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Objective:To evaluate delayed laparoscopic cholecystectomy (DLC) after percutaneous transhepatic gallbladder drainage (PTGBD) in acute cholecystitis.Methods:Clinical data of 64 patients who were diagnosed moderate (grade Ⅱ) acute cholecystitis by the 2018 Tokyo Guidelines in acute phase and underwent delayed LC at our hospital from Jan 2018 to Jan 2021 were compared between two groups ie PTGBD treatment (21 cases)in acute stage before DLC and DLC without PTGBD group (43 cases). The difficulty score of TG18 was used to evaluated every surgical procedure of the cases by reviewing the operation videos.Results:Patients in DLC after PTGBD group had a longer hospital stay and operation time, more blood lose and higher difficulty score than the DLC without PTGBD group(all P<0.05). There was no statistically significant difference in the conversion rate and morbidity rate between the two groups( P>0.05). Conclusion:This study fails to show there is any if ever benefit of PTGBD before DLC over DLC without PTGBD in the management of Grade Ⅱ acute cholecystitis.
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Objective:To evaluate the incidence of pretransplant sarcopenia and its effect on prognosis in patients receiving hematopoietic stem cell transplantation (HSCT).Methods:Several electronic databases (PubMed, Embase, Web of Science, Cochrane Library, EBSCO, CINAHL, CBM, CNKI, VIP, WanFang data) were searched from inception to March 2022. Cohort and case-control studies on the outcomes of HSCT patients with pre-transplant sarcopenia were collected, and the quality of the studies was evaluated using the Newcastle-Ottawa Scale. After literature screening, data extraction and quality evaluation, meta-analysis was performed using RevMan 5.3.Results:9 cohort studies were included, of which 6 were of high quality and 3 were of medium quality. The total sample size was 2,255 cases, including 862 cases in the sarcopenia group. The incidence of pretransplant sarcopenia in HSCT patients was 40% (95% CI: 0.35 to 0.46). Pretransplant sarcopenia was associated with decreased overall survival rate ( HR = 1.73, 95% CI: 1.38 to 2.04, P = 0.04) and increased non-relapse mortality after transplantation ( HR = 1.84,95% CI: 1.47 to 2.32, P < 0.01). There was no significant correlation between pretransplant sarcopenia and the incidence of acute graft-versus-host disease ( OR = 1.08, 95% CI: 0.84 to 1.39, P = 0.55). Sarcopenia before transplantation had no significant effect on the duration of hospital stay ( MD = 3.57, 95% CI: -0.13 to 7.26, P = 0.06). Conclusions:Pretransplant sarcopenia was associated with reduced overall survival and increased non-relapse mortality after transplantation. More attention to pretransplant sarcopenia is needed domestically and large-scale, multi-center, prospective studies assessing early screening for sarcopenia are necessary to provide guidance about prevention and treatment strategies.
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Detailed knowledge on tissue-specific metabolic reprogramming in diabetic nephropathy (DN) is vital for more accurate understanding the molecular pathological signature and developing novel therapeutic strategies. In the present study, a spatial-resolved metabolomics approach based on air flow-assisted desorption electrospray ionization (AFADESI) and matrix-assisted laser desorption ionization (MALDI) integrated mass spectrometry imaging (MSI) was proposed to investigate tissue-specific metabolic alterations in the kidneys of high-fat diet-fed and streptozotocin (STZ)-treated DN rats and the therapeutic effect of astragaloside IV, a potential anti-diabetic drug, against DN. As a result, a wide range of functional metabolites including sugars, amino acids, nucleotides and their derivatives, fatty acids, phospholipids, sphingolipids, glycerides, carnitine and its derivatives, vitamins, peptides, and metal ions associated with DN were identified and their unique distribution patterns in the rat kidney were visualized with high chemical specificity and high spatial resolution. These region-specific metabolic disturbances were ameliorated by repeated oral administration of astragaloside IV (100 mg/kg) for 12 weeks. This study provided more comprehensive and detailed information about the tissue-specific metabolic reprogramming and molecular pathological signature in the kidney of diabetic rats. These findings highlighted the promising potential of AFADESI and MALDI integrated MSI based metabolomics approach for application in metabolic kidney diseases.
