Lung cancer is the malignant tumor with the highest morbidity and mortality. The tumor-node-metastasis (TNM) staging has gradually shown its limitations in the accurate prediction of lung cancer, so it is urgent to construct a new clinical predictive model to guide the prevention and treatment of lung cancer. In recent years, as a comprehensive evaluation system based on peripheral immune related parameters, the value of peripheral immunoscore in the construction of predictive model has gradually become prominent. By quantifying the quantity and proportion of immune components in peripheral blood, the score can dynamically reflect the overall immune function and tumor microenvironment characteristics of the body. This paper systematically summarizes the latest research progress of peripheral immunoscore in early diagnosis, drug efficacy prediction, early warning of adverse reactions and prognosis evaluation of lung cancer, aiming to tap its potential clinical application value and provide some ideas and directions for developing new lung cancer-related predictive models.
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Humans ; Lung Neoplasms/drug therapy* ; Tumor Microenvironment ; Prognosis

The life view of physique-qi-spirit trinity is the core theory for explaining the physiological activities of human body and the evolution of disease pathology in traditional Chinese medicine(TCM),and will bring about an overview of TCM tumorigenesis.This paper explores the biological basis of tumor from the perspective of disorders of physique,qi and spirit:there is a correlation between qi-physique transformation and energy and substance metabolism,and between spirit-emotion and neuromodulation;the nerve-metabolism pathway contributes to partial biological basis of tumor from the perspective of disorders of physique,qi and spirit.Furthermore,it puts forward the strategies for prevention and treatment with TCM through the simultaneous regulation of physique,qi and spirit:eliminating the mass to inhibit the tumor,and improving physique to preserve life in the view of treating physique;replenishing qi to strengthen the body,and ventilating qi to remove toxins in the view of treating qi;regulating the spirit to treat cancer through comprehensive therapy in the view of treating spirit.The exploration on the biological basis of tumor from the perspective of disorders of physique,qi and spirit will further embody the unique advantages of TCM theories in understanding malignant tumors,and will provide useful references for the model of synergistic prevention and treatment of malignant tumors with TCM.

Objective To investigate the application value of Revolution CT dual-low technique coronary angiography in coronary heart disease.Methods One hundred patients with suspected coronary heart disease were retrospectively selected and randomly divided into control group and observation group,who all were examined by Revolution CT.In the control group(50 cases),the tube voltage was 120 kV,the contrast agent iohexol was 350 mg I/mL,and the dose of contrast agent was 1 mL/kg.In the observation group(50 cases),the tube voltage was 100 kV,the contrast agent iohexol was 350 mg I/mL,and the dose of contrast agent was 0.8 mL/kg.All patients underwent coronary digital subtraction angiography(DSA)examination at the same time.The image quality(subjective and objective evaluation indexes)and radiation dose of the two groups were compared,the diagnostic value of the two methods for coronary artery stenosis was compared,and the diagnostic consistency with coronary DSA between the two methods were compared using the Kappa test,as well as the typical coronary images of the two groups were analyzed.Results There were no significant differences in the sub-jective image quality grade and excellence rate between the observation group and the control group(P＞0.05).The CT value and noise of the observation group were higher than those of the control group(P＜0.05).There were no statistically significant differ-ences in the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the right coronary proximal and the left coronary main trunk between the two groups(P＞0.05).Compared with the control group,the volume CT dose index(CTDIvol),dose length product(DLP),and effective dose(ED)were lower in the observation group(P＜0.05).Compared with the results of coronary DSA,the positive predictive value,negative predictive value,sensitivity,specificity and accuracy of the two methods were＞80％,while there was no significant difference between the two groups(P＞0.05).The Kappa value of the observation group versus coronary DSA diagnosis was 0.871,the Kappa value of the control group ver-sus coronary DSA diagnosis was 0.889,and the consistency of both methods versus coronary DSA diagnosis was good.Conclusion Revolution CT dual-low technigue coronary angiography has good diagnostic value for coronary heart disease and can significantly reduce the radiation dose while ensuring image quality.

