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Objective:To investigate the infarct size and its related factors in patients with anterior choroidal artery (AchA) territory infarction.Methods:From April 2016 to April 2018, consecutive patients with acute AchA territory infarction hospitalized in the Department of Neurology, the Affiliated Shuyang Hospital of Xuzhou Medical University were enrolled retrospectively. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of the disease at baseline, and the Diffusion-Weighted Imaging (DWI) was used to determine the side, location, size, and morphology of the infarct lesions. The patients were divided into small infarction group (<20 mm) and large infarction group (≥20 mm). Multivariate logistic regression analysis was used to determine the independent risk factors for infarct size. Results:A total of 100 consecutive patients with acute AchA territory infarction were enrolled, including 86 (86.0%) in small infarction group, 14 (14.0%) in large infarction group. Based on the NIHSS score, there were 89 patients with mild stroke, 9 with moderate stroke, and 2 with severe stroke. According to DWI, 69 patients (69.0%) had long cord-like infarcts and 31 (31.0%) had other shapes of infarcts. The baseline NIHSS score (7.0 [2.0-10.5] vs. 3.0 [2.0-4.0]; Z=2.353, P=0.019) and the proportion of patients with severe stroke (14.3% vs. 0%; P=0.018), the infarcts in posterior part of periventricular area (85.7% vs. 57.0%; χ2=4.180, P=0.041) and medial globus pallidus (21.4% vs. 4.7%; χ2=5.206, P=0.023), and cord-like infarction (92.9% vs. 65.1%; χ2=4.332, P=0.037) in patients of the large infarction group were significantly higher than those of the small infarction group; leukocyte count (7.7±1.7×10 9/L vs. 6.6±1.8×10 9/L; t=2.214, P=0.036) and platelet count (234.5±39.5×10 9/L vs. 198.0±49.4×10 9/L; t=2.618, P=0.010) were significantly higher than those of the small infarction group; the proportion of patients with sensory impairment was significantly higher than that of the small infarction group (50.0% vs. 24.4%; χ2=3.908, P=0.048). Multivariate logistic regression analysis showed that platelet count (odds ratio 1.018, 95% confidence interval 1.000-1.621; P=0.044) and stroke severity (odds ratio 18.245, 95% confidence interval 1.534-217.052; P=0.022) were significantly and positively correlated with the infarct size. Conclusion:The related factors of the infarct size in patients with AchA territory infarction included sensory impairment, baseline NIHSS score, stroke severity, morphology and location of infarct lesions, and leukocyte and platelet counts, of which platelet count and stroke severity were independently positively correlated with the infarct size.
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Objective To investigate the relationship between the expression of ASPP2 mRNA and the methylation of ASPP2 gene in gastric cancer cells,to observe the inhibitory effect of 5-Aza-CdR on the growth of gastric cancer cells,to observe the effect of demethylation on the expression of ASPP2 mRNA and the methylation of ASPP2 gene in gastric cancer cells,and to explore the molecular mechanism of gastric cancer.Methods Real-time PCR was used to detect the expression of ASPP2 mRNA in two gastric cancer cells and normal gastric epithelial cells.BSP was used to detect the methylation of ASPP2 gene in two gastric cancer cells and normal gastric epithelial cells.CCK-8 was used to detect the growth inhibition rate of gastric cancer cells treated with 5-Aza-CdR of different concentrations,then they were used to detect expression of ASPP2 mRNA and the methylation of ASPP2 gene in gastric cancer cells again after the demethylation.Results ① The expression of ASPP2 mRNA in MKN-45 cells was significantly lower than that in GES-1 cells(P＜0.01).The expression of ASPP2 mRNA in MGC-803 cells was significantly lower than that in GES-1 cells (P＜0.01).There was no significant difference in MGC-803 cells and MKN-45 cells(P＞0.05).② The methylation rate of ASPP2 in MKN-45 cells was significantly higher than that in GES-1 cells (P＜0.01).The methylation rate of ASPP2 in MGC-803 cells was not significantly different from that in GES-1 cells (P＞0.05).The methylation rate of ASPP2 in MKN-45 cells was significantly higher than that in MGC-803 cells (P＜0.01).③ At the same time,the growth inhibition rate of each 5-Aza-CdR concentration group increased as the drug concentration depended.4.The expression of ASPP2 mRNA in MKN-45 cells was significantly higher than that before treatment (P＜0.01),the expression of ASPP2 mRNA in MGC-803 cells was not significantly different from that before treatment(P＞0.05).The methylation rate of ASPP2 in MKN-45 cells was significantly lower than that before treatment (P＜0.01).The methylation rate of ASPP2 in MGC-803 cells was not significantly different from that before treatment (P＞0.05).Conclusion ① Abnormal hypermethylation of ASPP2 gene in MKN-45 cells may be a molecular mechanism of decreased ASPP2 mRNA expression.② 5-Aza-CdR can inhibit the growth of MKN-45 and MGC-803 cells,and it can enhance the expression of ASPP2 mRNA in MKN-45 cells.Reversal of methylation in the promoter region of ASPP2 gene is the possible mechanism.③ Abnormal hypermethylation of the promoter region of ASPP2 gene may lead to silencing of mRNA expression that may be associated with gastric cancer.
