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Objective To summary the risk factors,clinical characteristics and treatment of acute colonic pseudo-obstruction (ACPO) after cesarean section(CS).Methods The case group enrolled 11 patients who were diagnosed with ACPO after cesarean section in the First Affiliated Hospital of University of Science and Technology of China from January 2006 to January 2018.Another 55 patients without ACPO after CS,performed within two weeks' difference from the case group,were randomly selected as the control group.Clinical data of all subjects were analyzed retrospectively.Potential clinical risk factors were statistically analyzed.T test,Chi-square test and logistic regression analysis were used for statistical analysis.Results In the case group,the abdominal distension presented on 2 d (n=1),3 d (n=7),4 d (n=2) and 17 d (n=1) respectively after CS,and all cases experienced abdominal pain and nausea.Vomiting was reported in some cases.Plain abdominal X-ray images revealed pneumocolon with colon pouch.The maximum diameter of cecum was 6 to 12 cm.Air-liquid levels were observed in two patients.All patients underwent fasting,gastrointestinal decompression,intravenous fluid infusion,correction of electrolyte imbalance,hypertonic saline enema and prophylactic antibiotic treatment.The disease condition lasted two to six days in these patients.Conservative treatment was successful in eight patients and failed in the other three who later went for operations.The maximum cecal diameters in the three patients who underwent surgery were all ≥ 9 cm,among whom one case progressed quickly and laparotomy was tempted to rule out mechanical intestinal obstruction.In this case,the pressure was successfully reduced by placing a thoracic catheter through the anus after the failure of intestinal puncture trying to release the gases.One patient underwent colostomy due to positive signs of peritoneal irritation after a failure of four-day conservative treatment.One patient suffered a relapse after having been treated conservatively for five days,and then underwent surgeries of resection of ileocecum,distal closure of the colon ascendens plus terminal ileostomy due to intestinal perforation.Multivariate logistic regression analysis showed that higher postoperative leukocyte count (OR=1.38,95％CI:1.12-1.71,P=0.003) and postoperative body temperature ＞38 ℃ (OR=6.47,95％CI:1.06-39.61,P=0.044) were the risk factors for ACPO after CS.Conclusions Elevated leukocyte count and body temperature ＞38 ℃ were two high-risk factors for ACPO after CS.ACPO is characterized by acute onset,and the first choice is conservative management.Active surgical treatment would be required if conservative treatment fails,especially when the maximum diameter of the cecum is ≥ 9 cm,which may increase the incidence of intestinal necrosis or perforation.
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Objective To explore the correlation between liver injury,fibrosis and levels of serum interleukin(IL)-18,transforming growth factor(TGF)-β1,and HBV DNA in patients with chronic hepatitis B(CHB).Methods Sixty-seven CHB cases were collected as experimental group and 20 healthy controls were enrolled as healthy control group.Serum levels of IL-18 and TGF-β1 were analyzed using enzyme linked immunosorbent assay(ELISA),and serum HBV DNA level was measured by fluorescent quantitative polymerase chain reaction(PCR).Liver biopsy was performed in 48 cases.Data analysis was done by variance analysis and data with heterogeneity of variance were analyzed by rank sum test.Partial correlation was employed to analyze the correlations between different data.Results The serum levels of IL-18,TGF-β1,alanine aminotransferase(ALT)and total bilirubin(TBil)were all higher in patients with hepatitis B and cirrhosis than those in controls(P<0.01).With the progression of liver injury,the levels of IL-18 and TGF-β1 were correspondingly increased,and the differences of TGF-β1 level between different groups were statistically significant(P<0.01),with the highest level in the patients with liver cirrhosis.There was no significant difference of the levels of ALT and TBil between the high and low viral load groups,but compared with control group,the differences were both significant(F=10.970,F=7.528;F=14.698,F=13.395;all P<0.05).TGF-β1 level gradually increased with fibrosis stage of CHB increasing from SO to S4,and there were significant differences between two stages except S3 and S4(P<0.01 or P<0.05).The difference of IL-18 level was only significant between SO stage and other stages.There was no significant difference of HBV DNA level among all stages. Partial correlation analysis indicated that IL-18 positively correlated with ALT and TBil(r=0.4806 and r=0.5047,respectively,both P<0.01).HBV DNA had no correlation with IL-18,TGF-β1,ALT and TBil.Conclusions Serum IL-18 and TGF-β1 levels play important roles in the progression of liver injury.Serum TGF-β1 level is correlated closely with post-hepatitis cirrhosis. Serum HBV DNA level is not significantly correlated with liver injury and fibrosis.