Diagnosis and Treatment Reasoning of Integrated Traditional Chinese and Western Medicine Against Acute Abdomen Based on Knowledge Graph / 中国实验方剂学杂志

ObjectiveIn view of the standardization of clinical diagnosis and treatment of the acute abdomen and the inheritance of diagnosis and treatment experience of prestigious veteran traditional Chinese medicine（TCM） doctors， a diagnosis and treatment reasoning algorithm based on association rule mining under incomplete evidence（AMIE）+ random walk was proposed to provide information services and technical support for primary doctors by recommending personalized diagnosis and treatment plans based on medical records. MethodThe experience of diagnosis and treatment of acute abdomen of prestigious veteran TCM doctors and the text data of clinical diagnosis and treatment guidelines of integrated TCM and western medicine were collected to complete the task of knowledge extraction and construct acute abdomen knowledge graph based on Neo4j. On the basis of ontology-supported rule-based reasoning， the rule reasoning based on similar syndromes was used to expand the syndrome combinations whose Jaccard similarity was greater than the threshold in the syndrome recommendation results. The semantic path coverage algorithm was used to calculate the semantic similarity between the symptom nodes. The symptom nodes were divided into 10 categories， and the symptom nodes in the same category were extended. The random walk algorithm was used to search the symptom nodes connected with the syndrome， and the connection rules between the syndrome and symptom nodes were extended to realize the knowledge reasoning of AMIE+ random walk. ResultThe acute abdomen knowledge graph included 1 320 nodes and 2 464 relationships. According to the link prediction evaluation index of knowledge reasoning， the reasoning results of the three algorithms in the auxiliary diagnosis and treatment of acute abdomen were compared. The AMIE+ random walk algorithm complemented the knowledge graph by extending the similar syndrome connection rules and the syndrome-symptom connection rules. Compared with the knowledge reasoning algorithm based on ontology rules， the area under the curve （AUC） was 15.18% higher and the accuracy was 30.36% higher， which achieved more accurate and effective knowledge inference. ConclusionThis study used knowledge graph technology to visualize the diagnosis and treatment of acute abdomen with TCM and western medicine， assisting primary clinicians in intuitively viewing the diagnosis and treatment process and data relationship. The proposed diagnosis and treatment reasoning algorithm can realize the personalized diagnosis and treatment plan recommendation at the level of "disease-syndrome-diagnosis-treatment-prescription"， which can assist primary doctors in disease diagnosis and treatment and clinical decision-making， contribute to the knowledge sharing and application of diagnosis and treatment experience and clinical guidelines of prestigious veteran TCM doctors， improve the level of primary clinical diagnosis and treatment， and promote the normalization and standardization of the diagnosis and treatment process of acute abdomen with integrated TCM and western medicine.

Relationship between neutrophil phenotypic and functional heterogeneity and diseases / 中华危重病急救医学

Neutrophils are the most abundant circulating leukocyte type in humans and comprise the host's first line of cellular defense against foreign pathogens invasion. On the other hand, neutrophils are the main mediators of tissue damage induced by acute and chronic inflammation. They were once considered to be short-lived, low transcriptional activity, and terminally differentiated homogeneous leucocytes that failed to return to circulation from tissue. However, more evidence has demonstrated that neutrophils can develop into different sub-populations with phenotypic heterogeneity and functional versatility under physiology and pathological conditions. This review summarizes the phenotypic and functional heterogeneity of neutrophils in sepsis and tumor genesis.

Advance in the role of innate lymphoid cells in inflammation / 中华危重病急救医学

Innate lymphoid cells (ILCs) are newly identified innate lymphocytes in humans and mice that are important and effective cells of innate immunity and regulate adaptive immunity. ILCs have been found to promote the start, regulation and resolution of inflammation. ILCs play an important role in the progress of infection, inflammation and tissue repair in the mouse model, and clinic researches also indicate the importance of ILCs in human health and disease. Based on the previous related researches, the types of ILCs and the role of these populations in promoting acute and chronic inflammation as well as resolution inflammation and tissue repair were mainly reviewed to provide new insights for the further study.

