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Objective:To explore the value of 18F-FDG PET/CT combined with pro-gastrin-releasing peptide (ProGRP) and neuron-specific enolase (NSE) in diagnosis and differential diagnosis of stageⅠA small cell lung cancer (SCLC). Methods:From June 2017 to October 2021, 113 patients (75 males, 38 females; age 32-79 years) with stageⅠA lung cancer (70 with adenocarcinoma, 25 with squamous cell carcinoma, 18 with SCLC; patients with adenocarcinoma and squamous cell carcinoma were combined into non-SCLC (NSCLC) group) and 30 patients with benign pulmonary nodule (21 males, 9 females; age 37-77 years) from the Affiliated Qingdao Central Hospital of Qingdao University were retrospectively analyzed. All patients were examined by 18F-FDG PET/CT and serum tumor markers associated with lung cancer. Differences of the clinical, imaging and tumor markers data among different groups were analyzed by χ2 test, Fisher exact test and Kruskal-Wallis rank sum test. Independent risk factors were analyzed by logistic regression analysis and ROC curve analysis was used to analyze the value of different predictive factors in diagnosis and differential diagnosis of SCLC. Results:There were significant differences in SUV max, lobulation sign, spiculation sign, calcification, pleural traction sign, ProGRP, NSE and carcinoembryonic antigen (CEA) among SCLC, NSCLC and benign nodules groups ( H values: 14.06-20.54, χ2 values: 8.16-14.95, all P<0.05), in which lobulation sign of SCLC was more than that of benign nodules (12/18 vs 26.7%(8/30); χ2=7.41, P=0.007), spiculation sign (2/18 vs 51.6%(49/95); χ2=10.01, P=0.002) and pleural traction sign (1/18 vs 35.8%(34/95); χ2=6.47, P=0.011) were less than those of NSCLC, SUV max was higher than that of benign nodules (7.4(5.8, 9.0) vs 2.3(1.4, 5.1); H=51.82, P<0.001), ProGRP was higher than that of NSCLC and benign nodules (64.0(40.1, 84.8) vs 38.7(26.9, 47.6), 36.7(29.1, 40.5) ng/L; H values: 36.13, 43.96, P values: 0.002, 0.001) and NSE was higher than that of benign nodules (12.4(10.9, 14.5) vs 7.4(5.4, 11.8) μg/L; H=40.53, P=0.001). When differentiated SCLC from NSCLC, spiculation sign (odds ratio ( OR)=0.043, 95% CI: 0.004-0.450, P=0.009) and ProGRP ( OR=1.083, 95% CI: 1.035-1.133, P<0.001) were independent risk factors for SCLC, and the AUC of the two factors combination was 0.875, with the sensitivity and specificity of 14/18 and 84.2%(80/95). When differentiated SCLC from benign nodules, SUV max( OR=2.706, 95% CI: 1.099-6.662, P=0.030), ProGRP ( OR=1.165, 95% CI: 1.009-1.344, P=0.038) and NSE ( OR=1.639, 95% CI: 1.016-2.645, P=0.043) were independent risk factors for SCLC, and the AUC of the three factors combination was 0.985, with the sensitivity and specificity of 17/18 and 96.7%(29/30). Conclusion:18F-FDG PET/CT combined with tumor markers ProGRP and NSE is helpful to improve the diagnosis and differential diagnosis of stage ⅠA SCLC.
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Objective:To investigate the feasibility and clinical effect of the computer assisted design of the lobulated perforator flap based on the descending branch of lateral circumflex femoral artery(d-LCFA) to reconstruct the soft tissue defects of heel.Methods:From October 2014 to November 2016, a computer assisted virtual technology was used to simulate the process of pre-operative design, isolation, and harvest of d-LCFA perforating flaps. This method was used to guide the design and harvest of the flap of d-LCFA in the repair of large-area soft tissue defects of the heel in all of the 5 patients. One patient received a combine flap of the d-LCFA flap and the perforating branch of the inferior abdominal artery flap(DIEPF). Heel appearance and function were reconstructed in phase I together with the repair of the defect. Donor site was directly sutured. The recovery effect was followed-up in the clinic.Results:The 3D visualised model of the vessels in the donor area for quadriceps artery was successfully established in all 5 patients, and the design and removal of the perforating flap were successfully guided. All the 10 flaps survived successfully in 5 patients, except 1 patient had a backflow disorder at the distal end of the inferior epigastric artery perforator flap, with partial necrosis and II grafting. After 6 to 12 months of follow-up(mean, 8.7 months), the flap showed good in colour and texture, with satisfactory heel appearance. The donor site was left with a linear scar.Conclusion:Computer assisted design technology can effectively help in the design of the polyfoliate perforator flap pedicled with d-LCFA, using this technique to assist the design and repair of large area soft tissue defect of heel could reconstruct the shape of heel in phase I and restore the function of the heel to the maximum extent.
