Cullin-9/p53 mediates HNRNPC degradation to inhibit erastin-induced ferroptosis and is blocked by MDM2 inhibition in colorectal cancer.

Colorectal cancer (CRC) is the leading cause of cancer associated death worldwide. Ferroptosis is a newly defined form of regulated cell death characterized by the accumulation of lipid hydroperoxides and exerts an increased attention for cancer treatment. However, little is known about ferroptosis in CRC. In this study, through whole genome sequencing and external differential differentiated expression analysis, we identify CUL9 as a novel important modulator for ferroptosis in CRC. Here we demonstrated that CUL9 can binds p53 to ubiquitylate heterogeneous nuclear ribonucleoprotein C for degradation. Overexpression of CUL9 increases resistance to erastin-induced ferroptosis. Then, we discovered this resistance was mediated by CUL9-HNRNPC-MATE1 negative loop, which can provide us with a novel target to overcome drug resistance to ferroptosis activators. Finally, we found that targeting MDM2 was developed as an effective strategy to destroy precious drug-resistant CRC cells.

Anatomic and histological analysis in a goat model used for maxillary sinus floor augmentation with simultaneous implant placement.

OBJECTIVES: The aim of the present study was to carry out an anatomic survey on the goat maxillary sinus in order to provide accurate and definite anatomic parameters for the design of sinus floor elevation and dental implantation studies in this valuable preclinic animal model. MATERIAL AND METHODS: The anatomic topographic structure of the maxillary sinuses was studied bilaterally in 10 adult goats by a gross survey as well as a histological analysis with parasagittal or coronal sections. Then following parameters were defined and measured: (1) maxillary alveolar height (MAH): vertical height from the alveolar crest to the sinus floor; (2) sinus lateral floor width (SLFW): horizontal distance from the lateral border of the anteroposterior bone crest to the sinus lateral wall; (3) infraorbital canal diameter (ICD); and (4) maxillary sinus volume (MSV): the volume occupied by water injected into the sinus. The data were presented with mean + or - SD on both sides. RESULTS: The goat has a maxillary sinus similar to humans, with a slender pyramidal shape that pneumatizes the entire maxilla, and a sinus wall covered with a mucosal lining. From the maxillary sinus floor, there is an anteroposterior bone crest protruding with the infraorbital canal enveloped. It divides the maxillary sinus floor into two parts. The SLFW of the lateral part of the maxillary sinus floor becomes broader, about 5.905 + or - 1.475 mm in the third premolar site, and the MAH increases towards the posterior area, where the maxillary sinus floor is close to the related teeth roots. According to original metrical data, we also proposed a possible operation procedure for sinus floor augmentation. CONCLUSIONS: There is enough space in the lateral floor of the maxillary sinus for dental implantation, and the third premolar area might be a suitable position suggested for maxillary sinus augmentation with simultaneous implant placement in a goat model.

Current situation and future countermeasures for implementing experiential teaching in geriatric nursing education / 中华医学教育探索杂志

Experiential teaching is a practical, reflective, and situational teaching method. Based on the systematic review of literature published worldwide, this paper summarizes the characteristics and organizational forms of experiential teaching, with a focus on its current application and existing problems in teaching geriatric nursing. This review provides suggestions for the reform of teaching methods of geriatric nursing in China.

Spatial transcriptomics reveals that metabolic characteristics define the tumor immunosuppression microenvironment via iCAF transformation in oral squamous cell carcinoma / 国际口腔科学杂志·英文版

