CT radiomics for prediction of microvascular invasion in hepatocellular carcinoma: A systematic review and meta-analysis

Abstract The power of computed tomography (CT) radiomics for preoperative prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) demonstrated in current research is variable. This systematic review and meta-analysis aim to evaluate the value of CT radiomics for MVI prediction in HCC, and to investigate the methodologic quality in the workflow of radiomics research. Databases of PubMed, Embase, Web of Science, and Cochrane Library were systematically searched. The methodologic quality of included studies was assessed. Validation data from studies with Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) statement type 2a or above were extracted for meta-analysis. Eleven studies were included, among which nine were eligible for meta-analysis. Radiomics quality scores of the enrolled eleven studies varied from 6 to 17, accounting for 16.7%-47.2% of the total points, with an average score of 14. Pooled sensitivity, specificity, and Area Under the summary receiver operator Characteristic Curve (AUC) were 0.82 (95% CI 0.77-0.86), 0.79 (95% CI 0.75-0.83), and 0.87 (95% CI 0.84-0.91) for the predictive performance of CT radiomics, respectively. Meta-regression and subgroup analyses showed radiomics model based on 3D tumor segmentation, and deep learning model achieved superior performances compared to 2D segmentation and non-deep learning model, respectively (AUC: 0.93 vs. 0.83, and 0.97 vs. 0.83, respectively). This study proves that CT radiomics could predict MVI in HCC. The heterogeneity of the included studies precludes a definition of the role of CT radiomics in predicting MVI, but methodology warrants uniformization in the radiology community regarding radiomics in HCC.

Therapeutic effects of B ultrasound-guided extracorporeal shock wave lithotripsy combined with tamsulosin hydrochloride medication on ureteral calculi / 中国基层医药

Objective:To investigate the therapeutic effects of B ultrasound-guided extracorporeal shock wave lithotripsy combined with tamsulosin hydrochloride medication on ureteral calculi.Methods:The clinical data of 130 patients with ureteral calculi who received treatment in Ninghai First Hospital from March 2019 to June 2020 were retrospectively analyzed. These patients were divided into an observation group and a control group ( n = 65/group) according to the different treatment methods. Patients in the control group received B ultrasound-guided extracorporeal shock wave lithotripsy, and those in the observation group received B ultrasound-guided extracorporeal shock wave lithotripsy combined with tamsulosin hydrochloride medication. Total response rate, stone-free rate after the first treatment, time taken to get rid of stone, treatment times, and Visual Analogue Scale (VAS) score 14 days after the first treatment were compared between the two groups. Renal function indexes (serum creatinine, blood urea nitrogen), mean arterial pressure, VAS score, blood loss, and immunoglobulin G, immunoglobulin M, malondialdehyde, superoxide dismutase levels were determined in the two groups. Results:The total response rate in the control group was significantly lower than that in the observation group [89.23% (58/65) vs. 98.46% (64/65), χ2 = 4.80, P < 0.05]. After 14 days of treatment, the VAS score in the observation group was significantly lower than that in the control group [(3.97 ± 0.36) points vs. (5.59 ± 0.87) points, t = 13.87, P < 0.05). After treatment, the stone-free rate after the first treatment in the control group was significantly lower than that in the observation group [61.54% (40/65) vs. 78.46% (51/65), χ2 = 4.43, P < 0.05). The time taken to get rid of stone and treatment times in the control group were (18.98 ± 3.52) days and (2.53 ± 0.50) times, respectively, which were significantly higher than (12.27 ± 2.77) days and (1.64 ± 0.55) times in the observation group ( t = 12.08, 9.66, both P < 0.05). Urine Kim-1 in the observation group was significantly higher than that in the control group [(89.46 ± 42.46) mmol/L vs. (72.75 ± 17.65) mmol/L, t = 2.93, P < 0.05]. Serum creatinine and blood urea nitrogen levels in the observation group were (101.75 ± 24.53) μmol/L and (348.76 ± 29.84) μmol/L, respectively, which were significantly lower than (139.53 ± 30.56) μmol/L and (397.65 ± 35.64) μmol/L in the control group ( t = 5.82, 8.48, both P < 0.05). After 20-minutes of anesthesia induction, the mean arterial pressure in the observation group was significantly higher than that in the control group [(83.45 ± 12.65) mmHg (1 mmHg=0.133 kPa) vs . (61.68 ± 9.75) mmHg, t = -10.99, P < 0.05]. Intraoperative blood loss in the observation group was significantly lower than that in the control group [(112.65 ± 30.74) mL vs. (170.68 ± 35.67) mL, t = 9.94, P < 0.05]. Serum immunoglobulin G and malondialdehyde levels in the observation group were (8.56 ± 1.74) g/L and (7.74 ± 0.74) mol/L, respectively, which were significantly higher than (7.75 ± 1.68) g/L and (5.21 ± 0.65) mol/L in the control group ( t = 2.70, 20.71, both P < 0.05). Serum immunoglobulin M and superoxide dismutase levels in the observation group were (1.23 ± 0.32) g/L and (71.75 ± 8.57) U/L, which were significantly lower than (1.55 ± 0.45) g/L and (90.64 ± 9.73) U/mL in the control group ( t = -4.67, -11.75, both P < 0.05). Conclusion:B ultrasound-guided extracorporeal shock wave lithotripsy combined with tamsulosin hydrochloride medication is more effective on ureteral calculi than B ultrasound-guided extracorporeal shock wave lithotripsy alone. The combined therapy can effectively reduce pain, increases the treatment efficacy, and is worthy of reference and promotion in clinical practice.

