RAD21: A Key Transcriptional Regulator in the Development of Residual Liver Cancer.

Objective: Thermal ablation is a commonly used therapy for hepatocellular carcinoma (HCC). Nevertheless, inadequate ablation can lead to the survival of residual HCC, potentially causing rapid progression. The underlying mechanisms for this remain unclear. This study explores the molecular mechanism responsible for the rapid progression of residual HCC. Methods: We established an animal model of inadequate ablation in BALB/c nude mice and identified a key transcriptional regulator through high-throughput sequencing. Subsequently, we conducted further investigations on RAD21. We evaluated the expression and clinical significance of RAD21 in HCC and studied its impact on HCC cell function through various assays, including CCK-8, wound healing, Transwell migration and invasion. In vitro experiments established an incomplete ablation model verifying RAD21 expression and function. Using ChIP-seq, we determined potential molecules regulated by RAD21 and investigated how RAD21 influences residual tumor development. Results: High RAD21 expression in HCC was confirmed and correlated with low tumor cell differentiation, tumor growth, and portal vein thrombosis. Silencing RAD21 inhibited the migration, invasion, and proliferation significantly in liver cancer cells. Patients with high RAD21 levels showed elevated multiple inhibitory immune checkpoint levels and a lower response rate to immune drugs. Heat treatment intensified the malignant behavior of liver cancer cells, resulting in increased migration, invasion, and proliferation. After subjecting it to heat treatment, the results indicated elevated RAD21 levels in HCC. Differentially expressed molecules regulated by RAD21 following incomplete ablation were primarily associated with the VEGF signaling pathway, focal adhesion, angiogenesis, and hepatocyte growth factor receptor signaling pathway etc. Conclusion: The upregulation of RAD21 expression after incomplete ablation may play a crucial role in the rapid development of residual tumors and could serve as a novel therapeutic target.

Ultrasound-guided microwave ablation of soft tissue venous malformations.

OBJECTIVE: To assess the feasibility, safety, and effectiveness of microwave ablation (MWA) for soft tissue venous malformations (VMs). METHODS: We retrospectively analyzed 20 patients with symptomatic VMs in the lower extremities and trunk. MWA was performed in all 20 patients. Contrast-enhanced ultrasound (CEUS) was performed immediately and 1 month after ablation. The data on the complete ablation rate, symptom improvement, and patient satisfaction were collected. Follow-up examinations began 1 month after ablation and continued for 2 to 19 months. RESULTS: MWA was performed on 20 patients. The overall complete ablation rate was 75% (15/20). The complete ablation rate for the 11 patients with lesions <5 cm and the 9 patients with lesions >5 cm were 100% (11/11) and 44% (4/9), respectively. The complete ablation rate for the 14 patients with localized and 6 patients with extensive lesions was 93% (13/14) and 33% (2/6), respectively. Five patients had experienced incomplete ablation; 1 had a lesion >5 cm with ectopic drainage vessels, one had multiple lesions adherent to blood vessels and nerves, and three had large and extensive lesions. Thirteen patients had experienced significant improvements in clinical symptoms; 6 showed slight improvement; and 1 showed no change in symptoms. No complications or recurrences were observed. All 20 patients were satisfied with the therapeutic effect (100%). Twelve patients were significantly satisfied and 8 were slightly satisfied. CONCLUSIONS: MWA with ultrasound guidance is a safe, effective, and minimally invasive therapy for symptomatic soft tissue VMs and may be a promising approach in the future.

Ultrasound-based radiomics for predicting different pathological subtypes of epithelial ovarian cancer before surgery.

OBJECTIVE: To evaluate the value of ultrasound-based radiomics in the preoperative prediction of type I and type II epithelial ovarian cancer. METHODS: A total of 154 patients with epithelial ovarian cancer were enrolled retrospectively. There were 102 unilateral lesions and 52 bilateral lesions among a total of 206 lesions. The data for the 206 lesions were randomly divided into a training set (53 type I + 71 type II) and a test set (36 type I + 46 type II) by random sampling. ITK-SNAP software was used to manually outline the boundary of the tumor, that is, the region of interest, and 4976 features were extracted. The quantitative expression values of the radiomics features were normalized by the Z-score method, and the 7 features with the most differences were screened by using the Lasso regression tenfold cross-validation method. The radiomics model was established by logistic regression. The training set was used to construct the model, and the test set was used to evaluate the predictive efficiency of the model. On the basis of multifactor logistic regression analysis, combined with the radiomics score of each patient, a comprehensive prediction model was established, the nomogram was drawn, and the prediction effect was evaluated by analyzing the area under the receiver operating characteristic curve (AUC), calibration curve and decision curve. RESULTS: The AUCs of the training set and test set in the radiomics model and comprehensive model were 0.817 and 0.731 and 0.982 and 0.886, respectively. The calibration curve showed that the two models were in good agreement. The clinical decision curve showed that both methods had good clinical practicability. CONCLUSION: The radiomics model based on ultrasound images has a good predictive effect for the preoperative differential diagnosis of type I and type II epithelial ovarian cancer. The comprehensive model has higher prediction efficiency.