【Objective】 To investigate the preparation quality and clinical application effect of pooled platelets with leukocytes reduced. 【Methods】 The quality and clinical effect of the buffy-coated method prepared pooled platelets leukocytes reduced (experimental group, n=40) and apheresis platelets leukocytes reduced (control group, n=40) were compared. 【Results】 The platelet volume (mL), platelet count (×10¹¹), red blood cell contamination (×10⁸) and residual white blood cell (×10⁶) of the experimental group and control group were 278.90±7.92 vs 276.52±8.01, 2.66±0.09 vs 2.66±0.83, 0.54±0.42 vs 0.83±0.84, 0.29±0.54 vs 0.27±0.51, respectively, with no significant difference. The results of bacterial culture were negative, all met the requirements of relevant national standards. In addition, the CCI (×10^3, 24 h) and PPR (%) were 15.11±9.86 vs 14.61±12.55 and 54.23±18.70 vs 61.41±19.09 respectively, with no significant difference, indicating a certain degree of therapeutic effect. 【Conclusion】 The quality and clinical therapeutic effect of pooled platelets leukocytes reduced were consistent with that of apheresis platelets leukocytes reduced.

Objective:To establish an evaluation index system of hospital culture construction led by Party building in public hospitals, and to explore the relationships among Party building, hospital culture and patient satisfaction, and explain the mediating effect of hospital culture between Party building and patient satisfaction.Methods:Literature review and two rounds of Delphi method were used to create an evaluation index system of hospital culture construction led by Party building in public hospitals. On such basis, a questionnaire was designed and 429 staff from 33 public hospitals in Shanghai were surveyed through April and June 2021. Cronbach α coefficient method and exploratory factor analysis were used to test the reliability and validity of the indexes, and the regression analysis method was used to verify the mediating effects. Results:Following two rounds of Delphi survey run by 14 experts, a performance evaluation index system for the hospital culture construction was constructed, comprising 5 level-1, 13 level-2 and 29 level-3 indexes. The Cronbach α coefficients of overall indexes and 5 level-1 indexes fell in the range of 0.860-0.901( P<0.01), and the retest reliability of overall index and 5 level-1 indexes fell between 0.91-0.93( P<0.01). Based on the exploratory factor analysis, all of the characteristic roots of the factors generated by orthogonal rotation were>1, and the total variance explained contribution rate was 56.84%, proving the good validity of the indexes. The effect of Party building on patient satisfaction was significant( β1=0.139, P<0.01), and that on hospital culture effect significant as well( β2=0.168, P<0.01), while that on patient satisfaction was also significant( β3=0.115, δ=0.448, P<0.01)with hospital culture effect introduced as the mediating effect. Conclusions:The evaluation index system of hospital culture construction led by Party building proves highly scientific and effective, and hospital culture plays to some extent a mediating role between Party building and patient satisfaction. This proves that Party building presents a significant transmission effect on patient satisfaction through hospital culture building. The study provides a reference for strengthening Party building and hospital culture construction and improving patient satisfaction in public hospitals.

Objective: To investigate the application value of real-time virtual sonography(RVS)in the diagnosis and treatment of complicated hepatolithiasis. Methods: The retrospective and descriptive study was conducted. The clinical data of 10 patients with complicated hepatolithiasis who were admitted to Hunan Provincial People′s Hospital between October 2017 and March 2018 were collected. There were 3 males and 7 females, aged from 40 to 69 years, with an average age of 57 years. Patients received abdominal color Doppler ultrasound examination, magnetic resonance cholangiopancreatography, and upper abdominal spiral computed tomography (CT) thinly scanning + enhanced examination. Data of CT examination were imported into RVS. RVS was used to locate hepatolithiasis, relationship between stones and vessels, anatomy of bile ducts and vessels in hepatic hilus. Surgical methods included RVS-guided hilar cholangiotomy, biliary stricturoplasty, bilateral hepatojejunostomy, hepatic segmentectomy (lobectomy), and hepatolithotomy. Observation indicators: (1) surgical and postoperative situations; (2) typical case analysis; (3) follow-up. Follow-up using outpatient examination was performed to detect residual stones up to June 2019. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results: (1) Surgical and postoperative situations: 10 patients underwent RVS-guided surgeries successfully for complicated hepatolithiasis, with successful match in RVS (difference between CT images and ultrosound images <2 mm). No residual stone was identified by choledochoscope during operation. The operation time and volume of intraoperative blood loss were 285 minutes (range, 210-360 minutes) and 200 mL (range, 100-600 mL), respectively. No blood transfusion was needed during the operations. The duration of hospital stay was 20.5 days (range, 14.0-29.0 days). There was no perioperative death. One patient had postoperative biliary leakage and abdominal infection, and was cured after conservative treatment. (2) Typical case analysis: the tenth patient, female, 60 years old, was diagnosed with complicated hepatolithiasis, and was prepared to undergo hepatolithotomy+ quadrate lobectomy and hilar cholangioplasty+ bilateral hepatojejunostomy. Preoperative CT images and intraoperative color Doppler ultrasound images of the patient were fused and matched on the sagittal section of the portal vein and the cross section of the right branch of portal vein, and stones and important vessels were marked on the images. After accurate positioning, a curette was used to remove the stones. Removal of biliary stones through hepatic parenchyma and peripheral dilated bile ducts was conducted at the site where stones obviously existed. After the stones were removed, the intrahepatic bile duct and hilar bile duct merged. The left end of the bile duct split was confirmed by real-time ultrasound. After location of portal vein was determined by ultrasound, vascular plastic surgery was perfomed to avoid stenosis. (3) Follow-up: 10 patients were followed up for 6-12 months, with a median follow-up time of 8 months. One of 10 patients was suspected residual stones at the right peripheral hepatic anterior lobe by postoperative angiography at 2 months after surgery, and was not removed stones by choledochoscope. The patient had no recurrent symptoms after T-tube removal. The other 9 patients had no residual stones. Conclusion RVS applied in complicated hepatolithiasis is helpful for the precise intraoperative diagnosis, and the surgical treatment can be safe and effective.

