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BACKGROUND: Lymph node (LN) involvement is a critical prognostic factor in patients with gallbladder carcinoma (GBC). Controversy exists regarding optimal categorization of nodal metastasis status, including anatomical location of positive nodes (AJCC 7th N staging), number of metastatic lymph nodes (NMLN), log odds of metastatic LNs (LODDS), and lymph node ratio (LNR). METHODS: Patients who underwent curative-intent resection for GBC from six Chinese tertiary hospitals between 2008 and 2013 were analyzed retrospectively. The relative discriminative abilities of the different LN staging systems were assessed by different models including the tree-augmented naïve Bayesian (TAN) model, Cox proportional hazards regression model, and binary logistic regression model. RESULTS: A total of 226 patients were involved in this cohort. Based on the TAN model and composite importance measures, the most important factor affecting the prognosis in the different LN staging systems was NMLN. Among the four TAN models which were built with 4 metastatic LN markers and baseline variables, the accuracy of the NMLN-based prognostic model was 88.15%, higher than 7th N staging (86.44%), LNR (87.34%), and LODDS (85.19%). The Cox model based on NMLN (C-index: 0.763, AIC: 1371.62) had a higher fitness than the others (7th N staging C-index: 0.756, AIC: 1375.51; LNR C-index: 0.759, AIC: 1378.82; LODDS C-index 0.748, AIC: 1390.99). The AUCs of different staging binary logistic regression models were NMLN (0.872), LNR (0.872), 7th N staging (0.869) and LODDS (0.856), respectively. CONCLUSIONS: NMLN was the optimal LN staging system in evaluating prognosis of GBC.
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Neoplasias de la Vesícula Biliar , Teorema de Bayes , Neoplasias de la Vesícula Biliar/cirugía , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/cirugía , Metástasis Linfática , Estadificación de Neoplasias , Pronóstico , Estudios RetrospectivosRESUMEN
BACKGROUND: With the aging of the population and the increasing trend of chronic illnesses, the demand for palliative care is growing. Undergraduate nursing students will be the main providers of palliative care in the future. Therefore, it's important to enhance their capability for palliative care. OBJECTIVES: The purpose of this study was to optimize palliative care education, based on undergraduate nursing students' perceptions and educational needs through the application of the importance-performance analysis and Borich needs assessment model. DESIGN: A cross-sectional descriptive study. SETTING: Nursing department in Wenzhou, China. PARTICIPANTS: A total of 448 full-time undergraduate nursing students were recruited for the study. METHODS: Importance-performance analysis was used to identify items that obtain high priority for improvement, and the Borich needs assessment model and the Locus for focus model were used to prioritize educational needs. The three methods were integrated to determine the top-priority content to meet undergraduate nursing students' educational needs in palliative care. RESULTS: The items located in Quadrant II of Importance-performance analysis, ranked in the first 10 in Borich needs assessment, and located in Quadrant I of the Locus for focus model were defined as top-priority content. These included: "respiratory symptoms: pleural effusion, superior vena cava syndrome, respiratory difficulty," "Care of terminal symptoms," "Awareness of dying," "Care of remains," "Cooperation between interdisciplinary teams," and "Rights and interests of dying patients." CONCLUSION: Several years of development of palliative care education have made nursing students aware of its importance. However, they have reported that education remains insufficient. A greater focus on palliative care education is needed to ensure they are better prepared. Specific attention should be given to cooperation between interdisciplinary teams, dealing with death and dying, rights and interests of people who were dying.
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Bachillerato en Enfermería , Estudiantes de Enfermería , Síndrome de la Vena Cava Superior , Humanos , Cuidados Paliativos , Bachillerato en Enfermería/métodos , Evaluación de Necesidades , Estudios TransversalesRESUMEN
Objective:To analyze the preoperative and postoperative serum cholinesterase (CHE) levels in patients with stage ⅠA-ⅢA breast cancer who underwent surgical treatment, and to explore the roles of them and peripheral blood inflammatory markers in the prognostic prediction of stage ⅠA-ⅢA breast cancer.Methods:The relevant blood indicators of 152 patients with stage ⅠA-ⅢA breast cancer who underwent surgery and postoperative adjuvant therapy from January 2012 to December 2017 at Affiliated Huai'an Hospital of Xuzhou Medical University were retrospectively studied. The optimal cut-off values of serum CHE levels and peripheral blood inflammatory markers [systemic immune-inflammation index (SII) and systemic inflammatory response index (SIRI) ] were calculated using X-tile 3.6.1 software. Patients were categorized into low and high value groups based on the optimal cutoff values. Kaplan-Meier curves and Cox regression analysis were used to assess the correlation between CHE and peripheral blood inflammation indexes