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Objective To investigate the predictive value of preoperative fibrinogen/albumin ratio (FAR) and systemic immune inflammation index (SII) on the postoperative prognosis of patients with pancreatic ductal adenocarcinoma. Methods An ROC curve was used in determining the best cutoff values of FAR and SII and then grouped. The Cox proportional hazards model was used in analyzing the prognostic factors of radical pancreatic cancer surgery, and then a Nomogram prognostic model was established. C-index, AUC, and calibration curve were used in evaluating the discrimination and calibration ability of the Nomogram. DCA curves were used in assessing the clinical validity of the Nomograms. Results The optimal cutoff values for preoperative FAR and SII were 0.095 and 532.945, respectively. FAR≥ 0.095, SII≥ 532.945, CA199≥ 450.9 U/ml, maximum tumor diameter≥ 4 cm, and the absence of postoperative chemotherapy were independent risk factors for the poor prognosis of pancreatic cancer (P<0.05). The discrimination ability, calibration ability, and clinical effectiveness of Nomogram prognostic model were better than those of the TNM staging system. Conclusion The constructed Nomogram prognostic model has higher accuracy and level of discrimination and more clinical benefits than the TNM staging prognostic model.
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Objective:To investigate the effects of docetaxel for postoperative chemotherapy of advanced gastric cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 311 patients with advanced gastric cancer who were admitted to Lanzhou University Second Hospital from January 2013 to December 2018 were collected. There were 224 males and 87 females, aged from 26 to 82 years, with a median age of 58 years. Of 311 patients, 204 cases undergoing chemotherapy with the FOLFOX regimen (oxaliplatin, calcium folinate, 5-fluorouracil) were allocated into the FOLFOX group, and 107 cases undergoing chemotherapy with the FLOT regimen (docetaxel, oxaliplatin, calcium folinate, 5-fluorouracil) were allocated into the FLOT group. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups of patients after matching; (2) follow-up; (3) analysis of survival factors; (4) subgroup analysis; (5) adverse reactions. Follow-up was performed using a combination of outpatient examination, hospitalization review and telephone interview to detect situations of patients chemotherapy, postoperative survival, tumor recurrence and metastasis up to February 2019. The propensity score matching was realized using the nearest neighbor method with 1: 1 ratio and caliper setting as 0.02. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability method. Rank data was analyzed using non parametric Rank sum test. The survival curve and rate were respectively drawn and calculated using the Kaplan-Meier method. The survival analysis was done using the Log-rank test. Univariate analysis and multivariate analysis were conducted using the COX regression model. Subgroup analysis was done using interaction test. Results:(1) The propensity score matching conditions and comparison of general data between the two groups of patients after matching: 198 of 311 patients had successful matching, including 99 in each group. Cases with tumor differentiated as poorly differentiation or well differentiation, cases with CA19-9 <27 U/mL or ≥27 U/mL, cases with CA125 <35 U/mL or ≥35 U/mL before propensity score matching were 109, 95, 156, 48, 186, 18 in the FOLFOX group, and 42, 65, 93, 14, 104, 3 in the FLOT group, respectively, showing significant differences in the above indicators between the two groups ( χ2=5.649, 4.798, 4.039, P<0.05). After propensity score matching, the above indicators were 44, 55, 85, 14, 96, 3 in the FOLFOX group, and 42, 57, 85, 14, 96, 3 in the FLOT group, respectively, showing no significant difference in the above indicators between the two groups ( χ2=0.082, 0.000, 0.000, P>0.05). (2) Follow-up: 198 patients of the two groups after matching were followed up for 2 to 69 months, with a median follow-up time of 38 months. During the follow-up, 92 cases survived without tumor, 2 cases underwent tumor recurrence or metastasis, and 104 cases died including 103 with tumor related death and 1 case with non-tumor related death. The courses of chemotherapy were 5.6±0.7 and 5.4±0.8 for the FOLFOX group and FLOT group, respectively, showing no significant difference between the two groups ( t=1.651, P>0.05). The 1, 3, and 5-year cumulative survival rates of patients were 72.2%, 31.5%, 27.7% and 83.2%, 42.8%, 38.2% for the FOLFOX group and FLOT group, respectively. The median overall survival time were 21 months and 34 months for the FOLFOX group and FLOT group, respectively, showing significant difference between the two groups ( χ2=4.473, P<0.05). (3) Analysis of survival factors: results of univariate analysis showed that cases undergoing chemotherapy with the FLOT regimen, cases with tumor as diffuse type of Lauren classification, cases with tumor as mixed type of Lauren classification, cases with tumor differentiated as well differentiation, cases with tumor diameter≥5 cm, cases with CA19-9≥27 U/mL, cases with carcinoembryonic antigen (CEA)≥3.4 μg/L, cases