Thirty patients with obstructive jaundice were investigated for serum complement-3 (C3) and plasma fibronectin (FN).The levels of C3 and FN of the juandiced patients were higher than that of thirty patients without obstructive jaundice (Ｐ＜0.01). As compared to pre-operation, the level of C3 of the jaundiced patients decreased obviously within two weeks after operation(Ｐ＜0.01), and recovered in the third week after operation. The level of FN of the juandice patients decreased evidently within one week(Ｐ＜0.01), and recovered in the second week after operation. However, the levels of C3 and FN of the patients without obstructive jaundice changed slightly after operation (Ｐ＜0.05). The high levels of C3 and FN of jaundiced patients may be relative to the latent infection. Consumption and immune imparing may be the reasons of C3 and FN to decrease.
Objective Ｔo summarize the advancement of ABO-incompatible liver transplantation. Methods Relevant literatures about ABO-incompatible liver transplantation, which were published recently domestic and abroad were reviewed and analyzed. Results Owing to various treatments recent years, outcomes of ABO-incompatible liver transplantation have been improved dramatically. Conclusion With effective immnosuppressive protocols and effective perioperative management, ABO-incompatible liver transplantation is feasible.
ObjectiveTo evaluate the safety of arthroscopic operation with artificial space on the buttocks for gluteal muscles contracture (GMC) by measuring the plasma osmolarity.
MethodsBetween May and June 2011, 30 cases of GMC were joined in the study. Of them, 11 were male and 19 were female with an age range from 4 to 39 years (mean, 24.4 years). Twenty-eight patients had a definite history of repeat intragluteal injection. The disease duration ranged from 1-30 years (mean, 14 years). During operation, normal saline solution was used as lavage fluid, and radiofrequency energy was used as cutter for releasing GMC. The plasma sodium, plasma potassium, blood glucose, blood urea nitrogen concentrations, and plasma osmolarity were compared before and after operation; input and output volume of lavage fluid and intravenous dropping volume were recorded. Whether patients suffered from water intoxication or not was observed. The effect was evaluated through the criteria proposed by XIA Rongxi et al.
ResultsThe operation was successfully completed in all patients, who had no water intoxication. The operation time was 16-70 minutes (mean, 33.4 minutes). The input volume was 2-23 L (mean, 6.3 L), the output volume was 2-22 L (mean, 5.8 L), and the absorption volume was 0.1-1.2 L (mean, 0.5 L); and the intravenous dropping volume was 350-1 300 mL (mean, 850 mL). No significant difference was found in plasma sodium, plasma potassium, blood glucose, blood urea nitrogen concentrations, and plasma osmolarity between before and after operations (P>0.05). All patients were followed up 3-26 months (mean, 12.7 months). At last follow-up, according to XIA Rongxi's et al evaluation standard, the results were excellent in 27 cases, good in 3 cases, and the excellent and good rate was 100%.
ConclusionArthroscopic operation with artificial space on the buttocks is safe and reliable in the treatment of GMC.
Plasma exchange (PE) is a therapeutic blood component replacement method. The blood of patients is first separated into plasma and blood cell components using a blood cell separator in vitro, the plasma containing harmful pathogenic substances is then discarded and replaced with the same volume of exchange solution. Finally the separated blood cells together with the exchange solution are returned back to the blood circulation of patients. By reducing the circulating antibodies, abnormal plasma proteins or cytokines and other pathogenic molecules, PE can block the disease process. PE has a good therapeutic effect on neuromyelitis optica-related optic neuritis (NMO-ON), which shows resistant to glucocorticoid therapy for the first onset. The American Society for Apheresis guideline evaluates PE for acute optic neuritis as a recommended grade 1B, type II indication. In the implementation of PE treatment for NMO-ON and other diseases, indications and contraindications should be strictly adhered to the guideline, treatment procedures and protocols should be optimized, common adverse events and its prevention and management should be known and alerted. It is important to conduct multi-center clinical cooperation and a high standard clinical randomized controlled study, to find out the optimal time window, the best protocol, and the associated factors for the efficacy and prognosis of PE in NMO-ON.
