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The authors introduced a pharmaceutical care mode by establishing a medication management platform(" Smart Pharmacists" platform), automatically and regularly sending personalized medication reminders for out-of-hospital patients. In virtue of the medication consultation service built on mobile internet technology, the hospital information system was seamlessly connected with the WeChat public account of the hospital, hence broadening pharmaceutical care. The " Smart Pharmacists" platform covered such six parts as medication reminder, medication record, voice broadcast, medication consultation, prescription query, and package insert inquiry. It serves as a reminder of taking medicine for patients out of the hospital and provides an accessible " pharmacist-patient interaction" service window, which will guarantee the safety and effectiveness of medication for out-of-hospital patients.
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Objective To study the clinical efficacy of intra-operative implantation of 125Ⅰ particles to treat advanced pancreatic cancer,and to evaluate the treatment effects on pain relief and survival of patients.Methods A retrospective study was conducted on 53 patients who were treated in the Third Affiliated Hospital of Inner Mongolia Medical University from May 2013 to November 2016.The patients were divided into the particle implantation group (n =32,palliative operation combined with intra-operative implantation of 125Ⅰ particles or just intra-operative implantation) and the control group (n =21,palliative operation).The outcomes on pain relief and median survival after operation were compared between the 2 groups.Results Patients in the implantation group were implanted with 20 to 70 (41.4± 12.1) particles.There were no postoperative complications such as pancreatic fistula and bleeding.There was also no perioperative death.Of the 46(86.8％) patients who were followed-up,three patients were still alive at the time the data were analyzed.The postoperative survival time of the patients ranged from 3 to 27 months.For the implantation group,the median survival time was 11.5 months.The 3-,6-,12-,24-months survival rates were 100.0％,90.6％,65.6％,15.6％,respectively.Postoperative pain relief happened in 92.6％ of patients.For the control group,postoperative survival time ranged from 2 to 17 months.The median survival time was 7 months.The 3-,6-,12-,24-months survival rates were 95.2％,57.1％,9.5％,0,respectively.Postoperative pain relief happened in 16.7％ of patients.Postoperative pain relief for patients in the implantation group was significantly better than the preoperative,and than patients in the control group (both P ＜ 0.05).The Log-rank test showed a significant difference in survival between the two groups (P＜0.05).Conclusion Particle implantation significantly relieved pain and prolonged survival time of the patients.
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Objective To find a reliable, simple, and easily-operated method for the screening of neonatal congenital heart disease (CHD). Methods A total of 7 105 neonates born from January 2017 to July 2017 were selected. The validity and reliability of physical examination, pulse oximetry screening (POS), and perfusion index (PI) in the screening of neonatal CHD were evaluated according to the diagnosis made by color Doppler echocardiography. Results When physical examination, POS or PI was used separately in screening for CHD, the sensitivities were in the range of 13.11%~73.77%, specificities 50.20%~99.34%, Youden indexes 0.12~0.70, the total coincidence rates 50.40%~98.86%, positive predictive values 1.27%~40.70%, and negative predictive values 99.29%~99.70%. When physical examination, POS and PI were combined (two or three indexes were positive) for screening, the sensitivities and Youden indexes were 85.25% and 0.82 respectively, which were higher than those of single indicators and suggested that the combination had higher authenticities. The total coincidence rate of the combination was 97.07%, and, although it was lower than POS group (98.86%) and PI screening group (98.58%), it still had a good reliability. Conclusions The combination of physical examination, POS and PI has a certain clinical value in neonatal CHD screening.
