Hypothesis of Genetic Diversity Selection in the Occurrence and Development of Lung Cancer: Molecular Evolution and Clinical Significance / 中国肺癌杂志

So far, the monoclonal hypothesis of tumor occurrence and development cannot be justified. The genetic diversity selection hypothesis for the occurrence and development of lung cancer links Mendelian genetics with Darwin's theory of evolution, suggesting that the genetic diversity of tumor cell populations with polyclonal origins-monoclonal selection-subclonal expansion is the result of selection pressure. Normal cells acquire mutations in oncogenic driver genes and have a selective advantage over other cells, becoming tumor initiating cells; In the interaction with the tumor microenvironment (TME), the vast majority of initiating cells are recognized and killed by the human immune system. If immune escape occurs, the incidence of malignant tumors will greatly increase, and subclonal expansion, intratumour heterogeneity, etc. will occur. This article proposed the hypothesis of genetic diversity selection and analyzed its clinical significance.
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Construction of a prediction model for postoperative prognosis in patients with resectable cholangiocarcinoma based on SIRT2 expression / 浙江大学学报·医学版

OBJECTIVES@#To develop a prediction model for postoperative prognosis in patients with cholangiocarcinoma (CCA) based on the expression of silence information regulator 2 (SIRT2).@*METHODS@#The differential expression of SIRT2 between CCA and normal tissues was analyzed using TCGA and GEO databases. Gene set enrichment analysis (GSEA) was used to explore potential mechanisms of SIRT2 in CCA. The expression of SIRT2 protein in CCA tissues and normal tissues (including 44 pairs of specimens) was also detected by immunohistochemistry (IHC) staining in 89 resectable CCA patients who underwent surgical treatment in The First Affiliated Hospital of Bengbu Medical College between January 2016 and December 2021. The relationship between SIRT2 expression and clinicopathological characteristics and prognosis of CCA patients was analyzed. A survival prediction model for patients with resectable CCA was constructed with COX regression results, the calibration curve and the time-dependent receiver operating characteristic curve (ROC) were used to evaluate the performance of the constructed model, and the predictive power between this model and the AJCC/TNM staging system (8th Edition) was compared.@*RESULTS@#SIRT2 mRNA was overexpressed in CCA tissues as shown in TCGA and GEO databases. IHC staining showed that SIRT2 protein expression in CCA tissues was significantly higher than that in adjacent non-tumor tissues. GSEA results showed that elevated SIRT2 expression may be involved in multiple metabolism-related signaling pathway, such as fatty acid metabolism, oxidative phosphorylation, amino acid metabolism, etc. SIRT2 expression level was related to serum triglycerides level, tumor size and lymph node metastasis (all P<0.05). The survival analysis results showed that the patients with higher SIRT2 expression had a significant lower overall survival (OS) than patients with lower SIRT2 expression (P<0.05). Univariate COX regression analysis suggested that pathological differentiation, clinical stage, postoperative treatment and SIRT2 expression level were associated with the prognosis of CCA patients (all P<0.05). Multivariate regression analysis confirmed that clinical stage and SIRT2 expression level were independent predictors of OS in postoperative CCA patients (both P<0.05). A nomogram based on SIRT2 for prediction of survival in postoperative CCA patients was constructed. The C-index of the model was 0.675, and the area under the time-dependent ROC curve (AUC) for predicting survival in the first, second, and third years was 0.879, 0.778, and 0.953, respectively, which were superior to those of AJCC/TNM staging system (8th Edition).@*CONCLUSIONS@#SIRT2 is highly expressed in CCA tissues, which is associated with poor prognosis in patients with resectable CCA. The nomogram developed based on SIRT2 may have better predictive power than the AJCC/TNM staging system (8th Edition) in prediction of survival of postoperative CCA patients.

Expression and Clinical Significance of Exosome Component 4 in Newly Diagnosed Patients with Diffuse Large B-Cell Lymphoma / 中国实验血液学杂志

OBJECTIVE@#To explore the expression of Exosome Component 4（EXOSC4） in the tissues of newly diagnosed patients with diffuse large B-cell lymphoma (DLBCL) and its clinical significance.@*METHODS@#The expression of EXOSC4 protein in the tissues of 181 newly diagnosed DLBCL patients was analyzed by immunohistochemical staining. Clinical data were collected. The correlation between EXOSC4 protein expression in the tissues of newly diagnosed DLBCL patients and clinical features were analyzed and its prognostic significance.@*RESULTS@#The positive rate of EXOSC4 protein expression was 68.51% in the tissues of 181 newly diagnosed DLBCL patients. These patients were divided into two groups, with 44 cases in high expression group and 137 cases in low expression group. There were no significant differences in age, gender, B symptoms, serum lactate dehydrogenase (LDH) level, Eastern Cooperative Oncology Group (ECOG) score, Ann Arbor stage, extranodal disease, International Prognostic Index (IPI) score, National Comprehensive Cancer Network IPI (NCCN-IPI) score, and cell origin between the two groups (P>0.05). Cox multivariate regression analysis showed that high EXOSC4 protein expression in tissues was an independent poor prognostic factor for OS and PFS in newly diagnosed DLBCL patients (all P<0.05). K-M survival analysis showed that newly diagnosed DLBCL patients with high EXOSC4 protein expression had significantly shorter overall survival (OS) and progression free survival (PFS) than those patients with low EXOSC4 protein expression (all P<0.05).@*CONCLUSION@#High EXOSC4 protein expression in tissues of newly diagnosed DLBCL patients is an independent poor prognostic factor for survival.

