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【Objective】 To introduce a modified microdot two-layer microsurgical vasovasostomy (MVV) and to analyze its effectiveness in patients with vas deferens obstruction caused by inguinal herniorrhaphy. 【Methods】 Clinical data of patients treated during Mar.2015 and Oct.2020 were retrospectively analyzed. According to different surgical methods, the patients were divided into the modified group and traditional group. The general data, intraoperative conditions, efficacies and complications of the two groups were compared. 【Results】 There were 59 cases in the modified group, 54(91.5%) of whom were successfully followed up, and 41 cases in the traditional group, 38(92.7%) of whom were successfully followed up. There were no significant differences in age, inguinal herniorrhaphy history, and unilateral/bilateral ratio between the two groups (P>0.05). The average operation time for unilateral lesions in the modified group was shorter than that in the traditional group [(89.44±24.86) vs. (112.04±43.40) min, P=0.032]. The postoperative patency rate (83.3% vs.73.7%, P>0.05) and natural pregnancy rate (33.3% vs.28.9%, P>0.05) of the modified group and traditional group were comparable. Incision fat liquefaction occurred in 2 cases (3.70%) in the modified group and in 1 case (2.63%) in the traditional group (P>0.05). 【Conclusion】 The modified microdot two-layer MVV is a safe surgical method with comparable effectiveness as the traditional approach. By adjusting the position of the marking points and the order of suturing, it helps the management of sutures, reduces the difficulty of vasovasostomy, shortens operation time, and can be applied to repair vas deferens obstruction caused by inguinal herniorrhaphy.
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【Objective】 To explore a new treatment of primary bilateral macronodular adrenal hyperplasia (PBMAH) and its efficacy. 【Methods】 Clinical data of 20 PBMAH patients treated in our hospital during Mar.2010 and Apr.2021 were retrospectively analyzed. All patients underwent laparoscopic subcutaneous displacement of vascularized adrenal. The clinical symptoms, plasma free cortisol, adrenocorticotrophic hormone (ACTH), and 24 h urinary free cortisol were regularly monitored after surgery. 【Results】 Of all 20 patients, 19 were followed up for 18 to 120 months (median 60 months). Three months after surgery, reexamination showed 1 patient had decreased plasma free cortisol and increased ACTH, but had no symptoms of low corticosteroids. After another 3 months, the plasma free cortisol and ACTH returned to normal. After 4 to 48 months, the parameters recovered in all patients and the clinical symptoms disappeared. 【Conclusion】 Laparoscopic vascularized adrenal displacement is a new and effective method for the treatment of PBMAH. It can alleviate the Cushing syndrome with no obvious adverse reactions.
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Objective:To investigate the effect of autologous costal cartilage cortex as nasal tip support and modified graft for nasal tip contour improvement.Methods:From June 2020 to June 2021, 116 patients (male 26, female 90, aged 20-45 years) who received rhinoplasty in the cosmetic surgery department of Myoung Beaucare Clinic of Beijing, were examined the costal cartilage by CT, and the costal cartilage was cut. The costal cartilage cortex was made into " strip" and " cap" grafts to shape the nasal tip, and the nasal dorsum was raised by polytetrafluoroethylene or silicone prosthesis for comprehensive rhinoplasty.Results:A total of 116 patients were followed up for an average of 11.7 months. After the operation, there was no space occupying in the nasal cavity, no graft protrusion, no obvious foreign body feeling in the nasal valve, and the nasal tip could swing left and right. At the same time, the nasal tip showed obvious signs, the lower lobule was full, and there were no complications such as cartilage appearance, exposure, infection, etc. Due to the untreated deviation of nasal septum, 3 cases had deviation of nasal columella and asymmetric nostrils. The shape of nasal tip was stable in the remaining 113 cases, and satisfactory results were obtained.Conclusions:By using autologous costal cartilage cortex as nasal tip support and modification graft for nasal tip contour improvement, the shaped nasal tip is soft and movable, and does not affect the airway. It is a good surgical technique in nasal tip plastic surgery, which is worthy of clinical application.
