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1.
Article in Chinese | WPRIM | ID: wpr-930964

ABSTRACT

Objective:To investigate the clinical efficacy and prognostic influencing factors of open abdomen technique for acute pancreatitis with abdominal compartment syndrome (ACS).Methods:The retrospective cohort study was conducted. The clinical data of 186 patients of acute pancreatitis with ACS who were admitted to 6 hospitals, including 65 cases in the 910th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army, 46 cases in the First Affiliated Hospital of Wenzhou Medical University, 33 cases in the Fujian Provincial Hospital, 31 cases in the Second Affiliated Hospital of Fujian Medical University, 7 cases in the People′s Hospital Affiliated to Quanzhou Medical College, 4 cases in the Shishi General Hospital, from January 2013 to December 2020 were collected. There were 142 males and 44 females, aged (43±8)years. Observation indica-tors: (1) patients conditions after being treatment with open abdomen technique; (2) analysis of clinical characteristics in patients with different treatment outcomes; (3) changing trend of the volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in patients with different treatment outcomes; (4) influencing factors for prognosis of patients. Measurement data with normal distribution were represented as Mean± SD, and compari-son between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or the continuity correction chi-square test. Repeated measurement data were analyzed using the repeated ANOVA. Spearman correlation analysis was used for correlation analyses. The COX regression model was used for univariate analysis and COX regression model with forward regression was used for multivariate analysis. Results:(1) Patients conditions after being treatment with open abdomen technique. Intra-abdominal pressure, oxygena-tion index, levels of lactic acid and sequential organ failure score of the 186 patients were (23.3±1.9)mmHg (1 mmHg=0.133 kPa), (121±24)mmHg, (5.0±3.4)mmol/L and 10.4±3.6 before the treatment with open abdomen technique and (11.2±2.9)mmHg, (222±38)mmHg, (3.2±2.1)mmol/L and 4.4±2.3 at postoperative 168 hours, showing significant differences in time effects before and after the treatment ( Ftime=855.26,208.50, 174.91,208.47, P<0.05). (2) Analysis of clinical characteristics in patients with different treatment outcomes. Of the 186 patients, 166 cases survived and were discharged, and 20 cases died during hospitalization. Age, sequential organ failure score, duration of ACS and levels of lactic acid during hospitalization before the treatment with open abdomen technique were (41±7)years, 9.4±3.4, 13(10,21)hours and (4.2±0.6)mmol/L in surviving patients, versus (45±6)years, 11.5±2.4, 65(39,84)hours and (5.2±0.5)mmol/L in dead patients, respectively, showing significant differences between them ( t=-2.10, -2.71, Z=-5.36, t=-7.16, P<0.05). Duration of postoperative acute gastro-intestinal injury, duration of continuous renal replacement therapy, time to liberation from mech-anical ventilation, duration of vasoactive drugs therapy, cases undergoing early abdominal closure, cases without intestinal fistula or with postoperative high-order intestinal fistula and low-order intestinal fistula during hospitalization after the treatment with open abdomen technique were 4(2,6)days, 4(3,7)days, 34(21,41)days, 3(2,6)days, 126, 131, 23, 12 in surviving patients, versus 13(10,17)days, 10(8,18)days, 0(0,3)days, 8(6,12)days, 1, 2, 15, 3 in dead patients, respectively, showing significant differences between them ( Z=-5.60, -3.75, -3.64, -3.06, χ2=41.43, 45.86, P<0.05). (3) Changing trend of the volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in patients with different treatment outcomes. The volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in surviving patients during hospitalization were (0.29±0.10)mL/(kg·h), (4.2±0.6)mmol/L, 0.0 kcal/(kg·d) and 9.4±3.4 before the treatment with open abdomen technique and (2.22±0.15)mL/(kg·h), (1.9±0.7)mmol/L, (20.7±2.9)kcal/(kg·d) and 3.7±2.2 at postoperative 168 hours. The above indicators in dead patients during hospitalization were (0.28±0.08)mL/(kg·h), (5.2±0.5)mmol/L, 0.0kcal/(kg·d) and 11.5±2.4 before the treatment with open abdomen technique and (0.28±0.09)mL/(kg·h), (7.7±0.8)mmol/L, (4.6±1.8)kcal/(kg·d) and 12.4±2.1 at postoperative 168 hours. There were significant differences in time effects in the above indicators in surviving patients and dead patients before and after the treatment with open abdomen technique ( Ftime=425.57, 188.59, 394.84, 37.52, P<0.05). There were interactive effects between the above indicators and the treatment outcome at different time points ( Finteraction=383.14, 233.04, 169.83, 36.61, P<0.05). There were signifi-cant differences in the change trends of the above indicators between the surviving patients and the dead patients during hospitalization ( Fgouprs=2 739.56, 877.98, 542.05, 240.85, P<0.05). (4) Influen-cing factors for prognosis of patients. Results of univariate analysis showed that age, sequential organ failure score, duration of ACS before surgery, procalcitonin, lactic acid, postoperative high-order intestinal fistula, abdominal hemorrhage, duration of postoperative acute gastrointestinal injury, duration of continuous renal replacement therapy, duration of vasoactive drugs therapy, early abdominal closure were related factors influencing prognosis of patients under-going treatment with open abdomen technique ( hazard ratio=1.07, 1.18, 1.39, 1.16, 8.25, 12.26, 2.83, 1.29, 1.56, 1.41, 0.02, 95% confidence interval as 1.00-1.15, 1.45-2.27, 1.22-1.57, 1.02-1.32, 1.75-38.90, 7.37-41.23, 1.16-6.93, 1.22-1.37, 1.23-1.99, 1.08-1.84, 0.00-0.16, P<0.05). Results of multivariate analysis showed that extended duration of ACS before surgery, postoperative high-order intestinal fistula and extended duration of postoperative acute gastrointestinal injury were independent risk factors influencing prognosis of patients undergoing treatment with open abdomen technique ( hazard ratio=1.05, 7.95, 1.17, 95% confidence interval as 1.01-1.32, 2.05-30.87, 1.13-1.95, P<0.05) and early abdominal closure was an independent protective factor ( hazard ratio=0.10, 95% confidence interval as 0.01-0.89, P<0.05). Results of Spearman correlation analysis showed that duration of ACS was positively correlated with sequential organ failure score before surgery ( r=0.71, P<0.05). Conclusions:Open abdomen technique is effective for acute pancreatitis with ACS. Extended duration of ACS before surgery, postoperative high-order intestinal fistula and extended duration of postoperative acute gastrointestinal injury are independent risk factors for prognosis of patients during hospitalization and early abdominal closure is an independent protective factor.

