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Objective:To investigate the predictive value of preoperative aspartate aminotransferase to alanine aminotransferase ratio (AAR) for early recurrence after radical resection of single small hepatocellular carcinoma.Methods:A retrospective cohort study was conducted to analyze the clinical data of 137 patients who underwent radical resection of liver cancer at the General Hospital of Ningxia Medical University from January 2017 to July 2021. These patients were categorized into a recurrence group ( n = 72) and a non-recurrence group ( n = 65) based on early postoperative recurrence. Univariate and multivariate logistic regression analyses were conducted in the training cohort to identify independent risk factors for early recurrence of small hepatocellular carcinomas. Subsequently, the AARs were grouped, and patients with similar propensity scores estimated by the logistic model were matched 1:1 using the Propensity Score Match method with a caliper value of 0.02 to eliminate confounders. Logistic regression analysis was then repeated to assess the predictive value of the matched AAR for postoperative recurrence in patients with single small hepatocellular carcinoma. Results:Univariate analysis revealed that age ( χ2 = 4.22, P = 0.040), the ratio of fibrinogen to albumin ( χ2 = 8.26, P = 0.004), and the AAR ( χ2 = 5.83, P = 0.016) were significantly associated with early recurrence of small liver cancer after radical resection. Multivariate logistic regression analysis further identified age ( P = 0.042), the ratio of fibrinogen to albumin ( P = 0.024), and the AAR ( P = 0.018) as independent risk factors for early recurrence of single small hepatocellular carcinoma following radical surgery. After excluding confounding factors using the Propensity Score Match method, 25 patient pairs were successfully matched. Post-matching logistic regression analysis revealed that an AAR > 0.74 ( P = 0.005) and age > 60 years ( P = 0.024) were independent risk factors for early recurrence in patients with single small hepatocellular carcinoma following radical resection. Conclusion:Preoperative AAR is an independent risk factor for early recurrence in patients with single small hepatocellular carcinoma following surgery, demonstrating excellent predictive value.
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Objective To analyze the prevalence and genetic characteristics of influenza A(H3N2) viruses in the city of Xiangyang in 2022-2023, and to provide a scientific basis for predicting the epidemic and mutation of influenza virus. Methods Throat swab specimens of the influenza like cases were collected from national influenza monitoring sentinel hospitals in Xiangyang every week. RNA was extracted from the specimens for influenza diagnosing using real-time RT-PCR．Viruses were isolated from H3N2 positive specimens, and HA and NA genes were amplified and sequenced．3D modeling analyses were conducted. Results The gene phylogenetic tree showed that the H3N2 isolates in 2022-2023 belonged to 3C.2a1b.2a1 and 3C.2a1b.2a2 branches, respectively. The A(H3N2) influenza virus strains all had amino acid point mutation sites on important antigenic determinants of HA protein. The epitope mutations of the 2022 A(H3N2) strain mainly occurred in regions B, C, and D. The epitope mutations of the A(H3N2) strain in 2023 mainly occurred in regions C and D. Different glycosylation sites of HA gene were found in 2022-2023 strains. No variation was found in key amino acid sites associated with neuraminidase inhibitor resistance. The difference of overall structure was not obvious in the three-dimensional simulation structure diagram. Conclusion The A(H3N2) influenza strains isolated in this study have shown antigenic drift, especially the mutation of HA, which may affect the protective effect of the vaccine on the local population and lead to influenza epidemic. The variations of HA and NA suggest that close attention should be paid to the epidemic and genetic variation of H3N2 subtype influenza virus, to provide a scientific basis for the selection of influenza virus vaccine strains and the prevention and control of influenza.
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BACKGROUND@#Teeth can be used as a raw material for preparing bone substitutes due to their similar chemical composition to bone. The objective of our study was to evaluate the effect of odontogenic biphasic calcium phosphate (BCP) incorporating dentin noncollagenous proteins (DNCPs) on osteogenesis and stability in maxillary sinus augmentation. @*METHODS@#The composition, structure and morphology of the odontogenic BCP were tested by X-ray powder diffraction (XRD), Brunauer–Emmett–Teller, and scanning electron microscopy methods. The biocompatibility and osteoinduction of DNCPs and materials were examined in vitro and their bone regeneration capacity was verified in vivo. @*RESULTS@#The results showed that the cells adhered and proliferated well on the DNCP-loaded BCP scaffold. The odontogenic BCP and DNCPs promoted osteogenic differentiation of cells, The new bone formation in the BCP groups and DNCP subgroups was significantly higher than the new bone formation in the control, and the new bone quality was better.The bone regeneration effect of odontogenic BCP was similar to the effect of deproteinized bovine bone mineral, but b-TCP did not maintain the height and volume of bone reconstruction. @*CONCLUSION@#In conclusion, the combined application of DNCPs and odontogenic BCP is an effective strategy for tissue engineering osteogenesis in the maxillary sinus region. The biomimetic strategy could provide a new approach for patients requiring maxillary sinus lifting.