Analysis of colorectal cancer screening practices in the general population of Tianjin / 中国肿瘤临床

Objective:Colorectal cancer screening was performed on a general population with age ranging between 40 and 74 years old to evaluate the screening effects of questionnaire survey, fecal occult blood (FOB) test, and colonoscopy, as well as to provide some implications of colorectal cancer screening strategies. Methods: Two-step screening model of questionnaire survey combined with FOB test was applied for the screening. Colonoscopy was conducted in a high-risk population identified through preliminary screening as final diagnosis. Results:Based on the 2,117,304 cases screened, the screening compliance was 39.72%, and 126,118 cases (5.96%) were identified as high risk. Colonoscopies were performed on 25,837 cases, of which 8,095, 1,236, 134, 112, and 336 were identified as adenoma, advanced adenoma, severe dysplasia lesions, early cancer, and advanced cancer, respectively. The early stage di-agnostic rate was 81.52%. Conclusion:The colorectal cancer screening method performed in Tianjin can significantly concentrate on the high-risk population with colorectal cancer, increase the positivity rate of total colonoscopy, and economize medical resources.

The Clinical Efficacy of Acute Obstructive Left-Sided Colorectal Cancer Treated by Colonoscopic Metal Stenting and Ileus Tube Catheterization / 天津医药

Objective To investigate the clinical efficacy of colonoscopic metal stenting and ileus tube catheteriza-tion on left colorectal cancer with acute obstruction. Methods Clinical data of 80 patients meeting the diagnostic criteria for acute obstruction of the left half of colorectal cancer were included in this study. Patients were randomly divided into met-al stent group (n=40) and ileus tube group (n=40). The metal stent group was treated by metal stent and the ileus tube group was treated by ileus tube. Both were carried on by colonoscopy and X-line. After the relief of obstruction ( 7-10 d), patients were underwent colorectal cancer radical resection and anastomosis. The technical operations, improvement of obstruction and the efficacy of surgical treatment were compared between two groups. Results The success rate was 87.5%in metal stent group and the 97.5%in ileus tube group. There was no significant difference in the success rate between two groups (P>0.05). No complications were found in two groups. The operation time and the treatment cost were higher in metal stent group than those in ileus tube group. The relief rates of obstruction were 100%and 95%for metal stent group and ileus tube group, and there was no difference between them. Two cases were operated for emergency because of the failure of obstruc-tion relief. The relief time of obstruction and the difference between C-reactive protein values were much better in metal stent group than those of ileus tube group. After the obstruction relief, patients underwent a radical resection of the tumor and anastomosis, no anastomotic leakage was found in two groups. There were no significant differences in the operation time, in-cision infection and hospitalization time between two groups. Conclusion Anal ileus tube catheterization has a better eco-nomic value in the treatment of acute obstruction, but the efficacy of metal stent is better.

Damage control surgery for acute superior mesenteric occlusion / 中华普通外科杂志

Objective To investigate the outcome of damage control sugery in patients with acute superior mesenteric occlusion (ASMO).Methods Seventeen patients with acute superior mesenteric occlusion from June 2008 to May 2012 were reviewed retrospectively.Diagnosis was confirmed by CT and/or DSA.Patients were divided into two groups:seven patients in damage control group (shortening surgical time,bowel exteriorization,temporary abdominal closure) ; ten patients in conventional surgical treatment group.The treatment outcomes of the two groups were compared.The survival of all patients was followed up for 6 months to 5 years at outpatient clinic.Results The overall mortality rate was (5/17) and surgical complications rate was (8/17).Operation time was (97 ±42) min and (236 ± 137) min(t =-4.72,P ＜0.01,P ＜ 0.05) respectively in damage control group and conventional surgical treatment group.Intestine resection length was (114 ± 94) cm and (229 ± 93) cm (t =-2.49,P =0.03,P ＜ 0.05) respectively.Complications rate was (1/7) and (7/10) (Fisher's dxact test P =0.05,P ≤0.05) respectively; mortality was (1/7) and (4/10) (Fisher's dxact test P =0.34,P ＞ 0.05) respectively.Conclusions Although damage control does not significantly reduce mortality,but the rational use of damage control can effectively reduce operation time,shorten intestine resection length and decrease surgical complications.

