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Purpose@#Knowing the distinction between benign and borderline/malignant phyllodes tumors (PTs) can help in the surgical treatment course. Herein, we investigated the value of magnetic resonance imaging-based texture analysis (MRI-TA) in differentiating between benign and borderline/malignant PTs. @*Methods@#Forty-three women with 44 histologically proven PTs underwent breast MRI before surgery and were classified into benign (n = 26) and borderline/malignant groups (n = 18 [15 borderline, 3 malignant]). Clinical and routine MRI parameters (CRMP) and MRI-TA were used to distinguish benign from borderline/malignant PT. In total, 298 texture parameters were extracted from fat-suppression (FS) T2-weighted, FS unenhanced T1-weighted, and FS first-enhanced T1-weighted sequences. To evaluate the diagnostic performance, receiver operating characteristic curve analysis was performed for the K-nearest neighbor classifier trained with significantly different parameters of CRMP, MRI sequence-based TA, and the combination strategy. @*Results@#Compared with benign PTs, borderline/malignant ones presented a higher local recurrence (p = 0.045); larger size (p < 0.001); different time-intensity curve pattern (p = 0.010); and higher frequency of strong lobulation (p = 0.024), septation enhancement (p = 0.048), cystic component (p = 0.023), and irregular cystic wall (p = 0.045). TA of FS T2-weighted images (0.86) showed a significantly higher area under the curve (AUC) than that of FS unenhanced T1-weighted (0.65, p = 0.010) or first-enhanced phase (0.72, p = 0.049) images. The texture parameters of FS T2-weighted sequences tended to have a higher AUC than CRMP (0.79, p = 0.404). Additionally, the combination strategy exhibited a similar AUC (0.89, p = 0.622) in comparison with the texture parameters of FS T2-weighted sequences. @*Conclusion@#MRI-TA demonstrated good predictive performance for breast PT pathological grading and could provide surgical planning guidance. Clinical data and routine MRI features were also valuable for grading PTs.
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Multiple myeloma (MM) is characterized by genetic heterogeneity and is a common secondary hematological malignancy. Many studies have revealed that variation in the number of long non-coding RNAs (lncRNAs) is related to the degree of MM malignancy. Advances in molecular biology technologies, such as fluorescence in situ hybridization, high-throughput sequencing, gene microarrays, and qRT-PCR, have furthered research into cytogenetic malfunction in MM. Eleven newly discovered lncRNAs in MM have been fully interpreted according to the different mechanisms of MM and have the potential to be promising biomarkers for MM diagnosis and therapy.
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In order to improve the clinical teaching quality of functional gastrointestinal diseases (FGIDs),the teachers tried to apply the Rome Ⅳ criteria in the clinical teaching of FGIDs,including ward rounds,case analysis,and clinical practice.This article firstly summarizes the necessity and importance of teaching based on the Rome Ⅳ criteria,then gives an interpretation of the Rome Ⅳ criteria,and finally establishes a problem-centered teaching mode in combination with discussion of typical FGID cases.The interpretation of the Rome Ⅳ criteria and clinical practice guided by experts help the students to understand the Rome Ⅳ criteria and use it to guide clinical practice and scientific research.This article also provides a theoretical basis for the application and promotion of the Rome Ⅳ criteria in the clinical teaching of gastroenterology.
