Analysis of risk factors for postoperative complications of hepatic hilar cholangiocarcinoma after extensive hepatectomy / 中国实用外科杂志

OBJECTIVE: To analyze the relationship between clinical characteristics and postoperative complications in patients with hilar cholangiocarcinoma(HCCA) who underwent major liver resection(MLR).METHODS: Clinical characteristics and postoperative complications of 335 patients with HCCA who underwent MLR from January 2010 to October 2017 were retrospectively analyzed.According to the severity of complications,the patients were divided into two groups:low clavien-dindo group(LCD)and high clavien-dindo group(HCD).RESULTS: There were 219 patients in LCD group and 116 patients in HCD group.Elevated INR,Bismuth Ⅲa/Ⅳ type and the right liver/expanding right/right trilobites resection were high risk factors of postoperative serious complications.The incidence of severe postoperative complications in the group with preoperative biliary drainage was 34.18%(67/196),which was not statistically significant different from that in the group without preoperative biliary drainage [35.25%(49/139),P=0.8396].The dose-response curve and Logistic regression indicated that there was a statistical difference in postoperative complication risk between patients with total bilirubin(TB)<140 mol/L and patients with TB≥ 140 mol/L(OR=1.917,95% CI 1.147～3.203,P=0.0130).After statistical correction,the statistical correlation remained,among which,the preoperative biliary drainage rate was 59.2%(151/255) in the group with TB<140 mol/L,and 56.3%(45/80)in the group with TB≥ 140 mol/L.CONCLUSION: In patients with HCCA combined with MLR,patients with TB ≥ 140 mol/L should be routinely treated with preoperative biliary drainage.Especially for the right liver resection,preoperative high INR patients,more attention should be paid to.METHODS: of preoperative biliary drainage have no significant effect on the overall postoperative complications and can be flexibly selected according to the needs of the disease.

Effects of Danshen Chuanxiongqin Injection Combined with Hyperbaric Oxygen on the Prevention of Early Complications of Acute Spinal Cord Injury / 中国药房

OBJECTIVE:To investigate the effects of Danshen chuanxiongqin injection combined with hyperbaric oxygen on the prevention of early complications in patients with acute spinal cord injury (ASCI).METHODS:A total of 89 ASCI patients were divided into control group (n=44) and combination group (n =45) according to random number table.Control group received routine symptomatic treatment combined with hyperbaric oxygen therapy.Combination group was additionally given Danshen chuanxiongqin intravenous injection 10 mL added into 250 mL 0.9％ Sodium chloride injection intravenously,bid,on the basis of control group.Both group was treated for 2 weeks.The changes of spinal cord function recovery index (Botsford score,FIM score),coagulation indexes [prothrombin time (PT),activated partial thromboplastin time (APTT)],hemodynamic indexes (high-shear blood viscosity,plasma viscosity,erythrocyte aggregation indexes) and inflammatory indexes [D-dimer (D-D),C reactive protein (CRP)] were compared between 2 groups before and after treatment.After 1 month of follow-up,the incidence of early complications as deep venous thrombosis and pulmonary embolism were compared between 2 groups.RESULTS:Two cases lost in control group and three cases lost in combination group;42 cases were included in each group.Before treatment,there was no statistical significance between these indexes between 2 groups (P＞0.05).After 2 weeks of treatment,Botsford score,FIM score,PT and APTT of 2 groups were enhanced significantly compared to before treatment;high-shear blood viscosity,plasma viscosity,erythrocyte aggregation indexes,D-D,CRP level were decreased significantly compared to before treatment;each index of combination group was significantly better than those of control group,with statistical significance (P＜0.05 or P＜0.01).The incidence of early complications in combination group was 16.7％,which was significantly lower than 35.7％ in control group,with statistical significance (P＜0.05).CONCLUSIONS:The application of Danshen chuanxiongqin injection combined with hyperbaric oxygen in the clinical treatment of ASCI can effectively reduce the risk of deep venous thrombosis,pulmonary embolism and other early complications.It has positive effects on alleviating inflammatory reactions,promoting blood microcirculation and improving prognosis of patients.

Effect of Pulmonary Rehabilitation on Pulmonary Function and Activities of Daily Living in Patients with Chronic Schizophrenia Complicated with Pulmonary Infection at Stable Stage / 中国康复理论与实践