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Objective To analyze the Clavien-Dindo classification and risk factors of complications after pancreaticoduodenectomy and investigate the relationship between the major risk factors and Clavien-Dindo classification of complications.Methods The retrospective case-control study was adopted.The clinical data of 200 patients who underwent pancreaticoduodenectomy at the Third Affiliated Hospital of Inner Mongolia Medical University from January 2010 to June 2015 were collected.The patients underwent Whipple surgery or pylorospreserving pancreaticoduodenectomy according to the tumor location.Observation indicators included:(1)postoperative complications using Clavien-Dindo classification,(2) univariate and multivariate analyses:the basic conditions of patients,surgery-related factors,pancreas-related factors,(3) relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy.The univariate analysis and count data were done using the chi-square test.The comparison between groups was done using independent samples nonparametric test (Kolmogorov-Smirnov Z) and multivariate analysis was done using the Logistic regression model.Results (1) Postoperative complication situations:of 200 patients,122 underwent Whipple surgery and 78 underwent pylorus-preserving pancreatico-duodenectomy,including 6 combined with vascular reconstruction and 1 with radiofrequency ablation of liver tumors.Ninety-eight patients had postoperative complications,including 41 patients with 2 or above kinds of complications.Pancreatic fistula was detected in 80patients,including 42 with grade A,28 with grade B and 10 with grade C,wound infection in 29 patients,delayed gastric emptying in 24 patients,postoperative intra-abdominal infection in 16 patients,postoperative intraabdominal hemorrhage in 10 patients including 8 receiving interventional treatment,postoperative biliary leakage in 7 patients and unintended reoperation in 2 patients.Three patients were dead during hospitalization.The incidence of complications in grade Ⅰ,Ⅱ,Ⅲ (Ⅲ a and Ⅲ b),Ⅳ and V of Clavien-Dindo classification was 28.00％(56/200),13.00％ (26/200),5.00％ (10/200),1.50％ (3/200) and 1.50％ (3/200).(2) The univariate and multivariate analyses:the results of univariate analysis showed that body mass index (BMI) and texture of the pancreas were risk factors affecting complications after pancreatico-duodenectomy (x2=6.483,Z =-3.189,P ＜0.05).The results of multivariate analysis showed that BMI ＞ 23.9 kg/m2 and soft pancreas were independent risk factors affecting complications after pancreaticoduodenectomy (OR =2.044,1.649,95 ％ confidence interval:1.212-3.447,1.194-2.275).(3) The relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy was analyzed,there were statistically significant differences between BMI or texture of the pancreas and Clavien-Dindo classification of complications after pancreaticoduodenectomy (x2 =13.897,27.077,P ＜ 0.05).Conclusions Clavien-Dindo classification of complications after pancreaticoduodenectomy is in favor of comprehensive comparisons and quality assessments among different studies,the primary classification is grade Ⅰ and Ⅱ.And decreasing BMI and good management of pancreatic stump may affect Clavien-Dindo classification of complications after pancreaticoduodenectomy.
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The gastric cancer is closely related to the coagulation function.On the one hand,gastric cancer result in changes of coagulation mechanism such as blood coagulation,anticoagulation and fibrinolysis coagulation,which further result in hypercoagulable state and thrombosis related diseases.On the other hand,the abnormal of the coagulation function aggravate the progress of stomach cancer,and affect the prognosis of patients seriously.We review the domestic and international studies on the relationships between gastric cancer and coagulation function,and clinical doctors should pay attention to the abnormal of coagulation function and anticoagulaion treatment on gastric cancer.
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Objective To investigate whether the interleukin-10 (IL-10) gene therapy has the effect of anti liver fibrosis in mice and its mechanism.Methods Liver fibrosis was induced by long-term thioacetamide administration in mice.Human IL-10 expression plasmid was delivered via electroporation after liver fibrosis was established.The immunohistochemistry was used to study the expression of IL-10 in liver.Sircol collagen determination method was used to detect the contents of collagen in the liver.The reverse transcription polymerase chain reaction (RT-PCR) was used to detect the expressions of liver fibrosis-related genes,including transforming growth factor-β1 (TGF-β1),collagen α1,tumor necrosis factor-α (TNF-α),intercellular adhesion molecule-1 (ICAM-1),fibronectin,vascular cell adhesion molecule 1 (VCAM-1),and matrix metalloproteinase-inhibiting factor (TIMP-1,TIMP-2).Results Immunohistochemical results showed IL-10 gene therapy reversed hepatic fibrosis.Sircol collagen assay showed that IL-10 gene therapy reduced the content of collagen fibers(P ＜ 0.05).RT-PCR revealed IL-10 gene therapy reduced liver TGF-β1,TNF-α,collagen α1,cell adhesion molecule,and TIMPs mRNA upregulation.Conclusions Electroporative IL-10 gene therapy might be an effective therapeutic reagent for liver fibrosis with potential future clinical applications.
