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Objective: To compare the prognostic value of 3 diagnostic criteria of bronchopulmonary dysplasia (BPD) in preterm infants with gestational age<32 weeks. Methods: The retrospective cohort study was conducted to collect the clinical data of 285 preterm infants with BPD admitted to the Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University from January 2019 to September 2021, who were followed up regularly after discharge. The primary composite adverse outcome was defined as death or severe respiratory morbidity from 36 weeks of corrected gestational age to 18 months of corrected age, and the secondary composite adverse outcome was defined as death or neurodevelopmental impairment. According to the primary or secondary composite adverse outcomes, the preterm infants were divided into the adverse prognosis group and the non-adverse prognosis group. The 2001 National Institute of Child Health and Human Development (NICHD) criteria, 2018 NICHD criteria, and 2019 Neonatal Research Network (NRN) criteria were used to diagnose and grade BPD in preterm infants. Chi-square test, Logistic regression analysis, receiver operating characteristic (ROC) curve and Delong test were used to analyze the prognostic value of the 3 diagnostic criteria. Results: The 285 preterm infants had a gestational age of 29.4 (28.1, 30.6) weeks and birth weight of 1 230 (1 000, 1 465) g, including 167 males (58.6%). Among 285 premature infants who completed follow-up, the primary composite adverse outcome occurred in 124 preterm infants (43.5%), and the secondary composite adverse outcome occurred in 40 preterm infants (14.0%). Multivariate Logistic regression analysis showed that severe BPD according to the 2001 NICHD criteria, gradeⅡand Ⅲ BPD according to the 2018 NICHD criteria and grade 2 and 3 BPD according to the 2019 NRN criteria were all risk factors for primary composite adverse outcomes (all P<0.05). ROC curve showed that the area under the curve (AUC) of the 2018 NICHD criteria and 2019 NRN criteria were both higher than that of the 2001 NICHD criteria (0.70 and 0.70 vs. 0.61, Z=4.49 and 3.35, both P<0.001), but there was no significant difference between the 2018 NICHD and 2019 NRN criteria (Z=0.38, P=0.702). Multivariate Logistic regression analysis showed that the secondary composite adverse outcomes were all associated with grade Ⅲ BPD according to the 2018 NICHD criteria and grade 3 BPD according to the 2019 NRN criteria (both P<0.05). ROC curve showed that the AUC of the 2018 NICHD criteria and 2019 NRN criteria were both higher than that of the 2001 NICHD criteria (0.71 and 0.71 vs. 0.58, Z=2.93 and 3.67, both P<0.001), but there was no statistically significant difference between the 2018 NICHD and 2019 NRN criteria (Z=0.02, P=0.984). Conclusion: The 2018 NICHD and 2019 NRN criteria demonstrate good and comparable predictive value for the primary and secondary composite adverse outcomes in preterm infants with BPD, surpassing the predictive efficacy of the 2001 NICHD criteria.
