Synchronous vs sequential laparoscopic cholecystectomy for cholecystocholedocholithiasis

AIM: To compare synchronous laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) and sequential LC combined with EST for treating cholecystocholedocholithiasis. METHODS: A total of 150 patients were included and retrospectively studied. Among these, 70 were selected for the synchronous operation, in which the scheme was endoscopic retrograde cholangiopancreatography combined with EST during LC. The other 80 patients were selected for the sequential operation, in which the scheme involved first cutting the papillary muscle under endoscopy and then performing LC. The indexes in the two groups, including the operation time, the success rate, the incidence of complications, and the length of the hospital stay, were observed.RESULTS: There were no significant differences between the groups in terms of the numbers of patients, sex distribution, age, American Society of Anesthesiologists score, serum bilirubin, γ-glutamyl transpeptidase, mean diameter of common bile duct stones, and previous medical and surgical history (P = 0.54, P = 0.18, P = 0.52, P = 0.22, P = 0.32, P = 0.42, P = 0.68, P = 0.70, P = 0.47 and P = 0.57). There was no significant difference in the surgical operation time between the two groups (112.1 ± 30.8 min vs 104.9 ± 18.2 min). Compared with the sequential operation group, the incidence of pancreatitis was lower (1.4% vs 6.3%), the incidence of hyperamylasemia (1.4% vs 10.0%, P < 0.05) was significantly reduced, and the length of the hospital stay was significantly shortened in the synchronous operation group (3 d vs 4.5 d, P < 0.001). CONCLUSION: For treatment of cholecystocholedo-cholithiasis, synchronous LC combined with EST reduces incidence of complications, decreases length of hospital stay, simplifies the surgical procedure, and reduces operation time.     

Transjugular intrahepatic portosystemic shunt vs endoscopic therapy in preventing variceal rebleeding

AIM:To compare early use of transjugular intrahepatic portosystemic shunt(TIPS) with endoscopic treatment(ET) for the prophylaxis of recurrent variceal bleeding.METHODS:In-patient data were collected from 190 patients between January 2007 and June 2010 who suffured from variceal bleeding.Patients who were older than 75 years;previously received surgical treatment or endoscopic therapy for variceal bleeding;and complicated with hepatic encephalopathy or hepatic cancer,were excluded from this research.Thirty-five cases lost to follow-up were also excluded.Retrospective analysis was done in 126 eligible cases.Among them,64 patients received TIPS(TIPS group) while 62 patients received endoscopic therapy(ET group).The relevant data were collected by patient review or telephone calls.The occurrence of rebleeding,hepatic encephalopathy or other complications,survival rateand cost of treatment were compared between the two groups.RESULTS:During the follow-up period(median,20.7 and 18.7 mo in TIPS and ET groups,respectively),rebleeding from any source occurred in 11 patients in the TIPS group as compared with 31 patients in the ET group(Kaplan-Meier analysis and log-rank test,P = 0.000).Rebleeding rates at any time point(6 wk,1 year and 2 year) in the TIPS group were lower than in the ET group(Bonferroni correction α' = α/3).Eight patients in the TIPS group and 16 in the ET group died with the cumulative survival rates of 80.6% and 64.9%(Kaplan-Meier analysis and log-rank test c2 = 4.864,P = 0.02),respectively.There was no significant difference between the two groups with respect to 6-wk survival rates(Bonferroni correction α' = α/3).However,significant differences were observed between the two groups in the 1-year survival rates(92% and 79%) and the 2-year survival rates(89% and 64.9%)(Bonferroni correction α' = α/3).No significant differences were observed between the two treatment groups in the occurrence of hepatic encephalopathy(12 patients in TIPS group and 5 in ET group,KaplanMeier analysis and log-rank test,c2 = 3.103,P = 0.08).The average total cost for the TIPS group was higher than for ET group(Wilcxon-Mann Whitney test,52 678 RMB vs 38 844 RMB,P 0.05),but hospitalization frequency and hospital stay during follow-up period were lower(Wilcxon-Mann Whitney test,0.4 d vs 1.3 d,P = 0.01;5 d vs 19 d,P 0.05).CONCLUSION:Early use of TIPS is more effective than endoscopic treatment in preventing variceal rebleeding and improving survival rate,and does not increase occurrence of hepatic encephalopathy.     

