Objective To evaluate the benefits of perioperative fast-track surgery (FTS) program on clinical outcome in patients with gastric cancer. Methods Totally, 82 patients were randomly allocated into FTS group (n = 41; received perioperative FTS program) and control group (n = 41; received a conventional therapy). The postoperative first defecation time, postoperative hospital stay, hospitalization expenditure, and postoperative complications were compared between the two groups. Results The postoperative first defecation time and postoperative hospital stay were (45.58 ± 26.91 ) h and (9.4 ± 3. 3 ) d in FT3 group and (58.01 ± 23.5 ) h and ( 12. 4 ±3.6 )d in control group (P = 0. 0287 and P = 0. 0002, respectively). Hospitalization expenditure was significantly lower in FTS group than that in control group [(2. 96 ± 0.44 ) yuan vs. ( 3.46 ± 0. 34 ) × 104 yuan, P ＜ 0. 0001 ).The complication was not significantly different between the two groups (7.3% vs. 17.1% , P =0. 232). Conclusion Perioperative FTS program can accelerate postoperative rehabilitation, shorten hospital stay, and decrease medical costs in patients with gastric cancer.

Objective To analyze the change of schistosomiasis endemic situation in Hubei Province, 2008. Methods The data of schistosomiasis control in the whole province, surveillance sites and standard examinations were collected and analyzed. Results Among all the 63 endemic counties (cities, districts), 21 reached the criteria of transmission interruption, 19 reached the criteria of transmission control, and 23 reached the criteria of infection control in 2008. Villages of Category Three, Category Four and Category Five accounted for 52.10% , 27.80% and 20.09% of all the endemic villages in the whole province, respectively. The infection rates of population and cattle were 1. 70% and 2. 20% , which decreased by 27. 04% and 34. 33% when comparing to those in 2007. The snail area was 77 363 hm~2, with a reduction of 315.70 hm~2 comparing to 2007. In the 74 provincial surveillance sites, the infection rate of population and cattle were 1. 32% and 1. 85% , respectively, with reduction rates of 32.99% and 68.38% comparing to 2007. The snail area was 2 833.98 hm~2 and the area with infected snails was 215.35 hm~2, the densities of living and infected snails were 0. 37 snails/0.1 m~2 and 0.000 3 snails/0. 1 m~2, respectively, and the infection rate of snails was 0.08%. Comparing to 2007, the snail area, densities of living and infected snails and the infection rate of snails decreased by 3.81 % , 21.28% , 40.00% and 27. 30% , respectively, while the area with infected snails increased by 4.52%. The results of standard examination suggested that all the 15 uncontrolled counties ( cities, districts) reached the criteria of infection control. Conclusions Though the endemic situation of schistosomiasis in Hubei Province has been controlled effectively, the endemic condition is still severe. Therefore, the comprehensive measures with an emphasis on infectious source control should be strengthened to consolidate the control result.

BACKGROUND: Nanosphere, an ideal nonviral gene delivery vector, is not excellence of immunogenicity and oncogenicity. Nanotechnology and gene interference are used to block hypoxia-inducible factor 1 alpha (HIF-1α) expression in esophageal squamous carcinoma tissue and decrease tolerance of malignant cells to chemotherapeutics. Theoretically, they become effective methods to inhibit malignant cell growth of esophageal squamous carcinoma. OBJECTIVE: To study the inhibitory effect of small interference RNA targeting HIF-1α (siRNA-HIF-1α) nanospheres on human esophageal squamous cancer TE-1 cell growth. DESIGN, TIME AND SETTING: Based on in vitro cultured esophageal squamous cancer TE-1 cells, a completely randomized controlled study was performed at the Central Laboratory, the Third Hospital Affiliated to Sun Yat-sen University from January 2007 to December 2008. MATERIALS: siRNA-HIF-1α was synthesized by Shanghai Bioengineering Company; siRNA-HIF-1α nanospheres were prepared using solvent evaporation technique; human esophageal squamous cancer TE cell strain was provided by Shanghai Cell Bank of the Chinese Academy of Sciences. METHODS: TE-1 cells cultured in vitro were assigned into four groups: saline, gene-free nanospheres, siRNA-HIF-1α, and siRNA-HIF-1α nanospheres groups. MAIN OUTCOME MEASURES: HIF-1α mRNA expression was detected by RT-PCR; HIF-1α protein expression was detected by Western blot; apoptosis of TE-1 cells was determined by flow cytometry; TE-1 cell growth was examined by MTT. RESULTS: At 72 hours after treatment, both HIF-1α mRNA expression and HIF-1α protein expression in the siRNA-HIF-1α nanospheres group were significantly less than other three groups (P < 0.01), but apoptotic rate was significantly greater than other three groups (P < 0.01). TE-1 cell growth was remarkably inhibited in the siRNA-HIF-1α nanospheres group, which was significantly different compared with other three groups (P < 0.01).CONCLUSION: siRNA-HIF-1α nanospheres can specifically reduce both HIF-1α mRNA and HIF-1α protein expressions in esophageal squamous carcinoma TE-1 cells, significantly increase tumor cell apoptosis, and remarkably inhibit TE-1 cell growth.

