1.Association between Modified Yiqi Huoxue Jiedu Formula (益气活血解毒方) or PARP Inhibitors Maintenance Therapy and Recurrence and Metastasis in Advanced Ovarian Cancer:A Propensity Score Matched Case-Control Study
Yongjia CUI ; Wenping LU ; Lei CHANG ; Yilin WEI ; Xiyue WANG
Journal of Traditional Chinese Medicine 2025;66(3):256-261
ObjectiveTo investigate the association between the maintenance treatment of modified Yiqi Huoxue Jiedu Formula (益气活血解毒方) or poly ADP ribose polymerase (PARP) inhibitors and the recurrence and metastasis of advanced ovarian cancer. MethodsA case-control study design was employed, dividing patients with advanced ovarian cancer into two groups based on the occurrence of recurrence and metastasis following first-line maintenance treatment. Patients with recurrence and metastasis comprised the case group, while those without recurrence and metastasis served as the control group. The previous first-line maintenance treatment method was set as the exposure factor in the study (with the use of modified Yiqi Huoxue Jiedu Formula defined as exposed and PARP inhibitors defined as unexposed). Basic information was collected for both groups, including the achievement of satisfactory R0 surgery, age, stage, neoadjuvant chemotherapy, lymph node metastasis, germline BRCA1/2 mutations, homologous recombination deficiency positivity, first-line maintenance treatment method (modified Yiqi Huoxue Jiedu Formula or PARP inhibitors), and CA125 levels after the last chemotherapy. The baseline data of the two groups were assessed for differences. If there exists difference, a 1∶1 nearest neighbor matching method was used for propensity score matching. Univariate and multivariate logistic regression analyses were employed to evaluate the association between the modified Yiqi Huoxue Jiedu Formula or PARP inhibitors and the recurrence and metastasis of ovarian cancer. ResultsA total of 201 patients with advanced ovarian cancer were included, with 97 in the case group and 104 in the control group. Both groups showed statistically significant differences in R0 surgery, stage, neoadjuvant chemotherapy, and CA125 levels after the last chemotherapy (P<0.05), indicating baseline imbalance. After propensity score matching, there were 71 patients in both the case and control groups, achieving baseline balance (P>0.05). Univariate logistic regression analysis indicated that the achievement of satisfactory R0 surgery (P = 0.006), disease stage (P = 0.001), the use of neoadjuvant chemotherapy (P = 0.024), treatment modality (P = 0.006), and CA125 levels after the last chemotherapy (P = 0.013) were associated with the recurrence and metastasis of ovarian cancer. Multivariate logistic regression analysis revealed that disease stage was an independent influencing factor for the recurrence and metastasis of ovarian cancer (P = 0.030), whereas the P-value for the correlation between first-line maintenance treatment and ovarian cancer was 0.188. ConclusionFirst-line maintenance treatment of ovarian cancer patients with the use of modified Yiqi Huoxue Jiedu Formula or PARP inhibitors does not correlate with the recurrence and metastasis of ovarian cancer.
