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The chemical constituents in the ethanol extract of Hypericum wightianum(Hypericaceae) were purified by column chromatography and identified via magnetic resonance imaging(NMR), high-resolution mass spectrum, and circular dichroism. A total of 22 compounds were identified, including eight polyprenylated phloroglucinols(1-8), three chromones(9-11), and three terpenoids(14-16) and so on. Among them, compounds 16 and 17 were first reported in the genus Hypericum, and compounds 1-11, 14, 15, and 19 were first isolated from H. wightianum. Compounds 1-4 were previously reported as two pairs of enantiomers. This study reported the chiral resolutions and absolute configurations of compounds 1-4 for the first time.
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Phloroglucinol , Hypericum/chemistry , Molecular Structure , Magnetic Resonance Spectroscopy , Drugs, Chinese Herbal/chemistryABSTRACT
Objective To analyze the prevalence trend of chronic hepatitis C and liver function impairment in Taixi area from 2018 to 2021, and to provide theoretical basis for preventing liver function impairment in hepatitis C patients in Taixi area. Methods The data of hepatitis C cases reported in Taixi were downloaded from the infectious disease reporting Information management system of Chinese Center for Disease Control and Prevention, and the epidemiological characteristics of hepatitis C were analyzed by descriptive epidemiological methods. The clinical data including gender, age, place of residence, smoking history, drinking history, therapeutic drugs, genotyping and other clinical data were collected from HIS system of the hospital. Patients were divided into liver function injury group and control group according to whether they had liver function injury. Univariate analysis and logistic regression were used to analyze the factors of liver function injury in hepatitis C patients in Taixi area. Results Among the 550 cases reported from 2018 to 2021, there were no deaths, including 292 males and 258 females. The male cases were more than the female cases, and the average age was (53.47±5.74) years old. There was no significant difference in the composition of male and female cases among different age groups (χ2=1.472,P>0.05). From 2018 to 2021, the proportion of patients aged 40 to 59 was significantly higher than that of patients aged 20 to 39 and ≥60. The occupation composition was mainly farmers, accounting for 44.36% (244/550), and 287 cases (52.18%) lived mainly in rural areas. From 2018 to 2021, 129 (23.45%) of 550 patients with hepatitis C had liver function injury. ALT, AST and GGT values in the liver function injury group were significantly higher than those in the control group (P5%, genotype 1b and high load of HCV-RNA were independent risk factors for liver function impairment in hepatitis C patients in Taixi area (P<0.05). Conclusion The incidence of hepatitis C was high in Taixi area from 2018 to 2021, and patients with CD4+CD25+Treg<5%, genotype 1b and high load of HCV-RNA had a high risk of liver function impairment. Therefore, active treatment should be carried out to reduce the occurrence of liver function injury.
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Objective:To establish and evaluate a nomogram for long-term survival of patients with intrahepatic cholangiocarcinoma (ICC) after radical resection.Methods:The data of ICC patients who underwent radical resection for the first time at Zhongshan Hospital, Fudan University from January 2014 to December 2017 were retrospectively analyzed. Of 167 patients who were enrolled, there were 104 males and 63 females, with the age of (60.3±10.9) years. Tumor tissues were collected for immunohistochemical staining and interpretation. Univariate Cox regression, LASSO regression and multivariate Cox regression were used to analyze influencing factors of postoperative long-term survival after ICC. R software was used to construct a nomogram in predicting ICC prognosis.Results:Cox regression analysis showed that TNM staging, poorly differentiated tumor, positive resection margin, positive mucin 5 expression and abnormal P53 expression to be independent risk factors associated with poor long-term survival after radical resection. The prognostic nomogram model of ICC was constructed based on these factors. The C-index was 0.821. The nomogram model consistency index had a high degree of prognostic differentiation. The 45° diagonal of the 3-year postoperative calibration curve which represented the actual survival fitted well with the segmented line which represented the predicted survival of the nomogram. The area under the receiver operating characteristic curve of the nomogram model was higher than that of AJCC TNM staging (0.894 vs. 0.803, z=4.10, P<0.001). The nomogram model was more effective in predicting postoperative survival of ICC patients than the TNM staging. Conclusion:TNM staging, poorly differentiated tumor, positive resection margin, positive mucin 5 expression and abnormal P53 expression were independent risk factors for postoperative survival of ICC. The nomogram model could better evaluate long-term prognosis of ICC patients after radical resection than the traditional TNM staging system.
