ObjectiveTo investigated the clinical significance of preoperative and postoperative neutrophil-lymphocyte ratio (NLR) change in evaluating long-term prognosis of patients with gastric cancer.MethodsThe clinicopathologic data of the patients who underwent the gastric cancer resection from January 2010 to December 2014 in the Panjin Liao-Oil Gem Flower Hospital were analyzed retrospectively. The patients were designed into an increased NLR group (preoperative NLR was lower than postoperative NLR) and decreased NLR group (preoperative NLR was higher than postoperative NLR) according to the change of NLR before and after operation. The differences of clinicopathologic characteristics between the two groups were compared and the influencing factors of 5-year survival rate of patients with gastric cancer were analyzed.ResultsIn this study, 194 patients were included, 145 of whom in the decreased NLR group and 49 in the increased NLR group. The proportions of the later TNM stage (stage Ⅲ), total gastrectomy, preoperative CEA level >5 μg/L, and with postoperative complications in the increased NLR group were significantly higher than those in the decreased NLR group (P<0.05). The results of multivariate analysis showed that the later TNM stage (stage Ⅲ), with postoperative complications, increased NLR, and postoperative adjuvant chemotherapy deficiency were the independent risk factors for the 5-year survival rate of patients with gastric cancer (P<0.05), and the survival of patients in the increased NLR group was worse than in the decreased NLR group by the Kaplan-Meier analysis (P=0.011).ConclusionThe change of preoperative and postoperative NLR has an important clinical value in evaluating the long-term prognosis of patients with gastric cancer.
Objective To systemically review the effectiveness and safety of human recombinant activated protein C (rhAPC) for severe sepsis. Methods Such databases as MEDLINE, EMbase, The Cochrane Library, VIP, CNKI and CBM were electronically searched for comprehensively collecting randomized controlled trials (RCTs) on the effectiveness and safety of human recombinant activated protein C (rhAPC) for severe sepsis from inception to July 2012. References of included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.0 software. Results Totally, five RCTs involving 6 307 patients were included. The results of meta-analysis showed that, no significant difference was found in 28-day mortality (RR=1.00, 95%CI 0.84 to 1.19, P=1.00) and 90-day mortality (RR=1.00, 95%CI 0.87 to 1.14, P=0.96) between the rhAPC group and the placebo group. The results of subgroup analysis showed that, the two groups were similar in the 28-day mortality of patients with different Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (APACHE II scorelt;25: RR=1.06, 95%CI 0.93 to 1.21, P=0.37; APACHE II score≥25: RR=0.93, 95%CI 0.69 to 1.24, P=0.60), and in the 28-day mortality by protein C deficiency class (APC deficiencylt;80%: RR=0.96, 95%CI 0.56 to 1.65, P=0.89; APC deficiencygt;80%: RR=0.61, 95%CI 0.34 to 1.08, P=0.09). Besides, bleeding risk in the rhAPC group was 1.62 fold more than that in the placebo group (RR=1.62, 95%CI 1.17 to 2.23, P=0.004). No significant difference was found in the incidence of adverse reaction (RR=1.04, 95%CI 0.92 to 1.18, P=0.53). Conclusion Current evidence suggests that, rhAPC could not improve the prognosis of patients with severe sepsis, but it significantly increases bleeding risk.
Objective To assess the influence of soy foods intake in Adolescence on the female adult’s breast cancer. Methods Literatures about the influence of soy foods intake in Adolescence on the female adult’s breast cancer were retrieved in The Cochrane Library, MEDLINE, EMbase, CNKI, VIP, WanFang Data and CBM from the date of their establishment to August 2011, meanwhile, the references of included papers were also retrieved. The data were extracted according to the inclusion and exclusion criteria by two reviewers independently, the quality of the included studies was assessed according to the Cochrane Newcastle-Ottawa scale and GRAEDprofiler 3.2.2, and meta-analysis was conducted by using Stata 11.0. Results A total of 6 studies involving 6 609 patients and 79 538 controls were included. The results of meta-analyses showed that compared with the non-intake or low intake of soy foods in Adolescence, high soy foods intake in Adolescence was associated with lower risk of breast cancer (OR=0.816, 95%CI 0.670 to 0.993); In the subgroup analysis, soy foods intake in Adolescence was more effective to prevent premenopausal (OR=0.661, 95%CI 0.550 to 0.796) rather than post-menopausal (OR=0.782, 95%CI 0.486 to 1.259) breast cancer; and the effects of soy foods intake in Adolescence were not significantly different between the eastern (OR=0.793, 95%CI 0.569 to 1.105) and western (OR=0.837, 95%CI 0.743 to 0.943) women. Conclusion Soy foods intake in Adolescence may be associated with a small reduction in the risk of adults’ breast cancer, especially for the premenopausal women, though there is no difference between the eastern and western women. However, restricted by quantity and quality of the studies, this conclusion should be confirmed by more studies.
