Objective To investigate the causes,preventive measures and treatment of digestive tract injury during laparoscopic cholecystectomy (LC). Methods From January 2000 to December 2007,totally 21 640 patients underwent LC in our hospital,among them,16 had digestive tract injury including injuries in the stomach and duodenum in 14 patients,in the colon in 1,and in the ileum in 1. Results Among the 16 cases,13 were detected during the operation,and thus laparoscopic repair were performed on 3 of the cases,and conversion to open surgery were carried out for the other 10 for repair of the injured tract (7 cases) or major resection of the stomach and Roux-en-Y anastomosis (3 cases). The other 3 patients were confirmed after LC;they received open surgery for repair of the ileum,colostomy or intra-abdominal cavity drainage. In the 16 cases,one patient died of duodenal leakage complicated with multiple organ dysfunction syndrome in 7 days after the operation;the other 15 patients were cured and discharged from hospital without severe complications. Conclusions Most of the digestive tract injury cases during LC are caused by pericholecystic inflammatory adhesion,which leads to insufficient exposure of the surgical field resulting in the tear or perforation of the digestive tract. Proper treatment in early stage is the key to the prognosis of the patients and prevention of severe complications.

Objective To investigate the effect of hyperbaric oxygen therapy on T-lymphocyte subpopulations in rats with acute pancreatitis. Methods 56 rats were randomly divided into three groups the sham group ( n = 8 ),control group( n = 24) and hyperbaric oxygen therapy group( treatment group, n = 24), then the control group and treatment groups were divided into three subgroups of 8 rats each undergoing euthanasia on days 1,3,7 after the acute pancreatitis induction. The CD4+ ,CD8+ subpopulations of T-lymphocytes in peripheral blood were detected respectively at the fist day and each day of the euthanasia. The sham group was used to make sure that the model was successfully induced. After euthanasia the pancrea was examined using electron microscopy. Results In the control group, the CD4+ cells in AP rats was significantly decreased and the ratio of CD4+/CD8+ also decreased. After 7days of HBO therapy,compared with the control group, the CD4+ lymphocytes of peripheral blood in the treatment group markedly increased( P ＜0.01 ). The CD8+ lymphocytes also increased to a certain extent. And the CD4+/CD8+ ratio of peripheral blood was obviously increased(P ＜0. 01 ). Also more severe pathological changes appeared in the untreated group than in the treatment group. Conclusion Hyperbaric oxygen therapy could improve the oxygen supply in acute panereatitis, regulate T cell immune function.

Objective To summarize the experience in prevention and treatment of bile duct injury during laparoscopic cholecysteclomy(LC). Methods Retrospective analysis on the clinical data of 31 cases of LC was carried out. Of them, 27 underwent one stage operative repair and 4 underwent palliative external drainage of the bile duct first. Results 16 cases succeeded and 11 failed in the one stage operative repairing.There were 15 cases underwent 2～4 operations in this series,and the re-operation rate was 48.4%. 29 patients was cured while 2 died. Conclusions During LC, the operative rule should always be strictly observed, and the key to preventing bile duct injury is to avoid clipping, cutting and coagulation blindly.

Objective To evaluate the therapeutic effect of combination of sandostatin and growth hormone (GH) in the treatment of severe acute pancreatitis (SAP ). Methods Sixty patients with SAP were divided randomly into 3 groups:(1)Sandostatin treatment(ST) group (n=15);(2)combination of sandostatin with GH treatment(CT) group (n=30) ;(3)control group (n=15). The changes in serum IL-1, IL-6,TNF-? and albumin levels after treatment, and the incidence of complications, the duration of hospital stay and cost were compared among the 3 groups. Results The complications, mortality, duration of hospital stay in the CT group were significantly shorter than those in ST group and control group (all P

Objective To study the relationship between the choice of operation and the efficacy on hepa- tolithiasis.Methods From Januray of 1995 to December of 2006,89 patients with hepatolithiasis underwent surgical treatment were retrospectively analyzed.Of them 33 cases underwent hepaticoplasty,hepatolobectomy in 7 cases, cholangiojejunostomy in 22 cases,choledocholithotomy with T-tube drainage in 27 cases.Results Out of the 89 cas- es,follow-up was completed in 81 cases for 6 months to 12 years.The postoperative stone residual rate of the group which underwent hepaticoplasty was 15.15 %(5/33)and cholannitis recurrence rate was 12.50 %(4/32),hepa- tolobecromy was 14.29%(1/7)and 16.67%(1/6),cholangiojejunostomy was 18.18%(4/22)and 30%(6/20), choledocholithotomy with T-tube drainage was 33.33 %(9/27)and 29.17 %(7/24).Conclusion Hepaticoplasty and hepatolobecromy were superior to cholangiojejunostomy and choledocholithotomy with T-tube drainage for treat- ment of hepatolithiasis.

