Interpretation of the World Society of the Emergency Surgery/the Global Alliance for Infection in Surgery/the Surgical Infection Society-Europe/the World Surgical Infection Society/the American Association for the Surgery of Trauma global clinical pathways for patients with intra- abdominal infections / 中华危重病急救医学

Intra-abdominal infections (IAI) is common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The principles of IAI management included early diagnosis, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using critical care resources, combined with an optimal surgical approach. In order to facilitate clinical management, establish a global standard and provide guidance for clinicians, the World Society of Emergency Surgery (WSES), the Global Alliance for Infection in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) worked together to complete an international multi-society document, which provided the evidence-based clinical pathways. Herein, we made a comprehensive interpretation for the clinical pathways combined with the latest domestic and international research developments, aiming to provide evidence for domestic doctors on the diagnosis and treatment of IAI, and ultimately benefit patients.

Interpretation of acute abdomen in the immunocompromised patients: WSES/SIS-E/WSIS/AAST/GAIS guideline / 中华危重病急救医学

World Society of Emergency Surgery (WSES), in conjunction with Surgical Infection Society Europe (SIS-E), World Surgical Infection Society (WSIS), American Association for the Surgery of Trauma (AAST), and Global Alliance for Infection in Surgery (GAIS) developed guideline about the management of acute abdomen in immunocompromised patients, which was published in the World Journal of Emergency Surgery (WJES) on August 9, 2021. The guidelines elaborate on the definition, classification, diagnosis and treatment of immunocompromised patients. In addition, based on evidence-based medicine, it provides guidance and suggestion on the management of specific acute abdominal infections in immunocompromised patients, common acute abdominal infections in transplanted patients, patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), as well as perioperative steroid management. An interpretation of the guideline was performed to accomplish a better understanding the current status and recommendations for the management of acute abdominal conditions in immunocompromised patients, and to make forward suggestions on its limitations.

Anthelmintics nitazoxanide protects against experimental hyperlipidemia and hepatic steatosis in hamsters and mice

Lipid metabolism disorders contribute to hyperlipidemia and hepatic steatosis. It is ideal to develop drugs simultaneous improving both hyperlipidemia and hepatic steatosis. Nitazoxanide is an FDA-approved oral antiprotozoal drug with excellent pharmacokinetic and safety profile. We found that nitazoxanide and its metabolite tizoxanide induced mild mitochondrial uncoupling and subsequently activated AMPK in HepG2 cells. Gavage administration of nitazoxanide inhibited high-fat diet (HFD)-induced increases of liver weight, blood and liver lipids, and ameliorated HFD-induced renal lipid accumulation in hamsters. Nitazoxanide significantly improved HFD-induced histopathologic changes of hamster livers. In the hamsters with pre-existing hyperlipidemia and hepatic steatosis, nitazoxanide also showed therapeutic effect. Gavage administration of nitazoxanide improved HFD-induced hepatic steatosis in C57BL/6J mice and western diet (WD)-induced hepatic steatosis in Apoe -/- mice. The present study suggests that repurposing nitazoxanide as a drug for hyperlipidemia and hepatic steatosis treatment is promising.

A preliminary study on ultrasonic classification and its clinical value of adhesive intestinal obstruction / 中华超声影像学杂志

