Exploration of the influence of early rehabilitation training on circulating endothelial progenitor cell mobilization in patients with acute ischemic stroke and its related mechanism under a lightweight artificial intelligence algorithm.

OBJECTIVE: This work aimed to explore the application of lightweight artificial intelligence algorithms in magnetic resonance imaging (MRI) image processing of patients with acute ischemic stroke (AIS) to clarify the effect and mechanism of early rehabilitation training on the mobilization of circulating endothelial progenitor cells (EPCs) in AIS. PATIENTS AND METHODS: A total of 98 AIS patients undergoing MRI examination were selected as the research objects and were randomly divided into a rehabilitation group (early rehabilitation training, 50 cases) and a routine group (conventional treatment, 48 cases) by random number table method and lottery method. In this work, based on the convolutional neural network (CNN) algorithm, a low-rank decomposition algorithm was introduced to optimize it, and a lightweight MRI image computer intelligent segmentation model (LT-RCNN) was established. The LT-RCNN model was used in the MRI image processing of AIS patients, and the role of the model in AIS image segmentation and lesion localization was analyzed. Furthermore, flow cytometry was used to detect the number of peripheral circulating EPCs and CD34+KDR+ cells in the two groups of patients before and after treatment. The serum levels of vascular endothelial growth factor (VEGF), tumor necrosis factor-α (TNF-α), interleukin 10 (IL-10), and stromal cell-derived factor-1α (SDF-1α) content were detected by Enzyme-Linked Immunosorbent Assay (ELISA). In addition, the correlation between each factor and CD34+KDR+ was analyzed by Pearson linear correlation. RESULTS: The diffusion-weighted imaging (DWI) signal of MRI images of AIS patients under the LT-RCNN model was high. The location of the lesion could be accurately detected, and the contour of the lesion could be displayed and segmented, and the segmentation accuracy and sensitivity were significantly better than before optimization. The number of EPCs and CD34+KDR+ cells in the rehabilitation group was increased compared with the control group (p<0.01); the expression levels of VEGF, IL-10, and SDF-1α were higher than those of the control group (p<0.001), and TNF-α content was lower than the control group (p<0.001). The number of CD34+KDR+ cells was positively correlated with VEGF, IL-10, and TNF-α contents (p<0.01). CONCLUSIONS: The results showed that the computer-intelligent segmentation model LT-RCNN could accurately locate, and segment AIS lesions and the early rehabilitation training could change the expression level of inflammatory factors and further promote the mobilization of AIS circulation EPCs.

[Current status and prospects of neoadjuvant therapy for resectable pancreatic cancer].

Pancreatic cancer is a highly malignant tumor. About 75% of patients with pancreatic cancer who underwent radical surgical resection will still experience postoperative recurrence. Neoadjuvant therapy could improve outcomes in patients with borderline resectable pancreatic cancer,has become a consensus;however it is still controversial in resectable pancreatic cancer. Limited high-quality randomized controlled trial studies support the routine initiation of neoadjuvant therapy in resectable pancreatic cancer. With the development of new technologies, such as next-generation sequencing, liquid biopsy, imaging omics, and organoids, patients are expected to benefit from the precision screening of potential candidates for neoadjuvant therapy and individualized treatment strategy.

[Current surgical concepts and future perspectives in the treatment of pancreatic cancer].