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Infant , Male , Child , Infant, Newborn , Humans , Infant, Premature , Bronchopulmonary Dysplasia/complications , Prognosis , Retrospective Studies , Gestational AgeABSTRACT
Objective:To compare the results of clinical diagnosis and severity grading in preterm infants with bronchopulmonary dysplasia (BPD) using three different diagnostic criteria and the consistency of two new diagnostic criteria.Methods:From January to December, 2020, infants with gestational age <32 w admitted to neonatal intensive care unit of our hospital were retrospectively enrolled in this cohort study. The patients were diagnosed and graded according to the 2001, 2018 and 2019 criteria of BPD. Chi-square test was used to compare the differences of BPD diagnostic rate and mortality rate using three criteria and Kappa coefficient test was used to compare the consistency between the two new criteria of 2018 NICHD and 2019 NRN.Results:A total of 231 preterm infants were enrolled, including 130 males (56.3%) and 101 females. 9 patients were dead. According to 2018 NICHD criteria, 97 cases (42.0%) were diagnosed with BPD, including 16 gradeⅠ, 44 grade Ⅱ, 31 grade Ⅲ and 6 grade ⅢA. The remaining 134 cases were not BPD (58.0%). No significant differences existed ( P>0.05) among the diagnostic rates of 2001 criteria (112/231, 48.5%), 2018 criteria (97/231, 42.0%) and 2019 criteria (91/231, 39.4%). For grade Ⅲ BPD, the diagnostic rate of 2001 criteria was significantly higher than the 2018 criteria (including grade Ⅲ and grade ⅢA, 16.0%) and 2019 criteria (6.5%) and the diagnostic rate of 2018 criteria was also significantly higher than 2019 criteria ( P<0.05). No significant differences existed in the overall mortality rate of BPD among three criteria ( P>0.05), however, the case mortality rate of grade Ⅲ BPD of 2001 criteria (3.9%) was significantly lower than 2018 criteria (24.3%) and 2019 criteria (20.0%) ( P<0.05). The 2018 and 2019 criteria were highly consistent in the overall diagnostic rate of BPD (Kappa value = 0.946), the positive consistency rate was 93.8% (95% CI 85.5%~97.5%) and the negative consistency rate was 100.0% (95% CI 96.5%~100.0%). But the consistency of severity grading for BPD was weak (Kappa value = 0.597) between the two criteria. Conclusions:The 2001 NICHD BPD criteria is no longer valid because it tends to overdiagnose severe BPD, thus underestimate the case mortality. The 2018 NICHD criteria is comprehensive and detailed and the 2019 NRN criteria is simple and practical. The two new criteria are highly consistent in the overall diagnosis of BPD, but the consistency of severity grading is weak.
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Objective:To explore the feasibility of technological modification and innovation of full-left/full-right liver splitting in situ for donors and examine the safety of clinical application for liver transplantation (LT).Methods:From March 2021 to June 2022, clinical and surgical data are retrospectively reviewed for 27 donors undergoing full-left/full-right liver splitting in situ and the corresponding 49 recipients undergoing full-left/full-right LT.According to the split liver technique used in donor liver surgery, they are divided into conventional split group(group A, 13 cases)and innovative split group(group B, 14 cases). The corresponding recipients are divided into two groups of recipient C(25 cases)and recipient D(24 cases). General profiles, intraoperative findings, type of vascular allocation and short-term outcomes in two groups are compared.After full-size split liver transplantation(fSLT), follow-ups continued until the end of September 2022.Results:There are 23 males and 4 females in donors.The causes of mortality for donors are traumatic head injury(12 cases)cerebrovascular accident(13 cases)and anoxia encephalopathy(2 cases). Baseline characteristics of two groups indicate that body weight and body mass index(BMI)are higher in group B and blood sodium level is lower than that in group A( P<0.05). No statistical differences exist for the others.Liver splitting time is significantly shorter in group B than that in group A(175 vs.230 min, P=0.022). No significant inter-group difference exists in type of vascular allocation.Retrohepatic inferior vena cava(IVC)is split in one case in group A and 10 cases in group B( P=0.001). Among 20 cases of right hemiliver requiring a reconstruction of segment Ⅴ/Ⅷ venous outflow, 12 cases in group A and 3 cases in group B are reconstructed with conventional independent bridging method(independent type)while another 5 cases in group B reconstruct with innovated technique by bridging Ⅴ/Ⅷ vein for splitting IVC with iliac vessel and molding all outflows as one for anastomosis(combined typ e). There is significant inter-group difference( P=0.004). No significant differences exist in operative duration, anhepatic phase or blood loss between groups C and B, except for T tube retaining in 7 cases of group A and 14 cases of group D( P=0.032). Twelve cases developed a total of 26 instances of≥Clavien-Dindo grade Ⅲ complications.Of which, 7 cases in group C and 5 cases in group D show no significant difference in postoperative morbidity.However, for serious biliary complications(≥Clavien Dindo grade Ⅲ), there are 6 cases in group C versus none in group D( P=0.016). Two cases died from postoperative complication with a postoperative mortality rate of 4.1%.Postoperative hospital stay is similar in two groups.And accumulates 6/12-month survivals were 95.9% and 87.7% for grafts and 95.9% and 92.4% for recipients respectively. Conclusions:Operative duration of full-left/full-right liver splitting in situ tends to shorten with an accumulation of a certain amount of cases.Technological modification and innovation in IVC splitting and segment Ⅴ/Ⅷ vein reconstruction should be further validated as both feasible and safe by short-term outcomes of the corresponding recipients.
