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Objective To investigate the independent risk factors for acute severe cholangitis and related protective factors, and to construct a risk prediction scoring model for acute severe cholangitis. Methods A retrospective analysis was performed for the clinical data of 381 patients with acute cholangitis who were admitted to Department of Hepatobiliary Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, from January 2016 to July 2021, among whom there were 273 patients with non-severe cholangitis and 108 patients with severe cholangitis. Univariate and multivariate logistic regression analyses were used to screen out the independent risk factors for acute severe cholangitis and related protective factors, and then a logistic regression model was established. The receiver operating characteristic (ROC) curve was used to evaluate the discriminatory ability of the model, the calibration curve was used to evaluate the prediction accuracy of the model, and decision curve analysis (DCA) was used to evaluate the clinical value of the model. Moreover, the enhanced Bootstrap method was used to perform internal validation of the model and evaluate the performance of the model in internal validation. The model was visualized by the construction of Web calculator, nomogram, and scoring system. The two-independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. Results The univariate and multivariate logistic regression analyses showed that total bilirubin (TBil) (odds ratio [ OR ]=1.014, 95% confidence interval [ CI ]: 1.009-1.020, P < 0.001), percentage of neutrophils ( OR =1.128, 95% CI : 1.088-1.175, P < 0.001), and age ( OR =1.053, 95% CI : 1.027-1.082, P < 0.001) were independent risk factors, and albumin (Alb) ( OR =0.871, 95% CI : 0.817-0.924, P < 0.001) was a protective factor. The above independent risk factors and protective factor were included in the logistic regression analysis for model fitting, and the predictive model obtained had an area under the ROC curve (AUC) of 0.925 (95% CI : 0.897-0.952), with a specificity of 0.817 and a sensitivity of 0.935 at the optimal cut-off value of 0.245. The calibration curve showed that the predicted probability of the model was approximately equal to the actual probability, with a Brier value of 0.098, and the decision curve analysis showed that the model had a higher net income within the threshold probability interval of 0.1-0.9. Internal validation showed an AUC internal validation of 0.915 and a Brier value internal verification of 0.106. Conclusion TBil, percentage of neutrophils, and age are independent risk factors for acute severe cholangitis, while Alb is a protective factor. The established risk prediction scoring model has good discriminatory ability, calibration, and clinical value and can identify patients with acute severe cholangitis at an early stage, which provides a reference for subsequent diagnosis and treatment.
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Objective:To evaluate radiofrequency ablation-assisted liver resection on early recurrence of hepatocellular carcinoma(HCC) with microvascular invasion (MVI).Methods:A total of 82 HCC patients from Jun 2015 to Jun 2020 were divided into assisted group ( n=41) and control group ( n=41) after local hepatectomy.And by pathology,both groups were further substratified into with or without MVI subgroups. Results:There was no statistically significant difference in the baseline data between two groups,nor there was difference in recurrence-free survival rate between the two groups ( χ 2=0.177, P=0.674). However, by subgroup analysis, the recurrence-free survival rate of ablation assisted group was higher than that of the simple local hepatectomy group among MVI positive patients ( χ 2=5.096, P = 0.024).Multivariate analysis showed that only tumor diameter ( HR=1.32, 95% CI: 1.02-1.72, P=0.036) was an independent risk factor for local recurrence at the incisal margin, while mode of operation ( HR=0.15 ,95% CI: 0.04-0.52 ,P=0.003) and MVI ( HR=8.65 ,95% CI: 2.19-34.19 ,P=0.002) were independent risk factors for intrahepatic distant metastasis. Conclusion:Local hepatectomy assisted by intraoperative radiofrequency ablation on hepatic cross section could effectively reduce the postoperative early recurrence rate for hepatocellular carcinoma patients with MVI.
