Early Postoperative Serum Carcinoembryonic Antigen Is a Stronger Independent Prognostic Factor for Stage II Colorectal Cancer Patients Than T4 Stage and Preoperative CEA.

BACKGROUND: Serum carcinoembryonic antigen (CEA) is an important biomarker for diagnosis, prognosis, recurrence, metastasis monitoring, and the evaluation of the effect of chemotherapy in colorectal cancer (CRC). However, few studies have focused on the role of early postoperative CEA in the prognosis of stage II CRC. METHODS: Patients with stage II CRC diagnosed between January 2007 and December 2015 were included. Receiver operating characteristic (ROC) curves were used to obtain the cutoff value of early postoperative CEA, CEA ratio and CEA absolute value. The areas under curves (AUCs) were used to estimate the predictive abilities of the CEA and T stage. The stepwise regression method was used to screen the factors included in the Cox regression analysis. Before and after propensity score (PS) - adjusted Cox regression and sensitivity analysis were used to identify the relationship between early postoperative CEA and prognosis. Meta-analysis was performed to verify the results. Kaplan-Meier survival curves were used to estimate the effects of CEA on prognosis. RESULTS: We included 1081 eligible patients. ROC curves suggested that the cutoff value of early postoperative CEA was 3.66 ng/ml (P <0.001) and the AUC showed early postoperative CEA was the most significant prognostic marker in stage II CRC (P = 0.0189). The Cox regression and sensitivity analysis before and after adjusting for PS both revealed elevated early postoperative CEA was the strongest independent prognostic factor of OS, DFS, and CSS (P < 0.001). Survival analysis revealed that patients with elevated early postoperative CEA had lower OS (53.62% VS 84.16%), DFS (50.03% VS 86.75%), and CSS (61.77% VS 90.30%) than patients with normal early postoperative CEA (P < 0.001). When the postoperative CEA was positive, the preoperative CEA level showed no significant effect on the patient's prognosis (all P-values were > 0.05). Patients with a CEA ratio ≤0.55 or CEA absolute value ≤-0.98 had a worse prognosis (all P-values were < 0.001). Survival analysis suggested that adjuvant chemotherapy for stage II CRC patients with elevated early postoperative CEA may improve the CSS (P = 0.040). CONCLUSIONS: Early postoperative CEA was a better biomarker for prognosis of stage II CRC patients than T stage and preoperative CEA, and has the potential to become a high-risk factor to guide the prognosis and treatment of stage II CRC patients.

Evaluation of the effects of immunotherapy and mesenchymal stem cells transplantation in the treatment of critically ill coronavirus disease 2019 patients / 中华危重病急救医学

Objective:To analyze the immunotherapy and clinical characteristics of coronavirus disease 2019 (COVID-19) patients, and focus on exploring the effects of immunotherapy and mesenchymal stem cells (MSC) transplantation in the critically ill patients' treatment.Methods:Fity-five COVID-19 patients were admitted to the Fifth People's Hospital of Wuxi from January 23rd to March 31st, 2020 as the research object. The demographic characteristics of the cases and the methods of immunotherapy were analyzed, focusing on the immunized indicators, positivity of pathogens and clinical indicators of critically ill COVID-19 patient, and the effects of immunotherapy and stem cell transplantation were evaluated.Results:Aged, male and people with comorbidities were the main risk factors in the development of severe and critical COVID-19. All of confirmed COVID-19 cases (n = 55) had been treated with interferon-α (IFN-α), of which 81.8% (n = 45, mild and ordinary) of the patients were recovered, 14.6% (n = 8) of the patients were converted to severe, 3.6% (n = 2) of the patients were converted to critical, and some severe patients were treated with gamma globulin and albumin as adjuvant treatment. Critically ill patients were not only treated with IFN-α, gamma globulin and albumin, but also treated with convalescent plasma and MSC transplantation. Due to pulmonary hemorrhage and persistently low blood oxygen saturation, terminal lung transplantation therapy was implemented. The total number of lymphocytes, CD4 +, CD8 + T lymphocytes, natural killer (NK) cells and B cells in peripheral blood of the two critical COVID-19 patients were significantly reduced, and the functions of lung, liver, and kidney were severely damaged on admission, manifested as significant increase of the levels of blood C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and blood urea nitrogen (BUN), etc. and decrease of blood oxygen saturation, and type Ⅰ respiratory failure, and the noninvasive assisted ventilation was needed to improve. After adjuvant immunotherapy such as gamma globulin, the nucleic acid of 2019 novel coronavirus (2019-nCoV) turned into negative. The CRP of one critically ill patient was significantly lower than the value at admission (minimum of 21 mg/L). But the lung inflammation progressed rapidly, and the pathological results of the lung tissue from the lung transplantation showed hemorrhage and irreversible fibrosis. The ability to secrete immunoglobulin A (IgA) was significantly reduced. Liver function had been significantly improved and stabilized after treatment with convalescent plasma during the recovery period. MSC transplantation treatment reduced the BUN level by > 50% compared with the previous period, and the total number of lymphocytes in the patient increased by more than 2 times (rose from 0.23×10 9/L to 0.57×10 9/L), but the total amount of lymphocytes was still lower than the normal reference value (< 1.1×10 9/L). The lung inflammation lesions were obviously absorbed, and the vital signs were stable. Conclusions:In addition to IFN, gamma globulin, antiserum and MSC transplantation therapy can help clear the virus and reduce inflammation. Although MSC transplantation fail to completely change the immunecompromised state of critically ill patients, it controlled the progression of inflammation in the liver and kidneys.

