Clinical efficacy and prognostic factors analysis of hepatectomy for hepatocellular carcinoma / 中华消化外科杂志

Objective To investigate the clinical efficacy and prognostic factors of hepatectomy for hepatocellular carcinoma (HCC).Methods The retrospective case-control study was conducted.The clinicopathological data of 789 HCC patients who were admitted to the Sichuan Cancer Hospital Affiliated to School of Medicine of University of Electronic Science and Technology of China from January 2009 to January 2016 were collected.There were 669 males and 120 females,aged from 42 to 60 years,with a median age of 52 years.Surgical procedures were determined according to the preoperative and intraoperative comprehensive evaluations of patients.Observation indicators:(1) situations of surgical treatment;(2) postoperative pathological examinations of patients;(3) follow-up and survival situations;(4) prognostic factors analysis.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival up to May 2017.Normality of measurement data was done using the K-S test.Measurement data with skewed distribution were represented as M (range).Count data were described as absolute number or percentage.The survival rate and survival curve were respectively calculated and drawn by the Kaplan-Meier method.The univariate analysis and multivariate analysis were done using the Log-rank test and COX regression model,respectively.Results (1) Situations of surgical treatment:all the 789 patients underwent successful hepatectomy,liver volume dissected accounting for 32.5％ (range,17.0％-52.0％) of the total liver volume.Of the 789 patients,413 underwent anatomical hepatectomy including 116 of hepatic segmentectomy,136 of right hemihepatectomy,77 of left hemihepatectomy,57 of left lateral lobe hepatectomy,27 of central hepatectomy,376 underwent nonanatomical hepatectomy including 344 of partial hepatectomy,17 of extended right hemihepatectomy,15 of extended left hemihepatectomy.Volume of intraoperative blood loss was 400 mL (range,200-500 mL) in the 789 patients and 173 had intraoperative blood transfusion.Of the 789 patients,240 had postoperative complications (68 with postoperative severe complications),including 65 of liver insufficiency,37 of ascites and pleural effusion,37 of pulmonary complications,19 of infectious complications,17 of cardiovascular complications,17 of abdominal hemorrhage,11 of gastrointestinal complications,9 of neruologic complications,8 of postoperative bile leakage,10 of other complications,11 of death;the same patient can merge multiple complications.The 229 survival patients with complications were cured by symptomatic supportive treatment.Duration of postoperative hospital stay was 9 days (range,7-11 days).(2) Postoperative pathological examinations.Results of postoperative pathological examinations showed 17 patients with bile duct tumor thrombus,92 with naked eye tumor thrombus at portal vein branches and 167 with microvascular invasion.Of the 789 patients,High-,moderate-,low-differentiated carcinoma were detected in 19,678,92 patients,respectively.(3) Follow-up and survival situations:690 of the 789 patients were followed up for 1-96 months,with a median time of 21 months.The l,3,5-year overall survival rates were 82.1％,66.1％,59.2％ in the 789 patients.(4) Prognostic factors analysis:results of univariate analysis showed that level of preoperative alphafetoprotein (AFP),Child grade of preoperative liver function,Barcelona clinic liver cancer staging,tumor diameter,surgical procedure of hepatectomy,volume of intraoperative blood loss,intraoperative blood transfusion,postoperative complications,postoperative severe complications,bile duct tumor thrombus,portal vein tumor thrombus,vascular invasion were related factors affecting prognosis of HCC patients after hepatectomy (x2 =8.603,8.864,39.970,28.978,6.376,26.144,8.955,6.596,9.910,7.288,37.566,19.183,P＜0.05).Results of multivariate analysis showed that tumor diameter,volume of intraoperative blood loss,portal vein tumor thrombus were independent factors affecting prognosis of HCC patients after hepatectomy (hazard ratio =1.085,1.000,2.259,95％ confidence interval:1.053-1.118,1.000-1.001,1.621-3.146,P＜0.05).Conclusion Hepatectomy for HCC has a good safety,with satisfactory clinical efficacy.Tumor diameter,volume of intraoperative blood loss,portal vein tumor thrombus are independent factors affecting prognosis of HCC patients after hepatectomy.

Extrahepatic bile duct resection in patients with hepatocellular carcinoma with bile duct tumor thrombi / 中华肝胆外科杂志

