ObjectiveTo exclusively compare the short-and long-term outcomes of hepatic resection (HR) patients with multifocal tumors meeting the Milan criteria between locating in same and different sections. MethodsA total of 219 consecutive HR patients with multifocal tumors meeting the Milan criteria were divided into group SS (n=97, same section) and group DS (n=122, different sections) according to their anatomical location (Couinaud's segmentation). ResultsThe 1-, 3-, and 5-year overall survival (OS) and recurrence-free survival (RFS) rates were significantly higher in the group SS than those in the group DS (P < 0.05). The subgroup analysis showed that patients with 2 tumors and those undergoing en bloc resection were associated with better OS and RFS (P < 0.05). ConclusionsFor HCC patients with multifocal tumors meeting the Milan criteria, those with tumors locating in same hepatic section may have better longterm survival and lower HCC recurrence rates than those locating in different sections after HR.
目的 探讨胰性脑病的可能的发病机制、发病情况及防治措施.方法 计算机检索中文科技期刊全文数据库(1989～2004),收集有关胰性脑病的临床研究,并进行统计分析.结果 共纳入43篇文献,435例患者.胰性脑病在重症急性胰腺炎中的发病率远高于轻症急性胰腺炎;发病年龄趋向中、老年;病死率为43.67%;病因仍以胆系疾病为主;伴发低氧的几率不高于未并发胰性脑病患者.结论 胰性脑病的发生可能是多因素共同作用的结果,仍需进一步探讨其发病机制.血清髓鞘碱性蛋白有望成为有价值的诊断指标.防治以治疗原发病急性胰腺炎为主,重在预防.胰酶抑制剂和早期营养支持有一定预防作用.
ObjectiveTo evaluate the therapeutic effect of liver transplantation (LT) combined with adenovirus-mediated delivery of herpes simplex virus thymidine kinase / ganciclovir (ADV-TK/GCV) in treatment of patients with hepatocellular carcinoma (HCC), so as to benefit more patients with HCC beyond the Milan criteria. MethodsThe clinicopathologic data of patients with HCC underwent LT by the author team since 2007 were collected and analyzed. The patients were assigned into simple LT group and LT+ADV-TK/GCV group. The 5-year cumulative overall survival rate and relapse free survival rate of all LT patients and the patients with LT beyond the Milan criteria by simple LT and LT+ADV-TK/GCV therapy were compared. Meanwhile, Cox regression was used to analyze the risk factors affecting long-term overall survival rate and relapse free survival rate of all patients with HCC after LT. ResultsA total of 216 patients eligible for inclusion were collected in this study, including 134 patients in the simple LT group and 82 patients in the LT+ADV-TK/GCV group, 162 of whom beyond the Milan criteria, including 101 patients underwent the simple LT and 61 patients underwent the LT+ADV-TK/GCV. There were no statistical differences in the baseline data between the simple LT and LT+ADV-TK/GCV in all patients and patients beyond the Milan criteria (P>0.05). There were no statistical differences in 5-year overall survival rate and relapse free survival rate of all patients with HCC (P>0.05). The 5-year cumulative overall survival rate of the LT+ADV-TK/GCV group was better than that of the simple LT group in the patients beyond the Milan criteria (χ2=4.11, P=0.047), but it was not found that the 5-year cumulative relapse free survival rate had statistical difference (27-month survival time as the critical value, P=0.46, P=0.06). Cox regression multivariate analysis results showed that the larger cumulative tumor diameter, the preoperative elevated serum alpha fetoprotein (>400 μg/L), later TNM stage, and without combination of ADV-TK/GCV therapy increased the probability of shorter overall survival of patients after LT; and the patient’s older age, the larger cumulative tumor diameter, and later TNM stage increased the probability of shorter relapse free survival after LT, and it was not found that the combination of ADV-TK/GCV therapy had an impact on the relapse free survival. ConclusionLT combined with ADV-TK/GCV therapy can obviously improve overall survival among patients beyond the Milan criteria, more patients with advanced HCC will be candidates for LT combined with ADV-TK/GCV therapy.
Objective Tissue engineering advance in supplying the reparative and reconstructive medicine with promising tissue engineered medical products(TEMPs) and the new therapy alternative. The related supervision and administration of TEMPs is being developed and the standard research of TEMPs is also in progress. The Food and Drug Administration(FDA) of the United States has treated TEMPs as combined products and supervised them according to the level of risk to patients. Lately, FDA has determined that the Center for Devices and Radiological Health (CDRH) should take charge of examination and approval of TEMPs, with the cooperation of the Center for Biological Evaluations and Research(CBER). The regulatory controls have been established respectively in European Union and Japan. In China, TEMPs are identified as medical devices combined with cells. The Department of Medical Device of the State Food and Drug Administration (SFDA) is responsible for the examination and approval of TEMPs, and National Institute for the Control of Pharmaceutical amp; Biological Products(NICPBP) is responsible for evaluation tests. The standards of TEMPs are formulated mainly by the American Society of Testing Materials(ASTM) and International Standardization Organization(ISO).
Recently, deep learning has achieved impressive results in medical image tasks. However, this method usually requires large-scale annotated data, and medical images are expensive to annotate, so it is a challenge to learn efficiently from the limited annotated data. Currently, the two commonly used methods are transfer learning and self-supervised learning. However, these two methods have been little studied in multimodal medical images, so this study proposes a contrastive learning method for multimodal medical images. The method takes images of different modalities of the same patient as positive samples, which effectively increases the number of positive samples in the training process and helps the model to fully learn the similarities and differences of lesions on images of different modalities, thus improving the model's understanding of medical images and diagnostic accuracy. The commonly used data augmentation methods are not suitable for multimodal images, so this paper proposes a domain adaptive denormalization method to transform the source domain images with the help of statistical information of the target domain. In this study, the method is validated with two different multimodal medical image classification tasks: in the microvascular infiltration recognition task, the method achieves an accuracy of (74.79 ± 0.74)% and an F1 score of (78.37 ± 1.94)%, which are improved as compared with other conventional learning methods; for the brain tumor pathology grading task, the method also achieves significant improvements. The results show that the method achieves good results on multimodal medical images and can provide a reference solution for pre-training multimodal medical images.
