Comparative Diagnosis Test Accuracy of Five Weighting Methods for Type 2 Diabetes Mellitus with Dampness-heat Syndrome / 中医杂志

ObjectiveTo compare the diagnostic accuracy of five different weighting methods of Chinese medicine syndrome and then analyze their diagnostic efficacy and characteristics， by taking Diagnostic Standard for Type 2 Diabetes Mellitus （T2DM） with Dampeness-heat Syndrome （abbreviated as diagnostic standard） as an example. MethodsData from expert questionnaire on the diagnostic standard and a cross-sectional survey of 1021 patients were collected. The comparative diagnostic test accuracy （CDTA） method was used to calculate the area under the ROC curve （AUC）， area under the PR curve （AUPR）， accuracy （ACC）， sensitivity， and specificity of five commonly used weighting methods in two categories， including knowledge-driven weighting methods （expert scoring synthesis method， analytic hierarchy process， and precedence chart method） and data-driven weighting methods （logistic regression contribution method and entropy weighting method）. ResultsAmong 1021 patients with T2DM， 389 cases were diagnosed as dampness-heat syndrome. The expert scoring synthesis method， analytic hierarchy process method， and precedence chart method were basically consistent in the weight scores of each item. The expert scoring comprehensive method， analytic hierarchy process method， and entropy weighting method have a smaller difference in the weight scores of each item， while there was larger difference in the weight scores of each item of the precedence chart method and the logistic regression contribution method. The AUC （95% CI）， AUPR， ACC， sensitivity， and specifi-city of the expert scoring synthesis method were 0.913 （0.893， 0.932）， 0.851， 0.870， 0.868 and 0.875， respectively； while those of the analytic hierarchy process method were 0.910 （0.890， 0.930）， 0.838， 0.879， 0.848 and 0.896； of the precedence chart method were 0.919 （0.900， 0.937）， 0.858， 0.875， 0.871 and 0.875； of the logistic regression contribution method were 0.867 （0.842， 0.891）， 0.792， 0.853， 0.769 and 0.898； and of the entropy weighting method were 0.895 （0.873， 0.916）， 0.820， 0.869， 0.802 and 0.908. ConclusionThe knowledge-driven weighting methods are better than the data-driven weighting methods in terms of diagnostic efficacy and reflecting expert experience.

Effect of body mass index on short-term effectiveness of high tibial osteotomy in treatment of varus knee arthritis / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effect of body mass index (BMI) on the short-term effectiveness of high tibial osteotomy (HTO) in the treatment of varus knee arthritis.@*METHODS@#The clinical data of 84 patients (84 knees) with varus knee arthritis treated with HTO between May 2016 and August 2020 were retrospectively analyzed. According to BMI, the patients were divided into normal group (32 patients in group A, BMI<25 kg/m 2), overweight group (27 patients in group B, BMI>30 kg/m 2), and obese group (25 patients in group C, BMI>30 kg/m 2). The BMI of groups A, B, and C were (23.35±0.89), (26.65±1.03), and (32.05±1.47) kg/m 2, respectively. There was no significant difference ( P>0.05) in gender, age, surgical side, disease duration, and preoperative Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, knee range of motion, and hip-knee-ankle angle (HKA) between groups. The operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation were recorded and compared between groups. The improvement of knee joint function and pain status were evaluated by knee joint HSS score, knee range of motion, and VAS score before and after operation, and measuring the HKA of patients on X-ray film. During the follow-up, the X-ray films of the knee joint were reexamined to observe the position of the internal fixator and the healing of osteotomy.@*RESULTS@#All patients completed the operation successfully and were followed up 8-40 months (mean, 19.3 months). There was no significant difference in follow-up time, operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation between groups ( P>0.05). No operative complications such as severe vascular or nerve injury occurred. After operation, deep venous thrombosis of lower extremities occurred in 1 case in groups A and B respectively, and fat liquefaction of surgical incision occurred in 2 cases in group C. There was no significant difference in the incidence of perioperative complications between groups (3.1% vs. 3.7% vs. 8.0%) ( P=0.689). During the follow-up, there was no bone nonunion, plate fracture or loosening. At last follow-up, HSS score, VAS score, knee range of motion, and HKA significantly improved in the 3 groups when compared with those before operation ( P<0.05), but there was no significant difference in the differences of the above indexes between groups before and after operation ( P>0.05).@*CONCLUSION@#BMI does not affect the short-term effectiveness of HTO in the treatment of varus knee arthritis. HTO can be selected for overweight and obese patients after standard medical treatment is ineffective.

