Simultaneous liver,pancreas-duodenum,and kidney transplantation has been rarely reported in the literature. Here we present a new and more efficient en bloc technique that combines classic orthotopic liver and pancrea...Simultaneous liver,pancreas-duodenum,and kidney transplantation has been rarely reported in the literature. Here we present a new and more efficient en bloc technique that combines classic orthotopic liver and pancreas-duodenum transplantation and heterotopic kidney transplantation for a male patient aged 44 years who had hepatitis B related cirrhosis,renal failure,and insulin dependent diabetes mellitus(IDDM). A quadruple immunosuppressive regimen including induction with basiliximab and maintenance therapy with tacrolimus,mycophenolate mofetil,and steroids was used in the early stage post-transplant. Postoperative recovery was uneventful and the patient was discharged on the 15 th postoperative day with normal liver and kidney function. The insulin treatment was completely withdrawn 3 wk after operation,and the blood glucose level remained normal. The case findings support that abdominal organ cluster and kidney transplantation is an effective method for the treatment of end-stage liver disease combined with uremia and IDDM.展开更多
目的探讨晚期肺癌炎症指数(advanced lung cancer inflammation index,ALI)对喉鳞状细胞癌(简称喉癌)患者发生术后咽瘘、复发转移以及预后中的预测价值。方法回顾性分析2014年1月~2023年12月黄石市中心医院收治114例喉癌患者的临床资料...目的探讨晚期肺癌炎症指数(advanced lung cancer inflammation index,ALI)对喉鳞状细胞癌(简称喉癌)患者发生术后咽瘘、复发转移以及预后中的预测价值。方法回顾性分析2014年1月~2023年12月黄石市中心医院收治114例喉癌患者的临床资料,涵盖肿瘤分期、ALI评分、年龄、性别、吸烟史、饮酒史、糖尿病、高血压、高血脂、冠心病、肿瘤分化情况、HPV感染及肿瘤部位等信息。根据患者是否发生咽瘘,分为咽瘘组10例和非咽瘘组104例,并通过单因素和多因素Logistic回归分析筛选术后咽瘘的独立影响因素。根据是否发生复发或转移,分为复发转移组22例和非复发转移组92例;根据随访结果,分为预后不良组25例和预后良好组89例,并采用Cox回归分析筛选影响复发转移及预后的因素。最后通过绘制受试者工作特征(ROC)曲线评估各项指标的预测效能。结果多因素Logistic回归分析显示,肿瘤分期(Ⅰ~Ⅱ期)[HR:0.040(95%CI=0.004~0.392)]和ALI评分[HR:0.885(95%CI=0.805~0.972)]为咽瘘发生的独立保护因素(P<0.05)。多因素Cox回归分析确认,肿瘤分期(Ⅰ~Ⅱ期)[OR=0.180(95%CI=0.063~0.518)]和ALI评分[OR=0.970(95%CI=0.939~0.992)]为复发转移以及不良预后的独立保护因素(P<0.05)。ROC曲线分析显示,ALI预测咽瘘的AUC为0.910,95%CI=0.849~0.970,截断值为29.877,敏感度和特异性分别为0.827和1.000;ALI预测复发转移的AUC为0.804,95%CI=0.698~0.910,截断值为34.398,敏感度和特异性分别为0.794%和0.682;ALI预测不良预后的AUC为0.846,95%CI=0.768~0.925,截断值为47.750,敏感度和特异性分别为0.920和0.618。结论ALI评分是喉癌患者术后发生咽瘘、复发转移及预后的独立保护因素,具有较好的预测效能,可为临床早期识别高风险患者并优化治疗方案提供参考。展开更多
基金Supported by National Natural Science Foundation of China,No.81400680Tianjin Natural Science Foundation,No.17JCQNJC12800
文摘Simultaneous liver,pancreas-duodenum,and kidney transplantation has been rarely reported in the literature. Here we present a new and more efficient en bloc technique that combines classic orthotopic liver and pancreas-duodenum transplantation and heterotopic kidney transplantation for a male patient aged 44 years who had hepatitis B related cirrhosis,renal failure,and insulin dependent diabetes mellitus(IDDM). A quadruple immunosuppressive regimen including induction with basiliximab and maintenance therapy with tacrolimus,mycophenolate mofetil,and steroids was used in the early stage post-transplant. Postoperative recovery was uneventful and the patient was discharged on the 15 th postoperative day with normal liver and kidney function. The insulin treatment was completely withdrawn 3 wk after operation,and the blood glucose level remained normal. The case findings support that abdominal organ cluster and kidney transplantation is an effective method for the treatment of end-stage liver disease combined with uremia and IDDM.
文摘目的探讨晚期肺癌炎症指数(advanced lung cancer inflammation index,ALI)对喉鳞状细胞癌(简称喉癌)患者发生术后咽瘘、复发转移以及预后中的预测价值。方法回顾性分析2014年1月~2023年12月黄石市中心医院收治114例喉癌患者的临床资料,涵盖肿瘤分期、ALI评分、年龄、性别、吸烟史、饮酒史、糖尿病、高血压、高血脂、冠心病、肿瘤分化情况、HPV感染及肿瘤部位等信息。根据患者是否发生咽瘘,分为咽瘘组10例和非咽瘘组104例,并通过单因素和多因素Logistic回归分析筛选术后咽瘘的独立影响因素。根据是否发生复发或转移,分为复发转移组22例和非复发转移组92例;根据随访结果,分为预后不良组25例和预后良好组89例,并采用Cox回归分析筛选影响复发转移及预后的因素。最后通过绘制受试者工作特征(ROC)曲线评估各项指标的预测效能。结果多因素Logistic回归分析显示,肿瘤分期(Ⅰ~Ⅱ期)[HR:0.040(95%CI=0.004~0.392)]和ALI评分[HR:0.885(95%CI=0.805~0.972)]为咽瘘发生的独立保护因素(P<0.05)。多因素Cox回归分析确认,肿瘤分期(Ⅰ~Ⅱ期)[OR=0.180(95%CI=0.063~0.518)]和ALI评分[OR=0.970(95%CI=0.939~0.992)]为复发转移以及不良预后的独立保护因素(P<0.05)。ROC曲线分析显示,ALI预测咽瘘的AUC为0.910,95%CI=0.849~0.970,截断值为29.877,敏感度和特异性分别为0.827和1.000;ALI预测复发转移的AUC为0.804,95%CI=0.698~0.910,截断值为34.398,敏感度和特异性分别为0.794%和0.682;ALI预测不良预后的AUC为0.846,95%CI=0.768~0.925,截断值为47.750,敏感度和特异性分别为0.920和0.618。结论ALI评分是喉癌患者术后发生咽瘘、复发转移及预后的独立保护因素,具有较好的预测效能,可为临床早期识别高风险患者并优化治疗方案提供参考。
