[Feasibility of a three-sided encapsulation procedure based on fascia anatomy in laparoscopic lateral lymph node dissection for middle and low rectal cancer].

Objective: To explore the feasibility and value of performing a three-sided encapsulation procedure based on fascia anatomy in laparoscopic lateral lymph node dissection (LLND) for middle and low rectal cancer. Methods: This was a retrospective review. The study cohort comprised patients who met the diagnostic criteria for rectal cancer according to the Chinese Guidelines for the Diagnosis and Treatment of Colorectal Cancer, had a short lymph node diameter of >5 mm on the lateral side within the 15 days before surgery, were evaluated as feasible candidates for laparoscopic total mesorectal excision+LLND surgery, had been diagnosed with low or intermediate level rectal cancer, and whose tumor was less than 8 cm away from the anal verge according to pathological examination of the operative specimen. Patients with a history of other malignant tumors of the abdomen or with incomplete follow-up data were excluded. Forty-two patients with middle and low rectal cancer who had undergone lateral lymph node dissection in diagnosis and treatment center of Gastrointestinal Cancer of Guangdong Hospital of Chinese Medicine from Jan.2018 to Dec.2022 were enrolled. There were 24 men (57.1%) and 18 women (42.9%) aged 58.4±11.8 years and the median BMI was 22.5 (19.3-24.1) kg/m2. The main point of the three-sided encapsulation procedure is to expand the external side medial to the external iliac artery and vein, narrowing the range of exterior side dissection. The anterior-medial side is designed to expand the vesical fascia to define the range of anterior-medial side extension. The internal side is fully extended to the ureterohypogastric nerve fascia; the distal point of the caudal extension reaches the level of the Alcock canal and the bottom reaches the piriformis, enabling dissection of the obturator nerve and No.283 lymph nodes. No.263D lymph nodes are dissected by exposing the internal iliac artery and its branches, dissecting the group No.263P lymph nodes, and severing the inferior vesical artery. Finally, the lateral lymphatic tissue is completely resected. Relevant variables were recorded, including the number of lateral lymph nodes detected, the rate of lymph node metastasis, operation duration, intraoperative blood loss, postoperative complications, postoperative hospital stay, and 3-year overall survival rate. Results: Laparoscopic surgery was successfully completed in all patients with no conversions to open surgery and no intraoperative complications. Twenty-seven (64.3%) of the study patients underwent left-sided LLND, 10 (23.8%) right-sided LLND, and five (11.9%) bilateral LLND, with lymph nodes cleared on both sides. All patients' lymph nodes were examined pathologically. A median of 17.0 (11.7, 26.0) lymph nodes was detected, the median of lateral lymph nodes being 5.0 (2.0, 10.2). The median operation time was 254.5 (199.0, 325.2) minutes. The median intra-operative blood loss was 50.0 (30.0, 100.0) mL. All patients were diagnosed with adenocarcinoma by pathological examination of the operative specimen. Two patients developed postoperative intestinal obstruction, one lymphatic leakage, and one a perineal incision infection. There were no cases of anastomotic leakage. The median postoperative hospital stay was 6.0 (5.0, 7.0) days and the median follow-up time 23.5 (9.0, 36.7) months. During follow-up, three patients (7.1%) died of tumor recurrence and metastasis. Two (4.8%) experienced mild urinary dysfunction, and one (2.4%) had moderate postoperative erectile dysfunction. One patient (2.4%) was found to have prostate and lung metastases 3 month after surgery. The 3-year overall survival rate was 74.4%. Conclusions: Three sided encapsulation is a safe and feasible procedure for LLND, achieving accurate and complete clearance of lateral lymphatic tissue.

[Efficacy of omalizumab in the treatment of eosinophilic granulomatous polyangiitis with asthma as the first symptom].

