Objective To optimize the formula of Dahuang Xiaoshi decoction components based on its hepatoprotective activity and evaluate their efficacy.Methods The Wistar rats were randomly divided into blank group,model group,ursodeoxycholic acid group(positive group),and orthogonal groups of Dahuang Xiaoshi decoction components.The acute liver injury model induced by alpha-napthyl-i sothiocyanate(ANIT)was used to optimize the allocation ratio of Dahuang Xiaoshi decoction components by taking liver function indicators as an index and combining with multiple statistical methods.The additional Wistar rats were taken to induce liver injury and optimize the compatible dosage of Natrii Sulfas(0,1,2,4 g)in Dahuang Xiaoshi decoction components based on the biological signs and liver function biochemical indicators.On this basis,the Wistar rats were randomly divided into blank group,model group,ursodeoxycholic acid group and different dosages(low,medium and high)of the Zhibaihuang components group.The liver protective effect of Zhibaihuang components was systematically evaluated through the general biological signs,liver function biochemical indicators,lipid peroxide indicators,liver pathological examination and bile transport-related indicators.Results Dahuang Xiaoshi decoction components optimized by orthogonal and multiple statistics could improve the biological signs and ameliorate the biochemical abnormalities in rats with liver injury.Dahuang Xiaoshi decoction components combined with different dosages of Natrii Sulfas could slow down the mass loss of ANIT-induced acute liver injury rats(P＜0.01 or P＜0.05)and recall the abnormally elevated serum liver function enzyme activities(P＜0.01 or P＜0.05).Except for alkaline phosphatase(ALP),there was no statistical difference in regulating other liver function enzyme activity between different allocations of Natrii Sulfas.After comprehensive consideration,its composition was optimized to the Zhibaihuang components without Natrii Sulfas.Further pharmacodynamic evaluation results showed that the optimized Zhibaihuang components could improve their abnormal biological signs(P＜0.01 or P＜0.05),decrease the serum liver function enzyme activity(P＜0.01 or P＜0.05)and the levels of T-BiL and TG(P＜0.05),and restore the levels of hepatic lipid peroxide(P＜0.01 or P＜0.05),repair liver pathological injury,adjust the expression of bile transport proteins(P＜0.05),and thus exert good liver protective activity.Conclusion The optimized Dahuang Xiaoshi decoction components,Zhibaihuang components,was obtained through orthogonal,multiple statistics and univariate investigation.It could improve the abnormal biological signs of animals,protect the liver and reduce enzymes,resist lipid peroxidation,restore abnormal metabolic indicators,and repair liver pathological injury,which provides a reference for its further clinical application and development.

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

Objective:To investigate the incidence of acute kidney injury (AKI) following pancreaticoduodenectomy and related risk factors in elderly patients.Methods:The clinical data of elderly patients who underwent pancreaticoduodenectomy in Henan Provincial People′s Hospital from January 2017 to June 2020 were collected retrospectively. According to the changes of serum creatinine within 48 h or 7 days after operation, the patients were divided into AKI group and non-AKI group. The basic clinical characteristics of the two groups were compared, and the incidence of AKI was calculated. Multivariate logistic regression model was used to analyze the risk factors of postoperative AKI.Results:A total of 322 elderly patients were enrolled, with age of (67.1±5.2) years old (60-85 years old) and 186 males (57.76%). Among 322 elderly patients, there were 41 patients (12.73%) suffering from AKI following pancreaticoduodenectomy. Compared with the non-AKI group, the level of bilirubin in AKI group was higher ( Z=-2.012, P=0.044), and the level of hemoglobin in AKI group was lower ( Z=-2.111, P=0.035). Multivariate logistic regression analysis showed that increased preoperative total bilirubin ( OR=1.003, 95% CI 1.000-1.006, P=0.027) and postoperative exploratory laparotomy ( OR=3.936, 95% CI 1.071-14.460, P=0.039) were the independent influencing factors for AKI after pancreaticoduodenectomy in elderly patients. Conclusions:The incidence of AKI after pancreaticoduodenectomy in elderly patients is 12.73%. Preoperative high bilirubin and postoperative exploratory laparotomy may be the independent risk factors for AKI after pancreaticoduodenectomy in elderly patients.

