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Objective To investigate the risk factors of multiple recurrent bile duct stones in patients with common bile duct (CBD) stones and received endoscopic sphincterotomy (EST ) treatment . Methods From June 1st ,2007 to June 1st ,2011 ,the patients received EST treatment were followed up , the follow‐up time was three to seven years .A total of 2 738 patients were successfully followed up , including 24 patients with two or more than two times of recurrent bile stone after EST who were enrolled in multiple recurrence group .One hundred patients without recurrence were randomly selected by table of random number as control group .The clinical data of two groups were compared by t test or Chi‐square test .The factors were analyzed with multivariate Logistic regression analysis and try to find out the risk factors of multiple recurrence .Results The comparative analysis between two groups showed that the three factors of juxtapapillary duodenal diverticula [17 .0% (17/100 ) vs 41 .7% (10/24 )] ,history of biliary tract surgery [13 .0% (13/100) vs 45 .8% (11/24)] and the angle enclosed between the horizontal portion of the CBD and the horizontal plane (angleofbile duct) less than 45° [2 .0% (2/100) vs 20 .8% (5/24)] were statistically significant (χ2 = 6 .914 、13 .37 、9 .595 ,all P < 0 .01 ) . Furthermore , logistic regression analysis indicated that juxtapapillary duodenal diverticula (B = 1 .421 ,OR = 4 .142 ,P = 0 .01) , history of biliary tract surgery (B = 1 .612 ,OR = 5 .011 ,P= 0 .004) and the angle of bile ductless than 45° (B= 2 .661 ,OR= 14 .31 ,P= 0 .005) were risk factors of multiple recurrence .Conclusion Juxtapapillary duodenal diverticula , history of biliary tract surgery , and the angle of bile duct less than 45° are independent risk factors of multiple recurrence of CBD stones .
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Objective To investigate the risk factors for recurrence of common bile duct(CBD) stones after treatment with ERCP.Methods Data of patients who underwent ERCP from July 2007 to Decem-ber 2011 for CBD stones were collected.The risk factors for recurrence including gender,age,history of chole-cystectomy,diameter of CBD,number of stones,gallstones,papillary diverticulum,lithotripsy and endoscopic nasobiliary drainage were assessed by univariate analysis and multivariate logistic regression analysis.Follow-up was conducted to retrospectively investigate stone recurrence rate.Results A total of 1 699 patients were fol-lowed up with a mean duration of 55.6 months.There were 134(7.9%)patients with stone recurrence over a mean duration of 24 months.The univariate analysis showed that diameter of CBD≥13 mm,history of cholecys-tectomy,number of stones≥2,lithotripsy were related to CBD stone recurrence.Multivariate analysis showed di-ameter of CBD≥13 mm(OR =1.607,95%CI:1.051-2.456,P =0.028),history of cholecystectomy(OR =7.101,95%CI:4.539-11.108,P =0.001),gallstones(OR =2.441,95%CI:1.417-4.206,P =0.001)were in-dependent risk factors for recurrence of CBD stones.Conclusion Diameter of CBD≥13 mm,history of chole-cystectomy,gallstones are independent risk factors for recurrence of CBD stones.
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Objective The study was aimed to detect the correlation of B cell activating factor (BAFF) promotor polymorphism-871 C/T and systemic lupus erythematosus (SLE).Methods BAFF promotor polymorphism-871 C/T was detected by the means of allele specific polymerase chain reaction (ASPCR) and agarose gel electrophoresis in 76 cases of SLE and 80 nonthrombosis normal individuals.The data of genotypic frequency and allele genotypic frequency were analyzed statistically with x2 test between the two groups.Results Fifty-one point two percent of normal individuals exhibited C/C.Thirty-five percent were heterozygous for C/T,and 13.8％ were homozygous for T/T.SLE group exhibited a different distribution pattern (30.3％ C/C,43.4％C/T,26.3％T/T).The allele frequency of T in SLE and normal individuals was 48.0％ and 31.2％ respectively.There was significant difference in the BAFF-871 C/T genotypic frequency between the SLE and nonthrombosis normal individuals (P＜0.05).Conclusion The polymorphism-871 C/T of BAFF promoter is correlated with the pathogenesis of SLE.The gene may be a major susceptible gene for SLE in Chinses Han people.Further investigations may be needed.