OBJECTIVEProtein induced by vitamin K absence or antagonist II (PIVKA II), also called des-gamma carboxy prothrombin (DCP), is a sensitive marker for the diagnosis of hepatocellular carcinoma (HCC), in Japan and the United States since the sensitive kits were available (1998). PIVKA II is not used in clinical diagnosis in China so far. The aim of this study was to assess the diagnostic value of PIVKA II in Chinese patients with HCC.

METHODSSerum PIVKA II and alpha-fetoprotein (AFP) levels were determined in 60 patients with HCC and 30 patients with cirrhosis not carrying HCC.

RESULTSThe mean serum concentration of PIVKA II in HCC patients (784.3 +/- 1364.1 mean +/- s) was higher than that in cirrhosis patients (16.1 +/- 31.7); this difference was highly significant (P < 0.0001). When the cutoff level of 40 mAU/ml was used as the level of discriminating HCC from cirrhosis, 51.7% of patients (31/60) with HCC had PIVKA II values above this level (sensitivity). Only 4 patients with cirrhosis had such high PIVKA II levels. Thus, the specificity of this test was 86.7% (26/30). Total accuracy was 62.2% [(31 + 26)/(60 + 30)]. Seven of 19 small HCCs (36.84%) had PIVKA II values above the cutoff level. Concentrations of AFP above 20 ng/ml were observed in 34 of 60 patients with HCC (56.7%) and in 11 patients with cirrhosis (36.7%). Eleven of 26 patients with HCC (46.2%) without increased AFP had concentrations of PIVKA II greater than 40 mAU/ml. No significant correlation was found between serum levels of AFP and PIVKA II that were measured in 60 HCC patients (rs = 0.101, P = 0.247). Combining the information from PIVKA II and AFP showed an increase of approximately 21.6% over AFP and 26.7% over PIVKA II alone. For small HCC patients, combining the information from PIVKA II and AFP showed an increase of approximately 15.8% over AFP alone and 21.1% over PIVKA II alone.

CONCLUSIONPIVKA II is a useful early diagnostic marker for HCC and may be more sensitive when combined with AFP in Chinese patients.

Adult ; Aged ; Aged, 80 and over ; Biomarkers ; Biomarkers, Tumor ; blood ; Carcinoma, Hepatocellular ; blood ; diagnosis ; pathology ; Female ; Humans ; Liver Cirrhosis ; blood ; Liver Neoplasms ; blood ; diagnosis ; pathology ; Male ; Middle Aged ; Protein Precursors ; blood ; Prothrombin ; alpha-Fetoproteins ; analysis

Objective To know the levels of antibodies against influenza A virus subtypes H1 and H3 of population in Shanghai during 2009, and the detection of antibodies against avian influenza virus subtypes H5 and H9 in population which contacts with avian. Methods The serological survey of the antibodies against influenza A viruses subtypes H1, H3, H5 and H9 in 356 close contacts with avian (professional population) and 332 general subjects (general population) at various age groups were carried out using hemagglutinin inhibit (HI) test. Results The positive rates of antibodies against influenza virus A/Brisbane/59/2007 (H1N1) in general population and professional population were 82.8% (275/332) and 73.9% (263/356), respectively; those of A/Brisbane/10/2007 (H3N2)were 50.6% (168/332) and 54.8% (195/356), respectively. The positive rate of antibodies against influenza virus A/Brisbane/59/2007 (H1N1 )was significantly higher than that of influenza A viruses subtype H3, which was consistent with etiological survey of influenza virus in Shanghai during 2008.The positive rates of antibodies against influenza A virus subtype H5 in professional population and general population were 4.2% (15/356) and 0.3% (1/332), respectively; those of influenza A virus subtype H9 were 34.6% (123/356) and 2.4% (8/332), respectively. The positive rates of antibodies against influenza virus A/Brisbane/59/2007 (H1N1 ) and A/Brisbane/10/2007 (H3N2) in age groups of 6 months-5 years and ≥60 years were lower than other age groups. Conclusions The immune protective response against seasonal influenza A subtype H1 and H3 of population in Shanghai is high,while those of children and the elders were low. The levels of antibodies against influenza A viruses subtype H5 and H9 in professinal population present obviously ascending trend, which indicates that the etiological and serological survey of influenza virus in this population should be enhanced.