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Objective:To explore the optimum time of ambulation of atrial fibrillation patients after radiofrequency ablation, to provide basis for patients' early postoperative rehabilitation.Methods:By convenient sampling method, a total of 120 patients with atrial fibrillation after radiofrequency ablation were collected at Yanghu Branch and City Branch of Changzhou Second People's Hospital from January 2020 to May 2021. They were divided into the early group, middle group and late group according to the random number table method, each group were 40 cases. All patients received routine postoperative intervention, the time of ambulation were 4, 6 and 12 h after operation in the early group, middle group and late group, respectively. The complication rate within 24 h after operation was compared among the three groups, and the comfort level of the three groups at 24, 48 and 72 h after operation was evaluated with Comfort Status Scale (GCQ).Results:Finally, 111 patients were included, including 37 in the early group, 38 in the middle group and 36 in the late group. There was no significant difference in the incidence of bleeding or hematoma, urinary retention, lumbago within 24 h after operation among the three groups ( P>0.05). The incidence of postural hypotension within 24 h after operation in the early group was 2.7% (1/37), which was lower than 21.1% (7/38) and 25.0% (9/36) in the middle and late groups, with a statistically significant difference ( χ2=4.86, 7.67, both P<0.05). At 48 and 72 h after operation, the scores of physiological dimension, psychological dimension and the total score of GCQ in the early group were (20.68 ± 3.07), (22.54 ± 3.35), (81.68 ± 6.11) and (22.54 ± 3.73), (24.38 ± 2.49), (84.92 ± 6.37), higher than those in the middle group (19.16 ± 2.19), (21.32 ± 2.27), (78.24 ± 5.58), (20.93 ± 2.85), (22.32 ± 2.04), (81.66 ± 6.56), and those in the late group (18.44 ± 1.50) (21.31 ± 1.99), (78.06 ± 4.32), (20.89 ± 2.25), (21.58 ± 1.86), (80.28 ± 6.44), the differences were statistically significant ( t values were 2.19-4.15, all P<0.05). Conclusions:Ambulation at 4 h after operation does not increase peripheral vascular complications, but can reduce the incidence of postural hypotension and improve the comfort of patients with atrial fibrillation after radiofrequency ablation.
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Objective:To explore the effects of hospital-to-community model-based case management on outcomes and life quality of patients with atrial fibrillation.Methods:By convience sampling method, a total of 90 cases of atrial fibrillation patients admitted to Changzhou Second People′s Hospital from January 2019 to May 2020 were randomly divided into control group and experimental group, with 45 cases in each group. The patients in the control group received routine nursing care, the experimental group implemented hospital-to-community model-based case management. The beliefs about medicine, medication compliance, quality of life and readmissions of cardiovascular events were compared between 2 groups before and 6 months after intervention.Results:Finally, 41 cases were included in the experimental group and 38 cases in the control group. Before intervention, there were no significant differences in various indexes between the two groups ( P>0.05). After 6 months of intervention, the scores of specific-necessity in Beliefs about Medicines Questionnaire-Specific (BMQ-Specific) and Morisky Medication Adherence Scale-8 (MMAS-8) were (16.98 ± 4.22) and (7.15 ± 0.69) points in the experimental group, higher than in the control group (14.95 ± 4.33) and (6.32 ± 1.07) points; the scores of specific-concerns in BMQ-Specific were (6.83 ± 1.91)points in the experimental group, lower than in the control group (8.42 ± 2.73) points. The differences were statistically significant ( t = 2.11, 4.07, 2.98, all P<0.05); the scores of physical function, role-physical, pain, general health, mental health dimensions and total scores in SF-36 were (80.37 ± 3.46), (46.63 ± 14.54), (90.37 ± 5.78), (70.07 ± 9.98), (84.20 ± 8.73) and (584.88 ± 25.71) points in the experimental group, higher than in the control group (70.13 ± 11.20), (37.34 ± 10.25), (83.37 ± 6.89), (59.55 ± 7.98), (77.58 ± 9.09) and (533.87 ± 31.62) points, the differences were statistically significant ( t values were 3.30-7.89, all P<0.05). At 6 months after discharge, the re-admission of cardiovascular events were 5 cases (12.2%) in the experimental group and 12 cases (31.6%) in the control group, the difference was statistically significant ( χ2=4.74, P<0.05). Conclusions:Hospital-to-community model-based case management can effectively promote beliefs about medicine and medication compliance, improve quality of life and decrease re-admission of cardiovascular events of patients with atrial fibrillation.
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Objective:To study the clinical and MRI features of alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis to compare with those of hepatic focal nodular hyperplasia (FNH) to arrive at a correct differential diagnosis.Methods:The data of 105 patients who underwent liver surgery for alpha-fetoprotein-negative hepatocellular carcinomas without cirrhosis at Zhongshan Hospital, Fudan University and the Traditional Chinese Medical Hospital of Nantong from March 2017 to November 2020 were retrospectively studied. There were 109 lesions in 95 males and 10 females. These patients had the age of (60.2±9.9) years. The data of 88 patients who were diagnosed to have hepatic FNH during the study period were collected, and there were 99 lesions in 36 males and 52 females. These patients had the age of (32.8±9.5) years. Variables including age, history of hepatitis B virus infection, T 1 weighted imaging (T 1WI), T 2 weighted imaging (T 2WI), diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC), enhancement mode, lesion shape, lesion boundary and capsule were compared between the two groups. Results:The age and the proportion of patients with a history of hepatitis B in the alpha-fetoprotein-negative hepatocellular carcinoma and without cirrhosis group were significantly higher than those in the hepatic FNH group (both P<0.05). The proportion of lesions with quasi-circular shape, clear boundary and with capsule in hepatocellular carcinoma group were significantly higher than those in the hepatic FNH group (all P<0.05). There were also significant differences in the T 1WI, T 2WI, enhancement modes, DWI, and ADC map between the two groups of lesions (all P<0.05). The areas under the receiver operating characteristic curve for the alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis by the age >45.5 year, with a history of hepatitis B, with clear lesion boundary, with a "washin and washout" enhanced mode and with lesion encapsulation were 0.97(95% CI: 0.95-0.99), 0.79(95% CI: 0.72-0.85), 0.78(95% CI: 0.72-0.85), 0.94(95% CI: 0.90-0.97), 0.99(95% CI: 0.98-1.00) respectively. Conclusions:The presence of a capsule, clear lesion boundary and "washin and washout" enhanced mode are helpful in differentiating alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis with hepatic FNH.
