Objective To summarize the recent pathogenetic researches on the acute pancreatitis. Methods Relevant references about the pathogenesis of acute pancreatitis, which were published recently domestic and abroad were collected and reviewed. Results Recent experimental data indicated that the synthesis and release of pro-inflammatory cytokines and chemotactic factors were responsible for local injury and systemic dissemination of the inflammatory mediators. Experimental studies also provided evidences implying that the immune system might play a role in the development of pancreatitis, such as the activation of lymphocyte and neutrophil. Additionally, the pancreas may completely recover or become fibrotic after an attack of acute pancreatitis and the presence of pancreatic stellate cell was known as a crucial factor in the fibrogenesis. Conclusion The pathogenesis of acute pancreatitis is very complicated, the factors that determine the ultimate severity of the attack are still unknown.
目的 明确异丙酚对于高血压脑出血患者血清炎性细胞因子的影响。 方法 将2008年3月-2009年3月收治的高血压脑出血患者47例分为两组，异丙酚组采用异丙酚、芬太尼、维库溴铵以及异氟醚诱导和维持麻醉；对照组采用依托咪酯、芬太尼、维库溴铵以及异氟醚诱导和维持麻醉。比较两组患者手术中不同时段血清白细胞介素（IL-6）、肿瘤坏死因子（TNF）、血栓素、内皮素、前列腺素E和降钙素水平。 结果 患者麻醉过程中生命体征平稳，无麻醉相关死亡。术前异丙酚组患者血清IL-6、TNF、血栓素、内皮素、前列腺素E和降钙素水平与对照组比较均无差异(P＞0.05)，而麻醉诱导后差异有统计学意义(P＜0.05)，而且差异随时间延长增大。 结论 采用异丙酚麻醉能降低术中血清炎性细胞因子水平。
ObjectiveTo systematically evaluate the effect of hyperbaric oxygen therapy on delayed encephalopathy caused by carbon monoxide poisoning.MethodsChina National Knowledge Infrastructure, Wanfang Data, CQVIP data, China Biology Medicine Database, PubMed, Embase, and Cochrance Library were searched by computer for randomized controlled trials on hyperbaric oxygenation for delayed encephalopathy caused by carbon monoxide poisoning which were published in English or Chinese from the dates of establishment of the databases to March 31st, 2019. After literature including, excluding, and screening, RevMan 5.2 software was used to conduct a meta-analysis.ResultsA total of 25 studies were included, including 1 797 patients, 924 in the hyperbaric oxygen therapy group (the trial group) and 873 in the control group. The clinical effective rate [relative risk (RR)=1.24, 95% confidence interval (CI) (1.19, 1.30), P<0.000 01], the normal rate of electroencephalogram [RR=2.10, 95%CI (1.18, 3.75), P=0.01], the Mini-Mental State Examination score [standard mean difference (SMD)= 3.19, 95%CI (2.06, 4.32), P<0.000 01], and the Activities of Daily Living score [SMD=1.46, 95%CI (1.02, 1.90), P<0.000 01] were all higher in the trial group than those in the control group.ConclusionHyperbaric oxygen therapy for delayed encephalopathy caused by carbon monoxide poisoning can improve symptoms.
ObjectiveTo investigate the effectiveness of sublobar resection and lobectomy via uniportal video-assisted thoracoscopic surgery (U-VATS) for lung metastases from colorectal cancer.MethodsRetrospective research was conducted on 42 colorectal cancer patients with lung metastases who underwent U-VATS sublobar resection and lobectomy at the Tongji Hospital, Huazhong University of Science and Technology between April 2016 and May 2019, including 24 males and 18 females with an average age of 58.0±9.9 years. Among them 17 patients received U-VATS sublobar resection and 25 patients received lobectomy. The operation time, intraoperative blood loss, postoperative pulmonary infection, drainage tube indwelling time, drainage volume on the first day after surgery, postoperative hospital stay were analyzed between the two groups, and the relationship between the prognosis and clinical characteristics of the two groups was compared.ResultsSublobar resection patients had less lung metastases (P=0.043) and shorter operation time (P=0.023) compared with the lobectomy patients. There was no significant difference between the lobectomy and sublobar resection groups in intraoperative blood loss (P=0.169), rate of postoperative infection (P=0.982), postoperative drainage duration (P=0.265), drainage volume on the first day after surgery (P=0.402) and postoperative hospital stay (P=0.612). The progression-free survival of the two groups was 25.19 months and 23.63 months (P=0.721), and their overall survival was 29.09 months and 30.64 months (P=0.554).ConclusionConsidering guantity and locations of lung metastases, U-VATS sublobar resection can achieve a similar prognosis to lobectomy for lung metastases from colorectal cancer. Further efficacy of this surgical strategy remains to be proved by longer follow-up.
