Colorectal cancer(CRC)stands among the top prevalent cancers worldwide and holds a prominent position as a major contributor to cancer-related mortality globally.Absent in melanoma 2(AIM2),a constituent of the interfe...Colorectal cancer(CRC)stands among the top prevalent cancers worldwide and holds a prominent position as a major contributor to cancer-related mortality globally.Absent in melanoma 2(AIM2),a constituent of the interferoninducible hematopoietic interferon-inducible nuclear antigens with 200 amino acid repeats protein family,contributes to both cancer progression and inflammasome activation.Despite this understanding,the precise biological functions and molecular mechanisms governed by AIM2 in CRC remain elusive.Consequently,this study endeavors to assess AIM2’s expression levels,explore its potential antitumor effects,elucidate associated cancer-related processes,and decipher the underlying signaling pathways in CRC.Our findings showed a reduced AIM2 expression in most CRC cell lines.Elevation of AIM2 levels suppressed CRC cell proliferation and migration,altered cell cycle by inhibiting G1/S transition,and induced cell apoptosis.Further research uncovered the participation of P38 mitogen-activated protein kinase(P38MAPK)in AIM2-mediated modulation of CRC cell apoptosis and proliferation.Altogether,our achievements distinctly underscored AIM2’s antitumor role in CRC.AIM2 overexpression inhibited proliferation and migration and induced apoptosis of CRC cells via activating P38MAPK signaling pathway,indicating AIM2 as a prospective and novel therapeutic target for CRC.展开更多
In recent decades, patient-reported outcomes have become important in clinical medicine. Nowadays, health-related quality of life (HRQOL) is considered a primary outcome in many clinical trials, and it is often the ma...In recent decades, patient-reported outcomes have become important in clinical medicine. Nowadays, health-related quality of life (HRQOL) is considered a primary outcome in many clinical trials, and it is often the major criterion for judging treatment success. At the beginning of the 21st century, morbidity and mortality rates after surgery of the alimentary tract have dropped dramatically and they can no longer be considered the only outcome measures to determine the success of a surgical procedure. QOL can yield a definitely more patient-orientated measure of outcome that provides us with a more formal measure of the patient’s judgment and desires, which can influence treatment decisions. Nevertheless, despite a very large number of published papers on HRQOL, there is some skepticism on the value of HRQOL and other patientrelated outcomes. Therefore, this topic highlight aims to assess how QOL after surgery of the alimentary tract is covered in the medical literature. Different reviews have analyzed the topic according to different points of view: benign and malignant disease; curative and palliative treatment; open and minimally invasive surgical approach; traditional and newly introduced surgical procedures. This topic highlight does not aim to cover all the possible diseases or different surgical procedures, but it does describe the different approaches in order to give the reader a broad spectrum of analysis of QOL after surgery. This quick overview could stimulate the reader to form his/her own opinion about how to use this primary outcome measure.展开更多
Non-variceal upper gastrointestinal bleeding(NVUGIB)is a common gastroenterological emergency associated with significant morbidity and mortality.Gastroenterologists and other involved clinicians are generally assiste...Non-variceal upper gastrointestinal bleeding(NVUGIB)is a common gastroenterological emergency associated with significant morbidity and mortality.Gastroenterologists and other involved clinicians are generally assisted by international guidelines in its management.However,NVUGIB due to peptic ulcer disease only is mainly addressed by current guidelines,with upper gastrointestinal endoscopy being recommended as the gold standard modality for both diagnosis and treatment.Conversely,the management of rare and extraordinary rare causes of NVUGIB is not covered by current guidelines.Given they are frequently lifethreatening conditions,all the involved clinicians,that is emergency physicians,diagnostic and interventional radiologists,surgeons,in addition obviously to gastroenterologists,should be aware of and familiar with their management.Indeed,they typically require a prompt diagnosis and treatment,engaging a dedicated,patient-tailored,multidisciplinary team approach.The aim of our review was to extensively summarize the current evidence with regard to the management of rare and extraordinary rare causes of NVUGIB.展开更多
AIM: To investigate the diagnostic ability of single-shot echo-planar imaging(EPI) diffusion-weighted imaging (DWI) to differentiate between malignant and benign pancreatic lesions. METHODS: A computerized search was ...AIM: To investigate the diagnostic ability of single-shot echo-planar imaging(EPI) diffusion-weighted imaging (DWI) to differentiate between malignant and benign pancreatic lesions. METHODS: A computerized search was performed on Pub Med, MEDLINE and EMBASE up to August 2014. Nine studies(10 sets of data) with a total of 304 malignant pancreatic lesions and 188 benign pancreatic lesions were included. The characteristics of each study included the study name, year of publication, magnetic resonance modalities used, patient population, strength of field, pulse time, repetition time, echo time(TE), maximum b factor, mean age, mean body weight, fat suppression, number of benign and malignant lesions, and true positive, true negative, false positive and false negative results. All analyses were performed using Meta-Di Sc and Stata 11.0.RESULTS: The pooled sensitivity and specificity of singleshot EPI DWI were 0.83(95%CI: 0.79-0.87) and 0.77(95%CI: 0.70-0.83), respectively. The positive likelihood ratio and negative likelihood ratio were 5.09(95%CI: 2.19-11.84) and 0.23(95%CI: 0.15-0.36), respectively. The P value for the χ2 heterogeneity for all pooled estimates was < 0.05. From the fitted summary receiver operating characteristic curve, the area under the curve and Q* index were 0.89 and 0.82, respectively. Publication bias was not present(t = 0.58, P = 0.58). Meta-regression analysis indicated that fat suppression, mean age, TE, and maximum b factor were not sources of heterogeneity(all P > 0.05). CONCLUSION: Single-shot EPI DWI is useful to differentiate between malignant and benign pancreatic lesions. Lesion size ≥ 2 cm is the limit for the diagnosis of early lesions.展开更多
AIM： To study the apoptosis induced by preoperative oral 5＇-DFUR administration in gastric adenocarcinorna and its mechanism of action. METHODS： Sixty gastric cancer patients were divided randomly into three groups...AIM： To study the apoptosis induced by preoperative oral 5＇-DFUR administration in gastric adenocarcinorna and its mechanism of action. METHODS： Sixty gastric cancer patients were divided randomly into three groups （20 each group） before operation： group one： 5＇-DFUR oral administration at the dose of 800-1200mg/d for 3 - 5 d, group two： 500mg 5-FU ± 200 mg/d CF by venous drip for 3 - 5 d, group three （control group）. One or two days after chemotherapy, the patients were operated. Fas/FasL, PD-ECGF and PCNA were examined by immunohistochemistry and apoptotic tumor cells were detected by in situ TUNEL method. Fifty-four patients received gastrectomy, including 12 palliative resections and 42 radical resections. Six patients were excluded. Finally 18 cases in 5＇-DFUR group, 16 cases in CF ± 5-FU group, and 20 cases in control group were analyzed. RESULTS： There was no significant difference in patient mean age, gender, white blood cell count, haernatoglobin （HB）, thromboplastin, perioperative complication incidence, radical or palliation resection, invasion depth （T）, Iymphonode involvement （N）, metastasis （M） and TNM staging among the three groups. However, the PCNA index （PI） in 5＇-DFUR group （40.51 ± 12.62） and 5-FU ±CF group （41.12± 15.26） was significantly lower than that in control group （58.33± 15.69） （F=9.083, P= 0.000）. The apoptotic index （AI） in 5＇-DFUR group （14.39 ±9.49） and 5-FU±CF group （14.11±9.68） was significantly higher than that in control group （6.88 ± 7.37） （F= 4.409, P= 0.017）. The expression rates of Fas and FasL in group one and group three were 66.7% （12/18） and 50% （9/18）, 43.8% （7/16） and 81.3% （13/16）, 45.0% （9/20） and 85% （17/20）, respectively. The expression rate of FasL in 5＇-DFUR group was significantly lower than that in the other two groups （X^2=6.708, P= 0.035）. Meanwhile, the expression rate of PD-ECGF was significantly lower in 5＇-DFUR group （4/18, 28.6%） than in CF±5-FU group （9/16, 56.3%） and control group （13/20, 65.0%） （7,2= 7.542, P= 0.023）. The frequency of Fas expression was significantly correlated with palliative or radical resection （X^2= 7.651, P= 0.006）, invasion depth （X^2= 8.927, P= 0.003）, lymphatic spread （7,2= 4.488, P=0.034） and UICC stages （X^2=8.063, P=0.045） respectively. By the end of March 2005, 45 patients were followed up. The 0.5-, 1-, 2-, 3-year survival rates were 96%, 73%, 60%, 48%, respectively, which were related with T, N, M and Fas expression, but not with PDECGF and FasL expression. CONCLUSION： Preoperative oral 5＇-DFUR administration may induce apoptosis of gastric carcinoma cells and decrease tumor cell proliferation index, but cannot improve the prognosis of patients with gastric cancer. Downregulation of FasL and PD-ECGF expression mediated by 5＇-DFUR may be one of its anti-cancer mechanisms. Fas expression correlates with the progression of gastric carcinoma and may be an effective prognostic factor.展开更多
