Performance evaluation of some domestically produced biochemical reagents / 中华检验医学杂志

Objective:To evaluation the performance of a total of 40 clinical biochemical reagents from three domestic manufacturers and two foreign manufacturers, and evaluate their clinical application value.Methods:The Beckman AU5400 automatic biochemical analyzer was used to verify the performance of 40 kinds of commonly used clinical biochemical reagents from three domestic manufacturers of Sichuan Maccura, Ningbo Medical System, and Shanghai Fosun Long March, and two foreign imported manufacturers of Roche and Japan′s Hitachi. The analysis samples were selected from the serum of patients who underwent clinical testing in Nanjing Drum Tower Hospital hospital from December 2021 to June 2022. Refer to China′s national health industry standards, China′s national pharmaceutical industry standards, the US Clinical Laboratory Standards Institute (CLSI) for the performance evaluation standards of in vitro diagnostic reagents, and the methods recommended in the relevant regulations of China′s State Food and Drug Administration on the management of in vitro diagnostic reagents. The precision, linear range, open bottle stability, interchangeability of calibrators and accuracy from different batches of 40 reagents were evaluated and validated. Simple linear regression analysis was used for linear regression, and P<0.05 indicated that the regression was statistically significant. Results:The overall precisions of 40 reagents were fine, except for one domestic reagent with low-level intra-batch coefficient of variation ( CV) exceeding the range declared in the specification. The intra-and inter-batch CVs of the remaining reagents were all smaller than those declared in their respective specifications. The linear ranges of domestic reagents and imported ones have achieved the linear ranges declared by each manufacturer. There were no statistical differences on the measurements between the reagents from open bottle of 30 days and the corresponding new ones for 40 reagents( P>0.05). The test values of domestic reagents and imported reagents after exchange of different batches of calibrators were within the ranges declared by each manufacturer. Both domestic reagents and imported reagents have passed the accuracy verification. Conclusions:The performance index of 27 biochemical detection indicators of the three domestic manufacturers are basically consistent with those of imported reagents, meeting the requirements of clinical biochemical laboratories. However, the bottle opening stability and anti-interference performance of some detection reagents needs to be improved.

Osteoarthritis and metabolism / 中国实用内科杂志

Compared to all the risk factors for osteoarthritis, the systemic metabolic factors have long been neglected. Recently, the role of metabolic disorders, including obesity, metabolic syndrome and hormone abnormalities, in the pathophysiology of osteoarthritis is becoming increasingly explicit. Furthermore, these facts have promoted the concept of “metabolic osteoarthritis”, which is helping to clarify the significance of metabolic factors as the evidence of phenotype of osteoarthritis and potential therapeutic targets for osteoarthritis.

Multivariate analysis of short-term prognosis of liver transplantation in patients with end-stage liver disease / 中华器官移植杂志

Objective@#To analyze many indicators during perioperative period of liver transplantation in patients with end-stage liver disease, only to seek related factors that can accurately predict short-term(≤three months)outcome.@*Methods@#We analyzed retrospectively clinical data of consecutive patients with end-stage liver diseases undergone liver transplantation in a single treatment center. Logistic regression analysis was used to analyze the perioperative indicators including recipient gender, age, body mass index, preoperative serum albumin level, serum sodium concentration, urea nitrogen level and donor-recipient blood group, et al. Correlated factors were analyzed by the method of multivariate logistic regression. Statistical processing package was SAS 9.1.3 soft. The difference was statistically significant with P<0.05.@*Results@#18/165 patients died within 3 months after transplantation(mortality rate: 10.9 %). According to the result of univariate analysis, the indicators correlated with early mortality which were statistically significant were preoperative serum sodium, blood urea nitrogen, PT-INR, CTP score, MELD score and MELD-Na score. On the base of the result of Logistic multiple regression. However, only MELD-Na score was associated with 3 months prognosis(P=0.001, β=-2.510, OR=0.088, 95 % CI=0.037~0.349).@*Conclusions@#Preoperative MELD-Na score is an independent risk factor for short-term survival in patients with end-stage liver disease. Higher MELD-Na score is, the early mortality is higher.