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Objective:To explore C-terminal tensin-like(CTEN) gene in breast cancer tissue and its significance. Methods:Explore the prevalence and clinical significance of CTEN expression in invasive breast cancer cases ( n = 1409 ) using immunohistochemistry and tissue microarray. Results: The staining pattern for CTEN in breast tumour cells was homogenous cytoplasmic staining. Moderate to strong cytoplasmic immunoreactivity for CTEN was observed in 90% of the studied cases(1268 cases) . CTEN expression was significantly associated with poor prognostic variables including larger tumour size(χ2=4. 254,P=0. 044), higher histological grade(χ2=7. 555,P=0. 019),axillary nodal involvement(χ2=5. 842,P=0. 035),poor Nottingham Prognostic Index (χ2=7. 578,P=0. 016),Local recurrence(χ2=5. 211,P=0. 039),Regional recurrence(χ2=4. 778,P=0. 042),Distant metastases (χ2=4. 780,P=0. 041) and Histological type(χ2=7. 634,P=0. 012). Significant associations were observed between increased CTEN expression and up-regulation of phosphorylated-Akt(P-Akt)(χ2=27. 23,P<0. 001),Phosphoinositide 3 kinase(PIK3)(χ2=37. 22,P<0. 001) and N-cadherin proteins(χ2=26. 91,P<0. 001). Kaplan-Meier survival analysis demonstrated that patients with high CTEN ex-pression had significantly shorter Breast Cancer Specific Survival(P=0. 004) and Metastasis-Free Survival(P=0. 041) than those with low-CTEN expression. Multivariate analysis showed that CTEN was not an independent prognostic marker in breast cancer. Conclusion:CTEN expression increase is a cancer gene,its association with poor prognostic parameters,and the expression of CTEN associated with poor prognosis of breast cancer parameters.
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ObjectiveTo evaluate the role of nitric oxide (NO) in ischemia reperfusion injury (IRI) and acute rejection (AR) of intestinal transplantation in rats.MethodsThe rat orthotopic intestinal transplantation was performed. Animals were assigned to the following 4 groups with random methods:transplant control group,L-arginine (L-Arg) group,NG-Nitro-L-arginine methyl ester (L-NAME) Ⅰ group (group Ⅰ ) and L-NAME Ⅱ group (group Ⅱ ).The rats in different group were given saline,L-Arg (150 mg· kg-1 · d-1 ),L-NAME (4 and 8 mg· kg-1 · d-1 ) injection respectively from the operative day.The recipient survival time was observed.The pathologic changes were observed by HE staining.The activity of nitric oxide synthases (NOS) was measured by using immunohistochemistry.The abilities of glucose absorption and serum NO levels were tested.Results The recipient survival timein transplant control group,L-Arg group,group Ⅰ and group Ⅱ were (11.7 ± 1.2),(10.2 ± 1.0),( 12.3 ± 1.5) and ( 17.3 ± 1.9) days respectively,and the survival in group Ⅱ was prolonged significantly (P＜0.01).As compared with control group,the Park scores in L-Arg group and group Ⅰ were reduced,and IRI were attenuated; the Park score in group Ⅱ was increased (P＜0.01),the IRI was aggravated,but the AR was attenuated.As compared with control group,during the IRI period,the iNOS staining in group Ⅰ was decreased,and both iNOS and nNOS staining in group Ⅱ was decreased; during the AR period,the iNOS staining in group Ⅱ was decreased obviously.The serum NO levels were increased gradually in all groups.As compared with control group,the increase of serum NO level in group Ⅱ was delayed.As compared with control group,the glucose absorption levels in L-Arg group were increased significantly from 30 min after reperfusion to POD-3 (P＜0.01),and the postoperative glucose absorption levels in groups Ⅰ and Ⅱ maintained the low levels.ConclusionNO may play a dual role as both cytotoxic and cytoprotective effects in IRI,and aggravate mucosal damage in AR in rats intestinal transplantation.The glucose absorptive capacity of graft is promoted by supplementation of LArg at early postoperative period.
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Objective To explore the influence of modified Lawrence's reconstuction procedures following total gastrectomy for gastric cancer to alimentation of patients. Methods Retrospective analysis of nutritional status and symptoms of digestive tract in 76 patiens of total gastrectomy for gastric cancer while 3 and 6 month after modified Lawrence's reconstuction procedure. Results Examination was given in 48 patients 3 month after operation. Emptying time of barium was 60-100 min, barium meal backflowing to esophagus was not observed in all patients when they were in erect or decubitus position, no sign of narrow of anastomotic stoma. The hemoglobin, total protein, body weight and food-intake of patients 3 or 6 months after operation was as same as them before operation. Conclusion The patients undergoing this reconstuction procedure will recover normal food habits soon after operation, Lawrence's reconstuction procedures is a satisfactory choice in patients of total gastrectomy for gastric cancer because of its safety and convenient.
