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Intrahepatic cholangiocarcinoma (ICC) is a primary liver cancer with malignant biological behaviors and ranks only second to hepatocellular carcinoma in incidence rate, and in recent years, the incidence and mortality rates of ICC have been increasing significantly. Since ICC has significant different biological characteristics from hepatocellular carcinoma and extrahepatic cholangiocarcinoma, ICC lacks characteristic clinical symptoms and specific tumor markers and has strong invasion, a low surgical resection rate, and a tendency of recurrence and metastasis after surgery, which results in poor overall prognosis. With the development of molecular biology techniques and the accumulation of diagnosis and treatment experience, there is a gradually deepened understanding of the biological characteristics and clinical outcomes of ICC, and the corresponding surgical diagnosis and treatment strategies and technical means are undergoing profound transformation. At present, multidisciplinary comprehensive treatment, mainly surgery, is the mainstream paradigm for the treatment of ICC, and emphasis on R0 resection and regional lymph node dissection helps to improve clinical outcome and prognosis. However, there are still some problems for consideration on the way to the early diagnosis and the precise, standardized, and individualized treatment of ICC.
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Objective To explore the relationship between heart rate variability (HRV),heart rate turbulence (HRT) and blood pressure (BP) control in hypertensive patients.Methods Hypertensive patients with controlled BP group (n =50) and uncontrolled BP group (n =40) and control group non-hypertensive patients (n =52)were enrolled in this study in our hospital during June 2015 to June 2016.HRV and HRT as well as clinical characteristic of the three groups were analyzed.Results (1) Body mass index was significantly higher in the controlled BP group than in the control group.There was no statistical difference in proportions and categories of antihypertensive medication between the uncontrolled and controlled BP groups (P ＞ 0.05).(2) VLF,LF and TS were significantly lower in the uncontrolled BP group than the control group,and HF was significantly lower in the uncontrolled BP group than in the controlled BP group (P ＜ 0.05).(3) Results of muhiple logistic regression analysis showed that lower rMSSD,pNN50,VLF,LF,HF and TS were risk factors for BP control after adjusting for gender,age,EF value,creatinine,blood lipids,Beta-blockers and history of smoking,coronary heart disease and diabetes mellitus.(4) Spearman correlation analysis of the hypertensive patients showed that LF was negatively correlated with TO,and SDNN,SDANN,rMSSD,pNN50,VLF,LF,HF were positively correlated with TS.Conclusion The present results demonstrate that uncontrolled BP is associated with abnormal HRV and HRT,which suggested autonomous nervous imbalance was existed in uncontrolled hypertensive patients.
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Objective To study the difference between piperacillin-tazobactam and other anti-infective agents in the treatment of blood stream infection caused by extended spectrum beta-lactamase (ESBL )-producing Enterobacteriaceae by systematic review and meta-analysis . Methods PubMed , Cochrane library ,Web of Science , CNKI , Weipu DATA , and CPVIP were systematically searched . Literatures were reviewed and data regarding mortality of mono -drug treatment with different antibiotics were collected . All data were pooled using the technique of meta-analysis by Revman 5 .3 , and heterogeneity tests were performed .Results Eleven articles containing 1620 patients were included . Escherichia coli and K lebsiella pneumonia were the main pathogens ,and there were 31 cases caused by Enterobacter cloacae .There was no statistically significant difference in mortality between carbapenems and piperacillin-tazobactam mono-therapy for the empirical treatment (RR = 0 .86 ;95％ CI :0 .62 - 1 .20 , P> 0 .05) or for definitive treatment (RR = 0 .63 ;95％ CI :0 .20 - 1 .97 ,P > 0 .05) .Carbapenems were used as the main antibiotics for definitive treatment as well as empirical treatment . Conclusion Piperacillin-tazobactam treatment is not associated with increased mortality of the patients with ESBL -positive enterobacteria bloodstream infection ,which can be used as an alternative antibiotics .
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Objective To explore the relationship between blood glucose level and blood pressure variability in hypertensive patients. Methods A total of 125 hypertensive patients hospitalized in the department of cardiology in our hospital during May 2015 to October 2016 were retrospectively analyzed. Patients were divided into hypertension with diabetes mellitus group (n=59) and hypertension without diabetes mellitus groups (n=66). Data of blood pressure, blood pressure variability and blood glucose levels were analyzed in the two groups. Results (1) Hyperlipidemia, low density lipoprotein and cholesterol levels were significantly lower in the hypertension with diabetes mellitus group than those of hypertension without diabetes mellitus group. Level of glycosylated hemoglobin (HbA1c), 24 h diastolic pressure variability coefficient (24 hDBPCV), daytime systolic blood pressure variability coefficient (dSBPCV), and daytime diastolic pressure variability coefficient (dDBPCV) were significantly higher in the hypertension with diabetes mellitus group than those of hypertension without diabetes mellitus group (P<0.05). (2) Spearman correlation analysis showed that hypertension with diabetes mellitus was positively correlated with 24 hDBPCV, dSBPCV and dDBPCV. (3) ROC curves of HbA1c for diagnosis of non-dipper blood pressure in hypertensive patients showed that the cut-off value of HbA1c was 5.85%and the area under curve was 0.692 (P<0.05). The sensitivity was 71.1% and the specificity was 63.7%. Conclusion The present results demonstrate that blood pressure variability is increased in hypertension patients with higher blood glucose. HbA 1c level has potential clinical value for diagnosis of non-dipper blood pressure in hypertensive patients.
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Objective To investigate the relationship between acute biliary pancreatitis and pancreaticobiliary maljunction and the role of magnetic resonance cholangiopancreatography(MRCP) in evaluation of pancreatico biliary maljunction.Methods To compare the liver function indicators of different groups of acute biliary pancreatitis patients(153 cases) associated with pancreatico biliary maljunction and without pancreatico biliary maljunction before and after the conservative treatment.Results The 32 acute biliary pancreatitis patients with pancreatico biliary maljunction detected by MRCP were compared with the 121 cases without pancreatico biliary maljunction.The ALT,AST,GGT after conservative treatment in both group of pancreatico biliary maljunction and Npancreatico biliary maljunction were significantly decreased (P ＜ 0.05).ALT,AST and GGT of pancreatico biliary maljunction group were higher than that of Npancreatico biliary maljunction group with statistical significance (P ＜ 0.05).Conclusions MRCP as a noninvasive cholangiopancreatography study of pancreatico biliary maljunction is a safe and reliable examination method,pancreatico biliary maljunction is one of the important causes of acute biliary pancreatitis.
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The capacity to generate iaterleukin-2(IL-2)of,and autologous rosette forming cel-ls(ARFC)ratio of 46 cancer patients(29 nasopharygeal carcinoma,11 lymphoma and6 leukemia)were studied.A several important things have been found as follows:(1)There was a significant decrease in capacity of cancer patient peripheral blood mono-nuclear cells(PBMC)to generate IL-2 after being stimulated for 48 hr by PHA(18%,whencompared to controls;P0.05);(3)The cancer patient plasma could markedly inhibit IL-2 generation,but control plasmadid not.This result suggested that the patient plasma contain immunosuppressive fact-or(s)which can block IL-2 generation;(4)ARFC ratio in cancerpatients was greatlylower than that of controls(10% and 22% respectively;P