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Objective: To explore the clinical characteristics of various types of infected pancreatic necrosis(IPN) and the prognosis of different treatment methods in the imaging classification of IPN proposed. Methods: The clinical data of 126 patients with IPN admitted to the Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from December 2018 to December 2021 were analyzed retrospectively. There were 70 males(55.6%) and 56 females(44.4%), with age(M(IQR)) of 44(17)years (range: 12 to 87 years). There were 67 cases(53.2%) of severe acute pancreatitis and 59 cases (46.8%) of moderately severe acute pancreatitis. All cases were based on the diagnostic criteria of IPN. All cases were divided into Type Ⅰ(central IPN)(n=21), Type Ⅱ(peripheral IPN)(n=23), Type Ⅲ(mixed IPN)(n=74) and Type Ⅳ(isolated IPN)(n=8) according to the different sites of infection and necrosis on CT.According to different treatment strategies,they were divided into Step-up group(n=109) and Step-jump group(n=17). The clinical indicators and prognosis of each group were observed and analyzed by ANOVA,t-test,χ2 test or Fisher exact test,respectively. Results: There was no significant difference in mortality, complication rate and complication grade in each type of IPN(all P>0.05). Compared with other types of patients, the length of stay (69(40)days vs. 19(19)days) and hospitalization expenses(323 000(419 000)yuan vs. 60 000(78 000)yuan) were significantly increased in Type Ⅳ IPN(Z=-4.041, -3.972; both P<0.01). The incidence of postoperative residual infection of Type Ⅳ IPN was significantly higher than that of other types (χ2=16.350,P<0.01). There was no significant difference in the mortality of patients with different types of IPN between different treatment groups. The length of stay and hospitalization expenses of patients in the Step-up group were significantly less than those in the Step-jump group(19(20)days vs. 33(35)days, Z=-2.052, P=0.040;59 000(80 000)yuan vs. 122 000(109 000)yuan,Z=-2.317,P=0.020). Among the patients in Type Ⅳ IPN, the hospitalization expenses of Step-up group was significantly higher than that of Step-jump group(330 000(578 000)yuan vs. 141 000 yuan,Z=-2.000,P=0.046). The incidence of postoperative residual infection of Step-up group(17.4%(19/109)) was significantly lower than that of Step-jump group(10/17)(χ2=11.980, P=0.001). Conclusions: Type Ⅳ IPN is more serious than the other three types. It causes longer length of stay and more hospitalization expenses. The step-up approach is safe and effective in the treatment of IPN. However, for infected lesions which are deep in place,difficult to reach by conventional drainage methods, or mainly exhibit "dry necrosis", choosing the step-jump approach is a more positive choice.
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Male , Female , Humans , Retrospective Studies , Pancreatitis, Acute Necrotizing/complications , Acute Disease , Intraabdominal Infections/complications , Necrosis/complications , Treatment OutcomeABSTRACT
Objective:To compare the safety and efficacy of the " step-up approach" versus the " step-jump approach" in treatment of infected pancreatic necrosis (IPN).Method:The clinical data of IPN patients who underwent step-up strategy or step-jump strategy treatment at the Department of Pancreatic and Biliary Surgery of the First Affiliated Hospital of Harbin Medical University from December 2018 to November 2022 were analyzed retrospectively. Propensity score matching (PSM) was done based on the nearest neighbor matching method (1: 1 ratio). After matching the baseline data (the caliper value was 0.01), a total of 62 patients with IPN were included, including 41 males and 21 females, aged (41.1±13.1) years old. Patients who were treated with the step-up strategy were included in the step-up group, while patients who were treated with the step-jump strategy were included in the step-jump group. There were 31 patients in each group after PSM, and the treatment effect of the two groups were compared.Results:Of the 62 patients with IPN, 43 received surgical intervention, and 19 were managed successfully using symptomatic anti-inflammatory treatment or percutaneous catheter drainage. The total hospitalization cost of patients in the step-jump group was significantly higher than that in the step-up group [122 000 (73 000, 179 000) yuan vs. 88 000 (46 000, 144 000) yuan, P=0.034]. The overall cure rate of IPN patients in the step-jump group was 93.5%(29/31). The 2 patients who died had type Ⅲ IPN. In the IPN patients in the step-up group were all cured, and the overall cure rate was 100%(31/31), with no death. There were no statistical differences between the two groups in the rates of death, postoperative complications, residual infection, debridement ≥2 times, and positive bacterial culture in blood or drainage fluid (all P>0.05). A total of 19.4% (12/62) patients had postoperative complications, including 4 patients with abdominal bleeding, 3 patients with new organ dysfunction, 2 patients with gastrointestinal bleeding, 2 patients with gastrointestinal fistula, and 1 patient with venous thrombosis in both lower limbs. Conclusion:Both the step-up treatment strategy and the step-jump treatment strategy were safe and effective for treatment of IPN patients.
