Objective To clarify relationship between signal heterogeneity on hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI and prognosis of hepatocellular carcinoma (HCC). Methods From January 2014 to January 2017 in the First Affiliated Hospital of Chongqing Medical University, a total of 77 patients with the pathologically proved HCC underwent Gd-EOB-DTPA-enhanced MRI prior to surgery were included in this study. On the basis of the signal heterogeneity in the hepatobiliary phase, the included patients were designed to homogeneous hypointensity group and heterogeneous hyperintensity group. The disease-free survival time were compared between the 2 groups and it’s influencing factors were analyzed. Results Seventy-seven patients with HCC were included, including 45 cases of homogeneous hypointensity and 32 cases of heterogeneous hyperintensity. There were no significant differences in the age, gender, etiology, liver function, alpha-fetoprotein, differentiated degree, Child-Pugh grade, lesion diameter, lesion border, and number of lesions between the 2 groups (P>0.05). However, the HCC patients with heterogeneous hyperintensity had a later BCLC staging (P=0.001). The disease-free survival time of the patients with homogeneous hypointensity and heterogeneous hyperintensity was (17.0±9.8) months and (12.4±10.4)months, respectively. The Kaplan-Meier survival curve showed that the disease-free survival time in the patients with homogeneous hypointensity was significantly better than that in the patients with heterogeneous hyperintensity (P=0.020). The results of univariate analysis showed that the other confounding factors had no effect on the disease-free survival time of patients with hepatocellular carcinoma (P>0.05) except for the signal of hepatobiliary phase (P<0.05). Furthermore, the hepatobiliary phase signal, BCLC stage, and degree of differentiation, which might be clinically considered as potentially influencing for the prognosis of patients with HCC, were included in the Cox multivariate proportional hazard regression model and found that the heterogeneous hyperintensity was still the risk factor of the disease-free survival rate in patients with HCC (P=0.047). Conclusion Signal heterogeneity on hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI is related to prognosis of patients with HCC, heterogeneous hyperintensity may indicate a lower disease-free survival rate.
Objective To summarize the relation between various kinds of immune cells infiltration in tumor microenvironment and prognosis of hepatocellular carcinoma (HCC). Method Literatures on the relation between immune cell infiltration in tumor microenvironment and prognosis of HCC in recent years were collected and reviewed. Results The immune cell infiltration in the tumor microenvironment of HCC was inextricably linked with the progression of HCC. CD4+ T cells, CD8+ T cells, M1 macrophages, B cells, and memory T cells might be associated with a good prognosis in patients with HCC, while regulatory T cells, regulatory B cells, and M2 macrophages might be related to the poor prognosis of patients with HCC. Conclusion The study of immune cell infiltration in HCC can provide new ideas for precise immunotherapy of HCC.
ObjectiveTo analyze the clinicopathologic features and prognosis of breast cancer patients with low human epidermal growth factor receptor-2 (HER2) expression. MethodsThe breast cancer patients underwent initially surgical resection in the First Hospital of Shanxi Medical University from October 2015 to October 2017 and met the criterion of this study were retrospectively gathered. Based on the immunohistochemical / in situ hybridization detection results, the patients were divided into three subtypes of HER2 zero, low, and positive expressions, and the differences in the clinicopathologic characteristics, overall survival (OS) and disease-free survival (DFS) of the three subtypes of breast cancer patients were compared. At the same time, the risk factors affecting the OS and DFS of breast cancer patients with low HER2 expression were analyzed. ResultsA total of 315 eligible patients were gathered in this study, including 68 patients with HER2 zero expression, 121 patients with low HER2 expression, and 126 patients with positive HER2 expression. There were no statistic differences in the menstrual status, T stage, and histological classification between the breast cancer patients with low HER2 and positive HER2 expressions (P>0.05), but the proportions of the patients with lymph node metastasis, histological grade Ⅲ, negative hormone receptor (HR) and high Ki67 expression in the low HER2 expression patients were lower than those in the positive HER2 expression patients. And compared with HER2 zero expression breast cancer patients, the proportions of premenopausal / perimenopausal, T2–4, N1–3, histological grade Ⅱ, ductal carcinoma, negative HR, and low Ki67 expression patients in the breast cancer patients with low HER2 expression were higher (P<0.05). While the survival curves of OS and DFS by Kaplan-Meier method had no statistic differences among the three subtypes of the breast cancer patients (χ2=0.070, P=0.966; χ2=0.362, P=0.835). The multivariate analysis results by Cox proportional hazards regression found that the low HER2 expression breast cancer patients with histological grade Ⅲ and negative HR had the higher risks of OS and DFS shortening (P<0.05). In addition, the risk of DFS shortening in the patients with T stage 2–4 and N stage 1–3 was increased (P<0.05). ConclusionsFrom the results of this study, breast cancer patients with low HER2 expression is different from the other two subtypes of breast cancer in terms of clinicopathologic characteristics. However, there are no statistical significances in comparing the OS and DFS of three types of breast cancer patients, but it is found that histological grading and HR are related to the OS and DFS of breast cancer patients with low HER2 expression, and it is also found that T stage and N stage are related to the DFS of breast cancer patients with low HER2 expression, so more attentions should be paid to the treatment plans.