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Objective:To investigate the expression of Macrophage migration-inhibitory factors (MIF) in hepatocellular carcinoma (HCC) tissues and its interaction with ERK1/2 signaling pathway, so as to establish a theoretical basis for further studying the molecular mechanism of MIF promoting HCC.Methods:From February 2020 to August 2021, 52 cases of hepatocellular carcinoma (HCC) tissues based on hepatitis B cirrhosis (HBV-LC) and 52 cases of adjacent tissues in Tianjin Medical University Cancer Hospital and 940th Hospital of Joint Logistic Support Force of PLA were collected as the experimental group, including 39 males and 13 females, aged 35-65 years. And 20 cases of normal liver tissue were selected as the control group. Immunohistochemistry was used to detect the expression of MIF, ERK1/2 and p-ERK1/2 proteins in liver tissues of the two groups, and in situ hybridization was used to detect the expression of ERK1/2 nucleic acid in liver tissues of the two groups.HepG2 HCC cells and L-02 normal hepatocytes were co-cultured with different concentrations of rMIF, the expression and phosphorylation levels of ERK1/2 and JNK1 proteins in the two kinds of liver cells were detected by Western-blot, and the expression levels of ERK1/2 nucleic acids in the two kinds of liver cells were detected by RT-PCR. One-way ANOVA was used for measurement data and χ 2 test was used for counting data. Results:The expressions of MIF, ERK1/2, p-ERK1/2 and ERK1/2 mRNA were significantly increased in HCC and para-cancer tissues (the expression of MIF in HCC group was 78.8%, and that in adjacent group was 75.0%; ERK1/2 80.8% in HCC group and ERK1/2 71.8% in paracancerous group. The expression of p-ERK1/2 75.0 % in HCC group and 46.2% in paracancerous group were respectively detected. ERK1/2 mRNA was expressed in HCC group 76.9%, ERK1/2 mRNA expression in paracancerous group 78.8%), and the differences were statistically significant compared with normal liver tissues ( P<0.05), but there was no significant difference between HCC and para-cancer tissues ( P>0.05). The expressions of ERK1/2, p-ERK1/2 and ERK1/2 mRNA in HepG2 HCC cells were significantly increased with the increase of rMIF concentration, and the increase was most obvious when rMIF concentration was 200 ng/ml, and the difference was statistically significant compared with L-02 normal hepatocytes ( P<0.05). Conclusion:MIF, ERK1/2 and p-ERK1/2 are highly expressed in HCC tissues and HepG2 HCC cells, suggesting that MIF promotes the occurrence and development of hepatocellular carcinoma through ERK1/2 signaling pathway.
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This paper summarized the the changes brought about by the Internet of things technology in the daily management of our dispensary from hardware upgrading, software updates, process optimization and other aspects. With the Internet of things technology, We can improve the efficiency of pharmaceutical care, reduce medical errors, control medical costs and improve the patient's medical experience. The Internet of things technology has certain application value in tradition Chinese medicine pharmacy of general hospital.
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Objective To evaluate the efficacy of interventional MRI in radiofrequency ablation (RFA)of breast cancer.Methods 12 patients with breast carcinoma proven by core-needle biopsy-were enrolled in this study.Among them, 7 patients were in phase Ⅳ(6 with lung metastasis, 1 with bone metastasis),and 5 patients were in phase Ⅲ(all of them rejected the surgical operation because of various contraindications,including severe hypertension,diabetes mellitus,liver or kidney dysfunction,and advanced age).Moreover, all of the tumor size could not be further shrunk after medical treatment (such as 4-6 cycles chemotherapy, endocrine therapy or targeted therapy).Additionally,breast lesions were still remained to be confirmed by imaging examination and biopsy pathology.Then the tumor and surrounding breast tissue were ablated with radiofrequency,followed by clinical follow-up and imaging examination after 1, 3, 6 and 12 months.Results All the patients completed 18 times RFA treatment.MRI showed that all the tumor lesions were necrotic, blood supply was disappeared and therewas no enhancement.Radiographic examination showed the original breast lesions were fuzzy or disappeared.All the tumors were achieved complete remission (CR) examined by imaging,and the effective rate was 100%.All the postoperative patients survived 1 year according to the follow-up data.Conclusion Interventional MRI is safe and effective method in the radiofrequency ablation of breast cancer.
