Changzheng Hospital Research Articles

Diagnostic value of plasma tryptophan and symmetric dimethylarginine levels for acute kidney injury among tacrolimus-treated kidney transplant patients by targeted metabolomics analysis

Few literatures have evaluated the exact role of metabolomics in the identification process of potential biomarkers for acute kidney injury among the patients receiving renal transplantation. On top of this, the success of metabolomics in biomarker translation seems to lie in the robust quantitative method. As such, a single-center retrospective observational study was conducted enrolling 42 patients underwent renal transplantation with/without acute kidney injury, as well as 24 healthy volunteers, in Shanghai Changzheng Hospital. Plasma amino acid metabolic patterns for the participants were investigated by targeted UHPLC-MS/MS metabolic profiling. The most significant changes of the explored metabolites were related to the disturbance of tryptophan metabolism and arginine metabolism. Abnormal circulating tryptophan and symmetric dimethylarginine were identified to be potential biomarkers of acute kidney injury, combination of which showed a higher area under receiver-operator curve value (AUC = 0.901), improved sensitivity (0.889) and specificity (0.831) compared with creatinine only. Overall, these results revealed that targeted metabolomics analysis would be a potent and promising strategy for identification and pre-validation of biomarkers of acute kidney injury in renal transplantation patients.

Shen-Shuai-Ning granule decreased serum concentrations of indoxyl sulphate in uremic patients undergoing peritoneal dialysis

Clearance of protein-bound uremic toxins (PBUTs) by dialysis is a challenge in the treatment of uremic patients. Shen-Shuai-Ning (SSN), a traditional Chinese medicine formulation, has been used commonly in China to retard kidney disease progression and decrease uremic toxins in chronic kidney disease (CKD) patients, but the effects of SSN on serum PBUTs in dialysis patients were not investigated. We conducted a randomized controlled trial in patients on peritoneal dialysis (PD) at dialysis center of Changzheng Hospital to evaluate the effects of SSN on serum PBUTs. Participants with SSN intervention took 5 g SSN granule three times daily for 12 weeks, while the baseline medications and dialysis prescriptions remained during the study in all patients. The serum concentrations of indoxyl sulphate (IS) and p-cresol sulphate (PCS) were determined by HPLC/MS/MS and biochemical parameters were assessed during the study. Sixty PD patients were enrolled and randomly allocated into SSN group and control group. Total IS level was significantly lower in SSN group than in control group at week 4, 8, and 12 (27.28 ± 18.19, 29.73 ± 19.10, and 29.41 ± 17.61 mg/l compared with 39.25 ± 20.23, 44.86 ± 23.91, and 45.34 ± 33.52 mg/l, respectively). However, there were no statistical difference of total PCS, free forms of IS and PCS concentrations between SSN group and control group during 12 weeks follow-up. Administration of SSN granule orally decreased serum total IS level effectively in uremic patients on PD with good tolerance. Benefits of PD patients’ outcomes from IS reduction by SSN awaits further large size and long duration clinical trials to verify.

Age Should Be Considered in the AJCC TNM Staging System of Pancreatic Neuroendocrine Tumors

Background Currently, there are two most common staging systems for pancreatic neuroendocrine tumors (pNETs), one from the European Neuroendocrine Tumor Society (ENETS) and the other from the American Joint Committee on Cancer (AJCC). However, there have been imperfections in both staging systems. The current study proposed a modified staging system based on the AJCC staging system and age factor. Methods Patients were selected from the Surveillance Epidemiology and End Results (SEER) database (2004 to 2013). Patient characteristics were collected, including clinical and pathological features. Prognostic factors for overall survival (OS) were evaluated by Cox proportional hazards models. The discriminatory powers of staging systems were determined using the concordance index (C-index). The age effect on the hazard ratio (HR) was evaluated by restricted cubic splines and survival analysis was conducted using Kaplan-Meier methods. Findings A total of 3034 patients with pNETs were included finally. The median age was 59 years, and age was an independent prognostic factor for pNETs. Under 60 years, the death risk of patients increased slowly with age growing. But the death risk rose sharply over 60 years, forming a mirror L-shaped survival curve. In the current AJCC tumor-node-metastasis (TNM) staging system, no statistical significance was observed between stage IA and IB (p=0.105). Patients with stage IIB even had longer OS than patients with IIA although there was no statistical significance (p=0.574). The proportion of stage III was small (2.7%). In the proposed aTNM staging system, significant survival differences could be observed among stage I, IIA and IIB (p<0.001) and the proportion of stage III rose from 2.7% to 25.7%. The C-index of the current AJCC TNM staging system was 0.720, while C-index of the proposed aTNM staging system was 0.753. Interpretation Our findings suggest age has a critical influence on the survival of patients with pNETs. Age factor should be considered in the future staging system of pNETs. Funding: This work was supported by National Natural Science Foundation of China (41776140). The authors would like to thank Dr. Haiyang Zhou from the Department of General Surgery, Changzheng Hospital, Second Military Medical University. Declaration of Interest: There are no conflicts of interest. Ethical Approval: All researchers can get data from the SEER database without restrictions, not involving ethics.

