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Objective:To investigate the risk factors for periprosthetic joint infection (PJI) after primary total knee arthroplasty (TKA) and construct a nomogram model for prediction of such risks.Methods:In this retrospective study, we enrolled 69 patients with PJI after primary TKA (the infection group, n=69) who had been admitted to Department of Orthopedics, Nanjing Jinling Hospital, The First School of Clinical Medicine, Southern Medical University from January 2010 to December 2019. The non-infection group included the patients of the same kind but without postoperative infection during the same period who were matched according to time of admission, age, and gender in a ratio of 1∶3 ( n=207). The data on body mass index, anesthesia method, operation time, preoperative C-reactive protein, preoperative albumin, and comorbid medical conditions were collected from both groups to screen the risk factors for postoperative development of PJI using univariate and multivariate conditional logistic regression analyses. After a nomogram of the risk factors was plotted using R software, the consistency index (C-index) was calculated. The receiver operating characteristic curve, calibration curve, and clinical decision curve were drawn. Results:Multivariate conditional logistic regression analysis showed that preoperative albumin <35 g/L ( OR=7.166, 95% CI: 3.427 to 14.983, P<0.001), operation time >90 min ( OR=3.163, 95% CI: 1.476 to 6.779, P=0.003), diabetes mellitus ( OR=3.966, 95% CI: 1.833 to 8.578, P<0.001), rheumatic diseases ( OR=3.531, 95% CI: 1.362 to 9.156, P=0.009), and chronic lung diseases ( OR=4.734, 95% CI: 1.790 to 12.521, P=0.002) were risk factors for development of PJI after primary TKA. The nomogram constructed with R software visualized the model. The C-index of the nomogram was 0.809 (95% CI: 0.751 to 0.867), indicating a good predictive capability of the model. The calibration curves of the model showed that the nomogram was in good agreement with the actual observations. The decision curves showed that the threshold probabilities of the model ranged from 0.08 to 0.75, providing a good net clinical benefit. Conclusions:Preoperative low albumin, prolonged operation time, diabetes, rheumatic diseases, and chronic lung diseases may be the risk factors for PJI after primary TKA. The nomogram prediction model based on these factors can provide a reference for clinicians to prevent PJI.
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Objective:To investigate the correlation of serum pro-gastrin-releasing peptide (ProGRP), sugar chain antigen 242(CA242), procalcitonin(PCT) levels in patients with chronic atrophic gastritis (CAG) with intestinal metaplasia and Helicobacter pylori(Hp) infection and prognosis.Methods:One hundred patients with CAG intestinal metaplasia in Emergency General Hospital were selected as the research objects, and they were divided into infection group (75 cases) and non-infected group (25 cases) according to whether they had Hp infection. The clinical data, levels of serum ProGRP, CA242, and PCT were compared between the two groups, and the diagnostic value of the combination of serum indicators in the diagnosis of Hp infection in CAG intestinal metaplasia patients and their correlation with prognosis were analyzed.Results:The degree of atrophy and intestinal metaplasia in the infected group were higher than those in the non-infected group ( P<0.05). The levels of serum ProGRP, CA242 and PCT in the infected group were higher than those in the non-infected group: (159.41 ± 42.38) ng/L vs. (105.84 ± 18.29) ng/L, (7.24 ± 2.28) kU/L vs. (4.12 ± 1.30) kU/L, (3.84 ± 1.12)μg/L vs. (2.57 ± 0.82) μg/L, there were statistical differences ( P<0.05). The results of Spearman analysis showed that the levels of ProGRP, CA242, PCT had positive correlation with atrophy degree ( r = 0.614, 0.629, 0.672, P<0.05), and had positive correlation with intestinal metaplasia degree ( r = 0.574, 0.591, 0.603, P<0.05). The area under the curve (AUC) for the combined diagnosis of Hp infection in patients with CAG intestinal metaplasia by serum ProGRP, CA242, and PCT was 0.874 (95% CI 0.793 - 0.932), the diagnostic sensitivity and specificity were 76.00% and 92.00%, respectively. The incidence of gastric neoplasms in patients with Hp positive combined diagnosis of serum ProGRP, CA242, and PCT within 2 years (11.86%) was higher than that of negative patients (0), but the difference was not statistically significant ( P>0.05). Conclusions:The levels of serum ProGRP, CA242 and PCT in patients with CAG intestinal metaplasia are closely related to Hp infection. The combination of various indicators has high application value in the diagnosis of Hp infection.
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As of May 3, 2023, the Coronavirus disease 2019 (COVID-19) pandemic has resulted in more than 760 million confirmed cases and over 6.9 million deaths. Several patients have developed pneumonia, which can deteriorate into acute respiratory distress syndrome. The primary etiology may be attributed to cytokine storm, which is triggered by the excessive release of proinflammatory cytokines and subsequently leads to immune dysregulation. Considering that high levels of interleukin-6 (IL-6) have been detected in several highly pathogenic coronavirus-infected diseases, such as severe acute respiratory syndrome in 2002, the Middle East respiratory syndrome in 2012, and COVID-19, the IL-6 pathway has emerged as a key in the pathogenesis of this hyperinflammatory state. Thus, we review the history of cytokine storm and the process of targeting IL-6 signaling to elucidate the pivotal role played by tocilizumab in combating COVID-19.