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The decline of body function and senile diseases caused by aging seriously affect human health and life span， which is an important topic in the field of life science. Bazi Bushen capsules is a representative Chinese patent medicine for tonifying essence， invigorating Qi and anti-aging， guided by Qiluo doctrine， and essence， Qi and spirit theory. Previous pharmacological and clinical studies have confirmed that this preparation has the comprehensive advantages of anti-aging， and prevention and treatment of aging-related diseases. Among them， pharmacological studies showed that Bazi Bushen capsules had the effect of improving the appearance status of mice， improving the level of sex hormones， inhibiting the formation of atherosclerosis， improving cardiac function， improving learning and memory cognitive ability， improving neurological function， improving osteoporosis and muscle function， improving sperm count and quality. The mechanism was related to the up-regulation of the recombinant sirtuin （SIRT6） level， down-regulation of the levels of aging-related proteins p53 and p16， up-regulation of telomerase reverse transcriptase level， and alleviation of inflammation and oxidative response. Clinical studies have proved that it can improve the symptoms of patients with kidney essence deficiency， improve exercise ability， and improve the sexual function of impotence patients. Anti-aging research of Bazi Bushen capsules based on Qiluo doctrine fully embodies the new mode of academic innovation and transformation of traditional Chinese medicine （TCM） with the combination of "theory-new drug-experiment-clinic"， which has made a demonstration for the anti-aging research of TCM.
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Along with increasing degree of population aging globally， senility， good health and long life have become the focus of the world. Guided by Qiluo doctrine， an essence， Qi and spirit theory is proposed as below， essence is the origin of life， Qi is the impetus of life and spirit is the embodiment of life. Based on holistic view of kidney deficiency involving the five internal organs and injuries of the five internal organs definitely affecting the kidney， a mechanism of aging is proposed as below， deficiency of kidney essence is the foundation of aging， deficiency of promordial Qi is the key of aging and physical and spiritual loss is the manifestation of aging. It provides a theoretical guidance for anti-aging study of rejuvenating the elderly and making the strong person stronger. By virtue of the experiences in kidney-tonifying medication accumulated for more than two thousand years， Bazi Bushen capsules has been developed， which has anti-aging efficacy， including tonifying kidney， replenishing essence， coordinating Yin and Yang， supplementing primordial Qi and nourishing body and spirit. Experimental researches have demonstrated that Bazi Bushen capsules can improve overall aging and systemic aging， as well as prevent and treat aging related diseases. Preliminary clinical studies demonstrate that this capsules can enhance athletic ability and improve sexual function， and is expected to become a representative Chinese patent medicine of anti-aging. This paper addresses aging and anti-aging on the basis of Qiluo doctrine， in the hope of helping prevention and treatment of aging related diseases.
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OBJECTIVE@#In traditional Chinese medicine, the herbal pair, Radix Achyranthis Bidentatae (RAB) and Eucommiae Cortex (EC), is widely used to treat osteoporosis. Herein, we determined whether this herbal pair can be used to ameliorate glucocorticoid (GC)-induced osteoporosis (GIOP) and find its optimal dosage in zebrafish.@*METHODS@#The characteristics of the aqueous extract of RAB and EC were separately characterized using high-performance liquid chromatography. Osteoporosis was induced in 5-day post-fertilization zebrafish larvae by exposing them to 10 μmol/L dexamethasone (Dex) for 96 h. Seven combinations of different ratios of RAB and EC were co-administered. Treatment efficacy was determined by calculating zebrafish vertebral area and sum brightness, via alizarin red staining, and by detecting alkaline phosphatase (ALP) activity. Multiple regression analysis was conducted to test the optimal dosage ratio.@*RESULTS@#According to the Chinese Pharmacopoeia (2015), β-ecdysone (β-Ecd) is a major bioactive marker in RAB extract, while pinoresinol diglucoside (PDG) is the major marker in EC extract. Both of β-Ecd and PDG content values aligned with the Chinese Pharmacopoeia standards. Treatment with 10 μmol/L Dex reduced zebrafish vertebral area, sum brightness, and ALP activity, but RAB and EC attenuated these effects. Combining 50 µg/mL RAB and 50 µg/mL EC was optimal for preventing GIOP in zebrafish. Reverse transcription-quantitative polymerase chain reaction was used to evaluate the mRNA expression of osteogenesis-related genes. A treatment of 10 μmol/L Dex decreased runt-related transcription factor 2 (Runx2), osteogenic protein-1 (OP-1), bone γ-carboxyglutamic acid-containing protein (BGLAP), and β-catenin levels. This effect was counteracted by RAB and EC co-treatment (P < 0.05). Additionally, the effect of using the two herbal extracts together was better than single-herb treatments separately. These results demonstrated that RAB and EC preserve osteoblast function in the presence of GC. The best mass ratio was 1:1.@*CONCLUSION@#RAB and EC herbal pair could ameliorate GC-induced effects in zebrafish, with 1:1 as the optimal dosage ratio.