AIM: To investigate the effect of hepatocyte nuclear factor 4α(HNF4α) on the differentiation and transformation of hepatic stellate cells(HSCs).METHODS: By constructing the recombinant adenovirus vector expressing H...AIM: To investigate the effect of hepatocyte nuclear factor 4α(HNF4α) on the differentiation and transformation of hepatic stellate cells(HSCs).METHODS: By constructing the recombinant adenovirus vector expressing HNF4α and HNF4αshRNA vector, and manipulating HNF4α expression in HSC-T6 cells, we explored the influence of HNF4α and its induction capacity in the differentiation of rat HSCs into hepatocytes.RESULTS: With increased expression of HNF4αmediated by AdHNF4α, the relative expression of Nanog was downregulated in HSC-T6 cells(98.33 ±12.33 vs 41.33 ± 5.67, P < 0.001). Consequently, the expression of G-P-6 and PEPCK was upregulated(G-P-6:14.34 ± 3.33 vs 42.53 ± 5.87, P < 0.01; PEPCK: 10.10± 4.67 vs 56.56 ± 5.25, P < 0.001), the expression of AFP and ALB was positive, and the expression of Nanog, Type Ⅰ collagen, α-SMA, and TIMP-1 was significantly decreased. HNF4α also downregulated vimentin expression and enhanced E-cadherin expression. The ultrastructure of HNF4α-induced cells had more mitochondria and ribosomes compared with the parental cells. After silencing HNF4α expression,EPCK, E-cadherin, AFP, and ALB were downregulated and α-SMA and vimentin were upregulated.CONCLUSION: HNF4α can induce a tendency of differentiation of HSCs into hepatocyte-like cells. These findings may provide an effective way for the treatmentof liver diseases.展开更多
Objective： To investigate the chemopreventive effect of tamoxifen combined with a COX-2 selective inhibitor, celecoxib, on breast cancer in rats chemically induced by 7,12-dimethylben （a）anthracene （DMBA）. Method...Objective： To investigate the chemopreventive effect of tamoxifen combined with a COX-2 selective inhibitor, celecoxib, on breast cancer in rats chemically induced by 7,12-dimethylben （a）anthracene （DMBA）. Methods：DMBA was irrigated into the stomaches of SD female rats to build breast cancer model. A total of 120 rats were divided into four groups： control group, tamoxifen group, celecoxib group and combined group. The incidence rate, latent period, number and volume of breast cancer were detected and analyzed. Results：The tumor incidence rate of tamoxifen group （48.15%, 13/27） and celecoxib group （50.00%, 14/28） were lower than that of control group （85.71%, 24/28）, but higher than that of combined group （21.43%, 6/28）. The tumor＇s latent period of tamoxifen group （97.54±1.85 d） and celecoxib group （96.79±2.89 d） were longer than that of control group （89.50±5.99 d）, but shorter than that of combined group （103.67±3.39 d）. The average tumor number of tamoxifen group （1.77±0.73） and celecoxib group （1.71±0.61） were less than that of control group （3.50±1.62）, but more than that of combined group （1.17_＋0.42）. The average tumor volume of tamoxifen group （1.78±0.71 cm^3） and celecoxib group （2.05±1.04 cm^3） were smaller than that of control group （6.42±3.96 cm^3）, but bigger than that of combined group （0.71±0.96 cm^3） （P 〈 0.05 respectively）. Conclusion ：Celecoxib and tamoxifen are effective drugs in preventing the occurrence of rat breast cancer chemically induced by DMBA. Furthermore, combination of them has better chemopreventive effect.展开更多
Objective The peritoneal cancer index(PCI)has been used for the detailed evaluation of the peritoneal spread in tumors of a gynecologic origin and has been found to be a prognostic indicator of survival.The aim of thi...Objective The peritoneal cancer index(PCI)has been used for the detailed evaluation of the peritoneal spread in tumors of a gynecologic origin and has been found to be a prognostic indicator of survival.The aim of this study was to identify the significance of the PCI in advanced gastric cancer(AGC)with peritoneal carcinomatosis(PC).Methods From 2010 to 2018,a retrospective analysis was carried out of 60 AGC patients with PC,including 21 patients with a PCI≤13 and 39 with a PCI>13.All patients were treated with both surgery and intraoperative peritoneal hyperthermic chemotherapy(IPHC).The performance status(Karnofsky performance status),age,sex,Borromann’s classification,differentiation,depth of invasion,lymph node metastasis,PCI,extent of gastrectomy,extent of lymph node dissection,and residual tumor volume were retrospectively evaluated and correlated to survival.Results The overall 5-year survival rate was 43%and mean survival was(54.47±4.53)months.The favorable clinical prognostic indicators of survival were Borromann’s classification,differentiation,depth of invasion,PCI,and residual tumor volume on univariate analyses(P<0.05).The Cox proportional regression hazard model showed that only the volume of residual tumor and PCI were associated with postoperative survival.The median survival time was 69.76 months for patients with a PCI≤13 and 39.96 months for patients with a PCI>13.There was a significant difference in survival rate between the two group(P=0.004).Postoperative major morbidity and mortality rates were 23.81%and 4.76%in the PCI≤13 group and 43.59%and 5.12%in the PCI>13 group,respectively.Conclusion The peritoneal spread in advanced gastric cancer with peritoneal carcinomatosis can be assessed in detail using the PCI.It is also a significant prognostic factor of survival and is useful in identifying subgroups.展开更多
Goal: To evaluate the impact of iodine-131 therapy received during childhood and adolescence and correlate it with the quality of life in these patients. Methods: We studied 19 patients diagnosed with cancer in childh...Goal: To evaluate the impact of iodine-131 therapy received during childhood and adolescence and correlate it with the quality of life in these patients. Methods: We studied 19 patients diagnosed with cancer in childhood or adolescence who underwent thyroidectomy and supplemental therapy with I-131. We also recruited a control group of healthy subjects with the same demographic parameters. All patients were subjected to a scintigraphy examination of the salivary glands, and were also asked to complete a questionnaire in order to assess their overall quality of life. In addition, a more specific questionnaire for patients with head and neck cancer was also given to all study participants. Results: The quantitative and qualitative analyses of the salivary glands showed functional deficits with greater involvement of the parotid gland for volume, concentration and excretion. The right submandibular gland showed significant changes for volume in the patient group. The questionnaires made it possible to observe significant differences between the patient and control groups for symptoms such as thick saliva, dry mouth and speech problems. Conclusion: In spite of being very effective and widely used, iodine radionuclide therapy is correlated with a lower quality of life in young people.展开更多