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Objective:To explore the application of nasal aesthetic polygon theory in the reconstruction of new domes on nasal tip with autogenous costal cartilage.Methods:From June 2019 to June 2021, 116 patients (26 males and 90 females) received rhinoplasty, CT-assisted examination of the costal cartilage, nasal bone and nasal cartilage was performed, and the autogenous costal cartilaginous cortex was used to make dome reconstruction grafts that were transplanted to the original alar cartilage and partially fixed to the original nasal septum cartilage to form a satisfactory and natural nasal shape.Results:All the patients were followed up for 6-24 months. No cartilaginous, overrotated or underrotated appearance was found in nasal tip. The shape of nasal tip was clear and good, with an obvious performance point and full lower lobule. The nose was tall and straight, and looked natural and beautiful in three dimensions.Conclusions:The nasal aesthetic polygon theory is used to guide the reconstruction of new domes with autogenous costal cartilage in nasal tip surgery. Compared to the cap and shield grafts, the nasal tip is more close to the normal anatomical structure, the shape and texture are more similiar to the natural state and the nasal tip is softer by using autogenous costal cartilage, and so it is an ideal surgical procedure for nasal tip reconstruction.
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Objective To screen the targets of traditional Chinese medicine-derived potential plant molluscicides based on network pharmacology and explore the mechanisms of molluscicidal actions. Methods The traditional Chinese medicines with molluscicidal actions were screened based on retrospective literature reviews, and their molluscicidal efficiency was summarized. The active ingredients and potential targets of traditional Chinese medicines were captured from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform, Unified Protein Database and literature mining using network pharmacology. The drug-active ingredient-target network was created using the software Cytoscape 3.7.2, and the key targets were subjected to Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis using the Metascape software. Results A total of 27 types of snail control drugs derived from traditional Chinese medicines were screened from publications and classified into 14 categories. Network pharmacology identified 190 active ingredients, and the active ingredients with a high degree in the drug-active ingredient-target network included quercetin, linoleyl acetate, luteolin, beta-carotene, (24S)-ethylcholesta-5,22,25-trans-3beta-ol, fumarine and arctiin, with 181 corresponding potential targets screened. KEGG pathway enrichment analysis revealed that these targets were mainly located in 16 pathways, including the neuroactive ligand-receptor interactions, regulation of adipocyte lipolysis and adrenergic signal in myocardial cells. Conclusions This study preliminarily demonstrates the multi-ingredient, multi-target and multi-pathway mechanisms of action of 27 molluscicides. The screened key ingredient may provide the basis for isolation, purification and pharmacological studies of molluscicides, and the screened key targets and key pathways may facilitate the illustration of mechanisms of actions of traditional Chinese medicine-derived molluscicides and development of novel green molluscicides.
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The purpose of this study was to investigate the effect of isorhyncophylline on hippocampal endogenous metabolites in spontaneously hypertensive rats (SHR) by 1H NMR metabolomics and molecular docking. Twelve SHR were randomly divided into a model group and a treatment group. Six Wistar-Kyoto rats were selected as a control group. The rats in the treatment group were administered isorhyncophylline (0.3 mg·kg-1) while the rats in the other two groups were treated with the same amount of sterilized saline solution. Animal experiment was authorized by the Ethics Committee of Shandong University of Traditional Chinese Medicine (No. SDUTCM20210721002). Hippocampal tissues were removed after administration for 8 weeks and assayed by 1H NMR based metabolomics technology combined with a pattern recognition method to find characteristic metabolites, and the metabolic targets were retrieved from the Kyoto Encyclopedia of Genes and Genomes database. Molecular docking technology was used to evaluate binding of isorhyncophylline to the core targets. The results of a principal components analysis (PCA) and partial least squares discriminant analysis (PLS-DA) showed a clear cluster of samples among three groups. There were seven differentially altered metabolites, and glucose metabolism and glutamate metabolism were the principal related pathways. Molecular docking indicated that isorhyncophylline had good binding properties with nine key candidate target proteins. According to the above research results, isorhyncophylline can influence energy metabolism and glutamate metabolism in the hippocampus.