Multivariate analysis of short-term prognosis of liver transplantation in patients with end-stage liver disease / 中华器官移植杂志

Objective To analyze many indicators during perioperative period of liver transplantation in patients with end-stage liver disease ,only to seek related factors that can accurately predict short-term(≤ three months)outcome .Methods We analyzed retrospectively clinical data of consecutive patients with end-stage liver diseases undergone liver transplantation in a single treatment center .Logistic regression analysis was used to analyze the perioperative indicators including recipient gender ,age ,body mass index ,preoperative serum albumin level ,serum sodium concentration ,urea nitrogen level and donor-recipient blood group ,et al .Correlated factors were analyzed by the method of multivariate logistic regression .Statistical processing package was SAS 9 .1 .3 soft .The difference was statistically significant with P< 0 .05 .Results 18/165 patients died within 3 months after transplantation(mortality rate :10 .9 ％ ) .According to the result of univariate analysis ,the indicators correlated with early mortality which were statistically significant were preoperative serum sodium , blood urea nitrogen ,PT-INR ,CTP score ,MELD score and MELD-Na score .On the base of the result of Logistic multiple regression . However ,only MELD-Na score was associated with 3 months prognosis(P=0 .001 ,β=-2 .510 ,OR=0 .088 ,95 ％ CI=0 .037～0 .349) .Conclusions Preoperative MELD-Na score is an independent risk factor for short-term survival in patients with end-stage liver disease .Higher MELD-Na score is ,the early mortality is higher .

Associations between normal serum levels of uric acid and knee symptoms, joint structures in patients with knee osteoarthritis / 中华疾病控制杂志

Objective To investigate the associations between normal serum uric acid (UA) levels and knee symptoms and structural changes in patients with knee osteoarthritis (OA).Methods A total of 205 patients with knee OA were enrolled. According to the inclusion and exclusion criteria, 122 patients with OA were included in the study. The general condition of patients were investingated. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was used to assess severity of the knee joint symptoms. The Kellgren-Lawrence (K-L) grading system was used to assess radiological severity of the knee joint. Osirix software was used to assess changes of knee structure in magnetic resonance imaging (MRI). Peroxidase method was used to measure the serum levels of uric acid. Patients with normal range of uric acid were included in the study.Results The patients with lower levels of UA (split at the median level, 263 μmol/L) had a higher proportion of women, lower height, weight and lower proportions of K-L grade≥2. After adjustment for sex, age and body mass index, serum UA was negatively associated with total WOMAC scores (β=-16.15, P=0.018), WOMAC pain (β=-3.15, P=0.037), and WOMAC stiffness (β=-1.65, P=0.025). However, there were no significant associations between serum UA levels and knee joint structure changes.Conclusions In OA patients with normal serum UA, serum UA is negatively associated with the severity of joint symptoms, suggesting that UA within normal range may play a protective role in OA symptoms.

Repression of PDK1- and LncRNA HOTAIR-Mediated EZH2 Gene Expression Contributes to the Enhancement of Atractylenolide 1 and Erlotinib in the Inhibition of Human Lung Cancer Cells.

