Clinicopathological characteristics and prognostic factors analysis of pancreatic cancer patients with liver metastasis / 中华胰腺病杂志

Objective:To investigate the clinicopathological characteristics and prognostic factors of pancreatic cancer patients with liver metastasis.Methods:The clinical data of 67 pancreatic cancer patients with liver metastases who received first treatment in Department of Oncology of the First Affiliated Hospital of Naval Medical University between July 2012 and June 2016 were retrospectively analyzed. The relationship between patient survival time and the clinicopathological characteristics including patients' age, gender, tumor location, physical activity status score, tumor markers, number of distant metastatic organs, radiotherapy at the primary site, first-line chemotherapy regimen, number of cycles of first-line chemotherapy received, and liver metastases undergoing transcatheter arterial chemoembolization (TACE) was analyzed. Kaplan-Meier curves were plotted to reveal survival time in pancreatic cancer patients with liver metastases, and univariate and multifactorial COX proportional risk regression models were used to analyze independent prognostic risk factors for pancreatic cancer patients with liver metastases.Results:All patients were followed up until December 31, 2018, and all 67 patients died. The results of univariate analysis showed that patients with positive tumor marker, number of distant metastatic organs ≥2, number of cycles of first-line chemotherapy ≤2, no radiotherapy to the primary site and no TACE had shorter survival than those with negative tumor marker, one distant metastatic organ, number of cycles of first-line chemotherapy ≥3, with radiotherapy to the primary site and TACE, and all the differences were statistically significant (all P values <0.05). The results of multifactorial analysis showed that positive tumor markers ( HR=0.567, 95% CI 0.332-0.954, P=0.031), number of distant metastatic organs ≥2 ( HR=0.581, 95% CI 0.353-0.977, P=0.039), number of first-line chemotherapy cycles ≤2( HR=1.890, 95% CI 1.155-3.121, P=0.013) and primary foci without radiotherapy ( HR=0.414, 95% CI 0.231-0.732, P=0.002) were the independent prognostic risk factors for pancreatic cancer patients with liver metastasis. Conclusions:The prognosis of pancreatic cancer patients with liver metastasis is affected by multiple factors, among which positive tumor markers, more distant metastatic organs, no radiotherapy at the primary site and fewer first-line chemotherapy cycles are independent prognostic risk factors for pancreatic cancer with liver metastasis.

Retrospective analysis of clinical characteristics of and treatment strategies for patients with long-acting anticoagulant rodenticide poisoning.

OBJECTIVE: Long-acting anticoagulant rodenticide (LAAR) poisoning remains a serious public health problem. The aim of this study was to explore the clinical characteristics of different LAARs and a method of making a decision on the VK1 treatment course and the time to stop VK1 treatment safely. METHOD: This retrospective study compared the clinical characteristics of two LAARs poisoning patients and used multivariate regression method to explore the relationship between blood LAAR concentration and vitamin K1 dose/treatment time. RESULT: A total of 115 patients with LAAR poisoning were included in this study after screening. Of these, 50 patients attempted to commit suicide. The median LAAR concentration of the patients at admission was 409 (157-1174) ng/mL, and the VK1 treatment duration was 14 (8-34) days. The total VK1 treatment time in patients with LAAR poisoning was positively correlated with admission LAAR concentration. During the maintenance treatment period, the VK1 dosage was positively correlated with blood LAAR concentration. CONCLUSION: Low dose of VK1 during the maintenance period is indicative of the blood LAAR concentration being relatively low. This provides a basis for judging the LAAR content in the body during the maintenance treatment period.

Epidemiology, clinical presentation, treatment, and follow-up of chronic mercury poisoning in China: a retrospective analysis.

