Affect Survival Time Research Articles

Survival analysis of gastric cancer patients with incomplete data.

PurposeSurvival analysis of gastric cancer patients requires knowledge about factors that affect survival time. This paper attempted to analyze the survival of patients with incomplete registered data by using imputation methods.Materials and MethodsThree missing data imputation methods, including regression, expectation maximization algorithm, and multiple imputation (MI) using Monte Carlo Markov Chain methods, were applied to the data of cancer patients referred to the cancer institute at Imam Khomeini Hospital in Tehran in 2003 to 2008. The data included demographic variables, survival times, and censored variable of 471 patients with gastric cancer. After using imputation methods to account for missing covariate data, the data were analyzed using a Cox regression model and the results were compared.ResultsThe mean patient survival time after diagnosis was 49.1±4.4 months. In the complete case analysis, which used information from 100 of the 471 patients, very wide and uninformative confidence intervals were obtained for the chemotherapy and surgery hazard ratios (HRs). However, after imputation, the maximum confidence interval widths for the chemotherapy and surgery HRs were 8.470 and 0.806, respectively. The minimum width corresponded with MI. Furthermore, the minimum Bayesian and Akaike information criteria values correlated with MI (-821.236 and -827.866, respectively).ConclusionsMissing value imputation increased the estimate precision and accuracy. In addition, MI yielded better results when compared with the expectation maximization algorithm and regression simple imputation methods.

Preservative Exposure and Surgical Outcomes in Glaucoma Patients

To study the impact of benzalkonium chloride (BAK) exposure from eye drops on subsequent time to trabeculectomy failure. Retrospective chart review of 128 glaucoma patients who had undergone a trabeculectomy between 2004 and 2006. The number and type of ophthalmic drops used preoperatively and relevant demographics were recorded. Surgical failure criteria included inadequate pressure lowering or need for postoperative ocular antihypertensives, laser trabeculoplasty, 5-fluorouracil needling, or repeated surgery. Patients were examined for these criteria over a minimum postoperative period of 2 years. Data were assessed using Kaplan-Meier and Cox regression models. Complete surgical success was achieved in 47.7% of patients. Patients received between 1 and 8 BAK-containing drops daily, with a median of 3. Time to surgical failure in patients receiving higher preoperative daily doses of BAK was shorter than in patients who had less BAK exposure (P=0.008). Proportional hazard modeling identified uveitic and neovascular glaucoma as significant confounders of the univariate model (P=0.024), although the main effect of BAK exposure was maintained with a hazard ratio of 1.21 (P=0.032). The number of different medications used to control intraocular pressure did not significantly affect survival time in a secondary Cox model (P=0.948). Increased preoperative exposure to ophthalmic solutions preserved with BAK is a risk factor for earlier surgical failure, independent of the number of medications used. This study extends earlier findings of potential adverse effects of ophthalmic preservatives on surgical outcomes to the modern pharmacopeia used in the medical management of glaucoma.

Results of surgical excision and evaluation of factors associated with survival time in dogs with lingual neoplasia: 97 cases (1995–2008)

To describe the clinical characteristics, treatments, outcomes, and factors associated with survival time in a cohort of dogs with lingual neoplasia that underwent surgical excision. Retrospective case series. Animals-97 client-owned dogs. Medical records of dogs with a lingual tumor examined between 1995 and 2008 were reviewed. Records were included if a lingual tumor was confirmed by histologic examination and surgical excision of the mass was attempted. Data were recorded and analyzed to identify prognostic factors. Clinical signs were mostly related to the oral cavity. For 93 dogs, marginal excision, subtotal glossectomy, and near-total glossectomy were performed in 35 (38%), 55 (59%), and 3 (3%), respectively. Surgery-related complications were rare, but 27 (28%) dogs had tumor recurrence. The most common histopathologic diagnoses for the 97 dogs were squamous cell carcinoma (31 [32%]) and malignant melanoma (29 [30%]). Eighteen (19%) dogs developed metastatic disease, and the overall median survival time was 483 days. Median survival time was 216 days for dogs with squamous cell carcinoma and 241 days for dogs with malignant melanoma. Dogs with lingual tumors ≥ 2 cm in diameter at diagnosis had a significantly shorter survival time than did dogs with tumors < 2 cm. Similar to previous studies, results indicated that lingual tumors are most commonly malignant, and squamous cell carcinoma and malignant melanoma predominate. A thorough physical examination to identify lingual tumors at an early stage and surgical treatment after tumor identification are recommended because tumor size significantly affected survival time.