Objective To assess the relationship between the change in fluid overload at 48 h after initiation of continuous renal replacement therapy (CRRT) and 28-day mortality in critically ill patients with acute kidney injury (AKI). Methods A retrospective cohort study was performed using data from the MIMIC-IV database from 2008 to 2019. Patients who received CRRT for AKI for more than 24 h within 14 d of admission to the intensive care unit were included. The exposure variable was the proportion of change of fluid overload (ΔFO%, defined as the difference between body weight normalized fluid input and output) at 48 h after CRRT initiation, and the endpoint was 28-day mortality. Generalized additive linear regression models and logistic regression models were used to determine the relationship between the exposure and endpoint. Results A total of 911 patients were included in the study, with a median (lower quartile, upper quartile) ΔFO% of −3.27% (−6.03%, 0.01%) and a 28-day mortality of 40.1%. Generalized additive linear regression model showed that the ΔFO% at 48 h after CRRT initiation was associated with a J-shaped curve with 28-day mortality. After adjusting for other variables, as compared with the second quartile of ΔFO% group, the first quartile group [odds ratio (OR)=1.23, 95% confidence interval (CI) (0.81, 1.87), P=0.338] was not associated with higher risk of 28-day mortality, while the third quartile group [OR=1.54, 95%CI (1.01, 2.35), P=0.046] and the fourth quartile group [OR=2.05, 95%CI (1.32, 3.18), P=0.001] were significantly associated with higher risk of 28-day mortality. There was no significant relationship between ΔFO% groups and 28-day mortality in the first 24-hour after CRRT initiation (P>0.05), but there was a linear relationship between ΔFO% and 28-day mortality in the second 24-hour after CRRT initiation, the larger the ΔFO%, the higher the mortality rate [OR=1.10, 95%CI (1.04 1.16), P<0.001 for per 1% increase]. ConclusionIn critically ill patients with AKI, the ΔFO% greater than −3.27% within 48 h after CRRT initiation is independently associated with an increased risk of 28-day mortality, and the goals of CRRT fluid management may be dynamical.
Objective To explore the value of surgical treatment in rectal small cell neuroendocrine carcinoma (RSCC). Method The clinical data of patients with pathologically diagnosed as RSCC from 2000 to 2019 were extracted from the Surveillance, Epidemiology and End Results (SEER) database, to explore the effect of surgical treatment on cancer-specific survival (CSS) and overall survival (OS). Results A total of 348 cases were included with the median follow-up of 8 months (IQR: 3–16 months). Of the 101 patients in the operation group, 84 died (83.2%), including 56 tumor-related deaths (55.4%). Of the 247 patients in the non-operation group, 215 died (87.0%), including 131 tumor-related deaths (53.0%). The estimated 1-year OS of the operation group and the non-operation group were 49.6% and 34.4%, respectively, and the estimated 1-year CSS of those were 62.2% and 49.2%, respectively. There were significant differences between the two groups (both P<0.05). Results of multivariate prognostic analysis by Cox proportional hazard model showed that differentiation, SEER stage, receiving operative treatment or not, receiving chemotherapy or not, and receiving radiotherapy or not were independent influencing factors for OS, and SEER stage, receiving operative treatment or not, receiving chemotherapy or not, and receiving radiotherapy or not were independent influencing factors for CSS (all P<0.05). The OS [RR=0.61, 95%CI was (0.45, 0.81), P<0.001] and CSS [RR=0.67, 95%CI was (0.47, 0.95), P=0.025] in RSCC patients were significantly improved by surgical treatment. Conclusion Surgical treatment can improve the OS and CSS in RSCC patients.
Sarcopenia is a syndrome associated with reduced strength, mass and function of skeletal muscles. Aging of gastric cancer patients, lack of nutritional intake, and pathological mechanisms of gastric cancer increase the likelihood of sarcopenia. Sarcopenia is associated with the development of gastric cancer and may be a risk factor for the formation of gastric cancer. Sarcopenia is closely related to the prognosis and treatment of gastric cancer. At present, the treatment of sarcopenia is still in the exploratory stage, and more research is needed to obtain better treatment plans and improve the quality of life of patients. This article reviews the research status of sarcopenia and gastric cancer in order to provide evidence for clinical research.
