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Sepsis-associated coagulopathy refers to extensive coagulation activation accompanied by a high risk of bleeding and organ failure. In severe cases, it is manifested as disseminated intravascular coagulation (DIC) and leads to multiple organ dysfunction syndrome (MODS). Complement is an important component of the innate immune system and plays an important role in defending against invasion of pathogenic microorganisms. The early pathological process of sepsis involves excessive activation of the complement system, which forms an extremely complex network through interactions with the coagulation, kinin and fibrinolytic system, amplifying and exacerbating the systemic inflammatory response. In recent years, it has been suggested that uncontrolled complement activation system can exacerbate sepsis-associated coagulation dysfunction or even DIC, indicating the potential value of intervening in the complement system in the treatment of septic DIC, and related research progress is reviewed in this article in order to provide new ideas for the discovery of sepsis-associated coagulopathy therapy drugs.
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Humans , Blood Coagulation Disorders , Complement Activation , Blood Coagulation , Multiple Organ Failure , SepsisABSTRACT
Cancer still has elevated morbidity and mortality, which undoubtedly impacts the life quality of affected individuals. Remarkable advances have been made in cancer therapy, although the toxicities of traditional therapies remain an obvious challenge. Dahuang Zhechong Pill (DHZCP), developed by Zhongjing Zhang in the Synopsis of the Golden Chamber, represents an effective anticancer traditional Chinese medicine (TCM). In this review, it was found that DHZCP is therapeutically utilized in liver, lung, gastric, pancreatic and other cancers in clinic. Pharmacological evidence showed that its anti-tumor mechanisms mainly involve induced cell cycle arrest, apoptosis and autophagy, as well as suppressed tumor cell proliferation, obstructed angiogenesis and metastasis, enhanced immunity, and reversal of multidrug resistance. The present review provides a solid basis for the clinical application of DHZCP and may promote the wide use of TCM in clinical antitumor application.
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From the perspective of cybernetics， this study investigated the fundamental principles of empirical thinking in traditional Chinese medicine， encompassing six stages： experience input and storage， experience extraction and activation， experience combination and reconstruction， judgment and decision-making based on experience， and experience evaluation and feedback. The potential limitations of empirical thinking in clinical applications were analyzed， mainly manifested as “individuality”， “superficiality”， “conservatism”， “prioritizing commonality over individuality”， and “cognitive inertia”. To overcome these limitations， this paper also explored strategies and methods for clinical error-correction from four points： the integration of rational and empirical thinking， the reinforcement of feedback mechanisms and transcendent correction， the integration of individualization and quantity-quality balance， and the management and transference of tacit knowledge under empirical thinking.
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Objective:To explore the clinical application of the electronic portal imaging device (EPID) based on the linear accelerator produced by Shanghai United Imaging Healthcare Co., Ltd. (UIH) to in vivo dose verification. Methods:A total of 68 patients (32 cases with head and neck tumors, 16 cases with chest tumors, and 20 cases with abdomen and pelvis tumors) who were treated with volumetric modulated arc therapy (VMAT) in the Henan Provincial People′s Hospital were selected in this study. Each patient underwent the pre-treatment dose verification using an Arccheck device (Pre Arccheck), the pre-treatment dose verification using an EPID (Pre EPID), and the in vivo dose verification using an EPID (In vivo EPID). Moreover, the position verification based on fan beam computed tomography (FBCT) was also performed for each patient in the first three treatments and then once a week. The patients were treated when the setup error in any direction ( x: left-right, y: head-foot, z: vertical) was less than 3 mm; otherwise, position correction would be conducted. The three-dimensional setup deviation d was calculated according to setup errors x, y, and z. Results:The γ passing rates of dose verifications Pre EPID and In vivo EPID of 68 patients were (99.97±0.1)% and (94.15±3.84)%, respectively, significantly different from that (98.86±1.48)% of the Pre Arccheck dose verification ( t = -6.12, 9.43; P < 0.05). The γ passing rates of the chest, abdomen and pelvis, and head and neck in the In vivo EPID dose verification showed no significant differences ( P > 0.05). The difference in the γ passing rates (5.56±3.72)% between dose verifications Pre EPID and first In vivo EPID was unrelated to the three-dimensional setup deviation d (1.46±1.51 mm) ( P > 0.05). As the treatment proceeded, the γ passing rate of In vivo EPID gradually decreased from (94.15±3.84)% in the first week to (92.15±3.24)% in the fifth week. From the third week to the fifth week, the γ passing rates of In vivo EPID were significantly different from those in the first week ( t = 2.48, 2.75, 3.09, P < 0.05). Conclusions:The setup errors within 3 mm do not affect the γ passing rate of in vivo dose verification. The clinically acceptable threshold for the γ passing rate of in vivo EPID needs to be further determined. In addition, in vivo dose verification can support the clinical application of adaptive radiotherapy to a certain extent.
