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Objective To explore the antimicrobial resistance of carbapenem-resistant Klebsiella pneumoniae(CRKP)isolated from blood and the related risk factors for infection in patients.Methods Clinical data of 383 KP-infected patients from whose blood Klebsiella pneumoniae(KP)were isolated during hospitalization period in a hos-pital from January 2018 to December 2021 were retrospectively analyzed.Patients were divided into CRKP group(n=114)and non-CRKP group(n=269)based on antimicrobial resistance.According to the prognosis,114 patients in the CRKP group were subdivided into the death group(n=30)and the survival group(n=84).General informa-tion,underlying diseases,antimicrobial use,and infection outcomes of two groups of patients were compared,and risk factors for infection and death after infection were analyzed.Results The resistance rates of KP to tigecycline and compound sulfamethoxazole showed upward trends,with statistically significant differences(both P=0.008).The CRKP group had higher resistance rates to amikacin,aztreonam,compound sulfamethoxazole,ciprofloxacin,cefepime,cefoperazone/sulbactam,piperacillin/tazobactam,tigecycline,ceftazidime,tobramycin,and levofloxacin,as well as higher in-hospital mortality than the non-CRKP group,with statistically significant differences(all P＜0.05).Acute pancreatitis prior to infection(OR=16.564,P＜0.001),hypoalbuminemia(OR=8.588,P＜0.001),stay in in-tensive care unit prior to infection(OR=2.733,P=0.017),blood transfusion(OR=3.968,P=0.001),broncho-scopy(OR=5.194,P=0.014),surgery within 30 days prior to infection(OR=2.603,P=0.010),and treatment with carbapenems(OR=2.663,P=0.011)were independent risk factors for the development of CRKP blood-stream infection(BSI).Cardiac insufficiency before infection(OR=11.094,P=0.001),combined with pulmonary infection(OR=20.801,P=0.010),septic shock(OR=9.783,P=0.002),disturbance of consciousness(OR=11.648,P=0.001),and receiving glucocorticoid treatment(OR=5.333,P=0.018)were independent risk factors for mortality in patients with CRKP BSI.Conclusion The resistance rate of KP from BSI to tigecycline and com-pound sulfamethoxazole presents upward trend.Underlying diseases,invasive procedures,and carbapenem treat-ment are closely related to CRKP BSI.Cardiac insufficiency,pulmonary infection,septic shock,disturbance of con-sciousness,and glucocorticoid treatment can lead to death of patients with CRKP BSI.
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Although it has become a consensus in the field of colorectal surgery to perform radical tumor treatment and functional protection under the minimally invasive concept, there exist many controversies during clinical practice, including the concept of embryonic development of abdominal organs and membrane anatomy, the principle of membrane anatomy related to right hemicolectomy, D3 resection, and identification of the inner boundary. In this paper, we analyzed recently reported literature with high-level evidence and clinical data from the author's hospital to recognize and review the membrane anatomy-based laparoscopic assisted right hemicolectomy for right colon cancer, emphasizing the importance of priority of surgical dissection planes, vascular orientation, and full understanding of the fascial space, and proposing that the surgical planes should be dissected in the parietal-prerenal fascial space, and the incision should be 1 cm from the descending and horizontal part of the duodenum. The surgery should be performed according to a standard procedure with strict quality control. To identify the resection range of D3 dissection, it is necessary to establish a clinical, imaging, and pathological evaluation model for multiple factors or to apply indocyanine green and nano-carbon lymphatic tracer intraoperatively to guide precise lymph node dissection. We expect more high-level evidence of evidence-based medicine to prove the inner boundary of laparoscopic assisted radical right colectomy and a more rigorous consensus to be established.
