术前血清胱抑素C水平对手术的肾癌患者预后的影响

目的探讨术前血清胱抑素C(Cystatin C,Cys-C)水平对肾癌患者预后的影响。方法回顾性分析2013年1月至2016年12月于徐州医科大学附属医院行根治性/部分肾切除术治疗的354例肾癌患者的临床病理和随访资料。根据受试者工作特征曲线(ROC)确定Cys-C的最佳临界值,将其分为高Cys-C组和低Cys-C组。运用Kaplan-Meier、Log-rank检验分析两组患者的总生存率和肿瘤特异性生存率的差异,通过单因素和多因素Cox模型分析影响患者总生存和肿瘤特异性生存的因素。结果共纳入354例患者,其中高Cys-C组36例、低Cys-C组318例。与低Cys-C组相比,高Cys-C组患者年龄更大、肿瘤分期更晚及尿素、肌酐、尿酸水平更高(P均<0.05),但肾小球滤过率相对较低(P<0.05)。Kaplan-Meier结果显示高Cys-C组与低Cys-C组5年总生存率分别为56.7%和96.2%,5年肿瘤特异性生存率分别为64.0%和96.5%(P均<0.05)。Cox多因素分析结果显示术前高Cys-C水平为肾癌患者术后总生存(HR:10.513,95%CI:2.539~43.522,P=0.001)和肿瘤特异性生存(HR:4.944,95%CI:1.017~24.043,P=0.048)的独立影响因素。结论肾癌患者术前血清Cys-C水平升高提示术后预后不良。     

术前血清miR-20a、miR-17在结直肠癌预后评估中的价值

目的探讨结直肠癌患者术前血清miR-20a、miR-17水平在术后不良临床结局评估中的价值。 方法选择2013年8月至2016年2月华中科技大学同济医学院附属协和医院就诊的结直肠癌患者73例作为病例组,收集患者术前以及术后1周、1个月、3个月时的血清标本,另收集81名同期体检健康对照组的血清标本,采用实时荧光定量PCR法检测两组血清miR-20a、miR-17表达水平。根据表达平均数分为高表达组与低表达组,采用Kaplan-Meier法对两组进行生存分析;Cox比例风险回归模型筛选不良预后的影响因素,受试者工作特征（ROC）曲线分析血清miR-20a、miR-17水平对结直肠癌不良预后的诊断效能。 结果病例组患者术后血清miR-20a、miR-17水平呈下降趋势（P<0.05）,且各检测点水平均高于对照组（P<0.05）。分化程度（HR=1.462,95% CI：1.096~1.951）、TNM分期（HR=1.642,95% CI：1.339~2.014）、术前血清miR-20a（HR=1.575,95% CI：2.035~3.652）、miR-17水平（HR=2.491,95% CI：2.131~2.914）是影响结直肠癌患者不良预后的独立危险因素（均P<0.001）。术前血清miR-20a、miR-17高表达者的3年总生存率更低（22.0% vs 78.3%,21.3% vs 73.1%,P<0.05）;两者联合检测预测结直肠癌患者预后不良的曲线下面积为0.955,敏感度为97.6%,特异度为91.2%。 结论结肠癌患者术前血清miR-20a、miR-17高表达与患者不良预后有关,术前检测有助于改善不良预后高风险患者的临床结局。     

术前血小板/淋巴细胞比值与肝癌预后的关系

目的:探讨术前血小板/淋巴细胞比值(PLR)与肝癌预后的关系。方法:回顾性分析行手术治疗的256例肝癌患者的临床资料。根据患者术前PLR水平,绘制PLR诊断肿瘤复发的受试者工作特征(ROC)曲线,确定PLR界值,分析术前外周血PLR水平分与患者临床病理因素及预后的关系。结果:PLR诊断肿瘤ROC曲线下面积为0.625(95%CI=0.544~0.706),灵敏度为0.53,特异度为0.70,界值为131.81。患者术前外周血PLR水平与术前血清白蛋白、Child-Pugh分级、是否伴有腹水、血管侵犯、TNM分期等临床病理因素有关(均P0.05)。Cox风险模型分析显示,TNM分期(HR=1.441,95%CI=1.721~2.635,P0.001)、PLR(HR=1.737,95%CI=1.317~2.291,P0.001)为肝癌预后的独立影响因素,而PLR(HR=1.893,95%CI=1.434~2.497,P0.001)为肝癌复发的独立影响因素。生存分析显示,低PLR患者术后1、3、5年无瘤生存率(81.2%、53.3%、29.6%)明显高于PLR患者(62.4%、30.4%、11.6%)。结论:术前PLR可以作为肝癌患者的预后指标,高PLR水平患者术后复发率高、预后差。     

