DANCR Regulates hESC Differentiation Towards Definitive Endoderm / 中山大学学报(医学科学版)

ObjectiveTo explore the function of DANCR during the differentiation of human embryonic stem cells （hESC） toward definitive endoderm （DE）. MethodsThe in vitro DE differentiation system was established and its efficiency was verified. The correlation between the expression level of DANCR and DE differentiation process was detected. Using lentivirus system， we stably knocked down DANCR in hESC. The shDANCR hESC line was applied to DE differentiation， using qPCR and Western blot to detect the expression of DE marker genes SOX17 and FOXA2， and that of primitive streak marker genes Brachyury （T）， EOMES， MIXL1 and GSC. Dual luciferase reporter assay and qPCR were used to confirm the interaction between DANCR and the WNT pathway during DE differentiation. ResultsThe in vitro differentiation system mimicked DE differentiation efficiently. And the expression of DANCR was gradually downregulated during differentiation. DANCR was efficiently knocked down in the shDANCR hESC line （P < 0.001）. Compared with those in the control group， the expression levels of primitive markers Brachyury （T）， EOMES， MIXL1 and GSC， as well as DE markers SOX17 and FOXA2， were significantly decreased in shDANCR groups （P < 0.05）. Furthermore， the transcriptional activity of the WNT pathway in shDANCR groups was lower than that in the control group （P < 0.05）. And RNA levels of downstream genes of the WNT pathway， FZD5， FZD8， SFRP1， FRZB and ANKRD6， were significantly decreased in shDANCR groups （P < 0.05）. However， differences in protein levels of the TGFβ pathway effectors SMAD2/3 and p-SMAD2 were statistically insignificant in shDANCR and control groups （P > 0.05）. Forced activation of β-CATENIN rescued DANCR knock down-induced deficiency in DE differentiation. ConclusionsThe expression of DANCR decreases during DE differentiation. DANCR may promote DE differentiation through modulating the activity of the WNT pathway.

Descarte de medicamentos e os impactos ambientais: uma revisão integrativa da literatura / Disposal of drugs and the ensuing environmental impacts: an integrative review of the literature

Resumo O objetivo deste artigo é investigar as evidências nacionais e internacionais disponíveis sobre o descarte de medicamentos e os impactos em matrizes ambientais. Trata-se de uma revisão integrativa da literatura realizada nas bases de dados PubMed, SciELO e Biblioteca Virtual em Saúde (BVS) e que incluiu artigos em inglês, espanhol e português publicados entre 2010 e 2020. Foram selecionados 26 artigos, que evidenciaram o descarte incorreto de medicamentos por profissionais e consumidores devido, principalmente, à falta de conhecimentos sobre os impactos ambientais que esses podem ocasionar. Estudos apontaram a contaminação de água, esgoto e sedimentos por fármacos descartados de forma incorreta. Além disso, observou-se que seres vivos aquáticos podem ser impactados pela presença de medicamentos em matrizes ambientais. O descarte de medicamentos incorreto ainda é uma realidade nas evidências avaliadas, que promove a contaminação de matrizes ambientais e muitas vezes não é removido por estações de tratamento de águas residuárias e interfere no equilíbrio da vida ambiental.

Abstract The scope of this article is to investigate the national and international evidence available on the forms of drug disposal and the presence of drugs in environmental matrices. It involved an integrative review of the literature conducted in the PubMed, SciELO and Virtual Health Library (VHL) databases, which included articles in English, Spanish and Portuguese published between 2010 and 2020. Twenty-six articles were selected, which revealed the incorrect disposal of medicines by professionals and consumers due mainly to the lack of knowledge about the environmental impacts that they may cause. Studies have highlighted the contamination of water, sewage and sediments by incorrectly discarded drugs. Furthermore, it was observed that aquatic living creatures can be impacted by the presence of drugs in environmental matrices. The incorrect disposal of drugs continues to be a reality in the evidence assessed, which leads to the contamination of environmental matrices and is often not removed by wastewater treatment plants and interferes with the equilibrium of environmental life.

Caracterización de las fístulas enterocutáneas posoperatorias / Characterization of Postoperative Enterocutaneous Fistulas

Introducción: Las fístulas enterocutáneas representan una enfermedad grave que deben afrontar un gran número de cirujanos durante el ejercicio de la profesión. El tratamiento suele ser extremadamente complejo y siempre requiere de una intervención multidisciplinaria adaptada para cada caso en particular. Objetivo: Evaluar las características clínico-epidemiológicas y terapéuticas de las fístulas enterocutáneas posoperatorias. Métodos: Se realizó un estudio observacional, descriptivo, con recogida prospectiva de datos en el quinquenio 2013-2017. El universo fue de 28 pacientes diagnosticados con fístula enterocutánea posoperatoria y se usaron las variables: edad, sexo, carácter de la intervención, diagnóstico operatorio, tipo de fístula, tratamiento definitivo, complicaciones y pilares de tratamiento. Resultados: La edad media fue de 49 años. Las fístulas fueron más frecuentes en el sexo femenino (53,57 por ciento). El 78,57 por ciento de los pacientes fueron intervenidos con carácter de urgencia, y el 25 por ciento tuvieron un diagnóstico operatorio de oclusión intestinal mecánica por bridas seguida de la oclusión intestinal por tumor de colon izquierdo (17,86 por ciento). La hemicolectomía izquierda con anastomosis término-terminal (21,43 por ciento) y la resección intestinal con anastomosis término-terminal (17,86 por ciento) fueron los principales procedimientos quirúrgicos realizados. Conclusiones: Las fístulas de tipo II y de bajo gasto prevalecieron en la serie de casos en una media de tiempo que se corresponde con lo reportado en la literatura. La infección del sitio quirúrgico fue la complicación más observada y los pilares del tratamiento fueron cumplidos en la mayoría de los pacientes prevaleciendo el cierre espontáneo como tratamiento definitivo(AU)

