ABSTRACT
The body is in a very complex pathophysiological state under trauma, including ischemia and hypoxia, inflammation caused by infection and tissue necrosis and accumulation of metabolic waste. Metastasis associated lung adenocarcinoma transcript 1 (MALAT1) is involved in the regulation of a variety of cell behaviors, such as proliferation, apoptosis, differentiation, migration, epithelial-mesenchymal transition, autophagy and morphological maintenance. Under trauma, the expression of MALAT1 is significantly increased. In different injury models, the role of MALAT1 is slightly different, and the specific mechanism is unknown. The authors summarize the regulatory effects of MALAT1 on the body under traumatic conditions from the biological characteristics of MALAT1 and its role in different injury models, so as to provide references for clinical control of inflammation development and improvement of disease prognosis.
ABSTRACT
Objective@#To investigate the clinicopathologic features and prognosis of the patients who had clear cell renal cell carcinoma (CCRCC) with metastasis to the pancreas.@*Methods@#From Jan, 2000 to Dec, 2018, 18 patients with clear cell renal cell carcinoma (CCRCC) and had pathologically diagnosed metastasis to the pancreas were enrolled at Peking Union Medical College Hospital. The clinical and pathological data were retrospectively analyzed.@*Results@#11 out of 18 patients were male, and the other 7 were female. The average age of onset of CCRCC was 51.4 years. 8 cases (44.4%) occurred in the left kidney, and the other 10 cases (55.6%) with right kidney tumor. Three patients had synchronous pancreatic metastasis, and the other 15 patients had metachronous pancreatic metastasis. The median time from CCRCC onset to pancreas metastasis was 156 months. The main complaints of pancreas metastasis were abdominal pain, jaundice, gastrointestinal bleeding, nausea, weakness, loss of weight and so on. Seven patients (38.9%) had single lesion of pancreas, while 11 patients (66.1%) had multiple lesions of pancreas. Nine patients (50%) had other organs metastasis besides pancreatic metastasis at the same time. Five patients underwent pancreatic metastasis resection, while 15 patients received oral tyrosine kinase inhibitor(TKI). The mean follow-up was 171.7 months(1~361.5 months) and 5 patients died. The median overall survival (mOS) was 122 months, and the 5 year-survival rate was 81.4%. In univariate analysis, synchronous metastasis to the pancreas, relapse after 10 years, Memorial Sloan Kettering Cancer Center prognostic index, International Metastatic Renal Cell Carcinoma Database Consortium index were all significant parameters for patients′survival.@*Conclusions@#Metastasis to the pancreas from clear cell renal cell carcinoma were rare. These patients had better survival outcomes, especially those relapsing after ten years. Pancreatic metastasis resection had no significant benefit on patient′s survival.
ABSTRACT
Objective The current manipulator with double parallel quadrilateral mechanism should be connected in series with a flexible degree of freedom (DOF) mechanism, which increases the volume of the manipulator, decreases the motion flexibility and creates the interference between the mechanical arms that hold the mirror and the device. Aimed at solving this problem, a novel mechanical arm was put forward to enhance the motion flexibility and reduce the volume of the manipulator. Methods The mechanical arm was designed by using the mechanism of five-link, slider and slide rail lower pair and wire transmission to realize the telescopic movement of the end effector. The kinematics model of the manipulator was established, and the MATLAB was used as the simulation tool to verify the correctness of the D-H parameters under the specific zero joint angle, and the motion equation of the manipulator was solved. Meanwhile, the three-dimensional workspace of the end effector was obtained by using Monte Carlo algorithm, and the preoperative plan of animal experiment for 3 arms was performed. Finally, cholecystectomy and other operations were acted in pigs, to verify the rationality and maneuverability of the design of double 5-link 2-DOF manipulator. Results The working space of Monte Carlo algorithm under MATLAB environment was -650.4 mm＜x＜649 mm, 163.8 mm＜y＜1 202 mm and -254.6 mm＜z＜829.8 mm. Sixteen cases of pig cholecystectomy were successfully completed, with an average operation time of 51 minutes. Conclusions The novel double 5-link 2-DOF manipulator could successfully complete cholecystectomy and other operations in pigs, which had no other symptoms after the operation. There was no interference between the mechanical arms, which fully verified the feasibility of the design scheme of the robot manipulator for minimally invasive surgery.