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Humans , COVID-19 , Interleukin-6 , Cytokine Release Syndrome , SARS-CoV-2 , Cytokines , BiologyABSTRACT
Objective Nicotinamide phosphoribosyltransferase (Nampt) is a new therapeutic target for ischemic stroke. The aim of this study was to investigate protective effect of liver-derived Nampt on ischemic stroke. Methods Liver-specific Nampt knockout mice were generated using the Cre/loxP system. NamptloxP/loxP mice were crossed with liver-specific Cre recombinase expression mice (Alb-Cre), and the progeny genotypes were identified by polymerase chain reaction. Body weight of knockout mice and control mice were measured. Nampt in liver and brain was determined by Western blot assay. Middle cerebral artery occlusion (MCAO), a classical ischemic stroke model, was generated in liver-specific Nampt knockout mice and control mice by electrocoagulation. After 24 h of modeling, neurological deficit scores of each group were evaluated and TTC staining was performed to determine the cerebral infarction volume. The level of plasma Nampt in each group was determined by ELISA. Results Liver-specific Nampt knockout mice with the genotype of NamptloxP/loxPAlb-Cre were successfully constructed. The hepatic Nampt expression in knockout mice was significantly decreased by 74.2% compared to control mice, while there was no significant difference in the expression of brain Nampt protein between the knockout group and the control group. Specific knockout of liver Nampt gene expression had no effect on the body weight of mice. Under normal physiological conditions, there was no significant difference in plasma Nampt levels between liver-specific Nampt knockout mice and control mice of the same gender. 24 h after MCAO modeling, there were no significant differences in neurological deficit scores, cerebral infarct volume and plasma Nampt concentration between liver-specific Nampt knockout group and control group. Conclusion Liver-specific Nampt knockout mice are successfully constructed. Liver-derived Nampt has no significant protective effects on ischemic stroke.
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Objective To explore the expression of CRELD2 at the gene and protein levels of mouse tissues, and to provide a reference for studying the biological function of CRELD2 in various tissues. Methods The expression level of CRELD2 in the liver, pancreas, stomach, and lung of C57BL/6J mice was determined by real-time PCR and Western Blot. Results RT-PCR and WB showed that CRELD2 was expressed in mouse liver, pancreas, stomach, and lung. The relative expression levels of CRELD2 from high to low were pancreas, stomach, liver, and lung at the gene level, and pancreas, liver, stomach, and lung at protein level respectively. The result suggested that the relative expression levels of the CRELD2 gene and protein in different tissues were not completely consistent, suggesting that it is related to transcriptional regulation. Conclusion CRELD2 is expressed in mouse liver, pancreas, stomach, and lung, and the relative expression levels of CRELD2 are not completely parallel at the gene and protein level.
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Objective:To investigate the value of plasma Epstein-Barr virus (EBV) DNA detection in the screening of nasopharyngeal carcinoma (NPC) and its clinical application in non-high-risk areas.Methods:Plasma EBV DNA results in 1 153 newly diagnosed nasopharyngeal carcinoma patients who were treated in Sichuan Cancer Hospital from 2015 to 2020 and 244 healthy control cases with matched sex and age were retrospectively analyzed. EBV DNA were detected by quantitative real-time PCR. Positive rate of EBV DNA was determined by the cutoff value of 400 (≥400 copies/ml as positive) and optimization threshold method (presence of S amplification curve as positive). Further analyses were conducted to compare EBV DNA load in different clinical stage, TNM stage and regions distribution characteristics. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic value of the cutoff value of 400 and optimization threshold method for NPC.Results:Compared with healthy controls, EBV DNA increased significantly in newly diagnosed NPC patients ( P<0.001). Both evaluation methods revealed that the EBV DNA positive percentage increased with TNM and clinical stage ( P<0.001). With 400 copies/ml as cutoff value, the diagnostic sensitivity and specificity were 40.85% and 100%, respectively. The area under the curve was 0.704 (95% CI 0.676-0.733, P<0.001). Evaluated by the optimization threshold method, the sensitivity and specificity could improve to 82.0% and 99.2%, respectively, and the area under the curve reached 0.910 (95% CI 0.894-0.924, P<0.001). Conclusions:In the low prevalence area of nasopharyngeal carcinoma, the sensitivity for diagnosis of nasopharyngeal carcinoma is only 40.9% by the 400 copies/ml cutoff value method. The optimization threshold method is a better choice to improve the diagnostic sensitivity without lowering the diagnostic specificity.