Introduction: Enterocutaneous fistulas are a serious disease that a large number of surgeons must face during the practice of their profession. Their treatment is usually extremely complex and always requires a multidisciplinary intervention adapted to each particular case. Objective: To evaluate the clinical-epidemiological and therapeutic characteristics of postoperative enterocutaneous fistulas. Methods: An observational and descriptive study was performed, with prospective data collection, in the five-year period 2013-2017. The study universe was 28 patients diagnosed with postoperative enterocutaneous fistula. The following variables were used: age, sex, nature of the intervention, operative diagnosis, type of fistula, definitive treatment, complications and treatment cornerstones. Results: The mean age was 49 years. Fistulas were more frequent in the female sex (53.57 percent). 78.57 percent of the patients underwent emergency surgery, while 25 percent had an operative diagnosis of mechanical intestinal occlusion due to adherences, followed by intestinal occlusion due to left colon tumor (17.86 percent). Left hemicolectomy with end-to-end anastomosis (21.43 percent) and intestinal resection with end-to-end anastomosis (17.86 percent) were the main surgical procedures. Conclusions: Type II and low-output fistulas prevailed in the case series at a mean time that corresponds to that reported in the literature. Surgical site infection was the most frequently observed complication, while the treatment cornerstones were fulfilled in most patients, with spontaneous closure prevailing as a definitive treatment(AU)

Delay in identification, healthcare-seeking, and definitive diagnosis of tuberculosis among students in Urumqi City from 2010 to 2019 / 预防医学

Objective@#To investigate the delay in identification, healthcare-seeking, and definitive diagnosis of tuberculosis among students in Urumqi City from 2010 to 2019, and to identify the influencing factors, so as to provide insights into tuberculosis control among students.@*Methods@#The demographic and diagnosis data of tuberculosis patients in Urumqi City from 2010 to 2019 were captured from the Tuberculosis Information Management System of Chinese Disease Control and Prevention Information System. The delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis was analyzed among students, and the factors affecting the delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis were identified using a multivariable logistic regression model. @*Results@#A total of 996 tuberculosis cases were identified among students in Urumqi City from 2010 to 2019. There were 702 students with delay in identification of tuberculosis (70.48%), 500 students with delay in healthcare-seeking (55.22%) and 534 students with delay in definitive diagnosis (53.61%). Multivariable logistic regression analysis identified active identification (OR=0.116, 95%CI: 0.032-0.420) as a factor affecting delay in identification of tuberculosis, women (OR=1.424, 95%CI: 1.104-1.836), non-local household registration (OR=1.311, 95%CI: 1.016-1.694) and active identification (OR=0.232, 95%CI: 0.064-0.848) as factors affecting delay in healthcare-seeking, and active identification (OR=0.143, 95%CI: 0.032-0.644) as a factor affecting delay in definitive diagnosis of tuberculosis among students.@*Conclusions@#There is a high proportion of delay in identification, healthcare-seeking and definitive diagnosis of tuberculosis among students in Urumqi City from 2010 to 2019, and female and non-locally household-registered students were at a high risk of delay in healthcare-seeking for tuberculosis. Active detection and screening of tuberculosis should be reinforced.

Prognostic value of pre-treatment prognostic nutrition index in patients with cervical and thoracic upper esophageal squamous cell carcinoma and radiation induced esophagitis / 中华放射肿瘤学杂志

Objective:To investigate the prognostic value of Onodera's prognostic nutrition index (PNI) before treatment in patients with cervical and upper thoracic esophageal squamous cell carcinoma (CUTESCC) undergoing definitive chemoradiotherapy (dCRT) and its predictive value in the occurrence of ≥ grade 2 radiation esophagitis (RE).Methods:The data of 163 CUTESCC patients eligible for inclusion criteria admitted to the Fourth Hospital of Hebei Medical University from January 2012 to December 2017 were retrospectively analyzed. The receiver operating characteristic (ROC) curve was used to calculate the best cut-off value of PNI for predicting the prognosis of patients. The prognosis of patients was analyzed by univariate and Cox multivariate analyses. Logistics binary regression model was adopted to analyze the risk factors of ≥ grade 2 RE in univariate and multivariate analyses. The significant factors in logistic multivariate analysis were used to construct nomogram for predicting ≥ grade 2 RE.Results:The optimal cut-off value of PNI was 48.57 [area under the curve (AUC): 0.653, P<0.001]. The median overall survival (OS) and progression-free survival (PFS) were 26.1 and 19.4 months, respectively. The OS ( χ2=6.900, P=0.009) and PFS ( χ2=9.902, P=0.003) of patients in the PNI ≥ 48.57 group ( n=47) were significantly better than those in the PNI < 48.57 group ( n=116). Cox multivariate analysis showed that cTNM stage and PNI were the independent predictors of OS ( HR=1.513, 95% CI: 1.193-1.920, P=0.001; HR=1.807, 95% CI: 1.164-2.807, P=0.008) and PFS ( HR=1.595, 95% CI: 1.247-2.039, P<0.001; HR=2.260, 95% CI: 1.439-3.550, P<0.001). Short-term efficacy was another independent index affecting PFS ( HR=2.072, 95% CI: 1.072-4.003, P=0.030). Logistic multivariate analysis showed that the maximum transverse diameter of the lesion ( OR=3.026, 95% CI: 1.266-7.229, P=0.013), gross tumor volume (GTV) ( OR=3.456, 95% CI: 1.373-8.699, P=0.008), prescription dose ( OR=3.124, 95% CI: 1.346-7.246, P=0.009) and PNI ( OR=2.072, 95% CI: 1.072-4.003, P=0.030) were the independent factors affecting the occurrence of ≥ grade 2 RE. These four indicators were included in the nomogram model, and ROC curve analysis showed that the model could properly predict the occurrence of ≥ grade 2 RE (AUC=0.686, 95% CI: 0.585-0.787). The calibration curve indicated that the actually observed values were in good agreement with the predicted RE. Decision curve analysis (DCA) demonstrated satisfactory nomogram positive net returns in most threshold probabilities. Conclusions:PNI before treatment is an independent prognostic factor for patients with CUTESCC who received definitive chemoradiotherapy. The maximum transverse diameter of the lesion, GTV, prescription dose and PNI are the risk factors for ≥ grade 2 RE in this cohort. Establishing a prediction model including these factors has greater predictive value.

