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ObjectiveTo investigate the application of Mengchao Liver Disease-Brain System version 2.0 in clinical diagnosis and treatment. MethodsThis study was conducted among 160 patients who were admitted to the internal medicine and surgical departments from June 9 to 21， 2021， and their data were automatically captured by the intelligent information system of Southeast Big Data Institute of Hepatobiliary Health， Mengchao Hepatobiliary Hospital of Fujian Medical University. The completeness and accuracy of Mengchao Liver Disease-Brain System version 2.0 were evaluated based on the intelligent diagnostic tools such as auxiliary diagnosis of chronic hepatitis B， interpretation of liver fibrosis， staging model of chronic hepatitis B， auxiliary diagnosis of liver cirrhosis， auxiliary staining of liver cirrhosis， auxiliary diagnosis of primary liver cancer， BCLC stage of primary liver cancer， Chinese staging of primary liver cancer， Child-Pugh score， and APRI score. ResultsAll auxiliary diagnostic tools had a complete rate of 94.17% in terms of the extraction of correct key dimensions within the test period. The artificial intelligence report had a structured accuracy of 97.55% in capturing data and an accuracy rate of 91.61% in text processing. ConclusionMengchao Liver Disease-Brain System version 2.0 provides an innovative mode for the construction of big data platform in medical specialties and has a high accuracy as an auxiliary diagnostic tool in clinical diagnosis and treatment.
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Objective:To compare the early effect of water sac blocking and Heartstring for proximal anastomosis of the calcific ascending aorta.Methods:The data of 400 consecutive patients undergoing elective off-pump coronary artery bypass grafting(OPCABG) in Beijing Anzhen Hospital from January 2022 to June 2022 were retrospectively analyzed. 46 patients with calcific ascending aorta including 40 males and 6 females, with the age ranged from 53 to 73 years and an average of(65.2±5.1) years, who were revealed by preoperative chest CT scan and intraoperative palpation. According to the method of proximal anastomosis, the patients were divided into 2 groups: water sac blocking group(n=19) and Heartstring group(n=27). The effect of preventing postoperative stroke was compared by counting the incidence of postoperative stroke. The efficacy of the 2 methods was compared by detecting the flow and pulsatility fraction of the saphenous vein trunk during surgery, observing the dynamic changes of the electrocardiogram and cTnI level within 48h after the surgery, and reviewing the coronary CTA 3 months after discharge.Results:There was no perioperative death, and all the patients were discharged 4-13 days postoperatively. No adverse events such as stroke and malignant ventricular arrhythmia occurred during perioperative period. 1 patient in each group developed low cardiac output syndrome postoperatively, and both improved after IABP placement. 1 patient in Heartstring group developed acute inferior myocardial infarction, which was improved after IABP placement. Coronary CTA 3 months after operation showed that there was no proximal anastomotic stenosis in both groups.Conclusion:There is no significant difference between the 2 proximal anastomosis methods in preventing stroke after OPCABG in patients with ascending aortic calcification. Compared with Heartstring, water sac blocking does not increase the risk of proximal anastomotic stenosis. In addition, water sac blocking does not require expensive consumables, which is especially suitable for patients with limited funds and can be generalized.
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In recent years, the artificial intelligence machine learning and deep learning technology have made leap progress. Using clinical decision support system for auxiliary diagnosis and treatment is the inevitable developing trend of wisdom medical. Clinicians tend to ignore the interpretability of models while pursuing its high accuracy, which leads to the lack of trust of users and hamper the application of clinical decision support system. From the perspective of explainable artificial intelligence, the authors make some preliminary exploration on the construction of clinical decision support system in the field of liver disease. While pursuing high accuracy of the model, the data governance techniques, intrinsic interpretability models, post-hoc visualization of complex models, design of human-computer interactions, providing knowledge map based on clinical guidelines and data sources are used to endow the system with interpretability.
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Mannose has recently drawn extensive attention for its substantial anti-cancer activities, but the underlying mechanism remains largely unclear. The aim of this study was to investigate the effects of mannose on experimental colitis-associated colorectal tumorigenesis and underlying mechanisms. Data clearly showed that at plasma concentrations achieved after oral administration, mannose slightly affected malignancy of tumor cells or tumor promoter-induced transformation of pre-neoplastic cells, but substantially suppressed manifestation of the M2-like phenotype of tumor-associated macrophages (TAMs) in a cancer cell and macrophage co-culture model. Mechanistically, mannose might greatly impair the production of tumor cell-derived lactate which has a critical role in the functional polarization of TAMs. Importantly, oral administration of mannose protected mice against colitis-associated colorectal tumorigenesis by normalizing TAM polarization. Collectively, these findings highlight the importance of TAMs in colorectal tumorigenesis, and provide a rationale for introducing mannose supplementation to patients suffering from inflammatory bowel diseases.
