RESUMO
Pancreatic cancer remains as one of the most lethal malignancies. Resistance to conventional therapies has led to little improvement in the survival of pancreatic cancer patients over the past few decades. Immune-based treatment strategies for pancreatic cancer, such as immune-checkpoint inhibitors, therapeutic vaccines, and combination immunotherapies show promise. Many immunotherapies have been explored in clinical trials, but they have yet to show significant therapeutic effects. Nevertheless, immunotherapy is inevitably the future of pancreatic cancer cure. This article introduces the current research progress and bottlenecks of immunotherapy for pancreatic cancer and puts forward further optimization directions and solutions. We hope to provide a reference for the future use of immunotherapy for pancreatic cancer.
RESUMO
Objective:To investigate the risk factors for acute cholangitis after endoscopic retrograde cholangiopancreatography (ERCP) and to construct its nomogram.Methods:Clinical data of patients who underwent ERCP for common bile duct stones in the First Hospital of Lanzhou University from January 2014 to December 2019 were retrospectively analyzed. A total of 95 patients with acute cholangitis after the operation (the acute cholangitis group) were included and 285 patients without acute cholangitis after the operation (the non-acute cholangitis group) were selected by random sampling at 1∶3 via the software. Logistic regression analysis was used to evaluate the risk factors for acute cholangitis after ERCP. A nomogram model was established to predict the incidence of acute cholangitis after ERCP based on the results of multivariate analysis.Results:Univariate analysis showed that there were significant differences in age, combination with diabetes, levels of alanine aminotransferase, alkaline phosphatase and glucose, roughness in gallbladder wall, bile duct diameter, stenosis in lower bile duct, proportion of patients who underwent endoscopic retrograde biliary drainage and endoscopic nasobiliary drainage between the two groups ( P<0.05). Logistic multivariate regression analysis showed that advanced age ( OR=1.108, 95% CI:1.079-1.138, P<0.001), combination with diabetes ( OR=4.524, 95% CI:1.299-15.758, P=0.018), roughness in gallbladder wall ( OR=2.495, 95% CI:1.106-5.630, P=0.028), increased bile duct diameter ( OR=1.303, 95% CI:1.181-1.437, P<0.001), and stenosis in lower bile duct ( OR=4.192, 95% CI:2.508-7.005, P<0.001) were independent risk factors for acute cholangitis after ERCP. Based on the results of multivariate analysis, the nomogram of acute cholangitis after ERCP was established. The area under the receiver operator characteristic curve was 0.887. Conclusion:Advanced age, combination with diabetes, rough gallbladder wall, increased diameter of bile duct and stenosis in lower bile duct are independent risk factors for acute cholangitis after ERCP. Clinicians can make clinical intervention based on the nomogram of risk factors above to improve the prognosis of patients.
RESUMO
Objective:To investigate the clinical characteristics of choledocholithiasis com-bined with periampullary diverticulum and influencing factor for difficult cannulation of endoscopic retrograde cholangiopancreatography (ERCP).Methods:The retrospective case-control study was conducted. The clinical data of 1 920 patients who underwent ERCP for choledocholithiasis in 15 medical centers, including the First Hospital of Lanzhou University, et al, from July 2015 to December 2017 were collected. There were 915 males and 1 005 females, aged (63±16)years. Of 1 920 patients, there were 228 cases with periampullary diverticulum and 1 692 cases without periampullary diverticulum. Observation indicators: (1) clinical characteristics of patients with choledocholithiasis; (2) intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis; (3) influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and com-parison between groups was conducted using the Wilcoxon rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The Logistic regression model was used for univariate and multivariate analyses. Results:(1) Clinical characteristics of patients with choledocholithiasis. Age, body mass index, cases with complications as chronic obstructive pulmonary disease, diameter of common bile duct, cases with diameter of common bile duct as <8 mm, 8?12 mm, >12 mm, diameter of stone, cases with number of stones as single and multiple were (69±12)years, (23.3±3.0)kg/m 2, 16, (14±4)mm, 11, 95, 122, (12±4)mm, 89, 139 in patients with choledocholithiasis combined with periampullary diverticulum, versus (62±16)years, (23.8±2.8)kg/m 2, 67, (12±4)mm, 159, 892, 641, (10±4)mm, 817, 875 in patients with choledocholithiasis not combined with periampullary diver-ticulum, showing significant differences in the above indicators between the