Expression changes and clinical significance of serum neuron-specific enolase and squamous cell carcinoma antigen in lung cancer patients after radiotherapy

Abstract Objective: To explore the changes and clinical significance of serum Neuron-Specific Enolase (NSE) and Squamous Cell Carcinoma antigen (SCC) in patients with lung cancer before and after radiotherapy. Methods: 82 patients with lung cancer were treated with radiotherapy, and effective clinical intervention was given during the radiotherapy process. The patients were followed up for 1 year after radiotherapy and were divided into a recurrence and metastasis group (n = 28) and a non-recurrence and metastasis group (n = 54) according to their prognosis. Another 54 healthy volunteers examined in the present study's hospital during the same period were selected as the control group. To compare the changes of NSE and SCC levels in serum in patients with lung cancer at admission and after radiotherapy, and to explore their clinical significance. Results: After intervention, NSE and SCC levels in the serum of the two groups of patients were significantly lower than those before intervention, and the levels of CD4+ and CD4+/CD8+ were significantly higher than those before intervention (p < 0.05); the level of CD8+ was not significantly different from that before intervention (p > 0.05). And NSE and SCC levels in the intervention group were significantly lower than those in the routine group, the levels of CD4+, CD4+/CD8+ were significantly higher than those in the routine group (p < 0.05). Conclusion: NSE and SCC in serum can preliminarily evaluate the effect of radiotherapy in patients with lung cancer and have a certain predictive effect on prognosis.

Variation of plantaris muscle: a case report with clinical significance / Variación del músculo plantar: reporte de un caso con significado clínico

SUMMARY: The plantaris muscle is located between the soleus and gastrocnemius muscles, within the posterior calf group. Due to degeneration and its loss of plantar-flexion function, the muscle is vestigial in human beings, but it retains clinical significance. Few cases of variation in the plantaris muscle have been reported, and this, therefore, appears to be rare. Nonetheless, absence of this muscle was identified via the dissection of a left lower limb (male), which also indicated the absence of an attachment in the usual position. The present report, which addresses such variation, may provide both inspiration and reference points for the clinical treatment of so-called "tennis leg", and for the use of plantaris muscle for the purposes of clinical, autologous graft repair.

RESUMEN: El músculo plantar se ubica entre los músculos sóleo y gastrocnemio, dentro del grupo posterior de la pierna. Debido a la degeneración y la pérdida de la función de flexión plantar, el músculo es un vestigio en los seres humanos, pero conserva su importancia clínica. Se han informado pocos casos de variación en el músculo plantar y, por lo tanto, esto parece ser raro. No obstante, se observó la ausencia de este músculo durante la disección de un miembro inferior izquierdo (masculino). El presente informe, que aborda dicha variación, puede proporcionar puntos de referencia para el tratamiento clínico de la llamada "pierna de tenista" y para el uso del músculo plantar con fines de reparación clínica con injerto autólogo.

Variations in the origin of the superior laryngeal artery and their clinical significance: a case report with a proposal for a new classification / Variaciones en el origen de la arteria laríngea superior y su significado clínico: reporte de un caso con una nueva propuesta de clasificación

SUMMARY: The superior laryngeal artery is the primary vessel providing the blood supply to the larynx. Commonly, it is derived from the superior thyroid artery. Different variations in the origin have been described in the current literature; knowledge of such variations is crucial for various surgical interventions of the larynx and surgical procedures in the lateral region of the neck regarding the carotid triangle. It should be noted that radiological studies, such as selective angiography of the thyroid gland, can also be misleading in cases of variations. Herein, we describe a case of bilateral superior laryngeal artery originating directly from the external carotid artery of the neck. The arteries at first have a transverse course and then pierce through the thyrohyoid membrane alongside internal laryngeal nerves. Moreover, we also review the known variations in the origin of the superior laryngeal artery and propose a new classification of all known variations.

