Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

ObjectiveThis study aimed to analyze the difference in setup error before and after correction of systematic error. To determine the most appropriate image-guided strategy during HT treatment， we use different scanning ranges and image-guidance frequencies in patients with nasopharyngeal carcinoma （NPC） treated with helical tomotherapy （HT）. MethodsFifteen patients with NPC who received HT treatment in Sun Yat-sen University Cancer Center from October 2019 to February 2020 were selected. Megavoltage computed tomography （MVCT） scanning was performed before each treatment. After five times of radiotherapy， system-error correction was performed to adjust the setup center. The setup errors before and after the correction of systematic errors， as well as the setup errors of different scanning ranges and different scanning frequencies， were collected for analysis and comparison. ResultsWhen comparing the setup errors before and after the correction of systematic error， the differences in setup errors in the left–right （LR）， superior–inferior （SI）， and anterior–posterior （AP） directions were statistically significant （P<0.05）.The different scanning ranges of "nasopharynx + neck" and "nasopharynx" were compared， and a statistically significant difference was found in yaw rotational errors （P<0.05）. In the comparison of daily and weekly scan frequency after system-error correction， a significant difference was found in AP direction （P<0.05）. ConclusionDuring radiotherapy for NPC， the systematic error can be corrected according to the first five setup errors， and then small-scale scanning was selected for image-guided radiotherapy every day.

Objective: To investigate the expression of glycoprotein non metastatic melanoma protein B (GPNMB) in renal eosinophilic tumors and to compare the value of GPNMB with CK20, CK7 and CD117 in the differential diagnosis of renal eosinophilic tumors. Methods: Traditional renal tumor eosinophil subtypes, including 22 cases of renal clear cell carcinoma eosinophil subtype (e-ccRCC), 19 cases of renal papillary cell carcinoma eosinophil subtype (e-papRCC), 17 cases of renal chromophobe cell carcinoma eosinophil subtype (e-chRCC), 12 cases of renal oncocytoma (RO) and emerging renal tumor types with eosinophil characteristics [3 cases of eosinophilic solid cystic renal cell carcinoma (ESC RCC), 3 cases of renal low-grade eosinophil tumor (LOT), 4 cases of fumarate hydratase-deficient renal cell carcinoma (FH-dRCC) and 5 cases of renal epithelioid angiomyolipoma (E-AML)], were collected at the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2017 to March 2022. The expression of GPNMB, CK20, CK7 and CD117 was detected by immunohistochemistry and statistically analyzed. Results: GPNMB was expressed in all emerging renal tumor types with eosinophil characteristics (ESC RCC, LOT, FH-dRCC) and E-AML, while the expression rates in traditional renal eosinophil subtypes e-papRCC, e-chRCC, e-ccRCC and RO were very low or zero (1/19, 1/17, 0/22 and 0/12, respectively); the expression rate of CK7 in LOT (3/3), e-chRCC (15/17), e-ccRCC (4/22), e-papRCC (2/19), ESC RCC (0/3), RO (4/12), E-AML(1/5), and FH-dRCC (2/4) variedly; the expression of CK20 was different in ESC RCC (3/3), LOT(3/3), e-chRCC(1/17), RO(9/12), e-papRCC(4/19), FH-dRCC(1/4), e-ccRCC(0/22) and E-AML(0/5), and so did that of CD117 in e-ccRCC(2/22), e-papRCC(1/19), e-chRCC(16/17), RO(10/12), ESC RCC(0/3), LOT(1/3), E-AML(2/5) and FH-dRCC(1/4). GPNMB had 100% sensitivity and 97.1% specificity in distinguishing E-AML and emerging renal tumor types (such as ESC RCC, LOT, FH-dRCC) from traditional renal tumor types (such as e-ccRCC, e-papRCC, e-chRCC, RO),respectively. Compared with CK7, CK20 and CD117 antibodies, GPNMB was more effective in the differential diagnosis (P<0.05). Conclusion: As a new renal tumor marker, GPNMB can effectively distinguish E-AML and emerging renal tumor types with eosinophil characteristics such as ESC RCC, LOT, FH-dRCC from traditional renal tumor eosinophil subtypes such as e-ccRCC, e-papRCC, e-chRCC and RO, which is helpful for the differential diagnosis of renal eosinophilic tumors.
Humans ; Kidney Neoplasms/pathology* ; Carcinoma, Renal Cell/pathology* ; Diagnosis, Differential ; Angiomyolipoma/diagnosis* ; Biomarkers, Tumor/metabolism* ; Leukemia, Myeloid, Acute/diagnosis* ; Membrane Glycoproteins

