Pre-operative enhanced magnetic resonance imaging combined with clinical features predict early recurrence of hepatocellular carcinoma after radical resection

BACKGROUND Indentifying predictive factors for postoperative recurrence of hepatocellular carcinoma(HCC)has great significance for patient prognosis.AIM To explore the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced magnetic resonance imaging(MRI)combined with clinical features in predicting early recurrence of HCC after resection.METHODS A total of 161 patients with pathologically confirmed HCC were enrolled.The patients were divided into early recurrence and non-early recurrence group based on the follow-up results.The clinical,laboratory,pathological results and Gd-EOB-DTPA enhanced MRI imaging features were analyzed.RESULTS Of 161 patients,73 had early recurrence and 88 were had non-early recurrence.Univariate analysis showed that patient age,gender,serum alpha-fetoprotein level,the Barcelona Clinic Liver Cancer stage,China liver cancer(CNLC)stage,microvascular invasion(MVI),pathological satellite focus,tumor size,tumor number,tumor boundary,tumor capsule,intratumoral necrosis,portal vein tumor thrombus,large vessel invasion,nonperipheral washout,peritumoral enhancement,hepatobiliary phase(HBP)/tumor signal intensity(SI)/peritumoral SI,HBP peritumoral low signal and peritumoral delay enhancement were significantly associated with early recurrence of HCC after operation.Multivariate logistic regression analysis showed that patient age,MVI,CNLC stage,tumor boundary and large vessel invasion were independent predictive factors.External data validation indicated that the area under the curve of the combined predictors was 0.861,suggesting that multivariate logistic regression was a reasonable predictive model for early recurrence of HCC.CONCLUSION Gd-EOB-DTPA enhanced MRI combined with clinical features would help predicting the early recurrence of HCC after operation.

Prognostic value and predictive model of tumor markers in stageⅠtoⅢgastric cancer patients

BACKGROUND Preoperative serum tumor markers have been widely used in the diagnosis and treatment of gastric cancer patients.However,few studies have evaluated the prognosis of gastric cancer patients by establishing statistical models with multiple serum tumor indicators.AIM To explore the prognostic value and predictive model of tumor markers in stage I and III gastric cancer patients.METHODS From October 2018 to April 2020,a total of 1236 patients with stage I to III gastric cancer after surgery were included in our study.The relationship between serum tumor markers and clinical and pathological data were analyzed.We established a statistical model to predict the prognosis of gastric cancer based on the results of COX regression analysis.Overall survival(OS)was also compared across different stages of gastric cancer.RESULTS The deadline for follow-up was May 31,2023.A total of 1236 patients were included in our study.Univariate analysis found that age,clinical stage,T and N stage,tumor location,differentiation,Borrmann type,size,and four serum tumor markers were prognostic factors of OS(P<0.05).It was shown that clinical stage,tumor size,alpha foetoprotein,carcinoembryonic antigen,CA125 and CA19-9(P<0.05)were independent prognostic factors for OS.According to the scoring results obtained from the statistical model,we found that patients with high scores had poorer survival time(P<0.05).Furthermore,in stage I patients,the 3-year OS for scores 0-3 ranged from 96.85%,95%,85%,and 80%.In stage II patients,the 3-year OS for scores 0-4 were 88.6%,76.5%,90.5%,65.5%and 60%.For stage III patients,3-year OS for scores 0-6 were 70.9%,68.3%,64.1%,50.9%,38.4%,18.5%and 5.2%.We also analyzed the mean survival of patients with different scores.For stage I patients,the mean OS was 55.980 months.In stage II,the mean OS was 51.550 months.The mean OS for stage III was 39.422 months.CONCLUSION Our statistical model can effectively predict the prognosis of gastric cancer patients.

