Combined radiomics nomogram of different machine learning models for preoperative distinguishing intraspinal schwannomas and meningiomas: a multicenter and comparative study.

AIMS: The objective of our study was to establish and verify a novel combined model based on multiparameter magnetic resonance imaging (MRI) radiomics and clinical features to distinguish intraspinal schwannomas from meningiomas. MATERIALS AND METHODS: This research analyzed the preoperative magnetic resonance (MR) images and clinical characteristics of 209 patients with intraspinal tumors who received tumor resection at three institutions. 159 individuals from institutions 1 and 2 were randomly assigned into a training group (n=111) and a test group (n=48) in a 7-3 ratio. A nomogram was constructed using the training cohort and was internally and externally verified in the test cohort and an independent validation cohort (n=50). Model performance was assessed utilizing the area under the curve (AUC) of receiver operating characteristics (ROC), decision curve analysis (DCA), and calibration curves. RESULTS: The nomogram exhibited superior predictive efficacy in distinguishing between spinal schwannomas and meningiomas when compared to both the radiomics model and the clinical model. The nomogram yielded AUCs of 0.994, 0.962, and 0.949 in the training, test, and external validation cohorts, respectively, indicating its exceptional differentiating ability. The DCAs demonstrated that the nomogram yielded the best net benefit. The calibration curves indicated that the nomogram got good agreement between the predicted and the actual observation. CONCLUSION: This research suggests that the nomogram incorporating clinical and radiomic features may be an effective auxiliary tool for distinguishing between intraspinal schwannomas and meningiomas, and has important clinical significance for clinical decision-making and prognosis prediction.

[The value of preservation of subvalvular structures in patients with mitral and aortic valve replacement surgery and its effect on left ventricular contractility].

Objective: To discuss the clinical value of preserving subvalvular structure in mitral and aortic valve replacement surgery and its effect on left ventricular contractility. Methods: A total of 97 patients who underwent mitral valve replacement surgery in the Adult Cardiac Surgery of Heart Center of Henan Provincial People's Hospital, Central China Fuwai Hospital from June 2016 to December 2018 were selected as the research subjects, of whom 45 cases were preserved subvalvular structure and 52 cases were in the total resection group (intraoperative total resection of the mitral valve and subvalvular chordae tendineae). General cardiac function indexes and left ventricular function quantitative indexes were compared before and in 3 months and 6 months after the operation of the two groups; The changes of the overall longitudinal strain of the long axis of the apex and the overall circumferential strain of the short axis of the left ventricle determined by the two-dimensional speckle tracking technology were compared before and after the operation. Results: The ages of the patients in the preservation group and the total resection group were (41.8±11.3) and (43.3±10.6) years old, respectively, and the male proportions were 58.0% (26 cases) and 44.0% (23 cases), respectively, with no significant difference (all P>0.05). The aortic occlusion time and cardiopulmonary bypass time of the patients in the preservation group were (57.8±4.5) and (78.6±6.7) min, respectively, which were longer than those in the total resection group [(48.1±4.4) and (48.1±4.4) min, respectively] (all P<0.05). The left atrial pressure of the patients in the preservation group at shutdown was (8.4±1.8) mmHg (1 mmHg=0.133 kPa), which was lower than that of the total resection group (11.3±2.5) mmHg (P<0.001). There were interaction effects between groups and time in regards to the left ventricular end-diastolic diameter ( LVEDD ), left ventricular ejection fraction ( LVEF ) and Tei index, as well as the strain rate of mitral annulus and left ventricular wall of interventricular septum of the preservation group and the total resection group (all P<0.05). LVEDD and LVEF of patients in the preservation group at 3rd month after operation were (44.7±4.0) mm and (45.5±4.2) mm, and at 6th months were (56.5±4.9)% and (58.8±5.0)%, respectively, all larger than (42.7±3.6) mm and (42.7±3.6) mm, (54.5±4.6)% and (56.3±4.8)% of the total resection group. The measured value of LVESD in the preservation group at 3rd month after surgery was (32.6±3.2) mm, which was greater than that in the total resection group (31.2±3.4) mm (P<0.05). The Tei index of patients in the preservation group at 3rd and 6th months after surgery were 1.0±0.2 and 0.8±0.2, respectively, which were lower than those in the total resection group 1.2±0.3 and 0.9±0.2 (all P<0.05). Conclusion: Preserving the subvalvular structure during mitral valve replacement surgery can better improve the patient's left ventricular function and left ventricular systolic capacity.