Tratamiento definitivo en traumatismo avulsivo de la región cérvico-facial: presentación de caso clínico / Definitive treatment in avulsive trauma of the cervico-facial region: clinical case report

Resumen Introducción: Las lesiones autoinfligidas por armas de fuego con cañón largo en la zona cérvico-facial no siempre logran consumar el suicidio y pueden ocasionar una herida avulsiva de esta región anatómica. Objetivo: Socializar los beneficios del tratamiento multidisciplinario inmediato en la atención al paciente con traumatismo facial complejo. Caso clínico: Paciente masculino de 60 años de edad con intento autolítico por arma de fuego, con pérdida importante de tejido a nivel mandibular y compromiso de la vía aérea. Resultados: Las distintas etapas de accionar quirúrgico se lograron en las primeras cuatro horas desde que sucedió el incidente. El paciente no presentó complicaciones posoperatorias ni necesidad de una nueva operación. Discusión: En la actualidad existe la tendencia a realizar tratamiento definitivo en un solo tiempo quirúrgico inicial. Conclusión: La intervención inmediata y protocolizada de las especialidades cirugía general, maxilofacial y cirugía plástica-reconstructiva en pacientes con heridas avulsivas de la región cérvico facial pueden lograr un tratamiento definitivo en un único tiempo quirúrgico y con resultados favorables.

Introduction: Self-inflicted injuries by long-barreled firearms in the cervico-facial area do not always succeed in consummating suicide and may result in an avulsive injury of this anatomical region. Aim: Socializing the benefits of the immediate multidisciplinary treatment in the medical care of patients with complex facial trauma. Clinical case: A 60-year-old male patient with an autolytic attempt by firearm, with loss of tissue at the mandibular level, as well as airway compromise. Results: The different stages of the surgical action were achieved during the first four hours since the incident occurred. The patient was discharged without the need for a new surgical procedure. Discussion: Currently there is e tendency to perform definitive treatment in a single initial surgical procedure. Conclusión: The immediate and protocolized intervention of specialties such as General Surgery, Maxillofacial and Plastic-Reconstructive Surgery in patients with avulsive wounds of the cervical-facial region can achieve a definitive treatment in a single surgical time and with favorable results.

Progress of researches on infection with two species of Echinococcus causing human diseases in animal hosts and influencing factors / 中国血吸虫病防治杂志

Echinococcosis is a serious zoonotic parasitic disease caused by infections with larval Echinococcus. The life cycle of Echinococcus involves a variety of animal hosts, including hoofed animals and rodents as intermediate hosts and carnivores as definitive hosts. The transmission of human echinococcosis is closely associated with the life cycle of E. granulosus and E. multilocularis among animal hosts in nature. This review summarizes the recent advances in the prevalence and influencing factors of E. granulosus and E. multilocularis infections in animal hosts, so as to provide insights into precision control of echinococcosis.

Estudio transoperatorio de tumores limítrofes de ovario. Características que pueden repercutir en el diagnóstico / The intraoperative study in borderline ovarian tumors. Characteristics that can impact the diagnosis

Resumen OBJETIVO: Determinar el porcentaje de concordancia del estudio transoperatorio con el diagnóstico definitivo de tumores limítrofes de ovario. MATERIALES Y MÉTODOS: Estudio observacional, transversal, retrospectivo y descriptivo efectuado en el Hospital de Ginecoobstetricia 4 Luis Castelazo Ayala, Ciudad de México, en pacientes operadas entre el 1 de enero de 2018 y el 31 diciembre de 2020 de un tumor abdominopélvico, con examen transoperatorio de tumor limítrofe de ovario. El estudio transoperatorio se evaluó como prueba diagnóstica y el diagnóstico definitivo como patrón de referencia para establecer la concordancia del primero con el diagnóstico definitivo de tumores limítrofes de ovario. RESULTADOS: Se analizaron 68 tumores limítrofes de ovario, entre los diagnosticados en el estudio transoperatorio y el definitivo. Se encontraron 59 casos con diagnóstico definitivo de tumor limítrofe de ovario. La concordancia con el estudio transoperatorio fue de 63.2%. Se sobrediagnosticaron 2 de 68 pacientes (2.9%) y se subdiagnosticaron 23 de 68 (33.8%). CONCLUSIONES: La concordancia obtenida es semejante a lo reportado en la bibliografía internacional. Los tumores mucinosos mayores de 10 cm son subdiagnosticados con mayor frecuencia debido a su extensión.

Abstract OBJECTIVE: To determine the percentage of concordance of the transoperative study with the definitive diagnosis of borderline ovarian tumors. MATERIALS AND METHODS: Observational, cross-sectional, retrospective and des-criptive study performed at the Hospital de Gineco Obstetricia 4 Luis Castelazo Ayala, Mexico City, in patients operated between January 1, 2018 and December 31, 2020 for an abdominopelvic tumor, with transoperative examination of borderline ovarian tumor. The transoperative study was evaluated as a diagnostic test and the definitive diagnosis as a reference standard to establish the concordance of the former with the definitive diagnosis of borderline ovarian tumors. RESULTS: Sixty-eight borderline ovarian tumors were analyzed, between those diagnosed in the transoperative study and the definitive one. We found 59 cases with definitive diagnosis of borderline ovarian tumor. The concordance with the transoperative study was 63.2%. Two of 68 patients (2.9%) were overdiagnosed and 23 of 68 (33.8%) were underdiagnosed. CONCLUSIONS: The concordance obtained is like that reported in the international literature. Mucinous tumors larger than 10 cm are most frequently underdiagnosed due to their extension.

Damage control in orthopaedical and traumatology

In Orthopedics, damage control is indicated in patients with pelvic and/or long bone fractures associated with hemodynamic instability. It is inappropriate to perform a complex definitive reduction and fixation surgery for severely injured trauma patients with hemodynamic instability. In these cases, it is recommended to perform minimally invasive procedures that temporarily stabilize the fractures and bleeding control. Closed or open fractures of the long bones such as femur, tibia, humerus, and pelvis can lead to hemodynamic instability and shock. Thus, orthopedic damage control becomes a priority. However, if the patient is hemodynamically stable, it is recommended to stabilize all fractures with an early permanent internal fixation. These patients will have a shorter hospital length of stay and a reduction in mechanical ventilation, blood components transfusions and complications. Therefore, the concept of orthopedic damage control should be individualized according to the hemodynamic status and the severity of the injuries. Open fractures, dislocations, and vascular injuries could lead to permanent sequelae and complications if a correct management and approach are not performed.

