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ObjectiveTo investigate the risk factors for early tumor recurrence after laparoscopic pancreaticoduodenectomy （LPD） in patients with pancreatic ductal adenocarcinoma （PDAC）， and to establish a predictive model. MethodsA retrospective analysis was performed for the clinical data of 240 PDAC patients who underwent LPD in The First Hospital of Jilin University from April 2016 to July 2022， with early postoperative tumor recurrence （time to recurrence ≤12 months） as the study outcome. The patients were randomly divided into training group with 168 patients and validation group with 72 patients at a ratio of 7∶3. In the training group， there were 70 patients （41.67%） with early postoperative recurrence and 98 （58.33%） without early recurrence， and in the validation group， there were 32 （44.44%） with early postoperative recurrence and 40 （55.56%） without early recurrence. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups； a logistic regression analysis was used to investigate the risk factors for early postoperative recurrence； the receiver operating characteristic （ROC） curve and the area under the ROC curve （AUC） were used to evaluate the discriminatory ability of the model， with AUC>0.75 indicating that the model had adequate discriminatory ability. The Bootstrap resampling method was used for validation after 1 000 times of random sampling， and the model was validated again in the validation group. The calibration curve and the Hosmer-Lemeshow goodness-of-fit test were used to evaluate the degree of calibration， and the decision curve analysis was used to evaluate clinical practicability. ResultsThe univariate and multivariate analyses showed that preoperative CA19-9 level≥37 U/mL （odds ratio ［OR］=6.265， 95% confidence interval ［CI］： 1.938 — 20.249， P<0.05）， maximum tumor diameter >3 cm （OR=10.878， 95%CI： 4.090 — 28.932， P<0.05）， poor tumor differentiation （OR=3.679， 95%CI： 1.435 — 9.433， P<0.05）， lymph node metastasis （OR=0.209， 95%CI： 0.080 — 0.551， P<0.05）， and absence of adjuvant chemotherapy after surgery （OR=0.167， 95%CI： 0.058 — 0.480， P<0.05）. A nomogram model was constructed based on these factors； the ROC curve analysis showed that the model had an AUC of 0.895 （95%CI： 0.846 — 0.943， P<0.001）， and the calibration curve and the Hosmer-Lemeshow test showed that the model had a good degree of calibration （P=0.173）. The decision curve analysis showed that the nomogram had a good clinical application value. ConclusionPreoperative CA19-9 level ≥37 U/mL， maximum tumor diameter >3 cm， poor tumor differentiation， lymph node metastasis， and absence of adjuvant chemotherapy after surgery are independent risk factors for the early recurrence of PDAC after LPD， and the nomogram model established based on these factors can effectively predict early postoperative recurrence.
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On-site supervision is a risk-based regulatory system that requires the scientific development of supervision plans for quality risks and hidden dangers in pharmaceutical enterprises， the rational allocation of supervision resources based on their risk levels， and the implementation of classified supervision measures. In this study， the quality risk monitoring business support system is set up for pharmaceutical enterprises by establishing the quality risk expert database and quality risk monitoring index system for pharmaceutical enterprises based on the difficulty analysis of on-site drug supervision. Based on this support system， the quality risk classification method， the differentiated spot check strategy and business auxiliary visualization system are established. This support system is used to learn the risk level of pharmaceutical enterprises， so as to innovate supervision methods and optimize monitoring strategies. Taking Jiangxi Province as an example， it is verified that the support system can guide the risk assessment of sample enterprises， can improve the targeting of on-site drug supervision in the process of technical review， scheme editing， on-site implementation and comprehensive evaluation， and can effectively improve the quality and efficiency of supervision.
