修正后Chlid记分在乙型肝炎相关性疾病中预后预测研究

Objective To evaluate whether the traditional Child-Turcotte-Pugh ( CTP) can be improved by adding serum creatinine and/or serum sodium values, and to assess whether the modified CTP score can challenge the short-term prognostic ability of the MELD score. Methods 187 patients with hepatitis B related disease were studied. CTP score, Child-Pugh-Na (CTP-Na) , Child-Pugh-creatinine (CTP- Cr)score,Child-Pugh-Na-creatinine ( CTP-Na-Cr) score,model for End-Stage Liver Disease ( MELD) score and MELD the incorporation of serum sodium ( MELD-Na) score were calculated. The 3-month and 1 year mortality in the patients was measured,and the validity of each models was analyzed. Results At 3-month and 1 year enrollment, the prognostic score of survival group was significantly lower than that of death group in each prognostic score model,P <0. 05. There were no significant difference between the same group in 3- month and 1 year enrollment of each prognostic score,P>0. 05. The CTP-Na-Cr score and MELD-Na score had a significantly higher AUC in comparison with MELD, CTP-Na and CTP at 3-month enrollment (P < 0. 05)and CTP-Na-Cr score also had a significantly higher AUC in comparison with MELD,CTP-Na and CTP at 1 year enrollment. There was no significant difference between 3-month AUC data and 1 year enrollment one of each prognostic score,P >0. 05. Conclusions The CTP-Na-Cr score model is a more accuracy model than other score models,it deserve further research.

AIM To evaluate the expression of CD44v3 and v6 protein in colorectal carcinoma and its prognosticsignificance.METHODS One hundred and twenty-one cases of formalin-fixed paraffin-embedded colorectal carcinomaspecimens were retrospectively analyzed using EnvisionTM immunohistochemical method with the monoclonalantibody CD44v3 and v6. The median follow-up time was 67.77 months and the prognostic value of theCD44v3 and CD44v6 was assessed using univariate and multivariate survival analysis.RESULTS The positive rates of CD44v3 and v6 protein were 60.3% and 57.9%, respectively. There wassignificant correlation between CD44v3 immunoreactivity and tumor location, lymph node metastasis, distantmetastasis and Duke's stage (P< 0.05, Spearman correlation test). Significant correlation between CD44v6immunoreactivity and patients' gender, lymph node metastasis, distant metastasis, Duke's stage was alsonoticed (P < 0.05, Spearman correlation test). The 5-year survival rates were 81.25% and 60.27% inCD44v3 negative and positive cases, respectively. As CD44v6, the 5-year survival rates were 80.39% and60.00% in CD44v6 negative and positive cases, respectively; these differences between the two groups ofpatients were significant (P<0.05, Log-rank test). In multivariate analysis using the Cox regression model,CD44v3 expression emerges as an independent prognostic indicator.CONCLUSION CD44v3 and v6 might play some important roles in metastasis of colorectal carcinoma, andCD44v3 expression might be a new useful independent prognostic marker of colorectal carcinoma.

AIM To study the nosocomial infection in the patients with liver diseases and its risk factors.METHODS A prospective survey of nosocomial infection in 848 patients with various liver diseases wascarried out in our hospital for a 24-month period.RESULTS Incidence of nosocomial infection in patients with liver diseases was 9.20%, nosocomialinfection rate in severe hepatitis was significantly higherthan in mild and moderate liver diseases. Infectionof respiratory tract accounted for 44.33%. Infection rate in abdominal cavity, intestinal tract, gallbladderand bile ducts, oral region, and other regions was 15.46%, 12.37%, 8.25%, 7.22% and 12.37%,respectively.CONCLUSION The factors related to nosocomial infection were the severity of liver diseases, cellularimmunological condition, Co-infection of hepatitis virus, severe accompanying diseases, improper medicalmanipulations and use of broad-spectrum antibiotics. Nosocomial infection obviously affects the prognosis ofliver diseases.

