Congenital biliary dilatation may consist of 2 disease entities

Background/Purpose

This study aims to establish the possible mechanisms of pathogenesis of congenital biliary dilatation and to classify the disease accordingly.

Methods

Radiologic features of congenital biliary dilatation and pancreaticobiliary malunion in 107 affected children were examined and correlated with laboratory results. Relative lengths/diameters were calculated to provide comparison between children of different ages. Intraluminal pressures of common bile duct (CBD) were measured intraoperatively.

Results

The minimal relative diameters of distal CBD negatively correlated with the maximal relative diameters/lengths of dilated CBD, the maximal relative diameters of common hepatic duct, and left/right hepatic ducts. The intraluminal pressure in patients with a stenotic distal CBD (stenotic group) was significantly higher than that in patients with a nonstenotic distal CBD (nonstenotic group). The narrower the distal CBD, the more deranged the liver function. Conversely, serum/bile amylase levels were more elevated in the nonstenotic group. Common channel protein plugs were only found in the nonstenotic group, whereas common hepatic duct strictures, intrahepatic duct dilatations, and calculi were detected more frequently in the stenotic group.

Conclusion

We propose to categorize congenital biliary dilatation into 2 subgroups: (1) cystic type with stenotic distal CBD associated with deranged liver function and common hepatic duct stricture and (2) fusiform type with nonstenotic distal CBD associated with pancreatitis and common channel protein plugs. Different underlying pathologies of each group require different operative strategies.     

冠心病合并糖尿病患者dTP分析及随访

目的 分析冠心病(CHD)合并糖尿病(DM)患者11脱氢血栓素B2/6-酮前列环素比值(11-dh-TXB2/6-k-PGF1a,dTP)及与主要不良心血管事件(MACE)和再住院之间的关系.方法 选择2013年7月至2014年6月270例CHD患者作为研究对象,其中136例非DM患者(非DM组),134例合并DM患者(DM组).记录患者临床情况,测量身高、体质量、血压、心率等指标,完善心电图、超声心动图、冠状动脉造影等检查.测定两组患者11-dh-TXB2和6-k-PGF1a水平,计算dTP值.随访1年,记录患者MACE事件及再次住院情况.Epdate软件建库,SPSS17.0软件进行统计分析.结果 非DM组与DM组dTP分别为1.8±0.6和2.0士0.7,差异有统计学意义(P＜0.05).对于非DM组,hs-CRP、收缩压、舒张压、冠状动脉病变数及严重病变数与dTP相关(P＜0.05).而对于DM组,hs-CRP、血糖、胆固醇水平、冠状动脉病变数及严重病变数与dTP相关(P＜0.05).随访1年,非DM组和DM组患者发生MACE事件分别为33例(24.3％)和44例(32.8％),两组比较差异无统计学意义(P＞0.05).非DM组和DM组再次住院患者分别为12例(8.8％)和24例(17.9％),两组比较差异有统计学意义(P＜0.05).发生MACE的患者与无MACE的患者住院时dTP分别为2.3±0.8和1.8±0.6,差异有统计学意义(P＜0.05).再住院患者与未再住院组患者住院时dTP分别为2.4±1.0和1.9±0.6,差异有统计学意义(P＜0.05).结论 CHD合并DM患者dTP明显增高,提示血小板明显活化,且较高的dTP增加了患者MACE事件及再次住院风险,应该强化抗血小板治疗.     

Patterns of transcription factor programs and immune pathway activation define four major subtypes of SCLC with distinct therapeutic vulnerabilities

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门诊输液室健康教育效果观察

目的 探讨在门诊输液室加强健康教育,提高输液患者的遵医行为,提高患者对疾病相关知识的知晓率,调高患者对护理服务质量的满意度,改善护患关系.方法 选择212例输液患者随机分为观察组和对照组各106例.对照组采用常规的输液护理,观察组在常规输液护理的基础上加强健康教育,二组患者对遵医行为的依从性,以及对疾病、药物、及输液知识的知晓率和对护理服务质量的满意度进行比较.结果 观察组的遵医行为,疾病、药物、输液相关知识的知晓率,以及对护理服务质量的满意度明显提高.结论 加强门诊输液室患者的健康教育可以提高患者的遵医行为及相关知识的知晓率,提高输液患者满意度,改善护患关系.     

Effects of perioperative statins on patient outcomes after noncardiac surgery: a meta-analysis

Background: Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery. However, controversy remains regarding whether perioperative administration of hydroxymethylglutaryl-CoA reductase inhibitors (statins) has a beneficial effect on patient outcomes.

Objective: We performed a meta-analysis to validate the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery.

