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Endoscopic stent implantation is one of the main methods for the treatment of biliary and pancreatic diseases. At present, the commonly used biliary and pancreatic stents are mainly plastic and metal stents which are still have some deficiencies in clinical applications, and the emergence of the new type of biodegradable polymer materials is expected to achieve the purpose of treatment to overcome these shortcomings. It is a potential hope to break through the bottleneck of endoscopic treatment of choleopancreatic diseases. Previous animal experiments and human clinical studies have preliminarily shown its safety and effectiveness, which can effectively solve some problems of bile and pancreatic duct stenosis and so on. Biodegradable polymer stents have been widely studied, but their clinical application progress is slow and not yet popular, and it has gradually become a research hotspot in recent years . This article discusses the research status and development direction of biodegradable polymer stents in biliary and pancreatic diseases.
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Objective:To investigate the risk factors of acute biliopancreatic complica-tions in patients of pregnancy combined with gallbladder stone and construction of prediction model.Methods:The retrospective case-control study was constructed. The clinical data of 98 patients of pregnancy combined with gallbladder stone who were admitted to the First Hospital of Lanzhou University from September 2011 to October 2022 and 53 patients of pregnancy combined with gallbladder stone who were admitted to Gansu Provincial Hospital May 2014 to October 2021 were collected. The age of 151 patients was 29(25,32)years. Observation indicators: (1) situations of patients of pregnancy combined with gallbladder stone; (2) risk factors of acute biliopancreatic com-plications in patients of pregnancy combined with gallbladder stone; (3) construction of prediction model for acute biliopancreatic complications in patients of pregnancy combined with gallbladder stone. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the rank sum test. Univariate and multi-variate analyses were conducted using the Logistic regression model. Nomogram prediction model was conducted, and the receiver operating characteristic (ROC) curve was used to evaluate discri-mination of the nomogram predic-tion model. The calibration curve and clinical decision curve were used to evaluate calibration and net clinical benefit of the nomogram prediction model. Internal validation of the prediction model was performed by applying 10-fold cross-validation. Results:(1) Situations of patients of pregnancy combined with gallbladder stone. The total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, prepregnancy body mass index (<18.5 kg/m 2, 18.5?24.0 kg/m 2, >24.0 kg/m 2), gesta-tional period (early, mid, late), primipara (positive, negative), stone type (solitary, non solitary), diameter of stone (≤10 mm, >10 mm), gallbladder wall thickness (≥4 mm, <4 mm) were (4.9±1.4)mmol/L, 1.88(1.22,2.93)mmol/L, 1.48(1.22,1.83)mmol/L, (2.8±0.9)mmol/L, 13, 75, 58, 37, 45, 69, 86, 65, 37, 114, 89, 62, 38, 113 in the 151 patients of pregnancy combined with gallbladder stone. Of the 151 patients, the age, prepregnancy body mass index (<18.5 kg/m 2, 18.5?24.0 kg/m 2, >24.0 kg/m 2), primipara (positive, negative), stone type (solitary, non solitary), diameter of stone (≤10 mm, >10 mm), gallbladder wall thickness (≥4 mm, <4 mm) were 31(28,37)years, 3, 30, 36, 29, 40, 32, 37, 26, 43, 4, 65 in 69 cases without symptom, versus 27(24,31)years, 10, 45, 22, 57, 25, 5, 77, 63, 19, 34, 48 in 82 cases combined with acute biliopancreatic complications, showing significant differences in the above indicators between them ( Z=?3.636, ?2.385, χ2=11.544, 32.862, 23.729, 25.310, P<0.05). Five of the 82 patients of pregnancy combined with gallbladder stone missed data of prepregnancy body mass index. Of the 82 patients, there were 42 patients of simple acute cholecystitis, 40 patients of common bile duct stone and/or acute biliary pancreatitis including 18 cases of common bile duct stone, 13 cases of acute biliary pancreatitis and 9 cases of common bile duct stone combined with acute biliary pancreatitis. (2) Risk factors of acute biliopancreatic complications in patients of pregnancy combined with gallbladder stone. Results of multivariate analysis showed that primipara, non solitary stone, diameter of stone ≤10 mm, gallbladder wall thickness ≥4 mm were independent risk factors of acute biliopancreatic complications in patients of pregnancy combined with gallbladder stone ( odds ratio=3.102, 6.305, 3.674, 6.686, 95% confidence interval as 1.280?7.519, 