ObjectiveTo analyze the causes and prevention principles of hepatic venous hemorrhage during laparoscopic hepatectomy.MethodLiteratures about the causes and prevention of hepatic venous hemorrhage during laparoscopic hepatectomy were collected, and then made an review with our own clinical experience.ResultsIntraoperative hepatic venous hemorrhage was one of the most dangerous complications during laparoscopic hepatectomy. The main reasons for its occurrence included subjective and objective factors. Through accurate preoperative assessment, rigorous attitude during operation and superb surgical skills, intraoperative control of the prsessure difference between the internal and external veins, could significantly reduce the incidence of intraoperative venous bleeding. For the hepatic vein bleeding that had occurred, the correct evaluation and treatment during the operation could reduce the adverse effect on the surgical efficacy.ConclusionCorrectly understand the causes of hepatic venous hemorrhage during laparoscopic hepatectomy, prevent and manage various techniques before and during operation can carry out laparoscopic hepatectomy more safely.
Targeted initiatives of West China Hospital of Sichuan University to cope with coronavirus disease 2019 epidemic in three stages were summarized, including “three reconstructions” to mobilize in pre-epidemic stage, “three earlies” strategy to precisely treat critically ill patients in epidemic stage, and “three orderlies” to resume hospital operation in post-epidemic stage. The development of comprehensive hospitals in China after the epidemic was also discussed. It’s recommended to continuously strengthen the role of emergency response, early warning, comprehensive treatment, high-level talent training, international exchange, regional leadership, and collaborative innovation, in response to the shortcomings exposed in the epidemic.
ObjectiveTo explore the safety and feasibility of mixed approach laparoscopic anatomical left hepatectomy for left hepatolithiasis.MethodThe clinical data and follow-up results of 23 patients with left hepatolithiasis admitted to the Department of Hepatobiliary Pancreatic Surgery in Leshan People’s Hospital from June 2018 to June 2020 were retrospectively analyzed.ResultsAll 23 patients underwent anatomical left hepatectomy under laparoscopy. The median of total operation time was 185 min (153–460 min), the median of operation time of liver dissection was 110 min (90–125 min), the median of total blood loss during operation was 175 mL (100–800 mL), the median of blood loss from liver dissection was 120 mL (60–560 mL), blood transfusion was performed in 2 patients during operation. Postoperative day 1: median of AST was 75 U/L (32–437 U/L), median of ALT was 83 U/L (25–537 U/L),median of TBIL was 24 μmol/L (15.6–42.7 μmol/L); postoperative day 3: median of AST was 31 U/L (23–129 U/L),median of ALT was 27 U/L (14–108 U/L), median of TBIL was 13.5 μmol/L (10.4–24.3 μmol/L). Postoperative blood transfusion was performed in 1 patient, and the median of postoperative hospital stay was 7 days (5–20 days), median of postoperative extubation time was 2.5 days (2–5 days). Postoperative complications occurred in 3 patients. All 23 patients were followed up after the operation for median of 12 months (6–18 months). During the follow-up period, the patients had no special discomfort, no stone recurrence, reoperation, and death.ConclusionMixed approach laparoscopic anatomical left hepatectomy is safe and feasible in the treatment of left hepatolithiasis.
Hospital incident command system is a series of management systems for emergencies response of hospitals from the United States. Some hospitals in many countries have applied this system, but it has not yet been applied in China. In the process of responding to the coronavirus disease 2019 epidemic, West China Hospital of Sichuan University managed coronavirus disease 2019 patients through a standardized and programmatic model using the concept and framework of hospital incident command system, which included organizing hospital incident management team, carrying out incident action plan, space management, personnel management, material management and information management, in order to carry out standardized and procedural crisis response. This article introduces these management measures of West China Hospital of Sichuan University, aiming to provide a reference for establishing a more complete hospital emergency management system in line with China’s system in the future.