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Objective To summarize the clinical characteristics of autoimmune pancreatitis (AIP) and discuss the role and significance of surgical intervention in the treatment of AIP.Methods The clinical data of 11 patients with preoperative confirmed AIP and 8 patients with preoperative suspected AIP receiving surgical intervention at the First Affiliated Hospital of Harbin Medical University from 2011 to 2017 were retrospectively analyzed.Results Among 11 preoperatively confirmed AIP patients,9 (47.4％) underwent endoscopic retrograde cholangiopancreatography (ERCP) with nasal bile duct implantation or biliary stent drainage,and 2 (10.5％)underwent choledochojejunostomy.Among 8 putative AIP patients in which a cancer was suspected 4 (21.1％) underwent choledochojejunostomy,3 (15.8％) did pancreaticoduodenectomy,and 1 (5.3％) had distal pancreatectomy plus splenectomy.Postoperative pathology confirmed pancreatic cancer in 3 cases,IPMN in 1 case.Conclusions While autoimmune pancreatitis is IgG4 related disease,surgical intervention is indicated when there is poor response to drug treatment or when a cancer is to be ruled out.
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Objective@#To summarize the experience of treatment for blunt pancreatic trauma.@*Methods@#The clinical data of 52 patients with blunt pancreatic trauma admitted to the Department of Pancreatic and Biliary Surgery of the First Affiliated Hospital of Harbin Medical University from January 2013 to June 2018 were analyzed retrospectively.There were 40 male and 12 female patients, aging from 12 to 112 years with a median age of 35.5 years.According to the organ injury scale by American Association for the Surgery of Trauma(AAST) for pancreatic injury severity, 15 cases were in grade Ⅰ(28.8%), 20 cases were in grade Ⅱ(38.5%), 10 cases were in grade Ⅲ(19.2%),5 cases were in grade Ⅳ(9.6%) and 2 cases were in grade Ⅴ(3.8%). Isolated blunt pancreatic trauma occurred in 11(21.2%) patients including 5 cases of grade Ⅰ,5 cases of grade Ⅱ and 1 case of grade Ⅲ, and associated injuries existed in 41 patients(78.8%).@*Results@#Among 52 patients, 36 patients(69.2%) were transferred from other hospitals and 16(30.8%) patients were admitted through the emergency department. Finally, 49 patients(94.2%) were cured and 3 patients (5.8%) died.For the 15 cases of grade Ⅰ,9 patients were managed non-operatively, 5 cases underwent peritoneal lavage and drainage after surgery for the other injured abdominal organs, and 1 patient received percutaneous catheter drainage(PCD) with non-operative treatment. For the 20 cases of grade Ⅱ,4 cases only received non-operative treatment and 2 cases also received PCD. Besides, 2 cases underwent debridement and drainage for peripancreatic necrotic tissue and external drainage for pancreatic pseudocyst retrospectively after about 25 days of getting injured. As for patients who received exploratory laparotomy, 5 patients underwent suture repair associated with external drainage, and 7 patients were managed only with external drainage. For the 10 cases of grade Ⅲ,6 patients were cured through distal pancreatectomy and splenectomy with external drainage, while 2 patients underwent endoscopic retrograde cholangiopancreatography and ductal stenting, and the other 2 patients just received debridement and drainage for peripancreatic necrotic tissue.For the 5 cases of grade Ⅳ,2 patients underwent jejunostomy and abdominal cavity drainage, 1 patient had a pancreaticoduodenectomy with drainage,1 patient received suture repair of the pancreas and pancreaticojejunostomy, and 1 patient was managed with suture repair of the head of pancreas and external drainage.For the 2 patients of grade Ⅴ,1 patient received exploratory laparotomy and gauze compression packing hemostasis, and the other patient underwent pancreaticoduodenal repair, gastrointestinal anastomosis, duodenal exclusion surgery and external drainage.@*Conclusion@#According to the AAST classifications, associated injuries, physiological status and intraoperative situation, it could be better to make a comprehensive judgment, achieve early diagnosis and take appropriate individualized treatment strategy, and to improve the overall therapeutic effect for blunt pancreatic trauma.
