ABSTRACT
Hepatocellular carcinoma (HCC) has an insidious onset, and most patients are in the advanced stage when attending the hospital and thus lose the opportunity for radical surgical resection, which results in the poor prognosis of patients. With the development of clinical treatment, the treatment of advanced HCC has gradually transitioned from the relatively single and limited treatment options in the past to the new model of comprehensive treatment. In recent years, immunotherapy, represented by immune checkpoint inhibitors (ICIs), has become widely used in clinical practice. At present, a number of clinical studies have been conducted for immunotherapy combined with local and targeted antitumor therapy, and in particular, ICIs combined with targeted therapy have become a research hotspot in the field of HCC treatment. This article reviews the research advances in immunotherapy for the treatment of HCC.
ABSTRACT
Objective:To analyze the long-term prognosis and prognostic factors of allergic bronchopulmonary aspergillosis(ABPA) in children suffering from cystic fibrosis (CF).Methods:An observational study was performed.All children who were admitted to the Department of Respiratory, Beijing Children′s Hospital, Capital Medical University from August 2014 to June 2018, with more than 2 years of followed up for the diagnosis of CF accompanied by ABPA were involved.Results:Three children met the inclusion criteria, with 2 boys and 1 girl, and their diagnostic age were 14, 8 and 9 years old, respectively.The follow-up duration ranged from 2 to 6 years.All the 3 cases were treated with systemic corticosteroids and antifungal agent.In case 1, the initial dose of prednisone was 0.75 mg/(kg·d), and the course of treatment was more than 5 years.The corticosteroid-dependent patient suffered from expectoration and chest pain, and radiographic findings indicated exacerbation, while his lung function was normal.Treating with initial dose of prednisone 2 mg/(kg·d) for 9 months, case 2 had normal serum immunoglobulin E(IgE) concentration, but his pulmonary artery was infiltrated by lesions, thus leasing to lobectomy.In case 3, the initial dose of prednisone was 0.6 mg/(kg·d), and the course of treatment was 18 months.And she developed persistent hypoxemia, and decreased pulmonary function, so lung transplantation was necessary 2 years after diagnosis.Conclusions:Systemic glucocorticoid combined with antifungal therapy is the main treatment for CF with ABPA, but there are individual differences in the efficacy.The level of serum total IgE is not always consistent with lung function and chest images.The overall prognosis is poor, and it is infeasible to evaluate the prognosis by single factor.
ABSTRACT
Objective To establish a nomogram for predicting the risk of post-hepatectomy complications (PHC) in hepatic echinococcosis by analyzing the risk factors for PHC in two types of hepatic echinococcosis, and to investigate its value in clinical practice. Methods A retrospective analysis was performed for the clinical data of 263 patients with two types of hepatic echinococcosis who underwent hepatectomy in Qinghai University Affiliated Hospital from January 2015 to August 2020, and among these patients, 93 were enrolled as PHC group and 170 were enrolled as control group. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the independent samples t -test was used for comparison of normally distributed continuous data between two groups; the chi-square test and the Fisher's exact test were used for comparison of categorical data between two groups. Univariate and multivariate logistic regression analyses were used to screen out independent risk factors for PHC, and a nomogram risk prediction model was established based on the weight of each independent risk factor. The Bootstrap resampling method was used for internal verification of the model; the receiver operating characteristic (ROC) curve was plotted to evaluate the discriminatory ability of the model; calibration curve and the Hosmer-Lemeshow test were used to evaluate the consistency of the model; decision curve analysis (DCA) was performed to verify the clinical effectiveness of the model. Results Albumin-bilirubin (ALBI) score (odds ratio [ OR ]=3.694, 95% confidence interval [ CI ]: 1.860-7.336, P < 0.05), time of operation ( OR =2.848, 95%CI: 1.384-5.859, P < 0.05), intraoperative blood loss ( OR =4.832, 95%CI: 2.384-9.793, P < 0.05), and hydatid diameter ( OR =3.073, 95%CI: 1.528-6.177, P < 0.05) were independent risk factors for PHC in two types of hepatic echinococcosis. A nomogram risk prediction model was established based on the weight of the above four independent risk factors, and the model had an area under the ROC curve of 0.877 (95% CI : 0.831-0.923). The model had a consistency index of 0.871 after internal verification using the Bootstrap resampling method, suggesting that the model had good discriminatory ability. The fitting of the observed value and the actual value of the calibration curve and the Hosmer-Lemeshow test ( P =0.905) showed that the predicted value of the nomogram risk prediction model had good consistency with the actual observed value. When the threshold probability was 35.6%, DCA showed a net clinical benefit of 22%, and the model had good clinical applicability within the threshold probability ranging from 8% to 89%. Conclusion ALBI score, time of operation, intraoperative blood loss, and hydatid diameter are independent risk factors for PHC in patients with two types of hepatic echinococcosis, and the nomogram risk prediction model established based on these factors has good accuracy, consistency, and clinical practicability.
