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Background Arsenic can enter the hypothalamus to induce estrogen effect and interfere with the function of the neuroendocrine system. The thyroid endocrine system (hypothalamic-pituitary-thyroid axis) is one of the main endocrine systems, and the mechanism of arsenic-induced thyroid endocrine toxicity is still unclear. Objective To investigate the effects of different arsenic exposure levels on estradiol (E2), hypothalamic thyrotropin-releasing hormone (TRH), and their receptor (ERα, ERβ, and TRHR) mRNAs in rats and the possible hypothalamic toxic pathway and mechanism. Methods Seventy Wister rats were randomly divided a control group (sterile water); low-, medium-, and high-dose arsenic exposure groups [0.8, 4.0, and 20.0 mg·kg−1 sodium arsenite (NaAsO2)]; estrogen receptor inhibitor (ICI182780) intervention + low-, medium-, and high-dose arsenic exposure groups; with 10 animals in each group, half male and half female. Rats in the arsenic exposure groups were exposed to NaAsO2 by drinking water for 19 weeks, and rats in the intervention groups were injected with 0.5 mg·kg−1 ICI182780 via tail vein at week 9, 3 times a week. The levels of E2 and TRH in serum of rats were detected by ELISA. The expression levels of estrogen receptor α (ERα), estrogen receptor β (ERβ), and TRH receptor (TRHR) mRNAs in hypothalamus of rats were detected by real-time PCR (RT-PCR). Results (1) E2 and its receptor mRNA: Compared with the control group, the serum E2 level of female rats was increased in the low-dose and the medium-dose arsenic exposure groups (P<0.05), and the serum E2 level of male rats was increased in the low-dose, the medium-dose, and the high-dose arsenic exposure groups (P<0.05), and the change of female E2 was greater than that of male rats. Compared with the control group, the relative expression levels of ERα mRNA and ERβ mRNA in female rats were increased in the low-dose, the medium-dose, and the high-dose arsenic exposure groups (P<0.05), so were the relative expression levels of ERα mRNA in male rats (P<0.05). (2) TRH and its receptor mRNA: Compared with the control group, the serum TRH level of female rats was increased in the high-dose arsenic group (P<0.05), the relative expression level of TRHR mRNA was increased in the low-dose, the medium-dose, and the high-dose arsenic exposure groups (P<0.05). Results (1) and results (2) suggested that females were more likely than males to have abnormal changes in E2, TRH, and related receptor genes after arsenic exposure. (3) Compared with female rats in the medium-high dose arsenic exposure group, the expressions of TRH and TRHR induced by arsenic exposure were inhibited after the intervention of ICI182780 (P<0.05), suggesting that arsenic in the hypothalamus may have toxic effects on TRH and TRHR by inducing estrogen-like effects. Conclusion Arsenic exposure can induce estrogen-like effects in the hypothalamus, interfere with thyroid function, and show dose-dependent and sex differences. E2 and TRH and their receptors may be the toxic pathway of arsenic-related estrogen-like effect.
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Objective:To compare the efficacy of arthroscopic all-inside ligament repair with suture augmentation and ligament reconstruction with tendons in the treatment of chronic ankle instability with poor remnant quality of the anterior talofibular ligament (ATFL) tissue.Methods:A retrospective cohort study was conducted to analyze the clinical data of 37 patients with chronic ankle instability treated at Huashan Hospital Affiliated to Fudan University from January 2018 to August 2020, including 34 males (34 ankles) and 3 females (3 ankles); aged 18-57 years [(32.2±7.2)years]. The time from injury to operation ranged from 3-360 months [48(12, 120)months]. All patients underwent arthroscopic all-inside ankle stabilization surgery, of which 19 underwent ligament repair with suture augmentation (augmented repair group) and 18 underwent traditional ligament reconstruction with allograft/autograft tendons (tendon reconstruction group). The degree of ATFL injury and intra-articular lesions (osteophytes, loose bodies and cartilage damage) were recorded during the operation. The Karlsson scale and Tegner scale were evaluated before operation and at the last follow-up. The number of patients who were able to complete partial weight-bearing/return to normal walking/return to sports postoperatively and the time required were compared between the two groups. Postoperative complications were observed.Results:All patients were followed up for 12-32 months [21(16, 28)months]. There were no significant differences in the degree of ATFL injury and intra-articular lesions (osteophytes, loose bodies and cartilage damage) seen during the operation between the two groups (all P>0.05). At the last follow-up, the Karlsson score in augmented repair group and tendon reconstruction group [95.0(90.0, 98.5)points and 95.0(87.8, 99.3)points] was significantly higher than the preoperative level [65.0(51.0, 75.0)points and 65.0(53.3, 78.0)points] (all P<0.01). At the last follow-up, the Tegner score in augmented repair group and tendon reconstruction group [5.0(3.5, 6.0)points and 5.0(3.3, 6.0)points] were significantly higher than the preoperative level [3.0(2.0, 4.0)points and 2.5(1.3, 