Objective:To establish the ultrasonic classification criteria of adhesive intestinal obstruction (AIO) and to discuss its clinical value.Methods:The data of 124 cases of AIO confirmed by surgery and pathology in Tianjin Nankai Hospital from January 2014 to October 2019 were retrospectively analyzed. The ultrasonic image features of AIO were summarized. According to the severity of ultrasound images it can be divided into three different types: simple (mild) AIO, complex (moderate) AIO and critical (severe) AIO. The surgery plan was simulated according to the ultrasonic classification results and compared with the actual surgery results.Results:①The ultrasonic classification results of 124 cases of AIO were as follows: simple (mild) AIO in 73 cases (58.9%), complex (moderate) AIO in 16 cases (12.9%), critical (severe) AIO in 35 cases (28.2%). ②The characteristic ultrasonic images of simple (mild) AIO were adhesion of the intestinal wall to the intestinal wall and the intestinal wall to the abdominal wall; the characteristic ultrasonic images of complex (moderate) AIO were adhesive band and adhesive mass; the characteristic ultrasonic images of critical (severe) AIO were internal hernia, volvulus, intussusception, intestinal ischemia and necrosis, and bloody ascites. ③According to the results of ultrasound classification, 124 cases of AIO were treated with simulated surgical procedures, and the coincidence rate with the surgical results was high (87.9%).Conclusions:US classification of AIO is helpful for clinical evaluation of the severity of AIO and can provide imaging basis for clinicians to make the correct treatment plan.

Research progress of the relationship between chronic inflammation and pancreatic ductal adenocarcinoma / 中华肝胆外科杂志

Studies have demonstrated a strong correlation between chronic inflammation and tumor initiation and progression.Chronic intlammation is mainly involved in tumor progression through intrinsic and extrinsic pathways,and transcription factors such as NF-κB and STAT3 play important roles.Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies.Chronic inflammation can promote the development of PDAC in cooperation with mutation of protooncogene.Inflammation signaling pathway plays an important role in malignant transformation in the PDAC,in which NF-κB and STAT3 are two major transcription factors.Targeting the key regulator points based on the crosstalk between inflammation signaling and PDAC may potentially represent a novel for PDAC prevention and treatment.This article briefly reviews the role of chronic inflammation in the development of PDAC,the PDAC-related inflammatory signal network caused by chronic inflammation,and crosstalk between NF-κB and JAK/STAT3 signaling pathways.

Current status and perspectives of integrated traditional Chinese and Western medicine therapy for pancreatitis / 临床肝胆病杂志

Integrated traditional Chinese and Western medicine therapy for pancreatitis has been used since the 1960s.According to the clinical manifestations and traditional Chinese medicine (TCM) syndrome differentiation of pancreatitis,pancreatitis was named true heart pain with cold limbs caused by spleen disease.Syndrome differentiation of acute pancreatitis and treatment with modified Dachaihu decoction achieved good clinical effects.After the 1990s,the research focus of pancreatitis research was shifted to severe acute pancreatitis (SAP).The clinical course of SAP was divided into three phases,and different therapeutic regimens were given.Clinical studies achieved good therapeutic effects in terms of cure rate and fatality rate.After 2000,integrated traditional Chinese and Western medicine therapy for chronic pancreatitis has been promoted systemically,and the cooperation between traditional Chinese medicine,endoscopic techniques,and operative treatment helps to significantly improve pain control,nutritional status,and incidence of complications.

Evaluation of caudal block with dexmedetomidine mixed with ropivacaine for management of perioperative analgesia in children / 中华麻醉学杂志

Objective To evaluate the efficacy of caudal block with dexmedetomidine mixed with ropivacaine for the management of perioperative analgesia in children.Methods Sixty pediatric patients,aged 1-5 yr,of ASA physical status Ⅰ or Ⅱ,scheduled for elective hypospadias repair,were equally and randomly assigned into 2 groups using a random number table:ropivacaine group (group R) and dexmedetomidine mixed with ropivacaine group (group DR).Each patient received a single caudal dose of 0.25％ ropivacaine 1 ml/kg in group R.Each patient received a single caudal dose of 0.25％ ropivacaine 1 ml/kg mixed with dexmedetomidine 2 μg/kg in group DR.Postoperative analgesia was assessed using FLACC scale,and the degree of motor block was assessed using modified Bromage scale within 24 h after the end of operation.The duration of analgesia (the time from onset of caudal block to first requirement for the rescue analgesic) and development of side effects were recorded.Results Compared with group R,the duration of analgesia was significantly prolonged,and the incidence of bradycardia and oversedation was increased in group DR.Hypoxemia,hypotension and postoperative motor block were not found in either group.Conclusion Addition of dexmedetomidine 2 μg/kg to caudal ropivacaine can significantly optimize the efficacy of caudal block with ropivacaine alone for the management of perioperative analgesia in children.

