A novel technique of percutaneous transhepatic treatment of biliary-enteric anastomotic occlusive strictures with compliant balloon-occluded distal cholangiography and large-bore catheter: a retrospective case series.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary balloon dilatation (PTBD) is a challenge in resolving biliary-enteric anastomotic occlusive strictures (BEAOS) and/or coexisting stones. The biliary-enteric anastomosis (BEA) often cannot be seen because of the surgically altered gastrointestinal anatomy. Here, a technique that combined percutaneous compliant-occluded distal cholangiography and the maintenance of a large-bore catheter is described to resolve this issue. Methods: A retrospective review of 10 patients who presented with BEAOS with/without coexisting stones who were treated with percutaneous compliant balloon-occluded distal cholangiography, bile duct stone removal, and the maintenance of a large-bore catheter between February 2017 and January 2021 was performed. Treatment response, laboratory examinations, including hepatic function tests, routine blood tests, and blood electrolytes, complications, and imaging data were evaluated. Paired t-tests were used to investigate the difference of laboratory examinations before and after the procedure. Results: All 10 cases were technically successful. A total of 9 stones in 6 patients were successfully removed by the compliant balloon. All catheters were removed after the patency of the stricture was confirmed by percutaneous transhepatic cholangiography (PTHC) 6 months later. No severe adverse events occurred during the perioperative period. There were 2 patients who experienced episodes of cholangitis during the follow-up period (mean, 17 months; range, 4-24 months), and neither BEAOS nor bile duct stones recurred within 2 years after the procedure. White blood cells (WBC), total bilirubin (TB), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were (6.0±1.4)×109/L and (6.0±1.6)×109/L (P=0.91), 31.4±15.7 and 29.6±10.3 µmol/L (P=0.74), 50.8±20.0 and 85.8±67.0 U/L (P=0.16), and 42.6±15.2 and 71.8±44.9 U/L (P=0.09) pre and postintervention, respectively. Conclusions: Percutaneous transhepatic compliant balloon-occluded distal cholangiography and the maintenance of a large-bore catheter probably provide an effective and safe alternative method for resolving BEAOS and/or coexisting stones.

Circulating Inflammatory Factor Levels in the Early Phase of COVID-19 are Associated with the Progression of Respiratory Failure: A Single-Center Retrospective Study.

Purpose: To evaluate the potential relationships between serum interleukin (IL)-2, IL-4, IL-6, IL-10, IL-17, interferon (IFN)-γ, and tumor necrosis factor (TNF)-α levels and occurrence of respiratory failure in patients with early-stage COVID-19 disease. Patients and Methods: We analyzed clinical characteristics, laboratory parameters, and immunoinflammatory markers in 302 patients diagnosed with SARS-CoV-2 infection who required hospitalization at Changshu Hospital of Nantong University. IL-2, IL-4, IL-6, IL-10, IL-17, IFN-γ, and TNF-α levels in the peripheral blood of patients hospitalized five days after disease onset were measured using multiplex bead-based flow fluorescent immunoassay (MBFFI). Results: Patients with respiratory failure had higher serum IL-4 [0 (0, 0.54) pg/mL], IL-6 [40.76 (12.33, 90.28) pg/mL], IL-10 [6.65 (4.12, 11.34) pg/mL], and IL-17 [9.48 (4.31, 12.13) pg/mL] levels than patients without respiratory failure (P=0.042, P<0.0001, P=0.012, and P=0.036, respectively). Serum IL-2, IFN-γ, and TNF-α levels were not significantly different between the two groups. The occurrence of respiratory failure was positively correlated with sex (R=0.122, P=0.034), lactic acid (R=0.193, P=0.007), white blood cell count (R=0.121, P=0.038), erythrocyte distribution width (R=0.131, P=0.024), thyrocalcitonin (R=0.280, P<0.0001), and D-dimer levels (R=0.214, P<0.0001) but negatively correlated with oxygen partial pressure (R=-0.208, P=0.004), oxygen saturation (R=-0.220, P=0.002), lymphocyte count (R=-0.129, P=0.026), and calcium (R=-0.152, P=0.042). Among the immunoinflammatory biomarkers, the occurrence of respiratory failure was positively correlated with IL-4 (R=-0.117, P=0.042), IL-6 (R=0.206, P<0.0001), IL-10 (R=0.145, P=0.012), and IL-17 (R=0.121, P=0.036) levels. Conclusion: Serum levels of pro-inflammatory cytokines IL-6 and IL-17 and anti-inflammatory cytokines IL-4 and IL-10 were significantly elevated in patients with respiratory failure and weakly positively correlated with the occurrence of respiratory failure. Further studies are required to explore these key immune mechanisms to help clinicians better manage acute complications, long-term sequelae, and possible future COVID-19 variants and be flexible in managing future epidemics and similar public health threats.

