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ObjectiveTo investigate the influencing factors for the clinical outcome of patients with drug-induced liver injury （DILI）， and to establish a nomogram prediction model for validation. MethodsA retrospective analysis was performed for the general information and laboratory data of 188 patients with DILI who were admitted to Heilongjiang Provincial Hospital Affiliated to Harbin Institute of Technology from January 2017 to December 2022， and according to their clinical outcome， they were divided into good outcome group with 146 patients and poor outcome group with 42 patients. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate Logistic regression analyses were used to investigate the independent influencing factors for the clinical outcome of DILI patients. R Studio 4.1.2 software was used to establish a nomogram model， and calibration curve， receiver operating characteristic （ROC） curve， and decision curve analysis （DCA） were used to perform internal validation. ResultsThe univariate Logistic regression analysis showed that liver biopsy for the diagnosis of DILI， platelet count， cholinesterase， albumin， prothrombin time activity， IgM， and IgG were associated with adverse outcomes in patients with DILI. The multivariate Logistic regression analysis showed that liver biopsy for the diagnosis of DILI （odds ratio ［OR］=0.072， 95% confidence interval ［CI］： 0.022 — 0.213， P<0.001）， clinical classification （OR=0.463， 95%CI： 0.213 — 0.926， P=0.039）， alanine aminotransferase （OR=0.999， 95%CI： 0.998 — 1.000， P=0.025）， prothrombin time activity （OR=0.973， 95%CI： 0.952 — 0.993， P=0.011）， and IgM （OR=1.456， 95%CI： 1.082 — 2.021， P=0.015） were independent influencing factors for clinical outcome in patients with DILI. The nomogram prediction model was established， and after validation， the calibration curve was close to the reference curve. The area under the ROC curve was 0.829， and the DCA curve showed that the model had good net clinical benefit. ConclusionThe nomogram prediction model established in this study has good clinical calibration， discriminative ability， and application value in evaluating the clinical outcome of patients with DILI.
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Organ transplantation is the most effective treatment for all categories of end-stage organ diseases. To resolve the shortage of donors in organ transplantation, widespread attention has been diverted to xenotransplantation. At present, clinicians mainly highlight the problems related to xenotransplantation rejection and viral infection. The physiology of xenotransplantation has been rarely studied. Kidney performs endocrine function by producing erythropoietin (EPO), renin and activating vitamin D. Although these pathways are usually well preserved in allogeneic transplantation, species-specific differences, especially those between pigs and non-human primates, may still affect the physiological function of transplant organs. In this article, the changes of EPO, renin-angiotensin-aldosterone system (RAAS) and active vitamin D3 of pig and human after xenotransplantation were illustrated, aiming to provide reference for subclinical research of xenotransplantation.
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Objective:To analyze the expression of mucin 1 (MUC1) and Ki67 in intrahepatic cholangiocarcinoma (ICC), and to explore the correlations between the expression of MUC1 and Ki67 and the clinicopathological features and prognosis of ICC patients.Methods:Clinical data of 398 patients with ICC admitted to Henan Provincial People's Hospital from January 2013 to March 2020 were retrospectively analyzed. A total of 104 patients were included in this study, including 67 males and 37 females, aged (56.6±9.3) years. Immunohistochemistry was used to detect the expression of MUC1 and Ki67 in cancer tissues. Univariate and multivariate Cox regression analysis were used to study the prognostic factors of ICC patients.Results:The expression of MUC1 was low in 65 patients and high in 39 patients. Ki67 expression was low in 52 patients and high in 52 patients. High expression of MUC1 was correlated with lymph node metastasis ( P<0.05), while high expression of Ki67 was correlated with tumor nodes number, lymph node metastasis and vascular invasion (all P<0.05). Multivariate analysis showed that ICC patients with high MUC1 expression ( HR=2.321, 95% CI: 1.420-3.792, P<0.001) and high Ki67 expression ( HR=2.012, 95% CI: 1.247-3.247, P=0.004) showed a poor prognosis after hepatectomy. ICC patients with high MUC1 expression ( HR=1.664, 95% CI: 1.058-2.618, P=0.028) and high Ki67 expression ( HR=1.883, 95% CI: 1.168-3.035, P=0.009) had a poor prognosis after hepatectomy. Conclusion:High expression of MUC1 and Ki67 is correlated with tumor growth and metastasis. MUC1 and Ki67 are independent risk factors for prognosis of ICC patients after hepatectomy.