RESUMEN: La arteria laríngea superior es el vaso principal que proporciona el suministro de sangre a la laringe. Comúnmente, se deriva de la arteria tiroidea superior. Han sido descritas diferentes variaciones en su origen y el conocimiento de éstas resulta crucial para las intervenciones quirúrgicas realizadas en la laringe, como también en los procedimientos quirúrgicos que se llevan a cabo en la región lateral del cuello, respecto al triángulo carotídeo. Cabe señalar que los estudios radiológicos, como la angiografía selectiva de la glándula tiroides, también pueden ser engañosos en casos de variaciones anatómicas. Aquí, describimos un caso de arteria laríngea superior bilateral que se originaba directamente de la arteria carótida externa. Las arterias al inicio tenían un curso transversal y luego atravezaban la membrana tirohioidea junto con los nervios laríngeos internos. Revisamos también las variaciones conocidas en el origen de la arteria laríngea superior y proponemos una nueva clasificación de todas las variaciones conocidas.

Clustered Origin of the Left Coronary Artery from the Left Sinus of Valsalva: Uncharacteristic Developmental Event in the Temporally Regulated Process

Coronary artery development is a sequential and progressively regulated process. However, there are a number of reports available on the disturbance to this temporal process resulting in variations of the artery. In these instances, the function of the coronary arteries was normal in providing blood supply to the heart. The normal and abnormal coronary artery development has been studied using a variety of approaches and the knowledge continues to evolve. The cadaveric specimen was obtained from the “willed body program” for the purpose of student dissection. During the cadaveric dissection of a 94-year old male Caucasian we observed that the left coronary artery arose from the coronary ostium in a cluster of multiple branches. A detailed study of the origin of the left coronary artery showed that there is one ostium from which multiple branches arose. The right coronary artery arose normally from the right coronary ostium. The coronary veins were normal and returned the blood through the coronary sinus to the right atrium. The anomalous finding is discussed in the light of what is already known about the normal coronary artery development and rationalize a possible explanation. We conclude that the abnormal development of the coronary artery is rarely detrimental and provides adequate blood circulation to the heart. However, knowledge of such malformation is important in clinical practice.

Pharmacokinetics and clinical significance of drugs for improving nonalcoholic fatty liver disease / 中国临床药理学与治疗学

Nonalcoholic fatty liver disease (NAFLD) is a common chronic liver disease in China. There is no specific drug approved for marketing at home and abroad. At present, some adjuvant drugs are mainly used to improve the progress of the disease. Being familiar with and mastering the pharmacokinetic characteristics is very important for the selection and use of drugs. According to the characteristics of drug absorption, distribution, metabolism and excretion, reasonable drugs are selected to improve the therapeutic effect and reduce adverse reactions. Therefore, this paper reviews the pharmacokinetics and clinical significance of drugs commonly used to improve nonalcoholic fatty liver disease in hope of providing basis for clinical medication.

Expression and Clinical Significance of Serum MiR-424 and MiR-765 in Multiple Myeloma / 中国实验血液学杂志

OBJECTIVE@#To investigate the expression and clinical significance of miR-424 and miR-765 in patients with multiple myeloma (MM).@*METHODS@#The eighty-one MM patients admitted to Sanya Central Hospital from January 2017 to July 2020 were divided into phase Ⅰ (n=16), phase Ⅱ (n=25) and phase Ⅲ (n=40) according to the international staging system, while they were divided into IgG type (n=46), IgA type (n=19), light chain type (n=10) and non secretory type (n=6) according to the results of immunotyping. Another 50 healthy normal persons in the same period were selected as the control group. The levels of serum miR-424, miR-765 and Cystatin C (Cys-C) were measured in each group. The diagnostic value of serum miR-424, miR-765 and Cys-C in MM was estimated by ROC curve. Pearson correlation was used to analyze the correlation between serum levels of miR-424, miR-765 and Cys-C in MM patients.@*RESULTS@#The serum levels of miR-424 (2.74±1.30 vs 0.85±0.26), miR-765 (2.05±0.82 vs 0.63±0.17) and Cys-C ［(2.18±0.86 vs 0.72±0.15) mg/L］ in MM group were significantly higher than those in control group (P<0.001). The serum levels of miR-424 (5.08±2.36 vs 1.12±0.34, 2.24±0.93), miR-765 (3.50±1.52 vs 0.74±0.20, 1.78±0.65) and Cys-C ［(3.81±1.30 vs 0.92±0.24, 1.68±0.55) mg/L］ in MM patients at stage Ⅲ were significantly higher than those in patients at stage Ⅰ and Ⅱ (P<0.001). Also the serum levels of the three molecules in phase II were significantly higher than those in phase I (P<0.001). The serum levels of miR-424 and miR-765 in MM patients at IgG type were significantly higher than those at IgA, light chain and non secretory types (P<0.001). ROC curve analysis showed that the area under the curve (0.952，95%CI: 0.890-0.993) was greatest for the combination of miR-424, miR-765 and Cys-C for diagnosis of MM, and its sensitivity and specificity were 95.0% and 87.2%. The results of correlation analysis showed that the serum levels of miR-424 and miR-765 were positively correlated with Cys-C (r=0.795，r=0.760).@*CONCLUSION@#The serum levels of miR-424 and miR-765 in MM patients are significantly increased in the pattern increasing with the progression of MM stage. Combined with Cys-C, miR-424 and miR-765 have high value in the diagnosis of MM.

