Adult ; Aged ; Female ; Hepatitis B e Antigens ; blood ; Hepatitis B, Chronic ; blood ; drug therapy ; Humans ; Male ; Middle Aged ; Thymidine ; analogs & derivatives ; therapeutic use ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the correlation between human neutrophil peptide (HNP) and spontaneous bacterial peritonitis (SBP) in order to assess the diagnostic value of quantitative measurement of these alpha-defensins.

METHODSSeventy-seven patients with cirrhosis and ascites were divided into two groups according to diagnosis of SBP (n = 45 with SBP and n = 32 without SBP). Twenty-eight healthy individuals were analyzed as controls. HNP was detected by double-antibody sandwich assay. Peripheral white blood cell (WBC) counts, neutrophil ratio, and levels of procalcitonin (PCT) and C-reactive protein (CRP) were determined by standard methods. Receiver operating characteristic (ROC) curves were used to compare the diagnostic values of HNP, PCT and CRP in SBP.

RESULTSThere were no significant differences between the three groups (SBP, non-SBP, and healthy controls) for WBC count ((6.01+/-2.25)*109 /L, (4.85+/-1.94)*109 /L, and (5.49+/-1.76)*109 /L; F = 2.91, P more than 0.05) and neutrophil ratio (70.70%+/-10.42%, (68.20%+/-8.97%, and 69.50%+/-8.69%; F = 3.07, P more than 0.05). However, compared to the non-SBP group and the healthy controls, the SBP group showed significantly higher levels of HNP ((9.99+/-3.33) ng/ml and (8.92+/-2.30) ng/ml vs. (17.66+/-6.40) ng/ml; q = 3.20 vs. 3.52, P less than 0.05), serum CRP ((15.08+/-9.95) ng/ml and (5.96+/-2.91) ng/ml vs. (31.32+/-18.65) mg/L; q = 11.03 vs. 3.69, P less than 0.05), and positive rate of PCT (25.0% and 10.0% vs. 62.2%; X2 = 10.41 vs. 15.40, P less than 0.0125). The areas under the curve (AUC) showed the following descending trend: HNP more than PCT more than CRP (0.719, 0.707, and 0.629 respectively). Using cut-off points of 10 ng/ml for HNP, 0.5 ng/ml for PCT, and 8 mg/L for CRP, the respective sensitivities for diagnosis of SBP were 71.1%, 62.2%, and 73.3%, the respective specificities were 71.9%, 75.0%, and 56.3%, and the respective Youden's indexes were 0.430, 0.372, and 0.296.

CONCLUSIONHNP is closely related to SBP and can diagnose SBP as reliably as PCT. CRP may help to diagnose SBP, but the results from routine blood testing did not show sufficient statistical significance for diagnosing SBP.

Adult ; Aged ; Bacterial Infections ; blood ; diagnosis ; C-Reactive Protein ; metabolism ; Calcitonin ; blood ; Calcitonin Gene-Related Peptide ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Peritonitis ; blood ; diagnosis ; microbiology ; Protein Precursors ; blood ; alpha-Defensins ; blood

BACKGROUNDTo evaluate the efficacy of alpha-2b interferon alone or combined with alpha1-thymosin in treatment of patients with chronic hepatitis B (CHB) resistant to lamivudine.

METHODSSixty six patients with CHB resistant to lamivudine were enrolled and randomized into treatment group A, treatment group B and control group. In the treatment group A 26 cases, after giving interferon-alpha alone for 1 month, lamivudine was withdrawn and continuously treated with interferon-alpha for 5 months. In the treatment group B 10 cases, after treatment with interferon-alpha and thymosin-alpha1 for 1 month, lamivudine was withdrawn and continuously treated with interferon-alpha and thymosin-alpha1 for 5 months. In control group (30 cases), after lamivudine was directly withdrawn, no anti-virus drug was given. Hepatic function tests and serum virological index were detected at regular intervals in all patients.

RESULTSNormalization rate of hepatic function, HBV DNA seroconversion rate and HBeAg/HBeAb seroconversion rate in two treatment groups were significantly higher than those in control group.

CONCLUSIONThe study suggested that interferon-alpha alone or combined with thymosin-alpha1 in treatment of patients with chronic hepatitis B resistant to lamivudine showed a beneficial effect.

