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Objective:Clinical research is widely carried out in medical institutions, and there are differences in the use of research and conventional medical funds. This paper aimed to analyze the compliance issues of insurance fund in clinical research and explore the management strategies in the institutions conducting clinical trials or research.Methods:By consulting the literature, questionnaire, and work practice, this paper analyzed the current situation and existing problems of the compliance of the medical insurance fund in domestic clinical trials, proposed targeted management measures for the use of funds, and standardizes the corresponding workflow.Results:This paper summarized three payment methods of research-related funds and analyzed the main problems at present, including the definition of trial requirements, the payment of combined drugs specified in the protocol, the particularity of medical device trials, the payment of adverse events in clinical trial, the insurance of post-marketing research and clinical trial. According to the regulatory requirements and work practices, the corresponding management countermeasures were sorted out, including that the project funds and insurance audit should be carried out inside the medical institution. Clinical research, medical insurance management departments, ethics committees, and other departments should collaborate on establishing and improving a compliance management system. The research team should strengthen the management of adverse events, strengthen the publicity and education of the participants, and make good use of the sharing platform.Conclusions:The research institution should establish standardized and feasible processes, the research team should strengthen the management, and the use of the sharing platform is conducive to ensuring the compliance of the medical insurance fund and protecting the interests of the participants.
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Objective:To explore the effect of pre-hospital health education based on "Internet +" on self-management efficacy, anxiety and depression of patients undergoing pulmonary tumor surgery, and provide reference for pre-hospital nursing care of this group.Methods:It was a randomized controlled trial. A total of 100 outpatients in Department of Pulmonary Oncology, Tumor Hospital of Tianjin Medical University to be hospitalized for surgery during November 2021 to March 2022, were divided into experimental group ( n=50) and control group ( n=50) by random number method according to the order of outpatient visits. Patients in control group received routine thoracic surgery nursing and health education after admission. Those in experimental group received "Internet +" pre-hospital health education during patients waiting for hospital beds for surgery, nursing care after admission was the same as that of the control group. The scores of Strategies Used by People to Promote Health (SUPPH) and Hospital Anxiety and Depression Score (HADS) were compared between the two groups 1 day before discharge. Results:At the time of outpatient visit, there was no statistically significant difference between the two groups in the comparison of all dimensions and total scores of SUPPH and the score of HADS ( P>0.05). Total SUPPH score, and self-decompression, self-decision and positive attitude score of experimental group were (110.62 ± 17.73) points, (38.74 ± 6.56) points, (11.98 ± 2.20) points, (59.90 ± 10.18) points, respectively, while in the control group, the scores were (92.86 ± 18.91) points, (32.46 ± 7.39) points, (9.76 ± 2.00) points and (50.64 ± 11.50) points, respectively, with statistically significant differences ( t values were -5.29--4.27, all P<0.01). Besides, the anxiety and depression scores of HADS in experimental group were (3.92 ± 2.25) points and (3.36 ± 2.38) points, respectively, while those in control group were (7.12 ± 3.49) points and (7.00 ± 3.53) points, respectively, and the differences were statistically significant ( t=5.45, 6.04, both P<0.01). Conclusions:The "Internet +" pre-hospital health education model can promote the self-management efficacy of patients undergoing pulmonary tumor surgery, and improve their psychological state during treatment. The study provided reference for promoting diversified extended nursing services in clinical practice.
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@#Photodynamic therapy, a new type of non-invasive treatment, is based on the principle that the photosensitizer excited by laser can transfer energy to oxygen, which generates cytotoxic singlet oxygen and thus induce tumor cell apoptosis or necrosis. As an oxygen-dependent therapy, the antitumor effect of photodynamic therapy is obviously limited by hypoxia environment of solid tumor tissue. Therefore, reversing and improving the hypoxia of tumor tissue can significantly enhance the efficacy of photodynamic therapy. This review focuses on the progress of tumor oxygenation strategy mediated by nano-delivery system, including direct oxygen delivery strategies, catalytic oxygen production strategies, responsive material in situ oxygen supply strategies and microorganism oxygen supply strategies, aiming to improve the antitumor effect of photodynamic therapy. It provides new ideas and new approaches for further study of oxygen-enchancing nano-delivery system for photodynamic therapy.
