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Objective To investigate the expression and clinical significance of serum long non-coding RNA small nucleolar RNA host gene 16(lncRNA SNHG16)and mothers against decapentaplegic homolog 4(SMAD4)in elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection(PI).Methods A total of 237 elderly COPD patients admitted to the hospital from January 2021 to January 2023 were enrolled in the study.Among them,117 patients with concomitant PI were classified as the concur-rent group,and 120 patients without concomitant PI were classified as the COPD group.Real-time fluores-cence quantitative polymerase chain reaction(qRT-PCR)was applied to detect the expression level of serum lncRNA SNHG16 in two groups.Enzyme linked immunosorbent assay(ELISA)was applied to detect the lev-el of SMAD4 in patients'serum.Simplified clinical pulmonary infection scale(sCPIS)was used to evaluate the degree of PI of patients in the concurrent group.Multivariate Logistic regression was applied to analyze the in-fluencing factors of PI in elderly COPD patients.Correlation between serum lncRNA SNHG16,SMAD4 levels and sCPIS in elderly COPD patients with PI was analyzed by using Spearman correlation analysis.Receiver op-erating characteristic(ROC)curve was applied to analyze the diagnostic value of serum lncRNA SNHG16 and SMAD4 levels in elderly COPD patients with PI.Results The serum relative expression level of lncRNA SNHG16 in the concurrent group was higher than that in the COPD group,but the serum SMAD4 level was lower than that in the COPD group(P<0.05).In addition,the proportions of patients with age≥70 years,smoking history,complicated with diabetes and COPD course≥5 years and the levels of tumor necrosis fac-tor-α(TNF-α),interferon-γ(INF-γ)in the concurrent group were higher than those in the COPD group,and FEV1/FVC and the level of interleukin-10(IL-10)in concurrent group were lower than those in COPD group(P<0.05).Multivariate Logistic analysis showed that age≥70 years old,complicated with diabetes,COPD course≥5 years,high levels of TNF-α,INF-γ and lncRNA SNHG16 were risk factors for elderly patients with COPD complicated with PI(P<0.05),but high FEV1/FVC and high levels of SMAD4 and IL-10 were protective factors(P<0.05).Spearman correlation analysis showed that serum relative expression level of ln-cRNA SNHG16 was positively correlated with sCPIS in COPD patients with PI(r=0.505,P<0.001),while SMAD4 level was negatively correlated with sCPIS(r=-0.550,P<0.001).The area under the curve(AUC)of the combined diagnosis of serum lncRNA SNHG16 and SMAD4 for PI in elderly COPD patients was higher than those of individual diagnosis(Z=2.416,P=0.016;Z=2.375,P=0.018).Conclusion The serum relative expression level of lncRNA SNHG16 increases and SMAD4 level decreases in elderly COPD pa-tients with PI,both are influencing factors for elderly COPD patients complicated with PI,and both are related to the degree of PI in patients,and both have diagnostic value for elderly COPD patients complicated with PI,and the diagnostic efficacy of combined detection is better.
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BACKGROUND:In recent years,increasing studies have focused on the abnormal proliferation and differentiation of acinous cells in the meibomian gland,suggesting that this process is closely related to the occurrence and development of dry eye.Structural and functional abnormalities such as blockage of the lumen of the meibomian gland and atrophy of the glands can cause or exacerbate dry eye.Therefore,the study of changes in the meibomian glands in dry eyes is important for understanding the pathogenesis of dry eyes in depth and finding new targets for the treatment and prevention of dry eyes. OBJECTIVE:To investigate the changes of the meibomian gland in a mouse model of aqueous deficient dry eyes. METHODS:Thirty-two female C57/B6 mice at 6-8 weeks were selected and randomly divided into experimental and control groups with 16 mice in each group.The mice in the experimental group were constructed by removing both the extra-orbital and intra-orbital lacrimal glands,while those in the control group were not treated.After 2 weeks of normal feeding,the corneal changes of both groups were observed under a slit lamp,and the tear secretion of both groups was measured.The meibomian glands of the two groups of mice were removed after decapitation.The changes in the gross morphology of the meibomian glands were observed and the meibomian glands were made into frozen sections.Hematoxylin-eosin staining was used to observe the structure of the meibomian glands,oil red staining was used to evaluate the function of the meibomian glands,and immunofluorescence staining and RT-qPCR were used to observe the expression of cytokeratin 14,Ki67 and abnormally differentiated small proline-rich protein 1B in the meibomian glands of mice. RESULTS AND CONCLUSION:Two weeks after modeling,lamellar defects were seen in the corneas of the experimental mice,and neovascularization of the limbal corneal was generated and invaded the central cornea.(2)Tear secretion volume was significantly reduced in the experimental group compared with the control group(P<0.05).Microscopic findings showed that the ducts of the meibomian glands in the experimental group were interrupted and atrophied,and their arrangement was disorganized.Hematoxylin-eosin staining results showed a significant increase in lipid vacuoles in the meibomian glands of the experimental mice compared with the control group.Lipid deposition was seen in oil red staining in the experimental group.Immunofluorescence and RT-qPCR results showed a significant increase in the expression of cytokeratin 14,Ki67 and small proline-rich protein 1B in the meibomian glands of mice in the experimental group compared with the control group(P<0.05).To conclude,aqueous deficient dry eye can lead to compensatory hypertrophy,increased proliferation,and abnormal lipid metabolism in the meibomian gland,as well as abnormal differentiation of the meibomian gland.
