Objective:To investigate the correlation of multi-slice spiral CT(MSCT)blood flow parameters including blood volume(BV),blood flow(BF),permeability surface(PS),mean transit time(MTT)and serum carbohydrate antigen 199(CA199)level with clinical pathological features of gastric cancer patients,and the diagnostic efficiency of their combined detection.Methods:A total of 58 patients with gastric cancer confirmed by pathological biopsy admitted to Suixian People's Hospital from Jun 2022 to Dec 2023 were collected as the gastric cancer group,and 58 patients with gastric benign lesions during the same period were collected as the benign control group.The MSCT blood flow parameters BV,BF,PS,MTT values,and serum CA199 levels were compared between the two groups and among different clinical pathological features.The correlation of BF,PS,and serum CA199 level with different clinical pathological features was analyzed.The diagnostic efficiency of the combined detection of BF,PS,and serum CA199 level for gastric cancer was analyzed.Results:The proportion of mass diameter≥5 cm,marginal obscurity,malignant niche,mucosal invasion and muscle invasion in the gastric cancer group were higher than those in the benign control group(P＜0.05).The BF,PS,and serum CA199 level in the gastric cancer group were higher than those in the benign control group(P＜0.05).No significant differences were found in BV and MTT between the two groups(P＞0.05).The BF,PS,and serum CA199 level in patients with stage Ⅰ-Ⅱ,middle and high differentiation,and no lymph node metastasis were lower than those in patients with stage Ⅲ-Ⅳ,low differentiation,and lymph node metastasis(P＜0.05).There were no significant differences in BV and MTT among different clinical pathological features(P＞0.05).Spearman correlation analysis showed that BF,PS and serum CA199 level were positively correlated with clinical stage and lymph node metastasis,and negatively correlated with differentiation degree(P＜0.05).The receiver operating characteristic(ROC)curve results showed that the AUC of combined detection of BF,PS,and serum CA199 level for diagnosing gastric cancer was 0.928,which was significantly higher than the AUCs of individual detection:BF(0.787),PS(0.829),and CA199(0.816).Conclusion:The MSCT blood flow parameters BF,PS,and serum CA199 level are all correlated with clinical pathological features of gastric cancer patients,and combined detection of these three indicators has high diagnostic efficiency for early diagnosis of gastric cancer.

Objective:To establish and assess the quality control and improvement system for metabolic and bariatric surgery in Beijing.Methods:Based on relevant documents from the National Health Commission and the Beijing Municipal Health Commission,and referencing the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) by the American Society for Metabolic and Bariatric Surgery,a quality control system was developed under the Beijing Quality Control and Improvement Center of Metabolic and Bariatric Surgery. The system incorporated on-site evaluations,data registration,and specialized training. From May to December 2023,on-site assessments were conducted at 21 hospitals in Beijing performing bariatric surgery,evaluating personnel qualifications,infrastructure,clinical workflows,and postoperative follow-up. A quality control database was created to collect real-time surgical data,and training was provided for data entry and professional skills. Assessment results were classified as excellent,qualified,or needing improvement,with rectification suggestions offered and follow-up visits conducted to track progress.Results:All 21 hospitals achieved a 100% compliance rate for surgical indications, 16 (76.2%) met standardized surgical operation criteria,and 14 (66.7%) had standardized postoperative management. However,only 5 (23.8%) achieved a 12-month postoperative follow-up rate of ≥60%,and 4 (19.1%) had established specialized databases. Key challenges included insufficient specialized staffing (19.1%), lack of multidisciplinary collaboration (47.6%), inadequate equipment (57.1%), and low follow-up rates (57.1%). The database collected data from over 2 000 patients across 111 fields. After rectification, specialized database coverage rose to 61.9% (13 hospitals). Multi-level training programs developed backbone physicians and specialized nurses,significantly addressing the shortage of specialized personnel.Conclusion:The quality control system established in this study,through the integration of on-site evaluation,data registration,and specialized training,effectively enhances the standardization of surgical practices and data management capabilities.