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BACKGROUND@#Pain and cartilage destruction caused by osteoarthritis (OA) is a major challenge in clinical treatment.Traditional intra-articular injection of hyaluronic acid (HA) can relieve the disease, but limited by the difficulty of longterm maintenance of efficacy. @*METHODS@#In this study, an injectable and self-healing hydrogel was synthesized by in situ crosslinking of N-carboxyethyl chitosan (N-chitosan), adipic acid dihydrazide (ADH), and hyaluronic acid–aldehyde (HA-ALD). @*RESULTS@#This supramolecular hydrogel sustains good biocompatibility for chondrocytes. Intra-articular injection of this novel hydrogel can significantly alleviate the local inflammation microenvironment in knee joints, through inhibiting the inflammatory cytokines (such as TNF-a, IL-1b, IL-6 and IL-17) in the synovial fluid and cartilage at 2- and even 12-weeks post-injection. Histological and behavioral test indicated that hydrogel injection protected cartilage destruction and relieved pain in OA rats, in comparison to HA injection. @*CONCLUSION@#This kind of novel hydrogel, which is superior to the traditional HA injection, reveals a great potential for the treatment of OA.
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Objective:The standardized medical device clinical trials in China began in a short time, and the quality of trials needs to be improved.This article intends to explore possible ways for the improvement of quality management of the medical device clinical trials.Methods:Through working practice and literature review, analyze the current status of medical device clinical trials and in vitro diagnostic reagent in China; put forward targeted improved measures for the quality management system; as well as verify its feasibility through practice.Results:This article summarizes three factors that limit the improvement of the quality of medical device clinical trials, including the insufficient research and development strength of sponsors, the limited professional level of research teams, and the differences in verification and drugs, based on the risk-based quality management concepts, puts forward improved measures from three aspects, which including building risk-based quality certification system, making full use of electronic information systems to ensure the trial quality, and strengthening training of clinical trial capacity of researchers, and verifies the feasibility of these measures via the practical experience of our hospital since 2016.Conclusions:The application of risk-based quality management system, electronic information system and clinical trial capacity training can improve the management quality for medical device clinical trial centers.
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BACKGROUND@#Pain and cartilage destruction caused by osteoarthritis (OA) is a major challenge in clinical treatment.Traditional intra-articular injection of hyaluronic acid (HA) can relieve the disease, but limited by the difficulty of longterm maintenance of efficacy. @*METHODS@#In this study, an injectable and self-healing hydrogel was synthesized by in situ crosslinking of N-carboxyethyl chitosan (N-chitosan), adipic acid dihydrazide (ADH), and hyaluronic acid–aldehyde (HA-ALD). @*RESULTS@#This supramolecular hydrogel sustains good biocompatibility for chondrocytes. Intra-articular injection of this novel hydrogel can significantly alleviate the local inflammation microenvironment in knee joints, through inhibiting the inflammatory cytokines (such as TNF-a, IL-1b, IL-6 and IL-17) in the synovial fluid and cartilage at 2- and even 12-weeks post-injection. Histological and behavioral test indicated that hydrogel injection protected cartilage destruction and relieved pain in OA rats, in comparison to HA injection. @*CONCLUSION@#This kind of novel hydrogel, which is superior to the traditional HA injection, reveals a great potential for the treatment of OA.
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@#Liposome injection is one of the most successful special injections that use nanotechnology to enhance drug efficacy and reduce accompanied toxicity. New liposomes with special structures and functions have emerged since the first liposome injection containing doxorubicin was marketed. This review summarized the principles and research progress of Stealth liposome technology and cationic liposome technology, analyzed the structural and functional characteristics and clinical application advantages of liposome products that have been marketed from the perspective of pharmacology, introduced current research hotspots of new liposomes, and analyzed the current regulatory status of liposome injection at home and abroad, thereby providing theoretical reference for the research and development（R&D）, clinical translation and supervision of liposome injection.
