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Lung cancer is the fastest-growing cancer type in terms of incidence and mortality worldwide， posing a huge threat to the health and life of the population. Radiation therapy is one of the main methods for treating lung cancer， and there is a clear dose-effect relationship between the radiation dose and local control rate of lung cancer. However， the lung is a radiation dose-limiting organ， and the radiation resistance of lung cancer tissues and the radiation damage to normal tissues limit the radiation efficacy for lung cancer. The pathogenesis of lung cancer in traditional Chinese medicine （TCM） is characterized by an initial deficiency in vital Qi， followed by the internal invasion and gradual accumulation of pathogenic Qi. After radiation therapy for lung cancer， the body's vital Qi becomes weaker， and syndromes of phlegm coagulation， Qi stagnation， and static blood blocking collaterals become more severe， leading to radiation resistance of lung cancer tissues. Therefore， the key issue to better clinical efficacy of radiation therapy for lung cancer patients is to use drugs to enhance the radiation sensitivity of lung cancer cells and improve the radiation tolerance of normal lung tissues. TCM can be used as a radiation sensitizer by regulating the cell cycle to increase the proportion of cells in the radiation-sensitive phase， promoting upregulation of pro-apoptotic genes and downregulation of anti-apoptotic genes to induce cell apoptosis， enhancing DNA damage caused by radiation and inhibiting damage repair， improving blood circulation and tissue oxygen supply， and so on， to enhance the sensitivity of tumor cells to radiation and amplify the toxicity of radiation to tumor tissues. TCM can also be used as a radiation protector by inhibiting cell damage， regulating cytokines and immune balance， reducing the release of inflammatory and fibrotic factors， and inhibiting the activation of related signaling pathways to prevent and treat radiation-induced lung injury. This article systematically reviewed the research results of TCM on radiation sensitization and radiation protection in lung cancer in recent years， aiming to elucidate the mechanism of TCM in regulating the effect of radiation therapy for lung cancer and provide more theoretical and practical basis for TCM to participate in improving the prognosis of lung cancer patients undergoing radiation therapy.
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Objective:To study the risk factors of complications after bowel resection for acute mesenteric ischemic disease.Methods:Retrospective case-control study was used to analyze the case data of 68 patients diagnosed with acute mesenteric ischemic disease (AMI) with bowel resection at the First Medical Center of the PLA General Hospital from January 2010 to January 2020, including 43 males and 25 females. The patients were divided into complication group ( n=21) and the non-complication group ( n=47) according to whether they had complications after surgery. The risk factors associated with the development of postoperative complications were analyzed by multivariate Logistic stepwise regression method to determine the risk factors with clinical significance. Measurement data with normal distribution were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups. Chi-square test was used for comparison between count data groups. Results:Univariate analysis showed that age >60 years, Marshall score≥2, type of resected bowel, pathology suggestive of irreversible transmural necrosis, length of ICU stay >6 d, length of mechanical ventilation >2 d, American Society of Anesthesiologists (ASA) classification, and preoperative procalcitonin≥2 ng/mL were the risk factors affecting the development of complications after bowel resection for acute mesenteric ischemic disease risk factors ( P<0.05). Multivariate Logistic regression analysis showed that age>60 years ( HR=12.364, 95% CI: 1.135-134.662, P=0.039) and preoperative procalcitonin ≥2 ng/mL ( HR=14.144, 95% CI: 1.280-156.303, P=0.031) were independent risk factors for the development of postoperative complications after AMI parallel bowel resection. Conclusion:The rate of complications after combined bowel resection for AMI is high. When patients are combined with age>60 years and preoperative procalcitonin≥2 ng/mL, preoperative prevention of postoperative complications should be emphasized to improve the prognosis of patients.
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Background Experimental studies have shown that radiofrequency electromagnetic waves emitted by mobile phones can cause adverse effects on male reproductive health, including decreased semen quality and altered sex hormones. However, the results of epidemiological studies on the relationship between mobile phone use and male semen quality are inconsistent. Furthermore, there are few epidemiological studies on the association of mobile phone use with sex hormones. Objective To explore the associations of mobile phone use with male semen quality and sex hormones. Methods A total of 2045 men visited the reproductive medicine center of a hospital in Wuhan and ordered infertility examination were recruited from December 2018 to January 2020. Information on mobile phone use was obtained using a questionnaire. Among them, 1232 and 1694 men were eligible for semen quality analyses and sex hormone analyses, respectively. Multiple linear and logistic regression models were used to analyze the associations of mobile phone use with male semen quality and sex hormones. Results After adjusting for potential confounders, there was no statistically significant associations of mobile phone use with sperm progressive motility, sperm total motility, sperm concentration, sperm count, or serum luteinizing hormone (P>0.05). However, serum total testosterone showed a declined tendency with increasing daily duration of mobile phone use (Ptrend=0.08). Compared with men with daily mobile phone use of 0-2 h, men with daily mobile phone use of 2.1-5, 5.1-8, and >8 h showed decreased serum total testosterone concentrations by 6.29% (95%CI: 0.40%-11.84%), 6.01% (95%CI: 0.60%-12.19%), and 7.87% (95%CI: 0.40%-14.79%), respectively. Conclusion Mobile phone use is not associated with male semen quality and serum luteinizing hormone, but increasing daily duration of mobile phone use is potentially associated with a tendency to lower male serum total testosterone.
