Effect of microvascular invasion on long-term prognosis of liver resection for multiple hepatocellular carcinomas / 医学研究生学报

ObjectiveOnly few studies have been published of the effect of microvascular invasion (MVI) on long-term prognosis of liver resection (LR) for multiple hepatocellular carcinomas (mHCCs). Therefore, we investigate the efficacy of MVI on long-term prognosis of the patients undergoing LR formHCCs.MethodsThe clinical data of 505 patients undergoing LR for mHCCs in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University between March 2009 and March 2015 were retrospectively analyzed. Patients were divided into the MVI(+) group （n=279）and MVI (-) group (n=226), and146 patients in MVI (+) group and 124 patients in MVI (-) group received adjuvant transarterial chemoembolization (TACE). The Kaplan-Meier approach was used for survival analysis and the Cox proportional-hazards regression model was used forthe risk factors of long-term survival rate.ResultsThe early recurrence rate of MVI (+) group was significantly higher than that of MVI (-) group (60.4% vs 40.5%, P<0.01), and the 1-, 3-, 5-year overall survival rate of MVI (+) group was significantly lower than those in MVI (-) group (70.5%, 47.4%, 33.4% vs 86.6%, 66.8%, 50.1%, P<0.05). Among MVI (+) patients, the early recurrence rate and 1-, 3-, 5-year overall survival rate in the adjuvant TACE group were better than those in the control group (early recurrence rate 41.3% vs 39.3%, P<0.05; 1, 3, 5 year overall survival rate 92.8%, 72.5%, 53.1% vs 78.6%, 59.5%, 47.3%, P<0.05). Multivariate Cox model indicated that the Alpha-foetoprotein (AFP) level, maximum tumor diameter/minimum tumor diameter, MVI and adjuvant TACE were independent risk factors for early recurrence (HR=1.48, 1.51, 1.34, 0.76, P<0.05); maximum tumor diameter, intraoperative blood transfusion, MVI and adjuvant TACE were independent risk factors for postoperative overall survival (HR=1.75, 1.75, 1.36, 0.68, P<0.05).ConclusionMVI is a risk factor for early recurrence and poor long-term prognosis after LR for mHCCs. For mHCCs with MVI, adjuvant TACE after LR could reduce the early recurrence rate and improve the long-term survival rate.

Investigation and analysis of cesarean section rate and indications in Shanghai / 中国实用妇科与产科杂志

OBJECTIVE:To study the current status of cesarean section rate(CSR)and cesarean section(CS)indications in Shanghai,and to provide basic evidence for reducing the rate of CS.METHODS:Six general and maternal and child hospi⁃tals(MCH)in Shanghai were selected,and all data of childbirth of these hospitals in 2016 were collected.The total CSR was calculated for all hospitals and the Chi-square tests were used to compare the CSR among different hospitals.The constitution of CS indications were reported by using the data collected from two out of the six hospitals.RESULTS:The to⁃tal CSR of all hospitals in this study was 47.88%(95% CI 47.30%-48.46%).The CSR in suburb an hospitals was signifi⁃cantly higher than that in outer suburbs and city center(51.72% vs. 50.54% vs. 43.24%,P<0.01),The CSR in secondary hospitals was significantly higher than that in tertiary hospitals(49.73% vs. 46.36%,P<0.01).The CSR in general hospi⁃tals was higher than that in MCH(54.54% vs. 43.81%,P<0.01).The CS without medical indications or for social reasons accounted for 25.15% of all CS,while the scar uterus(36.31%),maternal pregnancy-related complications(13.17%)and abnormal fetal head position(6.33%)were the three leading medical indications of CS.CONCLUSION:The CSR in Shang⁃hai is at a high level.There are significant differences in CSR among different hospitals.The scar uterine and social rea⁃sons are the leading causes of CS in Shanghai.