年龄与脊柱骨巨细胞瘤预后关系的研究进展

骨巨细胞瘤(GCT)是一种有局部侵袭性的良性骨肿瘤。女性较男性多见，并且好发于20～40岁的青壮年[1-3]。骨巨细胞瘤的生物学行为较特殊，术后易复发。目前临床实践中常从肿瘤影像或病理等方面来分析其生物学行为，并对其预后进行判断。而以往骨巨细胞瘤的研究报道，不同年龄段患者术后复发率存在差异[4-5]，提示年龄可能是影响骨巨细胞瘤生物学行为及预后的因素。但由于以往的研究多为全身骨骼骨巨细胞瘤的病例，并未明确反映出年龄与脊柱骨巨细胞瘤复发之间的关系。

5例肺动脉血栓内膜剥脱术后神经系统障碍的临床特点及原因

目的 总结5例肺动脉血栓内膜剥脱术治疗慢性肺动脉血栓栓寨症术后神经系统障碍的患者的临床表现特点,并尝试分析其原因.方法 回顾2002年至2010年,26例因慢性血栓栓塞性肺动脉高压症行肺动脉血栓内膜剥脱术的患者围手术期资料.总结术后生存患者中5例出现神经功能障碍并发症者的临床与影像学特点,分析其与无并发症患者的手术前、手术中的资料,寻找可能的影响因素.结果 26例中围手术期死亡4例,22例生存者心功能改善,生活质量明显提高.5例围手术期出现神经系统障碍表现者中,3例表现为嗜睡、谵妄、记忆力障碍,颅脑CT未见异常发现,治疗后症状1周内消失,2周内完全恢复;另2例患者除上述症状外,还表现为共济失调、步态不稳、舞蹈样动作,症状持续时间长,其中1例经高压氧治疗后1个月症状好转,颅脑CT未见异常发现,颅脑MRI显示双侧中脑,基底节区异常信号,治疗8周症状基本好转出院,6个月症状完全消失,复查颅脑MRI异常信号消失;1例颅脑CT未见异常发现,12周出院,恢复较差,生活部分自理.术后出现神经系统障碍患者Jamieson手术分型Ⅲ型、Ⅳ型比例较多(P=0.024),手术中停循环时间较长(P=0.034).结论 肺动脉血栓内膜剥脱术后早期神经系统障碍多表现为弥漫性脑皮层与对称性基底节区神经功能障碍,颅脑MRI相应区域异常信号,多数患者症状在2-8周内消失,6个月内颅腩MRI异常信号可以消失.出现神经系统功能障碍的患者多手术操作难度大,停循环时间较长,推测考虑与术中脑缺血缺氧有关.

To investigate the correlation among tumor angiogenesis, expressions of p53, nm23-I1, CD44v6, c-erbB-2 proteins and biological behavior and clinical outcome of gastric cancer. Methods: The intratumoral microvessel density (MVD) and expressions of p53, nm23-H1, CD44v6, c-erbB-2 were analyzed semiquantitively by immunohistochemical staining (S-P) of 59 paraffin-embedded gastric tumor specimens that were radically resected at the Department of surgery, Beijing Institute for Cancer Research, between January 1990 and December 1992. The median follow-up period was 75 month (range: 60~96 months). The significdance of these indicators was analyzed retrospectively. Results: MVD for tumors with lymph node metastasis and vascular invasion was significantly higher than those without (P=0.0168 and 0.0176, respectively). The levels of p53, CD44v6, c-erbB-2 expression were significantly higher in the groups of lymph node metastasis, serosal infiltration and vascular invasion than in those without. All differences reached the statistically significant levels (P<0.01~<0.05). The low expression of nm23-H1 was negatively correlated with lymph node metastasis, serosal infiltration and vascular invasion (P<0.01; <0.05 and <0.01, respectively). Univariate analysis showed that the overall survival of patients with higher MVD, or overexpressions of p53, CD44v6, c-erbB-2, or low expression of nm23-H1 were significantly worse than those with opposite conditions (P=0.0214, 0.0062, 0.0045, 0.0159, and 0.0162, respectively). Multivariate analysis showed that expression of p53 in this series was an independent prognostic indicator. Conclusion: The data suggested that the above-mentioned factors might be helpful in evaluating the metastatic potential of gastric cancer and making more effective assessment of prognosis for individual patient. Further study with larger samples and prospective investigation of these results would be worthwhile.

To explore the death-related factors of stageⅠrectal cancer patients. Methods: 89 cases of stage I rectal cancer patients between 1985 and 2000 were retrospectively studied for prognostic factors. Factors including age, gender, tumor size, circumferential occupation, gross type, pathological type, depth of tumor invasion, surgical procedure, adjuvant chemotherapy and postoperative complication were chosen for cox multivariate analysis (forward procedure) using Spss software (10.0 version). Results: multivariate analysis demonstrated that muscular invasion was an independent negative prognostic factor for stageⅠrectal cancer patients (P=0.003). Conclusion: Muscular invasion is a negative prognostic factor for stage I rectal cancer patients.