Benefits of Music Intervention on Anxiety, Pain, and Physiologic Response in Adults Undergoing Surgery: A Systematic Review and Meta-analysis.

PURPOSE: Evidence on factors influencing the variations of music's effect on anxiety and pain in surgical patients is unclear. We aimed to elucidate the effects of music intervention on anxiety and pain throughstudy characteristics. METHODS: We conducted a search on the PubMed, CINAHL, Embase, Cochrane, and Web of Science databases from March 7 to April 21, 2022, for randomized controlled trials (RCTs) for the effect of music intervention on anxiety, pain, and physiological responses in surgical patients. We included studies published within the last 10 years. We assessed the risk of bias in the study using the Cochrane risk of bias tool for randomized trials and performed meta-analyses using a random-effects model for all outcomes. We used change-from-baseline scores as summary statistics and computed bias-corrected standardized mean differences (Hedges'g) for anxiety and pain outcomes and mean differences (MD) for blood pressure and heart rate. RESULTS: Of the 454 records retrieved, 30 RCTs involving 2280 participants were found to be eligible. Music intervention was found to be superior to standard care in reducing anxiety (Hedges' g = -1.48, 95% confidence interval: -1.97 to -0.98), pain (Hedges's g = -0.67, -1.11 to -0.23), systolic blood pressure (MD = -4.62, -7.38 to -1.86), and heart rate (MD = -3.37, -6.65 to -0.10) in surgical patients. The impact of music on anxiety and pain relief varied significantly depending on the duration of the intervention. The largest effect was observed in interventions lasting between 30 and 60 minutes, with a decrease in anxiety and pain. CONCLUSIONS: Music intervention is an effective way to reduce anxiety, pain, and physiological responses in surgical patients. Future reviews examining the influence of different types of surgery on the effects of music would add to the body of knowledge in this field. This study has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42022340203, with a registration date of July 4, 2022.

Decrease of Membrane B7-H5 on CD14+ Cells in Severe Acute Pancreatitis Is Related to RANSON Scores and APACHE II Scores.

BACKGROUND: B7-H5 is an important ligand which is deeply involved in the immune response in various diseases. However, its clinical usefulness as an early indicator in acute pancreatitis (AP) remains unclear. AIMS: To determine the role of B7-H5 in severe acute pancreatitis (SAP). METHODS: Whole blood samples from patients with SAP (n = 20) and healthy donors (n = 20) were collected. Expression of soluble B7-H5 (sB7-H5) in plasma was determined by ELISA and membrane B7-H5 (mB7-H5) on the peripheral CD14+ cells was determined by flow cytometry. Peripheral blood mononuclear cells (PBMCs) were isolated from healthy donors and stimulated with serum from SAP patients, lipopolysaccharide (LPS), TNF-α, or IFN-γ, then, sB7-H5 and mB7-H5 were measured. The relationship between expression levels of mB7-H5 and clinical features of SAP patients were analyzed. RESULTS: The expression levels of sB7-H5 in plasma were increased and the expression levels of mB7-H5 on the peripheral CD14+ cells were decreased in SAP patients. These changes of B7-H5 expression pattern in cultured PBMCs could be induced by stimulation with serum from SAP patients, LPS, TNF-α, or IFN-γ. Expression levels of mB7-H5 were negatively related to levels of hematocrit, urea nitrogen, creatinine, lactic acid, RANSON scores, and APACHE II scores. CONCLUSION: Changes of B7-H5 expression pattern were involved in immune response of SAP. Innate immunity activation-induced decrease of mB7-H5 might be related to poor prognosis of SAP patients.

Benefits of Music Intervention on Anxiety, Pain, and Physiologic Response in Adults Undergoing Surgery: A Systematic Review and Meta-analysis

Purpose@#Evidence on factors influencing the variations of music’s effect on anxiety and pain in surgical patients is unclear. We aimed to elucidate the effects of music intervention on anxiety and pain throughstudy characteristics. @*Methods@#We conducted a search on the PubMed, CINAHL, Embase, Cochrane, and Web of Science databases from March 7 to April 21, 2022, for randomized controlled trials (RCTs) for the effect of music intervention on anxiety, pain, and physiological responses in surgical patients. We included studies published within the last 10 years. We assessed the risk of bias in the study using the Cochrane risk of bias tool for randomized trials and performed meta-analyses using a random-effects model for all outcomes. We used change-from-baseline scores as summary statistics and computed bias-corrected standardized mean differences (Hedges'g) for anxiety and pain outcomes and mean differences (MD) for blood pressure and heart rate. @*Results@#Of the 454 records retrieved, 30 RCTs involving 2280 participants were found to be eligible. Music intervention was found to be superior to standard care in reducing anxiety (Hedges' g = −1.48, 95% confidence interval: −1.97 to −0.98), pain (Hedges's g = −0.67, −1.11 to −0.23), systolic blood pressure (MD = −4.62, −7.38 to −1.86), and heart rate (MD = −3.37, −6.65 to −0.10) in surgical patients. The impact of music on anxiety and pain relief varied significantly depending on the duration of the intervention. The largest effect was observed in interventions lasting between 30 and 60 minutes, with a decrease in anxiety and pain. @*Conclusions@#Music intervention is an effective way to reduce anxiety, pain, and physiological responses in surgical patients. Future reviews examining the influence of different types of surgery on the effects of music would add to the body of knowledge in this field. This study has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42022340203, with a registration date of July 4, 2022.

