Objective To evaluate the correlation between plasma high sensitivity C reactive protein (hs-CRP) level and global registry of acute coronary events (GRACE) scores,and its predictive value for long-term (5 years) cardiovascular events in middle-aged and elderly patients with acute coronary syndrome (ACS).Methods 138 middle aged and elderly patients with ACS were divided into three groups according to GRACE scores:low risk group,middle risk group,high risk group.And based on quartiles of hs-CRP levels,subjects were segregated into 4 groups (Q1 to Q4).All subjects were followed up for about 5 years and adverse cardiovascular disease events were recorded.Results The hs-CRP level was gradually increased along with increasing risk according to GRACE risk stratification (hs-CRP low risk group,0.09 ± 0.22 ; middle risk group,0.21 ± 0.04 ;high risk group,0.43±0.23,P＜0.001).Meantime,GRACE risk scores were gradually increased along with increasing hs-CRP levels from Q1 to Q4 (Q1:133.0 ± 43.6; Q2:161.9 ± 60.2; Q3:169.3±52.6; Q4:188.4±47.5; all P＜0.001).Regression analysis showed that hs-CRP level was positively correlated with GRACE risk scores (r=0.576,P＜0.001).During a follow-up period of about 5 years,96 cardiovascular events were recorded.Receiver operating characteristic(ROC) curve analysis showed that area under the ROC curve (AUC) of hs-CRP was 0.821 (95 ％CI:0.749-0.892,P＜0.001) and AUC of GRACE risk score was 0.869 (95％CI:0.801 0.938,P＜0.001) in the evaluation of the long-term risk of incident cardiovascular events.The differences in prediction of long-term cardiovascular events in middle-aged and elderly patients with ACS were not significant (P =0.237) between GRACE risk score and hs CRP level.Conclusions Plasma hs-CRP level is positively associated with GRACE score.Both of them can predict long-term adverse cardiovascular events in middle-aged and elderly patients with acute coronary syndrome.

Objective To investigate the value of partial hepatectomy and vascular resection in the treatment of hilar cholangiocarcinoma. Methods Seventy four patients with hilar cholangiocarcinoma who underwent hepatectomy of Chinese People' s Liberation Army from January 2008 through December 2011 were analyzed retrospectively.Results Of the 74 patients,33 underwent radical resection and 19 palliative resection,22 received internal or external drainage.In the radical resection group,the median survival time was 27 months,and the overall survival rate at 1,2 and 3 years were 79％,64％ and 49％.In the palliative resection group,the median survival time was 14 months and the overall survival rate at 1,2 and 3 years were 56％,25％,and 19％.In the drainage group,the median survival time was 9 months and the overall survival rate at 1,2 and 3 years were 23％,15％,0.Conclusions Hepatectomy combined with hilar vascular resection helps increase survival rate of patients in radical excision of hilar cholangiocarcinoma and Surgical resection is the most elective method for treatment of hepatic hilar cholangiocarcinoma,and the radical resection might improve the prognosis of the patients with hilar cholangiocarcinoma.

Objective:To understand the reliability and validity of quality of life instruments for cancer patients-brain neoplasm [QLICP-BN (V1.0)], a self-developed quality of life scale for cancer patients.Methods:The quality of life of 112 patients with brain neoplasms in Yunnan Cancer Hospital from March 2012 to November 2013 was measured. The general data questionnaire and QLICP-BN (V1.0) were used for data collection. The reliability, validity and responsiveness of the scale were tested, and then the metric characteristics of the scale were evaluated.Results:The split-half reliability of the total score of the scale was 0.95, the Cronbach αcoefficient was 0.92, and the test-retest correlation coefficient rwas 0.78. After extracting common factors by the principal component method and rotating with the maximum variance, the specific module obtained three principal components, and the cumulative variance contribution rate was 64.18%. The score of specific module was 75.30±17.44 before treatment and 78.91±12.20 after treatment ( t=-2.481, P=0.015). The total score of scale before treatment was 65.26±12.29, and that after treatment was 69.62±10.41, with a statistically significant difference ( t=-4.492, P<0.001). The total responsiveness of the scale was 0.456, showing moderate responsiveness. Conclusion:QLICP-BN (V1.0) has good reliability, validity and a certain degree of responsiveness. It can be used as a measurement tool for the quality of life of patients with brain neoplasms in China.

