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The majority of diagnosed cases of gastric cancer are in the middle and late stages, while less than 10% of patients are diagnosed in the early stages in China. The standard treatment strategy for patients with progressive gastric cancer is surgery combined with postoperative adjuvant therapy or preoperative neoadjuvant followed by surgery combined with postoperative adjuvant therapy. Immunotherapy is now recognized as an innovative approach for cancers. It is worth exploring how to best use immunotherapy in neoadjuvant therapy to achieve better clinical benefit. Therefore, this paper reviews the progress of immunotherapy in neoadjuvant therapy for GC. Further studies and the understanding of immune system function by neoadjuvant therapy combined with immunotherapy will help to improve the treatment of gastric cancer.
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Objective:To analyze hepatic hemodynamic parameters detected by Doppler ultrasound (DU) of uncomplicated children who underwent left lateral segment(LLS) LDLT (LLS-LDLT), explore their change trends over time and determine the normal reference intervals.Methods:This retrospective study involved the data from 261 pediatric LLS-LDLT cases in Tianjin First Central Hospital from June 2014 to January 2018. Hemodynamic parameters included peak systolic velocity (PSV), end diastolic velocity (EDV), resistivity index (RI), and pulsation index (PI) of hepatic artery (HA), and portal vein velocity (PVV) during intra-operative and on the 1st, 3rd, 5th and 7th days after operation were collected. Among whom, 232 cases with uncomplicated and normal recovery were finally involved in our study, with 200 cases who were collected from June 2014 to August 2017 as test group. Those collected from September 2017 to January 2018, totally 32 cases were set as validation group. The change trends and normal ranges of hemodynamic parameters over time were analyzed in test group, and the results were further tested in the validation group.Results:In the test group, PSV HA, EDV HA showed a similar change trend at one week after surgery, with an overall decrease-rise trend; RI HA, PI HA also changed similarly with an overall rise-decrease trend. PVV at surgery was lower than at all time points after surgery. In addition, this study provided the normal reference intervals of hemodynamic parameters for LDLT patients at early postoperative period, which at intra-operation they were PSV HA 18.4-98.3 cm/s, EDV HA 0-43.3 cm/s, RI HA 0.41-1.0, PI HA 0.51-2.0, PVV 19.0-83.7 cm/s. Within 1 week after surgery: PSV HA 21.0-97.7 cm/s, EDV HA 0-32.7 cm/s, RI HA 0.47-1.0, PI HA 0.62-2.0, PVV 23.0-92.0 cm/s. By using those results, the coincidence rate of Doppler parameter change trend was 84.3%(27/32), 84.3%(27/32), 78.1%(25/32), 78.1%(25/32), 87.5%(28/32) for PSV HA, EDV HA, RI HA, PI HA, PVV in the validation group, respectively. As for the normal reference intervals of blood flow parameters, RI HA and PI HA in one case in the validation group were lower than the lower limits of the normal reference intervals, accounting for 3.1% of the total. PSV HA in two cases was lower than the lower limit of normal reference interval, accounting for 6.2% of the total. Conclusions:The hepatic hemodynamic in post-transplanted children detected by DU has specific changing trends and normal ranges, which provides valuable reference values for ultrasonologists and pediatric transplant clinicians.
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Objective To investigate the relationship between aberrant expression of interleukin 6 (IL-6) and gene methylation in patients with ulcerative colitis (UC),and to clarify the mechanism of epigenetics in UC.Methods From March 2017 to March 2018,a total of 59 UC patients admitted to the Department of Gastroenterology,General Hospital Affiliated to Tianjin Medical University were enrolled,and at the same time 58 normal individuals who received health checkups were selected as healthy controls.Blood samples and colonic mucosa specimens of UC group and healthy control group were collected.DNA methyltransferase (DNMT) activity,methylation level of CpG locus in IL-6 promoter region and expression level of IL-6 were detected.Chi-square test and student's t test were performed for statistical analysis.Results The methylation level and IL-6 expression level examination were completed in 24 and 30 cases of UC group,respectively;which were detected in 21 and 20 cases of healthy control group,respectively.The activity of DNMT of UC group was significantly lower than that of healthy control group ((16.48 ± 6.17) OD · h-1 · mg-1 vs.(62.48 ± 33.88) OD · h-1 ·mg-1),and the difference was statistically significant (t =3.707,P ＜ 0.05).The ratios of methylation,partial methylation and non-methylation of UC group were 31.2％ (15/48),50.0％ (24/48) and 18.8％ (9/48),respectively,and those of healthy control group were 58.3％ (35/60),21.7％ (13/60) and 20.0％ (12/60),and the difference between the two groups was statistically significant (x2 =10.495,P ＜ 0.05).The positive expression rate of IL-6 in intestinal mucosa of UC group was higher than that of healthy control group (100.0％,21/21 vs.25.0％,5/20),and the difference was statistically significant (x2 =24.837,P ＜0.05).The serum IL-6 level of UC group was higher than that of healthy control group ((1 075.02 ±661.95) ng/L vs.(583.43 ± 425.10) ng/L),and the difference was statistically significant (t =3.245,P ＜ 0.05).Conclusion The decrease of DNMT activity in the intestinal mucosa of UC patients may reduce the methylation level of IL-6 gene promoter region,which is correlated with the increased level of IL-6 expression in the intestinal mucosa and serum,and involve in the inflammatory process of UC.