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Objective:To systematically evaluate the efficacy of epinephrine in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).Methods:Randomized controlled trials (RCTs) on epinephrine for preventing PEP from inception to October 10, 2020 were searched in databases including PubMed, Embase, The Cochrane Library, Web of Science, VIP Information Network, China National Knowledge Infrastructure,WanFang Data,and clinical trial registration platforms including ClinicalTrials.gov,WHO International Clinical Trial Registration Platform. Literature was screened independently by two reviewers, data were extracted and the risk of bias of included studies were assessed. The meta-analysis was performed by RevMan 5.3.Results:A total of 410 papers were retrieved and 8 RCTs involving 4 208 patients were included. The results of meta-analysis showed that compared with the saline group, the epinephrine could reduce the incidence of PEP ( RR=0.29,95% CI:0.16-0.50, P<0.001). There were no significant differences in the therapeutic effect between group epinephrine and group indomethacin ( RR=0.17,95% CI:0.02-1.39, P=0.100) or group indomethacin combined with epinephrine and group indomethacin ( RR=1.15,95% CI:0.61-2.16, P=0.670). Conclusion:Local spraying of epinephrine on the duodenal papilla can reduce the incidence of PEP compared with normal saline. But the epinephrine or combination of indomethacin and epinephrine fails to reveal any benefit over indomethacin alone in preventing PEP.
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Objective:To explore whether life satisfaction has a mediating effect between child neglect and middle school student’ problematic mobile phone use.Methods:Totally 1 692 middle school students from four middle schools of Xiamen in June 2020 were selected by cluster stratified sampling.The self-rating questionnaire for adolescent problematic mobile phone use (SQAPMPU), child neglect scale (CNS) and quality of life scale for children and adolescents (QLSCA) were used for the survey. SPSS 23.0 software was used for descriptive statistics, correlation analysis, regression analysis and the mediating effect analysis.Results:The scores of CNS, QLSCA and SQAPMPU were (24.45±14.28), (134.44±19.34), (23.20±8.94)respectively.And the detection rate of problematic mobile phone use was 23.6%. There were significant differences in the scores of SQAPMPU scale in different grades, father's education degrees, mother's education degrees and monthly pocket money(all P<0.05). In SQAPMPU, high school students scored significantly higher than junior school students( t=-2.403, P=0.016), adolescents with undergrate education of their father and mother scored the lowest( F=3.411, P=0.017; F=2.729, P=0.043), adolescents with monthly pocket money of "500-1 000" and "1 000-2 000" scored significantly higher than those with monthly pocket money of "under 500". The total scores and sub scores of child neglect were significantly positively correlated with the total scores and sub scores of problematic mobile phone use ( r=0.177-0.360, all P<0.05). The total scores and sub scores of life satisfaction were significantly negative correlated with the total scores and sub scores of problematic mobile phone use ( r==-0.508--0.250, all P<0.05). Child neglect had a positive predictive effect on problematic mobile phone use ( t=15.598, R2=0.130, P<0.05), but had a negative predictive effect on life satisfaction ( t=-27.798, R2=0.321, P<0.05). There were the part intermediary role of life satisfaction between child neglect and problematic mobile phone use( t=-13.937, R2=0.222, P<0.05), and the mediating effect accounted for 58.29% of the total effect. Conclusion:The neglected experience in childhood of adolescents not only can directly affect problematic mobile phone use, but also can affect the problematic mobile phone use by affecting life satisfaction.
