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Objective To investigate the effect of early thoracic paracentesis drainage for pleural effusion with a small or moderate volume on acute lung injury in patients with severe acute pancreatitis (SAP). Methods A retrospective analysis was performed for the clinical data of 107 patients with SAP who were admitted to The General Hospital of Western Theater Command from January 2015 to December 2021, and according to whether thoracic paracentesis drainage was performed within the first three days after admission, the patients were divided into thoracic paracentesis drainage group (TPD group with 51 patients) and non-thoracic paracentesis drainage group (N-TPD group with 56 patients).The two groups were compared in terms of laboratory markers and clinical outcome on days 5 and 10 after admission.The independent-samples t test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. Results Compared with the N-TPD group, the TPD group had a significantly shorter length of stay in the intensive care unit, a significantly shorter length of hospital stay, and significantly lower hospital costs (all P < 0.05), while there were no significant differences between the TPD group and the N-TPD group in mortality rate (9.8% vs 14.3%, χ 2 =0.502, P =0.478) and the incidence rate of sepsis (29.4% vs 44.6%, χ 2 =2.645, P =0.104).The TPD group had a significant reduction in the incidence rate of acute respiratory distress syndrome (ARDS)( χ 2 =6.038, P =0.043), as well as a significantly lower incidence rate of moderate ARDS than the N-TPD group (7.8% vs 21.4%, χ 2 =3.874, P =0.049).Compared with the N-TPD group, the TPD group had a significantly lower rate of use of mechanical ventilation (35.3% vs 57.2%, χ 2 =6.735, P =0.034) and a significantly lower proportion of patients receiving invasive mechanical ventilation (9.8% vs 26.8%, χ 2 =5.065, P =0.024).Compared with the N-TPD group, the TPD group had a significantly lower incidence rate of pulmonary infection (23.5% vs 42.9%, χ 2 =4.466, P =0.035) and a significantly shorter duration of systemic inflammatory response syndrome (11.2±5.0 days vs 16.8±4.7 days, t =5.949, P < 0.001).Compared with the N-TPD group, the TPD group had significantly better laboratory markers (high-sensitivity C-reactive protein, interleukin-1, interleukin-6, interleukin-8, tumor necrosis factor-α, arterial partial pressure of oxygen, oxygen saturation, and oxygenation index) and incidence rate of respiratory failure on days 5 and 10 after admission (all P < 0.05).On day 10 after admission, the TPD group had significantly better APACHE Ⅱ score and modified Mashall score than the N-TPD group (both P < 0.05). Conclusion For SAP patients with a small or moderate volume of pleural effusion, early thoracic paracentesis drainage can effectively improve acute lung injury, alleviate systemic inflammatory response, shorten the length of hospital stay, and reduce hospital costs.
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Acute pancreatitis-associated ascites fluid (PAAF) is a common complication in patients with acute pancreatitis (AP) and is closely associated with the severity of AP, the development of local and systemic complications, and prognosis. PAAF may originate from the leakage of abdominal blood vessels, lymphatic vessels, and pancreatic duct. Recent studies have found that early removal of PAAF by abdominal paracentesis drainage can help to reduce systemic inflammation and alleviate pancreatitis-associated organ injury, thereby improving the conditions of patients with severe AP and reducing mortality. However, it is still not completely clear how PAAF aggravates systemic inflammatory response, participates in pancreatic injury and damage of distal organs, and leads to the aggravation of disease conditions in patients with AP. Therefore, this article gives an overview of PAAF and summarizes related studies in recent years, so as to provide directions for exploring the pathophysiological process and treatment of AP.
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Objective:To investigate the effect of primary duodenal bile reflux(DGR)on Helicobacter pylori(HP)infection and drug resistance in children in Wuxi area, and to provide the basis for the selection of anti-HP drugs in children with subsequent DGR.Methods:The clinical data of children who had received upper gastrointestinal endoscopy and HP examination because of abdominal pain, nausea, vomiting, gastrointestinal bleeding, dyspepsia and other upper gastrointestinal symptoms were collected from January 2020 to February 2022 in the Gastroenterology Department of Wuxi Children′s Hospital.According to the results of endoscopy, children were divided into DGR group (217 cases) and control group without DGR (1 252 cases), and their age, gender, HP infection rate and abdominal pain were analyzed.Results:A total of 1 469 children were included in this study, with a median age of 11(9, 14) years, 808(55.0%) males and 661(45.0%) females.HP infection was detected in 322(21.9%) cases.The median age of DGR group was higher than that in control group[13(11, 15) years vs. 11(8, 14) years, P<0.001], and the incidence of DGR was increased in the elder group( χ2=45.963, P<0.001). There was no significant difference between DGR group and control group in sex and whether abdominal pain was the first symptom ( P>0.05). There were 47(22.0%) cases positive for HP in DGR group and 275(22.0%)cases in control group, with no significant difference( P>0.05). A total of 256 cases were isolated and cultured positive of HP.And in vitro susceptibility tests of strains, there was no significant difference between DGR group and control group in the single and combined resistance rates of HP to metronidazole, clarithromycin, levofloxacin, amoxicillin, furazolidone and tetracycline hydrochloride( P>0.05). Conclusion:Elder children are more likely to have primary DGR.The occurrence of primary DGR has no significant effect on HP infection and drug resistance.