Objective To evaluate the effect of methylation determination about the peripheral plasma DNA in diagnose of hepatocellular carcinoma （HCC） and select the highly sensitive and specific methylated cancer suppressor genes. Methods Methylation-specific PCR （MSP） was used to detect the degree of methylation about SLIT2 and DAPK genes in peripheral plasma and associated cancer tissues of 34 patients with HCC confirmed by pathology, then analyzed their relationship to clinicopathologic feature. Results The positive rate of the promoter methylation of SLIT2 and DAPK genes in cancer tissues in 34 cases were 70.6% （24/34） and 79.4% （27/34）, while the relevant promoter methylation rate in plasma were 44.1% （15/34） and 50.0% （17/34） correspondingly. The sensitivity of detection of DNA methylation about SLIT2 and DAPK genes in plasma was 62.5% and 63.0%, respectively；both of the specificity for them were 100%. The negative predicted value was 52.6% and 41.2%, respectively；while both of the positive predicted value were 100%. There were no significant correlation between the clinicopathologic features and the methylation rate in cancer tissues and plasma （P＞0.05）. In plasma of patients whose AFP＜400 μg/L, the positive rate of combined detection of DNA methylation of SLIT2 and DAPK was 61.1% （11/18）. Conclusions The detection rate of DNA methylation of SLIT2 and DAPK genes in plasma is higher, and there is a significant correlation between the DNA methylation in HCC tissue and plasma, based on MSP method. DNA methylation in plasma, as an non-invasive method, could be used to diagnose HCC, especially for the patients whose AFP is negative. HBV infection may be only associate with DNA methylation of part gene.
ObjectivesTo systematically review the prognostic value of plasma soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) level in predicting 28-day mortality in sepsis.MethodsPubMed, The Cochrane Library, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect studies about the prognostic value of plasma sTREM-1 in early 28-day mortality in sepsis from inception to April 16th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 14.0 software.ResultsA total of 13 studies involving 1 115 patients were included. The results of meta-analysis showed that the sensitivity and specificity were 79% and 77%, respectively. The positive likelihood ratio and the negative likelihood ratio were 3.4 and 0.28, respectively. The diagnostic ratio was 12. The overall area under the summary receiver operator characteristic (SROC) curve was 0.80.ConclusionsCurrent evidence shows that plasma sTREM-1, as a single index, may play a prognostic role in the early 28-day mortality of sepsis in patients. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo evaluate the safety and clinical efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) versus transurethral plasma kinetic enucleation of the prostate (PKEP) in the treatment of benign prostate hyperplasia (BPH).MethodsRandomized controlled trials of HoLEP versus PKEP in the treatment of BPH published between January 2000 and March 2021 were searched in PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP database, and Wanfang database. Operative duration, estimated intraoperative blood loss, average duration of urinary catheterization, average duration of bladder irrigation, average length of hospital stay, and postoperative complications were used as safety evaluation indicators. Postoperative International Prostatic Symptomatic Score (IPSS), postoperative maximum urinary flow rate (Qmax), postoperative quality of life (QoL), and postvoid residual (PVR) were used as effective evaluation indicators.ResultsA total of 14 randomized controlled trials were included in this study, with a total of 1 478 patients (744 in the HoLEP group and 734 in the PKEP group). The results of the meta-analysis showed that the intraoperative blood loss in the HoLEP group was less than that in the PKEP group [weighted mean difference (WMD)=?25.95 mL, 95% confidence interval (CI) (?31.65, 20.25) mL, P=0.025], the average duration of urinary catheterization [WMD=?10.35 h, 95%CI (?18.25, ?2.45) h, P=0.042], average duration of bladder irrigation [WMD=?10.28 h, 95%CI (?17.52, ?3.04) h, P=0.038], and average length of hospital stay [WMD=?1.24 d, 95%CI (?1.85, ?0.62) d, P=0.033] in the HoLEP group were shorter than those in the PKEP group, and the incidence of postoperative complications [risk ratio=0.70, 95%CI (0.56, 0.87), P=0.047] and 6-month postoperative Qmax [WMD=?0.89 m/s, 95%CI (?1.74, ?0.05) m/s, P=0.037] in the HoLEP group were lower than those in the PKEP group. However, there was no significant difference in the operative duration, 3-month postoperative IPSS, 3-month postoperative Qmax, 3-month postoperative QoL, 3-month postoperative PVR, 6-month postoperative IPSS, 6-month postoperative QoL, or 6-month postoperative PVR between the two groups (P>0.05).ConclusionsIn the treatment of BPH, the effectiveness of HoLEP does not differ from that of PKEP, but HoLEP is safer. The conclusions of this study need to be verified in more precisely designed and larger sample-sized multi-center randomized controlled trials.