1.886?21.080, 1.457?9.265, 1.984?22.528, P<0.05). Results of multivariate analysis in further analysis showed that primipara, non solitary stone, gallbladder wall thickness ≥4 mm were independent risk factors of simple acute cholecystitis in patients of pregnancy combined with gallbladder stone ( odds ratio=3.671, 8.905, 7.137, 95% confidence interval as 1.386?9.723, 2.332?34.006, 1.902?26.773, P<0.05), and age, non solitary stone, diameter of stone ≤10 mm, gallbladder wall thickness ≥4 mm were independent risk factors of common bile duct stone and/or acute biliary pancreatitis in patients of pregnancy combined with gallbladder stone ( odds ratio=0.883, 5.361, 5.472, 8.895, 95% confidence interval as 0.789?0.988, 1.062?27.071, 1.590?18.827, 2.064?38.325, P<0.05). (3) Construction of prediction model for acute biliopancreatic complications in patients of pregnancy combined with gallbladder stone. The nomogram prediction model for acute biliopancreatic complications in patients of pregnancy combined with gallbladder stone was constructed based on the clinical factors of age, primipara, stone type, diameter of stone and gallbladder wall thickness. The area under the curve (AUC) of ROC curve of prediction model was 0.869 (95% confidence interval as 0.813?0.923), indicating that the prediction model with good predictive ability. Results of Hosmer-Lemeshow test showed a good fit ( χ2=5.680, P>0.05), indicating that the prediction model with good calibration. Results of decision curve analysis showed the prediction model with high net clinical benefit. Results of internal validation of the prediction model based on 10-fold cross-validation showed the AUC of ROC curve for the cross-validation sample was 0.833, indicating that the prediction model with good stability. Conclusions:Primigravida, non solitary stone, diameter of stone ≤10 mm, gallbladder wall thickness ≥4 mm are independent risk factors of acute biliopancreatic complications in patients of pregnancy combined with gallbladder stone. The prediction model for acute biliopancreatic complications has good predictive ability.
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Objective:To investigate the influencing factors of textbook outcomes in liver surgery (TOLS) after radical resection of gallbladder carcinoma.Methods:The retrospective case-control study was conducted. The clinicopathological data of 530 patients who underwent radical resection of gallbladder carcinoma in 15 medical centers, including the First Affiliated Hospital of Army Medical University et al, from January 2014 to January 2020 were collected. There were 209 males and 321 females, aged (61±10)years. Patients underwent radical resection of gallbladder carcinoma, including cholecystectomy, hepatectomy, invasive bile duct resection, and lymph node dissection. Observation indicators: (1) situations of TOLS; (2) influencing factors of TOLS. Measure-ment data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the Mann-Whitney U test. The univariate analysis was conducted using the corresponding statistical methods based on data type, and variables with P<0.10 were included in multivariate analysis. Multivariate analysis was conducted using the Logistic stepwise regression model. Results:(1) Situations of TOLS. All 530 patients underwent radical resection of gallbladder carcinoma, and there were 498 cases achieving R 0 resection, 508 cases without ≥grade 2 intra-operative adverse events, 456 cases without postoperative grade B and grade C biliary leakage, 513 cases without postoperative grade B and grade C liver failure, 395 cases without severe com-plications within postoperative 90 days, 501 cases did not being re-admission caused by severe com-plications within postoperative 90 days. Of the 530 patients, 54.53%(289/530) of patients achieved postoperative TOLS, while 45.47%(241/530) of patients did not achieve postoperative TOLS. (2) Influencing factors of TOLS. Results of multivariate analysis showed that American Society of Anesthesiologists classification >grade Ⅱ, preoperative jaundice, T staging as T3?T4 stage, N staging as N2 stage, liver resection as right hemi-hepatectomy, and neoadjuvant therapy were independent factors influencing TOLS in patients undergoing radical resection of gallbladder carcinoma ( odds ratio=2.65, 1.87, 5.67, 5.65, 2.55, 3.34, 95% confidence interval as 1.22?5.72, 1.18?2.95, 2.51?12.82, 2.83?11.27, 1.41?4.63, 1.88?5.92, P<0.05). Conclusion:American Society of Anesthesiologists classification >grade Ⅱ, preoperative jaundice, T staging as T3?T4 stage, N staging as N2 stage, liver resection as right hemi-hepatectomy, and neoadjuvant therapy are independent factors influencing TOLS in patients undergoing radical resection of gallbladder carcinoma.
