Study on the value of des-γ-carboxy-prothrombin combined with enhanced CT in predicting microvascular invasion of hepatocellular carcinoma / 中国实用外科杂志

OBJECTIVE: To explore the predictive value of preoperative enhanced CT combined with des-γ-carboxy-prothrombin(DCP) level for microvascular invasion(MVI) of hepatocellular carcinoma(HCC).METHODS: The clinicaldata of 105 cases of HCC diagnosed by pathology after surgical resection from January 1,2016 to March 1,2019 in thethe Affiliated Hospital of Southwest Medical University were analyzed retrospectively. According to the pathologicalresults,they were divided into two groups: experimental group(with MVI): 30 cases,control group(without MVI): 75 cases,using univariate and multivariate logistic regression analysis to predict influencing factors of MVI in HCC. Thereceiver working curve(ROC curve)was used to evaluate the predictive value of DCP combined with enhanced CT forMVI in HCC.RESULTS: Univariate analysis showed that serum DCP level(t=4.667,P<0.001),tumor size(t=9.427,P<0.001),capsule type(χ~2=18.456,P<0.001) and pathological type(χ~2=11.914,P=0.003) were risk factors for MVI in HCC,with statistically significant differences(P<0.05). Multivariate logistic regression analysis showed that tumor size(OR=12.610,P=0.001),capsule type(OR=14.363,P=0.008) and serum DCP level(OR=19.254,P=0.014)were independentrisk factors of MVI in HCC,with statistically significant differences(P<0.05). ROC curve analysis showed that thesensitivity,specificity and area under the curve(AUC) of serum DCP and enhanced CT model for predicting MVI in HCCwere 90.0%,74.7% and 0.856,respectively.CONCLUSION: Preoperative serum DCP level combined with enhanced CThelps predict MVI in HCC.

[Risk factors for the development of acute respiratory distress syndrome in children with measles].

OBJECTIVE: To study the risk factors for the development of acute respiratory distress syndrome (ARDS) in children with measles. METHODS: The clinical data of 55 children with measles were retrospectively studied. Of the 55 children, 11 were complicated by ARDS. The risk factors for the development of ARDS were investigated by univariate analysis and multivariate non-conditional logistic regression analysis. RESULTS: The univariate analysis showed that there were significant differences in the oxygen inhalation mode (nasal catheter/mask), the rate of sepsis, blood C-reactive protein (CRP) levels and lymphocyte counts at admission between the ARDS and non-ARDS groups (P<0.05). The presence of sepsis and higher blood CRP levels were identified as the major risk factors for the development of ARDS by the multivariate logistic regression analysis (OR=116.444, 1.050 respectively; P<0.05). CONCLUSIONS: The children with measles who have sepsis and higher blood CRP levels are at risk of ARDS.

[Short-term prognostic factors in children with acute liver failure].

OBJECTIVE: To investigate the factors that influence the short-term (6 months) prognosis in children with acute liver failure. METHODS: The clinical information of 53 children with acute liver failure treated between June 2008 and September 2013 was retrospectively analyzed. The patients were divided into survival group (n=21) and death group (n=32) according to their outcomes. The liver function parameters and incidence of complications were compared between the two groups, and multivariate logistic regression analysis was used to identify major factors affecting the short-term prognosis in these patients. RESULTS: There were significant differences between the death and survival groups in the indices of international normalized ratio (INR), blood ammonia and serum albumin (Alb), and complications such as hepatic encephalopathy, gastrointestinal hemorrhage, and multiple organ failure (P<0.05). Multivariate logistic regression analysis demonstrated that serum Alb, INR, and hepatic encephalopathy were the major factors affecting the short-term prognosis of acute liver failure (OR=0.616, 75.493 and 1210.727 respectively; P<0.05). CONCLUSIONS: INR, hepatic encephalopathy and serum Alb are the major factors that influence the short-term prognosis in children with acute liver failure.

Findings in children severely infected with a novel influenza A virus of swine origin: pulmonary imaging.

BACKGROUND: This article reviews the chest radiography of children with severe infection caused by a novel influenza A (H1N1) virus of swine origin (S-OIV). We analyzed the role of their pulmonary images in predicting the severity and diagnosis of the disease. METHODS: Among 97 patients with confirmed novel H1N1 infection, 42 patients treated with mechanical ventilation formed group 1, and the remaining 55 patients constituted group 2. The initial and subsequent radiograhic findings in groups 1 and 2 were compared with respect to the pattern, distribution, and extent of the abnormality. RESULTS: In group 1, 24 patients presented with three or more lung zone diseases, whereas only 5 patients in group 2 demonstrated these findings (P<0.001). A pneumomediastinum or pneumothorax was observed in 24/42 patients in group 1 and in 18/55 patients in group 2 (P=0.019). Twelve patients in group 1 and 5 in group 2 developed a ground-glass opacity cyst with a honeycomb appearance (P=0.007). CONCLUSIONS: The most common radiographic and computed tomography findings in children who were severely infected with S-OIV included unilateral or bilateral ground-glass opacities with or without associated focal or multifocal areas of consolidation. Children with bilateral involvement or with greater opacity on the chest radiographs were more likely to worsen and require the mechanical ventilation.

[Characteristics of circulatory disturbance and the treatment of severe hand-foot-and-mouth disease].

OBJECTIVE: To investigate the characteristics of circulatory disturbance and treatment of severe hand-foot-and-mouth disease (HFMD). METHOD: The clinical characteristics, laboratory findings, therapy and outcome of 22 severe HFMD patients were retrospectively analyzed. RESULT: All the 22 severe HFMD patients came from the countryside. All these patients had encephalitis. Fifteen cases had myocardial injury. All had symptoms of sympathetic excitation and 17 cases had hypertension [(128 ± 16)/(81 ± 14) mm Hg (1 mm Hg = 0.133 kPa)]. Fourteen cases had exacerbation with rapid decline of blood pressure [(61 ± 12)/(33 ± 12) mm Hg]. In cardiorespiratory failure stage, 13 patients had neurogenic pulmonary edema accompanied by circulatory failure and 12 cases had a lower glasgow scores (less than 7). Myocardial injury and ECG change were found in some cases. Inotropic and pressor drugs were given in patients with circulatory collapse. Five cases received fluid resuscitation due to refractoriness to inotropic drugs. Nine patients received blood purification. Seventeen survived and 5 cases died due to circulatory failure. CONCLUSION: Circulation failure of severe HFMD is the main cause of death. Early and appropriate circulation support is very important to reduce mortality.