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Objective: To investigate the effect of ubiquitin mutation at position 331 of tumor necrosis factor receptor related factor 6 (TRAF6) on the biological characteristics of colorectal cancer cells and its mechanism. Methods: lentivirus wild type (pCDH-3×FLAG-TRAF6) and mutation (pCDH-3×FLAG-TRAF6-331mut) of TRAF6 gene expression plasmid with green fluorescent protein tag were used to infect colorectal cancer cells SW480 and HCT116, respectively. The infection was observed by fluorescence microscope, and the expressions of TRAF6 and TRAF6-331mut in cells was detected by western blot. Cell counting kit-8 (CCK-8) and plate cloning test were used to detect the proliferation ability of colorectal cancer cells in TRAF6 group and TRAF6-331mut group, cell scratch test to detect cell migration, Transwell chamber test to detect cell migration and invasion, immunoprecipitation to detect the ubiquitination of TRAF6 and TRAF6-331mut with ubiquitinof lysine binding sites K48 and K63. Western blot was used to detect the effects of TRAF6 and TRAF6-331mut over expression on the nuclear factor kappa-B (NF-κB) and mitogen activated protein kinase mitogen-activated protein kinase (MAPK)/activating protein-1(AP-1) signal pathway. Results: The successful infection of colorectal cancer cells was observed under fluorescence microscope. Western blot detection showed that TRAF6 and TRAF6-331mut were successfully expressed in colorectal cancer cells. The results of CCK-8 assay showed that on the fourth day, the absorbance values of HCT116 and SW480 cells in TRAF6-331mut group were 1.89±0.39 and 1.88±0.24 respectively, which were lower than those in TRAF6 group (2.09±0.12 and 2.17±0.45, P=0.036 and P=0.011, respectively). The results of plate colony formation assay showed that the number of clones of HCT116 and SW480 cells in TRAF6-331mut group was 120±14 and 85±14 respectively, which was lower than those in TRAF6 group (190±21 and 125±13, P=0.001 and P=0.002, respectively). The results of cell scratch test showed that after 48 hours, the percentage of wound healing distance of HCT116 and SW480 cells in TRAF6-331mut group was (31±12)% and (33±14)%, respectively, which was lower than those in TRAF6 group [(43±13)% and (43±7)%, P=0.005 and 0.009, respectively]. The results of Transwell migration assay showed that the migration numbers of HCT116 and SW480 cells in TRAF6-331mut group were significantly lower than those in TRAF6 group (P<0.001 and P<0.002, respectively). The results of Transwell invasion assay showed that the number of membrane penetration of HCT116 and SW480 cells in TRAF6-331mut group was significantly lower than those in TRAF6 group (P=0.008 and P=0.009, respectively). The results of immunoprecipitation detection showed that the ubiquitin protein of K48 chain pulled by TRAF6-331mut was lower than that of wild type TRAF6 in 293T cells co-transfected with K48 (0.57±0.19), and the ubiquitin protein of K63 chain pulled down by TRAF6-331mut in 293T cells co-transfected with K63 was lower than that of wild type TRAF6 (0.89±0.08, P<0.001). Western blot assay showed that the protein expression levels of NF-κB, p-NF-κB and p-AP-1 in TRAF6-331mut-HCT116 cells were 0.63±0.08, 0.42±0.08 and 0.60±0.07 respectively, which were lower than those in TRAF6-HCT116 cells (P=0.002, P<0.001 and P<0.001, respectively). The expression level of AP-1 protein in TRAF6-HCT116 cells was 0.89±0.06, compared with that in TRAF6-HCT116 cells. The difference was not statistically significant (P>0.05). The protein expression levels of NF-κB, p-NF-κB and p-AP-1 in TRAF6-331mut-SW480 cells were 0.50±0.06, 0.51±0.04, 0.48±0.02, respectively, which were lower than those in TRAF6-SW480 cells (all P<0.001). There was no significant difference in AP-1 protein expression between TRAF6-331mut-SW480 cells and TRAF6-SW480 cells. Conclusion: The ubiquitin site mutation of TRAF6 gene at 331 may prevent the binding of TRAF6 and ubiquitin lysine sites K48 and K63, and then affect the expressions of proteins related to downstream NF-κB and MAPK/AP-1 signal pathways, and inhibit the proliferation, migration and invasion of colorectal cancer cells.