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Objective@#To investigate the prognostic factors of multi-drug resistant organism (MDRO) infection in patients with infected pancreatic necrosis(IPN).@*Methods@#A retrospective study was performed to assess the MDRO in IPN patients. The clinical data of 104 IPN patients admitted to the Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from June 2013 to January 2019 were analyzed. Fifty-six patients were allocated in the MDRO group and 48 patients in the non-MDRO group depended on drug sensitivity test. There were 37 males and 19 females in the MDRO group with age of 40 (23) years. The duration time was 3(5) days between onset and admission. In the non-MDRO group, 34 males and 14 females were included with age of (42±14) years. The duration time was 3(4) days between onset and admission. Normally distributed quantitative variables was represented by ±s, non-normally distributed quantitative variables was represented by M(QR). Wilcoxon rank-sum test and χ2 test were used to analyze the data. Univariate and multivariable Logistic regression analytic model were used to figure out the risk factors associated with MDRO infection.@*Results@#The mean duration of hospital stay was 29.5(31.8) days and hospitalization expenses were CNY 166 991(270 692), which were much higher than those in non-MDRO group (16.5(15.7) days, CNY 56 789(62 354)) (W=1 889, 2 019, both P<0.01). Gram-negative isolates(67.2%, 80/119) were commonly detected in IPN patients.Acinetobacter baumannii was the most common MDRO(27.0%,20/74). Initial use of carbapenem(OR=2.22, 95%CI: 1.02-4.96, P=0.047) and open necrosectomy(OR=10.00, 95%CI: 3.14-44.77, P<0.01) were the potential risk factors for MDRO-induced infections in IPN. Furthermore, the Logistic regression analysis revealed that open necrosectomy was the independent variable for MDRO infections(OR=9.42, 95%CI: 2.92-42.42, P<0.01).@*Conclusion@#Open necrosectomy is the independent risk factor for the infection of MDRO.
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OBJECTIVE To varify the difference of serum specific IgE levels in different ages and gender inpatients with Aspergillus fumigatus or Alternaria alternate induced allergic rhinitis. METHODS In this study, 85 patients with Aspergillus fumigatus or Alternaria alternate induced allergic rhinitis were included. sIgE tests was done by Immuno CAP 250TM System(Thermo Fisher Scientific, Uppsala, Sweden). RESULTS Mean level of aspergillus fumigatus sIgE was significantly lower than Alternaria alternate(P<0.05), single or dual fungi allergy show no impact on this difference. sIgE level showed positive correlation with age in Aspergillus fumigatus group(P <0.05), while negative in Alternaria alternate group(P <0.05). CONCLUSION Aspergillus fumigatus and Alternaria alternate are mostly common fungi allergens, sIgE detection of those two fungi are important for diagnosis of fungi induced allergic rhinitis and other respiratory diseases in people with different ages.