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Objective:To analyze the clinicopathological features, diagnosis and treatment of neuroendocrine carcinoma of gallbladder (GB-NEC).Methods:The clinical data of 17 patients with GB-NEC confirmed by postoperative pathology managed at the People's Hospital of Zhengzhou University from March 2013 to January 2020 were analyzed retrospectively. There were 9 males and 8 females, with an age of (68.9±11.2) years. The clinical and follow-up data were analyzed.Results:The main clinical manifestations were abdominal pain ( n=9, 52.9%), anorexia ( n=5, 29.4%), jaundice ( n=2, 11.8%), abdominal mass ( n=2, 11.8%), and asymptomatic ( n=2, 11.8%). Radical resection of gallbladder carcinoma was performed in 9 patients, and palliative resection in 8 patients. Postoperative chemotherapy was given to 4 patients. Postoperative pathology showed small cell type in 11 patients and large cell type in 6 patients. Immunohistochemical staining showed synaptophysin positivity in 17 patients (100.0%), chromogranin A positivity in 12 (70.6%), Ki67 positivity in 17 patients (100%, >50% was defined as positive). All 17 patients were followed-up from 78 to 745 days, with a median of 237 days. At the time of censor of this study, 13 patients had died. The 1-and 2-year cumulative survival rates were 26.5% and 19.9%, respectively. The 1- and 2-year cumulative survival rates of radical gallbladder carcinoma resection ( n=9) were 44.4% and 33.3%, respectively. Eight patients underwent palliative resection, and the longest follow-up time was 276 days. Conclusion:This study showed the incidence of GB-NEC was low. There was no specific clinical manifestations, and the diagnosis mainly depended on immunohistochemistry. Patients with GB-NEC had high expressions of Ki67 and had poor prognosis. Early radical resection was helpful to improve survival of these patients.
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Objective To describe the characteristics of dysphagia in patients with head and neck cancer during radiotherapy,and analyze the cause of dysphagia and the relationship between dysphagia and weight change.Methods Patients with head and neck cancer treated with radiotherapy in Beijing Cancer Hospital from November 2017 to June 2018 were recruited.The M.D.Anderson Dysphagia Inventory (MDADI) was used to assess the dysphagia of patients before (T1),during (T2) and at the end (T3) of the radiotherapy.Meanwhile,the weight,dietary intake and radiation adverse effects were investigated.Generalized estimating equations were used to analyze the impact factors of dysphagia and the relationship among dysphagia,dietary intake and weight change.Results Ninety-six patients were completely investigated and the incidence of dysphagia were 6.3％ (6/ 96),80.2％ (77/96) and 85.4％ (82/96) in T1,T2 and T3.With the progress of radiotherapy,the total score and the scores of 4 dimensions of MDADI dropped and the dietary intake declined.The average weight loss was (5.09±3.31) kg,and 76.1％ of the patients had weight loss over 5％ at the end of radiotherapy.The occurrence of dysphagia was associated with the radiotherapy-related oral and laryngeal mucositis and the weight loss was closely associated with the site of radiation,dysphagia,and dietary intake decline.Conclusions The dysphagia of patients with head and neck cancer is affected by radiation adverse effects,and is most severe at the end of radiotherapy.Dysphagia might result in dietary intake decline and weight loss.Clinicians should pay close attention to the swallowing function of the patients and take measures earlier accordingly.
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Objective To investigate the taste alteration caused by radiotherapy and its relationship with nutritional status in head and neck cancer patients during and after radiotherapy.Methods From March to November 2017,172 patients with head and neck cancer receiving radiotherapy were recruited from Beijing Cancer Hospital including 86 patients completing all follow up visits.Chemotherapy-induced Taste Alteration scale was used to evaluate radiotherapy-induced taste alteration and the Patient-generated subjective global assessment (PGSGA) was used for nutrition evaluation at baseline,mid-treatment,post-treatment and 1-2 months after radiotherapy (follow-up).Generalized estimating equations was applied to analyze the influencing factors of taste alteration and its relationship with nutritional status.Results The incidence of taste alteration were 9.3％,84.9％,94.2％ and 77.9％ respectively at baseline,mid-treatment,post-treatment and 1-2 months after radiotherapy (follow-up).Taste alteration score increased with the increase of radiation dose,reached the highest at the posttreatment and decreased at follow-up visit which was still higher than the score at baseline.PG-SGA score increased with the increase of radiation dose.The incidence of severe malnutrition after radiotherapy was 95.3％,decreased to 45.3％ at follow up visit.Nutritional status was closely related to taste alteration.Total radiation dose and concurrent chemotherapy were the influencing factors of taste alteration.Conclusions The taste of patients with head and neck cancer is affected by radiotherapy.As radiotherapy continues,the taste alteration aggravates and PG-SGA score increases gradually,thus malnutrition becomes a prominent problem.Such effect will persist for a period of time after radiotherapy,which should be paid attention and interventions should be conducted to prevent or reduce this effect,in order that the lasting of malnutrition induced by taste alteration can be avoided.
