Establishment and characterization of high-throughput culture platform for kidney organoids / 中华肾脏病杂志

Objective:To establish and identify a high-throughput culture platform for induced pluripotent stem cells to differentiated kidney organoids.Methods:Human urine-derived induced pluripotent stem cells were selected and plated at a suitable cell density, and differentiated using small molecule compounds such as CHIR99021/fibroblast growth factor 9/heparin during day 1-6. On day 7, cells with appropriate density were digested and resuspended, than added to a 96-well 3D culture plate for 24 hours. After the cells formed spheroids, fibroblast growth factor 9 and heparin were added to induce differentiation till day 24. The immunofluorescence and transmission electron microscopy were used to compare the differences of kidney organoids obtained by the reported differentiation protocol (transwell protocol) method and high-throughput culture platform.Results:Kidney organoids were successfully differentiated by two protocols. Immunofluorescence results showed that LTL, GATA-3, and synaptopodin, which were major kidney cell markers, were all expressed, and mature renal organoids were formed. The results of transmission electron microscopy showed that the kidney organoids successfully developed foot processes, the unique cellular feature of the glomerular podocytes, which were evenly distributed and neatly interspersed with each other. At the same intermediate mesodermal cell count of 1.0×10 7, approximately 7 renal organoids were obtained by the transwell protocol, while approximately 1 000 renal organoids were obtained by the high-throughput culture platform. Conclusion:A high-throughput culture platform for kidney organoids is successfully established, and a large amount of mature kidney organoids with complete structure and function can be obtained. The differentiation efficiency of kidney organoids is greatly improved.

Progress in surgical treatment for pulmonary tuberculosis / 中华胸心血管外科杂志

Due to an overall high incidence of pulmonary tuberculosis (TB) and the emergence of drug-resistant TB, the role of surgical treatment is likely to be expanding. This review discusses the use of surgery in the treatment of TB, including surgical indications, timing of surgery and preoperative management, type of operations, and postoperative anti-TB treatment.

Comparison of segmentectomy versus lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections: A multi-center randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective    To compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections. Methods    The patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group (n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group (n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed. Results    There was no significant difference in the baseline data between the two groups (P>0.05). No perioperative death was found. There was no statistical difference in the operation time (111.2±30.0 min vs. 107.3±34.3 min), blood loss (54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration (2.8±0.6 d vs. 2.6±0.6 d), hospital stay time (3.9±2.3 d vs. 3.7±1.1 d) or pathology staging (P>0.05) between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group (0.2±0.3 L vs. 0.4±0.3 L, P=0.005; 0.3%±8.1% vs. 2.9%±7.4%, P=0.041). Conclusion    Segmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.

Advances in the diagnosis and treatment of intersphincteric resection for ultra-low rectal carcinoma / 国际外科学杂志

It has been 20 years since Intersphincteric resection(ISR) was used as a supplement to Abdominoperineal resection(APR) for ultra-low rectal cancer. With the help of removing conjointed longitudinal muscle and total or partial internal sphincter, R0 resection is achieved under the condition of preserving external sphincter, levator ani muscle, and part of internal sphincter, thereby retaining part of the anal function. This article reviews the indications, anatomy, physiology and treatment outcomes of ISR.

Comparison of quantitative and semi-quantitative hemodynamic parameters of dynamic contrast-enhanced MRI for differentiating benign and malignant breast lesions / 中国医学影像技术

