Objective To study the effect of adjuvant transcatheter arterial chemoembolization (TACE) on intrahepatic recurrence after curative liver resection for primary hepatocellular carcinoma (PHC).Methods 130 PHC patients who underwent curative liver resection from June 2010 to February 2013 were selected and randomly allocated to the study group (n =67) and the control group (n =63).The study group underwent adjuvant TACE for 1 ～ 4 times,and the control group did not receive any adjuvant therapy.On follow-up for 36 months,the postoperative recurrence rates,tumour free survival time and tumor free survival rates of the two groups were compared.Results At 6 months after surgery,the serum AFP level [(379.8 ±91.7) μg/L vs.(414.5 ±84.3) μg/L] and the IGFBP-2 level [(2 855.3 ±727.5) μg/L vs.(3 259.6 ± 894.1) μg/L] in the study group were significantly lower than the control group (P ＜ 0.05).The 1-year cumulative recurrence rate in the study group (10.4％ vs.28.6％) was significantly lower than the control group (P ＜ 0.05).However,the 2-year and 3-year cumulative recurrence rates were not significantly different between the two groups (P ＞ 0.05).The 3-year cumulative tumor free survival rate of the study group (81.0％ vs.73.2％) was significantly higher than the control group (P ＜ 0.05).Patients in the study group with portal vein tumor thrombus had an 1-year cumulative recurrence rate of (12.8％ vs.31.6％) and a 2-year rate of (28.2％ vs.50.0％).In patients with a preoperative AFP ≥400 μg/L,the 1-year cumulative recurrence rates were (8.8％ vs.30.6％).When the tumor diameter was ≥10 cm,the 1-year,2 year and 3-year cumulative recurrence rates were significantly lower than the control group (P ＜ 0.05,11.8％ vs.46.7％),(35.3％ vs.75.3％) and (47.1％ vs.86.7％),respectively.The recurrence rates in patients who had no cancer thrombus,a preoperative AFP ≤400 μg/L and a tumor diameter ＜ 10 cm were not significantly different between the two groups (P ＞ 0.05).The recurrent rates of patients who underwent TACE 1 time and those who did not receive TACE showed no significant difference (P ＞0.05).In patients who had TACE twice,the 1-year (4.3％ vs.28.6％),2-year (15.2％ vs.41.3％) and 3-year (26.1％ vs.49.2) cumulative recurrence rates were significantly lower than patients who did not receive TACE (P ＜ 0.05).In patients who had TACE for more than three times,the cumulative recurrence rate was similar to patients who had TACE twice (P ＞ 0.05).Conclusions Adjuvant TACE helped to reduce PHC recurrence after curative liver resection during the high-risk period for recurrence.A 1-time TACE did not significantly reduce postoperative recurrence rate,and ≥ 3 times TACE did not significantly improve tumor-free survival rates.Adjuvant TACE and the number of TACE should be reasonably carried out based on the indications and pathological characteristics.

Objective To investigate the efficacy of the indocyanine green (ICG) clearance test (ICGR15) combined with the model for end-stage liver disease (MELD) for assessing the short-term prognosis of patients with liver failure.Methods Eighty patients with liver failure were analyzed retrospectively.ICGR15 and relevant clinical data within 24 hours of diagnosis were analyzed.Meanwhile,the MELD score and King's College Hospital (KCH) were evaluated.All findings were tested for correlation with 3-month mortality.Quantitative data were analyzed with analysis of variance and Student's t-test.Count data were analyzed with chi-square test.Correlation analysis was performed with Pearson's coefficient test.Results Among 80 patients with liver failure,39 patients survived and 41 died.The mortality rate of all patients was 51.2％.The serum total bilirubin,creainine concentrations,ICGR15,MELD scores and patient number in accordance with KCH criteria of surviving patients were (288.0±109.1) μmol/L,(63.3±24.4) μmol/L,(48.1±10.2)％,20.6±4.4,and 6 cases,respectively,which were lower than those in dead patients [(340.7 ± 108.2) μmol/L,(98.8 ± 59.1) μmol/L,(60.2 ± 10.6) ％,26.9 ± 7.1 and 19 cases,respectively] (P =0.033,P＝ 0.001,P＝ 0.000,P＝ 0.000 and P =0.003,respectively).There was no significant difference of ICGR15 among four types of liver failure.A positive correlation was observed between ICGR15 and MELD score (r=0.289,P=0.009).The ICGR15-MELD model was created by subjecting ICGR15 and MELD scores to Logistic regression analysis.The following ICGR15-MELD model,Logit (P) =0.105 × ICGR15 + 0.178 × MELD score-9.734,was constructed by Logistic regression analysis.The area under the receiver operating characteristic (ROC) curve was 0.860 and the cut offpoint of 0.3 had sensitivity of 85.40％ and specificity of 74.40％.The area under the curve of the ICGR15-MELD model was significantly higher than those of ICGR15 (0.791),MELD score (0.770) and KCH criteria (0.655).Conclusions ICGR15 and MELD scores perform better than the KCH criteria in predicting the prognosis of liver failure.The ICGR15-MELD model is superior to ICGR15,MELD score,and KCH in predicting the short term prognosis of patients with liver failure.

