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This study briefly introduces the revised content of Guidance for Registration of Metallic Bone Plate Internal Fixation System (Revised in 2021) compared to the original guidance, mainly including the principles of dividing registration unit, main performance indicators of standard specification, physical and mechanical performance research, and clinical evaluation. At the same time, in order to provide some references for the registration of metallic bone plate internal fixation system, this study analyzes the main concerns in the review process of these products based on the accumulation of experience combining with the current review requirements.
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Bone Plates , Fracture Fixation, Internal , Biomechanical PhenomenaABSTRACT
@#Objective To investigate the value of endovascular therapy for cognitive dysfunction in patients with moderate or severe vertebrobasilar artery stenosis. Methods A total of 78 patients with cognitive dysfunction due to basilar artery stenosis who were treated in the Outpatient and Inpatient Department of Neurology,People's Hospital of Rizhao,China from March 2019 to November 2022 were prospectively enrolled and divided into endovascular stenting(EVS) group and non-EVS group according to whether they underwent endovascular therapy. Before and after treatment,attention and processing speed-trail making test(TMT)-A,executive function-TMT-B,and mini-mental state examination(MMSE) were conducted. These neuropsychological tests were carried out again after 6 months of follow-up. Computed tomography perfusion examination was performed twice before and after treatment to evaluate the patients' cerebral blood perfusion. The clinical data of the two groups were compared to summarize the therapeutic effect on cognitive dysfunction. Results A total of 78 patients,aged(45.03±13.00)years,with a male-to-female ratio of 1.79∶1,were included in the study. There were no significant differences between the EVS group and the non-EVS group in age,sex,years of education,hypertension,diabetes,stroke history,smoking history,and drinking history(P>0.05). Within one week after treatment,MMSE improvement was significantly different between the EVS group and the non-EVS group(P<0.001). There were no significant differences in the changes in TMT-A and TMT-B between the two groups(P>0.05). After 6 months of follow-up,the improvements in MMSE,TMT-A,and TMT-B in the EVS group were better than those in the non-EVS group(P<0.05). In the EVS group,cerebral blood perfusion was significantly improved,the time to peak was significantly shortened,and the cerebral blood flow was increased. No similar changes were observed in the non-EVS group. Conclusion Endovascular stenting for vertebrobasilar artery stenosis has a certain clinical value in improving cognitive function,and the effect becomes more obvious with the extension of time.
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Surgery,radiotherapy and chemotherapy are three traditional treatments for malignant tumors.With the development of medicine,immunotherapy has been gradually adopted as an emerging therapy of malignancies.Recent clinical studies have demonstrated that the combination of radiotherapy and immunotherapy can induce the abscopal effect and improve the prognosis of patients.Compared with the conventional radiotherapy,stereotactic radiotherapy has a larger single dose and higher accuracy,which is more likely to induce the bystander effect and anti-tumor response.The combination of stereotactic radiotherapy and immunotherapy has been proven to be a more promising therapy in certain clinical trials.However,not all types of tumors can benefit from such combined therapy in clinical practice.The optimal dose,fraction pattern and lesion of radiotherapy,immune enhancement and safety remain to be further clarified.In this article,the research progress,related controversies and future research direction of stereotactic radiotherapy combined with immunotherapy for malignancies were reviewed.
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Since the first application of whole brain radiation therapy (WBRT) to brain metastases in 1950 s,it has been regarded as a standard treatment for brain metastases of non-small cell lung cancer (NSCLC).Recently,more accurate radiotherapy technique and more effective systemic therapy have been developed.Especially,the molecular targeted drugs are upgraded rapidly with stronger targeting capability and better permeability of the central nervous system.With the prolonged survival of patients,long-term damage to the nervous system induced by WBRT causes widespread concerns.This article will review the related controversies and research progress in the application of WBRT to NSCLC with brain metastases in modern integrated therapy.