Objective:To explore the risk factors for overall complications after laparoscopic pancreaticoduodenectomy(LPD) and to establish postoperative pancreatic fistula prediction model for LPD.Methods:The clinical data of 176 patients undergoing LPD from Jan 2014 to Mar 2018 were retrospectively analyzed.Results:One died within 30 days. Five patients underwent reoperation. Seventy-three patients (41%) had complications including pancreatic fistula in 30 cases(17.0%), postoperative hemorrhage in 16 (9.1%); bile leakage in 10 (5.7%); abdominal infection in 6 (3.4%); wound infection in 4 (2.2%); pulmonary infection in 4 (2.2%); gastric emptying disorder in 3 (1.7%). Age, intraoperative blood loss, diabetes mellitus were risk factors for overall postoperative complications of LPD(all P<0.05); Age, male gender, pancreatic duct diameter, pancreas texture, lesion size were risk factors for pancreatic fistula after LPD(all P<0.05). Conclusions:Age, intraoperative blood loss, diabetes mellitus were risk factors for overall postoperative complications of LPD; Age, male gender, pancreatic duct diameter, pancreas texture, and lesion size were risk factors for pancreatic fistula after LPD.

Objective: To summarize our clinical experience and management of an anomalous proximal bile duct joining the cystic duct in laparoscopic cholecystectomy (LC). Methods: A retrospective study was conducted on 8 patients who had an anomalous right anterior bile duct joining the cystic duct who were treated at the Hunan Provincial People's Hospital from March 2003 to January 2019. Results: All the 8 patients were diagnosed to have gallstones cholecystitis on preoperative CT, MRI and abdominal ultrasound. There were no suggestions of an anomalous bile duct. A total of 6 patients underwent reoperation after LC due to abdominal pain and biliary peritonitis. These 6 patients were treated with drainage and T-tube insertion. In the other 2 patients, the anomalous bile duct opening which joined the cystic duct were detected during LC. There was one patient converted to open laparotomy with preservation of the cystic duct and underwent common bile duct T-tube drainage. The other patients continued with laparoscopic surgery. The cystic duct was partially resected with removal of gallbladder, followed by common bile duct drainage. The average follow-up period was 3.4 years and the results were satisfactory. Conclusions Biliary duct anomaly is the main cause of iatrogenic proximal bile duct injury during laparoscopic cholecystectomy. It is not uncommon to have the anomaly of insertion of right anterior segmental bile duct to the cystic duct. To avoid iatrogenic biliary tract injury, careful preoperative study of X-ray films, accurate identification of the intraoperative gallbladder triangle anatomical structures. Strict adherence to carry out the three-word procedure of " discrimination, cut, identify" will help to reduce the incidence of biliary tract complications in laparoscopic cholecystectomy.