BACKGROUND: There are no reports on the incidence of chronic mercury poisoning in a large population in China. This study investigated the epidemiology, clinical manifestations, treatment, and follow-up of Chinese patients with chronic mercury poisoning. METHODS: Data for 288 mercury poisoning patients were collected at our hospital from July 2014 to September 2019, including sex, age, admission time, blood mercury content, urine mercury content, creatinine, urinary mercury/creatinine ratio, 24-h urinary protein levels, electromyography (EMG) findings, renal biopsy, and follow-up. Patient characteristics were evaluated by statistical and correlation analyses. RESULTS: First, mercury poisoning in China mainly occurred through occupational exposure and the inappropriate use of mercury-containing cosmetics and Chinese folk remedies (CFRs). Second, the most common symptoms were nervous system (50.3 %), kidney (16.4 %) and breathing (8.0 %). Mercury poisoning-induced Nephrotic syndrome (NS) and peripheral neuropathy are common long-term complications. The complications of occupational and cosmetics-induced mercury poisoning are consistent with international belief. However, the NS caused by CFRs is mainly membranous nephropathy and the probability of peripheral neuropathy caused by CFRs is higher than other pathogens. Third, follow-up data shows that 13 patients with EMG-confirmed neurological injury, 10 showed full recovery after 38.50 ± 8.03 months. Furthermore, among 18 patients with NS, 15 had normal urine protein and serum albumin levels after 22.67 ± 10.26 months. CONCLUSIONS: Regulation of skin-lightening cosmetic products, safety surveillance of CFRs, and prevention and control of occupational exposure must be improved to decrease the incidence of mercury poisoning in China.

Efficacy analysis of prussian blue or its combination with hemoperfusion in the treatment of acute thallium poisoning / 中华危重病急救医学

Objective@#To investigate the efficacy of prussian blue (PB) or its combination with hemoperfusion (HP) in the treatment of acute thallium poisoning.@*Methods@#Forty-seven patients with acute thallium poisoning with complete data hospitalized in the 307th Hospital of PLA from September 2002 to December 2017 were enrolled, and they were divided into mild poisoning group (blood thallium < 150 μg/L, urinary thallium < 1 000 μg/L) and moderate-severe poisoning group (blood thallium ≥ 150 μg/L, urinary thallium ≥ 1 000 μg/L) according to the toxic degrees. All patients were given symptomatic supportive treatments such as potassium supplementation, catharsis, vital organ protections, neurotrophic drugs, and circulation support. The mild poisoning patients were given PB with an oral dose of 250 mg·kg-1·d-1, while moderate-severe poisoning patients were given PB combined HP continued 2-4 hours each time. The PB dose or frequency of HP application was adjusted according to the monitoring results of blood and urine thallium. Data of gender, age, pain grading (numeric rating scale NRS), clinical manifestations, blood and urine thallium before and after treatment, length of hospitalization and prognosis were collected.@*Results@#Of the 47 patients, patients with incomplete blood and urine test results, and used non-single HP treatment such as plasmapheresis and hemodialysis for treatment were excluded, and a total of 29 patients were enrolled in the analysis. ①Among 29 patients, there were 20 males and 9 females, median age of 40.0 (34.0, 49.0) years old; the main clinical manifestations were nervous system and alopecia, some patients had digestive system symptoms. There were 13 patients (44.8%) in the mild poisoning group with painless (grade 0) or mild pain (grade 1-3) with mild clinical symptoms, the length of hospitalization was 17.0 (14.2, 21.5) days. There were 16 patients (55.2%) in the moderate-severe poisoning group with moderate pain (grade 4-6) or severe pain (grade 7-10) with severe clinical symptoms, the length of hospitalization was 24.0 (18.0, 29.0) days. ② After treatment, the thallium concentrations in blood and urine in the mild poisoning group were significantly lower than those before treatment [μg/L: blood thallium was 0.80 (0, 8.83) vs. 60.00 (40.00, 120.00), urine thallium was 11.30 (0, 70.10) vs. 370.00 (168.30, 610.00), both P < 0.01], the thallium concentrations in blood and urine in the moderate-severe poisoning group were also significantly lower than those before treatment [μg/L: blood thallium was 6.95 (0, 50.50) vs. 614.50 (245.00, 922.00), urinary thallium was 20.70 (1.95, 283.00) vs. 5 434.00 (4 077.20, 10 273.00), both P < 0.01]. None of the 29 patients died, and their clinical symptoms were improved significantly. All the 27 patients had good prognosis without sequela in half a year follow-up, and 2 patients with severe acute thallium poisoning suffered from nervous system injury.@*Conclusion@#In the acute thallium poisoning patients, on the basis of general treatment, additional PB in mild poisoning group and PB combined with HP in moderate-severe poisoning group can obtain satisfactory curative effects.