Research progress on the mechanism of hepatocarcinogenesis and development in tumor acidic environment / 中华肝胆外科杂志

Primary hepatocellular carcinoma (HCC) is one of the high-risk solid tumors in China. Although there has been more comprehensive progress on HCC caricinogenesis, migration and invasion, the 5-year survival is still poor. In recent years, it has been identified that tumor acidic microenvironment may promote the occurrence and development of hepatocellular carcinoma. In this paper, combined with the latest research at home and abroad, the research progress on the occurrence and development of hepatocellular carcinoma under an acidic environment was reviewed.

Research progress of adjuvant TACE therapy for liver cancer after radical resection / 中华肝脏病杂志

Transcatheter arterial chemoembolization (TACE) is the most commonly used method for non-surgical treatment of liver cancer, and it is usually used as an adjuvant therapy in patients who have not developed intrahepatic metastases after surgical resection. Postoperative adjuvant TACE therapy may provide a prognostic benefit in liver cancer patients with high recurrence risk. This article reviews the research progress of adjuvant TACE therapy for liver cancer after radical resection.

Changes in the structure of intestinal mucosal flora in colorectal cancer patients / 南方医科大学学报

OBJECTIVE@#To investigate the changes in bacterial flora in fecal samples, at the tumor loci and in adjacent mucosa in patients with colorectal cancer (CRC).@*METHODS@#We collected fecal samples from 13 patients with CRC and 20 healthy individuals and tumor and adjacent mucosa samples from 6 CRC patients. The differences in bacterial composition between the fecal and mucosa samples were analyzed with 16S rDNA sequencing and bioinformatics methods. We also detected the total number of bacteria in the feces using flow cytometry, isolated and identified the microorganisms in the fecal and mucosa samples using common bacterial culture media. We further tested the effects of 7 isolated bacterial strains on apoptosis of 3 CRC cell lines using lactate dehydrogenase detection kit.@*RESULTS@#The bacterial α-diversity in the feces of healthy individuals and in adjacent mucosa of CRC patients was significantly higher than that in the feces and tumor mucosa in CRC patients (P < 0.05). Lactobacillaceae is a specific bacteria in the feces, while Escherichia, Enterococcus, and Fusobacterium are specific bacteria in tumor mucosa of CRC patients as compared with healthy individuals. Cell experiment with3 CRC cell lines showed that Bacteroides fragilis isolated from the tumor mucosa of CRC patients produced significant inhibitory effects on cell proliferation (P < 0.0001), while the isolated strain Fusobacterium nucleatum obviously promoted the proliferation of the cell lines (P < 0.001).@*CONCLUSION@#The bacterial flora in the feces, tumor mucosa and adjacent mucosa of CRC patients is significantly different from that in the feces of healthy individuals, and the fecal flora of CRC patients can not represent the specific flora of the tumor mucosa. Inhibition of F. nucleatum colonization in the tumor mucosa and promoting B. fragilis colonization may prove beneficial for CRC treatment.

Screening and associated factors of hyperactivity behavior in preschool children in Anhui Province / 中国学校卫生

Objective@#To investigate the prevalence of hyperactive behavior and risk factors among preschool children, and to provide a reference for early intervention of problem behavior.@*Methods@#A total of 7 982 children aged 3-6 were selected from 30 kindergartens by multi stage stratified cluster random sampling in 5 areas, Anhui Province, and their parents were surveyed with Conners Parent Rating Scales(PSQ) and Related factors questionnaire from June to July 2020.@*Results@#A tollay of 126 children were detected with hyperactivity behaviors, with a detection rate of 1.6%. The detection rate of boys (2.2%) was higher than that of girls (0.8%). The difference was statistically significant ( χ 2=26.51, P <0.01). Among 126 hyperactive children, 40(31.7%)had another type of behavior problem, and 82(65.1%)had two or more additional behavior problems. The results of Logistic regression analysis showed that boy( OR =2.85, 95% CI =1.88-4.30), sleep deprivation( OR =1.87, 95% CI =1.31-2.68), occupation of mother being farmer or otherwise( OR =1.81, 95% CI =1.11-2.94) were associated with more hyperactivity behavior. While, living with parents in the past six months ( OR =0.61, 95% CI =0.40-0.92) was associated with less hyperactivity behavior( P <0.05).@*Conclusion@#Early intervention of preschool children s behavior problems should focus on boys, maintain reasonable sleep time and increase parental care.