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Objective@#To explore relationship between screen time and myopia in children aged 11-14 years in China.@*Methods@#The data were extracted from "National Nutrition and Health Systematic Survey and Application for 0-18 Years Old Children". A total of 12 397 children aged 11-14 years old from 14 provinces and 28 districts/counties in seven regions of China were surveyed by using multi stage stratified random sampling method. Daily screen time and visual acuity information were collected through a questionnaire.@*Results@#The myopia rate of 11-14 years old children in China was 45.0%, among which the rate of girls was higher than that of boys, and the rate of urban was higher than that of rural, and it increased with age ( χ 2=178.82,79.25, 495.96 , P <0.01). The daily screen time median of 12 397 children was 40.0 minutes, with boys(40.0 min) longer than girls( 35.0 min ) and urban children(40 min) longer than rural children(33.0 min) ( χ 2=20.86，102.68， P <0.01). The myopia rate of boys ( 42.5 %) with daily screen time greater than or equal to 60 minutes was higher than that of boys (36.4%) with daily screen time less than 60 minutes, and the myopia rate of girls (55.6%) with daily screen time greater than or equal to 60 minutes was higher than that of girls (48.0%)( χ 2=23.62，34.15， P <0.01). After adjusting for age, gender, region, time of medium and high intensity physical activity, intake of sugary food and sugary beverages, daily sleep time, multivariable Logistic regression model showed that girls with daily screen time greater than or equal to 60 minutes ( OR=1.14, 95%CI =1.03-1.27) had a higher risk of myopia than those with less than 60 minutes. After adjusting for confounding factors, there was no correlation between daily screen time and the degree of myopia in boys or girls( P >0.05).@*Conclusion@#Daily screen time greater than or equal to 60 minutes may be a risk factor for myopia in girls aged 11 to 14 years old. Given the complexity of the factors that affect vision, researches are needed to examine the relationship between screen time and myopia.
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Objective:To measure and analyze the morphological parameters of nasal septal cartilage obtained by rhinoplasty in Chinese, so as to provide theoretical guidance for clinical acquisition and application of nasal septal cartilage.Methods:From March 2014 to June 2021, 732 patients were received rhinoplasty in Myoung Beaucare Clinic of Beijing-Cosmetic Surgery. During the operation, 12 mm L-shaped nasal septal cartilage scaffold was obtained from nasal septal cartilage for transplantation. Measurement of the length, width, area, maximum thickness and minimum thickness of nasal septal cartilage was performed for further analysis.Results:For nasal septal cartilage obtained from comprehensive rhinoplasty, its length was 1.2 to 3.5 cm, with an average of 2.16 cm; the width was 1 to 3 cm, with an average of 1.84 cm; the area was 1.43 to 10.5 cm 2, with an average of 4.04 cm 2, with a maximum thickness of 0.5 to 3 mm, with an average of 1.92 mm and a minimum thickness of 0.2 to 0.5 mm, with an average of 0.92 mm. Conclusions:In the comprehensive rhinoplasty of nasal septal cartilage for Chinese, the 12 mm L-shaped nasal septal cartilage scaffold is retained, and the average length, width and area of nasal septal cartilage for transplantation are 2.16 cm, 1.84 cm, 4.04 cm 2, 1.92 mm and 0.92 mm respectively.
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Objective:To investigate the intention of medical students to be vaccinated against COVID-19 and to analyze the influencing factors.Methods:A self-filled electronic questionnaire survey was conducted among medical students from a medical school in Shanghai randomly selected from June 21 to 29, 2021. The questionnaire contained items of basic information, intention for COVID-19 vaccination, awareness of COVID-19 prevention measures and awareness of COVID-19 vaccine. Logistic regression was used to analyze the influencing factors.Results:The average age of the 966 respondents was (20.4±2.9) years, and 63.6% (614/966) of them were female;23.7% (229/966) of them had family members or relatives who had participated in anti-pandemic work or volunteer service;90.6% (875/966) of the respondents expressed they were very willing or willing to be vaccinated against COVID-19. The majority of the respondents thought that “COVID-19 infection is very serious” (94.3%, 911/966), “good protection can effectively prevent COVID-19 infection” (92.4%, 893/966), and “they can fully implement all kinds of protection measures” (73.5%, 710/966). About half of the respondents (51.8%, 501/966) knew about the adverse reactions and contraindications of COVID-19 vaccine. The low protected capability (47.4%, 458/966), short duration of protection (50.6%, 489/966), and many side effects (48.7%, 470/966) were the major concerns about COVID-19 vaccine. Logistic regression analysis showed that people thought that “COVID-19 infection is very serious” ( OR=5.30, 95 %CI:2.60-10.81, P<0.001), thought that “good protection can effectively prevent COVID-19 infection” ( OR=2.46, 95 %CI:1.26-4.81, P=0.009), thought that “they can fully implement all kinds of protection measures” ( OR=2.55, 95 %CI:1.53-4.25, P<0.001) were more willing to receive COVID-19 vaccination. While those concerned about vaccine quality did the opposite ( OR=0.29, 95 %CI:0.13-0.65, P=0.003). Conclusions:Medical students have a high intention of vaccination against COVID-19. The vaccine-related knowledge quality should be emphasized in future publicity to further enhance the intention of COVID-19 vaccination.
