Objective To investigate the predictive value of the combined tumor burden score (TBS) and platelet-albumin-bilirubin (PALBI) score model for postoperative tumor recurrence in liver transplant recipients with hepatocellular carcinoma (HCC). Methods The general information of 158 recipients diagnosed with HCC and underwent liver transplantation at the 900th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from 2008 to 2021 was collected. Lasso regression analysis combined with multivariate Cox regression analysis were used to identify independent risk factors for postoperative tumor recurrence after liver transplantation with HCC. A nomogram prediction model was constructed based on variables selected by Lasso regression analysis, and the predictive performance of the model was verified by calibration curve and clinical decision curve. The optimal cut-off values for postoperative tumor recurrence in liver transplant recipients with HCC were determined by receiver operating characteristic (ROC) curve, and Kaplan-Meier analysis was used to compare survival differences among different groups. Results Among the 158 liver transplant recipients with HCC, 82 experienced tumor recurrence, with a recurrence rate of 51.9% and a median tumor-free survival time of 10 (4, 25) months. Results of Lasso regression analysis and multivariate Cox regression analysis showed that alpha-fetoprotein (AFP) ≥400 ng/mL, TBS and PALBI score were all independent risk factors for postoperative tumor recurrence in liver transplant recipients with HCC (all P<0.05). The combined high TBS-high PALBI score showed the highest predictive value (hazard ratio 6.909, 95% confidence interval 3.067-15.563, P<0.001). A nomogram prediction model was constructed based on six variables selected by Lasso regression analysis. Calibration curve showed good consistency between the model's predicted results and the ideal curve. Decision curve analysis indicated that the nomogram prediction model provided the highest clinical benefit for predicting 1-year tumor-free survival after liver transplantation with HCC. Time-dependent ROC curves at 1, 3 and 5 years after surgery showed that TBS-PALBI model had good predictive performance, with no significant difference in area under the curve (AUC) compared with TBS-PALBI-AFP model. The optimal cut-off values for predicting postoperative tumor recurrence were determined by ROC curve, with a PALBI score cut-off of −2.334 and a TBS cut-off of 5.305. Recipients were divided into a low TBS-low PALBI score group (n=47) and a low/high TBS-low/high PALBI score group (at least one score was high) (n=111). Kaplan-Meier survival analysis showed that the low TBS-low PALBI score group had a higher tumor-free survival rate than the low/high TBS-low/high PALBI score group, with a significant difference (P<0.05). Conclusions TBS-PALBI model provides a novel, simple and effective tool for assessing the prognosis of liver transplant recipients with HCC. The nomogram model constructed based on this has significant advantages in predictive performance and may serve as a reference for guiding individualized treatment plans and improving clinical outcomes.

OBJECTIVES: To investigate the risk factors of overall postoperative complications in elderly patients undergoing gastrointestinal surgeries. METHODS: This study was conducted among a total of 1388 elderly patients, who underwent elective gastrointestinal surgeries at 17 centers across China between April, 2020 and April, 2022. The primary outcome was the incidence of postoperative complications within 30 days, including procedure-related, neuropsychiatric, respiratory, cardiovascular, and gastrointestinal complications as well as acute kidney injury. Baseline characteristics, preoperative psychological and functional status, intraoperative anesthesia and surgical factors, intraoperative medication, use of nerve block, and postoperative analgesia methods were compared between the patients experiencing one or more postoperative complications and those without complications. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for postoperative complications. The relationship between postoperative acute pain and each type of complication were explored. RESULTS: The incidence of overall postoperative complications was 50.8% (705/1388) in these patients. Multivariate analysis showed that age (OR: 1.026; 95% CI: 1.006-1.046), prognostic nutritional index (OR: 0.998; 95% CI: 0.997-1.000), preoperative EuroQol-5 dimensions score (OR: 0.094; 95% CI: 0.018-0.500), blood loss (OR: 1.002; 95% CI: 1.001-1.003), and acute postoperative pain (OR: 1.308; 95% CI: 1.033-1.657) were significantly associated with the occurrence of postoperative complications. Specifically, patients experiencing severe postoperative pain had a significantly higher incidence of neuropsychiatric (27.2% vs 19.8%), procedure-related (17.3% vs 10.2%), and cardiovascular complications (3.6% vs 1.7%). CONCLUSIONS An advanced age, a low preoperative nutritional index, a poor quality of life score, a greater volume of intraoperative blood loss, and acute postoperative pain are independent risk factors for postoperative complications in elderly patients undergoing gastrointestinal surgeries. There is a significant association between acute postoperative pain and multi-system complications.
Humans ; Postoperative Complications/etiology* ; Aged ; Risk Factors ; Digestive System Surgical Procedures/adverse effects* ; Male ; Female ; China/epidemiology* ; Pain, Postoperative/epidemiology* ; Incidence ; Aged, 80 and over