Association of arterial stiffness with coronary flow reserve in revascularized coronary artery disease patients

AIM: To investigate the association of arterial wave reflection with coronary flow reserve(CFR) in coronary artery disease(CAD) patients after successful revascularization.METHODS: We assessed 70 patients with angiographically documented CAD who had undergone recent successful revascularization. We measured(1) reactive hyperemia index(RHI) using fingertip peripheral arterial tonometry(RH-PAT Endo-PAT);(2) carotid to femoral pulse wave velocity(PWVc-Complior);(3) augmentation index(AIx), the diastolic area(DAI%) and diastolic reflection area(DRA) of the central aortic pulse wave(Arteriograph);(4) CFR using Doppler echocardiography; and(5) blood levels of lipoprotein-phospholipase A2(LpPLA2).RESULTS: After adjustment for age, sex, blood pressure parameter, lipidemic, diabetic and smoking status, we found that coronary flow reserve was independently related to AIx(b =-0.38, r = 0.009), DAI(b = 0.36, P = 0.014), DRA(b = 0.39, P = 0.005) and RT(b =-0.29,P = 0.026). Additionally, patients with CFR 2.5 had higher PWVc(11.6 ± 2.3 vs 10.2 ± 1.4 m/s, P = 0.019), SBPc(139.1 ± 17.8 vs 125.2 ± 19.1 mm Hg, P = 0.026), AIx(38.2% ± 14.8% vs 29.4% ± 15.1%, P = 0.011) and lower RHI(1.26 ± 0.28 vs 1.50 ± 0.46, P = 0.012), DAI(44.3% ± 7.9% vs 53.9% ± 6.7%, P = 0.008), DRA(42.2 ± 9.6 vs 51.6 ± 11.4, P = 0.012) and Lp PLA2(268.1 ± 91.9 vs 199.5 ± 78.4 ng/m L, P = 0.002) compared with those with CFR ≥ 2.5. Elevated Lp PLA2 was related with reduced CFR(r =-0.33, P = 0.001), RHI(r =-0.37, P 0.001) and DRA(r =-0.35, P = 0.001) as well as increased PWVc(r = 0.34, P = 0.012) and AIx(r = 0.34, P = 0.001). CONCLUSION: Abnormal arterial wave reflections are related with impaired coronary flow reserve despite successful revascularization in CAD patients. There is a common inflammatory link between impaired aortic wall properties, endothelial dysfunction and coronary flow impairment in CAD.     

耐多药肺结核并发糖尿病患者胸部CT扫描特征分析

目的 分析耐多药肺结核并发糖尿病患者与未并发糖尿病患者的胸部CT表现,以提高临床认识。方法 通过《首都医科大学附属北京胸科医院病案电子化管理系统》,搜集2012—2017年经改良罗氏培养基痰培养及绝对浓度法药物敏感性试验(简称“药敏试验”)确诊的耐多药肺结核且符合排除标准的660例患者资料,按照是否并发糖尿病将患者分为并发糖尿病组(159例,并发组)、未并发糖尿病组(501例,未并发组)。采用数字表法从两组患者中分别随机抽取60例患者进行对照研究,由2名影像科经验丰富医师在不知患者是否并发糖尿病的情况下重新阅读CT片,以记录胸部CT表现及病变分布范围。采用SPSS 17.0软件进行统计学分析,计数资料采用卡方检验或Fisher精确概率检验,计量资料采用非参数检验方法中的曼-惠特妮U检验,以P<0.05为差异有统计学意义。结果 并发组患者中的段或叶性实变[48.3%(29/60)]、大结节[26.7%(16/60)]、任何形式空洞[93.3%(56/60)]、胸腔积液[40.0%(24/60)]的发生率明显高于未并发组患者[分别为28.3%(17/60)、11.7%(7/60)、76.7%(46/60)、20.0%(12/60)](χ ²=5.08,P=0.024;χ ²=4.36,P=0.037;χ ²=6.54,P=0.011;χ ²=5.71,P=0.017),而支气管扩张[45.0%(27/60)]的发生率明显低于未并发组[70.0%(42/60)](χ ²=7.67,P=0.006);且并发组患者中的段性或叶性实变累及叶数[(0.78±0.96)个]、大结节累及肺叶数[(0.48±0.96)个]和任何形式空洞累及叶数[(2.05±1.43)个]明显多于未并发组[分别为(0.38±0.72)个、(0.13±0.39)个、(1.58±1.43)个](U=1380.50,P=0.011;U=1511.00,P=0.027;U=1432.00,P=0.046),而支气管扩张累及肺叶数[(0.97±1.37)个]明显少于未并发组[(1.58±1.57)个](U=1335.50,P=0.010)。结论 耐多药肺结核并发糖尿病患者CT扫描出现段以上肺实变的频率及分布范围、出现大结节和空洞的频率及累及范围、并发胸腔积液的频率均较未并发糖尿病患者高;而支气管扩张多见于未并发糖尿病患者。     