Adolescent ; Adult ; Antiviral Agents ; therapeutic use ; DNA, Viral ; blood ; genetics ; Drug Resistance, Viral ; Drug Therapy, Combination ; Female ; Hepatitis B Antibodies ; blood ; Hepatitis B e Antigens ; immunology ; Hepatitis B virus ; drug effects ; genetics ; immunology ; Hepatitis B, Chronic ; drug therapy ; virology ; Humans ; Interferon-alpha ; therapeutic use ; Lamivudine ; pharmacology ; therapeutic use ; Male ; Middle Aged ; Recombinant Proteins ; Thymosin ; therapeutic use ; Treatment Outcome

Objective To investigate the clinical efficacy of laparoscopy-assisted radical gastrectomy for gastric cancer.Methods The retrospective cohort study was adopted.The clinical data of 210 patients with gastric cancer who underwent laparoscopy-assisted radical gastrectomy at the Peking University Cancer Hospital between May 2009 and December 2012 were collected.Fifty-two,43 and 115 patients were respectively detected in stage Ⅰ,Ⅱ and Ⅲ of postoperative pathological stage.Laparoscopy-assisted radical distal,proximal and total gastrectomies were selectively performed according to the location and extent of tumors.(1) Overall treatment indicators were observed,including surgical procedure,with or without conversion to open surgery,operation time,volumes of intraoperative blood loss and transfusion,number of lymph node dissected,time to anal exsufflation,duration of hospital stay,occurrence of complications,radical degree of tumors of pathological examination.(2) Other indicators were observed,including pathological features of patients in stage Ⅰ,Ⅱ and Ⅲ [gender,age,body mass index (BMI),scores of American Society of Anesthesiologists (ASA),medicinal complication,location of tumors,degree of tumor differentiation and with or without vascular tumor thrombi],intraoperative and postoperative situations (surgical procedure,conversion to open surgery,operation time,volumes of intraoperative blood loss and transfusion,number of lymph node dissected,time to anal exsufflation,duration of hospital stay and radical degree of tumors),postoperative complications,reoperation,death within postoperative day 30 and during follow-up,3-and 5-year survival rates.(3) Evaluation criteria:stages and classification of tumors were evaluated according to the tumor node metastasis (TNM) classification of malignant tumours (Seventh Edition) published by American Joint Committee on Cancer (AJCC) and Union for International Cancer Control (UICC).Severity of complications was evaluated according to Clavien-Dindo classification.Patients were followed up by outpatient examination,telephone interview and correspondence once every half a year up to December 31,2015,abdominal / pelvic CT,chest X-ray and blood test were performed once every half a year within 2 years and once every year within 2-5 years postoperatively,and gastroscopy was performed once every year.Overall survival time was counted from operation date to end of follow-up or time of death.Measurement data with normal distribution were presented as x ± s and comparison between groups was analyzed using the ANOVA.Measurement data with skewed distribution were presented as M (range) and comparison between groups was analyzed using nonparametric test.Comparisons of count data were analyzed using the chisquare test.Survival curve was drawn by the Kaplan-Meier method,and survival analysis was done using the Logrank test.Results (1) Overall treatment:all the 210 patients underwent successful radical gastrectomy,including 100 undergoing distal gastrectomy,35 undergoing proximal gastrectomy and 75 undergoing total gastrectomy.There were 198 patients undergoing radical gastrectomy and 12 patients converted to open surgery.Operation time,volume of intraoperative blood loss,number of patients with blood transfusion and number of lymph node dissected were (258 ± 54) minutes,(103 ± 86) mL,19 and 29 ± 12,respectively.Postoperative recovery:time to anal exsufflation and duration of hospital stay were (3.8 ± 0.9) days and (17 ± 7) days.Fortyfive patients had postoperative complications and 2 were dead within 30 days postoperatively.R0 and R1 resections were respectively applied to 209 and 1 patients.(2) Comparisons among the patients with the different pathological stage:numbers of patients in stage Ⅰ,Ⅱ and Ⅲ were 9,17 and 36 with tumor located in the upper stomach,3,9 and 22 with tumor located in the middle stomach,40,16 and 47 with tumor located in the lower stomach,0,1 and 10 with tumor located in the cross-region stomach,30,23 and 23 in G1 and G2 of tumor differentiation,21,19 and 92 in G3 and G4 of tumor differentiation,7,13 and 69 with vascular tumor thrombi,respectively,with significant differences in above indicators among the patients in stage Ⅰ,Ⅱ and Ⅲ (x2 =25.990,32.928,35.027,P ＜ 0.05).(3) Intra-and post-operative comparisons among the patients with the different pathological stage:numbers of patients in stage Ⅰ,Ⅱ and Ⅲl were respectively 40,20 and 40 with distal gastrectomy,3,8 and 24 with proximal gastrectomy,9,15 and 51 with total gastrectomy,and number of lymph node dissected were 26 ± 9,29 ± 13 and 31 ± 12 in patients with stage Ⅰ,Ⅱ and Ⅲ,showing significant differences in above indicators among the patients in stage Ⅰ,Ⅱ and Ⅲ (x2 =25.730,F =4.336,P ＜ 0.05).(4) Numbers of patients with postoperative overall complications were 11,8 and 26 in stage Ⅰ,Ⅱ and Ⅲ,showing no significant difference (x2 =0.301,P ＞ 0.05).(5) Of 210 patients,203 were followed up for a median time of 43 months (range,1-80 months) with a follow-up rate of 96.67％ (203/210).Sixty-eight patients were dead till the end of follow-up,including 60 died of recurrence of tumor,2 died of surgical complications and 6 died of other causes.Postoperative 3-,5-year overall survival rates were 96.1％,87.8％,62.4％ and 92.9％,77.5％,52.7％ in patients with stage Ⅰ,Ⅱ and Ⅲ,respectively,with a significant difference (x2 =29.071,P ＜ 0.05).Conclusion Laparoscopy-assisted radical gastrectomy for advanced gastric cancer is at least equivalent to early gastric cancer in the safety,with the satisfactory long-term outcomes.

