Establishment and validation of a risk prediction model for portal vein thrombosis in liver cirrhosis by nomogram / 中华消化内镜杂志

Objective:To explore the independent risk factors of portal vein thrombosis (PVT) in liver cirrhosis, and to establish and evaluate a risk prediction model for PVT in patients with cirrhosis.Methods:A total of 295 cases of cirrhosis hospitalized in Renmin Hospital of Wuhan University from December 2019 to October 2021 were divided into a modeling set ( n=207) and an internal validation set ( n=88) by the random number table. In addition, patients with cirrhosis hospitalized in Yichang Central People's Hospital, Wuhan Puren Hospital, No.2 People's Hospital of Fuyang City and People's Hospital of China Three Gorges University during the same period were collected as an external validation set ( n=92). The modeling set was divided into PVT group ( n=56) and non-PVT group ( n=151). Univariate analysis was used to preliminarily screen the related indicators of PVT, and then multivariate logistic regression analysis with forward stepwise regression was used to determine independent risk factors for PVT. A nomogram prediction model was constructed based on the independent risk factors obtained. The internal and external validation set were used to verify the predictive ability of the model. Distinction degree was used to evaluate the ability of the model to distinguish patients with or without PVT. Hosmer-Lemeshow goodness-of-fit test was used to evaluate the consistency between predicted risk and the actual risk of the model. Results:Univariate analysis showed that smoking, history of splenectomy, trans-jugular intrahepatic portosystemic shunt (TIPS), gastrointestinal bleeding and endoscopic variceal treatment, and levels of hemoglobin, alanine aminotransferase, aspartate aminotransferase and D-dimer were significantly different between the PVT group and the non-PVT group ( P<0.05). Multivariate logistic regression analysis found that smoking ( P=0.020, OR=31.21, 95% CI: 1.71-569.40), levels of D-dimer ( P=0.003, OR=1.12, 95% CI: 1.04-1.20) and hemoglobin ( P=0.039, OR=0.99, 95% CI: 0.97-1.00), history of TIPS ( P=0.011, OR=18.04, 95% CI: 1.92-169.90) and endoscopic variceal treatment ( P=0.001, OR=3.21, 95% CI: 1.59-6.50) were independent risk factors for PVT in patients with liver cirrhosis. Receiver operator characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) for the internal validation set was 0.802 (95% CI: 0.709-0.895) ( P<0.001), and the AUC for the external validation set was 0.811 (95% CI: 0.722-0.900) ( P<0.001). Both AUC were larger than 0.75. The calibration curve of Hosmer-Lemeshow goodness-of-fit test showed that the P values of both internal validation set ( χ2=3.602, P=0.891) and the external validation set ( χ2=11.025, P=0.200) were larger than 0.05. Conclusion:Smoking, history of TIPS or endoscopic variceal treatment, levels of D-dimer and hemoglobin are independent risk factors for PVT in patients with liver cirrhosis. The prediction nomogram model based on the above factors has strong predictive ability.

Expression and the value of inflammatory factors and diseaseactivity in dry eyes of patients with rheumatoid arthritis / 中华风湿病学杂志

