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Objective:To evaluate the correlation between brain-derived neurotrophic factor (BDNF) and inflammatory markers in rheumatoid arthritis (RA) patients with depressive symptoms.Methods:This study was a cross-sectional study. RA patients' medical history were recorded and disease activity was evaluated. Serum BDNF, interleukin (IL)-6, tumor necrosis factor (TNF)-α were tested and clinical inflammatory indicators such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen (FIB), serum amyloid A (SAA) were recorded. RA patients were instructed to fill in the patient health Questionnaire-9 (PHQ-9) scale by themselves. Patients with a score greater than or equal to 5 were included in the RA with depressive symptoms group, and patients with a score of 4 or less were included in the RA without depressive symptoms group. The changes in BDNF and inflammatory indexes were compared between the two groups. Correlation analysis of PHQ-9, BDNF, inflammatory markers and DAS28 was performed. Logistic regression analysis was performed to find the risk factors of depression in RA.Results:A total of 140 RA patients were enrolled in this study, and 66 patients (47.1%) with a PHQ-9 score greater than or equal to 5 were included in the RA with depressive symptoms group. Compared with the RA without depressive symptoms group, RA patients with high disease activity, single and living alone, poor economic self-awareness and unemployed were more likely to have depressive symptoms. The serum level of BDNF[(2 276±333) pg/ml vs (1 367±431) pg/ml, t=13.91, P<0.001], IL-6[(39±28) pg/ml vs (27±8) pg/ml, t=3.66, P<0.001], TNF-α[(9.0±7.2) pg/ml vs (6.6±3.9)pg/ml, t=2.43, P=0.035], CRP[(25±13) mg/L vs (17±11) mg/L, t=3.94, P<0.001], ESR[(48±18) mm/1 h vs (34±21) mm/1 h, t=4.14, P=0.024], Fib[(3.8±1.1) g/L vs (3.0±0.5) g/L, t=5.92, P=0.023], SAA[(64±39) mg/L vs (37±19) mg/L, t=5.32, P<0.001] in RA with depressive symptoms group were significantly higher than those in RA without depressive symptoms group. Serum BDNF was significantly positively correlated with PHQ-9 score ( r=0.66, P<0.001), IL-6( r=0.20, P=0.019), TNF-α ( r=0.14, P=0.090), CRP ( r=0.32, P<0.001), ESR ( r=0.20, P= 0.001), Fib ( r=0.28, P=0.001), SAA( r=0.28, P=0.001) and DAS28 ( r=0.37, P<0.001) . BDNF [ OR (95% CI) =1.578(1.257, 2.354), P=0.001], IL-6[ OR (95% CI) =1.073(1.012, 1.075), P=0.006], CRP[ OR(95% CI)=1.085(1.045, 1.178), P=0.001], SAA[ OR(95% CI)=1.125(1.004, 1.198), P=0.018] and unemployment were risk factors for depressive symptoms in RA. Conclusion:Serum BDNF is positively correlated with PHQ-9 scores, inflammatory markers and disease activity in RA patients. BDNF, IL-6, CRP, SAA and unemployment are risk factors for depressive symptoms in RA. Effective treatment of RA can reduce the occurrence of depression symptoms.
