Sichuan Provincial People's Hospital Research Articles

Using (1)H-nuclear magnetic resonance metabolomics and gene ontology to establish pathological staging model for esophageal cancer patients

By combining the metabolomics and computational biology, to explore the relationship between metabolic phenotype and pathological stage in esophageal cancer patients, to find the mechanism of metabolic network disturbance and develop a new method for fast preoperative clinical staging. A prospective cohort study (from April 2013 to January 2016) was conducted. The preoperative patients from Sichuan Provincial People's Hospital, who were diagnosed with esophageal cancer from May 2013 to April 2014 were included, and their serum samples were collected to detect (1)H-nuclear magnetic resonance (NMR) metabolomics for the purpose of drawing the metabolic fingerprinting in different stages of patients with esophageal cancer. The data were processed with these methods-principal components analysis: partial least squares regression and support vector machine, for the exploration of the enzyme-gene network regulatory mechanism in abnormal esophageal cancer metabolic network regulation and to build the quantitative prediction model of esophageal cancer staging in the end. All data were processed on high-performance computing platforms Matalab. The comparison of data had used Wilcoxon test, variance analysis, χ(2) test and Fisher exact test. Twenty patients with different stages of esophageal cancer were included; and their serum metabolic fingerprinting could differentiate different tumor stages. There were no difference among the five teams in the age (F=1.086, P>0.05), the body mass index (F=1.035, P>0.05), the distance from the incisors to tumor (F=1.078, P>0.05). Among the patients with different TNM stages, there was a significant difference in plasma metabolome. Compared to ⅡB, ⅢA, Ⅳstage patients, increased levels of butanone, ethanol amine, homocysteine, hydroxy acids and estriol, together with decreased levels of glycoprotein, creatine, choline, isobutyricacid, alanine, leucine, valine, were observed inⅠB, ⅡA stage patients. Four metabolic markers (ethanol amine, hydroxy-propionic acid, homocysteine and estriol) were eventually selected. gene ontology analysis showed that 54 enzymes and genes regulated the 4 key metabolic markers. The quantitative prediction model of esophageal cancer staging based on esophageal cancer NMR spectrum were established. Cross-validation results showed that the predicted effect was good (root mean square error=5.3, R(2)=0.47, P=0.036). The systems biology approaches based on metabolomics and enzyme-gene regulatory network analysis can be used to quantify the metabolic network disturbance of patients with advanced esophageal cancer, and to predict preoperative clinical staging of esophageal cancer patients by plasma NMR metabolomics.

Validation of the Chinese Translation of the Spatial Hearing Questionnaire and Its Short Form.

Few questionnaires address how to measure spatial hearing ability in complex listening situations. The purpose of the study was (a) to validate the Chinese translation of the Spatial Hearing Questionnaire (C-SHQ) among Chinese participants and (b) to provide a shortened version for the purpose of clinical screening. This was a cross-sectional study. The C-SHQ was developed from the process of translation and back-translation of the original 24-item, English version (Tyler, Perreau, & Ji, 2009). The C-SHQ was administered to 146 patients at the Department of Otolaryngology Clinic of Sichuan Provincial People's Hospital between October 2013 and May 2014 at Sichuan, China. Exploratory factor analysis and reliability tests were performed for the full version, and confirmatory factor analysis was applied for the shortened version of the C-SHQ. The exploratory factor analysis revealed scores loaded on 3 similar factors compared with the original SHQ. The internal consistency reliability was high (Cronbach's α = 0.99). The confirmatory factor analysis indicated that a shortened version of 12 items is sufficient to measure spatial hearing abilities. The C-SHQ and its short form are both reliable and valid questionnaires, which are suitable for both research and clinical settings to measure spatial hearing ability in the Chinese population.

Epidemiology and risk factors for community-acquired blood stream infection caused by extended spectrum β-lactamases-producing Escherichia coli and Klebsiella pneumonia strains