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PURPOSE: Lung adenocarcinoma (LA) is one of the major types of lung cancer. MicroRNAs (miRNAs) play an essential role in regulating responses of natural killer (NK) cells to cancer malignancy. However, the mechanism of miR-218-5p involved in the killing effect of NK cells to LA cells remains poorly understood. MATERIALS AND METHODS: The expression of miR-218-5p was examined by quantitative real-time polymerase chain reaction (qRT-PCR). Serine hydroxymethyl transferase 1 (SHMT1) level was detected by qRT-PCR or western blots. Cytokines production of interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) were detected by ELISA. The killing effect of NK cells to LA cells was investigated using lactate dehydrogenase cytotoxicity assay kit. The interaction of miR-218-5p and SHMT1 was probed by luciferase activity assay. Xenograft model was established to investigate the killing effect of NK cells in vivo. RESULTS: miR-218-5p was enhanced and SHMT1 was inhibited in NK cells of LA patients, whereas stimulation of interleukin-2 (IL-2) reversed their abundances. Addition of miR-218-5p reduced IL-2-induced cytokines expression and cytotoxicity in NK-92 against LA cells. Moreover, SHMT1 was negatively regulated by miR-218-5p and attenuated miR-218-5p-mediated effect on cytotoxicity, IFN-γ and TNF-α secretion in IL-2-activated NK cells. In addition, miR-218-5p exhaustion inhibited tumor growth by promoting killing effect of NK cells. CONCLUSION: miR-218-5p suppresses the killing effect of NK cells to LA cells by targeting SHMT1, providing a potential target for LA treatment by ameliorating NK cells function.
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Humans , Adenocarcinoma , Blotting, Western , Cytokines , Enzyme-Linked Immunosorbent Assay , Heterografts , Homicide , Interleukin-2 , Killer Cells, Natural , L-Lactate Dehydrogenase , Luciferases , Lung Neoplasms , Lung , MicroRNAs , Necrosis , Real-Time Polymerase Chain Reaction , Serine , TransferasesABSTRACT
Objective@#To explore the clinical features of patients with synchronous lymphoma and carcinoma.@*Methods@#The clinical data of 17 patients with Synchronous lymphoma and carcinoma from February 2012 to October 2017 were analyzed retrospectively.@*Results@#Among 17 patients of lymphoma, 1 case HL, 2 cases B-NHL, 6 cases MZBL, 3 cases DLBCL, 1 case mantle cell lymphoma (MCL) , 3 cases NK/T- cell lymphoma, 1 case anaplastic large cell lymphoma(ALCL). In terms of 17 patients with carcinoma, 3 cases esophageal carcinoma, 3 cases gastric carcinoma, 2 cases colorectal carcinoma, 7 cases thyroid carcinoma, 1 case hepatocellular carcinoma and lung cancer. Up to 15 patients received operation, and some of them combined with chemotherapy, radiotherapy and autologous transplant. Follow-up analysis showed that 3 cases was undergoing treatment, 2 cases lost follow-up, 4 cases died, 3 cases achieved CR, 3 cases remained to be at SD, and 2 cases assessed for progression or recurrence.@*Conclusion@#The relationship between lymphoma and carcinoma was under discussion, patients with synchronous lymphoma and carcinoma were not unusual. We herein should raise awareness to avoid misdiagnosis.
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Sepsis is a life-threatening organ dysfunction caused by dysregulated host responses to infection. Despite decades of research, it remains the leading cause of death in intensive care units (ICUs). None of the current treatment, including antibiotics, organ protection and liquid resuscitation, is specifically effective for sepsis. Immunosuppression is one of the currently accepted pathogenesis and immunotherapy is one of the hot spot of current sepsis research. Immune related treatments include restricting the release of pathogen toxin and its removal, controlling the excessive inflammatory reaction and apoptosis inhibition, etc. Numerous pre-clinical studies using immunomodulatory agents such as interleukin-7 (IL-7), anti-programmed cell death-1 (PD-1) antibody and others, have demonstrated reversal of T cell dysfunction and improved survival resulting from reviewing recent advances in immunotherapy of sepsis. Therefore, immunotherapy may be a new way of sepsis treatment.
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Objective@#To analyze the clinical features, treatment and outcomes of primary lymphoma of bone (PLB) .@*Methods@#The clinical data of 11 PLB patients were retrospectively analyzed.@*Results@#11 patients were enrolled in our study including 7 females and 4 males. The median age of the patients was 45 years old. The main histologic type was diffuse large B cell lymphoma and anaplastic large cell lymphoma. Of the 11 PLB cases, 3 cases were at stage ⅠE, 2 at stage ⅡE, 6 at stage ⅣE respectively. 6 cases were treated with chemotherapy and radiotherapy, 2 cases with total joint arthroplasty and chemotherapy, and 3 cases chemotherapy alone respectively. 5 cases got complete remission, 4 cases partial remission and 2 cases stable disease respectively. The median progression free survival was 17 (5-58) months after a median follow up of 21 (6-58) months.@*Conclusions@#Most of PLB patients were clinically in late stage lacking of clinical and imagine features. The optimal treatment for PLB was radiotherapy combined with chemotherapy, and its prognosis was relatively good.
