Objective To investigate the phenotypic change and proliferation of fibroblasts in human inflammatory strictured bile duct wall. Methods We observed the density and ultrastructure of fibroblasts, and the histologic structure in human normal bile duct wall and inflammatory strictured bile duct wall by light and electron microscope.Results The results showed that fibroblasts were the main source of extracellular matrix production in bile duct wall. The phenotype of fibroblasts in inflammatory strictured bile duct wall changed obviously, quiescent fibroblasts were activated and transformed to myofibroblasts, with massive proliferation. Conclusion These data suggest that massive proliferation of activated fibroblasts and myofibroblasts is the main source of extracellular matrix overproduction which results in inflammatory bile duct stricture.
ObjectiveTo investigate the successful signs of laser photocoagulation or endolaser combined vitrectomy for congenital optic disc pit (ODP) with serous macular detachment.MethodsA retrospective case analysis. Twelve eyes of 12 patients with congenital ODP complicated with serous macular detachment diagnosed in Zhongshan Ophthalmic Center from 2003 to 2018 were included in this study. There were 2 males (2 eyes) and 8 females (8 eyes). The average age was 30.17 years old. Retinal laser photocoagulation and/or vitrectomy were performed in all the eyes. The optic disc and macular area were scanned using the tracking mode of the Germany Heidelberg Spectralis OCT instrument. The " dam-sign” change was a retinal choroidal scar on the channel between the ODP and the macula on the OCT image after treatment. The eyes were divided into a " dam-sign” change group (group A, 10 eyes) and no " dam-sign” change group (group B, 2 eyes). The BCVA of eyes in group A was 0.03-0.6. In group A, 1 eye was treated with laser photocoagulation alone, 9 eyes were treated with vitrectomy combined with laser photocoagulation. The BCVA of eyes in group B was 0.1. All the eyes in group B underwent vitrectomy combined with laser photocoagulation. The follow-up was ranged from 6 to 174 months. The same equipment and method before treatment were used for 1, 3, 6, 12, 18, and 24 months after treatment. The BCVA, absorption of subretinal fluid (SRF) and the formation of " dam-sign” change were observed.ResultsAt the last follow-up, the BCVA of eyes in group A was 0.4-1.0 (0.4 in 1 eye, 0.5 in 3 eyes, 0.6 in 2 eyes, 0.8 in 3 eyes, 1.0 in 1 eye). In 9 eyes treated with vitrectomy combined with laser photocoagulation, SRF was completely absorbed. In 1 eye treated with laser photocoagulation alone, SRF remained in small amount. The BCVA of the two eyes in group B was 0.03 and 0.3, respectively; and SRF was not absorbed in both of them.ConclusionsThe " dam-sign” change near optic disc after laser photocoagulation can promote SRF absorption and improve BCVA. It can be used as a success indicator after treatment.
ObjectiveTo investigate the ultrasonic changes of liver during various immune periods with different number of CD4+ T lymphocytes in HIV/AIDS patients with chronic viral hepatitis. MethodsThe clinical data of 100 patients with chronic viral hepatitis diagnosed between January 2010 and December 2012 were selected. Among them, 50 simple chronic viral hepatitis patients were designated as the control group, and the other 50 HIV/AIDS patients with chronic viral hepatitis were regarded as the experimental group. Ultrasonographic observation was applied on patients of the experimental group according to different immune period based on the number of CD4+ T lymphocytes. Indexes observed included liver size, the edge of liver, capsule of liver and hepatic parenchymal echo. The cross-check analysis was employed between observed results and clinical laboratory results. ResultsAbnormal changes of the experimental group were shown on the ultrasound observation of liver in different CD4+ T lymphocyte count immune periods, including enlargement of the liver, slightly blunt liver margin, slightly thick capsule, dense and uniform, slightly rough and not so uniform, or rough and not uniform hepatic parenchymal echo. There was no significant difference in ultrasonic changes of liver between the two groups when the CD4+ T cell number was over 300/mm3. However, the difference was significant when the CD4+ T cell number was below 100/mm3. ConclusionLiver abnormalities become more obvious as CD4+ T cell count decreases in HIV/AIDS patients with chronic viral hepatitis. Comprehensive considerations of various liver ultrasound indicators are helpful in clinical evaluation of HIV/AIDS patients with chronic viral hepatitis.