A novel reporter system monitoring sortase A catalyzed protein ligation efficiency / 生物工程学报

Efforts on directed evolution of sortase A to optimize its catalytic properties have been undertaken and shown the promise. To facilitate screening of sortase A mutants with expected catalytic properties, a novel ligation efficiency monitoring system, including reporter substrates GFP-LPETG and GGGYK-Biotin, was developed. GFP-LPETG, wild type sortase A, and a recently reported high activity sortase A mutant were prepared recombinantly from Escherichia coli BL21 (DE3). Taking advantage of the newly designed reporter system, the ligation efficiency catalyzed by wild type and mutant form of sortase A could be sensitively monitored via SDS-PAGE directly. Consistent with previous report, the mutant sortase A displayed much higher catalytic activity compared to wild type enzyme, indicating the new reporter system is easily and fast handled and sensitive. The application of this reporter system into systemic screening will facilitate future directed optimization of sortase A.

Risk factors in patients with hereditary gallstones in chinese pedigrees

We aimed to define the risk factors and to evaluate the impact of family background on the prevalence of gallstones in China. Thirty-eight gallstone pedigrees were collected and a case-control study was conducted. This study consisted of 272 first-degree relatives and 201 non-first-degree relatives of index patients. The participants completed a questionnaire and underwent physical and ultrasonographic examinations.The riskfactors examined included age, sex, body mass index [BMI], smoking status, alcohol consumption, pregnancy, fat content in dietary meat, history of gastrointestinal surgery, hypertension, hyperlipidemia, fatty liver, coronary heart disease and diabetes. The prevalence of gallstones in first-degree and non-first-degree relatives of index patients was 38.2 and 10.9%, respectively. Age, pregnancy and BMI significantly differed between cases and controls [p < 0.05]. The relative risks were: consumption of meat with a high fat content 1.4 [95% Cl 1.1-1.8]; hyperlipidemia 2.4 [95% Cl 1.3-4.6]; diabetes 1.9 [95% Cl 1.1-3.2]; fatty liver 4.9 [95% Cl 1.0-24]; coronary heart disease 2.5 [95% Cl 1.7-3.9]. Data showed that age, overweight, more consumption of high-fat food, high frequency of pregnancy, fatty liver, hyperlipidemia, coronary heart disease and diabetes could increase the risk of gallstones in the first-degree relatives of index patients

Construction and identification of the replication defective adenoviral vectors carrying mouse SCp2shRNA / 中华肝胆外科杂志

Objectives It was constructed that the replication defective adenoviral vectors carried the short hairpin sequences of mouse SCP2.And we will make a further study of mechanism between SCP2 gene and cholesterol stone in gallbladder.Methods The short hairpin sequences of mouse SCP2 were cloned by two-step PCR,and connected together with the plasmid pDC312.The Admax Adenoviral Vector System was used to generate the replication defective adenoviral vectors,which were purified by CsCl method.The processes of TCID50 were applied to detect the titers of the adenoviral vectors.Furthermore,Protein levels of SCP2 were determined by Western blot analysis,and the levels of SCP2、CYP7A1、HMGCR mRNA from the hepa1-6 cell of mouse were measured by the usage of RT-PCR.Results SCP2mRNA and SCP2 protein were down-regulated by the replication defective adenoviral vectors carried the SCP2-shRNA.With the decreasing SCP2mRNA,the levels of HMGCRmRNA were down-regulated at same the time,while CYP7A1mRNA were up-regulated.Conclusions The replication defective adenoviral vectors carried SCP2-shRNA were constructed successfully.The lower levels of SCP2 could affect the activities of HMG-CoA reductase and CYP7-a enzyme,which caused the variations of cholesterol metabolism and then decreased the formation of cholesterol stone.