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Objective:To explore the value of Hong′s single-stitch duct to mucosa pancreaticoenterostomy(HSDMP) in laparoscopic pancreaticoduodenectomy(LPD).Methods:The perioperative clinical data of 300 patients undergoing LPD admitted to the Second Department of Hepatobiliary Surgery in the First Hospital of Jilin University from April 2015 to March 2019 were retrospectively analyzed. The patients were categorized into pancreatic fistula group( n=43) and non pancreatic fistula group( n=257). according to the presence or absence of postoperative pancreatic fistula. Among them, pancreaticojejunostomy was performed with HSDMP in 210 patients, and 90 patients underwent traditional pancreaticoenterostomy. Univariate and multivariate logistic regression were used to analyze the risk factors for the development of pancreatic fistula after LPD, and the difference on the time of pancreaticojejunostomy and the incidence of postoperative pancreatic fistula were compared between HSDMP and traditional pancreaticojejunostomy. Results:Univariate analysis showed that the differences on BMI, abdominal operation history, pancreatic texture, and pancreatic duct diameter were statistically significant compared with non-pancreatic fistula group (all P value <0.05). Multivariate logistic regression showed that BMI ( OR1.180, 95% CI1.047-1.338, P=0.008) and pancreatic texture( OR=0.375, 95% CI 0.135-0.861, P=0.036) were independent risk factors for pancreatic fistula after LPD. Compared with traditional pancreaticojejunostomy, HSDMP was associated with shorter anastomosis time and low incidence of postoperative pancreatic fistula, but there was no statistical significance between the two groups. Conclusions:The independent risk factors for pancreatic fistula are high BMI and soft pancreatic texture. Compared with traditional pancreaticojejunostomy, HSDMP does not prolong LPD time and increase the incidence of postoperative pancreatic fistula.
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Objective:To evaluate surgical therapy for patients of hepatocellular carcinoma(HCC) with bile duct tumor thrombi(BDTT).Methods:A retrospective analysis was made on 66 patients with HCC and BDTT undergoing surgical treatment at the First Affiliated Hospital of Hunan Normal University from Jan 2011 to Dec 2016.Results:The overall median survival time of the patients was 31 months. The 1, 3, and 5-year survival rates were 87.9%, 45.5%, and 13.6%, respectively. Univariate analysis showed hepatitis B virus, liver cirrhosis and history of drinking, AFP≥200 ng/ml, tumor resection combined with biliary incision to remove tumor thrombus, tumor undifferentiated/poorly differentiated, tumor diameter ≥50 mm, AJCC 8th stage Ⅲ/Ⅳ and number of lesions ≥ 2 were risk factors for postoperative survival (all P<0.05). Multivariate analysis showed that drinking history, undifferentiated/poorly differentiated tumor, tumor diameter ≥50 mm, and AJCC 8th Ⅲ/Ⅳ stage were independent risk factors (all P<0.05). Conclusion:Surgical resection of HCC combined with BDTT can achieve a satisfactory survival and prognosis.
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Objective:To investigate the feasibility of ventral-combined-dorsal exposure of middle hepatic vein via caudal approach in laparoscopic anatomic hemihepatectomy of liver cancer.Methods:A retrospective analysis was performed on the clinical data of 44 patients undergoing laparoscopic antecedent hemihepatectomy with the ventral-combined-dorsal exposure of middle hepatic vein via caudal approach in the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital) from January 2021 to September 2021. Among the 44 patients, there were 24 male and 20 female patients, aged 56-66 (61±5) years. The operative time, intraoperative blood loss, occlusion time of the first hilum hepatis, postoperative complications and postoperative hospital stay were analyzed.Results:All 44 patients underwent the surgery successfully. The average operation time was (259.3±33.4) min. Intraoperative blood loss was (113.8±31.0) ml, and no intraoperative blood transfusion was performed. The mean intraoperative occlusion time of the first hilum was (56.1±7.1) min. No postoperative hemorrhage and biliary fistula and other complications occurred. The mean postoperative hospital stay is (9.3±1.4) days. Pathological examination confirmed hepatocellular carcinoma in 36 cases and intrahepatic cholangiocarcinoma in 8 cases.Conclusion:The ventral-combined-dorsal exposure of middle hepatic vein via caudal approach benefits exposure of middle hepatic vein in laparoscopic anatomic hemihepatectomy, reducing intraoperative accidental bleeding and ensuring surgical safety.
