ObjectiveTo investigate the clinical features, differential diagnosis and treatment for chromophobe cell renal carcinoma (CRCC) and renal oncocytoma. MethodsFrom December 2009 to May 2013, we selected 41 cases of CRCC and 22 cases of renal oncocytoma, retrospectively analyzed their clinical features, ultrasonography and CT findings and performed immunohistochemical staining for CK7, CD10, PAX-2, and Ksp-cadherin. ResultsCRCC could be associated with lower back pain or hematuria, and renal oncocytoma generally did not have clinical symptoms. Ultrasonography and CT examination were not specific for the differentiation between the two diseases. The expression rates of CK7, CD10, PAX-2, and Ksp-cadherin in CRCC were 66% (21/32), 22% (7/32), 23% (3/13) and 93% (14/15), respectively. In patients with oncocytoma, 7% (1/15) were positive for CK7, 7% (1/15) were positive for CD10, 86% (13/15) were positive for PAX-2, and 31% (4/13) were positive for Ksp-cadherin. Pearson chi-square analysis was performed with a significant P value set at <0.05. The results of CK7(-)CD10(-)PAX-2(+) and CK7(-)CD10(-)Ksp-cadherin(-) immunohistochemistry were integrated, which also showed the differences. ConclusionThe combination of CK7(-)CD10(-)PAX-2(+) and CK7(-)CD10(-)Ksp-cadherin(-) immunohistochemistry may be useful for differentiating between CRCC and oncocytoma. Combined with imaging examination, it can further improve the differential diagnosis of the two diseases.
ObjectiveTo explore the effectiveness of clinical pathway (CP) in patients underwent laparoscopic cholecystectomy (LC). MethodsA retrospective, case-matched, and clinical controlled study was applied. We selected patients with acute calculous cholecystitis (ACC) who were hospitalized in 363 Hospital and underwent LC between September 2012 and August 2013, and divided them into two groups (non-CP vs. CP:2 to 1) according to sex, age (±5), nation and complications. The indicators including length of stay (LOS), antibiotic usage and per-average hospital expenses were compared between groups. Data were analyzed using SPSS 13.0 software. ResultsA total of 1 044 patients were included, of which 348 were assigned to CP management (CP group), while the other 696 patients were 2 to 1 matched with those in the CP group. Compared to the non-CP group, the pre-operation LOS and total LOS in the CP group were shortened by 1.23 days and 2.08 days, respectively (P < 0.05); the per-average hospital expenses and per-average expenses of drugs in the CP group were decreased by ￥604.7 yuan and ￥287.5 yuan, respectively (P < 0.05); and the rate of antibiotic and non-restricted antibiotic usage in the CP group were dropped by 4.4% and 7.0%, respectively (P < 0.05). There was no significant difference between the groups in efficiency, hospital-related infection rate, the incidence of adverse events, the restricted and special antibiotic usage rate (P > 0.05). The variation coefficient of patients included in the CP group was 15.8%, and the time which did not meet the admission requirement of CP was the main reason for this variation (27, 49.1%). ConclusionClinical pathway could shorten the LOS and cut down the total hospital expenses. However, multidisciplinary cooperation is still needed, and we should optimize the CP processes continuously and enhance the flexibility of CP, so as to improve the quality of medical service.
Objective To explore the relationship between immune state and disease progression or severity of patients with hepatitis B virus (HBV). Methods A total of 332 patients infected with HBV diagnosed and treated from January 2012 to December 2013 were divided into acute hepatitis B (AHB) group (n=25), chronic hepatitis B (CHB) group (n=237) and cirrhosis group (n=70) according to disease progression. Moreover, CHB group was divided into mild (n=24), moderate (n=103), serious (n=72) and severe group (liver failure group,n=38) according to disease severity, while cirrhosis group was divided into hepatocellular carcinoma (HCC) group (n=13) and non-HCC group (n=57). The immune indexes including immunoglobulin (Ig), complement (C) and T-lymphocyte subsets were tested and compared. Results The immune indexes were not significantly different between AHB group and CHB group (P>0.05). Compared with AHB group and CHB group, cirrhosis group had higher levels of IgG and IgA, and lower levels of CD3+, CD4+ and CD8+ T cells count (P<0.05). Compared with non-HCC group, HCC group had more male patients without antiviral therapy, who had higher levels of C3 and C4 (P<0.05). As disease progressed, the levels of alanine fcell couaminotransferase, aspartate aminotransferase, total cholesterol, Fibroscan index, IgG, and IgA of CHB patients all gradually increased, while the levels of C3 and C4 and the counts of CD3+ and CD4+ T cells gradually declined. Conclusions The immune state of patients infected with HBV has a certain relationship with disease progression or severity, and immunoglobulin, complement and T cells count can partly reflect the severity of the disease. Cirrhosis patients accompanied with high levels of C3 and C4 should pay high attention to antiviral therapy and be vigilant on HCC.
ObjectiveTo systematically review the efficacy of repetitive transcranial magnetic stimulation (rTMS) on patients with mild cognitive impairment (MCI). MethodsWe searched databases including PubMed, The Cochrane Library (Issue 10, 2015), EMbase, PsycINF, EBSCO, CBM, CNKI, WanFang Data and VIP from inception to October 2015 to collect randomized controlled trials (RCTs) about rTMS for patients with MCI. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 5 RCTs involving 180 MCI patients were included. The results of meta-analysis showed that, compared with the control group, rTMS treatment could significantly improve the overall cognitive abilities of MCI patients (SMD=2.53, 95% CI 0.91 to 4.16, P=0.002), as well as the single-domain cognitive performances, including tests for episodic memory (MD=0.98, 95% CI 0.24 to 1.72, P=0.01) and verbal fluency (MD=2.08, 95% CI 0.46 to 3.69, P=0.01). rTMS was a well-tolerated therapy, with slightly more adverse events observed than the control group (RD=0.09, 95% CI 0.00 to 0.18, P=0.04), but cases were mainly transient headache, dizziness and scalp pain. ConclusionrTMS may benefit the cognitive abilities of MCI patients. Nevertheless, due to the limited quantity and quality of included studies, large-scale, multicenter, and high quality RCTs are required to verify the conclusion.