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28 February 2022, Volume 17 Issue 01 Previous Issue    Next Issue

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Pathological and etiological analysis of cholestatic liver disease in Anhui NING Ling, LIU Zhenjun, LI Wei, LIU Wen, LI Wei, ZHANG Zhenhua, FANG Weidong, GAO Youfang, ZHENG Xiaowei, LI Lei 2022, 17 (01):  53-57.  DOI: 10.16138/j.1673-6087.2022.01.010 Abstract ( 145 )   HTML ( 1 )   PDF (645KB) ( 58 )   Objective To explore the pathology and etiology in the patients with cholestatic liver disease.Methods From December 2017 to November 2021, 139 patients with unclarified liver dysfunction manifested as cholestasis were admitted from several hospitals in Anhui province. The clinical data including personal information, laboratory examination and liver biopsy were analyzed. Results Among 139 patients, there were 105 females and 34 males, and the average age was (50.2±11.5) years. All patients underwent liver biopsy, and 121 cases (87.1%) were definitively diagnosed, while the etiology of 18 cases(12.9%) were not clear. One hundred and twenty-one patients were given one or more etiological diagnoses as follows: 85 cases (61.2%) of autoimmune liver disease, 56 cases (40.3%) of primary biliary cholangitis, 15 cases(10.8%) of autoimmune hepatitis, 11 cases(7.9%) of autoimmune hepatitis combined with primary biliary cholangitis, 21 cases (15.1%) of drug-induced liver injury, 5 cases (3.6%) of metabolic fatty liver disease and 2 cases (1.4%) of vanishing bile duct syndrome. In addition, it was found that the alkaline phosphatase(ALP) level in the patients with the autoimmune liver disease was significantly higher [291.0 (225.0, 387.0) U/mL vs. 236.0 (181.0, 293.5) U/mL, P=0.002] than that in other patients.Conclusions Most patients with liver dysfunction and cholestasis were women, and the major diagnosis was autoimmune liver disease, especially primary biliary cholangitis, and the drug-induced liver damage was also one of main causes. ALP could be used to identify whether a patient had autoimmune liver disease. Figures and Tables | References | Related Articles | Metrics

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Analysis of clinical characteristics of biliary hyperlipidemic pancreatitis CHE Zaiqian, ZHAO Bing, WANG Yihui, ZHU Huihui, WANG Yuming, QI Xing, LI Mengjiao, CHEN Ying, MA Li, CHEN Erzhen, MAO Enqiang 2022, 17 (01):  58-62.  DOI: 10.16138/j.1673-6087.2022.01.011 Abstract ( 166 )   HTML ( 2 )   PDF (555KB) ( 57 )   Objective To study the clinical characteristics of biliary pancreatitis(BAP), hyperlipidemic pancreatitis (HLAP) and biliary hyperlipidemic pancreatitis(BHAP). Methods The patients diagnosed with acute pancreatitis in the emergency department of our hospital from January 2013 to June 2017 were studied retrospectively. The patients were divided into BAP, HLAP and BHAP groups according to the causes. The clinical data including age, sex, admission ward, time of onset, comorbidities, severity, organ support and inflammatory biomarkers were compared. The clinical prognosis parameters of patients in each group, such as hospitalization time, operation rate and mortality, were also analyzed. Results A total of 286 patients with acute pancreatitis were included. The clinical information of the patients in three groups were analyzed with pairwise comparison, and the results showed that the age of onset in both BHAP group and HLAP group was younger than that in BAP group(P<0.01). The comparison of procalcitonin(PCT) on admission showed that its level in BHAP group was significantly higher than that in the other two types of pancreatitis(P<0.01). In terms of organ support, the patients among three groups showed significant differences in mechanical ventilation (P<0.05), renal replacement therapy (P<0.01), and the use of vasoactive drugs (P<0.05). In terms of severity, the results of pairwise comparison among groups showed as follows: the modified Marshall score, BHAP group>BAP group (P<0.05); acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score and sequential organ failure assessment (SOFA) score, BHAP group>BAP group>HLAP group (P<0.01); bedside index for severity in acute pancreatitis (BISAP), BHAP group>HLAP group (P<0.01) and BAP group>HLAP group (P<0.05); computed tomography severity index (CTSI), BHAP group>BAP group (P<0.05) and BHAP group>HLAP group(P<0.01). In terms of prognosis, the comparison of hospital stays among three groups showed that it was longer in BHAP group than that in HLAP group(P<0.01). Conclusions BAP, HLAP and BHAP have different clinical characteristics. The patients of BHAP combined with biliary tract and hyperlipidemia are more likely to develop into severe pancreatitis, and have longer hospital stays. Figures and Tables | References | Related Articles | Metrics