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Animals , Glucocorticoids , Medicine, Chinese Traditional , Osteogenesis , Osteoporosis/prevention & control , ZebrafishABSTRACT
Objective:To investigate the effect of preoperative hemoglobin (Hb) level on the risk of developing acute kidney injury (AKI) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).Methods:A retrospective study was conducted. The hospitalized patients diagnosed with AMI who underwent PCI from May 2015 to May 2020 in the department of cardiology in the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University were enrolled. According to the serum creatinine (SCr) level before and after interventional therapy, the patients were divided into an AKI group and a non-AKI group. The difference in patients' Hb levels between the AKI and non-AKI groups was compared. Univariate and multivariate Logistic regression analyses were used to analyze the effects of Hb levels on the risk of AKI after interventional therapy in patients with AMI. Kaplan-Meier survival curve was used to evaluate the effects of Hb levels on patients with AMI in all-cause death in the hospital.Results:A total of 922 AMI patients were enrolled in this study, of which 165 patients (17.9%) developed AKI. Compared with the non-AKI group, female patients in the AKI group had a higher proportion [35.8% (59/165) vs. 26.9% (204/757)], older (age: 69.78±14.56 vs. 66.61±13.44), with a lower rate of smoking [42.4% (70/165) vs. 51.7% (391/757)] and a higher prevalence of hypertension [73.3% (121/165) vs. 63.5% (481/757)], however, the patients in AKI group also had a worse cardiac function [the proportion of Killip grade 3 or above was higher: 33.9% (56/165) vs. 13.9% (105/757)], lower Hb level (g/L: 127.61±22.18 vs. 132.79±19.45), and there were less patients using angiotensin converting enzyme inhibitor/angiotensin Ⅱreceptor blocker [ACEI/ARB, 60.0% (99/165) vs. 74.5% (564/757)] and more patients using diuretics [24.8% (41/165) vs. 17.7% (134/757)] in AKI group, the differences were statistically significant (all P < 0.05). Compared with non-AKI group, patients in AKI group had a longer operation time [operation time > 60 minutes: 4.2% (7/165) vs. 1.5% (11/757)] and received more contrast media during the operative procedure [contrast media > 100 mL: 16.4% (27/165) vs. 3.6% (27/757)], the individuals had a higher rate of intra-operative hypotension [16.4% (27/165) vs. 8.2% (62/757)], and more patients were implanted more than 2 stents [8.5% (14/165) vs. 3.6% (27/757), all P < 0.05]. Univariate Logistic regression analysis suggested that each 1 g/L increase in preoperative Hb level was associated with a 1.2% decrease in the risk of postoperative AKI [odds ratio ( OR) = 0.988, 95% confidence interval (95% CI) was 0.980-0.996, P = 0.003]. Meanwhile, for every 1 standard deviation increase in preoperative Hb level, the risk of postoperative AKI decreased by 22.1% ( OR = 0.779, 95% CI was 0.661-0.918, P = 0.003). The patients were divided into low, medium and high concentration groups according to Hb levels (Hb levels were < 110 g/L, 110-150 g/L, ≥ 150 g/L, respectively), and multivariate Logistic regression analysis showed that the risk of AKI was significantly reduced in the high concentration group compared with that in the low concentration group ( OR = 0.463, 95% CI was 0.241-0.888, P = 0.020). The Kaplan-Meier survival curve analysis indicated that the short term survival after coronary intervention in AMI patients with low Hb concentration was significantly lower than that in patients with medium and high Hb concentration (Log-Rank: χ2= 23.215, P < 0.001). Conclusions:Preoperative lower Hb level is an independent risk factor for postoperative AKI in AMI patients. AMI patients with lower Hb levels have an increased risk of all-cause mortality within 1 month after AMI.
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Objective:To investigate the value of multislice spiral computed tomography (MSCT) features in the differential diagnosis of pancreatic solid pseudopapillary neoplasm (pSPN) and hypovascular pancreatic neuroendocrine tumor (hypo-PNET).Methods:From January 2016 to January 2021, at Zhongshan Hospital of Fudan University, the clinical information, pathological results and imaging data of 81 patients with pSPN and 40 patients with hypo-PNET confirmed by surgical pathology were retrospectively analyzed. The tumor location, shape, growth mode, relationship between the long axis of the lesion and pancreas, boundary, whether with calcification, floating cloud sign, ring enhancement, sausage-like enhancement, intratumoral vascular sign, pancreatic duct dilatation, distal pancreatic atrophy, intratumoral cystic change, cystic-solid ratio of tumor, the maximum diameter of the lesion, the plain and enhanced computed tomography (CT) values of the solid part of the tumor of pSPN patients and hypo-PNET patients were compared and analyzed. Chi-square test, independent sample t test and Mann-Whitney U test were used for statistical analysis. The variables with statistical significance in univariate analysis were included in the binary logistic regression model to screen the independent predictors of pSPN and hypo-PNET, and the receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficiency of MSCT characteristics in the differential diagnosis of pSPN and hypo-PNET. Results:Compared with hypo-PNET patients, most of pSPN patients were female (71.6%, 58/81 vs. 45.0%, 18/40), younger (36.0 years old (27.0 years old, 46.0 years old) vs. 56.5 years old (48.2 years old, 63.7 years old), the tumors were mostly round or elliptical (76.5%, 62/81 vs. 55.0%, 22/40), most with clear boundaries (70.4%, 57/81 vs. 40.0%, 16/40), with more intratumoral calcification (53.1%, 43/81 vs. 20.0%, 8/40), with more floating cloud sign (65.4%, 53/81 vs. 35.0%, 14/40), more without intratumoral vascular sign (77.8%, 63/81 vs. 32.5%, 13/40), more without pancreatic duct dilatation (79.0%, 64/81 vs. 55.0%, 22/40), more with mixed solid and cystic mass (38.3%, 31/81 vs. 22.5%, 9/40), with longer maximum diameter of tumor (4.0 cm (3.0 cm, 5.6 cm) vs. 3.3 cm (2.6 cm, 4.2 cm), with lower enhanced CT values in the arterial and venous phases ((54.7±13.1) HU vs. (68.2±15.0) HU and (65.9±16.0) HU vs. (79.2±14.2) HU), and the differences were all statistically significant ( χ2=8.11; Z=-6.24; χ2=5.85, 10.32, 12.02, 10.03, 23.50, 7.51, 7.72; Z=-2.53; t=-5.08 and -4.46, all P<0.05). The results of binary logistic regression model indicated that the independent predictive factors for the diagnosis of pSPN and hypo-PNET included age ( OR=0.874, 95% confidence interval (95% CI) 0.827 to 0.923, P<0.001), calcification ( OR=5.412, 95% CI 1.428 to 20.506, P=0.013), intratumoral vascular sign ( OR=0.212, 95% CI 0.055 to 0.817, P=0.024), CT value in the arterial phase ( OR=0.943, 95% CI 0.899 to 0.988, P=0.015). For the combination diagnostic model based on clinical features and MSCT characteristics, area under ROC was 0.944 (95% CI 0.905 to 0.990), sensitivity was 87.7% and specificity was 92.5% ( P<0.001). The results of ROC analysis of the independent predictive factors and combined diagnostic model showed that the areas under the curve (95% CI) of the age, calcification, intratumoral vascular sign, CT value in the arterial phase and the combined diagnostic model was 0.665 (0.565 to 0.765), 0.726 (0.627 to 0.826), 0.850 (0.775 to 0.924), 0.757 (0.660 to 0.853), and 0.944 (0.905 to 0.983), respectively, and the diagnostic efficacy of the combined diagnostic model was higher ( P<0.001). Conclusion:MSCT features such as intratumoral calcification, intratumoral vascular sign, tumor density in the arterial phase combined with age can be used in the differential diagnosis of pSPN and hypo-PNET.
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Objective:To investigate the imaging characteristics of computed tomography (CT) and magnetic resonance imaging (MRI) of undifferentiated carcinoma with pancreatic osteoclast-like giant cell (UPC-OGC).Methods:From April 2015 to November 2019, at Zhongshan Hospital, Fudan University, 11 pathologically confirmed UPC-OGC patients who received upper abdominal CT or MRI before surgery and with complete clinical and pathological data were retrospectively included. The imaging characteristics of CT and MRI were analyzed, which included lesion location, number, shape, size, boundary, plain scan and enhancement features, adjacent tissue invasion and metastasis. Independent sample t test was used for statistical analysis. Results:The tumor lesions of 11 patients with UPC-OGC were all single, and the maximum diameter of lesion was (4.84±2.96) cm (ranged from 2.00 to 12.80 cm). The lesions of 7 patients with UPC-OGC were located in the head of pancreas, 2 located in the body of pancreas, 1 located in the tail of pancreas and 1 located in the junction of body and tail of pancreas. The lesion shapes of 3 patients with UPC-OGC were round, and the lesion shapes of 8 patients were oval with lobulation. The lesion boundaries of 8 patients with UPC-OGC were clear and the lesion boundaries of 3 patients were unclear. Seven patients with UPC-OGC were examined by plain and enhanced CT scan. Plain CT scan showed that the density of solid area of the tumor was similar to that of normal pancreatic parenchyma ((37.14±6.10) HU vs. (43.14±4.55) HU), and the difference was not significant ( t=-2.85, P=0.097). Contrast-enhanced CT scan in arterial phase showed that the degree of enhancement in solid area of the tumor was weaker than that of normal pancreatic parenchyma ((67.29±12.79) HU vs. (90.43±9.81) HU), and the difference was statistical significant ( t=-4.10, P=0.004), while contrast-enhanced CT scan showed that in venous phase the solid area of the tumor continued to strengthen and the degree of enhancement was similar to that of normal pancreatic parenchyma ((84.71±15.30) HU vs. (79.57±10.73) HU), and the difference was not significant ( t=0.38, P=0.535). Both CT and MRI enhanced scans showed uneven enhancement of the lesions, the degree of enhancement of solid component in arterial phase was slightly weaker than that of normal pancreatic parenchyma and the marginal and internal separation were progressively enhanced, and the degree of enhancement in the venous phase and balanced phase was slightly higher than that of the normal pancreatic parenchyma or similar to that of the normal pancreas. Conclusions:The imaging of CT and MRI of UPC-OGC have certain characteristics, which are helpful for the diagnosis and identification of the disease.