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Objective:To discuss the clinical and pathological features of the patients with renal oncocytoma.Methods:Making a retrospective analysis of the clinical data of 35 patients with renal oncocytoma who were admitted to the department of urology in the First affiliated Hospital of China Medical University from January 2013 to August 2020, discussing their clinical features, pathological characteristics, treatment and prognosis. The age range of the 35 patients was 35-79 years, with an average age of (59.0±11.3) years, there were 15 males and 20 females. The tumors of the 35 patients were unilateral, concluded 22 cases on the left side and 13 cases on the right side.Among the 35 patients, the tumors of 7 cases located in the upper pole, 14 in the middle pole, and 14 in the lower pole. At the time of admission, 5 patients complained with flank pain, 3 patients had gross hematuria, and the other patients were found during physical examination or examination due to other diseases. In the imaging examination, there were 33 cases of ultrasound data, including 18 cases of hypoechoic, 10 cases of hyperechoic, 3 cases of isoechoic and 2 cases of mixed echo. The data of CT were collected in 30 cases. The tumors showed isointense or slightly hypointense on plain scan, after enhancement, it showed low enhancement with clear boundary to the renal parenchyma and 12 patients had typical central stellate scar sign. All patients accepted surgical treatment, including 23 cases of retroperitoneal laparoscopic surgery and 12 cases of open surgery, but only 12 cases had partial nephrectomy.Results:The tumors were incised after the operation, the range of the tumors’diameter was 1.3-14.0 cm, with an average of (4.0±2.3) cm. The color of the cross-section was tawny in 14 cases, mahogany in 19 cases and 2 cases of other colors. The typical features of tumor cell under microscope were arranged in nests, alveolar or tubular shapes, the cells were round or polygonal.The cell size was uniform, the cytoplasm was rich in eosinophilic granules, the nuclei was deeply stained and the nucleoli was small. There are 9 indicators reach to 20 cases in immunohistochemical stain, and the positive rates of each indicator are respectively EMA 100.0%(23/23), E-cadherin 100.0%(20/20), CK 96.2%(25/26), CD117 95.5%(21/22), p504S(AMACR)35.0%(7/20), CD10 33.3%(9/27), CK7 31.0%(9/29), Vimentin 17.2%(5/29), Ki-67(0/28). Thirty-five patients were followed up after surgery, 4 patients were lost to follow-up, and the follow-up time of the other 31 patients ranged from 7 to 90 months, with an average of (46.9±25.0) months. All patients had a good prognosis without recurrence or metastasis. Among them, 3 patients had mild renal insufficiency in a short time after operation, and they have all recovered. Three patients with gross hematuria before the operation disappeared after the operation. In 5 patients with low back pain, only two patients felt significant improvement, and the other three still felt intermittent episodes of dull lumbar pain.Conclusions:Renal oncocytoma is a relatively rare benign tumor of the kidney. Because of the lack of effective diagnostic methods, it is difficult to differentiate from renal malignant tumors preoperatively. Pathological results are the golden standard for the diagnosis and differential diagnosis of renal oncocytoma. The main treatment of renal oncocytoma is surgery, and after surgery, the patient's prognosis is good, but renal oncocytoma has the possibility of recurrence and metastasis, regular follow-up and surveillance are still required.
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The characteristics of meridian sinew theory at the early era have been collected. It is believed that the running courses and indications of twelve meridian sinew regions in Lingshu (Miraculous Pivot) are closely associated with Zubi Shiyimai Jiujing (Moxibustion Therapy on the Eleven Meridians of Legs and Arms) and Yinyang Shiyimai Jiujing (Moxibustion Therapy on the Eleven Meridians of Yin and Yang). Due to the attachment of twelve regular meridians, the development of its own theory is blocked. Meridian sinew theory guides the diagnosis and treatment of many dominant disorders (e.g. pain disorder and bi syndrome) with acupuncture and moxibustion. The defensive qi is circulated among meridian sinews, which is the core of meridian sinew theory. The acupoint selection relies on the meridian sinew theory at the early era, such as "consolidating muscles when they involved in disorders, using painful sites as acupoints to treat diseases" "interaction of the associated muscles" and "conducting meridian qi along with the running courses of meridians". The crack needling (one of the nine needling techniques exerted between two muscles to treat muscular pain) is adopted generally to mobilize the defensive qi so as to resist pathogens, relieve the compression in foci and promote qi and blood circulation in meridians. The rational understanding of meridian sinew theory may improve the accuracy of diagnosis and treatment of meridian sinew disorders, "reduce the pressure" on meridian theory and contribute to the enrichment of the theoretical framework of acupuncture and moxibustion.
