Apatinib combined with olaparib induces ferroptosis via a p53-dependent manner in ovarian cancer.

OBJECTIVE: PARP inhibitors combined with antiangiogenic drugs have been reported to improve outcomes in BRCA wild-type ovarian cancer patients, the mechanism of the combination is unclear. In this study, we explored the mechanism of apatinib combined with olaparib in the treatment of ovarian cancer. METHODS: In this study, human ovarian cancer cell lines A2780 and OVCAR3 were used as experimental objects, and the expression of ferroptosis-related protein GPX4 after treatment with apatinib and olaparib was detected by Western blot. The SuperPred database was used to predict the target of the combined action of apatinib and olaparib, and the predicted results were verified by Western blot experiment to explore the mechanism of ferroptosis induced by apatinib and olaparib. RESULTS: Apatinib combined with olaparib-induced ferroptosis in p53 wild-type cells, and p53 mutant cells developed drug resistance. The p53 activator RITA sensitized drug-resistant cells to ferroptosis induced by apatinib combined with olaparib. Apatinib combined with olaparib-induced ferroptosis via a p53-dependent manner in ovarian cancer. Further studies showed that apatinib combined with olaparib-induced ferroptosis by inhibiting the expression of Nrf2 and autophagy, thereby inhibiting the expression of GPX4. The Nrf2 activator RTA408 and the autophagy activator rapamycin rescued the combination drug-induced ferroptosis. CONCLUSION: This discovery revealed the specific mechanism of ferroptosis induced by apatinib combined with olaparib in p53 wild-type ovarian cancer cells and provided a theoretical basis for the clinical combined use of apatinib and olaparib in p53 wild-type ovarian cancer patients.

Construction and application of the public health practice teaching model of "internal-external interactions" / 中华医学教育探索杂志

Practice teaching is an important link in the training of public health talents in colleges and universities. At present, there are still some problems in the education of public health and preventive medicine in the colleges and universities in China, such as attaching greater importance to theory than to practice and weak training of practical skills among students. In view of this situation, a public health practice teaching model of "internal-external interactions" has been constructed in Dalian Medical University with focuses on the following aspects: ①experiments in the university are optimized based on social needs; ②the practice base outside the university is expanded based on the teaching in the university; ③"internal-external interactions" are adopted to enhance practice training and improve post competence. The teaching practice shows that the implementation of the teaching model of "internal-external interactions" can help to improve practice teaching ability, promote the improvement in the training quality of public health talents, and meet the social demand for application-oriented professionals.

Celastrol targeting Nedd4 reduces Nrf2-mediated oxidative stress in astrocytes after ischemic stroke / 药物分析学报

Stroke is the second leading cause of death worldwide,and oxidative stress plays a crucial role.Celastrol exhibits strong antioxidant properties in several diseases;however,whether it can affect oxidation in cerebral ischemic-reperfusion injury(CIRI)remains unclear.This study aimed to determine whether celastrol could reduce oxidative damage during CIRI and to elucidate the underlying mechanisms.Here,we found that celastrol attenuated oxidative injury in CIRI by upregulating nuclear factor E2-related factor 2(Nrf2).Using alkynyl-tagged celastrol and liquid chromatography-tandem mass spectrometry,we showed that celastrol directly bound to neuronally expressed developmentally downregulated 4(Nedd4)and then released Nrf2 from Nedd4 in astrocytes.Nedd4 promoted the degradation of Nrf2 through K48-linked ubiquitination and thus contributed to astrocytic reactive oxygen species production in CIRI,which was significantly blocked by celastrol.Furthermore,by inhibiting oxidative stress and astrocyte activation,celastrol effectively rescued neurons from axon damage and apoptosis.Our study uncovered Nedd4 as a direct target of celastrol,and that celastrol exerts an antioxidative effect on as-trocytes by inhibiting the interaction between Nedd4 and Nrf2 and reducing Nrf2 degradation in CIRI.

