目的:探讨早期采用益活清下法治疗重症急性胰腺炎(severe acute pancreatitis,SAP)并肾功能不全的疗效。方法:35 例符合病例选择标准并接受益活清下法治疗的SAP并发肾功能不全患者,按发病后入院时间分为早期组(3d 内入院接受治疗,24例)和晚期组(3～7 d 内入院接受治疗,11例),比较治疗过程中两组患者各并发症的持续时间、病程、手术中转率及病死率。结果:两组入院48小时Ranson 评分、急性生理和慢性健康评价指标Ⅱ(APACHE Ⅱ )评分及CT 评分比较差异无显著性(Pgt; 0.05);早期组急性呼吸窘迫综合征、肾功能不全的持续时间低于晚期组(Plt; 0.05);早期组和晚期组中转手术率分别12.5%(3/24例)和 18.18%(2/11例),差异无统计学意义(Pgt; 0.05);病死率早期组和晚期组分别为 8.33%(2/24例)和9.09%(1/11例),差异无统计学意义(Pgt; 0.05);早期组和晚期组住院病程分别为(20.40±18.25)d 和(34.92±12.62)d,两组比较有统计学意义(Plt; 0.05)。结论:早期使用益活清下法对SAP合并肾功能不全可以取得更好疗效。
Objective To summarize the research progress of gastrointestinal stem cells and its role in gastric neoplasms. Methods The literatures related effect of gastrointestinal stem cells niche， gastrointestinal stem cells markers，and the cancer stem cell theory in the gastric neoplasms were retrieved through PubMed， the research progress of gastrointestinal stem cells and cancer stem cells in the gastric neoplasms was explored. Results The cancer stem cell theory arose a decade ago. Gastrointestinal stem cells played a very important role in the gastric neoplasms， which had specific markers and their niches included many kinds of tissue factors. Inflammation could induce gastrointestinal stem cells dysplasia and become cancer stem cells， which promoted the growth， invasion， and metastasis of the gastric neoplasms. Conclusions Gastric cancer stem cells could be one of an effective target in treatment for gastric neoplasms， and it may be provide a new breakthrough in treatment for gastric neoplasms.
ObjectivesTo systematically review the prophylactic efficacy of lidocaine administrated intravenously in advance on rocuronium associated injection pain/withdrawal movement in patients under general anesthesia.MethodsPubMed, The Cochrane Library, Web of Science, EMbase, CNKI, WanFang Data and VIP databases were electronically searched to collect relevant randomized controlled trials (RCTs) on pretreatment with lidocaine intravenously to prevent injection pain /withdraw movement from rocuronium from inception to September 30th, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 30 RCTs involving 2 518 patients were included. The results of meta-analysis showed that, compared to the control group, pretreating with intravenous lidocaine could significantly reduced the occurrence of total pain/withdrawal movement associated with rocuronium injection (RR=0.43, 95%CI 0.36 to 0.51, P<0.000 01), and whether with (RR=0.39, 95%CI 0.29 to 0.52, P<0.000 01) or without (RR=0.45, 95%CI 0.36 to 0.57, P<0.000 01) occluding the vein, intravenous lidocaine could prevent pain/withdrawal movement associated with rocuronium injection. In addition, the incidence of lidocaine group igniting moderate (RR=0.38, 95%CI 0.31 to 0.46, P<0.000 01) or severe (RR=0.23, 95%CI 0.18 to 0.30, P<0.000 01) pain/ withdrawal movement were less likely to occur. However, there was no difference between the lidocaine and control group in the incidence of mild injection pain/withdrawal movement induced by rocuronium (RR=0.89, 95%CI 0.75 to 1.06, P=0.19).ConclusionsCurrent evidence shows that pre-intravenous lidocaine can reduce the occurrence of injection pain/withdrawal movement associated with rocuronium injection patients, especially in the prevention of moderate and severe injection pain/withdrawal movement.