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Setting up branches of public hospital is one of the important ways to allocate high-quality medical re-sources.However,medical quality homogenization is the core problem of multi-campus hospitals.As a result of dif-ferent qualities of clinical departments setting,personnel,supervision,information technology,etc.,it is difficult for hospital branches to achieve medical homogenization as the main campus.It elaborated the implementation path of medical quality homogenization in the construction of one hospital with four campuses in a large public hospital di-rectly under the National Health Commission based on SPO theory.In the three dimensions of structure,process and result,it described the specific practice of resource allocation,comprehensive supervision,performance evalua-tion and improvement,etc,thus to discuss the medical management strategies of different types of branches of hospitals,which is expected to be helpful to the construction of public hospitals with multi-campus.
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Objective To promote the construction of a national party building indicator system for public hospitals,provide reference for the development of system documents such as quality evaluation methods for party building work in public hospitals.Methods Conduct a comprehensive and systematic collection,organization,and analysis of policy documents related to party building in public hospitals in China since 2018,and organize expert discussions.Results The positive coefficients of the three rounds of expert discussions were all 100％,and the expert authority coefficient was 0.878.A party building indicator system was constructed with 7 primary indicators and 40 secondary indicators,including leadership system and decision-making mechanism,leadership team and cadre talent team construction,grassroots party organization construction,party member team construction,medical ethics and clean governance construction,party building work guarantee,and others.Conclusion The indicator system has been unanimously recognized by experts and is authoritative and feasible,laying the foundation for the refined party building work in public hospitals.
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With the increasing prevalence of total knee arthroplasty (TKA), there is a corresponding rise in the number of patients requiring revision of total knee arthroplasty (R-TKA) for various reasons. R-TKA presents several complex challenges, with severe bone defect reconstruction being a critical obstacle to securing favorable long-term outcomes. Recently, the approach to managing bone defects has seen significant advancements, with a range of techniques proposed contingent on the defect's size and location. Severe bone defects require reconstruction with autologous or allogeneic bone grafts or metal fillers. However, bone grafts have their usage constrained by limited availability, risks of resorption and collapse, and the potential for disease transmission. Consequently, metal fillers have received widespread attention in practical applications due to their advantages, such as comprehensive source, customizability, and safety. The advantages of metal augment are that they provide immediate support without reinforcement and are not subject to necrosis and resorptive collapse. However, the difference in elastic modulus between metal and bone may lead to stress shielding and increase the risk of potential bone loss. Both Cone and Sleeve can achieve biological fixation of metaphyseal bone; however, in cases of periprosthetic infections, it is generally difficult to remove them easily due to the prosthetic bone in-growth and osseointegration. This study aims to provide a comprehensive review of the use of metal fillers to reconstruct bone defects during R-TKA. It is intended to aid orthopedic surgeons in understanding the spectrum of reconstructive possibilities and provide high-performance revision strategies for their patients.
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Tumors continue to be a major challenge in human survival that we have yet to overcome. Despite the variety of treatment options available, we have not yet found an effective method. As more and more research is conducted, attention has been turned to a new field for tumor treatment—the tumor microenvironment (TME). This is a dynamic and complex environment consisting of various matrix cells surrounding cancer cells, including surrounding immune cells, blood vessels, extracellular matrix, fibroblasts, bone marrow-derived inflammatory cells, signaling molecules, and some specific cell types. Firstly, endothelial cells play a key role in tumor development and the immune system’s protection of tumor cells. Secondly, immune cells, such as macrophages, Treg cells, Th17 cells, are widely involved in various immune responses and activities in the human body, such as inflammation responses promoting survival carefully orchestrated by the tumor. Even though many studies have extensively researched the TME and found many research schemes, so far, no key effective method has been found to treat tumors by affecting the TME. The TME is a key interaction area between the host immune system and the tumor. Cells within the TME influence each other and interact with cancer cells to affect cancer cell invasion, tumor growth, and metastasis. This is a new direction for cancer treatment. In the complex environment of the TME, post-translational modifications (PTMs) of proteins have been proven to play an important role in the TME. PTMs are dynamic, strictly regulated changes to proteins that control their function by regulating their structure, spatial location, and interaction. Among PTMs, a reversible post-translational modification called SUMOylation is a common regulatory mechanism in cellular processes. It is a post-translational modification that targets lysine residues with a small ubiquitin-like modifier (SUMO) in a reversible post-translational modification manner. SUMOylation is widely involved in carcinogenesis, DNA damage response, cancer cell proliferation, metastasis, and apoptosis, playing a pivotal role in the TME, such as DNA damage repair, tumor metastasis, and also participates in immune cell differentiation, activation, and inhibition of immune cells. On the other hand, SUMO or sentrin-specific protease (SENP) inhibitors can interfere with the SUMOylation process, thereby affecting many biological processes, including immune response, carcinogenesis, cell cycle progression, and cell apoptosis, etc. In summary, this review aims to introduce the dynamic modification of protein SUMOylation on various immune cells and the application of various inhibitors, thereby exploring its role in the TME. This is a challenging but hopeful field, and we look forward to future research that can bring more breakthroughs. In conclusion, the TME is a complex and dynamic environment that plays a crucial role in the development and progression of tumors. Understanding the intricate interactions within the TME and the role of PTMs, particularly SUMOylation, could provide valuable insights into the mechanisms of tumor development and potentially lead to the development of novel therapeutic strategies. The study of SUMOylation and its effects on various immune cells in the TME is an exciting and promising area of research that could significantly advance our understanding of tumor biology and potentially lead to the development of more effective treatments for cancer. This is a challenging but hopeful field, and we look forward to future research that can bring more breakthroughs.