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ObjectiveTo investigate the efficacy of intensity-modulated radiotherapy (IMRT) in treating large primary hepatocellular carcinoma (LHCC) which is unsuitable for surgery or has poor response to radiofrequency ablation, interventional therapy, and other local treatments, and to identify the prognostic factors for survival. MethodsWe retrospectively analyzed the clinical data of 29 LHCC patients who received IMRT from April 2008 to August 2011. There were five fractions per week and the dose for each fraction was 2 to 6 Gy; the total dose was 50 to 70 Gy. The short-term efficacy and prognosis were observed and analyzed. The Kaplan-Meier method was used to calculate survival rates and the log-rank test was used for survival difference analysis. Multivariate analysis was performed using the Cox regression model. ResultsThe complete remission, partial remission, stable disease, and disease progression rates were 3.57%, 32.14%, 53.57%, and 10.72%, respectively. The overall median progression-free survival (PFS) time was 6.43 months, and the median overall survival (OS) time was 11.43 months. The 1- and 2-year survival rates were 46.79% and 25.23%, respectively. Univariate analysis showed tumor response rate was an independent prognostic factor for PFS. The Cox proportional hazard model suggested the tumor response rate and prescribed dose were the independent prognostic factors for PFS. In addition, the independent prognostic factors for OS included tumor response rate, tumor diameter, and tumor volume. The common acute radiotherapy toxicities included gastrointestinal discomfort, radiation-induced liver damage, and myelosuppression. ConclusionIMRT is a safe and effective option for the LHCC patients who are unsuitable for surgery or in the cases that other local therapies fail.
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In order to meet the requirements of the multi-physiological signal measurement of the 3D-TV health assessment, try to find the suitable biological acquisition chips and design the hardware system which can detect different physiological signals in real time. The systems mainly uses ARM11/S3C6410 microcontroller to control the EEG/EOG acquisition chip RHA2116 and the ECG acquisition chip ADS1298, and then the microcontroller transfer the data collected by the chips to the PC software by the USB port which can display and save the experimental data in real time, then use the Matlab software for further processing of the data, finally make a final health assessment. In the meantime, for the different varieties in the different brain regions of watching 3D-TV, developed the special brain electrode placement and the experimental data processing methods, then effectively disposed the multi-signal data in the multilevel.
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Simulação por Computador , Desenho de Equipamento , Microcomputadores , Fenômenos Fisiológicos , Processamento de Sinais Assistido por Computador , SoftwareRESUMO
Objective To investigate the protective effects of recombinant human erythropoietin (rHuEPO) on caecal ligation and puncture (CLP)-induced acute liver injury.Methods Ninety-six healthy male Sprague-Dawley rats weighing 250-300 g were randomly divided into 3 groups:normal control group (sham group,n =32),CLP model group (sepsis group,n =32) and rHuEPO treatment group (n =32).The rat model of sepsis was established by caecal ligation and puncture.In treatment group,rats were treated with rHuEPO 5000 U/kg administered through caudalis vein after CLP procedure.Continuous observation was carried out until 24 h after modeling.Of each group,8 rats were sacrificed at 2 h,6 h,12 h and 24 h,respectively,and then the liver tissue samples and blood samples were collected.Blood samples were assayed for determining the levels of serum cytokines [tumor necrosis factor-alpha (TNF-α)],and inducible nitric oxide synthase (iNOS) by using the enzyme-linked immunoadsorbentassay (ELISA) method.The levels of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were also detected.Histopathological changes of liver tissues were observed under optical and transmission electron microscopy.Results (①)The levels of ALT,AST,TNF-a,iNOS in serum of rats in control group were lower than those in model group and rHuEPO group (P ＜0.01).The levels of TNF-α,IL-6 and iNOS in serum of rats in rHuEPO group were decreased significantly compared with model group (P ＜ 0.01).(②) The optical microscopy and the transmission electron microscopy showed hepatocyte edema,liver focal necrosis,inflammatory cell infiltration in portal area and severe congestion of interlobular veins,hepatocyte karyopyknosis,mitochondrial and endoplasmic reticulum (ER) obviously decreased in sepsis group at 24 h.Hepatic injury was attenuated after employment of rHuEPO.Conclusions Recombinant human erythropoietin can inhibit the levels of ALT,AST,TNF-a,iNOS in serum,thus modifying the inflammatory response and providing protective effects against acute liver injury in the wake of infection.
