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AIM:To investigate the changes of retinal microcirculation after phacoemulsification and the influencing factors of visual acuity.METHODS: Retrospective analysis. A total of 264 cataract patients(264 eyes)who underwent phacoemulsification in our hospital from January 2022 to December 2022 were selected as the study objects. Patients were divided into < 0.3 group(66 eyes)and ≥0.3 group(198 eyes)according to the recovery of best corrected visual acuity(BCVA)at 3 mo after surgery. The changes of retinal microcirculation indexes were compared before and after treatment. Logistic regression and LASSO regression models were used to screen the influencing factors of postoperative BCVA. A nomogram prediction model of postoperative BCVA was constructed and verified. A restricted cubic spline Logistic regression model was established to analyze the dose-response relationship between end-diastolic velocity(EDV), peak systolic velocity(PSV)and the risk of BCVA recovery.RESULTS: At 3 mo postoperatively, EDV and PSV were significantly improved compared with those before treatment, and resistance index(RI)levels were significantly lower than those before treatment(all P<0.05). Preoperative EDV, PSV, aqueous humor cell grade, fundus lesion grade, advanced age and Emery grade were influencing factors for poor BCVA recovery after phacoemulsification in cataract patients(P<0.05). The AUC before and after validation of the nomogram model by Bootstrap method were 0.869(95%CI: 0.815-0.903)and 0.866(95%CI: 0.802-0.895), respectively. The sensitivity was 88.36% and 88.27%, and the specificity was 91.82% and 91.78%, respectively. Restricted cubic spline model analysis showed no nonlinear dose-response relationship between EDV and PSV levels and the risk of poor BCVA recovery in either male or female(P>0.05).CONCLUSION: After phacoemulsification, retinal microcirculation in cataract patients improved significantly. EDV, PSV, aqueous humor cell grade, fundus lesion grade, advanced age and Emery grade are all factors influencing poor BCVA recovery after cataract surgery.
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Objective To summarize clinical experience of transabdominal pericardial anastomosis of suprahepatic vena cava of the donor and right atrium of the recipient in liver transplantation for Budd-Chiari syndrome (BCS) complicated with liver cancer. Methods Clinical data of a BCS patient complicated with liver cancer undergoing transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium in liver transplantation were retrospectively analyzed. Results The hepatic vein and suprahepatic vena cava were partially occluded in the patient. Liver transplantation was completed by transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium with beating-heart. In addition, due to pathological changes of the recipient's hepatic artery, splenic artery of the recipient was cut off, distal ligation was performed, and the proximal end was reversed and anastomosed with the common hepatic artery of the donor liver, and the reconstruction of hepatic artery was completed. The surgery was successfully performed. At approximately postoperative 1 week, the function of the liver allograft was gradually restored to normal, and no major complications occurred. The patient was discharged at postoperative 25 d. No signs of BCS recurrence was reported after 8-month follow-up. Conclusions It is safe and feasible to treat BCS by liver transplantation with transabdominal pericardial anastomosis of suprahepatic vena cava and right atrium. BCS patients complicated with liver cancer obtain favorable prognosis.
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Objective To evaluate the effect of different techniques of hepatic artery reconstruction on postoperative hepatic artery complications and clinical prognosis in liver transplantation. Methods Clinical data of 140 liver transplant recipients were retrospectively analyzed. All recipients were divided into the conventional hepatic artery reconstruction group (n=123) and special hepatic artery reconstruction group (n=17) according to hepatic artery reconstruction methods. Intraoperative and postoperative clinical indexes, the incidence of postoperative hepatic artery complications and survival rate were compared between two groups. Results The alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels at postoperative 1 d, total bilirubin (TB) at postoperative 7 d and prothrombin time international normalized ratio (PT-INR) at postoperative 30 d in special hepatic artery reconstruction group were higher than those in conventional hepatic artery reconstruction group, and the differences were statistically significant (all P < 0.05). There were no significant differences in the operation time, anhepatic phase, intraoperative blood loss, intraoperative transfusion volume of red blood cells, cold or warm ischemia time, the length of intensive care unit (ICU) stay, the length of hospital stay and postoperative blood flow of liver allograft between two groups (all P > 0.05). In the conventional hepatic artery reconstruction group, 5 recipients developed hepatic artery complications, whereas no hepatic artery complications occurred in the special hepatic artery reconstruction group, with no significant difference between two groups (P > 0.05). In the special hepatic artery reconstruction group, the 1-, 3- and 5-year cumulative survival rates were equally 82.4%, compared with 85.0%, 78.9% and 75.6% in the conventional hepatic artery reconstruction group, respectively. There was no significant difference between two groups (all P > 0.05). Conclusions When hepatic artery variations and (or) lesions are detected in donors and recipients, use of special hepatic artery reconstruction may effectively restore the hepatic arterial blood flow of liver allograft after liver transplantation, and will not affect the incidence of hepatic artery complications and survival rate of the recipients following liver transplantation.
