Objective To study the therapeutic effect of Roux-en-Y gastric bypass （RYGB） on type 2 diabetes mellitus （T2DM） rats and explore the possible mechanism of vaspin in RYGB on T2DM. Methods Twenty SD rats with T2DM and 20 age- and sex-matched normal SD rats were randomly divided into 4 groups according to the random digits table：T2DM-RYGB group， T2DM-sham operation （SO） group，RYGB group，and SO group，10 rats in each group. Fasting plasma glucose （FPG） level，serum insulin （INS） level，vaspin level，and homeostasis model of insulin resistance （HOMA-IR） were determined before operation and on week 4，8 after operation，respectively．At the same time，the correlation between vaspin and the indicators （FPG，INS，or HOMA-IR） was analyzed．Results Compared the indicators after operation with before operation，the FPG level，INS level，vaspin level，and HOMA-IR were not significantly different between the T2DM-RYGB group and T2DM-SO group （P＞0.05） or between the RYGB group and SO group （P＞0.05），but the FPG level，INS level，vaspin level，and HOMA-IR in the T2DM-RYGB group and T2DM-SO group were significantly higher than those in the RYGB group （P＜0.05） and SO group （P＜0.05），respectively. On week 4 after operation，the FPG level，INS level，vaspin level，and HOMA-IR decreased in the T2DM-RYGB group，except for the FPG level，the other indexes had no significant differences as compared with the values before operation. On week 8 after operation，the FPG level，INS level，vaspin level，and HOMA-IR further decreased in the T2DM-RYGB group，there were significant differences of these indicators between before operation and on week 8 after operation. Compared the indicators after operation with before operation，the FPG level，INS level，vaspin level，and HOMA-IR were not statistically significant （P＞0.05） in the T2DM-SO group，RYGB group，or SO group. The changes in serum vaspin level correlated positively with those in INS and HOMA-IR before operaion and on week 4，8 after operaion in the T2DM-RYGB group and T2DM SO group rats （P＜0.05），respectively. Conclusions RYGB surgery has a therapeutic effect on T2DM rats，and serum vaspin level decreases and insulin resistance is improved after RYGB surgery，which may be one of the mechanisms of the treatment for T2DM.
ObjectiveObservational studies have shown that plasma lipids are associated with the development of neurodegenerative diseases (NDD), but the causal relationship is unclear. This study investigated the causal relationship between 179 liposomes and NDD using a two-sample Mendelian randomization (MR). MethodsA two-sample MR method was used to comprehensively analyze the causal relationship between liposomes and major NDD such as Alzheimer's disease (AD), Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS). The two sample software package and Phenoscanner database were used to screen for appropriate instrumental variables (TV). In this study, inverse variance weighting (IVW) was used as the primary measure of MR analysis, and various sensitivity tests were performed. ResultsMR-IVW results showed that phosphatidylethanolamine (PE) (OR=0.90, 95%CI 0.83 to 0.99, P=0.03), phosphatidylcholine (PC) (OR=0.92, 95%CI 0.85 to 0.99, P=0.02) and phosphatidylinositol (PI) (OR=0.90, 95%CI 0.83 to 0.99, P=0.03) were protective factors for AD. Sterol ester (OR=1.18, 95%CI 1.04 to 1.34, P=0.01) and cholesterol (OR=1.26, 95%CI 1.02 to 1.56, P=0.03) increased the risk of PD. PE (OR=0.79, 95%CI 0.64 to 0.98, P=0.03) and PC (OR=0.83, 95%CI 0.69 to 0.98, P=0.03) reduced the risk of PD. Diacylglycerol (DAG) (OR=1.24, 95%CI 1.01 to 1.54, P=0.04) and sphingomyelin (SM) (OR=1.13, 95%CI 1.08 to 1.58, P=0.01) were the risk factors for MS. PI (OR=0.77, 95%CI 0.62 to 0.95, P=0.02) and PC (OR=0.74, 95%CI 0.88 to 0.95, P=0.02) were protective factors for MS. PI (OR=1.02, 95%CI 1.01 to 1.04, P=0.02) and triglyceride (TG) (OR=1.03, 95%CI 1.01 to 1.05, P=0.02) increased the risk of ALS, PC (OR=0.98, 95%CI 0.97 to 0.99, P=0.03) decreased the risk of ALS. ConclusionThere is a causal relationship between sterol ester, cholesterol, PC, PE, PI, DAG, SM, TG and different NDD, which provides a theoretical basis and support for further clinical studies.
Objective Ｔo summarize the advancement of ABO-incompatible liver transplantation. Methods Relevant literatures about ABO-incompatible liver transplantation, which were published recently domestic and abroad were reviewed and analyzed. Results Owing to various treatments recent years, outcomes of ABO-incompatible liver transplantation have been improved dramatically. Conclusion With effective immnosuppressive protocols and effective perioperative management, ABO-incompatible liver transplantation is feasible.