Objective To investigate the risk factors leading to complications in patients undergoing laparoscopic cholecystectomy (LC). Methods Clinical data of 11?974 patients undergoing LC from Mar. 1991 to June 2003 were collected and analyzed retrospectively. Fifteen clinical factors were recruited for the study in relation to surgical complications. Data were analyzed by ?2 test and Logistic regression. Results The overall operative complication rate was 1.896%. The procedure was shifted to open surgery in 2.389% of all cases, Logistic regression analysis revealed that Calot triangle adhesion, stage, expertise of the team, gallbladder wall thickness, gallbladder and vicinity adhesion were important risk factors for complications. Conclusion LC complications can be prevented by good training, strictly following protocol, and timely shifting to open surgery.

Objective To discuss the clinical value of combined antegrade and retrograde technique of laparoscopic cholecystectomy in prevention of bile duct injury.Methods Clinical data of 613 patients who underwent laparoscopic cholecystectomy with combined antegrade and retrograde technique from March 1991 to June 2006 were analyzed retrospectively.Results Cholecystolithiasis with atrophy of gallbladder was found in 121 cases,acute and subacute cholecystitis in 432 cases,cholecystolithiasis with chronic cholecystitis in 42 cases and polyps of cholecyst in 18 cases.Nine cases were converted to laparotomy(5 cases of cholecystolithiasis with atrophy of gallbladder and 4 cases of subacute cholecystitis).The average operation time was 43.5 minutes.Bile leakage occured in only 1 case after operation and fully recovered after 3 days of drainage,and all the other cases had smooth recovery with no bile duct injuries or serious complications such as haemorrhage,infection or death.The mean hospitalization time after operation was 5.5 days.Conclusions The application of combined antegrade and retrograde technique can increase the success rate of laparoscopic cholecystectomy,and reduce the incidence of injuries of bile duct,especially in those patients with inadequate exposure or anatomical variation of Calot′s triangle.

BACKGROUND: Cardiac rupture (CR) is a major lethal complication of acute myocardial infarction (AMI). However, no valid risk score model was found to predict CR after AMI in previous researches. This study aimed to establish a simple model to assess risk of CR after AMI, which could be easily used in a clinical environment. METHODS: This was a retrospective case-control study that included 53 consecutive patients with CR after AMI during a period from January 1, 2010 to December 31, 2017. The controls included 524 patients who were selected randomly from 7932 AMI patients without CR at a 1:10 ratio. Risk factors for CR were identified using univariate analysis and multivariate logistic regression. Risk score model was developed based on multiple regression coefficients. Performance of risk model was evaluated using receiver-operating characteristic (ROC) curves and internal validity was explored using bootstrap analysis. RESULTS: Among all 7985 AMI patients, 53 (0.67%) had CR (free wall rupture, n = 39; ventricular septal rupture, n = 14). Hospital mortalities were 92.5% and 4.01% in patients with and without CR (P < 0.001). Independent variables associated with CR included: older age, female gender, higher heart rate at admission, body mass index (BMI) <25 kg/m, lower left ventricular ejection fraction (LVEF) and no primary percutaneous coronary intervention (pPCI) treatment. In ROC analysis, our CR risk assess model demonstrated a very good discriminate power (area under the curve [AUC] = 0.895, 95% confidence interval: 0.845-0.944, optimism-corrected AUC = 0.821, P < 0.001). CONCLUSION This study developed a novel risk score model to help predict CR after AMI, which had high accuracy and was very simple to use.
Aged ; Aged, 80 and over ; Case-Control Studies ; Female ; Heart Rupture ; epidemiology ; etiology ; Humans ; Logistic Models ; Male ; Myocardial Infarction ; complications ; epidemiology ; Percutaneous Coronary Intervention ; Retrospective Studies ; Risk Factors ; Ventricular Function, Left ; physiology ; Ventricular Septal Rupture ; epidemiology ; etiology

OBJECTIVETo explore the correlation between the polymorphism in the DNA methyltransferase-3B (DNMT3B) gene promoter single nucleotide polymorphism (SNP)-149C→T (rs2424913) and-579G→T(rs1569686) and the genetic susceptibility to colorectal cancer in Jiangsu population.

