Micellar nanostructures formed by amphiphilic polymers are prone to dissociation when the in vivo environment changes.Polyprodrug micelles can cross-link with other hydrophobic drugs through noncovalent bonds,which ha...Micellar nanostructures formed by amphiphilic polymers are prone to dissociation when the in vivo environment changes.Polyprodrug micelles can cross-link with other hydrophobic drugs through noncovalent bonds,which has the advantage of fixed structure and avoids the use of chemical cross-linking agents.In this study,we prepared a polyprodrug with hydrophobic curcumin(CUR)and hydrophilic poly(ethylene glycol)(PEG)in the main chain through a click reaction between CUR derivatives containing azide groups and di-alkynly-capped PEG.Due to the presence of benzene rings in the structure of CUR,the polyprodrug can form non-covalent cross-linked nanoparticles(NCCL-CUR NPs)through hydrophobic andπ-πstacking interaction.The structure,molecular weight,and self-assembly properties of the polyprodrug were characterized.The anti-cancer drug camptothecin(CPT)was encapsulated in the polyprodrug nanoparticles,producing dual-drug-loaded nanoparticles(abbreviated as CPT@NCCL-CUR NPs).The test results indicate that the NPs have reductive responsiveness and can release the original drugs CUR and CPT in phosphate buffer(PB)solution containing glutathione(GSH),while remaining stability in physiological environment.Cell and in vivo experiments further demonstrate that the dualdrug-loaded CPT@NCCL-CUR NPs can inhibit the growth of tumor through synergistic effects.This work provides a valuable approach for the preparation of amphiphilic polyprodrug with anti-tumor CUR as the backbone,and the stable dual-drug-loaded NPs containing both CUR and CPT through non-covalent cross-linking for synergistic therapy.展开更多
AIM:To assess the efficacy of combined transcatheter arterial chemoembolization(TACE)and percutaneous microwave coagulation therapy(PMCT)for small hepatocellular carcinoma(HCC). METHODS:Thirty-five patients with a tot...AIM:To assess the efficacy of combined transcatheter arterial chemoembolization(TACE)and percutaneous microwave coagulation therapy(PMCT)for small hepatocellular carcinoma(HCC). METHODS:Thirty-five patients with a total of 41 HCC nodules(≤3 cm in diameter)were treated with TACE followed by computed tomograghy(CT)-guided percutaneous microwave coagulation therapy(PMCT) within 1-3 wk. RESULTS:By biopsies and enhanced CT scans, complete necrosis of the tumor and 3-5 mm of the surrounding non-cancerous area were observed in 34 foci.In seven foci,incomplete necrosis of the surrounding parenchyma was observed.Serum alpha- fetoprotein(AFP)levels returned to normal 10 d after treatment in 25 patients who originally had high serum AFP levels.The follow-up period was 6-31 mo,and all patients remained alive.One patient had a recurrence in the subsegments of the liver,and another patient had a recurrence near the original lesion. CONCLUSION:Combined therapy with TACE and PMCT is a safe and effective treatment without severe complications for small HCC.展开更多
Current understanding of autoimmune pancreatitis (AIP) recognizes a histopathological subtype of the disease to fall within the spectrum of IgG4-related disease. Along with clinical, laboratory, and histopathological ...Current understanding of autoimmune pancreatitis (AIP) recognizes a histopathological subtype of the disease to fall within the spectrum of IgG4-related disease. Along with clinical, laboratory, and histopathological data, imaging plays an important role in the diagnosis and management of AIP, and more broadly, within the spectrum of IgG4-related disease. In addition to the defined role of imaging in consensus diagnostic protocols, an array of imaging modalities can provide complementary data to address specific clinical concerns. These include contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging for pancreatic parenchymal lesion localization and characterization, endoscopic retrograde and magnetic resonance cholangiopancreatography (ERCP and MRCP) to assess for duct involvement, and more recently, positron emission tomography (PET) imaging to assess for extra-pancreatic sites of involvement. While the imaging appearance of AIP varies widely, certain imaging features are more likely to represent AIP than alternate diagnoses, such as pancreatic cancer. While nonspecific, imaging findings which favor a diagnosis of AIP rather than pancreatic cancer include: delayed enhancement of affected pancreas, mild dilatation of the main pancreatic duct over a long segment, the “capsule” and “penetrating duct” signs, and responsiveness to corticosteroid therapy. Systemic, extra-pancreatic sites of involvement are also often seen in AIP and IgG4-related disease, and typically respond to corticosteroid therapy. Imaging by CT, MR, and PET also play a role in the diagnosis and monitoring after treatment of involved sites.展开更多
AIM: To evaluate the effect of portal vein thrombosis and arterioportal shunts on local tumor response in advanced cases of unresectable hepatocellular carcinoma treated by transarterial chemoembolization. METHODS: A ...AIM: To evaluate the effect of portal vein thrombosis and arterioportal shunts on local tumor response in advanced cases of unresectable hepatocellular carcinoma treated by transarterial chemoembolization. METHODS: A retrospective study included 39 patients (mean age: 66.4 years, range: 45-79 years, SD: 7) with unresectable hepatocellular carcinoma (HCC) who were treated with repetitive transarterial chemoembolization (TACE) in the period between March 2006 and October 2009. The effect of portal vein thrombosis (PVT) (in 19 out of 39 patients), the presence of arterioportal shunt (APS) (in 7 out of 39), the underlying liver pathology,Child-Pugh score, initial tumor volume, number of tumors and tumor margin definition on imaging were correlated with the local tumor response after TACE. The initial and end therapy local tumor responses were evaluated according to the response evaluation criteria in solid tumors (RECIST) and magnetic resonance imaging volumetric measurements. RESULTS: The treatment protocols were well tolerated by all patients with no major complications. Local tumor response for all patients according to RECIST criteria were partial response in one patient (2.6%), stable disease in 34 patients (87.1%), and progressive disease in 4 patients (10.2%). The MR volumetric measurements showed that the PVT, APS, underlying liver pathology and tumor margin definition were statistically significant prognostic factors for the local tumor response (P = 0.018, P = 0.008, P = 0.034 and P = 0.001, respectively). The overall 6-, 12- and 18-mo survival rates from the initial TACE were 79.5%, 37.5% and 21%, respectively. CONCLUSION: TACE may be exploited safely for palliative tumor control in patients with advanced unresectable HCC; however, tumor response is significantly affected by the presence or absence of PVT and APS.展开更多
AIM: To compare the efficacy and safety of chemoem-bolization alone or chemoembolization combined with hepatic arterial infusion chemotherapy(HAIC),including oxaliplatin(OXA),5-fluorouracil(5-FU) and folinic acid(CF),...AIM: To compare the efficacy and safety of chemoem-bolization alone or chemoembolization combined with hepatic arterial infusion chemotherapy(HAIC),including oxaliplatin(OXA),5-fluorouracil(5-FU) and folinic acid(CF),in inoperable hepatocellular carcinoma(HCC) without distant metastasis. METHODS: Eighty-four inoperable HCC patients were enrolled. Thirty-ninepatient sunderwent chemoembolization alone,and the other 45 patients underwent chemoembolization + HAIC(OXA/5-FU/CF) treatment non-randomly. The progression free survival(PFS),objective response rate(ORR),disease control rate(DCR) and adverse reactions were compared between the two groups.RESULTS: A significant difference in the ORR was observed between the chemoembolization alone and chemoembolization + HAIC groups. There was no statistically significant difference in DCR between the two groups. The median PFS(m PFS) showed a significant difference between the two groups. For patients with BCLC stage A/B disease,with or without vessel invasion,the chemoembolization + HAIC group showed better m PFS when compared to chemoembolization alone,but no significant difference was found in patients with BCLC stage C disease. The parameter of pain(grade Ⅲ-Ⅳ) in the chemoembolization + HAIC group was increased statistically. CONCLUSION: Chemoembolization combined with HAIC with OXA/5-FU/CF may be safe and more effective than chemoembolization alone for inoperable HCC patients without distant metastasis.展开更多
