ObjectiveTo compare three staging systems for predicting the prognosis of patients with advanced hepatocellular carcinoma (HCC) after hepatectomy. MethodsThe clinical data of advanced HCC patients who underwent hepatectomy from January 2004 to December 2008 in this hospital were retrospectively analyzed.Tumor stage was evaluated following the Chinese staging system, tumor node metastasis (TNM) staging system, and cancer of the liver Italian program (CLIP) scoring system, respectively.Survival curves for the HCC patients were plotted using the Kaplan-Meier method and difference was compared by the log-rank test.The accuracy of each staging system for predicting survival of HCC patients was evaluated by calculating the area under curve of the receiver operating characteristic. ResultsFifty-five patients were included in this study, including 48 males and 7 females.The median age was 47 years and the median overall survival was 7 months.The clinical staging of HCC patients was 25 cases ofⅡB and 30 cases ofⅢA using Chinese staging system; 39 cases ofⅢA, 5 cases ofⅢB, 7 cases ofⅣA, and 4 cases ofⅣB using TNM staging system.The score of 0-1 was 16 cases, the score of 2-3 was 26 cases, and the score≥4 was 13 cases using CLIP scoring system.Log-rank test showed that the cumulative survival rate had a significant difference for the HCC patients betweenⅡB andⅢA of Chinese staging system (P < 0.05) and amongⅢA toⅣB of TNM staging system (P < 0.05).However, there was no significant difference in the HCC patients among score of 0-4 of CLIP scoring system (P > 0.05).The accuracy of Chinese staging system was higher than that of the TNM staging system and CLIP scoring system for predicting the survival rate of HCC patients (P > 0.05). ConclusionAccording to this limited preliminary data, Chinese staging system for strati-fying and predicting the prognosis of advanced HCC patients after hepatectomy is better than that of TNM staging system and CLIP scoring system.
ObjectiveTo investigate the effectiveness of medial sural artery perforator free flap (MSAP) for repairing defect after tongue cancer ablation. MethodsBetween March 2013 and April 2014, the defects after tongue carcinoma resection were repaired with MSAP in 12 patients, including 8 cases of high or medium differentiated squamous cell carcinoma (SCC) and 4 cases of moderately-poor differentiated SCC. There were 7 males and 5 females with a median age of 55 years (range, 45-68 years). The disease duration ranged from 2.0 to 8.5 months (mean, 4.3 months). The tumor located at the tongue edge in 8 cases and at the tongue abdomen in 4 cases (mouth floor infiltration in 1 case). According to TNM stage, 7 cases were rated as T2N0M0, 2 cases as T2N1M0, 2 cases as T3N1M0, and 1 case as T4N1M0. The size of tumor ranged from 3.0 cm×2.0 cm to 4.5 cm×3.0 cm. The size of MSAP varied from 4.0 cm×3.5 cm to 6.5 cm×6.0 cm. ResultsThe time of total operation ranged from 5.5 to 8.3 hours (mean, 6.8 hours), and flap harvesting time ranged from 54 to 85 minutes (mean, 65.6 minutes). The other flaps survived except 1 case of vein crisis. All the patients were followed up 6-18 months (mean, 13.7 months). With time passing, the pronunciation got better, and the skin showed mucosa-like change; the patients were capable of normal language exchange at 6 months after operation. No obvious scar on the leg or limitation of limb motion was observed. ConclusionThe MSAP is reliable for repair of defect after tongue cancer ablation, with the advantages of satisfactory recovery of tongue appearance, language function, and less donor site morbidity.
ObjectiveTo explore the effect of comfort care on patients undergoing CT enhanced scan. MethodsSixty patients undergoing CT enhanced scan were enrolled in June 2013, who were randomly divided into general care group (n=30) and comfort care group (n=30). General care group was given the routine care, while patients in the comfort care group accepted comfort care as well as routine care. The success rate of examination and excellent or good imaging rate between the two groups were compared. ResultsIn the general care group, the scan was successful in 21 patients and failed in 9, with a successful scan rate of 70.0% (21/30), and the excellent and good imaging rate was 71.4%. For the comfort care group, the scan examination succeeded in 29 patients and failed in 1 with a success rate of 96.7% (29/30), and the excellent and good imaging rate was 96.6% (28/29). The success rate in the two groups had statistical significance (χ2=7.680, P=0.006), and the excellent and good imaging rate was also significantly different (χ2=7.607, P=0.022). ConclusionComfort care for patients undergoing CT enhanced scan has a good effect in alleviating psychological stress, ensuring comfort and safety, and improving the success rate and excellent and good rate of imaging quality, which reflects its real value of nursing service in CT Department.
