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| 1 | Pathophysiological consequences of obstructive jaundice and perioperative management显示文摘Background: Obstructive jaundice is a common problem in daily clinical practice. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future management.Data sources: A Pub Med was searched for relevant articles published up to August 2016. The effect of obstructive jaundice on proinflammatory cytokines, coagulation status, hemodynamics and organ functions were evaluated.Results: The effects of obstructive jaundice included biliary tree, the hepatic cell and liver function as well as systemic complications. The lack of bile in the gut, the disruption of the intestinal mucosal barrier,the increased absorption of endotoxin and the subsequent endotoxemia cause proinflammatory cytokine production(TNF-α, IL-6). Bilirubin induces systemic inflammatory response syndrome which may lead to multiple organ dysfunction syndrome. The principal clinical manifestations include hemodynamic instability and acute renal failure, cardiovascular suppression, immune compromise, coagulation disorders,nutritional impairment, and wound healing defect. The proper management includes full replacement of water and electrolyte deficiency, prophylactic antibiotics, lactulose, vitamin K and fresh frozen plasma,albumin and dopamine. The preoperative biliary drainage has not been indicated in overall, but only in a few selected cases.Conclusion: The perioperative management is an essential measure in improving the outcome after the appropriate surgical operation in jaundiced patients especially those with malignancy. | Efstathios T Pavlidis Theodoros E Pavlidis | 2018 | Hepatobiliary & Pancreatic Diseases International2018，17，1： | 63 |
| 2 | 中医药辨证治疗急性加重期慢性阻塞性肺疾病随机对照试验疗效评价指标的系统评价显示文摘目的:在系统评价中医药辨证治疗急性加重期慢性阻塞性肺疾病(AECOPD)随机对照试验临床疗效基础上探讨其疗效评价指标的选择和使用。方法:计算机检索CBM、CNKI、VIP、万方数据库、Cochrane图书馆、PubMed和Embase数据库,收集公开发表中医药辨证治疗AECOPD随机对照试验的临床研究,由两位研究者按照纳入标准独立筛选文献、提取资料后,应用RevMan5.1软件进行Meta分析。结果:共纳入73篇相关文献,Meta分析结果显示中医辨证治疗能提高AECOPD患者的临床疗效和中医证候疗效,改善临床症状、肺功能,提高氧分压,降低二氧化碳分压,降低白细胞计数和CRP水平;疗效评价指标使用较多的有临床疗效、证候疗效、肺功能、血气分析、血常规、C反应蛋白、临床症状体征、中医证候积分等,其余如生活质量、影像学评价、住院时间和6 min步行距离等则相对较少。结论:中医药辨证治疗AECOPD具有较好的临床疗效,但由于纳入研究的质量不高,仍需开展大样本、多中心、方法科学的高质量临床试验;临床疗效评价指标的选用仍不规范,疗效指标的选择应根据临床研究的目的不同而有所侧重,另外还应体现中医药的临床特点。 | 张海龙 王明航 李风雷 王海峰 余学庆 李建生 | 2013 | 中医学报2013，28，6： | 53 |
| 3 | 中国的大气污染和COPD显示文摘最近,许多学者在关注大气污染和慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)的关系。在过去的这个冬季里,一种严重的大气污染形式——雾霾正悄然影响着中国北部和东部的大部分地区。在中国,已有研究开始评估户外大气污染和生物燃料烟雾对COPD的影响,但多数研究在关注大气污染对疾病诱发和恶化的作用,几乎还没有研究关注大气污染在诱导具有COPD特征的病理生理学改变中的作用。有证据显示,户外大气污染影响儿童和成人的肺功能,且可诱导COPD症状的加重。因此,户外大气污染被认为是COPD死亡率的危险因素,现有证据也提示户外大气污染的慢性暴露可以增加COPD的发病率。横断面研究显示生物燃料烟雾暴露是COPD的危险因素,一项长期的回顾性研究和另一项前瞻性队列研究均显示减少生物燃料烟雾与第一秒用力呼气量(forced expiratory volume in 1 second,FEV_1)的改善及COPD危险性的降低相关。总之,为了更透彻地理解大气污染对COPD的影响,我们建议以后的研究要增加随访时间,提供更标准化的COPD定义和更精确的污染来源特异性评估。 | 胡国平 钟南山 冉丕鑫 吴开杰(译) | 2016 | 中国胸心血管外科临床杂志2016，23，2： | 51 |
| 4 | Association between serum uric acid level and the severity of coronaryartery disease in patients with obstructive coronary artery disease显示文摘Background Many studies have shown that the serum uric acid (SUA) level is one of the cardiovascular risk factors.The aim of the study is to evaluate the relationship between SUA levels and the severity of coronary artery disease (CAD)assessed by angiography and the Syntax score in patients with obstructive CAD. | | 2014 | Chinese Medical Journal2014，，6： | 35 |