Objective: To investigate the efficacy, and safety of omalizumab in the treatment of eosinophilic granulomatous with polyangiitis (EGPA) with asthma as the first symptom. Method: The clinical characteristics of 22 EGPA patients with asthma as the first symptom treated with omalizumab in the First Affiliated Hospital of Guangzhou Medical University from March 2018 to December 2020 were retrospectively analyzed. The asthma control test (ACT) score, the frequency of asthma exacerbation (AE), the Birmingham Vasculitis Activity Score (BVAS), the variation rate of peak expiratory flow (PEF), the percentage of PEF to predicted value of PEF (PEFpred%), the percentage of forced expiratory volume in first second (FEV1) to predicted value of FEV1 (FEV1pred%), the dosage of oral corticosteroid (OCS) and other clinical data [M(Q1, Q3)] were collected before and after treatment, to observe the efficacy and adverse reactions of omalizumab. Results: There were 22 subjects recruited in this study. The median age was 42 (22-70) years. Eleven of the patients were males. After treated with omalizumab for 4 months, there were 68.2%(15/21) of patients who responded to the treatment. In the response group (n=15), the patients' ACT score increased from 19.0 (16.5, 21.0) to 23.0 (21.5, 24.0) (P=0.001). The frequency of AE decreased from 0.7 (0.3, 1.0) to 0 (0, 0.7) per four mouths (P<0.001). The BVAS decreased from 4.0 (2.0, 6.0) to 2.0 (2.0, 4.0) (P=0.007). The variation rate of PEF decreased from 18.8% (14.0%, 27.7%) to 9.2% (6.8%, 11.9%) (P=0.007). The PEFpred% increased from 80.8% (73.5%, 90.7%) to 100.5% (79.4%, 114.0%) (P=0.005). The maintenance dosage of OCS reduced from 15.0 (10.0, 20.0) mg/d to 8.8 (5.0, 10.0) mg/d (P=0.005). The level of baseline eosinophil in peripheral blood of patients in non-response group was higher than that in response group [11.4% (9.2%, 22.6%) vs 3.4% (1.1%, 6.5%), P<0.05]. A total of 190 injections were performed in 22 patients, and only 4 patients (2.1%) had adverse reactions after a single injection of omalizumab, such as dizziness, swelling of injection site and pruritus. The adverse reactions were tolerable. Conclusions: Omalizumab has certain curative effect on EGPA, can reduce asthmatic symptoms and OCS maintenance dosage, and has a good safety profile. The rate of response to the treatment is higher in patients with mild eosinophilic inflammation.

The function of the ACE2/Ang(1-7)/Mas receptor axis of the renin-angiotensin system in myocardial ischemia reperfusion injury.

OBJECTIVE: Angiotensin-converting enzyme 2(ACE2) is a critical element of the renin-angiotensin system (RAS), which can convert angiotensin (Ang)II to Ang(1-7), followed by binding Mas receptor (MasR) and subsequently produces cardioprotective effects through various signal transduction pathways. It has been discovered in research that activation of the RAS contributes a crucial influence during the myocardial ischemia reperfusion injury (MIRI) development. The features of ACE2, Ang(1-7), and MasR, as well as the function of the ACE2/Ang(1-7)/MasR axis in MIRI, are discussed in our review, with the therapeutic potential of this axis as a new treatment option for MIRI patients shown. MATERIALS AND METHODS: To retrieve a thorough collection of studies, we performed a search in PubMed using the following combination of keywords: (ACE2) or (Ang1-7) or (Mas receptor) and (Myocardial Ischemia reperfusion injury). The time limits used for the search were 1986 to 2021. RESULTS: In total, 367 articles were included. Titles and abstracts of articles were screened for relevance, and all relevant articles published in English were included. CONCLUSIONS: ACE2, a prominent member of the RAS, performs a crucial regulatory function in the cardiovascular system. ACE2 regulates the RAS inversely mainly by hydrolyzing the harmful AngII to the beneficial Ang(1-7). Increasing or activating ACE2 or Ang(1-7) may help prevent and treat MIRI. However, additional research into the specific processes behind the ACE2/Ang(1-7)/MasR axis in MIRI is necessary, as well as the performance of additional in-depth studies to go from basic research to clinical translation.

