Clinical research of Suchan-Yishen Decoction combined with conventional western medicine in treating proteinuria due to chronic glomerulonephritis / 国际中医中药杂志

Objective:To investigate the efficacy of Suchan-Yishen Decoction combined with western routine medicine on proteinuria due to chronic glomerulonephritis. Methods:A total of 86 patients with urinary protein, who met the inclusion criteria in Zhongshan people's hospital from January of 2017 to December of 2018, were selected and divided into two groups according to the random number table method with 43 patients in each group. The control group took valsartan capsule orally on the basis of conventional western medicine, and the observation group took Suchan-Yishen Decoctionon the basis of the control group. Both groups were treated continuously for two months. The CD3 +, CD4 +, CD8 + were determined by flow cytometry; the serum levels of interleukin (IL)-6, IL-17 and tumor necrosis factor (TNF)-α were determined by ELISA method. Results:The total effective rate was 88.4% (38/43) in the observation group and 67.4% (29/43) in the control group. The difference between the two groups was statistically significant ( χ2=4.324, P=0.038). After the treatment, levels of urinary protein (0.82 ± 0.13 g vs. 1.04 ± 0.17 g, t=6.009), BUN (6.12 ± 0.71 mmol/L vs. 6.60 ± 0.75 mmol/L, t=6.411) and SCr (82.87 ± 10.43 μmol/L vs. 94.11 ± 11.17 μmol/L, t=17.433) in the observation group at 24 h were all significantly lower than those of the control group ( P<0.01). After the treatment, levels of CD3 + and CD4 + in the observation group were significantly higher than those of the control group ( t values were 7.981, 8.904, respectively, all Ps<0.01), and level of CD8 + was significantly lower than that of the control group ( t=8.933, P<0.01). Serum levels of IL-6, IL-17, TNF-α in the observation group were significantly lower than those of the control group ( t values were 10.983, 49.005, 13.994, respectively, all Ps<0.01). Conclusions:The Suchan-Yishen Decoction combined with conventional western medicine can relieve the clinical symptoms of chronic glomerulonephritis patients, increase the therapeutic effect of proteinuria, correct the imbalance of T cell subgroup, and down-regulate serum levels of IL-6, IL-17, TNF-α.

Analysis of clinical diagnosis and treatment of IgG4 related pancreatitis and cholangitis / 国际外科学杂志

Objective To study the clinical features,experience of diagnosis and treatment in the IgG4 related pancreatitis and cholangitis.Methods Clinical date of sixteen cases of IgG4 related pancreatitis and cholangitis were analyzed as the observation group collecting from March 2006 to August 2016 of General Hospital of the Chinese People's Liberation Army.The clinical symptoms,imaging features and pathological findings were studied.Ten cases of bile duct carcinoma or pancreatic cancer with normal IgG4 value and no related immunodeficiency disease were selected as control group during the same period.Serum IgG4 values of two groups were observed.The patients were followed up in outpatient department after their discharged.The serum bilirubin,liver enzymes,serum IgG4,CA19-9 and CEA antibodies were checked up every 6 months,including imaging studies.The longest follow-up period was 6 years.Measurement data with normal distribution was represented as (x ± s) and comparison between the two groups was analyzed using t test.The count data were described as n (％).Results In observation group,cases with jaundice accounted for 68.75％ (11/16),abdominal pain and distension,loss of appetite and weight loss accounted for 43.75％ (7/16),62.50％ (10/16) and 37.50％ (6/16),respectively.Comparing different imaging methods,there were advantage in displaying the morphological signs of bile duct and pancreatic duct by MRCP.MRI was superior to the other methods in demonstrating pancreatic swelling and peripheral edema.Serum IgG4 value was an important basis for the diagnosis of the disease,the average value of serum IgG4 in the observation group was (105.7 ±21.6) g/L in 12 cases.The mean serum IgG4 level of 10 cases of control group (bile duct cancer and pancreatic cancer) was (9.1 ± 0.05) g/L,There was significant difference between the two groups (P =0.004).The pathological features of IgG4 associated cholangitis were massive lymphocytes,plasma cell infiltration,bile duct fibrosis,occlusive phlebitis,and IgG4 positive plasma cell infiltration.The observation group was followed up for 16 cases,12 cases survival,4 cases lost,the longest follow-up period was 6 years.Except for 3 patients who suffered jaundice again during hormone therapy,all the clinical symptoms of the remaining patients disappeared,all the indexes were normal.Conclusions The diagnosis of IgG4 related pancreatitis and cholangitis should be carefully diagnosed,serum IgG4 examination is an important criterion.The image data are an important means to confirm the diagnosis.Surgical intervention should be performed in failure of the hormone treatment.

