Objective To investigate the application effect of LEER (less pain, early move, early eat, and reassuring) mode in laparoscopic pancreaticoduodenectomy (LPD). Methods The clinical data of patients who underwent LPD in our hospital from March 2020 to March 2022 were retrospectively analyzed. Forty patients treated with the traditional mode during the perioperative period were classified as the traditional group, and 47 patients treated with the LEER mode were classified as the LEER group. The perioperative indicators, inflammatory stress indicators, immune indicators, nutritional indicators and postoperative complications were compared between the two groups. Results The visual analogue scale (VAS) score and hospitalization cost of the LEER group were lower than those of the traditional group (P<0.05). The postoperative ambulation time, anal exhaust/defecation time, drainage tube removal time, time to normal diet and hospital stay in the LEER group were shorter than those of the traditional group (P<0.05). Compared with preoperative, the WBC count and C-reactive protein (CRP) level of patients in the two groups increased after operation, but the changes of WBC count and CRP level in the LEER group were smaller than those in the traditional group (P<0.05). The IgA, IgM and IgG levels of patients in the two groups were not statistically different before and after operation (P>0.05), and the postoperative IgA, IgM and IgG of patients in the LEER group were higher than those in the traditional group (P<0.05). The change values of IgM and IgG in the LEER group were smaller than those of the traditional group (P<0.05), but there was no statistical difference in the change value of IgA between the two groups before and after operation (P>0.05). Compared with preoperative value, postoperative prealbumin (PA) and lymphocyte (LYM) levels in the two groups were decreased (P<0.05). The postoperative PA and LYM levels in the LEER group were higher than those in the traditional group (P<0.05). but the change value of PA before and after operation in the LEER group was smaller than that in the traditional group (P<0.05). There was no statistical difference in the change of LYM between the two groups before and after operation (P>0.05). The incidence of postoperative complications in the LEER group was 8.5% (4/47), and that in the traditional group was 35.0% (14/40). The incidence of postoperative complication in the LEER group was significantly lower than that in the traditional group (P=0.002). Conclusion Applying LEER mode in LPD can promote postoperative recovery of the patients, reduce postoperative stress response, improve nutritional status and protect immunity in the patients.
ObjectiveTo investigate the changes of inflammatory cytokines in bronchoalveolar lavage fluid (BALF) in rats exposed to paraquat (PQ). MethodsAdult healthy SD rats were randomly divided into a control group (n=8) and three experimental groups (PQ in low dosage of 15 mg/kg,medium dosage of 30 mg/kg,and high dosage of 60 mg/kg,n=24 in each group). The rats in three experimental groups were intragastrically administered with PQ,and the rats in the control group were treated with saline by gavage. Two rats in the control group and six rats in three experimental groups were sacrificed on 1st,7th,14th,and 21st day after exposure respectively. BALF was collected for measurement of interleukin-1(IL-1),IL-6,macrophage inflammatory protein-2(MIP-2),monocyte chemoattractant protein-1(MCP-1),and biopterin by ELISA. ResultsThe levels of cytokines in all experimental groups were higher than those in the control group at any time point. In the exposure day 1 to day 14, IL-1 and biopterin levels in BALF increased significantly with the increase in PQ dose. On 14th and 21st day,IL-6 level in BALF increased significantly with the increase in PQ dosage. The levels of IL-1,IL-6,and biopterin in the experimental groups reached the peak on 14th day. On 14th day,the MIP-2 level in BALF of high-dosage group was significantly higher than that of low-dosage and medium-dosage groups (all P<0.05). The level of MCP-1 in the low-dosage group was lower than that in the medium-dosage and high-dosage groups at any time point (P<0.05). ConclusionIL-1,IL-6,MIP-2,MCP-1,and biopterin may play important roles in the development and progression of PQ-induce lung inflammation.