Objective To investigate the incidences, risk factors, genotypes and epidemiology of community-acquired blood stream infection caused by extended spectrum β-lactamases (ESBLs)-producing Escherichia coli and Klebsiella pneumonia strains and to analyze the sensitivity of those ESBLs producing strains to commonly used antibiotics. Methods Forty-two patients who were diagnosed with community-acquired blood stream infection caused by Escherichia coli or Klebsiella pneumonia strains in Sichuan Provincial People's Hospital were recruited in this study. Disc diffusion method was used for the phenotypic confirmatory test of ESBLs. Agar dilution method was performed to measure the antimicrobial susceptibility of the ESBLs-producing strains to 13 clinically commonly used antibiotics. Genotypes of the ESBLs-producing strains were identified by polymerase chain reaction (PCR). Multilocus sequence typing (MLST) was used to analyze the epidemiology of ESBLs-producing strains. Logistic regression analysis was performed to analyze the risk factors for community-acquired blood stream infection. Results The ESBLs-producing Escherichia coli strains accounted for 56.3% (18/32) and the ESBLs-producing Klebsiella pneumoniae strains accounted for 20% (2/10). All of the 20 ESBLs-producing strains were sensitive to imipenem, meropenem, ertapenem, nitrofurantoin and moxalactam. The ESBLs-producing strains sensitive to amikacin, piperacillin-tazobactam and fosfomycin accounted for 95%, 90% and 85%, respectively. Drug resistance rates of the 20 strains to cefotaxime, levofloxacin, ciprofloxacin and cefepime were relatively high accounting for 100%, 80%, 80% and 75%, respectively. Among the 20 ESBLs-producing strains, 7 strains only carried the CTM gene, while the other 13 strains were all positive for two genotypes of ESBLs, mainly identified as TEM+ CTM-M-14 and TEM+ CTM-15 genotypes. The 18 Escherichia coli strains were classified into 10 ST types, most of which were ST131 type, followed by ST10 and ST38 types. This study indicated that malignant tumor might be a possible risk factor. Conclusion The prevalence of community-acquired blood stream infection caused by ESBLs-producing Escherichia coli strains was becoming increasingly serious. Malignant tumor might be the risk factor associated with the producing of ESBLs in Escherichia coli and Klebsiella pneumonia strains. TEM+ CTX-M-14 was the predominant genotype of ESBLs-producing strains and the prevalent clone was ST131 type. Carbapenems and enzyme inhibitor compounds were ideal drugs for the treatment of community-acquired blood stream infection caused by ESBLs-producing Escherichia coli and Klebsiella pneumonia strains. This study was limited by the small sample size. Therefore, it is necessary to conduct further researches based on a large number of samples. Key words: Community-acquired blood stream infection; Extended spectrum β-lactamases; Escherichia coli; Klebsiella pneumoniae; Risk factor

Effects of Qishenyiqi Dripping Pill on Pulmonary Function in Chronic Obstructive Pulmonary Disease

Objective: To investigate the effects of Qishenyiqi Dripping Pill (QDP) on pulmonary function in patients with chronic obstructive pulmonary disease (COPD). Methods: 97 patients with chronic obstructive pulmonary disease admitted to the general wards of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital randomized plus into experimental group (53 cases) and control group (44 cases) from October 2014 to November 2015. Twice daily QDP 1000mg for experimental group based on the treatment of control group in this study, pulmonary function of two groups was compared. Results: After treatment, FEV1 from 1.36±0.12L to1.60±0.22L in experimental group, and from 1.42±0.25 to 1.51±0.16L in control group. More statistically significant was found in experimental group, P value<0.05. FEV1/FVC from 56.3±6.39% to 64.32±5.21% in experimental group, and from 56.8±8.84% to 57.33±6.56% in control group. More statistically significant was found in experimental group, P value<0.05. MMEF from 56.80±18.22% to 67.45±7.55% in experimental group, and from 55.39±20.12% to 60.22±6.01% in control group. More statistically significant was found in experimental group, P value<0.05. Conclusions: Qishenyiqi Dripping Pill can significantly improved pulmonary function of patient with chronic obstructive pulmonary disease.

Improvement effect of early goal-directed therapy on the prognosis in patients with septic shock

Improvement effect of early goal-directed therapy on the prognosis in patients with septic shock

Comparison of three different molecular assays for the detection and molecular characterization of circulating tumor cells in breast cancer

