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Han HT, Yue P, Meng WB, Zhang L, Zhu KX, Zhu XL, Miao L, Wang ZF, Wang HP, Li X. [The comparison between endoscopic and surgical treatment of delayed iatrogenic bile duct injury by propensity score matching]. Zhonghua Wai Ke Za Zhi 2023; 61:871-879. [PMID: 37653989 DOI: 10.3760/cma.j.cn112139-20230119-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Objective: To compare the safety and clinical efficacy of endoscopic and surgical treatment of patients with delayed iatrogenic bile duct injury (DBDI) with severity (SG) grade 1 to 2. Methods: The clinical data of 129 patients with SG grade 1 to 2 DBDI who received endoscopic or surgical treatment in the First Hospital of Lanzhou University from November 2007 to November 2021 were retrospectively collected. There were 46 males and 83 females,aged (M(IQR)) 54(22)years(range: 21 to 82 years). The baseline data of the two groups were matched 1∶1 by propensity score matching(caliper value was 0.2). Independent sample t test,rank sum test,χ2 test or Fisher exact probability test were used to analyze the data of the two matched groups. Results: There were 48 patients in each of the endoscopic treatment and surgical groups after matching,and there was no difference in general information between the two groups(both P>0.05). The bile duct injury-repair interval and intraoperative anesthesia complications were not statistically significant between the two groups after matching(all P>0.05). Compared with the surgical group, patients in the endoscopic treatment group had significantly shorter operative time(50 (30) minutes vs. 185 (100) minutes, Z=7.675,P<0.01) and postoperative hospital stay(5 (5) days vs. 12 (7) days, Z=5.848, P<0.01).For safety,there was no statistical difference in the incidence of immediate postoperative complications between the two groups with Clavien-Dindo classification of surgical complications<Ⅲ;the incidence of serious postoperative complications (Clavien-Dindo classification of surgical complications≥Ⅲ) was significantly higher in the surgical group than in the endoscopic treatment group(P=0.012). The incidence of long-term postoperative complications was not statistically different between the two groups(28.1% vs. 20.7%,P=0.562). In terms of efficacy,the postoperative liver function indexes of patients in both groups improved significantly compared with the preoperative period and returned to normal or near normal levels; the postoperative infection indexes of both groups showed an increasing trend,but were within the normal range. Of the 96 patients in both groups,61 obtained follow-up,and the follow-up time was (89.4±48.0)months(range: 3 to 165 months),and there was no statistical difference between the two groups(P=0.079). The probability of excellent long-term follow-up (78.1% vs. 86.2%) was not statistically different between the two groups(P=0.412).In patients with Strasberg-Bismuth type E1,the probability of excellent long-term follow-up was higher in the endoscopic treatment group compared with the surgical group(13/14 vs. 2/5,P=0.037). Conclusions: For DBDI patients with SG grade 1 to 2 and bile duct continuity,endoscopy can be used as the first deterministic treatment. The advantages of endoscopic therapy compared to surgery are the lower incidence of postoperative serious complications,and the shorter duration of surgery and postoperative hospital stay.
