ObjectiveTo explore the effect of preoperative jaundice on the complications of laparoscopic cholecystectomy combined with intraoperative biliary stone removal in patients with common bile duct stones.MethodsA total of 104 patients with choledocholithiasis who underwent laparoscopic cholecystectomy combined with intraoperative biliary stone removal for common bile duct stones in Baishui County Hospital and No.215 Hospital of Shaanxi Nuclear Industry between January 2014 and February 2016 were enrolled and retrospectively analyzed. The patients were divided into the jaundice group (43 cases) and the jaundice-free control group (control group, 61 cases) according to the preoperative serum total bilirubin level. The differences in postoperative complication rates between the two groups were compared and risk factors affecting postoperative complications were explored.ResultsThe ALT and total bilirubin on the first day after operation in the jaundice group were higher than those in the control group (P<0.05). In addition, the hospital stay in the jaundice group was shorter than that of the control group (P<0.001). There was no significant difference in the incidence of total postoperative complication rate and the incidence of complications (included biliary leakage, ballistic hemorrhage, hyperthermia, incision complications, and other complications) between the two groups (P>0.05). There were no significant differences in Clavien-Dindo classification, comprehensive complication index (CCI), and ratio of CCI≥20 (P>0.05). Multivariate analysis showed that male and residual stones were independently associated with postoperative complications (P<0.05), but there was no statistical correlation between preoperative jaundice and postoperative complications (P>0.05).ConclusionPreoperative jaundice does not increase the risk of complications after acute laparoscopic surgery in patients with common bile duct stones.
【摘要】 目的 观察已构建的含胸苷激酶（TK）自杀基因的重组腺病毒（ADV-TK）对肝癌细胞的体外杀伤作用和对肝癌裸鼠移植瘤的治疗效果。 方法 将ADV-TK体外感染人肝癌细胞株SMMC-7721，噻唑蓝（MTT）法检测受感染的SMMC-7721细胞被不同浓度更昔洛韦（GCV）作用后的细胞存活率情况。构建肝癌SMMC-7721裸鼠移植瘤模型，观察肿瘤注射重组腺病毒ADV-TK结合GCV治疗移植瘤的变化。 结果 相同滴度的重组腺病毒与不同浓度的GCV作用于肝癌细胞株SMMC-7721后，MTT法检测到细胞的存活率随着GCV浓度的增加而不断降低。动物实验中ADV-TK治疗组肿瘤体积明显小于对照组（ADV-null及NS）（Plt;0.01）。 结论 重组腺病毒ADV-TK对肝癌SMMC-7721细胞的体外增殖和裸鼠体内的移植瘤生长均有明显的抑制作用。【Abstract】 Objective To explore the inhibitory effect of recombinant adenovirus containing TK gene (ADV-TK) on transfected human liver cancer cells SMMC-7721 in vitro and murine transplanted hepatocarcinoma in vivo. Methods SMMC-7721 cells transfected with ADV-TK were exposed to medium with GCV. The cell viability was measured by MTT assays. In the established model of SMMC-7721 human liver cancer, nude mice underwent intratumoral injection with 1 109 pfu ADV-TK, the control vector (ADV-null) or normal saline (NS) and again 7 days later, twice for all. GCV was given at a dose of l00 mg/(kg•d) on the following day of injection for 10 days. The tumor inhibitory effect was observed by measuring the tumor sizes. Results After transfected by ADV-TK in vitro, and combined with GCV, the cell growth of SMMC-7721 cell were significantly suppressed. The result of in vivo assay showed that tumor volumes in treatment group were apparently smaller than that in the control group (Plt;0.01). Conclusion Recombinant adenovirus combined with GCV shows a significant inhibitory effect on SMMC-7721 cells in vitro and murine transplanted hepatocarcinoma in vivo.