Objective: To investigate the safety and efficacy of 125I radioactive seed implantation in the treatment of mediastinal lymph node metastasis. Methods: Records of 53 patients enrolled in Shaanxi Provincial Tumor Hospital from June 2014 to June 2018 with me-diastinal lymph node metastasis treated by computed tomography (CT)-guided 125I seed implantation were analyzed retrospectively. The preoperative treatment planning system was validated after the surgery. Intraoperative and post-operative complications were re-corded. The improvement in quality of life was observed. Chest CT follow-up was conducted 1 month, 3 months, 6 months, 1 year, and 2 years after treatment. The local focus control was evaluated. The median survival and total survival were recorded, and the survival prognosis and causes of death were analyzed. Results: The median survival time was 254 days (8.5 months), one-year survival rate was 48.67%, and complete and partial response rate was 83.02% (44/53). Multivariate Cox model analysis showed that the survival progno-sis was related to the Eastern Cooperative Oncology Group (ECOG) score, distant metastasis at the time of implantation, concurrent chemotherapy after implantation, and secondary seed implantation (P<0.05). The rates of developing pneumothorax and hemoptysis during and after the surgery were 20.75% (11/55) and 13.20% (7/55), respectively. No patients died. After implantation, the remission rate of cough, shortness of breath, pain, hoarseness, and superior vena cava syndrome was 60.00%-82.61%. Conclusions: CT-guid-ed 125I seed implantation in the treatment of mediastinal lymph node metastasis has the advantages of minimal trauma, remarkable cu-rative effect, safety, and feasibility. It has important application value and is worthy of further clinical application.

To investigate the effect of controlled hypotension by urapidil on the predictive accuracy and diagnostic threshold of stroke volume variation (SVV) in hypertensive and non-hypertensive patients undergoing robotic hepatobiliary surgery.
 Methods: Eighty patients undergoing robotic hepatobiliary surgery under general anesthesia were divided into a hypertension group (n=25) and a non-hypertension group (n=38) according to whether or not essential hypertension was present (excluding some cases that didn't meet requirements). The pump speed was at 6.0-7.0 µg/(kg﹒min), and the range of hypotension was between 10%≤Δ systolic blood pressure (SAP)≤20%. Volume loading test was performed after artificial pneumoperitoneum was established in reverse-Trendelenburg position. Hemodynamic indexes including heart rate (HR), SAP, cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke volume index (SVI) and SVV were recorded before and after infusion. Then the receiver operating characteristic (ROC) curves of SVV was drawn to determine the accuracy and diagnosis of SVV in predicting volume status in hypertensive and non-hypertensive patients after anti-Trendelenburg posture and pneumoperitoneum.
 Results: In the patients with controlled hypotension by urapidil, the area under the ROC curve of SVV in the hypertension group was 0.974, the diagnostic threshold was 13.5%, the ROC curve of SVV in the non-hypertension group was 0.832, and the diagnostic threshold was 15.5%.
 Conclusion: SVV can accurately predict the volume status in the hypertension group and the non-hypertension group after controlled hypotension in the anti-Trendelenburg position and fixed pneumoperitoneal pressure, and the SVV diagnostic threshold in the non-hypertensive group is higher than that in the hypertensive group.
Biliary Tract Diseases ; surgery ; Blood Pressure ; Cardiac Output ; Fluid Therapy ; Hemodynamics ; Humans ; Hypotension, Controlled ; Liver Diseases ; surgery ; ROC Curve ; Robotic Surgical Procedures ; Stroke ; Stroke Volume