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Objective:To investigate the association of preoperative neutrophil-lymphocyte ratio combined with platelet-to-lymphocyte ratio (NLR-PLR) score with clinicopathological parameters and prognosis in patients with colorectal cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 178 patients with colorectal cancer who were admitted to the First Affiliated Hospital of China Medical University from January 2013 to December 2014 were collected. There were 101 males and 77 females, aged from 21 to 90 years, with an average age of 63 years. All patients underwent radical resection of colorectal cancer. Observation indicators: (1) cutoffs of NLR and PLR and correlation between them; (2) association between preoperative NLR-PLR score and clinicopathological characteristics of patients with colorectal cancer; (3) follow-up and survival; (4) analysis of the risk factors for prognosis of patients with colorectal cancer. Follow-up was performed once every 3 months using outpatient examination or telephone interview including tumor markers, computed tomography and enteroscopy to detect postoperative survival of patients up to June 2017. Overall survival time was defined as the date of surgery to the date of the last valid follow-up or the date of death. Measurement data with skewed distribution were expressed as M (range). Count data were expressed as absolute numbers, and comparison between groups was performed using the chi-square test. Comparison of ordinal data was performed using the Mann-Whitney U test. Kaplan-Meier method was used to draw survival curve, and Log-rank test was used for survival analysis. The COX proportional hazard model was used for univariate and multivariate analyses. Results:(1) Cutoffs of NLR and PLR and correlation between them. Receiver working characteristics of NLR and PLR showed that the NLR had a cutoff of 2.7 [area under curve (AUC)=0.739, 95% confidence interval ( CI): 0.638-0.841, P<0.05] and PLR had a cutoff of 246 (AUC=0.640, 95% CI: 0.521-0.758, P<0.05). There was a correlation between NLR and PLR ( r=0.712, P<0.05). (2) Association between preoperative NLR-PLR score and clinicopathological characteristics of patients with colorectal cancer. Results of preoperative NLR-PLR score showed that the NLR-PLR score was 0, 1, and 2 in 99, 52, and 27 patients, respectively. There were significant differences in tumor diameter, degree of tumor invasion, TNM staging, Dukes staging, and distant metastasis between patients with different preoperative NLR-PLR scores ( χ2=11.294, 10.816, 9.802, 9.525, 8.759, P<0.05). (3) Follow-up and survival: 178 patients were followed up for 1-53 months, with a median follow-up time of 37 months. The average survival time was 37 months for all the 178 patients, 50 months for 99 patients with NLR-PLR score of 0, 44 months for 52 patients with NLR-PLR score of 1, and 35 months for 27 patients with NLR-PLR score of 2. There was a significant difference in survival time between patients with NLR-PLR score of 0 and patients with NLR-PLR score of 1 ( χ2=6.388, P<0.05), between patients with NLR-PLR score of 0 and patients with NLR-PLR score of 2 ( χ2=26.388, P<0.05), between patients with NLR-PLR score of 1 and patients with NLR-PLR score of 2 ( χ2=5.350, P<0.05). (4) Analysis of the risk factors for prognosis of patients with colorectal cancer. Results of univariate analysis showed that degree of tumor invasion, TNM staging, Dukes staging, distant metastasis, NLR-PLR score, and platelet-NLR score were related factors for prognosis of patients with colorectal cancer [ hazard ratio ( HR)=2.439, 2.472, 2.221, 9.020, 2.671, 2.099, 95% CI: 1.443-4.124, 1.413-4.323, 1.282-3.849, 4.449-18.082, 1.742-4.097, 1.339-3.290, P<0.05]. Results of multivariate analysis showed that degree of tumor invasion, distant metastasis, and NLR-PLR score were independent factors for prognosis of patients with colorectal cancer ( HR=2.045, 5.641, 2.271, 95% CI: 1.051-3.979, 2.590-12.288, 1.185-4.354, P<0.05). Conclusions:The preoperative NLR-PLR score is associated with tumor diameter, degree of tumor invasion, TNM staging, Dukes staging, and distant metastasis in patients with colorectal cancer. Patients with higher score have larger tumor diameter, higher degree of tumor invasion, higher stage, and easier distant metastasis. Preoperative NLR-PLR score can effectively evaluate the prognosis of patients with colorectal cancer. Patients with higher NLR-PLR score have shorter survival time. The NLR-PLR score is an independent influencing factor for prognosis of patients with colorectal cancer.