En Ortopedia se indica control del daño en pacientes que presentan fracturas de pelvis y/o huesos largos asociado a condiciones generales inestables. Dada la severidad del trauma asociada a inestabilidad hemodinámica no es adecuado realizar una cirugía definitiva compleja de reducción y fijación de todas sus fracturas. En estos casos se recomienda realizar procedimientos poco invasivos que permitan estabilizar provisionalmente las fracturas, para; disminuir el dolor, controlar la hemorragia de las fracturas, obtener una alineación adecuada de los huesos fracturados y reducir las luxaciones. Estas medidas permiten controlar el daño del primer golpe para así disminuir las complicaciones. Las fracturas de los huesos largos fémur, tibia, húmero y pelvis cerradas o abiertas pueden llevar a una inestabilidad y estado de shock. Mientras que el paciente no tenga alteración hemodinámica, se recomienda estabilizar todas sus fracturas precozmente con una fijación interna que controle esta forma el daño y la necesidad de tiempo de hospitalización. Como resultado se disminuyen los días en cuidados intensivos, la ventilación mecánica, las transfusiones y las complicaciones. El concepto de control de daño para el manejo de las lesiones ortopédicas se debe individualizar de acuerdo a las condiciones generales de cada paciente y la gravedad de sus lesiones como: fracturas abiertas, luxaciones, luxación completa de la articulación sacroíliaca, luxofractura del talo, y lesiones vasculares, ya que estas lesiones requieren un manejo prioritario inicial generalmente definitivo en la mayoría de los pacientes con politraumatismo para evitar complicaciones serias futuras que pueden dejar secuelas definitivas al no recibir el tratamiento adecuado inicial.

Calidad de la biopsia hepática en 10 instituciones hospitalarias de Bogotá / Quality of liver biopsies taken in ten hospitals of Bogotá

Resumen Introducción: La biopsia hepática es la prueba de oro para el diagnóstico de las enfermedades que comprometen el hígado, una muestra adecuada y una muy buena lectura son elementos que determinan la utilidad de la prueba y el impacto en la toma de decisiones. Objetivo: Evaluar la calidad de las biopsias hepáticas a partir de la frecuencia de un diagnóstico definitivo en la lectura de las mismas y su relación con el número de espacios porta y su longitud informada. Materiales y métodos: Estudio observacional retrospectivo basado en registros, entre el 1 de enero de 2010 y el 30 de julio de 2017. Se realizó la revisión de las historias clínicas de los pacientes a quienes se les realizó biopsia hepática y se evaluó el resultado de la patología. Resultados: Se incluyeron 659 informes de patología de 10 instituciones. El porcentaje de reporte de espacios porta varió entre un 15 % y un 87,4 %, entre las instituciones. La mediana de longitud de la biopsia fue 15 mm (rango intercuartílico [RIC]: 10-20) con el valor más bajo de 1,3 (1-1,5) y el más alto de 1,8 (1,4-2) y la del número de espacios porta fue de 10 (RIC: 7-15), con el valor más bajo de 5 (1-8) y el más alto de 13 (10-17). Los diagnósticos definitivos se presentaron entre 35 % y 69 %, diagnósticos probables entre 25 % y 63 %, y sin diagnóstico entre un 5 % y 31,8 %. En el resultado de la regresión logística del diagnóstico y análisis univariado, se encontró que el número de espacios porta presentó un Odds ratio (OR) de 1,12 (intervalo de confianza [IC] 95 %: 1,05-1,19) y la longitud, OR: 1,74 (1,06-2,87); con el análisis multivariado, el número de espacios porta sigue siendo significativo (OR: 1,12 [1,02 a 1,22], p = 0,011). Conclusiones: En Bogotá existen 3 instituciones hospitalarias con adecuada calidad preanalítica en la toma de biopsias hepáticas y diagnósticos definitivos por encima del 60 %, asociados en esta serie con la presencia de un cilindro de tejido hepático de longitud y número de espacios porta adecuados. Con el análisis multivariado, el número de espacios porta presentó significancia. Se insiste en la importancia de la experiencia y entrenamiento del patólogo que evalúa la biopsia.

Abstract Introduction: Liver biopsy is the gold-standard test for the diagnosis of diseases involving the liver. An adequate sample and an accurate reading of the report are key to determine the usefulness of the test and its impact on decision-making. Objective: To assess the quality of liver biopsies based on the frequency of a "definitive diagnosis" in their report and their association with the number of portal spaces and reported length. Materials and methods: Record-based retrospective observational study, from January 1, 2010, to July 30, 2017. A review of the medical records of patients who underwent liver biopsy was performed, and the pathology result was evaluated. Results: 659 pathology reports from 10 hospitals were included. The percentage of portal space reporting varied between 15% and 87.4%. The median biopsy length was 15mm (IQR: 10-20) and the median number of portal spaces was 10 (IQR: 7-15). Definitive diagnoses were between 35% and 69%, probable diagnoses between 25% and 63%, and no diagnosis between 5% and 31.8%. The logistic regression of the diagnosis and a univariate analysis found that the number of portal spaces had an OR of 1.12 (95%CI: 1.05-1.19), while length had an OR of 1.74 (95%CI: 1.06-2.87). The multivariate analysis showed that the number of portal spaces is significant [OR: 1.12 (95%CI:1.02 to 1.22), p = 0.011]. Conclusions: In Bogotá, there are 3 hospitals with adequate pre-analytical quality of liver biopsies and definitive diagnoses above 60%, which in this series is associated with the presence of a cylinder of liver tissue of adequate length and the number of portal spaces. Multivariate analysis showed that the number of portal spaces is significant. The importance of the experience and training of the pathologist who evaluates the biopsy is stressed.

Damage control surgical management of combined small and large bowel injuries in penetrating trauma: Are ostomies still pertinent? / Cirugía de control de daños en lesiones combinadas de intestino delgado y colon en trauma penetrante: ¿Es pertinente el uso de ostomías?

Abstract Hollow viscus injuries represent a significant portion of overall lesions sustained during penetrating trauma. Currently, isolated small or large bowel injuries are commonly managed via primary anastomosis in patients undergoing definitive laparotomy or deferred anastomosis in patients requiring damage control surgery. The traditional surgical dogma of ostomy has proven to be unnecessary and, in many instances, actually increases morbidity. The aim of this article is to delineate the experience obtained in the management of combined hollow viscus injuries of patients suffering from penetrating trauma. We sought out to determine if primary and/or deferred bowel injury repair via anastomosis is the preferred surgical course in patients suffering from combined small and large bowel penetrating injuries. Our experience shows that more than 90% of all combined penetrating bowel injuries can be managed via primary or deferred anastomosis, even in the most severe cases requiring the application of damage control principles. Applying this strategy, the overall need for an ostomy (primary or deferred) could be reduced to less than 10%.