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Objective To investigate the application value of the tissue diffusion quantitative analysis technique of real-time elastic( RTE) imaging in evaluation of liver damage caused by brain death . Methods Fifty cases of brain dead donor liver were examined by ultrasound elastography ,at the same time , 11 parameters were obtained by the tissue dispersion quantitative analysis software ,included MEAN ( mean relative strain value within the ROI) ,SD( standard deviation of the relative strain value within the ROI) ,％AREA (area of low strain within the ROI) ,COMP(complexity of low strain area within the ROI) ,KURT (kurtosis) ,SKEW(skewness) ,CONT (contrast) ,ENT(entropy) ,IDM(inverse difference moment) ,ASM (angular second moment) ,CORR(correlation) ,and the pathologic specimens in the process of operating were obtained . According to pathological findings ,50 patients were divided into damaged group and non-damaged group ,and the results were compared and analyzed . The correlation analysis of electronic speculum results and RTE were carried out . According to the ROC curve ,the RTE parameters'cut-off value and AUC were obtained .Results Among 11 parameters of tissue diffusion analysis ,MEAN and IDM in damaged group were higher than those in non-damaged group( all P < 0 .05) ;and SKEW and ENT were lower in damaged group than those in non-damaged group ( all P <0 .05) ;there was no significant difference in the other parameters between the two groups(all P >0 .05) . The MEAN ,SKEW ,COMP ,ENT and IDM had correlativity with electronic speculum( r = -0 .633 , P =0 .000 ;r =0 .388 , P =0 .005 ;r =0 .315 , P =0 .026 ;r = 0 .324 , P = 0 .022; r = -0 .314 , P = 0 .026 ,respectively ) . The diagnostic efficiency and sensitivity of MEAN were the highest , the critical value of MEAN was 125 .84 , AUC was 0 .907 . Conclusions The tissue dispersion quantitative analysis technique is a noninvasive method to preliminary evaluation of liver damage caused by brain death . M EAN had the highest effectiveness in eleven parameters .
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Objective@#To investigate the clinical pathological features of Barrett′s esophagus in China, and to study the relationship between the number of goblet cells and the severity of Barrett′s esophageal dysplasia.@*Methods@#From January 2008 to October 2018, in the Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, the clinical and pathological data of 453 patients who underwent gastroscopy and pathologically diagnosed with Barrett′s esophagus were retrospectively analyzed. The clinical pathological features were compared between patients with goblet cells and patients without goblet cells. Periodic acid Schiff reaction (PAS) staining was performed on pathological slides of Barrett′s esophagus with goblet cells, and the relationship between the number of goblet cells, the number of positive crypts of goblet cells and the severity of Barrett′s esophageal dysplasia was analyzed. T test and chi-square test were performed for statistical analysis.@*Results@#Among 453 patients with Barrett′s esophagus, 251 (55.4%) were males and 202 (44.6%) were females. There were 218 Barrett′s esophagus with goblet cells, including 128 males (58.7%) and 90 females (41.3%). The average onset age was (60.6±11.9) years old, and the peak onset age was between 60 and 69 years old. The appearance under endoscopy mainly was circumferential type (58.2%, 127/218). There were 235 Barrett′s esophagus without goblet cells, 123 males (52.3%) and 112 females (47.7%). The average onset age was (56.1±14.4) years old, and the peak onset age was between 50 and 59 years old. The appearance under endoscopy was mainly circumferential type (40.0%, 94/235). The incidence of dysplasia in Barrett′s esophagus with goblet cells was higher than that without goblet cells (75.7%, 165/218 vs. 37.0%, 87/235), and the difference was statistically significant (χ2=68.501, P<0.01). PAS staining showed that goblet cells were stained purplish red. The number of goblet cells, total number of crypts, the number of positive crypts of goblet cells and the proportion of positive crypts of goblet cells of Barrett′s esophagus with mild dysplasia were all significantly higher than those of Barrett′s esophagus with moderate dysplasia (95.50±40.56 vs. 40.00±13.34, 21.00±8.31 vs. 11.83±2.92, 16.50±6.17 vs. 7.50±2.47 and 0.79±0.42 vs. 0.63±0.12, respectively), and the differences were statistically significant(t=-4.503, -3.605, -4.690 and -4.340, all P<0.01).@*Conclusion@#Barrett′s esophageal dysplasia may be related with appearance of goblet cells, and the decrease or disappearance of goblet cells may indicate the progression of Barrett′s esophagus.