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Deep learning is a process in which machine learning obtains new knowledge and skills by simulating the learning behavior of human brain through massive data training and analysis. With the development of medical technology, a large amount of data has been accumulated in the medical field, and the research on data may help to understand the relationships and rules within data and predict the onset and prognosis of human diseases. Deep learning can find the hidden information in data and has been increasingly used in the medical field. Primary liver cancer is a malignant tumor with high incidence and mortality rates, poor prognosis, and a high recurrence rate, and early diagnosis, timely treatment, and prediction of recurrence have always been the research hotspots in recent years. This article reviews the advances in the application of deep learning in the diagnosis and recurrence of liver cancer from the aspects of risk prediction, postoperative recurrence, and survival risk prediction.
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Objective @#To investigate the economic burden of cervical cancer and precancerous lesions, so as to provide the evidence for improving the management of cervical cancer and formulating the policies for reducing the economic burden of cervical cancer and precancerous lesions. @*Methods@#The hospitalized patients with cervical cancer and precancerous lesions were recruited from four hospitals in Xinjiang Uygur Autonomous Region from September 2020 to June 2021. The direct medical expenditures, direct non-medical expenditures, duration of absence from work in patients and their family members as carers were collected using a questionnaire designed by the Cancer Hospital of the Chinese Academy of Medical Sciences, and the economic burdens of cervical cancer and precancerous lesions were estimated. The factors affecting the economic burden of cervical cancer were identified using a multivariable linear regression model.@*Results@#Totally 265 patients with cervical cancer and precancerous lesions were included, with an average age of ( 49.80±10.07 ) years. There were 170 patients with cervical cancer, including 64 cases with stage I, 79 cases with stage II, and 27 cases with stages III/Ⅳ, and 95 patients with precancerous lesions, including 33 cases with low-grade squamous intraepithelial lesion ( LSIL ) and 62 cases with high-grade squamous intraepithelial lesion ( HSIL ). The median economic burdens (interquartile range) were 11 481 ( 4 523 ), 17 850 ( 9 096 ), 112 883 ( 59 623 ), 150 875 ( 105 206 ) and 197 842 ( 61 844 ) Yuan per patient among cases with LSIL, HSIL, and stage I, II and III/Ⅳ cervical cancer, respectively, among which the direct medical expenditures accounted for 85.89% to 93.86%. The median economic burdens (interquartile range) were 708 ( 1 711 ), 11 678 (6 590), 2 557 ( 19 472 ), and 14 943 ( 27 773 ) Yuan per patient with precancerous lesions, and were 910 (1 530), 105 770 ( 91 019 ), 39 765 ( 30 490 ), and 146 445 ( 123 039 ) Yuan per patient with cervical cancer during the diagnostic phase, the clinical treatment phase, the follow-up phase, and in total, respectively. Multivariable linear regression analysis results showed that pathological stage ( β'=0.202, P=0.003 ) and duration of hospital stay ( β'=0.695, P<0.001 ) correlated with the economic burden among patients with cervical cancer. @*Conclusion@#There is a high economic burden among patients with cervical cancer and precancerous lesions. Advanced pathological stage and long duration of hospital stay may increase the economic burden among cervical cancer patients.
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Objective:To investigate the early effect of different antithrombotic therapy in patients with coronary endarterectomy(CE) combined with off-pump coronary artery bypass grafting(OPCABG).Methods:Between January and December 2021, 154 consecutive patients including 120 males and 34 females with the age ranged from 39 to 78 years and an average of(62.6±7.2) years who underwent CE+ OPCABG were evaluated retrospectively. According to the postoperative anticoagulant therapy, patients were divided into two groups: Aspirin+ low molecular weight heparin group(n=81, LMWH group) and Aspirin+ ticagrelor group(n=73, ticagrelor group). The data of both preoperative and postoperative hemoglobin level and blood transfusion after the surgery were collected. The dynamic changes of electrocardiogram and cTnI level were observed within 48 h after the surgery.Results:There was no perioperative death, and all the patients were discharged 5-13 days postoperatively. After the initiation of anticoagulant therapy, the lowest hemoglobin value in the LMWH group and ticagrelor group was(88.3±14.6)g/L vs.(89.5±11.6)g/L( P>0.05), blood transfusion was performed in 8 vs. 5 patients with hemoglobin below 70g/L( P>0.05), peak cTnI within 48 h of surgery was 850.55(410.63, 1 662.63)pg/ml vs. 1 184.60(667.50, 3 169.63)pg/ml( P<0.05), the number of patients with perioperative myocardial infraction within 48h after the surgery confirmed by electrocardiogram was 2(2.5%) vs.2(2.5%), P>0.05. Conclusion:There was no significant difference between the two anticoagulant treatments in preventing perioperative myocardial infarction after CE+ OPCABG surgery. LMWH did not increase the risk of postoperative bleeding compared with ticagrelor. In addition, aspirin+ LMWH reduced the levels of peak TnI within 48 h of surgery, which may be associated with better long-term postoperative outcomes, but further research is needed to confirm this.
