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Chinese Journal of Digestion ; (12): 561-567, 2021.
Article in Chinese | WPRIM | ID: wpr-912212

ABSTRACT

Objective:To investigate the expression at protein level and diagnostic value of histone acetyltransferase MYST2 in pancreatic cancer.Methods:From December 1st, 2017 to June 30th, 2020, at Peking Union Medical College Hospital, a total of 54 cases of pancreatic cancer tissues and corresponding paracancerous pancreatic tissues (>5 cm from the surgical margin) resected and confirmed by pathology were collected. ASPC1 and BXPC3 pancreatic cancer cell lines were knocked down (ASPC1 and BXPC3 knockdown group), CFPAC1 and SW1990 pancreatic cancer cell lines were overexpressed (CFPAC1 and SW1990 overexpression group), the untreated ASPC1, BXPC3, CFPAC1 and SW1990 were set as blank vector control group. The expression at protein level of MYST2 was detected by Western blotting in patients with different degrees of pathological differentiation, human normal pancreatic duct epithelial cell line HPDE, human pancreatic cancer cell lines ASPC1, BXPC3, CFPAC1 and SW1990, knockdown group, overexpression group and blank vector control group. The cell proliferation, migration, invasion and colony formation ability of the knockdown group, overexpression group and blank vector control group were determined by real-time cellular analysis, Transwell migration and invasion test, and plate colony formation assay. MYST2 immunohistochemical scoring was performed on pancreatic cancer tissues and para cancer tissues. Receiver operating characteristic curve was drawn to analyze the value of different MYST2 protein expression levels in the diagnosis of pancreatic cancer. Independent sample t test and variance analysis were used for statistical analysis. Results:Among the pathological slides of 54 cases of pancreatic cancer, 13 cases were highly differentiated, 24 cases were moderately differentiated, 15 cases were poorly differentiated and 2 cases were undifferentiated, the MYST2 expression at protein level in pancreatic cancer cells was 3.12±1.67, 2.87±1.59, 2.12±1.03 and 1.08±0.34, respectively, and the difference was statistically significant ( F=1.241, P<0.05). The MYST2 expression levels of ASPC1, BXPC3, CFPAC1 and SW1990 were all higher than that of normal pancreatic ductal epithelial cell lines HPDE (1.41±0.47, 1.40±0.93, 1.13±0.62 and 1.71±0.46 vs. 0.82±0.25), and the differences were statistically significant( t=1.625, 1.577, 1.319 and 1.832, all P<0.05). The MYST2 expression level of BXPC3 knockdown group was lower than that of BXPC3 blank vector control group (0.39±0.12 vs. 0.75±0.34); that of ASPC1 knockdown group was lower than that of ASPC1 blank vector control group (0.43±0.22 vs. 0.82±0.48); that of CFPAC1 overexpression group was higher than that of CFPAC1 blank vector control group (1.38±0.45 vs. 0.82±0.37); that of SW1990 overexpression group was higher than that of SW1990 blank vector control group (1.34±0.65 vs. 0.51±0.22), and the differences were statistically significant ( t=1.414, 1.378, 1.319 and 1.934, all P<0.05). The cell proliferation of ASPC1 knockdown group was slower than that of ASPC1 blank vector control group, and the proliferation peak at 80 h was lower than that of blank vector control group (1.02±0.77 vs. 4.31±2.45); the cell proliferation of BXPC3 knockdown group was slower than that of BXPC3 blank vector control group, and the proliferation peak at 80 h was lower than that of blank vector control group (0.91±0.24 vs. 2.84±0.53); the proliferation of pancreatic cancer cells in SW1990 overexpression group was faster than that of SW1990 blank vector control group, and the proliferation peak at 80 h was higher than that of blank vector control group (3.10±0.67 vs. 1.04±0.17); the proliferation of pancreatic cancer cells in CFPAC1 overexpression group was faster than that that of CFPAC1 blank vector control group, and the proliferation peak at 80 h was higher than that of blank vector control group (5.45±1.13 vs. 1.01±0.29), and the differences were statistically significant ( t=1.427, 1.316, 1.292 and 1.501, all P<0.05). In the test of migration ability, the number of cells passed through the Transwell chamber of ASPC1 knockdown group was less than that of ASPC1 blank vector control group (34.08±17.62 vs. 118.76±5.31); that of BXPC3 knockdown group was less than that of BXPC3 blank vector control group (18.62±9.64 vs. 57.90±12.67); that of SW1990 overexpression group was more than that of SW1990 blank vector control group (134.84±24.65 vs. 37.82±6.73); that of CFPAC1 overexpression group was more than that of CFPAC1 blank vector control group (65.79±27.46 vs. 11.68±5.13), and the differences were statistically significant ( t=1.475, 1.322, 1.437 and 1.219, all P<0.05). In the test of invasion ability, the number of cells passed through the Transwell chamber of ASPC1 knockdown group was less than that of ASPC1 blank vector control group (9.79±5.75 vs. 45.76±12.71); that of BXPC3 knockdown group was less than that of BXPC3 blank vector control group (23.46±11.13 vs. 84.92±17.65); that of SW1990 overexpression group was more than that of SW1990 blank vector control group (156.42±34.50 vs. 42.13±22.17); that of CFPAC1 overexpression group was more than that of CFPAC1 blank vector control group (112.64±47.82 vs. 39.09±17.23), and the differences were statistically significant ( t=1.324, 1.635, 1.423 and 1.119, all P<0.05). The number of colony formation of the ASPC1 knockdown group was less than that of ASPC1 blank vector control group (13.15±6.42 vs. 86.79±35.17); that of BXPC3 knockdown group was less than that of BXPC3 blank vector control group (14.93±9.30 vs. 52.93±15.76); that of SW1990 overexpression group was more than that of SW1990 blank vector control group (129.10±57.31 vs. 62.42±37.43); that of CFPAC1 overexpression group was more than that of CFPAC1 blank vector control group (157.98±66.45 vs. 74.35±34.69), and the differences were statistically significant ( t=1.148, 1.290, 1.274 and 1.462, all P<0.05). The MYST2 score of pancreatic cancer tissues was higher than that of adjacent paracancerous pancreatic tissues (3.04±2.23 vs. 1.32 ± 0.70), and the difference was statistically significant ( t=3.479, P<0.05). When the total immunohistochemistry score of MYST2 was 3 point, the area under the curve was the largest (0.888, 95% confidence interval 0.827 to 0.948), and the Youden index was 0.56. Conclusion:MYST2 is associated with the proliferation, invasion and migration of pancreatic cancer cells, and promotes the development of pancreatic cancer.