Over the past 20 years, the concept of pancreatic surgery has been updated and surgical skills has improved dramatically. With the significant improvement of surgical safety and increase of resection rate for pancreatic cancer, some traditional surgical issues such as surgical indications, timing and extent of resection are being re-evaluated. The improvement of patients' prognosis is the gold standard for judging the surgical indications. The traditional criteria of "unresectable" based on morphology will be constantly broken through, and the estimation of resectability will transition from "what can we resect" to "what should we resect". Except for clinical research, standard extent of lymph node dissection is recommended. However, for borderline resectable and locally advanced pancreatic cancer after neoadjuvant treatment, extended lymph node dissection is recommended. All kinds of surgical approaches are feasible. The approach is subject to the needs of anatomy, anatomy is subject to the needs of radical treatment, and radical treatment is subject to the needs of improving prognosis. For some patients with locally advanced pancreatic cancer, sub-adventitial divestment of superior mesenteric artery and "Heidelberg triangle" cleaning are helpful to improve the resection rate and reduce the local recurrence rate,however, the impact on the long-term prognosis still needs to be further observed clinically. The quality of pancreaticojejunostomy has more influence on the incidence of pancreatic fistula than the type of pancreaticojejunostomy. For the centers with high volume patients and the surgeons with rich personal experience, laparoscopic or robot assisted surgery has the advantages of minimally invasive, but for pancreatic head carcinoma, it is not enough evidence to prove the oncological advantages of laparoscopic pancreaticoduodenectomy and robotic-assistant pancreaticoduodenectomy.

[The criteria of resectability for pancreatic ductal adenocarcinoma:tumor anatomy or tumor biology?]

Anatomical resectability criteria based on radiologic findings for pancreatic ductal adenocarcinoma has been the main or even the only criterion in practice for a long time. The anatomical criteria has played a very positive role in standardizing surgical indication and restricting medical behavior. However,in the current era of systematic treatment,the limitations of anatomical criteria are becoming increasingly prominent. Although the biological criteria which can be used to evaluate the resectability of pancreatic cancer is still very limited,the comprehensive benefit of CA19-9,PET-CT,neoadjuvant therapy,gene detection and so on can still provide a reference for the evaluation of the resectability of pancreatic cancer. At present,the evaluation of resectability of pancreatic cancer should still adhere to the basic principle of taking anatomical criteria as the basis,biological criteria as the guide,and improving the prognosis of patients as the goal.

[How to standardize the enhanced recovery after surgery in clinical practice?]

The enhanced recovery after surgery (ERAS) protocol is an evidence-based perioperative care pathway, which is to reduce the perioperative stress and metabolic variation, with the ultimate goal of improving patient recovery and outcomes. This article reviews some hot issues in the clinical practice of ERAS in China. Currently, the concept and pathways of ERAS are very consistent with China's medical reform, and the basic principle of "safety first, efficiency second" should be adhered to. In specific clinical practice, multidisciplinary cooperation, the improvement of surgical quality and the implementation of prehabilitation pathway should be advocated. In addition, the ERAS approaches should be implemented individually to avoid mechanical understanding and dogmatic implementation. The implementation of ERAS and its clinical outcome should be audited to accumulate experience, and a feedback mechanism should be established to improve the outcome continuously. In clinical practice, "fast recovery" should not be the sole purpose. For patients, the decrease in the risk of readmission rate is more important as compared to discharge rate. Additionally, the disparities between the development of ERAS clinical research in China and that in the world are also analyzed in this review. A national ERAS database should be established on the basic platform of academic groups to ensure the development of high-quality clinical research in China.

[The predictive value of the CHA2DS2-VASc score for in-hospital outcomes in patients with acute myocardial infarction: China PEACE-retrospective acute myocardial infarction study].