4.0)points] (all P<0.01). There were no significant differences in Karlsson score and Tegner score between the two groups (all P>0.05). All patients completed partial weight-bearing after 3.0(2.0, 4.0)weeks in augmented repair group and 4.0(3.5, 6.0)weeks in tendon reconstruction group. All patients returned to normal walking after 8.0(6.0, 9.0)weeks in augmented repair group and 8.0(5.5, 12.0)weeks in tendon reconstruction group. A total of 13 patients (63%) in augmented repair group and 13 patients (72%) in tendon reconstruction group successfully returned to sports postoperatively and the time required was 6.0(3.5, 8.0) months and 6.0(4.5, 12.0)months, respectively. There were no significant differences in the above indicators between the two groups (all P>0.05), but augmented repair group had a trend of faster completion of partial weight-bearing than tendon reconstruction group. There was 1 patient [5%(1/19)] in augmented repair group and 1 patient [6%(1/18)] in tendon reconstruction group who reported feelings of instability during exercise postoperatively ( P>0.05). None of the patients in augmented repair group had limited ankle range-of-motion, not different from 1 patient [6%(1/18)] in tendon reconstruction group ( P>0.05). Conclusion:In the treatment of chronic ankle instability with poor remnant quality of the anterior talofibular ligament (ATFL) tissue, both arthroscopic all-inside ligament repair with suture augmentation and ligament reconstruction with tendons can improve the short-term postoperative ankle function and activity level of the patients, and the former one has advantages such as simple operative procedures and none use of grafts.
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Objective:To investigate the influencing factors for lymph node metastasis and prognosis in stage T1 and T2 esophageal squamous cell carcinoma after radical surgery and construct nomogram prediction models.Methods:The retrospective cohort study was conducted. The clinico-pathological data of 672 patients with T1 and T2 esophageal squamous cell carcinoma who were admitted to the Affiliated Hospital of North Sichuan Medical College from January 2014 to December 2019 were collected. There were 464 males and 208 females, aged (65±8)years. All patients under-went radical esophagectomy+2 or 3 field lymph node dissection. Observation indicators: (1) lymph node dissection, metastasis and follow-up. (2) risk factors for lymph node metastasis of esophageal cancer after radical resection. (3) prognostic factors of esophageal cancer after radical resection. (4) construction and evaluation of the prediction models of lymph node metastasis and prognosis of esophageal cancer after radical resection. Follow-up was conducted using outpatient examination, telephone and internet consultations to detect survival of patients up to April 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Kaplan-Meier method was used to calculate survival rate and draw survival curve. Log-Rank test was used for survival analysis. Logistic regression model was used for univariate and multivariate analyses of risk for lymph node metastasis, and COX regression model was used for univariate and multivariate analyses of prognosis. Based on the results of multi-variate analysis, the nomogram prediction models for lymph node metastasis and prognosis predic-tion were constructed. The prediction discrimination of the nomogram models were evaluated using the area under curve (AUC) of the receiver operating characteristic curve (ROC). The calibration curve was used to evaluate the prediction consistency of the models. Results:(1) Lymph node dissection, metastasis and follow-up. The number of lymph node dissected was 14±8 and the number of lymph node metastasis was 2(range, 1?19) in 672 patients. Of the 672 patients, there were 182 cases had lymph node metastasis, including 58 cases in T1 stage and 124 cases in T2 stage. All 672 patients were followed up for 38 (range, 1?85)months. The average overall survival time of 672 patients was 65 months, with the 1-, 3-, 5-year overall survival rate as 89.0%, 74.3%, 66.0%, respectively. The average overall survival time of 325 patients in T1 stage and 347 patients in T2 stage were 70 months and 61 months. The 1-, 3-, 5-year overall survival rate of 325 patients in T1 stage and 347 patients in T2 stage were 95.0%, 83.5%, 73.4% and 87.4%, 69.9%, 59.2%, respectively, showing a significant difference in survival between them ( χ2=14.51, P<0.05). (2) Risk factors for lymph node metastasis of esophageal cancer after radical resection. Results of univariate analysis showed that tumor location, tumor histological grade, tumor T staging were related factors affecting lymph node metastasis of esophageal cancer after radical resection ( odds ratio=1.40, 1.54, 2.56, 95% confidence interval as 1.07?1.85, 1.20?1.99, 1.79-3.67, P<0.05). Results of multivariate analysis showed that tumor location, tumor histological grade, tumor T staging were independent factors affecting lymph node metastasis ( odds ratio=1.42, 1.61, 2.63, 95% confidence interval as 1.07?1.89, 1.25?2.09, 1.82?3.78, P<0.05). (3) Prognostic factors of esophageal cancer after radical resection. Results of univariate analysis showed that preoperative comorbidities, postoperative complications, tumor histological grade (G3), tumor T