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Objective@#To investigate the safety and efficiency of small incision minimally invasive approach pancreatic necrosectomy in the treatment of infected pancreatic necrosis.@*Methods@#The data of 164 patients who underwent small incision minimally invasive approach pancreatic necrosectomy for infected pancreatic necrosis at Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from January 2012 to December 2016 were analyzed retrospectively.Among 164 patients, there were 102 male and 62 female patients.The median age was 46 years(ranging from 19 to 79 years). One hundred and one patients(61.6%) suffered from severe acute pancreatitis and 63 patients(38.4%) suffered from moderately severe acute pancreatitis.Following step-up approach principle, the surgical procedures were performed for 131 patients(79.9%) who suffered from sepsis which could not be alleviated via percutaneous catheter drainage(PCD). The other 33 patients(20.1%) who did not undergo PCD directly took small incision minimally invasive approach pancreatic necrosectomy.Preoperative CT images were used to determine the location of the lesion.The PCD puncture points or the points where the abscess was closest to the skin were chosen as the incision.Gradually, the small incision minimally invasive approach pancreatic necrosectomy were performed via cutting all layers into the abscess.@*Results@#The median time from the onset of symptom to first operation was 32 days(ranging from 23 to 45 days). The average hospital stay was 46 days(ranging from 29 to 103 days). The average number of drainage tubes placed was 4 pieces(ranging from 2 to 8 pieces). Ninety-two patients(56.0%) underwent minimal access retroperitoneal pancreatic necrosectomy. Thirty-six patients(22.0%) underwent minimal invasive approach lesser omentum sac pancreatic necrosectomy.Thirty-six patients(22.0%) underwent minimal invasive approach lesser omentum sac pancreatic necrosectomy combined with minimal access retroperitoneal pancreatic necrosectomy.A total of 148 cases(90.2%) were cured via minimally invasive approach pancreatic necrosectomy, 8 cases(4.9%) were cured after transfering to open pancreatic necrosectomy.The cure rate was 95.1%(156/164). The mainly postoperative complications included pancreatic fistula(25 cases), intra-abdominal hemorrhage(10 cases), gastric fistula (2 cases), duodenal fistula(4 cases) and colonic fistula(3 cases). The overall incidence rate of complications was 26.8%(44/164). Eight cases were dead after surgery and the in-hospital mortality was 4.9%(8/164).@*Conclusion@#In summary, small incision minimally invasive approach pancreatic necrosectomy is an effective way to clean up necrotic tissue, improve the drainage, reduce complications in dealing with infected pancreatic necrosis.
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The retroperitoneum space comprises anterior pararenal space, perirenal space and posterior pararenal space. Pancreas is a retroperitoneal organ and located in the anterior pararenal space of the retroperitoneum. Left and right sides anterior pararenal space are potentially communicated, which contains many adipose tissues and a little connective tissues. The exacerbation of acute pancreatitis results in the lesion spreading into adjacent area of pancreas in the retroperitoneal space. In addition, the lesion could spread into bare area of stomach, posterior colonic region, subperitoneal space and pelvic retroperitoneal space through the same anatomical space or communicating space. Due to the fascia destruction by pancreatic enzymes or the lesion directly diffuse through the weak fascia, the lesion could also diffuse across fascia to perirenal space, posterior pararenal space, the peritoneal cavity and abdominal wall. Finally, a series of complications are developed. The diffusion paths of acute pancreatitis are complex and diverse. Familiarity with these diffusion paths is useful for determining the severity and guiding therapy.
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The longitudinal study sought to examine the dynamic development of cognitive skills for reading among elementary-level students in Mainland China.Two groups of students in first (n=164,mean age=6.65 years at first test) and second grade (n=202,mean age=7.73 years at first test) were followed on orthographic awareness,morphological awareness and rapid automatized naming (RAN) for two years.The children exhibited significant improvement in orthographic awareness,morphological awareness and RAN from grades 1 to 4.More importantly,to the orthographic and morphological awareness,while the children took a leap from grade 1 to 2 and grade 3 to 4,the progress developed at relatively slow rates from grade 2 to 3.In order to assure children's development of orthographic and morphological awareness,evidence-based orthographically and morphologically enhanced instruction is needed for Chinese children in the early elementary years,especially for those at the stage from grade 2 to 3.
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The longitudinal study sought to examine the dynamic development of cognitive skills for reading among elementary-level students in Mainland China.Two groups of students in first (n=164,mean age=6.65 years at first test) and second grade (n=202,mean age=7.73 years at first test) were followed on orthographic awareness,morphological awareness and rapid automatized naming (RAN) for two years.The children exhibited significant improvement in orthographic awareness,morphological awareness and RAN from grades 1 to 4.More importantly,to the orthographic and morphological awareness,while the children took a leap from grade 1 to 2 and grade 3 to 4,the progress developed at relatively slow rates from grade 2 to 3.In order to assure children's development of orthographic and morphological awareness,evidence-based orthographically and morphologically enhanced instruction is needed for Chinese children in the early elementary years,especially for those at the stage from grade 2 to 3.