| 5 | Preoperative biliary drainage in patients with hilar cholangiocarcinoma undergoing major hepatectomy显示文摘AIM:To investigate the effect of preoperative biliary drainage(PBD)in jaundiced patients with hilar cholangiocarcinoma(HCCA)undergoing major liver resections.METHODS:An observational study was carried out by reviewing a prospectively maintained database of HCCA patients who underwent major liver resection for curative therapy from January 2002 to December 2012.Patients were divided into two groups based on whether PBD was performed:a drained group and an undrained group.Patient baseline characteristics,preoperative factors,perioperative and short-term postoperative outcomes were compared between the two groups.Risk factors for postoperative complications were also analyzed by logistic regression test with calculating OR and 95%CI.RESULTS:In total,78 jaundiced patients with HCCA underwent major liver resection:32 had PBD prior to operation while 46 did not have PBD.The two groups were comparable with respect to age,sex,body mass index and co-morbidities.Furthermore,there was no significant difference in the total bilirubin(TBIL)levels between the drained group and the undrained group at admission(294.2±135.7 vs 254.0±63.5,P=0.126).PBD significantly improved liver function,reducing not only the bilirubin levels but also other liver enzymes.The preoperative TBIL level was significantly lower in the drained group as compared to the undrained group(108.1±60.6 vs 265.7±69.1,P=0.000).The rate of overall postoperative complications(53.1%vs 58.7%,P=0.626),reoperation rate(6.3%vs 6.5%,P=1.000),postoperative hospital stay(16.5 vs 15.0,P=0.221)and mortality(9.4%vs 4.3%,P=0.673)were similar between the two groups.In addition,there was no significant difference in infectious complications(40.6%vs 23.9%,P=0.116)and noninfectious complications(31.3%vs 47.8%,P=0.143)between the two groups.Univariate and multivariate analyses revealed that preoperative TBIL>170μmol/L(OR=13.690,95%CI:1.275-147.028,P=0.031),Bismuth-Corlette classification(OR=0.013,95%CI:0.001-0.166,P=0.001)and extended liver resection(OR=14.010,95%CI:1.130-173.646,P=0.040)were independent risk factors for postoperative complications.CONCLUSION:Overall postoperative morbidity and mortality rates after major liver resection are not improved by PBD in HCCA patients with jaundice.Preoperative TBIL>170μmol/L,Bismuth-Corlette classification and extended liver resection are independent risk factors linked to postoperative complications. | Jun-Jie Xiong Quentin M Nunes Wei Huang Samir Pathak Ai-Lin Wei Chun-Lu Tan Xu-Bao Liu | 2013 | World Journal of Gastroenterology2013，19，46： | 33 |
| 6 | Endobiliary radiofrequency ablation for malignant biliary obstruction显示文摘BACKGROUND: The cornerstone of palliative treatment for inoperable extrahepatic cholangiocarcinoma is the relief of malignant biliary obstruction. The most commonly applied method is endoscopic stenting. However, the procedure can be complicated with stent obstruction. In this respect, endobiliary radiofrequency ablation may serve as an adjunctive tool for prolonging the stent patency. METHODS: Patients who underwent endoscopic retrograde cholangiopancreatography for differential diagnosis and/ or palliative treatment after the diagnosis of inoperable extrahepatic cholangiocarcinoma between March 2011 and January 2012 were analyzed. Those in whom endobiliary radiofrequency ablation and endoscopic stenting was successfully performed were included in the study. Technical details of the procedure, duration of stent patency, length of hospital stay, short-term morbidity and mortality rate were documented. RESULTS: Seventeen patients were analyzed, and 10 patients were included in the study. The morbidity and mortality rate within the first 30 days after the procedure was 20% and 0%, respectively. In 2 patients, mild pancreatitis occurred because of the endobiliary procedure. In 1 patient, endobiliary decompression could not be achieved, and therefore, percutaneous transhepatic biliary drainage was carried out. The median duration of stent patency in 9 patients with successful biliary decompression was 9 months (range 6-15). CONCLUSION: Endobiliary radiofrequency ablation seems to be safe and feasible as a palliative measure and may prolong the stent patency and overall survival in patients with malignant biliary obstruction due to inoperable extrahepatic cholangio-carcinoma. | Halil Alis Cetin Sengoz Murat Gonenc Mustafa Uygar Kalayci Ali Kocatas | 2013 | Hepatobiliary & Pancreatic Diseases International2013，12，4： | 25 |
