A preliminary single-center investigation of percutaneous biliary stenting in malignant hilar biliary obstruction: what impacts the clinical success and the long-term outcomes?

PURPOSE: The purpose of this study is to investigate the influencing factors that may impact the clinical success, jaundice-free time, and overall survival in patients of malignant hilar biliary obstruction (MHBO) treated with a self-expanding metallic stent (SEMS). MATERIALS AND METHODS: Patients diagnosed with MHBO and treated with SEMS through percutaneous access from 1 Jul. 2013 to 1 Jul. 2018 were enrolled in this monocentric study. Demographic information, disease baseline measurements, and interventional strategies were collected and examined. Bilirubin was measured 1-3 days before and 3-7 days after stenting using the unit of "µmol/L." The bilirubin reduction ratio was compared between different study groups, which were separated by specific characteristics. Univariate and multivariate analyses were performed to evaluate each characteristic's impact on jaundice-free time (JF) and overall survival time (OS). Statistical analyses were conducted using SPSS 14.0, p < 0.05 indicated significance. RESULTS: Eighty patients were enrolled. Direct bilirubin (DB) and indirect bilirubin (IB) both significantly decreased after stenting (U = 1575.0, p < 0.001; U = 1541.0, p < 0.001). The DB reduction ratio of the "nearby lymph metastases" group was significantly higher (U = 566.0, p = 0.037). The IB reduction ratio in the "single stent" group was significantly higher (U = 554.0, p = 0.018). Sixty-six cases reached jaundice recurrence, the median JF was 6 months, and the 95% confidence interval was 4.411 ~ 7.589 months. Fifty-eight cases ended in death, the median OS was 7 months, and the 95% confidence interval was 5.759 ~ 8.241 months. "Nearby lymph metastases" and "distant metastases" independently impacted OS (OR = 2.344, p = 0.013; OR = 3.239, p = 0.042). "IB reduction ratio" independently impacted both JF and OS (OR = 0.422, p = 0.021; OR = 0.315, p = 0.001). CONCLUSION: The goal of treatment in patients with MHBO is to recover liver function. However, the overall survival is greatly impacted by the presence of metastases. Managing to obtain adequate liver function recovery may improve the long-term outcomes in affected patients.

Next-generation sequencing to investigate circular RNA profiles in the peripheral blood of preterm neonates with bronchopulmonary dysplasia.

BACKGROUND: Circular RNAs (circRNAs) are emerging noncoding RNAs that are involved in many biological processes and diseases. The expression profile of circRNAs in preterm neonates with bronchopulmonary dysplasia (BPD) remains unresolved. METHODS: In BPD infants, peripheral venous blood was drawn and circRNAs were extracted and sequenced by next-generation sequencing. The levels of the selected circRNAs were measured by real-time quantitative reverse transcription PCR. RESULTS: Among thousands of circRNAs, 491 circRNAs were significantly changed. Among the top 10 changed circRNAs, hsa_circ_0003122, hsa_circ_0003357, hsa_circ_0009983, hsa_circ_0003037, and hsa_circ_0009256 were significantly increased, while hsa_circ_0014932, hsa_circ_0015109, hsa_circ_0017811, hsa_circ_0020588, and hsa_circ_0015066 were significantly decreased. These altered circRNAs are involved in complicated biological functions and signaling pathways. Additionally, hsa_circ_0005577 (hsa_circ_FANCL), which was significantly increased in the moderate-to-severe BPD subjects, was correlated with oxygenation therapy. CONCLUSION: These results suggest that an aberrant circRNA profile in the peripheral blood of BPD infants might be important in BPD pathogenesis.

Down-regulation of miR-140-3p can alleviate neonatal repetitive pain in rats via inhibiting TGF-ß3.