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Objective:To investigate the clinical outcomes of patients with intrahepatic cholangiocarcinoma (ICC) undergoing surgical resection.Methods:Patients who undergoing radical surgical resection for ICC from Jan 2015 to Apr 2021 at the Department of General Surgery, the First Affiliated Hospital of Anhui Medical University were included in this retrospective cohort study.Results:There were 67 patients in the final analysis, The median follow-up duration was 14 months (range: 1-60 months). Firty three patients (79.1%) had tumor recurrence, 52 patients (77.6%) died, Among them, 49 patients (73.1%) died from tumor recurrence. The 1-、2-、and 3-year accumulated disease-free and overall survival rate were 35.6%, 19.6%, 16.8% and 53.7%, 32.4%, 20.8%. respectively. The overall survival rate of the group without microvascular invasion was significantly better than those of the group with microvascular invasion ( χ2=5.916, P=0.015). CA19-9≥1 000 U/ml was the only independent risk factor for the disease-free survival. CA19-9≥1 000 U/ml、blood loss≥600 ml、microvascular invasion and tumor recurrence were the independent risk factors for the overall survival. Conclusion:For ICC patients with single tumor, when the tumor diameter is less than 5 cm and has no microvascular invasion, surgical resection is recommended, and a satisfactory prognosis could be achieved.
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Objective:To observe the effect of early rehabilitation exercise on blood pressure of elderly patients with septic shock.Methods:A single-center, prospective, randomized controlled study was conducted in elderly patients with septic shock who were hospitalized in the department of critical care medicine of Huangshan Shoukang Hospital (High-tech Zone Central Hospital of Huangshan) from December 2018 to November 2020. According to the principle of simple random, all patients were divided into control group and intervention group. Both groups were treated with lower limb barometry to prevent deep vein thrombosis, 3 times a day, 30 minutes each time. After comprehensive treatment in the intensive care unit (ICU), the severity of patients was gradually improved, the hemodynamics was relatively stable, and the norepinephrine was reduced to 0.5 μg·kg -1·min -1. The control group continued to receive lower limb barometric treatment without rehabilitation training, while the intervention group began rehabilitation training when the dose of norepinephrine was reduced to 0.5 μg·kg -1·min -1. The duration of norepinephrine use, the length of ICU stay, and the occurrence of adverse events during rehabilitation training in intervention group was recorded. Results:Seventy-two patients were included in the final analysis, 35 in intervention group and 37 in control group. There was no significant difference in gender, age, Oxford acute severity of illness score (OASIS), acute physiology and chronic health evaluationⅡ (APACHEⅡ), mean arterial pressure (MAP) of 3 times and underlying diseases between two groups. Compared with control group, the length of ICU stay and duration of dose of norepinephrine ≤0.5 μg·kg -1·min -1 in intervention group were significantly shorter [length of ICU stay (hours): 193.0 (145.5, 312.0) vs. 242.5 (180.0, 483.5), P < 0.05; duration of dose of norepinephrine ≤0.5 μg·kg -1·min -1 (hours): 120.0 (72.0, 144.0) vs. 144.5 (120.0, 192.0), Z = 2.976, P = 0.003]. In intervention group, 35 patients did not show acute myocardial infarction, arrhythmia, syncope, central venous catheter detachment, and gastric tube detachment during the rehabilitation period, except 1 patient suffered from naked hematuria due to urinary catheter traction, which disappeared the next day after symptomatic treatment. Conclusion:The early rehabilitation exercise was beneficial to the recovery of autonomic blood pressure in elderly patients with septic shock, shorten the time of norepinephrine use and ICU stay.
