1.Accuracy of multivariate discriminant analysis versus fibrosis-4 in evaluating the liver fibrosis degree in patients with chronic HBV infection
Hongyu LIU ; Xiaoting LI ; Jianning JIANG ; Chao JIN ; Cailian CAI ; Keshan WANG ; Fangpeng LING ; Bingling FAN ; Minghua SU
Journal of Clinical Hepatology 2025;41(4):677-683
ObjectiveTo investigate the accuracy of multiple discriminant analysis (MDA) versus fibrosis-4 (FIB-4) in assessing liver fibrosis degree in patients with HBV infection, as well as the possibility of MDA as an indicator for disease progression. MethodsA total of 263 patients with HBV infection who underwent liver biopsy in The First Affiliated Hospital of Guangxi Medical University from April 2010 to April 2024 were included, and their clinical data were collected. According to the results of pathological examination, they were divided into non-significant fibrosis group (F<2) with 126 patients and significant fibrosis group (F≥2) with 137 patients. The correlation of MDA and FIB-4 with liver fibrosis degree was analyzed, and MDA and FIB-4 were compared in terms of their accuracy in assessing significant liver fibrosis. A total of 62 patients completed follow-up, and according to the presence or absence of progression to liver cirrhosis at the last follow-up visit, they were divided into progressive group with 21 patients and non-progressive group with 41 patients; the efficacy of MDA and FIB-4 in diagnosing disease progression was analyzed and compared. The independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the Kruskal-Wallis H test was used for comparison between multiple groups, and the Bonferroni method was used for further comparison between two groups. The chi-square test was used for comparison of categorical data. The Spearman’s correlation coefficient was used for correlation analysis. The Wilcoxon signed rank sum test was used for the analysis of baseline data and data at the end of follow-up, and the binary Logistic regression analysis was used to investigate the influencing factors for progression to liver cirrhosis. The receiver operating characteristic (ROC) curve was used to investigate the diagnostic efficacy of indicators, the Z-test was used for comparison of the area under the ROC curve (AUC), and the paired chi-square test was used for comparison of the sensitivity, specificity, and accuracy of the two indicators. ResultsThe correlation coefficient between FIB-4 and liver fibrosis degree was 0.378, while the correlation coefficient between MDA and liver fibrosis degree was -0.325 (both P<0.001). FIB-4 had an AUC of 0.688, a sensitivity of 64.96%, a specificity of 68.87%, a positive predictive value of 67.42%, a negative predictive value of 63.36%, an accuracy of 65.40%, and a cut-off value of 1.01, while MDA had an AUC of 0.653, a sensitivity of 52.55%, a specificity of 78.57%, a positive predictive value of 72.73%, a negative predictive value of 60.37%, an accuracy of 65.02%, and a cut-off value of 0.29, suggesting that compared with FIB-4, MDA had a lower sensitivity (P=0.004) and a higher specificity (P=0.001). The progressive group had a significantly higher age than the non-progressive group at baseline (t=2.611, P=0.011). For the progressive group, there was an increase in FIB-4 and a reduction in MDA from baseline to the end of follow-up (both P<0.001), while the non-progressive group showed no significant changes (both P>0.05). The multivariate Logistic regression analysis showed that aspartate aminotransferase (odds ratio [OR]=0.940, 95% confidence interval [CI]: 0.885 — 0.998, P<0.05) and MDA (OR=0.445, 95%CI: 0.279 — 0.710, P<0.001) were independent influencing factors for disease progression. MDA had an AUC of 0.893 and an optimal cut-off value of -0.01 in diagnosing the disease progression of liver cirrhosis. ConclusionMDA has a comparable accuracy to FIB-4 in the diagnosis of significant liver fibrosis, and MDA<-0.01 has a high accuracy in diagnosing the progression of liver fibrosis to liver cirrhosis, which can help to reduce the need for liver biopsy in clinical practice.