Objective: To evaluate the efficacy and safety of intravenous iron supplementation in patients with recurrent iron deficiency anemia (IDA) . Methods: This retrospective analysis of 90 patients with recurrent IDA from May 2012 to December 2021 was conducted, comparing the efficacy and safety of the intravenous iron therapy group and the oral iron therapy group. Results: Among the 90 patients with recurrent IDA, 20 were males and 70 were females, with a median age of 40 (range: 14-85) years. A total of 60 patients received intravenous iron supplementation and 30 received oral iron supplementation. The hematologic response rates in the intravenous iron group were significantly higher than those in the oral iron group at 4 and 8 weeks after treatment [80.0% (48/60) vs 3.3% (1/30) and 96.7% (58/60) vs 46.7% (14/30), all P<0.001, respectively]. The median increase in hemoglobin levels was also significantly higher in the intravenous iron group than in the oral iron group [38 (4, 66) g/L vs 7 (1, 22) g/L at week 4 and 44.5 (18, 80) g/L vs 19 (3, 53) g/L at week 8, all P<0.001]. The intravenous iron group had a significantly higher proportion of patients who achieved normal hemoglobin levels than the oral iron group (55.0% vs 0 and 90% vs 43.3%, all P<0.001, respectively). Iron metabolism indicators were tested before and after 8 weeks of treatment in 26 and 7 patients in the intravenous and oral iron groups, respectively. The median increase in serum ferritin (SF) levels in the intravenous iron group 8 weeks after treatment was 113.7 (49.7, 413.5) μg/L, and 54% (14/26) of these patients had SF levels of ≥100 μg/L, which was significantly higher than the median increase in SF levels in the oral iron group [14.0 (5.8, 84.2) μg/L, t=4.760, P<0.001] and the proportion of patients with SF levels of ≥100 μg/L (P=0.013). The incidence of adverse reactions was 3.3% (2/60) in the intravenous iron group, which was significantly lower than that in the oral iron group [20.0% (6/30), P=0.015]. Conclusion: Intravenous iron supplementation is more effective for hematologic response, faster hemoglobin increase, and higher iron storage replenishment rates compared with oral iron supplementation in patients with recurrent IDA, and it is well tolerated by patients.
Male ; Female ; Humans ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Anemia, Iron-Deficiency/epidemiology* ; Sucrose/therapeutic use* ; Ferric Compounds/therapeutic use* ; Retrospective Studies ; Iron/therapeutic use* ; Hemoglobins/therapeutic use*

Objective: To investigate the economic burden of bacillus Calmette-Guérin (BCG) lymphadenitis in Shandong Province. Methods: From May 2011 to December 2019, 304 patients applying for the province-level compensation of BCG lymphadenitis was selected from Shandong Province in this study. The basic situation, vaccination, outpatient (inpatient) records, cost and relevant information of those patients were collected to calculate the direct economic burden (including direct medical costs and direct non-medical costs), indirect economic burden and total economic burden. Comparison of the difference of economic burden of cases with different characteristics was taken. Results: The M(Q₁,Q₃) of age of BCG lymphadenitis patients was 3 (2, 4) months, among which 239 cases (78.6%) were male, 71 cases (23.4%) had lymphadenopathy, and 227 cases (74.7%) underwent surgery.The number of outpatient only, inpatient only and outpatient then inpatient was 25.7% (78 cases), 7.2% (22 cases) and 67.1% (204 cases), respectively. The M(Q₁,Q₃) of direct, indirect and total economic burden of single case after discount was 9 910 (5 713, 16 074), 2 081 (1 547, 3 122) and 12 262 (7 694, 18 571) yuan, respectively.The direct medical expenses accounted for 89.4% of the direct economic burden, the direct economic burden accounted for 84.9% of the total economic burden, the total economic burden of 80.0% cases accounted for only about 20.0% of the compensation amount, and the total economic burden of only 2.3% cases accounted for more than 60.0% of the compensation amount.The direct, indirect and total economic burden of patients with inpatient only and outpatient then inpatient was higher than that of patients with outpatient only; the direct, indirect and total economic burden of patients with operation was higher than that of patients with non-operation; the direct and total economic burden of patients with unulcerated lymph node was higher than that of patients with ulcerated lymph node(all P values<0.05). Conclusion: The economic burden of BCG lymphadenitis cases in Shandong Province is influenced by the mode of diagnosis and treatment, with direct medical expenses as the predominant component.
BCG Vaccine ; Cost of Illness ; Financial Stress ; Humans ; Infant ; Lymphadenitis/epidemiology* ; Male ; Vaccination

