Influencing factors of anastomotic leakage after laparoscopic intersphincter resection for extremely low rectal cancer and construction of nomogram prediction model / 中华消化外科杂志

Objective:To investigate the influencing factors of anastomotic leakage after laparoscopic intersphincter resection (ISR) for extremely low rectal cancer and construction of nomogram prediction model.Methods:The retrospective case-control study was conducted. The clinicopathological data of 812 patients who underwent laparoscopic ISR for extremely low rectal cancer in the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) from February 2012 to February 2022 were collected. There were 459 males and 353 females, aged (51±11)years. Observation indicators: (1) surgical situations; (2) follow-up; (3) influencing factors of postoperative anastomotic leakage; (4) construction and evaluation of nomogram prediction model for postoperative anastomotic leakage. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. The COX proportional hazard model was used for univariate and multivariate analyses. The R software(3.5.1 version) was used to construct nomogram prediction model. The receiver operating characteristic (ROC) curve was drawn and the area under curve (AUC) was used to evaluate the efficacy of the nomogram prediction model. The Bootstrap method was used for internal verification and to calculate the average consistency index (C-index). Results:(1) Surgical situations. All 812 patients underwent laparoscopic ISR for extremely low rectal cancer, including 388 cases undergoing partial ISR, 218 cases undergoing subtotal ISR and 206 cases undergoing complete ISR. All 812 patients underwent ileal protective ostomy, and there were 306 cases with double anastomosis and 203 cases with left colic artery preserved, respectively. The operation time and volume of intraoperative blood loss of 812 patients was (179±33)minutes and (33±13)mL, respectively. (2) Follow-up. All 812 patients were followed up for (13.5±0.9)months. Of the 812 patients, there were 62 cases with postoperative anastomotic leakage and the healing time of these cases was (33±6)days. (3) Influencing factors of postoperative anastomotic leakage. Results of multivariate analysis showed that male, neoadjuvant chemoradiotherapy, failure of reser-ving left colic artery were independent risk factors of anastomotic leakage after laparoscopic ISR for extremely low rectal cancer ( hazard ratio=5.98, 4.00, 16.26, 95% confidence interval as 1.66-24.12, 1.30-12.42, 3.00-90.89, P<0.05). (4) Construction and evaluation of nomogram prediction model for postoperative anastomotic leakage. According to the results of multivariate analysis, male, neoadju-vant chemoradiotherapy and failure of reserving left colic artery were used to construct the nomogram prediction model for anastomotic leakage after laparoscopic ISR for extremely low rectal cancer, and the score of these indexes in the nomogram prediction model was 50, 49, 93, respectively. The total score of these index corresponded to the incidence rate of anastomotic leakage. Results of ROC curve showed that the AUC of nomogram prediction model of anastomotic leakage after laparoscopic ISR for extremely low rectal cancer was 0.87 (95% confidence interval as 0.80-0.93, P<0.05), with sensi-tivity and specificity 0.96 and 0.60, respectively. Results of internal verification showed that the C-index of nomogram prediction model was 0.87. Conclusion:Male, neoadjuvant chemoradiotherapy, failure of reserving left colic artery are independent risk factors of anastomotic leakage after laparo-scopic ISR for extremely low rectal cancer, and the nomogram prediction model based on these indexes can predict the incidence rate of postoperative anastomotic leakage.

Microbial remediation of cadmium-contaminated soils and its mechanisms: a review / 生物工程学报

Excessive levels of cadmium (Cd) in soil exert serious negative impacts on soil ecosystems. Microorganisms are a common component of soil and show great potential for mitigating soil Cd. This review summarizes the application and remediation mechanisms of microorganisms, microbial-plants, and microbial-biochar in Cd-contaminated soil. Microorganisms such as Bacillus, Acinetobacter, Pseudomonas, and arbuscular mycorrhizal fungi (AMF) can change the biological validity of Cd through adsorption, mineralization, precipitation and dissolution. Different factors such as pH, temperature, biomass, concentration, and duration have significant effects on Cd bioavailability by microorganisms. Pseudomonas, Burkholderia, and Flavobacterium can promote the uptake of Cd2+ by hyperaccumulator through promotion and activation. Biochar, a soil amendment, possesses unique physicochemical properties and could act as a shelter for microorganisms in agriculture. The use of combined microbial-biochar can further stabilize Cd compared to using biochar alone.