Surveillance of Aedes populations in Jiangsu Province in 2020 / 中国血吸虫病防治杂志

Objective To investigate the seasonal Aedes population fluctuation and the resistance of Aedes populations to common insecticides in Jiangsu Province in 2020, so as to provide insights into vector-borne infectious diseases control.. Methods One village was randomly sampled from each of Xinbei District of Changzhou City and Zhangjiagang County of Suzhou City in southern Jiangsu Province, Hai’an County of Nantong City and Yandu District of Yancheng City in Central Jiangsu Province, and Suining County of Xuzhou City and Sihong County of Suqian City in northern Jiangsu Province during the period between May and October, 2020. A small ponding container was sampled, and larval Aedes mosquitoes were collected using straws once each in early and late stages of each month. All larvae were bred in laboratory to adults for population identification. In addition, larval breeding were observed in all small ponding containers in and out of 30 households that were randomly sampled from six surveillance sites, and the larval mosquito density was estimated using Breteau index. Larval A. albopictus mosquitoes were sampled around Cuiyuan New Village in Jintan District of Changzhou City, and bred in laboratory to the first offspring generation, and the susceptibility of adult female mosquitoes to deltamethrin, lambda-cyhalothrin, malathion, and propoxur was tested using the filter-paper bioassay recommended by WHO. Results A total of 1 165 larval Aedes mosquitoes were captured from small ponding containers in six surveillance sites of Jiangsu Province in 2020, and all were identified as A. albopictus following eclosion. The largest number of Aedes larvae captured was found in July. A total of 1 152 households were investigated in six surveillance sites, and the mean Breteau indexes were 9.58, 13.20, 13.71, 13.20, 12.18 and 5.58 from May to October, respectively, while a high Aedes transmission risk was seen in Xinbei District of Changzhou City, with a higher Breteau index than in Suining (H = 23.667, Padjusted = 0.001) and Sihong (H = 22.500, Padjusted = 0.003) counties. The field-captured A. albopictus from Cuiyuan New Village in Jintan District of Changzhou City remained sensitive to malathion, but was resistant to propoxur, and developed high-level resistance to deltamethrin and lambda-cyhalothrin. Conclusions A. albopictus was present in southern, central and northern Jiangsu Province in 2020, and the larval density peaked in July. A. albopictus captured from Cuiyuan New Village in Jintan District of Changzhou City has developed high-level resistance to pyrethroid pesticides.

Risk predictive models of healthcare-seeking delay among imported malaria patients in Jiangsu Province based on the machine learning / 中国血吸虫病防治杂志

Objective To create risk predictive models of healthcare-seeking delay among imported malaria patients in Jiangsu Province based on machine learning algorithms, so as to provide insights into early identification of imported malaria cases in Jiangsu Province. Methods Case investigation, first symptoms and time of initial diagnosis of imported malaria patients in Jiangsu Province in 2019 were captured from Infectious Disease Report Information Management System and Parasitic Disease Prevention and Control Information Management System of Chinese Center for Disease Control and Prevention. The risk predictive models of healthcare-seeking delay among imported malaria patients were created with the back propagation (BP) neural network model, logistic regression model, random forest model and Bayesian model using thirteen factors as independent variables, including occupation, species of malaria parasite, main clinical manifestations, presence of complications, severity of disease, age, duration of residing abroad, frequency of malaria parasite infections abroad, incubation period, level of institution at initial diagnosis, country of origin, number of individuals travelling with patients and way to go abroad, and time of healthcare-seeking delay as a dependent variable. Logistic regression model was visualized using a nomogram, and the nomogram was evaluated using calibration curves. In addition, the efficiency of the four models for prediction of risk of healthcare-seeking delay among imported malaria patients was evaluated using the area under curve (AUC) of receiver operating characteristic curve (ROC). The importance of each characteristic was quantified and attributed by using SHAP to examine the positive and negative effects of the value of each characteristic on the predictive efficiency. Results A total of 244 imported malaria patients were enrolled, including 100 cases (40.98%) with the duration from onset of first symptoms to time of initial diagnosis that exceeded 24 hours. Logistic regression analysis identified a history of malaria parasite infection [odds ratio (OR) = 3.075, 95% confidential interval (CI): (1.597, 5.923)], long incubation period [OR = 1.010, 95% CI: (1.001, 1.018)] and seeking healthcare in provincial or municipal medical facilities [OR = 12.550, 95% CI: (1.158, 135.963)] as risk factors for delay in seeking healthcare among imported malaria cases. BP neural network modeling showed that duration of residing abroad, incubation period and age posed great impacts on delay in healthcare-seek among imported malaria patients. Random forest modeling showed that the top five factors with the greatest impact on healthcare-seeking delay included main clinical manifestations, the way to go abroad, incubation period, duration of residing abroad and age among imported malaria patients, and Bayesian modeling revealed that the top five factors affecting healthcare-seeking delay among imported malaria patients included level of institutions at initial diagnosis, age, country of origin, history of malaria parasite infection and individuals travelling with imported malaria patients. ROC curve analysis showed higher overall performance of the BP neural network model and the logistic regression model for prediction of the risk of healthcare-seeking delay among imported malaria patients (Z = 2.700 to 4.641, all P values < 0.01), with no statistically significant difference in the AUC among four models (Z = 1.209, P > 0.05). The sensitivity (71.00%) and Youden index (43.92%) of the logistic regression model was higher than those of the BP neural network (63.00% and 36.61%, respectively), and the specificity of the BP neural network model (73.61%) was higher than that of the logistic regression model (72.92%). Conclusions Imported malaria cases with long duration of residing abroad, a history of malaria parasite infection, long incubation period, advanced age and seeking healthcare in provincial or municipal medical institutions have a high likelihood of delay in healthcare-seeking in Jiangsu Province. The models created based on the logistic regression and BP neural network show a high efficiency for prediction of the risk of healthcare-seeking among imported malaria patients in Jiangsu Province, which may provide insights into health management of imported malaria patients.