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Objective:To investigate the clinical characteristics of choledocholithiasis com-bined with periampullary diverticulum and influencing factor for difficult cannulation of endoscopic retrograde cholangiopancreatography (ERCP).Methods:The retrospective case-control study was conducted. The clinical data of 1 920 patients who underwent ERCP for choledocholithiasis in 15 medical centers, including the First Hospital of Lanzhou University, et al, from July 2015 to December 2017 were collected. There were 915 males and 1 005 females, aged (63±16)years. Of 1 920 patients, there were 228 cases with periampullary diverticulum and 1 692 cases without periampullary diverticulum. Observation indicators: (1) clinical characteristics of patients with choledocholithiasis; (2) intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis; (3) influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and com-parison between groups was conducted using the Wilcoxon rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The Logistic regression model was used for univariate and multivariate analyses. Results:(1) Clinical characteristics of patients with choledocholithiasis. Age, body mass index, cases with complications as chronic obstructive pulmonary disease, diameter of common bile duct, cases with diameter of common bile duct as <8 mm, 8?12 mm, >12 mm, diameter of stone, cases with number of stones as single and multiple were (69±12)years, (23.3±3.0)kg/m 2, 16, (14±4)mm, 11, 95, 122, (12±4)mm, 89, 139 in patients with choledocholithiasis combined with periampullary diverticulum, versus (62±16)years, (23.8±2.8)kg/m 2, 67, (12±4)mm, 159, 892, 641, (10±4)mm, 817, 875 in patients with choledocholithiasis not combined with periampullary diver-ticulum, showing significant differences in the above indicators between the two groups ( t=?7.55, 2.45, χ2=4.54, t=?4.92, Z=4.66, t=?7.31, χ2=6.90, P<0.05). (2) Intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis. The balloon expansion diameter, cases with intraoperative bleeding, cases with hemorrhage management of submucosal injection, hemostatic clip, spray hemostasis, electrocoagulation hemostasis and other treatment, cases with endoscopic plastic stent placement, cases with endoscopic nasal bile duct drainage, cases with mechanical lithotripsy, cases with stone complete clearing, cases with difficult cannulation, cases with delayed intubation, cases undergoing >5 times of cannulation attempts, cannulation time, X-ray exposure time, operation time were 10.0(range, 8.5?12.0)mm, 56, 6, 5, 43, 1, 1, 52, 177, 67, 201, 74, 38, 74, (7.4±3.1)minutes, (6±3)minutes, (46±19)minutes in patients with choledocholithiasis combined with periampullary diverticulum, versus 9.0(range, 8.0?11.0)mm, 243, 35, 14, 109, 73, 12, 230, 1 457, 167, 1 565, 395, 171, 395, (6.6±2.9)minutes, (6±5)minutes, (41±17)minutes in patients with choledocholithiasis not combined with periampullary diverticulum, showing significant differences in the above indicators between the two groups ( Z=6.31, χ2=15.90, 26.02, 13.61, 11.40, 71.51, 5.12, 9.04, 8.92, 9.04, t=?3.89, 2.67, ?3.61, P<0.05). (3) Influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Results of multivariate analysis showed total bilirubin >30 umol/L, number of stones >1, combined with periampullary diverticulum were indepen-dent risk factors for difficult cannulation in patients with periampullary diverticulum who underwent ERCP for choledocholithiasis ( odds ratio=1.31, 1.48, 1.44, 95% confidence interval as 1.06?1.61, 1.20?1.84, 1.06?1.95, P<0.05). Results of further analysis showed that, of 1 920 patients undergoing ERCP for choledocholithiasis, the incidence of postoperative pancreatitis was 17.271%(81/469) and 8.132%(118/1 451) in the 469 cases with difficult cannulation and 1 451 cases without difficult cannula-tion, respectively, showing a significant difference between them ( χ2=31.86, P<0.05). In the 1 692 patients with choledocholithiasis not combined with periampullary diverticulum, the incidence of postopera-tive pancreatitis was 17.722%(70/395) and 8.250%(107/1 297) in 395 cases with difficult cannula-tion and 1 297 cases without difficult cannulation, respectively, showing a significant difference between them ( χ2=29.00, P<0.05). In the 228 patients with choledocholithiasis combined with peri-ampullary diverticulum, the incidence of postoperative pancreatitis was 14.865%(11/74) and 7.143%(11/154) in 74 cases with difficult cannulation and 154 cases without difficult cannulation, respectively, showing no significant difference between them ( χ2=3.42, P>0.05). Conclusions:Compared with patients with choledocholithiasis not combined with periampullary divertioulum, periampullary divertioulum often occurs in choledocholithiasis patients of elderly and low body mass index. The proportion of chronic obstructive pulmonary disease is high in choledocholithiasis patients with periampullary diverticulum, and the diameter of stone is large, the number of stone is more in these patients. Combined with periampullary diverticulum will increase the difficult of cannulation and the ratio of patient with mechanical lithotripsy, and reduce the ratio of patient with stone complete clearing without increasing postoperative complications of choledocholithiasis patients undergoing ERCP. Total bilirubin >30 μmol/L, number of stones >1, combined with periampullary diverticulum are independent risk factors for difficult cannulation in patients of periampullary diverticulum who underwent ERCP for choledocholithiasis.
