Objective:To explore the effect of inflammatory cell levels on the anticoagulant efficacy in patients with liver cirrhosis complicated with portal vein thrombosis (PVT).Methods:A total of 106 patients with liver cirrhosis complicated with PVT who visited the Zhongshan Hospital, Fudan University from 2017 to 2022 were prospectively included. The PVT grade and recanalization were evaluated by imaging. Cox regression was used to analyze the predictive factors of anticoagulation efficacy. The time-dependent receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value of inflammatory cells for predicting anticoagulation efficacy. The Kaplan-Meier method was used to compare the 1-year PVT recanalization rate of patients with different levels of inflammatory cells.Results:Univariate analysis showed that Child-Pugh score ( HR=1.41), D-dimer ( HR=0.98), platelet ( HR=0.98), C-reactive protein to lymphocyte ratio ( HR=1.01), monocyte ( HR=0.21), lymphocyte ( HR=0.34), and prothrombin time( HR=1.32) was related to the improvement of PVT (all P<0.05). Multivariate analysis confirmed that lymphocytes ( HR: 0.41, 95% CI: 0.20-0.85, P=0.016) and prothrombin time ( HR: 1.23, 95% CI: 1.01-1.50, P=0.036) were independent predictors of anticoagulant efficacy. Grouped according to the ROC cutoff value, the 1-year recanalization rate of PVT in the high-level lymphocyte group (4.55% vs 32.84%, P=0.012) and the high-level monocyte group (5.56% vs 31.4%, P=0.028) was significantly lower than that in the low-level group. After excluding patients undergoing splenectomy, the recurrence rate in the high-level lymphocyte group was still lower than that in the low-level group (6.25% vs 33.77%, P=0.038). Conclusions:Among patients with liver cirrhosis accompanied by PVT, high levels of lymphocytes and monocytes are the key factors for the poor efficacy of anticoagulation therapy. For PVT patients with poor anticoagulation efficacy, the therapeutic strategy of anti-inflammatory combined with anticoagulation can be considered for exploration in the future.

Objective:To explore the effect of inflammatory cell levels on the anticoagulant efficacy in patients with liver cirrhosis complicated with portal vein thrombosis (PVT).Methods:A total of 106 patients with liver cirrhosis complicated with PVT who visited the Zhongshan Hospital, Fudan University from 2017 to 2022 were prospectively included. The PVT grade and recanalization were evaluated by imaging. Cox regression was used to analyze the predictive factors of anticoagulation efficacy. The time-dependent receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value of inflammatory cells for predicting anticoagulation efficacy. The Kaplan-Meier method was used to compare the 1-year PVT recanalization rate of patients with different levels of inflammatory cells.Results:Univariate analysis showed that Child-Pugh score ( HR=1.41), D-dimer ( HR=0.98), platelet ( HR=0.98), C-reactive protein to lymphocyte ratio ( HR=1.01), monocyte ( HR=0.21), lymphocyte ( HR=0.34), and prothrombin time( HR=1.32) was related to the improvement of PVT (all P<0.05). Multivariate analysis confirmed that lymphocytes ( HR: 0.41, 95% CI: 0.20-0.85, P=0.016) and prothrombin time ( HR: 1.23, 95% CI: 1.01-1.50, P=0.036) were independent predictors of anticoagulant efficacy. Grouped according to the ROC cutoff value, the 1-year recanalization rate of PVT in the high-level lymphocyte group (4.55% vs 32.84%, P=0.012) and the high-level monocyte group (5.56% vs 31.4%, P=0.028) was significantly lower than that in the low-level group. After excluding patients undergoing splenectomy, the recurrence rate in the high-level lymphocyte group was still lower than that in the low-level group (6.25% vs 33.77%, P=0.038). Conclusions:Among patients with liver cirrhosis accompanied by PVT, high levels of lymphocytes and monocytes are the key factors for the poor efficacy of anticoagulation therapy. For PVT patients with poor anticoagulation efficacy, the therapeutic strategy of anti-inflammatory combined with anticoagulation can be considered for exploration in the future.

