[Predictive Value of Platelet to Lymphocyte Ratio and Prognostic Nutritional Index on Prognosis of Hepatocellular Carcinoma after Liver Resection].

OBJECTIVE: To investigate the value of joint score of platelet to lymphocyte ratio (PLR) and prognostic nutritional index (PNI) to predict postoperative recurrence and mortality of patients with hepatocellular carcinoma (HCC) after liver resection. METHODS: Clinical data of HCC patients within Milan criteria who underwent liver resection at our center were retrospectively reviewed (n=269). The preoperative PLR and PNI of all patients were measured, and. the score of PLR+PNI was calculated. The patients with high PLR (≥150) and low PNI <45) were allocated a score of 2; while the patients had one or neither of these elevations were allocated a score of 1 or 0, respectively. Postoperative survival was estimated by Kaplan-Meier method with log-rank test. Multivariate analysis used Cox regression model. RESULTS: Multivariate analysis showed microvascular invasion, high alpha-fetoprotein (AFP) level, multiple tumors and PLR+PNI score were associated with postoperative recurrence. Microvascular invasion, transfusion and PLR+PNI score were independent risks factors for overall survival. The 5-year recurrence-free survival rates for the patient with PLR+PNI score of 0, 1, 2 were 43.4%, 27.8%, and 19.9% respectively (P<0.001). The 5-year overall survival rates were 84.1%, 72.3%, and 17.7% respectively (P<0.001). CONCLUSION: High PLR+PNI score seems related to high incidence of postoperative recurrence and low long-term survival in the patients with HCC after liver resection.

Factors influencing quality of life in Chinese patients with persistent somatoform pain disorder.

This cross-sectional survey aimed to explore quality of life (QoL) and its correlated factors in Chinese patients with persistent somatoform pain disorder (PSPD) and their related correlation factors in Shanghai, China. A total of 60 patients were assessed with Short Form (36) health survey (SF-36) for QoL, medical outcomes study pain measurement (MOSPM) for pain symptoms, Hamilton depression scale - 17 items (HAMD) for depression and Hamilton anxiety scale (HAMA) for anxiety. Results were as follows: (1) Patients scored significantly lower on all SF-36 subscales' scores ( p < .01) apart from the mental health and vitality subscales; (2) With the exception of the general health subscale, SF-36 subscales' scores were negatively correlated with the total score of MOSPM, three factor scores of MOSPM, and total scores of HAMD and HAMA; (3) PSPD patients with severe depression had significantly lower scores (p < .01) on SF-36 subscales' scores (except for GH subscale) and component summary scores as compared to PSPD patients with none or moderate depression; and (4) Multiple linear stepwise regression revealed that SF-36's physical component summary (PCS) subscale correlated with patients' age and MOSPM total score while SF-36's mental component summary (MCS) subscale correlated with total scores of HAMD and MOSPM total score. In sum, PSPD patients had a lower QoL as compared to general population. Pain, depression, and anxiety were significantly correlated with QoL of PSPD patients while age, pain, and depression were important factors influencing PCS and MCS.

Clinical evaluation of the efficacy and safety of tandospirone versus sertraline monotherapy for social anxiety disorder: a randomized open-label trial.

OBJECTIVE: Although selective serotonin reuptake inhibitors are now established as first-line pharmacotherapy for social anxiety disorder (SAD), other agents with different mechanisms have shown promise in treating SAD. The aim of this study was to examine the efficacy and safety of tandospirone in treating adolescents with SAD. METHODS: Adolescent patients meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for SAD were randomly assigned (1:1) to open-label treatment with either tandospirone or sertraline for 8 weeks. The primary outcome measures were changes from baseline in the Hamilton Anxiety (HAM-A) scale and response using the Clinical Global Impression of Improvement (CGI-I) scale. RESULTS: The adjusted mean change in HAM-A scores from baseline was indicating a significant improvement over baseline in both treatment arms (p < 0.0001). The mean CGI-I scale score at week was with no significant difference between the two arms (p = 0.42). Rates of response were 48.6% for tandospirone and 55.6% for sertraline using the CGI-I. Response rates were 37.1% for tandospirone and 41.7% for sertraline using a HAM-A response criterion (≥50% reduction). The adjusted mean change in Social Phobia Inventory scores from baseline was indicating a significant improvement over baseline in both treatment arms (p < 0.0001). CONCLUSIONS: Tandospirone is safe and effective and appears non-inferior to sertraline for SAD in youths.