and disease-free survival (DFS). Spearman correlation coefficient and Wilcoxon test were used to assess the correlation and changes of CHE and inflammation indexes before and after treatment. In addition to this, a nomogram prediction model was conscturcted based on independent prognostic factors by R software, which was validated by Bootstrap method.Results:The CHE levels of patients before and after treatment was 8 645.0 (7 251.3, 10 229.3) and 9 309.0 (7 801.0, 10 835.3) U/L, respectively, with a statistically significant difference ( Z=2.73, P=0.006) .The optimal cut-off values for postoperative CHE (Post-CHE), postoperative SII (Post-SII), and postoperative SIRI (Post-SIRI) associated with patients' DFS, being 7 773 U/L, 741, and 0.9, respectively. Univariate analysis showed that tumor size (≤2 cm vs.>2 cm and ≤5 cm: HR=2.55, 95% CI: 1.30-4.99, P=0.006; ≤2 cm vs. >5 cm: HR=8.95, 95% CI: 4.15-19.32, P<0.001), number of positive lymph nodes ( HR=3.84, 95% CI: 2.24-6.58, P<0.001), clinical stage (stage Ⅰ vs. stage Ⅱ: HR=1.52, 95% CI: 0.68-3.39, P=0.309, stage Ⅰ vs. stage Ⅲ: HR=8.12, 95% CI: 3.76-17.55, P<0.001), Ki-67 expression ( HR=2.19, 95% CI: 1.24-3.84, P=0.007), whether radiotherapy ( HR=2.05, 95% CI: 1.19-3.53, P=0.010), Post-CHE ( HR=6.81, 95% CI: 3.94-11.76, P<0.001), Pre-neutrophil to lymphocyte ratio (NLR) ( HR=1.11, 95% CI: 1.02-1.21, P=0.014), Post-NLR ( HR=5.23, 95% CI: 2.78-9.85, P<0.001), Pre-platelet to lymphocyte ratio (PLR) ( HR=2.08, 95% CI: 1.01-4.26, P=0.046), Post-PLR ( HR=7.11, 95% CI: 3.78-13.37, P<0.001), Pre-lymphocyte to monocyte ratio (LMR) ( HR=0.37, 95% CI: 0.20-0.66, P<0.001), Post-LMR ( HR=0.23, 95% CI: 0.13-0.41, P<0.001), Pre-SII ( HR=1.81, 95% CI: 1.05-3.12, P=0.033), Post-SII ( HR=6.12, 95% CI: 3.48-10.76, P<0.001), Pre-SIRI ( HR=2.12, 95% CI: 1.24-3.63, P=0.006), and Post-SIRI ( HR=4.93, 95% CI: 2.87-8.48, P<0.001) were associated with DFS in patients with stage ⅠA-ⅢA breast cancer. Multivariate analysis showed that tumor size (≤2 cm vs. >2 cm and ≤5 cm: HR=2.86, 95% CI: 1.41-5.78, P=0.003; ≤2 cm vs. >5 cm: HR=3.72, 95% CI: 1.50-9.26, P=0.005), number of positive lymph nodes ( HR=4.66, 95% CI: 2.28-9.54, P<0.001), Ki-67 expression ( HR=2.13, 95% CI: 1.15-3.94, P=0.016), Post-CHE ( HR=0.18, 95% CI: 0.10-0.33, P<0.001), Post-SII ( HR=2.71, 95% CI: 1.39-5.29, P=0.004), and Post-SIRI ( HR=3.77, 95% CI: 1.93-7.36, P<0.001) were independent influencing factors for DFS in patients with stage ⅠA-ⅢA breast cancer. Kaplan-Meier survival curve analysis showed that the median DFS of patients in the Ki-67<30% group was not reached, and the median DFS of patients in the Ki-67≥30% group was 89.0 months, and the 3- and 5-year DFS rates were 84.9% vs. 75.9% and 80.8% vs. 64.3%, respectively, with a statistically significant difference ( χ2=7.65, P=0.006) ; the median DFS of patients in the tumor size≤2 cm group was not reached, the median DFS of the 2 cm<tumor size≤5 cm group was 93.5 months, and the median DFS of the tumor size>5 cm group was 26.3 months, and the 3- and 5-year DFS rates were 95.5% vs. 74.6% vs. 42.1%, 86.3% vs. 68.6% vs. 25.3%, with a statistically significant difference ( χ2=40.46, P<0.001) ; the median DFS of patients in the group with the number of positive lymph nodes<4 was not reached, and the median DFS of the group with the number of positive lymph nodes≥4 was 30.7 months, and the 3- and 5-year DFS rates were 87.9% vs. 46.4% and 81.4% vs. 28.6%, respectively, with a statistically significant difference ( χ2= 47.34, P<0.001) ; the median DFS of patients in the Post-CHE<7 773 U/L group was 47.3 months, and the median DFS of patients in the Post-CHE≥7 773 U/L group was not reached, and the 3- and 5-year DFS rates were 52.8 % vs. 88.6% and 27.8% vs. 81.2%, respectively, with a statistically significant difference ( χ2=62.17, P<0.001) ; the median DFS was not achieved in patients in the Post-SII<741 group, and the median DFS was 30.5 months in the Post-SII≥741 group, with 3- and 5-year DFS rates of 88.1% vs. 38.5% and 80.1% vs. 30.8%, respectively, with a statistically significant difference ( χ2=50.78, P<0.001) ; the median DFS of patients in Post-SIRI<0.9 group was not reached, the median DFS of Post-SIRI≥0.9 group was 33.3 months, and the 3- and 5-year DFS rates were 93.5% vs. 46.7% and 84.9% vs. 39.9%, respectively, with a statistically significant difference ( χ2=40.67, P<0.001). Spearman correlation analysis revealed that Post-CHE was not correlated with Post-SII ( r=-0.111, P=0.175), and Post-CHE was negatively correlated with Post-SIRI ( r=-0.228, P=0.005). Post-treatment CHE was elevated compared to preoperative and the median DFS was not reached in patients with elevated CHE group and 61.8 months in patients with reduced CHE group after treatment, with a statistically significant difference ( χ2=25.67, P<0.001). The nomogram based on independent prognostic factors had good predictive performance, with a C-index of 0.893. Conclusion:The serum CHE level exhibited a significant increase following treatment. Postoperative serum CHE combined with SII and SIRI can effectively predict DFS in patients with stage ⅠA-ⅢA breast cancer, and the prognosis of patients with elevated CHE after treatment is better. The nomogram constructed based on independent prognostic factors has good predictive performance for DFS in breast cancer patients.