Clinical analysis of 48 patients with acute mushroom poisoning / 中华危重病急救医学

Objective To analyze the clinical manifestation and therapeutic method in patients with acute mushroom poisoning. Methods A retrospective study was conducted. The clinical data of 48 patients with acute mushroom poisoning admitted to Department of Poisoning Treatment of the 307th Hospital of PLA from January 2016 to May 2017 were analyzed. The clinical data including gender, age, clinical symptoms, onset season, initial symptoms, incubation time, the length of hospital stay, treatment, and prognosis. In addition to the conventional treatment, the patients with severe liver damage were treated with continuous blood purification (CBP). The changes in routine blood test, biochemical parameters, blood ammonia and coagulation function before and 1, 3 and 7 days after CBP were observed. Results There were 29 of male (60.4%) and 19 of female (39.6%) in 48 patients with acute mushroom poisoning, with an average age of (48.10±13.14) years. There were 9 patients suffering from gastroenteritis type, 26 suffering from liver damage type, 8 suffering from neuro-psychosis type, 2 suffering from hemolytic type, and 3 suffering from renal damage type. All of the poisoned patients had evident seasonal characteristic, mainly concentrated in the autumn, especially in August, according for 66.7% (32/48). The initial symptoms of poisoning patients were mainly manifested as nausea and vomiting (50.0%). In five kinds of poisoned patients, the incubation time [(1.44±1.15) hours] and the length of hospital stay [(3.50±2.33) days] of neuro-psychosis type was the shortest, and the incubation time of liver-damaged type [(10.63±3.50) hours] and the length of hospital stay of renal damage type [(20.67±0.58) days] was the longest. Patients received symptomatic treatment according to different types, among whom 12 patients with severe liver damage received additional treatment for CBP. After the treatment, alanine aminotransferase (ALT), aspartate aminotransferase (AST), MB isoenzyme of creatine kinase (CK-MB), lactate dehydrogenase (LDH), and prothrombin activity (PTA) were significantly improved as compared with those before CBP treatment, with significant differences between 7 days after CBP and before CBP [ALT (U/L): 213.08±127.30 vs. 2 766.83±1 909.66, AST (U/L): 50.00 (41.00, 85.00) vs. 2 142.00 (1 225.00, 3 126.00), CK-MB (U/L): 24.09±8.87 vs. 44.75±22.09, LDH (μmol·s-1·L-1):3.70±1.46 vs. 13.03±12.77, PTA: (79.08±24.29)% vs. (35.25±19.85)%, all P < 0.01]. Among 48 patients, 47 were cured and discharged, and 1 patient with liver failure died due to aggravation of liver dysfunction, abnormal coagulation and bleeding, and massive hemorrhage of gastrointestinal tract. Conclusions Acute mushroom poisoning patients demonstrated obvious seasonal characteristics, mostly liver-damaged type, and its initial symptoms were mainly presented as nausea, vomiting and other gastrointestinal manifestations. Early clarification of diagnosis, timely treatment, as well as providence with CBP treatment in severe patients should be carried out as soon as possible. In such a way the curative effect can be enhanced, the mortality can be reduced, and the prognosis of the patients could be improved.

MRI features and pathological analysis of intracalvarium hemangioblastomas / 中国介入影像与治疗学

Objective To discuss MRI and pathological features of intracranial hemangioblastoma.Methods MRIdata of 26 cases of hemangioblastoma confirmed with operation and pathology were analyzed retrospectively.Results There were 22 cases with single lesion and multiple lesions in 4 eases.And a total of 31 lesions located in the posterior cranial fossa,including 14 lesions in right cerebellar hemispheres,9 lesions in left cerebellar hemispheres,2 lesions in cerebellar inferior vermis,4 lesions in medulla oblongata,and 2 lesions in fourth ventricle.Ninteen lesions showed cystic nodular type,1 lesion was cystic type,11 lesions showed parenchymal type or partial parenchyma type.Cystic lesions showed long T1 and long T2 signal,T1WI of solid area showed slightly long T1 and slightly long T2 signal,of which 12 lesions were slightly shorter T1 signal.Solid areas significantly enhanced,cystic area had no enhancement,but cystic wall of 3 cystic nodular lesions were slightly enhanced.DWI of solid areas showed low signal.MRS showed the peak of Cho obviously increased,and the peaks of Cr and NAA obviously decreased or nearly disappeared,and the high peak of lipids and lactate were observed.Conclusion The conventional and functional MRI of intracranial hemangioblastoma have some characteristics,MRI has a great value in the diagnosis and localization of intracranial hemangioblastoma.