Factors Affecting Survival Time of Cholangiocarcinoma Patients: A Prospective Study in Northeast Thailand

Cholangiocarcinoma (CCA) is a major health problem and cause of death among people in Northeastern Thailand. In this prospective study 171 patients newly diagnosed with CCA by physicians in 5 tertiary hospitals in four provinces of northeastern of Thailand between February and July 2011 were followed up to January 2012. The outcome was survival time from diagnosis to death. A total of 758.4 person-months of follow-up were available. The mortality rate was 16.9 per 100 person-months (95%CI: 14.1-20.1). The median survival time among CCA patients was 4.3 months (95%CI: 3.3-5.1). Cox's proportional hazard model was used to study the independent effects of factors affecting survival time among patients. Statistically significant factors included advanced stage at diagnosis (HR: 2.5, 95%CI: 1.7-3.8), presentation with jaundice (HR: 1.7, 95%CI: 1.1-2.4) or ascites (HR: 2.8, 95%CI: 1.8-4.4), and positive serum carcinoembryonic antigen (HR: 2.3, 95%CI: 1.2-4.3). Patients who had received standard treatment had a better prognosis that those who did not (HR: 0.5, 95%CI: 0.3-0.7).

Timing of decontamination and treatment in case of percutaneous VX poisoning: A mini review

Low volatile organophosphorous nerve agents such as VX, will most likely enter the body via the skin. The pharmacokinetics of drugs such as oximes, atropine and diazepam, are not aligned with the variable and persistent toxicokinetics of the agent. Repeated administration of these drugs showed to improve treatment efficacy compared to a single injection treatment.Because of the effectiveness of continuous treatment, it was investigated to what extent a subchronic pretreatment with carbamate (pyridostigmine or physostigmine combined with either procyclidine or scopolamine) would protect against percutaneous VX exposure. Inclusion of scopolamine in the pretreatment prevented seizures in all animals, but none of the pretreatments affected survival time or the onset time of cholinergic signs. These results indicate that percutaneous poisoning with VX requires additional conventional treatment in addition to the current pretreatment regimen.Decontamination of VX-exposed skin is one of the most important countermeasures to mitigate the effects of the exposure. To evaluate the window of opportunity for decontamination, the fielded skin decontaminant Reactive Skin Decontaminant Lotion (RSDL) was tested at different times in hairless guinea pigs percutaneously challenged with 4× LD50 VX in IPA. The results showed that RSDL decontamination at 15min after exposure could not prevent progressive blood cholinesterase inhibition and therefore would still require additional treatment. A similar decontamination regimen with RSDL at 90min showed that it still might effectively increase the time window of opportunity for treatment.In conclusion, the delay in absorption presents a window of opportunity for decontamination and treatment. The continuous release of VX from the skin presents a significant challenge for efficacious therapy, which should ideally consist of thorough decontamination and continuous treatment.

Factors affecting survival time after recurrence of non-small-cell lung cancer treated with concurrent chemoradiotherapy

Dose-fractionation schedules of palliative or salvage radiotherapy (RT) for recurrence of non-small-cell lung cancer (NSCLC) are various because they highly depend on patient prognosis. For optimal selection of dose-fractionation schedules, factors affecting survival time after recurrence were examined. From 1992 to 2005, 115 patients with stage III NSCLC received curative-intent concurrent chemoradiotherapy (CCRT). Among these patients, 74 underwent recurrence and were reviewed. Evaluated factors were age at recurrence, gender, initial stage, histological subtype, initial radiation-field size, recurrent patterns (locoregional alone vs. distant ± locoregional), time to recurrence (≤6 vs. >6 months), and treatment for recurrence (chemotherapy, RT). Median follow-up time after recurrence was 7 (range 0-59) months. One- and 2-year overall survival rates after recurrence were 28 and 11%, respectively. Based on multivariate analysis, time to recurrence (p = 0.0001) and administration of chemotherapy for recurrence (p = 0.0190) were the independently significant factors. Early recurrence was the most significant factor for survival after post-CCRT recurrence of NSCLC. Administration of chemotherapy for recurrence was also a significant factor, whereas RT for recurrence was not significant. When RT was given to patients with post-CCRT recurrence of NSCLC, dose-fractionated schedules should be determined considering these factors.