Clinical features and management of severe COVID-19: A retrospective study in Wuxi, Jiangsu Province, China

ObjectiveWe aimed to investigate clinical features and management of 55 COVID-19 patients in Wuxi, especially severe COVID-19. MethodsEpidemiological, demographic, clinical, laboratory, imaging, treatment, and outcome data of patients were collected. Follow-up lasted until April 6, 2020. ResultsAll 55 patients included 47 (85.5%) non-severe patients and 8 (14.5%) severe patients. Common comorbidities were hypertension and diabetes. Common symptoms were fever, cough and sputum. Lymphopenia was a common laboratory finding, and ground-glass opacity was a common chest CT feature. All patients received antiviral therapy of -interferon inhalation and lopinavir-ritonavir tablets. Common complications included acute liver injury and respiratory failure. All patients were discharged. No death was occurred and no medical staff got infected. Patients with severe COVID-19 showed significantly older age, decreased lymphocytes, increased C reactive protein, and higher frequency of bilateral lung infiltration compared to non-severe patients. Significantly more treatments including antibiotic therapy and mechanical ventilation, longer hospitalization stay and higher cost were shown on severe patients. ConclusionsOur study suggested that patients with severe COVID-19 may be more likely to have an older age, present with lymphopenia and bilateral lung infiltration, receive multiple treatments and stay longer in hospital.

Discussion on Strengthening Medical Ethics Education and Accomplishment during Resident Standardized Training / 中国医学伦理学

The resident standardized training is an important stage in clinical medical personnel training sys-tem. Medical ethics education and accomplishment is one of the main training contents in this stage is, the necessa-ry requirement for physician growth, and the effective guarantee for training organization and implementation. Learning for relevant theory of medical ethics is the basis of medical ethics education, and the medical practice is the fundamental way of medical ethics accomplishment. In medical practice, the inner perception is the gradual sublimation of medical ethics accomplishment. The formation of residents′ medical ethics quality is dominated by heteronomy and guided by medical morality code. It emphasizes more on self-regulating the ethical behaviors and abiding by medical ethics faith and standards.

Treatment and prognosis of moyamoya disease / 中华全科医师杂志

Moyamoya disease is a tare intracranial angiopathy resulting in symptoms and prognosis similar with the stroke,if not diagnosed and treated early.The article reviews the characteristics,pathogenesis,treatment and prognosis of Moyamoya disease.Clinicians should be aware of this disease in routine work,so that the patients with Moyamoya disease can be early diagnosed and treated to avoid disability or death.

Risks of intracranial hemorrhage in patients with Parkinson's disease receiving deep brain stimulation and ablation.

OBJECTIVES: This study analyzed risk factors for hemorrhage in a large series of deep brain stimulation (DBS) and ablation procedures in patients with advanced Parkinson's disease (PD). METHODS: Six hundred and forty four subjects with advanced PD treated with DBS or ablation procedures between March 1999 and December 2007 were enrolled in the study. Procedures were performed by the same surgeon, and included DBS in 126 patients, ablation in 507 patients and DBS after prior unilateral ablation procedures in 11 patients. Of 796 target procedures, 207 were DBS including 202 subthalamic nucleus (STN) targets, 3 ventralis intermedius nucleus (Vim) targets and 2 globus pallidus internus (GPi) targets, and the others were 589 ablation procedures including 474 GPi targets and 115 Vim targets. Postoperative CT or MRI was performed in all patients within 24 h of lead implantation or ablation treatment. Statistical correlation analysis of risk factors for intracranial hemorrhage (ICH) was performed by stepwise logistic regression. Explanatory variables were patient age, sex, blood pressure, anatomical targets, the number of microelectrode recording (MER) penetrations and surgical modality. RESULTS: Postoperative symptomatic ICH occurred in 10 cases (8 pallidotomy and 2 thalamotomy) and asymptomatic ICH in 14 cases (9 pallidotomy, 4 thalamotomy and 1 DBS). Hypertension and surgical modality were significant factors contributing to hemorrhage (both P < 0.05). The likelihood of hemorrhage in hypertensive patients was 2.5 times that in normotensive patients. The risk of hemorrhage during ablation was 5.4 times that in DBS. The number of MER trajectories did not significantly correlate with ICH occurrence (P = 0.07). No statistically significant difference was found in age, sex and anatomical targets. CONCLUSION: This study demonstrated that hypertension is a risk factor for ICH in PD patients. DBS is generally a safe surgical modality as compared with ablation. Increasing microelectrode trajectories seemed to increase the risk of ICH, but no statistically significant difference was found (P = 0.07).

