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Objective:To analyze the influencing factors of abnormal 15-minute retention rate of indocyanine green (ICG R15) (≥10%) in patients with hepatocellular carcinoma, and to construct a nomogram model, and to evaluate the prediction efficiency of the nomogram model.Methods:The clinical data of 190 patients with hepatocellular carcinoma in Zhengzhou University People's Hospital from December 2017 to June 2022 were retrospectively analyzed, including 148 males and 42 females, aged (57.8±9.9) years. According to ICG R15, the patients were divided into ICG R15 normal group ( n=134, ICG R15<10%) and ICG R15 abnormal group ( n=56, ICG R15≥10%). Univariate and multivariate logistic regression were used to analyze the influencing factors of abnormal ICG R15, and the nomogram model was established. The predictive ability of the model was evaluated by receiver operating characteristic (ROC) curve and C-index, and the model was verified by calibration curve and decision analysis curve. Results:Abnormal ICG R15 group the proportion of liver cirrhosis, albumin ≤35 g/L, hemoglobin ≤110 g/L, platelet count ≤100×10 9/L, prothrombin time >13 s, alanine aminotransferase >40 U/L, aspartate aminotransferase >40 U/L, total bilirubin >34.2 μmol/L, and the largest tumor diameter >5.0 cm, spleen volume >383.1 cm 3, spleen volume to of non-tumor liver volume (SNLR) >0.276 and liver tumor volume >117.2 cm 3 were higher than that of ICG R15 normal group, and the differences were statistically significant (all P<0.05). Logistic regression analysis showed that liver cirrhosis ( OR=3.89, 95% CI: 1.28-11.80, P=0.016), spleen volume >383.1 cm 3( OR=5.17, 95% CI: 1.38-19.38, P=0.015), SNLR >0.276 ( OR=5.54, 95% CI: 1.44-21.26, P=0.013) and total bilirubin >34.2 μmol/L( OR=10.20, 95% CI: 1.88-55.39, P=0.007) increased the risk of abnormal ICG R15. A nomogram model was constructed based on the above risk factors. The C-index of the model was 0.915 (95% CI: 0.872-0.957), and the area under the ROC curve predicted by the nomogram model was 0.915 (95% CI: 0.871-0.958). The calibration curve showed that the correlation index of the abnormal ICG R15 predicted by the nomogram was similar to actual situation. Decision analysis curve showed high returns. Conclusion:Liver cirrhosis, spleen volume >383.1 cm 3, SNLR>0.276 and total bilirubin >34.2 μmol/L were indepentlent risk factors for abnormal ICG R15 in patients with hepatocellur carcinoma. The clinical prediction model of ICG R15 abnormality constructed by nomogram has good prediction efficiency, which can provide a reference for evaluating preoperative liver reserve function of patients with hepatocellular carcinoma.
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Objective:To explore the value of pre-ablation stimulated thyroglobulin (psTg) before 131I treatment combined with lymph node ratio (LNR) in predicting 131I treatment response in patients with papillary thyroid cancer (PTC). Methods:From January 2016 to December 2018, 178 PTC patients (47 males, 131 females; age (43.2±12.6) years) treated with 131I in the Affiliated Cancer Hospital of Zhengzhou University were retrospectively analyzed. According to 131I treatment response, patients were divided into excellent response (ER) group and non-ER group. The clinical data of the two groups were compared by χ2 test, independent-sample t test and Mann-Whitney U test. The cut-off values and AUCs of psTg and LNR to predict treatment response were calculated according to the ROC curve. Factors affecting 131I treatment response were analyzed by logistic multivariate regression analysis. Results:There were 118 patients (66.3%, 118/178) in ER group and 60 patients (33.7%, 60/178) in non-ER group, and there were significant differences in N stage ( χ2=11.15, P=0.004), 131I treatment dose ( χ2=12.65, P<0.001), American Thyroid Association (ATA) initial risk stratification ( χ2=15.25, P<0.001), number of metastatic lymph nodes ( χ2=22.63, P<0.001), LNR ( U=1 506.00, P<0.001) and psTg ( U=919.00, P<0.001) between the two groups. The cut-off values of psTg and LNR predicting ER were 3.97 μg/L and 0.29, with the AUC of 0.870 and 0.787 respectively. PsTg (odds ratio ( OR)=10.88, 95% CI: 4.67-25.36, P<0.001) and LNR ( OR=5.30, 95% CI: 1.85-15.23, P=0.002) were independent factors to predict 131I treatment response in PTC patients. When psTg≥3.97 μg/L, LNR ( OR=9.40, 95% CI: 2.06-42.92, P=0.004) was an independent factor affecting 131I treatment response in PTC patients. Conclusions:PsTg and LNR are independent factors affecting 131I treatment response in PTC patients. When psTg≥3.97 μg/L, LNR can be used as a supplementary factor to predict 131I treatment response. The combination of psTg and LNR can better predict 131I treatment response in PTC patients.