Resumption of ambulatory status after surgery for nonambulatory patients with epidural spinal metastasis

Improving the surgical outcome of nonambulatory patients with metastatic epidural spinal compression has been of great interest lately. Although there have been many reports regarding the surgical outcome of spinal metastasis, the surgical outcome in terms of the probability of operative success for nonambulatory patients has not been thoroughly described. If the probability of ambulatory recovery is known, the optimal surgical indications can be determined and implemented. To predict the surgical outcome and probability of ambulatory resumption for nonambulatory patients with spinal metastasis. Retrospective analysis. The surgical outcomes of patients who could not ambulate independently because of spinal metastasis from 1987 to 2010 were analyzed. The primary end point was postoperative ambulatory status. The secondary end point was survival time. Fifty-seven patients who could not ambulate independently at the time of surgery were included in the study. We defined "independent ambulation" as a better functional status than Nurick Grade 3, which is defined as "difficulty in walking which was not so severe as to require someone's help to walk." Preoperatively, functional status was Nurick Grade 4 in 21 patients and Grade 5 in 36 patients. Weakness developed 10.5 ± 11.9 days (median, 7.0; range, 1-80) before the operation and steadily worsened. Patients were unable to walk starting from 3.6 ± 4.9 days (median, 1.8; range, 0.5-23) before the operation. The spinal metastases were circumferentially decompressed. Postoperatively, 39 patients (68%) could walk. Complications occurred in 26% (15/57) of the patients, and the major complication rate was 12% (7/57). The mortality rate was 5% (3/57). The patient survival time was 287 ± 51 days (median, 128) after the operation. Postoperative ambulatory status (yes vs. no, p < .01) and occurrence of major complication (yes vs. no, p < .01) affected survival time. Overall, patients could walk for 193±41 days (median, 114) postoperatively. Motor grade (grade ≥ 4/5 vs. <4/5, p < .01) and the occurrence of a major complication (yes vs. no, p < .01) were significant factors for resumption of ambulation. The rate of ambulation resumption was 95% (20/21) in patients with a motor grade of 4 of 5, whereas it was 53% (19/36) in patients with a motor grade less than 4 of 5 (p < .01). The survival time of nonambulatory patients was dependent on ambulation recovery. About 95% of the nonambulatory patients could walk after surgery, when the operation was done in a timely manner with good remaining motor function. However, given the short life expectancy and the considerable surgical complication rate, surgery should only be prudently recommended to patients with optimal indications.

Acute Kidney Injury Is an Early Predictor of Mortality for Patients With Alcoholic Hepatitis

Alcoholic hepatitis (AH) is a severe condition with high mortality. To improve therapeutic strategies, it is important to identify factors that affect survival times. The age, bilirubin, international normalized ratio, and creatinine scoring system (also known as the ABIC scoring system) was developed previously to determine the prognosis of patients with AH. We studied effects of acute kidney injury (AKI) on survival of patients with AH. We retrospectively analyzed data from 103 patients with biopsy-proven AH. AKI was defined as an abrupt reduction (within 48 h) in kidney function that resulted in an absolute increase of at least 0.3 mg/dL (or a 50% increase) in serum levels of creatinine from baseline (the AKI network [AKIN] criteria). Twenty-nine patients (28%) developed AKI during hospitalization, with a median time to diagnosis of 3 days. Overall 90-day mortality was 23%, which was significantly higher among patients with AKI than those without (65% vs 7%; P < .0001). The age, bilirubin, international normalized ratio, and creatinine score (P < .0001) and development of AKI (P < .0001) were the most accurate independent predictors of 90-day mortality. The presence of systemic inflammatory response syndrome (P < .0001), serum bilirubin (P = .01), and international normalized ratio at admission (P = .03) were the most accurate predictors of AKI. Importantly, the AKIN criteria were more accurate than traditional criteria for renal failure (serum creatinine >1.5 mg/dL) in predicting 90-day mortality (area under the receiver operating characteristic, 0.83 vs 0.70, respectively; P = .02). Development of AKI reduces survival of patients with AH, in the short term. The AKIN criteria are useful and more accurate than traditional criteria in predicting mortality. Strategies to prevent AKI therefore should be considered in the management of patients with AH.