CAT, AGTR2, L-SIGN and DC-SIGN are potential receptors for the entry of SARS-CoV-2 into human cells

Since December 2019, the COVID-19 caused by SARS-CoV-2 has been widely spread all over the world. It is reported that SARS-CoV-2 infection affects a series of human tissues, including lung, gastrointestinal tract, kidney, etc. ACE2 has been identified as the primary receptor of the SARS-CoV-2 Spike (S) protein. The relatively low expression level of this known receptor in the lungs, which is the predominantly infected organ in COVID-19, indicates that there may be some other co-receptors or alternative receptors of SARS-CoV-2 to work in coordination with ACE2. Here, we identified twenty-one candidate receptors of SARS-CoV-2, including ACE2-interactor proteins and SARS-CoV receptors. Then we investigated the protein expression levels of these twenty-one candidate receptors in different human tissues and found that five of which CAT, MME, L-SIGN, DC-SIGN, and AGTR2 were specifically expressed in SARS-CoV-2 affected tissues. Next, we performed molecular simulations of the above five candidate receptors with SARS-CoV-2 S protein, and found that the binding affinities of CAT, AGTR2, L-SIGN and DC-SIGN to S protein were even higher than ACE2. Interestingly, we also observed that CAT and AGTR2 bound to S protein in different regions with ACE2 conformationally, suggesting that these two proteins are likely capable of the co-receptors of ACE2. Conclusively, we considered that CAT, AGTR2, L-SIGN and DC-SIGN were the potential receptors of SARS-CoV-2. Moreover, AGTR2 and DC-SIGN tend to be highly expressed in the lungs of smokers, which is consistent with clinical phenomena of COVID-19, and further confirmed our conclusion. Besides, we also predicted the binding hot spots for these putative protein-protein interactions, which would help develop drugs against SARS-CoV-2.

Identifying zoonotic origin of SARS-CoV-2 by modeling the binding affinity between Spike receptor-binding domain and host ACE2

Despite considerable research progress on SARS-CoV-2, the direct zoonotic origin (intermediate host) of the virus remains ambiguous. The most definitive approach to identify the intermediate host would be the detection of SARS-CoV-2-like coronaviruses in wild animals. However, due to the high number of animal species, it is not feasible to screen all the species in the laboratory. Given that the recognition of the binding ACE2 proteins is the first step for the coronaviruses to invade host cells, we proposed a computational pipeline to identify potential intermediate hosts of SARS-CoV-2 by modeling the binding affinity between the Spike receptor-binding domain (RBD) and host ACE2. Using this pipeline, we systematically examined 285 ACE2 variants from mammals, birds, fish, reptiles, and amphibians, and found that the binding energies calculated on the modeled Spike-RBD/ACE2 complex structures correlate closely with the effectiveness of animal infections as determined by multiple experimental datasets. Built on the optimized binding affinity cutoff, we suggested a set of 96 mammals, including 48 experimentally investigated ones, which are permissive to SARS-CoV-2, with candidates from primates, rodents, and carnivores at the highest risk of infection. Overall, this work not only suggested a limited range of potential intermediate SARS-CoV-2 hosts for further experimental investigation; but more importantly, it proposed a new structure-based approach to general zoonotic origin and susceptibility analyses that are critical for human infectious disease control and wildlife protection.