[Effect of silencing AEG-1 with small interfering RNA on the proliferation and cell cycle of gastric carcinoma SGC-7901 cells].

OBJECTIVE: To explore the effect of down-regulation of astrocyte elevated gene-1 (AEG-1) expression on cell proliferation and cell cycle of gastric carcinoma cells, and its possible molecular mechanism. METHODS: Control siRNA and AEG-1 siRNA were transfected into gastric carcinoma SGC-7901 cells. 48 h after transfection, the cells were divided into 3 groups including untransfected, siRNA control and AEG-1 siRNA transfection groups. Expressions of AEG-1 mRNA and protein in the 3 group cells were detected by real-time quantitative PCR and Western blot. The changes of cell proliferation were examined using CCK-8 kit, and the cell cycle distribution was detected by flow cytometry. Finally, expressions of cell proliferation and cell cycle related proteins were detected by Western blot. RESULTS: Real-time quantitative PCR and Western blot demonstrated that compared with the untransfected and siRNA control groups, expressions of AEG-1 mRNA and protein were significantly down-regulated in the AEG-1 siRNA transfection group (P < 0.05), but there was no significant difference between the untransfected and siRNA control groups (P > 0.05). Furthermore, in vivo experiment confirmed a significant down-regulation of AEG-1 protein in the AEG-1 siRNA transfection group (P < 0.05). In addition, AEG-1 siRNA obviously inhibited the proliferation of SGC-7901 cells at different time points after transfection with AEG-1 siRNA. The percentage of cells in G0/G1 phase in the AEG-1 siRNA transfection group [(61.26 ± 1.25)%] was significantly higher than those in the untransfected group [(46.17 ± 1.91)%] and siRNA control group [(46.46 ± 1.96)%], and there was a significant difference between them (all P < 0.001). Furthermore, the result of Western blotting revealed that down-regulation of AEG-1 expression evoked the down-regulation of cdk2 and cyclin D1 expressions and elevation of p21 expression in vitro and in vivo. CONCLUSIONS: The inhibition of cell proliferation and cell cycle arrest mediated by down-regulation of AEG-1 expression may be closely associated with the changes of expression of cell cycle related proteins including cdk2, cyclin D1 and p21.

The characteristics of bone marrow-derived endothelial progenitor cells and their effect on glioma.

BACKGROUND: EPCs were isolated primarily in 1997 by Asahara et al. and recent studies indicated that bone-marrow-derived EPCs contributed little to the endothelium of tumor vessels. Tumors of the CNS system demonstrate various features of angiogenesis. METHODS: EPCs derived from rat bone marrow were isolated and cultured in M199 medium without any induced factors. EPCs were studied using immunohistochemical staining, Flow cytometry and culture under three-dimensional condition to determine EPCs' characteristics in vitro. We also established an animal model by injecting EPCs marked with Hoechst 33342 into the back of BALB/c nude mice and performed hematoxylin-eosin (HE) and immunofluorescent staining to study EPCs' features in vivo. To research effect of EPCs on glioma, animals bearing tumors model with C6 glioma were established. About 27 day after injection, we performed immunohistochemical staining and Immunofluorescence staining. RESULTS: Our results showed that EPCs derived from rat bone marrow appeared typical morphological characteristics and were positive of CD34, CD133, KDR and CD31 antigens at different time in vitro under the special M199 medium without any induced factors. The percentage of cells that expressed CD133 decreased gradually. In brief, the present study showed that EPCs derived from rat bone marrow differentiated into ECs in medium the without any induced factors and formed tubular structures in three-dimensional circumstances. Animal experiments suggested that EPCs differentiated into ECs and other else non-endothelial cells, and that EPCs contributed M199 of glioma. DISCUSSION: These findings provides some novel results about biological characteristics of EPCs in vivo and ex vivo, and an update on the effect of EPCs on glioma and which would be helpful for the overall understanding of EPCs and make EPCs to be implied on the clinical therapy.

Health-related quality of life of liver transplant recipients: a single center experience.