BACKGROUND/AIMS: We previously showed that the major bioactive compound of Atractylodes macrocephula Koidz atractylenolide 1 (ATL-1) inhibited human lung cancer cell growth by suppressing the gene expression of 3-Phosphoinositide dependent protein kinase-1 (PDK1 or PDPK1). However, the potentially associated molecules and downstream effectors of PDK1 underlying this inhibition, particularly the mechanism for enhancing the anti-tumor effects of epidermal growth factor receptor-tyrosine-kinase inhibitors (EGFR-TKIs), remain unknown. METHODS: Cell viability and cell cycle distribution were measured using 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) and flow cytometry assays, respectively. Western blot analyses were performed to examine the protein expressions of PDK1 and of zeste homolog 2 (EZH2). The levels of long non-coding RNA (lncRNA) and HOX transcript antisense RNA (HOTAIR) were examined via qRT-PCR. RNA-binding protein immunoprecipitation assays were used to analyze HOTAIR interaction with EZH2. The promoter activity of the EZH2 gene was determined using Secrete-Pair Dual Luminescence Assay Kit. Exogenous expressions of PDK1, HOTAIR, and EZH2 were conducted via transient transfection assays. A xenografted tumor model was used to further evaluate the effect of ATL-1 in the presence or absence of erlotinib in vivo. RESULTS: We showed that the combination of ATL-1 and EGFR-TKI erlotinib further inhibited growth and induced cell arrest of the human lung cancer cells, determined by both MTT and flow cytometry assays. ATL-1 inhibited the protein expression and the promoter activity of EZH2, which was reversed in cells with PDK1 overexpression. Interestingly, ATL-1 inhibited the expression levels of HOTAIR. While silencing HOTAIR inhibited the expressions of PDK1 and EZH2, overexpression of HOTAIR reduced the ATL-1-reduced PDK1 and EZH2 protein expressions and EZH2 promoter activity. In addition, ATL-1 reduced the HOTAIR binding to the EZH2 protein. Moreover, we found that exogenously expressed EZH2 antagonized the effect of ATL-1 on cell growth inhibition. Consistent with the in vitro results, ATL-1 inhibited tumor growth and the expression levels of HOTAIR, protein expressions of EZH2 and PDK1 in vivo. Importantly, there was synergy of the combination of ATL-1 and erlotinib in this process. CONCLUSION: Here, we provide the first evidence that ATL-1 inhibits lung cancer cell growth through inhibiting not only the PDK1 but also the lncRNA HOTAIR, which results in the reduction of one downstream effector EZH2 expression. The novel interplay between the HOTAIR and EZH2, as well as repressions of the PDK1 and HOTAIR coordinate the overall effects of ATL-1. Importantly, the combination of ATL-1 and EGFR-TKI erlotinib exhibits synergy. Thus, targeting the PDK1- and HOTAIR-mediated downstream molecule EZH2 by the combination of ATL-1 and erlotinib potentially facilitates the development of an additional novel strategy to combat lung cancer.

Recent research and clinical progress of osteolysis after total knee arthroplasty / 医学研究生学报

Osteolysis often requires revision surgery following total knee arthroplasty (TKA). Wear and osteolysis can be significantly reduced through proper implant positioning and the modern highly cross-linked polyethylene liner. In future, more medications may appear to prevent or treat the bone osteolysis. In revision operations, bone defects resulting from osteolysis can be managed with the bulk allografts, metal augments or porous tantalum cones. A megaprosthesis with a rotating hinge device may be used for severe bone defect.

Micro-finite Element Analysis of Bony Acetabulum with a Press-fit Acetabular Cup / 医用生物力学

Objective To investigate the trabecular stress distributions on the cortical bone and determine whether the cancellous bone can share the load of the acetabulum with a press-fit acetabular cup. Methods The acetabulum was scanned via micro-computed tomography (CT) to build a three-dimensional micro-finite element analysis (μFEA) model of the acetabulum. The trabecular stress and strain of the bony acetabulum were calculated following total hip arthroplasty (THA) to investigate the biomechanical characteristics of their distributions. Results With the implantation of the press-fit acetabular cup into the acetabulum, the high-stress zone of the articular surface was found to be located in the pubic bone area, with a maximum stress of 1.398 MPa. The largest high-stress zone within the articular surface was at the craniomedial part where it was supported by the iliac. For the cancellous bone within the acetabulum, the high stress was relatively widely distributed on the craniomedial part. When a 1.372 kN load was applied, the high stress was found at the craniomedial and anterior-inferior parts of the articular surface where it was supported by the iliac and pubic bone, with a trabecular micro-damage occurring in the anterior-inferior part. The highest tensile stress at the craniomedial part was 0.604 MPa. For the cancellous bone within the acetabulum, the high stress was mainly distributed on the craniomedial and anterior-inferior parts. Conclusions The high stress near the periphery of the articular surface showed a three-point circular distribution, which was mainly distributed on the iliac, ischial, and pubic bone area. The stress was distributed more uniformly owing to the deformation of the cancellous bone in the acetabulum. The cancellous bone in the acetabulum has the function of load-bearing.