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Objective:To investigate the clinicopathological features and prognosis of mycosis fungoides.Methods:The clinical data of 34 patients with mycosis fungoides hospitalized in Liaoning Cancer Hospital from January 1996 to December 2016 were retrospectively analyzed. The clinicopathological characteristics and prognosis of the patients were summarized. The follow-up was up to June 2021. Kaplan-Meier method was used for survival analysis, and log-rank test was used to compare the overall survival (OS) of patients among different subgroups.Results:Among the 34 patients, 22 (64.7%) were male and 12 (35.3%) were female; the median onset age was 56.5 years (25-93 years). A total of 23 cases (67.6%) presented with the rash on the whole body, and the main manifestations of the rash in the tumor stage were tumor rupture (10 cases, 29.4%) and redness (7 cases, 20.6%); 20 cases (58.8%) were misdiagnosed at initial onset. In the terms of TNMB stage, 3 cases were at stage Ⅰ (8.8%), 11 cases were at stage Ⅱ(32.4%), 3 cases were at stage Ⅲ (8.8%), and 17 cases were at stage Ⅳ (50.0%); 17 cases (50.0%) had the lesions confined to the skin and 17 cases had distant metastasis. Among the patients with distant metastasis, 7 cases had visceral organs involvement, 5 cases had lymph nodes involvement, and 5 cases had bone marrow or peripheral blood involvement. There were 32 cases treated with first-line chemotherapy alone, 9 cases with radiotherapy alone, and 7 cases in combination with radiotherapy and chemotherapy. Among the 32 patients treated with first-line chemotherapy, 14 cases had complete remission (CR), 12 cases had partial remission (PR), and response rate (RR) was 81.3% (26 cases); among the 9 patients who received radiotherapy, 3 cases had CR, 5 cases had PR, and RR was 88.9% (8 /19). The median follow-up time was 142.5 months; until the last follow-up, 20 (58.8%) cases survived, 6 (17.6%) cases died and 8 (23.5%) cases lost the follow-up. Survival analysis showed that the median OS of the whole group was not reached. Compared with patients whose lesions were confined to the skin, patients with distant metastasis had poorer OS ( P = 0.039). Among patients with distant metastasis, those with lymph node involvement had better OS, followed by those with bone marrow or peripheral blood involvement, those with visceral organ involvement had the poorest OS ( P = 0.045). Conclusions:The clinical misdiagnosis rate of early-stage mycosis fungoides is high, and the diagnosis mainly depends on clinical, histological and pathological characteristics. Radiotherapy and chemotherapy have high efficiency for early-stage disease and the prognosis of patients with distant metastasis is poor. OS in patients with lymph node involvement is better than that in patients with bone marrow or peripheral blood involvement, and OS in patients with visceral organ involvement is the worst.
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The p21 activated kinase 4 (PAK4) is serine/threonine protein kinase that is critical for cancer progression. Guided by X-ray crystallography and structure-based optimization, we report a novel subseries of C-3-substituted 6-ethynyl-1H-indole derivatives that display high potential and specificity towards group II PAKs. Among these inhibitors, compound 55 exhibited excellent inhibitory activity and kinase selectivity, displayed superior anti-migratory and anti-invasive properties against the lung cancer cell line A549 and the melanoma cell line B16. Compound 55 exhibited potent in vivo antitumor metastatic efficacy, with over 80% and 90% inhibition of lung metastasis in A549 or B16-BL6 lung metastasis models, respectively. Further mechanistic studies demonstrated that compound 55 mitigated TGF-β1-induced epithelial-mesenchymal transition (EMT).
