Objective: To explore the clinical characteristics of various types of infected pancreatic necrosis(IPN) and the prognosis of different treatment methods in the imaging classification of IPN proposed. Methods: The clinical data of 126 patients with IPN admitted to the Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from December 2018 to December 2021 were analyzed retrospectively. There were 70 males(55.6%) and 56 females(44.4%), with age(M(IQR)) of 44(17)years (range: 12 to 87 years). There were 67 cases(53.2%) of severe acute pancreatitis and 59 cases (46.8%) of moderately severe acute pancreatitis. All cases were based on the diagnostic criteria of IPN. All cases were divided into Type Ⅰ(central IPN)(n=21), Type Ⅱ(peripheral IPN)(n=23), Type Ⅲ(mixed IPN)(n=74) and Type Ⅳ(isolated IPN)(n=8) according to the different sites of infection and necrosis on CT.According to different treatment strategies,they were divided into Step-up group(n=109) and Step-jump group(n=17). The clinical indicators and prognosis of each group were observed and analyzed by ANOVA,t-test,χ² test or Fisher exact test,respectively. Results: There was no significant difference in mortality, complication rate and complication grade in each type of IPN(all P>0.05). Compared with other types of patients, the length of stay (69(40)days vs. 19(19)days) and hospitalization expenses(323 000(419 000)yuan vs. 60 000(78 000)yuan) were significantly increased in Type Ⅳ IPN(Z=-4.041, -3.972; both P<0.01). The incidence of postoperative residual infection of Type Ⅳ IPN was significantly higher than that of other types (χ²=16.350,P<0.01). There was no significant difference in the mortality of patients with different types of IPN between different treatment groups. The length of stay and hospitalization expenses of patients in the Step-up group were significantly less than those in the Step-jump group(19(20)days vs. 33(35)days, Z=-2.052, P=0.040;59 000(80 000)yuan vs. 122 000(109 000)yuan,Z=-2.317,P=0.020). Among the patients in Type Ⅳ IPN, the hospitalization expenses of Step-up group was significantly higher than that of Step-jump group(330 000(578 000)yuan vs. 141 000 yuan,Z=-2.000,P=0.046). The incidence of postoperative residual infection of Step-up group(17.4%(19/109)) was significantly lower than that of Step-jump group(10/17)(χ²=11.980, P=0.001). Conclusions: Type Ⅳ IPN is more serious than the other three types. It causes longer length of stay and more hospitalization expenses. The step-up approach is safe and effective in the treatment of IPN. However, for infected lesions which are deep in place,difficult to reach by conventional drainage methods, or mainly exhibit "dry necrosis", choosing the step-jump approach is a more positive choice.
Male ; Female ; Humans ; Retrospective Studies ; Pancreatitis, Acute Necrotizing/complications* ; Acute Disease ; Intraabdominal Infections/complications* ; Necrosis/complications* ; Treatment Outcome

Objective To investigate the feasibility of extralevator abdominoperineal excision ( ELAPE) under laparoscope .Methods We retrospectively analyzed 12 patients with distal rectal cancer who underwent ELAPE in our center from June 2012 to August 2013 .During the procedures , the levator ani muscles were cut off laparoscopically at its origin at both sides on the pelvic wall , and its attachment on coccyx was removed posterior-ly.The dissection plane was taken along the Denonvillier fascia anteriorly as far as possible to the perineal body . The adjacent organs were removed if invaded by the tumors .The anus and its surrounding tissue were removed by perineal approach without changing patients'positions .The pelvic perinium was closed laparoscopically to prevent the intestine dropping .The operation time , blood loss , retrieval of lymph nodes , radial margin , and postoperative complications were recorded .Results The patients aged ( 65.2 ±12.5 ) years and their body mass index was 21.6 ±3.1.The distance from lower edge of tumor to anal verge was (3.3 ±0.7) cm.The procedure lasted (176.1 ±27.5) minutes, with a blood loss of (49.6 ±38.2) ml.The average number of node retrieval was 18.3 ±7.8 , and no positive radial margin was identified .The postoperative complications included urinary reten-tion in 2 patients.The perineal incision appeared to be class A healing in 9 patients.Conclusion By extensive-ly removing the levator ani muscles laterally and posteriorly , ELAPE procedure can be accomplished under lapa-roscope without changing operative position or flap repair of the pelvic floor .

