The value of preoperative systemic immune-inflammation index in predicting vascular invasion of hepatocellular carcinoma: a meta-analysis

Vascular invasion and systemic immune-inflammation index (SII) are risk factors for the prognosis of patients with hepatocellular carcinoma. At present, the correlation between the two is not clear. This meta-analysis explored the relationship between preoperative SII and vascular invasion in patients with hepatocellular carcinoma. According to the search formula, the Pubmed, Embase, Cochrane, Web of Science, and CNKI databases were searched for the relevant research until March 2020. After the quality evaluation of the included literature, the odds ratio (OR) and its corresponding 95% confidence interval (CI) were used as the effect measure. Stata 15. 0 software was used for statistical analysis. The meta-analysis eventually included seven retrospective cohort studies of 3583 patients with hepatocellular carcinoma. The results showed that the choice of SII cut-off value affects SII's efficiency in predicting the risk of vascular invasion. In the cohort of studies with appropriate SII cut-off value, the high SII preoperative group had a higher risk of vascular invasion (OR=2.62; 95%CI: 2.07-3.32; P=0.000) and microvascular invasion (OR=1.82; 95%CI: 1.01-3.25; P=0.045) than the low SII group. The tumor diameter (OR=2.88; 95%CI: 1.73-4. 80; P=0.000) of the high SII group was larger than that of the low SII group. There was no publication bias in this study (Begg's test, P=0.368). As a routine, cheap, and easily available index, SII can provide a certain reference value for clinicians to evaluate vascular invasion before operation.

Intention and influencing factors of medical staff in community diabetes management to recommend influenza vaccination / 预防医学

Objeetive@#To understand the intention and influencing factors of medical staff in community diabetes management to recommend influenza vaccination,so as to provide reference for promotion of influenza vaccination recommendation.@*Methods @#The Doctors, nurses and managers from 8 community health service centers（hospitals）in Jiangbei District of Ningbo,who provided diabetes management services,were recruited to collect their demographic features,job satisfaction and intention to recommend influenza vaccination. Logistic regression model was used to analyze the influencing factors for the intention to recommend. @*Results@#Totally 412 questionnaires were distributed and 399（96.84%）valid questionnaires were recovered. There were 178 general practitioners,161 nurses,20 managers and 40 other staffs,accounting for 44.61%,40.35%,5.01% and 10.03%, respectively. Among them,281 had the intention to recommend influenza vaccination,accounting for 70.43%. The results of multivariate logistic regression analysis showed that the medical staff who aged 30 to 39 years（OR=0.332,95%CI：0.118-0.932）,worked for more than 20 years（OR=0.136,95%CI：0.044-0.425）, concerned about medical disputes（OR=0.170,95%CI：0.074-0.392）and negative medical opinion（OR=0.336,95%CI：0.141-0.803）were less likely to recommend influenza vaccination;while the medical staff who were general practitioners（OR=3.664,95%CI：1.513-8.869）,managers（OR=14.695,95%CI：2.494-86.591）,and who were satisfied with professional training opportunities（OR=5.041,95%CI：1.686-15.072）,financial or moral rewards（OR=8.216,95%CI：3.213-21.011）,personal accomplishment（OR=3.955,95%CI：1.517-10.310）and interest in work（OR=6.669,95%CI：2.667-16.679）were more likely to recommend influenza vaccination.@*Conclusion@#Age,post,working age,medical dispute concern,negative medical opinion,professional training opportunities,financial or moral rewards,personal accomplishment and interest in work are associated with the intention to recommend influenza vaccination of the medical staff in community diabetes management.

Postoperative local incision analgesia for acute pain treatment in patients with hepatocellular carcinoma

Summary Objective: The present study aimed to investigate the analgesic effect and safety of using local incision analgesia to treat acute postoperative pain in patients with hepatocellular carcinoma (HCC). Method: A cohort of 60 patients undergoing liver cancer resection was randomly divided into three groups (n=20 per group): local incision analgesia (LIA) group, which received local infiltration with ropivacaine combined with a postoperative analgesia pump; intravenous patient-controlled analgesia (PCA) group, which received fentanyl intravenous analgesia postoperatively; and the control group, which received tramadol hydrochloride injection postoperatively according to the NRS scoring system. The postoperative analgesic effect in each group was compared and tumor recurrence (survival) was analyzed using the Kaplan-Meier method. Results: NRS scores, rate of analgesic usage, ambulation time (h) and intestinal function recovery time (h) were significantly reduced in LIA group compared with the control group at each postoperative time point (6, 12, 24 and 48 hours; p<0.05). Additionally, the NRS scores of LIA patients at 12 hours post-surgery was significantly reduced compared with PCA group (p<0.05), and the occurrence of postoperative adverse events in LIA group was significantly lower than that in PCA group (p<0.05). Survival analysis demonstrated that the mean survival time (tumor recurrence) was significantly increased in LIA group compared with the control group (χ2=4.749; p=0.029). Conclusion: Local incision analgesia improves the analgesic effect, causes fewer adverse reactions and increases postoperative survival time. Our study demonstrated that local incision analgesia is a safe and effective method of postoperative pain management following hepatectomy.