Preparation of paclitaxel-loaded nanoparticles targeting liver cancer stem cells and their effects on liver cancer Huh-7 and HepG2 cells / 肿瘤研究与临床

Objective:To investigate the preparation of paclitaxel-loaded nanoparticles targeting liver cancer stem cells and their effects on liver cancer HepG2 cells (CD133 positive subset accounting for 8%) and Huh-7 cells (CD133 positive subset accounting for 65%).Methods:Poly (lactic-co-glycolic acid)-loaded paclitaxel nanoparticles were prepared by using emulsification-solvent evaporation method. Paclitaxel-loaded nanoparticles decorated with anti-CD133 antibody, called targeted nanoparticles, were prepared by using 1- (3-dimethylaminopropyl)-3-ethylcarbodiimide/N-hydroxysuccinimide (EDC/NHS) cross-linking method. The manifestations and physicochemical characteristics of the nanoparticles including encapsulation efficiency, loading efficiency, particle size distribution, morphology and release in vitro were studied. Liver cancer Huh-7 and HepG2 cells accompanying with paclitaxel-loaded nanoparticles or targeted nanoparticles were cocultured. The uptake and accumulation of nanoparticles by liver cancer cells were analyzed by using flow cytometry, and positive cell proportion of CD133 was also detected. Cell survival was analyzed by using plate clonogenesis assay.Results:Scan electromicroscopy result showed particle size of targeted nanoparticles was (429.26±41.53) nm with zeta potential of -11.2 mV; targeted nanoparticles were possessed with spherical morphology and higher encapsulation efficiency [(87.53±5.90) %]. Flow cytometry showed that in Huh-7 cells at 37℃, the fluorescence intensity of targeted nanoparticles group (13 397±720) was higher than that of paclitaxel-loaded nanoparticles group (6 898±604), and the difference was statistically significant ( P < 0.05); there was no statistically difference in the fluorescence intensity of HepG2 cells in paclitaxel-loaded nanoparticles group and targeted nanoparticles group at 37 ℃ (7 899±343 vs. 8 432±516, P>0.05). CD133 positive cell proportion of Huh-7 cells in targeted nanoparticles group [(15.7±2.6)%] was lower than that in paclitaxel-loaded nanoparticles group [(54.9±7.4)%], and the difference was statistically significant ( t = 7.31, P = 0.008); there was no statistical difference of HepG2 cells between the two goups ( P > 0.05). Plate clonogenesis assay showed that the cell survival rate of Huh-7 cells in targeted nanoparticles group was lower than that in paclitaxel-loaded nanoparticles group at different time points, and the difference was statistically significant ( F = 5.56, P = 0.009); but there was no statistically significant difference in HepG2 cell survival rate between the two groups ( F = 1. 19, P = 0.142). Conclusion:Prepared nanoparticles targeting liver cancer stem cells have a good inhibitory effect on liver cancer Huh-7 cells.

Correlation of B-type Natriuretic Peptide Level with Hemodynamic Parameters and Inflammatory Cytokines in Patients with Gram-negative Sepsis / 中国医学科学院学报

Objective To study the correlation of B-type natriuretic peptide(BNP)level with hemodynamic parameters and inflammatory cytokines in patients with Gram-negative sepsis,and further determine the main factors for the significant increase of BNP level. Methods The prospective study method was applied,and septic patients infected with Gram-negative bacteria from May 2017 to October 2019 were enrolled.The patients were divided into the BNP<2400 ng/L group and the BNP≥2400 ng/L group by taking the average value of BNP as the dividing point.The independent predictors of BNP≥2400 ng/L were analyzed by Logistic regression.Pearson correlation analysis was used to analyze the correlation between BNP and various indicators. Results A total of 106 patients with Gram-negative sepsis were included,among which 60 cases present with higher serum BNP levels than the average of(2398.45 ± 421.45)ng/L.Thus BNP≥2400 ng/L was considered as a significantly increased BNP level.Multiple logistic regression analysis showed that cardiac index(CI)[odds ratio (

Immunomodulator use in paediatric severe sepsis and septic shock

INTRODUCTION@#The use of drugs that modulate the immune system during paediatric severe sepsis and septic shock may alter the course of disease and is poorly studied. This study aims to characterise these children who received immunomodulators and describe their clinical outcomes.@*METHODS@#This is a retrospective chart review of patients with severe sepsis and septic shock admitted into the paediatric intensive care unit (PICU). Clinical, haematological and outcome characteristics of patients with or without exposure to immune-modulating drugs were compared. Primary outcome was PICU mortality; secondary outcomes were 28-day ventilator-free days (VFD) and intensive care unit-free days (IFD). Univariate and multivariable analyses were performed for these outcomes.@*RESULTS@#A total of 109 patients with paediatric severe sepsis or septic shock were identified. Of this number, 47 (43.1%), 16 (14.7%) and 3 (2.8%) patients received systemic corticosteroids, intravenous immunoglobulins and granulocyte colony stimulating factor, respectively. Patients who received immune-modulating drugs were more likely to require invasive ventilation (38/54 [70.4%] versus 26/55 [47.3%], @*CONCLUSION@#Immune-modulating drugs were frequently used in paediatric severe sepsis and septic shock. Patients who received these drugs seemed to require more PICU support. Further studies are required to examine this association thoroughly.