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Objective:To explore the predictive value of preablative stimulated thyroglobulin (psTg) level before 131I treatment on the excellent response (ER) to 131I treatment in patients with functional residual lymph node metastasis without distant metastasis after papillary thyroid carcinoma (PTC) surgery. Methods:From March 2011 to June 2015, 72 patients (22 males, 50 females, age: 14-76 (46.5±14.4) years) who were diagnosed with functional lymph node metastasis without distant metastasis at the time of their first 131I treatment after total thyroid bilobectomy + lymph node dissection performed in the Affiliated Cancer Hospital of Zhengzhou University were retrospectively included, and their serum thyroglobulin antibody (TgAb) levels were normal. Patients were divided into ER group and non-ER group according to the treatment response assessment system. Independent sample t test, χ2 test, and Mann-Whitney U test were used to compare the basic clinical characteristics between the two groups, and then multivariate logistic regression was performed. The ROC curve was employed to evaluate the predictive value of psTg and lymph node size in 131I treatment response. Results:The treatment responses of 44 patients were ER, and those of 28 were non-ER. The differences in gender, age, clinical stage, number and location of postoperative metastatic lymph nodes between ER and non-ER groups were not statistically significant ( t=0.82, χ2 values: 0.16-2.60, all P>0.05), while there were significant differences in American Thyroid Association (ATA) initial risk stratification ( χ2=33.38), lymph node size ( U=296.50) and psTg ( U=111.00, all P<0.001). PsTg (odds ratio ( OR)=0.047, 95% CI: 0.004-0.500, P=0.011) and lymph node size ( OR=0.146, 95% CI: 0.032-0.666, P=0.013) were independent factors affecting ER, whereas ATA initial risk stratification was not an independent factor ( OR=0.266, 95% CI: 0.051-1.390, P=0.116). AUCs for psTg and lymph node size were 0.904 and 0.873, respectively. The cut-off value of psTg was 20.05 μg/L with the sensitivity and specificity of 96.4%(27/28) and 75.0%(33/44) respectively, and lymph node size was 0.75 cm with the sensitivity and specificity of 78.6% (22/28) and 81.8% (36/44) respectively. Conclusion:PsTg can be used to predict 131I outcomes in patients with functional lymph node metastases after PTC, and lymph node size also has effect on ER.
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Objective:To compare the short-term clinical outcomes of patients undergoing laparoscopic versus open radical resection of hilar cholangiocarcinoma.Methods:The clinical data of 91 patients who underwent radical resection for hilar cholangiocarcinoma at our hospital from January 2018 to June 2021 were analyzed retrospectively. There were 48 males and 43 females, with aged of (61.51±7.18) years old. The patients were divided into the laparotomy group ( n=59) and the laparoscopic group ( n=32) based on the operations they received. The general data, perioperative data and complications of the two groups were compared. Results:There was no perioperative death in the laparoscopic group, but one patient died of abdominal bleeding in the laparotomy group. All other patients recovered from postoperative complications with treatment. When compared with patients in the laparotomy group, the operation time [(381.28±102.37) vs. (296.81±84.74) min] and biliary intestinal anastomosis time [(17.81±2.81) vs. (15.19±2.27) min] were significantly longer in the laparoscopic group. However, the postoperative hospital stay [(12.34±3.46) vs. (15.10 ± 4.48) d], bed rest time [(3.38±0.66) vs. (5.24±0.88) d], analgesic time [(4.31±0.90) vs. (6.22±1.26) d] and postoperative time to first feeding [(3.91±0.89) vs. (5.32±0.86) d] were significantly lower ( P<0.05). There were no significant differences in amounts of intraoperative bleeding, numbers of lymph node harvested and incidences of postoperative complications between groups ( P>0.05). Conclusion:Under the premise of strictly indications, laparoscopic radical resection of hilar cholangiocarcinoma was safe and feasible, and had certain advantages in promoting the rapid recovery of patients.