ObjectiveTo investigate the role on adverse prognosis and risk factors of acute kidney injury (AKI) in hospitalized patients with chronic obstructive pulmonary disease (COPD). MethodsClinical data from hospitalized patients with COPD between January 2009 and June 2012 were studied retrospectively.AKI was diagnosed and classified by AKIN criterion. ResultsThree hundred and sixty-nine patients were enrolled,among whom 69(18.6%) were complicated with AKI.The patients with AKI were older,and had higher levels of hemoglobin,hematocrit value and sodium concentration,and higher rates of comorbidities of diabetes mellitus,proteinuria and shock,compared with the controls.Those with AKI had a 24.1% increased risk for ventilator,121.5% for intensive care,and 89.8% for death.And a higher AKI grade was related to a worse prognosis.The increased risk of AKI was 142.1% for every 5-year increase of age,155.7% for every 0.1 increase of hematocrit value,70.5% for every 0.1 increase of sodium concentration,and 49.1%,89.2%,148.2% and 685.7% for being complicated with proteinuria,coronary artery disease,diabetes mellitus and shock. ConclusionAKI is associated with adverse prognosis in hospitalized patients with COPD.Age,proteinuria,increased levels of hematocrit value and sodium concentration,and comorbidities of coronary artery disease,diabetes mellitus and shock are independent risk factors for AKI
ObjectiveTo explore the prognostic factors of malignant tumors in ampulla, lower bile duct, head of pancreas, uncinate process, and neck of pancreas after operation.MethodThe recent literatures on malignant tumors in this region at home and abroad were summarized.ResultsThe prognosis of five groups of malignant tumors in ampulla, lower bile duct, head of pancreas, uncinate process, and neck of pancreas was correlated with their origin, growth site, tumor diameter, nerve invasion, vascular invasion, lymphatic metastasis, pathological and histological classification, and cutting edge status. The different location and pathological classification of tumors made the different neurovascular invasion rate, lymphatic metastasis rate, and R0 resection rate.ConclusionsBy summarizing and analyzing the origin, growth site, diameter, nerve invasion, vascular invasion, lymphatic metastasis, pathological and histological classification, and cutting edge status of tumors, we can improve the clinical prediction of tumors in this region, select appropriate surgical methods before operation, and formulate more reasonable adjuvant treatment plan after operation, in order to improve the pertinence of the treatment of tumors in this region, improve the prediction, and finally better serve the clinical work.
Objective To investigate the clinical features, treatment, and influence factors of prognosis in patients with gastric neuroendocrine neoplasms (GNENs). Methods From March 2011 to January 2016, the clinicopathological data of 44 patients with GNENs who treated in The Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed to summarize the choice of treatment plan and analyze influence factors of prognosis. Results A total of 44 patients enrolled in this study. The major clinical manifestation included abdominal pain in 18 patients (40.9%), abdominal distension in 16 patients (36.4%), loss of appetite in 4 patients (9.1%), acid regurgitation and belching in 4 patients (9.1%), nausea and vomiting in 1 patient (2.3%), eating after choking sense in 3 patients (6.8%), gastrointestinal bleeding in 2 patients (4.5%), diarrhea in 1 patient (2.3%), and palpitations with weakness in 3 patients (6.8%). The treatment of 44 patients included radical resection in 26 patients (59.1%), endoscopic resection in 13 patients (29.6%), local excision in 1 patient (2.3%), and 4 patients had distant metastasis before operation were conducted of palliative treatment〔palliative resection in 2 patients (4.5%) and conservative treatment in 2 patients (4.5%)〕. Univariate analysis showed that the gender, the age, the tumor size, and the N staging (lymph node metastasis) were not associated with prognosis (P>0.050), but the tumor location and the depth of tumor invasion were related to the prognosis (P<0.050). The tumors located in the upper part of the stomach and the serosal infiltration indicated poor prognosis. However, neither of them can be used as independent factor to evaluate the poor prognosis of GNENs patients (P>0.050). Conclusions GNENs has nonspecific clinical manifestation. Radical surgery and endoscopic resection are the main treatment methods, but the influence factors of prognosis in GNENs patients need further study.
ObjectiveTo evaluate clinical feasibility and safety of total laparoscopic pancreaticoduodenectomy (TLPD).MethodThe clinical data of 51 consecutive cases who underwent TLPD, admitted in this department of pancreatic surgery of the Affiliated Hospital of Xuzhou Medical University from August 2016 to August 2018, were analyzed retrospectively.ResultsThe TLPDs were successfully completed in the 51 patients. The operative time was (375.5±75.2) min, the pancreaticojejunostomy time was (45.2±8.3) min and bilioenteric anastomosis time was (25.6±7.5) min. The intraoperative blood loss was (337.8±164.4) mL. The length of surgical incision was (6.0±1.2) cm. The duration of flatulence was (3.5±1.0) d. The time for liquid diet was (5.2±2.1) d, the postoperative first ambulation time was (2.0±1.2) d. The duration of postoperative hospital stay was (14.8±5.3) d. The total postoperative complication rate was 34.3% (17/51), with 19.6% (10/51) of B or C postoperative pancreatic fistula and 9.8% (5/51) of bleeding. The postoperative pathology showed that there were 45 cases of malignant tumor and there was no positive incisal margin. The maximum tumor size was (2.8±1.2) cm and the number of lymph nodes harvested was 12.6±7.8. All the patients were followed up for 2–24 months with a median time of 17 months. The 1-year overall survival rate and progression-free survival rate of the patients with malignant tumors were 84.4% (38/45) and 77.8% (35/45), respectively.ConclusionTLPD is safe and feasible in cases of clinical practice under skilled hand and there are advantages such as faster postoperative recovery and shorter hospital stay.