Objective To compare the diagnostic performance of quantitative and semi-quantitative hemodynamic parameters of breast dynamic contrast-enhanced MRI (DCE-MRI) in differential diagnosis of benign and malignant breast lesions. Methods Fifty-nine patients (66 lesions) with breast lesions underwent hybrid DCE MRI with high temporal and spatial resolution, and semi-quantitative and quantitative hemodynamic parameters were obtained. The semi-quantitative parameters included time-intensity curve (TIC), initial area under the gadolinium curve (IAUGC), maximum slope of increase (MaxSlope), contrast enhancement rate (CER) and positive enhancement integral (PEI), while quantitative parameters included volume transfer constant (Ktrans), rate constant (Kep) and extravascular extracellular volume fraction (Ve). The differences of all the parameters between benign and malignant breast lesions were compared by using non-parametric tests. ROC was used to analyze the diagnostic performance. Results There were 31 malignant lesions (malignant group) and 35 benign ones (benign group). There were significant differences of Ktrans, Kep, TIC, IAUGC and MaxSlope between the two groups (all P0.05). AUC of ROC curve of Ktrans, Kep, TIC, IAUGC and MaxSlope were all >0.7. AUC of semi-quantitative parameter combination in diagnosis of benign and malignant breast lesions were significantly higher than those of single parameter (all P<0.05), AUC of quantitative parameter in combination was not significantly higher than those of Ktrans (P=0.134), but significantly higher than those of Kep and Ve (all P<0 001). There was no significant difference in AUC between combined semi-quantitative and quantitative parameters in diagnosis of benign and malignant breast lesions (P=0.614). Conclusion Ktrans, Kep, TIC, IAUGC and MaxSlope have good diagnostic performance in differentiating benign and malignant breast lesions. The combined semi-quantitative and quantitative hemodynamic DCE-MRI parameters have similar diagnostic performance.

Risk factor analysis of perioperative complications in patients with radical gastrectomy for gastric cancer / 中华胃肠外科杂志

Objective@#To identify the risk factors of perioperative complications after radical gastrectomy for gastric cancer.@*Methods@#A retrospective case-control study was performed. Case inclusion criteria: (1) patients undergoing radical gastrectomy (D2); (2) primary gastric cancer without distant organ metastasis confirmed by postoperative pathology; (3) no neoadjuvant chemotherapy before surgery. Patients with peritoneal tumor dissemination found during operation, undergoing palliative operation due to distant metastasis, and undergoing combined organ resection and those without complete clinicopathological data were excluded. According to the above criteria, 426 patients with gastric cancer at our department from January 2015 to June 2017 were included in this study. Of 426 patients, 285 were male and 141 were female with a mean age of (55.4±9.7) years. According to the "Japan Clinical Cancer Research Group (JCOG) classification criteria for postoperative complications of gastric cancer", patients with grade II and higher complications were classified as complication group, and patients with no complication or grade I complication were classified as non-complication group. Baseline data were compared between two groups. Associations of perioperative complication with gender, age, body mass index, preoperative routine laboratory test, American Society of Anesthesiologists (ASA) classification, activities of daily living (ADL) assessment, past medical history as well as preoperative conditions (hypertension and/or diabetes), surgical resection procedure, incision type, operation time, intraoperative blood loss/body mass ratio were examined. Univariate analysis was performed using χ2 test and the Wilcoxon rank sum test to screen the statistically significant variables associated with perioperative complications. The significant variables were included in multivariate logistic regression analysis to identify risk factors of perioperative complication.@*Results@#Grade II or higher complications after surgery were developed in 97 patients (22.8%), which included anastomotic leakage in 18 cases (4.2%), postoperative bleeding in 9 cases (2.1%), abdominal abscess in 5 cases (1.2%), intestinal obstruction in 5 cases (1.2%), pancreatic leakage in 1 case (0.2%), and other adverse events in 59 cases (13.8%). Univariate analysis suggested that the gender, age, ADL, incision type, intraoperative blood loss/body mass ratio, and operation time were associated with perioperative complication (all P<0.05). Multivariate analysis revealed that elder age (OR=1.033, 95% CI:1.013-1.053, P=0.013), incision type of laparotomy (OR=2.091, 95% CI:1.247-3.508, P=0.004), longer operation time (OR=1.004, 95% CI:1.001-1.007, P=0.001) and higher ratio of intraoperative blood loss/body mass (OR=1.100, 95% CI: 1.039-1.163, P=0.031) were risk factors for postoperative complications.@*Conclusion@#Attention should be paid to those cases with elder age, laparotomy incision, longer operation time and higher ratio of intraoperative blood loss/body mass, and perioperative management after gastrectomy should be improved.

