Background/Aims: Existing hepatocellular carcinoma (HCC) prediction models are derived mainly from pretreatment or early on-treatment parameters. We reassessed the dynamic changes in the performance of 17 HCC models in patients with chronic hepatitis B (CHB) during long-term antiviral therapy (AVT). Methods: Among 987 CHB patients administered long-term entecavir therapy, 660 patients had 8 years of follow-up data. Model scores were calculated using on-treatment values at 2.5, 3, 3.5, 4, 4.5, and 5 years of AVT to predict threeyear HCC occurrence. Model performance was assessed with the area under the receiver operating curve (AUROC). The original model cutoffs to distinguish different levels of HCC risk were evaluated by the log-rank test. Results: The AUROCs of the 17 HCC models varied from 0.51 to 0.78 when using on-treatment scores from years 2.5 to 5. Models with a cirrhosis variable showed numerically higher AUROCs (pooled at 0.65–0.73 for treated, untreated, or mixed treatment models) than models without (treated or mixed models: 0.61–0.68; untreated models: 0.51–0.59). Stratification into low, intermediate, and high-risk levels using the original cutoff values could no longer reflect the true HCC incidence using scores after 3.5 years of AVT for models without cirrhosis and after 4 years of AVT for models with cirrhosis. Conclusions The performance of existing HCC prediction models, especially models without the cirrhosis variable, decreased in CHB patients on long-term AVT. The optimization of existing models or the development of novel models for better HCC prediction during long-term AVT is warranted.

BACKGROUND/AIMS: Evidence suggests that Shen-Kang (SK), a traditional Chinese herbal medicine, protects against various types of renal injury. In this study, we evaluated whether SK treatment confers renoprotection in a rat model of chronic tacrolimus (TAC) nephropathy. METHODS: Rats were treated daily with TAC (1.5mg/kg, subcutaneously) and SK (450 mg/kg, intravenously) for 4 weeks. The effects of SK on TAC-induced renal injury were assessed by measuring renal function, urine albumin excretion, histopathology, inflammatory cell infiltration, expression of profibrotic (transforming growth factor β1 [TGF-β1] and TGF-β inducible gene-h3 [βig-h3]) and proinflammatory cytokines, oxidative stress, and apoptotic cell death. RESULTS: Administration of SK preserved glomerular integrity (fractional mesangial area and Wilms tumor 1-positive glomeruli), attenuated tubulointerstitial fibrosis, and reduced the number of ectodermal dysplasia 1-positive cells, and this was paralleled by improved urine albumin excretion and renal dysfunction. At the molecular level, SK treatment suppressed expression of TGF-β1/Smad2/3, βig-h3, and proinflammatory cytokines. Oxidative stress and apoptotic cell death were significantly decreased with SK treatment, and apoptosis-related genes were regulated toward cell survival (active caspase-3 and the B-cell lymphoma-2/Bcl2-associated X [Bcl-2/Bax] ratio). CONCLUSIONS SK protects against TAC-induced renal injury.

OBJECTIVETo investigate the risk factors for the failure in treating periprosthetic infection of coagulase-negative staphylococci by two-stage revision.

METHODSFrom January 2005 to June 2015, 57 patients with periprosthetic hip and knee joint infection of coagulase-negative staphylococcus by two-stage revision were retrospectively reviewed with an average age of (61.3±11.9) years old. According to the drug resistance of methicillin, the patients were divided into methicillin sensitive group(MSCoN) and methicillin resistance(MRCoN) group, 25 cases in MSCoN group(9 knees and 16 hips) included 12 males and 13 females, 32 cases in MRCoN group(11 knees and 21 hips) included 14 males and 18 females. Follow-up for at least 2 years, the inflammatory markers, incidence rate of sinus and the duration of the symptoms, reinfection or persistent infection rate after two-stage revision were compared between two groups.

RESULTSMSCoN group and MRCoN group were followed up(81.7±38.3) months and(65.9±33.8) months, respectively;23 cases and 27 cases were successfully treated;there was no significant difference between two groups(=0.643). The patients who had surgery history were 4.04 times higher of failure than the patients without a history of surgery[OR=4.04, 95%CI(0.62, 26.5)]. Patients who had sinus were 4.26 times higher of failure than the patients without sinus[OR=4.26, 95%CI(0.7, 25.9)].