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Epigenetics concerns gene regulatory mechanisms beyond DNA sequence，such as DNA methylation，histone modification，chromatin remodeling，and non-coding RNA. Epigenetic mechanisms play a key role in development，cell fate decision and tumorigenesis. Chromatin modifications and its high order structure across our genome are major forms of epigenetic information，and its establishment and maintenance are closely related to cell metabolism. Metabolic changes in cancer cells include aerobic glycolysis，increased glucose uptake，abnormally active glutamine metabolism，and the use of non-conventional energy supply. These changes meet the vigorous energy and matter needs for the development and spread of cancer，and help tumor cells adapt to hypoxia microenvironment for their survival，proliferation，invasion and migration. There is a complex relationship between epigenetic modifications and cell metabolism in tumor. On the one hand，metabolites in tumor cells may act as cofactors，modification donors or antagonists of epigenetic enzymes，thus modulating the epigenetic landscape. On the other hand，epigenetic modifications can directly regulate the expression of metabolic enzymes，transporters，signaling pathway and transcription factors to affect cell metabolism. This article reviews the crosstalk between epigenetics and cancer metabolism，to explore their potential future applications in the treatment of tumors.
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Humans , Carcinogenesis , DNA Methylation , Epigenesis, Genetic , Gene Expression Regulation , Neoplasms/genetics , Tumor MicroenvironmentABSTRACT
In order to establish an infectious clone for CDV-3, a commercial vaccine strain of canine distemper virus for mink, to provide reference for the studies of pathogenesis and novel vaccine development of CDV. Thirteen pairs of primers were used to amplify the full-length genome of CDV-3 strain. Five long fragments were obtained based on single restriction site analysis of the whole genome of CDV-3 by RT-PCR. Five fragments were successively inserted into the multiple clone sites in the modified eukaryotic vector of pcDNA3.2 by restriction enzymes and splicing. Meanwhile, the hammerhead ribozyme and hepatitis delta virus ribozyme sequences were added to the beginning of F1 fragment and the ending of F5 fragment, respectively. Then, the full-length cDNA recombinant plasmid of CDV-3 was obtained and named as pcDNA3.2-CDV-3. In addition, three helper plasmids, expressing the N protein, P protein and L protein of the CDV-3 strain respectively, were constructed. The 293T cells were transfected with the full-length cDNA recombinant plasmid and three helper plasmids by Lipofectamine™ 2000. At 3 days post transfection, the supernatant was added to the monolayer of Vero cells to observe the typical syncytium of CDV. Indirect immunofluorescence and artificial label identification of recombinant virus rCDV-3 were conducted after the occurrence of lesions. Finally, the growth characteristics of wtCDV-3 and rCDV-3 were compared after passaging of rCDV-3. The identification of the full-length cDNA recombinant plasmid and three helper plasmids by restriction enzyme digestion and sequencing were consistent with expected. The Vero cells infected with the recombinant rCDV-3 showed typical syncytic. The identification of indirect immunofluorescence and labeled marker, and observation under electron microscope proved that the rCDV-3 was indeed rescued from the recombinant plasmid of pcDNA3.2-CDV-3. In comparison of the virus titers of wtCDV-3, rCDV-3 replicated massively and rapidly and reached the maximize virus titer of 10⁷·⁶⁶⁷ TCID₅₀/mL within 36 h post infection (p.i.) in Vero cells, while wtCDV-3 grew gradually to 10⁶·⁶⁶⁷ TCID₅₀/mL at 72 h p.i. in Vero cells. This reverse genetic system of CDV-3 strain has been established successfully, to provide reference for the studies of pathogenesis and novel vaccine development of CDV.
Subject(s)
Animals , Chlorocebus aethiops , Clone Cells , DNA, Complementary , Distemper Virus, Canine/genetics , Plasmids/genetics , Vero CellsABSTRACT
Objective:To describe a distal anastomosis support (DAS) technique, and retrospectively investigate the effect of DAS on the mid-term graft patency of patient with small posterior descending artery.Methods:Between January and December 2016, 100 patients with triple-vessel disease and small PDA who continuously underwent off-pump coronary artery bypass grafting (OPCABG) (OPCABG group, n=50) and OPCABG with DAS for anastomosis of PDA grafted by saphenous vein (SVG) (OPCABG+ DAS group, n=50) were evaluated retrospectively. The dynamic changes of electrocardiogram and TnI level were observed within 48h after the surgery. All patients came back to follow-up visit 6th, 12th, 24th and 36th postoperative month. The primary endpoint was the graft failure (FitzGibbon B or O) of SVG-PDA on the follow-up CTA.Results:There was no death during the operation. There was no acute inferior wall myocardial infarction confirmed by electrocardiogram. Peak TnI within 48h of surgery was 0.74(0.98)ng/ml vs. 0.92(1.29)ng/ml, P>0.05, and the number of patients with peak TnI≥70×ULN was 3(6%, 3/50) vs.5(10%, 5/50), P>0.05. There was no postoperative death, and all the patients were discharged 5-15 days postoperatively. We found significantly improved cumulative graft patency in OPCABG+ DAS group at 36 months after operation [85.7%(42/49) vs. 68.0%(34/50), P<0.05). In multivariate logistic regression analysis, PDA with atherosclerotic lesions ( OR=6.513, 95% CI: 1.279-33.180, P=0.024), and peak TnI≥70×ULN within 48 h of surgery ( OR=5.948, 95% CI: 1.128-31.368, P=0.036) were independent predictors of graft failure, whereas concomitant DAS ( OR=0.222, 95% CI: 0.069-0.713, P=0.011) was significant protective factor. Conclusion:Concomitant DAS conferred superior mid-term patency of SVG-PDA in patients with small PDA. Adding the DAS procedure to OPCABG may be a promising surgical option for small PDA with atherosclerotic lesions.
