Diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging parameters and serum tumor markers in rectal carcinoma prognosis

BACKGROUND Rectal carcinoma(RC),one of the most common malignancies globally,presents an increasing incidence and mortality year by year,especially among young people,which seriously affects the prognosis and quality of life of patients.At present,dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)parameters and serum carbohydrate antigen 19-9(CA19-9)and CA125 Levels have been used in clinical practice to evaluate the T stage and differentiation of RC.However,the accuracy of these evaluation modalities still needs further research.This study explores the application and value of these methods in evaluating the T stage and differentiation degree of RC.AIM To analyze the diagnostic performance of DCE-MRI parameters combined with serum tumor markers(TMs)in assessing pathological processes and prognosis of RC patients.METHODS A retrospective analysis was performed on 104 RC patients treated at Yantai Yuhuangding Hospital from May 2018 to January 2022.Patients were categorized into stages T1,T2,T3,and T4,depending on their T stage and differentiation degree.In addition,they were assigned to low(L group)and moderate-high differentiation(M+H group)groups based on their differentiation degree.The levels of DCE-MRI parameters and serum CA19-9 and CA125 in different groups of patients were compared.In addition,the value of DCE-MRI parameters[volume transfer constant(Ktrans),rate constant(Kep),and extravascular extracellular volume fraction(Ve)in assessing the differentiation and T staging of RC patients was discussed.Furthermore,the usefulness of DCE-MRI parameters combined with serum CA19-9 and CA125 Levels in the evaluation of RC differentiation and T staging was analyzed.RESULTS Ktrans,Ve,CA19-9 and CA125 were higher in the high-stage group and L group than in the low-stage group and M+H Group,respectively(P<0.05).The areas under the curve(AUCs)of the Ktran and Ve parameters were 0.638 and 0.694 in the diagnosis of high and low stages,respectively,and 0.672 and 0.725 in diagnosing moderate-high and low differentiation,respectively.The AUC of DCE-MRI parameters(Ktrans+Ve)in the diagnosis of high and low stages was 0.742,and the AUC in diagnosing moderate-high and low differentiation was 0.769.The AUCs of CA19-9 and CA-125 were 0.773 and 0.802 in the diagnosis of high and low stages,respectively,and 0.834 and 0.796 in diagnosing moderate-high and low differentiation,respectively.Then,we combined DCE-MRI(Ktrans+Ve)parameters with CA19-9 and CA-125 and found that the AUC of DCE-MRI parameters plus serum TMs was 0.836 in the diagnosis of high and low stages and 0.946 in the diagnosis of moderate-high and low differentiation.According to the Delong test,the AUC of DCE-MRI parameters plus serum TMs increased significantly compared with serum TMs alone in the diagnosis of T stage and differentiation degree(P<0.001).CONCLUSION The levels of the DCE-MRI parameters Ktrans and Ve and the serum TMs CA19-9 and CA125 all increase with increasing T stage and decreasing differentiation degree of RC and can be used as indices to evaluate the differentiation degree of RC in clinical practice.Moreover,the combined evaluation of the above indices has a better effect and more obvious clinical value,providing important guiding importance for clinical condition judgment and treatment selection.

Inhibitory effect of saffron on head and neck squamous cell carcinoma via targeting of ESR1 and CCND1 by its active compound crocetin

Background:Traditional Chinese medicine is promising for managing challenging and complex disorders,including cancer,and in particular,saffron is applied in treating various cancer types.However,its potential therapeutic efficacy and active components in managing squamous cell carcinoma of the head and neck(HNSCC)remain unclear yet.Methods:Using network pharmacology approaches,active ingredients of saffron,their target genes,and HNSCC-related genes were identified.Enrichment analyses were conducted for determining molecular functions and pathways enriched by genes that overlapped between the saffron target gene set and the HNSCC gene set.Among the four known active ingredients of saffron,crocetin was found to have the strongest inhibitory impact on HNSCC,based on the findings of cell viability and migration assays.Therefore,the potential target genes of crocetin in HNSCC cells were examined using molecular docking experiments and were confirmed by qPCR.Result s:Four active ingredients of saffron and 184 of their target genes were identified.Further,a total of 34 overlapping saffron-/HNSCC-associated targets related to the four active ingredients were screened,and crocetin was chosen for further investigation because it had the strongest inhibitory effect on HNSCC cells.Molecular docking experiments indicated that ESR1 and CCND1 were the target genes of crocetin.These results were confirmed through qPCR analysis,in which crocetin was found to lower the expression of the ESR1 and CCND1 genes in AMC-HN-8 and FaDu cells.Conclusion:According to our results,crocetin is a primary active anti-cancer component of saffron that may have potential in the development of novel HNSCC-treating medications.However,more thorough molecular research is necessary for confirming these results and elucidating the anti-cancer mechanism underlying saffron.