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Objective:To investigate the value of imaging features of contrast-enhanced computed tomography (CT) of pancreatic neuroendocrine neoplasm (panNEN) in predicting preoperative pathological grade.Methods:From February 2009 to August 2020, at Zhongshan Hospital affiliated to Fudan University, the CT data of 136 patients with panNEN diagnosed by surgery and pathology were retrospectively analyzed. According to World Health Organization classification of digestive tumors (5th edition, 2019), panNEN was classified into G1, G2, G3 neuroendocrine tumor (NET) and neuroendocrine carcinoma (NEC). The differences in CT values and correlative parameters of solid part of lesions with different pathological grades were compared. The receiver operator characteristic curve was drawn and the area under the curve (AUC) was calculated to evaluate the CT value and related parameters in the differential diagnosis of panNEN of different pathological grades. The Kruskal-Wallis test and chi-square test were used for statistical analysis.Results:A total of 142 tumor lesions were detected in 136 panNEN patients, of which the numbers of G1, G2, G3 NET and NEC were 58, 73, 7 and 4, respectively. Along with the increase of pathological grade, the degree of CT enhancement in the solid part of panNEN lesions gradually decreased. The CT value, CT value difference and relative density of arterial phase and venous phase of patients with G2 NET were all lower than those of patients with G1 NET (Arterial phase: 105 HU, 46 to 251 HU vs. 126 HU, 57 to 195 HU; 62 HU, 6 to 212 HU vs. 81 HU, 23 to 166 HU; 1.1, 0.4 to 2.5 vs. 1.4, 0.7 to 2.0. Venous phase: 90 HU, 49 to 159 HU vs. 107 HU, 63 to 162 HU; 49 HU, 9 to 134 HU vs. 62 HU, 24 to 128 HU; 1.1, 0.5 to 2.0 vs. 1.4, 0.9 to 2.0), and the differences were statistically significant ( Harterial phase=2.880, 2.607 and 3.482, Hvenous phase=3.426, 3.323 and 3.891, all P<0.05). The CT value difference, the percentage of lesion enhancement, the index of lesion enhancement in arterial phase, and the CT value difference and the index of lesion enhancement in venous phase of patients with G3 NET were all lower than those of patients with G2 NET (31 HU, 27 to 52 HU vs. 62 HU, 6 to 212 HU; 67%, 59% to 153% vs. 151%, 15% to 705%; 0.6 HU, 0.5 to 0.9 HU vs. 1.3 HU, 0.1 to 5.8 HU; 40 HU, 36 to 52 HU vs. 49 HU, 9 to 134 HU; 0.9, 0.7 to 1.6 vs. 1.5, 0.2 to 5.4), and the differences were statistically significant ( H=2.634, 2.801, 3.267, 2.264 and 2.882, all P<0.05). The relative density index of arterial phase and venous phase to identify G1 and G2 NET received maximum AUC value of 0.679 (95% confidence interval ( CI) 0.587 to 0.771, P<0.01) and 0.701 (95% CI 0.609 to 0.793, P<0.01), respectively. The index of lesion enhancement in arterial phase and venous phase to identify G2 and G3 NET received maximum AUC value of 0.875 (95% CI 0.793 to 0.956, P=0.001) and 0.828 (95% CI 0.700 to 0.956, P=0.004), respectively. Conclusion:The enhanced CT parameters of panNEN can be used to predict the pathological grade before operation.
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Objective:To analyze the clinicopathological characteristics of patients with unknown etiology of portal hypertension and investigate the efficacy of endoscopic management of gastroesophageal varices in these patients.Methods:Patients with unknown etiology of portal hypertension and gastroesophageal varices who received liver biopsy between January, 2017 and January, 2020 in Zhongshan Hospital were included. The characteristics of pathology, portal computed tomography (CT) angiography, and endoscopy were recorded and follow-up for the occurrence of bleeding after treatment.Results:A total of 31 patients were included and divided into cirrhosis with unknown etiology group ( n=10) and non-cirrhotic portal hypertension group ( n=21). Patients in the non-cirrhotic group were younger [28.0(29.5-49.5) vs 58.5(43.5-65.8), P=0.004] and mostly male (71.4%), and fewer comorbidities including diabetes (4.8% vs 40.0%, P=0.027). The features of pathology finding including vasculopathy, cholestasis, and hepatic sinusoidal dilatation as well as the Sarin classification and bleeding rate of gastroesophageal varices, proportion of patients receiving endoscopic treatment were shown similar between the two groups ( P>0.05). The hepatic venous pressure gradient (HVPG) was significantly lower in the non-cirrhotic group [4.5(2.8-12.8)mmHg vs 12(8-18)mmHg, P=0.018]. Among them, 21 patients received endoscopic treatment, and the bleeding rate had no difference between these two groups after endoscopic treatment ( P=0.751). Conclusions:Non-cirrhotic portal hypertension in a predominantly young male population has similar clinicalpathological characteristics when compared to cirrhotic portal hypertension with unknown etiology. HVPG can not reflect the actual portal pressure in these patients. Endoscopic treatment is the effective treatment option for the prevention of variceal bleeding.
