Background and Purpose:The early prediction of local tumor progression-free survival(LTPFS)after radiofrequency ablation(RFA)for colorectal cancer(CRC)lung metastases has significant clinical importance.The application of radiomics in the prediction of tumor prognosis has been explored.This study aimed to construct a radiomics-based nomogram for predicting LTPFS after RFA in CRC patients with lung metastases.Methods:This study retrospectively analyzed 172 CRC patients with 401 lung metastases admitted to Department of Interventional Radiology,Fudan University Shanghai Cancer Center from August 2016 to January 2019.This study was reviewed by the medical ethics committee of Fudan University Shanghai Cancer Center(ethics number:2402291-24).After augmentation of pre-ablation and immediate post-ablation computed tomography(CT)images,the target metastases and ablation regions were segmented manually to extract the radiomic features.Maximum relevance and minimum redundancy algorithm(MRMRA)and least absolute shrinkage and selection operator(LASSO)regression models were applied for feature selection.The clinical model,the radiomics model,and the fusion model were constructed based on the selected radiomic features and clinical variables screened by the multivariate analysis.The Harrell concordance index(C-index)and area under receiver operating characteristic(ROC)curves(AUC)were calculated to evaluate the prediction performance.Finally,the corresponding nomogram of the best model was drawn.Results:Among all the lung metastases,102(25.4%)had final recurrence,and 299(74.6%)had complete response(CR).The median follow-up time was 21 months(95%CI:19.466-22.534),and the LTPFS rates at 1,2,and 3 years after RFA were 76.5%(95%CI:72.0-80.4),72.1%(95%CI:66.6-76.9)and 69.9%(95%CI:64.0-75.1).In both the training and test dataset,the fusion model based on the final 12 radiomic features through the LASSO regression and 4 clinical variables screened by multivariate analysis achieved the highest AUC values for LTPFS,with C-index values of 0.890(95%CI:0.854-0.927)and 0.843(95%CI:0.768-0.916),respectively.Conclusion:The fusion model based on radiomic features and clinical variables is feasible for predicting LTPFS after RFA of CRC patients with lung metastases,whose performance is superior to the single radiomic and clinical model.At the same time,the nomogram of the fusion model can intuitively predict the prognosis of CRC patients with lung metastases after RFA,thus assisting clinicians in developing individualized follow-up review plans for patients and adjusting treatment strategies flexibly.

Objective:To explore whether the application of combined multimodal ultrasound parameters of heart, lung and diaphragm can predict the weaning outcome in critically ill patients.Methods:A total of 53 patients mechanically ventilated > 48 hours and prepared for spontaneous breathing trial (SBT), were prospectively selected from the Department of Critical Care Unit, Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from December 2022 to December 2023. The patients were eligible for weaning extubation and prepared to undergo a 30-minute SBT, during which the doctors examined the patient′s heart, lungs and diaphragm with ultrasound probes.According to the weaning outcomes, the patients were divided into successful group and failed group. The ultrasound parameters with statistical significance in the univariate analysis were incorporated into the binary logistic regression model to explore the independent influencing factors of weaning outcomes, and the ROC curve was plotted and the area under the curve (AUC) was calculated for statistical analysis.Results:Thirteen of the 53 patients failed weaning.There were significant differences in diaphragm excursion (DE), diaphragm thickening fraction (DTF), bilateral lung ultrasound score (LUS), total LUS and left ventricular ejection fraction (LVEF) between successful and failed groups (all P<0.05). The AUC for LVEF was 0.709 (95% CI=0.534-0.883, P=0.025) with the cutoff value 57.95%, the sensitivity 85.0%, and the specificity 61.5%. The AUC for the total LUS score was 0.878 (95% CI=0.772-0.984, P<0.001), with the cutoff value 17.50, the sensitivity 77.5%, and the specificity 92.3%. The AUC for the DE was 0.876 (95% CI=0.777-0.975, P<0.001) with the cutoff value 1.205 cm, the sensitivity 80.0%, and the specificity 92.3%. The AUC for DTF was 0.902 (95% CI=0.818-0.986, P<0.001) with the cutoff value 18.1%, the sensitivity 82.5%, and the specificity 92.3%. The AUC for the combination plotting of statistically significant ultrasound parameters, consisting of LVEF, LUS, DE and DTF, was 0.948 (95% CI=0.889-1.000, P<0.001) with the sensitivity 85.0% and the specificity 92.3%. Conclusions:Ultrasound parameters of the heart, lungs, and diaphragm provide critical information on cardiopulmonary and diaphragmatic function during SBT. Weaning failure is more common in patients with increased LUS and decreased LVEF, DE and DTF. The combination of four aspects can improve the accuracy of the prediction of weaning outcome.