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Objective:To investigate the thyroid function changes and clinical significance after acute traumatic and infectious abdominal surgery.Methods:The clinical data of patients admitted to the intensive care unit (ICU) for acute traumatic and infectious abdominal surgery during the period from January 1, 2012 to December 31, 2021 in the First Medical Center of People′s Liberation Army General Hospital were retrospectively analyzed using retrospective case-control study. Eligible cases were obtained according to the inclusion and exclusion criteria, and an observation group was set ( n=65). According to the factors such as gender, age, body mass index, and surgical site (organ), a 1∶1 propensity score matching method was used to match the same number of non-traumatic non-infectious abdominal surgery patients admitted in the same time interval, and they were set as the control group ( n=65). The preoperative white blood cells, neutrophils, interleukin -6, c-reactive protein, and procalcitonin were collected, and the thyroid function index for the first time after operation was calculated. The incidence of postoperative thyroid dysfunction was calculated. The thyroid function changes of patients with thyroid dysfunction after exogenous thyroid hormone replacement therapy and the effects on complications and mortality within 30 days were observed. Measurement data of normal distribution were expressed as mean standard deviation( ± s), and t-test was used for comparison between groups. Enumeration data were compared between groups using chi-square test. Results:In the observation group, there were 50 patients with thyroid dysfunction (76.9%). After a 1∶1 match, the baseline of the observation group and the control group was level and comparable. The preoperative inflammatory indexes such as leukocyte, neutrophil ratio, interleukin -6, C-reactive protein and procalcitonin in the observation group were (23.7±5.7)×10 12/L, 0.86±0.13, (66.7±16.3) ng/L, (365.8±77.9) mg/L and (17.9±3.5) μg/L, respectively. Those in the control group were (12.3±2.7)×10 12/L, 0.71±0.04, (8.5±4.7) ng/L, (14.3±6.5) mg/L and (1.3±0.6) μg/L, respectively. The elevations in the observation group were different from those in the control group( P<0.05). In the first postoperative thyroid function test, T3 and FT3 in the observation group were (1.07±0.54) nmol/L and (2.23±1.02) pmol/L, respectively, and those in the control group were (1.61±0.34) nmol/L and (4.36±1.25) pmol/L, respectively. These values in the observation group were significantly lower than those in the control group( P<0.05). On the 10th day after surgery, T3 and FT3 levels in the exogenous thyroid supplementation group rapidly increased and gradually returned to the normal level. In addition, the total hospitalization time of patients in the observation group was significantly shortened, and the incidence and mortality of postoperative complications were reduced. The results in the observation group were (13.47±4.66) d, 17.6% and 11.8%, respectively. The corresponding results in the control group were (16.33±5.18) d, 36.4% and 21.2%, respectively. The difference between the two groups was statistically significant( P<0.05). Conclusion:The incidence of thyroid dysfunction after acute traumatic and infectious abdominal surgery is high, and exogenous thyroxine supplementation can improve the outcome of patients.
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【Objective】 To establish and optimize a method for the determination of aluminum (Al) residue by inductively coupled plasma mass spectrometry (ICP-MS). 【Methods】 Nitric acid solution was used to treat samples and standards. The concentration of nitric acid solution and equipment parameters were optimized, and the specificity, linearity, repeatability, accuracy, detection limit, quantitative limit and intermediate precision of the optimized detection method were investigated to confirm whether it was suitable for the determination of Al residue in human serum albumin. 【Results】 The concentration of nitric acid was 5%, and digest time was 4 h. The equipment condition of ICP-MS was as follows: RF power: 1600 W, sampling depth: 10 mm, atomizer / carrier gas flow rate: 1.0 L/ min, compensation flow rate: 0.5 L/ min, experimental mode: standard mode, integration time: 0.2 s, data acquisition: 3 times. Specificity: The recoveries of Al: 92% (high concentration, RSD=3.5%), 98% (low concentration, RSD=4.9%). Linearity: In the range of (0~40) μg/L, the correlation coefficient between concentration and optical energy signal (CPS) of standard / sample were higher than 0.999 0. Accuracy/ Repeatability: The recoveries of sample (3 concentration): 108% (RSD=4.7%), 110% (RSD=4.9%) and 110% (RSD=2.8%). The detection limit was 0.006 μg/L, and the quantitation limit was 0.019 μg/L. Intermediate precision: personnel factor and date factor, P>0.05, RSD (12 times)=2%. Comparison between ICP-MS and atomic absorption spectrometry (AAS): the deviation between ICP-MS and AAS was 8%, and that of samples was 3%, with no significant difference noticed between the two methods. 【Conclusion】 After optimization, ICP-MS method has shown good performance in terms of specificity, linearity, repeatability, accuracy, detection limit, quantitative limit and intermediate precision, and is suitable for the determination of Al residue in human albumin products of our company.