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Objective To explore the effects and mechanisms of a traditional Chinese medicine (TCM) prescription, "Fang-gan Decoction" (FGD), in protecting against SARS-CoV-2 spike protein-induced lung and intestinal injuries in vitro and in vivo.Methods Female BALB/c mice and three cell lines pretreated with FGD were stimulated with recombinant SARS-CoV-2 spike protein (spike protein). Hematoxylin-eosin (HE) staining and pathologic scoring of tissues, cell permeability and viability, and angiotensin-converting enzyme 2 (ACE2) expression in the lung and colon were detected. Enzyme-linked immunosorbent assay (ELISA) was performed to detect the levels of inflammatory factors in serum and cell supernatant. The expression of NF-κB p65, p-NF-κB p65, p-IκBα, p-Smad2/3, TGF-β1, Caspase3, and Bcl-2 was evaluated by Western blotting.Results FGD protected against the damage to the lung and colon caused by the spike protein in vivo and in vitro according to the pathologic score and cell permeability and viability (P<0.05). FGD up-regulated ACE2 expression, which was reduced by the spike protein in the lung and colon, significantly improved the deregulation of inflammatory markers caused by the spike protein, and regulated the activity of TGF-β/Smads and NF-κB signaling.Conclusion Traditional Chinese medicine has a protective effect on lung and intestinal tissue injury stimulated by the spike protein through possible regulatory functions of the NF-κB and TGF-β1/Smad pathways with tissue type specificity.
Subject(s)
Mice , Animals , Female , Humans , NF-kappa B/metabolism , Spike Glycoprotein, Coronavirus/pharmacology , Transforming Growth Factor beta1/metabolism , Angiotensin-Converting Enzyme 2/pharmacology , COVID-19 , SARS-CoV-2/metabolism , Lung , Antineoplastic Agents , Transforming Growth Factor beta/pharmacology , Epithelial Cells/metabolism , Colon摘要
OBJECTIVE@#To explore the effect of a modified three-point bending fracture device for establishing a rabbit model of closed tibial fracture.@*METHODS@#The model of closed tibial fracture was established in 40 6-month-old male New Zealand white rabbits with a body weight of 2.5 to 3.0 kg, and the model was verified at 6 weeks after operation. Five rabbits underwent pre modeling without temporary external fixation before modeling, and then were fractured with a modified three-point bending fracture device;35 rabbits underwent formal modeling. Before modeling, needles were inserted, and splints were fixed externally, and then the fracture was performed with a modified three-point bending fracture device. The fracture model and healing process were evaluated by imaging and histopathology at 2 hours, 4 weeks, and 6 weeks after operation.@*RESULTS@#Two hours after modeling, the prefabricated module showed oblique fracture in varying degrees and the broken end shifted significantly;Except for 1 comminuted fracture, 2 curved butterfly fractures and 2 without obvious fracture line, the rest were simple transverse and oblique fractures without obvious displacement in formal modeling group. According to the judgment criteria, the success rate of the model was 85.71%. Four weeks after modeling, the fixed needle and splint of the experimental rabbits were in good position, the fracture alignment was good, the fracture line was blurred, many continuous callus growths could be seen around the fracture end, and the callus density was high. Six weeks after modeling, many thick new bone trabeculae at the fracture, marginal osteoblasts attached, and a small number of macrophages were seen under the microscope. The intramembrane osteogenesis area was in the preparation bone stage, the medullary cavity at the fracture had been partially reopened, the callus was in the absorption plastic stage, and many osteoclasts were visible. The X-ray showed that the fracture line almost disappeared, part of the medullary cavity had been opened, the external callus was reduced around, the callus was in the plastic stage, and the bone cortex was continuous. It suggests that the fracture model showed secondary healing.@*CONCLUSION@#The improved three-point bending fracture device can establish a stable rabbit model of closed tibial fracture, and the operation is simple, which meets the requirements of closed fracture model in basic research related to fracture healing.
