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@#Objective To establish the gene-based esophageal cancer (ESCA) risk score prediction models via whole transcriptome analysis to provide ideas and basis for improving ESCA treatment strategies and patient prognosis. Methods RNA sequencing data of esophageal squamous cell carcinoma (ESCC), esophageal adenocarcinoma (EAC) and adjacent tissues were obtained from The Cancer Genome Atlas database. The edgeR method was used to screen out the differential genes between ESCA tissue and normal tissue, and the key genes affecting the survival status of ESCC and EAC patients were initially identified through univariate Cox regression analysis. The least absolute shrinkage and selection operator regression analysis and multivariate Cox regression analysis were used to further screen genes and establish ESCC and EAC risk score prediction models. Results The risk score prediction models were the independent prognostic factors for ESCA, and the risk score was significantly related to the survival status of patients. In ESCC, the risk score was related to T stage. In EAC, the risk score was related to lymph node metastasis, distant metastasis and clinical stage. The constructed nomogram based on risk score showed good predictive ability. In ESCC, the risk score was related to tumor immune cell infiltration and the expression of immune checkpoint genes. However, this feature was not obvious in EAC. Conclusion 聽 聽The ESCC and EAC risk score prediction models have shown good predictive capabilities, which provide certain inspiration and basis for optimizing the management of ESCA and improving the prognosis of patients.
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@#Objective To explore whether surgery combined with adjuvant chemotherapy can bring survival benefits to patients with cervical and upper thoracic esophageal squamous cell carcinoma (ESCC). Methods The clinical data of patients with cervical and upper thoracic ESCC who underwent R0 resection and neck anastomosis in our department from 2006 to 2010 were retrospectively analyzed. Patients received neoadjuvant therapy or adjuvant radiotherapy were excluded. The adjuvant chemotherapy group was given a combination of taxanes and platinum based chemotherapy after surgery; the surgery alone group did not receive adjuvant chemotherapy. The Kaplan-Meier method was used to analyze the survival difference between the adjuvant chemotherapy group and the surgery alone group. Results A total of 181 patients were enrolled, including 141 (77.9%) males and 40 (22.1%) females, with an average age of 61.0±8.2 years (80 patients aged≤61 years, 101 patients aged>61 years). There were 70 (38.7%) patients of cervical ESCC, and 111 (61.3%) patients of upper thoracic ESCC. Eighty-seven (48.1%) patients underwent postoperative adjuvant chemotherapy, and 94 (51.9%) patients underwent surgery alone, and the basic clinical characteristics were well balanced between the two groups (P>0.05). The median survival time of patients in the adjuvant chemotherapy group and the surgery alone group was 31.93 months and 26.07 months, and the 5-year survival rate was 35.0% and 32.0%, respectively (P=0.227). There was no statistical difference in median survival time between the cervical ESCC and upper thoracic ESCC group (31.83 months vs. 29.76 months, P=0.763). For cervical ESCC patients, the median survival time was 45.07 months in the adjuvant chemotherapy group and 14.70 months in the surgery alone group (P=0.074). Further analysis showed that the median survival time of lymph node negative group was 32.53 months, and the lymph node positive group was 24.57 months (P=0.356). The median survival time was 30.43 months in the lymph-node positive group with adjuvant chemotherapy and 17.77 months in the lymph-node positive group with surgery alone. The survival curve showed a trend of difference, but the difference was not statistically significant (P=0.557). Conclusion There is no statistical difference in the long-term survival of cervical and upper thoracic ESCC patients after R0 resection. Postoperative adjuvant chemotherapy may have survival benefits for patients with cervical ESCC and upper ESCC with postoperative positive lymph nodes, but the differences are not statistically significant in this setting.
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@#Objective To evaluate the clinical outcomes of larynx-preserving limited resection with total thoracic esophagectomy and gastric pull-up reconstruction for the treatment of cervical esophageal squamous cell carcinoma (ESCC) without tumor involvement of the larynx and hypopharynx compared with the upper thoracic ESCC. Methods Retrospective and comparative analysis of consecutive patients with cervical and upper thoracic ESCC who underwent R0 surgical resection from 2006 to 2011 in our center was performed. Kaplan-Meier method was used to calculate the patients’ survival. Results In total, 44 pairs of patients, including 71 males and 17 females with an average age of 60.66±8.49 years were enrolled in the study after propensity score matching. The baseline characteristics of the two groups of patients were well balanced. There was no statistical difference in the operation time (P=0.100), blood loss (P=0.685), mortality rate in 30 days (P=1.000), total complication rate (P=0.829), cervical anastomosis leakage (P=0.816), mechanical ventilation (P=1.000), normal oral diet within 15 days (P=0.822) and anastomosis recurrence rate (P=0.676) between the two groups. Survival analysis showed that there was no statistical difference in survival time between the cervical group [31.83 (95%CI 8.65-55.02) months] and upper thoracic group [37.73 (95%CI 25.29-50.18) months, P=0.533]. The 5-year survival rates were 32.6% and 42.1%, respectively. Conclusion Larynx-preserving limited resection with total thoracic esophagectomy and gastric pull-up reconstruction for the treatment of cervical ESCC without involvement of the larynx and hypopharynx may result in a similar clinical outcome to upper thoracic ESCC.
