Research advances in the diagnosis and treatment of benign gallbladder disease / 中华肝胆外科杂志

Benign gallbladder diseases are common in general surgery practice, and laparoscopic cholecystectomy (LC) has become the standard treatment for these conditions. With the widespread adoption of LC and the improved understanding of gallbladder disease, it is necessary to re-evaluate the diagnosis and treatment of benign gallbladder disease. Based on the latest expert consensus on the diagnosis and treatment of benign gallbladder disease, this review aims to provide an overview of the diagnostic and treatment strategies for benign gallbladder diseases. Specifically, it focuses on enhancing our understanding of the role of benign gallbladder diseases in the development of gallbladder cancer, the impact of congenital biliary anomalies on the diagnostic and treatment processes of benign gallbladder diseases, and the significance of the preoperative examinations.

Prognostic analysis and predictive model construction of textbook outcome after gallbladder carcinoma surgery / 中华肝胆外科杂志

Objective:To analyze independent influencing factors of surgical textbook outcome (TO) in patients with gallbladder carcinoma, and to establish a nomogram for predicting TO and evaluated the predictive ability.Methods:Patients with gallbladder carcinoma who underwent surgery in Department of Hepatobiliary and Pancreatic Surgery at Dongfang Hospital Affiliated to Shanghai Tongji University and Department of Biliary Tract Surgery Ⅰ, Third Affiliated Hospital of Naval Medical University (Shanghai Eastern Hepatobiliary Surgery Hospital) from January 2013 to December 2018 were included and the clinical features were retrospectively analyzed. A total of 232 patients were included, including 114 males and 118 females, aged (61.0±9.8) years. According to whether TO reached or not, they were divided into TO group ( n=86) and non-TO group ( n=146). Univariate and multivariate logistic regression were used to analyze the independent influencing factors of TO. The predictive nomogram model of TO was constructed. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive ability of the model, and the consistency of the predictive model was evaluated by the consistency curve graph and the Hosmer-Lemeshow test. Results:The 1-year and 3-years cumulative survival rates of patients with gallbladder carcinoma in the TO group (86.0% and 62.8%) were better than those in the non-TO group (46.6% and 27.3%), and the difference was statistically significant (χ 2=60.74, P<0.001). In multivariate analysis, higher T stage ( OR=0.16, 95% CI: 0.03-0.79, P<0.001) and cervical gallbladder cancer ( OR=0.14, 95% CI: 0.02-0.94, P=0.004) had the greatest negative association with a TO, and the higher the degree of tumor differentiation ( OR=7.08, 95% CI: 1.34-37.56, P=0.001), the easier it is to achieve TO. The ROC curve showed that the area under the curve of the predictive model was 0.84 (95% CI: 0.79-0.90), suggesting that the model had good predictive performance. A nomogram to assess the probability of TO was developed and had good accuracy in both the consistency curve and Hosmer-Lemeshow test (χ 2=5.77, P=0.673). Conclusion:Tumor T stage, tumor differentiation degree and tumor location are independent influencing factors for achieving TO in patients with gallbladder carcinoma after surgery. The nomogram model constructed according to the above conclusions could accurately predict the probability of reaching TO.

Risk factors in predicting lymph node metastases in intrahepatic cholangiocarcinoma / 中华肝胆外科杂志

Objective:To study the risk factors of lymph node metastases in patients with intrahepatic cholangiocarcinoma (ICC) and to establish a risk prediction model of lymph node metastases in ICC.Methods:The clinicopathological data of 587 ICC patients who underwent radical hepatectomy and lymph node dissection at Third Affiliated Hospital of Naval Medical University (Shanghai Eastern Hepatobiliary Surgery Hospital) from January 2007 to December 2011 were retrospectively analyzed. There were 395 males and 192 females with ages which ranged from 20 to 82 (54.7±10.8) years. Independent risk factors of lymph node metastases were studied using univariate and multivariate logistic regression analysis, and a risk prediction model was established. Receiver operating characteristic (ROC) curve was used to evaluate the accuracy of this model.Results:Of 587 patients, 158 (26.9%) had lymph node metastases. Multivariate logistic regression analysis showed that platelet count >300×10 9/L ( OR=1.985, 95% CI: 1.030-3.824, P=0.041), carbohydrate antigen 19-9 >37 U/ml ( OR=2.978, 95% CI: 1.994-4.448, P<0.001), tumor situated in left hemiliver ( OR=1.579, 95% CI: 1.065-2.341, P=0.023), multiple tumors ( OR=1.846, 95% CI: 1.225-2.783, P=0.003), and absence of cirrhosis ( OR=2.125, 95% CI: 1.192-3.783, P=0.011) were independent risk factors for lymph node metastases in ICC. The area under the ROC curve was 0.714, with a cutoff value of 0.215, and the sensitivity and specificity being 75.9% and 58.3%, respectively. Conclusions:The risk prediction model of ICC lymph node metastases was established using readily available clinical data obtained before operation. This model has good predictive values and can provide a reference for treatment decision on patients with ICC.