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Humanos , Laparoscopia/métodos , Neoplasias do Colo/patologia , Excisão de Linfonodo/métodos , Colectomia/métodos , DissecaçãoRESUMO
Objective To explore the protective effects and mechanisms of cysteinyl leukotriene 2(CysLT2)receptor antagonist HAMI3379 on cerebral ischemia injury in rats.Methods 30 male SD rats were randomly divided into sham operation group,model group,and HAMI3379 group,with 10 rats in each group.The rats of model group were subjected to middle cerebral artery occlusion(MCAO)to construct the cerebral ischemia injury model,while HAMI3379 group received intraperitoneal injection of HAMI3379(0.2 mg/kg)before and after MCAO 30 min.The rats after cerebral ischemia injury were scored for neurological symptoms.The infarction volume of rats was observed by TTC staining,the activation marker Iba1 of microglia was detected by immunofluorescence staining,the mRNA level of M1/M2 polarized phenotype molecules of microglia was detected by Real-time PCR,the number of neurons was observed by NeuN staining,and neuronal degeneration was observed by Fluoro-Jade B staining.Western blotting assay was used to detect the expression of CysLT2 protein and nuclear factors κB-related protein Cα(PKCα),IκBα,p65 and p50 proteins in brain tissue.Results Compared with sham operation group,the neurological symptom score and cerebral infarction volume of model group were significantly increased(P<0.05).Compared with model group,the neurological symptom score and cerebral infarction volume of HAMI3379 group were significantly decreased(P<0.05).The results of immunofluorescence staining showed that the expression of microglia activation marker Iba1 was increased in brain tissue of rats after cerebral ischemia injury(P<0.05).Compared with sham operation group,mRNA expression of M1 polarized molecules(CD86,IL-1β,TNF-α)and M2 polarized molecules(CD206,TGF-β,IL-10)were significantly increased in the ischemic central brain tissue of model group(P<0.05).Compared with model group,the expression of M1 polarized molecules in HAMI3379 group was significantly downregulated(P<0.05),while the expression of M2 polarized molecules was significantly upregulated(P<0.05).Compared with sham operation group,the expressions of PKCα,IκBα,p65 and p50 in brain tissue of model group were significantly up-regulated(P<0.05);compared with model group,the expressions of PKCα,IκBα,p65,and p50 in HAMI3379 group were significantly down-regulated(P<0.05).The NeuN staining results showed that the number of neurons in the brain tissue of model group was decreased when compared with sham operation group(P<0.05),while the number of degenerated neurons was increased(P<0.05).Compared with model group,the number of neurons in HAMI3379 group was increased(P<0.05),while the number of degenerated neurons was decreased(P<0.05).Conclusions CysLT2 receptor antagonist HAMI3379 may regulate PKCα/IκBα/NF-κB signaling pathway,inhibits M1 polarization activation of microglia and promotes its transition to M2 polarization,inhibits neuronal degeneration,and plays a neuroprotective role.
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Objective:To explore the risk factors and prognosis of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection for inpatients in hepatobiliary surgery. Methods:The clinical data of patients with Klebsiella pneumoniae infection admitted to the Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital from January 2016 to December 2020 were retrospectively analyzed. For each patient with CRKP infection, two patients with non-carbapenem-resistant Klebsiella pneumoniae (non-CRKP) infection were selected for matching. A total of 720 patients with Klebsiella pneumoniae infection were involved, including 444 males and 276 females, aged (58.0±11.6) years old. According to the infection conditions, they were divided into two groups: CRKP group ( n=240) and non-CRKP group ( n=480). The 240 CRKP patients were divided into two subgroups according to their prognosis: death group ( n=34) and survival group ( n=206). The general information, laboratory test results, antibiotic use and infection outcomes of patients were recorded to analyze the risk factors of infection and death after infection. Results:Acute pancreatitis ( OR=3.473, 95% CI: 1.844-6.541), chronic cardiovascular disease before infection ( OR=2.028, 95% CI: 1.228-3.347), chronic renal failure ( OR=1.873, 95% CI: 1.142-3.073), hypoalbuminemia ( OR=3.060, 95% CI: 1.869-5.010), use of carbapenems ( OR=3.882, 95% CI: 2.518-5.985), admission to intensive care unit ( OR=1.783, 95% CI: 1.034-3.075) and surgery within 30 days before infection ( OR=13.463, 95% CI: 7.482-24.223) were independent risk factors for CRKP infection inpatients in hepatobiliary surgery(all P<0.05). Chronic respiratory disease before infection ( OR=3.784, 95% CI: 1.420-10.089), mechanical ventilation ( OR=5.085, 95% CI: 1.436-18.011), disturbance of consciousness ( OR=40.710, 95% CI: 3.564-464.943), hormone therapy ( OR=14.977, 95% CI: 3.819-58.743) and treatment of quinolone antibiotics ( OR=4.102, 95% CI: 1.226-13.726) were independent risk factors for death of inpatients with CRKP infection in hepatobiliary surgery (all P<0.05). The resistance of amikacin, tobramycin, ceftazidime, cefepime, aztreonam, ciprofloxacin, levofloxacin, co-sulfamethoxazole and piperacillin/tazobactamand in CRKP group were significantly different compared with non-CRKP group (all P<0.05). Conclusion:The occurrence of CRKP infection for inpatients in hepatobiliary surgery is related to various factors such as underlying diseases, antibiotic use and self-barrier destruction, and these factors affect the infection outcome of patients.