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Objective:To explore the preoperative risk factors of laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct exploration(LCBDE) in the treatment of cholecystolithiasis combined with choledocholithiasis, and establish a nomogram model to predict the transition to laparotomy.Methods:A retrospective analysis of the clinical data of 309 patients undergoing surgery in Cangzhou People′s Hospital from January 1, 2015 to December 31, 2019, were divided into 290 cases in non-laparotomy group and 19 cases in laparotomy group whether they were transferred to laparotomy. Obtained independent predictors of transition to laparotomy through univariate analysis and multivariate logistic regression analysis, and used RStudio to establish a nomogram model to verify it.Results:The results of univariate analysis showed that the history of abdominal surgery, BMI, white blood cell, neutrophil ratio, ALP, serum total bilirubin, gallbladder wall thickness, common bile duct diameter, and lower common bile duct stone incarceration were relative risk factors of LC combined with LCBDE for conversion to laparotomy ( OR=0.195, 0.369, 0.287, 0.241, 0.237, 0.082, 0.166, 0.198, 0.190; 95% CI: 0.073-0.517, 0.114-1.195, 0.096-0.859, 0.085-0.682, 0.092-0.613, 0.023-0.287, 0.058-0.475, 0.073-0.537, 0.056-0.649). Multivariate logistic regression analysis showed that white blood cells>10×10 9/L, alkaline phosphatase>150 U/L, serum total bilirubin>17.1 umol/L, gallbladder Wall thickness> 4 mm, common bile duct diameter>12 mm, and lower common bile duct stone incarceration were independent predictors of LC combined with LCBDE for conversion to laparotomy ( OR=6.498, 3.656, 22.160, 5.762, 4.849, 7.916; 95% CI: 1.434-29.442, 1.095-12.203, 4.485-109.496, 1.491-22.262, 1.384-16.988, 1.366-45.884). The nomogram model was established based on independent predictors, and then bootstrap repeated sampling was used to internally verify the predictive model. The calibration curve found that the model was in good agreement, with a C-index of 0.924(95% CI: 0.857-0.990) and the area under the receiver operating characteristics curve was 0.924(95% CI: 0.855-0.992), indicating the high accuracy of the model. Conclusion:The nomogram model established based on the factors of lower common bile duct stone incarceration, gallbladder wall thickness, common bile duct diameter, common bile duct diameter, white blood cells, alkaline phosphatase, and serum total bilirubin has good ability to predict conversion to laparotomy of LC combined with LCBDE, and has high clinical application value.
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Objective@#To analyze the relationship between daily behavior and self-perceived academic performance among students in Jiangxi, and to provide a scientific basis for developing health behavior among adolescents and children.@*Methods@#By using stratified cluster sampling, 12 primary and secondary schools from six counties of Jiangxi Province were selected, and a total of 2 284 students were investigated with questions including breakfast consumption, number of days participating in sports activities (≥45 min) and the average screen time during the past 7 days. Regression analysis was carried out by using ordered multi-classification logistic.@*Results@#Of the 2 284 students surveyed, 1 374(60.16%) perceived their academic performance as very good or good, 613 (26.84%) and 297(13.00%) perceived as moderate or poor. Primary school, having breakfast every day, not playing on mobile or computer during weekday was positively associated with higher self-perceived academic performance (OR=0.50, 0.57 and 0.64, respectively, P<0.05), no sports activities ≥45 min during the past 7 d was associated with poor(OR=1.57, P<0.01). Among the 2 284 students, 67.43% students ate breakfast every day in the past 7 d, 75.39% students did not play mobile phones or computers at school, 40.89% students did not participate in sports activities (≥45 min).@*Conclusion@#Breakfast skipping and insufficient physical exercise shows adverse effects, and no/limited screen time during weekdays shows positive effects on academic performance. Intervention of visky behaviors should to carried out from different perspectives to promote the develpment of the health habits among students.
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Ranpirnase (onconase, ONC) is a new drug, with weak RNase activity and strong cytotoxicity to various tumor cells in vitro and in vivo. This study is to obtain recombination onconase (rONC) with high bioactivity. Based on the codon preference of Pichia pastoris, we designed and synthesized the gene according to cDNA sequences of ONC and the α mating factor's prepeptide. We screened positive clones after transforming the recombination plasmids into P. pastoris X-33, GSS115 and SMD1168. We screened the best combination of seven different vectors and host strains. Moreover, we optimized culture condition in shake flasks and 10 L bioreactor, and purified rONC from the supernatant after inducing it with 0.25% methanol by aqueous two-phase extraction coupling G50 molecular exclusion method. The highest rONC production was 13 mg/L in pPICZα-A/X-33/ONC combination under the condition of pH 5.5 and 23 degrees C in shake flasks for 7 d; and that the highest rONC production was 180 mg/L when the induction is performed in the lower basic salt medium with pH 5.5 in the 10 L bioreactor for 7 d. The yield of rONC is more than 90% at a purity of above 95%. rONC can kill various tumor cells in vitro. The expression and purification of rONC would be useful for further investigation of this new drug.