Response of cholangiocarcinoma with epigastric metastasis to lenvatinib plus sintilimab: A case report and review of literature

BACKGROUND Cholangiocarcinoma(CCA)poses a significant clinical challenge due to its low radical resection rate and a propensity for high postoperative recurrence,resulting in a poor dismal.Although the combination of targeted therapy and immunotherapy has demonstrated notable efficacy in several solid tumors recently,however,its application in CCA remains underexplored and poorly documented.CASE SUMMARY This case report describes a patient diagnosed with stage IV CCA,accompanied by liver and abdominal wall metastases,who underwent palliative surgery.Subsequently,the patient received two cycles of treatment combining lenvatinib with sintilimab,which resulted in a reduction in abdominal wall metastasis,while intrahepatic metastasis displayed progression.This unexpected observation illustrates different responses of intrahepatic and extrahepatic metastases to the same therapy.CONCLUSION Lenvatinib combined with sintilimab shows promise as a potential treatment strategy for advanced CCA.Genetic testing for related driver and/or passenger mutations,as well as an analysis of tumor immune microenvironment analysis,is crucial for optimizing drug combinations and eventually addressing the issue of non-response in specific metastatic sites.

Simultaneous integrated dose reduction intensity-modulated radiotherapy effectively reduces cardiac toxicity in limited-stage small cell lung cancer

Objective:To assess the clinical outcomes and toxicities of once daily(QD)simultaneous dose reduction intensity-modulated radiotherapy(SDR-IMRT-QD;SDR-QD)versus conventional QD IMRT(C-QD)and twice daily(BID)IMRT in patients with limited-stage small cell lung cancer(LS-SCLC).Methods:After propensity score matching(PSM),a retrospective analysis involving 300 patients with LS-SCLC treated using SDR-QD,C-QD,or BID was performed from January 1,2014 to December 31,2019.The prescribed irradiation dose in the SDR-QD cohort was 60 Gy/PGTV and 54 Gy/PTV QD.The radiation dose was 60 Gy for both PGTV and PTV QD in the C-QD cohort.The radiation dose was 45 Gy for both PGTV and PTV in the BID cohort.Toxicities,short-term effects,and survival outcomes were recorded.A meta-analysis on the protective effects of pharmaceuticals for cardiac toxicities induced by anti-tumor therapy was performed.Results:The median overall survival time(MST)in the 3 cohorts were 32.7 months(SDR-QD),26.3 months(C-QD),and 33.6 months(BID);the differences between groups were statistically significant.Lower toxicities and doses to organs-at-risk(OARs)occurred in the SDR-QD and BID cohorts.Further,the cardiac dose dosimetric parameter Vheart40 was negatively associated with survival(r=-0.35,P=0.007).A Vheart40 value of 16.5%was recommended as a cut-off point,which yielded 54.7%sensitivity and 85.7%specificity for predicting negative survival outcomes.The meta-analysis indicated that pharmaceuticals significantly reduced the cardiac toxicities induced by chemotherapy,but not radiotherapy.Conclusions:SDR-QD was shown to have similar toxicities and survival compared with BID,but fewer toxicities and better survival than C-QD.In addition,cardiac dose exposure was negatively associated with survival.Thus,16.5%of the cardiac dosimetric parameter Vheart40 is recommended as the cut-off point,and a Vheart40>16.5%predicts poor survival.

Real-world effectiveness and safety of goserelin 10.8-mg depot in Chinese patients with localized or locally advanced prostate cancer