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Objective To investigate the clinical pathological features of Barrett's esophagus in China , and to study the relationship between the number of goblet cells and the severity of Barrett 's esophageal dysplasia.Methods From January 2008 to October 2018, in the Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital , the clinical and pathological data of 453 patients who underwent gastroscopy and pathologically diagnosed with Barrett 's esophagus were retrospectively analyzed .The clinical pathological features were compared between patients with goblet cells and patients without goblet cells . Periodic acid Schiff reaction (PAS) staining was performed on pathological slides of Barrett's esophagus with goblet cells, and the relationship between the number of goblet cells , the number of positive crypts of goblet cells and the severity of Barrett's esophageal dysplasia was analyzed .T test and chi-square test were performed for statistical analysis.Results Among 453 patients with Barrett's esophagus, 251 (55.4%) were males and 202 (44.6%) were females.There were 218 Barrett's esophagus with goblet cells , including 128 males (58.7%) and 90 females (41.3%).The average onset age was (60.6 ±11.9) years old, and the peak onset age was between 60 and 69 years old.The appearance under endoscopy mainly was circumferential type (58.2%, 127/218).There were 235 Barrett's esophagus without goblet cells , 123 males (52.3%) and 112 females (47.7%).The average onset age was (56.1 ±14.4) years old, and the peak onset age was between 50 and 59 years old.The appearance under endoscopy was mainly circumferential type (40.0%, 94/235).The incidence of dysplasia in Barrett's esophagus with goblet cells was higher than that without goblet cells (75.7%, 165/218 vs.37.0%, 87/235), and the difference was statistically significant (χ2 ＝68.501, P?0.01).PAS staining showed that goblet cells were stained purplish red .The number of goblet cells , total number of crypts , the number of positive crypts of goblet cells and the proportion of positive crypts of goblet cells of Barrett 's esophagus with mild dysplasia were all significantly higher than those of Barrett 's esophagus with moderate dysplasia (95.50 ±40.56 vs.40.00 ±13.34, 21.00 ±8.31 vs.11.83 ±2.92, 16.50 ±6.17 vs.7.50 ± 2.47 and 0.79 ±0.42 vs.0.63 ±0.12, respectively), and the differences were statistically significant ( t＝-4.503,-3.605,-4.690 and -4.340, all P?0.01).Conclusion Barrett's esophageal dysplasia may be related with appearance of goblet cells , and the decrease or disappearance of goblet cells may indicate the progression of Barrett's esophagus.
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Objective To evaluate the clinical significance of acoustic radiation force impulse ( ARFI) technique in the assessment of non-surgical complications after liver transplantation . Methods Three hundred and seventy-two patients with abnormal liver function after liver transplantation undergone ARFI exam before liver biopsy ( excluding surgical complications) . The shear wave velocity ( SWV ) between different groups divided according pathological results after biopsy was compared ,and SWV of 23 patients with normal liver function after liver transplantation was compared too . Moreover , 26 normal people were random selected as control group . Results ① Among the 372 patients ,there were 100 cases of rejection ,82 cases of biliary complications ,52 cases of hepatitis virus infection ,49 cases of drug induced liver injury ,56 cases of non-specific manifestation ,9 cases of steatosis ,3 cases of hypoxic-ischemic ,2 cases of inappropriate preserve injury and 19 cases of diagnosis were not clear . ② SWV of control group was ( 1 .49 ± 0 .66) m/s ,of normal liver function group was ( 1 .64 ± 0 .68) m/s ,of abnormal liver function group was ( 2 .08 ± 0 .66) m /s . Abnormal liver function group had higher SWV than normal liver function group and control group ( P < 0 .01) . There was no significant difference between normal liver function group and control group ( P > 0 .05) . ③ In the specific pathology manifestation patients ,hepatitis virus infection group had the highest SWV[ ( 2 .29 ± 0 .72) m /s] ,drug induced liver injury group had the lowest SWV [ ( 1 .94 ± 0 .57) m /s] ,and there were significant differences between two groups ( P < 0 .01) . ④ The ROC results showed that the area under curve of ARFI was 0 .688 for patients with abnormal liver function after liver transplantation , and 0 .655 for differential diagnosis between drug induced liver injury and hepatitis virus infection .Conclusions As a noninvasive technique ,ARFI is correlated with histopathology and has clinical value in the differential diagnosis of non-surgical complications after transplantation .