PS01.225: SINGLE HOLE PNEUMOPERITONEUM COMBINED WITH LAPAROSCOPIC RADICAL MASTECTOMY FOR ESOPHAGEAL CANCER

Abstract Background Minimally invasive esophagectomy (MIE) has been an alternative treatment for esophageal cancer. The objective of this study is to evaluate the safety and feasibility of single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy for esophageal cancer. Methods Retrospective analysis of clinical data was performed on 12 patients with esophageal cancer who underwent a single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy by one surgical team in Shanghai Changzheng hospital. Recorded outcome measures included operative time, blood loss, length of hospital stay, and perioperative complications. Results No perioperative mortality, pulmonary infection, arrhythmia, recurrent laryngeal nerve (RLN) palsy and thoracic duct injury was observed in all patients. The operative time, intraoperative blood loss and pressure of CO2 was (219 ± 9.3)min, (26.3 ± 2.7)ml and (50.5 ± 4.6)mmHg. The mean number of dissected thoracic lymph nodes was 19 ± 1.5. One patient was converted to open surgery because of massive bleeding intraoperation. Two patients occurred postoperative anastomotic leakage. Conclusion A single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy provides safe and feasible approach to minimally invasive esophagectomy for patients with early esophageal cancer. Disclosure All authors have declared no conflicts of interest.

Clinicopathological characteristics and prognostic factors of gastrointestinal stromal tumors in Chinese patients.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms in the gastrointestinal tract, exhibiting wide variability in their biological behavior. The aim of the present study was to investigate the clinicopathological characteristics and prognostic factors of GISTs in Chinese patients. All GIST cases (n=182) retrieved from the pathology database and the archived files in Shanghai Changzheng Hospital between January 2011 and December 2014 were reviewed. The clinical symptoms, preoperative investigations, treatments, pathological characteristics and follow-up data of these patients were reviewed, and univariate and multivariate survival analyses were performed. A total of 73.1% of the GISTs were located in the stomach, and the most common three symptoms included abdominal pain (30.2%), dyspepsia (23.1%) and gastrointestinal bleeding (21.4%). Univariate analysis revealed that larger tumor size (P<0.001), higher mitotic rate (P<0.001), aggressive behavior (P<0.001), negative smooth muscle actin expression (P=0.009) and palliative resection (P<0.001) contributed toward poor overall survival (OS). In addition, non-gastric disease location (P<0.001), larger tumor size (P<0.001), higher mitotic rate (P=0.004), aggressive behavior (P<0.001) and palliative resection (P<0.001) were associated with poor relapse-free survival (RFS). Multivariate analysis indicated that mitotic rate [hazard ratio (HR=3.761, P=0.015)] and aggressive behavior (HR=3.916, P=0.010) were independent risk factors for OS, while non-gastric location (HR=4.740, P=0.002) and aggressive behavior (HR=4.009, P=0.004) were independent risk factors for RFS. The present study provided information on the clinicopathological characteristics and epidemiology of GISTs in the Chinese population. Non-gastric disease location, higher mitotic rate and tumor metastasis or local invasion prior to treatment were identified as predictors of a poor prognosis.

Anterior Cervical Ossified Posterior Longitudinal Ligament En Bloc Resection: The Efficacy and Advantages of a Novel Surgical Technique for the Treatment of Cervical Ossification of the Posterior Longitudinal Ligament with Myelopathy

