Gastric cancer in women: A regional health-center seven year retrospective study

AIM: To investigate whether regional geography influences ethnic and gender trends for the development of gastric cancer(GC).METHODS: This retrospective analysis of the INVISION patient database at Louisiana State University Health Sciences Center-Shreveport(LSUHSC-S), a southern United States regional hospital, was performed from 2005-2011. Using the international statistical classification of diseases 9(ICD-9), inpatient, day surgery outpatient, and emergency outpatient diagnosis codes entered into medical records were used to identify GC patients. For each study year, the patients were evaluated for age, ethnicity, and gender, and each patient was counted only once throughout the study. Subsequent patient encounters were counted as visits and separated by inpatient and clinic visits. Complex or severe disease may require more frequent and intensive clinical management; therefore, we evaluated annual clinic visits as "surrogate markers" of disease severity. Finally, we studied the primary diagnosis for Helicobacter pylori(H. pylori) infection(ICD-9 code 41.86) as an additional factor that might increase the risk of GC.RESULTS: A total of 285 patients were diagnosed with GC at LSUHSC-S between 2005 and 2011. African Americans(181 patients, 89 males and 92 females, 63.5% of total patients) had significantly higher frequencies of GC diagnosis compared with non-Hispanic whites(104 patients, 54 males and 50 females, 36.5% of total patients), at a ratio of 1.74(P = 0.002). Within each ethnic group, men and women were diagnosed at approximately equal annual rates. Our findings differed significantly from United States national trends, which found that African American females and white females had lower risks for GC than their corresponding male counterparts. The United States national trend between 2005 and 2011 showed that African Americans males had a higher incidence of GC, with an annual mean(per 100000) of 16.31 ± 0.76 compared with white males(9 ± 0.1, P < 0.001), African American females(8.7 ± 0.34, P < 0.001) and white females(4.05 ± 0.07, P < 0.001). Among the GC patients, the number of clinic visits was highest among African American males(195.1 ± 28.1), who had significantly more clinic visits than African Americans females(123 ± 13.02, P < 0.05), white males(41.57 ± 4.74, P < 0.001) and white females(35 ± 8.9, P < 0.001). Similar trends were found for inpatient visits, with an annual mean of 11.43 ± 1.5 forAfrican American males, followed by African American females(7.29 ± 1.36), white males(2.57 ± 0.69) and white females(1.57 ± 0.612). African American males had significantly more inpatient visits than white males(P < 0.001), and African American females had more inpatient visits than white females(P < 0.01). African American patients showed the highest frequency of H. pylori positive status, with approximately 72% vs 28% for the white patients. CONCLUSION: Increase in GC diagnoses among women at LSUHSC-S is significantly higher than United States national averages, suggesting local geographic and socioeconomic influences may alter GC disease course.

Use of systems change and health information technology to integrate comprehensive tobacco cessation services in a statewide system for delivery of healthcare

Despite the availability of effective treatments and recommendations for systems change, full application of the USPublic Health Service clinical practice guideline for the treatment of tobacco use is seldom achieved. The present report describes a comprehensive, structured approach used to implement the guideline and to integrate evidence-based cessation services into a system for delivery of health care. The PRECEDE-PROCEDE model and systems strategies were employed to design and implement the Tobacco Control Initiative (TCI), which provides evidence-based cessation services for the patients of a statewide public hospital system. For the TCI, multi-level assessments, pilot programs, electronic data collection, and performance feedback were needed to produce system-wide changes in workflow and in the quality of care for tobacco users. Although there are advances in health information technology (HIT), systems approaches are required for responding effectively to the Health Information Technology for Economic and Clinical Health (HI-TECH) Act and to standards governing use of electronic data related to treatment of tobacco use and dependence.