@#Objective To explore the effect of pulmonary rehabilitation on activities of daily living(ADL)and pulmonary function in patients with chronic schizophrenia complicated with pulmonary infection at stable stage. Methods From January,2014 to July,2017,62 patients with chronic schizophrenia complicated with pulmonary infec-tion at stable stage were randomly divided into control group(n=31)and observation group(n=31).Both groups accepted routine medication,while the observation group received pulmonary rehabilitation for two months in ad-dition.The distance of 6-Minute Walk Test(6MWT),the modified Barthel index(MBI),modified British Medi-cal Research Council Dyspnea Scale (mMRC), C-reactive protein (CRP), Zung Anxiety Self-Rating Scale and Zung Depression Self-Rating Scale were compared before and after training. Results The total effective rate was higher in the observation group than in the control group(χ2=5.415,P=0.020).Com-pared with the control group,the distance of 6MWT increased(t=5.463,P=0.008),the score of MBI increased(t=2.142, P=0.028), the score of mMRC decreased (t=3.689, P=0.013), and the level of CRP decreased (t=-2.179,P=0.031)in the observation group.The scores of Zung Anxiety Self-Rating Scale(t=5.048,P=0.009) and Zung Depression Self-Rating Scale(t=-1.388,P=0.045)both decreased. Conclusion An early implementation of pulmonary rehabilitation could improve ADL and the exercise endurance,and reduce the incidence of infection in patients with chronic schizophrenia complicated with pulmonary infection at stable stage.

¹H-NMR based metabonomic approach to evaluate anti-coagulant effect of Danggui Sini decoction / 中国中药杂志

To study the anti-coagulant effect and influence of danggui Sini decoction (DSD) on rat's plasma endogenous metabolites by animal experiment and ¹H-NMR based metabolomics method. After intragastric administration of Danggui Sini Decoction for 7 days, Plasma thrombin time (TT) was measured. Rat plasma metabolic fingerprint in two groups was analyzed using ¹H-NMR, based on which the principal component analysis( PCA) and orthogonal partial least-squares discriminant analysis(OPLS-DA) models for metabonomic analysis. Potential biomarkers were screened by using variable importance in the projection (VIP) and T test. DSD could prolong TT of the rat significantly (P < 0.05). Compared with control group, six kinds of endogenous metabolites in DSD group change significantly (P < 0.05), among which isobutyrate, carnitine and phenylalanine content had an upward trend (P < 0.01) and lysine, Histidine and cholesterol content had a downward trend (P < 0.05). It is likely that carnitine, phenylalanine, Histidine and cholesterol are the potential metabolic markers in the anti-coagulant process and DSD affects the platelet aggregation and the expression of tissue factor and fiber protease by regulating the energy, amino acid and lipid metabolism.

CT and MRI findings in patients with autoimmune pancreatitis / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate computed tomography (CT) and magnetic resonance imaging (MRI) findings in patients with autoimmune pancreatitis (AIP).</p><p><b>METHODS</b>The imaging findings of pancreas and extra-pancreas in 24 patients with AIP were retrospectively reviewed. Among them, CT scan was performed in 18 patients, MRI in 11, and bGth CT and MRI in 10.</p><p><b>RESULTS</b>The pancreas showed diffuse enlargement (25%, 6/24), focal enlargement (37. 5%, 9/24), combined enlargement (25%, 6/24) ,and no enlargement (12. 5%, 9/24). Unenhanced CT showed hypoattenuation in AIP area (n = 2) . After intravenous injection of contrast medium, 17 patients showed abnormal contrast enhancement in the affected pancreatic parenchyma, including hypoattenuation during the arterial phase (50%, 9/18) and hyper attenuation during the delayed phase (94. 4%, 17/18). Precontrast MRI showed abnormal signal intense (n =9), including hypointense on T1-weight images (T1 WI) (n = 7), hyperintense (n = 7) and hypointense (n = 2) on T2-weight images (TIWI). Enhanced MRI demonstrated abnormal contrast enhancement within lesions (n = 11), including hypoattenuation during the arterial phase (81. 8%, 9/11) and good enhancement during the delayed phase (100%, 11111). A capsule-like rim was seen around pancreas (37. 5%, 9/24), among which CT detected in 6 out of 18 patients and MRI found in 7 out of 11 patients.The main pancreatic duct lumen within lesions has no visualization (100%, 24/24) and upstream dilation of the main pancreatic duct (n = 8) , ranging from 2. 2 to 4. 5 mm(mean 3. 1 0. 47 mm) in diameter. Narrowing of the common bile duct was shown in 14 patients. Miscellaneous findings were: infiltration of extrapancreatic vein (n = 9) and artery (n = 1); mild fluid collection around pancreas (n = 2); pseudocysts (n = 3). Fourteen patients also presented one or more of the following extrapancreatic imaging findings: narrowing of the intra-hepatic bile duct or hilar duct (n = 5); thickening of gallbladder wall (n = 5); fibrosis in mesenteric (n = 2), in retroperitoneal (n = 2) and in ligamentum teres hepatis (n = 1); renal involvement (n = 3); peri-pancreatic or para-aortic lymphadenopathy (n = 10); and ulcerative colitis (n = 3).</p><p><b>CONCLUSION</b>AIP display some characteristic CT and MRI imaging features: sausage-like change of the pancreas; capsule-like rims around lesions; delayed contrast enhancement in the affected pancreatic parenchyma; segment or diffuse pancreatic duct stenosis but mild upstream dilation and extrapancreatic organs involvement. CT and MRI findings combining with serological tests and pancreas biopsy can assist physicians to make accurate and timely diagnosis.</p>