术前外周血中纤维蛋白原水平与肾癌患者预后的关系

目的探讨术前外周血中纤维蛋白原水平与经手术治疗的肾癌患者预后的关系。方法回顾性分析北大医院2010至2012年行手术治疗的280例肾癌患者的临床病理资料和术后随访资料,采用受试者工作特征曲线法确定纤维蛋白原的最佳临界值,根据临界值将患者分入高水平纤维蛋白原组和低水平纤维蛋白原组。χ~2检验分析两组间多种临床病理特征的区别,并采用Kaplan-Meier法计算生存率,Log-rank检验分析组件差距,使用Cox风险回归模型分析肾癌患者预后的独立预测因子。结果术前血浆纤维蛋白原水平与年龄、高血压、肿瘤分级、肿瘤病理分期密切相关(P=0.035,P=0.006,P0.001,P0.001)。单因素分析结果显示,血浆纤维蛋白原水平、肿瘤的分级、病理分期与患者总生存时间显著相关(P均0.001)。进一步通过Cox回归模型分析发现,术前血浆纤维蛋白原水平是肾癌术后患者总体生存时间和肿瘤特异生存时间的独立预后因子,但并非无病生存时间的独立预后因子。结论术前血浆中高纤维蛋白原水平是肾癌术后患者不良预后的独立预测因素。     

术前外周血中性粒细胞与淋巴细胞比值在非转移性肾癌中预后价值的Meta分析

目的系统评价术前外周血中性粒细胞与淋巴细胞比值(NLR)在非转移性肾癌患者中的预后作用。方法检索从建库至2019年12月关于分析中性粒细胞与淋巴细胞比值与非转移性肾癌患者术后生存率关系的相关文献资料,检索数据库包括PubMed、Web of Science、EMBASE、Cochrane Library、中国生物医学文献数据库、万方数据库和中国知网。根据纳入及排除标准选择合适文献并提取相关信息和数据。使用Stata 12.0和RevMan 5.3软件进行Meta分析。结果共纳入11篇回顾性研究,涉及4 544例接受部分性或根治性肾切除术的非转移性肾癌患者。与术前外周血较高NLR相比,相对较低NLR的患者术后总生存率(HR=2.00,95%CI:1.41～2.82,P0.001)、无复发生存率(HR=2.05,95%CI:1.61～2.61,P0.001)和癌症特异性生存率(HR=2.33,95%CI:1.65～3.31,P0.001)较高。结论作为一项简单且有效的指标,NLR能够较好地预测非转移性肾癌患者的预后,但仍需更多前瞻性、大样本的试验验证。     

miR-214和miR-181c在胃癌组织中的表达及预后价值

目的探讨微小RNA-214（miR-214）和miR-181c在胃癌组织中的表达水平及对预后的影响。 方法选取2014年1月至2015年1月于川北医学院附属医院收治的68例胃癌患者为研究对象,均接受手术治疗,出院后随访1~60个月。利用实时荧光定量PCR技术检测患者癌组织和癌旁组织miR-214、miR-181c相对表达量;利用Kaplan-Meier曲线进行生存分析;Cox多因素回归分析影响胃癌患者预后的独立危险因素。 结果胃癌组织中miR-214、miR-181c表达水平均明显低于癌旁组织,差异有统计学意义（P<0.05）。根据miR-214、miR-181c表达均值将患者分为高表达组和低表达组,miR-214、miR-181c表达水平与年龄、性别、淋巴结是否转移无关,与TNM分期、肿瘤分化程度有关（P<0.05）。患者总生存率为44.12%,miR-214低表达组和高表达组术后5年累积生存率分别为35.71%、57.69%,两组间比较差异有统计学意义（P=0.035）;miR-181c低表达组和高表达组术后5年累积生存率分别为35.55%、60.87%,差异有统计学意义（P=0.024）。Cox多因素回归分析结果显示,TNM分期高（HR=1.569,95% CI：1.029~2.391,P=0.036）、miR-214低表达（HR=1.643,95% CI：1.294~2.087,P<0.001）及miR-181c低表达（HR=1.327,95% CI：1.045~1.685,P=0.021）是影响胃癌患者预后的独立危险因素。 结论miR-214、miR-181c在胃癌组织中表达显著下调,与胃癌患者临床病理参数及不良预后有关,参与胃癌的发生发展过程。     