Background: Severe neurologic deficit caused by cervical ossification of the posterior longitudinal ligament (COPLL) requires surgical treatment. However, the surgical strategies to treat cervical myelopathy caused by COPLL remains controversial. We aimed to determine the efficacy and advantages of en bloc resection of posterior vertebral wall and ossified mass in the treatment of COPLL. Methods: This is a retrospective case series. From July 2009 to June 2016, ninety-one COPLL patients underwent surgical treatment at the spine center of Shanghai Changzheng Hospital in China. Among them, forty-eight patients underwent anterior cervical ossified mass of posterior longitudinal ligament piecemeal resection (ACOP) by small Kerrison punch (from July 2009 to December 2013), and forty-three patients underwent anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE) by a burr-grinding technique (from January 2014 to June 2016). The canal occupational rates (CORs) of ossification in ACOP group were50-59% in 24 cases, 60-69% in 17 cases and ≥ 70% in 7 cases; in ACOE group, the CORs of ossification present as follows: 50-59% in 21 cases, 60-69% in 13 cases and ≥ 70% in 9 cases. In ACOP group the ossified masses were piecemeal resected and in ACOE group the ossified mass and the posterior vertebral wall were en bloc resected. All ossified dura maters in the two groups were removed if present, and arachnoids were covered with biological membranes. The Japanese orthopedic association (JOA) system was used to evaluate the neurologic outcomes of the two groups. X-rays were used to examine the positions of the internal fixations, and CT scans were used to evaluate the scopes of the ossification excision, and MRIs were implemented to evaluate the decompression situations of the spinal nerve. Findings: At the last follow-up visit for 24-90 months (35.1±6.4 months), the JOA scores all improved at postoperative three months, one year and the last follow-up in two groups. At the time of pre-operation, one year postoperative and the last follow-up, there was no significant difference in JOA scores of single-vertebral resection and double-vertebral resection between the two group. While at three months postoperative, the JOA scores of single-vertebral resection and double-vertebral resection in ACOE group were both higher than which in ACOP group. In terms of complications in ACOE group, intraspinal hematoma was not identified, cerebrospinal fluid leakage (CSFL) in one case, C5 root palsy in one case, internal fixation loosening in one case, hoarseness in one case and Horner syndrome in one case; in ACOP group, internal fixation loosening was not identified, CSFLs in 6 cases, C5 root palsy in two cases, hoarseness in four cases, intraspinal hematoma in one case and Horner syndrome in two cases. All complications were effectively recovered. No postoperative aggravation of neurological dysfunction and wound infection occurred. Comparing to ACOP, the ACOE is more efficient and safer with better neurological improvement in a short time follow-up (<3 months). The incidence of CSFL could be significantly reduced by ACOE in the treatment of COP. Funding: This study was supported by grants from of the National Natural Science Foundation of China (Grant No. 81171753) and the Science and Technology Commission of Shanghai Municipality (Grant No. 15140903800). Conflict of Interest: None of the authors has financial interest in the subject under discussion in this paper. Ethical Approval Statement: The treatment protocol and informed consent were approved by the Shanghai Changzheng Hospital Institutional Review Board, and that all subjects gave informed consent.

Value of DNA Methylation in Predicting Curve Progression in Patients with Adolescent Idiopathic Scoliosis

Background: There is considerable discordance for adolescent idiopathic scoliosis (AIS) patients' curve progression between monozygotic (MZ) twins, indicating that non-genetic factors must be involved in curve progression of AIS patients. Epigenetic processes may constitute one of these factors and have not yet been investigated in relation to curve progression in AIS patients. Methods: The genome and methylome of peripheral monocytes were compared between MZ twins discordant for curve progression. Sets of differentially methylated sites were validated using the MassARRAY platform of Sequenome on additional samples. Results: In the discovery study, we found evidence suggesting a lack of differences at the genome sequence level and the presence of epigenetic differences related to curve progression of AIS patients. The top 4 differentially methylated CpG sites associated with curve severity were tested and only site cg01374129 (CpG site located at chr8:122583383, Hg19) was confirmed in both two replication cohorts. Methylation levels of site cg01374129 were significantly lower in progression group compared with non-progression group. Cox regression analysis demonstrated hypo-methylation of site cg01374129 as an independent prognostic factor for curve severity. Site cg01374129 methylation as a marker achieved a sensitivity of 76.4% and a specificity of 85.6% in differentiating between samples from patients with and without curve progression (AUC = 0.827; 95% CI: 0.780 to 0.876). Conclusion: Increased curve is associated with decreased methylation at site cg01374129. Our results indicate that methylation of site cg01374129 may therefore serve as a promising biomarker in differing between patients with and without curve progression. Funding: This research was supported by grants from Translational Medicine Centre of Second Military Medical University for Precision Medicine (2017JZ25) and the National Natural Science Foundation of China (81772305) to XZ. Declaration of Interest: None declared. Ethical Approval: The ethical committee and institutional review board of Shanghai Changzheng Hospital approved this study.

