Objective To explore clinical methods for preventing the recurrence of biliary pancreatitis.Methods Clinical data of 112 consecutive cases of acute biliary pancreatitis from January 1999 to July 2001 treated in this hospital were analyzed retrospectively.Before admission all the patients had no history of biliary pancreatitis or cholecystectomy.According to whether or not an endoscopic sphincterotomy(EST) or cholecystectomy was given,the patients were divided into 4 groups: Conservative Group(n=45),EST Group(n=22),Cholecystectomy Group(n=29),and Combination Group(n=16).The recurrence rates of pancreatitis of the 4 groups were compared each other.Results The 112 patients were followed for 16~30 months(mean,18.5 months).Recurrence of pancreatitis was found in 12 patients in the Conservative Group(26.7%,12/45) and in 2 patients in the Cholecystectomy Group(6.9%,2/29).No recurrence was seen in the EST Group and the Combination Group.As compared with the Conservative Group,both EST and cholecystectomy significantly decreased the recurrence rate of biliary pancreatitis.The 2 recurrent patients in the Cholecystectomy Group were given an endoscopic retrograde cholangiopancreatography(ERCP),by which small common bile duct calculi were found.Conclusions Common bile duct calculus is the major cause of recurrence of biliary pancreatitis.Both EST and cholecystectomy can decrease the recurrence rate of biliary pancreatitis.EST is suitable for elderly high-risk patients because of its minimal invasion.

Objective [WT5”BZ] To evaluate the role of duodenoendoscopy in the diagnosis and treatment of acute pancreatitis with gallstone (AP).[WT5”HZ] Methods [WT5”BZ] 45 AP cases were randomized into group of endoscopic retrograde cholangiopancreatography (ERCP) (n=20) and non ERCP group (n=25). All patients were further stratified into mild and severe subgroups according to APACHE Ⅱ scores. All cases were given supportive treatment combined with traditional Chinese medicine. The patients in ERCP group received ERCP within 24 hours of admission. If stones were found, endoscopic sphincterotomy (ES) was performed to extract the stones by basket. In cases with multiple stones or if no stone could be immediatly identifiable, endoscopic naso billiary drainage (ENBD) was applied.[WT5”HZ] Results [WT5”BZ]In patients with severe AP, the morbidity, length of hospital stay and cost were significantly lower in ERCP treatment subgroup than those without ERCP treatment (all P

Objective To explore the clinical application of pereutaneous transluminal angioplasty(PTA) and endovascular bracket to treat lower extremity arteriosclorotic occlusion.Methods The clinical data of 36 patients(41 affected limbs)with lower extremity atherosclerotic occlusion who were treated with PTA and bracket implantation from Jan 2008 to Dee 2008 were summarized.Results The initial successful rate of PTA wag 95.1% (39/41).The clinical symptoms were considerably improved in 37 affected limbs,representing of pain disappearing,skin temperature increasing and the healing of refractory ulcer.The index of ankle to brachial significantly increased from 0.54±0.11 to 0.79±0.15(before v.s.after therapy).However,no improvement was observed in 3 affected limbs,and one affected limb Wag re-operated by the amputation.In the following 3 to 15 months.three superficial femorsI arteries were re-obstructed at the 5th,6th,12th month,respectively.One arteria tibialis pesterior was re-obstructed at the 8th month.The cumulative cure rate was 89.7%(35/39).Conclusions PTA is effective in treating atherosclerotic occlusive diseases.The endovascular bracket can increase the cumulative cure rate.PTA and endovascular bracket are safe and effective in treating lower extremity arteriosclerotie occlusion.