Progress of researches on antimalarial peptides / 中国血吸虫病防治杂志

Malaria remains a major global public health concern, and nearly half of the global populations are still at risk of malaria infection. However, continuous emergence and spread of drug-resistant malaria parasite strains lead to ineffectiveness of conventional antimalarials. Therefore, development of novel antimalarial agents is of urgent need for malaria elimination. As an important component of the host natural immune defense system, antibacterial peptides provide the first line of defense against pathogenic invasion, and the mechanism of preferentially attacking the cell membrane makes them difficult to develop drug resistance. Antimicrobial peptides are therefore considered as a promising candidate for novel antimalarial agents. This review summarizes the advances in researches on antimicrobial peptides with antimalarial actions and discusses the potential of antimalarial peptides as novel antimalarials.

Regular assessment is an effective approach to maintaining the capacity of prevention of re-establishment from imported malaria in China / 中国血吸虫病防治杂志

After achieving malaria elimination, preventing re-establishment from imported malaria and consolidating malaria elimination achievements are top priorities of the national malaria control program in China. Due to the long-term existence of overseas imported malaria cases and incomplete eradication of local epidemic conditions, there are multiple challenges for prevention of re-establishment from imported malaria in China. Hereby, we propose that regular assessment is an effective approach to maintaining the capability of prevention of re-establishment from imported malaria, and describe the purpose, significance, management and implementation of the capability assessment for prevention of re-establishment from imported malaria, so as to provide insights into the formulation and adjustment of malaria control strategies during the post-elimination phase.

Application prospect of minimally invasive surgical techniques in the treatment of biliary tract cancer / 中华消化外科杂志

Due to the inherent disease characteristics and surgical difficulties, the develop-ment of minimally invasive surgery in biliary tract cancer has encountered more difficulties and controversies. As one of the representative fields of modern precise surgery and an important part of multidisciplinary therapy, the value and application of minimally invasive surgery in the treatment of biliary tract cancer need to be further elaborated and standardized. Minimally invasive surgical techniques should be explored and studied under reasonable norms and supervision. More higher level evidence-based evidences should be obtained under the premise of ensuring the ethical prin-ciple of maximum benefit to patients, and ultimately promote the overall progress in the field.

Ab initio calculation of mechanical, electronic and optical characteristics of chalcogenide perovskite BaZrS3 at high pressures.

