Objective:To establish a convenient preoperative nomogram prediction model for early diagnosis of hepatocellular carcinoma (HCC)with microvascular invasion (MVI), and to evaluate the model through internal and external validations for use informulating reasonable and individualized treatment strategies for patients with early-staged HCC.Methods:The clinical data of 294 patients who underwent hepatectomy at the General Hospital of Ningxia Medical University from January 2017 to December 2020 were retrospectively collected and analyzed. Based on the different admission times, they were divided into the training group ( n=231) and the validation group ( n=63). Based on the results from previous published literatures and our relevant clinical experience, risk factors including γ-glutamyltranspeptidase (GGT), platelet-lymphocyte ratio (PLR), fibrinogen albumin ratio (FAR), lymphocyte monocyte count ratio (LMR) and ALT-platelet ratio (APRI) were subjected to multi-factor logistic regression analysis to determine independent risk factors of HCC with MVI, and a nomogram prediction model was then constructed. The validation group was applied to the model for validation. Results:Of 294 patients who were enrolled in this study, there were 231 patients in the training cohort, with an average age of (55.1±10.9) years. In the training group, 95 patients were MVI positive and 136 patients were MVI negative. In the validation group, 38 patients were MVI positive and 25 patients were MVI negative. Logistic regression analysis showed that FAR>0.06, GGT>50 U/L, APRI>0.16, tumor diameter>5 cm, LMR>3.57 and PLR>98.75 were independent risk factors ( P<0.05), and a nomogram prediction model was established. The correction curve of the nomogram showed that the actual prediction result was close to the ideal result of the prediction model. The internal validated results showed the C-indexes to be between 0.71 and 0.90, and the prediction model had good discrimination. DCA curve was used to evaluate the clinical net benefit of the predictive model. When the net benefit rate was above zero, the threshold of the prediction model was 4%-77%, indicating that the prediction model had good clinical practicability. Conclusion:The established nomogram prediction model based on preoperative clinical indexes of GGT, APRI, LMR, PLR, FAR and diameter of tumor could be used to predict early diagnosis of HCC with MVI. The nomogram has good clinical application values.

Adult ; China ; epidemiology ; Female ; Humans ; Low Back Pain ; epidemiology ; etiology ; Occupational Diseases ; epidemiology ; etiology

Objective To analyze the choice of implant materials,key points of operative proce- dures,prevention and management of postoperative complications in patients treated with cranioplasty. Methods Two hundred and twenty six patients with craniocerebral trauma underwent cranioplasty with different implant materials.Attention should be paid for the purpose of not tearing or injuring the dura ma- ter during operation.To take the dura mater up to the implant material and the edge of the bone flap,and put drainage under the scalp flap before closure of the incision.Results The clinical symptoms and neural function were improved in 146(64.6%)patients postoperatively.Postoperative complications mainly were infection,fluid collection and hematoma in the operative region.Follow-up showed the occur- rence of displacement or collapse of the implant materials in some patients.Conclusion Timely cra- nioplasty can not only resolve cosmetic problems but also improve clinical symptoms and neural function. The causes of postoperative complications are mainly related with the operative procedures and the materi- als used.

OBJECTIVETo investigate the clinicopathologic aspects of locoregional recurrence and their implication on the survival in patients with hypopharyngeal cancer.

METHODSA retrospective review of 101 patients with hypopharyngeal cancer that were treated with surgical management and postoperative radiotherapy from 1998 to 2004 was performed. The clinicopathologic risk factors for locoregional recurrence were evaluated by using univariate chi(2) tests and multiple stepwise Logistic regression models. Survival analysis was performed by using Kaplan-Meier method, Log-Rank test and Cox proportional hazard model.

RESULTSThe overall incidence of locoregional recurrence in this series of hypopharyngeal cancer was 43.6% (44/101). The rates of recurrence were local 13.9% (14/101), regional 31.7% (32/101). In a multivariate Logistic regression analysis, it was confirmed that number of levels with pathologic lymph node (OR = 0.334, P = 0.0242) was the most significant risk factors for locoregional recurrence. The same for regional recurrence was capsule rupture of pathologic lymph node (OR = 0.353, P = 0.0389) and multilevel positive nodal involvement in neck (OR = 0.259, P = 0.0069). The overall survival of hypopharyngeal cancer was 23.2%, and reduced to 11.4% for locoregional recurrence. The recurrences were managed by salvage surgery in 12 cases, which included local recurrences after partial pharyngolaryngectomy, ipsilateral regional recurrences after selective neck dissection, and contralateral regional recurrences at initially uninvolved neck. The overall survival of those patients sustained 33.3%. A multivariate Cox regression analysis revealed that the factors impacting the prognosis were recurrent time (RR = 0.317, P < 0.0001) and treatment modality after locoregional recurrence (RR = 6.119, P = 0.0001).