الموضوعات
Humans , Cell Line, Tumor , Cell Movement , Cell Proliferation , Colorectal Neoplasms/pathology , Lysine/metabolism , NF-kappa B/metabolism , TNF Receptor-Associated Factor 6/metabolism , Transcription Factor AP-1/metabolism , Ubiquitin/metabolismالملخص
OBJECTIVE@#To evaluate the long-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI) treated with different reperfusion strategies in Chinese county-level hospitals.@*METHODS@#A total of 2,514 patients with STEMI from 32 hospitals participated in the China Acute Myocardial Infarction registry between January 2013 and September 2014. The success of fibrinolysis was assessed according to indirect measures of vascular recanalization. The primary outcome was 2-year mortality.@*RESULTS@#Reperfusion therapy was used in 1,080 patients (42.9%): fibrinolysis ( n= 664, 61.5%) and primary percutaneous coronary intervention (PCI) ( n= 416, 38.5%). The most common reason for missing reperfusion therapy was a prehospital delay > 12 h (43%). Fibrinolysis [14.5%, hazard ratio ( HR): 0.59, 95% confidence interval ( CI) 0.44-0.80] and primary PCI (6.8%, HR= 0.32, 95% CI: 0.22-0.48) were associated with lower 2-year mortality than those with no reperfusion (28.5%). Among fibrinolysis-treated patients, 510 (76.8%) achieved successful clinical reperfusion; only 17.0% of those with failed fibrinolysis underwent rescue PCI. There was no difference in 2-year mortality between successful fibrinolysis and primary PCI (8.8% vs. 6.8%, HR = 1.53, 95% CI: 0.85-2.73). Failed fibrinolysis predicted a similar mortality (33.1%) to no reperfusion (33.1% vs. 28.5%, HR= 1.30, 95% CI: 0.93-1.81).@*CONCLUSION@#In Chinese county-level hospitals, only approximately 2/5 of patients with STEMI underwent reperfusion therapy, largely due to prehospital delay. Approximately 30% of patients with failed fibrinolysis and no reperfusion therapy did not survive at 2 years. Quality improvement initiativesare warranted, especially in public health education and fast referral for mechanical revascularization in cases of failed fibrinolysis.
الموضوعات
Humans , ST Elevation Myocardial Infarction/therapy , Percutaneous Coronary Intervention , East Asian People , Treatment Outcome , Myocardial Reperfusion , Myocardial Infarction , Registries , Hospitalsالملخص
Subepithelial connective tissue or free gingival grafts are often used in traditional mucogingival surgery to treat gingival recession and keratinized gingival insufficiency. However, due to the disadvantages of autologous soft tissue grafts, such as the preparation of the second surgical site, the limited amount of tissue in the donor site, and postoperative discomfort for patients, the research on autologous soft tissue substitute materials has attracted extensive attention. A variety of donor-substitute materials from different sources are currently used in membranous gingival surgeries, including platelet-rich fibrin, acellular dermal matrix, xenogeneic collagen matrix, etc. This paper reviews the research progress and application of several different types of substitute materials in soft tissue augmentation for natural teeth, providing a reference for the application of autologous soft tissue substitutes in clinical gingival augmentation surgery.
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The homing and engraftment of hematopoietic stem cells (HSC) into bone marrow is the first critical step for successful clinical hematopoietic stem cell transplantation (HSCT). SDF-1 / CXCR4 is considered to be a very promising target to promote HSC homing. In recent years, with the in-depth research on the HSC homing, a variety of new strategies for promoting HSC homing and engraftment have been explored, such as nuclear hormone receptor, histone deacetylase inhibitor, prostaglandin and metabolic regulation, so as to increase the success rate of HSCT and improve the survival of patients. In this review, the recent research advances in the mechanism of HSC homing and strategies to promote HSC homing and engraftment were summarized and discussed.
