Predicting intraoperative hemorrhage during curettage treatment of cesarean scar pregnancy using free-breathing GRASP DCE-MRI.

OBJECTIVE: To explore the feasibility of the golden-angle radial sparse parallel (GRASP) dynamic magnetic resonance imaging (MRI) technique in predicting the intraoperative bleeding risk of scar pregnancy. METHODS: A total of 49 patients with cesarean scar pregnancy (CSP) who underwent curettage and GRASP-MRI imaging were retrospectively selected between January 2021 and July 2022. The pharmacokinetic parameters, including Wash-in, Wash-out, time to peck (TTP), initial area under the curve (iAUC), the transfer rate constant (Ktrans), constant flow rate (Kep), and volume of extracellular space (Ve), were calculated. The amount of intraoperative bleeding was recorded by a gynecologist who performed surgery, after which patients were divided into non-hemorrhage (blood loss ≤ 200 mL) and hemorrhage (blood loss > 200 mL) groups. The measured pharmacokinetic parameters were statistically compared using the t-test or Mann-Whitney U test with a significant level set to be p < 0.05. The receiver operating characteristic (ROC) curve was constructed, and the area under the curve (AUC) was calculated to evaluate each parameter's capability in intraoperative hemorrhage subgroup classification. RESULTS: Twenty patients had intraoperative hemorrhage (blood loss > 200 mL) during curettage. The hemorrhage group had larger Wash-in, iAUC, Ktrans, Ve, and shorter TTP than the non-hemorrhage group (all P > 0.05). Wash-in had the highest AUC value (0.90), while Ktrans had the lowest value (0.67). Wash-out and Kep were not significantly different between the two groups. CONCLUSION: GRASP DCE-MRI has the potential to forecast intraoperative hemorrhage during curettage treatment of CSP, with Wash-in exhibiting the highest predictive performance. This data holds promise for advancing personalized treatment. However, further study is required to compare its effectiveness with other risk factors identified through anatomical MRI and ultrasound.

A Scoring System to Select the Candidates for Adjuvant Chemotherapy Alone in High-Risk Early-Stage Cervical Cancer Patients With Pelvic Lymph Node Metastases After Surgery.

BACKGROUND: The aim was to build a risk scoring system to guide the adjuvant treatment for early-stage cervical cancer patients with pelvic lymph node (LN) metastases after surgery. METHODS: A cohort of 1213 early-stage cervical cancer patients with pelvic LN metastases (T1-2aN1M0) were selected from the NCI SEER database, of which 1040 patients received adjuvant external beam radiotherapy concurrent with chemotherapy (EBRT+Chemo) and 173 patients received adjuvant chemotherapy alone. The Cox regression analysis was applied to identify the risk factors associated with worse survival. The exp (ß) of each independent risk factors from multivariate analysis was assigned to develop the risk scoring system. The total cohort was divided into different risk subgroups accordingly and the efficacy of different adjuvant modalities in each risk subgroups was compared. RESULTS: The patients were divided into 3 risk subgroups (Low-risk: total score <7.20, Middle-risk:7.20≤ total score≤ 8.40, High-risk: total score<8.40) based on the scoring system incorporating 5 independent risk factors. The survival analysis suggested that low-risk (hazard ratio [HR]=1.046, 95% CI: 0.586-1.867; P= 0.879) and middle-risk patients (HR=0.709, 95% CI: 0.459-1.096; P =0.122) could not benefit more from EBRT+Chemo than Chemo alone. However, EBRT+Chemo remained the superiority to Chemo alone in the high-risk subgroup (HR=0.482, 95% CI: 0.294-0.791; P =0.003). CONCLUSION: A risk scoring system has been built to direct the adjuvant treatment for early-stage cervical cancer patients with pelvic LN metastases after surgery, where Chemo alone was totally enough for low-risk and middle-risk patients stratified by the model while EBRT+Chemo was still recommended for patients in the high-risk subgroup.

A population-based risk scoring system to individualize adjuvant treatment for stage IIIC endometrial cancer patients after surgery.