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Objective To investigate the clinical characteristics and perioperative management of 1aparoscopic cholecystectomy(LC) in the elderly with gallbladder diseases. Methods From January 2006 to December 2016,the clinical data of two hundred and sixteen elderly patients with LC in the Sixth Affiliated People's Hospital of Jinshan Branch were analysed retrospectively. Results The operations of LC were successfully done in 206 patients ( 95. 8%) and 9 cases ( 4. 2%, 9/216 ) underwent conversion to open cholecystectomy for various reasons. Postoperative complications occurred in 22 cases (10. 2%,22/216). 2 cases died within 1 weeks after the operation,and the remaining patients recovered from the hospital. Conclusion Adequate perioperative management,strict surgical indications and operative skills are the necessary conditions for the successful implementation of LC in the elderly.
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Objective To investigate the methods for prevention and treatment of unexpected hemorrhage during operation of biliary tract.Methods The clinical data of 28 patients with intraoptrative hemorrhage from Jan.2006 to Dec.2016 in our hospital were retrospectively analyzed.Results The cause of introoperative hemorrhage included:iatrogenic biliary injuries in 14 cases (50％),cholelithasis complicated biliary infection in 9 cases (32.1％),bleeding in gall bladder bed in 3 patients (10.7％),and other causes in 2 cases (7.1％).The intraoperative blood loss was 600 to 3000 ml.According to the specific location of bleeding,the amount of blood loss,the cause of bleeding and other conditions,the individual treatment was given.26 were cured and 2 died of hemorrhagic shock and MODS.Conclusions The major causes of hemorrhage during operation of biliary tract comprise iatrogenic biliary injuries,biliary infection,and biliary lithiasis.The reasonable treatment of intraoperative hemorrhage should be based on the concrete bleeding etiologies.
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Objective To investigate the effect of family factors on the prognosis of patients with epilepsy and the relationship between family factors and clinical characteristics of epilepsy.Methods Data were collected from 107 patients definitely diagnosed with epilepsy who were treated by antiepileptic drugs for at least two years.All the patients were divided into good or poor prognosis group according to whether achieving at least one year free of seizures.The clinical and family data were colleeted.The questionnaire Family Adaptability and Cohesion Evaluation Scale-Ⅱ-Chinese Version containing 30 items was used for patients and the Epilepsy Knowledge Questionnaire containing 34 questions for primary caregiver.We compared the clinical and family factors between the two groups to identify the predictors of poor control of seizures with univariate and multiple Logistic regression,and observed the relationship between family factors and clinical features such as course,type of seizure,seizure frequency,etc,with Pearson correlation analysis.Results Patients with poor prognosis were more likely to have interictal epileptiform discharges (IEDs),multidrug treatment and pre-treatment seizure frequency of more than once monthly (84.6％ (44/52) vs 50.9 ％ (28/55),x2 =13.797,P =0.000;63.5 ％ (33/52) vs 34.5 ％ (19/55),x2 =8.947,P =0.003;38.5％ (20/52) vs 5.5％ (3/55),x2 =17.257,P =0.000).Family in rural area,unbalanced family type,number of family members were much more in poor prognosis group than in good prognosis group (51.9％ (27/52) vs 25.5 ％ (14/55),x2 =7.923,P =0.005;80.8 ％ (42/52) vs 49.1％ (27/55),x2 =11.712,P=0.000;4.1 ± 1.1 vs 3.6 ±0.8,t=2.631,P=0.010).And average family income,education level of father,the level of epilepsy knowledge of primary caregiver were significantly lower in poor prognosis group than in good prognosis group (19/20/13 vs 11/17/27,x2 =7.198,P =0.027;15/30/7 vs 4/34/17,x2 =10.709,P =0.005;36/11/5 vs 15/25/15,x2 =19.022,P =0.000).Multiple Logistic regression analysis demonstrated that IEDs (OR =12.332,95％ CI 2.756-55.190,P =0.001),pretreatment seizure frequency of more than once monthly (OR =8.401,95％ CI 1.573-44.884,P =0.013)were clinical risk factors of unfavorable prognosis;more family members (OR =3.021,95％ CI 1.554-5.870,P =0.001),poor epilepsy knowledge of primary caregiver (OR =3.392,95％ CI 1.304-8.821,P=0.012) and unbalanced family type (OR=4.794,95％ CI 1.217-18.894,P=0.025) were independent family risk factors of poor prognosis.The level of epilepsy knowledge of primary caregiver was inversely associated with duration (r =-0.237,P =0.014).Conclusions The prognosis of epilepsy is not only affected by clinical factors,but also by family factors.More family members,poor epilepsy knowledge of primary caregiver and unbalanced family type are independent risk factors of unfavorable prognosis.The poorer epilepsy knowledge the primary caregivers have,the longer duration the disease has.