Objective To review the role of extrahepatic bile duct resection in patients with hepatocellular carcinoma with bile duct tumor thrombi.Methods The Pubmed,Wan Fang and China Science and Technology Journal Database were reviewed systematically.Any case reports or studies involving treatment of hepatocellular carcinoma with bile duct tumor thrombi were included in this literature search.Two authors independently assessed the studies for inclusion and extracted the data.Univariate analysis was used to compare the baseline characteristics and the Kaplan-Meier method was used for analyzing survival and diseasefree survival outcomes.Results Using predetermined inclusion criteria,16 studies which included 170 patients entered into this study.All these patients underwent surgical resection of hepatocellular carcinoma and bile duct tumor thrombi.Based on the Satoh classification,45 patients were type Ⅰ,107 patients type Ⅱ and 18 patients type Ⅲ.Twenty-four patients underwent liver resection combined with extrahepatic bile duct resection.The remaining 146 patients underwent liver resection combined with thrombectomy.The 1-,3-,and 5-year survival rates of all the patients were 73.4％,41.5％ and 21.8％,and the corresponding recurrences free survival rates were 62.5％,29.2％ and 13.1％,respectively.On Kaplan-Meier analysis,there were no significant differences in the survival outcomes between the 2 groups of patients,(P ＞ 0.05).The 1-,3-,and 5-year survival rates of the extrahepatic bile duct resection group were 66.7％,41.7％ and 12.5％,and those of the thrombectomy group were 74.6％,41.3％ and 23.8％,respectively.On subgroup analysis (Satoh type Ⅱ and Ⅲ),no significant differences were observed between the two groups (P ＞0.05).The 1-,3-,and 5-year survival rates of the extrahepatic bile duct resection group were 65.2％,38.0％ and 13.0％,and those of the thrombectomy group were 72.8％,39.5％ and 20.9％,respectively.Conclusion Extrahepatic bile duct resection did not improve the overall survival of patients with hepatocellular carcinoma with bile duct tumor thrombi.

Advances in autophagy research of viral myocarditis / 中华实用儿科临床杂志

Recent studies have found that autophagy was not only involved both in the occurrence and development of viral myocarditis (VMC),but also,it plays a key role in anti-viral infections by degradating the viral components,presenting viral antigens and activating the immune response.Meanwhile,the virus can also escape the protective antiviral activity and maintain their own survival and replication by inducing the autophagy of the host cells,becoming the accelerator of the viral infection.The interaction of the virus and the host cell autophagy in VMC is a complex process.Its detailed pathogenesis has yet to be further explored.

Effects of dietary mixed probiotics on the growth performance, antioxidant activity and immune function in yellow-feathered broilers / 中国兽医学报

The present study aimed to study the effects of applying mixed probiotics in the feed on growth performance,antioxidant activity and immune function in yellow-feathered broilers.Three hundred sixty yellow-feathered broilers at 10-day-old were divided into 4 groups.Group A was fed with basal diets,group B with basal diets added 50 g/t mixed probiotics,group C with basal diets added 100 g/t mixed probiotics and group D with basal diets added 300 g/t mixed probiotics.Each group included 9 replicates(10 birds per replicates),and the experiment lasted 50 days.Results showed that group D got the highest average daily gain(ADG) of all groups,and compared with the control group A,ADG was increased by 4.11％ (P＜0.05).Group B got the lowest feed-gain ratio of all groups,and the feed-gain ratio was decreased by 4.58％(P＜0.05) compared with the control group A.Group D got significantly increased duodenal villous length,serum antioxidant index and antibody titer(P＜0.05) compared with the control group A.The effects of mixed probiotics on the growth performance,antioxidant activity and immune function were distinct in yellow-feathered broilers,and 100 g/t mixed probiotics was recommended.

Psychological Distress and Health-related Quality of Life in Relocated and Nonrelocated Older Survivors after the 2008 Sichuan Earthquake

PURPOSE: The purposes of the study were to examine psychological distress and health-related quality of life (HRQoL) in relocated and nonrelocated survivors aged 60 years and older, and to analyze predictors for psychological distress and HRQoL in older survivors 5 years after the 2008 Sichuan earthquake. METHODS: This was a cross-sectional descriptive study with 112 relocated older survivors and 156 nonrelocated older survivors. Our study used a multistage sampling method. The measurements used in the study included self-reporting questionnaire-20, medical outcomes study 36-item short form health survey, and an instrument measuring demographic and disaster-related characteristics. Descriptive and multiple linear regression analysis were performed to determine factors that contributed to psychological distress and HRQoL. RESULTS: The prevalence of psychological distress in relocated group (20.5%) was significantly higher compared to those in nonrelocated group (4.8%). Scores for HRQoL in relocated older survivors was significantly lower than those in nonrelocated older survivors. Relocation from preearthquake residence was the most significant predictor for psychological distress and HRQoL in the total sample. Other predictors were advanced age, lower educational level, the loss of family members during the earthquake, and the presence of chronic illnesses as well as the death of a spouse after the earthquake. CONCLUSIONS: Strategies can be designed in postdisaster recovery program, particularly for older survivors at high risk for psychological distress and poor HRQoL.