Objectives: This study aimed to evaluate the predictive value of the CHA2DS2-VASc score for in-hospital outcomes of patients with acute myocardial infarction (AMI). Methods: Data of 23 728 patients from the China patient-centered Evaluative Assessment of cardiac Events (China PEACE)Retrospective Acute Myocardial Infarction Study were analyzed retrospectively. The patients were categorized into 3 groups according to the CHA2DS2-VASc scores: the low score group (score 1-3), the middle score group (score 4-6) and the high score group (score 7-9). The in-hospital outcomes included major adverse cardiovascular events (MACE), death, death or withdrawal from treatment, reinfarction, ischemic stroke,etc. The CHA2DS2-VASc score was incorporated into multivariate Cox regression analyses to determine its independent impact on in-hospital outcomes. Receiver operating Characteristic (ROC) curves were constructed, and the area under the curve (AUC) was used to evaluate the predictive value of the CHA2DS2-VASc score for in-hospital mortality and death or withdrawal from treatment, respectively. Results: The patients had a median age of 66 (56,75) years, and 30.7% of them were females. Patients with higher CHA2DS2-VASc scores had a higher in-hospital mortality and more in-hospital complications (all P<0.001). After adjustment of baseline covariates, the subjects in the high score group were associated with high risks of in-hospital mortality (OR=6.13, 95%CI 4.77-7.87, P<0.001), death or treatment withdrawal (OR=6.43, 95%CI 5.16-8.00, P<0.001) and MACE (OR=4.94, 95%CI 4.06-6.01, P<0.001). The AUCs of the CHA2DS2-VASc score were comparable with those of the mini-global registry of acute coronary events(mini-GRACE)score in evaluation of in-hospital mortality (0.699 vs. 0.696, P=0.752) and the death or treatment withdrawal risk (0.708 vs. 0.713, P=0.489). Conclusions: The CHA2DS2-VASc score is an independent predictor of in-hospital outcomes for patients with AMI. Its predictive value was comparable with the mini-GRACE score, which could be used as a simple tool for early and rapid outcome evaluation for AMI patients.

[Prevalence of human soil-borne nematode infections in Yunnan Province: a cross-sectional study in 2015].

OBJECTIVE: To investigate the current prevalence of human soil-borne nematode infections in Yunnan province, so as to provide the scientific evidence for formulating the soil-borne nematodiasis control strategy in the province. METHODS: In 2015, a total of 20 survey sites were sampled in 10 counties (cities) of Yunnan Province using the stratified cluster random sampling method. Stool samples were collected from all local permanent residents at ages of one year and older in each survey site, and the soil-borne nematode eggs were identified using the modified Kato-Katz technique and the egg number was counted. In addition, the hookworm species was identified using the filter-paperculture method, and Enterobius vermicularis eggs were detected using the cellophane tape method in children at ages of 3 to 6 years. RESULTS: A total of 5 067 residents received stool examinations, and 950 residents were detected with soil-borne nematode infections, with an overall prevalence rate of 18.75%. The prevalence of Ascaris lumbricoides, Trichuris trichura and hookworm was 7.52%, 8.47% and 9.02%, respectively. Among 446 children detected using the cellophane tape method, 5 children were detected with E. vermicularis infections. Among the 160 residents with hookworm infections, there were 139 residents with Necator americanus infections (86.88%), 16 with A. duodenale infections (10.00%) and 5 with mixed infections (3.12%). Mild A. lumbricoides (67.98%, 259/381), T. trichura (88.58%, 380/429) and hookworm infections (94.53%, 432/457) were predominant. Among the four ecological zones, the highest prevalence of human soilborne nematode infections was found in the East Tibet-South Sichuan Ecological Zone (31.79%), and among the 10 survey counties (cities), the greatest prevalence was seen in Gongshan Derung and Nu Autonomous County (50.13%), while the lowest prevalence was found in Ninglang Yi Autonomous County (0.40%). The prevalence of human soil-borne nematode infections was 5.67% (43/759), 26.67% (610/2 287) and 14.70% (297/2 021) in high-, moderate- and low-economic-level regions, respectively. There were no significant differences in the prevalence of human soil-borne nematode infections in terms of ecological regions, survey counties (cities) or economic development levels (χ2 = 342.20, 814.60 and 201.34, all P < 0.05). There was no significantdifference in the prevalence of human soil-borne nematode infections between male (18.21%, 441/2 422) and female residents (19.24%, 509/2 645) (χ2 = 0.89, P > 0.05), and soil-borne nematode infections were detected in residents at all age groups, with the greatest prevalence found in residents at ages of 1 to 9 years (25.88%). In addition, the highest prevalence of soil-borne nematode infections was seen in residents with the Dulong Ethnic Minority (82.09%), in preschool children (25.06%) and in illiterate residents (24.80%), and there was no age-, ethnicity-, occupation- or education level-specific prevalence of soil-borne nematode infections detected (χ2 = 46.50, 1 016.96, 36.33 and 52.43, all P < 0.05). CONCLUSIONS: The prevalence of human soil-borne nematode infections remains high in Yunnan Province. The management of soil-borne nematodiasis requires to be reinforced among low-age children, farmers, old people and residents with low educations levels or ethnic groups.