MicroRNAs (miRNAs) have been shown to be involved in the pathophysiological processes of pain. At present, the roles and mechanisms of miRNAs in neonatal repetitive pain are largely unknown. In our research, the expression of miR-140-3p was increased in premature infants who received repetitive painful stimuli since admission, and in rat pups after repetitive needlestick stimulation. As a result of behavioral testing, the inhibition of miR-140-3p significantly suppressed abnormal mechanical and thermal hyperalgesia in rats after needlestick. Furthermore, the inhibition decreased the expression of the inflammatory cytokines IL-1ß, TNF-α, and IL-6, as well as glucocorticoid receptor expression in rats after needlestick. Using bioinformatic analyses, the 3'-untranslated region of TGF-ß3 was predicted to be a target of miR-140-3p. Down-regulation of miR-140-3p significantly promoted the expression of TGF-ß3 in vitro and in vivo. Mechanistic investigations revealed that TGF-ß3 is a direct target of miR-140-3p, and is involved in the miR-140-3p-mediated effects on neonatal repetitive pain and neuroinflammation. In summary, our current research suggests that down-regulation of miR-140-3p can inhibit painful tactile stimulation of rat pups by inhibiting TGF-ß3. Our results suggest that miR-140-3p may provide a new regulatory target for preventing the effects of neonatal repetitive pain.

[Clinical effect of early or late administration of caffeine citrate in prevention and treatment of apnea in very low birth weight infants].

OBJECTIVE: To study the clinical effect of early or late administration of caffeine citrate in the prevention and treatment of apnea in very low birth weight (VLBW) infants. METHODS: A total of 82 VLBW infants who were hospitalized and treated in the neonatal intensive care unit between June 2015 and May 2017 were enrolled. According to the age in days when caffeine citrate treatment was started, they were divided into early treatment group (<3 days) with 22 infants and late treatment group (3 - <10 days) with 60 infants. A retrospective analysis was performed for their clinical data. The two groups were compared in terms of general information during the perinatal period, treatment process, and clinical outcome. RESULTS: Compared with the late treatment group, the early treatment group had a significantly lower birth weight (P=0.004), significantly shorter durations of mechanical ventilation and oxygen inhalation (P<0.05), and a significantly lower incidence rate of bronchopulmonary dysplasia (P=0.032). There were no significant differences in other general information, treatment process, and clinical outcome between the two groups (P>0.05). CONCLUSIONS: Early administration of caffeine citrate can improve the prognosis of VLBW infants.

Bridging across the ampulla with metal stents: evidences for intestinal bile reflux.

BACKGROUND/AIMS: To investigate the early intestinal bile reflux following the implantation of metal stent across the ampulla and the mechanism of reflux cholangitis. METHODOLOGY: Twenty-three patients with implantation of metal stent across the ampulla were recruited. Prior to the implantation, the white blood cell count, neutrophil percentage, total blood bilirubin, direct bilirubin and the trypsin content in the bile were recorded; 2-5 days after implantation these indices were measured again, as well as the 99mTc -DTPA radioactivity. RESULTS: A high percentage (82.61%) of patients showed 99mTc in the bile in 2 hours, which accounts for 1.73% of total intake. In 4 cases the radioactivity was not found. Bile lipase and amylase levels were significantly higher than that in prior to the stent implantation. There were no changes in the white blood cell count and neutrophil percentage after stent implantation. Additionally, the total blood bilirubin and direct bilirubin decreased. CONCLUSIONS: After the implantation of metal stent across the ampulla, there is evidence for the early intestinal bile reflux, without signs for the reflux cholangitis.

Characterization of the complete mitochondrial genome of Quasilineus sinicus Gibson, 1990 (Nemertea: Heteronemertea) and its phylogenetic implications.

In this study, we sequenced and characterized the complete mitochondrial genome (mitogenome) of Quasilineus sinicus Gibson, 1990 (Heteronemertea, Nemertea) using Illumina sequencing technology. The circular mitogenome was 16,358 bp in length and comprised 22 transfer RNA genes, 13 protein-coding genes, and two ribosomal RNA genes. Its overall base composition included 20.82% A, 41.06% T, 26.68% G, and 11.44% C; in fact, the mitogenome had a high A + T content of 61.88%. Furthermore, our phylogenetic analysis demonstrated that Paleonemertea, Pilidiophora, and Hoplonemertea were monophyletic groups, and Q. sinicus was most closely related to Iwatanemertes piperata.

Applying arterial enhancement fraction (AEF) texture features to predict the tumor response in hepatocellular carcinoma (HCC) treated with Transarterial chemoembolization (TACE).