Mechanisms of the alleviation of islet graft injury in the gastric submucosa / 中华肝胆外科杂志

Objective To investigate the mechanisms of the alleviation of islet graft earlier injury in the gastric submucosa.Methods The recipients were divided into gastric submucosa group (n =8) and hepatic portal vein group (n =8).1200IEQ SD rat islets were transplanted into diabetic SD rats induced by the administration of streptozocin (STZ).Glucose tolerance test and pathological examination were performed 14 days post transplantation.30 min after the transplantation,the C-peptide of the two groups were detected.12 h after the transplantation,IL-1β and TNF-α of the two groups were examined.Results The mean survival time (MST) of grafts in gastric submucosa group was (25.9 ± 4.1) d and (16.0 ± 0.8) d (P ＜0.01) in portal vein group.The results of glucose tolerance test and immunofluorescent staining demonstrated that grafts in gastric submucosa group survived well and got excellent function 14 days post transplantation.Compared with the gastric submucosa group,after 30 min of the transplantation,C-peptide in portal vein group was significantly higher [(1.46 ± 0.28) ng/ml.vs.(3.84 ± 0.22) ng/ml,P ＜ 0.01].Additionally,the level of IL-1β [(29 ± 1.41) pg/ml.vs.(262.26 ± 53.37) pg/ml,P ＜ 0.01] and TNF-α [(23 ± 1.41) pg/ml.vs.(138.51 ± 39.5) pg/ml,P ＜ 0.01] in portal vein group,were also significantly higher than the gastric submucosa group,after 12 h of the transplantation.Conclusion Islet transplantation in gastric submucosa prolongs islet grafts survival by avoiding or alleviating IBMIR and the injuries induced by early inflammatory mediators.

Risk factors of iatrogenic pancreatitis following endoscopic retrograde cholangiopancreatography : a meta-analysis / 中华肝胆外科杂志

Objective To study the iatrogenic risk factors of post-ERCP pancreatitis (PEP).Method A meta-analysis was carried out on 15 clinical studies which included more than 100 patients published in the medical literature in the last twenty years.Result When the risk factors were analysed,OR for endoscopic sphincterotomy (EST) was 3.75 (95％CI 3.01-4.68),OR for papillae precut was 2.17 (95％CI 1.76-2.67),OR for biliary sphincter balloon dilation was 1.66 (95％CI 1.16-2.39),OR for pancreatic contrast injection was 2.79 (2.31-3.37),OR for sphincter of Oddi manome try was 5.86 (95％CI 5.04-6.80),OR for pancreatic stenting was 2.57 (95％CI 2.09-3.17).Conclusion The analysis indicated EST,papillae precut,balloon dilation,pancreatic contrast injection,Oddi manometry,non-prophylactic pancreatic duct stenting were the risk factors of post-ERCP pancreatitis.

Logistic analysis of impact factors of treatment decision: a study on 147 patients with traumatic ruptured spleen / 中华肝胆外科杂志

Objective To investigate the current status of treatment on traumatic ruptured spleen in a regional medical center in Tianjin,China.Method Logistic analysis of 16 impact ffactors of treatment decision on 147 patients with traumatic ruptured spleen.Results The type of trauma,pulse rate at admission,result of abdominal puncture and CT grade were related to treatment decision making.Splenectomy was carried out in 89 patients (60.54％) which accounted for 89.90％ of all surgical procedures.Splenectomy was carried out in 50.85％ of patients with CT grade 1 or 2 (or 85.71％ of grade 1 and 2 surgery),and 100％ of CT grade 3 or 4.Spleen preservation surgery was carried out in 7 patients with CT grade 1 or 2.Conclusion Splenectomy was carried out in most cases in this study.It is necessary to investigate the treatment of splenic trauma in regional medical centers,and to develop more reliable surgical techniques to carry out more spleen-preservation surgery ffor CT grade 1 or 2 ruptured spleen.

Clinical value of overnight laparoscopic cholecystectomy / 中华消化外科杂志

ObjectiveTo evaluate the feasibility and outcome of overnight laparoscopie cholecystectomy (OLC).MethodsThe clinical data of 149 patients with cholecystolithiasis or gallbladder polyps who were admitted to the Tianjin People's Hospital from October 2008 to December 2010 were retrospectively analyzed.All the patients underwent LC in the morning and were discharged 24 hours later.Modified Aldrete scoring was done 4-6hours after LC.Patients were contacted by telephone 3 days after LC and reexamined in the out-patient department 7 days after LC.The hospital cost of patients who underwent OLC or LC was compared using the t test.Results OLC was successfully performed on 149 patients,and the modified Aldrete scores of 130 patients were above 9.The visual analogue scale (VAS) of 118 patients were under 4,and the VAS of 31 patients were above 4.The condition of the 31 patients were closely monitered,and were administered morphine.Of the 149 patieuts,144were discharged 24 hours after operation,and the remaining 5 patients were admitted to general ward because of fever,peritoneal effusion or abdominal pain.The incidence of postoperative complication was 2.0％ (3/149) and the mortality was 0.All the patients were followed up,and none of the patients had an emergency readmission.The duration of incapacity was 5.2 days (range,2-7 days).The mean hospital cost of patients who received OLC was ( 7888 ± 396 ) yuan,which was significantly lower than ( 12121 ± 960) yuan of patients who received LC ( t =38.97,P ＜ 0.05 ).ConclusionOLC is effective and safe,and meets the requirement of health insurance policy.