Objective:To construct a diagnostic model for fatty liver using body composition analysis and further evaluate the diagnostic effect of the model on fatty liver.Methods:726 cases with chronic liver disease who visited Tianjin Second People's Hospital from April 2019 to June 2022 and had body composition analysis tests were retrospectively enrolled and were divided into a fatty liver group (551 cases with fatty liver) and a control group (175 cases without fatty liver) according to the measured values of abdominal ultrasound and controlled attenuation parameter. An independent sample t-test and a non-parametric rank sum test were used for statistical processing. Logistic regression was used to construct a diagnostic model. Hosmer-Lemeshow was used to validate the fit of model. Receiver operating characteristic curve was used to confirm the diagnostic efficiency of the model. In addition, 341 cases of chronic liver disease who visited Tianjin Second People's Hospital were included to further verify the application effect of the model between July 2022 and February 2023.Results:Compared with the control group, the differences in various indicators of body composition analysis in the fatty liver group were statistically significant ( P < 0.05). Basal metabolic rate (X1), visceral fat area (X2), and body fat (X3) were eventually included in the diagnostic model for BCA-FL (body composition analysis-fatty liver)= -7.771+0.002X1-0.035X2+0.456X3 with the Hosmer-Lemeshow test (P=0.059). The measured area under the receiver operating characteristic curve, the sensitivity, and the specificity were 0.888, 0.889, and 0.726, respectively, when the diagnostic threshold value was 0.615 with the Youden index and the receiver operating characteristic curve. In the validated model group, the area under the receiver operating characteristic curve, Youden index, sensitivity, and specificity were 0.875, 0.624, 0.799, and 0.825, respectively. Conclusion:The diagnostic model BCA-FL for fatty liver constructed using human body composition analysis has good diagnostic efficacy and is suitable for screening fatty liver in different basic liver disease populations.

OBJECTIVE To determine the protein binding rates of main effective components in Houpu paiqi mixture as magnolol and honokiol in animal plasma of different species， and compare the differences among species. METHODS The plasma of bovine， rabbit and rat （internal dialysate） was placed in 4.5， 9.0 and 13.5 μg/mL （according to the weight of the decoction pieces of Houpu paiqi mixture） dialysate containing drug for 24 h by equilibrium dialysate method. The concentrations of magnolol and honokiol in dialysis internal and external fluids were determined by ultra-performance liquid chromatography-tandem triple quadrupole mass spectrometry， and the plasma protein binding rates were calculated and compared. RESULTS At the concentrations of 4.5， 9.0 and 13.5 μg/mL， the protein binding rates of magnolol were （68.13±4.52）%， （74.34±1.12）% and （86.22±0.50）% in bovine plasma， （59.55±4.62） %， （72.81±4.56）% and （86.40±1.91）% in rabbit plasma， and （56.63± 2.87）%， （77.81±1.83）% and （83.18±0.65）% in rat plasma， respectively. The protein binding rates of honokiol were （34.82± 1.67）%， （40.29±3.28）% and （63.57±0.59）% in bovine plasma， （34.25±5.62）%， （62.12±7.36）% and （80.86±4.01）% in rabbit plasma， and （37.06±3.28）% ， （52.61±1.69）% and （79.83±7.38）% in rat plasma， respectively. There was generally statistical significance among those groups （P＜0.05 or P＜0.01）. CONCLUSIONS There are significant species differences in plasma protein binding rates of magnolol and honokiol， the main effective components of Houpu paiqi mixture， in a certain concentration-dependent trend.

