ObjectiveTo detect the metabolites of the serum and joint fluid from rabbits’ osteoarthritis model with 1H nuclear magnetic resonance spectroscopy (NMR) technique, study the metabolic differences and connections of serum, synovial and cartilage of rabbits after the articular cavity injection of sodium hyaluronate, and explore osteoarthritis and metabolic mechanism in the process of treating sodium hyaluronate using sodium hyaluronate, thus provide new ideas and basis of the specific mechanisms in the treatment of osteoarthritis via sodium hyaluronate.MethodsWe selected 30 healthy New Zealand white rabbits, 6 months old, and randomly divided them into three groups as follows: blank control group, model phosphate buffer saline (PBS) liquid injection group and model injection of sodium hyaluronate group, with 10 rabbits in each group. Ten weeks after surgery, all experimental animals were put to death and observed in correlation studies regarding general condition, imaging examination, and histological examination. Metabolites 1H NMR detection and data preprocessing were performed in the serum and joint fluid samples.ResultsThe results considering general condition, general sample observation, imaging examination and histology indicated advantages in sodium hyaluronate group over PBS group. Metabolomics analysis showed statistically significant changes of metabolites in the serum and joint fluid compared with the PBS group and the blank control group (P<0.05). According to the relevant ways of differences metabolites retrieval, analysis found that the effect of sodium hyaluronate on osteoarthritis might be related to protein biosynthesis, amino acid circulation, the metabolic process of pyruvic acid, gluconeogenesis and other metabolic pathways.ConclusionsBased on the research of 1H-NMR metabolomics, the results suggest that the effect of sodium hyaluronate on osteoarthritis is mainly related with the activation of protein metabolism, abnormal lipid and energy metabolic pathways. This study provides new ideas and basis on the concrete mechanism in the treatment of knee osteoarthritis using sodium hyaluronate.
Objective To analyze the risk factors for ventilator-associated pneumonia( VAP) in adult patients undergoing cardiac surgery with cardiopulmonary bypass ( CPB) . Methods A total of 127 consecutive adult patients who received postoperative ventilation for more than 48 hours between January 2002 and June 2008 in the cardiac surgical intensive care unit( CSICU) were included in this study. The patients were assigned into a VAPgroup( n =64) and a control group( n = 63) . Pre-, intra-, and postoperative factors were collected and analyzed between two groups, and the multivariate analysis( logistic regression)were used to identify the risk factors of VAP. Results The overall incidence of VAP was 5.1%. The mortality of VAP was 28. 1% . Compared to the control group, the patients in the VAP group had longer duration of cardiopulmonary bypass time, ventilation time, more blood products usage and the duration of stay in CSICU( P lt; 0. 001) , higher morbidity of low cardiac output syndrome and tracheotomy( P lt; 0. 01) and higher rate of aortic surgery and mortality( P lt; 0. 05) . The preoperative left ventricular ejection fraction ( LVEF) and postoperative oxygenation index( PaO2 /FiO2 ) were lower in the VAP group than those of the control group( P lt; 0. 001) . Five variables were found to be significantly related to the development of VAP by multivariate analysis: CPB time gt; 120 min( OR = 6. 352, P = 0. 000) ; PaO2 /FiO2 lt; 300 mm Hg( OR =3. 642, P = 0. 017) , transfusion of blood products ≥1500 mL( OR = 5. 083, P = 0. 039) , ventilation time≥5 days( OR = 9. 074, P = 0. 047) and tracheotomy( OR = 19. 899, P = 0. 021) . A total of 102 pathogens were obtained by sputum culture in 64 VAP patients. There were 62( 60. 8% ) cases of gram negative bacilli, 19 cases( 18. 6% ) of gram positive cocci and 21( 20. 6% ) cases of eumycetes. Conclusion This study shows that the cardiopulmonary bypass time, ventilation time, hypoxemia, blood products transfusion and tracheotomy are risk factors most likely associated with VAP development.