上海市部分养老机构结核病防控相关措施实施情况调查

目的: 了解上海市养老机构对结核病防控措施实施情况和工作人员对结核病核心信息知晓情况,为完善养老机构结核病防控措施提供依据。 方法: 2019年1—4月,上海市疾病预防控制中心组织上海市7个区的84家养老机构(城区30家、郊区54家)和其中的21家机构内的858名工作人员(城区234名,郊区624名)开展问卷调查。对养老机构中工作人员和入住老年人在入职/入住前后的胸片检查、结核病等传染病防控措施落实,以及工作人员接受传染病相关培训和对结核病防治核心信息知晓情况进行分析。 结果: 养老机构要求工作人员和老年人在入职/住前后定期进行胸片检查的比例分别为76.2%(64/84)和79.8%(67/84)、98.8%(83/84)和73.8%(62/84);落实每日查房制度、传染病报告制度、消毒隔离制度和传染病(包括结核病)相关知识培训的机构分别占97.6%(82/84)、89.3%(75/84)、91.7%(77/84)和81.0%(68/84)。其中,城区养老机构对工作人员入职前后和老年人入住后胸片检查的比例[分别为93.3%(28/30)、86.7%(26/30)、93.3%(28/30)],以及在传染病报告制度、消毒隔离制度和传染病(包括结核病)相关知识培训制度的落实情况[分别为100.0%(30/30)、100.0%(30/30)、96.7%(29/30)]均明显优于郊区机构[分别为66.7%(36/54)、75.9%(41/54)、63.0%(34/54)、83.3%(45/54)、87.0%(47/54)、72.2%(39/54)],差异均有统计学意义(χ²值分别为9.179、6.579、11.580、5.600、4.242、7.474,P值分别为0.010、0.037、0.003、0.018、0.039、0.006)。858名工作人员中,城区工作人员在入职前和入职后接受传染病相关培训率[分别为76.5%(179/234)和79.9%(187/234)]均高于郊区工作人员[分别为63.0%(393/624)和69.2%(432/624)](χ²值分别为13.988、9.666,P值分别为<0.001、0.002);对咳嗽超过2周、有咳痰和发热疑似症状,以及结核病是呼吸道传染病的知晓率[分别为88.5%(201/227)、74.9%(170/227)、49.3%(112/227)、95.2%(216/227)]均高于郊区工作人员[分别为71.3%(427/599)、64.3%(385/599)、41.1%(246/599)、84.8%(508/599)],差异均有统计学意义(χ²值分别为26.911、8.416、4.586、16.280,P值分别为<0.001、0.004、0.032、<0.001)。 结论: 养老机构应加强工作人员入职前后的胸片检查和传染病(包括结核病)相关知识培训,以及老年人入住后的胸片检查,尤其是郊区养老机构。     

Endoscopic papillary balloon intermittent dilatation and endoscopic sphincterotomy for bile duct stones

AIM: To compare the effectiveness and safety of endoscopic papillary balloon intermittent dilatation (EPBID) and endoscopic sphincterotomy (EST) in the treatment of common bile duct stones. METHODS: From March 2011 to May 2012, endoscopic retrograde cholangiopancreatography was performed in 560 patients, 262 with common bile duct stones. A total of 206 patients with common bile duct stones were enrolled in the study and randomized to receive either EPBID with a 10-12 mm dilated balloon or EST (103 patients in each group). For both groups a conventional reticular basket or balloon was used to remove the stones. After the procedure, routine endoscopic nasobiliary drainage was performed. RESULTS: First-time stone removal was successfully performed in 94 patients in the EPBID group (91.3%) and 75 patients in the EST group (72.8%). There was no statistically significant difference in terms of operation time between the two groups. The overall incidence of early complications in the EPBID and EST groups was 2.9% and 13.6%, respectively, with no deaths reported during the course of the study and follow-up. Multiple regression analysis showed that the success rate of stone removal was associated with stone removal method [odds ratio (OR): 5.35; 95%CI: 2.24-12.77; P=0.00], the transverse diameter of the stone (OR: 2.63; 95%CI: 1.19-5.80; P=0.02) and the presence or absence of diverticulum (OR: 2.35; 95%CI: 1.03-5.37; P=0.04). Postoperative pancreatitis was associated with the EST method of stone removal (OR: 5.00; 95%CI: 1.23-20.28; P=0.02) and whether or not pancreatography was performed (OR: 0.10; 95%CI: 0.03-0.35; P=0.00). CONCLUSION: The EPBID group had a higher success rate of stone removal with a lower incidence of pancreatitis compared with the EST group.     