two groups ( t=?7.55, 2.45, χ2=4.54, t=?4.92, Z=4.66, t=?7.31, χ2=6.90, P<0.05). (2) Intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis. The balloon expansion diameter, cases with intraoperative bleeding, cases with hemorrhage management of submucosal injection, hemostatic clip, spray hemostasis, electrocoagulation hemostasis and other treatment, cases with endoscopic plastic stent placement, cases with endoscopic nasal bile duct drainage, cases with mechanical lithotripsy, cases with stone complete clearing, cases with difficult cannulation, cases with delayed intubation, cases undergoing >5 times of cannulation attempts, cannulation time, X-ray exposure time, operation time were 10.0(range, 8.5?12.0)mm, 56, 6, 5, 43, 1, 1, 52, 177, 67, 201, 74, 38, 74, (7.4±3.1)minutes, (6±3)minutes, (46±19)minutes in patients with choledocholithiasis combined with periampullary diverticulum, versus 9.0(range, 8.0?11.0)mm, 243, 35, 14, 109, 73, 12, 230, 1 457, 167, 1 565, 395, 171, 395, (6.6±2.9)minutes, (6±5)minutes, (41±17)minutes in patients with choledocholithiasis not combined with periampullary diverticulum, showing significant differences in the above indicators between the two groups ( Z=6.31, χ2=15.90, 26.02, 13.61, 11.40, 71.51, 5.12, 9.04, 8.92, 9.04, t=?3.89, 2.67, ?3.61, P<0.05). (3) Influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Results of multivariate analysis showed total bilirubin >30 umol/L, number of stones >1, combined with periampullary diverticulum were indepen-dent risk factors for difficult cannulation in patients with periampullary diverticulum who underwent ERCP for choledocholithiasis ( odds ratio=1.31, 1.48, 1.44, 95% confidence interval as 1.06?1.61, 1.20?1.84, 1.06?1.95, P<0.05). Results of further analysis showed that, of 1 920 patients undergoing ERCP for choledocholithiasis, the incidence of postoperative pancreatitis was 17.271%(81/469) and 8.132%(118/1 451) in the 469 cases with difficult cannulation and 1 451 cases without difficult cannula-tion, respectively, showing a significant difference between them ( χ2=31.86, P<0.05). In the 1 692 patients with choledocholithiasis not combined with periampullary diverticulum, the incidence of postopera-tive pancreatitis was 17.722%(70/395) and 8.250%(107/1 297) in 395 cases with difficult cannula-tion and 1 297 cases without difficult cannulation, respectively, showing a significant difference between them ( χ2=29.00, P<0.05). In the 228 patients with choledocholithiasis combined with peri-ampullary diverticulum, the incidence of postoperative pancreatitis was 14.865%(11/74) and 7.143%(11/154) in 74 cases with difficult cannulation and 154 cases without difficult cannulation, respectively, showing no significant difference between them ( χ2=3.42, P>0.05). Conclusions:Compared with patients with choledocholithiasis not combined with periampullary divertioulum, periampullary divertioulum often occurs in choledocholithiasis patients of elderly and low body mass index. The proportion of chronic obstructive pulmonary disease is high in choledocholithiasis patients with periampullary diverticulum, and the diameter of stone is large, the number of stone is more in these patients. Combined with periampullary diverticulum will increase the difficult of cannulation and the ratio of patient with mechanical lithotripsy, and reduce the ratio of patient with stone complete clearing without increasing postoperative complications of choledocholithiasis patients undergoing ERCP. Total bilirubin >30 μmol/L, number of stones >1, combined with periampullary diverticulum are independent risk factors for difficult cannulation in patients of periampullary diverticulum who underwent ERCP for choledocholithiasis.
RESUMO
Objective To explore the value of preoperative LAR combined with AFP in evaluating the prognosis of patients with HCC. Methods We retrospectively analyzed the clinical data of 106 patients with HCC. Kaplan-Meier method was used to draw the survival curve. Univariate analysis was used to analyze possible variables affecting LAR. Cox risk regression model was used to evaluate the clinical value of preoperative LAR and AFP on the prognosis of HCC patients. Results The DFS and OS of the high LAR group and the high AFP group were shorter than those of the low LAR group and the low AFP group (P < 0.05). LAR≥4.58, AFP≥400μg/L and T3-T4 were independent risk factors affecting DFS and OS of HCC patients (P < 0.05). Postoperative interventional surgery was an independent factor influencing OS prolongation (P < 0.05). The DFS and OS were the shortest in the high LAR and high AFP group, and the DFS and OS were the longest in the low LAR and low AFP group (P < 0.05). Conclusion Preoperative LAR and AFP are independent poor prognostic factors of HCC. Preoperative LAR combined with AFP has a certain value in judging the prognosis of HCC patients.