Objective To explore the efficacy of unilateral biportal endoscopy(UBE)for lumbar intervertebral foramen stenosis combined with lumbar disc herniation through Sublamina approach.Methods From October 2021 to June 2022,7 elderly patients with typical symptoms of lumbar disc herniation in the intervertebral foramen area accompanied by spinal stenosis were retrospectively analyzed.There were 6 patients with lumbar disc herniation and nerve root canal stenosis at L4/5 and 1 patient at L5/S1.The mean course of disease was(8.6±2.5)months.All the patients were treated by UBE through Sublamina approach.Results Postoperative limb radicular symptoms of 7 patients were relieved.The visual analogue scale(VAS)of limb pain was significantly decreased from preoperative(8.6±1.3)to(2.1±1.1)at 2 d after the surgery(P<0.05),the Japanese Orthopaedic Association(JOA)score was significantly increased from preoperative(10.1±2.4)to(17.3±1.8)at 2 d after the surgery(P<0.05).Conclusion UBE for lumbar intervertebral foramen stenosis combined with lumbar disc herniation through Sublamina approach has a satisfactory therapeutic effect,providing a new idea for the surgical treatment of this disease.

Background/Aims: Existing hepatocellular carcinoma (HCC) prediction models are derived mainly from pretreatment or early on-treatment parameters. We reassessed the dynamic changes in the performance of 17 HCC models in patients with chronic hepatitis B (CHB) during long-term antiviral therapy (AVT). Methods: Among 987 CHB patients administered long-term entecavir therapy, 660 patients had 8 years of follow-up data. Model scores were calculated using on-treatment values at 2.5, 3, 3.5, 4, 4.5, and 5 years of AVT to predict threeyear HCC occurrence. Model performance was assessed with the area under the receiver operating curve (AUROC). The original model cutoffs to distinguish different levels of HCC risk were evaluated by the log-rank test. Results: The AUROCs of the 17 HCC models varied from 0.51 to 0.78 when using on-treatment scores from years 2.5 to 5. Models with a cirrhosis variable showed numerically higher AUROCs (pooled at 0.65–0.73 for treated, untreated, or mixed treatment models) than models without (treated or mixed models: 0.61–0.68; untreated models: 0.51–0.59). Stratification into low, intermediate, and high-risk levels using the original cutoff values could no longer reflect the true HCC incidence using scores after 3.5 years of AVT for models without cirrhosis and after 4 years of AVT for models with cirrhosis. Conclusions The performance of existing HCC prediction models, especially models without the cirrhosis variable, decreased in CHB patients on long-term AVT. The optimization of existing models or the development of novel models for better HCC prediction during long-term AVT is warranted.