CONCLUSIONSLocoregional recurrences are frequent and have a very negative impact on patient survival in hypopharyngeal cancer, which most commonly have a regional recurrence. Salvage surgery in suitable cases seems to improve survival rates. Much attention should be paid to cervical pathological factors for locoregional recurrences in hypopharyngeal cancer, especially multilevel and capsule rupture of pathologic lymph node.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; pathology ; Female ; Humans ; Hypopharyngeal Neoplasms ; pathology ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local ; pathology ; Neoplasm Staging ; Prognosis ; Retrospective Studies

OBJECTIVETo analyze the epidemiological characteristics, related risk factors, measures for its control of severe acute respiratory syndrome (SARS).

METHODSData on epidemiological features, pathogens and measures for control were collected and analyzed.

RESULTSSince Jan 2003, infectious atypical pneumonia (AP) has become epidemic in Guangzhou city. The first autochthonous case was identified on Jan 2nd. Number of cases started to increase since February and reached peak in the early 10 days of February. Hereafter the epidemic tended to decline in March and since early April, the average number of new cases began to decrease, less than 10 per day. Epidemiological studies revealed that the number of cases aged between 20 and 50 was higher than that below the age of 20. Of the total 966 cases, 429 were males versus 537 females. Geographically, the epidemics covered all 13 districts of Guangzhou, but 95% of the cases concentrated in 7 urban districts. As for professional distribution, health care workers accounted for 28.67% of the total cases. There were 36 deaths, aged from 5 to 89, with half of them older than 60. Out of the victims, 38.9% of them had complications as hypertension, diabetes, heart diseases and COPD etc. Data regarding the clustering features of cases showed that there were 42 families having 2 or more cases in one family, while 277 health workers suffered from SARS were concentrated in 28 hospitals. Only one outbreak took place in a public setting but no outbreak was reported in schools. Relevant research also indicated that SARS could be classified as an air-borne infectious disease, transmitted through aerosol and droplets, but close contact also played an important role in the mode of transmission. The disease was highly infectious, suggesting that people who had close contact with patients in the place with poor ventilation was in greater risk of getting infection. The incubation period ranged from 1 to 11 days (mainly from 3 to 8 days), with an average of 5 days. According to our observation, the following measures might be effective such as: early diagnosis, isolation and treatment provided to the patients, and suspected cases under medical observation should also be put in separate places. Improving ventilation and regular disinfection over air and stuff in hospital wards were also recommended. In order to prevent iatrogenic infection, sense on self-protection among health care workers must be strengthened. Patients were not allowed to be visited by any one other than hospital staff.

CONCLUSIONSARS is a preventable disease and can be under control. It is of great importance to prevent clustered SARS cases and the prevention of iatrogenic infection is essential.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; China ; epidemiology ; Contact Tracing ; Disease Outbreaks ; Family Health ; Female ; Humans ; Incidence ; Infectious Disease Transmission, Patient-to-Professional ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Severe Acute Respiratory Syndrome ; epidemiology ; prevention & control

OBJECTIVETo study the expression of anaplastic lymphoma kinase (ALK) and survivin proteins in anaplastic large cell lymphoma (ALCL) and there clinical significance.

METHODSThe morphologic characteristics were studied by routine light microscopy. Immunohistochemical staining for ALK and survivin proteins was performed using LSAB method.

RESULTSALK protein was positive in 51 cases (63%) and negative in 30 cases (37%) of the 81 cases of ALCL studied. The prognosis of patients with ALK protein expression was better than those without ALK expression (P < 0.05). As for survivin protein, there were various degrees of expression in all the 77 ALCL cases studied. High level of survivin protein expression was observed in 33 cases (42.9%), while low level of expression was seen in 44 cases (57.1%). The expression of survivin protein did not correlate with that of ALK protein (P > 0.05). The survival rate was significantly lower in patients with high survivin protein expression (P < 0.05). In cases with ALK protein expression, the prognosis was less favorable if there was also high co-expression of survivin protein (P < 0.05). In ALK protein negative cases, prognosis did not significantly correlate with the expression of survivin protein (P > 0.05). In addition, multivariate analysis confirmed the prognosis value of ALK protein expression, survivin protein expression and constitutional symptoms.