Adolescent ; Adult ; Analgesics ; administration & dosage ; Anesthetics, Intravenous ; administration & dosage ; Flurbiprofen ; administration & dosage ; Humans ; Hypnotics and Sedatives ; administration & dosage ; Midazolam ; administration & dosage ; Middle Aged ; Molar, Third ; Pain Measurement ; Pain, Postoperative ; prevention & control ; Patient Satisfaction ; Preoperative Care ; Prospective Studies ; Tooth Extraction ; Young Adult

The LEAFY (LFY) homologous gene of Dendrobium moniliforme (L.) Sw. was cloned by new primers which were designed based on the conservative region of known sequences of orchid LEAFY gene. Partial LFY homologous gene was cloned by common PCR, then we got the complete LFY homologous gene Den LFY by Tail-PCR. The complete sequence of DenLFY gene was 3 575 bp which contained three exons and two introns. Using BLAST method, comparison analysis among the exon of LFY homologous gene indicted that the DenLFY gene had high identity with orchids LFY homologous, including the related fragment of PhalLFY (84%) in Phalaenopsis hybrid cultivar, LFY homologous gene in Oncidium (90%) and in other orchid (over 80%). Using MP analysis, Dendrobium is found to be the sister to Oncidium and Phalaenopsis. Homologous analysis demonstrated that the C-terminal amino acids were highly conserved. When the exons and introns were separately considered, exons and the sequence of amino acid were good markers for the function research of DenLFY gene. The second intron can be used in authentication research of Dendrobium based on the length polymorphism between Dendrobium moniliforme and Dendrobium officinale.
Amino Acid Sequence ; Base Sequence ; DNA, Plant ; genetics ; Dendrobium ; genetics ; Exons ; Introns ; Orchidaceae ; genetics ; Phylogeny ; Plant Leaves ; genetics ; Plant Proteins ; genetics ; Plants, Medicinal ; genetics ; Sequence Alignment ; Sequence Homology, Amino Acid

OBJECTIVETo study the toxicity changes of different proportions of Radix Adenophora, Radix Glehniae combined with Veratrum nigrum L., thus providing acute toxicity data and investigating whether decoction factors were correlated with toxicity.

METHODSThe uniform design method was used by two factors and seven levels to investigate the toxicity changes in different proportions of Radix Adenophora, Radix Glehniae combined with Veratrum nigrum L. The decoction factors were also investigated.

RESULTSThe compatibility toxicity was affected mainly by Veratrum nigrum L. and the toxicity increased along with increased doses of Veratrum nigrum L. The toxicity of co-decoction was higher than mixed decoction in the same dosage of Radix Glehniae and Veratrum nigrum L. The promotion of the dissolution of the toxic component of Veratrum nigrum L. in co-decoction may be the cause of the higher toxicity.

CONCLUSIONRadix Adenophora and Radix Glehniae combined with Veratrum nigrum L. resulted in higher toxicity, which indicated that the incompatibility between Radix Adenophora, Radix Glehniae, and Veratrum nigrum L. In clinic practice, a prescription contained these drugs should be avoided.

Animals ; Drug Antagonism ; Drug Incompatibility ; Drugs, Chinese Herbal ; administration & dosage ; toxicity ; Female ; Male ; Mice

OBJECTIVELaparoscopic colorectal surgery is a skill-dependent procedure. The present study aims to analyze the learning curve of a properly trained surgeon, with basic laparoscopic techniques, to become skillful in performing laparoscopic colorectal operations.

METHODSA series of non-selective, consecutive 189 cases of laparoscopic colorectal surgery were accomplished, from December 2009 to February 2012, by one surgeon with years of skilled technique in laparoscopic cholecystectomy, rich experience in assisting laparoscopic colorectal surgery, and experience of approximately 180 procedures of gastric and colorectal surgery annually. 170 out of 189 procedures were radical operations for colorectal neoplasma, including right colectomies in 28 cases, left colectomies in 5 cases, sigmoidectomies in 28 cases, high Dixon procedures in 45 cases, low Dixon (total mesorectal excision, TME) procedures in 41 cases and Miles procedure in 23 cases. 19 other patients underwent combined procedures for multi-primary tumors or inflammatory enteritis. All these procedures were analyzed according to time span (the earlier half and later half) in respect to length of surgery, intraoperative blood loss, number of lymph nodes retrieved, intraoperative events and postoperative complications.