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Objective:To investigate the surgical method and clinical outcome of using nasal septal cartilage combined with auricular cartilage for management of nasal tip shape.Methods:A clinical study was conducted from April 2014 to June 2019, in which we managed nasal tip shape with nasal septal cartilage and auricular cartilage, and these materials were used as septal extension graft, spreader graft and cap graft. In total, 622 patients (28 males, 594 females; age from 18 to 42 years, mean age 27.47 years) were assessed for eligibility.Results:The follow-up period was from 6 months to 6 years. Nasal shape of all 622 patients was improved significantly after the operation. The nasal tip was natural and round, and there were no complications such as damage of nasal septum mucosa, exposure of prosthesis and infection of surgical site. Only 12 patients were found downward rotation of nasal tip, and 610 patients achieved satisfactory aesthetic results.Conclusions:Using septal cartilage combined with auricular cartilage is a safe, effective and suitable method for management of nasal tip shape.
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Objective:To explore the risk factors of lymphatic fistula after radical gastric cancer operation.Methods:We retrospectively analyze the clinicopathological data of gastric cancer patients who underwent radical surgery from May, 2019 to May, 2020 at the Third Department of Surgery, Fourth Hospital of Hebei Medical University, and analyze the risk factors impacting postoperative lymphatic leakage,for the establishment of the risk prediction scoring model.Results:A total of 487 patients with gastric cancer underwent radical gastrectomy, of which 32 patients (6.6%) had lymphatic leakage . Multivariate logistic regression analysis showed that hypoproteinemia before surgery (95% CI: 1.222-7.357, P=0.016), the lesion is located in the cardia-fundus of the stomach (95% CI: 1.117-6.788, P=0.028),stage T3-T4 (95% CI: 1.149-25.676, P=0.033), operation time ≥4 h (95% CI: 1.469-11.480, P=0.007), combined organ resection (95% CI: 1.106-12.886, P=0.034), D2+ lymph node dissection (95% CI: 1.969-11.510, P=0.001), anemia (95% CI: 1.271-9.392, P=0.015) were an independent risk factors. Equation based on multi-factor Logistic regression: logit( P)=-9.624+1.098×X 1+1.013×X 2+1.692×X 3+1.413×X 4+1.328×X 5+1.560×X 6+1.240×X 7 was estaslished, using Hosmer. Lemeshow test detects the goodness of fit of the regression equation ( P=0.348). The area under the ROC curve was 0.856 (95% CI: 0.787-0.926, P<0.001); the probability of lymphatic leakage when scores ≥4 points was 14.1%, when scores <4 points ,the probability of leakage was 2.5%. Conclusion:A risk prediction scoring model for lymphatic leakage after radical gastrectomy, can identify patients with high risk after surgery
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Objective:To investigate the effect of early enteral nutrition in patients with severe traumatic brain injury requiring exploratory abdominal surgery.Methods:The clinical data of 104 patients with severe traumatic brain injury requiring exploratory abdominal surgery treated in the PLA Army 72th Group Military Hospital from January 2016 to December 2020 were retrospectively analyzed. Among them, 47 patients were given early enteral nutrition (24-48 hr) as the observation group, and 57 patients were given delayed enteral nutrition (>48 hr), as the control group. The levels of hemoglobin, albumin, prealbumin, total bilirubin, alanine transaminase, C-reactive protein, white blood cells, postoperative infectious complications and clinical outcomes were compared between the two groups on the 1st, 7th and 14th days after surgery.Results:On the 14th day after operation, the prealbumin level of the observation group was higher than that of the control group, and the leukocyte level of the observation group was lower than that of the control group, with statistical significance ( P=0.020, P=0.013). The hospital stay and hospitalization costs of the observation group were lower than those of the control group ( P=0.017, P=0.032). The incidence of pulmonary infection in the observation group was 10.6%, which was lower than 29.8% in the control group ( P=0.017). Conclusions:Early postoperative enteral nutrition in patients with severe traumatic brain injury requiring exploratory abdominal surgery can significantly improve the nutritional status of patients, reduce the incidence of pulmonary infection, the hospital stay and the hospitalization cost.
