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Objective:To explore the prognostic value of tumor deposits (TD) by number and anatomical distribution in gastric cancer (GC) patients without lymph node metastasis.Methods:From Aug 2012 to Aug 2018 all 91 GC patients undergoing radical gastrectomy and without nodal metastasis at Yijishan Hospital of Wannan Medical College were enrolled in this study. Patients were divided into L1, L2, and L3 groups according to the number of TD and into Q1 and Q2 groups according to the anatomical regions of the TD.Results:The 3-year overall survival (OS) rates of groups L1, L2, and L3 were 58.9%, 52.1%, and 31.5%, respectively ( χ2=9.769, P=0.008). The 3-year OS rates of groups Q1 and Q2 were 58.9% and 7.1% ( χ2=46.310, P<0.001). The number of TD, their distribution, neural invasion, vascular invasion, tumor size, and pT stage were all related to prognosis by univariate analysis (all P<0.05). Tumor size>4 cm ( HR=2.460, 95% CI:1.307-4.629, P=0.005), distribution of TD (non-perigastric)( HR=3.959, 95% CI:2.077-7.545, P<0.001), neural invasion ( HR=4.299,95% CI:1.953-9.461, P<0.001), and pT 4 stage ( HR=2.283, 95% CI:1.250-4.171, P=0.007) were independent risk factors for prognosis by multivariate analysis. Conclusion:The distribution of TD (non-perigastric) is an independent risk factor for poor prognosis in gastric cancer patients after radical gastrectomy and with negative lymph node metastasis.
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Objective:To observe the effect of early rehabilitation exercise on blood pressure of elderly patients with septic shock.Methods:A single-center, prospective, randomized controlled study was conducted in elderly patients with septic shock who were hospitalized in the department of critical care medicine of Huangshan Shoukang Hospital (High-tech Zone Central Hospital of Huangshan) from December 2018 to November 2020. According to the principle of simple random, all patients were divided into control group and intervention group. Both groups were treated with lower limb barometry to prevent deep vein thrombosis, 3 times a day, 30 minutes each time. After comprehensive treatment in the intensive care unit (ICU), the severity of patients was gradually improved, the hemodynamics was relatively stable, and the norepinephrine was reduced to 0.5 μg·kg -1·min -1. The control group continued to receive lower limb barometric treatment without rehabilitation training, while the intervention group began rehabilitation training when the dose of norepinephrine was reduced to 0.5 μg·kg -1·min -1. The duration of norepinephrine use, the length of ICU stay, and the occurrence of adverse events during rehabilitation training in intervention group was recorded. Results:Seventy-two patients were included in the final analysis, 35 in intervention group and 37 in control group. There was no significant difference in gender, age, Oxford acute severity of illness score (OASIS), acute physiology and chronic health evaluationⅡ (APACHEⅡ), mean arterial pressure (MAP) of 3 times and underlying diseases between two groups. Compared with control group, the length of ICU stay and duration of dose of norepinephrine ≤0.5 μg·kg -1·min -1 in intervention group were significantly shorter [length of ICU stay (hours): 193.0 (145.5, 312.0) vs. 242.5 (180.0, 483.5), P < 0.05; duration of dose of norepinephrine ≤0.5 μg·kg -1·min -1 (hours): 120.0 (72.0, 144.0) vs. 144.5 (120.0, 192.0), Z = 2.976, P = 0.003]. In intervention group, 35 patients did not show acute myocardial infarction, arrhythmia, syncope, central venous catheter detachment, and gastric tube detachment during the rehabilitation period, except 1 patient suffered from naked hematuria due to urinary catheter traction, which disappeared the next day after symptomatic treatment. Conclusion:The early rehabilitation exercise was beneficial to the recovery of autonomic blood pressure in elderly patients with septic shock, shorten the time of norepinephrine use and ICU stay.