Atherosclerosis is a progressive human pathology that encompasses several stages of development. Endothelial dysfunction represents an early sign of lesion within the vasculature. A number of risk factors for atherosc...Atherosclerosis is a progressive human pathology that encompasses several stages of development. Endothelial dysfunction represents an early sign of lesion within the vasculature. A number of risk factors for atherosclero- sis, including hyperlipidemia, diabetes, and hypertension, target the vascular endothelium by re-programming its transcriptome. These profound alterations taking place on the chromatin rely on the interplay between sequence specific transcription factors and the epigenetic machinery. The epigenetic machinery, in turn, tailor individual transcription events key to atherogenesis to intrinsic and extrinsic insults dictating the development of atheroscle- rotic lesions. This review summarizes our current understanding of the involvement of the epigenetic machinery in endothelial injury during atherogenesis.展开更多
With the increasing clinical use of cytostatic and novel biologic targeted agents,conventional morphologic tumor burden assessments,including World Health Organization criteria and Response Evaluation Criteria in Soli...With the increasing clinical use of cytostatic and novel biologic targeted agents,conventional morphologic tumor burden assessments,including World Health Organization criteria and Response Evaluation Criteria in Solid Tumors,are confronting limitations because of their difficulties in distinguishing viable tumor from necrotic or fibrotic tissue.Therefore,the investigation for reliable quantitative biomarkers of therapeutic response such as metabolic imaging or functional imaging has been desired.In this review,we will discuss the conventional and new approaches to assess tumor burden.Since targeted therapy or locoregional therapies can induce biological changes much earlier than morphological changes,these functional tumor burden analyses are very promising.However,some of them have not gone thorough all steps for standardization and validation.Nevertheless,these new techniques and criteria will play an important role in the cancer management,and provide each patient more tailored therapy.展开更多
Objective: Physical restraint is frequently used in medical services,such as in mental health settings,intensive care units and nursing homes,but its nature varies in different institutions.By reviewing related litera...Objective: Physical restraint is frequently used in medical services,such as in mental health settings,intensive care units and nursing homes,but its nature varies in different institutions.By reviewing related literature,this study aims to clarify the concept of physical restraint in mental health nursing.Method: Three databases (PubMed,PsyclNFO and CINAHL) were retrieved,and Walker and Avant's concept analysis method was used to analyze the concept of physical restraint in mental health nursing.Results: Physical restraint is a coercive approach that enables the administration of necessary treatment by safely reducing the patient's physical movement.It should be the last option used by qualified personnel.Antecedents of physical restraint are improper behavior (violence and disturbance) of patients,medical assessment prior to implementation and legislation governing clinical usage.Consequences of physical restraint are alleviation of conflict,physical injury,mental trauma and invisible impact on the institution.Discussion: This study defined the characteristics of physical restraint in mental health nursing.The proposed concept analysis provided theoretical foundation for future studies.展开更多
Budd-Chiari syndrome(BCS)is a relatively rare clinical condition with a wide range of symptomatology,caused by the obstruction of the hepatic venous outflow.If left untreated,it has got an high mortality rate.Its mana...Budd-Chiari syndrome(BCS)is a relatively rare clinical condition with a wide range of symptomatology,caused by the obstruction of the hepatic venous outflow.If left untreated,it has got an high mortality rate.Its management is based on a step-wise approach,depending on the clinical presentation,and includes different treatment from anticoagulation therapy up to Interventional Radiology techniques,such as transjugular intrahepatic portosystemic shunt(TIPS).TIPS is today considered a safe and highly effective treatment and should be recommended for BCS patients,including those awaiting orthotopic liver transplantation.In this review the pathophysiology,diagnosis and treatment options of BCS are presented,with a special focus on published data regarding the techniques and outcomes of TIPS for the treatment of BCS.Moreover,unresolved issues and future research will be discussed.展开更多
Hepatocellular carcinoma(HCC)is one of the most common types of malignant tumor.Although radical surgery and liver transplantation are possible cures for the disease,most patients are beyond the optimum stage for radi...Hepatocellular carcinoma(HCC)is one of the most common types of malignant tumor.Although radical surgery and liver transplantation are possible cures for the disease,most patients are beyond the optimum stage for radical treatment at the time of diagnosis.Transarterial chemoembolization(TACE)is the first choice of treatment for advanced HCC.Owing to the widespread use of conventional TACE(cTACE),the problems with this treatment cannot be ignored.Drug-eluting beads(DEBs),a new type of embolization material,appear to overcome the problems of cTACE,and they have other advantages such as synchronous controlled continuous drug release after chemotherapy and embolization and low blood concentrations after treatment.This review summarizes the recent advances in the use of DEB-TACE to treat HCC.展开更多
Intermedin/adrenomedullin-2(IMD/AM2), a member of the calcitonin gene-related peptide/AM family,plays an important role in protecting the cardiovascular system. However, its role in the enhanced sympathoexcitation in ...Intermedin/adrenomedullin-2(IMD/AM2), a member of the calcitonin gene-related peptide/AM family,plays an important role in protecting the cardiovascular system. However, its role in the enhanced sympathoexcitation in obesity-related hypertension is unknown. In this study, we investigated the effects of IMD in the paraventricular nucleus(PVN) of the hypothalamus on sympathetic nerve activity(SNA), and lipopolysaccharide(LPS)-induced sympathetic activation in obesity-related hypertensive(OH)rats induced by a high-fat diet for 12 weeks. Acute experiments were performed under anesthesia. The dynamic alterations of sympathetic outflow were evaluated as changes in renal SNA and mean arterial pressure(MAP) in response to specific drugs. Male rats were fed a control diet(12% kcal as fat) or a high-fat diet(42% kcal as fat) for 12 weeks to induce OH. The results showed that IMD protein in the PVN was downregulated, but Toll-like receptor 4(TLR4) and plasma norepinephrine(NE, indicating