Improvement in liver function in patients with malignant obstructive jaundice after endoscopic biliary metallic stent drainage / 临床肝胆病杂志

ObjectiveTo explore the clinical efficacy of endoscopic biliary metallic stent drainage (EBMSD) in the treatment of malignant obstructive jaundice (MOJ). MethodsA total of 48 patients with MOJ who underwent EBMSD in the General Hospital of Beijing Military Command from January 2012 to April 2014 were included in the study. Liver function parameters, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin (TBil), direct bilirubin (DBil), and glutamyl transpeptidase (GGT), were compared before and after treatment. Comparison of continuous data was made by t test. ResultsPlacement of the stent was successfully performed in 44 (91.67%) of the 48 patients; single-stent drainage was performed in 34 cases, and double-stent drainage in 10 cases. The patients had significantly reduced levels of TBil, DBil, ALT, AST, ALP, and GGT after EBMSD (all P＜0.01); the patients treated by double-stent drainage had significantly more improvements in these liver function indices than those treated by single-stent drainage (all P＜0.01). Thirty-eight cases were successfully followed up after operation, and the 3- and 6-month survival rates of these patients were 94.25% and 73.39%, respectively. ConclusionEBMSD has remarkable efficacy in the treatment of MOJ. This operation can effectively relieve jaundice and improve quality of life in MOJ patients, and double-stent drainage is superior to single-stent drainage.

Clinical analysis of 125I radioactive seeds implantation treatment in 26 cases of advanced pancreatic cancer / 国际外科学杂志

Objective To investigate the effect of iodine-125 seed implantation in the treatment of unresectable pancreatic carcinoma.Methods A total of 26 pancreatic carcinoma patients were retrospectively analyzed.Patients undergoing palliative operation in combination with iodine-125 seed implantation.jundice recovery,objective tumor response,pain relieved,clinical benefit response,median survival time and complication were investigated.Results Half of cases with jundice has reduced and totally normal in 3 weeks.Abdominal pain was relieved in 94.7％ patients,average recovery duration was (5.0 ± 1.5) d.18 cases had gastroenterol function disorder (69.2％),gastroparesis in six cases (23％) and average recover time was (16 ± 5.1) d.24 of 26 cases were follow up study,median survival time was (12 ± 5.1) months,objective tumor response was smaller than preoperation in 9,no change in 10 and 5 cases became larger than before.Conclusions Palliative operation in combination with iodine-125 seed implantation is safe and effective in the treatment of unresectable pancreatic carcinoma.

External drainage of full pancreatic juice decreases pancreatic leakage in pancreatoduodenectomy / 国际外科学杂志

Objective To summarize the results of a new pancreaticojejunostomy technique designed to decrease incidence of pancreatic leakage in pancreatoduodenectomy.Methods The clinical data of 11 cases of pancreatoduodenectomy using remnant pancreatico-jejunum end-to-end anastomosis with external drainage of full pancreatic juice was analyzed retrospectively.Briefly,5-0 bioabsorbable suture was penetrated through the pancreatic stump and stent and then circulated the pancreatic stump for 2 circles and ligated.Octreotide was not administered in any cases post-operation.Results The operation was simple and timespared.Neither pancreatic leakage nor postoperative bleeding occurred in the cases.From 4 months to 3 years following operation,no other complications were found in all cases.Conclusions The method was safe,feasible and effective to decrease incidence of pancreatic leakage in pancreatoduodenectomy.

