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Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.
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Objective To systematically evaluate the short-term outcomes of laparoscopic splenectomy and azygoportal disconnection (LSD) with open splenectomy and azygoportal disconnection (OSD) in the prevention and treatment of portal hypertension (PHT) hemorrhage.Methods A meta-analysis was conducted to evaluate the short-term outcomes published in randomized controlled studies and high quality casecontrolled studies on patients who underwent LSD or OSD from January 2006 to January 2016.Results 1 359 patients from 18 Chinese and English articles which met the inclusion criteria were included into this study.LSD and OSD were performed in 685 patients (the LSD group) and 674 patients (the OSD group),respectively.Meta-analysis showed that there was no significant difference in operation time between the LSD and OSD groups [MD=17.66,95％CI=(-2.46 ～37.78),P＞0.05].When compared with the OSD group,the LSD group had a shorter postoperative hospitalization stay [MD =-3.99,95％ CI =(-4.82 ～ -3.16),P ＜ 0.05],earlier postoperatively first passing of flatus [MD =-1.09,95％ CI =(-1.41 ～ -0.78),P ＜ 0.05],less intraoperative bleeding [MD =-272.66,95％ CI =(-345.11 ～-200.21),P ＜ 0.05],a lower complication rate [OR =0.34,95％ CI =(0.25 ～ 0.47),P ＜ 0.05],less postoperative pain [MD =-2.54,95％ CI =(-2.79 ～-2.29),P ＜ 0.05],shorter postoperative ambulation time [MD =-3.16,95％ CI =(-3.53 ～-2.79),P ＜ 0.05],less amount of peritoneal drainage [MD =-180.28,95％ CI =(-293.06 ～-67.49),P ＜0.05] and earlier recovery from postoperative loss in appetite [MD =-1.42,95％ CI =(-1.70 ～-1.13),P ＜ 0.05].Conclusion Compared with the traditional OSD,LSD had the advantages of less invasiveness,quicker recovery and higher quality of life in the perioperative period.LSD is the preferred operation for the prevention and treatment of PHT massive hemorrhage.
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Objective To analyze the early mortality and morbidity of early postoperative complications of gastric cancer patients submitted to D1 or D2 gastrectomy for improving the surgical effect.Methods All consecutive patients who underwent D1 or D2 radical gastric resection between January 2006 and December 2007 were evaluated.Clinicopathologic features of the tumor,the extent of lymphadenectomy,the postoperative mortality and the early morbidity of complication were analysed.Results There were 130 patients admitted for the treatment of gastric cancer.34 underwent D1 dissection and 96 underwent D2 dissection.The early morbidity of D2 dissection was higher than that of D1 dissection (20.6% vs.39.6%,P<0.05).When complications were analyzed individually,there was no significant difference.Although the postoperative mortality was higher in the D2 group,no significant difference was observed(4.2% vs.0,P>0.05).4 patients underwent D2 dissection died.Considering the causes of the 4 died patients,respiratory complication related to anaatomotic and pancreatic leakage was the most important.Conclusion This study indicates that D2 dissection is a safe and effective procedure and the extent of lymphadenectomy may be related with high postoperative complication morbidity and mortality.Improving the surgical dissection skill and standardizing the gastric lymphadenectomy are the key ways to decrease the morbidity and mortality.
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Objective Study the effect of induced differentiation of abscisic acid (ABA) on human HCC cell line SMMC-7221.Methods Cultured SMMC-7221 cells were treated separately with RPMI-1640 culture medium, HMBA and ABA with different concentrations. Firstly, the appropriate concentration of ABA which inhibits SMMC-7221 cell proliferation was selected with the modified MTT method. Then electron microscopy was performed to observe the changes of microstructure. The cell cycle was analyzed by flow cytometry. Results Apart from 4?10 -4mmol/L concentration of ABA, the others could inhibit the cell proliferation. The inhibition rate increased with the time prolonging and the concentration increasing. The effect was most obvious with 4?10 -3mmol/L ABA. At this concentration the cells were arrested in G0/ G1 phase (P
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Objective To investigate the effects of ischemic postconditioning (I-post) on intestinal mucosa mitochondrion after ischemia-reperfusion (IR) injury in rat intestine.Methods By using rat model of intestine IR injury,male Sprague-Dawley rats were divided into 4 groups:sham-operation group (S),IR group (IR),ischemic preconditioning group (IPC),and I-post group.Intestinal mucosa mitochondrial ultrastructural changes were observed by using transmission electron microscope (TEM).Mucosal cellular mitochondrial respiration function was studied by measuring the mitochondrial dehydrogenase-dependent reduction of MTT to its formazan derivative,and intestinal mucosal mitochondrial membrane potential was detected by confocal laser scanning microscopy.Results Compared with that in IR group,the injury of mitochondrion in I-post group and IPC group began to recover.The mitochondrial respiratory function and the mitochondrial membrane potential were significantly improved in I-post group and IPC group (P0.05).Conclusion The mechanism of ischemic postconditioning against IR injury of intestine in rats is partly related to maintaining the mitochondrial ultrastructural changes and respiratory function and improving mitochondrial membrane potential.
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Objective To investigate the role of ischemic postconditioning(I-post) on intestinal mucosa in rats with ischemia-reperfusion (I/R) injury.Methods By using rat model of intestine I/R injury,32 male Sprague-Dawley rats were randomly divided into 4 groups: sham-operation group(S),I/R group(I/R),ischemic preconditioning group(IPC),and ischemic postconditioning group(I-post),respectively.The contents of malondialdehyde(MDA), the activity of superoxidase dismutase(SOD),and the activity of myeloperoxidase(MPO) in intestinal mucosa were measured respectively.The status of intestinal mucosa cellular apoptosis was detected by TdT-mediated dUTP-biotin nick end labeling(TUNEL).Chiu's count was used to assess the changes in intestinal pathological morphology.Results The content of MDA and activity of MPO were significantly reduced and the activity of SOD was enhanced in IPC group and I-post group compared with I/R group.There was obvious cellular apoptosis after reperfusion,and the apoptotic index in I-post group and IPC group was significantly lower than that in I/R group.Conclusion Ischemic postconditioning can result in protection against intestinal mucosa with I/R injury,which may be related to reducing the production of oxygen free radicals,maintaining the activities of antioxidant systems,and reducing intestinal mucosa cellular apoptosis.
