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Objective To explore the relationship between the outpatient visits for adult asthma and air pollution in a tertiary hospital in Hefei. Methods The number of outpatient visits for asthma in a tertiary hospital in Hefei from 2014 to 2020 was collected. The air pollutant data was obtained through the Hefei Air Monitoring Station, and the meteorological indicators of the same period were collected through the China Meteorological Network. The R statistical software was used to establish a generalized additive model to analyze the lag effect of air pollution on the number of outpatient visits for asthma. Results From 2014 to 2020, there were 7 220 asthma outpatients in the tertiary hospital in Hefei, including 3104 males and 4 116 females, 3 798 patients in warm season, and 3 422 patients in cold season. During the period, the average concentrations of SO2, NO2, CO, O3, PM10, and PM2.5 were 11.9μg/m3, 40.1μg/m3, 0.9 mg/m3, 87.3μg/m3, 81.3μg/m3, and 55.7μg/m3, respectively. The results of the single-pollutant model showed that every 10μg/m3 increase in SO2 concentration increased the risk of asthma by 0.74% (95%CI: 0.22%-1.29%), and the effect was the greatest on Lag2 day. NO2 increased the risk of asthma by 0.31% (95%CI: 0.13%-0.49%), with the greatest effect on Lag0 day. The analysis of the dual pollutant model found that whereas the effect of SO2 decreased after the incorporation of NO2, the effect increased after the incorporation of CO, O3, PM10, or PM2.5, respectively. The effect of NO2 on asthma decreased after the incorporation of SO2, whereas the effect on asthma increased after the inclusion of CO, PM10, or PM2.5. Stratified analysis of cold and warm seasons showed that the effect of NO2 on asthma was the greatest in lag0 in cold season. The effect of SO2 was higher in cold season than in warm season, and it was the highest in lag2. The gender stratification analysis showed that the effects of SO2 and NO2 on male asthma were higher than those on females. Conclusion From 2014 to 2020, the increase of SO2 and NO2 concentrations in Hefei is positively correlated with the risk of asthma in the outpatient department of a tertiary hospital. The effect has a certain lag. It is of great significance to formulate relevant preventive measures for the occurrence and attack of asthma.
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Objective:To evaluate the feasibility of a predictire model composed of non-specific test indexes in early diagnosis of gastric cancer.Methods:From the database of electronic medical record system of Shanghai Changhai Hospital, a total of 24 615 case records were included from January 1, 2010 to April 30, 2019, including 10 497 cases of gastric cancer, 5 198 cases of precancerous diseases, and 8 920 cases of health examination. Through stratified random sampling, the study population was divided into validation set, training set and test set. After data processing and quality control for all laboratory variables, the optimal machine learning algorithm and diagnostic efficiency grouping were selected through four machine learning algorithms, induding the gradient boosting decision tree, random forest, support vector machine, and artificial neural network, and the data were trained by backward stepwise regression method to build the best feature model.Result:In this study, a diagnostic model V22 consisting of 22 routine testing parameters was established. V22 could distinguish early gastric cancer from control group composed of healthy group and precancerous disease, AUC was 0.808, the sensitivity was 85.7%, and the specificity was 91.9%. For CEA negative gastric cancer, V22 also showed high diagnostic accuracy, AUC was 0.801.Conclusion:V22 was a valuable model for the diagnosis of gastric cancer. V22 was an auxiliary diagnostic model of gastric cancer with clinical application value, which could well distinguish early gastric cancer from the control group composed of healthy group and precancerous disease, and the detection rate of early gastric cancer was better than the traditional tumor marker CEA.
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Objective:To investigate the difference of accuracy between magnetic induction Freehand-3D ultrasound and two-dimensional ultrasound in measuring the volume of thyroid model.Methods:Forty thyroid models were established using porcine liver, and the Archimedes procedure was set as gold standard in the measurement of the volume of each model. The accuracy of measurement of the porcine thyroid model volume between two-dimensional ultrasound and magnetic induction Freehand-3D ultrasound were compared.Results:There were no significant differences in the accuracy of measurements of thyroid model volume among two-dimensional ultrasound, magnetic induction Freehand-3D ultrasound and Archimedes procedure (all P>0.05). Compared with the Archimedes procedure, magnetic induction Freehand-3D ultrasonic method showed higher correlation coefficient of the measurement of thyroid model volume ( r=0.998). Bland-Altman analysis showed the lower measure error with a relative error of 3.42% and range of -9.57% to 12.07%. And the limits of agreement were (-1.253, 0.999) in the magnetic induction Freehand-3D ultrasonic measurement. Conclusions:Compared with two-dimensional ultrasound, the magnetic induction Freehand-3D ultrasound show higher accuracy in the measurement of the volume of the thyroid model.
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Objective:To explore the expression of GATA3 in breast cancer tissues and its correlation with pathological types of tumors and prognosis.Methods:The paraffin samples of breast cancer tissues and paraffin samples of normal para-cancerous tissues from 100 breast cancer patients who underwent surgical excision in Luanzhou People′s Hospital of Hebei Province from June 2014 to June 2017 were retrospectively analyzed. The expression of GATA3 in breast cancer tissues and normal para-cancerous tissues was detected by immunohistochemistry. And its significance in prognosis evaluation was analyzed. The survival rates of patients with different GATA3 expression were analyzed by Kaplan-Meier survival curves.Results:The positive expression rate of GATA3 in breast cancer tissues was significantly lower than that in normal para-cancerous tissues: 61.00% (61/100) vs. 86.00% (86/100), and there was statistical difference ( χ2 = 16.044, P<0.01). The positive expression rate of GATA3 was related with histological grading, lymph node metastasis, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER-2), P<0.05, and not related with age, TNM staging or tumor long diameter ( P>0.05). Multivariate Logistic regression analysis result showed that histological grading at gradeⅢ, positive HER-2 and lymph node metastasis were independent risk factors of GATA3 positive expression of breast cancer tissues in patients with breast cancer ( OR = 1.747, 2.699 and 1.730; 95% CI 1.107 to 2.758, 1.035 to 7.039 and 1.139 to 2.626; P<0.05). The 3-year survival rate in GATA3 positive patients was significantly higher than that in GATA3 negative patients: 86.89% (53/61) vs. 66.67% (26/39), and there was statistical difference ( P<0.05). Conclusions:The positive expression rate of GATA3 in breast cancer tissues is significantly lower than that in normal para-cancerous tissues. The expression level of GATA3 is related to pathological types of breast cancer, histological grading, lymph node metastasis, ER, PR and HER-2. The expression level of GATA3 is of certain significance in evaluating prognosis of patients.