RESUMO
Objective:To investigate the drainage efficacy of different types of plastic stents in endoscopic ultrasound (EUS)-guided transgastric drainage for pancreatic pseudocysts.Methods:Clinical data of patients with pancreatic pseudocyst who underwent EUS-guided transgastric drainage in the surgical endoscopic center of the First Hospital of Lanzhou University from March 2014 to December 2020 were retrospectively analyzed. Patients were divided into the 10 F double plastic stents group and the 7 F double plastic stents group. The drainage efficacy, complications and long-term outcomes of the two groups were compared.Results:A total of 29 patients were included, 11 in the 10 F double plastic stents group and 18 others in the 7 F double plastic stents group. The operation time of the two groups was 48.2±8.0 min and 34.7±5.8 min, respectively, showing significant difference ( t=5.24, P<0.001). There was no significant difference in the incidence of postoperative complications such as abdominal pain [18.2% (2/11) VS 5.6% (1/18)], fever [9.1% (1/11) VS 11.1% (2/18)] or bleeding (both none) between the two groups (all P>0.05). Two months after the operation, abdominal CT scan showed that the complete disappearance rates of cysts cavity in the 10 F and 7 F groups were 90.9% (10/11) and 88.9% (16/18), respectively, with no significant difference ( P=1.00). Conclusion:There are similar drainage effect and postoperative complications rates between the 7 F and the 10 F plastic stent in EUS-guided transgastric drainage for pancreatic pseudocysts. However, operation with the 7 F stent is more convenient for a shorter time, which is worth of clinical promotion.
RESUMO
Objective:To analyze the correlations between the prognosis of patients with pancreatic cancer and macrophage infiltration, and to find the differential gene correlated with macrophage infiltration in patients with pancreatic cancer through bioinformatics.Methods:A total of 32 patients with pancreatic cancer admitted to the First Hospital of Lanzhou University from June 2015 to December 2018 were selected as the research objects, including 19 males and 13 females, with the age of (61.8±2.8) years. Cancer tissues, adjacent tissues, and related clinical data were collected. F4/80 (macrophage marker) immunohistochemical staining was performed on the samples. The survival time was followed up and its correlation with the above indexes was analyzed. The pancreatic cancer data from The Cancer Genome Atlas (TCGA) database was used for bioinformatics analysis.Results:The survival time of pancreatic cancer patients was negatively correlated with degree of macrophage infiltration in cancer tissues ( r=-0.522, P=0.002), but not with adjacent tissues ( r=0.168, P=0.358). The degree of macrophage infiltration in cancer tissue combined with preoperative serum carbohydrate antigen 19-9 (CA19-9), tumor TNM stage and vascular invasion can predict survival up to 47.4% of the survival time ( R2=0.474). TCGA database bioinformatic analysis showed that in pancreatic cancer there were 95 differentially expressed genes significantly correlated with M2 macrophage infiltration, among which JPH3 (positive correlation) and IL17REL (negative correlation) were the main genes. Conclusion:The degree of macrophage infiltration in cancer tissue can be used as a prognostic factor for patients with pancreatic cancer, and the combination with preoperative serum CA19-9, tumor TNM stage and vascular invasion is more accurate in predicting the prognosis. The related mechanism of M2 macrophage infiltration can be studied around the differential genes such as JPH3 and IL17REL.
RESUMO
ObjectiveTo investigate the accuracy of three laparoscopic liver resection (LLR) difficulty score systems (DSSs) in evaluating surgical difficulty and predicting short-term postoperative outcome. MethodsThe retrospective cohort study was conducted for 142 patients who underwent LLR in The First Hospital of Lanzhou University from June 2015 to May 2020, and their preoperative, intraoperative, and postoperative clinical data were collected. According to preoperative clinical data, DSS-B score, Hasegawa score, and Halls score were used to determine the difficulty score of surgery for each patient, and then the patients were divided into low, medium, and high difficulty groups. Intraoperative data were compared between the three groups to verify the accuracy of the three DSSs, and postoperative clinical data were used to evaluate the ability of DSSs to predict short-term postoperative outcome. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple or two groups. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups, and the Bonferroni method was used for correction of P values between two groups. The receiver operating characteristic (ROC) curve was plotted and the area under the ROC curve (AUC) was calculated to evaluate the efficiency of each DSS in predicting postoperative complications. ResultsAmong the 142 patients, there were 37 patients in the low difficulty group, 56 in the medium difficulty group, and 49 in the high difficulty group based on DSS-B score; there were 70 patients in the low difficulty group, 47 in the medium difficulty group, and 25 in the high difficulty group based on Hasegawa score; there were 46 patients in the low difficulty group, 62 in the medium difficulty group, and 34 in the high difficulty group based on Halls score. For the low, medium, and high difficulty groups based on DSS-B score, Hasegawa score, or Halls score, time of operation, intraoperative blood loss, and rate of hepatic portal occlusion increased with the increase in difficulty score (all P＜0.001); there