Evaluation of D-TACE combined with endovascular brachytherapy for HCC with MPVTT.

Background: Hepatocellular carcinoma (HCC) patients with main portal vein tumor thrombus (MPVTT) may be able to have TACE through stent implantation into the portal vein with thrombosis to recover portal blood flow. Purpose: The goal of this study was to compare clinical results of conventional transcatheter arterial chemoembolization (C-TACE) and doxorubicin-eluting bead transcatheter arterial chemoembolization (D-TACE) combined with endovascular brachytherapy in HCC patients with MPVTT. Methods: This study was a retrospective controlled study with follow-up dates spanning from Mar 2015 to Feb 2020. Patients with both HCC and MPVTT were divided into two groups. Portal vein stents with iodine-125 seed strands were implanted first; then, C-TACE or D-TACE was administered to all patients. Objective response rates were assessed. Results: A total of 26 patients were enrolled, with 13 in each group. During follow-up, the portal stent patency times were 112.3 ± 98.2 days in the C-TACE group and 101.7 ± 90.4 days in the D-TACE group. The time to disease progression was 42 days in the C-TACE group and 120 days in the D-TACE group (p=0.03). The overall survival time from the first intervention procedure was 216 days in the C-TACE group and 239 days in the D-TACE group (p=0.047). The D-TACE group was superior to the C-TACE group in terms of progression-free survival (PFS) and overall survival (OS) times. Conclusion: Endovascular implantation of brachytherapy combined with TACE is safe and effective in HCC patients with MPVTT. This combination therapy may be helpful for survival benefits to patients with stage BCLC-C HCC.

Upregulation of B7-H4 Is Involved in and Related to the Severity of Acute Pancreatitis.

The expression and clinical significance of co-stimulator B7-H4 in acute pancreatitis (AP) is still unclear. In vitro study showed that the expression of soluble B7-H4 (sB7-H4) and proportions of membrane B7-H4-positive CD14+ cells in the peripheral blood mononuclear cells were upregulated in response to stimulation with plasma from AP patients, lipopolysaccharides, or tumor necrosis factor α (TNF-α). sB7-H4 in the plasma of AP patients were positively correlated with interleukin (IL)-6, IL-10, IL-17A, TNF-α, and interferon-γ The areas under the curves (AUCs) of receiver operating characteristic (ROC) curves of plasma sB7-H4 to distinguish the AP patients from healthy donors, the mild AP (MAP) from the moderately severe acute pancreatitis (MSAP)+severe acute pancreatitis (SAP) or the SAP from the MAP+MSAP were 0.78 (P < 0.001) or 0.773 (P < 0.001) or 0.764 (P < 0.001). sB7-H4 in the plasma of patients were positively correlated with the RANSON scores, Bedside Index of Severity of Acute Pancreatitis scores, Marshall scores, and Acute Physiology And Chronic Health Evaluation II scores; and the AUCs of ROC curves of plasma sB7-H4 in the prediction of local complications was 0.726 (P = 0.001). In conclusion, the co-stimulator B7-H4 is involved in the immune response in AP.

Soluble B7-H5 Is a Novel Diagnostic, Severity, and Prognosis Marker in Acute Pancreatitis.

As an important ligand in T lymphocyte costimulatory pathways, B7-H5 is involved deeply in the immune response in various diseases. However, its clinical usefulness as an early indicator in acute pancreatitis (AP) remains unclear. In this study, the levels of sB7-H5 and cytokines in plasma samples of 75 AP patients, 20 abdominal pain patients without AP, and 20 healthy volunteers were determined. Then, the correlation of sB7-H5 and clinical features, cytokines, the Ranson score, APACHE II score, Marshall score, and BISAP score was analysed, and the value of sB7-H5 for diagnostic, severity, and prognosis of AP was evaluated. We found that the levels of sB7-H5 were specifically upregulated in AP patients. Receiver operating characteristic (ROC) analysis revealed that sB7-H5 can identify AP patients from healthy or abdominal pain patients with 78.9% or 86.4% sensitivity and 93.3% or 90.0% specificity. Further analysis showed that the levels of sB7-H5 were significantly correlated with WBC (p = 0.004), GLU (p = 0.008), LDH (p < 0.001), Ca2+ (p = 0.006), AST (p = 0.009), PLT (p = 0.041), IL-6 (p < 0.001), IL-10 (p < 0.001), and TNF-α (p < 0.001). And levels of sB7-H5 were gradually increased among patients with mildly acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP). It can distinguish the severity of AP with good sensitivity and specificity. Moreover, when dividing the patients into two groups according to the median level of sB7-H5, the local complication and length of stay of low levels of the sB7-H5 group were significantly less than those in high levels of the sB7-H5 group. And the levels of sB7-H5 in AP patients were significantly correlated with the Ranson score (p < 0.001), APACHE II score (p < 0.001), Marshall score (p < 0.001), and BISAP score (p < 0.001). The AUCs of assessing local complications of sB7-H5 at day 1 and day 3 were 0.704 (p = 0.0024) and 0.727 (p = 0.0373). These results showed the potential value of sB7-H5 as a diagnostic, severity, and prognosis marker of AP.