ABSTRACT
Objective@#The study was designed to analyze the clinicopanthologic characteristics, treatments and outcomes of a series of patients with primary angiosarcoma.@*Methods@#The clinical, surgical and pathological data and treatment of 68 patients with pathologically confirmed angiosarcoma admitted to Peking Union Medical College Hospital from January 1990 to June 2017 was retrospectively analyzed. Kaplan-Meier method and Log rank test were used for univariate survival analysis and Cox regression model was used for multivariate survival analysis.@*Results@#A total of 68 patients were enrolled, 38 were male, 30 were female. The median age at diagnosis was 50.5 years. The time from symptom onset to diagnosis was (7.5±7.5) months. The primary sites included face and scalp, breast, chest wall, lung, heart, liver, spleen, extremities, bones and so on. At diagnosis, the mean size of tumors were (7.4±7.3) cm, 28 patients (41.2%) had localized disease (stage Ⅰ+ Ⅱ) and 40 patients had metastatic disease (stage Ⅲ+ Ⅳ). There were 37 patients treated with surgery alone, three receiving radiotherapy alone, five receiving chemotherapy alone and sixteen receiving comprehensive treatment with 5 underwent surgery plus radiotherapy, three treated by surgery plus chemotherapy, four had surgery plus interventional therapy, two had chemoradiotherapy, one had radiotherapy and interventional therapy and 1 had surgery plus chemoradiotherapy and targeted therapy. Five patients received only palliative treatment, and 2 patients lost follow-up after diagnosed. Fifty patients were followed up with a median overall survival time of 8.5 months. The median survival time of patients with metastatic angiosarcoma was 6.6 months, significantly shorter than that of patients with localized disease (15.0 months, P=0.020). The median survival time of patients with cardiac angiosarcoma was 3.0 months, significantly shorter than that of patients with angiosarcoma at other sites (11.5 months, P=0.010). The median survival time of patients receiving comprehensive treatment was 31.0 months, significantly longer than that of patients without comprehensive treatment (5.6 months, P=0.007). Multivariate analysis showed that staging, heart occurrence and comprehensive treatment were independent factors for the prognosis of primary angiosarcoma (all P<0.05).@*Conclusions@#Angiosarcoma is a rare malignancy, and patients with metastatic disease or cardiac occurence have poor prognosis. Comprehensive treatment can improve the prognosis of patients with angiosarcoma.