Surgical resection of huge non-hepatic tumors in the right upper quadrant of abdomen / 中华肝胆外科杂志

Objective To study the pathology and treatment of huge nonhepatic tumors in the right upper quadrant of abdomen.Methods The clinical data of 9 patients with huge nonhepatic tumor in the right upper quadrant of abdomen treated surgically at our hospital from May 2004 to December 2009 were retrospectively analyzed.Results Preoperative imaging failed to define the tumors as nonhepatic in original in 7 patients and operation failed to recognize the origin of the tumors in 2 patients.All the tumors were successfully resected,with combined hemigastectomy in 1 patient,partial resection of the lateral wall of the infrahepatic vena cava in 2,complete resection of adipose capsule of the right kidney in 2,pancreatoduodenectomy plus transverse colectomy in 1,and transection of pancreatic duct of the body and tail of the pancreas and pancreaticojejunostomy in 1.The median operation time was 390 min (318-660 min).The median intraoperative blood loss was 2560 ml (400-6000 ml).The median intraoperative blood transfusion was 2450 ml (0 -5250 ml).The average diameter of the resected tumor was 14.5 cm (11-30 cm),and the average tumor weight was 2465 g (960-5100 g).Postoperative pathological diagnoses showed that 8 patients had malignant tumors and 1 had a potentially malignant and undifferentiated tumor (solid pseudopapillary tumor of pancreas).Perioperative pancreatic anastomotic leak occurred in 1 patient,and there were no severe postoperative complications and operative death in this series.Tumor recurrence was detected 5 months following operation in 1 patient.The 1,2-,3-year survival rates were 100％,56％,33％,respectively.One patient survived for more than 5 years.Conclusions Huge non-hepatic tumors in the right upper quadrant of abdomen could easily be misdiagnosed as hepatic neoplasms.The surgical resection rate was high.The prognosis for patients who received resectional treatment was satisfactory.

Experiences of reducing complications of post-pancreaticoduodenectomy (report of 62 cases) / 国际外科学杂志

ObjectiveTo discuss the treatment of complications post-pancreticoduedenectomy by reviewing the experiences from 62 cases.MethodsSixty-two cases of pancreticoduedenectomy from March 2001 to April 2011,mean age 59.3 ±4.1 years,were reviewed.All cases were divided into early group 24 cases and recent group (38 cases) by the difference in following aspects:perioperative management,the way of pancreatic bowel anastomosis and material choice,the vessels management,materials using in preventing leakage and bleeding.The differences in leakage,bleeding,infection,the stomach retention,biliary infections,liver abscess and incision infection in two groups were compared.ResultsThe early group showed pancreatic leakage in 10 cases,bleeding in 4 cases,celiac infection in 10 cases,gastric retention in 9 cases,biliary infections in 11 cases,liver abscess in 6 and infection of incision in 7 cases,respectively.Recent groups were in 4,0,0,0,1,2 and 3 cases,respectively.The comparisons showed the complications had reduced significantly in recent group than in the early group (x2 =77.08,P ＜ 0.001 ).ConclusionsMinimally invasive and high quality materials use,strengthening the perioperative management are the effective measures to reduce the postoperative complications.

Significance of stem cell transcription factor Nanog expression in hepatocellular carcinoma / 中华全科医师杂志

From August 2007 to April 2011,hepatocellular carcinoma (HCC) (n =40),paraHCC tissues (n =10),seminoma (n =10) and cavernous hemangioma (n =10) were selected.And the method of immunohistochemical streptavidin-perosidase was applied to detect the protein expression of Nanog.The expression ratios of Nanog were 17/40 (42％),1/10,0/10 and 5/5 in HCC,para-HCC tissues,seminoma and cavernous hemangioma respectively.Its expression showed no significant correlation with the patient gender,age,serum alpha fetoprotein (AFP),hepatitis B surface antigen (HBsAg),differentiation,Child grade and TNM stage ( P ＞ 0.05 ).It may be used as a surface marker of liver cancer stem cell.

Significance of aminopeptidase N/CD13 expression in hepatocellular carcinoma / 国际外科学杂志

Objective To study aminopeptidase N/CD13 expression in hepatocellular carcinoma and its relationship with clinical data and proguosis in patients with hepatocellular carcinoma.Methods The immunohistochemical SP method was used to detect the CD13 monoclonal antibody in 40 cases of hepatocellular carcinoma,10 cases of corresponding para-carcinoma and 10 cases of cavernous hemangioma.Results Forty cases ( 100％ ) hepatocellular carcinoma tissues were seen varying degrees of CD13 expression,3 (30％) corresponding para-carcinoma tissues were weakly positive,and 10 cases of cavernous hemangioma with no expression.The expression rate of CD13 was not significantly correlated with the patient gender,age,serum AFP value,HbsAg,differentiation,CHILD grade and TNM stage (P＞0.05).But the expression of CD13 was closely related with the patient serum AFP value,HbsAg,differentiation ( P ＜ 0.05 ).By the survival function graph we could find the expression rate was negativly correlated with survival in patients,but the expression was not significantly correlated with tumor relapse.Conclusion CD13 can be used as the surface marker of liver cancer stem cells,and it is expected to become an effective indicator of prognosis in patients with hepatocellular carcinoma.

