Objective To investigate the clinicopathologic features of gastrointestinal neuroendocrine carcinomas. MethodsThe diagnosis and treatment results of 45 cases were studied, and clinicopathologic features and immunohistochemical expressions of NSE, Syn and CgA were detected.ResultsMicroscopically carcinomas were divided into three types: type Ⅰ(25 cases), type Ⅱ(10 cases) and type Ⅲ(10 cases). The histologic categories were correlated with lymph node metastasis significantly( P0.05). The 5-year survival rate for type Ⅰ, type Ⅱ and type Ⅲ was 70%, 65% and 52%, respectively.ConclusionsThe combination of NSE, Syn and CgA immunohistochemical stainnig is necessary for the diagnosis of gastrointestinal neuroendocrine carcinomas. The histologic classification is coincident with the requirement of clinical treatment and prognosis.

To investigate the prevalence of Toxoplasma gondii infection among hepatitis B virus (HBV) patients in northern Shaanxi Province,139 patients and 43 healthy controls were recruited.All the plasma was screened for IgG antibody of Toxoplasma gondii.Then,the association between Toxoplasma gondii infection and HBV were analyzed.Results showed that the prevalence of Toxoplasma gondii infection was relative low with just 5.04％ in HBV patients but zero in healthy control.Most of those infected with toxoplasma gondii were male,HBeAg positive or with higher HBV viral load.However,no significant relationship was found between Toxoplasma gondii infection and gender,HBeAg status or viral load in univariate analyses.This study indicated the relative low infection rate of Toxoplasma gondii,which had no association with HBV infection in northern Shaanxi Province.

Objective To investigate the noninvasive indicators of indications for antiviral therapy in HBeAg-negative chronic hepatitis B virus (HBV) infection patients with alanine aminotransferase (ALT) ≤40 U/L under the guidance of liver pathology. MethodsA retrospective analysis was performed for the clinical data of 377 HBeAg-negative chronic HBV infection patients with ALT ≤40 U/L who were hospitalized in Affiliated Hospital of Yan’an University, from October 2013 to August 2018 and underwent liver biopsy, among whom the patients with inflammatory activity ＜A2 and fibrosis stage ＜F2 were enrolled as non-antiviral therapy group(n=266), and the patients with inflammatory activity ≥A2 or fibrosis stage ≥F2 were enrolled as antiviral therapy group(n=111). The chi-square test was used for comparison of categorical data between two groups; the t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; univariate and multivariate binary logistic regression analyses were used to screen out the influencing factors for the initiation of antiviral therapy; the receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficiency of each indicator in determining the need for antiviral therapy in HBeAg-negative chronic HBV infection patients with ALT ≤40 U/L. ResultsOf all 377 patients, 266 (70.6%) did not need antiviral therapy for the time being, and 111 (29.4%) had marked liver damage and thus needed active antiviral therapy. The multivariate analysis showed that liver stiffness measurement (LSM) (odds ratio ［HR］=2.003, 95% confidence interval ［CI］: 1.647-2.437, P＜005), HBsAg (HR=1.563, 95% CI: 1.110-2.200, P＜0.05), HBV DNA (HR=1.519, 95% CI: 1173-1.966, P＜0.05), and albumin (HR=0.939, 95% CI: 0.884-0.998, P＜0.05) were independent influencing factors for the initiation of antiviral therapy. The ROC curve analysis showed that the area under the ROC curve (AUC) was 0.749 (95% CI: 0.699-0799) for LSM, 0642 (95% CI: 0.586-0.699) for HBV DNA, and 0.565 (95% CI: 0.507-0.623) for HBsAg, and the combination of LSM, HBV DNA, and HBsAg had a larger AUC of 0.779 (95% CI: 0.732-0.827). ConclusionThe levels of LSM, HBV DNA, and HBsAg have a reference value in determining the initiation of antiviral therapy in HBeAg-negative chronic HBV infection patients with ALT≤40 U/L.