[Early identification value of quick sequential organ failure assessment score in patients with sepsis of different ages].

OBJECTIVE: To investigate the value of quick sequential organ failure assessment (qSOFA) score in early identification for sepsis patients of different ages. METHODS: A retrospective study was conducted. The clinical data of 1 529 patients with suspected infection in emergency department of Changshu No.2 People's Hospital from September 2017 to March 2020 were collected. All patients were assessed for qSOFA score, and the diagnosis and treatment were recorded. Sepsis-3 was defined as the diagnostic criteria for sepsis. All the patients were divided into five groups according to age, youth group (< 45 years old), middle-aged group (45-59 years old), presenile group (60-74 years old), elderly group (75-89 years old), and longevity group (≥ 90 years old). The patients' examination results, diagnosis and treatment status were collected. The distribution of different scores of qSOFA was analyzed to calculate the sensitivity, specificity, positive predictive value and negative predictive value of different qSOFA scores for the diagnosis of sepsis in patients with suspected infection of different ages. The receiver operator characteristic curve (ROC curve) was drawn to analyze the diagnostic value of qSOFA score for sepsis in patients with suspected infection at different ages. RESULTS: Of 1 529 suspected infection patients, there were 67 patients in youth group, 129 patients in middle-aged group, 465 patients in presenile group, 778 patients in elderly group and 90 patients in longevity group. There were significant differences in lactic acid (Lac), total bilirubin (TBil), creatinine (Cr), qSOFA score and the increased value of SOFA score compared with the basic value (ΔSOFA) among the suspected infection patients at different ages. Among suspected infection patients at different ages, the patients with qSOFA score ≥ 1 were the most, and the proportion of sepsis patients was larger. Further analysis showed that qSOFA score ≥ 1 had a high diagnostic sensitivity in patients with suspected infection at different ages. In the youth group, the sensitivity was 84.4%, and the specificity was the highest (74.3%). Although qSOFA score ≥ 2 had a high specificity in the diagnosis of sepsis (all > 97%), its sensitivity was very low (all < 44%). In this study, all patients with a qSOFA score of 3 were sepsis, and the positive predictive value of the diagnosis of sepsis in each group was 100%. ROC curve analysis showed that the area under ROC curve (AUC) of qSOFA score for the diagnosis of sepsis in all suspected infection patients was 0.771 [95% confidence interval (95%CI) was 0.747-0.794], when the best cut-off value was 0.5, the sensitivity was 93.4% and the specificity was 45.6%. Among suspected infection patients of all ages, the accuracy of qSOFA score in the diagnosis of sepsis in the youth group and the longevity group was relatively high, with AUC (95%CI) of 0.825 (0.724-0.927) and 0.837 (0.756-0.917), respectively; when the best cut-off value was 0.5, the sensitivity was 84.4% or 92.2%, and the specificity was 74.3% or 56.4%, respectively. CONCLUSIONS: qSOFA score has an early diagnosis value for sepsis, especially in the patients aged < 45 years old or ≥ 90 years old. Using qSOFA score ≥ 2 to screen patients with suspected infection is likely to cause missed diagnosis.

Product of driving pressure and respiratory rate for predicting weaning outcomes.

OBJECTIVE: Clinicians cannot precisely determine the time for withdrawal of ventilation. We aimed to evaluate the performance of driving pressure (DP)×respiratory rate (RR) to predict the outcome of weaning. METHODS: Plateau pressure (Pplat) and total positive end-expiratory pressure (PEEPtot) were measured during mechanical ventilation with brief deep sedation and on volume-controlled mechanical ventilation with a tidal volume of 6 mL/kg and a PEEP of 0 cmH2O. Pplat and PEEPtot were measured by patients holding their breath for 2 s after inhalation and exhalation, respectively. DP was determined as Pplat minus PEEPtot. The rapid shallow breathing index was measured from the ventilator. The highest RR was recorded within 3 minutes during a spontaneous breathing trial. Patients who tolerated a spontaneous breathing trial for 1 hour were extubated. RESULTS: Among the 105 patients studied, 44 failed weaning. During ventilation withdrawal, DP×RR was 136.7±35.2 cmH2O breaths/minute in the success group and 230.2±52.2 cmH2O breaths/minute in the failure group. A DP×RR index >170.8 cmH2O breaths/minute had a sensitivity of 93.2% and specificity of 88.5% to predict failure of weaning. CONCLUSIONS: Measurement of DP×RR during withdrawal of ventilation may help predict the weaning outcome. A high DP×RR increases the likelihood of weaning failure.Statement: This manuscript was previously posted as a preprint on Research Square with the following link: https://www.researchsquare.com/article/rs-15065/v3 and DOI: 10.21203/rs.2.24506/v3.