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Objective To investigate the clinical manifestations, etiology and risk factors of chronic pancreatitis guided by the M-ANNHEIM classification of chronic pancreatitis and to evaluate the validity and clinical significance of this classification. Methods A review of clinical data of inpatients in our hospital from December 2007 to December 2009 was conducted. The classification was carried out according to the pancreatitis were enrolled. There were 256 adult patients and 51 children and adolescent patients (age of onset<18 yr). Among these cases, 129(42%) reported a drinking history. 110 cases (35.8%) had a smoking history, 31 cases (10.1%) presented with hyperlipoidemia. 12 cases had some factors related to pancreatic duct such as pancreas divisum, pancreas trauma. There were 231 (75.2%) cases with calcification of pancreas, 45 (14.7%) with exocrine insufficiency (steatorrhea), 58 (18.9%) with endocrine dysfunction (diabetes mellitus), 32 (10.4%) underwent pancreatic surgeries, and 39 (12.7%) with pancreatic pseudocysts, biliary obstruction, pancreatic cancer and other severe complications. The M-ANNHEIM clinical staging of chronic pancreatitis was: no case in stage 0, 220(71.7%) cases in stage Ⅰ , 69(22.5%) cases in stage Ⅱ ,12(3.9%) cases in stage Ⅲ and 6 cases in stage Ⅳ. The mean value of the M-ANNHEIM score and severity index was 7.78,69 (22.5%) cases were in the minor level, 174 (56.7%) were in the increased level,62(20.2%) cases were in the advanced level. Conclusions The M-ANNHEIM classification of chronic pancreatitis is a simple, objective, accurate and noninvasive tool in clinical practice. This new classification system will be helpful for investigating the impact and interaction of various risk factors on the course of the disease.
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Objective To investigate the stent occlusion rate and its risk factor in chronic pancreatitis (CP). Methods From November 2006 to January 2010 a total of 77 pancreatic endoprostheses from 64 patients with CP were tested by simulating the pathophysiologically increased main pancreatic duct (MPD)pressure. The water flow during 15 seconds was recorded 4 times at a pressure of 10 cm water. Kaplan Meier method was used to evaluate the univariate relationship between risk factor and stent occlusion, and Cox regression survival analysis was used to evaluate the multivariate relationship between risk factor and stent occlusion. Results 64 patients with CP were included, with 43 males and 21 females, the mean age was 38 years (range, 4 ～ 80 years). The stents had been placed for a mean of 263 days ( range 26 ～ 759 days).Average stent diameter was 8F (range, 5 ～ 10 F). The overall occlusion rate was 67.5% (52/77), the nonocclusion rates at 90, 180, 360, 540 d were 96. 1% (74/77) , 72.7% (56/77) ,58.4% (45/77) and 35.1% (27/77). In the Cox regression analysis, endoprosthesis diameter ≥8.5F was shown to be the only risk factors for stent occlusion. Conclusions A significant proportion of stents placed after 180 d were not occluded, and were significantly lower than those reported from similar studies overseas. Pancreatic endoprosthesis diameter ≥8. 5F was prone to occlusion.
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Objective To investigate the value of MR multiparameter imaging for the clinical classification of chronic pancreatitis. Methods 65 patients with confirmed chronic pancreatitis by follow-up and pathologic examinations ( 14 mild, 37 moderate and 14 severe according to MANNHEIM system) and 20healthy volunteers were included in this study. MR examination including routine T1WI, T2WI, MRCP and dynamic enhanced MRI. The data were measured and statistical analysis was applied in four groups. Two radiologists assessed pancreatic duct diameter, pancreatic size, pancreatic cyst, pancreatic stone and pancreatic signal intensity on MRCP, T1-weighted and T2-weighted images. Pancreatic signal intensity were also measured on dynamic enhanced MR. Results Mean values of pancreatic signal intensity ratio on T1WI (rT1)in the pancreas were significantly reduced in patients with moderate and severe CP compared with volunteers.There was significant difference among four groups ( normal, 0. 98 ±0.27; mild, 0. 84 ±0. 12; moderate,0.81 ±0. 16; severe, 0.75 ±0.24). Mean values of pancreatic signal intensity ratio on T2WI (rT2) in the pancreas were no difference among four groups ( normal, 1.28 ± 0.3; mild, 1. 46 ± 0. 44, moderate, 1.46 ±0.55; severe, 1.76 ± 0.72). Pancreatic duct diameters were significantly increased in mild, moderate and severe CP groups [ mild (5.3 ± 2.4) mm; moderate ( 6.5 ± 3.3 ) mm; severe ( 8.1 ± 4.1 ) mm ] compared with patients without CP[ (2.0 ±0.6) mm; P < 0.01 ]. Severe degree of Cambridge classification was graded as mild in 4 (29%), moderate in 33 (89%), severe in 13 (93%). Pancreatic calcification was graded as mild in 2 ( 14% ), moderate in 11 (30%), severe in 5 (36%). Pancreatic pseudocyst was graded as mild in 0, moderate in 6 ( 16% ), severe in 3 (21.43%). Pancreatic parenchymal atrophy was graded as mild in 4 (29%), moderate in 22 (59%), severe in 10 (71%). They did not vary among CP groups. Parenchymal/arterial phase enhanced ratio (P/A) in the pancreas were significantly increased in patients with mild,moderate and severe CP (mild, 1. 10 ±0.08; moderate, 1.37 ±0.15; severe, 1.48 ±0.53) compared with patients without CP (0.88 ± 0.08, P < 0. 05 ). Significant correlation was present between the severity level of CP and the change of rT1, severe degree of Cambridge classification, the pancreatic duct diameter and P/A (r=0. 34, 0.41, 0. 62, - 0. 43; P < 0. 01 ). ROC analysis showed the presence of pancreatic duct diameters more than 2.5mm, rT1 less than 0. 8 and P/A more than 0. 8 had a sensitivity and specificity of diagnosing chronic pancreatitis of 94% and 79%, 90% and 48%, 95% and 47% respectively. Combined with the three variables, the specificity of diagnosing chronic pancreatitis can be improved to 95%.Conclusions T1-weighted, MRCP and dynamic enhanced MRI imaging can accurately evaluate the clinical severity of chronic pancreatitis. MRCP had the highest sensitivity and specificity, followed by T1-weighted and dynamic enhanced MRI imaging.