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OBJECTIVE: This study was designed to describe the anatomic features of the frontal recess by transnasal endoscopy (nasoscope), to analyze its implications in endoscopic frontal sinus surgery and to discuss the issues that may be experienced during such operations. MATERIALS AND METHODS: The patients included in this analysis were adults with chronic sinusitis or nasal polyp (n = 301, 562 sides) hospitalized in our hospital from August 1998 to April 2001. Chronic frontal sinusitis was confirmed in 280 cases (479 sides) by coronal and axial CT scan. Patients with a previous surgical history were excluded from the analysis. The surgical outcomes of these patients and CT imaging data were retrospectively reviewed and analyzed. The drainage pattern of the frontal sinus was identified based on CT scans preoperatively. Endoscopic frontal sinus surgery was performed in 250 cases (421 sides). The anatomic features of the frontal recess under nasoscope were classified into 2 types. RESULTS: The coronal CT results confirmed the position of the frontal sinus ostium between the uncinate process and the middle turbinate in 203 sides (48.2%) of all operated patients and the ostium was found to be located between the uncinate process and the lamina papyracea in 218 sides (51.8%). According to the location of the frontal sinus ostium, we grouped the anatomic features of the frontal recess into 2 types. Type I was documented in 203 sides (48.2%) and type II was seen in 218 sides (51.8%). CONCLUSIONS: The anatomic features of the frontal recess under nasoscope and their classification are very important and helpful for endoscopic frontal sinsus surgery. The upper part of the uncinate process is a dependable anatomic landmark for the localization of the frontal sinus ostium in CT scan and endoscopic frontal sinus surgery.
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Endoscopía , Hueso Frontal/patología , Sinusitis Frontal/diagnóstico por imagen , Sinusitis Frontal/patología , Pólipos Nasales/diagnóstico por imagen , Pólipos Nasales/patología , Adolescente , Adulto , Estudios de Cohortes , Femenino , Hueso Frontal/diagnóstico por imagen , Sinusitis Frontal/cirugía , Humanos , Masculino , Persona de Mediana Edad , Pólipos Nasales/cirugía , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
Objective:To investigate the effect of tumor-associated macrophage(TAM) on proliferation of renal carcinoma cells and its related mechanism.Methods:The model of TAM was established by stimulating human monocytic leukemia cell line THP-1 with phorbol myristate acetate (PMA), bacterial endotoxin (LPS) and interferon-γ (IFN- γ). Then the TAM model was co-cultured with carcinoma cell lines ACHN and 786-O in vitro .The cytokines IL-6, TNF-α and IL-1β in TAM supernatant were detected by enzyme-linked immunosorbent assay (ELISA). MTT method was used to detect the proliferation of ACHN and 786-O cells treated with supernatant of TAM or TAM/Tocilizumab. Western blot was used to detect lactate dehydrogenase A (LDHA) expression of both renal cancer cells co-cultured with TAM or TAM/Tocilizumab. The ACHN and 786-O cells with LDHA-overexpression and LDHA-knockdown were cultured in TAM supernatant in vitro. The cell proliferation was detected by MTT and the relative proliferation rate was calculated.Results:THP-1 cells was differentiated into TAM through the treatment of 80 ng/ml PMA combined with 20 ng/ml LPS and 20 ng/ml IFN- γ.The expression rate of CD68, a cell surface marker on TAM, was (36.2 ±4.5)%. When TAM was co-cultured with ACHN cells, the results of ELISA showed that the secretion of IL-6 in the supernatant was significantly elevated compared with that in the supernatant when ACHN cells cultured alone [(138.0 ±12.4) pg/ml and (19.7±4.9) pg/ml], and the secretion of TNF- α [(122.5 ±14.2) pg/ml and (12.6 ±2.3) pg/ml] and IL-1 β [(89.2 ±6.4) pg/ml and (69.2 ±3.5) pg/ml] were also significantly increased. The secretion of IL-6 [(119.2 ±14.8) pg/ml and (17.1 ±3.3) pg/ml], TNF- α [(122.6 ±14.4) pg/ml and (45.7 ±7.2) pg/ml] and IL-1 β [(95.1 ±11.8) pg/ml and (88.2 ±12.7) pg/ml] in the supernatant were also significantly elevated when 786-O cells co-cultured with TAM compared with 786-O cells cultured alone. After treated with the supernatant of TAM for 72 hours, the relative proliferation rates of ACHN and 786-O cells [(128.6 ±21.4)% and (124.2 ±19.7)%] were significantly higher than that of the control group (100.0%). At the same time, the expression of LDHA in ACHN and 786-O cells increased significantly. After 72 hours of treatment with the supernatant of TAM combined with tocilizumab, the relative proliferation rates of ACHN and 786-O cells [(76.5±13.7)% and (74.8±12.5)%] were significantly lower than that of the control group(100.0%), and the expression of LDHA was also significantly decreased at the same time. The relative proliferation rates of ACHN and 786-O cells in LDHA overexpression group [(121.5 ±17.2)% and (122.7±21.6)%]were significantly higher than that in blank-vector-transfection group[(93.3±10.7)% and (89.8±11.2)%], while the relative proliferation rates in LDHA-knockdown group [(61.4±11.2)% and (58.0 ±10.6)% ]were significantly lower than that in blank-vector-transfection group.Conclusions:By secreting IL-6, TAM can up-regulate the expression of LDHA and promote the proliferation of renal cancer cells.
