3D conformal radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma

AIM:To compare transcatheter arterial chemoembolization(TACE)and 3D conformal radiotherapy(3D-CRT)with TACE monotherapy in hepatocellular carcinoma(HCC).METHODS:We searched all the eligible studies from the Cochrane Library,Pub Med,Medline,Embase,and CNKI.The meta-analysis was performed to assess the survival benefit,tumor response,and the decline inα-fetoprotein(AFP)level.According to the heterogeneity of the studies,pooled OR with 95%CI were calculated using the fixed-effects or random-effects model.An observed OR>1 indicated that the addition of 3D-CRT to TACE offered survival benefits to patients that could be considered statistically significant.Statistical analyses were performed using Review Manager Software.RESULTS:Ten studies met the criteria to perform a meta-analysis including 908 HCC participants,with 400patients in the TACE/3D-CRT combination group and508 in the TACE alone group.TACE combined with 3DCRT significantly improved 1-,2-and 3-year overall survival compared with TACE monotherapy(OR=1.87,95%CI:1.37-2.55,P<0.0001),(OR=2.38,95%CI:1.78-3.17,P<0.00001)and(OR=2.97,95%CI:2.10-4.21,P<0.00001).In addition,TACE plus 3DCRT was associated with a higher tumor response(complete remission and partial remission)(OR=3.81;95%CI:2.70-5.37;P<0.00001),and decline rates of AFP level(OR=3.24,95%CI:2.09-5.02,P<0.00001).CONCLUSION:This meta-analysis demonstrated that TACE combined with 3D-CRT was better than TACE monotherapy for patients with HCC,which needs to be confirmed by large multicenter trials.

Apolipoprotein E Gene Polymorphisms Are Risk Factors for Spontaneous Intracerebral Hemorrhage:A Systematic Review and Meta-analysis

Intracerebral hemorrhage(ICH)is a serious clinical disease with high morbidity,whose pathogenesis might be related to apolipoprotein E(APOE)gene polymorphisms.To comprehensively evaluate the risk factors for ICH occurrence,we performed a meta-analysis.We searched online databases to identify eligible studies based on the relationship between APOE genetic polymorphisms and ICH occurrence risk.Specific and pooled odds ratios(ORs)were calculated and by assessing small study bias,we drew the relationship between APOE polymorphisms and ICH risk.We included 15 eligible studies in our study containing a total of 1642 ICH samples and 5545 normal controls.The comparison of e4 andε3 APOE genotypes revealed that specific and pooled ORs showed a significantly increased odds ratio in ICH patients with theε4 genotype,indicating thatε4 gene is a risk factor for ICH occurrence,and the heterogeneity is acceptable.Similarly,it was found that theε2 genotype also contributed to the incidence rate of ICH.However,after the subgroup analysis by ethnicity,this APOE genetic polymorphism acted as a harmful factor only in white populations,but did not show an effect in Asian populations.It was suggested that both 82 andε4 APOE alleles were risk factors for ICH in general.They were risk factors in white populations only,neither had a detectable effect in Asian populations after subgroup analysing by ethnicity.

Dbx2 exhibits a tumor-promoting function in hepatocellular carcinoma cell lines via regulating Shh-Gli1 signaling