staging, tumor N staging (N1 stage, N2 stage, N3 stage), tumor TNM staging (Ⅲ stage, Ⅳ stage) were related factors affecting prognosis of esophageal cancer after radical resection ( hazard ratio= 1.48, 1.64, 2.23, 1.85, 2.09, 4.48, 4.97, 3.54, 5.53, 95% confidence interval as 1.08?2.03, 1.20?2.23, 1.47?3.39, 1.34?2.54, 1.44?3.04, 2.89?6.95, 1.57?15.73, 2.48?5.05, 1.73?17.68, P<0.05). Results of multivariate analysis showed that preoperative comorbidities, G3 of tumor histological grade, T2 stage of tumor T staging, N1 stage, N2 stage, N3 stage of tumor N staging were independent risk factors affecting prognosis of esophageal cancer after radical resection ( hazard ratio=1.57, 1.89, 1.63, 1.71, 3.72, 3.90, 95% confidence interval as 1.14?2.16, 1.23?2.91, 1.17?2.26, 1.16?2.51, 2.37?5.83, 1.22?12.45, P<0.05). (4) Construction and evaluation of the prediction models of lymph node metastasis and prognosis of esophageal cancer after radical resection. Based on the results of multivariate analysis, tumor location, tumor histological grade, tumor T staging were applied to construct a nomo-gram model for lymph node metastasis prediction of esophageal cancer after radical resection, the score of tumor location, tumor histological grade, tumor T staging were 82, 100, 100, respectively, and the sum of the scores corresponding to the lymph node metastasis rate. Preoperative comor-bidity, tumor histological grade, tumor T staging, tumor N staging were applied to construct a nomo-gram model for 1-, 3-, 5-year overall survival rate prediction of esophageal cancer after radical resection, the score of preoperative comorbidity, tumor histological grade, tumor T staging, tumor N staging were 23, 38, 27, 100, respectively, and the sum of the scores corres-ponding to the 1-, 3-, 5-year overall survival rate. Results of ROC showed that the AUC of nomogram model for lymph node metastasis prediction after radical esophagectomy was 0.66 (95% confidence interval as 0.62?0.71, P<0.05). The AUC of nomogram model for 1-, 3-, 5-year overall survival rate prediction after radical esophagectomy were 0.73, 0.74, 0.71 (95% confidence intervals as 0.66?0.80, 0.68?0.79, 0.65?0.78, P<0.05). Results of calibration curve showed that the predicted lymph node metastasis rate and the predicted 1-, 3-, 5-year overall survival rate by nomogram models were consistent with the actual lymph node metastasis rate and 1-, 3-, 5-year overall survival rate. Conclusions:Tumor location, tumor histological grade, tumor T staging are independent factors affecting lymph node metastasis in T1 and T2 esophageal squamous cell carcinoma after radical surgery and nomogram model constructed by these indicators can predict the lymph node metas-tasis rate. Preoperative comor-bidities, G3 of tumor histological grade, T2 stage of tumor T staging, N1 stage, N2 stage, N3 stage of tumor N staging are independent risk factors affecting prognosis and nomogram model constructed by these indicators can predict the overall survival rate of patients after surgery.
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Objective@#To examine the associations of arsenic and estrogen levels with the risk of papillary thyroid carcinoma, so as to provide insights into prevention of papillary thyroid carcinoma.@*Methods@#Totally 57 patients with papillary thyroid carcinoma admitted to two tertiary hospitals in Urumqi, Xinjiang Uygur Autonomous Region in 2018 were selected as the case group, while 57 subjects with normal thyroid functions during the same period were selected as the control group. Subjects' gender, age, ethnicity, occupation and medical history of thyroid disease were collected using questionnaire surveys. Serum dimethyl arsenic acid (DMA) and monomethyl arsenic acid (MMA) were determined using high-performance liquid chromatography (HPLC) coupled to hydride generation-atomic fluorescence spectrometry (HG-AFS), serum thyroid hormone (TSH) by radioimmunoassay, estradiol (E2) by enzyme-linked immunosorbent assay and estrogen receptor ERα and ERβ by western blotting. The associations of arsenic and estrogen levels with the risk of papillary thyroid carcinoma were evaluated using a multivariable logistic regression model.@*Results@#There were 16 males (28.07%) and 41 females (71.93%) in the case group, with a mean age of (42.63±11.01) years, and there were 21 males (36.84%) and 36 females (63.16%) in the control group, with a mean age of (40.89±11.30) years. There were no significant differences between the case and control groups in terms of age (χ2=0.373, P=0.542), gender (χ2=1.000, P=0.317) or ethnic composition (χ2=0.291, P=0.590). The serum levels of TSH [2.85 (1.61) vs. 2.45 (1.79) μmol/L], E2 [74.93 (120.44) vs. 61.60 (37.35) pmol/L], ERα [1.49 (1.13) vs. 0.70 (0.31)], ERβ [1.59 (0.55) vs. 0.72 (0.36)], DMA [116.02 (100.48) vs. 32.33 (56.06) μg/L] and MMA [56.92 (47.90) vs. 27.90 (24.99) μg/L] were all significantly higher in the case group than in the control group (Z=-2.414, -2.292, -4.923, -5.167, -5.448 and -4.019, all P<0.05). Multivariable logistic regression analysis showed DMA (OR=1.013, 95%CI: 1.003-1.024) and E2 levels (OR=1.020, 95%CI: 1.004-1.036) were associated with the risk of papillary thyroid carcinoma.@*Conclusion@#Increased arsenic load and elevated estradiol levels may be associated with the risk of papillary thyroid carcinoma.