2.Analysis of the Distribution of Traditional Chinese Medicine Syndrome Elements and Influencing Factors in Patients with Immune-Related Adverse Events from Malignant Tumors: A Retrospective Study Based on Propensity Score Matching
Xiyue WANG ; Wenping LU ; Zhili ZHUO
Journal of Traditional Chinese Medicine 2025;66(11):1147-1156
ObjectiveTo analyze the distribution of traditional Chinese medicine (TCM) syndrome elements in patients with immune-related adverse events (irAEs) associated with malignant tumor immunotherapy and to explore the influencing factors for the occurrence of irAEs. MethodsClinical data were retrospectively collected from malignant tumor patients treated with programmed death-1 (PD-1) inhibitors, including demographic information, tumor history, duration of immunotherapy, occurrence of irAEs, types and grades of irAEs (G1-G5), and TCM four-diagnostic information. Patients were divided into irAEs group and the non-irAEs group based on the occurrence of irAEs. Propensity score matching (PSM) at a 1∶2 ratio was performed to balance baseline characteristics between groups. Syndrome elements before treatment and cumulative contributions of syndrome elements before and after irAEs onset were evaluated using the "Syndrome Elements Differentiation Scale". Logistic regression analysis was conducted to identify factors associated with the occurrence of irAEs. The use of glucocorticoids in the irAEs group was also analyzed. ResultsAfter 1∶2 matching, 59 patients were included in the irAEs group and 118 were in the non-irAEs group. No statistically significant differences were found between groups in terms of age, gender, primary tumor site, pathological type, or tumor stage (P>0.05). Patients in the non-irAEs group were more likely to have received targeted therapy, while the irAEs group had a longer duration of immunotherapy and a higher rate of positive programmed death-ligand 1 (PD-L1) expression (P<0.05). In total, 72 irAEs events occurred among 59 patients, with an overall incidence rate of 19.4% (59/304) and a grade 3~5 incidence rate of 6.8% (4/59), mainly presenting as cardiotoxicity, nephrotoxicity, and pneumotoxicity.Before immunotherapy, the top three syndrome elements in the irAEs group were spleen (71.2%, 42/59), kidney (42.4%, 25/59), and lung (39.0%, 23/59). For the pathogenic nature elements, yin deficiency (52.5%, 31/59), phlegm (40.7%, 24/59), and dampness (35.6%, 21/59) ranked highest. Compared to the non-irAEs group, the distribution of spleen, kidney, liver, yin deficiency, and qi deficiency elements showed significant differences in the irAEs group (P<0.05). After the occurrence of irAEs, the cumulative contributions of spleen, lung, stomach, heart, yin deficiency, qi deficiency, and yang hyperactivity elements increased significantly (P<0.05). Multivariate Logistic regression analysis indicated that duration of immunotherapy, spleen syndrome element, kidney syndrome element, liver syndrome element, yin deficiency element, and qi deficiency element were independent risk factors for irAEs (P<0.05 or P<0.01). Among the irAEs patients, 15 received glucocorticoid combined with TCM treatment, while 6 received glucocorticoid therapy alone. Patients receiving combined treatment required lower doses and shorter courses of glucocorticoids compared to those treated with glucocorticoids alone (P<0.05). ConclusionIn malignant tumor patients, spleen, kidney, lung, yin deficiency, phlegm, dampness, and qi deficiency are the predominant syndrome elements before and after the occurrence of irAEs. However, elements such as heat and qi stagnation significantly increase after irAEs onset. Duration of immunotherapy, spleen, kidney, liver syndrome elements, yin deficiency, and qi deficiency are independent risk factors for the development of irAEs.
3.Comparison of detection and manifestations of metastatic hepatocellular carcinoma by ultrasound at different frequencies
Hong QIN ; Yuli ZHU ; Qiannan ZHAO ; Feihang WANG ; Hansheng XIA ; Wentao KONG ; Wenping WANG
Chinese Journal of Clinical Medicine 2025;32(3):500-504
Objective To explore the value of high-frequency ultrasound in the detection of metastatic hepatocellular carcinoma and displaying lesion characteristics. Methods A total of 38 paitients with hepatocellular carcinoma satellite lesions within 40 mm of subcutaneous tissue were underwent low-frequency (1-5 MHz) and high-frequency (6-9 MHz) ultrasound. Detection rates and ultrasonic features were compared. Results High-frequency grayscale ultrasound had a higher detection rate (71.1% vs. 36.8%, P<0.001). Subgroup analysis showed higher detection rates with chemotherapy history (88.9% vs. 33.3%, P=0.002), fatty liver (71.9% vs 31.3%, P<0.001) or superficial lesion (within 20 mm, 76.5% vs 41.2%, P=0.031). High-frequency ultrasound also showed clearer margins (P=0.004) and more arterial-phase rim enhancement (P=0.007). Conclusions 6-9 MHz ultrasound detects metastatic hepatocellular carcinoma, especially superficial lesions, more effectively than 1-5 MHz ultrasound and better visualizes characteristics.
