Objective To compare the CLIP score, the JIS score, and the China staging system (CS) in the prediction of survival of patients with resectable hepatocellular carcinoma (HCC). Methods The Clinicopathologic and follow-up data of 224 patients who underwent hepatic resection for HCC from January 2000 to July 2005 were retrospectively studied. The patient distribution and the survival curve of each staging system were used to compare the ability to stratify and to discriminate prognosis. The likelihood ratio, chi-square test and the linear trend chi-square test were used to compare the homogeneity and the monotonicity of the relationship between stage and mortality rate of each staging system. The increase in the -2 log likelihood statistic on removal of any one staging system was in turn used as a means of ranking the individual staging systems according to their importance within the regression model. The statistical package used was SPSS version 16. 0 and Stata SE version 8.0. Results Based on the China staging system, the percentages of patients categorized as Ⅰa, Ⅰ b, Ⅱa,Ⅱb and Ⅲ a were 14. 3%, 17.4%, 21.9%, 31.7% and 14. 7% respectively, showing excellent stratification ability. However, nearly 81. 6% of the patients were classified as a CLIP score of 0-2, which showed poor stratification ability, and only 3. 1 % of the patients were classified as score 0 category of the JIS scoring system. In the follow-up period, the log-rank test and the corresponding Kaplan-Meier survival curves confirmed each staging system to be able to differentiate patient survival in the different stages. Individual pairwise comparisons revealed inconsistencies across the different staging systems. In particular, using the log-rank test, the JIS scoring system and the China staging system showed significant differences in patient survival on all pairwise comparisons. By contrast, the CLIP scoring system failed to differentiate significantly between score 2 and score 3 patients. The JIS scoring system could identify the best prognostic group who would benefit from curative and aggressive treatments, whereas the discriminatory value of the CLIP score was noted in the intermediate- and advanced-phase HCC patients. The China staging system was shown to have the best homogeneity, overall discriminatory capacity and monotonicity of gradient. The change in the -2 log likelihood statistic on removal of any staging system revealed that for this cohort of patients, the appropriate importance in the ranking of the independent contribution of each factor to the regression model was: CS> CLIP>JIS. Conclusion Among three clinical staging systems, the China staging system had the highest prognostic value, with better stratification and higher discriminatory capacity than the CLIP scoring system and the JIS scoring system for this cohort of patients who received partial hepatectomy for HCC. The CLIP scoring system performed better in identifying the worst prognostic patients.

Objective To investigate the effects of remote limb ischemic preconditioning (RLIP) on the lung injury in patients undergoing abdominal aortic aneurysm repair.Methods Sixty-two ASA Ⅱ or Ⅲ patients of both sexes,aged 54-72 yr,with body mass index 21-36 kg/m2,undergoing elective abdominal aortic aneurysm repair,were randomly divided to 2 groups ( n =31 each):control group (group C) and RLIP group.RLIP consisted of two 5-min cycles of left upper limb ischemia induced by a blood pressure cuff placed on the left upper arm and inflated to 200 mm Hg,with an intervening 5 min of reperfusion,during which time the cuff was deflated.RLIP was performed after anesthesia induction and before the start of surgery.Arterial and venous blood samples were taken at 10 min after intubation (T0),and 30 min and 4,8,12 and 24 h after aortic unclamping (T1-5) for blood gas analysis and determination of the concentrations of serum interleukin (IL)-6,tumor necrosis factor (TNF)-α,and plasma malondialdehyde (MDA) and superoxide dismutase (SOD) activity.The alveolar-arterial oxygen pressure difference (PA-aO2 ) and respiratory index (RI) were calculated.The peak airway pressure (Ppeak),plat airway pressure (Pplat) and positive end expiratory pressure (PEEP) were recorded at the same time points mentioned above to calculate dynamic lung compliance (Cd) and static lung compliance (Cs).The incidence of hypoxemia,extubation time and duration of stay in intensive care unit (IGU) were also recorded.Results Compared with group C,PA-aO2,RI and the concentration of IL-6 were significantly decreased at T3-5,Cs,Cd and SOD activity were significantly increased at T2-5,and the concentrations of TNF-α and MDA were significantly decreased at T2-5 in group RLIP ( P ＜ 0.05).Compared with group C,the incidence of hypoxemia was significantly decreased,and extubation time and duration of stay in ICU were significantly shortened in group RLIP ( P ＜ 0.05).Conclusion RLIP can reduce the lung injury through inhibition of the inflammatory response and lipid peroxidation in patients undergoing abdominal aortic aneurysm repair.