2.
Article in Chinese | WPRIM | ID: wpr-930247

ABSTRACT

Background:In the clinical setting, the effect of intra-abdominal hypertension on the human body is dependent on time, but its role is not yet clear.Objective:To investigate the effect of the duration of intra-abdominal hypertension (IAH) on the prognosis of critically ill patients.Methods:This prospective cohort study enrolled 256 IAH patients who were admitted to the Surgical ICU of 10 Grade A hospitals in Fujian Province from January 2018 to December 2020. The duration of IAH (DIAH) was obtained after monitoring IAP, and ICU length of stay, duration of mechanical ventilation, duration of continuous renal replacement therapy (CRRT) and average daily energy intake from enteral nutrition during ICU stay were observed and recorded. The correlation was analyzed by Spearman rank correlation. The patients were divided into the survival group and the death group according to their survival state at 60 days after enrollment. Thereafter, clinical characteristics between the two groups were compared. Multivariable logistic regression was used to study and validate the relationship between DIAH and 60-day mortality. The receiver operating characteristics (ROC) curve was established to evaluate the predictive abilities of DIAH on the mortality risk.Results:In critically ill patients, DIAH was positively correlated with duration of mechanical ventilation ( r=0.679, P<0.001), duration of CRRT ( r=0.541, P<0.001) and ICU length of stay ( r=0.794, P<0.001), respectively. In addition, there was a negative correlation between DIAH and average daily energy intake from enteral nutrition ( r=-0.669, P<0.001). After multivariable adjustment, DIAH was an independent risk factor for 60-day mortality in critically patients with IAH ( OR=1.05, 95% CI: 1.01-1.12; P = 0.012), and exhibited a linearity change trend relationship with mortality risk. The ROC curve analysis of DIAH showed that the area under ROC curve (AUC) was 0.825 (95% CI: 0.763~0.886, P<0.01). When the cut-off value was 16.5 days, the sensitivity was 78.4% and the specificity was 75.4%. Conclusions:DIAH is an important risk factor for prognosis in critically ill patients. Early identification and rapid intervention for the etiology of IAH should be performed to shorten DIAH.

3.
Article in Chinese | WPRIM | ID: wpr-868050

ABSTRACT

Objective:To explore the value of pressure-strain loop (PSL) for non-invasive quantitative assessment of left ventricular myocardial work index (GWI), global work efficiency (GWE), global constructive work (GCW), global wasted work (GWW) in the evaluation of left ventricular myocardial work in patients with hypertrophic cardiomyopathy (HCM).Methods:Thirty-one HCM patients (HCM group) and 36 healthy volunteers (control group) from December 2018 to September 2019 in Henan Provincial People′s Hospital were selected. Relevant clinical data were collected, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), left ventricular end systolic diameter (LVEDs), left atrial diameter (LAD), the maximum wall thickness (MWT), left ventricular mass index (LVMI), the global longitudinal strain (GLS), the peak strain dispersion(PSD) and GWI, GWE, GCW and GWW between the two groups were compared.Results:Compared with the control group, MWT, LAD, E/e′, LVMI in HCM group were significantly increased (all P<0.05); left ventricular myocardial functional parameters of GLS, GWI, GWE, GCW were significantly decreased, and GWW and PSD were significantly increased (all P<0.05). Left ventricular GLS, PSD and GWI, GCW, GWW, GWE have better repeatability within the observer and between observers. ICC within the observer were 0.852, 0.707, 0.917, 0.955, 0.675, 0.618, respectively. And their ICC between observers were 0.837, 0.631, 0.927, 0.944, 0.555, 0.670, respectively. Correlation analysis showed that GLS was positively correlated with GWI, GWE, and GCW ( r=0.765, 0.737, 0.815; all P<0.001), and negatively correlated with GWW and PSD ( r=-0.517, -0.606; all P<0.001). Conclusions:The left ventricular GWI, GWE and GCW decreased in HCM patients, while the GWW increased. PSL can evaluate the damage of left ventricular myocardial work in HCM patients.