Objective To analyze the challenges and growth of the clinical medicine undergraduates who participated in the China Scholarship Council funded international research exchange program, to provide a basis for the policy formulation and management of the follow-up projects. MethodsClinical medicine undergraduates from West China School of Medicine, Sichuan University who participated in the China Scholarship Council funded international research exchange program from 2013 to 2019 were selected. The survey was conducted using a self-designed questionnaire. Results A total of 64 clinical medicine undergraduates were surveyed. The laboratory safety training rates in the United States, Canada, and China were 100.00% (34/34), 100.00% (30/30), and 70.31% (45/64), respectively. The laboratory technical training rates were 97.06% (33/34), 90% (27/30), and 43.75% (28/64), respectively. During the experimental process, clinical medicine undergraduates from the United States [94.12% (32/34)], Canada [93.33% (28/30)], and China [65.63% (42/64)] would seek assistance from relevant personnel. The difficulty (H=47.798, P<0.001) and convenience (H=30.135, P<0.001) of booking laboratory instruments and equipment vary among the three countries. There were no statistically significant difference in the frequency, form, and research direction sources of guidance from mentors (P＞0.05). Majority of students thought the experience was helpful for scientific research thinking (59 people) and experimental skills (52 people), with 23 people obtained research output. Despite encountering challenges in study (11 people), life (8 people), language (14 people), and culture (11 people), the experience had positive impact on hobbies (35 people), independent living ability (55 people), and self-confidence (41 people). The students also had developed an international perspective (61 people), improved English ability (59 people), and progressed self-learning ability (57 people). Conclusions By participating in international research exchange programs, undergraduates can enhance their comprehensive research ability. Although there may be problems and challenges during the adaptation process, it also brings growth and self-confidence at the same time.
ObjectiveTo summarize the therapeutic targets of pancreatic cancer (PC). MethodsThe related literatures about the therapeutic targets of PC were reviewed. ResultsPC was one of the most challenging tumor in worldwide, and was characterized as a highly aggressive disease with poor overall prognosis and a high mortality rate. The hallmark of PC was its poor response to radio-and chemo-therapy. Current chemotherapeutic regimens could not provide substantial survival benefit with a clear increase in overall survival. Recently, several new approaches which could significantly improve the clinical outcome of PC had been described, involving signal-transduction pathways, immune response, stroma reaction, and epigenetic changes. ConclusionsMany therapeutic targets are involved in the treatment of PC. As current therapies failed to significantly improve the progression and the survival of PC, new therapeutic approaches and clinical studies are strongly required.
ObjectiveTo analyze the gender-specific distribution patterns of the disease burden of tracheal, bronchial, and lung cancer (hereinafter referred to as lung cancer) attributed to tobacco from 1990 to 2021 globally and in China and the United States (US), and to predict the trend of disease burden changes from 2022 to 2031, aiming to provide multi-dimensional evidence-based support for optimizing tobacco control strategies and precise lung cancer prevention and control systems. MethodsData on the disease burden of lung cancer attributed to tobacco from 1990 to 2021 globally and in China and the US were extracted and integrated from the Global Burden of Disease (GBD) 2021 database. The Joinpoint 4.9.1.0 software was used to analyze the corresponding trends in disease burden. The Bayesian age-period-cohort (BAPC) prediction model was employed to forecast the disease burden of lung cancer from 2022 to 2031. ResultsIn 2021, China had the highest number of deaths and disability-adjusted life years (DALYs) due to lung cancer attributed to tobacco, followed by the US. The top three risk factors for lung cancer globally and in China and the US from 1990 to 2021 were tobacco, air pollution, and occupational risks. The disease burden of lung cancer patients attributed to tobacco has been decreasing year by year in the global and US populations [the average annual percentage change (AAPC) values of age-standardized mortality rate and DALYs rate were: globally: ?0.96%, ?1.28%; US: ?2.33%, ?2.72%], while it has been increasing in China (the AAPC values of age-standardized mortality rate and DALYs rate were 0.28% and ?0.02%, respectively). From a gender perspective, the disease burden of male patients with lung cancer attributed to tobacco was much higher than that of female patients from 1990 to 2021. Compared to the global average, the disease burden of lung cancer attributed to tobacco in China and the US from 1990 to 2021 was still heavy, with China’s burden being higher than that of the US. The elderly population aged ≥65 years in the global context and in China and the US was the primary group affected by the disease burden of lung cancer attributed to tobacco. The BAPC prediction model indicated that from 2022 to 2031, the age-standardized rates of lung cancer attributed to tobacco in the global context and in China and the US would show a declining trend. ConclusionFrom 1990 to 2021, the disease burden of lung cancer attributed to tobacco in China and the US was still heavy compared to the global average, with China’s burden being significantly higher than that of the US. The focus on prevention and control for both countries remains among the middle-aged and elderly population (especially males), which is a key challenge for tobacco-related lung cancer prevention and treatment work in the next 10 years.
