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Objective To compare the efficacy of operative and non-operative methods in the treatment of severe thoracic trauma in Tibetan Plateau.Methods A retrospective case-control study was conducted to analyze 286 patients with severe thoracic trauma admitted to the Shigatse People's Hospital from August 2016 to October 2018.There were 206 males and 80 females,aged 13-71 years [(34.3 ±11.6) years].The duration from injury to hospital ranged from 2 to 49 hours [(22.8 ± 8.3) hours].The causes of injury including fall from height in 109 patients,traffic injury in 98,crush injury in 32,blunt injury in 29,cattle head injury in 9,knife stab injury in 6 and other causes in 3.The injury severity score (ISS) varied from 16 to 48 points on admission [(24.2 ± 8.8) points].A total of 159 patients underwent operation (Operation group) and 127 patients underwent non-operative treatment (Non-operation group).The ISS score was (25.2 ± 8.3)points in Operation group and (23.7 ±7.9)points in Non-operation group.The length of hospital stay,intensive care unit (ICU) care time,complication rate and mortality were recorded in two groups.The correlation of ISS and age with mortality was investigated.Results The length of hospital stay was (12.2 ± 3.8) days in the Operation group and (19.7 ± 5.8) days in the Non-operation group (P ＜ 0.05).In the Operation group,27 patients were admitted to the ICU and stayed for (4.7 ± 1.3)days,and in the Non-operation group 33 patients were admitted to the ICU and stayed for (11.7 ± 3.2) days (P ＜ 0.05).The complication rate was 17.6％ in the Operation group and 31.5％ in the Non-operation group (P ＜0.05).Two patients died in the Operation group,with the mortality rate of 1.3％;six patients died in the Non-operation group,with the mortality rate of 4.7％,with no statistical difference (P ＞ 0.05).There were statistically significant differences in the age of death between the Operation group and the Non-operation group (P ＜ 0.05).The differences in the ISS score and age between the survival and death patients within the two groups were statistically significant (P ＜0.05).Logistic regression analysis showed age (OR =1.090,95％ CI 1.002-1.186) and ISS (OR =1.058,95％ CI 1.027-1.090) were slqnificantly related to mortality.Conclusions For severe thoracic trauma in Tibetan Plateau,operative treatment can shorten the length of hospital stay and ICU care time and reduce the incidence of complications.The mortality ratio of the two groups has no significant difference.Age and ISS may be the high risk factors for death of severe thoracic trauma patients.
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Objective To explore the application value of modified self-traction Overlap method in intrathoracic esophagogastrostomy of Ivor Lewis surgery.Methods The retrospective and descriptive study was conducted.The clinical data of 12 patients with lower esophageal carcinoma who underwent Ivor Lewis surgery in the Zhongshan Hospital of Fudan University from January to May 2018 were collected.There were 9 males and 3 females,aged from 50 to 73 years,with a median age of 61 years.Modified self-traction Overlap method was used for intrathoracic esophagogastrostomy during the surgery.The esophagus was pulled down with the ligature as traction and rotated clockwise by 45 degrees to perform side-to-side esophagogastric anastomosis.The common opening was closed by a laparoscopic linear cutting suturing device to form an esophagogastric Overlap triangle anastomosis,and finally the esophagus was disconnected.Observation indicators:(1) intraoperative and postoperative situations;(2) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect survival situation and tumor recurrence and metastasis up to January 2019.Measurement data were described as M (range).Results (1) Intraoperative and postoperative situations:all the 12 patients underwent successful Ivor Lewis surgery,without conversion to open surgery.The operation time,time of tubular gastroesophageal anastomosis,volume of intraoperative blood loss,time to initial anal exsufflation and time for initial fluid diet intake were 145 minutes (range,125-189 minutes),20 minutes (range,16-35 minutes),98 mL (range,78-135 mL),4 days (range,3-5 days),6 days (range,5-7 days),respectively.All the patients had no complication.Patients underwent upper gastrointestinal iodine hydrography at 5 days after surgery,confirming no anastomotic leakage or stenosis.Patients recovered well and were discharged postoperatively.The duration of postoperative hospital stay was 8 days (range,7-11 days).(2) Follow-up situations:12 patients were followed up for 8.0-12.0 months,with a median time of 10.6 months.Patients survived well,with no tumor recurrence or metastasis.Condusion Modified self-traction Overlap method in thoracic esophagogastrostomy of Ivor Lewis surgery is safe and feasible for lower esophageal carcinoma,with easy operating
