ObjectiveTo investigate the diagnostic value of endoscopic retrograde cholangiopancreatography (ERCP) in obstructive jaundice of elderly patients. MethodsTotally 338 patients with obstructive jaundice underwent ERCP were divided into elderly group (age ≥60 years old) and nonelderly group (age lt;60 years old) based on age. The levels of serum amylase (AMY), ALT, and TBIL in 6, 24, and 48 h after ERCP were detected. The success rate of cholangiopancreatography, accuracy rate of diagnosis, and incidence of complications after ERCP in two groups were analyzed. ResultsThe difference of serum AMY, ALT, and TBIL levels of patients in 6, 24, and 48 h after ERCP were not significant between two groups (Pgt;0.05). The success rate of cholangiopancreatography in nonelderly group was 96.3% (130/135) and in elderly group was 96.1% (195/203), and no difference was found (Pgt;0.05). However, the accuracy rate of diagnosis of ERCP in nonelderly group (84.6%, 110/130) was significantly lower than that in elderly group (98.5%, 192/195), Plt;0.05. The difference of the incidence of complications was not significant between two groups 〔14.8% (20/135) vs. 17.2% (35/203)〕, Pgt;0.05. There was no mortality in two groups patients. ConclusionERCP is a safe, effective, and accurate method, which is of importance to the diagnosis of obstructive jaundice in elderly patients.
Objective To summarize the important role of myeloid differentiation factor 88 （MyD88） in toll like receptor （TLR） signaling pathway， and to summarize the relationship between MyD88 and relative diseases， and its potential application value. Methods Domestic and international publications online involving the role of MyD88 in TLR signaling pathway and the influence of MyD88 in some kinds of diseases in recent years were collected and reviewed. Results MyD88 was an important adapter protein， and played a connecting role in the TLR signaling pathway. It was the bottle neck of TLR signaling pathway， and could lead to the activation of many transcription factor to initiate innate immune response. It was also related to a variety of diseases. Conclusions MyD88 is the key adapter protein in TLR signaling pathway. It plays an important role in innate immunity， acquired immunity， and a variety of diseases， so it is a potential therapeutic target.
ObjectiveTo investigate the effect of using hemoglobin-revised trauma score (HB-RTS) on predicting mortality risk in trunk injury patients. MethodsAccording to case control study rules, medical records of patients with trunk injury who were treated between July 2011 and October 2013, were collected. Patients were divided into two groups according to their survival prognosis within 28 days. The HB-RTS, revised trauma score (RTS), and injury severity score (ISS) of the two groups were calculated. The receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) and Youden's index were calculated. And then, we selected the optimal cutoff value using HB-RTS and RTS to predict the trunk injury patients' mortality and calculated their sensitivity, specificity, and accuracy. In the end, the correlation of ISS with HB-RTS and RTS using linear correlation analysis method was analyzed. ResultsBesides RTS, HB-RTS and ISS in the death group were statistically significant higher than that in the survival group. The AUC of HB-RTS and RTS of the two groups were 0.922 and 0.888, respectively. The sensitivity of HB-RTS and RTS were 91.5% and 83%; and the specificity of HB-RTS and RTS were 95.7% and 76.6%, respectively. The correlation of HB-RTS and ISS was -0.592, while the correlation of RTS and ISS was 0.585. ConclusionCompared to RTS, ROC of HB-RTS is enlarged, the specificity is increased, and the sensitivity is decreased. HB-RTS has stronger correlation with ISS than with RTS. The predictive effect of HB-RTS is higher than RTS in predicting mortality of trunk injury patients.