BACKGROUND Hepatocellular carcinoma(HCC)is the fifth most common cancer worldwide.HCC patients suffer from a high mortality-to-incidence ratio and low cure rate since we still have no specific and effective treatment.Although tremendous advances have been made in the investigation of HCC,the specific mechanisms of the progression of this disease are still only partially established.Hence,more research is needed to elucidate the underlying potential mechanisms to develop effective strategies for HCC.AIM To determine the role of developing brain homeobox 2(Dbx2)gene in promoting the development of HCC.METHODS Dbx2 expression in clinical specimens and HCC cell lines was detected by Western blot(WB)and immunohistochemistry.Gain and loss of Dbx2 function assays were performed in vitro and in vivo.Cell viability assays were used to investigate cell growth,flow cytometry was employed to assess cell cycle and apoptosis,and trans-well assays were conducted to evaluate cell migration,invasion,and metastasis.The expression of key molecules in the sonic hedgehog(Shh)signaling was determined by WB.RESULTS Compared to matched adjacent non-tumorous tissues,Dbx2 was overexpressed in 5 HCC cell lines and 76 surgically resected HCC tissues.Dbx2 overexpression was correlated with large tumor size.Both gain and loss of function assays indicated that Dbx2 promoted HCC cell proliferation by facilitating the transition from G1 to S phase,attenuating apoptosis and promoted HCC proliferation,migration,and invasion in vitro and in vivo.Mechanistically,Dbx2 modulated Shh signaling by enhancing FTCH1 and GLi1 expression in HCC cells that overexpressed Dbx2,which was reversed in HCC cells with Dbx2 knockdown.CONCLUSION Our results indicate that Dbx2 is significantly upregulated in HCC tissues and plays significant roles in proliferation and metastasis of HCC cells by activating the Shh pathway.

The hydrochemical characteristics and its significance of geothermal water in both sides of large fault: Taking northern section of the Liaokao fault in north China as an example

Based on comparative analysis on hydrochemical characteristics of geothermal water in the north part of Liaokao fault,this research focuses on studying the indicative significance of hydrochemical characteristics for the formation of geothermal water.The result shows that:(1)There is no obvious hydraulic connection between the karst geothermal water(occurred in the east part of the Liaokao fault)and the sandstone geothermal water(occurred in the west part of Liaokao fault).(2)In a close hydrological environment,caused by tectonic activities,geothermal water remains longer time in reservoir,hence the water-rock interaction is more complete,with high degree of concentrations,whereas the renewable capacity of the water is weaker.(3)There is no high temperature mantle source fluid mixed in the geothermal water.Karst geothermal water occurred deep circulatory convection along Liaokao fault and its secondary fault,therefore there is deep crust source fluid added into the geothermal water,closer to the Liaokao fault,the greater affected by the deep crust fluid.However,sandstone geothermal water has weak deep circulatory convection.

Perilipin Gene 1237 T>C Polymorphism is not Associated with Obesity Risk in Northern Chinese Han Adults

Objective To identify the association between PLIN 1237 polymorphism and obesity in Chinese Han adults. Methods A total of 994 adults （157 obese subjects, 322 overweight subjects, and 515 normal controls） were recruited from two rural communities. PLIN 1237 polymorphism was genotyped by polymerase chain reaction-restriction-fragment-length-polymorphism （PCR-RFLP）. Association between PLIN polymorphisms and obesity status was estimated by ordinal logistic regression. Results The three genotypes of,PLIN 1237 were detected with a percentage of 54.3%, 37.1%, and 8.6% in TT, TC, and CC genotypes, respectively. For the PLIN 1237 polymorphism locus, the frequency of alleles T and C was 0.73 and 0.27, respectively. The PLIN 1237 polymorphisms were in Hardy-Weinberg equilibrium. PLIN 1237 polymorphism was not associated with obesity. The odds ratio for overweight or obesity for the CC＋TC genotype was 0.8（0.4, 1.4） in women （P=-0.4） and 0.6 （0.3, 1.3） in men （P=-0.2） after adjustment for age, education, household income and alcohol consumption, smoking, and physicalactivity. Conclusion Chinese Han adults have a lower frequency of variant-allele C in PLIN1237. PLIN1237 T〉C polymorphism is not significantly associated with obesity in northern Chinese adults.

