Objective:To explore the feasibility, safety and early prognosis of laparoscopic choledocholithotomy in patients with previous history of upper abdominal surgery.Methods:From January 2014 to December 2018, the clinical data of 156 patients with previous history of upper abdominal surgery in hepatobiliary and pancreatic surgery of Central Hospital of Edong Healthcare Group were analyzed retrospectively. Among them, 84 cases with laparoscopic common bile duct exploration and stone extraction were allocated into laparoscopic group, 72 cases with open common bile duct exploration and stone extraction were allocated into open group.In the laparoscopic group, there were 50 males and 34 females, aged 42-83 (66.4±17.8) years; In the open group, there were 40 males and 32 females, aged 45-82 (64.2±16.9) years. The operation time, intraoperative hemorrhage, first defecation time and postoperative hospital stay were compared between the two groups. The postoperative pain score and the incidence of early complications (bile leakage, abdominal distention, ascites, epigastric pain, residual stones) were compared between the two groups. The measurement data subject to normal distribution are represented by ( Mean± SD), the independent sample t test was used for group comparison, and the chi-square test was used for counting data comparison. Results:The laparoscopic group was converted to open surgery in 3 cases, and there was no perioperative death. In the laparoscopic group, the operation time, the intraoperative bleeding volume, the first defecation time, the postoperative hospital stay wee (122.8 ± 28.1) min, (80.3 ± 13.7) mL, (1.8 ± 0.3) d, (7.7 ± 0.8) d, and (146.6 ± 33.5) min, (125.8 ± 19.6) mL, (2.7 ± 0.6) d, (9.1± 1.2) d in the open group; The difference between the two groups was statistically significant ( P<0.05); On the 2nd and 4th day after operation, the abdominal pain scores in laparoscopic group were (3.6 ± 1.3) scores and (2.3 ± 0.7) scores, and (5.5±1.6) scores, (4.2±1.3) scores in the open group, the laparoscopic group were significantly lower than those in the open group ( P<0.05); The incidence of early postoperative complications in the laparoscopic group was 32.1% (27/84), and in the open group was 47.2% (34/72), but the difference was not statistically significant ( P>0.05). Conclusions:For patients with a history of upper abdominal surgery, laparoscopic common bile duct exploration and choledochoscopy are safe and feasible, The operation has the advantages of minimally invasive and less bleeding, which can relieve postoperative pain, shorten postoperative hospital stay, and will not increase the incidence of postoperative complications, It′s good for quick recovery. It is suitable for the promotion of grass-roots hospitals.

Objective:To investigate the clinical effect of laparoscopic common bile duct exploration through Micro-incision of cystic duct and its junction in for choledocholithiasis.Methods:The clinical data of 62 patients with cholecystolithiasis complicated with choledocholithiasis treated in the Department of hepatobiliary and pancreatic surgery of Huangshi Central Hospital, Edong Healthcare Group from January 2017 to December 2021 were analyzed retrospectively, and were divided into two groups according to different treatment schemes. Among them, 32 cases underwent laparoscopic cholecystectomy, common bile duct exploration and lithotomy (primary suture group), Laparoscopic choledocholithotomy and exploration + T-tube drainage (T-tube Drainage Group) 30 cases. The general data, operation time, intraoperative bleeding, postoperative exhaust time, first time out of bed, postoperative hospital stay, 24-hour postoperative pain score and the incidence of total complications were compared between the two groups.Results:The operation was successfully performed in both groups, there was no perioperative death.There was no significant difference in general data, operation time, intraoperative bleeding and the incidence of total complications between the two groups ( P> 0.05), the postoperative anal exhaust time, the first time out of bed and the postoperative hospital stay in the primary suture group were (20.3±5.8) h, (15.5±4.3) h and (4.5±1.7) d, respectively, which were significantly shorter than those in the T-tube drainage group (28.3±7.9) h, (22.8±6.7) h and (7.0±2.8) d( P<0.05); The hospitalization cost in the primary suture group was (18 725.9±855.8) yuan, which was significantly lower than that in the T-tube drainage group (23 450.7±975.4) yuan ( P< 0.05). The 24-hour pain score (2.7±0.9) scores in the primary suture group was significantly lower than that in the T-tube drainage group (3.8±1.2) scores ( P< 0.05). Conclusion:Laparoscopic common bile duct exploration through micro-incision of cystic duct and its junction is safe and effective, which can accelerate the rehabilitation of patients and reduce the cost of hospitalization, which is more in line with the concept of ERAS.