Appendiceal mucoceles:a report of 50 cases / 中华普通外科杂志

Objective To evaluate the diagnosis and surgical management of appandiceal mucoceles.Method The clinical data of 50 patients with appendiceal mucoceles surgically treated from January 2004 to January 2008 were reviewed retrospectively. Result The correct preoperative diagnosis rate was 8%.Eight patients were complicated with pseudomyxoma peritonei.The canceration rate was 4%.All the 50 patients recovered uneventfully after the surgery.There was no complications,no recurrence during the follow-up period,including the 2 patients with canceration. Conclusion It was difficult to make correct diagnosis of appendiceal mucoceles preoperatively.The diagnosis should always be in mind if the B-type ultrasonography indicated a cystoadenoma.Abdominal CT coupled with necessary digestive image examinations may improve the correct diagnosis rate.Some patients may be complicated with pseudomyxoma peritonei.Occasionally this abdominal mass was also associated with malignancy.Surgery is the management of choice,and the prognosis is good.

Risk factors of the onset of multiple organ dysfunction syndrome in patients with severe acute pancreatitis / 中华消化外科杂志

Objective To analyze the value of early evaluation in predicting the onset of multiple organ dysfunction syndrome (MODS) in patients with severe acute pancreatitis (SAP). Methods The clinical data of 338 patients with SAP who had been admitted to Tianjin Nankai Hospital from January 1998 to September 2008 were retrospectively analyzed. The patients were divided into MODS group (n = 163) and control group (n = 175) according to whether they did or did not have MODS. Risk factors causing MODS were analyzed by t test and Logistic regression analysis. Results The factors leading to the MODS included white blood cells count≥ 16 ×109/L, serum creatinine≥ 180 μmol/L, serum calcium≥2.5 mmol/L, c-reactive protein≥ 120 mg/L and pH value of blood≥7.35 (χ2 = 51.720, 21.421, 12.393, P < 0.05). The total cholesterol was a protective factor when it was 3.67-5.23 mmol/L. Conclusions Infection, renal insufficiency and hypercalcinemia are early predictive factors for MODS, and infection is the strongest predictive factor. Appropriate elevated total cholesterol can reduce the incidence of MODS.

Clinical analysis of 212 patients suffering from benign biliary strictures / 中国综合临床

Objective To analyze the etiology,diagnosis and therapy of benign biliary strictures and im-prove curative and preventive effects. Methods 212 patients suffering from benign biliary strictures in Nankai Hos-pital from January 2004 to December 2006 were retrospectively analyzed. Results Inflammatory strictures (65.12%,140/215) and strictures caused by operations (20.46%,44/215) were the most two causes. Strictures parts were mainly located in the latter segment of common bile duct 52.09% (112/215). In our group,the stent of strictures parts took 31.37% (64/204), bilioendodraignage 18.13% (37/204), and the modification of strictures parts 43.63% (89/204) as well as resection of stricture parts 1.96% (4/204). Conclusions Inflammatory stricture is the main cause in benign biliary strictures and the main locus is the hinder segment of common bile duct. The di-agnesis of benign biliary strictures before operation is important because it can help to decide the approach way and prognosis. The strategies of curing benign biliary strictures could include operations and endoscopy. The stent of stric-tures parts, bilioendodraignage and the modification of strictures parts are the main treaments for benign biliary stric-tures.