Determination of main chemical components in the Astragali Radix from the Liupan mountain area in Ningxia / 国际药学研究杂志

Objective To quantitatively determine the bioactive chemical components, polysaccharides, total flavonoids and total saponins, in the Astragali radix from the Liupan mountain area (Liupan mountain Astragali radix) in Ningxia of China. Methods With colorimetry and high-performance liquid chromatography with evaporative light-scattering detection (HPLC-ELSD), the total quantity of polysaccharides flavonoids and saponins were determined for the one year-old and four years-old Liupan mountain Astragali radix, which was further analyzed in comparison with the results of the Astragali radix from Shanxi province (Shanxi Astragali radix) of China. Results The content of total polysaccharides, total flavonoids and total saponins was 4.10％, 0.088％ and 4.67％, respectively, in the four-year-old Liupan mountain Astragali radix. Among them, the total polysaccharide content was higher than that in Shanxi Astragali radix, the others were all lower than those in Shanxi Astragali radix. Further, the contents of the three total components in the one year-old Liupan mountain Astragali radix were all lower than those in the four years-old Liupan mountain Astragali radix and in the Shanxi Astragali radix. Conclusion Prolonging the growth period could significantly increase total content of the polysaccharides but not the flavonoids and saponins in the Liupan mountain Astragali radix.

Anatomy of the retrohepatic tunnel in a Chinese population and its clinical application in liver surgery.

Liver hanging maneuver (LHM) is an important technique in liver surgery. However, applied anatomy of the retrohepatic tunnel for the surgical approach in Chinese population needs further study. In this study, to explore the basic anatomy of retrohepatic tunnel and its clinical application in a Chinese population, a total of 32 formalin-fixed cadavers were dissected, related parameters were measured, and their clinical applications were discussed. The length of the retrohepatic tunnel was (60.6 ± 9.9) mm. The width of the retrohepatic tunnel superior opening was (13.8 ± 3.9) mm. The width of the retrohepatic tunnel inferior opening was (15.2 ± 7.4) mm. The hepatic short vessels were distributed along the middle and lower 1/3 of hepatic inferior vena cava (HIVC), with a slight predominance on its left wall. A few hepatic short vessels were distributed along the upper 1/3 of the HIVC. We concluded: the anatomy of the retrohepatic tunnel provides a basis for use of LHM in liver surgery; more hepatic short vessels from hepatic caudate lobe can be preserved via right approach. The retrohepatic tunnel can be used as a good surgical approach in liver surgery; its application also has important significance in laparoscopic minimally invasive liver surgery.

Salvianolate reduces murine myocardial ischemia and reperfusion injury via ERK1/2 signaling pathways in vivo.

OBJECTIVE: To analyze the effects of salvianolate on myocardial infarction in a murine in vivo model of ischemia and reperfusion (I/R) injury. METHODS: Myocardial I/R injury model was constructed in mice by 30 min of coronary occlusion followed by 24 h of reperfusion and pretreated with salvianolate 30 min before I/R (SAL group). The SAL group was compared with SHAM (no I/R and no salvianolate), I/R (no salvianolate), and ischemia preconditioning (IPC) groups. Furthermore, an ERK1/2 inhibitor PD98059 (1 mg/kg), and a phosphatidylinositol-3-kinase (PI3-K) inhibitor, LY294002 (7.5 mg/kg), were administered intraperitoneal injection (i.p) for 30 min prior to salvianolate, followed by I/R surgery in LY and PD groups. By using a double staining method, the ratio of the infarct size (IS) to left ventricle (LV) and of risk region (RR) to LV were compared among the groups. Correlations between IS and RR were analyzed. Western-blot was used to detect the extracellular signal-regulated kinase 1/2 (ERK1/2) and protein kinase B (AKT) phosphorylation changes. RESULTS: There were no significant differences between RR to LV ratio among the SHAM, I/R, IPC and SAL groups (P>0.05). The SAL and IPC groups had IS of 26.1%±1.4% and 22.3%±2.9% of RR, respectively, both of which were significantly smaller than the I/R group (38.5%±2.9% of RR, P<0.05, P<0.01, respectively). Moreover, the phosphorylation of ERK1/2 was increased in SAL group (P<0.05), while AKT had no significant change. LY294002 further reduced IS, whereas the protective role of salvianolate could be attenuated by PD98059, which increased the IS. Additionally, the IS was not linearly related to the RR (r=0.23, 0.45, 0.62, 0.17, and 0.52 in the SHAM, I/R, SAL, LY and PD groups, respectively). CONCLUSION: Salvianolate could reduce myocardial I/R injury in mice in vivo, which involves an ERK1/2 pathway, but not a PI3-K signaling pathway.