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OBJECTIVE：To establish c harge-by-dose model for pediatric drugs in our hospital ，so as to provide reference for reducing patients ’expenditure，saving medical insurance funds and reducing drug proportion. METHODS ：Since June 2019，a total of 12 kinds of drugs with heavy usage ，high price and large savings in our hospital were selected to establish pediatric charge-by-dose list. The drugs included in the list were split into 1/2 or 1/5 small-sized drug for charge-by-dose model. The process，quality control standards and surplus （loss）drug record of charge-by-dose model were formulated to coordinate the use of pediatric drugs between pharmacies and pediatric departments. The quantity and amount of drugs which were split ，and the drug proportion in pediatric departments were compared between charge-by-dose model and charge-by-unit model （theoretical value of dosage conversion in the same period ）during Jun.-Dec. 2019. RESULTS ：From Jun. to Dec. 2019，the quantities of split drugs each month with charge-by-dose model and charge-by-unit model were （3 346.43±734.73）and（6 821.71±1 468.81）；the amounts of split drugs each month with two models were （53 576.03±10 958.78）yuan and （112 642.75±21 308.77）yuan， respectively，with statistical significance （P＜0.05）. The drug proportion in four pediatric internal medicines departments and one neonatal medicine department had decreased to varying degrees. CONCLUSIONS ：Pediatric drug charge by dose can reduce the use and amount of drugs ，save medical insurance expenditures ，decrease the drug proportion of department.
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Objective To investigate the changes of hypoxia-inducible factor (HIF-1α, HIF-2α) expression level in lung cancer A-549 cells under normoxic conditions, different hypoxia durations, and different oxygen concentrations. Methods A549 cells were divided into normoxic group, time control group, and oxygen concentration control group. Western blot was used to detect the expression of HIF-1α and HIF-2α in A-549 cells.Results The expression of HIF-1α and HIF-2α protein were lower under normoxia and significantly increased under hypoxic conditions. The difference was statistically significant. The lower the oxygen concentration, the more HIF-1α and HIF-2α protein expression levels were. The differences between high and high were statistically significant. The expression of HIF-1α protein increased at 2 h after hypoxia, peaked at 8 h, appeared plateau at 8 to 16 h, and decreased at 32 h, with a statistically significant difference. HIF-2α proteins gradually increased with prolonged hypoxia. Conclusions Under hypoxic conditions, the expression of HIF-1α and HIF-2α are increased, and the expression of HIF-2α has a time-dependent pattern, which may have more important biological significance.
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Objective To investigate the clinical features and prognostic factors of children with gigantic thoracic tumors.Methods Clinical data were collected from the database of Cardiothoracic Surgery,Shanghai Children's Hospital between January 2009 and June 2015.The analyses were mainly focused on the clinical data of 76 cases of thoracic giant tumor that underwent surgical treatment,Univariate survival analysis was performed with Kaplan Meier method.Results Pathological results showed that 35 cases were benign tumors and 41 cases were malignant tumors.For benign tumors,the main pathological classification were ganglioneuroma in 12 cases,vascular tumors in 9 cases,germ cell tumors in 8 cases.For malignant tumors,the main pathological classification were neuroblastoma in 13 cases,ganglioneuroblastoma in 7 cases and lymphoma in 7 cases,etc.After surgical resection 31 cases of benign tumors were long-term survival.The 5 year survival rates of 70 patients with gigantic thoracic tumors was more than 75％,39 patients with malignant tumors were more than 50％.Single factor in Kaplan Meier analysis showed that gender,location of primary tumor were not associated with neurogenic tumor prognosis(P ＞ 0.05).The age of patients,tumor stage,tumor pathological type,whether chemotherapy are associated with prognosis of neurogenic tumors the difference has statistical significance (P ＜ 0.05).Conclusion Surgical resection is a prognostic factor for patients with benign thoracic giant tumor.The recurrence and metastasis rates of malignant tumor is high.Its prognosis is poor.The survival time of patients with postoperative chemotherapy or radiotherapy can be prolonged.The most common children gigantic thoracic tumors are neurogenic tumors,There is no correlation between the prognosis of neurogenic tumors and sex or primary site.While age,tumor stage,pathology and whether with chemotherapy are associated with neurogenic tumor prognosis.