BACKGROUND: To develop a risk scoring system to tailor the adjuvant treatment for stage IIIC EC patients after surgery. METHODS: Data source was from the Surveillance, Epidemiology, and End Results (SEER) registry, where 3251 post-operative stage IIIC EC patients with different adjuvant treatment were included. Cox regression analysis was used to identify risk factors. The exp (ß) of each independent risk factors generating from the cox analysis was used to construct the risk scoring system, which was further utilized to divide the patients into different risk subgroups and the efficacy of different adjuvant modalities in each risk subgroups would be compared accordingly. RESULTS: Six independent risk factors were identified to develop the scoring system, which further divided the patients into three risk subgroups based on the total risk score (Low-risk≤8.46, 8.47 ≤ Middle-risk≤9.94, High-risk≥9.95). This study revealed that CRT was not superior to RT alone (HR:1.208, 95%CI: 0.852-1.741; P = 0.289) or CT alone (HR:1.260, 95%CI: 0.750-2.116; P = 0.382) in Low-risk subgroup. We also observed that CRT had a survival advantage over other treatment modalities in the Middle-risk subgroup (All P < 0.001), but CRT and CT alone to be superimposable in the High-risk subgroup (HR: 1.395, 95%CI: 0.878-2.216; P = 0.159). CONCLUSION: A risk scoring system has been developed to tailor the adjuvant treatment for stage IIIC EC patients after surgery, where RT or CT alone could be a substitute for CRT in Low-risk patients and CT alone was a potential alternative for High-risk patients while CRT remained to be the optimal choice for the Middle-risk patients.

Prognostic model for the exemption of adjuvant chemotherapy in stage IIIC endometrial cancer patients.

Background: This study aimed to develop a nomogram to predict the survival for stage IIIC endometrial cancer (EC) patients with adjuvant radiotherapy (ART) alone and personalize recommendations for the following adjuvant chemotherapy (ACT). Methods: In total, 746 stage IIIC EC patients with ART alone were selected from the Surveillance, Epidemiology, and End Results (SEER) registry. Cox regression analysis was performed to identify independent risk factors. A nomogram was developed accordingly, and the area under the receiver operating characteristic curve (AUC) and C-index were implemented to assess the predictive power. The patients were divided into different risk strata based on the total points derived from the nomogram, and survival probability was compared between each risk stratus and another SEER-based cohort of stage IIIC EC patients receiving ART+ACT (cohort ART+ACT). Results: Five independent predictors were included in the model, which had favorable discriminative power both in the training (C-index: 0.732; 95% CI: 0.704-0.760) and validation cohorts (C-index: 0.731; 95% CI: 0.709-0.753). The patients were divided into three risk strata (low risk <135, 135 ≤ middle risk ≤205, and high risk >205), where low-risk patients had survival advantages over patients from cohort ART+ACT (HR: 0.45, 95% CI: 0.33-0.61, P < 0.001). However, the middle- and high-risk patients were inferior to patients from cohort ART+ACT in survival (P < 0.001). Conclusion: A nomogram was developed to exclusively predict the survival for stage IIIC EC patients with ART alone, based on which the low-risk patients might be perfect candidates to omit the following ACT. However, the middle- and high-risk patients would benefit from the following ACT.

Final examination paper analysis of Surgery and Field Surgery in five-year students from comprehensive class of Grade 2014 / 中华医学教育探索杂志

Objective@#To analyze the quality of final exam papers of Surgery and Field Surgery for five-year medical students from comprehensive class of Grade 2014, so as to check the mastery of different students, perfect the construction of item banking, verify the quality of teaching and learning, and thus provide references to further teaching reform.@*Methods@#SPSS 21.0 was used for statistical analysis of 133 Surgery and Field Surgery papers of students from comprehensive class of Grade 2014.@*Results@#The highest score was 93.5, the lowest score was 52.0, and the average score was (70.60±9.00). Among those 133 students, six students were failed, occupying 4.51%. The overall difficulty coefficient of examination paper (P) was 0.71, and P value of multiple choice questions and blank-filling questions was 0.4-0.7. Difference degrees (D) of question types were more than 0.600 and the overall reliability was 0.764. Scores of examination paper were generally in normal distribution. The average scores of students form anesthesiology major were higher than those of students from navigation medicine major, but the average scores of students from above two majors were higher than those of students from psychology major, with statistically significant differences (P<0.05).@*Conclusion@#Question types of this paper are comprehensive and reasonable. The overall difficulty is not high, the difference degree is good, the reliability is good and the score distribution is reasonable. However, the question should be further improved, focusing on the reasonable distribution of difficulty of question. In addition, we should strengthen the teaching of the course in students from psychology major.

