Combination pattern of internal fixation for periprosthesis fractures of the proximal femur after hip replacement / 中华骨科杂志

Objective:To investigate the combination of internal fixation for periprosthetic fractures of the proximal femur (PFFF) after hip arthroplasty.Methods:The data of 58 patients with periprosthetic fractures after hip arthroplasty from May 2008 to March 2022 were retrospectively analyzed, including 31 males and 27 females. The average age was 75.5±18.2 years (range, 35-95 years). There were 39 total hip arthroplasty and 19 hemiarthroplasty; 37 biological prosthesis and 21 cemented prosthesis. Intraoperative periprosthetic fractures occurred in 6 cases and 52 cases postoperatively. Unified classification system (UCS): UCS IV.3A1 type 2 cases, 3A2 type 1 case, 3B1.1 type 19 cases, 3B2.1 type 25 cases, 3B3 type 2 cases, 3C type 9 cases. Fracture site: 3 cases in zone A (greater trochanter), 46 cases in zone B (around the femoral stem), and 9 cases in zone C (distal to the tip of the femoral stem. Internal fixation is composed of primary and secondary fixation, the main fixation method was the cerclage of steel wire or titanium cable, locking compression plate, and locking attachment plate fixation. The secondary fixation method was the cerclage of titanium cable, which was required to cover three zones A, B and C to form an overall balanced fixation. The modified Harris hip scores (mHHS), plate length, working length and screw number of different internal fixation combinations were compared.Results:The follow-up time was 54.2±21.6 months (range, 11-86 months). All patients showed signs of fracture healing at 10.2±1.5 weeks (range, 7-13 weeks) after operation, and bony union was observed at 19.6±1.3 weeks (range, 17-22 weeks) after operation. No delayed union or nonunion was observed. After operation, one case had a stress fracture and was revised with double-plate internal fixation; one case had a failed internal fixation and was revised with double-plate internal fixation and a large allograft bone graft. The mHHS score of UCSIV.3B2.1 group (80.3±4.6) was the lowest at 6 months after operation, and the difference between the groups of different types was statistically significant ( F=256.72, P<0.001). The score of simple internal fixation group (91.6±4.2) was higher than that of revision combined with internal fixation group (81.9±4.1), and the difference was statistically significant ( t=8.32, P<0.001). The plate length and working length were 24.9±2.5 cm and 12.6±1.7 cm for UCS IV.3B1.1, 25.4±2.6 cm and 13.6±1.8 cm for 3B2.1 and 28.1±2.5 cm and 4.9±1.9 cm for 3C, respectively ( F=5.33, P=0.005; F=6.78, P<0.001). The number of screws in zone A was significant difference among different UCS types ( F=52.67, P<0.001); UCS IV.3B1.1 (6.5±2.3) and 3B2.1 (6.7±2.2) were more than 3B3 (3.5±1.5) and 3C (3.7±1.6). The number of screws in zone B was significant difference among different UCS types ( F=42.15, P<0.001); The number of UCS IV.3B1.1 (2.3±1.6) and 3B2.1 (2.8±1.9) were significantly more than that of 3B3 (1.0±0.5) and 3C (1.2±0.6). The number of screws in zone C was significant differences among different UCS types ( F=39.62, P<0.001); The number of UCS IV.3B1.1 (3.8±1.9) and 3B2.1 (3.9±1.7) were more than that of 3B3 (2.0±0.5), the difference was statistically significant ( P<0.05). Conclusion:The function of hip after simple internal fixation of proximal femoral periprosthetic fractures was better than that of those who underwent revision at the same time; the number of screws of UCSIV.B1 and B2 is more than that of B3.

Universal chimeric Fcγ receptor T cells with appropriate affinity for IgG1 antibody exhibit optimal antitumor efficacy

Developing universal CARs with improved flexible targeting and controllable activities is urgently needed. While several studies have suggested the potential of CD16a in tandem with monoclonal antibodies to construct universal CAR-T cells, the weak affinity between them is one of the limiting factors for efficacy. Herein, we systematically investigated the impact of Fcγ receptor (FcγR) affinity on CAR-T cells properties by constructing universal CARs using Fcγ receptors with different affinities for IgG1 antibodies, namely CD16a, CD32a, and CD64. We demonstrated that the activities of these universal CAR-T cells on tumor cells could be redirected and regulated by IgG1 antibodies. In xenografted mice, 64CAR chimeric Jurkat cells with the highest affinity showed significant antitumor effects in combination with herceptin in the HER2 low expression U251 MG model. However, in the CD20 high expression Raji model, 64CAR caused excessive activation of CAR-T cells, which resulted in cytokine release syndrome (CRS) and the decline of antitumor activity, and 32CAR with a moderate affinity brought the best efficacy. Our work extended the knowledge about FcγR-based universal CAR-T cells and suggested that only the FcγRCAR with an appropriate affinity can offer the optimal antitumor advantages of CAR-T cells.