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Objective To detect the ZAP-70 and CD38 expression in these patients with chronic B lymphocytic leukemia (B-CLL) and explore their relationship and clinical significance. Methods The expressions of ZAP-70 and CD38 in bone marrow or peripheral blood of 21 patients with B-CLL were detected by flow cytometry. Results ZAP-70 was positively expressed in 9 of all patients, CD38 was positive in 8 of all patients. ZAP-70 and CD38 were both expressed in 8 patients, ZAP-70 and CD38 were none expressed in 8 patients. Conclusion CD38 and ZAP-70 expression can offer important prognostic information. Cases of B-CLL positive for ZAP-70 and CD38 indicate a worse prognosis. There is a good correlation between these new prognostic factors.
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Objective To comprehensively evaluate the curative effect and adverse effects of rituximab plus cyclophosphamide, vincristine, doxoruhicin and prednisone(R-CHOP) chemotherapy and CHOP chemotherapy alone on the treatment for low and moderate malignant B cell non-Hodgkin lymphoma (NHL). Methods By the application of the systematic review method of Cochrance International Collaboration, the world-wide randomized controlled trials (RCT) on the comparison between different curative effects of R-CHOP and CHOP chemotherapy alone on the treatment low and moderate malignant B cell NHL was collected and the study results was evaluated systematically. Results Seven RCT studies involving 1569 patients and had no heterogeneity between themselves (χ=5.31,P=0.50). The baseline of patients characteristics was comparable in all the studies. By comparing complete response (CR) rate and adverse effects through fixed effect analysis model, the results showed that R-CHOP was better than CHOP chemotherapy on the treatment for low and moderate malignant B cell NHL(OR =2.22, 95 %CI 1.72-2.85, P ＜0.000 01), and adverse events of R-CHOP had no significant difference compared with CHOP chemotherapy alone (P＞0.05). Conclusion With good curative effect on the treatment low and moderate malignant B cell NHL and without obvious differences from the CHOP chemotherapy alone in adverse effects, R-CHOP chemotherapy should be recommended as the best treatment method for low and moderate malignant B cell NHL And much more well-designed clinical RCT should be made to further prove its clinical effect.
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Objective To evaluate the risk factors of failure in pain resolution in chronic pancreatitis(CP)after endoscopic treatment.Methods We undertook a retrospective cohoa study of subjects with pain caused by CP,who underwent endoscopic treatment from January 1997 to December 2006.Cox proportional-hazards model was used for multivariate analysis of the variables that were possibly related to failure of treatment.Results Follow-up data were obtained from 172 patients(114 males and 58 females,mean age 39.4 yr.Pain resolution after endoscopic treatment was achieved in 148(86.0%).Cox proportional-hazards model showed risk factors of failure in pain resolution after endoscopic treatment were onset age(＞36 years,hazard rate(HR)=3.5),mild and moderate abdominal pain before endoscopy(HR=2.4),no decrease in amount alcohol consume(＜50%,HR=1.9)and inappropriate diet(HR=2.8).Conclusion Patients with CP should abstain from alcohol and have low-fat diet,especially for those with pain onset at older ages (＞36 years)and with mild and moderate abdominal pain before endoscopic treatment.
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Objective To investigate the long-term effect of endoscopic management of chronic pan-creatitis(CP) prospectively. Methods Based on the M-ANNHEIM diagnostic criteria of CP, the patients with CP were treated with endoscopic procedures, including papillotomy or pancreatic sphincterotomy, calcu-Ins removal, stonosis dilation and stent insertion. Pre-and post-operative incidence of acute pancreatitis (AP), abdominal pain, weight, endocrine and exocrine functions and change of pancreatic duct diameter were analyzed. Results From January 1,2006 to December 31,2007, a total of 107 patients with CP, in-cluding 74 males and 33 females, with a mean age of 41.2 years at admission, were recruited. All patients except 2 lost ones were followed up at a mean duration of 15 months (3-27 months). During the follow-up, 4 patients received surgery. Abdominal pain was completely resolved in 70 patients and partly resolved in 19 patients, with a total remission rate at 88. 1%. Insufficient endocrine funetion presented as diabetes was de-tooted in 10 patients before the treatment and no improvement was observed during the follow-up. Steatorrhea was presented in 10 patients and was resolved in 7 after the treatments. Weight gain at an average of 4 kg was achieved in 56. 4% (57/101) of the patients. No significant change in diameter of pancreatic duct was observed before and after the endoscopic procedure, which was not correlated with patient outcome. Conclusion Endoscopic managements can relieve abdominal pain and increase body weight in patients with CP.