A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function / 世界急诊医学杂志（英文）

BACKGROUND@#Hospital mortality rates are higher among patients with sepsis-associated acute kidney injury (SA-AKI) than among patients with sepsis. However, the pathogenesis underlying SA-AKI remains unclear. We hypothesized that the source of infection affects development of SA-AKI. We aim to explore the relationship between the anatomical source of infection and outcome in patients with SA-AKI.@*METHODS@#Between January 2013 and January 2018, 113 patients with SA-AKI admitted to our Emergency Center were identified and divided into two groups: those with pulmonary infections and those with other sources of infection. For each patient, we collected data from admission until either discharge or death. We also recorded the clinical outcome after 90 days for the discharged patients.@*RESULTS@#The most common source of infection was the lung (52/113 cases, 46%), followed by gastrointestinal (GI) (25/113 cases, 22.1%) and urinary (22/113, 19.5%) sources. Our analysis showed that patients with SA-AKI had a significantly worse outcome (30/52 cases, P<0.001) and poorer kidney recovery (P=0.015) with pulmonary sources of infection than those infected by another source. Data also showed that patients not infected by a pulmonary source more likely experienced shock (28/61 cases, P=0.037).@*CONCLUSION@#This study demonstrated that the source of infection influenced the outcome of SA-AKI patients in an independent manner. Lung injury may influence renal function in an as yet undetermined manner as the recovery of kidney function was poorer in SA-AKI patients with a pulmonary source of infection.

Consistency of autorefraction by two autorefractors in 1 138 Chinese children and adolescents / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To assess the consistency of refractive errors measured by two autorefractors in myopia screening of school-age Chinese children.<p>METHODS: Topcon RM-8900 and Tianle RM-9000 autorefractors were utilized to measure refractive errors under noncycloplegic condition in students aged 6 to 16 years old who were cluster sampled from four primary and secondary schools in Dongli district, Tianjin. Sperman correlation analysis and Bland-Altman method were used to evaluate the consistency of spherical diopters, cylindrical diopters and spherical equivalents measured by the two methods, and the axial difference distribution of astigmatism measured by the two methods was analyzed.<p>RESULTS:A total of 2 276 eyes of 1 138 subjects with a mean age of 10.49±2.66 a were finally enrolled. Spearman correlation analysis showed that sphere(<i>r</i>=0.958, <i>P</i><0.0001), cylinder(<i>r</i>=0.769, <i>P</i><0.0001), and spherical equivalent(<i>r</i>=0.962, <i>P</i><0.0001)measured by Tianle RM-9000 were highly correlated with those measured by Topcon RM-8900, respectively. Bland-Altman analysis showed spherical diopters measured by Tianle RM-9000 were significantly more hyperopic(<i>P</i><0.0001)with a mean difference of 0.44 D(SD: 0.37; 95% <i>CI</i>: -0.27, 1.16)while the maximum absolute value(1.13 D)of the difference within the 95% <i>CI</i> was above the clinically acceptable range; however, no significant difference(<i>P</i>=0.83)was found between cylindrical diopters measured by the two methods with a mean difference of -0.01 D(SD: 0.31; 95% <i>CI</i>=-0.62, 0.61)while the maximum absolute value(0.62 D)of the difference within the 95% <i>CI</i> was clinically acceptable. The proportion of the axial deviation within ±20° was 84.6%(1 503/1 777)in eyes with cylinder ≤-0.25D while that rose to 96.4%(853/885)in eyes with cylinder ≤-0.75D. <p>CONCLUSION: Spherical diopters measured by Tianle RM-9000 have a significant hyperopia bias than those measured by Topcon RM-8900 while the consistency of cylindrical diopters and cylindrical axes is clinically acceptable.

Consistency of autorefraction by two autorefractors in 1138 Chinese children and adolescents / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM: To assess the consistency of refractive errors measured by two autorefractors in myopia screening of school-age Chinese children.?METHODS: Topcon RM- 8900 and Tianle RM - 9000 autorefractors were utilized to measure refractive errors under noncycloplegic condition in students aged 6 to 16 years old who were cluster sampled from four primary and secondary schools in Dongli district, Tianjin. Sperman correlation analysis and Bland-Altman method were used to evaluate the consistency of spherical diopters, cylindrical diopters and spherical equivalents measured by the two methods, and the axial difference distribution of astigmatism measured by the two methods was analyzed.?RESULTS:A total of 2276 eyes of 1138 subjects with a mean age of 10.49± 2.66 a were finally enrolled. Spearman correlation analysis showed that sphere ( r = 0.958, P<0.0001) , cylinder ( r= 0.769, P<0.0001 ) , and spherical equivalent ( r=0.962, P<0.0001) measured by Tianle RM-9000 were highly correlated with those measured by Topcon RM-8900, respectively. Bland-Altman analysis showed spherical diopters measured by Tianle RM-9000 were significantly more hyperopic ( P< 0.0001 ) with a mean difference of 0. 44 D ( SD: 0.37;95％ CI: -0.27, 1.16) while the maximum absolute value ( 1.13 D) of the difference within the 95％ CI was above the clinically acceptable range;however, no significant difference ( P=0.83) was found between cylindrical diopters measured by the two methods with a mean difference of -0.01 D ( SD: 0.31;95％ CI= -0.62, 0.61 ) while the maximum absolute value ( 0.62 D ) of the difference within the 95％CI was clinically acceptable. The proportion of the axial deviation within ± 20° was 84.6％( 1503/1777) in eyes with cylinder ≤-0.25D while that rose to 96.4％ ( 853/885) in eyes with cylinder ≤-0.75D.?CONCLUSION: Spherical diopters measured by Tianle RM-9000 have a significant hyperopia bias than those measured by Topcon RM-8900 while the consistency of cylindrical diopters and cylindrical axes is clinically acceptable.

