Development of a nomogram for predicting liver transplantation prognosis in hepatocellular carcinoma

BACKGROUND At present,liver transplantation(LT)is one of the best treatments for hepatocellular carcinoma(HCC).Accurately predicting the survival status after LT can significantly improve the survival rate after LT,and ensure the best way to make rational use of liver organs.AIM To develop a model for predicting prognosis after LT in patients with HCC.METHODS Clinical data and follow-up information of 160 patients with HCC who underwent LT were collected and evaluated.The expression levels of alphafetoprotein(AFP),des-gamma-carboxy prothrombin,Golgi protein 73,cytokeratin-18 epitopes M30 and M65 were measured using a fully automated chemiluminescence analyzer.The best cutoff value of biomarkers was determined using the Youden index.Cox regression analysis was used to identify the independent risk factors.A forest model was constructed using the random forest method.We evaluated the accuracy of the nomogram using the area under the curve,using the calibration curve to assess consistency.A decision curve analysis(DCA)was used to evaluate the clinical utility of the nomograms.RESULTS The total tumor diameter(TTD),vascular invasion(VI),AFP,and cytokeratin-18 epitopes M30(CK18-M30)were identified as important risk factors for outcome after LT.The nomogram had a higher predictive accuracy than the Milan,University of California,San Francisco,and Hangzhou criteria.The calibration curve analyses indicated a good fit.The survival and recurrence-free survival(RFS)of high-risk groups were significantly lower than those of low-and middle-risk groups(P<0.001).The DCA shows that the model has better clinical practicability.CONCLUSION The study developed a predictive nomogram based on TTD,VI,AFP,and CK18-M30 that could accurately predict overall survival and RFS after LT.It can screen for patients with better postoperative prognosis,and improve longterm survival for LT patients.

心脑血管疾病患者围手术期抗栓药物治疗临床路径管理评价

目的评价心脑血管疾病患者围手术期抗栓药物治疗临床路径管理的干预效果。方法将2019年10月—2020年9月、2020年10月—2021年9月在北京朝阳医院外科治疗的心脑血管疾病住院患者分为常规治疗组和药师干预组。药师依据临床路径对患者用药方案进行干预,并持续跟踪随访至患者出院。以围手术期抗栓药物使用适宜占比、药品不良事件发生率、住院天数、住院总费用、出院后3个月再入院发生率等为指标评价围手术期抗栓药物临床路径管理效果。结果常规治疗组121例,药师干预组202例,两组心脑血管事件(5.0%vs.5.0%)、静脉血栓栓塞症(2.5%vs.3.0%)、出血事件(3.3%vs.2.0%)的发生率差异均无统计学意义(P>0.05);药师干预组围手术期抗栓药物使用的各类适宜占比(术前抗血小板药物治疗61.9%vs.24.0%,术前抗凝药物治疗66.3%vs.39.7%,术后抗血小板药物治疗80.7%vs.10.0%,术后抗凝药物治疗89.6%vs.65.3%,P<0.001)、住院天数(13.00 d vs.10.00 d,P=0.004)、住院期西药费用(2692.97元vs.2110.76元,P=0.008)、住院期抗凝药物费用(406.20元vs.200.28元,P<0.001)均显著低于常规治疗组。结论心脑血管疾病患者围手术期抗栓药物治疗临床路径的建立及应用可能会改善心脑血管疾病患者围手术期抗栓药物使用不适宜情况,不增加药品不良事件发生率,且减轻了患者的经济负担。

Existing form of Mo(Ⅵ)in acidic sulfate solution

The existing form of molybdenum in acidic sulfate solution was studied by means of ion exchange, infrared （IR） spectra and X-ray photoelectron spectroscopy （XPS）. The results indicate that the anionic molybdenum species are predominant in acidic sulfate solution, and Mo（VI） can combine with sulfate radical to form heteropoly acid anions [Mo205（804）2]2- and [MoO2（HSO4）4]2-. With the decrease in solution pH from 1.92 to 0.06, the existing form of Mo（VI） changes from MovO21（OH）3^3- to [Mo205（S04）2]2- and then becomes [MoOz（HSO4）4]2-, which results in the decrease in the resin adsorption capacity for molybdenum.