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Objective To evaluate the angle between the anterior talofibular ligament (ATFL) and posterior talofibular ligament (PTFL) in patients with mechanical ankle instability,so as to find out a new indirect diagnosis method for the chronic ATFL lesion.Methods One hundred subjects were included in this study,among which 50 patients with mechanical ankle instability were assigned to group A and 50 counterparts without it were selected into group B All patients were taken MR Images and the ATFL and PTFL angle at the axial plane was evaluated.The difference between two groups was evaluated.Results The ATFL and PTFL angle increased significantly in group A when compared to group B (82.1° ± 8.0° v.s,74.4° ± 5.9°,P＜0.01).The area under receiver operating characteristic curve (ROC)was 0.874 (P＜0.01),indicating great significance in diagnosing the chronic ATFL tear.Moreover,the angle was 79 degree,showing high sensitivity (0.88) and specificity (0.64) of diagnosing ATFL tear.Conclusion The ATFL and PTFL angle increases significantly in patients with the mechanical instability.Moreover,the possibility of ATFL tear increases when the ATFL and PTFL angle is greater than 79 degree.
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Objective:To compare the clinical efficacy of percutaneous radiofrequency ablation (RFA) under ultrasound guidance and high power microwave ablation (MWA) in the treatment of intermediated or advanced-staged primary liver cancer.Methods: 60 patients with primary liver cancer who were in accordance with the inclusion criteria were divided into radiofrequency ablation group (RFA group, 30 cases) and microwave ablation group (MWA group, 30 cases). A series indicators, such as postoperative complete remission rate of lesion, 1 year survival rate, 1 year progression-free survival rate, postoperative adverse reaction and postoperative complication, for these patients of two groups were compared and analyzed.Results:The total complete remission rate of the RAF group and the MWA group were 66.7% and 76.7%, respectively, and the difference between them was significant (x2=3.776, P0.05). For postoperative complication, there were 3 cases in RAF group while there were 5 cases in MWA group, and the difference between them was significant (x2=3.373, P0.05).Conclusion: For intermediated or advanced-staged primary liver cancer with the larger or multiple lesions, complete remission rate of high-power MWA group is better than that of RAF. But there was no significant difference for 1 year total survival rate and 1 year progression-free survival rate between the two groups, respectively. And the postoperative adverse reaction of high-power MWA group was higher than that of RAF group.
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Purpose To clarify the morphological parameter and describe the distance from the insertion of the lateral ankle ligaments to the adjacent bony landmarks through precisely anatomical explore of human cadaveric ankles,so as to provide anatomical evidences for the reconstruction of lateral ankle ligaments.Methods Nineteen ankle specimens were dissected to isolate the lateral ankle ligaments and measure the morphological parameters such as length,width,thickness and the distance from the insertion of the lateral ankle ligaments to the adjacent bony landmarks.Results The average length of anterior talofibular ligaments (ATFL) was 23.1 ± 2.98 mm,among which 8 were single-banded(42.1％)and 11 were double-banded(57.9％).The average distance from the fibular origination of ATFL to the anterior tubercle of fibula(AA)was 17.1 ± 3.00 mm,to the fibular obscure tubercle(AO)was 5.1 ± 1.69 mm,to the tip of the fibula(AT)was 14.1 ± 2.86 mm.The distances from the talus insertion of ATFL to the superior and inferior talus articular surface were 11.4 ± 2.25 mm and 18.4 ± 2.30 mm respectively,to the anterior lateral talus chondral surface was 4.8 ± 1.42 mm.The average length of calcaneofibular ligament(CFL)was 31.4 ± 3.55 mm.The average distance of the fibular origination from ATFL to CFL was 6.4 ± 2.55 mm.The average angle between ATFL and CFL was 116.6 ± 12.69°.The distance from the calcaneus insertion of CFL to the peroneal tubercle(CP)was 15.4 ± 2.86 mm,to the posterior superior border of calcaneus(CC)was 13.9 ± 2.46 mm,to the subtalar joint surface was 15.2 ± 3.21 mm.The coefficient variation assessing the anatomical reliability of different bony landmarks were as follows:ATFL fibular origination AA(17.54％) ＜AT(20.28％) ＜ AO(33.14％),CFL calcaneus insertion CC(17.70％)＜CP(18.57％)＜CS(21.1％).Conclusion Certain variations exist in the morphological parameters and the distances from the insertion of the lateral ankle ligaments to the adjacent bony landmarks.It provides anatomical evidence for lateral ankle ligament reconstruction in treating chronic ankle instability.