Objective To compare the efficacy and safety of endoscopic ligation treatment and endoscopic tissue glue injection for secondary prevention of gastric variceal bleeding.Methods Patients with cirrhosis and esophagogastric variceal bleeding treated with gastric variceal ligation in Zhongshan Hospital,Fudan University,from January 2017 to December 2019 were screened(ligation group).And during the same period,patients underwent endoscopic cyanoacrylate treatment were also screened(tissue glue group).59 patients were included in the two groups after propensity score matching.Univariate and multivariate Cox proportional hazard regression models were used to anslyze risk factors for re-bleeding.Kaplan-Meier curves were plotted to analyze re-bleeding rate and mortality of the two treatment groups.Results There was no statistically significant difference in the eradication rate of esophagogastric varices between the ligation group and the tissue glue group(83.05％vs 79.66％,P=0.778);the ligation group required fewer median endoscopic treatments for variceal eradication(2 vs 3,P=0.017)and a lower average dosage of cyanoacrylate(0.70 mL vs 2.67 mL,P＜0.001).Multivariate Cox regression analysis showed that portal shunt was a risk factor for esophagogastric varices re-bleeding(HR=3.14,95％CI 1.02-9.68,P=0.046),endoscopic variceal ligation was a protective factor against re-bleeding(HR=0.25,95％CI 0.08-0.71,P=0.010).Compared with endoscopic cyanoacrylate injection,endoscopic ligation treatment did not significantly increase the 2-year risk of esophagogastric variceal re-bleeding(18.69％vs 36.29％,P=0.067)or risk of death(1.69％vs 3.39％,P=1.000);patients with GOV1 type had a significantly lower risk of re-bleeding after endoscopic ligation treatment(0 vs 40.27％,P=0.012)and there was a trend towards a lower re-bleeding risk in patients with GOV2 type after endoscopic ligation treatment(13.27％vs 34.16％,P=0.056).Conclusions Endoscopic ligation treatment has higher eradication rate for esophagogastric varices,and does not increase the risk of re-bleeding,death,or other adverse events.Therefore,it can be considered an effective secondary prevention way for patients with gastric varices.

Objective:To explore changes in the serum TBNK lymphocyte subset levels in patients with lung cancer undergoing chemother-apy and analyze their correlation with prognosis.Methods:Ninety-two patients undergoing standard regimen lung cancer chemotherapy who attended Beijing Jingmei Group General Hospital from January 2020 to June 2023 were selected.The level of TBNK lymphocyte subpop-ulations was detected before the first chemotherapy and after one and three cycles of chemotherapy.Their prognosis was evaluated 3 months after the end of chemotherapy and assigned into the remission group(63 cases)and the non-remission group(29 cases).The correl-ation between the levels of TBNK lymphocyte subsets and prognosis was analyzed.Results:The CD3+,CD3+CD4+,and CD3-CD19+levels in the stage Ⅲ group were lower than those in the stage Ⅳ group after one and three cycles of chemotherapy,while the CD3+CD8+and CD3-CD16+CD56+levels were higher than those in the stage Ⅳ group(P<0.05).The CD3+,CD3+CD4+,and CD3-CD19+levels in the remission group were lower than those in the non-remission group after one and three cycles of chemotherapy,while the CD3+CD8+and CD3-CD16+CD56+levels were higher than those in the non-remission group(P<0.05).The staging and prognosis of lung cancer patients un-dergoing chemotherapy positively correlated with CD3+,CD3+CD4+,and CD3-CD19+,and negatively correlated with CD3+CD8+and CD3-CD16+CD56+(P<0.05).The area under the curve(AUC)of the TBNK lymphocyte subsets combined to predict the prognosis of lung can-cer patients after three cycles of chemotherapy was the highest,reaching 0.907(P<0.05).The TBNK lymphocyte subsets have a good risk warning effect on the prognosis of patients with lung cancer undergoing chemotherapy.Conclusions:Changes in peripheral blood TBNK lymphocyte subsets in patients with lung cancer undergoing chemotherapy were associated with immune function status and prognosis.Monitoring the levels of the relevant indicators can predict the prognosis of patients with lung cancer undergoing chemotherapy.