Evolution Characteristics and Clinical Significance of Blood Separation in Patients with Multiple Myeloma / 中国实验血液学杂志

OBJECTIVE@#To investigate the evolution of blood separation results by gel extraction of multiple myeloma (MM) patients, and to evaluate the clinical value of abnormal blood separation results for the evaluation of disease and prognosis.@*METHODS@#The clinical data of 5 patients diagnosed newly MM patients with abnormal blood separation of gel collection vessels in our hospital were retrospectively analyzed, and the changes of blood separation results and blood index levels were followed up with the improvement of treatment effect, and the correlation of different blood index levels was analyzed.@*RESULTS@#In 5 patients with newly diagnosed MM, the blood separation result showed floating phenomenon after centrifugation, which divided into three layers and the order from top to bottom is separator gel, serum, and red blood cells(RBC). With partial remission of clinical symptoms, the blood separation results were still abnormal, which were divided into three layers from top to bottom: serum, RBC and separator gel. Finally, with complete remission of the disease, blood separation results returned to normal, from top to bottom: serum, separator gel, RBC. With the blood separation results from abnormal to normal, the blood routine indicators: Hb, Hct levels gradually increased, neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR) gradually decreased; biochemical indexes: TP, GLB, Ig and β2-MG levels gradually decreased. Tumor load related indicators: serum IL-6, TNF-α, IL-17 levels gradually decreased, and IL-35 levels gradually increased; and the differences were statistically significant (P<0.05). Pearson correlation analysis showed that serum β2-MG was positively correlated with IL-6, TNF-α and IL-17 levels (r=0.710, 0.756, 0.581, P<0.05), and negatively correlated with IL-35 level (r=-0565, P<0.05).@*CONCLUSION@#Abnormal blood separation exists in MM patients, and there are significant differences in blood, tumor load and immune balance related indexes in patients with different blood separation results, which provides partial experimental basis for evaluation of disease, efficacy and prognosis with different blood separation results.

Anatomical morphometry of coracoclavicular ligament based on fresh cadaver and clinical significance / 解剖学报

Objective To measure the anatomical morphology of coracoclavicular ligament based on fresh cadavers, and to provide anatomical basis for anatomical reconstruction of coracoclavicular ligament. Methods A total of 52 the acromioclavicular joints (fresh body specimen) was dissected, and the anatomical characteristics of coracoclavicular ligament were observed by dissecting acromioclavicular joint specimens. The anatomic data of which the length of the conoid ligament (QR), the length of the trapezoid ligament (ST) ; the distance from the conoid ligament attachment on coracoid to coracoid tip (RV), the distance from the trapezoid ligament attachment on coracoid to coracoid tip (TV), the distance form conoid ligament attachment on the clavicular to acromioclavicular joint (QU), the distance form the trapezoid ligament attachment on the clavicular to acromioclavicular joint (SU), the distance from supraclavicular plane to subcoracoid plane (WX) were measured ; and the mean diameter of the trapezoid ligament attachment on the clavicular (ā), the mean diameter of the conoid ligament attachment on the clavicular(b¯), the mean diameter of the trapezoid ligament attachment on the coracoid (c¯), the mean diameter of the conoid ligament attachment on the coracoid (d¯) were calculation. The measurement result underwent statistical analysis. Results The minimum diameter of the trapezoid ligament attachment on the clavicular and coracoid on the left and right sides, respectively. There were no significant differences in those anatomical morphology of the coracoclavicular ligament (P>0.05). The anatomical morphology of the diameter of coracoclavicular ligament attachment on the male and female had no significant difference (P>0.05). The maximum length of the conoid ligament was (14.19±2. 43/15. 87±2. 99) mm on the left and right sides, respectively. The distance from the conoid ligament attachment on coracoid to coracoid tip was ( 36. 66 ± 4. 25/33. 61 ± 3. 45 ) mm on the left and right sides, respectively. The mean diameter of the conoid ligament attachment on the clavicular and coracoid was (11.95± 1.43/ 11.23± 1.12)mm and (9.20± 1.60/7.90±0.76) mm on the left and right sides, respectively. There were significant differences in those anatomical morphology of the coracoclavicular ligament(P 0.05). The anatomical morphology of the coracoclavicular ligament on the male and female had no significant difference (P>0.05). Conclusion The comprehensive measurement of anatomical morphology of coracoclavicular ligament can provide an anatomical basis for shoulder joint diseases related to coracoclavicular ligament injury. It will help surgical staff perform a complete anatomic reconstruction of coracoclavicular ligaments for the surgical treatment of dislocation of the acromioclavicular joint.