A theoretical examination of the structural, elastic, electronic and optical properties of the chalcogenide perovskite BaZrS3 under pressures of 0 and 20 GPa was performed using density functional theory ab initio calculations. The lattice constants of the BaZrS3 structure are well reproduced from our first-principles calculations and are in excellent agreement with experimental measurements. Moreover, the values of mechanical parameters, such as the elastic constant, increased under applied pressure. The electronic parameters indicate that the chalcogenide perovskite BaZrS3 has a direct band gap of 1.75 eV. To understand the optical response, the real and imaginary parts of the dielectric function of BaZrS3 have been studied, as well as the absorption coefficient, reflectivity and extinction coefficient. The induced pressure is found to enhance the optical parameters in the different energy regions. Our calculations predict that the studied chalcogenide perovskite BaZrS3 could be a candidate in photovoltaic, optoelectronic and mechanical applications.

Detection of Phosphatidylethanol in Whole Blood by UPLC-MS/MS / 法医学杂志

OBJECTIVES@#To establish the ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method to detect ethanol metabolites phosphatidylethanol (PEth) in whole blood.@*METHODS@#An appropriate amount of aqueous solution including 1% formic acid was added to 100 μL whole blood, the protein was precipitated with acetone, centrifuged and the supernatant was purified and enriched by using Bond Elut Certify column. The eluent was redissolved with 1/1 isopropanol/acetonitrile (v/v) solution after nitrogen blowing and then tested by UPLC-MS/MS. Selective reaction monitoring scanning was carried out in negative ionization mode, and quantitative analysis was performed by external standard method.@*RESULTS@#PEth showed a linear relationship over the concentration range of 1-160 ng/mL in whole blood (r=0.999 9) with peak area. The detection limit was 0.2 ng/mL, the quantification limit was 1 ng/mL, the recovery rate was 97.43%-103.61%, the accuracy was 0.99%-1.77%, the intra-day precision was 0.4%-2.4%, and the inter-day precision was 1.1%-3.3%, and the matrix effect was 91.00%-99.55%. PEth was not detected in the in vitro blood samples supplemented with ethanol. PEth was detected positive in three drunk driving cases, and the concentration were 195.49, 83.67 and 876.12 ng/mL, respectively.@*CONCLUSIONS@#The established method has high sensitivity and specificity and the analysis results are accurate. It is suitable for the qualitative and quantitative analysis of PEth in whole blood.

Risk prediction for deep venous thrombosis after total knee arthroplasty based on modified Caprini risk assessment model:a confirmatory study / 中国骨伤

OBJECTIVE@#To investigate the effectiveness of modified Caprini risk assessment model(Caprini MRAM) in predicting the risk of deep venous thrombosis (DVT) after total knee arthroplasty (TKA).@*METHODS@#A case-control study was used to collect 43 patients with DVT after TKA in lower limb department of Sichuan Orthopedic Hospital from January 2016 to November 2020 in the positive group, and 172 patients without DVT after TKA in the same period according to the 1∶4 ratio between positive and control group were selected in the control group. Caprini MRAM was used to score and grade the risk of DVT. The clinical data, score and risk classification of the two groups were compared. The relationship between the risk of DVT in the patients after TKA and the risk factors in the risk ckassification and assessment of Caprini MRAM was analyzed by multivariate logistic regression model.@*RESULTS@#The average score of caprini in DVT group was significantly higher than that in control group[(8.11±2.91) vs(4.07±2.12), P<0.001];DVT group was mainly at medium and high risk group(66.67%), while the control group was mainly at low risk (77.33%). There was a significant difference between the two groups in risk classification composition (P<0.001). BMI≥30 kg/m2, lower extremity edema (<1 month), severe pulmonary disease (<1 month), acute myocardial infarction (<1 month), bed rest (> 2 h), history of superficial or deep vein or pulmonary embolism and family history of thrombosis were the main risk factors for DVT in patients after TKA(all P<0.05). Preoperative D-dimer elevation (OR=4.380), BMI≥30 kg/m2(OR=2.518), lower extremity edema(<1 month)(OR=7.652), acute myocardial infarction (<1 month) (OR=1.994), bed rest (> 72 h)(OR=3.897), history of superficial or deep vein or pulmonary embolism (OR=13.517) and family history of blood embolism (OR=6.551) were independent risk factors for DVT in patients after TKA (all P<0.05). The risk of DVT was 13.457 and 2.739 times higher in high and moderate risk TKA patients with Caprini MRAM classification, respectively.@*CONCLUSION@#Caprini MRAM can be used to predict the risk of DVT in patients after TKA, especially for patients with high risk.