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BACKGROUND@#The incidence and the mortality of lung cancer rank first among all malignant tumors and it seriously affects human health. The common types of non-small cell lung cancer (NSCLC) are adenocarcinoma and squamous carcinoma with clinical research and more attention, while adenosquamous carcinoma is a rare pathological subtype of lung cancer, which clinical features and prognostic factors are not yet fully understood. The purpose of this study is to analyze the clinical features and prognosis of lung adenosquamous carcinoma, and construct a nomogram to predict the patients' prognosis.@*METHODS@#We obtained the data of adenosquamous carcinoma patients diagnosed between 2010 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database of the United States, and compared their clinical features and prognosis with those of lung adenocarcinoma and lung squamous cell carcinoma patients in the same period. Then we used univariate and multivariate analyses to explore the independent prognostic factors of adenosquamous carcinoma. Finally, we constructed and validated a nomogram to visually predict the outcomes of lung adenosquamous carcinoma.@*RESULTS@#1,453 patients with lung adenosquamous carcinoma were finally included. Compared with patients with lung adenocarcinoma and lung squamous cell carcinoma, the distributions of lung adenocarcinoma patients in most of the variables were medium between lung adenocarcinoma and squamous cell carcinoma. The prognosis of adenosquamous carcinoma was better than that of lung squamous cell carcinoma, but worse than that of lung adenocarcinoma. Multivariate analysis showed that age, differentiation, tumor-node-metastasis (TNM), surgery, and chemotherapy were independent prognostic factors (all P were less than 0.001). We constructed a nomogram with a C-index of 0.783 (0.767-0.799). The distinction test and consistency test showed that the nomogram could predict the patient's prognosis effectively.@*CONCLUSIONS@#Lung adenosquamous carcinoma has unique clinical, pathological, and prognostic characteristics. Age, differentiation, T, N, M, surgery, and chemotherapy status are independent predictors of prognosis in patients with adenosquamous carcinoma. Our nomogram can efficiently predict the prognosis of patients.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma, Adenosquamous , Diagnosis , Epidemiology , Pathology , Therapeutics , Databases, Factual , Lung Neoplasms , Diagnosis , Epidemiology , Pathology , Neoplasm Staging , Prognosis , Survival AnalysisABSTRACT
Objective To investigate the effects of quetiapine on serum levels of brain-derived neurotrophic factors ( BDNF) and the correlation between BDNF and psychiatric symptoms and cognitive function in patients with first-episode schizophrenia. Methods Eighty patients with first-episode schizophrenia ( treatment group) were treated with quetiapine orally for 4 weeks,at initial dose of 100 mg·d-1 and average dose of (580±120) mg·d-1 . The psychiatric symptoms were evaluated by using the positive and negative syndrome scale ( PANSS) . The cognitive function was assessed by using Wisconsin cards sort test ( WCST) . The serum BDNF level was detected with enzyme-linked immunosorbent assay ( ELISA) . Results The serum level of BDNF was markedly lower in schizophrenic patients before[(13. 72±8. 79) ng·mL-1,P<0. 01] and after treatment[(18. 02±9.06) ng·mL-1,P<0.05]in comparison with normal controls(23. 67±10. 13) ng·mL-1]. After treatment,the PANSS total scores and subscale scores decreased,WCST number of categories and the number of correct answers increased,and the number of wrong answers reduced. There was a positive correlation between the serum BDNF and negative symptoms ( SANS) ( r= 0. 54, P=0. 032),and the number of correct answers. Conclusion The quetiapine significantly increases serum level of BDNF in schizophrenia patients,which correlates positively with improvements in symptoms and cognitive function.
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Objective To study the application of the combined detection of Golgi glycoprotein 73(GP-73),phosphatidylinositol proteoglycan 3(GPC3 )and percentage of AFP heteroplasmon(AFP-L3%)in the diagnosis of primary hepatocellular carcinoma (PHC).Methods The concentrations of GP-73,GPC3 and AFP-L3 were detected by enzyme-linked immunosorbent assay(ELISA) in 154 patients with PHC(PHC group),78 patients with cirrhosis(cirrhosis group)and 56 healthy subjects(control group).Then the detection results were statistically analyzed.Results The levels of GP-73,GPC3 and AFP-L3% in the PHC group were signifi-cantly higher than those in the liver cirrhosis group and the control group(P <0.05).The positive rates of GP-73,GPC3 and AFP-L3% in the PHC group were 66.2%,72.1% and 53.2% respectively.The positive rate in the combined detection of these three in-dices could reach 97.9%,which was higher than the sensitivity and accuracy in any single index detection and the combination de-tection.In the PHC group,the comparison between different levels of GP-73 and AFP-L3% with the AFP levels showed the statis-tically significant difference(P <0.05 ).Conclusion The combination detection of GP-73,GPC3 and AFP-L3% can improve the sensitivity and accuracy for diagnosing PHC and has reference significance in the differential diagnosis of early PHC.