الموضوعات
Humans , Hematopoietic Stem Cells/physiology , Bone Marrow , Hematopoietic Stem Cell Transplantation , Gene Expression Regulation , Prostaglandins/metabolismالملخص
This study aims to investigate the effect of Astragali Radix-Curcumae Rhizoma(AC) combination on the proliferation, migration, and invasion of colon cancer HT-29 cells based on epithelial-mesenchymal transition(EMT). HT-29 cells were respectively treated with 0, 3, 6 and 12 g·kg~(-1) AC-containing serum for 48 h. The survival and growth of cells were measured by thiazole blue(MTT) colorimetry, and the proliferation, migration, and invasion of cells were detected by 5-ethynyl-2'-deoxyuridine(EdU) test and Transwell assay. Cell apoptosis was examined by flow cytometry. The BALB/c nude mouse model of subcutaneous colon cancer xenograft was established, and then model mice were classified into blank control group, 6 g·kg~(-1) AC group, and 12 g·kg~(-1) AC group. The tumor weight and volume of mice were recorded, and the histopathological morphology of the tumor was observed based on hematoxylin-eosin(HE) staining. The expression of apoptosis-associated proteins B-cell lymphoma-2-associated X protein(Bax), cysteine-aspartic acid protease-3(caspase-3), and cleaved caspase-3, and EMT-associated proteins E-cadherin, MMP9, MMP2 and vimentin in HT-29 cells and mouse tumor tissues after the treatment of AC was determined by Western blot. The results showed that cell survival rate and the number of cells at proliferation stage decreased compared with those in the blank control group. The number of migrating and invading cells reduced and the number of apoptotic cells increased in the administration groups compared with those in the blank control group. As for the in vivo experiment, compared with the blank control group, the administration groups had small tumors with low mass and shrinkage of cells and karyopycnosis in the tumor tissue, indicating that the AC combination may improve EMT. In addition, the expression of Bcl2 and E-cadherin increased and the expression of Bax, caspase-3, cleaved caspase-3, MMP9, MMP2, and vimentin decreased in HT-29 cells and tumor tissues in each administration group. In summary, the AC combination can significantly inhibit the proliferation, invasion, migration, and EMT of HT-29 cells in vivo and in vitro and promote the apoptosis of colon cancer cells.
الموضوعات
Humans , Animals , Mice , Caspase 3 , Matrix Metalloproteinase 2 , Matrix Metalloproteinase 9 , Vimentin , HT29 Cells , bcl-2-Associated X Protein , Colonic Neoplasms , Cell Proliferationالملخص
Immune thrombocytopenia (ITP) is an immune-mediated acquired hemorrhagic autoimmune disease. At present, the first-line therapeutic drugs for ITP include glucocorticoids and intravenous immunoglobulins. However, about 1/3 of the patients had no response to the first-line treatment, or relapsed after dose reduction or withdrawal of glucocorticoids. In recent years, with the gradual deepening of the understanding on the pathogenesis of ITP, the drugs targeting different pathogenesis continually emerge, including immunomodulators, demethylating agents, spleen tyrosine kinase (SYK) inhibitors and neonatal Fc receptor (FcRn) antagonist. However, most of these drugs are in clinical trials. This review summarized briefly the recent advances in the treatment of glucocorticoids resistance and relapsed ITP, so as to provide reference for the clinical treatments.
الموضوعات
Infant, Newborn , Humans , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Glucocorticoids/therapeutic use , Thrombocytopenia , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic useالملخص
Objective:To screen preoperative microvascular invasion (MVI)-related indicators in patients with hepatocellular carcinoma by machine learning, and to construct a predictive model for predicting MVI and evaluate it.Methods:The clinical data of hepatocellular carcinoma patients who underwent radical resection from January 2018 to March 2023 in General Hospital of Ningxia Medical University were retrospectively analyzed. A total of 437 patients were enrolled, including 325 males and 112 females, aged (56.3±13.6) years. The 437 patients were divided into a training set ( n=305) and a test set ( n=132) by computer-generated random numbers on a 7∶3 basis; the training set was used to construct the predictive model as well as to internally validate it by the five-fold cross-validation method, and the test set was used to externally validate the model. Two machine learning Boruta algorithm and LASSO regression, were used to screen MVI characteristic variables and construct multifactorial logistic regression prediction models. Receiver operating characteristic (ROC) curve, calibration curves, and decision curve were evaluated for predictive modeling, applying Shapley's additive explanatory analysis (SHAP) of the significance of key variables. Results:The intersection (5 variables) of 8 characteristic variables selected by Boruta algorithm and 8 variables selected by LASSO regression were selected: aspartate aminotransferase/lymphocyte ratio (ALR), tumor margin, intratumbral necrosis, tumor number and tumor maximum diameter, and the logistic regression model was constructed. The area under ROC curve for predicting the MVI were 0.77 (95% CI: 0.70-0.82) (training set), 0.76 (95% CI: 0.63-0.87) (validation set), and 0.84 (95% CI: 0.78-0.91) (test set). The prediction results of calibration curve logistic regression model were close to those of reagent, and the analysis of decision curve indicates that the model had good clinical application value. According to the mean absolute SHAP value, the order of importance was tumor margin, tumor maximum diameter, tumor number, ALR, and intratumoral necrosis. Conclusion:Tumor margin, tumor maximum diameter, tumor number, ALR and intratumoral necrosis were independent influencing factors for hepatocellular carcinoma associated with MVI, and the logistic regression model based on these factors was effective in predicting MVI.