ObjectiveTo investigate the clinicopathological characteristics and prognosis of elderly patients with colon cancer. MethodsThe clinicopathological and followup data of patients with colon cancer were compared retrospectively between those older than 60 years (405 patients) and those younger than 40 years (146 patients). ResultsFamily history, comorbidities, preoperative intestinal obstruction, and differentiation grade were significantly different between two groups (P＜0.05). The 5-year survival rate of patients in elder group and younger group was 64.9% and 56.8% respectively, and there was significant difference （P＜0.05）. The multivariate analysis indicated that the independent predictors of survival were comorbidities, perioperative CEA level, preoperative intestinal obstruction, tumor gross type, lymph node metastasis, hepatic metastasis, and TNM stage. ConclusionPatients older than 60 years with colon cancer have unique clinicopathological characteristics and better prognosis. The independent predictors of survival are comorbidities, perioperative CEA level, preoperative intestinal obstruction, tumor gross type, lymph node metastasis, hepatic metastasis, and TNM stage.
ObjectiveTo analyze perioperative prognostic factors of pediatric patients undergoing surgical correction of ventricular septal defect (VSD)and severe pulmonary arterial hypertension (PAH). MethodsForty pediatric patients with VSD and severe PAH (mean pulmonary artery pressure (PAPm) < 50 mm Hg)who underwent surgical repair in Beijing Anzhen Hospital from 2004 to 2012 were included in the study. There were 21 male and 19 female patients with their age of 7.2±3.3 years and body weight of 19.6±7.1 kg. All the patients were randomly divided into 2 groups:Group Ⅰ (Group=0, n=20, M/F:12/8, continuous nitroglycerin administration via central venous catheter (CVC)and GroupⅡ (Group=1, n=20, M/F:9/11, continuous prostaglandin E1 (PGE1)administration via CVC). The duration of intubation (Tintubation)was used as the dependent variable (Y). Patient age, cardiopulmonary bypass time (TCPB), postoperative PAPm, pulmonary vascular resistance index (PVRI), systemic to pulmonary pressure ratio (Ps/p), Group, left ventricular stroke work index (LVSWI)and right ventricular stroke work index (RVSWI)were used as independent variables (X). Multivariate liner regression analysis model was used to evaluate the influence of X on Y. ResultsThere was no perioperative death or severe complication in this group. Perioperative prognostic factors of pediatric patients undergoing surgical correction of VSD and severe PAH included group[x1, P=0.004, 95% CI (-71, -16)], TCPB[x2, P=0.011, 95% CI (0.9, 5.8)], posto-perative PAPm (x3, P=0.004 with 95% CI 3.2 to 13.3), RVSWI (x4, P=0.003 with 95% CI-16.9 to-4.3)and PVRI (x5, P=0.03 with 95% CI-0.29 to-0.02). The standardized regression equation was:Y=-0.60x1+0.54x2+2.22x3-1.70x4-0.15x5. ConclusionPGE1 administration, TCPB, postoperative PAPm, RVSWI and PVRI are predominant perioperative prognostic factors of pediatric patients undergoing surgical correction of VSD and severe PAH.
ObjectiveTo evaluate the predictors of generalized anxiety disorder (GAD) among teachers in 3 months after Lushan earthquake. MethodsA prospective cohort study was conducted to diagnostically evaluate the psychological sequelae and GAD during 14-20 days and 85-95 days after the earthquake. The possible predictive factors of psychological sequelae were assessed by a self-made questionnaire and the GAD was assessed by the GAD symptom criterion of M.I.N.I. in 3 months. The univariate and multivariate logistic regression analysis (ULRA, MLRA) were applied to analyze the predictors of GAD after the two-staged assessments. ResultsThere were a total of 319 teachers completed the two-staged assessments. The total response rate was 51.3%. Seventy teachers were diagnosed as GAD and the prevalence of GAD in 3 months was 21.9%. The predictive factors by ULRA included:male, older than 35 years old, having unlivable house, living in tents, sleeping difficulties, easy to feel sad, physical discomfort, loss of appetite, feeling short of social support, unable to calm down for working, feeling difficult for teaching, observing more inattention of students, and wanting to ask for a leave. The independent predictors by MLRA included:male, having unlivable house, feeling short of social support, and feeling difficult for teaching. ConclusionThe teachers have a higher likelihood of GAD after earthquake. It is essential to pay more attention to those male teachers, who feel short of social support and don't have a livable house thus to prevent the GAD at the early stage of post-earthquake.