2.
Article in Chinese | WPRIM | ID: wpr-912177

ABSTRACT

Objective:To explore the endoscopic features of early gastric cancer (EGC) related to non-curative endoscopic resection, and to construct an assessment model to quantify the risk of non-curative resection.Methods:From August 2006 to October 2019, 378 lesions that underwent endoscopic resection and were diagnosed pathological as EGC in the Department of Gastroenterology, Peking Union Medical College Hospital were included in this case-control study.Seventy-eight (20.6%) non-curative resection lesions were included in the observation group, and 234 lesions which selected from 300 lesions of curative resection were included in the control group according to the difference of operation year ±1 with the observation group, and the ratio of 1∶3 of the observation group to the control group. Univariate and multivariate logistic regression analysis were performed to explore the risk factors for non-curative resection. The independent risk factor with the minimum β coefficient was assigned 1 point, and the remaining factors were scored according to the ratio of their β coefficient to the minimum. A predictive model was established to analyze the 378 lesions.The non-curative resection rates of lesions of different scores were calculated. Results:Univariate analysis showed that the lesion diameter, the location, redness, ulcer or ulcer scar, fold interruption, fold entanglement, and invasion depth observed with endoscopic ultrasonography (EUS) were associated with non-curative resection of EGC lesions ( P<0.05), and contact or spontaneous bleeding may be associated with non-curative resection ( P=0.068). Multivariate logistic regression analysis showed that submucosal involvement (VS confined to the mucosa: β=0.901, P=0.011, OR=2.46, 95% CI: 1.23-4.92), lesion diameter of 3-<5 cm (VS <3 cm: β=0.723, P=0.038, OR=2.06, 95% CI: 1.04-4.09), lesion diameter of ≥5 cm (VS <3 cm: β=2.078, P=0.003, OR=7.99, 95% CI: 2.02-31.66), location in the upper 1/3 of the stomach (VS lower 1/3: β=1.540, P<0.001, OR=4.66, 95% CI: 2.30-9.45), and fold interruption ( β=2.287, P=0.008, OR=1.93, 95% CI: 0.95-3.93) were independent risk factors for non-curative resection of EGC lesions. The factor of lesion diameter of 3-<5 cm and submucosal involvement were assigned 1 point respectively, location in the upper 1/3 of the stomach was assigned 2 points, diameter of ≥5 cm and fold interruption were assigned 3 points respectively, and other factors were assigned 0 point. Then the analysis of 378 lesions showed that the probability of non-curative resection at ≥2 points was 41.9% (37/93), 4 times as much as that at 0 [11.5% (25/217)]. Conclusion:EGC lesions with diameter ≥3 cm, located in the upper 1/3 of the stomach, interrupted folds or submucosal involvement are highly related to non-curative resection. The predictive model based on these factors achieves satisfactory efficacy, but it still needs further validation in larger cohorts.

3.
Article in Chinese | WPRIM | ID: wpr-912167

ABSTRACT

Objective:To explore the approach of continuing education for digestive specialists through the establishment of training mode for diagnosis and treatment of early gastric cancer and the evaluation of training effect.Methods:A total of 48 participants of 3 sessions in the training course of early gastric cancer in Peking Union Medical College Hospital from September 2019 to January 2020 were enrolled in this study. Effects of six training methods were evaluated subjectively and objectively by a questionnaire survey and an on-site test.Results:After the training course of early gastric cancer, the diagnostic awareness (100.0%, 48/48), basic theoretical knowledge (97.9%, 47/48), endoscopic diagnosis ability (95.8%, 46/48) and endoscopic operation skills (87.5%, 42/48) of early gastric cancer of the trainees were significantly improved.The most effective training sessions were endoscopic images recognition, lectures of theoretical knowledge, case discussion and hands-on workshop. The results of theoretical knowledge test (79.38±8.10 VS 48.33±9.96, t=-21.176, P<0.001)and image diagnosis test (81.50±8.32 VS 49.58±13.48, t=-15.408, P<0.001) after training were significantly improved compared with those of before. Conclusion:The systematic training program of early gastric cancer that includes a variety of training methods is effective and should be widely promoted in the continuing education of digestive specialists.

4.
Article in Chinese | WPRIM | ID: wpr-912131

ABSTRACT

Objective:To summarize the clinical characteristics of bleeding during endoscopic submucosal dissection (ESD) and to analyze the risk factors for bleeding.Methods:Data of patients who received gastric ESD in endoscopy center of Peking Union Medical College Hospital from January 2015 to December 2019 were reviewed. The medical history, characteristics of gastric lesions, operation process and prognosis of the patients were analyzed.Results:A total of 437 gastric lesions of 422 patients were included in this study, and 406 lesions were gastric epithelial tumors. The bleeding rate during ESD was 32.3% (141/437), including 2 cases of acute massive hemorrhage. Intraoperative hemorrhage during ESD increased the incidence of myometrial injury and intraoperative perforation, and prolonged the operation time. Multivariate regression analysis showed that risk factors for bleeding during ESD were anatomical adhesion, the lesion location in the upper and middle 2/3 of the stomach, the lesion area ≥ 15 cm 2, male, and non-ESD absolute indications. Conclusion:Bleeding is the speed limiting factor for gastric ESD. For male patients, when the lesion is located in the upper and middle 2/3 of the stomach, large with anatomical adhesion during operation, precaution should be taken for intraoperative hemorrhage.

