Effect of Cesarean Section on the Severity of Postpartum Hemorrhage in Chinese Women: The Shanxi Study / 华中科技大学学报（医学）（英德文版）

Postpartum hemorrhage (PPH) is one of the most adverse obstetric outcomes.Our aim is to detect the risks of multilevel PPH in different cesarean section (CS) groups [including nulliparous CS with indications,nulliparous CS without indications,repeat cesarean (RC),vaginal birth after cesarean (VBAC),cesarean after vaginal birth (CAVB)].We conducted a retrospective cohort study,and the data on 127 145 women collected from January 2014 to May 2016 and from 35 tertiary hospitals in Shanxi province,China,were reviewed.Based on the measuring results of PPH,an ordered logistic regression model was used to analyze the adjusted PPH risks for each of the CS groups,and comparisons were drawn between them.Finally,a total of 99 066 nulliparous (77.92％) and 28 079 multiparous (22.08％) women were observed.The number of CS cases was 61 117,and the rate for CS was 48.07％.A total of 10 029 women did not show indications for CS and accounted for 16.41％ of the CS parturient,whereas 9103 women underwent a repeated cesarean,with a CS frequency of 14.89％.The number of VBAC cases was 989,whose rate was 9.88％ in prior CS women.The number (proportions) of PPH was 3658 (2.88％) in LI (PPH volume:≥900 and ＜1500 mL),520 (0.41％) in L2 (PPH volume:≥1500 and＜2100 mL),and 201 (0.16％) in L3 (PPH volume:≥2100 mL).The Ln (n=1,2,3,etc.) represented the increasing order of PPH severity.In the adjusted results,compared with spontaneous vaginal delivery (SVD) as the reference group,in the adjusted result for nulliparous,there was a decreased PPH risk in CS with indications (OR:2.32;CI:2.04-2.62),which was lower than that of CS without indications (OR:2.50;CI:2.01-2.96).The highest PPH risk in all subgroups (i.e.nulliparous and multiparous groups) was observed in the RC (OR:3.61;CI:3.16-4.17),which was nearly twice higher than that of the VBAC (OR:1.82;CI:1.33-2.52).CAVB (OR:1.03;CI:0.65-1.62) showed no significant difference with the reference group.Thus,we deemed that CS should be avoided in nulliparous pregnancies unless indicated,to prevent or reduce the rates for the use of RC or VBAC which are high risks of severe PPH to the parturient women.

Effect of Cesarean Section on the Severity of Postpartum Hemorrhage in Chinese Women: The Shanxi Study / 华中科技大学学报（医学）（英德文版）

Postpartum hemorrhage (PPH) is one of the most adverse obstetric outcomes.Our aim is to detect the risks of multilevel PPH in different cesarean section (CS) groups [including nulliparous CS with indications,nulliparous CS without indications,repeat cesarean (RC),vaginal birth after cesarean (VBAC),cesarean after vaginal birth (CAVB)].We conducted a retrospective cohort study,and the data on 127 145 women collected from January 2014 to May 2016 and from 35 tertiary hospitals in Shanxi province,China,were reviewed.Based on the measuring results of PPH,an ordered logistic regression model was used to analyze the adjusted PPH risks for each of the CS groups,and comparisons were drawn between them.Finally,a total of 99 066 nulliparous (77.92％) and 28 079 multiparous (22.08％) women were observed.The number of CS cases was 61 117,and the rate for CS was 48.07％.A total of 10 029 women did not show indications for CS and accounted for 16.41％ of the CS parturient,whereas 9103 women underwent a repeated cesarean,with a CS frequency of 14.89％.The number of VBAC cases was 989,whose rate was 9.88％ in prior CS women.The number (proportions) of PPH was 3658 (2.88％) in LI (PPH volume:≥900 and ＜1500 mL),520 (0.41％) in L2 (PPH volume:≥1500 and＜2100 mL),and 201 (0.16％) in L3 (PPH volume:≥2100 mL).The Ln (n=1,2,3,etc.) represented the increasing order of PPH severity.In the adjusted results,compared with spontaneous vaginal delivery (SVD) as the reference group,in the adjusted result for nulliparous,there was a decreased PPH risk in CS with indications (OR:2.32;CI:2.04-2.62),which was lower than that of CS without indications (OR:2.50;CI:2.01-2.96).The highest PPH risk in all subgroups (i.e.nulliparous and multiparous groups) was observed in the RC (OR:3.61;CI:3.16-4.17),which was nearly twice higher than that of the VBAC (OR:1.82;CI:1.33-2.52).CAVB (OR:1.03;CI:0.65-1.62) showed no significant difference with the reference group.Thus,we deemed that CS should be avoided in nulliparous pregnancies unless indicated,to prevent or reduce the rates for the use of RC or VBAC which are high risks of severe PPH to the parturient women.