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Femoral acetabular impingement (FAI) is a condition characterized by abnormal anatomical structures of the femoral head and/or acetabulum, leading to impingement between the proximal femur and the rim of the acetabulum during hip movement. This impingement causes damage to the acetabular cartilage, labrum, chronic hip pain, and limited range of motion. The diagnosis of this condition requires evaluation based on symptoms, physical signs, and imaging examinations. Among these, imaging plays a crucial role in assessing the pathology of FAI. In recent years, imaging techniques have contributed to a deeper understanding of the mechanisms underlying FAI and the development of hip-preserving surgeries. The purpose of this paper is to provide a reference for the imaging-related diagnosis and measurement of FAI. X-ray films include pelvic anteroposterior view, false-profile view and 45°Dunn view. Doctors can understand the anatomical morphology of the femur and acetabulum by measuring relevant indicators in the X-ray films. For example, the α Angle of the femur >50°-60 ° in the pelvic anteroposterior view can indicate CAM-type FAI. However, the crisscross sign, posterior wall sign and LCE Angle >40° suggest Pincer type FAI. The ACE Angle, which reflects the anterior coverage of the acetabulum, was mainly measured on the false-profile view. The ACE Angle <20° is considered as insufficient anterior acetabular coverage, and acetabular dysplasia may be present.If it >40° is the anterior acetabular overcoverage, suggesting pincer-type FAI. The 45°Dunn view is mainly used to show the femoral head and neck deformity at 3 o'clock, where the femoroacetabular impingement is obvious. This position has a good indication effect for CAM-type FAI. CT can show the shape of the hip joint more intuitively by three-dimensional reconstruction of the patient's hip joint, which is convenient for surgical planning and postoperative evaluation. In addition, CT can also be used for the differential diagnosis of external hip impingement, such as ischiofemoral impingement, anterior inferior iliac spine impingement and greatertrochanteric impingement. MR Has excellent soft tissue imaging ability and can show other lesions that are difficult to be found by X-ray and CT, such as acetabular labrum and cartilage injury. It is essential for preoperative evaluation. Appropriate imaging examination plays a key role in the diagnosis and treatment of FAI.
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Objective To investigate the mechanism of maslinic acid on pyroptosis and inflammato-ry response in myocardial ischemia/reperfusion(IR)injury.Methods H9C2 cardiomyocytes were randomly divided into control group,control+maslinic acid group,hypoxia reoxygenation(HR)group,and HR+maslinic acid group.Cellular model of HR injury was constructed by hypoxia for 4 h and then reoxygenation for 12 h.Forty-eight male SD rats were randomly divided into Sham group,IR group,IR+maslinic acid group,IR+maslinic acid+Tri group(n=12).Rat model of myocardial IR injury was established by ligating the left anterior descending branch for 30 min followed by reperfusion for 2 h.The viability of cardiomyocytes was detected,the levels of LDH,CK-MB,IL-1β and IL-18 in the supernatant of cardiomyocytes and rat serum samples were detec-ted in each group.Drug-molecular docking was performed to predict the binding site and binding force of maslinic acid and NOD-like receptor thermal protein domain-associated protein 3(NLRP3).Western blotting was used to detect IκBα,NF-κB P65,NLRP3,apoptosis-associated speck-like protein(ASC),and gasdermid D-N terminal(GSDMD-N)in each group of cardiomyo-cytes and myocardial tissues.Results Compared with the Control group,significantly reduced cell viability,enhanced protein levels of p-IκBα,p-NF-κB P65 and higher releases of LDH,IL-1β and IL-18 were observed in the HR group(P＜0.05).Maslinic acid treatment reversed HR-induced changes in above indicators(P＜0.05).Compared with the Sham group,the protein levels of p-IκBα,p-NF-κB P65,NLRP3,ASC,GSDMD-N and the releases of serum CK-MB,LDH,IL-1βand IL-18 were significantly increased in the IR group(P＜0.05).Maslinic acid treatment also reversed above indicators induced by IR injury(P＜0.05).The protein levels of p-IκBα,p-NF-κB P65,NLRP3,ASC and GSDMD-N were significantly increased,and the releases of serum CK-MB,LDH,IL-1β and IL-18 were also elevated in the IR+maslinic acid+Tri group than the IR+maslinic acid group(1681.00±136.20 U/L vs 1251.00±213.60 U/L,1776.00±185.80 U/L vs 1330.00±172.50 U/L,4.32±0.45 vs 2.95±0.26,3.89±0.20 vs 2.47±0.29,P＜0.05).Conclusion Maslinic acid can show target intervention in NLRP3 activity,thereby inhibiting inflammatory re-sponse and cell pyroptosis,and ultimately attenuate myocardial IR injury effectively.