Objective:A cohort of patients with oxaliplatin-associated portal hypertension was established and compared with patients with hepatitis B or schistosomiasis-associated cirrhotic portal hypertension to explore the course, disease features and prognosis of endoscopic treatment.Methods:From January 1, 2014 to December 31, 2021, patients diagnosed with portal hypertension and gastroesophageal varices after oxaliplatin chemotherapy at Zhongshan Hospital of Fudan University were selected (oxaliplatin general group). The patients who received endoscopic treatment for the first time because of esophagogastric variceal bleeding in the oxaliplatin general group were included in the oxaliplatin group. From January 1, 2014 to December 31, 2016, patients who initially received endoscopic treatment for the first time because of esophagogastric variceal bleeding due to hepatitis B or schistosomiasis-associated cirrhotic portal hypertension at Zhongshan Hospital of Fudan University were enrolled (hepatitis B group and schistosomiasis group). The history of oncology and chemotherapy, laboratory results, imaging and pathological findings were collected, and the clinical features were analyzed. Clinical data were collected, and the clinical features, 3-year cumulative non-bleeding rate and survival rate after endoscopic treatment of the 3 groups including oxaliplatin group, hepatitis B group and schistosomiasis group were compared. Kaplan-Meier survival curve was drawn to estimate treatment effects, and log-rank method was performed to test the differences in survival curves. Chi-square test and Mann-Whitney U test were used for statistical analysis. Results:There were 93 patients in oxaliplatin general group, with a median chemotherapy course of 8 (ranged from 6 to 10) cycles, and the median time from the end of chemotherapy to the diagnosis of gastroesophageal varices was 4 (ranged from 2 to 6) years. There were 55 patients in oxaliplatin group, 191 cases in hepatitis B group and 96 cases in schistosomiasis group. There were 78.5% (73/93) of patients in the oxaliplatin group classified as Child-Pugh grade A, and 33 patients (35.5%) with portal vein thrombosis. The abdominal imaging showed no obvious liver cirrhosis such as liver shrinkage and uneven surface. The pathology of 11 patients with liver biopsy in the oxaliplatin general group showed mainly vascular injury and fibrous deposition in the confluent area with lymphocytic infiltration, mild hepatocellular injury, and no pseudolobule formation. In terms of baseline characteristics, direct bilirubin, alanine transaminase, and aspartate transaminase levels of patients in the oxaliplatin group were all lower than those of the hepatitis B group and schistosomiasis group (4.8 (3.9, 6.5) μmol/L vs. 6.4 (4.7, 9.0) and 6.5 (4.4, 9.4) μmol/L; 17 (13, 22) U/L vs. 22 (15, 31) and 19 (15, 27) U/L; 22 (19, 25) U/L vs. 28 (22, 39) and 29 (22, 42) U/L), while albumin and prealbumin levels and the proportion of patients with Child-Pugh grade A were all higher than those of the hepatitis B group and schistosomiasis group (39.0 (35.0, 42.5) g/L vs. 34.0 (30.0, 38.3) and 33.8 (29.5, 36.0) g/L; 0.160 (0.130, 0.197) g/L vs. 0.120 (0.090, 0.150) and 0.110 (0.080, 0.140) g/L; 74.5% (41/55) vs. 55.5% (106/191) and 42.7% (41/96)), and the differences were all statistically significant ( U=3 298.50, 2 749.00, 2 159.00, 7 759.00, 5 822.50, χ2=6.92 and U=1 622.00, 1 878.50, 1 305.50, 3 989.00, 3 264.50, χ2=16.36; all P<0.05). The 3-year rebleeding risk in the oxaliplatin group was higher than that in the hepatitis B group ( HR=1.80, 95% confidence interval 1.07 to 3.02, P=0.026), but the difference was not statistically significant compared with that of the schistosomiasis group ( HR=1.04, 95% confidence interval 0.61 to 1.78, P=0.874). There were no statistically significant differences in the 3-year cumulative survival rate between the oxaliplatin group and the hepatitis B group and schistosomiasis group (96.4% (53/55) vs. 94.8% (181/191) and 95.8% (92/96), both P>0.05). Conclusions:The pathology of liver injury in patients with oxaliplatin-associated portal hypertension are mainly vascular injury and fibrous deposition in the confluent area. The efficacy of endoscopic treatment to prevent rebleeding in patients with oxaliplatin-associated portal hypertension is significantly inferior to that in patients with hepatitis B-associated portal hypertension, but comparable to that in patients with schistosomiasis-associated portal hypertension.

