ABSTRACT
Objective:To investigate the esophageal microecology in patients with esophageal carcinoma (EC), and to compare the difference in esophageal flora between patients with esophageal cancer and healthy people.Methods:From July 2018 to July 2019, at Taihe Hospital, 82 EC patients and 20 age-and gender-matched healthy controls during the same period were selected. The pathology of EC were divided into poorly differentiated (8 cases), moderately differentiated (9 cases) and well differentiated cancers (13 cases) according to the degree of differentiation. The esophageal tissue samples of EC patients and healthy individuals were collected. Sample DNA was extracted and the V4 region of bacterial 16S rRNA was amplified by polymerase chain reaction (PCR). Sequencing was performed by lllumina HiSeq 4000 sequencing platform. Alpha-diversity analysis and principal co-ordinates analysis (PCoA) were performed, and linear discriminant analysis (LDA) of linear discriminant analysis effect size (LEfSe) was used to screen different species. The random forest model was verified by receiver operating characteristic (ROC) curve and the esophageal bacterial phenotype was predicted by BugBase database. Non-parametric Kruskal-Wallis H test and Wilcoxon rank sum test were used for statistical analysis. Results:The Chao1 index of the EC patients was higher than that of healthy controls (362.51(284.29, 646.13) vs. 284.83(244.31, 344.74)), and the difference was statistically significant ( Z=-2.857, P=0.004). The results of PCoA showed that the distance between samples of EC patients and healthy control samples was relatively close, and there was no significant difference in the composition of microecology between the two groups ( P>0.05). The abundance of esophageal Cyanobacteria and Verrucomicrobia of EC patients were both higher than those of healthy controls (0.2% vs. 0.1%, 0.4% vs. 0), while the abundances of esophageal Proteobacteria, SR1 and TM7 phylum of EC patients were lower than those of healthy controls (21.9% vs. 34.2%, 0.1% vs. 0.2%, 0.2% vs. 0.5%), and the differences were statistically significant ( Q=0.090, 0.077, 0.010, 0.026 and 0.001, all P<0.05). The abundances of Clostridia, Elostridiales, Pasteurella, Pasteurellaceae, Eikenella, Actinobacillus and Haemophilus in poorly differentiated patients, moderately differentiated and higher differentiated patients were 28.3%, 24.2% and 17.0%, 28.3%, 24.2% and 17.0%, 3.2%, 0.3% and 5.0%, 3.2%, 0.3% and 5.0%, 0, 1.5% and 0.1%, 0.5%, 0 and 0.7%, 1.3%, 0.2% and 3.9%, respectively, and the differences were statistically significant ( Q=0.579, 0.557, 0.390, 0.711, 0.768, 0.768 and 0.768, all P<0.05). LEfSe analysis showed that the abundances of Fusobacterium, Ruminococcus, Odorbacterium and S24_7 of EC patients were higher than those of healthy controls (21.5% vs. 11.7%, 0.5% vs. 0.1%, 0.1% vs. 0 and 0 vs. 0), and the differences were statistically significant (LDA=2.591, 2.379, 2.790 and 2.927, all P<0.05). The ROC curve confirmed that the random forest model was reliable and the AUC value was 0.92. BugBase database phenotypic prediction showed that the phenotype of esophageal bacteria related to biofilm formation, pathogenic potential, mobile elements, oxygen demand (aerobic, anaerobic and facultative bacteria), and oxidative stress tolerance of EC patients were more abundant than those of healthy controls (all P<0.05). Conclusions:The esophageal flora of patients with esophageal cancer has changed. Fusobacterium, Ruminococcus, Odoribacterium and S24_7 may be potential biomarkers of esophageal flora.
ABSTRACT
The paper described efforts made by Guangdong province to achieve a goal of the healthcare reform Serious diseases can be treated within the county.In this reform,the province attempts such operation mechanisms as autonomous type,guided type and trusted type for the purpose of elevating the service capabilities of county-level public hospitals.To this end,four independent operation mechanisms have also been built for talent development,remuneration incentive,specialty development,and cost control.All these efforts aim at encouraging the hospitals to improve service capability and quality.