Functions of Müller cell-derived vascular endothelial growth factor in diabetic retinopathy

Müller cells are macroglia and play many essential roles as supporting cells in the retina.To respond to pathological changes in diabetic retinopathy(DR),a major complication in the eye of diabetic patients,retinal Müller glia produce a high level of vascular endothelial growth factor(VEGF or VEGF-A).As VEGF is expressed by multiple retinal cell-types and Müller glia comprise only a small portion of cells in the retina,it has been a great challenge to reveal the function of VEGF or other globally expressed proteins produced by Müller cells.With the development of conditional gene targeting tools,it is now possible to dissect the function of Müller cell-derived VEGF in vivo.By using conditional gene targeting approach,we demonstrate that Müller glia are a major source of retinal VEGF in diabetic mice and Müller cell-derived VEGF plays a significant role in the alteration of protein expression and peroxynitration,which leads to retinal inflammation,neovascularization,vascular leakage,and vascular lesion,key pathological changes in DR.Therefore,Müller glia are a potential cellular target for the treatment of DR,a leading cause of blindness.

Nuclear magnetic resonance spectroscopy is highly sensitive for lipid-soluble metabolites

Although the water-soluble metabolite profile of human mesenchymal stem cells is known, the lipid profile still needs further investigation. In this study, methanol-chloroform was used to extract lipid-soluble metabolites and perchloric acid was used to extract water-soluble metabolites. Fur- thermore, a dual phase extraction method using methanol-chloroform and water was used to obtain both water and lipid fractions simultaneously. All metabolite extractions were analyzed on a 9.4T high-resolution nuclear magnetic resonance spectrometer. Metabolite resonance peaks were as- signed in the acquired spectra according to the chemical shift, and the extraction efficiency of dif- ferent methods was compared. Results showed that in the spectra of water-soluble extracts, major metabolites comprised low molecular weight metabolites, including lactate, acetic acid, fatty acids, threonine, glutamic acid, creatine, choline and its derivatives, while in the spectra of lipid-soluble extracts, most metabolites were assigned to fatty acids. Among the different extraction procedures, perchloric acid was more efficient in extracting water-soluble metabolites and methanol-chloroform was efficient in extracting organic components compared with the dual phase extraction method. Nuclear magnetic resonance spectroscopy showed that as low as 0.7 mg organic yield was enough to obtain clear resonance peaks, while about 6.0 mg water-soluble yield was needed to obtain rela- tively favorable spectral lines. These results show that the efficiency of extracting water and lipid fractions is higher using perchloric acid and methanol-chloroform compared with dual phase ex- traction and that nuclear magnetic resonance spectroscopy is highly sensitive for analyzing lipid-soluble extracts.

Nomogram established using risk factors of early gastric cancer for predicting the lymph node metastasis

BACKGROUND For the prognosis of patients with early gastric cancer(EGC),lymph node metastasis(LNM)plays a crucial role.A thorough and precise evaluation of the patient for LNM is now required.AIM To determine the factors influencing LNM and to construct a prediction model of LNM for EGC patients.METHODS Clinical information and pathology data of 2217 EGC patients downloaded from the Surveillance,Epidemiology,and End Results database were collected and analyzed.Based on a 7:3 ratio,1550 people were categorized into training sets and 667 people were assigned to testing sets,randomly.Based on the factors influencing LNM determined by the training sets,the nomogram was drawn and verified.RESULTS Based on multivariate analysis,age at diagnosis,histology type,grade,T-stage,and size were risk factors of LNM for EGC.Besides,nomogram was drawn to predict the risk of LNM for EGC patients.Among the categorical variables,the effect of grade(well,moderate,and poor)was the most significant prognosis factor.For training sets and testing sets,respectively,area under the receiver-operating characteristic curve of nomograms were 0.751[95%confidence interval(CI):0.721-0.782]and 0.786(95%CI:0.742-0.830).In addition,the calibration curves showed that the prediction model of LNM had good consistency.CONCLUSION Age at diagnosis,histology type,grade,T-stage,and tumor size were independent variables for LNM in EGC.Based on the above risk factors,prediction model may offer some guiding implications for the choice of subsequent therapeutic approaches for EGC.