2.Effectiveness of fibrosis-4 versus aspartate aminotransferase-to-platelet ratio index in evaluating liver fibrosis degree in patients with chronic HBV infection
Xiaoting LI ; Bobin HU ; Hongyu LIU ; Chao JIN ; Cailian CAI ; Keshan WANG ; Yanchun WEI ; Jianning JIANG ; Minghua SU
Journal of Clinical Hepatology 2024;40(12):2424-2429
ObjectiveTo investigate the performance of fibrosis-4 (FIB-4) versus aspartate aminotransferase-to-platelet ratio index (APRI) in predicting advanced liver fibrosis and disease progression in patients with chronic HBV infection. MethodsA total of 497 patients with chronic HBV infection who underwent liver biopsy in The First Affiliated Hospital of Guangxi Medical University from February 2013 to December 2022 were enrolled, among whom 404 were enrolled in a retrospective study and 75 were enrolled in a prospective study. Related indicators were collected, including demographic features (sex and age), biochemical indices (alanine aminotransferase [ALT] and aspartate aminotransferase [AST]), and platelet count, and FIB-4 and APRI were calculated. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups; the chi-square test was used for comparison of categorical data between groups. The area under the ROC curve (AUC) was used to assess the ability of APRI and FIB-4 in evaluating liver fibrosis degree and disease progression in patients with chronic HBV infection. ResultsIn the retrospective analysis, compared with the FIB-4<2.67 group, the FIB-4≥2.67 group had a significantly higher proportion of the patients who were diagnosed with liver cirrhosis or hepatocellular carcinoma (66.19% vs 47.54%, χ²=12.75, P<0.001). The medians of FIB-4 and APRI increased significantly with liver fibrosis degree from F0 to F4 (H=42.5 and 35.9, both P<0.001). As for the fibrosis stage of F0-F4, the median of FIB-4 was significantly higher than that of APRI in the patients with the same fibrosis stage (H=59.71, P<0.001). FIB-4 and APRI had a similar AUC for predicting stage F3 fibrosis (0.67 vs 0.65, Z=0.71, P=0.480), while FIB-4 had a higher AUC for predicting stage F4 fibrosis than APRI (0.72 vs 0.64, Z=10.50, P<0.001). In the prospective study cohort, FIB-4 and APRI showed an increasing trend over time in predicting disease progression (chronic hepatitis B to liver cirrhosis), with an AUC of 0.718 (95% confidence interval [CI]: 0.476 — 0.760) and 0.555 (95%CI: 0.408 — 0.703), respectively, and FIB-4 had a significantly higher accuracy than APRI in predicting disease progression (χ2=12.44, P<0.001). ConclusionFIB-4 and APRI can be used to evaluate advanced liver fibrosis (F3 and F4) and predict disease progression, and FIB-4 is superior to APRI in certain aspects.
3.The role of TFEB activated by aerobic exercise on insulin resistance in skeletal muscle of high fat diet mice
Ping WANG ; Jiaxin LI ; Xiaolong CHEN ; Xin YU ; Xiaopeng JIN ; Minghua ZHU
Chinese Journal of Sports Medicine 2024;43(3):193-204