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Objective To explore the value of Oxford acute severity of illness score in evaluating the severity and prognosis of critical illness patients.Methods All adult patients admitted to the Department of Critical Care Medicine from August 2012 to July 2014 were retrospectively analyzed.The severity in survivors and non-survivors was evaluated by using Oxford acute severity of illness score and APACHE Ⅲ score,and then statistic analysis were performed.Results Of 470 patients,321 (68.297％) were male,the range of age and ((x) ±s) age were 18 to 97 years and (59 ± 18) years respectively,and 123 patients (26.170％) were in non-survivors group and 347 patients in survivors group.The area under the ROC of Oxford acute severity of illness score was 0.760 (95％ CI:0.712-0.808,P ＜ 0.001),and Youden index was biggest when Oxford acute severity of illness score was 30.5.The area under the ROC of APACHE Ⅲ score was 0.844 (95％ CI:0.806-0.882,P ＜ 0.01),and Youden index was biggest when APACHE Ⅲ score was 70.5.Mortality was high (above 70％) as Oxford acute severity of illness score increased (＞ 40),and Spearman r was 0.976 (P ＜ 0.01).Conclusions Oxford Acute Severity of Illness Score was useful to evaluating the severity and prognosis of critical illness patients and it was easy in clinical practice.
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We and others have shown that Astragalus extract [AE] regulates various cellular processes including inflammation and apoptosis. It remains elusive whether and how AE modulates apoptosis in gastric cancer cells in vitro and in vivo. The objective of this study is to determine the effects and mechanisms of AE on the proliferation and apoptosis of human gastric cancer SGC-7901 cells and on tumor growth in orthotopic transplantation gastric tumor model in nude mice. Human gastric adenocarcinoma SGC-7901 cells and nude mice implanted with gastric cancer cells were treated with different concentration of AE and 5-fluorouracil as control. Cellular proliferation, apoptosis and tumor growth as well as interleukin [IL]-6/signal transducer and activator of transcription [Stat] 3 signals pathway were determined. We found that AE inhibited proliferation but caused apoptosis in human gastric cancer cells. Furthermore, the tumor growth and volume were reduced by AE administration in nude mice implanted with gastric cancer cells. In addition, treatments with AE decreased the expression of Bcl-2 proteins, whereas the expression of Bax was increased after AE treatment in tumor tissues of nude mice transplanted with human gastric cancer cells. This was associated with AE-mediated reduction of IL-6, phosphorylated Stat3, survivin and vascular endothelial growth factor. Overall, AE enhances apoptosis in gastric cancer cells in vitro and in vivo, which is associated with decreased activation of IL-6/Stat3 signals
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Objective To explore the application value of pulse induced contour cardiac output (PiCCO) monitoring in diagnosis and treatment of patients with neurogenic pulmonary edema (NPE).Methods With review of literature, the data of 4 patients of severe neurological disease complicated by NPE admitted into Department of Critical Care Medicine of Huangshan People's Hospital Affiliated to Wannan Medical College from 2011 to 2013 were retrospectively analyzed and discussed in their PiCCO hemodynamic characteristics and processes of treatment.Results The PiCCO of 4 patients with NPE showed that the extravascular lung water index (EVLWI) was increased significantly (EVLWI was 12 - 42 mL/kg on admission and 10 - 22 mL/kg after hospitalization for 24 hours), all revealing a high permeability pulmonary edema type. The capacity balance of the first 24 hours in the 4 cases was all of positive balance (+1 130, +1 200, +1 750, +1 120 mL respectively). In the treatment, the supplementary colloid was strengthened, the vasoactive drugs such as, dopamine, dobutamine, milrinone, etc were applied to improve the circulatory oxygenation, then the EVLWI was declined; finally the disease situation in 3 cases was improved and one died.Conclusions The clinical diagnosis and treatment of NPE is complex, and many contradictions appear in the therapeutic course. PiCCO monitoring is valuable in early diagnosis, identification of pulmonary edema type, guidance in fluid supplement and vascular active drug application, and assessment of disease severity and prognosis.