BACKGROUND/AIMS: To evaluate the health related quality of life (HRQOL) of liver transplant recipients and to identify risk factors influencing post-operative HRQOL. METHODOLOGY: Adult patients who underwent primary liver transplantation from 2009 to 2010 were asked to complete a HRQOL survey at pre-operation and one year postoperatively. We compared the HRQOL of liver transplant recipients at pre-transplantation and one year postoperatively to the general population. Pre-transplant variables were analyzed to identify the risk factors influencing postoperative HRQOL. RESULTS: Pre-transplant HRQOL was significantly lower than that of the general population and significantly improved at one year postoperatively. Multivariate analyses suggested hepatocellular carcinoma, pre-transplant hypertension and high model for end-stage liver disease score were independent risk factors for postoperative physical component summary (PCS); and higher education level, marital status and lower income level negatively impacted on the postoperative mental component summary (MCS). CONCLUSIONS: Factors influencing postoperative HRQOL were identified in the present study. Transplant centers should pay more attention to patients with above-mentioned risk factors and strive to improve the HRQOL.

Effect of enhanced recovery after surgery program on patient-reported outcomes and function recovery in patients undergoing liver resection for hepatocellular carcinoma.

The aim of this study was to investigate the effect of enhanced recovery after surgery (ERAS) on perioperative outcomes, with an emphasis on patient-reported outcomes (PROs) and functional recovery.We compared the clinical outcomes in a cohort of 275 patients undergoing liver resection before and after the implementation of ERAS. The PROs were preoperatively and postoperatively compared until 14 days after surgery using the MD Anderson Symptom Inventory.The patients in the ERAS group experienced fewer symptoms and a shorter functional recovery time than the patients in the non-ERAS group. The group × time interactions were different between the groups for pain (F = 4.70, P = .001) and walking (F = 2.75, P = .03). On the 3rd, 4, and 5th days after surgery, the ERAS group experienced less pain and more walking than the non-ERAS group. The ERAS group experienced less fatigue (0.407 [95% confidence interval, CI: -0.795, -0.020], P = .035), less sleep interference (0.615 [95% CI: -1.215, -0.014], P = .045), a lower rate of reduced appetite (0.281 [95% CI: -0.442, -0.120], P = .001), and less abdominal distension (0.262 [95% CI: -0.504, -0.020], P = .034) than the non-ERAS group. Those in the ERAS group had a significantly shorter median time from surgery to mild fatigue (5.41 vs 6.87 days, P = .003), mild pain (4.45 vs 6.09 days, P = .001), mild interference when walking (3.85 vs 5.54 days, P < .001), and mild interference when sleeping (5.49 vs 7.43 days, P < .001). ERAS patients were more likely than non-ERAS patients to achieve a functional recovery (5.70 vs 6.79 days, P < .001) status in a shorter time period. The ERAS pathway, operation time, and the minimally invasive approach were independent predictors of functional recovery time.In hepatocellular carcinoma liver resection patients, the primary mechanism of ERAS is to reduce the postoperative interference burden and promote rapid functional recovery.

Sequential defunctionalization followed by thyroxine supplementation as preoperative preparation of hyperthyroid patients undergoing thyroidectomy.

BACKGROUND: Preparing hyperthyroid patients for thyroid surgery with a combination of antithyroid drugs and thyroxine has long been controversial because this combination usually results in only partial inhibition of thyroid function. We therefore used large doses of antithyroid drugs to completely inhibit the synthesis of thyroxine and render the thyroid gland defunctionalized. We then administered physiologic doses of thyroxine to inhibit thyroid-stimulating hormone secretion. We have named this treatment "sequential thyroid defunctionalization followed by thyroxine supplementation." METHODS: Four hundred and seventy-one hyperthyroid patients seen at our hospital were divided into experimental and control groups. The control group was treated preoperatively with antithyroid drugs and iodine preparation. The experimental group was further divided into four subgroups and treated with "sequential thyroid defunctionalization followed by thyroxine supplementation". Each of the four subgroups received different doses of antithyroid drugs and thyroxine for differing time periods. Thyroid function was assessed at each stage of treatment, as were operative blood loss volumes and postoperative complications. RESULTS: Compared to the control group, the four experimental groups showed less thyroid congestion and surface varices at surgery. Patients in subgroup A also had thyroid glands that were almost histologically normal. The mean operative blood loss volume of the experimental group was less than that of the control group (326 +/- 163) ml in the control group; (196 +/- 57) ml in subgroup A; (230 +/- 71) ml in subgroup B; (240 +/- 80) ml in subgroup C; and (312 +/- 97) ml in subgroup D). The postoperative complication rate of the experimental group was 8.64% (21/243) whereas that of the control group was 17.54% (40/228). CONCLUSIONS: Sequential thyroid defunctionalization followed by thyroxine supplementation is effective in reducing the bleeding volume and postoperative complication rate in selected hyperthyroid patients undergoing thyroidectomy.