Effects of Nigella sativa on outcome of hepatitis C in Egypt

AIM: To evaluate the safety, efficacy and tolerability of Nigella sativa (N. sativa ) in patients with hepatitis C not eligible for interferon (IFN)-α. METHODS: Thirty patients with hepatitis C virus (HCV) infection, who were not eligible for IFN/ribavirin therapy, were included in the present study. Inclusion criteria included: patients with HCV with or without cirrhosis, who had a contraindication to IFN-α therapy, or had refused or had a financial constraint to IFN-α therapy. Exclusion criteria included: patients on IFN-α therapy, infection with hepatitis B or hepatitis Ⅰ virus, hepatocellular carcinoma, other malignancies, major severe illness, or treatment non-compliance. Various parameters, including clinical parameters, complete blood count, liver function, renal function, plasma glucose, total antioxidant capacity (TAC), and polymerase chain reaction, were all assessed at baseline and at the end of the study. Clinical assessment included: hepato and/ or splenomegaly, jaundice, palmar erythema, flapping tremors, spider naevi, lower-limb edema, and ascites. N. sativa was administered for three successive months at a dose of (450 mg three times daily). Clinical response and incidence of adverse drug reactions were assessed initially, periodically, and at the end of the study. RESULTS: N. sativa administration significantly improved HCV viral load (380808.7 ± 610937 vs 147028.2 ± 475225.6, P = 0.001) and TAC (1.35 ± 0.5 vs 1.612 ± 0.56, P = 0.001). After N. sativa administration, the following laboratory parameters improved: total protein (7.1 ± 0.7 vs 7.5 ± 0.8, P = 0.001), albumin (3.5 ± 0.87 vs 3.69 ± 0.91, P = 0.008), red blood cell count (4.13 ± 0.9 vs 4.3 ± 0.9, P = 0.001), and platelet count (167.7 ± 91.2 vs 198.5 ± 103, P = 0.004). Fasting blood glucose (104.03 ± 43.42 vs 92.1 ± 31.34, P = 0.001) and postprandial blood glucose (143.67 ± 72.56 vs 112.1 ± 42.9, P = 0.001) were significantly decreased in both diabetic and non-diabetic HCV patients. Patients with lower-limb edema de     

Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholangiocarcinoma

AIM: To identify the most effective endoscopic biliary drainage technique for patients with hilar cholangiocarcinoma. METHODS: In total, 118 patients with hilar cholangiocarcinoma underwent endoscopic management [endoscopic nasobiliary drainage (ENBD) or endoscopic biliary stenting] as a temporary drainage in our institution between 2009 and 2014. We retrospectively evaluated all complications from initial endoscopic drainage to surgery or palliative treatment. The risk factors for biliary reintervention, post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis, and percutaneous transhepatic biliary drainage (PTBD) were also analyzed using patient- and procedure-related characteristics. The risk factors for bilateral drainage were examined in a subgroup analysis of patients who underwent initial unilateral drainage. RESULTS: In total, 137 complications were observed in 92 (78%) patients. Biliary reintervention was required in 83 (70%) patients. ENBD was significantly associated with a low risk of biliary reintervention [odds ratio (OR) = 0.26, 95%CI: 0.08-0.76, P = 0.012]. Post-ERCP pancreatitis was observed in 19 (16%) patients. An absence of endoscopic sphincterotomy was significantly associated with post-ERCP pancreatitis (OR = 3.46, 95%CI: 1.19-10.87, P = 0.023). PTBD was required in 16 (14%) patients, and Bismuth type III or IV cholangiocarcinoma was a significant risk factor (OR = 7.88, 95%CI: 1.33-155.0, P = 0.010). Of 102 patients with initial unilateral drainage, 49 (48%) required bilateral drainage. Endoscopic sphincterotomy (OR = 3.24, 95%CI: 1.27-8.78, P = 0.004) and Bismuth II, III, or IV cholangiocarcinoma (OR = 34.69, 95%CI: 4.88-736.7, P < 0.001) were significant risk factors for bilateral drainage. CONCLUSION: The endoscopic management of hilar cholangiocarcinoma is challenging. ENBD should be selected as a temporary drainage method because of its low risk of complications.     

Quantitative ultrastructure analysis of neuroendocrine cells of gastric mucosa in normal and pathological conditions

AIM: To study the quantitative ultrastructure of neuroendocrine cells of the gastric mucosa in normal and pathological conditions, including the duodenal ulcer (DU) and Zollinger-Ellison syndrome (ZES). METHODS: The neuroendocrine cells of the gastric mucosa of eight normal subjects, six patients with DU, and five patients with ZES were quantitatively investigated with by electron microscopy and ultrastructure image analysis. RESULTS: The volume density of neuroendocrine (NE) cells in the DU was 1.3% and 0.8% (vs 1.6% and 0.9%, P < 0.05) in gastric antrum and corpus, respectively. In the antrum, G cells were 65% (P < 0.05), D cells decreased in cell density (3% vs 9.5%) and in number per unit area (P < 0.01). In the corpus, the cell density of enterochromaffin-like (ECL) cells increased (49% vs 30%, P < 0.05); D cells and enterochromaffin (EC) cells decreased (2%, P < 0.01 and 4%, P < 0.05, respectively), and the number of D cells per unit area markedly decreased. In ZES, D cells in the corpus decreased in cell density (4% vs 22%, P < 0.01), and P cells also decreased (11% vs 24%, P < 0.05). The density of ECL cells increased (65% vs 30%, P < 0.01). CONCLUSION: In DU and ZES, both the number and type of NE cells presented some changes. Increased gastrin in DU and ZES patients may be caused by the decrease of D cells and somatostatin secretion.     