Objective To analyze the clinical value of serum and ascites tumor markers in the diagnosis of benign and malignant ascites ,and to provide reference for clinical diagnosis and treatment of ascites .Methods A total of 168 patients with ascites in Third Affiliated Hospital of Liaoning University of Chinese Medicine from November 2015 to June 2016 were selected .All patients were collected abdominal paracentesis ascites ,analysis of ascites tumor markers .Vein blood sample were collected ,centrifuged up-per serum and detected tumor markers including CA153 ,BXTM and CEA ,all patients underwent pathological test for diagnosis of benign and malignant ascites .The normal distribution method was used to determine the standard of judging malignant ascites and serum ,with the pathological diagnosis as the gold standard ,the four grid diagnosis table was used to calculate the sensitivity and specificity of different combination of ascites tumor markers and serum tumor markers in diagnosis of benign and malignant ascites . Results Among 168 cases ,56 cases were diagnosed with malignant ascites ,112 cases with benign ascites by pathological test .Com-bined detection results of three tumor markers in ascites :57 cases were malignant ,111 were benign .Combined detection results of three tumor markers in serum :64 cases were malignant ,104 cases were benign .The sensitivity and specificity of three tumor mark-ers in ascites were 85 .71% and 91 .96% respectively ,which were higher than 82 .41% and 83 .93% of the three tumor markers in serum .Conclusion The sensitivity and specificity of three tumor markers in ascites for diagnosis of benign and malignant ascites were superior ,which could be used as an important auxiliary means for diagnosis on the overall condition of patients with ascites , and provides an important reference for the subsequent selection other inspection methods .

Objective To investigate the value of combined detection of alpha fetoprotein (AFP) ,gamma-glutamyl transferase (GGT)and Golgi glycoprotein (GP73)in the diagnosis of primary hepatocellular carcino-ma.Methods 109 cases of primary liver cancer treated in the hospital from June 2015 to June 2017 were en-rolled in the study as primary liver cancer group ,76 cases of liver cirrhosis were enrolled in the study as liver cirrhosis group and 70 cases of healthy people who underwent healthy assessment were enrolled in the study as control group.The peripheral venous blood in each group was extracted fasting in the morning ,and the ser-um was separated.The levels of GP73 were measured by enzyme linked immunosorbent assay.The level of AFP was measured by chemiluminescent immunoassay ,and the level of GGT was measured by rate method. Results The serum levels of AFP ,GGT and GP73 in the primary liver cancer group were higher than those in the liver cirrhosis group and the control group ,and the serum levels of AFP ,GGT and GP73 in the liver cir-rhosis group were higher than those in the control group ,and the differences were statistically significant (P＜0.05).The specificity and the sensitivity of the combined detection of AFP ,GGT and GP73 were higher than those of single detection of AFP ,GGT ,and GP73.Conclusion The combined detection of AFP ,GGT and GP73 has important value in the diagnosis of early primary liver cancer ,and has relatively high sensitivity and specificity ,which is worthy of further clinical study.

OBJECTIVETo analyze the clinicopathological characteristics and the factors affecting the prognosis of intrahepatic biliary cystadenocarcinoma (IBC).

METHODSForty-six patients with histologically confirmed IBC from January, 2000 to April, 2014 were included. The clinical characteristics of the patients with IBC were compared with those of 58 patients with intrahepatic biliary cystadenoma (IBCA). Kaplan-Meier analysis was used to identify the factors affecting the prognosis of IBC.

RESULTSThe 46 patients with IBC included 15 men and 31 women with a mean age of 57.0 ± 10.5 years. Compared with the patients with IBCA, IBC patients had an older mean age (57.0 ± 10.7 vs 44.3 ± 15.3 years, P=0.03) and a greater proportion of male patients (15/46 vs 8/58, P=0.02). The differential diagnosis between IBC and IBCA was difficult on the basis of preoperative laboratory and imaging findings. The median overall survival of IBC patients was 56 months with 1-, 3-, and 5-year survival rates of 85.9%, 65.2%, and 47.7%, respectively. Gender, surgical approach, tumor growth pattern and distant metastasis were all significant prognostic factors for the overall survival of the patients.