Objective To systematic investigate whether phase angle of bioelectrical impedance is associated with the functionality, severity, and prognosis of individuals afflicted with chronic obstructive pulmonary disease (COPD). Methods Relevant literature from the PubMed, Embase, Web of Science, Scopus, CNKI, and WanFang databases was retrieved, and literature screening and data extraction in accordance with standardized methods were conducted. Literature quality was assessed by utilizing Mixed Methods Appraisal Tool. Subsequently, data pertaining to the results was extracted for summarization and induction, and descriptive analyzed through qualitative synthesis. Results A total of 11 studies, encompassing 2189 subjects, were included in this review, and the overall quality of the literature was deemed relatively high. Of these studies, three examined the correlation between phase angle and the severity of COPD, eight studies examined the correlation between phase angle and pulmonary and physical function in COPD, and seven studies reported the association between phase angle and adverse outcomes such as hospitalization time, nutritional risk, acute exacerbation and mortality in COPD. The collective findings suggestted that reduced levels of phase angle are linked to severe illness, diminished function, and unfavorable prognosis among individuals with COPD. Phase angle emerged as an independent predictor of lung function, physical exercise endurance, acute exacerbation and mortality in COPD patients. Conclusion The phase angle level of COPD patients is associated with their disease severity, function, and prognosis, and is an potential available indicator for clinical management of COPD patients.
Objective To evaluate the diagnostic value of analyzing the pattern of gallbladder wall enhancement on MDCT to identify the different causes of acute cholecystitis. Methods In January 2009 to December 2012， 169 patients diagnosed with acute cholecystitis caused by various pathologic conditions were performed MDCT scans， the images of portal venous phase and clinical data were retrospectively reviewed by two blinded radiologists. There were 146 cases in non-hepatopathy cholecystitis group and 23 cases in hepatopathy cholecystitis group. The other 5 normal gallbladder cases diagnosed by MDCT scans were retrospectively reviewed as contrast group. Using five patterns according to the enhancement pattern of flat gallbladder wall thickening on MDCT. The study cases were then divided into five patterns and the thickness of the mucous membrane were measured. The occurrence rate of each pattern and the thickness of the mucous membrane between the groups were compared respectively. Results In the non-hepatopathy cholecystitis group， there were typeⅡin 102 cases （69.9%）， typeⅢin 5 cases （3.4%）， typeⅣ in 30 cases （20.5%）， and typeⅤ in 9 cases （6.2%）. In the hepatopathy cholecystitis group， there were typeⅡin 2 cases （8.7%）， typeⅢ in 11 cases （47.9%）， typeⅣin 5 cases （21.7%）， and typeⅤin 5 cases （21.7%）. The occurrence rate of typeⅡin the non-hepatopathy cholecystitis group was significialtly higher than that in the hepatopathy cholecystitis group （P＜0.005）. The occurrence rate of typeⅢ and typeⅤ in the hepatopathy cholecystitis group were significialtly higher than those in the non-hepatopathy cholecystitis group（P＜0.005， P＜0.05）. The occurrence rate of type Ⅳ between the two groups had no significant difference （P＞0.05）. TypeⅠonly present in the contrast group. The non-hepatopathy group’s mean mucous membrane thickness was （2.61±1.30） mm ， which was thicker than the hepatopathy group’s （2.02±0.52） mm（t=2.22， P＜0.05）. Conclusion Analyzing the enhancement pattern of a thickened gallbladder wall on MDCT is helpful in identifying the causes of acute cholecystitis， and the gallbladder perforation or not.