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Objective To analyze the causes of delayed hemorrhage after colonoscopic treatment in colorectal diseases and the value of second colonoscopic treatment.Methods A retrospective study was conducted on 45 patients with colorectal protrusion lesions (polyps,adenoma,early carcinoma and lipoma) in the Daping hospital of the Third Military medical University from January 2010 to December 2016.The patients suffered from delayed hemorrhage after argon knife coagulation,submucosal resection,submucosal dissection or nylon snares colonoscopic treatment.The mode and clinical outcome of second colonoscopic treatment were summarized by aiming at the reasonsof delayed hemorrhage.Results The predilection sites of delayed hemorrhage were in turn rectum (28.89 ％),sigmoid colon (24.44 ％) and ascending colon (22.22 ％).Adenoma and intraepithelial neoplasia lesions were easier to occurr (88.89 ％).The types of delayed hemorrhage were mainly blood oozing at the lesion resection wound surface as well as blood gushing or ejection.The second colonoscopic treatment modes in these cases were mainly titanium clipping and ring clipping and suturing.Five cases were treated by submucosal injection of adrenaline (1 ∶ 10 000) combined with argon knife coagulation.Thirtyfive cases conducted argon knife coagulationcombined with titanium clipping,3 cases conducted titanium clipping and 2 cases adopted ring clipping hemostasis.Forty-two cases stopped bleeding by once colonoscopic treatment,while 3 cases suffered from re-bleeding,the colonoscopic treatment was performed again,1 case stopped bleeding after using titanium clipping and ring clipping hemostasis again,while other 2 cases were transfered to the surgery department for conducting colectomy.All 43 cases of delayed hemorrhage in this group were cured and discharged after successful hemostasis by colonoscopy.The firm wound treatment after colonoscopic treatment was very important for preventing delayed hemorrhage,and the underlying diseases and postoperative diet management were also the important factors of delayed hemorrhage.Conclusion Timely second colonoscopic examination and treatment can obtain satisfactory clinical effects in the patients sufferring from delayed hemorrhage after colonoscopic treatment.
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Gastrointestinal bleeding is a common acute and critical illness that may result in hemorrhagic shock.In conventional concept, sufficient blood transfusion to ensure volume resuscitation was necessary for this emergency condition.With the propose and application of restrictive transfusion strategy in clinical practice, the new concept has been applied in patients with gastrointestinal bleeding.Restrictive transfusion strategy could maintain the perfusion of vital organs with a minimized blood transfusion, and avoiding the coagulopathy and acidosis caused by massive transfusion.This article reviewed the advances in study on gastrointestinal bleeding and restrictive transfusion strategy.
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Objective@#To evaluate the efficacy and safety of the application of dye-tattooing under ultrasound guidance in preoperative localization of neck recurrences from thyroid cancer.@*Methods@#Between October 2014 to September 2016, 25 patients with 34 lesions were enrolled. There were 22 cases of papillary thyroid carcinoma and three cases of medullary thyroid carcinoma, all of which could not be detected by computed tomography. Surgeons located the recurrent lesions using dye-tattooing under ultrasound guidance along with radiologist three days before the operation.@*Results@#All lesions were successfully located (100%), 32 of which were located directly and two of which were located indirectly. Postoperative pathological examination confirmed 25 metastases of papillary thyroid carcinoma, two metastases of medullary thyroid carcinoma, and seven cases of false positives. The accuracy of ultrasound diagnosis was 79.4%. After 15 months of follow-up, neither tumor residual nor recurrences was detected according to imaging tests.@*Conclusions@#Dye-tattooing under ultrasound guidance represents a reliable and safe method for localization of neck recurrences from thyroid cancer. The cooperation between experienced surgeons and radiologists will be crucial to successful location.
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Objective@#To investigate the value of secondary cervical lymph node dissection in papillary thyroid carcinoma (PTC).@*Methods@#PTC patients with recurrence re-operated in a previously dissected area at our hospital during 2000-2016 were included in this analysis. Patients were divided according to the operative interval of 6 months. The level and number of lymph node metastasis and the number of lymph node dissection were analyzed to calculate the ratio of lymph node metastasis.@*Results@#A total of 336 PTC patients received 360 side lateral cervical lymph nodes dissection. The ratio of recurrence in unilateral lateral neck is 92.9%(312/336). The ratio of recurrence in multiple levels (more than two regions) were 47.5% (171/360). The recurrence ratio of level Ⅱ, Ⅲ, Ⅳ and Ⅴ were 55.6%(200/360), 44.2%(159/360), 59.7%(215/360) and 10.3%(37/360), respectively. Lymph node metastases were inclined to level Ⅱ (33.6%) and Ⅳ (35.8%). The mean number of lymph node dissection and metastasis in the group of operative interval ≤ 6 months was 26.56 per case and 4.37 per case, respectively. The mean number of lymph node dissection and metastasis in the group of operative interval >6 months was 16.80 per case and 3.20 per case, respectively. The number of lymph node dissection and metastasis between these two groups were significantly different (P=0.001, P<0.001).@*Conclusions@#Lymph node metastasis of PTC patients with secondary cervical lymph node dissection are inclined to level Ⅱ and level Ⅳ. Moreover, multi-level metastasis is not rare. Level Ⅱ and level Ⅳ require more attention in the first operation. Most of the patients undergo reoperation because of residual lymph nodes from the previous treatment. Normalization and completeness of the initial dissection are particularly important to PTC patients.