Protective effect and mechanisms of action of Mongolian medicine Sulongga-4 on pyloric ligation-induced gastroduodenal ulcer in rats.

BACKGROUND: Sulongga-4 (SL-4) is a herbal formula used in traditional Mongolian medical clinics for the treatment of peptic ulcers and gastroenteritis, even though its pharmacological mechanism has not been well characterized. AIM: To evaluate the protective effect and identify the mechanisms of action of SL-4 on gastroduodenal ulcer induced by pyloric ligation (PL) in rats. METHODS: PL was performed to induce gastric and duodenal ulcers in rats, which were then treated with oral SL-4 (1.3, 2.6, or 3.9 g/kg per day) for 15 d. PL-induced gastroduodenal ulceration. Therapeutic effects were characterized by pathological and histological evaluations and inflammatory indicators were analyzed by enzyme-linked immunosorbent assay. Microarray analyses were conducted to identify gene expression profiles of gastroduodenal tissue in PL rats with or without SL-4 treatment. The candidate target genes were selected and verified by quantitative reverse transcription polymerase chain reaction (qRT-PCR). RESULTS: SL-4 decreased histopathological features in the PL-induced ulcerated rats. SL-4 significantly (P < 0.05) decreased expression of tumor necrosis factor-α, interleukin (IL)-1ß, IL-6, endotoxin, platelet-activating factor, and increased prostaglandin E2 and epidermal growth factor in ulcer tissue. Microarray analysis was used to identify a panel of candidate target genes for SL-4 acting on PL-induced ulceration. Genes included some complement and coagulation cascade and retinol metabolism pathways that are closely associated with inflammatory responses and gastric mucosal protective mechanisms. qRT-PCR showed that altered expression of the selected genes, such as CYP2b2, UGT2b1, A2m, and MASP1 was consistent with the microarray results. CONCLUSION: SL-4 exerts protective effects against PL-induced gastroduodenal ulcers via reducing inflammatory cytokines and elevating expression of gastric acid inhibitory factors. Downregulation of CYP2b2 and UGT2b1 genes in retinol metabolism and upregulation of A2m and MASP1 genes in the complement and coagulation cascades pathways are possibly involved in SL-4-mediated protection against gastroduodenal ulcer.

Genome-wide quantitative trait loci mapping on Verticillium wilt resistance in 300 chromosome segment substitution lines from Gossypium hirsutum × Gossypium barbadense.

Cotton Verticillium wilt (VW) is a devastating disease seriously affecting fiber yield and quality, and the most effective and economical prevention measure at present is selection and extension of Gossypium varieties harboring high resistance to VW. However, multiple attempts to improve the VW resistance of the most widely cultivated upland cottons have made little significant progress. The introduction of chromosome segment substitution lines (CSSLs) provide the practical solutions for merging the superior genes related with high yield and wide adaptation from Gossypium hirsutum and VW resistance and the excellent fiber quality from Gossypium barbadense. In this study, 300 CSSLs were chosen from the developed BC5F3:5 CSSLs constructed from CCRI36 (G. hirsutum) and Hai1 (G. barbadense) to conduct quantitative trait locus (QTL) mapping of VW resistance, and a total of 40 QTL relevant to VW disease index (DI) were identified. Phenotypic data were obtained from a 2-year investigation in two fields with two replications per year. All the QTL were distributed on 21 chromosomes, with phenotypic variation of 1.05%-10.52%, and 21 stable QTL were consistent in at least two environments. Based on a meta-analysis, 34 novel QTL were identified, while 6 loci were consistent with previously identified QTL. Meanwhile, 70 QTL hotspot regions were detected, including 44 novel regions. This study concentrates on QTL identification and screening for hotspot regions related with VW in the 300 CSSLs, and the results lay a solid foundation not only for revealing the genetic and molecular mechanisms of VW resistance but also for further fine mapping, gene cloning and molecular designing in breeding programs for resistant cotton varieties.

A retrospective study of CT-guided percutaneous irreversible electroporation (IRE) ablation: clinical efficacy and safety.