CONCLUSIONSTwo-stage revision is an effective procedure in treating patients infected by MSCoN and MRCoN. There is no significant difference of treatment failure rate between MSCoN and MRCoN group by two-stage revision. Surgery history and sinus maybe the risk factors of treatment failure, while methicillin-resistance is not.

OBJECTIVETo observe the clinical effect of ceramic on ceramic total hip arthroplasty(THA)in Crowe IV developmental dysplasia of the hip(DDH).

METHODSFrom April 2008 to December 2015, 137 hips of 111 Crowe IV DDH patients received THA using Forte or Delta ceramic on ceramic by one senior surgeon, which consists of 85 unilateral hips and 26 bilateral hips. The average age of the patients was(38.88±10.83) years old ranging from 18 to 68 years old. The mean follow-up was(41.16±21.50) months ranging from 12 to 96 months. All the patients were evaluated by Harris Hip Score. Radiographic evaluations were made preoperatively and during follow-up. Harris scores, the incidence of complications such as ceramic fracture, squeaking, dislocation were observed.

RESULTSThe mean preoperative Harris score was 56.54±15.67, the mean postoperative Harris score was 88.30±6.86(=0.017). Periprosthetic osteolysis was not deteced around any cup. No ceramic fracture occurred. There were 3 cases of revision surgery due to infection, losening of the stem and limb length discrepancy, respectively; 3 cases of dislocation occurred. Seventy-seven patients were recorded the gait and the hip mobility, the hip flexion of 69 patients were above 120 degrees.

CONCLUSIONSCeramic on ceramic bearing showed an encouraging result in Crowe IV DDH total hip arthroplasty.

OBJECTIVETo study the complications and efficacy of self-made, antibiotic-loaded cement articulating spacers in the treatment of the infected hip replacement.

METHODSBetween January 2006 and July 2016, 265 patients (266 hips) received a self-made, antibiotic-loaded cement articulating spacer as part of a two-stage protocol. Among those patients, there were 143 males(144 hips) and 122 females(122 hips). The cement articulating spacers with vancomycin and two Steinman pins were made by a self-made mold system. Meanwhile, another antibiotic was added to the spacers according to the drug sensitivity test. Record if the infected prosthesis was removed, related complication with spacer(breakage and dislocation), Harris score, and control rate of infection.

RESULTSThe mean age of two-stage revision operation was(57.4±14.2) years. Thirty-nine patients(14.7%) used extended trochanteric osteotomy(ETO) to remove the infected prosthesis. And 38 patients occurred mentioned complications(14.3%). Spacer breakage occurred in 28 cases(10.5%) and dislocation occurred in 10 cases(3.8%). The mean follow-up time was(83.4±14.6) months. The Harris hip score was from 47.56±14.23 preoperatively to 86.43±12.84 at final follow-up(<0.05). The infection of 256 cases(96.6%) got control after revision operation. However, during postoperative follow-up, 4 cases occurred re-infection, and they were reoperated, and the infections obtained effective control after the operation. Thus total infection control rate was 95.1%(252/265).

CONCLUSIONSAntibiotic-loaded cement articulating spacer made by a self-made mold system is effective in controling infection caused by hip replacement. Related complication is less with spacer by a mould enclosing two Steinman pins. Using metallic internal fixation or allograft bone combined with spacer does not affect infection control.

OBJECTIVETo investigate and the clinical effect of S-ROM modular stem in femur reconstruction in hip revision arthroplasty.

METHODSFrom January 2008 to January 2016, 21 patients received revision hip arthroplasties using S-ROM stems. There were 5 males and 16 females with an average of 48.33 years old(range, 29 to 73 years old). There were 13 cases caused by aseptic loosening, 4 cases by infection, 2 cases by nonunion of sub-tuberosity osteotomy, 1 case for repeated dislocation, 1 case for traumatic great trochanter fracture. Primary THA reasons:12 cases for DDH(9 cases for Crowe IV), 5 cases for femoral neck fracture, 2 cases for necrosis of femoral head, 2 cases for proximal femoral deformity caused by early infection. The femur bone defects included Paprosky II in 11 cases, IIIa in 9, and IIIb in 1. Harris hip score , pain score and hip flexion were recorded before and after operation. The subjective satisfaction was recorded at the last follow-up.

