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Objective:To investigate the efficacy of endoscopic retrograde cholangiopancreatography in the treatment of Child-Pugh C cirrhosis complicated by obstructive jaundice and its effects on liver function and infection indexes.Methods:The clinical data of 86 patients with Child-Pugh C cirrhosis complicated by obstructive jaundice who received treatment in the Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, from June 2017 to June 2022 were retrospectively analyzed. These patients were divided into an observation group ( n = 56) and a control group ( n = 30) according to different treatment methods. Patients in the observation group underwent endoscopic retrograde cholangiopancreatography and those in the control group received conservative drug treatment. After 14 days of treatment, clinical efficacy was compared between the two groups. The changes in liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyl transpeptide (GGT)] and infection indicators [white blood cell count (WBC), procalcitonin (PCT), and C-reactive protein (CRP)] were compared between the two groups before and after treatment. The incidence of postoperative complications was compared between the two groups. At 6 months after treatment, the prognosis was compared between the two groups. Results:The total response rate in the observation group was 98.21% (55/56), which was significantly higher than 60.00% (18/30) in the control group ( Z = 23.43, P < 0.001). Before treatment, serum ALT, AST, GGT levels in the control group were (294.53 ± 45.19) U/L, (286.62 ± 17.15) U/L, and (304.53 ± 12.34) U/L, respectively, and they were (96.25 ± 16.7) U/L, (113.25 ± 8.56) U/L, (122.25 ± 9.24) U/L after 14 days of treatment. Before treatment, serum ALT, AST, and GGT levels in the observation group were (352.36 ± 70.23) U/L, (303.31 ± 12.12) U/L, and (368.36 ± 10.23) U/L, respectively, and they were (108.65 ± 12.38) U/L, (95.65 ± 6.54) U/L, and (85.66 ± 7.28) U/L, respectively, after 14 days of treatment. After treatment, serum ALT, AST, and GGT levels in each group were significantly decreased compared with those before treatment (observation group t = 22.54, 49.54, 64.76; control group t = 25.57, 112.83, 168.48, all P < 0.05). After treatment, the amplitude of decrease in serum ALT, AST, and GGT levels in the observation group were significantly greater than those in the control group ( t = 2.27, 3.18, 4.61, all P < 0.05). After treatment, PCT, CRP, and WBC in each group were significantly decreased compared with those before treatment (observation group: t = 11.68, 11.46, 5.42, control group: t = 20.39, 18.69, 19.02, all P < 0.05). After treatment, the amplitude of decrease in serum PCT, CRP, and WBC in the observation group were significantly greater than those in the control group ( t = 5.14, 1.67, and 2.11, all P < 0.05). Within 14 days after treatment, there were two cases of acute pancreatitis, one case of hyperamylasemia, and one case of transient biliary bleeding in the observation group. There was one case of acute pancreatitis in the control group. The incidence of complications in the observation group was slightly, but not significantly, higher than that in the control group ( P > 0.05). After treatment, 12 patients (40.00%) in the control group experienced worsening jaundice, and additional endoscopic retrograde cholangiopancreatography salvage treatment was given. After treatment, total bilirubin level decreased by > 50%, reaching the standard of significant efficacy. At 6 months after treatment, stent obstruction occurred in two patients, which was effectively treated by replacement. There were no deaths in each group during the follow-up period. Conclusion:Implantation of a nasobiliary duct or a biliary duct stent during endoscopic retrograde cholangiopancreatography is more effective at treating yelloxemia in patients with Child-Pugh C cirrhosis complicated by obstructive jaundice than medication. The former method can effectively relieve obstructive jaundice, smooth drainage, improve liver function, reduce infection, and be relatively safe.