Risk factors for prostate cancer in male patients with MRI-negative and PSA-abnormal findings / 中华男科学杂志

Objective@#To investigate the risk factors for clinically significant PCa diagnosed by transrectal ultrasound-guided systematic prostate biopsy in patients with MRI-negative and PSA-abnormal findings.@*METHODS@#From January 2014 to December 2017, 335 male patients with MRI-negative (PI-RADS 2.0 score ≤ 2) and PSA-abnormal (4－30 ng/ml ) findings underwent systematic prostate biopsy guided by transrectal ultrasound under local anesthesia in our department. We collected and analyzed the demographic data, clinical symptoms, complications, past history and PSA density (PSAD) of the patients.@*RESULTS@#Clinically significant PCa was diagnosed in 21 (6.3%) of the 335 patients. Multivariate logistic regression analysis showed that the independent risk factors were higher age (AUC: 0.704, P 71 years old or with PSAD >0.18 ng/ml/ml so as to avoid missed diagnosis and unnecessary invasive biopsy as well. /.

Expression and clinical significance of receptor-interacting protein serine-threonine kinases 1 in the nucleus pulposus of patients with lumbar disc herniation / 中国骨伤

OBJECTIVE@#To investigate the expression and clinical significance of receptor interacting protein serine-threonine kinases 1 (RIPK1) in the nucleus pulposus of patients with lumbar disc herniation (LDH).@*METHODS@#Nucleus pulposus tissue specimens of 40 patients with LDH patients underwent surgical treatment from January 2016 to January 2018 as the case group, and nucleus pulposus tissue specimens of 30 patients with lumbar spine fracture underwent surgical treatment at the same time as the control group. The expression of RIPK1 mRNA and protein of receptor interaction were detected by polymerase chain reaction (PCR) and Western blot, respectively. The expression of RIPK1 protein in the nucleus pulposus were detected by immunohistochemical staining. The concentrations of RIPK1 and tumor necrosis factor-α (TNF-α) in nucleus pulposus were detected by ELISA method. The relationship between the concentrations of RIPK1, TNF-α in nucleus pulposus and the Pearce grade of LDH patients was analyzed by one-way ANOVA. The correlation between RIPK1 and TNF-α was analyzed by Pearson.@*RESULTS@#RIPK1 was weakly positively expressed in nucleus pulposus of control group, and RIPK1 protein was positively or strongly positively expressed in case group. The expression of RIPK1 mRNA in nucleus pulposus of case group was higher than that of control group (@*CONCLUSION@#The expression levels of RIPK1 mRNA and protein in the intervertebral disc tissues of LDH patients are higher than those of normal intervertebral disc tissues, and increased with the increase of Pearce grade, which may be an important factor involved in LDH inflammatory disease.

Significación clínica y aspectos microbiológicos para el diagnóstico de pacientes con Staphylococcus lugdunensis / Clinical significance and microbiological aspects for the diagnosis of patients with Staphylococcus lugdunensis

El Staphylococcus lugdunensis se manifiesta más como Staphylococcus aureus que como un típico estafilococo coagulasa negativa, especialmente por su gran virulencia y capacidad para producir infecciones supuradas. Debido al protagonismo creciente de esta especie, es propósito de esta investigación destacar la significación clínica y los aspectos microbiológicos para el diagnóstico de pacientes con dicha infección.

The Staphylococcus lugdunensis is manifested more as Staphylococcus aureus that as a typical negative coagulase staphylococcus, especially for its great virulence and capacity to produce suppurated infections. Due to the growing protagonism of this species, this investigation aims at highlighting the clinical significance and microbiological aspects for the diagnosis of patients with this infection.

Correlation between anti-mitochondrial antibodies and clinical serological and cirrhotic markers of primary biliary cholangitis / 中华消化杂志