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Understanding of the nephrotoxicity induced by drug candidates is vital to drug discovery and development. Herein, an metabolomics method based on air flow-assisted desorption electrospray ionization mass spectrometry imaging (AFADESI-MSI) was established for direct analysis of metabolites in renal tissue sections. This method was subsequently applied to investigate spatially resolved metabolic profile changes in rat kidney after the administration of aristolochic acid I, a known nephrotoxic drug, aimed to discover metabolites associated with nephrotoxicity. As a result, 38 metabolites related to the arginine-creatinine metabolic pathway, the urea cycle, the serine synthesis pathway, metabolism of lipids, choline, histamine, lysine, and adenosine triphosphate were significantly changed in the group treated with aristolochic acid I. These metabolites exhibited a unique distribution in rat kidney and a good spatial match with histopathological renal lesions. This study provides new insights into the mechanisms underlying aristolochic acids nephrotoxicity and demonstrates that AFADESI-MSI-based metabolomics is a promising technique for investigation of the molecular mechanism of drug toxicity.
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Objective:To investigate the effects of metformin on the survival of patients with advanced non-small cell lung cancer (NSCLC).Methods:PubMed, EMbase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang and other databases were searched from the beginning of database construction to February 2020, relevant literatures were screened and included, and the characteristics of the literatures were extracted. RevMan 5.3 software was used to analyze progression-free survival (PFS), overall survival (OS), hazard ratio(HR) and 95% CI; the heterogeneity and publication bias were also evaluated. Results:A total of 11 studies were enrolled, and metformin did not improve PFS in patients with advanced NSCLC ( HR = 0.80, 95% CI 0.58-1.09, P = 0.15). The subgroup analysis results of different treatment strategies showed that metformin combined with tyrosine kinase inhibitor (TKI) ( HR = 0.71, 95% CI 0.32-1.57, P = 0.39), chemoradiotherapy ( HR = 0.97, 95% CI 0.59-1.61, P = 0.92), and immune checkpoint inhibitor (ICI) ( HR = 0.64, 95% CI 0.35-1.16, P = 0.14) did not improve the PFS. Metformin improved OS in patients with advanced NSCLC ( HR = 0.84, 95% CI 0.75-0.93, P = 0.001). Metformin combined with TKI ( HR = 0.68, 95% CI 0.38- 1.22, P = 0.19) and ICI ( HR =0.80, 95% CI 0.39-1.63, P = 0.54) did not improve OS of patients, while metformin combined with chemoradiotherapy could improve OS ( HR = 0.85, 95% CI 0.78-0.93, P < 0.01). No evidence of publication bias was shown in the funnel plot analysis. Conclusions:Metformin can prolong OS time in patients with advanced NSCLC, especially in patients undergoing metformin combined with radiotherapy and chemotherapy, or concurrent chemoradiotherapy.