Objective:Real-word data on long-acting luteinizing hormone-releasing hormone(LHRH)agonists in Chinese patients with prostate cancer are limited.This study aimed to determine the real-world effectiveness and safety of the LHRH agonist,goserelin,particularly the long-acting 10.8-mg depot formulation,and the follow-up patterns among Chinese prostate cancer patients.Methods:This was a multicenter,prospective,observational study in hormone treatment-na?ve patients with localized or locally advanced prostate cancer who were prescribed goserelin 10.8-mg depot every 12 weeks or 3.6-mg depot every 4 weeks with or without an anti-androgen.The patients had follow-up evaluations for 26 weeks.The primary outcome was the effectiveness of goserelin in reducing serum testosterone and prostate-specific antigen(PSA)levels.The secondary outcomes included testosterone and PSA levels,attainment of chemical castration(serum testosterone<50 ng/d L),and goserelin safety.The exploratory outcome was the monitoring pattern for serum testosterone and PSA.All analyses were descriptive.Results:Between September 2017 and December 2019,a total of 294 eligible patients received≥1 dose of goserelin;287 patients(97.6%)were treated with goserelin 10.8-mg depot.At week 24±2,the changes from baseline[standard deviation(95%confidence interval)]in serum testosterone(n=99)and PSA(n=131)were-401.0 ng/d L[308.4 ng/d L(-462.5,-339.5 ng/d L)]and-35.4 ng/m L[104.4 ng/m L(-53.5,-17.4 ng/m L)],respectively.Of 112 evaluable patients,100(90.2%)achieved a serum testosterone level<50 ng/d L.Treatment-emergent adverse events(TEAEs)and severe TEAEs occurred in 37.1%and 10.2%of patients,respectively.The mean testing frequency(standard deviation)was 1.6(1.5)for testosterone and 2.2(1.6)for PSA.Conclusions:Goserelin 10.8-mg depot effectively achieved and maintained castration and was well-tolerated in Chinese patients with localized and locally advanced prostate cancer.

Correlation of Epstein-Barr virus and its encoded proteins with Helicobacter pylori and expression of c-met and c-myc in gastric carcinoma

瞄准：为了调查 Epstein-Barr 病毒(EBV ) 和 EBV- 的相互关系，并且在胃的致癌作用探索他们的角色，与 Helicobacter pylori (H pylori ) 编码了蛋白质感染和表示遇见 c 并且在胃的癌的 c-myc oncogene 蛋白质。方法：185 胃的癌纸巾被聚合酶链反应(PCR ) 检测为 EBV 染色体的南部的污点和为编码 EBV 的小 RNA 1 (EBER1 ) 的原位杂交(ISH ) 。有积极 EBER1 信号的胃的癌被证实联系 EBV 的胃的癌(EBVaGC ) 。在 185 胃的癌的 H pylori 感染的地位被快速的 urease 和 PCR 估计。有积极 PCR 和 urease 的样品被定义为 H pylori 感染。表示遇见 c 并且在 EBVaGC 和匹配的 EBV 否定的胃的癌(EBVnGC ) 的纸巾的 c-myc oncogene 蛋白质被免疫组织化学检验。RT-PCR 和南部的杂交被用来检测原子抗原(EBNA ) 的表示 1 和 2，潜伏的膜蛋白质(LMP ) 1，在 EBVaGC 情况中的早基因 BARF1 和 BHRF1。结果：在 185 胃的癌的 H pylori 和 EBV 的积极的率是 59.45%(110/185 ) 并且 7.03%(13/185 ) 分别地。没有差别在在 pylori 积极的 H 和 H 之间的性别，年龄，病理学的区别，临床的阶段和淋巴节点转移被发现 pylori 否定的胃的癌。然而，在窦的 H pylori 感染的积极的率胃的癌比贲门和身体的高胃的癌。在我们的系列，年龄，病理学的区别，临床的阶段，淋巴节点转移和癌症的地点不在 EBVnGC 和 EBVaGC 之间是不同的，当在男病人的 EBV 的积极的率比女病人的显著地高时。在联系 EBV 、 EBV 否定的胃的癌的 H pylori 的确实是 46.15%(6/13 ) 并且 81.40%(104/172 ) 分别地。在 EBV 和 H pylori 感染之间没有重要关联。在表示上遇见 c 比在 EBVnGC 组在 EBVaGC 组是显著地更高的。然而，遇见 c 并且 c-myc 表示没显示出在二个组之间的有效差量。EBNA1 的抄本在所有 13 EBVaGCs 被检测，当 EBNA2 和 LMP1 mRNA 没被检测时。13 个盒子中的六个展出了 BARF1 抄本和 2 个展出 BHRF1 抄本。结论：在 EBVnGCs 的 H pylori 的确实比 EBVaGCs 的高，但是没有重要关联在 EBV 感染和 H pylori 感染之间被发现。H pylori 积极的胃的癌在窦地点是占优势的，当 EBVaGC 在贲门 / 身体地点有优势的一个趋势时。EBV 感染在 EBVaGC 与遇见 c 的反常表示然而并非与 c-myc 蛋白质被联系。在表示上遇见 c 没被 LMP1 导致。BARF1 和 BHRF1 可以通过不同小径在 EBVaGC 的肿瘤发生起重要作用。

Clinical and experimental study on angiopoietin-like protein 8 associated with proliferative diabetic retinopathy