RESULTSFor radical right colectomy, the D2 dissection conducted in the earlier phase (n = 8) had the similar length of surgery, more blood loss and less LN retrieval, compared with the D3 dissection conducted in recent phase (n = 20). The earlier performed high Dixon procedures (n = 22) consumed longer time than the later procedures (n = 23) consumed, but with similar blood loss and LN retrieval. Low Dixon (TME) procedures showed significant differences in length of surgery and blood loss relative to time span. Recently performed simoidectomy and Miles procedures showed a trend of shorter time consumed compared with earlier performed procedures. Conversion ratio to open surgery was 1.05%. Adverse effects occurred in 8 cases of surgeries, including intestinal injury (3/189), insufficient distal margin (2/189), intraoperative bleeding (2/189) and vaginal injury (1/76). There was no operative death. Chief complications included urinary retention 5.82%, ileus 4.76%, anastomotic leak 4.24%, perineal infection 23.08% (6/26), wound dehiscence 2.65%, gastrointestinal bleeding 1.59%, peritoneal infection 1.06%. Surgery for distal rectum tended to have more complications, such as urinary retention, anastomotic leak and perineal infection. The later performed low Dixon procedures produced insignificantly fewer anastomotic leaks than those in the earlier phase.

CONCLUSIONSFor a trained surgeon with basic laparoscopic techniques, there are at least 15 - 25 cases of different procedures needed for him/her to become skilled to perform laparoscopic surgery. The learning curve should also depend on the annual number of colorectal surgeries.

Aged ; Colonic Diseases ; surgery ; Colorectal Neoplasms ; surgery ; Colorectal Surgery ; methods ; Female ; Humans ; Laparoscopy ; methods ; Learning Curve ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; Treatment Outcome

Adult ; Homosexuality, Male ; psychology ; Humans ; Male ; Students ; psychology ; Surveys and Questionnaires ; Unsafe Sex

Objective To investigate the behavioral characteristics of men who have sex with men(MSM)with sadomasochism associated bleeding and to analyze the relationship with HIV/AIDS high risk behavior.Methods Using modified snowball sampling methods(target sampling methods)to carry out a cross-sectional study on persons with behavior of sadomasochism that associated with bleeding in MSM,using a valid questionnaire.Another control group without the related behavior was set up.SPSS 13.0 was used.Results People practicing sadomasochism associated with bleeding had higher percentage in the following indicators:number of accumulated same gender sexual partners (median=20),anal intercourse(median=10),oral intercourse(median=10),hand intercourse (median=15)with same gender sexual partners,number of same gender sexual partners in the previous six months(median=4),numbers of anal intercourse(median=3),hand intercourse(median=3),were more than in the control group.People with sadomasochism associated bleeding had higher rates in the following behaviors:condom was ever broken or slipped in the previous six months (22.6%),suffering from disease of sexual transmitted infections(28.0%),involving in group-sex intercourse(34.8%),having sex with same sex strangers at the place for MSM in the previous six months(62.2%),ever having initiative or passive behavior of oral-anal sex(64.0%),fist-sex(18.9%),finger-sex(66.7%),bleeding during sexual intercourse(58.3%),first coition object was pupil (33.8%),having strong suicide attempts(33.3%)and suicide attempt(23.6%)etc.were more than in the control group.Conclusion MSM who had the behavior of sadomasochism which associated with bleeding had the higher percentage of HIV/AIDS high risk behaviors than the persons without those behaviors.The latter group called for special concern on interventions.

ObJective To study the hypothalamic-pituitary-adrenal (HPA) axis function with dexamethasone suppression test (DST) in inpatients with unipolar depression or bipolar disorder at different mood states. Methods DST was performed in 38 inpatients with unipolar depression and 63 with bipolar disorder ([19 with type Ⅰ, 44 with type Ⅱ], [33 with depressive episode, 18 with manic episode and 12 with combined episodes]). After 4 weeks' treatment, DST was performed again on 17 patients with unipolar depression and 35 with bipolar disorder to compare the negative suppression ratio. Results Before treatment, the negative suppression rate of DST was significantly different between unipolar depression (36.8%) and bipolar disorder (14.3%), type Ⅰ bipolar disorder (10.5%), type Ⅱ bipolar disorder (15.9%) or bipolar disorder with current depressive episode (15.2%) (P<0.05). However, no statistic differences were showed among type Ⅰ bipolar disorder and type Ⅱ bipolar disorder, depressive episode of bipolar disorder (15.2%), manic episode of bipolar disorder (16.7%) or combined episodes of bipolar disorder (11.1%) (P>0.05). After treatment, the same comparison was performed, but negative suppression rate of DST was not significantly different among all the groups (P>0.05). With the clinical improvement, negative suppression rate of DST decreased in patients with unipolar disorder;while no significant differences were found between pre-treatment and post-treatment in patients with both unipolar and bipolar disorders (P>0.05). Conclusion At the status of illness, the negative suppression rate of DST in the unipolar depression, being independent from the clinical subtypes, types of episode and severity of the illness in bipolar disorder, is much higher than that in the bipolar disorder.