[Analysis of the microelements contents in melons and fruits of Xinjiang].

Through the atom absorption and emission spectrum analysis, it is detected 8 trace elements contents in eleven species of melons and fruits in Xinjiang. On comparative analysis with biological standard of China, it is found that the zinc quantity in apples is 66.75 mg x kg(-1), the strontium quantity in jujubes is 8.62 mg x kg(-1) and Chinese-date contains strontium 8.62 mg x kg(-1) in Hetian area; and that in the Kuerle area the pomegranate is potassium 687 mg x kg, in Hami Territory Chinese-date contains manganese, zinc, strontium, calcium, iron, potassium and nickel, all of them are more over the national biological standard. The contents of copper in eleven species of melons and fruits are lower than the biological standard of China The average contents of 8 kind microelement in the pomegranate of Kuerle, in the apples of Hetian, the Chinese-date of Hami are very high (respectively to be 91.82, 121.5 and 275.3 mg x kg(-1)), and in the watermelon of Wujiaqu, the pericarp (54.19 mg x kg(-1)) take place higher than in the pulp (48.69 mg x kg(-1)) by 1.11 times. The result can provides the conference for studies of melons and fruits foodstuff studies in Xinjiang.

[A new model for survival assessment based on the Chinese liver transplantation patients with hepatocellular carcinoma].

OBJECTIVE: To establish a new model for liver transplantation recipients with hepatocellular carcinoma (HCC) and validate the feasibility of it. METHODS: From February 1999 to June 2005, clinical data of 130 liver cancer patients who accepted liver transplantation were collected. Screening the pretransplant factors correlated with post-transplant survival using COX proportional-hazards regression, and establishing the assessment model. Finally, the area under the receiver operating characteristic curve (AUC ROC) were used to compare the validity of the new model with MELD. RESULTS: Screened by the COX model, serum concentrations of alkaline phosphatase, alphafetoprotein, sodium and the number of tumor nodule were significantly related with post-transplant survival. The new model with these four variables had greater ability to assess post-transplant recipients' outcomes, however, the MELD had not evaluation capacity. CONCLUSION: The established new model has a better ability to assess the risk of post-transplant mortality.

[Perioperative nursing of 50 recipients undergoing adult-to-adult living donor liver transplantation].

OBJECTIVE: To summarize the perioperative nursing experience for recipients undergoing adult-to-adult living donor liver transplantation(A-ALDLT). METHODS: 50 cases of recipients undergoing A-ALDLT in our hospital January 2002 to July 2006 were retrospectively analyzed for perioperative nursing. RESULTS: All the successful operations for A-ALDLT got without nursing complications. 1-year survival rate was 92%, which means the care effect was satisfactory. CONCLUSION: Perioperative nursing is one important factor of elements to guarantee the success of LDLT. The actively and effectively perioperative nursing measures are the important insurance to the recipients' recovery from graft operation.

[The mechanism and significance of cellular signal transduction in kidney glomerular mesangial cells of rat with obstructive jaundice].

OBJECTIVE: To study the mechanism of ceramide-induced cellular signal transduction and its effect on renal injury. METHODS: Sixty male Sprague-Dawley rats were randomly assigned to four groups (n = 15): control group, sham operation group, experiment group one and experiment group two. Except the control and the sham operation group, the other two experiment groups underwent the common bile duct bound to form the rat model of obstructive jaundice. The renal glomerular mesangial cells (GMC) were cultured primarily. After GMC were given different stimulating factors, we performed the measurement of the PLD activity and the GMC apoptosis analyzed by flow cytometry. RESULTS: The biological activity of PC-PLD was significantly decreased by TNF-alpha and ceramide (P< 0.05). On the other hand, the GMC apoptosis was induced by TNF-alpha and ceramide (P <0. 05). However, other opposite results were obtained in addition of ceramide inhibitor to GMC. CONCLUSION: TNF-alpha can induce the ceramide increase in GMC, which is significant to effect on the kidney injury of the rats with obstructive jaundice, by the means of inducing GMC apoptosis and decreasing the activity of PC-PLD.