ABSTRACT
Objective@#To analyze the clinical, radiologic characteristics, and outcome of consecutive patients with primary cardiac angiosarcoma.@*Methods@#The medical records of patients with primary cardiac angiosarcoma diagnosed through pathology at Peking Union Medical College Hospital between January 2001 and May 2018 were obtained. The results of echocardiography, coronary artery CT angiography (CTA), cardiac magnetic resonance (CMR), positron emission computed tomography (PET-CT), operation, postoperative treatment and prognosis of the patients were analyzed.@*Results@#A total of 16 patients were included, 9 were male, 7 were female, the median age was 42.5 years (31.7, 52.5). The interval from symptoms onset to diagnosis was 4.5 months (0.5-18.0 months). Eight patients were diagnosed at non-metastatic phase, while 8 patients were in metastatic phase. The main complaints were dyspnea, short breath, chest pain, hemoptysis, syncope, edema, fever, fatigue, and cough. Three patients (18.8%) had pericardial tamponade in the course of the disease. Echocardiography was performed on all 16 patients, cardiac mass was found in 12 patients, and pericardial effusion or pericardial thickening was observed in 4 patients. In 8 cases with results of coronary CTA, 5 cases presented signs of right atrium occupation, 1 case presented sign of right ventricle occupation, and 1 case presented isolated massive pericardial effusion. None abnormality was found in 1 case. Of the 7 patients who underwent CMR, 6 presented with right atrium mass occupation and 1 mediastinal mass. Four patients received PET-CT examination and results showed that all presented with hypermetabolic lesions: 2 in right atrium, 1 in pericardium, and 1 in mediastinum, and lung metastasis was found in 2 cases. Among the 16 patients, 13 received surgical treatment, 2 received adjuvant chemotherapy, and 1 received chemotherapy and radiotherapy after biopsy. The median overall survival was 3.0 months.@*Conclusion@#Cardiac angiosarcoma is a rare malignancy with poor prognosis, and echocardiography has only limited diagnostic value for angiosarcoma. CMR, CTA or PET-CT examinations could provide valuable clues for the diagnosis of this rare disease.
ABSTRACT
Objective To study the expression and role of galanin in the hypothalamus of rat with the drug-induced hyperprolactinemia.Methods Hyperprolactinemia was induced by daily intraperitoneal injections 50 mg/kg sulpiride solution.The protein in the hypothalamus of rat was extracted to determine the expression levels of galanin with Western Blot.The expression and colocalization of galanin and dopamine in model and control group were observed with immunofluorescence.Results The model group showed a significant increase of serum prolactin (PRL) level and a significant decrease of serum estradiol (E2) level,as compared to the control group ((15.74±2.49) ng/ml vs (10.25±1.29) ng/ml and (4.24±0.69)pg/ml vs (9.56±3.25) pg/ml,respectively,P＜0.05).Both the expression level of galanin and the number of neurons coexisting with galanin and dopamine were decreased in the hypothalamus of the hyperprolactinemia rat compared with the control group.Western Blot revealed that,compared to the control group,the sulpiride model group had a significant increase of galanin but not TH (0.405±0.112 vs 0.985±0.158,P＜0.05 and 0.871 ± 0.046 vs 0.890±0.054,P＞ 0.05,respectively).Conclusion Galanin expression level has decrease in the hypothalamus of the hyperprolactinemia rat,which contributes to the reduction of dopaminergic neurons.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the hemodynamics evidence of the descending branch of lateral circumflex femoral artery in a reversed way. To explore the clinical result of using the reversed descending branch of the lateral circumflex femoral artery as the receipt artery for free flaps for reconstruction of the leg soft-tissue defect.</p><p><b>METHODS</b>From October 2005 to February 2012, 38 patients with severe leg soft-tissue defects were treated. The proximal antegrade and retrograde mean artery pressure of the descending branch of the lateral circumflex femoral artery in 16 of 38 patients were recorded during operation. All wounds had osteomyelitis, bone and tendon exposure requiring coverage reconstruction. And there was no recipient artery in the injured lower leg for free flaps in all 38 patients. Reversed descending branches of lateral femoral circumflex arteries were used as recipient arteries for free flaps (free latissimus dorsi flap, free thoracoumbilical flap, and free anterolateral thigh flap) in all patients. The flap donor site was closed directly or with the skin graft.