| 7 | Effect of obstructive sleep apnea on type 2 diabetes mellitus:A comprehensive literature review显示文摘Obstructive sleep apnea(OSA)is frequently associated with obesity and metabolic syndrome.Also frequently associated with metabolic syndrome is type 2 diabetes mellitus(T2DM).Therefore,it is common to find OSA and T2DM together in individuals with metabolic syndrome.Additionally,both OSA and T2DM have a common pathophysiological link with development of insulin resistance.Individuals with severe insulin resistance are likely to have inadequate glycemic control.Long standing poorly controlled T2DM is associated with debilitating microvascular complications such as retinopathy,nephropathy,neuropathy and macrovascular complications such as coronary artery and cerebrovascular disease.There is extensively published literature exploring the cause-effect relationship between OSA and T2DM.In this article we provide an in-depth review of the complex pathophysiological mechanisms linking OSA to T2DM.Specifically,this review focusses on the effect of OSA on the microvascular complications of T2DM such as retinopathy,nephropathy and neuropathy.Additionally,we review the current literature on the effect of continuous positive airway pressure use in individuals with T2DM and OSA. | Srikant Nannapaneni Kannan Ramar Salim Surani | 2013 | World Journal of Diabetes2013，4，6： | 24 |
| 8 | The Change of Interleukin-6 and Tumor Necrosis Factor in Patients with Obstructive Sleep Apnea Syndrome显示文摘The levels of lipopolysaccharide (LPS) induced interleukin 6 (IL 6) and tumor necrosis factor α (TNF α) expression in culture of peripheral blood mononuclear cells (PBMC) and the plasma levels of IL 6 and TNF α in the patients with obstructive sleep apnea syndrome (OSAS) were measured and the relationship between OSAS and IL 6 or TNF α expression studied. Both IL 6 and TNF α were detected by using ELISA in 22 patients with OSAS and 16 normal controls. The levels of LPS induced IL 6 (787.82±151.97 pg/ml) and TNF α (4165.45±1501.43 pg/ml) expression in the supernatant of the culture of PBMC and plasma level of IL 6 (50.67±4.70 pg/ml) and TNF α (299.09±43.57 pg/ml) in the patients with OSAS were significantly higher than those in the normal controls (in the supernatant of the culture of PBMC: 562.69±197.54 pg/ml and 1596.25±403.08 pg/ml respectively; in the plasma: 12.69±2.75 pg/ml and 101.88±21.27 pg/ml respectively). There were significantly positive correlation between the levels of IL 6 and TNF α and the percentage of time of apnea and hyponea, as well as the percentage of time spending at SaO 2 below 90 % in the total sleep time. It was concluded that LPS induced IL 6 and TNF α levels as well as plasma IL 6 and TNF α levels in the patients with OSAS were up regulated, which may be associated with the pathogenesis of OSAS. | 刘辉国 刘瑾 熊盛道 沈关心 张珍祥 徐永健 | 2000 | Journal of Huazhong University of Science and Technology(Medical Sciences)2000，20，3： | 22 |
| 9 | Chronic obstructive pulmonary disease as a risk factor for lung cancer显示文摘The association between chronic obstructive pulmonary disease(COPD) and lung cancer has long been a subject of intense debate. The high prevalence of COPD in elderly smokers inevitably strengthens their coincidence. In addition to this contingent coincidence, recent studies have revealed a close association between the two diseases that is independent of the smoking history; that is, the existence of COPD is an independent risk factor for the development of lung cancer. Molecular-based evidence has been accumulating as a result of the efforts to explain the underlying mechanisms