Geritinib in the targeted therapy of acute myeloid leukemia with FLT3 mutation: report of 5 cases and review of literature / 白血病·淋巴瘤

Objective:To investigate the efficacy and safety of geritinib in the treatment of acute myeloid leukemia (AML) with FLT3 mutation.Methods:The clinical data of 5 AML patients with FLT3 mutation who were diagnosed in the University of Hong Kong-Shenzhen Hospital, Shenzhen People's Hospital, Shenzhen Second People's Hospital, Shenzhen University General Hospital from March 2020 to April 2021 were retrospectively analyzed. Relapsed patients concurrently received two- or three-drug chemotherapy combined with geritinib. Blood routine was checked once a week; liver function and renal function were checked once every 2 weeks during treatment. Bone marrow puncture was performed once every 1 to 3 months to monitor the bone marrow morphology, minimal residual disease (MRD) and FLT3 mutation expression levels. The efficacy, side effects, overall survival of these patients were analyzed after treatment with geritinib.Results:The white blood cell was increased in all the 5 patients at the initial diagnosis. FLT3 mutations analysis showed FLT3-internal tandem duplication (ITD) (3 cases) and FLT-3 tyrosine-kinase domain (TKD) (2 cases). Among 5 patients, 1 patient was relapse-free with maintenance therapy of oral geritinib after hematological stem cell transplantation (HSCT) for 60 days; among other 4 relapsed and refractory patients, 1 female patient after pregnancy relapsed after transplantation and then achieved complete remission followed by the maintenance therapy with geritinib after oral geritinib, 1 16-year-old patient achieved treatment outcome close to the complete remission after treatment with geritinib, 1 patient achieved complete remission after treatment with geritinib, and then underwent haplo-HSCT followed by the maintenance therapy with geritinib and the other 1 relapsed patient achieved complete remission after treatment with geritinib. After transplantation, 3 patients receiving maintenance treatment of geritinib did not relapse. The main side effects included anemia, decreased neutrophil count, rash, and increased aminotransferase. The median follow-up time of 5 patients was 15 months (6-20 months). All 5 cases survived until the last follow-up in November 2021 and 4 patients were disease-free.Conclusions:Relapsed and refractory AML patients with FLT3 mutation can achieve complete remission after treatment with geritinib and get a chance for transplantation. Geritinib may reduce the risk of recurrence after transplantation and improve survival rate. No serious side effects occur in geritinib treatment.

Clinical value of split domino donor auxiliary liver transplantation / 中华消化外科杂志

Objective:To investigate the clinical value of split domino donor auxiliary liver transplantation.Methods:The retrospective and descriptive study was conducted. The clinco-pathological data of 3 liver transplantation recipients who were admitted to Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School and 1 liver transplantation recipient who was admitted to external hospital in September 2018 were collected. The first case was male, aged 22 years, who was diagnosed as type II citrullinemia (CTLN2). The second case undergoing liver transplantation in external hospital was male, aged 59 years, who was diagnosed as decompensated alcoholic cirrhosis. The third case was female, aged 52 years, who was diagnosed as hepatocellular carcinoma of right lobe of liver. The fourth case was female, aged 51 years, who was diagnosed as hepatocellular carcinoma of right lobe of liver. The donor liver from a brain and cardiac death donor was split in vitro into the left liver and the right liver, in which the right liver without middle hepatic vein, and the modified piggyback liver transplantation using the left liver and the classical orthotropic liver transplantation using the right liver was conducted on the first and the second case, respectively. The original liver of the first case was split in vivo into the left liver and the right liver, and the piggyback auxiliary liver transplantation using the left liver and the piggyback auxiliary liver transplantation using the right liver was conducted on the third and the fourth case who underwent extended right hemihepatectomy, respectively. Observation indicators: (1) intraoperative situations; (2) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect liver function, liver imaging, complication and survival of recipients up to October 2021.Results:(1) Intraoperative situations. Liver transplantation was conducted successfully on the first, third and fourth case, with the operation time, the volume of intraoperative blood loss, the donor liver cold ischemia time, the graft-to-recipient weight ratio were 400 minutes, 370 minutes, 390 minutes, 600 mL, 1 300 mL, 1 600 mL, 230 minutes, 152 minutes, 135 minutes, 1.2%, 0.8%, 1.1%. (2) Follow-up. B-ultrasound examination of the first, third and fourth case after liver transplantation showed that the blood flow was normal, and all the 3 cases discharged and were followed up at postoperative 1, 6 and 12 month. The liver function, the level of blood ammonia and citrulline were normal of the first, third and fourth case at postoperative 1 week. Imaging examina-tion showed normal liver morphology of the first and third case, and a transplanted liver atrophy caused by portal vein steal of the fourth case. ① The level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), direct bilirubin (DBil) of the first case before liver transplantation, at postoperative 1 day, 2 day, 3 day, 7 day, 10 day, 6 month and 1 year were 22.8 U/L, 404.1 U/L, 355.5 U/L, 289.6 U/L, 31.0 U/L, 23.1 U/L, 42.1 U/L and 25.8 U/L, 31.5 U/L, 517.7 U/L, 327.6 U/L, 172.9 U/L, 15.9 U/L, 21.4 U/L, 47.5 U/L and 29.7 U/L, 3.8 μmol/L, 92.1 μmol/L, 87.4 μmol/L, 79.7 μmol/L, 90.1 μmol/L, 130.6 μmol/L, 33.8 μmol/L and 25.4 μmol/L, 2.3 μmol/L, 47.0 μmol/L, 44.1 μmol/L, 47.1 μmol/L, 57.4 μmol/L, 70.9 μmol/L, 24.7 μmol/L and 9.7 μmol/L, respectively. The level of citrulline and blood ammonia of the first case before and after liver transplantation were 999.0 μmol/L, 196.0 μmol/L and 14.6 μmol/L, 9.0 μmol/L, respectively. The first case was followed up for 3 years and survived without any liver transplantation related complication. ② The level of ALT, AST, TBil, DBil of the third case before liver transplantation, at postoperative 1 day, 2 day, 3 day, 7 day, 10 day, 6 month and 1 year were 21.3 U/L, 143.9 U/L, 182.0 U/L, 132.0 U/L, 17.2 U/L, 10.1 U/L, 17.6 U/L and 16.8 U/L,20.0 U/L, 291.0 U/L, 227.5 U/L, 106.4 U/L, 15.8 U/L, 10.8 U/L, 17.1 U/L and 19.4 U/L, 6.8 μmol/L, 50.9 μmol/L, 45.0 μmol/L, 34.0 μmol/L, 32.4 μmol/L, 22.3 μmol/L, 12.8 μmol/L and 14.9 μmol/L, 2.5 μmol/L, 18.4 μmol/L, 17.2 μmol/L, 14.9 μmol/L, 14.8 μmol/L, 12.1 μmol/L, 3.6 μmol/L and 4.4 μmol/L. The level of citrulline and blood ammonia of the third case after liver transplantation were 24.9 μmol/L and 16.0 μmol/L. The third case was followed up for 3 years and survived without any liver transplantation related complication. ③ The level of ALT, AST, TBil, DBil of the fourth case before liver transplantation, at postoperative 1 day, 2 day, 3 day, 7 day, 10 day, 6 month and 1 year were 35.0 U/L, 268.7 U/L, 682.0 U/L, 425.8 U/L, 57.5 U/L, 34.0 U/L, 29.4 U/L and 18.1 U/L, 37.0 U/L, 419.1 U/L, 436.2 U/L, 139.5 U/L, 35.2 U/L, 32.4 U/L, 54.7 U/L and 32.8 U/L, 7.1 μmol/L, 64.2 μmol/L, 41.4 μmol/L, 17.6 μmol/L, 34.2 μmol/L, 48.7 μmol/L, 14.1 μmol/L and 21.8 μmol/L, 2.8 μmol/L, 18.9 μmol/L, 16.1 μmol/L, 6.0 μmol/L, 14.6 μmol/L, 26.7 μmol/L, 3.9 μmol/L, 11.8 μmol/L. The level of citrulline and blood ammonia of the fourth case after liver transplantation were 8.4 μmol/L and 47.0 μmol/L. One week after surgery, the transplanted right liver of the fourth case occurred atrophy due to blood stealing from the right branch of the portal vein. B-ultrasound examination showed that the reflux of the hepatic artery and hepatic vein was unobstructed. Immunosuppressants were discontinued 3 months after operation on the fourth case and there was no complication such as rejection, bile leakage, biliary stricture, thrombosis and vascular stricture during follow-up. The fourth case died of lung metastasis 19 months after operation.Conclusion:Split domino donor auxiliary liver transplantation can be used for the treatment of metabolic liver disease and advanced hepatocellular carcinoma.