Vascular resection in pancreatic adenocarcinoma with portal or superior mesenteric vein invasion

AIM:To evaluate long-term survival after the Whipple operation with superior mesenteric vein/portal vein resection(SMV/PVR)in relation to resection length.METHODS:We evaluated 118 patients who underwent the Whipple operation for pancreatic adenocarcinoma at our Department of Hepatobiliary Pancreatic Surgery between 2005 and 2010.Fifty-eight of these patients were diagnosed with microscopic PV/SMV invasion by frozen-section examination and underwent SMV/PVR.In 28 patients,the length of SMV/PVR was≤3 cm.In the other 30 patients,the length of SMV/PVR was>3cm.Clinical and survival data were analyzed.RESULTS:SMV/PVR was performed successfully in 58patients.There was a significant difference between the two groups(SMV/PVR≤3 cm and SMV/PVR>3 cm)in terms of the mean survival time(18 mo vs 11 mo)and the overall 1-and 3-year survival rates(67.9%and14.3%vs 41.3%and 5.7%,P<0.02).However,there was no significant difference in age(64 years vs 58years,P=0.06),operative time(435 min vs 477 min,P=0.063),blood loss(300 mL vs 383 mL,P=0.071)and transfusion volume(85.7 mL vs 166.7 mL,P=0.084)between the two groups.CONCLUSION:Patients who underwent the Whipple operation with SMV/PVR≤3 cm had better long-term survival than those with>3 cm resection.     

Pathogen profile and drug resistance analysis of spontaneous peritonitis in cirrhotic patients

AIM: To investigate the microbiological characteristics and drug resistance in liver cirrhosis patients with spontaneous peritonitis.METHODS: We analyzed the data of patients with liver cirrhosis and abdominal infection at the First Affiliated Hospital of Zhejiang University between January 2011 and December 2013. Pathogens present in the ascites were identified,and their sensitivity to various antibiotics was determined. RESULTS: We isolated 306 pathogenic bacteria from 288 cases: In 178 cases,the infection was caused by gram-negative strains(58.2%); in 85 cases,grampositive strains(27.8%); in 9 cases,fungi(2.9%); and in 16 cases,more than one pathogen. The main pathogens were Escherichia coli(E. coli)(24.2%),Klebsiella pneumoniae(18.9%),Enterococcus spp.(11.1%),and Staphylococcus aureus(7.5%). Of the 306 isolated pathogens,99 caused nosocomial infections and 207 caused community-acquired andother infections. The E. coli and K. pneumoniae strains produced more extended-spectrum β-lactamases in cases of nosocomial infections than non-nosocomial infections(62.5% vs 38%,P 0.013; 36.8% vs 12.8%,P 0.034,respectively). The sensitivity to individual antibiotics differed between nosocomial and non-nosocomial infections: Piperacillin/tazobactam was significantly more effective against non-nosocomial E. coli infections(4% vs 20.8%,P 0.021). Nitrofurantoin had stronger antibacterial activity against Enterococcus species causing non-nosocomial infections(36.4% vs 86.3%,P 0.009).CONCLUSION: The majority of pathogens that cause abdominal infection in patients with liver cirrhosis are gram-negative,and drug resistance is significantly higher in nosocomial infections than in non-nosocomial infections.     

Comparison of Pentax HiLine and Olympus Lucera systems at screening colonoscopy

AIM:To compare the performance characteristics of Pentax HiLine(PHL)(with i-scan) and Olympus Lucera(OL) systems in a screening population.METHODS:Screening colonoscopies in asymptomatic guaiac faecal occult blood test-positive patients with PHL(n = 58) and OL(n = 425) colonoscopes were analysed.All procedures were performed by a single colonoscopist.PHL used white-light endoscopy(WLE) on scope insertion and contrast/surface enhancement(i-scan 1) on withdrawal,and OL utilised WLE both on insertion and withdrawal.Patient age,sex,instrument insertion and withdrawal times,nurse assessed patient comfort scores,midazolam and fentanyl doses,procedure completion and rates of lesion detection were recorded separately for each group.Comparisons between the groups were made using either Fisher’s exact test(for dichotomous variables) or Mann-Whitney U test(for ordinal and continuous variables).RESULTS:Colonoscopy completion rates were similar in both groups:413/425(97.2%) for OL and 55/58(94.9%) for PHL(P = 0.24).For complete colonoscopies,the two groups were well matched for age,sex,colonoscope insertion times(mean 11.1 min in OL vs 11.6 min in PHL,P = 0.93) and normal colonoscopy withdrawal times(mean 15.6 min in OL vs 14.7 min in PHL,P = 0.2).Patients in the PHL group experienced a small increase in discomfort(mean patient comfort scores were 0.49 in the OL and 0.95 in the PHL group,P < 0.0001).While Fentanyl doses required were similar between groups(mean 57.5 μg in OL vs 61.4 μg in PHL,P = 0.13),slightly more Midazolam was required in the PHL group(mean 2.1 mg in OL vs 2.4 mg in PHL,P = 0.035).There was no difference in polyp(58% in OL vs 67% in PHL) or adenoma(49% in OL vs 56% in PHL) detection rates between the groups.Neither the total number of polyps and adenomas,nor the characteristics of these(including size,location or presence of advanced features) were different between the two systems.CONCLUSION:This study suggests that there is no advantage of either colonoscope system in lesion detection.     