was a significant difference in intraoperative blood transfusion rate between the medium and high difficulty groups based on DSS-B score (P＜0.017), between the low and high difficulty groups based on Halls score (P＜0.017), and between the low, medium, and high difficulty groups based on Hasegawa score (P＜0.017). There was a significant difference in the rate of conversion to laparotomy between the medium and high difficulty groups based on DSS-B score (P＜0.017), and Hasegawa score and Halls score identified the difference between the low and high difficulty groups (P＜0.017). For the length of postoperative hospital stay, DSS-B score and Halls score only identified the difference between the low and high difficulty groups (P＜0.05), while Hasegawa score identified the difference between the low difficulty group and the medium/high difficulty groups (P＜0.05); for the incidence rate of postoperative complications, only Hasegawa score effectively identified the difference between the high difficulty group and the low/medium difficulty groups (P＜0.017). DSS-B score, Halls score, and Hasegawa score had an AUC of 0.636 (95% confidence interval ［CI］: 0.515-0.758), 0.557 (95% CI: 0.442-0.673), and 0.760 (95% CI: 0.654-0.866), respectively, in predicting postoperative complications, among which Hasegawa score had the highest predictive efficiency. ConclusionDSS-B score and Hasegawa score can better assess the difficulty of LLR, and Hasegawa score has an advantage in predicting short-term postoperative outcome.
RESUMO
Objective:To investigate the risk factors for common bile duct calculi recurrence and application value of its prediction model after endoscopic retrograde cholangiopancreato-graphy (ERCP) .Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 506 patients with common bile duct calculi who were admitted to the First Hospital of Lanzhou University from January 2015 to December 2017 for ERCP routine treatment were collected. There were 251 males and 255 females, aged (59±15)years. Patients received ERCP for common bile duct calculi. Observation indicators: (1) clinicopathological data of patients with common bile duct calculi; (2) risk factors for common bile duct calculi recurrence after ERCP; (3) establishment of prediction model for common bile duct calculi recurrence after ERCP. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate and multivariate analysis were conducted using the COX proportional hazard model. The prediction model for the recurrence of common bile duct stones after ERCP was established according to the coefficient of regression equation. The receiver operating characteristic curve(ROC) was drawed for efficiency evaluation with area under curve (AUC). Results:(1) Clinicopathological data of patients with common bile duct calculi: 104 of 506 patients with common bile duct calculi had recurrence and 402 had no recurrence. There were significant differences in the age, hyperlipidemia, common bile duct diameter, distal bile duct stricture, the number of calculi, gallbladder status, history of biliary tract surgery, endoscopic spinecterotomy, postoperative drainage mode between patients with and without recurrence ( Z=?2.844, χ2=6.243, Z=?2.897, χ2=11.631, 4.617, 16.589, 18.679, 2.070, 50.274, P<0.05). (2) Risk factors for common bile duct calculi recurrence after ERCP: Results of univariate analysis showed that age, time of first attack, hyperlipidemia, common bile duct diameter, distal bile duct stricture, the number of calculi, the maximum calculi diameter, gallbladder status, history of biliary tract surgery and postoperative biliary drainage mode were related factors for common bile duct calculi recurrence after ERCP ( hazard ratio=1.656, 2.179, 1.712, 1.657, 2.497, 1.509, 1.971, 2.635, 3.649,95% confidence interval as 1.113?2.463, 1.135?4.184, 1.122?2.644, 1.030?2.663, 1.501?4.154, 1.025?2.220, 1.122?3.464, 1.645?4.221, 1.575?8.456, P<0.05). Results of multivariate analysis showed that time of first attack <30 days, hyperlipidemia, distal bile duct stricture, history of biliary tract surgery and postoperative biliary drainage mode as cholangiopancreatic stent were independent risk factors for common bile duct calculi recurrence after ERCP ( hazard ratio=2.332, 1.676, 2.088, 2.566, 3.712, 95% confidence interval as 1.089?4.998, 1.060?2.649, 1.189?3.668, 1.456?4.521, 1.296?10.635, P<0.05). (3) Establishment of prediction model for common bile duct calculi recurrence after ERCP: based on multivariate analysis, indicators including time of first attack <30 days, hyperlipidemia, distal bile duct stricture, history of biliary tract surgery and postoperative biliary drainage mode as cholangiopancreatic stent were included into the coefficient of regression equation, and the prediction model for common bile duct calculi recurrence after ERCP was established: ln[(λ(t))/(λ 0(t))]=0.847×time of first attack+0.516×hyperlipidemia+0.736×distal bile duct stricture+0.942×history of biliary tract surgery+1.312×cholangiopancreatic stent. The perfor-mance evaluation showed that the AUC of ROC of prediction model was 0.757 (95% confidence interval as 0.713?0.811, P<0.05), and the optimal cut-off value was 1.41, the sensitivity and specificity were 69.2% and 72.9% respectively. Conclusions:The time of first attack <30 days, hyperlipidemia, distal bile duct stricture, history of biliary tract surgery and postoperative biliary drainage mode as cholangiopancreatic stent are independent risk factors for common bile duct calculi recurrence after ERCP. Patients with evaluation score >1.41 in prediction model were at high risk for common bile duct calculi recurrence after ERCP.