Quality of life and influencing factors of postoperative accelerated rehabilitation of esophageal cancer patients / 中华肿瘤杂志

Objective: To explore the quality of life and its influencing factors of enhanced recovery after surgery (ERAS) of esophageal cancer patients. Methods: The quality of life of 134 esophageal cancer patients was assessed using the quality of life assessment scale (EORTC QLQ-C30) developed by the European Cancer Research and Treatment Organization. Student's t test, One-way ANOVA and multiple linear regression statistical methods were used to analyze the effects of sociodemographic and clinical characteristics on patients' quality of life. Results: The overall score of quality of life (74.00) was lower than that of the general population (75.30). However, the scores of emotion and cognition in function dimension (93.97 and 95.77) were better than those of the general population (82.80 and 86.50). The results of fatigue, pain, insomnia and constipation in symptom dimension (14.18, 10.94, 11.69 and 5.72) were better than those of the general population (28.80, 20.50, 20.40 and 10.70). The pathological stage, body mass index and dietary were independent influencing factors for the quality of life of patients with esophageal cancer (P<0.05). Conclusions: ERAS can partially improve the quality of life of esophageal cancer patients. More attention should be paid to the esophageal cancer patients after surgery and take targeted measures to improve their quality of life.

Assessment of effects of intra-abdominal pressure monitoring on evaluating early enteral nutrition in patients with acute pancreatitis / 中华危重病急救医学

Objective:To explore the role of intra-abdominal pressure (IAP) monitoring in evaluating the efficacy of early enteral nutrition (EN) in patients with acute pancreatitis (AP).Methods:The clinical data were collected from the AP patients in department of criticle care medicine of Baoshan Branch of Huashan Hospital Affiliated to Fudan University from July 2020 to June 2021. The patients were divided into three groups according to their treatments: no gastrointestinal decompression with fasting group, gastrointestinal decompression with fasting group, gastrointestinal decompression with indwelling jejunal tube within 24 hours group. The data of white blood cell (WBC), procalcitonin (PCT), serum amylase (AMY) and IAP were analyzed before and after treatment, the initiation time oral feeding were also analyzed.Results:The decrease of WBC, PCT, AMY, and IAP in gastrointestinal decompression with indwelling jejunal tube within 24 hours group were significantly greater than those in the other groups [WBC (×10 9/L): -1.72±0.74 vs. -0.68±0.36, -1.23±86.97; PCT (μg/L): -3.14±5.19 vs. 0.06±0.48, -1.57±0.78; AMY (U): -148.43±75.89 vs. -74.85±78.84, -93.78±1.17; IAP (cmH 2O, 1 cmH 2O≈0.098 kPa): -4.82±1.66 vs. 0.36±1.32, -3.22±4.36, all P < 0.05]. There were no correlation between the changes of IAP and the changes of WBC, PCT or AMY in the non-gastrointestinal decompression with fasting group and the gastrointestinal decompression with indwelling jejunal tube within 24 hours group (all P > 0.05). The decreasing trend of IAP in patients with gastrointestinal decompression with fasting group was positively correlated with the change of AMY ( r = 0.65, P < 0.001). The initiation time of oral feeding in gastrointestinal decompression with indwelling jejunal tube within 24 hours group was significantly shorter than that in the other groups (hours: 89.538 vs. 111.273, 109.714), the difference was statistically significant ( P < 0.05). Conclusions:IAP monitoring, as an emergency means of monitoring the efficacy of early EN in AP patients, has the advantages of simplicity, efficiency and rationality, which has a more objective basis than the previous empirical treatment and open oral feeding.