sympathetic hyperactivity) levels, and systolic blood pressure were increased in OH rats. LPS(0.5 lg/50 nL)-induced enhancement of renal SNA and MAP was greater in OH rats than in obese or control rats. Bilateral PVN microinjection of IMD(50 pmol)caused greater decreases in renal SNA and MAP in OH rats than in control rats, and inhibited LPS-induced sympatheticactivation, and these were effectively prevented in OH rats by pretreatment with the AM receptor antagonist AM22-52.The mitogen-activated protein kinase/extracellular signalregulated kinase(ERK) inhibitor U0126 in the PVN partially reversed the LPS-induced enhancement of SNA. However,IMD in the PVN decreased the LPS-induced ERK activation,which was also effectively prevented by AM22-52. Chronic IMD administration resulted in significant reductions in the plasma NE level and blood pressure in OH rats. Moreover,IMD lowered the TLR4 protein expression and ERK activation in the PVN, and decreased the LPS-induced sympathetic overactivity. These results indicate that IMD in the PVN attenuates SNA and hypertension, and decreases the ERK activation implicated in the LPS-induced enhancement of SNA in OH rats, and this is mediated by AM receptors.展开更多
Objective To investigate the efficacy, safety, and associated mechanisms of injected ozonated saline in the treatment of VX2 tumors. Methods A total of 90 rabbits bearing VX2 tumors on their left hind legs were random...Objective To investigate the efficacy, safety, and associated mechanisms of injected ozonated saline in the treatment of VX2 tumors. Methods A total of 90 rabbits bearing VX2 tumors on their left hind legs were randomly divided into three groups. The control group(A) received normal saline, while groups B and C received 20 μg/mL and 40 μg/mL O_3/O_2 ozonated saline, respectively. Rabbits were anesthetized and 2 mL of blood was drawn directly from the heart to measure serum concentrations of interleukin(IL-6) and tumor necrosis factor(TNF-α). The skin covering the VX2 tumor was cut in each rabbit and the maximum and vertical diameters of the tumors were measured under direct visualization. Several milliliters of saline, saline pre-treated with 20 μg/mL O_3/O_2, or saline pre-treated with 40 μg/mL O_3/O_2 were directly injected into the tumors of groups A, B, and C, respectively(injection volume(milliliter) =1/2 volume of the tumor, V = 1/2ab^2). On days 4, 8 and 12 following treatment, 10 rabbits were randomly selected from each group for blood sample collection, and serum IL-6 and TNF-α were measured. The tumor growth rate was calculated by measuring the maximum and vertical diameters of the VX2 tumors under direct visualization. All selected rabbits were euthanized and the tumors, livers, and lungs were removed for pathological examination. The tumor necrosis rate was calculated by cutting the tumors into half along the longitudinal axis and measuring the maximum diameters of the intratumoral necrotic regions. Results The average tumor volume in the three groups increased to different degrees at each time point; however, the average tumor growth rates in groups B and C were substantially lower than that in group A, exhibiting a statistically significant difference. The difference in the tumor growth rate between group B and group C was not statistically significant. The serum concentrations of IL-6 and TNF-α increased in the three groups at each time point, with larger increases occurring in groups B and C; however, the greater increases did not reach statistical significance. Although the diameters of the necrotic areas were larger in both groups B and C than that in group A, significant differences in necrotic area diameters were only found when comparing groups A and C on days 4 and 12 following treatment. Conclusion Direct injection of different concentrations of ozonated saline into VX2 tumors significantly increased intratumoral necrosis and reduced the tumor growth rate. The associated mechanism may be partially mediated by IL-6 and TNF-α, as the serum concentrations of these molecules increased after the treatment.展开更多
AIM To determine a panel of serum micro RNAs(mi RNAs) that could be used as novel biomarkers for diagnosis of hepatocellular carcinoma(HCC).METHODS We initially screened 9 out of 754 serum mi RNAs by Taq Man Low Densi...AIM To determine a panel of serum micro RNAs(mi RNAs) that could be used as novel biomarkers for diagnosis of hepatocellular carcinoma(HCC).METHODS We initially screened 9 out of 754 serum mi RNAs by Taq Man Low Density Array in two pooled samples respectively from 35 HCC and 35 normal controls, and then validated individually by RT-qP CR in another 114 patients and 114 controls arranged in two phases. The changes of the selected mi RNAs after operation and their prognostic value were examined.RESULTS miR-375, miR-10 a, miR-122 and miR-423 were found to be significantly higher in HCC than in controls(P < 0.0001), and the area under the receiver-operating-characteristic curve for the 4-miR NA panel was 0.995(95%CI: 0.985-1). All the four mi RNAs were significantly reduced after surgical removal of the tumors(P < 0.0001), while still higher than normal controls(at least P < 0.05)CONCLUSION The four serum miR NAs(miR-375, miR-10 a, miR-122 and miR-423) could potentially serve as novel biomarkers for the diagnostic and prognostic of HCC.展开更多
BACKGROUND In early gastric cancer(GC),tumor markers are increased in the blood.The levels of these markers have been used as important indexes for GC screening,early diagnosis and prognostic evaluation.However,specif...BACKGROUND In early gastric cancer(GC),tumor markers are increased in the blood.The levels of these markers have been used as important indexes for GC screening,early diagnosis and prognostic evaluation.However,specific tumor markers have not yet been discovered.Diagnosis based on a single tumor marker has limited significance.The detection rate of GC is still very low.AIM To improve the diagnostic value of blood markers for GC.METHODS We used a multiparameter joint analysis of 77 indexes of malignant GC and gastric polyp(GP),64 indexes of GC and healthy controls(Ctrls).RESULTS By analyzing the data,there are 27 indexes in the final Ctrls vs GC with P values<0.01,the area under the curve(AUC)of albumin is the largest in Ctrls vs GC,and the AUC was 0.907.30 indexes in GP vs GC have P values<0.01.Among them,the D-dimer showed an AUC of 0.729.The 27 indexes in Ctrls vs GC and 30 indexes in GP vs GC were used for binary logistic regression,discriminant analysis,classification tree analysis and artificial neural network analysis model.For the ability to distinguish between Ctrls vs GC,GP vs GC,artificial neural networks had better diagnostic value when compared with classification tree,binary logistic regression,and discriminant analysis.When compared Ctrl and GC,the overall prediction accuracy was 92.9%,and the AUC was 0.992(0.980,1.000).When compared GP and GC,the overall prediction accuracy was 77.9%,and the AUC was 0.969(0.948,0.990).CONCLUSION The diagnostic effect of multi-parameter joint artificial neural networks analysis is significantly better than the single-index test diagnosis,and it may provide an assistant method for the detection of GC.展开更多
