Objective To clarify the effects of HBV co-infection on liver function of patients with different types of hepatic echinococcosis.Methods We recruited 409 patients diagnosed with hepatic echinococcosis at three hospitals in western regions in China from 2014 to 2015.Venous blood was withdrawn to detect to liver function indications.ELISA was performed to detect HBsAg.We analyzed liver function in patients stratified by different types of hepatic echinococcosis with or without HBV infection.Results The hepatic echinococcosis patients infected with HBV had more severe impairment in liver functions such as reduced albumin and increased transaminase.The patients with hepatic alveolar echinococcosis were more vulnerable to HBV infection compared with those with hepatic cystic echinococcosis (38.4％ vs.86.4％, P<0.05).In addition, liver injury was more severe in patients diagnosed with alveolar hepatic echinococcosis and HBV infection compared with those diagnosed with cystic hepatic echinococcosis and HBV infection (all P<0.05).Conclusion Hepatic alveolar echinococcosis patients co-infected with HBV have worse liver injury compared with those hepatic cystic with HBV. Therefore, they deserve special attention in clinical treatment.

Background Accumulating evidence indicates that systemic inflammation response is associated with the prognosis of various cancers.The aim of this study was to investigate the neutrophil-lymphocyte ratio (NLR),which is one of the systemic inflammation markers,in the prognosis of hepatocellular carcinoma (HCC) after treatment of transcatheter arterial chemoembolization (TACE).Methods The clinical data of 178 HCC patients who received TACE were retrospectively analyzed.The optimal NLR cutoff was determined according to the receiver operating characteristic (ROC) analysis.All patients were divided into NLR-normal group and NLR-elevated group according to the cutoff,and the clinical features of these two groups were comparatively analyzed.Meanwhile,the overall survival and disease free survival (DFS) were analyzed using the KaplanMeier method.The risk factors of postoperative survival were investigated using univariate and multivariate Cox regression analyses.Results The optimal NLR cutoff was defined at 1.85 and 42 (23.6％) patients had an elevated NLR (NLR＞1.85).The median survival time was 9.5 months (range 1-99 months).The clinical data between the two groups were comparable,except for α-fetoprotein.Follow-up results showed that the median survival of patients with normal NLR was 17.5 months (range:1-99 months) compared with 8 months (range:8-68 months) of patients with elevated NLR.The 1,3 and 5-year overall survival of patients in the NLR-normal group and NLR-elevated group were 57.3％,44.1％,and 27.2％ and 42.1％,19.6％,and 9.5％ respectively (x2=194.2,P ＜0.001).Similarly,the disease free survival also has a significant difference (x2=39.3,P ＜0.001).Multivariate Cox regression analysis showed that a high NLR was an independent factor affecting the survival rate of HCC after TACE (P=0.04).Conclusion Preoperative NLR was an important prognostic factor to predict the prognosis of patients with intermediate HCC treated with TACE.