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Objective:To evaluate the impact of laparotomy pancreatoduodenectomy (OPD), laparoscopic pancreatoduodenectomy (LPD) and Da Vinci robot assisted pancreatoduodenectomy (RPD) on the risk of pancreatic fistula in postoperative patients.Methods:The key words were laparoscopic, pancreaticoduodenectomy, robot, DaVinci, Whipple, complication, fistula, pancreaticoduodenectomy, laparoscopy, robot, postoperative complications and pancreatic fistula, and the databases of CNKI, Wanfang, VIP, CBM, Cochrane Library, PubMed, EMBASE and web of science were searched until August 1, 2020 for retrospective cohort studies and randomized controlled trials comparing the efficacy of OPD, LPD and RPD. The articles were screened according to the pre-set inclusion and exclusion criteria, and the quality of the articles was evaluated and the data were extracted. Based on Bayesian framework, R4.0.2, Revman 5.3 and Stata 16.0 software were used to analyze the extracted data for mesh meta analysis.Results:Thirty articles involving 3 428 patients were included, including 26 retrospective cohort studies and 4 randomized controlled studies. Mesh meta-analysis showed that in the incidence of pancreatic fistula, there was no significant difference between LPD and OPD, between LPD and RPD ( OR=0.93, 95% CI 0.63-1.4; OR=1.4, 95% CI 0.87-2.2, P<0.05), but the incidence of postoperative pancreatic fistula was significantly lower than that of OPD ( OR=1.5, 95% CI 1.1-2.1, P<0.05), 95% CI 1.12.1; P>0.05). The risk probability of pancreatic fistula was ranked as RPD (0.00), LPD(0.34) and OPD(0.65), that is, for the risk of postoperative pancreatic fistula, the advantages and disadvantages of the three surgical methods were ranked as RPD, LPD and OPD. Conclusions:Compared with OPD, RPD can significantly reduce the risk of pancreatic fistula after PD and improve the quality of operation; there was no significant difference between LPD and RPD in the incidence of postoperative pancreatic fistula, and both of them were safe and feasible.
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@#The transcription factor c-Myc regulates the proliferation, differentiation, metabolism and other key processes of normal cells extensively.The unleashed MYC oncogene frequently produces abundant c-Myc protein, which directly regulates the gene expression of key metabolic enzymes, or tumor-related metabolic pathways by inhibiting microRNA, leading to abnormal metabolism characterized by heightened nutrients uptake, enhanced glycolysis and glutaminolysis, and elevated fatty acid and nucleotide synthesis.This paper briefly summarizes how c-Myc regulated metabolism on glycolysis, glutamine metabolism, tricarboxylic acid cycle, lipid metabolism and nucleotide synthesis in cancer cell,which provides some theoretical reference for the development of antitumor targets and drugs involving c-Myc.
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Objective:To investigate the preoperative and intraoperative risk factors of clinical pancreatic fistula after laparoscopic pancreaticoduodenectomy (LPD).Methods:Clinical data of 100 patients undergoing LPD at the Second Department of Hepatobiliary and Pancreatic Surgery of the First Hospital of Jilin University from Jan 2019 to May 2019 were studied.Results:The total incidence of pancreatic fistula was 8%, and the incidence of clinical pancreatic fistula (grade B, C) was 6%. Univariate analysis found that gender (male), preoperative pancreatic plain CT value <33HU, soft texture of the pancreas, long operation time, alcoholic consuming history may be risk factors for pancreatic fistula after LPD( P<0.05), and further multivariate analysis found gender (male), preoperative pancreatic plain CT value <33 HU, soft texture of the pancreas were independent risk factors for clinical pancreatic fistula after LPD( P<0.05). Conclusions:Male patients, preoperative pancreatic plain CT value <33HU, soft texture of the pancreas were respectively independent risk factors predicting post-LPD clinical pancreatic fistula.