非小细胞肺癌患者围术期内皮抑素和表皮生长因子受体水平对生存的影响

目的分析非小细胞肺癌(NSCLC)患者的临床和病理特征、围术期血清内皮抑素和表皮生长因子受体(EGFR)水平对患者生存的影响。方法收集2008年1月至12月在上海交通大学附属第六人民医院胸外科接受手术治疗的50例NSCLC患者,从术后开始随访至2014年1月,平均随访时间为36.44个月。采用多因素回归分析方法分析50例NSCLC患者生存的相关因素。结果50例NSCLC患者的5年生存率为53.7%,中位生存期为50.6个月。肿瘤最大径3.5cm的患者生存率显著优于肿瘤最大径≥3.5cm的患者(χ~2=8.086,P=0.004);肺腺癌患者的生存率显著优于肺鳞癌患者(χ~2=7.527,P=0.006);术后病理分期Ⅰ期的患者生存率显著优于Ⅱ和Ⅲ期患者(χ~2=4.681,P=0.03;χ~2=7.990,P=0.005);术前内皮抑素水平20.4ng/ml的患者生存率显著优于内皮抑素水平≥20.4ng/ml的患者(χ~2=5.213,P=0.022);术后EGFR水平≥44.7pg/ml的患者生存率显著优于EGFR水平44.7pg/ml的患者(χ~2=13.908,P=0.000),差异均有统计学意义。多因素回归分析显示术后EGFR水平是影响预后的独立因素(P=0.000)。结论术前内皮抑素水平低的患者和术后EGFR水平高的患者具有更好的生存优势。     

动画视听加小剂量咪唑安定在学龄前小儿斜弱视患者麻醉诱导中的应用效果

目的探究动画视听加小剂量咪唑安定在学龄前小儿斜弱视患者麻醉诱导中的应用效果。方法回顾性分析2016年8月至2017年1月在本院就诊的100例弱斜视患儿,随机分为M组(n=30)、S组(n=30)及MS组(n=40)。M组给予咪唑安定治疗,S组进行动画视听教育,SM组进行视听术前教育,并给予咪唑安定治疗。观察比较3组患儿术前访视(T_1)、处理后5分钟(T_2)及静脉穿刺麻醉诱导时(T_3),3个时间点的耶鲁围术期焦虑量表(m YPAS)评分、诱导期合作度量表(ICC)评分、围术期生命体指标。结果诱导后,3组患者的心率(HR)、收缩压(SBP)、舒张压(DBP)均明显降低(P0.05);且MS组患者HR、SBP、DBP显著低于M、S组(P0.05)。随着时间的推移,患者的m YPAS评分逐渐降低,组内,T_2与T_3时刻的m YPAS评分显著低于T_1时刻(P0.05),且T_3时刻患者m YPAS评分显著低于T_2时刻(P0.05);组间,MS组在T_1、T_2、T_3时刻的m YPAS评分均显著低于M、S组(P0.05)。MS组诱导期合作度量表(ICC)、苏醒躁动及术后行为量表(PHBQ)评分显著低于M、S组(P0.05)。MS(2.50%)组头晕等不良反应发生率显著低于M(20.00%)、S组(23.33%)(P0.05)。结论动画视听加小剂量咪唑安定可以显著降低患儿的躁动,减低患者的焦虑,是理想的麻醉诱导方法。     