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Objective:To investigate the influencing factors for endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events in novice trainees and establishment of its prediction model.Methods:The prospective study was conducted. The clinical data of 12 novice trainees of ERCP in the First Hospital of Lanzhou University from July 2016 to July 2019 were selected. The operation was performed by 12 novice trainees of ERCP under the guidance of the endoscopic experts. Observation indicators: (1) ERCP-related adverse events in novice trainees; (2) analysis of influencing factors for ERCP-related adverse events in novice trainees; (3) establishment of a prediction model for ERCP-related adverse events in novice trainees. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed by the t test. Measurement data with skewed distribution were represented as M(range), and com-parison between groups was analyzed by the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed by the chi-square test. The Logistic regression model was used for univariate and multivariate analyses. The regression coefficients were used to construct a prediction model. The receiver operating characteristic curve was drawn, and the area under curve was used to evaluate the predictive ability. Results:(1) ERCP-related adverse events in novice trainees. Of the 300 patients with ERCP operated by 12 novice trainees, 52 cases had ERCP-related adverse events and 248 cases had no ERCP-related adverse events. Cases in grade 1?2 or grade 3?4 of ERCP difficulty classification, score for intubation time, score for cannulation time, cases with or without completion of the cannulation, cases with or with-out basket stone removal, cases with or without stenosis expansion, score for contrast-enhanced interpretation, score for implementation of reasonable treatment and score for expected purpose reached were 22, 30, 8(range, 5?10), 20(rang, 9?20), 24, 28, 11, 41, 0, 52, 39±17, 39±19 and 44±23 for novice trainees with ERCP-related adverse events, versus 146, 102, 6(range, 4?9), 12(range, 8?20), 163, 85, 94, 154, 20, 228, 52±22, 80±20, 52±23 for novice trainees without ERCP-related adverse events, showing significant differences in the above indicators between them ( χ2=4.79, Z=?2.46, ?2.72, χ2=7.01, 5.30, 4.49, t=?4.00, ?2.97, ?2.29, P<0.05). (2) Analysis of influencing factors for ERCP-related adverse events in novice trainees. Results of univariate analysis showed that the diffi-culty classification of ERCP, intubation time, cannulation time, completion of cannulation, basket stone extraction, contrast-enhanced interpretation, implementation of reasonable treatment and expected purpose reached were related factors for ERCP-related adverse events in novice trainees ( odds ratio=1.95, 1.11, 1.08, 0.45, 0.44, 0.97, 0.98, 0.98, 95% confidence intervals as 1.07?3.58, 1.02?1.22, 1.02?1.14, 0.24?0.82, 0.22?0.90, 0.96?0.99, 0.96?0.99, 0.97?1.00, P<0.05). Results of multi-variate analysis showed that difficulty classification of ERCP and contrast-enhanced interpretation were independent influencing factors for ERCP-related adverse events in novice trainees ( odds ratio=2.08, 0.95, 95% confidence intervals as 1.10?3.96, 0.92?0.99, P<0.05). (3) Establishment of a predic-tion model for ERCP-related adverse events in novice trainees. According to the important outcome indicators of clinical training and results of multivariate analysis, 4 indicators including difficulty classification of ERCP, intubation time, cannulation time and contrast-enhanced interpretation were included to establish a prediction model for ERCP-related adverse events in novice trainees, which indicated that trainees with the predicted score >0.4 were in high risk of ERCP-related adverse events. The area under receiver operating characteristic curve of the prediction model was 0.72(95% confidence interval as 0.65?0.79, P<0.05), with the best cut-off value as 0.40, the sensitivity as 76.9% and the specificity as 63.3%. Conclusion:The difficulty classification of ERCP and contrast-enhanced interpretation are independent influencing factors for ERCP-related adverse events in novice trainees. Novice trainees with a predicted score >0.4 are high-risk groups of ERCP-related adverse events.
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The treatment of iatrogenic bile duct injury is complex, especially for delayed iatrogenic bile duct injury, and the timing and treatment measures are crucial. Endoscopic surgery treatment, interventional treatment and surgery all play important roles. Endoscopic surgery treatment has become the main choice for iatrogenic bile duct injury because of its advantages of small trauma, fast recovery, short operation time and precise efficacy, etc. At the same time, endoscopic surgery treatment can create opportunities and conditions for secondary bile duct repair surgery, and can also control the occurrence of post-repair complications. With the further populari-zation and application of endoscopic technology, the development of imaging three-dimensional reconstruction technology and visualization analysis, endoscopic surgery treatment will definitely become the main treatment for delayed iatrogenic bile duct injury.
