基于循证的加速康复外科的集束化干预方案对结直肠癌根治术患者术后恢复及并发症的影响

目的 探讨基于循证的加速康复外科(ERAS)的集束化干预方案对结直肠癌根治术患者术后恢复及并发症的影响.方法 依据干预方式将116例结直肠癌根治术患者分为观察组和对照组,每组58例,对照组患者接受常规干预措施,观察组患者接受基于循证的ERAS集束化干预方案.比较两组患者术后恢复情况、并发症发生情况、炎性因子[C反应蛋白...     

Melatonin inhibits EMT and PD‐L1 expression through the ERK1/2/FOSL1 pathway and regulates anti‐tumor immunity in HNSCC

Melatonin is an endogenous hormone with various biological functions and possesses anti‐tumor properties in multiple malignancies. Immune evasion is one of the most important hallmarks of head and neck squamous cell carcinoma (HNSCC) and is closely related to tumor progression. However, as an immune modulator under physiological conditions, the roles of melatonin in tumor immunity in HNSCC remains unclear. In this study, we found that the endogenous melatonin levels in patients with HNSCC were lower than those in patients with benign tumors in head and neck. Importantly, lower melatonin levels were related to lymph node metastasis among patients with HNSCC. Moreover, melatonin significantly suppressed programmed death‐ligand 1 (PD‐L1) expression and inhibited epithelial–mesenchymal transition (EMT) of HNSCC through the ERK1/2/FOSL1 pathway in vitro and in vivo. In SCC7/C3H syngeneic mouse models, anti‐programmed death‐1 (PD‐1) antibody combined with melatonin significantly inhibited tumor growth and modulated anti‐tumor immunity by increasing CD8⁺ T cell infiltration and decreasing the regulatory T cell (Treg) proportion in the tumor microenvironment. Taken together, melatonin inhibited EMT and downregulated PD‐L1 expression in HNSCC through the ERK1/2/FOSL1 pathway and exerted synergistic effects with anti‐PD‐1 antibody in vivo, which could provide promising strategies for HNSCC treatment.     

文冠果花提取物对良性前列腺增生具有抑制作用

目的 探究文冠果花提取物对良性前列腺增生的抑制作用及可能的机制。方法 通过MTT法检测文冠果花提取物对良性前列腺增生细胞（BPH-1）增殖能力的影响、Annexin V/PI双染色法检测细胞凋亡、流式细胞仪测定细胞周期、免疫印迹法检测BPH-1细胞Bcl-2/Bax/Caspase3、PI3K/AKT蛋白表达水平。通过皮下注射丙酸睾酮建立大鼠良性前列腺增生（BPH）模型,文冠果花提取物给药28 d后取大鼠前列腺组织,通过HE染色观察组织病理变化,免疫印迹法检测前列腺组织中Bcl-2/Bax/Caspase3、PI3K/AKT的蛋白表达水平。结果 文冠果花提取物在125～1000μg/mL的浓度范围内抑制BPH-1细胞的增殖（P<0.05）;在G0/G1期产生周期阻滞,细胞的凋亡率与文冠果花提取物给药浓度正相关;文冠果花提取物处理后的细胞Bcl-2蛋白表达水平明显下调,Bax和Caspase3蛋白表达水平显著提升,PI3K/AKT蛋白磷酸化水平显著下调（P<0.05）;在动物实验中,与模型组相比,文冠果花提取物中剂量组和高剂量组p-AKT、Bcl-2表达水平降低,Bax表达水...     

羟基红花黄色素A通过抑制程序性坏死减轻小鼠重症中暑引起的急性肺损伤

目的 研究羟基红花黄色素A(HSYA)是否在重症中暑肺损伤中起保护作用及其可能的作用机制。方法 使用不同浓度（1.125、2.25、4.5 mg/kg）HSYA腹腔注射预处理小鼠,建立重症中暑（sHS）小鼠模型,分为低、中、高剂量HSYA中暑组、单纯中暑组及正常对照组,12只/组。初步观察及比较各组热耐受的情况,以确定HSYA最佳治疗剂量;后使用中剂量HSYA及RIP1活化抑制剂Nec-1预处理小鼠,分组为HSYA+HS组、Nec-1+HS组、HS组及正常对照组,8只/组,观察72 h恢复期核心体温变化特征,比较热耐受情况及生存情况。给予相同处理因素处理小鼠分组为正常对照组,HS组,HSYA+HS组及Nec-1+HS组,正常对照组6只,其余18只/组,分别于重症中暑恢复期不同阶段（0、2、6、12、24 h）处死小鼠,每个时间点处死3只小鼠,收集小鼠的肺组织、肺泡灌洗液及血液样本,取肺组织行HE染色,并进行病理评分,检测肺湿干重比,肺含水量,肺泡灌洗液中白细胞、中性粒细胞、蛋白含量;ELISA法检测肺泡灌洗液中HMGB1水平及血清中TNF-α、IL-6及HMGB1水平;Western ...     