AIM：To confirm the role of angiopoietin-like protein 8（Angptl 8） in proliferative diabetic retinopathy（PDR）.METHODS：The sera and aqueous humor of 10 PDR patients and 10 non-diabetic retinopathy（NDR） patients（idiopathic macular hole patients） were collected and the expression of Angptl 8 was detected by enzyme linked immune-sorbent assay（ELISA）.Experimental diabetes mice model was induced with streptozotocin.The expression of glycosylated hemoglobin and Angptl 8 in sera was detected.Recombinant Angptl 8 was re-infused into wild type（WT） diabetic mice and spatial frequency threshold and contrast sensitivity were measured.In vitro retinal pigment epithelium（RPE） were stimulated by recombinant Angptl 8 for 24 h.MMT assay were used to detect cell proliferation.At the same time,q RT-PCR and Western blot was used to measure the expression of proliferation-related factors in PRE cells.RESULTS：The expression of Angptl 8 was markedly increased in the sera and aqueous humor of PDR patients（F=99.02,P〈0.0001 in sera;t=10.42,P〈0.0001 in aqueous）.After successfully establishing the diabetic mice model,we found that glycosylated hemoglobin and Angptl 8 expression levels were increased.Re-infusion of recombinant Angptl 8 into WT diabetic mice could further decrease spatial frequency threshold and contrast sensitivity（P〈0.01）.In vitro,RPE cells stimulated by recombinant Angptl 8could increase the relative absorbance of MMT assay（1.486±0.042 vs 1.000±0.104,P〈0.05） and proliferating cell nuclear antigen（PCNA） expression（0.55±0.01 vs 0.29±0.03,P〈0.05）.The proliferative effect of Angptl 8 is mainly mediated by increasing the expression of proliferation-activating factors cyclin A1（4.973±0.205 vs 2.720±0.197,P〈0.05）,cyclin F（5.690±0.219 vs 4.297±0.292,P〈0.05） and E2 F2（2.297±0.102 vs 1.750±0.146,P〈0.05）,and reducing the expression of proliferation-inhibiting factors cdkn1（2.370±0.074 vs 3.317±0.135,P〈0.05） and cdkn2（4.793±0.065 vs 5.387±0.149,P〈0.05）.CONCLUSION：The expression of Angptl 8 is increased in PDR,and the increased Angptl 8 can promote proliferation and increase proliferation-related factors.

Safety and efficacy of a nerve matrix membrane as a collagen nerve wrapping: a randomized, single-blind, multicenter clinical trial

A new nerve matrix membrane derived from decellularized porcine nerves has been shown to retain the major extracellular matrix components, and to be effective in preventing adhesion between the nerve anastomosis sites and the surrounding tissues in a rat sciatic nerve transection model, thereby enhancing regeneration of the nerve. The effectiveness of the membrane may be attributed to its various bioactive components. In this prospective, randomized, single-blind, parallel-controlled multicenter clinical trial, we compared the safety and efficacy of the new nerve matrix membrane with a previously approved bovine tendon-derived type I collagen nerve wrapping. A total of 120 patients with peripheral nerve injury were recruited from Beijing Jishuitan Hospital, The First Bethune Hospital of Jilin University, and Yantai Yuhuangding Hospital, China. The patients were randomly assigned to undergo end-to-end and tension-free neurorrhaphy with nerve matrix membrane(n = 60, 52 male, 8 female, mean age 41.34 years, experimental group) or tendon-derived collagen nerve wrapping(n = 60, 42 male, 18 female, mean age 40.17 years, control group). Patients were followed-up at 14 ± 5, 30 ± 7, 90 ± 10 and 180 ± 20 days after the operation. Safety evaluation included analyses of local and systemic reactions, related laboratory tests, and adverse reactions. Efficacy evaluation included a static 2-point discrimination test, a moving 2-point discrimination test, and a Semmes–Weinstein monofilament examination. Sensory nerve function was evaluated with the British Medical Research Council Scale and Semmes–Weinstein monofilament examination. The ratio(percentage) of patients with excellent to good results in sensory nerve recovery 180 ± 20 days after the treatment was used as the primary effectiveness index. The percentages of patients with excellent to good results in the experimental and control groups were 98.00% and 94.44%, respectively, with no significant difference between the two groups. There were no significant differences in the results of routine blood tests, liver and renal function tests, coagulation function tests, or immunoglobulin tests at 14 and 180 days postoperatively between the two groups. These findings suggest that the novel nerve matrix membrane is similar in efficacy to the commercially-available bovine-derived collagen membrane in the repair of peripheral nerve injury, and it may therefore serve as an alternative in the clinical setting. The clinical trial was approved by the Institutional Ethics Committee of Beijing Jishuitan Hospital, China(approval No. 20160902) on October 8, 2016, the Institutional Ethics Committee of the First Bethune Hospital of Jilin University, China(approval No. 160518-088) on December 14, 2016, and the Institutional Ethics Committee of Yantai Yuhuangding Hospital, China(approval No. 2016-10-01) on December 9, 2016. The clinical trial was registered with the Chinese Clinical Trial Registry(registration number: Chi CTR2000033324) on May 28, 2020.