Objective To investigate the clinical features and prognosis related risk factors in nonalcoholic steatosis liver cirrhosis(NASLC).Methods From January 1st,2006 to December 31st, 2013,in a prospective cohort of 12 489 patients with liver cirrhosis set,174 patients were with NASLC and 306 patients with hepatitis B were the control.The patients were followed up every three months. The clinical data of patients were collected,including gender,age,height,body weight,blood pressure, history of hypertension,history of diabetes,family history of tumor,blood glucose level,high density lipoprotein cholesterol(HDL-C)level,low density lipoprotein cholesterol(LDL-C)level,triglyceride level,white blood cell,platelet,prothrombin time activity,total bilirubin,albumin,cholinesterase,blood urea nitrogen,creatinine,alpha-fetoprotein,abdominal ultrasound,abdominal computer tomography and endoscopy.Body mass index(BMI)and Child-Pugh scores were calculated.The differences between the two groups were analyzed in the incidence of ascites,hepatic encephalopathy,hepatorenal syndrome, esophageal varices bleeding,liver failure,hepatocellular carcinoma and mortality.Chi square test and t test were performed for statistical analysis.logistic regression analysis was used to analyze the risk factors associated with hepatocellular carcinoma in patients with NASLC.Results The proportion of female in NASLC group was higher than that in posthepatic cirrhosis group(56.0%,47/84 vs 28.7%,49/171), and the difference was statistically significant(χ2 =17.653,P<0.01).BMI,systolic pressure,diastolic pressure,level of fasting blood glucose,LDL-C,triglyceride,prothrombin time activity,albumin, cholinesterase,cases number of hypertension,diabetes and metabolic syndrome of NASLC group were all significantly higher than those of posthepatic cirrhosis group(t=6.267,4.091,5.773,2.914,1.877, 2.044,2.326,1.935 and 2.023;χ2=7.241,9.399 and 81.367;all P<0.05),however,serum levels of HDL-C,total bilirubin and creatinine were significantly lower than those of posthepatic cirrhosis group (t=6.127,8.487 and 3.261;all P < 0.05).T he three-year accumulative incidences of hepatic encephalopathy,hepatorenal syndrome and liver failure of NASLC group(8.3%,7/84;1.2%,1/84;0) were all lower than those of posthepatic cirrhosis control group(22.2%,38/171;9.9%,17/171 and 5.8%, 10/171;χ2 = 5.751,3.862 and 3.927,all P< 0.05).The three-year accumulative incidence of hepatocellular carcinoma of NASLC was 8.3%(7/84).The three-year accumulative incidence of mortality was lower than that of posthepatic cirrhosis group(2.4%,2/84 vs 13.5%,23/171;χ2 = 3.884,P=0.049).The results of logistic regression analysis showed that BMI(odds ratio(OR)= 1.469,95%confidence interval(CI)1.093 to 2.176,P=0.016)and diabetes(OR=1.734,95% CI 1.269 to 2.388, P=0.012)were independent risk factors associated with hepatocellular carcinoma in NASLC patients. Conclusions NASLC occurrs mainly in female with good liver function.BMI and diabetes are the risk factors associated with hepatocellular carcinoma in patients with NASLC.

PURPOSE: Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients.METHODS: A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed.RESULTS: There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%).CONCLUSIONS: Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.
Adrenal Cortex Hormones ; Asthma ; China ; Comorbidity ; Disease Progression ; Education ; Female ; Food Hypersensitivity ; Hospitalization ; Humans ; Hypertension ; Inpatients ; Medication Adherence ; Mortality ; Multivariate Analysis ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Risk Factors ; Seasons ; Self Care ; Smoke ; Smoking

BACKGROUND: Although intensively studied in patients with cardiovascular diseases (CVDs), the prognostic value of diastolic blood pressure (DBP) has little been elucidated in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study aimed to reveal the prognostic value of DBP in AECOPD patients. METHODS: Inpatients with AECOPD were prospectively enrolled from 10 medical centers in China between September 2017 and July 2021. DBP was measured on admission. The primary outcome was all-cause in-hospital mortality; invasive mechanical ventilation and intensive care unit (ICU) admission were secondary outcomes. Least absolute shrinkage and selection operator (LASSO) and multivariable Cox regressions were used to identify independent prognostic factors and calculate the hazard ratio (HR) and 95% confidence interval (CI) for adverse outcomes. RESULTS: Among 13,633 included patients with AECOPD, 197 (1.45%) died during their hospital stay. Multivariable Cox regression analysis showed that low DBP on admission (<70 mmHg) was associated with increased risk of in-hospital mortality (HR = 2.16, 95% CI: 1.53-3.05, Z = 4.37, P <0.01), invasive mechanical ventilation (HR = 1.65, 95% CI: 1.32-2.05, Z = 19.67, P <0.01), and ICU admission (HR = 1.45, 95% CI: 1.24-1.69, Z = 22.08, P <0.01) in the overall cohort. Similar findings were observed in subgroups with or without CVDs, except for invasive mechanical ventilation in the subgroup with CVDs. When DBP was further categorized in 5-mmHg increments from <50 mmHg to ≥100 mmHg, and 75 to <80 mmHg was taken as reference, HRs for in-hospital mortality increased almost linearly with decreased DBP in the overall cohort and subgroups of patients with CVDs; higher DBP was not associated with the risk of in-hospital mortality. CONCLUSION: Low on-admission DBP, particularly <70 mmHg, was associated with an increased risk of adverse outcomes among inpatients with AECOPD, with or without CVDs, which may serve as a convenient predictor of poor prognosis in these patients. CLINICAL TRIAL REGISTRATION Chinese Clinical Trail Registry, No. ChiCTR2100044625.
Humans ; Blood Pressure ; Pulmonary Disease, Chronic Obstructive/therapy* ; Cohort Studies ; Respiration, Artificial ; Inpatients ; Hospital Mortality