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Objective To investigate precipitants of epileptic seizure, and to explore the correlation between various precipitants and relationship between precipitants and clinical features of epilepsy.Methods Data were collected from 154 patients attending a tertiary-care epilepsy clinic of Nanjing Brain Hospital between April 2015 and April 2016.The patients with epilepsy were older than 16 years, had a clinical history of one year or more, and one seizure at least a year and one seizure at least in the latest three months.An enclosed questionnaire was combined with open interview to identify and characterize seizure precipitants and clinical characteristics of patients.Patients were asked respectively whether there were some precipitants three months before and during last three months.Correlation between seizure precipitants and relationship between precipitants and clinical characteristics, such as age, gender, course, seizure frequency and so on, were calculated.Results A total of 125 (81.2%) participants reported at least one precipitant.Common precipitants (in descending order) were as follows: emotional stress (56.0%), sleep disorder (38.4%), fatigue (27.2%), missed medication (20.0%).There were one to six different precipitants for one patient, and 60.8% of patients had two or more precipitants.There was a correlation between emotional stress and sleep disorders as well as fatigue (χ2=4.665, 8.668;P<0.05).Patients with idiopathic epilepsy were more sensitive to sleep disorders.There was no relationship between total precipitants and clinical features such as age, gender, age of onset, duration, type of seizure, seizure frequency, number of drug taking and so on.Conclusions Seizure precipitants were found widespread.The most common precipitants were found to be emotional stress, sleep disorders, fatigue and missed medication.There existed a correlation between emotional stress and sleep disorders as well as fatigue.There was no connection between total precipitants and patient′s demographic characteristics as well as clinical features.However, the type of seizure precipitants was different in patients with different demographic and clinical characteristics.
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Objective To explore the etiological factors,clinical characteristic and diagnosis of nonacute biliary pancreatitis (NABP) and acute biliary pancreatitis (ABP).Methods The Clinical data of 152 patients with NABP and 206 patients with ABP from January 2004 to December 2014 in the Hepatobiliary Surgery Department of Jinshan Branch of the Sixth People's Hospital of Shanghai were analyzed retrospectively.Results There were no statistically significant differences in terms of the Ranson score,blood amylase and C reactive protein (CRP) between two groups (P ＞ 0.05).The incidences rate of hepatic insufficiency,renal insufficiency and encephalopathy were 35.5％ (54/152),25.6％ (39/152) and 8.5％ (13/152) in the NABP group,and 25.7％(53/206),12.1％(25/206) and 3.3％(7/206) in the ABP group,with significant difference between the two groups (x2 =4.01,10.89,4.41;P ＜ 0.05).Conclusion The key to reduce the complications and improve the cure rate is to make clear the etiology of NABP and ABP and to take active and effective treatment for the cause of the disease.