Objective To evaluate the efficacy of lung-protective strategies of ventilation (LPSV) in acute respiratory distress syndrome (ARDS) patients after thoracic operation. Methods-Thirtyseven ARDS patients without preoperative complications who had underwent thoracic surgery successfully were divided into the conventional mechanical ventilation group (CMV group, n=20) and lungprotective strategies of ventilation group (LPSV group，n=17). Results of arterial blood gas, index of oxygenation (PaO2/FiO2), airway plateau pressure (Pplat), inspiration peak pressure (PIP), PEEP, after ventilation treatment 24 h and mechanical ventilation time， pulmonary barotrauma and so on were observed. Results The mechanical ventilation time， pulmonary barotrauma and mortality of the LPSV group were 7.3d, 5.9％ and 29.4％ respectively, which were significantly better than those in the CMV group(17.6d，15.0％ and 60.0％, Plt;0.05). peak inflation pressure (PIP)，Pplat(plat pressure) in the LPSV group were significantly lower than those in the CMV group (Plt;0.05). However, there were no significant differences including arterial oxygen saturation (SaO2),pH, partial pressure of carbon dioxide in artery (PaCO2) and PaO2/FiO2 in two groups. Conclusion LPSV is more effective for the patients in the ARDS patients after thoracic operation compared to CMV, which can markedly reduce the ventilatorinduced lung injuryand (VILI) and mortality.
Objective To discuss the elbow skin fold extension line in Kirschner wire internal fixation of extended supracondylar humeral fractures in children. Methods The clinical data of 58 children with extended supracondylar fractures of the humerus who met the selection criteria between August 2021 and July 2024 were retrospectively analyzed. In 28 cases, needle placement of medial epicondyle of humerus was performed with the assistance of the elbow skin fold extension line (study group), and 30 cases were assisted by routine touch of the medial epicondyle of the humerus (control group). There was no significant difference in baseline data such as gender, age, side, cause of injury, Gartland type, Kirschner wire configuration, and time from injury to operation between the two groups (P>0.05). The closed reduction rate, total operation time, time of medial humeral condyle pin placement, fluoroscopy times during medial pin placement, rate of one-time determination of medial entry point, ulnar nerve injury incidence, and fracture healing time were recorded and compared between the two groups. At the same time, the closed reduction rate of patients with the time from injury to operation ≤24 hours and >24 hours was compared. The elbow function was evaluated by Mayo elbow function score. Results The closed reduction rate of the study group was significantly higher than that of the control group (P<0.05). Among all patients, the closed reduction rate of patients with the time from injury to operation ≤24 hours [73.3% (22/30)] was significantly higher than that of patients >24 hours [42.9% (12/28)] (χ2=5.545, P=0.019). The total operation time, medial needle placement time, and fluoroscopy times in the study group were significantly less than those in the control group, and the one-time determination rate of medial needle entry point in the study group was significantly higher than that in the control group (P<0.05). There were 4 cases of ulnar nerve injury in the control group, and no ulnar nerve injury in the study group, but there was no significant difference in the incidence of ulnar nerve injury between the two groups (P>0.05). All patients were followed up 6-12 months (mean, 8 months). There was no bone nonunion in both groups, and the fracture healing time of the study group was significantly shorter than that of the control group (P<0.05). Volkmann ischemic contracture, heterotopic ossification, myositis ossificans, and premature epiphyseal closure were not observed after operation. No complications such as loosening or fracture of Kirschner wire occurred. At last follow-up, the Mayo elbow joint function score was used to evaluate function, and there was no significant difference between the two groups (P>0.05). Conclusion In the treatment of extended supracondylar fractures of the humerus in children, the elbow skin fold extension line can help to quickly locate the medial epicondyle of the humerus, quickly insert Kirschner wire, and reduce the operation time and trauma.
