Objective Construct a risk model for postoperative recurrence of hepatolithiasis and validate it.Methods From January 2020 to December 2021,237 patients undergoing hepatobiliary duct stone surgery were selected.All patients underwent liver lobectomy by the same team and were divided into two groups according to whether there was recurrence during the 2-year postoperative follow-up period.Among them,there were 34 cases in the recurrence group and 203 cases in the non-recurrence group.Using binary logistic regression analysis to identify risk factors for postoperative recurrence of liver and bile duct stones,and constructing a predictive model based on the results of binary logistic regression.Using ROC curve analysis to evaluate the diagnostic efficacy of the predictive model,and verifying its validity.Results Univariate analysis showed that age,BMI,course of disease,gender,common bile duct exploration,cholecystectomy,hypertension,diabetes,hepatitis and cirrhosis,smoking,drinking history in the recurrence group were not statistically significant compared with those in the non recurrence group(P＞0.05),while the size of stones in the liver,diameter of common bile duct,number of stones,biliary inflammation,biliary stricture,diverticulum near the nipple,residual stones,hypercholesterolemia in the recurrence group were statistically significant compared with those in the non recurrence group(P＜0.05).Logistic multiple regression analysis showed that intrahepatic stone size≥10 mm,number of stones＞1,biliary inflammation,biliary stricture,and diverticulum adjacent to the nipple were risk factors for postoperative recurrence of hepatobiliary stones[OR values(95％ CI)were 5.032(1.812-13.977),2.585(1.007-6.632),2.512(1.013-6.230),4.571(1.775-11.72),2.925(1.023-8.363),P＜0.05].Based on the risk factors,a prediction model was constructed.The Hosmer-Lemeshow fitting test showed that x2=3.506,P=0.743.Receiver operating characteristic(ROC)curve analysis showed that the area under the ROC curve(AUC)of the prediction model for recurrence after hepatobiliary calculi surgery was 0.828,the Youden index was 0.489,and the sensitivity and specificity were 76.5％ and 72.4％,respectively.95％ CI was(0.756,0.906).The accuracy was 88.2％.Conclusion The risk prediction model for postoperative recurrence of liver and gallbladder stones constructed in this study has certain predictive value.

Objective Construct a risk model for postoperative recurrence of hepatolithiasis and validate it.Methods From January 2020 to December 2021,237 patients undergoing hepatobiliary duct stone surgery were selected.All patients underwent liver lobectomy by the same team and were divided into two groups according to whether there was recurrence during the 2-year postoperative follow-up period.Among them,there were 34 cases in the recurrence group and 203 cases in the non-recurrence group.Using binary logistic regression analysis to identify risk factors for postoperative recurrence of liver and bile duct stones,and constructing a predictive model based on the results of binary logistic regression.Using ROC curve analysis to evaluate the diagnostic efficacy of the predictive model,and verifying its validity.Results Univariate analysis showed that age,BMI,course of disease,gender,common bile duct exploration,cholecystectomy,hypertension,diabetes,hepatitis and cirrhosis,smoking,drinking history in the recurrence group were not statistically significant compared with those in the non recurrence group(P＞0.05),while the size of stones in the liver,diameter of common bile duct,number of stones,biliary inflammation,biliary stricture,diverticulum near the nipple,residual stones,hypercholesterolemia in the recurrence group were statistically significant compared with those in the non recurrence group(P＜0.05).Logistic multiple regression analysis showed that intrahepatic stone size≥10 mm,number of stones＞1,biliary inflammation,biliary stricture,and diverticulum adjacent to the nipple were risk factors for postoperative recurrence of hepatobiliary stones[OR values(95％ CI)were 5.032(1.812-13.977),2.585(1.007-6.632),2.512(1.013-6.230),4.571(1.775-11.72),2.925(1.023-8.363),P＜0.05].Based on the risk factors,a prediction model was constructed.The Hosmer-Lemeshow fitting test showed that x2=3.506,P=0.743.Receiver operating characteristic(ROC)curve analysis showed that the area under the ROC curve(AUC)of the prediction model for recurrence after hepatobiliary calculi surgery was 0.828,the Youden index was 0.489,and the sensitivity and specificity were 76.5％ and 72.4％,respectively.95％ CI was(0.756,0.906).The accuracy was 88.2％.Conclusion The risk prediction model for postoperative recurrence of liver and gallbladder stones constructed in this study has certain predictive value.

Objective:To investigate the efficacy and safety of recombinant activated factor Ⅶ(rFⅦa)on uncontrolled perioperative hemorrhage in elderly patients in surgical intensive care unit(SICU).Methods:Clinical data of 27 elderly patients with uncontrolled perioperative hemorrhage treated successfully with rFⅦa in surgery-ICU of our hospital from May 2004 to December 2018 were retrospectively analyzed.And the application method and experience were summarized.Results:Of the 27 patients, 16 cases were cured, 11 cases died, and the total fatality rate was 40.74%(11/27). The bleeding stopped in 23 cases, four cases died of uncontrolled peri-operative hemorrhage, and the hemorrhage-caused fatality rate was 14.81%(4/27). Seven patients died of primary diseases after the control of bleeding, with a fatality rate of 25.93%(7/27 ). The thrombin time(TT), prothrombin time(PT), activated partial thromboplastin time(APTT)and international normalized ratio(INR)were reduced and the prothrombin activity(AT)was increased after versus before the application of rFⅦa( Z=-2.197, -3.180, -2.271, -2.803 and 2.756, P=0.028, 0.001, 0.023, 0.005 and 0.006, respectively). Conclusions:rFⅦa has a better effect on uncontrolled peri-operative hemorrhage in elderly patients, when traditional treatments are ineffective.

OBJECTIVETo investigate the effects of fresh and preserved amniotic membrane on polymorphonuclear neutrophils (PMNs) so as to understand the anti-inflammatory mechanism of amniotic membrane transplantation.

METHODSConditioned medium was collected 48 hours after fresh or preserved amnions were cultured in DMEM and 5% CO(2) at 37 degrees C. Then, polymorphonuclear cells were cultured in conditioned culture or DMEM. Fluorescent microscopy with 4',6-diamidino-2-phenylindole (DAPI) staining and cytometry were performed 6, 9, 12, and 15 hours later.

RESULTSApoptotic neutrophils were found in each group at different time points. The percentage of apoptotic cells at 6, 9, 12, and 15 hours after culture in the fresh and preserved amnion groups and the control group was 17.3%, 24.4%, 29.8%, 37.1%, and 16.2%, 20.1%, 23.7%, 27.7%, and 10.2%, 13.7%, 21.1%, 26.4%, respectively (t test, P(1) < 0.01, P(2) < 0.01 and P(3) < 0.01).

CONCLUSIONAmniotic membrane can accelerate apoptosis of polymorphonuclear neutrophils, reduce inflammation, and prevent ocular surface collagen from resolution, indicating that fresh amnion might have a stronger effect than preserved amnion.

Amnion ; physiology ; Apoptosis ; Cells, Cultured ; Neutrophils ; cytology ; immunology