Objective:To analyze the influencing factors of death in patients with acute respiratory distress syndrome (ARDS) combined with acute kidney injury (AKI) in intensive care unit (ICU) after continuous renal replacement therapy (CRRT).Methods:The demographic and clinical data of ICU patients with ARDS combined with AKI after CRRT at Henan Provincial People's Hospital from January 1, 2018 to December 31, 2018 were collected. According to the final treatment results of this hospitalization, the patients were divided into death group and survival group. Survival was defined as the improved patient's condition and hospital discharge. Death was defined as the patient's death during the ICU hospitalization or confirmed death after abandoning treatment and automatically being discharged from the hospital in the follow-up. The basic clinical characteristics and CRRT status between the two groups were compared. Multivariate logistic regression method was used to analyze the influencing factors of death in patients.Results:A total of 132 patients were enrolled, of which 90 patients (68.2%) died, with 84 males (63.6%) and median age of 59(45, 73) years. Compared with the survival group, the death group had higher age, proportion of malignant tumors, sequential organ failure assessment (SOFA) score, number of organ dysfunction and proportion of positive balance of fluid accumulation at 72 hours, longer time from entering ICU to CRRT, and lower mean arterial pressure (minimum value) and oxygenation index (all P<0.05). Multivariate logistic regression analysis results showed that the age≥60 years old ( OR=4.382, 95% CI 1.543-12.440, P=0.006), large number of organ dysfunction ( OR=1.863, 95% CI 1.109-3.130, P=0.019), high SOFA score ( OR=1.231, 95% CI 1.067-1.420, P=0.004) and long time from ICU admission to CRRT ( OR=1.224, 95% CI 1.033~1.451, P=0.020) were independent influencing factors of death in patients with ARDS combined with AKI after CRRT, and high oxygenation index ( OR=0.992, 95% CI 0.986-0.998, P=0.010) was an independent protective factor for patients' prognosis. Conclusions:The mortality of patients with ARDS combined with AKI after CRRT is still high. The age≥60 years old, large number of organ dysfunction, high SOFA score and long time from ICU admission to CRRT are independent influencing factors for death, and high oxygenation index is an independent protective factor for prognosis in patients with ARDS combined with AKI after CRRT.

Objective:To evaluate the clinical characteristics and prognosis of gallbladder cancer (GBC) patients in China.Methods:This retrospective multicenter cohort study enrolled 3 528 consecutive GBC patients diagnosed between January 2010 to December 2017 in 15 hospitals from 10 provinces. There were 1 345 (38.12%) males and 2 183 (61.88%) females.The age of diagnosis was (63.7±10.8) years old (range: 26 to 99 years old) .There were 213 patients (6.04%) in stage 0 to Ⅰ, whereas 1 059 (30.02%) in stage Ⅱ to Ⅲ, 1 874 (53.12%) in stage Ⅳ, and 382 (10.83%) unavailable. Surgery was performed on 2 255 patients (63.92%) . Three hundred and thirty-six patients received chemotherapy or radiotherapy (9.52%; of which 172 were palliative); 1 101 (31.21%) received only supportive treatment.The patient source, treatment and surgery, pathology, concomitant gallstone, and prognosis were analyzed.Results:Among the 3 528 GBC patients, 959 (27.18%) were from East China, 603 (17.09%) from East-North China, 1 533 (43.45%) from Central China, and 433(12.27%) from West China. Among the 1 578 resectable tumor, 665 (42.14%) underwent radical surgery, 913 (57.86%) underwent surgery that failed to follow the guidelines.Eight hundred and ninety-one (56.46%) patients were diagnosed before surgery, 254 (16.10%) during surgery, and 381 (24.14%) after surgery (time point of diagnosis couldn′t be determined in 52 patients) .Among the 1 578 patients with resectable tumor, 759 (48.10%) had concomitant gallstone.Among the 665 patients underwent radical surgery, 69 (10.4%) showed positive resection margin, 510 (76.7%) showed negative resection margin, and 86 (12.9%) unreported margin status.The 5-year overall survival rate (5yOS) for the 3 528-patient cohort was 23.0%.The 5yOS for patients with resectable tumor was 39.6%, for patients with stage ⅣB tumor without surgery was 5.4%, and for patients with stage ⅣB tumor underwent palliative surgery was 4.7%.Conclusions:More than half GBC patients in China are diagnosed in stage Ⅳ.Curative intent surgery is valuable in improving prognosis of resectable GBC.The treatment of GBC needs further standardization.Effective comprehensive treatment for GBC is in urgent need.