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Objective:To study the relationship between morphologic classification and prognosis of patients with intrahepatic cholangiocarcinoma (ICC).Methods:The clinicopathologic data of 125 ICC patients who underwent R 0 resection at the Ningbo Medical Center Li Huili Hospital from January 2011 to May 2019 were retrospectively analyzed. This cohort consisted of 67 males and 58 females, aged 26.0 to 82.0 (63.5±9.5) years old. Based on the resected specimens, the patients were divided into the mass forming type, periductal infiltrating type and mixed type. The survival rates and recurrence-free survival outcomes of the patients among the three types were compared, and the risk factors that influenced prognosis were analyzed. Results:Using the predetermined inclusion and exclusion criteria, 16 patients with missing data and other causes of death were excluded from the initial 125 patients. Also, as the number of the mixed type was small, these patients were excluded. Finally 62 patients in the mass forming type and 42 patients in the periductal infiltrating type were analyzed. In the mass forming group, there were 32 males and 30 females, aged (63.1±9.1) years. In the perivascular infiltration group, there were 22 males and 20 females, aged (64.1±10.2) years. The 1-, 3-, 5-year survival rates of the mass forming group were 78.1%, 33.2%, 18.9% (median survival 25 months). The 1-, 3-, 5-year survival rates of the periductal infiltrating type were 63.3%, 8.3%, 6.1% (median survival 15 months). There were statistically significant differences between the two groups ( P<0.05). The median recurrence-free survival for the mass forming and the periductal infiltrating groups were 18 and 11 months, respectively, with a statistically significant differences between them ( P<0.05). Univariate and multivariate analysis showed that TNM staging Ⅲ~Ⅳ ( HR=2.966, 95% CI: 1.549-5.679) and periductal infiltrating type ( HR=2.403, 95% CI: 1.236-4.670) were independent risk factors for survival of these patients after operations. TNM staging Ⅲ~Ⅳ ( HR=2.466, 95% CI: 1.325-4.589), low grade differentiation ( HR=0.528, 95% CI: 0.299-0.934) and periductal infiltrating type ( HR=2.432, 95% CI: 1.295-4.565) were independent risk factors for relapse-free survival of these patients ( P<0.05). Conclusions:Morphological classification was found to be an independent risk factor for prognosis of ICC patients in this study, with significantly worse long-term prognosis when compared with the mass forming type.
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Objective:To evaluate the efficacy of splenic artery ligation on liver function recovery and hypersplenism in liver transplant patients with end-stage liver disease complicating portal hypertension and hypersplenism.Methods:From Jan 2016 to Jan 2019, the clinical data of patients undergoing liver transplantation at our hospital were analyzed retrospectively, among which 53 patients were enrolled in the study with end-stage liver disease complicated with portal hypertension and hypersplenism. Patients were divided into ligation group( n=23) and no ligation group( n=30). The serum liver function and white blood cells, platelets and postoperative complications were compared. Results:20 pairs of patients were successfully matched by PSM method. All patients were followed up for over 6 months.There was no statistically significant difference between the two groups in all the observation points within 2 weeks after operation; Within 6 months, there was no statistically significant difference in WBC, platelet and Hgb.Statistically significant differences in postoperative complications such as infection, gastrointestinal bleeding, and splenic artery stealing syndrome were also not found between these two groups.Conclusions:Splenic artery ligation during liver transplantation does not accelerate liver function recovery nor ameliorate hypersplenism.