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Objective:To evaluate the effect of dual-tube epidural segmental injection of lidocaine analgesia on the delivery outcome and maternal and infant complications of persistent posterior occipital position postpartum or lateral occipital position postpartum patients with protracted active phase.Methods:The full and single-term primiparas ( n=216, 37 to 42 weeks gestation, 22 to 35 years) diagnosed as persistent posterior or lateral occipital position during the active period were selected from the Department of Obstetrics of Qingdao Municipal Hospital from January 2015 to October 2019. The subjects were randomly assigned into two groups: double-tube epidural block group ( n=108) and single-tube epidural block group ( n=108), 1% lidocaine was used for epidural analgesia respectively under ultrasound guidance. Senior midwife or obstetricians implement new partogram, and guide women to perform position management, and push or rotate the fetal head in a timely manner. Observation indicators: general condition, the use of non-pharmacological analgesic measures, analgesia related conditions and pain visual analogue scale (VAS) score, delivery-related indicator, cesarean section indication, anesthesia-related indicator, maternal and child complications. Results:(1) General condition: the age, weight, height, gestational age, the ratio of persistent lateral or posterior occipital position, cephalic score, and neonatal birth weight between the two groups of women were not statistically significant (all P>0.05). (2) The use of non-pharmacological analgesic measures: the women’s Lamaze breathing method, Doula delivery companionship, percutaneous electrical stimulation, and other measures between two groups were compared, and there were not significant differences (all P>0.05). (3) Analgesia related conditions and VAS scores of women undergoing vaginal delivery: compared with the single-tube epidural block group ( n=40), the second-partum time of the women in the double-tube epidural block group ( n=59) was significantly shortened [(124±44) vs (86±33) minutes, P<0.01]; after 30 minutes of analgesia (4.4±0.5 vs 0.9±0.5, P<0.01), during forced labor in the second stage of labor (5.7±0.6 vs 1.3±0.4, P<0.01), the VAS scores of pain were also significantly reduced ( P<0.01). (4) Labor-related indicators: compared with the single-tube epidural block group, the natural delivery rate (21.3% vs 49.1%) and the delivery experience satisfaction rate (51.9% vs 98.1%) of women in the double-tube epidural block group were significantly increased (all P<0.01), cesarean section rate (63.0% vs 45.4%), instrument assisted rate (15.7% vs 5.6%) decreased significantly (all P<0.05). (5) Cesarean section indications: compared with the single-tube epidural block group, the cesarean section rate caused by prolonged labor or protracted active phase of women in the double-tube epidural block group was significantly reduced (38.0% vs 22.2%； P<0.05), and the fetal distress, intrauterine infection, and social factors caused by cesarean section between the two groups were compared, while the differences were not statistically significant (all P>0.05).(6) Anesthesia related indexes: the block planes of the maternal upper tube administration in the double-tube epidural block group were mostly T7, T8, T9-L2 and L3,While,the block planes in the single-tube epidural block group were mostly T10, T11-S1, S2, S3, and the modified Bromage score were all 0. (7) Maternal and child complications: compared with the single-tube epidural block group, the postpartum hemorrhage rate (18.5% vs 7.4%), the perineal lateral cut rate (20.4% vs 5.6%), the neonatal asphyxia rate (12.0% vs 3.7%), ICU rate of transferred neonates (13.9% vs 4.6%) in the double-tube epidural block group were significantly reduced (all P<0.05). Soft birth canal injury rate, puerperal disease rate and neonatal birth rate between two groups were compared, and there were not statistically significant differences (all P>0.05). Conclusion:Dual-tube epidural segmental injection of lidocaine analgesia could increase the natural delivery rate of women with posterior occipital or lateral occipital position with active stagnation, reduce the rate of cesarean section and the rate of transvaginal instruments, and reduce the complications of mother and child.
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Objective:To construct a computed tomography (CT)-based radiomics model for predicting tumor recurrence of early-stage hepatocellular carcinoma (HCC) after resection, and explore its application value.Methods:The retrospective cohort study was conducted. The clinicopathological data of 243 patients with early-stage HCC who underwent hepatectomy in 2 medical centers between January 2009 and December 2016 were collected, including 165 in the First Affiliated Hospital of Nanjing Medical University and 78 in the Wuxi People′s Hospital. There were 182 males and 61 females, aged from 30 to 86 years, with a median age of 57 years. According to the random numbers showed in the computer, 243 patients were randomly assigned into training dataset consisting of 162 patients and test dataset consisting of 81 patients, with a ratio of 2∶1. Using radiomics technique, a total of 3 384 radiomics features were extracted from the tumor and its periphery at arterial-phase and portal-phase images of CT scan. In the training dataset, a radiomics signature was constructed and predicted its performance after dimension reduction of stable features by using aggregated feature selection algorithms [feature ranking via maximal relevance and minimal redundancy (MRMR) combined with random survival forest (RSF) + LASSO-COX regression analysis]. Risk factors for tumor recurrence were selected using the univariate COX regression analysis, and two radiomics models including radiomics 1 (preoperative) and radiomics 2 (postoperative) were constructed and predicted their performance using backward stepwise multivariate COX regression analysis. The two models were validated in the training and test dataset. Observation indicators: (1) follow-up; (2) construction of HCC recurrence-related radiomics signature for early-stage HCC after resection; (3) prediction performance of HCC recurrence-related radiomics signature for early-stage HCC after resection; (4) construction of HCC recurrence-related radiomics prediction model for early-stage HCC after resection; (5) validation of HCC recurrence-related radiomics prediction model for early-stage HCC after resection; (6) comparison of the prediction performance of radiomics model with that of other clinical statistical models and current HCC staging systems; (7) stratification analysis of postoperative recurrence risk based on radiomics models for early-stage HCC after resection. Patients were followed up using outpatient examination or telephone interview once every 3 months within the first 2 years and once every 6 months after 2 years. The follow-up included collection of medical history, laboratory examination, and abdominal ultrasound examination. Contrast-enhanced CT or magnetic resonance imaging (MRI) examination was performed once every 6 months, and they were performed in advance on patients who had suspected recurrence based on laboratory examination or abdominal ultrasound for further diagnosis. Follow-up was up to January 2019. The endpoint was time to recurrence, which was from the date of surgery to the date of first detected disease recurrence or metastasis. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed by the t test. Measurement data with skewed distribution were described as M (range), and comparison between groups was analyzed by the Mann-Whitney U test. Count data were described as absolute numbesr or percentages, and comparison between groups was analyzed using the chi-square test. The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method, and the survival analysis was performed using the Log-rank test. Serum alpha-fetoprotein level was analyzed after the natural logarithm transformation. X-tile software was used to select the optimal cut-point for continuous markers. Results:(1) Follow-up: all the 243 HCC patients received follow-up. Patients in the training dataset were followed up for 4.2-109.2 months, with a median follow-up time of 51.6 months. Patients in the test dataset were followed up for 12.7-107.6 months, with a median follow-up time of 73.2 months. The 2-, 5-year disease-free survival rates were 77.8% and 53.1% of the training dataset respectively, versus 86.4% and 61.7% of the test dataset. There was no significant difference in terms of disease-free survival between two datasets ( χ2=1.773, P>0.05). (2) Construction of HCC recurrence-related radiomics signature for early-stage HCC after resection: of the 3 384 radiomics features, 2 426 radiomics features with high stability were selected for analysis. There were 37 radiomics features identified after combining the top 20 radiomics features ranked by MRMR and RSF algorithms. LASSO-COX regression algorithm further reduced their dimensionality to retain 7 radiomics features and construct a radiomics signature. The indicators including region, scanning phase, and weighting coefficient of above mentioned seven features were Feature 1 (peritumoral, arterial phase, 0.041), Feature 2 (peritumoral, arterial phase, -0.103), Feature 3 (peritumoral, arterial phase, -0.259), Feature 4 (intratumoral, arterial phase, 0.211), Feature 5 (peritumoral, portal venous phase, -0.170), Feature 6 (intratumoral, portal venous phase, 0.130), and Feature 7 (intratumoral, portal venous phase, 0.090), respectively. Radiomics signature score=0.041×Feature 1-0.103×Feature 2-0.259×Feature 3+ 0.211×Feature 4-0.170×Feature 5+ 0.130×Feature 6+ 0.090×Feature 7. (3) Prediction performance of HCC recurrence-related radiomics signature for early-stage HCC after resection: the radiomics signature showed favorable prediction performance in both training and test datasets, with respective C-index of 0.648 [95% confidence interval ( CI): 0.583-0.713] and 0.669 (95% CI: 0.587-0.750). (4) Construction of HCC recurrence-related radiomics prediction model for early-stage HCC after resection: results of univariate analysis showed that ln(serum alpha-fetoprotein), liver cirrhosis, tumor margin status, arterial peritumoral enhancement, intratumoral necrosis, radiomics signature, satellite nodules, and microvascular invasion were related factors for tumor recurrence after resection of early-stage HCC ( hazard ratio=1.202, 1.776, 1.889, 2.957, 1.713, 4.237, 4.364, 4.258, 95% CI: 1.083-1.333, 1.068-2.953, 1.181-3.024, 1.462-5.981, 1.076-2.728, 2.593-6.923, 2.468-7.717, 2.427-7.468, P<0.05 ). Results of multivariate analysis showed that the radiomics model 1 (preoperative) consisted of ln(serum alpha-fetoprotein), tumor margin status, and radiomics signature ( hazard ratio=1.145, 1.838, 3.525, 95% CI: 1.029-1.273, 1.143-2.955, 2.172-5.720, P<0.05); the radiomics model 2 (postoperative) consisted of ln(serum alpha-fetoprotein), radiomics signature, microvascular invasion, and satellite nodules ( hazard ratio=1.123, 2.386, 3.456, 3.481, 95% CI: 1.005-1.254, 1.501-3.795, 1.863-6.410, 1.891-6.408, P<0.05). Risk prediction formulas: radiomics model 1 = 0.135×ln(serum alpha-fetoprotein)+ 0.608×tumor margin status (0: smooth; 1: non-smooth)+ 1.260×radiomics signature; radiomics model 2 = 0.116×ln(serum alpha-fetoprotein)+ 0.870×radiomics signature + 1.240×microvascular invasion (0: absent; 1: present)+ 1.247×satellite nodules (0: absent; 1: present). (5) Validation of HCC recurrence-related radiomics prediction model for early-stage HCC after resection: in both training and test datasets, radiomics model 1 provided good prediction performance, with respective C-index of 0.716 (95% CI: 0.662-0.770) and 0.724 (95% CI: 0.642-0.806), while radiomics model 2 provided better prediction performance, with respective C-index of 0.765 (95% CI: 0.712-0.818) and 0.741 (95% CI: 0.662-0.820). Calibration curves demonstrated good agreement between model-predicted probabilities and observed outcomes. (6) Comparison of the prediction performance of radiomics model with that of other clinical statistical models and current HCC staging systems: in the training dataset, the prediction performance of radiomics model 1 for tumor recurrence after resection of early-stage HCC was significantly different from that of ERASL model (preoperative), Barcelona clinic liver cancer (BCLC) staging, Hong Kong liver cancer (HKLC) staging, and cancer of the liver Italian program (CLIP) classification (C-index=0.562, 0.484, 0.520, 0.622, 95% CI: 0.490-0.634, 0.311-0.658, 0.301-0.740, 0.509-0.736, P<0.05); the prediction performance of radiomics model 2 for tumor recurrence after resection of early-stage HCC was significantly different from that of ERASL model (postoperative), Korean model, and the eighth edition TNM staging (C-index=0.601, 0.523, 0.513, 95% CI: 0.524-0.677, 0.449-0.596, 0.273-0.753, P<0.05). In the test dataset, the prediction performance of radiomics model 1 for tumor recurrence after resection of early-stage HCC was significantly different from that of ERASL model (preoperative), BCLC staging, HKLC staging, CLIP classification (C-index=0.540, 0.473, 0.504, 0.545, 95% CI: 0.442-0.638, 0.252-0.693, 0.252-0.757, 0.361-0.730, P<0.05); the prediction performance of radiomics model 2 for tumor recurrence after resection of early-stage HCC was significantly different from that of ERASL model (postoperative), Korean model, and the eighth edition TNM staging (C-index=0.562, 0.513, 0.521, 95% CI: 0.451-0.672, 0.399-0.626, 0.251-0.791, P<0.05). (7) Stratification analysis of postoperative recurrence risk based on radiomics models for tumor recurrence after resection of early-stage HCC: according to the analysis of X-tile, the score of radiomics model 1 < 1.4 (corresponding to total points < 62.0 in nomogram) was classified into low-risk group while the score of radiomics model 1 ≥ 1.4 (corresponding to total points ≥ 62.0 in nomogram) was classified into high-risk group. The score of radiomics model 2 < 1.7 (corresponding to total points < 88.0 in nomogram) was classified into low-risk group while the score of radiomics model 2 ≥ 1.7 (corresponding to total points ≥ 88.0 in nomogram) was classified into high-risk group. In the training dataset, the 2- and 5-year recurrence rates were 14.1%, 35.3% for low-risk patients and 63.0%, 100.0% for high-risk patients, which were predicted by radiomics model 1. There were significant differences between the two groups ( χ2= 70.381, P<0.05). The 2- and 5-year recurrence rates were 12.9%, 38.2% for low-risk patients and 81.8%, 100.0% for high-risk patients, which were predicted by radiomics model 2. There were significant differences between the two groups ( χ2= 98.613, P<0.05). In the test dataset, the 2- and 5-year recurrence rates were 5.6%, 29.3% for low-risk patients and 70.0%, 100.0% for high-risk patients, which were predicted by radiomics model 1. There were significant differences between the two groups ( χ2= 64.453, P<0.05). Ther 2- and 5-year recurrence rates were 5.7%, 28.1% for low-risk patients and 63.6%, 100.0% for high-risk patients, which were predicted by radiomics model 2. There were significant differences between the two groups ( χ2= 58.032, P<0.05). Conclusions:The 7-feature-based radiomics signature is built by selection of CT radiomics features in this study, and then HCC recurrence-related radiomics prediction model for early-stage HCC after resection is constructed. The proposed radiomics models can complement the existing clinical-radiological-pathological prognostic sources, accurately and individually predict tumor recurrence risk preoperatively and postoperatively, which facilitate clinical decision-support for patients with early-stage HCC.