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Objective:To investigate the application value of peripheral blood circulating tumor cell (CTC) classification in the prediction of preoperative microvascular invasion of hepato-cellular carcinoma (HCC).Methods:The retrospective case-control study was conducted. The clinico-pathological data of 102 HCC patients who were admitted to Zhengzhou University People's Hospital from September 2018 to September 2020 were collected. There were 71 males and 31 females, aged from 29 to 80 years, with a median age of 57 years. Observation indicators: (1) surgical situations; (2) results of CTC detection and microvascular invasion in HCC patients; (3) results of CTC classification and the best cut-off value of CTC classification in the prediction of microvascular invasion in HCC; (4) influencing factors for microvascular invasion in HCC; (5) comparison of clinicopathological features in HCC patients with different cell counts in mesenchymal phenotype of CTC (M-CTC). Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent sample t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and comparison between groups was analyzed using the nonparametric rank sum U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. The receiver operating characteristic (ROC) curve was used to determine the best cut-off value for the risk of microvascular invasion in patients. Univariate and multivariate analysis were performed using the Logistic regression model. Results:(1) Surgical situations. All 102 patients underwent surgery successfully, including 17 cases undergoing local hepatectomy, 43 cases under-going segmentectomy, 22 cases undergoing hepatic lobectomy, 13 cases undergoing hemilectomy and 7 cases undergoing enlarged hemilectomy. The operation time and the volume of intraoperative blood loss were 235(147,293)minutes and 300(110,500)mL of the 102 patients, respectively. (2) Results of CTC detection and microvascular invasion in HCC patients. Of 102 patients, there were 36 casas with epithelial phenotype of CTC (E-CTC), 86 cases with hybrid phenotype of CTC (H-CTC), 30 cases with M-CTC, respectively, and the total CTC (T-CTC) were positive in 89 cases. Results of postoperative pathological examination showed that there were 40 cases with micro-vascular inva-sion and 62 cases without microvascular invasion in the 102 patients. Of the 40 patients with micro-vascular invasion, the count of E-CTC, H-CTC, M-CTC and T-CTC were 0(0,1) per 5 mL, 4(2,5) per 5 mL, 1(0,2) per 5 mL and 5(3,8) per 5mL, respectively. The above indicators of the 62 cases without microvascular invasion were 0(0,1) per 5 mL, 3(1,5) per 5 mL, 0(0,0) per 5 mL and 3(2,6) per 5 mL, respectively. There were significant differences in the count of M-CTC and T-CTC between patients with and without microvascular invasion ( Z=-4.83, -2.96, P<0.05). (3) Results of CTC classi-fication and the best cut-off value of CTC classification in the prediction of microvascular invasion in HCC. The ROC curve showed that best cut-off value of M-CTC and T-CTC counts in the prediction of microvascular invasion in HCC were 1 per 5 mL and 4 per 5 mL, respectively, with the area under curve, the corresponding specificity, sensitivity were 0.70 (95% confidence interval as 0.60-0.81, P<0.05), 75.8%, 62.9% and 0.67 (95% confidence interval as 0.57-0.78, P<0.05), 60.0%, 72.5%, respec-tively. (4) Influencing factors for microvascular invasion in HCC. Result of univariate analysis showed that alpha fetoprotein (AFP), aspartate aminotransferase (AST), tumor diameter, tumor number, tumor margin, Barcelona clinic liver cancer staging, M-CTC counts and T-CTC counts were related factors influencing microvascular invasion in HCC ( odds ratio=3.13, 0.43, 4.92, 5.65, 2.54, 2.93, 8.25, 4.47, 95% confidence interval as 1.34-7.33, 0.19-0.98, 2.09-11.58, 2.35-13.63, 1.13-5.75, 1.27-6.74, 3.13-21.75, 1.88-10.61, P<0.05). Result of multivariate analysis showed that tumor diameter >5 cm, tumor number as multiple and M-CTC counts ≥1 per 5 mL were independent risk factors influencing microvascular invasion in HCC ( odds ratio=2.97, 4.14, 4.36, 95% c onfidence interval as 1.01-8.70, 1.14-15.02, 1.36-13.97, P<0.05). (5) Comparison of clinicopathological features in HCC patients with different cell counts in M-CTC. The 102 HCC patients were divided into the high M-CTC group of 30 cases with M-CTC counts ≥1 per 5 mL and the low M-CTC group of 72 cases with M-CTC counts <1 per 5 mL, according to the best cut-off value of M-CTC counts. Cases with hepatitis, cases with AFP >400 μg/L, cases with AST >35 U/L, cases with irregular tumor margin, cases with tumor diameter >5 cm, cases with tumor number as multiple and cases with micro-vascular invasion were 22, 17, 13, 21, 18, 16 and 22 in the high M-CTC group of 30 cases. The above indicators were 35, 18, 48, 26, 25, 21 and 18 in the low M-CTC group of 72 cases. There were significant differences in the above indicators between the high M-CTC group and the low M-CTC group ( χ2=5.25, 9.42, 4.80, 9.79, 5.55, 5.35, 20.75, P<0.05). Conclusions:The epithelial-mesen-chymal phenotype of peripheral blood CTC can be used to predict the preoperative microvascular invasion in HCC. Tumor diameter >5 cm, tumor number as multiple and M-CTC counts ≥1 per 5 mL are independent risk factors influencing microvascular invasion in HCC patients.
