Objective To define a parameter of autologous arteriovenous fistula stenosis that limits the fistula function for hemodialysis in our country.Methods Retrospectively study the doppler ultrasound of patients who accepted the percutaneous transluminal angioplasty (PTA) therapy due to autogenous arteriovenous fistula dysfunction;identify the least diameter of the fistula vein and compare it with the corresponding data of well-functioned fistula.Determine which absolute diameter constitutes a hemodynamically significant stenosis in a radioeephalic autologous arteriovenous fistula by receiver operating characteristic curve (ROC curve).Result Forty-two patients were enrolled in the study.The average age of those patients was 54.63±2.44 years old.Twenty-one patients were female.Twenty-six fistula located on the left arm.The minimal diameter of the dysfunction fistula averaged 1.57±0.07 mm,while the average forearm fistula vein diameter was 4.04±0.23 mm,significantly smaller than those in the compare group-an average minimal fistula vein diameter of 3.34±0.11 mm and a forearm vein diameter of 5.36(4.52,6.45) mm (P ＜ 0.05).The control group contained sixty-eight patients.The average age of those patients was 52.56±2.00 years old.Thirty-one patients were female.Forty-nine fistula located on the left arm.It was quiet appropriate in using minimal diameter of the fistula vein to indicate the dysfunction istula with an under-curve area of 0.979,95％C1 0.959-0.998.The under-curve area would be at the largest level when meeting the cutoff point at 2.40mm,in which it could achieve the area of 0.853.Conclusions The minimal diameter of the dysfunction wrist autogenous arteriovenous fistula was much smaller than the functioned ones.Minimal diameter of the fistula vein may serve as an effective parameter in detecting dysfunction fistula.

Objective To finding out the characters of vascular remolding after the establishment of native arteriovenous fistula on the wrist,and exploring the influential factors.Methods Doppler ultrasound was used to monitor the diameter of cephalic vein,brachial artery,radial artery and ulnar artery at the time before the surgery and one day,one week,two weeks,four weeks and eight weeks after the surgery respectively.The tendency of the diameter change was analyzed.Results Twenty eight patients completed the whole monitor session,in which eleven were female.The average age of those patients was (53.68 ± 2.61) years old.Twelve of them were diabetic nephropathy.The diameters of all vessel were increased more rapidly at the first day than any other days after surgery(all P ＜ 0.01).The patients were divided into two groups depending on whether diabetic nephropathy.No significant difference was found between the two groups on the tendency of diameter change in cephalic vein and brachial artery (all P ＞ 0.05).However,the tendency of diameter change in radial artery and ulnar artery was statistically significant difference between the two groups (all P ＜ 0.05).Conclusions Cephalic vein,brachial artery,radial artery and ulnar artery are all apparently dilated on the first day after the surgery.The vascular dilation and diameter increasing become much slower after the period,the diameter tend to be stable.The primary diseases may affect the tendency of the diameter change in radial artery as well as ulnar artery.

Object To investigate the maturity status of the cephalic vein when the native arteriovenous fistula matures and set up indicators of a matured native arteriovenous fistula.Methods The diameter,flow rate and wall thickness of the cephalic vein were prospectively measured by Doppler ultrasound after the native fistula was created.Mature judgment was done by skilled nurses depending on their experience before the fistula was punctured.The ultrasound data was marked as proposed mature at the same time.After three times dialysis,if blood flow was fluent and complications such as prolonged bleeding time and hematoma were absent,fistula mature was confirmed.Results Thirty-one patients were admitted to the study,then fistula were matured.The average age of those patients was (52.93±3.21) years old.Thirteen patients were female.Twenty two fistula located on the left arm.Thirteen of the patients were diabetic nephropathy.The average diameter of cephalic vein was increased from (3.10±0.11) mm before surgery to (4.74±0.16) mm when the fistula was matured,though it was still smaller than 6 mm which K/DOQI guideline had recommended (P ＜ 0.05).The average mature period was (57.10±3.21) days.The matured fistula had an average high flow rate of (569.76±48.34) ml/min and wall thickness of (0.95±0.04) mm.The one-side 95％ credibility interval of the diameter,flow rate and wall thickness of cephalic vein was 4.44 mm,486.37 ml/min and 0.67 mm,respectively.Conclusions The diameter of cephalic vein in a matured native arteriovenous fistula in our study was significantly smaller than 6 mm which K/DOQI guideline had recommended.The indicators of native arteriovenous fistula mature in our country may different from abroad.