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Objective To study the morphology and characteristics of the popliteal tibial nerve and measure relevant structural parameters of the peroneal nerve passing round the fibular head and neck by 3D(three-dimensional)MR advantage sequences,and provide valuable image information for basic research and clinical work.Methods Thirty-six left knee joints of healthy volunteers were scanned using 3D MR sequences,including 3D-FS-CUBE,3D-FS-SPGR.The anatomical features in MR imaging were observed by two doctors.The different level axis section areas of the popliteal tibial nerve were measured by reconstructed 3D MR advantage sequences.The coronal/sagittal diameters and the angle of the fibular head and neck(peroneal tunnel)were also measured and compared.SPSS 19.0 software was used for further statistical analysis.Results Optimum visual rates of the knee nerve of 3D-FS-CUBE,3D-FS-SPGR sequences were 25%,89%(P<0.01).Axial section of the tibial nerve of the popliteal space was as following:top level(Tn1,tibial nerve)(19.3 ± 1.02)mm2,midpoint level(Tn2)(23.6 ± 2.24)mm2,supracondylar level(Tn3)(29.1 ± 3.39)mm2.Coronal and sagittal diameters of the fibular head were(19.8 ± 2.95)mm,(19.7 ± 4.2)mm,and coronal and sagittal diameters of the fibular neck were(12.7 ± 3.1)mm, (13.6 ± 2.5)mm,respectively.The angle between the head and neck was 164°± 6.5°.Conclusion 3D-FS-SPGR sequence is the advantage sequence for displaying the knee nerves.The diameters of the popliteal tibial nerves gradually thicken from Tn 1 to Tn3.The structural measurements of the fibula head and neck have certain significance for fundamental research or prevention and treatment of common peroneal nerve entrapment.
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Objective To explore the application value of 3.0T MR diffusion tensor imaging (DTI)in 3D reconstruction of the knee peripheral nerve.Methods DTI with 25 motion probing gradients (MPGs)was performed on the left knee in 22 healthy young volunteers;By choosing the original images scaned in the vertical direction,three post-processing methods including maximum intensity proj ection (MIP),volume rendering (VR)and diffusion tensor tractography (DTT)were used.Two radiologists evaluated these images visually.For the same nerve,MIP,VR and DTT were compared using Friedman test.Intraclass correlation coefficient (ICC )analysis was used to compare the correlation among the three imaging methods.Score consistency between two observers was calculated by using the Kappa statistic.Results For the same nerve,there was no significant statistical difference for the MIP,VR and DTT imaging quality scores(P>0.05).The I CC value and the k value were 0.718-0.856,0.668-0.705,respectively.Conclusion Stereoscopic and clear displaying the tibial nerve/the common peroneal nerve in the knee can be achieved by using MIP,VR and DTT post-processing methods based on DTI original images.The reconstruction of MIP,VR is simple and efficient,in which the objectivity is better than DTT.The reconstruction of MIP,VR can be used as effective preview methods before the DTT reconstruction with complexity and strong subjective dependence.
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Objective To evaluate the clinical effect and efficacy of endoscopy treatment for isolated gastric varices 1 with tissue glue and metal clips. Metheds The clinical date of 21 patients who treated tissue glue and metal clips were retrospectively analyzed from Jan 2015 to Dec 2016. Results The treatments were completed successfully and reviewed by endoscopy after 1 week, 1 month, 3 months, 6 months. The gastric varices were reduced, and the serious complications of bleeding, embolism were little. Conclusion The endoscopy treatment for isolated gastric varices 1 with tissue glue and metal clips is contributed to clinical effect, and the treatment provides a reference for clinical treatment.
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Many applications of wireless sensor networks can benefit from fine-grained localization. In this paper, we proposed an accurate, distributed localization method based on the time difference between radio signal and sound wave. In a trilateration, each node adaptively chooses a neighborhood of sensors and updates its position estimate with trilateration, and then passes this update to neighboring sensors. Application examples demonstrate that the proposed method is more robust and accurate in localizing node than the previous proposals and it can achieve comparable results using much fewer anchor nodes than the previous methods.