AIM: To analyze the results of ultrasound guided percu- taneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the treatment of splenic abscess. METHODS: Thirty-six patients (14 females and 22 mal...AIM: To analyze the results of ultrasound guided percu- taneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the treatment of splenic abscess. METHODS: Thirty-six patients (14 females and 22 males, with an average age of 54.1 ± 14.1 years) with splenic abscess were treated with ultrasound guided PNA and/or PCD. Patients with splenic abscess < 50 mm in diameter were initially treated by PNA and those with abscess ≥ 50 mm and bilocular abscesses were initially treated by an 8-French catheter drainage. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, and mortality rates were analyzed. RESULTS: Twenty-seven patients had unilocular and 9 bilocular abscess. PNA was performed in 19 patients (52.8%), and 8 of them (42.1%) required PCD because of recurrence of abscess. In 17 patients (47.2%), PCD was performed initially. PCD was performed twice in six patients and three times in two. PNA was defi nitive treatment for 10 and PCD for 21 patients. One patient with PCD was referred for splenectomy, with successful outcome. In all 4 deceased patients, malignancy was the underlying condition. Twenty-one patients (58.3%) underwent 33 surgical interventions on abdomen before treatment. Cultures were positive in 30 patients (83.3%). Gram-negative bacillus predominated (46.7%). There were no complications related to the procedure. CONCLUSION: Percutaneous treatmnet of splenic abscess is an effective alternative to surgery, allowing preservation of the spleen. This treatment is especially indicative for the patients in critical condition postoperatively. We recommend PNA as primary treatment for splenic abscesses < 50 mm, and PCD for those ≥ 50 mm in diameter and for bilocular abscesses.展开更多
Objective To evaluate the rates of wound healing and limb preservation following angiosome-targeted infrapopliteal endovascular revascularization in the treatment of diabetic limb ischemia. Methods We performed a retr...Objective To evaluate the rates of wound healing and limb preservation following angiosome-targeted infrapopliteal endovascular revascularization in the treatment of diabetic limb ischemia. Methods We performed a retrospective analysis of data gathered from 102 infrapopliteal angioplasty cases(60 males and 42 females; mean age, 72 ± 11 years) with Fontaine IV ischemia(ankle-brachial index, ABI: 0.16 ± 0.06). Forty-seven angioplasties were performed based on the angiosome concept(direct revascularization, DR), while 55 did not incorporate the angiosome concept(indirect revascularization, IR). The curative effects of angioplasty were assessed by postoperative determinations of ABI performed every 3 months during clinical follow-up visits conducted to assess healing of the ischemic wound. Amputation and death events were recorded throughout the study. Results All 102 patients were successfully revascularized without complications, and during a mean follow-up period of 18 ± 11 months, the mean postoperative ABI improved to 0.84 ± 0.10. The postoperative 6 and 12 month healing rates in the DR group were 85.1% and 93.5%, respectively, while the limb-salvage rates were 100% and 93.5%, respectively. The postoperative 6 and 12 month healing rates in the IR group were 60% and 76.4%, respectively, while the limb-salvage rates were 90.1%, and 85.5%, respectively. Conclusion Angiosome-based Infrapopliteal angioplasty was associated with better wound healing and higher rates of limb salvage in cases of critical diabetic foot ischemia. Revascularization should be provided to patients who have undergone indirect perfusion of the ischemic angiosome, as acceptable rates of limb salvage are obtained.展开更多
BACKGROUND In hepatocellular carcinoma(HCC),abnormal expression of multiple micro RNAs(miRNAs)has been shown to be involved in the malignant biological behavior of liver cancer.The vast majority of liver cancer cases ...BACKGROUND In hepatocellular carcinoma(HCC),abnormal expression of multiple micro RNAs(miRNAs)has been shown to be involved in the malignant biological behavior of liver cancer.The vast majority of liver cancer cases in China are closely related to hepatitis B virus(HBV)infection,but there are few studies on the changes of miRNA expression in the progression from HBV infection to hepatoma.AIM To explore the role of miRNAs in the progression of HBV infection to cirrhosis and even to liver cancer.METHODS We screened differentially expressed miRNAs in 40 HBV cirrhosis,40 normal and15 HCC tissues by using a Taq Man Low Density Array and real time quantitative polymerase chain reaction.To evaluate the power of the selected miRNAs to predict disease,we calculated the area under the receiver-operating-characteristic curves.The overall survival of HBV cirrhosis patients was analyzed via KaplanMeier analysis.RESULTS The levels of miR-375,miR-122 and miR-143 were significantly lower in HBV cirrhosis tissues,while miR-224 was significantly higher than in the controls(P<0.0001).The area under the curves of the receiver-operating-characteristic curve for the 4-miRNA panel was 0.991(95%CI:0.974-1).Patients with a lower expression level of miR-224 or higher expression levels of miR-375,miR-122 and miR-143 had longer overall survival.CONCLUSIONThe four miRNAs(miR-375,miR-122,miR-143 and miR-224)may be helpful for early diagnosis of HBV infection,HBV cirrhosis,and prediction of its overall survival.展开更多
AIM To investigate the value of multiparameter joint analysis in the early diagnosis of gastric cancer(GC) in clinical practice.METHODS Concentrations of CEA, CA724 and three kinds of cytokines(TNF-α, IL-6 and IL-8) ...AIM To investigate the value of multiparameter joint analysis in the early diagnosis of gastric cancer(GC) in clinical practice.METHODS Concentrations of CEA, CA724 and three kinds of cytokines(TNF-α, IL-6 and IL-8) in 176 GC patients, 117 atypical hyperplasia patients, and 204 healthy control individuals were used for building the diagnostic model, then 58 GC patients, 41 atypical hyperplasia patients, and 66 healthy control individuals were enrolled independently. The joints of the indicators were analyzed by binary logistic regression analysis method.RESULTS For discriminating the healthy control group and the GC group, IL-6 had the best diagnostic value, and the area under curve(AUC) of joint analysis was 0.95(0.93-0.97). For the early stage and advanced stage GC, the AUC were 0.95(0.92-0.98) and 0.95(0.92-0.97). For discriminating the atypical hyperplasia group and GC group, CA724 had the best diagnostic value, and the AUC of joint analysis was 0.97(0.95-0.99). For the early stage and advanced stage GC groups, the AUC were 0.98(0.96-0.99) and 0.96(0.94-0.98). After evaluation, for discriminating the GC, early stage GC and advanced cancer group from the healthy control group, the diagnostic sensitivity was 89.66%, 84.21% and 92.31%, respectively, and the specificity was 92.42%, 90.91% and 90.91%. For discriminating the GC, early stage GC and advanced cancer groups from the atypical hyperplasia group, the diagnostic sensitivity was 87.93%, 78.95% and 92.31%, respectively, and the specificity was 87.80%, 85.37% and 90.24%.CONCLUSION We have built a diagnostic model including CEA, CA724, IL-6, IL-8, and TNF-α. It may provide potential assistance as a screening method for the early detection of GC.展开更多