Objective To analyze the relationship between the least diameter of autogenous arteriovenous fistula and other parameters like flow rate and artery diameter. To identify an appropriate way in defining fistula stenosis. Methods Physical examination and Doppler ultrasound were used to examine the autogenous arteriovenous fistula of maintenance hemodialysis patients. Well?used wrist arteriovenous fistula was included. The least diameter of the fistula vein was found and marked by ultrasound, and the diameter and the distance between the point and the anastomotic stoma were measured. Diameters of different places along the cephalic vein of the fistula, including the forearm place, the place close to elbow and the upper arm place were measured by ultrasound. Meanwhile, diameter as well as flow velocity and flow rate of brachial artery, radial artery and ulnar artery were also measured. Result Sixty?eight patients were enrolled in the study. The average age of those patients was 52.56 ± 2.00 years old. Thirty?one patients were female. Forty?nine fistula were located on the left arm. The average diameter and flow rate of brachial artery were 5.72(5.34, 6.33) mm and 821.50 (540.50, 1075.00) ml/min, respectively. The average diameters of radial artery and ulnar artery were 3.95 ± 0.10mm and 3.17(2.73,3.75) mm, respectively. The least diameter of cephalic vein was 3.34 ± 0.11mm in average. The distance between the least place to the anastomotic stoma was 3.76±0.14cm in average. The diameter of forearm cephalic vein was averaged 5.36(4.52, 6.45) mm. Diameter of place close to elbow and the upper arm place in the cephalic vein were (5.57±0.12) mm and (5.80±0.14) mm, respectively. The least diameter of cephalic vein was positively and statistically associated with the diameter and flow rate of brachial artery as well as radial artery. The least diameter was also positively and statistically associated with the diameter of each place in the cephalic vein. Statistical inter?group difference was found when the division was based on the value of the least diameter. Conclusion sThe least diameter of the wrist autogenous arteriovenous fistula vein will indeed affect the whole diameter and flow rate of the fistula. The value of the least diameter is more closely associated with the fistula function rather than narrow rate.

Objective To study liver function, hepatic energy metabolism, regeneration and apoptosis in obstructive jaundiced or normal liver after 70% partial hepatectomy (PH) with hepatic artery resection (HAR) in rats. Methods In this study, 133 male SD rats were enrolled, 6 rats were in sham operation group, 20 rats underwent choledochoduodenostomy after 70% PH and 20 rats did 70%- PH, choledochoduodenostomy plus HAR. The remaining 87 rats 5 days after common bile duct ligation (CBDL) were randomized into two groups: 70% PH with choledochoduodenostomy, and 70% PH with choledochoduodenustomy plus HAR. Serum TB, ALT, ALB and ALP; tissue of hepatic HGF, bcl-2 mRNA and protein expression; ATP, ADP and AMP in hepatic tissues; hepatocyte proliferation/ apoptosis index were observed postoperatively (24 h, 72 h and 7 d). MortaLity was calculated. Results Rats without obstructive jaundice could tolerate 70% PH plus HAR with good liver regeneration. Compared with other groups, the serum liver function index; ATP content and EC value; HGF,bcl-2 mRNA content of liver tissue and the hepatocyte proliferation/apoptosis index in 70% PH with HAR group significantly aggravated and the mortality signiticanfly increased in obstructive jaundice rats ( P < 0. 05). Conclusions (1) The liver regeneration and apoptosis were not significantly influenced in normal mrs undergoing 70% PH and 70% PH with HAR, moreover hepatoeyte energy metabolism and liver function recovered rapidly in both groups. (2) With the existence of severe bilirubinemia, 70% PH with HAR caused an increased mortality suggesting a rationale for a preoperative bilirubin reducing procedures before a major surgery in malignant obstructive jaundice.

OBJECTIVETo evaluate the efficacy of combined modality treatment and determine the prognostic factors for small cell lung cancer (SCLC).

METHODSFrom January 1974 to December 1995, 1260 patients with SCLC treated were retrospectively evaluated, with limited lesions in 732 patients, extensive lesions in 500 and stage unrecorded in 28. 553 patients were alloted into chemotherapy + radiotherapy (C + R) group, 355 into C + R + C group, 97 into R + C group, 126 into C group, 64 into R group and 65 into surgery (S + C + R) group. Patients with limited lesions received 2 - 4 cycles of chemotherapy including COMC, COMP, COMVP and CE-CAP. Radiotherapy was given to a dose of 40 - 70 Gy/4 - 7 w. Radiation portals for patients with limited lesions encompassed the primary tumor, hilar lymphatic drainage areas, partial mediastinum and bilateral supraclavicular regions. Patients with extensive lesions mainly received chemotherapy with or without palliative irradiation.