Correlation between three-dimensional speckle tracking parameters and serum index changes during left ventricular remodeling in patients with coronary heart disease

Objective:To study the correlation between three-dimensional speckle tracking parameters and serum index changes during left ventricular remodeling in patients with coronary heart disease. Methods: Patients who were diagnosed with coronary heart disease and angina pectoris in our hospital between March 2015 and May 2017 were selected as the CHD group of the study, and the healthy subjects who received medical examination in our hospital during the same period were taken as the control group;the three-dimensional speckle tracking parameters, peripheral blood signal molecule expression as well as serum cytokine and collagen metabolism index levels of the two groups were measured.Results: GLS and AGS levels in CHD group were significantly lower than those in control group whereas GCS and GRS levels were not significantly different from those in control group, and peripheral blood Notch1, Hes1, NF-κB and PKC expression intensity as well as serum sTWEAK, FGF23, TGF-β1, GDF15, sSema4D, CaN, MMP14, PINP and ICTP contents were significantly higher than those of control group;GLS and AGS levels in CHD group were negatively correlated with peripheral blood Notch1, Hes1, NF-κB and PKC expression intensity as well as serum sTWEAK, FGF23, TGF-β1, GDF15, sSema4D, CaN, MMP14, PINP and ICTP contents.Conclusions:The changes of three-dimensional speckle tracking parameters GLS and AGS in patients with coronary heart disease are closely related to the changes in signal pathway function, cytokine secretion and collagen metabolism during left ventricular remodeling.

人工智能白内障协同管理的通用平台

目的:建立和验证一个涉及多级临床场景的白内障协作通用的人工智能(artificial intelligence,AI)管理平台,探索基于AI的医疗转诊模式,以提高协作效率和资源覆盖率。方法:训练和验证的数据集来自中国AI医学联盟,涵盖多级医疗机构和采集模式。使用三步策略对数据集进行标记:1)识别采集模式;2)白内障诊断包括正常晶体眼、白内障眼或白内障术后眼;3)从病因和严重程度检测需转诊的白内障患者。此外,将白内障AI系统与真实世界中的居家自我监测、初级医疗保健机构和专科医院等多级转诊模式相结合。结果:通用AI平台和多级协作模式在三步任务中表现出可靠的诊断性能:1)识别采集模式的受试者操作特征(receiver operating characteristic curve,ROC)曲线下面积(area under the curve,AUC)为99.28%~99.71%);2)白内障诊断对正常晶体眼、白内障或术后眼,在散瞳-裂隙灯模式下的AUC分别为99.82%、99.96%和99.93%,其他采集模式的AUC均>99%;3)需转诊白内障的检测(在所有测试中AUC>91%)。在真实世界的三级转诊模式中,该系统建议30.3%的人转诊,与传统模式相比,眼科医生与人群服务比率大幅提高了10.2倍。结论:通用AI平台和多级协作模式显示了准确的白内障诊断性能和有效的白内障转诊服务。建议AI的医疗转诊模式扩展应用到其他常见疾病和资源密集型情景当中。

Validity of the Chinese Version of the Patient-Generated Subjective Global Assessment (PG-SGA) in Lung Cancer Patients

The prevalence of malnutrition is high among oncology patients in China. Although the Patient- Generated Subjective Global Assessment (PG-SGA) is widely recognized as an important nutritional assessment tool, it has not been validated for Chinese cancer patients. The purpose of this study was to conduct an analysis of nutrition screening and assessment data to validate the Chinese version of the PG-SGA in Chinese patients with lung cancer. This was an observational, cross-sectional study of 2,000 consecutive adult patients with lung cancer treated at several tertiary hospitals in China. Anthropometric and patient descriptive data were collected. The PG-SGA generated a score for the nutritional risk and a global rating for the nutritional status. The internal consistency, external consistency, and construct validity were evaluated, and a known-groups comparison and principal component analyses were conducted to evaluate the reliability and validity of the PG-SGA. The known-groups comparison demonstrated the ability of the PG-SGA to differentiate lung cancer patients of different nutritional and body mass index (BMI) groups. A confirmatory factor analysis supported the original four-factor structure of the PG-SGA. In terms of the internal and external consistency, the PG-SGA demonstrated intra-class correlation coefficients (ICC) up to 0.987. Alternative form validity was also demonstrated between Box 4 of the PG-SGA and the Karnofsky Performance Status score, with excellent external consistency (r = 0.972, P < 0.001). The construct validity was supported, and selected questionnaire dimensions were evident in the principal component analysis. Significant Spearman correlations (P < 0.001) were demonstrated. The Chinese version of the PG-SGA demonstrated significant reliability and sufficient exploratory properties to support its validity. It seems to be a valid tool that can be used to access the nutritional status of Chinese lung cancer patients. The validity of the PG-SGA in Chinese cancer patients warrants further investigation in other cancer types.