A new anastomosis method for choledochojejunostomy by the way behind antrue pyloricum / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Reflux cholangitis has been the most common complication after Roux-en-Y choledochojejunostomy. In this study we intended to evaluate the perioperative and long-term efficacy of a new anastomosis method for choledochojejunostomy.</p><p><b>METHODS</b>Clinical data of 143 eligible patients who underwent choledochojejunostomy in the Eastern Hepatobiliary Surgery Hospital affiliated to the Second Military Medical University, China between January 2007 and December 2010 were retrospectively analyzed. Among the patients, 38 consecutive cases underwent this new anastomosis method for choledochojejunostomy (improved group, IG) and 105 underwent standard Roux-en-Y choledochojejunostomy (control group, CG). Changes in the incidence of cholangitis, the time of beginning to eat liquid meals, post-operative delayed gastric emptying and liver function between the two groups were compared.</p><p><b>RESULTS</b>There was no statistical difference in the levels of alanine transaminase, alkaline phosphomonoesterase and gamma-glutamy transferase between the two groups. The time of beginning to eat liquid meals was significantly shorter in IG than CG (P < 0.05). The incidence of delayed gastric emptying was lower in IG than CG, with statistical tendency between the two groups (P = 0.052). Among nine patients with different degrees of acute cholangitis in the two groups, one patient (2.6%) in IG and eight (7.6%) in CG suffered from acute cholangitis within six months of follow-up after discharge, but with no statistical difference between the two groups (P > 0.05). Of the nine patients with acute cholangitis, none in IG and four in CG were hospitalized for further treatment (P > 0.05).</p><p><b>CONCLUSIONS</b>Patients in IG had satisfactory perioperative and long-term prognosis with shorter time of beginning to eat liquid meals and lower incidence of delayed gastric emptying. This new procedure of choledochojejunostomy by the way behind antrue pyloricum was easy and safe to perform with no mortality and low complication rates.</p>

Efficacy and safety of the thrombolytic therapy with urokinase after systemic-pulmonary shunt / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of thrombolytic therapy with urokinase after systemic-pulmonary shunt.</p><p><b>METHODS</b>Six patients who had thrombosis after systemic-pulmonary shunt were enrolled in this study. At the background of administration of the heparin at a dose of 0.2-0.3 U x kg(-1) min(-1), urokinase was intravenously administered with a loading dose of 15-20 U x kg(-1) x min(-1) and a locked time period of 30 minutes, and then the dose was incessantly decreased to 4-10 U x kg(-1) x min(-1). In addition to echocardiography (ECG), arterial partial pressure of oxygen/inspired oxygen fraction (PaO2/FiO2), fibrinogen, activated partial thromboplastin time, and prothrombin time were determined to assess the clinical efficacy and side effects.</p><p><b>RESULTS</b>The thrombolytic therapy with urokinase showed clinical effectiveness within 1 or 2 hours in all 6 patients. Efficiency of this therapy reached 100% during 12 to 24 hours. In 5 patients, the PaO2/FiO2 were over 50% higher than the early postoperative values. One patient received a second operation due to the excessively increased pulmonary blood flow. In 2 patients, pleural and mediastinal drainages increased when the thrombolytic therapy with urokinase began; however, they decreased after the urokinase dosages were adjusted.</p><p><b>CONCLUSION</b>It is feasible to use the thrombolytic therapy with proper dosage of urokinase after systemic-pulmonary shunt.</p>

Analysis of the relation between surgery and prognosis of hilar cholangiocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the prognosis factors of hilar cholangiocarcinoma, and investigate the relation between operative procedure and prognosis of it.</p><p><b>METHODS</b>A retrospective cohort study was investigated in 198 patients with hilar cholangiocarcinoma, who were treated in our hospital from December 1997 to December 2002. There were 117 males and 81 females. The age ranged from 27 to 81 years old with a mean of 56. Jaundice (94.5%), pruritus (56.6%) and abdominal pain (33.8%) were the main present symptoms. According to Bismuth-Corlette classification, there were 14 type I cases, 19 type II cases, 12 type IIIa cases, 15 type IIIb cases, 112 type IV cases and 26 unclassifiable cases. One hundred and forty four cases received open operative treatment, and the others only were treated with endoscopic approach (including ERBD or EMBE 21 cases, ENBD 31 cases) or percutaneous transhepatic cholangiodrainage (2 cases). Tumor resection was performed on 120 cases with a resection rate of 83.3%, included radical resection 59 cases (41.0%). Twenty-four cases underwent paunched biliary exploration and drainage.</p><p><b>RESULTS</b>The Cox's regression model analysis showed that occupation, preoperative maximum total serum bilirubin level, operative procedure and postoperative adjuvant radiation affected postoperative survival significantly, but gender, age, choledocholithiasis, hepatitis, preoperative serum CA19-9 level, Bismuth-Corlette type, histopathologic grading and postoperative chemotherapy were not significant prognostic factors. The postoperative survival of biliary drainage group, palliative resection group and radical resection group, which statistically differed pairwise. Between ERBD or EMBE group and palliative resection group, there was no statistical difference. So was between ERBD or EMBE group and biliary drainage group, or between ENBD group and biliary drainage group. The survival differed statistically between ERBD or EMBE group and ENBD group.</p><p><b>CONCLUSIONS</b>Operative procedure was the most important prognosic factor of hilar cholangiocarcinoma, radical resection still was the primary measure to cure and long term survival. For irresectable hilar cholangiocarcinoma, the effect of ERBD or EMBE could not be considered to be worse than that of open operative treatment.</p>

