A retrospective analysis of clinical characteristics and mortality risks in elderly patients with acute cholecystitis and cholangitis / 中华内科杂志

Objective To analyze the clinical characteristics and explore the risk predictors on mortality in elderly patients with acute cholecystitis and cholangitis.Methods We conducted a retrospective analysis of elderly patients hospitalized in the Second Medical Center of General Liberation Army Hospital for acute cholecystitis and cholangitis during 2000 to 2018.Clinical data and risk predictors on mortality were assessed.The patients were stratified into three groups based on age:Ⅰ (65-74 years old),Ⅱ (75-84 years old),and Ⅲ (≥85 years old).Logistic regression analysis was used to identify the predictors of mortality.Results A total of 574 patients were finally enrolled with the mean age 87.6 years including 191 in group Ⅰ,167 in group Ⅱ,and 216 in group Ⅲ.The main cause of acute cholecystitis and cholangitis was gallstone (76.3％),and the main symptom was abdominal pain (62.9％),followed by chills(62.5％),fever(59.8％),jaundice (47.2％) and septic shock(26.3％).Cholecystitis was the most common diagnosis in groups Ⅰ and Ⅱ,whereas it was cholangitis in group Ⅲ.Percutaneous transhepatic biliary/gallbladder drainage (PTBD/PTGD) and endoscopic retrograde cholangiopancreatography (ERCP) were administrated more frequently in groups Ⅲ.A total of 35 patients (6.1％) died during follow-up.Senior in age (OR=11.1),the Charlson comorbidity index (OR=19.5),cancers (OR=9.6),blood stream infections (OR=7.4),severity of cholecystitis and cholangitis (OR=4.2)were risk factors associated with mortality.Conclusions Even in the elderly patients with acute cholecystitis and cholangitis,comorbidity is one of the main factors affecting clinical outcomes.Due to the poor performance,this group of population presents more severe disease and undergoes conservative treatment strategies.

Clinical Features and Management of Ischemic Colitis in Elderly Patients / 胃肠病学

Ischemic colitis (IC)is one of the major causes of acute lower gastrointestinal bleeding and usually occurs in the elderly. Hypoperfusion of the mesenteric microvasculature,even induced by constipation in the elderly,is by far the approximate mechanism. The clinical manifestations of IC vary depending on the extent and duration of ischemia. The presenting symptoms include sudden cramping abdominal pain;an urgent desire to defecate;and passage within 24 hours of bright red or maroon blood or bloody diarrhea. CT scan should be the first imaging modality of choice for patients with suspected IC to assess the distribution and phase of colitis. Early colonoscopy (within 48 hours of presentation)should be performed to confirm the diagnosis if without gangrene and perforation. Nonsurgical treatment approach usually includes bowel rest,intravenous fluid,electrolyte repletion,correction of precipitating conditions and antibiotic usage,occasionally with administration of total parenteral nutrition. It has been shown that isolated right colonic ischemia (IRCI)has a worse outcome than ischemia affecting other regions of the colon. Surgical intervention should be considered in the presence of IRCI or pan-colonic ischemia and in the presence of gangrene.

A control study on selective biliary cannulation technique reducing incidence of post-ERCP pancreatitis / 中华肝胆外科杂志

Objective To determine if using a soft-tipped guidewire to cannulate the common bile duct may ameliorate development of PEP(post-ERCP pancreatitis)and facilitate cannulation of the CBD(common bile duct).Methods A total of 78 patients treated treateed in our hospital underwent ERCP through conventional direct cannulation(52 diagnostic ERCPs,26 therapeutics ERCPs)from 1998 to 2001 were randomly selected as group A while 112 patients underwent ERCP through guide wire-directed cannulation(21 diagnostic ERCPs,91 therapeutics ERCPs)from 2007 to 2008 as group B.Then we retrospectively studied and compared the following parameters between the two groups:1)Success rate of biliary access;2)visualization rate of pancreatic duct;3)the level of serum amylase,severity of abdominal pain and the rate of PEP.Meanwhile,the correlation between grading of pancreatic duct visualization and PEP was analyzed.Results The success rate of biliary access of the guidewire group(106/112 cases)was significantly greater than the conventional group(33/78 cases)(94.64%vs.42.30%,P<0.01).In group A,about61.53%(16/26)of the 26 cases could not continue the next therapeutics ERCP because of unsucceasful carmulation. The visualization rate of pancreatic duct of group A and B were 58.97%(46/78 cases)and 8.04%(9/112 cases)(P<0.01) respectively.On occurrence rate of PEP,group A(17/78 cases)was significantly higher than group B(4/112 cases)(21.79% vs.3.57%,P<0.01),and severe pancreatitis occurred in 3 patients in conventional group.However,there was no severe pancreatitis in the guide wire group.There were no significant differences (P>0.05) in terms of the rate of hyperamylasemia between the two groups.The significant correlation was found between the grading of pancreatic duct visualization and the occurrence of PEP.Condusion Guidewire-directed selective access to the bile duct lowers likdihood of PEP by facilitating cannulation and lowering the visualization rate of pancreatic duct.The occurrence of PEP could be predicted by the grading of pancreatic duct visualization,which is a very important but not the unique factor leading to PEP.