Adipose-derived stem cells enhance myogenic differentiation in the mdx mouse model of muscular dystrophy via paracrine signaling

Adipose-derived stem cells have been shown to promote peripheral nerve regeneration through the paracrine secretion of neurotrophic factors. However, it is unclear whether these cells can promote myogenic differentiation in muscular dystrophy. Adipose-derived stem cells （6 × 106） were injected into the gastrocnemius muscle of mdx mice at various sites. Dystrophin expression was found in the muscle fibers. Phosphorylation levels of Akt, mammalian target of rapamycin （mTOR）, eIF-4E binding protein 1 and $6 kinase 1 were increased, and the Akt/mTOR pathway was activated. Simultaneously, myogenin levels were increased, whereas cleaved caspase 3 and vimentin levels were decreased. Necrosis and fibrosis were reduced in the muscle fibers. These findings suggest that adipose-derived stem cells promote the re- generation and survival of muscle cells by inhibiting apoptosis and fibrosis, thereby alleviating muscle damage in muscular dystrophy.

Ultrasound Guidance and Nerve Stimulation Combined Versus Nerve Stimulation alone for Lumbar Plexus Block:A Randomized Controlled Trial

A nerve stimulation-guided lumbar plexus block is a well-established technique.It is not clear whether ultrasound guidance has additional value for this deep block technique.This study aimed to examine whether ultrasound guidance using a paramedian transverse scan through the intertransverse space(PMTS-ITS)approach in combination with nerve stimulation reduces the onset time of a complete sensory block.Forty-four patients who were scheduled to undergo arthroscopic knee surgery with an ultrasound visibility score(UVS)of≥10 for the lumbar plexus were enrolled and randomly allocated to the ultrasound guidance with nerve stimulation group(group U-N)or nerve stimulation group(group N)in this prospective,randomized,parallel-group,active-controlled study.The primary outcome was the onset time of a complete sensory block.The results showed that the onset time of a complete sensory block to pinprick and cold was 10(10–40)min and 10(10–40)min in group U-N,respectively,and 30(10–40)min and 20(10–40)min in group N(P=0.005,P=0.004),respectively.The performance time was 658±87 s in group U-N and 528±97 s in group N(P<0.001).There was no(0%)patient who required 5 or more needle passes in group U-N and 6(27.3%)in group N(P=0.028).The block failure rate was 9.1%in group U-N and 31.8%in group N(P>0.05).In conclusion,ultrasound guidance using the PMTS-ITS approach in combination with nerve stimulation led to a faster onset of a complete sensory block than nerve stimulation alone for a lumbar plexus block in patients with a UVS≥10.Ultrasound guidance with nerve stimulation significantly decreased the number of patients who required 5 or more needle passes.

Increased risk of psychiatric disorders in Chinese women with polycystic ovary syndrome

Objective:To assess the psychological health status and quality of everyday life of women with polycystic ovary syndrome(PCOS). Methods:A total of 846 patients were assessed with Self-Rating Anxiety Scales(SAS) and Self-Rating Depression Scales(SDS)(292 of PCOS patients,294 of non-PCOS infertile patients and 260 of healthy control).Specific questionnaires were employed to rate the quality of everyday life and adverse effects of different psychiatric factors. Results:The scores of SDS and SAS of PCOS patients were higher than those of non-PCOS infertile patients and healthy control.In addition,the negative psychiatric and psychological impact of PCOS was severe.The quality of everyday life in PCOS patients was undermined to certain extents. Conclusions:The features of polycystic ovary syndrome bring stress to patients,causing psychological disorder. The quality of everyday life in affected women is impaired partly.These results implicate that psychological support should be considered in the treatment of PCOS-associated infertility.