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Objective:To investigate the application value of fusion indocyanine green fluorescence imagine (FIGFI) in laparoscopic common bile duct reexploration.Methods:The clinical data of 65 patients who underwent laparoscopic common bile duct reexploration at Henan Province People′s Hospital from Jan 2015 to Dec 2019 were collected. According to the operational manner, the patients were divided into the conventional laparoscopic group (control group, 35 patients) and the FIGFI laparoscopic group (study group, 30 patients). The intraoperative and postoperative data were analyzed.Results:Operation time, time to identify extrahepatic bile duct, intra operative blood loss, and conversion to open surgery were (195.7±9.2) min vs (147.2±9.3) min, (39.3±3.7) min vs (21.8±1.8) min, (203.2±34.6) ml vs (108.9±32.1) ml, 8 vs 1, between the control group and the study group, respectively ( P<0.05). Postoperative cholangitis, bile leakage, intra abdominal infection, pancreatitis, and hospital stay were 11vs 2, 9 vs 2, 8 vs 1, 8 vs 1, (13.5±0.9) d vs (7.4±0.9) d, between the control group and the study group, respectively ( P<0.05). There was no statistically difference in case of residual stones (5 vs 3) and gastrointestinal fistula (3 vs 1) between the control group and the study group, respectively ( P>0.05). Conclusions:FIGFI provides real-time visualization of the extrahepatic biliary tract while doing laparoscopic common bile duct reexploration.
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Purpose@#Drug resistance is one of the main causes of chemotherapy failure in patients with small cell lung cancer (SCLC), and extensive biological studies into chemotherapy drug resistance are required. @*Materials and Methods@#In this study, we performed lncRNA microarray, in vitro functional assays, in vivo models and cDNA microarray to evaluate the impact of lncRNA in SCLC chemoresistance. @*Results@#The results showed that KCNQ1OT1 expression was upregulated in SCLC tissues and was a poor prognostic factor for patients with SCLC. Knockdown of KCNQ1OT1 inhibited cell proliferation, migration, chemoresistance and promoted apoptosis of SCLC cells. Mechanistic investigation showed that KCNQ1OT1 can activate transforming growth factor-β1 mediated epithelial-to-mesenchymal transition in SCLC cells. @*Conclusion@#Taken together, our study revealed the role of KCNQ1OT1 in the progression and chemoresistance of SCLC, and suggested KCNQ1OT1 as a potential diagnostic and prognostic biomarker in SCLC clinical management.
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Objective:To investigate the predictive value of portal vein (PoV) blood circulating tumor cells (CTCs) count in patients with pancreatic cancer on the postoperative prognosis.Methods:The data of 58 patients receiving radical resection of pancreatic cancer and PoV CTCs detection at People's Hospital of Zhengzhou University from Aug 2018 to Jun 2020 were collected. According to the cut-off value of PoV CTCs>10/5 ml made by receiver operating characteristic curve (ROC), patients were divided into high CTCs group and low CTCs group and the differences in clinicopathological parameters and prognosis of the two groups were compared.Results:Postoperative progression-free survival rate of the low CTCs group was higher than that of the high CTCs group ( χ 2=12.97, P<0.001).Univariate COX regression analysis showed that tumor diameter >4 cm, lymph node invasion, TNM staging, CTCs>10/5 ml, postoperative CA199>37 U/m were risk factors for postoperative prognosis. Multivariate COX regression analysis demonstrated that TNM stage ( OR=2.782, P=0.024), CTCs count >10/5 ml ( OR=2.583, P=0.047), postoperative CA199>37 U/m ( OR=3.775, P=0.004) were the independent risk factors of prognosis. Conclusion:A higher PoV CTCs count was a risk factor for poor prognosis of patients with pancreatic cancer after radical resection.
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Objective:To investigate the value of tumor budding in the clinicopathology and prognosis of pancreatic neuroendocrine tumors.Methods:The Cliniccal data of 105 pancreatic neuroendocrine tumor patients underwent resection in Henan Provincial People's Hospital from Jan 2010 to Dec 2016 were retrospectively analyzed. Tumor budding was calculated through hematoxylin-eosin (HE) and immunohistochemical stained slides. Based on the receiver operating characteristic curve (ROC), the number of tumor budding ≥10 was defined as the high-grade budding group, and <10 as the low-grade budding group. Multiple analysis was performed to determine the relationship between tumor budding and clinicopathology as well as prognosis.Results:High-grade budding group was observed in 35 cases and low-grade group in 70. High-grade budding were more common in tumors with advanced T stage, high risk of lymphatic metastasis, preoperative liver metastasis, vascular invasion and postoperative recurrence (respectively χ 2=9.043, 4.286, 10.130, 12.090, 9.260, all P<0.05). Multivariate COX regression analysis showed that tumor budding ( P=0.018), tumor grade ( P=0.026), preoperative liver metastasis ( P=0.042), vascular invasion( P=0.048) was independent risk factors predicting poor prognosis. Conclusion:Tumor budding is highly correlated with clinicopathological parameters which reflect the aggressiveness of pancreatic neuroendocrine tumor, it is also an important prognostic factor.