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Objective To investigate the effect of isosorbide mononitrate on the levels of NO,iNOS,IL-1 and IL-6 in lung tissue of spontaneously hypertensive rats (SHR).Methods Fourteen-week-old Wistar and SHR male rats were randomly divided into the W0,W1,S0 and S1 group,with 10 rats ineach group.Rats in the W0 and S0 group were fed with the normal saline and the ordinary food,rats in the W1 and S1 group were fed with isosorbide mononitrate and the ordinary food.Twelve weeks later,levels of NO,iNOS,IL-1 and IL6 in rat lung tissue were detected.Results Compared with the W0 group,levels of NO,iNOS,IL-1 and IL6 were significantly increased in the W1 groups (P ＜ 0.05,respectively).Compared with the SO group,levels of NO,iNOS,IL-1 and IL6 were significantly increased in the S1 group (P ＜ 0.05,respectively).In the W1 and S1 group,levels of iNOS and NO were positively correlated with IL-1 and IL-6.Conclusion 1.Isosorbide mononitrate may lead to increases of NO,iNOS,IL-1 and IL6 in lung tissue of Wistar rats,which indicates the presence of chronic inflammation.2.Longterm feeding of isosorbide mononitrate may lead to increases of inflammatory factors in SHR rats,contributing to the inflammatory state in rats.
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Objective To analyze the efficacy of chemoradiotherapy in the treatment of esophageal carcinoma and its influencing factors,and to provide an optimal combination mode of chemoradiotherapy for treating esophageal carcinoma. Methods A retrospective analysis was performed on clinical data from 232 patients with esophageal carcinoma who were admitted to our hospital from January 2006 to December 2012 and received radical chemoradiotherapy. All patients received three?dimensional conformal radiotherapy or intensity?modulated radiotherapy as well as platinum?based chemotherapy. The overall survival ( OS ) and local control ( LC) rates were calculated using the Kaplan?Meier method and analyzed using the Logrank test. Univariate and multivariate prognostic analyses were made by the log?rank test and the Cox proportional hazard model,respectively. Results In all patients,the 1?,3?,and 5?year LC rates were 66?1%,42?2%, and 38?5%,respectively;the median LC time was 24?4 months;the 1?,3?,and 5?year OS rates were 73?3%, 37?2%,and 19?5%,respectively;the median OS time was 21 months. The univariate analysis revealed that T stage,N stage,clinical stage,irradiation range,and no less than 3 cycles of chemotherapy were influencing factors for OS ( P=0?000,0?000,0?000,0?030,0?001) and LC ( P=0?112,0?031,0?009,0?074,0?218) . The multivariate analysis revealed that N stage,clinical stage,and no less than 3 cycles of chemotherapy were independent prognostic factors for OS ( P=0?006,0?000,0?001) . Conclusions The LC and long?term OS rates in patients with early?stage esophageal carcinoma can be substantially improved by radical chemoradiotherapy. The irradiation range and no less than 3 cycles of chemotherapy improve the long?term survival in patients.
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Pulmonary artery sling(PAS)is a rare congenital cardiovascular disease.Due to the compression of the trachea and esophagus,it often causes severe airway and/or esophageal compression symptoms.Once diagnosed,the patient should undergo surgical treatment.There are various treatments,including left pulmonary artery reconstruction,tracheal stenosis correction and tracheal balloon dilatation and stent technology.Whether or not to repair the tracheal stenosis usually based on the trachea diameter.But there has no ideal surgical procedure to the tracheal stenosis.The patient with complex introcardiac malformation and PAS should be corrected simultaneously with cardiopulrmonary bypass.
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Objective To evaluate the predictive values of different systems for clinical staging of esophageal carcinoma in one group of patients and improve the criteria for T staging,and to provide a basis for accurate clinical staging. Methods A retrospective study was performed in 701 patients with esophageal carcinoma who received radical radiotherapy in our hospital. The prognosis was performed according to American Joint Committee on Cancer ( AJCC) tumor-node-metastasis staging system,Chinese 2004 staging system,the draft of Chinese 2009 staging system,and gross tumor volume of the primary tumor (GTV-T). Results In terms of T stage,patients evaluated according to the AJCC staging system were in relatively early stages;23. 1% of them were in stage T1,and the survival curves of T3 and T4 patients were close to each other;the survival curves plotted according to the Chinese 2004 staging system were well separated, but relatively few patients were in stages T1 and T4 , yielding an uneven distribution;according to the draft of Chinese 2009 staging system, the survival curve of T3 patients intersected that of T4 patients, and up to 43. 2% of patients were in stage T4.The new T staging was performed based on GTV and the extent of tumor invasion into the adjacent tissue and organ, and the results showed that there was no intersection between survival curves and a relatively balanced T stage distribution. In terms of N staging,patients were divided into stages N0 ,N1 ,and N2 . The TNM staging was performed by a combination of N staging and new T staging, resulting in significant separation between survival curves ( P=0. 000) . Conclusions The combination of T staging,which is based on GTV and the extent of tumor invasion,and N staging,which is based on metastasis of lymph nodes, can accurately predict the survival of non-surgically treated patients with esophageal carcinoma.