ObjectiveTo compare short-term outcomes of radical correction of tetralogy of Fallot (TOF)with or without transcatheter embolization of major aortopulmonary collaterals (APC). MethodsClinical data of 58 TOF patients undergoing radical correction from January 2008 to June 2013 in the Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. There were 36 male and 22 female patients. Among them, 22 patients (Group A, 12 males and 10 females)received radical TOF correction combined with transcatheter embolization of major APC, and 36 patients (Group B, 24 males and 12 females)received radical TOF correction alone. Average age of group A was (24.91±6.77)years and that of group B was (22.42±5.06)years. Aortic cross-clamping time, ICU stay, postoperative hospital stay, left ventricular ejection fraction (LVEF)7 days and 3 months after the operation were compared between the 2 groups. ResultsThere was no in-hospital death. There was no statistical difference in sex, age, preoperative McGoon ratio or hemoglobin (Hb)levels between the 2 groups (P > 0.05). Aortic cross-clamping time[ (43.87±13.02)minutes vs. (53.60±11.69)minutes, P < 0.05], ICU stay[ (26.09±4.84)hours vs. (28.87±4.38)hours, P < 0.05] and postoperative hospital stay[ (12.32±1.81)days vs. (13.67±2.14)days, P < 0.05] of group A were significantly shorter than those of group B. LVEF 7 days after the operation of group A was significantly higher than that of group B (56.64%±8.19% vs. 52.58%±5.62%, P < 0.05), and there was no statistical difference in LVEF 3 months after the operation between the 2 groups (58.50%±8.78% vs. 55.42%±6.18%, P > 0.05). ConclusionFor surgical treatment of TOF, compared with radical correction alone, radical correction combined with transcatheter embolization of major APC can significantly shorten aortic cross-clamping time and improve postoperative heart function recovery.
ObjectiveTo evaluate clinical outcomes of mitral valve replacement (MVR) combined with coronary artery bypass grafting (CABG) compared with CABG alone for patients with coronary artery disease and moderate ischemic mitral regurgitation (IMR). MethodsA systematic literature search for studies which were published from January 1990 to August 2013 from PubMed, Cochrane Library, China Academic Journals Full-text Database, Wanfang Data, and VIP Journal Database and compared CABG+MVR and CABG alone for IMR patients was performed. Quality of randomized controlled trials was assessed by Jada scale. Quality of case control studies was assessed by Newcastle-Ottawa Scale (NOS). RevMan 5.0 was used for meta-analysis. ResultsSix clinical trials including 2 randomized controlled trials and 4 case control studies were included in this study. Jadad scale for both 2 randomized controlled trials was 5 points and NOS for all the 4 case controlled studies was 8 points. Meta-analysis showed that there was no statistical difference in early postoperative mortality between the 2 groups[randomized controlled trials:RR=1.69, 95% CI (0.28, 10.10), P=0.57;case controlled studies:OR=0.48, 95% CI (0.21, 1.13), P=0.09]. There was no statistical difference in 1-year survival rate between the 2 groups[randomized controlled trials:RR=1.00, 95% CI (0.93, 1.08), P=0.92;case controlled studies:OR=1.72, 95% CI (0.60, 4.95), P=0.32]. There was no statistical difference in 5-year survival rate between the 2 groups[OR=1.12, 95% CI (0.68, 1.83), P=0.66]. LVEF of CABG+MVR patients was significantly higher than that of CABG alone patients[MD=1.38, 95% CI (0.17, 2.59), P=0.03]. Postoperative New York Heart Association (NYHA) class of CABG+MVR patients was significantly better than that of CABG alone patients[MD=-0.85, 95% CI (-1.14, -0.56), P < 0.01]. ConclusionCompared with CABG alone, MVR combined with CABG cannot significantly increase postoperative survival rate of the patients, but can improve postoperative heart function recovery and quality of life.
ObjectiveTo discuss the influence of early postoperative hemodynamic, postoperative mortality and the incidence of adverse cardiovascular events with the phenomenon of prosthesis-patient mismatch. MethodsWe retrospectively analyzed the clinical data of 89 patients who had simple aortic valve replacement in our hospital bewteen January 2012 and January 2014. The 89 patients were divided into two groups including a match group (16 females and 48 males with average age of 58.1±10.4 years) and a mismatch group (15 females and 10 males with average age of 65.3±12.8 years). We compared early results between the two groups. ResultsThere is a statistic difference (P < 0.05) in aortic flow velocity, mean pressure gradient, and the maximum pressure gradient between the two groups. The survival rate of the match group is significantly lower than that of the mismatch group (P < 0.05). And there is a statistical difference in adverse cardiovascular event-free incidence between the two groups (P < 0.001). ConclusionThe phenomenon of prosthesis-patient mismatch can affect postoperative hemodynamic and lead to heart failure after surgery. And early mortality and the incidence of cardiovascular adverse events in patients are increased due to prosthesis-patient mismatch.