4.
Article in Chinese | WPRIM | ID: wpr-865101

ABSTRACT

Objective:To investigate the prognostic factors of Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG) after radical resection with different surgical approaches.Methods:The retrospective case-control study was conducted. The clinicopathological data of 442 patients who were admitted to Tianjin Medical University Cancer Institute and Hospital from February 2003 to July 2011 were collected. There were 362 males and 80 females, aged from 21 to 85 years, with a median age of 64 years. Patients underwent radical resection of AEG. Observation indicators: (1) surgical situations; (2) follow-up; (3) progrostic factors analysis of AEG after radical resection; (4) survival of patients after radical resection of AEG via abdominal approach; (5) survival of patients after radical resection of AEG via thoracoabdominal approach; (6) survival of patients after radical resection of Siewert type Ⅱ type AEG; (7) survival of patients after radical resection of Siewert type Ⅲ AEG. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival of patients up to June 2018. Measurement data with skewed distribution were described as M (range). Count data were expressed as absolute numbers or percentages. Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-rank test was used for survival analysis. Univariate analysis was conducted using the Kaplan-Meier method. Multivariate analysis was conducted using the COX proportional hazard model. Results:(1) Surgical situations: 442 patients underwent radical resection of AEG, including 204 via abdominal approach and 238 via thoracoabdominal approach. There were 391 patients with D 2 lymphadenectomy and 51 with D 2+ lymphadenectomy. (2) Follow-up: 442 patients were followed up for 8-162 months, with a median follow-up time of 37 months. All the 442 patients survived for 2-156 months, with a median survival time of 31 months. The 1-, 3-, 5-year overall survival rates were 79.2%, 42.0%, 30.0%, respectively. (3) Prognostic factors analysis of AEG after radical resection: results of univariate analysis showed that tumor diameter, Lauren type, pathological T staging, pathological N staging, pathological TNM staging, lymphatic vessel invasion, and soft tissue infiltration were related factors for prognosis of patients after radical resection of Siewert type Ⅱ and Ⅲ AEG ( χ2=4.028, 4.885, 19.435, 17.014, 34.449, 9.707, 11.866, P<0.05). Results of multivariate analysis showed that pathological TNM staging, lymphatic vessel invasion, and soft tissue infiltration were independent influencing fators for prognosis of patients after radical resection of Siewert type Ⅱ and Ⅲ AEG ( hazard ratio=1.255, 0.486, 1.454, 95% confidence interval: 1.024-1.539, 0.325-0.728, 1.096-1.928, P<0.05). (4) Survival of patients after radical resection of AEG via abdominal approach: of the 204 patients undergoing radical resection of AEG via abdominal approach, the 1-, 3-, 5-year survival rates were 83.6%, 50.4%, 37.8% for 121 patients with Siewert type Ⅱ AEG, respectively, versus 72.0%, 39.3%, 31.8% for 83 patients with Siewert type Ⅲ AEG, showing no significant difference in the survival between the two groups ( χ2=1.854, P>0.05). (5) Survival of patients after radical resection of AEG via thoracoabdominal approach: of the 238 patients undergoing radical resection of AEG via thoracoabdominal approach, the 1-, 3-, 5-year survival rates were 79.6%, 38.8%, 23.8% for 183 patients with Siewert type Ⅱ AEG, respectively, versus 79.1%, 37.6%, 29.3% for 55 patients with Siewert type Ⅲ AEG, showing no significant difference in the survival between the two groups ( χ2=0.215, P>0.05). (6) Survival of patients after radical resection of Siewert type Ⅱ AEG: of the 304 patients with Siewert typeⅡAEG, the postoperative 1-, 3-, 5-year survival rates were 83.6%, 50.4%, 37.8% for 121 patients undergoing radical resection of AEG via abdominal approach, respectively, versus 79.6%, 38.8%, 23.8% for 183 patients undergoing radical resection of AEG via thoracoabdominal approach, showing no significant difference in the survival between the two groups ( χ2=2.406, P>0.05). (7) Survival of patients after radical resection of Siewert type Ⅲ AEG: of the 138 patients with Siewert type Ⅲ AEG, the postoperative 1-, 3-, 5-year survival rates were 72.0%, 39.3%, 31.8% for 83 patients undergoing radical resection of AEG via abdominal approach, respectively, versus 79.1%, 37.6%, 29.3% for 55 patients undergoing radical resection of AEG via thoracoabdominal approach, showing no significant difference in the survival between the two groups ( χ2=0.640, P>0.05). Conclusions:Pathological TNM staging, lymphatic vessel invasion, and soft tissue infiltration are independent fators for prognosis of patients after radical resection of Siewert type Ⅱ and Ⅲ AEG. Siewert types and surgical approach are not related factors for prognosis of patients after radical resection of AEG. There is no significant difference in the survival between patients with different Siewert types of AEG undergoing radical resection via different surgical approaches.

5.
China Pharmacy ; (12): 2247-2252, 2020.
Article in Chinese | WPRIM | ID: wpr-825656

ABSTRACT

OBJECTIVE:To analyze the occurrence of acute kidney injury (AKI)after lung transplantation and its possible influential factors . METHODS :Medical records of 64 patients who received lung transplantation in our hospital from April 2017 to June 2018 were included in this retrospective study. Patients were divided into AKI group (44 cases)and non-AKI group (20 cases),according to whether AKI occurred after operation. According to diagnostic criteria for lung transplantation in our hospital , all patients were given Methylprednisolone sodium succinate for injection or Methylprednisolone sodium succinate for injection combined with Basiliximab for injection ,and triple immunosuppressive therapy of Tacrolimus capsules+Mycophenolate mofetil dispersible tablets or Mycophenolate mofetil capsules or Mycophenolate sodium enteric-coated tablets+Methylprednisolone tablets or Prednisone acetate tablets were given after operation. The occurrence of AKI in AKI group within a week after operation were recorded. Intraoperative influential factors (operation type , operation duration , ECMO support , immune inhibitor use , intraoperative blood loss ),postoperative influential factors [days of ICU ,mechanical ventilation and ECMO support ,median value of Scr within one week after operation ,median tacrolimus concentration and the use of potential nephrotoxic drugs (≥4 kinds), hospitalization days] and survival rate one year after operation were observed in 2 groups. RESULTS :Within one week after lung transplantation,44 patients(68.8%)had experienced at least one episode of AKI ,among which 19 cases(29.7%)were stage 1, 17 cases(26.5%)were stage 2 and 8 cases(12.5%)were stage 3. The incidence of AKI was the highest on post-operative day 4 (57.4%). The incidence of AKI at stage 3 exhibited growth trend within the first week after operation ,and reached the highest on median post-operative day 5(8.7%). Operation duration ,median value of Scr within one week after operation ,median tacrolimus concentration in non-AKI group were significantly shorter or lower than AKI group ;there was no significant difference in operation type, ECMO support , use of immunosuppressive agents , intraoperative blood loss ,ICU days ,mechanical ventilation days,ECMO support days ,the utilization rate of potential nephrotoxic drugs ( ≥4 kinds) and hospitalization days between 2 groups (P>0.05). There was no statistical significance in the survival rate at stage 1 and 2 one year after operation between AKI group and non-AKI group (P>0.05). One year after operation ,survival rate of AKI group at stage 3 was significantly lower than that of non-AKI group (P<0.05). CONCLUSIONS:The incidence of AKI is high after lung transplantation. Operation duration ,median value of Scr within one week after operation ,median tacrolimus concentration were possible factors for the occurrence of AKI after operation.