Role of des-gamma-carboxy prothrombin in assessment of liver function and prognosis of patients with liver cirrhosis

Objective To investigate the role of des-gamma-carboxy prothrombin (DCP) in assessment of liver function and prognosis of patients with liver cirrhosis. Methods From January 2013 to August 2016, a total of 137 patients with liver cirrhosis in Shanghai Changzheng Hospital were enrolled. The serum DCP level was measured, the clinical data was collected and the complication and survival situation was followed up. The 137 patients were divided into DCP negative group (DCP≤40 mAU/mL, 118 cases) and DCP positive group (DCP>40 mAU/mL, 19 cases). Forty-five patients with compensated liver cirrhosis were divided into high-level DCP group (DCP>16.5 mAU/mL, 32 cases) and low-level DCP group (DCP≤16.5 mAU/mL, 13 cases). Chi square test was used to analyze the difference in the positive rate of DCP in patients with different Child-Pugh classification. Spearman correlation test was performed to analyze the correlation between DCP and model for end-stage liver disease (MELD) scores. Kaplan-Meier survival curve was used to analyze the correlation between DCP and liver disease related mortality. Results Compared to that of DCP negative group, albumin level of patients in DCP positive group decreased (35 g/L, 20 to 57 g/L vs. 29 g/L, 17 to 42 g/L), however, total bilirubin (TBil), prothrombin time (PT), and international normalized ratio all increased (12.9 mg/L, 1.80 to 83.0 mg/L vs.22.2 mg/L, 6.4 to 169.0 mg/L; 15.5 s, 11.7 to 35.7 s vs.17.5 s, 13.9 to 33.4 s; 1.24, 0.96 to 3.72 vs.1.44, 1.09 to 3.22), and the differences were statistically significant (Z=-2.785, -2.891, -2.945 and -2.879, all P 40 mAU/mL) rates of Child-Pugh A, B and C patients were 1.8% (1/55), 21.2% (11/52) and 23.3% (7/30), respectively, and the difference was statistically significant (χ2=11.246, P=0.003). The DCP levels of patients with Child-Pugh class B and C cirrhosis were significantly correlated with MELD scores (r=0.259, P=0.021). There were 16 and three patients with ascites and spontaneous bacterial peritonitis (SBP) of DCP positive group, and the incidence was higher than that of DCP negative group (55.1%, 65/118 and 1.7%, 2/118), and the differences were statistically significant (χ2=5.744 and 97.636, both P<0.05). Patients in high-level DCP group had a higher proportion of clinical decompensation than low-level DCP group (53.1% (17/32) and two cases), the difference was statistically significant (χ2=5.397, P=0.024). The overall survival rate of DCP positive group (nine survival cases) were lower than that of DCP negative group (87.9%, 87/99), and the difference was statistically significant (χ2=5.442, P=0.020). Conclusions Serum DCP level is closely related to liver function, ascites and SBP in patients with liver cirrhosis. Furthermore, it is associated with occurrence of decompensation in compensated patients and liver-related mortality in patients with liver cirrhosis. DCP may be a useful serum marker for evaluation of disease severity and prognosis in patients with liver cirrhosis in clinical practice. Key words: Liver cirrhosis; Des-gamma-carboxy prothrombin; Liver fuction; Prognosis

Surgical strategy and outcome evaluation of acoustic neuroma resection through suboccipital retrosigmoid approach

Objectives To investigate the surgical strategy and evaluate the surgical results of acoustic neuroma resection through suboccipital retrosigmoid approach. Methods A total of 319 cases of acoustic neuromas underwent surgical resection through suboccipital retrosigmoid approach at Neurosurgery Department, Changzheng Hospital, Naval Military Medical University from January 2007 to December 2017 and retrospectively reviewed and analyzed in this study. Electroneurophysiological monitoring was conducted during the whole course of operation. Postoperative facial nerve function was assessed based on House-Brackmann (H-B) scale. Results Among all 319 cases, 291 (91.2%) tumors were totally or subtotally resected and 28 (8.8%) were partially resected. 221 (69.3%) patients did not develop any postoperative complications and 39 (12.2%) had intracranial infections, 11 (3.5%) reported intracranial hematoma, 10 (3.1%) had choke on water, 10 (3.1%) had cerebrospinal fluid leakage, and 3 (0.9%) died. A total of 262 patients were followed up for 3-89 months (median: 42 months). At 3-6 months post operation, the assessment of facial nerve function indicated grade Ⅰ in 148 (56.5%) cases, grade Ⅱ in 72 (27.5%) cases, grade Ⅲ in 26 (9.9%) cases and grade Ⅳ in 16 (6.1%) cases. There were 5 (1.9%) cases of tumor recurrence and 1 death reported during follow-up. Conclusion Microsurgical resection through suboccipital retrosigmoid approach combined with electroneurophysiological monitoring appears to be safe and effective for the treatment of acoustic neuromas with a relative low recurrence rate. Key words: Neuroma, acoustic; Microsurgery; Facial nerve; Suboccipital postsigmoid approach; Neurophysiological monitoring

Lung cancer screening with low-dose CT: a study on risk factors and establishing the high-risk model for lung cancer

