Fuzhou General Hospital Research Articles

Predicting delayed remission in Cushing's disease using radiomics models: a multi-center study.

No multi-center radiomics models have been built to predict delayed remission (DR) after transsphenoidal surgery (TSS) in Cushing's disease (CD). The present study aims to build clinical and radiomics models based on data from three centers to predict DR after TSS in CD. A total of 122 CD patients from Peking Union Medical College Hospital, Xuanwu Hospital, and Fuzhou General Hospital were enrolled between January 2000 and January 2019. The T1-weighted gadolinium-enhanced MRI images and clinical data were used as inputs to build clinical and radiomics models. The regions of interest (ROI) of MRI images were automatically defined by a deep learning algorithm developed by our team. The area under the curve (AUC) of receiver operating characteristic (ROC) curves was used to evaluate the performance of the models. In total, 10 machine learning algorithms were used to construct models. The overall DR rate is 44.3% (54/122). According to multivariate Logistic regression analysis, patients with higher BMI and lower postoperative cortisol levels are more likely to achieve a higher rate of delayed remission. Among the 10 models, XGBoost achieved the best performance among all models in both clinical and radiomics models with AUC values of 0.767 and 0.819 respectively. The results from SHAP value and LIME algorithms revealed that postoperative cortisol level (PoC) and BMI were the most important features associated with DR. Radiomics models can be built as an effective noninvasive method to predict DR and might be useful in assisting neurosurgeons in making therapeutic plans after TSS for CD patients. These results are preliminary and further validation in a larger patient sample is needed.

Radiomics model and clinical scale for the preoperative diagnosis of silent corticotroph adenomas.

Silent corticotroph adenomas (SCAs) are a subtype of nonfunctioning pituitary adenomas that exhibit more aggressive behavior. However, rapid and accurate preoperative diagnostic methods are currently lacking. The purpose of this study was to examine the differences between SCA and non-SCA features and to establish radiomics models and a clinical scale for rapid and accurate prediction. A total of 260 patients (72 SCAs vs. 188 NSCAs) with nonfunctioning adenomas from Peking Union Medical College Hospital were enrolled in the study as the internal dataset. Thirty-five patients (6 SCAs vs. 29 NSCAs) from Fuzhou General Hospital were enrolled as the external dataset. Radiomics models and an SCA scale to preoperatively diagnose SCAs were established based on MR images and clinical features. There were more female patients (internal dataset: p < 0.001; external dataset: p = 0.028) and more multiple microcystic changes (internal dataset: p < 0.001; external dataset: p = 0.012) in the SCA group. MRI showed more invasiveness (higher Knosp grades, p ≤ 0.001). The radiomics model achieved AUCs of 0.931 and 0.937 in the internal and external datasets, respectively. The clinical scale achieved an AUC of 0.877 and a sensitivity of 0.952 in the internal dataset and an AUC of 0.899 and a sensitivity of 1.0 in the external dataset. Based on clinical information and imaging characteristics, the constructed radiomics model achieved high preoperative diagnostic ability. The SCA scale achieved the purpose of rapidity and practicality while ensuring sensitivity, which is conducive to simplifying clinical work.

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Endometriosis Increases the Risk of Stroke: A Mendelian Randomization Study.

HomeStrokeVol. 54, No. 2Endometriosis Increases the Risk of Stroke: A Mendelian Randomization Study No AccessResearch ArticleRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialNo AccessResearch ArticleRequest AccessFull TextEndometriosis Increases the Risk of Stroke: A Mendelian Randomization Study Ming Zheng and Shaoping Zheng Ming ZhengMing Zheng Correspondence to: Ming Zheng, MD, PhD, Institute of Military Cognition and Brain Sciences, Academy of Military Medical Sciences, 27 Taiping Rd, Beijing 100850, China. Email E-mail Address: [email protected] or E-mail Address: [email protected] https://orcid.org/0000-0002-3651-7701 Institute of Military Cognition and Brain Sciences, Academy of Military Medical Sciences, Beijing, China (M.Z.). Beijing Institute of Basic Medical Sciences, China (M.Z.). *M. Zheng and S. Zheng contributed equally. Search for more papers by this author and Shaoping ZhengShaoping Zheng https://orcid.org/0000-0002-3544-0431 Departments of Obstetrics and Gynecology, Fuzhou General Hospital, Fujian, China (S.Z.). *M. Zheng and S. Zheng contributed equally. Search for more papers by this author Originally published23 Jan 2023https://doi.org/10.1161/STROKEAHA.122.041163Stroke. 2023;54:e30–e33AbstractDownload figureDownload PowerPointFootnotes*M. Zheng and S. Zheng contributed equally.For Sources of Funding and Disclosures, see page e32.Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.122.041163.Correspondence to: Ming Zheng, MD, PhD, Institute of Military Cognition and Brain Sciences, Academy of Military Medical Sciences, 27 Taiping Rd, Beijing 100850, China. Email [email protected]edu.cn or [email protected]com

Analysis of changes in the volume of edema around brain contusions and the influencing factors: A single-center, retrospective, observational study.