Short-term outcomes of laparoscopic total mesorectal excision compared to open surgery

AIM:To investigate the short-term outcome of laparoscopic total mesorectal excision(TME) in patients with mid and low rectal cancers.METHODS:A consecutive series of 138 patients with middle and low rectal cancer were randomly assigned to either the laparoscopic TME(LTME) group or the open TME(OTME) group between September 2008 and July 2011 at the Department of Colorectal Cancer of Shanghai Cancer Center,Fudan University and pathological data,as well as surgical technique were reviewed retrospectively.Short-term clinical and oncological outcome were compared in these two groups.Patients were followed in the outpatient clinic 2 wk after the surgery and then every 3 mo in the first year if no adjuvant chemoradiation was indicated.Statistical analysis was performed using SPSS 13.0 software.RESULTS:Sixty-seven patients were treated with LTME and 71 patients were treated with OTME(sex ratio 1.3:1vs 1.29:1,age 58.4 ± 13.6 years vs 59.6 ± 9.4 years,respectively).The resection was considered curative in all cases.The sphincter-preserving rate was 65.7%(44/67) vs 60.6%(43/71),P = 0.046;mean blood loss was 86.9 ± 37.6 mL vs 119.1 ± 32.7 mL,P = 0.018;postoperative analgesia was 2.1 ± 0.6 d vs 3.9 ± 1.8 d,P = 0.008;duration of urinary drainage was 4.7 ± 1.8 d vs 6.9 ± 3.4 d,P = 0.016,respectively.The conversion rate was 2.99%.The complication rate,circumferential margin involvement,distal margins and lymph node yield were similar for both procedures.No port site recurrence,anastomotic recurrence or mortality was observed during a median follow-up period of 21 mo(range:9-56 mo).CONCLUSION:Laparoscopic TME is safe and feasible,with an oncological adequacy comparable to the open approach.Further studies with more patients and longer follow-up are needed to confirm the present results.     

上海市900例老年住院结核病患者营养状况调查分析

目的 分析上海市老年结核病住院患者营养状况及其风险因素,为早期营养干预老年结核病住院患者提供依据。方法 连续性收集2018年8月1日至2019年8月1日同济大学附属上海市肺科医院结核病区住院超过24 h且确诊为结核病的1100例≥65岁老年患者,剔除无体质量记录、严重糖尿病、严重高血压、肝肾功能不全,以及神志不清者,最终纳入900例。对纳入患者的临床相关资料[包括患者性别、年龄、临床诊断、并发症、治疗次数、出入院日期、营养风险筛查量表(NRS 2002)分值]及营养相关指标[血红蛋白(Hb)、血清总蛋白(TP)、血清白蛋白(ALB)、血清前白蛋白(PAB)、视黄醇结合蛋白(RBP)、预后营养指数(PNI)、中性粒细胞/淋巴细胞比值(NLR)等因素]进行统计,分析影响老年结核病患者营养风险发生的危险因素。900例老年结核病患者中,443例(49.22%)NRS 2002≥3分者纳入有营养风险组,457例(50.78%)NRS 2002<3分者纳入无营养风险组。结果 因素分析显示,有营养风险组患者在75~和80~90岁组[18.28%(81/443)和18.51%(82/443)]、BMI<18.5[40.41%(179/443)]、治疗2次及以上[25.51%(113/443)]、结核性胸膜炎[21.67%(96/443)]方面的分布均明显高于无营养风险组[分别为9.19%(42/457)和8.75%(40/457)、0.00%(0/457)、17.51%(80/457)、13.13%(60/457)](χ²=51.350,299.500, 8.818, 16.280;P=0.000,0.000,0.012,0.000)。营养相关临床指标检测结果显示,有营养风险组患者的TP[(64.88±0.34)g/L]、ALB[(34.15±0.23)g/L]、PAB[(138.60±3.26)g/L]、Hb[(113.60±0.84)g/L]、RBP[(26.32±0.50)g/L]、PNI[(39.61±0.35)]均低于无营养风险组患者[分别为(67.30±0.28)g/L、(38.18±0.16)g/L、(194.10±3.22)g/L、(126.70±0.79)g/L、(34.32±0.22)g/L、(45.51±0.26)][F=19.496, 79.334, 34.030, 22.808,21.326, 72.464;P值均=0.000];而NLR(5.44±0.32)和住院时间[(6.61±0.17)d]明显高于无营养风险组患者[分别为(3.29±0.14),(5.53±0.13)d][F=6.335, P=0.012;F=5.994,P=0.015]。结论 老年结核病患者营养风险发生率较高,且与年龄、治疗次数呈正相关、与BMI呈负相关,并表现为有营养风险组患者的TP、ALB、PAB、Hb、RBP、PNI均明显低于无营养风险组患者,严重影响临床治疗效果、延长住院时间。     