5.
Article in Chinese | WPRIM | ID: wpr-911703

ABSTRACT

Objective:To compare the minimally invasive transforaminal lumbar interbody fusion (MTLIF) with open transforaminal lumbar interbody fusion (OTLIF) in treatment of lumbar degenerative disease.Methods:Clinical data of 63 patients with single segment lumbar degenerative disease treated in Department of Orthopedics of Beijing Hospital from November 2015 to September 2016 were retrospectively analyzed, among whom 30 cases received MTLIF and 33 cases received OTLIF. The operative time, intraoperative X-ray exposure times, intraoperative blood lose, postoperative drainage,perioperative fever, adjacent segment degeneration, loosening of internal fixation and cage collapse were observed in two groups 4 years after operation, and the visual analog scale (VAS) score of the lower back and the leg, the Oswestry disability index (ODI) score were compared between two groups.Results:The operation time [(191.6±50.5) min] and radiation exposure times [(15.5±6.4) times] in MTLIF group were significantly more than those in OTLIF group [(105.8±23.1) min, (7.2±1.4)times, t=17.210, t=10.850,all P<0.01]. The intraoperative blood loss [(150.4±70.4) ml], postoperative drainage [(90.4±30.7)ml], VAS score (2.4±0.7) and ODI score (24.5±3.7) 2 weeks after surgery in MTLIF group were significantly lower than those in OTLIF group [(250.7±43.9)ml,(216.3±67.8)ml,(4.5±1.6),(30.6±4.6), t=-12.830, t=-14.070, t=-6.890, t=-5.805,all P<0.01]. There were no significant differences in the incidence of fever [1 case(3.3%) vs. 4 cases(12.1%),χ2=-1.661, P=0.20], VAS score[(1.2±0.7) vs. (1.3±0.6), t=-0.628, P=0.53], ODI score[(14.2±2.7) vs. (14.7±2.5), t=-0.756, P=0.45], fusion rate of Bridwell grade Ⅰ [86.7%(26/30) vs. 84.8%(28/33),χ2=0.042, P=0.84] 1 year after surgery; and the adjacent segment degeneration [0 case(0) vs. 1 case(3.0%),χ2=0.924, P=0.34], internal fixation loosening [1 case(3.3%) vs. 1 case(3.0%),χ2=0.005, P= 0.95] and cage collapse 4 years after surgery [1 case(3.3%) vs. 1case(3.0%),χ2=0.005, P=0.95] between MTLIF group and OTLIF group. Conclusion:Compared with OTLIF, MTLIF has longer operation time and more radiation exposure, but it can achieve full decompression, the same fusion rate, less bleeding, less trauma, faster recovery, fewer complications and satisfactory long-term effect.

6.
Article in Chinese | WPRIM | ID: wpr-911641

ABSTRACT

Objective:To explore risk factors for relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in adult Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia (Ph-ALL).Methods:A retrospective analysis was performed for 65 adult Ph-ALL patients undergoing initial allo-HSCT from 2016 to 2018. The effect of baseline level and treatment pre-transplantation for relapse after allo-HSCT was analyzed.Results:There were 37 males and 28 females with a median age of 25(14-58) years during allo-HSCT. And the median follow-up period was 27 months post-HSCT. The 2-year overall survival (OS) was 78.8%(95%CI 67.8%-89.8%) and the 2-year relapse-free survival (RFS) 70.7% (95%CI 58.2%-83.2%). Pre-transplant chemotherapy was offered for 3 to 7 courses and the median dose of polyethylene glycol-conjugated asparaginase (PEG-ASP) was 3 doses (2 000 IU/m 2 per dose). Multiariate analysis revealed that the regimen included more than 4 doses of PEG-ASP pre-HSCT (HR=4.067, P=0.046) was a protective factor for post-transplant relapse (HR=0.193, P=0.009). High-risk chromosome karyotype was a risk factor for relapse (HR=0.193, P=0.009). The 2-year RFS rate was 90.0%(95%CI 79.2%-100.0%) for intensive PEG-ASP group and 56.9%(95%CI 39.1%-74.7%) for control group ( P=0.01). No significant inter-group difference existed in overall survival (OS)( P=0.079). The 2-year OS was 90.6% (95%CI 80.4%-100.0%) in intensive PEG-ASP group and 72.1% (95%CI 56.6%-87.6%) in control group. Conclusions:For adult ph-ALL patients, a higher dose of PEG-ASP in pretransplant chemotherapy regimens may improve post-transplant RFS and achieve a better outcome.