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Objective:To establish a new molecular typing method for Treponema pallidum (TP) based on TP0136 protein sequence heterogeneity. Methods:The amino acid sequences of TP0136 open reading frame (ORF) of 9 strains of Treponema pallidum ssp. Pallidum (TPA) , 3 strains of Treponema pallidum ssp. Pertenue (TPE) , 1 unclassified simian strain of Treponema Fribourg-Blanc (FB) and 1 strain of Treponema pallidum ssp. Endemicum (TEN) were searched from Genbank, and multiple sequence comparisons were performed to obtain the molecular typing results of TP0136 protein. The TP0136 protein-based molecular typing method was used to classify 23 TPA clinical isolates, which were collected from Dermatology Hospital of Southern Medical University from January 2015 to December 2018, and the typing results were compared with those by the traditional typing method based on the tp0548/Arp/Tpr genes. Results:TP0136 protein was highly heterogeneous in different TP strains. According to the amino acid sequence of TP0136, TPE, FB and TEN strains were divided into 4 subtypes of Ⅰ- Ⅳ, TPA strains were divided into 6 subtypes of Ⅴ-Ⅹ, and TPA clinical strains were classified into 4 subtypes of Ⅶ, Ⅸ, Ⅹ, Ⅺ. Through the traditional typing method described above, 23 TPA clinical strains could be divided into 5 types (13D/d, 14D/f, 14D/g, 15D/f, 16A/e) . By using the TP0136 protein-based typing method combined with traditional typing method, the above clinical strains could be further subdivided into 10 types, and the 14D/f type could be further divided into 3 subtypes by using the TP0136 protein-based typing method.Conclusion:The TP0136 protein-based molecular typing method can be used to distinguish TP species, which is helpful for further improvement of traditional TPA molecular typing.
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Objective To investigate the application and surgical experience of total laparoscopic pancreaticoduodenectomy ( TLPD ) in treating children with solid pseudopapillary neoplasm ( SPN ) of pancreas. Methods Clinical data 4 children with SPN who underwent TLPD in Jilin University First Hospital from April 2017 to June 2018 were retrospectively analyzed. Results Among the 4 children, a case was male and 3 cases were female. Their age ranged from 9 to 14 year-old, the height ranged from 1. 2 to 1. 7 meters, and body weight ranged from 30 to75 kg. All patients complained of upper abdominal pain, one child had nausea and vomiting, and one child had abdominal mass. All patients underwent abdominal enhanced CT scan before operation, which showed a mass-like low-density shadow or mixed density shadow in the pancreatic head, with slightly uneven enhancement or no obvious enhancement. All 4 patients underwent TLPD, and the operation was successful without conversion to open surgery. The duration of operation time ranged from 250 to 365 minutes, the intraoperative blood loss ranged from 80 to 120 ml, the tumor size ranged from 4 to 8 cm, and the hospital stay ranged from 10 to 22 days. One patient developed grade B pancreatic fistula after surgery and was cured after conservative treatment. Pathological examinations of all patients confirmed the diagnosis of pancreatic SPN. All patients were followed up until February 2019, and no significant discomfort was observed and no recurrence or metastasis was found. Conclusions TLPD was safe and feasible in children in relatively large pancreatic surgery centers with extensive laparotomy and TLPD experience.
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Objective@#To investigate the application and surgical experience of total laparoscopic pancreaticoduodenectomy (TLPD) in treating children with solid pseudopapillary neoplasm (SPN) of pancreas.@*Methods@#Clinical data 4 children with SPN who underwent TLPD in Jilin University First Hospital from April 2017 to June 2018 were retrospectively analyzed.@*Results@#Among the 4 children, a case was male and 3 cases were female. Their age ranged from 9 to 14 year-old, the height ranged from 1.2 to 1.7 meters, and body weight ranged from 30 to75 kg. All patients complained of upper abdominal pain, one child had nausea and vomiting, and one child had abdominal mass. All patients underwent abdominal enhanced CT scan before operation, which showed a mass-like low-density shadow or mixed density shadow in the pancreatic head, with slightly uneven enhancement or no obvious enhancement. All 4 patients underwent TLPD, and the operation was successful without conversion to open surgery. The duration of operation time ranged from 250 to 365 minutes, the intraoperative blood loss ranged from 80 to 120 ml, the tumor size ranged from 4 to 8 cm, and the hospital stay ranged from 10 to 22 days. One patient developed grade B pancreatic fistula after surgery and was cured after conservative treatment. Pathological examinations of all patients confirmed the diagnosis of pancreatic SPN. All patients were followed up until February 2019, and no significant discomfort was observed and no recurrence or metastasis was found.@*Conclusions@#TLPD was safe and feasible in children in relatively large pancreatic surgery centers with extensive laparotomy and TLPD experience.
