Résumé
Objective:To construct a nomogram model that can be used to predict thrombocytosis after splenectomy in patients with traumatic splenic rupture.Methods:The clinical data of 54 patients with splenectomy in Lu′an People′s Hospital from November 2016 to November 2021 were retrospectively analyzed. Among them, postoperative thrombocytosis occurred in 33 cases (postoperative thrombocytosis group), and 21 cases had no significant changes in platelets (postoperative platelet normal group). The general clinical data were recorded; the platelet parameters 14 d after operation were measured, including platelet count, mean platelet volume (MPV), procalcitonin (PCT) and platelet distribution width (PDW). The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of platelet parameters for thrombocytosis after splenectomy in patients with traumatic splenic rupture. Multivariate Logistic regression analysis was used to analyze independent risk factors of thrombocytosis after splenectomy in patients with traumatic splenic rupture. A nomogram model to predict thrombocytosis after splenectomy in patients with traumatic splenic rupture was established with R language software 4.0.2 package, internal validation of the nomogram model was performed using correction curves, and the prediction efficiency of the nomogram model was evaluated using decision curves.Results:The incidence of shock, rate of blood transfusion volume≥2 000 ml, platelet count and PCT in postoperative thrombocytosis group were significantly higher than those in postoperative platelet normal group: 69.70% (23/33) vs. 19.05% (4/21), 66.67% (22/33) vs. 38.10% (8/21), (823.56 ± 129.81) ×10 9/L vs. (521.92 ± 85.89) ×10 9/L, (0.87 ± 0.11)% vs. (0.54 ± 0.09)%, the MPV and PDW were significantly lower than those in postoperative platelet normal group: (10.23 ± 1.03) fl vs. (11.57 ± 0.92) fl and 0.113 ± 0.012 vs. 0.125 ± 0.020, and there were statistical differences ( P<0.01 or <0.05). ROC curve analysis results show that the area under curve of platelet count, MPV, PCT and PDW in for predicting the thrombocytosis after splenectomy in patients with traumatic splenic rupture were 0.973, 0.835, 0.987 and 0.734, and the optimal cut-off values were 642.29 ×10 9/L, 11.02 fl, 0.7% and 0.120. Multivariate Logistic regression analysis result showed that the platelet count, MPV, PCT, PDW, shock and blood transfusion volume were independent risk factors for thrombocytosis after splenectomy in patients with traumatic splenic rupture ( OR = 1.571, 1.243, 1.042, 1.413, 1.436 and 1.726; 95% CI 0.014 to 1.762, 0.743 to 2.862, 0.954 to 2.563, 0.584 to 2.389, 0.045 to 2.643 and 0.154 to 2.143; P<0.01 or <0.05). When platelet count, MPV, PCT, PDW, shock and blood transfusion volume were included as predictors for constructing the nomogram model, the internal validation results showed that the C-index of the nomogram model for predicting thrombocytosis after splenectomy in patients with traumatic splenic rupture was 0.793 (95% CI 0.267 to 2.311); the threshold value of the nomogram model for predicting thrombocytosis after splenectomy in patients with traumatic splenic rupture was >0.067, and the nomogram model provided a net clinical benefit; the clinical net benefit of the nomogram model was greater than that of platelet count, MPV, PCT, PDW, shock and blood transfusion volume. Conclusions:The nomogram model based on platelet count, MPV, PCT, PDW, shock and blood transfusion volume that affect the high risk of thrombocytosis after splenectomy in patients with traumatic splenic rupture has great clinical value in screening and identifying high risk patients.
Résumé
Objective:To compare the clinical efficacy and safety between spleen total resection splenectomy and spleen partial splenectomy in the treatment of patients with traumatic spleen rupture.Methods:84 cases of patients with traumatic spleen rupture from March 2013 to March 2016 were selected and divided into two groups.42 cases in the spleen total resection group were treated with spleen total resection,while the other 42 cases in the spleen partial nephrectomy group were treated with spleen partial splenectomy.The operative effect,the levels of platelet count,serum IgA,IgG,IgM,CD3 +,CD4 +,CD8 +,CD4 + / CD8 + levels before and after treatment,the incidence of complications were compared between two groups.Results:The intraoperative blood loss,exhaust time,length of hospital stay of spleen partial nephrectomy group were shorter than those of the spleen total resection group,but the operation time of research group was longer than that of the spleen total resection group (P＜0.05).The platelet count,CD8+ of spleen partial nephrectomy group were lower than those of the spleen total resection group (P＜0.05).The IgA,IgG,IgM,CD3+,CD4+,CD8+,CD4+/CD8+ of spleen partial nephrectomy group were significantly higher than those of the spleen total resection group (P＜0.05).The incidence rate of complications in the spleen partial nephrectomy group was lower than that of the spleen total resection group (P＜0.05).Conclusion:Spleen partial splenectomy was more effective than spleen total resection in the treatment of traumatic splenic rupture,which had little effect on the platelet and immune function.
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Objective To assess the effects of gonadectomy on carcinogenesis and development of hepatocellular carcinoma (HCC) induced by chemical substances in rat model. Methods Fifty male and 50 female Sprague-Dawley rats (age of 5-6 weeks) were equally divided into four groups: male experimental (surgical castration) and control groups and female experimental (surgical castration)and control groups. The HCC model was induced by diethylnitrosamine (DEN) and Nnitrosomorpholine (NMOR) in SD rats. The effects of gonadectomy on occurring and development of HCC were observed. Results The incidence of HCC in female experimental group was higher than that in female control group (11/11 vs 5/14, P=0. 001), while it was lower in male experimental group than that in male control group (3/10 vs 12/12, P=0. 001). It was demonstrated that gonadectomy could increase the growth of HCC (P=0. 013) and tumor metastasis (P=0. 036) in female rats, but not in male rats. The formation of liver cirrhosis and HCC was found at 8 and 16 weeks in male experimental group, at 12 and 20 weeks in male control group, at 16 and 20 weeks in female experimental group and at 12 and 16 weeks in female control group. These findings showed that gonadectomy could improve the development of carcinogenesis in female rats and delay the carcinogenesis in male rats. Conclusion Sex hormones, especially estrogens, may be involved in development and metastasis of rats HCC.
Résumé
Hepatocellular carcinoma is a major disease for serious threat to human health, ranked third in the world of cancer causes of death and second in China' s in cancer mortality. There are gender differences in the incidence of HCC and numerous studies on estrogen' s role in the formation of HCC, and the formation of estrogen in the liver plays a protective role during the hepatocarcinogenesis. Some studies have shown estrogen inhibiting the expression of interleukin-6 thereby reducing the incidence of HCC. IL-6 and HGF have an important role in promoting HCC formation process, estrogen and these factors have are also important links. Now require in-depth exploration of novel adjuvant therapy is required to improve the survival rate of patients with HCC.