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Objective:To investigate the diagnostic efficacy of 99Tc m-MIBI SPECT dual-phase imaging combined with rapid parathyroid hormone detection in thyroid cancer with suspected parathyroid mass. Methods:Data of 76 cases of thyroid cancer with suspected cervical parathyroid gland tumors receiving colorectal ultrasonography or CT examination in Thyroid Surgery Department of the Affiliated Cancer Hospital of Zhengzhou University were retrospectively analyzed. Blood samples were taken before surgery to detect parathyroid hormone. Parathyroid hormone was quickly detected after clamping the tumor blood vessels during surgery. Based on the postoperative pathological results, the sensitivity, specificity, accuracy and consistency of various diagnostic methods were evaluated. The ROC curve was drawn by measuring the value of the parathyroid gland concentration after reduction of the tumor blood vessels by clamping the tumor.Results:The sensitivity and accuracy of the 99Tc m-MIBI SPECT dual-phase imaging combined with the rapid detection of parathyroid hormone in diagnosis of suspected parathyroid tumors were (96.5%, 93.4%) better than the 99Tc m-MIBI SPECT dual-phase imaging methods (77.6%, 78.9%) and intraoperative rapid detection methods (86.2%, 82.8%) , and had a high consistency with the results of pathological examination, Kappa value of 0.81. The combined detection rate of suspected parathyroid tumors was significantly higher than that of 99Tc m-MIBI SPECT dual-phase imaging and rapid intraoperative detection, but there was no significant difference between 99Tc m-MIBI SPECT dual-phase imaging and intraoperative rapid detection. The area under the ROC curve of the reduction ratio a value after clamping the blood vessels of the tumor was 0.774, and the standard error was 0.073. The difference was statistically significant ( P<0.001,95% CI:0.631-0.918) . According to the results obtained by the ROC, the index (sensitivity + specificity-1) was plotted on the ordinate and a was the abscissa. The maximum value of the Jordan index was 0.584. The a value corresponding to this point was 0.52. 0.52 is the DCP value. The corresponding sensitivity, specificity, accuracy was 86.2%,72.2%,and 82.9%. Conclusion:99Tc m-MIBI SPECT dual-phase imaging combined with rapid parathyroid hormone detection during surgery has good diagnostic value for thyroid cancer with suspected parathyroid mass, and is completely consistent with pathological diagnosis.
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Objective:To evaluate the clinical value of 125I seed implantation guided by CT in treatment of advanced pancreatic cancer. Methods:The data of 63 patients with advanced pancreatic cancer in the Affiliated Cancer Hospital of Zhengzhou University from Jun. 2015 to Jun. 2018 (48 males and 15 females) were retrospectively analyzed. All patients underwent CT-guided 125I seed implantation, and regular follow-up after operation. All patients were followed up for 3 to 36 months to evaluate the clinical efficacy, including the volume of cancer before and after treatment, tumor marker CA199 and changes in complications such as abdominal pain and jaundice, and the survival status of the patients. Results:Three months after seed implantation, 9 cases (14.3%) had complete remission of cancer in 63 patients, 33 cases had partial remission (52.4%) , 15 cases had no change (23.8%) , and 6 cases had disease progression (9.5%) . The total effective rate was 67.7%. Three months after treatment, the volume of cancer was (31.92±14.93) cm 3, which was significantly smaller than that before treatment [ (44.88±16.19) cm 3; t=6.79, P<0.01]. Three months after treatment, Serum CA199 (77.21±58.69 U/ml) was significantly lower than that before treatment (327.76±110.42) U/ml ( t=16.56, P<0.05) . 125I seed implantation for advanced pancreatic cancer had an average survival period of (13.04±0.92) months and a median delivery period of 11 months. Of the 57 patients with different degrees of abdominal pain, 49 were better than before, and the pain relief rate was 85.9%. Among 42 patients with jaundice symptoms of varying degrees, 31 were better than before, and the jaundice remission rate was 73.8%. There were no serious complications related to treatment in any patients. Conclusion:125I seed implantation therapy can safely and effectively treat advanced pancreatic cancer, and improve related clinical symptoms such as abdominal pain and jaundice.
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Wearable physiological parameter monitoring devices play an increasingly important role in daily health monitoring and disease diagnosis/treatment due to their continuous dynamic and low physiological/psychological load characteristics. After decades of development, wearable technologies have gradually matured, and research has expanded to clinical applications. This paper reviews the research progress of wearable physiological parameter monitoring technology and its clinical applications. Firstly, it introduces wearable physiological monitoring technology's research progress in terms of sensing technology and data processing and analysis. Then, it analyzes the monitoring physiological parameters and principles of current medical-grade wearable devices and proposes three specific directions of clinical application research: 1) real-time monitoring and predictive warning, 2) disease assessment and differential diagnosis, and 3) rehabilitation training and precision medicine. Finally, the challenges and response strategies of wearable physiological monitoring technology in the biomedical field are discussed, highlighting its clinical application value and clinical application mode to provide helpful reference information for the research of wearable technology-related fields.