RESULTSThe operation time and blood loss were 189 min(125 to 290 min) and 867 ml (200 to 2 000 ml). At the final followup, the pain score improved from (17.14±9.56) points preoperatively to (41.71±2.03) points (=11.42,=0.00). The function score improved from (24.01±11.02) points preoperatively to (49.95±5.38) points (=9.73,=0.00). Harris hip score improved from (41.15±14.81) points preoperatively to(91.67±5.83) points(=15.33,=0.00). The degree of hip flexion increased from (93.10±27.27) points preoperatively to (121.90±16.62) points at the last follow-up (=4.59,=0.00). The mean subjective satisfaction was 9.48(10 points system), 14 of which were completely satisfactory. The last follow-up hip X-ray showed 21 cases of bone ingrowth, and other femoral stem without loosening or sinking sign significantly. There were 5 cases with bone anchor syndrome around proximal femoral cuff. There were 5 cases of proximal femur fracture, 3 cases of lesser trochanter fracture, 2 cases of greater trochanter fracture intra-operatively. Due to femoral canal stenosis, there were 4 cases of pre-tied wire at lesser trochanter to prevent fractures. There was 1 case of traumatic femoral fracture around stems with a distal oblique fracture, open reduction and locking plate fixation was performed. Other patients had no nerve stretch injury, dislocation, infection and lower limb deep vein thrombosis and other complications at the final follow-up.

CONCLUSIONSS-ROM prosthesis has satisfactory results in hip revision arthroplasty with Paprosky II and III femoral defects. Especially for patients with Crowe IV DDH and other proximal femoral deformities, it is possible to adapt to the medullary cavity morphology. Excellent initial stability, less complications and long-term biological fixation can be achieved with S-ROM in femur revision.

Purpose To investigate the clinicopathological significance of Tiam1 overexpression in ovarian carcinoma.Methods Tiam1 protein was detected in 98 serous carcinomas,64 ovarian mucinous cystadenocarcinomas and 27 benign ovarian tumors using immunohistochemical of SP two-step staining.Correlations between Tiam1 overexpression and clinicopathological features of ovarian carcinoma were evaluated.Overall survival and disease-free survival rates of ovarian carcinoma patients were calculated by Kaplan-Meier method.Results Tiam1 protein showed a cytoplasmic and nuclear staining pattern in ovarian carcinoma.The positive rate and strongly positive rate of Tiam1 protein were 84.7％ (83/98)and 70.4％ (69/98)in serous carcinoma,the positive rate and strongly positive rate of Tiam1 protein were 87.5％ (56/64) and 73.4％ (47/64) in ovarian mucinous cystadenocarcinoma,both of which were significantly higher than those in benign ovarian tumor (both P ＜ 0.01).High-level expression of Tiam1 was positively correlated with the histological grade,FIGO stage,and metastasis in ovarian carcinoma (both P ＜ 0.05),while independent of age and menopausal status (both P ＞ 0.05).Kaplan-Meier survival analysis showed that overall survival and disease-free survival of ovarian cancer patients with high expression of Tiam1 protein were significantly lower than those of patients with lower expression of Tiam1 protein (P ＜ 0.05),overall survival in metastatic ovarian cancer patients with high expression of Tiam1 protein was significantly lower than those in patients with low Tiam1 protein expression (P ＜ 0.05).Conclusion Tiam1 expression is significantly high in ovarian carcinoma.Tiam1 protein is closely associated with ovarian carcinoma progression,which may be a new potential prognostic biomarker and a therapeutic target for ovarian carcinoma.