The expression of Hoxa10 and its regulation by sex steroids andHB-EGF at the time of implantation in the human endometrium

Objective:The aim of this study was to determine the expression of Hoxa 10 in endometrium during the menstrual cycle and their response to sex steroids and HB-EGF.Methods:Forty endometrial samples from regularly cycling women were studied.The endometrial epithelial(EEC)and stromal(ESC)cells isolated by collagenase Ⅰ digestion and mechanical dissociation was cultured from every sample.The endometrial stromal cells(ESC)were incubated with 17-beta estradiol(10-8mol/L),medroxyprogesterone acetate(MPA)(10-6mol/L),RU486(10-8mol/L)or HB-EGF(10ng/ml)for 48 hours respectively.The expression of Hoxa10 mRNA was demonstrated by reverse transcription-polymerase chain reaction(RT-PCR).Result:Hoxa10 showed a regulated cycle phase-dependent expression pattern in stromal cells and epithelial cells.Hoxa10 expression dramatically increased during the midsecretory phase of the menstrual cycle,at the time of implantation.The expression of Hoxa10 in cultured endometrial stromal cells was stimulated by estrogen,progesterone and HB-EGF.Conclusion:The cycle phase-specific expression of Hoxa10 and up-regulated by sex steroids and HB-EGF suggests a tight regulation and establishing conditions necessary for implantation.

Textbook Outcome as a measure of surgical quality assessment and prognosis in gastric neuroendocrine carcinoma:A large multicenter sample analysis

Objective:Quality assurance is crucial for oncological surgical treatment assessment.For rare diseases,singlequality indicators are not enough.We aim to develop a comprehensive and reproducible measurement,called the"Textbook Outcome"(TO),to assess the quality of surgical treatment and prognosis of gastric neuroendocrine carcinoma(G-NEC)patients.Methods:Data from patients with primary diagnosed G-NEC included in 24 high-volume Chinese hospitals from October 2005 to September 2018 were analyzed.TO included receiving a curative resection,≥15 lymph nodes examined,no severe postoperative complications,hospital stay≤21 d,and no hospital readmission≤30 d after discharge.Hospital variation in TO was analyzed using a case mix-adjusted funnel plot.Prognostic factors of survival and risk factors for non-Textbook Outcome(non-TO)were analyzed using Cox and logistic models,respectively.Results:TO was achieved in 56.6%of 860 G-NEC patients.TO patients had better overall survival(OS),disease-free survival(DFS),and recurrence-free survival(RFS)than non-TO patients(P<0.05).Moreover,TO patients accounted for 60.3%of patients without recurrence.Multivariate Cox analysis revealed non-TO as an independent risk factor for OS,DFS,and RFS of G-NEC patients(P<0.05).Increasing TO rates were associated with improved OS for G-NEC patients,but not hospital volume.Multivariate logistic regression revealed that nonlower tumors,open surgery,and>200 mL blood loss were independent risk factors for non-TO patients(P<0.05).Conclusions:TO is strongly associated with multicenter surgical quality and prognosis for G-NEC patients.Factors predicting non-TO are identified,which may help guide strategies to optimize G-NEC outcomes.

Application effect of safety hazard self-examination mode in nursing risk management in hepatobiliary surgery

Objective:To explore the application effect of safety hazard self-examination mode in nursing risk management in hepatobiliary surgery.Methods:Sixty patients underwent hepatobiliary surgery in two tertiary hospitals in Shandong Province from May 2021 to October 2021.According to the different implementation time,they were divided into 30 cases in the observation group and 30 cases in the control group.The control group adopts routine risk assessment,and the observation group adopts the self-examination mode of potential safety hazards on the basis of routine risk assessment to compare the incidence of nursing risk between the two groups.Results:The observation group had a significantly lower incidence of safety hazards in terms of missing surgical instruments,lack of aseptic operation,and postoperative pressure injuries than the control group(P<0.05).Conclusion:The appropriate hazard self-examination mode in the hepatobiliary operation room is of positive significance to improve the safety awareness of operating staff and the comprehensive ability of operating room nurses.