Objective To evaluate the efficacy of sleep regulation technique of thought imprint psychotherapy in lower resistant state (TIP) for the treatment of primary insomnia.Methods 45 hospitalized outpatients with primary insomnia from sleep medical clinic of Guang'anmen Hospital were randomized at a 2 ∶ 1 ratio into a therapy group and a control group using random table.In the therapy group,patients received sleep regudation technique of TIP twice per week.In the control group,patients were asked to take zopiclone 3.75mg per night 30 minutes before bedtime.And the maximum dose can be 7.5mg according to their condition.The treatment lasted one month.Pittsburgh sleep quality index (PSQI) was used to assess sleep quality.Results ① After 4 weeks treatment,the clinical efficacy showed significant difference between the two groups (therapy group was 80％,control group was 33.3％).② Inner group comparison:therapy group was significantly improved in PSQI sleep quality (1.20 ± 0.71),sleep latency(1.53 ±1.01),sleep time(1.23 ±0.82),sleep efficiency(0.90±1.21),sleep disorders (1.30±0.65),sleep medication(0.13±1.36),daytime function (1.67±0.99),total score(8.30±3.19),(P＜0.05); the control group was significantly improved in the PSQI sleep quality(1.60±0.91),sleep latency(1.87±0.64),(P＜0.05).③ Inter group comparison:after treatment,compared to the control group,the therapy group was superior in the sleep latency,sleep time,sleep efficiency,sleep medication,daytime function,and total score ofPSQI (P＜0.05).Conclusion Sleep regulation techmique of thought imprint psychotherapy in lower resistant state can improve sleep quality of primary insomniacs.

Objective To evaluate the causes of postoperative complications in severe liver rupture and explore the prevention experienees.Methods The clinical data of 66 liver rupture patients who underwent surgical treatment in our hospital from January 2005 to July 2012 were retrospectively analyzed.The commou complications after surgery and the treatment measures of the complications were sludied.Results There were 9 deaths of severe liver rupture after surgery and related complications were found in 22 cases,including bile leakage (5 cases),intrahepatic abscess (3 eases),subphrenic infection (3 cases),pleural effusion (8 cases),intra-abdominal hemorrhage (2 cases),stress ulcer bleeding (2 cases).Conclusions Using damage control theory could improve the cure rate.Precise liver transection and postoperative excellent management was able to reduce the incidence of postoperative complications in severe liver rupture.