Clinic pathological features and prognosis of metaplastic breast carcinoma

Objective:To investigate clinic pathological peculiarities and evaluate the prognosis of metaplastic breast carcinoma.Methods:Patients with metaplastic breast carcinoma at the First Affiliated Hospital of Zhejiang University and Guangxing Hospital Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from 2008 to 2013 were retrospectively selected.Results:A total of 73 female patients were reviewed,including 41 cases of purely epithelial type and 32 cases of mixed epithelial and mesenchymal type.Median tumor size was 4.6cm.Forty-three patients(58.8%)presented with lymph node metastasis,84.9%of cases were in advanced TNM stage,and 60.2%of cases were overexpressed by Ki-67.At a median follow-up of 59 months,median overall survival and disease-free survival were 59.7 and 43.9 months,respectively.Five-year overall survival rate was 45.2%and disease-free survival rate was 30.1%,and 76.7%of patients had recurrence or metastasis.Univariate analysis showed that tumor size,lymph node,and radiotherapy were associated with overall survival and disease-free survival(P<0.05),while Ki-67 over-expression was correlated with overall survival(P<0.05).With multivariate analysis,tumor size,lymph node,and radiotherapy affected prognosis(P<0.05);however,pathological typing was not an independent prognostic factor(P>0.05).Conclusion:Metaplastic breast carcinoma is a rare malignant tumor with large tumor,high lymph node metastasis rate,staging relatively late,high local recurrence and distant metastasis rate.The treatment follows the principle of comprehensive treatment based on surgery,but the prognosis is poor.Tumor size,lymph node,and radiotherapy treatment affect the prognosis.Overexpression of Ki-67 can be used as a potential diagnostic,therapeutic and prognostic indicator for metaplastic breast cancer.

Analysis of influencing factors and interaction of body weight and disease outcome in patients with prediabetes

BACKGROUND The trend of prediabetes progressing to type 2 diabetes mellitus(T2DM)is prominent,and effective intervention can lead to a return to prediabetes.Exploring the factors influencing the outcome of prediabetes is helpful to guide clinical intervention.The weight change in patients with prediabetes has not attracted much attention.AIM To explore the interaction between body weight and the factors affecting the progression of prediabetes to T2DM.METHODS We performed a retrospective analysis of 236 patients with prediabetes and 50 with normal glucose tolerance(NGT),and collected clinical data and follow-up results of all patients.Based on natural blood glucose outcomes,we classified 66 patients with progression to T2DM into the disease progression(DP)group,and 170 patients without progression to T2DM into the disease outcome(DO)group.We analyzed the factors that influenced prediabetes outcome and the influence of body weight on prediabetes blood glucose outcome by unconditional logistic regression.A general linear model(univariate)was used to analyze the interaction between body weight and independent influencing factors.RESULTS There were 98 cases of impaired fasting glucose(IFG),90 cases of impaired glucose tolerance(IGT),and 48 cases of coexistent IFG and IGT.The body weight,waist circumference,body mass index,fasting blood glucose,and 2 h plasma glucose of patients with IFG,IGT,and coexistent IFG and IGT were higher than those in patients with NGT(P<0.05).Logistic regression analysis showed that body weight,glycosylated hemoglobin,uric acid,fasting insulin,and homeostatic model assessment for insulin resistance were independent factors affecting progression of prediabetes to T2DM(P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve predicted by the above indicators combined was 0.905[95%confidence interval(CI):0.863-0.948],which was greater than that predicted by each indicator alone.Logistic regression analysis with baseline body weight as an independent variable showed that compared with body weight 1,the odds ratio(95%CI)of body weight 3 was 1.399(1.142-2.126)(P=0.033).There was a multiplicative interaction between body weight and uric acid(β=1.953,P=0.005).CONCLUSION High body weight in patients with prediabetes is an independent risk factor for progression to T2DM,and the risk of progression is increased when coexisting with high uric acid level.