Neurotensin receptor 1 overexpression in inflammatory bowel diseases and colitis-associated neoplasia

AIM: To explore the association of neurotensin receptor 1 (NTSR1) with inflammatory bowel diseases (IBD) and colitis-associated neoplasia. METHODS: NTSR1 was detected by immunohistochemistry in clinical samples of colonic mucosa with IBD colitis, colitis-associated raised low-grade dysplasia (LGD) including dysplasia-associated lesions or masses (DALMs, n = 18) and adenoma-like dysplastic polyps (ALDPs, n = 4), colitis-associated high-grade dysplasia (HGD, n = 11) and colitis-associated colorectal carcinoma (CACRC, n = 13), sporadic colorectal adenomatous polyp (SAP, n = 17), and sporadic colorectal carcinoma (SCRC, n = 12). The immunoreactivity of NTSR1 was semiquantitated (as negative, 1+, 2+, and 3+) and compared among different conditions.RESULTS: NTSR1 was not detected in normal mucosa but was expressed similarly in both active and inactive colitis. LGD showed a significantly stronger expression as compared with non-dysplastic colitic mucosa, with significantly more cases showing > 2+ intensity (68.75% in LGD vs 32.26% in nondysplastic mucosa, P = 0.001). However, no significant difference existed between DALMs and ALDPs. CACRC and HGD showed a further stronger expression, with significantly more cases showing 3+ intensity than that in LGD (61.54% vs 12.50% for CACRC vs LGD, P = 0.022; 58.33% vs 12.50% for CACRC/HGD vs LGD, P = 0.015). No significant difference existed between colitis-associated and non-colitic sporadic neoplasia. CONCLUSION: NTSR1 in colonic epithelial cells is overexpressed in IBD, in a stepwise fashion with sequential progress from inflammation to dysplasia and carcinoma.     

Missed diagnosis of early gastric cancer or high-grade intraepithelial neoplasia

AIM: To investigate the causes of missed diagnosis of early gastric cancer (EGC) or high-grade intraepithelial neoplasia (HGIN) in Chongqing, China. METHODS: The present study summarizes 103 cases of EGC/HGIN detected by esophagogastroduodenos-copy (EGD) and pathological analysis from January 2010 to December 2011. Dimethyl silicone oil was administrated orally 15 min before the EGD procedures. The stomach was cleaned by repeated washing with saline when the gastroscope entered the stomach cavity. Suspected EGC lesions were subject to conventional biopsy sampling and pathological examinations. The correlation between lesion locations, endoscopic morphology of cancerous sites, training level of the examiners, pathological biopsies, and missed diagnosis was analyzed. RESULTS: Twenty-three cases were missed among the 103 cases (22.23%) of EGC/HGIN. The rate of missed EGC in the gastroesophageal junction (8/19, 42.1%) was significantly higher than at other sites (15/84, 17.86%) (χ2 = 5.253, P = 0.022). In contrast, the rate of missed EGC in the lower stomach body (2/14, 14.29%) was lower than at other sites (21/89,23.6%), but there were no significant differences (χ2 = 0.289, P = 0.591). The rate of missed EGC in the gastric antrum (5/33, 15.15%) was lower than at other sites (18/70, 25.71%), but there were no significant differences (χ2 = 1.443, P = 0.230). Endoscopists from less prestigious hospitals were more prone to not diagnosing EGC than those from more prestigious hospitals (χ2 = 4.261, P = 0.039). When the number of biopsies was < 4, the rate of missed diagnosis was higher (20/23, 89.96%) than for when there were > 4 biopsies (3/23, 13.04%) (P < 0.001). In addition, there was no significant difference in the rate of missed diagnosis in patients with 1-3 biopsy specimens (χ2 = 0.141, P = 0.932). CONCLUSION: Endoscopists should have a clear understanding of the anatomical characteristics of the esophagus/stomach, and endoscopic identification of early lesions increases with the number of biopsie     