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Objective@#To evaluate the efficacy and safety of Hong's pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy.@*Methods@#A retrospective analysis was carried out on 184 patients who underwent laparoscopic pancreaticoduodenectomy using Hong's pancreaticojejunostomy (the Hong’s pancreaticojejunostomy group) compared with 100 patients who underwent laparoscopic pancreaticoduodenectomy using traditional pancreaticojejunostomy (the traditional pancreaticojejunostomy group) at Department of Second Hepatobiliary and Pancreatic Surgery, the First Bethune Hospital of Jilin University, from April 2016 to December 2018. The differences between the two anastomotic methods in operation time, pancreaticojejunostomy time, intraoperative blood loss, postoperative hospital stay, postoperative complications, and incidences of pancreatic fistula were compared.@*Results@#The operation time, pancreaticojejunostomy time and intraoperative blood loss of the Hong's pancreaticojejunostomy group were significantly less than the traditional pancreaticojejunostomy group [(278.2±49.3) min vs. (337.3±67.4) min, (33.7±6.6) min vs. (46.8±8.5) min, (123.1±44.7) ml vs. (203.8±138.6) ml], respectively, (all P<0.05). There were no significant differences in postoperative hospital stay and pancreatic fistula rates between the two groups (all P>0.05).@*Conclusions@#Hong's pancreaticojejunostomy was safe, rapid and effective compared with traditional pancreaticojejunostomy. It did not increase the incidence of pancreatic fistula.
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Objective To isolate and culture a clinical strain (GDI) of Treponema pallidum (Tp) in Guangdong province,and to investigate the difference in nonsynonymous single nucleotide polymorphisms (nsSNPs) between the GD1 strain and Tp Nichols strain.Methods The GD1 strain was isolated from the hard chancre in a patient with primary syphilis in Guangdong province,and continuously subcultured in the testes of New Zealand white rabbit.The serial subcultivation of GD1 was multi-verified by dark-field microscopy,polymerase chain reaction (PCR) for TP0548 gene,DNA sequencing and genotyping.Meglumine diatrizoate density gradient centrifugation was performed to isolate rabbit tissues and concentrate GD1,and DNA sequencing was used to verify the nsSNPs in the TP0443 and TP0584 genes.Results The GD1 strain was successfully isolated from the lesions of the patient with syphilis,and classified as a subtype f of TP0548.Compared with the American Tp (Nichols strain),there were nsSNP mutations in the GD1 strain.One mutation was located in the TP0443 gene,leading to the the substitution of threonine by alanine at amino acid position 120,and another one was located in the TP0584 gene,which caused a change from alanine to threonine at amino acid position 314.Conclusion The GD1 strain was successfully isolated firstly from the lesions in a patient with syphilis in Guangdong province,and nsSNP mutations were confirmed in the GD 1 strain on the etiology.
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Objective@#To investigate the role of "Hong′s single-stitch duct to mucosa pancreaticojejunostomy(HSDMP)" in laparoscopic pancreaticoduodenectomy (LPD).@*Methods@#The clinical data including perioperative and short-term outcomes of 51 cases of LPD with HSDMP which performed in Zhejiang Provincial People′s Hospital(33 cases) and Frist Clinical Hospital of Jilin University(18 cases) between April and October 2016 were reviewed retrospectively. There were 31 male patients and 20 female patients. The mean age was(59±11)years. Body mass index (BMI) was 18 to 28 kg/m2 and the average BMI was (23.2±4.4)kg/m2. Preoperative diagnosis: 18 cases with pancreatic mass, 26 cases with peri-ampullary tumor, 3 cases with intra-ductal papillary mucinous neoplasms, 2 cases with duodenal carcinoma, 2 cases with serous cystadenoma.@*Results@#Fifty-one patients accepted LPD using HSDMP. One patient underwent LPD combined with resection of superior mesentery vein. The mean operation time was (307±69)minutes, the mean diameter of pancreatic duct for reconstruction was (3.1±1.1)mm.The mean operation time for HSDMP was (34±5) minutes, the estimated blood loss was (170±127)ml. Twelve cases(23.5%) had pancreatic fistula according to International Study Group definition, including 9 cases(17.6%) of grade A and 3 cases (5.9%) of grade B. Five cases(9.8%) had delayed gastric empty, 5 cases(9.8%) had bile leakage and 2 cases(3.9%) had pulmonary infection postoperative.All these complications were treated by non-surgical strategies. One patient(2.0%) suffered from postoperative intra-abdominal bleeding and recovered after reoperation. Pathologic results showed pancreatic ductal adenocarcinomas in 20 cases(39.2%), non-pancreatic original peri-ampullary tumors in 23 cases(45.1%), intra-ductal papillary mucinous neoplasms in 3 cases(5.9%), duodenal carcinoma in 2 cases(3.9%), serous cystadenoma in 2 cases(3.9%) and neuroendocrine tumors in one case(2.0%).@*Conclusions@#HSDMP could not only reduce the incidence of clinical pancreatic fistula, but also save operation time. It is a feasible and safe method for pancreaticojejunostomy.
