ABSTRACT
Objective To investigate the death of MHD patients with different blood phosphorus variability.Methods The clinical data of seventy-four cases of MHD patients with more than 3 months dialysis age in the hemodialysis center of Chaozhou Central Hospital from January 2014 to December 2016 were retrospectively analyzed.The general data and laboratory biochemical indexes were collected and according to the difference in coefficient of variation (CV),the patients were divided into two groups:high blood phosphorus variability group (CV≥0.226 mmol/L) and low blood phosphorus variability group (CV ＜0.226 mmol/L).The relationship between the coefficient of variation and all-cause mortality and cardiovascular mortality in MHD patients was analyzed.Results Among all selected patients,all-cause mortality rate was 22.9％ (17/24),12.2％ (9/74) died of cardiovascular disease,and the all-cause mortality 34.2％ (13/38)in the high blood phosphorus variability group was significantly higher than that in the other one1 1.1％ (4/36) (x2=5.574,P＜0.05);but there was no significant difference between the two groups in cardiovascular disease mortality (X2 =0.962,P＞0.05).And there was no significant difference between the serum phosphorus standard group and the substandard group in the all-cause mortality and the cardiovascular disease mortality (x2 =0.389,0.065,P ＞ 0.05).There was no significant difference in the cumulative survival rate between the patients in the serum phosphorus standard group who experienced all-cause death and cardiovascular disease death and the patients in the substandard group (P＞0.05).In the high blood phosphorus variability group,patients who reached serum phosphorus standard had higher total mortality rate and cardiovascular disease mortality rate,compared with patients who achieved serum phosphorus standard or experienced low phosphorus deficiency in the low blood phosphorus variability group (x2=0.211,0.197,P ＞0.05).Kaplan/Meier analysis showed that the cumulative survival rates of all patients with all-cause death and cardiovascular death in the high blood phosphorus variability group were significantly lower than those in the low level group (P＜ 0.05).Conclusion All-cause mortality and cardiovascular disease mortality are high in MHD patients with large variability in blood phosphorus,and the degree of blood phosphorus variation is helpful to predictthe death of MHD patients.
ABSTRACT
Objective To study the relationship between the washout speed in the contrast-enhanced ultrasound (CEUS) and the differentiation grading in pathology in patients with hypervascular hepatocellular carcinoma (HCC).Methods Totally 271 patients who underwent complete resection for hypervascular HCC from April 2009 to December 2014 at Nanchong Central Hospital were included in this study.CEUS examinations were perfomred in all patients 2-3 days before liver resection.A timer on the ultrasound screen displayed the time elapsed since the saline flush was used to determine time to washout.The washout rate were categorized into four levels based on enhancement in portal venous phase and delayed phase.The differentiation grade and the washout speed were compared using Kruskal-Wallis test.Results All 271 (100％) lesions were arterially enhanced with different washout rate.Washout speed 1 was found in 19 patients (7.0％),while speed 2 in 157 patients (57.9％),speed 3 in 65 (24.0％),and speed 4 in 30,respectively.The washout speed had a significant correlation with the differentiation (x2=179.8238,P ＜ 0.001).The faster washout speed,the higher differentiated.Washout speed 1 could distinghuish well-differentiated from the poor and moderately differentiated tumor.The sensitivity and specificity of preoperative washout speed 1 to identify well histologic grade were 98.0％ and 77.8％,the positive predictive value and negative predictive value were 96.0％ and 48.8％,and the positive likelihood ratio and negative likelihood ratiowere were 1.9 and 0.01.Washout speed 4 could distinghuish poor differentiated from well and moderately differentiated tumor The sensitivity and specificity of preoperative washout speed 4 to identify poor histologic grade were 24.3％ and 97.0％,the positive predictive value and the negative predictive value were 65.3％ and 61.3％,and the positive likelihood ratio and negative likelihood ratiowere were 3.2 and 0.7.Conculsions Washout speed can reflect the degree of differentiation roughly.Washout speed can effectively diagnose the well-differentiated HCC,but it is difficult for moderate and poor differentiated HCC.