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Objective: To explore whether acupuncture can improve sleep disturbance, cognitive impairment and emotional disorders caused by sleep deprivation, and its association with the attenuation of oxidative stress injury in prefrontal cortex. Methods: Fifty-two male Sprague-Dawley rats were randomly divided into a control group (n=10), a model group (n=14), a manual acupuncture (MA) group (n=14), and a sham-MA group (n=14). All the groups were established as sleep deprivation models via the modified multiple platform method, except for the control group. Rats in both the MA group and the sham-MA group received corresponding intervention, respectively. After modeling and intervention, the four groups received three behavioral tests, namely sleep monitoring, by comprehensive lab animal monitoring system (CLAMS), Morris water maze (MWM) test and open-field test (OFT), followed by oxygen free radical level test and Western blot (WB) detection for the expression levels of Bax and Bcl-2. Results: The MA group derived more sleep time within 24 h than either the model group or the sham-MA group (both P<0.05). On MWM orientation navigation test day 1, there were no significant differences in escape latency among the control, MA and sham-MA groups (P>0.05), and the escape latency was significantly shorter in these three groups than that in the model group (all P<0.05). On test day 4, the escape latency was markedly shorter in the MA group than that in either the model group or the sham-MA group (both P<0.05); meanwhile, the MA group showed significantly better performance compared with these two groups in space probe test (both P<0.05). In OFT, compared with the control group, there was a significant decline in the horizontal movement score in the other three groups (all P<0.05), and the decrease was more significant in the model group and the sham-MA group than that in the MA group (both P<0.05). The superoxide dismutase (SOD) content was markedly higher and the malondialdehyde (MDA) content was markedly lower in the MA group than those in the model group and the sham-MA group (all P<0.05). Compared with the model group and the sham-MA group, the expression of Bax was significantly lower and the expression of Bcl-2 was significantly higher in the MA group (all P<0.05). Conclusion: MA therapy can lengthen the sleep time in sleep-deprived rats and improve learning and memory impairments induced by sleep deprivation, and the underlying mechanism may be associated with the enhancement of antioxidant capacity in the prefrontal cortex and the inhibition of hippocampal neuronal apoptosis.
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Objective:To observe the effect of Tongxie Yaofang on the expressions of colon serotonin transporter （SERT）， liver 5-hydroxytryptamine<sub>2A</sub> receptor （5-HT<sub>2A</sub>R） protein， serum 5-HT and inflammatory factors in ulcerative colitis （UC） model rats of liver stagnation and spleen deficiency， in order to explore the basis of syndrome of liver stagnation and spleen deficiency and the intervention mechanism of Tongxie Yaofang. Method:Fifty male SD rats were randomly divided into blank control group， model group， high， medium and low-dose Tongxie Yaofang group （10，5，2.5 g·kg<sup>-1</sup>）， and salazosulacil group （0.3 g·kg<sup>-1</sup>）. The ulcerative colitis model of liver depression and spleen deficiency was established by 2，4，6-trinitrobenzene sulfonic acid （TNBS）/ethanol solution enema + restraint stress + diet loss. After successful modeling， the samples were collected after 21 days of drug intervention. Htoxylin eosin （HE） staining and oil red staining were used to observe the pathological changes of colon and liver in each group. Serum interleukin-6 （IL-6）， IL-9， 5-HT and superoxide dismutase （SOD） were detected by enzyme linked immunosorbent assay （ELISA）. Protein expressions of SERT in the colons and 5-HT<sub>2A</sub>R in liver of rats were detected by Western blot. Result:Compared with the normal group， obvious ulcers were formed in the colon and lipid droplets in the liver increased in the model group， serum levels of IL-6， IL-9 and 5-HT in the model group increased， while the level of SOD decreased （<italic>P</italic><0.05）. The protein expression of SERT in colon decreased， whereas the protein expression of 5-HT<sub>2A</sub>R in liver increased （<italic>P</italic><0.05）. Compare with model group， the pathological damage of colon was improved， and the formation of lipid droplets in liver was reduced in high， medium-dose Tongxie Yaofang groups and sulfasalazine group. The serum levels of IL-6， IL-9 and 5-HT decreased， while the level of SOD increased in Tongxie Yaofang group and sulfasalazine group （<italic>P</italic><0.05）. The protein expression of SERT in colon increased in high，low-dose Tongxie Yaofang groups and sulfasalazine group， and the protein expression of 5-HT<sub>2A</sub>R in liver decreased in medium， low dose Tongxie Yaofang groups and sulfasalazine group （<italic>P</italic><0.05）. Conclusion:Tongxie Yaofang may reduce the content of 5-HT， and regulate the intestinal motility and sensory system by up-regulating the expression of SERT in the colon， inhibit the expressions of IL-6，IL-9 and other inflammatory factors， and play an anti-inflammatory role， reduce the content of 5-HT and the expression of 5-HT<sub>2A</sub>R in the liver， increase the level of SOD， regulate emotion and lipid metabolism in the liver， and then exert the intervention effect on ulcerative colitis with liver depression and spleen deficiency on the whole.