Adult ; Aged ; Capsid Proteins ; metabolism ; Carcinoma, Squamous Cell ; metabolism ; pathology ; Cervical Intraepithelial Neoplasia ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Oncogene Proteins, Viral ; metabolism ; Uterine Cervical Neoplasms ; metabolism ; pathology ; Uterine Cervicitis ; metabolism ; pathology ; Young Adult

OBJECTIVETo observe the effects of Danlou Tablet (DT) on inflammatory reaction, and expressions of lipoprotein-associated phospholipase A2 (LP-PLA2), secretory phospholipase A2 (sPLA2), and to analyze potential mechanisms.

METHODSForty male Wistar rats were randomly and equally divided into five groups, i.e., the normal control group, the model group, the Western medicine (WM) group, the low dose DT group, the high dose DT group, 8 in each group. Rats in the normal control group were fed with basic forage for 12 successive weeks, while AS rat model was established in rats of the other four groups by feeding high fat and sugar forage plus intraperitoneal injection of vitamin D₃. Normal saline, atorvastatin calcium suspension (at the daily dose of 1.8 mg/kg), low dose DT suspension (at the daily dose of 450 mg/kg), and high dose DT suspension (at the daily dose of 900 mg/kg) were administered to rats in the model group, the WM group, the low dose DT group, the high dose DT group respectively by gastragavage for 8 successive weeks. The general condition of all rats was observed. Rats were sacrificed after gastric administration and their serum collected. Serum levels of lipids (TC, TG, HDL-C, LDL-C) and inflammatory factors [IL-6, TNF-α, monocyte chemoattractant protein 1 (MCP-1), oxidized low-density lipoprotein (ox-LDL), lipoprotein-associated phospholipase A2 (LP-PLA2), secretory phospholipase A2 (sPLA2)] were detected. Pathological changes of thoracic aorta were observed by HE staining. Protein and gene expressions of LP-PLA2 and sPLA2 in thoracic aorta were measured by Western blot and real-time fluorescent quantitative PCR respectively.

RESULTSCompared with the normal control group, rats in the model group were in low spirits and responded poorly. Typical atherosclerotic plaque could be seen in thoracic aorta of rats in the model group. Serum levels of TC, TG, LDL-C, IL-6, TNF-α, MCP-1, ox-LDL, LP-PLA2, and sPLA2 significantly increased (P < 0.05); protein and gene expressions of LP-PLA2 and sPLA2 in rat thoracic aorta increased (P < 0.05) in the model group. After 8 weeks of intervention, rats in 3 medication groups appeared active, and HE staining showed subsidence of plaque in rat thoracic aorta. Compared with the model group, serum levels of TC, TG, LDL-C, IL-6, TNF-α, MCP-1, ox-LDL, and LP-PLA2 decreased in 3 medication groups (P < 0.01, P < 0.05); serum sPLA2 level decreased, protein and mRNA expressions of LP-PLA2 and sPLA2 in rat thoracic aorta decreased in the WM group (P < 0.01, P < 0.05); protein and mRNA expressions of LP-PLA2 in rat thoracic aorta significantly decreased in the low dose DT group (P < 0.01, P < 0.05), and those of LP-PLA2 and sPLA2 decreased in the high dose DT group (P < 0.01, P < 0.05).

CONCLUSIONDT could fight against inflammatory reaction and AS possibly through inhibiting LP-PLA2 expression and reducing ox-LDL production.

1-Alkyl-2-acetylglycerophosphocholine Esterase ; blood ; Animals ; Aorta, Thoracic ; pathology ; Atherosclerosis ; drug therapy ; Chemokine CCL2 ; blood ; Drugs, Chinese Herbal ; pharmacology ; Inflammation ; drug therapy ; Interleukin-6 ; blood ; Lipids ; blood ; Lipoproteins, LDL ; blood ; Male ; Phospholipases A2 ; blood ; Plaque, Atherosclerotic ; Random Allocation ; Rats ; Rats, Wistar ; Tablets ; Tumor Necrosis Factor-alpha ; blood

To reduce the risk of 3′-terminal mismatch between primers and template and increase the sensitivity of polymerase chain reaction (PCR) in the detection of variable region of DNA. Methods: A pair of special primer(WU,WD) was designed to amplify a fragment of HBV DNA P gene by PCR. Other 2 similar pairs of primer (MU1, MD1, MU2, MD2) were obtained by knocking off 1 or 2 bases at the 3′-terminal of WU and WD. (1) Special primers (WU, WD) and degeneracy primers(WU, WD, MU1, MU2, MD1, MD2) were used to amplify 27 samples respectively by PCR under the same condition. The sensitivity of each PCR was compared. (2) Using degeneracy primers, serum HBV DNA was amplified from 4 patients who were resistant to lamivudine. The PCR products were sequenced to evaluate the effect of the 3′-terminal mismatch of primers upon PCR. Results: (1) The sensitivity of special primers and degeneracy primers were 70.4%(19/27) and 85.2%(23/27) respectively (P<0.05). (2) The sequencing analysis of the PCR products suggested that the 3′-terminal mismatch of primers caused false negative in the PCR detection. Conclusion: When amplifying the variable region of DNA, the false negative result can be avoided by using 3′-terminus shifted degeneracy primers.