Validity of the Chinese Version of the Patient-Generated Subjective Global Assessment (PG-SGA) in Gastric Cancer Patients

Purpose Malnutrition is severe among gastric cancer patients in China. While the Patient-Generated Subjective Global Assessment (PG-SGA) is a widely used nutritional assessment tool, the validation for Chinese patients with gastric cancer has not been performed yet. The aim of this research is to validate the Chinese version of the PGSGA in Chinese gastric cancer patients by conducting analyses of nutrition screening and assessment data. Methods Two thousand consecutive adult patients with gastric cancer were included in this observational, cross-sectional study in several tertiary hospitals in China. A survey was made among those patients, which included several questionnaires and some anthropometric parameters. We calculated the parameters to validate the use of PG-SGA categorizing the nutritional status of gastric cancer patients. Then we performed statistical analysis to evaluate the internal consistency, external consistency, and construct validity. Results This study verified the ability of the PG-SGA to differentiate gastric cancer patients into different nutritional groups. The confirmatory factor analysis verified the original four-factor structure of the PG-SGA. The internal and external consistency was measured by a concordance analysis which showed an intraclass correlation coefficients (ICC) of 0.987. The correlations of the Box 4 score with the Karnofsky performance status score demonstrated alternative form validity with good external consistency (Pearson, r = 0.643, P < 0.001). All three anthropometric dimensions of the PG-SGA were supported by principal component analysis. Spearman correlations (P < 0.001) were significant in the majority of tests. Conclusion The Chinese version of the PG-SGA is a valid tool to access the patients’ nutritional status for Chinese gastric patients.

Malnutrition and Quality of Life in Chinese Cancer Patients: a Clinical Study of 23,994 Subjects

Background Malnutrition is common in patients with cancer,and can negatively impact their quality of life(QoL)and even survival.However,there is currently no large data available on the prevalence of malnutrition in Chinese cancer patients.This study evaluated the prevalence of malnutrition and the QoL of Chinese patients with locoregional,recurrent or metastatic cancer.Methods We conducted a nationwide observational,multi-center,hospital-based cross-sectional study within the Chinese Society of Nutritional Oncology(CSNO)Network.All of the patients were diagnosed with one of the following 18 different types of malignant tumors:lung cancer,gastric cancer,liver cancer,colorectal cancer,breast cancer,esophageal cancer,cervical cancer,endometrial cancer,nasopharyngeal carcinoma,malignant lymphoma,leukemia,pancreatic cancer,ovarian cancer,prostate cancer,bladder cancer,brain cancer,biliary tract malignant tumors or gastrointestinal stromal tumors.These patients were enrolled from 72 hospitals located in different regions of China.The patients’nutritional status was evaluated based on the body mass index(BMI),loss of bodyweight,laboratory measurements and patient generated-subjective global assessment(PG-SGA)scores.The cancer patients’physical status and QoL were assessed by the Karnofsky Performance Status(KPS)questionnaire and the European Organization for Research and Treatment of Cancer(EORTC)QLQ-C30 questionnaire,respectively.Results From December 2013 to April 2016,23,994 patients hospitalized for cancer treatment(such as surgery,chemotherapy or radiotherapy)were enrolled in the study.The patients included 12,494(52.9%)males and 11,124(47.1%)females.The mean age was 55.8±13.7 years.The proportions of patients in cancer stagesⅠ,Ⅱ,Ⅲ,Ⅳand uncertain were 11.5%,20.3%,27.5%,30.2%and 10.5%,respectively.Among the 23,994 inpatients,the proportions of patients who were underweight(BMI<18.5 kg/m2),normal(18.5 kg/m2<BMI<24 kg/m2),overweight(24 kg/m2≤BMI<28 kg/m2)and obese(BMI≥28 kg/m2)were 9.3%,59.9%,26.1%and 4.7%,respectively.A total of 18.3%(4,101/22,424)of patients had lost 5%or more of their bodyweight within the past month and 19.6%(2,463/12,538)of patients had lost 10%or more of their bodyweight within the past 6 months.According to the PG-SGA scores,26.6%of the patients were severely malnourished(score≥9),31.3%were moderately malnourished(scores 4~8).A total of 22.2%of patients had a serum albumin level lower than 35g/L.Only 8.6%(2056/23,991)of the patients had severe KPS scores(≤60).The patients with these severe KPS scores were most frequently among those with cancers of the brain(19.7%),prostate(18.0%),pancreas(15.5%)and bladder(15.0%).Based on the QLQ-C30 score,11.6%of patients had a poor QoL.The PG-SGA score and global QoL were correlated(r=-0.593,P<0.001).Conclusion The prevalence of malnutrition in patients with cancer is relatively high,and is related to a poorer QoL.The present findings should be kept in mind when assessing cancer patients,because addressing the patient’s problems in nutritional status would be expected to improve both the clinical outcomes and QoL in cancer patients with malnutrition.