7.
Chinese Journal of Dermatology ; (12): 696-701, 2021.
Article in Chinese | WPRIM | ID: wpr-911508

ABSTRACT

Objective:To investigate the intervention effect of topical shikonin on an imiquimod-induced psoriasis-like mouse model and its effect on expression of CCAAT enhancer binding protein δ (CEBPD) .Methods:Twenty specific pathogen-free BALB/c male mice were randomly and equally divided into model group, shikonin 1 group, shikonin 2 group and blank control group by using simple random sampling. Mice in the model group, shikonin 1 group and shikonin 2 group were topically treated with 50 mg of 5% imiquimod cream every day on the shaved back to establish the psoriasis-like mouse model. After 6-hour treatment, mice in the shikonin 1 group and shikonin 2 group were treated with 0.5 ml of shikonin at concentrations of 0.576 and 5.76 g/L respectively in the modeling area for 8 consecutive days; the blank control group received no treatment. Changes in the skin lesions of these mice were observed by naked eyes every day, and evaluated by using psoriasis area severity index (PASI) ; after 8-day treatment, the mice were sacrificed by cervical dislocation, the dorsal skin tissues were resected, and immunohistochemical study and Western blot analysis were performed to determine the expression of CEBPD in the mouse epidermis. Statistical analysis was carried out with SPSS 16.0 software by using one-way analysis of variance for comparisons of observation indices among different groups, as well as least significant difference- t test for multiple comparisons. Results:On day 8, the mice in the model group presented with obvious erythema, scales, and infiltrative and thickened skin lesions; compared with the model group, the skin lesions were markedly improved in the shikonin 1 group and shikonin 2 group, and the improvement was more obvious in the shikonin 2 group. On day 8, the PASI score significantly differed among the blank control group, model group, shikonin 1 group and shikonin 2 group (0, 11.0±1.22, 8.6±0.55, 5.8±1.30 points, respectively; F=128.21, P<0.01) , and there were significant differences between any two groups (all P < 0.01) . Immunohistochemical study showed a significant difference in the expression of CEBPD ( A value) among the model group, shikonin 1 group, shikonin 2 group and blank control group (0.072±0.026, 0.177±0.036, 0.290±0.062, 0.407±0.051, respectively; F=48.895, P < 0.01) , and there were also significant differences between any two groups (all P < 0.01) . Western blot analysis showed that the CEBPD expression in the mouse epidermis was highest in the blank control group, followed in descending order by the shikonin 2 group, shikonin 1 group and model group, and significantly differed among the above 4 groups ( F=10.237, P<0.05) ; moreover, there were significant differences in the CEBPD expression between the model group and blank control group, as well as between the shikonin 1 group and blank control group (both P<0.05) , while no significant difference was observed between the shikonin 2 group and the blank control group ( P > 0.05) . Conclusion:Topical shikonin could effectively interfere with the development of imiquimod-induced psoriasis-like mouse model; CEBPD expression decreased in the psoriasis-like mouse model, and could be markedly upregulated by topical application of shikonin.

8.
Chinese Journal of Dermatology ; (12): 499-503, 2021.
Article in Chinese | WPRIM | ID: wpr-911478

ABSTRACT

Objective:To explore the mechanism underlying microRNA (miR) -125a-mediated inhibition of proliferation of keratinocytes.Methods:After 24-hour pretreatment with interleukin (IL) -23, human HaCaT keratinocytes were divided into miR-125a group and miR-NC group transfected with a miR-125a overexpression plasmid and a control plasmid, respectively. Cell counting kit-8 (CCK8) assay was performed to evaluate the proliferative ability of HaCaT cells in the two groups at 0, 24, 48 and 72 hours after transfection, real-time fluorescence-based quantitative PCR to determine the mRNA expression of miR-125a and IL-23 receptors (IL-23R) in the two groups 24 hours after transfection, and Western blot analysis to determine the protein expression of IL-23R, Janus kinase 2 (JAK2) , protein kinase B (AKT) and phosphorylated AKT (p-AKT) in the two groups 48 hours after transfection. Dual-luciferase reporter assay was performed to verify the targeting relationship between miR-125a and IL-23R. Comparison of means between two groups was carried out by using t test, and changes in the proliferative ability of HaCaT cells over time were evaluated by using repeated measures analysis of variance. Results:After plasmid transfection, the relative expression of miR-125a was significantly higher in the miR-125a group (6.377 ± 0.745) than in the miR-NC group (0.700 ± 0.222; t=7.305, P=0.002) . At 0, 24 and 48 hours after transfection, there was no significant difference in cellular proliferative ability between the miR-125a group and the miR-NC group ( t=0.663, 0.623 and 1.930, respectively, all P > 0.05) ; at 72 hours after transfection, the cellular proliferative ability was significantly lower in the miR-125a group than in the miR-NC group ( t=4.407, P < 0.05) . The IL-23R mRNA expression was significantly lower in the miR-125a group than in the miR-NC group ( t=3.082, P < 0.05) . Compared with the miR-NC group, the miR-125a group showed significantly decreased protein expression of IL-23R, JAK2 and p-AKT ( t=11.715, 6.996, 12.424, P < 0.001,=0.002, < 0.001, respectively) . Dual-luciferase reporter assay showed targeted binding of miR-125a to IL-23R. Conclusion:MiR-125a may inhibit the proliferation of keratinocytes by negatively regulating the IL-23R/JAK2/AKT signaling pathway.

9.
Article in Chinese | WPRIM | ID: wpr-911394

ABSTRACT

The causes of primary adrenal insufficiency(PAI) are varying, however, anti-phospholipid syndrome (APS) is a relatively rare one. PAI lacks unique clinical manifestations, so the confirmation of PAI was easily to be neglected by physicians. We report a case with abdominal pain as the first complaint, followed by multiple infections, thrombotic events, and aggravating fatigue. Through a series of the laboratory examination, medical imaging, and pathology examination, this patient was diagnosed as PAI caused by APS. Combining this report with literature review, we aim to raise awareness of the disease and avoid misdiagnosis and missed diagnosis.