Endoscopic ultrasonography features of malignant mediastinal and abdominal lymphadenopathy / 中华消化内镜杂志

Objective:To investigate the features of endoscopic ultrasonography in the diagnosis of malignant mediastinal and abdominal lymphadenopathy and to provide more evidence for endoscopic ultrasound-guided fine-needle aspiraiton (EUS-FNA).Methods:A case-control study was performed on 83 consecutive patients who underwent EUS in the Second Affiliated Hospital of Soochow University from September 2016 to February 2021. Lymph node properties were identified by pathological results of EUS-FNA and (or) surgery and follow-up for at least 6 months. According to the final diagnosis, patients were divided into malignant lymph node group ( n=56) and benign lymph node group ( n=27). Univariate analysis and multivariate logistic analysis were performed to identify independent risk factors for malignant lymphadenopathy in terms of EUS features. Results:Univariate analysis showed that the length of short axis, short-long axis ratio, shape, border, presence or absence of hilum, heterogeneous echo, and the growth pattern of lymph node were risk factors for malignant lymph nodes ( P<0.10). Multivariate logistic regression analysis showed that short axis>10 mm ( P=0.021, OR=9.751, 95% CI: 1.407-57.573), clear border ( P=0.009, OR=20.587, 95% CI: 2.149-197.251), absence of hilum ( P=0.019, OR=28.502, 95% CI: 1.725-470.864), nodal matting ( P=0.004, OR=45.539, 95% CI: 3.429-604.822), partial nodal fusion ( P=0.004, OR=50.012, 95% CI: 3.497-715.266) were independent risk factors for malignant mediastinal and abdominal lymph nodes. Conclusion:EUS is useful to differentiate the lymph node properties in the mediastinal or abdominal cavity. Short axis>10 mm, clear border, absence of hilum, nodal matting and partial nodal fusion are high-risk EUS features of malignant mediastinal or abdominal lymphadenopathy, where priority should be given to EUS-FNA.

Application of immunotherapy in esophageal squamous cell carcinoma / 中华胸心血管外科杂志

Esophageal cancer is one of the top ten of the world's most common cancer. Although the incidence of esophageal squamous cell carcinoma (ESCC) in some high-risk areas in East Asia has being decreasing, it is still the most common histologic subtypes. A great many of patients with ESCC not only are diagnosed in an advanced stage but also have a high mortality rate. With the application of tumor immunotherapy in ESCC treatment in recent years, the prognosis of ESCC patients has been improved to a certain extent. This article intends to review the research progress of immunotherapy in esophageal squamous cell carcinoma.

Purification and activity of anti-PD-L1&CXCR4 bispecific nanobody / 中国药科大学学报

@#Targeted programmed death-ligand 1 (PD-L1) and CXC chemokine receptor type 4 (CXCR4), gene sequences encoding anti-PD-L1 nanobody and anti-CXCR4 nanobody were cloned into the pET-22b (+) vector to construct recombinant expression plasmid of anti-PD-L1&CXCR4 bispecific nanobody, which was connected with 6 × His tag and transformed into E.coli BL21 (DE3). The expressed proteins were then found to exist as a soluble form in the supernatant of bacterial lysate after induction of IPTG.Three purification methods were used to obtain the target protein in order to improve the yield and purity of the bispecific nanobody.The bacterial supernatant was separated and purified by His Trap FF affinity chromatographic column.The target protein output could exceed 1 mg/L, and the product purity could reach up to 97%.Besides, the anti-PD-L1&CXCR4 bispecific nanobody shows a specific binding ability to two antigens on the cell surface, enhancing the cytotoxicity of IL-2 activated human peripheral blood mononuclear cells (PBMC) to tumor cell line AsPC-1, which lays the foundation for further evaluation of its drug efficacy in vivo.