Traumatic brain injury (TBI), a common neurosurgical condition, has well-known treatment guidelines. However, the mechanisms underlying the varying severity of brain edema secondary to TBI are largely unknown, leading to controversial treatments.This study seeks to measure edema volumes around brain contusions in different regions, analyze factors related to differences in edema volume and provide a theoretical basis for brain edema treatment.Data from 113 brain contusion patients treated at the Department of Neurosurgery of Fuzhou General Hospital from January 2017 to November 2019 were analyzed retrospectively. Based on computed tomography (CT) data, the patients were divided into the venous group (brain contusion in regions with large cortical veins, n = 47) and the nonvenous group (brain contusions in other regions, n = 66). Here, 3D Slicer software was used to calculate the brain contusion volume on the first CT obtained after injury and the brain contusion volume and its surrounding edema on the 5th day after injury. The brain contusion volume to surrounding edema volume ratio was calculated, and the number of patients who showed brain contusion progression requiring surgery was determined. Hematocrit (Hct), fibrinogen (Fg), and d-dimer levels within 6 hours and on the 5th day after admission were also compared.Patients in the venous group had a significantly increased percentage of area with edema around the brain contusion compared with patients in the nonvenous group (P < .05), and the 2 groups showed no significant difference in the number of patients with brain contusion progression or surgical treatment (P > .05) or Hct, Fg, or d-dimer (D-D) levels. For all patients, Hct, Fg, and D-D levels within 6 hours after admission were significantly different from those on the 5th day (P < .05 for all).Cortical venous obstruction may be the most important factor influencing edema around brain contusions. The Fg level decreased slightly, and the D-D level increased to its peak rapidly after mild-moderate TBI. This change was followed by a gradual increase in the former and a gradual decrease in the latter.

Observation of the Therapeutic outcome of Local Block with Promethazine and Routine Surgery in the Treatment of Popliteal Cyst

To analyze the therapeutic efficacy of local block with promethazine and routine surgery in the treatment of popliteal cyst and explore the clinical efficacy of arthroscopy-assisted modified popliteal cyst resection therapy, a total of 116 patients with popliteal cyst treated at the Fuzhou General Hospital of Nanjing Military Command were enrolled. These patients were divided into the control group, who underwent routine surgery and the research group, who were subjected to local block with promethazine, with 58 patients in each group. The therapeutic efficacy was observed and compared. The incision length and surgical time of the research group were significantly lower than that of the control group. By comparing the remission rates of clinical symptoms at 2 d, 1 mo, 2 mo and 1 y after surgery, the magnetic resonance imaging data, the recovery rate and recurrence rate, results showed that the research group had greater advantage over the control group (P<0.05). Local block with promethazine could produce ideal outcomes in the treatment of popliteal cyst than routine surgery.

Genetic variants of familial hematuria associated genes in three families with hematuria with probands initially diagnosed as IgA nephropathy

Objective: To examine genetic variants of familial hematuria (FH) associated genes in 3 families with hematuria with probands initially diagnosed with IgA nephropathy (IgAN). Methods: A retrospective analysis was performed on the clinical data, laboratory tests and genetic test results of three children with hematuria and the probands in three families with hematuria. The families were ascertained at the Department of Pediatrics, Fuzhou General Hospital of Nanjing Military Command from August 2014 to May 2018. Results: The proband of Family One, an 8-year-old boy, manifested gross hematuria. His renal biopsy pathology revealed IgAN. His father also manifested hematuria. Genetic testing showed that the proband and his father carried a heterozygous variant of the CFHR5 gene,533A>G (Asn178Ser). The child of Family Two, a 4-year-old girl, manifested hematuria. Her father, the proband of the family, was 36 years old, and manifested hematuria, proteinuria, high-frequency sensorineural deafness and renal insufficiency. He was diagnosed as IgAN according to clinical manifestations, renal pathology and routine immunohistochemistry without renal biopsy electron microscopy, renal tissue type Ⅳ collagen α3, α4, α5 chains immunofluorescence and skin type Ⅳ collagen α5 chain immunofluorescence. Genetic testing showed that the girl carried a heterozygous variant of the COL4A5 gene,566G>T (Gly189Val), and her father carried the hemizygous variant. The child of Family Three, a 7-year-old girl, manifested hematuria and proteinuria. Her mother, the proband of the family, was 34 years old, and manifested hematuria and proteinuria as well. The proband was diagnosed as IgAN by the same method used for Family Two. The girl's grandfather died of uremia at the age of 44. Genetic testing showed that the girl and her mother carried a heterozygous variant 539G>A (Gly180Glu)in COL4A5 gene. Conclusions: The variant of the CFHR5 gene identified in Family One is of uncertain signifance, and the two variants of the COL4A5 gene identified in Families Two and Three are pathogenic. The probands of Families Two and Three are diagnosed as Alport syndrome. The study suggests that clinicians should examine genetic variants of FH associated genes in families with hematuria when the probands were diagnosed as IgAN by their clinical manifestations, renal pathology and routine immunohistochemistry.