[Analysis of occurrence and treatment of perioperative complete atrioventricular block by transcatheter aortic valve implantation].

Objective: To retrospectively analyze the occurrence and treatment of perioperative complete atrioventricular block (CAVB) by transcatheter aortic valve implantation (TAVI). Methods: A total of 65 patients who underwent TAVI via femoral artery in the Heart Center of Henan People's Hospital from October 2017 to May 2021 were enrolled. Perioperative data of patients were recorded. The patients were divided into two groups according to whether complete atrioventricular block was occurred during TAVI: complete atrioventricular block group (Group CAVB) and non-complete atrioventricular block group (Group NCAVB). Multivariate logistic regression model was used to analyze the risk factors of complete atrioventricular block during transcatheter aortic valve implantation. The incidence of perioperative complications were recorded. Results: The patients age was (69.1±7.3) years old. and there were 35 males and 30 femals. There were 15 patients in group CAVB with complete atrioventricular block and 50 patients in group NCAVB. Multivariate analysis showed that preoperative right bundle branch block [OR (95%CI) vs 3.325 (2.132-13.061), P=0.005] and severe aortic valve calcification [OR (95%CI) vs 1.271 (1.052-3.326), P=0.030] were independent correlative factors for CAVB during TAVI perioperative period. The implantation rate of permanent pacemaker in group CAVB was 73.3% (11 cases), which was higher than 6.0% (3 cases) in group NCAVB (P<0.001). Conclusions: It indicated that preoperative right bundle branch block and severe aortic valve calcification are correlative factors for complete atrioventricular block for TAVI. The implantation rate of permanent pacemaker in complete atrioventricular block group increased significantly.

[Predictive value of cervical length measured by transvaginal ultrasound during the second and the third trimester of pregnancy for preterm birth in twin pregnancies].

Objective: To investigate the predictive value of cervical length (CL) measured by transvaginal ultrasound for preterm birth <32 weeks, <34 weeks in twin pregnancies in the second and the third trimester of pregnancy. Methods: A total of 490 twin pregnant women with CL measured by transvaginal ultrasound during the second trimester of pregnancy (20-24 weeks) and the third trimester of pregnancy (28-32 weeks) delivered in Peking University Third Hospital, and Tongzhou Maternal and Child Health Hospital from January 2014 to December 2017 were collected, and 161 cases out of which were measured by CL during both the second trimester and the third trimester of pregnancy. Based on the measured gestational weeks, 427 cases were in the second trimester group and 224 cases in the third trimester group. The predictive value of CL for preterm birth was evaluated by calculating the optimal cut-off point with sensitivity and specificity. Logistic regression analysis was used to assess the relationship between CL and preterm birth after adjusting for confounding factors (age of pregnant women, chorionic status, mulipara, assisted reproductive pregnancy and pre-pregnancy body mass index). Results: (1) The median CL of pregnant women in the second trimester group and the third trimester group were 36 mm (33-40 mm) and 28 mm (18-33 mm) respectively. In the second trimester group, 151 cases (35.4%, 151/427) were preterm birth and 276 cases (64.6%, 276/427) were full-term birth; the median CL of preterm and full-term pregnant women were 34 mm (30-37 mm) and 37 mm (34-40 mm), respectively, with significant difference (P<0.01). In the third trimester group, 100 cases (44.6%, 100/224) were preterm birth and 124 cases (55.4%, 124/224) were full-term birth; the median CL of preterm and full-term pregnant women were 22 mm (15-30 mm) and 31 mm (23-34 mm), respectively, with significant difference (P<0.01). (2) Prediction of preterm birth <32 weeks and <34 weeks was performed with CL in the second trimester group. The area under the receiver-operating characteristics curve were 0.78 (95%CI: 0.70-0.86) and 0.71 (95%CI: 0.64-0.79), respectively. The optimal cut-off points were 36.5 mm and 33.5 mm, respectively. After adjusting for confounding factors, CL was inversely associated with preterm birth <32 weeks and <34 weeks of gestation. (3) Prediction of preterm birth <32 weeks and <34 weeks were performed with CL in the third trimester group. The area under the receiver-operating characteristics curve were 0.86 (0.75-0.96) and 0.75 (0.67-0.84), respectively. The optimal cut-off points were 17.5 mm and 18.5 mm, respectively. After adjusting for confounding factors, CL was inversely associated with preterm birth at <32 weeks and <34 weeks of gestation. Conclusions: CL measured by transvaginal ultrasound in the second and the third trimester is a good predictor for preterm birth of twin pregnancy. CL≤36.5 mm and ≤33.5 mm at 20-24 weeks of gestation could predict preterm birth <32 weeks and <34 weeks respectively. CL≤17.5 mm and ≤18.5 mm at 28-32 weeks of gestation could predict preterm birth <32 weeks and <34 weeks respectively.

