Objective To investigate the feasibility and patient selection of T-tube free laparoscopic common bileduct exploration through mini-incision in confluence of common bile duct （CBD） and cystic duct. Methods The clinical data of 52 patients who underwent CBD exploration from January 2009 to December 2011 were retrospectively analyzed. A 3-4mm longitudinal incision of anterior wall of CBD was made along the confluence of CBD and cystic duct， and then the choledochoscope was inserted into CBD through this mini-incision for the exploration and treatment by laparoscopy and choledochoscopy， the incision was sewed up by T-tube free primary suture. Results All 52 cases were cured and stone clearance rate was 100% as revealed by choledochoscopy and cholangiography. The time of operation， intraoperativecholangiography， removal of stones with help of choledochoscope， and removal drainage tube after operation was from 90 to 200 min with an average of 100min， 3 to 10min with an average of 6min， 5 to 15 min with an average of 8 min，and 3-5d with an average of 3.5d ， respectively. The drainage flow was 20-60mL/d with an average of 30mL/d. No biliary leakage， abdominal pain， and choloplania or infection of incision was observed following operation. The hospital stay was 5 to 12d with an average of 6.5d after operation. No calculus regeneration or bile duct stricture occurred during following-up of 3 to 40 months with an average of 20 months. Conclusion With proper patient selection， T-tube free laparoscopic CBD exploration through mini-incision in confluence of CBD and cystic duct is safe and feasible by proficient surgeons in laparoscopy and choledochoscopy.
Liver cancer is one of the world’s most prevalent malignancies, and is also the third leading cause of cancer death in China. Hepatitis and cirrhosis background is a major feature of liver cancer patients in China, which makes specific requirements that suits the national conditions in many aspects of prevention and control like screening diagnosis, treatment options, and prognosis follow-up. The Specifications for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition), which is based on China’s practice, proposes liver cancer staging in line with China’s national conditions and forms a multi-disciplinary joint diagnosis and treatment model based on surgical treatment. Liver transplantation is included in liver cancer as one of the surgical treatments option. It also emphasizes the support of evidence-based medicine. The Specifications for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition) may have laid a solid foundation for future diagnosis and treatment of liver cancer in China.
Objective To give an individualized treatment to a young woman with primary dysmenorrhea. Methods According to the basic principle and methods of evidence-base medicine, we searched The Cochrane Library (Issue 1, 2009), MEDLINE (PubMed, January 1950 to May 2009), ACP Journal Club (OVID, January 1991 to May 2007) for systematic reviews and randomized controlled trials (RCTs) to acquire the best clinical evidence on the treatment of primary dysmenorrhea. Results A total of 11 systematic reviews and 1 RCT were identified. A reasonable treatment plan was made through combining the patient’s will with her family members’. Conclusion The treatment effect on primary dysmenorrhea of the young woman is improved by an individualized treatment plan based on an evidence-based method.
Objective To explore the current situation and influencing factors of self-management behavior in patients with primary glaucoma, so as to provide a theoretical basis for formulating intervention strategies to improve patients’ self-management ability. Methods Using convenient sampling method, 400 patients with primary glaucoma visiting the Outpatient Department of Ophthalmology, West China Hospital of Sichuan University between September 2019 and March 2020 were selected. Their current situation of self-management behavior was investigated by self-management behavior questionnaire, and the influencing factors of self-management behavior were analyzed. Results A total of 381 valid questionnaires were recovered. The total score of self-management behavior of patients with primary glaucoma was 51.11±6.22, and the mean scores of life debugging dimension, functional health care dimension, and medical management dimension were 2.66±0.67, 3.02±0.81, and 3.13±0.60, respectively. The results of multiple linear regression analysis showed that age [40-59 vs. <40 years old: unstandardized partial regression coefficient (b)=–2.830, 95% confidence interval (CI) (–4.813, –0.847), P=0.005; ≥60 vs. <40 years old: b=–2.660, 95%CI (–4.820, –0.498), P=0.016], occupation [in-service vs. farmers: b=2.639, 95%CI (0.303, 4.976), P=0.027; unemployed or retired vs. farmers: b=2.913, 95%CI (0.995, 4.831), P=0.003], smoking [smoking vs. non-smoking: b=–3.135, 95%CI (–5.196, –1.075), P=0.003], disease type [primary open-angle glaucoma vs. primary angle-closure glaucoma: b=–2.119, 95%CI (–3.317, –0.921), P=0.001], number of follow-up visits [≤2 vs. >2: b=–1.071, 95%CI (–2.118, –0.024), P=0.045], whether fixed doctor follow-up [unfixed vs. fixed: b=–2.619, 95%CI (–3.632, –1.605), P<0.001] were correlated with the total score of self-management behavior of patients with primary glaucoma. Conclusions The self-management behavior of patients with primary glaucoma is in the middle level. The main factors affecting the self-management behavior level of primary glaucoma patients include age, occupation, smoking, disease type, follow-up times, and fixed doctor’s follow-up. Ophthalmologists should pay attention to the current situation and influencing factors of self-management behavior and take feasible intervention measures to improve the self-management behavior of patients with primary glaucoma.