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ObjectiveTo explore the risk factors of the occurrence of acute kidney injury (AKI) in critically ill patients, and to investigate the effect of hydroxyethyl starch (HES) on renal function in these patients.Methods A prospective investigation was conducted. Critically ill patients admitted to Department of Critical Care Medicine of People's Hospital of Huangshan, Wannan Medical College from March 2012 to October 2013 were enrolled. For all the patients under observation, the following data were collected: demography, comorbidities, clinical presentation, severity of illness, and the use of blood product and drugs. All patients were divided into AKI group and non-AKI group by means of Acute Kidney Injury Network (AKIN) criteria, then the risk factors of AKI were investigated by means of univariate and multivariate logistic regression analysis. The effect of HES 130/0.4 administration on renal function in critically ill patients was evaluated.Results 314 patients were enrolled for study out of 1 152 patients admitted. Among these patients enrolled, 89 of them were found to suffer from AKI. AKI was classified as stage 1 in 59 patients, stage 2 in 19 patients, and stage 3 in 11 patients. It was shown by the univariate analysis that 12 variables were the risk factors of AKI, including age, hypertension, diabetes mellitus, acute physiology and chronic health evaluationⅡ (APACHEⅡ) score, sequential organ failure assessment (SOFA) score, coagulation SOFA score, neurological SOFA score, cardiovascular SOFA score, blood pH on intensive care unit (ICU) admission, blood glucose on ICU admission, accumulating dose of HES, and presence of shock (P 0.05). Using the multivariate logistic regression analysis, it was shown that total SOFA score [odds ratio (OR) = 1.20, 95% confidence interval (95%CI) = 1.09-1.32,P< 0.001], hypertension (OR = 2.44, 95%CI = 1.22-4.89,P= 0.012), blood glucose level on ICU admission (OR= 1.85, 95%CI = 1.32-2.59,P< 0.001), and presence of shock (OR = 3.81, 95%CI = 1.93-7.53,P< 0.001) were independent predictors of AKI in critically ill patients, however, the cumulative dose of HES was not independent risk factor for AKI (OR = 0.77, 95%CI = 0.68-0.87,P< 0.001).Conclusions Total SOFA score, hypertension, blood glucose level on ICU admission, and presence of shock were independent risk factors for AKI in critically ill patients. HES administration may not be a causative factor of an increased risk of AKI in the ICU.
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Objective To explore the significance of warning score of potential critical disease in predicting changes in patients with traumatic brain injury. Methods The clinic information of 75 patients with traumatic brain injury who were treated in the People's Hospital of Huangshan Affiliated to Wannan Medical College from Jan. to Dec. 2013 were analyzed retrospectively. The warning score of potential critical disease, modified early warning score( MEWS)and glasgow coma score( GCS)of all patients and the rates of changes in patients were calculated. Results Of 75 patients enrolled,60 were survived and 15 were died. Seventy-five patients were performed 448 times of warning score of potential critical disease,MEWS and GCS. The maximum, minimum of warning score of potential critical disease were 24 and 0,and the median score(P25,P75)was 4(2, 7). The maximum,minimum of MEWS were 24 and 0,and the median score( P25,P75 )was 4( 3,7 ). The maximum,minimum of GCS were 8 and 3,and the median score(P25,P75)was 5(4,7). The area under ROC of warning score of potential critical disease was 0. 76(95%CI =0. 66 -0. 86,P ﹤0. 01),Youden index was 0. 42 when score was taken 5. 5. The area under the ROC of MEWS was 0. 71( 95%CI =0. 61 -0. 81,P﹤0. 01),Youden index was 0. 4 when taken 3. 5 score. The area under the ROC of GCS was 0. 51(95%CI=0. 37-0. 63,P=0. 99),Youden index was 0. 27 when score was taken 4. 5. Conclusion The warning score of potential critical disease is effective to predict changes in conditions of patients with multiple injuries and better than MEWS and GCS.
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Objective To explore the value of waring score of potential critical disease in predicting changes in condition of patients with multiple injuries. Methods From January 1, 2013 to July 31, 2013, all patients with multiple injuries were included prospectively. Patients were observed as soon as ICU admission. The waring score of potential critical disease and MEWS of all patients and the rates of changes in condition of patients were calculated then statistic analysis was performed. Results Of 50 patients enrolled, 44 were survived and 6 were died and 295 changes were found. The maximum , minimum median (P25, P75) of waring score of potential critical disease were 22, 0, 5 (3, 7). The maximum, minimum median (P25, P75) of MEWS were 12, 0, 4 (2, 6). The area under the ROC of waring score of potential critical disease was 0.880 (95% CI, 0.813-0.947, P < 0.001). Youden index was the biggest when waring score of potential critical disease was 6.5. The area under the ROC of MEWS was 0.767 (95% CI, 0.661-0.873, P < 0.001). Youden index was the biggest when MEWS was 5.5. Conclusion The waring score of potential critical disease was effective to predict changes in conditions of patients with multiple injuries and better than MEWS.