Discussion on the technique of resection of liver tumor in the caudate lobe / 中华肝胆外科杂志

The caudate lobe of liver is anatomically divided into three parts: Spiegel portion, inferior vena cava portion and caudate process. The caudate lobe of the liver is located in the dorsal side of the liver, adjacent to the inferior vena cava, the three hepatic veins, and the left and right portal veins. The location of the caudate lobe depends on the location of anatomical landmarks and the location of staining, especially negative staining techniques. The left approach is suitable for Spiegel resection, and the right approach is suitable for paracentral resection of the inferior vena cava and caudate process. The dorsal approach and anterior approach combined with other approaches can achieve complete caudate resection. This article showed the combination of multimodal approach with total caudate lobectomy, partial caudate lobectomy and laparoscopic caudate lobectomy.

Research progress in retroauricular incision decompressive hemicraniectomy for the treatment of severe traumatic brain injury / 中华创伤杂志

Severe traumatic brain injury (sTBI) as the most common emergency severe syndrome in neurosurgery has a high mortality and poor prognosis. Decompressive craniectomy is the first treatment choice for sTBI. The reverse question mark incision was usually adopted in decompressive craniectomy, but some scholars also suggest using the n-type incision and Kempe incision. Although the curative effect is remarkable when using the above incisions, the incidence of postoperative complications is high, such as cerebrospinal fluid leakage, poor wound healing and flap ischemic necrosis. Moreover, the advantages and disadvantages of different incisions are not clear. Therefore, some scholars proposed retroauricular incision decompressive craniectomy for sTBI patients because this incision that retains blood supply through a new flap can provide better decompression effect and reduce incision-related complications. The authors review the research progress in retroauricular incision in aspects of the methods, indications and its advantages and disadvantages in constrast with other incisions, so as to provide a theoretical basis for the selection of incision for decompressive craniectomy in sTBI patients.

Application value of hepatic vein outflow tract reconstruction with ringed polytetrafluoroe-thylene vascular in right lobe living donor liver transplantation / 中华消化外科杂志

