Development of a nomogram for predicting liver transplantation prognosis in hepatocellular carcinoma

BACKGROUND At present,liver transplantation(LT)is one of the best treatments for hepatocellular carcinoma(HCC).Accurately predicting the survival status after LT can significantly improve the survival rate after LT,and ensure the best way to make rational use of liver organs.AIM To develop a model for predicting prognosis after LT in patients with HCC.METHODS Clinical data and follow-up information of 160 patients with HCC who underwent LT were collected and evaluated.The expression levels of alphafetoprotein(AFP),des-gamma-carboxy prothrombin,Golgi protein 73,cytokeratin-18 epitopes M30 and M65 were measured using a fully automated chemiluminescence analyzer.The best cutoff value of biomarkers was determined using the Youden index.Cox regression analysis was used to identify the independent risk factors.A forest model was constructed using the random forest method.We evaluated the accuracy of the nomogram using the area under the curve,using the calibration curve to assess consistency.A decision curve analysis(DCA)was used to evaluate the clinical utility of the nomograms.RESULTS The total tumor diameter(TTD),vascular invasion(VI),AFP,and cytokeratin-18 epitopes M30(CK18-M30)were identified as important risk factors for outcome after LT.The nomogram had a higher predictive accuracy than the Milan,University of California,San Francisco,and Hangzhou criteria.The calibration curve analyses indicated a good fit.The survival and recurrence-free survival(RFS)of high-risk groups were significantly lower than those of low-and middle-risk groups(P<0.001).The DCA shows that the model has better clinical practicability.CONCLUSION The study developed a predictive nomogram based on TTD,VI,AFP,and CK18-M30 that could accurately predict overall survival and RFS after LT.It can screen for patients with better postoperative prognosis,and improve longterm survival for LT patients.

Development of a diagnostic nomogram for alpha-fetoproteinnegative hepatocellular carcinoma based on serological biomarkers

BACKGROUND Hepatocellular carcinoma(HCC)is the third leading cause of cancer-related death worldwide.Serum biomarkers play an important role in the early diagnosis and prognosis of HCC.Because a certain percentage of HCC patients are negative for alpha-fetoprotein(AFP),the diagnosis of AFP-negative HCC is essential to improve the detection rate of HCC.AIM To establish an effective model for diagnosing AFP-negative HCC based on serum tumour biomarkers.METHODS A total of 180 HCC patients were enrolled in this study.The expression levels of GP73,des-γ-carboxyprothrombin(DCP),CK18-M65,and CK18-M30 were detected by a fully automated chemiluminescence analyser.The variables were selected by logistic regression analysis.Several models were constructed using stepwise backward logistic regression.The performance of the models was compared using the C statistic,integrated discrimination improvement,net reclassification improvement,and calibration curves.The clinical utility of the nomogram was assessed using decision curve analysis(DCA).RESULTS The results showed that the expression levels of GP73,DCP,CK18-M65,and CK18-M30 were significantly greater in AFP-negative HCC patients than in healthy controls(P<0.001).Multivariate logistic regression analysis revealed that GP73,DCP,and CK18-M65 were independent factors for diagnosing AFP-negative HCC.By comparing the diagnostic performance of multiple models,we included GP73 and CK18-M65 as the model variables,and the model had good discrimination ability(area under the curve=0.946)and good goodness of fit.The DCA curves indicated the good clinical utility of the nomogram.CONCLUSION Our study identified GP73 and CK18-M65 as serum biomarkers with certain application value in the diagnosis of AFP-negative HCC.The diagnostic nomogram based on CK18-M65 combined with GP73 demonstrated good performance and effectively identified high-risk groups of patients with HCC.