ObjectiveTo study the local vascular remodeling, inflammatory response, and their correlations following acute spinal cord injury (SCI) with different grades, and to assess the histological changes in SCI rats.MethodsOne hundred and sixteen adult female Sprague Dawley rats were randomly divided into 4 groups (n=29). The rats in sham group were received laminectomy only. A standard MASCIS spinal cord compactor was applied with drop height of 12.5, 25.0, or 50.0 mm to establish the mild, moderate, or severe SCI model, respectively. Quantitative rat endothelial cell antigen 1 (RECA1) and CD68 positive areas and the correlations were studied by double immunofluorescent (DIF) staining at 12 hours, 24 hours, 3 days, 7 days, and 28 days following SCI. Moreover, qualitative neurofilament-H (NF-H) and glial fibrillary acidic protein (GFAP) positive glial cells were studied by DIF staining at 28 days. ELISA was used to detect the levels of tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and IL-6 in spinal cord homogenates at 12 hours, 24 hours, and 3 days, and the correlations between TNF-α, IL-1β, or IL-6 levels and microvascular density (RECA1) were accordingly studied. Moreover, the neural tissue integrity and neuron damage were assessed by HE staining at 12 hours, 24 hours, 3 days, 7 days, and 28 days, and Nissl’s staining at 28 days following SCI, respectively.ResultsDIF staining revealed that the ratio of RECA1 positive area was the highest in moderate group, higher in mild and severe groups, and the lowest in sham group with significant differences between groups (P<0.05). The ratio of CD68 positive area was the highest in severe group, higher in moderate and mild groups, and the lowest in sham group with significant differences between groups (P<0.05), except the comparisons between mild and moderate groups at 24 hours and 28 days after SCI (P>0.05). There was no significant correlation between the RECA1 and CD68 expressions in sham group at different time points (P>0.05). At 12 and 24 hours after SCI, the RECA1 and CD68 expressions in mild and moderate groups showed significant positive correlations (P<0.05), while no significant correlation was found in severe group (P>0.05). No significant correlations between the RECA1 and CD68 expressions was shown in all SCI groups at 3 days and in severe group at 7 days (P>0.05), while the negative correlations were shown in mild and moderate groups at 7 days, and in all SCI groups at 28 days (P<0.05). In mild, moderate, and severe groups, the axons became disrupted, shorter and thicker rods-like, or even merged blocks with increased injury, while the astrocytes decreased in number, unorganized and condensed in appearance. ELISA studies showed that TNF-α, IL-1β, and IL-6 levels in sham group were significantly lower than those in other 3 groups at different time points (P>0.05). The differences in TNF-α, IL-1β, and IL-6 levels between SCI groups at different time points were sinificant (P<0.05), except IL-1β levels between the mild and moderate groups at 12 hours (P>0.05). Three inflammatory factors were all significantly correlated with the microvascular density grades (P<0.05). Histological analysis indicated that the damage to spinal cord tissue structure correlated with the extent of SCI. In severe group, local hemorrhage, edema, and infiltration of inflammatory cells were found the most drastic, the grey/white matter boundary was disappeared concurrently with the formation of cavity and shortage of normal neurons.ConclusionIn the acute stage following mild or moderate SCI, progressively aggravated injury result in higher microvessel density and increased inflammation. However, at the SCI region, the relation between microvessel density and inflammation inverse with time in the different grades of SCI. Accordingly, the destruction of neural structures positively relate to the grades of SCI and severity of inflammation.
ObjectiveTo study the clinical value of procalcitonin (PCT), WBC count, and C-reactive protein (CRP) in diagnosis of common bile duct stones with acute bile duct infection and systemic inflammatory response syndrome (SIRS).MethodsA total of 80 patients with bile duct stones were retrospectively analyzed, which were divided into two groups, SIRS group (n=40) and non-SIRS group (n=40). The numerical value of PCT, WBC count, and CRP were detected on 1, 4, and 7 day after admission, and calculated the score of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) on 1 day after admission. Then analyzed the clinical value of PCT, WBC count, and CRP in diagnosis of common bile duct stones with acute bile duct infection and SIRS.ResultsEach area under the ROC curve of PCT, CRP, and WBC count were 0.81, 0.78, and 0.72, respectively, with significant difference (P<0.05). The PCT, CRP, and WBC count had a certain accuracy in diagnosis of common bile duct stones with acute bile duct infection and SIRS. The positive-relationship between PCT, CRP, WBC count and APACHE Ⅱ score was significant (r=0.91, P<0.01; r=0.88, P<0.01; r=0.69, P<0.01).ConclusionTo detect the numerical value of PCT, WBC count, and CRP had significant clinical value in diagnosis of common bile duct stones with acute bile duct infection and SIRS.