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Objective To explore the relationship between blood pressure variability and different types of stroke.Methods One hundred and twenty-five ischemic stroke subjects,78 hemorrhagic stroke patients and 66 non-stroke individuals,collected in our hospital from January 1,2013 to December 31,2015,were enrolled according to the inclusion and exclusion criteria.All indicators of blood pressure variability were calculated from 24 h ambulatory blood pressure,including nighttime blood pressure fall (BPF),moming surge in blood pressure (MBPS),standard deviation (SD),weighted SD (wSD),and coefficient of variation (CV).Results As compared with non-stroke subjects,ischemic and hemorrhagic stroke individuals had significantly increased systolic MBPS (P＜0.05),and the systolic MBPS of ischemic stroke group was significantly lower than those of hemorrhagic stroke group (P＜0.05).CV,wSD and BPF of systolic blood pressure (SBP) in the ischemic and hemorrhagic groups were significantly higher than those in the non-stroke subjects (P＜0.05);CV and SBPF of diastolic blood pressure in hemorrhagic group were significantly different as compared those in the non-stroke subjects (P＜0.05).The factors which were significantly associated with ischemic stroke in Logistic regression,included high-density lipoprotein,nighttime SBP,wSD of SBP,CV of SBP,while smoking,nighttime SBP,wSD of SBP,MBPS,and CV of SBP were observed as important influence factors for hemorrhagic stoke patients.Conclusion Whether ischemic stroke,or hemorrhagic stroke are associated with short-term blood pressure variability.
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Sepsis remains the leading cause of death in intensive care unit.The pathogenesis of sepsis is extremely complex.Immune dysfunction plays an important role in the occurrence and development of sepsis.Many mechanisms are responsible for sepsis induced immune-suppression,including apoptotic depletion of immune cells,increased T regulatory and myeloid-derived suppressor cells,and cellular exhaustion.The article provided a brief review on the advance of immunologic mechanisms underlying sepsis.
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Objective To further understand the clinical manifestations and improve clinical diagnosis of patients with leptomeningeal metastasizing high-grade glioma.Methods Sixteen patients with leptomeningeal metastasizing high-grade glioma (WHO classification:grade Ⅲ-Ⅳ) in Department of Radiotherapy,the First Hospital of Jilin University from July 2010 to September 2015 were respectively analyzed.The pathological types included anaplastic gliomas (1),anaplastic oligodenastrocytoma (1),glioblastoma (12),small-cell glioblastoma (1),gliosarcoma (1).We reviewed the relative clinical manifestations of the patients,and further compared them with 163 patients with systemic malignant solid tumors at corresponding period.Results The median time from initial diagnosis to the diagnosis of leptomeningeal metastasis was 13.0 months (range 2-19 months).Plain and enhanced magnetic resonance imaging was obtained in all patients.The main radiographic characteristics included ependymal enhancement (11),leptomeningeal enhancement (3),nodules of implantation metastasis in spinal canal (1),cranial nerve enhancement (2),and ventricular dilatation (1).Eight patients received cerebrospinal fluid examination.The diagnosis of leptomeningeal metastasis in 15/16 patients was determined by radiographic findings.Comparing with leptomeningeal metastasis from systemic malignant tumors at the corresponding period,the incidence of headache in patients with high-grade glioma was significantly lower (6/16 vs 81.6％ (133/163);x2 =16.3,P ＜ 0.01);and the incidence of cranial nerve paralysis was also significantly lower (4/16 vs 56.4％ (92/163);x2 =5.79,P =0.016 1).The incidence of nerve root symptoms was lower than that of systemic malignant tumors,though without statistically significant difference (2/16 vs 26.4％ (43/163);x2 =1.49,P=0.222).Nine patients respectively received chemotherapy,intrathecal chemotherapy or intrathecal chemotherapy combined with whole brain radiotherapy.The median survival tine was 4.5 months (range 0.7-13.3 months).Conclusions The imaging examination played an important role in the diagnosis of high-grade leptomeningeal metastasizing glioma.Comparing with the systemic malignant solid tumors,the leptomeningeal metastasizing high-grade glioma had its unique clinical characteristics.