Objective Comparison of three different molecular assays for the detection and molecular characterization of circulating tumor cells in breast cancer. Methods The retrospective study compared three different molecular assays to detect CTC in the peripheral blood of 30 healthy individuals and 71 benign breast disease patients and 83 early and 84 metastatic breast cancer patients.All samples were collected at the outpatient, inpatient and physical examination department of Sichuan Provincial People's Hospital from January 2011 to June 2014. The same cDNAs were analyzed by: singleplex RT–qPCR assay for BCL–2, multiplex RT–qPCR for BCL–2, HER–2, HMAM, and a commercially available molecular assay (AdnaTest BreastCancer) for GA733–2, MUC–1, HER–2. The positive of CTC were compared among healthy individuals and benign breast disease patients and breast cancer patients. Chi square test was used to compare the expression of gene markers among the three groups, and the agreement of Kappa test was used to evaluate the method. Results (1) Detection rates of early breast cancer by single RT–qPCR, Adna kits and multiple RT–qPCR were 13.3%, 16.9% and 18.1%, respectively, and the detection of metastatic breast cancer were 31.0%, 42.9% and 35.7%, respectively. There were significant differences in the positive of CTC by three molecular assays between healthy individuals and benign breast disease patients and early breast cancer patients (The test values were 4.235 and 4.301, 5.367 and 5.474, 5.894 and 6.023 respectively, P 0.05). There were significant differences between metastasis breast cancer patients and healthy individuals and benign breast disease patients and early breast cancer patients (The test values were 8.429, 7.553 and 7.061; 10.24, 9.025 and 8.745; 9.658, 8.417 and 8.201 respectively, P<0.05). (2) In early breast cancer: The concordance between AdnaTest and single RT–qPCR was 79.5% while between AdnaTest and multiplex RT–qPCR was 77.1%.No agreement was found among them (The test values were 1.065 and 1.871, P were 0.371 and 0.258). The concordance between single RT–qPCR and multiplex RT–qPCR was 80.7%.No agreement was found between them (The test values was 2.814, P was 0.156). (3) In patients with overt metastasis: The concordance between AdnaTest and single RT–qPCR was 78.6%(The test values was 10.986). While between AdnaTest and multiplex RT–qPCR was 80.9%(The test values was 9.251). Agreements were found among them (P was 0.002 and 0.005 respectively). The concordance between single and multiplex RT–qPCR was 88.1%(The test values was 12.364). Agreement was found between them (P was 0.001). Conclusions No correlations were found among different molecular methods to detect CTC in the early primary breast cancer, but correlations were found in the metastatic breast cancer, suggesting that different rate of CTC caused by the number of CTC and its heterogeneity should be considered to the clinical diagnosis and treatment of breast cancer while molecular method is used.(Chin J Lab Med, 2015, 38: 666–671) Key words: Breast neoplasms; Neoplastic cells, circulating; Tumor markers, biological; Reverse transcriptase polymerase chain reaction

Anesthesia experiences on laparoscopic nephrectomy with da Vinci S robotics

To summarize the clinical anesthesia experiences in 20 patients who underwent laparoscopic nephrectomy with da Vinci S robotics. Anesthesia data of 20 patients from Sichuan Provincial People's Hospital, who underwent laparoscopic nephrectomy with da Vinci S robotics from August 2014 to November 2014, were analyzed and summarized. The anesthesia time, operation time, CO(2) pneumoperitoneum time, PaCO(2) and PETCO(2) were recorded. All patients were anesthetized and underwent surgery with da Vinci S robotics. The anesthesia time was (220±14) min, the operation time was (187±11) min, and the CO(2) pneumoperitoneum time was (180±13) min. The PaCO(2) and PETCO(2) were significantly elevated at 1.5 h after operation compared with those at the baseline (before pneumoperitoneum) (P<0.05). The pH value was significantly decreased at 2.5 h after operation compared to that at the baseline (P<0.05). The peak airway pressure of inspiration was significantly elevated at 0.5 h after the beginning of pneumoperitoneum compared to that at the baseline (P<0.05). The hemodynamics is stable during the laparoscopic nephrectomy with da vinci S robotics. However, the duration of CO(2) pneumoperitoneum is significantly increased compared to that of other surgical procedures, resulting in high airway resistance and acid-base disturbance.

Value of procalcitonin measurement in the diagnosis of bacterial infections in patients with fever and flare of chronic gouty arthritis