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Objective:To explore the effect of continuous quality improvement (CQI) on reducing the incidence of peritoneal dialysis (PD)-related peritonitis in patients within the first year of PD initiation.Methods:The patients who received catheter placement from January 2006 to December 2016 in our hospital were enrolled in this study. All patients were divided into four groups: pre-CQI group patients who initiated PD treatment from 2006 to 2007 (before CQI phase, group A), CQI Ⅰphrase patients who initiated PD treatment from 2008 to 2010 (group B), CQI Ⅱ phrase patients who initiated PD treatment from 2011 to 2013 (group C), and CQI Ⅲ phrase patients who initiated PD treatment from 2014 to 2016 (group D). The method of plan, do, check and act (PDCA) was conducted to decrease the incidence of PDRP. All the patients were followed up for 12 months or until they withdrew from PD in this period. Poisson analysis was used to compare the incidence of PDRP among the groups.Results:There were 2 383 PD patients recruited in this study, including 346 cases in group A, 850 cases in group B, 688 cases in group C and 499 cases in group D, with an age of (47.1±15.8) years, among whom 59.1% of the patients were male, and 21.4% with diabetes. The follow-up time was (10.9±2.8) months. Compared with group A, the incidence of PDRP was lower than that in group C (0.156 episodes/patient year vs 0.234 episodes/patient year, P=0.020); the incidence of gram positive PDRP decreased (0.052, 0.049, 0.054 episodes/patient year vs 0.104 episodes/patient year, all P<0.05) in group B, C, D; the incidence of gram negative PDRP increased in group B, then decreased in group C and group D (all P>0.05). Cox regression analysis indicated that CQI was independently associated with the incidence of gram positive PDRP ( HR=0.526, 95% CI 0.349-0.792, P=0.002). Conclusion:CQI can effectively reduce the incidence of gram positive PDRP in patients within the first year of PD initiation.
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Intragastric balloon (IGB) placement under endoscopy is a non-invasive method for weight loss.By placing a space-occupying balloon in the stomach, IGB treatment can achieve better effect of weight loss than medications.Herein we review the development of IGB, its effect on weight loss and the mechanism, and the eligible individuals for IGB treatment.We also examine the high-intensity postoperative management following IGB placement, which is important for maintaining long-term weight loss, and discuss the future development of IGB.The patients should understand that on the basis of ensuring a high safety, the weight-losing effect of IGB can be limited and relies heavily on postoperative management.Patients should make a decision on IGB placement after careful consideration of their own physical, economic, and psychological conditions, lifestyle and the line of work in addition to the indications of IGB.IGB placement combined with high-intensity postoperative management and active interventions of lifestyle and dietary habits help to achieve long-term effect of weight loss and improve obesity-related complications.
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Humans , Endoscopy , Gastric Balloon , Life Style , Obesity , Obesity, Morbid/surgery , Treatment Outcome , Weight LossABSTRACT
Objective@#To understand the etiology, genotype and molecular characteristics of acute viral gastroenteritis in Quanzhou from 2014 to 2017.@*Methods@#Specimens from 15 outbreaks of acute viral gastroenteritis in Quanzhou area from 2014 to 2017 were collected and real-time fluorescence quantitative PCR was used to detect norovirus GI and GII, sapovirus, astrovirus and rotavirus, and the result were statistically analyzed. Furthermore, specimens positive for norovirus was further subjected to the amplification and sequencing of polymerase and VP1 genes of norovirus, and sequences were analyzed using DNAstar and MEGA7.0 software.@*Results@#In this study, 96 specimens from 15 outbreaks of acute viral gastroenteritis were collected, and norovirus was detected in 30 specimens with a positive rate of 31.25%, among which 23 specimens were genotype GII and 7 specimens genotype GI. Meanwhile, 10 specimens were randomly selected for nucleic acid sequence analysis. The result showed that 9 of them were GII.P16/GII.2 and 1 was GI.6. The phylogenetic analysis showed that the new recombinant norovirus subtype GII.P16/GII.2 was highly homologous to the same subtype detected in outbreaks home and abroad recently.@*Conclusions@#The main pathogens caused the outbreak of acute viral gastroenteritis in Quanzhou from 2014 to 2017 were norovirus belonging to subtype GII.P16/GII.2 and subtype GI.6, and subtype GII.P16/GII.2 was the predominant strain which was found for the first time in Quanzhou.
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Objective@#To investigate whether type 2 diabetes mellitus increases the risk of hepatitis B-related cirrhosis combined with type 2 diabetes mellitus for the occurrence of primary hepatocellular carcinoma, and to compare the effects of different nature of diabetes duration on the risk of different anti-diabetic drugs.@*Methods@#A retrospective case-control study was conducted. (1) 325 cases with hepatitis B-related cirrhosis complicated with primary hepatocellular carcinoma were selected as the study group and 601 patients with hepatitis B cirrhosis as the control group. The relationship between diabetes mellitus and the risk of primary liver cancer was analyzed by multivariate logistic regression analysis. (2) Selected the study group and control group combined with type 2 diabetes mellitus, and used multivariate logistic regression analysis to study the relationship between diabetes-related factors and the risk of primary liver cancer.@*Results@#The incidence of diabetes was 14.2% in the study group and 6.0% in the control group, and the difference was statistically significant between the two groups (P < 0.05). Multivariate logistic regression analysis showed that type 2 diabetes was one of the independent risk factors for primary hepatocellular carcinoma, which had increased the risk of primary hepatocellular carcinoma (adjusted odds ratio (AOR): 1.982, 95% CI: 1.224-3.210). Patients with diabetes > 10 years (adjusted ratio: AOR value 6.011, 95% CI: 1.659-21.777) were at significantly higher risk for primary hepatocellular carcinoma than that of patients with diabetes < 10 years. Metformin (adjusted odds ratio: AOR 0.188, 95% CI: 0.052-0.688) had reduced the risk, while insulin (adjusted odds ratio: AOR 6.682, 95% CI: 1.899-23.510) had increased the risk.@*Conclusion@#Type 2 diabetes mellitus is one of the independent risk factors for primary HCC, which can increase the risk of hepatocellular carcinoma in hepatitis B cirrhosis in relation to the duration of diabetes mellitus. The risk of hepatocellular carcinoma is higher in patients with duration of diabetes > 10 years and metformin reduces the risk.