Salvianolate reduces murine myocardial ischemia and reperfusion injury via ERK1/2 signaling pathways in vivo / 中国结合医学杂志

<p><b>OBJECTIVE</b>To analyze the effects of salvianolate on myocardial infarction in a murine in vivo model of ischemia and reperfusion (I/R) injury.</p><p><b>METHODS</b>Myocardial I/R injury model was constructed in mice by 30 min of coronary occlusion followed by 24 h of reperfusion and pretreated with salvianolate 30 min before I/R (SAL group). The SAL group was compared with SHAM (no I/R and no salvianolate), I/R (no salvianolate), and ischemia preconditioning (IPC) groups. Furthermore, an ERK1/2 inhibitor PD98059 (1 mg/kg), and a phosphatidylinositol-3-kinase (PI3-K) inhibitor, LY294002 (7.5 mg/kg), were administered intraperitoneal injection (i.p) for 30 min prior to salvianolate, followed by I/R surgery in LY and PD groups. By using a double staining method, the ratio of the infarct size (IS) to left ventricle (LV) and of risk region (RR) to LV were compared among the groups. Correlations between IS and RR were analyzed. Western-blot was used to detect the extracellular signal-regulated kinase 1/2 (ERK1/2) and protein kinase B (AKT) phosphorylation changes.</p><p><b>RESULTS</b>There were no significant differences between RR to LV ratio among the SHAM, I/R, IPC and SAL groups (P>0.05). The SAL and IPC groups had IS of 26.1%±1.4% and 22.3%±2.9% of RR, respectively, both of which were significantly smaller than the I/R group (38.5%±2.9% of RR, P<0.05, P<0.01, respectively). Moreover, the phosphorylation of ERK1/2 was increased in SAL group (P<0.05), while AKT had no significant change. LY294002 further reduced IS, whereas the protective role of salvianolate could be attenuated by PD98059, which increased the IS. Additionally, the IS was not linearly related to the RR (r=0.23, 0.45, 0.62, 0.17, and 0.52 in the SHAM, I/R, SAL, LY and PD groups, respectively).</p><p><b>CONCLUSION</b>Salvianolate could reduce myocardial I/R injury in mice in vivo, which involves an ERK1/2 pathway, but not a PI3-K signaling pathway.</p>

The changes of bone biomechanical properties in osteoporosis / 医用生物力学

Osteoporosis, a skeletal disorder of low bone density and disrupted bone architecture leading to fractures, is a common and costly condition among postmenopausal women. The biomechanical properties of bone are determined by the amount and quality of bone material and the arrangement of the material in space, mainly affected by the bone cortex, trabecular bone and collagen. When osteoporosis occurs, the cortex, trabecular bone and collagen all have the corresponding changes, which lead to the changes in biomechanical properties of bone. In this review, the changes of bone cortex, trabecular and collagen are summarized, to provide the comprehensive understanding about the changes of bone biomechanical properties in osteoporosis.

Detection and the Significance of SOCS-1 Gene Methylation Status in Peripheral Blood of Systemic Lupus Erythematosus Patients / 现代检验医学杂志

Objective To investigate the relationship between the systemic lupus erythematosus (SLE)and the SOCS-1 gene methylation status of the peripheral blood DNA,to provide the basis for diagnosis and treatment of systemic lupus erythema-tosus.Methods Blood samples of SLE patients (27 cases)and healthy group (19 cases)in January 2015 to April were col-lected and the DNA were extracted.Using polymerase chain reaction combining DNA agarose gel electrophoresis to detect the SOCS-1 gene methylation status.Results In patients with systemic lupus erythematosus SOCS-1 gene complete methyl-ation accounted for 44% (12/27),incomplete methylation accounted for 56% (15/27).In healthy group SOCS-1 gene com-plete methylation accounted for 74% (14/19)and incomplete methylation accounted for 26% (5/19).The rate of complete methylation of SOCS-1 gene of SLE patients was lower than that of healthy group (χ2=3.88,P=0.049).Conclusion SLE patients may have lower SOCS-1 gene methylation status in the peripheral blood DNA,which is worth for further study.