Objective:To study the expression and value of inflammatory factors and disease activity in dry eyes of rheumatoid arthritis patients.Methods:From March 2017 to November 2019, 78 patients with rheumatoid arthritis complicated with dry eye diagnosed by the rheumatology department of our hospital, 80 patients with simple dry eye treated in the ophthalmology clinic and 80 normal volunteers were collected. All subjects were examined for OSDI questionnaire scores, tear film rupture time (BUT), tear secretion test (SIT), and corneal fluorescein staining (FL) scores. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF) and other disease activity-related indicators were collected. The concentrations of interleukin-1b (il-1b), tumor necrosis factor-a (tnf-a), chemokine 3(CCL3), CCL4, CCL5, and vascular endothelial growth factor (VEGF) in the collected tears were detected by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA). One-way Anova was used to analyze the correlative indexes among the three groups, LSD- t method was used for multiple comparison. Pearson's method was used to analyze the correlation between Ra activity and dry eye. Results:The results of OSDI [(44±9) points vs (44±9) points vs (24±7) points], SIT [(3.3±2.2) mm/5 min vs (3.6±2.1) mm/5 min vs (11.7±1.6) mm/5 min], BUT [(4.3±1.8) s vs (5.9±1.9) s vs (10.4±2.0) s], FL [(7.3±3.1) points vs (5.7±2.8) points vs (1.6±1.6) points] were com-pared among the three groups. There were significant differences among the three groups( F=154.22, P<0.01; F=470.49, P<0.01; F=217.72, P<0.01; F=101.99, P<0.01). The concentrations of IL-1β [(1.92±0.14) ng/L vs (1.28±0.18) ng/L vs (0.64±0.15) ng/L], IL-6 [(38.24±0.69) ng/L vs (36.31±0.82) ng/L vs (30.43±0.87) ng/L]、TNF-α [(0.78±0.03) ng/L vs (0.67±0.03) ng/L vs (0.56±0.02) ng/L], CCL3 [(91±25) ng/L vs (83±21) ng/L vs (24±18) ng/L], CCL4 [(187±76) ng/L vs (137±64) ng/L vs (37±5) ng/L], CCL5[(259±70) ng/L vs (182±42) ng/L vs (135±34) ng/L] and VEGF [(172±25) ng/L vs (152±22) ng/L vs (41±21) ng/L] in the tears of the three groups were significantly different( F=1 300.15, P<0.01; F=2 036.37, P<0.01; F=1 305.89, P<0.01; F=764.01, P<0.01; F=225.47, P<0.01; F=138.48, P<0.01; F=121.04, P<0.01). The indexes of disease activity (ESR, CRP, RF) were compared among the three groups. The positive rate of RF[(100%) vs (5%) vs (4%)] was significantly higher in Ra dry eye group than in the other two groups ( χ2=127.38, P<0.01) There were significant differences in ESR[(51±23) mm/1 h vs (9±4) mm/1 h vs (8±5) mm/1 h] and CRP[(44±23) g/L vs (5±4) g/L vs (6±4) g/L] among the three groups ( F=253.18, P<0.01; F=222.36, P<0.01) . BUT was negatively correlated with the activity index (ESR, CRP, RF) in rheumatoid arthritis dry eye group ( r=-0.398, P=0.005; r=-0.353, P=0.010; r=-0.302, P=0.038) , FL was positively correlated with activity index (ESR, CRP, RF) ( r=0.345, P=0.014; r=0.385, P=0.007; r=0.412, P=0.003) . There was no correlation between SIT, OSDI and activity index (ESR, CRP, RF)( r=-0.265, P=0.060; r=-0.156, P=0.318; r=-0.275, P=0.070); ( r=-0.087, P=0.582、 r=-0.065, P=0.664; r=-0.045, P=0.768). Conclusion:Inflammatory factors and disease activity indexes are highly expressed in rheumatoid arthritis patients with dry eye of disease, and there is a correlation between disease activity of rheumatoid arthritis and dry eye, which has some clinical meaing.

Detection of Rare Mutations in EGFR-ARMS-PCR-Negative Lung Adenocarcinoma by Sanger Sequencing

PURPOSE: This study aimed to identify potential epidermal growth factor receptor (EGFR) gene mutations in non-small cell lung cancer that went undetected by amplification refractory mutation system-Scorpion real-time PCR (ARMS-PCR). MATERIALS AND METHODS: A total of 200 specimens were obtained from the First Affiliated Hospital of Guangzhou Medical University from August 2014 to August 2015. In total, 100 ARMS-negative and 100 ARMS-positive specimens were evaluated for EGFR gene mutations by Sanger sequencing. The methodology and sensitivity of each method and the outcomes of EGFR-tyrosine kinase inhibitor (TKI) therapy were analyzed. RESULTS: Among the 100 ARMS-PCR-positive samples, 90 were positive by Sanger sequencing, while 10 cases were considered negative, because the mutation abundance was less than 10%. Among the 100 negative cases, three were positive for a rare EGFR mutation by Sanger sequencing. In the curative effect analysis of EGFR-TKIs, the progression-free survival (PFS) analysis based on ARMS and Sanger sequencing results showed no difference. However, the PFS of patients with a high abundance of EGFR mutation was 12.4 months [95% confidence interval (CI), 11.6−12.4 months], which was significantly higher than that of patients with a low abundance of mutations detected by Sanger sequencing (95% CI, 10.7−11.3 months) (p < 0.001). CONCLUSION: The ARMS method demonstrated higher sensitivity than Sanger sequencing, but was prone to missing mutations due to primer design. Sanger sequencing was able to detect rare EGFR mutations and deemed applicable for confirming EGFR status. A clinical trial evaluating the efficacy of EGFR-TKIs in patients with rare EGFR mutations is needed.