Characterization of liver cancer-targeted doxorubicin coupling segmented copolymer nanomicelles and its inhibitory effect on hepatocellular carcinoma HepG2 and Huh7 cells / 肿瘤研究与临床

Objective@#To investigate the characterization of doxorubicin (DOX) coupling segmented copolymer nanomicelles with dual effects of passive and active targeting to liver cancer and its antineoplastic function in vitro.@*Methods@#DOX was covalently conjugated to a terminal hydroxyl group of poly lactic-co-glycolic acid-poly ethylene glycol (PLGA-PEG) diblock copolymer to form DOX-PLGA-PEG. The formation of amido bond was determined by using fourier transform infrared spectroscopy (FTIR) and magnetic resonance method. Amphiphatic diblock copolymer DOX-PLGA-PEG could self-assemble to form nanomicelles in an aqueous phase by dialysis method. The DOX-PLGA-PEG targeted micelles decorated with liver cancer HAb18 F (ab')2 specific antibody were prepared by using physical bonding method. The size and the scattering scope of nanomicelles was determined by using granulometer and dynamic light scattering (DLS). Micelle morphology was examined by using scanning electron microscopy (SEM). The drug loading rate and entrapment rate of DOX-PLGA-PEG micelles or targeted micelles were measured by using ultraviolet spectrophotometry method, and stimulated release in vitro experiment was done. After administration of 2 mg/ml DOX-PLGA-PEG or targeted micelles, cell morphology change of liver cancer HepG2 and Huh7 was observed by using the phase-contrast photomicrography. After administration of 1 mg/ml DOX-PLGA-PEG or targeted micelles, cell survival was analyzed by using plate clone formation assay.@*Results@#The spectrum peak was around 1 575 cm-1 under the observation of FTIR, which was accord with the location of the peak of amido bond. Activating with p-nitrophenyl chloroformate, DOX was covalently conjugated to PLGA-PEG to produce DOX-PLGA-PEG via a carbamate linkage between the primary amine group in DOX and the terminal hydroxyl group in PLGA-PEG. DLS measurements showed that the diameter of DOX-PLGA-PEG micelles and targeted micelles was (55.0±6.3) nm and (87.6±9.3) nm, respectively, and polydispersity index was 0.098 and 0.142, respectively. SEM micrographs revealed that these nanomicelles had a spherical morphology and relatively smooth surface. Drug loading rate of DOX-PLGA-PEG micelles and targeted micelles was (2.4±0.2)% and (2.2±1.9)%, and the entrapment rate was (91.7±5.3)% and (87.5±4.8)%, respectively. The drug release curve in vitro of DOX-PLGA-PEG micelles and targeted micelles exhibited a biphasic pattern characterized by a fast initial release, followed by a slower and continuous release. The amount of the drug release rate was about 30% within 5 d, and 25% within 6 h. After 2 mg/ml DOX-PLGA-PEG micelles and targeted micelles, the cell morphology of liver cancer HepG2 and Huh7 had the impaired change, and the part of the cells were dead, the clonality decreased. The effect of targeted micelles was more significant compared with DOX-PLGA-PEG micelles. After DOX-PLGA-PEG micelles and targeted micelles, the survival rates of HepG2 and Huh7 cells were decreased with time, and the effect of targeted micelles was more effective compared with DOX-PLGA-PEG micelles (all P < 0.05). The 50% effective inhibition of the targeted micelles and DOX-PLGA-PEG micelles was obtained in 2.4 d and 5.5 d, respectively for Huh7 cells. At these time points, DOX concentration was 1.15 μg/ml and 1.24 μg/ml, respectively. The 50% effective inhibition of targeted micelles and DOX-PLGA-PEG micelles was obtained in 3.3 d and 7.4 d, respectively for HepG2 cells. At these time points, DOX concentration was 1.20 μg/ml and 1.31 μg/ml.@*Conclusion@#DOX nanomicelles with dual effects of passive and active targeting can release a large number of active drugs in vitro, which plays an obvious inhibitory role in the cell proliferation of liver cancer HepG2 and Huh7 cells.

Explore the value of ERCP in patients with choledocholithiasis after Billroth Ⅱ gastrointestinal anastomosis / 国际外科学杂志

Objective To explore the value of endoscopic retrograde cholangiopancreatography (ERCP) in patients with choledocholithiasis after Billroth Ⅱ gastrointestinal anastomosis.Methods A retrospective cohort study was conducted to retrospective review the data of 189 patients with choledocholithiasis treated by ERCP from December 2015 to November 2017 in Department of Hepatobiliary Surgery,Second Hospital of Hebei Medical University.According to the history of Billroth Ⅱ gastrointestinal anastomosis,the patients who have not undergone digestive surgery were divided into the normal group(n =167) and patients who have undergone digestive surgery were divided into reconstruction group (n =22).The operation time,the success rate of stone extraction,complications,the hospitalization time,total hospitalization expenses were compared between the two groups.Measurement data with normal distribution were represented as (Mean ± SD) and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range).Comparisons of count data were analyzed using the x2 test or Fisher exact probability.Results The operation time of the normal group was (40.18 ± 11.80) min,and the success rate of ERCP was 97.60％ (163/167),the operation time of reconstruction group was(61.81 ± 13.21) min,and the success rate of ERCP was 81.82％ (18/22),There were significant differences between the two groups (t =0.105,x2 =10.400,P ＜ 0.05).The complications,the hospitalization time and the total hospitalization expense of the normal group were 16.17％ (27/167),(3.47 ± 1.55) d,(20 620.69 ± 3 117.88) yuan,the reconstruction group were 18.18％ (4/22),(4.18 ± 2.08) d,(22 426.41 ±5 916.30) yuan,with no statistically significant difference (x2 =0.000,t =4.204),t =10.828,P ＞ 0.05).Conclusions ERCP is safe and feasible for patients with choledocholithiasis after Billroth Ⅱ gastrointestinal anastomosis.It also has a high success rate of stone removal and small trauma,which is worthy of promotion.