Effects of SARS-CoV-2 Mutations on Protein Structures and Intraviral Protein-Protein Interactions

Since 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) has infected ten millions of people across the globe, and massive mutations in virus genome have occurred during the rapid spread of this novel coronavirus. Variance in protein sequence might lead to change in protein structure and interaction, then further affect the viral physiological characteristics, which could bring tremendous influence on the pandemic. In this study, we investigated 18 non-synonymous mutations in SARS-CoV-2 genome which incidence rates were all [≥]1% as of July 15th, 2020, then modeled the mutated protein structures and compared them with the reference ones. The results showed that four types of mutations could cause dramatic changes in protein structures (RMSD [≥]5.0 [A]), which were Q57H and G251V in open reading frames 3a (ORF3a), S194L and R203K/G204R in nucleocapsid (N). Next, we found that these mutations could affect the binding affinity of intraviral protein interactions. In addition, the hot spots within these docking complexes were altered, among which the mutation Q57H was involved in both Orf3a-Orf8 and Orf3a-S protein interactions. Besides, these mutations were widely distributed all over the world, and their occurrences fluctuated as time went on. Notably, the incidences of R203K/G204R in N and Q57H in Orf3a were both over 50% in some countries. Overall, our findings suggest that SARS-CoV-2 mutations can change viral protein structure, binding affinity and hot spots of the interface, thereby may have impacts on SARS-CoV-2 transmission, diagnosis and treatment of COVID-19.

Rational Design of SARS-CoV-2 Spike Glycoproteins To Increase Immunogenicity By T Cell Epitope Engineering

The current COVID-19 pandemic caused by SARS-CoV-2 has resulted in millions of confirmed cases and thousands of deaths globally. Extensive efforts and progress have been made to develop effective and safe vaccines against COVID-19. A primary target of these vaccines is the SARS-CoV-2 spike (S) protein, and many studies utilized structural vaccinology techniques to either stabilize the protein or fix the receptor-binding domain at certain states. In this study, we extended an evolutionary protein design algorithm, EvoDesign, to create thousands of stable S protein variants without perturbing the surface conformation and B cell epitopes of the S protein. We then evaluated the mutated S protein candidates based on predicted MHC-II T cell promiscuous epitopes as well as the epitopes similarity to human peptides. The presented strategy aims to improve the S proteins immunogenicity and antigenicity by inducing stronger CD4 T cell response while maintaining the proteins native structure and function. The top EvoDesign S protein candidate (Design-10705) recovered 31 out of 32 MHC-II T cell promiscuous epitopes in the native S protein, in which two epitopes were present in all seven human coronaviruses. This newly designed S protein also introduced nine new MHC-II T cell promiscuous epitopes and showed high structural similarity to its native conformation. The proposed structural vaccinology method provides an avenue to rationally design the antigens structure with increased immunogenicity, which could be applied to the rational design of new COVID-19 vaccine candidates.

Computational Design of Peptides to Block Binding of the SARS-CoV-2 Spike Protein to Human ACE2

The outbreak of COVID-19 has now become a global pandemic and it continues to spread rapidly worldwide, severely threatening lives and economic stability. Making the problem worse, there is no specific antiviral drug that can be used to treat COVID-19 to date. SARS-CoV-2 initiates its entry into human cells by binding to angiotensin-converting enzyme 2 (hACE2) via the receptor binding domain (RBD) of its spike protein. Therefore, molecules that can block SARS-CoV-2 from binding to hACE2 may potentially prevent the virus from entering human cells and serve as an effective antiviral drug. Based on this idea, we designed a series of peptides that can strongly bind to SARS-CoV-2 RBD in computational experiments. Specifically, we first constructed a 31-mer peptidic scaffold by linking two fragments grafted from hACE2 (a.a. 22-44 and 351-357) with a linker glycine, and then redesigned the peptide sequence to enhance its binding affinity to SARS-CoV-2 RBD. Compared with several computational studies that failed to identify that SARS-CoV-2 shows higher binding affinity for hACE2 than SARS-CoV, our protein design scoring function, EvoEF2, makes a correct identification, which is consistent with the recently reported experimental data, implying its high accuracy. The top designed peptide binders exhibited much stronger binding potency to hACE2 than the wild-type (-53.35 vs. -46.46 EvoEF2 energy unit for design and wild-type, respectively). The extensive and detailed computational analyses support the high reasonability of the designed binders, which not only recapitulated the critical native binding interactions but also introduced new favorable interactions to enhance binding. Due to the urgent situation created by COVID-19, we share these computational data to the community, which should be helpful to develop potential antiviral peptide drugs to combat this pandemic.