[The comparison of prognosis and risk factors after radical resection for pancreatic ductal adenocarcinoma between China Pancreas Data Center and SEER].

Objectives: To compare the prognosis of patients underwent radical resection for pancreatic ductal adenocarcinoma(PDAC) in Surveillance, Epidemiology, and End Results(SEER) and China Pancreas Data Center(CPDC), and to compare the prognostic factors for PDAC in both databases. Methods: The data of patients underwent radical resection for PDAC in CPDC database from January 2016 to December 2017 and SEER database from January 2014 to December 2015 were retrospectively analyzed. The prognosis of patients in both databases was analyzed by the Kaplan-Meier method, Log-rank method, and propensity score matching, and the Cox proportional hazard regression was used to analyze the independent prognosis factors for PDAC. Results: There were 1 977 cases and 2 220 cases of pancreatic cancer that underwent radical resection from CPDC and SEER, respectively. There were more male patients(60.90%,1 204/1 977) than female patients(39.10%,773/1 977) in CPDC, while nearly 1∶1 ratio(male:1 112 cases,female:1108)was observed between male and female in SEER(χ²=48.977,P<0.01). The proportion of patients under 45 years old was the smallest in both databases, and the age group with the most significant proportion was 60 to 74 years old. The ratio of patients over 75 years old in the SEER(24.28%,539/2 220) was higher than that of CPDC(7.89%,156/1 977)(χ²=202.090,P<0.01), while the proportion of patients between 45 and 59 years old in CPDC(33.69%,666/1 977) was higher than that in SEER(19.77%,439/2 220)(χ²=103.640,P<0.01). There were more pancreatic head cancers than body and tail cancers in both databases, and no statistical difference was found in tumor size between the two databases (W=2 181 502,P=0.740). More positive and examined lymph nodes were found in SEER patients (W=3 265 131,W=2 954 363,all P<0.01); and the proportion of patients who had at least 15 lymph nodes dissected was higher in SEER(63.24%,1 404/2 220)(χ²=532.130,P<0.01). There were more patients without neoadjuvant or adjuvant therapy in CPDC(57.16%,1 130/1 977) than that in SEER(24.91%,553/2 220)(χ²=451.390,P<0.01). After propensity score matching, the overall survival for CPDC was better than that for SEER(Log-rank test:χ²=4.500,P=0.034), and the median overall survival was 24 months and 23 months respectively. Cox regressional analysis showed the common independent prognosis factors in both databases were ≥75 years old, pancreatic head cancer, poorly differentiated and undifferentiated tumors, T stage, N stage(All P<0.05). Neoadjuvant or adjuvant therapy was a protective factor in both databases(CPDC:Wald=27.082;SEER:Wald=212.285, all P<0.01) and 45 to 59 years old was protective factor in the SEER database(Wald=5.212,P=0.020). Conclusions: The data in both databases have a good consistency. However, in terms of data quality, examined lymph nodes count, and neoadjuvant/adjuvant therapy rate, the CPDC differs greatly from the SEER.

[Implementation and controversies of enhanced recovery after surgery in pancreaticoduodenectomy].

The concept of enhanced recovery after surgery(ERAS) has been widely accepted and applied in clinical practice.However,as one of the most complex surgical procedures in abdominal surgery,pancreaticoduodenectomy is characterized by long operation time,high incidence rate of postoperative complications and delayed recovery,there still remain some controversies about application of ERAS approaches in perioperative managements of pancreaticoduodenectomy.Although more and more studies has revealed the safety and efficacy of ERAS approaches in pancreaticoduodenectomy,the implementation of ERAS approaches should be still individualized in clinical practice to ensure safety of the patients.

Toroidal soft x-ray array on the EXL-50 spherical tokamak.

