Objective To investigate the risk factors for persistent hemodynamic depression after carotid angioplasty and stenting(CAS). Methods Sixty-one patients with CAS were included. By univariate Logistic regression analysis,the influencing factors for persistent hemodynamic depression were analyzed,by stepwise Logistic regression analysis and adjustment for age and gender factors,the independent risk factors for persistent hemodynamic depression were analyzed. Results In 61 patients,25 cases had hypotension,25 cases had bradycardia,all for 41.0% incidence. According to the patients intraoperative and postoperative blood pressure,heart rate conditions,the duration of hemodynamic depression,the cases were divided into persistent hemodynamic depression group (20 cases) and no-persistent hemodynamic depression group(41 cases). Univariate Logistic regression analysis indicated that persistent hemodynamic depression influencing factors were the symptomatic stenosis, severe stenosis, using balloon dilatation, implantation of laser-carving stent(P<0.05). With adjustment for age and gender factors, stepwise Logistic regression analysis showed that using balloon dilatation, implantation of laser-carving stent were the independent risk factors for persistent hemodynamic depression (OR = 5.046,95%CI 1.342-18.977,P = 0.017;OR = 4.142,95%CI 1.151-14.902, P= 0.030),symptomatic stenosis was the independent protective factor for persistent hemodynamic depression (OR = 0.264,95% CI 0.073-0.964,P= 0.044). Conclusions Persistent hemodynamic depression after CAS is a common complication.CAS patients with using balloon dilatation, implantation of laser-carving stent are more susceptible to persistent hemodynamic depression, while symptomatic stenosis is its protective factor.

BACKGROUND:Macropore morphology of a composite scaffold prepared by the three-dimensional printing technique is of great importance in determining the physicochemical and biological properties of tissue engineering scaffolds.OBJECTIVE:To fabricate strontium-containing mesoporous (Sr-MBG) bioactive glass (PCL) scaffolds by the three-dimensional printing technique, and to explore the effect of these scaffolds on MC3T3-E1 proliferation and osteogenic differentiation, thereby to find out the optimal macropore morphology.METHODS: Sr-MBG/PCL composite scaffolds were fabricated by the three-dimensional printing technique. The angles between fibrous latitudes and longitudes were set to 45°, 60° and 90°. Then the proliferation and alkaline phosphatase activity of MC3T3-E1 cells on the scaffolds were tested.RESULTS AND CONCLUSION: Cell counting kit-8 results showed that MC3T3-E1 cells could proliferate on all the three kinds of scaffolds. The proliferation rate of MC3T3-E1 cells on the 45° Sr-MBG/PCL scaffolds was just slightly higher than that on the 60° and 90° Sr-MBG/PCL scaffolds at days 1 and 4 (P > 0.05), but there was a significant increase at day 7 (P < 0.05). The 45° Sr-MBG/PCL scaffolds exhibited a significant increase in alkaline phosphatase activity of MC3T3-E1 cells compared to the 60° and 90° Sr-MBG/PCL scaffolds at day 14 (P < 0.05), while there was no significant difference among three groups at day 21 (P > 0.05). These results indicate that the 45° Sr-MBG/PCL scaffold is more suitable to promote the proliferation and osteogenic differentiation of the MC3T3 cells than the 60° and 90° Sr-MBG/PCL scaffolds.

BACKGROUND: Three-dimensional (3D) printing technique has showed unparalleled advantages in the field of tissue engineering scaffold preparation because of its outstanding merits of convenience, efficiency, controllability and ability to construct complex shapes.OBJECTIVE: To fabricate Fe-containing mesoporous calcium-silicate (MCS) /poly (3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHHx) composite scaffolds using the 3D printing technique and to test the characterization and cellular biocompatibility of the composite scaffolds.METHODS: Four groups of Fe-containing MCS/PHBHHx composite scaffolds were fabricated using 3D printing technique. The molar percentage of Fe in these four groups was 0%, 5%, 10%, 15%, respectively and they were marked as 0Fe-MCS/PHBHHx, 5Fe-MCS/PHBHHx, 10Fe-MCS/PHBHHx and 15Fe-MCS/PHBHHx. The scanning electron microscopy was used to observe the microstructure of the scaffolds after being soaked in the simulated body fluid.Osteoblast cell lines MC3T3-E1 were seeded on these four groups of scaffolds as well. Cell counting kit-8 method was adopted to test the cell proliferation at 1, 3, 7 days of culture. Intracellular alkaline phosphatase activity was tested at 7 and 14 days of culture.RESULTS AND CONCLUSION: (1) Compared with the scaffolds with no soaking process, spherical particles were formed on the scaffolds because of mineralization after soaking 3 days in the simulated body fluid. (2) At 1 day of culture,there was no difference in cell proliferation among the four groups. At 3 days of culture, the proliferation rate of the 15Fe-MCS/PHBHHx scaffold was remarkably higher than that of the rest three groups (P < 0.05). At 7 days of culture,the proliferation rate was significantly higher in the 10Fe-MCS/PHBHH and 15Fe-MCS/PHBHHx scaffolds than the 0Fe-MCS/PHBHH scaffold (P < 0.05), as well as significantly higher in the 15Fe-MCS/PHBHHx scaffold than the 10Fe-MCS/PHBHH scaffold (P < 0.05). (3) At 7 days of culture, no difference in alkaline phosphatase activity could be found among these four groups of scaffolds; however, at 14 days, the 5Fe-MCS/PHBHHx, 10Fe-MCS/PHBHHx and 15Fe-MCS/PHBHHx scaffolds exhibited an enhanced alkaline phosphatase activity compared with the 0Fe-MCS/PHBHHx scaffold. Meanwhile, the 15Fe-MCS/PHBHHx showed the highest alkaline phosphatase activity.These findings indicate that the MCS/PHBHH scaffolds containing Fe could promote the proliferation and osteogenic differentiation of the MC3T3-E1 cells.