Protein structure and sequence re-analysis of 2019-nCoV genome does not indicate snakes as its intermediate host or the unique similarity between its spike protein insertions and HIV-1

As the infection of 2019-nCoV coronavirus is quickly developing into a global pneumonia epidemic, careful analysis of its transmission and cellular mechanisms is sorely needed. In this report, we re-analyzed the computational approaches and findings presented in two recent manuscripts by Ji et al. (https://doi.org/10.1002/jmv.25682) and by Pradhan et al. (https://doi.org/10.1101/2020.01.30.927871), which concluded that snakes are the intermediate hosts of 2019-nCoV and that the 2019-nCoV spike protein insertions shared a unique similarity to HIV-1. Results from our re-implementation of the analyses, built on larger-scale datasets using state-of-the-art bioinformatics methods and databases, do not support the conclusions proposed by these manuscripts. Based on our analyses and existing data of coronaviruses, we concluded that the intermediate hosts of 2019-nCoV are more likely to be mammals and birds than snakes, and that the "novel insertions" observed in the spike protein are naturally evolved from bat coronaviruses.

Preoperative intravenous injection of tranexamic acid combined with postoperative local use of elastic bandage to reduce blood loss for complex tibial plateau fractures: a prospective controlled clinical trial / 中华创伤骨科杂志

Objective:To assess the effects of preoperative intravenous injection of tranexamic acid and postoperative local use of elastic bandage on blood loss in complex tibial plateau fractures (Schatzker types Ⅴ-Ⅵ).Methods:A sequence randomly generated by computer was used to randomize a cohort of 40 patients into 2 groups who were to receive surgery at Department of Orthopaedics and Trauma, Hong Hui Hospital from June 2018 to January 2019 for complex tibial plateau fractures. They were 24 men and 16 women, aged from 35 to 55 years (average, 46.0 years). In group A, intravenous injection of normal saline was conducted 5 to 10 min before surgical incision and no elastic bandage was used after surgery. In group B, a dose of 15 mg/kg tranexamic acid was intravenously given 5 to 10 min before surgical incision and elastic bandage was used to bandage the knee with compression after surgery. The 2 groups were compared in terms of total blood loss, hidden blood loss, transfusion rate, 48-h drainage flow, venous thromboembolism, postoperative wound complications, postoperative visual analogue scale (VAS), and D-dimer value 24 h after surgery.Results:There were no significant differences between the 2 groups in age, gender, body mass index, smoking history, concomitant medical conditions, American Society of Anesthesiologists (ASA) score, preoperative hemoglobin, preoperative hematocrit, preoperative D-dimerization or fibrin degradation products, showing comparability ( P>0.05). In groups A and B, hemoglobin values 24 h after surgery were 104.6 g/L ± 10.4 g/L versus 113.3 g/L ± 11.9 g/L, drainage volumes 48 h after surgery 277.1 mL ± 229.2 mL versus 207.1 mL ± 124.3 mL, hidden blood loss volumes 318.0 mL ± 83.4 mL versus 266.2 mL ± 60.9 mL, total blood loss volumes 792.8 mL ± 202.8 mL versus 692.2 mL ± 124.9 mL, D-dimer values 24 h after surgery 5.1 mg/L ± 1.3 mg/L versus 4.1 mg/L ± 0.7 mg/L, postoperative VAS scores 5.2 ± 0.9 versus 3.9 ± 1.1, lower limb cross-section diameters 24 h after surgery 35.5 cm ± 3.0 cm versus 34.4 cm ± 2.6 cm, lower limb cross-section diameters 72 h after surgery 33.8 cm ± 2.1 cm versus 32.8 cm ± 2.3 cm, postoperative rates of wound ecchymosis hematoma 20.0% (4 cases) versus 0 (0 cases), and hospital stays 6.6 d ± 1.0 d versus 6.2 d ± 1.2 d. There were significant differences between the 2 groups in all the above items ( P<0.05). However, there were no significant differences between the 2 groups in incidence of postoperative DVT, pulmonary embolism or other wound complications ( P>0.05). Conclusions:Preoperative intravenous injection of tranexamic acid and postoperative local use of elastic bandage is reasonable and safe for complex tibial plateau fractures, because it significantly reduces intraoperative blood loss but does not increase the risk of venous thromboembolism, and thus has a positive role in accelerating the recovery of patients.