Preparation of paclitaxel-loaded nanoparticles and their effect on hepatocellular carcinoma HepG2 and Huh-7 cells / 肿瘤研究与临床

Objective To prepare active and controlled paclitaxel-loaded nanoparticles, and to determine their effect on hepatocellular carcinoma HepG2 and Huh-7 cells. Methods The poly (D, L-lactide-co-glycolide) nanoparticles containing paclitaxel were prepared by o/w emulsification-solvent evaporation method. The drug encapsulation efficiency, loading efficiency and release profile rate in vitro were measured by high-performance liquid chromatography. The morphology and size of nanoparticles were observed by scanning electron microscopy and particle size analyzer, respectively. Hepatocellular carcinoma HepG2 and Huh-7 cells were co-cultured with paclitaxel nanoparticles, and the changes of cell morphology were observed by inverted microscope, and the cell viability was examined by the methyl thiazolyl tetrazolium assay. Results The nanoparticles were spherical shape with particle size 216 nm, and the drug encapsulation efficiency and loading efficiency was 87.4％and 1.79％, respectively. The drug release pattern showed an early burst release followed by a slow sustained release. Released drug from paclitaxel-loaded nanoparticles resulted in injury of HepG2 and Huh-7 cells. At 1, 2, 3 and 5 days after administration, the survival rates of HepG2 cells co-cultured with paclitaxel nanoparticles were (76.6±5.1)％, (57.3±4.9)％, (29.7±4.4)％, and (7.2±2.0)％,respectively,and the survival rates in the blank group were(94.3±6.8)％, (91.0±6.6)％, (90.7±5.6)％, and (87.4±5.7)％;the survival rates of Huh-7 cells were (82.1±8.0)％, (63.5±5.6)％, (40.2±3.9)％, and (11.4±3.6)％, respectively, and the survival rates in the blank group were (93.5 ±7.7)％, (92.5 ±6.8)％, (89.0 ±6.2)％, and (86.1 ±6.5)％. The survival rate of cells co-cultured with paclitaxel nanoparticles was lower than that of the blank group (all P< 0.05), and the cell survival rate showed a decrease change with prolonged co-cultured time (both P< 0.05). Conclusion Paclitaxel nanoparticles could play an anti-tumor effect on hepatocellular carcinoma HepG2 and Huh-7 cells in vitro in a controlled manner, providing a new dosage form for the clinical application of anti-hepatoma drugs.

Experimental study on the radiosensitization effect of etanidazole and paclitaxel on hepatocellular carcinoma H22 cells in mice / 肿瘤研究与临床

Objective To investigate the synergistic effect of etanidazole and paclitaxel on hepatocellular carcinoma H22 cells in mice. Methods To establish the murine xenografts, H22 cells was inoculated subcutaneously into the back of BALB/c mice. Among them, 40 tumor-bearing mice were divided into 4 groups by random number table method, 10 mice in each group, and each group injected with phosphate buffered saline (PBS), etanidazole (200 mg/kg), paclitaxel (1 mg/kg) and two drugs combination. Two hours after the administration, the mice were sacrificed by dislocation, and the drugs content in blood and tumor tissues of mice was measured by high-performance liquid chromatography. Sixty-five tumor-bearing mice were selected and divided into PBS non-irradiation group, PBS irradiation group, etanidazole irradiation group, paclitaxel irradiation group and two drugs combination irradiation group by random number table method, 13 mice/group. According to the grouping, the irradiated mice received 60Co source irradiation 2 hours after administration; the survival of 10 mice was observed at different time points, and the tumor volume was measured and calculated. The survival mice were killed by cervical dislocation 180 days after radiation. The other 3 mice in each group were killed after 2 days of irradiation, the tumor tissues were taken, and the expression of hypoxia inducible factor 1 (HIF-1) in these tumor tissues was detected by using immunohistochemistry. Statistical analysis of measurement data between groups was performed by using the one-way ANOVA and t test, and the survival analysis was made by Kaplan-Meier method. Results There was no significant difference of etanidazole and paclitaxel content in blood and tumor tissues between alone and combination administration groups at 2 hours after administration [etanidazole in blood: (55.5 ±4.7) μg/ml vs. (50.7±5.2) μg/ml; etanidazole in tumor: (31.2±3.5) μg/g vs. (33.6±5.4) μg/g; paclitaxel in blood: (316.9± 9.6)μg/ml vs. (289.5±10.3)μg/ml;paclitaxel in tumor: (161.7±7.2) μg/g vs. (181.3±11.6) μg/g; all P>0.05]. Within 40 days from the 10th day after the irradiation, the body weight of the irradiated group at each time point was significantly lower than that of the unirradiated group (all P< 0.05), but there was no significant difference in the body weight among the administration groups (all P>0.05). On the 40th day after irradiation, the tumor inhibition rates of the PBS irradiation group, etanidazole irradiation group, paclitaxel irradiation group, and two drugs combination irradiation group were 19.2％, 33.9％, 48.7％, and 61.6％, respectively. On the 180th day after irradiation, the survival rates of the PBS non-irradiation group, PBS irradiation group, etanidazole irradiation group, paclitaxel irradiation group, and two drugs combination irradiation group were 0, 0, 0, 12.5％, and 25.0％, respectively, and the median survival interval was 30.2, 54.7, 55.6, 83.4, and 102.8 d. After 2 days of irradiation, the positive expression rate of HIF-1 in the tumors tissues of PBS irradiation group, etanidazole irradiation group, paclitaxel irradiation group and two drugs combination irradiation group was lower than that in the PBS non-irradiation group, the differences were statistically significant [(45.7 ±4.8)％, (40.6 ±5.9)％, (24.5±5.6)％, (17.2±3.7％)％vs. (63.1±7.2)％, all P<0.05]. The positive expression rate of HIF-1 in the paclitaxel irradiation group and two drugs combination irradiation group was lower than that in the PBS irradiation group and etanidazole irradiation group (all P<0.05). Conclusion The combination of etanidazole and paclitaxel has synergistic radiation sensitization effect on hepatocellular carcinoma H22 cells in mice, and the expression level of HIF-1 is decreased, reflecting the decrease of hypoxic cells.