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Objective:To comprehensively evaluate the quality of colonoscopy in Endoscopy Center of Gansu Provincial Hospital, and to provide baseline data and theoretical basis for evaluating the quality of digestive endoscopy in China.Methods:It is a single-center, retrospective and cross-sectional study. Data were collected from patients who underwent colonoscopy and received therapies in the Endoscopy Center of Gansu Provincial Hospital from 1st January to 31st December in 2021. The quality control indicators including polyp detection rate, adenoma detection rate, cecal intubation rate, and adequate intestinal preparation rate were analyzed to evaluate the quality of colonoscopy in the endoscopy center.Results:A total of 7 562 patients who underwent colonoscopy were included in this study, with the age of (51.61±13.59) years, including 4 286 males (56.7%) and 3 276 females (43.3%) . There were 4 924 (65.1%) outpatients and 2 638 (34.9%) inpatients. Procedures were completed by full-time endoscopists on 6 456 patients (85.4%) , and those were by gastroenterologists or proctologists on 1 106 patients (14.6%) . The overall adenoma detection rate, polyp detection rate, cecal intubation rate, and adequate intestinal preparation rate were 11.9% (900/7 562), 32.9% (2 488/7 562), 93.0% (7 030/7 562), and 91.3% (6 906/7 562) respectively. The male, the elder, in patients, and examined by full-time endoscopists were associated with higher adenoma detection rate and polyp detection rate with significant difference ( P<0.05). Conclusion:The cecal intubation rate and adequate intestinal preparation rate of colonoscopy in Gansu Provincial Hospital could meet the guideline standard, but the adenoma detection rate still needs to be further improved. The elder and male patients are the key population for colonoscopy screening. In addition, great importance should be attached to the standardized training of endoscopists to further improve the quality of colonoscopy.
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Objective:To investigate the influence of lymphadenectomy on efficacy of patients with intrahepatic cholangiocarcinoma (ICC) at different locations.Methods:The retro-spective cohort study was conducted. The clinicopathological data of 123 patients with ICC who were admitted to the Affiliated Hospital of North Sichuan Medical College from January 2015 to January 2022 were collected. There were 78 males and 45 females, aged 55(rage, 50?60)years. All patients underwent radical resection. Observation indicators: (1) clinical characteristics of patients with ICC; (2) follow-up; (3) surgical situations in ICC patients with different number of lymph nodes dissected. Measurement data with normal distribution were represented as Mean± SD, and compari-son between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Kaplan-Meier method was used to draw survival curve and Log-Rank test was used for survival analysis. Results:(1) Clinical characteristics of patients with ICC. Of the 123 patients, 81 cases had peripheral ICC and 42 cases had central ICC. The albumin-bilirubin grade (grade 1, grade 2?3), preoperative lymph node metastasis risk assessment (low risk, high risk), the number of lymph nodes dissected (<6, ≥6), lymph node metastasis (positive, negative) were 57, 24, 51, 30, 49, 32, 15, 66 in patients with peripheral ICC, versus 19, 23, 17, 25, 14, 28, 16, 26 in patients with central ICC, showing significant differences in the above indicators between them ( χ2=7.40, 5.66, 8.17, 5.62, P<0.05). (2) Follow-up. All the 123 patients were followed up for 28(range, 21?38)months. The 3-year overall survival rate was 57.8% in the 81 patients with peripheral ICC, versus 32.3% in the 42 patients with central ICC, showing a significant difference between them ( χ2=5.98, P<0.05). Of the 42 patients with central ICC, there were 25 cases with high risk of lymph node metastasis before surgery and 17 cases with low risk of lymph node metastasis before surgery. Of the 25 central ICC patients with high risk of lymph node metastasis before surgery, the 3-year overall survival rate was 28.9% in the 18 cases with the number of lymph nodes dissected ≥6, versus 14.3% in the 7 cases with the number of lymph nodes dissected <6, showing a significant difference between them ( χ2=8.90, P<0.05). (3) Surgical situa-tions in patients with the different number of lymph nodes dissected. Of the 123 patients, cases with the number of lymph nodes dissected <6 and ≥6 were 63 and 60, and there was no significant difference in the operation time, intraoperative blood transfusion, postoperative complications, bile leakage, liver insufficiency, pulmonary infection, pleural effusion, abdominal effusion, or lymphatic leakage between them ( P>0.05). One patient might have multiple complications. Conclusions:The prognosis of patients with peripheral ICC is better than that of patients with central ICC. For patients with central ICC who are at high risk of lymph node metastasis before surgery, adequate lymph node dissection may result in a better prognosis.