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Objective@#To study the expression of ISYNA1 and association of ISYNA1 with clinicopathological significance in pancreatic ductal adenocarcinoma (PDAC).@*Methods@#Collecting clinical data and specimens of 68 PDAC patients at Department of General Surgery, the First Hospital of China Medical University from March 2008 to December 2017.There were 39 males and 29 females, aged 33 to 81 years(median 59 years).The expression of ISYNA1 in 68 paraffin embedded PDAC specimens was detected by immunohistochemistry,in which 34 had paired non-cancerous pancreatic tissues,the relationship between ISYNA1 expression and clinicopathological parameters was analyzed; and the correlation between ISYNA1 and p53 in 48 PDAC specimens were estimated.qRT-PCR and Western blot were used to examine the expression of ISYNA1 mRNA and protein level in 17 paired fresh PDAC specimens and adjacent non-cancerous pancreatic tissues,respectively.siRNA interference was used to knockdown the expression of p53 in Capan-2,SW1990 and Miapaca-2 cells,and association of p53 with ISYNA1 expression was explored. Statistical methods included Student′s test,χ2 test, Kaplan-Meier curve, Log-rank test and Pearson analysis, respectively.@*Results@#Immunohistochemistry results showed that the expression of ISYNA1 in PDAC(3.681±2.198)was significantly lower than that in normal pancreatic tissues(6.012±3.428)(t=-3.611,P=0.001).In 17 paired fresh PDAC specimens,ISYNA1 mRNA expression in non-cancerous pancreatic tissues(ΔCT: 3.721±2.234)was obviously higher than that in PDAC tissues (ΔCT: 5.889±1.607) (t=-4.636,P<0.01), and ISYNA1 protein level in non-cancerous pancreatic tissues(0.815±0.418)was similarly higher than that in PDAC tissues(0.517±0.240)(t=2.948,P=0.009).χ2 test showed the expression of ISYNA1 was negatively associated with tumor invasion depth(χ2=7.534,P=0.030)and vascular invasion(χ2=5.048,P=0.043);Pearson analysis showed there was no relationship between ISYNA1 and mutant p53(χ2=1.377,P=0.359).In p53 wild-type Capan-2 and SW1990 cells,Knockdown of p53 significantly down regulated ISYNA1 expression, whereas had no effect on ISYNA1 expression in p53 mutant Miapaca-2 cells. Kaplan-Meier survival analysis and Log-Rank test indicated patients with negative ISYNA1 expression had a shorter median survival time and poorer prognosis(χ2=4.953, P=0.026).@*Conclusions@#The expression of ISYNA1 in PDAC tissues is significantly decreased,which is associated with the prognosis of PDAC patients,it is only related to wild type p53,and has no relationship with mutant p53.Abnormal expression of ISYNA1 may play an important role in the progression of PDAC.
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Objective@#To analyze the status of domestic surgical treatment of synchronous peritoneal carcinomatosis from colorectal cancer in China.@*Methods@#Clinicopathological data of patients who underwent surgery from October 2003 to October 2018 in 16 domestic medical centers was retrospectively analyzed. Excel database was created which covered 77 fields of 7 parts: baseline information of patients, laboratory tests, imaging tests, chemoradiotherapy information, intra-operative findings, postoperative pathology and follow-up data. The Wilcoxon rank-sum test was used for comparison of the measurement data between groups. The χ2 test was used for comparison of the categorical data between groups. The survival curve was calculated by the Kaplan-Meier method.