BACKGROUND: To evaluate the clinical efficacy and safety of ablating renal cell carcinoma (RCC) by irreversible electroporation (IRE). METHODS: Fifteen patients (19 lesions) with RCC who underwent IRE were retrospectively reviewed. Seven patients had solitary kidneys. Two lesions were located in the renal hilus. One patient had chronic renal insufficiency. Percutaneous biopsy for histopathology was performed. The best puncture path plan was evaluated before CT-guided IRE. The estimated glomerular filtration rate (eGFR) was compared vs baseline at 1-2 months after the ablation. Contrast-enhanced computed tomography imaging changes were evaluated immediately after IRE. Contrast-enhanced computed tomography/magnetic resonance was performed 1 month, 3 months, 6 months, 12 months and every year thereafter. The complications after treatment were also reviewed. RESULTS: The success rate of the procedure was 100%. The median tumor size was 2.4 (IQR 1.3-2.9) cm, with an median score of 6 (IQR 5.5-8) per R.E.N.A.L. criteria (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines). Two cases (3 lesions) were punctured through the liver. In other cases, puncture was performed through the perirenal space. There were no severecomplications in interventional therapy. Transient gross hematuria occurred in 2 patients (centrally located). Self-limiting perinephric hematomas occurred in 1 patient. Needle puncture path metastasis was found in 1 patient 2.5 years after IRE. The subcutaneous metastasis was surgically removed, and there was no evidence of recurrence. There was no significant change in eGFR levels in terms of short- term clinical outcomes (t = 0.348, P = 0.733). At 6 months, all 15 patients with imaging studies available had no evidence of recurrence. At 1 year, 1 patient (1 of 15) was noted to have experienced needle tract metastasis and accepted salvage radiofrequency ablation (RFA) therapy. CONCLUSIONS: IRE appears to be a safe and effective treatment for RCC that may offer a tissue-sparing method and complete ablation as an alternative therapy for RCC.

A retrospective study of the use of percutaneous vesselplasty for pathological vertebral compression fractures.

Objective and Aims: To assess percutaneous vesselplasty's safety and efficacy in treating pathological vertebral compression fractures (VCFs). Subjects and Methods: This retrospective review covered nine patients with an equal number of symptomatic pathological VCFs treated with vesselplasty. The study assessed the patients' pain scores, subjective conditions, imaging guidance, and incidence of procedure-related complications. Results: The VCFs were at the T4 and L5 spine regions. The procedure success rate was 100%. In 88.89% (8/9) of the examined cases, there was a posterior vertebral body or pedicle involvement or both. Two patients with high thoracic VCFs underwent combined computed tomography and mobile C-arm fluoroscopy guidance. The other patients underwent digital subtraction angiography guidance. The average visual analog scale (VAS) score and the Oswestry Disability Index (ODI) before the treatment were 7.78 ± 0.67 standard deviation (SD) and 75.45 ± 7.55, respectively. The average VAS score and ODI 3 months after the treatment were 2.67 ± 0.50 (SD) and 32.45 ± 6.19 (P < 0.001), respectively. There were no recorded cases of symptomatic cement leakage or other operation-associated complications. Conclusions: Percutaneous vesselplasty appears to be a safe and effective minimally invasive local treatment for pathological VCFs. This approach may offer benefits in improving pain, mobility, and function and minimizing the bone cement leakage rate while providing a safe and effective alternative treatment for pathological VCFs.

Magnetic resonance imaging-guided microwave ablation of hepatic malignancies: Feasibility, efficacy, safety, and follow-up.

CONTEXT: Percutaneous image-guided thermal ablation has emerged as a valuable therapeutic approach for hepatic malignancies. Magnetic resonance imaging (MRI) has shown potential for great soft-tissue resolution and multiplanar capabilities in arbitrary imaging planes, which are also critical for treatment planning, targeting, and evaluation. AIMS: The aim of this study was to investigate the feasibility, technical success, safety, and follow-up of hepatic malignancies treated with MRI-guided microwave ablation (MWA). MATERIALS AND METHODS: MRI-guided MWA was performed in a closed-bore 1.5 T MR system. T1-weighted imaging was used as a monitoring tool during surgery. T2-weighted imaging was performed to obtain an adequate tumor margin, to calculate the tumor size. Multi-b-value diffusion-weighted imaging (DWI) was performed postprocedurally. Enhanced MRI was performed at 4 weeks, to assess the technical success, and every 3-6 months as a follow-up. RESULTS: Twenty-six patients (38 lesions) were enrolled in the study. A primary efficacy rate of 100% was achieved, and no major complications were observed. Two patient cohorts were identified based on lesion size. Six lesions with incomplete circles on reconstructed DWI appeared immediately postprocedure, and persistent hyperintense signals developed into new lesions over the subsequent 6-12 months. CONCLUSION: MRI-guided ablation is feasible and effective for planning and evaluating MWA in hepatic malignancies. The available clinical data strongly support the advantages of the assessment of tumors through 3D imaging versus routine axial images.