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The experiment was conducted between February 2004 and May 2006 at The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang province, China. Forty hybrid pigs were used in the experiment, 20 were used as donors and the other 20 were used as recipients. Donor operation: Abdominal aorta was lavaged in situ with 500 mL 4℃ heparinized saline (lavage pressure 7.8-9.8 kPa), intestinal canal cut from donor was conserved in 4℃ physiological saline.Recipient operation: Orthotopic small intestine transplantation and heterotopic small intestine transplantation were conducted according to exploring results, and abdominal cavity was washed with 40-45℃ physiological saline until the flush out liquid became warm.Periprocedural management: Preoperative discussion and postoperative discussion were done, and body temperature of pigs was monitoring and controlled. Early-stage feeding was used, 4 pigs could drink water freely after transplantation and took food normally at the second day, while other 16 pigs began to drink water 2 days after transplantation. Evaluation after the operation: No experimental animal had anastomotic leakage after taking food. Sixteen pigs survived over 7 days, average 9 days, the longest over 14 days. The success rate of the small intestine transplantation is 80% (16/20). Failure reasons: One with phlebothrombesis, one with blood loss and two with unknown reasons. Results showed that experience of periprocedural management had got relatively satisfactory effects through a great quantity of small intestine transplantation practices.
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BACKGROUND: Recently,the technique of isolation procedure of viable islets cell from large animals has been mature and used in clinical islet cell transplantation. Some study results indicate that low yields of pig islet cell isolations is probably not due to the presence of higher or more aggressive enzyme activities during the porcine isolation procedure. Therefore, the causative factors resulting in the inconsistent results should be sought for the intrinsic properties of the pancreatic islet and pancreas. The purpose of the study is to get more pancreatic islet cells for diabetic patients.OBJECTIVE: To investigate the effect of single enzymatic solution (SES)and multi-enzymatic solution(MES) on adult porcine pancreatic islet cell isolation,and to provide the theory base for diabetic patients rehabilitation.DESIGN: A completely randomized and controlled experiment based on animals.SETTING: General surgery and gerontology department in a university hospital.MATERIALS: The experiment was conducted in the Second Affiliated Hospital of Harbin Medical University from June 2003 to May 2004. Twenty consecutive random-bred adult pigs, 12 - 24 months old, weighing average 100 kg,were selected for experiment from Hada Slaughterhouse of Harbin.INTERVENTIONS: After slaughtering,the spleentic lobe of the pancreas was excised using sterile surgical gloves and surgical instruments. Each was immediately transported in 500 mL of sterile RPMI1640 solution at 4 ℃ to the laboratory for processing. After removal of fat peritoneum and superficial blood vessel,each pancreas was first immersed in 1:5 000 Liquor chlorhexidine for 3 minutes,then washed three times with cold RPMI1640, next mechanically minced into 1 mm×1 mm×1 mm fragments,weighed,and equally divided into two groups. Adult porcine islets were isolated with two different collagenase solutions(SES and MES).MAIN OUTCOME MEASURES: Islet count was performed with DTZ-staining. The viability was assessed by trypan-blue staining. Porcine islet insulin-secretory function was assessed by insulin content of cultured porcine islets and by insulin release. Islet morphological integrity was finally established by electron microscope examination.RESULTS: Overall islet cell content were statistically different between the two methods[(1 782 ±427) IE/g vs (1 293 ±451) IE/g,P<0.05]. No significant difference was found in viability,function or morphology of islet between MES and SES(P>0. 05).CONCLUSION: An average of isletisolated with MES method represents a uniquely massive yield in comparison with that by SES method. A good viability was also confirmed by static incubation and culture. The transplantation of those pancreatic islet cells can help to control the syndromes of diabetes.
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Objective Discussing reoperative reasons and selection of operation for congenital bile duct cysts.Method Retrospectively analyzing 15 reoperative patients for congenital bile duct cysts.Result Reoperative reasons include unresected cysts canceraztion (3 cases);unresected cysts calculogenesis (4 cases);anastomotic stoma between gut and cyst or bile duct stenosis (6 cases);reflux cholangitis(1 case);recurrence cholecystitis (6 cases).There are two kinds of operations,the first is interposed jejunal choledochoduodenostomy,the second is Rou-en-Y choledochojejunostomy.Conclusion Cysts and gallbladder must be resected totally,Roux-en-Y choledochojejunostomy can enhance effect of operation and prevent reflux cholangitis,this operation is very important for avoiding reoperation.