Objective:To evaluate the clinical characteristics and prognosis of gallbladder cancer (GBC) patients in China.Methods:This retrospective multicenter cohort study enrolled 3 528 consecutive GBC patients diagnosed between January 2010 to December 2017 in 15 hospitals from 10 provinces. There were 1 345 (38.12%) males and 2 183 (61.88%) females.The age of diagnosis was (63.7±10.8) years old (range: 26 to 99 years old) .There were 213 patients (6.04%) in stage 0 to Ⅰ, whereas 1 059 (30.02%) in stage Ⅱ to Ⅲ, 1 874 (53.12%) in stage Ⅳ, and 382 (10.83%) unavailable. Surgery was performed on 2 255 patients (63.92%) . Three hundred and thirty-six patients received chemotherapy or radiotherapy (9.52%; of which 172 were palliative); 1 101 (31.21%) received only supportive treatment.The patient source, treatment and surgery, pathology, concomitant gallstone, and prognosis were analyzed.Results:Among the 3 528 GBC patients, 959 (27.18%) were from East China, 603 (17.09%) from East-North China, 1 533 (43.45%) from Central China, and 433(12.27%) from West China. Among the 1 578 resectable tumor, 665 (42.14%) underwent radical surgery, 913 (57.86%) underwent surgery that failed to follow the guidelines.Eight hundred and ninety-one (56.46%) patients were diagnosed before surgery, 254 (16.10%) during surgery, and 381 (24.14%) after surgery (time point of diagnosis couldn′t be determined in 52 patients) .Among the 1 578 patients with resectable tumor, 759 (48.10%) had concomitant gallstone.Among the 665 patients underwent radical surgery, 69 (10.4%) showed positive resection margin, 510 (76.7%) showed negative resection margin, and 86 (12.9%) unreported margin status.The 5-year overall survival rate (5yOS) for the 3 528-patient cohort was 23.0%.The 5yOS for patients with resectable tumor was 39.6%, for patients with stage ⅣB tumor without surgery was 5.4%, and for patients with stage ⅣB tumor underwent palliative surgery was 4.7%.Conclusions:More than half GBC patients in China are diagnosed in stage Ⅳ.Curative intent surgery is valuable in improving prognosis of resectable GBC.The treatment of GBC needs further standardization.Effective comprehensive treatment for GBC is in urgent need.

Objective To evaluate the clinical efficacy of a single ilioinguinal approach in the surgical treatment of both-column acetabular fractures in which the anterior column was fixated by a reconstruction plate and the posterior column fixated by lag screws.Methods Between May 2013 and August 2016,a total of 23 patients with acetabular both-column fracture were treated through a single lioinguinal approach for fixation of both acetabular columns at Department of Orthopaedics,Jiangyin Hospital Affiliated to Medical College,Southeast University.They were 11 males and 12 females,aged from 20 to 71 years (mean,47.6 years).Operation time,amount of intraoperative blood loss,postoperative fracture reduction,union time and relevant postoperative complications were recorded.At the final follow-up,the function of affected hip was evaluated by Merie d'Aubigne-Postel scoring system.Results All the patients underwent the operation successfully.The operation time ranged from 120 to 210 minutes (mean,165.4 minutes).The intraoperative blood loss ranged from 320 to 1,120 mL (mean,554.8 mL).The 23 patients were followed up for 12 to 40 months (mean,28.1 months).All the fractures united well after 2 to 5 months (mean,3.7 months).According to the Matta's criteria,anatomic reduction was achieved in 17 cases,satisfactory reduction in 5 and unsatisfactory reduction in one,giving a satisfactory reduction rate of 95.7％;by the modified Merle d'Aubigne and Postel functional scores for the affected hip,13 cases were excellent,6 good,3 fair and one poor,giving an excellent and good rate of 82.6％.The complication rate during follow-up was 8.7％ (2/23).One case suffered from palsy of the lateral femoral cutaneous nerve but the symptom was relieved one month postoperatively without any treatment.One patient developed deep venous thrombosis at a lower extremity which responded to anticoagulant therapy.Conclusion Surgical treatment of acetabular double column fractures through a single ilioinguinal approach for fixation of the anterior column with a reconstruction plate and fixation of the posterior column with lag screws can achieve excellent control of reduction and fixation,which is less traumatic but leads to satisfactory clinical effects.