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【Objective】 To evaluate the efficacy and weight of sellar floor repair techniques such as different dura suture, bone reconstruction, and pedicled nasoseptal flap (PNSF) on the skull base reconstruction of medium and high flow cerebrospinal fluid leakage during endonasal endoscopic pituitary adenoma surgery. 【Methods】 We collected the data of Grade 2-3 cerebrospinal fluid leakage (Kelly grade) during endonasal endoscopic pituitary adenoma resection in our hospital from January 2015 to April 2021. Multiple reconstruction techniques such as dura suture, bone reconstruction and PNSF, and related factors such as age, sex, body mass index (BMI), diabetes, tumor size and diameter of diaphragmatic defect were recorded and introduced to multivariate regression to analyze the effects of the above factors on the duration of postoperative cerebrospinal fluid rhinorrhea and bed rest time, with a special focus on the weight priority of dura suture, bone reconstruction, and PNSF. 【Results】 A total of 281 patients were included, with the average age of (47±12.6) years, males accounting for 52.6%. There were 93 cases of PNSF, 268 cases of bone reconstruction, 109 cases of dura anchor suture, 50 cases of patch suture, and 122 cases without suture. The results of multivariate analysis indicated that the application of PNSF, bone reconstruction, and dura suture significantly reduced postoperative rhinorrhea time [reduced by 18.524, 35.876, and 16.983/19.791 (anchor suture/patch suture) hours, respectively; all PPNSF>bone reconstruction [Standard β=0.211/0.207 (anchor suture/patch suture)>0.200>0.165]. The weight of reducing bed time was bone reconstruction >dura suture > PNSF [Standard β=0.239>0.206/0.210 (anchor suture/patch suture) >0.164]. After stabilizing the learning curve in 25-30 cases, the average time for bone reconstruction was (3.9±0.4) minutes. After stabilizing learning curve in 30-40 cases, the dura suture technique took an average of (3.7±0.3) minutes per stitch, (3.7±1.0) stitches per case, and (13.6±2.7) minutes of total time consumption per case. 【Conclusion】 Dural anchoring and patching suture can both effectively shorten the duration of cerebrospinal fluid rhinorrhea and bed rest time. Bone reconstruction significantly improves the stability of reconstruction, especially in prompting patients’ early disengagement of bed rest. Moreover, the learning curves of the above two methods are economical and reasonable, and their weight is close to or even exceeds that of PNSF. Therefore, they can be an effective supplement or even substitute for PNSF.
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COVID-19 has been prevalent for three years. The virulence of SARS-CoV-2 is weaken as it mutates continuously. However, elderly patients, especially those with underlying diseases, are still at high risk of developing severe infections. With the continuous study of the molecular structure and pathogenic mechanism of SARS-CoV-2, antiviral drugs for COVID-19 have been successively marketed, and these anti-SARS-CoV-2 drugs can effectively reduce the severe rate and mortality of elderly patients. This article reviews the mechanism, clinical medication regimens, drug interactions and adverse reactions of five small molecule antiviral drugs currently approved for marketing in China, so as to provide advice for the clinical rational use of anti-SARS-CoV-2 in the elderly.
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Through the development of the guidance for case handling of radiological health law enforcement, health supervisors are instructed to accurately grasp the key points of law enforcement and case handling and standardize the process of collecting evidence and law application to ensure the correct implementation of administrative penalty. This article explains the structure and content of the guidance for case handling of radiological health law enforcement by taking the case of arranging radiation workers who have not undergone an occupational health examination to engage in the radiological occupational-disease-inductive operation in medical institutions as an example.