Objective:To predict the efficacy and safety of cephalosporins antibiotics combined with metronidazole for intra-abdominal infections using Bayesian network meta analysis.Methods:Databases including PubMed, Embase, the Cochrane Library, CNKI, Wanfang database, VIP database were searched for literatures from January 1990 to May 2018 with the key words of ( "intraabdominal infections" [MeSH Terms]) AND ( "Cephalosporins*" [MeSH Terms]) AND ( "randomized controlled trial" [MeSH Terms]),腹腔感染,继发性腹膜炎,腹腔脓肿,头孢. The randomized controlled trials (RCTs) about comparison of efficacy and safety between cephalosporins antibiotics combined with metronidazole versus other antibiotics for intra-abdominal infections were received and included. Experimental group included patients who received cephalosporins antibiotics combined with metronidazole for intra-abdominal infections, and control group included patients who received other antibiotics for intra-abdominal infections. The primary outcomes were the clinical cure rates, microbial clearance rate and incidence of serious adverse drug reactions. R 3.6.2 software random Bayesian model was used for meta analysis. The Markov Chain Monte Carlo was used for direct evaluation and indirect prediction. The tracing method, density plotting and leverage figure method were used to evaluate the model convergence and stability. No closed loop formed between intervention measures, so there was no need to evaluate consistency.Results:(1) Document retrieval: a total of 18 available RCTs were enrolled. There were 6 792 patients, including 3 402 in the experimental group, 3 390 in the control group. (2) Results of Bayesian network meta analysis. ① The clinical cure rates of the third generation cephalosporins+ metronidazole, carbapenems were significantly lower than the fourth generation cephalosporins+ metronidazole [ odds ratio ( OR)=0.46, 0.61, 95% confidence interval( CI) as 0.26-0.81, 0.38-0.97, P<0.05]. There was no significant difference in the clinical cure rate between the fifth generation cephalosporins+ metronidazole and carbapenems ( OR=1.03, 95% CI as 0.59-1.80, P>0.05). ② The microbial clearance rates of the fifth generation cephalosporins+ metronidazole, carbapenems were significantly lower than the fourth generation cephalosporins+ metronidazole ( OR=0.84, 0.41, 95% CI as 0.73-0.98, 0.23-0.74, P<0.05). There was no significant difference in the microbial clearance rate between the fifth generation cephalosporins+ metronidazole and carbapenems ( OR=0.76, 95% CI as 0.27-1.80, P>0.05). ③ The incidence of serious adverse drug reactions was significantly lower for the third generation cephalosporins+ metronidazole, the fourth generation cephalosporins antibiotics+ cetronidazole, the fifth generation cephalosporins+ metronidazole, carbapenems, quinolones+ metronidazole, and tigecycline than for quinolones ( OR=0.13, 0.13, 0.14, 0.13, 0.15, 0.13, 95% CI as 0.03-0.50, 0.02-0.98, 0.02-0.75, 0.02-0.59, 0.02-0.78, 0.02-0.57, P<0.05). Compared with carbapenems, the third generation cephalosporins+ metronidazole, the fourth generation cephalosporins+ metronidazole, the fifth generation cephalosporins+ metronidazole had no significant difference in the incidence of serious adverse drug reactions ( OR=0.96, 1.00, 1.10, 95% CI as 0.52-1.60, 0.31-3.50, 0.49-2.30, P>0.05). (3) Ranking of the efficacy and safety. ① The ranking list for clinical cure rates of different therapeutic regimens showed from high to low as quinolones+ metronidazole, the fourth generation cephalosporins+ metronidazole, synthetic penicillins, the second generation cephalosporins+ metronidazole, the fifth generation cephalosporins+ metronidazole, carbapenems, the third generation cephalosporins+ metronidazole, tigecycline, quinolones. The corresponding ranking probabilities of above regimens were 51.73%, 35.72%, 22.57%, 31.37%, 24.98%, 32.82%, 34.69%, 29.05%, 72.36%, respectively. ② The ranking list for microbial clearance rates of different therapeutic regimens showed from high to low as quinolones+ metronidazole, the fourth generation cephalosporins+ metronidazole, the second generation cephalosporins+ metronidazole, synthetic penicillins, the fifth generation cephalosporins+ metronidazole, carbapenems, the third generation cephalosporins+ metronidazole, tigecycline, quinolones. The corresponding ranking probabilities of above regimens were 89.62%, 77.01%, 38.60%, 20.94%, 26.26%, 26.39%, 22.22%, 20.19%, 62.55%, respectively. ③ The ranking list for incidence of serious adverse drug reactions of different therapeutic regimens showed from high to low as quinolones, quinolones+ metronidazole, the fifth generation cephalosporins+ metronidazole, carbapenems, the third generation cephalosporins+ metronidazole, tigecycline, the fourth generation cephalosporins+ metronidazole. The corresponding ranking probabilities of above regimens were 96.21%, 30.46%, 21.09%, 25.27%, 27.26%, 19.45%, 31.69%, respectively. Conclusion:In the treatment of middle- and low-risk intra-abdominal infections, it is recommended to empirically use cephalosporins+ metronidazole instead of carbapenems.

