1.Precise detection of weak partial D type 15 in the Chinese population: evaluation of their potential impact on blood transfusion safety and development of appropriate response strategies
Xu ZHANG ; Zhuren ZHOU ; Xuying HUANG ; Lichun LI ; Weiwei LI ; Ping HOU ; Xiaofeng LI ; Jianping LI
Chinese Journal of Blood Transfusion 2025;38(8):1030-1034
Objective: To investigate the precise detection methods for weak partial D type 15 and evaluate their implications for blood transfusion safety, along with the development of corresponding strategies. Methods: A combination of serological methods, including the microplate method, indirect antiglobulin tube method, and microcolumn gel card method, was employed to identify RhD-negative and RhD variant samples. RhD-negative samples were screened for the presence of RHD genes using whole-blood direct PCR amplification. Subsequently, RhD variant samples and RhD-negative samples containing RHD genes underwent full-coding-region sequencing of the RHD gene to confirm their genotypes. The genotyping results were further correlated with the serological test findings for comprehensive analysis. Results: Among 615 549 first-time healthy blood donors, 3 401 samples with an RhD-negative phenotype and 156 samples with RhD variant were identified. Of the 3 401 RhD-negative samples, 1 054 were found to harbor RHD genes. Gene sequencing analysis of the 156 RhD variants and the 1 054 serological negative samples revealed that 89 samples contained the RHD
15 (c. 845G>A) allele. Conclusion: The integration of serological testing methods and genotyping technologies for the precise determination of RhD blood type plays a critical role in ensuring the safety and compatibility of blood transfusions.
2.Safety of high-carbohydrate fluid diet 2 h versus overnight fasting before non-emergency endoscopic retrograde cholangiopancreatography: A single-blind, multicenter, randomized controlled trial
Wenbo MENG ; W. Joseph LEUNG ; Zhenyu WANG ; Qiyong LI ; Leida ZHANG ; Kai ZHANG ; Xuefeng WANG ; Meng WANG ; Qi WANG ; Yingmei SHAO ; Jijun ZHANG ; Ping YUE ; Lei ZHANG ; Kexiang ZHU ; Xiaoliang ZHU ; Hui ZHANG ; Senlin HOU ; Kailin CAI ; Hao SUN ; Ping XUE ; Wei LIU ; Haiping WANG ; Li ZHANG ; Songming DING ; Zhiqing YANG ; Ming ZHANG ; Hao WENG ; Qingyuan WU ; Bendong CHEN ; Tiemin JIANG ; Yingkai WANG ; Lichao ZHANG ; Ke WU ; Xue YANG ; Zilong WEN ; Chun LIU ; Long MIAO ; Zhengfeng WANG ; Jiajia LI ; Xiaowen YAN ; Fangzhao WANG ; Lingen ZHANG ; Mingzhen BAI ; Ningning MI ; Xianzhuo ZHANG ; Wence ZHOU ; Jinqiu YUAN ; Azumi SUZUKI ; Kiyohito TANAKA ; Jiankang LIU ; Ula NUR ; Elisabete WEIDERPASS ; Xun LI
Chinese Medical Journal 2024;137(12):1437-1446
Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.
