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Protective Effects of Epidermal Growth Factor on Pancreas of Rats with Acute Pancreatitis

【Abstract】Objective To investigate the protective effects of epidermal growth factor (EGF) on pancreas of rats with acute pancreatitis(AP). Methods Seventytwo male SpragueDawley rats were randomly divided into 3 groups: Control group, AP group and AP-EGF group. Subcutaneously injection of EGF (0.1 μg/g) were given to animals in the AP-EGF group after the establishment of the model of AP. The other two groups of animals received the same volume of saline. At 6 h, 12 h and 24 h after induction of AP, 8 animals in each group were sacrificed respectively， 4 ml of blood sample was withdrawn from heart，2 ml for the analysis of amylase activity and 2 ml for MDA content in serum. Ascites was sucked with dry gauzes and was weighed thereafter. Changes of pancreas morphology were evaluated at every time point. The same part of pancreas was removed for measurement of MDA content, apoptotic index (AI) and histologic changes. Results Histologic injury of the animals in the APEGF group was milder than that in the AP group. Ascites weight in the AP-EGF group decreased significantly compared with that in the AP group at 12 h and 24 h 〔(4.53±1.29) g vs (6.58±1.47) g, (7.64±1.85) g vs (11.96±2.13) g，P＜0.05，P＜0.01〕. Amylase activity in the APEGF group also decreased significantly compared with that in the AP group at 12 h and 24 h 〔(142.0±8.3) U/L vs (187.9±10.4) U/L, (194.3±10.4) U/L vs (253.3±8.6) U/L, P＜0.05，P＜0.01〕. MDA content in plasm 〔(2.34±0.23) μmol/L vs (3.15±0.38) μmol/L, P＜0.05〕 and in pancreas 〔(5.21±1.46) μmol/g vs (7.68±1.63) μmol/g, P＜0.01〕 in the APEGF group decreased significantly compared with those in the AP group at 24 h. AI of pancreas in the APEGF group increased significantly compared withthatintheAPgroupafteroperation〔(16.22±3.53)%〖KG4vs (7.35±1.04)%, (11.67±2.40)% vs (4.81±0.86)%, (6.38±1.42)% vs (1.97±0.21)%, P＜0.01〕. Conclusion EGF may accelerate the restoration of pathologic injury and alleviate the hemorrhage and edema of pancreas. It may also depress MDA content in plasm and in pancreas so that to lessen oxidative damage. EGF may protect pancreas by inducing cellular apoptosis.

Clinical Observation on Continuous Drainage of Abdominal Cavity in the Treatment of Thirty-eight Patients with Refractory Ascites

目的:觀察持續腹腔引流治療頑固性腹水的療效。方法:將頑固性腹水患者74例分為兩組,治療組38例,采用腹腔置管,持續腹腔引流腹水,3000mL/天;對照組36例,以常規補充白蛋白、限鈉、限水、利尿治療為主,比較兩組的療效。觀察治療組治療前后患者尿量、腹圍和體重變化,并比較治療組與對照組在肝、腎功能及電解質的變化及總體療效。結果:治療組療效優于對照組(Plt;0.05),與治療前比較,治療組治療后尿量、腹圍、體重有明顯改變(Plt;0.01), 肝、腎功能及電解質與對照組比較無明顯變化(Pgt;0.05)。結論:持續腹腔引流治療頑固性腹水經濟適用,不良反應少,患者依從性好。

Diagnostic value of serum procalcitonin and C-reactive protein for spontaneous bacterial peritonitis in patients with liver cirrhosis ascites

Objective To investigate predictive value of procalcitonin (PCT) and C-reactive protein (CRP) levels for spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis ascites. Methods The clinical data of 140 patients with liver cirrhosis ascites treated in our hospital from January 2012 to January 2016 were retrospectively analyzed. According to the presence of SBP, these patients were divided into SBP group and non-SBP group. The clinical data were compared between these two groups. The receiver operating characteristic (ROC) curve was constructed to assess their sensitivities and specificities of PCT and CRP for diagnosis of SBP. Results The PCT and CRP levels of the SBP group were significantly higher than those of the non-SBP group (P<0.05). The differences of serum ALT, AST and white cell count between the SBP group and the non-SBP were not statistically significant (P>0.05). The ROC curve analysis showed that the area under the ROC curve of PCT and CRP were 0.895 and 0.926, their corresponding cut-off value 2.1 μg/L and 24.8 mg/L, the sensitivities were 86.9% and 89.5%, the specificities were 85.1% and 83.5%, respectively. Conclusion Abnormally elevated PCT and CRP levels might have an important detective value for SBP in patients with liver cirrhosis ascites.

