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BACKGROUND: Chronic heart failure (CHF) is one of the most common cardiovascular diseases, which has caused huge economic burden worldwide. Wulingsan modified formulas have been historically used for CHF in China. However, the efficacy of its treatment for CHF has not been summarized by scholars and lacks of clinical evidence. This study aimed to assess the efficacy and safety of Wulingsan modified formulas for patients with CHF. METHODS: A comprehensive literature search was performed in the PubMed, EMBASE, Cochrane Library, Web of Science, Medline (Ovid), China National Knowledge Infrastructure, WanFang, China Science and Technology Journal Database, and SinoMed databases from the date of their inception up to 1(st) November, 2021. Only randomized controlled trials evaluating Wulingsan modified formulas in patients with CHF were included. The primary outcome of this study was efficacy of Wulingsan modified formulas in the treatment of CHF, and the secondary outcomes included brain natriuretic peptide, left ventricular ejection fractions, and any other changes in the patients’ condition. The risk ratio was applied to evaluate efficiency, and the weighted mean difference (WMD) and 95% confidence interval (CI) were used to merge the continuous variables. The I(2) statistic was used to assess the heterogeneity. Sensitivity analysis was used to evaluate whether the single research affected the whole results. Data were extracted by two independent investigators. The Cochrane Risk of Bias tool (version 2.0) was utilized to evaluate the included studies, STATA (version 15.0) was applied for sensitivity analysis, and RevMan 5.3 software was used to conduct the systematic review and meta-analysis. RESULTS: Nineteen studies with a total of 1,631 were included in this meta-analysis. The meta-analysis results were as follows: efficiency, the risk ratio =1.21, 95% CI: 1.15, 1.27; brain natriuretic peptide, WMD =−269.14, 95% CI: −349.25, −189.04; and left ventricular ejection fractions, WMD =8.80, 95% CI: 5.93, 11.68. All of these findings were statistically significant. No statistically significant adverse events were reported in the included articles. DISCUSSION: Wulingsan modified formulas are a reasonable and relatively safe adjuvant therapy for the treatment of CHF.

Background: Whether standard lymphadenectomy or extended lymphadenectomy should be performed is still under debate during pancreaticoduodenectomy (PD). We aimed to compare their morbidity and mortality rates among patients with pancreatic head cancer (PHC). Material and methods: In this retrospective study, a total of 322 patients were enrolled. According to the scope of intraoperative lymph node dissection, patients were divided into extended lymphadenectomy group (n=120) and standard lymphadenectomy group (n=202). Based on the resectability of the tumor, there were 198 cases of resectable PHC and 124 cases of boardline resectable PHC, respectively, in which further stratified analysis was carried out according to the extent of lymph node dissection.Results: All patients completed the operation successfully, with a perioperative morbidity rate of 27.9% and mortality rate of 0.9%. As for the overall patients, patients in the extended lymphadenectomy group had higher NLR, longer operation time, more intraoperative blood loss, lymph node dissection and patients with BRPHC. (PConclusions: Patients with BRPHC tended to have vast lymph node metastasis. Extended lymphadenectomy can improve their long-term survival.

Background: Patients with chronic pancreatitis (CP) have an increased risk of developing pancreatic cancer (PC). The purpose of this study was to identify predictors of PC in CP patients. Methods: Electronic medical records (EMRs) of CP patients from two cohorts were collected, and a logistic regression analysis was performed to investigate the risk factors for PC. Subsequently, we validated the value of the risk prediction model with the EMRs of a third cohort. Results: The derivation cohort consisted of 2,545 CP patients, and among them, 14 patients developed PC 7 years after CP diagnosis. Cyst of the pancreas [COP; odds ratio (OR): 4.37, 95% confidence interval (CI): 1.11 to 18.40, P=0.033], loss of weight (LW; OR: 3.21, 95% CI: 0.76 to 12.91, P=0.096) and high platelet (PLT) count (OR: 1.01 per 1 increment, 95% CI: 1.00 to 1.01, P=0.042) were independent risk factors for PC among CP patients. A risk prediction equation was constructed as follows: ln[p/(1–p)] = –6.68 + 1.55COP + 1.23LW + 0.0046PLT. The areas under the receiver operating characteristic (ROC) curve of our risk score were 0.83 and 0.72 in the derivation and validation cohorts, respectively. A score >0.0128 and >0.0122 had the best balance between sensitivity and specificity in the derivation and validation cohorts, respectively. Conclusions: In CP patients, LW, COP and high PLT count were identified as novel predictors of PC. A risk prediction model based on these factors exhibited moderate predictive value for CP patients.

BACKGROUND: The present study aimed to analyze the scar formation mechanism following Roux-en-Y choledochojejunostomy (CJS) in a novel rat model of obstructive jaundice. METHODS: The biliary obstruction model of Sprague-Dawley (SD) rats was established in advance, and 24 rats were randomly divided into 4 groups (control group, 1-day ligation group, 3-day ligation group, and 5-day ligation group). Changes in postoperative weight, common bile duct diameter, and laboratory indexes were analyzed to determine the best operation time. Roux-en-Y CJS in rats was studied based on the model, and the rats were randomly divided into 4 groups [control group, 3-day choledochojejunostomy (CJS) group, 7-day CJS group, and 30-day CJS group]. The same indexes were analyzed, and the characteristics of scar formation were evaluated by histopathology and polymerase chain reaction examination. RESULTS: The third day after common bile duct ligation is the best time for a Roux-en-Y CJS. The common bile duct diameter expands to 4.2 mm on average, and these physiological characteristics are consistent with current standard clinical findings. After completing CJS, the rats’ weight returned to normal levels, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), direct bilirubin (DB), and C-reactive protein (CRP) indexes gradually decreased (P

Background Liver transplantation (LT) is a life-saving treatment for patients with end-stage liver disease and acute liver failure. However, in-hospital death cannot be avoided. We designed this study to analyze patients' in-hospital mortality rate after LT and the factors correlated with in-hospital death. Methods The data of patients who received LT in our hospital between January 11, 2015, and November 19, 2019, were obtained from the China Liver Transplant Registry and medical records. The in-hospital mortality rate was calculated, and factors related to mortality, cause of death, and factors related to cause of death were analyzed by reviewing patients' data. Results A total of 529 patients who underwent cadaveric LT were enrolled in this study. Modified piggyback orthotopic LT was performed for all patients. Seventy patients died in the hospital after LT, and the in-hospital mortality rate was 13.2%. Factors including model for end-stage liver disease (MELD) score, Child-Pugh grading, intraoperative blood loss, and anhepatic phase were correlated with in-hospital death. MELD score and intraoperative blood loss were determined as the two independent risk factors of in-hospital death. The first two causes of death were infection (34.3%) and primary non-function (15.7%). Pulmonary fungal infection was the main cause of infectious death. MELD score was the independent risk factor for infectious death, and both body mass index of donors and cold ischemic time were independent risk factors of primary non-function. Conclusions In-hospital death poses a threat to certain patients undergoing LT. Our study suggests that the main cause of in-hospital death is an infection, followed by primary non-function.