ObjectiveTo analyze factors affecting post-hepatectomy liver failure (PHLF) of patients with hepatocellular carcinoma (HCC) and explore value of combining albumin-bilirubin (ALBI) score with standardized future liver remnant (sFLR) in prediction of PHLF.MethodsThe clinical data of patients with HCC underwent curative hepatectomy in the Second and the Fifth Departments of General Surgery of the First Hospital of Lanzhou University from January 2016 to June 2018 were retrospectively reviewed. The risk factors of PHLF were identified through the logistic regression, the area under the receiver operating characteristic curve (AUC) was used to analyze the predictive value of the ALBI score, sFLR, or ALBI score×sFLR.ResultsA total of 72 patients with HCC were enrolled, all of them were the Child-Pugh A grade. The incidence of PHLF was 27.78% (20/72) in these 72 patients with HCC, which was 12.96% (7/54) and 72.22% (13/18) in the 54 patients with ALBI- Ⅰ grade and 18 patients with ALBI- Ⅱ grade respectively, the difference was statistically significant (P<0.001). The results of multivariable analysis of PHLF showed that the PLT (OR=0.030, P=0.018), ALBI grade (OR=11.758, P=0.020), and sFLR (OR=0.835, P=0.003) were identified as the independent predictors of PHLF. The AUC for the ALBI score×sFLR in predicting the PHLF was 0.892, it was greater than that of the ALBI score (AUC=0.799) or the sFLR (AUC=0.773).ConclusionCompared with Child-pugh grade, ALBI grade is more accurate in predicting PHLF of HCC patients, and combining ALBI score with sFLR is better than sFLR or ALBI score alone in predicting PHLF of patients with HCC.
Objective To evaluate the efficacy of preoperative low-dose oral amiodarone for the prevention of atrial fibrillation （AF） after off-pump coronary artery bypass grafting （OPCAB） in patients older than 70 years. Methods A total of 156 patients older than 70 years who underwent OPCAB in Qingdao Fuwai Cardiovascular Disease Hospital from January 2011 to June 2012 were included in this prospective，double-blind and placebo controlled study. Preoperatively，all the 156 patients were randomly divided into amiodarone group and control group. In the amiodarone group，there were 80 patients including 38 male and 42 female patients who were given oral amiodarone （trade name： Cordarone） 200 mg，three times a day，3-5 days before surgery，and amiodarone was stopped on the OPCAB day and postoperatively. Preoperative duration of amiodarone intake was 4.0±1.2 days，and total amiodarone dosage was 2.6±0.5 g. In the control group，there were 76 patients including 35 male and 41 female patients who were given oral placebo as the same medication schedule，and preoperative duration of placebo intake was 4.0±1.4 days. Operation time，graft number，postoperative AF incidence，AF duration，hospital stay and readmission rate for cardiovascular events within 6 postoperative months were compared between the two groups. Results There was no in-hospital death in either group. There was no statistical difference in graft number，operation time，AF duration of patients who had postoperative AF，or postoperative hospital stay between the two groups. Postoperative AF incidence of the amiodarone group was significantly lower than that of the control group ［18.7% （15/80） vs. 34.2% （26/76），P=0.028］. Seventy-three patients in the amiodarone group （91.3%） and 66 patients in the control group （86.8%） were followed up for 8-24 months. During follow-up，2 patients in the amiodarone group died of acute myocardial infarction and cerebral hemorrhage respectively. There was no statistical difference in readmission rate for cardiovascular events within 6 postoperative months between the 2 groups ［6.8% （5/73） vs. 6.1% （4/66），P=0.860］ .Conclusion Preoperative low-dose oral amiodarone can significantly reduce the incidence of postoperative AF in patients older than 70 years undergoing OPCAB.
ObjectiveTo conduct meta-analysis with the reliability of objective structured clinical examination (OSCE), so as to the reliability of OSCE used in the tests for evaluating clinical capacities of medical students. MethodsArticles about evaluating clinical capacities of medical students using OSCE and using comprehensive coefficient of Cronbach's α to measure the reliability of OSCE were electronically searched in PubMed, ScienceDirect, CNKI, WanFang data and VIP from Jan. 1998 to May. 2013. Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then meta-analysis was performed using SSPS 17.0 software. ResultsThirty-four studies involving 53 coefficients of Cronbach's α were included, of which, there were 18 articles written in English involving 28 coefficients of Cronbach's α and 16 articles written in Chinese involving 25 coefficients of Cronbach's α. The results of meta-analysis showed that:the total coefficient of Cronbach's α of OSCE was 0.700 (95%CI 0.660 to 0.737). The coefficient of Cronbach's α of internationally-published literature was 0.745 (95%CI 0.696 to 0.790) and that of nationally-published literature was 0.648 (95%CI 0.584 to 0.705), with a significant difference between two groups. ConclusionCurrently, the reliability of internationally/nationally-used OSCE is 0.7, which has relatively better reliability when used in the tests for evaluating clinical capacities of medical students at home and aboard. However, the reliability of OSCE at abroad is fairly better than that at home.