MiR-192/215-5p Act as Tumor Suppressors and Link Crohn's Disease and Colorectal Cancer by Targeting Metabolic Pathways: A Comprehensive Database Mining and Experimental Study

Background: MicroRNAs (miRNAs) have emerged as key regulators involved in a variety of biological processes such as inflammatory bowel diseases and tumor progression. Previous studies have demonstrated that miR-192/215 participated in progression of Crohn's disease (CD) and colorectal cancer (CRC), respectively; however, their detailed functional relationships and molecular regulations between two diseases remain unclear. Methods: Here we used bioinformatics methods to systematically expound miR-192/215-5p macrocontrol regulatory networks shared by two diseases. For data mining and validation, several miRNA prediction tools including Tarbase, miRTARBASE, miRecored, miRpathDB, et al; Human miRNA tissue atlas, FunRich, miRcancer, MalaCards, GEPIA, cBioPortal, luciferase assay, et al. are extensively applied. Findings: miR-192/215-5p with identical seed sequence were specially distributed in colon tissues and enriched biological pathways were closely associated with human cancers. Emerging role of miR-192/215-5p in CD and CRC was also analyzed. In addition, we analyzed common pathways targeted by miR-192/215-5p in both diseases. Interpretation: Based on results derived from multiple approaches, we identified the biological functions of miR-192/215-5p as a tumor suppressor and link CD and CRC by targeting triglyceride synthesis and extracellular matrix remodeling pathways. Funding Statement: The research was supported by the Natural Science Foundation of Fujian Province [grant numbers 2012YZ0001-1 and 2016J01582], National Nature Science Foundation of China [grant numbers No.81402107 and No.81601618], Military Medical Science project [grant number No.15QNP025]. Declaration of Interests: No potential conflicts of interest were disclosed. Ethics Approval Statement: The study protocol was approved by the Ethics Committee of Fuzhou General Hospital, Xiamen University. Data collections and processions were performed according to policies of GEO and TCGA project.

Outbreak of mycoplasmal round pneumonia in an adult population: A case series.

Mycoplasmal pneumonia is a common type of adult community-acquired pneumonia in China, but round/spherical pneumonia caused by mycoplasma pneumoniae has rarely been reported. Here, we report an outbreak of mycoplasmal round pneumonia in a military dormitory in China. We analysed epidemiological, clinical, imaging and laboratory data from a series of adults affected by an outbreak of mycoplasmal round pneumonia in the dormitory of a military hospital (Fuzhou General Hospital) in Fuzhou, China. The dormitory included 2 separate buildings. Mycoplasma antibody was detected using a passive agglutination assay. The first case in our series, a 23-year-old male intern, presented on July 16, 2015 with a 3-day history of low-grade fever, dizziness, fatigue and chest tightness. Chest computed tomography revealed spherical masses. Over the following 4 days, 11 individuals who had been in close contact with the first patient were found to have similar masses. All 12 cases were mildly symptomatic or asymptomatic, and fever was the only sign visible upon physical examination. Chest radiology revealed single, round consolidations in 3 cases and multiple round consolidations in 9 cases; consolidations ranged in size from 0.2 to 2.9cm. Most cases had normal blood cell count, erythrocyte sedimentation rate and C reactive protein level. Nasopharyngeal swabs from all cases tested negative for 25 pathogens, including Mycoplasma pneumoniae, in a PCR-based assay performed on August 1, 2015. All 12 patients showed a 4-fold increase in the titre of anti-mycoplasmal pneumonia antibody in paired sera on August 13, 2015. Patients were given the antibiotic moxifloxacin or symptomatic treatment, and 11 of the 12 cases showed complete resolution of round pneumonia lesions within 4weeks. This case series illustrates the diversity of clinical manifestations as well as imaging findings for mycoplasmal pneumonia, to which clinicians should pay more attention. Mycoplasmal round pneumonia should be included in differential diagnosis of multiple pulmonary nodules in adults in order to enable accurate clinical identification of disease and successful treatment and resolution.