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Recently,immunologists have payed the attention to the effects of ionizing radiation on tumor immunity,and attempted to induce and improve anti-tumor immune effects with it.More and more evidences showed that exact radiotherapy scheme and irradiation dose,particularly combined with immunotherapy,could induce or regulate systemic immune response and contributed to tumor control and inflammatory occurrence.This paper reviewed the effects and mechanisms of radiotherapy on tumor immune and the results in combination with immunotherapy here for guiding the effective combined application of radiotherapy and immunotherapy.
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Objective To analyze the difference of dosimetry and evaluate clinical efficacy and acute toxicity reaction between RapidArc and fixed gantry angle dynamic intensity modulated radiotherapy (IMRT) in advanced cervical carcinoma.Methods A total of 43 patients with locally advanced cervical cancer were studied,including 22 patients treated with RapidArc and 21 patients with IMRT.All plans were prescribed 50.4 Gy in 28 fractions.The conformity index and homogeneity index of the targets,the monitor units(MUs) and delivery time were compared.Incidence of acute intestinal and bladder side effects and rates of efficacy were calculated.Results The conformity index of RapidArc was better compared to IMRT.The V40 and V50 of bladder and V30,V40 and V50 of rectum planned by RapidArc was significantly lower than that by IMRT(t =-2.386,-2.397,P ＜0.05;t =-5.525,-2.883,-2.686,P ＜0.05).The mean dose of femoral head planned by RapidArc was also significantly lower (t =-2.395,P ＜ 0.05).For RapidArc,mean MU and treatment time were reduced by 53.15％,and 62.14％,respectively.There was no difference in the incidence of acute intestinal and bladder toxicity and rates of complete remission and efficacy between the two groups.Conclusions In dosimetric analysis,RapidArc showed advantage in protecting organs at risk and reducing treatment time in radical radiotherapy for locally advanced cervical carcinoma.
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AIM:To investigate the relationship between autophagy and calcification in vascular smooth muscle cells ( VSMCs) after platelet-derived growth factor (PDGF)-BB stimulation.METHODS:Cultured VSMCs were stimulated with PDGF-BB for different time, the expression of vascular calcification-related proteins and autophagy-related proteins were detected by Western blot .The interaction be-tween Beclin1 and PI3KC3 was detected by co-immunoprecipitation.RESULTS: The expression of BMP2 and ALP showed a trend from decline to rise.ALP slumped at 12 h, and BMP2 slumped at 6 h.Moreover, the expression of Beclin-1 showed a trend from rise to decline, and peaked at 12 h.The conversion of LC3-ⅠtoⅡincreased in a time-dependent manner , and peaked at 24 h.The ex-pression of BMP2 and ALP was increased in VSMCs incubated with PDGF-BB and autophagy inhibitor 3-MA, compared with PDGF-BB-stimulated VSMCs.Furthermore, the interaction between Beclin1 and PI3KC3 was enhanced at 6 h after PDGF-BB stimulated, peaked at 12 h, and kept in high level at 24 h.Moreover, the phosphorylation level of Beclin 1 was enhanced by PDGF-BB stimulation, and peaked at 6 h.CONCLUSION:Our findings demonstrate that PDGF-BB-induced autophagy inhibits VSMC calcification by en-hancing Beclin1 phosphorylation and interaction between Beclin 1 and PI3KC3.
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Objective To investigate mutations of CSMD3 gene in a pedigree of familial cortical myoclonic tremor with epilepsy (FCMTE).Methods Peripheral blood (5 ml) was obtained from FCMTE patients (7 cases),suspected cases,and control individuals.Polymerase chain reaction (PCR) and purification of PCR products for sequencing were used to detect the existence of mutations in 73 exons of gene CSMD3.The resulting products were subjected to agarose gel electrophoresis and gel-imaging system.The PCR amplification products were sequenced.Results The sequencing results of 73 exons were compared with CSMD3gDNA sequence in human GenBank.We neither found any DNA sequence variation nor disease-related mutations.Conclusions The family does not have a mutation in the CSMD3 gene.We need to further find the disease genes and the mutations in this family.