BACKGROUND: To evaluate the application of Arterial Enhancement Fraction (AEF) texture features in predicting the tumor response in Hepatocellular Carcinoma (HCC) treated with Transarterial Chemoembolization (TACE) by means of texture analysis. METHODS: HCC patients treated with TACE in Shengjing Hospital of China Medical University from June 2018 to December 2019 were retrospectively enrolled in this study. Pre-TACE Contrast Enhanced Computed Tomography (CECT) and imaging follow-up within 6 months were both acquired. The tumor responses were categorized according to the modified RECIST (mRECIST) criteria. Based on the CECT images, Region of Interest (ROI) of HCC lesion was drawn, the AEF calculation and texture analysis upon AEF values in the ROI were performed using CT-Kinetics (C.K., GE Healthcare, China). A total of 32 AEF texture features were extracted and compared between different tumor response groups. Multi-variate logistic regression was performed using certain AEF features to build the differential models to predict the tumor response. The Receiver Operator Characteristic (ROC) analysis was implemented to assess the discriminative performance of these models. RESULTS: Forty-five patients were finally enrolled in the study. Eight AEF texture features showed significant distinction between Improved and Un-improved patients (p < 0.05). In multi-variate logistic regression, 9 AEF texture features were applied into modeling to predict "Improved" outcome, and 4 AEF texture features were applied into modeling to predict "Un-worsened" outcome. The Area Under Curve (AUC), diagnostic accuracy, sensitivity, and specificity of the two models were 0.941, 0.911, 1.000, 0.826, and 0.824, 0.711, 0.581, 1.000, respectively. CONCLUSIONS: Certain AEF heterogeneous features of HCC could possibly be utilized to predict the tumor response to TACE treatment.

The complete mitochondrial genome of soft coral Sinularia penghuensis Ofwegen and Benayahu, 2012 (Octocorallia: Alcyonacea): the analysis of mitogenome organization and phylogeny.

The complete mitochondrial genome of Sinularia penghuensis was sequenced and analyzed using next-generation sequencing. The present mitochondrial genome was 18730 bp in length, containing 14 protein-coding genes (PCGs) (cox1-cox3.nad1-nad6, nad4L, atp6, atp8, cytb, and MutS), two ribosomal RNA genes (rRNAs) (12S and 16S), and one transfer RNA gene (Met-tRNA). The phylogenetic analysis of family Alcyoniidae revealed that S. penghuensis and Sinularia maxima cluster together. Five species in Sinularia reveals high identity in mitogenome sequences that the lowest variable sites (SNPs) were found between S. penghuensis and S. maxima.

[The proliferous rule of bile duct endothelium after the placement of metallic biliary stent:a study in canine].

OBJECTIVE: To discuss the proliferous rule of bile duct endothelium after the placement of metallic biliary stent. METHODS: The metallic biliary stent was placed at the inferior segment of common bile duct of canine after a percutaneous transhepatic puncture at cholecyst. All the stented dogs were assigned randomly to 4 group including A, B, C and D, each group had been under research for 1 month, 3 months, 12 months and 24 months. The expression of PCNA and Ki-67 in bile duct endothelium covered by the stent were calculated on the immunohistochemistry staining images and compared with those uncovered in each group, then the expression of PCNA and Ki-67 in bile duct endothelium covered by the stent were compared between every two adjacent groups. The thickness of bile duct wall covered by the stent were measured on the HE staining images and compared between every two adjacent groups. The t-test was performed for the statistics. RESULTS: The animal model were successfully set in 18 canines. The expression of PCNA and Ki-67 in bile duct endothelium covered by the stent were significantly higher than those uncovered in every group (P < 0.05), which got much high within 1 month after stenting (P < 0.05) and gradually raised up again from 3 months to 1 year (P < 0.05) after a period of relatively low proliferation. The thickness of the bile duct covered by the stent changed following the same rule as well. CONCLUSION: The metallic biliary stent indeed induced the proliferation of bile duct endothelium. This phenomenon enhanced gradually from 3 months to 1 year after stenting, and continued persistently after that.

Enhanced CT Textures Derived From Computer Mathematic Distribution Analysis Enables Arterial Enhancement Fraction Being an Imaging Biomarker Option of Hepatocellular Carcinoma.