Tumor progression is closely related to tumor tissue metabolism and reshaping of the microenvironment. Oral squamous cell carcinoma (OSCC), a representative hypoxic tumor, has a heterogeneous internal metabolic environment. To clarify the relationship between different metabolic regions and the tumor immune microenvironment (TME) in OSCC, Single cell (SC) and spatial transcriptomics (ST) sequencing of OSCC tissues were performed. The proportion of TME in the ST data was obtained through SPOTlight deconvolution using SC and GSE103322 data. The metabolic activity of each spot was calculated using scMetabolism, and k-means clustering was used to classify all spots into hyper-, normal-, or hypometabolic regions. CD4T cell infiltration and TGF-β expression is higher in the hypermetabolic regions than in the others. Through CellPhoneDB and NicheNet cell-cell communication analysis, it was found that in the hypermetabolic region, fibroblasts can utilize the lactate produced by glycolysis of epithelial cells to transform into inflammatory cancer-associated fibroblasts (iCAFs), and the increased expression of HIF1A in iCAFs promotes the transcriptional expression of CXCL12. The secretion of CXCL12 recruits regulatory T cells (Tregs), leading to Treg infiltration and increased TGF-β secretion in the microenvironment and promotes the formation of a tumor immunosuppressive microenvironment. This study delineates the coordinate work axis of epithelial cells-iCAFs-Tregs in OSCC using SC, ST and TCGA bulk data, and highlights potential targets for therapy.

Application of three-dimensional printed guiding device for electrode implantation in sacral neuromodulation in children / 现代泌尿外科杂志

【Objective】 To investigate the application value of three-dimensional printed guiding device in sacral neuromodulation in children. 【Methods】 A total of 17 patients admitted during Jan.2017 and Nov.2022 were divided into two groups: control group (n=8), using traditional method to locate sacral foramen for puncture; three-dimensional printed guiding device group (n=5), using three-dimensional printing technology to make individual guiding device for puncture. The clinical indexes of the two groups were evaluated, including puncture time, puncture numbers, intraoperative X-ray exposure times, postoperative evaluation time and second-stage conversion rate. The evaluation indexes of postoperative complications were wound bleeding, wound infection, wound rupture, electrode fracture, displacement or prolapse. 【Results】 In the control group, 1 case was diagnosed as bladder-bowel dysfunction, the remaining 7 were neurogenic bladder; in the three-dimensional printed guiding device group, all 9 cases were diagnosed as neurogenic bladder. The puncture time was shorter in the three-dimensional printed guiding device group than in the control group [85(70-90) min vs.138(133-208) min], the puncture numbers were fewer [15(12-20) vs.22(18-26)], and the X-ray exposure times were fewer [12(12-17) vs.19(16-23)] (all P<0.05). The initial stimulation voltage, postoperative evaluation time and second-stage conversion rate were not statistically significant. 【Conclusion】 Compared with the traditional method, the use of three-dimensional printed guiding device can reduce the puncture numbers and shorten the puncture time in the process of sacral neuromodulation in children.

Influencing factors for inadequate bowel preparation of colonoscopy of different colonic segments / 中华消化内镜杂志

Objective:To investigate the influencing factors for inadequate bowel preparation of colonoscopy.Methods:A total of 677 patients who underwent colonoscopy at Peking Union Medical College Hospital from December 2021 to January 2023 were recruited, and all patients underwent standardized bowel preparation by using 3 L polyglycol electrolyte powder with fractional dose. The quality of bowel preparation was assessed by Boston bowel preparation scale, and the influencing factors for inadequate bowel preparation were analyzed by logistic regression analysis.Results:The rate of inadequate bowel preparation was 31.5% (213/677). Among the patients with inadequate bowel preparation, 85.4% (182/213) inadequate bowel preparation was only in proximal colon, 14.1% (30/213) was in both proximal and distal colon, and 0.5% (1/213) was only in distal colon. Inadequate bowel preparation in distal colon and total colon were combined into inadequate bowel preparation in distal colon. The results of logistic regression analysis showed that inadequate bowel preparation in proximal colon was more likely to occur in men ( P=0.001, OR=2.253, 95% CI: 1.399-3.629), outpatients ( P<0.001, OR=4.175, 95% CI: 2.410-7.231), those with no family history of colorectal cancer ( P=0.001, OR=2.117, 95% CI: 1.365-3.284), and diagnostic colonoscopy ( P=0.003, OR=1.978, 95% CI: 1.261-3.102). And spinal disease ( P=0.044, OR=7.430, 95% CI: 1.051-52.511), outpatients ( P<0.001, OR=135.577, 95% CI: 29.135-630.883),non-compliance of dietary requirements ( P=0.006, OR=4.772, 95% CI: 1.576-14.453), adverse reaction during bowel preparation ( P=0.015, OR=4.341, 95% CI: 1.329-14.179), no family history of colorectal cancer ( P=0.003, OR=7.110, 95% CI: 1.912-26.438), and poor last stool character ( P=0.001, OR=25.922, 95% CI: 3.779-177.832) were risk factors for inadequate bowel preparation in distal colon. Conclusions:The inadequate bowel preparation of colonoscopy mainly occurs in proximal colon, and the risk factors for the inadequate bowel preparation vary in different colonic segments. Therefore, the specific interventions should be performed according to the character of different colon segments to improve the quality of bowel preparation.