代谢相关因素与肾癌发病风险的相关性研究

目的 探讨代谢相关因素与肾癌发病风险的相关性. 方法 回顾性分析2007年4月至2010年12月165例病理诊断的肾癌患者资料,以2007年北京市西城区调查数据库中330名无肾癌居民作为对照组.采集两组人群年龄、性别、身高、体质量、体质指数(BMI)、吸烟史、高血压病史、糖尿病史和血清甘油三酯、胆固醇、高密度脂蛋白胆固醇(H DL-c)、低密度脂蛋白胆固醇(LDL-c)等检验资料.应用条件Logistic回归分析方法分析资料,评估吸烟史、BMI、高血压病史、糖尿病史及血清甘油三酯、总胆固醇、HDL-c、LDL-c检验值与肾癌发病风险的相关性. 结果 条件Logistic回归分析结果显示:糖尿病史(HR=2.761,95％ CI=1.546 ～4.929)、高血压病史(HR=2.753,95％ CI=1.710～4.432)与肾癌发病风险呈正相关,吸烟史(HR=0.329,95％ CI=0.209 ～0.519)、血清甘油三酯(HR=0.585,95％ CI=0.374 ～0.913)、HDL-C(HR=0.024,95％ CI=0.008 ～0.073)、BMI水平(HR =0.916,95％CI=0.853 ～0.984)与肾癌发病风险呈负相关.按血脂及脂蛋白水平分组分析结果显示:高低密度脂蛋白胆固醇血症(HR=15.994,95％ CI=6.544 ～ 39.093)、低高密度脂蛋白胆固醇血症(HR=3.236,95％ CI=1.992 ～5.257)、糖尿病史(HR=3.234,95％ CI=1.789～5.848)、高血压病史(HR=2.614,95％CI=1.630～4.191)与肾癌风险呈正相关,吸烟史(HR=0.368,95％ CI=0.233 ～0.580)、高胆固醇血症(HR=0.144,95％ CI=0.068 ～0.304)呈负相关. 结论 肾癌发病可能与肥胖、高血压病、糖尿病、血脂及脂蛋白异常等代谢异常因素有关,高血压病、糖尿病、高低密度脂蛋白胆固醇血症、低高密度脂蛋白胆固醇血症可能是肾癌的危险因素,高胆固醇血症、血清甘油三酯、HDL-c水平升高可能是肾癌发病的保护因素.     

术前/术后中性粒细胞-淋巴细胞比值与格拉斯哥预后评分对胆囊癌预后的预测价值

背景与目的:胆囊癌(GBC)是高病死率的恶性肿瘤,快速有效术前诊断及预后评估手段的缺乏为胆囊癌的手术及随访治疗增加了难度。近年来围绕着外周血炎症相关指标与肿瘤预后的研究较为广泛,但由于外周血参数的不稳定性,预测价值往往有限。本研究旨在探讨新型外周血参数模型术前/术后中性粒细胞-淋巴细胞数比值(PP-NLR)及格拉斯哥预后评分(GPS)在GBC预后评估中的作用。方法:回顾2005年1月—2015年12月收治的140例GBC患者临床资料,根据ROC曲线界值决定手术前后NLR界值,升高则分别赋值为1,反之则为0,PP-NLR定义为两者赋值之和,分别为0、1、2;将术前血清白蛋白35 g/L和术前CRP10 g/L分别赋值为1,否则为0,GPS定义为两者赋值之和,分别为0、1、2。采用Kaplan-Meier法与Log-rank检验及单因素分析方法分析PP-NLR和GPS与患者生存及临床病理因素的关系,用Spearman相关性分析方法分析PP-NLR和GPS与临床病理因素的相关性,用多因素Cox风险模型确定预后的独立危险因素。结果:ROC曲线确定术前及术后NLR的界值分别为2.51(敏感度0.961,特异度0.788)和2.38(敏感度0.745,特异度0.712)。生存分析显示,不同PP-NLR或GPS水平患者间生存率均有统计学差异(均P0.05),生存率在PP-NLR=1、PP-NLR=2、PP-NLR=3组呈依次降低(均P0.05);GPS=0组的生存率明显高于GPS=1组或GPS=2组(均P0.05),但GPS=1和GPS=2组间生存率无统计学差异(P0.05)。单因素分析显示,PP-NLR和GPS水平均与根治率、肿瘤侵润、淋巴结转移、远处转移、分化程度及炎症指标及肿瘤标志物水平等明显有关(均P0.05);相关性分析提示,PP-NLR与GPS与根治率、肿瘤侵润、淋巴结及远处转移、TNM分期及分化程度明显相关(均P0.05)。单因素分析提示,PP-NLR及GPS的升高均与低生存率有关(均P0.05),多因素分析显示,PP-NLR为影响患者预后的独立危险因素(PP-NLR=1:HR=0.357,95% CI=0.221～0.575,P0.05;PP-NLR=2:HR=0.357,95% CI=0.221～0.575,P0.05)。结论:PP-NLR和GPS均与GBC患者预后相关,且PP-NLR为独立预后危险因素,提示外周血参数PP-NLR及GPS可以简便、快速、有效的评估患者预后。此外,PP-NLR整体考虑了术前及术后的系统炎症及免疫状态,相对于GPS及单纯的手术前后NLR预测更为全面、价值更高,可为临床随访治疗提供理论依据。     