We assessed serum procalcitonin (PCT) levels to distinguish bacterial infections from non-bacterial infections in patients with fever and flare of chronic gouty arthritis. One hundred febrile patients with chronic tophaceous gout flare-ups were collected consecutively between November 2011 and January 2014 from the Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital. These patients were divided into non-infectious febrile group (68 patients) and bacterial infectious febrile group (32 patients, including 6 cases of pulmonary infection, 3 cases of infectious arthritis and 21 cases of skin infection, 2 patients died from severe infection were excluded), and 30 patients with flare of chronic gouty arthritis without fever and infection. Serum PCT, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell (WBC) count and neutrophil ratio were determined. 57.3% (39/68) patients in the non-infectious febrile group had PCT levels ≥ 0.5 × 10³ ng/L and the ratio in the infectious febrile group was 66.7% (20/30) . No statistically significant difference was detected between them (P>0.05). 16.7% (5/30) patients had PCT levels ≥ 0.5 × 10³ ng/L in the afebrile group and both the differences between the afebrile group and the two febrile groups were significant (P<0.05). The differences of ESR, CRP, WBC count and neutrophil ratio between the two febrile groups were not statistically significant (P>0.05). In the chronic gouty arthritis patients with fever, the sensitivity and specificity of high PCT level (≥ 0.5 × 10³ ng/L) for detection of bacterial infections was 33.9% and 74.4%, the positive predictive value was 36.9% and the negative predictive value was 71.9%. The area under the curve (AUC) of PCT, CRP, ESR, WBC count and neutrophil ratio in patients with fever and chronic gouty arthritis was 0.598, 0.636, 0.612, 0.596 and 0.727, respectively. Serum PCT levels may be not a good marker for detection of bacterial infections in the patients with fever and flare of chronic gouty arthritis. Larger studies are needed to evaluate the value of PCT measurement in the patients with fever and flare of chronic gouty arthritis.

Clinical significances of WT1 gene and AML1-ETO fusion gene expression for monitoring minimal residual disease in children with acute myeloid leukemia

Objective To explore the diagnostic value of WT1 gene and AML1-ETO fusion gene in the monitoring of minimal residual disease (MRD) and prediction of relapse in childhood acute myeloid leukemia (AML). Methods From May 2007 to March 2015, a total of 13 AML1-ETO fusion gene positive AML children and 15 leukemia fusion gene negative AML children who received initial treatment in Department of Pediatrics in Sichuan Provincial People's Hospital were enrolled as study objects, and divided into fusion gene positive group (n=13) and fusion gene negative group (n=15). Relative expression levels of WT1 gene and AML1-ETO fusion gene were detected by real-time fluorescence quantitative reverse transcription-polymerase chain reaction (qRT-PCR) technique in bone marrow samples from children of two groups at the beginning of treatment and during follow-up period. Correlation of relative expression levels of WT1 gene and AML1-ETO fusion gene were analyzed by SPSS statistical software. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of MRD predicting relapse were calculated and compared. Kaplan-Meier method was used to compare the relapse-free survival (RFS) rate between two groups and to assess MRD on the prediction of relapse. The study protocol was approved by the Ethical Review Board of investigation in Human Being of Sichuan Provincial People's Hospital.Informed consent was obtained from all participants. Results ①The relative expression levels of WT1 gene and AML1-ETO fusion gene were positively correlated in 83 bone marrow samples from 13 cases of fusion gene positive group (R2=0.874, P 0.05) at the time points of first diagnosis, first induction of remission, and relapse. ③After the first time induction of remission in the fusion gene positive group children, AML1-ETO quantitative levels as predictive relapse of diagnostic indicators were the highest in the sensitivity, accuracy, positive predictive value, negative predictive value as 85.7%, 76.9%, 75.0% and 80.0% respectively and negative likelihood ratio was minimum as 0.29. The specificity of WT1 gene in the fusion gene negative group was highest as 71.4%. ④After the first time induction of remission, there were 8 patients whose relative expression levels of AML1-ETO fusion gene were more than 0.01 in fusion gene positive group. Among these 8 cases, 6 patients relapsed and relapse rate was 75.0%. Relative expression levels of AML1-ETO fusion gene in other 5 cases were less than 0.01. Among the 5 cases, 1 patient relapsed and relapse rate was 20.0%. The difference of relapse rate between patents whose relative expression levels of AML1-ETO fusion gene were more and less than 0.01 was statistically significant (χ2=13.0, P=0.000). Up to the time of the follow-up , RFS rate of the patients with the relative expression level of AML1-ETO fusion gene more than 0.01 was significantly lower than that of patients with the relative expression level less than 0.01 (P=0.001). ⑤ After the first time induction of remission, there were 8 patients whose relative expression levels of WT1 gene were more than 0.01 in fusion gene negtive group. Among these 8 cases, 6 patients relapsed and relapse rate was 75.0%. Relative expression levels of WT1 gene in other 7 cases were less than 0.01. Among the 7 cases, 1 case relapsed and relapse rate was 14.3%. The difference of relapse rate between patients whose relative expression levels of WT1 gene were more and less than 0.01 was statistically significant (χ2=15.0, P=0.000). Up to the time of the follow-up , RFS rate of the patients with the relative expression level of WT1 gene more than 0.01 was significantly lower than that of patients with the relative expression level less than 0.01 (P=0.004). Conclusions AML1-ETO fusion gene is suitable for monitoring the MRD of AML children with fusion gene positive. WT1 gene is more suitable for detecting MRD and predicting relapse in AML children with fusion gene negative. It may indicate relapse when WT1 and AML1-ETO fusion gene relative expression levels significantly increased. Key words: Leukemia, myeloid, acute; gene, Wilms' tumor; AML1-ETO fusion gene, human; Neoplasm, residual; Polymerase chain reaction