Objective: To investigate the correlations between the systemic immune inflammatory index (SII) and prognosis of patients with gallbladder cancer. Methods: From April 2005 to January 2019, patients with gallbladder cancer underwent surgical treatment in the Department of Hepatobiliary and Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University were followed up and their SII values were analyzed. The receiver operating characteristic curve (ROC) was used to determine the best clinical boundary value of SII. According to the boundary value, patients were divided into two groups: low SII and high SII. Survival curves were drawn by Kaplan-Meier method. The overall survival time of the two groups was analyzed, and univariate analysis of postoperative survival was performed using log-rank test. Cox regression proportional hazard model was used for multivariate analysis of clinical prognosis. Results: A total of 312 patients were included, including 120 males and 192 females, aged 30.0 to 86.0 (61.5±9.9) years. The best clinical cut off value of preoperative SII was determined by ROC curve to be 510.42. A total of 312 patients with gallbladder cancer were divided into low SII group (SII≤510.42) and high SII group (SII>510.42). Kaplan-Meier survival curve was used to analyze the 1, 3 and 5-year survival rates of gallbladder cancer patients in low SII group and high SII group after operation. The survival rates were 65.7%, 39.6% and 30.2%, and 27.9%, 12.0% and 9.6% respectively. The median survival time was 25 months (95% CI: 16.9-33.1) and 9 months (95% CI: 8.1-9.9), respectively. The survival rate of gallbladder cancer patients in low SII group was better. There were significant differences of the overall survival rate between the two groups (P<0.05). Univariate analysis showed that SII>510.42 (HR=0.086, 95% CI: 0.032-0.289) was a risk factor for overall survival of gallbladder cancer patients. Cox multivariate analysis confirmed that preoperative SII (HR=2.649, 95% CI: 1.981-3.543) was an independent risk factor for overall survival of gallbladder cancer patients. Conclusions SII can be used as an independent prognostic factor to predict the prognosis of patients with gallbladder cancer. The higher the preoperative SII, the worse the prognosis of patients with gallbladder cancer.

Objective To analyze the clinical features of recurrent acute pancreatitis (RAP).Methods The clinical data of patients diagnosed as RAP were collected in Changhai Hospital, the Second Military Medical University between January 2016 to July 2016, and chronic pancreatitis(CP) patients and RAP patients to matching, as control group.A prospective cohort study about the clinical features of RAP and CP was set.The survival analysis model was established by Kaplan-Meier′s method, to calculate the cumulative rate of RAP which progressed into CP.Results The morbidity of male patients was 69.0% in the RAP group(n=100) and 60% in the CP group(n=100).The average first onset age of RAP and CP was 38 and 21 years old, respectively;and the teenagers accounted for 12% and 38.6%.The incidence of diabetes was 49.5% and 9%;and the incidence of fatty diarrhea was 46.6% and 19% of the two groups.The cumulative incidence of CP was 2% within 1 year, 4.6% in 3 years, and 12.4% in 5 years.Conclusions Men has higher morbidity in both RAP group and CP group.RAP patients′ first onset age was older than that of CP.Teenagers had a low incidence in RAP group.The risk of diabetes and fatty diarrhea was lower in RAP group than CP group.A certain proportion of RAP patients can progress to CP.

