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Objective:To study the predictive value of combining ultrasound elestography with serological examination on incidences of microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC).Methods:The clinical data of 288 patients with HCC who underwent liver resection at MengChao Hepatobiliary Hospital of Fujian Medical University from January 2018 to September 2020 were retrospectively analyzed. 104 MVI-negative and 184 MVI-positive patients who were confirmed by postoperative histopathology were divided into the MVI-negative and MVI-positive groups respectively. Serological indicators of alanine aminotransferase, aspartate aminotransferase, platelet, albumin, and alpha-fetoprotein were compared between groups. Imaging indexes including elasticity at liver tumor surrounding 1 cm area (S1), elasticity at liver tumor surrounding 2 cm area (S2), S1S2index (S1/S2×10) and longest tumor diameter were compared between groups. Multi-variate analysis was used to screen out independent risk factors in predicting MVI of hepatocellular carcinoma, and then a nomogram model was constructed.Results:Of 288 patients with HCC who met the inclusion criteria of this study, there were 225 males and 63 females, aged (56.3±9.7) years. Multivariate logistic regression analysis revealed that patients with HCC who had multiple tumors ( OR=2.47, 95% CI: 1.41-4.33, P=0.002), long tumor diameter ( OR=1.21, 95% CI: 1.08-1.36, P=0.031), AFP>400 μg/L ( OR=2.83, 95% CI: 1.54-5.22, P=0.015), a high S1S2index ( OR=1.33, 95% CI: 1.17-1.51, P=0.025) had high incidences of MVI. The nomogram model constructed from these risk factors showed the risk of MVI in HCC patients with a mean absolute deviation of compliance between the predicted value and the true value being 0.021. The receiver operating characteristic (ROC) curve showed that the area under ROC curve of the nomogram model which predicted MVI of HCC patients was 0.777 (95% CI: 0.720-0.835). Conclusions:Multiple tumors, long tumor diameter, AFP>400 μg/L and a high S1S2 index were independent risk factors for MVI in HCC patients. The nomogram model established by these factors accurately predicted the risk of MVI and provided a reference for better choice of treatment.
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Objective To investigate the correlation and predictive value between contrast-enhanced ultrasonography (CEUS) and microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC).Methods Total of 233 (162 male,71 female) patients treated from July 2013 to September 2016 at the Mengchao Hepatobiliary Hospital of Fujian Medical University were enrolled in this research.The mean age ± SD was 55.1 ± 11.6 years.MVI was positive in 85 patients and negative in 148 patients.All patients underwent CEUS examination within one week before operation.A quantitative analysis software was used to analyze the size,shape and volume of the tumors.The difference in the volume of the tumors before and after CEUS,the peak intensity of the tumors and the washout time of the tumors were recorded.This study aimed to analyze the influencing factors of MVI in HCC patients,and the predictive value of MVI.Results Compared with the MVI negative group,the MVI positive group had larger tumor diameters,higher proportions of middle/low differentiation,irregular shapes and rapid clearance,shorter clearance time and a larger difference in tumor volume before and after angiography (P＜0.05).Multivariate logistic regression analysis after excluding collinearity showed that a large diameter of tumors,large difference in tumor volume before and after CEUS,and faster washout were influencing factors of MVI in HCC patients.The ROC curve was used to analyze the predictive value of tumor volume difference on MVI before and after angiography.The cut-off value was 2.195.The sensitivity,specificity,positive predictive value and negative predictive value were 0.682,0.696,67.9％ and 72.8％,respectively.Conclusion Large diameter of tumors,large difference in volume of tumors before and after CEUS,and fast washout time were influencing factors of MVI in HCC patients.A quantitative analysis of CEUS could predict the presence of MVI.
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Objective To investigate the value of CEUS quantitative analysis in diagnosis of different pathological stages of small hepatocellular carcinoma (HCC).Methods Data of 112 patients with HCC confirmed by surgical or biopsy were analyzed retrospectively.All the diameter of single tumor or the sum of the largest two lesions in multiple tumors were within 3 cm.Three groups were classified based on the Edmonson stage:High differentiation group (n=50,stage Ⅰ or Ⅱ),median differentiation group (n=30,stage Ⅲ),low differentiation group (n=32,stage Ⅳ).Qontraxt ultrasound imaging analysis software was utilized to measure CEUS parameters,including the maximum intensity of tumor (TMAX),nontumor's intensity (NT),maximum intensity of nontumor (NTMAX),appear time,time to peak,washout time,and the ratio of TMAX/NT and TMAX/NTMAX were calculated.The differences among the three groups was compared by statistics test.Results The values of TMAX,TMAX/NTMAX and washout time were statistically different among the three groups (all P＜0.05).The maximum values of TMAX,TMAX/NTMAX and the shortest washout time were found in the low differentiation group.And the minimum values of TMAX,TMAX/NTMAX and the longest washout time were found in the high differentiation group.There were no statistical differences of NT,NTMAX,TMAX/NT,appear time and time to peak among the three groups (all P＞0.05).Conclusion The quantitative parameters of CEUS is helpful in distinguishing different Edmonson stage of small HCC.
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Objective To research and discuss the scientificalness and effectiveness of professional core competence training in the operating theatre so as to seek for a way for the professional growth of operating room nurses.Methods Under the guidance of Guideline on Core Competence Building of Professional Nurses compiled by Department of Health of Guangdong Province in 2009,in accordance with the theory of core competence training and taking into account of different yearly salaries and levels of 21 nurses,we made respective plans and carried them out.Results After implementing professional core competence training,the rate of operating nurses' mastering basic knowledge and techniques reaches 92.50％,the rate of mastering professional knowledge and techniques reaches 86.25％,the ability of clinical thinking increases by 85％,the ability of education and research development increases by 78.50％,the ability of self-training raises by 98.20％,safe management raises by 91.50％,and the emergency ability raises by 93.60％.The analysis and compare are based on seven aspects,therefore are of statistical significance.Conclusion The training of the core competence in the operating theatre is practical,scientific and feasible in-service education which not only improves operating room nurses' abilities of clinical thinking and solving clinical nursing problems,but also provides career progress for operating room nurses.