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Nanodosimetry, a new discipline developed on the basis of microdosimetry, is based on the structural characteristics of particle tracks and studies on the probability distribution of ionization pairs in a specific volume to characterize the damage degree of DNA strand. Now nanodosimetric quantities, which may be measured, gradually form the concept such as ionization cluster size, ionizing cluster size distribution and complementary cumulative probability distribution etc. This paper aims to establish and explain the relationship between nanodosimetry and DNA damage and repair. On the basis of reviewing the current measurement and calculation method of nanodosimetry, this paper summarized the development trend and application prospect of nanodosimetry, and put forward the future research direction of nanodosimetry.
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【Objective】 To improve method for determinating of biological potency of IgG Fc fragment in Chinese Pharmacopoeia and establish a method which is suitable for enzyme-labeled instrument. 【Methods】 The biological properties of FC fragment of IVIG in Chinese Pharmacopiea(General 3514) was adjusted, including sensitization process, sample treatment and dynamic curve parameters. Meanwhile, the kinetic curve of hemolysis was fitted with Origin, which made the method more suitable for enzyme plate. The biological properties of Fc fragment of IVIG was calculated by kinetics curve reaction of reference and sample. 【Results】 The method are stable, the RSD of repeatability and intermediate is 10%, also with significant improvement in efficiency. 【Conclusion】 The detection of properties of Fc fragment of IVIG is stable and efficient, it can be used for properties of Fc fragment of IVIG.
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Objective:To analyze the neurodevelopmental characteristics of the children with methylmalonic acidemia and investigate its possible influencing factors.Methods:The clinical questionnaire was used to collect clinical data of children with methylmalonic acidemia at the First Affiliated Hospital of Henan University of Chinese Medicine from February 2016 to February 2018, and Gesell development scal was used to evaluate the neurodevelopment.Results:Among the 86 patients, 45 cases were boys and 41 cases were girls.They were 2.4 to 62.5 months, and the minimum age was 8.3 months.Thirty-three cases were detected by neonatal screening, 53 cases were diagnosed after onset.The energy zone in this children were mild to severe developmental defects.Twenty-eight cases were 0 to 6 months old, and fine exercise, the large exercise and adaptability developmental defects were significant of them; 24 cases were >6 to 12 months old, and the language, adaptability and personal-social developmental defects were significant of them; 23 cases were >12 to 36 months old, and the language, adaptability and large movements developmental defects were significant of them; 11 cases aged >36 to 72 months had significant developmental defects in language, personal-social contact and adaptability.The developmental quotients of fine movements, big movements, adaptability, personal-social and language of the children diagnosed by newborn screening were much better than those diagnosed after onset in each energy zone(all P<0.05). Conclusions:Although the treatment is actively regulated, most children with methylmalonic acidemia still have neurodevelopmental abnormalities with varying degrees of severity.The children before the age of 6 months have significant defects in motor movement and adaptability development.The patients after the age of 6 months usually have language, adaptability and social contact defects.Newborn screening is important and nervous system damage is milder in the children diagnosed by newborn screening.
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Objective:To investigate the role of suppressor of cytokine signaling 1 (SOCS1) in berberine (BBR) mediated-inhibition of microglial activation.Methods:The combination of lipopolysaccharide (LPS) and interferon-γ (IFN-γ) activated N9 microglia to mimic neuroinflammation. The cells were divided into control group, simulated neuroinflammation group (10 ng/ml LPS+ 10 U/ml IFN-γ), BBR treatment group (1 μmol/L BBR+ LPS/IFN-γ), SOCS1-siRNA treatment group (SOCS1-siRNA+ BBR+ LPS/IFN-γ), and scrambled siRNA treatment group (SC-siRNA+ BBR+ LPS/IFN-γ). After incubation for 24 h, the expression levels of tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) in cell culture medium were detected by enzyme-linked immunosorbent assay. Western blotting was used to detect the expression levels of inducible nitric oxide synthase (iNOS) and nuclear factor κB (NF-κB). Immunocytochemical method was used to observe cell morphology and iNOS expression.Results:Compared with the control group, LPS/IFN-γ significantly increased the levels of TNF-α and IL-6 in the medium, up-regulated the expression levels of iNOS and NF-κB (all P<0.05), and increased the volume of microglia. 1 μmol/L-BBR significantly inhibited the release of TNF-α and IL-6 from microglia, decreased the expression levels of iNOS and NF-κB (all P<0.05), and improved cell morphology. SOCS1-siRNA significantly reversed the inhibitory effect of BBR on microglia activation (all P<0.05). Conclusions:BBR may inhibit LPS and IFN-γ-induced microglial activation through SOCS1 molecule.
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Asthma is one of the most common pulmonary chronic inflammatory diseases threatening public health.It is a heterogeneous disease driven by gene-environment interaction.The proposition of "hygiene hypothesis" and "microbial hypothesis" has gradually drawn attention to the close relationship between microorganisms and asthma.In recent years, studies on intestinal flora emerge endlessly.Studies have shown that intestinal flora is not only closely related to digestion, immunity, endocrine, circulation, neuropsychiatric system, but also to asthma.This paper reviews the possible relationship between intestinal flora and asthma in children from its physiological function, so as to explore the prevention and treatment strategy of asthma in the future.