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Monitoring, Physiologic , Wearable Electronic DevicesABSTRACT
Objective:To investigate the consistency of indirect calorimetry, Harris-Benedict (H-B) formula method and rule of thumb in calculating the daily total energy expenditure (TDEE) of patients with acute pancreatitis (AP), and provide the basis for the formulation of reasonable nutritional support program.Methods:A total of 66 AP patients admitted to Henan Provincial People's Hospital from June 2020 to December 2020 were included and retrospectively analyzed, including 35 males and 31 females with an average age of 41.8 years. They were divided into mild acute pancreatitis (MAP) group ( n=20) and moderate to severe AP group ( n=46) according to severity. TDEE was calculated by indirect calorimetry, H-B formula and rule of thumb, and Pearson correlation analysis and Bland-Altman diagram were used to analyze the correlation and consistency of the three methods, respectively. Results:There were no statistical significances in the TDEE of MAP group calculated by indirect calorimetry, H-B formula method and rule of thumb (both P>0.05). TDEE calculated by indirect calorimetry were higher than that of calculated by H-B formula and thumb method both in moderate and severe AP groups, and the difference was statistically significant (both P<0.05). Pearson correlation analysis showed that H-B formula method was positively correlated with the TDEE calculated by indirect calorimetry, and the correlation was 0.61 ( P<0.05). Bland-Altman plot analysis showed the consistence of the two methods. TDEE calculated by rule of thumb was positively correlated with that calculated by indirect calorimetry, and the correlation was 0.75 ( P<0.05). The bland-Altman plot analysis showed a good consistency between the two methods. Conclusion:For MAP patients, TDEE can be calculated by the H-B formula method and rule of thumb. In moderate and severe AP patients, TDEE should be calculated by indirect calorimetry as the basis for the formulation of nutritional support plan.
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Objective:This study aimed to compare the clinical outcomes of laparoscopic pancreaticoduodenectomy (LPD) versus open pancreaticoduodenectomy (OPD).Methods:The clinical data of 386 patients who successfully underwent pancreaticoduodenectomy at the People's Hospital of Zhengzhou University from June 2017 to December 2019 were retrospectively analyzed. According to the different surgical methods, patients were divided into the LPD group ( n=122) and the OPD group ( n=264). The differences in operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications, postoperative oncology survival outcomes and prognosis between groups were compared. Results:Of 386 patients in this study, there were 232 males and 154 females, aged (57.8±11.0) years. The operation time of the LPD group was (330.69±80.55) min which was significantly longer than that of the OPD group (241.13±77.24) min. The intraoperative blood loss 300.00(200.00, 400.00) ml was also significantly less than the OPD group 400.00(262.50, 500.00) ml, and the length of postoperative stay in the LPD group (12.21±5.24) d was significantly less than the OPD group (16.61±6.63) d, (all P<0.05). There were 36 patients (29.51%) in the LPD group and 81 patients (30.68%) in the OPD group who developed postoperative complications, with no significant difference between groups ( P>0.05). Postoperative oncology outcomes showed that the number of lymph nodes dissected in the LPD group was significantly more than that in the OPD group [(12.65±5.03) vs (10.07±5.09)], ( P<0.05). There were no significant differences between the two groups in tumor pathology type, size, degree of differentiation and R 0 resection rates (all P>0.05). All patients were followed up for 6-36 months, with a median follow-up of 20 months. The survival rates of patients with malignant tumors after following-up for more than 1 year in the LPD group was 84.72%(61/72), that in the OPD group was 85.81%(133/155), with no significant difference between groups ( P>0.05). Conclusion:LPD was safe and feasible with its advantages of minimally invasiveness.
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Mechanical ventilation is an importmant life-sustaining treatment for patients with acute respiratory distress syndrome. Its clinical outcomes depend on patients' characteristics of lung recruitment. Estimation of lung recruitment characteristics is valuable for the determination of ventilatory maneurvers and ventilator parameters. There is no easily-used, bedside method to assess lung recruitment characteristics. The present paper proposed a method to estimate lung recruitment characteristics from the static pressure-volume curve of lungs. The method was evaluated by comparing with published experimental data. Results of lung recruitment derived from the presented method were in high agreement with the published data, suggesting that the proposed method is capable to estimate lung recruitment characteristics. Since some advanced ventilators are capable to measure the static pressure-volume curve automatedly, the presented method is potential to be used at bedside, and it is helpful for clinicians to individualize ventilatory manuevers and the correpsonding ventilator parameters.