AIM:To evaluate whether combination therapy with antitumour necrosis factor α (TNFα) antibody and Zn acetate is beneficial in dextran sodium sulphate (DSS) colitis.METHODS:Colitis was induced in CD1-Swiss mice with ...AIM:To evaluate whether combination therapy with antitumour necrosis factor α (TNFα) antibody and Zn acetate is beneficial in dextran sodium sulphate (DSS) colitis.METHODS:Colitis was induced in CD1-Swiss mice with 5% DSS for 7 d.The experimental mice were then randomised into the following subgroups:standard diet + DSS treated (induced colitis group);standard diet + DSS + subcutaneous 25 μg anti-TNFα treated group;Zn acetate treated group + DSS + subcutaneous 25 μg anti-TNFα;standard diet + DSS + subcutaneous 6.25 μg anti-TNFα treated group and Zn acetate treated group + DSS + subcutaneous 6.25 μg anti-TNFα.Each group of mice was matched with a similar group of sham control animals.Macroscopic and histological features were scored blindly.Homogenates of the colonic mucosa were assessed for myeloperoxidase activity as a biochemical marker of inflammation and DNA adducts (8OH-dG) as a measure of oxidative damage.RESULTS:DSS produced submucosal erosions,ulcers,inflammatory cell infiltration and cryptic abscesses which were reduced in both groups of mice receiving either anti-TNFα alone or combined with zinc.The effect was more pronounced in the latter group (vs Zn diet,P < 0.02).Myeloperoxidase activity (vs controls,P < 0.02) and DNA adducts,greatly elevated in the DSS fed colitis group (vs controls,P < 0.05),were significantly reduced in the treated groups,with a more remarkable effect in the group receiving combined therapy (vs standard diet,P < 0.04).CONCLUSION:DSS induces colonic inflammation which is modulated by the administration of anti-TNFα.Combining anti-TNFα with Zn acetate offers marginal benefit in colitis severity.展开更多
Objective The extent of lymph node dissection for pancreatic head cancer(PHC)is uncertain and controversial;therefore,this study evaluated whether PHC patients can benefit from different extents of lymph node dissecti...Objective The extent of lymph node dissection for pancreatic head cancer(PHC)is uncertain and controversial;therefore,this study evaluated whether PHC patients can benefit from different extents of lymph node dissection.Methods A total of 106 PHC patients underwent standard regional lymphadenectomy(SRLN;n=56,52.8%)and extended regional lymphadenectomy(ERLN;n=50,47.2%)between September 2015 and September 2019.None of the study participants had distant metastases.The median survival time and complications were compared between the two groups.Results The median survival time in the SRLN and ERLN groups was 27.01 months and 21.17 months,respectively(P=0.30).The postoperative major morbidity and mortality rates were 37.50%and 1.79%in the SRLN group,and 46.00%and 2.00%in the ERLN group,respectively.Moreover,the tumor differentiation,tumor diameter,lymph node involvement,perineural invasion,vascular invasion,and margin status all correlated with survival(P<0.05).Conclusion For PHC patients,ERLN cannot provide a significant survival benefit over SRLN.Moreover,ERLN increased morbidity and mortality,although without statistical significance.This indicates that ERLN should not be considered in PHC patients.展开更多
Objective: The aim of our study was to analyze the clinical results and prognosis for early elderly patients after surgery and to explore the rational treatment. Methods: Between January 1992 and December 2008, 98 ear...Objective: The aim of our study was to analyze the clinical results and prognosis for early elderly patients after surgery and to explore the rational treatment. Methods: Between January 1992 and December 2008, 98 early elderly breast cancer patients aged ≥ 65 years were treated with surgery, of which 52 patients received modified radical mastectomy and 46 patients received simple mastectomy. Results: Sixty-four (65.3%) patients had comorbidities including coronary heart disease, hypertension, diabetes, etc. After a median follow up of 56 months (21 to 280 months), the 5-year cumulative survival rate of breast modified radical mastectomy group and mastectomy group were 84.0% and 82.7%, separately (P = 0.653). The 5-year recurrence rate were 3.8% and 8.1%, separately (P = 0.504). Conclusion: The simple mastectomy is suitable for the treatment of early elderly breast cancer patients for its lower complication and recurrence rate. Early old women with breast cancer may be safely treated by simple mastectomy. Our findings suggest that modified radical mastectomy does not significantly increase the overall survival.展开更多
Objective To investigate the risk factors for cervical lymph node metastasis of clinically lymph node-negative(cN0)papillary thyroid carcinoma(PTC).Methods Patients and Methods:The clinicopathologic data of patients w...Objective To investigate the risk factors for cervical lymph node metastasis of clinically lymph node-negative(cN0)papillary thyroid carcinoma(PTC).Methods Patients and Methods:The clinicopathologic data of patients with cN0 PTC who underwent at least one lobectomy plus central lymph node dissection at Xuzhou Central Hospital from January 2018 to December 2020 were retrospectively collected and the risk factors of lymph node metastasis analyzed.Univariate and multivariate analyses were performed to detect the risk factors for cervical lymph node metastasis.Results A total of 312 patients with cN0 PTC were enrolled in this study.The postoperative pathology results showed that 134 patients(42.9%)had central lymph node metastasis,of whom 24(17.9%)had lateral lymph node metastasis(LLNM).The univariate analysis results showed that male gender,age<45 years,tumor diameter≥10 mm,bilateral cancer,capsule invasion,and multiple foci were associated with cervical lymph node metastasis of cN0 PTC(P<0.05).Further logistic regression analysis results showed that these factors,except age,were independent risk factors for cervical lymph node metastasis of cN0 PTC(P<0.05).The results also showed that the risk of LLNM increased with an increase in the number of positive central lymph nodes in patients with cN0 PTC(P<0.05).Conclusion Cervical lymph node metastasis of cN0 PTC is related to many factors,and a high number of positive central lymph nodes indicates a high risk of LLNM.Patients with risk factors should undergo preventive central lymph node dissection at the first surgery,and in patients with a high number of positive central lymph nodes,lateral lymph node dissection should be discreetly performed.展开更多
Objective:To study the effectiveness of Qingre Yangyin Humo prescription in preventing radioaction esophagitis and its effect on the serum radiation damage indexes.Methods:Patients with advanced esophageal cancer who ...Objective:To study the effectiveness of Qingre Yangyin Humo prescription in preventing radioaction esophagitis and its effect on the serum radiation damage indexes.Methods:Patients with advanced esophageal cancer who received radiotherapy in the First Affiliated Hospital of Bengbu Medical College between June 2015 and December 2016 were selected as the research subjects and randomly divided into two groups, the intervention group received Qingre Yangyin Humo prescription during radiotherapy, and the control group received regular intervention during radiotherapy. The incidence of radiation esophagitis within 90 days after radiotherapy was observed, and serum inflammation indexes, oxidative stress indexes and pulmonary fibrosis index were determined before radiotherapy as well as 2 weeks and 4 weeks after radiotherapy.Results: After radiotherapy, serum TNF-α, IL-1β, IL-6, IL-8, MDA, 8-OHdG, MMP9, TGF-β1 and ACE levels of both groups were significantly higher than those before radiotherapy while GPX1, T-SOD and Mn-SOD levels were significantly lower than those before radiotherapy, and serum TNF-α, IL-1β, IL-6, IL-8, MDA, 8-OHdG, MMP9, TGF-β1 and ACE levels of intervention group were significantly lower than those of control group while GPX1, T-SOD and Mn-SOD levels were significantly higher than those of control group.Conclusion:Qingre Yangyin Humo prescription can prevent the occurrence of radiation esophagitis and reduce radiation damage during radiotherapy.展开更多
BACKGROUND The incidence of Langerhans cell histiocytosis(LCH) is low, and involvement of the thyroid is even rarer, which results in high missed diagnosis or misdiagnosis rates.CASE SUMMARY We report a young woman wi...BACKGROUND The incidence of Langerhans cell histiocytosis(LCH) is low, and involvement of the thyroid is even rarer, which results in high missed diagnosis or misdiagnosis rates.CASE SUMMARY We report a young woman with a thyroid nodule. Thyroid malignancy was suggested by fine needle aspiration, but she was eventually diagnosed with multisystem LCH, thus avoiding thyroidectomy.CONCLUSION The clinical manifestations of LCH involving the thyroid are atypical, and the diagnosis depends on pathology. Surgery is the main method for treating primary thyroid LCH, while chemotherapy is the main treatment method for multisystem LCH.展开更多