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Objective To analyze the risk factors of multi-drug resistant organism (MDRO) infection after liver transplantation. Methods The clinical data of 77 recipients undergoing liver transplantation were retrospectively analyzed. According to the incidence of MDRO infection, all recipients were divided into the non-MDRO infection group (n=51) and MDRO infection group (n=26). The infection rate and strain distribution of MDRO in liver transplant recipients were summarized. The risk factors of MDRO infection in liver transplant recipients were identified. Clinical prognosis of all recipients was statistically compared between two groups. Results The infection rate of MDRO after liver transplantation was 34% (26/77), mainly carbapenem-resistant MDRO infection. The main sites of infection included lung, abdominal cavity and incision. Univariate analysis showed that postoperative tracheal intubation ≥48 h, length of intensive care unit (ICU) stay ≥72 h, length of hospital stay ≥30 d, re-operation, continuous renal replacement therapy (CRRT) and tacrolimus (Tac) blood concentration ≥15 ng/mL were the risk factors for MDRO infection after liver transplantation. Cox regression analysis indicated that postoperative tracheal intubation≥48 h, re-operation, CRRT and Tac blood concentration ≥15 ng/mL were the independent risk factors for MDRO infection after liver transplantation. The fatality in the MDRO infection group was significantly higher than that in the non-MDRO infection group [31%(8/26) vs. 10%(5/51), P=0.01]. Conclusions Postoperative tracheal intubation ≥48 h, re-operation, CRRT and Tac blood concentration ≥15 ng/mL may increase the risk of MDRO infection after liver transplantation and affect clinical prognosis of the recipients.
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Objective:To investigate the clinical value of outpatient screening in department of general surgery during the Corona Virus Disease 2019 (COVID-19) outbreak.Methods:The retrospective and descriptive study was conducted. The clinical data of 57 patients who visited surgery clinic and emergency department of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between February 1st and 26th in 2020 were collected. There were 30 males and 27 females, aged (53±16)years, with a range from 17 to 87 years. All the 57 patients were measured score of outpatient screening in department of general surgery. The score ≥3 indicated high risk and the score < 3 indicated low risk. Observation indicators: (1) clinical data of patients; (2) score of outpatient screening for COVID-19 of patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed by the t test. Measurement data with skewed distribution were described as M (IQR), and comparison between groups was analyzed by the rank sum test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Results:(1) Clinical data of patients: of the 57 patients, there were 12 males and 14 females of the 26 confirmed or suspected cases, versus 18 males and 13 females of the 31 non-infection cases, showing no significant difference between the two groups ( χ2=0.805, P>0.05). The 26 confirmed or suspected cases of COVID-19 had an age of (57±16)years, and 31 non-infection cases had an age of (50±16) years, with no significant difference between the two groups ( t=-1.646, P>0.05). (2) Score of outpatient screening for COVID-19 of patients: the score of outpatient screening for COVID-19 of the 26 confirmed or suspected cases was 3.0(4.0), versus 1.0(1.0) of the 31 non-infection cases, showing a significant difference between the two groups ( Z=-3.695, P<0.05). There were 17 and 9 of the 26 confirmed or suspected cases with high risks and low risks, respectively, versus 3 and 28 of the 31 non-infection cases, with a significant difference between the two groups ( χ2=19.266, P<0.05). Conclusion:During the COVID-19 outbreak, outpatient screening in department of general surgery can effectively screen out high-risk patients.
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Novel coronavirus pneumonia (NCP) is a highly infectious disease, has a long incubation period and a variety of clinical manifestations, which has a significant impact on public health and life. Afterwards, scientific and standardized work processing during the epidemic is of great significance for prevention and control. In order to implement the central government's decision-making deployment and defeat the NCP as soon as possible, we had focused on the key points in the clinical work of general surgery according to latest relevant guidelines, literature and experience in epidemic prevention. Finally, we drafted the prevention and control strategies and recommendations to make a reference for medical staff of general surgery to fight NCP.
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Liver transplantation is the only effective method to treat various end-stage liver diseases. The shortage of standard donor liver is the main factor limiting the development of liver transplantation, whereas the application of marginal donor liver has significantly expanded the source of donor liver. New technologies, such as extracorporeal membrane oxygenation (ECMO), mechanical perfusion and hypothermia, can significantly improve the quality of marginal donor liver, which has good development prospects in organ function maintenance. This article reviews the common types of marginal donor liver and the application of related novel technologies in the maintenance of marginal donor liver function.
