A multicenter study to develop and validate a novel C-GALAD Ⅱ HCC prediction model based on serological markers / 中华检验医学杂志

Objective:To establish a model C-GALAD for detecting hepatocellular carcinoma (HCC) from the chronic liver disease and healthy people based on the serum markers.Methods:A clinical cohort including 229 hepatocellular carcinoma patients, 2 317 patients with chronic liver disease and 982 healthy people, was retrospectively collected from eight hospitals or physical examination institutions from April 2018 to October 2020. The data were divided into a training set and a testing set by stratified sampling with a 6∶4 ratio. A predictive model was established on the training set using a logistic backward regression method and validated on the testing set. In addition, clinical data from March to July 2021 in Beijing You′ an Hospital affiliated to Capital Medical University, including 84 patients with liver cancer and 204 patients with chronic liver disease collected were used for external independent validation of the model. The receiver operating characteristic curve (ROC) area under curve (AUC), the sensitivity and the specificity were used to evaluate the effectiveness of the model.Results:Through the logistic backward regression method, the seven signatures including age, gender, alpha-fetoprotein (AFP), alpha-fetoprotein alloplasm-3 ratio (AFP-L3%), des-gamma-carboxyprothrombin(DCP), platelet (PLT) and total bilirubin (TBIL) were selected as risk factors in the detection model. The area under the ROC curve (AUC) of the model on the testing set was 0.954, with an 88.04% sensitivity and a 94.85% specificity, and the AUC of model on the external independent validation set was 0.943, with an 89.29% sensitivity and a 90.2% specificity, which were better than other published models.Conclusion:The C-GALAD Ⅱ model can accurately predict the risk of hepatocellular carcinoma occurrence, and thus provide a trustworthy diagnosis method of hepatocellular carcinoma.

Effects of Alprostadil on serum inflammatory factors and liver function in patients with hepatitis B cirrhosis / 医学研究生学报

Objective Alprostadil can improve the clinical efficacy of the treatment of hepatitis B cirrhosis, but little literature is available about its effect on serum inflammatory factors in patients with hepatitis B cirrhosis.This study aimed to investigate the effect of alprostadil on serum inflammatory factors and liver function of the patients with hepatitis B cirrhosis and its possible action mechanisms.Methods We equally randomized 162 cases of hepatitis B cirrhosis admitted to our hospital from August 2014 to July 2015 into a control and an observation group, the former treated by conventional antiviral, liver-protecting and supportive therapies, and the latter with alprostadil in addition, both for 4 weeks.Then, we obtained the serum inflammatory factors, the contents of serum interleukin-6 (IL-6), high sensitive C reactive protein (hs-CRP) and tumor necrosis factor alpha (TNF-α) as well as such liver function indexes as glutamic-pyruvic transaminase (ALT), total bilirubin (TBil) and prothrombin activity (PTA), and compared them between the two groups before and after treatment.Results After 4 weeks of treatment, the effectiveness rate was significantly higher in the observation than in the control group (82.72% vs 62.96%, P<0.05).Compared with the baseline, the patients in the observation group showed significant improvement after treatment in serum IL-6 ([275.62±43.39] vs [97.15±19.73] pg/mL, P<0.05), hs-CRP ([425.54±55.58] vs [50.23±6.69] ng/L, P<0.05), TNF-α ([321.74±80.73] vs [85.45±13.61] pg/mL, P<0.05), ALT ([139.54±37.36] vs [96.13±23.62] μmol/L, P<0.05), TBil ([395.39±41.13] vs [271.55±25.12] μmol/L, P<0.05), and PTA ([38.50±4.19] vs [68.36±8.11]%), and the improvement was significantly better than in the control group (P<0.05).Conclusion Alprostadil helps alleviate the inflammatory condition, improve the liver function, and promote clinical efficacy in patients with hepatitis B cirrhosis.

Tertiary peritonitis treated with integrated traditional Chinese and western medicine and its APACHE Ⅲscoring / 实用医学杂志

Objective To investigate the clinical features , treatment regimen , and prognosis evaluation of tertiary peritonitis (TP). Methods Seventy-eight cases with TP were randomly enrolled into 2 groups, including the simple western medicine-treated group (32 cases) and the integrated traditional Chinese and western medicine-treated group (46 cases). The prognoses were evaluated according to the acute physiology and chronic health evaluationⅢ (APACHEⅢ, APⅢ) scoring. Results The mortality rate was 71.9% (23 of 32) in patients received the simple western medicine and was 32.6%(15 of 46) in patients received the integrated traditional Chinese and western medicine with significant difference between these two groups (P < 0.01). There was a significant correlation between AP Ⅲscore and actual mortality (r=0.73,P<0.01), and predicted mortality (r=0.76, P<0.01). Conclusions The therapeutic effect is acceptable and satisfactory for the TP patients received the integrated traditional Chinese and western medicine. The AP Ⅲ scoring system can be used to predict the prognosis of TP patients.