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Objective:To investigate the effects of mitochondrial arginyl-tRNA synthase (RARS2) on cell proliferation, invasion, migration and chemotherapy resistance of pancreatic cancer.Methods:Human pancreatic cancer cell lines AsPC-1 and PANC-1 were divided into negative control group, RARS2 interference group-1, RARS2 interference group-2, RARS2 overexpression control group and RARS2 overexpression group. Cell proliferation and sensitivity to gemcitabine were detected by CCK-8 assay, and cell invasion and migration were detected by Transwell assay. Western blot was used to detect the expression of RARS2 under different concentrations and different times of gemcitabine treatment. Western blot and PCR were used to detect the expression of RARS2 in gemcitabine-resistant AsPC cell.Results:Inhibition of RARS2 expression in AsPC-1 and PANC-1 cells significantly inhibited cell proliferation and enhanced sensitivity of gemcitabine to chemotherapy. Overexpression of RARS2 enhanced cell proliferation and decreased sensitivity to gemcitabine. In AsPC-1 cells, the number of migrated cells (100×) in negative control group, RARS2 interference group-1, RARS2 interference group-2, RARS2 overexpression control group and RARS2 overexpression group were (586.7±37.4) cells/field, (195.7±18.6) cells/field, (237.0±17.1) cells/field, (157.7±19.1) cells/field, (456.0±23.1) cells/field, the number of invasive cells were (87.7±13.2) cells/field, (24.7±6.5) cells/field, (31.7±6.1) cells/field, (29.3±4.5) cells/field, (94.3±9.3) cells/field, respectively. The migration and invasion ability of cells were decreased after the expression of RARS2 was decreased, and the migration and invasion ability of cells were enhanced after the expression of RARS2 was increased. PCR and Western blot assay showed that RARS2 expression in the gemcitabine-resistant AsPC-1 was higher than that in the common cell line. In AsPC-1 cells, the expression of RARS2 increased with increasing gemcitabine concentration and treatment time.Conclusion:RARS2 promotes cell proliferation, invasion, migration and chemoresistance of pancreatic cancer, and expression of RARS2 is positively correlated with gemcitabine concentration and treatment time.
الملخص
Stenotrophomonas maltophilia is a gram-negative bacillus which widely exists in natural and hospital environment, and it is also one of the common opportunistic pathogens in clinical settings. The virulence and pathogenicity of Stenotrophomonas maltophilia are weak, however, due to resistance to a variety of antibacterial drugs, it can cause bloodstream infections or pneumonia in immunocompromised or critically ill patients, leading to poor prognosis. Moreover, the inherent drug resistance and increasing acquired drug resistance may make the treatment of the first line antibiotics, like trimethoprim-sulfamethoxazole or quinolone ineffective. Therefore, it is important to understand the drug resistance mechanism and the main countermeasures for it. In this article, the research progress on drug resistance mechanism and treatment for Stenotrophomonas maltophilia are reviewed.
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Objective: To investigate the acute and long-term outcome of catheter ablation for the treatment of ventricular tachycardia (VT) in patients with arrhythmogenic left ventricular cardiomyopathy (ALVC). Methods: This retrospective, cross-sectional study enrolled ALVC patients undergoing radiofrequency ablation for the treatment of VT at the First Affiliated Hospital of Nanjing Medical University from January 2011 to December 2018 and collected their clinical characteristics and intraoperative electrophysiological examination. Patients were followed up every 6 months after radiofrequency ablation until August 2021. Echocardiographic results and VT recurrence post radiofrequency ablation were analysed. Results: Totally 12 patients were enrolled (mean age: (42±15) years, 11 males(11/12)). The mean of left ventricular end diastolic diameter (LVDd) and left ventricular ejection fraction (LVEF) were (51±5)mm and (65±5)%, respectively. Twelve VTs were induced in 10 patients during the electrophysiological study, and the mean tachycardia cycle length was (293±65) ms. Three-dimensional substrate mapping revealed the diseased area at endocardial site in one patient, at epicardial sites in the other 11 patients (involved endocardial sites in 2 cases) with the basal part near the mitral annulus being the predilection for the substrate (10/11). After the catheter ablation at the endocardial and epicardial sites respectively, the complete procedure endpoint was achieved in all patients (VT cannot be induced post ablation). The median follow-up time was 65 (25, 123) months. One patient was lost to follow-up, and the other 11 patients survived without VT. No significant cardiac function deterioration was detected by the echocardiographic examination ((51±5)mm vs. (52±5)mm, P>0.05 for LVDd, (65±5)% vs. (60±6)%, P>0.05 for LVEF) at the end of follow-up. Conclusion: After radiofrequency ablation, the complete procedure endpoint is achieved in ALVC patients, and the catheter ablation provides long-term ventricular tachycardia control during the long-term follow-up.