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@#AIM: To investigate the therapeutic effect of 23G vitrectomy system used in children with congenital cataracts.<p>METHODS: From November 2017 to December 2018, 11 children(19 eyes)aged 3-8 years old with congenital cataract were recruited in the Department of Ophthalmology, the First Affiliated Hospital of Hainan Medical University. 23G vitrectomy instruments were used to enter the anterior chamber through the incision at the corneal limbus, and complete ring resection of anterior capsule, cataract aspiration, intraocular lens implantation, and ring resection of posterior capsule combined with anterior vitrectomy. The visual acuity, intraocular pressure and ocular conditions of the children were observed during 3-24mo of follow-up.<p>RESULTS: All the surgeries were uneventful. During the surgeries, the anterior chambers were stable, the ring resections of lens capsules were accurate, and the IOLs were implanted at the 1<sup>st</sup> phase. The postoperative visual acuity was significantly improved compared with that before surgery. Only 1 patient had intraocular pressure higher than 25mmHg after surgery, which was controlled within the normal range after medication was given. During the follow-up period, all the children had clear corneas, no anterior chamber hemorrhage, no pupil deformation, the intraocular lens was in the center and the right position, the optic axis was transparent, and no obvious complications occurred.<p>CONCLUSION: The 23G vitrectomy system is safe and effective for the surgery of congenital cataract, it can achieve little trauma, accurate lens capsule resection, little postoperative reaction and few complications.
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OBJECTIVE@#To compare the clinical efficacy of distal radius T-plate combined with suture anchor and distal clavicle anatomical locking plate combined with suture anchor in the treatment of Neer Ⅱb distal clavicle fracture.@*METHODS@#From June 2014 to June 2018, 42 patients with Neer Ⅱb distal clavicle fractures were retrospectively analyzed. According to different surgical methods, they were divided into the observation group (T-shaped plate combined with suture anchor) and the control group (anatomical locking plate combined with suture anchor). There were 22 patients in the observation group and 20 patients in the control group. In the observation group, there were 13 males and 9 females, aged from 22 to 70 (45.78± 14.44) years old, 12 cases on the left side and 10 cases on the right side, 8 cases of traffic accident injury and 14 cases of fall. In the control group, there were 12 males and 8 females, aged from 24 to 66 (44.17±15.58) years, 13 cases on the left side and 7 cases on the right side, 6 cases of traffic accident injuryand 14 cases of fall. The operation time, intraoperative blood loss and fracture healing time were compared between the two groups, and Constant Murley score was used to evaluate shoulder joint function.@*RESULTS@#The patients in both groups were followed up for 18 to 24 (20.96±2.02) months. The incisions of both groups were healed at stageⅠ. The fracture ends of both groups were bony healed at the last follow up. There was no significant difference in operation time, intraoperative blood loss and fracture healing time between two groups (@*CONCLUSION@#The two methods can obtain satisfactory results in the treatment of Neer Ⅱb distal clavicle fractures, especially suitable for patients with comminuted distal clavicle fractures or osteoporosis; the clinical effect of the treatment of NeerⅡb distal clavicle fractures with T type distal radius plate combined with suture anchor is satisfactory, which provides another feasible treatment scheme for clinic.
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Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placas Ósseas , Estudos de Casos e Controles , Clavícula/cirurgia , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Estudos Retrospectivos , Âncoras de Sutura , Resultado do TratamentoRESUMO
OBJECTIVE@#To investigate and analyze the relationship between intraoperative graft flow measurements and the early mid-term outcomes after off-pump coronary artery bypass grafting (OPCAB).@*METHODS@#Patients who underwent isolated OPCAB in the Department of Cardiac Surgery of Peking University People's Hospital from January 2013 to June 2016 were included. Perioperative characteristics, graft flow measurements and postoperative follow-up outcomes were retrospectively collected. Comparison was made between flow measurements of grafts and the early mid-term outcomes. Flow measurements of grafts included the mean flow (MF) and the pulsatility index (PI). The early outcomes included peri-operative myocardial infarction (PMI), use of an intra-aortic balloon pump (IABP), reoperation for all causes, new-onset atrial fibrillation and in-hospital or 30-day mortality.@*RESULTS@#A total of 463 patients were included in the study. Mean age was (62.80±8.36) years, and 24.8% were females. The total number of grafts was 1 435, which averaged 3.10 grafts per patient. The MF and PI were separately (32.34±14.45) mL/min and 2.87±0.92. Of all the patients, 23(5%) had PMI, and 11 used IABP. Observed in-hospital or 30-day mortality was 0.86% (4 patients). Compared with non-PMI group, the MF was lower and the PI was higher in the PMI group (P<0.05). However, the differences of other early outcomes had no statistical significance between the PMI group and the non-PMI group. The lower MF (Wald=5.684, P=0.017, 95%CI: 0.894-0.989) and the higher PI (Wald=9.040, P=0.003, 95%CI: 1.252-2.903) were risk factors of PMI in multivariable Logistic regression modeling. The longest follow-up time was 37 months, and 7 patients died. The differences of graft flow measurements between the surviving group and the nonsurvivors had no statistical significance, but overall mid-term survival was lower in patients with poor left internal mammary artery (LIMA) to left anterior descending artery (LAD) graft flow (MF<10 mL/min; OR=9.6, P<0.05).@*CONCLUSION@#Intraoperative graft flow parameters during OPCAB can predict the early mid-term outcomes. The lower MF and the higher PI should increase the rate of PMI. A lower flow of LIMA to LAD graft (<10 mL/min) should increase the rate of midterm mortality, but further research will be needed to confirm and explore the findings.