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ObjectiveTo investigate the current status of compliance with antiviral therapy with nucleos(t)ide analogues (NAs) among chronic hepatitis B (CHB) patients treated in General Hospital of Ningxia Medical University. MethodsThe CHB patients who received antiviral therapy with NAs at the outpatient and inpatient services of Department of Infectious Diseases, General Hospital of Ningxia Medical University, from May to December, 2017 were enrolled. A questionnaire survey was performed for demographics, family history of CHB, detailed doctor’s advice, daily routines, physical exercise, compliance, awareness of the knowledge about hepatitis B, health belief, and social support, and the influence of various factors on compliance with NAs treatment was analyzed. The Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was used to investigate the influencing factors for compliance with antiviral therapy with NAs among CHB patients. ResultsA total of 612 questionnaires were distributed, among which 600 were collected, with a questionnaire recovery rate of 98% and a valid rate of 100%. Among the 600 CHB patients, 334 (55.67%) had good compliance with the antiviral therapy with NAs and 266 (44.33%) had poor compliance. Among the 266 CHB patients with poor compliance, 56 (21.05%) did not follow the doctor’s advice and took other drugs, 206 (77.44%) sometimes forgot medication, 187 (7030%) sometimes did not pay attention to medication (time, dose, and frequency), 135 (50.75%) reduced or stopped drugs after symptoms were improved, and 100 (37.59%) stopped the drugs due to symptom aggravation or appearance of other symptoms. The univariate analysis showed that 13 indices were the influencing factors for compliance with NAs treatment among CHB patients (all P＜0.05). A multivariate analysis was performed for these 13 indices and the results showed that race (odds ratio ［OR］=0.218, 95% confidence interval ［CI］: 0.076-0.996, P=0.007), mode of medical payment (OR=0.772, 95%CI: 0.445-0.919, P＜0.001), physical exercise (OR=2.55, 95%CI: 1.472-6.545, P=0.020), level of social support (OR=0.836, 95%CI: 0.649-0.947, P＜0.001), awareness of the outcome of incompliance (OR=0.577, 95%CI: 0.393-0.886, P＜0.001), and self-efficacy (OR=0.094, 95%CI: 0074-0.328, P＜0.001) were independent influencing factors for compliance with NAs treatment among CHB patients. ConclusionCompliance with antiviral therapy among CHB patients is closely associated with the mode of medical payment, psychological state, and self-management ability. Related measures, such as improvement of patients’ ability to pay medical expenses, education on disease risk for patients, and reduction of social discrimination, can help to improve treatment compliance.
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Objective To compare the clinical efficacy of anatomical hepatectomy (AR) and parenchymal-sparing hepatectomy (PSH) for Barcelona clinic liver cancer (BCLC) stage A hepatocellular carcinoma(HCC),and investigate its prognostic factors.Methods The propensity score matching and retrospective cohort study was conducted.The clinicopathological data of 269 patients with BCLC stage A HCC who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2009 to December 2017 were collected.There were 226 males and 43 females,aged from 23 to 84 years,with a median age of 56 years.All the 269 patients underwent radical resection and were confirmed as HCC using postoperative pathological examination.Of the 226 patients,146 undergoing AR and 123 undergoing PSH were allocated into the AR group and PSH group,respectively.Observation indicators:(1) the propensity score matching conditions and comparison of general data between groups after the propensity score matching;(2) intraoperative and postoperative situations;(3) follow-up and survival situations;(4) prognostic factors analysis.Patients were followed up by outpatient examination and telephone interview to detect survival once every 3 months within 1 year postoperatively,once every 6 months within 2-5 years postoperatively and once a year after 5 years postoperatively up to October 2018.The overall survival time was from surgery data to death or end of follow-up.The tumor-free survival time was from surgery date to time of tumor recurrence detected or end of follow-up without tumor recurrence.The propensity score matching was used to perform 1∶1 matching by nearest neighbor method.Count data were represented as absolute number,comparison between groups was analyzed using the chi-square test and McNemar test after propensity score matching.Measurement data with skewed distribution were represented as M (range),and comparison between groups was done using the Mann-Whitney U test and Wilcoxon signed rank sum test after propensity score matching.The survival rate and curve were respectively calculated and drawn by the Kaplan-Meier method,and Log-rank test was used for survival analysis.The COX proportional risk model was used for univariate and multivariate analysis.Results (1) The propensity score matching conditions and comparison of general data between groups after the propensity score matching:180 of 269 patients had successful matching,including 90 in each group.The maximum tumor diameter,cases with vascular embolism,cases of stage Ⅰ and Ⅱ (TNM staging) before matching were 5.0 cm (range,0.8-17.0 cm),42,97,99 in the AR group and 3.0 cm (range,1.0-17.0 cm),16,49,24 in the PSH group,respectively,with statistically significant differences between the two groups (Z =-4.277,x2 =9.803,6.664,P＜ 0.05).The above indices after matching were 4.0 cm (range,0.8-16.0 cm),15,70,68 in the AR group and 3.5 cm (range,1.0-17.0 cm),16,20,22 in the PSH group,with no statistically significant difference between the two groups (Z =-0.241,x2=0.039,0.124,P＞0.05).The confounding bias of maximum tumor diameter,vascular embolism and TNM staging were eliminated.(2) Intraoperative and postoperative situations:the operation time,volume of intraoperative blood loss,cases with intraoperative blood transfusion,cases with surgical margin ＜ 1 cm and ≥ 1 cm,cases with postoperative severe complications,duration of hospital stay,cases with postoperative tumor recurrence,cases with tumor recurrence within 2 years postoperatively,cases undergoing surgical treatment due to postoperative tumor recurrence,cases undergoing transcatheter arterial chemoemblization due to postoperative tumor recurrence after matching were 180 minutes (range,60-448 minutes),130 mL (range,30-6 000 mL),9,2,88,8,18 days (range,8-77 days),41,32,15,23 in the AR group,and 150 minutes (range,55-400 minutes),100 mL (range,50-3 000 mL),6,2,88,6,18 days (range,9-37 days),37,29,10,24 in the PSH group,respectively,showing no statistically significant difference between the two groups (Z =-1.987,-0.439,x2 =0.655,0.000,0.310,Z=-0.805,x2=0.362,0.223,0.816,0.624,P＞0.05).