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Objective To investigate the value of ultrasound multiplex mode in the evaluation ot liver damage caused by brain death.Methods Brain death model were established in 12 Ba-Ma pigs by gradual intracranial compression method.Color Doppler flow imaging (CDFI),contrast-enhanced ultrasonography (CEUS) and real-time elastography (RTE) were performed respectively before the model had been established which defined as control group,and at 0 h,3 h,6 h,9 h after brain death,the data were analyzed.According to the pathological changes of liver,the livers were divided into different groups for ROC curve analysis,and the effectiveness of single mode ultrasound and multiplex were compared.Results ①Compared with control group,velocity of portal vein (PVV) decreased,and resistance index(RI),hepatic artery systolic velocity/diastolic velocity (S/D),pulsatility index (PI) increased in experimental group (all P ＜ 0.05);arrival time of the hepatic artery(ATHA),arrival time of the portal vein(ATPV) and arrival time of the inferior vena cava(ATIVC) increased with the extension of brain death time (all P ＜0.05);mean value (MEAN),standard deviation(SD) of the relative strain value within the ROI,area of low strain within the ROI (％ AREA),complexity of low strain area within the ROI (COMP),skewness (SKEW),correlation(CORR) were significant different between experimental group and control group (all P ＜0.05).②RI,ATHA and MEAN demonstrated the highest diagnostic accuracy (AUC =0.518,0.833,0.917) among CDFI,CEUS and RTE indexes.③Combined with ATHA and MEAN had the highest effectiveness in ultrasound multiplex mode to evaluate liver injury caused by brain death.Conclusions Ultrasound multiplex mode combining CEUS and RTE in evaluation of liver injury caused by brain death has higher sensitivity and accuracy.
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Objective To investigate the clinical value of contrast-enhanced ultrasound (CEUS) in the diagnosis and grading of acute rejection of the transplanted pancreas after simultaneous pancreas-kidney transplantation.Methods Seventy cases pancreas grafts underwent gray scale ultrasound,color Doppler flow imaging(CDFI) and CEUS examination,the contrast agent perfusion processes were observed,and the parameters of time intensity curves(time-intensity curve,TIC) were calculated.The CEUS results were compared with the pathological findings.Results Twenty-one cases were acute rejection in 70 cases,of which 10 cases were mild,8 cases were moderate and 3 cases were severe;and 49 cases were non-rejection.①Gray scale and CDFI ultrasound:The pancreatic grafts of acute rejection were edema and enlarged,the parenchyma echo were decreased.The artery resistance index(RI) were significant different between acute rejection group and non-rejection group (0.77 ± 0.05 vs 0.74 ± 0.10,P ＜0.05),but there were no significant differences between mild,moderate and severe group (P ＞0.05).②CEUS:TIC curves showed a significantly longer time to reach peak [TTP,(21.7 ± 4.3)s vs (13.0 ± 2.9) s,P ＜0.01] and significantly reduced peakintensity(PI,18.8 ± 7.9 vs 29.6 ± 2.4,P ＜0.05).There was no significant difference between the mild and moderate groups (P ＞0.05) but statistically difference was found when the severe group compared with the other two groups (P ＜0.05).Conclusions CEUS can be used to observe the perfusion of the vascular and parenchyma of the pancreas,the results also can be quantitative analyzed.It is an effective method for the diagnosis of pancreas acute rejection of simultaneous pancreas-kidney transplantation.
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Liver fibrosis is an important pathological hallmark in the early stage of chronic liver injury,which can be gradually treated by drug treatment.Traditional medicine has limited therapeutic effect and is toxic to the normal organs.The drug delivery system based on nanotechnology can overcome the deficiency of traditional drugs to protect the drug which can be delivered to the target cells.Four major types of cells in liver play critical role in liver fibrogenesis,including hepatocytes,hepatic stellate cells,kupffer cells and hepatic sinusoidal endothelial cells.Liver targeted nanomedicine can be delivered to these liver cells based on their material and functional modification and enhance anti-inflammatory and anti-fibrotic effect.They also can reduce the toxic side effects and reverse liver fibrosis.This article gives an overview on current strategies of the application of nanotechnology in targeting treatment for liver fibrosis.