Purpose: This study aims to explore the imaging-clinic relationship and an optional imaging biomarker of hepatocellular carcinoma (HCC) by using texture analysis on arterial enhancement fraction (AEF). Materials and Methods: The HCC patients treated in No. 2 Interventional Ward, ShengJing Hospital of China Medical University from June 2018 to June 2019 were enrolled, for whom tri-phasic enhanced CT scans were acquired. Perfusion analysis and texture analysis were then performed on the tri-phasic enhanced CT images. After the region of interest (ROI) of viable HCC was drawn, 13 AEF textures describing the values distribution were conducted. A between-groups comparison of AEF textures was made where the cases had grouping properties, a correlation analysis was made between AEF textures and alpha-fetoprotein (AFP) as well as other clinical data which were digital, and regression analysis was made when a significant correlation was found. SPSS 19.0 (IBM) was utilized for statistical analysis; a significant difference was considered when P < 0.05. Results: Twenty-five HCC patients were enrolled. Several AEF textures were found to have a correlation with clinical features, including previous surgery history, age, glutamic oxaloacetylase, indirect bilirubin, creatinine, and AFP. The majority of AEF textures (up to 9/13) were found to have a correlation with AFP (SD, variance, uniformity, energy, entropy, inertia, correlation, inverse difference moment, and cluster prominence), while six or seven textures have a linear or cubic relationship with AFP (SD, variance, uniformity, inertia, correlation, cluster prominence, plus inverse difference moment). Conclusion: The AEF textures of HCC are strongly correlated with and are impacted by AFP, which may enable AEF to act as an optional imaging biomarker of HCC.

IL-33-induced neutrophil extracellular traps degrade fibronectin in a murine model of bronchopulmonary dysplasia.

Bronchopulmonary dysplasia (BPD) is the leading cause of chronic lung disease in preterm neonates. Extracellular matrix (ECM) abnormalities reshape lung development, contributing to BPD progression. In the present study, we first discovered that the ECM component fibronectin was reduced in the pulmonary tissues of model mice with BPD induced by lipopolysaccharide (LPS) and hyper-oxygen. Meanwhile, interleukin-33 (IL-33) and other inflammatory cytokines were elevated in BPD lung tissues. LPS stimulated the production of IL-33 in alveolar epithelial cells via myeloid differentiation factor 88 (MyD88), protein 38 (p38), and nuclear factor-kappa B (NF-κB) protein 65 (p65). Following the knockout of either IL-33 or its receptor suppression of tumorigenicity 2 (ST2) in mice, BPD disease severity was improved, accompanied by elevated fibronectin. ST2 neutralization antibody also relieved BPD progression and restored the expression of fibronectin. IL-33 induced the formation of neutrophil extracellular traps (NETs), which degraded fibronectin in alveolar epithelial cells. Moreover, DNase-mediated degradation of NETs was protective against BPD. Finally, a fibronectin inhibitor directly decreased fibronectin and caused BPD-like disease in the mouse model. Our findings may shed light on the roles of IL-33-induced NETs and reduced fibronectin in the pathogenesis of BPD.

MicroRNA­431 inhibits the expression of surfactant proteins through the BMP4/activin/TGF­ß signaling pathway by targeting SMAD4.

The synthesis and secretion of surfactant proteins (SPs) is an important sign of lung maturation. Furthermore, the morbidity of lung developmental diseases, including respiratory distress syndrome and bronchopulmonary dysplasia which are mainly caused by immature lung development and lack of SPs, is increasing. As is well known, multiple microRNAs (miRs/miRNAs) are able to influence lung development via numerous different signaling pathways. However, few studies examine the association between the miRNAs and lung developmental diseases. A previous study has demonstrated that miR­431 was significantly (F=33.49; P<0.001) downregulated in the lung tissues of Sprague­Dawley rats at 3 time points, embryonic day 19, embryonic day 21 and postnatal day 3. The present study reported that the regulation of miR­431 may influence the expression of SPs. Thus, the further potential mechanisms of miR­431 in negatively regulating lung development were examined in the present study. Stable A549 cell lines overexpressing or knocking down SMAD family member 4 (SMAD4) transfected with miR­431 overexpressed or knocked down, and their control groups were established. Subsequently, the expression of bone morphogenetic protein 4 (BMP4), SMAD4 and SPs (SP­A, SP­B and SP­C) at the RNA and protein levels were validated respectively by reverse transcription quantitative PCR and western blotting. miR­431 exhibited a decreased expression, while BMP4 and SPs exhibited increased expression at the mRNA and protein levels in the SMAD4 knockdown group. Meanwhile, the expression of SPs were reduced in the SMAD4­knockdown group via overexpressing miR­431 and increased in the SMAD4­overexpression group via inhibiting miR­431. The present results indicate that SMAD4 negatively regulates the expression of SPs, and that miR­431 negatively regulates the expression of SPs through inhibiting the BMP4/activin/transforming growth factor­ß signaling pathway by targeting SMAD4.