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Acupuntura , Pontos de Acupuntura , Terapia por Acupuntura , Meridianos , MoxibustãoRESUMO
Objective:To investigate the feasibility and clinical efficacy of anterolateral thigh chimeric perforator flap in repair of large area soft tissue defects around the knee joint.Methods:From January, 2015 to October, 2019, 9 patients with large area soft tissue defects around the knee joint were treated. All patients had different degrees of defect in knee joint capsule and joint opening. Before operation, the width of the flap was determined by "skin lifting and kneading test", and the location of perforators in anterolateral femoral region was confirmed and marked with the assistance of HHD detector. According to the size and shape of the wound surface, single leaf or lobulated perforator flap was designed based on the principle that the donor site should be closed directly. The minimum size of the flap was 14.0 cm×5.0 cm, there was 1 case of lobulated flap with the largest area, respectively was 17.0 cm×9.0 cm and 18.0 cm×8.5 cm. The chimeric tissue flap(muscle flap or fascia lata flap) was taken according to the location and severity of joint opening. The grafted tissue flap was used to fill the articular cavity, the flap was used to repair the wound of knee joint, the blood supply of the flap was reconstructed, and a drainage catheter was placed in the cavity of knee joint. The recovery follow-up conducted in outpatient department.Results:All flaps survived without vascular incident. The recipient site of flap in 1 patient was not thoroughly washed and drained, and there was more exudation. After dressing change and drainage, the rest recipient areas of the flap were healed in stage I. All patients entered 3 to 36(average 12) months of follow-up. The appearance and function of recipient area recovery were satisfactorily. Only a linear scar remained in donor site.Conclusion:Anterolateral thigh chemeric perforator flap is ideal for repairing large soft tissue defects around the knee joint.
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Objective:To explore the effects of specially formed radial collateral artery perforator flaps in reconstruction of the complex digit defects.Methods:From April, 2014 to March, 2020, 20 patients with multiple digit injuries combined with bone defects were treated by digit reconstruction with radial collateral artery chimeric and polyfoliate perforator flaps. Of the 20 patients, 7 patients were treated by chimeric perforator flaps, 12 by polyfoliate perforator flaps and 1 by chimeric polyfoliate perforator flap. Altogether 28 perforator flaps and 13 bone flaps were taken. The size of perforator flaps were 9.5 cm×4.0 cm to 4.0 cm×2.0 cm, and bone flap were 1.5 cm×0.6 cm×0.6 cm to 2.5 cm×1.0 cm×0.6 cm. All the donor sites were closed directly. Regular follow-up was performed. Function and clinical effect evaluation of repaired digits were made according to the Standard for Upper Limb Function Assessment of Hand Surgery Society of Chinese Medical Association and Sensory Function Assessment Criteria of British Medical Research Council (BMRC).Results:Twenty-seven flaps survived without any event. Venous congestion occurred in 1 flap with partial skin necrosis. Postoperative follow-up lasted from 3 months to 3.5 years (average 17.5 months). The appearance and texture of all flaps were good. All bone flaps properly healed. Sensory recovery achieved S 4 in 8 flaps, S 3 in 16 flaps and S 2 in 4 flaps. Hand function evaluation showed excellent in 12 patients and good in 8 patients. Conclusion:The specially formed radial collateral artery perforator flaps have the features of various designs with reliable blood supply, and are effective in repair of multiple digit injuries combined with soft tissue and bone defects.
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Objective:To observe the effect of modified Cangfu Daotantang on metabolism and pregnancy in patients with spleen deficiency and phlegm-dampness type polycystic ovary syndrome （PCOS）. Method:One hundred and twelve patients were randomly divided into control group and observation group according to the random number table. Both groups took non-pharmacological interventions， oral metformin hydrochloride， 500mg/time， 3 times/day； oral ethinyl estradiol and cyproterone tablets， 1 tablet/time， 1 time/day， starting from the third to fifth day of menstruation and lasting for twenty-one days， for a total of 3 menstrual cycles. Patients in control group additionally took Erchen pills orally， 10 g/time， 2 times/day， while patients in observation group additionally took modified Cangfu Daotantang orally， 1 dose/day. The course of treatment was six menstrual cycles in both groups （or termination after conception）. The waist-to-hip ratio （WHR）， body mass index （BMI）， insulin resistance index （HOMA-IR）， pancreatic <italic>β</italic>-cell function （HOMA-<italic>β</italic>）， triglycerides （TG）， low-density lipoprotein （LDL） and non-high-density lipoprotein （nHDL） elevation after treatment were compared. The number of ovulation cycles monitored by B-ultrasound （6 menstrual cycles）， ovulation rate， human chorionic gonadotropin （HCG） day endometrial thickness， follicle diameter， cervical mucus score>8 points and