Epidemiological characteristics, diagnosis, treatment and prognosis of gallbladder cancer in China: a report of 6 159 cases / 中华消化外科杂志

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

Correlations between Fetal Congenital Cardiovascular Anomalies and Chromosomal karotypes / 中国医师进修杂志

Objective To investigate the distribution of congenital cardiovascular malformations in fetuses with chromosomal abnormalities.Method Congenital cardiovascular malformations of fetuses were diagnosed by prenatal ultrasonic cardiography from Jan 2011 to Sep 2013,and whose chromosomal karotype were tested by amniocentesis or cordocentesis.The association between chromosomal karyotypes and distribution of congenital cardiovascular malformations was analyzed.Result In 173 Fetuses with chromosomal abnormalities,20(11.56％) cases had congenital cardiovascular malformations,including seven 21-trisomies,eight 18-trisomies,three 13-trisomies and two 45,X.64％ (16/25) fetuses with congenital cardiovascular malformations accompanied with other malformations had chromosomal abnormalities.Only 1.87％ (52/4379) fetuses with normal karotype had congenital cardiovascular malformations.Conclusion Chromosomal abnormality is the most reason of complicate CHD.Chromosomal karotype test should be detected in fetus with complicate CHD.

Effect of low molecular weight heparin on oxidative stress and renal function in elderly patients undergoing gastrectomy of stomach neoplasms / 中国生化药物杂志

Objective To investigate effect of low molecular weight heparin (LMWH)on oxidative stress and renal function in elderly patients undergoing gastrectomy of stomach neoplasms. Methods 90 elderly patients undergoing radical surgery were randomly divided into LMWH group (Ⅰ group,n=45)and control group (Ⅱ group,n=45). Patients inⅠ group received a subcutaneous injection of LMWH(100 u/kg,1/d)from the time before anesthesia induction to postoperative 5 days,and patients in Ⅱ group were given equal volume of saline. Venous blood samples were collected to determine level of malondialdehyde(MDA),aldose reductase(AR)activity level,superoxide dismutase(SOD)activity level,catalase (CAT)activity level,creatinine(Cr)and blood urea nitrogen(BUN)before anesthesia induction(T0 ),at the end of the surgery(T1 ),on postoperative 1 day(T2),3 days(T3)and 5 days(T4)respectively;urine specimen were also collected to measured albumin(Alb)and N-acetyl-beta-D-amino glycosidase enzymes(NAG)at the same time points. Results There were obvious statistical differences in MDA,AR,SOD and CAT at different time points by intra-group comparison (P0.05).Alb/Cr of both groups at T1 and T2 were significantly higher than those at T0 (P<0.05 ),while Alb/Cr in Ⅰ group at T1 was obviously lower than Ⅱgroup(P<0.05 ).NAG/Cr in both groups at T1 ,T2 and T3 were significantly higher than those at T0 (P<0.05 ),while NAG/Cr inⅡ group at T4 was still higher than that at T0 (P<0.05 ),and NAG/Cr inⅠgroup at T1 ~T4 was obviously lower thanⅡgroup (P<0.05 ). MDA and AR in both groups at T1 ,T2 were positively correlated with Alb/Cr and NAG/Cr respectively(P<0.05 ),whereas SOD and CAT in both groups at T1 ,T2 were negatively correlated with Alb/Cr and NAG/Cr respectively(P<0.05 ). Conclusion Oxidative stress reaction resulted from radical surgery of elderly patients is associated with perioperative renal damage. LMWH could reduce oxidative stress in elderly patients,and alleviate the kidney damage,as well as protect the renal function.