Objective:To explore the effects of Cox interaction model of client health behavior (Cox-IMCHB) -based nursing intervention on health outcomes and quality of life (QOL) among patients receiving liver transplantation.Methods:From October 2014 to August 2016, this study selected 65 patients met the inclusion and exclusion criteria in the First Bethune Hospital of Jilin University as subjects. Patients were divided into control group ( n=32) and observation group ( n=33) according to surgery order. Control group carried out the routine nursing for patients receiving liver transplantation, while observation group implemented the comprehensive nursing based on the Cox-IMCHB theory. Treatment compliance, follow-up rate and nursing service satisfaction of patients between two groups were observed one month and six months after surgery. Results:One month after surgery, there was no statistical difference in the compliance of patients between two groups ( P>0.05) . Six months after surgery, the total score of treatment compliance, scores of self-monitoring compliance, living habits compliance and follow-up compliance in observation group were 42.00 (40.00, 43.00) , 2.00 (2.00, 3.00) , 17.00 (16.00, 18.00) and 7.00 (7.00, 8.00) higher than those in control group with statistical differences ( P<0.05) . One month after surgery, there were no statistical differences in the patient satisfaction and rate of follow-up between two groups ( P>0.05) . Six months after surgery, the patient satisfaction and rate of follow-up in observation group were higher than those in control group with statistical differences ( P<0.05) . Conclusions:Cox-IMCHB-based nursing intervention for patients receiving liver transplantation can improve patients' long-term treatment compliance and patient satisfaction with utilization of medical service resource as well as nursing care so as to promote favorable outcomes.

Objective To investigate the value of gadoxetic acid-enhanced magnetic resonance imaging (MRI) on oxaliplatin-induced liver function injury in C57BL/6 mice.Metbods Forty male and six weeks old C57BL/6 mice without specific pathogens were included and the body weght ranged from 19 to 23 g.They were randomly assigned into control group,experimental group A,experimental group B and experimental group C (10 mice/group).The mice in the control group was intraperitoneally injected with saline solution.The mice in the experimental groups were intraperitoneally injected with oxaliplatin twice a week.The experimental group A,B and C were administered for 2 weeks,4 weeks and 6 weeks,respectively.The T1 relaxation time on the hepatobiliary phase and the first rapid enhancement slope percentage (ESP) in liver parenchyma were measured and calculated.Serum albumin and bilirubin values were measured and albumin and bilirubin (ALBI) scores were calculated.Pathological staining was used to observe liver tissue damage and fibrosis.The receiver operating characteristic (ROC) curve evaluated the ALBI score,ESP and T1 relaxation time on hepatobiliary phase for the diagnosis of liver function.Results Sixteen mice in the experimental groups (including group A,B and C) were included in the hepatic degeneration group (hepatocyte degeneration without fibrosis).Fourteen mice were included in the hepatic fibrosis group.T1 relaxation time on hepatobiliary phase in the hepatic fibrosis group was higher than that in the control group and in the hepatic degeneration group.The differences were statistically significant (P ＜ 0.05).The ESP of the control group,the hepatic degeneration group and the hepatic fibrosis group was increased,with statistically significant differences (all P ＜ 0.05).Compared with the control group,ALBI scores of the hepatic degeneration group and the hepatic fibrosis group were both decreased,with statistically significant differences (P ＜ 0.05).In the hepatic fibrosis group,the areas under the curve of ALBI scores,the T1 relaxation time on hepatobiliary phase and the ESP were 0.734,0.962 and 0.989,respectively.Conclusion The T1 relaxation time on hepatobiliary phase and the ESP of gadoxetic acid-enhanced MRI can effectively evaluate the hepatic function reduction induced by oxaliplatin-induced hepatic tissue injury in C57BL/6 mice.