The accumulation of myelin debris may be a major contributor to the inlfammatory response after diffuse axonal injury. In this study, we examined the accumulation and clearance of myelin debris in a rat model of diffuse axonal injury. Oil Red O staining was performed on sections from the cerebral cortex, hippocampus and brain stem to identify the myelin debris. Seven days after diffuse axonal injury, many Oil Red O-stained particles were observed in the cerebral cortex, hippocampus and brain stem. In the cerebral cortex and hippocampus, the amount of myelin debris peaked at 14 days after injury, and decreased signiifcantly at 28 days. In the brain stem, the amount of myelin debris peaked at 7 days after injury, and decreased signiifcantly at 14 and 28 days. In the cortex and hippocampus, some myelin debris could still be observed at 28 days after diffuse axonal injury. Our ifndings suggest that myelin debris may persist in the rat central ner-vous system after diffuse axonal injury, which would hinder recovery.

OBJECTIVE:To investigate the factors associated with sensory and motor recovery after the repair of upper limb peripheral nerve injuries.
DATA SOURCES:The online PubMed database was searched for English articles describing outcomes after the repair of median, ulnar, radial, and digital nerve injuries in humans with a publication date between 1 January 1990 and 16 February 2011.
STUDY SELECTION:The following types of article were selected:(1) clinical trials describ-ing the repair of median, ulnar, radial, and digital nerve injuries published in English;and (2) studies that reported sufifcient patient information, including age, mechanism of injury, nerve injured, injury location, defect length, repair time, repair method, and repair materials. SPSS 13.0 software was used to perform univariate and multivariate logistic regression analyses and to in-vestigate the patient and intervention factors associated with outcomes.
MAIN OUTCOME MEASURES:Sensory function was assessed using the Mackinnon-Dellon scale and motor function was assessed using the manual muscle test. Satisfactory motor recovery was deifned as grade M4 or M5, and satisfactory sensory recovery was deifned as grade S3+or S4. RESULTS:Seventy-one articles were included in this study. Univariate and multivariate logistic regression analyses showed that repair time, repair materials, and nerve injured were inde-pendent predictors of outcome after the repair of nerve injuries (P<0.05), and that the nerve injured was the main factor affecting the rate of good to excellent recovery.
CONCLUSION:Predictors of outcome after the repair of peripheral nerve injuries include age, gender, repair time, repair materials, nerve injured, defect length, and duration of follow-up.

Many studies have examined motor impairments using voxel-based lesion symptom mapping, but few are reported regarding the corresponding relationship between cerebral cortex injury and lower limb motor impairment analyzed using this technique. This study correlated neuro-nal injury in the cerebral cortex of 16 patients with chronic stroke based on a voxel-based lesion symptom mapping analysis. Neuronal injury in the corona radiata, caudate nucleus and putamen of patients with chronic stroke could predict walking speed. The behavioral measure scores were consistent with motor deifcits expected after damage to the cortical motor system due to stroke. These ifndings suggest that voxel-based lesion symptom mapping may provide a more accurate prognosis of motor recovery from chronic stroke according to neuronal injury in cerebral motor cortex.

Objective:To analyze the clinicopathologic characteristics and prognostic factors of small gastrointestinal stromal tumor (GIST) of the stomach.
Methods:A total of 31 small gastric GIST patients, including 10 males and 21 females, with a median age of 58 years (37-81 years), who underwent surgery at any time from 1999 to 2012 were included in this study. The clinical records of the patients were analyzed retrospectively.
Results:Abdominal discomfort and pain (10 cases, 32.3%, respectively) were the two most common complaints among the patients. All patients received surgery, 11 received gastric wedge resection, 11 received subtotal gastrectomy, 5 received laparoscopic gastric wedge resection, and 4 received endoscopic submucosal dissection. No severe adverse complication was observed. A total of 29 patients (93.5%) were followed up. During the follow-up, 2 patients were found to exhibit tumor recurrence, and 1 patient had liver metastases. One patient died of tumor progression, while another died of another malignant tumor. Median progression free survival (PFS) time was 120.3 months, and median overall survival (OS) time was 130.4 months.
Conclusion:Small gastric GIST has better prognosis. Surgery is the best choice for therapy. Micro-invasive procedures are safe and effective for elective patients. Tumor necrosis, tumor bleeding, and muscle invasion are potential prognostic factors of small gastric GIST.