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Objective To investigate the clinical efficacy of hepatic artery ringed and restriction operation-associating liver partition and portal vein ligation for staged hepatectomy (HARO-ALPPS) in the treatment of giant hepatocellular carcinoma.Methods The retrospective and descriptive study was conducted.Clinical data of a 45-year-old male patient with giant hepatocellular carcinoma who was admitted to the First Affiliated Hospital of Guangxi Medical University in July 2018 were collected.In the first stage operation,right portal vein ligation+ in situ liver partition + right hepatic artery ringed operation was performed on the patient.In the second stage operation,right hemihepatectomy was performed on the patient.Observation indicators:(1) surgical and postoperative situations of the first stage operation;(2) surgical and postoperative situations of the second stage operation;(3) postoperative pathological examination;(4) changes in future liver remnant (FLR) and tumor volume;(5) perioperative hemodynamic changes of right hepatic artery,proper hepatic artery and left hepatic artery;(6) perioperative hemodynamic changes of left-portal vein and main portal vein;(7) follow-up.Follow-up using outpatient examination was performed to detect the prognosis of patients up to February 2019.Count data were described as absolute number.Results (1) Surgical and postoperative situations of the first stage operation:the patient underwent right portal vein ligation+ in situ liver partition+ right hepatic artery ringed operation successfully.The operation time and volume of intraoperative blood loss were 376 minutes and 400 mL.Inflammatory indicators including body temperature,white blood cells (WBC),C-reactive protein,procalcitonin,and liver function indices including total bilirubin (TBil),albumin (Alb),alanine aminotransferase (ALT),aspartate aminotransferase (AST),ascites,indocyanine green retention rate at15 min (ICG R15),score of model for end-stage liver disease (MELD) before the second stage operation were improved after symptomatic supportive treatment.Prothrombin time (PT) was in the normal range after the first stage operation.There was no complication of Clavien-Dindo classification Ⅱ or above.(2) Surgical and postoperative situations of the second stage operation:the patient underwent right hemihepatectomy successfully.The operation time and volume of intraoperative blood loss were 322 minutes and 900 mL.The patient received 300 mL of fresh frozen plasma infusion.Inflammatory indicators including body temperature,C-reactive protein,and liver function indices including Alb,ALT,AST,ascites,were recoved to normal level after symptomatic supportive treatment.WBC,procalcitonin,TBil,and PT were in the normal range.There was no complication of Clavien-Dindo classification Ⅱ or above.(3) Postoperative pathological examination:① Ⅱ stage hepatocellular carcinoma was confirmed,mass-like type,with tissue necrosis and microvascluar invasion.There was no distal metastasis and tumor did not invade liver capsule or surgical margin.Ishak score of surrounding tissues was 3 in the inflammation and 2 in the fibrosis.② Chronic inflammation was detected in the gallbladder mucosa.③ Reactive hyperplasia was found in the 2 lymph nodes of the group 8.④ One in the group 12 lymph nodes showed reactive hyperplasia.Immunohistochemistry showed positive Glypican-3,Hepatocyte,Arginase-1,NM23,weakly positive vascular endothelial growth factor,and negative Ki-67,vascular endothelial cell marker CD34,biliary epithelial marker CK19 and CK 7,tumor suppressor gene P21 and P23.(4) Changes in FLR and tumor volume:FLR was 565 mL and 580 mL at the 5th and 14th day after the first stage operation respectively,accounting for 54％ and 57％ of total liver volume.The FLR to body weight ratio was 0.96 and 0.98,and the growth rate of FLR was 194％ and 202％.Tumor volume was 1 210 mL and 1 297 mL at the 5th and 14th day after the first stage operation respectively.Tumor necrosis volume was 635 mL and 500 mL at the 5th and 14th day after the first stage operation respectively.At the 5th and 14th day after the first stage operation,the liver CT examination showed that HARO was successfully underwent and the blood supply of remnant liver was good.Preoperative CT aothgraphy (CTA) examination showed that the right hepatic tumor had rich arterial blood supply.At the 5th day after the first stage operation,the CTA examination confirmed the ringed site of right hepatic artery,and the blood supply of the tumor gradually decreased.At the 14th day after the first stage operation,CTA examination showed significant decrease in the blood supply of liver tumors.Liver CT examination showed rich supply of the remnant liver and the liver volume of 829 mL at the 7th day after the second stage operation.(5) Perioperative hemodynamic changes of the right hepatic artery,proper hepatic artery and left hepatic artery.① Blood flow of right hepatic artery was 224.3,574.7,827.5,222.7,153.0,282.5,279.1,247.9 and 150.2 mL/min before the first stage operation,before right portal vein ligation,after right portal vein ligation and before right hepatic artery ringed and restriction,after right portal vein ligation and right hepatic artery ringed and restriction,at the 1st,3th,5th and 7th day after the first stage operation.Blood flow of right hepatic artery in the second stage operation was 505.0 mL/min.