BACKGROUND The incidence rate of breast cancer has exceeded that of lung cancer,and it has become the most malignant type of cancer in the world.BI-RADS 4 breast nodules have a wide range of malignant risks and are as...BACKGROUND The incidence rate of breast cancer has exceeded that of lung cancer,and it has become the most malignant type of cancer in the world.BI-RADS 4 breast nodules have a wide range of malignant risks and are associated with challenging clinical decision-making.AIM To explore the diagnostic value of artificial intelligence(AI)automatic detection systems for BI-RADS 4 breast nodules and to assess whether conventional ultrasound BI-RADS classification with AI automatic detection systems can reduce the probability of BI-RADS 4 biopsy.METHODS A total of 107 BI-RADS breast nodules confirmed by pathology were selected between June 2019 and July 2020 at Hwa Mei Hospital,University of Chinese Academy of Sciences.These nodules were classified by ultrasound doctors and the AI-SONIC breast system.The diagnostic values of conventional ultrasound,the AI automatic detection system,conventional ultrasound combined with the AI automatic detection system and adjusted BI-RADS classification diagnosis were statistically analyzed.RESULTS Among the 107 breast nodules,61 were benign(57.01%),and 46 were malignant(42.99%).The pathology results were considered the gold standard;furthermore,the sensitivity,specificity,accuracy,Youden index,and positive and negative predictive values were 84.78%,67.21%,74.77%,0.5199,66.10%and 85.42%for conventional ultrasound BI-RADS classification diagnosis,86.96%,75.41%,80.37%,0.6237,72.73%,and 88.46%for automatic AI detection,80.43%,90.16%,85.98%,0.7059,86.05%,and 85.94%for conventional ultrasound BI-RADS classification with automatic AI detection and 93.48%,67.21%,78.50%,0.6069,68.25%,and 93.18%for adjusted BI-RADS classification,respectively.The biopsy rate,cancer detection rate and malignancy risk were 100%,42.99%and 0%and 67.29%,61.11%,and 1.87%before and after BI-RADS adjustment,respectively.CONCLUSION Automatic AI detection has high accuracy in determining benign and malignant BI-RADS 4 breast nodules.Conventional ultrasound BI-RADS classification combined with AI automatic detection can reduce the biopsy rate of BI-RADS 4 breast nodules.展开更多
基金supported by the National Natural Science Foundation of China(No.21975169)the Project Fund of the Priority Academic Program Development(PAPD)of Jiangsu Higher Education Institutions+2 种基金the Key Laboratory of Polymeric Materials Design and Synthesis for Biomedical Function of Soochow Universitythe Research project of China Baoyuan Investment Co.,Ltd.Suzhou Science and Technology Plan Project(No.SKY2023051)。
文摘Micellar nanostructures formed by amphiphilic polymers are prone to dissociation when the in vivo environment changes.Polyprodrug micelles can cross-link with other hydrophobic drugs through noncovalent bonds,which has the advantage of fixed structure and avoids the use of chemical cross-linking agents.In this study,we prepared a polyprodrug with hydrophobic curcumin(CUR)and hydrophilic poly(ethylene glycol)(PEG)in the main chain through a click reaction between CUR derivatives containing azide groups and di-alkynly-capped PEG.Due to the presence of benzene rings in the structure of CUR,the polyprodrug can form non-covalent cross-linked nanoparticles(NCCL-CUR NPs)through hydrophobic andπ-πstacking interaction.The structure,molecular weight,and self-assembly properties of the polyprodrug were characterized.The anti-cancer drug camptothecin(CPT)was encapsulated in the polyprodrug nanoparticles,producing dual-drug-loaded nanoparticles(abbreviated as CPT@NCCL-CUR NPs).The test results indicate that the NPs have reductive responsiveness and can release the original drugs CUR and CPT in phosphate buffer(PB)solution containing glutathione(GSH),while remaining stability in physiological environment.Cell and in vivo experiments further demonstrate that the dualdrug-loaded CPT@NCCL-CUR NPs can inhibit the growth of tumor through synergistic effects.This work provides a valuable approach for the preparation of amphiphilic polyprodrug with anti-tumor CUR as the backbone,and the stable dual-drug-loaded NPs containing both CUR and CPT through non-covalent cross-linking for synergistic therapy.
文摘AIM:To assess the efficacy of combined transcatheter arterial chemoembolization(TACE)and percutaneous microwave coagulation therapy(PMCT)for small hepatocellular carcinoma(HCC). METHODS:Thirty-five patients with a total of 41 HCC nodules(≤3 cm in diameter)were treated with TACE followed by computed tomograghy(CT)-guided percutaneous microwave coagulation therapy(PMCT) within 1-3 wk. RESULTS:By biopsies and enhanced CT scans, complete necrosis of the tumor and 3-5 mm of the surrounding non-cancerous area were observed in 34 foci.In seven foci,incomplete necrosis of the surrounding parenchyma was observed.Serum alpha- fetoprotein(AFP)levels returned to normal 10 d after treatment in 25 patients who originally had high serum AFP levels.The follow-up period was 6-31 mo,and all patients remained alive.One patient had a recurrence in the subsegments of the liver,and another patient had a recurrence near the original lesion. CONCLUSION:Combined therapy with TACE and PMCT is a safe and effective treatment without severe complications for small HCC.
文摘Current understanding of autoimmune pancreatitis (AIP) recognizes a histopathological subtype of the disease to fall within the spectrum of IgG4-related disease. Along with clinical, laboratory, and histopathological data, imaging plays an important role in the diagnosis and management of AIP, and more broadly, within the spectrum of IgG4-related disease. In addition to the defined role of imaging in consensus diagnostic protocols, an array of imaging modalities can provide complementary data to address specific clinical concerns. These include contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging for pancreatic parenchymal lesion localization and characterization, endoscopic retrograde and magnetic resonance cholangiopancreatography (ERCP and MRCP) to assess for duct involvement, and more recently, positron emission tomography (PET) imaging to assess for extra-pancreatic sites of involvement. While the imaging appearance of AIP varies widely, certain imaging features are more likely to represent AIP than alternate diagnoses, such as pancreatic cancer. While nonspecific, imaging findings which favor a diagnosis of AIP rather than pancreatic cancer include: delayed enhancement of affected pancreas, mild dilatation of the main pancreatic duct over a long segment, the “capsule” and “penetrating duct” signs, and responsiveness to corticosteroid therapy. Systemic, extra-pancreatic sites of involvement are also often seen in AIP and IgG4-related disease, and typically respond to corticosteroid therapy. Imaging by CT, MR, and PET also play a role in the diagnosis and monitoring after treatment of involved sites.
文摘AIM: To evaluate the effect of portal vein thrombosis and arterioportal shunts on local tumor response in advanced cases of unresectable hepatocellular carcinoma treated by transarterial chemoembolization. METHODS: A retrospective study included 39 patients (mean age: 66.4 years, range: 45-79 years, SD: 7) with unresectable hepatocellular carcinoma (HCC) who were treated with repetitive transarterial chemoembolization (TACE) in the period between March 2006 and October 2009. The effect of portal vein thrombosis (PVT) (in 19 out of 39 patients), the presence of arterioportal shunt (APS) (in 7 out of 39), the underlying liver pathology,Child-Pugh score, initial tumor volume, number of tumors and tumor margin definition on imaging were correlated with the local tumor response after TACE. The initial and end therapy local tumor responses were evaluated according to the response evaluation criteria in solid tumors (RECIST) and magnetic resonance imaging volumetric measurements. RESULTS: The treatment protocols were well tolerated by all patients with no major complications. Local tumor response for all patients according to RECIST criteria were partial response in one patient (2.6%), stable disease in 34 patients (87.1%), and progressive disease in 4 patients (10.2%). The MR volumetric measurements showed that the PVT, APS, underlying liver pathology and tumor margin definition were statistically significant prognostic factors for the local tumor response (P = 0.018, P = 0.008, P = 0.034 and P = 0.001, respectively). The overall 6-, 12- and 18-mo survival rates from the initial TACE were 79.5%, 37.5% and 21%, respectively. CONCLUSION: TACE may be exploited safely for palliative tumor control in patients with advanced unresectable HCC; however, tumor response is significantly affected by the presence or absence of PVT and APS.