Objective:To investigate the application value of hepatic vein outflow tract reconstruction with ringed polytetrafluoroethylene vascular in right lobe living donor liver trans-plantation.Methods:The retrospective and descriptive study was conducted. The clinicopatho-logical data of 4 donors and 4 recipients undergoing right lobe living donor liver transplantation in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School and 17 donors and 17 recipients undergoing right lobe living donor liver transplantation in the First Affiliated Hospital with Nanjing Medical University from June 2015 to August 2018 were collected. Of 21 donors, there were 10 males and 11 females, aged from 35 to 57 years, with a median age of 46 years. The median body mass of 21 donors were 64 kg, with a range from 56 to 72 kg. Of 21 recipients, there were 16 males and 5 females, aged from 21 to 68 years, with a median age of 42 years. The median body mass of 21 recipients were 63 kg, with a range from 47 to 77 kg. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up was conducted by outpatient examination or telephone interview to detect graft function, tumor recurrence, vascular graft complications, patency of vascular graft and survival of recipients up to August 2020. All recipients will be followed up for all their lives. Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were represented as M (range). Count data were represented as absolute numbers or percentages. The Kaplan-Meier method was used to calculate patency rates of hepatic vein outflow tract and survival rates to draw patency curve and survival curve. Results:(1) Surgical and postoperative situations: the operation time, the weight of donor graft, graft to recipient weight ratio and duration of hospital stay of 21 donors were (367±72)minutes, (557±68)g, 0.89%±0.16% and (10+2)days, respectively. No major complication requiring reoperation or intervention occurred in any of the 21 donors. One donor undergoing mild bile leakage preserved peritoneal drainage for one week. All 21 recipients underwent classic orthotopic liver transplantation successfully. The time of hepatic vein outflow tract reconstruction in donor graft, operation time and time of anhepatic phase of 21 recipients were (24±4)minutes, (326±66)minutes and (42±6)minutes, respectively. The number of reconstructed middle hepatic vein in hepatic segment 5 and 8 were 18 and 15, with the diameter of (6.1±1.3)mm and (7.2±1.2)mm, respectively. The number of reconstructed inferior right hepatic vein were 10, with the diameter of (6.3±1.3)mm. The postoperative treatment time at intensive care unit and duration of hospital stay of 21 recipients were (1.5±0.9)days and (22.6±6.7)days, respectively. Ten of 21 recipients underwent postoperative complications. Five recipients underwent graft dysfunction including the level of alanine aminotransferase and aspartate aminotransferase >1 000 IU/L and the level of bilirubin slightly increasing, combined with increased ascites. Enhanced computed tomography scan showed congestion in the right anterior of graft and thrombosis in the middle hepatic vein of hepatic segment 5 and segment 8. All 5 recipients undergoing graft dysfunction recovered with normal liver function and ascites decreasing after symptomatic treatment including liver protection therapy, anticoagulation and albumin infusion. Two recipients underwent inferior vena cava thrombosis and intractable pleural effusion one month after operation. Vena cava venography examination showed thrombosis in the graft vascular. Of the 2 recipients, one case with collateral circulation formation recovered undergoing balloon dilatation and stent placement combined with anticoagulation therapy of warfarin. The other one case recovered after anticoagulation therapy of warfarin. One recipient undergoing bile leakage and abdominal infection with klebsiella pneumoniae recovered after symptomatic treatment. Two recipients undergoing abdominal infection or pulmonary infection recovered after symptomatic treatment. There was no serious complication or death during perioperative period. (2) Follow-up: all 21 recipients were followed up for 10 to 57 months, with a median follow-up time of 38 months. During the follow-up, no recipient underwent graft dysfunction and 2 recipients had tumor recurrence at postoperative 6 months. Six of the 21 recipients died within 2 years after operation including 3 cases dying of tumor recurrence, 2 cases dying of acute hemorrhage and 1 case dying of liver failure. There was no death caused by vascular graft complica-tions. The postoperative 1, 3, 6-month, and 1-year and 2-year potency rates of hepatic vein outflow tract in 21 recipients were 88.4%, 88.4%, 82.4%, 68.0% and 42.1%, respectively. The 6-month, 1-year and 2-year overall survival rates in 21 recipients were 100%, 94.4%, 71.4%, respectively.Conclusion:Application of hepatic vein outflow tract reconstruction with ringed polytetrafluoroethylene vascular in right lobe living donor liver transplantation is safe and feasible.

Prognostic value of lung ground glass opacities volume ratio in patients with acute paraquat poisoning / 中华急诊医学杂志

Objective:By comparing the volume% (V% GGOs) of ground glass opacities (GGOs) in high resolution CT (HRCT) of patients with acute paraquat (PQ) poisoning at different time points, its value in the early prognosis of patients with PQ poisoning was analyzed. Methods:The data of patients with PQ poisoning admitted to Department of Respiratory and Critical Care Medicine of Chinese Armed Police Forces from June 2017 to December 2018 were prospectively analyzed. According to the follow-up results after poisoning at 90 days, the patients were divided into the survival group and death group. Three-dimensional reconstruction technology was used to calculate the change of V% GGOs on the 3rd, 5th, and 7th day after poisoning. Chi-square test and One-Way ANOVA of variance were used to compare sex, age, and time of poisoning between the two groups. The Student's t test was used to compare V% GGOs between the two groups at different time points. The receiver operating characteristic curve (ROC) was used to determine the guiding significance of the indicator on the prognosis of patients with PQ poisoning at different time points. Results:A total of 89 patients with PQ poisoning were included in the study, 49 in the survival group and 40 in the death group. There were no statistical differences between the two groups of patients in sex, age, poisoning time, oxygenation index, mean arterial pressure, total bilirubin, blood urea nitrogen, alanine aminotransferase, and aspartate aminotransferase at admission (all P>0.05). The blood PQ concentration (mg/L) in the death group was significantly higher than that in the survival group (6.35 ±0.51 vs 3.49 ±0.21, P= 0.013). On the 3rd, 5th and 7th day after admission, the V% GGOs was significantly higher than that in the survival group (3rd day: 0.062±0.020 vs 0.049±0.007, P= 0.013; 5th day: 0.292±0.130 vs 0.123±0.044, P<0.01; 7th day: 0.334±0.116 vs 0.138±0.034, P=0.019). The area under the ROC curve showed that the prognosis AUC of the 7th day V% GGOs after poisoning was 0.967, the sensitivity was 100% and the specificity was 83.33% when the threshold was 0.16, but the time point was late. On the 5th day after poisoning, the V% GGOs judged the prognosis AUC was 0.842, the sensitivity was 82.35% and the specificity was 89.47% when the threshold was 0.14. On the 3rd day after poisoning, the V% GGOs judged the prognosis AUC was 0.708, the sensitivity was 55.00% and the specificity was 78.95% when the threshold was 0.05. At this time, the sensitivity and specificity were lower than those on the 5th and 7th day. Conclusions:The proportion of ground glass opacity volume in patients with PQ poisoning can be used to evaluate their prognosis, and the best time point is the 5th day after poisoning.