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OBJECTIVE@#To study the pathological changes of genioglossus with transmission electron microscope (TEM) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) dominated by lingual region obstruction, and to explore the role of tongue organizations in the pathogenesis and its clinical significance.@*METHOD@#Thirty-eight cases of genioglossus were collected from the patients received UPPP and partial glossectomy (3060 severe group 15 cases), 6 adult patients without oropharyneal and hypopharyneal obstructive disease received tongue tumor resection or trauma debridement surgery were collected as control group. The features of morphological changes in genioglossus were observed by TEM.@*RESULT@#Under the TEM, in the control group,the muscle fibers of the genioglossus organization arranges regular, mitochondrial shape between muscle was regular; The below 3 kinds of variations existed simultaneously in all genioglossus specimens of all the OSAHS patients. In the mild group, myofibrillar atrophied, arranged sloppily, the gap was increased, localized filaments were edema, connective tissue between muscle bundles was proliferated, mitochondria were swelling, some were spherical, crests were still clear; In the moderate group, myofibrillar obviously atrophied with different diametric sizes and disorderliness, the Z lines were shortened or distorted, part of the myofibrillar ruptured, dissolved or disappeared, the connective tissues between muscle bundles were obviously proliferated, mitochondria were swellen, vacuolar degeneration, crests were vague, shorten and irregulatio; In the severe group, a large number of myofibrillar were fractured, dissolved, disorganized, integrated condensate lumpy, spotty or flake arranged, Z-lines were distorted or disappeared. Mitochondria were sizes, showed vacuolar degeneration, crests were disappeared, some changes were flocculent, mitochondria accumulation phenomenon was visible in some samples. Moreover, with the AHI increased, the occurence ratio of mild changes was decreased while severe changes occurence ratio increased.@*CONCLUSION@#The changes of genioglossus and mitochondrial in OSAHS patients is a continuous, progressive process, moverover, with the aggravation of OSAHS, genioglossus histopathological changes had gradually worsening tendency.
Subject(s)
Adult , Humans , Glossectomy , Mitochondria , Muscle, Skeletal , Pathology , Sleep Apnea, Obstructive , Tongue , PathologyABSTRACT
<p><b>OBJECTIVE</b>To evaluate the effects of compound whole grain-soybean on insulin resistance and serum adipocytokines levels in impared fasting glucose population.</p><p><b>METHODS</b>According to inclusion and exclusion criteria, 163 cases of impared fasting glucose (IFG) Chinese Han population from the age of 40 to 75 years old, were screened from 12 community health centers of three main districts of Nanjing city by the multi-stage cluster and simple randomization method from March to September, 2008. The IFG subjects were randomly divided into the intervention group (87 individuals) and control group (76 individuals) by quasi-experimental design. The intervention group was provided with compound whole grain-soybean and health education, while only health education was provided for the control group. Body mass index (BMI), waist-to-hip ratio (WHR), lipid profiles, fasting blood glucose (FBG), fasting insulin (FINS) and homeostasis model assessment of insulin resistance (HOMA-IR), adipocytokines including leptin, lipocalin 2 (LCN-2) and adiponectin (ADP) levels were measured before and after the half a year intervention period. Chi square test was used to analyze the distribution differences. Two-sample t-test was used to compare the differences of the two groups before and after the half a year intervention period, and paired t-test was used to compare the differences between before and after intervention in the intervention group or control group. Wilcoxon rank sum test was used to compare the differences of all indexes between after and before dietary intervention.