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Objective To investigate the correlation and expression of PTEN, matrix metalloproteinase-9 (MMP-9),and vascular endothelial growth factor-C(VEGF-C)in colorectal cancer.Methods The expression of PTEN, MMP-9 and VEGF-C in 102 cases of colorectal cancer tissues and 30 cases of normal colorectal tissues was detected using immunohistochemical SP method.Their correlations with cliniopathologic features were analyzed. Results The positive expression of PTEN in colorectal cancer was significantly lower than that in the controls (54.9%vs 100%, P<0.01).Both MMP-9 and VEGF-C were over expressed compared with the controls(83.3%vs 21.7%and 69.6%vs 16.7%respectively, P<0.01).The expression of PTEN was negatively correlated with that of MMP-9 and VEGF-C, and the expression of MMP-9 was positively correlated with that of VEGF-C ( P<0.05).The expressions of the three proteins in colorectal cancer tissues were not associated with age, gender, or tumor size.There were significant associations between the expression of these proteins and lymph node metastasis, distant metastasis, differentiation, and TNM staging(P<0.05).The 1, 3 and 5-year survival rates of the patients with positive PTEN were significantly higher than those of the patients with negative PTEN(P<0.05).The 1, 3 and 5-year survival rates of the patients with positive MMP-9 and VEGF-C were significantly lower than those of the patients with negative MMP-9 and VEGF-C( P<0.05) .Conclusions The decrease in the expression of PTEN and increase in MMP-9 and VEGF-C are closely correlated to the development of colorectal cancer.Their expressions may be favorable markers and useful prognostic indicators in the patients with colorectal cancer.
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Objective To investigate the causes of repeated operations in patients with biliary diseases.Methods The clinical data of 265 patients who received repeated operations at the Jinshan Branch of Shanghai Sixth People's Hospital from January 2005 to June 2011 were retrospectively analyzed.The causes of repeated operations were analyzed. The first reoperation aimed at removing the calculi completely,repairing the injured biliary ducts and managing malignant tumors. The primary surgical procesures of the first reoperation included choledochotomy + T tube drainage,choledochotomy + Roux-en-Y choledochojejunostomy,endoscopic retrograde cholangiopancreatography + endoscopic sphincterotomy,choledochotomy + hepatectomy + T tube drainage or Rouxen-Y choledochojejunostomy,choledochotomy + biliary-endo-drainage,end-to-end anastomosis of bile duct + T tube drainage,radical or palliative resection of tumor,endoscopic biliary stent drainage or exploratory laparotomy.The second and multiple reoperations aimed at reconstructing the passage for biliary drainage. All data were analyzed using the chi-square test.Results A total of 69.8％ (120/172) of patients who had recurrent or retained calculi received first reoperation,which was significantly higher than 31.2％ ( 29/93 ) of those who received second or multiple reoperations (x2 =36.51,P ＜ 0.05 ).A total of 58.1％ (54/93) of patients who had benign stenosis of bilioenteric anastomosis received multiple reoperations,which was significantly higher than 4.1％ (7/172) than those who received first reoperation (x2 ＝ 99.32,P ＜ 0.05 ).Of the 265 patients,46 had complications.The incidence of complications of patients who receive first reoperation was 10.5％ ( 18/172),which was significantly lower than 30.1％ (28/93) of patients who received second or multiple reoperations ( x2 =13.61,P ＜ 0.05 ).Six patients died of hemorrhagic shock or multiple organ syndrome dysfunction postoperatively.The mortality rates for patients who received first reoperation and second or multiple reoperations were 1.7％(3/172) and 3.2％ (3/93),respectively,with no significant difference ( x2 ＝ 0.59,P ＞ 0.05 ).Conclusions The causes for reoperation of biliary disease are muhifactorial.Full assessment of the status of biliary diseases and ample preperation preoperatively,careful operation and precise and rational selection of operative procedures are keys to decrease the reoperative rates and perioperative complications.
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Objective To study the etiological factors,clinical characteristics and diagnosis of acute pancreatitis (AP).Methods The clinical data of 217 patients with AP treated from January 2005to December 2010 in our hospital were studied retrospectively.Results The majority of patients were male (60.4％).The average age was 52.5 years.Cholelithiasiss,hyperlipidemia and trauma were the most frequent etiologic causes of AP.There were 164 patients with mild (75.6％) and 53 patients with severe (24.4％) AP.151 patients underwent surgical or endoscopical treatment (69.6 ％) while 66 patients underwent non-operative treatment (30.4 ％).14 of 53 patients with severe AP died.Conclusions AP should be treated according to the cause and the type.The key to reduce complications and increase cure rate is to find the cause of AP and then treat the underlying disease.