CONCLUSIONIBC is a rare cystic lesion occurring primarily in middle-aged men. Complete resection is recommended for curative treatment and close follow-up is essential especially for male patients and patients with tumors exhibiting an invasive growth.

Adult ; Aged ; Bile Duct Neoplasms ; pathology ; Bile Ducts, Intrahepatic ; pathology ; Cystadenocarcinoma ; pathology ; Diagnosis, Differential ; Diagnostic Imaging ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Prognosis ; Retrospective Studies

Objective:To present briefly introductions and evaluations on the constructs, psychometric properties (reliability, validity, reactivity etc.) and applications of the system of Quality of Life Instruments for Cancer Patients QLICP(V1.0) including 12 kinds of scales for patients with head and neck cancer, brain cancer, lung cancer, breast cancer, esophageal cancer, gastric cancer, colorectal cancer, liver cancer, cervical cancer, ovarian cancer, leukemia and lymphoma.Methods:Based on our measuring data from relevant patients at hospitals, the constructs, characteristics and psychometrics of the system above were analyzed and presented. Internal consistency reliability for each domain and the overall scale was assessed using Cronbach's alpha coefficient, and test-retest reliability through calculating the Pearson correlation coefficient between the first and second assessments. The criterion-related validity was evaluated by correlating corresponding domains of two instruments. Responsiveness was assessed through comparing the mean difference between the pre-treatment and post-treatments with standardized response mean (SRM). The use agreements and literature reviews of this system were used to understand the applications of 12 kinds measurement scales.Results:The quality of life scales for 12 kinds of cancer patients of the system QLICP(V1.0) have good construct( 5 domains, 11-15 facets), reliability, validity and a certain degree of responsiveness. The internal consistency reliability Cronbach's α coefficients for the overall scale of QLICP in different cancers was from 0.67 to 0.92, and the test-retest reliability (correlation coefficient) was from 0.61 to 0.99. The criterion-related validity (correlation coefficient) was for the overall scale of QLICP in different cancers was from 0.28 to 0.89, and the responsiveness SRM was from 0.25 to 1.28. And also they were widely used in clinical practice and relevant studies for the corresponding cancers.Conclusion:The system QLICP(V1.0) is of outstanding characteristics with all psychometrics meeting requirements and better construct (clear hierarchical structure with items→ facets→ domains→ overall ), and can be used widely in clinical practice further.

Objective To evaluate the safety and efficacy of botulinum toxin type A for injection in the treatment of post-stroke upper limb spasticity (dosage was 200 U,or 240 U if combined with thumb spasticity).Methods The study was a multi-center,stratified block randomized,double-blind,placebocontrolled trial.All the qualificd subjects were from 15 clinical centers from September 2014 to February 2016.They were randomized (2∶1) to injections of botulinum toxin type A made in China (200-240 U;n =118) or placebo (n =60) in pivotal phase after informed consent signed.The study was divided into two stages.The pivotal trial phase included a one-week screening,12-week double-blind treatment,followed by an expanded phase which included six-week open-label treatment.The tone of the wrist,finger,thumb flexors was assessed at baseline and at weeks 0,1,4,6,8,12,16 and 18 using Modified Ashworth Scale (MAS),disability in activities of daily living was rated using the Disability Assessment Scale and impaction on pain,muscle tone and deformity was assessed using the Global Assessment Scale.The primary endpoint was the score difference between botulinum toxin type A and placebo groups in the tone of the wrist flexor using MAS at six weeks compared to baseline.Results Muscle tone MAS score in the wrist flexor of botulinum toxin type A and placebo groups at six weeks changed-1.00 (-2.00,-1.00) and 0.00 (-0.50,0.00) respectively from baseline.Botulinum toxin type A was significantly superior to placebo for the primary endpoint (Z =6.618,P ＜ 0.01).The safety measurement showed 10 subjects who received botulinum toxin type A had 13 adverse reactions,with an incidence of 8.47％ (10/118),and three subjects who received placebo had three adverse reactions,with an incidence of 5.00％ (3/60) during the pivotal trial phase.All adverse reactions were mild to moderate,none serious.There was no significant difference in adverse reactions incidence between the botulinum toxin type A and the placebo groups.During the expanded phase three subjects had four adverse reactions and the incidence was 1.95％.All adverse reactions were mild,none serious.Conclusion Botulinum toxin type A was found to be safe and efficacious for the treatment of post-stroke upper limb spasticity.Clinical Trial Registration:China Drug Trials,CTR20131191