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Objective To explore the expression of human epidermal growth factor receptor -3( HER3) in human epidermal growth factor receptor-2(HER2)-positive breast cancer and its relationship with the therapeutic effect of trastuzumab and clinical prognosis .Methods Clinicopathological characteristics of 235 HER2-positive breast cancer patients undergoing surgery in Jiangsu Cancer Hospital from Jan .2007 to Jun.2012 were analyzed retrospectively.The expression of HER3 was detected using immunohistochemisty staining .The expression of HER3 and its correlation with the clinicopathological characteristics were analyzed .All patients were followed-up to find out the impact of HER3 on the disease free survival and the therapeutic effect of trastuzumab .Results The positive rate of HER3 in Luminal B ( HER2 +) and HER2-overexpressing breast cancer was 100/135 (74.1%), and 85/100(85%)respectively.The difference had statistical significance (P<0.05).The histolog-ical grading and the lymph node metastasis were significantly different in Luminal B ( HER2+) breast cancer .The tumor volume , histological grading and lymph node metastasis were significantly different in HER 2-overexpressing breast cancer .The 5-year disease free survival of HER 2-positive breast cancer patients with negative HER 3 was higher than that with positive HER3.The non-relapse survival time was not significantly different between the pos-itive and negative HER 3 expression in Luminal B ( HER2+) breast cancer patients receiving trastuzumab treat-ment , but was significantly different in HER 2-overexpressing breast cancer patients .Conclusions HER3 is cor-related with unfavourable prognosis in HER 2-positive breast cancer .The treatment targeting HER3 may improve the clinical prognosis of both HER 2-positive and HER3-positive breast cancer patients .The HER2-overexpressing breast cancer patients with negative HER 3 may benefit more from trastuzumab treatment .
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Objective To investigate the compliance with endocrine therapy(ET) and assess the factors associated with treatment accuracy for breast cancer.Methods 379 patients with hormone receptor-positive breast cancer undergoing complete treatment from Jun.2006 to Jun.2008 in Jiangsu Cancer Hospital were followed up.Factors related to compliance were analyzed.Results Among the 322 (85.0％) patients successfully interviewed,15 (4.7％) patients did not receive ET,43 (13.4％) patients stopped taking drugs after discharge,14 (4.3％)patients had intermittent ET,and the rest 250 patients obeyed 5-year oral ET regularly.The treatment accuracy was 77.6％ (250/332).We found that majority of withdraw occurred within 2 months and within 2 years,accounting for 39.5％ and 48.8％,respectively.Job and education status were relevant to these patients.Moreover,too much concern of adverse drug effects and difficulty of long-term medication were the main reasons to noncompliance.Conclusions ET is effective in hormone receptor-positive breast cancer patients and has been used as a conventional therapy.However,due to the long therapeutic period and lack of medical supervision after discharge,its treatment accuracy and compliances are becoming low,resulting in decreased efficiency.It is therefore necessary to investigate such patients' management to improve the compliance and treatment accuracy of ET.
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Objective To explore the change of serum HER2/neu concentration during neoadjuvant chemotherapy for HER2-overexpressed breast cancer and its correlation with the response to the neoadjuvant chemotherapy.Methods The concentration of the serum HER2/neu in 78 cases of HER2-overexpressed advanced breast cancer treated with neoadjuvant chemotherapy were detected with enzyme-linked immunosordent assay(ELISA).The relationship between the serum HER2/neu concentration and the response of neoadjuvant chemotherapy was analyzed.Results The serum HER2/neu concentration of befor and after neoadjuvant chemotherapy was 18.6 ± 10.0ng/ml,11.6 ± 6.lng/ml respectively.The serum HER2/neu concentration decreased significantly(P ＜ 0.001).The response of neoadjuvant chemotherapy was correlated with the change of the serum HER2/neu concentration.The pathologic complete response was correlated with the serum HER2/neu concentration of prechemotherapy and the change of the serum HER2/neu concentration.Conclusion The change of serum HER2/neu concentration may serve as a marker predicting the response of neoadjuvant chemotherapy in HER2-overexpressed breast cancer.
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Objective To investigate the effect of immediate breast construction using prosthesi after nipple-areola-sparing mastectomy.Methods The immediate breast construction using prosthesi after nippleareola-sparing mastectomy was performed in 26 cases with breast cancer from January 2008 to December 2011 in Jiangsu Cancer Hospital.The postoperative cosmetic results and the complications were observed.The therapeutic effects were followed up.Results All operations were successful.The s,uperior rate of cosmetic result after one month according to JCRT was 88.5 ％ (23/26).No severe complication was found.After a median follow-up of 26 months (range 3-48 months),there was no recurrence and metastasis.Conclusion The immediate breast construction using prosthesi after nipple-areola-sparing mastectomy is maneuverable with satisfactory aesthetic result and the clinical effect,which deserves the further clinical application.