Objective:To investigate the correlation of multi-slice spiral CT(MSCT)blood flow parameters including blood volume(BV),blood flow(BF),permeability surface(PS),mean transit time(MTT)and serum carbohydrate antigen 199(CA199)level with clinical pathological features of gastric cancer patients,and the diagnostic efficiency of their combined detection.Methods:A total of 58 patients with gastric cancer confirmed by pathological biopsy admitted to Suixian People's Hospital from Jun 2022 to Dec 2023 were collected as the gastric cancer group,and 58 patients with gastric benign lesions during the same period were collected as the benign control group.The MSCT blood flow parameters BV,BF,PS,MTT values,and serum CA199 levels were compared between the two groups and among different clinical pathological features.The correlation of BF,PS,and serum CA199 level with different clinical pathological features was analyzed.The diagnostic efficiency of the combined detection of BF,PS,and serum CA199 level for gastric cancer was analyzed.Results:The proportion of mass diameter≥5 cm,marginal obscurity,malignant niche,mucosal invasion and muscle invasion in the gastric cancer group were higher than those in the benign control group(P＜0.05).The BF,PS,and serum CA199 level in the gastric cancer group were higher than those in the benign control group(P＜0.05).No significant differences were found in BV and MTT between the two groups(P＞0.05).The BF,PS,and serum CA199 level in patients with stage Ⅰ-Ⅱ,middle and high differentiation,and no lymph node metastasis were lower than those in patients with stage Ⅲ-Ⅳ,low differentiation,and lymph node metastasis(P＜0.05).There were no significant differences in BV and MTT among different clinical pathological features(P＞0.05).Spearman correlation analysis showed that BF,PS and serum CA199 level were positively correlated with clinical stage and lymph node metastasis,and negatively correlated with differentiation degree(P＜0.05).The receiver operating characteristic(ROC)curve results showed that the AUC of combined detection of BF,PS,and serum CA199 level for diagnosing gastric cancer was 0.928,which was significantly higher than the AUCs of individual detection:BF(0.787),PS(0.829),and CA199(0.816).Conclusion:The MSCT blood flow parameters BF,PS,and serum CA199 level are all correlated with clinical pathological features of gastric cancer patients,and combined detection of these three indicators has high diagnostic efficiency for early diagnosis of gastric cancer.

Objective:To establish and assess the quality control and improvement system for metabolic and bariatric surgery in Beijing.Methods:Based on relevant documents from the National Health Commission and the Beijing Municipal Health Commission,and referencing the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) by the American Society for Metabolic and Bariatric Surgery,a quality control system was developed under the Beijing Quality Control and Improvement Center of Metabolic and Bariatric Surgery. The system incorporated on-site evaluations,data registration,and specialized training. From May to December 2023,on-site assessments were conducted at 21 hospitals in Beijing performing bariatric surgery,evaluating personnel qualifications,infrastructure,clinical workflows,and postoperative follow-up. A quality control database was created to collect real-time surgical data,and training was provided for data entry and professional skills. Assessment results were classified as excellent,qualified,or needing improvement,with rectification suggestions offered and follow-up visits conducted to track progress.Results:All 21 hospitals achieved a 100% compliance rate for surgical indications, 16 (76.2%) met standardized surgical operation criteria,and 14 (66.7%) had standardized postoperative management. However,only 5 (23.8%) achieved a 12-month postoperative follow-up rate of ≥60%,and 4 (19.1%) had established specialized databases. Key challenges included insufficient specialized staffing (19.1%), lack of multidisciplinary collaboration (47.6%), inadequate equipment (57.1%), and low follow-up rates (57.1%). The database collected data from over 2 000 patients across 111 fields. After rectification, specialized database coverage rose to 61.9% (13 hospitals). Multi-level training programs developed backbone physicians and specialized nurses,significantly addressing the shortage of specialized personnel.Conclusion:The quality control system established in this study,through the integration of on-site evaluation,data registration,and specialized training,effectively enhances the standardization of surgical practices and data management capabilities.