ABSTRACT
Objective:To establish an individualized nomogram model to predict the risk of sarcopenia by analyzing the related factors of myopenia in elderly inpatients.Methods:Inpatients in the department of Affiliated Hospital of Qinghai University from January 2017 to December 2018, aged ≥ 60 years old, were included by the diagnostic criteria of Asian sarcopenia working group, and the independent risk factors were screened by logistic regression for the occurrence of sarcopenia. According to the independent risk factors, a nomogram model was established to predict the risk of sarcopenia. Bootstrap method was used to verify the model. C-index and calibration curve were used to evaluate the differentiation and calibration of the prediction model.Results:Totally 83 of 268 elderly patients had sarcopenia, the incidence was 30.9%. Age ( OR = 1.726, 95% CI 1.244-2.432), body mass index ( OR = 0.753, 95% CI 0.621-0.969), current smoking ( OR = 1.081, 95% CI 1.048-3.297), osteoporosis ( OR = 2.031, 95% CI 1.201-4.193) were all independent risk factors of myopenia in elderly patients. The concordance index for predicting the risk of myopenia was 0.775 (95% CI 0.722-0.827). Conclusion:Age, body mass index, osteoporosis, smoking are the independent risk factors of myopenia in elderly patients. The nomogram model can more directly evaluate the risk of sarcopenia in elderly patients.
ABSTRACT
Objective:To investigate the effect of hepatitis B virus (HBV) infection in patients with hepatic alveolar echinococcoisis after surgical resection and determine the differences of liver function between patients with different HBV-DNA levels.Methods:Patients were selected from January 2014 to July 2018 in the Affiliated Hospital of Qinghai University. Twenty-eight patients with hepatitis B and hepatic alveolar echinococcoisis were included in the experimental group, and 20 patients with hepatic alveolar echinococcoisis but without hepatitis B virus were included in the control group. Based on HBV-DNA level, the experimental group was divided into low-level group (HBV-DNA level<200 IU/ml, n=6), intermediate-level group (HBV-DNA level 200-20 000 IU/ml, n=15) and high level group (HBV-DNA level>20 000 IU/ml, n=7). Comparison of complications and liver function after liver resection in two groups.Univariate and multivariate logistic regression were used to analyze the influential factors of postoperative complications in patients.Comparison of postoperative liver function indexes in patients with different HBV-DNA levels. Results:In the control group, postoperative total bilirubin 10.6(8.3, 16.9) μmol/L, direct bilirubin 5.3(3.4, 10.0) μmol/L, prothrombin time 13.6(13.0, 15.8)s, and the incidence of complications 25.0%(5/20), were better than the experimental group 12.6(8.4, 46.9) μmol/L, 6.7(3.1, 26.4) μmol/L, 15.4(13.5, 18.1)s, 78.6% (22/28), the differences were statistically significant significance (all P<0.05). Multivariate logistic analysis showed that patients with HBV infection ( OR=4.593, 95% CI: 1.128-18.708) and intraoperative blood loss ≥1 000 ml ( OR=2.200, 95% CI: 1.106-4.378) were the hepatic alveolar echinococcoisis independent risk factors for postoperative complications. There were no significant differences in total bilirubin and albumin between the three groups of patients with different HBV-DNA levels ( P>0.05). Conclusion:Patients with HBV and hepatic alveolar echinococcoisis have worse liver function and are more prone to complications after surgical resection, but there is no significant difference in liver function among patients with different HBV-DNA levels.