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Objective:To investigate the predictive value of gadobenate dimeglumine (GD-BOPTA) multi-phase enhanced MRI for the expression of cytokeratin19 (CK19) in hepatocellular carcinoma (HCC).Methods:A total of 153 patients of HCC confirmed by pathology from June 2016 to February 2020 in First Affiliated Hospital of Fujian Medical University were enrolled retrospectively. According to the post-operative pathology, the patients were divided into CK19-negative group ( n=122) and CK19-positive group ( n=31). All the patients underwent MRI scan and Gd-BOPTA multi-phase enhanced scan before operation. MRI features on Gd-BOPTA MRI were compared between two groups. The qualitative indicators included tumor morphology, mosaic signs, intratumoral hemorrhage, intratumoral fat, non-rim arterial phase hyper-enhancement (APHE), non-peripheral washout, targetoid manifestation, enhanced capsule, corona enhancement, DWI signal, vascular invasion and hepatobiliary phase (HBP) enhancement. The quantitative indicator of tumor-to-liver signal ratio (SR) on HBP was recorded. The χ 2 test or Fisher exact probability method was used to compare the qualitative parameters between two groups, and student′s t test or Mann -Whitney U test was used for quantitative data. Predictive parameters were identified by univariate and multivariate logistic regression analysis to predict the value of the expression of CK19. The ROC curve was used to analyze the diagnostic efficacy of MRI parameters. Results:There were statistically significant differences between CK19-positive and CK19-negative groups ( P<0.05) in alpha fetoprotein, tumor morphology, non-rim APHE, non-peripheral washout, targetoid manifestation, corona enhancement, HBP enhancement and SR. Multivariate logistic regression analysis showed tumor morphology, corona enhancement, HBP enhancement and SR were independent predictors of CK19 expression in HCC. The area under the ROC curve of the combined four indicators for predicting CK19 expression in HCC was 0.823, and the sensitivity and specificity were 80.7% and 75.4%, respectively. Conclusions:Gd-BOPTA multi-phase enhanced MRI has an important value in the prediction of the expression of CK19 in HCC. The combination of signs of HBP can improve the prediction efficiency of CK19.
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Objective:To evaluate the clinical characteristics and identify potential factors of the early-stage hip involvement in patients with ankylosing spondylitis (AS) based on the magnetic resonance imaging (MRI).Methods:A retrospective group control study was carried out in 570 AS patients who were consecutively admitted to our hospital from 2014 to 2018. Patients with hip pain or hip function limitation but lacking definitive evidence of hip involvement on radiography were underwent hip MRI. Patients were divided into three groups: no hip involvement, early-stage hip involvement (hip involvement detected by MRI but with negative radiographs) and advanced-stage hip involvement (Bath Ankylosing Spondylitis Radiology Index-hip score ≥2). The study factors included demographic, laboratory, clinical and radiographic data. Simple and multiple ordinal logistic regression analysis were used to identify factors associated with the early-stage hip involvement and advanced-stage hip involvement.Results:A total of 236 patients (41.4%) presented with hip involvement, in which 146 cases (25.6%) were diagnosed with early-stage hip involvement, while 90 cases (15.8%) were diagnosed with advanced-stage hip involvement. Multivariate logistic regression analysis demonstrated that older age at onset [ OR=0.80, 95% CI (0.72, 0.90), P<0.01], more active inflammation in the sacroiliac joints [ OR=1.13, 95% CI(1.07, 1.18), P<0.01] and worse BASMI score [ OR=3.06, 95% CI(2.14, 4.13), P<0.01] were associated with the occurrence of early-stage hip involvement. Conclusion:MRI is superior to radiography in detecting early-stage hip involvement. MRI is more suitable for hip involvement assessment in AS patients with suspected symptoms or risk factors of hip involvement.
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Objective:To explore the relationship between death indicators and unplanned return indicators on healthcare quality evaluation.Methods:A total of 836 976 medical record data were collected from 31 tertiary public general hospitals in a diagnosis-related groups(DRG) data platform in 2017. Multiple death indices(low and low-risk risk group mortality, high-risk group mortality, crude mortality, and risk adjusted mortality) and unplanned return indices(31-day unplanned readmission rate and 31-day unplanned return to surgery rate) were calculated. Pearson′s correlation coefficient was used to examine the relationships among those indices.Results:Death indicators were correlated with each other, but the unplanned readmission rate was not correlated with the unplanned reoperation rate( r=0.305). There was no correlation between unplanned re-entry rate and death rate. The correlation coefficients were as follows: unplanned readmission rate versus low and low-risk group mortality( r=-0.227), versus high-risk group mortality( r=-0.098), versus actual mortality( r=-0.130), versus risk adjusted mortality( r=0.010); unplanned reoperation rate versus low and low-risk group mortality( r=0.105), versus high-risk group mortality( r=0.030), versus actual mortality( r=-0.004), versus risk adjusted mortality( r=-0.141). Conclusions:The indicators of death and the indicators of unplanned return are not the same in terms of actual management technology and evaluation effect. They are complementary to each other and can form an ideal combination of quality evaluation indicators.