4.Association of serum NRG4 and Metrnl levels with insulin resistance in patients with metabolic syndrome
Shichen ZHANG ; Wenping WANG ; Ping WANG ; Xiaojie DING ; Shanshan WANG ; Man QIN
International Journal of Laboratory Medicine 2025;46(5):580-584
Objective To investigate the association of neuregulin 4(NRG4)and meteorin-like protein(Metrnl)with insulin resistance in patients with metabolic syndrome(MS).Methods From September to November 2023,totally 60 MS patients in Anhui No.2 Provincial People's Hospital were selected as MS group,and 60 physical examination healthy people were selected as control group.The changes of human mor-phological indicators,biochemical indicators,blood routine,NRG4,Metrnl,insulin resistance index(HOMA-IR)and other indicators in the two groups were observed,and the correlation between NRG4,Metrnl and HO-MA-IR and each index was analyzed,and the diagnostic value of NRG4 and Metrnl for MS was evaluated.Re-sults Compared with the control group,the levels of white blood cell count(WBC),alanine aminotransferase(ALT),uric acid(UA),triglyceride(TG),total cholesterol(TC),fasting insulin(FINS),HOMA-IR,body weight,body mass index(BMI),waist circumference,hip circumference,waist-hip ratio(WHR),and body fat ratio were significantly increased in MS group(P<0.05),however,high density lipoprotein cholesterol(HDL-C),NRG4,and Metrnl were significantly decreased(P<0.05).Spearman correlation analysis showed that serum NRG4 was positively correlated with Metrnl and HDL-C(P<0.05),and negatively correlated with TG,FINS,HOMA-IR,body weight,waist circumference,hip circumference,WHR,and ALT(P<0.05).Serum Metrnl was positively correlated with NRG4 and HDL-C(P<0.05),and negatively correlated with TG and hip circumference(P<0.05).Binary Logistic regression analysis showed that NRG4 and Metrnl were protective factors for MS(P<0.05).The receiver operating characteristic curve analysis showed that the sensitivity of NRG4,Metrnl,and their combination for diagnosing MS was 67%,41%,and 67%,respec-tively,the specificity was 71%,95%,and 86%,respectively,and the area under the curve was 0.713,0.635,and 0.787,respectively.Conclusion The levels of serum NRG4 and Metrnl are decreased in MS patients,and NRG4 is associated with insulin resistance.The combination of NRG4 and Metrnl has a certain diagnostic val-ue for MS.
5.Relationship between peripheral blood MPV/PLT,BUN/Lp(a)and prognosis of patients with acute exacerbation of COPD
Xiaorong XU ; Yuxin QI ; Wenping YANG ; Xinyun SU ; Xiaoyue BAI ; Haibin WANG
International Journal of Laboratory Medicine 2025;46(16):1995-1999,2005
Objective To investigate the relationship between the mean platelet volume(MPV)to platelet count(PLT)ratio(MPV/PLT),blood urea nitrogen(BUN)to lipoprotein a[Lp(a)]ratio[BUN/Lp(a)]and the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods A total of 106 patients with acute exacerbation of COPD admitted to the hospital from January 2021 to January 2024 were selected as the research objects.According to the prognosis,they were divided into sur-vival group(72 cases)and death group(34 cases).The results of routine laboratory tests,blood lipid and lipo-protein levels were compared between the two groups.Multivariate Logistic regression was used to analyze the influencing factors of death in patients with acute exacerbation of COPD.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of MPV/PLT and BUN/Lp(a)for the prognosis of pa-tients with acute exacerbation of COPD.Results Compared with the survival group,the invasive ventilation rate,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,C reactive protein(CRP),white blood cell count(WBC),MPV,BUN,MPV/PLT and BUN/Lp(a)were significantly increased in the death group(P<0.05).The non-invasive ventilation rate,lymphocyte count,PLT and Lp(a)levels were signifi-cantly decreased(P<0.05).Multivariate Logistic regression analysis showed that APACHE Ⅱ score,CRP,WBC,lymphocyte count,MPV,PLT,MPV/PLT,BUN,Lp(a)and BUN/Lp(a)were the influencing factors of death in patients with acute exacerbation of COPD(P<0.05).ROC curve results showed that the sensitivity and specificity of MPV/PLT combined with BUN/Lp(a)for predicting the prognosis of patients with acute exacerbation of COPD were 88.2%and 84.7%,respectively,and the area under curve was 0.887.Conclusion MPV/PLT and BUN/Lp(a)are closely related to the prognosis of patients with acute exacerbation of COPD.The combination of MPV/PLT and BUN/Lp(a)has a high predictive value for the prognosis of patients.