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OBJECTIVE@#To investigate the functional pathways enriched and differentially expressed genes (DEGs) in peripheral blood mononuclear cells (PBMCs) of patients with gram-positive and gram-negative sepsis.@*METHODS@#Dataset GSE9960 obtained from NCBI GEO database containing PBMC samples from 16 non-infectious systematic inflammatory response syndrome (SIRS) patients, 17 gram-positive septic patients and 18 gram-negative septic patients were included in the study. Functional pathway annotations were conducted by gene set enrichment analysis and weighted gene co-expression network analysis. DEGs were filtered and master DEGs were then validated in PBMCs of gram-positive septic, gram-negative septic and non-infectious SIRS patients.@*RESULTS@#The enriched gene sets in gram-positive sepsis and gram-negative sepsis were significantly different. The results indicated the opposite co-expression networks in SIRS and gram-negative sepsis, and the entirely different co-expression networks in gram-positive and gram-negative sepsis. Furthermore, we validated that @*CONCLUSIONS@#The results indicate that there are differences in the mechanism and pathogenesis of gram-positive and gram-negative sepsis, which may provide potential markers for sepsis diagnosis and empirical antimicrobial therapy.
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Humans , Biomarkers/analysis , Gene Expression Profiling , Gram-Negative Bacterial Infections/physiopathology , Gram-Positive Bacterial Infections/physiopathology , Leukocytes, Mononuclear/pathology , Sepsis/physiopathologyABSTRACT
Objective:To investigate the clinicopathological characteristics of primary gastrointestinal stromal tumors (GIST) with PDGFRα mutation and analyze the prognosis of different subtypes.Methods:From Jun 2010 to Jun 2019, the clinicopathological data of 35 patients with primary PDGFRα mutation GIST, who underwent surgical therapy in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively.Results:The main symptoms was abdominal pain (28 cases, 80%), followed by abdominal mass (6 cases, 17%), and hemafecia (1 case, 3%). 31 primary lesions (89%) were located in the stomach and 4 (11%) in other than stomach. 13 cases (37%) were of epithelioid cells, 14 cases (40%) were of spindle cells and 8 cases (23%) were of mixed cells. 27 cases (77%) were CD117 positive , 28 cases (80%) CD34 positive , and 30 cases (86%) were DOG-1 positive. 19 cases (54%) had D842V mutation and 16 cases (46%) had non-D842V mutation. Complete surgical resection was performed in all patients, with no perioperative death. The 3-year recurrence-free survival rate of the D842V mutation group was lower than that of the non-D842V mutation group (84% vs. 100%, P=0.045). Conclusions:The mutation rate of PDGFRα gene was low, mostly derived from the stomach. PDGFRα mutation GIST presents inert biological behavior and the overall prognosis was good.
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Objective@#To analyze the consistency of gastroscopic biopsy in the diagnosis of high grade intraepithelial neoplasia(HGIN) and postoperative pathological diagnosis, and explore the risk factors associated with missed diagnosis of HGIN.@*Methods@#From January 2012 to December 2018, the clinical data of 63 patients who were diagnosed with HGIN by gastroscopic biopsy prior to operation and underwent complete resection in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively analyzed. There were 55 males and 8 females, with a median age of 60 (35 to 76) years old. The gender, age, endoscopic lesion shape, longest diameter, CT image and inflammatory markers were analyzed, to investigate the correlation between them and pathological upgrading after operation. Receiver operating characteristic (ROC) curve was drawn to analyze the cut off value of measurement data, and the comparison of count data was performed by chi-square test or Fisher exact probability method. Univariate analysis was used to screen potential risk factors, and multivariate logistic regression analysis was futher utilized to analyze the independent risk factors of postoperative pathological upgrading.@*Results@#A total of 63 patients were enrolled, including 47 cases underwent surgical resection and 16 cases underwent endoscopic submucosal dissection(ESD). Among them, 19 patients(30.2%) were pathologically diagnosed with HGIN, while 44 patients(69.8%) were pathologically diagnosed with invasive cancer after resection. Preoperative contrast-enhanced CT showed that 11 patients(17.5%) with perigastric fat spiculation around the lesion, all of which were confirmed as invasive carcinoma after operation. Univariate analysis showed that the longest diameter of the lesion ≥2 cm (P=0.002), ulcer lesions under gastroscopy (P=0.013), platelet to lymphocyte ratio (PLR) ≥103 (P=0.030), lymph node enlargement (P=0.046) and spiculation of the perigastric fat (P=0.025) were significant differences between the groups. Logistic regression analysis showed that the longest diameter of the lesion ≥2 cm (P=0.033) and ulcer lesions under gastroscopy (P=0.007) were independent risk factors for predicting postoperative pathological upgrading.@*Conclusions@#Gastroscopy biopsy in the diagnosis of high-grade intraepithelial neoplasia of the stomach has poor consistency with pathological diagnosis after operation. Clinicians should take active surgical intervention, especially for cases with the longest diameter of the lesions ≥2 cm, ulcer or perigastric fat spiculation on CT.