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Objective To calculate the standardized cesarean delivery rate by considering the individual characteristics of puerprae, and to evaluate the medical quality of obstetrics in the hospital. Methods Medical records of 69 406 puerprae from January to December in 2016 were collected from 33 tertiary general hospitals in Shanxi province. A logistic regression model was used to construct a maternal risk adjustment model of cesarean delivery, with the area under the ROC curve (AUC) used to evaluate the goodness of fit of the model. Results Of the 69 406 puerprae, 30 881 used caesarean delivery, accounting to 44. 37% . The cesarean section rate difference was statistically significant among those of different age, nationality, conditions upon admission, whether to participate in a clinical pathway, fetus number, birth weight and maternal gestational age, as well as the severity of complications (P< 0. 001). According to the logistic model, those of older age, history of cesarean delivery, twins or triplet births, neonatal overweight, malposition, placenta previa, and those with various pregnancy complications tend to use maternal cesarean section surgery, with a goodness-of-fit of 0. 82. With risk adjusted, the ranking of actual cesarean section rate and standardized cesarean section rate varies among the hospitals. Conclusions With the factor of puerprae factor adjusted, the standardized cesarean delivery rate can eliminate risk factors of the puerprae, it is feasible to scientifically evaluate the cesarean delivery rate of the hospital′s obstetric department.
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Objective To investigate glycemic control,changes of inflammatory factors and their clinical significance in severe sepsis patients.Methods One hundred and three severe sepsis patients with abnormal hyperglycemia were randomly divided into the two groups and receive intensive insulin therapy (IIT) and conventional insulin therapy (CIT) respectively.According to glycosylated hemoglobin level,the two groups were further divided into stress hyperglycaemia and diabetes mellitus subgroups.The mortality and incidence of hypoglycemia were compared between the groups and subgroups.Enzyme linked immunosorbent assay was used to detect TNF-α,IL-6 levels before treatment,3 and 7 days after treatment.Results In IIT group,the mortality in diabetes mellitus subgroup was significantly higher than that in stress hyperglycaemia subgroup (66.7％ vs.30.8％,P ＜ 0.05),while the mortality in stress hyperglycaemia subgroup significantly higher than that in diabetes mellitus subgroup (54.1％ vs.25.0％,P ＜ 0.05) in CIT group.Multivariate Logistic regression analysis revealed IIT increased the risk for death in diabetes mellitus subgroup (OR =1.221,95％ CI:1.075-1.434),while decreased the risk for death in stress hyperglycaemia subgroup (OR =0.872,95％ CI:0.714-0.975).The incidence of hypoglycemia was significantly higher in IIT group than that in CIT group (13.7％ vs.1.9％,P ＜0.05).Before treatment,the levels of TNF-α,IL-6 in stress hyperglycaemia patients were significantly higher than those in diabetes mellitus patients.After 7 day treatment,The levels of TNF-α,IL-6 decreased significantly in stress hyperglycaemia patients (P ＜ 0.01),and decreased more significantly in IIT group than that in CIT group.Conclusion Severe sepsis patients with stress hyperglycaemia can attain better glycemia control and inhibition of inflammatory factors,and clinical benefit from IIT.
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Objective:To identify the correlation between neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and hepatocellular carcinoma (HCC) patients who underwent transarterial chemoembolization (TACE). Methods: We retrospectively re-viewed 216 patients who were diagnosed with HCC and treated with TACE between January 2007 and June 2015 at the Department of Hepatobiliary Oncology, Cancer Center, Sun Yat-sen University. The patients were stratified into two groups using NLR and PLR cutoff values. NLR and PLR were analyzed and compared through the area under receiver operating characteristic curves at different time points. Univariate and multivariate analyses were applied to evaluate the correlation between NLR, PLR, and HCC patients who were treated with TACE. Results:The median follow-up period was 431.11 d. The estimated 1-, 2-, and 3-year overall survival (OS) rates were 61.3%, 44.2%, and 40.5%for the entire study cohort, respectively. The median OS was 410.5 d. The estimated 1-, 2-, and 3-year OS rates for NLR<1.77 group and NLR≥1.77 group were 81.6%, 63.0%, and 45.7%;and 43.1%, 27.0%, and 19.3%, respectively. The dif-ference was significant (P<0.001). The estimated 1-, 2-, and 3-year OS rates for PLR<94.62 group and PLR≥94.62 group were 62.7%, 47.0%, and 37.0%;and 46.8%, 29.0%, and 18.5%, respectively. The difference was significant (P=0.002). In a multivariate analysis, NLR≥1.77 was a risk factor associated with poor outcome for patients with HCC who received TACE therapy. Conclusion:NLR level be-fore TACE is an indicator of systemic inflammation and is a risk factor associated with the prognosis of HCC patients who were treated with TACE.