Clinical research on the application of trans-esophageal echocardiography in monitoring Nuss surgery

To investigate the validity and safety of trans-esophageal echocardiography (TEE) in monitoring of Nuss surgery. A total of 140 patients with pectus excavatum from Sichuan Provincial People's Hospital underwent Nuss surgery from August, 2011 to Aμgust, 2013. Among them, 72 patients received TEE monitoring while 68 patients didn't. The injury of heart and large vessels by the introducer and Nuss steel bar was observed by intraoperative TEE monitoring under middle-esophageal four chamber view and middle-esophageal aortic short axis view. The operation in all patients had been performed successfully without any severe complications. Satisfactory TEE images were obtained in all patients. The procedure of inserting the inducer and Nuss steel bar behind sternum and steel bar overturn could be seen clearly. No injury in heart and large vessels was detected. Local streak-like hemorrhage in 3 patients was observed under intra-operative TEE screen, but no further new bleeding was found in postoperative TEE examination. The blood was absorbed and couldn't see under trans-thoracic echocardiography in 1 month after the operation. The TEE is a non-invasive monitoring method. It is sensitive to detect the status of the heart and large vessels and can prevent the severe complications due to Nuss surgery.

Significance of eIF4E expression detected by semi-quantitative reverse transcription-PCR in monitoring therapeutic effect of acute myeloid leukemia

Objectives To explore the significance of the relative level of eIF4E in monitoring therapeutic effect of acute myeloid leukemia (AML), by comparing the relative level of eIF4E in AML patients who received initial treatment, complete remission (CR), non-remission and relapse. Methods From August 2012 to May 2014, a total of 152 AML patients who received initial treatment in Department of Hematology in Sichuan Provincial People's Hospital were enrolled in this study, as study group. According to France-America-Britain (FAB) assistance typing method, these patients included 18 cases of M1 subtype, 60 cases of M2 subtype, 28 cases of M3 subtype, 20 cases of M4 subtype, 24 cases of M5 subtype and 2 cases of M6 subtype. In the same period, 20 cases with non-tumorous blood diseases patients were detected as control group, which included 14 cases with immune thrombocytopenia, 6 cases with iron deficiency anemia. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Sichuan Provincial People's Hospital. Informed consent was obtained from all participants.Bone marrow samples were collected from study and control group patients, and the eIF4E expression was detected by semi-quantitative reverse transcription (RT) -PCR method, the mutation of FLT3/ITD was also detected by RT-PCR method. Results Among 152 newly diagnosed AML patients, only 131 cases accepted the chemotherapy. 95 cases had acquired CR and the CR rate was 72.5%. In patients with CR, 34 cases relapsed after an average follow-up of 18 months, and the relapsed rate was 35.8%. The eIF4E relative level in 152 cases of untreated AML was 0.81±0.27, which was significantly higher than that of control group 0.04±0.01 (W=3 040, P 0.05). The eIF4E level decreased significantly in patients with CR 0.28±0.17 compared with untreated patients 0.87±0.25 (W=4 408, P 0.05). Conclusions eIF4E plays an important role in AML, the relative level of eIF4E decreased obviously in CR patients and increased in relapsed patients. Detection of eIF4E expression with semi-quantitative RT-PCR could be used for monitoring therapeutic effect in AML patients. Key words: eIF4E gene; Acute myeloid leukemia; Polymerase chain reaction