Through literature search in regular database and official websites of relevant countries, this paper combs and summarizes the main characteristics of disease prevention and control systems in five countries, the United States, Germany, South Korea, Australia and Japan, and the European Union at key levels including legal construction, organizational structure, financing, personnel construction and international cooperation, in order to provide decision support for the construction of disease prevention and control system in China in the future.

Objective To investigate the risk factors for pulmonary infection in patients with acute-on-chronic liver failure(ACLF),and to establish a predictive model.Methods A retrospective analysis was performed for 585 ACLF patients who were admitted to Department of Infectious Diseases,The Second Affiliated Hospital of Air Force Medical University,from January 2009 to September 2022,and according to the condition of pulmonary infection after admission,they were divided into infection group with 213 patients and non-infection group with 372 patients.The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between groups.The clinical data of these patients were collected.Univariate and multivariate Logistic regression analyses were used to investigate the risk factors for pulmonary infection in ACLF patients and establish a predictive model,and the receiver operating characteristic(ROC)curve was plotted to assess the predictive value of the model.The Hosmer-Lemeshow test was used to evaluate the degree of fitting of the model,and the ROC curve and the area under the ROC curve(AUC)were used to assess the predictive performance of the model.Results Among the 585 patients with ACLF,213 experienced pulmonary infection,with an infection rate of 36.41%.The multivariate logistic analysis showed that upper gastrointestinal bleeding(odds ratio[OR]=2.463,P=0.047),infection at other sites(OR=2.218,P=0.004),femoral vein catheterization(OR=2.520,P＜0.001),and combined use of two or more antibiotics(OR=2.969,P＜0.001)were risk factors for pulmonary infection in ACLF patients.These factors were included in the risk factor predictive model of Logit(P)=-1.869+0.901×upper gastrointestinal bleeding+0.755×infection at other sites+0.924×femoral vein catheterization+1.088×combined use of two or more antibiotics.The ROC curve analysis showed that the model had a good predictive value(Hosmer-Lemeshow χ2=3.839,P=0.698),with an AUC of 0.753(95%confidence interval:0.700-0.772).Conclusion There is a relatively high incidence rate of pulmonary infection in patients with ACLF,and upper gastrointestinal bleeding,spontaneous peritonitis,femoral vein catheterization,and combined use of two or more antibiotics are related risk factors.The model established based on these factors can effectively predict the onset of pulmonary infection in ACLF patients.

Through literature search in regular database and official websites of relevant countries, this paper combs and summarizes the main characteristics of disease prevention and control systems in five countries, the United States, Germany, South Korea, Australia and Japan, and the European Union at key levels including legal construction, organizational structure, financing, personnel construction and international cooperation, in order to provide decision support for the construction of disease prevention and control system in China in the future.

Objective To observe the effect of Danshen injection (DSI) on pulmonary fibrosis in silicosis mice, and to analyze the differential metabolic pathway on pulmonary fibrosis in silicosis using DSI by urine metabolomics. Methods The specific pathogen free C57BL/6J mice were randomly divided into control group, silicosis model group, DSI prevention group and DSI treatment group. The mice in the last three groups were given 1 mL silica suspension with a mass concentration of 50 g/L by the one-time non-exposed tracheal method, and the mice in the control group were not given any treatment. Subsequently, mice in the DSI prevention group and the DSI treatment group were given intraperitoneal injection of DSI with a dose of 5 mL/kg body weight from 24 hours after exposure to dust and from the 29th day after exposure to dust, respectively, once per day until the 56th day after exposure. Mice in the other two groups were not treated. After DSI intervention, the lung histopathological changes of mice in all groups were evaluated. The components of mouse urine metabolites were analyzed using ultra-high performance liquid chromatography-quadrupole-time-of-fight mass spectrometry method. Human Metabolome Database was used to screen the potential differential metabolites (DMs). The related metabolic pathways were analyzed using MetaboAnanlyst 5.0 Web analytics platform. Results The result of hematoxylin-eosin staining and Van Gieson staining of mouse lung tissues showed that the pulmonary alveolar structure destroyed, typical fibrotic nodules appeared, collagen fiber deposition increased, and clumpy accumulation in the silicosis model group, compared with the control group. Compared with the silicosis model group, the degree of pulmonary alveolar inflammation and fibrosis in the lung tissues of mice in the DSI prevention group was obviously reduced to close to the control group, while pulmonary alveolar inflammation and fibrosis in the lung tissues of mice in the DSI treatment group were also reduced, although the outcome was not as good as that in the DSI prevention group. The result of urine metabolomics analysis identified four DMs in the model group and control group, seven DMs were identified in the DSI prevention group and silicosis model group, seven DMs were identified in the DSI treatment group and silicosis model group. A total of three DMs pathways related to pulmonary fibrosis in silicosis model group and the protective effect of DSI prevention group were identified, including D-arginine and D-ornithine metabolism, folic acid biosynthesis and metabolism, pantothenate and succinyl coenzyme A biosynthesis pathways (all P<0.01). Conclusion DSI treatment in any time point can interfere the process of pulmonary fibrosis in the silicosis mice, while the interference is more effective in the DSI group treated right after dust-exposure. DSI interferes with the urinary metabolism pathway of silicosis mice, and the D-arginine and D-ornithine metabolism, folic acid biosynthesis and metabolism, pantothenate and succinyl coenzyme A biosynthesis pathways may participate in the inhibiting process of early pulmonary fibrosis in silicosis mice by DSI.