Objective To investigate the changes of indications, degree of difficulty in procedure, complication and its severity in endoscopic retrograde cholangiopancreatography (ERCP) in Changhai hospital from 2001 to 2007. Methods The clinical data, including demographic data, indications, degree of difficulty in procedure, success rate, complication rate and severity of complication, of 2374 patients who underwent ERCP in 2001 and 2007 (966 in 2001 and 1408 in 2007), were retrospectively reviewed. Results Indications of ERCP changed at an interval of 5 years. Operations due to bile duct stone decreased (59.0% vs. 49.3%, P=0.000), while operations due to pancreas disease, especially chronic pancreatitis (6.6% vs. 18.5%, P=0.000) and recurrent pancreatitis (0.2% vs.1.6%, P=0.001), increased. Patients with biliary duct problems after liver transplantation appeared in 2007. The procedures of ERCP performed in 2007 were more difficult (P=0.000), with an increased percentage of Degree 5 procedure (7.3% vs. 33.3%, P=0.000). The number of diagnostic ERCP significantly decreased (Degree 1 + Degree 3, 30.5% +2.8% vs. 5.9% +3.1%, P=0.000). There was no significant difference in the success rate between the two years (P=0.084). The complication rate of ERCP in 2007 was significantly higher than that in 2001 (3.73% vs. 7.88%, P=0.000), but the severity of complication showed no significant difference (P=0.820). Conclusion Cases of diagnostic ERCP decreased in 2007. Indications of ERCP have changed, with a decrease in bile duct diseases and an increase in pancreatic diseases. The procedures are more complicated, but it does not lead to lower success rate. The increase in complication rate is possibly due to increase of therapeutic ERCP.

Objective:To study the influencing factors of liver regeneration and their prognostic impact after split liver transplantation.Methods:The clinical data of 44 patients who underwent split liver transplantation at the Organ Transplant Center of Affiliated Hospital of Qingdao University from January 2015 to July 2021 were analysed. There were 19 males and 25 females, aged (49±12) years old. Based on whether the liver regeneration rate (LRR) was greater than 100%, these patients were divided into the good regeneration group (LRR≥100%, n=24) and the poor regeneration group (LRR<100%, n=20). The differences in the perioperative data and postoperative survival rates between the two groups were compared. The patients were followed up by outpatient reexamination or telephone. Results:On days 15, 30, 90, and 180 after operation, the volume change rates in the transplanted liver were (117.04±7.00)%, (164.03±16.72)%, (180.98±26.30)%, (159.40±26.28)%, respectively. The body mass index, anhepatic period, intraoperative bleeding, intraoperative blood transfusion, hospitalization time, recovery time of liver function, fatty degeneration of donor liver and type of donor liver were the influencing factors of liver regenera-tion after split liver transplantation. The levels of aspartate aminotransferase and alanine aminotransferase on the days 1, 2, 3, 4, 5, 6 and 7 after operation in the group of patient with good regeneration were significantly lower than those in the group of patient with poor regeneration ( P<0.05). The levels of total bilirubin in the group of patient with good regeneration was significantly lower than those in the group of patient with poor regeneration on days 5, 6 and 7 after operation ( P<0.05). The portal vein flow per 100 g of liver mass in the good regeneration group was significantly better than the poor regeneration group on day 1 and 30 after operation. The 6-month cumulative survival rates of the good regeneration group and the poor regeneration group were 95.8% and 70.0% respectively, and the difference was significant ( P=0.017). Conclusions:Body mass index, anhepatic period, intraoperative blood loss, intraoperative blood transfusion, hospitalization time, recovery time of liver function, fatty degeneration of donor liver and type of donor liver were the influencing factors of liver regeneration after split liver transplantation. The prognosis of recipients with poor liver regeneration was significantly worse than recipients with good liver regeneration.

Objective:To summarize the experience of treatment for chronic pancreatitis by analyzing the clinical information of 10 533 patients with chronic pancreatitis admitted to First Affiliated Hospital of Naval Medical University (Changhai Hospital) in the past 28 years.Methods:Clinical data including the age, sex, place of birth, admission time, admission age, admission department, discharge time, hospitalization times and treatment methods of chronic pancreatitis patients admitted to Changhai Hospital from January 1995 to February 2022 were analyzed retrospectively. The changes of chronic pancreatitis patients′ admission, demographic characteristics and treatment mode were summarized.Results:A total of 10 533 patients were analyzed, including 7 443 males (70.66%) and 3 090 females (29.34%), and male to female ratio was 2.41∶1. The average age of admission was (45.7±15.0) years. In terms of geographical distribution, East China was the largest, followed by North China and Northwest China. 10 533 patients were admitted for 19 920 times, and there were 18 156 times (91.14%) in gastroenterology department and 1 452 times (7.29%) in general surgery department. Patients in gastroenterology department were admitted for (1.88±1.45) times and the average length of hospitalization was (10.33±5.63) days. A total of 14 134 endoscopic retrograde cholangiopancreatography [(1.45±1.41) times per patient] were performed among 8 022 patients, and 13 882 pancreatic extracorporeal shock wave lithotripsy [(2.22±0.36) times per patient] were performed among 6 629 patients. In general surgery department, patients were admitted for (1.03±0.16) times and the average length of hospitalization was (14.90±9.00) days. 1 242 patients underwent surgical treatment. The ratio of endoscopic therapy to surgery increased from 0.12∶1 in 1995 to 15.72∶1 in 2021.Conclusions:The study shows that chronic pancreatitis was more common in middle-aged males in China, and the treatment modes of chronic pancreatitis in Changhai Hospital had changed from surgery to endoscopic therapy.