Surgical treatment of hepatic hemangiomas: a study of 908 patients / 中华肝胆外科杂志

Objective To study the surgical treatment of hepatic hemangiomas and the timing of surgery.Methods A retrospective study was conducted on 908 patients with giant hemangiomas who underwent surgery between December 1997 and December 2017.The clinical data,surgical indications,surgical outcomes,lesion size,and the effect of TAE were compared.Results The diameter (mean + /-S.D.)of the resected hepatic cavernous hemangiomas was (11.1 ± 6.2) cm (the longest diameter was 60 cm).585 patients (64.4％) underwent enucleation of hepatic hemangiomas and 323 patients (35.6％) underwent anatomical hepatectomy.Six patients died perioperatively (mortality rate 0.7％).The incidence of severe complication (Clavien-Dindo grade 3 ～ 5) was 3.8％.The incidence of severe postoperative complication for enucleation (2.7％) was significantly less than anatomic liver resection (5.6％,P ＜0.05).When the lesion was more than 20 cm,the complication and mortality rates were significantly higher than those less than 20 cm (P ＜ 0.05).The complication and mortality rates in patients who underwent TAE before surgery were significantly higher than those without TAE (P ＜ 0.05).Conclusions Surgical enucleation of hemangiomas was superior to anatomical hepatectomy.With increase in tumor size,the risk of surgery increased.Surgical treatment was safe and effective for giant hepatic hemangiomas.For giant hepatic hemangiomas with significant increase in size,prompt surgical treatment is recommended.

Technology Optimization of Stir-bake with Saltwater Processing for Fujian Alismatis Rhizoma and Estab-lishment of Its HPLC Fingerprint / 中国药房

OBJECTIVE:To optimize the stir-bake with saltwater processing technology for Fujian Alismatis rhizoma,and es-tablish its HPLC fingerprint. METHODS:Using 23-acetyl alisol B,total triterpenoids contents and appearance as comprehensive in-dexes,single factor experiment and orthogonal test were employed,3 factors'levels including the quantity of salt,processing tem-perature and time were optimized. HPLC was used to develop fingerprints of 10 batches of Fujian Alismatis rhizoma at wavelength of 208,245 nm;the similarity between fingerprints and control profile was compared by using software. RESULTS:The optimal technology was as follow as 2 kg salt dissolved with 10 kg water for each 100 kg Fujian Alismatis rhizoma,moistening for 1 h, stir-frying for 8 minutes under 100 ℃. In verification test,the appearance of 3 batches of processed products were all in line with requirements,average comprehensive score was 93.94 (RSD=6.63%,n=3);23-acetyl alisol B and total triterpenoids contents were stable(RSD=7.41%,7.39%,n=3),respectively. Totally 17 and 10 common peaks were marked in 208 nm and 245 nm re-spectively;similarities of 10 batches of samples'fingerprints were higher than 0.9. CONCLUSIONS:Optimized stir-bake with salt-water technology is reasonable,feasible,and reproducible;the stability of common peaks of established fingerprints can conduct ef-fective quality evaluation for Fujian Alismatis rhizoma processed by saltwater.

Quantitative analyses on the fund theses in the Journal of Practical Radiology and Chinese Journal of Radiology / 实用放射学杂志

Objective To quantitatively analyze the fund theses published in the Journal of Practical Radiology(JPR)and Chinese Journal of Radiology(CJR)in order to detect effective approaches to the improvement of the journal quality and academic level of the JPR.Methods The number of funds-supported theses published,the ratio of fund theses,grade,regional,source of institutions and publication time-lag distribution of the fund theses were statistically analyzed by using bibliometrics in the two journals in 2013.Re-sults Six hundred and eighteen theses were published in JPR in 2013,the total number of fund theses were 137(accounted for 22.2% of total articles),the ratio of fund theses were 0.22,the provincial and municipal fund theses accounted for 59.2%.All fund theses were from 23 regions and 82 institutions throughout the country.The average of publication time-lag was 235.6 days.Three hundred and thirteen theses were published in CJR in 2013,the total number of fund theses were 97(accounted for 31.0% of total articles),the ratio of fund theses were 0.31,the provincial and municipal fund theses accounted for 32.0%.All fund theses were from 18 regions and 70 institutions throughout the country.The average of publication time-lag was 228.4 days.Conclusion JPR has its own superi-ority,meanwhile,it also has a significant disparity and insufficiency comparing to CJR.In order to further promote the quality conno-tations and the academic level of JPR,efforts should be made on subject selection and planning,initiative collection of manuscripts, priority publishment to excellent manuscripts,shortening publication time-lag,etc.Additionally,a database of core authors and ex-perts should be established.