Prognostic analysis of patients suffering from distal bile duct cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To study prognostic factors after surgical procedure for distal bile duct cancer.</p><p><b>METHODS</b>A retrospective clinical analysis was made in 173 cases of distal bile duct cancer, admitted to our hospital from February 1996 to December 2002. Fourteen clinicopathologic factors that could possibly influence survival were selected. A multivariate analysis of these individuals was performed using the Cox Proportional Hazards Model.</p><p><b>RESULTS</b>There were 99 males and 74 females. The age ranged from 27 to 74 years old with a mean of 55.5. Radical resection was performed on 152 cases with radical resection rate of 87.9%. 29 cases died of liver metastasis with a rate of 46.8% in total death cases. The statistical analysis showed that surgical procedure, lymph node metastasis and pathological differentiation grade affected postoperative survival significantly, but transfusion, invasion of pancreas, postoperative radiotherapy and chemotherapy, ERCP, diameter of tumour, serum level of CA-19-9, preoperative total serum bilirubin level (TBIL), ratio of albumin to globulin (A/G), sex and age are not significant factors influencing postoperative survival.</p><p><b>CONCLUSIONS</b>Radical resection is only curative treatment modality. Aggressive treatment and prevention on postoperative liver metastasis is a important strategy to improve the survival for distal bile duct cancer.</p>

Comparative study on safety and immunogenicity between influenza subunit vaccine and split vaccine / 中华流行病学杂志

<p><b>OBJECTIVE</b>To compare the reactogenicity and serology between influenza subunit vaccine and split vaccine.</p><p><b>METHODS</b>A randomized, double-blind study was carried out among children (age 6 - 12 years) in order to compare the safety and immunogenicity of an influenza inactivated subunit vaccine (Agrippal, Chiron Vaccines) with that of a split vaccine (Flurix, GSK).</p><p><b>RESULTS</b>A total of 499 subjects were vaccinated and included in the safety analysis. A total of 249 subjects received Agrippal and 250 received Flurix. All subjects were kept under medical observation for 30 minutes in order to check the evidence of having any immediate local and systemic reaction. Daily observation records were collected during the 3-day follow-up after vaccination. 6.4% of the cases with fever >or= 37.5 degrees C was reported in the Flurix group, but 2.4% in Agrippal group which was significantly less than the former group (P > 0.05). Blood samples (the D0 pre- and D23 post-vaccination sera) were collected from 224 of Agrippal group and 223 of Flurix group and analysed by the haemagglutination inhibition (HI) assay. Agrippal and Flurix induced similar seroprotection (HI titer >or= 1:40, H1N1 99.6% vs 100.0%; H3N2 99.1% vs 99.1%) and seroconversion (4-fold increase, 95.1% vs 97.8%; H3N2 74.5% vs 79.8%) rates and geometric mean titer (GMT) increase (16.0 vs 21.0; 5.4 vs 6.4) against the two A subtypes. A similar seroprotection rate (94.2% vs 96.4%) and GMT increase (21.2 vs 18.2) against the influenza B strain were also noticed in both vaccines. No significant difference was found in the results of immunological assay between the two vaccines (P < 0.05). A lower seroconversion rate against B strain was observed in Agrippal group than in Flurix group (91.1% vs 97.3%).</p><p><b>CONCLUSION</b>In terms of safety, both vaccines were generally well tolerated. The fever reaction was less frequently seen in the Agrippal group. Both vaccines induced an effective immune response in the vaccines.</p>