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Affiliation(s)
- H T Han
- The First School of Clinical Medicine,Lanzhou University; Department of General Surgery and Surgical Endoscopy Center,the First Hospital of Lanzhou University; Institute of Hepatobiliary and Pancreatic Surgery of Gansu Province; Key Laboratory Biotherapy and Regenerative Medicine of Gansu Province,Lanzhou 730030,China
| | - P Yue
- The First School of Clinical Medicine,Lanzhou University; Department of General Surgery and Surgical Endoscopy Center,the First Hospital of Lanzhou University; Institute of Hepatobiliary and Pancreatic Surgery of Gansu Province; Key Laboratory Biotherapy and Regenerative Medicine of Gansu Province,Lanzhou 730030,China
| | - W B Meng
- The First School of Clinical Medicine,Lanzhou University; Department of General Surgery and Surgical Endoscopy Center,the First Hospital of Lanzhou University; Institute of Hepatobiliary and Pancreatic Surgery of Gansu Province; Key Laboratory Biotherapy and Regenerative Medicine of Gansu Province,Lanzhou 730030,China
| | - L Zhang
- The First School of Clinical Medicine,Lanzhou University; Department of General Surgery and Surgical Endoscopy Center,the First Hospital of Lanzhou University; Institute of Hepatobiliary and Pancreatic Surgery of Gansu Province; Key Laboratory Biotherapy and Regenerative Medicine of Gansu Province,Lanzhou 730030,China
| | - K X Zhu
- The First School of Clinical Medicine,Lanzhou University; Department of General Surgery and Surgical Endoscopy Center,the First Hospital of Lanzhou University; Institute of Hepatobiliary and Pancreatic Surgery of Gansu Province; Key Laboratory Biotherapy and Regenerative Medicine of Gansu Province,Lanzhou 730030,China
| | - X L Zhu
- The First School of Clinical Medicine,Lanzhou University; Department of General Surgery and Surgical Endoscopy Center,the First Hospital of Lanzhou University; Institute of Hepatobiliary and Pancreatic Surgery of Gansu Province; Key Laboratory Biotherapy and Regenerative Medicine of Gansu Province,Lanzhou 730030,China
| | - L Miao
- The First School of Clinical Medicine,Lanzhou University; Department of General Surgery and Surgical Endoscopy Center,the First Hospital of Lanzhou University; Institute of Hepatobiliary and Pancreatic Surgery of Gansu Province; Key Laboratory Biotherapy and Regenerative Medicine of Gansu Province,Lanzhou 730030,China
| | - Z F Wang
- The First School of Clinical Medicine,Lanzhou University; Department of General Surgery and Surgical Endoscopy Center,the First Hospital of Lanzhou University; Institute of Hepatobiliary and Pancreatic Surgery of Gansu Province; Key Laboratory Biotherapy and Regenerative Medicine of Gansu Province,Lanzhou 730030,China
| | - H P Wang
- The First School of Clinical Medicine,Lanzhou University; Department of General Surgery and Surgical Endoscopy Center,the First Hospital of Lanzhou University; Institute of Hepatobiliary and Pancreatic Surgery of Gansu Province; Key Laboratory Biotherapy and Regenerative Medicine of Gansu Province,Lanzhou 730030,China
| | - X Li
- The First School of Clinical Medicine,Lanzhou University; Department of General Surgery and Surgical Endoscopy Center,the First Hospital of Lanzhou University; Institute of Hepatobiliary and Pancreatic Surgery of Gansu Province; Key Laboratory Biotherapy and Regenerative Medicine of Gansu Province,Lanzhou 730030,China
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Yang N, Zhao W, Pan Y, Lyu XZ, Hao XY, Qi WA, Du L, Liu EM, Chen T, Zhang WS, Zhang CF, Zhu GN, Wang QM, Meng WB, Liang YB, Jin YH, Wang W, Xing D, Tian JH, Ma B, Wang XH, Song XP, Ge L, Yang KH, Liu XQ, Wei JM, Chen Y. [Development of a Ranking Tool for Scientificity, Transparency and Applicability of Clinical Practice Guidelines]. Zhonghua Yi Xue Za Zhi 2022; 102:1-10. [PMID: 35701091 DOI: 10.3760/cma.j.cn112137-20220219-00340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To address the limitations of existing methods and tools for evaluating clinical practice guidelines, we aimed to develop a comprehensive instrument focusing on the three main dimensions of guideline development: scientificity, transparency, applicability. We will use it to rank the guidelines according to the scores. We abbreviated it as STAR, and its reliability, validity and usability were also tested. Methods: A multidisciplinary expert working group was set up, including methodologists, statisticians, journal editors, medical professionals, and others. Scoping review, Delphi methods and hierarchical analysis were used to determine the final checklist of STAR. Results: The new instrument contained 11 domains and 39 items. Intrinsic reliability of each domain was indicated by Cronbach's α coefficient, with a average value of 0.646. The Cohen's kappa coefficients for methodological evaluators and clinical evaluators were 0.783 and 0.618. The overall content validity index was 0.905. The R2 for the criterion validity analysis was 0.76. The average score for usability of the items was 4.6, and the mean time spent to evaluate each guideline was 20 minutes. Conclusion: The instrument has good reliability, validity and evaluating efficiency, and can be used for evaluating and ranking guidelines more comprehensively.