ABSTRACT
Objective This retrospective study is to analysis the special medical conditions that most Chinese secondary hospitals are facing with,and to review the safeguards and pitfalls for arterial switch operations,in order to probe intothe feasibility of this procedure for Chinese secondary hospitals and provide our experiences to help other surgeons to avoid pitfalls on complex procedures.Methods Between January 2006 and December 2011,totally 21 newborns and infants with TGA/VSD and TGA/IVS underwent arterial switch operation.There were 15 males and 6 females.In the TGA/VSD group,there were 16 cases,ranging from 30 days to 1 year at surgeries,and weight from 3.4-8.5 kg with average of (5.33 ± 1.42) kg.In the TGA/IVS group,there were 5 cases,ranging from 13 days to 1 month at surgeries,and weight from 3.1-5.5 kg with average of (3.75 ± 1.17)kg.All patients underwent one stage of arterial switch operation.Routine follow-up checking points are set at discharging,3 months,half year and every year after operation.Results The early death rate is 9.5％ (2/21),and the reexploration rate is 9.5％ (2/21).In the TGA/VSD group,average cardiopulmonary bypass time is (151 ± 33) minuntes with the aortic crossclamp time is (1 19 ± 26) minutes.Ventilator support time is 24-159 hours,and the length of ICU stay is 3-17 days.1 case has residual VSD with the diameter less than 2 mm.The pulmonary flow velocity in 2 cases increase mildly to 2.0 m/s and 2.2 m/s,and another 2 cases increase severely to 3.1 m/s and 3.7 m/s.The aortic flow velocity in 3 cases increase to 2.0m/s.ECG instructs no case has myoinfarction signs.In the TGA/IVS group,average cardiopulmonary bypass time is (170 ± 52) minuntes with the aortic crossclamp time is (137 ± 48) minutes.Ventilator support time is 51-144 hours,and the length of ICU stay is 4-14 days;The pulmonary flow velocity in 2 cases increase mildly to 2.0 m/s.The aortic flow velocity in 1 cases increase to 2.0 m/s.ECG instructs no case has myoinfarction signs.Conclusion Unbalanced medical resources distribution causes significant differences between heart centers and the secondary hospitals in China,especially on the complex congenital heart diseases procedures.However,with relatively solid background on correction of the simple congenital heart diseases,the Chinese secondary hospitals can still perform arterial switch operation with satisfactory mortality and morbidity,and provide more prompt medical services for more population.
ABSTRACT
Objective To investigate the application value of the combined detection of the serum levels of tumor-associated car-bohydrate antigen 125(CA125) and human epididymis epithelial secretory protein 4 (HE4) in the diagnosis and the differentiation diagnosis of ovarian cancer .Methods Serum levels of CA125 and HE4 in 51 patients with ovarian cancer ,37 patients with benign ovarian tumor and 40 healthy females as the healthy control group were measured by chemiluminescent immunoassay (CLIA) and enzyme linked immunosorbent assay(ELISA) respectively .The detection results combined with the clinical data were performed the statistical analysis .Results The serum levels of CA125 and HE4 in the ovarian cancer group were significantly higher than those in the benign ovarian tumor group and the healthy control group (P<0 .01) .Serum concentration in the stage Ⅲ - Ⅳwere higher than that in the stage Ⅰ - Ⅱ(P<0 .01) .In the combined detection of HE4 and CA125 ,the sensitivity ,specificity and accuracy for diag-nosing ovarian cancer were 84 .6% ,83 .9% and 89 .4% respectively .Their sensitivity and accuracy were higher than those of any single marker detection ,the specificity was consistent with that in the single CA 125 detection .Conclusion The combined detection of serum CA125 and HE4 is conducive to increase the diagnosis efficiency and has certain application value in the differential diag-nosis of benign and malignant ovarian tumor .