Multivariate Analysis of Prognosis in Patients with Pancreatic Cancer

Objective Pancreatic cancer is a highly malignant digestive system tumor. The prognosis of pancreatic cancer may be affected by many factors. But there is a lack of research on the multivariate analysis of prognostic factors of pancreatic cancer. This study aimed to explore the factors that multivariate influence the prognosis of pancreatic cancer. Methods We conducted a retrospective cohort study using electronic medical record database from The First Hospital of Jilin University from January 2014 to December 2016. Clinical information, such as TNM stage, serum tumor markers, serum albumin and the patient-generated subjective global assessment (PG-SGA), were collected. Kaplan- Meier method was used to calculate survival rate. The survival curve was compared with the Log-rank test. A multivariate analysis was performed for each prognostic factor using the Cox proportional hazards model. The significance level was 0.05. Results 1. The median overall survival time (OS) of 493 patients was 10 months. The 1-year, 2-year, and 3-year cumulative survival rates were 41.5%, 20.6%, and 9.9%, respectively. Univariate survival analysis revealed that TNM stage (P < 0.001), treatment regimen (P < 0.001), CA125 (P < 0.001), the level of serum albumin (P = 0.014), and nutritional status (P = 0.006) were significantly correlated with prognosis of pancreatic cancer. COX proportional hazards regression model showed that TNM stage (P = 0.038), Carbonhydrate antigen 125 (CA125)(P = 0.003) and the level of serum albumin were independent factors affecting the median OS. The prognosis of patients with Ⅳ stage, elevated levels of serum albumin group and elevated levels of CA125 group were poor. 2. Seventy-three patients with pancreatic cancer underwent surgical resection. The median postoperative survival time was 28 months. The 1-year, 2-year, and 3-year cumulative survival rates were 74.4%, 47.7%, and 21.4%, respectively. Univariate analysis revealed that TNM stage (P = 0.032), pathological type (P = 0.012), hypoglycemia (P = 0.040), CA125 (P < 0.001), were significantly correlated with prognosis of pancreatic cancer. COX proportional hazards regression model showed that TNM stage (P = 0.008), pathological type (P = 0.045) and CA125 (P = 0.017), were independent prognostic factors after resection of pancreatic cancer. The prognosis of patients with advanced stage, non-ductal adenocarcinoma and elevated levels of CA125 group was poor. Conclusions 1. TNM stage, CA125 and serum albumin are independent prognostic factors for the overall survival of patients with pancreatic cancer. 2. TNM stage, pathological type, and CA125 are independent prognostic factors for the postoperative survival time in patients with pancreatic cancer after resection.

Electroacupuncture upregulated platelet derived growth factor expression in spared dorsal root ganglion of cats

A bilateral spared dorsal root ganglion model was established in healthy adult cats by bilateral resection of L1-5 and L7-S2 dorsal root ganglia. L6 dorsal root ganglia were spared. Zusanfi （ST36） and Xuanzhong （BL39） or Futu （ST32） and Sanyinjiao （SP6） were alternatively electro-stimulated on the right leg. Immunohistochemical staining of anti-serum platelet-derived growth factor demonstrated that the number of total neurons and medium-small sized platelet-derived growth factor positive neurons was significantly decreased on the 7~ day following injury. After 7 days of acupuncture, the total number of positive and large neurons staining for platelet-derived growth factor on the acupuncture side significantly increased compared to the non-acupuncture side. After acupuncture for 14 days, the total positive and medium-small sized neurons significantly increased compared with the non-acupuncture side. Results indicate that acupuncture promoted the synthesis of platelet-dedved growth factor in spared dorsal root ganglia.

Nocardiosis with diffuse involvement of the pleura:A case report

BACKGROUND Nocardiosis is an uncommon infection that usually occurs in immunocompromised patients,and the pulmonary system is the most common site.We report an uncommon case of nocardiosis with diffuse involvement of the pleura,which presented as multiple localized nodular or hillock lesions on computed tomography(CT)with local chest wall infiltration.CASE SUMMARY A 54-year-old woman was referred to our hospital due to cough and fever for 20 d.She had a history of nephrotic syndrome for 7 mo and was given prednisone(60 mg/d)6 mo previously.The hormone was then gradually reduced to the current dose of 25 mg/d.Chest CT showed many nodular or hillock lesions in the right pleura,mediastinum,and interlobar fissure areas.On the lower layer,one lesion infiltrated the chest wall.She was treated with piperacillin sodium and sulbactam sodium,but the therapeutic effect was not good.In this regard,ultrasound-guided local infiltration anesthesia was further conducted for perihepatic hydrops drainage to improve diagnostic accuracy.Puncture fluid culture isolated Nocardia species,confirming the diagnosis of nocardiosis.Subtype Nocardia farcinica was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.Antibiotic treatment was switched to trimethoprim/sulfamethoxazole and imipenem.After 8 d of treatment,the patient was discharged from the hospital with improved condition,and she has been recurrence-free for 2 years.CONCLUSION This report illustrates that nocardiosis should be suspected when clinicians encounter patients who are immunocompromised and have diffuse involvement of the pleura.