Objective To explore the role of transcription factor EB(TFEB)induced by aerobic exer-cise in improving insulin resistance(IR)of skeletal muscles in high-fat diet mice.Method Eighteen male SPF C57BL/6 mice aged 6 weeks were randomly divided into a common diet group(CON),a high-fat diet group(HFD),and a high-fat diet exercise group(HFDE),each of 6.Both high-fat groups were on high-fat diet for 12 weeks.Then the HFDE group underwent daily 60-minute tread-mill exercise with the slope of 0°,at a speed of 12 m/min,5 times per week for 12 weeks.Finally,the glucose tolerance and insulin sensitivity were detected using the intraperitoneal injection glucose tol-erance test(IPGTT)and intraperitoneal injection insulin tolerance test(IPITT).The fasting blood glu-cose and insulin contents were measured by biochemical method,and the IR level was calculated by using the homeostatic model assessment of insulin resistance(HOMA-IR).Moreover,Western blotting was employed to detect the expression of phosphorylated transcription factor EB(pTFEB)and TFEB in skeletal muscle,glucose transporter 4(GLUT4)in cytoplasm and membrane,phosphorylated insulin re-ceptor substrates1(pIRS1),phosphorylated protein kinase B(pAKT),phosphoinositide 3-kinase(PI3K),and phosphorylated akt substrate of 160 kD(pTBC1D4)in skeletal muscle.The correlation of pTFEB and TFEB to insulin signaling pathway-related proteins was analyzed.Results(1)Compared with the CON group,there was a significant increase in the average body weight,IPGTT,blood glucose at each time point of IPGTT,area under curve(AUC),serum insulin,HOMA-IR,protein expressions of pTFEB,total-TFEB and GLUT4 in cytoplasm of the HFD group(P<0.01),but a significant decrease in the average protein expressions of pIRS1,pAKT,PI3K,pTBC1D4 and GLUT4 in cell membrane of skeletal muscles(P<0.01).However,no significant differences were found between the two groups in the average expression of pTFEB and T-TFEB proteins.(2)Compared to the HFD group,a signifi-cant increase was found in the average body weight,blood glucose at each time point of IPGTT,blood glucose of IPITT at 0 min,30 min and 60 min and AUC,serum insulin,HOMA-IR,expres-sions of pTFEB,T-TFEB and GLUT4 in cytoplasm of HFDE group(P<0.05 or P<0.01),with a signifi-cant decrease in the average protein expressions of pIRS1,pAKT,PI3K,pTBC1D4 and GLUT4 in cell membrane and T-TFEB in nucleus(P<0.01).(3)TFEB was negatively correlated with the expres-sion of pIRS1,PI3K,pAKT,and pTBC1D4 proteins(r=-0.8642,r=-0.7789,r=-0.8946,r=-0.8040)but positively correlated with cytoplasmic GLUT4(r=0.8532,P<0.01).Moreover,TFEB in the nucleus was of positive correlation with GLUT4 in the cell membrane(r=0.7744,P<0.01).Conclusions High-fat diet can decrease the expression of insulin signaling pathway related proteins in skeletal mus-cles of mice and weaken their insulin action,leading to the disorder of glucose and lipid metabolism.However,aerobic exercise can significantly increase the expression of such proteins to promote insulin function and sensitivity,and relieve disorders in glucose and lipid metabolism.This effect may be achieved through the promotion of skeletal muscle TFEB nuclear translocation,which activates IRS1/PI3K/AKT/TBC1D4/GLUT4 signaling pathway and facilitates GLUT4 membrane translocation,ultimately enhancing glucose uptake in skeletal muscle cells.The authors speculate that the TFEB-mediated insu-lin signaling pathway may be an important molecular pathway for aerobic exercise to improve insulin re-sistance.