Abstract： Objective To summarize the clinical experiences of performing extracorporeal membrane oxygenation (ECMO) on patients with heart and respiratory failure, and compare the clinical outcomes of Medtronic system and Quadrox PLS system. Methods We retrospectively analyzed the clinical data of 121 heart and respiratory failure patients who underwent ECMO treatment in Fu Wai Hospital from December 2004 to December 2009. Based on the different systems used, 121 patients were divided into two groups. In group M, there were 65 patients including 41 males and 24 females, with an age of 26.6±25.9 years; and they accepted Medtronic ECMO system treatment. In group Q, there were 56 patients including 39 males and 17 females, with an age of 32.4±23.9 years and they underwent Quadrox PLS ECMO system treatment. The evaluation of the clinical outcomes of these two different systems was based on the comparison of transmembrane pressure drop (TMPD), anticoagulation, hemolysis, plasma leakage, organ function, complication and hospital mortality between the two groups. Results Compared with group M, ECMO with Quadrox PLS system was associated with lower TMPD (at the beginning of ECMO: 15.0±6.0 mm Hg vs.28.0±5.0 mm Hg, P=0.000; 24 hours later: 16.0±5.0 mm Hg vs. 30.0±7.0 mm Hg, P=0.000) and less thrombus formation(7.1% vs.23.1%, P=0.037), less plasma leakage (0.0% vs. 50.8%, P=0.000), less hemolysis (14.3% vs. 29.2%, P=0.047). There were no significant differences between the two groups in support duration, complication rate, and hospital mortality(Pgt;0.05). Conclusion Both devices have similar effects for safe clinical application, but Quadrox PLS ECMO system has a relatively high biocompatibility with lower TMPD, less plasma leakage, and thrombus formation.
ObjectiveTo summarize the clinical manifestations and treatment of plasma cell mastitis.
MethodsWe retrospectively analyzed the diagnosis and treatment of 53 patients with plasma cell mastitis admitted into the hospital between January 2008 and December 2014.
ResultsTwelve patients with nipple discharge underwent mammary gland segment resection in which the complete discharging tube system and part of the normal gland were resected. In the 26 patients with inflammatory masses, 12 had acute inflammation with mass formation who were treated with abscess incision drainage and silver alginate wound dressing before second-stage lesion resection. Fourteen patients with only local swelling, tenderness and no abscess formation underwent lesion resection after the abscesses were reduced by combined traditional Chinese medicine (TCM) and western medical treatment. Seven patients with painless mass all had abscesses in the areola area, among whom 5 had complete inflammatory capsule and they underwent lumpectomy. Two patients had cheese-like tissue beside the abscess, and they underwent segmental resection. In the 8 patients with chronic fistula, one at the age of 51 was cured by simple mastectomy after recurrence, and the other 7 underwent lesion resection after combined TCM and western medical treatment. All the 53 patients were diagnosed to have plasma cell mastitis by surgical biopsy, and they were all cured with no recurrence 6 months after surgery.
Conclusions Plasma cell mastitis is usually misdiagnosed because of its diversified clinical manifestations. For patients whose lesion is large and not confined, it's better for them to receive combined TCM and western medical treatment. Surgical time and approach should be chosen appropriately. Surgical lesion resection is the only method for complete treatment in patients with plasma cell mastitis.
Objective To study the therapeutic effect of Roux-en-Y gastric bypass （RYGB） on type 2 diabetes mellitus （T2DM） rats and explore the possible mechanism of vaspin in RYGB on T2DM. Methods Twenty SD rats with T2DM and 20 age- and sex-matched normal SD rats were randomly divided into 4 groups according to the random digits table：T2DM-RYGB group， T2DM-sham operation （SO） group，RYGB group，and SO group，10 rats in each group. Fasting plasma glucose （FPG） level，serum insulin （INS） level，vaspin level，and homeostasis model of insulin resistance （HOMA-IR） were determined before operation and on week 4，8 after operation，respectively．At the same time，the correlation between vaspin and the indicators （FPG，INS，or HOMA-IR） was analyzed．Results Compared the indicators after operation with before operation，the FPG level，INS level，vaspin level，and HOMA-IR were not significantly different between the T2DM-RYGB group and T2DM-SO group （P＞0.05） or between the RYGB group and SO group （P＞0.05），but the FPG level，INS level，vaspin level，and HOMA-IR in the T2DM-RYGB group and T2DM-SO group were significantly higher than those in the RYGB group （P＜0.05） and SO group （P＜0.05），respectively. On week 4 after operation，the FPG level，INS level，vaspin level，and HOMA-IR decreased in the T2DM-RYGB group，except for the FPG level，the other indexes had no significant differences as compared with the values before operation. On week 8 after operation，the FPG level，INS level，vaspin level，and HOMA-IR further decreased in the T2DM-RYGB group，there were significant differences of these indicators between before operation and on week 8 after operation. Compared the indicators after operation with before operation，the FPG level，INS level，vaspin level，and HOMA-IR were not statistically significant （P＞0.05） in the T2DM-SO group，RYGB group，or SO group. The changes in serum vaspin level correlated positively with those in INS and HOMA-IR before operaion and on week 4，8 after operaion in the T2DM-RYGB group and T2DM SO group rats （P＜0.05），respectively. Conclusions RYGB surgery has a therapeutic effect on T2DM rats，and serum vaspin level decreases and insulin resistance is improved after RYGB surgery，which may be one of the mechanisms of the treatment for T2DM.