ABSTRACT
Objective:To analyze the risk factors for bile leakage in patients undergoing cystic echinococcosis surgery to establish a nomogram model to predict the risk of bile leakage.Methods:The clinical data were retrospectively analyzed that 203 patients with cystic echinococcosis treated in Qinghai University Affiliated Hospital from January 2015 to October 2018. Logistic regression was used to screen out independent risk factors of biliary leakage in patients undergoing cystic hydatid surgery. Then the R software was used to establish a predictive nomogram model. Bootstrap method was used to validate the nomogram model and ROC curve was used to explore the predictive efficacy of the model in predicting the bile leakage.Results:There were 54 cases of biliary leakage in 203 patients with cystic echinococcosis, the incidence was 26.1%. ALP ( OR=11.193, 95% CI 5.066-24.731), GGT ( OR=2.728, 95% CI 1.246-5.975), cyst diameter ( OR=3.491, 95% CI 1.550-7.861), hilar cyst ( OR=2.503, 95% CI 1.176-5.329) were all independent risk factors for biliary leakage of cystic echinococcosis. The consistency index was 0.835 for predicting PPC risk, and the area was 0.823 (95% CI 0.754-0.892) under the curve for predicting the risk of cystic echinococcal bile leakage. Conclusions:ALP, GGT, cyst diameter and hepatic hilar cyst are independent risk factors for cystic echinococcal bile leakage. Nomogram model can evaluate the risk of cystic echinococcal bile leakage more intuitively, with potentially high clinical application value.
ABSTRACT
Cystic lesions of the liver are classified into parasitic and non-parasitic lesions. Parasitic lesions mainly refer to hepatic cystic echinococcosis, and non-parasitic lesions can be further classified into benign, borderline, and malignant lesions. At present, there are still no comprehensive standard treatment of cystic space-occupying lesions in the liver. With reference to related literature in China and foreign countries, this article reviews the etiology, clinical manifestations, and diagnosis and treatment of hepatic cystic diseases, so as to improve the understanding of this disease.
ABSTRACT
This article studied the formation process of the "patient participation" concept, based on the definition of its connotation and extension. It is held that"patient participation" concept has evolved to include improving patient's willingness, ability and rights to participate, changing the traditional dominance of medical workers, and promoting information disclosure and credibility among others. The concept of "patient participation" comes into being to meet patient needs in the process of medical service, and the analysis of the concept formation can help better understand patients'demands.
ABSTRACT
High mortality and incidence rate of complications after hepatectomy are closely associated with postoperative liver failure. Due to limited research on liver failure at present, no consensus has been reached on the definition of liver failure after hepatectomy. This article summarizes the definition, pathogenesis, risk factors, liver function assessment methods, and preventive measures of postoperative liver failure. It is pointed out that adequate preoperative assessment of liver function reserve, effective methods for bleeding control, shortening time of operation, preservation of functional liver tissue as much as possible, and timely and effective diagnosis/treatment and prevention during the perioperative period can reduce the incidence rate of liver failure, improve patient prognosis, and maximize the benefits of patients.
ABSTRACT
<p><b>OBJECTIVE</b>To compare the efficacy of limus-eluting stent (LES) with paclitaxel-eluting stent (PES) for patients with coronary small vessel disease.</p><p><b>METHODS</b>The studies of LES and PES used for patients with coronary small vessel disease were searched in PubMed, Web of Science, ClinicalTrials, SinoMed, CNKI, Wanfang data and CQVIP. The relative risk (RR) estimates with 95% confidence intervals and other statistical variables were calculated with Stata 14.0, and the meta analysis was performed with RevMan 5.2.</p><p><b>RESULTS</b>Eight studies involving 4738 patients were included in the meta-analysis. Compared with PES, LES implantation was associated with significant reduction in major adverse cardiovascular events (=0.64, 95%:0.53-0.77,=4.59,<0.01), myocardial infarction (=0.61, 95%:0.45-0.82;=3.24,<0.01), stent thrombosis (=0.22, 95%:0.13-0.37,=5.71,<0.01), and target lesion revascularization (=0.56, 95%:0.44-0.71,=4.72,<0.01), while no difference was observed in cardiac death (=1.08, 95%:0.62-1.88,=0.26,>0.05) and target vessel revascularization(=0.80, 95%:0.45-1.44,=0.74,>0.05).</p><p><b>CONCLUSIONS</b>LES has better efficacy than PES for patients with coronary small vessel disease, which may be the preferred stents for these patients.</p>
ABSTRACT
Objective To study the effects of formaldehyde on the level of microelements in mouse liver and blood and explore the microelements as biomarker in injury induced by formaldehyde.Methods The mice were randomly divided into control,low(1/40LD50),moderate(1/20LD50) and high(1/10LD50) dose groups exposed to formaldehyde by inhalation(n=20),two hours per day for three and six weeks,and than the contents of Cu,Fe,Zn and Mn in mouse liver and blood were measured.Results The contents of Fe,Zn and Mn in liver in high dose group three weeks after exposure and the contents of Fe and Zn in liver in high dose group six weeks after exposure were significantly lower than those in control group(P