endometrial morphology type A rate were measured and recorded. The recovery of menstruation， pregnancy and early miscarriage were recorded. Luteinizing hormone （LH）， estradiol （E<sub>2</sub>）， follicle stimulating hormone （FSH）， dehydroepiandrosterone sulfate （DHEAS）， testosterone （T）， anti-Müllerian hormone （AMH） levels， and insulin before and after treatment -Like growth factor-1 （IGF-1）， leptin （LP）， adiponectin （APN）， growth differentiation factor-9 （GDF-9） and tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>） levels were detected. Result:WHR， BMI and HOMA-IR levels of the observation group were lower than those of the control group （<italic>P</italic><0.05， <italic>P</italic><0.01）. HOMA-<italic>β</italic> level was higher than that in the control group （<italic>P</italic><0.01）. The increase rates of LDL， TG， and nHDL in the observation group were 19.61%（10/51），25.49%（13/51），23.53%（12/51）， respectively， lower than 41.18%（21/51），47.06%（24/51），45.10%（23/51）respectively in the control group （<italic>χ</italic><sup>2</sup>=5.607， <italic>χ</italic><sup>2</sup>=5.131， <italic>χ</italic><sup>2</sup>=5.263， <italic>P</italic><0.05）. The menstrual recovery rate in the observation group was 90.20% （46/51）， higher than 72.55% （37/51） in the control group （<italic>χ</italic><sup>2</sup>=5.239，<italic>P</italic><0.05）. The observation group had more ovulation cycles than the control group （<italic>P</italic><0.01）. The pregnancy rate in the observation group was 50.98% （26/51）， higher than 31.37% （16/51） in the control group （<italic>χ</italic><sup>2</sup>=4.047，<italic>P</italic><0.05）. On HCG day after treatment， the endometrial thickness and follicle diameter in the observation group were better than those in the control group （<italic>P</italic><0.01）. The proportion of patients with cervical mucus score> 8 points was 78.43% （40/51） in the observation group， higher than 56.86% （29/51） in the control group （<italic>χ</italic><sup>2</sup>=5.420，<italic>P</italic><0.05）. The intimal morphology type A rate in the observation group was 52.94% （27/51）， higher than 31.37% （16/51） in the control group （<italic>χ</italic><sup>2</sup>=4.864，<italic>P</italic><0.05）. The levels of AMH， E<sub>2</sub>， DHEAS， LH， T ， IGF-1， LP and TNF-<italic>α</italic> in the observation group were lower than those in the control group （<italic>P</italic><0.01）， while the APN and GDF-9 levels were superior to those in the control group （<italic>P</italic><0.01）. Conclusion:On the basis of conventional western medicine intervention， modified Cangfu Daotantang can regulate abnormal metabolism and reproductive endocrine in patients with PCOS， improve conception， and regulate the expression of IGF-1， GDF-9， adipocytokines and inflammatory factors， improve ovulation and improve pregnancy rate.
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Heart failure is a complex clinical syndrome，which is the final result of compensatory failure of heart injury caused by various reasons. Long-term persistent cardiac stress leads to mitochondrial dysfunction，which in turn further damages cardiomyocytes and leads to disease progression. Timely removal of damaged mitochondria in cardiomyocytes and maintaining a good living environment of viable mitochondria is not only an effective means to protect cardiomyocytes，but also a new way to prevent and treat heart failure and ventricular remodeling. Mitochondrial quality control is a series of cellular activities for mitochondria to maintain their structural and functional stability，including oxidative stress response，regulation of mitochondrial dynamics，mitochondrial autophagy，intracellular calcium regulation and so on. Traditional Chinese medicine（TCM） mostly uses drugs of replenishing Qi and activating blood circulation in the treatment of chronic heart failure，and Qi and mitochondria are similar in function. According to TCM，the performance of the body as "static，descending and inhibitory" in the case of Qi deficiency can also be compared with the energy defect of mitochondria. The classical method of tonifying qi and activating blood circulation in TCM can be applied here. In recent years，TCM takes mitochondria as the target and carries out many related experimental studies from the point of view of myocardial energy supply. It is found that Chinese herbs for replenishing Qi and activating blood circulation can participate in regulating the quality control mechanism of intracellular mitochondria with multiple targets and links. It is proved by experiments that Chinese herbs for replenishing Qi and activating blood circulation can exert myocardial protective effect through this mechanism.
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A child who suffered a complex and exceptionally large soft tissue defects of both lower extremities and feet was referred in January, 2017. A debulking deep inferior epigastric perforator (DIEPF) was used to cover the defect in right shank. The defects in left shank and foot were reconstructed by latissimus dorsi flap and bilateral debulking anterolateral thigh perforator flap (ALTPF) . Two years after operation, the appearance and texture of both lower limbs were good, and the child could walk and run almost normally. There were slightly noticeable scars left in both thighs and the back.