Validation and evaluation of clinical prediction systems for first and repeated transarterial chemoembolization in unresectable hepatocellular carcinoma: A Chinese multicenter retrospective study

BACKGROUND The treatment outcome of transarterial chemoembolization(TACE)in unresectable hepatocellular carcinoma(HCC)varies greatly due to the clinical heterogeneity of the patients.Therefore,several prognostic systems have been proposed for risk stratification and candidate identification for first TACE and repeated TACE(re-TACE).AIM To investigate the correlations between prognostic systems and radiological response,compare the predictive abilities,and integrate them in sequence for outcome prediction.METHODS This nationwide multicenter retrospective cohort consisted of 1107 unresectable HCC patients in 15 Chinese tertiary hospitals from January 2010 to May 2016.The Hepatoma Arterial-embolization Prognostic(HAP)score system and its modified versions(mHAP,mHAP2 and mHAP3),as well as the six-and-twelve criteria were compared in terms of their correlations with radiological response and overall survival(OS)prediction for first TACE.The same analyses were conducted in 912 patients receiving re-TACE to evaluate the ART(assessment for re-treatment with TACE)and ABCR(alpha-fetoprotein,Barcelona Clinic Liver Cancer,Child-Pugh and Response)systems for post re-TACE survival(PRTS).RESULTS All the prognostic systems were correlated with radiological response achieved by first TACE,and the six-and-twelve criteria exhibited the highest correlation(Spearman R=0.39,P=0.026)and consistency(Kappa=0.14,P=0.019),with optimal performance by area under the receiver operating characteristic curve of 0.71[95%confidence interval(CI):0.68-0.74].With regard to the prediction of OS,the mHAP3 system identified patients with a favorable outcome with the highest concordance(C)-index of 0.60(95%CI:0.57-0.62)and the best area under the receiver operating characteristic curve at any time point during follow-up;whereas,PRTS was well-predicted by the ABCR system with a C-index of 0.61(95%CI:0.59-0.63),rather than ART.Finally,combining the mHAP3 and ABCR systems identified candidates suitable for TACE with an improved median PRTS of 36.6 mo,compared with non-candidates with a median PRTS of 20.0 mo(logrank test P<0.001).CONCLUSION Radiological response to TACE is closely associated with tumor burden,but superior prognostic prediction could be achieved with the combination of mHAP3 and ABCR in patients with unresectable liver-confined HCC.

The Experimental Study on Treating Transgenic HBV Mice with Recombined IL-2-PreS DNA Vaccine

The aim of this study is to investigate the feasibility and mechanism of hIL-2-preS DNA vaccine as prevention and therapeutic approach against Hepatitis B. Eukaryon expression vector involving hIL-2 and preS gene was constructed with recombinant technique and transferred into normal BALB/c mice and HBV transgenic mice (Tg-Mice) respectively. Then a series of detection were performed: detection of anti-preS2, HBs antibody and HBsAg in BALB/c mice and Tg-mice with ELISA, quantification of HBV DNA copies in HBV Tg-mice serum with real-time PCR, determination of hepatitis degree with immunopathological HE staining and detection of liver function. Anti-preS1 can be detected at 4 th , 6 th and 10 th week in inoculated BALB/c mice. Injection with gene gun gained an advantage over muscular and subcutaneous injection since it acquired just 1/10 inoculation quantity (10 μg/mouse). Highest expression of IgG2a at 4 th week suggested Th1-mediated immune response, which facilitated HBV cleaning. Of all inoculated HBV Tg-mice, 80% of them showed anti-preS2, HBs antibody positive and HBV DNA decreased, and 20% showed negative for HBsAg. HE staining to hepatic tissue showed obvious infiltration of inflammatory cells, swelling and granular degeneration of hepatocytes. In our study, IL-2-preS DNA vaccine which can provoke the humoral and cellular immune response and break the immune tolerance supports the designation and construction of new vaccine against HBV and specific immune remedy for HBV continuous infection.

凝固酶阴性葡萄球菌qacA／B基因检测分析

目的了解凝固酶阴性葡萄球菌（CNS）qacA／B耐消毒剂基因耐药基因存在状况，为临床提供CSN对消毒剂的潜在耐药信息。方法收集临床标本中分离出的CNS，并根据其对头孢西丁的敏感性分为耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）和甲氧西林敏感凝固酶阴性葡萄球菌（MSCNS）两组，采用聚合酶链反应（PCR）检测qacA／B基因，并对组间检出率进行比较。结果38株CNS中qacA／B基因阳性13株（占34．2％），其中MRCNS35．7％，MSCNS30．0％。结论CNS的qacA／B基因携带率较高，且MRCNS菌株与MSCNS菌株组间携带率无统计学意义。MSCNS携带qacA／B基因为国内首次报道。