Expression and significance of microRNA-129-1 in colon cancer based on database mining / 中华消化杂志

Objective:To investigate the expression, regulation, potential mechanism and clinical significance of microRNA(miRNA)-129-1 in colon cancer.Methods:The changes of expression and methylation of miRNA-129-1 were analyzed from the methylation, mRNA expression and miRNA expression data of colon cancer in the cancer genome atlas (TCGA) database. The target genes of miRNA-129-1 were predicted from miRwalk 2.0 and TargetScan database. DAVID 6.7 online software was used for gene oncology and Kyoto encyclopedia of genes and genomes enrichment analysis. STRING database was used for protein-protein interaction analysis. TCGA data were applied again to analyze the differential expression and prognosis of key target genes of miRNA-129-1. Paired t test and independent sample t test were used for statistical analysis. The receiver operating characteristic curve (ROC) was used to evaluate the diagnostic value of miRNA-129-1 gene methylation in colon cancer. Kaplan-Meier method and log-rank test were used to analyze the effects of miRNA-129-1 expression on survival. Results:The sequence of miRNA-129-1 among different species was conserved. After all colon cancer samples, and control samples of TCGA database were analyzed, the results showed that compared with those of control samples, the expression of miRNA-129-1 decreased in cancer samples (0.98±0.81 vs. 5.74±0.59), and the methylation levels of cg04524088, cg04840800, cg11364290, cg20734982 and cg24044186 locus of miRNA-129-1 significantly decreased (0.321±0.130 vs. 0.563±0.051, 0.432±0.123 vs. 0.624±0.064, 0.475±0.153 vs. 0.768±0.033, 0.659±0.180 vs. 0.816±0.037 and 0.862±0.096 vs. 0.916±0.019, respectively) in colon cancer tissues, and the differences were all statistically significant ( t=14.95, 11.36, 9.39, 11.74, 5.32 and 3.47, all P<0.01). The results of ROC analysis showed that the methylation levels of the above five locus of miRNA-129-1 gene had high diagnostic efficiency in colon cancer (area under curve=0.946, 0.915, 0.950, 0.758 and 0.667, all P<0.01). The results of survival analysis indicated that low expression of miRNA-129-1 was associated with poor prognosis (hazard ratio ( HR)=0.55, P=0.018). The results of bioinformatics analysis demonstrated that the target genes of miRNA-129-1 were enriched in serine / threonine kinase receptor, mitogen-activated protein kinase and other functional gene clusters closely related to tumor, and there was a complex interaction network among the target genes proteins. The high expression of ephrin type-B receptor2 ( EPHB2) gene, a potential key target gene of miRNA-129-1, was associated with the short overall survival and disease-free survival time ( HR=1.9 and 1.6, both P<0.01). Conclusions:The expression and methylation of miRNA-129-1 play an important regulatory role in the development and development of colon cancer. The methylation of miRNA-129-1 has potential value in the diagnosis of colon cancer, and miRNA-129-1 is an influencing factor for the prognosis of patients with colon cancer. EPHB2 may be a potential key target gene of miRNA-129-1.

Improving proteolytic stability of Npu DnaE C-fragment in Escherichia coli expression system / 中国药科大学学报

@#Naturally split Npu DnaE intein can mediate rapid trans-splicing and C-cleavage, which is of great use in many aspects of protein engineering. However, the degradation of NpuC during expression and purification reduces the yield and purity of recombinant protein. N2C, an extended NpuN2-containing N-terminal NpuC fragment, was constructed to improve NpuC stability. N2C was expressed in BL21(DE3) and purified by affinity chromatography. The degradation ratio was calculated by ImageJ, and the factors affecting the C-terminal cleavage reaction of intein, such as temperature, DTT concentration and N/C ratio, were also investigated. The results showed that N2C lowered the proportion of degradation to 2.7%-7.2% and the yield of C-terminal cleavage reached 90% in 30 min at 37 °C with an N/C ratio of 5∶1 catalyzed by 1 mmol/L DTT. N2C can not only improve the stability of NpuC in Escherichia coli expression system, but also retain the activity of C-terminal cleavage reaction, which is of great significance for its application in protein purification.