Cloning and characterization of two chlorophyll A/B binding protein genes and analysis of their gene family in Camellia sinensis.

In this study, two chlorophyll A/B binding protein (CAB) genes (CsCP1 and CsCP2) in tea plant were cloned. The proteins encoded by these genes belong to the external or internal antenna proteins of PS II, respectively. They may be the targets of physiological regulation for tea leaf cell PS II because they all contain multiple functional domains and modifiable sites. The CAB gene family in the tea genome consists of 25 homologous genes. We measured the expression patterns of ten genes in the CsCP1 and CsCP2 subfamily under six different stresses. CsCP1 expression was inhibited in response to 6 kinds of stress; CsCP2 expression was slightly upregulated only after cold stress and ABA treatment. However, the expression levels of CSA016997 and CSA030476 were upregulated significantly in the six stresses. The results suggested that the 10 CAB genes may have different functions in tea leaves. Moreover, changes in the expression of the 10 genes under stress appear to be related to ABA- and MeJA-dependent signalling pathways, and their responses to MeJA treatment is faster than those to ABA. In addition, we introduced our experiences for cloning the genes in the context of complex genomes.

Radiomics Signatures of Computed Tomography Imaging for Predicting Risk Categorization and Clinical Stage of Thymomas.

PURPOSE: The aim of this study is to develop and compare performance of radiomics signatures using texture features extracted from noncontrast enhanced CT (NECT) and contrast enhanced CT (CECT) images for preoperative predicting risk categorization and clinical stage of thymomas. MATERIALS AND METHODS: Between January 2010 and October 2018, 199 patients with surgical resection and histopathologically confirmed thymoma were enrolled in this retrospective study. We extracted 841 radiomics features separately from volume of interest (VOI) in NECT and CECT images. The features with poor reproducibility and highly redundancy were removed. Then a least absolute shrinkage and selection operator method (LASSO) logistic regression model with 10-fold cross validation was used for further feature selection and radiomics signatures build. The predictive performances of radiomics signatures were assessed by receiver operating characteristic (ROC) analysis. The areas under the receiver operating characteristic curve (AUC) between radiomics signatures were compared by using Delong test. RESULT: In differentiating high risk thymomas from low risk thymomas, the AUC, sensitivity, and specificity were 0.801(95% CI 0.740-0.863), 0.752 and 0.767 for radiomics signature based on NECT images, and 0.827 (95% CI 0.771 -0.884), 0.798, and 0.722 for radiomics signature based on CECT images. But there was no significant difference (p=0.365) between them. In differentiating advanced stage thymomas from early stage thymomas, the AUC, sensitivity, and specificity were 0.829 (95%CI 0.757-0.900), 0.712, and 0.806 for radiomics signature based on NECT images and 0.860 (95%CI 0.803-0.917), 0.699, and 0.889 for radiomics signature based on CECT images. There was no significant difference (p=0.069) between them. The accuracy was 0.819 for radiomics signature based on NECT images, 0.869 for radiomics signature based on CECT images, and 0.779 for radiologists. Both radiomics signatures had a better performance than radiologists. But there was significant difference (p = 0.025) only between CECT radiomics signature and radiologists. CONCLUSION: Radiomics signatures based on texture analysis from NECT and CECT images could be utilized as noninvasive biomarkers for differentiating high risk thymomas from low risk thymomas and advanced stage thymomas from early stage thymoma. As a quantitative method, radiomics signature can provide complementary diagnostic information and help to plan personalized treatment for patients with thymomas.

Terbutaline alleviates the lung injury in the neonatal rats exposed to endotoxin: Potential roles of epithelial sodium channels.