QTL mapping and genetic effect of chromosome segment substitution lines with excellent fiber quality from Gossypium hirsutum × Gossypium barbadense.

Chromosome segment substitution lines (CSSLs) are ideal materials for identifying genetic effects. In this study, CSSL MBI7561 with excellent fiber quality that was selected from BC4F3:5 of CCRI45 (Gossypium hirsutum) × Hai1 (Gossypium barbadense) was used to construct 3 secondary segregating populations with 2 generations (BC5F2 and BC5F2:3). Eighty-one polymorphic markers related to 33 chromosome introgressive segments on 18 chromosomes were finally screened using 2292 SSR markers which covered the whole tetraploid cotton genome. A total of 129 quantitative trait loci (QTL) associated with fiber quality (103) and yield-related traits (26) were detected on 17 chromosomes, explaining 0.85-30.35% of the phenotypic variation; 39 were stable (30.2%), 53 were common (41.1%), 76 were new (58.9%), and 86 had favorable effects on the related traits. More QTL were distributed in the Dt subgenome than in the At subgenome. Twenty-five stable QTL clusters (with stable or common QTL) were detected on 22 chromosome introgressed segments. Finally, the 6 important chromosome introgressed segments (Seg-A02-1, Seg-A06-1, Seg-A07-2, Seg-A07-3, Seg-D07-3, and Seg-D06-2) were identified as candidate chromosome regions for fiber quality, which should be given more attention in future QTL fine mapping, gene cloning, and marker-assisted selection (MAS) breeding.

Transcriptomic and biochemical analysis of upland cotton (Gossypium hirsutum) and a chromosome segment substitution line from G. hirsutum × G. barbadense in response to Verticillium dahliae infection.

BACKGROUND: Verticillium wilt (VW), also known as "cotton cancer," is one of the most destructive diseases in global cotton production that seriously impacts fiber yield and quality. Despite numerous attempts, little significant progress has been made in improving the VW resistance of upland cotton. The development of chromosome segment substitution lines (CSSLs) from Gossypium hirsutum × G. barbadense has emerged as a means of simultaneously developing new cotton varieties with high-yield, superior fiber, and resistance to VW. RESULTS: In this study, VW-resistant investigations were first conducted in an artificial greenhouse, a natural field, and diseased nursery conditions, resulting in the identification of one stably VW-resistant CSSL, MBI8255, and one VW-susceptible G. hirsutum, CCRI36, which were subsequently subjected to biochemical tests and transcriptome sequencing during V991 infection (0, 1, and 2 days after inoculation). Eighteen root samples with three replications were collected to perform multiple comparisons of enzyme activity and biochemical substance contents. The findings indicated that VW resistance was positively correlated with peroxidase and polyphenol oxidase activity, but negatively correlated with malondialdehyde content. Additionally, RNA sequencing was used for the same root samples, resulting in a total of 77,412 genes, of which 23,180 differentially expressed genes were identified from multiple comparisons between samples. After Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis on the expression profiles identified using Short Time-series Expression Miner, we found that the metabolic process in the biological process, as well as the pathways of phenylpropanoid biosynthesis and plant hormone signal transduction, participated significantly in the response to VW. Gene functional annotation and expression quantity analysis indicated the important roles of the phenylpropanoid metabolic pathway and oxidation-reduction process in response to VW, which also provided plenty of candidate genes related to plant resistance. CONCLUSIONS: This study concentrates on the preliminary response to V991 infection by comparing the VW-resistant CSSL and its VW-susceptible recurrent parent. Not only do our findings facilitate the culturing of new resistant varieties with high yield and superior performance, but they also broaden our understanding of the mechanisms of cotton resistance to VW.

Preliminary application of 3D-printed coplanar template for iodine-125 seed implantation therapy in patients with advanced pancreatic cancer.

AIM: To evaluate a 3D-printed coplanar template for iodine-125 seed implantation therapy in patients with pancreatic cancer. METHODS: A retrospective analysis of our database was performed, and a total of 25 patients with pancreatic cancer who underwent iodine-125 seed implantation between January 2014 and November 2017 were analyzed. Of these, 12 implantations were assisted by a 3D-printed coplanar template (group A), and 13 implantations performed freehand were selected as a control group (group B). A 3D coplanar template was designed and printed according to a preoperative CT scan and treatment planning system. The iodine-125 seeds were then implanted using the template as a guide. Dosimetric verification was performed after implantation. Pre- and postoperative D90, V100, and V150 were calculated. The success rate of iodine-125 seed implantation, dosimetric parameters, and complications were analyzed and compared between the two groups. RESULTS: Iodine-125 seed implantation was successfully performed in both groups. In group A, the median pre- and postoperative D90 values were 155.32 ± 8.05 Gy and 154.82 ± 16.43 Gy, respectively; the difference between these values was minimal and not statistically significant (P > 0.05). Postoperative V100 and V150 were 91.05% ± 4.06% and 64.54% ± 13.40%, respectively, which met the treatment requirement. A better dosimetric parameter was observed in group A than in group B, and the difference was statistically significant (V100: 91.05% ± 4.06% vs 72.91% ± 13.78%, P < 0.05). No major procedure-related complications were observed in either group. For group A, mild hemorrhage was observed in 1 patient with a peritoneal local hematoma due to mesenteric vein damage from the iodine-125 seed implantation needle. The hematoma resolved spontaneously without treatment. Postoperative blood amylase levels remained within the normal range for all patients. CONCLUSION: A 3D-printed coplanar template appears to be a safe and effective iodine-125 seed implantation guidance tool to improve implantation accuracy and optimize dosimetric distribution.