Methods: Electronic databases (PubMed, Web of Science, EMBASE, and the Cochrane Library) were searched for randomized controlled trials (RCTs) published up to 10 November 2017. RCTs were eligible for inclusion if they compared perioperative statin treatment with control treatment in patients scheduled for noncardiac surgery and reported data pertaining to clinical outcomes.

Results: Twelve RCTs involving 4707 patients (2371 in the perioperative statin group and 2336 in the control group) were ultimately included in this meta-analysis. The incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation were all lower in patients treated with statins than in control group patients, as shown by the fixed-effects model (odds ratio (OR)?=?0.460, 95% confidence interval (CI)?=?0.324–0.653, p?=?0 for myocardial infarction; OR?=?0.617, 95% CI?=?0.476–0.801, p?=?0 for composite of death/myocardial infarction/stroke; OR?=?0.406, 95% CI?=?0.247–0.666, p?=?0 for new atrial fibrillation). No significant differences in the incidences of stroke or transient ischemic attack, all-cause mortality and cardiovascular mortality were observed between the statin and control arms.

Conclusions: This meta-analysis supports the hypothesis that perioperative statins effectively reduce the incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation in patients undergoing noncardiac surgery.

• Key Messages

• Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery.

• We performed a meta-analysis to confirm the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery.

     

Nickel-foam-supported β-Ni(OH)2 as a green anodic catalyst for energy efficient electrooxidative degradation of azo-dye wastewater

Electrochemical oxidative degradation (EOD) is a particularly promising technique for removing organic pollutants from wastewater. However, due to the high overpotential of EOD in conventional anode materials, the energy cost of EOD is usually very high, which greatly promotes the search for highly active, stable, and energy-efficient anodic catalysts. Herein, we demonstrated that nickel-foam-supported (NF-supported) β-Ni(OH)₂ (NF/β-Ni(OH)₂) prepared via a facile hydrothermal method could be used as an energy efficient anode for EOD. The as-prepared 3D porous NF/β-Ni(OH)₂ exhibited high activity toward the electrochemical oxidation of methyl orange (MO) in the low potential region (<1.07 V vs. SCE). This property differs greatly from those of the conventional anode materials that require a high positive potential to keep them active for EOD, making NF/β-Ni(OH)₂ an energy-efficient and active anode material for EOD. With an oxidation current density of 0.25 mA cm⁻², the decolorization of MO was completed within 30 min, and the COD removal after 3h of reaction was 63.0%. The normalized energy consumption for the 3 h degradation of MO was 22.2 kW h (kg COD)⁻¹, which is only a fraction of (or even one tenth of) the values reported in the literature. Moreover, NF/β-Ni(OH)₂ had a good stability and recyclability for EOD. No activity decay was observed during 10 h of EOD and the COD removal remained almost unchanged after four consecutive reaction cycles. We demonstrated experimentally that the NF/β-Ni(OH)₂ anode could generate large amounts of hydroxyl radicals and that the oxidation of MO by hydroxyl radicals was the main mechanism during EOD. We believe that this work opens a new avenue for developing highly active and energy-efficient anode materials that can work in the low potential region for EOD.

A novel NF/β-Ni(OH)₂ catalyst for energy efficient electrochemical degradation of methyl orange was fabricated via a facile hydrothermal method.     

Improving the solubility and bioavailability of anti-hepatitis B drug PEC via PEC–fumaric acid cocrystal

PEC is a new generation of phosphamide ester anti-hepatitis B virus drug. It is a prodrug of tenofovir and can be rapidly metabolized to tenofovir. However, its poor solubility in water (0.219 mg mL⁻¹ at 25 °C) has limited its oral bioavailability. In this study, we aimed to improve the solubility and consequently the oral bioavailability of PEC via a cocrystal. A cocrystal of PEC with fumaric acid (FUA) (PEC–FUA, 1 : 1) was successfully obtained and characterized. The crystal structure of this cocrystal was tested using a single crystal X-ray diffraction method. The intrinsic dissolution rate (IDR) characterization was performed in a pH 6.8 buffer. The solubility of this cocrystal in 0.1 M HCl (pH 1.0) and pH 6.8 phosphate buffers was investigated, and the results showed that the solubility of the cocrystal was 3.8 and 4.0 times that of free PEC, respectively. We also studied the pharmacokinetics of beagle dogs. The mean AUC_{0–24 h} of the cocrystal is about 4.2 times that of free PEC, indicating that the solubility and bioavailability of PEC can indeed be improved by forming the cocrystal. It may become an ideal solid form of an active pharmaceutical ingredient suitable for pharmaceutical preparations, and it can be further studied later.

A cocrystal of PEC with fumaric acid (FUA) (PEC–FUA, 1 : 1) was successfully obtained and characterized. The mean AUC_{0–24 h} of the cocrystal is about 4.2 times that of free PEC.