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Objective:To investigate the risk factors for postoperative delirium in the elderly patients with hip fracture and to construct an online nomogram of the risk factors.Methods:Retrospectively analyzed were the data of 483 elderly patients with hip fracture who had been treated with artificial joint replacement from May 2020 to August 2021 at Department of Orthopaedics (Department of Joint Surgery), Jinling Hospital Affiliated to Medical College of Nanjing University. There were 166 males and 317 females, aged from 61 to 99 years (average, 82.1 years). Fracture types: 333 femoral neck fractures and 150 intertrochanteric fractures. The patients were divided into a delirium group ( n=149) and a delirium-free group ( n=334) according to whether postoperative delirium occurred after surgery. The 2 groups were compared in terms of general data like age, gender, body mass index, and concomitant diseases, as well as in terms of indexes like pre-operative albumin, preoperative hemoglobin, and postoperative C-reactive protein (CRP). Factors with P < 0.05 were included in the multi-factor logistic regression analysis to screen out the risk factors for postoperative delirium. The "rms" package of R software was used to draw the nomogram; the Bootstrap method was used to repeat the sampling 1,000 times for evaluation, calculation of the consistency index ( CI), and drawing of the ROC curve and correction curve; the decision curve was plotted using the "rmda" package. Results:There were significant differences between the delirium group and the delirium-free group in age, preoperative anxiety, Alzheimer＇s disease, history of cerebrovascular disease, preoperative albumin, intraoperative hypotension and postoperative CRP ( P < 0.05). The multifactorial logistic regression analysis showed that high age, preoperative anxiety, Alzheimer＇s disease, preoperative albumin < 35 g/L, and postoperative CRP ≥90 mg/L were the risk factors for postoperative delirium in the elderly patients with hip fracture after artificial joint replacement ( P < 0.05). The area under the ROC curve of the nomogram constructed by incorporating the risk factors for postoperative delirium was 0.894 (95% CI: 0.865 to 0.923) with a CI of 0.889; the calibration curve showed that the calibration curve of this nomogram model tended to be close to the ideal curve. The decision curve analysis showed that the threshold value was 0.01 to 1.00, showing the net benefit rate of this nomogram model > 0 when used to predict the postoperative delirium in the elderly patients with hip fracture. Conclusions:High age, preoperative anxiety, Alzheimer's disease, preoperative albumin < 35 g/L, and postoperative CRP ≥90 mg/L may be the risk factors for postoperative delirium in the elderly patients with hip fracture after artificial joint replacement. The online nomogram based on these factors demonstrates a good value in prediction of postoperative delirium.
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Tocilizumab has been reported to attenuate the "cytokine storm" in COVID-19 patients. We attempted to verify the effectiveness and safety of tocilizumab therapy in COVID-19 and identify patients most likely to benefit from this treatment. We conducted a randomized, controlled, open-label multicenter trial among COVID-19 patients. The patients were randomly assigned in a 1:1 ratio to receive either tocilizumab in addition to standard care or standard care alone. The cure rate, changes of oxygen saturation and interference, and inflammation biomarkers were observed. Thirty-three patients were randomized to the tocilizumab group, and 32 patients to the control group. The cure rate in the tocilizumab group was higher than that in the control group, but the difference was not statistically significant (94.12% vs. 87.10%, rate difference 95% CI-7.19%-21.23%, P = 0.4133). The improvement in hypoxia for the tocilizumab group was higher from day 4 onward and statistically significant from day 12 (P = 0.0359). In moderate disease patients with bilateral pulmonary lesions, the hypoxia ameliorated earlier after tocilizumab treatment, and less patients (1/12, 8.33%) needed an increase of inhaled oxygen concentration compared with the controls (4/6, 66.67%; rate difference 95% CI-99.17% to-17.50%, P = 0.0217). No severe adverse events occurred. More mild temporary adverse events were recorded in tocilizumab recipients (20/34, 58.82%) than the controls (4/31, 12.90%). Tocilizumab can improve hypoxia without unacceptable side effect profile and significant influences on the time virus load becomes negative. For patients with bilateral pulmonary lesions and elevated IL-6 levels, tocilizumab could be recommended to improve outcome.
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Humans , Antibodies, Monoclonal, Humanized , COVID-19/drug therapy , SARS-CoV-2 , Treatment OutcomeABSTRACT
Objective To study the effect of nicotinamide mononucleotide (NMN) on the mortality of the lipopoly-saccharide (LPS)-induced endotoxic shock mouse model. Methods 10-week-old C57BL/6J male mice were randomly divided into groups, and were injected intraperitoneally (i.p.) with LPS (10 mg/kg) to induce endotoxic shock models. NMN was i.p. injected in three ways: (1) 0.5 h after modeling, doses of 10, 30, 100 and 300 mg/kg; (2) 0.5 h before modeling, doses of 30, 100, 300 and 600 mg/kg; or (3) 0.5 and 12 h after modeling, dose of 300 mg/kg each time. The death times of each group were recorded, and the survival curves were drawn. Results Compared with the solvent control group, NMN at different doses given 0.5 h after or before modeling didn’t improve the survival rate or delay the death time of endotoxic shock mice; But when given at 0.5 and 12 h 300 mg/kg after modeling, NMN accelerated the death of mice and increased the mortality of mice. NMN products by two manufacturers showed similar effects. Conclusion NMN has no therapeutic effect on LPS-induced endotoxic shock, and repeated administration of NMN after endotoxic shock will increase the mortality.
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The insidious onset of cholangiocarcinoma and the lack of early diagnosis markers have made most patients diagnosed with cholangiocarcinoma in the advanced stage of the disease. At present, surgical treatment is the first choice for patients with cholangiocarcinoma, but surgery also faces problems such as high risks and many difficulties. Recent studies have found that long non-coding RNA (lncRNA) and circular RNA (circRNA) have the functions of regulating the cell proliferation, metastasis, invasion, epithelial-mesenchymal transition and drug resistance of cholangiocarcinoma. This article aims to review the potential regulatory role of lncRNA and circRNA in the occurrence and development of cholangiocarcinoma, in order to provide clinical references for the early diagnosis, targeted therapy and patient's prognosis evaluation of cholangiocarcinoma.