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Objective@#To investigate the morbidity and treatment of early postoperative complications after laparoscopic D2 radical gastrectomy for gastric cancer, and to explore the risk factors.@*Methods@#A case-control study was performed to retrospectively collect clinicopathological data of 764 patients undergoing laparoscopic D2 radical gastrectomy for gastric cancer at our department between January 2015 and December 2017. Patient inclusion criteria: (1) gastric cancer diagnosed by preoperative electronic gastroscopy and biopsy, and confirmed by postoperative pathology; (2) without invasion into adjacent organs by preoperative evaluation of tumors; (3) tumors without definite liver and distant metastasis; (4) R0 resection of gastric cancer and standard D2 lymph node dissection; (5) patients with informed consent. Exclusion criteria: (1) unperformed laparoscopic D2 radical resection; (2) other types of gastric tumor confirmed by pathology; (3) cases with incomplete clinical data. Complication occurring within two weeks after laparoscopic D2 gastrectomy was defined as early postoperative complication. Patients were divided into two groups: non-complication group (693 cases) and complication group (71 cases) according to the occurrence of complications after operation. The clinicopathological data of two groups were analyzed and compared with t test and χ2 test, and the factors of P < 0.2 were included in the multivariate logistic regression model to analyze the risk factors of postoperative complications.@*Results@#Of 764 patients, 71 (9.3%) developed early postoperative complications, with median onset time of 3 (1 to 11) days. Surgical complications accounted for 7.9% (60/764), including 13 cases (1.7%) of abdominal hemorrhage, 12 cases (1.6%) of anastomotic leakage, 10 cases (1.3%) of incision infection, 8 cases (1.0%) of anastomotic bleeding, 7 cases (0.9%) of gastric stump weakness, 4 cases (0.5%) of abdominal infection, 4 cases (0.5%) of duodenal stump leakage and 2 cases (0.3%) of small intestinal obstruction. Non-surgical complications accounted for 1.4% (11/764), including 6 cases (0.8%) of pulmonary infection and 5 cases (0.7%) of cardiovascular disease. Two cases (0.3%) died of sepsis caused by severe abdominal infection; 9 cases (1.2%) recovered after receiving the second operation, among whom 5 cases were abdominal hemorrhage, 2 cases were anastomotic leakage and 2 cases were duodenal stump leakage; the remaining patients were healed with conservative treatment. Compared with patients without complications, patients with complications had higher proportions of BMI ≥24 kg/m2 [42.3% (30/71) vs. 24.2%(168/693), χ2=10.881, P=0.001], comorbity [64.8% (46/71) vs. 33.5% (232/693), χ2=27.277, P<0.001], combined organ resection [70.4% (50/71) vs. 20.5% (142/693), χ2=85.338, P<0.001], and pTNM stage of III [70.4% (50/71) vs. 40.1% (278/693), χ2=24.196, P<0.001], meanwhile had longer time to postoperative flatus [(4.2±2.1) days vs. (2.9±1.2) days, t=4.621, P=0.023], longer hospital stay [(34.6±12.6) days vs. (14.2±6.2) days, t=9.862, P<0.001] and higher hospitalization cost [(126.8±64.5) thousand yuan vs. (85.2±35.8) thousand yuan, t=11.235, P<0.001]. Multivariate analysis showed that BMI ≥24 kg/m2 (OR=3.762, 95% CI: 1.960-8.783, P=0.035), accompanying disease (OR=8.620, 95% CI: 1.862-29.752, P<0.001), combined organ resection (OR=6.210, 95% CI: 1.357-21.568, P=0.026), and pTNM stage (OR=4.752, 95% CI: 1.214-12.658, P<0.001) were the independent risk factors of postoperative complications.@*Conclusions@#Laparoscopic D2 radical gastrectomy is a safe and effective approach for gastric cancer. Most early postoperative complications can obtain satisfactory efficacy after conservative treatment. Perioperative management should be strengthened for those patients with high BMI, accompanying diseases, combined organ resection, and advanced pTNM stage.