@*Results@#Of the 1 003 patients, there were 575 male and 428 female patients with the age of (58.5±14.1) years (range: 18 to 92 years). In a total of 920 patients, the carcinoma of sigmoid colon was performed in 292 cases (31.8%) with the highest ratio. The proportion of patients with liver metastasis and lung metastasis were 27.9% (219/784) and 8.3% (64/769). Preoperative detection of carcino-embryonic antigen level was the most common method in China (87.74%, 880/1 003), and the positive rate was 64.5% (568/880). The correct rate of preoperative imaging tests was 40.7% (280/688). The ratio of peritoneal carcinomatosis index (PCI) scores between 0 and 10 was the highest (59.6%, 170/285). Two hundred and sixty-two (27.0%) patients were performed by totally laparoscopic operation in 971 patients. The resection of primary tumor was performed in 588 of the 817 patients (72.0%). In a total of 457 cases, 253 (55.4%) patients were performed cytoreduction which group scored completeness of cytoreduction (CCR) 0. The postoperative hyperthermic intraperitoneal chemotherapy was implemented in 70 of the 334 cases (21.0%). Among 1 003 cases, 562 cases (56.03%) had complete follow-up data and the median overall survival was 15 months. The primary tumor resection and the CCR scores were affected by the PCI scores. The patients underwent primary tumor resection (187/205 vs. 26/80, χ2=105.085, P=0.000) and the patients were performed cytoreduction which scored CCR 0 or CCR 1 (162/204 vs. 8/78, Z=-10.465, P=0.000) had significant difference between the groups of PCI<20 and ≥20. There was a close correlation between the surgical method and the CCR scores (Z=-3.246,P=0.001).When the maximum degree of tumor reduction was planned, most surgeons would choose laparotomy. The overall survival time was longer in patients with primary tumor resection (P=0.000). The median survival time was 18.6 months in the group of primary tumor resection.@*Conclusions@#It is difficult to diagnose the synchronous peritoneal carcinomatosis from colorectal cancer before the operation. Primary tumor resection has an obvious effect to prolong the survival time. It is necessary to standardize the treatment of peritoneal metastasis.
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Objective To evaluate the relationship between perioperative peripheral blood Type 17 helper (Th17) cells and Th17-related cytokines and postoperative cognitive dysfunction (POCD) in elderly patients undergoing general anesthesia.Methods Ninety-six patients of both sexes,aged 65-86 yr,of American Society of Anesthesiologists physical status Ⅱ or m,scheduled for elective hip replacement under general anesthesia,were selected.At 3 days before operation and 1,2,3 and 7 days after operation,Montreal Cognitive Assessment (MoCA) was used to evaluate the cognitive function,and fasting venous blood samples were taken for determination of the percentage of Th17 cells and serum interleukin-17 (IL-17) and IL-22 concentrations.The patients were divided into POCD group and non-POCD group according to whether the patients developed POCD at day 7 after operation or not.Pearson linear correlation of the percentage of Th17 cells and serum IL-17 and IL-22 concentrations with MoCA scores was analyzed.Results Twenty-six patients developed POCD (27.1％).The percentage of peripheral blood Th17 cells and serum IL-17 and IL-22 concentrations were significantly higher at each time point after operation than before operation in POCD group and at 1 and 2 days after operation than before operation in non-POCD group (P＜0.05).The percentage of peripheral blood Th17 cells and serum IL-17 and IL-22 concentrations were significantly higher at each time point after operation in POCD group than in non-POCD group (P＜0.05).The percentage of peripheral blood Thl7 cells was negatively correlated with MoCA scores (r =-0.867,P＜0.01) and serum IL-17 and IL-22 concentrations were negatively correlated with MoCA scores (r=-0.662 and-0.638,P＜0.01) in group POCD.Conclusion The development of POCD is related to the increase in the percentage of peripheral blood Th17 cells and concentrations of Th17-related cytokines IL-17 and IL-22 in elderly patients undergoing general anesthesia.