基金Supported by The Capital Health Development Special Scientific Research Projects,No.2014-2-2154the Single Center Prospective Study,No.NCT01997957
文摘AIM: To compare the efficacy and safety of chemoem-bolization alone or chemoembolization combined with hepatic arterial infusion chemotherapy(HAIC),including oxaliplatin(OXA),5-fluorouracil(5-FU) and folinic acid(CF),in inoperable hepatocellular carcinoma(HCC) without distant metastasis. METHODS: Eighty-four inoperable HCC patients were enrolled. Thirty-ninepatient sunderwent chemoembolization alone,and the other 45 patients underwent chemoembolization + HAIC(OXA/5-FU/CF) treatment non-randomly. The progression free survival(PFS),objective response rate(ORR),disease control rate(DCR) and adverse reactions were compared between the two groups.RESULTS: A significant difference in the ORR was observed between the chemoembolization alone and chemoembolization + HAIC groups. There was no statistically significant difference in DCR between the two groups. The median PFS(m PFS) showed a significant difference between the two groups. For patients with BCLC stage A/B disease,with or without vessel invasion,the chemoembolization + HAIC group showed better m PFS when compared to chemoembolization alone,but no significant difference was found in patients with BCLC stage C disease. The parameter of pain(grade Ⅲ-Ⅳ) in the chemoembolization + HAIC group was increased statistically. CONCLUSION: Chemoembolization combined with HAIC with OXA/5-FU/CF may be safe and more effective than chemoembolization alone for inoperable HCC patients without distant metastasis.
文摘Atherosclerosis is a progressive human pathology that encompasses several stages of development. Endothelial dysfunction represents an early sign of lesion within the vasculature. A number of risk factors for atherosclero- sis, including hyperlipidemia, diabetes, and hypertension, target the vascular endothelium by re-programming its transcriptome. These profound alterations taking place on the chromatin rely on the interplay between sequence specific transcription factors and the epigenetic machinery. The epigenetic machinery, in turn, tailor individual transcription events key to atherogenesis to intrinsic and extrinsic insults dictating the development of atheroscle- rotic lesions. This review summarizes our current understanding of the involvement of the epigenetic machinery in endothelial injury during atherogenesis.
文摘With the increasing clinical use of cytostatic and novel biologic targeted agents,conventional morphologic tumor burden assessments,including World Health Organization criteria and Response Evaluation Criteria in Solid Tumors,are confronting limitations because of their difficulties in distinguishing viable tumor from necrotic or fibrotic tissue.Therefore,the investigation for reliable quantitative biomarkers of therapeutic response such as metabolic imaging or functional imaging has been desired.In this review,we will discuss the conventional and new approaches to assess tumor burden.Since targeted therapy or locoregional therapies can induce biological changes much earlier than morphological changes,these functional tumor burden analyses are very promising.However,some of them have not gone thorough all steps for standardization and validation.Nevertheless,these new techniques and criteria will play an important role in the cancer management,and provide each patient more tailored therapy.
基金We acknowledge this paper was supported by the program of Key Specialty of TCM Nursing of Guangzhou City,which aims to enrich theoretical content of mental health nursing
文摘Objective: Physical restraint is frequently used in medical services,such as in mental health settings,intensive care units and nursing homes,but its nature varies in different institutions.By reviewing related literature,this study aims to clarify the concept of physical restraint in mental health nursing.Method: Three databases (PubMed,PsyclNFO and CINAHL) were retrieved,and Walker and Avant's concept analysis method was used to analyze the concept of physical restraint in mental health nursing.Results: Physical restraint is a coercive approach that enables the administration of necessary treatment by safely reducing the patient's physical movement.It should be the last option used by qualified personnel.Antecedents of physical restraint are improper behavior (violence and disturbance) of patients,medical assessment prior to implementation and legislation governing clinical usage.Consequences of physical restraint are alleviation of conflict,physical injury,mental trauma and invisible impact on the institution.Discussion: This study defined the characteristics of physical restraint in mental health nursing.The proposed concept analysis provided theoretical foundation for future studies.
文摘Budd-Chiari syndrome(BCS)is a relatively rare clinical condition with a wide range of symptomatology,caused by the obstruction of the hepatic venous outflow.If left untreated,it has got an high mortality rate.Its management is based on a step-wise approach,depending on the clinical presentation,and includes different treatment from anticoagulation therapy up to Interventional Radiology techniques,such as transjugular intrahepatic portosystemic shunt(TIPS).TIPS is today considered a safe and highly effective treatment and should be recommended for BCS patients,including those awaiting orthotopic liver transplantation.In this review the pathophysiology,diagnosis and treatment options of BCS are presented,with a special focus on published data regarding the techniques and outcomes of TIPS for the treatment of BCS.Moreover,unresolved issues and future research will be discussed.
文摘Hepatocellular carcinoma(HCC)is one of the most common types of malignant tumor.Although radical surgery and liver transplantation are possible cures for the disease,most patients are beyond the optimum stage for radical treatment at the time of diagnosis.Transarterial chemoembolization(TACE)is the first choice of treatment for advanced HCC.Owing to the widespread use of conventional TACE(cTACE),the problems with this treatment cannot be ignored.Drug-eluting beads(DEBs),a new type of embolization material,appear to overcome the problems of cTACE,and they have other advantages such as synchronous controlled continuous drug release after chemotherapy and embolization and low blood concentrations after treatment.This review summarizes the recent advances in the use of DEB-TACE to treat HCC.
基金supported by the National Natural Science Foundation of China(81000106 and81470539)
文摘Intermedin/adrenomedullin-2(IMD/AM2), a member of the calcitonin gene-related peptide/AM family,plays an important role in protecting the cardiovascular system. However, its role in the enhanced sympathoexcitation in obesity-related hypertension is unknown. In this study, we investigated the effects of IMD in the paraventricular nucleus(PVN) of the hypothalamus on sympathetic nerve activity(SNA), and lipopolysaccharide(LPS)-induced sympathetic activation in obesity-related hypertensive(OH)rats induced by a high-fat diet for 12 weeks. Acute experiments were performed under anesthesia. The dynamic alterations of sympathetic outflow were evaluated as changes in renal SNA and mean arterial pressure(MAP) in response to specific drugs. Male rats were fed a control diet(12% kcal as fat) or a high-fat diet(42% kcal as fat) for 12 weeks to induce OH. The results showed that IMD protein in the PVN was downregulated, but Toll-like receptor 4(TLR4) and plasma norepinephrine(NE, indicating sympathetic hyperactivity) levels, and systolic blood pressure were increased in OH rats. LPS(0.5 lg/50 nL)-induced enhancement of renal SNA and MAP was greater in OH rats than in obese or control rats. Bilateral PVN microinjection of IMD(50 pmol)caused greater decreases in renal SNA and MAP in OH rats than in control rats, and inhibited LPS-induced sympatheticactivation, and these were effectively prevented in OH rats by pretreatment with the AM receptor antagonist AM22-52.The mitogen-activated protein kinase/extracellular signalregulated kinase(ERK) inhibitor U0126 in the PVN partially reversed the LPS-induced enhancement of SNA. However,IMD in the PVN decreased the LPS-induced ERK activation,which was also effectively prevented by AM22-52. Chronic IMD administration resulted in significant reductions in the plasma NE level and blood pressure in OH rats. Moreover,IMD lowered the TLR4 protein expression and ERK activation in the PVN, and decreased the LPS-induced sympathetic overactivity. These results indicate that IMD in the PVN attenuates SNA and hypertension, and decreases the ERK activation implicated in the LPS-induced enhancement of SNA in OH rats, and this is mediated by AM receptors.