Objective:To explore the clinicopathological factors in node-negative colon cancer patients with synchronous liver metasta-ses and to improve the efficiency of follow-up and rate of early diagnosis for high-risk patients. Methods:Clinical data of 140 colon cancer patients who underwent operation from January 2008 to December 2012 in Beijing Cancer Hospital were analyzed. The high-risk variables associated with synchronous liver metastases were subjected to univariate and multivariate analyses. Results:Synchro-nous liver metastases developed in 13 out of the 140 node-negative colon cancer patients. Eight out of those 13 patients (61.5%) ex-hibited complications with incomplete colon obstruction, and 6 cases underwent surgical treatment for both primary tumor and liver metastases. Both univariate and multivariate analyses revealed that preoperative abnormal serum carcinoembryonic antigen levels (≥5 ng/mL) and vascular invasion were significant independent risk factors for synchronous liver metastases. Conclusion:The risk of syn-chronous liver metastases for colon cancer patients with negative lymph node is slightly high. Vascular invasion and abnormal preoper-ative CEA levels are significant independent risk factors for synchronous liver metastases. Specific examination of livers is necessary for the special cohort at the time of diagnosis or after operation to avoid misdiagnosis.

Objective: This study aimed to compare the short- and long-term outcomes of laparoscopy-assisted radical gastrectomy between elderly and non-elderly patients with gastric cancer. Methods: A total of 219 patients who underwent laparoscopy-assisted radical gastrectomy in the Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute from April 2009 to October 2013 were included in this retrospective study. All patients were divided into elderly (≥65 years) and non- elderly (<65 years)groups. We compared these groups based on clinicopathological characteristics, postoperative morbidities, and survival. Results:Theelderly group showed higher ASA scores and higher number of preoperative comorbidities (P<0.05). The operative time, blood loss,and conversion rate did not differ significantly between the groups (all P>0.05). The mean time to first ambulation in elderly group was 2.2±2.3d while first ambulation time in the non-elderly group was 1.4±1.3d,which showed significant difference between the two groups (P<0.05). No significant differences were observed between groups in terms of postoperativemorbidities (34.8％ vs. 28.5％, P> 0.05) as well as 3-year disease-free survival and overall survival (P>0.05). However, the elderly patients withpostoperative morbidities experienced significantly poorer overall survival rate than non-elderly patients (44.5％ vs. 70.5％, P<0.05). Conclusion: Laparoscopy-assisted gastrectomy can be safely and successfully performed in an elderly population with acceptable short- and long-term outcomes.Enhanced perioperative treatment is necessary to improve postoperative outcomes.