Does the use of double hormone replacement therapy for trauma patient organ donors improve organ recovery for transplant

BACKGROUND With an ongoing demand for transplantable organs,optimization of donor management protocols,specifically in trauma populations,is important for obta-ining a high yield of viable organs per patient.Endocrine management of brain-dead potential organ donors(BPODs)is controversial,leading to heterogeneous clinical management approaches.Previous studies have shown that when levo-thyroxine was combined with other treatments,including steroids,vasopressin,and insulin,BPODs had better organ recovery and survival outcomes were increased for transplant recipients.AIM To determine if levothyroxine use in combination with steroids in BPODs increased the number of organs donated in trauma patients.METHODS A retrospective review of adult BPODs from a single level 1 trauma center over ten years was performed.Exclusion criteria included patients who were not solid organ donors,patients who were not declared brain dead(donation after circulatory death),and patients who did not receive steroids in their hospital course.Levothyroxine and steroid administration,the number of organs donated,the types of organs donated,and demographic information were recorded.Univariate analyses were performed with P<0.05 considered to be statistically significant.RESULTS A total of 88 patients met inclusion criteria,69(78%)of whom received levothyroxine and steroids(ST/LT group)vs 19(22%)receiving steroids without levothyroxine(ST group).No differences were observed between the groups for gender,race,pertinent injury factors,age,or other hormone therapies used(P>0.05).In the ST/LT group,68.1%(n=47)donated a high yield(3-5)of organ types per donor compared to 42.1%(n=8)in the ST group(P=0.038).There was no difference in the total number of organ types donated between the groups(P=0.068).CONCLUSION This study suggests that combining levothyroxine and steroid administration increases high-yield organ donation per donor in BPODs in the trauma patient population.Limitations to this study include the retrospective design and the relatively small number of organ donors who met inclusion criteria.This study is unique in that it mitigates steroid administration as a confounding variable and focuses specifically on the adjunctive use of levothyroxine.

Saposin C stimulates growth and invasion,activates p42/44 and SAPK/JNK signaling pathways of MAPK and upregulates uPA/uPAR expression in prostate cancer and stromal cells

Aim:To determine the effect of saposin C (a known trophic domain of prosaposin) on proliferation,migration and invasion,as well as its effect on the expression of urokinase plasmonogen activator (uPA),its receptor (uPAR) and matrix metalloproteinases (MMP)-2 and -9 in normal and malignant prostate cells.In addition,we tested whether saposin C can activate p42/44 and stress-activated protein kinase/c-Jun NH_2-terminal kinase (SAPK/JNK) signal transduction pathways of the mitogen-activated protein kinase (MAPK) superfamily.Methods:We employed West- ern blot analysis,phospho-specific antibodies,cell proliferation assay,reverse transcriptase-polymerase chain reaction, in vitro kinase assays and migration and invasion to determine the effect of saposin C on various biological behaviors of prostate stromal and cancer cells.Results:Saposin C,in a cell type-specific manner,upregulates uPA/uPAR and immediate early gene c-Jun expression,stimulates cell proliferation,migration and invasion and activates p42/44 and SAPK/JNK MAPK pathways in prostate stromal and cancer cells.Normal prostate epithelial cells were not responsive to saposin C treatment in the above studies.Conclusion:Saposin C functions as a multipotential modulator of diverse biological activities in prostate cancer and stromal cells.These results strongly suggest that saposin C functions as a potent growth factor for prostatic cells and may contribute to prostate carcinogenesis and/or the development of hormone-refractory prostate cancer.

Identification of speckle-type POZ protein somatic mutations in African American prostate cancer

The speckle-type POZ protein （SPOP） is a tumor suppressor in prostate cancer （PCa）. SPOP somatic mutations have been reported in up to 15% of PCa of those of European descent. However, the genetic roles of SPOP in African American （AA）-PCa are currently unknown. We sequenced the SPOP gene to identify somatic mutations in 49 AA prostate tumors and identified three missense mutations （p.Y87C, p.F102S, and p.G111E） in five AA prostate tumors （10%） and one synonymous variant （p.11061） in one tumor. Intriguingly, all of mutations and variants clustered in exon six, and all of the mutations altered conserved amino acids. Moreover, two mutations （p.F102S and p.G111E） have only been identified in AA-PCa to date. Quantitative real-time polymerase chain reaction analysis showed a lower level of SPOP expression in tumors carrying SPOP mutations than their matched normal prostate tissues. In addition, SPOP mutations and novel variants were detected in 5 of 27 aggressive PCa and one of 22 less aggressive PCa （P 〈 0.05）. Further studies with increased sample size are needed to validate the clinicopathological significance of these SPOP mutations in AA-PCa.