[Three dimensional nephrometry system for partial nephrectomy: Our initial exploration].

OBJECTIVE: To construct a preoperative evaluation system for partial nephrectomy using CT three-dimensional visualization technology and to explore its practical value. METHODS: The clinical data of the patients who underwent partial nephrectomy for renal tumors in Department of Urology, Peking University First Hospital were collected retrospectively. At the same time, the homogenized standard data of patients who underwent partial nephrectomy for renal tumors were collected in 16 clinical centers in China. The CT three-dimensional visualization system was applied (IPS system, Yorktal) to evaluate tumor anatomy, blood supply, perirenal fat and other information. The parameters were summarized to build a three-dimensional nephrometry system, on the basis of which virtual surgery design and intraoperative navigation were completed. RESULTS: A three-dimensional visualization image was established based on the enhanced CT urography. The nephrometry system included the longest diameter and volume of the tumor, proportion volume of tumor invading the parenchyma, maximum depth of the tumor invading the parenchyma, contact surface area, flatness of the tumor surface, renal segment where the tumor was located, vascular variation, and perirenal fat. The average two-dimensional diameter of the tumor was (2.78±1.43) cm, the average three-dimensional maximum diameter was (3.09±1.35) cm, and the average postoperative pathological size was (3.01±1.38) cm. The maximum tumor diameter in the three-dimensional image was significantly related to the prolonged renal artery clamping time and intra-operative blood loss (r=0.502, P=0.020; r=0.403, P=0.046). The three-dimensional and pathological tumor volume were (25.7±48.4) cm3 and (33.0±36.4) cm3, respectively (P=0.229). The tumor volume was significantly related to the intraoperative blood loss (r=0.660, P < 0.001). The proportion volume of the tumor invading into renal parenchyma was significantly related to the prolongation of renal artery clamping and the occurrence of postoperative complications (r=0.410, P=0.041; r=0.587, P=0.005). The tumor contact surface area and the presence of vascular variation did not show correlation with the perioperative data and postoperative complications. While the preoperative evaluation was completed, the reconstructed three-dimensional image could be zoomed, rotated, combined display, color adjustment, transparency, and simulated cutting on the Touch Viewer system. The process generally consisted of showing or hiding the tissue, adjusting the transparency of the interested area, rotating and zooming the image to match the position of the surgical patient. Together, these functions met the requirements of preoperative virtual surgery plan and intraoperative auxiliary navigation. CONCLUSION: Three-dimensional images can provide a more intuitive anatomical structure. The CT three-dimensional visua-lization system clearly displays tumor anatomical parameters, blood supply and perirenal fat. The three-dimensional nephrometry system for renal tumors can help predict the difficulty of partial nephrectomy and perioperative complications. Importing the reconstructed three-dimensional visualization image into the specified program or robot operating system can complete virtual surgery and intraoperative navigation, helping the surgeon to better grasp the surgical process. The indexes included in the nephrometry system and the score weights of each index need to be confirmed and perfected by multi-center study with large samples.

[Study on purification effect of formaldehyde in cleanroom by new return air device].

Objective: To effectively reduce the concentration of poisons in cleanroom, protect the health of workers, realize the optimization and automatic control of the new return air device. And the influence of initial concentration, air volume, temperature and relative humidity of formaldehyde on the purification effect of the new return air device was explored. Methods: The purification effect of the new return air device installed with the activated carbon and the photocatalyst purification net or ordinary activated carbon purification network was tested in a 60 m(3) simulated cleanroom. The concentration of formaldehyde was determined by solution absorption-phenol reagent spectrophotometry. Based on the single factor experiment to determine the combination of two purification nets. The effects of air volume, initial formaldehyde concentration, temperature and relative humidity on the purification effect of the new return air device were investigated by orthogonal test. Then, the performance parameters of the return air device to purify formaldehyde were determined. Results: The formaldehyde purification efficiency of the two types of purification nets in the new return air device was higher than that of the ordinary activated carbon purification network (P<0.05) . The combination of activated carbon and photocatalyst purification net has no effect on the formaldehyde purification efficiency of the return air device (P>0.05) . According to the direct analysis and variance analysis, air volume was the most sensitive factor (F value is 18.894, P<0.05) , followed by initial concentration (F value is 16.128, P<0.05) , while temperature and relative humidity have little effect (F value is 0.041 and 0.599, respectively, P>0.05) . LSD analysis showed that there was no significant difference in the purification efficiency of formaldehyde between 475 m(3)/h and 626 m(3)/h (P>0.05) . From the perspective of formaldehyde purification efficiency and energy saving, when the air volume is set to 475 m(3)/h, the new return air device has higher purification efficiency for high concentration of formaldehyde. Conclusion: The new return air device consisting of activated carbon and photocatalyst purification net can play a good purification role in cleanroom with different temperatures and different humidity. Its formaldehyde purification efficiency is affected by air volume and initial concentration.