Advances in anatomy and biomechanics of the proximal femur / 医用生物力学

Hip fracture is one of the major causes of death and injuries of the elderly, and its occurrence rate is increasing with the progress of aging population, which becomes a heavy economic burden on the family and society. The main treatment for proximal femoral fractures includes fracture fixation and hip arthroplasty. This review is focused on the relationship between anatomical structure and load transfer mechanism of the proximal femur, mechanical distributions on cortical and cancellous bone in the proximal femur, and the latest progress in biomechanical research on risk prediction of hip fracture both in China and abroad, which will contribute to understand hip fracture from a biomechanical perspective, improve the accuracy of risk prediction of hip fracture in the elderly, as well as treatment of hip fracture, the correct selection and application of othopaedic implants.

Influences of osteoporosis on relationship between trabecular stress and microdamage / 医用生物力学

Objective To quantify the stress and strain of trabecular bone with microdamage/microfracture by using micro-CT and micro-finite element (μFE) analysis, so as to investigate the effects of osteoporosis on relationship between trabecular stress and microdamage/microfracture. Methods Two cylindrical specimens of healthy and osteoporotic acetabular trabecular bones were scanned by micro-CT to build 3D μFE analysis models. The uniaxial compression on two specimens was simulated under frictionless displacement boundary condition. The trabecular stress, trabecular strain, microdamage and microfracture under different apparent strains were calculated through nonlinear μFE analysis. Results For both the healthy and osteoporotic trabeculae under apparent strain of 0.05%-0.50%, the undamaged trabecular stress was under 50 MPa, while the damaged trabecular stress was above 110 MPa. Compared with the osteoporotic trabeculae, the mean stress of the healthy trabeculae was relatively higher, but the maximum stress of the osteoporotic trabeculae was higher. Trabecular damage occurred in both the healthy and osteoporotic trabeculae, while the healthy trabeculae showed more microdamage, and microfracture occurred in the osteoporotic trabeculae. Conclusions Within the scope of apparent strain, the healthy trabeculae can withstand a higher stress with more trabecular microdamage, and microfractures might occur in the osteoporotic trabeculae under the high stress.

Experience of surgical treatment for autoimmune hepatitis complicated with cirrhosis and hyper-splenism / 临床外科杂志

Objective To investigate the effect of splenectomy on autoimmune hepatitis complicated with cirrhosis and hypersplenism.Methods Nine cases of autoimmune hepatitis complicated withcirrhosis and hypersplenism were treated with splenectomy and periesophagogastric devascularization.Results All patients recovered well.Their liver functions recovered to the preoperative level within twoweeks after operation.No significant differences were found between preoperative and postoperative levelsof transaminase and bilirubin(P >0.05).The count of leukocyte and platelet rose to the normal level andthere were significant differences between the preoperative and postoperative levels(P <0.05).Patients'symptoms of hypersplenism were corrected and their coagulation function improved significantly (P <0.05).Conclusion In patients with autoimmune hepatitis complicated with cirrhosis and hypersplenism,splenectomy with periesophagogastric devascularization is an effective procedure for improving hypersplenism,enhancing blood coagulation,and reducing bleeding.