Objective To assess the efficacy and safety of the tubeless approach with a ureteral stent versus nephrostomy tube for postoperative drainage following percutaneous nephrolithotomy, and to provide guidance for clinical practice. Methods Randomized controlled trials (RCTs) were identified from PubMed (1966 to August 2008), Ovid (1966 to August 2008), Embase (1966 to August 2008), The Cochrane Library (Issue 3, 2008) and CBM (1978 to 2008). We also handsearched for relevant published and unpublished reports and check their references. The quality of the included trials was evaluated by two reviewers. We used The Cochrane Collaboration’s RevMan 5.0.16 software for meta-analysis. Results Eight studies involving 507 patients were included. We divided the patients into three groups: small (8~9 Fr), medium (16~18 Fr) and large (20~24 Fr) according to the diameter of nephrostomy tube for the analysis. Our meta-analyses showed: ①Hospital stay (hours): There was no statistically significant difference between tubeless and small bore tubes, but a difference was found in the comparison of tubeless versus medium and large bore tubes [WMD (95%CI) –32.4 (–33.64, –31.16) and –39.07 (–67.75, –10.39), respectively]; ② Puncture site urinary leakage: No statistically significant difference was found between tubeless and small bore tubes, of between tubeless versus medium tubes [RR= 0.07, 95%CI (0.00, 1.15), P=0.06]; ③ Visual analogue scale scores for postoperative pain on Day 1: There was no statistically significant difference between tubeless and small bore tubes, but there was a difference in tubeless versus medium and large bore tubes [MD (95%CI) –2.80 (–2.94, –2.66) and –2.04 (–2.29, –1.79), respectively];④No statistically significant difference was found in transfusion, fever or infection and operating time between tubeless and any size of nephrostomy tube. Conclusion No statistically significant difference between tubeless versus small bore tubes is found for any of the outcome measurements we analysed. Compared with medium and large bore tubes, tubeless PCNL of ureteral stent could reduce hospital stay, urine leakage and postoperative pain without an increase in complications. There is a moderate possibility of selection bias, performance bias and publication bias in this review, because of the small number of the included studies, which weakens the strength of the evidence of our results. Better evidence from more high-quality randomized controlled trials is needed.
目的 研究CD14过表达对胃癌细胞核转录因子-κB（NF-κB）活性以及人β防御素-2（hBD-2）表达的影响，探讨CD14在胃癌发生发展中的作用。 方法 体外培养CD14稳定转染的胃癌SGC-7901细胞系及空质粒转染的对照细胞，CD14蛋白受体胞壁酰二肽刺激细胞，凝胶迁移实验检测NF-κB的活性，蛋白质印迹法检测NF-κB蛋白的表达，同时分别用逆转录-聚合酶链反应以及蛋白质印迹法检测hBD-2 mRNA及蛋白的表达。 结果 与对照组相比，CD14过表达的细胞中NF-κB的活性明显增强，蛋白表达量也大幅度增加，同时hBD-2的mRNA及蛋白的表达都有所提高。 结论 胃癌细胞中CD14在介导NF-κB的激活以及hBD-2的表达中发挥重要作用。
ObjectivesThe present network meta-analysis was conducted to evaluate the potential efficacy and safety of various surgical approaches in the treatment of benign prostatic hyperplasia with enlarged prostate.MethodsPubMed, EMbase, The Cochrane Library, Clinicaltrials.gov and CNKI databases were electronically searched to identify eligible studies. Two reviewers independently screened literature, extracted data and evaluated risk of bias and the ADDIS 1.16.8 software was used to conduct meta-analysis.ResultsA total of 23 studies involving 2 849 patients with 5 approaches including open prostatectomy (OP), holmium laser enucleation of the prostate (HoLEP), plasmakinetic/bipolar plasmakinetic enucleation of the prostate (PK/BPEP), transurethral vaporization of the prostate (TUVP), and laparoscopic prostatectomy (LSP) were included. HoLEP, PK/BPEP and OP were superior to the other methods in improving the objective indicators and subjective feelings of patients during both short and medium-term follow-up. However, compared with OP, HoLEP and PK/BPEP were observed to result in a significantly lower hemoglobin level (MD=1.65, 95%CI 0.35 to 4.41; MD=2.62, 95%CI 0.64 to 2.90), longer postoperative irrigation time (MD=4.67, 95%CI 1.29 to 10.66; MD=2.67, 95%CI 1.32 to 6.63), as well as indwelling catheter after operation (MD=1.64, 95%CI 0.48 to 4.15; MD=2.52, 95%CI 0.60 to 3.78). In terms of short-term complications, PK/BPEP (RR=0.45, 95%CI 0.13 to 1.29) was found to be significantly lower than that of OP.ConclusionsHoLEP and PK/BPEP can be probably used as a superior treatment option for large volume benign prostatic hyperplasia because of its better curative effect, higher safety and quick postoperative recovery.