Objective To investigate the clinical features and treatment of residual gallbladder lesions after cholecystectomy.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 83 patients with residual gallbladder lesions after cholecystectomy who were admitted to the Affiliated Hospital of Inner Mongolia Medical University between January 2009 and April 2016 were collected.Among the 83 patients,74 had residual gallbladder (41 combined with bile duct stones and 33 with simple residual gallbladder)and 9 had simple residual bile duct stones.Patients received laboratory and imaging examinations,and then selected suitable surgery according to residual lesions.Observation indicators included:(1) clinical features:medical history,clinical manifestation,features of laboratory and imaging examinations;(2) surgical and postoperative situations:surgical procedure,operation time,volume of intraoperative blood loss,time of drainagetube removal,postoperative complications and duration of postoperative hospital stay;(3) postoperative pathological examination;(4) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and recurrence of lesions using abdomen color Doppler ultrasound up to October 2016.Measurement data with normal distribution were represented as ~ ±s.Results (1) Clinical features:① medical history:all the 83 patients had histories of cholecystectomy,including 57 with emergency operation and 26 with selective operation.② Clinical manifestation:initial clinical manifestation occurred at 1-324 months postoperatively,with an average time of 96 months.Of 83 patients,49 had right upper abdominal colic associated with right shoulder or back rediating pain,fever,nausea and vomiting,24 had jaundice as the main symptoms,8 had gradually worse conditions,with right upper quadrant abdominal pain,chills and fever associated with jaundice in the advanced stage and 2 had abdominal discomfort associated with incomplete intestinal obstruction.③ Laboratory examination:elevated alanine transaminase (ALT) and aspartate transaminase (AST) levels were detected in 48 patients,elevated total bilirubin (TBil) level in 28 patients and elevated serum and urinary amylase level in 4 patients,respectively.④ Imaging examination:of 83 patients,77 had positive results of magnetic resonanced eholangio-pancreatography (MRCP),43 had positive results of abdominal color Doppler ultrasound and 39 (4 combined with pancreatitis) had positive results of abdominal computed tomography (CT).(2) Surgical and postoperative situations:all the 83 patients underwent surgery.Of 74 patients with residual gallbladder,72 underwent residual gallbladder resection (of 41 combined with bile duct stones,35 undergoing residual gallbladder resection + bill duct exploration and removing the stone + T-tube drainage,6 initially undergoing endoscopic sphincterotomy for removing bile duct stones and then residual gallbladder resection and 31 undergoing simple residual gallbladder resection),1 combined with residual gallbladder cancer underwent residual gallbladder resection + common bile duct resection + hepatic duct-jejunum internal drainage and 1 combined with residual gallbladder cancer and common bile duct space-occupying lesion underwent palliative biliary-enterostomy.Nine patients with simple residual bile duct stones underwent endoscopic sphincterotomy for removing bile duct stones.Operation time,volume of intraoperative blood loss,time of drainage-tube removal and duration of postoperative hospital stay were (92±39)minutes,(63±12)mL,(5±4)days and (9±5)days in 74 patients with residual gallbladder,respectively.There was no severe postoperative complication.Operation time,volume of intraoperative blood loss and duration of postoperative hospital stay were (57±33)minutes,(25±9)mL and (5 ± 3) days in 9 patients with simple residual bile duct stones,respectively.No severe complication was occurred in 9 patients.(3) Postoperative pathological examination:the length of residual cystic duct in 74 patients with residual gallbladder was (2.8 ± 1.0) cm,combining with stones.Of 74 patients,simple hyperplasia of residual gallbladder were detected in 54 patients,dysplasia in 14 patients,tumor-like hyperplasia and benign tumor in 4 patients and adenocarcinoma in 2 patients.(4) Follow-up situation:all the 83 patients were followed up for 6-71 months,with a median time of 33 months.Eighty-one patients were healthy survival,without recurrence of lesions.One patient had recurrence of bile duct stones at 34 months postoperatively,and then was cured by choledochojejunostomy,without recurrence up to the end of follow-up.One patient with residual gallbladder cancer complicated with common bile duct space-occupying lesion died at 9 months postoperatively.Conclusions Patients have recurrent right upper abdominal colic associated with right shoulder or back rediating pain,fever and jaundice after cholecystectomy,and lesions of residual gallbladder or bile duct stones should be considered.Reoperation is safe and feasible for patients,with a good clinical outcome.