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Objective To compare the short-term surgical outcomes of robotic-assisted gastrectomy versus laparoscopic-assisted procedures for gastric cancer patients.Method From 2014 to 2018,108 robotic procedures and 263 laparoscopic surgery were done at the Department of Gastrointestinal Surgery Affiliated Hospital of Qingdao University.Results Compared with the laparoscopic group,the robotic group had longer operation time [(269 ± 32) min vs.(205 ± 30) min,t =18.314,P ＜0.05],less intraoperative blood loss [(94 ± 52) ml vs.(130 ± 32) ml,t =-8.212,P ＜ 0.05],lower conversion rate (2.9％ vs.8.7％,x2=4.184,P＜ 0.05),more lymph node dissection [(45±11) vs.(41±10),t=3.502,P＜ 0.05],earlier exhaust time [(59 ±8) hvs.(61 ±9) h,t=-2.396,P＜ 0.05],higher total hospitalization cost [(75 763 ±2 981) yuan vs.(52 746 ± 3 904) yuan,t =55.024,P ＜ 0.05].There were no significant differences in hospital stay [(6.6 ±0.9) d vs.(6.5 ± 1.1) d,t =0.618,P ＞0.05],the proximal margin [(5.7 ± 1.1) cm vs.(5.4 ± 1.2) cm,t =1.583,P ＞ 0.05] and distal tumor margin [(4.7 ± 2.1) cm vs.(4.9 ± 2.0) cm,t =0.848,P ＞ 0.05].There were no significant differences in the incidence of complications (13.9％ vs.15.2％,x2 =0.106,P ＞0.05)and grade by Clavien-Dindo operation complications (Z =-0.271,P ＞ 0.05) between the two groups.Conclusion Da Vinci robotic radical gastrectomy is safe,better than laparoscopic procedure in intraoperative manipulation.
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Objective To establish and optimize a mouse myocardial infarction (MI) model, and to use twice limb lead ECGs immediately after coronary ligation and 4 h after surgery to evaluate the occurrence of myocardial infarction. Methods Twenty-nine male C57BL/6J mice were anesthetized with isoflurane. then a myocardial infarction model was established by ligating the left anterior descending (LAD) coronary artery through the third/fourth intercostal space of left anterior chest. Immediate and 4 h postoperative limb lead ECGs were performed. Twenty-four hours after surgery, the chest was opened and the occurrence of myocardial infarction was evaluated. The heart samples were taken for TTC staining to determine the infarct area and calculate the infarct area. Results During the mice underwent coronary artery ligation the intraoperative mortality was 6.8% (2/29), and the early postoperative (<4 h) mortality was 10.3% (3/29). The 24 h survival rate was 82.8% (24/29). 24 hours after TTC staining confirmed the occurrence of infarction, the myocardial infarction model was established. The success rate of the model was 79.3% (23/29), and the average infarct size (infarcted myocardial weight / whole ventricular weight) was (28 ± 6)%; The mice successfully established by the model showed obvious ST-T changes in the ECG at 4 hours after surgery, suggesting that a myocardial infarction has occurred. Conclusions The mouse myocardial infarction model was successfully established. The combined use of ECG immediately after surgery and 4 h after surgery could be used as a rapid and non-invasive evaluation method for mouse myocardial infarction.
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Objective To investigate the effects of stage Ⅰ opening and stage Ⅱ opening of prophylactic ileostomy on postoperative recovery in low rectal cancer.Methods The prospective study was conducted.The clinical data of 88 patients with low rectal cancer who underwent laparoscopic rectal resection and prophylactic terminal ileostomy in the Affiliated Hospital of Qingdao University from September 2016 to May 2017 were collected.According to random number table,patients undergoing laparoscopic rectal resection combined with prophylactic ileostomy with stage Ⅱ opening were allocated into experimental group,and patients undergoing laparoscopic rectal resection combined with prophylactic ileostomy with stage Ⅱ opening were allocated into control group.Observation indicators:(1) comparison of postoperative clinical endpoints indices;(2) comparison of postoperative complications;(3) comparison of stress response indices.Follow-up was performed using outpatient examination and telephone interview to detect recovery of patients.The patients were followed up for the first time within 24 hours after discharge and kept in contact with the doctor at any time within 1 week after discharge.The patients were followed up at 2 weeks after discharge in outpatient department and then were followed up by telephone interview once a week within 1 month after operation.Patients returned to hospital if there was any discomfort after discharge,and were re-admitted if necessary.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the independent sample t test.Repeated measurement data were analyzed using repeated ANOVA.Count data were described as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test or Fisher exact propability.Results Eighty-eight patients were screened for eligibility,including 61 males and 27 females,aged from 44 to 74 years,with an average age of 61 years.There were 45 patients in the experimental group and 40 in the control group,respectively.(1) Comparison of postoperative clinical endpoints indices:the operation time,time to first semiliquid diet,postoperative fever time,quality of life score,duration of hospital stay,and total hospitalization expenses were (122± 9) minutes,(5.1 ± 1.6) days,(54 ± 8) hours,18.6 ± 1.5,(6.7 ± 1.2) days,(53 269 ± 2 888)yuan in the experimental group,and (128 ± 10) minutes,(6.4 ± 2.4) days,(65 ± 7) hours,17.1 ± 1.3,(8.1± 1.4)days,(59 419± 1 921)yuan in the control group,respectively.There was no significant difference in operation time or time to first semiliquid diet between the two groups (t=1.716,1.329,P＞0.05).There were significant differences in the postoperative fever time,quality of life score,duration of hospital stay,and total hospitalization expenses between the two groups (t =8.688,5.850,3.897,11.707,P＜0.05).