Prediction of pelvic floor muscle function in stress urinary incontinence

Objective: To explore the predictive effect of pelvic floor muscle function on stress urinary incontinence (SUI) . Methods: A total of 258 women in gynecological outpatients at Fuzhou General Hospital were evaluated the pelvic floor muscle function by intravaginal manometery, then all of outpatients were divided into urinary incontinence group and non-incontinence group, and compared pelvic floor muscle function and clinical characteristic to establish prediction model of SUI by classification tree and analyse the predictive role of pelvic floor muscle function for SUI. Results: There were significant difference in body mass index [BMI; (22.8±2.9) vs (21.5±2.7) kg/m2, P<0.05], maximum newborn weight [ (3 396±424) vs (3 284±384) g, P<0.05] between urinary incontinence group (n=114) and non-incontinence group (n=144) . However, there were no significant differences in age, parity and mode of delivery between two groups (all P>0.05) . There were significant differences (all P<0.01) in maximum vaginal pressure [ (21±7) vs (35±9) mmHg (1 mmHg=0.133 kPa) ], average pressure [ (13±7) vs (23±9) mmHg], fatigue [ (-65±20) % vs (-46±17) %] and collecting time [ (1.0±0.6) vs (0.8±0.5) s] between two groups. Prediction model, which obtained by classification tree analysis with the affecting factors of SUI (including BMI, maximum vaginal pressure, fatigue and collecting time) , suggested that the incidence of SUI was 88.6% (70/79) , when maximum vaginal pressure ≤26.2 mmHg. While, when maximum vaginal pressure was greater than 28.2 mmHg, there was no occurrence of SUI (0/7) . But it would increase, when BMI >22.6 kg/m2. Conclusions: The occurrence of SUI is related to the BMI and pelvic floor muscles function. It would increase the risk of SUI with vaginal maximum pressure (≤26.2 mmHg) and BMI (>22.6 kg/m2) . While there is almost no SUI, while vaginal maximum pressure >28.2 mmHg. To select high-risk group of SUI and intervene early according to the prediction model, which may be make sense of reducing incidence of SUI.

Clinical value of carbon nanoparticles marker for neoadjuvant chemoradiotherapy of rectal cancer

Objective To explore the clinical value of carbon nanoparticles marker before neoadjuvant chemoradiotherapy (NACRT) of locally advanced rectal cancer. Methods Clinical data of 18 patients (11 male and 7 female) with locally advanced rectal cancer admitted to Fuzhou General Hospital from July 2015 to December 2015 was analyzed retrospectively. Patients were 45.8±12.5 (35-68) years old. Before NACRT, carbon nanoparticles were injected through an endoscope. The multiple-point injection was 1 cm from the lesion (4 quadrants of the upper, lower, left and right) to avoid direct injection into the tumor. The injection suspension of carbon nanoparticles was 5 mg per point. After endoscopic marking, the duration of NACRT plus rest was 8±2 (5-11) weeks, and then the surgery was performed. Effects of endoscopic carbon nanoparticles markers on judgment of the tumor size, the distance from the lower margin of the tumor to the anal border, the intraoperative condition and the rate of anus preservation were observed. Results The operation time was 10.0±3.5(5-15)min. No adverse reactions, and bleeding, perforation or other complications occurred. After NACRT, all tumors were reduced, completely disappeared in 7 cases (38.9%), and pathologically respond in 6 cases (33.3%). The distance between the lower margin of the tumor and the margin of the anal border was 6.4±1.8 (4.5-10.0)cm. In the operation, 100% lesions were found to be stained black outside the intestine, with clear location and partial lymph node dysphasia. Eight cases received anus preserving operation, and the rate of anus preservation was 44.4%. Conclusion The carbon nanoparticles marker can accurately position the tumor and label the lymph node for locally advanced rectal cancer before NACRT. The dyeing effect is lasting, conducive to the surgery or follow-up observation. Key words: Colorectal neoplasms; Antineoplastic combined chemotherapy protocols; Carbon nanoparticles; Tumor markers

Contribution of Spinal PKCγ Expression to Short- and Long-lasting Pain Behaviors in Formalin-induced Inflamed Mice