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Objective To investigate the risk factors of disease progression and adverse pregnancy outcome in patients with systemic lupus erythematosus (SLE) during pregnancy.Methods Clinical data of 118 pregnant women with SLE admitted from June 2004 to October 2015 were retrospectively analyzed.The patients were divided into selective pregnant group (group A,n =72 cases) and non-selective pregnant group (group B,n =46) according to the disease activity of SLE.The disease progression and pregnancy outcomes were compared between two groups.Results The various system damages occurred in group B,including hematological damage in 16 cases,kidney damage in 19 cases,erythra in 10 cases,arthritis in 10 and serositis in 12 cases;while the corresponding cases in group A were 10,14,6,4 and 4(x2 =7.133,P=0.008;x2 =6.658,P =0.010;x2 =4.304,P =0.038;x2 =7.030,P =0.008;x2 =10.095,P =0.001).SLE exacerbation occurred in 28 cases (74％) of group B and 12 cases (17％) of group A (x2 =34.944,P =0.000).The logistic regression analysis showed that hypocomplementemia,proteinuria,SLEDAI score before pregnancy and positive anti-dsDNA antibody were the risk factors of SLE disease exacerbation during pregnancy.The maternal complications occurred in group B,including pregnancyinduced hypertension in 7 cases,preeclampsia in 10 cases and infections in 11 cases/times;while the corresponding cases (case/time) in group A were 2,6 and 4 (x2 =4.526,P =0.033;x2 =4.304,P =0.038;x2 =8.525,P =0.004).There were 14 cases of therapeutic induced labor,7 case of stillbirth and 27 cases of total fetal loss in group B,while the corresponding cases in group A were 2,0 and 4 (x2=18.317,P =0.000;x2 =9.080,P =0.003;x2 =40.920,P =0.0300).The logistic regression analysis showed that positive anticardiolipin antibody,proteinuria,SLEDAI score before pregnancy and renal dysfunction during pregnancy were risk factors of fetal loss.There were 87 cases of successful delivery (73.7％),the successful delivery rates were 41.3％ (19/46) in group B and 94.4％ (68/72) from group A,respectively.The infant complications occurred in group B,including premature birth in 15 cases,low birth weight in 13 cases,neonatal jaundice in 5 cases and mild asphyxia in 5 cases;while the corresponding cases in group A were 24,18,4 and 2 (x2 =11.442,P =0.001;x2 =11.395,P =0.001;x2 =4.664,P =0.031;x2 =8.035,P =0.005).Conclusion SLE patients whose disease conditions are not well controlled would lead to higher percentage of disease deterioration during pregnancy and worse pregnancy outcomes.
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Objective To analyze the importance of procalcitonin (PCT) and high-sensitivity Creactive protein (hsCRP) in assessing the severity of pneumonia and sepsis patients as well as prognostic evaluation.Methods A total of 77 patients with pneumonia complicated with sepsis were randomly (random number) selected from May 2013 to May 2016 in our hospital and 50 patients with simple pneumonia were enrolled as control group.The sepsis pneumonia patients were divided into three groups,namely sepsis group,severe sepsis group and septic shock group.The sepsis patient were further divided into survival group and death group according to the death of patient within 2 weeks.Statistics was employed to study the roles of PCT and hsCRP in evaluating the severity of pneumonia and sepsis patients as well as prognostic evaluation.Results Compared with control group,the levels of PCT and hsCRP were higher in patients of sepsis groups (P ＜ 0.05).The levels of PCT and hsCRP were gradually increased as the severity of the patient getting worse (P ＜ 0.05).The levels of PCT and hsCRP in the death group were higher than those in the survival group.The areas under ROC curve of PCT and hsCRP for diagnosis of sepsis and septic shock as the optimal cut-off point at ≥ 2 ng/mL and at ≥ 75 mg/L,had the sensitivity of 62.1％ and 81.2％,respectively,and the specificity of 89.2％ and 68.2％,respectively.Conclution PCT and hs CRP levels have a certain value in assessing the severity of pneumonia and sepsis patients as well as prognostic evaluation.