RESULTSThe overall CR and PR rates were 26.7% and 52.3%. Local recurrence and distant metastasis rates were 58.8% and 61.5%. The 1-, 3- and 5-year survival rates were 50.2%, 14.7% and 11.7%, with median survival time of 12 months. The era, sex, age, tumor stage and treatment modality were all significant prognostic factors by both uni-variate and multi-variate analyses (P < 0.05). The result of S + C + R rated the best among these modalities and the result of C + R + C was superior to C + R, though the difference of which was not significant.

CONCLUSIONSurgical resection should be considered as one part of comprehensive therapy for small cell lung cancer patients with limited lesions whenever possible. On top of routine chemotherapy early administration of radiotherapy is advisable.

Adult ; Antineoplastic Combined Chemotherapy Protocols ; Carcinoma, Small Cell ; mortality ; therapy ; Combined Modality Therapy ; Female ; Humans ; Lung Neoplasms ; mortality ; therapy ; Male ; Middle Aged ; Radiotherapy ; Survival Rate ; Treatment Outcome

Background and objective Brain metastasis was frequent in non-small cell lung cancer (NSCLC) patients with poor prognosis. Geiftinib was an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor which has been used in the treatment of NSCLC. Our study was to evaluate the effcacy and toxicities of geiftinib in lung adenocarcinoma patients with brain metastases. Methods We retrospectively reviewed clinical records of 32 lung adenocarcinoma patients with brain metastases, who had received geiftinib 250 mg Qd until disease progression or intolerable toxicities. Results hTe median overall survival (mOS) and median progression-free survival (mPFS) were 24.7 months and 11.2 months, respectively. Response rate (RR) and disease control rate (DCR) were 62.5%and 93.8%, respectively. hTe mOS and mPFS of geiftinib-naive patients were 35.6 months and 11.3 months, respectively, and RR and DCR were 75.0%and 100.0%, respectively. hTe mOS and mPFS of geiftinib treatment patients were 18.6 months and 6.7 months, respectively, and RR and DCR were 50.0%and 83.3%, respectively. hTe mOS and mPFS of patients with sensitive EGFR mutation were 24.8 months and 10.8 months, respectively, and RR and DCR were 75.0%and 100.0%, respectively. hTe mOS and mPFS of patients with unknown EGFR status were 35.6 months and 12.3 months, respectively, and RR and DCR were 53.3%and 86.7%, respectively. Treatment was well tolerated and no severe toxicities were observed. Common toxicities include:rash in 15 patients (46.9%), diarrhea in 7 cases (21.9%) and oral ulcer in 1 case (3.1%). Conclusion Geiftinib was highly effective and well tolerated in lung adenocarcinoma patients with brain metastases, and could be recommended as a treatment choice for this population.

Objective To explore the predictive efficacy of XGboost model in predicting risk of relapse and re-admission within 90 d in patients with ischemic stroke,and provide basis for early screening and prevention of high-risk population with ischemic stroke.Methods The clinical data of 6070 primary ischemic stroke patients admitted to our hospital from January 2007 to July 2017 were retrospectively collected.XGboost model and multivariate Logistic regression model were utilized to screen out the influencing factors of relapse and re-admission within 90 d in patients with ischemic stroke.A predictive model was set up.Receiver operating characteristic (ROC) curve was drawn and compared.Sensitivity,specificity and Youden index were calculated and compared to evaluate the prediction performance of XGboost model.Results During the observation period,a total of 520 patients with relapsed ischemic stroke were observed within a period of 90 d,and the incidence density was 8.57％.Multivariate Logistic regression analysis showed that length of first hospital stay,hypertension,pulmonary infection,neutrophil percentage,red blood cell distribution width (variable coefficient),and alkaline phosphatase level were independent influencing factors for re-hospitalization within 90 d of ischemic stroke,(OR=1.016,P=0.000,95％CI:1.008-1.025;OR=4.598,P=0.000,95％CI:3.717-5.687;OR=1.452,P=0.025,95％CI:1.048-2.012;OR=1.013,P=0.006,95％CI:1.004-1.022;OR=1.161,P=0.000,95％CI:1.090-1.237;OR=1.003,P=0.023,95％CI:1.000-1.005).Analysis of importance of risk factors for re-admission of ischemic stroke using XGboost model showed that the top 6 factors were hypertension,red blood cell distribution width,direct bilirubin,length of hospital stay,pulmonary infection,and alkaline phosphatase,and the corresponding importance scores were 32,20,19,18,15 and 14,respectively.ROC curve analysis results indicated that the area under the ROC for re-admission for XGboost model was 0.792 (95％CI:0.717-0.762),which was improved by 5％ as compared with that for multivariate Logistic regression model (0.739 [95％CI:0.764-0.818]).The sensitivity was 89.30％ and the Youden index was 0.444 for XGboost model,which were significantly higher than those for multivariate Logistic regression model (77.3％,0.405).Conclusions XGboost model is superior to multivariate Logistic regression model in predicting recurrence and re-admission of first ischemic stroke patients within 90 d.This model is suitable for prediction and early diagnosis of re-admission of ischemic stroke,which is of great clinical value.