4.Seroepidemiological analysis of hepatitis B virus infection among adolescents aged 0-14 years in Henan Province and preliminary evaluation of the effectiveness of childhood hepatitis B vaccine immunization program
Yonghao GUO ; Yanping CHEN ; Qiaohua DOU ; Qian LIU ; Jianhui YANG ; Minghua SENG ; Wanyu LYU ; Changshuang WANG ; Mingxia LU ; Jin XU ; Yanyang ZHANG ; Dongyang ZHAO
Chinese Journal of Preventive Medicine 2024;58(2):202-207
Objective:To analyze the seroepidemiological characteristics of hepatitis B virus (HBV) infection among adolescents aged 0-14 years in Henan Province and to evaluate the effectiveness of the childhood hepatitis B vaccine (HepB) immunization program.Methods:From September 2021 to March 2022, a total of 4 883 adolescents aged 0-14 years were selected from 25 villages or communities of 18 provincial-level cities in Henan Province by using the multi-stage random cluster sampling method. Demographic data were collected through questionnaires. The 3 ml of blood samples were collected from individuals aged 0-4 years and 5 ml of blood samples were collected from individuals aged 5-14 years to test HBsAg, HBcAb and HBsAb. Data on vaccination were collected through Henan Provincial Immunization Information System and hepatitis B cases in Henan Province were collected through China Infectious Disease Reporting System. The effectiveness of the childhood HepB immunization program was analyzed.Results:The average age of 4 883 subjects was (7.32±2.81) years old. The positive rates of HBsAg and HBcAb were 0.1% (7/4 883) and 1.0% (50/4 883), and the population standardized rates were 0.3% and 1.7%. In 2002, the positive rate of HBsAg among adolescents aged 0-14 years in Henan Province was 3.39%. Compared with that in 2002, the number of chronic HBV infections among adolescents in Henan Province in 2022 decreased by about 0.7 million. In 2002, the vaccination rate of newborns who completed all three doses of vaccine was 6.26%. In 2003, the vaccination rate of the hepatitis B vaccine rose rapidly, reaching 90% in 2013 for the first time. After 2014, the vaccination rate in Henan Province continued to remain above 95%. The proportion of cases among children aged 1-4 years in clinical reports decreased from 0.43% (1 108/256 566) in 2006 to 0.01% (78/80 655) in 2021. The proportion of cases among adolescents aged 5-19 years decreased from 18.21% (46 710/256 566) in 2006 to 1.1% (827/80 655) in 2021.Conclusions:From 2002 to 2022, the positive rate of HBsAg among adolescents aged 0-14 years has decreased significantly in Henan Province. The effectiveness of the HepB immunization program for children is good.
5.Seroepidemiological analysis of hepatitis B virus infection among adolescents aged 0-14 years in Henan Province and preliminary evaluation of the effectiveness of childhood hepatitis B vaccine immunization program
Yonghao GUO ; Yanping CHEN ; Qiaohua DOU ; Qian LIU ; Jianhui YANG ; Minghua SENG ; Wanyu LYU ; Changshuang WANG ; Mingxia LU ; Jin XU ; Yanyang ZHANG ; Dongyang ZHAO
Chinese Journal of Preventive Medicine 2024;58(2):202-207
Objective:To analyze the seroepidemiological characteristics of hepatitis B virus (HBV) infection among adolescents aged 0-14 years in Henan Province and to evaluate the effectiveness of the childhood hepatitis B vaccine (HepB) immunization program.Methods:From September 2021 to March 2022, a total of 4 883 adolescents aged 0-14 years were selected from 25 villages or communities of 18 provincial-level cities in Henan Province by using the multi-stage random cluster sampling method. Demographic data were collected through questionnaires. The 3 ml of blood samples were collected from individuals aged 0-4 years and 5 ml of blood samples were collected from individuals aged 5-14 years to test HBsAg, HBcAb and HBsAb. Data on vaccination were collected through Henan Provincial Immunization Information System and hepatitis B cases in Henan Province were collected through China Infectious Disease Reporting System. The effectiveness of the childhood HepB immunization program was analyzed.Results:The average age of 4 883 subjects was (7.32±2.81) years old. The positive rates of HBsAg and HBcAb were 0.1% (7/4 883) and 1.0% (50/4 883), and the population standardized rates were 0.3% and 1.7%. In 2002, the positive rate of HBsAg among adolescents aged 0-14 years in Henan Province was 3.39%. Compared with that in 2002, the number of chronic HBV infections among adolescents in Henan Province in 2022 decreased by about 0.7 million. In 2002, the vaccination rate of newborns who completed all three doses of vaccine was 6.26%. In 2003, the vaccination rate of the hepatitis B vaccine rose rapidly, reaching 90% in 2013 for the first time. After 2014, the vaccination rate in Henan Province continued to remain above 95%. The proportion of cases among children aged 1-4 years in clinical reports decreased from 0.43% (1 108/256 566) in 2006 to 0.01% (78/80 655) in 2021. The proportion of cases among adolescents aged 5-19 years decreased from 18.21% (46 710/256 566) in 2006 to 1.1% (827/80 655) in 2021.Conclusions:From 2002 to 2022, the positive rate of HBsAg among adolescents aged 0-14 years has decreased significantly in Henan Province. The effectiveness of the HepB immunization program for children is good.
