2. Clinical analysis of 34 cases with sepsis and systemic capillary leak syndrome
Huanxian MA ; Xianjie SHI ; Yurong LIANG ; Haida SHI ; He WANG ; Yongsheng ZHAO
Chinese Journal of Surgery 2017;55(9):702-707
Objective:
To study the clinical characteristics of sepsis with systemic capillary leak syndrome(SCLS) and to evaluate the therapeutic effect and clinical significance of fluid therapy adjusted timely in these patients.
Methods:
The clinical data of 34 patients with sepsis and SCLS in the Department of Hepatobiliary Surgery ICU of General Hospital of People′s Liberation Army General Hospital from July 2014 to January 2016 were retrospectively analyzed.There were 21 males and 13 females, aged from 21 to 74 years, with an average age of 56.3 years.Primary disease as follows: 18 cases with severe acute pancreatitis, 7 postoperative cases of subtotal hepatectomy, 5 postoperative cases of pancreatoduodenectomy, 4 postoperative cases of cholelithiasis.These patients were divided into survival group and death group according to their 28-day survival status.The clinical data including C-reactive protein(CRP), platelets (PLT), brain natriuretic peptide (BNP), the level of arterial blood lactic acid(LAC), oxygenation index(PaO2/FiO2, OI), net fluid balance(NFB) and norepinephrine dosage(NE) were collected and compared between two groups at three different intervals(day 1-3, day 4-6, day 7-9). The measurement data and numeration data were statistically analyzed with
3. Analysis of the spectrum and resistance of pathogen causing sepsis in patients with severe acute pancreatitis
Huanxian MA ; Lei HE ; Shouwang CAI ; Xianlei XIN ; Haida SHI ; Lin ZHOU ; Xianjie SHI
Chinese Journal of Surgery 2017;55(5):378-383
Objective:
To investigate the characteristics of spectrum and drug resistance of pathogens causing sepsis in patients with severe acute pancreatitis(SAP).
Methods:
The clinical data of 63 SAP patients with sepsis admitted in Department of Hepatobiliary, People′s Liberation Army General Hospital from January 2014 to December 2015 were retrospectively studied. There were 47 males and 16 females, aged from 22 to 73 years, with an average age of (52±11)years. Samples were collected mainly from: (1)pancreatic and peripancreatic necrosis and abdominal drainage; (2)bile; (3) blood or deep venous catheter; (4) sputum and tracheal catheter and thoracic drainage; (5) urine. Strain identification and drug-resistance test were preformed on positive specimens.
Results:
Of 244 pathogenic isolates, mainly derived from abdominal cavity(36.0%), blood stream (14.0%), central venous catheter(11.8%), necrotic tissue(9.1%) and sputum(8.1%); 154(63.1%) were gram-negative bacteria, 68 cases(27.9%) were gram-positive bacteria and 22 cases(9.0%) were fungi respectively. The top six common pathogens isolated were
4. Non-surgical treatment of acute pancreatitis with colonic fistula
Jian FENG ; Zhiwei LIU ; Shouwang CAI ; Xianlei XIN ; Jiye CHEN ; Pengfei WANG ; Lei HE ; Huanxian MA
Chinese Journal of Surgery 2019;57(12):917-920
Objective:
To examine the effectiveness of non-operative of colonic fistula following acute pancreatitis.
Methods:
Retrospective analysis of 354 patients with acute pancreatitis who were admitted to Department of Hepatobiliary Surgery of Chinese People′s Liberation Army General Hospital from January 2013 to December 2018. Age of the patients was (46±14) years (range: 14-85 years); 249 cases (70.3%) were males. There were 41 cases of acute edematous pancreatitis and 313 cases of acute necrotising pancreatitis. Two hundred and fifteen cases were diagnosed as moderate severe acute pancreatitis and 139 were diagnosed as severe acute pancreatitis. Among 313 cases of acute necrotising pancreatitis, 62 cases underwent non-surgical treatment, 251 cases underwent surgical treatment in which 218 of minimal access retroperitoneal pancreatic necrosectomy underwent percutaneous nephroliguectomy with peripancreatic necrotic tissue removal technique.
Results:
There were 15 cases of colon fistula following acute necrotising pancreatitis, and the incidence rate was 4.2%(15/354). There were 7 males and 8 females, with age of (39±8) years (range: 27 to 50 years). The median interval between acute pancreatitis onset and diagnosis of colonic fistula was 71 days(27-134) days. Two cases occurred at the hepatic flexure of the colon, 4 cases at transverse colon, and 9 cases at splenic flexure of colon. Of the 354 patients, 39 cases died and the mortality was 11.0%. Two patients underwent laparotomy, and one of them died. The remaining 13 patients underwent non-surgical treatment and were discharged.
Conclusion
Acute pancreatitis with colonic fistula can be treated with non-surgical treatment and can achieve good prognosis.