OBJECTIVE: To review the development of adult and pediatric liver transplantation in Tianjin First Center Hospital, and to enhance academic exchanges, improve technological innovation, and jointly promote the progress and maturity in the field of liver transplantation. METHODS: The development of liver transplantation in Tianjin First Center Hospital was analyzed. The clinical data of adult and pediatric liver transplantation from September 1998 to September 2018 were collected. The important events and technological innovation achievements of liver transplantation during the 20 years were summarized. RESULTS: The first clinical liver transplantation was attempted in Tianjin First Central Hospital in April 1980. The first long-term survival adult liver transplantation in China was completed in 1994 (11 years survival after the operation). The specialized team of liver transplantation was formally established in September 1998. The 20-year clinical exploration and progress reflected the characteristics of era changes and technological innovation during the rapid development of liver transplantation in China. Our center performed liver re-transplantation in January 1999, reduced-size pediatric liver transplantation in August 2000. In May 2001, we organized the formulation for the preventive and treatment plan for hepatitis B recurrence after liver transplantation. We performed combined liver and kidney transplantation in July 2002, split liver transplantation (SLT) in April 2004, the first domino liver transplantation (DLT) in August 2005. Pediatric living donor liver transplantation (LDLT) was initiated in October 2006, adult LDLT was carried out in August 2007. In September 2007, the first living donor combined liver and kidney transplantation from the same donor in Asia was performed. The first domino+living donor double grafts liver transplantation in the world was performed in January 2009. In March 2011, we performed laparoscopically assisted right hepatic lobe liver transplantation (LDLT) with middle hepatic vein. In May 2014, living donor laparoscopic left lateral lobe procurement was successfully established. In April 2016, simultaneous liver, pancreas and kidney multi-organ transplantation was completed. Domino donor-auxiliary liver transplantation was performed in February 2017. In December 2017, extracorporeal membrane oxygenation (ECMO)-supported liver transplantation in a patient with severe pulmonary hypertension was successfully completed. Liver transplantation combined with partial splenectomy was established in April 2018. Cross-domino liver transplantation (hypersensitive kidney transplantation with auxiliary liver transplantation+pediatric liver transplantation) was performed in May 2018. During the 20 years, the team has performed or assisted other centers in Beijing, Shanghai, Guangzhou and Shenzhen to carry out more than 10 000 cases of liver transplantations. A total of 7 043 cases of various types of liver transplantation were performed in the single center of the hospital (6 005 adult liver transplantations and 1 038 pediatric liver transplantations). Concerning adult liver transplantation, the cumulative 1-year, 3-year and 5-year survival rate from September 1998 to March 2003 were 83.1%, 73.0% and 69.0%, from April 2003 to March 2009 were 85.3%, 76.2% and 72.1% and from April 2009 to September 2018 were 87.5%, 79.2% and 75.1%, respectively. The cumulative 1-year, 3-year and 5-year survival rate for pediatric liver transplantation were 93.5%, 92.2% and 90.2%, respectively. The nucleoside (acid) analogue combined with low dose hepatitis B immunoglobulin (HBIG) was developed to prevent the recurrence of hepatitis B after liver transplantation, this plan has reduced the recurrence rate of hepatitis B and the 5-year re-infection rate of hepatitis B virus (HBV) after liver transplantation significantly. The risk assessment system for tumor recurrence after liver transplantation was established and individual treatment method was established based on this assessment system. Continuous exploration and improvement of liver transplantation for liver cancer, liver re-transplantation, liver transplantation with portal vein thrombosis, SLT, DLT and multi-organ combined transplantation have significantly improved the clinical efficacy of patients and the post-operative survival rate. CONCLUSIONS The liver transplantation team of Tianjin First Center Hospital has carried out a scientific and technological exploration on the key problems and technical difficulties of clinical liver transplantation. This work strongly has initiated and promoted the rapid development of liver transplantation in China. The restrictive barrier of hepatitis B recurrence after liver transplantation has been overcome. The risk prevention and control system of tumor recurrence after liver transplantation has been established. A series of innovative achievements that can be popularized have been achieved in the field of complex liver transplantation and expansion of donor liver source. The iterative progress and sustainable development of liver transplantation have been realized.
China ; Humans ; Liver Transplantation

OBJECTIVE:To provide reference for improving rational drug use in undergraduates from non-medical college. METHODS:By questionnaire survey,9 non-medical colleges were collected according to college entrance examination admission batches and school types stratification sampling. The questionnaires were issued among 860 college students by encounter sampling. The survey included medication knowledge,medication behavior,personal basic information three aspects. Single factor analysis and Logistic regression analysis were conducted for their influential factors. RESULTS:A total of 860 questionnaires were sent out, and 812 valid questionnaires were collected with effective recovery rate of 94.4%. In respect of medication knowledge,4.2% of college students answered all of the five questions correctly,the correlation of correct rate with monthly disposable income was maximal(P=0.007);correct rate of the minority students with monthly disposable income more than 6 000 yuan was higher. In respect of medication behavior,14.4% of college students answered all of the seven questions correctly,the correlation of correct rate with whether the family had long-term(more than half a year)medication experience was maximal(P=0.035);the students whose family had no long-term(more than half a year)medication experience member and had medical personnel used drugs more standardly. CONCLUSIONS:The non-medical college students in Beijing lack of medication knowledge and have poor compliance;medication behavior is also unreasonable. Society,universities and families should strengthen the health education of students,and guide students to standardize the self-medicine therapy.