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Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ponte de Artéria Coronária , Ponte de Artéria Coronária sem Circulação Extracorpórea , Artéria Torácica Interna , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE@#To observe the clinical prognosis and surgical treatment results in patients with postinfarction ventricular septal rupture, and to discuss the risk factors, methods & timing of treatment.@*METHODS@#From January 2006 to February 2019, 23 patients with postinfarction ventricular septal rupture were admitted to the department of cardiac surgery, Peking University People's Hospital, including 12 males (52.2%) and 11 females (47.8%), aged (64.26 ±11.09) years. Among them, 18 cases underwent operation, and 5 cases did not receive surgical treatment. The clinical data and follow-up data were summarized retrospectively.@*RESULTS@#Among the patients treated with operation, the average time from perforation to operation was (19.39 ±13.67) d, including 6 cases (33.3%) of perforation within 1 week, 6 cases (33.3%) within 2 to 4 weeks and 6 cases (33.3%) more than 4 weeks. Emergency surgery was performed in 11 cases (61.1%) because of hemodynamic instability, and selective operation in 7 cases (38.9%). Direct enlarged patch was used in 13 cases (72.2%), and some infarct exclusion techniques were used in 5 patients (27.8%). In 18 cases, coronary artery bypass grafting was performed in 12 cases (66.7%). Of all the surgical patients, 7 (38.9%) died during hospitalization. Compared with the survival patients, the perioperative death patients had earlier perforation [(1.83±0.75) d vs. (5.22 ±4.66) d, P=0.019] and higher emergency operation rate (100% vs. 36.4%, P=0.009) and lower simultaneous bypass grafting rate (28.6% vs. 90.1%, P=0.008). The median follow-up time was 2 years (3 months to 10 years). 2 patients died of heart failure in 2 months after operation, and 9 cases (50.0%) survived for a long time. Of the 5 patients who had not been treated, 2 died while waiting for operation, and 3 patients who refused surgery died within 1 week after discharge.@*CONCLUSION@#Surgery is an effective treatment for patients with acute myocardial infarction complicated with ventricular septum perforation. The best time for operation should be determined by real-time evaluation and monitoring, combined with the situation of patients. Concomitant coronary artery bypass grafting may be beneficial to these patients.
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Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Cardíacos , Ponte de Artéria Coronária , Infarto do Miocárdio , Estudos Retrospectivos , Resultado do Tratamento , Ruptura do Septo VentricularRESUMO
Inhibitory GABAergic interneurons are fundamental elements of cortical circuits and play critical roles in shaping network activity. Dysfunction of interneurons can lead to various brain disorders, including epilepsy, schizophrenia, and anxiety. Based on the electrophysiological properties, cell morphology, and molecular identity, interneurons could be classified into various subgroups. In this study, we investigated the density and laminar distribution of different interneuron types and the co-expression of molecular markers in epileptic human cortex. We found that parvalbumin (PV) and somatostatin (SST) neurons were distributed in all cortical layers except layer I, while tyrosine hydroxylase (TH) and neuropeptide Y (NPY) were abundant in the deep layers and white matter. Cholecystokinin (CCK) neurons showed a high density in layers IV and VI. Neurons with these markers constituted ~7.2% (PV), 2.6% (SST), 0.5% (TH), 0.5% (NPY), and 4.4% (CCK) of the gray-matter neuron population. Double- and triple-labeling revealed that NPY neurons were also SST-immunoreactive (97.7%), and TH neurons were more likely to express SST (34.2%) than PV (14.6%). A subpopulation of CCK neurons (28.0%) also expressed PV, but none contained SST. Together, these results revealed the density and distribution patterns of different interneuron populations and the overlap between molecular markers in epileptic human cortex.