Over-expression of spinal protein kinase Cγ(PKCγ) contributes to the induction of persistent bilateral hyperalgesia following inflammatory injury, yet the role of spinal PKCγ in short- and long-lasting pain behavior is poorly understood. This study aimed to characterize the contribution of spinal PKCγ to spontaneous pain and long-lasting bilateral hyperalgesia in formalin-induced inflamed mice using pharmacological inhibition. Laboratory animal study. The study was performed in the Department of Human Anatomy and K.K. Leung Brain Research Centre, Preclinical School of Medicine, the Fourth Military Medical University (Xi'an, China) and the Department of Anesthesiology, Fuzhou General Hospital (Fuzhou, China). Male mice were unilaterally intraplantarly injected with formalin to induce inflammatory pain. Spontaneous pain behaviors, including flinches and lickings, were recorded by off-line video during the first hour post-injection and counted. Using von Frey tests, long-lasting bilateral mechanical paw withdrawal thresholds were determined before injection and at indicated time points thereafter. Temporal expression of spinal PKCγ was observed by immunohistochemical staining. For pharmacological inhibition, mice were treated daily with intrathecal Tat carrier or selective PKCγ inhibitor KIG31-1, from 1 hour prior to 10 days after formalin injection. Spontaneous pain behaviors and long-lasting bilateral mechanical hyperalgesia were assessed. Spinal PKCγ expression was also observed by using immunohistochemical staining and western blot. The number of PKCγ-immunoreactive (ir) spinal neurons was significantly higher at 10 days, but not 2 hours, after formalin intraplantar injection, and accompanied by long-lasting bilateral hyperalgesia. Furthermore, long-lasting bilateral hyperalgesia could be reversed by pharmacological inhibition of over-expressed spinal PKCγ; however, pretreating with intrathecal KIG31-1 showed no antinociceptive effects on short-term spontaneous pain behaviors. All results were obtained from the mice and no PKCγ inhibitors were available through clinical practice. Therefore, it remains difficult to draw definitive connections between animal research and human application. Our findings suggest that spinal PKCγ plays a predominant role in long-lasting bilateral hyperalgesia, but not in the spontaneous pain behaviors induced by formalin. Formalin, spontaneous pain, mechanical hyperalgesia, protein kinase C gamma, KIG31-1, mice.

Genetic Influence of Toll-Like Receptors on Non-HIV Cryptococcal Meningitis: An Observational Cohort Study

Background Cryptococcal meningitis (CM) is a significant source of mortality, the pathogenesis of which has not been fully understood, especially in non-HIV infected populations. We aimed to compare single nucleotide polymorphisms (SNPs) of Toll-like receptor (TLR) in non-HIV CM patients with those of healthy controls, and to assess the links among TLR SNPs, cytokine concentrations in cerebrospinal fluid (CSF), and clinical severity. Methods This observational cohort study was done in 2 stages: a discovery stage and a validation stage. We conducted a case-control genetic association study between 159 non-HIV CM patients and 468 healthy controls. TLR SNPs significantly related to susceptibility were further validated in a second cohort of 583 subjects from a certain district. Cytokine concentrations in CSF were used to evaluate the in situ immune response of CNS after infection. Correlations among TLR SNPs, CSF cytokine concentrations, and clinical severity were validated in a third prospective cohort of 99 previously untreated non-HIV CM patients. Logistic regression model was used to determine the independent predictors for disease severity. Findings In the discovery stage, the genotype distributions of 8 TLR SNPs in non-HIV CM patients exhibited a significant difference in comparison with controls, of which 3 SNPs remained statistically significant in patients without predisposing factors. In the validation stage, 5 of the 8 nominated TLR SNPs were found to influence CSF cytokine expression. Eighteen cytokines were significantly up-regulated in severely ill patients, among which 12 were affected by TLR2 rs3804099. The rs3804099 was also found in relation to disease severity. High IL-10 levels in CSF (OR 2*97, 95% CI 1*49-5*90; p=0*002) was suggested as an independent predictor for severity after adjusted for possible confounders. Interpretation TLR participate in both the occurrence and the pathogenesis of non-HIV CM. The in situ immune responses of CM were under genetic influence of TLR and contributed to disease severity. Our findings inform of an opportunity for early evaluation and treatment of non-HIV CM. TLR might also become a potential target on which to base host-directed immunotherapy. Funding: National Natural Science Foundation of China and National Key Basic Research Program of China (973 Program). Declaration of Interest: We declare no competing interests. Ethical Approval: Ethical approval was obtained from the medical ethics committee of Huashan Hospital, Mengchao Hepatobiliary Hospital, Fujian HIV/AIDS Diagnosis and Treatment Center, and No. 476 Hospital of Fuzhou General Hospital.