Surgical treatment and prognosis of Borrmann type IIII( gastric cancer involving the whole stomach / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the surgical treatment and prognosis of Borrmann type IIII( gastric cancer involving the whole stomach.</p><p><b>METHODS</b>Clinicopathological characteristics and survival data of 223 patients with Borrmann type IIII( gastric cancer involving the whole stomach (defined as the tumor infiltrating 3 regions of the stomach) receiving surgical treatment at the Department of Abdominal Surgery of Zhejiang Cancer Hospital between January 2002 and December 2015 were analyzed retrospectively. The survival time of patients with different clinicopathological features and different treatment methods was compared. Cox regression was used to analyze the independent prognostic factors.</p><p><b>RESULTS</b>Two hundred and twenty-three patients with Borrmann type IIII( gastric cancer involving the whole stomach accounted for 24.0% (223/930) of all Borrmann type IIII( gastric cancer cases undergoing surgical resection at the same period. There were 147 males and 76 females with an average age of 57.8 years. All the patients underwent total gastrectomy. Of these patients, radical resection was performed in 149 cases(66.8%) and palliative resection in 74 cases (33.2%). Combined organ resection was performed in 43 patients (19.3%), including 25 splenectomies, 6 pancreatic body and tail plus spleen and transverse colon resections, 2 transverse colon plus spleen resections, 2 right colon resections, 2 transverse colon resections, 2 ovariectomies, 1 partial jejunal resection, 1 pancreatoduodenectomy, 1 pancreatic tail plus transverse colon resection, and 1 partial pancreatectomy. Postoperative complications occurred in 28 patients(12.6%), including 10 patients with combined organ resection. Esophagojejunal fistula was the most frequent complication, accounting for 39.3%(11/28). Perioperative mortality occurred in 3 patients (1.3%). Thirty-nine patients underwent preoperative adjuvant chemotherapy (clinical stage: cT4aN0M0 in 1 patient, cT4bN1-2M0 in 12 patients, cT4aN1-2M0 in 20 patients, and cT4aN3M0 in 6 patients). Among these 39 patients, post-chemotherapeutic degenerative response was detected in 25 postoperative pathological specimens (64.1%), radical resection was performed in 21 patients (53.8%), distant metastasis was observed in 7 patients (17.9%) and peritoneal metastasis was found in 17 patients (43.6%) during operation. The average maximal tumor diameter was 13.2 cm (range from 6 to 22). Histological types included 23 moderate-poorly differentiated adenocarcinomas (10.3%), 146 poorly differentiated adenocarcinomas (65.5%), 41 signet ring cell carcinomas (18.4%), 11 mucinous adenocarcinomas(4.9%), 1 squamous cell carcinoma (0.4%) and 1 undifferentiated carcinoma (0.4%). Tumor-infiltrating duodenum was found in 57 patients (25.6%) and tumor-infiltrating esophagus in 132 patients (59.2%). The positive margin was found in 66 patients (29.6%): upper margin in 35 patients (15.7%), lower margin in 22 patients (9.9%), and both margins in 9 patients(4.0%). Immunohistochemical positive HER2(3+) was detected in 4 patients (1.8%). Tumor infiltrating into serosa(T4a) was found in 197 patients (88.3%) and infiltrating into adjacent organ (T4b) in 26 patients(11.7%). One hundred and forty-three cases (64.1%) had lymphatic or venous invasion, 187 (83.9%) had neural invasion, and 35 (15.7%) had cancer nodules. Of 149 patients undergoing radical resection, 5 patients were stage II(b, 9 patients were III(a, 20 patients were III(b and 115 patients were III(c. Of 145 patients(65.0%) undergoing postoperative chemotherapy, the average cycles of chemotherapy was 3.6 (median 3 cycles) and only 69 patients (47.6%) completed 4 cycles or more. Patients were followed up for 1-102 months (average 17.3 months). The median overall survival time was 13.8 months and the 1-, 3-, and 5-year survival rate was 57.9%, 14.1% and 6.8% respectively. The median survival time of the 149 cases with radical resection was 16.7 months and the 1-, 3- and 5-year survival rate was 67.5%, 16.5% and 8.4% respectively; the median survival time of the 74 cases with palliative resection was 10.3 months and the 1-, 3- and 5-year survival rate was 42.6%, 8.5% and 1.7% respectively, whose differences were statistically significant (all P=0.000). Multivariate analysis showed that tumor staging (P=0.005), radical resection (P=0.009), lymphatic or venous invasion (P=0.017) and postoperative chemotherapy (P=0.001) were independent prognostic factors.</p><p><b>CONCLUSIONS</b>Surgical treatment for Borrmann type IIII( gastric cancer involving the whole stomach is safe. Radical resection can improve the prognosis though the overall survival is poor.</p>