Comparison of GP and TP regimens in the treatment of recurrent or metastatic nasopharyngeal carcinoma and their effects on the serum epithelial cadherin and platelet-derived growth factor levels / 中国医师进修杂志

Objective To evaluate the clinical efficacy of gemcitabine plus cisplatin (GP) regimen and paclitaxel plus cisplatin (TP) regimen in the treatment of recurrent or metastatic nasopharyngeal carcinoma.Methods One hundred and thirty patients with recurrent or metastatic nasopharyngeal carcinoma of Qinhuangdao Harbor Hospital,Hebei Province between September 2012 and December 2017 were chosen,and were divided into GP group (68 cases) and TP group (62 cases)according to the selection of treatment.GP group was treated with GP regimen,and TP group was treated with TP regimen.The clinical efficacy and adverse reactions of the two groups were observed,and the serum epithelial cadherin (SE-CAD) and platelet-derived growth factor (PDGF-BB) were measured before and after chemotherapy.Results There was no significant difference in short-term efficacy between GP group and TP group (P＞0.05),and the total effective rates were 88.24％ (60/68) and 79.03％ (49/62) respectively;1 month after treatment,SE-CAD in GP group and TP group were (2.57 ± 0.81) and (2.50 ± 0.96) g/L,PDGF-BB were (102.22 ± 31.18) and (110.15 ± 37.21) ng/L,and the difference was not statistically significant (P＞0.05);progression-free survival (PFS) in GP group and TP group were 13 and 12 months,and overall survival (OS) were 17 and 16 months,and the difference was not statistically significant (P＞0.05);there were no significant difference in leucopenia,hemoglobin,thrombocytopenia and abnormal liver and kidney function between GP group and TP group (P＞0.05);the incidence of gastrointestinal reactions in GP group was 16.18％ (11/68),which was significantly lower than that in TP group was 38.71％(24/62),and the difference was statistically significant (P＜0.01).Conclusions GP and TP regimens are effective in the treatment of recurrent or metastatic nasopharyngeal carcinoma.There is no significant difference in SE-CAD and PDGF-BB levels between the two regimens after treatment,but GP regimen has a lower incidence of gastrointestinal reactions.

Clinical observation of primary extranasal nasal-type NK/T cell lymphoma treated with P-GEMOX as a first-line regimen / 白血病·淋巴瘤

Objective:To investigate the clinical efficacy of P-GEMOX (pegaspargase, gemcitabine and oxaliplatin) as a first-line regimen for the treatment of primary extranasal nasal-type NK/T cell lymphoma (NKTCL).Methods:The clinical manifestations, treatment response and prognosis of 7 patients with primary extranasal nasal-type NKTCL who underwent P-GEMOX chemotherapy as a first-line therapy in Shenzhen People's Hospital from September 2015 to October 2018 were retrospectively analyzed.Results:The median age of 7 patients with primary extranasal nasal-type NKTCL was 41 years old (27-74 years old), which was more commonly found in males (6 cases); the primary and invading extranasal sites included ileocecal, lymph nodes, skin, testis, adrenal gland, central nervous system, etc. The P-GEMOX regimen was used as a first-line therapy, although some patients had a short-term effect, all patients eventually progressed rapidly and died. The overall survival time was 2 weeks to 21 months.Conclusion:The short-term efficacy of P-GEMOX as a first-line therapy for the treatment of primary extranasal nasal-type NKTCL is acceptable, but the long-term efficacy is poor.

Effect of ferulic acid on pulmonary function in mice with chronic obstructive pulmonary disease and its mechanism / 中国中西医结合急救杂志

Objective To investigate the protective effect of ferulic acid on lung function in mice with chronic obstructive pulmonary disease (COPD) and its possible mechanism. Methods Sixty mice were randomly divided into normal control group, COPD model group, Rofloast group and ferulic acid high, medium and low dose groups, each group with 10 rats, and during administration one rat died in the mode group and was eliminated. The COPD model was duplicated by smoking method; the mice in normal control group were fed normally without any treatment. After modeling for 30 days, normal saline begun to be given to the COPD model group and normal control group; the mice in Rofluast group were given Rofluast 65 μg/kg; ferulic acid 160, 80, 40 mg/kg were given to high, middle and low dose groups respectively. The indexes were determined after consecutive 90 days of treatment, the changes of peak inspiratory flow (PIF) rate, peak expiratory flow (PEF) rate and ventilation volume per minute (MV), mean lining interval (MLI), alveolar destruction index (DI), interleukin-6 (IL-6) and tumor necrosis factor-α(TNF-α) levels in serum and bronchoalveolar lavage fluid (BALF), the protein expressions and phosphorylation levels of p38 mitogen-activated protein kinases (p38MAPK), extracellular signal-regulated kinase (ERK) and c-Jun amino terminal kinase (JNK) in the pulmonary tissue MAPK signaling pathway were observed in each mouse of various mice groups. Results In the COPD model group, the PIF, PEF, and MV were all significantly lower than those in the normal control group [PIF (mL/s): 2.32±0.18 vs. 3.41±0.12, PEF (mL/s): 2.31±0.22 vs. 2.90±0.15, MV (mL/s): 26.20±2.70 vs. 35.18±2.30); Luofusite and all doses of ferulic acid can increase PIF, PEF, and MV, and the degree of increase in the high dose ferulic acid group was more significant than those in the moderate and low dose ferulic acid groups [PIF (mL/s): 3.24±0.13 vs. 2.88±0.15, 2.51±0.10, PEF (mL/s): 2.81±0.16 vs. 2.66±0.11, 2.58±0.17, MV (mL/s):31.18±1.20 vs. 28.25±2.20, 27.09±1.10]; however, there was no statistical significant difference between the Rofluas group and the ferulic acid groups (all P > 0.05). The levels of the MLI, DI, and inflammatory factors in serum and BALF, and the protein expressions and phosphorylation levels of p38MAPK, ERK, JNK in lung tissue in model group were all significantly higher than those in normal control group [MLI (μm): 52.10±0.26 vs. 21.90±0.14, DI: (60.78±3.32)% vs. (22.47±1.05)%, IL-6 in serum (ng/L): 22.34±4.51 vs. 3.50±1.55, TNF-αin serum (ng/L): 27.11±3.99 vs. 4.66±1.76, IL-6 (ng/L) in BALF: 142.92±20.10 vs. 18.77±4.17, TNF-α(ng/L): 150.16±20.77 vs. 22.01±4.15, P-ERK/ERK (gray value): 0.59±0.03 vs. 0.38±0.05, P-p38MAPK/p38MAPK (gray value): 0.52±0.02 vs. 0.31±0.05, P-JNK/JNK (gray value): 0.56±0.03 vs. 0.25±0.01, all P < 0.05]. The levels of MLI, DI, and inflammatory factors in serum and BALF, p38MAPK, ERK, JNK protein expression and phosphorylation in lung tissue were reduced by Rofluas and various doses of ferulic acid, the reduction levels in the high dose group of ferulic acid were more significant than those in the middle and low dose groups of ferulic acid [MLI (μm): 25.00±0.19 vs. 30.10±0.29, 38.80±0.41, DI: (26.32±3.05)% vs. (29.75±6.17)%, (40.56±5.81)%, IL-6 in serum (ng/L): 9.20±1.87 vs. 12.35±2.16, 18.95±3.12, TNF-α(ng/L): 13.37±2.73 vs. 18.02±2.62, 21.31±3.75, IL-6 (ng/L) in BALF: 64.27±11.72 vs. 99.33±13.02, 120.31±18.02, TNF-α(ng/L): 58.20±10.28 vs. 93.83±16.26, 122.68±14.85, P-ERK/ERK (gray value): 0.43±0.04 vs. 0.46±0.04, 0.52±0.02, P-p38MAPK/p38MAPK (gray value): 0.33±0.03 vs. 0.34±0.03, 0.38±0.02, P-JNK/JNK (gray value): 0.32±0.04 vs. 0.38±0.05, 0.47±0.06). The ferulic acid could improve the inflammatory cell infiltration situation in mice with COPD. Conclusions Ferulic acid can improve pulmonary inflammation in COPD rats. The effective mechanism is possibly related to the inhibition of the protein expressions and phosphorylation levels of the key proteins such as p38MAPK, ERK and JNK in the MAPK signaling pathway.

