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Objective:To study the effect of diabetes mellitus (DM) on sepsis in patients with pyogenic liver abscess (PLA).Methods:The clinical data of 116 patients with PLA treated in the Affiliated Hospital of Jiangnan University from January 2021 to May 2022 were retrospectively analyzed, including 64 males and 52 females, aged (62.3±12.6) years old. Patients were divided into DM group ( n=56) and non-DM group ( n=60), which were also divided into the sepsis group ( n=29) and the non-sepsis group ( n=87). The clinical features were compared among the groups, the risk factors of PLA complicated with sepsis were analyzed by multivariate logistic regression. Mediation model was used to analyze how DM affects the development of sepsis. Results:Compared with the non-DM group, patients in DM group had higher incidences of hypertension and acute physiology and chronic health evaluation II, a higher proportion of blood neutrophil count, a higher serum levels of triglyceride, urea nitrogen, fasting blood glucose and glycated hemoglobin at admission. The DM group also higher incidences of hypoproteinemia, pleural effusion, and sepsis, with longer hospital stay and higher hospitalization cost (all P<0.05). The levels of hemoglobin, albumin and hematocrit were lower in DM group (all P<0.05). Multivariate logistic regression analysis showed that comorbidity of DM ( OR=3.431, 95% CI: 1.245-9.455) and abscess with a larger diameter ( OR=1.664, 95% CI: 1.258-2.220) were associated with a higher risk of developing sepsis (all P<0.05). Mediation model showed that neutrophil count and triglyceride were the mediating variables of sepsis in patients with PLA. Conclusion:Comorbidity of diabetes is an independent risk factor of developing sepsis in patients with pyogenic liver abscess. Diabetes may induce sepsis by affecting the neutrophils and triglyceride.
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With the popularity and development of minimally invasive surgery such as laparoscopic cholecystectomy, the incidence of iatrogenic biliary tract injury and biliary duct stenosis after injury has been increased significantly. The biliary duct injury of laparoscopic cholecystectomy is mainly heat damage, and the biliary duct tissue is prone to biliary duct stenosis after heat injury. Currently the treatment of complex iatrogenic biliary stricture has still been a difficult and unfinished problem. It’s necessary to explore the therapy options of iatrogenic biliary stricture based on animal models of biliary stricture. According to the literature at home and abroad, this article reviewed the methods and advantages and disadvantages of several models of benign biliary stricture.
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Objective To investigate the expressions of acid sensing ion channel 1a(ASIC1a) and activator protein-1 (AP-1) in hepatocellular carcinoma,and to analyze the relationship between expressions and clinical features.Methods At the transcription level,expression spectroscopy chips and bioinformatics were used to analyze the changes of signal pathways before and after ASICla interference in hepatocellular carcinoma cells.63 cases of HCC and 42 cases of tumor adjacent tissue samples were chosen from the Third People's Hospital of Wuxi,between January 2010 and December 2014.Immunohistochemical staining was utilized to detect the expressions of ASIC1 a,c-Jun,c-Fos.The relationships among the three were analyzed by the nonparametric Spearman rank correlation coefficient.Results After ASIC1a inhibition,the expression of AP-1 (c-Jun and c-Fox) decreased significantly.The expressions of c-Jun and c-Fox were greatly decreased in interference group compared with control group.The positive rates of ASIC1a,c-Jun and c-Fos in HCC tissues were significantly higher than that of the adjacent tissues,68.3％ vs.19.0％,55.6％ vs.11.9％,47.6％ vs.11.7％ (P ＜ 0.05).Correlation analysis showed that the expression of ASIC1a was positively correlated with c-Jun and c-Fos expression (r =0.404,0.309,P ＜ 0.05).The expressions of ASIC 1 a,c-Jun and c-Fos were not related to age,tumor diameter and gender (P ＞ 0.05),which were related to the clinical stage,AFP and lymph node metastasis of the tumor (P ＜ 0.05).Conclusion ASIC1a may.affect the development of hepatocellular carcinoma through the downstream gene AP-1.
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Objective To explore the relationship between gut mucosal barrier dysfunction and immune response in patients with early severe acute pancreatitis (SAP).Method 46 patients with early SAP were enrolled into this study from January 2010 to December 2012.Results The levels of endotoxin,the lactulose/mannitol (L/M) ratio,the D (-)-lactate concentration,and the proportion of HLA-DR-positive monocytes all decreased from a high level,while the frequency of Tregs increased during the first 14 days.The Th1/Th2 ratio decreased,with a decreased Th1 and an increased Th2 profile in the first week,but it subsequently increased,with an increased Th1 profile.Conclusions The data from this study showed that immunosuppression and immune imbalance happened in patients with early SAP,and showed a positive relationship with gut mucosal barrier dysfunction in patients with early SAP.Thus,early protection of the function of intestinal mucosal barrier is important in the treatment of SAP.
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With the initiation of laparoscopic techniques in general surgery and a significant expansion of minimally invasive techniques in the last 20 years.However,some of the shortcomings of laparoscopic technology has limited it's surgical application.More recently,the da Vinci robotic surgical system further defined the ability of a roboticassist device to address limitations in laparoscopy.This in cludes a significant improvement in instrument dexterity,dampening of natural hand tremors,three dimensional visualization,ergonomics,and camera stability.As experiencewith robotic technology increased and its applications to advanced laparoscopic procedures have become more understood,more procedures have been performed with robotic assistance.We review the current status of da Vinci robotic technology and its applications in general surgical procedures.