(2) Comparison of postoperative complications:the incidence of ileostomy-related complications was 22.2％ (10/45) in the experimental group,including 5 cases of ileostomy edema,2 of fluid and electrolyte imbalance,2 of fecal dermatitis,1 of ileostomy infection;the incidence of ileostomy-related complications was 34.9％ (15/43) in the control group,including 4 cases of ileostomy edema,3 of fluid and electrolyte imbalance,4 of fecal dermatitis,2 of ileostomy infection,1 of ileostomy membrane separation,and 1 of ileostomy stenosis;there was no significant difference in the incidence of ileostomy-related complications between the two groups (x2 =1.733,P＞0.05).The incidence of system complications was 17.8％ (8/45) in the experimental group,including 2 case of acute urinary retention,2 of incisional infection,1 of abdominal infection,1 of pulmonary infection,1 of urinary infection,1 of deep venous thrombosis of the lower extremities;the incidence of system complications was 20.9％ (9/43) in the control group,including 1 case of acute urinary retention,1 of incisional infection,1 of intestinal obstruction,1 of pulmonary infection,1 of urinary infection,1 of deep venous thrombosis of the lower extremities,1 of anastomotic fistula;there was no significant difference in the incidence of system complications between the two groups (x2 =0.140,P＞0.05).There was no death in the two groups.Patients with postoperative anastomotic leakage in the experimental group were recovered and discharged after re-surgical exploration and continuous abdominal irrigation,and the remaining patients were discharged after active conservative treatment.(3) Comparison of stress response indices:from preoperation to postoperative 5 days,the C-reactive protein (CRP),tumor necrosis factorα (TNF-α),interleukin-6 (IL-6) were changed from (2.2±0.7)ng/L to (43.9±12.0) ng/L,from (12.2±1.9) fmmol/L to (11.3 ± 1.4) fmmoL/L,from (95 ± 17) ng/L to (107 ± 14) ng/L in the experimental group,and from (2.2±0.8) ng/L to (58.8±10.7) ng/L,from (11.6±1.6) fmmol/L to (12.7±1.3) fmmol/L,from (94± 16) ng/L to (117± 13)ng/L in the control group,respectively,showing significant differences in the changing trends of CRP,TNF-α,IL-6 between the two groups (F=260.042,55.428,120.337,P＜0.05).However,the changing trend within groups had interactive effects with time,showing no significant difference (F =3.514,2.366,1.864,P＞0.05).Conclusion Compared with stage Ⅱ opening,stage Ⅰ opening of prophylactic ileostomy in laparoscopic rectal resection for low rectal cancer is safe and effective,which can reduce postoperative stress response and promote patients' rehabilitation.
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Objective@#To investigate the effects of stage Ⅰ opening and stage Ⅱ opening of prophylactic ileostomy on postoperative recovery in low rectal cancer.@*Methods@#The prospective study was conducted. The clinical data of 88 patients with low rectal cancer who underwent laparoscopic rectal resection and prophylactic terminal ileostomy in the Affiliated Hospital of Qingdao University from September 2016 to May 2017 were collected. According to random number table, patients undergoing laparoscopic rectal resection combined with prophylactic ileostomy with stage I opening were allocated into experimental group, and patients undergoing laparoscopic rectal resection combined with prophylactic ileostomy with stage Ⅱ opening were allocated into control group. Observation indicators: (1) comparison of postoperative clinical endpoints indices; (2) comparison of postoperative complications; (3) comparison of stress response indices. Follow-up was performed using outpatient examination and telephone interview to detect recovery of patients. The patients were followed up for the first time within 24 hours after discharge and kept in contact with the doctor at any time within 1 week after discharge. The patients were followed up at 2 weeks after discharge in outpatient department and then were followed up by telephone interview once a week within 1 month after operation. Patients returned to hospital if there was any discomfort after discharge, and were re-admitted if necessary. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the independent sample t test. Repeated measurement data were analyzed using repeated ANOVA. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact propability.@*Results@#Eighty-eight patients were screened for eligibility, including 61 males and 27 females, aged from 44 to 74 years, with an average age of 61 years. There were 45 patients in the experimental group and 40 in the control group, respectively. (1) Comparison of postoperative clinical endpoints indices: the operation time, time to first semiliquid diet, postoperative fever time, quality of life score, duration of hospital stay, and total hospitalization expenses were (122±9)minutes, (5.1±1.6)days, (54±8)hours, 18.6±1.5, (6.7±1.2)days, (53 269±2 888)yuan in the experimental group, and (128±10)minutes, (6.4±2.4)days, (65±7)hours, 17.1±1.3, (8.1±1.4)days, (59 419±1 921)yuan in the control group, respectively. There was no significant difference in operation time or time to first semiliquid diet between the two groups (t=1.716, 1.329, P>0.05). There were significant differences in the postoperative fever time, quality of life score, duration of hospital stay, and total hospitalization expenses between the two groups (t=8.688, 5.850, 3.897, 11.707, P<0.05). (2) Comparison of postoperative complications: the incidence of ileostomy-related complications was 22.2%(10/45) in the experimental group, including 5 cases of ileostomy edema, 2 of fluid and electrolyte imbalance, 2 of fecal dermatitis, 1 of ileostomy infection; the incidence of ileostomy-related complications was 34.9%(15/43) in the control group, including 4 cases of ileostomy edema, 3 of fluid and electrolyte imbalance, 4 of fecal dermatitis, 2 of ileostomy infection, 1 of ileostomy membrane separation, and 1 of ileostomy stenosis; there was no significant difference in the incidence of ileostomy-related complications between the two groups (χ2=1.733, P>0.05). The incidence of system complications was 17.8%(8/45) in the experimental group, including 2 case of acute urinary retention, 2 of incisional infection, 1 of abdominal infection, 1 of pulmonary infection, 1 