Objective To investigate the clinical effects of laparoscopic pancreaticoduodenectomy (LPD) for distal cholangiocarcinoma.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 37 patients who underwent LPD for distal cholangiocarcinoma in the Hunan Provincial People's Hospital between January 2013 and November 2016 were collected.LPD for distal cholangiocarcinoma was performed using the "en-block" procedure.According to the principle of "one axis,two planes and four zones",anatomy used posterior approach,anterior approach and medial approach,lymph node dissection was performed from carotid sheath outside,and en bloc specimens were resected.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival situations.Follow-up using outpatient examination was performed to detect the patients' recurrence-free survival up to November 2017.Measurement data with normal distribution were represented as (x)±s.The survival curve and rate were drawn and calculated by the Kaplan-Meier method.Results (1) Surgical and postoperative recovery situations:all the 37 patients underwent successful LPD,without conversion to open surgery and perioperative death.The operation time,volume of blood loss and case with intraoperative blood transfusion were (326 ± 55) minutes,(176± 39)mL and 1,respectively.The time to initial exsufflation and time for diet intake were respectively (4.5± 1.6)days and (5.3±2.7)days.Of 37 patients,14 had postoperative complications,including 8 with pancreatic fistula (6 with biochemical fistula and 2 with grade B pancreatic fistula),1 with biliary fistula,3 with postoperative bleeding (2 with intra-abdominal bleeding and 1 with gastrointestinal anastomosis bleeding),2 with delayed gastric emptying (grage A),2 with intra-abdominal infection and 2 with pulmonary infection;the same patients can merge multiple complications.Three patients were in Clavien-Dindo classification ≥ Ⅲ.One patient received reoperation and other patients were improved by symptomatic treatment.Duration of hospital stay of 37 patients was 13.5 days (range,8.0-33.0 days).Eight patients underwent adjuvant chemotherapy of 4-6 cycles by taking orally tegafur or gemcitabine with cisplatin.(2) Postoperative pathological examination:tumor diameter and pancreatic duct diameter of 37 patients were (2.1±1.1)cm and (2.5±1.2) mm,respectively.Of 37 patients,9,13 and 15 were respectively detected in high-differentiated,moderate-differentiated and lowdifferentiated adenocarcinoma.Surgical margins:35 patients received R0 resection and 2 received R1 resection.Number of lymph node dissected,cases with lymph node metastasis and number of positive lymph nodes were respectively 18.5±4.9,16 and 1.7± 1.4.Analysis of lymph node metastasis location showed that the positive rates in 8a,12,13,14 and 17 groups lymph nodes were respectively 5.4％ (2/37),18.9％ (7/37),21.6％ (8/37),8.1％ (3/37) and 10.8％ (4/37);Perineural invasion (PNI),lymphovascular invasion (LVI),pancreatic invasion and duodenal invasion were identified in 14,9,16 and 6 patients,respectively.TNM stage:stage 0,Ⅰ A,Ⅰ B,ⅡA and Ⅱ B were respectively detected in 1,3,5,12 and 16 patients.(3) Follow-up situation:of 37 patients,36 were followed up for 6-45 months,with a median time of 26 months.The median recurrence-free survival time,1-and 3-year recurrence-free survival rates were respectively 28 months,80.6％ and 42.2％.Conclusion LPD is safe and effective for distal cholangiocarcinoma,and "en-block" resection not only helps to optimize the process of LPD for distal cholangiocarcinoma,but also has a significant effect on R0 resection and lymph node dissection.

Objective To investigate the diagnosis, treatments for primary hepatic neuroendocrine neoplasm (NEN) and the efficacy.Methods Clinical data of 10 patients with primary hepatic NEN admitted in Hunan People's Hospital from March 2013 to December 2015 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 3 males and 7 females, aged 21-65 years old and the median age was 45 years old. According to the WHO classification for digestive system tumor 2010 version, there were 6 cases of neuroendocrine tumor (NET) G2, and 4 cases of neuroendocrine carcinoma (NEC). The clinical data, imaging characteristics, treatment, tumor pathological characteristics and prognosis of the patients were analyzed.Results Right upper abdominal pain was observed in 5 cases, right upper abdominal mass in 1 case, asthenia and anorexia1 in 1 case, and the remaining 3 cases were found with tumor when receiving routine physical examination. For imaging finding, 8 cases were diagnosed as isolated liver mass, and 2 were found with multiple masses in the liver. All of the 10 patients were confirmed by pathological examination, of which 3 were diagnosed by biopsy before operation, and 7 were confirmed with pathology after operation. 6 cases underwent radical resection, 1 case received microwave ablation, 1 underwent liver resection and intravenous chemotherapy pump implantation, 1 received chemotherapy alone and 1 abandoned treatment. To the submission date of this article, 6 cases survived without recurrence, 1 case suffered recurrence 1 month after operation with multiple lymph node metastases in the peritoneum and remained alive. 2 cases died, 1 of which died of no treatment after biopsy, 1 died of multiple distant metastases after 1 period of chemotherapy, and 1 lost follow-up.Conclusions There is no specific clinical manifestations of hepatic NEN. It should be confirmed by pathological examination. Surgical resection is the first choice for treatment. For patients with unresectable mass, TACE, microwave ablation and chemotherapy can be applied.