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Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Química Encefálica , Genética , Fisiologia , Córtex Cerebral , Metabolismo , Patologia , Colecistocinina , Metabolismo , Epilepsia , Patologia , Regulação da Expressão Gênica , Fisiologia , Interneurônios , Metabolismo , Neuropeptídeo Y , Metabolismo , Parvalbuminas , Metabolismo , Fosfopiruvato Hidratase , Metabolismo , Somatostatina , Metabolismo , Tirosina 3-Mono-Oxigenase , MetabolismoRESUMO
Objectives:To describe the early and long-term survival of off-pump coronary artery bypass grafting(OPCAB)and to analyze the impact and risk factors of peri-operative events on mortality and long-term survival in OPCAB patients aged over 75 years old. Methods:From January 2001 to December 2012,233 patients aged over 75 underwent OPCAB in our hospital, 173 cases (74.25%) were male,the average age was (77.1±2.3) years.The perioperative data was retrospectively collected.Binary Logistic regression was used to define the risk factors related to the perioperative events and mortality.Follow-up was performed regularly post-surgery. Univariate analysis and Cox regression model were used to find out factors affecting the long-term outcomes. Results:Fifteen out of 233 patients died during the perioperative period. Binary Logistic regression showed that preoperative arrhythmia (OR=6.767, P=0.002),IABP ( intraoperative, post-operative) (OR=4.292, P=0.040;OR=19.455, P＜0.001), ICU stay time (OR=1.500, P=0.001), mechanical ventilation time (OR=1.004, P=0.002), reintubation or tracheotomy (OR=30.000, P＜0.001), re-thoracotomy (OR=26.750, P＜0.001), postoperative cerebral infarction (OR=5.889, P=0.041) were risk factors of perioperative mortality. The remaining 218 patients were followed up for a mean of (92.84±45.52) months, 121 patients died during follow-up. The survival rate at l, 3, 5, 8 and 10 years was 90.99%, 87.55%, 85.31%, 68.93% and 56.70%, respectively. Univariate analysis showed that sex(male), hypertension, preoperative arrhythmia, reintubation or tracheotomy were risk factors of the long-term mortality (P＜0.05). Cox regression analysis showed that reintubation or tracheotomy (HR 4.387, 95%CI=1.876-10.259,P＜0.010) was the independent risk factor affecting the long-term survival. Conclusions:Preoperative arrhythmia, IABP (intraoperative, postoperative), ICU stay time, mechanical ventilation time, reintubation and tracheotomy, re-thoracotomy, postoperative cerebral infarction are risk factors of perioperative mortality. Reintubation or tracheotomy is the independent risk factor affecting the long-term survival.Taken together, OPCAB in patients aged over 75 is associated with favorable perioperative and long-term outcome,and it serves a safe and effective operative strategy for coronary artery revascularization in patients aged over 75.
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Trastuzumab is a humanized monoclonal antibody that targets at human epidermal growth factor receptor 2(Her2)proto-oncogenes,which can act on Her2 over-expression of tumor cells,inhibits tumor cells proliferation, differentiation,migration and other physiological activities,reduces the risk of tumor metastasis and extend the sur-vival time of patients.
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Objective:To improve the immobilization efficiency of antibody molecules on immune microarray,the method of es-tablishment and optimization of agarose self-assembled membrane carrier with three-dimensional hydrogel structure was established. Methods: The agarose self-assembled membrane carrier was prepared by using glass slide as the carrier,using agarose and sodium periodate modification on glass surface. The agarose self-assembled membrane carrier was characterized by TEM, AFM and FTIR. The optimum preparation conditions were obtained. The carrier for two different species of fixed source antibody efficiency were studied. Antibody loading capacity of agarose self-assembled membrane carrier and ordinary aldehyde carrier were investigated and compared by fluorescence microscopy imaging and Image J software. Results: The agarose nano-membrane carrier had uniform and compact surface. This structure could increase the specific surface area and improve the probe fixed rate. The optimal concentration of agarose for preparation of carrier was 1. 0% . When the concentration of IgG was 0. 3-0. 4 mg/ml,the oxidized self-assembled chitosan film substrate had highest antibody loading capacity. And it had a 3. 94 fold higher antibody loading capacity than the ordinary aldehyde carrier. Conclusion: The agarose nano-membrane carrier is an ideal method for surface modification of immobilized antibody molecules, which is more suitable for preparation of immune microarray carrier.