基金supported by the National Natural Science Foundation of China(81071245)
文摘Objective To investigate the efficacy, safety, and associated mechanisms of injected ozonated saline in the treatment of VX2 tumors. Methods A total of 90 rabbits bearing VX2 tumors on their left hind legs were randomly divided into three groups. The control group(A) received normal saline, while groups B and C received 20 μg/mL and 40 μg/mL O_3/O_2 ozonated saline, respectively. Rabbits were anesthetized and 2 mL of blood was drawn directly from the heart to measure serum concentrations of interleukin(IL-6) and tumor necrosis factor(TNF-α). The skin covering the VX2 tumor was cut in each rabbit and the maximum and vertical diameters of the tumors were measured under direct visualization. Several milliliters of saline, saline pre-treated with 20 μg/mL O_3/O_2, or saline pre-treated with 40 μg/mL O_3/O_2 were directly injected into the tumors of groups A, B, and C, respectively(injection volume(milliliter) =1/2 volume of the tumor, V = 1/2ab^2). On days 4, 8 and 12 following treatment, 10 rabbits were randomly selected from each group for blood sample collection, and serum IL-6 and TNF-α were measured. The tumor growth rate was calculated by measuring the maximum and vertical diameters of the VX2 tumors under direct visualization. All selected rabbits were euthanized and the tumors, livers, and lungs were removed for pathological examination. The tumor necrosis rate was calculated by cutting the tumors into half along the longitudinal axis and measuring the maximum diameters of the intratumoral necrotic regions. Results The average tumor volume in the three groups increased to different degrees at each time point; however, the average tumor growth rates in groups B and C were substantially lower than that in group A, exhibiting a statistically significant difference. The difference in the tumor growth rate between group B and group C was not statistically significant. The serum concentrations of IL-6 and TNF-α increased in the three groups at each time point, with larger increases occurring in groups B and C; however, the greater increases did not reach statistical significance. Although the diameters of the necrotic areas were larger in both groups B and C than that in group A, significant differences in necrotic area diameters were only found when comparing groups A and C on days 4 and 12 following treatment. Conclusion Direct injection of different concentrations of ozonated saline into VX2 tumors significantly increased intratumoral necrosis and reduced the tumor growth rate. The associated mechanism may be partially mediated by IL-6 and TNF-α, as the serum concentrations of these molecules increased after the treatment.
基金Supported by the National Key R&D Program of China,No.2016YFC0106604National Natural Science Foundation of China,No.81502591
文摘AIM To determine a panel of serum micro RNAs(mi RNAs) that could be used as novel biomarkers for diagnosis of hepatocellular carcinoma(HCC).METHODS We initially screened 9 out of 754 serum mi RNAs by Taq Man Low Density Array in two pooled samples respectively from 35 HCC and 35 normal controls, and then validated individually by RT-qP CR in another 114 patients and 114 controls arranged in two phases. The changes of the selected mi RNAs after operation and their prognostic value were examined.RESULTS miR-375, miR-10 a, miR-122 and miR-423 were found to be significantly higher in HCC than in controls(P < 0.0001), and the area under the receiver-operating-characteristic curve for the 4-miR NA panel was 0.995(95%CI: 0.985-1). All the four mi RNAs were significantly reduced after surgical removal of the tumors(P < 0.0001), while still higher than normal controls(at least P < 0.05)CONCLUSION The four serum miR NAs(miR-375, miR-10 a, miR-122 and miR-423) could potentially serve as novel biomarkers for the diagnostic and prognostic of HCC.
基金Supported by the National Key R&D Program of China,No.2016YFC0106604National Natural Science Foundation of China,No.81502591.
文摘BACKGROUND In early gastric cancer(GC),tumor markers are increased in the blood.The levels of these markers have been used as important indexes for GC screening,early diagnosis and prognostic evaluation.However,specific tumor markers have not yet been discovered.Diagnosis based on a single tumor marker has limited significance.The detection rate of GC is still very low.AIM To improve the diagnostic value of blood markers for GC.METHODS We used a multiparameter joint analysis of 77 indexes of malignant GC and gastric polyp(GP),64 indexes of GC and healthy controls(Ctrls).RESULTS By analyzing the data,there are 27 indexes in the final Ctrls vs GC with P values<0.01,the area under the curve(AUC)of albumin is the largest in Ctrls vs GC,and the AUC was 0.907.30 indexes in GP vs GC have P values<0.01.Among them,the D-dimer showed an AUC of 0.729.The 27 indexes in Ctrls vs GC and 30 indexes in GP vs GC were used for binary logistic regression,discriminant analysis,classification tree analysis and artificial neural network analysis model.For the ability to distinguish between Ctrls vs GC,GP vs GC,artificial neural networks had better diagnostic value when compared with classification tree,binary logistic regression,and discriminant analysis.When compared Ctrl and GC,the overall prediction accuracy was 92.9%,and the AUC was 0.992(0.980,1.000).When compared GP and GC,the overall prediction accuracy was 77.9%,and the AUC was 0.969(0.948,0.990).CONCLUSION The diagnostic effect of multi-parameter joint artificial neural networks analysis is significantly better than the single-index test diagnosis,and it may provide an assistant method for the detection of GC.
文摘AIM: To analyze the results of ultrasound guided percu- taneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the treatment of splenic abscess. METHODS: Thirty-six patients (14 females and 22 males, with an average age of 54.1 ± 14.1 years) with splenic abscess were treated with ultrasound guided PNA and/or PCD. Patients with splenic abscess < 50 mm in diameter were initially treated by PNA and those with abscess ≥ 50 mm and bilocular abscesses were initially treated by an 8-French catheter drainage. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, and mortality rates were analyzed. RESULTS: Twenty-seven patients had unilocular and 9 bilocular abscess. PNA was performed in 19 patients (52.8%), and 8 of them (42.1%) required PCD because of recurrence of abscess. In 17 patients (47.2%), PCD was performed initially. PCD was performed twice in six patients and three times in two. PNA was defi nitive treatment for 10 and PCD for 21 patients. One patient with PCD was referred for splenectomy, with successful outcome. In all 4 deceased patients, malignancy was the underlying condition. Twenty-one patients (58.3%) underwent 33 surgical interventions on abdomen before treatment. Cultures were positive in 30 patients (83.3%). Gram-negative bacillus predominated (46.7%). There were no complications related to the procedure. CONCLUSION: Percutaneous treatmnet of splenic abscess is an effective alternative to surgery, allowing preservation of the spleen. This treatment is especially indicative for the patients in critical condition postoperatively. We recommend PNA as primary treatment for splenic abscesses < 50 mm, and PCD for those ≥ 50 mm in diameter and for bilocular abscesses.