</p><p><b>RESULTS</b>After dietary intervention for half a year on the IFG population, BMI ((24.87 ± 3.69) kg/m(2)), FBG((6.27 ± 0.24) mmol/L), FINS((7.14 ± 1.05) mU/L) , HOMA-IR (1.99 ± 0.31), leptin ((13.07 ± 2.22) µg /L), LCN-2 ((67.42 ± 18.20) µg/L) of intervention group were decreased significantly compared to the levels of BMI ((25.16 ± 4.07) kg/m(2)), FBG((6.40 ± 0.28) mmol/L), FINS ((7.32 ± 1.54) mU/L), HOMA-IR (2.08 ± 0.45), leptin ((13.43 ± 2.52) µg/L), LCN-2((74.87 ± 17.81) µg/L) before dietary intervention, t values were 4.48, 7.08, 2.05, 3.39, 3.28 and 6.36, respectively, and all P values were < 0.05, while ADP ((5.07 ± 1.51) mg/L) of intervention group after dietary intervention was increased significantly compared to the level of ADP ((4.92 ± 1.53) mg/L) before dietary intervention, t = -2.47 and P < 0.05. The medians (P25, P 75) of differences after and before dietary intervention in the intervention group were BMI (-0.25(-0.68, 0.02) kg/m(2)), FBG (-0.08 (-0.20, 0.00) mmol/L), FINS (-0.15(-0.32, 0.00) mU/L), HOMA-IR (-0.07(-0.12, -0.03)), leptin (-0.36(-0.77, 0.12) µg/L), LCN-2 (-5.85(-14.29, -0.71) µg/L) and ADP (0.15(-0.13, 0.36) mg/L), and the medians of differences of after and before dietary intervention in the control group were BMI (0.00(-0.23, 0.29) kg/m(2)), FBG (0.00(-0.03, 0.04) mmol/L), FINS (-0.01(-0.13, 0.04) mU/L), HOMA-IR (-0.01(-0.05, 0.02)), leptin (-0.07 (-0.57, 0.46) µg/L), LCN-2 (-0.85(-5.39, 1.63) µg/L) and ADP (0.02(-0.19, 0.13) mg/L). There were significantly statistical differences between them (Z values were -3.65, -4.88, -3.08, -5.23, -2.16, -4.43 and 3.05, all P values were <0.05).</p><p><b>CONCLUSION</b>Dietary intervention of compound whole grain-soybean can improves glucose level, increase insulin sensitivity and ameliorate insulin resistance state of IFG population.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Adipokines , Blood , Adiponectin , Blood , Apolipoproteins , Blood , Blood Glucose , Metabolism , Insulin , Blood , Insulin Resistance , Soybeans , Waist-Hip RatioABSTRACT
OBJECTIVE@#In order to improve the postoperative effect of modified UPPP, removing the partial pharyngeal muscle in surgery, we investigate the postoperative effect, the characteristics of pharyngeal cavity and the potential complications in OSAHS patients.@*METHOD@#To choose 82 OSAHS patients with obstructive oropharyngeal plane diagnosed by Apneagraphy (AG), Fibre nasopharyngoscope combined with Müller examination and nasopharyngeal 3D-CT, which had completed clinical data inpatients in the anesthesia underwent of the partial pharyngeal muscles in the postoperative, divided into a control group of 26 cases, operating the H-UPPP surgery which did not remove partial pharyngeal muscle; The experimental group of 56 cases did a H-UPPP surgical which removed partial pharyngeal muscle of possible concurrent symptoms such as nasal regurgitation, Eustachian tube dysfunction and other follow-up study in six months after the monthly telephone follow-up or outpatient exams to understand the disease. Patients were evaluated the sleepiness by ESS(Epworth sleepiness scale) in 6 months after the surgery, compared with the preoperative ESS scores, do a t test for statistical analysis. AG can be used to evaluate effects of the UPPP after 6 months. By measuring uvula length (L1), extent from free edge of soft palate to postpharyngeal (L2) and stenosis of nasopharynx width (L3) mean, we investigate the characteristics of pharyngeal cavity using the multiple linear regression to do the hypothesis test and evaluate the association between measuring mean and effect. Using SPSS19.0 software do the preoperative contrast analysis.