ObjectiveTo compare effectiveness of single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) and single anastomosis sleeve ileal (SASI) bypass on weight loss and glucose regulating as well as difference in micronutrient deficiency in obese rats with type 2 diabetes mellitus. MethodsThirty-six Spraque-Dawley rats fed with high fat diet combined with intraperitoneal injection of low-dose streptozotocin (35 mg/kg) for 1 month were used to induce obese rats with type 2 diabetes mellitus, then were randomly averagely divided into 3 groups: SADI-S group, SASI group, and sham operation (SO) group. Eight rats from numbered rats of each group were randomly selected to carry out experimental observation. The rats’ body weight, food intake, and fasting blood glucose (FBG) were measured from before operation to postoperative 1–6 months. Meanwhile blood was collected before surgery, as well as at month 1 and 6 after surgery for oral glucose tolerance testing (OGTT) and insulin resistance testing (ITT). Serum glucagon-like peptide (GLP-1), hemoglobin, and albumin levels, as well as vitamin B12, calcium, and ferrum concentrations were measured before surgery as well as at month 1 and 6 after surgery. Results① The body weight, food intake (except 5–6 months), and FBG level in the SADI-S group and SASI group were lower than the SO group (P<0.05) from 1- to6-month after operation, and all obviously decreased at month 1 after operation (P<0.05), but there was no statistical differences between the SADI-S group and SASI group (P>0.05). ② The postoperative OGTT and ITT blood glucose levels in the SADI-S group and SASI group were lower than those in the SO group (P<0.05) and were lower than those in the preoperative levels (P<0.05), and the SADI-S group had a lower OGTT blood glucose level than the SASI group at month 6 after operation (P<0.05). ③ The GLP-1 levels of the SADI-S group and SASI group were higher than that of the SO group (P<0.05), and higher than before operation at month 6 after operation (P<0.05) , but there was no statistical difference was found between the SADI-S group and SASI group after operation (P>0.05). ④ The postoperative albumin levels of the SADI-S group and SASI groups= were lower than of the SO group (P<0.05) and were lower than before operation, and albumin level of the SADI-S group was lower than of the SASI group at postoperative month 6 (P<0.05); while the hemoglobin had no statistical differences among the 3 groups (P>0.05). ⑤ The ferrum concentration of the SADI-S group was lower than that of the SASI group and SO group at 1 month after operation (all P<0.05), while it increased slightly at month 6 after operation and had no statistical difference between the SADI-S group and SASI group (P>0.05); the calcium concentrations of the SADI-S group and SASI group only at 6 month after operation were lower than those of the SO group (P<0.05), and were lower as compared with before operation (P<0.05) , but no statistical difference was found between the SADI-S group and SASI group (P>0.05); the vitamin B12 had no statistical differences among the 3 groups (P>0.05). ConclusionsFor obese rats with type 2 diabetes mellitus, SADI-S and SASI have similar weight loss effect. Long-term glucose reduction of SADI-S shows a advantage than SASI, but influence of postoperative micronutrients of SASI is inferior to SASI.
ObjectiveTo evaluate the clinical application and the efficacy of contrast enhanced ultrasonography (CEUS)guided percutaneous radiofrequency ablation (RFA) in patients with liver metastases. MethodsTotal 136 patients with 219 liver metastatic tumors, which were detected by CEUS before RFA therapy, were analyzed retrospectively. The diamter of tumors was (3.2±1.2) cm. Among them, the largest tumor more than 3 cm in diameter were found in 48.5% (66 patients), and 57.4% (78 patients) were with solitary metastasis. Enhanced CT and (or) MRI, and laboratory tests were applied to evaluate the outcomes after RFA treatment by regular followup. ResultsTumors were not detected by conventional ultrasonography in two cases, and 47.0% (63/134) of the patients with the largest tumor were 0.3 cm larger by CEUS than by conventional ultrasonography. More 40 tumors were detected in 18.4% (25/136) patients by CEUS. Followup ranged from 3 to 68 months (median time of 12 months). Early tumor necrosis rate one month after therapy was 98.2% (215/219 tumors). The incidence of local recurrence, new intrahepatic metastasis, and extrahepatic metastasis was 16.9% (23/136), 38.2% (52/136), and 8.8% (12/136), respectively. Local recurrence and new intrahepatic metastasis happened 2-25 months (median time of 6 months) after treatment. Local recurrence rates of the largest tumors ≥ 3 cm and tumor lt; 3 cm was 22.7% and 11.4%， respectively (P=0.079). The rate of new intrahepatic metastasis for the solitary metastasis cases was significantly lower than that for multiple metastases cases (25.6% versus 55.2%, P=0.000). The 1, 2, 3year survival rates were 82.5%, 64.3%, and 50.1%, and the 1, 2, 3year local recurrence free survival rates were 67.7%, 53.8%, and 38.3%, respetively. Patients with solitary metastasis survived longer than that with multiple metastases (P=0.034). ConclusionPatients with liver metastases treated by CEUSguided percutaneous RFA can get better survival rate, and CEUS is of much value for clinic application.