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As a threat to human health, steroid-induced osteonecrosis of femur head is a common refractory orthopedic disease mainly caused by glucocorticoids, with poor prognosis and unclear pathogenesis. Osteogenesis-associated signaling pathways play an important role in bone formation. Glucocorticoid-induced abnormal activation and transport of these signaling pathways lead to abnormal differentiation of bone marrow mesenchymal stem cells, dysfunction of bone metabolism, and osteogenesis disorders, which may be the main reasons for the occurrence and development of steroid-induced osteonecrosis of femur head. Bone formation and remodeling need the participation of bone marrow mesenchymal stem cells, which are stem cells characterized by continuous self-renewal and differentiation. The key to strengthening bone remodeling is to improve the osteogenic differentiation capacity, which is the key point to inhibit bone resorption and prevent bone marrow mesenchymal stem cells from differentiating into osteoclasts. Traditional Chinese medicine (TCM) has been used in the treatment of osteonecrosis in ancient times. It is recorded in the Treasury of Words on Materia Medica (《本草汇编》) that "The deficiency in the lower energizer cannot be tonified without Eucommiae Cortexz.The soreness in lower legs cannot be alleviated without Eucommiae Cortex...The pain in the waist and knee cannot be relieved without Eucommiae Cortex...Tonifying liver and invigorating kidney, Eucommiae Cortex is an essential medicine." This indicates that ancient physicians have already begun to use the liver-tonifying, kidney-invigorating, and sinew-bone-strengthening effects of Eucommiae Cortex for the treatment of osteonecrosis. As the national support for the development of TCM strengthens, increasing studies have been conducted on the TCM prevention and treatment of steroid-induced osteonecrosis of femur head. Studies have suggested that Chinese medicinal herbs can exert a positive effect on the differentiation of bone marrow mesenchymal stem cells by affecting targeted signaling molecules, and promote osteogenesis and bone defect repair, thus combating the occurrence and development of steroid-induced osteonecrosis of femur head. The regulation of osteogenic signaling pathway by Chinese medicines to prevent steroid-induced osteonecrosis of femoral head has become a hot research topic. This article reviews the studies about the prevention and treatment of steroid-induced osteonecrosis of femur head with the active components in Chinese medicinal herbs by regulating osteogenic signaling pathways. We then explore the mechanism of the active components in promoting the differentiation of bone marrow mesenchymal stem cells into osteoblasts and inhibiting their differentiation into osteoclasts to facilitate bone formation, aiming to provide a reference for the further study of treating steroid-induced osteonecrosis of femoral head with Chinese medicinal herbs.
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Immunogenic cell death (ICD) plays a major role in cancer immunotherapy by stimulating specific T cell responses and restoring the antitumor immune system. However, effective type II ICD inducers without biotoxicity are still very limited. Herein, a tentative drug- or photosensitizer-free strategy was developed by employing enzymatic self-assembly of the peptide F-pY-T to induce mitochondrial oxidative stress in cancer cells. Upon dephosphorylation catalyzed by alkaline phosphatase overexpressed on cancer cells, the peptide F-pY-T self-assembled to form nanoparticles, which were subsequently internalized. These affected the morphology of mitochondria and induced serious reactive oxygen species production, causing the ICD characterized by the release of danger-associated molecular patterns (DAMPs). DAMPs enhanced specific immune responses by promoting the maturation of DCs and the intratumoral infiltration of tumor-specific T cells to eradicate tumor cells. The dramatic immunotherapeutic capacity could be enhanced further by combination therapy of F-pY-T and anti-PD-L1 agents without visible biotoxicity in the main organs. Thus, our results revealed an alternative strategy to induce efficient ICD by physically promoting mitochondrial oxidative stress.
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Retinal ischemia is the common pathologic process in many ophthalmic diseases, including ischemic optic neuropathy, retinal artery and vein occlusion, carotid artery obstructive disease, retinopathy of prematurity, chronic diabetic retinopathy and glaucoma. It is very important to establish animal models to investigate pathology mechanism and explore the treatment of retinal ischemia disease. At present, the commonly used methods for establishing retinal ischemia animal models include increasing intraocular pressure, ligating of blood vessels, suture method, photochemical method, and drug injection etc. This article summarizes the methods to establish the animal models and analyzes the indication for each animal model. It is expected that the method of establishing a retinal ischemic animal model will be helpful to the experimental design of follow-up retinal ischemia studies.