Extension Protocol for the Investigation on Nutrition Status and Clinical Outcome of Patients with Common Cancers in China(INSCOC)Study:2021 update

Background Malnutrition is common in patients with cancer,and this adversely affects the survival and quality of life of patients.Chinese Society for Nutritional Oncology issued a multi-center,large-scale,long-term follow-up prospective study,the Investigation on Nutrition Status and Clinical Outcome of Patients with Common Cancers in China(INSCOC study)since 2013.This is an extension to the previous 2013-2020 study protocol.This study still sought to:①address the prognostic impact of nutritional factors and quality of life on cancer patient survival;②describe the overall and cancer-specific incidence and/or distribution of malnutrition and different measurements of patient quality of life.Methods and study design This is an observational,multi-centered,hospital-based prospective cohort study.Data collection will be performed at baseline(within 48 hours after patient admission),during the hospital stay and 30 days after hospital admission.Follow-up will be conducted for 1-20 years after enrollment.The primary outcome will be the all-cause mortality/overall survival,and secondary outcomes will be the length of hospital stay and costs of hospitalization.Study factors will include demographic characteristics,tumor characteristics,information about chronic diseases,hematological measurements(e.g.,red blood cell count,total lymphocyte counts,hemoglobin,albumin,prealbumin,creatinine,C-reactive protein,IL-6),anthropometric measurements(e.g.,height,weight,arm circumference,arm muscle circumference,triceps skinfold thickness,and waist circumference),body composition parameters,PG-SGA scores,quality of life(as indicated by the QLQ-C30 questionnaire),muscle mass(as indicated by the calf circumference),muscle strength(as indicated by the handgrip strength),muscle function(as indicated by the six-meter walking speed test)and physical status assessments(as indicated by the Karnofsky Performance Status scores).This clinical study protocol was approved by local Ethics Committees of all the participating hospitals.Written informed consent is required for each subject included.Discussion This multi-center,large-scale,long-term follow up prospective study will help improve the diagnosis of malnutrition in cancer patients and identify the risk factors associated with adverse clinical outcomes.The anticipated results of this study will highlight the need for a truly scientific appraisal of nutrition therapy in Chinese oncology populations,and finally help treat the potentially reversible elements of malnutrition in cancer patients to improve their clinical outcomes in the future.

Sex differences in the scored Patient-Generated Subjective Global Assessment in 19,528 cancer patients