10.
Article in Chinese | WPRIM | ID: wpr-911260

ABSTRACT

Objective:To evaluate the effects of sevoflurane combined with propofol anesthesia on the synaptic plasticity in the hippocampus after operation in rats with mild cognitive impairment (MCI) and the relationship with potassium-chloride cotransporter-2 (KCC2)/sodium-potassium-chloride cotransporter 1 (NKCC1).Methods:Clean-grade healthy male Sprague-Dawley rats, aged 16-18 months, weighing 440-540 g, in which MCI was induced by severe bilateral common carotid artery stenosis (BCAS). Forty-eight rats with MCI were divided into 4 groups ( n=12 each) using a random number table method: sham operation group (group Sham), sevoflurane anesthesia group (group S), propofol anesthesia group (group P), and sevoflurane and propofol anesthesia group (group SP). After disappearance of eyelash reflex, open reduction and internal fixation was performed after tibial fracture was induced in S, P and SP groups.Anesthesia method was as follows: 1.7% sevoflurane was inhaled and propofol 20 mg·kg -1·h -1 was intravenously infused for 3 h in group SP, 3% sevoflurane was inhaled for 3 h in group S, and propofol was intravenously infused at rate of 40 mg·kg -1·h -1 for 3 h in group P. The novel object recognition (NOR) test was performed at 14 days after operation, and the discrimination index in NOR test was calculated.The in vivo electrophysiological experiment was performed on 19 days after operation to measure long-term potentiation and amplitude of the field excitatory postsynaptic potential (fEPSP). The expression of KCC2 and NKCC1 was determined by Western blot, and the ratio of KCC2/NKCC1 was calculated.The density of dendritic spines in the hippocampal CA1 region was determined by Golgi-COX staining performed at 30 days after operation. Results:Compared with Sham group, the discrimination index in NOR test, hippocampal KCC2/NKCC1 ratio, density of dendritic spines in hippocampal CA1 region, and amplitude of fEPSP were significantly decreased in S and P groups ( P<0.05), and no significant change was found in the parameters mentioned above in group SP ( P>0.05). Compared with group S or group P, the discrimination index in NOR test, hippocampal KCC2/NKCC1 ratio, density of dendritic spines in hippocampal CA1 region, and amplitude of fEPSP were significantly increased in group SP ( P<0.05). Conclusion:Sevoflurane combined with propofol anesthesia does not aggravate postoperative cognitive dysfunction in the rats with MCI, which may be related to maintaining the balance of hippocampal KCC2/NKCC1 and protecting the synaptic plasticity in hippocampi.

11.
Chinese Journal of Urology ; (12): 830-833, 2021.
Article in Chinese | WPRIM | ID: wpr-911128

ABSTRACT

Objective:To evaluate the feasibility and clinical efficiency of robot-assisted laparoscopic radical prostatectomy (RARP) via extraperitoneal PORT-free single incision approach.Methods:The data of 33 patients with prostate cancer underwent the extraperitoneal PORT-free single incision RARP from November 2020 to January 2021 in Sichuan Provincial People's Hospital was retrospectively reviewed. The average age was 66.7 (58-78) years, the median PSA was 20.77 (2.89, 56.44) ng/m, and the mean Gleason score was 7.0 (6.0-9.0). The mean prostate volume was 48.4 (25.0-220.0) ml. Clinical stage: 32 cases was in cT 2a-2cN 0M 0, 1 case in cT 3aN 0M 0. 16 cases had a history of operation. All 33 operations were performed by the same operator. All operations were performed by extraperitoneal PORT-free single-incision approach. The surgical condition, postoperative complication, pathology, and follow-up results were observed. Results:In this study, 33 operations were successfully completed without conversion to open or additional single hole channel instruments. The average operation time was 61.3 (38.0-120.0) min, with the mean intraoperative bleeding volume of 72.2 (45.0-220.0) ml and the mean bladder neck urethral anastomosis time of 11.7 (8.5-15.7) min. The mean postoperative hospital stay was 7.9 (6.0-15.0) d, the mean postoperative indwelling time of urinary catheter was 6.8 (6.0-14.0) d, and the mean postoperative evacuation time was 1.0 (0.5-3.0) d. The average incision length was 5.2 (4.6-5.8) cm. There was no obvious complications. The postoperative pathological stage: 21 cases were in < pT 3a, 12 cases were in ≥ pT 3a, and 6 cases (18.8%) had positive resection margin. 29 cases (88.9%) acquired satisfactory urinary continence after operation, and the frequency of urinary pad use was ≤ 1 tablet/day. Conclusions:The extraperitoneal single-incision RARP surgical channel without PORT is safe and feasible with a satisfying cosmetic effect, which saves costs and requires less specific channel device. Simultaneously, the new approach has strong replicability, short-term tumor control and urinary control effect with rapid postoperative recovery. However, the sample size of this study is relatively small, which needs further research and demonstration

12.
Chinese Journal of Geriatrics ; (12): 770-773, 2021.
Article in Chinese | WPRIM | ID: wpr-910915

ABSTRACT

Objective:To investigate the clinical effectiveness of vertebroplasty for osteoporotic vertebral compression fractures in the elderly aged 90 years and over.Methods:Clinical data of 64 elderly patients aged 90 years and over who had undergone percutaneous vertebroplasty for vertebral compression fractures between January 2015 and January 2021 were retrospectively analyzed.Changes in preoperative and postoperative pain, intraoperative bone cement leakage, postoperative pneumonia, bedsores, urinary tract infections, lower extremity venous thrombosis and changes in preoperative and postoperative physical mobility were evaluated.Pain scores, physical mobility scores, bone cement extravasation and complications such as re-fractures of the vertebral body, postoperative pneumonia, bedsores, urinary tract infections and thrombosis were recorded before surgery, 3 and 30 days after surgery.Results:The visual analogue scale(VAS)scores of 64 patients before surgery, 3 and 30 days after the procedure were 8.34±1.12, 2.17±1.45 and 1.83±1.15, retrospectively( F=540.876, P<0.01). The physical mobility scores before surgery, 3 and 30 days after the procedure were 2.83±0.94, 1.59±0.70 and 1.39±0.60, retrospectively( F=65.492, P<0.01). There were 18 cases(28.13%)of bone cement leakage during surgery, 4 cases(6.25%)of pneumonia within 30 days after surgery, 9 cases(14.06%)of urinary tract infections, 3 cases(4.69%)of lower extremity venous thrombosis, 1 case(1.56%)of bedsores, and 2 cases(3.13%)of vertebral re-fractures after surgery.No patient died during the 30-day follow-up. Conclusions:Percutaneous vertebroplasty can reduce pain and improve physical mobility and is an effective and safe minimally invasive treatment for elderly patients with spinal compression fractures aged 90 years and over.