Application of organ system based learning model in undergraduate clinical practice teaching of anesthesiology / 中华医学教育探索杂志

Objective:To evaluate the teaching effect of organ system based learning model on undergraduate clinical practice teaching of anesthesiology.Methods:Thirty-five undergraduates of Batch 2013 who practiced in the Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University (round 2) were enrolled as the control group; another 27 undergraduates of Batch 2014 were enrolled as the experimental group. The examination before entering the department evaluated the basic knowledge levels of the two groups. The control group was given the traditional practice teaching mode, while the experimental group was given the practice teaching mode based on organ system. The teaching effect of the organ system based learning model on the practice of department of anesthesiology was evaluated by the examination after the practice and questionnaire survey on students. SPSS 19.0 was used for data statistics and t test was conducted for analysis. Results:There was no significant difference in gender, age and admission education performance between the two groups ( P=0.168, 0.592, 0.750). In the quality and analysis scores of the medical records, the review defense scores, and the theoretical scores, the average scores of the experiment group were all higher than those in the control group ( P=0.021, <0.001, <0.001) at the end of the practice; there was no significant difference in operational exam between the two groups ( P=0.106). The results of questionnaire survey showed that the average scores of the experiment group in the satisfaction of learning mode, teaching efficiency, education and teaching level and teaching information were all higher than those in the control group ( P<0.001, <0.001, <0.001, <0.001); there was no significant difference between the two groups in students' learning efficiency and inspiration ( P=0.778, 0.104). Conclusion:The organ system based learning model in undergraduate clinical practice teaching of anesthesiology has significantly improved the education quality, the theoretical achievement and comprehensive ability of interns.

Clinical efficacy of laparoscopic anatomical right posterior sector combined with anterior-dorsal segment resection for hepatocellular carcinoma / 中华消化外科杂志

Objective:To investigate the clinical efficacy of laparoscopic anatomical right posterior sector combined with anterior-dorsal segment resection for hepatocellular carcinoma.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 15 patients with hepatocellular carcinoma who underwent laparoscopic anatomical right posterior sector combined with anterior-dorsal segment resection in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from September 2020 to August 2021 were collected. There were 9 males and 6 females, aged 66(range, 35?77)years. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect tumor recurrence and survival of patients in the postoperative 90 days. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations. All the 15 patients underwent laparoscopic anatomical right posterior sector combined with anterior-dorsal segment resection successfully, without blood transfusion and conversion to laparotomy during the operation. The operation time, volume of intraoperative blood loss and occlusion time of first porta hepatis of the 15 patients were (155±17)minutes, (254±66)mL and (51±7)minutes, respectively. (2) Postoperative situations. The duration of postoperative hospital stay of the 15 patients was (7.4±2.1)days. Results of postoperative histopathological examination showed hepatocellular carcinoma and R 0 margins in all the 15 patients with a minimum distance from margin to tumor of (1.5±0.8)cm. There was none of the 15 patients transferred to intensive care unit, perioperative death or rehospitalization within 30 days after surgery. Of the 15 patients, 2 cases had postoperative complications, including 1 case with biliary fistula (grade Ⅰ of Clavien-Dindo classification) and 1 case with ascites (grade Ⅱ of Clavien-Dindo classification). Patients with complications were improved after washing and drainage, abdominal puncture and drainage. (3) Follow-up. All the 15 patients were followed up for the postoperative 90 days and none of them had tumor recurrence or death within postoperative 90 days. Conclusion:The laparoscopic anatomical right posterior sector and anterior-dorsal segment resec-tion for hepatocellular carcinoma is safe and feasible.

Clinical value of a new direct visualization system of China-made peroral cholangiopancreatography (with video) / 中华消化内镜杂志

Objective:To investigate the efficacy and safety of a new China-made direct visualization system of peroral cholangiopancreatography in the diagnosis and treatment of biliopancreatic diseases.Methods:Clinical data of 37 patients who underwent endoscopic examination through the direct visualization system of peroral cholangiopancreatography at Digestive Endoscopy Center of Nanjing Drum Tower Hospital from April 2020 to June 2021 were retrospectively analyzed. Technical success rate and complications were analyzed.Results:The examination was completed in 37 patients through the system. The technical success rate was 100.0%. The nature of biliary stricture was confirmed in 24 cases, presenece or absence of bleeding or residual stones in the bile duct was confirmed in 6 cases, neoplasm or residual stones in the pancreatic duct was determined in 2 cases, biliary stricture was passed assisted with visualized guidewire in 2 cases, and lithotripsy was performed assisted with biliary laser in 3 cases. Nine patients were pathologically diagnosed as having malignant biliary stricture, and 8 of them were confirmed malignant by the system. Drainage was performed in 34 cases after the examination. There were 3 cases of cholangitis, 4 cases of bacteremia and 2 cases of postoperative pancreatitis after the operation, which were relieved in a short time after conservative treatment. Bleeding occurred in 1 case which was improved after two times of endoscopic hemostasis.Conclusion:The new direct visualization system of peroral cholangiopancreatography is safe and effective in the diagnosis and treatment of biliopancreatic diseases.