[Effect of miR-19b on the proliferation and apoptosis of P19CL6 cells during the late-stage of cardiac differentiation].

Objective: To explore the effect of miR-19b on the function of P19CL6 cells and its molecular mechanism. Methods: Overexpression of miR-19b was carried out by transfecting miR-19b plasmid into the P19CL6 cells. MTT assay and flow cytometry were used to determine cell growth and apoptosis, respectively. Western blot was used to detect the expression level of Sox6 in P19CL6 cells. ELISA assay was used to detect the expression levels of apoptosis-related genes (Bax, Bcl-2) in P19CL6 cells at late-stage cardiac differentiation. Further online software TargetScan was used to predict the target genes of miR-19b and verified by dual luciferase reporter assay. Results: Our data showed that overexpression of miR-19b in P19CL6 cells significantly increased the cell growth rates and the apoptosis inhibition rates. The ratio of apoptosis-related proteins (Bax/Bcl-2) was significantly reduced. Results from the TargetScan and dual luciferase reporter showed that Sox6 is the direct target of miR-19b. Conclusions: We conclude that miR-19b might promote cell proliferation and inhibits cell apoptosis during the late-stage of cardiac differentiation by targeting Sox6 expression.

[Feasibility of retrograde approach for percutaneous closure of ventricular septal defect under solely guidance of transesophageal echocardiography].

OBJECTIVE: To evaluate the feasibility of retrograde transcatheter closure of ventricular septal defects (VSD) under trans-esophageal echocardiography (TEE). METHODS: Twelve patients with VSD, with 4 residual shunt, treated by transcatheter VSD closure under solely guidance of TEE were summarized. Mean age, body weight and average diameter of VSD in 12 cases were (11.58±6.57) years, (31.85±13.28) kg, (5.50±2.20) mm, respectively. All patients were treated by retrograde transcatheter closure under solely guidance of TEE. The post-operative efficiency was estimated by TEE immediately. Patients were followed up by echocardiography, X-ray examination and electrocardiogram at 24 hours, 1, 3 and 6 months after the procedures. RESULTS: All 12 patients were treated successfully under solely guidance of TEE. The diameter of devices were 5-14 mm. There were 1 case with trivial residual shunt after the procedures immediately. No patients suffered from residual shunt, occluder malposition, peripheral vascular injury and pericardial effusion during the follow-up. CONCLUSION: Percutaneous transcatheter closure of VSD completely guided by TEE is safe and effective. This method could avoid the radiation and contrast media reaction, and also could simplify the procedure.

[Application of new chest holder in the median sternotomy for open heart surgery in adults].