Gelsolin level for prognostic evaluation in patients with critically illness

To investigate the changes of plasma gelsolin level in patients with critical illness and its application in prognostic evaluation. Ninety six critically ill patients admitted in ICU of Sichuan Provincial People's Hospital from February 2012 to December 2013 were enrolled in the prospective cohort study. Plasma gelsolin levels were detected with enzyme linked immunosorbent assay (ELISA) at admission (d1), d2, d4 and d8 after admission, and also detected in blood samples of 186 healthy subjects as controls. Logistic regression model was used to analyze the relationship between the level of plasma gelsolin and prognosis of patients. The average levels of plasma gelsolin were significantly lower in critically ill patients than those in control subjects (F=1986.37, P<0.01). There was significant difference in overall level of gelsolin between survival patients and fatal patients (F=16.691, P<0.01). APACHE Ⅱ score was associated with survival outcomes (r=0.489, P=0.009); the APACHE Ⅱ score was significantly higher in fatal patients than that in survival patients (29.5±7.7 vs 22.1±5.7, t=5.375, P<0.01). There was a negative correlation between plasma gelsolin levels and fatal outcomes (r=-0.512, P<0.01). Logistic regression analysis showed that the overall plasma gelsolin levels and the last measured level was a prognostic factor for critically ill patients (P<0.05). Plasma gelsolin levels are correlated with the severity of critically ill patients, and plasma gelsolin can be used as indicator of prognosis.

Higher apolipoprotein B levels are associated with earlier onset of first-ever atherosclerotic stroke

Background: Many studies have revealed apolipoproteins are risk factors for ischemic stroke, but the influence of apolipoproteins on onset age of first-ever atherosclerotic stroke has not been well investigated. Methods: We recruited 357 qualified participants from consecutive patients with acute ischemic stroke who came to the stroke registry center in Sichuan Provincial People's Hospital, Chengdu, China. Patients were stratified into tertiles according to the distributions of apoB levels for large artery atherosclerosis (LAA) and small artery atherosclerosis (SAA) groups. The onset age of stroke was analyzed tripartitely in terms of early-onset group, the middling-onset group and the late-onset group. Multinomial logistical regression was used to analyze the associations between the two. Results: The risk of early-onset stroke increased monotonically with higher apoB levels (the second tertile, adjusted OR = 2.61, 95% CI 1.18–5.79 (p = 0.018); the third tertile, adjusted OR = 19.52, 95% CI 5.93–64.31 (p < 0.001)), and patients with the highest tertile of apoB levels had a 9.20 times (95% CI, 2.97–28.53, p < 0.001) increased risk of middling-onset stroke in reference to late onset of stroke. Conclusions: The present study suggests the higher the apolipoprotein B levels are, the earlier an atherosclerotic stroke might occur in a Chinese population.

Combined thoracoscopic and laparoscopic minimally invasive esophagectomy.

With the improvement in thoracoscopic and laparoscopic surgery, thoracoscopic and laparoscopic esophagectomy (TLE), a minimally invasive approach, has attracted increasing attention as an alternative to open three-field esophagectomy. From June 2012 to October 2013, 90 patients underwent laparoscopic and thoracoscopic resection of esophageal carcinoma in our department. The VATS esophagectomy technique described here is the approach currently employed in the department of thoracic surgery at Sichuan Provincial People's Hospital of China.

The clinical correlates and prognostic impact of QRS prolongation in patients with dilated cardiomyopathy: A single-center cohort study

a Cardiac Arrhythmia Center, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China b Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, China c The Center of Heart Development, Key Lab of MOE for Development Biology and Protein Chemistry, College of Life Science, Hunan Normal University, Changsha, Hunan 410081, China d Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong

INTENSIVE GLUCOSE CONTROL IN THE TREATMENT OF HYPERGLYCEMIA IN PATIENTS WITH AN ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A PROSPECTIVE STUDY

Background and Objective: This study was conducted to evaluate the influence of IGC in the treatment of hyperglycemia combined with AECOPD. Methods: A total of 267 consecutively hospitalized patients with AECOPD combined with hyperglycemia in the general wards of the East Ward of Sichuan Academy of Medical Sciences ＆ Sichuan Provincial People's Hospital and West China Hospital from May 2007 to August 2013 were included in this study. All the patients were allocated to either the IGC group or the control group according to the doctor’s recommendation. The short-term mortality rate as well as the duration and medical cost of the hospitalization were investigated. Results: The median length of the hospital stay was 15 days in the IGC group, whereas the median was 12 days (p=0.05) in the control group. The median medical cost was 8,866 Yuan in the IGC group, whereas this value was 8,051 Yuan in the control group. However, the medical costs, the mortality rates and the positive sputum culture rates were not statistically different between the two groups. There were more cases of hypoglycemia and hypokalemia in the IGC group than in the control group. Conclusions: Intensive glucose control treatment did not result in any benefits in the patients with hyperglycemia and AECOPD and may prolong the length of stay and increase the risk of hypoglycemia and hypokalemia.