ABSTRACT
Related researches found that there exist relative specific microRNA (miRNA) expression patterns in the blood or urine of patients with tumor,and miRNA in the blood and urine are stable and reproducible.Therefore,miRNA can serve as non-traumatic biological markers for the early diagnosis,individualized treatment,prognosis monitoring or follow-up of cancer.
ABSTRACT
Let-7 is found to be downregulated in lung cancer while many kinds of oncogenes expression always increase, and restoration of the let-7 to normal expression level inhibits lung cancer growth evidently.Thus, let-7 might serves as good targets or effective interference tools in exploration of anticancer therapeutics,and has a good prospect in applying it in the early diagnosis, prognosis and therapy in lung cancer.
ABSTRACT
Objective To analyze the clinical features in multiple myeloma(MM)patients, and the summaries the treatment effect of different therapies. Methods The clinical initial symptoms, laboratory data,clinical efficacy of treatment with MP, M2, VAD, BD,T hal + DEX and other chemotherapy in 120 patients newly diagnosed with multiple myeloma were retrospectively analyzed. Results Among 120 MM cases,the incidence peak was situated in 40 - 60 years age group, the mean age at oneset was 54 years, which indicated that the onset age were getting younger in China. Bone pain, anemia, infection were the most common initial symptoms of MM. In terms of clinical efficacy:①Significant difference between MP and VAD programs(χ2 = 10. 626,P ＜0. 05＝,but no significant difference between MP and M2 programs(χ2 = 2. 439, P ＞ 0. 05), MP and Thal + DEX programs(χ2 = 5. 870, P ＞0. 05. ②Significant difference between M2 and VAD programs(χ2 = 8. 307, P ＜ 0. 05＝; No significant difference between M2 and Thal + DEX programs(χ2 = 2. 592, P ＞ 0. 05). ③ No significant difference between VAD and Thal +DEX programs(χ2 =0. 916,P＞ 0. 05). ④BD program is the most efficient program,but this discovery need further confirmation because of the small number of cases observed. Conclusions At present, chemotherapy is the main treatment for MM, most scheme like MP, M2, VAD, BD, etc. , have certain effect depend on different patient groups but remain improving. The choice of appropriate chemotherapy and autologous or allogeneic hematopoietic stem cell transplantation will help to improve the prognosis of the disease.
ABSTRACT
Objective To explore the correlation between psychosomatic health and depressive symptoms among university students. Methods Using a stratified random sampling method we selected 1197 students from a university in Wuhan and adopted the 21 - item Beck Depression Inventory (BDI) together with a self - designed questionnaire for assessment and data collection. We received completed questionnaires from 1179 students (432 male and 747 female students). We computed the contingency frequency of study variables and examined risk factors for depressive symptom using conditional logistic regression. Results We observed about 30.27% of the young students with depressive symptoms, and 24.34% , 5.0% and 0.93% of them had a mild, modest and severe depressive symptom, respectively. The rate in female students was slightly higher than that in male students (31.86% vs 27.55%). We compared variables such as sex, study year, speciality and liveplace of family with the BDI scores by Chi - square Test, but there was not significant difference. We performed a part of multivariate logistic regressions and adjusted with sex, study year, liveplace of family and singlechild. We found that significant associated risk factors with depressive symptoms included parent(s) with diagnosed psychiatric illness(OR =2.38, P
ABSTRACT
Objective: To summarize the experience of valve replacement for multiple valve insufficiency in patients with giant left ventricle and the operative indication. Methods: Multiple valvular operations were performed in 62 patients with giant left ventricle between 1991 and 2002. Combined mitral and aortic valve replacement was performed in 56, tricuspid valve annuloplasty in 43, left atrium placation surgery in 12, and mitral valve replacement in 5. Results: The early postoperative complication and mortality rate were 45.2% and 17.7%, respectively .The late mortality rate was 6.5%. The main factors influencing the early surgical results were preoperative severe left ventricular enlargement (ESD ≥6.0cmand EDD ≥8.0cm) and systolic dysfunction (EF ≤0 40 and FS ≤0 25), perioperative ventricular fibrillation, postoperative low cardiac output and multiple organal failure. The main factors affecting long term survival were postoperative severe ventricular arrhythmia and left ventricular enlargement with depressed systolic performance. Conclusion: The keys to improve the early and late results of multiple valve replacement in these patients with giant left ventricle are the choice of optimum surgical timing, the proper management of the high risk factors mentioned above during perioperative and follow up periods.