6.
China Pharmacy ; (12): 2105-2110, 2019.
Article in Chinese | WPRIM | ID: wpr-817189

ABSTRACT

OBJECTIVE: To study the correlation of tacrolimus concentrations among transplant patients’ whole blood, plasma and blood cells, analyze the effects of transplant types and ages on the their correlation, and to provide reference for rational drug use in clinic. METHODS: Totally 20 patients receiving tacrolimus anti-rejection therapy after transplantation and undergoing therapeutic drug monitoring (TDM) were randomly selected. According to the type of transplantation, they were divided into renal transplantation group and lung transplantation group (10 cases for each group).  According to age, they were divided into three groups: 20-40 years old group, 41-60 years old group and 61-80 years old group (4, 9, 7 cases for each group). Their residual blood after TDM was collected. Chemiluminescence microparticle immuno assay  (CMIA) was used to detect the concentration of tacrolimus in whole blood. UPLC-MS/MS was used to measure the concentrations of tacrolimus in plasma and blood cells. Pairs plots and Spearman rank correlation analysis were used to analyze the correlation of tacrolimus between whole blood and plasma, between whole blood and blood cells, between plasma and blood cells as well as the effects of transplant types and ages on tacrolimus concentrations among tansplant patient’s whole blood, plasma and blood cells. RESULTS: The correlation of tacrolimus concentrations in whole blood and plasma (r=0.623,P<0.01) was slightly stronger than that of whole blood and blood cells (r=0.591, P<0.01); while  the correlation of tacrolimus concentration in plasma and blood cells was relatively weak (r=0.497,P<0.05). Transplant type and age had an effect on the correlation of tacrolimus concentrations among patients’ whole blood, plasma, blood cells. The correlation of tacrolimus concen- tration in whole blood, blood cells and plasma in renal transplantation group was also weak (all r<0.5), and was weaker than that in lung transplantation group. The correlation of tacrolimus concentration among whole blood, plasma and blood cells was weak in patients of aged 20-40 years old group (all r<0.3), and was weaker than that of patients of aged 41-60 years old group and 61-80 years old group. CONCLUSION: Post-transplantation patients’ tacrolimus concentrations in whole blood, plasma and blood cell have a weak correlation. Rejections and adverse effects should be monitored in these patients, especially those renal transplantation patients or those patients aged 20 to 40.

7.
Article in Chinese | WPRIM | ID: wpr-754369

ABSTRACT

Objective: To investigate the clinicopathological characteristics and prognostic factors of gastric stump cancer (GSC). Meth-ods: Clinicopathological data of 105 patients diagnosed with GSC at Tianjin Medical University Cancer Institute and Hospital between May 2004 and July 2017 were retrospectively analyzed. Results: Comparison of clinicopathological features of GSC-B and GSC-M: the average ages of the patients in the GSC-B and GSC-M groups were (63.22±8.95) and (58.93±10.06) years, respectively, and the male: fe-male ratios in the GSC-B and GSC-M groups were 17.5:1.0 and 2.6:1.0, respectively. The time intervals from initial surgery to the diag-nosis of GSC in the two groups were (390.95±95.18) and (64.53±73.15) months, respectively; the numbers of lymph nodes harvested in the GSC-B and GSC-M groups were 17.6±12.5 and 6.2±6.5, respectively; and the ratios of well differentiation to poor differentiation in the GSC-B and GSC-M groups were 0.89:1 and 0.20:1, respectively. The differences between all the above factors were statistically significant (P<0.05). Comparison of clinicopathological features of the anastomotic site group and non-anastomotic site group: there was no statistical difference between all the clinicopathological features (P>0.05). Univariate analysis showed that distant metastasis and R0 resection were prognostic factors in the patients with GSC. Multivariate analysis showed that R0 resection was an independent prognostic factor in the patients with GSC. Conclusions: The clinicopathological features of patients in the GSC-B and GSC-M groups were different. Patients with GSC would not benefit from palliative surgery if they could not receive radical surgery. R0 resection is an independent prognostic factor for patients with GSC.