Adult ; Biomarkers ; blood ; Case-Control Studies ; Female ; Granzymes ; blood ; Hepatitis B ; blood ; immunology ; Humans ; Male ; Middle Aged ; Perforin ; blood ; T-Lymphocytes, Cytotoxic ; metabolism

Objective:To investigate whether increased levels of preoperative carcinoembryonic antigen (CEA) and CA199 were associated with the mortality of patients with advanced colorectal cancer and to determine whether CA199 can be used to discriminate patients with normal preoperative CEA level from good to poor prognosis. Methods:A total of 314 patients with advanced colorectal cancer cases who underwent primary tumor resection were collected from 2014 to 2016 at Peking University Cancer Hospital and Institute. Preoperative CEA and CA199 serum levels were examined using electrochemiluminescence immunoassay. The association of CEA and CA199 with clinicopathologic features and their possible prognostic values were analyzed. Results:In the tested patients, 5.4%of whom had increased CA199 level but not up-regulated CEA level, whereas 28.3%only had increased CEA level, and 21.3%had both CEA and CA199 levels increased. Kaplan-Meier survival curves indicated that patients with elevated preoperative CEA level had worse disease-free survival (DFS) and overall survival (OS) than those with normal CEA (P<0.001 and P<0.001, respectively). Meanwhile, patients with elevated CA199 level had worse DFS and OS than those with normal CA199 (P<0.001 and P<0.001, respectively). Preoperative CA199 level could be used in discriminating patients with normal CEA from good to poor prognosis (P=0.012). Multivariate analysis revealed that elevated CA199 level was an independent prognostic factor for OS in patients with advanced colorectal cancer (HR=2.025, 95%CI=1.331-3.082, P=0.001). Conclusion:Combined detection of preoperative CEA and CA199 can be used in evaluating the prognosis of patients with advanced colorectal cancer. Preoperative serum CA199 level can be used in evaluating the prognosis of patients with colorectal cancer without an increase in CEA level. Patients with increased CA199 level had worse 5-year survival than those with increased CEA level.

OBJECTIVETo study the safety and feasibility of transorally inserted anvil (OrVil(TM)) in laparoscopic-assisted radical resection for Siewert type II adenocarcinoma of the esophagogastric junction (AEG).

METHODSClinical data (operative time, rate of thoracotomy, residual cancer in the proximal margin, and postoperative recovery) of 72 patients suffered from Siewert type II AEG were analyzed retrospectively, including 46 cases of applying OrVil(TM) in digestive tract reconstruction for laparoscopic-assisted radical resection and 26 cases of applying pouch clamp embedding anvil, between May 2009 and August 2012 in Department of Minimally Invasive Gastrointestinal Surgery at the Peking University Cancer Hospital and Institute.

RESULTSThe length between proximal margin and superior border of tumor was (2.5±1.5) cm in OrVil(TM) group, significantly longer than that in the traditional group [(1.6±1.1) cm, P<0.01]. Moreover, the intraoperative frozen pathological positive incidence of cancer remnant was 2.2% (1/46), and rate of thoracotomy was 0, both of which were significantly lower as compared to the traditional group [23.1% (6/26) and 15.4% (4/26) respectively, both P<0.01]. However, intraoperative blood loss and postoperative complications did not differ between the two groups (both P>0.05).

CONCLUSIONSAs for laparoscopic-assisted Siewert type II AEG radical resection, application of OrVil(TM) in digestive tract reconstruction is a safe surgical procedure, and can effectively reduce the rate of intra-operative thoracotomy, which is beneficial to postoperative recovery.

Adenocarcinoma ; surgery ; Aged ; Esophageal Neoplasms ; surgery ; Esophagogastric Junction ; Female ; Gastrectomy ; methods ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; surgery

OBJECTIVETo investigate the application and short-term efficacy of laparoscopic complete mesocolic excision in right colectomy.

METHODSThe data of continuous 70 cases of ascending colon cancer enrolled in the Peking University Cancer Hospital and Institute between April, 2009 and November, 2011 were analyzed retrospectively.

RESULTSA total of 65 cases received laparoscopic CME procedure and were enrolled in the final analysis. The median number of lymph nodes retrieved was 24, the median operation time was 185 min, the median blood loss was 50 ml. The overall postoperative complication rate was 9.2%(6/65), and the median time of first flatus and post-operative hospital stay was 3 days and 7 days respectively. The median 30-day hospital readmission and postoperative death were not found. The 2-years overall survival rate and disease-free survival rate were 98.5% and 83.1% respectively.

CONCLUSIONSLaparoscopic complete mesocolic excision in right colectomy is feasible and do not give patients extra burden. The short-term follow up reveals good efficacy.

Colectomy ; Colon, Ascending ; surgery ; Colonic Neoplasms ; surgery ; Disease-Free Survival ; Humans ; Laparoscopy ; Lymph Nodes ; Operative Time ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Survival Rate