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Objective:To explore the risk factors associated with liver metastasis in T 1 stage colorectal neoplasms patients and establish a prognostic model. Methods:Clinicopathological data of T 1 stage colorectal neoplasms patients from the Surveillance, Epidemiology, and End Results (SEER) database between January 1, 2004, and December 31, 2019 were included. The differences in clinicopathological characteristics between patients with and without liver metastasis were compared using Chi-square test, Wilcoxon rank-sum test, and multivariate Logistic regression analysis. Survival curves were plotted using Kaplan-Meier method, and the Log-Rank test was used to compare survival differences between the two groups. Univariate and multivariate analysis of prognostic factors were performed using the proportional Cox regression hazards regression model. Patients were randomly divided into training set and validation set at a ratio of 6∶4 using simple random sampling method. A nomogram model was established based on independent prognostic factors based on the results of the multivariate Cox regression analysis. The predictive ability of the model was evaluated using time-dependent receiver operating characteristic (ROC) curves and calibration curves. Results:A total of 28 258 T 1 stage colorectal neoplasms patients were included in the study. The multivariate Logistic regression analysis for liver metastasis occurrence indicated that the neuroendocrine neoplasms, elevated carcinoembryonic antigen (CEA) levels, larger neoplasms size, positive lymph node metastasis, and presence of cancer nodules were statistically significant differences ( P<0.05). For T 1 stage colorectal neoplasms patients with liver metastasis, the results of the multivariate Cox regression analysis showed that age, primary site, ethnicity, chemotherapy, and surgical treatment were independent prognostic factors ( P<0.05). The nomogram constructed based on these five prognostic factors had time-dependent ROC areas under the curve of 0.758, 0.797 and 0.729 for 1-year, 3-year, and 5-year survival rates, respectively, 0.749, 0.857, 0.871 in the validation set. The calibration curves of the nomogram in the training and validation sets were close to the 45-degree diagonal line. Conclusions:Neuroendocrine neoplasms, elevated CEA levels, larger neoplasms size, positive lymph node metastasis, and presence of cancer nodules are independent risk factors for liver metastasis in T 1 stage colorectal neoplasms. Age, primary site, ethnicity, chemotherapy, and surgical treatment are independent prognostic factors. The nomogram constructed based on these clinical characteristics has good discrimination and calibration abilities.
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Objective:To assess the efficacy and safety of the combination therapy of camrelizumab, apatinib, nab-paclitaxel, and S-1 for patients with locally unresectable advanced gastric cancer.Methods:From September 1, 2019 to August 1, 2021, in Beijing Friendship Hospital Affiliated to Capital Medical University, 17 patients with advanced gastric cancer were enrolled in this prospective, single-arm study. All the enrolled patients received camrelizumab, nab-paclitaxel, apatinib and S-1 combination therapy (in each 21 days cycle, camrelizumab 200 mg intravenously, D1; nab-paclitaxel 240 mg/m 2 intravenously, D2; apatinib 500 mg orally, once a day, D1-D21; S-1 40-60 mg twice a day, D1-D14). Patients who have been evaluated by multidisciplinary team to be eligible for radical surgery should stop treatment for at least 2 weeks. Patients were discontinued from the study when disease progression or unbearable toxicity, or withdrew consent. We analyzed the conversion rate, objective response rate (ORR), disease control rate (DCR), overall survival (OS) and safety.Statistical data were show by numbers and persentages(%), and comparisons between subgroups were assessed by Fisher′s exact probability method. Patients survival was analyzed using Kaplan-Meier curves and compared between groups using Log-rank. Results:At the data of cutoff (December 15, 2021), the median follow-up duration was 19.6 months. Eight of 17 patients underwent gastrectomy, and all of them were R0 resection (47.1%, 95% CI: 0.262-0.690). ORR was 47.1%, DCR was 82.4%, the median overall survival was 23.63 months. Grade 3 and 4 adverse events occurred in 3 patients (17.6%), including neutropenia, thrombocytopenia, anemia and upper gastrointestinal hemorrhage. There were no serious treatment-related adverse events or treatment-related deaths. Conclusion:In this trial, the combination of camrelizumab, apatinib, nab-paclitaxel and S-1 as the conversion therapy showed significant anti-tumor activity and manageable adverse events, providing a new option for locally unresectable advanced gastric cancer.
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Biliary tract cancer (BTC) is a series of rare malignancies with poor overall prognosis. Radical surgery the preferred treatment option, but most patients have lost the opportunity of surgery at the time of diagnosis. At present, there are limited systematical treatment options for biliary tract cancers, and such treatments have poor efficacy and short duration of responses. In the past few years, immune checkpoint inhibitor therapy has been established as an effective systemic therapy option for many solid tumors and hematological tumors. The research for biliary tract cancer treated by of immune checkpoint inhibitors has been continuously carried out and demonstrated the anti-tumor efficacy and safety. However, in view of the low incidence and high heterogeneity of BTC more large number of clinical trials and practices need to be carried out, and the effective combination regimens and predictive biomarkers are urgent to be explored. This article reviews the recent clinical studies on immune checkpoint inhibitors for biliary tract cancer, and summarizes the ongoing clinical studies. At the same time, the predictive biomarkers of immune checkpoint inhibitors proposed by domestic and foreign researches in recent years are summarized.