Influenza pandemics are unpredictable recurrent events with global health,economic,and social consequences.The objective of this review is to provide an update on the latest developments in early diagnosis and specifi...Influenza pandemics are unpredictable recurrent events with global health,economic,and social consequences.The objective of this review is to provide an update on the latest developments in early diagnosis and specific treatment of the disease and its complications,particularly with regard to respiratory organ failure.Despite advances in treatment,the rate of mortality in the intensive care unit remains approximately 30%.Therefore,early identification of potentially severe viral pneumonia is extremely important to optimize treatment in these patients.The pathogenesis of influenza virus infection depends on viral virulence and host response.Thus,in some patients,it is associated with an excessive systemic response mediated by an authentic cytokine storm.This process leads to severe primary pneumonia and acute respiratory distress syndrome.Initial prognostication in the emergency department based on comorbidities,vital signs,and biomarkers(e.g.,procalcitonin,ferritin,human leukocyte antigen-DR,mid-regional proadrenomedullin,and lactate)is important.Identification of these biomarkers on admission may facilitate clinical decision-making to determine early admission to the hospital or the intensive care unit.These decisions are reached considering pathophysiological circumstances that are associated with a poor prognosis(e.g.,bacterial co-infection,hyperinflammation,immune paralysis,severe endothelial damage,organ dysfunction,and septic shock).Moreover,early implementation is important to increase treatment efficacy.Based on a limited level of evidence,all current guidelines recommend using oseltamivir in this setting.The possibility of drug resistance should also be considered.Alternative options include other antiviral drugs and combination therapies with monoclonal antibodies.Importantly,it is not recommended to use corticosteroids in the initial treatment of these patients.Furthermore,the implementation of supportive measures for respiratory failure is essential.Current recommendations are limited,heterogeneous,and not regularly updated.Early intubation and mechanical ventilation is the basic treatment for patients with severe respiratory failure.Prone ventilation should be promptly performed in patients with acute respiratory distress syndrome,while early tracheostomy should be considered in case of planned prolonged mechanical ventilation.Clinical trials on antiviral treatment and respiratory support measures specifically for these patients,as well as specific recommendations for different at-risk populations,are necessary to improve outcomes.展开更多
Perianal lesions are common in patients with Crohn's disease, and display aggressive behavior in some cases. An accurate diagnosis is necessary for the optimal management of perianal lesions. Treatment of perianal...Perianal lesions are common in patients with Crohn's disease, and display aggressive behavior in some cases. An accurate diagnosis is necessary for the optimal management of perianal lesions. Treatment of perianal Crohn's disease includes medical and/or surgical options. Recent discoveries in the pathogenesis of this disease have led to advances in medical and surgical therapy with good results. Perianal lesions in Crohn's disease remain a challenging aspect for both gastroenterologists and surgeons and lead to a greatly impaired quality of life for all patients affected by this disease. A multidisciplinary approach is mandatory to obtain the best results.展开更多
AIM：To clarify the role of activated Notch2 in the invasiveness of gastric cancer.METHODS：To investigate the invasiveness of silencing Notch2 gene expression,we established a Notch2small interfering RNA（siRNA） tra...AIM：To clarify the role of activated Notch2 in the invasiveness of gastric cancer.METHODS：To investigate the invasiveness of silencing Notch2 gene expression,we established a Notch2small interfering RNA（siRNA） transfected cell line using the MKN-45 gastric cancer cell line.After the successful transfection confirmed by real-time reverse transcription-polymerase chain reaction（RT-PCR） and Western blotting,migration and invasion assays were employed to evaluate the aggressiveness of the gastric cancer.RT-PCR and Western blottings were employed to confirm the down-regulation of Notch2 and to evaluate the expression of epithelial mesenchymal transition-related gene matrix metallopeptidase 9（MMP9）,Akt,p-Akt.To confirm the relationship between PI3KAkt and MMP9,the PI3K inhibitor LY294002 was used to treat MKN-45 cells.RESULTS：Notch2 expression was dramatically decreased after Notch2 siRNA transfection（100.00% ± 9.74% vs 11.61% ± 3.85%,P 〈 0.01 by qRT-PCR）.There was also a marked reduction of Notch target gene Hes1（100.00% ± 4.74% vs 61.61% ± 3.58%,P 〈 0.05） at the mRNA,indicating an inhibition of Notch signaling.Inhibition of Notch signaling was also confirmed by the marked reduction of Notch2 intracellular domain at the protein levels（100.00% ± 9.74% vs 65.61% ± 7.58%,P 〈 0.05）.Down-regulation of Notch2 by siRNA enhanced tumor cell invasion（100.00% ± 21.64% vs 162.22% ± 16.84%,P 〈 0.05） and expression of MMP9（1.56 fold,P 〈 0.05）,and activated the pro-MMP9 protein to its active form（1.48 fold,P 〈 0.05）.There was no significant difference in the protein levels of Akt between the two groups（100.00% ± 10.87% vs 96.61% ± 7.33%,P 〉 0.05）,while down-regulation of Notch2 elevated p-Akt expression（100.00% ± 9.87% vs 154.61% ± 13.10%,P 〈 0.05）.Furthermore,p-Akt and MMP9 was down-regulated in response to the inhibitor LY294002（p-Akt 100.00% ± 8.87% vs 58.27% ± 5.01%,P 〈 0.05;MMP9 100.00% ± 9.17% vs 50.03% ± 4.88%,P 〈 0.05）.CONCLUSION：Notch2 may negatively regulate cell invasion by inhibiting the PI3K-Akt signaling pathway展开更多
Advanced endoscopic imaging is revolutionizing our way on how to diagnose and treat colorectal lesions. Within recent years a variety of modern endoscopic imaging techniques was introduced to improve adenoma detection...Advanced endoscopic imaging is revolutionizing our way on how to diagnose and treat colorectal lesions. Within recent years a variety of modern endoscopic imaging techniques was introduced to improve adenoma detection rates. Those include high-definition imaging, dye-less chromoendoscopy techniques and novel, highly flexible endoscopes, some of themequipped with balloons or multiple lenses in order to improve adenoma detection rates. In this review we will focus on the newest developments in the field of colonoscopic imaging to improve adenoma detection rates. Described techniques include high-definition imaging, optical chromoendoscopy techniques, virtual chromoendoscopy techniques, the Third Eye Retroscope and other retroviewing devices, the G-EYE endoscope and the Full Spectrum Endoscopy-system.展开更多
Along with its wide anatomical distribution, somatostatin (SST) acts on multiple targets via a family of 5 receptors to produce a broad spectrum of biological effects. Therefore, a variety of peptide analogs have been...Along with its wide anatomical distribution, somatostatin (SST) acts on multiple targets via a family of 5 receptors to produce a broad spectrum of biological effects. Therefore, a variety of peptide analogs have been produced and are widely used in clinical treatment. However, because of their flaws in the structure of peptide, the clinical efficacy is limited. In this review, we summarize the structure, pharmacological effects and the potential clinical value of non-peptide SST analogs. We focus on the research and development of non-peptide SST analogs since 1998, and discuss the problems and potential prospects for non-peptide SST analogs. We believe that as more non-peptide somatostatin analogs are successfully developed, the extensive clinical application of SSTs will contribute a great deal to medical science.展开更多
基金supported by the Gusu Medical Key Talent Project of Suzhou City of China(GSWS2020005)the New Pharmaceutics and Medical Apparatuses Project of Suzhou City of China(SLJ2021007)+3 种基金the Suzhou City Key Clinical Disease Diagnosis and Treatment Technology Special Project,China(LCZX202129)Wujiang Science and Educational Health Revitalization Fund Project,Suzhou,China(WWK202015)the Scientific Research Project of Suzhou Ninth People’s Hospital,Suzhou,China(YK202008)and Suzhou“Science and Education”Youth Science and Technology Project,Suzhou,China(KJXW2020075).