Value of 18F-FDG-PET/CT in diagnosis of classic fever of unknown origin / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate the application of (18)F-FDG PET/CT in diagnosis of classic fever of unknown origin.</p><p><b>METHODS</b>A total of 27 consecutive patients with classic fever of unknown origin (FUO) (19 men, 8 women; aged 24-82 y) underwent (18)F-FDG PET/CT scans. The images were interpreted by visual inspection and semiquantitative analysis(standardized uptake value, SUV). Final diagnosis was based on histopathology or clinical follow-up.</p><p><b>RESULTS</b>The cause of FUO was confirmed by followed investigations in 21 of 27 cases after PET/CT scan, including 10 cases of infection, 4 of noninfectious inflammation, 4 of malignancies and 3 of miscellaneous disorders; and remaining 6 cases were still confirmed FUO. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 100.0 %, 83.3%, 83.3%, 100.0% and 96.3%, respectively.</p><p><b>CONCLUSION</b>For patients with fever of unknown origin, (18)F-FDG-PET/CT can be a sensitive, reliable imaging modality. It is suggested that (18)F-FDG-PET/CT should be considered earlier in detecting the causes of FUO, which is difficultly diagnosed by conventional modalities.</p>

Study of paroxysmal kinesigenic dyskinesia with fMRI / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To detect the differences in subcortical structures between patients with paroxysmal kinesigenic dyskinesia (PKD) and normal subjects during movement preparation and execution.</p><p><b>METHODS</b>The PKD patients performed a movement task, in which a CUE signal (preparation) indicated the movement sequence prior to the appearance of an imperative GO signal (execution). Event-related functional magnetic resonance imaging (fMRI) and 3dDeconvolve program of AFNI were used to estimate the hemodynamic response function and to generate activation maps.</p><p><b>RESULT</b>During movement preparation, the activated brain areas in PKD patients were less than those of normal subject, and there was no activation in basal ganglia in PKD patients. During execution, the activation was also less in PKD patients except in bilateral M1.</p><p><b>CONCLUSION</b>During intermission, abnormalities of the brain still exist in PKD patients when during preparing or performing movement. The movement circuit in the brain displays an unusual state. The attack may be caused by reducing of inhibition in brain areas.</p>

Clinical value of three-dimensional dynamic contrast-enhanced MR angiography in diagnosis of angiostenosis after liver transplantation / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate the clinical application of three-dimensional dynamic contrast-enhanced MR angiography (3D DCE MRA) in diagnosis of angiostenosis after liver transplantation.</p><p><b>METHODS</b>Twenty recipients of liver transplantation underwent 3D DCE MRA examination. The blood vessel rating grades were accessed and the relative diameter of vascular anastomosis was measured; and the results were compared with those of US or DSA examination.</p><p><b>RESULTS</b>Satisfactory angiography images were obtained in all cases by 3D DCE MRA, including 11 cases with normal and mild stenosis, 5 with moderate and 4 with severe stenosis in hepatic artery. Except one case in which 3D DCE MRA showed severe stenosis but DSA showed moderate stenosis, the results of MRA were all consistent with those of US or/and DSA in the stenosis degree of the portal vein, hepatic vein and the postcava.</p><p><b>CONCLUSION</b>3D DCE MRA is an effective technique to evaluate the degree of angiostenosis after liver transplantation.</p>

Effect of Astragalus Injection with Heparin in Treatment of High Coagulable Blood in Children with Nephrotic Syndrome / 实用儿科临床杂志

Objective To explore the effect of astragalus injection with heparin in treatment of children with nephrotic syndrome(NS) whose blood was high coagulable.Methods Seventy-two children suffering from NS, whose blood was high coagulable,were randomly divi-ded into 2 groups. The suffering children of 2 groups were given diuretic and anti-infective and hypotenive drugs, simultaneously taking prednisone 2 mg/( kg?d). In addition, the suffering children of therapeutic group was given astragalus injection 20 mL and heparin 100 IU/kg which were added in the glucose injection 200 mL absorbed by intravenous drop.They had blood test since they had taken the medicine once a day and maintained 2-4 weeks′ time.Results The suffering children′s PLT,febrinogen(Fbg) and prothrombin time(PT) of therapeutic group were all lowered down to normal quantity in 10 days but those of contrastive group in 2 weeks or more. The time of urinary protein′s vani-shing of the therapeutic group averages out to (8.9?4.1) d;but contrastive group became normal after 2 weeks and urinary albumen disa-ppeared in (12.8?6.2) d.Conclusions The astragalus injection with heparin is significant to shortening the course of treatment and redu-cing the relapse and preventing from thrombosis in the treatment of NS of suffering children whose blood is high coagulable.The treatment of anti-coagulation can be one of conventional plans.