Adiponectin in Relation to Coronary Plaque Characteristics on Radiofrequency Intravascular Ultrasound and Cardiovascular Outcome / Relação da Adiponectina com as Características da Placa Aterosclerótica ao Ultrassom Intravascular com Radiofrequência e Desfechos Cardiovasculares

Abstract Background: Prospective data on the associations of adiponectin with in-vivo measurements of degree, phenotype and vulnerability of coronary atherosclerosis are currently lacking. Objective: To investigate the association of plasma adiponectin with virtual histology intravascular ultrasound (VH-IVUS)-derived measures of atherosclerosis and with major adverse cardiac events (MACE) in patients with established coronary artery disease. Methods: In 2008-2011, VH-IVUS of a non-culprit non-stenotic coronary segment was performed in 581 patients undergoing coronary angiography for acute coronary syndrome (ACS, n = 318) or stable angina pectoris (SAP, n = 263) from the atherosclerosis-intravascular ultrasound (ATHEROREMO-IVUS) study. Blood was sampled prior to coronary angiography. Coronary plaque burden, tissue composition, high-risk lesions, including VH-IVUS-derived thin-cap fibroatheroma (TCFA), were assessed. All-cause mortality, ACS, unplanned coronary revascularization were registered during a 1-year-follow-up. All statistical tests were two-tailed and p-values < 0.05 were considered statistically significant. Results: In the full cohort, adiponectin levels were not associated with plaque burden, nor with the various VH-tissue types. In SAP patients, adiponectin levels (median[IQR]: 2.9(1.9-3.9) µg/mL) were positively associated with VH-IVUS derived TCFA lesions, (OR[95%CI]: 1.78[1.06-3.00], p = 0.030), and inversely associated with lesions with minimal luminal area (MLA) ≤ 4.0 mm2 (OR[95%CI]: 0.55[0.32-0.92], p = 0.025). In ACS patients, adiponectin levels (median[IQR]: 2.9 [1.8-4.1] µg/mL)were not associated with plaque burden, nor with tissue components. Positive association of adiponectin with death was present in the full cohort (HR[95%CI]: 2.52[1.02-6.23], p = 0.045) and (borderline) in SAP patients (HR[95%CI]: 8.48[0.92-78.0], p = 0.058). In ACS patients, this association lost statistical significance after multivariable adjustment (HR[95%CI]: 1.87[0.67-5.19], p = 0.23). Conclusion: In the full cohort, adiponectin levels were associated with death but not with VH-IVUS atherosclerosis measures. In SAP patients, adiponectin levels were associated with VH-IVUS-derived TCFA lesions. Altogether, substantial role for adiponectin in plaque vulnerability remains unconfirmed.