② Blood flow of proper hepatic artery was 399.7,793.5,830.5,1 075.4,784.7.5,821.2,722.8,467.4 and 555.4 mL/min before the first stage operation,before right portal vein ligation,after right portal vein ligation and before right hepatic artery ringed and restriction,after right portal vein ligation and right hepatic artery ringed and restriction,at the 1st,3th,5th and 7th day after the first stage operation.Blood flow of proper hepatic artery was 505.0,473.3,158.5,627.0,103.8 and 139.8 mL/min before right hepatectomy in the second stage operation,after right hepatectomy,at the 1st,3th and 5th day after the second operation,respectively.③ Blood flow of left hepatic artery was 147.5,13.8,19.4,16.2,62.1,93.9,67.1,30.8 and 106.1 mL/min before the first stage operation,before right portal vein ligation,after right portal vein ligation and before right hepatic artery ringed and restriction,after right portal vein ligation and right hepatic artery ringed and restriction,at the 1st,3th,5th,7th and 10th day after the first stage operation.Blood flow ot left hepatic artery was 52.0,43.2,112.4,103.6,80.7 and 56.1 mL/min before right hepatectomy in the second stage operation,after right hepatectomy,at the 1st,3th and 5th day after the second operation,respectively.(6) Perioperative hemodynamic changes of left-portal vein and main portal vein.① Blood flow of left portal vein was 552.6,181.2,412.2,320.0,1 777.7,1 284.7,749.5 and 484.2 mL/min before the first stage operation,before right portal vein ligation,after right portal vein ligation and right hepatic artery ringed and restriction,at the 1st,3th,5th,7th and 10th day after the first stage operation,respectively.Blood flow of left portal vein was 793.3,979.0,485.2,1 042.5,803.5 and 548.3 mL/min before right hepatectomy in the second stage operation,after right hepatectomy,at the 1st,3th,5th and 7th day after the second operation respectively.② Blood flow of main portal vein was 1 186.0,696.7,833.7,431.7,1 319.1,668.4,890.7,550.8 mL/min before the first stage operation,before right portal vein ligation,after right portal vein ligation and right hepatic artery ringed and restriction,at the 1st,3th,5th,7th and 10th day after the first stage operation,respectively.Blood flow of main portal vein was 846.4,937.4,891.2,1 671.0,2 697.8,and 1 230.0 mL/min before right hepatotectomy in the second stage operation,after right hepatectomy,at the 1st,3th,5th and 7th day after the second stage operation,respectively.(7) Follow up:the patient was followed up for 6 months and survived well,with Child A of liver function and normal alpha fetoprotein level.Liver contrast CT examination showed increase in the remnant liver,good blood supply,and no tumor recurrence.The FLR was 727 mL at the 2 months after operation.Conclusion For patients with giant hepatocellular carcinoma,HARO-ALPPS can be performed to decrease blood supply of tumor,increase tumor necrosis area,and reduce the incidence of intrahepatic arteriovenous fistula,which ensure blood supply of remnant liver hyperplasia.
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Objective@#To analyze the prevalence and influencing factors of suicidal behaviors among middle school students in minority areas of Guizhou Province, and to provide the reference for targetedly preventing suicidal behavior among middle school students.@*Methods@#Questionnaire survey including adolescent health information, Depression Self-rating Scale for Children(DSR-SC), Childhood Trauma Questionnaire-Short Form (CTQ-SF) and the Pittsburgh Sleep Quality Index survey were conducted among 6 139 middle school students in minority areas of Guizhou Province, Logistic regression was used to analyze the influencing factors of suicidal behavior of middle school students.@*Results@#A total of 1 241(20.2%) had suicidal ideation in the past 12 months, and 250 (4.1%) of middle school students had committed suicide in the past 12 months. Suicidal ideation among middle school students was positively associated with: female, non-residence, being only child, smoking, having poor relationship with teachers, poor relationship with classmates, school violence victimization, physical abused, sexual abuse, emotionally neglected, having depression, having sleeping disorders(OR=1.67, 1.64, 0.84, 0.72, 0.67, 0.58, 2.06, 2.45, 2.12, 1.68, 2.82, 1.62). While being women(OR=1.52), non-residence(OR=2.25), smoking(OR=0.52), poor relationship with teachers(OR=0.49), poor relationship with classmates(OR=0.47), school violence victimization (OR=1.79) and physically abused(OR=2.17), sexual abused(OR=1.97), physically neglected(OR=1.94), depressive symptoms(OR=3.14), sleep disorders (OR=1.66) were associated positively with the risk of suicide attempt.@*Conclusion@#Suicide-related behaviors are more common in minority areas of Guizhou Province. Teachers and parents should attach great importance to it, and their suicidal risk should be early recognized to reduce suicide-related behaviors.