Prognostic significance of postoperative in-hospital complications in elderly patients. I. Long-term survival

To determine the impact of in-hospital postoperative complications on long-term survival, we prospectively studied consecutive patients > or = 70 yr of age undergoing noncardiac surgery. Potential clinical risk factors were measured and evaluated for their association with the occurrence of long-term postoperative mortality. Long-term survival was determined by using the Kaplan-Meier method. Multivariate correlates of survival were analyzed with the Cox proportional hazards model. The survival of the study group was also compared with the age- and gender-matched general United States population. Five hundred seventeen patients who survived the initial hospitalization were studied. The mean follow-up duration was 28.6 +/- 12.8 mo. One hundred sixty-four of 517 patients (31.7%) were deceased at the time of follow-up. A history of cancer (hazard ratio [HR] 2.44, 95% confidence interval [CI] 1.78-3.38, P < 0.0001), ASA physical status >II (HR 2.27, 95% CI 1.61-3.21, P < 0.0001), neurologic disease (HR 1.59, 95% CI 1.13-2.24, P = 0.008), age (HR 1.42 per decade, 95% CI 1.11-1.81, P = 0.005), postoperative pulmonary complications (HR 2.41, 95% CI 1.30-4.48, P = 0.005), and renal complications (HR 6.07, 95% CI 2.23-16.52, P < 0.0001) were significant independent predictors of decreased long-term survival. Compared with the United States population, patients with complications had a greater increase in mortality risk in the first 3 mo after surgery (HR 7.3 versus general population) than those without complications (HR 2.9, P = 0.023). An effort to improve perioperative care delivery to elderly surgical patients must include measures to minimize in-hospital postoperative complications, particularly those involving the pulmonary and renal systems.     

Prognostic Value of Sarcopenia and Albumin in the Surgical Management of Localized Renal Cell Carcinoma

IntroductionA universally accepted model for preoperative surgical risk stratification in localized RCC patients undergoing nephrectomy is currently lacking. Both the evaluation of body composition and nutritional status has demonstrated prognostic value for patients with cancer. This study aims to investigate the potential associations between sarcopenia and hypoalbuminemia and survival outcomes in patients with localized kidney cancer treated with partial or radical nephrectomy.Materials and MethodsWe retrospectively analyzed 473 patients with localized RCC managed with radical and partial nephrectomy. Skeletal muscle index (SMI) was measured from preoperative CT and MRI. Sarcopenic criteria were created using BMI- and sex-stratified thresholds. Relationships between sarcopenia and hypoalbuminemia (Albumin <3.5 g/dL) with overall (OS), recurrence-free (RFS), and cancer-specific survival (CSS) were determined using multivariable and Kaplan-Meier analysis.ResultsOf the 473 patients, 42.5% were sarcopenic and 24.5% had hypoalbuminemia. Sarcopenia was significantly associated with shorter OS (HR=1.51, 95% CI 1.07-2.13), however, was nonsignificant in the RFS (HR = 1.33, 95% CI 0.88-2.03) and CSS (HR=1.66, 95% CI 0.96-2.87) models. Hypoalbuminemia predicted shorter OS (HR=1.76, 95% CI 1.22-2.55), RFS (HR=1.86, 95% CI 1.19-2.89), and CSS (HR=1.82, 95% CI 1.03-3.22). Patients were then stratified into low, medium, and high-risk groups based on the severity of sarcopenia and hypoalbuminemia. Risk groups demonstrated an increasing association with shorter OS (all p<0.05). Reduced RFS was observed in the medium risk-hypoalbuminemia (HR=2.18, 95% CI 1.16-4.09) and high-risk groups (HR=2.42, 95% CI 1.34-4.39). Shorter CSS was observed in the medium risk-hypoalbuminemia (HR=2.31, 95% CI 1.00-5.30) and high-risk groups (HR=2.98, 95% CI 1.34-6.61).ConclusionLocalized RCC patients with combined preoperative sarcopenia and hypoalbuminemia displayed a two to a three-fold reduction in OS, RFS, and CSS after nephrectomy. These data have implications for guiding prognostication and treatment election in localized RCC patients undergoing extirpative surgery.     