ObjectiveTo explore the impact of different tracts on the effectiveness and safety of percutaneous nephrolithotomy (PCNL) on complete staghorn calculus.MethodsPatients with complete staghorn calculus who underwent single channel PCNL by the same surgeon in West China Hospital of Sichuan University from October 2009 to August 2019 were included. The removing time, the rate of immediate stone removal, the average extubating time, and the incidences of postoperate complications such as fever and bleeding were analyzed statistically.ResultsA total of 379 patients were included. There were 146 cases in the upper tract group, 170 cases in the lower tract group and 63 cases in the middle tract group. Compared with the upper and middle tract groups, the lower tract group had shorter stone removing time [(50.34±18.52) vs. (53.41±22.75) vs. (41.79±17.45) min, P<0.001], shorter average extubating time [(5.53±1.83) vs. (6.17±1.44) vs. (4.96±1.91) d, P=0.007]. The rate of immediate stone removal was higher in the the upper tract group (40.56% vs. 32.79% vs. 34.71% ), but there was no statistical difference among the three groups (P=0.447). There was no significant difference among the three groups in the fever incidence (25.44% vs. 24.24% vs. 26.85%, P=0.938) or bleeding incidence (3.54% vs. 3.03% vs. 4.03%, P=1.000). In addition, there were 8 cases of pleural injury in the upper tract group.ConclusionsCompared with the lower and middle tract, PCNL with upper tract has a higher rate of removing stones for complete staghorn calculus, but there was no significant difference among the three groups. The incidences of bleeding and fever after surgery are similar in the three groups, but the risk of pleural injury may be increased in the upper tract group.
Objective To study the effect of hypoxia on the prol iferation of hBMSCs and human placental decidua basal is-MSCs (hPDB-MSCs), and to provide the theoretical basis for discovering the new seed cells source for tissue engineering. Methods Density gradient centrifugation method was adopted to isolate and culture hBMSCs and hPDB-MSCs,flow cytometry (FCM) was appl ied to detect cell surface marker. After establ ishing the experimental model of CoC12 chemical hypoxia, MTT method was appl ied to evaluate the prol iferation of hBMSCs and hPDB-MSCs at different time points (6, 12, 24, 48, 72, 96 hours) with various CoC12 concentration (0, 50, 75, 100, 125, 150, 175, 200 μmol/L). Results FCM analysis revealed that hPDB-MSCs and hBMSCs expressed CD9, CD29, CD44, CD105, CD106 and human leucocyte antigen ABC (HLA-ABC), but both were absent for CD34, CD40L and HLA-DR. Compared with hBMSCs, hPDB-MSCs expressed stage-specific embryonic antigen 1 (SSEA-1), SSEA-3, SSEA-4, TRA-1-60 and TRA-1-81 better. The prol iferations of hPDB-MSCs and hBMSCs were inhibited within the first 12 hours under hypoxia condition, but promoted after 12 hours of hypoxia. Compared with the control group, the hBMSCs were remarkably prol iferated 24 hours after hypoxia with CoC12 concentration of 150 µmol/L (P lt; 0.05), while hPDB-MSCs were significantly prol iferated 12 hours after hypoxia with CoC12 concentration of 75 µmol/L (P lt; 0.05). Conclusion Compared with hBMSCs, hPDB-MSCs express more specific surface antigens of embryonic stem cells and are more sensitive to the prol iferation effects of chemical hypoxia, indicating it may be a new seed cells source for tissue engineering.
Objective To assess the efficacy of medical expulsive therapy for ureteral calculi with tamsulosin. Methods We searched PubMed, MEDLINE, EMBASE, BIOSIS, International Pharmaceutical Abstracts (IPA) Database, The Cochrane Library and Chinese Journal Full-text Database from 1995 to September 2006, as well as the proceedings of urological scientific conferences from 2000 to 2006. Randomized controlled trials(RCTs) comparing tamsulosin and other therapies for ureteral calculi among adults were included. Data were extracted by two reviewers independently and synthesized by STATA 9.0 software. Results A total of 16 studies involving 1521 patients with distal or juxtavesical ureteral calculi were included. Compared with conservative therapy, tamsulosin showed higher expulsion rate [RR 1.50, 95%CI (1.20 to 1.87), Plt;0.0001], shorter expulsion time [SMD –1.29, 95%CI (–2.27, –0.31)] and fewer patients requiring ESWL or ureteroscopy [RR 0.40, 95%CI (0.27, 0.59), Plt;0.05]. Compared with conservative therapy, the combination of tamsulosin plus deflazacort also showed higher expulsion rate [RR 1.59, 95%CI (1.31, 1.93)], shorter expulsion time [SMD –0.8, 95%CI (–1.18, –0.42)] and fewer patients requiring ESWL or ureteroscopy [RR 0.13, 95%CI (0.06, 0.31), Plt;0.05]. Compared with deflazacort alone, the combination of tamsulosin plus deflazacort demonstrated similar expulsion rate [RR 1.31, 95%CI (0.78, 2.23), P=0.31], but significantly reduced the dosage of analgesics [SMD 15.20, 95%CI (14.98, 15.52)] and decreased the proportion of patients requiring ESWL or ureteroscopy [RR 0.09,, 95%CI (0.02, 0.47), Plt;0.05]. Compared with deflazacort plus nifedipine, the combination of tamsulosin plus deflazacort showed higher expulsion rate [RR 1.20, 95%CI (1.07, 1.35), P=0.002], but similar expulsion time [SMD –1.34, 95%CI (–3.47, 0.79)] and proportion of patients requiring ESWL or ureteroscopy [RR 0.34, 95%CI (0.05, 2.22), Pgt;0.05]. As for side effects, tamsulosin-based treatment and conservative therapy were comparable (Pgt;0.05). Conclusions Tamsulosin has a beneficial effect on the expulsion of ureteral calculi, especially for distal and juxtavesical ureteral calculi. Tamsulosin-based medical expulsive therapy at the dosage of 0.4mg daily is effective and safe for patients with distal ureteral calculi. More large-scale studies are required to define the efficacy of combination therapy of tamsulosin plus deflazacort.