Resumen El trauma de las vísceras huecas representa una gran proporción de las lesiones asociadas al trauma penetrante. Actualmente, las lesiones aisladas de intestino delgado o colon se manejan a través de anastomosis primaria en pacientes sometidos a laparotomía definitiva o anastomosis diferida en pacientes que requieran cirugía de control de daños. El dogma quirúrgico tradicional de la ostomía se ha probado que es innecesario y en muchos casos puede aumentar la morbilidad. El objetivo de este artículo es describir la experiencia obtenida en el manejo de lesiones combinadas de vísceras huecas de pacientes con trauma penetrante. Se determinó que el manejo primario o diferido del intestino a través de anastomosis es el abordaje quirúrgico preferido en pacientes que presentan lesiones penetrantes combinadas de intestino delgado y colon. Se ha reportado que el 90% de lesiones combinadas penetrantes intestinales pueden ser manejadas a través de anastomosis primaria o diferida incluso en los casos más severos requieren la aplicación de los principios de control de daños. Aplicando esta estrategia, la tasa general para ostomía (primaria o diferida) puede ser reducida a menos del 10%.

Safety analysis of definitive surgery for chronic radiation intestinal injury / 中华胃肠外科杂志

Objective: To investigate the safety of definitive surgery for chronic radiation intestinal injury. Methods: A descriptive case series study was performed. Clinical data of 105 patients who were diagnosed as chronic radiation intestinal injury, had complete data and received definitive surgery (the radiation-induced intestinal segment and digestive tract reconstruction) at Department of Gastrointestinal Surgery of Beijing Tsinghua Changgung Hospital from June 2016 to May 2020 were retrospectively analyzed. There were 30 males (28.6%) and 75 females (71.4%) with the median age of 58 years (P25, P75: 52, 64 years). Patients who had tumor recurrence or refused surgical treatment were excluded. According to the preoperative evaluation and clinical manifestations, to select the resection range. Outcome parameters: (1) preoperative evaluation (nutrition risk assessment and status of obstruction or fistula); (2) clinical manifestations and treatment strategies; (3) details of surgical parameters; (4) postoperative complications, and Clavien-Dindo classification III to V was defined as main moderate-severe complication. Results: (1) Preoperative evaluation: Eighty-eight patients (83.8%) developed symptoms of chronic radiation intestinal injury more than 1 year after the end of radiotherapy. Ninety-eight patients (93.3%) had preoperative NRS-2002 score ≥3, 74 patients (70.5%) received preoperative parenteral nutritional support, and the median time of nutritional support was 10.5 (7.0, 16.0) days. Sixteen patients (15.2%) received small intestinal decompression tube implantation due to severe obstruction. (2) Clinical manifestations and treatment strategies: Among 105 patients, 87 (82.9%) presented with obstruction and received definitive resection of the radiation-induced intestinal segment plus one-stage digestive tract reconstruction; 18 (17.1%) presented with intestinal fistula and all of them received definitive resection of the radiation-induced intestinal segment, intestinal fistula plus one-stage digestive tract reconstruction. Among above 18 patients with fistula, 3 patients with ileorectal stump fistula received pedicled pelvic closure of greater omentum at the same time; 4 patients had ileal vesical fistula, of whom 2 patients received cystectomy and bladder repair due to preoperative nephrostomy decompression, and the other 2 patients received transection of the small intestine proximal and distal to the fistula and anastomosis of the intestinal loop without fistula resection, intestinal fistula or bladder fistula repair. (3) The details of surgical parameters: Median operative time and intraoperative blood loss was 230 (180, 300) minutes and 50 (20, 50) ml respectively. Ninety-two patients (92/105, 87.6%) underwent ileocolonic anastomosis, and anastomosis on the hepatic flexure or splenic flexure colon were performed in 88 (83.8%) and 4 (3.8%) patients respectively. Ileoileal anastomosis was performed in 13 patients (12.4%). The anastomotic site of 92 patients (87.6%) was strictly located in the contralateral quadrant of the radiation field, and the anastomotic site of 13 patients (12.4%) was far from the radiation field. Nine patients (8.6%) had more than one anastomosis, 5 patients (4.8%) had less than 180 cm of residual small intestine, 7 patients (6.7%) underwent retrograde intestinal permutation, 4 patients (3.8%) underwent abdominal wall reconstruction surgery due to abdominal wall defects, and 87 patients (82.9%) had severe abdominal pelvic adhesions (grade 3-4 adhesions). Intraoperative complications occurred in 3 patients (2.9%), which were found in time and handled properly. The median postoperative hospital stay was 13.0 (12.0, 24.5) days, and all the patients had resumed oral feeding upon discharge. (4) Postoperative complications: Fourteen patients (13.3%) had 18 major complications (grade III to V). The incidence of postoperative anastomotic leakage was 5.7% (6/105), and the incidence of anastomotic leakage for ileocolon anastomosis and ileoileal anastomosis was 2.2% (2/92) and 4/13, respectively (χ(2)=17.29, P<0.001). The incidence of postoperative anastomotic leakage of intestinal fistula and intestinal obstruction was 3/18 and 3.4% (3/87), respectively (χ(2)=4.84, P=0.028). The mortality at 30 days after operation was 1.0% (1/105), after abdominal infection and septic shock caused by postoperative anastomotic leakage resulting in multiple organ failure. Conclusion: For chronic radiation intestinal injury patients with obstruction or fistula, definitive surgical treatment is feasible and safe with acceptable major complications.