OBJECTIVETo describe the treatment and prognosis of solid pseudopapillary neoplasms (SPN) with metastases or recurrence.

METHODSThe clinical date of 24 patients with histological confirmed SPN with metastases or recurrence from January 2000 to April 2014 were retrospectively analyzed. There were 22 females and 2 males, with mean age of (36 ± 16) years. Fourteen patients had local recurrence or metastasis after surgery, with a mean time of recurrence (44 ± 29) months. Ten patients were defined SPN with distant metastasis at first admission. Nineteen patients underwent surgical resection, among them, 11 patients received complete resection. Nine cases underwent chemotherapy. Kaplan-Meier method was used to identify prognostic factors.

RESULTSTwenty-four patients were followed-up, 9 patients died. Median survival time was 47 months, and 1-year, 3-year, and 5-year survival was 91.7%, 65.1%, 49.6%, respectively. Age (χ(2) = 6.858, P = 0.009), primary tumor diameter (χ(2) = 4.322, P = 0.038), extrahepatic metastasis (χ(2) = 5.279, P = 0.022) and complete resection of metastases and recurrence (χ(2) = 4.666, P = 0.031) were important prognostic factors for survival (P < 0.05).

CONCLUSIONSFor SPN with metastases or recurrence, good prognosis can also obtain after complete resection. Age, primary tumor diameter, extrahepatic metastasis and complete resection of metastases and recurrence are influence factors on prognosis of patients.

Adult ; Antineoplastic Combined Chemotherapy Protocols ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; surgery ; Pancreatic Neoplasms ; pathology ; surgery ; Prognosis ; Retrospective Studies ; Survival Rate ; Young Adult

Objective: To compare the differences and similarities among the system of quality of life instruments for cancer patients (QLICP) V1.0, the quality of life questionnaire (QLQ) from European Organization for Research and Treatment of Cancer (EORTC) and Functional Assessment of Cancer Therapy (FACT) from Center on Outcomes, Research and Education (CORE) of America. Methods: Based on literatures and our measuring data from patients at hospitals, the constructs, characteristics and psychometrics of the systems above were analyzed and compared. Internal consistency reliability was assessed using Cronbach α coefficient for each domain, and test-retest reliability through calculating the Pearson correlation coefficient r between the first and second assessments as well as intra-class correlation (ICC). Construct validity was evaluated by Pearson correlation coefficient r (item-domains correlations) and factor analysis. The criterion-related validity was evaluated by correlating corresponding domains of two instruments. Responsiveness was assessed through comparing the mean difference between the pre-treatment and post-treatment with standardized response mean (SRM). Results: The instruments of three systems were of different outstanding characteristics with all psychometrics meeting requirements. Measurements for 12 types of cancers showed that the internal consistency reliability Cronbach α coefficient for the overall scale of QLICP (V1.0) was 0.67-0.92, and for FACT was 0.79-0.98. The test-retest reliability (r or ICC) for the overall scale of QLICP (V1.0) was 0.61-0.99, and for FACT was 0.60-0.98. The SRM for the overall scale of QLICP (V1.0) was 0.25-1.28, and for FACT was 0.11-0.83. However, the QLICP was of better construct (clear hierarchical structure with items→facets→domains→overall) and Chinese culture. Conclusion The instruments of three systems can be used as the instruments to assess quality of life for patients with cancer with selections basing on different settings.