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Humans , Lung , Positive-Pressure Respiration , Respiration, Artificial , Respiratory Distress Syndrome, Newborn , Ventilators, MechanicalABSTRACT
Objective:To compare the short-term outcomes of patients undergoing laparoscopic pancreaticoduodenectomy (LPD) and those with open pancreaticoduodenectomy (open pancreatiloduodenectomy, OPD).Methods:The clinical data of 85 patients with LPD and 103 patients with OPD at our hospital from Jun 2017 to Jun 2019 were analyzed retrospectively.Results:There was no significant difference in clinical data and between the two groups ( P>0.05). Compared with OPD group, the operation time in LPD group was longer [(407.6±117.4) min vs. (220.8±23.9) min]( P<0.05), but the intraoperative blood loss was less [(285.1±21.9) ml vs. (550.5±65.5) ml]( P<0.05). There was more lymph node dissection (13.5±1.4 vs. 8.8±0.6) ( P<0.05), earlier feeding per month ( P<0.05), shorter time for the use of analgesia and hospital stay ( P<0.05). There was no significant difference in the incidence of postoperative complications such as pancreatic fistula, biliary fistula, gastroparesis and intra abdominal bleeding ( P>0.05). Conclusions:LPD is as safe and reliable as OPD, LPD has the advantages of more precise display during operation, while less traumatic and quicker recovery after operation.
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Objective To investigate the clinical effect of three-dimensional laparoscopic splenectomy for massive splenomegaly secondary to liver cirrhosis.Methods The clinical data of 67 patients who underwent laparoscopic splenectomy for massive splenomegaly at Henan Province People's Hospital from Jan 2013 to Dec 2018 were collected.Results Operation time,volume of intraoperative blood loss and blood transfusion,number of patients with intraoperative blood transfusion,and conversion to laparotomy were in favor of 3D group,with statistically differences (t =12.900,18.255,19.711,x2 =10.747,0.685,P ＜ 0.05).Postoperative intraabdominal bleeding,pancreatic fistula,and postoperative hospital stay in 2D group were more than those in 3D group,with statistically differences (x2 =3.511,4.527,t =12.969,P ＜ 0.05).All patients were followed up for 5 to 60 months.Portal thrombosis occurred in 6 patients vs 5 patients,respectively (x2 =0.028,P ＞ 0.05) and resolved with oral coumarin.Conclusions Three-dimensional laparoscopic splenectomy can provide more realistic visual effects of surgical procedures and has an obvious advantage in laparoscopic splenectomy for massive splenomegaly secondary to liver cirrhosis.
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Objective To study the effects of different parenteral nutrition on acute inflammatory response,immune cells and lipid metabolism in patients after pancreaticoduodenectomy.Methods Eighty patients after pancreaticoduodenectomy were divided into study group and control group,with 40 cases in each group.Structural fat emulsion was used in study group and medium/long chain fat emulsion in control group.The changes of acute inflammation,immune cells and lipid metabolism were compared between the two groups.Results (1)The levels of C-reactive protein (CRP) and serum prostaglandin E2 (PGE2) in the two groups were significantly higher on the first day after operation than those before operation.The difference between the two groups was statistically significant (P ＜ 0.05).The level of CRP and PGE2 decreased to the preoperative level on the seventh day after operation,but the decline rate in the study group was significantly faster than that in the control group (P ＜ 0.05).(2) The levels of CD3 +,CD4 +,CD8 +,CD4 +/CD8 + in the study group were significantly higher than those in the control group (P ＜ 0.05).(3) After 3-7 days of intravenous parenteral nutrition infusion,the blood lipid level was significantly lower in study group (P ＜ 0.05).Conclusion Structural fat emulsion alleviates the inflammatory reaction in patients after pancreaticoduodenectomy,promotes the recovery of immunity,significantly reduces the level of blood lipids.
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Objective To evaluate the clinical application value of portal vein implantation pump for chemotherapy in patients with intrahepatic cholangiocarcinoma (ICC) after radical surgery.Methods The clinical data of 97 patients with ICC who underwent radical surgery in Henan People's Hospital from June 2012 to June 2016 were retrospectively analyzed.Results Among the 97 patients,14 patients received portal venous pump chemotherapy (portal group),33 patients received peripheral venous chemotherapy (peripheral group),and 50 patients did not receive postoperative chemotherapy (control group).There were no statistically significant differences in gender and age between the three groups.The results of survival analysis indicated that the disease-free survival (DFS) period and overall survival (OS) time in the portal group and the peripheral group were significantly better than that in control group (both P ＜ 0.05).In addition,despite the lack of statistical significance (P ＞ 0.05),for the control of intrahepatic metastasis,portal vein pump chemotherapy was better than that of systemic chemotherapy via peripheral vein,and almost all side effects of chemotherapy in the portal group were lower than those in the peripheral group.Conclusion Portal vein pump chemotherapy can improve the prognosis of intrahepatic bile duct patients,especially for the control of intrahepatic metastasis,and can reduce systemic side effects of chemotherapy.