BACKGROUND:Previous studies have reported that rapamycin can affect the proliferation, migration and adhesion abilities of endothelial progenitor cels, but there is no report on the effect of autophagy, as wel as the interaction between autophagy and apoptosis. OBJECTIVE: To observe the effect of rapamycin activated autophagy activation on the proliferation, apoptosis, and cycle of endothelial progenitor cels. METHODS:Density gradient centrifugation was used to obtain mononuclear cels from bone marrow, and the mononuclear cels were inoculated on human fibronectin-coated culture plate.Then after cultured for 7 days the adherent cels colected were the endothelial progenitor cels. Different concentrations of rapamycin (0.01, 0.1, 1 and 10 μg/L) were added and cultured for 24 hours. Western blot was used to detect the LC3-II protein expression and monitor the induction of autophagy, flow cytometry was used to observe the cel cycle progression and apoptosis changes, and methylthiazolyldiphenyl-tetrazolium bromide colorimetric assay was used to observe the proliferation ability. Meanwhile, the ultrastructural changes were observed under transmission electron microscope. RESULTS AND CONCLUSION:Compared with the control group, there was no significant increasing of LC3-II protein expression of endothelial progenitor cels in 0.01 μg/L rapamycin group, and the LC3-II protein expression was in the high level. The LC3-IIprotein expression in the 1 μg/L and 10 μg/L rapamycin groups was higher than that in the control group, but lower than that in the 0.01 μg/L rapamycin group, which indicated that autophagywas particularly active when the concentration of rapamycin was 0.01 μg/L. The apoptosis of endothelial progenitor cels was increased with the increasing of concentration of rapamycin, and the proliferation rate was decreased with the increasing of concentration of rapamycin. The results indicate that activation of autophagy by bapamycin can promote the cel apoptosis, change the cel cycle significantly, and can inhibit the proliferation of endothelial progenitor cels.

Objective To investigate the effect of proliferation,apoptosis and cell cycle of 3-MA on rat endothelial progenitor cells. Methods Bone marrow-derived mononuclear cells were isolated from rat bone marrow by ficoll. There were five groups. The control group and four 3-MA concentration groups: 1. 25 mmol/L,2. 5 mmol/L,5 mmol/L, 10 mmol/L. MTT was used to measure the proliferation of endothelial progenitor cells. Flow cytometry ( FCM) was used to detect cell apoptosis and cell cycle. Results (1)5 mmol/L 3-MA promotes proliferation of endothelial progenitor cells, while 10 mmol/L 3-MA inhibits the proliferation of endothelial progenitor cells (P ＜ 0. 05). (2) 10 mmol/L 3-MA promotes apoptosis of endothelial progenitor cells, compared with the control, the difference was significant ( P ＜ 0. 05 ). (3) 3-MA at the concentration of 5 mmol/L reduces cells at G0/G1 phase and increases S and G2/M phase cells; 10 mmol/L 3-MA induces endothelial progenitor cells blockade at S phase, G2/M phase cells decreased, compared with the control, the difference was significant (P ＜ 0. 05). Conclusions 5 mmol/L 3-MA promotes the proliferation of endothelial progenitor cells. 10 mmol/L 3-MA inhibits the proliferation and promotes apoptosis of endothelial progenitor cells.

Objective To investigate the association of serum interleukin-6 and interleukin-18 concentration in patients with meta-bolic syndrome (MS), and explore the role of inflammtory markers in these patients. Methods 83 patients with MS were enrolled into study group, among of them, 47 were male and 36 were female, their average was 48.95±10. 17 years. The control group was made of 85 normal volunteers. The levels of fasting blood glucose (FBG), fasting insulin, plasma lipids, interleukin-6 and interleukin-18 were meas-ured in all the patients and normal subjects. The insulin sensitive index was calculated. The levels of the fasting blood inflammatory markers were compared between the two groups. Results Compared with the control group, the HOMA-βof the MS group was significantly de-creased, but the levels of IL-18 and IL-6 were significantly increased. The serum IL-18 levels were positive correlated with FPG, FINS, TG, HOMA-IR, IL-6. Conclusion There are IR and abnormal serum level of IL-18 and IL-6 in patients with MS. It has an intimate association between abnormal serum IL-18 and IR. The inflammatory reaction may play an important role in the development of IR in patients with MS.

OBJECTIVETo investigate the clinicopathological features and postoperative short-term complications in the elderly gastric cancer patients.

METHODSClinical data of 270 elderly patients with gastric cancer who underwent gastrectomy in Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine between July 2012 and June 2014 were analyzed retrospectively. Among 270 patients, 220 were 70 to 79 years old( old group) and 50 were ≥80 years old(oldest group). The clinicopathological features were compared between the two groups. Perioperative factors were analyzed to determine if they are associated with postoperative complications. Multivariate logistic regression model was performed.