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Objective To summarize our experience on diagnosis and treatment of bilateral primary breast cancer (BPBC). Methods Clinicopathologic records, including clinical manifestations, diagnosis and immunohistochemical expressions of 16 patients with BPBC, treated from 2001 to 2009 in Jiangsu Provincial Cancer Hospital, were analyzed retrospectively. Results The 16 patients with BPBC accounted for 0.47% of all patients diagnosed as malignant tumors of breast during the same period in our hospital. All of the 16 patients were women, with the median age of 53 years (ranged 41-69 years). 7 patients were in bilateral synchronous breast cancer (BSBC), with the median age 47 years (ranged 41-54 years), among whom 5 patients got BSBC just before menopause. 9 patients were in bilateral asynchronous breast cancer (BABC), with the median age 58 years (ranged 43-69 years), among whom 1 patient got BABC before menopause. The median interval between the first and second breast carcinoma of BABC was 52 months (ranged 14-196 months). Conclusions Compared with BABC, the occurrence age of the patients with BSBC was smaller. BABC was more common in premenopausal women. The interval time of BABC was irregular. The active follow-up after the occurrence of contralateral breast cancer and endocrine therapy for estrogen receptor-positive patients were recommended.
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Objective: To sum up the therapeutic effect of early enteral nutrition(EN) in postoperative patients with esophageal or cardiac cancer.Methods: The clinical data of 106 postoperative patients with esophageal or cardiac cancer who had received early enteral nutrition treatment were analyzed retrospectively.Results: All the patients recovered well.The occurrence of the serious postoperative complication,such as anastomotic leak,hypoalbuminemia and so on had been decreased.Conclusion: Early EN for postoperative patients with esophageal or cardiac cancer is a physiological nutrition support way.EN can maintain gastrointestinal function and improve nutritional status.
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Objective To study the effect of mitochondrial permeability transition(MPT) after ischemia/reperfusion(I/R), and to find the relationship between MPT and apoptosis of hepatocytes in rats. Methods SD rats were divided into three groups:sham operation group, I/R group, and I/R+CsA group. A model of hepatic I/R in rats was made according to the method of Nauta. Active caspase-3 in cytoplasm was examined by immunohistochemistry, and the content of cytochrome C protein was evaluated by Western blotting. The incidence of apoptic hepatocytes was determined by TUNEL method. Cyclosporine A(10 mg?kg -1?d -1) was used as an inhibitor of MPT owing to its inhibitive effect on mitochondrial permeability transition pore(PT pore), and the influences of CsA were analyzed. Results Pretreated with CsA ameliorated injury after reperfusion. The number of apoptotic liver cells was decreased. CsA significantly prevented the release of cytochrome C from mitochondria, demonstrating its effect on MPT through preventing PT pore from opening. Conclusion MPT may play a key role in the apoptosis of liver cell after I/R. CsA, a powerful inhibitor of PT pore, is capable of abating the effect of MPT, reducing the release of cytochrome C, retarding the activation of caspase-3 and hence ameliorates apoptosis of hepatocytes following I/R procedure.