of urinary infection, 1 of deep venous thrombosis of the lower extremities; the incidence of system complications was 20.9%(9/43) in the control group, including 1 case of acute urinary retention, 1 of incisional infection, 1 of intestinal obstruction, 1 of pulmonary infection, 1 of urinary infection, 1 of deep venous thrombosis of the lower extremities, 1 of anastomotic fistula; there was no significant difference in the incidence of system complications between the two groups (χ2=0.140, P>0.05). There was no death in the two groups. Patients with postoperative anastomotic leakage in the experimental group were recovered and discharged after re-surgical exploration and continuous abdominal irrigation, and the remaining patients were discharged after active conservative treatment. (3) Comparison of stress response indices: from preoperation to postoperative 5 days, the C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) were changed from (2.2±0.7)ng/L to (43.9±12.0)ng/L, from (12.2±1.9)fmmol/L to (11.3±1.4)fmmol/L, from (95±17)ng/L to (107±14)ng/L in the experimental group, and from (2.2±0.8)ng/L to (58.8±10.7)ng/L, from (11.6±1.6)fmmol/L to (12.7±1.3)fmmol/L, from (94±16)ng/L to (117±13)ng/L in the control group, respectively, showing significant differences in the changing trends of CRP, TNF-α, IL-6 between the two groups (F=260.042, 55.428, 120.337, P<0.05). However, the changing trend within groups had interactive effects with time, showing no significant difference (F=3.514, 2.366, 1.864, P>0.05).@*Conclusion@#Compared with stage Ⅱ opening, stage Ⅰ opening of prophylactic ileostomy in laparoscopic rectal resection for low rectal cancer is safe and effective, which can reduce postoperative stress response and promote patients′ rehabilitation.
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Objective@#To examine the value and clinical application of convolutional neural network in pathological diagnosis of metastatic lymph nodes of gastric cancer.@*Methods@#Totally 124 patients with advanced gastric cancer who underwent radical gastrectomy plus D2 lymphadenectomy at Affiliated Hospital of Qingdao University from July 2016 to December 2018 were selected in the study. According to the chronological order, the first 80 cases were served as learning group. The remaining 44 cases were served as verification group. There were 45 males and 35 females in the study group, with average age of 57.6 years. There were 29 males and 15 females in the validation group, with average age of 9.2 years. The pre-training convolutional neural network architecture Resnet50 was trained and fine-tuned by 21 352 patches with cancer areas and 14 997 patches without cancer areas in the training group. A total of 78 whole-slide image served as a test dataset including positive (n=38) and negative (n=40) lymph nodes. The convolutional neural network computer-aided detection (CNN-CAD) system was used to analyze the ability of convolutional neural network system to screen metastatic lymph nodes at the level of slice by setting threshold, and evaluate the system′s classification accuracy by calculating its sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver operating characteristic curve (AUC).@*Results@#The classification accuracy of CNN-CAD system at slice level was 100%.The AUC for the CNN-CAD system was 0.89. The sensitivity was 0.778, specificity was 0.995, overall accuracy was 0.989. Positive and negative predictive values were 0.822 and 0.994, respectively. The CNN-CAD system achieved the same classification results as pathologists.@*Conclusions@#The CNN-CAD system has been constructed to distinguished benign and malignant lymph node slides with high accuracy and specificity. It could achieve the similar classification results as pathologists.
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Objective@#To investigate the expressional levels and diagnostic values of miR-18a and miR-21 in esophageal carcinoma.@*Methods@#The expressions of miR-18a and miR-21 in esophageal cancer tissues and adjacent tissues from 45 esophageal cancer patients, peripheral blood from 45 esophageal cancer patients and 50 healthy donors respectively were detected by RT-PCR. The expressions of miR-18a and miR-21 in normal esophageal epithelial cell HET-1A, esophageal cancer cell lines including ECA109, KYSE150 and TE1 were also detected. Chemiluminescence immunoassay was used to quantitatively detect the concentrations of carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC), CYRFA21-1 and TPA (tissue polypeptide antigen) in peripheral blood serum from esophageal cancer patients and healthy controls. Meanwhile, the diagnostic effects of miR-18a and miR-21 on esophageal cancer were compared with those of tumor markers in serum.@*Results@#The expression levels of miR-18a and miR-21 in esophageal cancer cells ECA109, KYSE150 and TE1 were 1.64±0.17, 1.62±0.19, 1.46±0.12 and 20.52±1.48, 6.73±0.73, 1.43±0.19, respectively, higher than those in normal esophageal epithelial cells (both P<0.01). The expressions of miR-18a and miR-21 in esophageal cancer tissues were 32.48±28.62 and 8.67±11.98, respectively, significantly higher than those in adjacent tissues (all P<0.001). The expression levels of miR-18a and miR-21 in peripheral blood of patients with esophageal cancer were 12.66±11.92 and 9.15±8.14, respectively, significantly higher than those in the normal control group (both P<0.001). The receiver operating characteristic (ROC) curve analysis showed that the area under the curve of miR-18a and miR-21 for diagnosis of esophageal cancer were 0.948 and 0.913 5, respectively. Compared with traditional esophageal tumor markers, the expressions of miR-18a and miR-21 were more sensitive in the diagnosis of esophageal cancer. The sensitivity and accuracy of the expressions of miR-18a and miR-21 combined with traditional esophageal tumor markers in diagnosis of esophageal cancer can be further improved to 97.8% and 68.4%, respectively.@*Conclusion@#Our study reveals that the expressions of miR-18a and miR-21 play important roles in the diagnosis of esophageal cancer and may be potentially novel biomarkers.