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Objective:To develop and validate a clinical prediction model for the risk of malignant ventricular arrhythmia in patients with acute myocardial infarction (AMI) during hospitalization, and evaluate the effect of the prediction model.Methods:A retrospective study was conducted. A total of 2 649 patients with AMI admitted to cardiology department of Changzhou No.2 People's Hospital of Nanjing Medical University from December 2012 to August 2020 were enrolled. The clinical characteristics including gender, age, medical history, discharge diagnosis, vital signs during hospitalization, electrocardiogram characteristics at admission, laboratory examination indexes, interventional treatment, drug usage, malignant ventricular arrhythmias [mainly included sustained ventricular tachycardia (VT), ventricular flutter or ventricular fibrillation (VF)], and death were recorded. All patients were divided into two groups according to whether VT/VF occurred during their hospitalization. Independent risk factors for VT/VF during hospitalization were evaluated by multivariate Logistic regression analysis, and a clinical prediction model was constructed. The receiver operating characteristic curve (ROC curve) was plotted, and the area under ROC curve (AUC) was calculated to evaluate the accuracy of the prediction model.Results:A total of 2 649 eligible patients with AMI were enrolled, of whom 134 (5.06%) developed VT/VF during hospitalization. The in-hospital mortality rate in VT/VF group was significantly higher than that in non-VT/VF group (38.1% vs. 1.7%, P < 0.01). Compared with the non-VT/VF group, the patients in the VT/VF group with lower systolic blood pressure [SBP (mmHg, 1 mmHg = 0.133 kPa): 125.9±28.2 vs. 132.0±24.2], higher random blood glucose (mmol/L: 8.6±4.8 vs. 7.4±3.7), worse cardiac function [Killip heart function grade ≥ 3: 36.6% vs. 10.7%, left ventricular ejection fraction (LVEF) < 0.50: 56.7% vs. 33.6%, frequent premature ventricular contractions: 12.7% vs. 1.2%] and more hypokalemia (46.3% vs. 17.3%), with significant differences (all P < 0.05). Multivariate Logistic regression analysis showed that Killip classification of cardiac function ≥ 3 [odds ratio ( OR) = 3.540, 95% confidence interval (95% CI) was 2.336-5.363], random blood glucose > 11.1 mmol/L ( OR = 1.841, 95% CI was 1.171-2.893), LVEF < 0.50 ( OR = 0.546, 95% CI was 0.374-0.797), frequent premature ventricular contractions ( OR = 12.361, 95% CI was 6.077-25.144), potassium < 3.5 mmol/L ( OR = 4.268, 95% CI was 2.910-6.259), SBP < 90 mmHg ( OR = 0.299, 95% CI was 0.150-0.597) and creatinine (Cr) > 100 μmol/L ( OR = 2.498, 95% CI was 1.170-5.334) were independent risk factors for VT/VF in patients with AMI (all P < 0.05). The clinical prediction model of VT/VF risk was constructed based on the variables selected by multivariate regression analysis. The ROC curve analysis showed that the AUC of the model in predicting VT/VF was 0.779 (95% CI was 0.735-0.823, P < 0.001); the optimal cut-off value of the model was 17, the sensitivity was 76.1%, the specificity was 67.3%. Conclusions:The incidence of VT/VF during hospitalization of AMI patients significantly increases the risk of in-hospital death. The independent risk factors of VT/VF are Killip grade ≥ 3, random blood glucose > 11.1 mmol/L, LVEF < 0.50, frequent ventricular premature beats, potassium < 3.5 mmol/L, SBP < 90 mmHg and Cr > 100 μmol/L. The newly constructed clinical prediction model has certain predictive value for the occurrence risk of VT/VF.
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Objective:To investigate CT imaging appearance of pancreatic solid pseudopapillary neoplasm (pSPN) in predicting pathological invasive behaviors.Methods:The clinical data and CT data of 103 patients with solid pseudopapillary neoplasm confirmed by surgical resection and pathology were retrospectively analyzed. According to the pathological results, all cases were divided into two groups: invasive group with 38 cases and non-invasive group with 65 cases. All 103 cases of pSPN had a single lesion. Image analysis included tumor location, size, shape, capsule,calcification, hemorrhage and proportion of cystic or solid component, etc. The density of solid components in all lesions was measured in plain scan, arterial phase and venous phase of CT images. Enhancement degree in arterial phase, enhancement degree in venous phase and enhancement degree between venous phase and arterial phase were calculated, and the differences between the two groups were statistically analyzed. For data analysis, the comparison of continuous variables between two groups was done with Student′s t-test. Categorical variables were tested using the χ 2 test or Fisher′s exact test. Diagnostic accuracy of density in arterial phase, density in venous phase, enhancement degree in arterial phase and enhancement degree in venous phase were assessed as the area under the receiver-operating characteristic (ROC) curve. Results:There were statistically significant differences in tumor capsule and proportion of cystic or solid component between the two groups ( P<0.05). There were no significant differences in neoplasm maximum diameter, location, morphology, calcification, hemorrhage, pancreaticobiliary dilatation and pancreatic atrophy between the two groups ( P>0.05). The density[(76.65±16.71) HU] and enhancement degree[(41.04±17.02) HU] in venous phase in invasive group were higher than those in non-invasive group [respectively (70.09±12.02),(34.55±11.41) HU] and the differences were statistically significant ( P<0.05). There were no statistically significant differences in the density in plain scan, density in arterial phase, enhancement degree in arterial phase and enhancement degree between venous phase and arterial phase ( P>0.05). The area under the ROC curve of density in arterial phase, density in venous phase, enhancement degree in arterial phase and enhancement degree in venous phase were respectively 0.598, 0.634, 0.613, and 0.617, among which only density in venous phase had the discriminant efficacy, and the optimal critical value was 78.65 HU. Conclusion:The pSPN has no capsule or incomplete capsule, more solid components, and obvious enhancement of the solid components in the tumor in venous phase may suggest that the tumor has more invasive behavior.
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Objective:To analyse the MRI features of hilar schwannomas and pathology.Methods:The MRI and pathological features of 5 patients with hilar schwannomas which were confirmed histopathologically at Zhongshan Hospital, Fudan University from January 2012 to August 2019 were retrospectively analyzed. There were 3 males and 2 females, with age ranging from 47 to 67 years (median age 59 years). Contrast-enhanced MRI scans were performed in these 5 patients. The site, shape, size, edge, signal and enhancement pattern of these lesions and pathologicl findings were analysed.Results:All the lesions were single, located in and around the perihilar region. Four lesions were oval or roundish, and 1 lesion was sausage-shaped. Two lesions were solid while 3 lesions were cystic solid. All lesions had clear borders with intact capsules. The solid parts in all the lesions showed isointensity or slightly hypointensity on T 1 weighted imaging, hyperintensity on fat-suppression T 2 weighted imaging (T 2WI), hyperintensity on diffusion weighted imaging, slightly hyperintensity / isointensity / slightly hypointensity on apparent diffusion coefficient maping with progressive mild to moderate enhancement. Thick septum was observed in the cystic part. The septum and capsule showed mild to moderate delayed enhancement. Fluid-fluid level was seen in one lesion. The cystic solid lesion in one patient showed the " target sign" on fat-suppression T 2WI. All the 5 tumors were close to blood vessels, and their long axes followed the shape of the portal vein. In 1 patient, the lesion slightly compressed the adjacent bile ducts. Pathological examination showed that all the tumors in the 5 patients had complete fibrous envelopes, and the solid parts of the tumor showed mainly spindle cells. Conclusions:The MRI features of hilar schwannomas were oval or sausage-shaped lesions, with the long axis along the portal vein. They were prone to develop cystic changes, and a"target sign"could be shown on fat-suppression T 2WI. The solid parts, septa and capsules of the lesions showed mild to moderate progressive enhancement after contrast-injection.