The relationship between tumour proliferative activity, the systemic inflammatory response and survival in patients undergoing curative resection for colorectal cancer

Background  The aim of the present study was to examine the relationship between Ki-67, C-reactive protein and cancer-specific survival in patients undergoing resection for colorectal cancer.
Method  One hundred and forty-seven patients undergoing potentially curative resection for colorectal cancer had preoperative C-reactive protein concentrations and tumour Ki-67 labelling index measured.
Results  On univariate analysis, age ( P  < 0.001), Dukes stage ( P  < 0.001), C-reactive protein ( P  < 0.001) and expression of Ki-67 (< 0.01) were associated with poorer cancer-specific survival. Ki-67 labelling index and C-reactive protein were correlated ( r _s = 0.172, P  = 0.037). On multivariate analysis, age (HR 1.96, 95% CI 1.26–3.04, P  = 0.003), Dukes stage (HR 4.38, 95% CI 2.11–9.09, P  < 0.001) and C-reactive protein (HR 4.09, 95% CI 2.04–8.24, P  < 0.001) retained significance.
Conclusion  Increased tumour proliferation is associated with a systemic inflammatory response and poor cancer-specific survival in patients undergoing potentially curative surgery for colorectal cancer.     

Surgical management of atherosclerotic renovascular disease

OBJECTIVE: This review describes the clinical outcome of surgical intervention for atherosclerotic renovascular disease in 500 consecutive patients with hypertension. METHODS: From January 1987 to December 1999, 626 patients underwent operative renal artery (RA) repair at our center. A subgroup of 500 patients (254 women and 246 men; mean age, 65 plus minus 9 years) with hypertension (mean blood pressure, 200 plus minus 35/104 plus minus 21 mm Hg) and atherosclerotic RA disease forms the basis of this report. Hypertension response was determined from preoperative and postoperative blood pressure measurements and medication requirements. Change in renal function was determined with estimated glomerular filtration rates (EGFRs) calculated from serum creatinine levels. Proportional hazards regression models were used for the examination of associations between selected preoperative parameters, blood pressure and renal function response, and eventual dialysis-dependence or death. RESULTS: Two hundred three patients underwent unilateral RA procedures, 297 underwent bilateral RA procedures, and 205 patients underwent combined renal and aortic reconstruction. After surgery, there were 23 deaths (4.6%) in the hospital or within 30 days of surgery. Significant and independent predictors of perioperative death included advanced age (P <.0001; hazard ratio [HR], 3.23; 95% confidence interval [CI], 1.85 to 5.70) and clinical congestive heart failure (P =.013; HR, 3.05; 95% CI, 1.26 to 7.34). Among the patients who survived surgery, hypertension was considered cured in 12%, improved in 73%, and unchanged in 15%. For the entire group, renal function increased significantly after operation (preoperative versus postoperative mean EGFR, 41.1 plus minus 23.9 versus 48.2 plus minus 25.5 mL/min/m(2); P <.0001). For individual patients, with a 20% or more change in EGFR considered significant, 43% had improved renal function (including 28 patients who were removed from dialysis-dependence), 47% had unchanged function, and 10% had worsened function. Preoperative renal insufficiency (P <.001; HR, 2.35; 95% CI, 1.86 to 2.98), diabetes mellitus (P =.007; HR, 2.14; 95% CI, 1.15 to 3.97), prior stroke (P =.042; HR, 1.50; 95% CI, 1.02 to 2.22), and severe aortic occlusive disease (P =.003; HR, 1.69; 95% CI, 1.19 to 2.31) showed significant and independent associations with death or dialysis during the follow-up examination period. After operation, blood pressure cured (P =.014; HR, 0.52; 95% CI, 0.30 to 0.88) and improved renal function (P =.011; HR, 0.40; 95% CI, 0.19 to 0.81) showed significant and independent associations with improved dialysis-free survival rate. All categories of function response and time to death or dialysis showed significant interactions with preoperative EGFR. CONCLUSION: The surgical correction of atherosclerotic renovascular disease resulted in blood pressure benefit and retrieval of renal function in selected patients with hypertension. The patients with cured hypertension or improved EGFR after operation showed increased dialysis-free survival as compared with other patients who underwent surgery.     

