Survival prediction of the Bolondi substaging model for patients with intermediate-stage hepatocellular carcinoma after hepatectomy / 中华消化外科杂志

Objective To investigate the overall survival prediction of the Bolondi substaging model for patients in intermediate-stage of Barcelona clinic liver cancer (BCLC) after hepatectomy.Methods The retrospective cohort study was adopted.The clinical data of 343 patients with intermediate-stage hepatocellular carcinoma (HCC) who were admitted to the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University between February 2008 and January 2010 were collected.All the patients received the detailed medical history collection,physical examination,laboratory and imaging examinations after admission,and then hepatectomy was performed according to the results of above examinations.Research methods:(1) patients were allocated into the B1,B2 and B3/4 groups based on the Bolondi's substaging model,and the prognostic analyses among groups were conducted.(2) The related factors affecting the prognosis of patients in the B1 and B2 groups were analyzed.(3) The patients in the B1 and B2 groups were allocated into the 4 groups [patients of B1 group with negative microvascular invasion (MVI) were divided in the M1 group,patients of B1 group with positive MVI in the M2 group,patients of B2 group with negative MVI in the M3 group and patients of B2 group with positive MVI in the M4 group] according to the situations of MVI,and stratified analysis was conducted.Observation indicators:basic clinical and pathological features and survival of patients in the B1,B2 and B3/4 groups were observed.Risk factors analysis affecting the prognosis of patients and stratified analysis of MVI in the B1 and B2 groups were conducted.All the patients were followed up by outpatient examination and telephone interview up to February 2014,and the abdominal ultrasound,liver function and serum alpha-fetoprotein (AFP) tests was performed once every 3 months within 2 years postoperatively and once every 6 months after 2 years postoperatively.The continuous variables and categorical variables were respectively represented as M(Qn) and percentage.The comparisons of continuous variables and categorical variables among groups were analyzed by ANOVA or Kruskal-Wallis test and chi-square test or Fisher exact probability,respectively,and one-way ordinal categorical variables were analyzed by the Kruskal-Wallis test.The survival curve was drawn using the KaplanMeier method.The univariate analysis and multivariate analysis were done using the Log-rank test and COX regression model.Results (1) The basic clinical pathological features:of 343 patients with HCC,143,183 and 17 patients (12 in the B3 substaging and 5 in the B4 substaging) were respectively allocated into the B1,B2 and B3/4 groups.There were statistically significant differences in the age,peritoneal effusion,total bilirubin (TBil),albumin (Alb),alanine transaminase (ALT),prothrombin time (PT),platelet (PLT),alpha-fetoprotein (AFP),extent of liver resection,surgical margin ivasion,tumor diameter,number of tumor,Edmondson-Steiner grade,Up-to-7 score,Up-to-7 standard and Child-pugh score among the 3 groups (F =3.377,NA,11.245,32.616,6.884,11.564,33.100,12.902,NA,NA,239.089,10.357,x2=8.906,F =251.508,x2 =343.000,106.790,P ＜ 0.05).(2) Survival of patients:all the patients were followed up for 2.8-70.8 months with a median time of 38.7 months.The 1-,3-,5-year survival rates and median survival time in the B1,B2 and B3/4 groups were 85.8％,72.8％,52.9％ and 63.2％,47.5％,16.8％ and 45.5％,30.4％,8.4％ and 55.1 months,35.1 months,12.2 months,respectively,showing a statistically significant difference (x2 =22.800,P ＜ 0.05).(3) Risk factors analysis:the results of univariate analysis showed that the peritoneal effusion,Alb,Hb,AFP,esophagogastric varices,surgical margin invasion,tumor diameter,MVI and Edmondson-Steiner grade were related risk factors affecting the prognosis of patients with HCC after hepatectomy [HR =2.04,2.46,2.50,1.78,1.55,3.54,1.71,1.76,1.69,95％ confidence interval (CI):1.13-3.69,1.20-5.02,1.51-4.15,1.29-2.45,1.06-2.25,1.65-7.61,1.23-2.38,1.23-2.51,1.08-2.64,P＜0.05].The results of multivariate analysis showed that the Alb ＜ 35 g/L,Alb ＜ low limit of normal,tumor invading to surgical margin,tumor diameter ＞ 5 cm and positive MVI were independent risk factors affecting the overall survival of patients with HCC after hepatectomy (HR =2.82,2.16,2.93,1.48,1.53,95％ CI:1.37-5.80,1.27-3.69,1.33-6.44,1.05-2.09,1.06-2.22,P＜0.05).(4) There were 61,82,57 and 126 patients in the M1,M2,M3 and M4 groups,and M2 and M3 groups were merged into the M2/3 group because of being similar survival situations of patients.The 1-,3-,5-year survival rates and median survival time in the M1,M2/3,and M4 groups were 90.0％,83.2％,67.7％ and 68.8％,59.9％,41.6％ and 52.7％,42.1％,23.6％ and 69.0 months,49.2 months,24.9 months,respectively,with a statistically significant difference among the 3 groups(x2=20.200,P ＜ 0.05).Conclusions The Bolondi substaging model produces an optimal survival prediction for patients in intermediate stage of BCLC after hepatectomy.The patients in the B1 and B2 substaging have better long-term survival outcomes after hepatectomy.