Human prostate cancer heterotransplants： a review on this experimental model

A common model used for preclinical research was in vitro human tumor cell culture. An alternative model was the direct implantation of a unique patient＇s tumor biopsy specimens into immunodeficient host mice. Published data from PubMed （http：//www.ncbi.nlm.nih.gov） and Current Contents Connect databases （http：//thomsonreuters.com/ products_services/science/science_roducts/a-z/current_contents_connect） were reviewed. Prostate cancer （PCa） heterotransplantation was evaluated using histopathology, morphology, cell differentiation, DNA content, tumor marker expression, metastases, tumor kinetics, tumor take rate and tumor vasculature in the first tumor heterotransplant. The heterotransplanted tumor retained the biological properties of the original tumor, such as morphology, degree of differentiation, pathology, secretory activity, expression of tumor markers and human vasculature. Human PCa heterotransplants have considerable experimental advantages over cell culture following xenotransplantation.

Cutaneous leishmaniasis in Louisiana-one-year follow-up:A case report

Reports of leishmaniasis are scarce in North America.It is considered to be one of the neglected tropical diseases.It is seen in immigrants from endemic areas to United States.Treatments are not readily available in the United States.Untreated or inadequately treated cutaneous leishmaniasis not only causes localized disfigurement but can advance to more permanent and devastating mucosal disfigurement and perforation,if caused by a species that can also cause mucocutaneous leishmaniasis.CASE SUMMARY A 42-year-old human immunodeficiency virus negative male immigrant from Honduras presented to the emergency department of our facility in Louisiana with a 2-mo history of a left lower extremity ulcer.It started as a painless blister that progressed in size and developed into other smaller lesions tracking up the thigh and became tender and erythematous.Clinically looked nontoxic and healthy.He was afebrile.Blood tests,except inflammatory markers,were within normal limits.The cellulitis of the leg was treated with 6 d of vancomycin that also relieved the pain.Skin biopsy was obtained,and histopathology was suspicious for leishmania.Polymerase chain reaction/deoxyribonucleic acid sequencing done by centers for disease control and prevention confirmed the diagnosis as Leishmania panamensis.There was no involvement of nasooropharyngeal mucosa,confirmed by otolaryngology.The patient was treated with miltefosine for 28 d.Clinic follow-up after approximately 11 mo revealed a healed skin ulcer.CONCLUSION Cutaneous leishmaniasis should be in the differential diagnosis of skin ulcers of travelers from endemic areas.Awareness regarding diagnosis and treatment of leishmaniasis needs to be enhanced.

Foot Care Knowledge and Practice among Diabetic Patients Attending General Outpatient Clinic in Tribhuvan University Teaching Hospital

Background: Diabetes Mellitus results in several serious complications and among them foot problem is one of the commonly ignored complications. This study is an attempt to find out the level of patient’s awareness and practice in Nepalese context. Objective: The aim of this study is to determine the knowledge and practice of foot care among patients with diabetes in Nepal. Methods: This is a six-month long cross-sectional study done in the General Practice Clinic of Tribhuvan University Teaching Hospital. Diabetic patients were given structure questionnaires on knowledge, foot care practices, and demographic information. Results: Illiteracy was found be significantly associated with poor knowledge and practice of foot care. Those who have no education are more likely to have poor knowledge and foot care practice. The odds of having poor knowledge is 6.414 (3.075, 13.379) in those who have no education/primary education compared to those who have education and the odds of poor foot care practice is 4.5180 (2.077, 8.411) in those who have no education/primary education compared to those who have education with significance of Conclusion: This study has highlighted the need of appropriate education intervention for the patients with diabetes who have no education background to prevent from foot complications. Health education materials such as graphics, photos are needed to make them comprehensible for the illiterate patients.

Comment on ＂Effect of transferred NK4 gene on proliferation, migration, invasion, and apoptosis of human prostate cancer DU145 cells＂ by Dan Yue et al. in Asian Journal of Androtogy

Hepatocyte growth factor/scatter factor （HGF/SF） interacting with its cell surface receptor tyrosine kinase （RTK） c-met proto-oncogene drives downstream signaling pathways which lead to cell proliferation, migration, invasion, apoptotic cell-death protection, angiogenesis during embryogenesis, repair and regeneration, and neoplastic growth and metastatic progression [1-6].

Higher rates of autism and attention deficit/hyperactivity disorder in American children:Are food quality issues impacting epigenetic inheritance?