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Objective@#To evaluate the role of multidisciplinary team (MDT) clinic in the diagnosis of pancreatic diseases and patient compliance with MDT advice in the current medical system.@*Methods@#The study included 512 patients that had visited the pancreas-oriented MDT clinic of Zhongshan Hospital between May 2015 and May 2019.The clinical and pathological data were collected and analyzed retrospectively. Diseases were classified in accordance with 2010 WHO classification of tumors of the digestive system and usual clinical practices. Compliance was determined according to whether a patient received corresponding therapies or undergoing further checks or follow-ups.@*Results@#Among the 512 patients that had visited the MDT clinic, 121 patients were referred due to undetermined diagnosis. Classified according to the final diagnosis, the rate of undetermined diagnosis in different disease categories from high to low in order was inflammatory diseases of the pancreas (75.0%, 24/32), other lesions of the pancreas (56.1%,23/41), pancreatic cystic lesions (19.1%,17/89), pancreatic carcinomas (18.3%,48/262) and pancreatic neuroendocrine neoplasms (pNEN)(10.2%,9/88). The MDT clinic made diagnosis to 68 patients directly with an accuracy of 89.7%. The rate of compliance in the entire cohort was 63.4%. The rate of compliance of patients from June 2017 to May 2019 (68.4%) was higher than that of patients from May 2015 to May 2017(59.6%). The compliance rate of patients in different disease categories from high to low in order was inflammatory diseases of the pancreas(84.4%, 27/32), pancreatic carcinomas (67.9%, 178/262), pNEN(60.2%,53/88), other lesions of the pancreas (56.1%,23/41), and pancreatic cystic lesions(49.4%, 44/89). The compliance rate of patients with different MDT advice from high to low in order was best supportive care(78.6%,22/28), antitumor approaches beyond surgery(71.6%,159/222), further tests(62.6%, 77/123), surgery(53.7%, 65/121) and follow-up(49.2%, 31/63). In patients suggested for surgery, the compliance rate of patients with carcinomas(67.4%, 33/49) was higher than patients with other kinds of neoplasms.@*Conclusions@#MDT clinic could facilitate the diagnosis of pancreatic diseases conveniently and inexpensively. The overall compliance rate of MDT clinic patients is rather low, and patients with carcinomas have a relative high rate of compliance with the suggestion of surgery.
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The pathological grading diagnosis of pancreatic neuroendocrine neoplasms is the basis of clinical treatment and prognosis.The general principle guiding the classification of NEN has been evoluted several times.From the size of tumor,to the proliferation index as a key factor,and subsequently proposed distuishing between well-differentiated neuroendocrine tumors and poorly differentiated neuroendocrine carcinomas.Firstly,neuroendocrine tumors and neuroendocrine carcinomas were classified according to their morphology.Then,according to mitotic image and Ki67 proliferation index,the former was classified into G1,G2 and G3 grades.
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Objective To explore the clinical application effect of multiple end-to-side anastomosis in free anterolateral thigh perforator flap transplantation.Methods From January,2013 to October,2017,29 cases were applied the technology of multiple end-to-side anastomosis to the same recipient vessel in anterolateral thigh perforator flap transplantation for wound repair.Fifteen cases treated with multiple end-to-side anastomosis on flap arteries,and 2-3 arteries were anastomosed,with the average of 2.13.Nine cases were treated with venous multiple end-to-side anastomosis,and 2-4 veins were anastomosed,with the average of 3.11.Five cases treated with arterial and venous multiple end-to-side anastomosis,and 4-6 vessels were anastomosed,with the average of 5.20.Distribution of wounds:10 cases with hands and wrists wounded,15 cases with forearms and elbow joints wounded,and 4 cases with lower legs and feet wounded.The soft tissue defect size was 5 cm×13 cm-11 cm×27 cm,and the flap area was 6 cm× 15 cm-12 cm×29 cm.Postoperative followed-up was performed every 3-6 months to review flap survival.Results All flaps of 29 cases survived.Venous congestion occurred in 2 flaps within 48 h after the operation,among which,1 was overcomed after released the dressing and sutures,and the other underwent surgical exploration.The venous end-to-side anastomotic stomas were unobstructed,and hematoma was formed.After the hematoma compression was removed,circulation was recovered and the flap survived.With followed-up for 6 months to 2.5 years,both donor site and recipient site of the flaps healed well and the injured distal limbs had no hemodynamic disorder.Conclusion The application of multiple end-to-side anastomosis to the same recipient vessel for free transplantation of anterolateral thigh perforator flaps is safe and reliable.