Objective: To explore the application of new chest holder in the median sternotomy for open heart surgery in adults. Methods: Two hundred adult patients in Henan Provincial People's Hospital from May 2013 to May 2015 were enrolled in the study and randomly divided into two groups. Experimental group included 100 cases who accepted the new type of chest holder in the open heart surgery. Control group were also composed of 100 cases whose sternums were fixed with the pure steel wire cerclage. Sternal closure time was recorded since the sternum closing. All subjects were followed up to obtain the chest incision healing, the incidence of sternal dehiscence, infection and secondary thoracotomy, and thus to estimated the effect of new chest holder. Results: All patients in the experimental group reached the effect of firm closed chest surgery. Sternal closure time of experimental group was much shorter than that of control group[(10±2) vs (21±4) min, P<0.001]. No sternal instability, dehiscence, infection and secondary thoracotomy were found during the follow-up. However, in the control group, 3 secondary thoracotomy cases, 6 sternal dehiscence cases and 2 sternal infection cases were detected. Conclusions: New type of chest holder in the median sternotomy for open heart surgery is more convenient with small surgical trauma. It can also effectively reduce the incidence of sternal instability, dehiscence, infection and secondary thoracotomy.

Location Dependence of Mass Sensitivity for Acoustic Wave Devices.

It is introduced that the mass sensitivity (Sm) of an acoustic wave (AW) device with a concentrated mass can be simply determined using its mode shape function: the Sm is proportional to the square of its mode shape. By using the Sm of an AW device with a uniform mass, which is known for almost all AW devices, the Sm of an AW device with a concentrated mass at different locations can be determined. The method is confirmed by numerical simulation for one type of AW device and the results from two other types of AW devices.

Magnetostrictive particle based biosensors for in situ and real-time detection of pathogens in water.

Biosensors for in situ detection of pathogenic bacteria in liquid are developed using magnetostrictive particles (MSP) as the sensor platform. The sensing elements used are phage E2 against Salmonella typhimurium, monoclonal antibody against Listeria monocytogenes, polyclonal antibody against Escherichia coli, and polyclonal antibody against Staphylococcus aureus, respectively. These biosensors were characterized in cultures with different populations ranging from 5 × 10(1) to 5 × 10(8) cfu/mL. It is found that the MSP-based biosensors work well in water and have a rapid response with a response time in minutes, which makes the MSP-based sensors suitable for in situ and real-time detection of pathogenic bacteria in liquid. The experimental results show that all MSP-phage and MSP-antibody biosensors in size of 1.0 mm × 0.3 mm × 15 µm exhibit a detection limit better than 100 cfu/mL. Based on the Hill plot, it is concluded that each bacterial cell is bound onto the sensor surface through about four-to-five sites. When the cultures with low population (<10(6) cfu/mL) are tested, both MSP-phage and MSP-antibody sensors exhibit the similar response. However, the phage-MSP sensors exhibit a higher capability in the capture of target bacterial cell.

Modeling and improvement of a low-frequency micro-accelerometer.

A sensitivity- and resolution-improving method for a low-frequency micro-vibration accelerometer is presented in this paper. A sensitivity model of the measurement system is derived and established. The key parameters that limit the sensitivity and the resolution of the accelerometer were identified through the sensitivity coefficient analysis method. The structural parameters and the signal process method were then optimized. Experimental results show that the sensitivity of the accelerometer has improved from 1.10 V/(m/s2) to 19.21 V/(m/s2), and the resolution has improved from 1.47 mm/s2 to 0.21 mm/s2. The lowest working frequency range has expanded from 1 Hz to 0.7 Hz. The presented method is effective and cheap and can be applied to other sensors.

Multishell intermetallic onions by symmetrical configuration of ordered domains.

Ordered domains are utilized to construct new nanostructures, i.e., multishell intermetallic onions, which are formed by symmetrical configuration of ordered domains. Through density-functional theory calculations, we have shown that the energy penalties for introducing antiphase boundaries into the nanoparticles are small in some alloy systems compared to typical surface energies, making it feasible to prepare intermetallic onions by tuning surface energies. The unique surface atomic arrangements would provide opportunities for developing novel materials like efficient catalysts.

Direct subangstrom measurement of surfaces of oxide particles.