Final examination paper analysis of Surgery and Field Surgery in five-year students from comprehensive class of Grade 2014 / 中华医学教育探索杂志

Objective To analyze the quality of final exam papers of Surgery and Field Surgery for five-year medical students from comprehensive class of Grade 2014, so as to check the mastery of different students, perfect the construction of item banking, verify the quality of teaching and learning, and thus provide references to further teaching reform. Methods SPSS 21.0 was used for statistical analysis of 133 Surgery and Field Surgery papers of students from comprehensive class of Grade 2014. Results The highest score was 93.5, the lowest score was 52.0, and the average score was (70.60 ±9.00). Among those 133 students, six students were failed, occupying 4.51％. The overall difficulty coefficient of examination paper (P) was 0.71, and P value of multiple choice questions and blank-filling questions was 0.4-0.7. Difference degrees (D) of question types were more than 0.600 and the overall reliability was 0.764. Scores of examination paper were generally in normal distribution. The average scores of students form anesthesiology major were higher than those of students from navigation medicine major, but the average scores of students from above two majors were higher than those of students from psychology major, with statistically significant differences (P<0.05). Conclusion Question types of this paper are comprehensive and reasonable. The overall difficulty is not high, the difference degree is good, the reliability is good and the score distribution is reasonable. However, the question should be further improved, focusing on the reasonable distribution of difficulty of question . In addition , we should strengthen the teaching of the course in students from psychology major.

DNA Extraction of Cast-off Cells of Fingerprints from 502 Glue Fumigated Contact Samples / 法医学杂志

OBJECTIVE@#To establish a method of fingerprint position, sample transfer and fingerprint DNA extraction in contact samples.@*METHODS@#Sixty-six cases were visualized by 502 glue fingerprint fumigation. Two methods, ordinary wipe and acetone wipe, were used to transfer cast-off cells of fingerprints from testing samples, respectively. DNA was extracted and purified by ultramicro magnetic bead kit. The data was resolved on genetic analysis after amplification.@*RESULTS@#In 33 samples, 30 samples got better STR analysis by acetone wipe method. The peak range was 1,000-4,000 RFU and peak shapes were equable. It was hard to get ideal STR typing by ordinary wipe method.@*CONCLUSION@#The samples are visualized by 502 glue fingerprint fumigation and the case-off cells are transferred by acetone wipe method. The method shows better STR analysis result, which might be a better method for forensic science practice.

Video-assisted thoracoscopic surgery for penetrating thoracic trauma / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>For penetrating thoracic trauma, there is no consensus on whether operative exploration or conservative treatment is better. In this study, we compared the clinical effect of video-assisted thoracoscopic surgery (VATS) and thoracotomy on the patients with penetrating thoracic trauma.</p><p><b>METHODS</b>From January 2000 to December 2010, 123 patients with penetrating thoracic trauma were treated in Affiliated Hospital of Chengdu University. Based on the inclusion criteria, 80 patients were enrolled and randomly assigned into VATS and thoracotomy group.</p><p><b>RESULTS</b>The operation time, amount of bleeding and drainage in VATS group were all lower than traditional operation (p < 0.05).</p><p><b>CONCLUSION</b>The results indicate that VATS has the merits of shorter operation time, non-blind area, exact surgical path and less bleeding comparing with traditional operation.</p>