Effect of apatinib on cell proliferation, migration and apoptosis in pancreatic cancer cell line AsPC-1 / 中华胰腺病杂志

Objective To investigate the effect of apatinib on the proliferation,apoptosis and migration of pancreatic cancer cell line AsPC-1 in vitro.Methods Pancreatic cancer AsPC-1 cells were treated by apatinib in different concentrations.Cell proliferation and apoptosis were measured by CCK-8 and flow cytometry,and the effect of apatinib on cell migration ability was observed by wound healing assay.Results In control and 10,20,30,40 and 50umol/L apatinib treatment group,the inhibitory rates of AsPC-1 cells were 0,(1.45 ±0.68)％,(16.92±0.70)％,(23.84±0.84)％,(34.35±1.55)％ and (37.33± 0.81) ％,respectively.Cell proliferation was obviously inhibited by apatinib as the concentration increased,and the differences were statistically significant (P ＜ 0.05).In control and 20,40 umol/L apatinib treatment group,the apoptotic rates were (9.44 ± 0.18) ％,(16.62 ± 0.19) ％ and (25.42 ± 0.41) ％,respectively.Number of apoptotic cells was obviously increased by apatinib as the concentration increased,and the differences were statistically significant (P ＜ 0.05).In control and 20,40 umol/L apatinib treatment group,the migration ability was (29.5 ± 0.7) ％,(17.4 ± 0.9) ％ and (6.6 ± 0.5) ％,which was greatly decreased as the concentration increased,and the differences were statistically significant (P ＜ 0.05).Conclusions Apatinib can effectively inhibit the proliferation and migration of pancreatic cancer AsPC-1 cells and induce apoptosis.

MRI features and pathological analysis of intracalvarium hemangioblastomas / 中国介入影像与治疗学

Objective To discuss MRI and pathological features of intracranial hemangioblastoma.Methods MRIdata of 26 cases of hemangioblastoma confirmed with operation and pathology were analyzed retrospectively.Results There were 22 cases with single lesion and multiple lesions in 4 eases.And a total of 31 lesions located in the posterior cranial fossa,including 14 lesions in right cerebellar hemispheres,9 lesions in left cerebellar hemispheres,2 lesions in cerebellar inferior vermis,4 lesions in medulla oblongata,and 2 lesions in fourth ventricle.Ninteen lesions showed cystic nodular type,1 lesion was cystic type,11 lesions showed parenchymal type or partial parenchyma type.Cystic lesions showed long T1 and long T2 signal,T1WI of solid area showed slightly long T1 and slightly long T2 signal,of which 12 lesions were slightly shorter T1 signal.Solid areas significantly enhanced,cystic area had no enhancement,but cystic wall of 3 cystic nodular lesions were slightly enhanced.DWI of solid areas showed low signal.MRS showed the peak of Cho obviously increased,and the peaks of Cr and NAA obviously decreased or nearly disappeared,and the high peak of lipids and lactate were observed.Conclusion The conventional and functional MRI of intracranial hemangioblastoma have some characteristics,MRI has a great value in the diagnosis and localization of intracranial hemangioblastoma.

Clinical observation of albumin-bound paclitaxel plus S-1 in patients with advanced pancreatic cancer after the failure of gemcitabine / 中国癌症杂志

Background and purpose: Pancreatic cancer is often diagnosed at advanced stage, therefore, chemotherapy remains the cornstone of treatment for advanced pancreatic cancer. However, no standard regimen has been established as second-line therapy for advanced pancreatic cancer. The purpose of the study was to evaluate the efifcacy and safety of albumin-bound paclitaxel plus S-1 for the treatment of advanced pancreatic cancer patients in second-line setting after the failure of gemcitabine treatment. Methods:Clinical outcomes of 19 patients with advanced pancreatic cancer were analyzed. These patients received albumin-bound paclitaxel plus S-1 as second-line therapy after the failure of gemcitabine treatment. Albumin-bound paclitaxel was administered at a dose of 125 mg/m2 over 30 minutes on day 1 and 8 of a 21-day cycle. From d1-14, all patients received oral S-1 40 mg/m2, twice daily. Results:All patients were available for evaluation. Of the 19 patients, 1 case got complete response (CR), 4 cases had partial response (PR) and 9 cases had stable disease (SD). The objective response rate (ORR) was 26.3%, the disease control rate (DCR) was 73.7%and the median progression free survival (PFS) was 5.2 months. The main toxicities include hematological toxicity, myodynia, gastrointestinal reactions, sensory neuropathy, fatigue and alopecia. Conclusion:The combination of albumin-bound paclitaxel and S-1 is effective and tolerated in the treatment of advanced pancreatic cancer patients who resistant to gemcitabine.