Theory and technical practice of anatomic liver resection based on portal territory for the treatment of hepatocellular carcinoma / 中华消化外科杂志

Anatomic resection aims to improve the surgical efficacy of hepatocellular carcinoma by systematic resection of portal territory. However, due to its deviation of traditional theory and practice, the oncology effect is questionable. Anatomic resection based on portal territory(PT-AR) is planned by the analysis of real portal vein territory, and performed complete resection of tumor-bearing portal territory by fluorescent guidance, while exposing typical inter-territory hepatic vein, so as to ensure the complete function of future liver remnant. PT-AR is based on the core theory of classical anatomic resection, which will correct the deviation of traditional theory and practice from the technical level, so as to lead a better surgical oncology outcomes for hepatocellular carcinoma.

Long-term outcomes of fully covered self-expanding metal stent for benign refractory pancreatic stenosis (with video) / 中华消化内镜杂志

Objective:To investigate the safety and long-term outcomes of fully covered self-expanding metal stent (FCSEMS) placement in patients with benign refractory pancreatic stenosis.Methods:Data of 18 patients with benign refractory pancreatic stenosis who underwent endoscopic treatment with FCSEMS in Nanjing Drum Tower Hospital between March 2013 and July 2020 were collected. The technical success, clinical success, adverse events and long-term outcomes were analyzed.Results:FCSEMS placement was successful in all 18 patients, with technical success rate of 100.0% (18/18). After stenting, the visual analogue scale (VAS) significantly decreased [2.00 (1.75, 3.00) VS 6.00 (5.00, 7.00), Z=-3.572, P<0.001]. The VAS decreased by more than 50% in 15 cases, and the clinical success rate was 83.3% (15/18). Stent-related adverse events included intolerable pain in 3 patients, stented-induced de novo stricture in 2 patients, and distal migration of stent in 2 patients. The stents were successfully removed in all patients after 137.5 (59.0, 417.0) days. There was significant reduction in terms of decreased upstream ductal dilatation after stent removal [9.1 (6.7, 14.1) mm VS 11.0 (7.6, 16.2) mm, Z=10.508, P<0.001]. After stent removal, 10 of the 14 patients maintained the response to pancreatic stenting and 4 recurred during the follow-up of 37-1 246 days. Conclusion:FCSEMS placement appears to be safe and effective in the treatment of benign refractory pancreatic stenosis and can provide persistent improvement in the stricture.

Efficiency and safety of traditional growing rod technique in the treatment of early onset dystrophic scoliosis secondary to type 1 neurofibromatosis with intraspinal rib head in children / 中华骨科杂志