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Nanotechnology has emerged as an ideal approach for achieving the efficient chemo agent delivery. However, the potential toxicity and unclear internal metabolism of most nano-carriers was still a major obstacle for the clinical application. Herein, a novel "core‒shell" co-assembly carrier-free nanosystem was constructed based on natural sources of ursolic acid (UA) and polyphenol (EGCG) with the EpCAM-aptamer modification for hepatocellular carcinoma (HCC) synergistic treatment. As the nature products derived from food-plant, UA and EGCG had good anticancer activities and low toxicity. With the simple and "green" method, the nanodrugs had the advantages of good stability, pH-responsive and strong penetration of tumor tissues, which was expected to increase tumor cellular uptake, long circulation and effectively avoid the potential defects of traditional carriers. The nanocomplex exhibited the low cytotoxicity in the normal cells
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This paper explores a method of managing the risk of the stock index futures market and the cross-market through analyzing the effectiveness of price limits on the Chinese Stock Index 300 futures market. We adopt a cross-market artificial financial market (include the stock market and the stock index futures market) as a platform on which to simulate the operation of the CSI 300 futures market by changing the settings of price limits. After comparing the market stability under different price limits by appropriate liquidity and volatility indicators, we find that enhancing price limits or removing price limits both play a negative impact on market stability. In contrast, a positive impact exists on market stability if the existing price limit is maintained (increase of limit by10%, down by 10%) or it is broadened to a proper extent. Our study provides reasonable advice for a price limit setting and risk management for CSI 300 futures.
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Comercio/economía , Comercio/métodos , Inversiones en Salud/economía , Modelos Económicos , Algoritmos , Análisis de Varianza , ChinaRESUMEN
Speaking lesson is an effective way and teaching skill to prepare lessons for the teaching of anatomy. Taking the speaking lesson design of lecture teaching of the neck as an example, this article shows the teaching of topographic anatomy for "5+3" integrated clinical medical students. Adhering to the teaching concept of "student-centered", we have launched the theoretical teaching of "problem-centered discussion" and the experimental teaching of "operator responsibility system" in groups, with the "thanksgiving" humanistic education running through the whole process of theoretical and experimental courses. The teaching is a good way to cultivate the students' gratitude consciousness and humanistic quality, self-learning ability, critical thinking ability, communication and expression ability, hands-on operation ability and teamwork spirit, which has laid a solid foundation for training medical professionals in the new era.
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Objective@#To analyze the clinical value of serum tumor markers CA19-9, CA242, CEA, CA724 and CA125 in the diagnosis and prognosis of gallbladder carcinoma patients.@*Methods@#A retrospective analysis of the preoperative serum levels of CA19-9, CA242, CEA, CA724 and CA125 in 132 patients with gallbladder cancer admitted to Eastern Hepatobiliary Surgery Hospital from March 2009 to December 2013 for sensitivity comparison, Kaplan-Meier survival table was used for univariate survival analysis, and the log-rank method was compared for differences. The Cox regression model was used for multivariate survival analysis.@*Results@#The sensitivities of CA19-9, CA242, CA125, CEA and CA724 were 67.4%, 63.6%, 42.4%, 24.2% and 22.7%, respectively. There were no significant differences of the sensitivity between CA19-9 and CA242 (P>0.05). However, whether CA19-9 or CA242, there were significant differences of diagnostic sensitivity compared to CEA or CA724 or CA125 (all P<0.05). When CA19-9 was combined with CA125 or CEA or CA724, respectively, the sensitivity was improved, but there was no significant difference compared with CA19-9 alone (all P>0.05). Similarly, CA242 also has such a situation when compared with CA242 alone (all P>0.05). Univariate survival analysis showed there were statistically significant differences in CA19-9, CA242, and CEA (all P<0.05). Cox regression suggested that CA242 is an independent prognostic factor for gallbladder carcinoma. CA242 is closely related to histological grade of gallbladder carcinoma, lymph node metastasis and TNM staging.@*Conclusions@#CA19-9 and CA242 have definite value in the diagnosis of gallbladder carcinoma. CA242 is an independent prognostic factor for gallbladder carcinoma.
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Objective To analyze the clinical value of serum tumor markers CA19-9, CA242, CEA, CA724 and CA125 in the diagnosis and prognosis of gallbladder carcinoma patients. Methods A retrospective analysis of the preoperative serum levels of CA19-9, CA242, CEA, CA724 and CA125 in 132 patients with gallbladder cancer admitted to Eastern Hepatobiliary Surgery Hospital from March 2009 to December 2013 for sensitivity comparison, Kaplan-Meier survival table was used for univariate survival analysis, and the log-rank method was compared for differences. The Cox regression model was used for multivariate survival analysis. Results The sensitivities of CA19-9, CA242, CA125, CEA and CA724 were 67. 4%, 63. 6%, 42. 4%, 24. 2% and 22. 7%, respectively. There were no significant differences of the sensitivity between CA19-9 and CA242 (P >0. 05). However, whether CA19-9 or CA242, there were significant differences of diagnostic sensitivity compared to CEA or CA724 or CA125 (all P<0. 05). When CA19-9 was combined with CA125 or CEA or CA724, respectively, the sensitivity was improved, but there was no significant difference compared with CA19-9 alone (all P>0. 05). Similarly, CA242 also has such a situa-tion when compared with CA242 alone (all P>0. 05). Univariate survival analysis showed there were statis-tically significant differences in CA19-9, CA242, and CEA (all P<0. 05). Cox regression suggested that CA242 is an independent prognostic factor for gallbladder carcinoma. CA242 is closely related to histological grade of gallbladder carcinoma, lymph node metastasis and TNM staging. Conclusions CA19-9 and CA242 have definite value in the diagnosis of gallbladder carcinoma. CA242 is an independent prognostic factor for gallbladder carcinoma.