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Objective To investigate the correlation between interleukin-6 (IL-6) and future liver remnant (FLR) growth after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 15 patients who underwent ALPPS at the First Affiliated Hospital of Guangxi Medical University between March 2017 and May 2018 were collected.Observation indicators:(1) intraoperative situations in the first staged ALPPS and the second staged ALPPS;(2) postoperative situations:① postoperative complications and duration of hospital stay,② results of pathological examination;(3) IL-6 concentration in the peripheral blood before and after operation;(4)follow-up situations.Follow-up using outpatient examination,telephone interview and internet was performed to detect life quality and survival of patients.Imaging examination was done to detect tumor recurrence and metastasis.Follow-up was done up to May 2018.Measurement data with normal distribution or similar normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Repeated measures data were analyzed by the repeated measures ANOVA.Correlation comparison was done using Pearson bivariate correlation test.Results (1) Intraoperative situations.① The first staged ALPPS:15 patients had liver parenchymal transection via anterior approach combined with selective hepatic vascular exclusion,without allogenic blood transfusion.The operation time,volume of intraoperative blood loss,FLR at postoperative 16 days,interval time to the second staged ALPPS,growth rate of liver volume,ratio of FLR and standard liver volume (SLV) were respectively 324 minutes (range,240-387 minutes),356 mL (range,200-600 mL),(582± 134) cm3,24 days (range,9-34 days),35％±20％ and 53％±7％.② The second staged ALPPS:of 15 patients,13 underwent the second staged ALPPS successfully including 11 undergoing middle hepatic vein preserved right hepatectomy and 2 undergoing expanded right hemihepatectomy or right trisegmentectomy,1 underwent transcatheter arterial chemoembolization (TACE) due to FLR/SLV =31％,1 was detected yellow-white nodules at left lobe and confirmed as hepatocellular carcinoma by frozen section pathological examination,and then improved and discharged after 5-FU abdominal local chemotherapy combined with postoperative TACE.The operation time,volume of intraoperative blood loss of 13 patients undergoing the second staged ALPPS were 324 minutes (range,140-515 minutes) and 639 mL(range,100-1 400 mL).Two patients had blood transfusion including 1 with 800 mL of fresh frozen plasma and 4.0 U of red cells and 1 with 600 mL of plasma and 9.5 U of de-leucocytes and red cells.(2) Postoperative situations.① Postoperative complications and duration of hospital stay:15 patients had no perioperative death,9 and 6 were detected grade A and grade B liver failure respectively,15 had grade Ⅰ complications of Clavien-Dindo classification and no patient had grade Ⅱ and above complications,10 had pleural effusion including 1 with volume of effusion ＞500 mL.Of 13 patients undergoing the second staged ALPPS,4 and 9 were detected grade A and grade B liver failure respectively,8 and 5 had grade Ⅰ and Ⅱ complications of Clavien-Dindo classification and no patient had grade Ⅲ and above complications,11 had few pleural effusion with volume of effusion ＜500 mL.Patients with grade B liver failure and grade Ⅱ complications were recovered and discharged after treatments of liver protection,gastric protection,reinforced dressing change,continuous use of Alb,fresh frozen plasma transfusion.The patient with volume of pleural effusion ＞ 500 mL was improved after closed thoracic drainage and other patients with pleural effusion were improved after symptomatic and supportive treatment.Duration of total hospital stay was 31 days (range,22-49 days) in 15 patients.② Results of pathological examination:13 patients undergoing complete ALPPS were diagnosed as hepaticocellular carcinoma with R0 resection and without cancer cells involving surgical margin,including 7 with grade Ⅱ portal vein tumor thrombus.Ishak score for postoperative pathological fibrosis and liver cirrhosis was 7.7±1.4 in 15 patients,including 1 case of 5,1 case of 6,2 case of 7,6 case of 8,5 case of 9.(3) IL-6 concentration in the peripheral blood before and after operation:IL-6 concentration in the peripheral blood before surgery was (8±3)ng/L in 15 patients,and (207±150)ng/L,(104±65)ng/L,(45±38)ng/L,(26±9)ng/L,(18±10)ng/L at 1,3,5,7,10 days after the first staged ALPPS,showing a statistically significant difference in changing trend before and after surgery (F=25.877,P＜0.05) and statistically significant differences in paired comparison between 1,3,5,7,10 days after the first staged ALPPS and before surgery respectively (P＜0.05).There was correlation between IL-6 concentration in the peripheral blood at 1,3 days after the first staged ALPPS and growth of FLR (r=0.766,0.881,P＜0.05),and also between IL-6 concentration in the peripheral blood at 1,3 days after the first staged ALPPS and growth rate of FLR (r =0.810,0.879,P＜ 0.05).(4) Follow-up:15 patients were followed up for 1-14 months with a median time of 7 months.Of the 15 patients,1 without the second staged ALPPS died of multiple organ dysfunction syndrome at 7 months after the first staged ALPPS,14 survived and took care of theirselves in daily life during follow-up with improved life quality,including 1 detected multiple lung metastases at 12 months after complete ALPPS with mild increased AFP and 13 undetected new lesions in the remnant liver on contrast-enhanced CT and liver contrast-enhanced ultrasonography with normal AFP.Conclusion The peak of IL-6 concentration in peripheral blood at 1,3 days after the first staged ALPPS is significantly correlated with the hyperplasia of FLR,which may be used to predict the hyperplasia of FLR.