Objective:To explore the clinical value of one-step CT angiography from deep vein of lower limbs to pulmonary artery in the direction of head and foot.Methods:Twenty-eight patients who presented Haikou Affiliated Hospital of Central South University Xiangya School of Medicine from January 2017 to June 2019 were collected. All patients who underwent one-step CT angiography of the deep veins of the lower extremities to the pulmonary artery were randomly divided into two groups, A or B, and scanned from the entrance of the thorax to 10 cm below the knee joint. Group A was foot-head direction group with delayed time scanning according to empirical method. Group B was the head-foot direction group with a single point triggered automatic tracing scan at the level of the main pulmonary artery trunk. The independent sample t-test was used to compare the scan time, dose length product (DLP), and mean CT value of enhancement of the pulmonary artery opening between the two groups. Results:The average scanning time of the foot-head scanning group was (36.4±1.2)s, the average DLP was (684.4±37.8) mGy·cm, and the average enhanced CT value of pulmonary artery image was (181.3±15.5) HU. The average scanning time of the head foot scanning group was (16.4±0.3) s, the average DLP was (441.8±34.4) mGy·cm, and the average enhanced CT value of the pulmonary artery image was (257.9±24.5) HU. Scanning time, mean DLP, and pulmonary artery level enhancement values were significantly different between the two groups ( t=17.92, 4.71, 2.44, P<0.05). Conclusions:The clinical value of one-step CT angiography from deep vein of lower limbs to pulmonary artery in the head-foot direction is significantly better than that in the head-foot direction. It can significantly shorten the scanning time, reduce the radiation dose, and increase the enhancement value of pulmonary artery to improve the detection of pulmonary embolism.

Objective:To explore the impact of donor cold ischemia time(CIT)on early recovery after liver transplantation(LT).Methods:From January 2016 to December 2020, the relevant clinical data were retrospectively reviewed for 456 LT recipients.According to the value of CIT of donor liver, they were assigned into two groups of CIT >5 h and CIT≤5 h. T, Mann-Whitney U or Chi square test was employed for statistical processing.Intraoperative findings and liver function(LF)parameters of two groups were compared, including operative duration, intraoperative volume of hemorrhage, erythrocyte transfusion and anhepatic phase.LF parameters included alanine aminotransferase(ALT), aspartate aminotransferase(AST)and total bilirubin(TB)within Day 1-7 post-LT.Postoperative recovery was evaluated by postoperative stay of intensive care unit(ICU), normalization time of liver function recovery, length of postoperative hospitalization and incidence of postoperative complications.Results:Among them, 407(89.3%)patients underwent classic orthotopic LT.Median CIT of donor liver was 309 min.In CIT≤5 h and CIT >5 h groups, operative duration was[(446.3+ 76.8)vs.(526.0+ 98.1)min], anhepatic phase time[(51.9+ 13.3)vs.(62.6+ 18.9)min]and intraoperative volume of erythrocyte transfusion[(7.3+ 5.8)vs.(10.0+ 6.87)U]. And the differences were statistically significant( P<0.001, 0.001 & 0.001). Postoperative hospitalization stay was longer[(29.1±15.9)vs.(27.1±13.0)]day.And the incidence of postoperative complications was higher in CIT >5 h group[22.7%(54/238)vs.12.4%(27/218)]. And the difference was statistically significant( P=0.045 & 0.004). As compared with CIT≤5 h group, ALT, AST & TB spiked in CIT >5 h group at Day 1 post-operation and the differences were statistically significant( P=0.002, P<0.001, P=0.001). In CIT >5 h group, ALT rose at Day 2/5/6/7 post-LT( P=0.026, 0.026, 0.015 & 0.011), AST jumped from Days 2-6( P=0.002, 0.004, 0.035, 0.029 and 0.019)and TB increased from Days 2-7 post-LT and the differences were statistically significant( P=0.003, 0.014, 0.030, 0.039, 0.027 & 0.009). LF recovered at CIT≤5 h and CIT>5 h group[(10.0±3.2)vs.(10.7±3.3)day]. There were significantly statistical differences( P=0.044). Conclusions:Non-conducive to patient recovery, prolonged cold ischemic time aggravates early LF injury post-LT.