阑尾套细胞淋巴瘤1例

套细胞淋巴瘤(mantle cell lymphoma, MCL)旧称中心细胞性淋巴瘤,具有高度侵袭性。其中位发病年龄为60岁,男女发病比例为2∶1,大多数患者诊断时处于疾病的Ⅲ、Ⅳ期,肿瘤已广泛累及淋巴结、骨髓、脾和外周血[1]。MCL累及胃肠道时以多发性淋巴瘤性息肉病为主要表现形式[2],罕见累及阑尾。本文报告1例以急性化脓性阑尾炎为表现的阑尾套细胞淋巴瘤,并结合文献讨论并分析其诊断及治疗。

大型综合医院眼眶病专业门诊疾病谱分析及诊治经验

目的:观察眼眶病专业门诊患者疾病谱变化和疾病分布特点,介绍眼眶门诊疾病的诊治流程和方法;明确眼眶病专业的工作重点和社会需求。方法:前瞻性观察研究。设计登记表,记录本治疗组门诊眼眶病患者性别、年龄、门诊诊断。眼眶病共分为七大类,统计分析七大类疾病的构成比、男女比例、发病年龄,以及优势病种的亚类和前三位常见疾病。介绍本院眼眶病专业门诊的诊治流程。结果:2021-04-01/12-31本治疗组门诊登记眼眶病患者共1059例。最常见的是甲状腺相关眼病325例(30.7%),其他依次是眼眶肿瘤282例(26.6%)、眼眶外伤213例(20.1%)、眼眶炎症205例(19.4%),眼眶血管畸形、先天性和遗传性病和其他3类眼眶疾病共34例(3.2%)。病理诊断:眼眶肿瘤良性150例(72.8%),前三位分别是血管淋巴管瘤、眼眶囊肿和神经源性肿瘤;恶性56例(27.2%),前三位分别是眶淋巴瘤、泪腺腺样囊性癌和横纹肌肉瘤。眼眶外伤最常见的是眼眶爆裂骨折,其次是视神经损伤、眼眶软组织挫伤。眼眶炎症中非感染性占89.8%,感染性占10.2%。结论:眼眶病疾病谱有所变化,常见和优势病种依次是甲状腺相关眼病、眼眶肿瘤、眼眶外伤和眼眶炎症,共占96.8%,是眼眶病专业门诊医师的主要工作内容。应根据疾病谱变化合理配置眼眶病专业的医疗资源,适应社会发展需求。

Near-infrared dye-loaded magnetic nanoparticles as photoacoustic contrast agent for enhanced tumor imaging

Objective: Photoacoustic(PA) tomography(PAT) has attracted extensive interest because of its optical absorption contrast and ultrasonic detection. This study aims to develop a biocompatible and biodegradable PA contrast agent particularly promising for clinical applications in human body.Methods: In this study, we presented a PA contrast agent: 1, 2-distearoyl-sn-glycero-3-phosphoethanolamine-N-[methoxy(polyethylene glycol)](DSPE-PEG)-coated superparamagnetic iron oxide(SPIO) nanoparticles(NPs) loaded with indocyanine green(ICG). We used ICG and SPIO NPs because both drugs are approved by the U.S. Food and Drug Administration. Given the strong absorption of near-infrared laser pulses, SPIO@DSPE-PEG/ICG NPs with a uniform diameter of ~28 nm could significantly enhance PA signals.Results: We demonstrated the contrast enhancement of these NPs in phantom and animal experiments, in which the in vivo circulation time of SPIO@DSPE-PEG/ICG NPs was considerably longer than that of free ICG. These novel NPs also displayed a high efficiency of tumor targeting.Conclusions: SPIO@DSPE-PEG/ICG NPs are promising PAT contrast agents for clinical applications.

Multi-layered fluorinated graphene cathode materials for lithium and sodium primary batteries

Fluorinated graphene has a promising application prospect in lithium primary batteries(LPBs)and sodium primary batteries(SPBs).Herein,five fluorinated graphene materials with different fluorine contents(FG-x)are prepared by a large-scale gas fluorination process.It is found that the structural characteristics of FG-x strongly depend on the fluorination temperature:the fluorine content(i.e.,F/C ratio)gradually increases with the fluorination temperature rising,resulting in the enlargement of interlayer spacing and the increase of average bonding strength between C and F.FG-0.75 sample with the intermediate degree of fluorination achieves the maximum energy densities in LPBs(2239.8 Wh·kg^(-1))and SPBs(1939.2 Wh·kg^(-1)).The interlayer distance is critical to the rate capability of FG-x,and FG-0.95 with the largest lattice spacing exhibits the best rate performance in both Li/CFx and Na/CFx batteries.The electrochemical reaction mechanism and the structural evolution of FG material revealed by ex situ X-ray photoelectron spectroscopy(XPS),X-ray diffraction(XRD)characterization,and in situ Raman spectra further confirm the effect of interlayer distance.