with tumor as T4 stage of T staging, cases with tumor as N2 stage of N staging, cases with tumor as N3 stage of N staging, cases undergoing distal gastrectomy and cases undergoing total gastrectomy were related factors influencing postoperative survival of patients ( hazard ratio=0.659, 1.617, 1.798, 0.672, 1.726, 1.655, 1.942, 2.036, 2.536, 4.085, 1.810, 2.310, 95% confidence interval: 0.444-0.978, 1.024-2.556, 1.105-2.926, 0.457-0.990, 1.159-2.569, 1.006-2.723, 1.295-2.912, 1.190-3.484, 1.409-4.564, 2.491-6.697, 1.020-3.211, 1.261-4.233, P<0.05). Results of multivariate analysis showed that cases undergoing chemotherapy with the FLOT regimen, cases with CEA≥3.4 μg/L, cases with tumor as N2 stage of N staging and cases with tumor as N3 stage of N staging were independent risk factors influencing postoperative survival of patients ( hazard ratio=0.622, 1.732, 2.217, 4.039, 95% confidence interval: 0.418-0.926, 1.124-2.670, 1.200-4.097, 2.448-6.662, P<0.05). (4) Subgroup analysis: results of subgroup analysis showed that of the different subgroups using gender, age, tumor Lauren classification, tumor differentiation degree, tumor location, tumor diameter, tumor markers, tumor T staging, tumor N staging and surgical procedures as subgrouping index, the efficacy difference between the FLOT group and the FOLFOX group was the same (interaction P>0.05). (5) Adverse reactions: the incidence of grade Ⅲ-Ⅳ adverse reactions of leukopenia, anemia, thrombocytopenia, nausea, vomiting and liver and kidney dysfunction were 11.1%(11/99), 2.0%(2/99), 3.0%(3/99), 12.1%(12/99), 4.0%(4/99), 1.0%(1/99) and 34.3%(34/99), 1.0%(1/99), 9.1%(9/99), 24.2%(24/99), 4.0%(4/99), 0 in the FOLFOX group and the FLOT group, respectively. There were significant differences of the incidence of leukopenia and nausea between the two groups ( χ2=15.213, 4.889, P<0.05). There was no significant difference of the incidence of thrombocytopenia between the two groups ( χ2=3.194, P>0.05) and there was no significant difference of the incidence of anemia, vomiting and liver and kidney dysfunction between the two groups ( P>0.05). There was no patient in the two group withdrawal from chemotherapy as no tolerance to toxic reactions. All patients were treated with glucocorticoids, proton pump inhibitors and serotonin receptor antagonists during chemotherapy. Patients undergoing leukopenia were treated with granulocyte stimulating factor. Conclusions:Compared with FOLFOX regimen, FLOT regimen which adds docetaxel significantly prolongs the postoperative median overall survival time of patients with advanced gastric cancer. However, FLOT regimen increases the incidence of grade Ⅲ-Ⅳ adverse reactions of leukopenia and nausea.
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Objective To investigate the general surgeon growth time, and to probe into the factors affecting the surgeon growth. Methods 72 surgeons who worked more than 15 years in the field of general surgery in 12 hospitals of Gansu Province were investigated, focusing on education, resident rotation train-ing, teachers' qualification, refresher training, the frequency of intra-hospital technical exchange, and scale of hospital employed. SPSS 18.0 statistical software was applied to analyze the data. t test was used in com-parison between groups, and multiple groups were compared by using single factor analysis of variance. Results The surgeon growth time was (9.84±1.51) years averagely. In the process of growing up, the growth time of the general surgeons who experienced hospital resident rotated training, refresher training, intra-hos-pital technical exchange was significantly shorter than that of no-related-experienced surgeons. The higher the education, the higher the quality of the teachers and the higher the level of medical institutions, the shorter the doctor's growth time. Conclusion In the same medical institutions, the resident rotated training, the teacher's qualification, higher hospital training, and the frequency of intra-hospital technical exchange have the positive function to the surgeon's general growth, so in making young doctor training plan we should consider the value of the above-mentioned factors.
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Objective To explore the value of Gd-EOB-DTPA enhanced magnetic resonance imaging (MRI) in the quantitative evaluation of liver function.Methods Between June 2012 and June 2013,we prospectively included 8 patients with cirrhosis and 6 patients with primary hepatic carcinoma (PHC).The Child-Pugh classification,indocyanine green retention rate at 15 minutes (ICGR15),and Primovist enhanced MR imaging were performed in all the patients.Using the deconvolution method to calculate hepatic extraction fraction (HEF),the correlations between HEF and Child-Pugh and ICGR15 were analyzed.Results For cirrhosis,there was a significant correlation between the HEF and the ICGR15 by the Pearson correlation coefficient (r =-0.971,P ＜ 0.05).For hepatocarcinoma,there was also a significant correlation (r =-0.855,P ＜ 0.05).The average HEF of PHC was 21.80％ (14.89％ ～ 35.90％).Conclusions The Gd-EOB-DTPA enhanced MRI accurately evaluated liver function quantitatively.It may be used for patients with PHC for preoperative examination.