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Objective To investigate the effects of sequential pulmonary resuscitation maneuver (RM) with pulmonary protective ventilation on hemodynamics and arterial blood gas in patients with acute respiratory distress syndrome (ARDS) caused by severe chest trauma. Methods Ninety-six ARDS patients caused by severe chest trauma admitted to Dongguan People's Hospital from January 2017 to December 2018 were enrolled, and they were divided into a RM group and a mechanical ventilation group according to different ventilation modes, 48 cases being in each group. The mechanical ventilation group was given low tidal volume ventilation combined with the best positive end-expiratory pressure (PEEP); while the RM group was given sequential lung RM therapy on the basis of treatment in the mechanical ventilation group. The heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), cardiac output (CO), cardiac output index (CI), systemic circulation resistance index (SVRI) arterial blood gas were monitored before and after treatment in the two groups, and oxygenation index(PaO2/FiO2) was calculated; The mechanical ventilation time, intensive care unit (ICU) hospitalization time, incidence of ventilator associated pneumonia (VAP), mortality and incidence of adverse reaction were observed between the two groups. Results After treatment, the pH value and arterial partial pressure of carbon dioxide (PaCO2) of the two groups had no significant change; with the prolongation of treatment, the arterial partial pressure of oxygen (PaO2) and arterial blood oxygen saturation (SaO2);PaO2/FiO2 were increased significantly, total carbon dioxide (TCO2) was decreased significantly, after 72 hours of treatment, the degree of change in the RM group were more remarkable greater than those in the mechanical ventilation group [PaO2 (mmHg, 1 mmHg = 0.133 kPa): 91.02±9.03 vs. 80.34±7.66, SaO2: 0.96±0.04 vs. 0.94±0.04, TCO2 (mmol/L): 24.72±2.83 vs. 23.54±2.76, PaO2/FiO2 (mmHg): 238.47±19.83 vs. 185.34±17.37, all P < 0.05]. The ICU hospitalization time and mechanical ventilation time in the RM group were significantly lower than those in the mechanical ventilation group [ICU hospitalization time (days): 22.03±3.39 vs. 26.75±4.04,mechanical ventilation time (days): 13.38±4.04 vs. 19.33±5.02], and the incidence of VAP and mortality in the RM group were significantly lower than those in the mechanical ventilation group[incidence of VAP: 25.00% (12/48) vs. 8.33% (4/48), mortality: 18.75% (9/48) vs. 22.92% (11/48), both P < 0.05]. With the extension of time, CVP, MAP, CO, CI and SVRI in RM group all showed a trend of first decreasing and then increasing, while HR showed a trend of increasing and then decreasing, and the above indicators in 5 minutes after pulmonary re-opening, gradually returned to normal, showing no statistical significances compared with those before treatment [HR (bpm): 97.88±6.22 vs. 98.20±8.37, CVP (mmHg): 6.33±1.35 vs. 6.32±1.36, MAP (mmHg): 94.56±5.96 vs. 95.03±9.82, CO (L/min): 6.34±1.42 vs. 6.40±1.23, CI (L·min-1·s-1):2.08±0.32 vs. 2.17±0.53, SVRI: 2 404.34±31.34 vs. 2 474.34±29.73, all P > 0.05]. No adverse reactions occurred in the two groups. Conclusion Pulmonary protective ventilation sequential lung recruitment maneuver can significantly improve the oxygenation of ARDS caused by severe chest trauma, shorten the durations of mechanical ventilation and hospitalization in ICU, reduce the incidence of VAP, improve pulmonary inflammation, and in the mean time it has no serious adverse effects on hemodynamics.
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Objective To explore the clinical value of laparoscopic totally extraperitoneal herniorrhaphy (LTEP) and open to tally extraperitoneal (OTEP) for bilateral inguinal hernias.Methods From January 2015 to December 2017,61 male patients with bilateral inguinal hernias,who were in accordance with the inclusion criteria,were prospectively randomized into laparoscopic totally extraperitoneal herniorrhaphy group (LTEP group,n =31)or totally extraperitoneal herniorrhaphy via hypogastric midline incision group(OTEP group,n =30).Operative outcomes,postoperative complications,recurrence,the levels of C-reactive protein (CRP) were analyzed.The data were analyzed by statistical software.Results The operative baselines of patients in two groups were equivalent.In patients who received laparoscopic totally extraperitoneal herniorrhaphy,decreased levels of CRP on the 1th day after operation,postoperative ambulation and hospital stay [(88.7 ± 18.5) mg/L vs (102.0 ±25.1) mg/L,P=0.022];[(5.6±2.2) h vs (20.0±5.5) h,P＜0.001;(3.0±0.6) dvs (4.5±1.0) d,P ＜ 0.001],were found compared with the OTEP group significantly,LTEP group had more hospitalization expense than OTEP group [(14 779.3 ± 1450.1) yuan vs (13 650.0 ± 1 787.3) yuan,P ＜ 0.001].There were no mesh infection,chronic pain,scrotal edema and recurrence of inguinal hernia in two groups.No difference was found between the two groups in the other operative outcomes and postoperative complications.Conclusion Both laparoscopic totally extraperitoneal herniorrhaphy and totally extraperitoneal herniorrhaphy via hypogastric midline incision are effective and safe in the treatment of bilateral inguinal hernias,each has both advantages and disadvantages,and complement each other.