Role of lymphatics in bacterial translocation from intestine in burn rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the role of lymphatics in bacterial translocation from intestine of rats with burn.</p><p><b>METHODS</b>Escherichia coli (E. coli) labeled with chloromethylbenzamidodialkylcarbocyanine (CM-DIL) were prepared. Sixty adult male Wistar rats were randomly divided into scald group and sham injury group according to the envelope method, with 30 rats in each group. Rats in both groups were gavaged with 0.5 mL fluid containing CM-DIL-labeled E. coli. Rats in scald group were inflicted with 30% TBSA deep partial-thickness scald (verified by pathological section) and resuscitated with fluid. Rats in sham injury group were sham injured by bathing in 25 degrees C water for 10 s (verified by pathological section) and also received with fluid infusion. Mesenteric lymph node (MLN), liver, mesenteric lymph fluid (MLF), and liver vein blood (LVB) were harvested at post injury hour (PIH) 2, 24, and 72. Bacteria translocation was detected with fluorescent tracing technique and bacteria culture. The endotoxin content in above-mentioned four kinds of specimens was quantitatively determined with chromogenic substrate limulus amebocyte lysate. The carrying capacity of endotoxin in MLF and LVB was calculated. Data were processed with t test or one-way analysis of variance.</p><p><b>RESULTS</b>(1) Living bacteria were in short-stick form, and they were seen moving in single or in doubles or triples in sample fluid. Dead bacteria were in irregular aggregates. Labeled bacteria in small amount were detected in sham injury group, their number peaked at PIH 24. A large amount of labeled bacteria were detected in scald group at PIH 2, which peaked at PIH 24 and decreased at PIH 72. The largest amount of labeled bacteria were found in MLN in scald group as compared to those in the other samples, and the number peaked at PIH 24 [(5872 +/- 1976) x 10(3) CFU/g], which was obviously higher than that [(216 +/- 110) x 10(3) CFU/g, t = 30.129, P = 0.000] in sham injury group. The number of bacteria decreased at PIH 72, but it was still significantly different from that in sham injury group ( t = 4.323, P = 0.000). The number of bacteria in LVB was the smallest. (2) 29 (24.2%) samples out of the 120 samples in sham injury group were positive for bacteria. 72 (60.0%) samples out of the 120 samples in scald group were positive for bacteria. No alive bacterium was detected at any time point in LVB sample in both group; the other three samples were detected with alive bacteria since PIH 2. There were more alive bacteria detected in MLN and liver as compared with the other two kinds of samples in scald group. The amount of bacteria in MLN, liver, and MLF in scald group were higher than those in sham injury group (with t value respectively 4.353, 4.354, 4.965, P values all equal to 0.000). (3) The endotoxin level in each kind of sample at each time point was obviously higher in scald group than that in sham injury group, and it peaked at PIH 2 in liver and MLF. The difference of endotoxin level among 4 kinds of samples in scald group at PIH 2 was statistically significant ( F = 258.47, P = 0.000), and the endotoxin level was higher in liver, MLN, and MLF. They were obviously higher than those in sham injury group (with t value respectively 43.378, 43.123, 22.423, P values all equal to 0.000). The endotoxin level in MLF was 9 times of that in LVB. (4) The carrying capacity of endotoxin in LVB and MLF at each time point in scald group was higher than that in sham injury group.</p><p><b>CONCLUSIONS</b>CM-DIL marked bacteria can reflect the microbial translocation condition. The lymphatic route is an important pathway for bacteria translocation.</p>

Changes in cytokine levels and CD4+/CD8+ T cells ratio in draining lymph node of burn wound.

The aim of this study was to determine the changes of cytokine levels in draining lymph fluid and the changes of CD4+/CD8+ T-cells ratio in draining lymph node of burn wound. Male Wistar rats were subjected to unilateral hind limb burn (burn limbs group) and contralateral hind limb without burn (control limbs group). On hours 6, 24, and 72 after burn, rats were killed; lymph fluid in the efferent lymph trunk of the common iliac lymph nodes (CILN) were collected; and lymph fluid Interferon-gamma (IFN-gamma), interleukin-4 (IL-4) and tumor necrosis factor-alpha (TNF-alpha) concentrations were measured by enzyme-linked immunosorbent assay. The CD4+/CD8+ T cells ratio of CILN was submitted to flow cytometry. The results showed TNF-alpha concentrations were significantly greater in the burn limbs group when compared with the control limbs group (P < .05). The IFN-gamma/IL-4 ratio was significantly lower (P < .05). The CD4+/CD8+ T-cell ratio was significantly lower on postburn hours 72 (P < .05). This study provides evidence that the burn wound can increase TNF-alpha levels and decrease IFN-gamma/ IL-4 ratio in the draining lymph fluid and decrease CD4+/CD8+ T cells ratio in the draining lymph node.