13.
Article in Chinese | WPRIM | ID: wpr-910433

ABSTRACT

Objective:To retrospectively analyze the setup errors of thermoplastic head and shoulder molds alone or combined with vacuum pad in hypofractionated stereotactic radiotherapy (HFSRT) for non-small cell lung cancer (NSCLC) with brain metastases.Methods:Fifty-four NSCLC patients with brain metastases who received HFSRT from 2017 to 2019 were enrolled in this study. Twenty-four patients were fixed with thermoplastic head and shoulder molds (group A), and 30 patients were fixed with thermoplastic head and shoulder molds plus vacuum pad (group B). The interfraction and intrafraction setup errors were acquired from cone-beam CT online image registration before and after the HFSRT. Optical surface system was applied in monitoring the intrafraction setup errors. The setup errors in each direction between two groups were analyzed by independent samples t-test. Results:For the interfraction setup errors of the whole group, the proportion of the horizontal setup errors of ≥3mm was 7.0% to 15.4% and 7.0% to 12.6% for the rotation setup errors of ≥2°. In group A, the anteroposterior setup error was (1.035±1.180)mm, significantly less than (1.512±0.955)mm in group B ( P=0.009). In group A, the sagittal rotation setup error was 0.665°±0.582°, significantly less than 0.921°±0.682° in group B ( P=0.021). For the intrafraction setup errors of the whole group, the proportion of horizontal setup errors of ≥1mm was 0% to 0.7%, whereas no rotation setup error of ≥1° were observed. In group B, bilateral, anteroposterior and sagittal rotation setup errors were (0.047±0.212)mm, (0.023±0.152)mm and 0.091°±0.090°, significantly less compared with (0.246±0.474)mm, (0.140±0.350)mm and 0.181°±0.210° in group A ( P=0.004, P=0.020, P=0.001), respectively. Optical surface monitoring data were consistent with the obtained results. Conclusions:Thermoplastic head and shoulder molds (with or without vacuum pad) combined with online image registration and six-dimensional robotic couch correction can be applied in HFSRT for brain metastases from NSCLC. The intrafraction setup errors in group B are smaller than those in group A. Optical surface system has certain value in monitoring the intrafractional movement.

14.
Article in Chinese | WPRIM | ID: wpr-910426

ABSTRACT

Objective:To develop and validate a nomogram model for predicting radiation-induced pneumonitis in esophageal cancer based on CBCT radiomics characteristics combined with clinical characteristics and lung dosimetric parameters.Methods:Clinical data, dosimetric parameters and CBCT images of 96 patients with thoracic middle esophageal squamous cell carcinoma treated by intensity-modulated radiation therapy (IMRT) from 2017 to 2019 were analyzed retrospectively. The CBCT images of each patient in three different time periods were obtained. All patients were assigned randomly into the primary cohort ( n=67) and validation cohort ( n=29). Double lungs were selected as the region of interest (ROI), and 3D-slicer software was used for image segmentation and feature extraction. The LASSO regression were applied to identify candidate radiomic features and construct the Rad-score. The optimal time period, clinical and dosimetric parameters were selected to construct the nomogram model, and then the area under the receiver operating characteristic curve (AUC) was used to evaluate the prediction effect of the model. Results:The predictive capacity of the model in the first time period was the highest. In the primary cohort, the AUC was 0.700(95% CI: 0.568-0.832), the sensitivity was 61.5%, and the specificity was 75.0%. In the validation cohort, the AUC was 0.765(95% CI: 0.588-0.941), the sensitivity was 84.6% and the specificity was 64.7%, respectively. In the combined nomogram model, the AUC in the primary cohort was 0.836(95% CI: 0.700-0.918), the sensitivity was 96.0% and the specificity was 54.8%. In the validation cohort, the AUC was 0.905(95% CI: 0.799-1.000), the sensitivity was 92.9% and the specificity was 73.3%, respectively. The diagnostic efficiency of combined nomogram model was the best. Conclusions:The nomogram model based on early lung CBCT radiomics has certain predictive efficiency for RP. The model of lung CBCT radiomics in early stage of radiotherapy can predict RP of esophageal cancer. The nomogram model based on Rad-score combined with V 5Gy, MLD and tumor stage yields better predictive accuracy, which can be used as a quantitative prediction model for RP.

15.
Chinese Journal of Trauma ; (12): 786-792, 2021.
Article in Chinese | WPRIM | ID: wpr-909939

ABSTRACT

Objective:To investigate the surgical method and clinical effect of the free peroneal artery perforator flap designed by vascular localization with three-dimensional CT angiography(3D-CTA)in repairing soft tissue defects of the dorsal forefoot.Methods:A retrospective case series study was conducted to analyze the clinical data of 17 patients with soft tissue defects of the dorsal forefoot admitted to Hospital of the 80th Group Army of PLA from February 2015 to January 2019,including 11 males and 6 females,aged from 16 to 65 years[(39.2±9.7)years]. The area of soft tissue defects ranged from 3.0 cm×2.0 cm to 10.0 cm×7.0 cm,and the size of skin flap was from 3.5 cm×2.5 cm to 10.5 cm×7.5 cm. Preoperative 3D-CTA was performed to select the appropriate perforator vessels,and a personalized skin flap was designed according to the examination results and wound conditions. Of all,10 patients were repaired with the peroneal perforator flap at the first stage,and 7 patients grafted with peroneal perforator flap with wound expansion in the second stage. The perforator diameter,vertical distance from the starting point of the perforator to the tip of the lateral malleolus and horizontal distance from the starting point of the perforator to the outer edge of the lower leg were compared between preoperative 3D-CTA and actual intraoperative measurements. The survival of the flap and occurrence of the vascular crisis were observed after operation. The foot function was assessed with the American Orthopedic Foot and Ankle Society(AOFAS)ankle hindfoot score preoperatively and at postoperative 6 months. Six months after operation,effect of flap repair was evaluated by using flap satisfaction score and flap sensory function measured by the criteria established by British Medical Rresearch Council(BMRC). Incision healing and motor function of the donor area were detected.Results:All patients were followed up for 6-12 months[(9.6±2.3)months]. There was no statistically significant differences in perforator diameter,vertical distance from the starting point of the perforator to the tip of the lateral malleolus and horizontal distance from the starting point of the perforator to the outer edge of the lower leg between preoperative 3D-CTA and actual intraoperative measurements( P>0.05). All flaps survived without vascular crisis. Six months after operation,a higher AOFAS ankle hindfoot score[(84.0±7.9)points]was found when compared to that preoperatively[(51.3±8.2)points](P<0.05),with excellent results in 12 patients and good results in 5 patients. At 6 months after the operation,the thickness of the flap was flush with the surrounding skin,which did not affect the wearing of shoes;the thickness of the flap was level with the surrounding skin but did not affect the wearing of shoes. The repair effect was satisfactory with the flap satisfaction score of(8.7±2.3)points.Based on the criteria established by BMRC,the sensory function of the flap continued to improve,including 10 patients reaching the level of S 3-S 4 with the two-point discrimination of(10.2±2.0)mm and 7 patients reaching the level of S 2. All incisions at the donor area were healed well without obvious scar contracture or motion limitation. Conclusions:For soft tissue defects of the dorsal forefoot,3D-CTA assisted vascular localization is able to have individualized and precise design of peroneal artery perforator flap preoperatively to assist rapid and accurate skin flap cutting and accelerate defect healing and functional recovery in the dorsal foot. Moreover,the free peroneal artery perforator flap has advantages of high patients' satisfaction,with minor trauma on donar site or without damaging the main artery.

