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Objective:To evaluate delayed laparoscopic cholecystectomy (DLC) after percutaneous transhepatic gallbladder drainage (PTGBD) in acute cholecystitis.Methods:Clinical data of 64 patients who were diagnosed moderate (grade Ⅱ) acute cholecystitis by the 2018 Tokyo Guidelines in acute phase and underwent delayed LC at our hospital from Jan 2018 to Jan 2021 were compared between two groups ie PTGBD treatment (21 cases)in acute stage before DLC and DLC without PTGBD group (43 cases). The difficulty score of TG18 was used to evaluated every surgical procedure of the cases by reviewing the operation videos.Results:Patients in DLC after PTGBD group had a longer hospital stay and operation time, more blood lose and higher difficulty score than the DLC without PTGBD group(all P<0.05). There was no statistically significant difference in the conversion rate and morbidity rate between the two groups( P>0.05). Conclusion:This study fails to show there is any if ever benefit of PTGBD before DLC over DLC without PTGBD in the management of Grade Ⅱ acute cholecystitis.
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Objective: The aim of this study was to identify the molecular subtypes of chronic obstructive pulmonary disease [COPD] and to prioritize COPD candidate genes using bioinformatics methods
Materials and Methods: In this bioinformatics study, the gene expression dataset GSE76705 [including 229 COPD samples] and known COPD-related genes [candidate genes] were downloaded from the Gene Expression Omnibus [GEO] and the Online Mendelian Inheritance in Man [OMIM] databases respectively. Based on the expression values of the candidate genes, COPD samples were divided into molecular subtypes through hierarchical clustering analysis. Candidate genes were accordingly allocated into the defined molecular subtypes and functional enrichment analysis was undertaken. Pathway deviation scores were then analyzed, followed by the analysis of clinical indicators [FEV1, FEV1/FVC, age and gender] of COPD patients in each subtype, and prediction models were constructed. Furthermore, the gene expression dataset GSE71220 was used to bioinformatically validate our results
Results: A total of 213 COPD-related genes were identified, which divided samples into three subtypes based on the gene expression values. After intersection analysis, 160 common genes including transforming growth factor beta1 [TGFB1], epidermal growth factor receptor [EGFR] and interleukin 13 [IL13] were obtained. Functional enrichment analysis identified 22 pathways such as 'hsa04060: cytokine-cytokine receptor interaction pathways, 'hsa04110: cell cycle' and 'hsa05222: small cell lung cancer'. Pathways in subtype 2 had higher deviation scores. Furthermore, three receiver operating characteristic [ROC] curves [accuracies >80%] were constructed. The three subtypes in COPD samples were also identified in the validation dataset GSE71220
Conclusion: COPD may be further subdivided into several molecular subtypes, which may be useful in improving COPD therapy based on the molecular subtype of a patient
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ObjectiveTo compare the efficacy and health economics between open choledocholithotomy and endoscopic sphincterotomy (EST) these two operations on patients with choledocholithiasis. Methods177 patients (aged 20-75 yrs, with simple choledocholithiasis on medical imaging,who had not been treated with either biliary tract surgery or EST, and had no severe complications)were treated electively at the Beijing Friendly Hospital and Beijing Jishuitan Hospital from 2002 to 2009. These patients were divided into two groups according to the treatment they received: open operation (n=62), or EST (n=115). There was no significant difference in sex, age, ASA class,symptoms before operation, and complications before operation between the 2 groups. The following data were compared: operation time, blood loss, size and number of stone, duration of postoperative ileus, duration of abdominal pain, incidence of postoperative complications, duration of hospitalization, cost of hospitalization and operation, and incidence of residual stones. ResultsFor the open operation group, the operation time was 50-300 min (M=110), the blood loss was 10-300 ml (M=60), the duration of post-operative ileus was 24-96 h(M=48), the duration of abdominal pain was 0-96 h(M=48), the duration of hospitalization was 8-70 d(M=21), the duration of hyperamylasemia after operation was 8.1％ and the cost for operation was 546-2498 yuan (M=1503. 2). For the EST group, the operation time was 10-120 min (M=25), the blood loss was 2-40 ml (M=10),the duration of post-operative ileus was 1-48 h (M=3), the duration of abdominal pain was 0-144 h (M-0), the period of hospitalization was 5-56 d (M=17), the duration of hyperamylasemia after operation was 40％ and the cost for operation was 2028-5728 yuan (M=2028). There were significant differences in every aspect between these 2 groups of patients. Conclusions EST has a significantly shorter operation time, less blood loss, shorter duration of postoperative ileus, shorter duration of abdominal pain, shorter duration of hospitalization. However, EST had a significantly higher incidence of hyperamylasemia after operation and the cost was higher than open operation.