6.Investigation Report of the Species and Reserves of Chinese Materia Medica Resources in Sichuan Based on the 4th Chinese Materia Medica Resource Inventory
Qingmao FANG ; Qingmiao LI ; Yi ZHOU ; Wentao ZHU ; Bing LUO ; Mei ZHANG ; Xianjian ZHOU ; Ping WU ; Ping HU ; Hongsu WANG ; Cheng PENG ; Jin PEI ; Yuecheng LI ; Hao ZHANG ; Cheng ZHUANG ; Youqing GAN ; Minghua LUO ; Junning ZHAO
World Science and Technology-Modernization of Traditional Chinese Medicine 2024;26(8):1946-1958
Objective To compare the changes of the Chinese Materia Medica resources(CMMR)in Sichuan based on the data of the 3rd Chinese Materia Medica Resource Inventory(CMMRI,1983-1986)and the 4th CMMRI(2011-2022).Methods Using new techniques,after field investigation,collection and identification of the specimens of the animals,plants and minerals.The data of the CMMR in Sichuan found in the 4th CMMRI were analysed and compared with the data of 3rd CMMRI.Results ①9055 species of CMMR were found in Sichuan during the 4th CMMRI,including 8272 species of medicinal plants,745 species of medicinal animals and 38 species of medicinal minerals.Compared with the 3rd CMMRI,the number of CMMR found in Sichuan have greatly increased.The number of medicinal plants increased 5018 species,the number of medicinal animals increased 637 species and the number of medicinal minerals increased 5 species,too.②The medicinal plants is the main part of the CMMR,and the higher plants(7774 species)has the absolute advantage of the CMMR.The top 20 families which have plenty of plant species include Compositae,Rosaceae,Leguminosae,Ranunculaceae,etc.③ Based on the data of the CMMR of the 183 counties in Sichuan,the reserves of 235 species of wild CMMR in Sichuan is about 36.72 million ton.There were 49 CMMR which have reserves beyond 100 thousand tons,such as Arisaematis rhizoma,Epimedii folium,Cimicifugae rhizoma,Acori tatarinowii rhizoma,Gentianae macrophyllae radix,Polygoni multiflori radix etc.④In 2021,there were 215 species of CMMR cultivated in Sichuan,the main species were Aurantii fructus,Chuanxiong rhizoma,Polygonati rhizome,Salviae miltiorrhizae radix et rhizome.The planting area was 8.17 million and the production was 1.26 million ton.⑤All 183 countries were found CMMR,the number of the species of CMMR in 30 countries exceeded 800,including 16 countries which had more than 1000 kinds of CMMR,such as Emeishan,Hongya,Muli etc.The total types of the CMMR(up 118.31%),the reserves of the wild CMMR(up 119 times)and the number of the counties(up 3 times)which had plenty of CMMR,showed a marked increase over the 3rd CMMRI.8 new species were found in the the 4th CMMRI,such as Codonopsis atriplicifolia,Tongoloa tagongensis,Allium xinlongense,etc.Conclusion The species,the reserves of the CMMR and the resource rich countries in Sichuan are the top 3 in China and Sichuan is worthy of the title of"Hometown of Traditional Chinese Medicine".The compositions and types of the family,genus and species of the CMMR in Sichuan have significantly increased.The basic information of the CMR in Sichuan was clearly found out during the 4th CMMRI,and beneficial for the sustainable development and utilization of the CMMR in Sichuan.