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Objective To explore etiological factors, clinical characteristic and diagnosis of acute recurrent pancreatitis (ARP). Methods Clinical data of 68 patients with ARP from Jan. 2003 to Dec. 2009 were reviewed retrospectively. Results Among 532 acute pancreatitis (AP) cases, 68 were diagnosed as ARP ( 12.8% ). The majority of ARP patients were male, amounting 76.5% of the total. The average age of ARP patients was 45.6 years. Cholelithiasis, hyperlipemia and alcohol were the most frequent factors causing ARP. Among the 68 ARP cases, 58 cases were mild (85.3%) and 10 cases were severe ( 14. 7% ). 54 cases underwent surgery or endoscopic treatment (79.4%) while 14 cases underwent non-operative treatment (20.6%). As a result, 66 cases were cured or improved and 2 cases with severe ARP died. Conclusion The key to reduce recurrent rate of ARP is to find out the causes of recurrence and then treat the diseases accordingly.
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Objective To explore and analyse the causes of reoperation after biliary duct operation, so as to decrease the reoperation rate of biliary tract. Methods Clinical data of 71 patients who underwent reoperation of biliary duct diseases in our hospital between January 2005 to September 2010 were analysed,and the causes of biliary duct reoperation were summarized and analysed. Results The main cause of reoperation was recurrent or retained bile stone (76.1%,54/71), noncalculous stenosis of biliary tract ( 15.5 %, 11/71 ),biliary tract obstruction due to tumor (4.2%,3/71), and other factors (4.2%,3/71).Conclusion Recurrent or retained bile duct stone were the main cause for biliary reoperation, but noncalculous stenosis of biliary tract and biliary tract obstruction due to tumor could not be ignored. The initial rational operative method, approporiate operation time and the thoroughness of operation are the key factors to decrease bile duct reoperations.
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Objective To investigate the distribution of biliary bacteriology and their sensitivity to antibiotics in patients with biliary tract infection in Jinshan area in recent 3 years.Methods Bile specimens collected from 367 patients with cholelithiasis between June 2006 and June 2009 were cultured and tested for drug sensitivity to aerobic bacteria.The results were statistically analyzed.Results One hundred and fifty-six bacterial strains were found in 142 (38.7%) bile specimens including gram negative strains (97,62.2%),gram positive strains (51,32.7% ),and fungal strains (8,5.1%).Enterococcus (17.9%) was major pathogen and follwed by Escherichia coli (12.8%),staphylococcus (11.5%),Klebsiella pneumoniae (8.3%),Pseudomonas aeruginosa (7.7%).Whereas the mixed infection was found in 26 (18.3%) specimens.The positive rate of bacterial infection was 53.1% in patients over 60 years of age (X2=8.36,P<0.01 ) and 47.1% in patients with acute biliary infection(X2=4.68,P<0.05).The drug susceptibility revealed that gram negative strains had low resistance to Meropenem (7.5 %),and followed by Imipenem (8.8 %),Cefoperazone +Sulbactam (19.7%),Amikacin (21.9%) and Tazobactam+Piperacillin (TZP,25.3%),but they were highly resistant to Ampicillin,Quinolones and some third generation of Cephalosporins (>50% ).In gram positive strains,none was resistant to Vancomycin,11.3% to fosfomycin and 11.6% to chloromycetin.They were highly resistant to Penicillins,Ampicillin and Cefazollin (>40%).ConclusionsEnterococcus,Escherichia coli,Sstaphylococcus and Klebsiella pneumoniae are commonly seen pathogens in biliary tract infection in Jinshan area.Use of Sulperazone or TZP plus Amikacin and metronidazole is recommended.Imipenem and Vancomycins may be second choice in treatment of severe biliary infection and refractory infection.
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Objective To explore the diagnosis and treatment of acute biliary pancreatitis (ABP) and when to operate. Methods 126 cases of ABP from Jan. 2005 to Dec. 2009 in our hospital were analyzed retrospectively. Results The cases number of the mild non-obstructive type, mild obstructive type, severe non-obstructive type, and severe obstructive type was 54, 33, 15, 24 respectively. 43 patients underwent early operation, 80 patients underwent postponed operation and three patients died preoperatively as a consequence of fulminat severe pancreatitis. 117 cases ( 92.86% ) were cured and 9 cases ( 7. 14% ) with severe acute pancreatitis died. Conclusion ABP should be treated according to its type. The key to reduce the complications and increase the cure rate is to determine the proper operation time according to the condition of individual patient.