Intrauterine inflammation generates inflammatory mediators that damage the developing bronchoalveolar epithelium, resulting in neonatal lung injury. Lung fluid transport disorders are the main reasons for the development of pulmonary edema, an important pathology of lung injury. Previous studies suggested that epithelial sodium channels (ENaCs) play an important role in lung fluid transport. Here, we investigated whether changes in the expression of ENaCs were observed when neonatal rat lung injury was induced by maternal exposure to endotoxin. We also examined the therapeutic effect of terbutaline nebulizer inhalation on this injury. The results showed that maternal exposure to endotoxin increased the levels of TNF-α and IL-1ß in bronchoalveolar lavage fluid, suppressed α-, ß-, γ-ENaC in the neonatal rat lung, and resulted in the formation of pulmonary edema on postnatal days 1 and 7. Terbutaline up-regulated the expression of ß- and γ-ENaC in the distal lung after 7 days of treatment. The potential signal molecules cAMP, PKA, and CREB expressions were increased after terbutaline treatment. In summary, maternal exposure to endotoxin decreased the expression of ENaCs in neonatal rats which, in turn, may exacerbate pulmonary edema. Inhalation of the ß2-adrenergic receptor agonist terbutaline improved lung liquid clearance. By increasing the expression of sodium ion channels, the effective removal of alveolar fluid provides a new way for the prevention and treatment of neonatal lung injury.

Vitamin D and IL-10 Deficiency in Preterm Neonates With Bronchopulmonary Dysplasia.

Introduction: Vitamin D deficiency and inflammation are involved with bronchopulmonary dysplasia (BPD) in preterm neonates; however, the clinical evidence still remains scarce. We hypothesized that vitamin D and inflammatory cytokines may be risk factors for BPD in infants. Methods: Preterm infants born between 28 and 31 weeks' gestation were recruited between January 2016 and 2017. Blood samples were all collected at corresponding time points. Vitamin D was measured using an automatic biochemical analyzer, and inflammatory cytokines (TNF-α, IL-1ß, IL-6, and IL-10) were measured using ELISA. Results: The baseline characteristics for preterm infants without BPD (non-BPD control, n = 20) or with BPD (n = 19) were similar. In the blood samples collected 24-h post birth, vitamin D was significantly reduced in the BPD neonates (non-BPD vs. BPD, 28.96 ± 3.404 vs. 17.99 ± 2.233 nmol/l, p = 0.0134). Inflammatory cytokines TNF-α, IL-1ß, and IL-6 were comparable in both groups. The anti-inflammatory cytokine IL-10, however, was significantly decreased in 24-h blood samples from BPD preterm infants (non-BPD vs. BPD, 44.61 ± 10.48 vs. 11.64 ± 2.351 pg/ml, p = 0.0054). In the BPD infants with mild or moderate disease, vitamin D deficiency was quite similar. IL-10 deficiency, however, was more aggravated in the BPD infants with moderate disease. No changes in Vitamin D or cytokines (TNF-α, IL-1ß, IL-6, and IL-10) were observed for blood samples collected 2 or 4 weeks after birth. Conclusion: In our pilot study, Vitamin D and IL-10 levels at 24-h of life were risk factors for the development of BPD in very preterm infants.

Is there a potential link between vitamin D and pulmonary morbidities in preterm infants?

BACKGROUND: There hasn't been conclusive proof about the association between vitamin D and pulmonary morbidities of prematurity. METHODS: 106 preterm infants were retrospectively included into this study. Clinical data and blood samples of all the patients were collected within 24 h of admission. RESULTS: (1) Respiratory distress syndrome (RDS) patients were mainly concentrated in "≤30 weeks" stage when compared with other two gestational age groups. The only significant decrease of vitamin D concentration between RDS and non-RDS patients reflected in "≤30 weeks" stage (RDS vs. non-RDS: 29.48 ± 13.06 vs. 40.47 ± 20.52 nmol/l). (2) Bronchopulmonary dysplasia (BPD) patients were also concentrated in "≤30 weeks" stage. Vitamin D concentration showed significant difference both in "≤30 weeks" stage and "30-34 weeks" stage (≤30 weeks stage, BPD vs. non-BPD: 33.20 ± 16.51 vs. 39.21 ± 16.65 nmol/l; 30-34 weeks stage, BPD vs. non-BPD: 30.36 ± 15.50 vs. 41.21 ± 20.40 nmol/l). (3) Though vitamin D concentration in mechanical ventilation (MV) group was lower than non-MV group, there're no significant differences. (4) Vitamin D concentration in dead cases was significant lower than survival patients at discharge. (5) It showed a good correlation between vitamin D concentration and serum Ca, serum P, duration of MV and duration of oxygen support in "≤30 weeks" stage. CONCLUSION: The significant decrease of vitamin D concentration between RDS and non-RDS patients only reflected in "≤30 weeks" stage. And significant decrease of vitamin D concentration in BPD patients was both showed in "≤30 weeks" stage and "30-34 weeks" stage, which is consistent with "duration of oxygen support". However, the overall effect did not show any difference in all preterm infants. It seems that the appropriate concentration of vitamin D is beneficial to lung maturation of human. Certainly, large sample, multi-center randomized controlled trials are necessary.