A toroidal soft x-ray array system for spectrum and intensity measurements on the EXL-50 spherical tokamak is described. Silicon drift detectors and digital multichannel analyzers are adopted for all 21 channels of the array, and an average energy resolution of 147 eV at 5.89 keV has been achieved at count rates over 500 kcps. In total, 20 channels of the array are symmetrically observed in both co- and counter-current directions on the EXL-50 mid-plane with a spatial resolution of around 10 cm, and the remaining one serves as a background reference channel. Tungsten emissions from tungsten coating of the limiters on the central post are observed. The influence of hard x rays on measured soft x-ray spectra and system operation is discussed.

Effects of TGF-ß1 on the expression of endometrial stromal cell-related protein and mRNA.

OBJECTIVE: To investigate the effects of transforming growth factor ß1 (TGF-ß1) on α-smooth muscle actin (α-SMA), insulin-like growth factor I (IGF-I), and type I collagen (Col I) expression in endometrial stromal cells as well as on fibronectin (FN) level. PATIENTS AND METHODS: 56 patients with normal endometrial tissue obtained from surgery were selected from June 2018 to November 2019. Endometrial stromal cells were isolated from patients and then assigned to the control group and observation group (addition of TGF-ß1) followed by the analysis of cellular activity by Thiazole blue staining; and α-SMA, IGF-I, Col I, and FN mRNA and protein levels by real-time fluorescent PCR and Western blot. RESULTS: The cell proliferation rate at 12 h, 24 h, 36 h, and 72 h after culture in both groups was higher than 0 h (p < 0.05) with higher cell proliferation in the observation group than the control group (p < 0.05). Real-time fluorescence PCR results showed that the levels of α-SMA, IGF-I, Col I, and FN mRNA in endometrial stromal cells of the observation group after TGF-ß1 intervention were higher than those in the control group (p < 0.05). Meanwhile, α-SMA, IGF-I, Col I, and FN protein level was also elevated in the observation group after TGF-ß1 treatment (p < 0.05). CONCLUSIONS: TGF-ß1 can stimulate the proliferation of endometrial stromal cells, which may be related to regulate α-SMA, IGF-I, Col I, and FN expression.

Inhibition of microRNA-184 reduces H2O2-mediated cardiomyocyte injury via targeting FBXO28.

OBJECTIVE: Cardiovascular disease, especially coronary heart disease, is one of the diseases with the highest mortality. A large number of studies have found that microRNAs (miRNAs) are closely related to the occurrence and development of myocardial ischemia. This article mainly focused on the regulation of miR-184 on oxidative stress, inflammation, and apoptosis in myocardial infarction (MI). MATERIALS AND METHODS: MiR-184 inhibitor or negative control (NC) were transfected into H9c2 cells. Then, H9c2 cells were treated with H2O2 to construct a cardiomyocyte injury model. H9c2 cells were divided into 4 groups: control group, H22O2 treatment group, H2O2 + NC group, and H2O2 + miR-184 inhibitor group. The oxidative stress of H9c2 cells was observed by the expression levels of SOD, ROS, and MDA in each group. The inflammatory response of H9c2 cells was reflected by the expression of TNF-α, IL-6, and IL-1ß detected by ELISA kits. Western blot was used to detect the expression of cleaved Caspase-3, Bcl-2, Bax and F-box protein 28 (FBXO28). Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was utilized to detect miR-184 expression. TdT-mediated dUTP Nick-End Labeling (TUNEL) staining and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay were used to observe the apoptosis and cell viability. The Luciferase reporter experiment was used to prove whether miR-184 could target FBXO28. RESULTS: MiR-184 expression was significantly increased in H2O2-induced H9c2 cell injury model. After H9c2 cells were transfected with miR-184 inhibitor to silence miR-184, the levels of ROS and MDA were markedly reduced, while the expression of SOD was greatly increased. At the same time, the expression of inflammatory factors was greatly reduced. Silencing miR-184 also increased Bcl-2 expression, and reduced the expression of cleaved Caspase-3 and Bax. In addition, compared with the H2O2 + NC group, the number of TUNEL positive cells in the H2O2 + miR-184 inhibitor group was also significantly reduced, and the cell viability was remarkably increased. The Luciferase reporter experiment proved that FBXO28 is a target gene of miR-184. CONCLUSIONS: MiR-184 expression was increased in H2O2-treated H9c2 cells. Inhibition of miR-184 markedly inhibited oxidative stress and inflammation in cardiomyocytes, thereby inhibiting cardiomyocyte apoptosis, through the regulation of FBXO28.