Subject(s)
Rabbits , Male , Animals , Bony Callus , Fracture Healing , Tibial Fractures/surgery , Osteogenesis , Radiography摘要
@#Objective To explore the causes of conversion to thoracotomy in patients with minimally invasive esophagectomy (MIE) in a surgical team, and to obtain a deeper understanding of the timing of conversion in MIE. Methods The clinical data of patients who underwent MIE between September 9, 2011 and February 12, 2022 by a single surgical team in the Department of Thoracic Surgery of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. The main influencing factors and perioperative mortality of patients who converted to thoracotomy in this group were analyzed. Results In the cohort of 791 consecutive patients with MIE, there were 520 males and 271 females, including 29 patients of multiple esophageal cancer, 156 patients of upper thoracic cancer, 524 patients of middle thoracic cancer, and 82 patients of lower thoracic cancer. And 46 patients were converted to thoracotomy for different causes. The main causes for thoracotomy were advanced stage tumor (26 patients), anesthesia-related factors (5 patients), extensive thoracic adhesions (6 patients), and accidental injury of important structures (8 patients). There was a statistical difference in the distribution of tumor locations between patients who converted to thoracotomy and the MIE patients (P<0.05). The proportion of multiple and upper thoracic cancer in patients who converted to thoracotomy was higher than that in the MIE patients, while the proportion of lower thoracic cancer was lower than that in the MIE patients. The perioperative mortality of the thoracotomy patients was not significantly different from that of the MIE patients (P=1.000). Conclusion In MIE, advanced-stage tumor, anesthesia-related factors,extensive thoracic adhesions, and accidental injury of important structures are the main causes of conversion to thoracotomy. The rate varies at different tumor locations. Intraoperative conversion to thoracotomy does not affect the perioperative mortality of MIE.
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Objective:To explore the effect of total hip arthroplasty via modified direct anterior approach on hip function, balance function and gait parameters in patients undergoing primary total hip arthroplasty.Methods:Eighty-nine patients who underwent total hip arthroplasty for the first time in Anqing First People′s Hospital of Anhui Medical University from January 2020 to December 2021 were selected as the study subjects by prospective study, and they were divided into the observation group (modified direct anterior approach total hip arthroplasty, 45 cases) and the control group [direct anterior approach (DAA) total hip arthroplasty, 44 cases] according to the random number table method. Perioperative indexes of the two groups were observed and complications were counted, and hip function, balance function, gait parameters and follow-up imaging data were compared between the two groups at 1 year after postoperative follow-up.Results:After treatment, the anal exhaust time, hospital stay, blood loss, ambulation time and postoperative feeding time in observation group were shorter or less than those in control group:(9.15 ± 1.33) h vs. (10.89 ± 1.53) h, (5.07 ± 2.21) d vs. (7.04 ± 2.23) d, (53.48 ± 12.43) ml vs. (64.44 ± 12.53) ml, (4.07 ± 0.21) d vs. (6.15 ± 1.24) d, (0.47 ± 0.13) d vs. (0.75 ± 0.24) d, P<0.05. At 3, 6 and 12 months after treatment, the hip function scores in the two groups were risen compared with those before treatment ( P<0.05), and the above hip function scores in observation group were higher compared to control group: (65.47 ± 8.38) points vs. (57.91 ± 2.83) points, (76.12 ± 5.31) points vs. (72.25 ± 2.44) points, (85.27 ± 4.45) points vs. (83.24 ± 4.55) points, P<0.05. The balance function scores of the two groups at 3, 6 and 12 months after treatment were enhanced compared with those before treatment ( P<0.05), and the balance function scores in observation group were higher than those in control group: (35.26 ± 1.22) points vs. (29.51 ± 1.49) points, (39.42 ± 4.36) points vs. (37.57 ± 2.21) points, (45.57 ± 2.01) points vs. (43.36 ± 2.18) points, P<0.05. The stride distance and stride length in the observation group were higher compared to the control group: (0.78 ± 0.12) m vs. (0.71 ± 0.19) m, (0.46 ± 0.04) m vs. (0.32 ± 0.08) m, while the stride frequency and gait asymmetry index were lower than those in the control group: (89.74 ± 8.05) steps/min vs. (98.68 ± 9.04) steps/min, 0.10 ± 0.02 vs. 0.16 ± 0.05, P<0.05. After treatment, the incidence rate of complications in the observation group was lower than that in the control group: 2.44%(1/41) vs. 19.51%(8/41), P<0.05. At 1-month follow-up after surgery, there were no statistical differences in acetabular cup anteversion angle, abduction angle, femoral stem peripheral zona pellucida score, and lower limb lebgth between the two groups ( P>0.05). Conclusions:Modified direct anterior approach total hip arthroplasty can promote postoperative recovery, improve hip function, enhance balance function, reduce risk of complications, and improve gait parameters.
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This article reported a case of kaposiform lymphangiomatosis (KLA) identified in the fetal stage and diagnosed at the neonatal stage. A routine ultrasound examination at 19 weeks of gestation showed multiple masses in the whole body of the fetus (involving neck, chest wall and armpit) complicated by pleural and peritoneal effusion. Shunting was performed to drain pleural effusion from the right chest in another hospital at 26 +5 weeks of gestation. The patient was born at 34 +3 weeks of gestation by cesarean section due to "intrauterine distress" and required invasive ventilator assisted ventilation support after birth because of respiratory distress. A large amount of hemorrhagic effusion was drained out during the shunting. Coagulation dysfunction and thrombocytopenia occurred on the 3rd day after birth and KLA was suspected. Empirical treatment with sirolimus turned out to be ineffective. Biopsy was taken on postnatal day 7. However, the patient died on the 12th day after birth due to respiratory and circulatory failure. Pathological findings obtained the day after death were consistent with the features of KLA. The diagnosis of KLA was confirmed based on the clinical manifestations and pathological results.