Objective:To investigate the recurrence sites, risk factors, and prognosis of patients with persistent or recurrent squamous cell carcinoma (SCC) of the cervix within one year atfer undergoing concurrent chemoradiotherapy (CCRT).
Methods:Clinical data of 30 patients with persistent or recurrent SCC of the cervix within one year atfer CCRT between July 2006 and July 2011 were analyzed retrospectively. hTese data were compared with those of 35 SCC cases with no signs of recurrence atfer complete remission. hTese 35 patients were treated during the same period (between 2006 and 2011) and selected randomly.
Results:Among these 30 patients, 25 exhibited distant metastases of which 14 were observed within 6 months atfer CCRT. Univariate analysis showed higher incidence of pelvic or para-aortic lymphadenectasis and SCC-ag>10 ng/mL in the group with persistent or recurrent disease before treatment (P<0.01). Multivariate analysis by logistic regression revealed that the pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag>10 ng/mL were the independent risk factors. Palliative chemotherapy was the main treatment option for patients with persistent or recurrent disease. hTe 2-year survival rate was 21.7%, and the median survival time was 17 months.
Conclusion:Patients with persistent or recurrent SCC of the cervix atfer CCRT exhibited a high rate of distant metastasis with poor prognosis. The pre-therapeutic pelvic or para-aortic lymph node enlargement and SCC-ag>10 ng/mL were identiifed as the independent risk factors for persistent or recurrent SCC within 1 year atfer CCRT.

神经特异性烯醇化酶血清浓度与重型脑外伤预后的相关性研究

AIM:To eluciate the role of neuron specific enolase(NSE) in predicting prognosis after severe head injury.METHODS: 30 patients with severe head injury were involved into this study,ranging from 26 to 64 years old.Concentration of NSE in serum was measured in all cases within 12 hours after head injury.And prognosis of all patients were evaluated by GOS.RESULTS:The concentration of NSE in serum of both groups,with good or poor outcome,were higher than normal group.The concentrations within 12 hours after head injuries had a close relationship with the prognosis.As a serum marker to assess the prognosis,NSE had high positive prediction ratio.CONCLUSION:The finding suggested that NSE may be a promising predictor for assessing the prognosis after severe head injury.

混合性脑卒中患者血浆内皮素及一氧化氮变化对预后影响的研究

Objective To explore the influence of NO and serum endothelins change on prognosis of mixed type stroke patients. Method To test amount of ET and NO,to analysis the influence of NO and ET on prognosis using high effective liquid chromatography and radio immunology method and compared with the control group,then treat with t test. Result Concentrations of serum ET and NO of observe groups were apparently larger than that of control group (P<0.01, P<0.05). Conclusion Serum ET and NO increase apparently in mixed type stroke patients,the higher concentration, the severer disease and deformity of mobility. ``

婴儿痉挛的预后与EEG和头颅CT结果的关系

Objective To investigate relationship between prognosis of infant spasm and electroencephalogram(EEG) and head CT.Method 47 infants underwent EEG and head CT.Follow up was performed to compare the prognosis during different periods.Result Among 31 infants with abnormal head CT,2 infants were cured,17 were improved and effective rate was 61.3% . Among 16 patients with normal head CT,6 were cured,8 were improved,and effective rate was 87.5% . Among 34 infants with high rhythm disorder,8 were cured,21 were improved,effective rate was 85.29% . For 13 infants with abnormal EEG of other types,no infants were cured,4 were improved,and effective rate was 30.8% .Conclusion Changed head CT not various EEG has no significant effect on prognosis of infant spasm(P >0.05).Prognosis is favorable in infants with high rhythm disorder(P<0.01).

细胞凋亡相关基因Bcl-2及Bax在骨肉瘤中的表达与自下而上质量的关系

Objective Apoptosis related gene Bcl 2 and Bax in osteosarcoma patients with different clinical appearance were being studied to analyze the prognosis of the patients. Method The cases were divided into two different groups according to the results of the follow up.33 cases in high risk group and 18 cases in low risk group. Expression of Bcl 2 and Bax were immunohistochemically stained by ABC method. Result Positive expression rate of Bcl 2 was 61% in high risk group (20/23) and 33% in low risk group (1/8). Positive expression of Bax was 22% in high risk group (6/27) and 67% in low risk group(12/18).Conclusion Expression of Bcl 2 and Bax was related to the prognosis of osteosarcoma. Positively expressed Bcl 2 in osteosarcoma cells may indicate bad prognosis. If Bax is highly expressed in osteosarcoma cells, this may indicated a good prognosis.