AFP mRNA monitoring in hepatocellular carcinoma with metastasis and relapse / 国际外科学杂志

Surgical resection is the best way to treat liver cancer,but the effect of tumor with post-operational metastasis and relapse post-operational was severely restricted.Metastasis and relapse of hepatocellular carcinoma(HCC) is not only a serious threat to people' s health,but also a heavy burden to the family and society.The recognized marker of HCC now is AFP,but the lack of specificity and the bionomics limit it to be the marker of metastasis and relapse of HCC.With the developing of gene technology,AFP mRNA,the prosoma of AFP,is used as a marker of monitoring the metastasis and relapse of HCC.We review AFP mRNA monitoring in HCC with metastasis and relapse.

Complications after bile duct exploration for secondary choledocholithiasis using a combined laparoscopic and choledochoscopic approach / 中华肝胆外科杂志

Objective To study the complications after laparoscopic bile duct exploration.MethodsTwo approaches for bile duct exploration were used in 105 patients: (1) laparoscopic transcystic common bile duct exploration (LTCBDE) was used for patients with gallstones with choledocholithiasis and cystic duct dilation. No T tube was used for drainage, (2) Laparoscopic common bile duct exploration (LCBDE) was used for patients with gallstones with choledocholithiasis but without cystic duct dilation. The common bile duct was sutured primarily without T tube drainage in those patients with a small number of stones. T tube drainage was used in those patients with many stones or severe edema at the lower end of the common bile duct. ResultsWe carried out LTCBDE+ LC in 70 patients and LCBDE+LC in 35 patients, 14 patients had T tube drainage and 21 patients had no T tubes in the latter group of patients. Postoperatively, there were ascites in 17 patients (LTCBDE 6 and LCBDE 11 ), biliary peritonitis in 5 patients (1 LTCBDE and 4 LCBDE), abdominal pain in 13 patients (LTCBDE 4 and LCBDE 9), and fever in 11 patients (LTCBD 3 and LCBDE 8). All the complications responded to conservative treatment. 14 patients in the LCBDE group had residual stones.Choledochoscopy was used to remove the residual stones.There was no pancreatitis. Conclusions Adequate preoperative workup, good clinical judgment and precise treatment skill help to reduce complication rates after operation for gallstones with choledocholithiasis.

Cyctic duct dilation in bile duct exploration by laparoscope combined with choledochoscope / 国际外科学杂志

Objective To study the application of cyctic duct dilatiion in bile duct exploration through the cystic duct by laparoscope combined with choledochoscope.Methods LC + laparoscopic transcyctic common bile duct exploration were performed in gallstones combined choledocholithiasis in 70 cases.The dilation of cyctic duct was performed by gas-baloon or metal dilator in 39 cases.The dilation of cyctic duct was not performed in 31 cases.Results There was one case of bile leakage and one case of cystic duct damaging in cystic duct dilation group.One case was found bleeding in abdomen postoperation in non-dilation group.Abdominal drainage was(60 ±11)mL and(55 ±8)mL in dilation group and non-dilation group,respectively.Conclusions The dilation of cyctic duct is simple and safe to create the tunnel for common bile duct exploration through the cystic duct by choledochoscope.

Changes of morphology of cystic duct in bile duct stones secondary to choledocholithiasis / 中华肝胆外科杂志

Objective To study the morphological changes of the cyctic duct in bile duct stones secondary to choledocholithiasis.Methods The results of imaging examinations before cholecystectomy and biliary exploration with laparoscopy and cholechodoscopy were respectively analyzed in 108 patients.Meanwhile, the cystic duct morphology, diameter and dilatation during the operation were determined to investigate the features of changes in its morphology.Results Gallstones were confirmed in all of the 108 cases by B-model ultrasonography preoperatively.The gallstone was positive in common bile duct in 76 cases.Common bile duct dilatation was seen in 75 cases and cystic duct dilatation in 21.Common bile duct dilatation was found in 81 cases by MRCP and in 45 by CT.Cystic duct dilatation was found in 36 cases by MRCP and in 19 by CT.Cystic duct variety was found in 9 cases by MRCP.Laparoscopic transcyctic common bile duct exploration(LTCBDE)was performed in those patients with short and wide cystic duct.Conclusion MRCP is the effective method for considering the outlooks of the cystic duct in bile duct stones secondary to choledocholithiasis.