Clinical analysis of short- and long-term complications after endoscopic Oddi's sphincterotomy in 95 patients / 中华肝胆外科杂志

Objective To investigate the short- and long-term complications after endoscopic Oddi's sphincterotomy (EST) upon endoscopic retrograde cholangiopancreatography (ERCP) procedure and determine whether the size of EST correlates to the occurrence of EST complications.Methods 95 cases receiving EST in the process of ERCP in our hospital were studied and followed up. The patients were divided into large, moderate and small incision groups according to the size of EST and the states of short-term and long-term EST complications were statistically analyzed.Results The incidence of short-term complications of EST was 18. 94% (18/95). They included bleeding in the process of ERCP in 11 cases, delayed bleeding in 3, acute pancreatitis in 1, acute cholangitis in 2 and duodenal perforation in 1. All these patients but 1 with duodenal perforation were discharged after undergoing symptomatic treatments. Eleven out of the 95 patients had long-term complications (11.57 % ). These included biliary system infection in 5 cases, recurrent calculus of bile duct in 3, papilla stricture in 1 and chronic relapsing pancreatitis in 2. All 11 patients recovered after therapeutic ERCP again or symptomatic drug treatments. There was no significant difference in incidence of short-term (χ2 =2.433, P=0.296) or long-term complications (χ2 = 1.151, P=0.562) among the 3 groups. Furthermore, there was no statistical correlation between the incision size of Oddi and complications including operative bleeding (P=0.109), short-term complications (P=0.124) and longterm complications(P=0.402). Conclusion There are many short-term and long-term complications after EST, but there is no correlation between the complications and the incision size of Oddi. The occurring rate of complications might be reduced through accurate direction of papilla incision, avoidance from injury of blood vessel, keeping bile drainage unobstructed and protection of the function of Oddi sphincter as far as possible in the process of ERCP.

SYNTHESIS AND ANTICANCER ACTIVITY OF 3-［(3′-METHYL-4′-(SUBSTITUTED PHENYL)-1′,3′-BUTADIENYL］ INDOLE DERIVATIVES / 药学学报

AIM　To study the synthesis and anticancer activity of 3-［(3′-methyl-4′-(substituted phenyl)-1′,3′-butadienyl］ indole derivatives. METHODS　Electrophilic-substitution, aldol-condensation, selective-reduction, phase-transfer Wittig reaction and hydrolysis reaction were used in the synthesis of the title compounds. RESULTS　Eleven compounds of 3-［(3′-methyl-4′-(substituted phenyl)-1′,3′-butadienyl］ indole were synthesized. They are new compounds. Compound 8 showed different inhibitory effects on HL-60, HCT-8 and Bel7402 cell lines in vitro, and its inhibitory rate of antiinflammation was 100％ at 10-5 mol*L-1 concentration. CONCLUSION　Compound 8 showed high anticancer and antiinflammatory activities, and is worth further studying.

SYNTHESIS AND BIOLOGICAL ACTIVITY OF 2-[(SUBSTITUTED PHENYL)VINYL] INDOLE DERIVATIVES / 药学学报

AIM　To synthesize derivatives of 2-[substituted phenyl)vinyl] indole and find compounds with biological activities by screening in vitro. METHODS　Twenty-one compounds of 2-[(substituted phenyl)vinyl] indole were synthesized by reduction, oxidation and Witting reaction. MS, 1HNMR and elemental analysis were used to determine the structures of the new compounds. RESULTS　These compounds are new ones. CONCLUSION　Six compounds (3,9,11,13,18 and 20) showed effects on some different receptors, such as alpha2, D2 and H1, and is worth further studying.

SYNTHESIS OF SUBSTITUTED 4-STYRYLCOUMARIN AND THEIR ANTITUMOR ACTIVITIES / 药学学报

AIM　A series of 4-styrylcoumarin derivatives had been designed and synthesized in order to find compounds of antitumor activities by screening. METHODS　Title compounds (1-20) were synthesized by Phase-Transfer Wittig reaction or Wittig-Horner reaction, and screened by several antitumor models in vitro. Their structures were determined by 1HNMR, MS and elemental analysis. RESULTS　Twenty compounds (1-20) are new compounds. Compound 18 had effects on KB cell lines in vitro. CONCLUSION It was seen that compound 18 had certain antitumor activities, and it was worth further studying.

APE/Ref-1 expression in gastric cancer / 解放军医学杂志

Objective To study the expression of APE/Ref-1 in gastric cancer. Methods Detection of APE/Ref-1 protein was performed with gastric cancer tissue microarray (TMA) by IHC in gastric cancer, non-neoplastic mucosa and lymph node with metastasis. Results The positive rates of APE/Ref-1 in cytoblast in non-neoplastic mucosa, tumor tissue, and metastatic lymph nodes were 96.6%, 97.1% and 98.9%, respectively, while the positive rates in cytoplasm were 71.8%, 21.4% and 10.0%, respectively and in both cytoblast and cytoplasm were 71.4%, 21.4% and 10.0%, respectively. Compared to non-neoplastic mucosa, tumor lesion had lower APE/Ref-1 expression in cytoblast and cytoplasm. In 35.9% of patients it was decreased slightly and in 11.2% of them it was decreased markedly in cytoblast (P

Clinical characteristics of acute pancreatitis in elderly patients / 中华老年医学杂志

Objective To study the clinical features of acute pancreatitis (AP) in elderly patients. Methods The elderly AP patients from January 1993 to October 1999 in our hospital were studied retrospectively. Results There are 83 cases with a male to female ratio of 1 5∶1 and a median age of 72 7 years.AP was diagnosed in 83 cases for 107 times which included 80 times of mild AP and 27 times of severe AP 13 patien with APts were diagnosed for more than one times.Abdominal pain was the primary symptom in 94 4% patients. 6 patients had no pain 53 0%(44/83) and 84 6%(11/13) patients had cholelithiasis and recurrent AP respectively.60 5% and 72 6% patients were diagnosed by type B ultrasonic and CT respectively . Conclusions In elderly AP patients,abdominal pain was the primary symptom, but a part of patients had no typical symptoms.Cholelithiasis including biliary sludge was an inducement especially in recurrent AP patients. Type B ultrasonic and CT examination were important means in diagnosis.