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Objective:To investigate and analyze the hospital staff and patients, awareness about anesthesiologists′ work.Methods:A questionnaire survey was conducted among the hospital staff in the non-anesthesiology departments and non-operating room and the patients undergoing elective surgery at the same time in tertiary hospitals.Logistic regression was used to analyze the factors affecting the level of awareness of the respondents.Results:Sixty point three percent of the respondents had a low level of awareness about the anesthesiologists′ work.Compared with the patients, the physicians ( OR=2.866, 95%CI: 1.405-5.848) had higher level of awareness.There was no significant difference in the levels of awareness among the nurses ( OR=1.633, 95%CI: 0.815-3.273), medical technicians ( OR=1.359, 95%CI: 0.630-2.935), administrative staff ( OR=1.470, 95%CI: 0.651-3.317) and the patients.The respondents, aged 36-50 yr ( OR=1.848, 95%CI: 1.224-2.792), with master′s degree ( OR=2.068, 95%CI: 1.090-3.925) and bachelor′ s degree ( OR=3.624, 95%CI: 1.701-7.723), had higher level of awareness, and the respondents without history of anesthesia and surgery ( OR=0.574, 95%CI: 0.380-0.867) and without medicine-related education background ( OR=0.354, 95%CI: 0.145-0.865) had lower level of awareness. Conclusion:There is insufficient awareness about anesthesiologists′ work among hospital staff and patients.Hospital staff are generally better than patients in terms of the level of awareness, but there are differences among different job categories.There is no significant difference in the level of awareness among nurses, medical technicians, administrative staff and patients.The respondents who are middle-aged, with higher education level, with history of anesthesia and surgery and with medicine-related education background, have higher level of awareness.
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Objective:To evaluate the effect of microevolution on phenotypes and drug resistance of the Trichosporon asahii biofilm. Methods:The standard strain of Trichosporon asahii was obtained from the Fungal Biodiversity Institute of the Royal Netherlands Academy of Arts and Sciences, the fluconazole-sensitive primary strain (TO) of Trichosporon asahii was isolated from a case of trichosporonosis diagnosed in the Department of Dermatology, the Seventh Medical Center of Chinese People′s Liberation Army General Hospital in 2000, and the fluconazole-resistant evolved strain (TEVO) of Trichosporon asahii was isolated from the above patient in 2014. Biofilms of the above-mentioned strains were formed in vitro, and tetrazolium salt XTT reduction assay was performed to evaluate growth kinetics of the Trichosporon asahii biofilm, and laser scanning confocal microscopy to determine the thickness of the biofilm; the sessile minimum inhibitory concentrations (SMICs) of fluconazole, itraconazole and voriconazole against the biofilms at different growth stages were determined in vitro for the evaluation of the resistance of the biofilms. One-way analysis of variance was used for comparisons among multiple groups, and Hartley test for testing homogeneity of variance. If the variance was homogeneous, least significant difference test was used for multiple comparisons; if the variance was heterogeneous, Tamhane′ T2 test was used for multiple comparisons. Results:In the adhesion (0 h) and formation stages (4- 24 hours) of the Trichosporon asahii biofilm, the metabolic activity of the evolved strain TEVO was the weakest (adhesion stage: F = 35.705, P < 0.001; formation stage: F = 15.042, P < 0.001) . At 48 hours after adhesion, the biofilms matured, and the TO strain showed the weakest metabolic activity ( F = 10.985, P < 0.001) . In the maturation stage, the biofilm thickness of the TEVO strain (26.1 ± 1.18 μm) was significantly higher than that of the TO strain (22.8 ± 1.73 μm, P = 0.001) , but significantly lower than that of the standard strain (29.5 ± 1.28 μm, P = 0.001) . As drug susceptibility testing showed, the SMICs of azole antifungal agents against the TEVO strain were higher than those against the TO strain in the adhesion and formation stages of the Trichosporon asahii biofilm, and the SMICs of azole antifungal agents against the biofilms of the 3 strains of Trichosporon asahii were all over 1 024 mg/L in the maturation stage of the biofilm. Conclusion:Under the dual pressure of host environment and antifungal drugs, adaptive changes took place in the phenotypes of the Trichosporon asahii biofilm with an increase in the resistance to azole antifungal drugs.