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Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a common hereditary cerebral small vessel disease, and white matter lesion is its classic pathological feature. MRI showed T 2 white matter hyperintensity, its pathogenesis is complex, and the effective preventive measures are still lacking. This article reviews the possible mechanism of white matter lesion in patients with CADASIL, and provides new ideas for clinical alleviation of white matter lesion and improvement of prognosis.
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OBJECTIVE@#To investigate the inhibitory effect of 27-P-coumayl-ursolic acid (27-P-CAUA), the active ingredient in triterpenoids from the leaves of Ilex latifolia Thunb, against breast cancer cells and explore the underlying mechanism.@*METHODS@#CCK-8 assay was used to assess the changes in viability of breast cancer HCC-1806 cells after 27-P-CAUA treatment for 24, 48, or 72 h. The inhibitory effect of 27-P-CAUA on proliferation of the cells was determined by clonogenic assay. JC-1 was used to detect the changes in mitochondrial membrane potential and flow cytometry was performed for analyzing cell apoptosis following 27-P-CAUA treatment. Immunofluorescence assay was used to observe the expression of cl-caspase-3 and P62 in the treated cells. Western blotting was performed to observe the effect of 27-P-CAUA and chloroquine pretreatment on the expressions of LC3I/II, P62 and HER2 signaling pathway proteins in the cells.@*RESULTS@#The results of CCK-8 and clonogenic assays showed that 27-P-CAUA treatment significantly inhibited the proliferation of HCC-1806 cells (P < 0.01) with IC50 values of 81.473, 48.392 and 18.467 μmol/L at 24, 48, and 72 h, respectively. 27-P-CAUA treatment also caused obvious changes in mitochondrial membrane potential (P < 0.01) and induced cell apoptosis in HCC-1806 cells with a 3.34% increase of the early apoptosis rate. Immunofluorescence assay revealed a significant increase of cl-caspase3 expression in 27-P-CAUA-treated HCC-1806 cells, and treatment with 40 μmol/L 27-P-CAUA resulted in significant cell apoptosis (P < 0.01). 27-P-CAUA obviously reduced the expression of LC3II, caused P62 degradation and induced autophagy in HCC-1806 cells. Chloroquine pretreatment obviously blocked the autophagy-inducing effect of 27-P-CAUA. 27-P-CAUA treatment also inhibited the phosphorylation of HER2 and AKT proteins and progressively lowered the expressions of HER2 and phosphorylated AKT protein in HCC-1806 cells (P < 0.01).@*CONCLUSION@#27-P-CAUA can inhibit the proliferation and induce mitochondrial autophagy and apoptosis of HCC-1806 cells by inhibiting the HER2/PI3K/AKT signaling pathway.
Subject(s)
Female , Humans , Apoptosis , Autophagy , Breast Neoplasms , Carcinoma, Hepatocellular/metabolism , Cell Line, Tumor , Cell Proliferation , Liver Neoplasms/metabolism , Phosphatidylinositol 3-Kinases/metabolism , Proto-Oncogene Proteins c-akt/metabolism , Signal Transduction摘要
Objective:To investigate the clinicopathological characteristics and prognostic factors of patients with esophageal cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 447 patients with esophageal cancer who were admitted to the Fourth Hospital of Hebei Medical University from January 1, 2017 to December 31, 2020 were collected. There were 312 males and 135 females, aged 60(range, 37?82)years. Observation indica-tors: (1) clinicopathological characteristics; (2) treatment; (3) follow-up; (4) analysis of prognostic factors for esophageal cancer. Follow-up using telephone interview or outpatient examination was conducted to detect survival of patients up to December 2021. The total survival time was from the surgery date to death or the last follow-up. Patients with duration of follow-up more than 2 years were included for survival and prognostic analysis. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were represented as absolute numbers. Kaplan-Meier method was used to draw survival curves and calculate survival rates. Log-Rank test was used for survival analysis. Univariate analysis was conducted using the Log-rank test. Multivariate analysis was conducted using the COX hazard regression model. Results:(1) Clinicopathological characteristics. Of the 447 patients, 69.80%(312/447) were males and 30.20%(135/447) were females, and there were 3, 18, 101, 229, 93, 3 cases aged 30?39 years, 40?49 years, 50?59 years, 60?69 years, 70?79 years, 80?89 years, respectively. About the pathological type, there were 424 cases with squamous carcinoma, 11 cases with small cell carcinoma, 4 cases with adenosquamous carcinoma, 3 cases with sarco-matoid carcinoma, 2 cases with adenocarcinoma, 1 case with neuroendocrine carcinoma, 1 case with undifferentiated carcinoma, and 1 case with adenoid cystic carcinoma. There were 2 cases with tumor located at cervicothoracic segment, 49 cases with tumor located at upper