Bile leakage is a common complication of hepatocellular carcinoma (HCC) after hepatectomy, which affects the prognosis and medical quality. It is emphasized that taking preventive measures according to the etiology and related risk factors could help to reduce the incidence of bile leakage, improve the quality and safety of HCC diagnosis and treatment, and achieve the main indicators of HCC quality control in the 2022 version of National Cancer Center. In this review, combined with the team of Peng’s leakage test technology research and clinical practice, brief talk about personal experience.
目的：研究人参皂甙Rg 1对原代培养胎鼠脑神经细胞存活和可塑性的影响。方法：实验分为：实验组（人参皂甙Rg 1 1 mg/L,10 mg/L,100 mg/L），阳性药物对照组（bFGF 20 μg/L）以及空白对照组。相差倒置显微镜观察细胞生长情况，并测量细胞突起的长度；用MTT法测定培养细胞的存活率；Western-blot法检测神经生长相关蛋白GAP-43和神经丝蛋白NF-200的表达。结果：（1）细胞平均突起长度：实验高中剂量组神经元突起的平均长度均长于对照组。（2）MTT值：实验高中低剂量组的灰度均明显大于对照组。（3）GAP43和NF 200的表达：实验高中剂量组的蛋白表达均明显大于对照组。结论：人参皂甙Rg 1对于体外培养的胎鼠脑神经细胞的存活有较强的维持作用，并能促进突起生长，使神经可塑性相关蛋白表达上调。
Objective To explore the feasibility of identifying clonal origin of hepatocellular carcinoma (HCC) by analyzing the mitochondrial DNA D-Loop region variations. Methods Forty-two patients with a total of 112 HCC nodules consequentially hospitalized for radical resection of HCC in the department of hepatobiliary surgery of the First Affiliated Hospital of Guangxi Medical University from April 2004 to August 2007 were included for study group (multinodular HCCs). Control group included 20 cases of HCC (40 samples) hospitalized in the same period that consisted of two sub-groups: control groupⅠconsisted of 16 cases of single nodular HCC that each had two pieces of inconsecutive tumor tissues and control groupⅡconsisted of 4 cases of HCC with portal vein tumor embolus whose tumor tissues and portal vein tumor embolus were collected simultaneously. Normal control included 5 patients who were donors for liver transplantation or underwent liver trauma without any liver disease. Polymerase chain reaction (PCR) and direct sequencing were applied to study the mtDNA D-Loop region. The sequences of multinodular lesions were compared among different groups. Results For all the 42 cases of the study group, basic group variations appeared in 131 sites (131/1 122, 11.7%, the number 1 122 was the length of mtDNA D-Loop) with point mutation in 15 sites, insert in 9 sites, and deletion in 16 sites. And of all the variations in the study group, 98 were polymorphism. In study group, 20 cases were categorized as multicentric occurrence (MO) based on their variant mtDNA D-Loop sequences in each nodule from the same patient. And 22 cases were characterized as intrahepatic metastasis (IM) based on the identical mtDNA D-Loop sequences found in each nodule from the same patient. In all 20 cases in the control group, the inconsecutive tumor tissues or the portal vein tumor embolus and original tumors shared identical mtDNA D-Loop sequences. For the normal control group, basic group variations appeared in 14 sites, and they were all polymorphism including a new polymorphism (NT 479 Agt;G). Conclusions There is a high rate of changes in mtDNA D-Loop region. And our study speculates a novel discrimination of MO and IM origins among multinodular HCCs using PCR and direct sequencing of the mtDNA D-Loop sequences.