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The research probed into studies at home and abroad on the correlation between hospital service capacity and quality of care,without finding definite correlation between the two.In view of such issue in China,the authors discussed the corelation between hospital service capacity and quality of care of China's hospitals,the relationship between hospital scale expansion and medical quality,and the evaluation of medical quality,providing references for researchers and policy-makers.
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Objective To detect the serum 25- OH-D levels in patients with systemic lupus erythematosus (SLE) and investigate the function of vitamin D in the pathogenesis of SLE. Methods Eighty SLE patients including 40 healthy donors and 40 RA (rheumatoid arthritis) patients were enrolled in this study. Serum 25-OH-D levels were detected with ECL method. Results (1)Serum 25-OH-D levels in patients with active SLE were lower than those with inactive SLE patients and healthy controls. (2)Serum 25-OH-D levels were negatively correlated with SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) scores (r = -0.45,P < 0.01) and 24-hours urinary protein excretion (r = -0.32,P < 0.05). Conclusion Serum 25-OH-D levels in SLE patients decrease and have close relationship with disease activity and renal lesions.
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ObjectiveTo investigate the expression and significance of Thl7 cells in peripheral blood of patients with Rheumatoid Arthritis (RA).MethodsThirty-three active RA and 27 stable RA patients and 30 healthy individuals were enrolled in the study.Intracellular flow cytometry detection of TH17 cells in peripheral blood was established.The correlations between Th17 cells and RA disease activity (DAS28 scale) as well as bone erosion were analyzed.ResultsThe expressions of Th17 cells in the patients with RA were significantly higher than those of healthy controls [ ( 1.60 ± 0.51 ) ％ vs (0.81 ± 0.21 ) ％,t =10.30,P ＜ 0.001 ].The Th17 levels in active RA patients were also higher than that of stable RA patients and healthy subjects [ ( 1.94 ±0.38 ) ％ vs ( 1.19 ± 0.27) ％,t =8.85,14.60,P ＜ 0.01 ].And the Th1 7 levels in stable RA patients were also higher than that of healthy subjects (t =5.88,P ＜0.01 ).Active RA patients with bone erosion ( 19 cases) also had higher levels of Th17 cells than those without bone erosion ( 14 cases) [ ( 2.09 ± 0.39 ) ％ vs.( 1.74 ±0.29 ) ％,t =2.83,P ＜ 0.01 ].The expression of Th17 cells was positively correlated with the DAS28 score ( r =0.86,P ＜ 0.01 ).ConclusionThere is a high expression of Th17 cells in peripheral blood of RA patients,which is related to disease activity and bone erosion.Th17 cells might play an important role in the pathogenesis of RA.