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Objective To investigate the influence of Zhuanggu granule on the concentration of IL-1β and TN-F-α in knee cavity of patients with knee degenerated osteoarthritis. Methods A total of eighty patients with knee degenerated osteoarthritis were recruited into a Zhuanggu granule group (30 cases), a Sulphuric acid Glucosamine group (15 cases) and a Sodium Hyaluronate group (15 cases) according to Doll grouping method. After all groups were treated for 4 weeks, the changes of concentration of IL-1β and TNF-α was detected before and after the therapy Results After the treatment, the concentration of IL-1β and TNF-α in Zhuangu granule group was significantly lower than the other two groups (Sodium Hyaluronate and sulphuric Glucosamine group). Conclusion Zhuangu Granule could influence the concentration of IL-1β and TNF-α in patients of knee degenerated osteoarthritis.
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Objective To summarize the experience on diagnosis and treatment of primary hyperparathyroidism(PHPT).Methods Clinical data of 91 PHPT patients treated in Beijing Jishuitan Hospital from November 1992 to December 2008 were analyzed retrospectively.Results Among 91 PHPT cases,88 were diagnosed as parathyroid adenoma(96.7%),3 were diagnosed as parathyroid carcinoma (3.3%).Serum calcium and PTH levels increased in all cases.Main clinical manifestations were osteodynia and kidney stones.The accuracy rate of preoperative B-ultrasound.CT and ECT~(99m)Tc-MIBI on location was 83.5%(76/91),60.9%(14/23)and 98.6%(69/70)respectively.Parathyroidectomy was performed in all but one cases,in which parathyroid carcinoma was managed by ipsilateral hemithyroidectomy and modified neck dissection.The cure rate of primary operation was 97.8%(89/91).Ninety cases were followed-up from 8 months to 14 years postoperatively,87 cases with parathyroid adenoma achieved complete remission,2 with parathyroid carcinoma suffered from tumor recurrence and 1 died.Conclusion Patients with chronic bone diseases,repeatedly recurrent nephrolithiasis,peptic ulcer disease should be a suspect of PHPT.The routine examinations of serum calcium and phosphorus are to be conducted.UItrasonography and ECT~(99m)Tc-MIBI should be considered as the methods of first choice for preoperative localization.
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Objective To evaluate the necessity and safety of implanting temporary vena eava fihers to prevent pulmonary emboli in patients of lower extremity fractures concomitant with acute deep venous thrombosis(DVT). Methods A total of 782 patients with lower extremity fractures were complicated with DVT perioperatively. Among them, 91 received temporary vena cava filters implantation before orthopedic operations for the prevention of pulmonary embolism. All patients were followed up post-operation. Results Vena cava filters were successfully implanted in 89 patients. Mean implantation time was 27 days (range from 14 to 42 days). Thrombus trapped within the filters were found in 78 patients (87.6%) after the filters removal. Eight-two filters (92.1%) were retrived successfully at the first attempt as scheduled. Seven filters(7.9%) with big trapped thrombi were removed at the 2nd attempt after additional thrombolytic therapy. No patients needed a permanent filter. No fetal pulmonary embolism (PE) or other major complications were detected during the three to six months follow-ups period. Conclusion Temporary vena cava filter can reduce the incidence and mortality of pulmonary embolism as well as the occurrence of mid- or long-term complications in lower limb fracture patients complicated with DVT.
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Objective To study the effect of peroxisome proliferator-activated receptor garama (PPARγ) ligand on hepatic fibrosis in rats. Methods Forty Wistar rats were randomly divided into two groups: the control group(20 rats) ,in which liver cirrhosis was induced by adding 0. 3‰ thioacetamide in the fodder for 6 months, and rosiglitazone group(20 rats) in which 200 ppm of rosiglitazone in combination with 0. 3‰ thioacetamide was added in the fodder. Liver tissue's mRNA expression of PPARγ, TGF-β1 ,type Ⅰ pro-collagen and α-smooth muscle actin(α-SMA) was detected by RT-PCR. The protein expression of PPARγ, TGF-β1 ,type Ⅰ collagen and α-SMA was detected by Western blot. The expression of collagenof liver histological section was evaluated by Van Gieson (VG) staining. Results The expression ofPPARγ at mRNA level significantly increased in rosiglitazone group compared with those in the control group ( t = 6. 93, P < 0. 01 ), while the expression of TGF-β1 ( t = 3. 89, P < 0. 01 ) and type Ⅰ pro-collagen ( t =5.67,P <0. 01 ) were lower than that in the control group. The protein expression of PPARγ, TGF-β1 and type Ⅰ collagen was in similar tendence with that of mRNA expression. The expression of α-SMA decreased significantly in rosiglitazone group compared with that in the control group (t = 3. 12,P < 0.01 ). The collagen stainings of liver histological section in rosiglitazone group was lower than those in the control group (t = 3.47, P < 0. 01 ). Conclusion PPARγ ligand inhibits the production of collagen in fibrofic livers in rats and prevents hepatic fibrosis in vivo.