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Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. The maintenance of T lymphocyte subpopulation abundance and function is of great significance during sepsis, as T lymphocytes not only eliminate target cells by specific killing effect but also respond to antigen-presentation signals and assist B lymphocyte-mediated humoral immunity. Sepsis disrupts the homeostasis of effector T lymphocyte subsets, leading to lymphocytopenia, functional deficits, and affecting the stability of the T lymphocyte pool in many aspects of cell loss and acquisition, which in turn triggers persistent immunosuppression. Multiple mechanisms of cell death and proliferation have been reported to be involved in the dyshomeostasis and repair of T lymphocyte homeostasis. The article reviews the development of quantity and quality over homeostasis in effector T lymphocyte subsets and the possible mechanisms involved in immunosuppression in sepsis.
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Objective:To explore the effect of metastatic lymph node ratio (MLR) on the prognosis of adjuvant radiotherapy for stage-Ⅲ gastric cancer patients with no more than 15 lymph nodes dissection.Methods:According to the inclusion and exclusion criteria, a total of 590 patients diagnosed with stage-Ⅲ gastric cancer (excluding adenocarcinoma of esophagogastric junction) were included in this study from the SEER database between 2010 and 2016. No more than 15 lymph nodes were examined in all patients. Among them, 291 patients received surgery combined with adjuvant chemotherapy (surgery + chemotherapy group), and 299 patients received surgery combined with adjuvant radiochemotherapy (surgery + radiochemotherapy group). These two groups were treated with 1∶1 propensity score matching (PSM). We retrospectively analyzed the effect of MLR on prognosis of stage-Ⅲ gastric cancer patients with no more than 15 lymph nodes dissection, and evaluated the significance of postoperative adjuvant radiotherapy among patients with different MLR.Results:According to the analysis result of area under curve (ROC), 0.5 was defined as the best cut-off point of MLR. In the two groups of patients with stage-Ⅲ gastric cancer included in the study, the median survival time was 23 months in the surgery + radiochemotherapy group, and the 1 -, 3 -, and 5-year overall survival (OS) ratio were 77.1%, 33.2% and 22.8%, respectively. The median survival time was 21 months in the surgery + chemotherapy group, and the 1 -, 3 -, and 5-year OS ratio were 72.2%, 33.6% and 23.1%, respectively. There was no statistically significant difference between the two groups in OS. The result of subgroup analysis showed that there was no statistically significant difference in OS between the surgery + radiochemotherapy group and the surgery + chemotherapy group among patients with MLR≤0.5, while OS of the surgery + radiochemotherapy group was significantly better than the surgery + chemotherapy group among patients with MLR>0.5( χ2=8.542, P < 0.05). Multivariate Cox regression analysis showed that race, T stage, N stage, MLR and adjuvant radiotherapy were the important factors affecting OS of stage-Ⅲ gastric cancer patients with no more than 15 lymph nodes dissection( Wald=8.544, 7.547, 10.925, 18.047, 10.715, P < 0.05). After PSM, there was no statistically significant difference in OS between the two groups. The result of subgroup analysis showed that there was no statistically significant difference in OS between the surgery + radiochemotherapy group and the surgery + chemotherapy group among patients with MLR≤0.5, while OS of the surgery + radiochemotherapy group was significantly better than the surgery + chemotherapy group among patients with MLR>0.5( χ2=6.944, P < 0.05). Multivariate Cox regression analysis showed that race, T stage, N stage, MLR and adjuvant radiotherapy were the important factors affecting OS of stage-Ⅲ gastric cancer patients with no more than 15 lymph nodes dissection ( Wald=7.154, 8.023, 7.744, 17.016, 4.149, P < 0.05). The result of prognosis analysis of two groups before and after PSM were consistent. Conclusions:MLR is an important prognostic factor for stage-Ⅲ gastric cancer patients with no more than 15 lymph nodes dissection. The OS of patients with MLR ≤ 0.5 can′t benefit from postoperative adjuvant radiotherapy, while patients with MLR > 0.5 should be advised to receive postoperative adjuvant radiotherapy to improve the prognosis.