RESUMO
Objective To investigate the expression of LncRNA LINC00857 in pancreatic cells and the effect of lncRNA LINC00857 down-regulation on proliferation, migration and apoptosis of pancreatic cancer PANC-1 cells and possible mechanism. Methods The lentiviral vector GV112 was constructed and infected PANC-1 cells to obtain experimental group, while the blank plasmid was transfected as a negative control group and the cells without intervention were taken as normal control group. CCK-8 assay, Transwell assay, scratch test, flow cytometry, Western blot were used to detect the effect of LINC00857 down-regulation on cell proliferation, migration, apoptosis, cell cycle and EMT-related proteins. Results LINC00857 expression in pancreatic cancer cells were significantly higher than that in normal pancreatic epithelial cells (P < 0.001). Knockdown of LINC00857 could significantly inhibit the proliferation and migration of PANC-1 cells (P < 0.0001); compared with the negative control group, the apoptosis rates of cells in the experimental groups were significantly increased (P < 0.05), the number of cells in G0/G1 phase increased (P < 0.01), the number of cells in S phase decreased (P < 0.05), and the cells were blocked in the G1 phase, E-cadherin expression was significantly up-regulated (P < 0.05) and N-cadherin and Vimentin expression were significantly down-regulated (N-cadherin: P < 0.01, Vimentin: P < 0.05). Conclusion LINC00857 can promote proliferation and migration of PANC-1 cells and inhibit its apoptosis by regulating G1/S phase transition and EMT signaling pathway.
RESUMO
Due to the need of the diagnosis and minimally invasive treatment of biliary tract diseases, peroral choledochoscopy has recently become an important method for the diagnosis and treatment of biliary tract diseases, which helps to avoid some invasive and unnecessary surgical procedures. This article introduces the clinical advantages of SpyGlassTM DS Direct Visualization System and its indications and possible complications in biliary duct diseases. SpyGlassTM DS provides endoscopic imaging of the biliary tree and can perform biopsy under direct view, and thus it plays an important role in the diagnosis and treatment of biliary tract diseases. In particular, it can improve the diagnostic accuracy of biliary stricture with unknown nature and the surgical success rate and stone clearance rate of complex bile duct stones, with similar incidence rates of complications as conventional endoscopic retrograde cholangiopancreatography. SpyGlassTM DS is a safe and effective procedure and supplements the standard endoscopic diagnosis and treatment.
RESUMO
Objective:To determine a better treatment and endoscopic stent for type Ⅳ hilar cholangiocarcinoma.Methods:Clinical data of 65 patients diagnosed with type Ⅳ hilar cholangiocarcinoma at Department of General Surgery, the First Hospital of Lanzhou University from September 2010 to September 2018 were retrospectively analyzed. According to different endoscopic drainage methods, the patients were divided into three groups, endoscopic retrograde biliary drainage (ERBD) group (n=38), ERBD + endoscopic metal biliary endoprosthesis (EMBE) group (n=23) and EMBE group (n=4). According to different contrast methods, patients were divided into the contrast media group (n=26), air contrast group (n=22) and non-contrast group (n=17). Incidence of postoperative acute cholangitis, incidence of bilirubin levels decline and in-hospital mortality were analyzed.Results:The incidences of acute cholangitis in ERBD group, ERBD+ EMBE group and EMBE group were 23.7% (9/38), 52.2% (12/23) and 75.0% (3/4), respectively, with significant differences ( χ2=7.499, P=0.006). The in-hospital mortalities of the above three groups were 5.3% (2/38), 13.0% (3/23) and 50.0% (2/4), respectively, with significant differences ( χ2=7.729, P=0.021). For pairwise comparisons, there was significant difference in in-hospital mortalities between ERBD group and EMBE group ( χ2=8.406, P=0.004). The incidences of acute cholangitis were 57.7% (15/26), 27.3% (6/22) and 17.6% (3/17), respectively, in the contrast media group, the air contrast group and the non-contrast group, with significant difference ( χ2=8.407, P=0.015). For pairwise comparisons, there was significant difference in acute cholangitis incidence between the contrast media group and the non-contrast group ( P=0.012). Conclusion:For type Ⅳ hilar cholangiocarcinoma, biliary double plastic stent implantation can significantly reduce the incidence of postoperative acute cholangitis and the mortality during hospitalization, which can be used as the preferred stent scheme. Additionally, intraoperative contrast agents may increase the incidence of postoperative acute cholangitis which should be used with caution.