The analysis of health effects of exposure to occupational hazards on works in gypsum mining enterprise / 中华劳动卫生职业病杂志

Objective@#To investigate the health of gypsum miners in Hubei province and analyze the health effects of occupational disease hazards exposure on gypsum miners.@*Methods@#In April 2017, occupational disease hazard factors were tested on the site of a gypsum mine, and 500 workers were selected by random sampling to conduct questionnaires, relevant data such as occupational health examination was collected, and descriptive statistical analysis was performed.@*Results@#The main occupational hazards of gypsum miners were gypsum dust and noise. The time-weighted average concentration of 8 h in the workplace was 4.32 to 9.34 mg/m3, and the post pass rate was 69.2% (9/13) ; Respiratory dust 0.13-5.15 mg/m3, post pass rate 75.0% (3/4). Gypsum miners had finger dysfunction and muscle numbness, joint pain (29.2%, 88/301) and chest pain and breathing difficulties (17.6%, 53/301). Followed by tinnitus, auricle pus, running water (4.7%, 14/301), abnormal muscle tension (2.7%, 8/301). The exposure of occupational disease hazards was associated with respiratory, auditory and neurological symptoms of gypsum miners.@*Conclusion@#The long-term exposure of gypsum workers to gypsum dust, noise and other harmful factors may result in obvious symptoms of respiratory system and other health damage.

Analysis of SATB2 gene mutation in a child with Glass syndrome / 中华医学遗传学杂志

OBJECTIVE@#To analyze the clinical characteristics and genetic basis of a child affected with Glass syndrome.@*METHODS@#Clinical manifestations and auxiliary examination results of the child were analyzed. Potential mutation was detected with next generation sequencing and validated by Sanger sequencing.@*RESULTS@#The child has featured growth and mental retardation, delayed speech, cleft palate, crowding of teeth, and downslanting palpebral fissures. DNA sequencing revealed a de novo heterozygous missense mutation c.1166G>A (p.R389H) in exon 8 of the SATB2 gene in the child.@*CONCLUSION@#The heterozygous mutation c.1166G>A (p.R389H) of the SATB2 gene probably account for the Glass syndrome in the patient.

Clinical application of LDLT after reconstruction of IVC using artificial blood vessel in the treatment of HCC beyond Milan Criteria / 中华肿瘤杂志

Objective@#To assess application of reconstruction of retrohepatic inferior vena cava using artificial blood vessel in right lobe living donor liver transplantation (LDLT) in the treatment of hepatocellular carcinoma (HCC) beyond Milan Criteria.@*Methods@#The clinical data of 9 HCC patients who underwent right lobe liver transplantation after reconstruction of retrohepatic inferior vena cava using artificial blood vessel between June 2015 and Nov 2016 at Liver Transplantation Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The liver of the patients was removed with retrohepatic inferior vena cava, and then the right donor graft was implanted by conventional orthotopic liver transplantation.@*Results@#All 9 liver transplantations were performed successfully. The time of reconstruction of hepatic venous outflow of the donor graft was (22.6±3.0) min, anhepatic time was (45.0±7.1) min, and total operation time was (321.9±52.5) min. All patients recovered uneventfully, ICU and hospital stay day were (1.2±0.4) days and (18.4±3.0) days. 2 patients suffered from thrombosis of artificial blood vessel, one recovered after conservative treatment and another was treated by placement of vein stent. No abdominal/pulmonary infection and non-artificial blood vascular complications were found, and none died in perioperative period. Postoperative pathological results showed that all patients were hepatocellular carcinomas and vascular tumor thrombosis was found in 5 cases. All patients were follow up, 1 patient died of pulmonary and brain metastasis 10 months after operation. One patient survived with local recurrence of tumor in liver. The other patients had no tumor recurrence and metastasis.@*Conclusion@#Replacement of retrohepatic inferior vena cava using artificial blood vessel in right lobe living donor liver transplantation is safe and feasible in the treatment of HCC beyond Milan Criteria, and might improve the resection rate of diseased liver and the prognosis of HCC patients after living donor liver transplantation.