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Diagnostic value of endoscopic ultrasonography in assessment of gastrointestinal stromal tumors: a meta-analysis LIU Dongxin, YU Rongguo, XU Chao 2022, 17 (01):  63-69.  DOI: 10.16138/j.1673-6087.2022.01.012 Abstract ( 218 )   HTML ( 2 )   PDF (1093KB) ( 60 )   Objectives To evaluate the diagnostic value of endoscopic ultrasonography(EUS) in the assessment of gastrointestinal stromal tumors (GIST). Methods Eight databases were searched. The authors separately assessed the quality of each study using the quality assessment diagnostic accuracy studies-2(QUADAS-2) criteria. Stata 16.0 software was used to construct a receiver operating characteristic curve(ROC curve) and the area under curve(AUC) was calculated. The possible heterogeneous effects were explored through meta regression, and a subgroup analysis was performed. The publication bias was assessed. Results A total of 12 articles were screened, including 529 cases of lesions. The quality assessment showed that one study had a high risk in terms of flow and time interpretation bias, but all included studies had unclear bias in reference criteria. The meta-analysis showed the summary sensitivity and specificity were 0.88 [95% confidence interval (CI): 0.78-0.93] and 0.84 (95% CI: 0.70-0.93) respectively. The positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio were 5.6 (95% CI :2.7-11.4),0.15 (95% CI: 0.08-0.27), and 38 (95% CI: 14-103), respectively. The AUC of ROC curve was 0.93. There was no significant publication bias in Deeks’ Funnel plot. Conclusions The EUS shows a certain significance in guiding clinicians to diagnose GIST accurately. Figures and Tables | References | Related Articles | Metrics

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Comparison of the efficacy of percutaneous coronary intervention and coronary artery bypass grafting in octogenarian with chronic total occlusion of left anterior descending artery HU Jian, YANG Zhenkun, YAN Xiaoxiang, DU Run, DING Fenghua, LIU Jun 2022, 17 (01):  70-72.  DOI: 10.16138/j.1673-6087.2022.01.013 Abstract ( 178 )   HTML ( 5 )   PDF (304KB) ( 41 )   Objective To compare the clinical efficacy of percutaneous coronary intervention (PCI) and coronary artery bypass grafting(CABG) for octogenarians with chronic total occlusion of the left anterior descending artery. Methods From January 2016 to July 2020, a total of 73 octogenarians with chronic total occlusive disease of the left anterior descending artery who received interventional therapy and CABG in our hospital were enrolled in the study, in which 42 patients received interventional therapy and 31 patients underwent CABG. The clinical characteristics and incidence of major adverse cardiac events (including death, recurrence of angina pectoris and revascularization due to ischemia) during the hospitalization and one-year follow-up period were recorded in detail. Results There was no significant difference between two groups in age, gender composition, smoking, hypertension, diabetes, hyperlipidemia, stroke, history of myocardial infarction, history of previous PCI, history of peripheral vascular disease and SYNTAX score(all P>0.05). There was no significant difference between two groups in the rate of successful revascularization (90.5% vs 97.1%, P=0.473), and the rate of target vessel revascularization during one-year follow up period (7.89% vs 2.86%, P=0.667). Compared with the CABG group, the cost of the PCI group [(73 400±15 400) CNY vs (11 7700±13 400) CNY, P=0.000] and length of hospital stay in [(4.62±0.67) d vs (10.00±1.90) d, P=0.000] were significantly lower. Conclusions The PCI and CABG are two effective revascularization methods for octogenarians with chronic total occlusion of the left anterior descending artery. Compared with CABG, PCI is less expensive and the length of hospital stay is shorter. Figures and Tables | References | Related Articles | Metrics