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This article discussed the possible physiological mechanism of "treating waist by abdominal massage therapy" from the perspectives of TCM and modern medicine, and analyzed the effects of abdominal massage from the nerve, fascia, visceral, muscle and other aspects, with a purpose to elucidate that the occurrence of relevant diseases may be caused by a variety of factors, and different massage techniques have different effects on the body.
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Objective Analyze and compare the clinical data of patients with choledocholithiasis combined with benign biliary stricture and Oddi sphincter received laparoscopic percutaneous endoscopic dilation of duodenal papilla and endoscopic sphincterotomy, to explore the clinical experience and investigate the safety and superiority of laparoscopic papillary dilatation and the clinical value in extending the first phase suturing.. Methods From January 2016 to January 2017, 60 patients with choledocholithiasis combined with Oddi sphincter received laparoscopic nipple expansion (30 cases, Group L) and the others received endoscopic sphincterotomy (30 cases, Group E). All the patients clinical data was retrospectively compared and analyzed to explore the clinical experience. Results All operation were successfully performed with no perioperative deaths occurred.. By comparison of the clinical data before and after surgery, we learned that the changes of alanine aminotransferase (ALT), aspartate transaminase (AST), direct bilirubin and postoperative biliary tract bleeding has no statistically significant difference (P > 0.05), while the operation time, the changes of blood amylase and lipase, postoperative gastrointestinal symptoms, postoperative pancreatitis, gastrointestinal function recovery time has statistically significant differences (P < 0.05). There has one self-healing bile leakage case in Group L thanks to routine placement of abdominal drainage tube intraoperatively. The patients gastrointestinal function recovered quick and not suffered pancreatitis because of there's no incision of nipple sphincter. Conclusion Laparoscopic papillary dilation reflects its superiority for not increase postoperative liver function damage, DBIL abnormalities, residual stones, biliary tract bleeding and biliary stricture, while can effectively decrease the incidence of complications such as postoperative pancreatitis, bile reflux and gastrointestinal symptoms. It is safe and effective with less postoperative complications in appropriately application in treatment of fine diameter common bile duct stones with sphincter of Oddi stenosis.
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Objective Analyze and compare the clinical data of patients with choledocholithiasis combined with benign biliary stricture and Oddi sphincter received laparoscopic percutaneous endoscopic dilation of duodenal papilla and endoscopic sphincterotomy, to explore the clinical experience and investigate the safety and superiority of laparoscopic papillary dilatation and the clinical value in extending the first phase suturing.. Methods From January 2016 to January 2017, 60 patients with choledocholithiasis combined with Oddi sphincter received laparoscopic nipple expansion (30 cases, Group L) and the others received endoscopic sphincterotomy (30 cases, Group E). All the patients clinical data was retrospectively compared and analyzed to explore the clinical experience. Results All operation were successfully performed with no perioperative deaths occurred.. By comparison of the clinical data before and after surgery, we learned that the changes of alanine aminotransferase (ALT), aspartate transaminase (AST), direct bilirubin and postoperative biliary tract bleeding has no statistically significant difference (P > 0.05), while the operation time, the changes of blood amylase and lipase, postoperative gastrointestinal symptoms, postoperative pancreatitis, gastrointestinal function recovery time has statistically significant differences (P < 0.05). There has one self-healing bile leakage case in Group L thanks to routine placement of abdominal drainage tube intraoperatively. The patients gastrointestinal function recovered quick and not suffered pancreatitis because of there's no incision of nipple sphincter. Conclusion Laparoscopic papillary dilation reflects its superiority for not increase postoperative liver function damage, DBIL abnormalities, residual stones, biliary tract bleeding and biliary stricture, while can effectively decrease the incidence of complications such as postoperative pancreatitis, bile reflux and gastrointestinal symptoms. It is safe and effective with less postoperative complications in appropriately application in treatment of fine diameter common bile duct stones with sphincter of Oddi stenosis.