Resumo Fundamento: Faltam dados prospectivos sobre as associações de adiponectina com medidas in-vivo de grau, fenótipo e vulnerabilidade da aterosclerose coronariana. Objetivo: Investigar a associação da adiponectina plasmática com medidas de aterosclerose derivadas de ultrassonografia virtual intravascular (VH-IVUS) e eventos cardíacos adversos importantes (major adverse cardiac events - MACE) em pacientes com doença arterial coronariana estabelecida. Métodos: Em 2008-2011, a VH-IVUS de um segmento coronariano não estenótico não culpado foi realizado em 581 pacientes submetidos à angiografia coronariana para síndrome coronariana aguda (SCA, n = 318) ou angina pectoris estável (APE, n = 263) a partir do estudo de ultrassonografia aterosclerótica-intravascular (ATHEROREMO-IVUS). Sangue foi amostrado antes da angiografia coronária. Foram avaliados a carga de placa coronária, a composição tecidual, as lesões de alto risco, incluindo fibroateroma de capa fina (FCF) derivado de VH-IVUS. Mortalidade por todas as causas, SCA, e revascularização coronária não planejada foram registradas durante um ano de acompanhamento. Todos os testes estatísticos foram bicaudais e os valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Na coorte completa, os níveis de adiponectina não foram associados à carga de placa, nem a vários tipos de tecido virtual histológico. Entre os pacientes com APE, os níveis de adiponectina (mediana[IIQ]: 2,9(1,9-3,9) µg/mL) foram associados positivamente às lesões FCF derivadas de VH-IVUS, (OR[IC 95%]: 1,78[1,06-3,00], p = 0,030), e inversamente associados a lesões com área luminal mínima (ALM) ≤4,0 mm2 (OR[IC 95%]: 0,55[0,32-0,92], p = 0,025). Em pacientes com SCA, os níveis de adiponectina (mediana[IIQ]: 2,9 [1,8-4,1] µg/mL) não foram associados à carga de placa nem a componentes teciduais. A associação positive de adiponectina ao óbito esteve presente na coorte completa (HR[IC 95%]: 2,52[1,02-6,23], p = 0,045) e (limítrofe) em pacientes com APE (HR[IC 95%]: 8,48[0,92-78,0], p = 0,058). Entre pacientes com SCA, essa associação perdeu significância estatística após ajuste multivariado (HR[IC 95%]: 1,87[0,67-5,19], p = 0,23). Conclusão: Na coorte completa, os níveis de adiponectina foram associados à obito, mas não a medidas de aterosclerose por VH-IVUS. Em pacientes com APE, os níveis de adiponectina foram associados a lesões FCF derivadas de VH-IVUS. Em geral, o papel da adiponectina na vulnerabilidade da placa permanece não confirmado.

The expressions of acid sensing ion channel 1a and activator protein-1 in hepatocellular carcinoma and their relationships with clinical features / 中华肝胆外科杂志

Objective To investigate the expressions of acid sensing ion channel 1a(ASIC1a) and activator protein-1 (AP-1) in hepatocellular carcinoma,and to analyze the relationship between expressions and clinical features.Methods At the transcription level,expression spectroscopy chips and bioinformatics were used to analyze the changes of signal pathways before and after ASICla interference in hepatocellular carcinoma cells.63 cases of HCC and 42 cases of tumor adjacent tissue samples were chosen from the Third People's Hospital of Wuxi,between January 2010 and December 2014.Immunohistochemical staining was utilized to detect the expressions of ASIC1 a,c-Jun,c-Fos.The relationships among the three were analyzed by the nonparametric Spearman rank correlation coefficient.Results After ASIC1a inhibition,the expression of AP-1 (c-Jun and c-Fox) decreased significantly.The expressions of c-Jun and c-Fox were greatly decreased in interference group compared with control group.The positive rates of ASIC1a,c-Jun and c-Fos in HCC tissues were significantly higher than that of the adjacent tissues,68.3％ vs.19.0％,55.6％ vs.11.9％,47.6％ vs.11.7％ (P ＜ 0.05).Correlation analysis showed that the expression of ASIC1a was positively correlated with c-Jun and c-Fos expression (r =0.404,0.309,P ＜ 0.05).The expressions of ASIC 1 a,c-Jun and c-Fos were not related to age,tumor diameter and gender (P ＞ 0.05),which were related to the clinical stage,AFP and lymph node metastasis of the tumor (P ＜ 0.05).Conclusion ASIC1a may.affect the development of hepatocellular carcinoma through the downstream gene AP-1.

Hemostatic clips to facilitate intubation during ERCP with ampulla around duodenal diverticulum / 中国内镜杂志

Objective To investigate the effectiveness of hemostatic-clip-assisted method during ERCP with ampulla around duodenal diverticulum. Methods 25 patients with ampulla around duodenal diverticulum encountered cannulation difficulty, 11 cases underwent with clip-assisted method, 14 cases with ordinary ways. Number of successful cases, cannulation time, post-operation complication were analyzed. Results All the 11 cases succeeded in clip group. 12 patients succeeded in none-clip group. Cannulation time between the two groups were discrepant. There was no difference in number of successful cases and post-operation complication rate. Conclusion Successful application of hemostatic clip help to expose and facilitate cannulation of an ampulla around a duodenal diverticulum.

Purse-string suture with single channel gastroscopy for the gastric wall perforation during endoscopic submucosal dissection of gastric fundus / 中国内镜杂志

Objective To evaluate the perforation repair method of purse-string suture with single channel after gastroscopy endoscopic submucosal resection (ESD) in treating gastric submucosalal stromal tumor originating from muscularis propria lay of gastric fundus. Methods 15 patients with GIST from gastric fundus muscularis propria were treated with ESD. The diameters of tumors were from 1.5 ～ 3.5 cm. Purse-string suture with single channel gastroscopy was performed for the gastric wall perforation during ESD. Results All patients underwent repair successfully. The procedure time was 10 ～ 15 min. No severe complications occurred. Conclusion Purse-string suture with single channel gastroscopy is a feasible and effective perforation repair method during ESD of gastric fundus.