Effects of marzulene(L-glutamine and sodium gualenate)on the cellular immunity of patients with severe acute pancreatitis / 中国中西医结合急救杂志

Objective To observe the effects of marzulene(L-glutamine and sodium gualenate)on cellular immune function in patients with severe acute pancreatitis(SAP). Methods A prospective study method was conducted in which 80 patients with SAP were divided into trial group and control group(each 40 cases)according to the table of random number methods,and in the mean time 20 healthy volunteers were enrolled in the healthy control group. Both SAP groups received standard total parenteral nutrition(TPN)with same quantities of heat and nitrogen, and the trial group additionally accepted intravenous drip of marzulene 0.4 g?kg-1?d-1(once a day)for 7 days,while the control group received the same amount of normal saline intravenous drip for 7 days. One day before treatment and on the 7th day after treatment,the peripheral venous blood samples were collected. The T-lymphocyte proliferation activity was tested by methyl thiazolyl tetrazolium(MTT)assay,and the interleukin-2(IL-2)and interleukin-6(IL-6) secretion levels were detected by enzyme-linked immunosorbent assay(ELISA). Results Compared to the healthy control group,the levels of T lymphocyte proliferation activity〔absorbance(A)value〕and IL-2(ng/L)were markedly decreased and IL-6(ng/L)secretion level was obviously increased before treatment in the two SAP groups(P<0.05 or P<0.01). Compared to prior treatment,the levels of T lymphocyte proliferation activity and IL-2 were significantly increased after 7 days of treatment in the trial group(both P<0.05),and basically restored to normal levels,while in the control group they were progressively decreased(both P<0.05),the levels in trial group being significantly higher than those of the control group(T lymphocyte proliferation activity:1.08±0.27 vs. 0.43±0.25,IL-2:16.5±1.4 vs. 9.4±2.9,both P<0.05),but compared to prior treatment,the level of IL-6 was significantly decreased in the two SAP groups(both P<0.05),the level of IL-6 in control group was recovered to the level of healthy control group,and the level in trial group being significantly lower than that of the control group(18.8±4.5 vs. 22.3±3.1, P<0.05). Conclusions The patients with SAP have cellular immune dysfunction,the manifestations being the suppression of T lymphocyte proliferation and IL-2 and increase of IL-6 release. Early application of marzulene can help to improve the immune function of lymphocytes in patients with SAP.

Effects of ginkgolide B (BN52021) on pathological changes Of pancreatic tissue in rats with severe acute pancreatitis / 中华消化外科杂志

Objective To investigate the inhibitory effect of ginkgolide B (BN52021) on severe acute pancreatitis (SAP) via detecting the antagonistic effect of BN52021 on platelet-activating factor (PAF). Methods One hundred and eighty Wistar rats were randomly divided into control group (n = 60), SAP group (n = 60) and BN52021 group (n =60) according to the random number table. The 3 groups were divided into 6 subgroups at different time points after operation (1 h, 2 h, 3 h, 6 h, 12 h, and 24 h). The changes of serum amylase in each group were monitored. The expression of platelet-activating factor receptor (PAFR) mRNA and protein was detected by RT-PCR and Western blot, and the pathological changes of pancreatic tissues were observed. All the data were analyzed by one-way ANOVA. Results Serum amylase level and pathological results showed that it was successful in preparing SAP model. The serum amylase levels at postoperative hour 3, 6 and 24 were (4185 ±148) U/L, (3785 ± 124) U/L and (1360 ± 161) U/L in BN52021 group, which were significantly lower than those in SAP group [(4799 ± 107) U/L, (4920 ± 140) U/L, (2283 ± 127) U/L)]. The pathological scores at postoperative hour 3, 6, 12 were 5.95±0. 19, 5.55±0.36, 6.72±0. 30 in BN52021 group, which were significantly lower than those in SAP group (8.85 ± 0.39, 9.15 ± 0.55, 10.10 ±0. 65). The mRNA and protein expression of PAFR were gradually increased at the early stage (0.49 ± 0.09-0.71 ± 0.14 vs 0. 43 ～ O. 06-1.69 ± 0.06), and reached peak at postoperative hour 3. The expression levels of PAFR mRNA and protein in BN52021 group and SAP group at postoperative hour 3 had statistical difference among the 3 groups (F = 4.58, 6.24, P < 0.05). Conclusions The expression of PAFR mRNA and protein in the pancreatic tissue of SAP rats is dynamically changing. PAFR plays an important role in the occurrence and progression of SAP. BN52021 can reduce the expression of serum amylase and improve the pancreatic pathological changes, but it has no effect on the expression of PAFR in pancreatic tissue.

Physician-Patient Communication:The Essential Quality of Medical Students / 中国医学伦理学

Satisfactory communication skill is the essential requirement for medical students to become future qualified medical doctors.Clinical clerkship is the key process to absorb medical knowledge and professional skill,cultivate the ability to solve practical problems in medical practice,and develop medical students into qualified doctors by guiding them to reasonably handle physician-patient relationship,better solve medical disputes,and gradually improve their legal awareness.Therefore,medical students should strengthen to cultivate their communication ability,and set up reasonable sense of physician-patient communication.