Structure-guided discovery of potent and oral soluble epoxide hydrolase inhibitors for the treatment of neuropathic pain

Soluble epoxide hydrolase (sEH) is related to arachidonic acid cascade and is over-expressed in a variety of diseases, making sEH an attractive target for the treatment of pain as well as inflammatory-related diseases. A new series of memantyl urea derivatives as potent sEH inhibitors was obtained using our previous reported compound 4 as lead compound. A preferential modification of piperidinyl to 3-carbamoyl piperidinyl was identified for this series via structure-based rational drug design. Compound A20 exhibited moderate percentage plasma protein binding (88.6%) and better metabolic stability in vitro. After oral administration, the bioavailability of A20 was 28.6%. Acute toxicity test showed that A20 was well tolerated and there was no adverse event encountered at dose of 6.0 g/kg. Inhibitor A20 also displayed robust analgesic effect in vivo and dose-dependently attenuated neuropathic pain in rat model induced by spared nerve injury, which was better than gabapentin and sEH inhibitor (±)-EC-5026. In one word, the oral administration of A20 significantly alleviated pain and improved the health status of the rats, demonstrating that A20 was a promising candidate to be further evaluated for the treatment of neuropathic pain.

Intensity of Intraoperative Spinal Cord Hyperechogenicity as a Novel Potential Predictive Indicator of Neurological Recovery for Degenerative Cervical Myelopathy

Objective@#To analyze the correlations between intraoperative ultrasound and MRI metrics of the spinal cord in degenerative cervical myelopathy and identify novel potential predictive ultrasonic indicators of neurological recovery for degenerative cervical myelopathy. @*Materials and Methods@#Twenty-two patients who underwent French-door laminoplasty for multilevel degenerative cervical myelopathy were followed up for 12 months. The Japanese Orthopedic Association (JOA) scores were assessed preoperatively and 12 months postoperatively. Maximum spinal cord compression and compression rates were measured and calculated using both intraoperative ultrasound imaging and preoperative T2-weight (T2W) MRI. Signal change rates of the spinal cord on preoperative T2W MRI and gray value ratios of dorsal and ventral spinal cord hyperechogenicity on intraoperative ultrasound imaging were measured and calculated. Correlations between intraoperative ultrasound metrics, MRI metrics, and the recovery rate JOA scores were analyzed using Spearman correlation analysis. @*Results@#The postoperative JOA scores improved significantly, with a mean recovery rate of 65.0 ± 20.3% (p < 0.001). No significant correlations were found between the operative ultrasound metrics and MRI metrics. The gray value ratios of the spinal cord hyperechogenicity was negatively correlated with the recovery rate of JOA scores (ρ = -0.638, p = 0.001), while the ventral and dorsal gray value ratios of spinal cord hyperechogenicity were negatively correlated with the recovery rate of JOA-motor scores (ρ = -0.582, p = 0.004) and JOA-sensory scores (ρ = -0.452, p = 0.035), respectively. The dorsal gray value ratio was significantly higher than the ventral gray value ratio (p < 0.001), while the recovery rate of JOA-motor scores was better than that of JOA-sensory scores at 12 months post-surgery (p = 0.028). @*Conclusion@#For degenerative cervical myelopathy, the correlations between intraoperative ultrasound and preoperative T2W MRI metrics were not significant. Gray value ratios of the spinal cord hyperechogenicity and dorsal and ventral spinal cord hyperechogenicity were significantly correlated with neurological recovery at 12 months postoperatively.

Intensity of Intraoperative Spinal Cord Hyperechogenicity as a Novel Potential Predictive Indicator of Neurological Recovery for Degenerative Cervical Myelopathy

Objective@#To analyze the correlations between intraoperative ultrasound and MRI metrics of the spinal cord in degenerative cervical myelopathy and identify novel potential predictive ultrasonic indicators of neurological recovery for degenerative cervical myelopathy. @*Materials and Methods@#Twenty-two patients who underwent French-door laminoplasty for multilevel degenerative cervical myelopathy were followed up for 12 months. The Japanese Orthopedic Association (JOA) scores were assessed preoperatively and 12 months postoperatively. Maximum spinal cord compression and compression rates were measured and calculated using both intraoperative ultrasound imaging and preoperative T2-weight (T2W) MRI. Signal change rates of the spinal cord on preoperative T2W MRI and gray value ratios of dorsal and ventral spinal cord hyperechogenicity on intraoperative ultrasound imaging were measured and calculated. Correlations between intraoperative ultrasound metrics, MRI metrics, and the recovery rate JOA scores were analyzed using Spearman correlation analysis. @*Results@#The postoperative JOA scores improved significantly, with a mean recovery rate of 65.0 ± 20.3% (p < 0.001). No significant correlations were found between the operative ultrasound metrics and MRI metrics. The gray value ratios of the spinal cord hyperechogenicity was negatively correlated with the recovery rate of JOA scores (ρ = -0.638, p = 0.001), while the ventral and dorsal gray value ratios of spinal cord hyperechogenicity were negatively correlated with the recovery rate of JOA-motor scores (ρ = -0.582, p = 0.004) and JOA-sensory scores (ρ = -0.452, p = 0.035), respectively. The dorsal gray value ratio was significantly higher than the ventral gray value ratio (p < 0.001), while the recovery rate of JOA-motor scores was better than that of JOA-sensory scores at 12 months post-surgery (p = 0.028). @*Conclusion@#For degenerative cervical myelopathy, the correlations between intraoperative ultrasound and preoperative T2W MRI metrics were not significant. Gray value ratios of the spinal cord hyperechogenicity and dorsal and ventral spinal cord hyperechogenicity were significantly correlated with neurological recovery at 12 months postoperatively.

