ObjectiveTo explore the risk factors affecting operation treatment selection of acute adhesive small bowel obstruction (ASBO), and establish a prediction model of surgical treatment selection to provide a guidance for clinical decision-making. MethodsThe patients with acute ASBO admitted to this hospital and met the inclusion and exclusion criteria, from January 2019 to December 2022, were retrospectively collected, and the patients were assigned into the surgical treatment and conservative treatment according to the treatment selection. The differences in the clinicopathologic factors between the patients with surgical treatment and conservative treatment were compared. Meanwhile, the factors with statistical differences (P<0.05) or the factors with clinical significance judged based on professional knowledge were included to screen the influencing factors of surgical treatment selection using the multivariate logistic regression analysis, and the selected influencing factors were used to construct the logistic regression prediction model equation. The area under the receiver operating characteristic curve (AUC) and its 95% confidence interval (95%CI) was used to evaluate the prediction efficiency of the prediction model equation. ResultsA total of 231 patients with acute ASBO were included, 117 (50.6%) of whom underwent surgical treatment and 114 (49.4%) underwent conservative treatment. In all 16 clinicopathologic factors between the patients with surgical treatment and conservative treatment had statistical differences (P<0.05) including the body mass index (BMI), preopeative high fever, intestinal type, sign of peritonitis, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score excluded age scoring, abdominal surgery history and times of abdominal surgery history, times of pre-admission seek medical advice and preoperative conservative treatment time, the air-liquid level by X-ray plain film, and severe small bowel obstruction and adhesive bands by CT examination, as well as the white blood cell count (WBC), neutrophil percentage, albumin (ALB), and urea nitrogen. The multivariate logistic regression analysis showed that the acute ASBO accompanied by sign of peritonitis (β=1.778, P=0.028), history of abdominal surgery (β=1.394, P=0.022), and adhesive bands (β=1.321, P=0.010) and severe small bowel obstruction (β=1.183, P=0.018) by CT examination, WBC (β=0.524, P＜0.001), APACHEⅡ score excluded age scoring (β=0.291, P＜0.001), and BMI (β=0.191, P=0.011) had positive impacts on adopting surgical treatment, while preoperative ALB (β=–0.101, P=0.023) and conservative treatment time (β=–0.391, P＜0.001) had negative impacts on adopting surgical treatment. The accuracy, specificity, and sensitivity of the logistic regression prediction model equation constructed according to these 9 influencing factors were 84.8%, 71.1%, and 77.7%, respectively. The AUC (95%CI) of the prediction model equation to distinguish selection of surgical treatment from conservative treatment was 0.942 (0.914, 0.970). ConclusionsAccording to the preliminary results of this study, surgical treatment is recommended for patients with acute ASBO accompanied by signs of peritonitis, history of abdominal surgery, adhesive bands and severe small bowel obstruction by CT, increased preoperative WBC, high APACHEⅡ score excluded age scoring, high BMI, preoperative low ALB level, and shorter preoperative conservative treatment time. And the logistic prediction model equation constructed according to these characteristics in this study has a good discrimination for patients with surgical treatment or conservative treatment selection.
Objective To investigate the effect of porcine small intestinal submucosa extracellular matrix (PSISM) on the vitality and gene regulation of hepatocyte so as to lay the experimental foundation for the application of PSISM in liver tissue engineering. Methods The experiment was divided into two parts: ① BRL cells were cultured with 50, 100, and 200 μg/mL PSISM-medium which were prepared by adding PSISM into the H-DMEM-medium containing 10%FBS in groups A1, B1, and C1, and simple H-DMEM-medium served as a control (group D1); ② BRL cells were seeded on 1%, 2%, and 3% PSISM hydrogel which were prepared by dissolving PSISM in sterile PBS solution containing 0.1 mol/L NaOH in groups A2, B2, and C2, and collagen type I gel served as a control (group D2). At 1, 3, and 5 days after culture, the morphology and survival of liver cells were detected by the Live/Dead fluorescent staining. The cell vitality was tested by cell counting kit-8 (CCK-8) assay. And the relative expressions of albumin (ALB), cytokeratin 18 (CK18), and alpha-fetoprotein (AFP) in hepatocytes were determined by real-time fluorescent quantitative PCR (RT-qPCR). Results The Live/Dead fluorescent staining showed the cells survived well in all groups. CCK-8 results displayed that the absorbance (A) value of group C1 was significantly higher than that of group D1 at 5 days after culture with PSISM-medium, and there was no significant difference between groups at other time points (P>0.05). After cultured with PSISM hydrogels, theA values of groups A2, B2, and C2 were significantly higher than those of group D2 at 3 and 5 days (P<0.05), theA value of group A2 was significantly higher than that of groups B2 and C2 at 5 days (P<0.05), but there was no significant difference between groups at other time points (P>0.05). RT-qPCR showed that the relative expressions of ALB and CK18 mRNA significantly increased and the relative expression of AFP mRNA significantly decreased in groups A1, B1, and C1 when compared with group D1 (P<0.05). The relative expression of CK18 mRNA in group C1 was significantly lower than that in groups A1 and B1 (P<0.05). The relative expressions of ALB and CK18 mRNA were significantly higher and the relative expression of AFP mRNA was significantly lower in groups A2, B2, and C2 than group D2 (P<0.05); the relative expression of CK18 mRNA in group A2 was significantly higher than that in group B2 (P<0.05), and the relative expression of AFP mRNA in group A2 was significantly lower than that in group C2 (P<0.05), but no significant difference was found between other groups (P>0.05). Conclusion PSISM has good compatibility with hepatocyte and can promote the vitality and functional gene expression of hepatocyte. PSISM is expected to be used as culture medium supplement or cell carrier for liver tissue engineering.