METHODSGenomic DNA was extracted from the leukocyte cell of blood samples collected from 544 colorectal cancer (CRC) patients (including 280 cases of colon cancer and 264 cases of rectal cancer) since January 2009 and July 2010, in a hospital, Jiangsu Province. The same samples were collected from the other 533 control subjects. Polymerase chain reaction with restriction fragment length polymorphism (PCR-RFLP) and DNA sequencing analysis were employed to assess the polymorphism of DNMT3B gene promoter-149C→T and-579G→T.

RESULTSFor DNMT3B-149C→T, no significant deviation was observed in the genotype distributions of polymorphisms between CRC cases (TT: 98.90% (538/544); CT: 1.10% (6/544)) and controls (TT: 97.75% (521/533); CT: 2.25% (12/533)) (χ(2) = 2.07, P = 0.15). The CC genotype was not detected in either patients or control subjects. The DNMT3B-149CT genotype was not associated with the risk of CRC (adjusted OR = 0.48, 95%CI: 0.18 - 1.30). For DNMT3B-579G→T, the genotype distributions of polymorphisms in CRC patients (TT: 90.07% (490/544); GT: 9.19% (50/544); GG: 0.74% (4/544)) were significantly different from those in control group (TT: 81.80% (436/533); GT: 17.82% (95/533); GG: 0.38% (2/533)) (χ(2) = 15.49, P < 0.05). The results showed that the-579 G allele could significantly decrease the risk of CRC (adjusted OR = 0.50, 95%CI: 0.35 - 0.72) in comparison with the -579 TT genotype. In addition, stratification analysis showed that for DNMT3B-579G→T, the genotype distributions of polymorphisms in colon cancer (TT: 92.50% (259/280); GT: 7.50% (21/280)) were significantly different from those in the controls (TT: 81.80% (436/533); GT: 17.82% (95/533); GG: 0.38% (2/533)) (χ(2) = 13.53, P < 0.05); and similar result was found in rectal cancer (TT: 87.50% (231/264); GT: 10.98% (29/264); GG: 1.52% (4/264)) and controls (TT: 81.80% (436/533); GT: 17.82% (95/533); GG: 0.38% (2/533)) (χ(2) = 5.64, P = 0.018). G allele carriers could decrease the risk of colon cancer (adjusted OR = 0.38, 95%CI: 0.23 - 0.63), and the risk of rectal cancer (adjusted OR = 0.65, 95%CI: 0.42 - 0.99). However, for DNMT3B-149C→T , there were no significant deviation in the genotype distributions of polymorphisms between colon cancer (TT: 98.57% (276/280); CT: 1.43% (4/280)) and controls (TT: 97.75% (521/533); CT: 2.25% (12/533)) (χ(2) = 0.82, P = 0.366); and there was no significant deviation between rectal cancer (TT: 99.24% (262/264); CT: 0.76% (2/264)) and controls (TT: 97.75% (521/533); CT: 2.25% (12/533)) either (χ(2) = 1.89, P = 0.169).

CONCLUSIONOur research demonstrates that the-579 G allele is a potential protective factor for the occurrence of CRC, however, the polymorphism of DNMT3B-149 gene shows no close correlation with the occurrence and development of CRC among Chinese population.

Aged ; Alleles ; Asian Continental Ancestry Group ; genetics ; Case-Control Studies ; Colorectal Neoplasms ; genetics ; DNA (Cytosine-5-)-Methyltransferases ; genetics ; Female ; Genetic Predisposition to Disease ; Genotype ; Humans ; Male ; Middle Aged ; Polymorphism, Single Nucleotide

Objective To investigate the effects of different Leptospira strains on phagocytosis of peritoneal macrophages of guinea pigs,and explore the role of innate immune in the pathogenesis of leptospirosis. Methods Peritoneal macrophages of guinea pigs were infected in vitro by three different Leptospira strains,the virulent Leptospira interrogans serovar Lai type strain Lai,the avirulent L.interrogans serovar Lai type strain IPAV,and the nonpathogenic L.biflexa serovar Patoc type strain PatocⅠ,respectively,and heat inactivated Staphylococcus epidermidis was added 0.5,1.5,3 and 6 h after infection and incubated for 30 min.The effect of Leptospira on the phagocytosis of macrophage was evaluated by the inactivated Staphylococcus epidermidis phagocytosis rate and phagocytosis index.Phagocytosis and ultrastructure of peritoneal macrophages were observed by transmission electron microscopy 3 h after infection,and changes of cytoskeleton of the macrophages were observed by laser scanning confocal microscopy. Results The phagocytic rates and phagocytic indexes of strain Lai,strain IPAV and strain PatocⅠinfection groups were significantly lower than those of control group 3 h and 6 h after infection(P