Objective To explore the factors influencing the prognosis of patients with primary liver cancer(PLC) after hepatectomy on purpose to provide the preventive measures for improving the long-term effect.Methods All of the 189 patients who underwent hepatectomy with PLC from May,1994 to January,1998 were included by reviewing their clinical pathological characteristics and treatments. Totally, 22 factors contributed to the long-term survival rate(SR)and the disease-free SR were analysed . All patients were followed up at least 5 years. Results The 3- and 5-year cumulative SRs in the total group were 63% and 45% respectively. The 3- and 5-year SRs and disease-free SRs in the curative resection (CR) group (n=162) were 67%,47%,and 45% and 26% respectively. It was showed that the way by which a tumor was found, tumor size, portal thrombi, satellite nodule, cirrhosis type, TNM stage, tumor envelope, recurrence and treatment, vascular exclusion and transfusion, differentiation grade and CR were prognostic factors by individual variable analysis. A multivariable analysis showed that CR , tumor size and reoperation were significant factors associated with the prognosis. Conclusion The type of CR and tumor size are determinants influencing the prognosis. Early diagnosis of small carcinoma and CR as soon as possible is essential to improving the prognosis of PLC. Avoiding transfusion and controlling the progress of cirrhosis are expected to improve the disease-free SR.

目的:探讨大肠癌组织类型、临床分期与P53基因突变的相关关系.方法:采用PCR-SSCP方法对30例大肠癌P53基因突变状况进行了检测.结果:发现6例(20%)P53基因突变,其中,1例在第4外显子,5例在第5外显子,第2,3外显子末检出突变.在不同组织分化程度中,P53基因突变率分别为高分化腺癌和中分化腺癌均为1/8(12.5%),低分化腺癌为3/10(30.0%),未分化腺癌为1/4(25.0%).在临床分期中,Dukes＇B期为1/10(10.0%),C期为2/12(16.7%),D组为3/8(37.5%).结论:P53基因突变与Dukes＇分期有关,并且P53基因突变很少发生第2,3外显子.

The predictive factors of prognosis and treatment strategies for small?cell carcinoma(SCC) of the urinary tract are controversial. This study was aimed to investigate the clinical experience and management of patients with SCC of the urinary tract. We collected data of patients who were diagnosed with genitourinary SCC(GSCC) between 2002 and 2013 and were treated in the Fudan University Shanghai Cancer Center. Atotal of 18patients were diagnosed with GSCC of which 10 originated from the prostate, seven from the bladder and one from the adrenal gland. The mean follow?up time was 15.5months and progression?free survival(PFS) was 9.3months. Primary tumor resection was attempted in 13 of 18patients(72.2%) in whom radical surgery was performed in six of 14(42.9%) limited disease patients. Most of the patients(13, 72.2%) received cisplatin?based chemotherapy. Patients who had normal lactic dehydrogenase(LDH) levels showed a signiifcantly higher median PFS and overall survival(OS) compared with patients with high LDH levels(P=0.030,P=0.010). Patients with limited disease treated with a radical operation experienced a non?signiifcant(P=0.211) longer PFS compared with patients who were not treated, but this reached statistical signiifcance after analyzing OS(P=0.211,P=0.039). Our patients showed a poor prognosis as reported previously. Serum LDH levels beyond the normal range indicate a poor prognosis. For GSCC patients who are diagnosed with limited disease, radical surgery is strongly recommended along with cisplatin?based chemotherapy.

Several studies have reported that C-reactive protein (CRP), an inlfammation biomarker, may be associated with the prognosis of prostate cancer (PCa). The objective of this systematic review is to summarize the predictive role of CRP for survival in PCa as reported in previous studies. Related studies were identiifed, and evaluated for quality through multiple search strategies. Data was collected from studies comparing overall and cancer-speciifc survival (CSS) in patients with elevated CRP levels and those having lower levels. However, for progression-free survival (PFS), data were collected according to the log of CRP. The hazard ratio (HR) and its 95% conifdence interval (CI) were used to assess the strength of associations. A total of nine studies (n= 1,497) were evaluated in this meta-analysis (ifve for overall survival (OS), four for CSS and two for PFS). For OS and PFS, the pooled HR of CRP was statistically signiifcant at 1.51 (95%CI, 1.28-1.79) and 1.50 (95%CI, 1.25-1.81), respectively. For CSS, the pooled HR was 1.91 (95%CI, 1.36-2.69) with higher CRP expression in PCa, which strongly indicates poorer survival in PCa. This study demonstrates that CRP may have a critical prognostic value in patients with prostatic cancer.