Liver transplantation for treatment of hilar cholangiocarcinoma with a report of three cases

Objective To investigate the feasibility of liver transplantation in the treatment of inoperable hilar cholangiocarcinoma. Methods The clinical data for 3 patients with unresectable hilar cholangiocarcinoma who underwent liver transplantation in the Department of Hepatobiliary Surgery of Fuzhou General Hospital of People′s Liberation Army from January 2006 to December 2012 were retrospectively analyzed. The patients were followed up by phone, outpatient service, and hospitalization. The starting point of the follow-up was the operation date. The patient's death was the end point. The clinical and pathological features, postoperative survival, tumor recurrence, and prognostic factors were observed. The follow-up deadline was December 2017. Results All 3 patients underwent classical orthotopic liver transplantation using retrograde perfusion through inferior vena cava and no perioperative deaths occurred. All 3 patients were followed up for 10 to 132 months. During the follow-up period, of 1 patient who died of tumor recurrence, the pathological TNM stage was T4aN1M0, and both had Union for International Cancer Control stage Ⅳa, and the tumor-free survival time was 3 months, and the survival time was 12 months. Of 1 patient who died of other causes, the pathological TNM stage was T3N1M0, and both had Union for International Cancer Control stage Ⅲ, and the tumor-free survival time was 12 months, and the survival time was 12 months. One case as of the end of follow-up, the patient has survived for 132 months, the pathological TNM staging was T2aN0M0, and both had Union for International Cancer Control stage Ⅱ. Conclusions Lymph node positive and high pathological TNM stage were poor prognosis factor for hilar cholangiocarcinoma who underwent liver transplantation. Patients with early hilar cholangiocarcinoma who don′t have lymph node metastasis are expected to benefit from liver transplantation. Key words: Liver transplantation; Bile duct neoplasms; Hilar cholangiocarcinoma

Prognostic Value of Model for End-Stage Liver Disease Incorporating with Serum Sodium Score for Development of Acute Kidney Injury after Liver Transplantation.

Background:Contribution of model for end-stage liver disease incorporating with serum sodium (MELD-Na) score in predicting acute kidney injury (AKI) after orthotopic liver transplantation (OLT) is yet to be identified. This study assessed the prognostic value of MELD-Na score for the development of AKI following OLT.Methods:Preoperative and surgery-related variables of 321 adult end-stage liver disease patients who underwent OLT in Fuzhou General Hospital were collected. Postoperative AKI was defined and staged in accordance with the clinical practice guidelines developed by Kidney Disease: Improving Global Outcomes. Univariate and multivariate analysis was performed to determine the risk factors for AKI following OLT. The discriminating power of MELD/MELD-Na score on AKI outcome was evaluated by receiver operating characteristic (ROC) curve. Spearman's correlation analysis was used for identifying the correlated relationship between MELD/MELD-Na score and the severity levels of AKI.Results:The prevalence of AKI following OLT was in 206 out of 321 patients (64.2%). Three risk factors for AKI post-OLT were presented, preoperative calculated MELD score (odds ratio [OR] = 1.048, P = 0.021), intraoperative volume of red cell suspension transfusion (OR = 1.001, P = 0.002), and preoperative liver cirrhosis (OR = 2.015, P = 0.012). Two areas under ROC curve (AUCs) of MELD/MELD-Na score predicting AKI were 0.688 and 0.672, respectively; the difference between two AUCs was not significant (Z = 1.952, P = 0.051). The Spearman's correlation coefficients between MELD/MELD-Na score and the severity levels of AKI were 0.406 and 0.385 (P = 0.001, 0.001), respectively.Conclusions:We demonstrated that preoperative MELD score, intraoperative volume of red cell suspension transfusion and preoperative liver cirrhosis were risk factors for AKI following OLT. Furthermore, we preliminarily validated that MELD score seemed to have a stronger power discriminating AKI post-OLT than that of novel MELD-Na score.

Cerebral infarction caused by accidental incarceration of aneurysm-adjacent branches with temporary clips

Objective To explore the potential reasons of cerebral infarction caused by accidental incarceration of aneurysm-adjacent branches with temporary clips, and to give guidance to the appropriate application of temporary clips. Methods A retrospective analysis was conducted on the clinical data of 10 patients with accidental incarceration of branches of parent artery or aneurysm-adjacent perforator vessels who were admitted to Department of Neurosurgery of Fuzhou General Hospital from January 2004 to December 2016. Under microscopes, we observed the definite lesions of branches and perforator vessels during the procedures, features of temporary clips and the intraoperative procedure, and postoperative cerebral infarction with varying degrees in corresponding territories. Two cases of posterior communicating artery aneurysm and 2 cases of carotid bifurcation aneurysm were found on the extracranial superior mesenteric artery adventitia with varying degrees of atherosclerosis, misclipping occurred at the anterior pre-choroidal artery, recurrent artery of Heubner and lenticulostraiate artery. For 4 cases of anterior communicating artery aneurysms and 2 cases of middle cerebral artery aneurysm, mis-clipping was found at A1 or A2 and M1 segments adjacent to perforation. Results Among the 10 patients, CT review 2-4 days post surgery demonstrated cerebral infarction with varying degrees adjacent to the aneurysm branches, perforating branch of blood supply. Disturbance of consciousness occurred in 2 cases. Compared with preoperative state, short-term significant decrease in strength of limb muscles was observed in 5 cases, incomplete motor aphasia in 1 and asymptomatic cerebral infarction in 2. At follow-up ranging from 4 months to 3 years, 2 cases reported dementia and 2 cases had permanent hemiplegia, out of which 3 were disabling and needed long-term care. Conclusions Cerebral infarction caused by accidental incarceration of branches or perforator vessels with temporary clips could be related not only to the incarceration duration, age and vascular sclerosis, but also to the over-contraction of small blood vessels and the closing force of a temporary clip. Therefore, caution should be warranted regarding those factors in the use of temporary clips. Key words: Intracranial aneurysm; Vascular system injuries; Therapeutic occlusion; Brain infarction