Background:The scored Patient-Generated Subjective Global Assessment(PG-SGA)has been widely used to assess the nutritional status of cancer patients.The purpose of this study is to compare the differences in PG-SGA scores and the 7 domain scores of the PG-SGA in male and female cancer patients.Methods:This study was conducted at 72 hospitals from July 2013 to December 2018,a part of the Investigation on Nutritional Status and its Clinical Outcomes of Common Cancers.The PG-SGA was recorded to evaluate the nutritional status of patients.A total of 19,528 patients with 13 common malignancies were included in this study.Student t test and the χ^(2) test were applied to analyze the sex diferences in the 7 domain scores.The Cancer Genome Atlas(TCGA)database was used to analyze the expression levels of symptom-related genes.Results:There were significant sex dfferences in the PG-SGA(P=0.032),notably in patients with gastric cancer(male vs female:9.09±4.86 vs 9.58±5.07,P=0.005)and esophageal cancer(9.64±4.90 vs 10.46±4.96,P=0.011)and the average total PG-SGA of female patients was slightly higher than that of male patients(7.64±4.98 vs 7.77±5.14).The differences were mainly related to the weight,eating,symptom,as well as activity and physical function scores in the stratified analysis.Possible causes of the sex differences were the rates of nausea,vomiting,dry mouth,and other symptoms,in both gastric and esophageal cancer patients.Analysis of the TCGA database suggested that most of the related genes were sex neutral,except for genes related to dysphagia in gastric cancer(VEGFC was higher in female patients,VEGFA and VEGFB higher in male patients).Conclusions:There are sex differences in the PG-SGA scores in patients with various tumor types(female patients generally had higher scores than male patients),with differences mainly in the weight,eating,symptom,as well as activity and physical function scores.The sex differences in PG-SGA scores might be due to the differences in the clinical manifestations of the disease,and further studies should be carried out to investigate other factors influencing the PG-SGA scores in cancer patients.This study provides basic data supporting the individualized nutritional treatment of cancer patients in clinical practice.

Nutritional Assessment of Gynecological Cancer Patients in China

Background Malnutrition is common among cancer patients,but few studies have evaluated the nutritional status among gynecological cancer patients in China.This study aimed to assess the nutritional status of women with gynecological cancer using the patient-generated subjective global assessment(PG-SGA).Methods Data for gynecological cancer patients treated at 44 tertiary hospitals were retrieved from a multicenter study on tumor nutrition.The R Software was used for statistical analyses.Univariate analyses of PG-SGA scores were performed using the Chi-squared test for categorical variables and the Wilcoxon-rank sum test or Kruskal-Wallis test for continuous variables,as appropriate.The significance level was 0.05.Results Data for 1962 women with three types of gynecological cancer(cervical,uterine and ovarian cancer)were used for the data analysis.The median PG-SGA score was 4(interquartile range,IQR:1,8),the median participants’age was 51(IQR:46,59)years old,and the patients had a median BMI of 22.9(IQR:20.7,25.4).The percentages of women who had a medical co-morbidity,or had undergone any radical resection,chemotherapy,or radiotherapy were approximately 27.7%,55.4%,52.5%,and 30.2%,respectively.The levels of serum albumin and high density lipoprotein cholesterol(HDL-C)were 40.1g/L(IQR:36.8,43.1)and 1.2mmol/L(IQR:1.0,1.5),respectively.The identified risk factors for malnutrition based on the PG-SGA score were age(0.05±0.01,p=0.002),BMI(-0.34±0.04,p<0.001),having a medical co-morbidity(0.95±0.33,p=0.004),receiving radiotherapy(1.52±0.31,p<0.001),the serum albumin level(-0.18±0.03,p<0.001),and the HDL-C(-1.12±0.35,p=0.001)as indicated by a linear regression analysis.Conclusions A higher PG-SGA score is positively associated with the age of the patient,having a medical co-morbidity,and receiving radiotherapy,and is negatively related to the patients’BMI and serum albumin and HDL-C levels.

Increased dopamine and its receptor dopamine receptor D1 promote tumor growth in human hepatocellular carcinoma