Objective: To study the changes of the sensitivity of the methicillin-resistant Staphylococcus aureus (MRSA) to oxacillin after Chinese herbs. effects, so as to find Chinese medicine that can enhance the sensitivity of MRSA to antibiotics and provide new ideas for the clinical treatment of MRSA infection. Methods: A total of 33 commonly used antibacterial herbs were selected to prepare extracts, which act on clinically isolated MRSA. The broth micro dilution method was used to determine the minimal inhibitory concentration (MIC) of oxacillin on MRSA before and after the action of Chinese medicine. If there is a statistically significant difference (P ＜ 0.05), the medicine is effective. Results:The MIC of oxacillin on MRSA were 128-512 μg·ml-1, after the effect of Bletilla extracts, the change of MIC showed a statistically significant difference (P ＜ 0.05), which could increase the sensitivity of MRSA (271) to oxacillin. Conclusion:Bletilla extracts can enhance the sensitivity of MRSA (271) to oxacillin and the compatibility with antibiotics is expected to restore the efficacy of antibiotic.

Methicillin-resistant staphylococcus aureus (MRSA) has become the main pathogen for hospital and community acquired infections. Based on the resistance mechanism of MRSA, this article reviews the reducing and eliminating effect of Chinese herb extracts on bacterial drug resistance, by means of PBP2a protein binding, γ-lactamase, plasmid, efflux system, cell structure and biofilmdamage.

OBJECTIVETo summarise and analyse the experience and methods of managing the perioperative respiratory problems in patients with tumor of trachea or carina surgically treated during the last decade, and the ways of preventing severe postoperative respiratory complications in the future.

METHODSThirty-eight patients with tumor of trachea or carina surgically treated from 1991 to 2000 by different modes of tracheobronchial plastic surgery were retrospectively studied to summarise and analyse the changes in preoperative pulmonary function, postoperative complications and the management of perioperative respiratory problems.

RESULTSOut of 38 patients, 29 (76.3%) gave abnormal results to preoperative pulmonary function tests. 55.3% (21/38) of the whole series developed 45 postoperative complications with respiratory complications as the major one (80.0%). Seventeen patients who had undergone carinal pneumonectomy or carinal resection plus reconstruction gave far more complications (28 complications) than the remaining 21 patients treated by other modes of surgery (17 complications). Four patients died of postoperative complications with a mortality rate of 10.5%.

CONCLUSIONPatients treated with carinal pneumonectomy or carinal resection plus reconstruction give much more complications than patients treated by any other modes of large airway surgery. Fiberoptic bronchoscopic (FOB) guided intubation, precise surgical treatment, postoperative mechanical ventilation support, use of effective antibiotics and sufficient nutritional support are important for a successful management of these patients.

Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Perioperative Care ; Postoperative Complications ; Respiratory Function Tests ; Surgery, Plastic ; Tracheal Neoplasms ; surgery

OBJECTIVETo summarize surgical treatment of lung cancer patients with poor pulmonary function.

METHODSFrom 1991 to 1999, 181 lung cancer patients with poor pulmonary function underwent operation. The correlation between the results of preoperative pulmonary functional tests and the postoperative cardiopulmonary complications was analyzed by Chi-square test (chi(2)).

RESULTSIn 181 patients, pneumonectomy was done in 43, lobectomy in 118, partial lung resection in 16 and exploration in 4. The postoperative complication and mortality rates of the resection group were 42.3% (75/177) and 7.9% (14/177). The cardiopulmonary complication rates were 25.6%, 48.3%, 31.3% in pneumonectomy, lobectomy and partial lung resection. The morbidity and mortality rates of 8 patients who received preoperative chemotherapy and/or radiotherapy were 75.0% and 37.5%. The morbidity and mortality rates of 12 patients who had had a previous history of thoracotomy were 66.7% and 33.3%. In the present series, the 1-, 3- and 5-year survival rates were 71.1%, 42.2% and 31.1%. The 5-year survival rates of patients with stage I, II and III lesions were 55.0%, 25.0% and 0.

CONCLUSIONPreoperative spirometry is an important evaluation test for lung cancer patients with poor pulmonary function. It should be evaluated in combination with other pulmonary function tests such as CO(2) diffusion and cardiopulmonary excise tests, etc whenever possible. Patients with a history of thoracotomy, chemotherapy and radiotherapy should be carefully evaluated before operation to avoid high morbidity and mortality. Stage I and II lung cancer patients with poor pulmonary function can undergo operation if they have been well managed preoperatively and well taken care of with nursing care perioperatively.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lung Neoplasms ; mortality ; physiopathology ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Respiratory Function Tests ; Spirometry