(3) Follow-up and survival situations:180 patients were followed up for 4-114 months,with a median time of 43 months.Forty of 180 patients died (21 in the AR group and 19 in the PSH group) and 78 had tumor recurrence (41 in the AR group and 37 in the PSH group).The 1-,3-,5-year overall survival rates and tumor-free survival rates were 92.0％,76.3％,71.8％ and 70.8％,53.0％,47.4％ in the AR group,92.3％,80.6％,62.0％ and 72.3％,56.4％,46.1％ in the PSH group,respectively,showing no statistically significant difference between the two groups (x2 =0.034,0.000,P＞0.05).Stratified analysis:of the AR group,the 1-,3-,5-year overall survival rates and median tumor-free survival rate were 95.3％,82.0％,82.0％ and 54.6％ in the patients with grade Ⅰ of preoperative albumin-bilirubin,100.0％,86.8％,86.8％ and 61.5％ in the patients with maximum tumor diameter ≤≤5 cm,91.3％,75.0％,69.7％ and 43.1％ in the patients with liver cirrhosis,89.9％,73.2％,66.6％ and 54.6％ in the patients with moderate-low differentiated tumor.Of the PSH group,the 1-,3-,5-year overall survival rates and median tumor-free survival rate were 90.9％,74.9％,63.0％ and 43.4％ in the patients with grade Ⅰ of preoperative albumin-bilirubin,98.2％,85.8％,61.7％ and 46.0％ in the patients with maximum tumor diameter ≤≤ 5 cm,98.0％,88.7％,70.0％ and 43.4％ in the patients with liver cirrhosis,90.7％,79.2％,59.0％ and 43.4％ in the patients with moderate-low differentiated tumor.There were no statistically significant difference in the 1-,3-,5-year overall survival rates between the two groups (x2 =1.892,1.320,0.732,0.002,P＞0.05) and a statistically significant difference in the tumor-free survival rate between the two groups (x2 =0.337,0.051,0.551,0.061,P ＞ 0.05).(4) Prognostic factors analysis.Results of univariate analysis showed that preoperative albumin-bilirubin grade,preoperative alpha fetoprotein (AFP),maximum tumor diameter,number of tumors,satellite lesion,vascular embolism,TNM staging,volume of intraoperative blood loss,postoperative severe complications were related factors affecting overall survival after radical resection for HCC (hazard ratio=1.762,1.001,1.139,1.955,2.561,2.495,2.766,1.000,2.599,95％ confidence interval:1.048-2.962,1.000-1.001,1.080-1.201,1.063-3.596,1.254-5.227,1.446-4.304,1.655-4.624,1.000-1.001,1.317-5.128,P＜0.05).Preoperative AST,positive HBsAg,preoperative AFP,maximum tumor diameter,vascular embolism,TNM staging,postoperative severe complications were related factors affecting tumor-free survival after radical resection for HCC (hazard ratio=1.004,1.594,1.000,1.065,2.203,2.132,1.775,95％ confidence interval:1.001-1.007,1.020-2.490,1.000-1.001,1.019-1.113,1.474-3.293,1.462-3.109,1.034-3.047,P＜0.05).Results of multivariate analysis showed that preoperative AFP,maximum tumor diameter,satellite lesion,postoperative severe complications were independent factors affecting overall survival after radical resection for HCC (hazard ratio =1.001,1.114,2.241,2.251,95％ confidence interval:1.000-1.001,1.033-1.202,1.003-5.008,1.100-4.607,P＜0.05).Positive HBsAg was an independent factor affecting tumor-free survival after radical resection for HCC (hazard =1.576,95％ confidence interval:0.987-2.516,P＜ 0.05).Conclusions There was no significant difference in long-term efficacy between AR and PSH in patients with BCLC stage A HCC.Preoperative AFP,maximum tumor diameter,number of tumors,satellite lesion,postoperative severe complications are independent factors affecting long-term survival of BCLC stage A patients after HCC radical resection.
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Objective To analyze the correlation between the direct measurement of pulmonary artery pressure and the related echocardiographic parameters in rats with pulmonary arterial hypertension ( PA H ) , and establish a predictable equation for pulmonary artery pressure using non‐invasive ultrasonic parameters . Methods Fifteen male Wistar rats were randomly divided into normal control ( NC ) group with five rats and PA H model group with 10 rats .PA H model was established by intraperitoneal injection of 1% MCT solution in the dose of 60 mg/kg . All the rats were examined by ultrasonic apparatus to record cardiac parameters including right ventricle anterior wall thickness ( RVAWT ) ,pulmonary artery diameter ( PAD) , aorta diameter ( AOD ) , pulmonary artery acceleration time ( PAAT ) , pulmonary artery ejection time ( PAET ) ,right ventricle end‐diastolic diameter ( RVEDD ) ,right ventricle end‐diastolic length ( RVEDL ) , tricuspid annular plane systolic excursion ( T APSE) and left ventricular ejection fraction ( LVEF ) before experiments as well as 2 and 4 weeks after modeling . At the fifth week of modeling ,all the rats were administrated with thoracotomy and right ventricular catheter to obtain pulmonary artery systolic ,diastolic and mean pressures ( PASP ,PADP and PAM P) . Results As time went on ,measures of RVAWT ,PAD , PAD/AOD ,RVEDD ,RVEDL ,RVEDD/RVEDL increased ,while measurements of PAA T ,PAA T/PAET , T APSE decreased in the model group .T he changes of RVAWT ,PAD ,PAA T/PAET ,RVEDD in the model group appeared early in the second week in contrast to data before molding ( P ＜0 .05) . When comparing model group with NC group ,there were statistic differences of RVAWT ,PAAT/PAET as early as 2 weeks after modeling measuring (all P ＜0 .05) and the dramatic variance in the parameters of PAD/AOD ,PAAT , RVEDD ,RVEDD/RVEDL ,T APSE appeared in 4‐week observation . Correlation analysis suggested there were high‐degree correlations between PAA T ,PAA T/PAET and PASP ,PAM P ( for PASP : r ＝ －0 .829 ,－0 .865 ,P＜ 0 .05 ; for PAM P : r ＝ －0 .831 , －0 .842 , P ＜ 0 .05 ) ,and moderate‐degree correlations between RVAWT ,PAD/AOD ,RVEDD ,RVEDD/RVEDL ,T APSE and PASP ,PAM P ( for PASP :|r|＝0 .615－0 .786 , P ＜0 .05 ; for PAM P : r ＝0 .683－0 .799 , P ＜0 .05) .T he linear dependent equations were established as PASP ＝ －169 .392 PAAT/PAET + 105 .092 ( r2 ＝ 0 .748 , P ＝ 0 .000 ) ,PASP ＝ 49 .576 RVAWT+67 .314RVEDD/RVEDL －45 .198 ( r2 ＝0 .731 , P ＝0 .003) ,PAM P＝ －150 .664PAAT/PAET+88 .156 ( r2 ＝0 .709 , P ＝ 0 .001 ) ,PAM P＝37 .988RVAWT +82 .072RVEDD/RVEDL －50 .517 ( r2 ＝0 .794 , P ＝ 0 .001 ) to represent the relationships between PASP or PAM P and PAAT/PAET or RVAWTcombined RVEDD/RVEDL . Conclusions Echocardiography can monitor changes in heart structure and hemodynamics .Ultrasonic parameters especially PAAT/PAET or RVAWT ,RVEDD/RVEDL could be used to estimate PASP or PAM P measured by catheterization .