of this association. These mechanisms may include the following: the retention of airborne carcinogens followed by the activation of oncogenes and the suppression of tumor suppressor genes; the complex molecular mechanism associated with chronic inflammation in the distal airways of patients with COPD; the possible in-volvement of putative distal airway stem cells; and gel netic factors that are common to both COPD and lung cancer. The existence of COPD in patients with lung l cancer may potentially affect the process of diagnosis, surgical resection, radiotherapy, chemotherapy, and end-of-life care. The comprehensive management of COPD is extremely important for the appropriate treatment of lung cancer. Surgical resections with the aid of early interventions for COPD are often possible, even for patients with mild-to-moderate COPD. New challenges, such as lung cancer CT screening for individuals t at high risk, are now in the process of being implemented. Evaluating the risk of lung cancer in patients with COPD may be warranted in community-based lung cancer screening. | Yuichi Takiguchi Ikuo Sekine Shunichiro Iwasawa Ryota Kurimoto Koichiro Tatsumi | 2014 | World Journal of Clinical Oncology2014，5，4： | 21 |
| 10 | Endothelial function and T-lymphocyte subsets in patients with overlap syndrome of chronic obstructive pulmonary disease and obstructive sleep apnea显示文摘Background:The coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is termed overlap syndrome (OS).COPD and OSA both have increased risks of developing cardiovascular diseases.This study aimed to explore if patients with OS exhibited a higher prevalence of cardiovascular complications,and if patients with OS exhibited vascular endothelial dysfunction and abnormalities in the cellular immune function of T lymphocytes.Methods:Totally 25 patients with stable COPD (COPD group),25 patients with OSA (OSA group),25 patients with OS (OS group),and 20 healthy adults (control group) were enrolled between January 2017 and December 2017 from the Respiratory Department of Tianjin Medical University General Hospital.The clinical characteristics of the four groups were collected and the expression levels of soluble vascular cell adhesion molecule-1 (sVCAM-1),tumor necrosis factor-α(TNF-α),and T-lymphocyte subsets were detected.One-way analysis of variance,x^2 test and Pearson correlation were used to manage the data.Results:The prevalence of hypertension and coronary heart disease was significantly higher in the OS group than in the control,OSA,and COPD groups (x^2 =20.69,P < 0.05 and x^2 =11.03,P < 0.05,respectively).The levels of sVCAM-1 and TNF-α were significantly higher in the OS group than in other groups (F =127.40,P < 0.05 and F =846.77,P < 0.05,respectively).The percentage of CD4+ lymphocytes and CD4+/CD8+ were both significantly lower in the OS group than in any other group (F =25.40,P < 0.05 and F =75.08,P < 0.05,respectively).There were significantly negative correlations in the levels of sVCAM-1 and TNF-α with CD4^+/CD8^+ lymphocytes (r =-0.77,P < 0.05 and r =-0.83,P < 0.05,respectively).Conclusions:The prevalence of hypertension and coronary heart disease was higher in patients with OS than in patients with either OSA or COPD alone.Patients with OS exhibited more severe vascular endothelial injury,stronger inflammatory response,and lower cellular immune function. | Juan Wang Xin Li Wan-Ju Hou Li-Xia Dong Jie Cao | 2019 | Chinese Medical Journal2019，，14： | 18 |
| 11 | Urgent endoscopic ultrasound-guided choledochoduodenostomy for acute obstructive suppurative cholangitis-induced sepsis显示文摘Acute obstructive suppurative cholangitis(AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography(ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy(EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis. | Kosuke Minaga Masayuki Kitano Hajime Imai Kentaro Yamao Ken Kamata Takeshi Miyata Shunsuke Omoto Kumpei Kadosaka Tomoe Yoshikawa Masatoshi Kudo | 2016 | World Journal of Gastroenterology2016，22，16： | 18 |