@*RESULT@#After 6 months in surgery, 56 cases in the experimental group, effect in 50 cases (89.29%), effective in 6 cases (10.71%); ESS score: Preoperative 11.74 +/- 2.48, after the first 6 months 3.84 +/- 2.05. Twenty-six cases in control group,effect in 19 cases (73.08%), effective in 7 cases (26.92%); ESS score: Preoperative 11.91 +/- 2.40, after the first 6 months 6.92 +/- 2.47, t-test P value of less than 0.05 between the experimental group and the control group; There are no ear fullness, hearing loss, increase their own sound which reflect eustachian tube dysfunction and other complications in two groups; The function of pharyngeal cavity could be recovered normal lever after 6 months; After 6 months of the operation, in the experimental group and the control group L1 mean was respectively (5.91 +/- 3.38) mm and (6.20 +/- 3.76) mm (P>0.05); L2 mean was respectively (15.70 +/- 3.29)mm and (15.35 +/- 1.44) mm (P> 0.05); L3 mean was respectively (20.54 +/- 3.33) mm and (16.43 +/- 2.21) mm (P<0.05). Nasal fauces pitch mean was significantly widened. By the multiple linear regression analysis, the postoperative effect has the linear correlation between L2 and 1,3 residual mean with the negative correlation. Due to the standardized coefficient, L3 residual mean has the most influence on the postoperative effect.@*CONCLUSION@#Modified UPPP surgery removing the partial pharyngeal muscle is in favor of upgrading the postoperative effect with significantly increasing the width of postoperative nasal pharyngeal isthmus area, then there are not occur the eustachian tube dysfunction, the soft palate function, swallowing and articulation function disabled.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Follow-Up Studies , Palate, Soft , General Surgery , Pharyngeal Muscles , General Surgery , Pharynx , General Surgery , Sleep Apnea, Obstructive , General Surgery , Treatment Outcome , Uvula , General SurgeryABSTRACT
OBJECTIVE@#To analyze failure reasons of surgical treatment of obstructive sleep apnea hypopnea syndrome (OSAHS), and explore the methods of reoperation.@*METHOD@#By selecting 27 patients, who accepted surgical treatment for OSAHS and recurred, we analyzed failure reasons and obstructive location by apneagraph, nasopharyngeal 3D-CT, electronic nasopharynlaryngoscope. Among them, 14 patients accepted reoperation, such as uvulopalatopharyngoplasty (UPPP), nasoendoscopic surgery, adenoidectomy, partial glossectomy, tracheotomy were applied matching to differential obstructive location. AHI, lowest SaO2, Epworth sleepiness scale (ESS), complication were recorded after 6 months.@*RESULT@#After 6 months, their AHI decreased from 48.19 +/- 13.11 to 11.32 +/- 4. 42, ESS scores decreased from 12.93 +/- 4.60 to 4.93 +/- 1.44, P<0.05. Two of the 14 patients were cured, while the other 12 were efficient. No complications were observed.@*CONCLUSION@#Obstructive location judgement and proper surgical operation are the keys of the treatment. Preoperative AG sleep monitoring, nasopharyngeal 3D CT, electronic nasopharynlaryngoscope examination for determining blocking plane, the decision of surgery which is significant.
Subject(s)
Adult , Female , Humans , Male , Palate , General Surgery , Palate, Soft , General Surgery , Pharynx , General Surgery , Recurrence , Reoperation , Sleep Apnea, Obstructive , General Surgery , Treatment Outcome , Uvula , General SurgeryABSTRACT
Objective To summarize the clinical features,diagnosis,treatment and prognosis of hepatolithiasis complicating cholangiocarcinoma. Methods From June 1958 to March 2011,709 cases of hepatolithiasis were admitted to Department of General Surgery,Peking University Third Hospital.The cases concomitant with cholangiocarcinoma were reviewed. Results 20 of 709 (2.8％ ) hepatolithiasis cases developed cholangiocarcinoma.17 cases (85％,17/20) were followed-up for 2 years (0 - 15 years).The hepatolithiasis course before the malignant diagnosis was 15 ± 1 1 years (3 -38 years).14 cases had frequent episodes of cholangitis,15 cases had liver cirrhosis.Preoperative diagnosis was established by CT,MRCP,B-ultrasound and tumor markers in 55％ (11/20) cases.4 cases underwent radical resection,7 received palliative resection,9 cases received conservative treatment.In radical resection,one lost to follow-up,one survived one year,two for 5 years.In palliative resection,2 lost to follow-up,two survived one year,one survived 3 years, one for 5 years. None in conservative group survived more than one year.Conclusions Cholangiocarcinoma developed from hepatolithiasis with a long history,frequent cholangitis,liver cirrhosis,especially in cases with imige showing thickness of bile duct or mass and rising tumor markers (CA19-9,CA125,CEA).The cases undergoing radical resection may have a favorable prognosis.