3.Construction a nomogram model for predicting stress urinary incontinence in young and middle-aged women
Ping ZHOU ; Abuduwaili MUKADAISI· ; Zelan LIANG ; Yibing LIU ; Ming HOU
Chinese Journal of Postgraduates of Medicine 2024;47(9):803-807
Objective:To construct a nomogram model for predicting stress urinary incontinence (SUI) in young and middle-aged women.Methods:Using a sampling survey method, 1 000 questionnaires were distributed to young and middle-aged women in 2 streets of Urumqi community from May 2021 to October 2023 to investigate their basic situation, lifestyle habits and gynecological related information. The International Urinary Incontinence Advisory Committee urinary incontinence questionnaire was used to diagnose SUI, and the patients were divided into SUI group and control group based on the results. Seven hundred and eighty-six questionnaires were collected. The survey results of the two groups were analyzed, and a nomogram model for predicting the occurrence of SUI in young and middle-aged women was constructed and validated.Results:Among the 786 young and middle-aged women, there were 147 cases in the SUI group and 639 cases in the control group. The age, body mass index (BMI), and the incidences of diabetes, chronic constipation, delivery history, macrosomia delivery history, pelvic floor dysfunction in SUI group were significantly higher than those in control group: (44.51 ± 8.20) years vs. (38.60 ± 12.35) years, (27.31 ± 4.53) kg/m 2 vs. (24.28 ± 4.38) kg/m 2, 13.61% (20/147) vs. 3.44% (22/639), 19.05% (28/147) vs. 5.01% (32/639), 90.48% (133/147) vs. 75.90% (485/639), 17.01% (25/147) vs. 3.44% (22/639) and 11.56% (17/147) vs. 3.29% (21/639), and there were statistical differences ( P<0.01). Multivariate Logistic regression analysis result showed that age>44 years, BMI≥30 kg/m 2, diabetes, chronic constipation, delivery history, macrosomia delivery history and pelvic floor dysfunction were independent risk factors for SUI in young and middle-aged women ( RR = 1.511, 2.543, 4.636, 4.293, 2.526, 6.220 and 5.834; 95% CI 1.007 to 2.268, 1.661 to 3.894, 2.281 to 9.422, 2.339 to 7.881, 1.374 to 4.643, 3.205 to 12.071 and 2.641 to 12.888; P<0.05 or <0.01). The age, BMI, diabetes, chronic constipation, delivery history, macrosomia delivery history and pelvic floor dysfunction were used as predictors to construct a nomogram model for predicting the SUI in young and middle-aged women. The 550 cases were randomly selected from the dataset as the training set and the remaining 236 cases as the validation set. The receiver operating characteristic curve was drawn, and the result showed that the area under the training set curve was 0.818 (95% CI 0.773 to 0.862), and the area under the validation set curve was 0.826 (95% CI 0.764 to 0.889); the Hosmer-Lemeshow goodness of fit test in validation set that result showed that the nomogram model had high reliability ( χ2 = 8.48, P>0.05). Conclusions:The incidence of SUI in young and middle-aged women is high. The age >44 years, BMI≥30 kg/m 2, diabetes, chronic constipation, delivery history, macrosomia delivery history and pelvic floor dysfunction are independent risk factors for SUI in young and middle-aged women. The nomogram model based on related risk factors has high predictive value and credibility.
4.Clinical study of modified Poge Jiuxin decoction combined with acupuncture in the treatment of septic cardiomyopathy
Zhi'en ZHOU ; Shanxiu YAN ; Ping LU ; Juan YAO ; Mulong BAO ; Juan HOU ; Yimo JIAN ; Yao MA
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care 2024;31(2):151-156