[Manual suture or stapler closure: management of pancreatic stump during distal pancreatectomy].

Postoperative pancreatic fistula is the most common complication after distal pancreatectomy.With the update of the domestic and international guidelines or consensuses, the definition of pancreatic fistula has become more standardized.And the classification of pancreatic fistula is able to represent the severity of clinical outcomes more accurately.Currently, the determination of risk factors of pancreatic fistula after distal pancreatectomy, the establishment of prediction model, and the surgical closure mode of pancreatic stump still remain the major topics.With the rapid development of laparoscopic and robotic surgery in pancreatectomy, there are more and more selectionsin transection and managing the pancreatic stump after distal pancreatectomy for prevention of pancreatic fistula.However, there has not been a uniform fashion in terms of manual suture or stapler use to close the pancreatic stump.Herein the current status and development of pancreatic fistula after distal pancreatectomy are reviewed.The strategy of managing the pancreatic stump after distal pancreatectomy should be adopted individually according to the texture and thickness of pancreatic parenchyma.

Regulatory effect of lncRNA NKILA on autophagy induced by sepsis kidney injury.

The article "Regulatory effect of lncRNA NKILA on autophagy induced by sepsis kidney injury, by Y.-M. Yang, Y.-H. Li, L.-L. Ding, Y. Fu, N. Li, published in Eur Rev Med Pharmacol Sci 2019; 23(18):8011-8017. DOI: 10.26355/eurrev_201909_19017. PMID: 31599426" has been withdrawn from the authors. The Publisher apologizes for any inconvenience this may cause.

[Associations between postprocedural D-dimer, hs-CRP, LDL-C levels and prognosis of acute myocardial infarction patients treated by percutaneous coronary intervention].

Objective: To investigate the association between postprocedural D-dimer, high sensitivity C-reactive protein(hs-CRP) and low-density lipoprotein-cholesterol(LDL-C) and outcomes of acute myocardial infarction (AMI) patients treated by percutaneous coronary intervention(PCI), in order to clarify the impacts of thrombotic, inflammatory and cholesterol risks on long-term prognosis. Methods: Patients with AMI who underwent emergency PCI from January 2010 to June 2017 in Fuwai Hospital with complete baseline data were enrolled. Patients were stratified into four groups according to quartiles of D-dimer, hs-CRP and LCL-C. Cox regression was used to analyze the relationship between these biomarkers and prognosis. Restricted cubic spline (RCS) was used to characterize the continuous association between risk of all-cause death and biomarkers. The primary outcome was all-cause death. Results: A total of 3 614 patients were included in the analysis. The age was (59.2±12.0) years old, and 2 845 (78.7%) were male and 3 161 (87.5%) patients were diagnosed as ST-segment elevation myocardial infarction. The follow-up time was 652 (414, 1 880) days. Survival analysis showed that postprocedural D-dimer and hs-CRP were significantly associated with all-cause mortality (all P<0.05). Cox regression with multiple adjustments showed that patients with D-dimer≥580 µg/L presented higher risk of all-cause death (HR=2.03, 95%CI 1.22-3.38, P=0.006), compared to patients with D-dimer<220 µg/L. RCS analysis showed that risk of all-cause death was stably high when D-dimer reached 500 µg/L. Multivariable Cox regression also showed that patients with hs-CRP<2.74 mg/L (HR=1.86, 95%CI 1.10-3.15, P=0.020)or hs-CRP≥11.99 mg/L (HR=2.14, 95%CI 1.35-3.40, P=0.001) presented higher mortality compared to patients whose hs-CRP was 2.74-7.18 mg/L. RCS analysis indicated a J-shaped relation between hs-CRP and mortality, as greater risk of death was observed when hs-CRP was lower than 2 mg/L or higher than 10 mg/L. LDL-C was not associated with outcomes (all P>0.05). Conclusions: Postprocedural D-dimer is significantly associated with long-term prognosis of AMI patients treated by PCI. Patients with extremely high or low levels of hs-CRP presents worse outcomes. Intensive and tailored antithrombotic or anti-inflammatory therapies should be considered for patients with increased thrombotic risk and those with extremely high or low inflammatory risk.