Expression of tumor necrosis factor related apoptosis inducing ligand and its receptor in thymus during early post-burn stage in rat with severe burns / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effect of tumor necrosis factor related apoptosis inducing ligand (TRAIL) and its receptor on apoptosis in thymus during early post-burn stage in rat with severe burns.</p><p><b>METHODS</b>Fifty Wistar rats were randomly divided into sham scald group (SS, n = 10) and burn group (n = 40). The apoptosis in thymus in rats was detected with annexin V/FITC-PI double staining at 4, 12, 24, 48 post-burn hours (PBH). The expression of TRAIL death receptor DR5, DR4 and its decoy receptor DcR1, DcR2 in thymus were detected by RT-PCR and Western blot at above time-points.</p><p><b>RESULTS</b>Compared with that in SS group (6.7 +/- 0.8)%, the apoptosis in the thymus in burn group started to increase at 4 PBH [(17.1 +/- 0.4)%], peaked at 12 PBH [(25.2 +/- 1.1)%], and it was still evidently higher than that in SS group at 48 PBH (P < 0.05). There was no obvious difference in the apoptosis rate in rats in burn group among all the time-points. The expression of DR5 in burn group at each time-points was significantly higher than those in SS group, while that of DcR2 shown an opposite tendency (P < 0.05). The expression of DR4, DcR1 was similar in both groups.</p><p><b>CONCLUSION</b>The marked increase in apoptosis rate in rat thymus at early post-burn stage, and the significant change in the expression of DR5 and DcR2 show that TRAIL pathway may participate in apoptosis.</p>

Hypoxic culture induces expression of sialin, a sialic acid transporter, and cancer-associated gangliosides containing non-human sialic acid on human cancer cells.

Tumor hypoxia figures heavily in malignant progression by altering the intracellular glucose metabolism and inducing angiogenic factor production, thus, selecting and expanding more aggressive cancer cell clones. Little is known, however, regarding hypoxia-induced antigenic changes in cancers. We investigated the expression of N-glycolyl sialic acid (NeuGc)-G(M2), a cancer-associated ganglioside containing non-human sialic acid, NeuGc, in human cancers. Cancer tissues prepared from patients with colon cancers frequently expressed NeuGc-G(M2), whereas it was virtually absent in nonmalignant colonic epithelia. Studies on cultured cancer cells indicated that the non-human sialic acid was incorporated from culture medium. Hypoxic culture markedly induced mRNA for a sialic acid transporter, sialin, and this accompanied enhanced incorporation of NeuGc as well as N-acetyl sialic acid. Transfection of cells with sialin gene conferred accelerated sialic acid transport and induced cell surface expression of NeuGc-G(M2). We propose that the preferential expression of NeuGc-G(M2) in cancers is closely associated with tumor hypoxia. Hypoxic culture of tumor cells induces expression of the sialic acid transporter, and enhances the incorporation of non-human sialic acid from the external milieu. A consequence of this is the acquisition of cancer-associated cell surface gangliosides, typically G(M2), containing non-human sialic acid (NeuGc), which is not endogenously synthesized through CMP-N-acetyl sialic acid hydroxylase because humans lack the gene for the synthetic enzyme. As hypoxia is associated with diminished response to radiotherapy and chemotherapy, NeuGc-G(M2) is a potential therapeutic target for hypoxic cancer cells.