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Introduction@#Many effective anticancer drugs are limited to use for hepatocellular carcinoma (HCC) therapy due to drug resistance mechanisms in liver cells. In recent years, tumor-targeted drug delivery and inhibition of drug resistance-related mechanisms become an integrated strategy to combat effectively chemoresistant cancer. @*Aim@#Herein, lactobionic acid-conjugated D-α-Tocopheryl polyethylene glycol 1000 succinate (TPGS-LA conjugate) was developed as a potential asialoglycoprotein receptor (ASG PR (-targeted nanocarrier and an efficient inhibitor of P-glycoprotein (P-gp) to enhance etoposide (ETO) efficacy against HCC. @*Methods@#Main properties of ETO-loaded TPGS-LA nanoparticles (NPs) were tested through in vitro and in vivo studies after prepared using nanoprecipitation method and characterized by dynamic light scattering (DLS). @*Results@#According to the results, smaller sized (~141.43 nm) and positively charged ETO-loaded TPGS-LA NPs were more suitable to provide an efficient delivery to hepatoma cells by avoiding clearance mechanisms. It was found that ETO-loaded TPGS-LA NPs could enhance noticeably cytotoxicity of ETO in HepG2 cells. Besides, markedly higher internalization by ASGPR overexpressed HepG2 cells and efficient accumulation at tumor site in vivo were revealed in TPGS-LA NPs group. More importantly, animal studies confirmed that ETO-loaded TPGS-LA NPs achieved the highest therapeutic efficacy against HCC. Interestingly, ETO-loaded TPGS-LA NPs also exhibited a great inhibitory effect on P-gp compared to ETO-loaded TPGS NPs. @*Conclusion@#These results suggest that TPGSLA NPs could be used as a potential delivery system of ETO against HCC.
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Objective@#To investigate bone remodeling in patients with different types of juvenile condylar resorption after stabilization splint treatment using cone-beam CT (CBCT).@*Methods@#Fifty-nine juvenile condylar resorption patients (114 sides of condyle) treated with stabilization splint from January 2012 to May 2018 in Department of Temporomandibular Joint, Stomatological Hospital of Chongqing Medical University were selected as splint group, while twenty-four patients (48 sides of condyle) who underwent natural remodeling without stabilization splint treatment after 6-12 months were severed as control group. Pre-and post-treatment CBCT was taken for all patients. There were three types of condyles (including type Ⅰ, type Ⅱ and type Ⅲ) before treatment and four types of condyles (including progression, no changes, stable without new bone and remodeled with new bone) after treatment. Progression and no change were considered as poor curative effect, and stable without new bone and remodeled with new bone were considered to be effective. The vertical distance of the condylar height was measured and compared before and after treatment in the two groups.@*Results@#Significant difference in treatment outcome was found in types Ⅰ and Ⅱ between the splint group and the control group (Z=-2.874, P=0.004; Z=-3.874, P=0.000), and no significant difference was found in type Ⅲ between the two groups (Z=-0.617, P=0.537). The difference of condylar progression percentage [splint group: 43% (15/35), control group: 80% (16/20)] was statistically significant between the two groups in type Ⅱ (χ2=7.139, P=0.011), and no significant difference was found in types Ⅰ and Ⅲ between the two groups (χ2=0.103, P=0.748; χ2=1.249, P=0.540). In two groups, the condylar height difference before and after treatment in type Ⅱ condylar resorption was statistically significant (P<0.05).@*Conclusions@#Stabilization splint treatment was effective in patients with different types of juvenile condylar resorption, especially in type Ⅰ. However, it was difficult to reverse the height reduction of the condylar bone regardless of treatment.
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Tumor-associated fibroblasts(TAFs),the most important stromal cells of the tumor microenvironment (TME),have been found to support tumorigenesis and tumor metastasis in a variety of ways,including paracrine, direct contact with cells,immune regulation and extracellular matrix remolding.Therefore,TAFs in the TME have been an optimal target for cancer therapy.In this review,the TAFs targeted therapies are summarized to provide the new strategy for tumor treatments based on the analysis of the location and specific biological phenotypes of TAFs in tumors.