thoracic segment, 273 cases with tumor located at mid-thoracic segment, and 123 cases with tumor located at lower thoracic segment. There were 6, 24, 74, 59, 192, 80, 12 cases in stage pT0, pT1a, pT1b, pT2, pT3, pT4a, pT4b of pathological T staging, respectively. There were 207, 63, 142, 28, 7 cases in stage pN0, pN1, pN2, pN3, pN4 of pathological N staging by Japan Esophagus Society (JES), respectively. There were 207, 128, 76, 36 cases in stage pN0, pN1, pN2, pN3 of pathological N staging by Union for International Cancer Control (UICC), respectively. About TNM staging, there were 25, 53, 127, 174, 68 cases in stage 0, Ⅰ, Ⅱ, Ⅲ, Ⅳa of JES staging, and 16, 9, 53, 35, 108, 96, 45, 85 cases in stage 0, Ⅰa, Ⅰb,Ⅱa, Ⅱb, Ⅲa, Ⅲb, Ⅲc of UICC staging, respectively. (2) Treatment. Of the 447 patients, 63 cases underwent neoadjuvant therapy(12 cases combined with immunotherapy), 384 cases underwent no neoadjuvant therapy. There were 347, 97, 2, 1 cases with surgical approach as right thoracic approach, left thoracotomy approach, cervical abdominal approach, left thoracoabdominal approach, respectively. There were 316, 5, 126 cases with surgical platform as totally endoscopic esophagec-tomy, Hybrid surgery, open surgery, respectively. There were 350 and 97 cases with digestive recons-truction as posterior mediastinal approach and intrathoracic approach, respectively. Surgical margin as R 0, R 1, R 2 resection was detected in 323, 116, 8 cases, respectively. Six of 447 patients died during the hospital stay. (3) Follow-up. All the 447 patients were followed up for 25(range, 2?48)months, including 233 cases with the follow-up more than 2 years. The median survival time of 233 patients was unreached, and the postoperative 2-year survival rate was 76.8%. (4) Analysis of prognostic factors for esophageal cancer. Results of univariate analysis showed that gender, neoadjuvant therapy, surgical margin, pT staging, pN staging by JES, pN staging by UICC, TNM staging by JES, TNM staging by UICC were related factors influencing prognosis of 233 patients with esophageal cancer ( χ2=6.62, 17.81, 32.95, 37.93, 27.06, 35.56, 45.24, 37.84, P<0.05). Results of multivariate analysis showed that gender, surgical margin, TNM staging by JES were independent factors influencing prognosis of 233 patients with esophageal cancer ( hazard ratio=0.48, 1.94, 1.46, 95% confidence intervals as 0.25?0.91, 1.07?3.52, 1.16?1.84, P<0.05). Conclusions:The incidence of esophageal cancer is relatively high in males, with the onset age mainly distribute in 60?69 years and the mainly pathological type as squamous carcinoma. Patients with esophageal cancer have advanced tumor staging, low proportion of neoadjuvant therapy, high R 0 resection rate of surgical treatment. Gender, surgical margin, TNM staging by JES are independent factors influencing prognosis of patients with esophageal cancer.
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Objective:To compare the clinical effects of hip arthroplasty through direct anterior approach (DAA) in lateral decubitus in the treatment of hip osteoarthritis caused by Kaschin-Beck disease and congenital acetabular dysplasia.Methods:The prospective study method was used to select the patients who needed hip arthroplasty in the Fourth Department of Orthopedics, the Second Affiliated Hospital of Harbin Medical University from January 2015 to December 2019. All of them were operated with lateral decubitus DAA. According to the inclusion criteria, they were divided into Kacshin-Beck disease hip osteoarthritis group (group A) and congenital acetabular dysplasia hip osteoarthritis group (group B). Hip Harris score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, visual analogue scale (VAS) score were conducted, and hip abduction angle and flexion angle were measured before surgery, 3, 14 days and 1, 3, and 12 months after surgery.Results:Nineteen and twenty-two patients were included in group A and group B, respectively. All patients successfully completed the surgery. There was no significant difference in Harris score between the two groups before surgery, 3, 14 days, and 1, 12 months after surgery ( P > 0.05). There were no significant differences in WOMAC score, VAS score, hip abduction angle and hip flexion angle between the two groups before surgery and each time point after surgery ( P > 0.05). In the same group, there were significant differences in Harris score, WOMAC score, VAS score, hip abduction angle and hip flexion angle at different time points ( P < 0.001). All postoperative indicators were significantly improved compared with those before surgery. Conclusions:There is no significant difference in the clinical effects of hip arthroplasty through lateral decubitus DAA in the treatment of hip osteoarthritis caused by Kaschin-Beck disease and congenital acetabular dysplasia. This surgical method has good therapeutic effect on both types of hip osteoarthritis.