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Objective To probe the oprⅠ gene in rat model with Pseudomonas aeruginosa septicemia by FQ-PCR,and compare the sensitivity and specificity between FQ-PCR and traditional germiculture,and check the change of oprI gene before and after the antibiotic therapy as to rapidly judge its sensitivity.Methods The standard Pseudomonas aeruginosa with five different concentration were prepared,the drug-sensitive test wbre used to find lhe sensitive antibiotics.120 SD rats were random divided into five groups,five different concentrations of Pseudomonas aeruginosa were injecked into the rats with the same volume.Six rats of each group were picked up for taking blood for culture at the time points of Oh,12h,24h,and 48h after narcotization.Finally,the oprⅠ gene of each blood samples were checked with FQ- PCR.72 rats were random divided into three groups,therapeutic group,treated group and control group.Pseudomonas aeruginosa with the concentration of 1×109 CFU/ml were injected into those rats.Sensitive antibiotics,insensitive antibiotics and 0.9% NaCl were given to the therapeutic,treated and control group rats respectively.Six rats of each group were picked up for taking blood for culture at the time point of Oh,12h,24h,and 48h after narcotized.Finally,the oprⅠ gent of each blood sample were checked with FQ-PCR.Results The blood culture were positive in each period of the concentrations 1×109 CFU/ml and 1×108 CFU/ml.Results of FQ-PCR showed that the copy number decreased with time going,all of which were positive.The blood culture were positive at the time points of Oh and 12h with the concentrations of 1×107 CFU/ml and 1×106 CFU/ml,were positive with concentration of 107 CFU/ml at the time point of 24h,but negative with concentration of 107 CFU/m at the time point of 48h,and negative with the concentration of 1×106 CFU/ml at the time points of 24h and 48h.The blood culture were negative in each period of the concentration of 1×105 CFU/ml,and the results of FQ-PCR were negative.The blood culture were positive in each period of both treated and control group,but negative in each period of therhpeutic group,all the results of FQ-PCR were positive.Conclusion The coincidence rate between the method of FQ-PCR and trgditional germicuhure were 100%.Though the sensitivity of FQ-PCR was not increased,the time needed by diagnosis was shorter After treated with effective antibiotic,fhe sensitivity of FQ-PER to diagnosis Pseudomonas aeruginosa septicemia was higher than that of traditional germicuhure,and the experiment time was shorter.Detected the changes of the oprⅠ gene copies number may be helpful to estimate the sensitivity of antibiotic.
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Objective To investigate the expression and significance of B lymphocyte stimulator (Blys) and its receptor BAFF (BAFF-R) in peripheral blood mononuclear cells (PBMCs) from patients with systemic lupus erythematosus (SLE). Methods The expression of Blys and BAFF-R was measured by flow cytometry in 90 pa-tients with SLE,which was compared with that of 45 healthy controls. The relationships between the expression of Blys, BAFF-R and other laboratory parameters as well as disease activity were analyzed. Results The expression of Blys and BAFF-R in PBMCs from patients with SLE was significantly elevated compared to healthy controls (P <0.001), so did the active group (P < 0.001) and inactive group (P < 0.001 and P < 0.01). The expression of Blys in PBMCs from active SLE patients was higher than that of inactive patients (P <0.05). However,there was no statisti-cal difference of BAFF-R between the two groups. The expression of Blys in PBMCs was positively related to SLEDAI (r =0.728,P <0.001) ,IgG and IgM(r=0.691,P<0.001 and r =0.453,P<0.01) ,but negatively related to C3 and CA (r = -0.510, P < 0.001 and r = -0.312, P < 0.05). The expression of Blys in dsDNA positive group was higher than those of dsDNA negative group (P < 0.01). The expression of Blys and BAFF-R in Cl qAb positive group was higher than those of ClqAb negative group as well (P <0.01). Conclusion The expression of Blys and its receptor BAFF-R in PBMCs from SLE is elevated ,which may reflect the disease activity and is related to the pro-duction of autoantibody. They might be involved in the pathogenesis of SLE.