16.
Article in Chinese | WPRIM | ID: wpr-909154

ABSTRACT

Objective:To evaluate the stability of newly formed blood vessels in the carotid plaque using qualitative and quantitative analysis of contrast-enhanced ultrasound images and to investigate its correction with the occurrence of ischemic stroke.Methods:A total of 100 patients with carotid artery plaques diagnosed by routine ultrasound who received treatment between August 2017 and December 2019 in Haiyan People's Hospital, China were included in this study. They were divided into an ischemic stroke group ( n = 60) and a non-ischemic stroke group ( n = 40) according to the occurrence of stroke. Two groups of patients underwent contrast-enhanced ultrasound examination of the carotid artery. The correlation between the stability of the newly formed vessels in the carotid plaque and the occurrence of ischemic stroke was quantitatively analyzed. Results:Contrast-enhanced ultrasound results revealed low or medium intensity of echoes. The proportion of patients exhibiting grade 3-4 intensity of echoes in the ischemic stroke group was significantly higher than that in the non-ischemic stroke group ( P < 0.05). Time to peak in the ischemic stroke group was significantly shorter than that in the non-ischemic stroke group [(25.46 ± 3.25) seconds vs. (32.77 ± 4.28) seconds, t = 3.783, P = 0.000]. In the ischemic stroke group, peak intensity [(59.62 ± 10.18) dB vs. (47.53 ± 14.36) dB, t = 3.263, P = 0.000] and the area under the receiver operating characteristic curve [(2 365.37 ± 346.03) cm 2vs. (1 695.42 ± 525.44) cm 2, t = 4.981, P = 0.000] were significantly higher than those in the non-ischemic stroke group (both P < 0.05). Conclusion:Contrast-enhanced ultrasound visual scoring combined with quantitative ultrasonography technology can be used to assess the stability and possible development process of carotid plaques, which provide practical and reliable evidence for selecting a rational opportunity for clinical treatment of ischemic cerebrovascular disease and developing a reasonable treatment plan.

17.
Article in Chinese | WPRIM | ID: wpr-906185

ABSTRACT

Objective:To investigate the effect of the production process of Zushima Guanjie Zhitong Gao from solvent method to hot-pressed method on <italic>in vitro</italic> kinetic behavior of this preparation. Method:Solvent and hot-pressed methods were used to prepare three batches of samples above pilot scale, and <italic>in vitro</italic> release and percutaneous penetration of the index components (7,8-dihydroxycoumarin and methyl salicylate) in Zushima Guanjie Zhitong Gao were investigated by modified Franz diffusing cells. Result:The contents of 7,8-dihydroxycoumarin and methyl salicylate in Zushima Guanjie Zhitong Gao prepared by solvent method were 73.72, 494.67 μg/patch, and their contents in hot-pressed method samples were 159.21, 2 638.99 μg/patch, respectively. In the solvent method samples, the average cumulative release amounts of 7,8-dihydroxycoumarin and methyl salicylate in 24 h were 2.04, 12.21 μg, and their average cumulative release amounts in 24 h of hot-pressed method samples were 2.16, 36.24 μg, respectively. In the solvent method samples, the average cumulative permeation amounts of 7,8-dihydroxycoumarin and methyl salicylate in 24 h were 0.38, 2.79 μg, and they were 0.40, 7.49 μg in hot-pressed method samples. The cumulative release and permeation amounts in 24 h of 7,8-dihydroxycoumarin in the hot-pressed method samples were basically the same as those of the solvent method samples, but the cumulative release and permeation amounts in 24 h of methyl salicylate in the hot-pressed method samples were significantly higher than those of the solvent method samples (<italic>P</italic><0.05). Conclusion:The retention of 7,8-dihydroxycoumarin and methyl salicylate by hot-pressed method is better than that of the solvent method. The process change has no significant effect on the <italic>in vitro</italic> kinetics of 7,8-dihydroxycoumarin in Zushima Guanjie Zhitong Gao, however, after the change from the solvent method to the hot-pressed method, the methyl salicylate in this preparation has a higher cumulative release and permeation amounts.

