Association between plasma trimethylamine-N-oxide level and premature coronary heart disease / 中华全科医师杂志

Objective:To investigate the associations between plasma trimethylamine-N-oxide (TMAO) level and premature coronary heart disease (PCHD).Methods:From July 2018 to July 2020, total of 166 patients with suspected coronary heart disease were enrolled from the Heart Center of Shenzhen Bao′an Hospital affiliated to Southern Medical University. According to the coronary imaging results and age of onset, they were divided into young control group ( n=30), PCHD group ( n=49), middle-aged and elderly control group ( n=30) and the middle-aged and elderly coronary heart disease group ( n=57). Plasma TMAO concentration in each group was determined by stable isotope liquid chromatography/mass spectrometry, and the correlation of plasma TMAO level with PCHD and SYNTAX score was analyzed. Results:The plasma TMAO level in PCHD group was significantly higher than that in young control group [(7.54±2.10) μmol/L vs. (4.60±1.89) μmol/L; t=6.73, P?0.001] and middle-aged and elderly coronary heart disease group [(3.90±1.75) μmol/L; t=2.45, P=0.015]. The plasma TMAO level was positively correlated with SYNTAX score in PCHD group ( r=0.66, P?0.001) and in middle-aged and elderly coronary heart disease group ( r=0.27, P=0.042). Multivariate logistic regression analysis showed that plasma TMAO level was an independent risk factor for PCHD ( OR=2.30, P?0.001). Receiver operating characteristic (ROC) curve analysis showed that when the cutoff level of plasma TMAO was 6.08 μmol/L, the sensitivity and specificity for diagnosis of PCHD were 73.5% and 76.7%, respectively. Conclusion:The plasma TMAO level is significantly correlated with PCHD and had certain predictive value for PCHD.

Analysis of therapeutic effect and prognosis of pancreatectomy, pancreatic duct drainage and combined procedures for pancreatic ductal stones / 中华胰腺病杂志

Objective To analyze the curative effect and prognosis of pancreatic ductal stone treated by pancreatectomy,pancreatic duct drainage or combined procedures.Methods The clinical data of 296 pancreatic ductal stone patients who received surgical treatment in First Affiliated Hospital of the Army Medical University between January 2008 and June 2017 were retrospectively analyzed.The cases were divided into pancreatectomy group (162 cases),pancreatic duct drainage group (104 cases) and combined procedures group (30 cases) according to their surgical procedures.The clinical characteristics and short-term and longterm outcomes of surgical treatment between the three groups were analyzed.Kaplan-Meier method was used to estimate the survival rate of no recurrence of pain after operation.Log-rank test and Cox-proportional hazard model were used to analyze the influencing factors on the recurrent pain free survival after surgery.Results The ratio of male patients was highest in pancreatectomy group,and the incidence of pancreatic exocrine insufficiency was highest in pancreatic duct drainage group.Of 296 patients,Ⅰ type pancreatic stone was most in pancreatectomy group and combined procedures group (80.2％,70.0％),and Ⅲ type pancreatic stone was most in pancreatic duct drainage group (46.2％).Medium size pancreatic stone was most in pancreatectomy group (52.5％),and medium and large size pancreatic stone was most in pancreatic duct drainage group (80.8％).Obvious pancreatic atrophy was most in pancreatic duct drainage group.Pancreatic head swelling,bile ductal dilation or compression,combined with pancreatic or surrounding organ complications were most in pancreatectomy,and all the differences were statistically significant (all P ＜ 0.05).In the short-term effect,the overall rate of pain relief was 99.3％,and there was no statistical difference among three groups.Pancreatic duct drainage group was superior to the other two groups in terms of operative time,bleeding volume,postoperative hospitalization days and postoperative complications (all P ＜0.05),but the total incidence of residual stones after operation in drainage group (64.8％) was higher than that in the other two groups,and the difference was statistically significant (all P ＜ 0.05).In the long-term effect,there were no significant differences in pain recurrence,stone recurrence reoperation,postoperative pancreatic function,body weight and quality of life recovery among the three groups.The 1-year,3-year and 5-year no recurrent pain after operation was 89.0％,79.2％ and 68.9％,respectively.Univariate and multivariate analysis showed that the course of CP ≥5 years(HR =2.113,95％ CI 1.160-3.848,P=0.014) and postoperative long-term alcohol consumption (HR =1.971,95％ CI 1.073-3.620,P =0.029) were independent risk factors affecting pain recurrence after surgery.Conclusions Surgery is still an important means for the treatment of pancreatic ductal stone.The short-term and long-term effect of pancreatectomy,pancreatic duct drainage and combined procedures for pancreatic ductal stones are definitely effective.However,none of the three methods can prevent the continued loss of pancreatic function in some patients.According to the preoperative clinical features,surgery strategy should be formulated individually,and the postoperative health guidance and follow-up should be emphasized,which can help to improve the prognosis of the patients with pancreatic ductal stones.