Lung adenocarcinoma with initial binocular symptoms

Dear Editor,Lung adenocarcinoma with choroidal metastasis is a common form of cancer,with breast cancer accounting for 40%-53%and lung cancer accounting for 20%-29%of primary cases with choroidal metastases[1].This type of metastatic cancer typically affects people aged 40-70y,and is more prevalent in women than men[1].Ocular symptoms,including vision loss,can be an early indication of the disease,as many tumors are asymptomatic in their early stages.Studies have shown that 40.3%of cases involve the macular region,which explains why ocular symptoms are often the first manifestation of the disease[2].When choroidal metastasis is suspected in patients without a history of cancer,a combination of diagnostic tools should be used to identify the primary source of the tumor.Choroidal tumors can serve as an indication of future lung cancer diagnosis in some patients with lung cancer[1].In this report,we present a case of bilateral lung adenocarcinoma where ocular symptoms were the first indication of the disease.

Initiatives to clarify mechanisms of hydrological evolution in human-influenced Yellow River Basin

Significant changes in water cycle elements/processes have created serious challenges to regional sustainability and high-quality development in the Yellow River Basin in China.It is necessary to investigate the impacts of climate change and human activities on hydrological evolution and disaster risk from a holistic perspective of the basin.This study developed initiatives to clarify the mechanisms of hydrological evolution in the human-influenced Yellow River Basin.The proposed research method includes:(1)a tool to simulate multiple factors and a multi-scale water cycle using a grid-based spatiotemporal coupling approach,and(2)a new algorithm to separate the responses of the water cycle to climate change and human impacts,and de-couple the eco-environmental effects using artificial intelligence techniques.With this research framework,key breakthroughs are expected to be made in the understanding of the impacts of land cover change on the water cycle and blue/green water redirection.The outcomes of this research project are expected to provide theoretical support for ecological protection and water governance in the basin.

后膜骨架蛋白1a在小鼠脑缺血再灌注损伤中的作用

目的探讨后膜骨架蛋白1a(Homer 1a)在小鼠脑缺血再灌注损伤中的作用。方法以Homer1a基因敲除小鼠为研究对象,复制脑缺血再灌注小鼠模型,根据行为学评分标准评价小鼠脑缺血再灌注的损伤程度。运用TTC染色法观察计算小鼠脑梗死体积。Tunel法检测脑缺血再灌注小鼠脑组织中细胞凋亡情况。GFAP法检测星形胶质细胞的增殖情况。Western blot检测小鼠脑组织中IL-1β、TNF-α、IL-6水平。结果实验组小鼠行为学评分高于脑缺血组,说明Homer 1a基因敲除小鼠脑缺血再灌注损伤较脑缺血组更为严重。实验组小鼠脑梗死体积与脑缺血组比较,差异有统计学意义(P<0.05),实验组增多。实验组小鼠脑组织细胞凋亡高于脑缺血组(P<0.05)。实验组和脑缺血组小鼠脑组织中星形胶质细胞数都高于正常组(P<0.05),而实验组小鼠脑组织中星型胶质细胞数量低于脑缺血组。实验组小鼠脑组织中IL-1β、TNF-α、IL-6表达水平均高于脑缺血组(P<0.05)。结论 Homer 1a基因敲除小鼠可以加重脑缺血再灌注后的损伤。Homer 1a可以减弱脑缺血再灌注损伤。

消化道出血行内镜治疗后发生早期再出血的危险因素分析

目的分析影响消化道出血行内镜治疗后发生早期再出血的危险因素。方法选取2016年1月-2018年12月在该院接受内镜治疗的消化道出血患者167例,按内镜治疗后是否发生早期再出血分为再出血组(n=33)及对照组(n=134),查阅病历资料统计相关影响因素,多因素Logtisic回归分析影响消化道出血行内镜治疗后发生早期再出血的危险因素。结果Glasgow-Blatchford危险评分(GBS)、Rockall危险评分(RS)、急性上消化道出血AMIS65评分、入院时血红蛋白值及血小板指数是消化道出血行内镜治疗后发生早期再出血的独立影响因素(P<0.05)。结论消化道出血行内镜治疗的患者,应重视术前GBS、RS、AMIS65评分、入院时血红蛋白和血小板指数水平,严密监测,积极预防早期再出血。

An Adaptive Median Filter Algorithm Based on B-spline Function

According to the B-spline convolution mask, first, the contrast sensitiveness （CS） is computed and then is viewed as a noise sensitiveness coeficient （NSC） to adaptively determine a noise-recognized threshold value. Based on the noise density function （NDF） in a 3×3 window, the filtering window size is adaptively adjusted, and then a median filter is used to eliminate the noise-marked pixels. The experiment results show that the proposed algorithm can preserve image detail information well and effectively remove the noises, particularly the impulse noises that is also called salt-and-pepper noises superimposed on the computed tomography （CT） and magnetic resonance imaging （MRI） medical images.