RESUMO
Objective:To systematically evaluate the effectiveness and safety of epinephrine injection and norepinephrine spraying for treating non-variceal upper gastrointestinal bleeding.Methods:Databases including the PubMed, Embase, Cochrane Library, CNKI, CBM, VIP and WanFang Data with the retrieval time from inception to December 2018 were searched to collect the related clinical trials. The references of included studies were also retrieved. Studies were screened, data were extracted, and the risk of bias was assessed by 2 reviewers separately. The meta-analysis was conducted by using RevMan 5.3 software. The grading of recommendations, assessment, development and evaluation (GRADE) quality of evidence system was used to assess the results of meta-analysis.Results:A total of 10 studies involving 884 participants were included. The results showed that compared with the norepinephrine spraying, epinephrine injection was superior in the following aspects with significant differences: the effective rate ( RR=1.21, 95% CI: 1.12-1.30, P<0.001); the one-week recurrent bleeding rate ( RR=0.28, 95% CI: 0.17-0.45, P<0.001); the immediate hemostatic rate ( RR=1.38, 95% CI: 1.25-1.52, P<0.001); and the emergent operation rate ( RR=0.35, 95% CI: 0.19-0.63, P<0.001). Conclusion:Epinephrine injection is more effective and safer for treating non-variceal upper gastrointestinal bleeding in comparison with norepinephrine spraying.
RESUMO
Objective:To evaluate the effect of transitional care on the quality of life of patients with pancreatitis.Methods:We searched the following databases such as PubMed, Web of Science, Cochrane Library, CNKI, CBM, and WanFang Data electronically. Other sources as applying were also retrieved. Comprehensive collection of continuing care on the quality of life in patients with pancreatitis related research. According to the evaluation method of Cochrane system, the quality evaluation and data extraction were carried out, and the RevMan 5.3 software was used for Meta analysis.Results:A total of 21 randomized controlled trials involving 1 818 patients (910/908) were included. SF-36 health survey scale, analysis of 8 Meta subgroups showed that all groups P<0.05, and the combined effect was statistically significant. The results of the intervention with telephone as the main outcome indicator were: maintaining a regular lifestyle [weight mean difference ( WMD) value was 4.33, 95% confidence interval ( CI)2.52-7.44, P<0.01], quitting smoking and drinking ( WMD value was 5.95, 95% CI 3.69-9.59, P<0.01), maintaining a healthy diet ( WMD value was 8.62, 95% CI 5.07-9.59, P<0.01). Continuous nursing based on telephone intervention can reduce the recurrence rate ( WMD value was 0.20, 95% CI 0.13-0.31, P<0.01). Meta-analysis based on the intervention of establishing archives for continuous nursing showed that WMD value was 0.25, 95% CI 0.12-0.52, P<0.01, and archives and telephone showed that WMD value was 0.24, 95% CI 0.09-0.63, P=0.004, and the combined effect was statistically significant. Conclusions:Continuous nursing can improve the quality of life of patients with pancreatitis, improve the compliance with medical advice, and reduce the recurrence rate, but it needs to be further verified by a large sample, high-quality, multi-centered randomized controlled trial.
RESUMO
Objective@#To investigate the effection of 10% glucose on laparoscopic cholecystectomy.@*Methods@#Including 82 cases in patients undergoing laparoscopic cholecystectomy from June 2018 to November 2018 in the First Hospital of Lanzhou University. They were divided into the experimental group(40 cases) and the control group (42 cases) according to admission time. The control group used conventional nursing measures, fast day after 0:00. The experimental group took orally 400 ml 10% glucose solution on the night before surgery, 10% glucose 100 ml at 6:00 on the day. And then the perioperative safety, comfort and hospital satisfaction were observed.@*Results@#No postoperative nausea and vomiting and complications occurred in the two groups. The perioperative satisfaction score of the experimental group was greater than the control group, which was 94.00±3.08 and 80.00±11.54 points, respectively, and the difference was statistically significant (t=3.45, P<0.01). The VAS scores of thirst, hunger, fatigue and anxiety in the experimental group were 2.97±3.55, 1.50±0.57, 2.50±1.00, 2.25±0.96, respectively, which were lower than those in the control group (3.55±2.98, 2.25±0.50, 5.50±0.57, 5.25±1.89), and the differences were statistically significant (t= 2.83-5.19, P<0.01 or 0.05). The VAS scores of thirst, hunger and fatigue in the experimental group were 3.60±1.00, 3.50±0.56, 2.75±1.50, respectively, 4 h after surgery, which were lower than those in the control group (7.00±0.58, 4.75 ±1.25, 5.75±0.50), with statistically significant differences (t=5.00, 3.69, 3.79, P<0.05). Compared with preoperative situation, the thirst and hunger degree of the two group both increased after surgery, while the anxiety degree of the control group decreased, and the difference was statistically significant (t=-9.91-5.20, P<0.05 or 0.01).@*Conclusions@#Oral administration of 10% glucose solution before laparoscopic cholecystectomy is safe and effective, which can improve perioperative comfort and hospitalization satisfaction of patients.