Clinical value of the conventional liver function test in liver reserve function assessment for large hepatocellular carcinoma

Objective To study the clinical value of the conventional liver function tests in liver reserve function assessment for large hepatocellular carcinoma. Methods The clinicopathological data of 113 patients with Child-Pugh A hepatocellular carcinoma who underwent radical resection with large hepatocellular carcinoma in the Department of Hepatobiliary Surgery of Fuzhou General Hospital of People′s Liberation Army from January 2014 to December 2016 were retrospectively analyzed. The patients were divided into two groups according to the recovery of postoperative liver function, which 105 patients recovered well and 8 patients had hepatic decompensation among them. The liver function index of two groups were analyzed. Measurement data with approximately normal distribution were represented by and groups were compared using t test; measurement data with skewed or uneven disstribution were represented by M (range)and group werecompared using Man-Whitney U test; count data were compared using Fisher exact test; risk factors for postoperative liver dysfunction were analyzed using Logistic single factor and multivariate and ROC curve were drawn. Results Preoperative prothrombin time, international standardization ratio, platelet, prealbumin, total bilirubin, alkaline phosphatase, γ-glutamyl transpeptidase comparison between the two groups were statistically significant (Z=-1.983, -2.180, -2.608, -2.007, -3.577, -2.228, -2.575, P<0.05). Logistic univariate analysis showed that platelet, total bilirubin and prealbumin were the risk factors for the recovery of liver function of radical resection hepatic decompensation with large hepatocellular carcinoma. Logistic multivariate regression analysis showed that preoperative high total bilirubin and low preabumin were independent risk factors of radical resection hepatic decompensation with large hepatocellular carcinoma. Logistic univariate analysis showed that preoperative high total bilirubin and low prealbumin were not risk factors of radical resection liver failure with large hepatocellular carcinoma. The area under the curve of total bilirubin was 0.880, P=0.000, 95%CI: 0.808-0.953, the sensitivity was 87.5%, specificity was 84.8% and the area under prealbumin curve was 0.769, P=0.011, 95%CI: 0.648-0.891, sensitivity was 75.2%, specificity was 77.5% by the ROC curve. The best threshold of total bilirubin and prealbumin after radical resection with large hepatocellular carcinoma were 17.55 μmol/L and 0.18 g/L respectively by the ROC curve. Conclusion The Child-Pugh A patients in radical resection hepatic decompensation with large hepatocellular carcinoma recover well when the preoperative liver function is as follows: total bilirubin<17.55 μmol/L and prealbumin≥0.18 g/L. Key words: Large hepatocellular carcinoma; Prealbumin; Hepatic reserve; Hepatic decompensation; Liver failure

A clinican linical analysis of 29 cases of chronic pulmonary aspergillosis

Objective: To improve the understanding of chronic pulmonary aspergillosis (CPA) by analyzing the clinical manifestations, imaging and pathological features, diagnosis, treatment and prognosis of this disease. Methods: Cases of CPA, proven by microbiological evidence based on pathological study in Fuzhou General Hospital of the People's Liberation Army and Affiliated Fuzhou City First Hospital of Fijian Medical University from January 2006 to October 2016 were retrospectively analyzed. Results: The patients consisted of 17 males and 12 females, aged 24 to 75 years, mean (42±16) years. The underlying disorders included post-tuberculosis infection (n=11), bronchiectasis (n=8), chronic obstructive pulmonary disease (n=3) and diabetes mellitus (n=2). The main clinical symptoms included productive cough (n=25), chronic sputum production (n=18) and hemoptysis (n=15). Serum GM antigen tests were performed in 19 cases, and the result was positive in 12 patients. BALF GM antigen tests were performed in 2 cases, both of which were positive. Chest CT showed that the lesions were located predominantly in the upper lobes (n=24). Single cavity with interior irregular intraluminal material (n=16) and multiple cavities with interior irregular intraluminal material (n=10) were the most frequent CT findings, while the "air crescent sign" was found in 13 cases. In the 22 patients who underwent surgical treatment, Aspergillus filaments were found in the cavity (n=20) or the bronchi (n=2) of lung samples, and histological examination didn't show tissue invasion by fungi. Surgical therapy was performed in 22 patients, with complete remission in 19 cases, and death in 3 cases. Anti-fungal therapy was administered in 6 patients, with partial remission in 4, and stable disease in 2 cases. One patient was not treated. Conclusions: CPA is more frequently seen in patients with underlying chronic pulmonary diseases. The common CT findings are single or multiple cavities with interior irregular intraluminal materials. Aspergillus filament in the cavity or bronchi of lung samples, without parenchymal invasion, is the proof of CPA. The surgical cure rate for simple aspergilloma and aspergillus nodule is high, while the risk of operation for chronic cavitary disease is high. GM antigen test may be an evidence for diagnosing CPA.