Background:Dopamine and dopamine receptor D1(DRD1),a member of the dopamine receptor family,have been indicated to play important roles in cancer progression,but dopamine secretion in hepatocellular carcinoma(HCC)and the effects of DRD1 on HCC remain unclear.This study was designed to explore the contribution of the dopaminergic system to HCC and determine the relationship between DRD1 and prognosis in HCC patients.Methods:The dopamine metabolic system was monitored using enzyme-linked immunosorbent assays(ELISAs).The expression of DRD1 was detected by microarray analysis,immunohistochemistry(IHC),and quantitative real-time PCR(qRT-PCR).Stable DRD1 knockout and overexpression cell lines were established for investigation.Transwell,colony formation,and Cell Counting Kit 8(CCK8)assays were performed to assess the malignant behaviors of cancer cells.The cAMP/PI3K/AKT/cAMP response element-binding(CREB)signaling pathway was evaluated by Western blot.This pathway,which is agitated by DRD1 in striatal neurons,had been proven to participate in tumor progression.Xenograft HCC tumors were generated for in vivo experiments.Results:Dopamine secretion increased locally in HCC due to an imbalance in dopamine metabolism,including the upregulation of dopa decarboxylase(DDC)and the downregulation of monoamine oxidase A(MAOA).Dopamine promoted the proliferation and metastasis of HCC.DRD1 was highly expressed in HCC tissues and positive DRD1 expression was related to a poor prognosis in HCC patients.The upregulation of DRD1 agitated malignant activities,including proliferation and metastasis in HCC by regulating the cAMP/PI3K/AKT/CREB pathway,and the downregulation of DRD1 had opposing effects.The effects of dopamine on HCC was reversed by depleting DRD1.SCH23390,a selective DRD1 antagonist,inhibited the proliferation and metastasis of HCC cells both in vitro and in vivo.Conclusion:Dopamine secretion was locally increased in HCC and promoted HCC cell proliferation and metastasis.DRD1 was found to exert positive effects on HCC progression and play a vital role in the dopamine system,and could be a potential therapeutic target and prognostic biomarker for HCC.

A novel surgical technique for dissection of Siewert typeⅡadenocarcinoma of the esophagogastric junction:the transthoracic single-port assisted laparoscopic esophagogastrostomy

Introduction The surgical approach for Siewert type II adenocarcinoma of the esophagogastric junction(AEG)is controversial.The JCOG9502 trial[1,2]has shown that the left thoracoabdominal approach has not improved the prognosis but increased the morbidity in patients with Siewert typeⅡorⅢAEG compared with the abdominal-transhiatal(TH)approach.However,lower mediastinum lymphadenectomy and digestive tract reconstruction using the laparoscopic TH approach are technically difficult[3].

PLSCR1 promotes apoptosis and clearance of retinal ganglion cells in glaucoma pathogenesis

Glaucoma is the leading cause of irreversible blindness worldwide.In the pathogen-esis of glaucoma,activated microglia can lead to retinal ganglion cells(RGCs)apoptosis and death,however,the molecular mechanisms remain largely unknown.We demonstrate that phospholipid scramblase 1(PLSCR1)is a key regulator promoting RGCs apoptosis and their clearance by microglia.As evidenced in retinal progenitor cells and RGCs of the acute ocular hypertension(AOH)mouse model,overexpressed PLSCR1 induced its translocation from the nucleus to the cytoplasm and cytomembrane,as well as elevated phosphatidylserine exposure and reactive oxygen species generation with subsequent RGCs apoptosis and death.These damages were effectively attenuated by PLSCR1 inhibition.In the AOH model,PLSCR1 led to an increase in M1 type microglia activation and retinal neuroinflammation.Upregulation of PLSCR1 resulted in strongly elevated phagocytosis of apoptotic RGCs by activated microglia.Taken together,our study provides important insights linking activated microglia to RGCs death in the glaucoma pathogenesis and other RGC-related neurodegenerative diseases.

Prognosis of acute coronary syndrome complicated by stress hyperglycemia after percutaneous coronary intervention therapy