Objective:To analyze the pathogenic genes and clinical phenotypes of a Chinese Han family with autosomal dominant retinitis pigmentosa (ADRP).Methods:A pedigree investigation study was conducted, and a Chinese Han RP family that underwent genetic counseling in the Henan Provincial People's Hospital in November 2019 was collected.Twenty members of this family from 4 generations, including 9 patients and 11 phenotypically normal individuals, were enrolled.Visual acuity, peripheral visual field test and fundus examination were performed on some family members.Peripheral blood samples were collected from the family members, and DNA was extracted.Exon-targeted sequencing containing 43 genes associated with RP was performed on the proband using the Ion Torrent PGM sequencing platform.The mutations were verified by polymerase chain reaction and Sanger sequencing.Online software was applied to predict the protein function of the variant.The amino acid sequences of the variant loci were compared using the ClustalW2 multiplex alignment program.The pathogenicity of the variant was analyzed according to American College of Medical Genetics and Genomics (ACMG) criteria and guidelines for classification of genetic variant.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Henan Provincial People's Hospital (No.HNEECKY-2019[15]).Results:The family was consistent with autosomal dominant inheritance.The proband, a 26-year-old male, had bilateral night blindness since childhood, with visual acuity of 0.25 in the right eye and 0.5 in the left eye.There was osteoblast-like pigmentation in his both retinas, thinned retinal vessels and pale optic disc.Full-field electroretinogram examination showed reduced scotopic a- and b-wave peaks and severely reduced photopic a- and b-wave peaks.The rest of the family began to develop night blindness when 7 to 10 years old, having complete loss of peripheral vision around 50 years of age, and typical RP changes were found in ophthalmic examination.Genetic testing revealed a heterozygous missense variant c. 982delC (p.L328fs) in exon 5 of the family's rhodopsin ( RHO) gene (NM_000539.3). This variant resulted in the change of 21 amino acids after amino acid 328 in the encoded RHO protein, increasing amino acids in the coding region from 348 to 358 and altering the structure of the RHO protein.The analysis of protein homology sequence alignment between several different species showed that the locus was highly conserved.According to the guidelines of the ACMG criteria and guidelines for classification of genetic variants, the variant was a pathogenic mutation because there were six evidences including one very strong evidence of pathogenicity PVS1, two moderate evidences of pathogenicity PM2 and three supporting evidences of pathogenicity, PP1, PP3 and PP4. Conclusions:The c. 982delC variant in the RHO gene is a pathogenic mutation in this pedigree, and this variant is reported for the first time in a Chinese Han family.

Standardized Residency Training (SRT) in China is gradually maturing. To standardize the training quality in each training base, corresponding standards have been published with regular revisions to various indicators. However, some training bases and professional bases still face challenges such as inadequate awareness of qualified teaching resources, lack of precise regulations, and absence of standardized process assessment. Through years of cumulative in-depth interpretation of various assessment indicators and innovations based on the characteristics of laboratory medicine residents, the clinical laboratory base in Cancer Hospital, Chinese Academy of Medical Sciences is continuously improving the quality of teaching staff through a multi-level teacher qualification training mode and a strict assessment mechanism. Meanwhile, a comprehensive and effective training system has been established to ensure the smooth implementation of SRT tasks. In addition, a diversified lecture system and a standardized progressive assessment process have been established to enhance the overall clinical abilities of residents.

Objective     To systematically evaluate the safety, efficacy, and economics of intracardiac echocardiography (ICE) versus transesophageal echocardiography (TEE) in left atrial appendage occlusion (LAAO). Methods     PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Database were systematically  searched to collect relevant studies on comparing ICE and TEE-guided LAAO from inception to June 15th, 2022. Two reviewers independently screened the literatures, extracted the data, and assessed the risk of bias of the included studies. Meta-analyses were performed using RevMan 5.3 and R 4.0.3. Retrospective cohort studies were excluded for sensitivity analysis. Subgroup analyses were performed based on the types of occluder and ICE catheter. Results     A total of 14 studies with 6 599 patients were included. Meta-analyses showed no statistical differences in technical success rate, overall complications, device embolization, peri-device leakage, device-related thrombus, stroke, vascular complications, bleeding, operation time, fluoroscopy time, or contrast agent volume between the ICE and TEE-guided LAAO. The total in-room time (MD=–33.47 min, 95%CI –41.20 to –25.73, P<0.000 01) and radiation dosage (MD=–170.20 mGy, 95%CI –309.79 to –30.62, P=0.02) were lower in the ICE group than those in the TEE group, whereas the incidence of pericardial effusion/tamponade was higher than the TEE group (RR=1.57, 95%CI 1.01 to 2.45, P=0.048). Except for pericardial effusion/tamponade, subgroup analyses and sensitivity analysis showed similar results. The analysis based on the cost data from the United States showed comparable or even lower total costs for ICE versus TEE, but comparative domestic cost studies were lacking. Conclusion     Current evidence suggests that ICE-guided LAAO can reduce radiation dosage and total in-room time, and there is no statistical difference in the overall complication rate between the two groups. Owing to the limitations of sample size and quality of the included studies, the conclusion still needs to be verified by large sample size and high-quality randomized controlled trials.