Clinical Study on the Treatment of Obstinate Hepatocirrhosis Ascites by Dextran After Paracentesis

目的:為了探討肝硬化放腹水后應用右旋糖酐40代替人血白蛋白治療頑固性腹水的臨床療效及其經濟性。方法:將216例肝硬化頑固性腹水患者隨機分為A,B,C三組。A組:定期放腹水后應用右旋糖酐40;B組:定期放腹水后應用人血白蛋白或血漿;C組:傳統治療方法,限鈉和不斷增加利尿劑用量。結果:A組分別與B組,C組相比較,其腹水消退時間,ALT復常率,輸血不良反應,住院費用,平均住院日,好轉治愈率,死亡率,以上各項對比均有顯著性差異(Plt;0.05)。血清蛋白量的對比無顯著性差異(Pgt;0.05)。結論:肝硬化放腹水后應用右旋糖酐40治療頑固性腹水,能縮短病程,減少住院日,降低醫療費用,降低死亡率。

Effectiveness and Safety of Hyperthermia plus Intraperitoneal Hyperthermic Perfusion Chemotherapy for Malignant Ascites: A Meta-Analysis

Objective　To systematically review the effectiveness and safety of hyperthermia (HT) plus intraperitoneal hyperthermic perfusion chemotherapy (IHPC) versus IHPC alone for malignant ascites. Methods　Such databases as PubMed, The Cochrane Library, EMbase, VIP, WanFang, CNKI and CBM were electronically and comprehensively searched for randomized controlled trials (RCTs) on HT plus IHPC vs. IHPC alone for malignant ascites from inception to March 2013. Two reviewers independently screened studies according to inclusion and exclusion criteria, extracted data and assessed quality of the included studies. References of the included studies were also retrieved. Then, meta-analysis was performed using RevMan 5.1 software. Results　A total of 16 RCTs involving 984 patients were included. The results of meta-analysis showed that, compared with the IHPC alone group, the HT plus IHPC group had a higher effective rate of controlling ascites (OR=3.40, 95%CI 2.58 to 4.48, Plt;0.000 01), better improvement in quality of life (OR=2.77, 95%CI 1.90 to 4.05, Plt;0.000 01), with significant differences. The two groups were alike in 1-year survival with no significant difference (OR=1.80, 95%CI 0.61 to 5.31, P=0.28). As for safety, there was no significant difference between the two groups in the incidences of nausea and vomiting, abdominal distension and pain, myelosuppression, diarrhea, and constipation. Conclusion　The results of this systematic review show that, compared with IHPC alone, HT plus IHPC improves the effective rate as well as the quality of life of patients with malignant ascites, and it does not increase the incidences of adverse reactions. Due to the limited quality and quantity of the included studies, more high quality RCTs with larger sample size are needed to verify the above conclusion.

Role of L-Arg in Acute Lung Injury Induced by Intra-Peritoneally Injection of Perforative Peritonitis Ascitic Fluids in Rats

Objective　To investigate the pathogenesis of acute lung injury in rats induced by intra-peritoneally injection of perforative peritonitis ascitic fluids（PPAF） and the role of L-arginine （L-Arg） in acute lung injury in this model. Methods　Perforative peritonitis （PP） models were established in 60 rats and PPAF were collected. Forty-eight rats were randomly divided equally into NS group，PPAF group, and L-Arg group. Rats were randomly subjected to death at 7 h and 12 h. Peripheral blood WBC were counted，levels of NO and malondialdehyde （MDA） in serum were examined. Lung injury score and wet/dry ratio were evaluated， and level of myeloperoxidase （MPO） in lung tissues and lung cell apoptosis were tested. Results　WBC count of peripheral blood, levels of NO and MDA in serum， level of MPO in lung tissue, lung injury score， wet/dry ratio， and lung cell apoptosis rate in PPAF group were significantly higher than that in NS group at each time point（P＜0.01）. Level of NO in serum in L-Arg group was higher than that in PPAF group （P＜0.01）， but lower level of MDA in serum， lower level of MPO in lung tissue and lung injury score，lower wet/dry ratio， and lung cell apoptosis rate were observed in L-Arg group（P＜0.05）. In PPAF group and L-Arg group， level of NO in serum， wet/dry ratio, and lung cell apoptosis rate were higher at 12 h than that at 7 h（P=0.000）. Serum NO level was in negative correlation with serum MDA level （r=-0.257，P=0.021）， MPO level in lung tissue（r=-0.444， P=0.011），and lung cell apoptosis（r=-0.351， P =0.010） in PPAF group and L-Arg group， but serum MDA level was in positive correlation with cell apoptosis（r=0.969， P＜0.001） in each group. Conclusions　Acute lung injury rats model can be established by intra-peritoneally injection of PPAF. Enhanced oxidizing reaction and cell apoptosis take part in the occurrence of acute lung injury. L-Arg plays a protective role in acute lung injury.