6.Serum Vasostatin-1 and Autotaxin levels in patients with pre-eclampsia and their clinical significance
Wenping SUN ; Dexiong ZHAO ; Pinhua WANG ; Shenglan WANG
International Journal of Laboratory Medicine 2025;46(22):2726-2731
Objective To investigate the levels of serum Vasostatin-1 and Autotaxin and their clinical sig-nificance in patients with pre-eclampsia(PE).Methods A total of 120 patients with PE(PE group)admitted to the hospital from January 2021 to January 2023 and 60 healthy pregnant women who underwent routine prenatal examinations during the same period(control group)were selected as the research subjects.Accord-ing to the severity of the disease,the patients in the PE group were divided into the severe PE group(65 ca-ses)and the mild PE group(55 cases).According to the pregnancy outcomes,they were divided into the poor group(57 cases)and the good group(63 cases).The levels of serum Vasostatin 1 and Autotaxin were detec-ted by enzyme-linked immunosorbent assay.Multivariate unconditional Logistic regression was used to analyze the influencing factors of adverse pregnancy outcomes of PE.The receiver operating characteristic curve was drawn to evaluate the predictive value of serum Vasostatin 1 and Autotaxin levels for adverse pregnancy out-comes of PE.Results Compared with the control group,the levels of serum Vasostatin 1 and Autotaxin in the PE group increased,and the differences were statistically significant(Z=-5.924,-6.188;both P<0.001).Compared with the mild PE group,the levels of serum Vasostatin 1 and Autotaxin in the severe PE group in-creased,and the differences were statistically significant(Z=-4.667,-4.180;both P<0.001).Compared with the good group,the levels of serum Vasostatin 1 and Autotaxin in the poor group increased with statisti-cal significance(Z=-5.500,-5.390;both P<0.001).The results of Logistic regression analysis showed that severe PE(OR=3.383,95%CI:1.270-9.011),high 24 h urine protein(OR=1.888,95%CI:1.199-2.972),high Vasostatin-1(OR=1.022,95%CI:1.008-1.036)and Autotaxin(OR=4.370,95%CI:1.739-10.983)were independent risk factors for adverse pregnancy outcomes in patients with PE(P<0.05).The area under the curve for the combined prediction of adverse pregnancy outcomes in PE patients by serum Va-sostatin 1 and Autotaxin levels was 0.864(95%CI:0.790-0.920),which was greater than predicted sepa-rately,which were 0.791(95%CI:0.708-0.860),0.786(95%CI:0.701-0.855),and the differences were statistically significant(Z=2.595,2.462;both P<0.05).Conclusion Elevated serum Vasostatin-1 and Au-totaxin levels in PE patients are associated with the aggravation of the disease and adverse pregnancy out-comes.The combined detection of serum Vasostatin 1 and Autotaxin levels has a high predictive efficacy for the pregnancy outcomes of patients with PE.
7.Exploring Traditional Chinese Medicine Syndrome Characteristics Associated with Immunotherapy Efficacy in Cervical Cancer Using Propensity Score Matching
Zhili ZHUO ; Wenping LU ; Yongjia CUI ; Xiyue WANG ; Lei CHANG
Journal of Guangzhou University of Traditional Chinese Medicine 2025;42(8):1831-1838
Objective To investigate traditional Chinese medicine(TCM)syndrome characteristics associated with immunotherapy efficacy in cervical cancer using propensity score matching(PSM),aiming to identify the population benefiting from immunotherapy.Methods A retrospective analysis was conducted in 253 cervical cancer patients,who received the treatment with programmed death receptor 1(PD-1)inhibitors at Guang'anmen Hospital,China Academy of Chinese Medical Sciences from January 2020 to October 2024.Clinical data and TCM four-examination data were collected.After balancing the confounders via PSM(1∶1 matching)and with therapeutic efficacy as the dependent variable,multivariate logistic regression was performed to analyze the characteristics of TCM syndrome in the immunotherapy-response group and then a predictive model was constructed.Results(1)After matching with PSM,198 cases were included,99 cases in response group and 99 cases in non-response group.