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Objects To explore the association of ulcerative colitis (UC) with the imbalance between Th1,Th 2 and Th17 cells in the colonic tissues.Methods A total of 41 UC patients and 52 controls was recruited in the present study.The real-time fluorescent quantitative PCR was applied for detecting the mRNA levels of Thl,Th2 and Th 17 cells-associated transcription factors T-bet,GATA-3 and RORγt and cytokines IFN-γ,IL-4 and IL-17A in the colonic tissues.Simultaneously,the expressions of IFN-γ,IL-4 and IL-17A in the colonic tissues were also examined by an immunohistochemical staining method.Results Compared with the controls,the mRNA expressions of GATA-3,RORγt and IL-17A were more significantly enhanced in UC patients (0.84 ± 0.24 vs.0.69 ± 0.22,P=0.002;0.99 ± 0.29 vs.0.83 ± 0.23,P=0.004;1.59 ± 0.65 vs.1.35 ± 0.43,P=0.035).According to the ＂Truelove and Witts Severity Index＂,those patients were divided into different subgroups.The mRNA expressions of GATA-3,RORγt,and IL-17A were shown to be higher in patients with moderate and severe UC than in those with mild UC (0.90 ± 0.18 vs.0.78 ± 0.16,P=0.030;1.11 ± 0.31 vs.0.87 ± 0.26,P=0.011;1.83 ± 0.64 vs.1.34 ± 0.66,P=0.020).Moreover,the immunohistochemistry results demonstrated that the IL-17A positive cells were positioned mainly in the intestinal epithelial layer and lamina propria.Compared to the controls,the mean integral optic density of IL-17A was significantly increased in the colonic tissues of UC patients (0.25 ± 0.07 vs.0.13 ± 0.03,P＜0.001).The similar results were obtained for IL-17A in patients with moderate and severe UC when compared to those with mild UC (0.31 ± 0.07 vs.0.19 ± 0.06,P＜0.001).In contrast to the controls,the mRNA ratios ofGATA-3/T-bet,RORγt/ T-bet and RORγt/GATA-3 were significantly higher in the tissues of colonic UC patients (1.12 ± 0.30 vs.0.96 ± 0.31,P=0.014;1.33 ± 0.37 vs.1.15 ± 0.33,P=0.015;1.44 ± 0.45 vs.1.20 ± 0.42,P=0.009),and in the patients,the mRNA ratios for GATA-3/T-bet,RORγt/T-bet and RORγt/GATA-3 were significantly higher in the patients with moderate and severe UC than in those with mild UC (1.27 ± 0.35 vs.1.00 ± 0.32,P＜0.001;1.45 ± 0.37 vs.1.19 ± 0.36,P=0.028;1.59 ± 0.43 vs.1.28 ± 0.46,P=0.031).Conclusions These findings suggest that the imbalance between Thl,Th2 and Th17 cells in the colonic tissues may be implicated in UC.
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Objective To analyze the epidemiology of outbreaks and epidemic characteristics of respiratory diseases caused by human adenovirus in China so as to provide some data for its epidemic and outbreak control and clinical diagnosis .Methods Data on respiratory adenovirus outbreaks and surveillance from 1997 to 2015 was collected from PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang Databases.All the data was analyzed according to the descriptive epidemiology , including the time , area and population distribution .Clinical data and the serotypes of adenovirus were also analyzed.Results From 1997 to 2015, the epidemical serotypes of adenovirus included 1 to 7, 11, 14 and 55 in China, and the dominating serotypes were 7 and 3, which accounted for 62.33％(599/961) and 24.97％(240/961)of the total cases of outbreaks, and for 36.79％(312/848) and 53.18％(451/848) of the total cases of surveillance.The peaks of annual outbreaks were in 2004 and 2013, which made up 41.12％(2212/5380) and 16.49％(887/5380)of the total outbreak cases in this study .Most of the surveillance cases years occurred in 2010 and 2011, which accounted for 17.59％(297/1688) and 17.77％(300/1688) of the total cases of surveillance .The seasonal distribution of the outbreaks was characterized by the highest possibility in spring and winter .Outbreaks of respiratory adenovirus were reported by 12 provinces or municipalities .The number of reported outbreaks related to serotype 3 was the largest in Jiangsu Province, which made up 58.33％(140/240) of the total.Most of the reported cases related to serotype 7 occurred in Hubei Province, which made up 67.41％ (333/494) of the total.Most of cases were found in Peking and Jiangsu , which accounted for 57.56％(971/1687)and 32.42％(547/1687)of the total positive cases respectively.The high-risk populations were children and new recruits , who accounted for 73.97％(2907/3930) of the total.The clinical features of adenovirus infection were fever (63％-100％),sore throat (31.9％-100％), pharyngeal hyperemia (60％-100％) and cough (5.88％ -100％).Conclusion Human respiratory adenovirus has become one of the main pathogenic microorganisms that induce acute respiratory diseases in schools and in the military in China , so human adenovirus and related respiratory disease should be monitored in such populations .The epidemiological characteristics of different types of respiratory adenovirus and the patterns of spread should be analyzed in order to reduce morbidity and mortality.