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Objective To investigate the clinical efficacy of total pancreatectomy (TP) tor pancreatic cancer.Methods The retrospective descriptive study was conducted.The clinicopathological data of 11 patients who underwent TP for pancreatic cancer in the First Affiliated Hospital of Harbin Medical University from March 2009 to January 2016 were collected.Patients received planned TP or unplanned TP and digestive tract reconstruction using biliojejunal end-to-side anastomosis and side-to-side gastrojejunostomy.Observation indicators included:(1) treatment situations;(2) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect the level of fasting blood glucose,glycosylated hemoglobin,dosages of insulin and pancreatic enzymes,symptoms of emaciation and diarrhea and patients' prognosis up to November 2016.Measurement data were represented as (x)±s,average (range) and M (range).Results (1) Treatment situations:all the 11 patients underwent successful TP,including 4 undergoing planned TP due to pancreatic multiple spaceoccupying lesions by preoperative imaging examination and 7 undergoing unplanned TP.Two patients received partial resection of the superior mesenteric vein and artificial vascular replacement due to tumor invading superior mesenteric vein.Two patients without cholangiectasis received external drainage through intraoperative biliary stent placement,and drainage tube was removed at month 1 postoperatively.Operation time was 270-640 minutes,with an average of 450 minutes.Volume of intraoperative blood loss was 200-1 500 mL,with an average of 564 mL.Five patients had intraoperative blood transfusion,with volume of 400-1 600 mL.Results of postoperative pathological examination of 11 patients:R0 and R1 resection were respectively detected in 10 and 1 patients;4 and 7 patients were in stage Ⅱ A and Ⅱ B,showing pancreatic ductal adenocarcinoma.Number of lymph node dissected with an average of 17.2±2.3 per case.Seven patients were complicated with local lymph node metastases,with a number of 2.1 per case.Three of 11 patients received postoperative 6-cycle chemotherapy regimens of gemcitabine and cisplatin.Four patients with postoperative complications were improved by conservative treatment,including 2 with infection,1 with bile leakage and 1 with delayed gastric emptying,without death.Duration of hospital stay was 15-56 days,with an average of 24 days.(2) Follow-up situation:11 patients were followed up for 5-24 months.During follow-up,levels of fasting blood glucose and glycosylated hemoglobin were respectively 5.0-10.0 mmol/L and 5.4％-10.4％,with averages of 7.6 mmol/L and 7.5％.Dosages of insulin and pancreatic enzymes were respectively 18.0-28.0 U/d and 450-900 mg/d,with averages of 22.7 U/d and 640 mg/d.During follow-up,4,5 and 2 patients had respectively increased,normal and decreased appetites.Three,4 and 4 patients had respectively increased,unchanged and decreased body weights.Symptoms of diarrhea,fatty liver (outpatient reexamination) and hypoglycemia were occurred in 2,2 and 1 patients,respectively.Of 11 patients,2 had tumorfree survival,and 9 had survival with tumor,with a median survival time of 12 months (range,5-23 months),including 3 with abdominal metastases or recurrence,2 with liver metastases,2 with pulmonary metastases and 2 with retroperitoneal lymphatic metastasis.Conclusion TP is safe and feasible for pancreatic cancer,it can also provide better quality of life for patients under conditions of regulating blood glucose and supplying pancreatic enzyme.
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Objective To investigate the clinical efficacy of total pancreatectomy (TP) tor pancreatic cancer.Methods The retrospective descriptive study was conducted.The clinicopathological data of 11 patients who underwent TP for pancreatic cancer in the First Affiliated Hospital of Harbin Medical University from March 2009 to January 2016 were collected.Patients received planned TP or unplanned TP and digestive tract reconstruction using biliojejunal end-to-side anastomosis and side-to-side gastrojejunostomy.Observation indicators included:(1) treatment situations;(2) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect the level of fasting blood glucose,glycosylated hemoglobin,dosages of insulin and pancreatic enzymes,symptoms of emaciation and diarrhea and patients' prognosis up to November 2016.Measurement data were represented as (x)±s,average (range) and M (range).Results (1) Treatment situations:all the 11 patients underwent successful TP,including 4 undergoing planned TP due to pancreatic multiple spaceoccupying lesions by preoperative imaging examination and 7 undergoing unplanned TP.Two patients received partial resection of the superior mesenteric vein and artificial vascular replacement due to tumor invading superior mesenteric vein.Two patients without cholangiectasis received external drainage through intraoperative biliary stent placement,and