The mediating effect of self-control in the relationship between alexithymia and internet addiction among college students / 中华行为医学与脑科学杂志

Objective:To explore the mediating role of self-control in the relationship between alexithymia and internet addiction.Methods:From August to September 2019, a total of 433 college students were selected from three universities in Jiangxi province by cluster random sampling method. The Chinese internet addiction scale-revised, the twenty-item Toronto alexithymia scale and brief self-control scale were used for questionnaire testing. SPSS 23.0 software was used for descriptive statistics, Pearson correlation analysis and PROCESS V3.5 macro program was used to test the mediating effect.Results:The total scores of alexithymia, internet addiction and self-control were (53.61±9.44), (45.31±9.84) and (41.91±6.09), respectively. Pearson correlation analysis showed that alexithymia was significantly positively correlated with internet addiction ( r=0.47, P<0.01), and significantly negatively correlated with self-control ( r=-0.37, P<0.01). The negative correlation between self-control and internet addiction was significant ( r=-0.46, P<0.01). Multivariate hierarchical regression analysis showed that alexithymia directly predicted internet addiction after controlling the influence of gender. Self-control played a partially mediating role in the relationship between alexithymia and internet addiction (effect size=0.13, 95% CI: 0.082-0.185), the mediating effect accounted for 25% of the total effect. Conclusion:Alexithymia not only directly affects college students′ internet addiction, but also indirectly affects college students′ internet addiction through self-control.

Comparatively Study on the Thromboelastography and Light Transmission Aggregometry in Monitoring Clopidogrel Effect / 现代检验医学杂志

Objective To comparatively study the difference between thromboelastography (TEG)and light transmission ag-gregometry (LTA)in monitoring clopidogrel effect in patients with acute coronary syndrome.Methods 68 patients with a-cute coronary syndrome,who were in hospital from February to December 2013,were enrolled in this study.They received TEG and LTA to determine platelet aggregation.Results Clopidogrel effect was (47.84±26.04)% and (45.64±20.92)%respectively by TEG and LTA.There were negative correlation between LTAADP and TEGADP(r=-0.752,P<0.001),pos-itive correlation between LTAADP and MAADP(r=0.789,P<0.001),negative correlation between TEGADP and MAADP(r=-0.820,P<0.001).Conclusion There was a good correlation between the two methods.TEG can be used to evaluate thera-peutic effect of Clopidogrel effect.

Randomised clinical trial on rh-Endo combined with FOLFOX4 regimen as an adjuvant therapy for stage Ⅱ and Ⅱ colorectal cancer patients / 中华普通外科杂志

Objective To evaluate the long-term efficacy of recombinant human endostatin (rh-Endo) combined with FOLFOX4 as an adjuvant treatment for patients of stage Ⅱ and Ⅲ colorectal cancer.Methods Eligible patients were randomly assigned to receive FOLFOX4 or FOLFOX4 plus rh-Endo regimen in which patients receiving 7.5 mg/m2 Ⅳ on day 1-7,repeated every 2 weeks,to a total of 12 cycles in 6 months.Results A total of 197 eligible patients were accrued in this research with 105 patients in the control group and 92 patients in the experimental arm.Median follow-up period was 42 months.The baseline characteristics distributed were balanced by treatment.Rh-Endo combined with FOLFOX4 regimen resulted in significant improvement on DFS compared to FOLFOX4 regimen for patients with stage Ⅲ colon cancer (HR =0.19,95％ CI0.05-0.75,P =0.0124),and with a 34％ improvement on 3-year DFS and 81％ reduced recurrence.Although rh-Endo combined with FOLFOX4 regimen failed to make significant difference on DFS in the whole (HR =0.75,95％ CI 0.31-1.83,P =0.5589),it was also observed a 17％ improveiment on 3-year DFS.No statistical significant difference on DFS was observed in patients with stage Ⅱ disease.Conclusions Rh-Endo combined with FOLFOX4 regimen significantly improved the disease-free survival for patients with stage Ⅲ colorectal cancer,indicating that patients with stage Ⅲ disease,but not stage Ⅱ disease,can benefit from FOLFOX4 plus rh-Endo regimen in adjuvant treatment.

Clinical Analysis on 112 Episodes of Urinary Tract Infection in Patients with Lupus Nephritis / 医学研究杂志

Objective To analyze the clinical feature and its risk factors on 112 episodes of urinary tract infection (UTI) in patients with lupus nephritis. Methods 112 episodes of UTI in patients with lupus nephritis in our department during the past 5 years were reviewed retrospectively. Epidemiological data and information on urinary symptoms, disease activity (SLEDAI) , leukocyte and platelet data were collected. Autoantibodies, complement levels, urine culture, and antibiogram were determined. Urological studies were carried out. The use of corticosteroids and (or) immunodepressive were also investigated. Results The prevalence of UTI in lupus nephritis patients was 36.5% , and complexity infection(58%) was the main UTI . Symptomatic UTI was 62% , and symptomless UTI was 38% . The mean SLEDAI score was 15.7(SD3.05) , which influenced the onset of UTI (P1/100 IU/ml, leucopenia and thrombocytopenia (P

Method for detecting ECG arrhythmia / 医疗卫生装备

Usually, the frequency of heartbeat can be used to discriminate different kinds of arrhythmia from a normal cardiac rhythm, but the result is not satisfying. This paper presents a method that can differ ventricular fibrillation (VF) and ventricular tachycardia (VT) from a normal sinus rhythm (NSR). VT and VF are fatal arrhythmia for patients, but timely electroshock is a good remedy for them. The method above can be integrated into the monitor system or telemedicine to diagnose patients and then treat them properly. With auto regressive (AR) model applied to modeling, Itakura and Euclidian distance measurements are used to classify data. With this method, VF and VT conditions are detected with error less than 10%.