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Objective To analyze the correlation between serum anti-C1q antibody (anti-C1q Ab)and renal pathological characteristic,disease activity as well as some laboratory tests in patients with lupus nephritis (LN).Methods Serum anti-C1q antibodies were detected by enzyme-linked immunosorbant assay ELISA) in 120 patients with systemic lupus nephritis (SLE),which included 60 LN patients and 60 non-LN patients.Renal biopsy was conduted in all LN patients.The relationships between serum anti-C1q Ab level and renal pathohistology,lupus nephritis activity,as well as some laboratory parameters were analyzed.Results The mean level of serum anti-C1q Ab in LN patients was (89+26) U/ml,significantly higher than that of nonLN patients (57±23) U/ml (P＜0.01).Twelve cases of renal biopsies were classified as WHO Class Ⅱ,fourteen cases Class Ⅲ,eighteen cases Class Ⅳ,and sixteen cases Class Ⅴ.Significant difference of serum anti-C1q Ab level between each class was found by ANOVA test,and serum anti-C1q Ab level of Class Ⅳ was the highest (P＜0.01).Renal biopsies showed a positive correlation between serum anti-C1q Ab level and activity index of renal pathohistology (P＜0.01).Renal deposition of C1q was related with the level of serum anti-C1q Ab.Serum anti-C1q Ab level was positively correlated with proteinuria (P＜0.01),and negatively correlated with levels of C3 and C4 (P＜0.01).Mean level of serum anti-C1q antibody in SLE patients with positive antidsDNA was higher than that in the patients with negative anti-dsDNA (P＜0.01).Conclusion Serum antiC1q Ab level is significantly associated with lupus nephritis activity and renal pathohistology.It is a useful marker to predict renal lesion and disease activity in lupus nephritis.
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<p><b>OBJECTIVE</b>To study the micrometastasis distribution in liver tissue surrounding hepatocellular carcinoma (HCC), and provide reference for appropriate surgical safety margin.</p><p><b>METHODS</b>Thirty-six patients with HCC but without clinical metastasis underwent hepatectomy. Their specimens showing ample surgical margin were made into giant sections. Tumor micrometastasis in liver tissue around the primary tumor were examined microscopically. In each specimen, the surrounding tissue was divided into proximal(p) and distal(d) areas. In either area, three lines of demarcation 0.5 cm, 1.0 cm, and 2.0 cm away from the margin of the primary tumor were designated as L(0.5), L(1.0) and L(2.0). Therefore, the surrounding tissue was divided into six zones - Z(p0.5), Z(p1.0), Z(p2.0) and Z(d0.5), Z(d1.0), Z(d2.0). The maximum micrometastasis spread distance (MMSD) and density (D(p0.5), D(p1.0), D(p2.0) and D(d0.5), D(d1.0), D(d2.0)) in each zone were analyzed after search for micrometastasis in the giant sections.</p><p><b>RESULTS</b>72.5% (111/153) micrometastases were found in form of microscopic tumor emboli. Their spread distance could be up to 6.1 cm. In 66.7% (24/36) specimens, micrometastases were found in the surrounding tissue. In 91.7% (22/24) of them, the distal MMSD was less than 3 cm. The proximal MMSD was less than 1.5 cm in 92.3% (12/13). The comparison of micrometastasis density in the different zones were D(d0.5) > D(d1.0) > D(d 2.0); D(p0.5) > D(p1.0) > D(p2.0); D(d1.0) > D(p1.0); D(d2.0) > D(p2.0) with significant differences.</p><p><b>CONCLUSION</b>(1) Micrometastases of HCC exist mainly in form of microscopic tumor emboli, (2) The longer the distance from the primary focus, the lower the micrometastasis incidence, (3) In zones more than 0.5 cm away from the primary focus, tumor micrometastasis incidence is significantly lower in the proximal zones than that in the distal zones and (4) For HCC patients without clinical metastasis, a surgical margin of 3 cm wide in the distal area and 1.5 cm wide in the proximal area may reduce the rate of postoperative recurrence.</p>
Asunto(s)
Humanos , Carcinoma Hepatocelular , Cirugía General , Hepatectomía , Métodos , Neoplasias Hepáticas , Patología , Cirugía General , Metástasis de la Neoplasia , Recurrencia Local de NeoplasiaRESUMEN
Objective To explore the clinical diagnosis and management of focal nodular hyperplasia (FNH) of the liver. Methods Forty-two FNH cases treated in the past 9 years were studied retrospectively. The clinical and pathologic data were reviewed. Results Preoperative liver function test and AFP were normal. The preoperative radiography in FNH was usually not specific, with less than 50% cases were suggestive of FNH of the liver. Surgical resection resulted in a permanent cure with no significant postoperative complications. More than one year follow-up found recurrence in one case. Conclusion Clinical, laboratory and radiological findings when combined could help in establishing tentative diagnosis of FNH. Surgery is recommended in cases with equivocal diagnosis or in fear of hepatocellular carcinoma.