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Objective:To investigate the effect and possible mechanism of curcumin on the growth and invasion of thyroid carcinoma papillary K1 cells.Methods:K1 cells were randomly divided into control group, solvent control group, and curcumin group with 10, 30 and 50 μmol/L. The control group was only added with fresh medium, the solvent control group was added with dimethyl sulfoxide medium, and the 10, 30, 50 μmol/L curcumin groups were added with 10, 30 and 50 μmol/L curcumin respectively. The effects of curcumin on the growth of thyroid cancer papillary carcinoma K1 cells were observed by MTT assay. PI and Hochest3342 double staining were used to detect cell death. Transwell chamber was used to verify the effect on cell invasion. Western blot was used to observe the effects of curcumin on expression of Vimentin and E-cadherin.Results:Compared to the control group and solvent control group, the cell survival rate significantly decreased and the cell death rate of 10, 30, 50 μmol/L curcumin groups significantly increased ( P<0.05). The cell invasion rate (80.12% ± 3.43%, 65.59% ± 4.11%, 30.32% ± 4.67% vs. 100.00% ± 2.81%, 98.82% ± 2.18%) of 10, 30, 50 μmol/L curcumin groups significantly decreased ( P<0.05). The expression of E-cadherin (0.41 ± 0.12, 0.63 ± 0.14, 0.70 ± 0.13 vs. 0.34 ± 0.10, 0.35 ± 0.11) of 10, 30, 50 μmol/L curcumin groups significantly increased ( P<0.05), and the expression of Vimentin (0.70 ± 0.11, 0.22 ± 0.10 vs. 0.87 ± 0.12, 0.87 ± 0.13) of 10, 30, 50 μmol/L curcumin groups significantly decreased ( P<0.05). Conclusions:Curcumin can inhibit the proliferation and invasion of papillary thyroid carcinoma K1 cells and accelerate cell death.
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Objective@#To explore the application of endoscopic tattooing with carbon nanoparticles in the treatment of advanced colorectal cancer (ACRC).@*Methods@#A randomized controlled study was used. Inclusion criteria: (1) age more than 18 years old, and colorectal cancer was found for the first time and confirmed by colonoscopy and biopsy; (2) advanced colorectal cancer (preoperative TNM stage of T3/N1 or above, local unresectable lesion, M1 stage and simultaneously resectable metastatic lesion), and patients agreed to receive neoadjuvant therapy; (3) advanced colorectal cancer (TNM stage of T3/N1 or above) with simultaneous unresectable metastatic lesion, and patients refused operation and consented to chemoradiotherapy. Patients with previous abdominal surgery history, radiotherapy and chemotherapy history, urgent need for surgery or endoscopic stent placement and those with severe allergic constitution were excluded. Based on the above criteria, 120 patients diagnosed with ACRC in No.900 Hospital of the Joint Logistics Team from January 2016 to December 2017 were prospectively enrolled and randomly divided into tattoo group and non-tattoo group by random number table method. Tattoo group were tattooed within 1-7 days before chemoradiotherapy. The labeling location of the lesions: (1) if the colonoscopy could pass smoothly, 4 points were injected into the intestinal wall of the both opposite sides 1 cm cephalad and caudad of the tumor; (2) if the colorectal cavity was severely narrow and the colonoscopy could not pass, only 4 points were injected in 4 quadrants at 1 cm caudad of the tumor. Each injection point was injected with 0.1 ml carbon nanoparticles, and the size of the tumor was measured according to the range of carbon nanoparticles staining. The efficacy was evaluated after 8 weeks of chemoradiotherapy. Patients who were defined to be suitable for operation underwent operation 6 weeks after chemoradiotherapy. The following parameters were compared between two groups: lesion identification time, operation time, blood loss, distance from lesion to distal margin, the rate of first positive margin and the rate of anal sphincter preservation (rectal cancer). Among patients who had been evaluated as having no indication for surgery, those who were effective in chemoradiotherapy continued to receive chemotherapy in the original regimen; if the treatment failed, the chemotherapy regimen was replaced, and the efficacy was finally evaluated after six months [referring to the revised RECIST guidelines (version 1.1)].