| 12 | Endoscopic management of biliary disorders during pregnancy显示文摘BACKGROUND:Biliary interventions during pregnancy are associated with risks to both the pregnancy and developing fetus.In this report we summarize our experience with endoscopic interventions including endoscopic ultrasound (EUS)in the management of biliary disorders during pregnancy. METHODS:Endoscopic retrograde cholangiopancreatographies (ERCPs)performed between May 2003 through January 2010(n=607)were identified from our database,and cases of interventions during pregnancy were reviewed.All procedures were done using conscious sedation and lead shielding. RESULTS:Nine ERCPs(1.5%)were performed in 8 pregnant patients.Their median gestational period was 22 weeks (range,<2-36 weeks).Two,5 and 2 patients were in their first,second and third trimester,respectively.Indications for ERCP included obstructive jaundice(6 patients)cholangitis (2),and acute pancreatitis/obstructive jaundice(1).Two patients underwent EUS before ERCP.Fluoroscopy was used in 5 ERCPs(median 12 seconds;range 2-20 seconds),and the overall time for a ERCP ranged from 5 to 25 minutes. During ERCP endoscopic sphincterotomy was performed in 5 patients,stenting in 6,and balloon clearance in 3.One procedure caused complication in induction of labor.During pregnancy,there were 4 non-procedure related complications including acute cholecystitis(1),HELLP syndrome resulting in spontaneous abortion(1)and stent migrations(2).Five pregnancies had uncomplicated term deliveries,whereas 2 required urgent caesarian sections(one for fetal distress and 1 for cholangitis secondary to stent migration).One patient was well in her second trimester during follow-up.Seven babies were well at birth with median APGAR scores of 9,and 10 at 5 and 10 minutes,respectively.One baby died of sudden death syndrome at age of 40 days. CONCLUSIONS:ERCP is a safe procedure for pregnant women.It can be conducted for biliary stenting and subsequent clearance after deliveries.EUS has a complementary role. Different strategies can be applied according to the conditions or expertise of endoscopists. | Vui Heng Chong Anand Jalihal | 2010 | Hepatobiliary & Pancreatic Diseases International2010，9，2： | 18 |
| 13 | Biliary drainage for obstructive jaundice caused by unresectable hepatocellular carcinoma: the endoscopic versus percutaneous approach显示文摘BACKGROUND: For palliative treatment of the obstructive jaundice associated with unresectable hepatocellular carcinoma (HCC), percutaneous transhepatic biliary drainage (PTBD) or endoscopic retrograde biliary drainage (ERBD) has been performed. PTBD is preferred as an initial procedure. Little is known about the better option for patients with obstructive jaundice caused by unresectable HCC. METHODS: Sixty patients who had received ERBD or PTBD for the palliative treatment of obstructive jaundice caused by unresectable HCC between January 2006 and May 2010 were included in this retrospective study. Successful drainage, drainage patency, and the overall survival of patients were evaluated. RESULTS: Univariate analysis revealed that the overall frequency of successful drainage was higher in the ERBD group (22/29, 75.9%) than in the PTBD group (15/31, 48.4%) (P=0.029); but multivariate analysis showed marginal significance (P=0.057). The duration of drainage patency was longer in the ERBD group than in the PTBD group (82 vs 37 days, respectively, P=0.020). Regardless of what procedure was performed, the median survival time of patients who had a successful drainage was much longer than that of the patients who did not have a successful drainage (143 vs 38 days, respectively, P<0.001).CONCLUSION: Besides PTBD, ERBD may be used as the initial treatment option to improve obstructive jaundice in patients with unresectable HCC if there is a longer duration of drainage patency after a successful drainage. | Jongkyoung Choi Ji Kon Ryu Sang Hyub Lee Dong-Won Ahn Jin-Hyeok Hwang Yong-Tae Kim Yong Bum Yoon Joon Koo Han | 2012 | Hepatobiliary & Pancreatic Diseases International2012，11，6： | 17 |