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Objective:To investigate the clinical value of cephalosporin combined with morinidazole in the prevention of surgical site infection (SSI) for gastrointestinal fistula.Methods:The retrospective cohort study was conducted. The clinicopathological data of 107 patients with gastrointestinal fistula who undergoing selective digestive tract reconstruction surgery in General Hospital of Eastern Theater Command from January to December 2017 were collected. There were 76 males and 31 females, aged from 18 to 79 years, with a median age of 46 years. Of 107 patients, 43 cases receiving cephalosporin for prevention of SSI were allocated into cephalosporin monotherapy group, 64 cases receiving cephalosporin combined with morinidazole were allocated into combination therapy group, respectively. Observation indicators: (1) incidence of SSI; (2) stratification; (3) pathogen culture results of SSI; (4) adverse drug reaction; (5) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect other complications of patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Results:(1) Incidence of SSI: 29 of 107 patients had postoperative SSI, including 15 cases with superficial SSI, 7 cases with deep SSI, and 7 cases with organ/space SSI. There were 18 cases of cephalosporin monotherapy group with SSI, including 7 cases with superficial SSI, 5 cases with deep SSI, and 6 cases with organ/space SSI. The above indicators were 11, 8, 2, 1 of combination therapy group, respectively. There was a significant difference in the overall SSI between the two groups ( χ2=7.925, P<0.05). There was also a significant difference in the organ/space SSI between the two groups ( P<0.05). There was no significant difference in the superficial SSI between the two groups ( χ2=0.305, P>0.05). There was no significant difference in the deep SSI between the two groups ( P>0.05). (2) Stratification: there were 10 cases and 33 cases with type Ⅱ incision and type Ⅲ incision in the 43 cases of cephalosporin monotherapy therapy group, respectively. The above indicators were 11 and 53 in the combination group, respectively. For the type Ⅱ incision, 1 patient of cephalosporin monotherapy group had SSI, and 2 cases of combination therapy group had SSI, showing no significant difference between the two groups ( P>0.05). For the type Ⅲ incision, 17 patient of cephalosporin monotherapy group had SSI, and 9 cases of combina-tion therapy group had SSI, showing a significant difference between the two groups ( χ2=11.499, P<0.05). (3) Pathogen culture results of SSI: of 29 patients with SSI, 21 were positive for bacterial culture, including 12 cases with single bacterial infection, 9 cases with mixed infection of multi-bacteria. A total of 33 strains were cultured. (4) Adverse drug reaction: there was no adverse drug reaction in the 107 patients. (5) Follow-up: 107 patients were followed up for 30 days after surgery. No complication occurred in the 107 patients. Conclusion:Cephalosporin combined with morini-dazole can be used to prevent the SSI for patients with gastrointestinal fistula.