Genetic analysis of two children patients affected with CHARGE syndrome / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To analyze two Chinese pediatric patients with multiple malformations and growth and development delay.</p><p><b>METHODS</b>Both patients were subjected to targeted gene sequencing, and the results were analyzed with Ingenuity Variant Analysis software. Suspected pathogenic variations were verified by Sanger sequencing.</p><p><b>RESULTS</b>High-throughput sequencing showed that both patients have carried heterozygous variants of the CHD7 gene. Patient 1 carried a nonsense mutation in exon 36 (c.7957C>T, p.Arg2653*), while patient 2 carried a nonsense mutation of exon 2 (c.718C>T, p.Gln240*). Sanger sequencing confirmed the above mutations in both patients, while their parents were of wild-type for the corresponding sites, indicating that the two mutations have happened de novo.</p><p><b>CONCLUSION</b>Two patients were diagnosed with CHARGE syndrome by high-throughput sequencing.</p>

Study of the effect of indwelling time of ICU peripheral arterial catheter on catheter-related bloodstream infection / 中国实用护理杂志

Objective To investigate the correlation between catheter indwelling time and catheter-related bloodstream infection in patients with ICU. Methods Chosen 60 cases of peripheral arterial catheterization and indwelling arterial catheters because of illness need more than 7 days of age, from September 2015 to January 2016 who were treated in respiratory and critical care medicine. Numbered in the order of entry (1-60), andnumber of singular werein the control group and number of even were in the experimental group. In the control group, the catheter was removed and the catheter was replaced at 7 days after the catheter was inserted,the experimental group continued to use the catheter for 7 days until the patient did not need to remove the catheter. Microbial culture was carried out in two groups of catheter tip,The bacterial setting rate of catheter tip culture was compared between the two groups. Results The control group of bacterial colonization rate was 7.14％ (2/28), the experimental group of bacterial colonization rate was 10.34％ (3/29), the difference between the two groups was not statistically significant (χ2=0.000, P>0.05). Conclusions Nursing care of patients with indwelling arterial catheters just follow the principle of maximum aseptic artery puncture and disinfection treatment, and patients without clinical symptoms need not to prevent catheter-related infection by peripheral arterial catheter replacement.

Sodium citrate anticoagulation in continuous plasma adsorption treatment of clinical research / 中华急诊医学杂志

Objective Explore the sodium citrate anticoagulation in the continuity of plasma adsorption closed-circuit circulation of anticoagulation therapy method and effect. Methods Line into the continuity of plasma adsorption treatment of 156 cases of acute drug poisoning patients were randomly(random number) divided into two groups, 78 cases in each group, respectively adopt low molecular heparin (group A), sodium citrate anticoagulation (group B). Contrast analysis of two groups after the therapy began 30 min, 3 h, 6 h before the filter in patients with pressure, transmembrane pressure, pressure drop, at the same time to compare two groups of 10 min before the start of treatment, after treatment began to 3 h, 6 h platelet, coagulation time live enzymes, vein in the body of free Ca2+, Na+and HCO3- 24 h and internal bleeding. Results Two groups in gender, age, clinical diagnosis, blood purification time comparative differences had no statistical significance (P>0.05);Two groups of 30 min after the start of treatment, 3 h, 6 h patients before pressure, transmembrane pressure, filter pressure drop compared differences were no statistical significance (P>0.05); Part of coagulation treatment after low molecular heparin group live enzymes the sodium citrate group significantly prolonged (P<0.01);Platelets, HCO3- the two groups after treatment, intravenous free Ca2+ and Na+ differences had no statistical significance (P>0.05). Conclusions In the continuous plasma adsorption treatment process using sodium citrate anticoagulation with clinical feasibility, safety.

Multiple congenital anomalies-hypotonia-seizures syndrome 1: case report and review of literature / 中华儿科杂志

Objective@#To analyze and summarize the clinical and molecular characteristics of the patients with multiple congenital anomalies- hypotonia-seizures syndrome 1 (MCAHS 1).@*Method@#Clinical data and test results were collected from a patient who was diagnosed with confirmed genetic basis of MCAHS 1 in Shanghai Children′s Medical Center since December 2015. The patient and his parents were examined by the next generation sequencing (NGS) technology using peripheral blood genomic DNA, and the relevant mutations identified by NGS were verified with Sanger sequencing. Related literature was searched from PubMed and Embase databases (from their establishment to January 2017) by using "PIGN gene" as a keyword, the retrieved articles were further reviewed for the clinical manifestations, results and prognosis of PIGN related variants.@*Result@#A nearly 4-month-old Chinese boy was presented with epilepsy, hypotonia, developmental delay, accompanied by nearly normal laboratory test results. The NGS analysis revealed a compound heterozygous variations in the PIGN gene, included a known splice site mutation (c.963G>A) which was inherited from his father, and a novel nonsense mutation (c.2773A>T, p.Lys925*) which was inherited from his mother. Nine associated articles were retrieved. Including our patient, a total of 22 cases were identified as the PIGN variants. The most common clinical manifestations were developmental delay, hypotonia, and epilepsy.Missense varients were most frequently found. Prognosis was poor. Eight cases died, while survived cased suffered from refractory epilepsy, profound mental retardation, muscle weakness, etc.@*Conclusion@#MCAHS1 is characterized by epilepsy, severe developmental delay, hypotonia, and may be accompanied by multiple malformations of other systems. Homozygous or compound heterozygous variants in PIGN gene are the cause of the disease.