文摘Colorectal cancer(CRC)stands among the top prevalent cancers worldwide and holds a prominent position as a major contributor to cancer-related mortality globally.Absent in melanoma 2(AIM2),a constituent of the interferoninducible hematopoietic interferon-inducible nuclear antigens with 200 amino acid repeats protein family,contributes to both cancer progression and inflammasome activation.Despite this understanding,the precise biological functions and molecular mechanisms governed by AIM2 in CRC remain elusive.Consequently,this study endeavors to assess AIM2’s expression levels,explore its potential antitumor effects,elucidate associated cancer-related processes,and decipher the underlying signaling pathways in CRC.Our findings showed a reduced AIM2 expression in most CRC cell lines.Elevation of AIM2 levels suppressed CRC cell proliferation and migration,altered cell cycle by inhibiting G1/S transition,and induced cell apoptosis.Further research uncovered the participation of P38 mitogen-activated protein kinase(P38MAPK)in AIM2-mediated modulation of CRC cell apoptosis and proliferation.Altogether,our achievements distinctly underscored AIM2’s antitumor role in CRC.AIM2 overexpression inhibited proliferation and migration and induced apoptosis of CRC cells via activating P38MAPK signaling pathway,indicating AIM2 as a prospective and novel therapeutic target for CRC.
文摘In recent decades, patient-reported outcomes have become important in clinical medicine. Nowadays, health-related quality of life (HRQOL) is considered a primary outcome in many clinical trials, and it is often the major criterion for judging treatment success. At the beginning of the 21st century, morbidity and mortality rates after surgery of the alimentary tract have dropped dramatically and they can no longer be considered the only outcome measures to determine the success of a surgical procedure. QOL can yield a definitely more patient-orientated measure of outcome that provides us with a more formal measure of the patient’s judgment and desires, which can influence treatment decisions. Nevertheless, despite a very large number of published papers on HRQOL, there is some skepticism on the value of HRQOL and other patientrelated outcomes. Therefore, this topic highlight aims to assess how QOL after surgery of the alimentary tract is covered in the medical literature. Different reviews have analyzed the topic according to different points of view: benign and malignant disease; curative and palliative treatment; open and minimally invasive surgical approach; traditional and newly introduced surgical procedures. This topic highlight does not aim to cover all the possible diseases or different surgical procedures, but it does describe the different approaches in order to give the reader a broad spectrum of analysis of QOL after surgery. This quick overview could stimulate the reader to form his/her own opinion about how to use this primary outcome measure.
文摘Non-variceal upper gastrointestinal bleeding(NVUGIB)is a common gastroenterological emergency associated with significant morbidity and mortality.Gastroenterologists and other involved clinicians are generally assisted by international guidelines in its management.However,NVUGIB due to peptic ulcer disease only is mainly addressed by current guidelines,with upper gastrointestinal endoscopy being recommended as the gold standard modality for both diagnosis and treatment.Conversely,the management of rare and extraordinary rare causes of NVUGIB is not covered by current guidelines.Given they are frequently lifethreatening conditions,all the involved clinicians,that is emergency physicians,diagnostic and interventional radiologists,surgeons,in addition obviously to gastroenterologists,should be aware of and familiar with their management.Indeed,they typically require a prompt diagnosis and treatment,engaging a dedicated,patient-tailored,multidisciplinary team approach.The aim of our review was to extensively summarize the current evidence with regard to the management of rare and extraordinary rare causes of NVUGIB.
基金Supported by Key Program of Scientific Research of Fujian Medical University,FMU 09ZD014
文摘AIM: To investigate the diagnostic ability of single-shot echo-planar imaging(EPI) diffusion-weighted imaging (DWI) to differentiate between malignant and benign pancreatic lesions. METHODS: A computerized search was performed on Pub Med, MEDLINE and EMBASE up to August 2014. Nine studies(10 sets of data) with a total of 304 malignant pancreatic lesions and 188 benign pancreatic lesions were included. The characteristics of each study included the study name, year of publication, magnetic resonance modalities used, patient population, strength of field, pulse time, repetition time, echo time(TE), maximum b factor, mean age, mean body weight, fat suppression, number of benign and malignant lesions, and true positive, true negative, false positive and false negative results. All analyses were performed using Meta-Di Sc and Stata 11.0.RESULTS: The pooled sensitivity and specificity of singleshot EPI DWI were 0.83(95%CI: 0.79-0.87) and 0.77(95%CI: 0.70-0.83), respectively. The positive likelihood ratio and negative likelihood ratio were 5.09(95%CI: 2.19-11.84) and 0.23(95%CI: 0.15-0.36), respectively. The P value for the χ2 heterogeneity for all pooled estimates was < 0.05. From the fitted summary receiver operating characteristic curve, the area under the curve and Q* index were 0.89 and 0.82, respectively. Publication bias was not present(t = 0.58, P = 0.58). Meta-regression analysis indicated that fat suppression, mean age, TE, and maximum b factor were not sources of heterogeneity(all P > 0.05). CONCLUSION: Single-shot EPI DWI is useful to differentiate between malignant and benign pancreatic lesions. Lesion size ≥ 2 cm is the limit for the diagnosis of early lesions.