Objective To observe the effects of modified Poge Jiuxin decoction combined with acupuncture in the treatment of septic cardiomyopathy(SIC),and explore its possible mechanism.Methods Totally 72 patients with SIC admitted to Chengdu First People's Hospital from January 2022 to June 2023 were enrolled.The patients were divided into control group and treatment group according to random number table method,with 36 cases in each group.Patients in control group received basic treatment for SIC.On this basis,the treatment group was administrated with modified Poge Jiuxin decoction[includes Prepared Aconite 30 g(earlier decocted),Red Ginseng 30 g(another stew),Cornel Meat 60 g,Dried Ginger 30 g,Raw Keel 30 g(earlier decocted),Raw Oyster 30 g(earlier decocted),Magnet 30 g(earlier decocted),Poria Cocos 90 g,Plantain Seeds 30 g(in bag),Roasted Licorice 60 g,Musk 0.5 g(artificial)],one dose a day,100 mL in 3 meals a day.Acupuncture at bilateral Zusanli,Guangyuan,Neiguan,Sanyinjiao and Qihai points,twice a day.Both groups were treated for 7 days.The changes of C-reactive protein(CRP),procalcitonin(PCT),cardiac tropomin I(cTnI),N-terminal pro-B type natriuretic peptide(NT-proBNP)and lactic acid(Lac)were observed before and after treatment,acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)were calculated,left ventricular ejection fraction(LVEF),left ventricle fractional shortening(LVFS),and mitral orifice early/late diastolic blood flow velocity ratio(E/A ratio)were measured with echocardiography,the heart rate(HR),mean arterial pressure(MAP),mechanical ventilation time,vasoactive drug use time,in the intensive care unit(ICU)stay time,the incidence of multiple organ dysfunction syndrome(MODS)and 28-day mortality were recorded.Results After treatment,the indexes of inflammation(CRP,PCT),myocardial markers(cTnI,NT-proBNP),hemodynamics and perfusion(HR,Lac),illness severity score(APACHEⅡ,SOFA)and the 28-day mortality in the two groups were significantly reduced,while LVEF and MAP were significantly increased compared to before treatment.The improvement of various indexes in the treatment group were better than those in the control group[CRP(mg/L):22.18±9.46 vs.68.45±13.46,PCT(μg/L):1.16±0.59 vs.4.35±1.28,LVEF:0.48±0.06 vs.0.41±0.05,cTnI(μg/L):0.60±0.14 vs.0.98±0.30,NT-proBNP(ng/L):204.35±26.54 vs.240.12±56.12,HR(bmp):88.75±10.05 vs.98.57±10.56,MAP(mmHg,1 mmHg≈0.133 kPa):82.10±5.08 vs.73.46±3.55,Lac(mmol/L):0.75±0.28 vs.1.60±0.36,APACHEⅡscore:10.46±1.80 vs.15.50±2.16,SOFA score:2.60±1.24 vs.6.76±1.60,all P<0.05].After treatment,LVFS and E/A ratio in the two groups increased significantly compared to those before treatment,however,there was no significant difference between the treatment group and the control group after treatment[LVFS:(25.12±3.46)%vs.(22.61±3.88)%,E/A ratio:1.16±0.46 vs.0.96±0.32,both P>0.05].The vasoactive drug use time and ICU stay time were shortened in the treatment group than those in the control group[vasoactive drug use time(days):9.62±3.05 vs.10.48±3.40,ICU stay time(days):12.51±2.04 vs.13.72±1.14,both P<0.05],the incidence of MODS and the 28-day mortality were lower than those of the control group[38.89%(14/36)vs.52.77%(9/36),44.44%(16/36)vs.47.22%(17/36)],but there were no statistical differences(both P>0.05).Conclusion Modified Poge Jiuxin decoction combined with acupuncture can effectively improve the prognosis of patients with SIC,and its mechanism may be related to inhibition of inflammatory reaction and improvement of cardiac function.
5.Clinical characteristics and the risk factors of sepsis-induced myocardial dysfunction
Zhi'en ZHOU ; Shanxiu YAN ; Ping LU ; Juan YAO ; Mulong BAO ; Juan HOU ; Yimo JIAN ; Yao MA
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care 2024;31(4):428-432