7.Therapy of Dispelling Stasis, Removing Toxin, and Promoting Urination (Xuebijing Injection Combined with Modified Linggui Zhugantang) Affects Prognosis of Sepsis-induced Cardiomyopathy
Mei XU ; Mingming DUAN ; Minghua YANG ; Jin ZHAO ; Yiming ZHAO ; Baozhu SHI
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(7):146-152
ObjectiveTo evaluate the effect of the therapy of dispelling stasis, removing toxin, and promoting urination (modified Linggui Zhugantang combined with Xuebijing injection) on the prognosis of sepsis-induced cardiomyopathy (SICM). MethodA total of 96 patients were randomly assigned into an observation group and a control group, with 48 patients in each group. The patients in the control group received sepsis bundle, and those in the observation group additionally received the therapy of dispelling stasis, removing toxin, and promoting urination (intravenous drip of Xuebijing injection and oral administration of modified Linggui Zhugantang). The course of treatment in both groups was 7 days. The disease and prognosis indicators [28-day mortality, intensive care unit (ICU) length of stay, major adverse cardiac events (MACE), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA) score, and mortality in emergency department sepsis (MEDS) score], cardiac function indicators [left ventricular ejection fraction (LVEF), E/A ratio of peak velocity blood flow from left ventricular relaxation in early diastole (the E wave) to peak velocity flow in late diastole caused by atrial contraction (the A wave), E/e′ ratio of mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (e′), and afterload-corrected cardiac performance (ACP)], myocardial injury markers [high-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro-brain natriuretic peptide (NT-proBNP), heart-type fatty acid-binding protein (H-FABP), and high mobility group box-1 (HMGB-1)], hemodynamic indicators [extravascular lung water index (EVLWI), global end-diastolic volume index (GEDVI), cardiac index (CI), and systemic vascular resistance index (SVRI)], and TCM syndrome scores were assessed and compared between the two groups. ResultThe 28-day mortality and the incidence of MACE in the observation group were slightly lower than those in the control group. The ICU length of stay in the observation group was shorter than that in the control group (P<0.05). After treatment, APACHE Ⅱ, SOFA, MEDS, syndrome score of stasis-caused internal obstruction, E/e′ ratio, hs-cTnT, NT-proBNP, H-FABP, and HMGB1 decreased compared with those before treatment (P<0.05), while LVEF, E/A ratio, and ACP increased (P<0.05). Moreover, the changes were more significant in the observation group (P<0.05). On days 3, 5, and 7 after treatment, the EVLWI and SVRI in the observation group were lower than those in the control group (P<0.05), while CI showed an opposite trend (P<0.05). The observation group had higher GEDVI than the control group on days 3 and 5 after treatment (P<0.05). ConclusionOn the basis of conventional bundle therapy, modified Linggui Zhugantang combined with Xuebijing injection with the effect of dispelling stasis, removing toxin, and promoting urination can inhibit the generation of myocardial injury markers and improve hemodynamics to shorten the length of ICU stay, mitigate the TCM syndrome, and reduce the risk of death, thereby improving the prognosis of SICM.
8.Characteristics of hemagglutinin-neuraminidase gene of human parainfluenza virus type 3 among patients with acute respiratory tract infection in Henan Province
Minghua SENG ; Sheng ZHAO ; Kaichao YANG ; Naiyue HU ; Zhibo ZHANG ; Jin XU ; Yonghao GUO
Chinese Journal of Microbiology and Immunology 2023;43(4):265-270
Objective:To analyze the molecular characteristics of hemagglutinin-neuraminidase (HN) gene of human parainfluenza virus type 3 (HPIV3) among the cases with acute respiratory tract infection (ARI) in Henan Province.Methods:Nasal/throat swab samples collected from patients with severe acute respiratory tract infection (SARI) in Luohe and patients with influenza-like illness (ILI) in Zhengzhou were used in this study. HPIV nucleic acids in the samples were detected using real-time fluorescent PCR. HPIV3-positive samples were subjected to RT-PCR for the amplification of HN genes and the sequences were analyzed with Sanger method. CExpress and MEGA7.0 software were used for sequences editing, evolution tree construction and gene sequence analysis.Results:A total of 374 throat swab samples collected form ARI cases in Luohe and Zhengzhou were tested and 20 (5.3%) of them were positive for HPIV3. Eighteen HPIV3 HN gene sequences were successfully amplified and all belonged to C3 subgroups, including 16 sequences of C3f genotype and two sequences of C3a genotype. The 18 HN gene sequences shared the homology of 97.6%-100.0% in nucleotide and 99.3%-100.0% in amino acid, but the differences between them and the prototype strain Wash/47885/57 were significant. There were 12 amino acid mutations shared by them, including four function-related mutations (H295Y, I391V, D556N and I53T). There were no significant differences in the nucleotide or amino acid sequences as compared with the epidemic strain of China/BCH4210A/2014.Conclusions:The C3f and C3a branches of HPIV3 were the epidemic genotypes in Henan Province in recent years and a local circulating prevalence might be established. Continuous and in-depth monitoring of HPIV3 C3 subtype would be of great significance for the prevention and control of HPIV3-associated diseases.