Due to the need of the diagnosis and minimally invasive treatment of biliary tract diseases, peroral choledochoscopy has recently become an important method for the diagnosis and treatment of biliary tract diseases, which helps to avoid some invasive and unnecessary surgical procedures. This article introduces the clinical advantages of SpyGlassTM DS Direct Visualization System and its indications and possible complications in biliary duct diseases. SpyGlassTM DS provides endoscopic imaging of the biliary tree and can perform biopsy under direct view, and thus it plays an important role in the diagnosis and treatment of biliary tract diseases. In particular, it can improve the diagnostic accuracy of biliary stricture with unknown nature and the surgical success rate and stone clearance rate of complex bile duct stones, with similar incidence rates of complications as conventional endoscopic retrograde cholangiopancreatography. SpyGlassTM DS is a safe and effective procedure and supplements the standard endoscopic diagnosis and treatment.

Objective To evaluate the feasibility and efficacy of endoscopic push?radial dissection (EPRD)for benign esophageal stricture(BES). Methods Clinical data of 24 patients diagnosed as having BES who received EPRD were analyzed. The procedure and efficacy were evaluated. Results All 24 patients underwent EPRD successfully with mean operation time being 32 min(15?45 min).The mean esophageal stric?ture incision length was 3?? 2 cm (1?? 0?8?? 0 cm).No severe complications related to EPRD occurred, or trans?ferred for surgery. Patients were followed up for 1?5 months (mean 2?? 8 months). Dysphagia was relieved signif?icantly during the follow?up in 23 patients where endoscopy could go through smoothly. But dysphagia re?oc?curred in one patient 2 weeks after the operation, who underwent a second EPRD and stent implantation, then dysphagia was relieved. Conclusion EPRD is safe, feasible and effective for benign esophageal stricture.

Objective To investigate drug resistance genes and epidemic characteristics of β-lactamase carried by carbapenem-resistant Acinetobacter baumannii (CRAB) in the respiratory intensive care unit(RICU) in a hospital.Methods Clinically isolated CRAB from RICU patients in October-December 2015 were collected.Five drug resistance genes (KPC-2,IMP,VIM,NDM-1,OXA-23) were specifically amplified by polymerase chain reaction (PCR),amplified products were performed agarose gel electrophoresis and sequencing analysis,the homology was analyzed with pulsed-field gel electrophoresis (PFGE).Results A total of 22 CRAB strains were isolated in October-December 2015,19 (86.36％) of which were isolated from sputum.The resistance rate of 22 CRAB strains to compound sulfamethoxazole was 59.09 ％,resistance rate to minocycline was 9.09 ％,all were sensitive to polymyxin B,resistance rates to other antimicrobial agents were more than 80％.Three kinds of resistance genes KPC-2,IMP and NDM-1 were not found by PCR amplification,positive rates of VIM and OXA-23 were both 100％.PFGE homology analysis revealed that 22 strains were divided into 13 different types,each type contained 1-5 strains,9 types(69.23％) contained only 1 strain respectively,the other 4 types (30.77％) contained 2-5 strains.A5,A7,and A8;A9,A11,A14,A19 and A22;A4,A10 and A12;A16 and A18 were of the same type respectively.Conclusion The main types of β-lactamase-resistant genes of CRAB in RICU are VIM and OXA-23.Homology analysis shows a small parts are of the same clone strains,which reveals epidemic of a small scale.