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Analysis of risk factors for mortality in patients with bloodstream infection of Carbapenem-resistant Klebsiella pneumonia BIAN Xiujuan, BAO Zhiyao, CHEN Hong, CHENG Luxiao, SHI Baoping 2022, 17 (01):  73-77.  DOI: 10.16138/j.1673-6087.2022.01.014 Abstract ( 190 )   HTML ( 2 )   PDF (557KB) ( 60 )   Objective: To evaluate the clinical characteristics and risk factors for mortality of bloodstream infections of Carbapenem-resistant Klebsiella pneumonia(CRKP). Methods The electronic medical records of the patients with CRKP bloodstream infection in Ruijin hospital in Shanghai from January 2017 to June 2019 were reviewed and analyzed retrospectively. The patients were divided into survival group and death group according to the clinical endpoint of 30 d after infection, and their clinical characteristics and risk factors for mortality were analyzed. Results A total of 74 patients with CRKP bloodstream infection were enrolled, and the mortality rate was 55.4%. The independent risk factors for mortality within 30 d were acute physiology and chronic health evaluation (APACHE) Ⅱscore≥16.5 [odds ratio (OR)=1.118, 95% confidence interval(CI): 1.012-1.236, P=0.029], and septic shock(OR=1.52, 95% CI: 3.002-52.227, P=0.001). Conclusions The patients with CRKP bloodstream infection have a high mortality rate. The higher APACHEⅡ score is, the greater risk of mortality will be. For each additional point in the score, the risk of death increased 11.8%. The risk of death in the patients with septic shock is 12.52 times higher than that in higher than without septic shock. Figures and Tables | References | Related Articles | Metrics

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Evaluate therapeutic efficacy of resistance training and aerobic training for gerontal patients with chronic obstructive pulmonary disease QIU Liwen, XU Yiming, ZHANG Yin, SHEN Honghua, CHEN Shen 2022, 17 (01):  78-83.  DOI: 10.16138/j.1673-6087.2022.01.015 Abstract ( 227 )   HTML ( 2 )   PDF (619KB) ( 62 )   Objective To evaluate the effects of resistance and aerobic training on the patients with chronic obstructive pulmonary disease (COPD). Methods A total of 80 gerontal patients with stable COPD were enrolled in this study. They were randomly assigned to a combination training group (resistance and aerobic training) or an aerobic training group, respectively, and received training for 12 weeks. Thirty-seven patients completed combined training and 35 patients completed aerobic training. The clinical information including lung function, arterial blood gas, exercise ability, St. George’s respiratary questionnaire (SGRQ) score, anxiety and depression status were evaluated, and compared among three time points(pre, post 12-week training, and 3-month follow-up). Results After 12-week training, the body mass index (BMI), partial pressure of oxygen(PaO2), 3-minute walking distance(3MWD) and SGRQ scores in the combined training group were significantly improved compared with those before treatment(P<0.05). There were also significant differences in 3MWD and SGRQ scores after 3-month follow-up compared with their own baseline (P<0.05). The PaO2 and 3MWD (after treatment and 3-month follow up) was significantly improved compared with those before treatment in aerobic training group(P<0.05). After 12-week training and 3-month follow-up, BMI, 3MWD and SGRQ scores in the combined training group were significantly improved compared with the aerobic training group (P<0.05), the depression state in the combined training group was also improved; while the anxiety state in the combined training group was worse than that in the aerobic training group after 3 months(P<0.05). There was no significant difference in pulmonary function, arterial blood gas analysis, heart rate and COPD assessment test between two groups(P>0.05).Conclusions The therapeutic efficacy of 12-week training of resistance and aerobic for the gerontal patients with stable COPD significantly improved their exercise ability, quality of life and BMI; and the effect on excise ability could last more than three months. However, it couldn’t make a significant change in pulmonary function. Figures and Tables | References | Related Articles | Metrics