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Objective:To introduce a novel surgical technique for dissecting perforator vessels (orderly retrograde four-side dissection) in anterolateral thigh perforator flap (ALTPF) and explore its clinical outcome.Methods:Respective analysis of 94 patients who underwent reconstruction of soft tissue defects with ALTPF which were dissected by orderly retrograde four-side dissection between June, 2013 and December, 2016. After surgery, the survival of flaps, recovery in shape and function of the recipient sites, and the effect on shape and function of the donor sites were observed.Results:The size of ALTPF ranged from 7 cm×5 cm to 32 cm×10 cm. Ninety-four perforators were included in 94 ALTPF, which were 89 perforators of the descending branch of circumflex femoral lateral artery, 4 perforators of the transverse branch of circumflex femoral lateral artery and 1 perforator of femoral medial artery. The time for flap harvesting was 35-95(54.39±16.39) min. Success rate of perforator harvesting was 98.9%, only 1 perforator was injured and another encountered vasospasm during surgery. Three cases had vascular crisis after flap transfer with 2 venous crises and 1 artery crisis. All of the flaps completely survived except 1 that had a partial necrosis. The follow-up time was (12.91±9.17) months. No muscular weakness on donor sites was shown in all cases.Conclusion:Orderly retrograde four-side dissection of perforator vessels in the ALTPF has achieved less donor site morbidity, shorter surgical time and is safer than the traditional techniques. It is a reliable technique to harvest perforator flaps.
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Objective:To evaluate the feasibility and clinical results of micro-dissected chimeric (II-MCh) perforator flap based on the descending branch of lateral circumflex femoral artery(d-LCFA) for repairing composite soft tissue defects of limbs.Methods:From April, 2011 to December, 2019, a total of 19 cases of composite soft tissue defects of limbs combined with deep cavity were repaired with II-MCh perforator flap or micro-dissected thin lobulated (III-MPCh) perforator flap based on d-LCFA. The flap was micro-dissected before cut off the perforator. The deep dead cavity was filled with muscle flap, and the superficial wound was repaired with micro-dissected thin perforator flap. The sizes of flaps were 6.0 cm×3.0 cm-33.0 cm×8.0 cm. The muscle flaps were cut with volumes of 5.0 cm×3.0 cm×1.0 cm-13.0 cm×10.0 cm×1.5 cm. Donor sites of the flap were closed directly. Postoperative reviews were assigned at 1, 3, 6, 9 and 12 months. The appearance, colour, texture and recurrence of infection of the flap were checked and recorded.Results:Sixteen flaps survived successfully without necrosis and with primary healing at the donor sites. Two flaps had venous occlusion within 24 hours after surgery and healed after surgical exploration and venous anastomosis. One flap had arterial crisis within 24 hours after surgery and healed after surgical exploration and arterial anastomosis. All patients entered follow-up for 8-36 months with an average of 16 months. All recipient sites achieved satisfactory appearance and function, and only linear scars left at the donor sites.Conclusion:The II-MCh perforator flap based on d-LCFA is a special modality of anterolateral thigh perforator flap, which achieves a satisfying appearance at the recipient site by micro-dissecting the flap within one procedure. This emerging technique can effectively fill the dead cavity, and is an effective method to repair complex soft tissue defects of limbs combined with deep cavity.
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Objective:To explore the curative effects of thoracodorsal artery chimeric perforator flap used to repair extremity soft tissue defects complicated with a deep dead cavity.Methods:From July 2014 to July 2019, 17 patients with extremity soft tissue defects complicated with a deep dead cavity were repaired by a thoracodorsal artery chimeric perforator flap at Department of Orthopaedics, Xiangya Hospital. They were 10 males and 7 females, aged from 2 to 39 years (mean, 20.2 years). There were 7 cases of traffic accident trauma, 5 ones of chronic osteomyelitis, 2 ones of crushing injury and 3 ones of radical resection of tumor. The defects were located at the lower extremity in 15 cases and at the upper extremity in 2. The wound sizes ranged from 5 cm × 3 cm to 24 cm × 9 cm. All the wounds were complicated somewhat with a dead cavity or exposure of deep tissues after debridement. The muscular component of thoracodorsal artery chimeric perforator flap was used to fill the dead cavity while the skin component to cover the superficial wounds. The flap donor sites were closed directly. The flap survival and donor site recovery were followed up regularly after operation. The curative effects were assessed according to the comprehensive evaluation criteria of hand surgery for flaps.Results:Necrosis of the distal flap occurred in only one case which responded to dressing change; the flaps survived uneventfully in the other 16 cases. The recipient and donor sites of flaps healed primarily in all patients. Venous crisis developed in one case which survived uneventfully after vascular crisis exploration. The 17 patients were followed up for 6 to 24 months (mean, 15.8 months). In all patients the flap presented with good color, texture and elasticity but without obvious swelling. At the last follow-up, the curative effects by the comprehensive evaluation criteria of hand surgery for flaps were excellent in 10 cases, good in 6 and fair in one. Only linear scar remained at the flap donor site and abduction of the shoulder was not affected.Conclusion:The thoracodorsal artery chimeric perforator flap is an ideal means for repair of extremity soft tissue defects complicated with a deep dead cavity because it can repair the deep dead cavity and body surface wounds at the same time only after anastomosis of a bundle of vascular pedicles.