IgA nephropathy (IgAN) is one common type of glomerulonephritis caused by a deposition of immune complexes in mesangium and partial capillary loops. It is also an important risk factor for end-stage renal disease (ESRD). Kidney transplantation (KT) has been an ultimate treatment for IgAN patients progressing into ESRD. However, there is still a high risk of recurrence after transplantation. Currently no effective treatment is available for recurrent IgAN. This review summarized the latest researches of managing IgAN recurrence after KT, such as optimal treatment, immunosuppression, complement therapy and surgery.

BACKGROUND: Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting. METHODS: To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks. RESULTS: A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor. CONCLUSIONS Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.
Humans ; Male ; Retrospective Studies ; Diabetes Mellitus, Type 2/complications* ; Obesity, Morbid ; Anastomotic Leak/epidemiology* ; Gastrectomy/methods* ; Reoperation/methods* ; Registries ; Laparoscopy/methods* ; Treatment Outcome

Abdomen/diagnostic imaging* ; Artificial Intelligence ; Body Composition ; Magnetic Resonance Imaging ; Practice Guidelines as Topic

Objective:To analyze the prognosis-related factors of patients with surgical treatment of lung cancer brain metastases.Methods:From January 2016 to November 2018, the clinical data of the patients with lung cancer brain metastases received surgical treatment in Department of Neurosurgery, Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College were retrospectively collected, and completed data of 83 patients were obtained. The single factor analysis was based on the log-rank method, and the multi-factor analysis was used by the Cox proportional hazard model, and the R software was used to map the influencing factors into the nomogram and verify them.Results:The median overall survival (OS) of 83 patients was 27.0 months. The median OS of patients with surgery alone was 15.7 months, the median OS of patients with surgery combined with radiotherapy, chemotherapy or targeted therapy was 27.7 months, and the difference was statistically significant ( χ2=8.735, P=0.003). The results of single factor analysis showed that gender ( χ2=4.652, P=0.031), smoking history ( χ2=8.239, P=0.004), postoperative targeted treatment ( χ2=13.697, P<0.001), postoperative adjuvant therapy ( χ2=8.735, P=0.003), pathology of metastatic tumor ( χ2=11.799, P=0.001), and lung cancer molecular graded prognostic assessment (Lung-molGPA) sore ( χ2=11.333, P=0.004) affected patients′ OS. The results of multivariate analysis showed that smoking history ( HR=0.311, 95% CI: 0.107-0.901, P=0.031), postoperative targeted therapy ( HR=3.563, 95% CI: 1.286-9.868, P=0.015), pathology of metastatic tumor ( HR=0.364, 95% CI: 0.137-0.965, P=0.042), Lung-molGPA score ( HR=0.595, 95% CI: 0.374-0.946, P=0.028) were independent prognostic factors for OS of patients with lung cancer brain metastases. In order to further evaluate the prognosis of patients, nomogram was drawn using these four independent prognostic factors. The model had high accuracy and could better evaluate the prognosis of patients. Conclusion:Lung cancer brain metastases patients with operative indication can benefit from surgery, and active adjuvant therapy after operation can further prolong the OS of patients. The nomogram constructed by smoking, targeted therapy, pathology of metastatic tumor and Lung-molGPA score can be used to evaluate individual patient outcomes and guide clinical treatment.