Clinicopathological and CT features of mucinous cystic neoplasms of the pancreas / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the clinicopathological and CT features of mucinous cystic neoplasms (MCNs) of the pancreas and analyze the correlative risk factors for malignant pancreatic mucinous cystic neoplasms.</p><p><b>METHODS</b>Ninety-eight patients who underwent curative resection for mucinous cystic neoplasms of the pancreas at PLA General Hospital from April 1994 to January 2013 were included in this study. All clinicopathological data available were retrospectively analyzed. All patients were divided into benign tumors + premalignant lesion group (70 patients) and malignant tumor group (28 patients). Clinicopathological and CT features of the mucinous cystic neoplasms of the pancreas and risk factors of malignant pancreatic mucinous cystic neoplasms were analyzed.</p><p><b>RESULTS</b>Mucinous cystic neoplasms were seen mostly in perimenopausal women (71.4%, 70/98 cases,), and 51.0% (50/98 cases) of the patients had obvious clinical signs, mostly non-specific abdominal pain, but jaundice was present only in cases of malignant mucinous cystic neoplasms. Benign mucinous cystic neoplasms were mostly located in the distal pancreas (74.3%) and characterized with septa and thin cystic wall, while more malignant mucinous cystic neoplasms were located at the proximal pancreas (57.1%) and characterized with thick cystic wall and solid components. Univariate analysis showed that findings associated with malignancy gender, age ≥ 60, presence of symptoms, jaundice, weight loss, tumor location, margin, wall thickness, solid components and dilation of the main pancreatic duct were significantly correlated with malignant tumor development (P < 0.05 for all). The results of multiple logistic regression analysis showed that thick wall and solid components were independent prognostic factors for malignancy (OR = 31.417 and 34.976, P < 0.05 for both).</p><p><b>CONCLUSIONS</b>Gender, age ≥ 60, presence of symptoms, jaundice, weight loss, tumor location, margin, wall thickness, solid components and dilation of the main pancreatic duct are important diagnostic indices of malignant mucinous cystic tumors of the pancreas, while thick wall and solid components are independent risk factors of malignant pancreatic mucinous cystic neoplasms.</p>

By means of key discipline construction improve medical quality / 中华医学科研管理杂志

Objective In order to improve the medical quality of our hospital,we adopted the method to strengthen the construction of key disciplines.Methods Xi'an Honghui hospital were retrospectively analyzed from 2008 to 2008 in order to improve medical quality,to take in the discipline construction of main methods and results,and tries to summarize.Results The clinical medical treatment,teaching,scientific research and human resources allocation,etc.Work with key subject as the center,to other disciplines has played a significant radiation and driving effects,medical quality and level are improved significantly.Conclusions The key subject is the inner motive power of sustainable development of the hospital,is one of the important elements to build hospital brand,discipline construction is the key to promote the development of the hospital,is the core and soul of hospital management.