Roles of G protein-coupled receptors in inflammatory bowel disease

Inflammatory bowel disease(IBD)is a complex disease with multiple pathogenic factors.Although the pathogenesis of IBD is still unclear,a current hypothesis suggests that genetic susceptibility,environmental factors,a dysfunctional immune system,the microbiome,and the interactions of these factors substantially contribute to the occurrence and development of IBD.Although existing and emerging drugs have been proven to be effective in treating IBD,none can cure IBD permanently.G protein-coupled receptors(GPCRs)are critical signaling molecules implicated in the immune response,cell proliferation,inflammation regulation and intestinal barrier maintenance.Breakthroughs in the understanding of the structures and functions of GPCRs have provided a driving force for exploring the roles of GPCRs in the pathogenesis of diseases,thereby leading to the development of GPCR-targeted medication.To date,a number of GPCRs have been shown to be associated with IBD,significantly advancing the drug discovery process for IBD.The associations between GPCRs and disease activity,disease severity,and disease phenotypes have also paved new avenues for the precise management of patients with IBD.In this review,we mainly focus on the roles of the most studied proton-sensing GPCRs,cannabinoid receptors,and estrogen-related GPCRs in the pathogenesis of IBD and their potential clinical values in IBD and some other diseases.

Ataxia telangiectasia-mutated-Rad3-related DNA damage checkpoint signaling pathway triggered by hepatitis B virus infection

AIM: To explore whether acute cellular DNA damage response is induced upon hepatitis B virus (HBV) infection and the effects of the HBV infection.METHODS: We incubated HL7702 hepatocytes with HBV-positive serum,mimicking a natural HBV infection process.We used immunoblotting to evaluate protein expression levels in HBV-infected cells or in non-infected cells; immunofluorescence to show ATR foci ands Chk1 phosphorylation foci formation; flow cytometry to analyze the cell cycle and apoptosis; ultraviolet (UV) radiation and ionizing radiation (IR)-treated cells to mimic DNA damage; and Trypan blue staining to count the viable cells.RESULTS: We found that HBV infection induced an increased steady state of ATR protein and increased phosphorylation of multiple downstream targets including Chk1,p53 and H2AX.In contrast to ATR and its target,the phosphorylated form of ATM at Ser-1981 and its downstream substrate Chk2 phosphorylation at Thr-68 did not visibly increase upon infection.However,the level of Mre11 and p21 were reduced beginning at 0.5 h after HBV-positive serum addition.Also,HBV infection led to transient cell cycle arrest in the S and the G2 phases without accompanying increased apoptosis.Research on cell survival changes upon radiation following HBV infection showed that survival of UV-treated host cells was greatly increased by HBV infection,owing to the reduced apoptosis.Meanwhile,survival of IR-treated host cells was reduced by HBV infection.CONCLUSION: HBV infection activates ATR DNA damage response to replication stress and abrogates the checkpoint signaling controlled by DNA damage response.

Movement Invariants-based Algorithm for Medical Image Tilt Correction

In this paper, the edge detection for a medical image is performed based on Sobel operator, and the bounding box is obtained, by which the effective medical sub-image is extracted. Then, the centroid and the normalized central moments of the medical sub-image are calculated, and the rotation angle a is obtained by minimizing the second-order central moment based on its rotation invariance. Finally, the whole medical image is rotated around the centroid by --a to correct the tilted image. F^rthermore, inspired by the uniformity degree of the image, the rotation angle ct is revised, which achieves a better correction effect and performance. The experimental results show that the proposed algorithms are fairly reliable and accurate for the determination of tilt angles, and are practical and effective tilt correction techniques.