Deep Learning and Its Applications in Biomedicine / 基因组蛋白质组与生物信息学报·英文版

Advances in biological and medical technologies have been providing us explosive volumes of biological and physiological data, such as medical images, electroencephalography, genomic and protein sequences. Learning from these data facilitates the understanding of human health and disease. Developed from artificial neural networks, deep learning-based algorithms show great promise in extracting features and learning patterns from complex data. The aim of this paper is to provide an overview of deep learning techniques and some of the state-of-the-art applications in the biomedical field. We first introduce the development of artificial neural network and deep learning. We then describe two main components of deep learning, i.e., deep learning architectures and model optimization. Subsequently, some examples are demonstrated for deep learning applications, including medical image classification, genomic sequence analysis, as well as protein structure classification and prediction. Finally, we offer our perspectives for the future directions in the field of deep learning.

Shanghai Pulmonary Hospital Experts Consensus on the Management of Ground-Glass Nodules Suspected as Lung Adenocarcinoma (Version 1) / 中国肺癌杂志

Background and objective As computed tomography (CT) screening for lung cancer becomes more common in China, so too does detection of pulmonary ground-glass nodules (GGNs). Although anumber of national or international guidelines about pulmonary GGNs have been published,most of these guidelines are produced by respiratory, oncology or radiology physicians, who might not fully understand the progress of modern minimal invasive thoracic surgery, and these current guidelines may overlook or underestimate the value of thoracic surgery in the management of pulmonary GGNs. In addition, the management for pre-invasive adenocarcinoma is still controversial. Based onthe available literature and experience from Shanghai Pulmonary Hospital, we composed this consensus about diagnosis and treatment of pulmonary GGNs. For lesions which are considered as adenocarcinoma in situ, chest thin layer CT scan follow-up is recommended and resection can only be adopt in some specific cases and excision should not exceed single segment resection. For lesions which are considered as minimal invasive adenocarcinoma, limited pulmonary resection or lobectomy is recommended. For lesions which are considered as early stage invasive adenocarcinoma, pulmonary resection is recommend and optimal surgical methods depend on whether ground glass component exist, location, volume and number of the lesions and physical status of patients. Principle of management of multiple pulmonary nodules is that primary lesions should be handled with priority, with secondary lesions taking into account.
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Experience of treatment for very early stage lung adenocarcinoma of 1817 cases / 中华胸心血管外科杂志

Objective To discuss the treatment methods of early adenocarcinoma.Methods Analyzed all the lung adenocarcinoma patients who received the surgical treatment in our hospital from January 2013 to December 2015 and compare the surgical treatment for the very early stage lung adenocarcinoma.Results There are totally 8 908 lung adenocarcinomas cases enrolled.Among all the cases,there are 1 143 cases of AIS and 674 cases of MIA.VATS surgery was performed on all these very early stage of adenocarcinoma cases.The proportion of lobectomy in AIS decreased year by year,the proportion of surgery type for MIA is relatively stable.Lymph node metastasis was not found in all patients.Conclusion Both AIS and MIA are re presented as ground glass opacity(GGO) in CT scan.If the lesion is larger than 8mm and has been followed up for a period can be considered for VATS.For AIS,sub-lobectomy is recommended.But for MIA,both lobectomy and sub-lobectomy are ac ceptable and lymph node sampling is enough.