ObjectiveBy analyzing the correlation between the clinicopathological features of patients with colorectal liver metastases (CRLM) and their postoperative survival, this study is aimed to identify new and accurate prognostic indicators on the prognoses to provide a reference of the treatment strategy selection for patients with CRLM. MethodsThe clinical data of 233 patients with CRLM who received operation treatments in the Eastern Hepatobiliary Hospital of the Second Military Medical University from January 2006 to December 2009 were retrospectively investigated, and their clinicopathological features, as well as their prognosis were analyzed. The survival curve was drawn by Kaplan-Meier method, and the survival rates were analyzed by log-rank test. Parametric survival analysis was used to identify predictors of cancer-specific survival. ResultsThe median survival time after cancer resection was 37.0 months, with cumulative 1-year, 3-year, and 5-year survival rates of 93.0%, 61.0%, and 17.0%, respectively. The median survival time, with cumulative 3-year, and 5-year survival rates of patients who had received radical operations was better than the others who received palliative operations:40.53 months vs 27.20 months, 59.0% vs 29.0%, and 20.0% vs 0(P < 0.05), respectively. In overall surviva, the results of univariate analysis showed that 13 factors, including surgical method, the first relapse after liver metastasis resection, the number of liver metastases, surgical margin, other unresectable extrahepatic metastases or resectable invasion in blood vessels or the surrounding tissue, whether any chronic liver disease was associ-ated, preoperative serum CEA level, preoperative serum CA19-9 leve, the position of the liver metastases, whether the liver metastasis capsule was complete, TNM stagethe of primary cancer, whether the liver metastasis was simultaneous liver metastases, and the maximum diameter of the liver metastases, were closely related to the clinicopathological features associated with prognosis and the differences were statistically significant (P < 0.05). The results of multivariate survival analysis demonstrated that received palliative operations, simultaneous liver metastases, there were other unresectable extrahepatic metastases or resectable invasion in blood vessels or the surrounding tissue, liver metastases without a complete capsule, the number of liver metastases appeared as multiple and widedistribution, unassociated chronic liver disease of the patients, the maximum diameter of the liver metastases>3 cm, were the independent risk factors affecting the postoperative survival of the patients with CRLM (P < 0.05). ConclusionsIt is important for long-term survival of patients with CRLM who were received operations. Received palliative operations, simultaneous liver metastases, there were other unresectable extrahepatic metastases or resectable invasion in blood vessels or the surrounding tissue, liver metastases without a complete capsule, the number of liver metastases appeared as multiple and widedistribution, unassociated chronic liver disease of the patients, the maximum diameter of the liver metastases>3 cm, were the independent risk factors affecting the postoperative survival of the patients with CRLM.
Objective To discuss the clinicopathologic risk factors related to local recurrence of rectal cancer after radical surgery. Methods The complete clinicopathologic data of 368 patients with rectal cancer from January 2004 to April 2011 in this hospital were retrospectively analyzed by univariate and multivariate analysis methods. Results There were 73 cases suffered from local recurrence and accounted for 19.84% （73/368） of rectal cancer during the same period. Univariate analysis results showed that gender， tumor from anal margin， tumor circumference， TNM staging， histology type， vessel infiltration， tumor perforation， stomal leak， and chemoradiotherapy were associated with postoperative recurrence （P＜0.05）. Multivariate analysis results showed that tumor from anal margin， tumor circumference， TNM staging， histology type， vessel infiltration， tumor perforation， and chemoradiotherapy were prognostic factor for local recurrence of rectal cancer （P＜0.05）. Conclusions There are many factors related to postoperative local recurrence， but the most dangerous factor is vessel infiltration.