CONCLUSIONSurvivin protein expression can serve as an independent prognostic predictor of unfavorable clinical outcome in patients with ALCL, especially when ALK protein is positive.

Adolescent ; Adult ; Aged ; Biomarkers, Tumor ; metabolism ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Inhibitor of Apoptosis Proteins ; Lymphoma, Large-Cell, Anaplastic ; metabolism ; pathology ; Male ; Microtubule-Associated Proteins ; metabolism ; Middle Aged ; Multivariate Analysis ; Neoplasm Proteins ; metabolism ; Prognosis ; Protein-Tyrosine Kinases ; metabolism ; Receptor Protein-Tyrosine Kinases ; Survival Analysis ; Young Adult

OBJECTIVETo probe blood serum Ab-IgG characteristics of severe acute respiratory syndrome (SARS) patients in Guangzhou and investigate the related factors.

METHODSThe serum of such population diagnosed as SARS convalescent patients, non-SARS patients, family consanguineous contraction persons, wild animal and vegetable salesman and community common people was collected. The lab detective method of ELISA was adopted for these serum samples. And the epidemic investigations for the SARS patients were also carried out.

RESULTSOf these populations, the detective rate of Ab-IgG for the clinic diagnosed SARS patients, which was 53.7%; That for the wild animal salesman and community common people were 16.7% and 0.9%, respectively. Among the clinic diagnosed SARS patients, the positive antibody detective rate was 90.4% for those which had specific contact history or infectivity, which was higher than that for other population. Among the specific contact history or infectivity cases, the antibody positive rate for the young and the old was lower than that for the adult. Meanwhile the difference did not exist among other cases. The antibody positive rate was identical between the male and the female. And the antibody detective rate was decreased by the month.

CONCLUSIONAs a whole SARS-CoV Ab-IgG detective rate for the clinic diagnosed SARS patients was 53.7% only. The reasons for that mainly lie in the wrong clinic diagnosis besides these factors such as age, hormone use and reagent and so on. The combination of lab detection results and epidemic investigation was propitious to the diagnosis veracity. It was impossible for the sub-clinic infection of SARS-CoV virus. The importance in the virus transmitting course need to be further studied.

Adult ; Antibodies, Viral ; blood ; Child ; China ; epidemiology ; Female ; Humans ; Immunoglobulin G ; blood ; Male ; Middle Aged ; SARS Virus ; immunology ; Seroepidemiologic Studies ; Severe Acute Respiratory Syndrome ; epidemiology ; immunology

Objective:To analyze the effects of BANCR on proliferation,apoptosis,invasion and angiogenesis in human hepatocarcinoma cell line HepG2.Methods:The expression of BANCR was detected by quantitative real-time reverse transcription PCR (qRT-PCR).BANCR siRNA and Scramble was respectively transfected into human hepatocarcinoma cell line HepG2.Cell proliferation was detected by CCK-8.Flow cytometry was performed to analyze the apoptosis.Transwell assay was used to test the invasion.Angiogenesis was analyse by tube formation assay.Western blot was executed to check the expression of proliferating cell nuclear antigen (PCNA),caspase-3,matrix metalloprotein 9 (MMP-9),vascular endothelial growth factor(VEGF),acidic fibroblast growth factor (bFGF)and interferon-γ (IFN-γ).Results:The expression of BANCR in HepG2 was higher than L02 (P＜0.05).Compared with control group,the cell proliferation folds in BANCR siRNA was largely decreased.Besides,BANCR siRNA group had a higher apoptosis rate and less invasive cells (P＜0.05).Western blot showed that the expression level of caspase-3 and IFN-γwas obviously enhanced in BANCR siRNA group,and the expression of PCNA,MMP-9,Fn,Vimentin,VEGF and bFGF was distinctly surpressed in BANCR siRNA group compared to control group (P ＜ 0.05).Conclusion:siRNA interference of BANCR promotes apoptosis and represses proliferation,invasion and angiogenesis in human hepatocarcinoma cell line HepG2.