Opinions on several issues concerning radical pancreaticoduodenectomy for pancreatic head carcinoma / 中华肝胆外科杂志

According our practice of raical pancreaticoduodenectomy for pancretic head carcinoma and combined with these reviews, we suggested the active and palliative pancreaticoduodenectomy should be aviod. Skeletonization of hepatoduodenal ligament and the retroperitoneal resection should be the routine procedure in pancreticoduodenectomy, and at least invovle two regional lymph nodes. In addition, regardless of the metastase of No 13 lymph node, ristricted retroperitoneal resection for resectable pancretic carcinoma was needed. Exposured the superior mesenteric artery and distinguished inferior of uncinate process of pancrease with the artery, were the key point of the uncinate process of pancrease resection. Preoperative evaluation of angiography and other images, the ratio of activeness and combination with vessel resection would be improved. The style of pancreaticojejunostomy could be selected by the experience of the operator, we are apt to the double-deck invaginated pancreaticojejunostomy. Additionally, utilization of the electronic surgical workstation, should be careful and also need to accumulate more experience.

Early screening of pancreatic cancer by combination of EUS with tumor marker detection / 中华肝胆外科杂志

Objective To determine the clinical value of EUS in combination with detection of CA19-9 and CA242 for early diagnosis of pancreatic cancer.Methods General features of high-risk group were determed by EUS and the plasma levels of CA19-9 and CA242 measured by ELISA.Results The serum level of CA19-9 was abnormal in 9.80% (10/102) and that of CA242 in 12.75% (13/102) of the patients.They were both abnormal in 7 cases.Of the 7 cases, 3 were found to suffer from pancreatic cancer by EUS, 1 had the tumor that had been clinically confirmed, 1 had posterior peritoneal tumor and 2 were normal.Among 102 cases detected by EUS, 2 showed low echo in pan-creatic head, 2 semi-cyst, 3 pancreatic cancer and proved by pathology.Accurate diagnotic rate, sensi-tivity and specificity were 90.20% (92/102), 50% (4/8) and 93.62% (88/94), respectively, for serum CA19-9.For the serum CA242, the 3 parameters were 87.25% (89/102), 50% (4/8) and 90.43% (85/94), respectively.For combination of both methods, they were 98.04% (100/102), 100%(8/8) and 97.87%(92/94), respectively.Accurate diagnostic rate of the latter was significantly higher than that of the former 2(P＜0.05).Concision Combination of EUS with detection of serum CA19-9 and CA242 is of great vlaue for early screening of pancreatic cancer.

Effect of CXCL16 on the biological behavior of human pancreatic cancer cell line PANC1 / 中华胰腺病杂志

Objective To investigate the effect of CXCL16 on the biological behavior of human panereatic cancel cells PANC1.Methods Exponentially growing PANCI cells was exposed exposed to different concentration of rhCXCL16(50,100,200 mg/ml)and CXCL16 antibody for4 h,and PANC1 without rhCLCL16 Ireatment was used as the control.The proliferation was determined by MTT method,adhesion rate was determined by Mqrtigel matrix,invasion and migration of PANC1 cells were assayed by Transwell chamber.Results After 100 ng/ml rhCXCL16 treatment,proliferation,adhesion rate,invasion and migration of PANC1 eels were 0.264±0.021.991.4± 8.6)%,1.246±0.216,1.361± 0.276,respectively;and the adhesion rate.invasion and migration were significantly higher than(20.6±3.2)%,0.259±0.013,0.199±0.008 in the control group(P<0.01).and without significant effect on proliferation.After 200 ng/ml rhCXCL16 treatment,proliferation,adhesion rate,invasion and migration of PANC1 cells were further improved.Conclusions rhCXCL16 could enhance the ability of adhesion,invasion and migration of PANC1 cells.