Definitive screening design combined with design space for optimizing purification process of Scutellariae Radix extract / 中国中药杂志

In the pharmacopoeia, many process parameters for the purification process of Scutellariae Radix are unclear. In this study, deterministic screening design combined with design space method was used to optimize the purification process of Scutellariae Radix extract. Nine method parameters such as mass fraction of solution(X_1), first acid precipitation pH(X_2) and first holding time(X_3) in the purification process were firstly studied by definitive screening design. The yield of baicalin was defined as the evaluation index. A stepwise regression method was used then to build quantitative models between evaluation index and method parameters and the three most critical impact parameters were determined. Probability-based design space was calculated and successfully verified with the experimental error simulation method. Finally, the second standing temperature, the first standing temperature and the pH value of the second acid precipitation were determined as the three most critical method parameters. The recommended operating space was as follows: the second standing temperature 5-7 ℃, the first standing temperature 13-15 ℃, and the pH of the second acid precipitation 1.5-1.7. Within this operating space, the baicalin yield in the purification process was over 80%, and the probability of reaching the standard was over 0.96. In this study, we optimized the effect of various parameters for the purification process of the Scutellariae Radix extract in the pharmacopoeia on the yield of baicalin and provided a reference for industrial production of the exact of Scutellariae Radix.

Evaluation of Antimicrobial Prescription in Empiric and Definitive Therapy Of Bloodstream Infections due to Salmonella spp. and Salmonella typhi

@#Introduction: As the main cause of typhoid, Salmonella spp., especially Salmonella typhi contribute to the incidence of community-acquired bloodstream infections in developing countries. Annually, there are around 20 million cases of typhoid fever and more than 150,000 deaths reported. However, several studies suggest Salmonella spp. have become resistant to some antimicrobials. This resistance to antibiotics may be caused by inappropriate antimicrobial prescriptions. Methods: This research was a descriptive observational study. Data of clinical isolates of Salmonella spp. from blood cultures and results of antimicrobial sensitivity tests were obtained from the Clinical Laboratory Installation of Dr. Sardjito General Hospital. The data were then processed and analyzed using descriptive statistics and proportion tests. Results: We obtained 14 isolates of Salmonella spp. and 11 isolates of Salmonella typhi. All of the Salmonella spp. isolates were resistant to cefazolin, but 100% of isolates were sensitive to aztreonam, ceftazidime, ciprofloxacin, etc. All of the Salmonella typhi isolates were resistant to tetracycline and cefazolin, but 100% of isolates were sensitive to aztreonam, ceftazidime, ciprofloxacin, etc. The number of inappropriate definitive antimicrobial prescriptions due to Salmonella spp. and Salmonella typhi infections at Dr. Sardjito General Hospital was 47.36% (p=0.0015;95%CI:0.2846-0.6614). The proportion of cephalosporin used as empiric therapy for bloodstream infection was 68% (95%CI:0.52-0.83). Conclusions: Significant number of inappropriate antimicrobial prescriptions in definitive treatment of bloodstream infections caused by Salmonella typhi and Salmonella spp. were found at Dr. Sardjito General Hospital in 2018. More efforts are needed to properly prescribe antimicrobials and prevent increases in antibiotic resistance microbes.

Antibiotic sensitivity profile of Klebsiella isolates and it’s impact on clinical outcome

Background: Antimicrobials are the greatest discovery of the twentieth century. To limit the emergence and spread of resistance, antibiotic therapy should be adjusted according to the results of microbiological culture. Klebsiella isolates causes various types of infections and the incidence of antibiotic resistance is also high in Klebsiella infections. So, Authors plan this study to analyze how the results of microbiological cultures influence the antibiotic use in the treatment of Klebsiella infections.Methods: It is a record based observational prospective study which assessed the impact of Klebsiella positive culture results on antibiotic prescribing pattern and its impact on clinical outcome. Patients with empirical antibiotic therapy and Klebsiella positive were included and patients with inadequate data were excluded in this study and the data were recorded. Recorded data were entered and analyzed in Microsoft Office Excel-2013. Unpaired student t-test was used to compare the mean duration of hospital stay using Past software (version 3.20).Results: There were total 400 patients in our study. Amikacin was the most common drug (n=202) used as empirical therapy. Empirical antibiotic therapy was changed in 161(40.25%) patients. Meropenem was the most commonly used definitive drug. Mean duration of hospital stay is less in empirical sensitive antibiotic therapy as compared to empirical resistance antibiotic therapy having p value <0.0001 which shows significant difference between two groups showing better clinical outcome.Conclusion: Initial empirical therapy with broad-spectrum antimicrobials is a treatment strategy for severe Klebsiella infections.

Effects of definitive repair surgery on health-related quality of life in patients with bile duct injury after laparoscopic cholecystectomy / 中华消化外科杂志