Objective:To study the relationship between adult fluoride exposure and grip strength in rural areas of China with fluorosis, as well as the roles of basal metabolic rate (BMR) and body fat percentage (BFP) in the association between fluoride exposure and grip strength.Methods:From April to May 2017, a cluster sampling method was used to conduct a questionnaire survey, physical examination, and biological sample collection on residents aged 18 - 60 in Tongxu County, Kaifeng City, Henan Province (epidemic areas of drinking-water-borne fluorosis). A total of 1 168 subjects were included in the study, including 427 males and 741 females. The fluoride ion selective electrode method and the picric acid method were used to determine the concentrations of urine fluoride and urine creatinine, and the adjusted urine fluoride concentration (CUF) was calculated. BMR and BFP were measured by a bioelectrical impendence method, and the grip strength was measured by a Jamar grip dynamometer. The relationship between CUF, BMR, BFP and grip strength were analyzed using a generalized linear model regression. The mediation effect model was used to assess the mediating effect of BMR and BFP on the association between CUF and grip strength.Results:Female grip strength decreased by 0.28 kg ( P = 0.043) for every 1.00 mg/L increment in CUF. No similar association was found between the two in males ( P = 0.744). Regardless of gender stratification, BMR was positively correlated with grip strength ( P < 0.001). For every 1.00% increase in BFP, female grip strength decreased by 0.18 kg ( P = 0.043). The mediation effect model analysis results showed that the mediation effect ratios of BMR and BFP in the association between CUF and grip strength in female were 65.1% ( P < 0.001) and 8.4% ( P = 0.111), respectively. Conclusion:Fluoride exposure is associated with changes in female grip strength, and BMR changes play a partial mediating role in the association between fluoride exposure and female grip strength.

Objective To investigate the effects of one-lung ventilation time on the concentration of tumor necrosis factor (TNF)-α and interleukin (IL)-6 in the bronchoalveolar lavage fluid (BALF), serum inflammatory markers and early pulmonary infection after radical resection of esophageal cancer. Methods Ninety patients with thoracoscope and laparoscopic radical resection of esophageal carcinoma were chosen. According to the thoracoscope operation time, the patients were divided into 3 groups including a T1 (0.5–1.5 hours) group, a T2 (1.5–2.5 hours) group and a T3 (>2.5 hours) group. Immediately after the operation, the ventilated and collapsed BALF were taken. Enzyme-linked immunosorbent assay (ELISA) method was used to determine the concentration of IL-6 and tumour necrosis TNF-α. The concentrations of procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) were measured on the first, third, fifth day after operation. The incidence of pulmonary infection was observed within 3 days after operation. Result The IL-6 values of the right collapsed lung in all groups were higher than those in the left ventilated lung. The TNF-α value of the right collapsed lung in the T2 group and T3 group was higher than that in the left ventilated lung (P<0.05). Compared with in the right collapsed lung, the TNF-α and IL-6 values gradually increased with the the duration of one-lung ventilation (P<0.05). Compared with the left ventilated lung groups, the IL-6 value increased gradually with the duration of one-lung ventilation time (P<0.05). The TNF-α value of the T3 group was higher than that of the T1 and T2 groups (P<0.05). The PCT value of the T3 group was higher than that of the T1 group and T2 group on the third, fifth day after operation (P<0.05). But there was no significant difference in CRP and WBC among the three groups at different time points. The incidence of pulmonary infection in the T3 group was significantly higher than that in the T1 group within 3 days after operation (P<0.05). Conclusion With the extension of one-lung ventilation time, the release of local and systemic inflammatory mediators is increased, and the probability of pulmonary infection is higher.

Objective     To evaluate the clinical efficacy of dexmedetomidine in perioperative management of on-pump cardiac surgery. Methods     Randomized controlled trials (RCTs) were identified through a systematic literature search of PubMed, EBSCO, Web of Science, Cochrane Library, CBM, CNKI, Wanfang Database (up to December 2016). RevMan 5.3 software was used for meta-analysis. Results     Sixteen studies with 1 432 patients were included. Dexmedetomidine significantly decreased the risk of postoperative delirium (RR=0.28, 95% CI 0.18 to 0.44, P<0.000 01) and postoperative atrial fibrillation (RR=0.65, 95% CI 0.44 to 0.98, P=0.04) compared with the controls. The duration of intubation (RR=–1.96, 95% CI –2.07 to –1.86, P<0.000 01), length of ICU stay (RR=–0.49, 95% CI –0.74, –0.24, P=0.000 1) and hospital stay (RR=–1.24, 95% CI –2.26 to –0.22, P=0.02) in the dexmedetomidine group were significantly shorter than those of the control group. In addition, dexmedetomidine was shown to improve the score of the the Montreal Cognitive Assessment (RR=0.88, 95% CI 0.42 to 1.35, P=0.000 2) compared to the control group. Conclusion     Dexmedetomidine can reduce the complications after cardiac surgery, which is safe and effective. However, more studies with good methodologic quality and large samples are still needed to make further assessment.