长链非编码RNA低表达与胃癌患者预后关系的Meta分析

目的对胃癌组织中长链非编码RNA（LncRNA）表达水平与患者临床病理特征关系及预后价值进行系统性评价。 方法计算机检索中国学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBMdisc）、万方数据库、重庆维普数据库和英文数据库EMbase、PubMed、The Cochrane Library（2017年4期）、Web of Science,查找建库至2017年4月发表的有关胃癌组织中LncRNA低表达与患者预后的研究。经2名研究人员独立地进行筛选文献、提取数据、质量评价后,采用STATA 12.0软件对数据行Meta分析,Begg's和Egger's漏斗图评价发表偏倚。 结果共纳入6篇594例胃癌患者LncRNA低表达的研究,组织样本均来自于国内。胃癌患者的LncRNA表达水平与TNM分期（RR=2.06,95% CI =1.73~2.46,P=0.001）、肿瘤浸润深度（RR=2.73,95% CI =2.17~2.43,P=0.001）和区域淋巴结转移（RR=1.63,95% CI =1.37~1.94,P=0.001）相关,而其他临床病理特征与LncRNA表达水平无相关关系,差异无统计学意义。5篇报道胃癌患者总生存期（OS）的研究间存在统计学异质性（I²=68.9%,P=0.012）,分析显示与LncRNA高表达组相比,LncRNA低表达组患者的OS较短,总体生存情况较差,差异有统计学意义（HR=0.56,95% CI =0.31~0.99,P=0.046）。3篇报道无疾病进展生存期（DFS）的研究存在统计学异质性（I²=71.0%,P=0.032）,分析显示LncRNA高表达组和低表达组间DFS差异无统计学意义（HR=0.57, 95% CI=0.32~1.03,P=0.061）。各项研究对合并OS影响的敏感性分析结果显示合并HR的结果稳定性好,发表偏倚可能性较小（Egger's,P=0.651;Begg's,P=0.806）。 结论低表达的LncRNA是胃癌预后不良的危险因素,LncRNA的表达水平与胃癌患者的TNM分期、肿瘤的浸润深度和区域淋巴结转移密切相关。     

心血管手术相关急性肾损伤患者行连续性肾脏替代治疗后的预后因素分析

目的探讨心血管手术相关急性肾损伤患者行连续性肾脏替代治疗后不同预后的相关因素。 方法本研究纳入2015年1月至2018年12月在南京医科大学第一附属医院住院行心血管手术治疗且接受连续性肾脏替代治疗的患者,按90 d是否死亡和90 d内RRT治疗天数(≤14 d,15～90 d,>90 d)将患者分为4组,分析90 d死亡、90 d透析依赖、90 d延迟摆脱透析的相关影响因素。 结果本研究共纳入210例患者,平均随访400 d。其中90 d死亡114例,90 d生存且14 d内摆脱透析37例,90 d生存15～90 d内摆脱透析46例,90 d生存且透析依赖13例。多因素Cox回归显示：90 d死亡的独立危险因素包括高龄(HR＝1.029,95%CI: 1.013～1.045,P<0.001)、术前血清肌酐低(HR＝0.993,95%CI: 0.987～0.998,P＝0.008)、CRRT前APACHE Ⅱ高评分(HR＝1.043, 95%CI: 1.004～1.084,P＝0.028)、CRRT前SOFA评分高(HR＝1.130, 95%CI: 1.052～1.213,P<0.001)、CRRT前脓毒症(HR＝2.327, 95%CI: 1.591～3.403,P<0.001)、CRRT前过低的舒张压(HR＝0.979,95%CI: 0.963～0.996,P＝0.013)。90 d存活患者透析依赖的独立危险因素包括术前较低的eGFR(HR＝0.962,95%CI: 0.940～0.984,P<0.001)。90 d存活患者中延迟摆脱透析的危险因素有血清白蛋白低(OR＝0.837,95%CI: 0.717～0.977,P＝0.024)、机械通气时间长(OR＝1.434,95%CI: 1.175～1.749,P<0.001)、CRRT前尿量少(OR＝0.739,95%CI: 0.623～0.876,P<0.001)。 结论心血管手术相关急性肾损伤并行连续性肾脏替代治疗患者中,90 d死亡与高龄、CRRT前疾病的严重程度、脓毒症和过低的舒张压有关;90 d存活患者透析依赖与患者术前较差的肾功能有关;90 d存活患者延迟摆脱透析与血清白蛋白低、机械通气时间长、CRRT前尿量少有关。     

Short-term and 5-year outcome after primary isolated coronary artery bypass graft surgery: results of risk stratification in a bilocation center.

