ABSTRACT
Objective:To study the clinical characteristics and management strategies of late bleeding after laparoscopic pancreaticoduodenectomy (LPD).Methods:The clinical data of 58 patients with post-pancreaticoduodenectomy hemorrhage (PPH) admitted to the Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University from March 2018 to March 2022 were retrospectively analyzed, including 42 males and 16 females, aged (61.88±11.02) years old. According to the occurrence of intra-abdominal erosion factors (e.g., pancreatic fistula, biliary fistula, gastrointestinal anastomotic fistula, intra-abdominal abscess), patients were divided into the erosion group ( n=42) and non-erosion group ( n=16). All patients underwent standard lymphadenectomy. Clinical data including the PPH time-point, occurrence of rebleeding, and treatment outcomes were accessed. The management strategies of PPH in the two groups of patients were analyzed. Results:The PPH time-point in the erosion group and non-erosion patients was 8.00 (5.00, 19.25) d and 21.50 (12.75, 26.75) d, respectively ( P=0.001). PPH can occurred within one month after surgery in both erosion and non-erosion groups. In the erosion group, 31 cases (73.81%, 31/42) were treated by re-operation, two (4.76%, 2/42) by interventional radiology and nine (21.43%, 9/42) with conservative protocol, respectively. In the non-erosion group, five cases (31.25%, 5/16) were treated by re-operation, seven (43.75%, 7/16) by interventional radiology and four (25.00%, 4/16) with conservative protocol, respectively. The incidence of re-bleeding is higher in the erosion group [47.6% (20/42) vs 12.5% (2/16), P<0.05]. Clinical manifestations, sites and severity of bleeding, and treatment outcomes were also different in the erosion and non-erosion groups (all P<0.05). Conclusions:The occurrence of intra-abdominal erosion factors can affect the clinical characteristics and treatment strategy of late bleeding after laparoscopic pancreaticoduodenectomy. Surgery remains the treatment of choice for post-pancreaticoduodenectomy hemorrhage either as an urgent or last resort.
ABSTRACT
Objective To investigated the clinical distributions and antimicrobial susceptibility of Streptococcus agalactia strains isolated from the patients .Methods The identification and susceptibility of the strains were mainly measured by automatic VITEK‐Ⅱ system ,the K‐B disc diffusion tests were used for the resistance test of erythromycin ,meropenem ,and D‐test .Results The iso‐lates were mainly from urine (63 .1% ) ,genital tract(7 .8% ) and wound secretion(6 .7% ) .They were obtained from patients in dif‐ferent situations ,including 110 patients who were older than 50 years old (61 .5% ) ,113 female patients (63 .1% ) ,12 gravidas (6 .7% ) ,3 vertical transmitted newborns(1 .7% ) ,and 82 patients with cancer ,undergoing chemo radiotherapy ,with diabetes ,tuber‐culosis or after operations(45 .8% ) .The resistant rates of the isolated Streptococcus agalactia to erythromycin and clindamycin were 42 .9% -93 .3% and 41 .9% -80 .0% respectively .The positive rate of D‐test was 4 .1% .The strains were highly resistant to tet‐racycline(>80% ) ,while the resistance to penicillin was below 10% except in 2008 .All isolates were susceptible to vancomycin and meropenem .Only one strain was resistant to Quinupristin‐dalfopristin .Conclusion Streptococcus agalactia infection in adults most‐ly cause genitourinary tract ,skin and soft tissue infections .There were more females than males with Streptococcus agalactia infec‐tion .Penicillin andβ‐lactams are still the first choice for the treatment .Erythromycin ,clindamycin and tetracycline should be used with caution under the guidance of laboratory susceptibility test results .
ABSTRACT
Objective To explore the relationship between birth weight and the prevalence of metabolic syndrome (MS).Methods A population cohort study was carried out among 561 adults who were born in 1956,1960 or 1964 in Jinzhong City of Shanxi Province in August 2008 and October 2012.All the participants were required to fill in a questionnaire survey,take physical examinations and laboratory tests.Height,body weight,waist circumference,blood glucose,triglyceride and blood pressure were recorded.Their mothers were interviewed through phone call.Results One hundred individuals were finally qualified,including 42 men and 58 women.Thirty-nine and 41 MS patients were detected in 2008 and 2012,respectively.Prevalence of MS showed statistically significant difference among those born in 1964,1960 or 1956(2008:x2 =6.41,P ＜ 0.05; 2012:x2 =8.14,P ＜ 0.05).The average body weight of babies born in 1960 ((2.9 ± 0.6) kg) was significantly lower than those born in 1964 ((3.2 ±0.4) kg) or 1956 ((3.3 ±0.5) kg) (t values were 5.88 and 6.32,respectively; both P ＜0.05).The rate of poor nutrition during pregnancy was significantly higher in 1960 (68.9％) than in 1956 (28.6％) and 1964 (45.2％) (x2 values were 14.15 and 4.39,respectively; both P ＜ 0.05).In Pearson correlation analysis,coefficient of birth weight and post-MS was-0.106,the coefficient of nutrition during pregnancy and post-MS was -0.005.Conclusions The non-low birth weight children whose mothers had pregnancy malnutrition show higher prevalence of MS in adult.It could be important to carry out health management among children whose mother has experienced pregnancy malnutrition.