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<p><b>OBJECTIVE</b>To determine the level of leptin in gingival crevicular fluid (GCF) of patients with aggressive periodontitis (AgP) and to analyze the relationship between leptin and periodontal cilinical parameters.</p><p><b>METHODS</b>Fifty-four patients with AgP and 30 healthy controls were recruited. Detailed clinical examinations were conducted, and clinical parameters such as bleeding index (BI), probing depth (PD), attachment loss (AL) were recorded. Two teeth were selected as test teeth in each subject, one from posterior area and the other from anterior region. The level of GCF leptin was measured by enzyme linked immunosorbent assay.</p><p><b>RESULTS</b>The level of GCF leptin in AgP patients was significantly lower than that of control subjects [(16.5±4.6) ng vs.(26.0±6.0) ng, P < 0.05]. The level of GCF leptin was negatively related to BI (-0.306, P < 0.01), PD (-0.346, P < 0.01) and AL (-0.250, P < 0.01).</p><p><b>CONCLUSIONS</b>AgP patients have significantly decreased level of GCF leptin and the level of leptin was negatively related to BI, PD and AL.</p>
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Adulto , Femenino , Humanos , Masculino , Periodontitis Agresiva , Metabolismo , Estudios de Casos y Controles , Ensayo de Inmunoadsorción Enzimática , Líquido del Surco Gingival , Química , Leptina , Índice PeriodontalRESUMEN
Objective To evaluatc the efficacy and safcty of recombinant endostatin (Endostar)combined with concurrent radio-chemotherapy (CRCT) in patients with unresectable stage Ⅲ non-small cell lung cancer (NSCLC).Methods From March 2009 to November 2011,47 patients received threedimensional conformal radiotherapy of 60-66 Gy in 30-33 fractions over 6-7 weeks And concurrent chemotherapy of docetaxel 65 mg/m2 and cisplatin 65 mg/m2.Endostar was administered once a week before and on week 2,4,6 during CRCT at a dose level of 7.5 mg/m2/d.Tumor response was evaluated with thoracic CT scans performed 4 weeks after completion of treatment in accordance with RECIST 1.1 criteria.Acute toxicities were evaluated in accordance with CTCAE 3.0.Results Forty-four patients completed treatment and toxicity evaluation,42 patients completed evaluation of efficacy.Five patients achieved complete response,29 partial response,3 stable disease,and 5 progressive disease,2 were net assessed.Overall response rate was 77％.One-year overall survival rate was 81％,and one-year progression-free survival rate was 51％.Twelve patients died,2 died of treatment related toxicities,8 of cancer,and 2 of unknown causes.Nineteen patients developed grade 3/4 neutrocytopenia,grade 3 acute esophagitis and pneumonitis were observed in 4 and 4 patients,respectively,and 1 patient died of pneumonitis.No patient developed cardiovascular toxicities and hemorrhage.Conclusions Endostar combined with CRCT for unresectable stage Ⅲ NSCLC was safe and the short term outcomes were promising.Further investigations are warranted.
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Objective To explore the technique and effect of selected three-field lymphadenectomy by left thoracotomy in treatment of thoracic middle or lower section esophageal squamous carcinoma. Methods From Jun. 2005 to Mar. 2009, 213 patients with thoracic middle or lower section of esophageal carcinoma received esophagectomy, bilateral mediastinal lymphadenectomy and pleural membrane resection.Group 1 -5, 7 - 12a, 16al, and 19 were performed to dissect abdominal lymph node and extended thoracic and abdominal lymphadenectomy and only lymph node extraction of mesoesophagus in neck field. Results 14197 lymphatic nodes(LN) were detected in 213 case. The average number of resected LN was 66. 65 ±24. 73. The metastatic lymph node was detected in 105 cases. The metastatic rate was 49.05% (105/213).There were 423 metastatic lymph nodes. The lymph nodes metastasis was 2. 97% (423/14197) of all dissected lymphatic nodes. No remnant carcinoma in the upper and lower cutting edge was found in pathological examination. The operation time ranged from 2. 92 ～ 4. 67 ( 3. 37 ± 0. 42) hours. Blood transfusion during perioperative period was 0 ～ 6u ( 1.08 ± 0. 93 ) u. Perioperative plasma transfusion was 0 ～ 1400( 103.77 ± 184. 89) ml. The hospital-time was 14 ～ 39 ( 17.64 ±4. 12) days. There were no anastomotic leakage and recurrent laryngeal nerve injury. One case died from respiratory failure, the mortality was 0. 04% ( 1/213). Conclusion Surgical approach in the management of left thoracotomy in the sixth intercostals could extend resection of chest-field lymph node dissection, decrease neck field lymph node dissection. Abdomen-field lymph node dissection reached selected D3. The selected lymphadenectomy procedure had the advantages of small traumas and few complications.
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Purpose:To analyze the prognostic factors of testicular seminoma.Materials and Methods:133 patients with testicular seminoma histologically proved were treated from October, 1975 to December,1990. Most of them were firstly treated with orchiectomy and minority were treated with orchiectomy plus lymphadenectomy in abdomen cavity. All patients were treated with postoperative radiotherapy and a little part of them were combined with irregular chemotherapy. Results: The overall 5-year survival rates were:92.5(65/70) for stage Ⅰ, 52.6(10/19) for stageⅡ, 25%(4/16) for stage Ⅲ and 22.2%(2/9) for stage Ⅳ. Patients received radiation dose of 20～30Gy gave a five year survival rate of 80% which was much better than those who received radiation dose 30Gy(P