Using aberration-corrected transmission electron microscopy combined with first-principles calculations, we show that the surface structure of Co3O4, a typical complex oxide, can be directly imaged and quantitatively analyzed at the subangstrom scale. The atomic positions of both light oxygen and heavier cobalt within the surface layers have been measured to an accuracy of several picometers. The surface electronic structure analysis suggests a polarity compensation model based on the electronic polarizability of surface ions.

Circular RNA hsa_circ_0008039 promotes proliferation, migration and invasion of breast cancer cells through upregulating CBX4 via sponging miR-515-5p.

OBJECTIVE: Breast cancer (BC) is the second most frequent malignancy worldwide. Hsa_circ_0008039 exerts the carcinogenic factors in BC. However, the pathogenesis of hsa_circ_0008039 involved in BC is still unclear. PATIENTS AND METHODS: The expression levels of hsa_circ_0008039, microRNA-515-5p (miR-515-5p) and chromobox homolog 4 (CBX4) in BC tissues and cells were detected by real-time quantitative polymerase chain reaction (RT-qPCR). Cell proliferation, migration and invasion were assessed by 3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2-H-tetrazolium bromide (MTT) and transwell assays, severally. The binding relationship among hsa_circ_0008039, miR-515-5p and CBX4 was predicted by starBase, then verified by the dual-luciferase reporter assay and immunoprecipitation (RIP) assay. The interaction between hsa_circ_0008039 and miR-515-5p was confirmed by RNA pull-down assay. The protein level of CBX4 was detected by Western blot assay. The biological role of hsa_circ_0008039 was detected by xenograft tumor model in vivo. RESULTS: Hsa_circ_0008039 was upregulated in BC tissues and cells, and expedited proliferation, migration and invasion of BC cells. MiR-515-5p was downregulated in BC tissues and cells and worked as a target of hsa_circ_0008039. CBX4 was highly expressed in BC tissues and cells, and contributed to proliferation, migration and invasion of BC cells. Hsa_circ_0008039 enhanced CBX4 expression by competitively binding to miR-515-5p, thereby promoting BC development. Hsa_circ_0008039 knockdown repressed BC tumor growth in vivo. CONCLUSIONS: These findings implicated that hsa_circ_0008039 contributed to proliferation, migration and invasion in vitro and promoted tumor growth in vivo by miR-515-5p/CBX4 axis in BC, suggesting a potential therapeutic strategy for BC treatment.

[Clinical study on preserving right gastroepiploic vein during laparoscopic right hemicolectomy].

Objective: The operative approach and steps of laparoscopic right hemicolon cancer radical resection have been standardlized and professional consensus has been reached. However, some detailed issues such as the handling of Henle's trunk and whether to preserve the right gastroepiploic vein (RGEV) still remain controversial. This study investigates the safety, feasibility, short- and long-term outcomes of preserving RGEV during laparoscopic right hemicolectomy. Methods: A retrospective cohort study was carried out. Clinical data of 92 patients undergoing laparoscopic right hemicolectomy in Taizhou People's Hospital from March 2016 to May 2018 were retrospectively analyzed. All the patients were treated with complete mesocolon resection (CME) and had complete postoperative pathological data and follow-up data. Based on the tumor location, 49 patients preserved RGEV (preservation group) and 43 did not (non-preservation group). Pathological data, postoperative complications, short- and long-term outcomes were compared between the two groups. Results: There were no significant differences in baseline data between the two groups (all P>0.05). No significant differences were found in operation time, intraoperative blood loss, unplanned reoperation, anastomotic leak, number of harvested lymph nodes, number of metastatic lymph node, and time to food intake after surgery between two groups (all P>0.05). Compared with non-preservation group, the preservation group had faster recovery of anal gas passage after operation [(3.1±1.0) days vs. (4.0±1.7) days, t=-2.787, P=0.007], shorter length of hospitalization [(11.5±1.5) days vs. (15.0±7.9) days, t=-2.823, P=0.007], and reduced the hospitalization expenses [(46 000±5000) yuan to (57 000±33 000) yuan, t=-2.076, P=0.044]. No postoperative gastroparesis (PGS) occurred in the preservation group, while 6 cases in the non-preservation group developed gastroparesis during perioperative period (P<0.05). The median time of follow-up time was 31.8 (5.2-43.7) months. The overall survival time of the preservation group and non-preservation group was (35.4±1.8) months and (37.6±1.7) months, respectively without significant difference (P=0.336); the disease-free survival was (32.0±2.2) months and (35.5±2.0) months, respectively without significant difference as well (P=0.201). Conclusions: Dissection of the Henle's truck and preservation of RGEV is safe and feasible during laparoscopic right hemicolectomy, which can significantly reduce the incidence of postoperative gastroparesis, shorten the recovery time of postoperative intestinal function and hospitalization, and decrease the cost of hospitalization. The efficacy of RGEV preservation is similar to non-preservation of RGEV.