Abstract:Objective To detect the expression of hepatic function indices and autoantibodies in patients with chronic hepatitis B patients, patients with autoimmune liver disease and patients with chronic hepatitis B combined with autoimmune liver disease, and to evaluate the clinical significance of autoantibodies and hepatic function indexes in the early diagnosis of chronic hepatitis B combined with autoimmune liver disease.Methods A total of 109 healthy controls (HC), 72 patients with chronic hepatitis B (CHB), 74 patients with autoimmune liver disease (AILD), and 24 patients with chronic hepatitis B combined with autoimmune liver disease (CHB+AILD) in the Fifth People’s Hospital of Suzhou from 2013 to 2021 were enrolled in this study. Basic information and the value of admission hepatic function indexes and autoantibodies were collected for all enrolled samples, while no autoantibody test was performed for healthy volunteers. All data were processed using GraphPad Prism and SPSS software.Results There were no significant differences in age and gender among the four groups. The detection rates of anti-mitochondrial antibody M2 (AMA-M2) and anti-soluble acidic phosphorylated nuclear protein antibody (anti-SP100 antibodies) in CHB+AILD group [29.2%(7/24), 17.4%(4/23)] were significantly higher than those in CHB group [5.1%(3/59), 0(0/59)], suggesting that the detection of these two autoantibodies is helpful to the differential diagnosis of CHB and CHB+AILD. In addition, eight hepatic function indexes displayed significant differences among the four groups. The levels of total bilirubin and direct bilirubin in CHB+AILD group were significantly higher than those in CHB and AILD groups, while the levels of total protein and albumin were significantly lower than those in CHB and AILD groups. Alkaline phosphatase and glutamyltranspeptidase in AILD group and CHB+AILD group were significantly higher than those in CHB group. The logistic regression analysis showed that total bilirubin, direct bilirubin, albumin, alanine aminotransferase and alkaline phosphatase could form a promising prediction model, which was useful for clinicians in the differential diagnosis of CHB and CHB+AILD (area under the curve, AUC=0.902).Conclusion The combination of autoantibody and hepatic function index detection can be helpful for clinicians in the differential diagnosis of CHB, AILD and CHB+AILD, thus contributing to the early and correct diagnosis of CHB+AILD and providing theoretical basis for patients to obtain reasonable treatment and clinical cure earlier.

We aimed to assess the risks of
China ; Cryptosporidiosis/microbiology* ; Cryptosporidium/isolation & purification* ; Giardia/isolation & purification* ; Giardiasis/microbiology* ; Humans ; Risk Assessment ; Water Microbiology ; Water Supply/statistics & numerical data*

Objective To compare the performance of modified Kato-Katz thick smear method (KK method) and PCR assay in field detection of Clonorchis sinensis in human fecal samples, which provides insight into the selection of tools for detecting C. sinensis. Methods Based on the epidemiological investigation of human C. sinensis infections in Tengxian County of Guangxi Zhuang Autonomous Region in 2016, a total of 133 fecal samples were randomly selected and stored at -20 ℃. All fecal samples were detected for C. sinensis infection using KK method and PCR assay, and the detection rate was compared between the two techniques. In addition, Kappa test was used to evaluate the consistency between the two methods. Results Among all fecal samples, the overall detection rate of C. sinensis was 77.44% (103/133), and the detection rate was significantly higher by PCR assay (70.68%, 93/133) than by KK method (57.14%, 76/133) (χ² = 26.15, P < 0.01). There were 88.16% (67/76) of the microscopy-positive fecal samples positive for PCR assay, and 47.37% (27/57) of the microscopy-negative fecal samples positive for PCR assay. The detection rate of C. sinensis by PCR assay (94.74%, 18/19) was higher in fecal samples with EPG of > 1 000 than in samples with EPG of < 1 000 (85.96%, 49/57) (χ² = 1.05, P = 0.436). The consistency of the detection rate of C. sinensis was moderate between the KK method and PCR assay (Kappa = 0.73). Conclusions The detection rate of C. sinensis by PCR assay is significantly higher than by KK method. In low-endemic areas of C. sinensis infections, the combination of KK method and PCR assay is suggested, so as to improve the detection rate.