Risk factors analysis of pancreatic ductal stones combined with malignant tumor beside stones / 中华消化外科杂志

Objective To investigate the risk factors of pancreatic ductal stones (PDS) combined with malignant tumor beside stones.Methods The retrospective case control study was conducted.The clinicopathological data of 190 patients with PDS who underwent surgical treatment at the First Affiliated Hospital of Army Medical University (Third Military Medical University) between January 2008 and June 2017 were collected.Of 190 patients,175 and 15 were detected PDS complicated with chronic pancreatitis and malignant tumor beside stones respectively.Observation indicators:(1) risk factors analysis of PDS combined with malignant tumor beside stones;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was done to detect treatment of patients who had PDS combined with malignant tumor beside stones and postoperative survival up to December 2017.Univariate analysis was done by chi-square test,Fisher exact probability or rank sum test,and multivariate analysis was done using Logistic regression model.The survival curve was drawn and survival rate was calculated by Kaplan-Meier method.Results (1) Risk factors analysis of PDS combined with malignant tumor beside stones:results of univariate analysis showed that increased serum tumor markers,diameter of PDS,common bile duct dilation or compression,pancreatic parenchymatous atrophy were related factors affecting PDS combined with malignant tumor beside stones (x2 =12.501,Z =-2.508,x2 =12.230,5.863,P＜0.05).Results of multivariate analysis showed that increased serum tumor markers,common bile duct dilation or compression,pancreatic parenchymatous atrophy were independent risk factors affecting PDS combined with malignant tumor beside stones (odds ratio:5.482,8.062,4.993,95％ confidence interval:1.556-19.313,1.620-40.107,1.188-20.977,P＜0.05).(2) Follow-up and survival situations:162 of 190 patients were followed up for 2-111 months with a median time of 20 months,including 149 of PDS complicated with chronic pancreatitis and 13 of PDS combined with malignant tumor beside stones.During the follow-up,the 1-,3-,5-year overall survival rates after operation were 46.7％,6.7％ and 0 in 13 patients of PDS combined with malignant tumor beside stones,and 3 patients received postoperative chemotherapy.The 1-,3-,5-year overall survival rates of the 149 patients who had PDS combined with chronic pancreatitis were 97.0％,93.5％,91.6％.Conclusion Increased serum tumor markers,common bile duct dilation or compression,pancreatic parenchymatous atrophy are independent risk factors affecting PDS combined with malignant tumor beside stones.

Clinical research progress of mesenteric internal hernia after Roux-en-Y reconstruction / 中华胃肠外科杂志

Postoperative internal hernia is a rare clinical complication which often occurs after digestive tract reconstruction. Roux-en-Y anastomosis is a common type of digestive tract reconstruction. Internal hernia after Roux-en-Y reconstruction, which occurs mainly in the mesenteric defect caused by incomplete closure of mesenteric gaps in the process of digestive tract reconstruction, is systematically called, in our research, as mesenteric internal hernia after Roux-en-Y reconstruction. Such internal hernia can be divided, according to the different structures of mesentric defect, into 3 types: the type of mesenteric defect at the jejunojejunostomy (J type), the type of Petersen's defect (P type), and the type of mesenteric defect in the transverse mesocolon (M type). Because of huge differences in the number of cases and follow-up time among existing research reports, the morbidity of internal hernia after LRYGB fluctuates wildly between 0.2% and 9.0%. Delayed diagnosis and treatment of mesenteric internal hernia after Roux- en-Y reconstruction may result in disastrous consequences such as intestinal necrosis. Clinical manifestations of internal hernia vary from person to person: some, in mild cases, may have no symptoms at all while others in severe cases may experience acute intestinal obstruction. Despite the difference, one common manifestation of internal hernia is abdominal pain. Surgical treatment should be recommended for those diagnosed as internal hernia. A safer and more feasible way to conduct the manual reduction of the incarcerated hernia is to start from the distal normal empty bowel and trace back to the hernia ring mouth, enabling a faster identification of hernia ring and its track. The prevention of mesenteric internal hernia after Roux-en-Y reconstruction is related to the initial surgical approach and the technique of mesenteric closure. Significant controversy remains on whether or not the mesenteric defect should be closed in laparoscopic Roux-en-Y anastomosis. This article is to review the reports and researches on internal hernia resulting from the mesenteric defect after Roux-en-Y digestive tract reconstruction in recent years, so as to promote understanding and attention on this disease. And more active preventive measures are strongly suggested to be taken in operations where digestive tract reconstruction is involved.

Insulin resistance in first-degree relatives of patients with Graves disease / 实用医学杂志

Objective To observe insulin resistance in first-degree relatives of patients with Graves disease. Methods All subjects in control group and experiment group including first-degree relatives of GD patients underwent oral glucose tolerance tests (OGTT) and insulin releasing tests then the degree of insulin resistance was analyzed. Results Blood glucose at each point of OGTT, insulin level and insulin resistance index 1 (HOMA-IR) of experiment group were higher than those in control group, while insulin activity index (IAI) and HOMA-βwere significantly lower than those in control group. Conclusion Patients insulin resistance could be found among first-degree relatives of GD patients.