RESULTSBefore operation, most elderly patients (n=161, 59.6%) had 2 or more than 2 comorbidities, including hypertension (n=154, 57.0%), anaemia (n=126, 46.7%), diabetes (n=53, 19.6%), arhythmia (n=52, 19.3%), cardiovascular disease(n=33, 12.2%), and chronic pulmonary disease(n=28, 10.4%). Elderly gastric cancers were more likely to locate at the lower third of the stomach (n=116, 43.0%). The pathological type was mainly the poorly differentiated carcinoma (n=152, 56.3%), and stage III was more common in TNM staging(n=138, 51.1%). As compared to the old group, the oldest group had more preoperative comorbid diseases(P=0.048), more previous surgery(P=0.029), more preoperative transfusion (P=0.019), more combined cholecystectomy (P=0.007) and feeding jejunostomy (P=0.037), but less tumor invasion of nerves(P=0.045). No significant differences in other clinicopathological parameters were found between the two groups (all P>0.05). A total of 121 (44.8%) patients presented postoperative complications, including severe complication in 30 cases(11.1%) and death in 4 cases(1.5%). Forty-seven patients(17.4%) presented operation-associated complications, including infection in 28 cases(10.4%) and leakage in 21 cases(7.8%). One hundred and seven(39.6%) patients presented non-operation-associated complications, including pneumonia in 48 cases(17.8%), hypertension in 23 cases(8.5%), and arhythmia in 17 cases(6.3%). Postoperative morbidities of Clavien-Dindo class II complication and non-operation-associated complication were higher in the oldest group compared with old group(P<0.05), while other postoperative complications were compared between the two groups, only urinary tract infection was significantly different(P<0.05). Univariate analysis showed that postoperative complications were significantly associated with age(χ(2)=7.308, P=0.007), number of comorbid diseases (χ(2)=10.872, P=0.001), cardiovascular disease (χ(2)=9.412, P=0.002), hypertension (χ(2)=4.934, P=0.026) and preoperative transfusion (χ(2)=3.911, P=0.048). Multivariate analysis showed that only the number of comorbid diseases was an independent risk factor for postoperative complications(OR=2.810, 95% CI: 1.710 to 4.616, P=0.000).

CONCLUSIONNon-operation-associated postoperative complications are more likely to occur in the elderly patients due to more comorbid diseases. Perioperative intensive care should be carried out for the elderly gastric cancer patients with comorbid diseases in order to improve surgical safety and efficacy.

Aged ; Aged, 80 and over ; China ; Comorbidity ; Gastrectomy ; adverse effects ; Humans ; Hypertension ; complications ; Logistic Models ; Multivariate Analysis ; Neoplasm Staging ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; complications ; surgery

Objective:To explore the diagnostic value of laparoscopy in the postoperative recurrence of peritoneal metastasis in gastric cancer, and to investigate the efficacy of bidirectional intraperitoneal and systemic (BIPS) chemotherapy for the recurrence.Methods:The descriptive case series study was conducted. Case inclusion criteria: (1) gastric cancer patients without synchronous distant metastasis received D2 radical gastrectomy; (2) postoperative adjuvant chemotherapy was administered; (3) no other distant metastasis except recurrence of peritoneal metastasis; (4) age of 18-75 years; (5) Eastern Cooperative Oncology Group (ECOG) performance-status score≤2; (6) pretreatment evaluation suggested that surgery and chemotherapy could be tolerated. Eight consecutive gastric cancer patients with postoperative recurrence of peritoneal metastasis who met the above criteria at Department of Gastrointestinal Surgery of Ruijin Hospital from September 2015 to September 2016 were enrolled into the study. There were 6 males and 2 females with the median age of 52 (38-68) years. They received laparoscopy or laparotomy first, and then were evaluated with reference to the Sugarbaker peritoneal cancer index (PCI) and the peritoneal metastasis classification of gastric cancer developed by the Japanese Gastric Cancer Research Association. A peritoneal access port was implanted in the subcutaneous space of the lower abdomen and the patients received chemotherapy for 21 days as a course of treatment. All the patients received intraperitoneal 20 mg/m 2 of paclitaxel (PTX) via implanted subcutaneous peritoneal access ports and intravenous 50 mg/m 2 of PTX at day 1 and day 8, meanwhile 80 mg/m 2 of Tigio was orally administered per day for 14 consecutive days, followed by 7 days of interval. Follow-up ended on December 15, 2019. Results:Of these 8 patients with recurrence of peritoneal metastasis after gastric cancer surgery, 1 case underwent laparotomy and loop stoma of terminal ileum because of complete colonic obstruction, and the remaining 7 cases underwent laparoscopy successfully and the recurrence of peritoneal metastasis was clearly diagnosed. Two patients with ovarian metastasis underwent laparoscopic bilateral adnexectomy. The median follow-up time was 17.5 (1.5 to 39.0) months, the median number of BIPS chemotherapy course was 11 (1 to 30), and the median survival time (MST) after BIPS chemotherapy was 17.0 months. The major adverse reaction in BIPS treatment was mainly myelosuppression, of which grade 3/4 leukopenia and neutropenia developed in 1 and 2 cases respectively. No BIPS-related death occurred. The MST of gastric cancer after radical gastrectomy was 40.0 months.Conclusions:Laparoscopy is a safe and feasible method for diagnosing the recurrence of peritoneal metastasis of gastric cancer. BIPS chemotherapy is effective and safe for its treatment and deserves further study.