Expression and purification of soluble recombinant antibody fragment and immunotoxin in Escherichia coli using Npu DnaE C-cleavage mutant / 中国药科大学学报

@#The purpose of this experiment is to achieve the soluble expression of immunotoxins in Escherichia coli and avoid the complicated operation caused by the formation of inclusion bodies. An anti-mesothelin monoclonal antibody SS1 and it′s derivative SS1P which composing of SS1 and a truncated pseudomonas exotoxin PE38KDEL were used as the passenger protein. We took advantages of solubility promoting fusion tags and the self-cleaving split intein in recombinant antibody fragment and immunotoxin expression and purification. We constructed solubilizing tags-NpuCD118G fusion tags, and recombinant SS1/SS1P were fused at the C-terminal of the fusion tags. The constructs were expressed in E. coli(SHuffle T7)cytoplasm in soluble form at low temperature. Dextrin Beads 6FF column and Nickel column was used to purify the fusion protein. The self-cleavage of the fusion protein was achieved by adding the NpuN fragment. The released solubilizing tag and unreacted precursor were removed by Nickel column and the cleaved antibody fragment and immunotoxinwere further captured by Capto L. The dissociation constant of the obtained Fv and immunotoxin were determined by Fortebio. In summary, the current method could enhance the solubility of antibody fragment and immunotoxin in E. coli, and could improve the purification process. This method provides a reference for the development of a method for soluble expression and purification of immunotoxin-type pharmaceutical recombinant proteins based on the Escherichia coli expression system.

Splicing reaction of split inteins between non-natural exteins containing amino acid sequences of antibody hinge area / 中国药科大学学报

@#Intein is a functional protein that mediates self-cleavage from precursor protein and simultaneously connects the exteins on both sides of the intein via peptide bonds. Among all kinds of inteins, split intein has a wide range of applications in the field of antibody ligation. However, since the naturally split intein specifically recognizes the first three amino acid sequences “cysteine, phenylalanine, and asparagine”(CFN)of the extein, exogenous amino acids are inevitably introduced after the protein splicing reaction. In this study, the amino acid sequence “cysteine, aspartic acid, and lysine”(CDK)of the antibody hinge region was substituted for “CFN” as the recognition site for the intein and the split intein Npu DnaE was mutated into Npu*GEP DnaE. The results showed that the mutant could recognize “CDK” and the intein splicing reaction could successfully take place. The factors affecting the intein splicing reaction platform, such as pH, temperature and the concentration of NaCl and DTT were investigated in this study. The results showed that the splicing reaction of the mutant performed well, which indicated its potential usefulness in bispecific antibody assembly. In conclusion, the problem of introducing foreign amino acids was alleviated, the broadness of intein substrate was further expanded, and further technical support for the application of intein to the antibody assembly was provided.

Advances in antibody drug expression techniques / 生物工程学报

The 21st century is regarded as the century of biotechnological drugs, among which monoclonal antibodies and their derived targeting drugs have established themselves as the leading modality of biopharmaceutical pharmaceutics for a wide range of indications covering malignant tumors and autoimmune disorders. Since the manufacturing of the first antibody drug from hybridoma cells, the technologies have been intensely studied and there emerged numerous breakthroughs in recombinant cell line establishment, antibody expression and purification, quality control and other related areas. This article summarizes the critical progresses of antibody drugs expression technologies, especially of mammalian cell expression system, Escherichia coli expression system, the transgenic animal reactor and the cell free protein synthesis system, to give a detailed illustration of the recent advances in antibody drugs development.

18F-FDG PET/CT imaging manifestations of peritoneal carcinomatosis from colorectal cancer and its clinical significance / 中华核医学与分子影像杂志

Objective@#To analyze 18F-fluorodeoxyglucose(FDG) PET/CT imaging manifestations in patients with peritoneal carcinomatosis (PC) from colorectal cancer (CRC) and investigate its clinical significance.@*Methods@#From May 2016 to August 2018, 46 patients (25 males, 21 females; age range: 36-82(62.0±10.4) years) with PC from CRC who underwent 18F-FDG PET/CT imaging in Affiliated Hospital of Nantong University and had complete clinical data were retrospectively analyzed. The peritoneal carcinomatosis index (PCI) grading system was used to evaluate the PC lesions. Independent-sample t test and Kruskal-Wallis H test were used for data analysis.@*Results@#There were various CT manifestations of PC, while FDG metabolism on PET was observed in all 46 patients. Patients were divided into different groups according to the location of the primary CRC lesion. The diameter of PC lesion in the left colon group was (2.46±1.26) cm, which was significantly different from that of the rectum group ((3.19±1.72) cm; t=-2.77, P<0.01). The maximum standardized uptake value (SUVmax) in the right colon group were significantly higher than that in the left colon group (9.16±4.79 vs 6.99±3.50; t=2.92, P<0.01). The PCI score ranged from 1 to 30 in 46 patients, and there was no significant difference in PCI score distribution (≥20 vs <20) among the right colon group, left colon group and rectum group (H=0.242, P>0.05). Ten patients had abdominal and pelvic effusion.@*Conclusion@#18F-FDG PET/CT can well display the PC in patients with CRC, and the combination of PCI and 18F-FDG PET/CT plays an important role in the diagnosis and treatment of PC.