Value of serum NT-proBNP in the clinical evaluation of heart failure / 中国医师进修杂志

Objective To investigate the relationships between the concentration of serum NT-proBNP,New York Heart Association(NYHA) classification,left ventricular ejection fraction((LVEF),)and the value of serum NT-proBNP in the evaluation of cardiac function and the diagnosis of chronic heart failure.Methods One hundred and two subjects were selected,including 30 healthy controls and 72 patients with heart failure.The concentration of serum NT-proBNP was determined by an automated electrochemiluminescence immunoassayan Roche Elecsys 2010.LVEF was measured by the modified Simpson′s equation with echocardiography.The diagnosis of clinical physician was considered to be the golden standard for heart failure.Results The relationships between the concentration of serum NT-proBNP and NYHA,serum NT-proBNP levels(287.7 pg/ml) was significantly higher in heart failure patients(287.7 pg/ml) than that in healthy controls 287.7 pg/ml vs (46.1 pg/ml),P

Expression and significance of TRAIL receptors in fibroblasts of hypertrophic scar / 中华整形外科杂志

<p><b>OBJECTIVE</b>To detect the expression of TRAIL receptors in fibroblasts of hypertrophic scar in the proliferative stage and explore its significance.</p><p><b>METHODS</b>30 samples of hypertrophic scar were taken from 30 burn cases in the proliferative stage. 30 samples of normal skin were taken as the control. The expressions of TRAIL receptors in the fibroblasts of hypertrophic burn scar and the normal skin were assayed by semiquantitative RT-PCR and flowcytometry.</p><p><b>RESULTS</b>The expression level of DR5 in the fibroblasts of hypertrophic burn scar is much lower than the control (P < 0.05); the expression level of DcR1 in the fibroblasts of hypertrophic burn scar is much higher than the control (P < 0.05).</p><p><b>CONCLUSIONS</b>The down-regulated DR5 expression and elevated DcR1 expressions in the fibroblasts of hypertrophic burn scar may attribute to the apoptosis change induced by TRAIL and explain the apoptosis differences between the fibroblasts of hypertrophic scar and normal skin to a certain extent.</p>

The changes in the tumor necrosis factor alpha, interleukin-6 and interleukin-8 levels in the lymph and of the dynamics of the lymphokines during shock stage of rats with major burns / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the dynamic changes in the lymphokines and the changes in tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-8 (IL-8) levels in the lymph during shock stage of rats with major burns.</p><p><b>METHODS</b>Forty-two male adult Wistar rats were randomly divided into burn resuscitation group (A, n = 18), burn non-resuscitation (B, n = 18) and the control (C, n = 6) groups. The TNF-alpha, IL-6 and IL-8 levels in the lymph were determined with radioimmunoassay at 6, 24, 48 postburn hours (PBH). The lymphokines in the mesenteric lymphatic vessels was observed at 6, 24 and 48 PBH with inverted microscopy and digital image processing, and the contraction frequency of the lymphatic was calculated. The lymph was collected by cannulation of the chylous cistern, and its speed of flow was calculated.</p><p><b>RESULTS</b>The lymphatic contents of TNF-alpha and IL-6 in both A and B groups began to increase at 6PBH, reaching the peak values at 24 PBH (TNF-alpha in A and B groups were 1.61 +/- 0.27 ug/L and 1.86 +/- 0.34 ug/L, respectively; IL-6 in A and B groups were 398 +/- 67 ng/L and 572 +/- 97 ng/L, respectively), and they were significantly higher than those in C group at each time points (P < 0.01), meanwhile there was also obvious difference in them between A and B groups (P < 0.01). The lymphatic contents of IL-8 in A and B groups began to increase at 24 PBH, and continued to increase till 48PBH (540.29 +/- 0.32 ng/L in A group, 863.48 +/- 105.16 ng/L in B group), which were evidently higher than those in C group (P < 0.01). There was significant difference in IL-8 contents between A and B groups (P < 0.01). The contraction frequency of the mesenteric lymphatic vessels in A and B groups were decreased, especially so at 24 PBH (P < 0.01). The speed of lymphatic flow in A and B groups was increased at each time points (P < 0.01). The central chylous vessels in the villi of the small intestine were extremely dilated as seen under microscope.</p><p><b>CONCLUSION</b>After burn injury, the lymphatic vessels dilated, with its motility decreased and speed of flow increased, and the contents of TNF-alpha, IL-6 and IL-8 in lymph were increased during the shock stage of burn rats. Fluid resuscitation could improve the lymph circulation.</p>