Objective:To investigate the efficiency and safety of traditional growing rod in the treatment of early onset dystrophic scoliosis secondary to type 1 neurofibromatosis (NF1-DS) with intraspinal rib head in children.Methods:From September 2006 to May 2020, this study recruited 20 children with intraspinal rib head with early onset NF1-DS who had received traditional growing rods. There were 13 boys and 7 girls and the age of the initial operation was 7.0±1.6 years (range, 4.1-9.8 years). There were 7 cases of simple left chest bend, 9 cases of simple right chest bend, and 4 cases of double chest bend; 13 patients had varying degrees of kyphosis deformity. Two children had neurological symptoms before surgery, American Spinal Injury Association Impairment Scale (AIS) were grade D. The proportion of the intraspinal rib head (IRP), the Cobb angle of the main chest bend, apical vertebra rotation (AVR), apical vertebral translation (AVT), trunk shift (TS) and sagittal TK, lumbar lordosis (LL), sagittal balance and T 1-S 1 height were measured before and after first time internal fixation and at last follow-up, and the complications were also evaluated. Results:All 20 patients were followed up and the average follow-up time was 41.6±23.8 months (range, 24-99 months). A total of 85 operations was conducted including 63 protrude operations. After operation, the IRP was significantly lower than that before operation (preoperative 33.1%±17.5% vs. postoperative 22.2%±11.3%, P<0.001) and no significant correction loss was found at last follow-up 23.7%±12.4% ( P>0.05). The mean Cobb angle decreased from 75.9°±26.7° preoperatively to 45.0°±18.5° postoperatively ( P<0.001) and there was still significant improvement at the last follow-up (41.0°±17.2°) compared with postoperatively ( P<0.05). The AVR was significantly reduced after surgery compared with preoperatively (33.0°±10.1° vs. 39.3°±13.3°, P<0.001), and the last follow-up (40.1°±11.4°) was significantly improved compared with postoperative ( P=0.005). The T 1-S 1 height increased from 259.8±70.7 mm preoperatively to 296.9±78.4 mm postoperatively ( P=0.001), and at the last follow-up 296.9±78.4 mm was still significantly higher than after operation ( P<0.001), with an average annual increase of 12.4±3.2 mm. Significant correction of AVT, TK, LL and sagittal balance were noted after initial surgery ( P<0.05), and no significant correction loss was found at last follow-up ( P>0.05). There were 10 complications in 7 cases. There were 5 complications of pedicle screw loosening, 1 complication of bolt droping, 2 complications of broken rod, 1 complication of distal junctional kyphosis and 1 complication of adding-on phenomenon. 2 cases with nerve injury were recover after operation (AIS grading E). None of the children had new neurological complications during growth rod insertion and multiple stretching during follow-up. Conclusion:For children with early onset NF1-DS with intraspinal rib head, if the preoperative AIS grade is D or E, traditional growing rod technique is relatively safe and effective and can make the intraspinal rib head remove from the spinal canal partly.

Effects of Dasatinib on the Maturation of Monocyte-Derived Dendritic Cells Derived from Healthy Donors and Chronic Myelogenous Leukemia Patients / 中国实验血液学杂志

OBJECTIVE@#To investigate the effects of dasatinib on the maturation of monocyte-derived dendritic cells (moDCs) derived from healthy donors (HDs) and chronic myelogenous leukemia (CML) patients.@*METHODS@#Peripheral blood mononuclear cells (PBMCs) were isolated from HDs (n=10) and CML patients (n=10) who had got the remission of MR4.5 with imatinib treatment. The generation of moDCs from PBMCs was completed after 7 days of incubation in DC I culture medium, and another 3 days of incubation in DC II culture medium with or without 25 nmol/L dasatinib. On the 10th day, cells were harvested and expression of molecules of maturation related marker were assessed by flow cytometry. The CD80+CD86+ cell population in total cells was gated as DCs in the fluorescence-activated cell storting (FACS) analyzing system, then the expression of CD83, CD40 or HLA-DR in this population was analyzed respectively.@*RESULTS@#The proportion of CD80+CD86+ cells in total cells didn't show a statistical difference between HD group and patient group (89.46%±9.70% vs 87.39%±9.34%, P=0.690). Dasatinib significantly enhanced the expression of the surface marker CD40 (P=0.008) and HLA-DR (P=0.028) on moDCs derived from HDs compared with the control group, while the expression of CD83 on moDCs didn't show a significant difference between dasatinib group and the control group (P=0.428). Meanwhile, dasatinib significantly enhanced the expression of the surface marker CD40 (P=0.023), CD83 (P=0.038) and HLA-DR (P=0.001) on moDCs derived from patients compared with the control group.@*CONCLUSION@#For CML patients, the same high proportion of moDCs as HDs can be induced in vitro, which provides a basis for the application of DC-based immunotherapy strategy. Dasatinib at the concentration of 25 nmol/L can efficiently promote the maturation of moDCs derived from HDs and CML patients in vitro. Dasatinib shows potential as a DC adjuvant to be applied in DC-based immunotherapy strategies, such as DC vaccine and DC cell-therapy.