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Objective:To compare the efficacy of arthroscopic anterior cruciate ligament reconstruction using tendon autograft with figure-of-four position and traditional knee hyperflexed position for femoral tunnel creation.Methods:A retrospective case series study was conducted to analyze the clinical data of 46 patients with ACL injury admitted to Second Affiliated Hospital of Harbin Medical University from August 2019 to October 2019, including 26 males and 20 females; aged 24-40 years [(31.1±7.5)years]. All patients underwent arthroscopic ACL reconstruction using tendon autograft. The femoral tunnel was created with figure-of-four position in 21 patients (figure-of-four position group) and with traditional knee hyperflexed position in 25 patients (knee hyperflexed position group). The operation time was compared between the two groups. The center position, length and angle of femoral tunnel were evaluated and measured by three dimensional CT reconstruction and Bernard quadrant method at 8 weeks postoperatively. The knee function was assessed by knee Lysholm score preoperatively, at 8 weeks and at 1 year postoperatively. Complications were observed as well.Results:All patients were followed up for 2-20 months [(15.3±2.1)months]. The operation time was (28.5±2.6)minutes in figure-of-four position group, significantly less than (39.5±2.4)minutes in knee hyperflexed position group ( P<0.05). The tunnel center position was located at (27.1±1.4)% and (25.1±2.6)% within the Bernard quadrant in figure-of-four position group, similar with (28.1±2.8)% and (26.1±3.1)% in knee hyperflexed position group (all P>0.05). Total tunnel length and thick tunnel length were (42.1±2.4)mm and (34.1±2.4)mm in figure-of-four position group, significantly longer than (38.2±2.5)mm and (31.1±2.7)mm in knee hyperflexed position group (all P<0.05). The coronal plane angle of the tunnel was (41.1±2.4)° in figure-of-four position group, significantly smaller than (47.5±2.6)° in knee hyperflexed position group ( P<0.05). The sagittal plane angle of the tunnel was (42.1±1.4)° in figure-of-four position group, significantly greater than (37.1±1.8)° in knee hyperflexed position group ( P<0.05). Figure-of-four position group showed the knee Lysholm score of (53.4±5.2)points preoperatively, (97.1±1.4)points at 8 weeks postoperatively and (98.3±2.3)points at 1 year postoperatively. Knee hyperflexed position group showed the knee Lysholm score of (54.3±7.4)points preoperatively, (97.1±1.6)points at 8 weeks postoperatively and (98.1±1.3)points at 1 year postoperatively. The knee Lysholm score did not differ significantly between the two groups (all P>0.05), but the knee function was significantly improved in both groups when compared with that before the operation (all P<0.05). There were 1 patient with femoral tunnel fracture, one with injury to the medial condylar cartilage and one with injury to the posterior root of lateral meniscus in knee hyperflexed position group, while no above-mentioned complications occurred in figure-of-four position group ( P<0.05). Conclusion:Arthroscopic ACL reconstruction using tendon autograft with femoral tunnel creation through figure-of-four position and traditional knee hyperflexed position can both contribute knee functional recovery, but the figure-of-four position has the advantages of short operation time, accurate tunnel positioning, favorable length and angle of the tunnel and less complications.
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Objective: To examine the associations between plasma n-3 polyunsaturated fatty acids (PUFAs) in the second trimester and gestational diabetes mellitus (GDM) among Chinese pregnant women. Methods: Based on data from the Tongji-Shuangliu Birth Cohort enrolled from 2017 to 2019 in the Shuangliu Maternal and Child Health Hospital, it conducted a case-control study among 269 GDM cases who were diagnosed by 75 g oral glucose tolerance test, and 538 non-GDM controls matched at a 1∶2 ratio on maternal age and gestational weeks. The age range of the 807 women was 18-40 years. Fasting plasma n-3 PUFAs were determined by gas chromatography-mass spectrometry in the second trimester (24-28 weeks). Participants were categorized into quartiles (Q1-Q4) of plasma n-3 PUFAs based on distributions in the control group. Conditional logistic regression models were applied to estimate the associations between plasma n-3 PUFAs and GDM. Results: The median (interquartile) relative concentrations of plasma n-3 PUFA C22∶5n-3 was significantly lower in women with GDM 0.87 (0.72, 1.07) compared with women without GDM 0.94 (0.75, 1.19)(P=0.001). Plasma n-3 PUFA C22∶5n-3 was inversely associated with GDM, with an OR (95%CI) of 0.75 (0.62-0.90) for each SD increase of relative concentration. Compared with the Q1 group, the OR values and 95%CIs of Q2, Q3, and Q4 groups were 0.97 (0.62-1.51), 0.72 (0.45-1.15), and 0.54 (0.32-0.90), respectively (Ptrend<0.05). However, there were no significant associations of C18∶3n-3, C20∶5n-3, C22∶6n-3, and total n-3 PUFAs with GDM. Conclusion: Plasma n-3 PUFA C22∶5n-3 was inversely associated with GDM during the second trimester.
Subject(s)
Child , Female , Humans , Pregnancy , Case-Control Studies , Diabetes, Gestational , Fatty Acids, Unsaturated , Glucose Tolerance Test , Pregnancy Trimester, Second摘要
Background@#and Purpose This study aimed to construct an optimal dynamic nomogram for predicting malignant brain edema (MBE) in acute ischemic stroke (AIS) patients after endovascular thrombectomy (ET). @*Methods@#We enrolled AIS patients after ET from May 2017 to April 2021. MBE was defined as a midline shift of >5 mm at the septum pellucidum or pineal gland based on follow-up computed tomography within 5 days after ET. Multivariate logistic regression and LASSO (least absolute shrinkage and selection operator) regression were used to construct the nomogram. The area under the receiver operating characteristic curve (AUC) and decisioncurve analysis were used to compare our nomogram with two previous risk models for predicting brain edema after ET. @*Results@#MBE developed in 72 (21.9%) of the 329 eligible patients. Our dynamic web-based nomogram (https://successful.shinyapps.io/DynNomapp/) consisted of five parameters: basal cistern effacement, postoperative National Institutes of Health Stroke Scale (NIHSS) score, brain atrophy, hypoattenuation area, and stroke etiology. The nomogram showed good discrimination ability, with a C-index (Harrell’s concordance index) of 0.925 (95% confidence interval=0.890–0.961), and good calibration (Hosmer-Lemeshow test, p=0.386). All variables had variance inflation factors of 0.7, suggesting no significant collinearity among them. The AUC of our nomogram (0.925) was superior to those of Xiang-liang Chen and colleagues (0.843) and Ming-yang Du and colleagues (0.728). @*Conclusions@#Our web-based dynamic nomogram reliably predicted the risk of MBE in AIS patients after ET, and hence is worthy of further evaluation.