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The high recurrence rate of hepatocellular carcinoma (HCC) after surgery cannot be ignored, but there are still no consensus statements and guideline recommendations for adjuvant therapies after HCC surgery. Current studies have shown that microvascular invasion is one of the high-risk factors for postoperative recurrence of HCC, and for HCC patients with microvascular invasion, timely postoperative adjuvant therapy may delay the time to recurrence and bring benefits to patients. At this stage, the prevention of postoperative recurrence of HCC and the prolongation of survival time through adjuvant therapy have attracted more and more attention. This article reviews the research advances in adjuvant therapy after surgery for HCC with microvascular invasion in recent years, in order to provide reference and help for postoperative adjuvant therapies for HCC patients with microvascular invasion.
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Since the outbreak of coronavirus disease 2019 (COVID-19), the health authorities in various regions have formulated a group of traditional Chinese medicine (TCM) diagnosis and treatment programs based on the consensus analysis of etiology and pathogenesis of TCM experts, and recommended the guiding prescriptions for different syndromes in three stages of prevention, treatment and recovery. In order to effectively summarize the understanding of the pathogenesis of each scheme and the rules of the formulation of various prescriptions, based on 49 TCM prevention and treatment plans issued by the health administration departments, 308 TCM prescriptions were sorted by stages (151 prescriptions in the treatment period, 118 prescriptions in the prevention period and 39 prescriptions in the recovery period). The 2019-nCoV pneumonia prescriptions was further processed by using TCM inheritance platform system. The common syndromes and the frequency of commonly used Chinese medicines were summed up. The commonly used drug pairs and combinations in different stages were extracted, and their association rules were analyzed. The rules of the Chinese herbal prescription for COVID-19 were preliminarily summarized. During the treatment period, the main syndrome types are inner blocking causing collapse, epidemic toxin in the lung, cold dampness in the lung and toxic heat in the lung, involving 187 kinds of herbs, 29 kinds of herbs with single taste frequency more than 20 times.Armeniacae Semen Amarum is the most frequently used, Gypsum Fibrosum-Armeniacae Semen Amarum is the most frequently used drug-pair, the core formula is Maxing Shigan Tang, and the main pathogenesis is cold, wet and heat. There is no unified syndrome type in the prevention period, involving 119 herbs in total. There are 13 kinds of herbs with single taste frequency more than 20 times. The most frequently used is Astragali Radix. The most frequently used medicine pair is Astragali Radix-Saposhnikoviae Radix. The core formula is Yupingfeng San, and the main pathogenesis is Qi deficiency. During the recovery period, the main syndromes are deficiency of lung and spleen Qi deficiency and Qi and Yin deficiency, involving 113 herbs, 12 kinds of herbs with single taste frequency more than 10 times, Poria with the highest frequency of use, Citri Reticulatae Pericarpium-Poria with the highest frequency of drug pairing, Erchentang and Shengmaiyin with the main pathogenesis of deficiency of spleen Qi and Yin. The purpose of this study is to provide multiple references for strengthening clinical precise treatment, improving the effect of TCM treatment and promoting the management of TCM prevention and control resources.
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Objective@#To investigate the clinicopathologic features of intravascular diffuse large B-cell lymphoma (IVLBCL) in the central nervous system (CNS).@*Methods@#The clinical and radiological data of three cases of CNS-IVLBCL in Xuanwu Hospital, Capital Medical University from 2014 to 2017 were collected. And pathological and immunohistochemical features of these patients were retrospectively analyzed. The related literatures were also reviewed.@*Results@#All the three patients aged from 62 to 76 years, with duration of 4-8 months. Clinical manifestations of the three patients included dizziness, fatigue, seizures, etc. They showed intracranial multiple lesions in the frontal, temporal, parietal and corona radiata, etc. MRI demonstrated cerebral infarction or space-occupying lesions. Microscopic observation showed small vessel lumina filled with tumor cells in the white matter. Tumor cells had large, round nucleus, and prominent nucleoli. The chromatin of tumor cells was broadly granular, and the mitotic figures were visible. Tumor cells expressed B cell markers, such as CD20, CD79α, paired box protein 5 (PAX-5). CD34 staining demonstrated that tumor cells were located in the lumen of the blood vessels. Two patients died within half a year after diagnosis, and the other one was lost to follow-up.@*Conclusions@#The clinical symptoms and MRI demonstrations of CNS-IVLBCL are variable and the prognosis is extremely poor. Morphological observation and immunohistochemical phenotyping for biopsy specimens are helpful for early diagnosis and actively combining chemotherapy to prolong survival of patients.