A biomimetic nanoplatform for customized photothermal therapy of HNSCC evaluated on patient-derived xenograft models / 国际口腔科学杂志·英文版

Cancer cell membrane (CCM) derived nanotechnology functionalizes nanoparticles (NPs) to recognize homologous cells, exhibiting translational potential in accurate tumor therapy. However, these nanoplatforms are majorly generated from fixed cell lines and are typically evaluated in cell line-derived subcutaneous-xenografts (CDX), ignoring the tumor heterogeneity and differentiation from inter- and intra- individuals and microenvironments between heterotopic- and orthotopic-tumors, limiting the therapeutic efficiency of such nanoplatforms. Herein, various biomimetic nanoplatforms (CCM-modified gold@Carbon, i.e., Au@C-CCM) were fabricated by coating CCMs of head and neck squamous cell carcinoma (HNSCC) cell lines and patient-derived cells on the surface of Au@C NP. The generated Au@C-CCMs were evaluated on corresponding CDX, tongue orthotopic xenograft (TOX), immune-competent primary and distant tumor models, and patient-derived xenograft (PDX) models. The Au@C-CCM generates a photothermal conversion efficiency up to 44.2% for primary HNSCC therapy and induced immunotherapy to inhibit metastasis via photothermal therapy-induced immunogenic cell death. The homologous CCM endowed the nanoplatforms with optimal targeting properties for the highest therapeutic efficiency, far above those with mismatched CCMs, resulting in distinct tumor ablation and tumor growth inhibition in all four models. This work reinforces the feasibility of biomimetic NPs combining modular designed CMs and functional cores for customized treatment of HNSCC, can be further extended to other malignant tumors therapy.

Research progress on the mechanism of role of podoplanin in sepsis / 中华危重病急救医学

Podoplanin (PDPN) is a small transmembrane mucin-like glycoprotein which is expressed on the surface of lymphatic endothelial cells, glomerular podocytes, type-Ⅰ alveolar epithelial cells and some tumor cells. PDPN plays crucial function in variety of physiological and pathological processes such as embryonic development, immunoreaction, inflammation and cancer. C-type lectin-like receptor 2 (CLEC2) is mainly expressed on the platelet which specific ligand is PDPN. The interaction between PDPN and CLEC2 has received extensive attention. In this review, we summarized recent researches on the role of in sepsis and elaborated the possible mechanisms and some potential therapies for sepsis by targeting PDPN, which may provide theoretical basis for the mechanism and treatment of sepsis.

Current status and prospect of supermicrosurgery in maxillofacial reconstruction / 中华显微外科杂志

Supermicrosurgery is a hot topic in the field of microsurgery and reconstruction. The core concept of supermicrosurgery is precision and minimally invasive, which coincides with the concept of maxillofacial reconstruction. Oral and maxillofacial regions play an important role in aesthetics and function, and the structure of oral and maxillofacial tissues is complex. Various types of flaps, especially vascularised free flaps, are required for the repair of various complex maxillofacial defects. However, at present, conventional microsurgery does meet the requirement of mandibular reconstruction in special cases. Super microsurgical technique can further supplement the deficiency of conventional methods of repair and reconstruction in maxillofacial reconstruction. Under the guidance, many new methods of maxillofacial surgery have inevitably emerged. The application of supermicrosurgery in maxillofacial head and neck is still in its early stage, and there are still many difficulties to overcome and many technical issues to be furtherresolved. Supermicrosurgery is not only an advanced technique, but also an advanced concept in surgery. Supermicrosurgery is expected to show its clinical value in oral and maxillofacial reconstruction. In this paper, the application of supermicrosurgery in maxillofacial reconstruction is reviewed and its application prospect is prospected.