Objective To predict clinical chemotherapy sensitivity of primary non-small cell lung cancer（NSCLC） by methylthiazal （MTT） tumor chemosensitivity assay method in vitro and detection of multidrug resistance gene1 （MDR1）, and provide reference for clinical individualized treatment. Methods We selected 80 fresh primary NSCLC samples from NSCLC patients who underwent surgical resection in Zibo Central Hospital Affiliated to Binzhou Medical College between January 2009 and December 2011. There were 46 male patients and 34 female patients with their median age of 54 （29 to 81）years. Viable NSCLC cells obtained from malignant tissue were tested for their sensitivity to cisplatin （DDP）, gemcitabine （GEM）, docetaxe （DOC）, etoposide （VP-16） ,and vinorelbine （NVB） using MTT assay in vitro. Fluorescent quantitative reverse transcriptase-polymerase chain reaction （RT-PCR） was used to analysis the expression level of multidrug resistance gene1 （MDR1）. Results After exposure to antitumor drugs, morphologic changes, decrease of metabolic activity, and apoptosis were detected in NSCLC cells. MTT results showed that different individual cancer cells had different chemosensitivity to antitumor drugs, and cancer cells also had different chemosensitivity to different antitumor drugs. Inhibitory rates of cancer cells exposed to DOC, GEM, and VP-16 were significantly higher than those of cancer cells exposed to DDP and NVB （42.5%±9.5%, 40.5%±6.5%, 38.4%±7.6% versus 31.5%±8.5%，32.5%±7.8%, P＜0.05）.The positive rate of MDR1 in tumor tissues was 40.0% （32/80）. The expression of MDR1 was not associated with tumor histological type, degree of differentiation, lymph node metastasis and TNM stage. The expression of MDR1 was associated with resistance to NVB （χ2=5.209，P=0.022），GEM （χ2=4.769，P=0.029），VP-16 （χ2=4.596，P=0.032），and DDP（χ2=6.086，P=0.014）, but not associated with resistance to DOC（χ2=0.430，P=0.512）. Conclusion MTT chemosensitivity assay can effectively predict clinical chemotherapy sensitivity. Detection of MDR1, together with MTT chemosensitivity assay, can more accurately predict NSCLC chemosensitivity and be a guide for individualized chemotherapy of NSCLC.
Objective To investigate the clinicopathological features, treatment and prognosis of primary pulmonary lymphoepithelioma-like carcinoma (PPLELC). Methods Forty-five patients with PPLELC admitted to Sichuan Cancer Hospital from April 2016 to March 2023 were retrospectively analyzed. Their clinical data and survival were collected and summarized. Results Of the 45 patients, 28.9% (13/45) were asymptomatic, 97.2% (35/36) were positive for Epstein-Barr virus encoded small RNA, 83.3% (10/12) were positive for programmed cell death-ligand 1 (PD-L1), and the tumor proportion score (TPS) fluctuated between 10.0% to 95.0%. Genetic testing revealed 1 case of EGFR gene 19-Del mutation. Among the 45 patients, 28 cases received surgical treatment, of which 16 received adjuvant chemotherapy, 8 received adjuvant radiotherapy, and 2 received neoadjuvant chemotherapy. As of the follow-up cut-off date, 33 patients survived and 12 patients died, with a median survival time not reached and an overall survival rate of 70.2% and 63.2% at 3 and 5 years, respectively. The 3- and 5-year disease-free survival rates were 67.2% and 57.6% for the 28 operated patients, respectively, and the progression-free survival rates were 58.3% and 29.2% for the 13 stage Ⅳ patients, respectively. Conclusions PPLELC is associated with Epstein-Barr virus infection and is a rare subtype of non-small cell lung cancer (NSCLC). Most patients do not have common gene mutations such as EGFR or ALK and have a high rate of positive PD-L1 expression. The disease is usually treated with a multi-method combination of mainly surgery, and is sensitive to radiotherapy and chemotherapy and has a better prognosis than other types of NSCLC.