[Study on the effect of activated carbon on formaldehyde in clean workshop].

Objective: To study the effect of activated carbon on the purification of formaldehyde in the clean workshop return air purification device and its influencing factors. Methods: From May to June 2018, choosed 4 different commercial activated carbons (bamboo charcoal, 1-3 mm, 3-5 mm; coconut shell charcoal, 6-12 mesh, 8-16 mesh) to make 5 types of activated carbon purification net. In the simulated clean plant laboratory, the detection of occupational disease hazards was used to test the purification effect of different types of activated carbon purification nets on formaldehyde. Results: The purification effect of different types of activated carbon increased with the prolongation of purification time, and the difference was statistically significant (P<0.05) . Compared with other types of activated carbon, coconut shell charcoal (8-16 mesh, double layer) had the best purification effect, 15 min and 30 min purification efficiency was 58.72% and 85.20% respectively, and the difference was statistically significant (P<0.05) . The purification effect of double-layer coconut shell charcoal was better than single layer (P<0.05) . The purification effect of double-layer coconut shell charcoal (8-16 mesh) was better than double-layer coconut shell charcoal (6-12 mesh) , the difference was statistically significant (P<0.05) . Coconut shell charcoal (8-16 mesh, double layer) had better purification effect than bamboo charcoal (P<0.05) . Conclusion: Different specific surface area, particle size, and thickness of activated carbon have a certain effect on the purification effect of formaldehyde, and its selection has a certain significance in improving the occupational health protection level in the clean plant, solving the safe use of return air and reducing energy consumption.

[Clinical analysis of 3 cases of eosinophilic granulomatosis with polyangiitis].

Objective: To improve the clinical recognition of eosinophilic granulomatosis with polyangiitis(EGPA) in clinical manifestations, diagnosis and treatment. Methods: The clinical manifestations, pathological characteristic, imaging manifestations, diagnosis and the therapy of three patients with EGPA were presented. Results: These 3 patients had asthma-like symptoms and extrapulmonary manifestations of systemic vasculitis. They were 20, 40 and 44 years old. All of them were female.They denied exposure or contact. Chest radiographic examination showed that the most common features were nodule shadow and tree-in-bud in the lung. The pathological manifestation was characterized by hypereosinophilia, high total IgE(over 300 KU/L) and high CRP(over 14.1mg/L). The FeNO of 2 patients was over 100ppb. The ANCA of these 3 patients was negative. The pulmonary pathology was observed had eosinophil infiltration in the alveolar, interstitial and vessel for 3 cases. The clinical manifestations were nonspecific. All patients were treated by glucocorticoid and immune-inhibitor(alkylating agents or purine synthesis inhibitors) therapy. Because patients were complicated with other organs involved, they needed long-time treatment. Conclusions: This disease is diverse and complex, with a lack of pathognomonic symptoms. We should highly suspect eosinophilic granulomatosis with polyangiitis, when the patients present severe asthma and eosinophilia. Early detection, early treatment, and the prognosis could be better.

[Review on the associations of signal transducer and activators of transcription 3 with hepatocellular carcinoma].