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Objective To investigate the clinicopathologic features of intravascular diffuse large B?cell lymphoma (IVLBCL) in the central nervous system (CNS). Methods The clinical and radiological data of three cases of CNS?IVLBCL in Xuanwu Hospital, Capital Medical University from 2014 to 2017 were collected. And pathological and immunohistochemical features of these patients were retrospectively analyzed. The related literatures were also reviewed. Results All the three patients aged from 62 to 76 years, with duration of 4-8 months. Clinical manifestations of the three patients included dizziness, fatigue, seizures, etc. They showed intracranial multiple lesions in the frontal, temporal, parietal and corona radiata, etc. MRI demonstrated cerebral infarction or space?occupying lesions. Microscopic observation showed small vessel lumina filled with tumor cells in the white matter. Tumor cells had large, round nucleus, and prominent nucleoli. The chromatin of tumor cells was broadly granular, and the mitotic figures were visible. Tumor cells expressed B cell markers, such as CD20, CD79α, paired box protein 5 (PAX?5). CD34 staining demonstrated that tumor cells were located in the lumen of the blood vessels. Two patients died within half a year after diagnosis, and the other one was lost to follow?up. Conclusions The clinical symptoms and MRI demonstrations of CNS?IVLBCL are variable and the prognosis is extremely poor. Morphological observation and immunohistochemical phenotyping for biopsy specimens are helpful for early diagnosis and actively combining chemotherapy to prolong survival of patients.
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Objective To evaluate radiography with CO2 combined with contrast agents for endoscopic drainage of unresectable hilar cholangiocarcinoma. Methods Clinical data of 43 patients with unresectable hilar cholangiocarcinoma undergoing endoscopic drainage at the First Hospital of Lanzhou University from October 2010 to October 2015 were analyzed retrospectively. According to different contrast agents in radiography, patients were divided into the study group ( CO2 combined with contrast agent) and the control group ( contrast agent alone) . There were 23 cases in the study group and 20 cases in the control group. Total postoperative bilirubin(TBIL),white blood cell(WBC),procalcitonin(PCT)and the incidence of complications in the two groups were compared. Results The endoscopic procedure ranged from 50 min to 70 min. TBIL, WBC, PCT at 48 h and 72 h after operation in the study group were lower than those in the control group[48 h TBIL:(173. 42±66. 78) μmol/L VS (210. 81±78. 34) μmol/L,P=0. 025;72 h TBIL:(104. 64±56. 35) μmol/L VS (159. 33±59. 59) μmol/L, P=0. 023; 48 h WBC:(11. 51±7. 78)×109/L VS (15.83±6.67)×109/L, P=0.026; 72 h WBC:(10.92±5.64)×109/L VS (14.72±4.97)×109/L, P=0. 026; 48 h PCT:(0. 56±0. 18) ng/mL VS (1. 24±0. 73) ng/mL, P=0. 003; 72 h PCT:(0. 42± 0. 27) ng/mL VS (0. 90±0. 20) ng/mL, P=0. 001]. The incidence of postoperative cholangitis in the study group was lower than that in the control group [ 13. 0％( 3/23) VS 40％( 8/20) , P=0. 043] . Relatively low incidence of postoperative pancreatitis occurred in both groups, with no significant difference [ 4. 3％( 1/23) VS 10. 0％(2/20),P=0. 090]. Conclusion Radiography with CO2 combined with contrast agents during endoscopic drainage procedures for unresectable hilar cholangiocarcinoma is safe and effective, which could lower incidence of postoperative cholangitis.
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<p><b>OBJECTIVE</b>To detect potential mutation of TCOF1 gene in a Chinese family affected with Treacher-Collins syndrome.</p><p><b>METHODS</b>Clinical data of the patient was collected. The analysis included history taking, clinical examination and genetic testing. All coding regions of the TCOF1 gene were subjected to PCR amplification and Sanger sequencing.</p><p><b>RESULTS</b>A novel mutation c.2261ins G (p.E95X) of the TCOF1 gene was discovered in the patient. The same mutation was not found in his parents and 100 healthy controls.</p><p><b>CONCLUSION</b>The c.2261insG (p.E95X) mutation of the TCOF1 gene probably underlies the disease in the patient. Genetic testing can facilitate diagnosis and genetic counseling for families affected with TCS.</p>
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American Society of Clinical Oncology has named immunotherapy 2.0 as the advance of this year recently .This se-lection is based on the recognition of the amazing progress achieved by the immunotherapy agents .Lung cancer is the leading cause of cancer death worldwide .Immunotherapy , along with traditional treatment strategies such as chemotherapy , radiation therapy and targe-ted therapy , provides patients of lung cancer with more possibilities .The new era of immunotherapy seems irresistible .