[Chlorhexidine-grafted coating to improve antibacterial property of the micro/nanoporous titanium surfaces].

Objective: To investigate the antibacterial properties and the osteoblast-compatibility of chlorhexidine (CHX)-modified porous titanium. Methods: Smooth pure titanium specimen with diameter of 10.0 mm and thickness of 1.5 mm treated with alkali heat method were set as control group. Those with covalent conjugation of aminosilane were set as silane group, and those with CHX grafted by glutaraldehyde were set as CHX group. Scanning electron microscope (SEM) was used to observe the surface morphology and element compositions were detected by X-ray photoelectron spectroscopy. Hydrophilicity was analyzed by surface water contact angle test (n=6), while surface amino/imine groups quantification were performed through acid orangeⅡ(n=5) and the CHX was quantified by optical densitometric method (n=5). Live/dead bacterial staining, the morphology of adherent bacteria by SEM, plate counting method and inhibition zone method were executed to evaluate the antibacterial property of the samples. Osteoblast compatibility was evaluated by methyl thiazolyl tetrazolium. Cell-bacterial co-culture was conducted to evaluated the cell viability on the samples under the circumstance with bacteria. Results: After CHX grafting, pores on the titanium surface were decreased, while the atom ratio of C, N, Cl increased and the water contact angle decreased to 37.5°±4.0°. The density of CHX on the surface was (5.07±0.39) µg/cm(2). The results of live/dead bacterial staining and the morphology of adherent bacteria showed that only little dead bacterial (bacterial wall rupture) adherent on the surface of CHX group, which proved that the modified surface could inhibit bacteria adhesion and even destroyed bacteria; the plate counting displayed sporadic colonies and a transparent inhibition zone could be observed, which demonstrated that CHX group could suppress bacteria multiplication from surrounding environment. When incubating for 1 and 3 days, the cell viability of CHX group showed no significant difference from that of control group (P>0.05) ; when incubating for 5 days, the value of cell viability of CHX group was 0.547±0.087, and this was significantly lower than that of the control group (0.751±0.056) (P<0.05), demonstrating a slight inhibition of cell proliferation by CHX. The results of bacteria-cell co-culture for 3 days showed that a mass of bacteria adhered on the surface of the control group while considerable cells adhered on the surface of CHX group and exhibited a good shape. Conclusions: Porous titanium surface grafted by CHX showed an excellent antibacterial properties and allowed cell adhesion in bacterial circumstance, providing immediate implantation options for patients with bad oral health.

[Current research status and progress in comprehensive diagnosis and treatment of pancreatic cancer in the era of targeted therapy].

The incidence of pancreatic cancer (PC) has continuously shown an upward trend all over the world. It remains one of the most challenging malignant tumors in clinical practice and is characterized by difficult diagnosis in early stages, low surgical resection rate and poor prognosis. Due to its significant genetic heterogeneity, there are notable individual differences in disease progression, clinical efficacy, sensitivity to chemoradiotherapy, and prognosis among PC patients. In-depth study is needed to reveal the molecular biological characteristics of different PC subtypes and their correlation with clinical manifestations and chemoradiotherapy sensitivity, which could contribute to develop corresponding targeted therapeutic strategies.It is not only the fundamental basis for the innovation of PC morphological classification to molecular subtyping, but also a prerequisite for achieving a shift in treatment mode from "standard therapeutic strategy for different diseases" to "treat the same disease with different strategies" .This article reviews several hot issues on the comprehensive diagnosis and treatment of PC in the era of targeted therapy and prospects its future development.