Objective To investigate clinical characteristics and the risk factors of sepsis-induced myocardial dysfunction(SIMD),and to provide evidence for the diagnosis,treatment and prevention of SIMD.Methods The clinical data of 284 patients with sepsis(≥18 years old)admitted to the department of critical care medicine of Chengdu Integrated Traditional Chinese Medicine&Western Medicine Hospital/Chengdu First People's Hospital from January 2020 to December 2022 were retrospectively analyzed.This includes gender,age,chronic underlying diseases,the mean arterial pressure(MAP),heart rate(HR),laboratory test results,disease severity score,the proportion of requiring mechanical ventilation,vasoactive drugs treatment and renal replacement therapy,length of intensive care medicine(ICU)stay and the 28-day mortality.Patients were divided into SIMD group and non-SIMD group according to the occurrence of SIMD,allowing for an analysis of the clinical characteristics of two groups of patients.Univariate and multivariate Logistic regression analyses were used to identify the risk factors of SIMD,and receiver operator characteristic curve(ROC curve)were plotted to analyze the predictive value of each risk factor for the occurrence of SIMD.Results A total of 284 septic patients were included,including 136 cases(47.89%)in the SIMD group and 148 cases(52.11%)in the non-SIMD group.Compared with the non-SIMD group,the levels of age,N-terminal pro-brain natriuretic peptide(NT-proBNP),cardiac tropomin I(cTnI),lactic acid(Lac)at admission to ICU,the proportion of vasoactive drugs treatment,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)and sequential organ failure assessment(SOFA)in the SIMD group were significantly higher than those in the non-SIMD group[age(years):75.92±2.35 vs.55.02±1.68,NT-proBNP(ng/L):3 037.00±544.50 vs.2 493.92±630.21,cTnI(μg/L):0.12±0.07 vs.0.06±0.03,Lac in ICU(mmol/L):4.46±1.21 vs.2.98±1.02,the proportion of vasoactive drugs treatment:40.44%(55/136)vs.21.62%(32/148),APACHEⅡ score:24.25±1.02 vs.20.95±0.85,SOFA score:7.41±4.69 vs.6.21±2.81,all P<0.05],but the 24-hour Lac clearance rate of the SIMD group was significantly lower than that of the non-SIMD group[(13.80±7.01)%vs.(25.41±8.90)%,P<0.05].Multivariate Logistic regression analysis showed that age≥75 years,24-hour Lac clearance rate and NT-proBNP≥3 000 ng/L were the independent factors of SIMD in patients with sepsis[odds ratio(OR)and 95%confidence interval(95%CI)were 5.990(2.143-16.742),0.348(0.155-0.786)and 2.708(1.093-6.711),P values were 0.001,0.011 and 0.031].ROC curve analysis showed that age,24-hour Lac clearance rate,NT-proBNP had predictive value for the development of SIMD[area under the curve(AUC)were 0.637,0.811,0.743,95%CI were 0.573-0.701,0.761-0.860,0.687-0.800,all P<0.05].Conclusions SIMD occurs more frequently in patients with sepsis.Increased age,elevated NT-proBNP,and reduced 24-hour Lac clearance rate are independent risk factors of SIMD,warranting clinical attention.
6.Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients (version 2024)
Yao LU ; Yang LI ; Leiying ZHANG ; Hao TANG ; Huidan JING ; Yaoli WANG ; Xiangzhi JIA ; Li BA ; Maohong BIAN ; Dan CAI ; Hui CAI ; Xiaohong CAI ; Zhanshan ZHA ; Bingyu CHEN ; Daqing CHEN ; Feng CHEN ; Guoan CHEN ; Haiming CHEN ; Jing CHEN ; Min CHEN ; Qing CHEN ; Shu CHEN ; Xi CHEN ; Jinfeng CHENG ; Xiaoling CHU ; Hongwang CUI ; Xin CUI ; Zhen DA ; Ying DAI ; Surong DENG ; Weiqun DONG ; Weimin FAN ; Ke FENG ; Danhui FU ; Yongshui FU ; Qi FU ; Xuemei FU ; Jia GAN ; Xinyu GAN ; Wei GAO ; Huaizheng GONG ; Rong GUI ; Geng GUO ; Ning HAN ; Yiwen HAO ; Wubing HE ; Qiang HONG ; Ruiqin HOU ; Wei HOU ; Jie HU ; Peiyang HU ; Xi HU ; Xiaoyu HU ; Guangbin HUANG ; Jie HUANG ; Xiangyan HUANG ; Yuanshuai HUANG ; Shouyong HUN ; Xuebing JIANG ; Ping JIN ; Dong LAI ; Aiping LE ; Hongmei LI ; Bijuan LI ; Cuiying LI ; Daihong LI ; Haihong LI ; He LI ; Hui LI ; Jianping LI ; Ning LI ; Xiying LI ; Xiangmin LI ; Xiaofei LI ; Xiaojuan LI ; Zhiqiang LI ; Zhongjun LI ; Zunyan LI ; Huaqin LIANG ; Xiaohua LIANG ; Dongfa LIAO ; Qun LIAO ; Yan LIAO ; Jiajin LIN ; Chunxia LIU ; Fenghua LIU ; Peixian LIU ; Tiemei LIU ; Xiaoxin LIU ; Zhiwei LIU ; Zhongdi LIU ; Hua LU ; Jianfeng LUAN ; Jianjun LUO ; Qun LUO ; Dingfeng LYU ; Qi LYU ; Xianping LYU ; Aijun MA ; Liqiang MA ; Shuxuan MA ; Xainjun MA ; Xiaogang MA ; Xiaoli MA ; Guoqing MAO ; Shijie MU ; Shaolin NIE ; Shujuan OUYANG ; Xilin OUYANG ; Chunqiu PAN ; Jian PAN ; Xiaohua PAN ; Lei PENG ; Tao PENG ; Baohua QIAN ; Shu QIAO ; Li QIN ; Ying REN ; Zhaoqi REN ; Ruiming RONG ; Changshan SU ; Mingwei SUN ; Wenwu SUN ; Zhenwei SUN ; Haiping TANG ; Xiaofeng TANG ; Changjiu TANG ; Cuihua TAO ; Zhibin TIAN ; Juan WANG ; Baoyan WANG ; Chunyan WANG ; Gefei WANG ; Haiyan WANG ; Hongjie WANG ; Peng WANG ; Pengli WANG ; Qiushi WANG ; Xiaoning WANG ; Xinhua WANG ; Xuefeng WANG ; Yong WANG ; Yongjun WANG ; Yuanjie WANG ; Zhihua WANG ; Shaojun WEI ; Yaming WEI ; Jianbo WEN ; Jun WEN ; Jiang WU ; Jufeng WU ; Aijun XIA ; Fei XIA ; Rong XIA ; Jue XIE ; Yanchao XING ; Yan XIONG ; Feng XU ; Yongzhu XU ; Yongan XU ; Yonghe YAN ; Beizhan YAN ; Jiang YANG ; Jiangcun YANG ; Jun YANG ; Xinwen YANG ; Yongyi YANG ; Chunyan YAO ; Mingliang YE ; Changlin YIN ; Ming YIN ; Wen YIN ; Lianling YU ; Shuhong YU ; Zebo YU ; Yigang YU ; Anyong YU ; Hong YUAN ; Yi YUAN ; Chan ZHANG ; Jinjun ZHANG ; Jun ZHANG ; Kai ZHANG ; Leibing ZHANG ; Quan ZHANG ; Rongjiang ZHANG ; Sanming ZHANG ; Shengji ZHANG ; Shuo ZHANG ; Wei ZHANG ; Weidong ZHANG ; Xi ZHANG ; Xingwen ZHANG ; Guixi ZHANG ; Xiaojun ZHANG ; Guoqing ZHAO ; Jianpeng ZHAO ; Shuming ZHAO ; Beibei ZHENG ; Shangen ZHENG ; Huayou ZHOU ; Jicheng ZHOU ; Lihong ZHOU ; Mou ZHOU ; Xiaoyu ZHOU ; Xuelian ZHOU ; Yuan ZHOU ; Zheng ZHOU ; Zuhuang ZHOU ; Haiyan ZHU ; Peiyuan ZHU ; Changju ZHU ; Lili ZHU ; Zhengguo WANG ; Jianxin JIANG ; Deqing WANG ; Jiongcai LAN ; Quanli WANG ; Yang YU ; Lianyang ZHANG ; Aiqing WEN
Chinese Journal of Trauma 2024;40(10):865-881
Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.
7.Somatostatin mediates Nrf2/HO-1 pathway to improve acute pancreatitis-associated acute lung injury
Hou-Ping ZHOU ; Yuan YUAN ; Bei-Bei LI ; Ting-Zheng OU ; Ming-Ming SHANG
The Chinese Journal of Clinical Pharmacology 2024;40(18):2729-2733
Objective To explore the mechanism of somatostatin in improving acute lung injury associated with acute pancreatitis.Methods Wistar rats were randomly divided into sham operation group(injection of normal saline),model group(puncture of common bile duct and injection of 5%sodium taurocholate with wire ligation),somatostatin group(injection of somatostatin into tail vein of model group),somatostatin+miR-146a-5p inhibitor group(on the basis of somatostatin group,tail vein injection of miR-146a-5p inhibitor and somatostatin+oe-angiogenin-like protein 4(ANGPTL4)group(on the basis of somatostatin group,tail vein injection of oe-ANGPTL4 plasmid).Hematoxylin-eosin(HE)staining was used to observe the pathological changes of pancreatic and lung tissues;pathological score and tissue wet-dry weight ratio were determined,real-time fluorescence quantitative polymerase chain reaction(qRT-PCR)was used to detect miR-146a-5p and ANGPTL4 mRNA expression and Western blot was used to detect the expression of related proteins in lung tissues of rats.Tumor necrosis factor-α(TNF-α)was detected by enzyme-linked immunosorbent assay(ELISA).Results In sham operation group,model group and somatostatin group,the damage degree of pancreas tissue(based on modified computed tomography severity index)were 1.25±0.28,3.20±0.34,2.15±0.31,respectively;the damage degree of lung tissue(based on the Smith lung injury score system)were 1.40±0.13,5.10±0.58,3.10±0.38,respectively.The relative expression levels of ANGPTL4 mRNA in sham operation group,model