Application of purse string suture stitched in gastric wall of anastomotic stoma for intrathoracic esophagogastric apparatus anastomosis

Objective To explore the safety and clinical efficacy of the purse string suture stitched in gastric wall of anastomotic stoma for intrathoracic esophagogastric apparatus anastomosis.Methods The clinical data of 238 patients with thoracic esophageal carcinoma and 24 patients with carcinoma of the esophagogastric junction received intrathoracic apparatus anastomosis at the Sichuan Provincial People's Hospital from January 2008 to December 2011 were retrospectively analyzed.There were 122 patients received conventional intrathoracic esophagogastric anastomosis (conventional group) and 140 patients received purse string suture stitched in gastric wall of anastomotic stoma before intrathoracic esophagogastric anastomosis (improvement group).The incidences of anastomotic fistula and stenosis of the 2 groups were compared.All data were anlayzed using the t test,chisquare test or Fisher exact probability.Results There were no significant differences in the operation time,intraoperative blood loss,volume of drainage of peritoneal effusion within 24 hours after operation,postoperative hospital stay and postoperative pTNM staging between the 2 groups (t =0.410,0.798,0.634,0.362,x2=0.605,P ＞ 0.05).There were no significant differences in the anastomotic location,stapler type,the weight of stapler esophageal end tissue between the 2 groups (x2 =0.118,0.221,t =0.459,P ＞ 0.05).There were no significant differences in the incidences of pulmonary complication,arrhythmia and mortality between the 2 groups (P ＞ 0.05).The weight of stapler stomach end tissue in the improvement group was significantly greater than that of the conventional group,while the incidences of postoperative anastomotic fistula and stenosis of the improvement group were significantly lower than those of the conventional group (t =13.856,P ＜ 0.05).Conclusion The purse string suture stitched in gastric wall of anastomotic stoma for intrathoracic esophagogastric apparatus anastomosis is simple and safe,and could effectively reduce the rate of anastomotic fistula and stenosis. Key words: Esophageal neoplasms; Neoplasms of the esophagogastric junction; Apparatus anastomosis; Anastomotic fistula; Anastomotic stenosis

Application of laparoscopic-guided selective portal vein ligation in the two-stage hepatectomy for patients with primary hepatocellular carcinoma

Objective To investigate laparoscopic-guided selective portal vein ligation in the two-stage hepatectomy for patients with primary hepatocellular carcinoma (HCC).Methods Twenty-three patients with HCC who were not suitable for one-stage hepatectomy were admitted to the Sichuan Provincial People's Hospital from March 2009 to February 2012.Their clinical data were retrospectively analyzed.Laparoscopic-guided selective portal vein ligation was firstly performed,dynamic changes of hepatic volume and predicted volume of liver to be resected were detected by computed tomography.Two-stage open hepatectomy was performed after assessment of resectability of HCC.All data were analyzed using the analysis of variance or q test.Results Laparoscopic-guided selective portal vein ligation was successfully performed on 22 patients (2 patients received concomitant cholecystectomy because the right branch of portal vein was difficult to expose),1 patient was converted to open surgery because of hemorrhage during portal vein separation.Three patients with multiple lesions received transcatheter arterial chemoembolization at 1 week after selective portal vein ligation.Dull pain in the hepatic region,low fever,nausea and vomiting were observed in the 23 patients,while no severe complications including peritoneal hemorrhage,bile leakage,hepatapostema was observed.The levels of aspartate aminotransferase,alanine aminotransferase and total bilirubin were back to normal at 1 week after the surgery.The right liver volume at postoperative week 3 was (590 ± 154)cm3,which was significantly smaller than (698 ± 135)cm3 before surgery.Compared with right liver volume at postoperative week 1,2,3,the right liver volume before operation was significantly smaller (F=15.62,P ＜0.05).The left hepatic volume at postoperative week 3 was (408 ± 149)cm3,which was significantly bigger than (331 ± 68)cm3 before operation.The left liver volume before operation was significantly different from those at postoperative week 1,2,3 (F =17.48,P ＜ 0.05).The predicted ratio of liver to be resected was 60％ ± 18％ at postoperative week 3,which was significantly smaller than 67％ ± 15％ before operation (F =12.35,P ＜ 0.05).Two patients with insufficient hyperplasia of offside liver,2 patients with intrahepatic metastasis at postoperative week 3,2 patients were lost to follow up and 3 patients gave up hepatectomy,14 patients received hepatectomy at 2-4 weeks after laparoscopic-guided selective portal vein ligation.The resection rate was 60.9％ (14/23).There were 2 patients received extended right hepatectomy,8 received right hepatectomy,4 received non-anatomical hepatectomy.All the 14 patients recovered well,and no hepatic failure,severe peritoneal effusion and infection was observed.Conclusion Laparoscopic-guided selective portal vein ligation is easy to perform,and it extends the indication of hepatectomy,increases the safety of two-stage hepatectomy. Key words: Liver neoplasms; Portal vein embolization; Portal vein ligation; Laparoscopy; Two-stage surgery