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Objective To investigate the impact of systolic blood pressure (SBP) at admission on in-hospital outcomes in patients with ST elevated acute myocardial infarction (STEMI).Methods Data of 336 STEMI patients admitted from September 2008 to May 2011 were retrospectively analyzed.Total of 336 STEMI patients were classified into 4 groups as per the level of SBP at admission:group A (＜ 101 mmHg,n =59) ; group B (101-120 mmHg,n =109) ; group C (121-140 mmHg,n =98) and group D (＞ 140 mmHg,n =69).And clinical features,coronary angiography (CAG) findings,the strategy of treatment,complications and hospital mortality were compared among 4 groups with SPSS version 18.0 software.Results The mortality rates of the four groups were 18.64％,1.83％,4.08％,1.45％,respectively.The patients with SBP ＜ 106 mmHg were in greater risk of in-hospital mortality,Killip class ≥ 3 at admission,shock and refractory arrhythmias,and more patients in this group needed pacemaker and intraaortic balloon pump (IABP) treatment than patients in other 3 groups.While there was no significant difference in mortality rate between other three groups.Multivariate logistic regression analysis demonstrated SBP ＜ 101 mmHg (OR =6.368,P =0.002) and peak value of troponin Ⅰ (OR =3.781,P =0.008) were independent risk factors of in-hospital death in STEMI patients.Conclusions The STEMI patients with SBP ＜ 101 mmHg at admission had higher mortality rate and low SBP at admission had great prognostic value in short-term outcomes of STEMI.
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Objective To explore the therapeutic effect of lipid emulsion on acute organophosphorus poisoning and its consequence of acute lung injury. Methods A total of 48 sealant - grade Sprague-Dawley (SD) rats were randomly divided into four groups A,B,C,D,namely saline control group,lipid emulsion control group,the conventional therapy group and lipid emulsion administration group. After dichlorvos (DDVP) 11 mg/kg was given by intra-peritoneal injection,if there was no loss of DDVP during the injection process,the model of poisoning was considered to be made successfully.Then the rat models in four groups were respectively treated:with normal saline (5 ml/kg) intravenous injection in group A,lipid emulsion (5ml/kg) intravenous injection in group B,atropine (5 mg/kg) and pralidoxime chloride (40 mg/kg) intramuscular injection in group C,and combined use of lipid emulsion (5 ml/kg) with atropine and pralidoxime chloride in group D after administration of DDVP by intra-peritoneal injection.The activity of cholinesterase (CHE) in blood was detected before and 0.5 h,2 h and 4 h after DDVP poisoning. The clinical manifestations,the survival of rats,the wet weight of rat' s lung and the pathological changes of the lung tissue were observed within following 24 h. The rates of survival and symptoms of rats were compared between paired groups by using the x2 test,and the mean values of biomarkers were compared paired groups by using t test. Results In groups A and B,the intensity of muscular fasciculation and salivation were more severe and appeared sooner after DDVP exposure in comparison with groups C and D leading to lower survival rates in group A and B. Compared with group C,the rate of 24 h survival was higher and the intensity of muscular fasciculation was weaker in group D ( P ＜ 0.05 ).In group A and group B,the 24-hour survival rates were 1/12 and 2/12,respectively ( P ＜ 0.05 ).The levels of CHE in blood significantly decreased after DDVP poisoning ( P ＜ 0.05 ).There was no significant difference in activity of CHE between group B and group A,and in groups C and D,the levels of CHE in blood were not significantly higher than that in the group B 0.5 h after DDVP poisoning ( P ＜ O.05 ).In groups C and D,the activity of CHE in blood was significantly higher compared with group A and B,and that in group D was higher compared with C,and that in group B was higher compared with A 2 and 4 hours after DDVP poisoning ( P ＜ 0.05 ).In groups C and D,the wet weight of rat lung was significantly lighter compared with groups A and B,and that in group D was lighter compared with C,and that in group B was lighter compared with A 24 h after DDVP poisoning P ＜ 0.05 ).The electron microscopic findings showed the combined use of lipid emulsion with atropine and pralidoxime chloride obviously lessened the lung histopathologic changes after DDVP poisoning.Conclusions The lipid emulsion combined with atropine and pralidoxime chloride can be beneficial to controlling the toxic symptoms,reduce the death rate,accelerate the resume of the activity of CHE in blood,and relieve the lung injury induced by acute organophosphorus poisoning.