The Multiple Roles of Autophagy in Neural Function and Diseases

Autophagy involves the sequestration and delivery of cytoplasmic materials to lysosomes,where proteins,lipids,and organelles are degraded and recycled.According to the way the cytoplasmic components are engulfed,autophagy can be divided into macroautophagy,microautophagy,and chaperone-mediated autophagy.Recently,many studies have found that autophagy plays an important role in neurological diseases,including Alzheimer's disease,Parkinson's disease,Huntington's disease,neuronal excitotoxicity,and cerebral ischemia.Autophagy maintains cell homeostasis in the nervous system via degradation of misfolded proteins,elimination of damaged organelles,and regulation of apoptosis and inflammation.AMPK-mTOR,Beclin 1,TP53,endoplasmic reticulum stress,and other signal pathways are involved in the regulation of autophagy and can be used as potential therapeutic targets for neurological diseases.Here,we discuss the role,functions,and signal pathways of autophagy in neurological diseases,which will shed light on the pathogenic mechanisms of neurological diseases and suggest novel targets for therapies.

A minimally invasive alternative for the treatment of nutcracker syndrome using individualized three-dimensional printed extravascular titanium stents

Background: This study was designed to evaluate the clinical and radiographic outcomes of patients with nutcracker syndrome (NCS) who were treated with three-dimensional printing (3DP) extravascular titanium stents (EVTSs). The 3DP EVTS was expected to release the hypertension of the left renal vein (LRV) produced by its compression between the superior mesenteric artery (SMA) and the aorta without causing any complications. Method: The pre-operative kidney model of each patient was printed out to enable surgical planning. After that, the EVTS was designed based on the LRV’s primitive physiologic structure using computer-aided design software, and each stent was printed out with a precision setting of 20 μm. Seventeen patients who had been suffering from NCS underwent laparoscopic 3DP EVTS placement. The surgical procedure was designed for the placement of EVTS, taking great care in positioning and fixing the stent. Surgical data, which included patient demographic characteristics as well as pre- and post-operative test results, were collected and analyzed. Results: The mean duration of surgery was 75 ± 9 min, and the mean blood loss was 20 ± 5 mL. Computed tomography examinations revealed that the pre- and post-operative angle between the SMA and the aorta ranged from 18.7°± 4.3° to 48.0°± 8.8°(P < 0.05);in patients with left varicocele, the mean diameter of the left spermatic vein ranged from 3.7 ± 0.5 to 1.3 ± 0.2 mm (P < 0.05). Moreover, Doppler ultrasound examinations showed that the peak velocity of blood flow at the hilar area ranged from 12.4 ± 3.3 to 18.5 ± 3.4 cm/s (P < 0.05). No side effects were observed in the 24 to 42 months following surgery. Conclusion: The findings after 2 years of follow-up suggest that the 3DP EVTS is a safe and effective minimally invasive alternative for the treatment of NCS.