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OBJECTIVE：To study the effect of Cangfu daotan pill （CDP）containing serum on autophagy of ovarian granulosa cells（GCs）of rat. METHODS ：Three-month-old SD rat were divided into normal saline group （normal saline ，ig），FSH injection group（10.71 IU/kg，ih），CDP irrigation high-dose ，medium-dose and low-dse groups [ 0.5，1，2 mg/g（by crude drug ），ig]，with 6 rats in each group. They were given relevant medicine subcutaneously/intragastrically ，once a day ，for consecutive 3 days. After last medication ，blood sample was collected from the abdominal aorta to obtain drug-containing serum. GCs of rat were divided into blank control group ，model group ，FSH group （positive control ）and CDP high-dose ，medium-dose and low-dose groups. The autophagy model was induced by giving testosterone propionate ，except that the blank control group was directly added with 100 μL serum of normal saline group. Then model group was given 100 μL serum of normal saline group，and administration groups were given 100 μL drug-containing serum of corresponding drug group. The contents of estradiol（E2）and progesterone （P）in supernatant of cells were determined by ELISA. Western blot assay was used to detect protein expression of PI 3K，Akt and mTOR in cells. The mRNA expression of PI 3K，Akt，mTOR，Beclin 1，LC3Ⅰ，LC3Ⅱ and p 62 were detected by RT-PCR. RESULTS ： Compared with blank control group ，the content of E 2 in supernatant ，relative mRNA and protein expression of PI 3K，Akt and mTOR were decreased significantly in model group （P＜0.01），while relative mRNA expression of Beclin 1，LC3Ⅰ and LC 3Ⅱ were increased significantly （P＜0.01）. Compared with model group ，the content of E 2 in supernatant were significantly increased in FSH group ，CDP medium-dose and high-dose groups ，while relative mRNA expression of Beclin 1，LC3Ⅰ，LC3Ⅱ and p 62 were decreased significantly （P＜0.05 or P＜0.01）；relative mRNA and protein expression of PI 3K，Akt and mTOR were increased significantly in administration groups （P＜0.05 or P＜0.01）. CONCLUSIONS ：CDP can inhibit autophagy of GCs by activating related protein and mRNA expression of PI 3K/Akt/ mTOR signaling pathway.
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OBJECTIVE：To stu dy the improvem ent effect and mechanism of Guizhi fuling pill （GZFLP） on rats with phlegm-dampness type polycystic ovary syndrome （PCOS）.METHODS：Totally fifty female SD rats with regular estrous cycle were randomly divided into blank control group （n＝10） and model group （n＝40）. The model group received letrozole intragastrically [1 mg/（kg·d），for 21 d ] to induce phlegm-damp PCOS rat model. Forty model rats were randomly divided into model group ，metformin group [positive control ，0.135 g/（kg·d）] and GZFLP low-dose ，high-dose groups [4.49，17.96 g/（kg· d）]，with 10 rats in each group. Each medicine group was given intragastric administration ，once a day ，for 30 consecutive days. Blank control and model group were given intragastric administration of equal volume normal saline.After last medication ，oral glucose tolerance test （OGTT）was used to detect the level of blood glucose in rats at 0，30，60 and 120 min. ELISA assay was used to detect the levels of follicle-stimulating hormone （FSH），luteinizing hormone （LH），estradiol（E2）and testosterone （T）； body weight ，the weight of uterus ，bilateral ovaries and paragonadal fat were weighed. HE staining was used to observe morphological changes of ovarian tissue sections. RT-PCR method and Western blotting assay were used to detect mRNA and protein expression of CYP 19a1 in ovary and Glut 4 in uterine. RESULTS ：Compared with blank control group ，the levels of blood glucose 30，60，120 min after intragastric administration of glucose solution as well as serum levels of LH ，E2 and T were increased significantly in model group （P＜0.05）；the body weight ，the weight of uterus ，bilateral ovaries and paragonadal fat were increased significantly （P＜0.05）；the volume of thecal cells increased significantly and showed spherical shape ；the mRNA and protein expression of CYP 19a1 in ovarian tissue and Glut 4 in uterine tissue were decreased significantly （P＜0.05 or P＜0.01）. Compared with model group ，above indexes of administration groups were improved significantly （P＜0.05 or P＜0.01）；the thickness of theca cell layer and the volume of theca cells in GZFLP low-dose and high-dose groups were also improved. CONCLUSIONS：GZFLP can up-regulate the expression of CYP19a1 in ovary and Glut4 in uterus ，so as to improve the abnormal glucose metabolism in phlegm-dampness type PCOS model rats ，reduce insulin resistance ，lower serum estrogen levels ，and reduce the degree of polycystic changes in ovary ，thereby playing a role in the treatment of PCOS.