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Objective To study the effects of deep hypothermia and L-arginine(NO precursor) pretreatment on cerebral protection after circulatory arrest and resuscitation in a canine model. Methods Ten healthy adult dogs of both sexes, weighing 14.45?2.3kg, were randomly divided into two groups(n=5): sham treatment group and L-arginine pretreatment group. Extracorporeal circulation was established routinely,circulatory arrest was induced when the nasopharyngeal temperature was reduced to 18℃, then the animals were resuscitated 90min later with extracorporeal circulation. SjvO2 was measured at 30min before circulatory arrest, 0min, 45min, 90min after circulatory arrest and at 60minutes after resuscitation. The ultrastructure changes in cerabral cortex were observed with transmission electron microscope (HITACHI 7500). The brain water content was also determined after the dogs were sacrificed. Results SjvO2 had decreased obviously after circulatory arrest, attaining the lowest level in CA 90min.After resuscitation it increased again in both groups. The levels of SjvO2 in dogs of L-arginine pretreatment group were markedly higher than that of control group at 45min and 90min after circulatory arrest (P
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Objective To summarize the methods of diagnosis and operation of carcinoma of the extrahepatic bile ducts. Methods The clinical data of 100 cases of carcinoma of the extrahepatic bile ducts which were treated in our hospital from 1972 to 1999 were retrospectively analysed. In this series, there were 68 cases of the cancer located in the upper portion of exlrahepatic duct(proximal cancer), 12 in midder portion(midder cancer), 18 in lower portion(distal cancer), and 2 in whole bile duct. Results The initial symptom was upper abdominal discomfort or vague pain, abdominal distension, weakness, weight loss and progressive jaundice. BUS, CT and MRI were scatheless. If the intrahepatic bile duct dilatation or extrahepatic cholestatic jaundice were revealed, PTC(13 cases in this series) or ERCP(42 cases in this series) were to further determine the location of tumor. According to the position and type of the tumor, the different operations were selected. Twenty-five cases(36.8%) of the proximal cancer were resected, including 15 cases of type Ⅰ treated with localresection or “skeletonization” resection, 9 cases of type Ⅱ treated with resection of the tumor and caudate lobe, 1 case of type Ⅲb treated with resection of the tumor, caudate lobe and left hepatic trisegmentectomy. Nine cases(75%) of midder cancer were resected. After resected the proximal and midder cancer, bile duct reconstruction by Roux-en-Y hepaticojejunostomy was performed on all the cases. Fourteen cases(77.8%) of distal cancer were treated by pancreatoduodenectomy. The total resection rate in this series was 48%. Of the cancer resected cases, 35 were followed up, the five-year survival rate was 58%. 32 of the 52 cases without cancer resection were followed up, and all of them died one to one and half year after operation. Conclusions BUS, CT and MRI are the first selective methods for early diagnosis of the carcinomas of extrahepatic bile duct. If needed, PTC or ERCP should be done because of these methods have more accurate diagnostic value. Surgical resection of the tumor is the only likelihood for effective treatment.
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Objective To evaluate the effect of FTY720 on pancreas islet xenograft rejection by setting up the rat-to-mouse islet xenotransplantation model. Methods Rat islets were harvesed by means of pancreatic duct irregution with collagenase and purified by discontinuous density gradient method. Then the islets were transplanted under the kidney capsule of the mouse. The recipients were divided into 3 groups randomly: control group,the mouth was administrated with saline without any immunosuppressant; experiment group 1,the mouth was administrated with FTY720 (1.0 mg/kg) orally from the operation day to day 14 after operation; experiment group 2,the mouth was administrated with combination of FTY720(1.0 mg/kg) with CsA(15 mg/kg) from the operation day to day14 after operation. The xenograft were removed with the kidney at day 3, 5, 7 and 14 after transplantation, and the rejection was analyzed. Results In the control group and experiment group 1, the xenografts were completely destroyed within one week; on day 7, no intact islets could be seen, but numerous lymphocytes infiltration were found. In experiment group 2, many intact islets were still seen under the kidney capsule in day7 and 14 after operation; and infiltrated lymphocytes could hardly or just occasionally be found. Conclusions FTY720 alone can not inhibit the rejection of islet xenotransplantation; FTY720 combination with CsA can inhibited islet xenograft rejection effectively in the rat-to-mouse model.
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Objective We investigated the effect of rhIL-10 on reperfusion injury and acute rejection in rats after liver transplantation. Methods ACI (RTI a) rats and LEW (RTI 1) rats were used as donors and recipients. The dose of rhIL-10 was 0,2,10,and 50??g?kg -1?d -1. Results rhIL-10 at a dosage of 10??g?kg -1?d -1 significantly prolonged recipient′s survival time (13.1?1.0?d vs. 9.4?0.7d,P