Impact of oral anti-hepatitis B therapy on the survival of patients with hepatocellular carcinoma initially treated with chemoembolization / 癌症

<p><b>INTRODUCTION</b>Most hepatocellular carcinomas (HCC) develop in a background of underlying liver disease including chronic hepatitis B. However, the effect of antiviral therapy on the long-term outcome of patients with hepatitis B virus (HBV)-related HCC treated with chemoembolization is unclear. This study aimed to evaluate the survival benefits of anti-HBV therapy after chemoembolization for patients with HBV-related HCC.</p><p><b>METHODS</b>A total of 224 HCC patients who successfully underwent chemoembolization were identified, and their survival and other relevant clinical data were reviewed. Kaplan-Meier and Cox regression analyses were performed to validate possible effects of antiviral treatment on overall survival (OS).</p><p><b>RESULTS</b>The median survival time (MST) was 15.9 (95% confidence interval [CI], 9.5-27.7) months in the antiviral group and 9.6 (95% CI, 7.8-13.7) months in the non-antiviral group (log-rank test, P = 0.044). Cox multivariate analysis revealed that antiviral treatment was a prognostic factor for OS (P = 0.008). Additionally, a further analysis was based on the stratification of the TNM tumor stages. In the subgroup of early stages, MST was significantly longer in the antiviral-treatment group than in the non-antiviral group (61.8 months [95% CI, 34.8 months to beyond the follow-up period] versus 26.2 [95% CI, 14.5-37.7] months, P = 0.012). Multivariate analysis identified antiviral treatment as a prognostic factor for OS in the early-stage subgroup (P = 0.006). However, in the subgroup of advanced stages, MST of the antiviral-treated group was comparable to that of the non-antiviral group (8.4 [95% CI, 5.2-13.5] months versus 7.4 [95% CI, 5.9-9.3] months, P = 0.219). Multivariate analysis did not indicate that antiviral treatment was a significant prognostic factor in this subgroup.</p><p><b>CONCLUSION</b>Antiviral treatment is associated with prolonged OS time after chemoembolization for HCC, especially in patients with early-stage tumors.</p>

Clinical observation of sorafenib monotherapy in Chinese patients with advanced hepatocellular carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To observe the efficacy and safety of sorafenib monotherapy in Chinese patients with advanced hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>Thirty-eight patients with advanced HCC of Child-Pugh status A or B were included in this study. Patients received orally administered sorafenib at a dose of 400 mg twice a day on a continuous schedule. Adverse events were documented. The efficacy and safety were evaluated every four to six weeks.</p><p><b>RESULTS</b>During the treatment, partial response (PR) was observed in 1 patient (2.6%), minor response (MR) in 5 (13.2%), stable disease (SD) in 16 (42.1%), and progressive disease (PD) in 16 (42.1%), respectively. The median oral administration time of sorafenib was 180 days (range, 15-550 d), and the mean overall survival was 370 days (range, 42-562 days). The median response duration was 169 days (range, 42-426 days). The mean overall survival of 22 patients with controlled disease (PR + MR + SD) was 428 days (95% CI 330-526 days). The most frequent adverse events were dermal reaction (27 cases, 71.1%), gastrointestinal reaction (25 cases, 65.8%), and constitutional symptoms (14 cases, 36.8%). Most of the drug related adverse events were mild and easily to manage and reversible.</p><p><b>CONCLUSION</b>Sorafenib monotherapy is effective and tolerable in a part of Chinese patients with advanced hepatocellular carcinoma and liver function of Child-Pugh A or B, and may prolong their survival.</p>

Experience of radiofrequency ablation on liver malignancies: a report of 803 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the 8-year experience of radiofrequency ablation (RFA) on liver malignancies and explore the effect and prognostic factors.</p><p><b>METHODS</b>From August 1999 to February 2007, 803 patients with liver malignancies, among which there were 672 with primary liver cancer (PLC) and 131 with liver metastasis, were treated with RFA. There were 781 cases who were performed percutaneously under the guidance of ultrasound, 8 cases under CT, 9 cases with laparoscopy and 5 cases with laparotomy. And there were 117 cases who were treated by RFA combined with percutaneous ethanol injection and 108 cases by RFA combined with trans-catheter arterial chemoembolization.</p><p><b>RESULTS</b>In the treatment of all the 803 patients with liver malignancies, the mortality was 0.25%, the rate of severe complications was 0.37%. The rate of complete ablation was 92.5%, the loco-recurrence rate was 13.8% and the 1, 2, 3, 4, 5-year survivals were 95.1%, 85.6%, 75.7%, 60.7% and 47.5%, respectively. For the 672 patients with PLCs, the 1, 2, 3, 4, 5-year survivals with stage Ia (Chinese staging system) were 97.8%, 91.5%, 84.6%, 77.1% and 61.9%, respectively, with stage Ib were 93.9%, 83.7%, 69.8%, 45.1% and 42.2%, respectively, with stage II were 86.2%, 67.3%, 47.3%, 17.2% and 0, respectively, and the 1, 2-year survivals with stage III were 67.8% and 0, respectively (P < 0.01).</p><p><b>CONCLUSIONS</b>RFA is a safe and effective method for liver malignancy, and the tumor size and stage are important prognostic factors.</p>