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Objective To analyze the epidemiological characteristics of an outbreak caused by respiratory adenovirus in a university,and study the factors of respiratory adenovirus outbreak and ways of prevention and control.Methods The pharyngeal swabs of each case were identified by real time-PCR and sequencing.All the epidemiological and clinical information of these cases was collected via field interviews and medical records.Epidemiological characteristics of the outbreak were analyzed descriptively.Results 193 cases,including 89 cases of pneumonia,from a total of 807 cases,were admitted to the hospital.The incidence was 32.79%(807/2461).798 adenovirus positive samples were detected from 2461 pharyngeal swab samples.The total positive detection rate was 32.42%(798/2461).The positive rate of adenovirus was 98.88%(798/807).Clinical symptoms included fever(95.7%), cough(76.9%)and sore throat(52.2%).The outbreak was brought under effective control after integrated intervention measures were taken.Conclusion Respiratory adenovirus often causes outbreaks in crowded populations.Early symptomatic surveillance and standardized laboratory detection methods are crucial for prevention and control of outbreaks.Integrated control measures should be taken according to the field conditions and characteristics of the outbreak.
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<p><b>BACKGROUND</b>Antiphospholipid syndrome (APS)-related immune factors are considered as an important cause of recurrent spontaneous abortion (RSA). Anticoagulant and anti-inflammatory treatments are believed to effectively improve adverse pregnancy outcomes by affecting the abnormal autoimmune response of the maternal-fetal interface. The aim of this study was to observe the clinical characteristics and treatment outcomes of anticoagulant regimens and anti-inflammatory plus anticoagulation regimens for APS-related RSA.</p><p><b>METHODS</b>APS-related RSA cases from September 2011 to September 2016 at Peking University Third Hospital were retrospectively analyzed. The patients were assigned to study group (anti-inflammation plus anticoagulation) and control group (simple anticoagulation). The incidence of repeat abortion, the incidence of placental dysfunction, the gestational weeks of pregnancy, and the mean weight of the fetus were observed.</p><p><b>RESULTS</b>The pregnancy and neonatal outcome indicators of the repeat pregnancy loss rate (11.11% vs. 22.70%), placental dysfunction-related diseases (6.35% vs. 15.60%), the mean birth weight of infants born after 24 weeks gestation (3152.41 ± 844.67 g vs. 2765.76 ± 816.40 g), full-term delivery weight (3456.28 ± 419.79 g vs. 3076.18 ± 518.79 g), the proportions of low birth weight infants (12.70% vs. 21.98%), and small for gestational age (6.35% vs. 14.18%) differed significantly between the study and control groups (all P< 0.05). The incidence of preterm delivery, term delivery, and stillbirth was not significantly different between the two groups, and there was no significant difference between the study and control groups in gestational age at birth (37.6 ± 3.3 weeks vs. 36.9 ± 3.2 weeks; P > 0.05).</p><p><b>CONCLUSION</b>The anti-inflammatory and anticoagulation regimen is more effective than the simple anticoagulation regimen in the treatment of APS recurrent abortion.</p>
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<p><b>OBJECTIVE</b>The objective was to observe damage of hippocampus in rats after exposure to infrasound, and to assess HSP70 expression in hippocampus.</p><p><b>METHODS</b>SD rats in the experimental group were exposed to 140 dB (8 Hz) infrasound for 2 h per day for 3 days. The morphology of the hippocampus was examined by transmission electronic microscopic (TEM). Cell apoptosis was observed by TUNEL staining at 0 h, 24 h, 48 h, and 2 w after exposure. HSP70 expression was detected by immunohistochemistry (IHC) and Western blotting (WB).</p><p><b>RESULTS</b>TEM showed that hippocampus was significantly damaged by exposure, and exhibited recovery 1 week after exposure. The TUNEL data showed that neuronal apoptosis after exposure was significantly higher than in the control rats at 24 h and 48 h, and the apoptotic cells decreased one week after exposure. IHC and WB showed HSP70 expression was significantly higher in the exposed rats, peaked at 24 h.</p><p><b>CONCLUSION</b>Exposure to 140 dB (8 Hz) infrasound for 2 h per day for 3 days appeared to induce damage to the hippocampus of rats, based on changes in ultrastructure and increased cell apoptosis. However, recovery from the damage occurred overtime. HSP70 expression also increased after the exposure and decreased by 48.</p>