ObjectiveTo summarize the clinical manifestations and treatment of plasma cell mastitis. MethodsWe retrospectively analyzed the diagnosis and treatment of 53 patients with plasma cell mastitis admitted into the hospital between January 2008 and December 2014. ResultsTwelve patients with nipple discharge underwent mammary gland segment resection in which the complete discharging tube system and part of the normal gland were resected. In the 26 patients with inflammatory masses, 12 had acute inflammation with mass formation who were treated with abscess incision drainage and silver alginate wound dressing before second-stage lesion resection. Fourteen patients with only local swelling, tenderness and no abscess formation underwent lesion resection after the abscesses were reduced by combined traditional Chinese medicine (TCM) and western medical treatment. Seven patients with painless mass all had abscesses in the areola area, among whom 5 had complete inflammatory capsule and they underwent lumpectomy. Two patients had cheese-like tissue beside the abscess, and they underwent segmental resection. In the 8 patients with chronic fistula, one at the age of 51 was cured by simple mastectomy after recurrence, and the other 7 underwent lesion resection after combined TCM and western medical treatment. All the 53 patients were diagnosed to have plasma cell mastitis by surgical biopsy, and they were all cured with no recurrence 6 months after surgery. Conclusions Plasma cell mastitis is usually misdiagnosed because of its diversified clinical manifestations. For patients whose lesion is large and not confined, it's better for them to receive combined TCM and western medical treatment. Surgical time and approach should be chosen appropriately. Surgical lesion resection is the only method for complete treatment in patients with plasma cell mastitis.
Abstract: Objective To summarize the clinical experience of plasma exchange （PE） during recardiopulmonary bypass (CPB) of patients with severe haemolysis in cardiac surgery. Methods Between January 2001 and December 2005, five patients required PE for severe haemolysis after cardiac surgery. There were periprosthetic leakage and infective endocarditis in 3 patients, congenital heart disease of pulmonary artery stenosis with unsatisfied right ventricular outflow tract patching in 1 patient and thrombosis during extracorporeal membrane oxygenation (ECMO) in 1 patient. They all need blood purification to avoid acute renal failure. Results Five patients were successfully treated with PE during CPB without major complications. The amount of plasma and blood transfused in the 5 patients were 2.2±0.8L and 0.6±0.3L respectively. The volume of plasma exchange and ultrafiltrate were 3.9±1.8L and 2.4±1.3L respectively.The electrolytes and bloodgas analysis in all patients were maintained at the normal levels. The hemodynamics was stable. After heart resuscitation CPB stopped smoothly. Disappearance of periprosthetic leakage and satisfaction of right ventricular outflow tract patching were observed by echocardiograms after peration.Extubation was performed 24h after the operation in 5 patients, and they were discharged 12 to 53 d after the operation with fully recovery. The urine was clear and the body temperature was normal. Before they left thehospital, the concentration of free hemoglobin was tested in 3 patients. The concentration of free hemoglobin was slightly higher in 1 patient (68mg/L), and normal in 2 patients (lt;40mg/L). Conclusion PE during CPB in severe haemolysis is a safe technique which can effectively prevent acute renal failure caused by severe mechanical haemolysis after cardiac surgery.
Objective To systematically review the prognostic and clinicopathological value of plasma fibrinogen in renal cell carcinoma (RCC). Methods An electronic search of the PubMed, EMbase, The Cochrane Library (Issue 5, 2016), CNKI, CBM and WanFang Data databases was performed to collect cohort studies about the prognostic value of plasma fibrinogen in RCC from inception to May 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. Results A total of 3 744 RCC patients from 7 cohort studies were included. The results of meta-analysis showed that the lower plasma fibrinogen expression group was superior to the higher expression group in overall survival (HR=2.13, 95%CI 1.74 to 2.61,P<0.00 001) and cancer-specific survival (HR=3.12, 95%CI 2.19 to 4.44,P<0.00 001). Subgroup analysis showed that plasma fibrinogen expression was higher in stage Ⅲ to Ⅳ than stage ⅠtoⅡ (OR=0.27, 95%CI 0.13 to 0.55,P=0.000 3) and was higher in Fuhrman grading G3+G4 than grading G1+G2 (OR=0.49, 95%CI 0.40 to 0.59,P<0.000 01). However, the level of plasma fibrinogen was not found to be associated with gender (OR=0.85, 95%CI 0.69 to 1.05,P=0.14). Conclusion Current evidence shows plasma fibrinogen expression is associated with the prognostic and clinicopathological value of RCC. Due to limited quantity and quality of included studies, the above conclusions are still needed to be verified by more high quality studies.
Objective To discuss the relationship between motilin, vasoactive intestinal peptide and the gallstone formation. Methods The level of motilin, vasoactive intestinal peptide in plasma, bile and gallbladder tissue of 48 cases of chololithiasis before operation and the first, third, seventh day after cholecystectomy were mesured by radioimmunoassay. Results The level of motilin in plasma was markedly increased in patients with chololithiasis before cholecystectomy and the first day after cholecystectomy. The level of motilin, vasoactive intestinal peptide in bile and gallbladder tissue were significantly increased in patients and motilin was positively correlated with vasoactive intestinal peptide in the gallbladder tissue. Conclusion Motilin, vasoactive intestinal peptide might affect the gallstone formation by affecting the motility of gallbladder.