Two tests to detect anti-double stranded DNA antibodies in the diagnostic value of systemic lupus erythematosus / 中华检验医学杂志

Objective To investigate the concurrent application value of indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA) in systemic lupus erythematosus (SLE).Methods A retrospective study.All patients who took anti-double stranded DNA (dsDNA) antibody test from June 1 2011 to September 30 2011 in our department were recruited in this study.The patients' anti-dsDNA antibody results and clinical diagnosis were collected and analyzed retrospectively.The consistence,sensitivity and specificity of IIF and ELISA tests were calculated and the consistence was compared by Kappa test.Results The positive rates of detecting anti-dsDNA antibodies by ELISA and IIF tests were 16.3％ and 13.1％ respectively.The consistency between these two tests was 90.8％,and showed good correlation by Kappa test (Kappa =0.641,P ＜ 0.05 ).Of 9.2％ of inconsistent results between IIF andi ELISA,most cases ( 6.2％ ) were ELISA positive and IIF negative.Taking the clinical diagnosis of lupus as a golden standard,the accuracy of IIF and ELISA was 84.8％ and 84.4％ respectively and the difference was no significant (x2 =0.25,P ＞ 0.05 ).The sensitivity and specificity for diagnosing lupus by IIF were 46.1％ and 99.2％,and 51.3％ and 96.7％ by ELISA.Conclusions Our results suggested that anti-dsDNA antibodies in samples should be detected by both ELISA and IIF tests simultaneously.If ELISA was used first and the positive samples were further tested by IIF,at least 3％ of ELISA negative and IIF positive samples would be misdiagnosed as anti-dsDNA antibodies negative.IIF negative and ELISA positive samples should be further analyzed the affinity of anti-dsDNA antibodies in order to help the diagnosis and evaluation of SLE.

Injection of NKG5SV gene to inhibit growth and metastasis of hepatocellular carcinoma / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the injection of NKG5SV gene to inhibit growth and metastasis of hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>NKG5SV gene was inserted into retroviral vector pLXSN by normal methods. LacZ gene was used as control. LCI-D20 tumor together with saline, pLXSN-LacZ DNA or pLXSN-NKG5SV was subcutaneously inoculated to the nude mice. Tumor formation rate and tumor size were noted 35 days after inoculation. LCI-D20 tumor was inoculated subcutaneously. Saline, pLXSN-LacZ DNA or pLXSN-NKG5SV was intratumorally injected respectively 10 days after inoculation. Tumor growth was observed 35 days after inoculation. Liver cancer was resected 22 days after intrahepatic inoculation. Saline, pLXSN-LacZ DNA or pLXSN-NKG5SV was respectively injected at incisal margin or intraspleen. Mice were killed 35 days after inoculation to observe tumor recurrence at incisal margin, intrahepatic metastasis and extrahepatic metastasis.</p><p><b>RESULTS</b>Tumor formation rate and tumor diameter(cm) were 1.76 +/- 0.11, 1.51 +/- 0.34, 0.33 +/- 0.04 in the control group, LacZ group, NKG5SV group respectively when tumor and different cDNA were inoculated together. Tumor diameter(cm) and weight(g) were 0.87 +/- 0.08, 0.83 +/- 0.05, 0.26 +/- 0.04; 0.43 +/- 0.06, 0.38 +/- 0.04, 0.08 +/- 0.06 in the control group, LacZ group, NKG5SV group respectively when different cDNA were injected into the LCI-D20 tumor. Sites with extrahepatic metastasis nidi, incisal margin recurrence tumor size(cm), intrahepatic metastasis nidi, metastasis involved hepatic lobes in the control group, LacZ group, NKG5SV group were 4.25 +/- 1.48, 4.25 +/- 1.04, 0.63 +/- 0.51; 1.51 +/- 0.27, 1.35 +/- 0.17, 0.81 +/- 0.17; 2.50 +/- 1.41, 2.38 +/- 1.06, 1.25 +/- 0.71; 2.13 +/- 0.99, 2.00 +/- 0.75, 1.38 +/- 0.74 respectively when NK cells were injected at incise margin. They were 4.38 +/- 1.85, 4.25 +/- 1.48, 1.00 +/- 0.75; 1.13 +/- 0.23, 0.97 +/- 0.29, 0.76 +/- 0.16; 2.50 +/- 1.41, 2.05 +/- 1.12, 0; 2.13 +/- 0.83, 1.75 +/- 0.88, 0 respectively when NK cell were injected intrasplenicly.</p><p><b>CONCLUSIONS</b>NKG5SV gene can inhibit HCC growth and postoperative metastasis and recurrence.</p>

Effects of Tetrandrine on Hood Pressure, Plasma Renin Activity and the Contractility of the Ventricular Papillary Muscle and Portal Vein in Rats / 第二军医大学学报

The effects of tetrandrine (Tet) on blood pressure, plasma renin activity (PRA) and the contractility of the papillary mascle and portal vein were studied in rats. After 4 d administration of Tet 30 mg/kg, 2/d, ig, blood pressure was decreased markedly in anesthetized male SD rats, but there were no effects on heart rate and PRA. A single dose of Tet 15 mg/kg iv reduced blood pressure and heart rate significantly, while did not change PRA. This single dose produced similar hypotensive effect in rats with and without pretreatment of Tet 30 mg/kg, 2/d, 4d, indicating the absence of tolerance. Tet inhibited the paced papillary muscle contractility and the spontaneous portal vein contractility, and the EC50 were 5.33?10-6mol/L and 4.25?10-5 mol/L, respectively. So the vascular selectivity of Tet is 0.12.