Objective To summarize the features of computed tomography (CT) and magnetic resonance imaging (MRI) of autoimmune pancreatitis (AIP) and investigate the key points of diagnosis and identification.Methods The retrospective and descriptive study was conducted.The clinical data of 21 patients with AIP who were admitted to the Affiliated Hospital of Inner Mongolia Medical University between February 2012 and February 2015 were collected.All the patients underwent plain and enhanced scans of CT and MRI,and magnetic resonanced cholangio-pancreatography (MRCP),and then received hormone therapy.Eleven patients with pancreatic cancer and 11 normal subjects who were diagnosed by MRI in the same period were selected,and apparent diffusion coefficient (ADC) was calculated and compared.Observation indicators:(1) situation of imaging examination:① pancreatic manifestations:density,signal,atrophy,calcification and enlargement of pancreas,change of pancreatic duct,② manifestations out of pancreas:changes of biliary tract system and kidney,③ diffusion weighted imaging (DWI) and ADC:comparisons of ADC among AIP,pancreatic cancer and normal pancreas;(2) diagnosis;(3) treatment and follow-up.The follow-up using outpatient examination and telephone interview was performed to detect the clinical symptoms and signs up to February 2016.Measurement data with normal distribution were represented as (-x)-± s.Comparisons among groups were done using one-way ANOVA.Pairwise comparison was analyzed by Dunnett'T3 test.Results (1) Situation of imaging examination:Of 21 patients,17 received scan of CT and 11 received scan of MRI (7 combined with scan of CT).① Pancreatic manifestations:14 patients had diffuse enlargement of pancreas,with full edge and “sausage-like” change.Plain scan of CT showed uniform isodense shadow,and enhanced scan showed that reduced enhancement in arterial phase and gradually homogenous enhancement in portal vein phase and lag phase with no enhancement in edge of pancreas.Plain scan of MRI showed lesions were manifested as slight hypointensity on T1 weighted imaging (T1WI),slight hyperintensity on T2WI and hyperintensity on DWI.Enhanced scan of MRI showed delayed enhancement,edge of lesions was manifested as slight hypointensity on T1WI and T2WI,without enhancement.Atrophy and calcification of pancreas:3 patients had atrophy of pancreatic parenchyma in which scattered calcification were seen.Enlargement of pancreas:4 patients had localized enlargement of pancreas showing “false tumor-like” change,including 2 with localized enlargement in head of pancreas.Change of pancreatic duct:MRCP showed that diffuse stenosis,local stenosis and local dilatation of pancreatic ducts were respectively detected in 4,3 and 1 patients.② Manifestations out of pancreas:11 patients had changes of biliary tract system,showing intrahepatic bile duct and common bile duct dilation,partial stenosis and extensive bile duct wall thickening.Enhanced scan of MRI showed there was obvious enhancement of bile duct wall.MRCP of 4 patients showed that the beak-like stenosis was seen in the distal common bile duct.Three patients had kidney changes,enhanced scan of CT showed that kidney demonstrated patch-shape hypodense shadow in arterial phase and homogenous enhancement of patch-shape hypodense shadow in lag phase,and plain scan of MRI showed that kidney lesions demonstrated equal signal on T1WI fat suppression (FS) and patch-shape low signal on T2WI FS.Lesions had gradually homogenous enhancement in substance phase and lag phase.③ DWI and ADC:lesions in patients with AIP and pancreatic cancer demonstrated high signal on DWI (b =1 000 s/mm2) compared with adjacent tissues (no involvement in pancreas or normal pancreatic parenchyma),ADC of pancreas in patients with AIP,with pancreatic cancer and with normal population was (0.001 30 ± 0.000 35)mm2/s,(0.000 80 ± 0.000 14) mm2/s and (0.001 60-± 0.000 24) mm2/s,respectively,with a statistically significant difference (F =30.409,P ＜ 0.05).There were statistically significant differences between patients with pancreatic cancer and patients with AIP or normal population (P ＜ 0.05) and no statistically significant difference between patients with AIP and with normal population (P ＞ 0.05).