| 14 | Imbalance of osteoprotegerin/receptor activator of nuclear factor-κB ligand and oxidative stress in patients with obstructive sleep apnea-hypopnea syndrome显示文摘Background:Obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with a higher prevalence of osteoporosis.However,the underlying mechanisms linking OSAHS with bone loss are still unclear.The aim of this study was to investigate the changes of receptor activator of nuclear factor-κB ligand (RANKL,an osteoclastogenesis-promoting factor) and osteoprotegerin (OPG,the decoy receptor for RANKL),oxidative stress and bone metabolism markers in OSAHS,in order to understand the potential mechanisms underlying bone loss in OSAHS patients.Methods:Forty-eight male patients with OSAHS,confirmed by polysomnography (PSG) study,were enrolled.Twenty male subjects who were confirmed as not having OSAHS served as the controls.The subjects’bone mineral density (BMD) was assessed in lumbar spine and femoral neck using dual-energy X-ray absorptiometry (DXA).Blood samples were collected from all subjects for measurement of RANKL,OPG,the bone formation marker bone-specific alkaline phosphatase (BAP),the bone resorption marker tartrate-resistant acid phosphatase 5b (TRAP-5b),and total antioxidant capacity (TAOC).Results:The BMD and the T-score of the femoral neck and the lumbar spine were significantly lower in OSAHS patients as compared to the control group (P< 0.05).The serum level of BAP was significantly decreased in the OSAHS group (15.62 ± 5.20 μg/L) as compared to the control group (18.83 ± 5.50 μg/L,t= -2.235,P< 0.05),while the levels of TRAP-5b did not differ between the two groups (t= -1.447,P> 0.05).The serum level of OPG and the OPG/RANKL ratio were lower in the OSAHS group compared to the control group (bothP< 0.05).TAOC level was also decreased significantly in the OSAHS group (P< 0.05).Correlation analysis showed that the TAOC level was positively correlated with BAP in the OSAHS group (r= 0.248,P= 0.04),but there were no correlations between TAOC and the BMD or the T-scores.The correlations between the level of OPG (or the OPG/RANKL ratio) and BMD or TAOC did not reach significance.Conclusion:In OSAHS patients,lower levels of TAOC were associated with decreased bone formation,suggesting a role of oxidative stress in bone loss,while the role of OPG/RANKL imbalance in bone metabolism in OSAHS needs further evaluation . | Xiao-Rong Ma Yong Wang Yong-Chang Sun | 2019 | Chinese Medical Journal2019，，1： | 16 |
| 15 | Atrial fibrillation in obstructive sleep apnea显示文摘Atrial fibrillation(AF) is a common arrhythmia with rising incidence.Obstructive sleep apnea(OSA) is prevalent among patients with AF.This observation has prompted significant research in understanding the relationship between OSA and AF.Multiple studies support a role of OSA in the initiation and progression of AF.This association has been independent of obesity,body mass index and hypertension.Instability of autonomic tone and wide swings in intrathoracic pressure are seen in OSA.These have been mechanistically linked to initiation of AF in OSA patients by lowering atrial effective refractory period,promoting pulmonary vein discharges and atrial dilation.OSA not only promotes initiation of AF but also makes management of AF difficult.Drug therapy and electrical cardioversion for AF are less successful in presence of OSA.There has been higher rate of early and overall recurrence after catheter ablation of AF in patients with OSA.Treatment of OSA with continuous positive airway pressure has been shown to improve control of AF.However,additional studies are needed to establish a stronger relationship between OSA treatment and success ofAF therapies.There should be heightened suspicion of OSA in patients with AF.There is a need for guidelines to screen for OSA as a part of AF management. | Sandeep K Goyal Abhishek Sharma | 2013 | World Journal of Cardiology2013，5，6： | 16 |