@*Results@#Three patients withdrew from this study, and 117 patients were enrolled in this study finally, including 59 cases in tattoo group and 58 cases in the non-tattoo group. There were no significant differences in baseline data between two groups (all P>0.05). All the patients had slight adverse reactions of radiotherapy and chemotherapy before operation, and could tolerate after symptomatic management without interruption of treatment. All the patients in the tattoo group had no discomfort such as fever, abdominal pain, abdominal distention, hematochezia, etc. and the intestinal mucosa could be seen clearly with black staining after being tattooed. A total of 77 patients were evaluated with surgical indications, including 39 cases in the tattoo group (tattoo-operable) and 38 cases in the non-tattoo group (non-tattoo-operatable). There were no significant differences in baseline data between the two groups (all P>0.05). Forty patients without operation indications continued chemoradiotherapy, including 20 cases in tattoo group (tattoo-inoperable) and 20 cases in non-tattoo group (non-tattoo-inoperable), whose differences in baseline data between the two groups were not significant as well (all P>0.05). No obvious edema, necrosis or abscess were found in the tattooed segments and the black spots could be seen quickly and clearly on the serosa of rectum in tattoo-operable patients. As compared to non-tattoo group, tattoo group had significantly shorter lesion identification time [(3.4±1.4) minutes vs. (11.8±3.4) minutes, t=-14.07,P<0.001], shorter operation time [(155.7±44.5) minutes vs. (177.2±30.2) minutes, t=-2.48,P=0.015], less blood loss [(101.3±36.7) ml vs.(120.2±38.2) ml, t=-2.22,P=0.029], shorter distance from lesion to distal margin [(3.7±1.0) cm vs. (4.6±1.7) cm, t=-2.20, P=0.034], while tattoo group had slightly higher rate of anal sphincter preservation [66.7%(16/24) vs. 45.5%(10/22), χ2=2.10,P=0.234] and lower rate of first positive resection margin [0 vs. 4.5%(1/22), χ2=0.62,P=0.480], but their differences were not significant. There were no significant differences in the degree of tumor differentiation and TNM stage between two groups. Patients without operative indication were evaluated for efficacy of chemoradiotherapy again after half a year. One case of complete response (CR), 8 of partial response (PR), 10 of stable disease (SD) and 1 of progressive disease (PD) were found and the improvement rate was 45.0% (9/20) in tattoo-inoperable patients. No case of CR, 6 of PR, 11 of SD and 3 of PD were found and the improvement rate was 30.0% (6/20) in non-tattoo-inoperable patients. There was no significant difference in the improvement rate between the two groups (P=0.514).@*Conclusions@#Endoscopic tattooing with carbon nanoparticles injection is safe and reliable for colorectal tumor positioning. It can assist rapid detection of lesions during surgery after neoadjuvant treatment, perform accurate resection, significantly shorten the operation time and reduce surgical trauma; can assist colonoscopy accurately to measure the size of the lesions before and after chemoradiotherapy, and increase the means of assessing the efficacy to guide the follow-up treatment plan. This technique is worth clinical promotion and application.
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Objective@#To observe the cardiomyocytes regeneration after myocardial infarction in Chinese small pigs, analyze the mechanism of myocardial fibrosis after myocardial regeneration.@*Methods@#Nine Chinese small pigs, weight 18-20 kg, 6 pigs in the experimental group(to ligate LAD at the equal blood flow point), and 3 in the control group(no any operation was performed). Monitor the hemodynamics of the left ventricle. Cardiac specimens were taken after 4 weeks of LAD ligation, the left ventricle was divided into 17 segments, and fixed in 4% paraformaldehyde for 1 week. Hematoxylin-Eosin/(HE) staining, PTAH、Ki-67-DAB and α-sarcomeric-actin-DAB staining for pathological observation.@*Results@#Four weeks of LAD ligation, different range of infarct size could be found in all the 17 segment of left ventricle. There was significant systolic pressure difference between the proximal and distal part in the left ventricular cavity. After 4 weeks of LAD ligation, there were a large number of new cardiomyocytes around the infarction area, which connected with the original mature cardiomyocytes directly. Large number of disassembled cardiomyocytes in the infarcted area and myocardial fibers were broken, cell structure disappeared, and nuclei were scattered in fibrotic tissues.@*Conclusion@#New cardiomyocytes after myocardial infarction were derived from the mature cardiomyocytes. Myocardial regeneration, cell disintegration, and myocardial fibrosis were performed synchronously under the influence of myocardial tension.