AnapplicationofMDCTtissuesegmentationtechnologyonthequantitativeevaluation andthevolumedegreedivisionofthepleuraleffusion / 实用放射学杂志

Objective Toexploreasimpleandaccuratemethodfordeterminingthequantitativeevaluationandthevolumedegree divisionofpleuraleffusionbyMDCTtissuesegmentationtechnology.Methods Thevolumeofwaterinjectedintothreecontainersof differentshapeswasmeasuredby MDCTtissuesegmentationtechnique,andwerefurthercomparedwiththevolumeoftheactual waterinjection.Byusingthesamemethod,theliquidvolumeofpleuraleffusionbeforeandafterpumpingfrompatientswasmeasured andthedifferencebetweentheanteriorandtheposteriorwascalculated.Thenthedifferencebeforeandafterthepumpingwascomparedwiththe actualvolumeofclinicalfluidpumping.Atthesametime,thespecificmethodtodeterminethedegreedivisionofpleuraleffusionwas established.Results Forcontainersofdifferentshapes,theresultfromtheCTscanningliquidmeasurementwasthesameasactualwater injection,andhadahighcorrelation.Thedifferencebetweenbeforeandafterfluidextractionandclinicalactualfluidextractionwas linearcorrelated(positivecorrelation,r=0.986,P<0.001).Accordingtothemethodfordegreedivisionofadulthemothorax,MDCT tissuesegmentationtechnologydividedthevolumeofpleuraleffusionbeforethepumpingintosmall,mediumandlargeamounts.There were44caseswithsmallpleuraleffusion,11caseswithmoderatepleuraleffusionand7caseswithlargepleuraleffusion.Conclusion The volumeofpleuraleffusion measuredby MDCTtissuesegmentationtechnologycanreflecttheactualvolumeofpleuraleffusionin clinictoacertainextent,and MDCTtissuesegmentationtechnologycanbeusedtodividethevolumedegreeofpleuraleffusion.

Numerical Study on Effects of Different Adhesive Materials for Ceramic Restoration on Stress Distributions / 医用生物力学

Objective To investigate the effect of different adhesive materials on all-ceramic restoration. Methods The all-ceramic restoration system model of mandibular first molar was established by spiral computed tomography (CT) scanning and computer-aided design (CAD) modeling. Four types of resin adhesive materials (Duo Cement,Lute-It,Rely-X ARC,Variolink II) used in clinics were selected, and the stress distribution was calculated using the ABAQUS software. Results The stress at the bonding interface was the highest when low filler adhesive Lute-It was used. Based on the viscoelasticity analysis, resin adhesives with a larger storage modulus and loss modulus could yield lower stress extremes. Conclusions The study suggests that high-filler type resin adhesives with a large energy storage modulus and loss modulus should be used clinically.

Advances of transforming growth factor-β inhibitors / 药学学报

Transforming growth factor-β is an important cytokine with various bioactivities, including embryonic development, wound healing, chemotaxis and cell cycle regulation. Epithelial-mesenchymal transition (EMT) is the main pathway of tumor cell to obtain the ability of invasion and metastasis. The TGF-β is the key factor known to induce EMT in cancer cells and plays an important role in the process. In recent years, some progress has been obtained. Some TGF-β inhibitors have approved in the market or in clinical trials. TGF-β inhibitors can play an important role on the treatment of tumors, glaucoma, liver and kidney fibrosis disease and scar repair. Novel TGF-β inhibitors reported in recent years were reviewed in this article.