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<p><b>OBJECTIVE</b>To evaluateclinical features, treatment and outcomes of patients diagnosed with primary breast diffuse large B-cell lymphoma（DLBCL）.</p><p><b>METHODS</b>Clinical data were analyzed for all patients diagnosed with primary breast DLBCL（n=21）. Kaplan-Meier method was used to estimate 5- year overall survival（OS）rate, and the difference was compared by Log- rank test.</p><p><b>RESULTS</b>The 21 cases of patients with primary breast DLBCL were all female with median age at diagnosis as 48 years （range 21-64 years）. 13 patients had International Prognostic Index（IPI）of 0, 6 IPI 1, and 2 IPI 2. The 5- year OS rates of CHOP/R- CHOP and R±DICE after R±EPOCH groups were 40.0% and 72.2% , respectively（P=0.035）. The central nervous system relapse rate of CHOP/R-CHOP and R±DICE after R± EPOCH groups were 16.7% and 6.7%（P=0.500）, respectively. The 5- year OS rates of patients with primary breast DLBCL staging Ⅱ E-Ⅲ E and Ⅰ E were 21.4% and 83.3% , respectively（P=0.025）.</p><p><b>CONCLUSION</b>Primary breast DLBCL was rare. The patients of primary breast DLBCL with chemotherapy regimen of R±DICE after R±EPOCH might have a better prognosis and lower relapse rate of central nervous system; the primary breast DLBCL patients staging ⅡE-ⅢE might have a poor prognosis.</p>
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Female , Humans , Antibodies, Monoclonal, Murine-Derived , Antineoplastic Combined Chemotherapy Protocols , Breast Neoplasms , Diagnosis , Drug Therapy , Pathology , China , Cisplatin , Cyclophosphamide , Dexamethasone , Doxorubicin , Etoposide , Ifosfamide , Lymphoma, Large B-Cell, Diffuse , Diagnosis , Drug Therapy , Pathology , Neoplasm Recurrence, Local , Prednisone , Prognosis , Retrospective Studies , VincristineABSTRACT
<p><b>OBJECTIVE</b>To investigate the effect of ERK1/2 inhibitor AZD8330 on human Burkitt's lymphoma cell line Raji cells and its mechanism.</p><p><b>METHODS</b>Raji cells were treated with different concentrations of AZD8330. CCK-8 was used to detect the cell viability. The apoptosis rate of Raji cells was detected by flow cytometry using Annexin V/PI-staining. Real-time PCR was used to assess the expression of Bcl-2, Bcl-xl, caspase-3 and VEGF genes. The protein expression level of Bcl-2, Bcl-xl, caspase-3 and p-ERK1/2 was tested with Western blot.</p><p><b>RESULTS</b>The cell survival rate decreased to(62.09±0.86)%,(50.06±1.33)% and (39.13±2.34)% respectively after cells were treated with AZD8330 at 1.00 μmol/L in vitro for 24 h, 48 h and 72 h, and statistically significant differences were observed in groups with different time of treatment(P<0.05). Apoptosis of cells treated with AZD8330 at 0.10, 1.00, 10.00 μmol/L in vitro for 24 h, 48 h and 72 h was analyzed, and the statistically significant differences were observed in groups of different time and concentration treatment (P<0.05). AZD8330 induced Raji cell apoptosis and upregulated expression of Bcl-2, Bcl-xl, VEFG and decreased the expression of caspase-3 in a dose and time dependent manner, and statistically significant differences were observed in groups of different time and concentration treatment (P<0.05). At the same time, the Bcl-2, Bcl-xl and p-ERK1/2 proteins expression is suppressed obviously, but the expression of caspase-3 protein increased.</p><p><b>CONCLUSION</b>AZD8330 induces cell apoptosis by down-regulating the activation of ERK1/2 signal transduction pathway in Burkitt's lymphoma cell line Raji cells in a dose and time dependent manner.</p>
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Humans , Apoptosis , Burkitt Lymphoma , Caspase 3 , Cell Line, Tumor , Dihydropyridines , Flow Cytometry , MAP Kinase Signaling System , Protein Kinase Inhibitors , Real-Time Polymerase Chain ReactionABSTRACT