Choledochoplasty for major bile duct defect in Mirizzi syndrome / 中华肝胆外科杂志

ObjectiveTo evaluate the various methods of choledochoplasty in the repair of major bile duct defects in Mirizzi syndrome.MethodsThis is a retrospective study on 3 patient with Mirizzi syndrome with a large bile duct defect.These defects were repaired by using a vascular gastric pedicle patch in our department from July 2008 to November 2011.The authors searched the domestic medical literature on surgical repair for Mirizzi syndrome in the past ten years.The patients were treated by various surgical methods,and they were analyzed according to the Csendes Classification.ResultsThere were no surgical complications in our three patients.There was one patient with a Csendes type Ⅲ,while the remaining 2 patients were with Csendes type Ⅳ.At a median follow- up of 2.5 years,no patient developed signs of chronic cholangitis.In the medical literature,there were 93 patients who were with Csendes type Ⅰ ; and 58 patients were treated by cholecystectomy only,while 35 patients were treated by partial cholecystectomy plus mucosal ablation.Of the 40 patients with type Ⅱ,29 patients were treated by direct fistula repair,9 patients by pedicle gallbladder flap and 2 patients by pedicle round ligament.Of the 20 patients with type Ⅲ,9 patients were treated by pedicle gallbladder flap.1 patient by pedicle round ligament,3 patients by pedicle gastric flap and 7 patients by Rouxen- Y hepaticojejunostomy.For the 5 patients with type Ⅳ,they were treated by Roux-en- Y hepaticojejunostomy.Of these 159 patients,postoperative complications included biliary fistula (n=1 ),upper gastrointestinal bleeding (n=1),and biliary stricture (n=1).All the remaining patients were cured.ConclusionIn patients with Mirizzi Syndrome,the choice of treatment depends on the size of the fistula.For patient with a major tissue defect in the common hepatic duct,a pedicle vascular gastric flap is a good treatment.

Variations in serum level of cytokines associated with vascular endothelial cells before and after treatment with either TACE or liver resection in patients with hepatocellular carcinoma / 中华肝胆外科杂志

ObjectiveTo determine the serum levels of cytokines associated with vascular endothelial cells before and after treatment with either transcatheter arterial chemoembolization (TACE) or partial hepatectomy in patients with hepatocellular carcinoma (HCC).MethodsThere were 30 patients who received partial hepatectomy (the operation group) and 30 patients who received TACE (the TACE group).Cytokines were measured before and after treatment.ResultsThe serum levels of IL-1β,IL-6,IL-8,VEGF and EGF of the post-TACE patients were significantly lower than the pre-TACE patients.The serum levels of IL-10,IFNγ and TNFα of the post-TACE patients were significantly higher than the pre-TACE patients.The serum levels of IL-1β,IL-6.IL-8,VEGF and EGF in the postoperative patients were significantly lower than the post-TACE patients.The serum levels of IL-10,IFNγ and TNFα of the postoperative patients were significantly higher than the post-TACE patients.ConclusionThe results suggested that the serum levels of angiogenic factors in the postTACE patients were significantly higher than the postoperative patients.The serum levels of the inhibitors of vascular endothelial cells of the post-TACE patients were significantly lower than the postoperative patients.

Comparative studies of perioperative period correlation factor of hepatectomy treatment for liver malignant tumor / 中华肝胆外科杂志

Objective To compare superiorities of liver malignant tumors underwent regular and irregular hepatectomies through approaching perioperative factors.Methods 1019 consecutive hepatectomies of liver malignant tumor from 1986 to 2009 at Air Force General Hospital and General Hospital of Chinese PLA were investigated retrospectively according to their medical documentation.Results Multivariate analysis showed that liver malignant tumors on which regular hepatectomy and irregular hepatectomy were performed,there was no significant difference in the blood loss,complications,mortality related to operation,hospital stay,and so on.But the operating time of regular hepatectomy was obvious more than that of irregular hepatectomy (P＜ 0.001,OR=1.004).Conclusions Although for liver malignant tumor,regular hepatectomy seems to be superior to irregular hepatectomy based on oncological theory,in clinical practice,there were no significant difference between the perioperative risk of regular hepatectomy and that of irregular hepatectomy.

Hemostatic effect of non-insufflation intra-abdominal compression on liver injury / 中华创伤杂志