Objective:To investigate the risk factors for common bile duct calculi recurrence and application value of its prediction model after endoscopic retrograde cholangiopancreato-graphy (ERCP) .Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 506 patients with common bile duct calculi who were admitted to the First Hospital of Lanzhou University from January 2015 to December 2017 for ERCP routine treatment were collected. There were 251 males and 255 females, aged (59±15)years. Patients received ERCP for common bile duct calculi. Observation indicators: (1) clinicopathological data of patients with common bile duct calculi; (2) risk factors for common bile duct calculi recurrence after ERCP; (3) establishment of prediction model for common bile duct calculi recurrence after ERCP. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate and multivariate analysis were conducted using the COX proportional hazard model. The prediction model for the recurrence of common bile duct stones after ERCP was established according to the coefficient of regression equation. The receiver operating characteristic curve(ROC) was drawed for efficiency evaluation with area under curve (AUC). Results:(1) Clinicopathological data of patients with common bile duct calculi: 104 of 506 patients with common bile duct calculi had recurrence and 402 had no recurrence. There were significant differences in the age, hyperlipidemia, common bile duct diameter, distal bile duct stricture, the number of calculi, gallbladder status, history of biliary tract surgery, endoscopic spinecterotomy, postoperative drainage mode between patients with and without recurrence ( Z=?2.844, χ2=6.243, Z=?2.897, χ2=11.631, 4.617, 16.589, 18.679, 2.070, 50.274, P<0.05). (2) Risk factors for common bile duct calculi recurrence after ERCP: Results of univariate analysis showed that age, time of first attack, hyperlipidemia, common bile duct diameter, distal bile duct stricture, the number of calculi, the maximum calculi diameter, gallbladder status, history of biliary tract surgery and postoperative biliary drainage mode were related factors for common bile duct calculi recurrence after ERCP ( hazard ratio=1.656, 2.179, 1.712, 1.657, 2.497, 1.509, 1.971, 2.635, 3.649,95% confidence interval as 1.113?2.463, 1.135?4.184, 1.122?2.644, 1.030?2.663, 1.501?4.154, 1.025?2.220, 1.122?3.464, 1.645?4.221, 1.575?8.456, P<0.05). Results of multivariate analysis showed that time of first attack <30 days, hyperlipidemia, distal bile duct stricture, history of biliary tract surgery and postoperative biliary drainage mode as cholangiopancreatic stent were independent risk factors for common bile duct calculi recurrence after ERCP ( hazard ratio=2.332, 1.676, 2.088, 2.566, 3.712, 95% confidence interval as 1.089?4.998, 1.060?2.649, 1.189?3.668, 1.456?4.521, 1.296?10.635, P<0.05). (3) Establishment of prediction model for common bile duct calculi recurrence after ERCP: based on multivariate analysis, indicators including time of first attack <30 days, hyperlipidemia, distal bile duct stricture, history of biliary tract surgery and postoperative biliary drainage mode as cholangiopancreatic stent were included into the coefficient of regression equation, and the prediction model for common bile duct calculi recurrence after ERCP was established: ln[(λ(t))/(λ 0(t))]=0.847×time of first attack+0.516×hyperlipidemia+0.736×distal bile duct stricture+0.942×history of biliary tract surgery+1.312×cholangiopancreatic stent. The perfor-mance evaluation showed that the AUC of ROC of prediction model was 0.757 (95% confidence interval as 0.713?0.811, P<0.05), and the optimal cut-off value was 1.41, the sensitivity and specificity were 69.2% and 72.9% respectively. Conclusions:The time of first attack <30 days, hyperlipidemia, distal bile duct stricture, history of biliary tract surgery and postoperative biliary drainage mode as cholangiopancreatic stent are independent risk factors for common bile duct calculi recurrence after ERCP. Patients with evaluation score >1.41 in prediction model were at high risk for common bile duct calculi recurrence after ERCP.

The behavioral responses of a tilapia (Oreochromis niloticus) school to low (0.13 mg/L), moderate (0.79 mg/L) and high (2.65 mg/L) levels of unionized ammonia (UIA) concentration were monitored using a computer vision system. The swimming activity and geometrical parameters such as location of the gravity center and distribution of the fish school were calculated continuously. These behavioral parameters of tilapia school responded sensitively to moderate and high UIA concentration. Under high UIA concentration the fish activity showed a significant increase (P<0.05), exhibiting an avoidance reaction to high ammonia condition, and then decreased gradually. Under moderate and high UIA concentration the school's vertical location had significantly large fluctuation (P<0.05) with the school moving up to the water surface then down to the bottom of the aquarium alternately and tending to crowd together. After several hours' exposure to high UIA level, the school finally stayed at the aquarium bottom. These observations indicate that alterations in fish behavior under acute stress can provide important information useful in predicting the stress.
Ammonia ; administration & dosage ; Animals ; Artificial Intelligence ; Behavior, Animal ; drug effects ; physiology ; Dose-Response Relationship, Drug ; Exercise Test ; methods ; Image Interpretation, Computer-Assisted ; methods ; Social Behavior ; Swimming ; physiology ; Tilapia ; physiology