drainage tube was removed at month 1 postoperatively.Operation time was 270-640 minutes,with an average of 450 minutes.Volume of intraoperative blood loss was 200-1 500 mL,with an average of 564 mL.Five patients had intraoperative blood transfusion,with volume of 400-1 600 mL.Results of postoperative pathological examination of 11 patients:R0 and R1 resection were respectively detected in 10 and 1 patients;4 and 7 patients were in stage Ⅱ A and Ⅱ B,showing pancreatic ductal adenocarcinoma.Number of lymph node dissected with an average of 17.2±2.3 per case.Seven patients were complicated with local lymph node metastases,with a number of 2.1 per case.Three of 11 patients received postoperative 6-cycle chemotherapy regimens of gemcitabine and cisplatin.Four patients with postoperative complications were improved by conservative treatment,including 2 with infection,1 with bile leakage and 1 with delayed gastric emptying,without death.Duration of hospital stay was 15-56 days,with an average of 24 days.(2) Follow-up situation:11 patients were followed up for 5-24 months.During follow-up,levels of fasting blood glucose and glycosylated hemoglobin were respectively 5.0-10.0 mmol/L and 5.4％-10.4％,with averages of 7.6 mmol/L and 7.5％.Dosages of insulin and pancreatic enzymes were respectively 18.0-28.0 U/d and 450-900 mg/d,with averages of 22.7 U/d and 640 mg/d.During follow-up,4,5 and 2 patients had respectively increased,normal and decreased appetites.Three,4 and 4 patients had respectively increased,unchanged and decreased body weights.Symptoms of diarrhea,fatty liver (outpatient reexamination) and hypoglycemia were occurred in 2,2 and 1 patients,respectively.Of 11 patients,2 had tumorfree survival,and 9 had survival with tumor,with a median survival time of 12 months (range,5-23 months),including 3 with abdominal metastases or recurrence,2 with liver metastases,2 with pulmonary metastases and 2 with retroperitoneal lymphatic metastasis.Conclusion TP is safe and feasible for pancreatic cancer,it can also provide better quality of life for patients under conditions of regulating blood glucose and supplying pancreatic enzyme.
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OBJECTIVE:To explore the effects and safety of Hedan tablets on the levels of blood lipid,inflammatory factors and oxidative stress in coronary heart disease(CHD)patients with type 2 diabetes mellitus(DM2). METHODS:A total of 118 pa-tients diagnosed as CHD with DM2 were collected from our hospital during Jul. 2013-Nov. 2015,and then divided into observation group(63 cases)and control group(55 cases)according to random number table. Control group received conventional treatment such as controlling blood glucose,regulating blood lipid,vasodilator,anticoagulant. Observation group additionally received He-dan tablets 1.46 g before meal,tid,on the basis of control group. Both groups received treatment for 6 months. The levels of blood lipid (TC,TG,LDL-C,HDL-C),serum inflammatory factors (TNF-α ,IL-10,IL-6,hs-CRP) and oxidative stress indexes (MDA,SOD,NO)before and after treatment as well as the occurrence of ADR were compared in 2 groups. RESULTS:Before treatment,there was no statistical significance in levels of blood lipid,serum inflammatory factors or oxidative stress indexes be-tween 2 groups(P>0.05). After treatment,the serum levels of TC,TG,LDL-C,TNF-α,IL-6,hs-CRP and MDA in 2 groups were decreased significantly,while those of IL-10,SOD and NO were increased significantly;the observation group was signifi-cantly better than the control group,with statistical significance(P0.05). CONCLUSIONS:Hedan tablets can effectively improve the level of blood lipid,reduce the lev-el of inflammatory factors,relieve inflammatory injury,reduce the level of oxygen free radical,strengthen antioxidant capacity and lighten oxidative stress injury with good safety.
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Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by high heritability. Recently, autism, the most profound form of ASD, has been increasingly attributed to synaptic abnormalities. Postsynaptic density 95 (PSD95), encoding PSD protein-95, was found essential for synaptic formation, maturation and plasticity at a PSD of excitatory synapse. It is possibly a crucial candidate gene for the pathogenesis of ASD. To identify the relationship between the rs13331 of PSD95 gene and ASD, we performed a case-control study in 212 patients and 636 controls in a Chinese population by using a polymerase chain reaction-restriction fragment length polymerase (PCR-RFLP) assay. The results showed that in genetic analysis of the heterozygous model, an association between the T allele of the rs13331 and ASD was found in the dominant model (OR=1.709, 95% CI 1.227-2.382, P=0.002) and the additive model (OR=1.409, 95% CI=1.104-1.800, P=0.006). Our data indicate that the genetic mutation C>T at the rs13331 in the PSD95 gene is strikingly associated with an increased risk of ASD.