9.Effects of different treatments on prognosis of triple-negative breast cancer
Xiaojing LIU ; Minghua ZHU ; Si ZUO ; Di MENG ; Yan BI ; Wei WANG ; Shujuan JIN
Journal of International Oncology 2022;49(1):33-38
Objective:To analyze the clinical features and the effects of different treatments on 5-year overall survival (OS) rate and 5-year disease free survival (DFS) rate of stage 0-Ⅲ triple-negative breast cancer (TNBC).Methods:The data of 209 patients diagnosed as stage 0-Ⅲ TNBC in Ward 2 of Department of General Surgery of the Fifth Medical Center of PLA General Hospital from January 2004 to December 2013 were selected. The relationships between the clinical features, treatments and 5-year OS rate, 5-year DFS rate were retrospectively analyzed. Kaplan-Meier method was used to draw survival curves, and Cox proportional risk model was used for multivariate analysis.Results:Univariate analysis found that clinical stage and methods of surgery were associated with 5-year OS rate ( χ2=52.615, P<0.001; χ2=17.329, P=0.001) and 5-year DFS rate ( χ2=55.112, P<0.001; χ2=18.816, P<0.001). Multivariate analysis showed that clinical stage was an independent prognostic factor of DFS ( HR=3.637, 95% CI: 2.146-6.164, P<0.001) and OS ( HR=3.545, 95% CI: 2.091-6.009, P<0.001). For the TNBC patients without axillary lymph node metastasis ( n=118), the 5-year OS rates of patients with breast conservation surgery + sentinel lymph node biopsy, total breast resection + sentinel lymph node biopsy, modified radical mastectomy and breast conserving surgery + axillary lymph node dissection were 97.6%, 97.7%, 91.4%, 100% respectively, the 5-year DFS rates were 97.3%, 94.3%, 85.8%, 100% respectively, and there were no significant differences among the four groups ( χ2=3.369, P=0.338; χ2=3.868, P=0.276). The 5-year OS rate (74.5% vs. 91.1%) and 5-year DFS rate (73.6% vs. 86.8%) were significantly different in patients receiving neoadjuvant chemotherapy ( n=106) compared with those receiving adjuvant chemotherapy ( n=80) ( χ2=4.504, P=0.034; χ2=4.683, P=0.030). The patients receiving neoadjuvant chemotherapy had later clinical stages than those receiving adjuvant chemotherapy ( χ2=35.314, P<0.001). There were no significant differences in 5-year OS rate and 5-year DFS rate between the patients receiving neoadjuvant chemotherapy and adjuvant chemotherapy with the same clinical stage (all P>0.05). The 5-year OS rates of patients with pathologic complete response (pCR), partial response (PR) and stable disease (SD) obtained by neoadjuvant chemotherapy were 100%, 75.8% and 57.1% respectively, and the 5-year DFS rates were 100%, 74.5% and 55.7% respectively, with statistically significant differences ( χ2=10.086, P=0.006; χ2=10.399, P=0.006). Between the pCR group and the PR group, the 5-year OS rate ( χ2=4.238, P=0.040) and 5-year DFS rate ( χ2=4.525, P=0.033) were significantly different. Between the pCR group and the SD group, the 5-year OS rate ( χ2=8.163, P=0.004) and 5-year DFS rate ( χ2=8.509, P=0.004) were significantly different. Between the PR group and the SD group, the 5-year OS rate ( χ2=3.931, P=0.047) and 5-year DFS rate ( χ2=3.896, P=0.048) were significantly different. Conclusion:For the patients with stage 0-Ⅲ TNBC, clinical stage is an independent prognostic factor. For the TNBC patients without axillary lymph node metastasis, breast conservation surgery + sentinel lymph node biopsy, total breast resection + sentinel lymph node biopsy, modified radical mastectomy and breast conserving surgery + axillary lymph node dissection have similar outcomes. There is no significant difference between neoadjuvant chemotherapy and adjuvant chemotherapy in the prognosis of patients with the same clinical stage, but patients with pCR or PR obtained by neoadjuvant chemotherapy can achieve better survival.