The event-related potentials study on positive emotional Stroop effect in male subjects / 中华行为医学与脑科学杂志

Objective To study the mechanism underlying attentional biases toward event-related potentials (ERPs) in healthy male subjects.Methods 18 male healthy subjects performed emotional stroop task by pressing the buttons to the picture border color of two categories including the neutral and positive.The RT and Accuracy were recorded automatically.The ERPs were recorded by Neuroscan system.Results The behavioral results showed that neither the reaction time (628.11 ± 55.46) ms vs (628.81 ± 53.92) ms nor accuracy (96.87 ± 4.42) ％ vs (95.76±7.41)％ found difference under two conditions.ERPs results showed that the positive pictures evoked more greater P2 ((8.16±4.99)μV vs (4.30±3.83)μV) and P3 ((6.31±4.53)μV vs (4.27±4.16)μV) than neutral pictures.Conclusion Attentional biases toward positive emotion can be found in healthy male subjects,which can be related to emotional control process.

Study on the establishment of skin photoaging model in guinea pig and on the protective effects of nitroxide tempol / 中华老年医学杂志

Objective To explore the establishment of skin photoaging model and the protective effects of nitroxide tempol on skin in guinea pig. Methods The guinea pig skin photoageing model was established by using solar-simulaten radiation (SSR). Dermal structure was observed with hematoxylin-eosin staining. The structure and expression of elastic fiber were analyzed by Weigert's staining. The uhrastructure of dermal fibroblasts and elastic fiber were observed by electron microscopy. Tempol was used before each exposure at the concentration of 5 mg/ml or 0. 5 mg/ml, and the protective effects of tempol on skin were assessed. Results After seventeen weeks' exposure, there was typical "solar elastosis" damage in the upper dermis. Mature elastic fibers were severely degraded and there was large amount of elastotic material accumulated in the upper dermis. Dermal fibroblasts appeared metabolically hyperactive and mitochondria in the cells were damaged. Some cells even broke up. Tempol at the concentration of 5 mg/ml or 0. 5 mg/ml could prevent photodamage of the photoageing model in the dermis, and Tempol at the concentration of 5 mg/ml had stronger protective effects. Conclusions Guinea pig can be applied as an useful animal model of skin photoageing. Antioxidant tempol has photoprotective effects on photodamage of the photoageing model in guinea pig and can be used as an anti-photoageing agent.

Numerical Analysis of the Influence of Cement Thickness on Stress Distribution in All-ceramic Crowns / 航天医学与医学工程

Objective To provide theoretical basis for clinical treatment of all-ceramic crown prosthodontics,the influence of cement thickness on the stress distribution in all-ceramic crowns under load was studied numerically.Methods The finite element analysis(FEA) model of a standard mandibular first molar was established using spiral CT and CAD software,and then it was applied to analyze the stress distribution of all-ceramic crowns under vertical loading using FEA software.Results Stress concentration was found in mesial and distal cement;the stress distribution at the cement upper and lower interface was found to be similar,and the stress magnitude discrepancy between the two interfaces was small;the stress of the model with 0.15 mm cement in the cervix was lower about 30% than the one of the 0.05 mm model.Conclusions The cement thickness plays an important role in the stress distribution of all-ceramic restoration system.The model with 0.15 mm cement shows a better resistance to destruction among the three models investigated.

Study on Curricula-setting in Pre-job Training of Graduates from Local Medical Universities as New Recruits / 中华医学教育探索杂志

With the development of new military revolution,the training system of officers has greatly changed.The supplement of professionals in army has begun to depend on the graduates from local universities.Based on status-on-quo investigation of the first new recruits' graduates from local medical universities,the authors established a curricula-system of pre-job training by applying the literature review and Delphi method.

A quantitative index system for casualty forecasting in refugees living in border areas / 第二军医大学学报

Objective:To investigate the priorities of each factor influencing the casualties in refugees living in border areas, so as to provide evidence for casualty forecasting in the refugees. Methods: We summarized the factors affecting the refugee casualty in the border area through searching and reviewing the related literatures. The identified factors were classified into 3 levels and the quantitative index system was established by using Delphi method, i.e. expert consulting method. The names and the meanings of each index were revised according to experts’ suggestions after 3 rounds of consulting. The weights of each index were determined by analytic hierarchy process (AHP) and comparing-reordering method. Results: A 3-level quantitative system was successfully constructed, which consisted of 4 first level indices (including natural factors, social factors, medical factors, and war factors), 12 second level indices, and 37 third level indices; the weights of all indices were determined. Conclusion: The result of our study can be used in predicting refugee casualty and provide a reference for the medical service of refugees living in the border areas.