Semi-quantitative Assessment of Brain Maturation by Conventional Magnetic Resonance Imaging in Neonates with Clinically Mild Hypoxic-ischemic Encephalopathy

Background：Mild hypoxic-ischemic encephalopathy （HIE） injury is becoming the major type in neonatal brain diseases.The aim of this study was to assess brain maturation in mild HIE neonatal brains using total maturation score （TMS） based on conventional magnetic resonance imaging （MRI）.Methods：Totally,45 neonates with clinically mild HIE and 45 matched control neonates were enrolled.Gestated age,birth weight,age after birth and postmenstrual age at magnetic resonance （MR） scan were homogenous in the two groups.According to MR findings,mild HIE neonates were divided into three subgroups：Pattern Ⅰ,neonates with normal MR appearance; Pattern Ⅱ,preterm neonates with abnormal MR appearance; Pattern Ⅲ,full-term neonates with abnormal MR appearance.TMS and its parameters,progressive myelination （M）,cortical infolding （C）,involution of germinal matrix tissue （G）,and glial cell migration bands （B）,were employed to assess brain maturation and compare difference between HIE and control groups.Results：The mean of TMS was significantly lower in mild HIE group than it in the control group （mean ± standard deviation [SD] 11.62 ± 1.53 vs.12.36 ± 1.26,P 〈 0.001）.In four parameters of TMS scores,the M and C scores were significantly lower in mild HIE group.Of the three patterns of mild HIE,Pattern Ⅰ （10 cases） showed no significant difference of TMS compared with control neonates,while Pattern Ⅱ （22 cases）,Ⅲ （13 cases） all had significantly decreased TMS than control neonates （mean ± SD 10.56 ± 0.93 vs.11.48 ± 0.55,P 〈 0.05; 12.59 ± 1.28 vs.13.25 ± 1.29,P 〈 0.05）.It was M,C,and GM scores that significantly decreased in Pattern Ⅱ,while for Pattern Ⅲ,only C score significantly decreased.Conclusions：The TMS system,based on conventional MRI,is an effective method to detect delayed brain maturation in clinically mild HIE.The conventional MRI can reveal the different retardations in subtle structures and development processes among the different patterns of mild HIE.

Effects of Prior Antiplatelet Therapy on the Prognosis of Primary Intracerebral Hemorrhage： A Meta-analysis

Background：Antiplatelet therapy （APT） was prevalently being used in the prevention of vascular disease,but the influence of prior APT on the prognosis of patients with intracerebral hemorrhage （ICH） remains controversial.This meta-analysis was to explore the effects of prior APT on the prognosis of patients with primary ICH.Methods：PubMed and Embase were searched to identify the eligible studies.The studies comparing the mortality of ICH patients with or without prior APT were included.The quality of these studies was evaluated by the Newcastle-Ottawa quality assessment scale.The adjusted or unadjusted odds ratio （OR） for mortality between ICH patients with and without prior APT were pooled with 95% confidence interval （95% CI） as the effect of this meta-analysis.Results：Twenty-two studies fulfilled the inclusion criteria and exhibited high qualities.The pooled OR was 1.37 （95% CI：1.13-1.66,P =0.001） for univariate analysis and 1.41 （95% CI：1.05-1.90,P =0.024） for multivariate analysis.The meta-regression indicated that for each 1-day increase in the time of assessment,the adjusted OR for the mortality of APT patients decreased by 0.0049 （95% CI：0.0006-0.0091,P =0.026） as compared to non-APT patients.Conclusion：Prior APT was associated with high mortality in patients with ICH that might be attributed primarily to its strong effect on early time.

The Integration Model of Closed-Loop Supply Chain Resource Allocation Considering Remanufacturing

Logistics resource planning is an integration model of materials requirement planning and distribution resource planning which is a resource allocation technology. It is a technology of satisfying both production material supply and resource allocation optimization which is based on inventory management. For the remanufacturing supply chain, recycling and rebuilding of products form a reverse materials movement loop which challenges the traditional logistics resource planning system. For the characteristics of reverse logistics of remanufacturing supply chain, we propose a closed-loop supply chain resource allocation model based on autonomous multientity. We focus on integration resource allocation model of materials requirement planning and distribution resource planning considering remanufacturing.

Dedication on the Occasion of Professor Xiaqi Ding's 80th Birthday

This volume is dedicated to Professor Xiaqi Ding, an academician of the Chinese Academy of Sciences, on the occasion of his eightieth birthday.