Objective To evaluate the effect of the high concentration of sevoflurane wash-in in induction of anesthesia on the cardiac function in young infants.Methods ASA Ⅰ young infants,aged 28-60 days,undergoing resection of hemangioma on body surface under general anesthesia,were studied.According to the principle of randomized block design,8 blocks were designed based on the body weight (3.0-3.4 kg,3.5-3.9 g,4.0-4.4 kg,4.5-4.9 kg,5.0-5.4 kg,5.5-5.9 kg,6.0-6.4 kg,6.5-6.9 kg),with 3 infants in each block.The infants were randomly divided into 3 groups (n =8 each):anesthesia induction with 6％,7％ and 8％ sevoflurane groups (groups S1-3).In groups S1-3,the infants inhaled 6 ％,7 ％ and 8 ％ sevoflurane respectively for induction of anesthesia.Transthoracic echocardiographic examinations were performed before sevoflurane inhalation (baseline,T1) and at 4 min of sevoflurane inhalation (T2) to record the stroke volume (SV),left ventricle end-diastolic volume (LVEDV),ejection fraction (EF),stroke volume index (SI),heart rate (HR),cardiac output (CO),cardiac index (CI),peak early diastolic velocity of mitral annulus (Ea),peak late diastolic velocity of mitral annulus (Aa),peak systolic velocity of mitral annulus (Sa),and Tei index.The mitral annulus poteroseptal Ea/Aa (Ea/Aa) was calculated.Results Compared with the baseline value,SV,EF,SI,Ea/Aa and Tei index were significandy increased,HR,Sa,Ea and Aa were significantly decreased (P ＜ 0.05),and no significant change was found in LVEDV,CO and CI at 4 min of sevoflurane inhalation in groups S1-3 (P ＞ 0.05).Tei index was significantly higher in groups S2.3 than in group S1 (P ＜ 0.05).There was no significant difference in the parameters of cardiac function between group S2 and group S3 (P ＞ 0.05).Conclusion 6 ％,7 ％ and 8 ％ sevoflurane wash-in in induction of anesthesia exert no effect on the cardiac function in young infants,and the 3 concentrations can be recommended for clinical use.

The paper introduced a therapeutic method of lower-resistant state therapy in the treatment of hysterical aphasia.This method was rapid and effective comparing to other therapeutic methods,showing great clinical values.

ObjectiveTo study the effect of thought imprint psychotherapy in lower resistant state (a TCM psychotherapy ) treating insomnia accompanied by depression.MethodsIntervened patients by sleep regulating technique of lower resistant state for 6 months.PSQI and PSG were tested prior and post treatment.ResultsThe data from PSQI and PSG indicated the improvement of their sleep quality:PSQI:sleep quality (2.500±0.589) vs (1.416±0.928),initiating sleep time(2.375±0.875) vs (1.416±0.880),sleep time (2.125±0.947) vs (1.500±0.884),sleep efficiency (1.625±1.135) vs (0.958±0.954),sleep disorder (1.875±0.536)vs (1.416±0.775),daytime function (2.416±0.880) vs (1.833± 1.203); PSG:sleep efficiency (0.82±0.11)％ vs (0.88±0.10)％,number of wake (3.92±3.24) vs (2.38±1.21),stage 1 percentage (27.4±11.9)％vs (23.5±7.8)％,stage 3 percentage (10.2±6.8) ％ vs (15.6±5.9)％,REM sleep percentage (23.89±6.84) ％ vs (16.16 ± 6.36) ％,P＜0.05 or 0.01.ConclusionSleep regulating technique in lower resistant state can improve patients' sleep quality.

Objective To investigate the expression of liver cancer stem cells(LCSCs) biomarkers and tumour angiogenesis in patients with hepatocellular carcinoma (HCC) and its clinical significance.Methods Immunohistochemistry was used to detect the expression of CD90,CD133 and CD34 in tumor tissues from 61 patients with HCC undergoing curative hepatectomy.Results The positive rates of CD90and CD133 in HCC tissues were 29.5％ (18/61)and 31.1％ (19/61),the positive rates of CD90 and/or CD133 in HCC were 45.9％ (28/61).The positive rate of LCSCs biomarkers in patients with vascular invasion,tumor differentiation Ⅲ/Ⅳ,non-complete encapsulation,and TNM stage Ⅲ/Ⅳ was significantly higher than those with non-vascular invasion,tumor differentiation Ⅰ / Ⅱ,with complete encapsulation,and TNM stage Ⅰ/Ⅱ.There were a significant positive correlation between LCSCs biomarkers expression and MVD(r =0.5,P ＜ 0.05).As compared with negative LCSCs expression and MVD low group,patients with a positive LCSCs biomarkers expression and MVD high in tumours had significantly lower overall survival (OS) and poor relapse-free survival (RFS).Conclusions High expression levels of LCSCs biomarkers are related to markers of angiogenesis microvessel density (MVD).By combining two of those we can classify paitients and anticipate the prognosis after surgery.