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Receptor-interacting protein (RIP) kinase 1 is involved in immune-mediated inflammatory diseases including ulcerative colitis (UC) by regulating necroptosis and inflammation. Our group previously identified TAK-632 (
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Objective To synthesize and investigate cytotoxicity of an indole-chalcone derivative FC58. Methods The target compound was synthesized through the Aldol condensation with 1-(3,4,5-trimethoxyphenyl)ethan-1-one and 1H-indole-3-carbaldehyde. The Cell Titer-Blue method was used to determine in vitro cytotoxicity. The cell cycle experiment was performed to analyze the action characteristics of FC58. Results FC58 exhibited high cytotoxicity against various leukemia cells and resulted in G2/M phase arrest. It showed stronger drug resistant index than traditional tubulin inhibitors such as paclitaxel, vinblastine and doxorubicin. Conclusion FC58 represents a promising lead compound for multi-drug resistant leukemia.
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Objective:To investigate the effect of chemotherapy combined with postoperative adjuvant radiotherapy on the overall survival (OS) of early and advanced (Ⅰ-Ⅱ A and Ⅱ B-Ⅳ) small cell neuroendocrine carcinoma of the cervix (SCNEC)patients and analyze the prognostic factors. Methods:The Surveillance, Epidemiology and End Result (SEER) database was used to search and screen out 269 SCNEC patients who received chemotherapy from 2004 to 2016. These patients were divided into four groups according to different treatment regimens: chemotherapy + postoperative radiotherapy group, chemotherapy + surgery group, chemotherapy + radiotherapy group and chemotherapy-alone group. Kaplan-Meier curve was utilized to compare the OS of SCNEC patients with stage Ⅰ-Ⅱ A and Ⅱ B-Ⅳ with different treatment regimens. Log-rank test and Cox regression analysis were used to evaluate significant clinicopathological factors on prognosis. Results:For patients with stage Ⅰ-Ⅱ A, the 5-year OS rate of chemotherapy + postoperative radiotherapy group, chemotherapy + surgery group, chemotherapy + radiotherapy group and chemotherapy-alone group were 39.9%, 71.7%, 24.5% and 0, respectively. Among patients with stage Ⅰ-Ⅱ A, chemotherapy + surgery group had a better prognosis ( HR 0.403, 95% CI: 0.112-1.112, P=0.047) than chemotherapy + postoperative radiotherapy group. For stage Ⅱ B-Ⅳ patients, the 5-year OS rate of the chemotherapy + postoperative radiotherapy group, chemotherapy + surgery group, chemotherapy + radiotherapy group and chemotherapy-alone group were 35.2%, 24.3%, 17.7% and 0, respectively. Among patients with stage Ⅱ B-Ⅳ, chemotherapy + surgery group, chemotherapy + radiotherapy group and chemotherapy-alone group all had worse prognosis ( HR 1.726, 95% CI: 0.944-3.157; HR 1.605, 95% CI: 0.968-2.661; HR 5.632, 95% CI: 3.143-10.093, P<0.05) than chemotherapy + postoperative radiotherapy group, respectively. In addition, the patients whose age ≤60 years old and tumor diameter<4 cm had a worse prognosis compared to those older than 60 years old ( HR 7.868, 95% CI: 3.032-20.415; HR 1.465, 95% CI: 1.006-2.435, P<0.05)and tumor diameter≥4 cm ( HR 2.576, 95% CI: 1.056-6.287; HR 1.965, 95% CI: 1.026-3.766, P<0.05). Conclusions:Chemotherapy combined with postoperative adjuvant radiotherapy can′t improve the OS of patients with early (Ⅰ-Ⅱ A) SCNEC, but can significantly improve the OS of advanced (Ⅱ B-Ⅳ) patients. Age, tumor size and treatment regimens are independent risk factors.