The safety and efficacy of interstitial 125I seed implantation brachytherapy for metastatic epidural spinal cord compression.

OBJECTIVE: The objective of this study is to investigate the safety and efficacy of 125I seed interstitial implantation brachytherapy for metastatic epidural spinal cord compression (MESCC) as well as the life quality of patients. MATERIALS AND METHODS: From April 2009 to May 2015, 28 patients who met the eligibility criteria were retrospectively reviewed. The number of implanted 125I seeds ranged from 7 to 62, with appropriate activity of 0.5-0.8 mCi. The postplan showed that the matched peripheral dose (MPD) of tumors was 80-140 Gy. The duration of follow-up ranged from 1 to 32 months with a median of 18 months. Visual analog scale (VAS), Karnofsky Performance Scale (KPS), and motor performance were evaluated before and after treatment. RESULTS: Seed implantation was well tolerated by all patients. Pain was obviously alleviated in all patients. VAS score of patients was significantly decreased from 4.89 ± 1.52 before treatment to 1.61 ± 1.20 after treatment, and KPS score was significantly increased from 73.93 ± 12.27 to 86.76 ± 10.90 (P < 0.05). The local control rates of 1, 2, and 3 years were 77%, 34%, and 14%, respectively, with a median of 19 months (7-32 months). The survival rates of 1, 2, and 3 years were 81%, 54%, and 14%, respectively, with a median of 25 months. Seven (100%) nonwalking patients regained motor ability. No myelopathy or other neurologic sequelae were encountered. CONCLUSION: Interstitial 125I seed implantation brachytherapy may be a promising local therapy, which was an alternative and palliative way for treating MESCC.

Comparative transcriptome analysis of cotton fiber development of Upland cotton (Gossypium hirsutum) and Chromosome Segment Substitution Lines from G. hirsutum × G. barbadense.

BACKGROUND: How to develop new cotton varieties possessing high yield traits of Upland cotton and superior fiber quality traits of Sea Island cotton remains a key task for cotton breeders and researchers. While multiple attempts bring in little significant progresses, the development of Chromosome Segment Substitution Lines (CSSLs) from Gossypium barbadense in G. hirsutum background provided ideal materials for aforementioned breeding purposes in upland cotton improvement. Based on the excellent fiber performance and relatively clear chromosome substitution segments information identified by Simple Sequence Repeat (SSR) markers, two CSSLs, MBI9915 and MBI9749, together with the recurrent parent CCRI36 were chosen to conduct transcriptome sequencing during the development stages of fiber elongation and Secondary Cell Wall (SCW) synthesis (from 10DPA and 28DPA), aiming at revealing the mechanism of fiber development and the potential contribution of chromosome substitution segments from Sea Island cotton to fiber development of Upland cotton. RESULTS: In total, 15 RNA-seq libraries were constructed and sequenced separately, generating 705.433 million clean reads with mean GC content of 45.13% and average Q30 of 90.26%. Through multiple comparisons between libraries, 1801 differentially expressed genes (DEGs) were identified, of which the 902 up-regulated DEGs were mainly involved in cell wall organization and response to oxidative stress and auxin, while the 898 down-regulated ones participated in translation, regulation of transcription, DNA-templated and cytoplasmic translation based on GO annotation and KEGG enrichment analysis. Subsequently, STEM software was performed to explicate the temporal expression pattern of DEGs. Two peroxidases and four flavonoid pathway-related genes were identified in the "oxidation-reduction process", which could play a role in fiber development and quality formation. Finally, the reliability of RNA-seq data was validated by quantitative real-time PCR of randomly selected 20 genes. CONCLUSIONS: The present report focuses on the similarities and differences of transcriptome profiles between the two CSSLs and the recurrent parent CCRI36 and provides novel insights into the molecular mechanism of fiber development, and into further exploration of the feasible contribution of G. barbadense substitution segments to fiber quality formation, which will lay solid foundation for simultaneously improving fiber yield and quality of upland cotton through CSSLs.