10.Correlation between serum VEGF level and white matter hyperintensity and cognitive dysfunction in patients with cerebral small vessel disease
Jin WANG ; Jianhua ZHAO ; Hao LIU ; Junli LIU ; Fangli YANG ; Qiong LI ; Minghua WANG ; Panpan ZHAO ; Fan WANG ; Qing LI ; Zhixiu XU ; Junyan YUE ; Jian ZHANG ; Sibei JI ; Ruiyan CAI ; Shaomin LI
Chinese Journal of Behavioral Medicine and Brain Science 2022;31(4):333-340
Objective:To investigate the relationship between serum vascular endothelial growth factor (VEGF) levels and white matter high signal and non-dementia vascular cognitive dysfunction in patients with cerebral small vascular disease (CSVD).Methods:Total 106 patients with CSVD who were admitted to the Department of Neurology of the First Affiliated Hospital of Xinxiang Medical College from April 2019 to December 2020 were enrolled.They were divided into vascular cognitive impairment no dementia group (VCIND group, n=47) and no vascular cognitive impairment group (N-VCI group, n=59)according to mini-mental assessment scale (MMSE), Montreal cognitive assessment (MoCA) scale and activity of daily living scale (ADL). Serum VEGF levels were detected by enzyme-linked immunosorbent assay (ELISA). The baseline data, serum VEGF levels, MoCA score and Fazekas score were compared between the two groups.The correlation between serum VEGF level and white matter high signal and cognitive function was analyzed.SPSS 19.0 software was used for data processing.The statistical methods were t-test, Chi square test, nonparametric test, Logistic regression analysis, Pearson correlation analysis and Spearman correlation analysis. Results:There were significant differences in serum VEGF level((464.18±114.58)pg/mL, (414.17±45.80)pg/mL, F=22.880), MoCA score((13.07±6.48), (20.17±4.06), F=17.920) and Fazekas score (4(3, 5), 3(1, 3), Z=-4.189)between the two groups (all P<0.05). The level of VEGF( β=0.008, OR=1.008, 95% CI=1.001-1.015, P<0.05) was the influencing factor of cognitive function in patients with CSVD .The level of VEGF was negatively correlated with the total score of MoCA, attention and calculation power, and orientation ability ( r=-0.345, -0.373, -0.445, all P<0.05) and it was positively correlated with the total Fazekas score and the Fazekas score of paraventricular and deep white matter ( r=0.392, 0.495, 0.302, all P<0.05). There was a linear trend between the high signal grade of paraventricular and deep white matter and VCIND (both P<0.05). Conclusion:Serum VEGF level is correlated with cognitive function and white matter hyperintensity in patients with CSVD.The increase of VEGF level may be a factor reflecting cognitive dysfunction.In addition, with the increase of white matter hyperintensity level, the risk of VCIND in CSVD is increased.

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