ObjectiveTo investigate the value of uterine compression suture through laparoscopy in the treatment of cesarean scar pregnancy (CSP). MethodsA random controlled study was conducted on 85 CSP patients diagnosed between September 2013 and December 2014. The patients were randomly divided into control group (n=43) and study group (n=42). The control group received routine evacuation under laparoscopy, while the study group received routine evaluation under laparoscopy combined with uterine compression suture. The efficacy of the two treatments were compared and analyzed. ResultsThe operation time of the control group and the study group was (36.6±17.7) and (45.6±14.8) minutes, respectively. Total amount of bleeding during and after the operation was (207.9±165.8) and (96.1±29.0) mL for the two groups of patients, and the above differences were statistically significant (P＜0.05). There was no significant difference in the indicators of anal exhaust time, hospitalization stay, blood β-human chorionic gonadotrophin clearance time, and menstruation recovery time between the two groups (P>0.05). ConclusionUterine compression suture through laparoscopy is a safe and reliable method to reduce the bleeding of CSP, which is easy to perform and worthy of promotion.
ObjectiveTo explore the utility of magnetic resonance-T1ρ-weighted imaging (T1ρWI) in the diagnosis of human primary hepatic carcinoma. MethodsNine patients were prospectively collected from West China Hospital of Sichuan University during January 2014 and June 2014, who had liver lesion that identified by the ultrasound or CT examination, and then were verified as primary hepatic carcinoma with pathological biopsy. A routine T2WI, pre-and post-contrast T1WI, pre-and post-contrast T1ρWI were performed on a 3.0 T clinical imager. The tumor-to-normal-tissue contrast was compared between pre-contrast T1ρWI/post-contrast T1ρWI and other sequences respectively, to investigate the value of T1ρWI in the diagnosis of human primary hepatic carcinoma. ResultsThe tumor-to-normal-tissue contrast of pre-and post-contrast T1WI were lower than that of pre-contrast T1ρWI (t=3.532, P=0.008; t=3.666, P=0.006), while there was no statistical difference between T2WI and pre-contrast T1ρWI (t=-1.448, P=0.186). And compared with post-contrast T1ρWI, post-contrast T1WI had lower tumor-to-normal-tissue contrast (t=3.468, P=0.008). ConclusionsT1ρWI can provide a better image of human primary hepatic carcinoma, thus T1ρWI is expected to become a new and useful method in MR scanning. It also shows potential value who can be used as an artery imaging that without using contrast agents.
Objective To investigate the application value of spiral CT postprocessing technique in the airway stent implantation technology. Methods Twenty-three patients with malignant airway stenosis or malignant tracheoesophageal fistula who needed the treatment of airway stent implantation from May 2012 to April 2016 were collected, including 19 males and 4 females with an average age of (61.6±10.0) years. Bronchoscopy and spiral CT with three-dimensional airway reconstruction were proceeded for the same patients before and after stent implantation, and the relevant data about narrow airway was measured by volume rendering, multiplanar reformation (MPR) and CT virtual endoscopy (CTVE) in a variety of ways, to confirm the location and size of narrow airway and fistulas, the degree and length of airway stenosis, as well as the distal end of the situation, and evaluate the patency of airway, the position and shape of stents, adjacent airway and complications after stenting. The positive forecast outcomes of the two inspections wascompared. Results Airway stents were placed successfully according to the data from the spiral CT airway three-dimensional reconstruction. Thirty stents were implantated in the 23 patients, including 21 column-type stents, 3 L-type stents, and 6 Y-type stents. All stents stayed in situ, with patency and no deformation.The fistulas were closed and the airways were reopened. Symptoms of cough after eating and drinking and dyspnea were relieved. The positive rates of bronchoscopy and CT examination on diagnosis of airway stenosis were both 100% (23/23). Complications: MRP showed tumor growth leading to stenosis again in 3 patients, and CTVE displayed mucous congestion in 2 patients. Conclusions The technique of 64-layer spiral CT postprocessing technique can measure the relate data of airway stricture or fistulas as a kind of convenient, quick, accurate, and noninvasive method in patients with malignant airway stenosis or tracheoesophageal fistula who need the treatment of airway stenting. It is of high reference value both to airway stent implanting and postoperative observation, and is worthy of application.