ObjectiveTo compare the effectiveness of magnetic resonance spectroscopy (MRS) and Dynamic Contrast-enhancement (DCE-MRI) with 1.5 T MR scanner in diagnosing prostate cancer. MethodsFrom April 2011 to December 2012, based on the results of biopsy, we measured 216 regions of interest (ROIs) in images of MRS and DCE-MRI, comprised of 131 ROIs from cancer zone and 85 ROIs from non-cancer zone. The data were analyzed with statistical methods, including receiver operating characteristic (ROC) curve. ResultsThere were significant differences between the malignant group and the benign group (P<0.05) in Cit integral, Cho integral, CC/Cit ratio, the type of time-signal intensity curve, initial value, enhancement rate and ratio of enhancement. According to ROC curve, the area under curve (AUC) of CC/Cit and enhancement rate was 0.853 and 0.719, respectively. AUC of time to peak, time difference, enhancement rate and Cit integral was lower than 0.400. The optimal operating point (OOP) of CC/Cit was 0.775, with a specificity of 0.85 and a sensitivity of 0.79, and the AUC was 0.853. The OOP of the ratio of enhancement was 60.89, with a specificity of 0.66 and a sensitivity of 0.71, and the AUC was 0.719. ConclusionMRS is more sensitive and specific than DCE-MRI to diagnose prostate cancer when an 1.5 T MR scanner is used. On the other hand, MRS is susceptible to interference, but DCE-MRI can make up for these deficiencies.
ObjectiveTo compare the effectiveness of T2 weighted image (T2WI) and some compounded MRI techniques, including T2WI combined with magnetic resonance spectroscopy (T2WI+MRS), T2WI combined with diffusion weighted imaging (T2WI+DWI) and T2WI combined with dynamic contrast-enhancement [T2WI+(DCE-MRI)] respectively, with 1.5 T MR scanner in diagnosing prostate cancer through a blinding method. MethodsBetween March 2011 and April 2013, two observers diagnosed 59 cases with a blinding method. The research direction of radiologist A was to diagnose prostate cancer. The observers diagnosed and scored the cases with T2WI, T2WI+(DCE-MRI), T2WI+MRS, T2WI+DWI and compositive method respectively. The data were statistically analyzed with receiver operating characteristic (ROC) curve. ResultsAccording to the ROC curve, both observers got the sequence of area under curve (AUC) as T2WI+DWI > T2WI+(DCE-MRI) > T2WI+MRS > T2WI. On the basis of the result from observer A, the AUC from each technique was similar. The AUC of T2+DWI was slightly bigger than others. The specificity of single T2WI was the lowest; the sensitivity of T2WI was slightly higher. The AUC of the compositive method was marginally larger than T2WI+DWI. According to the result from observer B, the AUC of T2WI+DWI was obviously larger than the others. The AUC of single T2WI was much smaller than the other techniques. The single T2WI method had the lowest sensitivity and the highest specificity. The AUC of T2WI+DWI was slightly larger than the compositive method. The AUC of T2WI+(DCE-MRI), T2WI+MRS, single T2WI methods from observer A was obviously higher than those from the score of observer B. The AUC of T2WI+DWI from the two observers was similar. ConclusionThe method of combined T2WI and functional imaging sequences can improve the diagnosing specificity when a 1.5 T MR scanner is used. T2WI+DWI is the best method in diagnosing prostate cancer with least influence from the experience of observers in this research. The compositive method can improve the diagnosis of prostate cancer effectively, but when there are contradictions between different methods, the T2WI+DWI should be considered as a key factor.
ObjectiveTo explore the clinical application and recent progress of preoperative liver function evaluation methods.MethodThe literatures about the studies of indexes of preoperative liver function evaluation were summarized and analyzed.ResultsSerological indexes could reflect liver function in many aspects; Indocyanine green clearance test, Child-Pugh and MELD scoring system could improve the accuracy of evaluating liver reserve function; Imaging examination and artificial intelligence (radiomics and deep learning) helped to diagnose the degree of liver fibrosis and accurately measure the volume of functional liver.ConclusionsEach method of preoperative liver function evaluation has certain limitation. It needs comprehensive analysis combined with a variety of evaluation indexes so as to objectively and accurately evaluate liver function and formulate an individualized diagnosis and treatment plan that furthest benefits patients.