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Objective@#To analyze the distribution and the molecular biological characteristics of variant subtypes (H5, H7 and H9) of avian influenza virus (AIV) in the live poultry related external environment of Quanzhou form 2014 to 2017, and provide regional references for the prevention, control and early-warning of human infections.@*Methods@#Samples from monitoring sites of live poultry were collected in Quanzhou from 2014 to 2017. Influenza A and variant subtypes of AIV (H5, H7 and H9) were detected by real time RT-PCR, and the detection results were further analyzed statistically. Furthermore, the HA and NA genes of four representative H7N9 strains were sequenced, and the results were further analyzed with DNAstar and MEGA7.0.@*Results@#Among the samples from external environment, the positive rate of nucleic acid of influenza A was 29.04% (377/1 289), of which the positive rates of H5, H7 and H9 subtypes were 3.80%, 13.34% and 12.02%, respectively. The positive rate of H7N9 was higher than those of the other subtypes in all monitored years, of which the highest rate was found in 2017 (21.88%). As to the different types of samples, chopping board possessed the highest positive rate of influenza A (65.4%), followed by waste water (59.3%) and drinking water for the poultry (29.6%). Among the different monitoring sites, the positive rate of poultry farm is 6.94%, far lower than that in the open air (61.7%) and the live poultry trading market (52.8%). Sequencing of the HA and NA genes of four strains of H7N9 showed that the strains from external environment and the strains from H7N9 patients belonged to Pearl River Delta and Yangtze River Delta lineage, respectively. The cleavage sites of HA proteins of these four strains were all PKGR/G without highly pathogenic mutation. Meanwhile, they were low pathogenic H7N9 without oseltamivir resistant mutation (R292 K in NA), while they all possessed the E627 K mutation in the PB2 genes associated with virulence.@*Conclusions@#H7N9 AIV existed in the live poultry related external environment of Quanzhou, especially the farmers’ and the live poultry trading market, so that more persistent surveillance could be needed in the future.
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Objective To perform an exploratory investigation on confocal laser endomicroscopy (CLE) in the diagnosis of malignant bladder tumour.Methods From June 10 to July 11,2017,6 male bladder cancer patients underwent white light cystoscopy (WLC) + CLE examination,aging 64-86 years (median 72 years).All patients received TURBT on suspected lesions.WLC and CLE imaging results were recorded and validated by pathologic specimens.Results Lesions confirmed by histopathology were 3 low grade non-invasive papillary urothelial carcinomas,1 high grade non-invasive papillary urothelial carcinoma,1 low grade invasive urothelial carcinoma,1 high grade invasive urothelial carcinoma,1 carcinoma in situ (CIS),1 high grade dysplasia,1 cystitis glandularis,1 chronic inflammation,and 1 scar tissue.For CLE images in the normal urothelium,three layers of cells with different presentation were observed,namely,the superficial umbrella cells,the intermediate cells smaller in size and uniformly shaped,and the capillary network in the lamina propria.For non-invasive urothelial carcinoma,tumour cells appeared as papillary lesions growing from fibrovascular cores,with low grade cells appearing monomorphic and more cohesively arranged,and high grade cells relatively pleomorphic,more disorganised and with tortuous blood vessels in the fibrovascular core.For invasive urothelial carcinoma,tumour cells invaded the lamina propria,with uniform appearances,poor cohesion and indistinct cellular borders,and high grade ones were more pleomorphic.CIS and inflammation both appeared as erythematous patch-like flat lesions under WLC and sometimes difficult to differentiate.Under CLE,the former appeared as dysplastic and disorganised cells with indistinct cellular borders,with intact lamina propria,and inflammatory cells were discovered as infiltrative clusters in the lamina propria that were uniformly shaped and loosely connected.Dysplasia appeared somewhat similar compared with CIS under WLC,but with lower cellular irregularity as confirmed with pathology.Cellular appearance and structure in scar tissue was similar to that in the normal urothelium,but superficial umbrella cells were more likely absent,with thinner cell layers,and inflammatory infiltration was sometimes discovered in the lamina propria.Conclusions CLE provides real-time cellular imaging of the urothelium,and shows promising potential for clinical diagnosis,especially in differentiating fiat urothelial lesions.Large prospective studies are required for further validation.
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Background To identify the CT features of anterior mediastinal thymoma and lymphoma and evaluate CT findings that may help in suggesting specific diagnosis among these tumors
Method A total of fifty-eight chest CT scan studies with pathological diagnosis of thymoma [n = 30] and lymphoma [n =28] were retrospectively reviewed by two radiologists who were blind to the pathological results. The CT features showing cyst and calcification within the lesion, contrast enhancement, relation with pleura and adjacent vessels, bone invasion and lymph node enlargement were evaluated
Results In lymphoma [67.9%], the presence of associated mediastinal lymphadenopathy was significantly compared to thymoma. [P < 0.05]. The presence of calcification within the lesion was significantly found in thymoma than the lymphoma [p <0.05]. The presence of adjacent vessels relationship within the lesion was higher in lymphoma than the thymoma. [p <0.05] The remaining CT findings showed no significant difference among these diseases [p > 0.05]
Conclusion In conclusion age, lymph nodes involvement, calcification and relationship to adjacent vessels on CT scan will be helpful to give specific diagnosis on anterior mediastinum lymphoma and thymoma
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Objective To study the role of quality control circle(QCC) in reducing operation-related acute pressure ulcer.Methods The QCC activity group composed by 13 nursing staff analyzed the current situation and causality of operation-related acute pressure ulcer,and made the pointed counter measures to reducing the incidence rate.Results Following the development of QCC activity,the incidence rate of operation-related acute pressure ulcer decreased from 1.83% to 0.73%. The sense of responsibility,communication,teamwork,motivation,quality control ability and harmony of all the group members were improved significantly after the activity.Conclusions The QCC activity could not only effectively reduced the incidence rate of operation-related acute pressure ulcer,but also consolidated our team spirit and enhanced the quality management capability of all team members.
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Background Researches showed that transforming growth factor-β2 (TGF-β2) promotes the activity of human Tenon capsular fibroblasts (TFs),which plays a role in the scarring of filtering blebs after antiglaucoma surgery.However,its mechanism is not fully clear.Lysyl oxidases (LOXs) are important extracellular matrix proteases which can catalyze the cross-linking of collagen and elastin.Investigating the impact of TGF-β2 on the expression of LOXs has a great significance for the understanding of the pathogenesis of filtering bleb scarring and its prevention.Objective This study was to investigate the effect of TGF-β2 on the expression of LOXs in cultured human TFs.Methods The TFs at 4-8 generations were divided into normal control group and different concentrations of TGF-β2 treated-groups,and 100,200,400,800 μ1 of TGF-β2 with the final concentration of 2,4,8 and 16 ng/ml was added into the medium to treat human TFs respectively for 24 hours.The LOXs in the cells were detected by Western blot to determine the optimal dose of TGF-β2.The 4 ng/ml TGF-β2(200 μ1) was used to treat human TFs for 6,12,24 and 48 hours respectively,and the change of LOXs expression in the cells over time was assayed by Western blot.The expression and distribution of LOX protein in the normal cells and TGF-β2-treated cells was detected by using immunofluorescence technique.This study was approved by Daping Hospital of Third Military Medical University Ethic Commission.The guardians of the patients who offered the specimen knew the purpose of the study and signed informed consent.Results Western blot assay showed that the expressions of LOX,LOXL1,LOXL2,LOXL3 and LOXL4 in the cells were gradually elevated from the normal control group and 2,4,8,16 ng/ml TGF-β2-treated groups,showing significant differences among the groups (F =37.338,13.438,31.067,11.767,15.167,all at P＜0.01).The expression of LOXL2 protein in the cells was 0.68±0.07,1.09±0.10,1.32±0.07,1.50± 0.06 and 1.89±0.12 in the normal control group and 6-,12-,24-and 48-hour groups respectively after 4 ng/ml TGF-β2 treatment,with a significant increase over time (F =82.832,P=0.000).The expression of LOX was weak in the normal cultured TFs,while the fluorescence intensity of LOX expression was evidently enhanced in the cytoplasm of the cells in the TGF-β2-treated group.Conclusions TGF-β2 upregulates the expressions of LOXs in human TFs in a dose-and time-dependent manner,which probably offers a basis for the further study on the prevention of filtering bleb scarring after glaucoma surgery.