OBJECTIVE: We retrospectively investigated the short and mid-term outcome of non-emergent primary isolated coronary artery bypass graft (CABG) surgery in relation to risk stratification in the fully equipped university location (FE) and the low volume, limited facility location (LVLF) of our department. METHODS: Between September 1995 and December 1996, 832 patients were referred to our department to undergo a primary isolated CABG operation. The surgical team selected 482 patients (58%) as being at low-risk. These were treated in the LVLF hospital. The other 350 patients with mixed-risk were treated in the FE hospital. The selection consisted primarily of exclusion of patients with moderate or poor left ventricular function, severe COPD or renal impairment, from surgery in the LVLF location. Finally, the prognostic value of the EuroSCORE and the Parsonnet score was tested on our patient population. RESULTS: Overall in-hospital mortality was 1.6% (13 patients). One patient died in the LVLF group (0.2%) and 12 patients (3.4%) in the FE group. LVLF patients experienced less complications during the hospital period compared to the FE patients (5 versus 21%; P=0.0001). The Parsonnet risk model and the EuroSCORE risk model showed both a good relation with in-hospital mortality. After discharge, an increased risk of late mortality was observed up to 1 year postoperative in the FE group compared to the LVLF group (2.7 versus 0.5%; P=0.01). Risk factors for 5-year mortality were pre-operative renal impairment (blood creatinine >150 micromol/l) (hazard ratio (HR): 2.8; 95% confidence interval (CI): 1.4-5.5), diabetes (HR: 2.1; 95% CI: 1.3-3.5), impaired LVEF (HR: 1.9; 95% CI: 1.2-3.0), COPD (HR: 1.9; 95% CI: 1.1-3.5) and older age (HR: 1.07 per year; 95% CI: 1.01-1.10). Lipid-lowering therapy was a predictor of lower mortality at 5-years (HR: 0.5; 95% CI: 0.4-0.9). CONCLUSION: By careful decision making, selection of low-risk patients for a low volume and limited facility location resulted in excellent in-hospital survival with very low complication rates.     

Predictive Value of CEA for Survival in Stage I Rectal Cancer: a Population-Based Propensity Score-Matched Analysis

Background

The aim of the study was to assess whether preoperative carcinoembryonic antigen (CEA) level is an independent predictor of overall- and cancer-specific survival in stage I rectal cancer.

Methods

Stage I rectal cancer patients were identified in the Surveillance, Epidemiology, and End Results database between 2004 and 2011. The impact of an elevated preoperative CEA level (C1-stage) compared with a normal CEA level (C0-stage) on overall and cancer-specific survival was assessed using risk-adjusted Cox proportional hazard regression models and propensity score methods.

Results

Overall, 1932 stage I rectal cancer patients were included, of which 328 (17 %) patients had C1-stage. The 5-year overall and cancer-specific survival for patients with C0-stage were 85.7 % (95 % CI 83.2–88.2 %) and 94.7 % (95 % CI 93.1–96.3 %), versus 76.8 % (95 % CI 70.9–83.1 %) and 88.1 % (95 % CI 83.3–93.2 %) for patients with C1-stage (P?<?0.001 and P?=?0.001). The negative impact of C1-stage on overall and cancer-specific survival was confirmed by risk-adjusted Cox proportional hazard regression analysis (hazard ratio [HR]?=?1.57, 95 % CI?=?1.15–2.16, P?=?0.007 and 2.04, 95 % CI?=?1.25–3.33, P?=?0.006), and after propensity score matching (overall survival [OS]: HR?=?1.46, 95 % CI?=?1.02–2.08, P?=?0.044 and cancer-specific survival [CSS]: HR?=?3.28, 95 % CI?=?1.78–6.03, P?<?0.001).

Conclusion

This is the first population-based investigation of a large cohort of exclusively stage I rectal cancer patients providing compelling evidence that elevated preoperative CEA level is a strong predictor of worse overall and cancer-specific survival.