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Objective To investigate the clinical effect of selective laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGD) in the treatment of elderly patients with acute severe cholecystitis,as well as the most appropriate timing for selective operation.Methods A total of 90 patients with acute severe cholecystitis aged above 60 years who were admitted to Department of Hepatobiliary Surgery in The First Hospital of Jilin University from January 2015 to June 2016 were enrolled,and according to the time of selective LC,they were divided into group A (with 2 months),group B (2-4 months),and group C (＞4 months),with 30 patients in each group.The clinical effects of PTGD and selective LC were observed.The t-test was used for comparison of continuous data between two groups,an analysis of variance was used for comparison between three groups,and LSD-t test was used for comparison between any two groups;the chi-square test was used for comparison of categorical data between groups.Results All the patients underwent successful PTGD,and the time to abdominal pain remission was 2.52 ± 0.76 hours.Body temperature returned to normal with 24-72 hours after surgery,and there were significant improvements in laboratory markers (white blood cell count,neutrophil count,and liver function) (all P ＜ 0.05).No patient experienced complications such as bile leakage,hematobilia,pneumothorax,and colon perforation caused by puncture,and there was no case of PTGD after the tube was detached.There were significant differences between the three groups in gallbladder wall thickness before LC (F =8.029,P ＜ 0.001),time of operation (F =24.674,P ＜ 0.001),intraoperative blood loss (F =12.864,P ＜ 0.001),length of hospital stay (F =22.844,P ＜ 0.001),rate of conversion to laparotomy (x2 =12.345,P =0.002),and incidence rate of complications (x2 =8.750,P =0.013).Compared with group A,groups B and C had significantly lower gallbladder wall thickness before LC,intraoperative blood loss,length of hospital stay,rate of conversion to laparotomy,and incidence rate of complications (all P ＜ 0.05),and group B had significantly lower time of operation,intraoperative blood loss,and length of hospital stay than group C (all P ＜ 0.05).Conclusion Selective LC with 2-4 months after PTGD has a marked clinical effect and high safety in the treatment of elderly patients with acute severe cholecystitis.
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Diabetic retinopathy(DR) is characterized by retinal edema,macular edema,eye sight degeneration,etc.and it can cause blindness .Etiopathogenisis and pathogenesis studies of DR was gradually deep and good curative effects were achieved. The author reviewed by consulting DR relevant treatment literature of traditional Chinese medicine in recent years.In order to provide reference for clinical treatment of DR.
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Objective To investigate the application of venereal disease research laboratory(VDRL) test and toluidine red unheated serum test(TRUST) in syphilis laboratory diagnosis.Methods Serum,plasma and cerebrospinal fluid (CSF) in syphilis patients and healthy controls were measured by VDRL and TRUST.Results The VDRL detection results in serum and CSF sepcimens were generally higher than the TRUST detection results by 1-2 titers,while in plasma specimen,the VDRL detection results were generally lower than the TRUST detection results by 1-2 titers than TRUST when using plasma specimen.In addition,the VDRL detection in normal control serum and plasma specimens all appeared different degrees of false positive,but in the detection of normal control CSF,the results of TRUST and VDRL were consistent.Conclusion TRUST is more suitable for serum and plasma specimens,and CSF is suitable for the CSF specimen,but not suitable for serum and plasma detection.