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Coronavirus infection seriously threatens human health. There is no specific medication or vaccine so far. In recent years, domestic and foreign researchers have developed a variety of small-molecule inhibitors against the ligand S protein, RdRp, PLpro and 3CLpro of three highly pathogenic coronavirus, SARS-CoV，MERS-CoV，SARS-CoV-2. This article reviews the characteristics of these coronaviruses, action targets, small molecule inhibitors, and structure-activity relationships.
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Objective@#To evaluate the indication, safety and effectiveness of transoral robotic surgery (TORS) for oropharyngeal cancer based on our preliminary experience.@*Methods@#Twelve patients, including six with tonsil cancer, five with tongue base cancer and one with posterior pharyngeal wall cancer, who underwent TORS with Da Vinci Si surgical system from March 2017 to October 2018 at Tongji Hospital of Huazhong University of Science Technology were respectively analyzed. And the surgical time, intraoperative blood loss, postoperative local bleeding, dyspnea, nerve function injury, oral intake time, whether or not to receive chemoradiotherapy were analyzed.@*Results@#All tumors in the 12 patients were en bloc removed by TORS. Surgical time ranged from 25 to 80 min with an average of 34.2 min. The blood loss ranged from 10 ml to 50 ml with an average of 20.8 ml. The recovery time for oral intake ranged from 1 day to 30 days with an average of 8.4 days. No patient underwent tracheostomy after TORS. Also, no patient manifested with airway obstruction, bleeding or nerve injury symptoms after operation. All 12 patients reached pathologically negative surgical margins. The patients were followed up for 4 to 22 months, with a median of 12 months. All patients who combined with more advanced than T3 stage, or more advanced than N2 stage were recommended to oncologist, then, followed with radiotherapy or chemoradiotherapy if no relevant contradictions occurred. No local recurrence or distant metastasis case was found.@*Conclusion@#With proper indications, the application of TORS in oropharyngeal cancer is a relatively safe, effective and minimal invasive therapy, which merits more clinical applications.
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Objective To examine the expressions of multidrug resistance gene (MDR)-1 and P-glycoprotein (P-gp) in nasopharyngeal squamous cell carcinoma CNE1 cell line before and after X-ray exposure.Methods CNE1 cells were exposed to X-ray.After the irradiation,the CNE1 cells were cultured for 24 hours and tested.The mRNA expressions of MDR-1 in CNE1 cells were measured by semi-quantitative real-time polymerase chain reaction (RT-PCR) before and after X-ray exposure,and the protein expressions of P-gp in CNE1 cells were detected by Western blotting.The protein expressions of P-gp in CNE1 cells were observed by confocal microscope before and after X-ray exposure.Results The results of RT-PCR showed that the absorbance (A) values of MDR-1 mRNA in CNE1 cells were 0.17 ±0.01 and 0.34 ±0.03 before and after irradiation,and the difference was statistically significant (t =16.541,P ＜ 0.001).The results of Western blotting showed that the A values of P-gp protein in CNE1 cells were 0.02 ± 0.01 and 0.04 ± 0.01,and the difference was statistically significant (t =4.612,P =0.016).The green fluorescence intensity of P-gp protein in CNE1 cells after X-ray irradiation was higher than that before X-ray irradiation by confocal microscope.Conclusion X-ray irradiation can cause the high expressions of MDR-1 and P-gp in CNE1 cells,suggesting that X-ray irradiation can induce the occurrence of multidrug resistance in CNE1 cells.