Combined survival analysis of cardiac patients by a Cox PH model and a Markov chain

The control and treatment of dyslipidemia is a major public health challenge, particularly for patients with coronary heart diseases. In this paper we propose a framework for survival analysis of patients who had a major cardiac event, focusing on assessment of the effect of changing LDL-cholesterol level and statins consumption on survival. This framework includes a Cox PH model and a Markov chain, and combines their results into reinforced conclusions regarding the factors that affect survival time. We prospectively studied 2,277 cardiac patients, and the results show high congruence between the Markov model and the PH model; both evidence that diabetes, history of stroke, peripheral vascular disease and smoking significantly increase hazard rate and reduce survival time. On the other hand, statin consumption is correlated with a lower hazard rate and longer survival time in both models. The role of such a framework in understanding the therapeutic behavior of patients and implementing effective secondary and primary prevention of heart diseases is discussed here.

Genetic Variations in the Regulator of G-Protein Signaling Genes Are Associated with Survival in Late-Stage Non-Small Cell Lung Cancer

The regulator of G-protein signaling (RGS) pathway plays an important role in signaling transduction, cellular activities, and carcinogenesis. We hypothesized that genetic variations in RGS gene family may be associated with the response of late-stage non-small cell lung cancer (NSCLC) patients to chemotherapy or chemoradiotherapy. We selected 95 tagging single nucleotide polymorphisms (SNPs) in 17 RGS genes and genotyped them in 598 late-stage NSCLC patients. Thirteen SNPs were significantly associated with overall survival. Among them, rs2749786 of RGS12 was most significant. Stratified analysis by chemotherapy or chemoradiation further identified SNPs that were associated with overall survival in subgroups. Rs2816312 of RGS1 and rs6689169 of RGS7 were most significant in chemotherapy group and chemoradiotherapy group, respectively. A significant cumulative effect was observed when these SNPs were combined. Survival tree analyses identified potential interactions between rs944343, rs2816312, and rs1122794 in affecting survival time in patients treated with chemotherapy, while the genotype of rs6429264 affected survival in chemoradiation-treated patients. To our knowledge, this is the first study to reveal the importance of RGS gene family in the survival of late-stage NSCLC patients.

Genetic influences on survival time after severe hemorrhage in inbred rat strains

To find a genetic basis for differential ability to survive severe hemorrhage, we previously showed eightfold differences in survival times among inbred rat strains. We assumed that rat strains had similar normalized blood volumes (NBV; ml/100 g body wt). As NBV might vary among strains and constitute one genetic variable affecting survival time to hemorrhage, in experiment 1 of the current studies we first measured total blood volumes and calculated NBV in specific inbred rat strains (Brown Norway/Medical College of Wisconsin, BN; Dark Agouti, DA; Fawn Hooded Hypertensive, FHH; Lewis, LEW; and Dahl Salt-Sensitive, SS) previously found to be divergent in survival time. NBV differed by 20% (P < 0.01; BN > SS > FHH = LEW = DA) and had a heritability (h(2)) of 0.56. Hence, differential survival times in our previously published study might reflect strain-dependent differences in NBV. Then studies were conducted wherein rats were catheterized and, ∼24 h later, 47% of their blood volume was removed; these rats were observed for a maximum of 4 h. In experiment 2, blood volumes were measured the day prior to hemorrhage. Percent survival and survival time did not differ among strains. To obviate possible confounding effects of blood volume determination, in experiment 3 the average NBV for each strain was used to determine hemorrhage volumes. Percent survival (P < 0.01) and survival times (P < 0.001) were different with DA demonstrating the best (62.5%, 190 ± 29 min) and BN the worst (0%, 52 ± 5 min) survival responses. These data indicate that both blood volume and survival time after hemorrhage in rats are heritable quantitative traits, and continue to suggest that genetic assessment of these phenotypes might lead to novel therapeutics to improve survival to hemorrhage.