Objective To investigate the dynamics changes of the myeloid-derived suppressor cells (MDSCs) and regulatory T (Treg) cells in mice infected with Echinococcus granulosus and explore the possible biological significance. Methods Thirty female BALB/c mice of 6 weeks old were randomly divided into the infection and control groups, of 15 mice in each group. Mice in the infection group were intraperitoneally injected with 2 000 E. granulosus protoscoleces, while those in the control group were injected with the same volume of physiological saline. Mouse liver white blood cells were harvested 3 (early stage), 6 (medium stage) and 12 months (late stage) post-infection, and the proportions of MDSCs, their subpopulations (M-MDSCs and PMN-MDSCs) and Treg cells were assessed by flow cytometry. Results The proportions of MDSCs were (1.61 ± 0.36)%, (5.68 ± 0.69)% and (16.18 ± 0.69)% in mouse liver white blood cells in the infection group 3, 6 and 12 months post-infection with E. granulosus, and (2.19 ± 0.42)%, (0.99 ± 0.07) % and (4.18 ± 0.84)% in the control group, and there were significant differences in the proportion of the MDSCs in mouse liver white blood cells between the infection and control groups 6 and 12 months post-infection (P < 0.01). The proportions of M-MDSCs were (0.69 ± 0.27)%, (5.30 ± 0.72)% and (10.75 ± 0.29)% in mouse liver white blood cells in the infection group 3, 6 and 12 months post-infection, and (0.42 ± 0.24)%, (0.69 ± 0.02)% and (2.12 ± 0.13)% in the control group, and there were significant differences in the proportion of the M-MDSCs in the mouse liver white blood cells between the infection and control groups 6 and 12 months post-infection (P < 0.01). The proportions of PMN-MDSCs were (0.93 ± 0.23)%, (0.32 ± 0.02)% and (5.14 ± 1.03)% in mouse liver white blood cells in the infection group 3, 6 and 12 months post-infection, and (1.77 ± 0.26)%, (0.28 ± 0.05)% and (1.99 ± 0.90)% in the control group, and there were significant differences in the proportion of PMN-MDSCs in mouse liver white blood cells between the infection and control groups 3 and 12 months post-infection (P < 0.05). The proportions of Treg cells were (3.35 ± 0.14)%, (6.24 ± 0.38)% and (3.41 ± 0.07)% in mouse liver white blood cells in the infection group 3, 6 and 12 months post-infection, and (3.48 ± 0.46)%, (3.65 ± 0.45)% and (3.12 ± 0.12)% in the control group, and there were significant differences in the proportion of Treg cells in mouse liver white blood cells between the infection and control groups 6 and 12 months post-infection (P < 0.01). Conclusions The percentages of both MDSCs and Treg cells increase in mouse liver white blood cells 6 and 12 months post-infection with E. granulosus, and a more remarkable increase is seen in the percentage of MDSCs, which is mainly found in M-MDSCs. These findings suggest that M-MDSCs may play a major immunosuppressive role in the medium and late stages of E. granulosus infection in mice.

Objective To understand the prevalence of anemia and its influencing factors in infants aged 6 to 24 months in poor areas of Gansu Province, and to provide reference for improving the prevalence of anemia in local children. Methods A multi-stage sampling method was used to conduct a survey on infant and caregivers, in the 12 children nutrition improvement project counties in Gansu Province. T-test and analysis of variance were used to compare the hemoglobin content, the chi-square test was used to compare the prevalence of anemia, and the Logistic regression model was used to analyze the influencing factors. Results Among the 3 188 effective data, the detection rate of anemia was 25.69% (819). The detection rate of anemia among boys and girls was 24.54% and 26.90%, respectively. There was no significant difference in the detection rate of anemia among different sexes ( 2=2.326, P=0.127). The detection rate of anemia between different age groups were statistically significant ( 2=42.339, P<0.001); The results of multivariate analysis showed that children's age, children's ethnic groups, parents' awareness of feeding knowledge, the feeding method of 6 months after birth and the way of taking nutritional packs were associated with anemia (all P<0.05). Conclusions The prevalence of anemia in infants aged 6 to 24 months in poor areas in Gansu Province was relatively high. Strengthening the education of caretakers’ knowledge of guardian feeding and scientific child-rearing, and ensuring the nutrition packages intake can significantly reduce the prevalence of anemia prevalence in poor areas in Gansu Province.