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Objective@#To investigate the efficacy and feasibility of laparoscopic resection for gastric gastrointestinal stromal tumor (GIST) in unfavorable location by comparing with open surgery.@*Methods@#Clinicopathological and follow-up data of 176 patients with gastric GIST in unfavorable location admitted at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to December 2017 were analyzed retrospectively. There were 94 males and 82 females, aging of (57.4±12.7) years (range: 20-90 years). Of the 176 patients, 64 underwent laparoscopic surgery (laparoscopic group) and 112 underwent open surgery (open group). One-to-one propensity score matching (PSM) was performed to balance the covariance between laparoscopic group and open surgery group. Before PSM, the differences between the two group in tumor size and modified National Institutes of Health risk classification were significant. After PSM, there were 63 pairs (63 cases in laparoscopic group and 63 cases in open group) and the baseline characteristics were comparable between the two groups(P>0.05). The difference of short-term outcome between the two groups were compared using t test, χ2 test or Wilcoxon rank-sum test. The survival curve was established by Kaplan-Meier method and the Log-rank test was used to compare the survival of the two groups.@*Results@#The operation time of laparoscopic group was shorter ((141.6±100.6) minutes vs. (100.4±67.7) minutes, t=2.681, P=0.008), the hospitalization cost was higher ((5.2±0.7) ten thousand yuan vs. (4.2±0.8) ten thousand yuan, t=7.357, P=0.000) than open group. The time to first flatus ((49.1±8.2) hours vs. (71.0±4.6) hours, t=-18.482, P=0.000) and preoperative hospital stay ((10.3±6.0) days vs. (14.8±7.6) days, t=-3.717, P=0.000) was shorter in laparoscopic group. With a median follow-up time of 44 months (range: 10 to 154 months), the 1-, 3-, 5-year relapse-free survival rates in the laparoscopic group and open group were 98.3%, 92.1%, 92.1% and 100%, 86.3%, 83.2%, respectively (χ2=0.696, P=0.404). The 1-, 3-, 5-year overall survival rates in the laparoscopic group and open group were 96.6%, 94.7%, 94.7% and 100%, 91.1%, 81.4%, respectively (χ2=0.366, P=0.545).@*Conclusions@#In experienced medical centers, laparoscopic resection is safe and feasible for GIST in unfavorable location. Compared to open surgery, laparoscopic resection achieves a faster postoperative recovery and a similar long-term prognosis.
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Objective To explore the clinical prognosis and efficacy of adjuvant therapy with imatinib of postoperative patients with gastric intermediate-risk gastrointestinal stromal tumor (GIST).Methods The clinicopathological data and follow-up data of 93 gastric intermediate-risk GIST cases from Jan 2005 to Dec 2016 at Union Hospital were analyzed retrospectively.Univariate and multivariate analysis were performed to assess the prognostic factors.Results There were 93 patients undergoing complete GIST resection with 42(45％) cases receiving post-op imatinib 400 mg/d for targeted therapy.The median target therapy period was 12 (6-72) months.86％ (80 cases) patients were followed up for 46 (6-120) months.The 1-,3-,5-year recurrence-free survival rate (RFS) of the whole group were 100％,91.5％,88.5％ respectively.Multivariate analysis revealed that mitotic count (P =0.040,RR =6.078,95％ CI:0.541-68.274) and neutrophil-lymphocyte ratio (NLR) (P =0.036,RR =6.102,95％ CI:0.782-47.632) were prognostic risk factors of RFS.For those mitotic count ＞ 2/50 HPF and NLR ＞ 2.3,adjuvant therapy with imatinib significantly increases RFS.Conclusion Mitotic count and NLR were independent risk factors of RFS in gastric intermediate-risk GIST.For those with mitotic count ＞ 2/50 HPF and NLR ＞ 2.3,postoperative adjuvant therapy with imatinib helps improve the prognosis.