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BACKGROUND@#Electromagnetic navigation bronchoscopy is a tool that can accurately navigation peripheral lung lesions. Because of electromagnetic navigation bronchoscopy (ENB) is too expensive, it has not been widely used in China. It is urgent for us to summarize experience in clinical application, especially in the diagnosis of pulmonary nodules.@*METHODS@#The clinical data of patients with pulmonary peripheral lesions (PPLs) in our department undergoing ENB biopsy between July 2017 and December 2018 were retrospectively analyzed.@*RESULTS@#There were 18 patients with 21 PPLs (10 males and 8 females). Among them, 11 patients got the final pathological diagnosis, 8 cases were diagnosed with adenocarcinoma lung cancer, 1 case was diagnosed with tuberculosis and 2 cases were diagnosed with small cell lung cancer. The positive rate of diagnosis was 61.1%. The sensitivity was 73.3%. The positive diagnosis rate is related to the size of the lesion, the positive diagnosis rate for lesions >2 cm is 100.0% (P=0.04).@*CONCLUSIONS@#Electromagnetic navigation bronchoscope is safe and effective in clinic. It has a high positive rate for the diagnosis of peripheral lung lesions larger than 2 cm, ENB has broad clinical application prospects.
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@#Objective To establish a model of tracheomalacia in beagle dogs. Methods Six healthy male beagles were selected with a weight of 12-15 kg and age of 12-18 months. The dog was placed in supine position after being anesthetized. Then midline incision was performed on dogs' cervical skin and main trachea was dissected. Six continuous cartilage rings separated from the tracheal wall were removed. Finally, the endotracheal mucosal was examined and the wound was sutured layer by layer. Different degrees of cartilage were removed to simulate different degrees of tracheomalacia. The beagle dogs were classified into two groups (n=3 in each group): a mild tracheomalacia (MTM) group (part of the cartilage near the trachea membrane was retained) and a severe tracheomalacia (STM) group (cartilage was removed as much as possible). Results The dogs in the MTM group survived for a long time after the operation, showing symptoms of airway stenosis such as wheezing and coughing. The dogs were killed at postoperative week 2, and the pathological examination was performed. In the STM group, severe asphyxia occurred in the experimental animals after tracheal intubation removed, and all dogs died within 1 hour after surgery. Postoperative bronchoscopy revealed that the trachea of the MTM group dogs collapsed in the phase of inhalation, but it could maintain a certain patency. The trachea of the STM group dogs collapsed completely in the phase of inhalation. Postoperative X-ray showed that the diameter of the airway in the MTM group was reduced and trachea did not completely collapse. In the STM group, the trachea collapsed completely at the cartilage removed segment. Pathological examination showed that the cartilage in the MTM group was partially removed and tracheomalacia was obvious in the cartilage removed segment. In the STM group, most of the cartilage was removed with only few cartilages left. Conclusion The clinical symptoms of tracheomalacia in different degrees can be simulated and repeatable. Animal models can be established by controlling the degree of removal of tracheal cartilage ring in dogs. This method provides a simple, repeatable and standardized large animal model for the treatment and transformation of tracheomalacia.
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@#A novel coronavirus (SARS-CoV-2) that broke out at the end of 2019 is a newly discovered highly pathogenic human coronavirus and has some similarities with severe acute respiratory syndrome coronavirus (SARS-CoV). Angiotensin-converting enzyme 2 (ACE2) is the receptor for infected cells by SARS-CoV. SARS-CoV can invade cells by binding to ACE2 through the spike protein and SARS-CoV-2 may also infect cells through ACE2. Meanwhile, ACE2 also plays an important role in the course of pneumonia. Therefore the possible role of ACE2 in SARS and coronavirus disease 2019 (COVID-19) is worth discussing. This paper briefly summarized the role of ACE2 in SARS, and discussed the possible function of ACE2 in COVID-19 and potential risk of infection with other organs. At last, the function of ACE2 was explored for possible treatment strategies for SARS. It is hoped to provide ideas and theoretical support for clinical treatment of COVID-19.