Effects of the infant stool color card screening program on 5-year outcome of biliary atresia in taiwan

In Taiwan, a screening system using an infant stool color card to promote the early diagnosis of biliary atresia (BA) was established in 2002. This study aimed to investigate the 5-year outcome of BA before and after using the screening program. BA patients were divided into three cohorts according to their birth dates. The patients in cohort A (n = 89) were born before the stool card screening program (1990-2000); those in cohort B (n = 28) were screened by the stool card regional screening program (2002-2003); and those in cohort C (n = 74) were screened by the stool card universal screening program (2004-2005). The relative odds ratios were computed using logistic regression to compare the different factors affecting survival time. The rate of age at Kasai operation <60 days was 49.4% and 65.7% in cohorts A and B+C, respectively (P = 0.02). The jaundice-free (total serum bilirubin <2.0 mg/dL) rate 3 months after surgery was 34.8% and 60.8% in cohorts A and B+C, respectively (P < 0.001). The 3-year jaundice-free survival rate with native liver was 31.5% in cohort A and 56.9% in cohort B+C (P < 0.001), whereas the 3-year overall survival rates were 64.0% and 89.2%, respectively (P < 0.001). The 5-year jaundice-free survival rate with native liver was 27.3% in cohort A and 64.3% in cohort B (P < 0.001), and the 5-year overall survival rates were 55.7% and 89.3%, respectively (P < 0.001). The stool color card screening program for BA allows for earlier Kasai operation, which increases the jaundice-free rate at 3 months postsurgery. With higher surgical success rates, the 3- and 5-year outcome of BA patients in Taiwan improves remarkably.

Determining the role of external beam radiotherapy in unresectable intrahepatic cholangiocarcinoma: a retrospective analysis of 84 patients

BackgroundIntrahepatic cholangiocarcinoma (ICC) is the second most common type of primary liver cancer. Only few studies have focused on palliative radiotherapy used for patients who weren't suitable for resection by surgery. This study was conducted to investigate the effect of external beam radiotherapy (EBRT) for patients with unresectable ICC.MethodsWe identified 84 patients with ICC from December 1998 through December 2008 for retrospective analysis. Thirty-five of 84 patients received EBRT therapy five times a week (median dose, 50 Gy; dose range, 30-60 Gy, in fractions of 1.8-2.0 Gy daily; EBRT group); the remaining 49 patients comprised the non-EBRT group. Tumor response, jaundice relief, and survival rates were compared by Kaplan-Meier analysis. Patient records were reviewed and compared using Cox proportional hazard analysis to determine factors that affect survival time in ICC.ResultsAfter EBRT, complete response (CR) and partial response (PR) of primary tumors were observed in 8.6% and 28.5% of patients, respectively, and CR and PR of lymph node metastases were observed in 20% and 40% of patients. In 19 patients with jaundice, complete and partial relief was observed in 36.8% and 31.6% of patients, respectively. Median survival times were 5.1 months for the non-EBRT group and 9.5 months for the EBRT group (P = 0.003). One-and two-year survival rates for EBRT versus non-EBRT group were 38.5% versus 16.4%, and 9.6% versus 4.9%, respectively. Multivariate analysis revealed that clinical symptoms, larger tumor size, no EBRT, multiple nodules and synchronous lymph node metastases were associated with poorer prognosis.ConclusionsEBRT as palliative care appears to improve prognosis and relieve the symptom of jaundice in patients with unresectable ICC.

肺外小細胞癌例の検討―下咽頭小細胞癌例の報告とともに―

Extrapulmonary small-cell carcinoma (EPSCC) is clinically underrecognized and optimal management remains illusive. Although head and neck EPSCC tends to involve early widespread dissemination and poor prognosis, recently reported favorable outcomes have used concurrent chemoradiotherapy in limited-stage disease. We report an EPSCC case of arising in the hypopharynx successfully treated by induction chemotherapy followed by concurrent chemoradiotherapy. To clarify EPSCC clinically, we retrospectively reviewed clinical courses of all EPSCC records between 1999 and 2008 in a single-institution series. The 14 subjects identified had primary sites at the gastrointestinal tract in 5, uterine cervix in 3, genitourinary system in 2 and at the gallbladder, liver, hypopharynx, and an unidentified primary lymph node in one case each. Of the 14, 2 cases had stage I, 2 cases had stage II, 4 cases had stage III, 5 cases had stage IV in tumor-node-metastasis (TNM) classification. Stage IV subjects usually underwent platinum-based chemotherapy, to which 25% showed partial response (PR) and 75% progressive disease (PD) with median overall survival (OS) of 114.0 days, or 16 weeks. Of stage III or lower subjects, 75% underwent surgery and 62.5% chemotherapy. OS was 1244.0 days or 3.7 years and 2-year survival rates was estimated at 87.5%. Survival duration differed significantly between those in stage III or lower and those in group IV. Age significantly affected survival time in the Cox proportional hazard regression model. Brain metastasis was uncommon in this series, despite the absence of prophylactic cranial radiation. Further studies are needed to improve and clarify the clinical EPSCC course.