8.
Article in Chinese | WPRIM | ID: wpr-806748

ABSTRACT

Objective@#To investigate the value of longitudinal strain and peak strain dispersion in the evaluation of left ventricular longitudinal strain and longitudinal strain synchrony in essential hypertensive patients with preserved ejection fraction.@*Methods@#A total of 50 essential hypertensive patients with preserved ejection fraction were collected as hypertensive group, they were divided into left ventricular hypertrophy( LVH) group (n=29) and non left ventricular hypertrophy(NLVH) group(n=21), and 26 healthy volunteers were collected as control group, two-dimensional echocardiography was performed. Peak systolic longitudinal strain(LPS), global LPS (GLPS), time to LPS (TTPLS) and longitudinal peak strain dispersion (PSD) were determined by the offline EchoPAC 201.54 software. It can automatically obtaine the bull′s-eye map of the corresponding 18-segmental LPS and TTPLS.@*Results@#Left atrial diameter (LAD) was higher in NLVH group than that in control group(P<0.05). LAD, left ventricle end-systolic diameter(LVESD), left ventricular end diastolic diameter(LVEDD), interventricular septal thickness (IVST), left ventricular mass index (LVMI) and left ventricular posterior wall thickness (LVPWT) were higher in the LVH group than those in the control group and NLVH group (all P<0.05), there was no significant differences in left ventricular ejection fraction(LVEF) among the three groups (all P>0.05). LPS and TTPLS: LPS of basal, middle, apical left ventricular segments were significantly lower and TTPLS of middle left ventricular segments were significantly longer in the LVH group than those in the control group and NLVH group (all P<0.05). LPS of middle left ventricular segments was significantly lower in the NLVH group and TTPLS of basal left ventricular segments was obviously greater in the LVH group than those in the control group (all P<0.05). PSD increased and absolute value of GLPS decreased gradually in the control group, NLVH group and LVH group(all P<0.05). There was a negative correlation between absolute value of GLPS and PSD in the hypertensive group (r=-0.61, P<0.01). Measurement of PSD had well repeatability and stability.@*Conclusions@#Longitudinal strain and PSD are promising approach to evaluate left ventricular longitudinal systolic function earlier in hypertensive patients with preserved ejection fraction. It has well repeatability and stability and it provides help for clinical diagnosis and efficacy assessment.

9.
Article in Chinese | WPRIM | ID: wpr-338406

ABSTRACT

<p><b>OBJECTIVE</b>To study the risk factor of perioperative complication in gastric cancer patients with radical therapy and its influence on prognosis.</p><p><b>METHODS</b>Clinical, pathological and follow-up data of 1 148 gastric cancer patients undergoing radical gastrectomy at Tianjin Medical University Affiliated Tumor Hospital between January 2009 and August 2011 were retrospectively collected. Pearson 2 test and Logistic regression analysis were used to analyze the risk factor of perioperative complication. Cox regression analysis was used to evaluate the influence of perioperative complications on the prognosis in patients after radical gastrectomy. Kaplan-Meier survival curve was applied to calculate the survival.</p><p><b>RESULTS</b>Of 1 148 patients, 851 were male, 297 were female, age ranged from 19 to 89 (average 59.9) years. Perioperative complication occurred in 312 cases (27.2%), including 140 cases of pulmonary infection and 53 cases of abdominal infection. Multivariate Logistic regression analysis showed that ≥65 years old (OR:0.736, 95%CI: 0.558 to 0.971, P=0.030), serum albumin less than 35 g/L(OR:2.626, 95%CI: 1.479 to 4.665, P=0.001), Borrmann type IIII((OR: 0.748, 95%CI: 0.610 to 0.917, P=0.005), tumor site at upper 1/3 of stomach (OR:1.326, 95%CI:1.167 to 1.506, P=0.000), combined organ resection(OR:0.624, 95%CI:0.428 to 0.909, P=0.014) were independent risk factors of perioperative complication. Tumor site at upper 1/3 of stomach (OR:1.649, 95%CI: 1.368 to 1.988, P=0.000), ≥65 years old (OR:0.548, 95%CI:0.379 to 0.792, P=0.001), without intraoperative chemotherapy (OR:1.671, 95%CI:1.146 to 2.437, P=0.008) were independent risk factors of perioperative pulmonary infection; Borrmann type IIII((OR:0.576, 95%CI:0.369 to 0.900, P=0.015), with intraoperative chemotherapy (OR:0.431, 95%CI:0.230 to 0.810, P=0.009), intraoperative blood loss ≥400 ml(OR:0.411, 95%CI:0.176 to 0.959, P=0.040) and combined organ resection (OR:0.412, 95%CI:0.215 to 0.789, P=0.008) were independent risk factors of perioperative intraperitoneal infection. Cox regression analysis revealed that without intraoperative chemotherapy, proximal subtotal or total gastrectomy, TNM stage III(, N3 stage lymph node metastasis, positive soft tissue outside lymph node, combined organ resection and organ failure were independent risk factors affecting the prognosis of gastric cancer patients after radical resection (all P<0.05), however the perioperative complication was not independent risk factor affecting the prognosis (P=0.259). The median survival time was 35 months, and 5-year survival rate was around 38.7%. The median survival time of gastric cancer patients with operative complications and without complications were 28.0 and 36.5 months, and the 5-year survival rates were 37.2% and 39.3%, whose difference was not statistically significant (P=0.259).</p><p><b>CONCLUSION</b>There is a higher risk of perioperative complication in those gastric cancer patients with old age, preoperative low serum albumin level, tumor site at upper 1/3 of stomach, Borrmann type IIII(, intraoperative combined organ resection, while the perioperative complication has no significant effects on the long-term survival.</p>

