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.
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.
目的 初步探討影響男性乳腺癌患者預后的因素。 方法 收集2003年1月－2011年12月經病理確診、接受治療、臨床資料較完整的36例男性乳腺癌患者的臨床資料。采用對數秩檢驗和Cox回歸分析影響男性乳腺癌患者預后的因素。 結果 36例患者無進展生存期（PFS）為3～95個月，中位PFS為45個月。單因素分析顯示：腫瘤直徑（P=0.001）、陽性淋巴結（P=0.001）、TNM分期（P＜0.001）、手術方式（P=0.001）是影響預后的因素。多因素分析顯示：陽性淋巴結（P=0.024）和TNM分期（P=0.022）是影響預后的主要因素。 結論 陽性淋巴結和TNM分期是影響預后的主要因素，以手術為主的綜合治療模式是提高男性乳腺癌患者生存率的重要措施。
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 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 analyze the risk factors for delirium of the Stanford A aortic dissection patients after surgery. Method We retrospectively analyzed the clinical data of 335 patients with type A aortic dissection in Guangdong Cardiac Institution from January 2012 through December 2014. There were 280 males and 55 females. The average of age was 48.5±10.3 years. Delirium status of the patients were evaluated based on confusion assessment method for intensive care unit (CAM-ICU). The patients were divided into two groups including a delirium group and a control group. We tried to find the risk factors for postoperative delirium. Results There were 169 patients of delirium with a incident rate of 50.4%. One-way analysis of variance and multivariate analysis indicated that pre-operative D-dimer level (OR=2.480, 95% CI 1.347-4.564, P<0.01), the minimum mean arterial pressure during operation (OR=0.667, 95% CI 0.612-0.727, P<0.01), the postoperative ventilation time (OR=2.771, 95% CI 1.506-5.101, P<0.01) and the postoperative acute kidney failure (OR=1.911, 95% CI 1.065-3.430, P<0.05) were the independent risk factors for delirium of the Stanford A aortic dissection patient after surgery. Conclusion The incident rate of postoperative delirium of the Standford A aortic dissection patient is relatively high. Patients in this study with elevated pre-operative D-dimer level, lower intraoperative mean arterial pressure, longer postoperative ventilation and combination of acute kidney failure have a higher rate of postoperative delirium. Better understanding and intervention of these factors are meaningful to reduce the occurrence of postoperative delirium.
Objective To investigate the long-term prognosis of cerebral venous sinus thrombosis (CVST) and to identify the early predictors of poor outcome. Methods We performed a prospective register study on the prognosis of CVST patients. All patients were followed up continuously. The primary endpoint was death or dependence as assessed by the modified Rankin Scale (mRS) score gt;2 at month 6. A multivariable logistic regression model was applied to identify the predictors of outcome. Results A total of 52 CVST patients were included. The rates of recurrence and death at month 6 were 13.5% and 7.7%, respectively, and 29.9% of the patients were dead or dependent at month 6. The multivariable logistic regression analysis revealed that the predictors of death or dependence at month 6 were intracranial parenchymal lesion (OR=14.62, 95%CI 2.36 to 90.36) and delayed diagnosis (OR=13.14, 95%CI 1.90 to 90.84). Conclusion In China, CVST is still a disease that may lead to death or dependence. Its long-term prognosis is relatively poor compared to that reported in western patients. This difference may due to the delayed diagnosis of CVST in China.
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.
Objective To explore the risk factors of invasive fungal infection ( IFI) in respiratory ward. Methods A multi-center, retrospective, case-control study was carried out. Patients from five general hospitals in Chongqing city, diagnosed as fungal infection, or whose respiratory specimens were fungal positive, were retrospectively screened for IFI. Patients with respiratory infection and colonization of nonfungal cases in the same period of hospitalization were enrolled as control. Results Thirty-four patients diagnosed with IFI and 50 patients diagnosed with bacterial infection were analyzed for the risk factors of IFI. The demographic characteristics of patients including age and gender were not different( P gt; 0. 05) , but hospitalization days, carbapenem antibiotic use, chemotherapy, deep venous catheterization, total parenteralnutrition( TPN) , neutropenia, and renal disfunction were different significantly between the IFI group and the control group. Multiple logistic regression analysis showed that carbapenem antibiotic use ( OR = 6. 753) ,central venous catheterization ( OR = 5. 021) and TPN ( OR = 3. 199) were main risk factors of invasive fungal infection. Conclusion The carbapenem antibiotic use, central venous catheterization and TPN are risk factors for IFI in respiratory ward.
Objective To explore the effect of vitamin E (VE) on subclinical atherosclerosis (AS) in patients with newly diagnosed type 2 diabetes mellitus. Methods Eighty-five newly diagnosed type 2 diabetic patients without AS were divided into two groups [VE group (n =43) and control group (n =42)] according to the random numeration table. All the patients received comprehensive intervention including the control of blood glucose, blood pressure, blood lipid and body weight and anti-platelet drugs. VE capsule (200 mg/d) was added to VE group (n =41) to evaluate its effects on the incidence of subclinical AS after one year intervention. Results Three patients withdrew during one year follow up. No significant differences of age, sex, baseline body mass index, waist to hip ratio, blood lipid, blood pressure, 24 h urinary albuminuria, insulin resistance index, high sensitive C-reactive protein level, intima-medial thickness (IMT) of common carotid artery, femoral artery and common iliac artery were found between VE group and control group (Pgt;0.05). The decrease of IMT of common carotid artery in VE group after one year intervention was more significant than that in control group (Plt;0.05), whereas the other metabolic parameters mentioned above showed no significant differences between the two groups (Pgt;0.05). The incidence of subclinical AS was significantly higher in VE group(26.8%, 11/41) than that in control group (7.3%, 3/41) (Plt;0.05). Conclusions One year VE supplementation with multifactorial intervention has no beneficial effect on subclinical AS in newly diagnosed type 2 diabetic patients.