation.</p>

Prevention and treatment of rejection after simultaneous pancreas-kidney transplantation / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To explore methods of preventing and reversing rejection after simultaneous pancreas-kidney (SPK) transplantation.</p><p><b>METHODS</b>Seventeen patients underwent SPK transplantation from September 1999 to September 2003 were reviewed retrospectively. Immunosuppression was achieved by a triple drug regimen consisting of cyclosporine, mycophenolate mofteil (MMF), and steroids. Three patients were treated with anti-CD3 monoclone antibody (OKT3, 5 mg x d(-1)) for induction therapy for a mean period of 5-7 days. One patients received IL-2 receptor antibodies (daclizumab) in a dose of 1 mg x kg(-1) on the day of transplant and the 5th day posttransplant. One patient was treated with both OKT3 and daclizumab for induction.</p><p><b>RESULTS</b>No primary non-functionality of either kidney or pancreas occurred in this series of transplantations. Function of all the kidney grafts recovered within 2 to 4 days after transplantation. The level of serum creatinine was 94 +/- 11 micromol/L on the 7th day posttransplant. One patient experienced the accelerated rejection, resulting in the resection of the pancreas and kidney grafts because of the failure of conservative therapy. The incidence of the first rejection episodes at 3 months was 47.1% (8/17). Only the kidney was involved in 35.3% (6/17); and both the pancreas and kidney were involved in 11.8% (2/17). All these patients received a high-dose pulse of methylprednisone (0.5 g x d(-1)) for 3 days. OKT3 (0.5 mg x d(-1)) was administered for 7-10 days in two patients with both renal and pancreas rejection. All the grafts were successfully rescued.</p><p><b>CONCLUSION</b>Rejection, particularly acute rejection, is the major cause influencing graft function in SPK transplantation. Monitoring renal function and pancreas exocrine secretion, and reasonable application of immunosuppressants play important roles in the diagnosis and treatment of rejection.</p>

Analysis of rejection after simultaneous pancreas-kidney transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To explore methods of preventing and reversing rejection after simultaneous pancreas-kidney transplantation (SPK).</p><p><b>METHODS</b>Seventeen patients performed SPK operation from Sep, 1999 to Sep, 2003 were reviewed retrospectively. Immunosuppression was achieved by triple regimen consisting of cyclosporine, mycophenolate mofetil (MMF)/azathioprine and steroid. 2 patients were treated with Dalizumab, the other three patients used OKT3 as immune induction.</p><p><b>RESULTS</b>1 patient experienced the accelerated rejection, the pancreas and kidney grafts were resected because of failure of conservative therapy. 8 patients experienced renal acute rejection, 2 cases suffered from pancreas acute rejection at the same time. All these patients received daily high dose pulse steroid for 3 days. OKT3 was administered in 2 patients with steroid resistance rejection. All the grafts were successfully rescued.</p><p><b>CONCLUSIONS</b>Reasonable application of immunosuppression after SPK operation and adoption of systemic measures which can reduce sensitivity of high risk receptor before SPK operation are the effective methods of preventing and treating rejection.</p>