Objective@#To investigate the effects of definitive repair surgery on health-related quality of life (HRQOL) in patients with bile duct injury after laparoscopic cholecystectomy (LC).@*Methods@#The retrospective case-control study was conducted. The clinicopathological data of 181 patients with bile duct injury caused by LC for benign gallbladder diseases who underwent definitive repair surgery and 50 patients without complications after LC for benign gallbladder diseases in the Mianyang Central Hospital from January 2000 to December 2017 were collected. There were 82 males and 99 females of 181 patients with bile duct injury, aged from 31 to 68 years, with an average age of 47 years. Definitive repair surgery was performed according to different types of bile duct injury, and questionnaire of HRQOL was conducted preoperatively and one year after operation. There were 18 males and 32 females of 50 patients without complications after LC, aged from 35 to 69 years, with an average age of 41 years. Questionnaire of HRQOL was conducted on LC patients without complications one year after operation. Observation indicators: (1) classification of bile duct injury; (2) intraoperative situations of definitive repair surgery; (3) postoperative situations of definitive repair surgery; (4) follow-up; (5) results of the SF-36 scale assessment. Follow-up was conducted by outpatient examination and telephone interview up to December 2018. Patients were reexamined liver function and color Doppler ultrasonography once every 6-12 months, and further magnetic resonance cholangiopancreatography (MRCP) or computed tomography examination to detect recurrence of anastomotic biliary stricture and cholangitis. Measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was analyzed by the paired t test. Measurement data with skewed distribution were described as M (range), and count data were described as absolute numbers.@*Results@#(1) Classification of bile duct injury: of the 181 patients with bile duct injury, there were 64 cases of E1 type, 70 cases of E2 type, 35 cases of E3 type, 9 cases of E4 type, and 3 cases of E5 type. (2) Intraoperative situations of definitive repair surgery: all the 181 patinets with bile duct injury underwent definitive repair surgery successfully, including 61 undergoing end-to-end biliary anastomosis, 109 undergoing Roux-en-Y choledojejunostomy, 11 undergoing hemi-hepatectomy combined with Roux-en-Y anastomosis. There were 52 patients combined with hilar cholangioplasty. The operation time and volume of intraoperative blood loss of 181 patients were (190±126) minutes and 601.5 mL (range, 150.0-2 100.0 mL). There were 24 cases with blood transfusion and 18 cases with T-tube stent. (3) Postoperative situations of definitive repair surgery: 40 of 181 patients had complications, including 14 cases of incisional infection, 10 cases of bile leakage, 8 cases of perihepatic effusion, 7 cases of pulmonary infection, and 1 case of abdominal hemorrhage. The patient with postoperative abdominal hemorrhage underwent reoperation for hemostasis, and other patients with complications were cured after ultrasound-guided puncture and drainage or conservative treatment. Duration of postoperative hospital stay of 181 patients with bile duct injury was 12.6 days (range, 6.0-34.0 days). There was no perioperative death occurred. (4) Follow-up: 157 of 181 patients were followed up for 8.2-201.3 months, with a median follow-up time of 92.7 months. Twenty-eight patients had anastomotic stricture recurred, 16 of which were treated with reoperation, 10 were treated with endoscopic stent implantation, and 2 cases were treated with balloon dilatation in interventional department; the stricture was repaired again in all cases. Thirteen patients had recurrent cholangitis, showing no obvious anastomotic stricture on MRCP, and symptoms can be effectively controlled after conservative treatment. (5) Results of the SF-36 scale assessment: 181 patients with bile duct injury completed the SF-36 scales before definitive repair surgery, and 157 completed one year after definitive repair surgery. All the 50 patients without complications completed SF-36 scales one year after LC. The scores of HRQOL in physiological function, role functioning, somatic pain, general health, vitality, social function, emotional function, mental health, the scores of physical component summary, and mental component summary of 181 patients with bile duct injury before surgery were 79±15, 65±12, 40±17, 42±14, 59±20, 27±15, 48±23, 56±22, 60±11, and 56±11, respectively. The above indices one year after definitive repair surgery were 87±10, 78±15, 71±20, 64±20、68±19, 70±25, 67±21, 69±23, 71±13, 68±15, respectively. The above indices of 50 patients without complications one year after LC were 90±13, 81±20, 87±16, 72±20, 73±15, 86±17, 79±22, 77±19, 82±18, 79±18, respectively. The 181 patients with bile duct injury had significant elevation in above indices one year after definitive repair surgery (t=2.051, 2.016, 3.875, 3.014, 2.563, 3.225, 2.964, 2.357, 2.150, 2.203, P<0.05). The 50 patients without complications also had significant elevation in above indices one year after definitive repair surgery (t=2.817, 2.206, 3.641, 3.112, 3.202, 3.310, 3.011, 2.899, 2.150, 2.118, P<0.05). There were significant differences in the general health and mental health one year after definitive repair surgery between 181 patients with bile duct injury and 50 patients without complications (t=2.014, 2.011, P<0.05), and no significant difference in the physiological function, role functioning, somatic pain, vitality, social function, or emotional function between the two groups (t=0.852, 0.915, 0.907, 1.102, 1.284, 1.120, 0.863, 1.109, P>0.05).@*Conclusion@#Definitive repair surgery can significantly improve HRQOL in patients with bile duct injury caused by LC.

Effects of definitive repair surgery on health-related quality of life in patients with bile duct injury after laparoscopic cholecystectomy / 中华消化外科杂志

Objective To investigate the effects of definitive repair surgery on health-related quality of life (HRQOL) in patients with bile duct injury after laparoscopic cholecystectomy (LC).Methods The retrospective case-control study was conducted.The clinicopathological data of 181 patients with bile duct injury caused by LC for benign gallbladder diseases who underwent definitive repair surgery and 50 patients without complications after LC for benign gallbladder diseases in the Mianyang Central Hospital from January 2000 to December 2017 were collected.There were 82 males and 99 females of 181 patients with bile duct injury,aged from 31 to 68 years,with an average age of 47 years.Definitive repair surgery was performed according to different types of bile duct injury,and questionnaire of HRQOL was conducted preoperatively and one year after operation.There were 18 males and 32 females of 50 patients without complications after LC,aged from 35 to 69 years,with an average age of 41 years.Questionnaire of HRQOL was conducted on LC patients without complications one year after operation.Observation indicators:(1) classification of bile duct injury;(2) intraoperative situations of definitive repair surgery;(3) postoperative situations of definitive repair surgery;(4) follow-up;(5) results of the SF-36 scale assessment.Follow-up was conducted by outpatient examination and telephone interview up to December 2018.Patients were reexamined liver function and color Doppler ultrasonography once every 6-12 months,and further magnetic resonance cholangiopancreatography (MRCP) or computed tomography examination to detect recurrence of anastomotic biliary stricture and cholangitis.Measurement data with normal distribution were expressed as Mean±SD,and comparison between groups was analyzed by the paired t test.Measurement data with skewed distribution were described as M (range),and count data were described as absolute numbers.Results (1) Classification of bile duct injury:of the 181 patients with bile duct injury,there were 64 cases of E1 type,70 cases of E2 type,35 cases of E3 type,9 cases of E4 type,and 3 cases of E5 type.(2) Intraoperative situations of definitive repair surgery:all the 181 patinets with bile duct injury underwent definitive repair surgery successfully,including 61 undergoing end-to-end biliary anastomosis,109 undergoing Roux-en-Y choledojejunostomy,11 undergoing hemi-hepatectomy combined with Roux-en-Y anastomosis.There were 52 patients combined with hilar cholangioplasty.The operation time and volume of intraoperative blood loss of 181 patients were (190±126) minutes and 601.5 mL (range,150.0-2 100.0 mL).There were 24 cases with blood transfusion and 18 cases with T-tube stent.(3) Postoperative situations of definitive repair surgery:40 of 181 patients had complications,including 14 cases of incisional infection,10 cases of bile leakage,8 cases of perihepatic effusion,7 cases of pulmonary infection,and 1 case of abdominal hemorrhage.The patient with postoperative abdominal hemorrhage underwent reoperation for hemostasis,and other patients with complications were cured after ultrasound-guided puncture and drainage or conservative treatment.Duration of postoperative hospital stay of 181 patients with bile duct injury was 12.6 days (range,6.0-34.0 days).There was uo perioperative death occurred.(4) Follow-up:157 of 181 patients were followed up for 8.2-201.3 months,with a median follow-up time of 92.7 months.Twenty-eight patients had anastomotic stricture recurred,16 of which were treated with reoperation,10 were treated with endoscopic stent implantation,and 2 cases were treated with balloon dilatation in interventional department;the stricture was repaired again in all cases.Thirteen patients had recurrent cholangitis,showing no obvious anastomotic stricture on MRCP,and symptoms can be effectively controlled after conservative treatment.(5) Results of the SF-36 scale assessment:181 patients with bile duct injury completed the SF-36 scales before definitive repair surgery,and 157 completed one year after definitive repair surgery.All the 50 patients without complications completed SF-36 scales one year after LC.The scores of HRQOL in physiological function,role functioning,somatic pain,general health,vitality,social function,emotional function,mental health,the scores of physical component summary,and mental component summary of 181 patients with bile duct injury before surgery were 79±15,65±12,40±17,42±14,59±20,27±15,48±23,56±22,60±11,and 56±11,respectively.The above indices one year after definitive repair surgery were 87±10,78±15,71±20,64±20、68± 19,70 ± 25,67 ± 21,69 ± 23,71 ± 13,68 ± 15,respectively.The above indices of 50 patients without complications one year after LC were 90±13,81±20,87±16,72±20,73±15,86±17,79±22,77±19,82±18,79 ± 18,respectively.The 181 patients with bile duct injury had significant elevation in above indices one year after definitive repair surgery (t=2.051,2.016,3.875,3.014,2.563,3.225,2.964,2.357,2.150,2.203,P＜0.05).The 50 patients without complications also had significant elevation in above indices one year after definitive repair surgery (t=2.817,2.206,3.641,3.112,3.202,3.310,3.011,2.899,2.150,2.118,P＜0.05).There were significant differences in the general health and mental health one year after definitive repair surgery between 181 patients with bile duct injury and 50 patients without complications (t =2.014,2.011,P＜0.05),and no significant difference in the physiological function,role functioning,somatic pain,vitality,social function,or emotional function between the two groups (t=0.852,0.915,0.907,1.102,1.284,1.120,0.863,1.109,P＞0.05).Conclusion Definitive repair surgery can significantly improve HRQOL in patients with bile duct injury caused by LC.