Relationship between multifunctional proteglycan versican and metastasis of lung cancer / 国际肿瘤学杂志

Multifunctional proteglycan, versican, is recently recognized as a gene related to tumor metastasis. Versican may maintain or inhibit cell growth, affect cell adherence and regulate the mutual interaction between cells or cell and matrix. Higher expression of versican always correlates with worse prognosis.

Hemorrhagic complications after sterotactic surgery for Parkinson's d isease: An etiologic analysis / 中国微创外科杂志

ObjectiveTo discuss the causes and the managem ent of hemorrhagic c omplications after sterotactic surgery for Parkinson's disease (PD).Me thodsA total of 350 PD patients unresponsive to drug therapy from April 1999 to Decemb er 2001 underwent sterotactic surgery. Intracranial hemorrhage occurred in 6 cas es, consisting of 3 cases of lesion hemorrhage and 3 cases of puncture path hemo rrhage.ResultsOf the 6 cases, 4 were treated by surgical ope rations, with re covery of consciousness but hemiplegia left, and 2 were treated conservatively w ithout dysfunction left. No fatal cases were seen in the study.Conclus ionsHe morrhagic complications are often in association with repeated puncture, excessi ve heat, operative skills, patient's general condition and so on. Accurate targe t location by MRI combined with microelectrode guidance, reduce of microelectrod e recording times, lowering of the lesion temperature, and sufficient perioperat ive care contribute to the prevention of intracranial hemorrhagic complications.

Expression of neural cell adhesive molecule in human brain astrocytoma / 第二军医大学学报

Objective: To study the expression of neural cell adhesive molecule (NCAM) and its clinical significance in human astrocytoma. Methods: Expression of NCAM mRNA and its protein (CD56) were detected by in situ hybridization using NCAM antisense complementary RNA probe and by immunohistochemical staining in 40 cases of astrocytoma. Results:Expression of NCAM mRNA and CD56 in 1, 2 grade astrocytoma was significantly higher than that in 3, 4 grade astrocytoma. The expression of NCAM mRNA accorded with the expression of CD56. Conclusion: Expression of NCAM mRNA and CD56 is correlated with the malignant degree of astrocytoma. The high expression of NCAM may be correlated with invasion and metastasis of astrocytomas. It is suggested that the expression of NCAM may be an important clue in assessment of malignancy and invasion of astrocytoma, and it may be a guide for the choice of post operation therapy.

Functional imaging of Parkinson disease after treated by deep brain stimulation of subthalamic nucleus / 第二军医大学学报

Objective:To investigate the metabolism changes in corpus striatum of hemiparkinsonian monkeys after chronic high frequency stimulation in subthalamic nucleus (STN) by SPECT and PET imaging. Methods: Two hemiparkinsonian monkeys, induced by unilateral internal carotid artery infusion of 1-methyl-4-phenyl-1,2,3,6-tetrahydropy-rindine (MPTP), were implanted with stimulation electrodes in STN of lesioned side according to stereotaxic atlas of the monkey brain. SPECT and PET examination were performed before and 1, 3 months after stimulation. Results: PD symptoms of monkeys, including rigidity, bradykinesia and gait abnormality, were significantly improved. SPECT imaging indicated that dopamine transporter (DAT) binding to corpus striatum in stimulated side increased and D 2 receptor (D 2 R) decreased to the level of unlesioned side after stimulating. PET imaging showed that right corpus striatum had lower density than left corpus striatum before stimulation. One month after chronic high frequency stimulation, bilateral corpus striatum had low density, but the right was slightly higher than that of the left;3 months after stimulation the right was obviously higher than the left . Conclusion: The symptoms of hemiparkinsonian monkeys can be obviously improved by STN deep brain stimulation(DBS). The increased DAT binding and glucose metabolism of corpus striatum in stimulated side and the decreased D 2 R binding after stimulation suggest that the activity of striatal dopaminergic system may be promoted by STN DBS.