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Objective To study the feasibility of local resection for the tumor of the ampulla of Vater. Methods The result of 14 cases with carcinoma of the ampulla of Vater treated by local resection and 18 cases undergoing Whipple procedure in this hospital between 1988.5～1999.5 was analyzed. Results The postoperative morbidity for local resection was 7% and 39% for Whipple procedure respectively, P 0 05,and 5 year survival rate was 30% and 62% respectively, P
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ObjectiveTo evaluate nonoperative management of adult blunt hepatic injury. MethodThe outcome of 132 cases with adult blunt hepatic trauma admitted in this hospital between Oct 1982 and Oct 2002 was analyzed. Thirty-four cases (25.8%) were treated by nonoperative management. Before 1995, only a portion of patients underwent CT scan and after 1995, diagnosis of liver injury was established by CT scan in all cases. ResultThe nonoperative management rate before 1995 was 16.7% (14/84) and after 1995, it was 41.7% (20/48)(P0.05). ConclusionWith the progress of image monitoring and life support system, some patients of blunt hepatic injury could be managed by conservation therapy.
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Objective To explore the early diagnosis and optimum operative approach of traumatic diaphragma rupture (TDR) . Methods The clinical dada of 23 patients with TDR admitted to our hospital in recent 10 years were retrospectively analyzed. Results The diagnosis of TDR was made before operation in 12 cases1 (52.2%), and intraoperation in 8 (34.8), and misdiagnosed in 3 cases (13.1%). All the 23 patients underwent operation. Of the 23 patients, the operation was performed via thorax approach in 12 patients , via abdominal approach in 8, and via thorax-abdominal approach in 3. Hernation of the abdominal viscera into the thorax was observed in 18 cases, and single TDR in 5 cases.Empyema occurred after operation in 2 patients. 3 cases(13.1%) dead of hypovolemic shock and multiple organs failure. Conclusions The diagnosis of TDR may be difficult. The key of the diagnosis of TDR is to think of it. Once the diagnosis is made or suspected, the operation should be taken as early as possible. The choice of operative approach should be according to the injury mechanism and location; the choice of the operative procedure should be according to the intraoperative findings.
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Objective To analyse and explore the situation and causes of misdiagnosed primary hyperparathyroidism(PHPT),so as to develop some strategies for preventing and reducing misdiagnosis.Methods Clinical data of 94 misdiagnosed patients with PHPT treated in Beijing Jishuitan Hospital from November 1992 to April 2009 were collected and analyzed retrospectively.Results All cases were confirmed by operation and pathology.Among the 94 cases,90 cases were of parathyroid adenoma,and 4 cases of parathyroid carcinoma.The rate of misdiagnosis was 97.9%(94/96).The length of time of misdiagnosis was 2 months to 20 years;
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In view of the challenges and opportunities presented in the new century and after rational deliberations on five occasions, the completely new model of "hi tech+humanistic solicitude=the green hospital" was put forward and the overall framework of "one line of thought", "two cornerstones", and "three goals" was carefully formulated. In the meantime, all staff members of the hospital were called on to be involved in the "six major activities". As a result, great changes have taken place in the appearance and development of the hospital. It has been proved through practice that "the green hospital" is a successful model conforming to the trends of the times.
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Objective To investigate the polymorphism of the vitamin D receptor(VDR)gene in relation to primary hyperparathyroidism(PHPT). Method Polymerase chain reaction and restriction analysis were used to determine VDR genotypes in 30 patients with PHPT and in normal subjects.ResultsThe frequency distribution of VDR genotypes in PHPT patients was 0 in BB,1(3.3%) in Bb, 29(96.7%) in bb; and in normal persons was 2(3.3%) in BB, 11(18.4%) in Bb, and 47(78.3%) in bb. There was a significant difference between PHPT patients and normal persons in distribution of BB, Bb, bb genotypes (P≤0.05).ConclusionsThere is some distribution alterations of VDR gene polymorphism in PHPT patients.