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Objective To study the function of early persistent vacuum suction drainage in patients with high risk of pancreatic fistula after pancreaticoduodenectomy (PD).Methods From Jul.2010 to Jun.2013,the clinical data of 286 patients undergoing PD were retrospectively evaluated.87 patients with high risk of pancreatic fistula were screened and then divided into early persistent vacuum suction drainage group (the observation group) and conventional drainage group (the control group) according to postoperative drainage manners.We statistically analyzed the two groups in terms of general information,blood loss,operative time,medical expenses,hospital stay,mortality and morbidity of complications such as pancreatic fistula.Results There were 40 patients screened into the observation group and 47 patients into the control group.No difference was found between the observation group and the control group in basic clinical data or surgical data.There was no statistical difference between the two groups in delayed gastric emptying,bile leakage,bleeding or the incidence of pancreatic fistula and intra-abdominal infection.The incidence of pancreatic fistula with grade B and C in the observation group was statistically lower than that of the control group(12.5％ vs 34.0％,P＜0.05).The incidence of intraabdominal infection in observation group was statistically lower than those in the control group (20.0％ vs 40.4％,P＜0.05).The incidence of total complications in observation group was statistically lower than that in the control group (60.0％ vs 83.0％,P＜0.05),but no difference was found between the observation group and control group in morality.Early persistent vacuum suction drainage could reduce hospital stay((21.93±7.14) days vs (28.70±12.45) days,P＜0.05) and clinical expense ((64.8±12.0) thousands vs (75.2± 14.6) thousands,P＜0.05) in patients with high risk of pancreatic fistula after PD.Conclusions Early persistent vacuum suction drainage can reduce the rate of grade B and C pancreatic fistula in patients with high risk of pancreatic fistula undergoing PD.The manner can also reduce the incidence of intra-abdominal infection,total complications and cost of hospital stay.This manner can accelerate postoperative recovery of patients undergoing PD and is worth of widely used.
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Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by high heritability. Recently, autism, the most profound form of ASD, has been increasingly attributed to synaptic abnormalities. Postsynaptic density 95 (PSD95), encoding PSD protein-95, was found essential for synaptic formation, maturation and plasticity at a PSD of excitatory synapse. It is possibly a crucial candidate gene for the pathogenesis of ASD. To identify the relationship between the rs13331 of PSD95 gene and ASD, we performed a case-control study in 212 patients and 636 controls in a Chinese population by using a polymerase chain reaction-restriction fragment length polymerase (PCR-RFLP) assay. The results showed that in genetic analysis of the heterozygous model, an association between the T allele of the rs13331 and ASD was found in the dominant model (OR=1.709, 95% CI 1.227-2.382, P=0.002) and the additive model (OR=1.409, 95% CI=1.104-1.800, P=0.006). Our data indicate that the genetic mutation C>T at the rs13331 in the PSD95 gene is strikingly associated with an increased risk of ASD.
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Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Autism Spectrum Disorder , Genetics , Case-Control Studies , China , Disks Large Homolog 4 Protein , Intracellular Signaling Peptides and Proteins , Genetics , Membrane Proteins , Genetics , Polymorphism, Restriction Fragment Length , Polymorphism, Single NucleotideABSTRACT
<p><b>OBJECTIVE</b>To investigate the effect of utilizing octreotide during perioperative period on pancreatic fistula after pancreaticoduodenectomy (PD).</p><p><b>METHODS</b>Three hundreds and six patients admitted from January 2010 to October 2014, who prepared to undergo pancreaticoduodenectomy (PD) were randomly divided into octreotide group (147 cases) and control group (159 cases). In octreotide group, octreotide was used in subcutaneous injection instantly after PD, each 8 hours until postoperative 10(th) day, and patients in control group were injected with the same volume of saline. Differences of pancreatic fistula (Grade A, Grade B, Grade C), hospitalization days and treatment cost were compared. χ(2) test, t-test and Fisher exact test were used to analyzed to the data, respectively.