RESUMO
Objective To investigate the effection of 10％ glucose on laparoscopic cholecystectomy. Methods Including 82 cases in patients undergoing laparoscopic cholecystectomy from June 2018 to November 2018 in the First Hospital of Lanzhou University. They were divided into the experimental group(40 cases) and the control group (42 cases) according to admission time. The control group used conventional nursing measures, fast day after 0:00. The experimental group took orally 400 ml 10％glucose solution on the night before surgery, 10％glucose 100 ml at 6:00 on the day. And then the perioperative safety, comfort and hospital satisfaction were observed. Results No postoperative nausea and vomiting and complications occurred in the two groups. The perioperative satisfaction score of the experimental group was greater than the control group, which was 94.00 ± 3.08 and 80.00 ± 11.54 points, respectively, and the difference was statistically significant (t=3.45, P<0.01). The VAS scores of thirst, hunger, fatigue and anxiety in the experimental group were 2.97±3.55, 1.50±0.57, 2.50±1.00, 2.25±0.96, respectively, which were lower than those in the control group (3.55±2.98, 2.25±0.50, 5.50±0.57, 5.25± 1.89), and the differences were statistically significant (t=2.83-5.19, P<0.01 or 0.05). The VAS scores of thirst, hunger and fatigue in the experimental group were 3.60±1.00, 3.50±0.56, 2.75±1.50, respectively, 4 h after surgery, which were lower than those in the control group (7.00±0.58, 4.75 ±1.25, 5.75±0.50), with statistically significant differences (t=5.00, 3.69, 3.79, P<0.05). Compared with preoperative situation, the thirst and hunger degree of the two group both increased after surgery, while the anxiety degree of the control group decreased, and the difference was statistically significant (t=-9.91-5.20, P<0.05 or 0.01). Conclusions Oral administration of 10％ glucose solution before laparoscopic cholecystectomy is safe and effective, which can improve perioperative comfort and hospitalization satisfaction of patients.
RESUMO
Objective To determine the best endoscopic treatment for acute obstructive suppurative cholangitis (AOSC).Methods Data of 93 patients who were diagnosed as having AOSC in endoscopic center in the last three years were retrospectively analyzed.All patients were divided into three groups according to the different treatment methods:ENBD group,ENBD+ERBD group and double ERBD group.Postoperative temperature,bilirubin levels and mortality were compared.Results For patients with high level obstruction,incidence of fever in ENBD+ERBD group and double ERBD group were significantly higher than that of ENBD group (1/18 VS 4/10,P ＜ 0.05;0 VS 4/10,P ＜ 0.05).There were no significant differences in incidence of fever(1/18 VS 0) or bilirubin level decrease (17/18 VS 14/15) between ENBD+ERBD group and double ERBD group.For high level obstruction,if the patient had biliary imaging with contrast medium during operation,they would have higher incidence of high fever[(4/10 VS 3.45％ (1/28)] and mortality(3/11 VS 0),lower declining rate of bilirubin level [10/14 VS 96.55％(28/29)] than those without.Conclusion Both left and right hepatic ducts drainage should be recommended for high level biliary obstruction.During the operation,contrast medium should be limited to minimum dose,and should be avoided in high level obstruction cases.Air biliary imaging could be used when necessary.
RESUMO
Secreted frizzled-related protein (SFRP) can inhibit the expression of Wnt signaling pathway through Frizzled protein.The silencing of SFRP gene promoter methylation is associated with the occurrence and metastasis of many cancers such as colorectal cancer,gastric cancer,liver carcinoma,lung cancer and ovarian cancer.Several studies have found that SFRP gene has latent clinical value,which is expected to become the novel target for the gene diagnosis and treatment of cancer.