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Objective: To determine the positional relationship between impacted mandibular third molar(IMTM) and mandibular canal(MC) by CBCT. Methods: 664 IMTMs with root apexes contacted to MCs on panoramic radiograph were further examined by CBCT,the exact positional relationship between IMTMs and MCs was observed and analyzed by I-Dixel software. Results: The 664 cases were divided into lowly(6. 3％),intermediately(60. 7％) and highly(33. 0％) impacted groups by the depth of IMTMs in mandibulae showed on CBCT images. The distance(mm) from the root apexes of IMTMs to the intact superior wall of MCs(n = 329) in lowly, intermediately and highly impacted cases were 1. 39 ± 1. 38,1. 28 ± 1. 03 and 1. 79 ± 1. 54 respectively(P ＜ 0. 05). MCs on the buccal side,lingual side,under the IMTMs and between the root apexes were found in 49. 8％,12. 0％,36. 6％ and 1. 5％ of the cases; the MC wall deffect was found in 65. 8％,27. 5％ and 95. 0％ of the cases with the MCs under,on buccal and lingual side of the IMTMs, respectively(P ＜ 0. 001). Conclusion: CBCT examination is necessary for the determination of the positional relationship between MC canal and IMTM with the root apex cotacted or overlapped to MC.
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Transcatbeter aortic valve replacement(TAVR) has been operated successfully since 2002 in France and lasted for 16 years now.In this period,the operation number is explosive and the indication of operation is expansived progressively.But this progress is slow in China,even in Asia,since the expensive fee,special character of aortic anatomy of Asian and the concern of its' complication.Now we summarize this situations of TAVR in recently year and want to give a new ideal to our reader.
ABSTRACT
Objective To evaluate the effect of thoracic paravertebral block combined with general anesthesia on postoperative cognitive dysfunction (POCD) in elderly patients undergoing pulmonary lobecto-my. Methods A total of 120 elderly patients of both sexes, aged 65-81 yr, of American Society of Anes-thesiologists physical status Ⅱ or Ⅲ, with New York Heart Association Ⅰor Ⅱ, were divided into 3 groups (n＝40 each) using a random number table method: anesthesia group (group GA), epidural block combined with general anesthesia group (group EG), and paravertebral block combined with general anes-thesia group (group PG). In group PG, paravertebral block was performed under ultrasound guidance, 0. 25% ropivacaine 20 ml was injected after the paravertebral catheter was placed, and anesthesia was in-duced after confirming the plane of block. In group EG, epidural block was performed with 2% lidocaine 3 ml after epidural puncture was successfully performed at L6,7interspace, epidural 0. 375% ropivacaine 8-15 ml was intermittently injected, and anesthesia was induced after confirming the height of block. Anes- thesia was induced with IV midazolam 0. 05-0. 10 mg∕kg, etomidate 0. 3 mg∕kg, sufentanil 0. 4 μg∕kg and rocuronium 0. 6 mg∕kg. The patients were tracheally intubated and mechanically ventilated. The develop-ment of POCD was recorded at 1 day before operation and 7 days after operation. Blood samples were col-lected from the internal jugular vein before anesthesia, at 15 min after skin incision and at 7 days after oper-ation for determination of serum adiponectin ( ADP) and S-100β protein concentrations. Results Com-pared with group GA, the incidence of POCD was significantly decreased, and the serum S-100β protein concentrations were decreased and serum ADP concentrations were increased at 15 min after skin incision and 7 days after operation in PG and EG groups ( P＜0. 05). Compared with group EG, the incidence of POCD was significantly decreased, and the serum S-100β protein concentrations were increased and serum ADP concentrations were decreased at 15 min after skin incision and 7 days after operation in group PG (P＜0. 05). Conclusion Thoracic paravertebral block combined with general anesthesia induces better efficacy in decreasing the occurrence of POCD than general anesthesia alone or combination of epidural block and general anesthesia in elderly patients undergoing pulmonary lobectomy, which is related to the decreased concentrations of blood ADP in elderly patients undergoing pulmonary lobectomy.