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Objective To investigate the clinical efficacy and prognostic factors of radical hepatectomy of hepatocellular carcinoma (HCC).Methods The retrospective case-control study was conducted.The clinicopathological data of 760 HCC patients who were admitted to the First Affiliated Hospital of Nanjing Medical University from August 2003 to June 2015 were collected.Surgical procedures were determined according to the location,number and size of tumors and anatomical relations among vessels.Observation indicators included:(1)intra-and post-operative situations:surgical procedures,operation time,volume of intraoperative blood loss,cases of intraoperative blood transfusion,postoperative complications,duration of postoperative hospital stay and pathological examination;(2) follow-up:1-,3-,5-year overall and tumor-free survival situations;(3) prognostic factors analysis of HCC patients.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival up to January 2016.Measurement data with normal distribution were represented as-x±s.The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method.The univariate analysis and multivariate analysis were done using the COX regression model.Results (1) Intra-and post-operative situations:all the 760 patients underwent successful operations,including 419 undergoing anatomical hepatectomy and 341 undergoing non-anatomical hepatectomy.R0 and R1 resections were respectively applied to 742 and 18 patients.Two patients were combined with portal vein resection and reconstruction and 1 was combined with resection and reconstruction of inferior vena cava.Operation time,volume of intraoperative blood loss and cases of intraoperative blood transfusion were (226± 115) minutes,(714±706) mL and 88,respectively.Fifty-five patients had postoperative complications,including 20 with abdominal effusion or abscess,16 with pleural effusion,9 with recurrent fever,8 with incisional infection,7 with intra-abdominal hemorrhage,6 with liver failure,3 with pyloric or intestinal obstruction and 2 with renal failure (some patients with multiple complications).Of the 55 patients with postoperative complications,7 with hemorrhage underwent reoperation or interventional therapy and other patients underwent conventional symptomatic treatment.Of 55 patients,5 patients died and other 50 patients were improved.Duration of postoperative hospital stay was (14±6) days.There were 457 patients with minimum margin of tumors ≤ 1.0 cm and 303 with minimum margin of tumors ＞ 1.0 cm.(2) Followup:all the 760 patients were followed up for 1-139 months,with a median time of 25 months.The overall and tumor-free median survival times were 59 months and 31 months,respectively.The 1-,3-,5-year overall and tumor-free survival rates were 81.7％,63.4％,47.9％ and 68.7％,44.9％,29.6％,respectively.(3) Prognostic factors analysis of HCC patients:results of univariate analysis showed that clinical symptoms,alpha-fetoprotein (AFP),Barcelona clinic liver cancer staging,surgical procedures,intraoperative blood transfusion,minimum margin of tumors,number and diameter of tumors,tumor capsule,tumor differentiation,vascular cancer embolus,macrovascular invasion and tumor staging of American Joint Committee on Cancer (AJCC) were related factors affecting prognosis of HCC patients after radical hepatectomy [HR =1.39,1.50,1.92,0.65,1.45,1.68,1.96,1.66,2.26,1.50,2.68,3.37,2.00,95％ confidence interval (CI):1.08-1.79,1.16-1.94,1.68-2.20,0.50-0.84,1.04-2.02,1.28-2.20,1.54-2.49,1.42-1.94,1.69-3.02,1.22-1.85,1.99-3.60,2.61-4.36,1.77-2.27,P＜0.05].Results of multivariate analysis showed that AFP,number and diameter of tumors,tumor differentiation and tumor staging of AJCC were independent factors affecting prognosis of HCC patients after radical hepatectomy (HR=1.61,1.62,1.31,1.40,1.78,95％CI:1.14-2.26,1.22-2.14,1.06-1.63,1.10-1.79,1.27-2.51,P ＜ 0.05).Conclusions The anatomical and non-anatomical hepatectomies are safe and feasible for optional HCC patients,with a good long-term outcome.AFP,number and diameter of tumors,tumor differentiation and tumor staging of AJCC are independent factors affecting prognosis of HCC patients after radical hepatectomy.
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Objective To analyze the mutation status of K‐ras gene in colorectal cancer patients ,further more ,to provide guid‐ance for personalized therapy for colorectal cancer .Methods Nested and COLD‐PCR were used to detect the K‐ras mutations in 560 patients with colorectal cancer .Results In 560 colorectal cancer patients ,the total positive rate of K‐ras gene mutations was 27 .08% ,the mutation rate was 0 in 128 plasma samples and it was 27 .08% in 432 tissue samples .The mutate sites were G12S , G12C ,G12D ,G12A ,G12V ,G13R ,G13C ,G13D ,Q61K ,Q61L ,there were significant differences existed in different samples (P <0 .000 1) ;the mutation rate of 362 male patients was 20 .44% and the types of mutation include G12S ,G12C ,G12D ,G12V ,G13R , G13C ,G13D ,Q61K and Q61L .The mutation frequency was 21 .72% in 198 female patients ,the mutation points were G12S ,G12C , G12D ,G12A ,G12V ,G13R and G13D .There were no significant difference between different sex (P= 0 .722 7) ;the mutation fre‐quency was 20% in 80 youth patients including G12S ,G12C ,G12D ,G12V ,G13D and the mutation rate was 33 .07% in 127 middle age patients ,the points of mutation were G12S ,G12D ,G12A ,G12V ,G13R ,G13C ,G13D ,Q61K ,Q61L ,the mutation frequency was 16 .71% in 353 old age patients ,the types of mutation include G12C ,G12D ,G12V ,G13R ,G13D ,the difference was significant a‐mong different age patients (P= 0 .000 5) .Conclusion The total rate of mutations is 27 .08% in 560 colorectal cancer patients ,and the main points of mutation is G12D ,G12V ,G13D .There are significant differences in different type of samples as well as in differ‐ent ages ,but no statistical significance in different sex patients .