[Study on thyroid defunctionalization method for the preoperative preparation of hyperthyroid operation].

OBJECTIVE: To set up and publicize the thyroid defunctionalization method for the preoperative preparation of hyperthyroid operation. METHODS: 476 hyperthyroid patients admitted in our hospital from March 1990 to February 2005 were studied by groups. They were divided randomly into a test group (244 patients), in which "preoperative preparation method of sequential thyroid defunctionalization" was applied to hyperthyroid patients, and based on the different drug dosages and treating terms used, further 4 subgroups (A, B, C and D) were divided to observe the treatment efficiency; And a control group (232 patients), in which antithyroid drugs and iodine preparation were applied preoperatively to cases. Thyroid functions in every stage of treatment were tested by radioimmunoassays (RIA), and operative bleeding volumes and postoperative complications were observed. RESULTS: Compared to the control group, the thyroid congestion and surface varices were alleviated in the test groups, in which the thyroid tissue of subgroup A most closed to euthyroidism histologically. The mean operative bleeding volume of test group was less than that of the control group. The bleeding volumes were (324.76 +/- 163.26) mL for the control group, (195.74 +/- 57.07) mL for the subgroup A, (230.00 +/- 70.81) mL for the subgroup B, (240.47 +/- 80.29) mL for the subgroup C and (314.75 +/- 96.46) mL for the subgroup D. There was no significant difference between the control group and subgroup D, but compared with the subgroup A, B, and C, there was the significant difference between control and treated subgroup (P < 0.05). The postoperative complication rate of the test group was 8.61% (21/244), while that of the control group was 17.24 (40/232). There was statistic difference between two groups (P < 0.005). CONCLUSION: The key to "preoperative preparation method of sequential thyroid defunctionalization" is as follows: the synthesis of thyroxin should be fully inhibited to thyroid defunctionalized; sufficient exogenous thyroxin should be supplemented; the term of thyroid function compensation should be long enough. The "preoperative preparation method of sequential thyroid defunctionalization" can decrease perioperational complications effectively and operation risks.

The link between long noncoding RNAs and depression.

The major depressive disorder (MDD) is a relatively common mental disorder from which that hundreds of million people have suffered, leading to displeasing life quality, which is characterized by health damage and even suicidal thoughts. The complicated development and functioning of MDD is still under exploration. Long noncoding RNA (lncRNAs) are highly expressed in the brain, could affect neural stem cell maintenance, neurogenesis and gliogenesis, brain patterning, synaptic and stress responses, and neural plasticity. The dysregulation of certain lncRNAs induces in neurodevelopmental, neurodegenerative and neuroimmunological disorders, primary brain tumors, and psychiatric diseases. Although advances have been made, no fully satisfactory treatments for major depression are available, further investigation is requested. And recently data showed that the expression level of the majority of lncRNAs demonstrated a clear tendency of upregulation, and the certain dysregulated miRNAs and lncRNAs in the MDD have been proved to have a co-synergism mechanism, that is why we speculate lncRNA might get the capability to regulate MDD. Few identified lncRNAs have been deeply studied in detailed experiments up until now, little predictions of their function have been raised, and further researches is calling for discover their signal pathway and related regulatory networks.

Heparin Saline Versus Normal Saline for Flushing and Locking Peripheral Venous Catheters in Decompensated Liver Cirrhosis Patients: A Randomized Controlled Trial.