Background and objective At present no standard second-line combination has been established for recurrent small cell lung cancer (SCLC). hTerefore we evaluate the effcacy and safety of irinotecan in combination with nedapla-tin/cisplatin against refractory or relapsed small cell lung cancer. Methods In this retrospective study, we analyzed the data of 1,140 patients who diagnosed small cell lung cancer at our hospital from April 2009 to April 2012. Of all the patients, 34 patients were treated with irinotecan and nedaplatin (irinotecan 60 mg/m2 on days 1, 8 nedaplatin 85 mg/m2 day 1, every 3 weeks) , and 20 patients were treated with irinotecan and cisplatin (irinotecan 60 mg/m2 on days 1, 8 cisplatin 75 mg/m2 day 1, every 3 weeks) as the second-line treatment. Prognostic factors of overall survival (OS) were estimated by Kaplan-Meier and Cox's Regression-proportional hazards model. Results Of all the 54 eligible patients, median progression free survival (PFS) was 4.9 months, and median OS was 13.3 months. Median PFS was 5.4 months for irinotecan plus nedaplatin (IN) and 4.9 months for irinotecan plus cisplatin (IC), respectively (P=0.465). Median OS was 14.3 months and 13.3 months, respectively (P=0.704). In multivariate analysis, ECOG PS, number of metastases and cycles of chemotherapy were independent prognostic factors. hTe toxicities were mild, while toxicity proifle was slightly different for each of the arms:hematologic toxicity was higher in IN group, and diarrhea was higher in IC group. Conclusion Irinotecan plus platinum is effective and tolerable for refractory and relapsed small cell lung cancer. Irinotecan plus nedaplatin is non-inferior to irinotecan plus cisplatin in terms of effcacy and safety.

Objective: To investigate the efficacy and safety of using pegylated recombinant human granulocyte-colonystimulating factor (PEG-rhG-CSF) in preventing neutropenia in multiple chemotherapy cycles. Methods: A multicenter, prospective, open-label, singlearmstudy was designed. Patients with malignant tumors, such as lung, ovarian, and colorectal cancers, who received multiple cycles of chemotherapy with the prophylactic use of PEG-rhG-CSF for 2-4 consecutive cycles participated in the study. Results: After the prophylactic use of PEG-rhG-CSF, the incidence of grade IV neutropenia decreased from 4.76% (13/273) in the first cycle to 1.83% (5/273), 1.15% (2/174), and 2.08% (2/96) in subsequent cycles. Meanwhile, the incidence of grade III neutropenia decreased from 11.36% (31/ 273) in the first cycle to 6.23% (17/273), 2.87% (5/174), and 3.13% (3/96) in subsequent cycles. The incidence of febrile neutropenia (FN) during the first cycle was 0.73% (2/273). The duration of FN was 2 days in one case and 5 days in another case. FN was not observed during the second, third, or fourth cycle. After the secondary prophylactic use of PEG-rhG-CSF, the incidence of grade IV neutropenia decreased from 25% (7/28) to 3.57% (1/28), 0% (0/28), and 6.67% (1/15) in subsequent cycles. Meanwhile, the incidence of grade III neutropenia decreased from 71.43% (20/28) to 10.71% (3/28), 14.29% (4/28), and 0% (0/15) in subsequent cycles. The proportion of patients who received antibiotic therapy during the entire chemotherapy period was 10.48% (44/420). Conclusion: The application of PEG-rhG-CSF once per chemotherapy cycle can effectively reduce the occurrence of neutropenia in patients under multiple cycles of chemotherapy treatment with good safety.