Background Several studies have reported an association of hyperglycemia with increased mortality and complications in hospital patients with acute coronary syndrome （ACS）. However, the influence of stress hyperglycemia （SH） on the medium- and long-term prognoses in ACS patients has not yet been determined. Methods Random venous blood glucose levels were determined in 433 ACS patients and the patients were divided into two groups based on blood glucose results and disease histories. The 171 patients included in the experimental group had no history of diabetes, had no diabetes and/or glucose metabolism disorders during hospitalization and follow-up and had fasting blood glucose levels of I〉 7.0 mmol/L and random blood glucose levels 1〉 11.1 mmol/L. The 262 patients included in the control group had no history of diabetes, had no diabetes and/or glucose metabolism disorders during hospitalization and follow-up, and had fasting blood glucose levels 〈 6.1 mmoL/L and random blood glucose levels 〈 7.8 mmol/L. Basic clinical information, coronary angiographic lesion characteristics, PCI success rate, complication rate, incidence and morbidity rate of cardiovascular events during the hospitalization period and 6 years of follow-up were compared between the two groups. Results There was no significant difference in age, gender or disease history between the two groups. The triglyceride levels and the left ventricular ejection fractions were significantly higher （P = 0.00） and significantly lower （P = 0.03） in the experimental group than in the control group, respectively. Both groups were subjected to coronary angiography and PCI. The PCI success rates of the two groups did not differ significantly （P = 0.63）. The experimental group had more type B2 lesions, but fewer type A lesions compared with the control group. The experimental group had significantly more stents implanted compared with the control group （P 〈 0.05）. The cardiovascular events were significantly increased （P = 0.01） in the experimental group compared with the control group 1 year after discharge. The incidence of cardiovascular events did not differ significantly between the two groups 1-2 years after discharge. The event incidences were significantly higher （P -- 0.05） in the experimental group than in the control group at the end of follow-up. The experimental group was more prone to myocardial infarction and ischemic target vessel revascularization than the control group, but the control group was more prone to unstable stenocardia and heart failure than the experimental group. The psychogenic mortality of the two groups were similar. The interval and the overall mortality rates （P = 0.054） of the two groups were also similar. Conclusions Patients with ACS complicated by SH were more likely to have cardiovascular events 1 year after PCI, whereas SH did not affect the mid- or long-term prognoses of these patients. SH is an independent risk factor for cardiovascular events.

Evaluation of early liquid drinking after radical gastrectomy in gastric cancer:a Chinese multicenter propensity score matching analysis

Background:Enhanced recovery after surgery is used in gastrointestinal surgery.This study aimed to access the effects of early liquid drinking(ELD)on gastrointestinal function recovery in patients with gastric cancer(GC)who underwent radical gastrectomy,as high-quality evidence on the outcomes of ELD after gastrectomy is currently lacking.Methods:Clinicopathological data of patients with GC from 11 centers were retrospectively analysed.Clinical outcomes were investigated in 555 patients,including 225 who started drinking liquid within 48 h(ELD group)of surgery and 330 who started drinking liquid after flatus resumption(traditional liquid drinking[TLD]group).Propensity score matching(PSM)analysis was performed using a match ratio of 1:1 and 201 patients were selected from each group for the analysis.Primary outcome was time to first passage of flatus.Secondary outcomes included time to first defecation,post-operative hospitalization days,occurrence of short-term post-operative complications,and hospitalization costs.Results:After PSM,baseline characteristics were not significantly different between the two groups.The time to first flatus(2.7261.08 vs 3.3661.39 days),first defecation(4.3461.85 vs 4.7761.61 days),and post-operative hospital stay(8.2764.02 vs 12.9464.43 days)were shorter in the ELD group than in the TLD group(all P<0.05).The ELD group had lower hospitalization costs than the TLD group([7.8362.44 vs 8.7863.41]104 RMB,P=0.041).No significant differences were observed in the incidence of post-operative complications.Conclusions:Compared with TLD,post-operative ELD could promote rapid recovery of gastrointestinal function and reduce hospitalization costs;moreover,ELD does not increase the risk of post-operative complications.

Effects of Malachite Green on the Development of Mouse Embryo In Vitro

Objective To observe effects of malachite green （MG） on the development of mouse embryo in vitro.Methods Two-cell mouse embryos were obtained and exposed to different concentrations of MG （0 ng/ml, group A, the control; 10 ng/ml, group B; 100 ng/ml, group C; 1 000 ng/ml, group D）. The 2-cell mouse embryo assay was used to determine the 2-cell embryo development to the blastocyst. In addition, at the same concentrations of MG, the human sperm motility assay was used to evaluate the influence of MG on sperm viability.Results At the 8-cell stage, groups C and D showed inhibitory effects when compared with the control （P〈0.01）. Rate of the blastocyst in groups C and D was lower than that of the control （P〈O.O1）. In the sperm motility assay, significant changes in motility after 24 h of incubation in groups C and D were observed compared with the control （P〈0. 01）. However, no differences were found on 24 h sperm motility between group B and the control （P〉0.05）. Conclusion MG would have deleterious effects on the development of mouse embryo, and the effects were dose-related. The sperm motility assay could also detect high levels of MG in culture medium.