基金Supported by Natural Science Foundation of Zhejiang Province, No. 20010536
文摘AIM： To study the apoptosis induced by preoperative oral 5＇-DFUR administration in gastric adenocarcinorna and its mechanism of action. METHODS： Sixty gastric cancer patients were divided randomly into three groups （20 each group） before operation： group one： 5＇-DFUR oral administration at the dose of 800-1200mg/d for 3 - 5 d, group two： 500mg 5-FU ± 200 mg/d CF by venous drip for 3 - 5 d, group three （control group）. One or two days after chemotherapy, the patients were operated. Fas/FasL, PD-ECGF and PCNA were examined by immunohistochemistry and apoptotic tumor cells were detected by in situ TUNEL method. Fifty-four patients received gastrectomy, including 12 palliative resections and 42 radical resections. Six patients were excluded. Finally 18 cases in 5＇-DFUR group, 16 cases in CF ± 5-FU group, and 20 cases in control group were analyzed. RESULTS： There was no significant difference in patient mean age, gender, white blood cell count, haernatoglobin （HB）, thromboplastin, perioperative complication incidence, radical or palliation resection, invasion depth （T）, Iymphonode involvement （N）, metastasis （M） and TNM staging among the three groups. However, the PCNA index （PI） in 5＇-DFUR group （40.51 ± 12.62） and 5-FU ±CF group （41.12± 15.26） was significantly lower than that in control group （58.33± 15.69） （F=9.083, P= 0.000）. The apoptotic index （AI） in 5＇-DFUR group （14.39 ±9.49） and 5-FU±CF group （14.11±9.68） was significantly higher than that in control group （6.88 ± 7.37） （F= 4.409, P= 0.017）. The expression rates of Fas and FasL in group one and group three were 66.7% （12/18） and 50% （9/18）, 43.8% （7/16） and 81.3% （13/16）, 45.0% （9/20） and 85% （17/20）, respectively. The expression rate of FasL in 5＇-DFUR group was significantly lower than that in the other two groups （X^2=6.708, P= 0.035）. Meanwhile, the expression rate of PD-ECGF was significantly lower in 5＇-DFUR group （4/18, 28.6%） than in CF±5-FU group （9/16, 56.3%） and control group （13/20, 65.0%） （7,2= 7.542, P= 0.023）. The frequency of Fas expression was significantly correlated with palliative or radical resection （X^2= 7.651, P= 0.006）, invasion depth （X^2= 8.927, P= 0.003）, lymphatic spread （7,2= 4.488, P=0.034） and UICC stages （X^2=8.063, P=0.045） respectively. By the end of March 2005, 45 patients were followed up. The 0.5-, 1-, 2-, 3-year survival rates were 96%, 73%, 60%, 48%, respectively, which were related with T, N, M and Fas expression, but not with PDECGF and FasL expression. CONCLUSION： Preoperative oral 5＇-DFUR administration may induce apoptosis of gastric carcinoma cells and decrease tumor cell proliferation index, but cannot improve the prognosis of patients with gastric cancer. Downregulation of FasL and PD-ECGF expression mediated by 5＇-DFUR may be one of its anti-cancer mechanisms. Fas expression correlates with the progression of gastric carcinoma and may be an effective prognostic factor.
基金Supported by National Natural Science Foundation of China,No.81070359
文摘AIM: To investigate the effect of hepatocyte nuclear factor 4α(HNF4α) on the differentiation and transformation of hepatic stellate cells(HSCs).METHODS: By constructing the recombinant adenovirus vector expressing HNF4α and HNF4αshRNA vector, and manipulating HNF4α expression in HSC-T6 cells, we explored the influence of HNF4α and its induction capacity in the differentiation of rat HSCs into hepatocytes.RESULTS: With increased expression of HNF4αmediated by AdHNF4α, the relative expression of Nanog was downregulated in HSC-T6 cells(98.33 ±12.33 vs 41.33 ± 5.67, P < 0.001). Consequently, the expression of G-P-6 and PEPCK was upregulated(G-P-6:14.34 ± 3.33 vs 42.53 ± 5.87, P < 0.01; PEPCK: 10.10± 4.67 vs 56.56 ± 5.25, P < 0.001), the expression of AFP and ALB was positive, and the expression of Nanog, Type Ⅰ collagen, α-SMA, and TIMP-1 was significantly decreased. HNF4α also downregulated vimentin expression and enhanced E-cadherin expression. The ultrastructure of HNF4α-induced cells had more mitochondria and ribosomes compared with the parental cells. After silencing HNF4α expression,EPCK, E-cadherin, AFP, and ALB were downregulated and α-SMA and vimentin were upregulated.CONCLUSION: HNF4α can induce a tendency of differentiation of HSCs into hepatocyte-like cells. These findings may provide an effective way for the treatmentof liver diseases.
文摘Objective： To investigate the chemopreventive effect of tamoxifen combined with a COX-2 selective inhibitor, celecoxib, on breast cancer in rats chemically induced by 7,12-dimethylben （a）anthracene （DMBA）. Methods：DMBA was irrigated into the stomaches of SD female rats to build breast cancer model. A total of 120 rats were divided into four groups： control group, tamoxifen group, celecoxib group and combined group. The incidence rate, latent period, number and volume of breast cancer were detected and analyzed. Results：The tumor incidence rate of tamoxifen group （48.15%, 13/27） and celecoxib group （50.00%, 14/28） were lower than that of control group （85.71%, 24/28）, but higher than that of combined group （21.43%, 6/28）. The tumor＇s latent period of tamoxifen group （97.54±1.85 d） and celecoxib group （96.79±2.89 d） were longer than that of control group （89.50±5.99 d）, but shorter than that of combined group （103.67±3.39 d）. The average tumor number of tamoxifen group （1.77±0.73） and celecoxib group （1.71±0.61） were less than that of control group （3.50±1.62）, but more than that of combined group （1.17_＋0.42）. The average tumor volume of tamoxifen group （1.78±0.71 cm^3） and celecoxib group （2.05±1.04 cm^3） were smaller than that of control group （6.42±3.96 cm^3）, but bigger than that of combined group （0.71±0.96 cm^3） （P 〈 0.05 respectively）. Conclusion ：Celecoxib and tamoxifen are effective drugs in preventing the occurrence of rat breast cancer chemically induced by DMBA. Furthermore, combination of them has better chemopreventive effect.
基金supported by the Department of Oncological Surgery,Xuzhou Central Hospital,Xuzhou, China
文摘Objective The peritoneal cancer index(PCI)has been used for the detailed evaluation of the peritoneal spread in tumors of a gynecologic origin and has been found to be a prognostic indicator of survival.The aim of this study was to identify the significance of the PCI in advanced gastric cancer(AGC)with peritoneal carcinomatosis(PC).Methods From 2010 to 2018,a retrospective analysis was carried out of 60 AGC patients with PC,including 21 patients with a PCI≤13 and 39 with a PCI>13.All patients were treated with both surgery and intraoperative peritoneal hyperthermic chemotherapy(IPHC).The performance status(Karnofsky performance status),age,sex,Borromann’s classification,differentiation,depth of invasion,lymph node metastasis,PCI,extent of gastrectomy,extent of lymph node dissection,and residual tumor volume were retrospectively evaluated and correlated to survival.Results The overall 5-year survival rate was 43%and mean survival was(54.47±4.53)months.The favorable clinical prognostic indicators of survival were Borromann’s classification,differentiation,depth of invasion,PCI,and residual tumor volume on univariate analyses(P<0.05).The Cox proportional regression hazard model showed that only the volume of residual tumor and PCI were associated with postoperative survival.The median survival time was 69.76 months for patients with a PCI≤13 and 39.96 months for patients with a PCI>13.There was a significant difference in survival rate between the two group(P=0.004).Postoperative major morbidity and mortality rates were 23.81%and 4.76%in the PCI≤13 group and 43.59%and 5.12%in the PCI>13 group,respectively.Conclusion The peritoneal spread in advanced gastric cancer with peritoneal carcinomatosis can be assessed in detail using the PCI.It is also a significant prognostic factor of survival and is useful in identifying subgroups.