Efficacy of TIPS in treatment of recurrent portal hypertension after splenectomy and devascularization in patients presenting with upper gastrointestinal bleeding / 中华肝胆外科杂志

Objective:To study the efficacy, feasibility and safety of transjugular intrahepatic portosystemic shunt (TIPS) in treatment of recurrent portal hypertension after splenectomy and devascularization in patients presenting with upper gastrointestinal bleeding.Methods:Cirrhotic patients with recurrent portal hypertension after splenectomy and devascularization and presenting with upper gastrointestinal bleeding from August 2015 to December 2020 were studied. Thirty-nine patients were included in this study. There were 24 males and 15 females, with age of (51.56±9.08) years old. These patients were treated with TIPS by using the Viabahn stent. Intraoperative portal vein pressure, success operative rate, hemostasis rate after surgery, changes in hematological indicators and postoperative efficacy and complication rate were studied.Results:Thirty-eight of 39 patients successfully underwent TIPS shunt and 1 patient failed because of portal vein spongiosis. The success rate was 97.44%(38/39). Thirty-three patients underwent TIPS and variceal vein embolization, while 5 patients were treated with TIPS alone. Thirty-nine Viabahn stents with a diameter of 8 mm were implanted in 38 patients, of which 5 patients had the stent expanded to its nominal diameter of 8 mm. The remaining 33 patients (86.84%) had a shunt with a diameter of 6 mm. The hemostasis rate of postoperative gastrointestinal bleeding was 97.37% (37/38). The portal vein pressure and portal venous pressure gradient decreased from (31.28±6.24), (20.61±5.14) mmHg (1 mmHg=0.133 kPa) to (19.58±4.69), (9.24±3.07) mmHg respectively, the differences were significant (all P<0.001). All patients were followed-up for 3 to 36 months, with a median follow-up of 12 months. The postoperative rebleeding rate was 6.90% (2/29). The incidence of hepatic encephalopathy was 13.79% (4/29), and the incidence of shunt disorder was 13.79% (4/29). Conclusion:TIPS was safe, effective and feasible in treating patients with recurrent portal hypertension after splenectomy and devascularization presenting with upper gastrointestinal bleeding. Most patients obtained good clinical outcomes with a 6 mm diameter shunt.

Effects of body mass index, appendicular skeletal muscle mass index and serum lipid levels on the risk of tumor progression in patients with high-risk renal clear cell carcinoma / 中华临床营养杂志

Objective:To evaluate the potential effects of serum lipid levels, appendicular skeletal muscle mass index (ASMI) and body mass index (BMI), together with its dynamic changes, on tumor progression in renal clear cell carcinoma patients, so as to inform body weight management.Methods:This prospective cohort study included a total of 100 patients with high-risk clear cell renal cell carcinoma. Serum lipid levels were detected, ASMI and BMI were measured using bioelectrical impedance analysis and the dynamic changes of BMI were tracked. The effects of BMI, ASMI and serum lipid levels on tumor progression within 2 years were explored.Results:Patients with normal BMI and low ASMI had 5.248 (95% CI: 1.946 to 14.153, P = 0.001) times higher risk of tumor progression than those who were overweight or obese. For every 0.1-unit increase in pre-operative HDL-C, the risk of tumor progression decreased by 0.771 (95% CI: 0.631 to 0.942, P = 0.011) times. Patients who experienced more than 5% decrease in BMI compared with baseline had 5.165 (95% CI: 1.735 to 15.370, P = 0.003) times the progression risk of patients whose BMI changed within ±5% from baseline. Conclusions:The advantage of obese clear cell carcinoma patients over normal-weight patients in tumor progression-free survival may be influenced by ASMI, pre-onset involuntary weight loss and lipid levels. Therefore, patient weight management should not merely focus on absolute BMI but tailor to individual characteristics, including cancer stage, body composition and metabolic status.