10.
Article in Chinese | WPRIM | ID: wpr-707717

ABSTRACT

Objective To evaluate the value of longitudinal peak strain ( GLS ) and peak strain dispersion ( PSD) in left ventricular myocardial synchrony and systolic function in patients with obstructive sleep apnea syndrome ( OSAS ) . Methods Seventy male patients with OSAS diagnosed by polysomnography and 26 healthy volunteers were enrolled in this study . According to AHI ,the OSAS patients were divided into three groups :mild group ,moderate group and severe group . Echocardiography was performed on the next day . The Left ventricular ejection fraction ( LVEF) ,diastolic blood pressure , systolic blood pressure ,left ventricular end-diastolic diameter ( LVDd) ,left ventricular end-systolic diameter ( LVDs) ,left atrial diameter ( LAD) ,interventricular septum thickness ( IVST ) ,left ventricular posterior wall thickness ( LVPW) ,global systolic longitudinal strain( GLS) and peak strain dispersion ( PSD) were compared among four groups . The correlation between GLS ,PSD and AHI were analyzed . Results ① Age , height ,weight ,body mass index ( BMI) ,LVEF ,diastolic blood pressure ,systolic blood pressure ,LVDd , LVDs ,LAD and LVPW were not statistically different among the OSAS mild ,moderate ,severe group and control group ( P > 0 .05) . IVST in severe groups was increased than that in control group ( P < 0 .05) . ②Compared with the control group and the mild group ,the PSD increased and the GLS decreased significantly in the moderate and severe groups ( P < 0 .05) ,and there was a statistically significant decrease in the GLS between the severe group and the moderate group ( P < 0 .05) . There was no statistical difference in other parameters among 4 groups ( P > 0 .05) . ③ Pearson correlation analysis showed that AHI was associated with GLS( r 2 = 0 .5026) and PSD( r 2 = 0 .6845) ( P < 0 .05) . Conclusions GLS and PSD can early evaluate the left ventricular myocardial synchrony and systolic function changes in patients with OSAS .

11.
Article in Chinese | WPRIM | ID: wpr-711409

ABSTRACT

Objective To detect and analyze the percentages of CD4+T, CD8+T and invariant na-ture killer T ( iNKT) cells as well as iNKT subsets in different tissues and organs of non-obese diabetic (NOD)/LtJ mice before the onset and in the early and late stages of type 1 diabetes (T1D) for better under-standing the immune function in different disease stages. Methods Female NOD/LtJ mice were selected as experimental subjects. Their fasting blood glucose levels were measured by blood glucose meter. Glycosuria and blood glucose level ≥11. 1 mmol/L in two consecutive detections were used as the diagnostic criteria of T1D. These mice were divided into three groups as follows: non-onset, early stage and late stage groups. Changes in food and water intake, glucose level in the urine, body weight, mental state, fur color and urine volume were recorded. Percentages of CD4+T, CD8+T and iNKT cells and ratios of subsets in peripheral blood, thymus, spleen, liver and inguinal lymph nodes were detected by flow cytometry (FACS). Results (1) Compared with the non-onset and the early stage groups, mice in the late stage group were apathetic and had rough hair. Moreover, significantly increased water and food intake and urine output (P<0. 05) and de-creased body weight, thymus index, spleen index and the absolute lymphocyte counts of spleen, liver and thymus (P<0. 05) were observed in the late stage group. (2) Compared with the non-onset group, the early stage group showed significantly increased percentages of CD4+T cells in spleen, liver, thymus and inguinal lymph nodes (P<0. 05). Compared with the early stage group, the late stage group showed decreased per-centages of CD4+T cells in liver, thymus, inguinal lymph nodes and peripheral blood (P<0. 05). Compared with the non-onset group, the percentages of CD8+T cells in the early stage group were significantly increased in spleen and thymus, but reduced in inguinal lymph nodes (P<0. 05). Compared with the early stage group, the percentages of CD8+T cells in late stage group were significantly reduced in liver and thymus, but increased in inguinal lymph nodes (P<0. 05). (3) The percentages of iNKT cells in liver and inguinal lymph nodes of mice in the early stage group were significantly higher than those of the non-onset group (P<0. 05). The percentages of iNKT cells in peripheral blood and liver of mice in the late stage group were sig-nificantly lower than those of the early stage group (P<0. 05). No significant difference in the percentages of iNKT cells in spleen and thymus was found among the three groups (P>0. 05). (4) Compared with the non-onset group, the percentages of iNKT1 subset in thymus in the early and late stage groups were significantly increased, while the percentages of iNKT2 subset were significantly decreased (P<0. 05). No significant difference in the percentages of iNKT1 and iNKT2 subsets in spleen, liver and inguinal lymph nodes was found among the three groups (P>0. 05). (5) The percentages of iNKT2 subset in spleen, liver and ingui-nal lymph nodes were significantly lower than those of the iNKT1 subset in the three groups (P<0. 05). The percentage of iNKT2 subset in thymus was significantly higher than that of iNKT1 subset in the non-onset group (P<0. 05). (6) Compared with the non-onset and the late stage groups, the early stage group showed significantly increased levels of IFN-γ, IL-4 and IL-17A and up-regulated ratio of IFN-γ/IL-4 (P<0. 05). Compared with the non-onset and the early stage groups, the late stage group showed significantly increased IL-6 level (P<0. 05). Compared with the non-onset group, IL-10 level in the other two groups was in-creased, especially in the late stage group (P<0. 05). No significant difference in IL-2 level was found among the three groups (P>0. 05). Conclusion Increased percentages of iNKT cells and iNKT1 subset in NOD/LtJ mice with early stage of T1D might be involved in the development of T1D.

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The Journal of Practical Medicine ; (24): 3185-3188, 2017.
Article in Chinese | WPRIM | ID: wpr-661323

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Objective To investigate the effect of miR-152 on ox-LDL induced cholesterol accumulation in RAW264.7 macrophages and to verify its target genes. Methods RAW264.7 macrophages were divided into two groups:miR-152 group and negative control group. Total cholesterol(TC),cholesterol ester(CE)concentra- tion and the ratio of CE/TC were observed in the two group by ox-LDL for 48 h. Furthermore,bioinformatics meth-od,dual luciferase reporter assay,real-time quantitative PCR and Western blot were applied to detect the target gene of miR-152. Results As compared with the control group,the contents of TC,CE and the ratio of CE/TC were increased in the miR-152 group. The mRNA and protein expressions of ABCA1 were significantly lower in miR-152 group. Conclusions MiR-152 could inhibit macrophage foam cell formation through decreasing the expres-sion of ABCA1.