Clinical singnificance of manipulative reduction monitored by ultrasound for the treatment of intussusception in children / 中华超声影像学杂志

Objective To investigate the value of the manipulative reduction monitored by ultrasound for the intussusception of children.Methods One hundred and three intussusception children were dynamically observed by ultrasound,and were pressed softly beginning with the head of the intussusceptum,and observed whether there was intestinal peristalsis, and whether the intussuseeptum shortened and disappeared finally.The results were analyzed based on the size of the masse, the length of the intussusceptum,and the patients' age,and compared with the X-ray high pressure air enema.Results Fifty (48.5 ％) intussusception children were recovered.The recoverability was related to the size of the mass, the length of the intussusceptum, and the age of the children (level of cooperation).Thirty-nine patients were recovered after reexamined one hour later.The recoverability of manipulative reduction monitored by ultrasound for the mass diameter less than 2.0 cm was obviously higher than that by X-ray high pressure air enema.Conclusions Manipulative reduction monitored by ultrasound could cure almost half of the intussusception children patients directly.It could decrease the number of patients who were treated with high-pressure air enema,it could relieve the pain of the children and reduce their medical expenses.It also could be acted as a screening way to other therapies like high pressure air enema.

Detection and analysis of genomic copy number variations in a 46,X0, +der(?) fetus by array-based comparative genomic hybridization / 基础医学与临床

Objective To understand genomic copy number variations (CNVs) and ascertain karyotype for a 46,X0, + der(?) fetus, and investigate possibility and superiority of array-based comparative genomic hybridization (array-CGH ) in clinical cytogenetic diagnosis. Methods G-banded chromosome analysis was carried out. The whole genome of the fetus was scanned and analysed by array-CGH. The results of array-CGH were confirmed by RT-qPCR. Results G-banded chromosome analysis showed that the fetal karyotype was 46,X0, +der(?). Array-CGH revealed the derivative chromosome as Y chromosome without CNVs. A total number of 118 submicroscopic CNVs were identified. Comparable results between array-CGH and RT-qPCR were obtained for 9 novel CNVs. Conclusion Comparing with conventional cytogenetic analysis, array-CGH is of high resolution, high-throughput and high accuracy, which provides a technical platform for accurate detection of submicroscopic chromosomal aberrations.

Preliminary Observation on Pagosid in Treatment of Osteoarthritis of Knee Joint and Retrograde Spondylitis / 中国药房

AIM： To verify the therapeutic effect of pagosid in treating osteoarthritis of knee joint and retrograde spondylitis METHODS： 60 patients were randomly divided into treatment group（ pagosid） and control group（ zulida）  The clinical manifestations of osteoarthritis and spondylitis， including pain， joint dysfunction and swelling， were observed one month after treatment RESULTS： The total effective rates for osteoarthritis were 88 9％ in treatment group and 82 4％ in control group and those for spondylitis were 83 3％ in treatment group and 81 8％ in control group There were no statistical differences between two groups（ P>0 05）  CONCLUSION： Both pagosid and zulida have the therapeutic effects on inflammation， pain， swelling and dysfunction of joint， and pagosid does not induce adverse reactions， while zulida could result in considerable gastroenteric tract side reactions

Monitoring and Nursing Measures of Methicillin Resistant Staphylococcus Aureus in ICU / 中国实用护理杂志

Cbiective: To seek for effective nursing measures with the view of reducing nooocmial infection caused by methicillin resistant staphlococcus aurcus (MRSA). Method: The factores associated with nosocomial infection caused by MRSA were analysed on 205 cases from ICU during Jan. ～Jun 2000. Results: 88.6% of staphyloooccus aureus were MRSA in ICU. The percentage of nosocomial infection caused by MRSA was 7.3%. Conclusions:The rate of nosocomial infection causes by MRSA could be effectively reduce. Following proper measures were suggested:sterilization, isolation,nursing of intubation and nanagement of respiratory tract

Effects of cimetidine on platelet function and thrombosis / 中国病理生理杂志

AIM: To observe the effects of cimetidine(Cim) on platelet function and thrombosis. METHODS: After incubated with Cim in vitro , rat platelets were activated with ADP or thrombin. The platelet aggregation, platelet malondialdehyde(MDA) formation, platelet intracellular free calcium([Ca 2+ ] i), and thromboxane B 2 (TXB 2) were measured. The effects of Cim on electric-induced thrombosis in rat carotid artery were examined. RESULTS: Cim potentiated ADP induced platelet aggregation , increased the thrombin induced [Ca 2+ ] i and MDA formation, decreased TXB 2. Also, Cim shortened the duration of electric-stimulated occlution time in rat carotid artery. CONCLUSION: Cim increased platelet function and accelerated thrombosis.