OBJECTIVE： To optimize and improve the quality standard for Citrus reticulata formula granules. METHODS： Totally 13 batches of C. Reticulata formula granules from 4 different manufacturers were used as trial samples， and qualitative identification of hesperidin and nobiletin in the samples were carried out by TLC according to the method of 2015 edition of Chinese Pharmacopoeia （part Ⅳ）. The quantitative analysis of naringin， hesperidin， hesperetin， nobiletin and tangeretin in C. reticulatae formula granules were conducted by UPLC[The determination was performed on Waters Acquity UPLC BEH C18 column with mobile phase consisted of acetonitrile-0.2％ phosphoric acid aqueous solution （gradient elution）. The detection wavelength was set at 283 nm， and sample size was 3 μL]. RESULTS： The results of TLC showed that in the chromatograms of samples， same color spots were shown in the corresponding positions of the chromatogram of reference substance. The results of UPLC showed， that the linear range of naringin， hesperidin， hesperetin， nobiletin and tangeretin were 0.64-6.44， 15.78-157.80， 0.17-1.66， 2.08-20.85 and 2.04-20.43 μg/mL， respectively （all r≥0.999 2）； the limits of detection were 0.03， 0.33， 0.10， 0.20 and 0.06       μg/mL； the limits of quantitation were 0.07， 1.34， 0.20， 0.60 and 0.22 μg/mL. The average recoveries were 99.4％， 99.6％， 99.7％， 99.7％ and 99.7％ （n＝9）； RSDs of precision （n＝6）， stability （n＝7） and reproducibility （n＝6） tests were all≤2.03％； naringin was detected in only 3 batches of samples from one manufacturer （the content ranged from 0.067 3 to 0.069.6    mg/g）， while the other 4 components were detected in 13 batches of samples （the contents of them ranged 0.646 5-1.728 0，   0.102 6-0.290 5， 0.023 1-0.689 8， 0.018 2-0.270 7 mg/g）. CONCLUSIONS： In this study， the quality standard of C. reticulata formula granules was improved by qualitative and quantitative methods， and the contents of hesperidin， hesperetin， nobiletin and tangeretin were not less than 0.60， 0.10， 0.02 and 0.01 mg/g， respectively.

Objective To evaluate the correlation between microvascular invasion(MVI) and prognosis in patients with hepatocellular carcinoma (HCC),and to analyse the influencing factors of MVI in patients with HCC.Methods Total of 81 patients with hepatocellular carcinoma treated in Beijing Hospital from January 2014 to December 2016 were retrospectively studied.There were 65 males and 16 females.The mean age was 59.6± 12.7 years,and the age ranged from 21 to 87 years old.Pathological examination showed presence of MVI in 35 patients.Results Total of seventy-six patients with hepatocellular carcinoma were followed-up.The 1-,2-,3-and 4-year overall survival rates in the 35 patients with microvascular invasion of hepatocellular carcinoma were 78.6％,55.4％,38.3％,and 32.2％,respectively.The 1-,2-,3-,and 4-year overall survival rates of the 41 patients without microvascular invasion were 93.4％,76.5％,68.2％ and 68.2％,respectively.The difference was significant (P＜0.05).Cox multivariate regression analysis showed that microvascular invasion was an independent risk factor of overall survival after surgery (HR=3.071,95％ CI:1.239～7.610,P＜0.05).Sub-group analysis was done on patients with microvascular invasion based on pathological results which included the number of MVI lesions,the call number in the MVI lesion,the distance of the MVI to the primary liver cancer,and the gradings of MVI.There were no significant differences in the overall survival outcomes (P＞0.05).Multivariate logistic regression analysis showed the maximum diameter of tumor ＞ 5 cm (OR =6.340,95％ CI:2.000 ～ 20.096),preoperative total bilirubin (TBil) ＞ 17 μmol/L (OR =5.067,95％CI:1.386 ～ 18.525),and preoperative alpha-fetoprotein (AFP) ＞400 μg/L (OR =6.042,95％ CI:1.435 ～ 25.444) were independent risk factors of microvascular invasion (P＜ 0.05).Conclusion Hepatocellular carcinoma patients with microvascular invasion had poor prognosis.Preoperative AFP,preoperative TBil,and diameter of tumor were independent risk factors of microvascular invasion in patients with hepatocellular carcinoma.