ObjectiveTo determine the predictive value of preoperative systemic immune-inflammatory index (SII) regarding the development of postoperative pulmonary complications (PPCs) after abdominal surgery.MethodsThisretrospective study involved 433 patients undergoing elective abdominal surgery. Logistic regression risk model was used to evaluate the prognostic value of SII. We drew the receiver-operating characteristic (ROC) curve and calculated the area under the ROC curve to compared the predictive ability of SII, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to- lymphocyte ratio (MLR).ResultsThe independent risk factors of PPCs were preoperative respiratory diseases, preoperative history of chronic liver disease, maintenance of intravenous or inhalation anesthesia, and intraoperative infusion of more colloid (P<0.05). However, SII, PLR, NLR, and MLR did not predict the occurrence of PPCs, and they also did not predict ≥3 grade of PPCs (AUC<0.60, P>0.05).ConclusionsPreoperative SII is not a prognostic biomarker of PPCs occurrence in patients undergoing elective abdominal surgery. Other biomarkers, such as PLR, NLR, and MLR, also have no predictive value for the PPCs in these patients.
Objectives To explore the expression of macrophage inflammatory protein-1beta (MIP-1β) in patients with none-small cell lung cancer (NSCLC) of different pathological types and its association with cancer clinical stages and metastasis of lymph nodes.Methods MIP-1β mRNA from fresh lung tissue of 38 NSCLC patients was amplified by RT-PCR and half-quantified.Immunohistochemical technique was performed to find out the expression of MIP-1β in paraffin-embedded lung tissue from 66 patients with NSCLC.The area and degree of stain were evaluated to determine the positive rate，which was compared between with or without metastasis of lymph nodes，different pathological types and TNM clinical stages.Results MIP-1β protein was found in cytoplasm of malignant cells of squama cell cancer and adenocarcinoma without significant difference between them，while not found in bronchus-alveolus cell cancer.The MIP-1β mRNA expression in squama cell cancer and adenocarcinoma were significant higher than which in bronchus-alveolus cell cancer without significant difference between each other.The positive rates of MIP-1β in lung cancer of Ⅰ，Ⅱ and Ⅲ stages were 74.2%，29.4% and 85.7% respectively，which of Ⅰ and Ⅲ stages cancer were significant higher than Ⅱ stage without significant difference between each other.The positive rates of MIP-1β in lung cancer with or without metastasis of lymph nodes were 45.8% and 76.3% respectively with significant difference between them.Conclusion MIP-1β is expressed in lung cancer cells and relates to the pathological type，TNM stage and the metastasis of lymph nodes.
Objective To understand the dynamic changes of inflammatory indicators in the peripheral blood of patients with malignant cerebral edema at different time points after acute cerebral infarction, and provide a basis for early prediction and prevention of malignant cerebral edema. Methods Consecutive patients with acute cerebral infarction within 24 h of onset who were admitted to the Department of Neurology, West China Hospital of Sichuan University between January 1st, 2017 to December 31st, 2018 were collected. The basic clinical data of the patients were collected, and the data of inflammatory cells (white blood cell count, absolute neutrophil count, absolute lymphocyte count, and neutrophil to lymphocyte ratio) and acute phase reactants (blood glucose, fibrinogen, albumin, and fibrinogen to albumin ratio) were dynamically collected at admission and 1, 3, and 7 d after admission, respectively. Differences between groups were compared using generalized estimating equations. Results A total of 798 patients with acute cerebral infarction were included, of whom 93 (11.65%) developed malignant cerebral edema. At all time points examined, the white blood cell counts, absolute neutrophil counts, and neutrophil to lymphocyte ratios were higher in the malignant cerebral edema group than those in the non-malignant cerebral edema group (Wald χ2=63.737, P<0.001; Wald χ2=91.848, P<0.001; Wald χ2=75.197, P<0.001); 1 and 3 d after admission, the absolute lymphocyte counts were lower in the malignant cerebral edema group than those in the non-malignant cerebral edema group (Wald χ2=18.580, P<0.001). The blood glucose levels were higher in the malignant cerebral edema group compared with the non-malignant cerebral edema group 1, 3, and 7 d after admission (Wald χ2=16.722, P<0.001); no significant between-group effect was found in the albumin levels (Wald χ2=3.643, P=0.056); the fibrinogen levels were significantly different between groups 3 d after admission (Wald χ2=8.923, P=0.003), and the fibrinogen to albumin ratios differed between the two groups 3 and 7 d after admission (Wald χ2=6.739, P=0.009). Dynamic analysis of multiple time points in the malignant cerebral edema group found that these inflammatory markers mostly reached their extreme values 3 d after admission. Conclusions Compared with the non-malignant cerebral edema group, the inflammatory cell-related indicators (except lymphocytes) and the acute phase inflammatory reactant-related indicators in malignant cerebral edema patients are significantly higher, and the absolute lymphocyte count is significantly lower. Three days after admission to hospital is probably the most significant time point for the change of each inflammatory indicator.