</p><p><b>RESULTS</b>No statistical significance (P>0.05) between two groups in the incidence of pancreatic fistula after PD (Grade A: 8.8% vs. 10.2%, Grade B: 2.7% vs. 4.4%, Grade C: 0.7% vs. 1.3%; χ(2)=0.197, 0.700, 0.288; P=0.657, 0.403, 0.591), the length of hospitalization((12.1±1.2)days vs. (13.0±1.2)days)(t=1.711, P=0.104) and treatment cost (79 700±6 700 vs. 77 600±5 200)(t=1.378, P=0.185). When accompanied with high risk factors, such as soft texture of pancreas, pancreatic duct size less than 3 mm, BMI≥25 kg/m(2) and diabetes, compared with control group, octreotide group had the lower incidence rate of pancreatic fistula and clinical correlative pancreatic fistula(all P<0.05) after PD.</p><p><b>CONCLUSIONS</b>Generally, octreotide makes no contribution to reduce the incidence of pancreatic fistula after PD. However, for patients who is accompanied with high risk factors, such as soft texture of pancreas, pancreatic duct size less than 3 mm, BMI≥25 kg/m(2) and diabetes, octreotide can effectively prevent pancreatic fistula after PD.</p>
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Humans , Anastomosis, Surgical , Incidence , Octreotide , Therapeutic Uses , Pancreas , Pathology , Pancreatectomy , Pancreatic Ducts , Pathology , Pancreatic Fistula , Drug Therapy , Pancreaticoduodenectomy , Perioperative Period , Prospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To analyze the diagnostic value of CD64index of neutrophils for patients with leukemia combined with early infection.</p><p><b>METHODS</b>From June 2014 to June 2015, 100 AL patients admitted in Third People's Hospital of Qinghai province were chosen as AL group, among them 50 AL patients were in infection group and other 50 patients were in non-infection group; at the same time, 200 healthy people were chosen as control group. The sensitivity, specificity and Youden's index of PCT, CRP, Neu% and CD64index in 300 subjects were calculated, and the diagnostic value of different indicators were compared.</p><p><b>RESULTS</b>In 100 AL patients, the sensitivitys of CD64, Neu%, PCT and CRP were respectively 88.00%, 82.00%, 74.00% and 70.00%; their spesitivitys were respectively 80.00%, 78.00%, 82.00% and 84.00%; their Youden's indexex of were respectively 0.68, 0.60, 0.56 and 0.54.</p><p><b>CONCLUSION</b>CD64index of neutrophils has diagnostic value for patients with leukemia combined with early infection.</p>
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Developmental dyslexia in children is one of the neurodevelopmental disorders and is affected by various susceptible genes. In recent years, researchers have found some susceptible genes for dyslexia via chromosome analysis, genome-wide association studies, association analysis, gene function research, neuroimaging, and neurophysiological techniques. This article reviews the research advances in susceptible genes for developmental dyslexia, and with the study on susceptible genes for dyslexia, it lays a foundation for in-depth studies on the "gene-brain-behavior" level and provides scientific clues for exploring etiology and pathogenesis of dyslexia.
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Child , Humans , Dyslexia , Genetics , Forkhead Transcription Factors , Genetics , Genetic Predisposition to Disease , Microtubule-Associated Proteins , Genetics , Nerve Tissue Proteins , Genetics , Nuclear Proteins , Genetics , Receptors, Immunologic , GeneticsABSTRACT
Objective To investigate the mechanism of recurrent laryngeal nerve injury during total thyroidectomy.Methods The clinical data of 36 patients suffering from recurrent laryngeal nerve injury in total thyroidectomy from 2003 to 2014 was analyzed retrospectively.Results 21 cases had temporary recurrent laryngeal nerve injury while 16 cases had permanent injury.The cases of injury included giant thyroid goitre,with variation of recurrent laryngeal nerve,undergoing secondary surgery,with tumor invasion and complicating thyroiditis.During the first surgery,the incidence of temporary recurrent laryngeal nerve injury was 0.43％,and the incidence of permanent damage was 0.27％.The temporary and permanent injury incidence of secondary surgery after initial subtotal thyroidectomy was 4.59％ and 4.59％,respectively.For patients with grade 3 thyroid gland,that was 1.81％ and 0.30％,respectively and 0.51％,0.72％ respectively in malignant cases.In cases complicating thyroiditis temporary recurrent laryngeal nerve injury occurred in 1.01％.Conclusions There is increased risk of recurrent laryngeal nerve injury in giant goiter cases undergoing secondary operations.Hence it is suggested that initial surgical procedure be hemithyroidectomy or total thyroidectomy