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<p><b>OBJECTIVE</b>To investigate the possibility and short-term effect of high dose chemotherapy with peripheral blood stem cell support in the preoperative therapy of breast cancer, and-its influence on the following operation and would healing.</p><p><b>METHODS</b>Three patients with T(3)N(1)M(0) (III(a)), T(4)N(1)M(0) (III(b)), T(4)N(1)M(1) (IV) of breast cancer were diagnosed histopathologically. After receiving HDC/APBSCT, the 3 patients were operated on. HDC/APBSCT process included 2 cycles of FEC induction chemotherapy; PBSC mobilization, APBSC collection and cryopreservation and PBSC infusion; and high-dose chemotherapy, APBSC infusion and supportive therapy. The therapy consisted of CTX2.5 g/m(2), VP-16 600 mg/m(2), and cerboplatin 600 mg/m(2) delivered on day 1, APBSC infusion 48 h later, rhG-CSF (150 microg, BID) was administered 4 h after infusion of APBSC until WBC was higher than 10 x 10(9)/L. During HDC/APBSCT, the patients were protected in the air laminar flow room with supportive therapy of antibiotics, anti-virus and anti-fungus drugs. They left the air laminar flow room after their WBC was greater than 2 x 10(9)/L. Case 1 was treated by radical mastectomy, Case 2 by improved radical mastectomy, Case 3 by improved radical mastectomy and transplantation of skin for the large area.</p><p><b>RESULTS</b>Rapid recovery of bone marrow function was observed in all 3 patients. Operation was performed 4 weeks after HDC/PBSCT in Cases 1, 2 and 33 days in Case 3. No influence was seen on operative procedure and would healing, especially in Case 3 with a large area of skin transplantation. Two patients with stage III(a) and III(b) have been alive since the treatment for 30 months and the other with stage IV died of brain metastasis 16 months later.</p><p><b>CONCLUSIONS</b>HDC/APBSCT as a preoperative therapy for breast cancer has no influence on the coming surgery and would healing, even on skin transplantation for a large area. It has a practical response in stage III(a) and III(b), but it is still controversial in stage IV. This method as a salvage therapy for patients with breast cancer of intemuediate or stage.</p>
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Adult , Female , Humans , Middle Aged , Antineoplastic Combined Chemotherapy Protocols , Therapeutic Uses , Breast Neoplasms , Therapeutics , Combined Modality Therapy , Hematopoietic Stem Cell Transplantation , Mastectomy, Radical , Neoplasm Staging , Preoperative Care , Salvage TherapyABSTRACT
Objective To observe the serum VEGF/ES ratios before and after operation and at clinical relapse in patients with breast cancer, and to discuss the potential effect of tumor surgery and postoperative relapse on the angiogenesis balance. Methods The serum VEGF and ES levels of 59 cases of breast cancer before and after operation and at clinical relapse were determined using competitive enzyme immunoassays and ELISA, (respectively), and compared with the results of 30 cases of benign breast tumors and 59 cases of normal (controls). Results (1) Preoperatively, the serum ES and VEGF levels of breast cancer patients were (significantly) elevated, as compared to the other 2 groups, and the VEGF/ES ratio was 9.1. Postoperatively, at 3 weeks, VEGF level decreased significantly and ES remained at a high level. The VEGF/ES ratio was (3.3). (2)At the time of clinical relapse, serum VEGF level was followed by marked elevation, and the VEGF/ES ratio increased up to 14.2. Multivariate analyses showed that the postoperative VEGF/ES ratio was an independent factor related to the postoperative recurrence of breast cancer. Conclusions Breast cancer surgery may affect the balance between serum VEGF and ES, and the determination of VEGF/ES ratio can have auxiliary value in the assessment of prognosis of breast cancer patients.
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Objective To evaluate the accuracy of sentinel lymph node biopsy (SLNB) in predicting the axillary lymph node status in breast cancer patients undergoing a breastectomy. Methods From Mar 2002 to Jun 2003,patent blue dye and/or 99m Tc-Sc were used to detect sentinel lymph nodes,samples were sent for fast pathology.Three patients in which the SLN were judged as negative by both the two tests were freed of futher axillary lymph node dissection (ALND). Results SLN were successfully identified in 78 of 81 (96.3%) patients. The accuracy rate of SLNB to predict axillary lymph node status was 97.5%,with 9.7% false negative rate. The success rate,accuracy rate and false negative rate by blue dye only and by a combination of two above methods were 92.5%,94.2%,15.8%,and 100%,100%,0, respectively . Conclusions SLNB accurately predict the axillary status in clinically node negative breast cancer patients .
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Objective To evaluate the effects of different surgical treatments on severe polycystic liver disease (SPLD). Methods A total of 22 patients with SPLD were surgically treated in our Department from December 1989 to July 1999. Of the patients, 5 were treated with the partial hepatic resection in combination with cyst fenestration (group A), 7 with laparotomic fenestration (group B), 4 with laparoscopic fenestration (group C) and 6 with puncture under the guidance of ultrasonography B (group D). The surgical outcome and long term follow up results were retrospectively analyzed. Results After the treatments, all the patients experienced immediate relief of symptoms. However, the follow up for an average of 3 years showed that 10 patients developed recurrence of the disease. The recurring rates were 0, 28.5%, 65.5% and 100% in groups A, B, C and D, respectively. Conclusions The approach of partial hepatic resection in combination with cyst fenestration is the most effective treatment for SPLD. Laparoscopic fenestration may not be an appropriate surgical way for treatment of SPLD.