Low Serum Albumin Correlates with Poor Survival in Gastric Cancer Patients.

Preoperative nutritional status as evidenced by serum albumin measurement is associated with cancer prognosis but the clinical significance of this for patients with gastric cancer (GC) is unclear. Therefore, we evaluated an association between preoperative serum albumin and GC patient survival in the Fujian area which has a higher incidence for GC in China. GC patients (n = 309) who underwent surgical treatment at Fuzhou General Hospital between 2010 and 2013 were retrospectively assessed using a Kaplan-Meier method and log-rank test, as well as univariate and multivariate Cox model analyses, to confirm a correlation between patient survival and preoperative serum albumin. Data show that low serum albumin was associated with poorer survival. Preoperative serum CEA, CA199, and albumin and tumor size, T staging, and lymph node metastases (LNM) were significantly associated with overall survival according to univariate analysis. Lower serum albumin (HR: 2.018, 95% CI [1.204 - 3.381], p = 0.008) and advanced cancers with deeper invasion (T3 + T4 stages) and with lymph node metastases were significantly associated with increased death risk according to multivariate analysis. Preoperative serum total protein, patient age, tumor size, T staging, and LNM were correlated with serum albumin according to chi-squared analysis. Preoperative serum albumin may be related to GC patient survival and may hold promise as a prognostic predictor for such survival.

Analysis of the clinical value of immunohistochemistry in the diagnosis of gastrointestinal stromal tumors

Objective To investigate the expression of immunophenotype in gastrointestinal stromal tumors and analyze its clinical value in the diagnosis and prognosis of gastrointestional stromal tumors. Methods Reviewed the clinical data of 323 patients with gastrointestinal stromal tumors in Fuzhou General Hospital of PLA from January 2004 to January 2014. Detected expressions of CD-117, DOG-1, CD-34, alpha-SMA, S-100. Desmin and Ki-67 by immunohistochemical S-P method, frequency statistics, independent sample t test and correlation analysis was carried out with SPSS 20. Results The positive rates of CD-117, DOG-1 and GIST in the group CD-34 were 97%, 95.6% and 86% respectively, the positive rates of alpha-SMA, S-100 and Desmin were 59.8%, 27.7% and 17% respectively, the positive expression of CD-117, CD-34, alpha ɑ-SMA and Desmind in intestinal gastrointestinal stromal tumors and gastric gastrointestinal stromal tumors were significantly different, among them (P<0.05), the positive rates of gastrointestinal stromal tumors and alpha-SMA in intestinal CD-117 were significantly higher than those in gastric gastrointestinal stromal tumors (3.37 vs 2.99, P=0.002; 1.59 vs 1.09 P=0.005). The positive expression of CD-34 and Desmin was significantly lower than that of gastric gastrointestinal stromal tumors (1.90 vs 3.02, P=0.000; 0.12 vs 0.50, P=0.001). The expression of CD-117 was significantly correlated with location and risk grade (P=0.000, 0.002). The expression of DOG-1 was significantly correlated with the risk grade, and the overall survival (P<0.05). The expression of CD-34 was significantly correlated with location, size, risk grade, status, and overall survival (P=0.000, 0.007, 0.016, 0.001). There was a significant correlation between the expression of alpha-SMA and location (P=0.036). There was a significant correlation between the expression of S-100 and the overall survival (P=0.036). The expression of Desmin was significantly correlated with the age and location of the first visit (P=0.001). Conclusion In the diagnosis of gastrointestinal stromal tumors, CD-117, DOG 1 and CD-34 combined alpha-SMA and Desmin have good complementation, it is also helpful to judge the location of the intestine and stomach of gastrointestinal stromal tumors, if necessary, it can also be detected by gene mutation, with reference to the level of mitotic figures, which can reduce the misdiagnosis rate and increase the detection rate. Key words: Immunohistochemistry; Prognosis; Neoplasms; Gastrointestinal stromal tumors