Natural History and Prognostic Factors of Advanced Cholangiocarcinoma without Surgery, Chemotherapy, or Radiotherapy: A Large-Scale Observational Study

Background/AimsWe aimed to evaluate survival time and prognostic factors in patients with advanced unresectable cholangiocarcinoma who have not received surgery, chemotherapy, or radiotherapy.MethodsA total of 1,377 patients, who were diagnosed with primary cholangiocarcinoma between 1996 and 2002, were reviewed retrospectively according to the following inclusion criteria: histologically proven primary adenocarcinoma arising from the bile-duct epithelium, advanced unresectable stages, no severe comorbidity that can affect survival time, and no history of surgery, chemotherapy, or radiotherapy.ResultsOf the 1,377 cases reviewed, 330 patients complied with the inclusion criteria and were thus eligible to participate in this study; 203 had intrahepatic cholangiocarcinoma and 127 had hilar cholangiocarcinoma. The overall survival time of the entire cohort (n=330) was median 3.9 months (range; 0.2 to 67.1). The survival time was significantly shorter in the intrahepatic cholangiocarcinoma group (3.0±5.3 months) than in the hilar cholangiocarcinoma group (5.9±10.1 months; Kaplan-Meier survival analysis). Multivariate analysis revealed that distant metastasis was a poor prognostic factor for intrahepatic cholangiocarcinoma (p< 0.001), baseline serum albumin >3.0 g/dL was a favorable prognostic factor (p=0.02), and baseline serum carcinoembryonic antigen level >30 ng/mL was a poor prognostic factor for hilar cholangiocarcinoma (p=0.01).ConclusionsThe median survival of advanced unresectable cholangiocarcinoma is dismal.

Resection Margin and Recurrence-Free Survival After Liver Resection of Colorectal Metastases

Optimal margin width is uncertain because of conflicting results from recent studies using overall survival as the end-point. After recurrence, re-resection and aggressive chemotherapy heavily affect survival time; the potential confounding effect of such factors has not been investigated. Use of recurrence-free survival (RFS) may overcome this limitation. The aim of this study is to evaluate the impact of width of resection margin on RFS and site of recurrence after hepatic resection for colorectal metastases (CRM). From a prospectively maintained institutional database (1/1999-12/2007) we identified 314 patients undergone hepatectomy for CRM (1/1999-12/2007) with detailed pathologic analysis of the surgical margin and complete follow-up imaging studies documenting disease status and site of recurrence, which was categorized as: resection margin (M(arg)), other intra-hepatic ((other)IH), lung (L) or other extra-hepatic ((other)EH). Recurrence-free estimation was the survival end-point. Median follow-up was 56.5 months. Two hundred and fifteen patients (68.8%) recurred at 288 sites after a mean of 15.5 months. A positive resection margin was associated with an increased risk of M(arg) recurrence (P < 0.001). The presence of >or=2 metastases was the only factor increasing the risk of positive margins (P < 0.05). The width of the negative resection margin (>or=1 cm versus >1 cm) was not a prognostic factor of worse RFS (30.2% versus 37.3%, P = 0.6). Node status of the primary tumour, and size and number of CRM were independent predictors of RFS. Tumour biology and not the width of the negative resection margin affect RFS.

Blood volumes in inbred rat strains with different survival times after severe hemorrhage

We have previously shown 8‐fold differences in survival time among inbred rat strains after a 55% hemorrhage, and found a strong genetic component for this trait (Klemcke et al., Shock 29: 748, 2008). Blood volumes (BV) for all strains were assumed to be 5.83 % of body weight (BW), and BV removed was based on this figure. However, BV might vary in a strain‐dependent manner. If true, this may be one genetic variable affecting survival time after hemorrhage (STaH). To examine this possibility, we measured BV in select strains using an Evans blue procedure. BV varied among Brown Norway, Salt Sensitive, Fawn Hooded Hypertensive, Lewis, and DA rat strains respectively (9.16±.21a ; 7.45±.21b; 7.01±.24b,c ; 7.01±.22b,c ; 6.57±.22c % of BW; means with different letter superscripts are different, P&lt;.01), and showed a heritability (h2) of 0.75. When these BV were used to calculate the % of BV removed from rats in our previous study, those percentages differed (37.0±0.3a; 45.4±0.5b; 50.0±0.4d; 47.8±0.9c; 52.1±.2e %; P&lt;.01) and were highly and inversely correlated with previously determined STaH (r = ‐0.77; P &lt;.01). These data indicate that previously noted differences in STaH among strains might be accounted for in part by removal of a different % of BV. They also suggest that BV −which is amenable to environmental (e.g., exercise) and genetic manipulation− is a genetically‐controlled characteristic that might be used to improve STaH.