ObjectiveTo investigate the association between tumor size and prognosis of patients with hepatocellular carcinoma (HCC) after hepatectomy.MethodsClinical data of 172 patients undergoing radical hepatectomy and diagnosed as HCC by pathological examination in the First Afifliated Hospital of Xi'an Jiaotong University between December 2002 and December 2011 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 172 patients, 139 were males and 33 were females; 98 were with age≤55 years old and 74 were with age >55 years old. The receiver operating characteristic (ROC) curve of the relationship between postoperative survival time and tumor size was drawn, and the cut-off value for tumor size was determined at 5.75 cm. According to the best cut-off value, the patients were divided into the small HCC group (tumor size < 5.75 cm,n=85) and huge HCC group (tumor size≥5.75 cm,n=87). The relationship between tumor size and clinicopathologic parameters was analyzed, and the median survival time, cumulative survival rate and disease free survival rate of two groups were compared. The clinicopathologic parameters were included as the factors inlfuencing the survival and prognosis of patients, and independent risk factor analysis was performed. The relationship between tumor size and clinicopathologic parameters was analyzed using Chi-square test. Kaplan-Meier method and Log-rank test were used for survival and prognosis analysis. Cox proportional hazard model was used for univariate analysis and multivariate analysis.ResultsTumor size was associated with the preoperative AFP, number of tumors and TNM staging (χ2=13.272, 9.378, 7.311;P<0.05). The median survival time and the median recurrence time for the huge HCC group were 24 months and 9 months respectively and were 39 months and 37 months for the small HCC group. The 1-, 3-, 5-year cumulative survival rate for the huge HCC group were 65.5%, 36.0%, 22.9% respectively and were 89.5%, 76.3%, 72.5% respectively for the small HCC group. The overall survival of the huge HCC group was lower than that of small HCC group (χ2=33.644,P<0.05). The 1-, 3-, 5-year disease free survival rate for the huge HCC group were 44.7%, 25.5%, 21.9% respectively and were 84.8%, 67.8%, 66.3% respectively for the small HCC group. The disease free survival rate of huge HCC group was lower than that of small HCC group (χ2=38.908,P<0.05). Preoperative platelets count (Plt)≥155×109/L, tumor size > 5.75 cm and advanced stage of TNM were the independent risk factors inlfuencing the postoperative prognosis of HCC patients (HR=1.588, 3.066, 2.029;P<0.05).ConclusionsTumor size is the independent risk factor inlfuencing the prognosis of HCC patients after hepatectomy. The prognosis of patients with tumor size > 5.75 cm is poor.

BACKGROUNDAccumulating evidence indicates that systemic inflammation response is associated with the prognosis of various cancers. The aim of this study was to investigate the neutrophil-lymphocyte ratio (NLR), which is one of the systemic inflammation markers, in the prognosis of hepatocellular carcinoma (HCC) after treatment of transcatheter arterial chemoembolization (TACE).

METHODSThe clinical data of 178 HCC patients who received TACE were retrospectively analyzed. The optimal NLR cutoff was determined according to the receiver operating characteristic (ROC) analysis. All patients were divided into NLR-normal group and NLR-elevated group according to the cutoff, and the clinical features of these two groups were comparatively analyzed. Meanwhile, the overall survival and disease free survival (DFS) were analyzed using the Kaplan-Meier method. The risk factors of postoperative survival were investigated using univariate and multivariate Cox regression analyses.

RESULTSThe optimal NLR cutoff was defined at 1.85 and 42 (23.6%) patients had an elevated NLR (NLR>1.85). The median survival time was 9.5 months (range 1-99 months). The clinical data between the two groups were comparable, except for a-fetoprotein. Follow-up results showed that the median survival of patients with normal NLR was 17.5 months (range: 1-99 months) compared with 8 months (range: 8-68 months) of patients with elevated NLR. The 1, 3 and 5-year overall survival of patients in the NLR-normal group and NLR-elevated group were 57.3%, 44.1%, and 27.2% and 42.1%, 19.6%, and 9.5% respectively (χ(2) = 194.2, P < 0.001). Similarly, the disease free survival also has a significant difference (χ(2) = 39.3, P < 0.001). Multivariate Cox regression analysis showed that a high NLR was an independent factor affecting the survival rate of HCC after TACE (P = 0.04).

CONCLUSIONPreoperative NLR was an important prognostic factor to predict the prognosis of patients with intermediate HCC treated with TACE.

Adult ; Aged ; Carcinoma, Hepatocellular ; pathology ; therapy ; Chemoembolization, Therapeutic ; Female ; Humans ; Liver Neoplasms ; pathology ; therapy ; Lymphocytes ; metabolism ; physiology ; Male ; Middle Aged ; Neutrophils ; metabolism ; physiology

SARS-CoV-2 can cause multiple organ injuries in some susceptible people in a short time, which seriously threatens the health and safety of people, and intensive care and multiple extracorporeal organ support are important means of treatment. Although many experts’ consensus and clinical guidelines have been published, a series of clinical problemsstill exist during the treatment procedure, and no consensushas not been reached until now. Therefore,in this paper wemake some reflections and explorations to provide experience and help for clinicians.