group,somatostatin group and somatostatin+miR-146a-5p inhibitor group were 1.00±0.17,1.63±0.20,1.21±0.18 and 1.73±0.28.The levels of TNF-α in sham operation group,model group,somatostatin group,somatostatin+miR-146a-5p inhibitor group and somatostatin+oe-ANGPTL4 group were(76.33±7.25),(125.05±13.56),(80.11±10.68),(118.62±14.32)and(105.32±13.52)pg·mL-1,respectively;the relative expression levels of nuclear factor E2-related factor 2(Nrf2)protein were 1.00±0.27,0.51±0.07,0.88±0.14,0.68±0.12,0.51±0.09,respectively;the relative expression levels of heme oxygenase-1(HO-1)protein were 1.00±0.25,0.58±0.11,0.79±0.18,0.48±0.07 and 0.50±0.08,respectively.The above indexes of the model group were compared with those of the sham operation group,and the above indexes of the somatostatin group were compared with those of the model group,somatostatin+miR-146a-5p inhibitor group and somatostatin+oe-ANGPTL4 group,and the differences were statistically significant(all P<0.05).Conclusion Somatostatin has antioxidant and anti-inflammatory effects and can ameliorate acute lung injury associated with acute pancreatitis.The mechanism may be related to Nrf2/HO-1 pathway mediated by miR-146a-5p/ANGPTL4.
8.Clinical characteristics of choledocholithiasis combined with periampullary diverticulum and influencing factor analysis for difficult cannulation of endoscopic retrograde cholangiopan-creatography: a report of 1 920 cases
Ping YUE ; Zhenyu WANG ; Leida ZHANG ; Hao SUN ; Ping XUE ; Wei LIU ; Qi WANG ; Jijun ZHANG ; Xuefeng WANG ; Meng WANG ; Yingmei SHAO ; Kailin CAI ; Senlin HOU ; Kai ZHANG ; Qiyong LI ; Lei ZHANG ; Kexiang ZHU ; Haiping WANG ; Ming ZHANG ; Xiangyu SUN ; Zhiqing YANG ; Jie TAO ; Zilong WEN ; Qunwei WANG ; Bendong CHEN ; Yingkai WANG ; Mingning ZHAO ; Ruoyan ZHANG ; Tiemin JIANG ; Ke LIU ; Lichao ZHANG ; Kangjie CHEN ; Xiaoliang ZHU ; Hui ZHANG ; Long MIAO ; Zhengfeng WANG ; Jiajia LI ; Xiaowen YAN ; Ling'en ZHANG ; Fangzhao WANG ; Wence ZHOU ; Wenbo MENG ; Xun LI
Chinese Journal of Digestive Surgery 2023;22(1):113-121
Objective:To investigate the clinical characteristics of choledocholithiasis com-bined with periampullary diverticulum and influencing factor for difficult cannulation of endoscopic retrograde cholangiopancreatography (ERCP).Methods:The retrospective case-control study was conducted. The clinical data of 1 920 patients who underwent ERCP for choledocholithiasis in 15 medical centers, including the First Hospital of Lanzhou University, et al, from July 2015 to December 2017 were collected. There were 915 males and 1 005 females, aged (63±16)years. Of 1 920 patients, there were 228 cases with periampullary diverticulum and 1 692 cases without periampullary diverticulum. Observation indicators: (1) clinical characteristics of patients with choledocholithiasis; (2) intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis; (3) influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and com-parison between groups was conducted using the Wilcoxon rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The Logistic regression model was used for univariate and multivariate analyses. Results:(1) Clinical characteristics of patients with choledocholithiasis. Age, body mass index, cases with complications as chronic obstructive pulmonary disease, diameter of common bile duct, cases with diameter of common bile duct as <8 mm, 8?12 mm, >12 mm, diameter of stone, cases with number of stones as single and multiple were (69±12)years, (23.3±3.0)kg/m 2, 16, (14±4)mm, 11, 95, 122, (12±4)mm, 89, 139 in patients with choledocholithiasis combined with periampullary diverticulum, versus (62±16)years, (23.8±2.8)kg/m 2, 67, (12±4)mm, 159, 892, 641, (10±4)mm, 817, 875 in patients with choledocholithiasis not combined with periampullary diver-ticulum, showing