(2)Analysis of the distribution of TCM syndrome elements showed that the differences in the pathogenic syndrome elements of qi deficiency,qi stagnation,blood stasis,heat and phlegm between the two groups were statistically significant(P<0.05 or P<0.01),while there were no statistically significant differences in the disease-location syndrome elements of uterus,kidneys,lungs,spleen,liver,and heart,as well as in the pathogenic syndrome elements of blood deficiency,yin deficiency,yang deficiency,cold,and dampness(P>0.05).The main pathogenic syndrome elements in the response group were qi deficiency,blood deficiency and heat,while those in the non-response group were qi stagnation,heat and phlegm.(3)The results of univariate regression analysis showed that targeted therapy(P=0.040),programmed cell death-ligand 1(PD-L1)expression level(P<0.001),qi deficiency(P=0.009),blood deficiency(P<0.001),yang deficiency(P<0.001),yin deficiency(P<0.001),qi stagnation(P=0.003),blood stasis(P<0.001),cold(P<0.001),cold(P<0.001),heat(P<0.001),phlegm(P<0.001),and dampness(P<0.001)were the factors associated with the efficacy of PD-1 inhibitors.(4)The results of multivariate logistic regression analysis showed that previous targeted therapy(OR=0.36,95%CI:0.16-0.83)and pathogenic syndrome elements of qi stagnation(OR=0.23,95%CI:0.10-0.49),phlegm(OR=0.28,95%CI:0.13-0.61)were the risk factors of associated with the efficacy of PD-1 inhibitors,while PD-L1 expression level(OR=15.27,95%CI:2.60-89.63),and pathogenic syndrome element qi deficiency(OR=2.90,95%CI:1.42-5.89)were the protective factors associated with the efficacy of PD-1 inhibitors in cervical cancer.(5)Receiver operating characteristic(ROC)curve analysis demonstrated that the area under the ROC curve(AUC)of the predictive model for evaluating PD-1 inhibitor efficacy in cervical cancer was 0.78(95%CI:0.71-0.84),indicating certain predictive value.Conclusion PD-L1 expression level and TCM pathogenic syndrome elements such as qi deficiency,qi stagnation,and phlegm are the independent factors influencing PD-1 inhibitor efficacy in cervical cancer,providing insights for optimizing integrated TCM-western medicine treatment strategies.
8.Study on Distribution Characteristics of Intestinal Flora and its Relationship with Thyroid Function in Patients with Hashimoto's Thyroiditis
Rui TONG ; Wei ZHANG ; Jian WANG ; Jing WU ; Wenping WU
Journal of Modern Laboratory Medicine 2024;39(3):60-66
Objective To explore the intestinal flora distribution characteristics in patients with Hashimoto's thyroiditis(HT)and analyze the correlation between intestinal flora changes and HT and the predictive value on the occurrence of HT,so as to provide reference for clinical diagnosis and treatment of HT.Methods A total of 120 patients with HT admitted to Qinhuangdao Traditional Chinese Medicine Hospital from June 2022 to June 2023 were included in observation group,and 30 healthy physical examination subjects during the same period were enrolled as control group.Both groups performed intestinal flora detection and thyroid function detection.The α diversity and the relative abundance of intestinal flora at phylum level were compared between the two groups and among HT patients with different thyroid functions,and the correlation between α diversity of intestinal flora and relative abundance of intestinal flora