Objective To study classroom teaching quality evaluation standards from two perspectives of teachers and students,and comparatively study difference of evaluation standards for teachers and students.Methods Questionnaire survey method is adopted.Classroom teaching quality evaluation entry questionnaire is distributed to 320 teachers and 560 students.SPSS 18.0 software is utilized for statistical analysis on the collected data.Expert consultation method is applied to determine membership degree on the analysis results.Finally,14 experts and 20 students are invited to sequence the importance of each dimension obtained after membership determination.Expert evaluation method is used for calculating the weight of each dimension thereof.Results Generally,the results show that all the teaching quality evaluation standards which have been selected by teachers and students can be assorted into 5 dimensionalities,namely teaching content,teaching method,teaching norm,teaching organization and students' learning condition.Particularly,teachers maintain that 23 indicators can be chosen to assess the classroom teaching quality while students think that 24 items are qualified for evaluating the room teaching quality,and they reach a consensus in 13 items.Besides,there is a big difference in their weight of the 5 dimensionalities.Conclusions By comparing and analyzing the choices and opinions about the classroom teaching quality evaluation standard between teachers and students,we learn that the two relative groups' assessments and comments are far different mainly attributing to their different evaluation perspectives on classroom teaching quality.Therefore,we advise different evaluation indicator systems should be adopted respectively for evaluation subjects in classroom teaching quality evaluation.

OBJECTIVEThe goal of this study was to analyze protein requirements in healthy adults through a meta-analysis of nitrogen balance studies.

METHODSA comprehensive search for nitrogen balance studies of healthy adults published up to October 2012 was performed, each study were reviewed, and data were abstracted. The studies were first evaluated for heterogeneity. The average protein requirements were analyzed by using the individual data of each included studies. Study site climate, age, sex, and dietary protein source were compared.

RESULTSData for 348 subjects were gathered from 28 nitrogen balance studies. The natural logarithm of requirement for 348 individuals had a normal distribution with a mean of 4.66. The estimated average requirement was the exponentiation of the mean of the log requirement, 105.64 mg N/kg•d. No significant differences between adult age, source of dietary protein were observed. But there was significant difference between sex and the climate of the study site (P<0.05).

CONCLUSIONThe estimated average requirement and recommended nutrient intake of the healthy adult population was 105.64 mg N/kg•d (0.66 g high quality protein/kg•d) and 132.05 mg N/kg•d (0.83 g high quality protein/kg•d), respectively.

Adult ; Dietary Proteins ; Female ; Humans ; Male ; Nitrogen ; metabolism ; Nutritional Requirements

OBJECTIVETo explore the effects of acupuncture on the peripheral serum expression of heat shock protein 70 (HSP70) and tumor necrosis factor α (TNF-α) in rats with cerebral ischemia-reperfusion injury (CIRI).

METHODSIn total, 152 Sprague-Dawley (SD) rats were randomly divided into an operated group and a non-operated group according to a random digits table. The operated group included a sham-operated group, a model group and an acupuncture group, whereas the non-operated group consisted of a normal group. Except for the normal group, each group was further divided into 12, 24, 48, 72, 96, and 144 h time points according to different reperfusion times. Eight rats were assigned in each operated group and in the normal group. The rat model of CIRI was established by the thread occlusion method in the model and acupuncture groups. The acupuncture group was treated with electroacupuncture at Baihui (DU20) and Zusanli (ST36) for the required time after successful operation. Blood was sampled to detect the HSP70 and TNF-α content by enzyme linked immunosorbent assay.

RESULTSThe expression of HSP70 protein in the peripheral serum of the experimental groups was higher than that in the normal control group. The peak time in both the model and the sham-operated groups was 12 h, and the peak time in the acupuncture group was 24 h. The expression in the acupuncture group declined to a lower level at 72 h and was lower than that in the model and sham-operated groups (P<0.05). The peak time for the expression of TNF-α protein in the peripheral serum of both the model and the acupuncture groups was 24 h, but the expression in the acupuncture group was lower than the model group. Additionally, the expression of TNF-α in all experimental groups was higher than the normal group (P<0.05).

CONCLUSIONSAcupuncture at DU20 and ST36 in rats attenuated CIRI, which was associated with a reduction in the expression of HSP70 and TNF-α. These results provide clues to acupuncture's neuroprotective properties. Acupuncture at DU20 and ST36 in rats after CIRI can adjust the expression of HSP70 and TNF-α in the peripheral serum, which might be one of the mechanisms of acupuncture's attenuation of CIRI.

Acupuncture ; Animals ; Brain Ischemia ; blood ; HSP70 Heat-Shock Proteins ; blood ; Male ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; blood ; Tumor Necrosis Factor-alpha ; blood