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Objective To study the seropositive ratio of the antibody to aquporin 4 (AQP4-IgG) and myelin oligodendrocytes glycoprotein antibody(MOG-IgG)in patients with autoimmune-associated central nervous system (CNS) diseases. Meanwhile, epidemiology and clinical manifestation and diagnosis,laboratory examination and magnetic resonance imaging(MRI)of AQP4-IgG seropositive and MOG-IgG seropositive patients are described. Methods 2068 patients serum samples were collected and enrolled in the multi-center research. The methodology of cell-mediated immunofluorescence staining was used to detect serum AQP4-IgG and MOG-IgG. Clinic medical records were collected and characteristics of epidemiology and manifestation were compared. Results 681 patients were AQP4-IgG seropositive and 110 patients were MOG-IgG seropositive. The female/male ratio and age of onset of patients with AQP4-IgG seropositive(616 female and 65 male,female:male=9.50:1.00;Age of onset=41.7±14.9)were significantly higher than that of patients with MOG-IgG (57 female and 53 male, female:male=1.08:1.00, P<0.0001; Age of onset=27.0 ±17.7, P<0.0001). The optic neuritis was significantly higher in patients with AQP4-IgG seropositive and patients with MOG-IgG seropositive (38.4% vs.53.5%, P<0.05).Among patients with AQP4-IgG seropositive, 42.14% conformed the diagnostic criteria of neuromyelitis optica (NMO),which was higher than that of patients with MOG-IgG seropositive (13.64%, P<0.0001). Laboratory examination showed that there was no significant difference in cerebrospinal fluid protein levels between patients with AQP4-IgG seropositive and those with MOG-IgG seropositive.MRI imaging suggested that AQP4-IgG positive patients were more common in cervical thoracic spinal cord lesions, while MOG-IgG positive patients were more involved in thoracolumbar spinal cord. The study also found that these two groups of patients could be comorbid with other autoimmune antibodies. Conclusions This multi-center research has revealed that patients with AQP4-IgG seropositive and those with MOG-IgG seropositive display differences in epidemiology,clinic manifestations and diagnosis,laboratory examination and MRI imaging. AQP4-IgG and MOG IgG auto-antibody detection are necessary for clinic diagnosis and differential diagnosis.
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Objective To analyze common complications of arm port and chest port using meta-analysis and to investigate the safety of ann port.Methods Randomized controlled trials,cohort studies and well-designed casecontrol trials published in CNKI,Wanfang,VIP,PubMed,CINAHL and Embase regarding complication comparison between arm port and chest port were searched.Review Manager 5.3 software was applied to analyze outcome indicators.Results Nine retrospective cohort studies and 2511 patients were included.The results of meta-analysis showed that the incidence of thrombosis in ann port group was lower than that in chest port group,and the difference was statistically significant [0R=0.51,95％CI (0.28,0.92),P=0.03].However,there was no significant difference in incidence of infection[OR=0.85,95％CI(0.53,1.38),P=0.52],incidence of obstruction[OR=1.05,95％CI(0.37,3.01),P=0.92],incidence of sepsis [OR =0.44,95％ CI (0.10,1.87),P=0.27],incidence of skin incision [OR =0.28,95％ CI (0.07,1.17),P=0.08].Conclusion The incidence of thrombosis in ann port was lower than that in chest port,and there was no obvious advantage in the incidence of infection,obstruction,sepsis and skin incision.
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Objective To investigate the clinical, biochemical and genetic features of a Chinese boy with holocarboxylase synthetase deficiency (HCSD). Methods The clinical and genetic data of a rare case of HCSD were retrospectively analyzed. Results After birth, the boy showed development delay. At 3 months old, the boy was started with rehabilitation. Tandem mass spectrum and gas chromatography analysis was carried in the 5th month after birth because of the recurrent upper respiratory tract infection and elevated level of C5-OH in the blood and decreased level of C0,and elevated level of 3-OH-propionic, pyruvic acid, methylcrotonylglycine in the urine were in accordance with the HCSD. Genetic analysis found compound heterozygous mutations of c.1648G>A and c.1544G>A in gene, of which the latter one is novel. After the treatment of biotin (20 mg/d) and L-Carnitine, the condition of this boy was gradually improved. Conclutions HCSD is characterized with slow onset and inconspicuous manifestations. The confirmed diagnosis can be built with MS/MS, GC/MS analysis and gene mutation analysis. The effect of early biotin treatment is satisfactory. In this study,we carried out clinical and genetic diagnosis,which lays a solid foundation for prenatal diagnosis and early treatment.