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Objective:To explore whether EZH2 can regulate the expression of miR-200b/a/429 and,thus,affect human tongue squamous cell carcinoma(TSCC).Methods:EZH2 was knocked down in TSCC lines SCC15 and UM-1 with siRNA(si-EZH2)method.The expression levels of EZH2 and epithelial mesenchymal transition related proteins were detected by Western blot.qPCR was used to determine the expression level of miR-200b/a/429 after knockdown of EZH2.Transwell and wound-healing assays were employed to detect the invasion and migration ability of tumor cells.The cytoskeleton was observed with an immunofluorescence assay.EZH2 expression in human head and neck squamous cell carcinoma(HNSCC)was detected by an immunofluorescence assay and qPCR.Results:EZH2 was significantly knocked down by siRNA, thus the expression level of miR-200b/a/429 and E-cadherin increased.While the expression of the N-cadherin,Vimentin,MMP2,and MMP9 proteins decreased;the migration and invasion of HNSCC cells in the si-EZH2 group was markedly inhibited.The EZH2 expression level in patients with lymph node metastasis in HNSCC specimens was higher than those without lymph node metastasis(P<0.01).Conclusions:EZH2 inhibits the expression of miR-200b/a/429 and promotes the invasion and migration of TSCC cells.
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Ajuba was found in cell connections, and the subsequent studies showed that it can shuttle between the nucleus and cytoplasm for signals transmission. Under normal physiological conditions, Ajuba promotes cell proliferation and differentiation by regulating cell cycle and participating in signaling pathways. In addition, Ajuba is closely related to the development of various tumors, such as breast cancer, colorectal cancer, head and neck squamous cell carcinoma, etc. However, Ajuba functions as an oncogene or a tumor suppressor gene in different tumors. In carcinomas, Ajuba can also promote tumor cell proliferation and promote tumor invasion and metastasis by regulating epithelial-mesenchymal transition. Some progress has been made in the development of small molecular inhibitors or targeted drugs for Ajuba, and there are considerable therapeutic prospects.
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Objective To observe the influence of the clinical pathway management intervention on medical service behaviors.Methods The clinical cases data in a grade A class 3 hospital of Zhangjiakou City,Hebei Province during 2011-2013 were retrospectively analyzed.The influence of implementing the clinical pathway management on the diagnosis results,medical records writing quality,clinical medication,operation,hospitalization time,medical costs,assisted examination items selection were observed and analyzed.Results The admission and discharge diagnosis coincidence rate and preoperative and postoperative diagnostic coincidence rate of 3 diseases entities in the two groups were 100%,the difference had no statistical significance (P>0.05);the medical record grade-A rate in the implementing clinical pathway group was significantly higher than that in the non-implementing clinical pathway group,the medical record grade-B rate was significantly lower than that in the non-implementing clinical pathway group,the difference was statistically significant (P0.05);the average hospitalization time,total costs,drug costs,laboratory fee and examination fee in the implementing clinical pathway group were lower than those in the non-implementing clinical pathway group,the difference was statistically significant (P<0.05);the operation fee,healthy material fee and nursing fee had no statistically significant difference was statistically significant(P<0.05).Conclusion Implementing the clinical pathway can standardize the doctor′s diagnosis and treatment behaviors and makes the medical work to develop to be more favorable for patients.
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Objective: To summarise the Clinical experience of esophageal replacement with colon after esophagectomy. Methods: Reviewed the clinical data of 20 patients who underwent esophageal replacement with colon between March 2011 to Mach 2014. 17 patients underwent 3 incisions esophagectomy, colon was extracted behind the sternum, resected the left-half manubrium sterni, left sternoclavicular joint and the first sternocostal joint for the cervical incision; 12 operations were assisted by the thoracoscopy. 3 patients underwent open two-field esophagectomy through right thoracoabdominal incision.Results: No perioperative death. 2 cases with anastomotic leakage of cervical, 2 cases with intestinal fistula, 2 cases with intestinal obstruction, 5 cases with hoarseness, 5 cases with pulmonary infections; the complication rate was 35% (n=7). No ischemic necrosis in the whole section of the interposed colon. Follow up for one or four years, 2 deaths, 2 distance metastasis.Conclusion: For the patients who need the reconstruction of the esophagus but the stomach is unavailable, the better option for the replacement is the colon. Assisted by the thoracoscopy could reduce the surgical trauma. Resecting the left-half manubrium sterni, left sternoclavicular joint and the first sternocostal joint for the cervical incision is helpful for the construction of the substernal pathway, reduction of the anastomotic leakage, and the healing of the fistula.