Objective To study the correlation between traditional Chinese medicine(TCM)constitution and pathogenic factors in patients with ankylosing spondylitis(AS).Methods One hundred patients of AS and their family members who had medical consultation in the Fifth Hospital of Xi'an(i.e.,Shaanxi Hospital of Integrated Traditional Chinese and Western Medicine)in August 2019 and September 2020 were selected as the study subjects.The guidelines of Classification and Determination of Traditional Chinese Medicine Constitution issued by the China Association of Chinese Medicine were adopted to determine the traditional Chinese medicine(TCM)constitution types of the study subjects.The sociodemographic information,living habits,clinical symptoms,and TCM constitution types of the AS patients and their family members were collected by means of questionnaires and clinical investigations,and then the pathogenic factors of the patients with AS were investigated.The binomial Logistic regression model was used to analyze the correlation between TCM constitution types and pathogenic factors in patients with AS.Results(1)Among the 100 AS patients,the majority of them had the biased constitutions,and the biased constitutions with the occurrence frequency in descending order were yang deficiency constitution,qi deficiency constitution,and damp-heat constitution,which accounted for 33.00%,14.00%,and 18.00%,respectively.(2)The prevalence rates of AS in the first-,second-,and third-degree relatives of AS patients were 56.25%,40.00%and 25.00%,respectively.For the positive rates of human leukocyte antigen B27(HLA-B27)in AS patients and their family members,HLA-B27 in AS patients was all positive,while the positive rates of HLA-B27 in the first-,second-,and third-degree relatives of AS patients were 44.31%,30.67%and 15.63%,respectively.(3)The results of regression analysis showed that the disease duration of AS patients was significantly correlated with qi deficiency constitution,the grading of sacroiliac arthritis was correlated with qi stagnation constitution,and age was correlated with blood stasis constitution(P＜0.05 or P＜0.01).The results indicated that disease duration and age were the important factors affecting the constitution types of AS patients,and disease duration was closely related to qi deficiency while age was closely related to blood stasis.Conclusion AS is a highly hereditary autoimmune disease,and its onset is associated with HLA-B27.Yang deficiency is the basic constitution type of AS,and damp-heat constitution is the main constitution type in the progression of AS(especially in the active stage of the disease).The prolongation of the disease will exacerbate the illness condition of AS and then the manifestations of qi deficiency will be more obvious.