Objective To discuss the safety and the application of the self-designed multifunctional inflatable pelvis and hip-joint fixator (MIPHF) in damage control in pelvic fracture patients.Methods The MIPHF was subjected to pressure test and quality inspection.From September 2016 to June 2017,61 pelvic-fracture patients were treated with our self-designed MIPHF as pre-hospital first-aid care according to the concept of damage control orthopedics (DCO) (MIPHF group).The control group consisted of 69 pelvic-fracture patients who had not received pre-hospital first-aid care with the self-designed MIPHF from December 2015 to August 2016.There were no statistically significant differences between the two groups in gender,age,types of pelvic fracture,and preoperative injure severity score (ISS).The study compared the two groups for the case fatality rate,volume of blood transfused during surgeries,early complication rates,fracture reduction (Matta standards),and long-term efficacy (Cole scores).Results The pressure test showed that the MIPHF had a good fixation effect on the pelvis.And the quality inspection showed that the material used for the MIPHF was in line with national standards and the safety was guaranteed.The MIPHF group had 1 death (1.6％) and the control group had 8 deaths (11.6％),which was a significant difference (x2=4.979,P=0.026).All survival patients in both groups were followed up.The MIPHF group (61 cases) received 3.0 to 18.0 months follow-up,with an average of 9.0 months.And the control group (69 cases) had 18.0 to 30.0 months follow-up,with an average of 21.9 months.In the MIPHF group,23 cases were treated conservatively,and 37 cases were treated with surgery.Among them,3 cases were fixed with external fixator,20 cases with anterior open reduction and internal fixation,9 cases with posterior open reduction and internal fixation,and 5 cases with combined anterior and posterior fixation.The timing of surgery was 1 to 20 days after injury,with an average of 4.1 days.The volume of blood transfused in the MIPHF group during surgery was 200 to 1500 ml,with an average of 628.6 ml.In the control group,27 patients were treated conservatively,and 42 patients were treated with surgery.Among them,2 cases were fixed with external fixator,24 cases with anterior open reduction and internal fixation,10 cases with posterior open reduction and internal fixation,and 6 cases with combined anterior and posterior fixation.The timing of surgery was 1 to 15 days after injury,with an average of 3.l days.The volume of blood transfused in the control group during surgery was 200 to 4000 ml,with an average of 1 707.1 ml.There was a significant difference between the two groups in intraoperative blood transfusion(Z=-2.330,P=0.020).The MIPHF group had 10 (16.4％) cases of early serious complications and the control group had 22 (31.9％) cases,which had a significant difference (x2=4.187,P=0.041).According to the criteria proposed by Matta et al.,the good rate of results for treating fractures was 82.0％ in the MIPHF group and 60.9％ in the control group,which got a significant difference (x2=6.967,P=0.008).The MIPHF group and the control group also differed significantly in their mean long-term Cole scores (27.2±4.0 versus 25.1 ±5.6,t=2.457,P=0.015).Conclusion MIPHF,which reflects the DCO concept,may be recommended as pre-hospital first-aid care for patients with pelvic fracture because it can lessen bleeding and prevent secondary pelvic injury,thus reduce case fatality rate and the incidence of complications.It can also improve the success rate of treating pelvic fracture,which will positively affect long-term outcomes.

OBJECTIVE:To evaluate the effectiveness,safety and economy about Wenxin granules in the treatment of cardio-vascular diseases based on Meta-analysis. METHODS:Using“Wenxin granules”“Wenxinkeli”“Wenxin”as the search terms, searching PubMed,ProQuest,Springer,The Cochrane Library,CNKI,VIP and Wanfang data(Jan. 2000-Oct. 2015)through com-puter,relevant journals and conference papers by hand,randomized controlled trials about Wenxin granules in the treatment of car-diovascular diseases were screened and classified according to indications. Meta-analysis was performed by using RevMan 5.3 soft-ware,while cost-effectiveness analysis and minimum cost analysis were used for economic evaluation. RESULTS:Totally,38 liter-atures were involved,including 20 literatures of arhythmia,9 of premature ventricualr contraction,4 of coronary disease angina pectoris,3 of unstable angina pectoris,2 of pediatric viral myocarditis. Meta-analysis showed that compared with control drug, Wenxin granules showed better clinical efficacy for arrhythmia with less ADR;showed better clinical efficacy and ECG efficacy for premature ventricualr contraction with less ADR;showed better clinical efficacy for angina pectoris of coronary disease,unstable angina pectoris and pediatric viral myocarditis,with statistical significance (P<0.05). The incremental cost-effectiveness analysis showed that the additional cost of Wenxin granules in the treatment of above indications was worth it all,compared to control drug. Single factor sensitivity analysis supported the stability of results. CONCLUSIONS:Wenxin granules have a better effectiveness, safety and economy in the treatment of cardiovascular diseases,but still need high-quality evidence to support.