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Objective To evaluate the application value of DNA ploidy detection using flow cytometry method(FCM)in malignant tumor identifi?cation,so as to provide the theoretical basis for the clinical diagnosis of malignant tumors. Methods Two researchers finished the literature screen?ing independently,and all the literatures were given the secondary screening according to the inclusion and exclusion criteria. The included literature data was analyzed by Meta?DiSc 1.4,including heterogeneity test,sensitivity,specificity,diagnostic odds ratio(DOR)and summary receiver operat?ing characteristic(SROC)etc. Results Totally 12 literatures were included in the study finally,including a total of 1 340 subjects consisting of 516 cases with malignant tumor and 824 cases with benign tumor. Heterogeneity inspection results showed that the Spearman correlation coefficient of sensitivity logarithm and(1-specificity)logarithm was-0.343 and there was no threshold effect(P=0.275). DOR curves was Cochran?Q=26.49 (P=0.005 5),indicating the heterogeneity was caused by non threshold effects. Combined statistical quantity was calculated with a random effects model and the results were as followings:the sensitivity was 0.72(95%CI:0.68?0.76,I2=50.1%)and the specificity 0.84(95%CI:0.81?0.86,I2=65.5%). SROC curve drawing,DNA ploidy detection of benign and malignant tumors showed AUC=0.845 3 and Q*=0.776 8. Conclusion FCM DNA heteroploid has a high accuracy for diagnosis of malignant tumor,which can be an important supporting means for the discrimination between benign and malignant tumor.
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With the rapid development of medical and health sciences,the pressure on the new skills learning for health professionals has also increased.Advanced training has become important opportunity for the career development of the health professionals.This study takes a third—grade class —A hospital to conduct a case study,using the questionnaire to collect information and analyzed the factors that might affect the pressure for advanced training.This paper also discussed how to improve the quality of advanced training by reduce the pressure of the medical staff from the view point of hospital and individuals.
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In the current situation,how to adapt to the new medical reform and determine its development goal has become the primary concern of the managers of No.1 Affiliated Hospital of Hebei North University.The internal and external conditions were analyzed by the method of SWOT and the advantages,disadvantages,opportunities and challenges facing the hospital were also observed.Finally,a series of countermeasures were put forward in accordance with the strategies by SWOT.
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Scientific research management is an important part of hospital management and also embodied the important aspect of the overall strength of hospital.In order to further improve the No.1 Affiliated Hospital of Hebei North University scientific research management ability,this paper uses SWOT analysis method to analyze the internal and external environment,and concluded strengths,weaknesses,opportunities and challenges in scientific research management.By using SWOT analysis strategy,we proposes corresponding countermeasures toimprove hospital scientific research management level.
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With the advent of the knowledge economy,hospital management of scientific research work is facing new challenges.At present,administrators in charge of scientific research in most primary hospitals of China do not have the systematic training on knowledge and skills involving research management.Thus,training a master business and familiar with the operation of modern hospital science and technology management of high-quality management personnel is urgent needed.As long as Do a good job on training of the management personnel of scientific research in the primary hospital,can enrich the scientific research management team,do good on the management work of sci ence and technology in the hospital,hospital work to be continuous development of science and technology and enhance.
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Objective To construct a tyrosine kinase B(TrkB) targeted RNA interference (RNAi) lentiviral vector.Methods Four oligonucleotides targeting rat TrkB gene were synthesized and cloned into lentiviral vector pXZRNAi 1.0 to construct recombinant lentiviral vectors pXZRNAi-shTrkB-1,2,3,4.Neural stem cells prepared from rat hippocampus were infected with these high-titer viruses.Real-time PCR was employed to detect the TrkB mRNA expression and western blot was used to assess the gene silencing efficacy of these recombinants.Results Enzyme digestion and DNA sequencing results demonstrated that these shRNAs were correctly inserted into lentiviral vectors and the four recombinants were constructed successfully with the titer of 8.6 × 105cfu/ml.The infection efficiency of the letivirus on neural stem cells reached 80％.Compared with the uninfection group,the expression levels of TrkB mRNA in neural stem cells decreased significantly after transfected with pXZRNAi-shTrkB-3 and 4((66.7 ± 5.5) ％ and(76.8 ± 4.9) ％ respectively,P ＜ 0.05) ; and the protein expression levels were also significantly decreased ((68.5 ± 4.3)％ and (78.2 ± 5.1)％ respectively,P ＜ 0.05).Conclusion The lentiviral vectors for TrkB have been successfully constructed with high yield of lentivirus,which provides versatile method for assessing gene function in neural stem cells.