ObjectiveTo compare the clinical efficacy of typeⅡhybrid surgery versus Sun’s surgery in treating acute Stanford A aortic dissection. MethodsA retrospective analysis was conducted on the clinical data of patients with acute Stanford A aortic dissection who were treated at the Central Hospital of Wuhan affiliated to Tongji Medical College, Huazhong University of Science and Technology from 2016 to 2022. According to the surgical method, patients were divided into a typeⅡhybrid group and a Sun’s surgery group, and the clinical efficacy of the two groups was compared. ResultsA total of 52 patients were included, with 22 in the typeⅡhybrid surgery group and 30 in the Sun’s surgery group. The typeⅡhybrid group consisted of 18 males and 4 females, with an average age of (58.18±6.00) years, while the Sun’s surgery group consisted of 22 males and 8 females, with an average age of (53.03±11.89) years. All surgeries were successfully completed. There were 4 (13.3%) perioperative deaths in the Sun’s surgery group, including 2 patients of multiple organ failure, 1 patient of paraplegia, and 1 patient of uncontrollable postoperative bleeding. There was 1 (4.5%) perioperative death in the typeⅡhybrid surgery group, who was suspected of acute coronary syndrome and took a loading dose of dual antiplatelet drugs preoperatively. The patient underwent secondary thoracotomy for hemostasis, was re-cannulated during the operation, and finally died of circulatory failure after implantation of intra-aortic balloon pumping. There was no statistical difference in perioperative mortality between the two groups (P=0.381). Compared with the Sun’s surgery group, the typeⅡhybrid surgery group had shorter cardiopulmonary bypass time [153.00 (135.00, 185.25) min vs. 182.50 (166.50, 196.75) min, P=0.013], aortic cross-clamping time [77.00 (70.50, 92.00) min vs. 102.50 (93.50, 109.75) min, P<0.001], postoperative ICU stay [4.00 (2.83, 6.00) days vs. 8.00 (6.38, 11.78) days, P<0.001], postoperative ventilator support time [72.00 (29.50, 93.25) h vs. 87.65 (39.13, 139.13) h, P=0.138], less intraoperative blood loss [(1586.82±209.41) mL vs. (1 806.00±292.62) mL, P=0.004], postoperative 24 h drainage volume [612.50 (507.50, 762.50) mL vs. 687.50 (518.75, 993.75) mL, P=0.409], and shorter postoperative hospital stay [18.00 (13.00, 20.25) days vs. 22.00 (17.00, 29.25) days, P=0.013]. There was no statistically significant difference in the incidence of other early postoperative complications such as secondary thoracotomy for hemostasis, tracheotomy, renal dysfunction requiring dialysis, stroke, and paraplegia between the two groups (P>0.05). ConclusionFor patients with acute Stanford A aortic dissection, typeⅡhybrid surgery is safe and effective; compared with traditional Sun’s surgery, typeⅡhybrid surgery has relatively less trauma, lower incidence of complications, satisfactory short-term results, and further research is needed on long-term prognosis.
Objective To study the mechanism of alleviating lung ischemia-reperfusion injury by postischemic treatment with namefene hydrochloride, and explore the optimal timing of drug treatment throughout the disease course. Methods A total of 60 rats were randomly divided into six groups with 10 rats in each group: a sham group, a model group, a nalmefene A (NA) group, a nalmefene B (NB) group, a nalmefene C (NC) group and a nalmefene D (ND) group. The sham group without drug treatment was not treated with ischemia-reperfusion. The lung ischemia-reperfusion model was established by occlusion of the left pulmonary hilum in the model group without drug treatment. After ischemic treatment, the NA, NB, NC and ND groups were respectively injected with nalmefene (15 μg/kg) by the tail vein at 5 min before, 10 min, 30 min and 60 min after pulmonary circulation reperfusion. At the 3rd hour after reperfusion, all rats were sacrificed and the specimens from the upper lobe of the left lung tissue were preserved to observe pulmonary lesions, detect wet/dry weight ratio and the activity of myeloperoxidase (MPO), the expressions of tumor necrosis factor-α (TNF-α), Toll-like receptor 2 (TLR2) mRNA and MyD88 mRNA as well as the expressions of TLR2, MyD88, NF-κB p65 and p-NF-κB p65 in lung tissue. Results There were different degrees of alveolar septal destruction, obvious pulmonary interstitial edema, the infiltration of inflammatory cell, the exudationred of blood cell in the mesenchyme, and the collapse of partial alveolar in the model group and the NA, NB, NC, ND groups. In terms of wet/dry weight ratio, the score of lung tissue injury, the activity of MPO, the expressions of TNF-α, TLR2 mRNA and MyD88 mRNA as well as the expressions of TLR2, MyD88, NF-κB p65 and p-NF-κB p65 in lung tissue, the model group were significantly higher than the sham group (P<0.01); there was no significant difference between the ND group and the model group (P>0.05). The corresponding test values of the nalmefene groups with post-ischemic treatment showed the characteristics of ND group> NC group> NB group> NA group (P<0.01). Conclusion The effect of nammefene on alleviating lung ischemia-reperfusion injury is closely related to the inhibition of TLR2, MyD88, NF-κB p65 and phosphorylation of NF-κB p65 with a characteristic of time-dependent manner.