| 16 | Xanthogranulomatous cholecystitis mimicking gallbladder cancer and causing obstructive cholestasis显示文摘BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder that can mimic gallbladder carcinoma. METHODS: We present the case of a 35-year-old Hispanic male complaining of right upper quadrant pain and jaundice for 2 months prior to admission. He denied a history of fever, nausea/ vomiting, and weight loss. The past medical history was relevant only for diabetes. He had no previous history of jaundice or previous operations. RESULTS: CA19-9 was slightly elevated (52 U/mL). Abdominal ultrasonography showed an irregular thickening of the gallbladder wall and no gallstones were detected. CT scan also revealed an irregular thickening of the wall of the gallbladder body suggestive of malignancy. At laparotomy, the mass was adherent to the duodenum and colon, and although the frozen section biopsy was negative, the intraoperative findings were suggestive of malignancy, and the patient underwent left liver trisegmentectomy, resection of the common bile duct and Roux-en-Y hepaticojejunostomy. Pathological examination unexpectedly revealed XGC without malignancy. CONCLUSIONS: Preoperative and intraoperative differential diagnosis of XGC from gallbladder carcinoma remains a challenge when it is associated with inflammatory involvement of surrounding tissues. Since gallbladder carcinoma and XGC may coexist, radical resection is justified when malignancy cannot be completely ruled out. | Paulo N Martins Patricia Sheiner Marcelo Facciuto | 2012 | Hepatobiliary & Pancreatic Diseases International2012，11，5： | 15 |
| 17 | 老年慢性阻塞性肺疾病急性期合并肺结核感染的治疗方法及其疗效探讨显示文摘目的:探讨老年慢性阻塞性肺疾病(chronic obstructive lung disease,COPD)急性期合并肺结核感染的治疗方法及其疗效。方法:选取2014年2月至2016年2月我院收治的老年慢性阻塞性肺疾病急性期合并肺结核感染的患者92例,根据治疗方式随机分为治疗组和对照组,对照组给予COPD对症支持治疗和抗肺结核治疗,治疗组在对照组基础上加用痰热清,比较两组患者治疗有效率、痰培养阴转率以及肝肾损害情况的差异。结果:治疗组患者治疗后痰培养阴转率(36例,85.71%)与对照组(41例,82.0%)的差异无统计学意义(P>0.05)。两组患者治疗后的症状积分均低于治疗前,且差异具有统计学差异(P<0.05),治疗组治疗后的症状积分(85.62±11.37)低于对照组(91.25±12.38),且差异具有统计学差异(P<0.05)。治疗组治疗后痊愈2例(4.76%),显效26例(61.90%),有效10例(23.81%),无效4例(9.52%);对照组治疗后痊愈1例(2.0%),显效17例(34.0%),有效22例(44.0%),无效10例(20.0%);治疗组治疗疗效明显优于对照组,且差异具有统计学意义(P<0.05)。治疗组治疗后发生肝肾损害14例,对照组11例,两组患者治疗后肝肾损害发生率的差异无统计学意义(P>0.05)。结论:在不影响痰培养阴转率和不加重肝肾负担的情况下,老年COPD急性期合并肺结核感染患者接受一般性治疗的同时进行中医治疗,其疗效更为显著。 | 石菡 | 2016 | 临床与病理杂志2016，36，10： | 15 |
| 18 | Impact of obstructive sleep apnea on pulmonary hypertension in patients with chronic obstructive pulmonary disease显示文摘Background:Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) syndrome are highly prevalent respiratory conditions. Their coexistence is referred to as the overlap syndrome. They are both related to pulmonary hypertension (PH) development. This study investigated the effects of OSA on PH in patients with COPD and the associated factors. Methods: Consecutive patients with stable COPD were recruited for an observational cross-sectional study from September 2016 to May 2018 at Peking University Third Hospital. In total, 106 patients with COPD were enrolled and performed home portable monitoring and echocardiography. OSA was defined by an apnea hypopnea index (AHI)>10 events/h. Based on OSA absence or presence, patients were divided into the COPD with OSA and COPD without OSA groups. Factors affecting pulmonary artery pressure (PAP) and PH were identified using univariate analysis and logistic regression models. Results: In the 106 patients with COPD, the mean age was 69.52 years, 91.5% were men, and the mean forced expiratory volume in 1 s (FEV!) percentage of predicted was 56.15%. Fifty-six (52.8%) patients with COPD were diagnosed with OSA, and 24 (22.6%) patients with COPD were diagnosed as PH. Compared with COPD without OSA group, the median PAP in COPD with severe OSA group increased by 5 mmHg (36.00 [26.00-50.00] mmHg vs. 31.00 [24.00-34.00] mmHg, P = 0.036). COPD with percent of night-time spent with oxygen saturation below 90%(T90)> 10% group had higher PAP than COPD with T90 < 1 % group (36.00 [29.00-50.00)] mmHg vs. 29.00 [25.50-34.00] mmHg, F = 7.889, P = 0.007). Univariate analysis revealed age, FEVi% predicted, T90, and Charlson index had statistically significant effects on PH. Multiple regression analysis showed a significant and independent effect of both FEVj% predicted (odds ratio [OR]= 3.46;95% confidence interval [Cl]: 1.15-10.46;P = 0.028) and AHI (OR = 3.20;95% Cl: 1.09-19.35;P = 0.034) on PH. Conclusions: Patients with COPD with OSA are more susceptible to PH, which is associated with declining lung function and increased severity of OSA. Thus, nocturnal hypoxemia and OSA in elderly patients with COPD should be identified and treated. | Wan-Lu Sun Jian-Li Wang Guo-Hua Jia Wen-Jun Mi Yi-Xuan Liao Yong-Wei Huang Zheng Hu Li-Qiang Zhang Ya-Hong Chen | 2019 | Chinese Medical Journal2019，，11： | 15 |
| 19 | Inflammatory bowel disease and airway diseases显示文摘Airway diseases are the most commonly described lung manifestations of inflammatory bowel disease(IBD). However,the similarities in disease pathogenesis and the sharing of important environmental risk factors and genetic susceptibility suggest that there is a complex interplay between IBD and airway diseases. Recent evidence of IBD occurrence among patients with airway diseases and the higher than estimated prevalence of subclinical airway injuries among IBD patients support the hypothesis of a two-way association. Future research efforts should be directed toward further exploration of this association,as airway diseases are highly prevalent conditions with a substantial public health impact. | Maria Vutcovici Paul Brassard Alain Bitton | 2016 | World Journal of Gastroenterology2016，22，34： | 15 |
| 20 | Relationship between brain—derived neurotrophic factor and cognitive function of obstructive sleep apnea/hypopnea syndrome patients显示文摘Objective:To determine the relationship between the blood serum brain-derived neurotrophic factor(BDNF) level and cognitive function deterioration in patients with obstructive sleep apnea/ hypopnea syndrome(OSAHS),and to explore the possible mechanism of cognitive impairment. Methods:Twenty-eight male OSAHS patients and 14 normal males(as controls) were enrolled in the study.Polysomnography and the Montreal cognitive assessment(MoCA) were conducted. The blood serum BDNF levels were measured using ELISA.Results:The OSAHS group had significantly decreased blood serum BDNF levels compared with the control group(t=-10.912, P=0.000).The blood serum BDNF level of the subjects was significantly positively associated with the MoCA score(r=0.544,P=0.000),significantly negatively associated with the apneahypopnea index(AHI) and shallow sleep(S1+S2)(AHI:r=-0.607,P=0.000;S1+S2:r =-0.768,P= 0.000),and significantly positively associated with the lowest SaO2(LSO),slow wave sleep(S3+S4), and rapid eye movement sleep(REM)(LSO:r=0.566,P = 0.000;S3+S4:r=0.778,P=0.000;REM: r=0.575,P=0.000).Conclusions:OSAHS patients have significantly decreased blood serum BDNF levels compared with the control.Nocturnal hypoxia as well as the deprivation of slow wave sleep and REM may lead to the decreased serum BDNF level of OSAHS patients.This decreased blood serum BDNF level may contribute to the cognitive impairment in OSAHS. | Wei-Hong Wang Guo-Ping He Xu-Ping Xiao Can Gu Hua-Ying Chen | 2012 | Asian Pacific Journal of Tropical Medicine2012，5，11： | 15 |
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