Evaluation of the Value of α-L-fucosidase Levels with Receiver Operating Characteristic Curve in the Diagnosis of Benign and Malignant Ascites

【摘要】　目的　應用受試者工作特征曲線（receiver operating characteristic curve，ROC曲線）探討α-L-巖藻糖苷酶（AFU）對惡性腹水和非結核良性腹水的診斷價值。　方法　2004年7月—2008年1月對213例診斷明確的良、惡性腹水（其中良性腹水117例、惡性腹水96例）AFU活性進行檢測。采用ROC曲線評價AFU的診斷靈敏度、特異度、準確性、陽性預測值、陰性預測值、陽性似然比、陰性似然比及Youden指數，評價其診斷效率。　結果　惡性腹水組AFU水平（164.96±87.72） μmol/（L?h），良性腹水組（104.02±62.07） μmol/（L?h），兩者比較差異有統計學意義（Plt;0.01）。AFU診斷惡性腹水的ROC 曲線下面積為0.754±0.034，最佳分界值101.95 μmol/（L?h）。以AFU≥101.95 μmol/（L?h）來預測惡性腹水，其診斷的靈敏度為82.3%，特異度為63.2%，準確性為72.8%、陽性預測值為65.3%、陰性預測值為83.1%、陽性似然比為2.23、陰性似然比為0.28及Youden指數為0.455。　結論　腹水AFU活性檢測有助于惡性腹水和非結核良性腹水的鑒別診斷，是一個比較理想的實用指標，適合于基層醫院的臨床應用。【Abstract】　Objective　To assess the value of α-L-fucosidase (AFU) levels with receiver operating characteristic curve (ROC curve) in the diagnosis of malignant and non-tuberculous benign ascites. 　Methods　Ascitic AFU activity was measured in 213 patients (117 with benign ascites and 96 with malignant ascites) diagnosed with benign or malignant ascites. The diagnostic sensitivity (SEN), specificity (SPE), accuracy, positive predictive value (PV+), negative predictive value (PV-), positive likelihood ratio (LR+), negative likelihood ratio (LR-) and Youden index (YI) of AFU were assessed with receiver operating characteristic curve, and the diagnostic effectiveness of AFU was evaluated. 　Results　The average level of AFU in the malignant group [(164.96±87.72) μmol/(L?h)] was significantly higher than that in the benign group [(104.02±62.07) μmol/(L?h)] (Plt;0.01). The area under the curve (AUC) of the ROC curve of AFU was 0.754±0.034 for malignant ascites diagnosis, and the optimal cut-off value was 101.95 μmol/(L?h). When an AFU level equal to or higher than 101.95 μmol/(L?h) was used to predict malignant ascites, the diagnostic sensitivity was 82.3%, specificity was 63.2%, accuracy was 72.8%, PV+ was 65.3%, PV- was 83.1%, LR+ was 2.23, LR- was 0.28 and YI was 0.455. 　Conclusion　Detection of AFU activity in ascites is helpful to differentiate the diagnose between malignant and non-tuberculous benign ascites, which is a relatively ideal index to fit for clinical application of local hospitals.

The efficacy and safety of drainage with abdominal catheterization in cirrhotic patients with large-volume ascites

Objective To investigate the efficacy and safety of abdominal indwelling catheterization for the patients with large-volume ascites. Methods A total of 84 patients with liver cirrhosis complicated with large-volume ascites admitted in the first affiliated hospital of Xi’an Jiaotong University from January 2015 to December 2015 were retrospectively analyzed. Patients were divided into two groups, one was the puncture group and another was the catheterization group. The efficacy and safety were evaluated. Results Forty-four patients were enrolled in catheterization group, whereas forty patients were enrolled in puncture group. Symptoms associated with ascites had been eased and patients’ qualities of life had been improved in 2 weeks in each group. The tube fell out rate was 27.3% for patients in catheterization group. There was no operation related complications such as death, bleeding and intestinal perforation occurred. Either Child B stage or Child C stage, the dynamic changes of liver function and renal function in catheterization group were comparable to those in puncture group. No adverse event such as catheterization-related or puncture-related infection was observed. Conclusion Abdominal catheterization is effective and safe in management of large amount of ascites complicated with cirrhosis, however, the high rate of tube-fell-out should be paid more attention.

Surgical Management for Budd-Chiari Syndrome

Individualized Treatment on Patients with Budd-Chiari Syndrome

目的 探討布-加綜合征的個體化治療。 方法 我們對首都醫科大學附屬復興醫院及宣武醫院、二炮總醫院及其他醫院2004年2月至2009年5月期間會診收治的20例布-加綜合征患者的臨床資料進行回顧性分析。結果 20例患者中術后24 h死亡1例（5.0%），死于DIC； 19例順利出院。19例患者術后均獲隨訪，隨訪時間（34.7±3.3）個月，其中恢復良好者占73.7%（14/19）； 1例（5.3%）行腸-腔-頸轉流術者，術后間斷出現肝性腦病，短期住院治療后可以改善； 術后18個月1例（5.3%）行腸-腔轉流術者因全身臟器衰竭死亡。結論 個體化手術治療方案可明顯提高布-加綜合征患者的生存率。