Objective To explore the correlation of risk factors affecting the L2-4BMD level in patients with post-menopausal osteoporosis. Methods Ninety-two patients with post-menopausal osteoporosis were surveyed with a retrospective questionnaire. We used the findings to set up a multiple stepwise regression model and perform correlation analysis with L2-4BMD levels as the dependent variable and risk factors as the independent variables. Results Assuming that age has a definite effect on the L2-4BMD level of menopausal women, menopausal age limit, history of milk drinking, menopausal age, menarche age, fracture history and bend-back entered into the multiple stepwise regression equation. Conclusions Menopausal age limit, history of milk drinking, menopausal age, menarche age, fracture history, and bend-back influence patients with menopausal osteoporosis.The menopausal age limit is especially important. Awareness of the risk factors of osteoporosis should be raised.
Primary human hepatocytes (PHH) are the gold standard of in vitro human liver model for drug screening. However, a problem of culturing PHH in vitro is the rapid decline of cytochrome P450 (CYP450) activity, which plays an important role in drug metabolism. In this study, thermo-responsive culture dishes were used to explore the conditions for murine embryonic 3T3-J2 fibroblasts to form cell sheet. Based on the cell sheet engineering technology, a three-dimensional (3D) “sandwich” co-culture system of 3T3-J2 cell sheet/PHH/collagen gel was constructed. The tissue structure and protein expression of the model section were observed by hematoxylin eosin staining and immunofluorescence staining respectively. Phenacetin and bupropion were used as substrates to determine the activity of CYP450. The contents of albumin and urea in the system were determined by enzyme linked immunosorbent assay (ELISA). The results showed that the complete 3T3-J2 cell sheet could be obtained when the cell seeding density was 1.5×106 /dish (35 mm dish) and the incubation time at low temperature was 60 min. Through cell sheet stacking, a 3D in vitro liver model was developed. Compared with the two-dimensional (2D) model, in the 3D model, the cell-cell and cell-matrix connections were tighter, the activities of cytochrome P450 CYP1A2 and cytochrome P450 CYP2B6 were significantly increased, and the secretion levels of albumin and urea were increased. These indexes could be maintained stably for 21 d. Therefore, cell sheet stacking is helpful to improve the level of liver function of 3D liver model. This model is expected to be used to predict the metabolism of low-clearance drugs in preclinical, which is of great significance for drug evaluation and other studies.
Objective To improve the diagnosis and treatment of primary adenocarcinoma of the duodenum. MethodsLiteratures were reviewed.ResultsThe morbidity of primary duodenal adenocarcinoma was low and its clinical manifestation had no characteristics.The most effective methods in the diagnosis of the disease were gastrointestinal radiography and endoscopy with the accuracy of 88% and 89% respectively.The disease could be cured by resection of the lesion. The selection of operative type depended on the stage and position of the tumor.Radical resection and tumor stage played an important role in the prognosis.Conclusion Early diagnosis and rational operation are the major ways to improve the resectability and to modify the therapeutic result.
ObjectiveTo investigate the drug utilization in primary healthcare system of Xinjin county of Chengdu in 2010. MethodsThe drug utilization information in regional health information platform of Xinjin county were collected. Microsoft Excel 2003 software was used to describe the types, forms and expenditure of medicines, particularly the use of antibiotics among outpatients and inpatients. ResultsThe drug utilization of 17 hospitals in Xinjin county in 2010 was summarized below:a) there were 1 507, 1 356 and 695 kinds of drugs dispended for outpatients, and 1 271, 1 023 and 317 for inpatients in county-level hospitals (CLH), township hospitals (TH) and community healthcare centre (CHC), respectively. Among which, oral biomedicine and traditional Chinese medicine (TCM) accounted for about 45% of total types, and 46% to 73% of total drug expenditure among outpatients; while oral biomedicine and the injection accounted 37% to 61% of total types of medicines dispended to inpatients, particularly injection of biomedicine accounting for over 75% of total drug expenditure among inpatients. b) The expenditure of top 30 drugs in primary care hospitals accounted for 50% of total drug expenditure among outpatients and over 85% among inpatients. c) Among the top 20 drugs, there were 15 antibiotics, which accounted for 26.5% of total drug expenditure in Xinjin county. The top 10 antibiotics were mainly cephalosporin, accounting for 59.36% and 66.27% of total antibiotics expenditure among outpatients and inpatients respectively. Conclusiona) The main forms of medicines dispended to outpatients are oral biomedicine and TCM, while oral agents and injection of biomedicine are the majority of medicines used for inpatients. b) The top 30 drugs should be monitored for rational use of drugs considering the huge expenditure. And c) the types, proportion of use and expenses of antimicrobial drugs ranked the first in CLH, CHC and TH, which may imply irrational use of antibiotics.