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Objective To investigate the effects of the extent of regional lymph node dissection on the prognosis of patients with T4 gallbladder carcinoma.Methods The retrospective cohort study was conducted.The clinicopathological data of 64 patients with T4 gallbladder carcinoma who underwent radical cholecystectomy in the 4 medical centers between January 2013 and December 2016 were collected,including 31 in the Eastern Hepatobiliary Surgery Hospital of Naval Medical University,16 in the First Affiliated Hospital of Xi'an Jiaotong University,11 in the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and 6 in the Affiliated Hospital of North Sichuan Medical College.There were 27 males and 37 females,aged from 35 to 77 years,with a median age of 59 years.Sixty-four patients underwent radical cholecystectomy and regional lymph node dissection.According to the extent of intraoperative lymph node dissection,25 patients (13 in the Eastern Hepatobiliary Surgery Hospital of Naval Medical University,6 in the First Affiliated Hospital of Xi'an Jiaotong University,4 in the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and 2 in the Affiliated Hospital of North Sichuan Medical College) whose extent of lymph node dissection involved lymph nodes next to cystic duct,hepatoduodenal ligament,back of head of pancreas,next to common hepatic artery and celiac trunk were allocated into the extended dissection group,39 patients (18 in the Eastern Hepatobiliary Surgery Hospital of Naval Medical University,10 in the First Affiliated Hospital of Xi'an Jiaotong University,7 in the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine and 4 in the Affiliated Hospital of North Sichuan Medical College) whose extent of lymph node dissection involved lymph nodes next to cystic duct and hepatoduodenal ligament were allocated into the control group.Observation indicators:(1) postoperative complications;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative overall survival up to January 2018.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was evaluated with the independentsample t test.Count data were represented as absolute number or percentage,and comparison between groups was analyzed using the chi-square test and Fisher exact probability.The survival curve was drawn using the KaplanMeier method,and the comparison of survival rates was done by the Log-rank test.Results (1) Postoperative complications:64 patients with T4 gallbladder carcinoma underwent successful radical cholecystectomy and regional lymph node dissection,without intraoperative death.Twelve patients had different degrees of postoperative complications.Four of 7 patients undergoing extended radical cholecystectomy had postoperative complications.Twenty-five patients in the extended dissection group were cured by conservative treatment,including 4 with intraperitoneal infection and 2 with pancreatic leakage,with a complication incidence of 24.0% (6/25).Thirtynine patients in the control group were cured by conservative treatment,including 5 with intraperitoneal infection and 1 with gastric retention,with a complication incidence of 15.4% (6/39).There was no statistically significant difference in the complication incidence between the two groups (x2=0.284,P>0.05).(2) Follow-up and survival situations:64 patients were followed up for 1-60 months.The postoperative overall median survival time was l l months.The postoperative median survival time,1-,3-and 5-year cumulative survival rates were respectively 18 months,80%,16%,9% in the extended dissection group and 8 months,21%,4%,0 in the control group,with a statistically significant difference in the prognosis between the two groups (x2=14.744,P< 0.05).Conclusions On the premise of practiced surgical skill,extended regional lymph node dissection cannot increase incidence of surgical complication in patients with T4 gallbladder carcinoma after radical resection.Actively extending lymph node dissection up to near common hepatic artery,peri-celiac trunk and back of head of pancreas can improve long-term survival and prognosis.
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Objective@#To compare the efficacy of modified pancreaticojejunostomy with traditional pancreaticojejunostomy following pancreaticoduodenectomy, and to investigate the risk factors of postoperative pancreatic fistula.@*Methods@#Clinical data of 68 patients who underwent pancreaticoduodenectomy between October 2017 and October 2018 at the Second Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital was retrospectively collected and analyzed.According to the method of pancreaticojejunostomy, the patients were divided into two groups: modified pancreaticojejunostomy group (34 patients) and traditional pancreaticojejunostomy group (34 patients). There were 18 males and 16 females, aged (60.4±9.6) years of modified pancreaticojejunostomy groups; there were 17 males and 18 females, aged (58.9±10.9) years of traditional pancreaticojejunostomy group. The major postoperative complications such as pancreatic fistula were compared between the two groups, and the risk factors of postoperative pancreatic fistula were analyzed by univariate and multivariate analyses.@*Results@#All of the 68 operations were successfully completed. The overall incidence of postoperative complications was 51.5% (35/68). The incidence of postoperative pancreatic fistula was 13.2% (9/68), of which all were cases of grade B.There were 16 patients (23.5%) occurred with abdominal infection, and 11 patients (16.2%) occurred with delayed gastric emptying, including 1 case of grade A, 1 case of grade B and 9 cases of grade C.And 9 patients (13.2%) occurred with postoperative bleeding was, including 2 cases of mild bleeding, 5 cases of moderate bleeding, and 2 cases of severe bleeding.Biliary leakage occurred in one patient (1.5%) and chylous leakage occurred in two patients (2.9%). The modified pancreaticojejunostomy could significantly reduce the incidence of postoperative bleeding compared with control group (χ2=4.610, P=0.032). And there were no significant differences for other postoperative complications between the two groups (all P>0.05). According to the results of univariate analysis: age, intraoperative bleeding and diameter of pancreatic tube were related factors affecting postoperative pancreatic fistula (P=0.025, 0.019, 0.017, respectively). The results of multivariate analysis showed that intraoperative bleeding>400 ml and diameter of pancreatic tube <3 mm were independent risk factors of pancreatic fistula following pancreaticoduodenectomy (P=0.025, 0.008, respectively).@*Conclusion@#The modified pancreaticojejunostomy is feasible with advantages of reducing postoperative bleeding following pancreaticoduodenectomy.