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CNKI, PubMed and other databases were retrieved to extract eligible randomized controlled trial(RCT) about modified Xuefu Zhuyu Decoction(MXZD) combined with Western medicine(trial group) versus Western medicine alone(control group) in the treatment of leiomyoma. Therefore, a total of 25 RCTs were included, involving 2 328 patients. Bias risk evaluation tool in Cochrane Handbook 5.1.0 was used for evaluating the quality of these RCTs. Meta-analysis was performed for the reported indicators, including total efficiency, serum hormone level [progesterone(P), luteinizing hormone(LH), estradiol(E_2), follicle stimulating hormone(FSH)], uterine size, fibroids size and adverse reactions by using Stata 14.0 software. Meta-analysis showed that the total efficiency(RR=1.21,95%CI[1.17,1.25],P<0.05) of trial group was better than that of control group. Serum hormone level(WMD_P=-3.86,95%CI[-4.31,-3.41],P<0.05; WMD_(LH)=-3.64,95%CI[-4.47,-2.82],P<0.05; WMD_(E_2)=-39.99,95%CI[-53.45,-26.52],P<0.05; WMD_(FSH)=-3.79,95%CI[-4.86,-2.72],P<0.05), uterine size(WMD=-50.02,95%CI[-55.98,-44.06],P<0.05), fibroids size(WMD=-15.79,95%CI[-18.11,-13.46],P<0.05) and adverse reactions(RR=0.65,95%CI[0.48,0.88],P<0.05) of trial group were all lower than those of control group, with statistical significances. Trial sequential analysis(TSA) was performed by using TSA 0.9 software, and showed a reliable therapeutic effect of the experimental group. In short, our study indicated that modified Xuefu Zhuyu Decoction combined with Western medicine had a better therapeutic effect on leiomyoma than Western medicine alone, but more high-quality studies are needed to verify this conclusion in the future.
Assuntos
Humanos , Medicamentos de Ervas Chinesas , Leiomioma/tratamento farmacológico , MedicinaRESUMO
Objective In order to test and improve the monitoring technical level and ability of radiation environmental monitoring network in Zhejiang Province, ensure the accuracy and reliability of monitoring data and information, and obtain the cosmic ray response values of instruments and equipment in this year. Methods In September 2018，an intercomparison meeting of environmental gamma radiation air absorbed dose rate within the radiation environmental monitoring network of Zhejiang province was held in Ningbo，which was organized by Zhejiang Province Radiation Environmental Monitoring Center.A total of 33 sets of instruments from 15 member units participated in the intercomparison measurements at 5 environmental measuring points, and the comparison results were evaluated by the Z score values. Results It was found that the |Z| of all measurement results were less than or equal to 2, and the evaluation results were satisfactory and acceptable. Conclusion The measured data of scintillation counters have relatively wider dispersion，and the high pressure ionization chambers have bigger response valuetocosmic ray. The measurement results of the two kinds of instruments keep a good linearity except for the measurement points of cosmic ray response.
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Objective:To investigate the feasibility and clinical effect of combined transplantation of bilateral perforator flap based on the descending branch of lateral circumflex femoral artery in the reconstruction of large soft tissue defects of lower limbs.Methods:From January, 2014 to September, 2019, 35 cases of large soft tissue defects of lower limbs were repaired by combined transplantation of bilateral perforator flap based on the descending branch of lateral circumflex femoral artery, and the donor sites were directly closed. The wound involved the shank, ankle and foot; The areas of defect ranged from 17.0 cm×12.0 cm to 33.0 cm×18.0 cm. External fixation were performed on 19 cases with open comminuted tibia fracture, and flap transplantation was preformed after through debridement and negative-pressure wound therapy for 5-7 days. The lateral femoral cutaneous nerve was remained in the flap, which was anastomosed with sensory nerves in the recipient site. The colour, texture, sensation, secondary ulcer of the flap and limb function were followed-up after the operation.Results:Of the 35 cases, 34 cases completely survived, and necrosis occurred in 1 case. The donor sites were closed primarily and complication was not observed in any of the cases. The followed-up period ranged from 6 to 38 months, at 17.6 months in average. The appearance and function of the reconstructed lower limbs were satisfactory.Conclusion:The combined transplantation of the perforate flap of descending branch of lateral femoral circumflex artery is safe and reliable. It can be used to repair large defect and the damage of the donor site is limited. It is an effective method to repair large area of soft tissue defects of lower limbs.