Evaluation of the psychological and biological changes of patients diagnosed with benign and malignant breast tumors

Posttraumatic stress disorder (PTSD) is a severe anxiety disorder developed by exposure to any incident or circumstance that results in psychological trauma. In this study we compared the psychological and physiological changes between patients with malignant and benign breast tumors. We selected 150 Chinese women with a breast mass, aged 20 to 45 years, from the Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital between 2009 and 2011 for this study; 30 healthy participants were enrolled into the control group. All subjects were examined and had their tumor mass aspirated for diagnosis. Equal numbers of patients with benign and malignant tumors were recruited. Patients with malignant tumors presented with low grade, minimal tumor invasion and non-involved lymph nodes. Questionnaires regarding anxiety, depression and PTSD were conducted 2 hours before getting the diagnostic result and 1 month after the diagnosis. Serum levels of IL-6, TNF-α, cortisol and high-sensitivity C-reactive protein before and after diagnosis were investigated and compared. The number of occurrences of oral ulcerative mucositis was also recorded. All patients experienced a certain degree of anxiety and their biomarkers were elevated compared with the normal reference range before the pathological report was disclosed. However, 1 month after the operation, the benign tumor group showed significantly lower levels of biomarkers and anxiety scores than patients with a malignant breast tumor. The results were consistent throughout 12 months of study. Study subjects with a benign tumor returned to their normal condition after being diagnosed, while patients with a malignant tumor suffered from a certain degree of PTSD or depression.

Liver histological changes in chronic hepatitis B patients with alanine aminotransferase lower than two times the upper limit of normal

Objective To assess the liver histopathological characteristics of chronic hepatitis B (CHB) patients with alanine aminotransferase(ALT)lower than 2 times the upper limit of normal (ULN) through liver biopsy, and try to provide subjective evidence for clinical anti-viral treatment.Methods From October 2005 to August 2010, patients accepted liver biopsy in department of infectious disease, Sichuan provincial people's hospital were enrolled. The criteria for liver biopsy was as follow, (1) HBsAg-positive for more than 6 months, (2) HBeAg-positive patients with HBV DNA ≥103 copies/ml or HBeAg-negative patients with HBV DNA≥ 104copies/ml, (3) ALT was lower than 2 times ULN for more than 6 months,and without any hepatic protectants, (4) never accepted any antiviral treatment before, including IFN or nucleoside analogues, (5) willing to accept liver biopsy. Before liver biopsy, routine blood test, prothrombin time, liver function test, hepatitis B antigen and antibody test, HBV DNA quantification were examined. The biopsy position was located under routine ultrasound, liver biopsy were performed to assess the grading of inflammation and necrosis and the degree of fibrosis. The correlation between all the factors and liver inflammation and fibrosis were analyzed. Results Totally 383 cases (240 males and 143 females) met the diagnostic criteria, aged from 16 to 59 years old and the mean age was 28.0 years old. Cases of liver inflammation in G0, G1, G2, G3andG4 grade was 2 cases (0.5％), 165 cases (43.1％), 191 cases (49.9％), 25 cases (6.5 ％ ) and 0 cases (0 ％ ) respectively, cases≥G2 grade accounted 56.4 ％ of total. Meanwhile,stage of fibrosis in S0, S1, S2, S3 and S4 was 103 cases (26.9％), 265 cases (69. 2％), 13 cases (3.4％), 2 cases (0.5％) and 0 cases (0％) respectively, percentage of liver fibrosis in S2stage and over was only 3.9％. The occurrence of serious liver inflammation was associated with age, ALT levels, HBV DNA levels and HBeAg status (P＜0.05). There was no obvious association between HBV DNA level and liver fibrosis (P＞0.05). Conclusions There were obvious liver inflammation and different degree of liver fibrosis in CHB patients with alanine aminotransferase(ALT)lower than 2 times ULN. The degree of liver injury assessed by liver biopsys is recommended as an evaluation for the necessary of anti-viral therapy. Key words: Hepatitis B, chronic; Alanine transaminase; Inflammation; Liver cirrhosis; Biopsy