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Objective@#To discuss the rationality of stage pT3 in the AJCC 8th TNM criteria of gallbladder carcinoma.@*Methods@#A retrospective study was performed to analyze the clinical and pathological data of 88 patients with pT3 gallbladder carcinoma admitted to Department of Second Biliary Surgery of Eastern Hepatobiliary Surgery Hospital, affiliated to Naval Medical University from May 2013 to September 2018.pT3 stage tumors were divided into two groups: (1) pT3a stage: tumors had penetrated serosa but not directly invaded liver and/or an adjacent organ or structure; (2) pT3b stage: tumor penetrating serosa and directly invaded liver and/or an adjacent organ or structure. There were 45 patients with pT3a stage, including 15 males and 30 females, aged 36 to 80 years, with a median age of 59 years; 43 patients with pT3b, including 24 males and 19 females, aged 41 to 78 years old, median aged 63 years old.Patients with pT3a and pT3b were further divided into two groups respectively: radical resection group and extended radical resection group according to surgical radicalization. Independent sample t-test was used for comparison between two groups with normal distribution measurement data. Wilcoxon rank sum test was used between groups of non-normally distributed measurement data.The comparison of the count data was performed by χ2 test or Fisher exact probability method. Survival analysis was performed using Kaplan-Meier method, and survival rate was compared using Log-rank test.@*Results@#(1)Serum total bilirubin(15.6(90.3)mmol/L), albumin(40.2(4.8)mmol/L), and CA19-9(132.90(455.78)U/ml) levels in pT3b patients were higher than that in pT3a patients(10.2(6.8)mmol/L, 41.8(4.9)mmol/L, 14.35(36.27)U/ml), respectively(Z=-3.816, -1.966, -3.739, all P<0.05),postoperative complication rate in pT3b patients(24.4%) was higher than that in pT3a patients(8.9%)(P<0.05),postoperative hospital stay(12(7)days) and overall hospital stay((26±17)days) of pT3b patients were longer than that of pT3a patients((10±5) days and (19±7)days) (P<0.05). (2) The 1-, 3-, 5-year survival rates of pT3b and pT3a patients were 53%,22%,22% and 69%, 46%,38%,and the median survival time was 13 months and 26 months, respectively. The difference in survival rates between the two groups was statistically significant(χ2=5.117, P=0.024). (3)The 1-, 3-year survival rates of extended radical resection group(n=19) and radical resection group(n=24) in the pT3b stage were 73%, 36% and 28%, 7%, respectively.The survival time was 20 months and 9 months,respectively,and the difference in survival rates between the two groups was statistically significant(χ2=4.976, P=0.026).@*Conclusions@#pT3 gallbladder carcinoma could be further subdivided into pT3a stage and pT3b stage based on the TNM criteria of AJCC 8th gallbladder carcinoma. Extended radical resection for pT3b gallbladder carcinoma should be further considered after comprehensive assessment of the patient′s basic condition and surgical tolerance.
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Objectives@#To propose a novel clinical classification system of gallbladder cancer, and to investigate the differences of clinicopathological characteristics and prognosis based on patients who underwent radical resection with different types of gallbladder cancer.@*Methods@#The clinical data of 1 059 patients with gallbladder cancer underwent radical resection in 12 institutions in China from January 2013 to December 2017 were retrospectively collected and analyzed.There were 389 males and 670 females, aged (62.0±10.5)years(range:22-88 years).According to the location of tumor and the mode of invasion,the tumors were divided into peritoneal type, hepatic type, hepatic hilum type and mixed type, the surgical procedures were divided into regional radical resection and extended radical resection.The correlation between different types and T stage, N stage, vascular invasion, neural invasion, median survival time and surgical procedures were analyzed.Rates were compared by χ2 test, survival analysis was carried by Kaplan-Meier and Log-rank test.@*Results@#Regional radical resection was performed in 940 cases,including 81 cases in T1 stage,859 cases in T2-T4 stage,119 cases underwent extended radical resection;R0 resection was achieved in 990 cases(93.5%).The overall median survival time was 28 months.There were 81 patients in Tis-T1 stage and 978 patients in T2-T4 stage.The classification of gallbladder cancer in patients with T2-T4 stage: 345 cases(35.3%)of peritoneal type, 331 cases(33.8%) of hepatic type, 122 cases(12.5%) of hepatic hilum type and 180 cases(18.4%) of mixed type.T stage(χ2=288.60,P<0.01),N stage(χ2=68.10, P<0.01), vascular invasion(χ2=128.70, P<0.01)and neural invasion(χ2=54.30, P<0.01)were significantly correlated with the classification.The median survival time of peritoneal type,hepatic type,hepatic hilum type and mixed type was 48 months,21 months,16 months and 11 months,respectively(χ2=80.60,P<0.01).There was no significant difference in median survival time between regional radical resection and extended radical resection in the peritoneal type,hepatic type,hepatic hilum type and mixed type(all P>0.05).@*Conclusion@#With application of new clinical classification, different types of gallbladder cancer are proved to be correlated with TNM stage, malignant biological behavior and prognosis, which will facilitate us in preoperative evaluation,surgical planning and prognosis evaluation.