Status of diagnosis and management of acute appendicitis in 2017: a national multi-center retrospective study / 中华胃肠外科杂志

OBJECTIVE@#To analyze the current status of diagnosis and management of acute appendicitis (AA) in China.@*METHODS@#Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary.@*RESULTS@#A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001).@*CONCLUSIONS@#The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.

Therapeutic effects of endoscopic ultrasound-guided holmium laser ablation for pancreatic primary implantation carcinoma in nude mice / 中华消化内镜杂志

Objective To explore the effectiveness of endoscopic ultrasound( EUS)-guided holmium laser ablation for primary pancreatic implantation tumor in nude mice. Methods Pancreatic cancer cell line SW1990 were implanted into 204-6-week-old male balb/c nude mice to establish primary pancreatic implantation tumor in situ models. Then the nude mice were randomly divided into two groups, the treatment group(n=10) and the control group(n=10). The treatment group underwent EUS-guided holmium laser ablation in the pancreatic tumor. And no interventions were given to the control group. The volume of tumors of the two groups were measured under EUS at time points of 7 d, 14 d and 28 d after ablation. The activities, appetites and psychosis of all nude mice were evaluated in the meantime. At 28 d after ablation, lesions of pancreas were dissected and sliced for H&E staining. Results There were no complications in the treatment group, and all nude mice could tolerate the procedure. The mental state, activities and appetites of nude mice in the experimental group were better than those in the control group. Tumors of the control group enlarged. There was significant difference in the tumor size between the two groups at 28 d after ablation. HE staining showed coagulation necrosis in the ablation area. Conclusion EUS-guided holmium laser, producing coagulative necrosis in the ablation area, is effective for primary pancreatic implantation carcinoma in nude mice for about 28 days.

Clinical value of biochemical markers in predicting organ failure in acute pancreatitis induced by hyperlipidemia / 中华胰腺病杂志

Objective To investigate the early predictive value of several commonly used biochemical markers for predicting persistent organ failure ( POF ) in patients with hyperlipidemic acute pancreatitis ( HLAP) . Methods Clinical data of 157 patients with HLAP within 72 hours after the onset of first attack who were admitted to the Dept. of Gastroenterology in Changhai Hospital from January 2015 to December 2017 were retrospectively analyzed, including 106 cases without POF ( non POF group ) and 51 cases with POF ( POF group) . Hct, BUN, Cr, APACHEⅡand BISAP were recorded within 24 hours after admission. Receiver-operating characteristic ( ROC) curve was drawn to calculate area under the ROC curve ( AUC) and evaluate the performance of Hct, BUN, Cr, APACHEⅡand BISAP scores in predicting HLAP complicated with POF, which was compared by DeLong test. Results Values of BUN, Cr, APACHEⅡand BISAP were significantly higher in HLAP patients with POF than those without POF [(10. 30 ± 7. 43) vs (5. 34 ± 2. 26) mmol/L, (165. 31 ± 123. 93) vs (65. 61 ± 20. 82)μmol/L, (10. 22 ± 6. 22) vs (4. 61 ± 2. 99) points, (2. 61 ± 0. 87) vs (1. 42 ± 1.07) points], and the differences were all statistically significant (all P<0.05), whereas Hct was not significantly different between the two groups. The AUC of Cr and BUN for predicting POF was 0. 77(95％ CI, 0. 69-0. 86) and 0. 71 (95％ CI, 0. 61-0. 81), respectively, and the optimum predictive Cut-off values were 130 μmol/L and 8. 95 mmol/L, respectively. The sensitivity was 53％, and the specificity was 99％ and 94％;the accuracy was 84％ and 81％;negative predictive value was 81％, and positive predictive value was 96％ and 82％. DeLong test showed that predictive performance of BUN and Cr was not statistically different from that of APACHEⅡand BISAP. Conclusions Cr≥130 μmol/L and BUN≥8. 95 mmol/L can be used clinically to predict the presence of POF in HLAP, and the predictive efficacy were comparable to APACHEⅡand BISAP.