OBJECTIVETo investigate the levels and functions of CD4(+)CD25(+) regulatory T cells and specific transcription factor Foxp3 and Th17 cells related cytokine in peripheral blood mononuclear cells (PBMC) and renal tissues, and explore their roles in pathogenesis of Henoch-Schonlein purpura nephropathy (HSPN) in children.

METHODFrom March, 2011 to March, 2013, 30 cases of HSPN children underwent renal biopsy and were treated in Guiyang Children's Hospital were enrolled into this study. Ten healthy children who underwent health check up were enrolled as blood sample control group. The normal kidney tissue specimens were taken from 5 children who underwent surgery for urologic disorders were used as renal sample control group. The circulating proportions of CD4(+)CD25(+) regulatory T cells in PBMC of 30 cases of HSPN children and 10 cases of control group were determined by flow cytometry, respectively.Reverse transcription-polymerase chain reaction (RT-PCR) were used to analyze the mRNA expressions of IL-17, IL-1β and Foxp3 in PBMC. The expression of IL-17 and IL-1β in renal tissue of HSPN and control group were measured by immunohistochemistry. CD4(+)CD25(+) regulatory T cells, Foxp3, IL-17, IL-1β expression were analyzed and compared in HSPN group and control groups respectively.

RESULTThirty cases of HSPN pathological classification were as follows: type I was found in 0 case; type II in 9 cases; type III in 16 cases; type IV in 5 cases; type V in 0 case. The circulating proportions of CD4(+)CD25(+)/CD4(+)T cells and the CD4(+)CD25(+)Foxp3(+)Treg/CD4(+)T cells level were (5.84 ± 0.78)%, (1.01 ± 0.46) % in HSPN groups were substantially lower than those in control group. All these two differences had statistical significance (t = 27.200, 33.260, P < 0.05). The mRNA levels of IL-17, IL-1β in HSPN groups (0.86 ± 0.01,0.71 ± 0.01) were higher than those in control group (t = 25.000, 31.840, all P < 0.05). Foxp3 mRNA expression in HSPN groups (0.24 ± 0.02) were significantly lower than those in control group (t = 21.690, P < 0.05). Protein expression of IL-17 and IL-1β in renal tissues of HSPN children (13.31 ± 0.54, 11.56 ± 0.28) were significantly stronger than those in the control group (t = 27.6, 14.0, all P < 0.01). The highest level of protein expression of IL-17 and IL-1β in renal biopsy of HSPN was in type IV (IV>III>II, F = 545.800, 262.500, all P < 0.01).

CONCLUSIONThe disorder of quantity and function of CD4(+)CD25(+) regulatory T cells, and increase in levels of IL-17, IL-1β (cytokine related to Th17 cells) may play important roles in pathogenesis of HSPN in children; increased protein expression of IL-17, IL-1β in renal tissue may contribute to the development of renal pathological damage in HSPN children.

Case-Control Studies ; Child ; Child, Preschool ; Female ; Flow Cytometry ; Forkhead Transcription Factors ; genetics ; metabolism ; Humans ; Interleukin-17 ; genetics ; metabolism ; Interleukin-1beta ; genetics ; metabolism ; Kidney ; metabolism ; pathology ; Male ; Nephritis ; etiology ; immunology ; pathology ; Purpura, Schoenlein-Henoch ; complications ; immunology ; pathology ; RNA, Messenger ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Severity of Illness Index ; T-Lymphocytes, Regulatory ; immunology ; Th17 Cells ; immunology