Objective@#To explore the correlation between the level of anti-mitochondrial antibody (AMA) and clinical indicators of first visited primary biliary cholangitis (PBC) patients with positive AMA.@*Methods@#From January 2013 to December 2016, the clinical data of 1 323 patients with positive AMA and/or AMA-M2 detected for the first time were collected through the Information System of Peking University People′s Hospital. Among them, 183 were detected by indirect immunofluorescence assay, 431 were measured by immunoblotting, and 709 were determined by enzyme-linked immunosorbent assay (ELISA). Patients were divided into undiagnosed PBC group (non-PBC group, 973 cases) and newly diagnosed PBC group (new-PBC group, 350 cases including 268 cases of non-liver cirrhosis and 82 cases of liver cirrhosis); among 709 cases detected by ELISA, there were 567 cases in the non-PBC group and 142 cases in the new-PBC group (115 cases of non-liver cirrhosis PBC group and 27 cases of liver cirrhosis PBC group). Among 183 cases determined by indirect immunofluorescence assay, there were 118 cases in the non-PBC group and 65 cases in the new-PBC group. Among them 69 cases with low AMA titer (1∶40—1∶80) (53 cases of non-PBC group and 16 cases of new-PBC group), 95 cases with medium titer (1∶160—1∶320) (59 cases of non-PBC group and 36 cases of new-PBC group) and 19 cases with high titer (≥1∶640) (six cases of non-PBC group and 13 cases of new-PBC group). AMA levels among groups were compared, and its correlation with clinical serology and cirrhosis indicators of PBC including immunoglobulin (Ig)G, IgM, platelet, alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltranspeptadase (GGT), alkaline phosphatase (ALP), serum total protein, serum albumin, total bilirubin (TBil), total cholesterol (TC), and aspartate aminotransferase to platelet ratio index (APRI) and fibrosis (Fib-4) was analysed. Mann-Whitney U test, Kruskal-Wallis test, and linear regression analysis were performed for statistical analysis.@*Results@#By ELISA method, the median titer of AMA-M2 of 709 patients was 53 RU/mL, the serum AMA and AMA-M2 levels of new-PBC group were both higher than those of non-PBC group (1∶320 vs. 1∶80, 180 RU/mL vs. 47 RU/mL), and the differences were statistically significant (χ2 = 14.111, Z = -7.531, both P < 0.01). In non-PBC group, the AMA-M2 value was positively correlated with age, serum IgG, IgM, AST, GGT, ALP, serum total protein and TC, all of which were statistically significant (Rho = 0.114, 0.108, 0.337, 0.089, 0.197, 0.086, 0.121 and 0.073, all P<0.05). In new-PBC group, AMA-M2 value was positively correlated with age, IgM, serum total protein and TC, however was negatively correlated with platelet count, all of which were statistically significant (Rho = 0.218, 0.483, 0.230, 0.161, and -0.183, all P<0.05). The median values of serum AMA and AMA-M2 of PBC without liver cirrhosis group were both tended to be lower than those of PBC with liver cirrhosis (1∶160 vs. 1∶320; 174 RU/mL vs. 495 RU/mL), however the differences were not statistically significant (both P>0.05). AMA-M2 value of patients in PBC with liver cirrhosis group was positively correlated with IgM level (r = 0.38, P = 0.039), but was not correlated with APRI and Fib-4 (all P > 0.05). The median of AMA value of 183 patients who underwent indirect immunofluorescence test was 1∶160. In non-PBC group, the IgM levels of patients with low, medium and high AMA titers gradually increased (the median levels were 1.2, 1.7 and 1.8 g/L, respectively); in new-PBC group, the levels of IgM, GGT and ALP of patients with low, medium and high AMA titers gradually increased (median IgM levels were 1.5, 3.7 and 4.1 g/L, respectively; GGT levels were 144, 182 and 317 U/L, respectively; and ALP levels were 137, 168 and 221 U/L, respectively), and the differences were statistically significant (χ2 =6.260, 7.081, 8.030, 15.226, all P<0.05). In non-PBC group, the median level of serum AMA-M2 of men was lower than that of women (41 RU/L vs. 50 RU/L), and the difference was statistically significant (Z = -2.945, P = 0.003). In new-PBC group, the median level of serum AMA-M2 of men tended to be lower than that of women (113 RU/mL vs. 206 RU/mL), but the difference was not statistically significant (P=0.257).@*Conclusion@#Serum AMA level is correlated with many clinical parameters and may be related with the disease severity in patients with PBC.

Clustered Origin Of Left Coronary Artery From The Left Sinus Of Valsalva: Uncharacteristic Developmental Event In The Temporally Regulated Process

Background: The coronary artery development is a sequential and progressively regulated process. However,there are number of reports available on the disturbance to this temporal process resulting in variations of theartery. In these instances, the function of the coronary arteries was normal in providing blood supply to theheart. The normal and abnormal coronary artery development has been studied using variety of approaches andthe knowledge continues to evolve.Materials and Methods: The cadaveric specimen was obtained from the “willed body program” for the purpose ofstudent dissection. We report here an anomaly found in a 94-year old Caucasian male died of cerebral arteryinfarction.Results and Observations: We observed that the left coronary artery arose from the coronary ostium in a clusterof multiple branches. The right coronary artery arose normally from the right coronary ostium. Further dissectionshowed the co-dominant nature of the left and right coronary arteries in providing blood supply to the posterioraspect of the heart and the interventricular septum.Conclusions: Knowledge of coronary artery and its disposition is important in clinical practice especially incoronary artery stent placement, coronary artery bypass surgery and coronary sinus catheterization.