Effect of hydrogen inhalation on mitochondrial biosynthesis in lung tissues during acute lung injury in mice with sepsis / 中华麻醉学杂志

Objective To evaluate the effect of hydrogen ( H2 ) inhalation on mitochondrial bio?synthesis in lung tissues during acute lung injury in mice with sepsis. Methods One hundred and four male ICR mice, aged 6 weeks, weighing 20-25 g, were divided into 4 groups ( n=26 each) using a ran?dom number table: sham operation group ( group S) , sham operation + H2 group ( group S+H2 ) , sepsis group ( group Sep) and sepsis + H2 group ( group Sep+H2 ) . Sepsis was produced by cecal ligation and puncture. In S+H2 and Sep+H2 groups, the mice inhaled 2% H2 for 1 h starting from 1 and 6 h after opera?tion. Twenty mice in each group were selected, and the survival rates on postoperative days 1, 2, 3, 5 and 7 were recorded. On the postoperative day 1, 6 mice in each group were selected, and blood samples were collected from the common carotid artery for measurement of arterial oxygen partial pressure, and the oxygenation index was calculated. The pulmonary specimens were obtained for examination of the pathologi?cal changes which were scored and for determination of the expression of peroxisome proliferator?activated re?ceptor gamma coactivator?1α ( PGC?1α) in lung tissues by Western blot. The pulmonary mitochondria were isolated for determination of mitochndrial membrane potential ( MMP ) and ATP contents using spectropho?tometry and a bioluminescence technique, respectively. Results Compared with group S, the survival rate, oxygenation index and MMP and ATP content in lung tissues were significantly decreased, and the pathological scores and PGC?1α expression in lung tissues were significantly increased in Sep and Sep+H2 groups (P<0.05). Compared with group Sep, the survival rate, oxygenation index, and MMP, ATP content and PGC?1α expression in lung tissues were significantly increased, and the pathological scores were significantly decreased in group Sep+H2 ( P<0.05) . Conclusion H2 inhalation can ameliorate acute lung injury in mice with sepsis, and the mechanism is associated with the enhanced function of PGC?1αand promoted mitochondrial biosynthesis in lung tissues.

The safety and efficacy of radiofrequency ablation for treating large hepatic hemangiomas / 中华普通外科杂志

Objective To assess the safety and efficacy of radiofrequency ablation (RFA) for the treatment of large (≥5 cm in diameter) hepatic hemangiomas.Methods Clinical data of 50 patients with large hepatic hemangiomas (≥5 cm in diameter) treated with RFA between October 2007 and December 2012 were analyzed.Patients were divided into two groups (5-10 cm and ≥ 10 cm) according to tumor size.Results Thirty-two patients had 36 hemangiomas of 5-10 cm in diameter and 18 patients had 19 hemangiomas of ≥ 10 cm in diameter.Technical success,complications related to RFA,completed ablation,symptom relief,change in size of ablation zone and recurrence of the residual tumor were analyzed.The average diameters of the two groups were 7.1 ± 1.2 cm and 13.2-± 2.4 cm separately (t =-12.57,P ＜ 0.01) ; the technical achievement ratios of the two groups were both 100％ ; Seven of 32 patients with hemangiomas 5-10 cm and all the 18 patients with hemangiomas ≥ 10 cm had 13 and 61 complications related to RFA,the incidence of complications were 21.88％ and 100％ respectively (x2 =28.13,P ＜ 0.01); 94.55％ hemangiomas (52/55) acquired complete ablation,the complete ablation rates of 5-10 cm hemangiomas and ≥10 cm hemangiomas were 100％ (36/36) and 84.21％ (16/19) respectively (P =0.014).The mean diameters of ablation zone were respectively decreased to 5.3 ± 1.0 cm and 10.62±1.8 cm (t =-14.30,P ＜0.01).Conclusions RFA for hepatic hemangiomas 5-10 cm in diameter is safe and effective; while its complication for ablation of hemangiomas ≥ 10 cm is high.