Bioinformatic analysis of the prognostic value of ZNF860 in recurrence-free survival and its potential regulative network in gastric cancer.

OBJECTIVE: In this study, we aimed to investigate the expression profile of C2H2 zinc finger (ZNF) 860 (ZNF860) in gastric cancer (GC), its prognostic significance and its potential regulatory network in GC. PATIENTS AND METHODS: The level-3 data in the Cancer Genome Atlas-Stomach Adenocarcinoma (TCGA-STAD) was acquired for a secondary analysis, in which clinicopathological, genetic and survival data from 415 GC patients were collected. RESULTS: The gastric cancerous tissues had significantly upregulated ZNF860 expression. In univariate analysis, male patients, no responses to primary therapy, with male patients and high ZNF860 RNA expression were associated with unfavorable RFS in early GC (stage I/II). Multivariate analysis showed that high ZNF860 RNA expression was independently associated with shorter recurrence-free survival (RFS) in patients with early GC (HR: 5.289, 95%CI: 1.839-15.214, p=0.002). Among 413 cases of GC tumors with copy number alteration (CNA) data available, 35 cases (8.5%) had DNA amplification (+1/+2), while 121 cases (29.3%) had DNA copy loss. ZNF860 amplification was associated with significantly elevated ZNF860 expression. In comparison, DNA copy loss did not necessarily result in ZNF860 downregulation. The methylation of 5 CpG sites in ZNF860 gene (cg24264962, cg24391989, cg10702818, cg15840985, and cg25692785) was negatively correlated with ZNF860 expression. Six genes (OSBPL10, FAM208A, TOPBP1, SPTY2D1, NAB1, and CMTM6) were positively co-expressed with ZNF860, suggesting that ZNF860 probably acts as a transcription enhancer in GC. CONCLUSIONS: ZNF860 RNA upregulation was an independent prognostic indicator in terms of RFS in stage I/II GC. DNA CNAs and methylation alterations might collaboratively regulate ZNF860 expression.

The effect of salt and phage concentrations on the binding sensitivity of magnetoelastic biosensors for Bacillus anthracis detection.

This article presents an investigation of the effect of salt and phage concentrations on the binding affinity of magnetoelastic (ME) biosensors. The sensors were fabricated by immobilizing filamentous phage on the ME platform surface for the detection of Bacillus anthracis spores. In response to the binding of spores to the phage on the ME biosensor, a corresponding decrease occurs in resonance frequency. Transmission electron microscopy (TEM) was used to verify the structure of phage under different combinations of salt/phage concentration. The chemistry of the phage solution alters phage bundling characteristics and, hence, influences both the sensitivity and detection limit of the ME biosensors. The frequency responses of the sensors were measured to determine the effects of salt concentration on the sensors' performance. Scanning electron microscopy (SEM) was used to confirm and quantify the binding of spores to the sensor surface. This showed that 420 mM salt at a phage concentration of 1 x 10(11) vir/mL results in an optimal distribution of immobilized phages on the sensor surface, consequently promoting better binding of spores to the biosensor's surface. Additionally, the sensors immobilized with phage under this condition were exposed to B. anthracis spores in different concentrations ranging from 5 x 10(1) to 5 x 10(8) cfu/mL in a flowing system. The results showed that the sensitivity of this ME biosensor was 202 Hz/decade.