Feasibility of using three-dimensional CT reconstruction to evaluate inferior mesenteric artery types before radical resection of rectal cancer / 中国实用外科杂志

OBJECTIVE: To explore the feasibility and value of using three-dimensional CT reconstruction to evaluate the inferior mesenteric artery(IMA) classification and its characteristics in rectal cancer patients.METHODS: The clinical data of 108 rectal cancer patients admitted in Department of General Surgery, Daping Hospital of Army Military Medical University from January 2017 to November 2018 were analyzed retrospectively. The IMA images obtained by three-dimensional CT reconstruction before the operation were reviewed,the IMA was typed according to the different characteristics of IMA branches, and compared and analyzed the differences and characteristics of each IMA type. The length of IMA and the distance from the root of IMA to the bifurcation of the abdominal aorta were measured,and their associations with clinical features were analyzed.RESULTS: Of the 108 cases,60 were male and 48 were female. The IMA was classified into four types, of which 53(49.1%)were type Ⅰ,24(22.2%)were type Ⅱ,18(16.7%)were type Ⅲ,and 13(12%)were type Ⅳ. Univariate ANOVA showed that there were no statistically significant differences in age,BMI,LIMA,DIMA,number of positive lymph nodes,intraoperative blood loss and postoperative hospital stay among the patients with different IMA types(P>0.05). However,there was a statistically significant difference in IMA length between type II and type I or type Ⅲ(P=0.022 and 0.011,respectively). The average IMA length(LIMA)was(5.7±2.0)cm,and the average distance(DIMA)between the root of IMA and the bifurcation of the abdominal aorta was(6.3±2.3)cm.CONCLUSION: Three-dimensional CT angiography can be used before radical resection of rectal cancer to obtain the types of IMA branches and their pathways,so as to provide guidance for the treatment of IMA and preservation LCA in radical resection of rectal cancer.

Expression and clinical significance of plasma interleukin 17 and interleukin 21 in patients with immune related hematopathy / 中国综合临床

Objective To investigate the changes of expression levels of interleukin?17(IL?17) and interleukin?21( IL?21) secreted by helper T cells 17 before and after treatment of three immune?related hematological diseases,and to explore the clinical significance??Methods Sixty patients with IRH admitted to the Department of Hematology,the First Affiliated Hospital of Hebei North University from May 2017 to October 2018 were selected as subjects??They were divided into aplastic anemia group (24 cases),immune thrombocytopenia group (20 cases) and autoimmune hemolytic anemia group (16 cases)??Another 60 healthy volunteers who had physical examination in our hospital at the same time were selected as the control group??In the 3 IRH groups,patients were treated with glucocorticoids or immunologic agents,and the control group was given vitamin C??At the time of initial diagnosis,2 weeks and 3 months after IRH treatment,all the patients in the 4 groups were examined for blood?related indicators,and the therapeutic effects of different stages and the plasma levels of IL?17 and IL?21 in the peripheral blood of the 4 groups before and after treatment were compared??Results At the initial diagnosis,the plasma IL?17 levels in the aplastic anemia group,immune thrombocytopenia group and autoimmune hemolytic anemia group were ((196??52± 17??46), (185??69± 18??19),(126??13 ± 11??22) ng／L),respectively,which were higher than those in control group ((72??36± 10??21) ng／L), the differences were statistically significant ( all P＜0??05)??The plasma IL?21 levels in the aplastic anemia group,immune thrombocytopenia group and autoimmune hemolytic anemia group were ((136??82±20??16),(145??92±22??18),(119??66±12??69)) ng／L,respectively,which were higher than those in control group (( 84??01 ± 9??87) ng／L), and the differences were statistically significant ( all P＜0??05)??After 2 weekly treatment,the levels of IL?17 and IL?21 in the 3 groups were significantly lower than those at the first visit (all P＜0??05)??After 3 months of treatment,the levels of IL?17 and IL?21 in the 3 groups were also significantly lower than those at the first diagnosis ( IL?17: aplastic anemia group ( 84??69 ±12??15) ng／L,immune thrombocytopenia group (90??56±11??64) ng／L,autoimmune hemolytic anemia group (62??83±5??68) ng／L;IL?21: aplastic anemia group ( 96??28± 8??84) ng／L,immunological thrombocytopenia group (103??21±10??62) ng／L,autoimmune hemolytic anemia group (78??64±9??68) g／L),and the difference were statistically significant ( all P＜0??05)??There was no significant change in the control group ( 83??84 ±9??95) ng／L(P＞0??05)??After 3 months of treatment,the total effective rates of treatment in the three groups (the aplastic anemia group 83??33%( 20／24), immunological thrombocytopenia group90??00%( 18／20), autoimmune hemolytic anemia group 75??00%( 12／16)) were higher than 2 weekly treatment ( aplastic anemia group 41??67%( 10／24 ), immunological thrombocytopenia group 40??00%( 8／20 ), autoimmune hemolytic anemia group25??00%(4／16)),and the differences were statistically significant( all P ＜0??05)??Conclusion The changes of plasma IL?17 and IL?21 levels are helpful to indicate the occurrence and progression of immune?related hematopathy,to find therapeutic targets and to improve prognosis,which has important clinical significance in the clinical diagnosis,prognosis and treatment of different types of IRH??