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Objective To evaluate and compare the imaging quality and diagnostic accuracy of two types of scanning techniques of 256-slice spiral CT angiography, prospective electrocardiogram(ECG)-gated sequence and non ECG-gated high-pitch sequence, used respectively for patients with Stanford type A aortic dissection (AAD) at the root of ascending aorta.Methods A retrospective study was conducted. Sixty-eight patients with AAD were definitely diagnosed by CT angiography were admitted to the Fifth Central Hospital of Tianjin from August 2015 to July 2017, and they were divided into two groups according to different scanning methods: 36 cases of AAD underwent prospective ECG-gated CT angiography (CTA) and 32 patients underwent non ECG-gated high-pitch CTA. A 3-grade scoring system was used to interpret the image quality of the aortic sinus, aortic valve junction zone and coronary artery opening. The CT value and noise value (SD) of aortic root were measured, the image signal to noise ratio (SNR) was calculated and compared with the discovery in exploratory operation; the patients' CTA imaging quality and the coincidence rate of lesion type diagnosis were compared between the two groups.Results All aortic CTA images could meet the diagnostic requirements. The imaging quality scores of aortic sinus, arotic valve junction zone and coronary artery opening images in ECG-gated CTA group were higher than those in non ECG-gated high-pitch CTA group (aortic sinus: 2.94±0.23 vs. 1.89±0.67, sinuscanal junction zone: 2.94±0.23 vs. 1.83±0.70, coronary artery opening images: 2.86±0.35 vs. 1.31±0.52, allP < 0.01); comparisons between the ECG-gated CTA group and non- ECG-gated CTA group in objective indexes, CT value, arotic SD value and SNR at the root of ascending aorta showed there were no statistically significant differences [the value of CT (HU): 425.20±94.38 vs. 439.29±86.78, the SD value of aorta (HU): 22.85±9.40 vs. 26.40±9.41, SNR: 21.23±8.16 vs. 19.70±9.98, allP > 0.05]. The coincidence rate between the diagnosis of AAD at the root of ascending aorta and the discovery in the exploratory operation in ECG-gated CTA group was higher than that in non ECG-gated CTA group [94.4% (34/36) vs. 68.8% (22/32),P < 0.01].Conclusion The diagnostic accuracy and image quality of AAD root of ascending aorta in prospective ECG-gated CTA group were significantly higher than those in non ECG-gated CTA group.
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Posterior ankle pain is one of the most common intractable pain,whose etiology is diverse and difficult to diagnose.The causes of posterior ankle pain usually include posterior subtalar tarsal coalition,medial flexor tendon pathology,peroneal pathology,tendon pathology,Haglund syndrome,posterior ankle impingement syndrome,sinus tarsi pathology and tarsal tunnel syndrome.MRI can not only be used to evaluate the superficial soft tissue and deep ligaments and tendons,but also is suitable for showing bone marrow edema and bone contusion,therefore being the first choice for diagnosis of posterior ankle pain.Research progresses of MRI for diagnosis of etiology of posterior ankle pain were reviewed in this paper.
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Posterior ankle pain is one of the most common intractable pain,whose etiology is diverse and difficult to diagnose.The causes of posterior ankle pain usually include posterior subtalar tarsal coalition,medial flexor tendon pathology,peroneal pathology,tendon pathology,Haglund syndrome,posterior ankle impingement syndrome,sinus tarsi pathology and tarsal tunnel syndrome.MRI can not only be used to evaluate the superficial soft tissue and deep ligaments and tendons,but also is suitable for showing bone marrow edema and bone contusion,therefore being the first choice for diagnosis of posterior ankle pain.Research progresses of MRI for diagnosis of etiology of posterior ankle pain were reviewed in this paper.