Surgical procedures for management of right portal venous branching in right lobe living donor liver transplantation.

OBJECTIVE: This study sought to describe the surgical management of right portal venous (PV) branches encountered among 104 cases of right lobe living donor liver transplantation (LDLT). METHODS: From January 2002 to September 2007, we performed 104 cases of right-lobe LDLT including 11-donors who had anomalous right portal venous branches (APVB). One recipient had PV sponginess hemangioma. The donor right PV branches were type I in 93 cases, type II (trifurcation) in nine cases, and type III in two cases. Except one narrow bridge of tissue excision, the PV branches were transected on the principal of donor priority: PV branches were excised approximately 2 to 3 mm from the confluence while leaving the donor's main portal vein and confluence intact. In type II APVB, donor PV branches were obtained with two separate openings in six cases; with two separate openings joined as a common orifice at the back table in two cases, with one common opening with a narrow bridge of tissue in one case. In type III APVB, the donor right anterior and posterior PV branches were obtained with separate openings. The donor right PV branches with one common opening in 92 cases of type I PV branches and a joined common orifice in three cases of type II APVB were anastomosed to the recipient's main portal vein or to right branching. As the unavailable recipient PV for sponginess hemangioma, one case of type I right PV branches was end-to-end anastomosed to one of the variceal lateral veins of about 1 cm diameter in a pediatric patient. The PV were reconstructed as double anastomoses in six type II APVB and in one type III APVB obtained with two separate PV openings. In the another type III APVB reconstruction, we successfully utilized a novel U-shaped vein graft interposition. RESULTS: The type II APVB donor receiving a narrow bridge of portal vein tissue excision developed portal vein thrombosis on the third postoperative day and underwent reexploration for thrombectomy. There were no vascular complications, such as portal vein thrombosis or stricture among other donors or all recipients. The velocity of blood flow in the U-graft was normal. The anastomosis between the type I donor right portal vein and recipient variceal lateral vein was unobstructed. CONCLUSION: Right PV branches should be excised on the principal of donor priority while leaving the donor's main portal vein and confluence intact. Single anastomoses was the fundamental procedure of right branch reconstruction. Double anastomoses could be used as the main management for type II and type III APVB reconstruction. U-graft interposition may be a potential procedure for type III APVB reconstruction. Single anastomoses between the donor right portal vein and the recipient variceal lateral vein may be performed when recipient portal vein is unavailable. These innovations for excision and reconstruction of right PV branches were feasible, safe, and had good outcomes.

Ulinastatin protects rats with myocardial infarction by activating Nrf2/NOS pathway.

OBJECTIVE: The aim of the study was to explore the pharmacological role of ulinastatin in rats with myocardium infarction (MI) and its underlying mechanism. MATERIALS AND METHODS: Rats were randomly assigned into sham group, MI group, and ulinastatin group, with 8 rats in each group. MI model in rats was constructed and specific drug administrations were performed in each group. Electrocardiogram and hemodynamics were detected before and after animal procedures. Myocardium function in rats was accessed by determining serum levels of creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH). Hematoxylin and eosin (HE) staining was performed to detect the infarct area in rat myocardium. Terminal Deoxynucleotidyl Transferase dUTP Nick-end Labeling (TUNEL) assay was conducted to calculate the ratio of apoptotic cells in rat myocardium. Subsequently, relative oxidative stress indicators in rats were accessed, including total antioxidant capacity (T-AOC), catalase (CAT), glutathione (GSH), Superoxide Dismutase (SOD), malondialdehyde (MDA), and reactive oxygen species (ROS). Western blot was conducted to detect protein levels of nuclear factor E2-related factor 2 (Nrf2), Nuclear Factor κB (NF-Κb), heme oxygenase-1 (HO-1), and NAD(P)H:quinone oxidoreductase 1 (NQO1) in rat myocardium. RESULTS: No significant differences in heart rate, the voltage of the QRS wave and Q-T interval were observed among rats in sham group, MI group, and ulinastatin group prior to the animal procedures. However, at the end of the animal procedures, rats in ulinastatin group showed higher heart rate and voltage of QRS wave, as well as shorter Q-T interval than those in MI group. Rats in ulinastatin group presented lower serum levels of CK-MB and LDH compared with those in MI group, whereas they did not return to baseline. Rats in ulinastatin group showed higher levels of LVSP, dP/dtmax, LVEDP, and -dP/dtmax than those in MI group. Larger infarct area was observed in MI group compared with that of sham group, whereas ulinastatin treatment remarkably reduced the infarct area. HE staining showed remarkable pathological lesions in MI rats, whereas ulinastatin group showed milder lesions in rat myocardium. TUNEL assay showed fewer TUNEL-positive cells in ulinastatin group than those of MI group. Levels of T-AOC, CAT, GSH, and SOD were remarkably higher in myocardium homogenate of MI group than sham group, whereas ulinastatin treatment significantly decreased these levels. Ulinastatin group showed less ROS accumulation and decreased MDA level in rats than those of MI group. Ulinastatin treatment upregulated Nrf2, HO-1, and NQO1, whereas downregulated NF-κB expression. CONCLUSIONS: Ulinastatin protects MI rats by inhibiting inflammatory response through activating Nrf2/NOS pathway.