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Tea is one of the most popular drinks in the world, but counterfeit or adulterated tea can be found now and then on the tea market. The traditional methods dependent on sensory, physical and chemical tests cannot identify the composition of adulterated plant species accurately. We developed therefore a method for identification of adulterated plants in tea based on qualitative detection of plant rbcL (Ribulose 1,5-bisphosphate carboxylase-oxygenase large subunit) fragments, which involved amplification, sequencing and sequence analyses of rbcL fragments. Seven tea samples were analyzed with the established method. The results showed that Yueyanghuangcha (yellow tea) and Xinyangmaojian (green tea) were pure with only detection of the tea plant Camellia sinensis; Zhengshan Souzhong (black tea), Tieguanyin (oolong tea), Tailaoyinzhen (white tea), Liupao and Pu-erh (dark tea) were, to a certain extent, adulterated with non-Camellia sinensis plants. The method introduced in this study only requires a small amount of tea samples, easy to operate and reliable. It can be used to determine if any tea samples are adulterated.
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Objective To reveal the virulence genes and the polymorphisms of chromosomal 16S rRNA gene of Yersinia enterocolitic strains isolated from different districts in Jiangsu Province,2015. Methods Five virulence genes(ail,virF,yadA,ystA and ystB)of Yersinia enterocolitic strains isolated from different districts in Jiangsu Province were detected by using polymerase chain reaction(PCR),and phylogenetic analysis of chromosomal 16S rRNA gene was performed by amplification and sequencing. Results In this study,73 Yersinia enterocolitic strains were collected in Jiangsu Province in 2015.Among them,56(76.7%)strains carried virulence genes,and ail-virF-yadA -ystA -ystB+were the dominate types in diarrhea patients and other hosts.All strains can be clustering into 4 groups according to the phylogenetic analysis of chromosomal 16S rRNA gene.Conclusions The non-pathogenic Yersinia enterocolitic(ystB+)is the dominant strain in Jiangsu province,and the pathogenic strains are also found in this region.The result of phylogenetic analysis of chromosomal 16S rRNA gene and the profiles of virulence genes are highly consistent.
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<p><b>OBJECTIVE</b>Based on the characteristics of hierarchical data, a multilevel model was used to analysis possible influencing factors of urinary cadmium levels in one county population, and to discuss the advantages of multilevel model for processing hierarchical data in practical problems.</p><p><b>METHODS</b>In May 2013, 1 460 participants aged 20 and above in 12 administrative villages in one county in central China were recruited by cluster sampling. Urinary cadmium level and its possible influencing factors were investigated, and cadmium level in farmland soil of survey area was also tested. A total of 1 410 participants completed the survey and met the inclusion criterion. 318 farmland samples in survey area were detected. According to the data, individuals were set as the level one unit, and the village was set as level two unit. the data were analyzed by MIXED procedure for hierarchical data of SAS 9.3 software. In the case of not considering the hierarchy of data, the general linear model was fitted by SAS 9.3 software, and the fitting results of the two models were compared.</p><p><b>RESULTS</b>A total of 1 410 participants were included finally, the age was (55.2 ± 11.1) years. 645 (45.74%) were males and 765 (54.26%) were females. The amount of household per capita consumption of rice was (100.9 ± 40.3) kg/y. All 18.65% (262/1 410) of the participants had mining and mineral separation work experience. The urinary cadmium level was (9.39 ± 2.16) µg/g Cr. Most of the soil cadmium levels in villages were greater than tolerance value. The fitting results of general linear model suggested that whether doing mining and mineral separation work does not have significant difference (χ(2) = 1.05, P = 0.305). There was significant difference in the village soil cadmium levels, age, the amount of household per capita consumption of rice, and gender (χ(2) = 401.39, 34.9, 4.16 and 86.15, respectively, P < 0.01, <0.01, 0.041, <0.01, respectively). The fitting result of empty model showed the ICC was 0.435 5, the urinary cadmium had clustering at village level. The results of multilevel model showed that the explanatory variables of the village soil cadmium levels, age, the amount of household per capita consumption of rice and gender had significant difference (Wald χ(2) values 2.55, 6.34, 2.37 and 10.32, respectively, P = 0.029, <0.01, = 0.018 and <0.01), while whether doing mining and mineral separation work had no significant difference (χ(2) = 0.78, P = 0.438). To the fitting optimization index using for the comparison of models, the results of multilevel model were less than that of general linear model. The regression coefficient of level-2 explanatory variable (the village soil cadmium levels) was 0.84, which could explain the 35.26% of the total variance.</p><p><b>CONCLUSION</b>Multilevel model could analyze hierarchical data more reasonably than general linear model. Urinary cadmium levels is highly influenced by the village soil cadmium levels.</p>