Objective To investigate the clinical applications of plasma shock wave lithotripsy （PSWL） in the treatment of calculi via choledochoscope. Methods Between 2004 and 2009, 56 huge residual calculi (54 cases) were underwent PSWL via choledochoscope treatment in our hospital. Calculi size: diameter ≤10 mm in 9 calculi, 10 mm lt;diameter ≤15 mm in 24 calculi, 15 mm lt;diameter ≤20 mm in 17 calculi, and diameter gt; 20 mm in 6 calculi. Twenty four cases of these 54 patients had bile duct stricture. Procedure: Firstly found the calculus, and then the lithotriptor wire was introduced to the place 0.5-1.0 mm far away from the calculus surface through choledochoscope channel, and powered on, fired, destructed. Results Forty-eight cases of 54 patients were cured by PSWL with 1 times, 2 cases with 2 times, 2 cases with 3 times, and 2 cases with 4 times. Shock 4-300 times were exported per PSWL, with an average of 65 times. Crushing each stone needed shock for 4-680 times, with an average of 77 times. The calculi were ruptured in different degrees by PSWL, of which 20 cases were completely ruptured. All calculi were completely extracted. Except one case with bile duct stricture was found a small amount of bile duct bleeding during operation, all other patients had no operation complications. Conclusion PSWL technique plays an important role in lithotripsy. It is easy to deal with intrahepatic impacted calculi by PSWL, especially the pigment stones with rough surface.
Objective To explore the safety and efficacy of plasma diafiltration (PDF) in the treatment of liver failure. Methods Patients with liver failure requiring artificial liver treatment in West China Hospital of Sichuan University from December 2020 to December 2022 were selected and divided into three groups according to treatment modality: PDF group, double plasma molecular adsorption system (DPMAS) group and plasma exchange (PE) group. Serum albumin levels and total bilirubin (TB) levels were tested before and after treatments to compare the clearance of these substances among three groups. Adverse events were recorded. Results A total of 88 patients were included, with a total of 179 treatments conducted. Among them, 27 cases in PDF group were treated for 62 times. In PE group, 18 cases were treated for 33 times. In DPMAS group, 43 cases were treated for 84 times. There were no significant differences between the three groups in age, sex, TB, international standardized ratio, albumin, hemoglobin, blood pH value, blood sodium, blood potassium, blood free calcium, or lactate (P>0.05). There was no statistically significant difference in the absolute value of TB decrease, percentage of TB decrease, absolute value of albumin change, and percentage of albumin change before and after treatment among the three groups (P>0.05). Transient hypotension occurred in one patient in DPMAS group. There were two and three allergic reactions in PDF and PE groups, respectively. In addition, 2 patients in PE group had hypocalcemia. Conclusions PDF can be safely used in patients with liver failure, and its therapeutic effect on reducing bilirubin is similar to DPMAS and PE groups. Compared with PE, it needs less plasma supplement. As it can provide ultrafiltration, PDF would be helpful in patients with liver failure accompanied by renal insufficiency oliguria.
Abstract： Objective To summarize the clinical experiences of performing extracorporeal membrane oxygenation (ECMO) on patients with heart and respiratory failure, and compare the clinical outcomes of Medtronic system and Quadrox PLS system. Methods We retrospectively analyzed the clinical data of 121 heart and respiratory failure patients who underwent ECMO treatment in Fu Wai Hospital from December 2004 to December 2009. Based on the different systems used, 121 patients were divided into two groups. In group M, there were 65 patients including 41 males and 24 females, with an age of 26.6±25.9 years; and they accepted Medtronic ECMO system treatment. In group Q, there were 56 patients including 39 males and 17 females, with an age of 32.4±23.9 years and they underwent Quadrox PLS ECMO system treatment. The evaluation of the clinical outcomes of these two different systems was based on the comparison of transmembrane pressure drop (TMPD), anticoagulation, hemolysis, plasma leakage, organ function, complication and hospital mortality between the two groups. Results Compared with group M, ECMO with Quadrox PLS system was associated with lower TMPD (at the beginning of ECMO: 15.0±6.0 mm Hg vs.28.0±5.0 mm Hg, P=0.000; 24 hours later: 16.0±5.0 mm Hg vs. 30.0±7.0 mm Hg, P=0.000) and less thrombus formation(7.1% vs.23.1%, P=0.037), less plasma leakage (0.0% vs. 50.8%, P=0.000), less hemolysis (14.3% vs. 29.2%, P=0.047). There were no significant differences between the two groups in support duration, complication rate, and hospital mortality(Pgt;0.05). Conclusion Both devices have similar effects for safe clinical application, but Quadrox PLS ECMO system has a relatively high biocompatibility with lower TMPD, less plasma leakage, and thrombus formation.