ObjectiveTo explore the association between a single nucleotide polymorphism in PALB2 rs249954 and breast cancer.MethodsStudies regarding the association between a single nucleotide polymorphism in PALB2 rs249954 and breast cancer were searched from CNKI, WanFang, CBM, PubMed, Embase, Cochrane Library, Science Direct, and Web of Science. The eligible studies were screened based on the inclusion, exclusion criteria, and principle of quality evaluating. Meta-analysis and the assessment of published bias were performed by Stata 14.0 software.ResultsA total of 7 studies were eligible for this study, including 3 247 cumulative cases of breast cancer and 3 294 controls. Through the comparison of a variety of genetic models, we found that there was no significant for the OR of additive model〔T vs C: OR=1.14, 95% CI was (0.95, 1.37), P=0.156〕 , dominant gene model〔CT+TT vs CC: OR=1.22, 95% CI was (0.97, 1.54), P=0.088〕 , recessive gene model〔TT vs CT+CC: OR=1.11, 95% CI was (0.84, 1.45), P=0.464〕 , codominant gene model CC vs TT and TT vs CT〔 OR=0.79, 95% CI was (0.54, 1.15), P=0.226; OR=0.95, 95% CI was (0.82, 1.11), P=0.523〕 ; there was significant difference for codominant gene model CC vs CT〔OR=0.82, 95% CI was (0.67, 1.00), P=0.048〕 , but the conclusion was different after sensitivity analysis. Besides, there was notable difference for overdominant model〔CC+TT vs CT: OR=0.85, 95% CI was (0.77, 0.94), P=0.001〕 .ConclusionThe mutant genotype heterozygous (CT) of rs249954 in PALB2 will increase the breast cancer risk.
Coronavirus disease 2019 epidemic is a serious and infectious public health event that causes physical damage and may also have an impact on mental health. West China Hospital of Sichuan University combines the internet hospital platform with the traditional telephone model, establishes a new coronavirus disease 2019 intervention integration platform, and builds a new “four-in-one” medical service system, which contains epidemic consultation, psychological consultation, self-evaluation and home prevention and control. It has established a way for the public to communicate with professional, reduced the spread of coronavirus disease 2019 in space, and effectively carried out psychological decompression and comfort work, disseminated the knowledge of fighting coronavirus disease 2019, and provided medical advice. This article mainly introduces the out-of-hospital psychological intervention model of West China Hospital of Sichuan University during the coronavirus disease 2019 epidemic, and aims to provide a reference for exploring the psychological intervention methods for major public health emergencies.
Proton pump inhibitors (PPIs) are widely used in digestive system diseases, but long-term use of PPI may cause Clostridium difficile infection, small intestinal bacterial overgrowth, spontaneous bacterial peritonitis and gastrointestinal barrier dysfunction. Probiotics can improve the digestive tract microecological disorder caused by the application of PPI by inhibiting the colonization of bacteria in the intestinal tract, regulating the body’s immunity, reducing the pH value of the intestinal tract, and enhancing the barrier function of the intestinal mucosa. This article elaborates on the influence of PPI on the microecology of the digestive tract and the regulation of probiotics on the microecology of the digestive tract, aiming to provide some ideas for the digestive tract microecological disorders caused by the application of PPI in clinical practice and their intervention strategies.
Objective To investigate the effect of TIMP-2 gene that was transfected by adenovirus on extracellular matrix of abdominal aortic through assessing the changes of morphology and histopathology of the rat models with abdominal aortic aneurysm. Methods The rat models with abdominal aortic aneurysm were constructed by intraluminally perfusing porcine pancreatic elastase. Twenty-four SD rats with aneurysm were then randomly divided into 3 groups: AdTIMP-2 group (perfused locally with solution of TIMP-2 gene transfected by adenovirus vector to abdominal aorta), AdCMV group (transfected by non-viral vector), and PBS group. After 14 days, the concentrations of elastin and collagen that were collected from the samples of aortic wall were measured by image analysis system and the fixed aortic tissues were examined by light microscopy and some other specific staining methods. Results None of abdominal aortic aneurysm developed in TIMP-2 gene transfected group, with significantly higher rates of developed aneurysm in the other groups (P＜0.01). The diameters of arteries on day 14 in the AdTIMP-2 group were (2.33±0.06) mm, which were significantly smaller than those in the AdCMV group 〔（3.52±0.11） mm〕 and PBS group 〔（3.43±0.09） mm〕. The elastic fibers and collagenous fibers were preserved with more integrity in AdTIMP-2 group and inflammation cells that were observed in adventitia of artery were also less than those of the other groups. Conclusion TIMP-2 gene transfected by adenovirus vector could restore the degradation of extracellular matrix that was aroused by elastase and could block the formation of abdominal aortic aneurysm, which may provide a new strategy for the treatment of abdominal aortic aneurysm.