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Article in Chinese | WPRIM | ID: wpr-611728

ABSTRACT

Objective·To investigate the role and mechanism of CaMKKβ in RAW264.7 macrophage M2 polarization induced by interleukin-4 (IL-4).Methods·IL-4 induced RAW264.7 polarization was measured by RT-PCR and ELISA.Western blotting was used to analyze the total and phosphorylated protein levels of CaMKKβ,AMPK,JAK2 and STAT3 during polarization.A lentiviral vector carrying an shRNA targeting the CaMKKβ gene was successfully constructed.The expression of M1 and M2 markers and the expression of phosphorylated AMPK,JAK2,STAT3 were detected by RT-PCR and Western blotting respectively.The protein activity ofAMPK,JAK2 and STAT3 were selectively blocked,and then the effect of IL-4 on macrophage polarization was detected by RT-PCR.Results·IL-4 significantly polarized RAW264.7 cells towards M2 macrophages (P<0.05),and the phosphorylated protein expression of CaMKKβ,AMPK,JAK2,STAT3 was significantly increased (all P<0.05).The expression of M2 markers induced by IL-4 was decreased and the phosphorylation ofAMPK,JAK2 and STAT3 was also decreased after knockdown of CaMKKβ by shRNA (all P<0.05).The polarization of macrophages to M2 was decreased after the activities of AMPK,JAK2 and STAT3 proteins were blocked respectively (all P<0.05).Conclusion·CaMKKβ promotes IL-4 induced M2 macrophage polarization via activation of AMPK/JAK2/STAT3 pathway.

14.
The Journal of Practical Medicine ; (24): 3185-3188, 2017.
Article in Chinese | WPRIM | ID: wpr-658404

ABSTRACT

Objective To investigate the effect of miR-152 on ox-LDL induced cholesterol accumulation in RAW264.7 macrophages and to verify its target genes. Methods RAW264.7 macrophages were divided into two groups:miR-152 group and negative control group. Total cholesterol(TC),cholesterol ester(CE)concentra- tion and the ratio of CE/TC were observed in the two group by ox-LDL for 48 h. Furthermore,bioinformatics meth-od,dual luciferase reporter assay,real-time quantitative PCR and Western blot were applied to detect the target gene of miR-152. Results As compared with the control group,the contents of TC,CE and the ratio of CE/TC were increased in the miR-152 group. The mRNA and protein expressions of ABCA1 were significantly lower in miR-152 group. Conclusions MiR-152 could inhibit macrophage foam cell formation through decreasing the expres-sion of ABCA1.

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The Journal of Practical Medicine ; (24): 3342-3345, 2016.
Article in Chinese | WPRIM | ID: wpr-503285

ABSTRACT

Objective To research effects of water extraction of Salvia miltiorrhiza in sperm quality of mice. Methods Forty adult male Kunming mice were randomly divided into 5 groups, including low concentration group, medium concentration group, high concentration group, control group and positive control group in eight mice in each group. The low, medium and high concentration groups were given by gavage with 1 500, 3 000 and 6 000 mg/kg water extraction of salvia miltiorrhiza once a day respectively, while the control group was given gavage with 10 mL/kg normal saline daily, as well as the positive control group was injected with 100 mg/kg cyclophosphamide once; All mice were sacrificed after 30 days. We measured the weight gain, viscera coefficient and sperm quality in each mouse. Results There were no statistical difference in the weight of every week, increase of the weight, testis and epididymis coefficients among the control group, the low, medium and high concentration groups (P > 0.05), while the weight and weight increase were significantly higher than that in the positive control group (P < 0.05). Sperm concentration, viability, morphology, motility, PR, VSL, VAP of low, medium and high concentrations group were significantly improved than the control group (P < 0.05), and the sperm quality in the four groups were higher than that in the positive control group (P < 0.05). Conclusion Water extraction of salvia miltiorrhiza can obviously improve the sperm viability, morphology, and motility of mice.

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Journal of Clinical Hepatology ; (12): 1334-1337, 2016.
Article in Chinese | WPRIM | ID: wpr-778487

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ObjectiveTo investigate the risk factors for postoperative pulmonary infection in patients with primary liver cancer through a retrospective analysis, and to provide a reference for appropriate preventive measures in clinical treatment. MethodsA total of 286 patients with liver cancer who visited Department of Hepatology, 180 Hospital of PLA, from May 2011 to December 2015 were enrolled, and according to the presence or absence of postoperative pulmonary infection, these patients were divided into infection group (36 patients) and non-infection group (250 patients). The factors for postoperative pulmonary infection were analyzed. The t-test was used for comparison of continuous data between groups, the chi-square test was used for comparison of categorical data between groups, and logistic multivariate regression analysis was used to analyze the risk factors for postoperative pulmonary infection. ResultsThe univariate analysis showed that age distribution, smoking history, diabetes, intraoperative blood transfusion volume, and the indwelling time of abdominal drainage tube showed significant differences between the two groups (all P<0.05). The multivariate analysis showed that smoking history, diabetes, intraoperative blood transfusion volume, and the indwelling time of abdominal drainage tube were independent risk factors for postoperative pulmonary infection in patients with primary liver cancer (all P<0.05). Among the anesthesia-related factors, application of single-use medical devices and perioperative antibacterial agents significantly reduced the incidence rate of postoperative pulmonary infection (both P<0.05). ConclusionSmoking history, diabetes, intraoperative blood transfusion volume, the indwelling time of abdominal drainage tube, no use of single-use medical devices during anesthesia, and no use of perioperative antibacterial agents are risk factors for postoperative pulmonary infection in patients with primary liver cancer. Corresponding preventative and treatment methods can effectively prevent the development of postoperative pulmonary infection.