Objective To establish standards of high-risk populations for low-dose CT (LDCT) lung cancer screening projects by analyzing lung cancer risk factors. Methods LDCT was performed in 6 990 subjects undergoing physical examinations in Changzheng Hospital from September 2013 to September 2016, including 4 567 males and 2 423 females. Mineralization nodes, solid nodules, pure ground glass nodules and partial solid nodules were defined as positive results. All cases of lung cancer were confirmed by pathological examination. The morbidity and risk factors of lung cancer were analyzed using t-test, chi-square test and logistic regression analysis. And there were 13 risk factors involved, including age, sex, body mass index (BMI), smoking, the family history of lung cancer and other malignant tumors, the history of chronic bronchitis or chronic obstructive pulmonary disease, the history of pulmonary fibrosis, the history of tuberculosis, the history of other malignant tumors, the history of cardiovascular disease, the history of second hand smoke exposure, the history of exposure to radon and the history of exposure to asbestos. The cut point of risk factors was analyzed according to the receiver operating characteristic (ROC) curve. Results Sixty-nine cases of lung cancer and 85 malignant nodules were detected in this screening. There were 34 males and 35 females among the lung cancer patients and their age ranged from 24 to 88 years with an average age of (60±16) years. In all the factors involved in this study, sex (χ2=7.937), age (t=19.509, χ2=29.991) and cardiovascular disease (χ2=5.333) were proved to be the risk factors of lung cancer by single factor analysis. Logistic regression analysis showed that sex (OR=0.478, 95%CI: 0.297-0.769, P=0.002) and age (OR=1.024, 95%CI: 1.024-1.060, P=0.001) were independent risk factors of lung cancer. ROC analysis showed an area under the curve (AUC) of 0.62 for age, 0.587 for age of males and 0.659 for age of females. According to ROC curves, people over 56.5 years old (sensitivity 55.1%, specificity 75.0%, accuracy 74.8%), males over 56.5 years old (sensitivity 52.9%, specificity 73.4%, accuracy 73.3%) and females over 57.5 years old (sensitivity 57.1%, specificity 80.5%, accuracy 80.1%) were high-risk groups. Conclusions In this study, sex and age were proved to be the risk factors of lung cancer. Males over 56.5 years old and females over 57.5 years old are more likely to suffer from lung cancer. However, this study is a single center study, so that other risk factors of lung cancer are not ruled out completely. Key words: Lung neoplasms; Tomography, X-ray computed; Risk factors; Screening

Analysis of the difference between the results of caloric tests and video head pulse tests in patients with vestibular migraine and vestibular neuritis

Objective:To compare the results of caloric tests and video head impulse tests (VHIT) in patients with vestibular migraine (VM) and vestibular neuritis (VN), so as to provide help for the differential diagnosis of the two patients. Method:Retrospectively analyze VM and VN patients within 2 weeks of onset from August 1, 2016 to December 31, 2017 in neurology clinic of the Changzheng Hospital of Second Military Medical University, all patients were examined by caloric tests and VHIT, and the results of the two groups were compared and analyzed.Result:The 40 cases of VM patients， among them, 23 cases were abnormal in caloric test, 17 cases showed unilateral canal paresis, 6 cases showed bilateral weakness, the unilateral abnormality rate was higher than that of bilateral abnormality（P<0.01）. 8 cases were abnormal in VHIT, 3 cases had unilateral vestibulo-ocular reflex (VOR) gain decline, 5 cases had bilateral VOR gain decline, unilateral and bilateral VHIT abnormal rate had no difference (P>0.05). The 45 cases of VN patients. Among them, 45 cases were abnormal in caloric test, 37cases showed unilateral canal paresis, 8 cases showed bilateral weakness, the unilateral abnormality rate was higher than that of bilateral abnormality（P<0.001). 35 cases were abnormal in VHIT, 21 cases had unilateral VOR gain decline, 14 cases had bilateral VOR gain decline, unilateral and bilateral VHIT abnormal rate had no difference (P> 0.05). By statistical analysis, the abnormal rate of caloric test of VN and VM were higher than that of VHIT, and the abnormal rate of caloric test and VHIT in VM patients were lower than that of VN. The slow phase velocity (SPV) and the VHIT gain of the three group of semicircular canals of strong and weak caloric response sides in the VM patients were higher than those of the corresponding canals in the VN patients.Conclusion:The low frequency damage of vestibule function of semicircular canals in VN and VM patients is more than that of high frequency. Compared with VM, the high and low frequency damage of the semicircular canals in VN patients are more common(P<0.05), and prone to high and low frequency simultaneous involvement (P<0.001). From the SPV of caloric test and VHIT gain values, the degree of damage to the high and low frequency semicircular canals of in VN patients was more serious than that in VM patients.