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Objective@#To analyse the postoperative metastasis or recurrence of cervical lymph nodes in individual neck levels for papillary thyroid carcinoma and to evaluate the outcomes and complications of re-surgery.@*Methods@#A retrospective cohort study of 259 patients who underwent lymph node dissection for PTC relapse from January 2010 to June 2011. Lymph node metastases in each of neck levels were detected, postoperative complications were evaluated, and the patients were followed up with examining thyroglobulin levels to assess the therapeutic effect.Continuous variables were compared with t test.Categorical variables were compared with Fisher′s exact test.@*Results@#Lymph node metastasis was found in 259 cases and lymph node metastasis rates in levels Ⅱ, Ⅲ, Ⅳ, Ⅴ and Ⅵ were 43.2%, 50.2%, 45.6%, 8.1% and 59.1% respectively. In 44 cases received the neck dissection of level Ⅱ, the metastasis rates in the levels Ⅱa and Ⅱb were respectively (52.3% vs 18.2%, P=0.887). Recurrence in unilateral lateral neck was more common than that in bilateral lateral neck (73.1% vs 20.6%, P<0.001). The lymph nodes in lateral neck were more likely to metastasize than those in central region (80.7% vs 59.1%, P<0.001). There were 47 cases (18.1%) had postoperative complications, including 10 cases with permanent hypocalcemia.@*Conclusions@#The scope of re-operation for neck metastasis or recurrence in papillary thyroid carcinoma should include the dissection of levels Ⅱ-Ⅳ and Ⅵ. The incidence of postoperative complications for re-surgery is high, and re-surgery should be performed by experienced surgeon.
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Background:Gastroesophageal reflux disease(GERD)is a common disorder of digestive system,however,some of patients are not responding to conventional 4-8 weeks proton pump inhibitor therapy. Aims:To investigate the effect of digital music gastric electrical pacing on clinical symptoms,anxiety and depression and esophageal motility in patients with refractory GERD. Methods:Fifty-three patients with refractory GERD from Jan. 2014 to Oct. 2015 at the Third Affiliated Hospital,the Third Military Medical University were recruited. All of them fulfilled the Montreal definition of GERD. Digital music gastric electrical pacing was performed for 15 days and the efficacy was evaluated by clinical symptom scoring,Hamilton anxiety scale( HAMA),Hamilton depression scale( HAMD)and esophageal motility manometry. Results:After 15-day treatment,the main symptoms,including heartburn,daytime and nocturnal acid reflux,upper abdominal pain,nausea,and sleep disorder were significantly improved(P < 0. 001). A great proportion of patients were complicated with anxiety and/ or depression at recruitment,and after treatment the scores of HAMA and HAMD were decreased significantly(P < 0. 001). Meanwhile,the lower esophageal sphincter resting pressure(LESP),distal wave amplitude,peristaltic wave duration,speed of peristaltic wave and distal contraction integral after treatment were significantly increased as compared with the baseline values(P < 0. 05). Conclusions:Digital music gastric electrical pacing is effective for treatment of refractory GERD with increase of LESP and esophageal body motility. The clinical symptoms and anxiety and depression are improved simultaneously. Digital music gastric electrical pacing is expected to be a new choice of non-medicine treatment for esophageal motility disorders.