Antinociceptive effect of berberine on visceral hypersensitivity in rats

AIM: To assess the protective effect of berberine administration and the role of nitric oxide (NO) in visceral hypersensitivity. METHODS: Fifty male Sprague-Dawley rats were randomly assigned to five groups. An inflammatory bowel disease model was induced in rats by intracolonic instillation of 1 mL 4% acetic acid at 8 cm proximal to the anus for 30 s and restraint stress. After subsidence of inflammation on day 7 of the experiment, the rats were subjected to rectal distension, performed by a balloon (6-Fr, 2 mm external diameter, disposable silicon balloon-urethral catheter for pediatric use) which was rapidly inflated with increasing volumes of prewarmed (37 ℃) water (0.1, 0.2, 0.3, 0.4, 0.6, 0.8 and 1 mL) for 30 s at four-minute intervals, and then the abdominal withdrawal reflex (AWR) and the level of fecal output were measured, respectively. AWR scores either 0, 1, 2, 3 or 4 were obtained by blinded observers. Rats had been pretreated with berberine or aminoguanidine (NO synthetase inhibitor) or berberine + aminoguanidine before measurement. RESULTS: The rats in the placebo group showed a hypersensitive response to rectal distension (2.69 ± 0.08 vs 1.52 ± 0.08, P = 0.000) and defecated more frequently than those in the control group (5.0 ± 0.16 vs 0.44 ± 0.16, P = 0.000). Comparing the berberine with placebo group, the AWR scores were reduced for all distension volumes and were significant at 0.2-1 mL (1.90 ± 0.08 vs 2.69 ± 0.08, P = 0.000), while the numbers of hard pellets, soft pellets, formless stools, and total fecal output in the placebo group were significantly larger than in the berberine group (5.0 ± 0.16 vs 2.56 ± 0.16, P = 0.000). Administration of aminoguanidine or berberine + aminoguanidine before VH score measurement reversed the antinociceptive effect of berberine (2.52 ± 0.08 vs 1.90 ± 0.08, P = 0.000; 2.50 ± 0.08 vs 1.90 ± 0.08, P = 0.000). The numbers of hard pellets, soft pellets, formless stool, and total of fecal output in aminoguanidine group were significantly larger tha     

Low-dose amitriptyline combined with proton pump inhibitor for functional chest pain

AIM:To investigate the efficacy of amitriptyline with proton pump inhibitor(PPI)for the treatment of functional chest pain(FCP).METHODS:This was a randomized,open-label trial investigating the addition of low dose amitriptyline(10 mg at bedtime)to a conventional dose of rabeprazole(20 mg/d)(group A,n = 20)vs a double-dose of rabeprazole(20 mg twice daily)(group B,n = 20)for patients with FCP whose symptoms were refractory to PPI.The primary efficacy endpoints were assessed by global symptom score assessment and the total number of individuals with > 50% improvement in their symptom score.RESULTS:The between-group difference in global symptom scores was statistically significant during the last week of treatment(overall mean difference;3.75 ± 0.31 vs 4.35 ± 0.29,the between-group difference;P < 0.001).Furthermore,70.6% of patients in group A had their symptoms improve by > 50%,whereas only 26.3% of patients in group B had a similar treatment response(70.6% vs 26.3%,P = 0.008).Specifically,patients in group A had a significantly greater improvement in the domains of body pain and general health perception than did patients in group B(52.37 ± 17.00 vs 41.32 ± 12.34,P = 0.031 and 47.95 ± 18.58 vs 31.84 ± 16.84,P = 0.01,respectively).CONCLUSION:Adding amitriptyline to a PPI was more effective than a double-dose of PPI in patients with FCP refractory to a conventional dose of PPI.     

Suppository naproxen reduces incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis: Randomized controlled trial

AIM: To determine the efficacy of rectally administered naproxen for the prevention of post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP).METHODS: This double-blind randomized control trial conducted from January 2013 to April 2014 at the Gastrointestinal and Liver Diseases Research Center in Rasht, Iran. A total of 324 patients were selected from candidates for diagnostic or therapeutic ERCP by using the simple sampling method. Patients received a single dose of Naproxen(500 mg; n = 162) or a placebo(n = 162) per rectum immediately before ERCP. The overall incidence of PEP, incidence of mild to severe PEP, serum amylase levels and adverse effects were measured. The primary outcome measure was the development of pancreatitis onset of pain in the upper abdomen and elevation of the serum amylase level to 3 × the upper normal limit(60-100 IU/L) within 24 h after ERCP. The severity of PEP was classified according to the duration of therapeutic intervention for PEP: mild, 2-3 d; moderate 4-10 d; and severe, 10 d and/or necessitated surgical or intensive treatment, or contributed to death.RESULTS:PEP occurred in 12 %(40/324) o f participants, and was significantly more frequent in the placebo group compared to the naproxen group(P 0.01). Of the participants, 25.9%(84/324) developed hyperamylasemia within 2 h of procedure completion, among whom only 35 cases belonged to the naproxen group(P 0.01). The incidence of PEP was significantly higher in female sex, in patients receiving pancreatic duct injection, more than 3 times pancreatic duct cannulations, and ERCP duration more than 40 min(P s 0.01). There were no statistically significant differences between the groups regarding the procedures or factors that might increase the risk of PEP, sphincterotomy, precut requirement, biliary duct injection and number of pancreatic duct cannulations. In the subgroup of patients with pancreatic duct injection, the rate of pancreatitis in the naproxen group was significantly lower than that in the placebo(6 patients vs 23 patients, P 0.01, RRR = 12%, AR = 0.3, 95%CI: 0.2-0.6). Naproxen reduced the PEP in patients with ≥ 3 pancreatic cannulations(P 0.01, RRR = 25%, AR = 0.1, 95%CI: 0.1-0.4) and an ERCP duration 40 min(P 0.01, RRR = 20%, AR = 0.9, 95%CI: 0.4-1.2).CONCLUSION: Single dose of suppository naproxen administered immediately before ERCP reduces the incidence of PEP.