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Objective To investigate the action mechanism of microRNA‐152(miRNA‐152) in the cisplatin(DDP) resistance process in non‐small cell lung cancer (NSCLC) .Methods The miRNA‐152 level in NSCLC cell line A549 and its cisplatin‐resistant cell line A549/DDP was detected by the real time quantitative PCR(qRT‐PCR) .miRNA‐152 mimic was transfected for increasing the intracellular miRNA‐152 level in A549/DDP .The MTT assay ,inverted miroscope technique and flow cytometry were adopted to observe the effect of up‐regulating miRNA‐152 on cell proliferation inhibition and apoptosis ,meanwhile ,the level changes of intra‐cellular Bcl‐2 and NF‐κB were also observed by adopting qRT‐PCR and Western blot .Results The low expression of miRNA‐152 and the high expression of Bcl‐2 and NF‐κB were found in A549/DDP cells .Up‐regulation of miRNA‐152 enhanced the inhibitory effect of DDP in A549/DDP cells .Furthermore ,after up‐regulating miRNA‐152 ,the inhibiting rate and apoptosis rate of A549/DDP cells caused by DDP were significantly higher than those in the cells without up‐regulating miRNA‐152 ,the difference was statisti‐cally significant(P<0 .05) .In addition ,miRNA‐152 mimic transfection significantly decreased the expression of Bcl‐2 and NF‐κB in A549/DDP cells .Conclusion Low expression of miRNA‐152 may induce the resistance of NSCLC to DDP ,miRNA‐152 could medi‐ate the sensitivity of NSCLC cells to DDP via regulating Bcl‐2 and NF‐κB levels .
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Objective To explore the prediction value of the modified clinical staging standard of GTV volume on non-surgical treatment esophageal carcinoma by analyzing the GTV volume of esophageal carcinoma and the invasion degree of structures and surrounding organs as the T stage standard.Methods A retrospective analysis was performed for 701 esophageal cancer patients treated by definitive radiotherapy from Jan.2006 to Dec.2012.After grouping and analysis by the previous GTV volume staging standards, we put forward the idea that considering effects of invasion degree of structures and surrounding organs of tumor on the basis of GTV volume when it came to T stage, which would be re-classified by downgrading and reevaluation of survival and prognosis.Results There was no significant survival differences between T3 and T4 on previous GTV volume staging standards (P ＞ 0.05), and also had shown an inconspicuous survival difference between stage Ⅲ and stage Ⅳ when combined with three-group N stage(P ＞ 0.05).We had modified the T stage standards of GTV volume: Based on different size of GTV volume, and in consideration of the invasion of adjacent structures and organs, new T stages had shown good separation on a corresponding survival curve(x2 =59.702 ,P ＜0.05).In clinical TNM staging which combined with the new T stage and three-group N stages, the 701 patients were divided into stage Ⅰ , Ⅱ , Ⅲ and Ⅳ, with corresponding 5-year survival rates of 33.5％ , 26.3％ , 13.4％ , 9.2％ , respectively, which strongly revealing significant differences of survival rates (x2 =82.577, P ＜ 0.05).Conclusions The new T staging standard, which combined GTV volume with invasion degree of adjacent structures and organs, could accurately predict the prognosis of patients with radical radiotherapy of esophageal carcinoma.
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Objective To investigate the expression and clinical significance of cell division cycle 6 (CDC6)and homeobox gene A5(HOXA5)in esophageal squamous cell carcinoma. Methods The expres-sion of CDC6 and HOXA5 in 51 specimens esophageal squamous cell carcinoma and 27 normal specimens esophageal tissues were evaluated by immunohistochemistry. Analyzed the relationship among the expression of CDC6 and HOXA5 protein and the clinicopathologic features of esophageal squamous cell carcinoma,along with the correlation between these two proteins. Results Immunohistochemical results showed that the positive expression rate of CDC6 and HOXA5 in esophageal squamous cell carcinoma tissue were 66. 7%(34 / 51)and 60. 8%(31 / 51),respectively,significantly higher than those in normal esophageal tissue18. 5%(5 / 27), 22. 2%(6 / 27),(χ2 = 16. 370,P = 0. 000;χ2 = 10. 528,P = 0. 001);There were significant positive correlation in the expression of CDC6 and HOXA5 and histological type(χ2 = 9. 031,P = 0. 011;χ2 = 7. 372,P = 0. 000), TNM stage(χ2 = 10. 474,P = 0. 015;χ2 = 11. 667,P = 0. 009),and there were no correlation in the expression of CDC6 and HOXA5 and age(χ2 = 0. 000,P = 1. 000;χ2 = 0. 001,P = 0. 972),sex(χ2 = 0. 049,P = 0. 824;χ2 = 0. 107,P = 0. 743),lymph node metastasis(χ2 = 3. 186,P = 0. 074;χ2 = 2. 212,P = 0. 137)in esophageal squamous cell carcinoma tissues. The expression of CDC6 and HOXA5 showed a positive correlation( r =0. 454,P = 0. 001). Conclusion The positive expression rate of CDC6 and HOXA5 in esophageal squamous cell carcinoma tissue were significantly higher than in normal esophageal tissue and close correlation with TNM stage and differentiation. High expression of CDC6 and HOXA5 may play important roles in the occurrence, development and proliferation of esophageal squamous cell carcinoma.