Effects of radix Astragali injection on apoptosis of lymphocytes and immune function in patients with systemic lupus erythematosus / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the effect of Radix Astragali Injection on apoptosis of lymphocytes and immune function in treating patients with systemic lupus erythematosus (SLE).</p><p><b>METHODS</b>Eighty SLE patients were randomly assigned into the routine treatment group (RT) treated with conventional therapy and the Radix Astragali treated group (RA) treated with Radix Astragali Injection besides routine treatment. The expressions of Fas and Bcl-2 antigen on lymphocytes and the changes of T lymphocyte subsets in peripheral blood before and after treatment were observed.</p><p><b>RESULTS</b>After treatment, the expression of Fas antigen on lymphocytes significantly lowered (P < 0.01), and that of Bcl-2 antigen, CD4+ lymphocyte subset and CD4+ / CD8+ ratio significantly increased in both groups (all P < 0.01). However, the changes of Fas antigen expression, CD4+ and CD4+ / CD8+ ratio were more significant in the RA group than those in the RT group (P < 0.05).</p><p><b>CONCLUSION</b>Radix Astragli Injection can enhance the inhibitory function of corticosteroid/immunosuppressant on apoptosis, and regulate the ratio and function of T lymphocyte subsets to normal range, which may be a useful approach for enhancing the efficacy of treatment to SLE.</p>

Clinical treatment of small hepatocellular carcinoma / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the suitable treatment methods of small hepatocellular carcinoma (SHCC).</p><p><b>METHODS</b>From 2000 to 2004, 849 cases of SHCC (< or = c5 cm) were enrolled and divided into two groups: resection group (n = 406) and minimally invasive treatment (MIT) group (n = 443). The survival rates, recurrence rates, and post-treatment complications were compared retrospectively.</p><p><b>RESULTS</b>The 3-year survival rate in the resection group was 72.1%. The 3-year survival rates in tumor < or = 3 cm and tumor 3-5 cm of resection group were 73.3% and 70.5% (P = 0.46), respectively. The 1-year, 2-year, and 3-year recurrence rates in resection group were 13.5%, 29.9%, and 39.8%, respectively. The 3-year survival rates in MIT group was 73.8%. The 3-year survival rates in tumor < or = 3 cm and tumor 3-5 cm of MIT group were 74.7% and 72.2% (P = 0.45), respectively. The 1-year, 2-year, and 3-year recurrence rates in MIT group were 12.6%, 28.7%, and 40.4%, respectively. The 3-year survival rate was significantly different between these two group in tumor < or = 3 cm (P < 0.05). The post-treatment complication rates of these two group were 30.8% and 6.1% (P < 0.01), respectively.</p><p><b>CONCLUSIONS</b>MIT is as effective as the traditional resection in SHCC. However, MIT is superior to the traditional resection in terms of minimal invasion and less post treatment complication rate. The recurrence rate of HCC was still high after treatment. Comprehensive therapies, including MIT, may increase the survival rate and life quality in SHCC patients.</p>

Variance of cost-effectiveness when treat different acute myocardial infarction with different pattern / 中华急诊医学杂志

Objective To investigate the variance of cost-effectiveness when treat acute myocardial infaretion of different severe extents with different pattern.Methods Acute myocardial infarction patients were selected from emergency eommand center of Guangzhou from October 2003 to December 2005.These patients wew assigned by the center to First-Class Hospitals at Grade 3 and First-class Hospital at Grade 2,and were followed up after 6 months after post-discharge.Cost in hospital and mortality in hospital were registered.The health of all patients were quantificated using SF-36.According to the assigned hospitals,the patients were divided into single infarction group and complex infarction group.Cost in hospital,mortality in hospital,short-term quality of life were compared between the them.Results Compared with and First-Class Hospital at Grade 2 (101 cases),the single infarction patients in First-Class Hospitals at Grade 3 had higber costs in hospital (P=0.016),better society function,affection role,mental health and health status (P