Clinical study of survival time for chronic liver failure.

To identify independent risk factors influencing the survival time of patients with chronic liver failure and construct a predictive model. Retrospective analysis was applied to clinical data of 362 patients with chronic liver failure treated with artificial liver in Tianjin third centre hospital between May 2002 and May 2007. Data were analyzed with SPSS 13.0 statistic software, t test and rank test were used on quantitative data, chi-square test was used on qualitative data, Cox regression analysis was used to select the independent risk factors influencing the survival time. According to independent risk factors from Cox regression model, a prognostic model was established. 1. Independent risk factors (P less than 0.05) influencing the survival time were: Child-Pugh score, bilirubin separation ALT, ascites, arginine, age, tyrosine and serum sodium. 2. By receiver operating characteristic curves (ROC) analysis, the area under ROC (AUR) to predict the outcome of chronic liver failure patients was 0.782, and the cutoff score was 27.69. 1. Child-Pugh score, bilirubin separation ALT, ascites, arginine, age, tyrosine and serum sodium are independent risk factors affecting survival time of patients with chronic liver failure. 2. Cox model we constructed can reliably predict the survival time of patients with chronic liver failure.

Treatment of portal vein tumor thrombus of hepatocellular carcinoma with percutaneous laser ablation

Portal vein tumor thrombus (PVTT) is a common complication of hepatocellular carcinoma (HCC), and is associated with extremely poor prognosis. In this retrospective study, we first evaluate the application of percutaneous laser ablation as a treatment for PVTT due to advanced hepatocellular carcinoma. 108 patients (2002.7-2005.12) that have adequate liver function and be in reasonably good general condition were enrolled at Eastern hepatobiliary surgery hospital. The thrombus was ablated via an optic fiber placed in the guide needle with the guiding of ultrasound. In the follow-ups, the serial imaging and laboratory routines were examined and the overall clinical progress was measured at regular intervals until time of death. In the clinical assessment, survival time and factors affecting survival time were analyzed. The changes of laboratory test (alanine transaminase and alpha fetoprotein) and clinical manifestation (ascites and diarrhea) of the PVTT patients before and after laser ablation were observed. Patency of the tumor-occluded portal vein branch is the only factor that affect the survival time, the longer the patency time, the longer the survival time. The long-term survivals of patients in our study are 55.56, 33.58 and 22.38% at 1, 2 and 3 years, respectively. Both laboratory test and clinical presentations were improved. Alphalpha fetoprotein in the positive patients decreased and alanine transaminase in the abnormal patients normalized at 1 month after the treatment. Ascites disappeared in 44.00% patients (11/25), and diarrhea ameliorated in 57.14% (12/21). Laser ablation might be a novel and effective treatment for PVTT associated with advanced HCC.

Genes contributing to prion pathogenesis

Prion diseases are caused by conversion of a normally folded, non-pathogenic isoform of the prion protein (PrP(C)) to a misfolded, pathogenic isoform (PrP(Sc)). Prion inoculation experiments in mice expressing homologous PrP(C) molecules on different genetic backgrounds displayed different incubation times, indicating that the conversion reaction may be influenced by other gene products. To identify genes that contribute to prion pathogenesis, we analysed incubation times of prions in mice in which the gene product was inactivated, knocked out or overexpressed. We tested 20 candidate genes, because their products either colocalize with PrP, are associated with Alzheimer's disease, are elevated during prion disease, or function in PrP-mediated signalling, PrP glycosylation, or protein maintenance. Whereas some of the candidates tested may have a role in the normal function of PrP(C), our data show that many genes previously implicated in prion replication have no discernible effect on the pathogenesis of prion disease. While most genes tested did not significantly affect survival times, ablation of the amyloid beta (A4) precursor protein (App) or interleukin-1 receptor, type I (Il1r1), and transgenic overexpression of human superoxide dismutase 1 (SOD1) prolonged incubation times by 13, 16 and 19 %, respectively.