A Nomogram Based on Aspartate Aminotransferase/Alanine Aminotransferase (AST/ALT) Ratio to Predict Prognosis After Surgery in Gastric Cancer Patients.

INTRODUCTION: Using the TMN classification alone to predict survival in patients with gastric cancer has certain limitations, we conducted this study was to develop an effective nomogram based on aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio to predict overall survival (OS) in surgically treated gastric cancer. METHODS: we retrospectively analyzed 190 cases of gastric cancer and used Cox regression analysis to identify the significant prognostic factors for OS in patients with resectable gastric cancer. The predictive accuracy of nomogram was assessed using a calibration plot, concordance index (C-index) and decision curve. This was then compared with a traditional TNM staging system. Based on the total points (TPS) by nomogram, we further divided patients into different risk groups. RESULTS: multivariate analysis of the entire cohort revealed that independent risk factors for survival were age, clinical stage and AST/ALT ratio, which were entered then into the nomogram. The calibration curve for the probability of OS showed that the nomogram-based predictions were in good agreement with actual observations. Additionally, the C-index of the established nomogram for predicting OS had a superior discrimination power compared to the TNM staging system [0.794 (95% CI: 0.749-0.839) vs 0.730 (95% CI: 0.688-0.772), p < 0.05]. Decision curve also demonstrated that the nomogram was better than the TNM staging system. Based on TPS of the nomogram, we further subdivided the study cohort into 3 groups including low risk (TPS ≤ 158), middle risk (158 < TPS ≤ 188) and high risk (TPS > 188) categories. The differences in OS rate were significant among the groups. CONCLUSION: the established nomogram is associated with a more accurate prognostic prediction for individual patients with resectable gastric cancer.

Hepatic functional and pathological changes of type 1 diabetic mice in growing and maturation time.

To detect the changes in the liver function in both male and female OVE26 mice from young to adults for better understanding of type 1 diabetes-induced hepatic changes, OVE26 mice and wild-type FVB mice were raised in the same environment without any intervention, and then killed at 4, 12, 24 and 36 weeks for examining liver's general properties, including pathogenic and molecular changes. The influence of diabetes on the bodyweight of male and female mice was different. Both male and female OVE26 mice did not obtain serious liver injury or non-alcoholic fatty liver disease, manifested by mild elevation of plasma alanine transaminase, and less liver lipid content along with significantly suppressed lipid synthesis. Uncontrolled diabetes also did not cause hepatic glycogen accumulation in OVE26 mice after 4 weeks. Oxidative stress test showed no change in lipid peroxidation, but increased protein oxidation. Changed endoplasmic reticulum stress and apoptosis along with increased antioxidant capacity was observed in OVE26 mice. In conclusion, uncontrolled type 1 diabetes did not cause hepatic lipid deposition most likely because of reduced lipids synthesis in response to insulin deficiency. Enhanced antioxidant capacity might not only prevent the occurrence of severe acute liver injury but also the self-renewal, leading to liver dysfunction.

Defecation delay in patients after lung tumor surgery: a prospective nested case-control study.

BACKGROUND: Defecation delay (greater than or equal to 3 days post-surgery) is a common symptom in patients after lung tumor surgery. This study investigated the incidence and relevant risk factors of defecation delay in patients after lung tumor surgery. METHODS: Between October 2019 and March 2020, a prospective nested case-control study was conducted in 80 patients who received lung tumor surgery in the Department of Thoracic Surgery at the Sun Yat-sen University Cancer Center. According to the Rome III criteria for functional constipation and the accepted definitions in the literature, patients with defecation delay time greater than or equal to 3 days post-surgery were classified as the defecation delay group, and the remaining patients were considered the control group. A questionnaire survey was conducted to explore the trait of the stool, defecation time, postoperative activity, diet, and perioperative pain score. Statistical analyses were performed to compare the risk factors affecting defecation time in the two groups. RESULTS: Out of 80 patients, a total of 44 patients (44/80) experienced defecation delay after the operation. Univariate analysis showed that there were significant differences between the two groups in operation methods (P<0.029), postoperative stool trait (P<0.001), difficulty in defecation (P<0.01), and perioperative pain score (P=0.0178), suggesting that change of stool characteristics and pain were possible factors causing defecation delay. Multivariate analysis also revealed significant differences between the two groups in the postoperative pain score on the first day post-surgery (P=0.03). CONCLUSIONS: Defecation delay is a common symptom in patients after lung cancer surgery, and is related to operation method, pain score, and changes in stool characteristics. This study identified that minimally invasive surgery, postoperative pain relief treatment, and health education may play an important role in preventing delayed defecation.