Effect of neutrophil-to-lymphocyte ratio in newly diagnosed peripheral blood on the prognosis of patients with multiple myeloma / 白血病·淋巴瘤

Objective@#To explore the effect of neutrophil-to-lymphocyte ratio (NLR) in peripheral blood on the survival of patients with multiple myeloma (MM).@*Methods@#The clinical data of 195 patients with MM who were diagnosed in Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2007 to December 2015 were retrospectively analyzed. According to NLR, the patients were divided into the low NLR group (NLR<3) or high NLR group (NLR≥3). The relationship between NLR and the parameters including clinical indicators, treatment response and overall survival of the patients was detected.@*Results@#There were 61 cases in the high NLR group and 134 cases in the low NLR group. Compared with the low NLR group, creatinine and serum calcium in the high NLR group were higher (all P < 0.05). Complete remission rate after initial induction therapy in the low NLR group (32.1%, 43/134) was higher than that in the high NLR group (16.4%, 10/61), and there was a statistically significant difference (χ2=5.218, P=0.022). Median survival time in the low NLR group (38 months) was longer than that in the high NLR group (27 months), with a statistically significant difference (P=0.022). Cox univariate and multivariate analysis showed NLR≥3 was a risk factor (P=0.024), but not an independent risk factor (P=0.064).@*Conclusion@#NLR is associated with creatinine and serum Ca, which can be used to evaluate the overall survival time and inductive treatment response in patients with MM.

Treatment of sebaceous gland hyperplasia with fractional Q-switched 1064 nm laser / 中华整形外科杂志

Objective@#To investigate the therapeutic effect of fractional Q-switched 1 064 nm laser in treatment of sebaceous gland hyperplasia.@*Methods@#36 patients with sebaceous gland hyperplasia were recruited and treated with fractional Q-switched 1 064 nm laser, once per 1-2 weeks, 6-8 times for a course, lesion clearance, post-treatment scaring and pigmentation were observed.@*Results@#Skin lesions gradually shrank or came off after one course of treatment with fractional Q-switched 1 064 nm laser, leaving mild difference of texture compared with the surrounding skin, no obvious scaring or pigment anomaly occurred, no recurrence was found during 6-month follow-up.@*Conclusions@#Fractional Q-switched 1 064 nm laser is effective for clearance of sebaceous gland hyperplasia, furthermore, it presents more pleasant cosmetic outcome could be obtained by a single technique.

Expression and significance of osteopontin in chronic pancreatitis rats / 中华胰腺病杂志

Objective To detect the expression of osteopontin (OPN) in the pancreatic tissues of chronic pancreatitis (CP) rats,and analyze the relationship between the expression of OPN and pancreatic fibrosis.Methods A total of 20 male Wistar rats were randomly divided into control group and CP model group.Control group was treated by tail vein injection of absolute ethanol and glycerol,and CP model group received a single tail vein injection of dibutyltin dichloride (DBTC) to construct CP model.Six weeks after the procedure,the rats were sacrificed to obtain pancreatic tissue,and pathological examinations were routinely performed.Sirius-red staining was used to assess the degree of pancreatic fibrosis.The expression of OPN,α-SMA and Col I in the pancreas of CP rats was detected by immunohistochemistry and Western blot,and the relationship between the expression of OPN and the degree of fibrosis was analyzed.Results In CP model group,3 rats died.In the 7 rats which survived,light microscopic examination observed great proliferation of fibrous tissue in pancreatic interlobular space,vacuolization and necrosis of acinous cells,the infiltration of inflammatory cells in the pancreatic interlobular space and dilation of pancreatic duct.Results of Sirius-red staining showed that a large number of fresh red stripe and reticular collagen fibers were deposited in the interlobular space of the pancreatic tissues in the CP group,whereas there were only a few fiber deposited around the blood vessels and the pancreatic duct in the control group and the stained area in CP group (51 ± 11)％ was significantly larger than that of control group (9 ± 4)％ and the difference was statistically significant (P ＜ 0.01).The results of immunohistochemistry showed that the expression of OPN in CP group was strong positive in 3 rats and positive in 4 rats,which in control group was weak positive in 3 rats and negative in 7 rats.OPN expression in CP group was significantly higher than that in control group (Z =-5.170,P ＜ 0.01),and the expression of OPN was positively correlated with the Sirius-Red staining area (r =0.790,P ＜ 0.01).Western-blot results showed that the expression of OPN,α-SMA and Col I in CP group was significantly higher than that in control group (0.70 ±0.22 vs 0.24 ±0.11,0.71 ± 0.10 vs 0.06 ± 0.01,2.83 ± 1.42 vs 0.39 ± 0.07),and the differences were statistically significant (all P ＜ 0.05).Conclusions A single tail vein injection of DBTC can be used to successfully establish CP rat model.The expression of OPN is significantly increased in the CP group and is positively correlated with pancreatic fibrosis.