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AIM To study the flavonoids from the leaves of Astragalus membranaceus (Fish.) Bge..METHODS The ethyl acetate and n-butyl alcohol fractions of 75％ ethanol extract from A.membranaceus leaves were isolated and purified by silica,ODS and preparative HPLC column,then the structures of obtained compounds were identified by spectral data.RESULTS Thirteen compounds were isolated and identified as quercetin (1),quercetin-3-O-β-D-glucopyranoside (2),rhamnocitrin-3-O-β-D-glucopyranoside (3),rhamnocitrin-3-O-β-neohesperidoside (4),rhamnocitrin-3-O-3-D-glucopyranoside (1'''→2'')-β-D-apiofuranosyl (5),complanatuside (6),glycitein (7),4',7-dihydroxy-3-methoxy isoflavone (8),genistein (9),calycosin-7-O-β-D-glucopyranoside (10),genistin (11),glycitin (12),tiliroside (13).CONCLUSION Compounds 5,8,13 are isolated from genus Astragalus for the first time,and compound 2 is first isolated from this plant.
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Objective To explore the influence of different preservation conditions and time period on the testing results of Alzheimer's disease(AD) associated neuronal thread protein(AD7C-NTP) in urine specimen.Methods From Oct.2015 to Jan.2016,urine specimen were collected from 50 AD patients,and divided into three groups,according to the different storage temperature,including room temperature group,4 ℃ group and-20 ℃ group.Preservatives were added into specimen of 4 ℃ preservation group and-20 ℃ preservation group.AD7C-NTP level was detected at different preservation time of all specimen.Results The testing results of AD7C-NTP in specimen of room temperature group and 4 ℃ groups,detected within three days,were not significantly different with initial detection value(P>0.05).After seven days,the testing results in specimen of 4 ℃ group were not significantly different with initial detection value(P>0.05).However,after one day,the testing results in specimen of-20 ℃ group were significantly different with initial detection value(P<0.05).Contrast with 4 ℃ without preservative group,the adding of preservative could not increase the stability of AD7C-NTP.The adding of preservative in specimen of-20 ℃ could obviously increase stability,but the deviation of testing results was beyond acceptable limits.Conclusion 4 ℃ without preservatives could be the optimal storage condition for detection of AD7C-NTP in the urine.
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Objective To investigate the clinical significance of joint application of carcinoembryionic and carbohydrate antigen 19-9 for improving the prognosis of patients with gallbladder cancer.Methods A retrospective analysis of clinical-pathological features and prognosis were conducted including 390 patients with gallbladder cancer,who were treated from January 2003 to December 2013 at Eastern Hepatobiliary Surgery Hospital of Second Military Medical University.The clinical value of joint application of careinoembryionic and carbohydrate antigen 19-9 in prognosis was explored.The survival of patients was followed up by telephone or outpatient.Continuous variables were indicated as median (average) and categorical variables were expressed as number(n).Mann-Whitney U test was applied for continuous variables.Categorical variables were compared by the Chi-square test or Fisher probability method.The survival curve was drawn by the Kaplan-Meier method.The univariate analysis and multivariate analysis of prognosis were respectively done using the Log-rank test and COX regression model.Results Of the 390 patients,327 had complete data.The median (range) follow-up time was 49 (1-123) months.Both carcinoembryionic and carbohydrate antigen 19-9 could be used to predict prognosis of gallbladder cancer.A linear combination of carcinoembryionic and carbohydrate antigen 19-9 was significantly better(0.9365) than carbohydrate antigen 19-9 (0.7619) as well as carcinoembryionic (0.7937) alone in term of specificity.Preoperative blood test carcinoembryionic and carbohydrate antigen 19-9 nature showed double-negative group had the best prognosis,with a median survival of 27.06 months,R0 radical rate was 86.1％.Doublepositive group had the worst prognosis,with a median survival of 6.17 months,R0 radical rate was 45.1％.Conclusions Combinations of pretherapeutic tumor makers carcinoembryionic and carbohydrate antigen 19-9 can improve the accuracy of predicting prognostic in patients with gallbladder cancer,and the clinical application is practical.