Research progress on combined treatment of radiotherapy and anti-CTLA-4 antibody / 中华放射肿瘤学杂志

Radiotherapy (RT) is one of the three prevailing therapeutics for tumors. With rapid development of immunotherapy (IM), the combination of IM and RT has gainned increasingly widespread attention. Cytotoxic T lymphocyte associated protein-4(CTLA-4) inhibitor is an important checkpoint target in immune activation and regulation, which exerts significant anti-tumor effects in melanoma and non-small cell lung cancer, etc. Accordingly, the combination of RT and anti-CTLA-4 antibody has become a hot spot. This article reviews research progress on pre-clinical and clinical evidences of RT combined with anti-CTLA-4 antibody, which provides evidence for further exploration in this field.

Effects of nurse-led interRAI-based multidisciplinary team management on body composition and metabolic parameters among elderly patients with metabolic syndrome / 中华临床营养杂志

Objective:To investigate the effects of nurse-led interRAI-based multidisciplinary team management on body composition and metabolic parameters among elderly patients with metabolic syndrome.Methods:100 elderly patients aged 60-74 with the diagnosis of metabolic syndrome were randomized into control group ( n=50) and study group ( n=50). The control group was followed up after routine physical examination. Based on interRAI assessment, the study group received nurse-led individualized intervention which integrated management regarding geriatric internal medicine, clinical nutrition, psychology and physical rehabilitation. This 12-week study measured body composition indexes body protein, body fat mass (BFM), skeletal muscle mass (SMM), body mass index (BMI), waist-to-hip ratio (WHR) and biochemical indexes [triglycerides (TG), high density lipoprotein cholesterol (HDL-C) and glycosylated hemoglobin (HbA1c)] on the first day and 12 weeks after enrollment and compared those parameters between the two groups. Results:After 12 weeks of intervention, compared with the control group, the study group showed significantly increased body protein [(10.48±2.02) kg vs (9.72±1.65) kg, P=0.043], SMM [(29.61±6.07) kg vs (27.36±4.96) kg, P=0.046], BFM [(17.86±3.42) kg vs (19.64±5.07)kg, P=0.042], WHR (0.88±0.05 vs 0.89±0.03, P=0.021) and TG [(2.31±0.42) mmol/L vs (2.95±0.52) mmol/L, P=0.014]. There was no significant difference in BMI [(25.06±3.41) kg/m 2vs (24.40±2.48) kg/m 2, P=0.272], HDL-C [(0.94±0.10) mmol/L vs (0.91±0.31) mmol/L, P=0.246] and HbA1c [(6.11±0.51)% vs (6.37±0.42)%, P=0.185]. After 12 weeks of intervention, body fat [(17.86±3.42) kg vs (20.71±5.98) kg, P=0.004], WHR (0.88±0.05 vs 0.91±0.05, P=0.001), TG [(2.30±0.42)mmol/L vs (2.75±0.37) mmol/L, P=0.032] and HbA1c [(6.11±0.51) mmol/L vs (6.35±0.63) mmol/L, P=0.015] in the study group were significantly lower compared with baseline and there was no difference in those parameters at baseline and 12 weeks after enrollment in the control group. Conclusion:The nurse-led multidisciplinary management model based on interRAI assessment can effectively improve the body composition and certain metabolic indexes of the elderly with metabolic syndrome.

A clinical study of standard remnant liver volume in predicting post-hepatectomy liver failure in patients with hepatocellular carcinoma after hemihepatectomy of cirrhotic liver / 中国肿瘤临床

Objective: To explore the correlation between standard remnant liver volume(SRLV) and post-hepatectomy liver failure (PHLF)in patients with hepatocellular carcinoma(HCC)and cirrhotic livers.Methods:In total,181 patients who underwent hemihepa-tectomy in Affiliated Tumor Hospital of Guangxi Medical University from September 2013 to August 2016 were enrolled in the study. Total liver,tumor,remnant liver,and resected liver volumes were measured using the Myrian liver surgical planning system before sur-gery. Intraoperative resected liver volume (including resected normal liver and tumor volumes) were collected using the drainage method.The patients were divided into the PHLF(22 cases)and non-PHLF groups(159 cases)according to whether PHLF occurred based on the"50/50"criteria.The risk factors of PHLF were then explored.The cut-off of SRLV and efficiency of predicting PHLF were analyzed in the subgroup of patients with cirrhotic livers.The grade of liver cirrhosis was retrospectively analyzed using helical comput-ed tomography(CT).Results:Twenty-two of the 181 patients developed PHLF and one died of it.Preoperative total bilirubin levels and SRLV were identified as independent factors for predicting PHLF using a Logistic regression model.In total,102 patients with cirrhotic livers were selected in subgroup analysis based on postoperative cirrhotic pathology.Eighteen patients developed PHLF and one died of PHLF in the subgroup.Using receiver-operating characteristic(ROC)curve analysis,340 mL/m2was the cut-off of SRLV for patients with HCC and cirrhotic livers(area under the curve:0.861,P<0.01;sensitivity and specialty rates were 94.4% and 74.7%,respectively). Eighty-four cases were of grade Ⅰ or Ⅱ cirrhosis,18 cases were of grade Ⅲ cirrhosis,and there were no cases of grade Ⅳ cirrhosis based on retrospective analysis using helical CT.Conclusions:Patients with cirrhotic livers with an anticipated SRLV of≤340 Ml/m2after he-patic resection are at increased risk for PHLF after emihepatectomy.