Objective:To explore the diagnostic value of laparoscopy in the postoperative recurrence of peritoneal metastasis in gastric cancer, and to investigate the efficacy of bidirectional intraperitoneal and systemic (BIPS) chemotherapy for the recurrence.Methods:The descriptive case series study was conducted. Case inclusion criteria: (1) gastric cancer patients without synchronous distant metastasis received D2 radical gastrectomy; (2) postoperative adjuvant chemotherapy was administered; (3) no other distant metastasis except recurrence of peritoneal metastasis; (4) age of 18-75 years; (5) Eastern Cooperative Oncology Group (ECOG) performance-status score≤2; (6) pretreatment evaluation suggested that surgery and chemotherapy could be tolerated. Eight consecutive gastric cancer patients with postoperative recurrence of peritoneal metastasis who met the above criteria at Department of Gastrointestinal Surgery of Ruijin Hospital from September 2015 to September 2016 were enrolled into the study. There were 6 males and 2 females with the median age of 52 (38-68) years. They received laparoscopy or laparotomy first, and then were evaluated with reference to the Sugarbaker peritoneal cancer index (PCI) and the peritoneal metastasis classification of gastric cancer developed by the Japanese Gastric Cancer Research Association. A peritoneal access port was implanted in the subcutaneous space of the lower abdomen and the patients received chemotherapy for 21 days as a course of treatment. All the patients received intraperitoneal 20 mg/m 2 of paclitaxel (PTX) via implanted subcutaneous peritoneal access ports and intravenous 50 mg/m 2 of PTX at day 1 and day 8, meanwhile 80 mg/m 2 of Tigio was orally administered per day for 14 consecutive days, followed by 7 days of interval. Follow-up ended on December 15, 2019. Results:Of these 8 patients with recurrence of peritoneal metastasis after gastric cancer surgery, 1 case underwent laparotomy and loop stoma of terminal ileum because of complete colonic obstruction, and the remaining 7 cases underwent laparoscopy successfully and the recurrence of peritoneal metastasis was clearly diagnosed. Two patients with ovarian metastasis underwent laparoscopic bilateral adnexectomy. The median follow-up time was 17.5 (1.5 to 39.0) months, the median number of BIPS chemotherapy course was 11 (1 to 30), and the median survival time (MST) after BIPS chemotherapy was 17.0 months. The major adverse reaction in BIPS treatment was mainly myelosuppression, of which grade 3/4 leukopenia and neutropenia developed in 1 and 2 cases respectively. No BIPS-related death occurred. The MST of gastric cancer after radical gastrectomy was 40.0 months.Conclusions:Laparoscopy is a safe and feasible method for diagnosing the recurrence of peritoneal metastasis of gastric cancer. BIPS chemotherapy is effective and safe for its treatment and deserves further study.

Themedical's () infantgenre in western Hunan Province is one of the most famous infantgenres in China. Based on physiological and pathological characteristics of infants, generation-inhibition theory of five-elements andmedical's promotion-inhibition theory of five-meridians, theprotocol of "" was flexibly adjusted; according to different constitution types, including lung-deficiency type, spleen-deficiency type, kidney-deficiency type,-deficiency type,-deficiency type,-deficiency type, phlegm-wet type, phlegm-heat type, different protocols were adopted to prevent or reduce the asthma recurrence and reach the aim of regulating constitution and disease prevention.