ObjectiveTo investigate the application significance of serum histidine decarboxylase (HDC) and D-lactate for early-stage of strangulated intestinal obstruction in rats. MethodsThirty male Wistar rats were randomly divided into two groups:blank control group (n=10) and experimental group (n=20). Rats of experimental group were established to be strangulated intestinal obstruction model by ligating 4 cm-long ileum, and were divided into obstruction-1 hour group (n=10) and obstruction-3 hour group (n=10) according to the time of intestinal obstruction. Rats of blank control group only underwent sham operation. When intestinal obstruction models were built, the change of pathology in ileum tissue was observed by light microscope. The Park/Chiu scale was used to evaluate the severity of intestinal lesion. At the same time, blood was drawn from the heart to measure the concentration of serum HDC and D-lactate by ELISA method. Real time quantitative PCR was used to detect the expression of HDC mRNA in ileum tissues. ResultsThe median injury score of ileum tissues of rats in blank control group, obstruction-1 hour group, and obstruction-3 hour group were 0 (0-1), 2 (2-3), and 5 (4-5) respectively, and increased in blank control group, obstruction-1 hour group, and obstruction-3 hour group one by one (P<0.01). The median concentrations of serum HDC of rats in blank control group, obstruction-1 hour group, and obstruction-3 hour group were 10.5 pg/mL (4.60-17.18 pg/mL), 87.93 pg/mL (41.33-119.03 pg/mL), and 150.67 pg/mL (67.33-198.14 pg/mL) respectively, and increased in blank control group, obstruc-tion-1 hour group, and obstruction-3 hour group one by one (P<0.05). The median concentrations of serum D-lactate in rats of blank control group, obstruction-1 hour group, and obstruction-3 hour group were 0 ng/mL (0-3.90 ng/mL), 0 ng/mL (0-15.63 ng/mL), and 4.92 ng/mL (0-48.13 ng/mL) respectively, and there was no significant difference among the 3 groups (P>0.05). The median expression levels of HDC mRNA in ileum tissue of rats in obstruction-3 hour group was 7.81 (7.05-8.39), which was significantly higher than those of the obstruction-1 hour group[1.77 (1.74-1.94)] and blank control group[0.97 (0.88-1.15)], P<0.01, but there was no significant difference between obstruction-1 hour group and blank control group (P>0.05). ConclusionsConcentration of serum HDC can be used for early diagnosis of strangulated intestinal obstruction. Serum D-lactate has no significant change at early-stage of strangulated intestinal obstruction.
ObjectiveTo summarize cardiopulmonary bypass (CPB) management experience in tetralogy of Fallot (TOF) infants weighing less than 8 kg. MethodsA total of 120 TOF infants weighing less than 8 kg received surgical repair in Wuhan Union Hospital from July 2009 to August 2013. There were 85 males and 35 females with their age of 1-18 months and body weight of 4-8 kg.The diagnosis of all the patients was made with echocardiography and diagnostic cardiac catheterization. Moderate hypothermia or profoundly hypothermic CPB with low-flow perfusion was used according to different surgical procedures. Imported membrane oxygenators and 4:1 cold blood cardioplegia were used. Zero-balance ultrafiltration during CPB and modified ultrafiltration during rewarming were performed. ResultsCPB time was 65-200 (115.3±9.6) minutes, and aortic cross-clamping time was 40-110 (60.3 ±10.2) minutes. A total of 112 patients received moderate hypothermia and low-or moderate-flow perfusion, and 8 patients received profound hypothermia and low-flow perfusion. Ultrafiltration volume was 780.5±50.3 ml, and hematocrit (HCT) increased to 0.35-0.40 after modified ultrafiltra-tion. Heart beat was automatically recovered in 114 patients (95%) after aortic unclamping. Weaning off CPB was successful in 119 patients, and 1 patient received extracorporeal membrane oxygenation because of difficult weaning from CPB. Postoperative mechanical ventilation time was 26.5±14.5 hours, and length of ICU stay was 121.5±16.5 hours. Five patients died of low cardiac output syndrome, and the other 115 patients were discharged successfully. ConclusionAppropriate hemodilution and colloidal pump priming solutions, perfusion methods suitable with surgical procedures, 4:1 cold blood-potassium cardioplegia, continuous zero-balance ultrafiltration during CPB and modified ultrafiltration during rewarming to maintain reasonable HCT and colloid osmotic pressure are all crucial factors in CPB management for surgical repair of TOF in infants.