Expression and clinical significance of plasma methylated Septin9 gene in patients with gastric cancer / 中华消化杂志

Objective To explore the expression and clinical significance of plasma methylated Septin 9 gene ( mSEPT9) in patients with gastric cancer .Methods From March to October in 2018, 380 patients visited Xijing Hospital of Digestive Diseases were selected .The patients were divided into gastric cancer (GC) group, atrophic gastritis (AG) group and non-atrophic gastritis (NAG) group.The positive expression rate of plasma circulating mSEPT9 of the three groups were detected by polymerase chain reaction (PCR) fluorescence probe method, its correlation with clinicopathological characteristics of gastric cancer were analyzed and also compared with the positive rate of carcinoembryonic antigen ( CEA), carbohydrate antigen 19-9 ( CA19-9). Chi-square test and continuity correction chi-square test were performed for statistical analysis .Results The actual number of valid samples was 357 including 147 of GC group, 83 of AG group and 127 of NAG group.The positive rate of plasma mSEPT9 of GC group was higher than those of AG group and NAG group (46.9%, 69/ 147 vs.4.8%, 4/83 and 3.9%, 5/127), and the differences were statistically significant ( χ2 ＝43.438 and 63.912, both P?0.016).The sensitivity and specificity of plasma m SEPT9 in patients with gastric cancers were 46.9%(69/147) and 95.7%(201/210), respectively.The positive rate of mSEPT9 was higher in gastric cancer patients with tumor maximum diameter over 5.0 cm, intestinal-type gastric cancer in Lauren classification, lymphatic metastasis, vascular and neurological invasion , middle-late stage (stageⅢandⅣ) in clinical classification, which were 57.6%(38/66) vs.35.6%(26/73), 52.6%(51/97) vs.31.0%(13/42), 53.0%(61/115) vs.25.0%(8/32), 55.6%(65/117) vs.13.3%(4/30), 50.8%(65/128) vs. 4/19 and 53.5%(61/114) vs.24.2%(8/33), respectively; and the differences were statistically significant (χ2 ＝6.728, 5.517, 7.905, 17.091, 5.871 and 8.998, all P?0.05).The positive rate of plasma mSEPT9 in gastric cancer patients was higher than those of CEA and CA 19-9 (46.9%, 69/147 vs.32.0%, 47/147 and 17.7%, 26/147, respectively), and the differences were statistically significant (χ2 ＝6.892 and 17.437, both P?0.016).Conclusions The positive expression of plasma m SEPT9 in gastric cancer patients has not only high sensitivity but good specificity as well , and it is also related to the clinical stage .The detection of this gene may have important clinical significance in non-invasive diagnosis and prognosis evaluation in patients with advanced gastric cancer .

Clinical significance of combined use of serum CC16 and SP-D in early diagnosis for occupational silicosis / 中国职业医学

OBJECTIVE: To study the method and significance of serum level of Clara cell protein(CC16) and surfactant protein D(SP-D) in the early diagnosis of patients with occupational silicosis. METHODS: By a convenience sampling method, 73 male patients with occupational silicosis were included in the silicosis group, 27 male workers who exposed to dust without occupational silicosis were selected as the dust exposure group, and 27 healthy men with no history of occupational dust exposure were selected as control group. The levels of serum CC16 and SP-D were detected by enzyme-linked immune sorbent assay. RESULTS: Serum levels of CC16 in patients of silicosis and dust exposure groups were significantly lower than those of the control group [(40.15±13.31) vs(53.85±11.45) mg/L,(25.2±48.18) vs(53.85±11.45) mg/L, P<0.05]. The serum level of CC16 in silicosis group was higher than that of dust exposure group [(25.24±8.18) vs(40.15±13.31) mg/L, P<0.05]. Serum level of SP-D in silicosis group was significantly higher than those in the controls and dust exposure group [(59.22±10.67) vs(49.07±9.72) mg/L,(59.22±10.67) vs(46.82±10.40) mg/L, P<0.05]. Bayes discrimination analysis was used to establish a combined diagnostic discriminant model with age, CC16 and SP-D levels. The correct rates for the control group, the dust exposure group and the silicosis group were 100.0%, 59.3% and 83.6%, respectively, and the classification accuracy was 81.9%. The discrimination effect is good. Based on the length of service, age, CC16 and SP-D levels, the Bayes discriminant analysis was used to establish a combined diagnostic discriminant model. The correct rates of the dust exposure and silicosis groups were 100.0% and 91.8%, respectively, and the classification accuracy was 94.0%. CONCLUSION: Bayes discriminant analysis combined with serum level of CC16 and SP-D is useful for the early diagnosis of occupational silicosis and improve the diagnostic accuracy.