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Objective To investigate whether decursin(Dec) could inhibit EC109 cells proliferation by suppression of janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) signaling pathway in human esophageal squamous cell carcinoma.Methods The EC109 cells were treated with Dec(20,40,and 80 pmmol/L) for48 h.The cell viability was evaluated by MTT;the apoptotic cells was labelled by TUNEL;the mitochondrial oxidative stress level was detected by fluorescent staining;and western blotting was used to analyze the proteins of JAK2/STAT3 signaling and apoptosis in EC109 cells,respectively.After co-application of JAK2 / STAT3 antagonist(AG490),the inhibitory ability of Dec to EC109 was observed from the in vivo and in vitro levels.Results Compared to the control group,different concentrations of Dec dose-dependently down-regulated expressions of p-JAK2 [(55.89 ± 6.04) ％] and p-STAT3 [(45.27 ± 8.65) ％],repressed EC109 cell activity(0.43 ± 0.078),increased apoptotic rate[(35.31 ± 8.41)％],reduced MMP levels[(37.23 ± 6.89)％],promoted reactive oxygen species(ROS) [(231.81 ± 19.63)％],decreased glutathione (GSH) activity [(46.78 ± 6.91)％,P＜0.05].However,Dec did not significantly affect the activity of the normal esophageal epithelium HET-1A cells(P ＞0.05).Meanwhile,Dec obviously leaded to reduction of Bcl2,increment of Bax,and augment of Caspase-3 cleavage (P ＜0.05).Additionally,the inhibitory effect of Dec on EC109 was specifically intensified after co-application of AG490 in vivo and in vitro levels(P ＜0.05).Conclusion Dec can fight against human esophageal squamous cell carcinoma in vitro and in vivo via activation of mitochondrial oxidative stress-induced apoptosis which was mediated by JAK2/STAT3 pathway.
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Objective To evaluate the safety,effectivity and feasibility of Video-assisted thoracoscopic surgery(VATS) for the treatment of bronchiectasis.Methods The data of patients with bronchiectasis treated by surgery from January 2010 to September 2016 in Tangdu hospital,the Forth Military Medical University,were reviewed and analyzed retrospectively.Results There were 343 cases enrolled in this study,which were divided into Thoracotomy group(230 cases) and VATS group(113 cases,17 of them were converted into open surgery).There were 125 males and 105 females in Thoracotomy group,with the average age of(46.1 ± 14.4) years,and 45 males and 68 females in VATS group with the average age of(45.8 ± 13.4) years.Four patients died during the perioperative period and all of them were from Thoracotomy group.Compared with the Thoractomy group,the blood loss [(292.1 ± 301.7) ml vs(475.7 ± 525.4) ml,P =0.001],length of hospitalization [(6.4 ± 2.4) dvs.(9.1 ±6.6)d,P＜0.001],drainage time[(6.4 ±2.4)d vs.(9.1 ±6.6)d,P ＜0.001] were significantly lower in VATS group,but no difference in operation time.The cost in VATS group was higher [(4.5 ± 1.3) ten-thousand yuan vs (3.9 ± 1.8) ten-thousand yuan,P =0.001].For patients without comorbidities,the incidence of postoperative complications was lower in VATS group compared with that in Thoractomy group (P =0.003).There was no significant difference between two groups for patients with comorbidities (P =0.274),but there was a trend of declining in VATS group.Conclusion VATS is safe,effective and feasible to treat bronchiectasis,and should be a priority.
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KylinRay-IMRT is the advanced radiotherapy treatment planning module of accurate radiotherapy system (KylinRay) aiming to provide accurate and efficient plan design platform. In this paper the system design, main functions and key technologies of KylinRay-IMRT were introduced. KylinRay-IMRT supports three dimensional conformal radiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT) and many other types of treatment plan design with function modules including patient data management, image registration and fusion, image contouring, image three dimensional reconstruction and visualization, three dimensional conformal radiotherapy planning, intensity modulated radiotherapy planning, plan evaluation and comparison, and report print. KylinRay-IMRT has been tested by the national standard YY/T 0889-2013, the results showed that the performance of KylinRay-IMRT can fully meet the standard requirements.