Objective To assess the effectiveness and safety of non-insufflation intra-abdominal compression as a prehospital hemostatic technique in treatment of liver injury.Methods Twenty-nine male Wistar rats were enrolled and randomly assigned into four experimental groups:IAP0 group ( n =8 ),IAP5 group (n =8),IAP10 group (n =8) and IAP15 group (n =5).Then,the anticoagulated rat models of severe liver injury were established with different intra-abdominal pressures ( 0,5,10 and 15 mm Hg) by using a non-expansible insufflated gas bag.Once the mean artery pressure (MAP) was less than 95 mm Hg,Lactated Ringer' s solution was infused through the right jugular vein at speed of 3.3 ml · min-1 · kg-1 until MAP reached 100 mm Hg.Thirty minutes later,the animals were killed by intravenous injection of 0.2 ml saturated potassium chloride solution to measure the intraperitoneal total blood loss,liver weight,volume of infused solution and MAP.Results No death was observed in IAP0,lAP5 and IAP10 groups and four rats (4/5) died at 10-15 minutes following exposure to the 15 mm Hg intra-abdominal pressure in IAP15 group.Total blood loss was reduced to ( 54.20 ±11.30)ml/kg in IAP0 group,(43.98 ±9.2) ml/kg in IAP5 group,(32.49 ±7.40) ml/kg in IAP10group and (25.77 ± 14.16) ml/kg in IAP15group ( P ＜0.01 ).The infused volume of resuscitation solution was (31.06 ± 3.14) ml in IAP10 group,which was higher than (24.94 ±6.67) ml in IAP0 group,(23.06 ± 7.98) ml in IAP5 group and (16.50 ±7.27) ml in IAP15 group (P ＜0.05).Liver weight was ( 11.18 ± 1.45) g in IAP5 group,( 12.13 ± 0.96) g in IAP10 group and ( 11.41 ± 1.20) g in IAP15 group,which was significantly higher than (10.03 ±0.58) g in IAP0 group (P＜0.05).The MAP was (64.81 ± 19.65) mm Hg in IAP5 group and (65.80 ± 15.36) mm Hg in IAP10 group ( insignificant difference between groups,P ＞ 0.05 ),which was higher than (41.22 ± 10.00) mm Hg in IAP0 group and (44.50 ±28.60) mm Hg in IAP15 group (P ＜0.05).Conclusions Non-pneumatic intra-abdominal compression can effectively control bleeding in rat models of severe liver injury,while the adverse effect of intra-abdominal hypertension should be avoided.

The serum levels of cytokines associated with vascular endothelial cells in preoperative and postoperative patients with hepatocarcinoma / 中华肝胆外科杂志

Objective To determine the serum levels of cytokine IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, VEGF, IFNγ, EGF, MCP-1 and TNFα in preoperative and postoperative patients with hepatocarcinoma(HCC). Methods 30 patients with hepatocirrhosis were taken as hepatocirrho-sis group; 30 normal health examiners were taken as the normal control group. 30 patients with hepatocarcinoma were taken as HCC group; 30 patients with hepatic hemangioma were taken as the control group. Cytokines had been measured by biochips methods in evidence 180 automatic biochips analyze.Results The serum levels of IL-1β, IL-6, IL-8, VEGF and EGF of the patient with HCC and cirrhosis were significantly higher than those in normal control group. The serum levels of IL-10, IFNγand TNFα of the patient with HCC and cirrhosis were significantly lower than those in normal control group. The serum levels of IL-1β, IL-6, IL-8, VEGF and EGF of the preoperative patient with HCC were significantly higher than those in the postoperative patient with HCC. The serum levels of IL-10,IFNγ and TNFa of the preoperative patient with HCC were significantly lower than those in the postoperative patient with HCC. Conclusions These results suggest that the serum levels of angiogenic factors in HCC were increased. The serum levels of the inhibitors of vascular endothelial cells in HCC were decreased. The serum levels of angiogenic factors in the postoperative patient with HCC were decreased. The serum levels of inhibitors of vascular endothelial cells in the postoperative patient with HCC were increased.

Biliary nut-craker syndrome caused by hilar biliary stricture due to portal vein variation / 中华消化外科杂志

Benign biliary stricture is a challenging problem in hepatobiliary surgery. Benign biliary stricture is associated with major portal vein variation, which is not be found in literatures. A male patient with benign biliary stricture was admitted to the Chinese PLA General Hospital in March, 2010.The stricture was located in the hilar confluence with intrahepatic biliary dilation and hepatolithiasis. The result of computed tomography showed that the hilar biliary confluence was compressed by the left portal vein and right anterior portal vein. The patient was cured after receiving gallbladder interposition, choledocholithotomy and T tube drainage. We suggested that the benign hilar biliary stricture due to portal vein variation may be named as biliary nut-craker syndrome.