Objective To explore the experience and needs of orthopedic inpatients for pre-hospital examinations led by nurses, provide a reference for optimizing the pre-hospital examination procedures and improve the pre-hospital examination experience of patient. Methods Using the method of phenomenology, semi-structured in-depth interviews were conducted on 35 patients who attended the Department of Orthopedics of the Second Affiliated Hospital of Army Medical University from July to August 2018 and had undergone pre-hospital examinations. Colaizzi’s seven-step method was used to encode, analyze, organize, summarize, and refine topics. Results Patients’ experience and needs for pre-hospital examinations led by nurses could be divided into three major sections: attitudes and emotions, individualized pre-rehabilitation needs and pre-hospital examination feelings. Attitudes and emotions included high treatment expectations, feelings of loss, and some patients’ understanding of pre-hospital examinations. Individualized pre-rehabilitation needs included pre-rehabilitation needs with cardiopulmonary diseases, pre-rehabilitation needs with sleep dysfunction, nutritional conditioning needs, and medication safety needs. Patients’ feelings during pre-hospital examinations mainly included complicated procedures and staff attitudes that need to be improved. Conclusion Some links in the pre-hospital inspection process urgently need to be optimized. In pre-hospital examinations, it is necessary to focus on patient expectation management and predictive communication, improve multidisciplinary cooperation, formulate personalized pre-rehabilitation plans, optimize examination procedures, strengthen humanistic care, and improve patient experience.
“Chinese Guideline for Diagnosis and Treatment of Primary Liver Cancer （version-2022）” （China Liver Cancer Staging, Abbreviation “CNLC 2022”） was updated recently and the “Barcelona Clinical Liver Cancer Strategy for Prognosis Prediction and Treatment Recommendation: The 2022 update” （Abbreviation “BCLC 2022”） was also updated in December 2021. The similarities and differences of the two guidelines were interpreted. For the BCLC stage B and C, which are equivalent to CNLC stage Ⅱa and Ⅱb and CNLC stage Ⅲa, respectively, the recommendation of surgical treatment and radiation therapy are disparate in the CNLC 2022 and BCLC 2022. For the systematic treatment of advanced liver cancer, Atezolizumab-Bevacizumab, Renvatinib and Sorafenib were both recommended as the first-line medication in the two guidelines. However, the CNLC 2022 is more flexible than BCLC 2022, which provides more treatment options for Chinese liver cancer patients. It is worth paying attention to two important new concepts proposed in the BCLC 2022: stage migration during treatment and untreatable progression. The BCLC stage B was divided into three subgroups according to tumor burden and liver function and different clinical pathways were recommended in the BCLC 2022.
Objective To systematically review the incidence and risk factors of postoperative urinary retention (POUR) in patients undergoing hip or knee arthroplasty, and provide a theoretical basis for medical staff to assess and identify high-risk groups in advance. Methods PubMed, Embase, the Cochrane Library, Medline, China National Knowledge Infrastructure, Wanfang Data, VIP database, and SinoMed were electronically searched from the establishment of the databases to January 2023, for literature on the incidence and risk factors of POUR in patients undergoing hip or knee arthroplasty. Two researchers independently screened studies, extracted data, and assessed study quality. Meta-analysis was performed using Stata 14.0 software. Results A total of 21 articles were included, including 9041 patients undergoing hip or knee arthroplasty. The results of meta-analysis showed that the incidence of POUR in patients undergoing hip or knee arthroplasty was 26% [95% confidence interval (CI) (19%, 32%)]. Age [odds ratio (OR)=1.03, 95%CI (1.00, 1.05), P=0.03], male [OR=2.68, 95%CI (1.72, 4.18), P<0.001], infusion volume [OR=2.17, 95%CI (1.08, 4.35), P=0.030], spinal anesthesia [OR=1.72, 95%CI (1.29, 2.30), P<0.001], history of urinary retention/urethral stricture [OR=1.84, 95%CI (1.35, 2.49), P<0.001], use of analgesic pump [OR=4.73, 95%CI (2.29, 9.78), P<0.001], use of glycopyrronium bromide [OR=2.79, 95%CI (1.53, 5.11), P=0.001] were risk factors for POUR in patients undergoing hip or knee arthroplasty. Conclusions The incidence of POUR in patients undergoing hip or knee arthroplasty is relatively high. Age, male, infusion volume, spinal anesthesia, history of urinary retention/urethral stenosis, use of analgesia pump, and use of glycopyrronium bromide are causes of POUR. It is suggested that medical staff should identify the risk of related factors and take early intervention to reduce the occurrence of POUR.