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Objective@#To study the impact of intraoperative pancreatic resection margin status on prognosis in patients with pancreatic head cancer.@*Methods@#The clinical and follow-up data of 109 patients who underwent pancreaticoduodenectomy at Ningbo Lihuili Hospital from March 2012 to October 2018 were analyzed retrospectively. The association of intraoperative resection margin status and other clinicopathological factors on prognosis was analyzed by the Kaplan-Meier method and the Cox proportional hazard model. Logistic multivariate analysis was used to study factors influencing the margin status.@*Results@#Of 109 patients, 20 had a positive intraoperative resection margin, and 89 had a negative margin. Postoperative pathological examination showed that all the patients had a negative surgical margin. Univariate analysis suggested that CA19-9 before operation, preoperative adjuvant chemotherapy, intraoperative pancreatic resection margin status, maximum diameter of tumor, perineural invasion, lymphovascular invasion, tumor differentiation, and N staging were significantly related to survival in the entire cohort (all P<0.05). Multivariate analysis showed CA19-9 ≥37 IU/ml, perineural invasion, lymph node metastasis, tumor diameter ≥4 cm and poor tumor differentiation were independent risk factors of bad prognosis (P<0.05). Univariate analysis of prognosis showed significant differences in lifetime prognosis between the positive margin group and the negative group (median survival time: 11 months vs. 21 months, P<0.05), but a positive resection margin was not an independent risk factor on prognosis (P>0.05). Analysis of the clinicopathological factors between the two groups showed that in the positive pancreatic neck margin group, the distribution of adverse pathologic factors like low tumor differentiation, tumor diameter ≥4 cm, perineural invasion and lymphovascular invasion were significantly different compared with the negative group (P<0.05). Tumor diameter ≥4 cm (OR=5.72, 95%CI: 1.60~20.49) and low tumor differentiation (OR=3.79, 95%CI: 1.20~11.95) were independent influencing factors of positive margin on logistic multivariate analysis.@*Conclusions@#Intraoperative pancreatic positive margin was not an independent risk factor of prognosis, but it was meaningful in predicting survival. Presence of positive margins was often combined with existence of some adverse pathological features, such as large tumor diameter and low tumor differentiation. Prognosis of patients with a positive margin was often poor. A positive pancreatic margin was an intraoperative marker of poor tumor biology in patients with pancreatic ductal adenocarcinoma.
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Hepatocellular carcinoma is one of the most common malignancies of liver cancer.Partial hepatectomy and liver transplantation are potentially curative treatments in patients with hepatocellular carcinoma.However,the postoperative tumor recurrence rate is high with poor long-term survival outcome.Studies have shown that the presence of microvascular invasion is an independent risk factor of post-resection prognosis.Therefore it draws attention that whether postoperative TACE can prevent the recurrence of liver cancer.This article reviews the research progress postoperative TACE effect on hepatocellular carcinoma patients with microvascular invasion,in order to provide the reference for selection of further treatment.
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Objective:To investigate the expression level of pyruvate kinase M2 (PKM2) in tissues of non-small cell lung cancer (NSCLC) patients and the correlation between PKM2 expression level and radiation sensitivity. Methods:A total of 45 NSCLC pa-tients were chosen and treated with radiotherapy for two months after surgery. The patients were classified into four groups based on the curative effect. The mRNA expression levels of PKM2 in tumor and the homologous paraneoplastic tissues of NSCLC patients were de-tected prior to radiotherapy using real time-polymerase chain reaction (RT-PCR), and the protein expressions of PKM2 in the tumor and paraneoplastic tissues of NSCLC patients were detected with Western blot analysis and immunohistochemical method. The mRNA and protein expression levels of PKM2 in the tumor tissues of different groups were detected with RT-PCR and Western blot assays. Re-sults:The effective rate of radiotherapy for 2 months is 44.8%in NSCLC patients. The expression level of PKM2 is significantly high-er in tumor tissues than in homologous paraneoplastic tissues of NSCLC patients and is negatively correlated with the curative effect of radiotherapy. Conclusion:The expression level of PKM2 is significantly higher in tumor tissues than in the paraneoplastic tissues of NSCLC patients. Patients with lower PKM2 expression level are more sensitive to radiotherapy.
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A kind of coronary stent was made from Nickel-free stainless steel, and the technological process of the stent was studied. A preferable flexible and support force stent was simulated by a commercial finite element code ANSYS with laser cutting, pickling and vacuum annealing. This kind of coronary stent has more superiority. It was also presented that a self designed automatic stent electro-polishing device, which greatly improve efficiency and quality, and the optimization electro-polishing process was put forward.