CYP3A5 promotes proliferation of pancreatic cancer cells by regulating cyclin D1 protein expression / 中华胰腺病杂志

Objective To investigate the effect of CYP3A5 on the proliferation of pancreatic cancer cells and its underlying mechanisms.Methods The protein expression of CYP3A5 in five pancreatic cancer cell lines BxPC-3,FG,MDA28,8902 and PANC1 was detected by Western blotting.The PANC1 cells with the lowest protein expression of CYP3A5 and the BxPC-3 cells with highest expression of CYP3A5 were transfected with CYP3A5 overexpression plasmid and CYP3A5 targeted-siRNA (siRNA-CYP3A5),respectively.CCK-8 and cloning formation assay were used to investigate the role of CYP3A5 overexpression and knockdown in the proliferation of pancreatic cancer cells.The changes of the protein and mRNA expression of cell cycle regulating gene cyclin E,cyclin D1 and apoptosis related gene Bcl-2 were detected by Western blotting and PCR,respectively.Results CYP3A5 protein expression in PANC1 cells increased significantly after the transfection of CYP3A5 overexpression plasmid (1.66 ± 0.14 to 1,P =0.0021),which greatly decreased in BxPC-3 cells transfected with siRNA CYP3A5 (0.18 ± 0.02 to 1,P ＜0.0001).A450 values of the CYP3A5 overexpression group and the empty plasmid group in PANC1 cells cultured for 48 and 72 h were 1.36 ±0.05 vs 1.15 ± 0.03,2.1 ± 0.09 vs 1.42 ± 0.03,respectively,which were significantly higher in CYP3A5 overexpression group than empty plasmid group,and the differences were statistically significant (P value ＜ 0.005 or 0.001).The A450 values of BxPC-3 cells in CYP3A5-siRNA transfected group and siRNA-NC transfected group were 0.62 ±0.01 vs 0.77 ± 0.03、0.83 ± 0.01 vs 1.18 ± 0.02,respectively,which in The CYP3A5-siRNA transfection group was significantly lower than that of siRNA-NC transfection group,and the difference was statistically significant (P ＜ 0.05 or ＜ 0.001).The clone formation rate of PANC1 cells in the overexpression group was (19.33 ± 0.58)％,which was significantly higher than that in the empty plasmid group (9.67±0.63) ％,and the clone formation rate in CYP3A5-siRNA group was (8.5± 0.8)％,which was significantly lower than that of group siRNA-NC (16± 0.6)％,and the differences were statistically significant (P ＜0.01).The protein expression of cyclin D1 in CYP3A5 overexpression PANC1 cells was 2.00 ± 0.11,which was obviously higher than 1.00 in empty plasmid group (P ＜0.01).The protein expression of cyclin D1 in siRNA CYP3A5 BxPC cells was 0.45 ±0.04,which was obviously lower than 1.00 in siRNA NC group,and the difference was statistically significant (P＜0.01).However,CYP3A5 overexpression or inhibition did not influence the relative expression of cyclin D1 mRNA and cyclin E,Bcl-2 pretein expression.Conclusions CYP3A5 can promote the proliferation of pancreatic cancer cells by up-regulating cyclin D1 protein expression.