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Chronic obstructive pulmonary disease (COPD) has become the third-leading cause of death worldwide, which is a severe economic burden to the healthcare system. Chronic bronchitis is the most common condition that contributes to COPD, both locally and systemically. Neutrophilic inflammation predominates in the COPD airway wall and lumen. Logically, repression of neutrophilia is an essential fashion to COPD treatment. However, currently available anti-neutrophilic therapies provide little benefit in COPD patients and may have serious side effects. Thus, there is an urgent need to explore an effective and safe anti-neutrophilic approach that might delay progression of the disease. Sialic acid-binding immunoglobulin-like lectin (Siglec)-9 is a member of the Siglec cell surface immunoglobulin family. It is noteworthy that Siglec-9 is highly expressed on human neutrophils and monocytes. Ligation of Siglec-9 by chemical compounds or synthetic ligands induced apoptosis and autophagic-like cell death in human neutrophils. Furthermore, administration of antibody to Siglec-E, mouse functional ortholog of Siglec-9, restrained recruitment and activation of neutrophils in mouse models of airway inflammation in vivo. Given the critical role that neutrophils play in chronic bronchitis and emphysema, targeting Siglec-9 could be beneficial for the treatment of COPD, asthma, fibrosis, and related chronic inflammatory lung diseases.
Subject(s)
Animals , Humans , Mice , Asthma , Lung , N-Acetylneuraminic Acid , Neutrophils , Pulmonary Disease, Chronic Obstructive/drug therapy , Sialic Acid Binding Immunoglobulin-like LectinsABSTRACT
OBJECTIVE@#To study the role and mechanism of histone deacetylase 1 (HDAC1) and histone deacetylase 2 (HDAC2) in mouse neuronal development.@*METHODS@#The mice with Synapsin1-Cre recombinase were bred with @*RESULTS@#The mice with @*CONCLUSIONS@#Deletion of
Subject(s)
Animals , Mice , Blotting, Western , Histone Deacetylase 1/genetics , Histone Deacetylase 2 , Histone Deacetylases/genetics , Immunohistochemistry , Neurons/metabolism , Signal TransductionABSTRACT
Objective:To observe the relationship between hemoglobin variability and serum albumin in maintenance hemodialysis (MHD) patients, and analyze the related factors.Methods:110 MHD patients who met the inclusion criteria in the hemodialysis center of Chancheng District Central Hospital of Foshan City were selected. The basic clinical data, biochemical indexes and hemoglobin variation related indexes were collected. The patients were divided into group 1 (normal albumin group ≥35 g/L) and groups 2 (low albumin group <35 g/L) according to serum albumin level.Results:⑴ Compared with group 1 (normal albumin group), the body mass index (BMI), serum creatinine and transferrin saturation in group 2 (low albumin group) were significantly decreased [(20.78±3.45)kg/m 2 vs (22.87±3.91)kg/m 2; (913.06±175.05)μmol/L vs (1 039.20±285.43)μmol/L; (24.83±14.36)% vs (30.39±10.38)%, P<0.05]. However, there was no significant difference in age, gender, dialysis age, intact parathyroid hormone (iPTH), high sensitivity C-reactive protein (hs-CRP), ferritin, erythropoietin dosage, iron supplement way, vascular access, urea nitrogen, kt/V between the 2 groups ( P>0.05). ⑵ Compared with group 1, the group 2 had lower mean hemoglobin value, fewer times of reaching the standard, lower hemoglobin minimum value and larger hemoglobin coefficient of variation ( P<0.05). There was no significant difference in hemoglobin standard deviation and maximum hemoglobin ( P>0.05). ⑶ Pearson correlation analysis showed that serum albumin was positively correlated with mean hemoglobin, times of reaching the standard and minimum hemoglobin ( r=0.401, 0.378, 0.200, P<0.05), and negatively correlated with coefficient of variation of hemoglobin ( r=-0.237, P=0.013). Conclusions:Maintenance hemodialysis patients with hypoalbuminemia have lower level of hemoglobin and greater coefficient of hemoglobin variability.Improving nutritional state maybe increase hemoglobin level and decrease coefficient of hemoglobin variability.