In the United States,schools offer special education services to children who are diagnosed with a learning or neurodevelopmental disorder and have difficulty meeting their learning goals.Pediatricians may play a key role in helping children access special education services.The number of children ages 6-21 in the United States receiving special education services increased 10.4%from 2006 to 2021.Children receiving special education services under the autism category increased 242%during the same period.The demand for special education services for children under the developmental delay and other health impaired categories increased by 184%and 83%respectively.Although student enrollment in American schools has remained stable since 2006,the percentage distribution of children receiving special education services nearly tripled for the autism category and quadrupled for the developmental delay category by 2021.Allowable heavy metal residues remain persistent in the American food supply due to food ingredient manufacturing processes.Numerous clinical trial data indicate heavy metal exposures and poor diet are the primary epigenetic factors responsible for the autism and attention deficit hyperactivity disorder epidemics.Dietary heavy metal exposures,especially inorganic mercury and lead may impact gene behavior across generations.In 2021,the United States Congress found heavy metal residues problematic in the American food supply but took no legislative action.Mandatory health warning labels on select foods may be the only way to reduce dietary heavy metal exposures and improve child learning across generations.

结直肠癌组织中CD24和Src的表达及其意义

背景与目的本课题组前期研究提示CD24可促进大肠癌细胞的增殖,同时可以激活Raf-ERK通路和p38MAPK激酶。但CD24分子因缺乏跨膜结构而不足以传递细胞信号,而Src家族激酶和MAPK通路关系密切且和肠癌密切相关。因此,本研究拟探讨结直肠癌组织中CD24及SFKs成员之一的Src的表达和相互关系,及其在结直肠癌演进过程中的作用,为进一步的功能鉴定奠定基础。方法对204例结直肠癌组织进行连续切片,应用免疫组化方法检测CD24、Src的表达情况,分析两者表达的相关性及与结直肠癌患者临床病理特征和预后的关系。结果免疫组化染色提示,正常结直肠黏膜组织中CD24、Src均无表达,而在结直肠癌组织中则有不同程度的CD24、Src染色。二者的表达强弱情况均与肿瘤细胞的分化程度、Duke分期、肿瘤浸润程度、淋巴结转移以及远处转移有关(P<0.01),而与患者年龄、性别、肿瘤部位以及肿瘤大小无关(P>0.05)。相关分析统计提示CD24表达与Src表达呈正相关关系(r=0.544,P<0.01)。生存分析提示CD24及Src低表达患者的生存率均要高于高表达患者;COX模型多因素分析显示,CD24和Src表达不是独立的预后因素。结论 CD24和Src的表达与结直肠癌的演进密切相关,二者组织学表达具有相关性,CD24和Src的表达不是结直肠癌的独立预后因素。

硫酸镁调节SO2衍生物对大鼠海马神经元钠通道的刺激作用

利用全细胞膜片钳技术研究了硫酸镁(MgSO4)对SO2衍生物刺激大鼠海马神经元电压门控性钠通道的调节作用.结果表明,MgSO4对SO2衍生物增大大鼠海马神经元钠电流的效应具有抑制作用,此作用随着SO2衍生物浓度的增加而减弱,随着MgSO4浓度的增加而增强.不同时间加入MgSO4均会显著抑制SO2衍生物增大钠电流的效应,说明MgSO4不仅对SO2衍生物增大钠电流的效应具有抑制作用,而且可即时和延效性地抑制此损伤效应的发生.研究结果提示,硫酸镁对SO2衍生物刺激大鼠海马神经元钠通道具有抑制作用,这可能是MgSO4对SO2引发的中枢神经系统损伤具有防护和治疗作用的机制之一.

FLT3在急性白血病靶向治疗中的研究进展

FMS-like Tyrosine Kinase 3(FLT3)是一种受体酪氨酸激酶,在造血干细胞、前体B细胞等的增殖、分化以及存活中具有重要作用。急性白血病的发病往往伴随着FLT3的异常活化,FLT3突变是造成其异常活化的主要原因,且FLT3突变的患者往往具有较差的预后。FLT3抑制剂的研究为白血病靶向治疗提供了广阔的前景。