ObjectiveTo investigate the changes of diamine oxidase(DAO) and endotoxin(ET) during the treatment of systemic inflammatory response syndrome with human growth hormone and the relationship between human growth hormone and intestinal mucosal barrier injury. MethodsOne hundred and fortysix patients with systemic inflammatory response syndrome were randomly divided into operative group and nonoperative group, which were again randomly divided into the study group and control group.Plasma concentration of DAO and ET were determined before the treatment and 1 week after the treatment.ResultsPlasma concentration of DAO and ET in study group decreased after treatment with significant difference (P＜0.05，P＜0.01).ConclusionHuman growth hormone can protect intestinal mucosa barrier.
【Abstract】ObjectiveTo investigate the effect of Salvia Miltiorrhiza (SM) and Shengmai injection （SI） in treating systemic inflammatory response syndrome (SIRS) and their mechanism. Methods The animal model of SIRS was established by injectinglipopolysaccharide(LPS, 1 mg/kg)intraperitoneally. Forty Wistar rats were randomly divided into four groups: control group, SM group, SI group and combined treatment group (SM+SI group), which were treated with normal saline（5 ml/kg） plus LPS（1 mg/kg）, SM（5 ml/kg）plus LPSKG4（1 mg/kg）, SI（5 ml/kg）plus LPS（1 mg/kg）, SM（2.5 ml/kg） plus SI（2.5 ml/kg） and LPS（1 mg/kg） respectively. Six rats of each group were sacrificed for sample collection of blood, liver, lung and kidney 8 hours after LPS injection. Blood routine, serum TNF-α and IL-6 were measured. Specimen of organs were fixed in formalin and sent for routine pathological examination. The survival of other 4 rats of each group were observed untill 48 hours after LPS injection. SPSS 10.0 was used in statistical analysis. Results Two rats in control group died 13 hours and 22 hours after LPS injection respectively, the remaining 2 rats in this group and the rats in other 3 groups survived 48 hours after LPS injection. The white blood cell count of control group was significantly higher than that of other groups. The serum TNF-α and IL-6 of control group were significantly more than those of other groups. Pathological damages were found in all groups, and the most severe ones were in control group. SM and SI could decrease the level of serum TNF-α and IL-6 in the process of LPS-stimulated SIRS, down-regulate the severe inflammatory response, attenuate organ damages of the liver, lung and kidney, and increase forty-eihgt-hour survival rate obviously. Conclusion The experiment provides a theoretical base for clinical use of SM and SI in treatment of SIRS.
Objective To investigate the reasons, status, treatment and precautions of misdiagnosis of pulmonary inflammatory pseudotumor. Methods Between January 2005 and December 2015, one hundred eighteen articles about pulmonary inflammatory pseudotumor published in Wanfang and CNKI databases were retrospectively analyzed, among them forty-four articles referring to misdiagnosis rate. The misdiagnosis rate, distribute of misdiagnosed diseases, reasons and main means of definite diagnosis were analyzed. Results There were 1 286 cases of pulmonary inflammatory pseudotumor in the 44 articles, of them 1 012 cases were misdiagnosed. The misdiagnosis rate was 78.84%. Pulmonary inflammatory pseudotumor was often misdiagnosed as lung cancer (65.81%), tuberculosis (15.42%, which included 72 cases of tuberculoma and accounted for 7.11%) and benign pulmonary neoplasms (9.59%). Most misdiagnosed patients did not suffer from adverse consequences, except a few patients undergo unnecessary extended operations. Lack of specificity in clinical manifestations, lack of awareness about the disease, dependent on auxiliary examination and lack of awareness about the fine feature of the disease were the main reasons of misdiagnosis. The majority of misdiagnosed cases were terminal pathological diagnosed through the operation or after percutaneous biopsy. Conclusions Pulmonary inflammatory pseudotumor is lack of specificity in clinical manifestations and easy to be misdiagnosed. It is very important to analyze and identify the fine feature of imaging changes. To reduce and avoid misdiagnosis, clinicians should improve the awareness of this disease.