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Objective To observe the cardiomyocytes regeneration after myocardial infarction in Chinese small pigs, ana-lyze the mechanism of myocardial fibrosis after myocardial regeneration. Methods Nine Chinese small pigs, weight 18-20 kg, 6 pigs in the experimental group( to ligate LAD at the equal blood flow point) , and 3 in the control group( no any operation was performed) . Monitor the hemodynamics of the left ventricle. Cardiac specimens were taken after 4 weeks of LAD ligation, the left ventricle was divided into 17 segments, and fixed in 4％ paraformaldehyde for 1 week. Hematoxylin-Eosin/( HE) stai-ning,PTAH、Ki-67-DAB and α-sarcomeric-actin-DAB staining for pathological observation. Results Four weeks of LAD liga-tion, different range of infarct size could be found in all the 17 segment of left ventricle. There was significant systolic pressure difference between the proximal and distal part in the left ventricular cavity. After 4 weeks of LAD ligation, there were a large number of new cardiomyocytes around the infarction area, which connected with the original mature cardiomyocytes directly. Large number of disassembled cardiomyocytes in the infarcted area and myocardial fibers were broken, cell structure disap-peared, and nuclei were scattered in fibrotic tissues. Conclusion New cardiomyocytes after myocardial infarction were derived from the mature cardiomyocytes. Myocardial regeneration, cell disintegration, and myocardial fibrosis were performed synchro-nously under the influence of myocardial tension.
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Objective To evaluate the value of clinical application in chest tumor biopsy by DSA rotating reconstruction technology and CT guided technology.Methods The 63 cases of chest tumors collected,38 cases of lung tumors,25 cases of mediastinal tumors.Applicating of CT and DSA scan and formulating puncture path,according to their respective descending thoracic tumor puncture guide way.DSA and CT guided traditional way from the success rate of puncture,operation time,X-ray exposure and complications were analyzed.Results 45 cases take CT guidance,18 cases take DSA guidance.60 cases,the pathological results achieved and positive rate was 95.2％.CT group success rate of first puncture in 68.9％ (31/45),DSA group 88.9％ (16/18),statistically significant.CT group pneumothorax rate 17.8 ％ (8/45),DSA group pneumothorax rate 11.1％ (2/18),no statistical difference.Operation time CT group (23.111 ± 4.281) minutes,DSA group (12.889 ± 3.693) minutes,with significantly statistical differences.CT group exposure (11.563±3.023) mGy,DSA group exposure (9.956±2.193) mGy,statistically significant.Conclusion The chest tumor puncture biopsy by DSA rotating reconstruction technique guided with flexible,fast and convenient,and superior to traditional CT with real-time monitoring,shorten the operation time,reduce the exposure,the success rate of first puncture aspects.
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Objective To evaluate the short-term outcomes and analyze the complications of medial unicompartmental knee osteoarthritis (MUKOA) treated by unicompartmental knee arthroplasty (UKA).Methods Retrospectively analyzed the patients suffered with MUKOA and registered into our department from Jul 2015 to Jan 2017.71 cases were enrooled in the study,of which 17 are male (19 UKA) and 54 are female (66 UKA).The general information,perioperative data,Hospital for Special Surgery (HSS) score,visual analogue score (VAS) and complications of the group were analyzed.Results Females were three times more than males (54∶ 17).The average age of female subjects was lower than that of male,the difference was significant (P ＜ 0.05).The rate of Osteoporosis of females was significantly higher than that of males (P ＜ 0.05).The operative time,length of incision,total overt blood loss and postoperative in-bed time were (54.06 ± 6.24) min,(8.56 ± 0.83) cm,(86.10 ± 5.44) ml,(3.51 ± 1.01) d,respectively.No significant differences were found between males and females (P ＞ 0.05).The preoperative,3 months and 6 months postoperative HSS scores were 45.2 ± 4.5,80.3 ± 5.7 and 88.4 ± 4.2,respectively.No differences were found between males and females (P ＞ 0.05).The preoperative,3 months and 6 months postoperative VAS scores were 6.6 ± 1.2,1.7 ± 0.7 and 0.5 ± 0.5,respectively.No differences were found between males and females (P ＞ 0.05).There were 2 revised cases,and the reasons for revision were infection and unstability caused by sport injury.Conclusions UKA is an ideal choice for patients with MUKOA,Especially for the ones older than 60 years.However,the corrections on lower-limb forceline and joint unstability are limited,thus,the indications for UKA should be controlled strictly.