Efficiency of hemoperfusion on clearing thallium based on atomic absorption spectrometry / 中华危重病急救医学

ObjectiveTo determine thallium in whole blood by atomic absorption detection method, and to investigate the eliminating effect of hemoperfusion (HP) for thallium in blood.Methods The blood of Beagle dogs which had not exposed to thallium before were obtained for preparation of thallium nitrate (TlNO3)-containing solution in three concentrations according to the conversion formula based on animal weight and volume of blood. HP was performed in the simulated in vivo environment. The content of TlNO3 in blood of the next group was determined on the amount of TlNO3 for the last HP of the former dose group. Thallium quantity in different samples was measured with atomic absorption spectrometer blood samples before and after HP. Finally, the thallium concentration in blood was analyzed statistically.Results Thallium concentrations showed a good linear relationship in the range of 0-200μg/L (r = 0.998 4). The intra-day precision (RSD) was lower than 4.913%, the intra-day recovery rate was 96.2%-111.9%; the inter-day precision (RSD) was lower than 7.502%, the inter-day recovery rate was 89.6%-105.2%. The concentration of thallium in blood was significantly reduced after HP per time in high, middle, and low dose groups [(453.43±27.80) mg/L to (56.09±14.44) mg/L in high dose group,F = 8.820,P = 0.003;(64.51±13.60) mg/L to (3.19±0.23) mg/L in middle dose group,F = 36.312,P = 0.000; (5.40±0.98) mg/L to (0.38±0.25) mg/L in low dose group,F = 46.240,P = 0.000]. The adsorption rate of four times of HP in high, middle and low dose group were (87.63±2.48)%, (95.06±1.54)% and (92.76±4.87)%, respectively, without significant difference (F = 4.231,P = 0.070 ).Conclusions The method for measuring thallium was established, and it shows a very stable, simple, sensitive for determination of thallium. HP can effectively remove thallium from blood. Thallium concentration can be reduced by 90% after four times of HP. HP is also effective even when thallium concentration is not high.

[Mutation analysis of the pathogenic gene in a Chinese family with hereditary hemochromatosis].

Hereditary hemochromatosis (HHC) is a rare autosomal recessive disorder. We recruited a consanguineous Chinese family including the proband with HHC and other four members without HHC. Using whole-exome sequencing, we identified two homozygous mutations (c.G18C [p.Q6H] and c.GC962_963AA [p.C321X]) in the hemojuvelin gene (HJV) in the proband with HHC. No mutation was found in other four previously identified HHC related genes, HAMP, TFR2, FPN and HFE. The functional impact of p.Q6H mutation is weak whereas p.C321X, a premature termination mutation, results in a truncated HJV protein, which lacks the glycosylphosphatidylinositol (GPI) anchor domain. In addition to the mutations in HJV, other 12 homozygous mutations were identified in this patient. However, none of these mutations showed strong damaging impact and the mutated genes are not related to iron metabolism. Our in-house data further demonstrated that p.C321X is absent in the general Chinese population, suggesting that the homozygous mutation p.C321X in HJV is causative in the patient with HHC. Accordingly, all of the four members without HHC from the same family carried wild-type alleles or heterozygous mutations, but not the homozygous mutation in this site. Thus, we found for the first time that the homozygous mutation p.C321X in HJV can result in HHC, which will help genetic diagnosis and prenatal counseling for HHC.

Chronic hypoxia in altering metabolism of intestinal flora of infants / 局解手术学杂志

Objective To investigate the metabolism change of intestinal flora due to chronic hypoxia in infants. Methods Ten infants with tetralogy of fallot were considered as the chronic hypoxia group,10 healthy infants were regarded as the control group. The urine concen-tration of hippurate in the morning with fasting was detected by 1 H nuclear magnetic resonance. Results The concentration of hippurate was decreased in hypoxia group compared with the control group,(47. 15 ± 32. 88) mg/L vs (346. 698 ± 13. 555) mg/L,with significant differ-ence,P=0. 002. Conclusion Chronic hypoxia alters metabolism of intestinal flora in infants.