at phylum level,serum levels of anti-thyroglobulin antibody(TgAb)and thyroid peroxidase antibody(TPOAb)and thyroid function was analyzed by spearman correlation analysis.Receiver operating characteristic(ROC)curve was used to analyze the predictive efficiency of α diversity and relative abundance of intestinal flora at phylum level on HT.Results Compared with control group,the intestinal flora α diversity indexes of shannon-wiener diversity index(shannon)and simpson diversity index(simpson)were lower in observation group[4.66±0.61 vs 5.21±0.46,0.89±0.06 vs 0.93±0.07],and the differences were statistically significant(r=4.617,3.156,P<0.05).The relative abundance of Bacteroidetes in observation group was lower than that in control group(52.31%±2.02%vs 58.59%±2.11%),while the relative abundances of Firmicutes,Proteobacteria,Fusobacteria,Actinobacteria and Verrucomicrobia were higher than those in control group(37.15%±2.43%vs 33.46%±2.56%,3.36%±0.26%vs 2.79%±0.19%,1.02%±0.09%vs 0.65%±0.11%,1.01%±0.12%vs 0.57%±0.13%,0.82%±0.11%vs 0.41%±0.09%),and the differences were statistically significant(t=15.096,7.360,11.267,19.231,17.665,18.882,all P<0.001).The levels of serum TgAb(169.12±10.23 IU/ml vs 18.59±1.78 IU/ml)and TPOAb(56.43±12.11 IU/ml vs 2.51±0.57 IU/ml)in observation group were higher compared with those in control group,and the differences were statistically significant(t=80.097,24.319,all P<0.001).Among 120 HT patients in this study,there were 89 cases with normal thyroid function and 31 cases with abnormal thyroid function.The intestinal flora α diversity indexes of shannon(4.49±0.64 vs 4.83±0.58),and simpson(0.87±0.07 vs 0.91±0.05)in patients with abnormal thyroid function were lower than those in normal patients,and the differences were statistically significant(t=2.736,3.439,all P<0.05).The relative abundance of Bacteroides was lower(49.10%±1.99%vs 55.52%±2.05%),while the relative abundances of Firmicutes,Proteobacteria,Fusobacteria,Actinobacteria and Verrucomicrobia were higher than those in normal people(38.87%±2.60%vs 35.43%±2.26%,3.60%±0.26%vs 3.12%±0.19%,1.15%±0.09%vs 0.89%±0.11%,1.16%±0.13%vs 0.86%±0.11%,0.97%±0.13%vs 0.67%±0.09%)],and the differences were statistically significant(t=15.128,7.016,9.849,14.576,12.464,14.148,all P<0.001).Spearman correlation analysis showed that the intestinal flora α diversity indexes(shannon and simpson)and relative abundance of Bacteroides in patients with HT were negatively correlated with serum TgAb and TPOAb levels(r=-0.436,-0.427,-0.402;-0.419,-0.456,-0.416,all P<0.001),but were positively correlated with thyroid function(r=0.401,0.409,0.487,all P<0.001).The relative abundances of Firmicutes,Proteobacteria,Fusobacteria,Actinobacteria and Verrucomicrobia were positively correlated with serum TgAb and TPOAb levels(r=0.411,0.441,0.447,0.421,0.447;0.425,0.415,0.438,0.402,0.469,all P<0.001),but were negatively correlated with thyroid function(r=-0.412,-0.417,-0.475,-0.463,-0.471,all P<0.001).ROC curve analysis revealed that the best cut-off value,the area under curve(AUC),sensitivity,specificity,95%confidence interval(95%CI)and Youden index in shannon,simpson,combined detection of simpson and shannon,and the combined detection of relative abundance of intestinal bacteria at phylum level for predicting HT were 4.677,0.749,49.17%,96.67%,95%CI(0.672~0.816)and 0.458;0.940,0.644,80.00%,53.33%,95%CI(0.562~0.721)and 0.333;0.752,85.83%,50.00%,95%CI(0.664~0.810)and 0.462;0.743,96.67%,46.67%,95%CI(0.665~0.811)and 0.548,respectively Conclusion HT had intestinal flora imbalance which was related to thyroid cell destruction and thyroid dysfunction in patients with HT.Intestinal flora detection has predictive efficiency on HT.