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Objective To study the clinical characteristics and relative risk factors of hypertensive inpatients aged over 80 years.Methods From February 2003 to May 2012,336 hypertensive inpatients aged over 80 years were enrolled in the study.Medical history and family history including height,weight,blood pressure,fasting glucose,total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,creatinine,urea nitrogen,uric acid and urine protein levels were recorded and analyzed statistically.Results The elderly hypertensive inpatients over 80 years old had systolic hypertension with widening pulse pressure and the decline in glomerular filtration rate.The incidence of dyslipidemia,atrial fibrillation,microalbuminuria,coronary heart disease,cerebrovascular disease were 56.5 ％ (190/336),13.4 ％(45/336),15.8％ (53/336),41.4％ (139/336) and 24.1％ (81/336),respectively.Whereas there was no significant sex difference (P＞0.05).A significant difference was found in the incidence of left vetricular hypertrophy between males (10.4％,25/240) and females (22.9％,22/96) (x2 =8.91,P＜0.01).The prevalence of diabetes in males (46.3％,111/240) was significantly higher than in females (28.1％,27/96) (x2=9.38,P＜0.01).From the 336 patients in the study,311 (92.6％)were treated by antihypertensive agents.The antihypertensive drugs included diuretics (37 patients,11.9％),calcium channel blocker (182 patients,58.5％),angiotensin receptor antagonists (89 patients,28.6％),angiotensin converting enzyme inhibitors (68 patients,21.9％),β-blockers (92 patients,29.6％),α-blockers (31 patients,10.0％),either alone (109 patients,35.0％) or in combination (202 patients,65.0％).96 (30.9％) patients were medically treated for dyslipidemia (drugs including statins).151 (48.6％) patients were treated with antiplatelet drugs.Conclusions The elderly hypertensive inpatients,over 80 years old,were accompanied by multiple risk factors and target organ damage,and most of them was treated with antihypertensive agents in combination.
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Objective To evaluate the feasibility and clinical effectiveness of arthroscopic femoral osteoplasty for cam-type femoroacetabular impingenent(FAI).Methods From October 2007 to April 2009,31 patients with cam-type FAI underwent hip arthroscopy,including 12 males and 19 females with an average age of 34.1 years(range,18-45).Physical examination,X-ray,3D-CT scans were carried out preoperatively to make the definite diagnosis.All patients were treated with hip arthroscopic debridement and femoral osteoplasty.The patients were followed-up at 1 month,3 months,6 months,1 year,and every year post operation.Outcomes were measured with pain visual analogue scale(VAS),ROM of hip,impingement tests,α angle and modified Harris hip score at final follow-up.Results All patients were followed up for average 22.7 months(range,18-36).At final follow-up,impingement tests among all patients were negative,the range of flexion increased from 101.0°±14.2° to 121.0°±11.7°,the range of internal rotation in a position of 90° flexion increased from 5.0°±9.8° to 30.1°±12.7°,α angle decreased from 74.2°±10.7° preoperatively to 44.7°±8.3°,VAS pain score decreased from 6.1±1.1 preoperatively to 0.9±0.7,modified Harris hip score improved from 41.2±5.7 preoperatively to 73.6±4.1,all differences were statistically significant.Conclusion Arthroscopic femoral osteoplasty for cam-type FAI can win the satisfactory achievements for complete excision of bony prominence at anterior-lateral femoral head-neck junction,restoration of the femoral offset,significant relief of clinical symptoms and improvement of hip range of motion.
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Objective To compare the clinical results of Endobutton and Rigidfix graft fixation at the femoral tunnel after ACL reconstruction with hamstring autografts.Methods 48 patients accepting ACL reconstruction with hamstring autografts were retrospective studied.According to different fixation adopted at the femoral tunnel,they were divided into group A(24 patients,with Rigidfix cross pin)and group B(24 patients,with Endobuaon).All Cases were fixed with Intrafix interference screw and Spiked Washer screw at the tibial tunnel.The average follow-up time was 27 months.KT-1000 arthrometric measurement and the IKDC,Lysholm,Tegner scores were used for evaluation.The diameter of bone tunnel was also measured by MRI.Results Tunnel widening were found in both groups,but the increase of both the femoral and tibial tunnels in group B were significantly greater than group(P<0.05).In both groups after operation,there was significantly increases of IKDC suhjective scores,Lysholm scores,Tegner scores and KT-1000 results also had obviously improvement(P<0.05).But no significant difference was found between two groups after operation.Conclusion Compared with double cross-pins for fixation at the femoral tunnel,tunnel widening was more prone to happen when using Endobutton suspensory fixation system.