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Objective To explore the correlation between serum lipoprotein-related phospholipase A2 (Lp-PLA2), cystatin C (Cys-C) levels and disease severity in patients with hepatitis B cirrhosis (HBC). Methods Clinical data of 110 HBC patients in the hospital from October 2017 to May 2019 were retrospectively analyzed. According to Child-Pugh classification criteria of liver cirrhosis, they were divided into grade A (n=42), grade B (n=37) and grade C groups (n=31). Another 30 healthy controls during the same period were enrolled as control group. The levels of serum Lp-PLA2 and Cys-C were detected. And their correlation with disease severity was analyzed. Results Levels of serum Lp-PLA2 and Cys-C in HBC group were higher than those in control group (P<0.05). The levels of serum Lp-PLA2 and Cys-C were the highest in grade C group, followed by grade B group and grade A group (P<0.05). The areas under the ROC curve (AUC) of serum Lp-PLA2 combined with Cys-C for evaluating grade A and B, grade B and C HBC were 0.875 and 0.837, which were higher than those of Lp-PLA2 (0.772, 0.750) and Cys-C (0.750, 0.691) alone (P<0.05). Spearmann rank correlation analysis showed that levels of serum Lp-PLA2 and Cys-C were positively correlated with disease severity (r=0.659, 0.561, P<0.05). Conclusion The levels of serum Lp-PLA2 and Cys-C are significantly increased in HBC patients, which are gradually increased with the aggravation of HBC. The two indexes are positively correlated with disease severity, which are of diagnostic efficiency for the classification of liver cirrhosis.
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Objective:To propose and verify a surgical classification system for the axial primary malignant and aggressive benign tumor.Methods:The CZH surgical classification system was originally developed for the axial primary malignant and aggressive benign tumor. The CZH surgical classification system includes seven types, according to the anatomic features and the extension of tumor violation. A total of 136 patients (79 males and 57 females) with axial primary malignant and aggressive benign tumor from multiple tertiary centers who received surgery from July 2006 to July 2019 were included. The average age was 44.40±17.55 years (8-83 years) old. There were 99 malignant tumors and 37 aggressive benign tumors included. The number of patients with each classification was presented as followed, Type I 13, Type II 15, Type IIIa 3, Type IIIb 20, Type IVa 43, Type IVb 12, Type Va 21, Type Vb 3, Type VI 2, Type VIIa 3 and Type VIIb 1. Surgical procedures were selected according to different types in classification. The inter- and intra-observer consistencies were evaluated by the Kendall's W test. The VAS, Frankel score, overall survival and recurrence free survival were recorded during the follow-up. Results:The inter- and intra-observer consistent coefficient was 0.973 and 0.996, respectively ( P<0.05). The single posterior approach was adopted for the Type II tumors. Other patients underwent surgery by the combined antero-posterior approach. The majority in anterior approach (113 cases) was the modified submandibular approach. The reconstruction modes included anterior "T" shape titanium mesh (112 cases) or the 3D printed prothesis (7 cases) combined with the posterior occipto-cervical fusion (92 cases) or the pedicle screw system (44 cases). The average surgical duration and the volume of intraoperative bleeding was 348.40±136.14 min (60-760 min) and 1 225.69±859.40 ml (80-4 000 ml), respectively. The operation duration and volume of intraoperative bleeding among each type were with statistical difference. The patients with Type IV, V tumors had longer operation duration than those with Type II tumors. Those with Type V and VII tumors had longer operation duration than those with Type I tumors. The patients with Type V tumors had more intraoperative bleeding than those with Type I-IV tumors. The average preoperative VAS score was 4.15±2.25 and then was reduced significantly to 0.62±0.71 and 0.38±0.59 at one and three months after operation, respectively. The Frankel score was also significantly ameliorated at one and three months postoperatively. There were 22 postoperative complications (16.2%). The complications included cerebral spinal fluid leak (12.5%), dysphagia and/or dysphonia (7.4%), dyspnea (5.1%), wound infection (3.7%), wound hemorrhage (2.2%) and pharyngeal dehiscence (1.5%). The incidence of postoperative complication was 25.9% in Type IV-VII tumors, while 11.8% in Type I-III tumors. Conclusion:CZH surgical classification system was verified with high observer consistency. This classification system could assist surgeons to select proper surgical approaches, resection modes and reconstruction modes, and thus ensure the safety of surgery and reduce the recurrence. The tumors in Type IV, V and VII may be with more challenging for surgeons. The incidence of postoperative complication in Type IV-VII tumors may be higher than that in Type I-III tumors.
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Retinoic acid, an active metabolite of vitamin A, exerts multiple effects on regulating embryonic development and inducing differentiation, proliferation, apoptosis as well as resistance in various cancer cells. Apart from the classic genomic action (binding to the nuclear receptors to regulate the expression of its downstream target genes), retinoic acids also play important roles in anti-cancer effect through non-genomic pathways (via extranuclear and non-transcriptional effects).