Surgical treatment of hepatocellular cancer with hypersplenism / 中华肝胆外科杂志

Objective To determine the efficacy of liver cancer resection combined with splenectomy for patients with hepatocellular carcinoma with hypersplenism.Methods Among 35 patients with hepatocellular cancer and hypersplenism treated from March 2004 to January 2006 at our hospital,12 patients accepted simultaneous liver cancer resection and splenectomy (the splenectomy group)and 23 only accepted liver cancer resection (the non-splenectomy group).The liver function,platelets and white blood cells were analyzed retrospectively.Results All the operations were successfully carried out.Within 1 week after operation,the white blood cell count increased from (3.2 ± 1.7) × 109/L to (8.5±-5.3) × 109/L,the platelet count increased from (52.6±23.7) × 109/L to (245.3±94.6) ×109/L(P＜0.01) in the group of patients with combined splenectomy,while little change occurred in the non-splenectomy group.The liver function in the splenectomy group recovered to the preoperational value within 1 week.Two years after operation,7 (58.3％) patients were still surviving in the splenectomy group and the mean tumor-free survival was (16.4 ± 4.3) months compared with (14.3 ±5.2) months in 10 (43.5％) patients in the non-splenectomy group,(P＜0.005).Conclusion Liver cancer resection combined with splenectomy was efficacious to hepatocellular cancer with hypersplenism.

Umbilical venous catheterization related infection in the neonatal intensive care unit / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the incidence and pathogens of umbilical venous catheterization (UVC) related infection in the neonatal intensive care unit (NICU).</p><p><b>METHODS</b>A total of 112 neonates (birth weight 1,500 g) who received UVC within 24 hrs after birth were included. Blood culture was performed right after UVC. At 24 hrs and 1 week after UVC, umbilical skin scrub cultures were performed. Skin redness and swelling for more than 24 h, or severe abdominal distension, or poor general condition for unknown reason after UVC, or positive blood culture results, were the criteria for catheterization related infection.</p><p><b>RESULTS</b>The incidence rate for UVC related infection was 8.9%. Total culture positive rate was 9.4%. At 24 hrs and 1 week after UVC, the umbilical skin scrub culture positive rate was 7.1% and 16.2%, respectively. Rate of Gram positive and Gram negative pathogens was 55.2% and 44.8%, respectively. Group B Streptococcus was main Gram positive pathogen. Klebsiella and E.coli were the main Gram negative pathogens.</p><p><b>CONCLUSIONS</b>UVC is, to some extent, related to nosocomial infection in the NICU. Among UVC related infection, Gram positive and Gram negative pathogens take almost the chance.</p>

Effects of inosine on neuronal apoptosis and the expression of cytochrome C mRNA following hypoxic-ischemic brain damage in neonatal rats / 中国当代儿科杂志

<p><b>OBJECTIVE</b>It has been reported that neuronal apoptosis plays a critical role in pathology of hypoxic-ischemic encephalopathy (HIE). Cytochrome C (CytC) is an important apoptotic protease activating factor. Inosine might have a neuroprotective effect against cerebral ischemia reperfusion injury by inhibiting the neuronal apoptosis and the expression of CytC mRNA in adult rats. This study examined the effects of inosine on neuronal apoptosis and CytC mRNA expression following hypoxic-ischemic brain damage (HIBD) in order to investigate the neuroprotectivity of inosine against cerebral ischemia injury in neonatal rats and the possible mechanism.</p><p><b>METHODS</b>A total of 140 healthy 7-day-old Sprague-Dawley rat pups were randomly assigned into Control (n=40), HIBD (n=50) and Inosine treatment groups (n=50). HIBD rat models were established by ligating the left common carotid artery, followed by 8% O2 hypoxia exposure for 2 hrs in the HIBD and Inosine treatment groups. The Control group was not subjected to hypoxia-ischemia (HI). The Inosine treatment and the HIBD groups were randomly divided into 5 sub-groups sacrificed at 6 and 12 hrs, and 1, 3 and 7 days post- HI (n=10 each). The Control group rats were sacrificed at the corresponding time points (n=8 each). Inosine was administered to the Inosine treatment group by intraperitoneal injection immediately after HIBD at the dosage of 100 mg/kg twice daily for 7 days. TUNEL staining and in situ hybridization method was used to detect neuronal apoptosis and CytC mRNA expression respectively.</p><p><b>RESULTS</b>Few apoptotic cells and CytC mRNA positive cells were found in brain tissues of the Control group. In the HIBD group, the number of apoptotic cells and the CytC mRNA expression in the cortical and hippocampal gyrum CA1 areas increased 6 hrs after HI, peaking at 1 day after HI and then decreased gradually. Until the 7th day, the number of apoptotic cells and the CytC mRNA expression in the cortical and hippocampal gyrum CA1 areas in the HIBD group remained significantly higher than in the Control group. Inosine treatment decreased the apoptotic cells and the CytC mRNA expression in both areas from 6 hrs to 7 days after HI compared with the HIBD group. The linear correlation analysis demonstrated that the number of apoptotic cells was positively correlated to the CytC mRNA expression in neonatal rats with HIBD (r=0.88, P < 0.01) .</p><p><b>CONCLUSIONS</b>Inosine can reduce the number of apoptotic cells and down-regulate the expression of CytC mRNA following HIBD in neonatal rats. The decreased number of apoptotic cells was positively correlated to the decreased CytC mRNA expression after inosine treatment, suggesting that inosine offered neuroprotectivity against HIBD possibly through inhibiting the CytC mRNA expression and resulting in a decrease of cell apoptosis.</p>