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Objective To investigate the expression level of protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) in serum of primary liver cancer patients with HBV infection and combined with alphafetoprotein (AFP) and AST/ALT ratio in the diagnosis of primary liver cancer with HBV infection.Methods Sera of 68 HBV infection patients with primary liver cancer were collected.Meanwhile, sera of 109 HBV infection patients (8 cases of gallbladder diseases, 94 cases of benign liver diseases, 7 csaes of other organ diseases) were collected as controls.The serum levels of PIVKA-Ⅱand AFP were detected by the method of chemiluminescent immunoassay and electrochemical luminescence respectively.The rate method was used to detect the content of AST and ALT, and the ratio of AST/ALT was calculated.Compared the expression level of tumor markers in each group, and the receiver operating characteristic (ROC) curve was applied to evaluate the diagnostic efficacy of individual and combined application of each index in the diagnosis of primary liver cancer.Results The sera levels of PIVKA-Ⅱ, AFP and AST/ALT ratio in primary liver cancer with HBV infection group were all higher than those in control group (P＜0.01).ROC curve analysis showed that with the critical value of PIVKA-Ⅱ, AFP and AST/ALT ratio in serum were 100.42 mAu/mL, 232.35 ng/mL and 1.571 in the diagnosis of primary liver cancer with HBV infection, the area under the ROC curve (AUC) were 0.942, 0.786 and 0.723 respectively;the sensitivity were 89.70％, 58.80％and 51.50％;the specificity were 91.70％, 88.10％and 79.80％.The AUC of PIVKA-Ⅱcombined with AST/ALT ratio in the diagnosis of primary liver cancer with HBV infection was 0.955, the sensitivity and specificity wree 86.80％and 93.40％respectively.Conclusion The value of PIVKA-II in the diagnosis of primary liver cancer with HBV infection is obviously better than that of AFP and AST/ALT ratio.The combined detection with AST/ALT ratio will be helpful to improve the diagnostic efficacy of primary liver cancer with HBV infection.
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OBJECTIVE@#To compare the effects of robotic and laparoscopic-assisted radical total gastrectomy on lymph node dissection and short-term outcomes in patients with Siewert type II adenocarcinoma of esophagogastric junction (AEG).@*METHODS@#Inclusion criteria: the tumor center was located between 2 cm above and below the esophagogastric junction and was confirmed as adenocarcinoma by endoscopic biopsy.@*EXCLUSION CRITERIA@#tumor with local invasion of the liver,spleen, pancreas or other organs; intraoperative finding of tumor dissemination or distant metastasis; patients undergoing palliative surgical treatment or preoperative neoadjuvant chemotherapy; patients with serious heart diseases, lung diseases, liver diseases, kidney diseases and other comorbidities; patients with multiple primary cancers;patients receiving emergency surgery. According to the above criteria, 82 patients with Siewert type II AEG who underwent gastrointestinal surgery at the Affiliated Hospital of Qingdao University from October 2014 to October 2018 were enrolled in the study. They were randomly divided into robotic surgery groups (41 cases) and laparoscopic group (41 cases) according to a computer-generated randomized allocation table. Both groups underwent radical total gastrectomy plus D2 lymph node dissection through the transabdominal esophageal hiatus approach. The intraoperative conditions and postoperative short-term outcomes were compared between two groups, including surgery time, intraoperative blood loss, length of esophagectomy, postoperative complications, postoperative gastrointestinal recovery time, length of hospital stay, postoperative unplanned reoperation rate and rehospitalization rate. Mean±SD is used for the measurement data that conforms to the normal distribution, and two independent sample t-tests are used to compare the two groups; the comparison of the count data is performed by the χ² test.@*RESULTS@#There were 35 males (85.4%) with age of (62.3±10.0) years and body mass index of (24.4±3.2) kg/m² in the robotic surgery group. There were 37 males (90.2%) with age of (62.5±10.0) years and body mass index of (23.8±2.6) kg/m² in the laparoscopic group. No significant differences in the baseline data between two groups were found (all P>0.05). All the patients of both groups completed R0 resection successfully without conversion to laparotomy or perioperative death. Compared with the laparoscopic group, the robotic group had less intraoperative blood loss [(70.7±39.9) ml vs. (110.2±70.6) ml, t=3.118, P=0.003], longer resected esophagus [(3.0±0.7) cm vs. (1.9±0.5) cm, t=8.759, P0.05). The highest lymph node metastasis rate was approximately 20% and observed in No.1, No.2, No.3, and No.7, followed by No.8a, No.9, No.11p, and No.110 with around 5%. The lymph node metastasis rate in other stations (No.4sa, No.4sb, No.4d, No.5, No.6, No.11d, No.12a, No.19, No.20 and No.111) was less than 5%.There were no significant differences in postoperative complication rate, postoperative fever time, postoperative exhaust and defecation time, fluid diet time, and postoperative hospital stay (all P>0.05). There were 2 patients(4.9%) with unplanned reoperation and 1 patient (2.4%) with unplanned re-admission in the laparoscopic group,while 3 patients (7.3%)with unplanned reoperation and 2 patients (4.9%)with unplanned re-admission in the robotic surgery group, whose differences were also not statistically significant (χ²=0.240,P=0.675;χ²=0.346,P=1.000).