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Affiliation(s)
- N Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - W Zhao
- General Editorial Office, Chinese Medical Association Publishing House, Beijing 100052, China
| | - Y Pan
- Marketing and Sales Department, Chinese Medical Association Publishing House, Beijing 100052, China
| | - X Z Lyu
- Editorial Department, Chinese Medical Journal, Chinese Medical Association Publishing House, Beijing 100052, China
| | - X Y Hao
- Editorial Department, Chinese Medical Journal (English Edition), Chinese Medical Association Publishing House, Beijing 100052, China
| | - W A Qi
- Editorial Department, British Medical Journal (Chinese Edition), Chinese Medical Association Publishing House, Beijing 100052, China
| | - L Du
- Evidence-Based Medicine Center, West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610041
| | - E M Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014
| | - T Chen
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - W S Zhang
- Department of Obstetrics and Gynecology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - C F Zhang
- Children's Hospital of Fudan University, Shanghai 201102, China
| | - G N Zhu
- Department of Dermatology, Xijing Hospital, Xi'an 710032, China
| | - Q M Wang
- Department of Medical Oncology, Henan Cancer Hospital, Zhengzhou 450008, China
| | - W B Meng
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Y B Liang
- Department of Ophthalmology, The Eye Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Y H Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430072, China
| | - W Wang
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, China
| | - D Xing
- Department of Trauma and Orthopaedics, Peking University People's Hospital, Beijing 100044, China
| | - J H Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - B Ma
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - X H Wang
- School of Public Health, Lanzhou University, Lanzhou 730000
| | - X P Song
- School of Public Health, Lanzhou University, Lanzhou 730000
| | - L Ge
- School of Public Health, Lanzhou University, Lanzhou 730000
| | - K H Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - X Q Liu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union & Peking Union Medical College, Beijing 100730
| | - J M Wei
- Chinese Medical Association Publishing House, Beijing 100052, China
| | - Yaolong Chen
- Research Unit of Evidence-Based Evaluation and Guidelines (2021RU017), Chinese Academy of Medical Sciences, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China Guidelines and Standards Research Center, Chinese Medical Association Publishing House, Beijing 100052, China
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Meng WB, Liu JP, Wang XW, E LH. Effect of Bcl-2-siRNA on proliferation and apoptosis of pediatric acute B lymphoblastic leukemia (A-BLL) cells. Genet Mol Res 2015; 14:12427-36. [PMID: 26505392 DOI: 10.4238/2015.october.16.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study analyzed the effect of small interfering RNA specific for the Bcl-2 gene (siRNA Bcl-2) on the proliferation and chemotherapeutic sensitivity of pediatric A-BLL cells. Marrow samples were obtained from sixty newly-diagnosed A-BLL pediatric patients. The Bcl-2 mRNA expression in these samples was quantified by real time polymerase chain reaction. The Bcl-2 mRNA re-expression was analyzed by RNA interference using Bcl-2-siRNA. Cellular proliferation was detected using the MTT (Thiazolyl Blue Tetrazolium Bromide) assay. The cell apoptosis was quantified by flow cytometry. The Bcl-2 mRNA expression was significantly higher in the drug-resistance group than in the chemotherapy sensitivity group prior to chemotherapy (P < 0.05). In addition, the Bcl-2 mRNA expression in the chemotherapy sensitivity group was significantly higher before chemotherapy than that after chemotherapy (P < 0.05). The Bcl-2 mRNA expression significantly decreased in the leukemic cells of the Bcl-2-siRNA transfection group. We observed statistically significant differences in the relative mRNA expression levels among the Bcl-2-siRNA transfection, blank control, liposome empty transfection, and unrelated sequence oligonucleotide groups (P < 0.05). The rate of apoptosis in pediatric A-BLL leukemic cells was observed to increase significantly after transfection with Bcl-2-siRNA compared to the control, liposome empty transfection, and unrelated sequence oligonucleotide groups (P < 0.05). Therefore, we concluded that Bcl-2-siRNA can successfully inhibit the multiplicative capacity of A-BLL leukemic cells and promote apoptosis.