18.
Article in Chinese | WPRIM | ID: wpr-906056

ABSTRACT

Objective:To observe the protective effect of Huangqi Guizhi Wuwutang combined with Shengmaiyin on the heart function in patients with diabetic cardiomyopathy and explore its anti-myocardial fibrosis and anti-inflammatory effects. Method:The 96 patients were randomly divided into observation group (48 cases) and control group (48 cases). Both groups were given comprehensive measures to control blood sugar, blood lipids, blood pressure and heart failure. Patients in control group took Tongmai Jiangtang capsule, 3 granules/time, 3 times/day. Patients in observation group took Huangqi Guizhi Wuwutang combined with modified Shengmaiyin, 1 dose/day. The treatment courses were three months in both groups. Left ventricular ejection fraction (LVEF), early diastolic peak velocity E peak/late diastolic peak velocity A peak (E/A), left ventricular end diastolic diameter (LVEDd) and cardiac output per stroke (SV) through echocardiography were recorded before and after therapy. Cardiac troponin-I (cTn I), troponin T (cTn-T), creatine kinase isoenzyme -MB (CK-MB), lactate dehydrogenase (LDH), transforming growth factor-<italic>β</italic><sub>1</sub> (TGF-<italic>β</italic><sub>1</sub>) before and after treatment , matrix metalloproteinase-2 (MMP-2), insulin-like growth factor-1 (IGF-1), interleukin-6 (IL-6), IL-1, tumor necrosis factor-<italic>α</italic> (TNF-<italic>α</italic>), N-terminal pro-B-type natriuretic peptide (NT-proBNP), soluble ST2 (sST2) and galectin-3 (Gal-3) levels were detected. Symptom of cardiac insufficiency and traditional Chinese medicine (TCM) syndrome score were evaluated before and after treatment. Result:The LVEF and E/A data in observation group were higher than those in control group (<italic>P</italic><0.01). The levels of cTn-I, cTn-T, LDH and CK-MB in the observation group were lower than those in the control group (<italic>P</italic><0.01). After treatment, the levels of TGF-<italic>β</italic><sub>1</sub>, MMP-2, IGF-1, IL-6, IL-1, TNF-<italic>α</italic>, NT-proBNP, sST2 and Gal-3 in the observation group decreased and were lower than those in the control group (<italic>P</italic><0.01). The clinical efficacy of the observation group was better than that of the control group (<italic>Z</italic>=1.974,<italic>P</italic><0.05). Conclusion:On the basis of conventional intervention of western medicine, Huangqi Guizhi Wuwutang combined with modified Shengmaiyin has anti-inflammatory and anti-myocardial fibrosis effects, with inhibitory effect on myocardial remodeling, and can reduce myocardial tissue damage to improve ventricular diastolic function and protect heart function. With such high clinical efficacy, it is worthy of clinical use.

19.
Article in Chinese | WPRIM | ID: wpr-906041

ABSTRACT

Osteoporosis (OP) is one of the most common diseases in the aged population worldwide. Due to the rapid change in world population structure, the effective prevention and treatment of OP is increasingly becoming the health problem of global concern and also the hot spot of clinical research. OP can be affected by many factors such as heredity, endocrine dyscrasia, nutritional deficiency, and bad living habits. The breakdown of coupling of osteoclast-mediated bone resorption to osteoblast-mediated bone formation leads to stronger bone resorption than bone formation, which is currently recognized as the main pathogenesis of OP. The exploration of OP in modern medicine based on molecular immunology has revealed that related cytokines play an important role in the pathogenesis of OP,and regulating the osteoclast-mediated bone resorption and osteoblast-mediated bone formation is essential for controlling the occurrence and development of OP. Tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6) are able to stimulate bone formation and inhibit osteoblast function, thus playing a key role in bone destruction. By contrast, such cytokines as vascular endothelial growth factor (VEGF), transforming growth factor-β (TGF-β), bone morphogenetic protein (BMP), and osteoprotegerin (OPG) strengthen osteoblast differentiation and promote bone formation. At present, western medicine like calcitonin, estrogen, and bisphosphonate are mostly used for clinical treatment of OP, but a long-term use of these drugs will result in poor compliance and obvious gastrointestinal adverse reactions. Traditional Chinese medicine (TCM) occupies an important position in the treatment of OP due to its advantages of overall regulation, low price, and few side effects. In addition, with the deepening of research on network pharmacology and molecular biology, it has been found that TCM exerts the therapeutic effect against OP by interfering with the expression of various cytokines and adjusting bone homeostasis. This paper has elaborated the role of related cytokines in the pathogenesis of OP and reviewed the research results concerning the regulation of related cytokines by TCM, in order to provide reference for the prevention and treatment of OP with TCM.

20.
Article in Chinese | WPRIM | ID: wpr-905892

ABSTRACT

Objective:To investigate the effect and mechanism of Chaihu Jia Longgu Mulitang (CJLM) on hippocampal NOD-like receptor protein 3 (NLRP3)inflammasome pathway in rats with depression. Method:Sixty male SD rats were randomly divided into a normal group,a model group, a MCC950 (1 mg·kg<sup>-1</sup>) group, and high- (13 g·kg<sup>-1</sup>), medium- (6.5 g·kg<sup>-1</sup>), and low-dose (3.25 g·kg<sup>-1</sup>) Chaihu Jia Longgu Mulitang groups, with 10 rats in each group.The depression model was induced by isolation combined with chronic unpredictable mild stimulation(CUMS) in rats except for those in the normal group. Rats were treated correspondingly for 21 days by intraperitoneal injection in the MCC950 group and gavage in other groups. The normal group and the model group received an equal volume of normal saline. The depression-like behaviors of rats were observed by sucrose preference test (SPT) and novelty-suppressed feeding test. Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of interleukin-1<italic>β </italic>(IL-1<italic>β</italic>) and IL-18 in the hippocampus of depressed rats. Western blot was used to detect the protein levels of NLRP3, apoptosis-associated speck-like protein containing a C-terminal caspase recruitment domain (ASC), and Caspase-1. Result:Compared with the normal group, the model group showed decreased sucrose preference rate (<italic>P</italic><0.01), prolonged novelty-suppressed feeding time (<italic>P</italic><0.01), enhanced protein expression of NLRP3,ASC, and caspase-1<italic> </italic>(<italic>P</italic><0.05, <italic>P</italic><0.01), and elevated expression of IL-1<italic>β</italic> and IL-18 (<italic>P</italic><0.01). Conclusion:CJLM can alleviate depression-like behaviors in CUMS-induced model rats, and the underlying mechanism is related to the inhibition of the NLRP3 inflammasome pathway.

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