@*CONCLUSION@#Robot-assisted radical total gastrectomy for Siewert II AEG is safe and feasible, which is characterized by more sophisticated operation, less blood loss and higher quality of lymph node dissection, especially for subphrenic and inferior mediastinal lymph nodes.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Adenocarcinoma , Classification , Pathology , General Surgery , Esophageal Neoplasms , Classification , Pathology , General Surgery , Esophagectomy , Esophagogastric Junction , Pathology , General Surgery , Gastrectomy , Laparoscopy , Lymph Node Excision , Methods , Retrospective Studies , Robotic Surgical Procedures , Stomach Neoplasms , Classification , Pathology , General Surgery , Treatment OutcomeABSTRACT
OBJECTIVE: To explore the relationship between occupational stress and occupational musculoskeletal disorders( OMD) in coal miners. METHODS: A total of 362 coal miners were selected through cluster sampling method. The prevalence of OMD was investigated by the Nordic Standardized Questionnaires for Musculoskeletal Disorders( Chinese version). The Job Content Questionnaire and Effort Reward Imbalance Questionnaire were used to assess the occupational stress and depression of coal miners was determined by the Epidemiological Studies Depression Scale. RESULTS: The prevalence of OMD in coal miners was 63. 5%. There were 45. 9%( 166/362) of coal miners suffered from occupational stress with job demand-control model imbalance and 62. 4%( 226/362) of coal miners have occupational stress with effortreward model imbalance. The multiple logistic non-conditional regression analysis showed that the longer service length with exposure to occupational hazard factors,the more working days per week,the lower job contents and technical decisionmaking power,the higher the occupational stress with effort-reward imbalance,and the higher the depression and the higher the risk of OMD( P < 0. 05). CONCLUSION: Occupational stress and depression are both risk factors of OMD in coal miners.
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<p><b>OBJECTIVE</b>To evaluate the clinicopathological features and prognostic factors of carcinoma in the remnant stomach (CRS).</p><p><b>METHODS</b>Clinicopathological data of 217 consecutive CRS patients from January 2000 to March 2017 at Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University were retrospectively analyzed. CRS was defined as the primary cancer arising from the remnant stomach following gastrectomy, regardless of the initial disease or operation, and at no special time interval. The clinicopathological features and treatment were compared between CRS after benign disease operation (CRS-B) group and CRS after gastric cancer operation (CRS-C) group, and factors influencing prognosis were analyzed using Cox regression model analysis.</p><p><b>RESULTS</b>Of 217 patients, 189 were male and 28 were female with mean age of (60.9±11.2) years. The interval between the first and the second operations was (18.3±15.1) years. The CRS-B group comprised 108 patients and the CRS-C group comprised 109 patients. Compared to CRS-C group, CRS=B group had higher ratio of male [92.6% (100/108) vs. 81.7% (89/109), χ=5.779, P=0.016], longer interval [30(25-40) years vs. 4(1.5-8.0) years, Z=-1.685, P=0.000], longer tumor diameter [(5.9±3.2) cm vs. (3.9±2.4) cm, t=3.390, P=0.000] and later tumor stage [patients in stage I(, II(, III(, and IIII(: 6 (8.0%), 14 (18.7%), 41 (54.7%), and 14 (18.7%) vs. 16 (25.4%), 14 (22.2%), 21(33.3%), and 12(19.0%), respectively, Z=-2.018, P=0.044]. A total of 138 patients underwent surgery, including 118(85.5%) patients of curative resection and 20(14.5%) patients of palliative resection. The other 79 patients did not receive surgery due to extensive metastasis or miscellaneous reasons. Among 138 patients receiving surgery, 3 patients underwent endoscopic resection, 6 patients underwent minimally invasive surgery (laparoscopy or robot), and 129 patients underwent laparotomy. Forty-eight patients underwent surgery involving combined resection. The median postoperative hospital stay was 10(8-14) days. The incidence of postoperative complication was 23.2%(32/138). A total of 91 patients were followed up for 7-120 months, including 51 patients in CRS-B group and 40 in CRS-C group. The overall 1-, 3-, and 5-year survival rates of the 75 patients receiving curative resection were 80.7%, 55.1%, and 41.6%, respectively. The overall 1-, 3-, and 5-year survival rates were 73.5%, 48.3%, and 29.0% respectively in CRS-B group and 83.1%, 51.2%, and 32.5% respectively in CRS-C group. There was no significant difference between two groups (P=0.527). Multivariate analysis showed that age (RR=1.879, 95%CI: 1.015-3.479, P=0.045), radical procedure (RR=2.956, 95%CI: 1.421-6.150, P=0.004) and TNM stage (RR=1.570, 95%CI: 1.047-2.354, P=0.029) were independent prognostic factors for CRS.</p><p><b>CONCLUSIONS</b>As compared to the CRS-C group, the CRS-B group has higher percentage of male, longer interval, larger tumor diameter and later TNM stage. Radical resection indicates better prognosis.</p>