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Objective To discuss the effect of Montelukast (Mont) on MDA,SOD,W/D,TNF-α,IL-10 and NF-κBp65 in lung tissue of Wistar rats poisoned by paraquat (PQ) and also to observe the pathological changes of the lung tissue.Methods A total of 104 Wistar rats were divided into 3 groups in random (random number),namely PQ group (n =40),Mont group (n =40) and control group (n =24).PQ (20 mg/kg) was administered by intra-peritoneal route to rats of PQ group and Mont group and narcotics were used for 2 hours.Mont in dose of 50 mg/kg was administered intra-gastrically to rats of Mont group per day and saline instead were administered to PQ group and control group per day until they were sacrificed for experiment.Of both PQ group and Mont group,10 rats were sacrificed at each interval of 1,3,5 and 7 days respectively after modeling,whereas 6 rats of control group were sacrificed at each interval.The levels of MDA and SOD in lung tissue and W/D of lung tissue,the levels of serum TNF-α and IL-10 and the level of NF-κBp65 in lung tissue were determined.Further,the specimen of lung tissue was prepared for electron microscopy observation.Results The level of MDA in lung tissue of PQ group was (8.19 ± 0.53) nmol/mg prot,which was significantly higher than that of control group on the 7th day.The level of SOD in lung tissue of PQ group was (128.76 ± 10.18) U/mg prot,which was significantly lower than that of control group.In PQ group,the W/D of lung tissue (6.62 ±0.42),level of serum TNF-α (156.16 ± 11.13) pg/ml,level of IL-10 (43.63 ±4.44) pg/ml and level of NF-κBp65 in lung tissue (0.23 ±0.02) were significantly higher than those in control group (P ＜0.01).In Mont group on the 7th day,the level of serum TNF-α (129.99 ±13.13) pg/ml,level of serum IL-10 (34.28 ± 3.80) pg/ml and level of NF-κBp65 in lung tissue (0.20 ±0.02) were significantly lower than those in PQ group (P ＜ 0.01).In the PQ group,pathological changes of lung tissue under the light and electron microscopes were acute diffused lung injury manifested itself in hemorrhage,effusion and infiltration of inflammatory cells inside the alveolar space,and the necrosis and defluxion of Ⅰ type and Ⅱ type epithelia cells.The pathological changes in Mont group were localized with infiltration of scanty inflammatory cells,and Ⅰ type epithelia cells were intact and there was no obvious necrosis of Ⅱ type epithelia cells.Conclusions Mont has protective effects on acute lung injury caused by PQ poisoning in rats.
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Objective To investigate the protective effects of recombinant human erythropoietin (rHuEPO) on caecal ligation and puncture (CLP)-induced acute kidney injury (AKI).Methods A total of 260 healthy male Sprague-Dawley rats (250-300 g) were randomly divided into 6 groups:normal control group,sham group,CLP model group,the large dose rHuEPO (5000 U/kg)group,the middle dose rHuEPO (1000 U/kg) group,and the small dose rHuEPO (500 U/kg) group.The rat models of sepsis were established by CLP.In treatment groups,rats were treated with rHuEPO through caudalis injection after CLP surgery.Each group was divided into 2-,6-,12-,24-,36-hour subgroups with 10 rats.Rats were sacrificed and the tissue samples including kidney and blood samples were collected.The kidney function,plasma cytokines [interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α)],kidney injury moleclue 1 (KIM-1) and inducible nitric oxide synthase (iNOS)were measured.Cytokines were determined by ELISA method.The expression of nuclear factor-kappaB (NF-κB) protein in kidneys were detected by immnunohistochemistry method.Pathological changes of kidney tissues were observed by light and transmission electron microscopy for cytokine content and apoptosis.Results Compared with CLP model group,renal function,the levels of TNF-α,IL-6,KIM-1 and iNOS in serum,the expression of NF-κB,significantly decresed in large dose rHuEPO group (all P ＜ 0.05).rHuEPO also lessened the histological changes in large dose group.rHuEPO did not lessen the histological changes in others.Conclusion rHuEPO can inhibit the levels of TNF-α,IL-6 and iNOS in serum,thus modify the inflammatory response and provide protective effects against acute kidney injury induced by sepsis.