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Objective:To explore the intervention effect of proteasome inhibitor MG132 in rats with collagen-induced arthritis(CIA),which resembles human rheumatoid arthritis(RA).Methods:Forty-eight female SD rats were randomly divided into three groups,including blank control group,CIA model group and MG132-treated group.There were sixteen rats in each group.Rats in CIA model group and MG132-treated model group were injected with type Ⅱ collagen to established CIA rats.21 days after the initial immunization,the rats in the MG132-treated model group were injected subcutaneously with 1 mg/kg MG132 once daily for 2 weeks.42 days after the initial immunization,the change of paw-swelling and the arthritis scores were determined.The synovial pathology examination was performed with HE staining.The 20S proteasome activity in synovial tissue was measured by fluorescence substrate assay.The expression of NF-κB/p65,IκBα in synovial tissue were analyzed by Western blot.Results:Proteasome inhibitor MG132 significantly attenuated the severity of arthritis and histopathological changes in CIA rats.Compared with the blank control group,the 20S proteasome activity was increased significantly in the CIA model group(P<0.05),and decreased after injection of MG132.Compared with CIA rats,the expression of NF-κB/p65 significantly decreased in rats treated with MG132(P<0.01).Compared with the blank control group,the expression of IκBα protein decreased in CIA model group.After injected with MG132,the protein was significantly increased(P<0.01).Conclusion:The proteasome inhibitor MG132 may attenuates the severity of arthritis and histopathological changes in CIA rats.These effects may be mediated through the inhibition of NF-κB activity.
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Objective·To investigate safety of laparoscopic surgery in diagnosis and treatment of gynecologic diseases in elderly women over 70 years old. Methods·A total of 420 cases of elderly patients over 70 years old from January 2009 to December 2016 were retrospectively analyzed in Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. According to ages, the patients were divided into elderly group (70-80 years old,including 70 years old) and advanced age group (80 years old and above); according to surgical methods, the patients were divided into laparoscopy group and laparotomy group. The ages, American Society of Anesthesiology (ASA) classifications, body mass indexes (BMI), preoperative complications, surgical methods, intraoperative circumstances, postoperative pathology results and postoperative complications were analyzed. Results·There were no significant differences in age, ASA classification and BMI between laparoscopy group and laparotomy group in the same age group (P<0.05). Most patients had various chronic diseases before operations. Taking total hysterectomy as an example, laparoscopy groups in the two age groups were superior to laparotomy groups in the comparison of surgical time, bleeding volume, anal evacuation time and length of hospital stay (P<0.05). In the two age groups,laparoscopic malignant tumor radical surgery took less time, less bleeding and shorter anal evacuation time than laparotomy (P<0.05). Elderly laparoscopy group had less poor wound healing cases than elderly laparotomy group (P<0.05), while there was no statistical difference in other postoperative complications (P>0.05). All the patients completed the surgeries without perioperative deaths. Conclusion·Laparoscopy is safe in the diagnosis and treatment of gynecological benign and malignant diseases in elderly women with shorter operation time, less bleeding and faster postoperative recovery compared with laparotomy.
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The history of the auto biochemistry analyzer made in China was introduced.The present situation and problems of the auto biochemistry analyzer made in China were described under the conditions of new medical reform.It's pointed out developing medical equipment market in China might promote the progress of national enterprises in China.The development of medical equipment and corresponding industry depends on supervision in elementary units,support of policy and finance.
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Objective To observe the clinical efficacy ofChanhou Fujiu decoction plus acupuncture-moxibustion in preventing and treating incomplete drug abortion.Method A total of 204 patients in early-stage pregnancy asking for drug abortion were randomized into group A, group B, and group C, 68 cases in each group. Group A was given oral administration of Mifeprostone and Misoprostol tablets, plus Azithromycin dispersible tablet for prevention of infection. Group B was intervened by orally takingChanhou Fujiu decoction in addition to the treatment given to group A. Group C was intervened by acupuncture-moxibustion therapy based on the treatment given to group B. The vaginal bleeding time and amount, and the recovery of menstruation in the three groups were observed after the intervention, and the clinical efficacies were compared.Result Compared with group A, the vaginal bleeding amount after drug abortion was significantly smaller (P<0.05), the bleeding duration were significantly shorter (P<0.05), and time taken for the recovery of menstruation was markedly shorter (P<0.05) in group B and C, and there were no significant abnormal conditions in the menstrual periods (P>0.05). Compared with group B, group C had significantly smaller amount of vaginal bleeding (P<0.05) and shorter duration of vaginal bleeding (P<0.05), and there were no significant abnormal conditions in the time taken for the recovery of menstruation and menstrual periods (P>0.05). The total effective rate was 75.0％ in group B and 95.6％ in group C, both significantly higher than 58.8％ in group A (P<0.05), and the total effective rate in group C was markedly higher than that in group B (P<0.05). Conclusion Chanhou Fuyuan decoction plus acupuncture-moxibustion can effectively prevent and treat complications of drug abortion, and is an effective method in preventing and treating incomplete drug abortion.
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The history of the auto biochemistry analyzer made in China was introduced.The present situation and problems of the auto biochemistry analyzer made in China were described under the conditions of new medical reform.It's pointed out developing medical equipment market in China might promote the progress of national enterprises in China.The development of medical equipment and corresponding industry depends on supervision in elementary units,support of policy and finance.