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BACKGROUND:Currently, human umbilical cord derived-mesenchymal stem cel s are mainly for local transplantation, which has some shortcomings, such as large trauma, bleeding, complications, that limit its widespread application in clinical practice. OBJECTIVE:To investigate the feasibility of intravenous transplantation of human umbilical cord derived-mesenchymal stem cel s for repair of spinal cord injury. METHODS:Eighty Wistar rats with spinal cord hitting were divided into five groups:blank control group with no transplantation (n=10), DMEM local transplantation group (n=15), DMEM intravenous transplantation group (n=15), cel local transplantation group (n=20), cel intravenous transplantation group (n=20). The functional recovery of spinal cord injury was observed with Basso, Beattie and Bresnahan scores at regular time as wel as hematoxylin-eosin staining and immunohistochemistry staining. RESULTS AND CONCLUSION:During 1 day to 2 weeks after transplantation, there was no significant difference in the Basso, Beattie and Bresnahan scores between the five groups;within 4-12 weeks after transplantation, the Basso, Beattie and Bresnahan scores were significantly higher in the two cel transplantation groups than the other three groups, but there was no difference between these two cel transplantation groups (P>0.05). Histological observation showed that the number of voids and glial scars was less in the cel local transplantation group and cel intravenous transplantation group compared with the other three groups, and there was also no difference between the two cel transplantation groups. These results indicate that the intravenous transplantation of human umbilical cord derived-mesenchymal stem cel s is similar to the local transplantation in the repair of acute spinal cord injury, which is simple and avoids secondary injuries and various complications. It is recommended that this method provide a new approach for cel transplantation.
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BACKGROUND: A proper preservation method would be of important significance for experiments and clinical application ofolfactory ensheathing cells (OECs) OBJECTIVE: To explore proper cyropreservative systems for OECs.METHODS: OECs during the logarithmic growth phase were harvested, cryopreserved for 1, 3 and 6 months and then revitalized.RESULTS AND CONCLUSION: MTT assay and tryplan blue staining showed that cells exhibited highest viability after treatmentwith 5% dimethyl sulfoxide (DMSO)-6% hydroxyethyl starch (HES), followed by 10% DMSO, and lastly the 5% DMSO. Use ofrefrigerator or cryogenic control system with different cryopreservation time did not yield obvious effects on viability of OECs.Therefore, 5% DMSO-6%HES is recommended as a cryopreservative agent for OECs.
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Ginko biloba extract is an active compound with broad biological function.This review summarizes the immuomodulatory effect of Ginko biloba extract on immune organ development, monocyte macrophage, natural killer cell, humoral immunity, cellular immunity, cytokines, red cell immunity and mucosal immunity.
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Objective To investigate the nutritional risks, prevalence of undernutrition, and nutritional interventions among inpatients in departments of nephrology in some hospitals in Guangzhou, with an attempt to provide evidences for the nutritional support of patients with kidney diseases. Methods Totally 378 adult patients in departments of nephrology in Guangzhou were enrolled in this study by fix-point consecutive sampling. Nutritional Risk Screening 2002 (NRS 2002) was applied for nutritional risk assessment. Nutrition risk was defined by NRS score ≥3 and undernutrition by BMI ＜ 18.5 kg/m2 or serum albumin ＜ 30 g/L. Nutritional interventions were also evaluated in all patients. The relationship between nutritional risk and nutritional support was analyzed. Results The overall prevalence of undernutrition was 21.7% and the nutritional risk was 41.3%. They were especially high among patients with chronic kidney dysfunction (24. 3% and 60. 7% , respectively). The nutritional risk was 42. 3% in patients accompanied with diabetes (P＞0. 05). Of these 378 patients, 102 (27.0%) received nutritional interventions, in which the nutritional support rate was 50. 0% (78/156) for patients with nutritional risks and 10. 8% (24/222) for those without nutritional risks. Conclusions The nutritional risks and prevalence of undernutrition are high among inpatients in the departments of nephrology in hospitals in Guangzhou. Proper application of nutritional interventions remains a concern. Evidence-based guidelines are required to improve this situation.
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@#ObjectiveTo explore the effects of comprehensive rehabilitation on life quality of patients with stroke in recovery phase.Methods83 patients with stroke in recovery phase (over 3 months) accepted comprehensive rehabilitation. Their extremity motor function and activity of daily living (ADL) were compared before and after rehabilitation.ResultsThere were statistically significant difference on Brunnstrom scores and ADL scores before and after rehabilitation(P<0.01).ConclusionComprehensive rehabilitation can improve motor function and quality of life in post-stroke patients.