9.Minimally invasive robot-assisted treatment of tibial plateau fractures of Schatzker types Ⅱ and Ⅲ that can be indirectly reduced
Fei XIAO ; Wenping HE ; Junwen WANG ; Jing JIAO ; Ming CHEN ; Yucheng HUANG ; Keke CHENG ; Tianrun LEI
Chinese Journal of Orthopaedic Trauma 2024;26(7):604-610
Objective:To explore the advantages of minimally invasive internal fixation assisted by an orthopedic robot in the treatment of tibial plateau fractures of Schatzker types Ⅱ and Ⅲ that can be indirectly reduced.Methods:A retrospective study was conducted of the 18 patients who had been treated for tibial plateau fractures of Schatzker types Ⅱ and Ⅲ at Department of Orthopaedics, The Fourth Hospital of Wuhan from December 2019 to December 2021. They were 12 males and 6 females with an age of (45.2±9.6) years. All fractures were closed. Of them, 6 were complicated with an avulsion fracture at the insertion point of the anterior cruciate ligament, 1 with tear of the medial collateral ligament, and 8 with tear of the lateral meniscus. All patients were treated with minimally invasive internal fixation using the "fence" screw technique after indirect reduction assisted by an orthopedic surgical robot. Those combined with avulsion fracture of the anterior cruciate ligament and meniscus tear underwent one-stage arthroscopic surgery, while those combined with tear of the medial collateral ligament underwent one-stage open repair. The fracture reduction was evaluated according to the Rasmussen radiological scoring system, and the knee joint function evaluated using the American Hospital for Special Surgery (HSS) scoring system.Results:All the 18 patients were fully followed up for (10.6±1.9) months. The X-ray films immediately after surgery showed good fracture reduction. The fractures healed after (11.3±1.2) weeks. At 6 months after surgery, the Rasmussen knee score was (16.8±1.0) points, giving 5 excellent and 13 good cases; the HSS score was (93.2±3.0) points, giving 17 excellent and 1 good cases. By the last follow-up, no serious complications occurred, such as common peroneal nerve injury, popliteal vascular injury, postoperative infection, or internal fixation failure.Conclusion:Since minimally invasive internal fixation assisted by an orthopedic robot can lead to fine clinical efficacy for tibial plateau fractures of Schatzker types Ⅱ and Ⅲ, this technique can be widely applied in clinical practice.
10.A nomogram to predict the risk of postoperative recurrence of hepatocellular carcinoma based on preoperative clinical indicators and ultrasound features
Yadan XU ; Feihang WANG ; Kailing CHEN ; Yang TANG ; Qi ZHANG ; Wenping WANG ; Wentao KONG ; Zhengbiao JI ; Xiaolong ZHANG
Chinese Journal of Hepatobiliary Surgery 2024;30(8):566-571
Objective:To establish a nomogram prediction model for recurrence within 2 years after radical resection of hepatocellular carcinoma (HCC) based on clinical and ultrasonographic characteristics.Methods:Clinical data from 405 HCC patients (including 327 males and 78 females), aged 60 (53, 66) years old, who underwent radical hepatectomy in the Zhongshan Hospital, Fudan University, from January to December 2021, were retrospectively collected. The patients were divided into two groups: the training group ( n=283) and the validation group ( n=122). Based on recurrence within 2 years after surgery, the 283 patients in the training group were further categorized into the recurrence group ( n=73) and the non-recurrence group ( n=210). Among the 122 patients in the validation group, 33 had recurrence within 2 years, while 89 did not. Data on age, microvascular invasion, alpha-fetoprotein (AFP), AFP lentil lectin-reactive fraction (AFP-L3), protein induced by vitamin K absence or antagonist-II (PIVKA-II), tumor number, and enhancement homogeneity were collected. Logistic regression analysis was performed on the training group to identify risk factors associated with postoperative recurrence, and a nomogram model for predicting HCC recurrence was constructed based on these factors. Calibration curves were used to compare the consistency between predicted and actual outcomes in both the training and validation groups. Results:Multivariate logistic regression analysis revealed that younger age ( OR=0.976, 95% CI: 0.953-1.000, P=0.004), higher AFP-L3 ( OR=1.066, 95% CI: 1.014-1.120, P=0.012), higher PIVKA-II ( OR=1.000, 95% CI: 1.000-1.001, P=0.042), multiple tumors ( OR=0.399, 95% CI: 0.225-0.706, P=0.038), and heterogeneous enhancement ( OR=0.472, 95% CI: 0.243-0.916, P=0.045) were significant risk factors for recurrence after partial hepatectomy in HCC patients. The nomogram constructed based on these variables had a C-index of 0.87 (95% CI: 0.81-0.93) in the training group and 0.83 (95% CI: 0.77-0.89) in the validation group. The calibration curves for predicting recurrence within 2 years after partial hepatectomy in HCC patients showed a high degree of fit in both the training and validation groups, indicating a good agreement between predicted and actual outcomes. Conclusion:The nomogram model constructed based on preoperative clinical and ultrasonographic characteristics can effectively predict the risk of recurrence within 2 years after radical resection of HCC.

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