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Objective:To investigate the feasibility and clinical effects of the chimeric multi-paddled anteriolateral thigh perforator flap (ALTP) for reconstruction of complex defects in extremities, which was pedicled with the descending branch of lateral circumflex femoral artery (d-LCFA).Methods:From August, 2010 to December, 2017, 11 cases of severe soft-tissue defects were repaired with this flap, including 4 cases of car accident trauma, 2 of machine injury, 2 of fall injuries, 1 of ploughing machine injury, 1 of crushing injury, and 1 of spoke injury. The injuries accompanied with different degrees of infections, dead space and left huge soft-tissue defects after radical debridement (10.0 cm×9.0 cm-20.0 cm×18.0 cm) . Dead cavity was filled by the muscular flap, and the large area soft-tissue defects were repaired by chimeric multi-paddled perforator flap. Appearance, colour and texture of the flap, recurrence of infection and knee extension were recorded at 1, 3, 6, 9 and 12 months follow-up.Results:After the operation, all recipient sites had no hematoma and no infection. Eight flaps survived successfully, and donor sites healed primarily. One flap had partial necrosis because of a mechanical stretch of the perforator during the operation, then repaired by the ipsilateral chimeric perforator flap based on d-LCFA. One flap occurred vascular crisis on the second day after the surgery, and it was rescued and survived completely after surgical exploration. The other flap which repaired wound on hand had partial necrosis too, and then repaired with posterior interosseous artery perforator flap. The follow-up periods ranged from 2 to 32 (mean, 10.2) months. All flaps had satisfactory appearance and texture. Only linear scars left at the donor sites. There were no motion limitations at the hip and knee joints of the effected leg.Conclusion:The anteriolateral thigh perforator flap combined with multi-paddled and chimeric techniques can reduce donor site morbidities, simplify the anastomosis of blood vessel, and improve the appearance and effects of the recipient site. It is a feasible method in repairing severe soft tissue defects of limbs.
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Objective:To explore the value of 18F-fluorodexyglucose (FDG) PET/CT combined with integrated contrast-enhanced CT on the diagnosis of hepatic epithelioid hemangioendothelioma(HEH). Methods:Six patients (2 males, 4 females, age: (41.0±5.6) years) histopathologically confirmed to be HEH in Qingdao Central Hospital between November 2013 and November 2018 were retrospectively analyzed. All patients underwent 18F-FDG PET/CT dual-phase imaging and three-phase dynamic enhanced scanning with integrated CT. Characteristics of 18F-FDG PET/CT and contrast-enhanced CT images were classified and analyzed. Results:All 6 patients had multi-lesions (30 lesions in total). The capsule retraction sign was found in 16.7% (5/30) lesions, target sign was found in 33.3% (10/30) lesions, and " lollipop sign" was found in 13.3% (4/30) lesions. There were three ways of enhancement showed by CT: mild progressive enhancement, delayed enhancement, and black target sign/white target sign in the portal phase. Among the 30 lesions, 66.7% (20/30) had higher 18F-FDG uptake than liver parenchyma, with maximum standardized uptake value (SUV max) of 4.18±0.64 during routine imaging and 4.23±0.70 during delayed imaging, and the retention index was 0.65(-1.88, 4.60). The rest 33.3% (10/30) showed similar 18F-FDG uptake to liver parenchyma, with SUV max of 2.75±0.52 during routine imaging, and 2.78±0.55 during delayed imaging. The uptake of 18F-FDG increased with time in 22 lesions and decreased in 8 lesions. In the metabolically heterogeneous lesions, the relatively high-metabolization site was also the site with higher peak enhancement; in the lesions with uniform metabolism, the CT enhancement was also uniform. Bilateral pulmonary metastases were found in 2/6 patients. Conclusion:18F-FDG PET/CT dual-phase imaging combined with CT three-phase dynamic enhanced scanning is helpful in accurate diagnosis of HEH and could show extrahepatic metastases.
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Objective To explore the feasibility of 3D printed individualized applicator for the intracavitary HDR-brachytherapy for nasopharyngeal carcinoma.Methods CT scan was performed in 1 case of recurrent rT1 nasopharyngeal carcinoma and 1 case of T2 residual nasopharyngeal carcinoma and the obtained images were transmitted to 3D image processing software.The geometric contour parameters of the nasopharyngeal cavity were obtained and a pipeline was designed to make it close to the recurrent gross tumor volume (rGTV).Individualized cavity applicators were created by using 3D printer.The applicator was inserted into the patient's nasopharyngeal cavity through oral cavity.The source tube and false source were inserted into the preset pipe of the applicator.CT scan was performed again and the images were transmitted to the 3D brachytherapy planning system.Mter delineating the target volume and organ at risk,treatment plan was optimized.After completing the first treatment,the applicator was removed.Before second treatment in a few days,CT scan was reviewed to confirm whether the position was correct.Results When the applicator was inserted into the nasopharyngeal cavity,it could be fully aligned with the nasopharyngeal wall and self-fixed without additional fixation measures.Comparing the location of false source in multiple reviews of CT scan,the error was ≤ 1 mm.No significant discomfort was reported throughout the treatment.In optimized three-dimensional treatment,100％ prescription dose curve included the full rGTV,maximum dose of the brain stem and spinal cord was＜30％ prescription dose.Recurrent patients were given with a prescription dose of DT 40Gy/8 fractions/4 weeks and patients with residual tumors were given with 12Gy/2 fractions/1 week.No tumor recurrence was observed at postoperative 3 months in two cases.Conclusions The 3D printed individualized nasopharyngeal intracavitary applicator has the advantages of self-fixation,accurate location,good repeatability and good patient tolerance.The short-term outcome is effective,whereas its long-term clinical effect and adverse reactions need to be further observed.