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Humans , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted , Radiotherapy, Conformal , Radiotherapy, Intensity-Modulated , Tomography, X-Ray ComputedABSTRACT
Objective:To analyze the EGFR gene polymorphism in the non-small cell lung (NSCLCs) cancer in southern of Shaanxi Province.Methods:The next generation sequencing technology was used to detect the mutation of exon 18,19,20 and 21 of EGFR gene.We analyzed EGFR gene mutation rate in NSCLCs patients.233 patients was involved in our study.Results:82 cases with EGFR gene mutations was found,the mutation rate of exon18,19,20 and 21 was 1.3％,16.3％,0％ and 18％ respectively.The mutation rate of EGFR in male patients was lower (31.2％,39/125) than that of female cases (39.8％,43/108),the mutation rate of squamous cell carcinoma (22％,9/41) was lower than that of adenocarcinoma (39.1％,75/192).Conclusions:NSCLCs patients from southern Shaanxi Province had high mutation rate ofEGFR gene,and exon 19 and exon 21 mutations were in the majority.EGFR gene mutation rate was not related to gender and pathological types.
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Objective:To explore expression of plasma omentin -1 in patients with central obesity (CO) complicated essential hypertension (EH) and its clinical significance .Methods : Serum level of omentin - 1 was measured by enzyme linked immunosorbent assay in 57 CO patients without EH (pure CO group) and 67 CO complicated EH patients (CO + EH group) ,and 56 healthy subjects (normal control group) .Blood glucose ,blood lipid and biochemical indexes were compared and analyzed among three groups ,and Logistic multi - factor gradual regression analysis was used to perform risk factor analysis .Results : Serum omentin - 1 level in CO + EH group was significantly lower than those of pure CO group and normal control group [ (25.15 ± 3.95) ng/ml vs .(45.63 ± 9.66) ng/ml ,(53.12 ± 7.97) ng/ml , P 0.05 ;Logistic multi - factor gradual regression analysis indicated that age and homeostasis model - insulin resistance index (HOMA - IR ) were independent risk factors affecting EH occurrence in obese people (OR = 1.124 ,95% CI : 1.000 - 1.248 ,P = 0.049 ;OR = 3.446 ,95% CI : 1.087 - 5.607 ,P = 0.001) ,while serum omentin - 1 level was an independent protective factor (OR = 0.423 ,95% CI : 0.210 - 0.636 , P = 0.001) .Conclusion : Serum omentin - 1 level may possess certain guiding significance in early diagnosis ,prevention and treatment for patients with central obesity complicated essential hypertension .
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Objective To explore the expression of and its clinical significance of plasma omentin-1 in coronary heart disease in central obesity. Methods Plasma omentin-1 levels were measured by enzyme linked immunosorbent assay( ELISA)in 49 central obesity participants without coronary heart disease and 67 central obesity participants with coronary heart disease,as well as 56 normal healthy individuals as control group. In addition,glucose and lipid metabolism parameter and morphological characters were assessed. Finally multivariate logistic regression analysis was used to explore the risk fact for coronary heart disease in central obesity. Results The serum plasma omentin-1 level of central obesity participants without coronary heart disease group was (45. 63 ± 9. 66)μg/L,much higher than those of people in and central obesity participants with coronary group ((30. 67 ± 6. 78 )μg/L,P ﹤0. 01 ),while lower than control group(( 53. 12 ± 7. 97 )μg/L,P ﹤ 0. 01 ) . Multivariate logistic regression analysis revealed that,age was independent risk factor of coronary heart disease in central obesity(OR=1. 176,95%CI:1. 012-1. 330,P=0. 041),while plasma omentin-1 and high density lipoprotein cholesterol were independent protective factors(OR=0. 576,95%CI:0. 254-0. 898,P=0. 000;OR=0. 466,95%CI:0. 242 -0. 690,P =000). Conclusion Detection of plasma omentin-1 level may play an important role in early diagnosis and prevention of coronary heart disease in central obesity.
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AIM: To investigate the effect of single immunoglobin IL-1 receptor related protein (SIGIRR) on damage of alveolar epithelial cells in acute lung injury induced by lipopolysaccharide. METHODS: The acute alveolar epithelial cell injury model was constructed by stimulation of A549 cells with LPS. In order to over-express SIGIRR, the A549 cells were transferred with eukaryotic expression vector containing full length SIGIRR cDNA. The transcriptional activity of NF-κB was measured by dual-luciferase reporter assay system. The concentrations of IL-1β, TNF- α and IL-6 were detected by ELISA. The levels of these inflammatory factors between the transfected cells and untransfected cells were compared. RESULTS: The over-expression of SIGIRR inhibited the transcriptional activity of NF-κB. The increases in IL-1β, TNF-α and IL-6 concentrations in alveolar epithelial cells induced by LPS were observed. CONCLUSION: SIGIRR in alveolar epithelial cells inhibits TLR4 signals triggered by LPS and attenuates the inflammatory reactions in alveolar epithelial cells, which plays a protective role against the acute damage of the alveolar epithelial cells.