Preoperative risk factors of portal venous thrombosis after splenectomy and gastric pericardial devascularization for portal hypertension / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the preoperative risk factors of portal venous thrombosis (PVT) after splenectomy and gastric pericardial devascularization in patients with liver cirrhosis and portal hypertension.</p><p><b>METHODS</b>Clinical data was collected for 127 patients who underwent splenectomy and gastric pericardial devascularization for portal hypertension at our hospital between January 2010 and December 2012.The patient data were analyzed retrospectively according to patient status of presence or absence of PVT postoperatively.The preoperative risk factors of PVT were statistically analyzed.</p><p><b>RESULTS</b>There were no significant differences between the postoperative PVT-positive and-negative groups in regards to sex, age, receipt of emergency surgery, presence of ascites, admission to hospital for upper gastrointestinal bleeding, grade of esophageal-gastric varices, Child-Pugh classification, spleen vein diameter, liver function (as determined by levels of alanine aminotransferase, total bilirubin, direct bilirubin, albumin, globulin, cholinesterase, and gamma-glutamyltransferase), renal function (as determined by creatinine level), and coagulation function (as determined by prothrombin time, prothrombin activity degree, activated partial thromboplastin time, international normalized ratio, fibrinogen, thrombin time, and antithrombin III).However, there were significant differences between the groups for the parameters of postoperative PVT presence, upper gastric bleeding history, aspartate aminotransferase level, and blood urea nitrogen level (all P less than 0.05).Portal vein diameter and history of upper gastric bleeding were both identified as independent risk factors for PVT (P less than 0.05).Incidence of postoperative PVT was higher in patients who had portal vein diameter > 13.15 mm (cutoff value of 13.75 mm) and in patients who had a history of upper gastric bleeding.</p><p><b>CONCLUSION</b>Portal vein diameter and history of upper gastric bleeding were independent risk factors for PVT occurrence after splenectomy and gastric pericardial devascularization in patients with liver cirrhosis and portal hypertension.</p>

Evaluation effect of three scoring systems in the prediction of short-term outcomes following liver transplantation / 中华肝胆外科杂志

Objective To evaluate the predictive effect of preoperative CTP score,MELD score and MELD-Na score on short-term prognosis (≤ 3 months) after liver transplantation,to analyze factors which correlated with survival,and to seek indicators that accurately predicted short-term outcomes.Methods The clinical data of 73 consecutive patients with end-stage liver diseases who underwent liver transplantation in a single center were retrospectively analyzed.The area under the ROC curve (AUC) was used to determine the predictive power.Correlated factors were analyzed by multivariate logistic regression.The statistical processing package used was SAS 9.1.3 software.Results 11 (15.1％) of 73 patients died within 3 months after liver transplantation.The areas under the ROC curve of the preoperative CTP score,MELD score and MELD-Na score for predicting short-term survival were 0.817,0.839 and 0.860 respectively.There was no significant difference among these 3 scoring systems.On univariate analysis,indicators significantly correlated with early mortality were preoperative serum sodium,serum urea,PT-INR,CTP score,MELD score and MELD-Na score.On logistic multiple regression,only MELD-Na score remained as a significant indicator (P =0.001,β =-2.496,OR =0.085,95％ CI:0.019 ～ 0.370).Conclusions The MELD-Na scoring system showed superior predictability of early mortality in patients who underwent liver transplantation.The preoperative MELD-Na score was an independent risk factor of short-term survival.The higher the MELD-Na score,the higher was the early mortality.

Total trans-oral endoscopic thyroidectomy and cervical lymphadenectomy: a human cadavers surgery study / 中华外科杂志

<p><b>OBJECTIVE</b>To find an approach for trans-oral endoscopic thyroidectomy (TOET) and cervical lymphadenectomy using conventional endoscopic surgical instruments on frozen fresh cadavers.</p><p><b>METHODS</b>Six frozen fresh cadavers were used in three groups of trans-oral trocar installation experiments: oral vestibule installation, sublingual region installation, and combined bi-vestibular and sublingual installation. TOET (with pretrachealis method to thyroid fixation removal) and cervical lymphadenectomy were performed experiments on another 6 frozen fresh cadavers using the best access approach found in the aforementioned experiments.</p><p><b>RESULTS</b>In oral vestibule trocar installations, the trocars caused large lacerated wound and damaged air tightness. In sublingual installations, only one trocar could be installed in the sublingual area because the space in sublingual area was limited. In combined bi-vestibular and sublingual installations, no gland, vessel or nerve was damaged. Combined bi-vestibular and sublingual access were selected as the surgical approach on the basic of analysis the merits of each approach. TOET and cervical lymphadenectomy in area III, IV, VI, VII were performed without making any accessory damage through combined bi-vestibular and sublingual access approach.</p><p><b>CONCLUSIONS</b>TOET is feasible. Combined bi-vestibular and sublingual approach is available for TOET. Part of the cervical lymph nodes could be resected. Pretrachealis approach to thyroid fixation removal can still be used.</p>