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ObjectiveTo survey the status of Helicobacter pylori (HP)infection in cholangiocarcinoma,and its relation to clinical and pathological parameters and prognosis. MethodsHP infection in 80 cholangiocarcinoma samples and 30 controls was detected by PCR,in those with positive results the expression of Cag A and its subtypes of Vac A sla,m1 and m2 was further tested by PCR.ResultsChi-square test showed that the detection rate of in HP ( + ) in cholangiocarcinoma group is 71％,higher than 20％ in control group.The positive cases of CagA and VacA sla,m1,m2 in cholangiocarcinoma group was respectively 30,40,5 and 43 cases.HP infection in cholangiocarcinoma was correlated with the location of the tumor(x2 =27.580,P ＜ 0.05 ). MultivariateLogisticanalysisshowedthat cholangiocarcinoma is over 10 times more likely in HP ( + ) patients than HP ( - ) ( OR =10.531 ).Cox regression analyses showed that the infection of HP(HR =8.105,P =0.032),the staging of TNM( Ⅱ/ⅢHR=9.141,P=0.040,Ⅳ HR =29.071,P=0.040) and surgery (HR=9.531,P =0.015) are all independent prognostic factors of cholangiocarcinoma. Life table analyses showed HP infection negatively affects the survival time of cholangiocarcinoma after a surgery ( u =10.074,P =0.002),and the median survival time is 7.25 months shorter than HP( - ) patients. ConclusionsIt is common that HP infection complicating cholangiocarcinoma,usually with the genotype of VacA sla/m2,HP infection is a risk factor for cholangiocarcinoma,and negatively affects oatients survival after surgery.
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Objective To explore the relationship between cholelithiasis and the function of sphincter of Oddi (SO). Methods To identify the existence of calculi, choledochoscopy was performed in patients 6 weeks after exploration of the common bile duct (CBD) and T tube drainage, in which 71 were patients with stones in gall bladder, CBD or intra-hepatic bile duct, and 9 with trauma of pancreas or liver.Biliary manometry was performed after choledochoscopy, and an additional manometry was applied after calculus removal if calculi were detected. The indices measured included SO basal pressure ( SOBP), amplitude of SO contractions (SOCA), frequency of SO contractions (SOF) and CBD pressure (CBDP). The patients with cholelithiasis were classified into cholecystolithiasis group, choledocholithiasis group, and hepatolithiasis group according to the position of calculi. Patients with trauma were assigned as the control group.Results All variables in 50 patients with choledocholithiasis were similar before and after the procedure.The variables in patients with cholecystolithiasis and choledocholithiasis had no difference from those of the control (P ＞ 0. 05 ). The SOBP and SOCA of patients in hepatolithiasis group were lower than those of the control group ( P ＜ 0. 05 ), while no difference in SOF was detected (P ＞ 0. 05 ). Conclusion The function of SO in patients with hepatolithiasis is abnormal ( decrease in SOBP and SOCA). Biliary manometry cannot be the reliable evidence for the existence of calculi in bile duct.
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Objective To establish the canine model of esophageal variees caused by portal hyper-tension. Methods The model was established in 12 dogs with a side-to-side portacaval shunt, an ameroid constrictor around the portal vein and double ligation and cross suture of the cephalic part of the inferior vena cava (IVC), and the development of esophageal varices was confirmed 6 weeks later by endoscopy and portal vein angiography. Results The mean pre- and postoperative portal pressure were (11.0 ± 1.1) mm Hg and (22. 9 ± 1.2) nun Hg, respectively (P =0. 010). Endoscopy detected mild to moderate esophageal varices in all dogs, which was confirmed by portal vein angiography, and varices was also seen in abdominal wall. Conclusion Canine model of esophageal varices induced by portal hypertension can be established with the procedure.