Nosocomial mortality and early assessment of patients with severe acute pancreatitis / 中华急诊医学杂志

Objective To analyze risk factors in order to predict the in-hospital mortality of patients with se-vere acute pancreatitis (SAP), especially the factor of total cholesterol. Method Factors for predicting in-hospi-tal mortality were evaluated retrospectively from the clinical data collected from 338 SAP patients of Tianjin Nankai Hospital between January 1999 and December 2008 according to the Guidelines for for clinical diagnosis and classi-fication of Acute Panereatitis set by the Society of Chinese Medical Association in 2003. The patients were treated with intensive care, blood routine examination, blood biochemical test and even computed tomography within 24 hours after admission. The patients were divided as per outcome into deceased and survivor group. All patients were admitted within 72 hours after the onset of symptoms. The Off-square test was used for univariate analysis and multivariate test was performed by logistic regression. Results Compared with TC≤3.67 mmol/L, when the TC was between 3.67 -4.37 mmol/L, OR was 0.664 (P = 0.412), while TC was between 4.37 mmol/L and 5.23 mmol/L, OR was 0.144 (P =0.021).The OR was 1.013 (P =0.018) when TC was ≥5.23 mmol/L. The variation of serum TC levels was accompanied with the changes of C-reactive protein (CRP). When the CRP was ≥170 mg/L, OR was 7.074 (P =0.031). When the serum ALB≤30 g/L, OR was 7.224 (P =0.029).Conclusions The CRP, ALB, TC can be used for early predicting the in-hospital mortality of SAP patients. TC is a protective factor when it was between 4.37 mmol/L and 5.23 mmol/L, while it is a risk factor when ≥5.23 mmol/L or≤3.67 mmol/L. CRP> 170 mg/L or ALB < 30 g/L increases the probability of fatal outcome. Low level of albumin is a stronger predictor than the high level of CRP. Moderate elevation of TC level seems to in-crease the resistance to inflammation and hence improving the survival rate of patients with SAP and reducing the in-hospital mortality.

Whole Body Simulation and Visualization of Metabolic Process of ~(18)F 2-fluoro-2-deoxy-D-glucose / 航天医学与医学工程

Objective To simulate the metabolic distribution process of 18F 2-fluoro-2-deoxy-D-glucose(FDG) in human body and to visualize this distribution process through 3D images with high resolution and high quality. Methods The model parameters of FDG metabolism in tissues were estimated through clinical experiments, and the curves which represent the FDG metabolic process in tissues were calculated using the model parameters and blood input function. This FDG distribution process in human body was visualized basing on the high-resolution anatomical structure. Results The simulation and visualization results directly and clearly displayed the FDG metabolic distribution process after injection to human body. The properties of the FDG distribution process represented by our simulation were consistent with that represented by clinical experiment. Conclusion The method presented in this study is effective to simulate and visualize human functional information of metabolism, and it may provide a useful tool for education and research on nuclear imaging.

HRCT appearance of localized organizing pneumonia / 中华放射学杂志

Objective To analyze the CT, especially HRCT appearance of localized organizing pneumonia. Methods The CT scans of nine patients with histologically proved localized organizing pneumonia were studied retrospectively. Results The size of the lesions in nine cases varied from 2 to 4 cm( average 2.5 cm). Eight lesions were located in the peripheral lung parenchyma near the pleural surface. The lesions were detected as round in four, anomaly in five. The margin of six lesions had inward bow indentation. Infiltrating lesions in surrounding structures were found in four cases. Conclusion The CT, especially HRCT appearance of localized organizing pneumonia shows some features that can make most of them to be differentiated from other lesions.

Evaluation of Artificial Pneumothorax CT Examination in Detection of Pleural Metastatic Tumor / 实用放射学杂志

Objective To evaluate the ability of the artificial pneumothorax CT examination in detection and diagnosis of pleural metastatic tumor.Methods A retrospective study of 14 patients with pleural effusion using artificial pneumothorax CT examination was conducted.Results Six of the 14 patients were found to have a nodule or nodules on the pleura.The pleural metastatic tumors of 3 cases were from the lung cancers and another 3 from breast cancers were proved histologically.Conclusion The artificial pneumothorax CT examination is a effective and simple method in detecting of pleural metastatic tumor.