ObjectiveTo summarize and analyze the clinical characteristics of patients with acute diffuse lung changes and respiratory failure.MethodsThe clinical data of patients in the Department of Critical Care Medicine, Dazhou Central Hospital between January 2016 and December 2018 were retrospectively collected, whose main clinical manifestation was acute respiratory distress syndrome with acute onset (<3 weeks) and main imaging manifestation was diffuse changes in both lungs. The clinical characteristics of patients were summarized, and the causes of the disease were explored.ResultsA total of 65 patients with acute diffuse lung changes and respiratory failure were enrolled, including 42 males (64.6%) and 23 females (35.4%). The average age was (57.1±18.4) years, the average time from onset to treatment was (7.5±5.9) d, and the average length of stay in the intensive care unit was (8.9±4.1) d. A total of 23 cases died, with a case-fatality rate of 35.4%. Among the 65 patients, there were 50 case (76.9%) of infectious diseases, including 36 cases of bacterial infections (including 4 cases of tuberculosis), 8 cases of viral infections (all were H1N1 infections), and 6 cases of fungal infections (including 1 case of pneumocystis infection); and there were 15 cases (23.1%) of non-infectious diseases, including 4 cases of acute left heart failure, 2 cases of interstitial pneumonia, 2 cases of vasculitis, 1 case of myositis dermatomyositis, 1 case of aspiration pneumonia, 1 case of acute pulmonary embolism, 1 case of acute drug lung injury, 1 case of neurogenic pulmonary edema, 1 case of drowning, and 1 case of unknown origin.ConclusionsInfectious diseases are the main cause of acute diffuse lung changes and respiratory failure, while among non-infectious diseases, acute heart failure and immune system diseases are common causes.
ObjectiveTo investigate the changes of facial soft tissue before and after orthognathic surgery in patients with skeletal Class Ⅲ malocclusion.MethodsBetween August 2016 and April 2017, 30 patients with skeletal Class Ⅲ malocclusion who underwent maxillary LeFort Ⅰ osteotomy and sagittal split mandible osteotomy were selected as study subjects. Among them, 11 were male and 19 were female with an average age of 22.6 years (range, 18-35 years). Full head CT scan and facial soft tissue three-dimensional image scan were performed within 2 weeks before surgery and at 6 months after surgery. A three-dimensional facial image model was established using Artec Studio 11.0 and CMF Proplan 3.0 software to analyze the facial soft tissue changes before and after surgery. The soft tissue anatomical landmarks in each area of the face were measured and compared before and after surgery.ResultsThe area of facial soft tissue change after surgery was the maxillary nose and the lower jaw area, and the two sides did not exceed the vertical boundary of the outer canthus. After surgery, the horizontal points of bilateral alar bases and bilateral cheeks changed significantly (P<0.05). The sagittal points of subnasale, pronasale, bilateral alar bases, upper lip margin significantly forwarded (P<0.05); the sagittal points of the bilateral cheilions, lower lip margin, midpoint of chin-lip groove, pogonion, and menton significantly backwarded (P<0.05). The vertical points of the upper lip margin, bilateral cheilions, lower lip margin, bilateral cheeks, and bilateral inner canthus points significantly descended (P<0.05), and the vertical point of the menton significantly elevated (P<0.05). After surgery, the nasal column was significantly shortened, the upper lip got longer and the alar base widened when compared with those before surgery (P<0.05).ConclusionThe overall change of face after double jaw surgery is shorter and fuller, and the mandible of facial soft tissue change is larger than that of maxillary, which suggests that the postoperative facial changes should be taken into account in the surgical design.
Plasma exchange (PE) is a therapeutic blood component replacement method. The blood of patients is first separated into plasma and blood cell components using a blood cell separator in vitro, the plasma containing harmful pathogenic substances is then discarded and replaced with the same volume of exchange solution. Finally the separated blood cells together with the exchange solution are returned back to the blood circulation of patients. By reducing the circulating antibodies, abnormal plasma proteins or cytokines and other pathogenic molecules, PE can block the disease process. PE has a good therapeutic effect on neuromyelitis optica-related optic neuritis (NMO-ON), which shows resistant to glucocorticoid therapy for the first onset. The American Society for Apheresis guideline evaluates PE for acute optic neuritis as a recommended grade 1B, type II indication. In the implementation of PE treatment for NMO-ON and other diseases, indications and contraindications should be strictly adhered to the guideline, treatment procedures and protocols should be optimized, common adverse events and its prevention and management should be known and alerted. It is important to conduct multi-center clinical cooperation and a high standard clinical randomized controlled study, to find out the optimal time window, the best protocol, and the associated factors for the efficacy and prognosis of PE in NMO-ON.
In recent years, the incidence of hyperlipidemia acute pancreatitis (HLAP) has been increasing year by year, but its pathogenesis has not been completely clear. There are many clinical treatment methods for HLAP, such as lipid-lowering drugs, low molecular weight heparin, insulin, and plasma exchange. Actively reducing serum triglyceride is the core of treatment. Plasma exchange can quickly and effectively reduce the level of triglyceride, and its application in the treatment of HLAP is gradually increasing. This article reviews the recent advances in the pathogenesis, clinical characteristics, diagnosis, and treatment of HLAP, focusing on the mechanism, indications, timing, and disadvantages of plasma exchange therapy for HLAP.