[Regulation of Ruxolitinib on matrix metalloproteinase in JAK2V617F positive myeloroliferative neoplasms cells].

Objective: To investigate the regulation of JAK2 tyrosine kinase inhibitor ruxolitinib on extracellular matrix metalloproteinase (MMP in JAK2V617F positive myeloproliferative neoplasms (MPN) cells. Methods: ①Forty cases of newly diagnosed JAK2V617F positive MPN patients and 15 healthy volunteers as control in Baoding No.1 Hospital between January 2012 and December 2015 were enrolled in this study. JAK2V617F/JAK2 ratio was detected by real-time-PCR; the expression levels of phosphorylation protein tyrosine kinase 2 (p-JAK2) , MMP-2 and MMP-9 in pathological tissues of bone marrow were detected by immunohistochemistry. The bone marrow cells of JAK2V617F positive MPN patients were treated with ruxolitinib, then the migration ability and MMP-2, MMP-9 gene and protein expression levels were detected. ②The human erythroleukemia cell line HEL cells were treated with different concentrations of ruxolitinib (0, 50, 100, 250, 500, 1 000 nmol/L) . The cell viability was detected by CCK-8 test; cell migration ability was tested by transwell chambers. The mRNA expression levels of JAK2, MMP-2 and MMP-9 were detected by real-time-PCR. The protein expression levels of p-JAK2, MMP-2 and MMP-9 were detected by Western blot. Results: ①The expression levels of p-JAK2, MMP-2 and MMP-9 in the newly diagnosed group were significantly higher than control group respectively [ (78.56±24.55) % vs (41.59±17.29) %, P<0.05; (48.25±18.74) % vs (22.79±13.89) %, P<0.05; (53.29±19.28) % vs (15.56±14.96) %, P<0.05]. Spearman correlation analysis showed the positive correlation of MMP-2 and MMP-9 protein expression levels with JAK2V617F mutation (r=0.526, P=0.001; r=0.543, P=0.001) . ②The proliferation of HEL cells was inhibited by different concentrations of ruxolitinib in time and dose dependent manner. ③Cell migration test showed the number of cells leaked to the low chamber in MPN patients bone marrow cells and HEL cells treated with 5 nmol/L of ruxolitinib group were significantly lower than that without ruxolitinib treatment after 24 h [ (154.7±27.5) vs (320.3±67.3) , t=13.47, P<0.05; (70.7±10.5) vs (135.3±16.7) , t=13.89, P<0.05]. The mRNA and protein expression levels of JAK2, MMP-2 and MMP-9 decreased with the increased concentration of ruxolitinib. Conclusion: Ruxolitinib inhibits MPN cell migration and expression of MMP-2 and MMP-9 via JAK2 signal pathway.