Advancement in multimodality therapy of local recurrent in radical resection of rectal cancer / 国际外科学杂志

After receiving radical resection of primary rectal cancer,about 4％ to 30％ patients would occur local recurrence.Diagnosis of local recurrence relies on postoperative follow-up,physical examination,tumor markers and imageological examination.For the local recurrent patients,conservative therapeutic regimen had been popular in the past days with poor prognosis and quality of life.Nowadays multimodality treatment with radical resurgery combined with chemoradiotherapy and IORT has been taking the main part in the management of local recurrence.The choice of surgery depends on the site of recurrence and invasion situation inside the pelvic cavity.The aim of the radical reoperation is R0 resection because it leads to an optimistic prognosis.Previously irradiated patients are relatively safe after receiving median-dose reirradiation.For the cases whose recurrence are unavailable for radical resection,palliative operation and chemoradiotherapy may be the wise choice to relieve their symptoms and improve the quality of life.

The safety of surgical treatment and the feasibility of laparoscopic surgery for the elderly patients with gastric cancer / 肿瘤研究与临床

ObjectivesTo discuss the safety of surgical treatment and the feasibility of laparoscopic surgery for the elderly patients with gastric cancer. MethodsThe clinical and pathological materials of 104 elderly patients(65 years old or above) undergone surgical treatments retrospectively were analyzed,in order to analysis the postoperative complication incidence and the short-term outcomes in different age groups and different surgical pattern groups.ResultsThere were more preoperative comorbidities in ≥75 years old group than in ＜75 years old group(especially hypertension and diabetes),however,the incidence of postoperative complications was not significantly different.There was no difference of preoperative comorbidities, postoperative complications, surgical time or the amouts of blood loss during surgery between the laparoscopic and the traditional surgical groups,while the laparoscopic groups had short period of postoperative hospitalizing and earlier orally intake of fluid diet. There was also no difference of pathological results.ConclusionThe elderly patients with gastric cancer should have surgical treatments if the conditions are permitted, and the areas of dissection should be standard as far as possible. The old patient undergone laparoscopic surgery may have a shorter hospitalized period after operation, because their recovery of bowel function is more quickly.

Macrophage in tumor metastasis / 国际肿瘤学杂志

There is persuasive clinical and experimental evidence that macrophages promote cancer initiation and malignant progression. The aggregation of macrophages indicates poor prognosis of tumor associated diseases. During tumor initiation, macrophages create an inflammatory environment that is mutagenic to cells and promotes cell growth; as tumors progressing, macrophages create premetastatic niche for the arriving tumor cells at premetastatic sites ; then macrophages provide critical nutrients for these initial metastatic tumor cells.Along with these great achievements in research of macrophage, it is believed that several novel directions of tumor therapy surely occur in the future.

The correlation of collateral grading and clinical outcome in carotid severe stenosis / 中国综合临床

ObjectiveTo research collateral pathways and collateral grading through digital subtract angiography(DSA) and their relation to clinical prognosis.MethodsCollateral pathways and collateral grading of 49 cases suffered from severe internal carotid artery (ICA) stenosis (70% -99% ) were assessed through DSA.Incidence of stroke,TIA or cerebral hemorrhage were observed in the following 12 months.Results①In all the subjects,no collateral pathway exist in 9 cases(18.9%),and primary and secondary collateral pathways occurred in 39(79.6% ) and 25(51.0%)cases.Pathway is not related to clinical prognosis.②There were 9 ,15 and 25 cases in 0 grade,1 -2 grade and 3 -4 grade collateral circulation and the complication ratio is 44.4%,50.66% and 24.00% respectively.Incidence of ischemic cerebrovascular disease is significantly higher in 3 - 4 grade patinets than those in 0 and 1 - 2 grade pation(x2 =4.856,3.242;all P ＜ 0.05 ).ConclusionsCollateral levels but not pathway were correlated with clinical prognosis in patients with severe stenosis of internal carotid artery.