significant differences in the above indicators between the two groups ( t=?7.55, 2.45, χ2=4.54, t=?4.92, Z=4.66, t=?7.31, χ2=6.90, P<0.05). (2) Intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis. The balloon expansion diameter, cases with intraoperative bleeding, cases with hemorrhage management of submucosal injection, hemostatic clip, spray hemostasis, electrocoagulation hemostasis and other treatment, cases with endoscopic plastic stent placement, cases with endoscopic nasal bile duct drainage, cases with mechanical lithotripsy, cases with stone complete clearing, cases with difficult cannulation, cases with delayed intubation, cases undergoing >5 times of cannulation attempts, cannulation time, X-ray exposure time, operation time were 10.0(range, 8.5?12.0)mm, 56, 6, 5, 43, 1, 1, 52, 177, 67, 201, 74, 38, 74, (7.4±3.1)minutes, (6±3)minutes, (46±19)minutes in patients with choledocholithiasis combined with periampullary diverticulum, versus 9.0(range, 8.0?11.0)mm, 243, 35, 14, 109, 73, 12, 230, 1 457, 167, 1 565, 395, 171, 395, (6.6±2.9)minutes, (6±5)minutes, (41±17)minutes in patients with choledocholithiasis not combined with periampullary diverticulum, showing significant differences in the above indicators between the two groups ( Z=6.31, χ2=15.90, 26.02, 13.61, 11.40, 71.51, 5.12, 9.04, 8.92, 9.04, t=?3.89, 2.67, ?3.61, P<0.05). (3) Influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Results of multivariate analysis showed total bilirubin >30 umol/L, number of stones >1, combined with periampullary diverticulum were indepen-dent risk factors for difficult cannulation in patients with periampullary diverticulum who underwent ERCP for choledocholithiasis ( odds ratio=1.31, 1.48, 1.44, 95% confidence interval as 1.06?1.61, 1.20?1.84, 1.06?1.95, P<0.05). Results of further analysis showed that, of 1 920 patients undergoing ERCP for choledocholithiasis, the incidence of postoperative pancreatitis was 17.271%(81/469) and 8.132%(118/1 451) in the 469 cases with difficult cannulation and 1 451 cases without difficult cannula-tion, respectively, showing a significant difference between them ( χ2=31.86, P<0.05). In the 1 692 patients with choledocholithiasis not combined with periampullary diverticulum, the incidence of postopera-tive pancreatitis was 17.722%(70/395) and 8.250%(107/1 297) in 395 cases with difficult cannula-tion and 1 297 cases without difficult cannulation, respectively, showing a significant difference between them ( χ2=29.00, P<0.05). In the 228 patients with choledocholithiasis combined with peri-ampullary diverticulum, the incidence of postoperative pancreatitis was 14.865%(11/74) and 7.143%(11/154) in 74 cases with difficult cannulation and 154 cases without difficult cannulation, respectively, showing no significant difference between them ( χ2=3.42, P>0.05). Conclusions:Compared with patients with choledocholithiasis not combined with periampullary divertioulum, periampullary divertioulum often occurs in choledocholithiasis patients of elderly and low body mass index. The proportion of chronic obstructive pulmonary disease is high in choledocholithiasis patients with periampullary diverticulum, and the diameter of stone is large, the number of stone is more in these patients. Combined with periampullary diverticulum will increase the difficult of cannulation and the ratio of patient with mechanical lithotripsy, and reduce the ratio of patient with stone complete clearing without increasing postoperative complications of choledocholithiasis patients undergoing ERCP. Total bilirubin >30 μmol/L, number of stones >1, combined with periampullary diverticulum are independent risk factors for difficult cannulation in patients of periampullary diverticulum who underwent ERCP for choledocholithiasis.