ObjectiveTo investigate the prognostic factors for inflammatory breast cancer based on the data from West China Hospital with a relatively large sample. MethodsClinical data of 41 patients with histopathologically confirmed inflammatory breast cancer (IBC) who received treatment at West China Hospital Oncology Center of Sichuan University between January 2009 and December 2014 were collected and analyzed. Log-rank test and Cox regression model were used for statistical analysis. ResultsIn the study, negative estrogen receptor, negative progestrone receptor and positive human epidermal growth factor receptor-2 were identified in 58.5%, 61.0% and 34.2% of the inflammatory breast cancer tissues, respectively. Progress free survival (PFS) were between 2 and 60 months, with a median of 35 months. Univariate analysis showed that Tumor Node Metastasis (TNM) stage (P=0.016) and therapeutic effect (P=0.002) influenced the survival. Multivariate analysis showed that TNM stage (P=0.006), therapeutic effect (P=0.002), and anthracycline-taxane based chemotherapy (P=0.041) were the significant prognostic factors. ConclusionTNM stage is the major prognostic factor for IBC. Preoperative chemotherapy with paclitaxel-epirubicin combination can improve the PFS of IBC. Comprehensive treatment mode with operation is recommended for the treatment of IBC.
Objective To investigate the related factors of effects on distant visual acuity after photodynamic therapy (PDT) for choroidal neovascularization (CNV). Methods One hundred and thirty-five cases (135 eyes ) of CNV treated with PDT were observed. The gender, preoperative distant and near visual acuity, disease course, pathogeny, area of CNV, types of CNV ascertained by fundus fluorescein angiography (FFA), and changes of CNV in FFA were recorded. Multi-factor regression analysis of visual acuity within 1 month and 3 months after PDT was performed with SPSS statistics software. Results The distant visual acuity within 1 month postoperatively was related to the preoperative distant visual acuity, the area of CNV and the changes in the FFA（P=0.000,0.030,0.062）, and 3 months after PDT, it was related to the distant and near visual acuity preoperatively and the changes in the FFA（P=0.000,0.054,0.034）. The condition of distant visual acuity within 1 month postoperatively was related to the FFA type of CNV and the disease course（P=0.018,0.08）. Conclusion The smaller the area of CNV is, the better postoperative distant visual acuity would be. The proportion of improvement of visual acuity is relatively higher in patients with classic CNV. Early treatment for the patients with the indicatio may improve the visual acuity effectively. (Chin J Ocul Fundus Dis，2004，20：292-294)
ObjectiveTo investigate the long-term efficacy and the influencing factors of thymectomy for thymoma patients associated with myasthenia gravis. MethodsWe retrospectively analyzed the clinical and follow-up data of 126 thymoma patients associated with myasthenia gravis underwent extended thymectomy from June 2002 to December 2015 in our hospital. There were 26 males and 37 females at the mean age of 54.51±12.62 years. We built up survival analysis model to analyze the effect of those following factors on postoperative result:sex, the age when operated, the preoperative course of disease, the condition of associating with other diseases, history of critical illness, steroid administration time before operation, Osserman classification, Masaoka staging, WHO pathological type, surgical approach, tumor size and so on. Result The average follow-up time was 35(5-96) months. During follow-up period, 12 patients (19%) achieved complete remission, 39 patients (62%) achieved partial remission, 7 patients (11%) kept stable, 5 patients (8%) deteriorated and the total effective rate was 81%. The result of log-rank analysis showed that the preoperative course of disease (P=0.027), history of critical illness on myasthenia gravis (P=0.035) and Osserman classification (P=0.018) were related to incomplete remission, whlie the result of Cox regression analysis showed that the preoperative course of disease (P=0.001) and Osserman classification (P=0.012) were the independent risk factors for incomplete remission. ConclusionExtended thymectomy is an effective treatment for thymoma patients associated with myasthenia gravis, but the symptom of those patients whose preoperative course of disease are more than 12 months or Osserman classification is at ⅡB, Ⅲ and Ⅳ type of Osserman classification have poor effect after operation.