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Objective To explore the clinical features, diagnosis, and treatment of congenital disorder of glycosylation type 1a (CDG-Ⅰa), a rare inherited metabolic disease. Methods The clinical data and the gene detection results of one case of CDG-Ia which was discovered because the case had encephalopathy and hepatopathy were retrospectively analyzed. The related literatures were reviewed. Results Male infant suffered with face and trunk rash, motor development retardation, malnutrition, cheek fat plump, low limbs muscle tone, and bilateral crater nipple at 3 months old. Abnormal liver function and mild renal impairment were found after examination. The development quotient was low. Head MRI showed that bilateral frontal and temporal sulcus widening, and cerebellar atrophy. Urinary organic acids, amino acids, carnitine, and biotin activities were normal. Gene sequencing revealed that there were two heterozygous mutations, c.430T>C (p.F144L) and c.713G>C (p.R238P), in the PMM2 gene. The diagnosis of CDG-Ⅰa was confirmed. Both of the infant's parents were healthy, and each of them carries a pathogenic mutation. The infant had an elder brother who had mental disorder and died for liver and kidney function damage and hydronephrosis at 8 months old. Conclusion CDG-Ⅰa is an autosomal recessive disease. For infants with unexplained multiple organ damage, especially combined with intelligent and motor development retardations, strabismus, nipple retraction, and cerebellar atrophy, the possibility of CDG-Ⅰa should be considered. Gene detection of PMM2 can help the diagnosis.
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Objective:To study the relationship of Guangxi Zhuang women being infected by HPV16 and suffering from cervical cancer with HLA-DQB1 allele polymorphism.Provide clues for seeking hereditary susceptibility gene or resistant gene of cervical cancer of Guangxi Zhuang women.Methods:Chose the cervical cancer diagnosed female patients and health women 171 cases respectively aged between 25 and 45 of Guangxi as subject investigated(people in the two groups were paired by age ±3 years).Took their samples to extract HPV DNA and human genome DNA.Then detected HLA-DQB1 alleles and HPV genetype applying PCR-SSP and molecular diversion hybrid technology.Finally the data were statistically analyzed.Results:(1)The total infection rate of HPV in 171 cases of cervical cancer patient was 91.22%,in which the high-risk virus accounted for 90.76%,HPV16 was the main pathogenic subtypes(43.58%).(2)The allele carrying rate of HLA-DQB1*04 in the cervical cancer group was higher than the health control group with statistically significant difference(P0.05).(3)The occurrence frequency of HLA-DQB1*04 alleles in HPV16 positive cervical cancer patients was significantly higher than HPV16 negative patients with statistically significant difference(P<0.05).Conclusion:HLA-DQB1*04 alleles are probably the susceptibility genes of cervical cancer of Guangxi Zhuang women;HLA-DQB1*06/09 alleles are probably the protective genes of cervical cancer of Guangxi zhuang women;HLA-DQB1*02/05/07/08 alleles seem irrelevant to hereditary susceptibility of cervical cancer of Guangxi Zhuang women.And Guangxi Zhuang women carried HLA-DQB1*04 alleles are more likely to infect HPV16 that increase the risk of cervical cancer.
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[Objective]To compare the differences of neuromyelitis optica spectrum disorder(NMOSD)and multiple sclerosis (MS) on pregnancy ,and analyze the mutual impact of pregnancy on the diseases.[Methods]Prospectively collected clinical information of 235 NMOSD patients and 125 MS patients ,including the annualized relapse rate (ARR),the Expanded Disability Status Scale(EDSS)and pregnancy outcomes. 70 NMOSD patients and 30 MS patients were screened out as information patients. The ARR and EDSS score in two groups were compared during the year before pregnancy,during pregnancy and after 1 year postpartum, respectively. 50 cases of normal pregnant women for the same period as the control group ,then to compared the difference of three groups on pregnancy outcomes.[Results]Attacks occurring during pregnancy or one year after childbirth/abortion in NMOSD and MS were 53.25%(41/77)and 20.00%(7/35)(P=0.001);The ARR during the first 3 months postpartum periods of NMOSD and MS group(2.65,2.51)was significantly higher than during the year before pregnancy(0.27,0.49,P < 0.001)and during pregnancy (0.32,0.2,P<0.001);The EDSS score of two groups increased after 1 year postpartum(3.06 ± 2.16,2.19 ± 1.28)than that during the year before pregnancy(1.58 ± 0.48,1.92 ± 1.29,P < 0.001)and during pregnancy(1.92 ± 1.35,1.67 ± 0.70,P < 0.001). There was no difference on ARR and EDSS score between NMOSD and MS group. NMOSD ,MS and normal control group had no dif?ference on pregnancy outcomes and neonatal weight.[Conclusions]Compared with MS,the attack of NMOSD had more closer relation?ship with pregnancy;both NMOSD and MS would increase the risk of disease relapsing and disability after pregnancy;the diseases had no effect on pregnancy outcomes.
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Objective To observe the clinical efficacy of fire-needle plus round-sharp-needle acupuncture in treating primary trigeminal neuralgia.Method Sixty-two patients with primary trigeminal neuralgia were randomized into a treatment group and a control group, 31 cases in each group. The treatment group was intervened by fire-needle therapy at the trigger points followed by deep needling with round-sharp needle at Xiaguan (ST7), and the distal points Hegu (LI4) and Neiting (ST44) were also treated. The same acupoints were selected in the control group but treated with ordinary needling method. The clinical efficacies were evaluated after 2 treatment courses.Result The total effective rate was 93.5%(29/31) in the treatment group versus 77.4% (24/31) in the control group, and the difference was statistically significant (P<0.05).Conclusion Fire-needle plus round-sharp-needle acupuncture is an effective approach in treating primary trigeminal neuralgia.