文摘Goal: To evaluate the impact of iodine-131 therapy received during childhood and adolescence and correlate it with the quality of life in these patients. Methods: We studied 19 patients diagnosed with cancer in childhood or adolescence who underwent thyroidectomy and supplemental therapy with I-131. We also recruited a control group of healthy subjects with the same demographic parameters. All patients were subjected to a scintigraphy examination of the salivary glands, and were also asked to complete a questionnaire in order to assess their overall quality of life. In addition, a more specific questionnaire for patients with head and neck cancer was also given to all study participants. Results: The quantitative and qualitative analyses of the salivary glands showed functional deficits with greater involvement of the parotid gland for volume, concentration and excretion. The right submandibular gland showed significant changes for volume in the patient group. The questionnaires made it possible to observe significant differences between the patient and control groups for symptoms such as thick saliva, dry mouth and speech problems. Conclusion: In spite of being very effective and widely used, iodine radionuclide therapy is correlated with a lower quality of life in young people.
文摘AIM:To evaluate whether combination therapy with antitumour necrosis factor α (TNFα) antibody and Zn acetate is beneficial in dextran sodium sulphate (DSS) colitis.METHODS:Colitis was induced in CD1-Swiss mice with 5% DSS for 7 d.The experimental mice were then randomised into the following subgroups:standard diet + DSS treated (induced colitis group);standard diet + DSS + subcutaneous 25 μg anti-TNFα treated group;Zn acetate treated group + DSS + subcutaneous 25 μg anti-TNFα;standard diet + DSS + subcutaneous 6.25 μg anti-TNFα treated group and Zn acetate treated group + DSS + subcutaneous 6.25 μg anti-TNFα.Each group of mice was matched with a similar group of sham control animals.Macroscopic and histological features were scored blindly.Homogenates of the colonic mucosa were assessed for myeloperoxidase activity as a biochemical marker of inflammation and DNA adducts (8OH-dG) as a measure of oxidative damage.RESULTS:DSS produced submucosal erosions,ulcers,inflammatory cell infiltration and cryptic abscesses which were reduced in both groups of mice receiving either anti-TNFα alone or combined with zinc.The effect was more pronounced in the latter group (vs Zn diet,P < 0.02).Myeloperoxidase activity (vs controls,P < 0.02) and DNA adducts,greatly elevated in the DSS fed colitis group (vs controls,P < 0.05),were significantly reduced in the treated groups,with a more remarkable effect in the group receiving combined therapy (vs standard diet,P < 0.04).CONCLUSION:DSS induces colonic inflammation which is modulated by the administration of anti-TNFα.Combining anti-TNFα with Zn acetate offers marginal benefit in colitis severity.
文摘Objective The extent of lymph node dissection for pancreatic head cancer(PHC)is uncertain and controversial;therefore,this study evaluated whether PHC patients can benefit from different extents of lymph node dissection.Methods A total of 106 PHC patients underwent standard regional lymphadenectomy(SRLN;n=56,52.8%)and extended regional lymphadenectomy(ERLN;n=50,47.2%)between September 2015 and September 2019.None of the study participants had distant metastases.The median survival time and complications were compared between the two groups.Results The median survival time in the SRLN and ERLN groups was 27.01 months and 21.17 months,respectively(P=0.30).The postoperative major morbidity and mortality rates were 37.50%and 1.79%in the SRLN group,and 46.00%and 2.00%in the ERLN group,respectively.Moreover,the tumor differentiation,tumor diameter,lymph node involvement,perineural invasion,vascular invasion,and margin status all correlated with survival(P<0.05).Conclusion For PHC patients,ERLN cannot provide a significant survival benefit over SRLN.Moreover,ERLN increased morbidity and mortality,although without statistical significance.This indicates that ERLN should not be considered in PHC patients.
文摘Objective: The aim of our study was to analyze the clinical results and prognosis for early elderly patients after surgery and to explore the rational treatment. Methods: Between January 1992 and December 2008, 98 early elderly breast cancer patients aged ≥ 65 years were treated with surgery, of which 52 patients received modified radical mastectomy and 46 patients received simple mastectomy. Results: Sixty-four (65.3%) patients had comorbidities including coronary heart disease, hypertension, diabetes, etc. After a median follow up of 56 months (21 to 280 months), the 5-year cumulative survival rate of breast modified radical mastectomy group and mastectomy group were 84.0% and 82.7%, separately (P = 0.653). The 5-year recurrence rate were 3.8% and 8.1%, separately (P = 0.504). Conclusion: The simple mastectomy is suitable for the treatment of early elderly breast cancer patients for its lower complication and recurrence rate. Early old women with breast cancer may be safely treated by simple mastectomy. Our findings suggest that modified radical mastectomy does not significantly increase the overall survival.
文摘Objective To investigate the risk factors for cervical lymph node metastasis of clinically lymph node-negative(cN0)papillary thyroid carcinoma(PTC).Methods Patients and Methods:The clinicopathologic data of patients with cN0 PTC who underwent at least one lobectomy plus central lymph node dissection at Xuzhou Central Hospital from January 2018 to December 2020 were retrospectively collected and the risk factors of lymph node metastasis analyzed.Univariate and multivariate analyses were performed to detect the risk factors for cervical lymph node metastasis.Results A total of 312 patients with cN0 PTC were enrolled in this study.The postoperative pathology results showed that 134 patients(42.9%)had central lymph node metastasis,of whom 24(17.9%)had lateral lymph node metastasis(LLNM).The univariate analysis results showed that male gender,age<45 years,tumor diameter≥10 mm,bilateral cancer,capsule invasion,and multiple foci were associated with cervical lymph node metastasis of cN0 PTC(P<0.05).Further logistic regression analysis results showed that these factors,except age,were independent risk factors for cervical lymph node metastasis of cN0 PTC(P<0.05).The results also showed that the risk of LLNM increased with an increase in the number of positive central lymph nodes in patients with cN0 PTC(P<0.05).Conclusion Cervical lymph node metastasis of cN0 PTC is related to many factors,and a high number of positive central lymph nodes indicates a high risk of LLNM.Patients with risk factors should undergo preventive central lymph node dissection at the first surgery,and in patients with a high number of positive central lymph nodes,lateral lymph node dissection should be discreetly performed.
文摘Objective:To study the effectiveness of Qingre Yangyin Humo prescription in preventing radioaction esophagitis and its effect on the serum radiation damage indexes.Methods:Patients with advanced esophageal cancer who received radiotherapy in the First Affiliated Hospital of Bengbu Medical College between June 2015 and December 2016 were selected as the research subjects and randomly divided into two groups, the intervention group received Qingre Yangyin Humo prescription during radiotherapy, and the control group received regular intervention during radiotherapy. The incidence of radiation esophagitis within 90 days after radiotherapy was observed, and serum inflammation indexes, oxidative stress indexes and pulmonary fibrosis index were determined before radiotherapy as well as 2 weeks and 4 weeks after radiotherapy.Results: After radiotherapy, serum TNF-α, IL-1β, IL-6, IL-8, MDA, 8-OHdG, MMP9, TGF-β1 and ACE levels of both groups were significantly higher than those before radiotherapy while GPX1, T-SOD and Mn-SOD levels were significantly lower than those before radiotherapy, and serum TNF-α, IL-1β, IL-6, IL-8, MDA, 8-OHdG, MMP9, TGF-β1 and ACE levels of intervention group were significantly lower than those of control group while GPX1, T-SOD and Mn-SOD levels were significantly higher than those of control group.Conclusion:Qingre Yangyin Humo prescription can prevent the occurrence of radiation esophagitis and reduce radiation damage during radiotherapy.