ObjectiveTo investigate the status of research and development methods of Cochrane overviews. MethodsThe Cochrane Library and PubMed were searched up to March 2014 to identify Cochrane overviews. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed and analyzed search strategy, quality assessment method, data analysis, and study results. ResultsA total of 18 Cochrane overviews were included. Among them, 4 (22.2%) overviews included formal statistical indirect comparison; 8 (44.4%) included only results from direct comparison; 6 (33.4%) only systematically analyzed current studies without data pooling; 12 (66.7%) only searched The Cochrane Library, while 6 (33.3%) expanded search to other databases; 14 (77.8%) applied the AMSTAR tool to assess methodological quality of included literature; 12 (66.7%) applied the GRADE system to assess the quality of evidence; and 9 (50%) yielded new outcomes. ConclusionCurrently, the development and reporting standards of Cochrane overviews are still immature. Investigators should choose proper methods based on research objectives when developing Cochrane overviews.
ObjectiveTo analyze the sensitivity of peak flow meter screening in different subgroups of chronic obstructive pulmonary disease (COPD). MethodsA total of 156 outpatients with COPD from Peking Union Medical Hospital from May 2013 to December 2014 were recruited in the study. Each patient's symptoms,history of exposure to risk factors,and the times of exacerbation in last year was recorded. All patients completed CAT,mMRC,the St George's Respiratory Questionnaire (SGRQ),6 minutes walking test,spirometry,and peak expiratory flow (PEF) by peak flow meter. ResultsUsing the cut-off of PEF%pred=80%,the PEF detected 120 COPD patients in 156 subjects. The predictive factors of abnormal PEF%pred in COPD was FEV1%pred and the total score of SGRQ (P<0.05). PEF screening could identify 76.9% of COPD patients,30.0%-60.0% of patients of less symptoms (mMRC<2 or CAT<10 or SGRQ<25),83.3%-90.9% of COPD patients with more symptoms (mMRC ≥ 2 or CAT ≥ 10 or SGRQ ≥ 25),27.7% of COPD patients with mild airflow limitation,68.5% of COPD patients with moderate airflow limitation,83.3% of COPD patients with moderate to very severe airflow limitation. When grouped by GOLD combined assessment method,PEF screening could identify 35.2% of patients of group A,75.0% of patients of group B,and 95.9% of patients of group C and D. The cut-off value of PEF% pred=80% showed low sensitivity to early stage of COPD,but when using the cut-off value of PEF% pred=95%,that sensitivity increased signifcantly. ConclusionsPeak flow meter may be used as a tool to screen COPD. It can identify part of COPD patients especially for those patients with more symptoms,requiring regular treatment,with deteriorated pulmonary function and high risk of exacerbation.
Objectives To discuss the methodology of evaluation of traditional Chinese medicine (TCM) placebo simulation effects and the problems of blind implementation and so as to improve the quality of double-blind clinical trials of TCM. Methods Focusing on case of placebo preparation of TCM investigational new drug, simulation effects of the placebo were evaluated in terms of shape, color, taste and smell. The possibility of placebo be a drug and the similarity between placebo and drug were tested. Results There was no significant difference between placebo and investigational new drug to be judged as a drug (P>0.05). As for the similarity between placebo and drug, there was no significantly difference of the shape (P>0.05), for which the similarity was 100%. The color, taste and smell were significant different between placebo and drug (P<0.05), for which the similarity were 50%, 10% and 15% respectively. Conclusions It is very difficult to simulate TCM based on its certain color, taste or smell. Therefore, the subjects and the investigators’ compliance should be kept to avoid breaking the blind intentionally in the process of the trial and the influence of unblinding should be estimated at the end of the trial.
目的 探讨肝脏局灶性结节性增生（FNH）的临床诊断与治疗，以提高对FNH的认识。方法 回顾性分析我院普通外科2004年7月至2011年7月期间收治的21例经术后病理证实为FNH的临床资料。结果 本组21例FNH患者中男6例，女15例，平均年龄31.1岁。单发19例，多发2例。9例为体检发现，无不适症状；12例有右上腹隐痛不适症状，均无肝炎、肝硬变病史；1例女性患者有长期口服雌激素病史。化验检查：谷丙转氨酶轻度升高1例，其余肝功能检查、肿瘤标志物及HBsAg均为阴性。术前影像学检查诊断符合率：彩超检查为42.9% （6/14），CT检查为50.0% （6/12），MRI检查为38.5% （5/13）。术后均恢复良好，随访至今无复发。结论 FNH术前确诊率仍较低，主要依赖术后病理学检查。对于术前诊断不明确、病灶巨大或有临床症状者仍应采取手术切除治疗。