</p><p><b>RESULTS</b>The proximal antegrade mean artery pressure of the descending branch of lateral circumflex femoral artery was(81.6 +/- 12.4) mmHg. The proximal retrograde pressure was(48.2 +/- 10.7) mmHg. The proximal retrograde mean artery pressure was 59.07 percent of the proximal antegrade pressure. The donor skin graft survived and wound healed primarily. After operation, 2 flaps had distal partial necrosis and healing was achieved after dressing change. All the other flaps survived completely without vascular problems. All the patients were followed up for 11 months to 2.5 years (mean, 1.6 years). The flap appearance was satisfactory. The texture and color of flaps in all cases were good.</p><p><b>CONCLUSIONS</b>The reverse descending branch of lateral circumflex femoral artery is a reliable recipient artery for the free flaps. It is an easy and simple technique that can be used for reconstruction of the defects in the lower leg, with the reversed descending branch of lateral circumflex femoral artery as recipient artery.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Blood Pressure , Femoral Artery , General Surgery , Free Tissue Flaps , Hemodynamics , Lower Extremity , Wounds and Injuries , Soft Tissue Injuries , General SurgeryABSTRACT
Objective To explore the changes and clinical significance of regulatory T cell/T help cell 17 (Th17) in the peripheral blood from patients with dermatomyositis (DM).Methods Thirty-six patients with DM were recruited and thirty-six healthy individuals were enrolled as normal controls.The percentage of regulatory T cell/Th17 cell was assessed by flow cytometry and the mRNA levels of Foxp3/RORγt were detected by real-time quantitative reverse wanscription polymerase chain reaction (RT-PCR).The plasma levels of TGF-β1/IL-17 were measured by enzyme linked immunosorbent assay (ELISA).T-test was used for statistical analysis and Pearson's linear analysis were used for correlation analysis.Results The percentage of CD4+ Foxp3+ T cell,the mRNA expression of Foxp3 and the plasma levels of TGF-β1 decreased significantly in patients with DM than in normal controls [(7.2±2.3)％ vs (9.1±3.2)％,(0.44±0.19) vs (0.62±0.25),(37 400±4814) pg/ml vs (41 200±6348) pg/ml,P＜0.05].The percentage of Th17 cell,the mRNA expression of RORγt and the plasma levels of IL-17 increased in patients with DM compared with normal controls [(1.22±0.41)％ vs (0.83±0.14)％,(0.85±0.34) vs (0.61±0.21),(77±32) pg/ml vs (58±20) pg/ml,P＜0.05].There was negative correlation between the percentage of regulatory T cell,the mRNA levels of Foxp3,the plasma levels of TGF-β1 and the serum levels of CK in patients with DM (r=-0.573,-0.593,-0.618,P＜0.05).There was positive correhtion between the percentage of Thl7 cell,the mRNA levels of RORγt,the plasma levels of IL-17 and the serum levels of CK in patients with DM (r=0.582,0.609,0.623,P＜0.05).Conclusion The imbalance of regulatory T cell/Th17 cell may exist in the peripheral blood of patients with DM.Regulatory T cell/Th17 cell may be associated with the pathology of DM.
ABSTRACT
Objective To investigate the relevant risk factors for,clinical manifestation and treatment responses of symmetric acral keratoderma in 9 patients.Methods Clinical data were collected from 9 outpatients with symmetric acral keratoderma.Skin lesions were photographed,tissue specimens were obtained from the lesions and subjected to fungal and histopathological examinations.The patients were given topical treatment.Results There were 8 males and 1 female in these patients with an average age of 28.2 years and age at onset of 24.6 years.The disease duration varied from 2 months to 16 years.The lesions were predominantly distributed on the dorsum of both hands and wrists symmetrically and circularly.Ankles were the third popular site involved.Generally,the lesions were aggravated in summer,spontaneously cured in winter.Most of the patients had a history of occupational contact with plastics or rubber.Some patients suffered from ichthyosis vulgaris.Microscopic examination for fungal element was negative.Histopathology revealed epidermal hyperkeratosis,acanthosis and mild papillomatosis.The urea and Vitamin E cream mixed with clobetasol propionate cream at a ratio of 1 ∶ 1 proved to be effective.Conclusions Ichthyosis vulgaris may be a risk factor for symmetric acral keratoderma.The whitening of lesions after short exposure to water may be a kind of physical phenomenon with the involvement of water and air.Topical steroids may serve as the first-line treatment choice for symmetric acral keratoderma.