Hepatocellular carcinoma (HCC) is one of the most common malignancies with high fatality rate in China. To investigate the related risk factors and therapeutic targets, and actively carry out the prevention and early treatment is of great public health value. Signal transducer and activators of transcription 3 (STAT3) is the key molecule of multiple inflammation-associated signaling pathways. Recent studies have found that HCC patients have high expressing levels of STAT3 in tumor tissues, and aberrant activation of STAT3 is closely associated with the occurrence, development, invasion, metastasis, and prognosis of HCC. In this paper, we reviewed the researches on the associations of STAT3 with the occurrence and prognosis of HCC and prospected on the issues of causal prophylaxis and targeted therapy for HCC which could offer reference for the protection strategy of HCC.

[Effect of estrogen on dopamine release evoked by electric stimulation of central amygdaloid nucleus].

In vivo fast cyclic voltammetry (FCV) was used to investigate dopamine (DA) release from central amygdaloid nucleus (CAN) of ovariectomized (OVX), estrogen-treated and normal female rats. Radioimmunoassay was used to measure the serum concentration of estradiol (E(2)). DA release was significantly higher in OVX rats treated with estradiol benzoate (EB) as compared with controls. The DA release due to electric stimulation is dose-dependent on serum concentration of estradiol, suggesting that estrogen may play an important role in regulating DA release from CAN.

[Relationship between dopamine and iron contents in the brain of parkinsonian rats].

Using fast cyclic voltammetry (FCV), atomic absorption/flame emission spectrophotometry and high performance liquid chromatography for electrochemical detection, we studied the change in iron content in the substantia nigra (SN) of 6-hydroxydopamine (6-OHDA) lesioned Parkinsonian (PD) rats and the toxic effect of intranigral injection of iron on DA neurons. The neuroprotective effect of desferrioxamine mesylate was also observed. The results are as follows. (1) The iron content in SN on the lesioned side of 6-OHDA-lesioned PD rats was about three times as high as that in nonstandard PD rats. (2) The iron content in caudate putamen (CPu) on the lesioned side of PD rats was not different from that on the unlesioned side. (3) DA release as well as the content of DA and its metabolites were significantly decreased on the lesioned side of PD rats. (4) In the rats pretreated with intracerebroventricular desferrioxamine mesylate before 6-OHDA injection, the release and content of DA on the lesioned side were not significantly different from those on the unlesioned side. (5) Intranigral injection of 40 micrograms FeCl3 resulted in a dramatic reduction of both DA release and content in CPu. The above results strongly suggest that 6-OHDA reduces the DA release from CPu, in which iron plays an important role. Elevation of iron content in SN is one of the mechanisms responsible for the reduction of DA content. Desferrioxamine mesylate may exert a protective action on dopaminergic neurons.

[The expression of p97 on the membrane of the reticulocyte and the role in iron uptake in rabbit].

AIM: To investigate the expression of p97 on the membrane of the reticulocyte and the possible role in non-transferrin bound iron uptake. METHODS: The SDS-PAGE and the radioisotope (59Fe) was used in this investigation. RESULTS: (1) The protein of the supernatant of reticulocytes was separated on SDS-PAGE. There was one band near 97kDa. The same result was obtained with reticulocytes treated with PI-PLC and the Mean OD of the band was higher than that of untreated reticulocytes. But for the mature erythrocytes, there wasn't apparent band near 97kD. (2) No apparent effect of only PI-PLC treatment on iron uptake by reticulocytes (P > 0.05). Reticulocytes, depleted endogenous-transferrin and then treated by PI-PLC, gave a significant decrease in iron uptake in cytosol and in heme (P < 0.05). CONCLUSION: The results support the possibility that p97 might be able to be expressed on the membrane of reticulocytes and plays a role in non-transferrin bound iron uptake by this type of cells in rabbit.

Long-term follow-up of minimal residual disease in childhood acute lymphoblastic leukemia patients by polymerase chain reaction analysis of multiple clone-specific or malignancy-specific gene markers.

