ObjectivesTo explore the association between liver dysfunction and premature birth (PTB).MethodsA prospective cohort of HBV-infected or uninfected pregnant women of Han nationality attending antenatal care at Nantong Maternal and Child Health Hospital was recruited from January 1st, 2012 to June 30th, 2016. Liver function tests (LFTs) were monitored through pregnancy. Robust Poisson regression was used to estimate adjusted risk ratios (RRs) on HBV infection and LFT abnormalities.ResultsAmong 35 452 pregnant women (1 073 HBV carriers and 34 379 non-HBV women), 4 266 (12.03%) had at least one instance of abnormal LFT results. One fold upper limit of normal aspartate aminotransferase (AST), two folds upper limit of normal total bilirubin, and four folds upper limit of normal total bile acid rather than HBsAg positivity, were identified as independent risk factors for PTB by Robust Possion regression analysis.ConclusionsAbnormal LFTs among pregnant women is an independent risk factor of PTB. We suggest monitoring the LFTs results of high-risk population throughout pregnancy.
ObjectiveTo discuss the diagnosis and endoscopic therapy of pancreaticobiliary maljunction by multidisciplinary team (MDT).MethodThe preoperative MDT discussion and the diagnosis and treatment process of patient with pancreaticobiliary maljunction in the Fifth People’s Hospital of Zunyi in 2019 were summarized.ResultsThe patient was admitted for “upper abdominal pain approximately 10 h”. The obvious extramural confluence of the pancreaticobiliary tract was observed and the length of common channel was approximately 1.8 cm. But the junction of the pancreaticobiliary tract was obviously controlled by the sphincter of Oddi, and the amylase value of the bile was higher than that of the serum. After the MDT discussion, there were still doubts about the diagnosis of pancreaticobiliary maljunction or high confluence of pancreaticobiliary ducts. After the left hepatic lateral lobectomy and exploration of common bile duct, the amylase value of bile, which was collected by the T-tube, was still obviously increased. Then the endoscopic sphincterotomy was performed, the amylase value of the bile decreased obviously and no abnormality was found in the follow-up for half a year after discharge.ConclusionsConcept and diagnostic criteria of “Japanese clinical practice guidelines for pancreaticobiliary maljunction” are conflicting and inaccurate. Severity of pancreaticobiliary reflux and change of amylase value of bile might have a more important diagnostic value. Endoscopic sphincterotomy might be suitable for a few special types of pancreaticobiliary maljunction.
Object To evaluate the significance of double common bile duct （DCBD） in hepatobiliary surgery. Metheds The data of diagnosis and treatment of two patients with DCBD in our hospital between Jul. to Dec. 2010 were analyzed retrospective， and the related literatures were reviewed. Results The right hepatic bile duct of DCBD due to mistaking it for cystic duct in 1 case was accidental injuried during laparoscopic cholecystectomy. Another example，the DCBD was confirmed by intraoperative exploration and choledochoscopic examination， at the same time with chole-dochal cyst， anomalous pancreaticobiliary ductal junction （APBDJ）， primary hepatolithus， and choledocholith， and then operation was performed. Two cases were typeⅤb of DCBD. A total of 32 English literatures were reviewed. Since the beginning of 1932 English literature had reported 100 cases of DCBD. The type Ⅱand typeⅢwere the most common type of DCBD， and the typeⅤonly 10 cases. There were 27 cases of DCBD in twenty-five Chinese articles from 1994 to 2012. The typeⅤwas the most common type of DCBD. The accessory common bile duct （ACBD） opening in the duod-enum， gastric， and pancreatic duct were the most common. The common complications included stone， APBDJ， choled-ochal cyst， tumor etc. Conclusions DCBD is a very rare anatomic variation of extrahepatic bile duct， often accompanied by calculus of bile duct and common bile duct cyst， APBDJ， and other biliary anatomy abnormality， and potentially carci-nogenic potential. The existence of DCBD may increase the risk of iatrogenic bile duct injury and complexity of biliary operation. In view of this， this abnormality of extrahepatic duct should be paid with close attention during operation.
Exercise prescription is an effective tool for the prevention and control of hypertension, diabetes and dyslipidemia. However, a full set of exercise prescription is difficult to be implemented in China's primary medical institutions and community public health service centers. Therefore, under the support of the theoretical system of exercise prescription and the standard development norms, this clinical pathway of exercise prescription is developed according to the characteristics of national physical fitness and the status quo of primary healthcare institutions in China, aiming at simplifying the process of exercise prescription development, reducing the professional threshold, empowering primary healthcare, and providing a scientific and feasible solution for the promotion of exercise prescription in primary healthcare institutions.
目的：了解有症状冠状动脉异常患者的临床特点和预后。方法：搜集1999年11月~2005年10月期间，因胸痛在心导管室行冠状动脉造影的病例，分析冠状动脉异常患者所占构成比，对该类患者进行随访，分析其临床特点及临床终点事件(死亡、心脏猝死、心肌梗死以及血运重建等)的发生情况。结果：在研究期间，共2003例胸痛患者进行了冠状动脉造影，74例患者有冠状动脉异常(构成比3.7%)，包括心肌桥54例、冠状动脉瘘16例、冠状动脉异常起源3例、单支冠状动脉1例。其中23名冠状动脉异常患者伴发有严重的冠状动脉粥样硬化病变或主动脉瓣病变。对无上述伴发疾病的冠状动脉异常患者进行随访，在随访期内(平均随访40月)，与冠状动脉正常患者相比，该类患者临床终点事件发生率无差异。结论：在有胸痛症状行冠状动脉造影的患者中，冠状动脉异常的构成比较低。该类患者的临床预后近似于冠状动脉正常患者。
Congenital heart disease (CHD) is a series of structural cardiac abnormalities resulting from abnormal fetal heart development. With the prolongation of survival time, their cognitive function problems begin to be concerned. From fetus period to adulthood, people with complex CHD are more likely to have abnormalities in brains. Children with complex CHD have a significantly increased risk of developmental disorders in cognitive functions, such as intelligence, attention and psychosocial disorders. These diseases persist into their adulthood. Adults with CHD have earlier neurocognitive decline, poorer performance in intelligence, executive function, attention and academic achievement, and are more likely to have mood disorders, higher incidence of mental disorders and lower quality of life. This paper reviews the studies on cognitive function of adult patients with CHD from the dimension of the whole life cycle.