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Affiliation(s)
- W B Meng
- Department of Obstetrics and Gynecology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - J P Liu
- Department of Pediatric Hematology, Inner Mongolia People's Hospital, Hohhot, China
| | - X W Wang
- Department of Pediatric Hematology, Inner Mongolia People's Hospital, Hohhot, China
| | - L H E
- Department of Stomatology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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Zhang H, Zhou WC, Li X, Meng WB, Zhang L, Zhu XL, Zhu KX, Bai ZT, Yan J, Liu T, Xu XC, Li YM. 5-Azacytidine suppresses the proliferation of pancreatic cancer cells by inhibiting the Wnt/β-catenin signaling pathway. Genet Mol Res 2014; 13:5064-72. [PMID: 25061731 DOI: 10.4238/2014.july.4.22] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
5-Azacytidine has been shown to be an effective anti-pancreatic cancer drug, but the mechanism remains unknown. In the current study, we explored the effect of 5-azacytidine on abnormal activation of the Wnt-β-catenin signaling pathway in pancreatic cancer cells. The human pancreatic cancer cell line Bxpc-3 was treated with different concentrations of 5-azacytidine for various times. The proliferation and early apoptosis of the cells were evaluated using the CCK8 method and flow cytometry, respectively. mRNA and protein expression of β-catenin, c-myc, and cyclinD1 were detected using real-time fluorescent quantitative polymerase chain reaction and Western blot analysis, respectively. The proliferation of Bxpc-3 cells was suppressed by 5-azacytidine. The early apoptosis of the cells was significantly enhanced over time and with increasing drug concentrations. The expression of β-catenin, c-myc, and cyclinD1 were down-regulated, showing significant differences between different concentrations and treatment times (P < 0.05). 5-Azacytidine suppressed the proliferation of pancreatic cancer cells by inhibiting the Wnt/β-catenin signaling pathway, particularly the expression of β-catenin, c-myc, and cyclinD1. This study may provide a new potential strategy for diagnosing and treating pancreatic cancer.
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Affiliation(s)
- H Zhang
- Department II of General Surgery, The First Hospital of Lanzhou University, Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
| | - W C Zhou
- Department II of General Surgery, The First Hospital of Lanzhou University, Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
| | - X Li
- Department II of General Surgery, The First Hospital of Lanzhou University, Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
| | - W B Meng
- Department II of General Surgery, The First Hospital of Lanzhou University, Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
| | - L Zhang
- Department II of General Surgery, The First Hospital of Lanzhou University, Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
| | - X L Zhu
- Department II of General Surgery, The First Hospital of Lanzhou University, Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
| | - K X Zhu
- Department II of General Surgery, The First Hospital of Lanzhou University, Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
| | - Z T Bai
- Department II of General Surgery, The First Hospital of Lanzhou University, Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
| | - J Yan
- Department II of General Surgery, The First Hospital of Lanzhou University, Hepatopancreatobiliary Surgery Institute of Gansu Province, Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
| | - T Liu
- General Surgery, The Second Hospital of Lanzhou University, Lanzhou, China
| | - X C Xu
- General Surgery, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Y M Li
- General Surgery, The Second Hospital of Lanzhou University, Lanzhou, China
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