基金supported by Liaoning Provincial Hospital Reform Key Clinical Diagnosis and Treatment Capacity Building Project(Youth Project):Diabetic Foot Multidisciplinary Cooperative Comprehensive Treatment Model Construction Project.(201507-201707)
文摘Objective To evaluate the rates of wound healing and limb preservation following angiosome-targeted infrapopliteal endovascular revascularization in the treatment of diabetic limb ischemia. Methods We performed a retrospective analysis of data gathered from 102 infrapopliteal angioplasty cases(60 males and 42 females; mean age, 72 ± 11 years) with Fontaine IV ischemia(ankle-brachial index, ABI: 0.16 ± 0.06). Forty-seven angioplasties were performed based on the angiosome concept(direct revascularization, DR), while 55 did not incorporate the angiosome concept(indirect revascularization, IR). The curative effects of angioplasty were assessed by postoperative determinations of ABI performed every 3 months during clinical follow-up visits conducted to assess healing of the ischemic wound. Amputation and death events were recorded throughout the study. Results All 102 patients were successfully revascularized without complications, and during a mean follow-up period of 18 ± 11 months, the mean postoperative ABI improved to 0.84 ± 0.10. The postoperative 6 and 12 month healing rates in the DR group were 85.1% and 93.5%, respectively, while the limb-salvage rates were 100% and 93.5%, respectively. The postoperative 6 and 12 month healing rates in the IR group were 60% and 76.4%, respectively, while the limb-salvage rates were 90.1%, and 85.5%, respectively. Conclusion Angiosome-based Infrapopliteal angioplasty was associated with better wound healing and higher rates of limb salvage in cases of critical diabetic foot ischemia. Revascularization should be provided to patients who have undergone indirect perfusion of the ischemic angiosome, as acceptable rates of limb salvage are obtained.
基金Supported by the National Key R&D Program of China,No.2016YFC0106604.
文摘BACKGROUND In hepatocellular carcinoma(HCC),abnormal expression of multiple micro RNAs(miRNAs)has been shown to be involved in the malignant biological behavior of liver cancer.The vast majority of liver cancer cases in China are closely related to hepatitis B virus(HBV)infection,but there are few studies on the changes of miRNA expression in the progression from HBV infection to hepatoma.AIM To explore the role of miRNAs in the progression of HBV infection to cirrhosis and even to liver cancer.METHODS We screened differentially expressed miRNAs in 40 HBV cirrhosis,40 normal and15 HCC tissues by using a Taq Man Low Density Array and real time quantitative polymerase chain reaction.To evaluate the power of the selected miRNAs to predict disease,we calculated the area under the receiver-operating-characteristic curves.The overall survival of HBV cirrhosis patients was analyzed via KaplanMeier analysis.RESULTS The levels of miR-375,miR-122 and miR-143 were significantly lower in HBV cirrhosis tissues,while miR-224 was significantly higher than in the controls(P<0.0001).The area under the curves of the receiver-operating-characteristic curve for the 4-miRNA panel was 0.991(95%CI:0.974-1).Patients with a lower expression level of miR-224 or higher expression levels of miR-375,miR-122 and miR-143 had longer overall survival.CONCLUSIONThe four miRNAs(miR-375,miR-122,miR-143 and miR-224)may be helpful for early diagnosis of HBV infection,HBV cirrhosis,and prediction of its overall survival.
基金Supported by Henan Province science and Technology Research Projects,No.162102310041National Key R&D Program of China,No.2016YFC0106604National Natural Science Foundation of China,No.81502591
文摘AIM To investigate the value of multiparameter joint analysis in the early diagnosis of gastric cancer(GC) in clinical practice.METHODS Concentrations of CEA, CA724 and three kinds of cytokines(TNF-α, IL-6 and IL-8) in 176 GC patients, 117 atypical hyperplasia patients, and 204 healthy control individuals were used for building the diagnostic model, then 58 GC patients, 41 atypical hyperplasia patients, and 66 healthy control individuals were enrolled independently. The joints of the indicators were analyzed by binary logistic regression analysis method.RESULTS For discriminating the healthy control group and the GC group, IL-6 had the best diagnostic value, and the area under curve(AUC) of joint analysis was 0.95(0.93-0.97). For the early stage and advanced stage GC, the AUC were 0.95(0.92-0.98) and 0.95(0.92-0.97). For discriminating the atypical hyperplasia group and GC group, CA724 had the best diagnostic value, and the AUC of joint analysis was 0.97(0.95-0.99). For the early stage and advanced stage GC groups, the AUC were 0.98(0.96-0.99) and 0.96(0.94-0.98). After evaluation, for discriminating the GC, early stage GC and advanced cancer group from the healthy control group, the diagnostic sensitivity was 89.66%, 84.21% and 92.31%, respectively, and the specificity was 92.42%, 90.91% and 90.91%. For discriminating the GC, early stage GC and advanced cancer groups from the atypical hyperplasia group, the diagnostic sensitivity was 87.93%, 78.95% and 92.31%, respectively, and the specificity was 87.80%, 85.37% and 90.24%.CONCLUSION We have built a diagnostic model including CEA, CA724, IL-6, IL-8, and TNF-α. It may provide potential assistance as a screening method for the early detection of GC.
文摘BACKGROUND The incidence rate of breast cancer has exceeded that of lung cancer,and it has become the most malignant type of cancer in the world.BI-RADS 4 breast nodules have a wide range of malignant risks and are associated with challenging clinical decision-making.AIM To explore the diagnostic value of artificial intelligence(AI)automatic detection systems for BI-RADS 4 breast nodules and to assess whether conventional ultrasound BI-RADS classification with AI automatic detection systems can reduce the probability of BI-RADS 4 biopsy.METHODS A total of 107 BI-RADS breast nodules confirmed by pathology were selected between June 2019 and July 2020 at Hwa Mei Hospital,University of Chinese Academy of Sciences.These nodules were classified by ultrasound doctors and the AI-SONIC breast system.The diagnostic values of conventional ultrasound,the AI automatic detection system,conventional ultrasound combined with the AI automatic detection system and adjusted BI-RADS classification diagnosis were statistically analyzed.RESULTS Among the 107 breast nodules,61 were benign(57.01%),and 46 were malignant(42.99%).The pathology results were considered the gold standard;furthermore,the sensitivity,specificity,accuracy,Youden index,and positive and negative predictive values were 84.78%,67.21%,74.77%,0.5199,66.10%and 85.42%for conventional ultrasound BI-RADS classification diagnosis,86.96%,75.41%,80.37%,0.6237,72.73%,and 88.46%for automatic AI detection,80.43%,90.16%,85.98%,0.7059,86.05%,and 85.94%for conventional ultrasound BI-RADS classification with automatic AI detection and 93.48%,67.21%,78.50%,0.6069,68.25%,and 93.18%for adjusted BI-RADS classification,respectively.The biopsy rate,cancer detection rate and malignancy risk were 100%,42.99%and 0%and 67.29%,61.11%,and 1.87%before and after BI-RADS adjustment,respectively.CONCLUSION Automatic AI detection has high accuracy in determining benign and malignant BI-RADS 4 breast nodules.Conventional ultrasound BI-RADS classification combined with AI automatic detection can reduce the biopsy rate of BI-RADS 4 breast nodules.