9.Guideline for the diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients (version 2023)
Yuan XIONG ; Bobin MI ; Chenchen YAN ; Hui LI ; Wu ZHOU ; Yun SUN ; Tian XIA ; Faqi CAO ; Zhiyong HOU ; Tengbo YU ; Aixi YU ; Meng ZHAO ; Zhao XIE ; Jinmin ZHAO ; Xinbao WU ; Xieyuan JIANG ; Bin YU ; Dianying ZHANG ; Dankai WU ; Guangyao LIU ; Guodong LIU ; Qikai HUA ; Mengfei LIU ; Yiqiang HU ; Peng CHENG ; Hang XUE ; Li LU ; Xiangyu CHU ; Liangcong HU ; Lang CHEN ; Kangkang ZHA ; Chuanlu LIN ; Chengyan YU ; Ranyang TAO ; Ze LIN ; Xudong XIE ; Yanjiu HAN ; Xiaodong GUO ; Zhewei YE ; Qisheng ZHOU ; Yong LIU ; Junwen WANG ; Ping XIA ; Biao CHE ; Bing HU ; Chengjian HE ; Guanglin WANG ; Dongliang WANG ; Fengfei LIN ; Jiangdong NI ; Aiguo WANG ; Dehao FU ; Shiwu DONG ; Lin CHEN ; Xinzhong XU ; Jiacan SU ; Peifu TANG ; Baoguo JIANG ; Yingze ZHANG ; Xiaobing FU ; Guohui LIU
Chinese Journal of Trauma 2023;39(6):481-493
Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.
10.Effect of intensive blood pressure control after successful endovascular therapy on outcomes in patients with anterior circulation stroke: a multicentre, open-label, blinded-endpoint, randomized controlled trial
Chengfang LIU ; Qiwen DENG ; Hongchao SHI ; Feng ZHOU ; Yukai LIU ; Meng WANG ; Qiaoyu ZHANG ; Bingqi ZHANG ; Min LI ; Lei PING ; Tao WANG ; Haicun SHI ; Wei WANG ; Jiankang HOU ; Shi HUANG ; Jinfeng LYU ; Rui SHEN ; Yingdong ZHANG ; Junshan ZHOU
International Journal of Cerebrovascular Diseases 2023;31(6):401-408
Objective:To compare the effects of intensive and standard blood pressure control on the outcomes of patients with acute ischemic stroke in the anterior circulation who have successfully recanalized after endovascular therapy (EVT).Methods:A multicenter, open-label, blinded-endpoint, randomized controlled design was used. Patients with anterior circulation stroke received EVT and successfully recanalized in Nanjing First Hospital, Nanjing Medical University and several branch hospitals from July 2020 to October 2022 were prospectively included. They were randomly divided into the intensive blood pressure control group (target systolic blood pressure [SBP] 100-120 mmHg) or the standard blood pressure control group (target SBP 121-140 mmHg). The blood pressure of both groups needs to achieve the target within 1 h and maintain for 72 h. The primary outcome endpoint was outcome at 90 d, and the good outcome was defined as a score of 0-2 on the modified Rankin Scale. Secondary outcome endpoints included early neurological improvement, symptomatic intracranial hemorrhage (sICH) within 24 h, and death and serious adverse events within 90 d.Results:A total of 120 patients were included, including 63 in the intensive blood pressure control group and 57 in the standard blood pressure control group. There was no statistically significant difference in baseline characteristics between the two groups. The SBP at 72 h after procedure was 122.7±8.1 mmHg in the intensive blood pressure control group and 130.2±7.4 mmHg in the standard blood pressure control group, respectively. There were no significantly differences in the good outcome rate (54.0% vs. 54.4%; χ2=0.002, P=0.963), the early neurological improvement rate (45.2% vs. 34.5%; χ2=1.367, P=0.242), the incidence of sICH (6.3% vs. 3.5%; P=0.682), mortality (7.9% vs. 14.0%; χ2=1.152, P=0.283) and the incidence of serious adverse events (12.7% vs. 15.8%; χ2=0.235, P=0.628) at 90 d between the intensive blood pressure control group and the standard blood pressure control group. Conclusion:In patients with anterior circulation stroke and successful revascularization of EVT, early intensive blood pressure control don’t improve clinical outcomes and reduce the incidence of sICH.

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