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Objective To evaluate the clinical significance of combined detection of phosphatidyhnositol 3 proteoglycans (GPC3) and alpha-fetoprotein heterogeneity (AFP-L3) and total bile acids (TBA) in diagnosis of primary hepatocellular carcinoma.Methods Collected 154 cases of primary hepatocellular carcinoma patients (hepatocellular carcinoma group) and 78 cases of cirrhosis patients (cirrhosis group) and 56 normal controls (control group) from May 2011 to December 2012.The level of GPC3,AFP-L3 was measured by enzyme-linked immunosorbent assay,the level of alpha-fetoprotein (AFP) was determined by mdioimmunoassay,and the level of TBA was measured by enzymatic cycle,and they were compared.Results The level of GPC3,AFP-L3 and TBA was (10.70 ± 3.10) μ g/L,(338.60 ± 379.20) μ g/L,(79.91 ± 70.64) μ mol/L in hepatocellular carcinoma group,which was higher than that in cirrhosis group [(2.70 ±0.71) μg/L,(6.45 ±2.79) μg/L,(33.10 ±21.90) μmol/L] and control group [(1.28 ± 0.60) μ g/L,(0.68 ± 0.56) μ g/L,(5.40 ± 2.20) μ mol/L],the level of GPC3,AFP-L3 and TBA in cirrhosis group was higher than that in control group,and there was significant difference (P＜ 0.01).The sensitivity of three tumor markers combined detection was 97.2％ (280/288),which was significantly higher than that of individual detection of GPC3 (72.1％,111/154),AFP-L3 (53.2％,82/154),TBA (94.8％,146/154),the difference was statistically significant (P ＜ 0.01).Conclusion Serum GPC3,AFP-L3 and TBA combined detection can improve the sensitivity of primary hepatocellular carcinoma and has important chnical significance in early diagnosis of primary hepatocellular carcinoma.
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Objective:To investigate the expression of human epidermal growth factor receptor 4 (HER4) and metastasis-related protein (MMP-9) in human esophageal carcinoma tissues, and their relationship with clinicopathological features of the disease. Methods:Immunohistochemical Envision technique was applied to detect the expressions of HER4 and MMP-9 in 45 specimens of esophageal carcinoma tissues, paracancerous tissues and normal tissues. Statistical method was used to analyze the association of the positivity of HER4 with clinical pathological index and MMP-9 expression.Results:The positive rates of HER4 expression were 73.3%, 33.3%, and 2.2% in 45 specimens of esophageal carcinoma tissues, paracancerous tissues, and normal tissues, respectively. The expression of HER4 was correlated with TNM stage and lymph node metastasis (P0.05). The expression of MMP-9 correlated with T stage, invasion depth, TNM stage, and lymph node metastasis (P<0.05). Conclusion:The expression of HER4 is apparently different in esophageal carcinoma tissues, paracancerous tissues, and normal tissues. Its positive expression in esophageal carcinoma tissues is correlated with TNM stage and lymph node metastasis. The expression of MMP-9 in esophageal carcinoma tissues is correlated with the T stage, TNM staging, and lymph node metastasis. The positive expression of HER4 in esophageal carcinoma tissues is associated with the expressions of MMP-9.
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Objective To investigate appropriate diagnosis and treatment of solitary fibrous tumor of the pleura (SFTP).Methods Clinical and pathological data of ten patients treated in our hospital from 2002 to 2007 were reviewed. Results Our series consisted of three men and seven women. In two patients correct diagnosis was made before operation through ultrasonography-gnided core needle biopsy. All the patients were treated surgically including three resected by video-assisted thoracic surgery (VATS). Histopathologically, five tumors were malignant and the other five were benign. Immunohistochemical staining showed malignant SFTP (3/5) were less frequently positive for CD34 than benign group (5/5). Nestin was only detected in malignancies (2/5), which were negative for CD34. Except for one, all patients were followed-up for 6 to 35 months (mean 17.3 months). One patient experienced a recurrence and one died of brain metastasis. Conclusion Ultrasonography-guided core needle biopsy combined with immunohistochemical analysis is a safe and rapid method to provide a confirmatory diagnosis before surgery. For smaller, pedunculated tumors, VATS may be a bettor approach. Besides, we speculated CD34-negative and nestin-posifive might be a malignant marker for SFTP.