Objective to determine the modulus of elasticity (E) of small intestinal submucosa (SIS), a new biological graft material. Methods The longitudinal tensile testing was performed on 21 specimens of canine jejunum with the electronic material test machine. Results Stress (σ)strain (ε) data were obtained. It was found that the stress (σ)strain (ε) data fitted the expressionσ＝Kεα very well, the mean correlation coefficients R2 was0.991 6.Then the expression of the modulus of elasticity (E) of SIS was E=K1/ασ1-1/α. The mean values of α and K were 3.966 9 and 374.55，so E=4.3992σ0.75. Conclusion The modulus of elasticity was found to increase with increasing stress. The variations law is similar to that of the vessels. Furthermore when σ is 001333 MPa(100 mmHg),E is about 0.16 MPa, which is similar to that of the vessels.
目的：探讨DSA诊断小肠血管畸形的价值。方法：本文分析21例小肠血管畸形患者的临床及DSA特征，其中男性14例，女性7例，所有患者均行肠系膜上、下动脉造影。结果：临床特征：①急性消化道出血为主症状；②常规检查一般为阴性；③血红蛋白含量短期内降至4～6 g/mL。DSA特征：①动静脉瘘；②局部肠壁染色增浓；③局部血管异常增多，结构紊乱。其中12例进行了动脉导丝栓塞，2例栓塞后出血，进行外科手术切除。结论：DSA是诊断血管畸形所致小肠出血的最有效的方法，动脉导丝栓塞是安全，有效的治疗方法，同时为外科手术切除提供的正确部位。
目的 探讨小肠扭转的CT影像学表现及多层螺旋CT的诊断价值。 方法 回顾性分析2006年2月－2011年8月14例经手术证实肠扭转患者的临床及影像资料。 结果 14例小肠扭转患者中有9例出现“U形征”，13例有肠管和血管的“漩涡征”，4例有“鸟喙征”，2例可见“靶环征”，1例可见空回肠“转位征”。 结论 肠管及血管的“漩涡征”是诊断小肠扭转的特异性征象，“鸟喙征”、“靶环征”等其他CT征象为小肠扭转的正确诊断提供可靠依据。多层螺旋CT扫描及三维重组对小肠扭转的诊断具有重要价值。
OBJECTIVE: To explore the expressive characteristics of epidermal growth factor (EGF) and its receptor (EGFR) in tissues of fetal and adult intestines. METHODS: The expression intensity and distribution of EGF and EGFR were detected with pathological and immunohistochemical methods in 6 specimens of adult (16-54 years) intestines and 18 specimens of fetal intestines with different gestational ages (13-31 weeks). RESULTS: Positive protein particles of EGF and EGFR could be detected in tissues of fetal and adult intestines. The protein expressions of EGF and EGFR were elevated progressively with the gestational age. EGF was mainly located in the cytoplasm and extracellular matrix of intestinal villus cells, endothelial cells and tunica serosa epithelial cells, while EGFR chiefly distributed in the cellular membrane of these cells. CONCLUSION: The endogenous EGF and EGFR might be involved in the intestinal development at embryonic stage, in the structural and functional maintenance at adult stage, and in the wound healing after injury.
目的评价应用疝环充填式无张力疝修补术治疗腹股沟嵌顿疝并发小肠坏死的手术效果。方法对于我院2001年5月至2009年5月期间收治的21例腹股沟嵌顿疝并发小肠坏死患者应用疝环充填式无张力疝修补术给予一期修补，先行坏死肠管切除，后置入网塞。结果无手术死亡病例，1例患者发生切口感染，经换药后治愈。平均住院时间65 d。全部患者随访6个月至8年，平均51个月，未见复发。结论 疝环充填式无张力疝修补具有创伤小、安全及患者恢复快的优点，对于腹股沟嵌顿疝并发小肠坏死可以行一期修补，临床效果满意。
This experimental study was aimed at observing the influence of bile salt and lactulose on intestinal mucosa of obstructive jaundiced rat. Twenty adult Wistar rate were divided into four groups (five rats for each group): sham operation, common bile duct ligation (CBDL), CBDL plus sodium deoxycholate feeding and CBDL plus lactulose feeding. The results showed that the intestinal mucosa of rats with obstructive jaundice took on marked edema, markedly decreased activities of adenosine triphosphatase, alkaline phosphatase and succinic dehydrogenase and intensified acid phosphatase activity. However, the intestinal mucosa of the rats, treated with bile salt or lactulose as compared with that of the obstructive jaundiced rats showed both pathological and histochemical improvement.