Therapeutic efficacy of different preoperative chemotherapy combined with laparoscopic gastrectomy for patients with malignant gastric tumor / 局解手术学杂志

Objective To compare the therapeutic effects and side effects of cisplatin-S-1 (CS) program and docetaxel-cisplatin-S-1(DCS) program on patients with malignant gastric tumor who were treated by laparoscopic gastrectomy.MethodsA total of 67 patients in our hospital from January 2010 to June 2013 were included in this study,of which 33 cases accepted cisplatin-S-1 program (CS group),34 cases accepted DCS program (DCS group).The related side effects including diarrhea,nausea and acute upper respiratory infection,change of routine blood tests,blood biochemical index,and death caused by chemotherapy were analyzed.The related index of surgery including operation time,blood loss,recovery time of gastrointestinal function,pain incidence,hospital stay,lymph nodes resection success rate,postoperative infection,obstruction,intestinal emptying delays were recorded.Meanwhile,the 3-year survival rate after operation and postoperative 3-year recurrence rate between the two groups were compared.Results There was no significant difference in operation time,intraoperative blood loss,postoperative recovery time of gastrointestinal function,the lymph nodes resection success rate,the incidence of postoperative pain,as well as the length of hospital stay,postoperative infection rate,and complications such as obstruction and intestinal emptying delays between the two groups(P>0.05).And there was no significant difference in chemotherapy-related complications between the two groups(P>0.05).But the postoperative 3-year survival rate and postoperative 3-year recurrence rate of DCS group was better than those of the CS Group(P<0.05).Conclusion There is no significant difference in complications and surgery-related index between the two preoperative chemotherapy.However,the DCS programs have more advantages in therapeutic effects.

Treatment of periprosthetic femoral fractures following hip arthroplasty utilizing locking compression plates / 中华骨科杂志

Objective To evaluate the clinical outcomes of periprosthetic femoral fractures (PFF) following hip arthroplasty utilizing locking compression plates (LCP) in regard to tips and tricks on the construction of LCP augmented with locking attachment plate (LAP) and titanium cables (TC).Methods A total of 41 cases of PFF follow hip arthroplasty (THA 3,Hemi-arthroplasty 2) between May 2008 to April 2016 have been retrospectively analyzed.There were 13 males and 28 females with an average age of 70.5±8.6 years,including 11 case of Unified Classification System (UCS) type Ⅳ.3B1.1,21 cases of B2.1 and 9 cases of type C.All were closed fractures caused by simple fall in terms of low-energy injury.Surgical options depended on individual configuration of the fractures with the combination of LCP and LAP or TC.In respect of reduction techniques,minimally invasive plate osteosynthesis (MIPO) was used in 5 cases for type B1.1 and 8 cases for type C,Mini-open in 6 cases for type B1.1 and 1 case for type C.Posterolateral approach with open reduction internal fixation were selected for type B2.1.The patients were followed up periodically.Harris score,Mukundan criteria and complications were recorded.Results Five cases died of the comorbidities (heart failure 3,pulmonary infection 1,multiple organs failure 1) within 1 year postoperatively.The follow-up rate was 78.0％ (32 out of 41 cases) and the average follow-up time was 41 months (ranging 11 to 71 months).No malunion,no reduction lost,no hardware failure,no hip dislocation and revision surgery following PFF care found.All cases showed the signs of fracture healing from 8 to 12 (average 10 weeks) postoperatively except 2 cases of delay union.The postoperative complications shown in 11 cases,including 2 cases of superficial infection of the wound,6 cases of deep vein thrombosis (popliteal vein 2,intramural gastrocnemius vein 4) and 3 cases of the prosthetic loosening.Harris score at the latest follow-up were 91.5±2.1 for group B1.1,77.5±4.2 for group B2.1 and 83.5±3.8 for group C.The LCP lengths were 248.9±24.3 mm,258.6±25.2 mm,280.4±24.0 mm for group B1.1,B2.1 and C respectively.The LCP length of group B1.1 was short than that of group C (P＜0.05).The screw numbers for the proximal fragments were 6.1±1.8,6.5±0.7 and 3.8±0.7 for group B1.1,B2.1 and C respectively.The number of screws used in B1.1 and B2.1 were more than that in C (P＜0.05).The screw numbers for the distal fragments were 3.5±0.5,3.9±0.5 and 5.1±0.8 for group B1.1,B2.1 and C respectively,indicating less screws used in B1.1 and B2.1 than that in C (P＜0.05).The cable numbers were 1.9±1.3,2.5±0.9 and 3.7±0.7 respectively for group B1.1,B2.1 and C (P＜0.05).The LAP used in 2,12 and 6 cases for type B 1.1,B2.1 and C respectively without significant difference statistically (P＞0.05).Conclusion Utilizing LCP for PFF following hip arthroplasty can achieve satisfactory short and mid-term clinical outcomes with the prerequisites of precise and individualized preoperative planning.LCP augmented by LAP and TC is a reliable option with low complication rate.However,type C PFF needs longer plate with more screws at distal fragment and more titanium cables.