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Objective:To investigate the diagnosis and treatment for intra-abdominal fistula in China, and to explore the prognostic factors.Methods:A multi-center cross-sectional study was conducted based on the Registration System of Chinese Gastrointestinal Fistula and Intra-Abdominal Infections to collect the clinical data of patients with intra-abdominal fistula from 18 medical centers from January 1, 2018 to December 31, 2018, including basic information, medical records and prognosis.Results:A total of 106 patients were enrolled in this study, including 57 males and 49 females, with an average age of (48.0±17.8)years. The most common type of intra-abdominal fistula was entero-vesical fistula (34.0%), followed by entero-vaginal fistula (31.1%), entero-enteric fistula (26.4%) and multiple fistula (8.5%). The direct causes of intra-abdominal fistula were mainly surgical operation (66.0%), followed by spontaneous fistula due to Crohn′s disease (18.9%), radiation intestinal injury (11.3%), and 4 cases (3.8%) of unknown reasons. During the whole treatment, 95 patients received nutritional support therapy, mainly EN+ PN (75.8%). Finally, 86 patients (81.1%) received surgical treatment, with a healing rate of 95.3%. After surgery, 8.1% of patients developed surgical site infections (SSI), and 10.5% had a relapse of fistula. 20 patients (18.9%) were treated conservatively, with a self-healing rate of 80.0%. The overall mortality rate was 8.5%, and the highest mortality (15.2%) was found in entero-enteric fistula. Statistical analysis showed that the age ( t=-4.664, P<0.001), leucocyte level ( U=663.000, P=0.010), sepsis ( P=0.002) and multiple organ dysfunction syndrome (MODS) ( P=0.019) were higher in the death group than those in the healing group. Multivariate analysis suggested that advanced age ( OR=1.073, 95% CI: 1.008-1.141, P=0.026) and complications of sepsis ( OR=11.806, 95% CI: 1.064-131.048, P=0.044) were independent risk factors of the death for patients with intra-abdominal fistula. Conclusions:The overall mortality rate of intra-abdominal fistula is still high, and malignant tumor is the most common primary disease. Advanced age and sepsis are independent risk factors for death in patients with intra-abdominal fistula.
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Objective:To investigate the clinical features and prognosis of duodenal lateral fistula (DLF), and to explore the high-risk factors affecting its prognosis, so as to improve its treatment outcome.Methods:The regression study was conducted based on the database of the Registration System of Chinese Gastrointestinal Fistula and Intra-Abdominal Infections. DLF patients who were hospitalized from January 1, 2018 to December 31, 2018 and had complete clinical data in the database were selected as the research object. The clinical data included patient gender, age, length of hospital stay, hospitalization costs, intensive care unit (ICU) admission, underlying diseases, primary diseases, direct causes of DLF, complications, treatment and outcomes.Results:A total of 142 patients with DLF were enrolled, including 97 males and 45 females, with a median age of 54 years. The top three primary diseases of DLF were gastrointestinal ulcers and perforations in 33 cases (23.2%), biliary tract disease in 27 cases (19.0%), and trauma in 24 cases (16.9%). There were 117 cases (82.4%) with single DLF, and 25 cases (17.6%) were combined with other fistula. Among the 142 patients, 127 were healed (49 by surgery and 78 self-healing) and 15 (10.6%) died. 14 cases (9.9%) underwent percutaneous catheter drainage, and 18 cases underwent laparotomy drainage. Univariate prognostic analysis showed that advanced age (≥60 years old) (χ 2=6.891, P=0.009), primary diseases as gastrointestinal ulcers/perforations (χ 2=8.515, P=0.004), combined with other fistula (χ 2=5.798, P=0.016), malnutrition (χ 2=5.595, P=0.018), pulmonary infection (χ 2=12.449, P<0.001), hemorrhage (χ 2=6.466, P=0.011), multiple organ dysfunction syndrome(MODS ) (χ 2=37.258, P<0.001), underwent laparotomy drainage (χ 2=6.466, P=0.011) were associated with mortality. Multivariate prognostic analysis confirmed that age ≥60 years old ( OR=44.375, 95% CI: 2.676-735.822, P=0.008), combined with other fistula ( OR=16.54, 95% CI: 1.744-156.913, P=0.015) and MODS ( OR=238.447, 95% CI: 9.496-5 987.78, P=0.001) were independent risk factors of the death for DLF patients. Conclusions:The mortality rate of DLF is still relatively high. Iatrogenic duodenal injury (surgical operation, endoscopic treatment) is the main direct cause of fistula. Advanced age, combined with other fistula and MODS significantly increases the risk of death of patients.