基金Supported by the Zhejiang Provincial Public Welfare Research Project,No. LGF22H070008。
文摘BACKGROUND The incidence of Langerhans cell histiocytosis(LCH) is low, and involvement of the thyroid is even rarer, which results in high missed diagnosis or misdiagnosis rates.CASE SUMMARY We report a young woman with a thyroid nodule. Thyroid malignancy was suggested by fine needle aspiration, but she was eventually diagnosed with multisystem LCH, thus avoiding thyroidectomy.CONCLUSION The clinical manifestations of LCH involving the thyroid are atypical, and the diagnosis depends on pathology. Surgery is the main method for treating primary thyroid LCH, while chemotherapy is the main treatment method for multisystem LCH.
文摘Influenza pandemics are unpredictable recurrent events with global health,economic,and social consequences.The objective of this review is to provide an update on the latest developments in early diagnosis and specific treatment of the disease and its complications,particularly with regard to respiratory organ failure.Despite advances in treatment,the rate of mortality in the intensive care unit remains approximately 30%.Therefore,early identification of potentially severe viral pneumonia is extremely important to optimize treatment in these patients.The pathogenesis of influenza virus infection depends on viral virulence and host response.Thus,in some patients,it is associated with an excessive systemic response mediated by an authentic cytokine storm.This process leads to severe primary pneumonia and acute respiratory distress syndrome.Initial prognostication in the emergency department based on comorbidities,vital signs,and biomarkers(e.g.,procalcitonin,ferritin,human leukocyte antigen-DR,mid-regional proadrenomedullin,and lactate)is important.Identification of these biomarkers on admission may facilitate clinical decision-making to determine early admission to the hospital or the intensive care unit.These decisions are reached considering pathophysiological circumstances that are associated with a poor prognosis(e.g.,bacterial co-infection,hyperinflammation,immune paralysis,severe endothelial damage,organ dysfunction,and septic shock).Moreover,early implementation is important to increase treatment efficacy.Based on a limited level of evidence,all current guidelines recommend using oseltamivir in this setting.The possibility of drug resistance should also be considered.Alternative options include other antiviral drugs and combination therapies with monoclonal antibodies.Importantly,it is not recommended to use corticosteroids in the initial treatment of these patients.Furthermore,the implementation of supportive measures for respiratory failure is essential.Current recommendations are limited,heterogeneous,and not regularly updated.Early intubation and mechanical ventilation is the basic treatment for patients with severe respiratory failure.Prone ventilation should be promptly performed in patients with acute respiratory distress syndrome,while early tracheostomy should be considered in case of planned prolonged mechanical ventilation.Clinical trials on antiviral treatment and respiratory support measures specifically for these patients,as well as specific recommendations for different at-risk populations,are necessary to improve outcomes.
文摘Perianal lesions are common in patients with Crohn's disease, and display aggressive behavior in some cases. An accurate diagnosis is necessary for the optimal management of perianal lesions. Treatment of perianal Crohn's disease includes medical and/or surgical options. Recent discoveries in the pathogenesis of this disease have led to advances in medical and surgical therapy with good results. Perianal lesions in Crohn's disease remain a challenging aspect for both gastroenterologists and surgeons and lead to a greatly impaired quality of life for all patients affected by this disease. A multidisciplinary approach is mandatory to obtain the best results.
基金Supported by The National Natural Science Foundation of China,No. 30870364Fund for Key Laboratory of Digestive System Tumors,Gansu Province,No. lzujbky-2011-t03
文摘AIM：To clarify the role of activated Notch2 in the invasiveness of gastric cancer.METHODS：To investigate the invasiveness of silencing Notch2 gene expression,we established a Notch2small interfering RNA（siRNA） transfected cell line using the MKN-45 gastric cancer cell line.After the successful transfection confirmed by real-time reverse transcription-polymerase chain reaction（RT-PCR） and Western blotting,migration and invasion assays were employed to evaluate the aggressiveness of the gastric cancer.RT-PCR and Western blottings were employed to confirm the down-regulation of Notch2 and to evaluate the expression of epithelial mesenchymal transition-related gene matrix metallopeptidase 9（MMP9）,Akt,p-Akt.To confirm the relationship between PI3KAkt and MMP9,the PI3K inhibitor LY294002 was used to treat MKN-45 cells.RESULTS：Notch2 expression was dramatically decreased after Notch2 siRNA transfection（100.00% ± 9.74% vs 11.61% ± 3.85%,P 〈 0.01 by qRT-PCR）.There was also a marked reduction of Notch target gene Hes1（100.00% ± 4.74% vs 61.61% ± 3.58%,P 〈 0.05） at the mRNA,indicating an inhibition of Notch signaling.Inhibition of Notch signaling was also confirmed by the marked reduction of Notch2 intracellular domain at the protein levels（100.00% ± 9.74% vs 65.61% ± 7.58%,P 〈 0.05）.Down-regulation of Notch2 by siRNA enhanced tumor cell invasion（100.00% ± 21.64% vs 162.22% ± 16.84%,P 〈 0.05） and expression of MMP9（1.56 fold,P 〈 0.05）,and activated the pro-MMP9 protein to its active form（1.48 fold,P 〈 0.05）.There was no significant difference in the protein levels of Akt between the two groups（100.00% ± 10.87% vs 96.61% ± 7.33%,P 〉 0.05）,while down-regulation of Notch2 elevated p-Akt expression（100.00% ± 9.87% vs 154.61% ± 13.10%,P 〈 0.05）.Furthermore,p-Akt and MMP9 was down-regulated in response to the inhibitor LY294002（p-Akt 100.00% ± 8.87% vs 58.27% ± 5.01%,P 〈 0.05;MMP9 100.00% ± 9.17% vs 50.03% ± 4.88%,P 〈 0.05）.CONCLUSION：Notch2 may negatively regulate cell invasion by inhibiting the PI3K-Akt signaling pathway
文摘Advanced endoscopic imaging is revolutionizing our way on how to diagnose and treat colorectal lesions. Within recent years a variety of modern endoscopic imaging techniques was introduced to improve adenoma detection rates. Those include high-definition imaging, dye-less chromoendoscopy techniques and novel, highly flexible endoscopes, some of themequipped with balloons or multiple lenses in order to improve adenoma detection rates. In this review we will focus on the newest developments in the field of colonoscopic imaging to improve adenoma detection rates. Described techniques include high-definition imaging, optical chromoendoscopy techniques, virtual chromoendoscopy techniques, the Third Eye Retroscope and other retroviewing devices, the G-EYE endoscope and the Full Spectrum Endoscopy-system.
文摘Along with its wide anatomical distribution, somatostatin (SST) acts on multiple targets via a family of 5 receptors to produce a broad spectrum of biological effects. Therefore, a variety of peptide analogs have been produced and are widely used in clinical treatment. However, because of their flaws in the structure of peptide, the clinical efficacy is limited. In this review, we summarize the structure, pharmacological effects and the potential clinical value of non-peptide SST analogs. We focus on the research and development of non-peptide SST analogs since 1998, and discuss the problems and potential prospects for non-peptide SST analogs. We believe that as more non-peptide somatostatin analogs are successfully developed, the extensive clinical application of SSTs will contribute a great deal to medical science.