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Objective:To investigate the clinical efficacy of laparoscopic radical resection of hilar cholangiocarcinoma.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 25 patients with hilar cholangiocarcinoma who were admitted to Henan Provincial People′s Hospital from January 2017 to July 2019 were collected. There were 16 males and 9 females, aged from 51 to 75 years, with a median age of 64 years. All the 25 patients underwent laparoscopic radical resection of hilar cholangiocarcinoma. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up using out-patient examination and telephone interview was performed to detect local recurrence and distant metastasis of patients up to December 2019. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were described as M (range). Count data were described as absolute numbers. Results:(1) Surgical situations: of the 25 patients, 15 patients in Bismuth typeⅠunderwent laparoscopic radical resection of hilar cholangiocarcinoma+ regional lymph node dissection+ Roux-en-Y choledocho-jejunostomy, 2 patients in Bismuth type Ⅱ underwent laparoscopic radical resection of hilar cholangiocarcinoma+ perihilar resection+ regional lymph node dissection+ Roux-en-Y choledochojejunostomy, 2 patients in Bismuth type Ⅲa underwent laparoscopic radical resection of hilar cholangiocarcinoma+ regional lymph node dissection+ right hemihepatectomy+ hepatic caudate labectomy+ Roux-en-Y choledochojejunostomy, 3 patients in Bismuth type Ⅲb underwent laparoscopic radical resection of hilar cholangiocarcinoma+ regional lymph node dissection+ left hemihepatectomy+ hepatic caudate labectomy+ Roux-en-Y choledochojejunostomy, 3 patients in Bismuth type Ⅳ underwent laparoscopic radical resection of hilar cholangiocarcinoma+ regional lymph node dissection+ hepatic caudate labectomy+ Roux-en-Y choledochojejunostomy. The operation time was (388±118)minutes, and volume of intraoperative blood loss was 200 mL(range, 50-2 000 mL). Six patients were treated with blood transfusion intraoperatively. The operation time of 2 patients in Bismuth type Ⅲa was 375 minutes and 465 minutes, and the volume of intraoperative blood loss was 200 mL and 1 000 mL, respectively; 1 case received blood transfusion. The operation time of 3 patients in Bismuth type Ⅲb was 410 minutes, 465 minutes, 501 minutes, and the volume of intraoperative blood loss was 300 mL, 400 mL, 450 mL, respectively; neither had intraoperative blood transfusion. The operation time of 3 patients in Bismuth type Ⅳ was 415 minutes, 560 minutes, 600 minutes, and the volume of intraoperative blood loss was 300 mL, 600 mL, 800 mL, respectively; 1 case had intraoperative blood transfusion. (2) Postoperative situations: of the 25 patients, 4 patients had grade Ⅰ complications, including 2 cases of biliary fistula (1 case in Bismuth type Ⅰ and 1 case in Bismuth type Ⅲa), 1 case of pulmonary infection (Bismuth type Ⅳ), and 1 case of postoperative liver insufficiency (Bismuth type Ⅲa), all of them were improved after conservative treatment. Results of postoperative pathological examination: bile duct adenocarcinoma and high-grade intraepithelial neoplasia were detected in 23 and 2 patients; there were 8 cases with nerve invasion, 3 cases with lymph node metastasis and no vascular thrombus. The duration of hospital stay and hospitalization expenses were 24 days (range, 10-45 days) and 9.4×10 4 yuan [range, (5.3-18.7)×10 4 yuan] for all the 25 patients; the above indicators were 36 days, 45 days, 15.1×10 4 yuan, 18.7×10 4 yuan for the 2 patients in Bismuth type Ⅲa, 15 days, 26 days, 33 days, 7.3×10 4 yuan, 11.5×10 4 yuan, 15.9×10 4 yuan for 3 patients in Bismuth type Ⅲb, 24 days, 39 days, 41 days, 12.1×10 4 yuan, 15.2×10 4 yuan, 16.7×10 4 yuan for the 3 patients in Bismuth type Ⅳ, respectively. (3) Follow-up: 25 patients were followed up for 2-36 months, with a median follow-up of 16 months. Of the 25 patients, 18 had no recurrence or metastasis, 2 patients in Bismuth type Ⅳ had extensive intraperitoneal metastasis, 1 patients in Bismuth type Ⅲa had trocar hole metastasis, and 4 patients died. Conclusions:Laparoscopic radical resection of hilar cholangiocarcinoma is safe and feasible. Surgeries should be selected strictly based on surgical indications and the Bismuth type.