Two types of markers, namely the clone-specific markers including T-cell receptor (TCR) gamma, TCR delta, and Ig heavy-chain (IgH) gene rearrangements, and malignancy-specific fusion gene mRNA such as SIL-TAL-1, BCR-ABL, and HRX-partner genes, were investigated by molecular biology techniques in 65 Chinese patients with acute lymphoblastic leukemia (ALL). In combination, these markers were informative among 96% of patients. Minimal residual disease (MRD) was followed up in 23 of these patients with available materials over a period varying from 8 to 54 months with at least one leukemia-specific probe. In most children, MRD was decreased continuously to an ultimately undetectable level within 6 to 12 months after remission induction therapy. One patient exhibited low-level residual leukemic cells for 4 years before the MRD turned negative. Another patient remained in complete remission for 45 months, although a positive signal was detected at 34 months using TCR delta probe, but was negative with a TCR gamma marker which was positive at presentation. In three patients who relapsed, MRD either persisted through the clinical course or became positive and eventually increased 3-11 months before clinical relapse. These data suggested that the combined use of multiple gene markers is a valuable tool for the PCR-based MRD detection, since it can cover most ALL patients. Furthermore, long-term follow-up of MRD is helpful for determining the dosage as well as the period of maintenance chemotherapy and for predicting impending relapse.

[Studies on pharmacologic disposition of adriamycin in dog after hepatic arterial embolization with adriamycin carboxymethyl-dextran-microspheres].

The ion exchange adriamycin carboxymethyl-dextran-microspheres (AD-CM-DMS) was chosen as a model preparation. Pharmacokinetics, targeting and embolization effects of the microspheres were studies after hepatic arterial embolization in vivo in dogs. After hepatic arterial infusion, the concentrations of ADM in peripheral vein blood and hepatic tissue were determined by HPLC. The peak concentrations were (0.558 micrograms/ml for AD-CM-DMS and 1.013 micrograms/ml for ADM solution. T1/2 (alpha), T1/2 (beta) and MRT of AD-CM-DMS were respectively 2.82, 3.19 and 1.28 times as much as those of ADM solution. At the target site, the tissue concentrations of AD-CM-DMS were respectively 8.0 and 9.1 times those of ADM solution. The dynamic vessel angiography revealed no external and internal collaterals and no complete degradation of AD-CM-DMS after sixteen weeks was observed. These results suggest that AD-CM-DMS are useful as embolic agent for the treatment of hepatic cancer. It could facilitate intensive chemotherapy with minimum systematic side effect.

Antitumor agents. 134. New shiraiachrome-A- and calphostin-C-related perylene derivatives as cytotoxic and antiviral agents and inhibitors of protein kinase C.

Shiraiachrome-A and -B have been isolated from the mycelium of the Chinese bamboo fungus Shiraia bambusicola as the cytotoxic principles. A series of new perylene derivatives (7-27) related to Shiraiachrome-A and -B as well as Calphostin-C have been synthesized and evaluated for their cytotoxicity, antiviral activity, and inhibitory activity against protein kinase C. The results indicated that 11 and 12 are potent cytotoxic agents against HCT-8, RPMI-7951, and TE-671 solid tumor cells, whereas 24 and 26 demonstrated strong antiviral activity against HSV-1 and HSV-2. Compound 10 is an inhibitor of protein kinase C.

The relationship between animal fat intake, cigarette smoking, and lung cancer.

An international ecologic study on the relationship between fat intake, cigarette consumption, and age-specific lung cancer mortality rates was conducted using data obtained from 29 countries. The 1969-71 and 1984-86 mortality rates for lung cancer were related to smoking habits and to levels of animal fat intake. Highly significant independent positive correlations for lung cancer with both cigarette smoking and animal fat consumption were seen. No significant independent relationship was found between lung cancer mortality and vegetable fat consumption. In a multiple regression analysis linking lung cancer mortality to dietary intake of animal fat, cigarette smoking, and the interaction term between cigarette smoking and animal fat intake, only the latter term was significant (P less than 0.001) pointing towards a role for animal fat as a promoter of lung cancer.