Regional blood flow occlusion in hepatectomy for liver neoplasms / 中华普通外科杂志

Objective To evaluate regional blood flow occlusion (RBFO) in hepatectomy for liver neoplasms. Methods In this study, hepatic tumors were resected under RBFO in 28 cases (RBFO group), and under Springle's technique (control group) in 24 cases. The Child-Pugh classifications of liver function were grade A in all patients. The ligature ribbon was put in liver parenchyma around tumor to block the blood supply before resecting the tumor under guiding of B sounography in RBFO group. Anesthesia time, blood loss and transfusion, hospitalization, change of liver function and complications were compared between the two groups. Results Blood loss, anesthesia time and postoperative hospital stay were (340±92) ml, (98.4±25.0) min, ( 10.2±2.3 ) d in RBFO group and (620±124) ml, ( 135.8±47.5 ) min, (16.5±5.1 ) d, respectively, in control group, differences were all significant between the two groups (P <0.01, t = 9.222,9.328 and 5.875, respectively). On post-op day 2, ALT (U/L) was (378.4±35.2) vs. (539.2±115.4) (t=7.012, P<0.01), TBIL (37.5±11.2) vs. (51.8±29) mmol/L(t=8.818, P<0.01),PT (17.4±2.4) vs. (20.4±2.8) see(t =4.16, P<0.01) in RBFO group and control group, respectively. ALT was (57.1±15.5) vs. (98.1±21.2) U/L(t =8.039),TBIL (25.4±4) vs. (46.3±13) mmol/L(t=8.085),PT (13.2±4.2) vs. (15.7±2.2) see (t=2.621)on post-op day 7 respectively, again the differences were all significant between the two groups (all P<0.01). Conclusion Regional blood flow occlusion is an effective technique to control blood loss during hepatectomy for liver neoplasms.

Effects of liver compression on intrahepatic iodine solution dissemination in rats / 国际外科学杂志

Objective To study the regulation of iodine solution dissemination through the portal vein duo to compression of liver tissue in SD rat models.Methods SD rats were divided into three groups:liver segment blocking group,non-liver segment blocking group and placebo group.Right anterior segments of liver were blocked by blocking ribbon before the compression of liver tissue in liver segment blocking group,the liver tissue was pressed in 20 times.The procedures were all the same with blocking groups in non-liver segment blocking group except that the liver tissue is free from blocking.Placebo group only was opened and closed the abdomens.The iodine solution was injected into the liver tissue in right anterior segments and iodine ball should be confirmed under the X-ray in every experimental rats.The severity of the iodine predations in the liver was divided into four degree:Degree A indicated the iodine ball was in situ;no predations;Predations were in right anterior segments only in degree B;Degree C was found iodine spots in other liver segments except right anterior segments;Degree D indicated iodine spread to other organs.The iodine balls were pressed under the pressure between 10 and 15 mm Hg.Results Majority of iodine balls(36/45,80%)were formed successfully in liver tissues.Compression of the iodine balls in liver tissues can cause iodine predations in the vessels in liver.The severity of the dissemination was related to the pressure and the range of the pressings.The blocking of the liver segments before the operation can reduce the predations of iodine.Conclusion Pressing of the liver tissue can caused the iodine balls disseminate in vessels,cancer cells or cause thrombus disseminate in the vessels,Which can be reduced by avoiding the compression of the liver or tumom during the operation.

Color Doppler flow imaging in relative factors influencing recurrence of liver cancer after hepatectomy / 中华超声影像学杂志

Objective To assess the value of color Doppler flow imaging (CDFI) in indicating the recurrence and prognosis of liver cancer.Methods Two hundred and eighty-seven patients with primary liver cancer were enrolled,thirty-seven cases received operations ( 12.9% ).The size,profile,margin,echogen,blood supply of the tumors were observed preoperatively by CDFI. Twenty-eight patients were followed for 0.5 to 5 years.Results Recurrent nodules were seen in 24 cases (85.7%) during five years.Lesions larger than 5 cm recurred much earlier than those less than 5 cm in the diameter of the patients( P