Clinical Outcomes of Primary and Revision Untethering Surgery in Patients with Tethered Cord Syndrome and Spinal Bifida

Tethered cord syndrome (TCS) is an increasingly recognized clinical condition, with untethering surgery considered the classically effective treatment. Yet, as evidence has aggregated, the surgical outcomes of untethering remain controversial. This study aimed to systematically evaluate the clinical outcomes in patients who underwent primary or revision untethering. This retrospective study was conducted at the Department of Spine Surgery of Changzheng Hospital between January and December 2016. Patients with TCS who underwent untethering surgery were recruited for the study. Information collected included demographic data, main clinical manifestations, and outcomes after untethering surgery. A total of 112 patients (60 males and 52 females) were included in this study, with mean follow-up of 13.7 years. The surgical outcomes of the primary untethering varied among symptoms, with remission rates of 30.0% for pain, 24.4% for paresthesia, 18.6% for motor deficit, 12.6% for bladder dysfunction, and 21.2% for bowel dysfunction. Moreover, 23.3%-40.2% of patients suffered deterioration after surgery during the follow-up period. Twenty-eight patients underwent revision untethering surgery. In these patients, the remission rate decreased by 5.6%-16.7% compared with the primary operation. Moreover, most patients (58.8%-70.6%) experienced no benefits after revision surgery. With a possible high risk of recurrence, further exploration of the indications and timing of the untethering surgery is needed. Conservative treatment and omnidirectional care might be a better choice for patients with retethering with recurrent symptoms.

A single-center experience of liver transplantation for alcoholic liver disease

Objective To study liver transplantation in the treatment of alcoholic liver disease (ALD). Methods A retrospective study was conducted on 40 patients with ALD who underwent liver transplantation in the Changzheng Hospital of the Second Military Medical University from April 2005 to June 2017. The data were expressed as mean±standard deviation (±s) in populations with a normal distribution, and as median (min~max) in populations with an abnormal distribution. The survival rate was analyzed by life tables, and the Cox regression analysis was used for multivariate analysis. Results All patients were followed up until August 31, 2017. The follow-up time was 2~4 518 days, with a median of 997 days. Among the 40 patients, 8 had already died (3 died of multiple organ failure, 2 of biliary complications, 1 of liver failure, 1 of sepsis and 1 of recurrence of hepatocellular carcinoma (HCC). The 1-year survival rate was 81.0%, and the 5-year survival rate was 77.0%. Four of 40 patients developed tumor recurrence. The initial recurrence time was 189~337 days (median 236.5). The recurrence sites included the liver, colon combined with lungs, lungs, and lumbar vertebrae. Six of 40 (15.0%) patients had relapse in alcoholism. Multivariate analysis showed that age was a prognostic factor (RR=1.109, P 0.05). Conclusions ALD patients were mostly 40~60 years old. Age was an independent factor affecting survival. The younger the patient, the better the prognosis. Other factors were of no prognostic significance. Key words: Alcoholic liver disease(ALD); Liver transplantation(LT); Survival analysis; Alcoholism

Comprehensive analysis on 559 cases of adrenal incidentalomas in the elderly Chinese.

ObjectiveThis study was conducted to describe the incidence, classifications and characteristics of adrenal incidentalomas (AIs) in the elderly Chinese.MethodsPrimary clinical records in Shanghai Changzheng Hospital (n = 559) were collected for incident cases of AI between January 1, 2002 and December 1, 2016. We examined demographics, endocrine functions, treatment, etiology, and prognoses.ResultsWe identified 559 new diagnoses of elderly onset AIs, of which 41.25% were male and were diagnosed at a mean age of 74.39 ± 9.03 years. About 61% showed no typical symptoms. Upon systematic review, 41.34% showed dysglycemia, high blood pressure, kaliopenia, and so on. 24.15% (n = 135) received complete or partial endocrine function assessments. A total of 281 cases underwent surgical treatment, and 278 cases went through regular follow‐ups without any operation. Preoperative evaluation was basically consistent with postoperative pathology (P > .05). During the follow‐up, the presence of new subclinical hypercortisolism was 8.99%, and the tumor grew up 3.92% per year (1.96 ± 0.09 mm). 51 cases (9.12%) eventually received further invasive examinations or surgical treatments.ConclusionThe detection of AI in the elderly Chinese is increasing annually. The imaging method and endocrine function tests have great roles in distinguishing between benignancy and malignancy. The diagnosis and treatment of the elderly Chinese with AI should receive multidisciplinary assessment. Biochemical and morphological follow‐up of aged patients with AI should be conducted every 5 years at least.

Outcomes of poor responders following growth hormone co-treatment with IVF/ICSI mild stimulation protocol: a retrospective cohort study.

