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Objective To investigate the relationship between low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (LHR) and asymptomatic carotid plaques and their stability in high-risk stroke population.Methods Between December 2012 and April 2015,a total of 39 944 permanent resident population ≥40 years were used as subjects of the survey from 11 rural communities in Haitou Town,Banzhuang Town and Tashan Town,Ganyu District,and 9 urban communities in Xinpu District and Haizhou District,Lianyungang City using epidemiological survey method of cluster sampling.Excluding those who took lipid-lowering drugs within 3 months and had a history of stroke or transient ischemic attack,6 592 people at high risk of stroke were finally screened out.Ultrasound was used to detect carotid plaques.The subjects were divided into plaque-free group and plaque group.The latter was further divided into stable plaque group and unstable plaque group.Multivariate logistic regression analysis was used to evaluate the independent risk factor for carotid plaques and their stability.The odds ratio (OR) and 95％ confidence interval (CI) were calculated.Receiver Operating Characteristic (ROC) curve was used to evaluate the prediction efficiency of LHR on carotid plaques.Results Multivariate logistic regression analysis showed that low-density lipoprotein cholesterol (LDL-C) was an independent risk factor for carotid plaques,while high-density lipoprotein cholesterol (HDL-C) was an independent protection factor of carotid plaques.Using the lowest quintile (Q1) of LHR as a reference,carotid plaque risk increased significantly with the increasing LHR (Q2:OR 1.448,95％ CI 1.082-1.937,P =0.013;Q3:OR 2.414,95％ CI 1.754-3.322,P＜0.001;Q4:OR 2.939,95％ CI 1.945-4.441,P＜0.001;Q5:OR 4.884,95％ CI 3.143-7.115,P＜0.001).ROC curve analysis showed that the area under the curve (AUC) of LHR predicting carotid plaques was 0.795 (95％ CI 0.792-0.807;P＜ 0.001),and the optimal cut-off value was 3.00 (sensitivity 68.37％,specificity 75.65％).LHR ≥3.92 (LHR in the Q4 and Q5 subgroups) was an independent risk factor for unstable carotid plaques (OR 2.915,95％ CI 2.104-4.040;P＜0.001).The AUC of the LHR predicting unstable carotid plaques was 0.658 (95％ CI 0.633-0.684;P＜0.001).Conclusions LHR was an independent predictor of carotid plaques in high-risk stroke patients.It had higher predictive value for carotid plaques,and its conversion threshold for promoting plaque formation was 3.00.When LHR was ≥3.92,there was a significant increase in the risk of unstable carotid plaques.
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<p><b>OBJECTIVES</b>To explore successful models of management of enterocutaneous fistulas and unresolved problems requiring further study.</p><p><b>METHOD</b>Analysis of therapeutic results of 1168 cases treated in one center from January 1971 to December 2000.</p><p><b>RESULTS</b>In this group of patients, the recovery rate was 93% and 37% of fistulas healed spontaneously after non-operative treatment. The mortality rate was 5.5%, most of which occurred due to sepsis. Of 659 cases receiving definitive operations for enteric fistula, 98% recovered. Recovery, mortality and operational success rates (94.2%, 4.4%, 99.7%) of cases treated between January 1985 and December 2000 were significantly better than those (90.4%, 8.2%, 95.5%) of cases treated earlier (January 1971-December 1984) (P < 0.05).</p><p><b>CONCLUSIONS</b>The results from this study were better overall than those reported in previous literatures. The change in therapeutic strategy, improved technique in control of sepsis, rational nutritional support and careful monitoring of vital organs are the key reasons for improvement of managing enteric fistulas. However, increasing spontaneous closure of fistula, improving the therapeutic rate of specific enteric fistula (IBD or radiation enteritis) and performing definitive operations for enteric fistula at early stages are still problematic and require further study.</p>
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Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Cutaneous Fistula , General Surgery , Intestinal Fistula , General Surgery , Nutritional Support , SepsisABSTRACT
Objective:To study the effects of Somatostatin-14 and-8 on portal hemodynamics and plasma levels of the insulin-like growth factor(IGF-1),nitric oxide(NO),endothelin-1(ET-1) and glucagon(GLU) in patients with portal hypertension after transjugular intrahepatic portosystemic shunt(TIPS). Methods:Fourteen portal hypertension patients underwent TIPS,their portal pressures directly measured by the intravenous catheter placed in the portal vein,the hemodynamic changes observed and the plasma levels of IGF-1,NO,ET-1 and GLU determined before and 8 and 24 hours after the infusion of Somatostatin-14 or-8 according to a cross-over design.Results:The average decrease in portal pressure after the intravenous infusion of Somatostatin-14 and-8 was(9.4?1.0) cmH2O and(5.0?1.0) cmH2O,respectively(P0.05) 8 and 24 hours after the infusion.Conclusion:Both Somatostatin-14 and-8 can significantly reduce portal pressure,although the former is more potent than the latter.The underlying mechanism may involve their inhibition of the secretion of GLU,IGF-1 and other hormones as well as their reduction of hepatic metabolism and portal inflow.
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0.05) and hospital mortality(both 3.1%) between the two groups.All the pancreatic fistula patients were cured by non-surgical treatment.Conclusion: The comparative study of the two reconstructive techniques revealed no difference in the incidence of pancreatic fistulas following pancreaticoduodenectomy.