Objective: To observe the expansion rule of directional skin and soft tissue expander (hereinafter referred to as expander) in abdominal scar reconstruction. Methods: A prospective self-controlled study was conducted. Twenty patients with abdominal scar who met the inclusion criteria and admitted to Zhengzhou First People's Hospital from January 2018 to December 2020 were selected by random number table method, including 5 males and 15 females, aged 12-51 (31±12) years, with 12 patients of type Ⅰ scar and 8 patients of type Ⅱ scar. In the first stage, two or three expanders with rated capacity of 300-600 mL were placed on both sides of the scar, of which at least one expander had rated capacity of 500 mL (as the follow-up observation object). After the sutures were removed, water injection treatment was started, with the expansion time of 4 to 6 months. After the water injection volume reached 2.0 times of the rated capacity of expander, abdominal scar excision+expander removal+local expanded flap transfer repair was performed in the second stage. The skin surface area at the expansion site was measured respectively when the water injection volume reached 1.0, 1.2, 1.5, 1.8, and 2.0 times of the rated capacity of expander, and the skin expansion rate of the expansion site at corresponding multiples of expansion (1.0, 1.2, 1.5, 1.8, and 2.0 times) and adjacent multiple intervals (1.0-1.2, 1.2-1.5, 1.5-1.8, and 1.8-2.0 times) were calculated. The skin surface area of the repaired site at 0 (immediately), 1, 2, 3, 4, 5, and 6 months after operation, and the skin shrinkage rate of the repaired site at different time points (1, 2, 3, 4, 5, and 6 months after operation) and different time periods (0-1, 1-2, 2-3, 3-4, 4-5, and 5-6 months after operation) were calculated. Data were statistically analyzed with analysis of variance for repeated measurement and least significant difference-t test. Results: Compared with the expansion of 1.0 time ((287.6±2.2) cm² and (47.0±0.7)%), the skin surface area and expansion rate of the expansion site of patients ((315.8±2.1), (356.1±2.8), (384.9±1.6), and (386.2±1.5) cm², (51.7±0.6)%, (57.2±0.6)%, (60.4±0.6)%, and (60.5±0.6)%) were significantly increased when the expansion reached 1.2, 1.5, 1.8, and 2.0 times (with t values of 46.04, 90.38, 150.14, 159.55, 45.11, 87.83, 135.82, and 118.48, respectively, P<0.05). Compared with the expansion of 1.2 times, the skin surface area and expansion rate of the expansion site of patients were significantly increased when the expansion reached 1.5, 1.8, and 2.0 times (with t values of 49.82, 109.64, 122.14, 144.19, 49.51, and 105.85, respectively, P<0.05). Compared with the expansion of 1.5 times, the skin surface area and expansion rate of the expansion site of patients were significantly increased when the expansion reached 1.8 times (with t values of 38.93 and 39.22, respectively, P<0.05) and 2.0 times (with t values of 38.37 and 38.78, respectively, P<0.05). Compared with the expansion of 1.8 times, the skin surface area and expansion rate of the expansion site of patients both had no statistically significant differences when the expansion reached 2.0 times (with t values of 4.71 and 4.72, respectively, P>0.05). Compared with the expansion of 1.0-1.2 times, the skin expansion rate of the expansion site of patient was significantly increased when the expansion reached 1.2-1.5 times (t=6.95, P<0.05), while the skin expansion rate of the expansion site of patient was significantly decreased when the expansion reached 1.5-1.8 and 1.8-2.0 times (with t values of 5.89 and 40.75, respectively, P<0.05). Compared with the expansion of 1.2-1.5 times, the skin expansion rate of the expansion site of patient was significantly decreased when the expansion reached 1.5-1.8 and 1.8-2.0 times (with t values of 10.50 and 41.92, respectively, P<0.05). Compared with the expansion of 1.5-1.8 times, the skin expansion rate of the expansion site of patient was significantly decreased when the expansion reached 1.8-2.0 times (t=32.60, P<0.05). Compared with 0 month after operation, the skin surface area of the repaired site of patient at 1, 2, 3, 4, 5, and 6 months after operation was significantly decreased (with t values of 61.66, 82.70, 96.44, 102.81, 104.51, and 102.21, respectively, P<0.05). Compared with 1 month after operation, the skin surface area of the repaired site of patient was significantly decreased at 2, 3, 4, 5, and 6 months after operation (with t values of 37.37, 64.64, 69.40, 72.46, and 72.62, respectively, P<0.05), while the skin shrinkage rate was significantly increased (with t values of 32.29, 50.00, 52.67, 54.76, and 54.62, respectively, P<0.05). Compared with 2 months after operation, the skin surface area of the repaired site of patient was significantly decreased at 3, 4, 5, and 6 months after operation (with t values of 52.41, 60.41, 70.30, and 65.32, respectively, P<0.05), while the skin shrinkage rate was significantly increased (with t values of 52.97, 59.29, 69.68, and 64.50, respectively, P<0.05). Compared with 3 months after operation, the skin surface area of the repaired site of patient was significantly decreased at 4, 5, and 6 months after operation (with t values of 5.53, 38.00, and 38.52, respectively, P<0.05), while the skin shrinkage rate was significantly increased (with t values of 25.36, 38.59, and 37.47, respectively, P<0.05). Compared with 4 months after operation, the skin surface area (with t values of 41.10 and 50.50, respectively, P>0.05) and skin shrinkage rate (with t values of 48.09 and 50.00, respectively, P>0.05) of the repaired site of patients at 5 and 6 months after operation showed no statistically significant differences. Compared with 5 months after operation, the skin surface area and skin shrinkage rate of the repaired site of patient at 6 months after operation showed no statistically significant differences (with t values of 9.40 and 9.59, respectively, P>0.05). Compared with 0-1 month after operation, the skin shrinkage rate of the repaired site of patient at 1-2, 2-3, 3-4, 4-5, and 5-6 months after operation was significantly decreased (with t values of 13.56, 40.00, 49.21, 53.97, and 57.68, respectively, P<0.05). Compared with 1-2 months after operation, the skin shrinkage rate of the repaired site of patients at 2-3, 3-4, 4-5, and 5-6 months after operation was significantly decreased (with t values of 12.37, 27.72, 30.16, and 31.67, respectively, P<0.05). Compared with 2-3 months after operation, the skin shrinkage rate of the repaired site of patients at 3-4, 4-5, and 5-6 months after operation was significantly decreased (with t values of 33.73, 41.31, and 54.10, respectively, P<0.05). Compared with 3-4 months after operation, the skin shrinkage rate of the repaired site of patient at 4-5 and 5-6 months after operation showed no statistically significant differences (with t values of 10.90 and 23.60, respectively, P>0.05). Compared with 4-5 months after operation, the skin shrinkage rate of the repaired site of patient at 5-6 months after operation showed no statistically significant difference (t=20.90, P>0.05). Conclusions: The expander can effectively expand the abdominal skin, thus repairing the abdominal scar deformity. Maintained expansion for one month after the water injection expansion reaches 1.8 times of the rated capacity of the expander can be set as a phase Ⅱ operation node.
Female ; Male ; Humans ; Cicatrix/surgery* ; Prospective Studies ; Tissue Expansion Devices ; Skin ; Abdominal Wall