No research has studied the effect of GH co-treatment in mild stimulation protocol for poor responders. We therefore conducted this retrospective analysis to assess the outcome of IVF/ICSI cycles after the adjunct GH use to the mild stimulation protocol in poor responders. 132 poor responders who received mild stimulation protocol at Reproductive Medicine Center of Changzheng Hospital from January 2014 to December 2016 were included in this study. Good-quality embryo rate, clinical pregnancy rate, and live birth rate were compared between the GH group (n=61) and control group (n=71). IVF good-quality embryo rate (68.1 versus 51.5%; P=0.008*) and ICSI good-quality embryo rate (53.9 versus 36.7%; P=0.045*) was significantly higher in the GH group. Though the clinical outcomes did not reach a statistically significant difference between the two groups due to the limited sample size, there was a trend of higher rate in GH group in the aspect of clinical pregnancy rate (52.4 versus 47.1%; P=0.609) and live birth rate (35.7 versus 27.5%; P=0.392). The results suggested that the adjuvant GH treatment in mild stimulation protocol for poor responders could significantly improve good-quality embryo rate, and might therefore improve the clinical outcomes.

Intracisternal tuberculoma: a refractory type of tuberculoma indicating surgical intervention

BackgroundCentral nervous system (CNS) tuberculoma is a rare disease with severe neurological deficits. This retrospective research is to review the data of patients diagnosed as CNS tuberculoma. Surgeries were performed in all patients. The clinical features especially the neurological image and the anatomical characters of the tuberculomas were concerned.MethodsTotally 11 patients diagnosed as CNS tuberculoma were admitted in Guangzhou First People’s Hospital (7cases) and Changzheng Hospital (4 cases) during 2006–2015. The data including preoperative condition, neurological imaging, and surgical findings was collected and analyzed.ResultsThe lesions of nine patients (9/11) were totally or subtotally excised and two (2/11) were partially excised. Neurological functions of all patients were improved after surgery without secondary infection. Lesions of nine (9/11) patients preoperatively progressed as a result of paradoxical reaction. Of the 9 patients demonstrated paradoxical progression, all lesions were partially or totally located at the cisterns or the subarachnoid space. Preoperative ATTs lasted 2 to 12 months and tuberculomas were not eliminated. The arachnoid was found thickened and tightly adhered to the lesions during surgeries. Of the 2 cases that paradoxical reaction were excluded, both patients (case 6, intramedullary tuberculoma; case 11, intradural extramedullary tuberculoma) were admitted at onset of the disease. ATTs were preoperatively given for 1 week as neurological deficits aggravated. The tuberculous lesions of CNS or other system showed no obvious change and paradoxical reaction could not be established in both cases.ConclusionsExudates of tuberculosis is usually accumulated in the cisterns and frequently results in the paradoxical formation of tuberculoma. Intracisternal tuberculoma is closely related to paradoxical reaction and refractory to anti-tuberculosis therapy. Micro-surgical excision is safe and effective. Early surgical intervention may be considered in the diagnosis of intracisternal tuberculoma especially when paradoxical reaction participates in the development of tuberculoma.

Analysis of correlation between spinal nerve high tension and disc degeneration in 100 cases

Objective: To explore the correlation between the spinal nerve high tension and lumbar disc degeneration, the pathogenesis of hanging intervertebral disc degeneration. Methods: From June 2016 to June , a retrospective analysis 2017 of 100 cases of lumbar spinal stenosis were included in Department of Spine Surgery, Changzheng Hospital, the Second Military Medical University. They were divided into experimental group (50 cases, nerve high tension group) and control group (50 cases, nervous tension in the normal group) according to preoperative lumbar MRI of cauda equina syndrome and settlement of intraoperative detecting nerve tension. The Pfirrmann grade was used to evaluate degree of lumbar (L3/4-L5/S1) disc degeneration.The correlation between spinal nerve tension and lumbar disc degeneration was analyzed, and the severity of experimental group and control group on lumbar disc degeneration was compared. Results: There was no significant difference in the age and sex ratio between the two groups (P>0.05). The Pfirrmann score of the experimental group was L3/4 (4.74±1.6) grade, L4/5 (5.32±1.33) grade, L5/S1 (5.54±1.13) grade; the control group Pfirrmann score was L3/4 (3.5±1.16) grade, L4/5 (4.12±0.9) grade, and L5/S1 (4.1±0.97) grade.The severity of intervertebral disc degeneration in experimental group was higher than that in control group, with statistical significance (P<0.05). There was a correlation between lumbar disc degeneration and nerve tension in L3/4, L4/5 and L5/S1, and the correlation trend was L5/S1> L4/5> L3/4. Conclusion: There is a correlation between lumbar disc degeneration and spinal nerve high tension.A new pathogenesis of hanging intervertebral disc degeneration that the degeneration of lumbar disc is a compensatory mechanism in order to alleviate the axial stretch injury is put forward.