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Objective To summarize the experience of complex hepatic artery reconstruction in orthotopic liver transplantation. Methods Clinical data of 7 liver transplantation recipients who underwent complex hepatic artery reconstruction from January 2015 to March 2019 were retrospectively analyzed. Among them, 4 recipients received classical liver transplantation and 3 cases underwent piggyback liver transplantation. Intraoperative general conditions including anhepatic phase, intraoperative blood loss, hepatic artery anastomosis time and operation time of the recipients were recorded. The clinical prognosis and complications were observed. Results In two donors, variant right hepatic artery was used for vascular reconstruction. The celiac trunk or the common hepatic artery of the donors was anastomosed with the common hepatic artery of the recipients. Iliac artery bypass was employed in 2 cases, and then the hepatic artery of the donors was anastomosed with the abdominal aorta of the recipients. The superior mesenteric artery of 1 donor was end-to-end anastomosed with the common hepatic artery of the recipient. The celiac trunk of 1 donor was anastomosed with the splenic artery of the recipient. Only 1 case was required to undergo secondary liver transplantation due to acute hepatic artery thrombosis after hepatic artery anastomosis. All the 6 recipients successfully completed the liver transplantation. No perioperative death was observed. The anhepatic phase endured from 49 to 77 min. The intraoperative blood loss was ranged from 300 to 1 500 mL. The anastomosis time of hepatic artery was 23-56 min. The operation time was ranged from 5.3 to 11.1 h. The length of postoperative hospital stay was 23-56 d. Neither hepatic artery thrombosis nor stenosis occurred. The liver function of all recipients was basically restored to normal within postoperative 2 weeks. No severe surgical complications occurred. The liver graft achieved excellent function. Conclusions Appropriate identification of the hepatic artery variation, proper management of liver artery of the donors and recipients and reconstructing the blood supply of liver graft are the crucial procedures of liver transplantation.
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Objective To analyze the consistency of gastroscopic biopsy in the diagnosis of high grade intraepithelial neoplasia (HGIN) and postoperative pathological diagnosis,and explore the risk factors associated with missed diagnosis of HGIN.Methods From January 2012 to December 2018,the clinical data of 63 patients who were diagnosed with HGIN by gastroscopic biopsy prior to operation and underwent complete resection in the Union Hospital,Tongji Medical College,Huazhong University of Science and Technology were retrospectively analyzed.There were 55 males and 8 females,with a median age of 60 (35 to 76) years old.The gender,age,endoscopic lesion shape,longest diameter,CT image and inflammatory markers were analyzed,to investigate the correlation between them and pathological upgrading after operation.Receiver operating characteristic (ROC) curve was drawn to analyze the cut off value of measurement data,and the comparison of count data was performed by chisquare test or Fisher exact probability method.Univariate analysis was used to screen potential risk factors,and multivariate logistic regression analysis was futher utilized to analyze the independent risk factors of postoperative pathological upgrading.Results A total of 63 patients were enrolled,including 47 cases underwent surgical resection and 16 cases underwent endoscopic submucosal dissection(ESD).Among them,19 patients(30.2％) were pathologically diagnosed with HGIN,while 44 patients(69.8％) were pathologically diagnosed with invasive cancer after resection.Preoperative contrast-enhanced CT showed that 11 patients (17.5％) with perigastric fat spiculation around the lesion,all of which were confirmed as invasive carcinoma after operation.Univariate analysis showed that the longest diameter of the lesion ≥2 cm (P =0.002),ulcer lesions under gastroscopy (P =0.013),platelet to lymphocyte ratio (PLR) ≥ 103 (P =0.030),lymph node enlargement (P =0.046) and spiculation of the perigastric fat (P =0.025) were significant differences between the groups.Logistic regression analysis showed that the longest diameter of the lesion ≥2 cm (P =0.033) and ulcer lesions under gastroscopy (P =0.007) were independent risk factors for predicting postoperative pathological upgrading.Conclusions Gastroscopy biopsy in the diagnosis of high-grade intraepithelial neoplasia of the stomach has poor consistency with pathological diagnosis after operation.Clinicians should take active surgical intervention,especially for cases with the longest diameter of the lesions ≥2 cm,ulcer or perigastric fat spiculation on CT.