(2) Diagnosis:11 patients were diagnosed by CT examination,with a diagnostic accuracy of 11/17.Eight patients were diagnosed by MRI examination,with a diagnostic accuracy of 8/11.One patient was misdiagnosed as cancer of pancreatic head by CT and MRI examinations,and 1 was misdiagnosed as cancer in the distal common bile duct.(3) Treatment and follow-up:21 patients underwent regular hormone therapy,and 40 mg prednisolone was given orally a daily for 3-4 weeks and then gradually reduced to 5 mg up to complete relief of the symptoms.All the 21 patients were followed up for 12-45 months.Of 17 patients with abdominal pain and distension,symptoms of 7 patients disappeared and symptoms of 10 patients decreased or occasionally occurred.Of 10 patients associated with jaundice,symptoms of 7 and 2 patients disappeared and decreased,respectively,and symptoms of 1 patient subsided.Conclusion CT and MRI examinations of pancreas demonstrate “sausage-like” and “false tumor-like” changes,the non-neoplastic bile and pancreatic duct stenosis combined with IgG4 related diseases in other organs is an important imaging evidence for diagnosis and differential diagnosis of AIP.

Objective To observe the blood flow changes of left ventricular cavity and quantify the energy loss (EL) and circulation of left ventricular during systole and diastole in patients with dilated cardiomyopathy(DCM) via vector flow mapping(VFM).Methods Thirty-six healthy volunteers and 32DCM patients were enrolled.According to the severity of mitral regurgitation(MR),DCM patients were divided into two groups.The quantitative parameters,including average energy loss(EL-base,EL mid,EL-apex) and circulation (vortex quantity,vortex area,circulation) were measured in the different periods of VFM imaging mode in apical four-chamber view,apical three-chamber view and apical two-chamber view respectively.The difference of parameters was evaluated between different groups during the different periods.The early transmitral valve blood flow velocity E,the late transmitral valve blood flow velocity A,the ratio of early transmitral valve blood flow velocity to the early diastolic mitral valve velocity E/e,the ratio of early transmitral valve blood flow velocity to the late transmitral valve blood flow velocity E/A and Tei index were derived via dual-Doppler imaging technology.Meanwhile,the correlation between VFM parameters with E,A,E/A,E/e or Tei index was also analyzed.Results ①The level of EL were decreased significantly among EL-mid and EL-apex during early diastole,EL-mid during mid-systole,EL-mid and EL-apex during late-systole (P ＜0.05),when compared with the control group.The vortex quantity,vortex area and circulation during early diastole and the vortex area and circulation during atrial contraction period were significantly different between two groups (all P ＜ 0.05).As for mid-diastole,only vortex area showed significant difference (P ＜0).01).(②) When compared with different grades of MR in DCM patients,the level of all segments EL during diastole and EL-base during systole increased with severity of MR(P ＜0.05).The circulation during diastole also increased with the severity of MR(P ＜0.05).③The vortex area and circulation had positive correlation with E/e during diastole in all subjects(all P ＜0.05).The vortex area during atrial contraction period and early diastole had positive correlation with E/A and Tei index in all subjects(r =0.630,0.345,0.468,0.316,0.663,0.264,respectively,allP ＜0.01).EL-mid during late-systole were negatively correlated with LV end diastolic volume,end systolic volume,but positively correlated with ejection fraction in all subjects(r =0.335,-0.312,0.340,respectively,all P ＜0.05).While,there was positive correlation between E/A with the basal segment of mid-diastole(r =0.376,P ＜0.01).Conclusions The visualization of hydromechanics inside the heart of DCM patients could be directly accomplished by VFM,which can provide a new method for diagnosis and evaluation of DCM.