Efficacy of recombinant bovine basic fibroblast growth factor in treatment of dry eye following phacoemulsification with IOL implantation / 中华实验眼科杂志

Background The study on eye surface damage following phacoemulsification with intraocular lens (IOL) implantation is increasingly concerned,and these symptoms were associated with dry eye and often treated by polyethylene glycol eyedrops to remit the discomfortableness.Recombinant bovine basic fibroblast growth factor (rb-bFGF) eyedrops contains neurotrophic factors, but its effect on eye surface damage is worth researching.Objective This study was to evaluate the repair effects of rb-bFGF on ocular surface injury after phacoemulsification with IOL implantation.Methods A randomized controlled trail was designed.Ninety eyes of 72 consecutive patients with age-related cataract were enrolled in Fenyang Hospital of Shanxi Province from September 2010 to August 2013 under the informed consent.Phacoemulsification with IOL implantation was performed on all the eyes, and tobramycin and dexamethasone eye drops was used for 15 days as basis therapy.According to the treatment sequence,the operative eyes were assigned to rb-bFGF eyedrops group, polyethylene glycol eyedrops group and basis therapy group.rb-bFGF drops and polyethylene glycol drops were topically administered 4 times per day since the first day after surgery for consecutive 30 days in corresponding group,and only basis therapy was maintained in the basis therapy grouply.Corneal fluorescence (FL) staining scores,breakup time of tear film (BUT) and Schirmer Ⅰ test (S Ⅰ t) without topical anesthesia were examined in 1 day before operation and 1 day,7 days, 15 days and 30 days after operation.The efficacy was intergrouply compared.Results No significant differences were seen in the demography and the relevant surface examinational outcomes among the rb-bFGF group, polyethylene glycol drops group and the basis therapy group before surgery (age : F =1.50;gender :x2 =0.336, both at ＞ 0.05;FL : F =0.31;BUT:F =0.65;S Ⅰ t: F =0.57;all at P ＞ 0.05).Compared with the before operation, FL scores were obviously increased,and BUT values were reduced and S Ⅰ t values were elavated in all the eyes early stage of surgey and then gradually improved with the lapse of postoperative time, showing significant differences (Ftime =7.83,7.32,7.17, all at P＜0.01).The FL scores,BUT and S Ⅰ t in 15 days after surgery in the rb-bFGF drops group and 30 days after surgery in the polyethylene glycol drops group was closed to those of before surgery (all at P＞0.05).However,there were still significant differences between the before and after operation in the basis were closed to those of before surgery therapy group (all at P＜0.05).In addition, significant differences were found in corneal FL scores, BUT and S Ⅰ t among these three groups (Fgroup =5.08,4.15,4.61, all at P＜0.05).In postoperative 15 days and 30 days, the S Ⅰ t values were (12.32±1.18) and (11.32±1.98) mm/5 rmin,which were significantly lower than (14.36±1.77) and (13.36±2.32) mm/5 min in the polyethylene glycol drops group and (17.25 ±2.24) and (13.25 ±2.53) mm/5 min in the basis therapy group (all at P ＜ 0.05).Conclusions The topical application of rb-bFGF combined with tobramycin and dexamethasone eyedrops can improve the dry eye-related symptoms and promote the repair of the ocular surface injury after phacoemulsification with IOL implantation,and the clinical efficacy of rb-bFGF eyedrops is better than that of polyethylene glycol eyedrops or only tobramycin and dexamethasone eyedrops.