Quantitative chromatographic fingerprint analysis of Sanye Tangzhiqing Decoction based on quality by design concept / 中国中药杂志

In this work,a high performance liquid chromatography-ultraviolet( HPLC-UV) detection technology was used to establish fingerprint analysis method for Sanye Tangzhiqing Decoction following an analytical quality by design( AQb D) approach. Firstly,column temperature,flow rate,and gradient elution conditions were determined as the method parameters needing to be optimized. Then according to the results of definitive screening design,three critical method attributes( CMAs) were identified,including peak number,the percentage of common peak area to total peak area,and retention time of the last peak. A stepwise regression method was used then to build quantitative models between CMAs and method parameters. Probability-based design space was calculated and successfully verified using the experimental error simulation method. After the analysis conditions were optimized,the contents of six components,namely chlorogenic acid,paeoniflorin,rutin,hyperoside,quercetin-3-O-β-D-glucuronide,and salvianolic acid B were simultaneously determined. There were 19 common peaks in the fingerprint and their common peak area accounted for 96% of the total peak area. Both fingerprint and quantitative analysis methods were validated applicable in methodology study,and they can be applied to determine new samples.

Clinical outcomes in different target volume for cervical and upper-thoracic esophageal cancer in definitive chemoradiotherapy / 中华放射医学与防护杂志

Objective To investigate the prognostic effects and failure patterns of different clinical target volumes of IMRT in definitive chemoradiotherapy for cervical and upper-thoracic esophageal cancer,in order to provide a reference for radiotherapy target area delineation.Methods A retrospective analysis was performed on the clinical data of 132 patients with cervical and upper-thoracic esophageal cancer who received definitive IMRT and concurrent chemotherapy in our hospital from 2010 to 2014.Seventy-one patients received elective nodal irradiation (ENI) and the other 61 patients received involvedfield irradiation (IFI).The Kaplan-Meier method was used to calculate local control (LC),progressionfree survival (PFS) and overall survival (OS) rates.The significant difference was evaluated by the logrank test.The prognostic factors were determined by Cox univariate and multivariate analyses.Results The last follow-up time was December 2017,the median follow-up time was 59.5 (14.2-95.8) months.Follow-up rate was 99.2％.For the ENI and IFI groups,the 1-,3-,5-year LC were 77.5％,58.8％,48.8％ vs.64.3％,29.1％,26.2％ (x2=9.68,P=0.002),PFS were 68.6％,37.7％,25.9％ vs.47.5％,17.2％,3.6％ (x2=11.39,P=0.001),OS were 81.7％,53.9％,31.3％ vs.70.5％,31.9％,16.3％ (x2=7.70,P =0.006),respectively.In multivariate analysis,T stage,N stage,and RT field were independent factors for LC,PFS and OS(P＜0.05).The total failure rates,local-regional recurrent rate in ENI group were lower than those in IFI group (x2 =13.23,5.24,P＜0.05).No significant differences were found in acute radiation esophagitis,pneumonitis and myelosuppression (Grades ≥ 3) between the two groups(P＞0.05).Conclusions Compared with IFI,ENI can significantly reduce local-regional recurrence and distant metastasis and improve the long-term survival for cervical and upper-thoracic esophageal cancer patients who received definitive chemoradiotherapy.

Radiotherapy for elderly esophageal cancer / 国际肿瘤学杂志

For resectable elderly esophageal cancer,neoadjuvant chemoradiotherapy combined with surgery is still the preferred treatment under the condition of fully measuring the patient's physical function.Definitive chemoradiation is the first choice for patients with inoperable esophageal cancer,and may be a good alternative for elderly operable patients with good response to tumor regression.For older patients (＞80 years old),radiotherapy alone may be mild and conservative enough to be the preferred option.At the same time,compared with conventional radiation dose (50.4 Gy),selective regional lymph node irradiation,standard PF regimen (cisplatin + 5-fluorouracil),radiotherapy of high dose (≥60 Gy),involving field irradiation combined with single-drug chemotherapy (such as tegio) can bring better prognosis.