5.Minimally invasive treatment for crade Ⅲ&Ⅳ blunt pancreatic injuries
Jian FENG ; Zhiwei LIU ; Shouwang CAI ; Xianlei XIN ; Jiye CHEN ; Pengfei WANG ; Weizheng REN ; Lei HE ; Huanxian MA
Chinese Journal of Hepatobiliary Surgery 2021;27(12):909-912
Objective:To explore the strategy and efficacy using minimally invasive treatment for grade Ⅲ&Ⅳ blunt pancreatic injuries.Methods:Retrospective data retrieved from medical records of 13 patients with grade Ⅲ&Ⅳ blunt pancreatic injuries who underwent minimally invasive treatment at the Chinese PLA General Hospital from July 2011 to June 2019 were analysed. There were 10 males and 3 females, aged (38±9) years. Minimally invasive treatment included percutaneous catheter drainage (PCD) and minimal-access retroperitoneal pancreatic necrosectomy (MARPN). Date from enrolled patients were anylsed.Results:There were 9 patients suffering from grade Ⅲ injuries and 4 patients suffering from grade Ⅳ injuries. On initial conservative treatment of these 13 patients, all developed local complications. The local complications were treated using minimally invasive treatment strategies: 13 patients underwent PCD. The median intervention time for PCD was 25 days after trauma; 10 patients were further treated with MARPN, and the median intervention time of MARPN was 41 days after trauma. Twelve patients recovered well and were discharged home. One patient died. The mortality rate was 7.7% (1/13). The median postoperative hospital stay was 19 days.Conclusion:For patients with pancreatic grade Ⅲ&Ⅳ injuries who were hemodynamically stable and had no other associated gastrointestinal injuries, initial conservative treatment, followed by subsequent minimally invasive treatment based on MARPN technology could be used to treat local complications.
6. Application value of laparoscopic radiofrequency ablation for specific-location hepatocellular carcinoma
Haida SHI ; Xianjie SHI ; Huanxian MA ; Yurong LIANG ; Lin ZHOU ; Yong SHI
Chinese Journal of Oncology 2017;39(1):56-59
Objective:
To investigate the therapeutic efficacy and safety of laparoscopic radiofrequency ablation (LRFA) for specific-location hepatocellular carcinoma.
Methods:
To retrospectively analyze 496 patients with specific-location hepatocellular carcinoma treated with LRFA from January 2010 to January 2015 in our hospital. There was a total of 652 hepatic lesions with a mean diameter of (2.8±1.3) cm including 397 cases with single lesion and 99 cases with multiple lesions. The hepatic lesions were adjacent to major hepatic vessels, hepatic hilar region, diaphragmatic dome, gallbladder, or gastrointestinal tract and on the surface of the liver, respectively.
Results:
The 496 patients with 652 hepatic lesions were treated with LRFA successfully.The mean operation time was (48.2±9.6) minutes and the mean LRFA time per lesion was (30.3±8.6) minutes. No severe complications such as bleeding, bile leakage, gastrointestinal tract damage, diaphragmatic injury and liver function failure occurred after operation. The complete necrosis rate of the specific-location hepatocellular carcinomas was 78.4% (389/496) in one month after RFA, partially necrosis rate was 21.6% (107/496) and overall necrosis rate was 100%. In addition, the 1- and 3-year overall survivals (OS) were 95.6% and 88.5%, and progression free survivals (DFS) were 87.9% and 80.8%, respectively.
Conclusions
LRFA is a safe, effective, economic and minimally-invasive therapeutic approach for patients with specific-location hepatocelluar carcinoma and has good clinical application value.
7.Silencing RRM1 gene reverses paclitaxel resistance in human breast cancer cell line MCF- 7/R by inducing cell apoptosis.
Nannan TIAN ; Lei ZHOU ; Danni YANG ; Huanxian WU ; Yunci MA ; Lin LÜ ; Shaoyu WU
Journal of Southern Medical University 2019;39(3):304-312
OBJECTIVE:
To investigate the effects of ribonucleotide reductase catalytic subunit M1 (RRM1) gene silencing on drug resistance of human breast cancer cell line MCF-7/R.
METHODS:
We established a paclitaxel-resistant breast cancer MCF-7 cell line (MCF-7/R) by exposing the cells to high-concentration paclitaxel in a short time. Small interfering RNAs (siRNAs) targeting RRM1 were designed to silence RRM1 expression in human breast cancer MCF-7/R cells. MTT assay was used to detect the IC values and the sensitivity to paclitaxel in the cells with or without siRNA transfection. The changes in the proliferative activity of MCF7 and MCF-7/R cells following RRM1 gene silencing were evaluated using EdU assay. Flow cytometry was used to analyze the cell apoptosis and cell cycle changes. We assessed the effect of RRM1 gene silencing and paclitaxel on the tumor growth in a nude mouse model bearing subcutaneous xenografts with or without siRNA transfection.
RESULTS:
We detected significantly higher expressions of RRM1 at both the mRNA and protein levels in the drug-resistant MCF- 7/R cells than in the parental MCF-7 cells ( < 0.01). Transfection with the specific siRNAs significantly reduced the expression of RRM1 in MCF-7/R cells ( < 0.05), which showed a significantly lower IC value of paclitaxel than the cells transfected with the negative control siRNA ( < 0.05). RRM1 silencing significantly inhibited the proliferation ( < 0.01) and enhanced the apoptosis-inducing effect of paclitaxel in MCF-7/R cells ( < 0.001); RRM1 silencing also resulted in obviously reduced Akt phosphorylation, suppressed Bcl-2 expression and promoted the expression of p53 protein in MCF-7/R cells. In the tumor-bearing nude mice, the volume of subcutaneously transplanted tumors was significantly smaller in MCF-7/R/siRNA+ PTX group than in the other groups ( < 0.001).
CONCLUSIONS
RRM1 gene silencing can reverse paclitaxel resistance in human breast cancer cell line MCF-7/R by promoting cell apoptosis.
Animals
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Apoptosis
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Breast Neoplasms
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Drug Resistance, Neoplasm
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Gene Silencing
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Humans
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MCF-7 Cells
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Mice
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Mice, Nude
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Paclitaxel
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RNA, Small Interfering
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Ribonucleotide Reductases
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Tumor Suppressor Proteins