Superficial circumflex iliac artery perforator flap for reconstruction of buccal and plate soft tissue defects / 中华整形外科杂志

Objective@#To investigate the therapeutic effect of free superficial circumflex iliac artery perforator (SCIP)flap for reconstruction of soft tissue defects secondary to resection of retromolar and lateral buccal squamous cell carcinoma.@*Methods@#From January 2014 to January 2017, eight patients with retromolar and lateral buccal squamous cell carcinoma received radical resection and reconstructed with SCIP flap immediately. CTA and color Doppler sonography were routinely performed before the surgery. According to the size of the defect in the recipient area, the flap vascularized by the perforator vessel was carefully prepared and transferred to the buccal-pharynx-palate composite defect. The recipient area and donor area were sutured tightly after arteriovenous anastomosis under microscope. The survival and functional recovery of the flap were observed after operation.@*Results@#The flap sizes ranged from 5 cm× 6 cm to 7 cm×9 cm.The mean diameter of the superficial circumflex iliac arteries was 0.65 mm. And the mean diameter of the veins was 1.2 mm. The mean arterial pedicle length was 7.0 cm, and the venous pedicle length was 8.0 cm. Eight flaps were all survived. The shape of the buccal-parapharyngeal-palate was good and the mouth opening was normal after operation.@*Conclusions@#Superficial circumflex iliac artery perforator flap was a good choice for repairing the defect of parapharyngeal squamous cell carcinoma in the posterior molar region.

Progresses of endovascular treatment of hepatic venous outflow obstruction after pediatric liver transplantation / 中国介入影像与治疗学

Hepatic venous outflow obstruction is a vascular complication after pediatric liver transplantation.Endovascular treatment has become the first therapeutic option for hepatic venous outflow obstruction after pediatric liver transplantation.The progresses in endovascular treatment of hepatic venous outflow obstruction after pediatric liver transplantation were reviewed in this article.

Endovascular treatment of portal vein stenosis after pediatric liver transplantation for biliary atresia / 中国介入影像与治疗学

Objective To observe the value of endovascular treatment of portal vein stenosis (PVS) after pediatric liver transplantation for biliary artesia.Methods The data of 14 children with PVS after liver transplantation for biliary atresia were retrospectively evaluated.All children were confirmed by portal vein angiography,and were treated with 1-2 times of percutaneous transluminal angioplasty with or without percutaneous transluminal stent angioplasty.The effect of endovascular interventional therapy in 14 children was analyzed.Results A total of 14 children received 23 times of endovascular interventional therapy.The technical success rate of the first treatment was 82.61％ (19/23).Ten children were treated with balloon dilatation,and stent angioplasty was performed in 4 children after balloon dilatation.These stents were not narrowed after implantation.There were no complications related to treatment in 14 cases.Conclusion Endovascular treatment for PVS after liver transplantation for biliary atresia is safe and effective.