Quality of Life of Patients with Spinal Metastasis from Cancer of Unknown Primary Origin: A Longitudinal Study of Surgical Management Combined with Postoperative Radiation Therapy.

Patients with spinal metastasis from cancer of unknown primary origin have limited life expectancy and poor quality of life. Surgery and radiation therapy remain the main treatment options, but, to our knowledge, there are limited data concerning quality-of-life improvement after surgery and radiation therapy and even fewer data on whether surgical intervention would affect quality of life. Patients were enrolled between January 2009 and January 2014 at the Changzheng Hospital, Shanghai, People's Republic of China. The quality of life of 2 patient groups (one group that underwent surgery followed by postoperative radiation therapy and one group that underwent radiation therapy only) was assessed by the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire during a 6-month period. A subgroup analysis of quality of life was performed to compare different surgical strategies in the surgical group. A total of 287 patients, including 191 patients in the group that underwent surgery and 96 patients in the group that underwent radiation therapy only, were enrolled in the prospective study; 177 patients completed all 5 checkpoints and 110 patients had died by the final checkpoint. The surgery group had significantly higher adjusted quality-of-life scores than the radiation therapy group in each domain of the FACT-G questionnaire (all p < 0.05). Subgroup analysis showed that adjusted functional and physical well-being scores were higher in the circumferential surgical decompression group. Surgery followed by postoperative radiation therapy improved and maintained quality of life in patients with spinal metastasis from cancer of unknown primary origin in the 6-month assessment. In terms of surgical strategies, circumferential decompression seems better than laminectomy alone in quality-of-life improvement. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Nomograms for prognostic factors of spinal giant cell tumor combining traditional clinical characteristics with inflammatory biomarkers after gross total resection.

Giant cell tumor (GCT) of bone is a common primary bone tumor, which exhibits local aggressiveness and recurrent potential, especially for the spinal lesion. Increasing evidence indicates that inflammation plays a vital role in tumorigenesis and progression. The prognostic value of inflammatory biomarkers in GCT has not been established. A retrospective analysis was conducted in patients with spinal GCT in Changzheng Hospital Orthopedic Oncological Center (CHOOC) between January 2005 and October 2015 and 129 patients were identified eligible. Traditional clinical parameters and inflammatory indexes such as Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and albumin/globulin ratio (AGR) were concluded and analyzed. Kaplan-Meier analysis was used to calculate the disease-free survival (DFS). Cox regression analysis was performed to assess the prognostic factors. Nomograms were established to predict DFS quantitatively for the first time, and Harrell’s concordance index (c-index) was adopted to evaluate prediction accuracy. As results, the DFS was 78.3% in the cohort. Patients were stratified into 2 groups by NLR (≤ 2.70 and > 2.70), PLR (≤ 215.80 and > 215.80), LMR (≤ 2.80 and >2.80) and AGR (< 1.50 and ≥ 1.50). Patients with NLR > 2.70, PLR > 215.80, LMR ≤ 2.80 and AGR < 1.50 were significantly associated with decreased DFS (p < 0.05). Multivariate analysis indicated that treatment history, tumor length, bisphosphonate treatment, NLR and PLR were independent factors of DFS (p < 0.05, respectively). In addition, nomogram on DFS was established according to all significant factors, and c-index was 0.728 (95% CI: 0.710-0.743). Nomograms based on DFS can be recommended as practical models to evaluate prognosis for spinal GCT patients.

Increased SNAT1 is a marker of human osteosarcoma and potential therapeutic target

BackgroundSLC38A1/SNAT1 has been found to play an essential role in human development, but its role in osteosarcoma (OS) has yet to be evaluated. The purpose of this study was to assess the expression of SLC38A1/SNAT1 in patients with OS, and further investigate the mechanisms by which it affects tumor growth and metastasis.MethodsTissue microarray blocks and immunohistochemical studies were carried out to assess the expression of SNAT1 in 165 OS specimens. Its correlation with clinicopathological characteristics was then analyzed. The function of SNAT1 in OS cells was investigated by silencing SNAT1 using SNAT1-shRNA in vitro and in vivo.ResultsSNAT1 was highly expressed in 85% OS and significantly closely associated with pulmonary metastasis. Patients with high SNAT1 expression survived for shorter periods than those with low SNAT1 expression. Suppression of endogenous SNAT1 led to inhibition of cell proliferation, cell colony formation, and cell migration in vitro, and retarded tumor growth in xenograft models. Silencing SNAT1 reduced expression of MMP9, vimentin, fibronectin, p-Akt, p-mTOR, and VEGF.ConclusionsOur results indicated that increased expression of SNAT1 is a common event in OS. SNAT1 played an essential role in the development and progression of osteosarcoma, which may serve as a prognostic and therapeutic marker of OS.