Cerebral ischemia and neuroregeneration

Cerebral ischemia is one of the leading causes of morbidity and mortality worldwide. Although stroke （a form of cerebral ischemia）-related costs are expected to reach 240.67 billion dollars by 2030, options for treatment against cerebral ischemia/stroke are limited. All therapies except anti-thrombolytics （i.e., tissue plasminogen activator） and hypothermia have failed to reduce neuronal injury, neurological deficits, and mortality rates following cerebral ischemia, which suggests that development of novel therapies again st stroke/cerebral ischemia are urgently needed. Here, we discuss the possible mechanism（s） underlying cerebral ischemia-induced brain injury, as well as current and future novel therapies （i.e., growth factors, nicotinamide adenine dinucleotide, melatonin, resveratrol, protein kinase C isozymes, pifithrin, hypothermia, fatty acids, sympathoplegic drugs, and stem cells） as it relates to cerebral ischemia.

Current development of the second generation of mTOR inhibitors as anticancer agents

The mammalian target of rapamycin (mTOR), a serine/threonine protein kinase, acts as a "master switch" for cellular anabolic and catabolic processes, regulating the rate of cell growth and proliferation. Dysregulation of the mTOR signaling pathway occurs frequently in a variety of human tumors, and thus, mTOR has emerged as an important target for the design of anticancer agents. mTOR is found in two distinct multiprotein complexes within cells, mTORC1 and mTORC2. These two complexes consist of unique mTOR-interacting proteins and are regulated by different mechanisms. Enormous advances have been made in the development of drugs known as mTOR inhibitors. Rapamycin, the first defined inhibitor of mTOR, showed effectiveness as an anticancer agent in various preclinical models. Rapamycin analogues (rapalogs) with better pharmacologic properties have been developed. However, the clinical success of rapalogs has been limited to a few types of cancer. The discovery that mTORC2 directly phosphorylates Akt, an important survival kinase, adds new insight into the role of mTORC2 in cancer. This novel finding prompted efforts to develop the second generation of mTOR inhibitors that are able to target both mTORC1 and mTORC2. Here, we review the recent advances in the mTOR field and focus specifically on the current development of the second generation of mTOR inhibitors as anticancer agents.

Non-alcoholic fatty liver disease and thyroid dysfunction:A systematic review

Thyroid hormones are totally involved in the regulation of body weight, lipid metabolism, and insulin resistance. Therefore it is anticipated that thyroid hormones may have a role in the pathogenesis of non alcoholic fatty liver disease(NAFLD) and non alcoholic steatohepatitis(NASH). In this study, we reviewed the current literature on the association between thyroid dysfunction and NAFLD/NASH. A search for English language medical literature reporting an association between thyroid dysfunction and NAFLD/NASH in humans was conducted across PubMed, ISI Web of Science, and Scopus in August, 2013. Out of 140 studies initially identified through the search, 11 relevant articles were included in the final review. Thyroid dysfunctions in the form of overt or subclinical hypothyroidism are prevalent among patients with NAFLD/NASH. Hypothyroidism appears to be an independent risk factor for NAFLD/NASH in some studies; however, other newly published studies failed to find such anassociation. The results of the studies on the role of thyroid abnormalities in NAFLD/NASH are inconsistent, and further research is recommended to determine the relationship between hypothyroidism and NAFLD/NASH and the underlying mechanisms.

Epstein-Barr virus infection mechanisms

Epstein-Barr virus(EBV) infection occurs by distinct mechanisms across different cell types. EBV infection of B cells in vitro minimally requires 5 viral glycoproteins and 2 cellular proteins. By contrast, infection of epithelial cells requires a minimum of 3 viral glycoproteins, which are capable of interacting with one or more of 3 different cellular proteins. The full complement of proteins involved in entry into all cell types capable of being infected in vivo is unknown. This review discusses the events that occur when the virus is delivered into the cytoplasm of a cell, the players known to be involved in these events, and the ways in which these players are thought to function.