ABSTRACT
Objective: To evaluate the effect of open-chest surgery for cancer patients in advanced stage, in aged and with respiratory insufficiency. Methods: From May 1992 to December 2002, 637 patients with lung cancer underwent thoracotomy in out hospital. 118 of the 637 patients fit in with the standards of advanced, aged or respiratory insufficiency. RVEF was consecutively assessed in 118 before pulmonary resection by echocardiography. According to right ventricular function, the 118 patients were dicided into group A(n=77, RVEF
ABSTRACT
<p><b>BACKGROUND</b>To evaluate the preoperative right ventricular ejection fraction (RVEF) as a predictor of postoperative complications after lung resection.</p><p><b>METHODS</b>RVEF was consecutively assessed in 254 patients before pulmonary resection by echocardiography. According to preoperative right ventricular function, the patients were divided into: group Ia (n=82, RVEF≥45%), group Ib (n=92,RVEF < 45%), group Ic (n=42, RVEF < 40%),and group Id (n=38, RVEF≤35%). Postoperative RVEF was detected again in 122 patients 3 weeks later after lung resection.</p><p><b>RESULTS</b>Preoperative RVEF of patients with postoperative complications was significantly higher than that of patitents without postoperative complications (P < 0.001). Among group Ia, Ib, Ic, and Id, there were significant differences in postoperative morbidities (P < 0.005). Patients with a preoperative RVEF less than 40% had a higher incidence of complications than those with RVEF over 40% (P < 0.005). Of the 122 patients, postoperative RVEF was remarkably lower than preoperative RVEF (P < 0.01).</p><p><b>CONCLUSIONS</b>The preoperative RVEF may be a predictor of postoperative complications for lung resection. RVEF higher than 40% is considered as a safe range for pneumonectomy.</p>
ABSTRACT
Objective To investigate the characteristics and patterns of lymph node metastasis in lung cancer and to provide evidence for determining the range of lymph node dissection.Methods One hundred and eighteen patients with lung cancer received complete resection combined with systematic lymph node dissection according to the mapping system developed by Naruke.Results A total of 835 lymph nodes were dissected from 118 lung cancer patients.The positive ratios of N1 and N2 were 15.6% and 17.4% respectively.Fifteen patients were found with skipping N2 which were located in 2,4,5,6 and 7 lymph node groups respectively.There was no significant relationship between the size of primary tumor and lymph node metastasis.Small cell lung cancer showed the highest risk of lymph node metastasis.The metastatic rate of lymph node in adenocarcinoma was markedly higher than that of squamous cell carcinoma.Skipping mediastinal lymphatic metastasis was found more frequently in lower lobar tumors than that in upper lobar ones.Conclusion Lymph node metastasis of lung cancer may occur in multiple groups and regions,even in a skipping pattern.Systematic lymph node dissection may be routinely performed in pulmonary resection for lung cancer.
ABSTRACT
Objective To summarize the modern treatment of rectal cancer(RC). Methods A literature review was made on the modern therapy of RC. Results Pre-and post-operative chemotherapy and radiotherapy, mesorectal resection, and low RC resection and anastomosis using anastomat to preserve the anus could improve the resection rate, 5-year survival rate and life quality in patients with RC, as wall as could reduce recurrence rate of RC after resection. Conclusions Pre-and post-operative chemothapy and radiotherapy, mesorectal resection, anastomat application are the ideal treatment for rectal cancer nowadays.