Efficacy of polyethylene glycol combined with pranoprofen drops on dry eye in patients with Sj(o)gren's syndrome and effect in content of interleukin-6 and tumor necrosis factor-α in tears / 中华风湿病学杂志

Objective To investigate the efficacy of pranoprofen drops on dry eye of patients with Sj(o)gren's syndrome (SS).Methods This is a prospective study.Sixty-eight inpatients with dry eye in our hospital were randomly divided into the experimental and control groups.Right eyes were taken for the trial,with 34 cases in each group.The experimental group was given pranoprofen eye drops combined with polyethylene glycol eye drops.Eyes of the control group were given polyethylene glycol drops only.Corneal fluorescein staining (FL),tear film breakup time (BUT) and Schirmer test (SIT) were tested before treatment and 1,2,4 weeks after treatment by the same care giver.The levels of IL-6 and TNF-α in tears were detected by ELISA.Analysis of variance of repeated data and t test were used for statistical analysis.Results The difference of FL,BUT,SIT and content IL-6 and TNF-α in tears in the experimental group patients before treatment and 1,2,4 weeks after treatment were signifcant (F=4.65,7.53,6.43,9.96,10.87; P＜0.05),which were statistically significantly different between the experimental group and the control group patients (F=3.27,5.85,4.36,8.36,7.23; P＜0.05).One week after treatment and before treatment,the difference of BUT and SIT of the two groups was not statistically significant (P＞0.05),those of the 2 weeks after treatment were statistically significantly different [BUT of the experimental group was (11.1±2.5) s,BUT of the control group was (9.7±1.9) s,t=2.594 8,P＜0.05; the SIT of the experimental group was (7.3±1.7) mm,the SIT of the control group was (5.9±1.7) mm,t=3.571 8,P＜0.05].BUT of the two groups at 4 weeks after treatment was statistically significantly different [BUT of the experimental group was (14.4±2.8) s,BUT of the control group was (11.4±2.6) s,t=4.469 4,P＜0.05; the SIT of the experimental group was (9.9±2.1) mm,the SIT of the control group was (8.7±1.9) mm,t=2.568 0,P＜0.05].The difference of FL and IL-6 and TNF-α in tears pretreatment between the two groups was not statistically significant (P＞0.05).At week 1,2,4 after treatment,the differences between the two groups were statistically significant (tFL=4.173 9,3.190 7,4.072 6; tIL-6=2.131 5,2.316 4,5.310 1; tTNF-α=2.216 4,4.871 9,8.175 0; P＜0.05).No significant discomfort and side effects were observed in the two groups.Conclusion Pranoprofen drops can significantly improve symptoms of dry eye in patients with pSS,in particular,the repair of the cornea,may be related to the inhibition of the expression of ocular inflammatory cytokines IL-6 and TNF-α,and thus reduce the ocular surface inflammatory reaction.

Comparison of diagnostic value in different parts and staging gastric cancer with 64-slice spiral CT / 实用放射学杂志

Objective To evaluate the role of 64-slice spiral CT with diphase dynamic scanning in predicting the T staging of gas-tric carcinoma in different locations and assessing the sensitivity of metastasis of lymph nodes.Methods 185 patients with gastric carcinoma proved by pathology underwent diphase 64-slice CT scan and performed a TNM staging according to UICC classification. The results were compared with surgical pathological findings.Results The detection sensitivity for earlier stage gastric carcinoma was 92.0% and 99.4% for the advanced stage gastric carcinoma,While the overall accuracy rates of T and N staging were 85.4%, 69.2% respectively.Compared with the pathologic findings,the accuracy rate of CT scan for T1,T2,T3,T4 staging was 72.0%, 69.6%,90.8% and 83.3% respectively.The differences were statistically significant between T1 and T3,T2 and T3.The accuracy rate of T staging was 86.0%,84.8% respectively when the lesions were located in cardia and in antrum and this difference was not statistically significant.When the lesions were located in the body of the stomach,the differences were also not statistically signifi-cant with the accuracy rate of T staging was 89.5%,86.4% ,87.2% respectively for the lateral wall of the lesser curvature,the posterior wall of the lesser curvature and both the lesser curvature and larger curvature involved.As for the N staging,The accuracy rate of N0,N1,N2,N3 was 54.3%,87.5%,68.1% and 53.6%.The differences were significant statistically between N0 and N1, N1 and N3.Conclusion There was a high accuracy in the preoperative TNM staging of the gastric carcinoma with 64-slice spiral CT. The accuracy rate of T staging of the gastric carcinoma is not relative to the lesion’s location.