Objective To construct replication-defective adenovirus containing tk gene (ADV-tk). Methods Recombinant adenovirus of ADV-tk was constructed using homologous recombination in cells. After the interested tk gene fragment in the recombinant plasmid obtained was confirmed by PCR, the titre of purified recombinant adenovirus was detected. In vitro study, tk gene in SMMC7721 cells transfected by ADV-tk was investigated by RT-PCR. In vivo study, ADV-tk was injected intraperitoneally into BALB/c nude mice with liver cancer and apoptosis cells in tumor were observed. Results Recombinant adenovirus containing ADV-tk was proved successfully. The titre of purified recombinant adenovirus was 1.4×1010 pfu/ml. In vitro study, tk was integrated and expressed by SMMC-7721 cells. In vivo study, with the injection of ADV-tk, apoptosis cells in tumor increased. Conclusion A replication-defective adenovirus containing tk gene is successfully constructed, which may useful for further research on tumor suicide gene therapy with ADV-tk.
In recent years, the diagnosis and management technology of type B aortic dissection (TBAD) has developed rapidly worldwide along with evidence-based medicine practice and clinical research data. But the standard clinical criteria are still limited. Based on this, the Society of Thoracic Surgeons (STS) and the American Association for Thoracic Surgery (AATS) established an expert group dominated by aortic surgeons to collate and analyze the comprehensive literature data of acute and chronic, complicated and uncomplicated TBAD. And then, the group formulated and officially released the clinical practice guidelines for TBAD in 2022. In this paper, we interpreted and analyzed the main contents of the guideline in combination with domestic research, in order to provide reference and help for the clinical diagnosis and treatment of TBAD at the present stage in China.
Objective To review the application and research progress of dexamethasone in the perioperative period of joint arthroplasty and arthroscopic surgery. Methods The relevant domestic and foreign literature in recent years was extensively reviewed. The application status and therapeutic effect of dexamethasone in the perioperative period of joint arthroplasty and arthroscopic surgery were summarized. Results Studies have shown that intravenous administration of 10-24 mg dexamethasone before or/and within 24-48 hours after operation can reduce the incidence of nausea and vomiting, and reduce the consumption of opioids in patients after hip and knee arthroplasties with high safety. The duration of nerve block during arthroscopic surgery can be prolonged by perineural injecting local anesthetics and 4-8 mg dexamethasone, but the effect of postoperative analgesia is still controversial. Conclusion Dexamethasone is widely used in joint and sports medicine. It has the effects of analgesia, antiemetic, and prolonging the time of nerve block. In the future, high-quality clinical studies on the application of dexamethasone in shoulder, elbow, and ankle arthroplasties and arthroscopic surgery are needed, and more attention should be paid to the long-term safety of dexamethasone.
Currently, the medical imaging methods based on artificial intelligence are developing rapidly, and the related literature reports are increasing year by year. However, there is no special reporting standard, and the reporting of the results is not standardized. In order to improve the report quality of this kind of research and help readers and evaluators evaluate the quality of this kind of research more scientifically, a checklist for artificial intelligence in medical imaging (CLAIM) was put forward abroad. This paper introduces the content of CLAIM and explains its items.
As precision medicine continues to gain momentum, the number of predictive model studies is increasing. However, the quality of the methodology and reporting varies greatly, which limits the promotion and application of these models in clinical practice. Systematic reviews of prediction models draw conclusions by summarizing and evaluating the performance of such models in different settings and populations, thus promoting their application in practice. Although the number of systematic reviews of predictive model studies has increased in recent years, the methods used are still not standardized and the quality varies greatly. In this paper, we combine the latest advances in methodologies both domestically and abroad, and summarize the production methods and processes of a systematic review of prediction models. The aim of this study is to provide references for domestic scholars to produce systematic reviews of prediction models.
The use of clinical predictive modeling to guide clinical decision-making and thus provide accurate diagnosis and treatment services for patients has become a clinical consensus and trend. However, the models available for clinical use are more limited due to unstandardised research methods and poor quality of evidence. This paper introduces the development process of clinical prediction models from six aspects, data collection, model development, performance evaluation, model validation, model presentation and model updating, as well as the clinical prediction model research report statement and risk of bias assessment tools in order to provide methodological references for domestic researchers.