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Objective:To evaluate the value of lung ultrasound score (LUS) on predicting weaning outcome in patients with intro-abdominal infection (IAI) undergoing mechanical ventilation.Methods:Patients with IAI undergoing mechanical ventilation admitted to Research Institute of General Surgery of East War Zone Hospital and intensive care unit (ICU) of the First People's Hospital of Lianyungang from January to December in 2018 were included. The patients who satisfied weaning criteria were enrolled in the weaning process, which included spontaneous breathing trial (SBT) and extubation. They were divided into SBT success group and SBT failure group according to whether passed 120-minute SBT or not. LUS scores before and after SBT were compared between the two groups. The patients in the SBT success group were extubated, and they were divided into successful extubation group and failed extubation group for sub-group analysis according to whether re-intubation was needed in 48 hours after extubation. LUS score before extubation (at the end of SBT) and 48 hours after extubation (48 hours after extubation in the successful extubation group or before re-intubation in the failed extubation group) were compared. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of LUS score before SBT for SBT failure and LUS score before extubation for the failure.Results:A total of 76 patients with IAI undergoing mechanical ventilation were included. Twenty-three patients had duration of mechanical ventilation less than 48 hours, severe chronic obstructive pulmonary disease (COPD), tracheotomy or automatic discharge were excluded, and 53 patients were enrolled. SBT was failed in 9 patients, and successfully performed in 44 patients, of whom 23 patients with successful extubation, and 21 with failed extubation. The LUS scores before and after SBT in the SBT failure group were significantly higher than those in the SBT success group (before SBT: 13.22±1.99 vs. 10.79±1.64, t = -3.911, P = 0.000; after SBT: 19.00±1.12 vs. 13.41±1.86, t = -8.665, P = 0.000). ROC curve analysis showed that the area under ROC curve (AUC) of LUS score before SBT for predicting SBT failure was 0.82 [95% confidence interval (95% CI) was 0.67-0.98, P = 0.002]. When the optimum cut-off value was 12.5, the sensitivity was 66.7%, and the specificity was 84.1%. Sub-group analysis showed that the LUS scores before and after extubation in the failed extubation group were significantly higher than those in the successful extubation group (before extubation: 14.19±1.60 vs. 12.69±1.81, t = -2.881, P = 0.006; after extubation: 16.42±1.59 vs. 12.78±1.54, t = -7.710, P = 0.000). ROC curve analysis showed that the AUC of LUS score before extubation for predicting the failure was 0.81 (95% CI was 0.69-0.92, P = 0.000). When the optimum cut-off value was 13.5, the sensitivity was 80.0%, and the specificity was 65.2%. Conclusion:LUS score can effectively predict SBT outcome, risk of re-intubation after extubation in patients with IAI undergoing mechanical ventilation.
ABSTRACT
Objective: To make a distinction between Ludisia discolor and its relatives genus in molecular level, SCoT markers were employed to assess the genetic relationship and construct the DNA fingerprint. Methods: Orthogonal design method were carried out to optimize the suitable SCoT-PCR reaction system based on five factors. The optimum annealing temperature and SCoT primers were also screened. The 12 germplasm resources were used as materials, the screened primers were selected to analyze the genetic relationship of 12 materials. POPGENE was used to calculate the genetic diversity, NTSYS was performed to analyze cluster, and DNA map was constructed. Results: The optimized SCoT-PCR reaction system was constructed and a total of 12 rich bands were screened out as the primers of SCoT molecular marker with polymorphism ratio of 98.98%. According to Nei's genetic similarity coefficient, a total of 12 materials were divided into three cluster when coefficient was 0.45. Goodyera schlechtendaliana was in category I with seven L. discolor lines, indicating that these samples had close relationship. In category II, there were three samples came from Anoectochilus roxburghii. Moreover, a green L. discolor sample was alone clustered into category III. The DNA fingerprint map by the SC8 primer could identify the 12 materials. Conclusion: There are rich genetic diversities in 12 samples of L. discolor and its relatives genus, and the construction of DNA fingerprint map provides a theoretical basis for the identification of L. discolor and its relatives genus, which were tested in this study.