早期内镜干预与保守治疗应用于急性重症胆源性胰腺炎疗效对比的Meta分析

目的比较早期内镜逆行胰胆管造影术(ERCP)±内镜下十二指肠乳头括约肌切开术(EST)和保守治疗应用于急性重症胆源性胰腺炎(ASBP)的有效性及安全性。方法在Pubmed、Web of Science、Embase、Cochrane Library、中国知网数据库、万方数据库和维普数据库中检索有关比较早期内镜干预和保守方法治疗ASBP的随机对照研究(RCT),并使用RevMan 5.3软件分析数据。结果纳入10篇RCT,共806例患者。Meta分析结果显示,与保守治疗相比,早期内镜干预能降低ASBP总并发症发生率(OR=0.58,95%CI:0.41~0.82,P=0.002)、系统并发症发生率(O^R=0.46,95%CI:0.32~0.67,P=0.000)和胆管炎发生率(OR=0.11,95%CI:0.03~0.42,P=0.001);缩短患者腹痛持续时间(MD=-6.09,95%CI:-7.47~-4.70,P=0.000)和住院时间(MD=-10.15,95%CI:-13.20~-7.09,P=0.000);但两组患者在死亡率、多器官功能障碍综合征(MODS)发生率、呼吸衰竭发生率、局部并发症发生率、假性囊肿发生率和胰腺脓肿/坏死发生率等方面比较,差异均无统计学意义(P>0.05)。结论早期内镜干预治疗ASBP是安全可行的,且具有降低并发症发生率、缓解腹痛及缩短住院时间等优势,有望成为治疗ASBP的首选方法。

Percutaneous drainage in the treatment of intrahepatic pancreatic pseudocyst with Budd-Chiari syndrome:A case report

BACKGROUND Intrahepatic pancreatic pseudocyst(IHPP)is an extremely rare complication of acute pancreatitis,with only a few cases previously described in the literature.To the best of our knowledge,IHPP with Budd-Chiari syndrome(BCS)has not yet been described.CASE SUMMARY A 35-year-old male presented with abdominal pain,vomiting and anorexia,followed by severe swelling of the lower body after 4 d.The morphological assessment(using computed tomography revealed the presence of a huge cyst of 18.28 cm×10.34 cm under the liver capsule accompanied by a large amount of ascites.Percutaneous puncture allowed us to detect a high level of amylase in the collection,confirming the diagnosis of IHPP.The cyst was treated by percu-taneous drainage,producing complete resolution of the cyst.CONCLUSION IHPP can be treated with percutaneous drainage,endoscopic drainage,surgery or even conservative treatment,depending on the specific condition.We recommend percutaneous drainage as the first choice of treatment when IHPP with secondary BCS.

Application of Prussian blue staining in the diagnosis of ocular siderosis

AIM:To explore the value of Prussian blue staining in the diagnosis of ocular siderosis.METHODS:Between January 2012 and January 2013,the Prussian blue stain used in anterior lens capsule and vitreous liquid after centrifugation from patients with definitive diagnosis and suspicious diagnosed of ocular siderosis. At the same time, give a negative control.RESULTS:Anterior lens capsule membrane and liquid of vitreous cavity from patients with definitive diagnosis and suspicious diagnosed of ocular siderosis revealed ferric ions that stained positively with Prussian blue. In the control group, there is no positive reaction.CONCLUSION:Prussian blue staining in the diagnosis of ocular siderosis has a very significant worth,suspected cases can be definitive diagnosed.