Postoperative early intrahepatic recurrence and the prognosis in patients of hepatocellular carcinoma / 中华普通外科杂志

Objective To investigate the predictive factors and prognosis of early intrahepatic recurrence after curative resection of hepatocellular carcinoma(HCC).Methods Clinicopathological dats of 184 HCC patients with intrahepatic recurrence after curative resection were collected.Thirteen clinicopathological factors and prognosis after recurrence were retrospectively analyzed. Results Univariate analysis showed that preoperative scrota alpha-fetoprotein(AFP)>100 ng/ml,tumour size>5 cm,venous invasion and intra-operative blood transfusion were predictive factors of early intrahepatic recurrence,and selum albumin<35 g/L was marginally predictive factor.Multivariate analysis showed that serum AFP>100 ng/ml,tumour size>5 cm and venous invasion were independent predictive factots of early intrahepatic recurrence.The survival of patients suffering from early recurrence was significantly shorter than those with late recurrence.with median survival period of 12 mos vs 18 mos(P=0.012).Conclusion Serum AFP,tumour size and venous invasion were independent predictive factors of early intrahepatic recurrence in HCC patients after radical resection of the primary tumor.Early intrahepatic recurrence implies poor prognosis.

Long-term follow-up of patients with inferior vena cava filters in the prevention of pulmonary embolism / 中华放射学杂志

Objective To evaluate the long-term safety, efficacy and complications of placement vena cava filter in prevention of pulmonary embolism. Methods Seventy-three patients with proven diagnosis of deep venous thrombosis (DVT) and (or) pulmonary embolism (PE) by Doppler ultrasonography, DSA, CT or MRI, received percutaneous inferior vena cava filters (IVCF) from January 1994 to June 2005. The clinical data and imaging findings were evaluated retrospectively. The patients underwent telephone interview or questionnaire, abdominal X-rays, Doppler ultrasonography, computed tomographic pulmonary angiography (CTPA) or indirect CT venography (CTV) after a follow-up duration of 5 months to 11 years. Results Seventy-eight vena cava filters were used. There was 1 case of incomplete filter opening when placing filter. In follow-up, thrombi were trapped in the filter in 2 cases, filter tilting happened in 1 case, and there were no filter migration, filter disruption, filter perforation. Five of 73 cases were lost in follow-up visit, 14 patients died after implantation (5 days to 41 months, average 14.5 months). Among the 54 living patients, the identified recurrent PE was not noted. Three cases of recurrent DVT, 1 case of inferior vena caval thrombosis and 1 case of thrombosed filters were seen in follow- up. Conclusion Inferior veua cava filter is safe and effective for the long-term prevention pulmonary embolism, and the long-term major complications after filter placement are not frequent.

Clinical diagnosis of 5 cases of pituitary stalk interruption syndrome / 中华内分泌代谢杂志

Objective To raise the level of clinical diagnosis for the patients with pituitary stalk interruption syndrome (PSIS). Methods Five patients (4 males) with PSIS were retrospectively analyzed with respects to the clinical features, endocrine status and image characteristics. Magnetic resonance imaging (MRI) scan was performed at hypothalamic-pituitary region. Results The clinical manifestations of all patients consisted of growth retardation and delayed puberty without polyuria. Deficiency of multiple anterior pituitary hormones was revealed in all patients by the evaluation of endocrine status. The features of MRI included a lack of visible pituitary stalk, absence of posterior lobe hypersignal in the sella turcica and a hyperintense spot in the region of the thalamus opticus. Conclusion The clinical characteristics of patients with PSIS are growth retardation and delayed puberty. The evaluation of anterior pituitary function is necessary. The detection of an anatomical abnormality around hypothalamic-pituitary region by MRI is important diagnostic evidence.

Transplantation of rectus abdominis musculocutaneous flap after open-window thoracostomy to manage chronic refractory pleural empyema and fistula with 2 cases report / 中华胸心血管外科杂志

Objective To report the experience of using rectus abdominis musculocutaneous flap after open-window thoracosto- my in managing refractory chronic pleural empyema.Methods From Nov.2004 to Mar.2006,intrathoracic transplantation of the musculocutaneous flap was performed successfully in 4 patients with empyema and fistula after upper lobectomy.The myocutaneous flap was designed in such a way that epigastrica vessels were incorporated.Results The rectus abdominis myocutaneous flap has provided sufficient bulk for tract obliteration.Over a mean follow-up period of 10 months,patients are free from recurrent infections and skin nacrosis.Conclusion Vaseularized museulocutaneous flap may help in healing refractory empyema.