Objective To explore the expression differences of procalcitonin (PCT) in different infection sites and bacterial strains, and to provide the evidence for early differential diagnosis of infectious diseases with PCT as a biomarker. Methods The patients with various kinds of infections diagnosed in West China Hospital of Sichuan University between January 2012 and June 2016 were retrospectively included. The expression differences of PCT in various infection sites and bacterial strains were analyzed. Results A total of 1 005 patients were include in this study, including 259 with systemic infection and 746 with local infection. The median PCT level in the systemic infection group was higher than that in the local infection group (8.57 vs. 0.10 ng/mL, P<0.05). In the 779 patients with pulmonary infection, the median PCT level of the patients with sepsis caused by pulmonary infection was higher than that of the ones without sepsis (4.61vs. 0.10 ng/mL, P<0.05), and the median PCT level of the patients with positive sputum culture was higher than that of the ones with negative sputum culture (0.28vs. 0.08 ng/mL, P<0.05). In the 48 patients with urinary tract infection, the median PCT level of the patients with sepsis caused by urinary tract infection was higher than that of the ones without sepsis (12.00vs. 0.42 ng/mL, P<0.05), and the median PCT level of the patients with complicated urinary tract infection was higher than that of the patients with simplex urinary tract infection (19.15vs. 5.02 ng/mL, P<0.05). In the 259 patients with systemic infection, the median PCT level of the patients with infective shock was higher than that of the ones without infective shock (40.26vs. 3.83 ng/mL, P<0.05); the mean PCT level of patients with infection of Gram-negative bacteria, Gram-positive bacteria and fungi was 13.66, 0.99, and 3.30 ng/mL with a significant difference (P<0.05). Conclusion The PCT level has unique advantages in identifying different sites of the infection, early diagnosing complicated urinary tract infection, and evaluating the severity of infection, which could provide evidence in early identification for sepsis caused by various kinds of infectious pathogens.
Objective The objective of this study is to evaluate the effect of enhanced recovery after surgery (ERAS) in the perioperative period of pancreatoduodenectomy. Methods This article conducted the forward-looking analysis on the information of 227 patients undergoing the pancreatoduodenectomy in West China Hospital from January 2016 to June 2017, and then compared the differences between the patients subjected to ERAS (ERAS group) and thosesubjected to regular measures (control group) with respect to time of setting in sickbed, time of mobilizing out ofsickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, the time of nasogastric tube, postoperative hospitalization duration and expenses, postoperative complications, and postoperative pain scores. Results ① Postoperative indexes: by comparison of the ERAS group and the control group, it was found that the ERAS group had shorter (or lower) time of setting in sickbed, time of mobilizing out of sickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, the time of nasogastric tube, postoperative hospitalization duration and expenses (P<0.05). ② Postoperative complications: of all postoperative complications, including pancreatic fistula, postoperative hemorrhage, delayed gastric emptying, biliary fistula, abdominal infection, incision complication, lung infection, and heart complication were without statistically significant differences (P>0.05) between the 2 groups.③ Reoperation and readmission: there was no significant difference on the incidences of reoperation and readmission between the 2 groups (P>0.05). ④ Postoperative pain scores: except 22 : 00 of the 6-day after operation, the pain scores in the ERAS group were all lower than those in the control group at 2 h and 8 h after operation, and the time points of 1–6 days after operation (8 : 00, 16 : 00, and 22 : 00), with statistically differences (P<0.05). Conclusion Without increasing the incidence of complications, ERAS may speed up the rehabilitation of patients undergoing the pancreatoduodenectomy and mitigate the pain of patients.
Blockchain is a modern technological model for concatenating transaction records (also called blocks) by means of cryptography to concatenate and protect the contents. The core of blockchain technology lies in the demand of reducing cost, improving efficiency and optimizing the industry credit environment. The role of blockchain is mainly manifested in the value increment brought by application in industrial scenarios. This paper introduces the application of blockchain technology in medical records information preservation and sharing, regional medical complex construction, protection of sensitive information of patients, improvement of industry transparency, drug authenticity tracing, improvement of medical work mode, and effective improvement of medical cost safety accounting efficiency and discusses the existing problems in the application of blockchain technology in medical care industry, aiming to provide a reference for better application of blockchain technology in medical care industry in the future.