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<p><b>OBJECTIVES</b>To evaluate the essentials for successful management of entero-cutaneous fistulas and their.</p><p><b>METHODS</b>We analyzed. The therapeutic results of 1 168 cases treated in a single center from January. 1971 to December. 2000.</p><p><b>RESULTS</b>In these patients, the cure rate of fistulas was 93% and 37.1% after non-operative treatment. Most cases died of sepsis (60/65 cases, 93.2%) with a total mortality of 5.5%. In 659 cases who had undergone operation for enteric fistula, 647 (98.2%) recovered. The cure rate, mortality rate and successful rate of operation (94.2%, 4.4%, 99.7%) in the period of January. 1985 - December. 2000 were better than those (90.4%, 8.2%, 95, 5%) in the early period of January 1971 December 1984 (P < 0.05).</p><p><b>CONCLUSIONS</b>The change of therapeutic strategy, improved technique in control of sepsis, rational nutritional support and careful monitoring of vital organs are essential to the management of enteric fistulas. How to increase the spontaneous closure of fistula, the therapeutic rate of specific enteric fistula (e.g. IBD, radiation enteritis) and the operative rate of enteric fistula in the early period requires further study.</p>
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Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Digestive System Fistula , Mortality , Therapeutics , Nutritional Physiological Phenomena , Postoperative Complications , Microbiology , Mortality , Treatment OutcomeABSTRACT
<p><b>OBJECTIVES</b>To study the long-term results of selective vagotomy plus antrectomy in treatment of duodenal ulcer.</p><p><b>METHODS</b>One hundred and ninety-three patients with duodenal ulcer were subjected to selective vagotomy plus antrectomy from November 1977 to November 2001. These patients included 28 patients with refractory ulcer, 112 with recurrent bleeding, 41 with pylori obstruction, and 12 with duodenal and gastric ulcer.</p><p><b>RESULTS</b>BAO, IMAO, PMAO and serum gastrin were decreased significantly after an 1 - 24-year follow-up after selective vagotomy plus antrectomy. The characteristics of inhibitory secretive were observed in parietal cells. Follow-up after operation for 1 - 10 years and 11 - 24 years showed that 95.60% and 96.61% of patients belonged to Visick grade I and II, and 4.40% and 3.39% of patients belonged to Visick grade III, respectively. No ulcer recurrence was seen during the 1 - 24 year follow-up after the operation.</p><p><b>CONCLUSION</b>SV + A is an effective method for duodenal ulcer, especially for complicated duodenal ulcer, with permanent reduction of gastric acid and no recurrence.</p>
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Adult , Female , Humans , Male , Digestive System Surgical Procedures , Duodenal Ulcer , General Surgery , Pylorus , Treatment Outcome , Vagotomy, Proximal GastricABSTRACT
Objectives The purpose of this study was to compare the effect of somatostatin and octreotide on portal vein pressure in portal hypertensive patients.KG*2MethodsWT5”BZ Portal pressure in 12 patients with portal hypertension after TIPS was measured directly by means of a cathater placed in portal vein after infusion of somatostatin (6 mg/24h) or octreotide(0 6 mg/h). The drugs was infused intravenously and alternatively in each individual patient on day 1 or day 3 after TIPS. Portal pressure was assessed at baseline and at 1、2、4、6、8、12、24、30、36 hours after infusion of each drug.KG*2ResultsKG1The average decrease of portal pressure was 9 4?1 0 cm H 2 O and 5 0?1 0 cm H 2 O respectively after the intravenous infusion of somatostatin or octreotide( P
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Objective: To evaluate the effectiveness of bowel nutritional rehabilitation therapy in patients with gut dysfunction caused by acute mesenteric artery occlusion. Methods: Two patients with acute mesenteric artery occlusion received management of revascularization by operative and nonoperative approach. Viability dusky bowel was leaved in one patient. Second look laparotomy was performed to access the viability of the bowel in another patient. The patients remained gut dysfunction and received bowel nutritional rehabilitation therapy early after operation. Results: The gut function of the patients recovered and had normal diet after bowel nutritional rehabilitation therapy. Conclusions: The gut dysfunction caused by acute mesenteric artery occlusion should be treated with bowel nutritional rehabilitation early.
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Objectives: To investigate the effect of growth hormone on liver protein synthesis in patients with portal hypertension following TIPS. Methods: Ten patients with liver cirrhosis and portal hypertension were injected with rhGH (8 U/day) for 7days after TIPS. The serum levels of Alb, PA and FN were detected before and days 3 and 7 after TIPS and use of rhGH. Plasma insulin like growth factor 1 (IGF 1) was also measured by immunoradiological method. Results: As compared with the day before TIPS and rhGH, the levels of IGF 1, Alb , PA and FN were significantly increased on the 7th day after TIPS and rhGH treatment( P
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Objective To investigate the clinical results of combined TIPSS and azygoportal disconnection for portal hypertension in controlling and preventing esophageal variceal bleeding. Methods From Oct. 1996 to Dec. 2001, 60 patients with portal hypertension were admitted to our department because of variceal bleeding and submitted to the treatment with the combination TIPSS and azygoportal disconnection. According to Child Pugh classification, 11 patients were in class A, 37 in class B, and 12 in class C. 41 patients showed mild ascites and 8 with severe ascites. The mild and severe esophageal varices were proven by upper digestive barium meal. The procedure was divided into two stages; first, TIPSS procedure with the stent of diameter 0.8cm and length 6-7cm was successfully inplanted in all patients, second, all patients underwent azygoportal disconnection two weeks later after TIPSS. Results After the combination TIPSS and azygoportal disconnection, the recent complications included three cases with bleeding at operative fields, one case with infradiaphagmatic abscess and seven with slight encephalopathy. No rebleeding of esophageal varices and death occurred during the treatment. During the follow up of 1-5 years, the rates of shunt occlusion, rebleeding and death were 11.9%, 3.5% and 7.0% respectively. Conclusions The combination TIPSS and azygoportal disconnection is an efficient therapeutic methods for portal hypertension.