Construction of modified rat orthotopic models of renal transplantation / 中国组织工程研究

BACKGROUND: Rat model of renal transplantation is the best way for studying human rejection following renal transplantation. However, the utilization of this model is limited due to refined surgical technique.OBJECTIVE: To explore a microsurgery operation method for constructing a stable, reliable orthotopic renal transplantation model.DESIGN, TIME AND SETTING: The animal observation experiment was performed at the animal laboratory of Tianjin Union Medicine Centre from September to November 2008.MATERIALS: A total of 40 SD rats, weighing 250-300 g, were medially adopted as donators and recipients. METHODS: The renal vessels were separated by blunt separation. The kidneys of donators were infused, removed and conserved at low temperature. To the recipients, the left kidney was removed, and renal blood vessel was anastomosed by ext-ext anastomosis and reconstructed urinary passage by implanting ureter into bladder. 6-point acupuncture was used to suture wound. MAIN OUTCOME MEASURES: The rationality and the authenticity of this operation were evaluated through analyzing the operative time, postoperative death rate and the cause of death.RESULTS: The total time of operation was (150±17) min, with warm ischemia time of (15±2) s and (55±5) min cold ischemia time. Three rats died at the first week after operation, which caused by anesthetic accident, stomatorrhagia and ureterostenoma. The achievement ratio of operation was 85%. At day 8 after operation, exploratory laparotomy of survived rats showed that the transplanted kidney was recovered well without embolism or stenosis at the stoma.CONCLUSION: An orthotopic renal transplantation model of rat is constructed by ext-ext anastomosis and reconstructed urinary passage by implanting ureter into bladder.

Effect of Extracorporeal Liver Alloperfusion in Treatment of Acute Liver Failure in Pigs / 中国普外基础与临床杂志

Objective To evaluate the feasibility and curative effect of extracorporeal liver perfusion (ECLP) in treatment of acute liver failure (ALF) in pigs. Methods The experiments were carried out in healthy pigs (weight 20-30 kg) under general anesthesia. All of the pigs were randomly divided into 3 groups. ALF model was established by liver blood supply obstructing and portal-systemic shunting. ALF group (n=5): ALF pigs were killed 8 h after establishing. ALF+ECLP group (n=5): ALF pigs were perfused with ECLP for 4 h and killed 8 h after establishing. Normal liver+ECLP group (n=4): normal pigs were dealt with just as ALF+ECLP group. The data of PT, AST, TNF, blood ammonia were collected in all groups. Pathologic changes in liver and brain were detected. Results The levels of PT, AST, TNF, blood ammonia, RBC and HCT in the ALF+ECLP group were lower than those in the ALF group (P

Pathogenesis of delayed xenograft rejection in pig-to-rhesus monkey cardiac transplantations / 中国免疫学杂志

Objective:To investigate the pahtogengesis and pathology of delayed xenograft rejection (DXR) after pig to rhesus monkey heart xenotransplantation.Methods:Heterotopic xenogeneic heart transplantation in the abdominal cavity was performed using piglet as donors.4 monkeys were used as recipients.Complete complement depletion was achieve in the recipients treated with repetitive doses of a high activity cobra venom factor (Y CVF).The recipients were immunosuppressed with a combination of cyclosporine A,cyclophosphamide and steroids.Sera were analyzed for C3,C4 levels and complement activity and anti pig endotheliocyte xenoantibody.The graft were examined histopathologically and immunohistochemically for C3,C4,C5b 9,IgM,IgG,necrosis factor alpha (TNF alpha),intercellular adhesion molecule 1 (ICAM 1),CD57 (NK cells),CD68 (macrophages),CD4 and CD8.Results:The xenografts survived 8,10,13,13 days respectively and all grafts occoured DXR.Venular thrombosis was outstanding feature within DXR xenografts,complicated with interstitial edma,local hemorrhage and myocardial necrosis,with mild to moderate cellular infiltration.The serum C3 levels and complement activity almost decreased to 0 from the day of transplantation due to Y CVF,the C4 level began to decrease 2 4 days before the cardic xenografts losing their function.The anti pig endotheliocyte xenoantibody also decreased after transplantation,and slightly increased during DXR,all rejected xenografts showed C3,C4,C5b 9,IgG and IgM deposits in different degree.Large numbers of macrophages (50% of total leukocytes) were found infiltrating the entire xenograft,a few natural killer cells (8%～10%),some of CD4+T cells (15%) and CD8+T cells (25%) were detcted also,up regulation of ICAM 1 on the graft endothelial cells and TNF alpha in the interstitial were demonstrated in the rejected heart.Conclusion:Both Humor and cell mediated immunologic reaction may play an important role in pahtogengesis of DXR. [