ObjectiveTo systematically review the efficacy and safety of bone mesenchymal stem cells (BMSCs) transplantation for ischemic stroke. MethodsWe electronically searched PubMed, The Cochrane Library (Issue 12, 2014), EMbase, CBM, CNKI and WanFang Data from inception to December 2014, to collect randomized controlled trials (RCTs) of BMSCs transplantation for ischemic stroke. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 6 RCTs involving 332 patients were included. The results of meta-analysis showed that, the BMSCs transplantation group was superior to the routine treatment group with significant differences in the neurologic deficits score (NIHSS score)(MD=-2.09, 95%CI -2.88 to -1.29, P<0.000 01), motor function (Fugl-Meyer rating scale) (MD=15.25, 95%CI 13.51 to 16.99, P<0.000 01) and daily life ability (Barthel index) (MD=20.04, 95%CI 9.91 to 30.17, P=0.000 1) after 3 months treatment. Two trials reported the adverse events including fever and headache, but the patients relieved in a brief period. ConclusionCurrent evidence shows that BMSCs transplantation can improve the neurological deficits, motor function and daily life ability after ischemic stroke with less adverse effect. No serious adverse events are observed. However, more high quality studies are needed to confirm its effects for lowering rates of death and dependency of BMSC.
ObjectiveTo systemically review the efficacy and safety of Schwann cells (SCs) or activated Schwann cells (ASCs) transplantation in the treatment of traumatic spinal-cord injury (TSCI) in rats models. MethodsRandomized controlled trials (RCTs) about the effects of SCs and ASCs transplantation for TSCI in rats were searched in PubMed, EMbase, The Cochrane Library (Issue 12, 2014), CBM, CNKI, WanFang Data and VIP from inception to December 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 14 RCTs involving 510 rats were included. The results of meta-analysis showed that:compared with the control group, the Basso, Beattie and Bresnahan (BBB) scores in the SCs or ASCs transplantation group were superior in 4 weeks (SMD=2.31, 95%CI 1.48 to 3.13, P<0.000 01), 8 weeks (SMD=3.93, 95%CI 3.06 to 4.81, P<0.000 01) and 12 weeks (SMD=6.15, 95%CI 4.30 to 8.00, P<0.000 01) after surgery. The BBB scores in the SCs or ASCs transplantation combined with other therapies group were also better in 4 weeks (SMD=1.06, 95%CI 0.44 to 1.68, P=0.000 8), 8 weeks (SMD=2.26, 95%CI 1.57 to 2.96, P<0.000 01) and 12 weeks (SMD=1.49, 95%CI 0.72 to 2.25, P<0.000 01) after surgery. Compared with the SCs group, the BBB score in the ASCs transplantation group were superior in 4 weeks (SMD=4.31, 95%CI 3.50 to 5.13, P<0.000 01) and 12 weeks (SMD=5.44, 95%CI 3.99 to 6.89, P<0.000 01) after surgery. No significant difference was found in mortality between the transplantation group and the control group. ConclusionCurrent evidence indicates that SCs and ASCs can promote the recovery of motor function in the rats with TSCI. More functional recoveries can be obtained in ASCs transplantation compared with SCs transplantation. Due to limited quality of the included studies, the above conclusion should be verified by conducting more large-scale, high quality RCTs.
ObjectiveTo find the relationship between bicuspid aortic valve (BAV) and the dilatation or aneurysm of the aorta using electrocardiogram-gated computed tomography angiography (CTA). MethodsWe collected the clinical data of the BAV coexisting with suspected aortic dilatation or aneurysm from February 2012 through April 2015. A total of 124 patients were analyzed retrospectively. There were 97 males and 27 females at an anverage age of 50.35±16.26 years. According to the CTA, patients were classified into two groups: a pure BAV(without raphe) group and a BAV (with raphe) group. we recorded the aortic diameters, gender, age, and so on. ResultsOf the 124 patients, 91 (73.4%) had BAV with raphe, and 33 patients (26.6%) had pure BAV. The analysis revealed that the diameter of the annulus (23.90±3.34 mm vs. 21.74±3.46 mm, P=0.005), the sinuses of Valsalva (40.93±6.78 mm vs. 37.35±7.06 mm, P=0.022), the tubular portion of the ascending aorta (45.38±7.66 mm vs. 38.29±8.18 mm, P=0.0001), and the part of the aorta proximal to the innominate artery (34.19±4.98 mm vs. 30.23±6.62 mm, P=0.02) between patients with BAV with raphe and pure BAV had significant differences. And there was a significant difference in prevalence of dilatation of the aorta between patients with pure BAV and BAV with raphe [77/91 (84.6%) vs.18/31(58.1%), P=0.004]. Of the 91 BAV with raphe patients, we found 76 patients (83.5%) with right and left coronary cusps (R-L) fusion, 13 patients (14.3%) with right and non-coronary cusps (R-N) fusion, and 2 patients (1.2%) with left and non-coronary cusps (L-N) fusion. There was a statistical difference in the aortic root diameters between R-L fusion BAV and R-N fusion BAV. The diameter of the distal ascending aorta and proximal aortic arch between R-L and R-N fusion BAV had statistical differences. ConclusionsBAV with raphe is more common than pure BAV and is more often associated with dilatation and aneurysm of the ascending aorta. Otherwise R-L fusion BAV is associated with increased diameters of the aortic root, while R-N fusion BAV is associated with increased diameters of the distal ascending aorta and proximal arch.