A prospective randomized, controlled, single-blinded trial to compare the effectiveness and safety of heparin saline (HS) to those of normal saline (NS) as flushing and locking solutions for peripheral venous catheter (PVC) in decompensated liver cirrhosis (DLC) patients.Patients with DLC at our institution between April 2012 and March 2013 were enrolled after obtaining informed consent. The patients were randomly allocated into 2 groups: the NS group received preservative-free 0.9% sodium chloride as the flushing and locking solution, while the HS group received HS (50 U/mL). PVC-related events and the duration of PVC maintenance were compared between the 2 groups. Moreover, the preinfusion and postinfusion levels of prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet (PLT) were also compared.A total of 32 and 36 DLC patients in the NS (125 PVCs) and HS (65 PVCs) groups, respectively, were analyzed. Baseline characteristics, including gender, age, Child-Pugh grade, PVC type and administration of anticoagulant, and irritant agents, were comparable between the 2 groups (P > 0.05). The maintenance times of the HS and NS groups were 80.27 ±â€Š26.47 and 84.19 ±â€Š29.32 hours, respectively (P = 0.397). Removal of PVC for abnormal reasons occurred in 30.7% and 22.4% of patients in the HS and NS groups (P = 0.208). The PVC occlusion rates were 6.2% and 5.6% in the HS and NS groups, respectively (OR = 1.11, 95% CI 0.31-3.92). The PT, APTT, and PLT levels were comparable between the 2 groups both before and after infusion (P > 0.05). Incremental analyses showed that Child-Pugh grade C might be a risk factor for the suppression of PLT in the HS group.We consider NS to be as effective as and safer than conventional HS for flushing and locking PVC in decompensated liver cirrhosis patients.

Efficacy of venlafaxine extended-release monotherapy for first-episode depression with painful physical symptoms.

Pain is the most common symptom reported in both the general population and the general medical setting. The aim of this study is to evaluate the effectiveness, tolerance, and safety of venlafaxine extended-release (XR) monotherapy in treating first-episode outpatients fulfilling the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for major depressive disorder with associated painful physical symptoms. Of the 102 outpatients enrolled, 86 (84.3%) completed the study. Venlafaxine XR treatment (75-225 mg/day) was followed by a significant decrease in the total scores for the 17-item Hamilton Depression Rating Scale from baseline to the second weekend (t value=16.12, P<0.0001) and at every subsequent visit (weeks 4, 6, and 8, all P<0.0001). Significant differences were also found in the mean Visual Analog Scales for overall pain and the mean medical outcomes study pain measures from baseline to the second weekend (t value=14.99, P<0.0001; t value=12.59, P<0.0001) and at every visit (all P<0.0001). At the end of the eighth week, venlafaxine XR achieved response and remission rates of 68.6 and 40.2%, respectively. The remission rate for pain responders (improvement in Visual Analog Scale overall pain from baseline to last observation ≥50%) was significantly greater than that for pain nonresponders (56.1 vs. 20.0%, P<0.0001). The most common (≥10%) adverse events were nausea (31.4%), dizziness (26.5%), and somnolence (22.5%). Venlafaxine XR is possibly an effective and safe option in the treatment of depression and associated painful physical symptoms.

A randomized double-blind clinical trial on analgesic efficacy of fluoxetine for persistent somatoform pain disorder.

OBJECTIVES: To verify the efficacy and safety of fluoxetine in treating patients with persistent somatoform pain disorder (PSPD). METHODS: In this 8-week, randomized double-blind placebo-controlled study, 80 patients with an ICD-10 diagnosis of PSPD were randomly assigned to receive 20mg fluoxetine or a placebo. Several psychological scales including Medical Outcomes Study Pain Measures (MOSPM), Hamilton Depression Scale-17 items (HAMD(17)) and Treatment Emergent Symptom Scale (TESS) were used to assess analgesic efficacy and safety of fluoxetine, and the possible analgesic mechanism of fluoxetine was preliminarily analyzed. All data were analyzed by SPSS11.5 with t-test, one-way ANOVA and a mixed-effects model repeated measures analysis. Intent-to-treat (ITT) analysis was performed and the last observation carry forward (LOCF) was used for missing values. RESULTS: There was a significant difference of MOSPM total score between the fluoxetine and placebo group after 2 weeks of treatment. The analgesic effect of fluoxetine was related with treatment time, and depressive patients showed a better analgesic effect than non-depressive patients. An adverse effect of fluoxetine was scarcely found. CONCLUSIONS: Fluoxetine has a better analgesic effect than a placebo in treating persistent somatoform pain disorder, and is considered a safe treatment; its analgesic effect may be related to an antidepressant effect.