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Objective To investigate the changes and significance of the contents of cholecystokinin (CCK) acceptors and nitric oxide synthase (NOS) in sphincter of Oddi and the contents of CCK and nitric oxide (NO) in the blood of the patients with calculus of bile duct. Methods The contents of CCK acceptors and NOS in sphincter of Oddi and the contents of CCK and NO in the blood were determined in 41 patients with gallstone and 6 controls. Results The contents of CCK and NO in the blood of patients with gallstone were significantly higher than that in control [ ( 38.91±4.85 ) pmol/L vs ( 30.67±1.81 ) pmol/L; (40.84±4.74 ) pmol/L vs ( 32.81±1.11) pmol/L] ;The contents of CCK acceptors and NOS in sphincter of Oddi in the patients with gallstone were signifi-cantly lower than in the controls [ (67.59±5.87 ) ng/L vs ( 78.99±1.71 ) ng/L; ( 457.52±45.40 ) ng/L vs ( 519.61±11.38 ) ng/L] ;The contents of CCK and NO in the blood in the different groups with calculus of bile duct were significantly different from those in the controls. Conieusion The degree of the decrease of the contents CCK acceptors and NOS in sphincter of Oddi leads to the decrease of Oddi sphincter function,resuting in cholestasis and promoting the formation of bile duct stone.
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Objective To design and express a novel peptide based on ricin toxin antibody in E. coli, and to evaluate its biological activity. Methods Based on the crystal structure of ricin toxin A chain (RTA) and the RTA-rRNA interact in the complex model, the steric conformation of RTA was theoretical modeled and its functional domain was preliminarily determined. The humanized single-domain RTA antibody was designed rationally by computer-guidod molecular design method. Its coding sequence was ob- tained by overlapping extension PCR, and cloned into the pET-32a vector. The fusion protein was then ex-pressed in E. coli BL21 (DE3), identified by Western blot, and purified with Ni-NTA agarose. The binding and neutralizing activity of this novel peptide for riein was evaluated by competitive ELlSA assay and MTT assay. Results A recombinant human single-domain antibody expressing a polypeptide against RTA in the CDR3 loop was designed. The fusion protein was successfully expressed in E. coll. The purified protein can bind to ricin, and neutralize its activity in SP2/0 viability assay. Conclusion The success of the novel pep-tide based on riein toxin antibody provides a novel method to develop new generation of ricin antagonists.
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Bile duct stone is the common and frequently-occurring disease, its incidence upwards trend. In recent years, people realize that Oddi sphincter movement disorders play an important role in the inci-dence of bile duct stones. NO, CCK, VIP and theie interactian have effects on sphincter function and dis-charged from the regulation of bile. These factors are necessary to conduct an in-depth study to investigate the cause of bile duct stone and its treatment.
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Objective To evaluate the diagnosis and surgical management for pancreatic duct stones (PDS). Methods The clinical data of 19 PDS patients admitted to our hospital from Jan. 1985 to Sep. 2003 were analyzed retrospectively. Results Epigastric pain was the first symptom in all patients,and chronic pancreatitis was associated, pancreatic carcinoma coexisted in 6 cases. Fifteen cases were found to have PDS or pancreatic duct dilation by B-type ultrasonography. Twelve patients underwent pancreatolithotomy plus side to side Roux-en-Y pancreaticojejunostomy. Pancreatoduodenectomy was performed on four patients ,caudal pancreatectomy and pancreatolithotomy on three patients. Six pancreatic carcinoma patients died during follow-up of 9～26 months. Abdominal pain was relieved completely in 11 cases and partially in 1,stones and pain recurred in one patient. Conclusions B-type ultrasonography、CT and endoscopic retrograde cholangiopancreatography(ERCP) are most useful diagnostic methods;Surgical procedures should be selected according to the following factors: (1) location of the pancreatic duct stones. (2) stenosis of the main pancreatic duct.(3) pancreatic duct stones associated with or without pancreatic carcinoma.
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Purpose:To determine the independent prognostic factors of survival for extrahepatic cholangiocarcinoma after operation. Methods:The clinical data of 52 patients with cholangiocarcinom a treated by operation in our hospital from 1992 to 2002 were retrospectively an alyzed and 10 possible factors influencing survival were selected . A multivaria te analysis was performed in these patients by the computer′s Cox proportional hazard model. Results:The over-all cumulative survival rate was 44.2% in a y ear,23.1% in three years and 9.6% in five years.The univariate analysis showed t he major significant prognostic factors influencing survival of these patients w ere mass of tumor of TNM stage,invasion and metastasis , method of operation , e xpression of E-cd and MMP-9 (P