Systematic review of the predisposing, enabling, and reinforcing factors which influence nursing administration of opioids in the postoperative period.

AIM: To provide an overview of the administration of opioid analgesics by nurses when prescription is on an "as-needed" basis for postoperative pain, and to identify the important factors that determine the decisions of nurses, by using the framework of predisposing, reinforcing, and enabling causes in educational diagnosis and evaluation. METHODS: Multiple databases were searched for the period from 2000-2012. Out of a total of 1755 citations and 148 abstracts retrieved, 39 studies met the criteria for inclusion. Studies were considered eligible for review if they focused on situations or factors influencing a nurse's performance in pain assessment and the administration of opioid analgesics in postoperative pain management. RESULTS: The topics of the descriptive and qualitative studies presented four themes: (i) nurses' knowledge and attitudes about pain management; (ii) the situation of nurses' work practices in administrating range orders for opioid analgesics; (iii) factors that influenced nurses' work practices; and (iv) perceived barriers to effective pain management from the nurse's perspective. The experimental studies investigated the effects of different approaches in nurses' pain management practices in postoperative settings and their outcomes for patients. CONCLUSION: A knowledge deficit was observed to be the reason in most cases for a nurse's failure to administrate adequate analgesics for postoperative pain relief. Pain-related education for nurses is the cornerstone to improve pain management. The integration of enabling and reinforcing factors will help nurses to develop the ability to make the decision to engage in a comprehensive intervention to improve pain management and patient outcomes.

Postoperative pain experience and barriers to pain management in Chinese adult patients undergoing thoracic surgery.

AIMS: The purpose of this study was (1) to explore postoperative pain experience among Chinese thoracotomy patients during hospitalisation; (2) to identify patient-related barriers to pain management; and (3) to explore how these barriers were related to patients' pain experience. BACKGROUND: Major thoracotomy causes severe pain and extreme stress for patients. Unrelieved postoperative pain leads to high risks of postoperative complications and chronic post-thoracotomy pain syndrome, compromising the quality of life for those patients. DESIGN: Cross-sectional design. METHODS: A tertiary general hospital in mainland China was selected for this study. A total of 94 patients undergoing scheduled major thoracotomy operations participated in the study. All patients completed Brief Pain Inventory-Chinese version, the Barrier Questionnaire-Taiwan Form Surgical version and a demographic questionnaire. RESULTS: Patients suffered moderate to severe pain and experienced extremely high interferences with daily activities after major thoracotomy operation. Patients reported the four highest barrier scores in the subscale of Barrier Questionnaire-Taiwan Form Surgical version were fear of tolerance, inhibition of wound healing, time intervals and distracting the physician from treating the disease. Patient's demographic data had no significant impact on their concerns about communicating pain and using of analgesics with exception of the subscale 'fatalism' of the Barrier Questionnaire-Taiwan Form Surgical version in patients with higher education levels or patients with 'non-farmer' occupation. However, there were no significant correlations indicated either between Barrier Questionnaire-Taiwan Form Surgical version score and pain severity or pain interference. CONCLUSIONS: Patients were underexposure of pain treatment after thoracotomy operation in the study, while patients' concerns about reporting pain and using analgesics had minimal impacts on their pain experience. RELEVANCE TO CLINICAL PRACTICE: Education approach for patients is inadequate to improve the status of unrelieved postoperative pain. Appropriate pain management regime together with attentive nursing care should be provided to achieve better pain relief for Chinese patients.

[Concentration and significance of s-ICAM-1, s-VCAM-1, and vWF in the plasma of patients with rheumatic heart disease].

OBJECTIVE: To measure the concentrations of soluble intercellular adhesion molecule-1 (s-ICAM-1), soluble vascular cell adhesion molecule-1 (s-VCAM-1), and von Willebrand factor (vWF) in the plasma of patients with rheumatic heart disease (RHD), and to provide basic theory for the mechanism of valvular and myocardial damage. METHODS: The consecutive patients with RHD (n=40) and healthy people (n=40) were chosen. All blood samples were taken from the peripheral veins. s-ICAM-1, s-VCAM-1 and vWF levels in all samples were measured by enzyme-linked immunosorbant assay. RESULTS: s-ICAM-1, s-VCAM-1 and vWF levels were significantly elevated in patients with RHD compared with healthy people (P < 0.01. The level of sICAM-1 was elevated in patients with atrial fibrillation compared with patients without atrial fibrillation. CONCLUSION: The concentrations of s-ICAM-1, s-VCAM-1 and vWF levels were significantly elevated in patients with static rheumatic fever, which might be one of the pathogenic mechanisms of valvular damage, endothelial dysfunction, and myocardial damage in rheumatic heart disease.