Objective To establish a short-term mortality risk scoring standard for sepsis-associated acute respiratory distress syndrome (sARDS) and provide a reference tool for clinicians to evaluate the severity of sARDS patients. Methods A retrospective cohort study was conducted on sARDS patients admitted to the adult intensive care unit (ICU) of the First Affiliated Hospital, Hengyang Medical School, University of South China from January 1, 2013 to August 31, 2020. They were divided into a death group and a survival group according to whether they died within 28 days after admission to ICU. Clinical data of the patients was collected within 24 hours admitted to ICU. Related risk factors for mortality within 28 days after admission to ICU were screened out through univariate logistic regression analysis. A risk prediction model for mortality within 28 days after admission to ICU was established by multivariate logistic regression analysis. The Hosmer-Lemeshow χ2 test and the area under the receiver operating characteristic (ROC) curve were used to evaluate the model’s goodness-fit and accuracy in predicting 28-day mortality of the sARDS patients, respectively. Finally, the clinical prognosis scoring criteria 28-day mortality of the sARDS patients were established according to the weight coefficients of each independent risk factor in the model. Results A total of 150 patients were recruited in this study. There were 67 patients in the survival group and 83 patients in the death group with a 28-day mortality rate of 55.3%. Four independent risk factors for 28-day mortality of the sARDS patients, including invasive mechanical ventilation, the number of dysfunctional organs≥3, serum lactic acid≥4.3 mmol/L and the severity of ARDS. A risk prediction model for mortality within 28 days of the sARDS patients was established. The area under the ROC curve and 95% confidence interval (CI), sensitivity and specificity of the risk prediction model for 28-day mortality for the sARDS patients were 0.896 (95%CI 0.846 - 0.945), 80.7% and 82.1%, respectively, while that for acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score were 0.865 (95%CI 0.805 - 0.925), 71.1% and 89.6%; for sequential organ failure assessment (SOFA) score were 0.841 (95%CI 0.7799 - 0.904), 68.7%, and 82.1%; for the prediction scores of lung injury were 0.855 (95%CI 0.789 - 0.921), 81.9% and 82.1%, respectively. It was indicated that the prediction accuracy of this risk prediction model of 28-day mortality maybe was better than that of APACHE-Ⅱ score, SOFA score and prediction score of lung injury. In addition, four risk factors were assigned as invasive mechanical ventilation (12 points), serum lactic acid≥4.3mmol /L (1 point), number of organs involved≥3 (3 points), and severity of ARDS (mild for 13 points, moderate for 26 points, severe for 39 points). Further more, the score of each patient was 13 - 55 points according to the scoring criteria, and the score grade was made according to the percentile method: 13 - 23 points for the low-risk group for 28-day mortality, 24 - 34 points for the medium-risk group for 28-day mortality, 35 - 45 points for the high-risk group for 28-day mortality, and over 45 points for the extremely high-risk group for 28-day mortality. According to the scoring criteria, the prognosis of the patients in this study was analyzed. The mortality probability of each group was 0.0% in the low-risk group, 13.8% in the medium-risk group, 51.9% in the high-risk group, and 89.7% in the extremely high-risk group, respectively. Conclusions The invasive mechanical ventilation, the number of involved organs≥3, serum lactic acid≥4.3 mmol /L and the severity of sARDS are independent risk factors for 28-day mortality of the sARDS patients. The scoring criteria may predict the risk of 28-day mortality for the sARDS patients.
ObjectiveTo analyze why sleeve gastrectomy (SG) with jejunojejunal bypass (SG-JJB), despite being the second most common bariatric procedure in China, has not been recommended in national and international guidelines nor endorsed by expert consensus; to investigate the primary obstacles to its standardization and widespread adoption; and to propose strategies leveraging China’s extensive clinical experience to refine the technique, establish standardized protocols, and address existing challenges, thereby defining its future role in metabolic surgery. MethodsBy systematically reviewing the evolution, current evidence profile, and distinctive features of SG-JJB compared to other SG-Plus procedures, this study aimed to identify constraints hindering its adoption. Concurrently, considering the characteristics of domestic healthcare resources, we explored the feasibility of procedural refinements, key steps for standardization, and solutions to potential challenges, thereby facilitating the optimization and standardization of SG-JJB. ResultsThe three key constraints hindering SG-JJB development were: risks of blind loop syndrome, uncertainty regarding optimal bypass limb length, and limited evidence on long-term efficacy. To address these issues, this study proposed leveraging China’s clinical and multi-center collaboration strengths to: conduct high-quality studies defining the impact of bypass length on outcomes, establish unified diagnostic and monitoring protocols for blind loop syndrome, and systematically collect longitudinal data to evaluate long-term efficacy, thereby informing evidence-based surgical standardization. ConclusionsSG-JJB holds significant potential in Chinese bariatric-metabolic practice, yet its standardization faces persistent challenges. Addressing concerns about blind loop syndrome, defining optimal bypass limb length, and accumulating robust long-term efficacy data are pivotal for advancing SG-JJB standardization and adoption. Leveraging domestic clinical resources through multi-center collaborations, high-quality research, and evidence-based protocol development is the essential pathway to overcoming these barriers, achieving standardized implementation, and securing recognition in authoritative guidelines.