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Objective To optimize the extraction of polysaccharides from Ophiopogon japonicus by the use of response surface methodology.Method According to the design principle of Box-Behnken, effects of extraction temperature, extraction time , extraction times and solid-liquid ratio on the extraction yield of Ophiopogon japonicus polysaccharides were studied by response surface methodology,meanwhile regression analysis of these experimental data was used by Design-Expert 8.05b software.Results The optimum extraction conditions from Ophiopogon japonicus were concluded as follows: the extraction temperature was 93℃, extraction time was 2 h, extraction times was 3 times, and solid-liquid ratio was 1:15 g/ml.Conclusion Under these conditions, the extraction yield of Ophiopogon japonicus polysaccharides is up to 5.440%, and the relative error is 7.328%.
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Objective To explore the effects of different extraction methods on yield of Smilax glabra polysaccharides and antioxidant activities. Methods Crude polysaccharides were extracted by using cold water, hot water, NaOH aqueous solution, and EDTA?2Na aqueous solution . Antioxidant activities of Smilax glabra polysaccharides were compared by the methods of scavenging superoxide anion radical , scavenging hydroxyl radical or reducing power. Results Yield of crude cold water-soluble polysaccharides, crude boiling water-soluble polysaccharides, crude alkali-soluble polysaccharides and crude acid-soluble polysaccharides were 0.31%, 1.1%, 10.8 %, 2.0%, respectively. Polysaccharides by using four kinds of different extraction methods had strong scavenging superoxide anion radical power; crude cold water-soluble polysaccharides, crude boiling water-soluble polysaccharides , crude acid-soluble polysaccharides had strong scavenging hydroxyl radical and reducing power , the capacity increased with the increasing concentration of Smilax glabra polysaccharides; the scavenging hydroxyl radical and reducing power capacity of crude alkali-soluble polysaccharides is very poor. Conclusion Polysaccharides by using four kinds of different extraction methods have certain antioxidant activity, the antioxidant capacity to scavenge free radical in vitro showed positive correlation with the concentration of Smilax glabra polysaccharides, considering the yield of polysaccharides, EDTA?2Na aqueous solution extraction method is the best.
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Objective To investigate the clinical value of contrast-enhanced ultrasound (CEUS) in the diagnosis of postoperative complications after pancreas transplantation.Methods Eighty-six post pancreastransplantation patients were examined by CEUS to observe the perfusion of contrast agent,plot timeintensity curve (TIC),and compare to the results of enhanced CT,MRI and pathology.Results Eleven cases of thrombosis,13 cases of rejection and 13 cases of pancreatitis were observed among 86 patients.Result from CEUS showed that:① Distribution of normal pancreatic grafts vascular and parenchyma was even,TIC follows positive skewed distribution.②Thrombosis:there was no perfusion in the embolic vessels and no enhancement or low uneven enhancement in the parenchyma.③ Rejection:perfusion of the parenchyma was slow,peak value was decreased,rising and falling slope of the TIC was reduced with blunt peak.④Pancreatitis:perfusion of the parenchyma was uneven,the regional low enhanced area was visible,clear of the contrast agent was relatively slow,rising slope of TIC was reduced and the peak value was decreased.Conclusions CEUS can monitor the perfusion of the pancreatic grafts vascular and parenchyma,and get useful perfusion parameters.It has been proven as an effective method to definitely diagnose postoperative complications after pancreas transplantation.
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Objective To investigate the value of acoustic radiation force impulse (ARFI)and color Doppler flow imaging (CDFI)in the diagnostic of acute rejection (AR)after liver transplantation.Methods B mode ultrasound,CDFI and ARFI exams were performed on fifty-eight patients who was diagnosed with AR through liver biopsy in our hospital.The liver allograft size,mean velocity of portal vein,hepatic vein spectrum waveform and shear-wave velocity were obtained and compared with the results of 30 healthy subjects as control group.Results Compare to control group,the AR group had a significant increase in liver allograft,decrease in mean velocity of portal vein,the elimination of triphasic wave of hepatic vein,and a significant increase in shear-wave velocity (P =0.000,0.000,0.007,0.000,respectively).The correlation coefficient between four criteria and grouping was 0.478,0.557,0.286,0.483,respectively.The area under ROC curves for diagnosing AR using the four criterias mentioned above was 0.914.Conclusions Combination of CDFI and ARFI in diagnosing of AR after liver transplantation has higher sensitivity and accuracy.