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Objective:To evaluate the value of 99Tc m-hydrazinonicotinamide-(poly-(ethylene glycol)) 4-E((poly-(ethylene glycol)) 4-c((Arg-Gly-Asp)fK)) 2 (3PRGD 2) imaging on predicting pathological complete response (pCR) outcomes to neoadjuvant chemotherapy (NAC) in patients with breast cancer and to compare it with 18F-FDG imaging. Methods:From October 2017 to October 2019, 41 patients (age: (61.5±7.8) years) who were diagnosed with stage Ⅱ and Ⅲ breast cancer and planned to receive preoperative NAC in the First Affiliated Hospital of Fujian Medical University and Xiehe Affiliated Hospital of Fujian Medical University were prospectively enrolled. All patients underwent both 99Tc m-3PRGD 2 and 18F-FDG imaging before NAC (baseline), and after the first and the fourth NAC cycle. The tumor/background ratio (T/B; 99Tc m-3PRGD 2) and SUV max ( 18F-FDG) in breast tumors and axillary lymph node (ALN) metastases were separately calculated. The relative T/B changes (ΔT/B 1, ΔT/B 2) and SUV max changes (ΔSUV max1, ΔSUV max2) after the first and the fourth NAC cycle compared to baseline were obtained. Patients underwent surgery after NAC and the pathology was used as the gold standard to determine whether patient achieved pCR. The predictive performance of ΔT/B and ΔSUV max regarding the identification of pCR or non-pCR was evaluated by using ROC analysis and the AUCs were compared by Delong test. Results:Of 41 patients, 13 (31.7%) were achieved pCR after NAC. For breast tumors, the AUCs of ΔT/B 1, ΔT/B 2, ΔSUV max1 and ΔSUV max2 were 0.827 ( P=0.001), 0.687 ( P=0.057), 0.859 ( P<0.001) and 0.713 ( P=0.030) respectively, and the AUCs of ΔT/B 1 and ΔSUV max1 had no significant difference ( z=0.33, P=0.740). For ALN metastases, the AUCs of ΔT/B 1, ΔT/B 2, ΔSUV max1 and ΔSUV max2 were 0.859 ( P=0.002), 0.778 ( P=0.014), 0.572 ( P=0.523) and 0.802 ( P=0.007) respectively, and the AUC of ΔT/B 1 was significantly higher than that of ΔSUV max1 ( z=2.10, P=0.035). Conclusion:The early relative changes of breast tumors and ALN metastases in 99Tc m-3PRGD 2 imaging during NAC can offer predictive information for pCR to NAC in patients with breast cancer, and early relative changes of ALN metastases in 99Tc m-3PRGD 2 imaging may have a higher predictive value for pCR than 18F-FDG imaging.
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Lung cancer， a malignancy with high incidence rate and mortality rate， is a major threat to human life and health. At present， the common methods for the treatment of lung cancer include surgical resection， radiotherapy， chemotherapy， targeted therapy， and immunotherapy， but these methods generally have the problems of severe toxic/side effect and high treatment cost. Traditional Chinese medicine（TCM） has a history of more than 2 000 years of application in China and has its unique advantages in the treatment of tumors. Modern pharmacological experiments have found that TCM can inhibit tumor growth， prolong patients' survival， and improve clinical symptoms and patients' quality of life by inducing tumor cell apoptosis， inhibiting tumor angiogenesis， and reducing tumor cell drug resistance. Apoptosis is a process of spontaneous programmed cell death， which is closely related to the occurrence and development of the tumor. Studies have shown that many Chinese medicines can inhibit the development of lung cancer by inducing apoptosis. This study searched， analyzed， and summarized the available papers on the mechanism of TCM in the treatment of lung cancer by inducing apoptosis. It is found that Chinese medicine induces lung cancer cell apoptosis mainly by regulating apoptosis-related factors and apoptosis-related signaling pathways ［inhibitor of apoptosis proteins （IAPs）， B cell lymphoma-2 （Bcl-2）， p53 protein， the second mitochondria-derived activator of caspase （SMAC）/direct IAP-binding protein with low isoelectric point （DIABLO）， extrinsic apoptotic pathway， endogenous mitochondrial pathway， Janus kinase （JAK）/signal transducer and activator of transcription （STAT） signaling pathway， mitogen-activated protein kinase （MAPK） signaling pathway， and phosphoinositide 3-kinase （PI3K）/protein kinase B （Akt） signaling pathway. In addition， the Wnt/β-catenin/survivin signaling pathway and the Notch signaling pathway also play an important role in inducing apoptosis.