Objective:A cohort of patients with oxaliplatin-associated portal hypertension was established and compared with patients with hepatitis B or schistosomiasis-associated cirrhotic portal hypertension to explore the course, disease features and prognosis of endoscopic treatment.Methods:From January 1, 2014 to December 31, 2021, patients diagnosed with portal hypertension and gastroesophageal varices after oxaliplatin chemotherapy at Zhongshan Hospital of Fudan University were selected (oxaliplatin general group). The patients who received endoscopic treatment for the first time because of esophagogastric variceal bleeding in the oxaliplatin general group were included in the oxaliplatin group. From January 1, 2014 to December 31, 2016, patients who initially received endoscopic treatment for the first time because of esophagogastric variceal bleeding due to hepatitis B or schistosomiasis-associated cirrhotic portal hypertension at Zhongshan Hospital of Fudan University were enrolled (hepatitis B group and schistosomiasis group). The history of oncology and chemotherapy, laboratory results, imaging and pathological findings were collected, and the clinical features were analyzed. Clinical data were collected, and the clinical features, 3-year cumulative non-bleeding rate and survival rate after endoscopic treatment of the 3 groups including oxaliplatin group, hepatitis B group and schistosomiasis group were compared. Kaplan-Meier survival curve was drawn to estimate treatment effects, and log-rank method was performed to test the differences in survival curves. Chi-square test and Mann-Whitney U test were used for statistical analysis. Results:There were 93 patients in oxaliplatin general group, with a median chemotherapy course of 8 (ranged from 6 to 10) cycles, and the median time from the end of chemotherapy to the diagnosis of gastroesophageal varices was 4 (ranged from 2 to 6) years. There were 55 patients in oxaliplatin group, 191 cases in hepatitis B group and 96 cases in schistosomiasis group. There were 78.5% (73/93) of patients in the oxaliplatin group classified as Child-Pugh grade A, and 33 patients (35.5%) with portal vein thrombosis. The abdominal imaging showed no obvious liver cirrhosis such as liver shrinkage and uneven surface. The pathology of 11 patients with liver biopsy in the oxaliplatin general group showed mainly vascular injury and fibrous deposition in the confluent area with lymphocytic infiltration, mild hepatocellular injury, and no pseudolobule formation. In terms of baseline characteristics, direct bilirubin, alanine transaminase, and aspartate transaminase levels of patients in the oxaliplatin group were all lower than those of the hepatitis B group and schistosomiasis group (4.8 (3.9, 6.5) μmol/L vs. 6.4 (4.7, 9.0) and 6.5 (4.4, 9.4) μmol/L; 17 (13, 22) U/L vs. 22 (15, 31) and 19 (15, 27) U/L; 22 (19, 25) U/L vs. 28 (22, 39) and 29 (22, 42) U/L), while albumin and prealbumin levels and the proportion of patients with Child-Pugh grade A were all higher than those of the hepatitis B group and schistosomiasis group (39.0 (35.0, 42.5) g/L vs. 34.0 (30.0, 38.3) and 33.8 (29.5, 36.0) g/L; 0.160 (0.130, 0.197) g/L vs. 0.120 (0.090, 0.150) and 0.110 (0.080, 0.140) g/L; 74.5% (41/55) vs. 55.5% (106/191) and 42.7% (41/96)), and the differences were all statistically significant ( U=3 298.50, 2 749.00, 2 159.00, 7 759.00, 5 822.50, χ2=6.92 and U=1 622.00, 1 878.50, 1 305.50, 3 989.00, 3 264.50, χ2=16.36; all P<0.05). The 3-year rebleeding risk in the oxaliplatin group was higher than that in the hepatitis B group ( HR=1.80, 95% confidence interval 1.07 to 3.02, P=0.026), but the difference was not statistically significant compared with that of the schistosomiasis group ( HR=1.04, 95% confidence interval 0.61 to 1.78, P=0.874). There were no statistically significant differences in the 3-year cumulative survival rate between the oxaliplatin group and the hepatitis B group and schistosomiasis group (96.4% (53/55) vs. 94.8% (181/191) and 95.8% (92/96), both P>0.05). Conclusions:The pathology of liver injury in patients with oxaliplatin-associated portal hypertension are mainly vascular injury and fibrous deposition in the confluent area. The efficacy of endoscopic treatment to prevent rebleeding in patients with oxaliplatin-associated portal hypertension is significantly inferior to that in patients with hepatitis B-associated portal hypertension, but comparable to that in patients with schistosomiasis-associated portal hypertension.

Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Logistic Models ; Phenotype ; Risk Factors

Objective:This study aimed to evaluate the rebleeding risk and prognosis of patients being treated after acute esophageal varices bleeding by two different treatment strategies: sclerosing agent combined with tissue glue injection, esophageal varices ligation (EVL), through comparing the therapeutic effects and securities.Methods:A total of 76 patients who underwent endoscopy and received treatment in Zhongshan Hospital Affiliated to Fudan University due to acute esophageal variceal bleeding were included retrospectively. 6 patients with active bleeding and 70 patients with thrombus in esophagus varices under gastroscopy. Among them, 21 cases were treated with sclerosing agent combined with tissue glue injection (sclerosing tissue glue group), and 55 cases were treated with EVL (EVL group). The emergency endoscopic diagnosis and treatment of the two groups were compared, and the risk factors of rebleeding 6 months after endoscopic treatment were analyzed by univariate and multivariate analysis.Results:All patients received endoscopic treatment successfully. During the follow-up period of 6 months after endoscopic treatment, rebleeding occurred in 13 cases. Kaplan Meier analysis showed that the 6-month rebleeding rate in the sclerosing tissue glue group was significantly higher than that in the EVL group (41.6% vs 12.3%, P=0.011). There were 8 deaths in total. Kaplan Meier analysis showed that there was no significant difference in 6-month mortality between the two groups (17.5% vs 10.1%, P=0.616). Multivariate analysis further showed that malignant tumor ( HR=3.700, 95% CI: 1.187-11.536, P=0.024) and treatment mode of esophageal variceal bleeding ( HR=4.834, 95% CI: 1.443-16.193, P=0.011) were independent risk factors for rebleeding 6 months after endoscopic treatment of acute esophageal variceal bleeding. Conclusions:This study found that EVL and the combining injection of lauromacrogol and cyanoacrylate could be used in emergent hemostatic treatment for acute esophageal varices bleeding. Moreover, EVL is the prioritized approach in endoscopic emergency treatment with a lower rebleeding rate and fewer complications. Sclerotherapy combined with tissue glue can be used as one of the measures of emergency treatment, which is not better than ligation.

Objective: To systematically analyze the distribution of research hotspots related to the COVID, provide reference for future scientific research. Methods: Relevant literatures collected by PubMed database since December 1, 2019 were retrieved, the key information related to literatures was extracted and analyzed, and the wordcloud2 package of R software was used for word frequency analysis. Results: A total number of 194 valid papers were obtained, which published in 81 journals. Most papers was published in early February 2020, and a maximum of 24 papers were published in a single day. 167 papers (86.08%) were written in English. These papers included case reports, expert opinions, guidelines, articles, reviews, communications and other forms, and the subjects included epidemiology, prevention and control, virology, diagnosis and treatment, pathology and etiology, vaccines and drugs, epidemic prediction models, and bioinformatics analysis. The proportion of article in English literatures was higher than that in Chinese literatures (P=0.005). Among them, 91 papers (46.9%) were independently completed by the Chinese researchers, 15 papers (7.7%) were completed by the Chinese and foreign researchers, and 88 papers (45.4%) were completed by foreign researchers. Conclusions At present, the researches on the new coronavirus pneumonia mainly focus on virology and epidemiology, but lack of relevant research results such as treatment and prognosis.

Objective To investigate the factors influencing the image quality of prostate magnetic resonance spectroscopy (MRS),and to put forward quality control measures to improve MRS in success ratio and image quality.Methods Totally 1 255 patients with prostate diseases confirmed pathologically from October 2009 to December 2015 had their MRS data analyzed retrospectively.MRS was executed with multi-voxel 3D chemical shift imaging technique,and special-purpose software was involved in for post processing.Re-scanning would be performed in case of baseline clutter,low SNR and etc.Results There were 1 218 patients had MRS executed well in preparedness,positioning,parameters setup,post processing,baseline and chemical shift,one patient underwent unsuccessful MRS due to incorrect bed mode,9 ones due to unstable baseline resulting from unsatisfactory preparedness,26 ones due to unstable baseline resulting from bad shimming and 1 case due to non-standard post processing.Conclusion Prostate SRS depends on patient preparedness,positioning,parameters setup,shimming and post processing.