Castleman disease of the pancreas mimicking pancreatic malignancy on^(68)Ga-DOTATATE and 18F-fluorodeoxyglucose positron emission tomography/computed tomography:A case report

BACKGROUND Castleman disease is an uncommon nonclonal lymphoproliferative disorder,which frequently mimics both benign and malignant abnormalities in several regions.Depending on the number of lymph nodes or regions involved,Castleman disease(CD)varies in diagnosis,treatment and prognosis.It rarely occurs in the pancreas alone without any distinct clinical feature and tends to be confused with pancreatic paraganglioma(PGL),neuroendocrine tumors(NETs),and primary tumors,thus impeding proper diagnosis and treatment.CASE SUMMARY A 28-year-old woman presented with a lesion on the neck of the pancreas,detected by ultrasound during a health examination.Physical examination and laboratory findings were normal.The mass showed hypervascularity on enhanced computed tomography(CT),significantly increased 18F-fluorodeoxyglucose uptake on positron emission tomography(PET)/CT,and slightly increased somatostatin receptor(SSTR)expression on^(68)Ga-DOTATATE PET/CT,suggesting no distant metastases and subdiagnoses such as pancreatic PGL,NET,or primary tumor.Intraoperative pathology suggested lymphatic hyperplasia,and only simple tumor resection was performed.The patient was diagnosed with the hyaline vascular variant of CD,which was confirmed by postoperative immunohistochemistry.The patient was discharged successfully,and no recurrence was observed on regular review.CONCLUSION High glucose uptake and slightly elevated SSTR expression are potentially new diagnostic features of CD of the pancreas.

Chinese research into ulcerative colitis from 1978 to 2017:A bibliometric analysis

BACKGROUND Over the last 40 years,with accumulating evidence demonstrating a significant increase in the incidence of ulcerative colitis(UC)in China,the number of studies on UC has been rapidly increasing.But it still lacks a comprehensive metaanalysis of publications regarding UC for the last four decades in China.Thus,a bibliometric analysis of UC is warranted to investigate the trend and distribution of the publications on UC in China in recent years.And it is supposed that the number of the papers related to UC increased by year.AIM To investigate the current status of research output from Chinese studies related to UC during the period of 1978 to 2017,with special attention paid to the distribution of publication dates,journals,regions,and research organizations.METHODS Publications on UC were searched in the Chinese periodical database SinoMed from January 1978 to December 2017.The search term used for retrieval was“ulcerative colitis”.The language of the publications was restricted to English or Chinese.The studies have to be performed in China.Then,a bibliometric analysis was performed on the distribution of publication dates,journals,regions,and research organizations with EndNote,Excel,MySQL,and GraphPad Prism.RESULTS A total of 16257 papers matched the search criteria,which included 7561 papers published in core journals,4641 evidence-based articles,and 4177 publications of randomized controlled trials.These papers were mainly published in Chinese Journal of Coloproctology,World Chinese Journal of Digestology,Chinese Journal of Digestion,Chinese Journal of Integrated Traditional and Western Medicine on Digestion,and Modern Journal of Integrated Traditional Chinese and Western Medicine.In particular,the majority of these organizations were located in Jiangsu,Henan,Shandong,and Guangdong Provinces which are rich areas or have the largest population per province.Most of these studies were conducted by academic institutions.CONCLUSION Over the past four decades,the output of research into UC in China has increased significantly,with academic institutions playing a central role in the academic field,but the number and quality of these researches vary substantially among different regions.

Clinical significance of breast cancer susceptibility gene 1 expression in resected non-small cell lung cancer:A meta-analysis

BACKGROUND The clinical significance of breast cancer susceptibility gene 1(BRCA1)in nonsmall cell lung cancer(NSCLC)patients undergoing surgery remains unclear up to now.AIM To explore the relation of BRCA1 expression with clinicopathological characteristics and survival in patients with resected NSCLC.METHODS EMBASE,PubMed,Web of Science,and The Cochrane Library databases were searched to identify the relevant articles.To assess the correlation between the expression of BRCA1 and clinicopathological characteristics and prognosis of patients with resected NSCLC patients,the combined relative risks or hazard ratios(HRs)with their corresponding 95%confidence intervals[CIs]were estimated.RESULTS Totally,11 articles involving 1041 patients were included in the meta-analysis.The results indicated that the expression of BRCA1 was significantly correlated with prognosis of resected NSCLC.Positive BRCA1 expression signified a shorter overall survival(HR=1.60,95%CI:1.25-2.05;P<0.001)and disease-free survival(HR=1.78,95%CI:1.42-2.23;P<0.001).However,no significant association of BRCA1 expression with any clinicopathological parameters was observed.CONCLUSION BRCA1 expression indicates a poor prognosis in resected NSCLC patients.BRCA1 might serve as an independent biomarker to predict clinical outcomes and help to customize optimal adjuvant chemotherapy for NSCLC patients who had received surgical therapy.