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Article in Chinese | WPRIM | ID: wpr-477893

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Objective To evaluate the plasma level of miR-21 in hepatocellular carcinoma (HCC) patients and its clinical diagnostic significance .Methods Case-control study was used .The plasma level of miR-21 was measured by real-time quantitative PCR.The relative expressions of miR-21 were calculated. This study included 60 cases of patients with HCC , 71 patients with liver cirrhosis ( LC ) , 52 healthy volunteers ( HV) from January to June in 2014 in Henan Province People′s Hospital.The receiver operating characteristic ( ROC) curves were analyzed to determine the sensitivity and specificity of miR-21 expression levels in HCC diagnosis. Differences between groups were assessed by the t-test.Results Plasma microRNA-21 level in the 60 patients with hepatocellular carcinoma ( 2.6 ±1.1 ) was significantly higher than in patients with chronic hepatitis (1.6 ±0.9) and healthy volunteers (1.0 ±0.6) (t=5.322,P=0.004;t =8.349, P =0.000 3, respectively ) .Plasma microRNA-21 level in the HCC patients were positively correlated with tumor size and differentiation (tdif=3.366,P=0.019;tsize =3.490,P=0.012). ROC analysis of plasma microRNA-21 yielded an AUC of 0.796 with 70.0% sensitivity and 65.3%specificity when differentiating hepatocellular carcinoma from chronic hepatitis , and an AUC of 0.934 with 89.5% sensitivity and 81.8% specificity when differentiating hepatocellular carcinoma from healthy volunteers.Conclusion The plasma level of miR-21 in HCC patients has high specificity , and maybe help to diagnose of HCC.

18.
Article in Chinese | WPRIM | ID: wpr-601361

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Objective To establish an eukaryotic vector of monkey B virus glycoprotein D gene and analyze the expression of gD gene in human embryonic kidney 293T cells.Method First, the protein of monkey B virus glycoprotein D was obtained by gene synthesis.The gene fragments were digested with Pst I and Not I, and ligated to pEGPF-N3. Then, the recombinant plasmid pEGPF-N3-GD was transfected into 293T cells.The expression of gD protein in the cells was detected by Western blot, and the expression localization was investigated using laser scanning confocal microscopy. Results The recombinant plasmid pEGPF-N3 carrying gD gene was successfully constructed, and normally expressed in the 293T cells.Conclusions Glycoprotein D of monkey B virus is expressed successfully in the 293T cells and the protein is located on the cell surface.It may be useful for the preparation of specific recombinant antigen to the glycoprotein D of monkey B virus on cell surface, and can be also used for preparation of antigen slide for detection of monkey B virus.

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Journal of Clinical Hepatology ; (12): 1153-1156, 2014.
Article in Chinese | WPRIM | ID: wpr-499077

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Objective To profile the types of bacteria in bile culture and study their antibiotic sensitivity pattern in patients with varying de-grees of acute cholangitis and to provide data guidance for the prevention and treatment of bacterial infection.Methods The clinical data of 230 patients with acute cholangitis who were admitted to our hospital from April 2010 to April 2014 were retrospectively analyzed.Classifica-tion of pathogenic bacteria and the antibiotic sensitivity test in bile cultures were performed using VITEK 2 Compact Biomerieux microbiologi-cal system.Results Within the 230 patients,172 tested positive for biliary bacteria,and the positive rate was 74.78%(172/230).There were 237 strains of pathogenic bacteria,including 135 strains of Gram-positive bacteria (56.96%),comprised mainly of Enterococcus and Staphylococcus aureus,96 strains of Gram-negative bacteria (40.5 1%),comprised mainly of Pseudomonas aeruginosa,Escherichia coli, and Klebsiella pneumonia,and 6 strains of fungi (2.53%),comprised mainly of yeast.Significant difference in the positive rate of bacteria was detected between patients with mild and severe cholangitis (χ2 =4.58,P =0.028).Gram-negative bacteria were the predominant i-solates in patients with mild and moderate acute cholangitis,while multiple bacterial infection was more common in patients with severe cholangitis.Biliary bacteria had a higher rate of susceptibility to vancomycin,imipenem,and amikacin compared with other antibiotics. Conclusion Gram-positive bacteria are the predominant pathogens in acute cholangitis.Early detection,immediate intervention,and ac-curate drug susceptibility test should be implemented at regular intervals to direct effective clinical therapy.

20.
Article in Chinese | WPRIM | ID: wpr-600094

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Objective To investigate the effects of different doses Alpha-Linolenic acid ( ALA ) on the expressions of fatty acid synthesis-related genes in HepG2 cells.Methods HepG2 cells were divided into two groups, normal control group (NC) and high fat group (HF) in which cells were firstly cultured for 36h in the medium contained 0.5mmol/L stearic acid.Real-time quantitative PCR was taken to detect mRNA expression of genes SREBP1C, FAS and ACC which are related to fatty synthesis.While there are significant differences in fatty synthesis, 10%, 20%, 50%, 70% and 100%ALA took the place of stearic acid, 36h later, real-time quantitative PCR and Western blotting were taken to detect mRNA and protein expression of genes related to fatty synthesis.Results SREBP1C mRNA expression of ALA substitution groups were significantly lower than the high-fat group ( P <0.001) .The FAS of 0.5 mmol/L ALA group and 0.35 mmol/L ALA group were significantly lower than the high-fat group (P <0.001).ACC genes mRNA level was not significantly different from high-fat group.SREBP1C and FAS protein expression were significantly lower than the high-fat group, but ACC showed no significant difference.Conclusions Saturated fatty acids promote hepatocyte fatty acid synthesis, ALA abates fatty acid synthesis by inhibiting FAS and SREBP1C gene expression.

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