The application of sigma metrics quality models in quality management of clinical biochemistry laboratory / 中华检验医学杂志

Objective To improve the quality of clinical biochemistry laboratory by quality indicators of pre-analytical,analytical,post-analytical phase and the whole process.Methods Analytical Phase:The Sigma values of items were calculated,applying the equation Sigma =(TEa％-Bias％)/CV％.Total allowable error (TEa) is from analyticalal specification defined in WS/T403-2012 of China,Bias％ is from the evaluation results of National Center for Clinical Laboratory (NCCL) trueness verification PT series and CV％ is from internal quality control data during the last 6 months in our lab.Normalized Sigma metrics plot was made to evaluate the analysis performance and the quality control strategies were designed accordingly.The quality goal indexes (QGI) were also calculated to propose improvement measures for items below 6 Sigma.Quality indicators of pre-,post-analytical and whole analytical phase,such as quality of specimen,critical value notification,critical value notification in time,TAT of hs-cTnT,TAT of emergency biochemical items,rewrite of laboratory reports and unacceptable performance in EQA-PT were measured in Sigma metrics too.The Sigma metrics changes before and after taking improvement measures were compared to conform the effectiveness.Results The average Sigma value of 17 biochemical tests was 5.29,of which 8 items (UA,K,ALP,CK,AMY,AST,TG,Na) achieved excellent to world class level (≥ 5 Sigma),6 items (LDH,Cre,TC,ALT,Mg,Glu) achieved marginal to good level (5 ＞ Sigma ≥ 3),BUN performed poorly (3 ＞ Sigma ≥ 2),Ca,TP performed unacceptably (Sigma ＜ 2) with serious quality defects.The Sigma values of unacceptable specimen,critical value notification,critical value notification in time,unacceptable turn around time (TAT) of hs-cTnT,unacceptable turn around time (TAT) of emergency biochemical items,rewrite of laboratory reports,unacceptable performance in EQA-PT were 4.17,3.60,2.75,1.72,3.27,4.52,3.33 respectively,rising to 4.30,4.30,2.90,2.45,3.75,4.80,3.60 accordingly after improvement.Conclusions Sigma metrics is potentially an ideal approach for clinical biochemistry laboratories management,which is helpful to find out problems,put forward improvement measures,and confirm the effectiveness,so as to achieve the purpose of continuous quality improvement.

Endovascular interventional therapy of portal vein stenosis after pediatric liver transplantation / 中国介入影像与治疗学

Objective To evaluate the value of percutaneous transhepatic angioplasty in treatment of portal vein stenosis (PVS) after pediatric liver transplantation.Methods The data of 8 pediatric patients with PVS after liver transplantation were retrospectively evaluated.All cases were confirmed by portal vein angiography,and were treated with percutaneous transluminal angioplasty and/or percutaneous transluminal stent angioplasty.The effect of endovascular interventional therapy in 8 cases was analyzed.Results A total of 12 times of 8 patients received endovascular interventional therapy.The success rate was 66.67％ (8/12).The clinical success rate of the first treatment was 62.50％ (5/8).Three cases were treated with balloon dilation after the first balloon dilation,and there was no recurrence of PVS after operation in 2 cases.After the treatment of balloon dilation,stent angioplasty was performed in 1 case.There were no complications related to treatment in 8 cases.Conclusion Endovascular interventional treatment is a safe and effective way for PVS after pediatric liver transplantation.

Preoperative localization of additional pulmonary nodules in suspected lung cancer patients / 实用放射学杂志

Objective To study CT-guided localization of additional pulmonary nodules with microcoils prior to video-assisted thoracoscopic surgery (VATS) resection in patients with suspected lung cancer.Methods Eleven patients suspected lung cancer underwent preoperative microcoils localization towards additional small pulmonary nodules.The head of microcoil was pinpointed adjacent to the target nodule while its end tail remained above the visceral pleura.VATS were performed within 24 hours, and comprehensive assessments were conducted according to surgical and pathological outcomes of primary and additional lesions, and suitable surgical processes were followed.Results All 11 localizing pulmonary nodules (4-15 mm in diameter) were successfully removed after VATS, 9 microcoils'' end tails of which were placed above visceral pleural surface.There were no serious complications related with localizing procedure.Other 16 lesions including 11 primary ones were resected.The surgical and pathological outcomes for lung lesions were utterly assessed.Conclusion Microcoil preoperative localization provides helpful orientation for complete resection and assessment of multiple pulmonary lesions in patients with suspected lung cancer.