Comparative mitogenomic analyses unveil conserved and variable mitogenomic features and phylogeny of Chedrinae fish

Chedrinae fish,which belong to Danionidae,have important ornamental,economic,and scientific value.At present,however,their mitogenomic features are unclear and their phylogenetic relationships remain controversial.In this study,we presented five new Chedrinae mitochondrial genomes(mitogenomes)and analyzed the conserved and variable mitogenomic characteristics of 17 Chedrinae fish.The gene composition and arrangement and secondary structure of transfer RNAs(tRNAs)were highly conserved among the Chedrinae mitogenomes.However,the length of the control region and base composition were variable.Interestingly,the mitogenome of Barilius barila was unusual,with lower A+T content in the first codon of protein-coding genes(PCGs)(47.32%versus average of 54.47%)and distinct pattern of codons per thousand codons(CDspT).Three Chedrinae fish had a long tandem repeat(>291 bp)in the 5'-end of the control region,which may increase their adaptability.In addition,tRNALys had notably larger DHU and TΨC loops than other tRNAs.The phylogenetic trees of the Chedrinae fish suggested that the Barilius genus was not a monophyletic group but could be divided into two main groups based on significant differences in A+T content.This study provides insights into the mitogenomic features and phylogenetic implications of Chedrinae fish,which should benefit their systematics and conservation.

Terminal Pregnancy Complicated by Measles and Premature Labor:a Case Report

Measles infection in pregnant women is a very dangerous clinical condition.Patients usually had complicated pneumonia,and virus could pass through the placenta to the fetus and lead to premature delivery,stillbirth,miscarriage and neonatal measles.In this report,one such case,which was diagnosed by clinical signs and symptoms,clinical and laboratory examination was described.After proper therapeutic treatment,the infection was well-controlled and a baby was born by nature labor.

Progress in processing of porous titanium:a review

As a novel structural and functional material,porous titanium and its alloys have been widely used in the aerospace,marine engineering and biomedical fields due to their high corrosion resistance,low density,good biocompatibility and excellent mechanical properties.Therefore,in this paper,a comprehensive review of powder metallurgy(PM)(including additive manufacturing(AM)processes)for fabricating porous titanium is firstly covered in terms of their working principles,capabilities,shortcomings and strengths.Simultaneously,the influencing factors of various methods on final pore structure of porous Ti are involved.Secondly,a summary of the chemical methods(CM)to obtain the porous Ti is also provided,such as dealloying method and reduction method.Finally,the tendency and direction of preparation technology as well as application of porous titanium were prospected.

Pseudo-dynamic analysis of a 3D tunnel face in inclined weak strata

A new discretization technique is proposed for a three-dimensional(3D)tunnel face in weak strata with a random position in space.This method limits the angle,height,and thickness of the strata on the tunnel face.The original whole piece of soil is separated by a series of parallel planes,and two parallel planes are used as a stratum.Each radial discrete plane is separated when it passes through the strata,and the change in the soil properties of discrete points on the truncated plane is considered separately inside the strata.Considering the spatial and temporal characteristics of seismic waves,a pseudo-dynamic analysis of the tunnel face is carried out.The tunnel face active damage types under earthquake conditions are quantitatively analyzed,and the corresponding support pressure design diagrams are given for the case without weak strata.For the case containing weak strata,the presence of weak strata can have adverse effects on the face.The failure mechanism of the weak strata is given by the discretization method.For different friction angles,the presence of the weak strata changes the friction angles of the soils.For the thickness,location and angle of the weak strata,the variation in the support pressure is given in this paper.To more intuitively depict the change in the failure mechanism in the presence of weak strata,the change in the failure mechanism under different thicknesses and weaknesses of weak strata is plotted.