Impact of obesity and spleen length on laparoscopic splenectomy combined with pericardial devascularization / 中华肝胆外科杂志

Objective To evaluate the impact of obesity and spleen length on laparoscopic splenectomy combined with pericardial devascularization.Methods We retrospectively analyzed 121 patients with portal hypertension who underwent laparoscopic splenectomy combined with pericardial devascularization in our hospital.Using BMI,these patients were classified as the obesity and the non-obesity groups.Using length of the spleen,the patients were divided into two subgroups:spleen AC diameter ＞ 20 cm and spleen AC diameter ≤20 cm.Results (1) For the Obesity group,the operation time,the rate of conversion to open operation and the complication rate after operation were higher than the non-obesity group [(184.0 ± 49.0) min vs (142.0 ±39.0) min,26.1％ vs 8.0％,26.1％ vs 6.7％,respectively,P＜0.05].However,the differences were not significant for mean blood loss,intraperitoneal drainage and complication rate after operation.For patients with massive splenomegaly,the obesity group had higher rates of conversion into open operation and complication (42.9％ vs 11.7％,33.3％ vs 8.8％,respectively,P ＜0.05).For patients with non-massive splenomegaly,the differences were not significant between the obesity and non-obesity groups (P ＞ 0.05).(2) For obesity patients,the spleen AC diameter ＞ 20 cm group had a longer operation time and a higher rate of conversion to open operation [(224.0 ± 42.0) min vs (152.0 ± 44.0) min,42.9％ vs 12.0％,respectively,P ＜ 0.05].The length of spleen had no effect on the operation and its complication (P ＞ 0.05).Conclusions Obesity extended the operation time and increased the rates of conversion to open operation and complication after operation.The spleen length had a major impact on the rates of conversion to open operation and complication after operation for the groups of obesity patients.

Building the Reference Range of Low Hemoglobin Density(LHD％) of Healthy Population in Humen District of Guangdong and Discuss Its Clinical Application Value / 现代检验医学杂志

Objective To establishe the reference range of low hemoglobin density (LHD ％) of health population in Humen District of Guangdong,and discuss the clinical application value.Methods Randomly selected from January 2015 to September 2016 in Humen Hospital of Dongguan City physical examination of 1 650 cases of healthy people as control group,and selected the same period by the clinical diagnosis of iron deficiency anemia (iron-deficiency anemia,IDA) group,67 cases of patients with IDA Sysmex XT-1800i fully automatic blood analyzer were used respectively to detect blood routine,and then based on the average haemoglobin concentration (mean corpuscular hemoglobin concentration,MCHC),calculate the LHD％,and the calculation results were analyzed.Results The control healthy crowd LHD％ value was 2.41％ ± 0.85 ％,95％ reference range was 0.74 ％ ～4.08％,male was higher than the female,the difference was statistically significant (t =3.209,P＜0.05).IDA patients before treatment LHD％ was 30.97％ ± 18.65％,significantly higher than the control group,the difference was statistically significant (t=19.536,P＜ 0.01),and with the level of hemoglobin (Hb) showed a negative correlation (r=-0.4313).LHD％ values after treatment in patients with IDA group were significantly lower,but the recovery speed was slower than the Hb and MCHC.By ROC curve analysis,when the cut-off of LHD％ value was 4.10％,the LHD％ for IDA early diagnostic sensitivity of 96.78％,specificity of 100％.Conclusion Established the reference range of low hemoglobin density (LHD ％) of healthy population in Humen district of Guangdong,and LHD％ is IDA good indicator of early diagnosis and curative effect of dynamic monitoring.

Effects and mechanisms of receptor-interacting serine-threonine kinase 3 in the formation of cholestatic hepatic injury / 中华消化外科杂志