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Objective To investigate the expression of TP 0155 mRNA in rabbits with early infection of Treponema pallidum ( T.pallidum ). Methods Three New Zealand white rabbits were subcutaneously injected with T.pallidum Nichols Seattle strains.Each rabbit was inoculated at ten sites with 106 T.pallidum/site.Skin lesions at the primary stage of syphilis were observed at different time points. Biopsy from one of the lesions was obtained from each rabbit every three days for detection of TP 0155 mRNA and house keeping gene TP 0574 mRNA.TP0155 plasmid standard was constructed by molecular cloning technique , and the quantitative PCR was used to continuously detect the expression of TP 0155 mRNA and TP0574 mRNA from lesion at different time points.Kruskal Wallis test and Bonferroni method were used to analyze the data.Results On d6, red papules appeared on the dorsal skins of rabbits ,there were ulcers in the center of the lesions on d19,presenting typical appearance of syphilis chancre.On d24 the scab of ulcer became smaller; on d25 the rabbits showed disseminated secondary syphilis , which became smaller and disappeared on d30.The copy numbers of TP0155 plasmid standards were 7.48 ×109 copies/μL.There were significant differences in expression of both TP 0155 mRNA and TP0574 mRNA at different time points (χ2 =32.756 and 52.344,both P<0.01).The expression levels of TP0155 mRNA and TP0574 mRNA increased in the early stage, and both reached the peak at d15 (both P<0.05), and then rapidly declined. There were significant differences in normalized TP 0155 mRNA ( TP0155 ×1000/TP0574 mRNA ) at different time points(χ2 =19.758,P<0.05),which reached the peak on d24 and d30,respectively (all P<0.05).Conclusion The level of TP0155 mRNA increases with the disappearance of chancre and secondary syphilis lesions , suggesting that TP0155 might be involved in immune escape of T.pallidum.
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Background and Objective: Biliary cysts in pregnant women are a complex medical issue, especially when complicated with cholangitis. It is a serious and life-threatening diagnosis that can seriously endanger both the expectant mother and the fetus. However, during pregnancy, surgical treatment would lead to further complications and higher fetal mortality. Here, we propose a novel therapeutic approach that would be safe for both mother and child during pregnancy, with a definitive treatment postponed until after delivery
Methods: In this retrospective study we have summarized the clinical course of six adult patients diagnosed with choledochal cysts during pregnancy. Treatment was conducted in two stages, firstly, percutaneous cholecystostomy under ultrasound guidance and sustained negative pressure suction until delivery, and secondly, selective choledochal cyst excision when the patients recovered from delivery
Results: All the six patients gave birth to healthy babies. Four patients had Type-I choledochal cysts, and underwent Roux-en-Y hepaticojejunostomy surgery. Two patients had a Type-IV choledochal cyst. The first patient with Type-IV choledochal cyst underwent anastomosis between the secondary hepatic bile duct and jejunum and the second patient underwent laparoscopic cyst internal drainage. No serious complications were recorded after gallbladder drainage or during the perioperative period
Conclusions: Based on our single-centre experience we can conclude that treatment of choledochal cyst with cholangitis during pregnancy can be conducted safely and efficiently through the two stages strategy that we proposed in this paper. The first stage should be percutaneous cholecystostomy followed by elective surgical treatment following delivery
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Objective ToobservetheclinicaleffectandefficacyofprostaglandinE1(PGE1),thedrugformicrocirculationimprovement, inthetreatmentofacutepancreatitis(AP).Methods Atotalof80patientswithmild-to-moderateAPwhowerehospitalizedandtreated in Second Department of Hepatobiliary and Pancreatic Surgery of the First Hospital of Jilin University from May 2014 to January 2015 were enrolled and randomized into two groups.Forty-four patients in control group received the conventional comprehensive therapy for AP,and 36 patients in experiment group received PGE1 in addition to the conventional therapy.The time to disappearance of abdominal symptoms and the time for serum and urine levels of amylase and serum levels of lipase,C-reactive protein (CRP),and procalcitonin (PCT)to re-turn to normal were compared between the two groups.The independent-samples t-test was applied for comparison of continuous data be-tween the two groups,and the chi-square test or Fisher′s exact test was applied for comparison of categorical data between the two groups. Results ThetwogroupshadsignificantdifferencesinthetimeforserumlevelsofamylaseandCRPandpercentageofneutrophilstoreturn to normal and hospital costs (P=0.041,0.030,0.012,and 0.026,respectively).PGE1 quickly relieved abdominal pain and distention, reducedtheserumlevelofamylase,shortenedthelengthofhospitalstay,andreducedhospitalcosts.Conclusion PGE1hasgoodclinical effect and safety in the treatment of AP,and can be applied as an adjuvant drug in the comprehensive therapy for AP.