Bare-metal stents across the Vater's ampulla is a safe method for patients with lower bile duct obstruction.

This study explored the effect of the implant position of stents across the Vater's ampulla on treatment outcomes in patients with lower bile duct obstruction.In the retrospective study, 41 patients with malignant obstruction of the lower bile duct and obstructive jaundice received percutaneous transhepatic biliary placement of bare-metal stents. Basic demographic data on patients, such as sex, age, and primary diseases, and follow-up data, including postoperative complications and jaundice-free survival, were recorded. The follow-up data on patients with an involved ampulla, patients with an uninvolved ampulla, patients with a stent across the ampulla, and patients with a stent at a site other than the ampulla were compared. Furthermore, prognostic factors for jaundice- free survival were investigated using Cox proportional hazards regression analysis.Among the 41 patients, 38 patients experienced subsiding of jaundice, whereas 3 cases had unsuccessful stent patency. Whether or not the ampulla was involved did not influence the incidence rates of postoperative complications and the jaundice-free survival time. Notably, when stents were placed across the ampulla, the jaundice-free survival time was significantly longer than when stents were placed at sites other than across the ampulla (P < .05). Furthermore, placement of the stent across the ampulla or at other sites was an independent prognostic factor (hazard ratio = 0.154, 95% confidence interval 0.042-0.560, P = .005) for jaundice-free survival of patients.The current study revealed that the implant position of a stent across the ampulla resulted in maintenance of stent patency and prolongation of the jaundice-free survival time.

Factors affecting the accuracy and safety of computed tomography-guided biopsy of intrapulmonary solitary nodules ≤30 mm in a retrospective study of 155 patients.

Computed tomography (CT)-guided percutaneous fine needle biopsy is a common method for lung biopsy. The objective of this study was to investigate factors affecting the accuracy and safety of CT-guided percutaneous lung biopsy of nodules ≤30 mm in diameter. Between January 2013 and March 2014, 155 patients underwent a CT-guided percutaneous biopsy procedure on an intrapulmonary solitary nodule measuring ≤30 mm in diameter. Prospectively collected data were retrospectively reviewed and examined for the influence of clinical and pathological characteristics (age, gender, smoking status, adhesion of nodule to the pleura, puncture depth, nodule size and time of biopsy) on the accuracy of biopsy and incidence of pneumothorax and hemorrhage. The accuracy of CT-guided biopsy was 90.3% (140/155). Biopsies predominantly contained lung adenocarcinoma (114/140; 81.4%) or squamous cell carcinoma of the lung (10/140; 7.1%). Accuracy was significantly dependent on nodule size, ranging in accuracy from 85 to 97% for patients with nodule diameters of ≤20 or 21-30 mm, respectively (P<0.05). Pleural adherence of the nodule significantly increased the accuracy of the biopsy (P<0.05). Patients with a nodule of 11-20 mm in diameter had a significantly higher incidence of pneumothorax compared with patients with a smaller nodule (P=0.013). In conclusion, the nodule size and adhesion to the pleura influenced the accuracy of CT-guided biopsy of intrapulmonary nodules that were ≤30 mm in diameter. Nodule size may also affect the incidence of severe complications. CT-guided percutaneous lung biopsy has a high accuracy and is easy and safe to conduct for intrapulmonary solitary nodules of ≤30 mm in diameter.