Objective To investigate the effects and mechanisms of receptor-interacting serine-threonine kinase 3 (RIP3) in the formation of cholestatic hepatic injury.Methods The experimental study was conducted.(1) Processing and viability of hepatic stellate cell line HSC-T6:HSC-T6 cells were transfected by RIP3-siRNA and NC-siRNA,respectively.The viabilities of un-transfected,RIP3-siRNA-transfected and NC-siRNA-transfected HSC-T6 cells were respectively measured by cell-counting kit-8 (CCK-8).HSC-T6 cells were treated by 100 μmol/L Glycochenodeoxycholic acid (GCDCA) at 0,2,4,8 and 12 hours,and then were extracted and stored,12-hour cell viability was measured by CCK-8.RIP3 that was treated by 100 μmol/L GCDCA knocked down HSC-T6 cells to establishment RIP3 knockdown HSC-T6 cells (RIP3-KD cells).RIP3-KD cells were cultured for 12 hours,and cell viability was measured.(2) Mice model of bile duct ligation (BDL):40 adult mice were randomly divided into 8 groups,5 mice in each group.Sham group:bravery manager was only separated,without ligation,and bloods of inferior vena cava and liver tissues were extracted at 7 days postoperatively.The BDL-1,-3,-5,-7,-14,-21 and-28 d groups:bloods of inferior vena cava and liver tissues were extracted at 1,3,5,7,14,21 and 28 days postoperatively,respectively.(3) The relative expressions of RIP3,α-SMA and TNF-αmRNA in the cells and liver tissues were detected by quantitative real-time polymerase chain reaction (RT-PCR).(4) The relative expressions of RIP3,α-SMA and TNF-α proteins were detected by Western blot.Measurement data with normal distribution were represented as-x±s.The ANOVA was used for data analysis in different time gradient.Comparisons among groups were analyzed using the ANOVA.Pairwise comparison was done by the t test.Results (1) The HSC-T6 cells viability and expressions of RIP3,α-SMA,TNF-α mRNA and proteins:results of CCK8 test showed that 12-hour viabilities of GCDCA-treated HSC-T6 cells,GCDCA-treated RIP3-KD cells,HSC-T6 cells and RIP3-KD cells were 61.3％ ±0.3％ and 83.2％ ±0.4％ and 98.4％ ±0.7％ and 97.4％ ±0.7％ respectively,showing statistically significant differences in the viabilities among them (F =115.200,P＜ 0.05),and showing no statistically significant difference in the viabilities between HSC-T6 cells and RIP3-KD cells (t =1.283,P＞ 0.05).There were statistically significant differences in the viabilities between HSC-T6 cells and GCDCA-treated HSC-T6 cells or GCDCA-treated RIP3-KD cells (t =17.910,6.604,P＜ 0.05) and between GCDCA-treated HSC-T6 cells and GCDCA-treated RIP3-KD cells (t=7.186,P＜0.05).Results of RT-PCR test showed relative expressions of RIP3 mRNA in un-transfected,RIP3-siRNA-transfected and NC-siRNA-transfected HSC-T6 cells were respectively 0.012 1±0.001 3,0.011 2±0.003 1 and 0.002 8±0.000 5,with a statistically significant difference (F =20.410,P ＜ 0.05).There was no statistically significant difference in relative expressions of RIP3 mRNA between un-transfected and NC-siRNA-transfected HSC-T6 cells (t =0.483,P ＞0.05).The relative expression of RIP3 mRNA in RIP3-siRNA-transfected HSC-T6 cells was significant different from that in un-transfected and NC-siRNA-transfected HSC-T6 cells (t =11.760,4.586,P＜0.05).The relative expressions of RIP3 mRNA,α-SMA mRNA and TNF-α mRNA in GCDCA-treated HSC-T6 cells at 0,2,4,8 and 12 hours were 0.012 1±0.001 3,0.011 2±0.003 1,0.021 2±0.002 2,0.027 8±0.002 1,0.029 8±0.002 3 and 0.571±0.012,0.611±0.024,0.691±0.021,0.711±0.021,0.752±0.031 and 0.873±0.022,0.912± 0.024,1.015±0.031,1.210±0.042,1.471±0.041,respectively,showing an increased trend over time and statistically significant differences (F=70.720,30.050,166.700,P＜0.05).The relative expressions of RIP3 mRNA in HSC-T6 cells and GCDCA-treated HSC-T6 cells were 0.012 1±0.001 3 and 0.029 8±0.002 3,with a statistically significant difference (t=13.970,P＜0.05).Results of Western blot showed that relative expressions of RIP3 protein in un-transfected,RIP3-siRNA-transfected and NC-siRNA-transfected HSC-T6 cells were respectively 0.054 ± 0.012,0.013 ± 0.008 and 0.052± 0.021,with a statistically significant difference (F =7.410,P＜0.05).There was no statistically significant difference in relative expressions of RIP3 protein between un-transfected and NC-siRNA-transfected HSC-T6 cells (t =0.143,P ＞ 0.05),and statistically significant differences were found in relative expressions of RIP3 protein between RIP3-siRNA-transfected HSC-T6 cells and un-transfected or NC-siRNA-transfected HSC-T6 cells (t =4.924,3.006,P＜0.05).The relative expressions of RIP3,α-SMA and TNF-oα proteins in GCDCA-treated HSC-T6 cells at 0,2,4,8 and 12 hours were 0.045±0.024,0.047±0.034,0.062±0.025,0.121±0.015,0.154±0.034 and 0.064±0.031,0.072±0.017,0.097±0.035,0.078±0.031,0.254±0.051 and 0.078±0.025,0.094±0.037,0.129±0.041,0.198±0.011,0.324±0.061,respectively,showing an increased trend over time and statistically significant differences (F =9.658,15.810,20.090,P＜0.05).The relative expressions of RIP3 protein in HSC-T6 cells and GCDCA-treated HSC-T6 cells at 12 hours were 0.045±0.024 and 0.154±0.034,with a statistically significant difference (t =4.536,P＜0.05).(2) Expressions of RIP3,α-SMA and TNF-α mRNA in hepatic tissues of mice in each group:the results of RT-PCR showed that relative expressions of RIP3 mRNA,α-SMA mRNA and TNF-α mRNA in the Sham,BDL-1 d,BDL-3 d,BDL-5 d,BDL-7 d,BDL-14 d,BDL-21 d,BDL-28 d groups were 0.047 3±0.003 1,0.041 2±0.007 8-0.339 7±0.017 1 and 2.948±0.612,2.654± 1.032-8.387±0.910 and 0.563±0.078,0.610±0.113-1.078± 0.289,respectively,with statistically significant differences (F =25.180,27.820,7.425,P＜0.05).The results of western blot showed that relative expressions of RIP3,α-SMA and TNF-α proteins in Sham,BDL-1 d,BDL-3 d,BDL-5 d,BDL-7 d,BDL-14 d,BDL-21 d,BDL-28 d groups were 0.245±0.011,0.228±0.023-1.018±0.052 and 0.424±0.057,0.392±0.041-0.985±0.081 and 0.551 ±0.052,0.588±0.087-0.962±0.074,respectively,with statistically significant differences (F=19.160,94.410,22.750,P＜0.05).Conclusion Cholestasis promotes hepatic injury and fibrosis by inducing TNF-α pathway activation and upregulation RIP3.

Hepatitis B reactivation in hepatocellular carcinoma patients after hepatic resection vs radiofrequency ablation / 中华普通外科杂志

Objective To study hcpatitis B virus (HBV) reactivation and related risk factors for ≤5 cm hepatocellular carcinoma (HCC) by radiofrequency ablation (RFA) or hepatic resection.Methods From Sep 2006 to Jan 2013,193 patients received hepatectomy and 146 patients received RFA.Univariate and multivariate logistic regression analysis was used to assess risk factors.Stratified x2 test for HBV reactivation,Unpaired student's t-test for CD4 +,CD8 +,CD4+/CD8+ and NK cell proportions.Results (1) Antiviral therapy,Child-Pugh grade,vascular invasion and treatment modality were significant risk factors of HBV reactivation (P ＜ 0.05).(2) HBV reactivation was lower in patients receiving antiviral therapy than those who did not (16/181 vs.25/158,x2 =3.869,P =0.049),the reactivation in hepatectomy group was higher than RFA group in those not using antiviral therapy (20/92 vs.5/66,x2 =5.788,P =0.016),but the difference was not significant in the antiviral therapy patients (10/101 vs.6/80,x2 =0.319,P =0.572).(3)CD3+,CD4+,CD4+/CD8+ and NK cell proportions after 7 days treatment decreased in different degree for both hepatic resection and RFA group with or without antiviral therapy (P ＜0.05).For patients who did not received antiviral therapy,the proportions of RFA after 7 days treatment were higher than the hepatic resection group (P ＜ 0.05).Conclusions Compared with ≤5 cm carcinoma treated by RFA,hepatic resection decreased the proportions of immune cells,preoperative antiviral therapy relieves immune suppression,decreases the incidence of HBV reactivation.