Distribution of bleeding gastrointestinal angioectasias in a Western population

AIM:To define which segments of the gastrointestinal tract are most likely to yield angioectasias for ablative therapy. METHODS:A retrospective chart review was performed for patients treated in the Louisiana State University Health Sciences Center Gastroenterology clinics between the dates of July 1, 2007 and October 1, 2010. The selection of cases for review was initiated by use of our electronic medical record to identify all patients with a diagnosis of angioectasia, angiodysplasia, or arteriovenous malformation. Of these cases, chart reviews identified patients who had a complete evaluation of their gastrointestinal tract as defined by at least one upper endoscopy, colonoscopy and small bowel capsule endoscopy within the past three years. Patients without evidence of overt gastrointestinal bleeding or iron deficiency anemia associated with intestinal angioectasias were classified as asymptomatic and excluded from this analysis. Thirty-five patients with confirmed, bleeding intestinal angioectasias who had undergone complete endoscopic evaluation of the gastrointestinal tract were included in the final analysis. RESULTS:A total of 127 cases were reviewed. Sixtysix were excluded during subsequent screening due to lack of complete small bowel evaluation and/or lack of documentation of overt bleeding or iron deficiency anemia. The 61 remaining cases were carefully examined with independent review of endoscopic images as well as complete capsule endoscopy videos. This anal- ysis excluded 26 additional cases due to insufficient records/images for review, incomplete capsule examination, poor capsule visualization or lack of confirmation of typical angioectasias by the principal investigator on independent review. Thirty-five cases met criteria for final analysis. All study patients were age 50 years or older and 13 patients (37.1%) had chronic kidney disease stage 3 or higher. Twenty of 35 patients were taking aspirin (81 mg or 325 mg), clopidogrel, and/or warfarin, with 8/20 on combination therapy. The number and location of angioectasis was documented for each case. Lesions were then classified into the following segments of the gastrointestinal tract:esophagus, stomach, duodenum, jejunum, ileum, right colon and left colon. The location of lesions within the small bowel observed by capsule endoscopy was generally defined by percentage of total small bowel transit time with times of 0%-9%, 10%-39%, and 40%-100% corresponding to the duodenum, jejunum and ileum, respectively. Independent review of complete capsule studies allowed for deviation from this guideline if capsule passage was delayed in one or more segments. In addition, the location and number of angioectasias observed in the small bowel was further modified or confirmed by subsequent device-assisted enteroscopy (DAE) performed in the 83% of cases. In our study population, angioectasias were most commonly found in the jejunum (80%) followed by the duodenum (51%), stomach (22.8%), and right colon (11.4%). Only two patients were found to have angioectasias in the ileum (5.7%). Twenty-one patients (60%) had angioectasias in more than one location.CONCLUSION:Patients being considered for endoscopic ablation of symptomatic angioectasias should undergo push enteroscopy or anterograde DAE and reinspection of the right colon.

A facile,branched DNA assay to quantitatively measure glucocorticoid receptor auto-regulation in T-cell acute lymphoblastic leukemia

Glucocorticoid(GC) steroid hormones are used to treat acute lymphoblastic leukemia(ALL) because of their pro-apoptotic effects in hematopoietic cells.However,not all leukemia cells are sensitive to GC,and no assay to stratify patients is available.In the GC-sensitive T-cell ALL cell line CEM-C7,auto-up-regulation of RNA transcripts for the glucocorticoid receptor(GR) correlates with increased apoptotic response.This study aimed to determine if a facile assay of GR transcript levels might be promising for stratifying ALL patients into hormone-sensitive and hormone-resistant populations.The GR transcript profiles of various lymphoid cell lines and 4 bone marrow samples from patients with T-cell ALL were analyzed using both an optimized branched DNA(bDNA) assay and a real-time quantitative reverse transcription-polymerase chain reaction assay.There were significant correlations between both assay platforms when measuring total GR(exon 5/6) transcripts in various cell lines and patient samples,but not for a probe set that detects a specific,low abundance GR transcript(exon 1A3).Our results suggest that the bDNA platform is reproducible and precise when measuring total GR transcripts and,with further development,may ultimately offer a simple clinical assay to aid in the prediction of GC-sensitivity in ALL patients.

Use of rotational atherectomy for reducing significant dissection in treating de novo femoropopliteal steno-occlusive disease after balloon angioplasty

动脉的解剖的 BackgroundDevelopment 被认为是为在 femoropopliteal 疾病的跳伞 stenting 的一个重要关键因素。我们试图与旋转 atherectomy 并且没有 it.MethodsFrom 2011年1月处于在处理组之间的解剖率和结果评估差别到2016年10月，我们在 de-novo 的汽球 angioplasty ( BA )以后比较了 angiography ， femoropopliteal ，速闭塞的损害他们是否被旋转 atherectomy 在 BA 以前对待。59 损害(8 吸藏；3 包含的腿弯部的片断；损害长度：86.3