Objective To study the effect and mechanism of Xuebijing injection on sepsis-induced acute lung injury (ALI) in mice by regulating autophagy. Methods A total of 80 BALB/c male mice were randomly divided into control group, model group, Xuebijing group and Xuebijing+3-methyladenosine (3-MA) group, with 20 mice in each group. The control group received sham operation, while sepsis-induced ALI model was established in the later three groups by cecal ligation and puncture, on that basis, the Xuebijing group was given 10 mL/kg Xuebijing by intraperitoneal injection and the Xuebijing+3-MA group was given 10 mL/kg Xuebijing and 10 mg/kg autophagy inhibitor 3-mA by intraperitoneal injection. The cumulative survival rates of the four groups were observed 72 h after modeling, and the pathological changes of lung tissues, lung wet weight /dry weight ratios, inflammatory cytokines [tumor necrosis factor-α (TNF-α), interleukin (IL)-1 β, and IL-18] contents, numbers of autophagosome, and the protein expression levels of autophagy genes [microtubule-associated protein light chain3 (LC3)-Ⅱ/LC3-Ⅰand Beclin-1] were detected. Results In the control group, the 72-hour cumulative survival rate was 100%, the lung wet weight /dry weight ratio was 3.89±0.85, the TNF-α, IL-1β, and IL-18 contents were (0.83±0.14) ng/mg, (0.74±0.15) ng/mg, and (84.51±13.25) pg/mg, respectively, the number of autophagosome was (0.41±0.09)/field, and the expression levels of LC3-Ⅱ/LC3-Ⅰ and Beclin-1 were 0.20±0.04 and 0.17±0.03, respectively. In the model group, the lung tissue showed typical ALI pathological changes, the 72-hour cumulative survival rate (50%) was lower than that in the control group, and the lung wet weight /dry weight ratio (6.77±0.94), contents of TNF-α, IL-1β, and IL-18 [(3.15±0.76) ng/mg, (2.88±0.62) ng/mg, (274.62±45.58) pg/mg], autophagosome number [(3.14±0.55)/field], and expression levels of LC3-Ⅱ/LC3-Ⅰ and Beclin-1 (0.69±0.09, 0.35±0.06) were higher than those in the control group (P<0.05). In the Xuebijing group, the ALI pathological changes alleviated, the 72-hour cumulative survival rate (75%), autophagosome number [(5.77±0.75)/field], and expression levels of LC3-Ⅱ/LC3-Ⅰ and Beclin-1 (0.98±0.13, 0.62±0.08) were higher than those in the model group (P<0.05), and the lung wet weight /dry weight ratio (4.23±0.76) and contents of TNF-α, IL-1β, and IL-18 [(1.52±0.32) ng/mg, (1.29±0.30) ng/mg, (121.36±26.51) pg/mg] were lower than those in the model group (P<0.05). In the Xuebijing+3MA group, the ALI pathological changes aggravated, the 72-hour cumulative survival rate (55%), autophagosome number [(0.78±0.16)/field], and expression levels of LC3-Ⅱ/LC3-Ⅰ and Beclin-1 (0.37±0.05, 0.32±0.05) were lower than those in the Xuebijing group (P<0.05), and the lung wet weight /dry weight ratio (6.31±0.91) and contents of TNF-α, IL-1β, and IL-18 [(2.88±0.56) ng/mg, (2.41±0.58) ng/mg, (252.35±37.65) pg/mg] were higher than those in the Xuebijing group (P<0.05). Conclusion Xuebijing injection can reduce ALI induced by sepsis in mice, and activation of autophagy is the molecular mechanism.