ObjectiveTo explore the predictive value of systemic immune-inflammation index (SII) combined with neutrophil-monocyte ratio (NMR) on postoperative anastomotic leakage in elderly colon cancer. MethodsThe clinical data of 493 elderly colon cancer patients who attended the Department of General Surgery of the First Hospital of Lanzhou University from January 2018 to October 2023 were retrospectively analysed, and divided into an anastomotic leakage group (n=29) and a non-anastomotic leakage group (n=464) according to the occurrence of anastomotic leakage or not, and the differences between the two groups in terms of SII and NMR at different time points were compared. Area under the curve (AUC) of receiver operating characteristic (ROC) was used to compare the predictive value of SII, NMR and the combination of the two on the occurrence of anastomotic leakage after surgery in elderly colon cancer patients. Logistic regression was used to analyse the independent risk factors for postoperative anastomotic leakage in elderly colon cancer patients. ResultsThe SII and NMR in the anastomotic leakage group were higher than those in the non-anastomotic leakage group on the 3 rd and 5 th day after operation (P<0.05). ROC curve analysis showed that the AUC values for SII on postoperative day 3, NMR on postoperative day 5, and the combination of the two to predict anastomotic leakage were 0.613, 0.743, and 0.750, respectively. The results of DeLong’s test suggested that the difference between the AUC values of NMR on postoperative day 5 combined with SII on postoperative day 3 and SII on postoperative day 3 was statistically significant (P=0.047). Multifactorial logistic regression analysis showed that age, male, diabetes, preoperative radiotherapy and chemotherapy, tumor located in the left colon, SII on postoperative day 3, and NMR on postoperative day 5 were independent risk factors for postoperative anastomotic leakage in elderly patients with colorectal cancer (all P<0.05). ConclusionsPostoperative day 3 SII combined with postoperative day 5 NMR, postoperative day 3 SII, and postoperative day 5 NMR all have predictive value for postoperative anastomotic leakage in elderly patients with colorectal cancer. Both have the potential to serve as important predictors of postoperative anastomotic leakage in elderly patients with colon cancer.
ObjectiveTo investigate the safety and clinical efficacy of dendritic cell (DC)-cytokine induced killer (CIK) cell adoptive immunotherapy combined with chemotherapy in patients with gastric cancer after radical gastrectomy.MethodsForty-eight patients with gastric cancer after the radical gastrectomy receiving the DC-CIK cell adoptive immunotherapy combined with XELOX or FOLFOX chemotherapy were enrolled as a study group in the First Hospital of Lanzhou University from January 2014 to January 2016. In addition, 48 patients with gastric cancer after the radical gastrectomy in the same period and only receiving XELOX or FOLFOX chemotherapy were collected as a control group. The CD3+, CD3+CD4+, CD3+CD8+, CD3–CD56+ (NK cell), and CD3+CD56+ (NKT cell), toxic reaction, quality of life were evaluated in both groups before and after the treatment, and the long term effect were compared in both groups.Results① There were no significant differences in the gender, age, clinical stage, etc. between the two groups (P>0.05). ② The CD3+, CD3+CD4+, CD3+CD8+, CD3–CD56+, and CD3+CD56+ cells in the peripheral blood had no significant changes between before and after treatment in the study group (P>0.05), which were decreased after the treatment in the control group as compared with before the treatment and were significantly lower than those in the study group (P<0.05). ③ The levels of CEA, CA19-9, and CA724 in the peripheral blood after the treatment in the study group and the control group were significantly lower than those before the treatment (P<0.05), which in the study group were significantly lower than those in the control group after the treatment (P<0.05). ④ The incidences of leukopenia, thrombocytopenia, and diarrhea in the study group were significantly lower than those in the control group (P<0.05). ⑤ Compared with before the treatment, the body function and emotional function after the treatment were significantly improved in the study group (P<0.05). And in the body function, emotion function, role function, cognitive function, and social function were significantly improved than those in the control group (P<0.05) after the treatment. ⑥ The progression-free survival in the study group was significantly better than that in the control group (P<0.05). There was no significant difference in the overall survival between the study group and the control group (P>0.05).ConclusionDC-CIK cell adoptive immunotherapy combined with chemotherapy could significantly improve immune status and quality of life of patients with gastric cancer after radical gastrectomy, reduce adverse effects of chemotherapy, improve long term effect, and prolong progression-free survival.