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Objective To investigate the clinical efficacy and safety of domestic imatinib in the treatment of gastrointestinal stromal tumor (GIST). Methods Clinicopathological and follow-up data of GIST patients who received domestic imatinib treatment from January 2014 to December 2017 in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were analyzed retrospectively. The treatment efficacy and adverse reactions were analyzed. Results A total of 35 patients included 20 males and 15 females with a median age of 53 years old (28-79 years old). Among all the patients, 25 with primary GIST underwent complete resection, in which 20 cases were classified as high risk and 5 as moderate risk according to the risk stratification. Of the remaining 10 recurrent/metastatic or unresectable GIST patients, 6 cases had metastasis in liver, 2 cases had metastasis in peritoneum, 1 case had extensive abdominal and pelvic metastasis, and the other 1 case was initially unresectable. The follow-up data of all the 35 patients were available, with a median follow-up time of 25 months (4-49 months). Twenty-five primary patients with complete resection received adjuvant therapy with a median time of 14 months (4-44 months). The median time of follow-up was 25 months (4-49 months), and none of the primary patients was detected with recurrence or metastasis of GIST. Meanwhile, of the 10 patients with recurrent/metastatic or unresectableGIST, the median time of medicine-taking was 24 months (3-49 months). Seven of 10 patients received imatinib monotherapy, including 5 cases of partial remission and 2 cases of stable disease. The other 3 patients with localized progression received complete resection along with imatinib therapy. All the 10 patients achieved durable clinical benefit. Twenty-seven patients (77.1％) experienced adverse events, and only 1 case (2.9 ％) had grade 3 adverse events. Conclusion Domestic imatinib is effective and safe for patients who received adjuvant therapy after complete resection of primary GIST as well as those with recurrent/metastatic or unresectable GIST, but it remains to be further confirmed by large samples of prospective studies.
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As one of the most common bariatric surgeries performed in clinics,vertical sleeve gastrectomy (VSG) is highly efficient for treating morbid obesity and diabetes,with its underlying mechanisms elusive and controversial.More and more studies regard obesity and diabetes as a kind of gastrointestinal disease.Moreover,the fact that gastrointestinal tract is the direct target of bariatric procedures potentially makes it a key player in weight loss and blood glucose control after surgery.From this aspect,authors thus discuss the molecular mechanisms of VSG for treating type 2 diabetes mellitus in this review.
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Objective To investigate the clinical characteristics,treatment strategies and curative effect of recurrence and metastasis of primary gastrointestinal stromal tumor (GIST) after complete resection along with adjuvant therapy with imatinib,and to analyze the risk factors of recurrence and metastasis after adjuvant therapy.Methods The demographic data,clinicopathological characteristics and follow-up data of 80 primary GIST patients who received adjuvant therapy with imatinib for at least 1-year duration and had already stopped taking imatinib from January 2005 to December 2017 in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology were analyzed retrospectively.The survival analysis was performed using Kaplan-Meier approach.Univariate analysis was conducted using log-rank test.Multivariate analysis was produced by Cox regression model.Results Of the enrolled 80 patients,recurrence and metastasis were detected in 17 cases after completion of postoperative adjuvant therapy with imatinib,with a median recurrence time of 12 months.All the 17 patients showed no specific clinical manifestations.Liver metastasis,peritoneum metastasis and local recurrence were found in 9,5 and 3 cases,respectively.In the 17 patients with recurrence and metastasis,9 patients received imatinib monotherapy.Among the 9 patients,6 achieved partial responses,while 3 demonstrated stable disease,and secondary drug resistance was found in 7 patients during the follow-up period,with a median progression-free survival of 35 months (95％ CI:15-55 months) and median overall survival of 49 months (95％ CI:30-68 months).A total of 7 patients with recurrence and metastasis were treated with imatinib after operation and achieved satisfying tumor control,and secondary drug resistance was found in 4 patients during the follow-up period,with a median progression-free survival of 31 months (95％ CI:6-56 months) and fell short of median overall survival.The remaining 1 patient gave up treatment.Univariate analysis showed that tumor location (x2 =4.120,P =0.042),preoperative neutrophil-to-lymphocyte ratio (NLR) (x2 =7.513,P =0.006) and preoperative platelet-to-lymphocyte ratio (PLR) (x2 =6.575,P =0.010) were associated with recurrence and metastasis of GIST patients after completion of adjuvant therapy.Multivariate analysis revealed that tumor location (HR =3.787,95％ CI:1.126-12.732,x2 =4.631,P =0.031) was an independent prognostic factor for those patients.Conclusion GIST patients who are identified recurrence and metastasis after completion of adjuvant imatinib treatment show no specific clinical manifestations after stopping andjuvant therapy with imatinib.Compared with gastric GIST,non-gastric origin GIST has a higher risk of recurrence.Imatinib monotherapy and surgery combined with imatinib therapy are both effective in treating this subgroup of patients.