Objective To improve the understanding of leptomeningeal metastasis (LM),we analyzed the data of clinical manifestations,imaging findings and cytological analysis of cerebrospinal fluid (CSF) in a group of patients with LM of malignant solid tumors.Methods The clinical data of 94 patients with LM of malignant solid tumors between 2009 and 2014 in our hospital were retrospectively analyzed.We compared the clinical manifestations and auxiliary examinations of patients with different pathological types of LM.The Chi-square test was used to compare the results.Results The pathological types included adenocarcinoma (61),small cell carcinoma (24),squamous carcinoma (6),melanoma (1),large-cell carcinoma (1),and hepatocellular carcinoma (1).The median age was 58 (37-75) and the median KPS score was 40 (10-80).About 98.9％ (93/94) patients had neurologic symptoms.Neuroimaging examination was performed in 84 patients,with the sensitivity of 88.1％ (74/84);cytological analysis of CSF was performed in 85 patients,with the sensitivity of 88.2％ (75/85);while CSF biochemical examination was performed in 85 patients,with the sensitivity of 90.6％ (77/85).The sensitivity of cytology in adenocarcinoma (96.6％,56/58) was higher than those in small cell carcinoma (80％,16/20;P =0.056).The sensitivity of neuroimaging in small cell carcinoma (95.8％,23/24) was higher than that in adenocarcinoma (83.3％,45/52;P =0.409).However,the sensitivity of cytology (1/5) and neuroimaging (4/6) in squamous carcinoma was low,which led to the need of comprehensive analysis for the diagnosis.The incidence of headache,spinal nerve-related symptoms,ependymal enhancement and metastatic nodules of lumbosacral intraspinal in adenocarcinoma and small cell carcinoma showed statistically significant difference,which was 88.5％ (54/61) and 29.2％ (7/24;P ＜ 0.01),18.0％ (11/61) and 45.8％ (11/24;P =0.008),2/6 and 25.0％ (6/24;P=0.017),1.9％ (1/61)and50.0％ (12/24;P ＜ 0.01),respectively.Conclusions Neuroimaging and CSF examination are still the key points for the diagnosis of LM of malignant solid tumors.The clinical manifestations are correlated with pathological types of primary tumor.
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<p><b>BACKGROUND</b>In 2012, the working group on abdominal problems of the European Society of Intensive Care Medicine (ESICM) proposed a definition and also guidelines for the grading system and treatment of acute gastrointestinal injury (AGI). Until now, clinical reports on this topic have not been available, and the practicality of using the AGI grading system requires further validation in the clinic. Therefore, we conducted this study to evaluate the feasibility of utilizing the current AGI grading system in a clinical environment, and to provide evidence for its usefulness in assessing the severity and prognosis of critically ill patients with gastrointestinal dysfunction.</p><p><b>METHODS</b>A total of 133 patients were examined for the presence or absence of AGI, their scores on the Acute Physiology and Chronic Health Evaluation (APACHE) II and Lausanne Intestinal Failure Estimation (LIFE) test, and 28 days mortality. The presence and severity of AGI was based on guidelines provided by the ESICM. The patients were assigned to a NO-AGI group (n = 50) or an AGI group (n = 83). The AGI group was then further divided into three subgroups, consisting of AGI I (risk group, n = 38), AGI II (gastrointestinal dysfunction group, n = 33) and AGI III+AGI IV (gastrointestinal failure group, n = 12). These subgroups were then compared for differences in AGI indicators.</p><p><b>RESULTS</b>There were no statistically significant differences between the AGI group and the NO-AGI group in terms of age, gender, APACHE II score or LIFE score (P > 0.05); however, the two groups showed a significant difference in their respective rates of 28 days mortality (32.5% in the AGI group vs. 8.0% in the NO-AGI group (P < 0.05)). Patients in the three AGI subgroups showed significant differences in their 28 d mortality rates, APACHE II, and LIFE scores. AGI grading system showed strong positive correlations with APACHE II and LIFE scores (P < 0.05).</p><p><b>CONCLUSIONS</b>The current AGI grading system can be used to identify and evaluate gastrointestinal dysfunction in critically ill patients, and also to provide a preliminary assessment regarding the prognosis for patients with different grades of AGI.</p>