RESUMO
Objective To investigate the early (within 72 hours) application and effect of endoscopic pancreatic and (or) biliary stents combined with Qingyi granules in treatment of acute biliary pancreatitis (ABP) patients.Methods A retrospective analysis was done to the 245 patients admitted for ABP from Jan.2012 to Jan.2016 in the First Hospital of Lanzhou University.133 patients (group A) were treated within 72 hours by endoscopic pancreatic and (or) biliary stents combined with Qingyi granules through feeding tube.112 patients (group B) were treated by endoscopic pancreatic and (or) biliary stents and feeding tube without Qingyi granules.Then the study was done to compare the difference of recover days of abdominal distension,abdominal pain,normalization time of amylase and WBC,length of stay,decrease level of PCT,and the incidence of ABP complications.Results Group A was superior to group B in terms of the recover days of abdominal distension (3.8±3.2)d vs (5.2± 2.4)d,abdominal pain (2.6±2.1)d vs (4.9±2.7)d,normalization time of amylase(2.8±1.6)d vs (4.4±3.7)d,WBC (2.6±1.3)d vs (4.1± 2.7)d,length of stay(9.4±2.1)d vs (12.6±3.3)d and postoperative PCT level(2.59±2.33)ng/ml vs (3.98±3.03)ng/ml,and the difference had statistical significance (P＜0.05),while there was no significant difference between the two groups in the incidence of ABP complications.Conclusions For ABP patients,early placement of endoscopic pancreatic and (or) biliary duct stents combined with Qingyi granules through feeding tube can remove the etiology,and block the disease from further progress.Early enteral nutrition can contribute to the recovery of intestinal mucosa and the maintenance of internal environment.Combined with Qingyi granules,it can relief the symptoms,decrease the laboratory index and shorten the hospitalization time.
RESUMO
ObjectiveTo investigate the treatment of Mirizzi syndrome (MS) by ERCP、laparoscopy and choledochoscopy. MethodsIn this study 12 cases were confirmed intraoperatively as with MS from July 2005 to June 2009. Patients were treated by ERCP,laparoscopy and choledochoscopy according to the Csendes Classification. ResultThere were 7 MS patients complicating common bile duct stones among all 12 MS cases.There were 8 cases of Type Ⅰ Csendes MS,3 cases of Type Ⅱ and 1case of Type Ⅲ.11cases were treated by the ERCP、laparoscopy and choledochoscope.4 cases was treated by primary closure of common bile duct in laparoscopy,all the patients were cured.The case of type Ⅲ with T tube placed for stone caused bile duct injury had no stricture of the common bile duct as demonstrated by postoperative follow-up cholangiography.ConclusionsERCP,laparoscopy and choledochoscopy are effective for the treatment of Mirizzi syndrome.
RESUMO
Objective To investigate the efficacy of endoscopy for the treatment of benign biliary stricture after biliary surgery.Methods The clinical data of 127 patients with benign biliary stricture after biliary surgery at the First Hospital of Lanzhou University from January 2007 to December 2011 were retrospectively analyzed.According to the Bismuth classification,there were 60 patients with type Ⅰ,35 with type Ⅱ,21 with type Ⅲ and 11 with type Ⅳ.The efficacies of endoscopy for the treatment of biliary stricture with different Bismuth subtypes were analyzed.Results The location and severity of biliary stricture were confirmed by endoscopic retrograde cholangiopancreatography (ERCP) + cholangiography.Sixteen patients ( including 7 with type Ⅲ and 9 with type Ⅳ) were transferred to surgical treatment due to severe biliary stricture.A total of 111 patients underwent endoscopic treatment successfully,with the success rate of 87.4％ (111/127).The success rates of endoscopy for the treatment of patients with Bismuth Ⅰ,Ⅱ,Ⅲ and Ⅳ biliary strictures were 95％ (57/60),86％ (30/35),9/14and 1/2,respectively.Twenty-nine patients were implanted with retrievable metallic biliary stent,and 82 were implantated with plastic biliary stent.Of the 111 patients,only 6 patients were complicated by acute pancreatitis,and they were cured by conservative treatment.The alleviative rates of yellow skin and icteric sclera,tenderness and distending pain of right upper quadrant,fever were 73％ (81/111 ),83％ (74/89),90％ (73/81 ) and 89％(68/76) at 1 week after treatment,and they were 88％ (98/111),91％ (81/89),94％ (76/81) and 92％(70/76) at 8 weeks after treatment.The efficacy of endoscopy was good in 97 patients and poor in 14 patients,and the 14 patients were converted to open surgery.The symptoms including yellow skin and icteric sclera,tenderness and distending pain of right upper quadrant,fever were completely alleviated at postoperative month 6.Conclusion Endoscopic treatment for benign biliary stricture is safe and effective.