Decreased expression of claudin-18.2 in alpha-fetoprotein-producing gastric cancer compared to conventional gastric cancer

BackgroundAlpha-fetoprotein-producing gastric cancer (AFPGC) is a subtype of gastric cancer (GC) with more aggressive biological behavior. As a highly specific tight junction component exclusively present in gastric mucosa and gastric adenocarcinomas, claudin-18.2 (CLDN18.2) has become an emerging target in GC. In this study, we aimed to provide insight into AFPGC and investigate the expression and the clinical implications of CLDN18.2 in AFPGC.MethodsWe retrospectively collected 98 cases of AFPGC and reviewed their clinical, morphological, and immunohistochemical features. Another 356 patients with stage-matched conventional GC (cGC) were enrolled as a control group. We further surveyed CLDN18.2 expression by immunohistochemistry (IHC) in 51 AFPGC tissues and explained its association with the clinicopathological parameters of AFPGC.ResultsOur results showed that AFPGC was a unique GC type with elevated serum alpha-fetoprotein (AFP), which was a predictor of a worse prognosis. AFPGC showed typical morphological features and positive staining of at least 1 hepatocytic or enteroblastic marker. The expression rate of CLDN18.2 was low, with a positivity rate of 21.6%, which was much lower than that observed in cGC tissues (38.5%). A significant correlation was found between CLDN18.2 expression and the differentiation of AFPGC. CLDN18.2 expression was negatively correlated with the serum AFP level of AFPGC. We also found that AFPGC with a hepatoid type (HPT) component showed a significantly lower CLDN18.2 expression than those without.ConclusionsThis study demonstrated that CLDN18.2 was significantly decreased in AFPGC and was negatively correlated with the patient’s preoperative serum AFP level. The negative correlation between AFP and CLDN18.2 could be explained by retro-differentiation of AFPGC. Special treatment strategies might be needed for this unique tumor type.     

Spleen stiffness-spleen size-to-platelet ratio risk score as noninvasive predictors of esophageal varices in patients with hepatitis B virus-related cirrhosis

This study was conducted to evaluate the predictive value of spleen stiffness-spleen size-to-platelet ratio risk score (SSPS) as a noninvasive predictor of esophageal varices (EVs) and to compare it with others.In this retrospective study, from April 2017 to October 2018, a total of 65 patients with hepatitis B virus-related cirrhosis who underwent the liver and spleen stiffness (LS, and SS) measurements by 2 dimensional-shear wave elastography and endoscopic evaluation for EVs were enrolled. Liver stiffness-spleen size-to-platelet ratio risk score (LSPS) and SSPS were calculated. The prognostic values were assessed by the area under the receiver operating characteristic curve (AUC).Twenty-six patients had no EV on endoscopy. Among 39 patients who had EVs, 12 patients had high risk EVs. The AUCs of the LS value, SS value, LSPS, and SSPS for predicting EVs were 0.72, 0.77, 0.80, and 0.85, respectively. The AUCs of the LS value, SS value, LSPS, and SSPS for predicting high-risk EVs were 0.55, 0.78, 0.67, and 0.80, respectively. SSPS had the highest specificity, at 96.15%, for predicting EVs.SSPS may be beneficial to exclude from having EVs and it is expected that the frequency of performing endoscopies for screening EVs can be reduced.     

Extracellular ATP promotes angiogenesis and adhesion of TNBC cells to endothelial cells via upregulation of CTGF

Our previous works have indicated that extracellular ATP is an important prometastasis factor. However, the molecular mechanism involved needs to be further studied. We demonstrated that extracellular ATP treatment could upregulate the expression of connective tissue growth factor (CTGF) in both triple‐negative breast cancer (TNBC) cells and endothelial cells (ECs). Extracellular ATP stimulated the migration of TNBC cells and ECs, and angiogenesis of ECs via the P2Y2––YAP‐CTGF axis. Furthermore, we demonstrated that adenosine triphosphate (ATP) stimulated TNBC cell adhesion to ECs and transmigration through the EC layer via CTGF by upregulation of integrin β1 on TNBC cells and VCAM‐1 on ECs. Both apyrase (ATP‐diphosphohydrolase) and CTGF shRNA treatments could inhibit the metastasis of inoculated tumors to lung and liver in a mouse model, and these treated tumors had fewer blood vessels. Collectively, our data indicated that extracellular ATP promotes tumor angiogenesis and the interactions between TNBC cells and ECs through upregulation of CTGF, thereby stimulating TNBC metastasis. The pleiotropic effects of ATP in angiogenesis and cell adhesion suggest that extracellular ATP or CTGF could be an effective target for TNBC therapy.     

Unusual morphologic features of low‐grade endometrial stromal sarcoma: A case report

BackgroundEndometrial stromal tumours are uncommon tumours of the uterus. They mainly occur in perimenopausal women. Tumours with typical clinicopathological features do not usually pose diagnostic problems. However, rare clinicopathological features can occur, and clinicians without significant experience may have difficulty diagnosing these tumours and managing these patients.MethodsHerein, we report a case of endometrial stromal sarcoma that occurred in a 25‐year‐old woman. The pathological features, immunophenotype, treatment and prognosis were discussed.ResultsThe tumour revealed morphological heterogeneity, and there were similar proliferative‐type endometrial stromal cells, an extensive amount of mature adipose tissue, and prominent rhabdomyoblastic and smooth muscle cells. Histopathological and immunohistochemical studies confirmed low‐grade endometrial stromal sarcoma with smooth muscle, adipocytic and rhabdomyoblastic differentiation (approximately 60% were differentiated tissues). The final treatment of the tumour was total abdominal hysterectomy with bilateral salpingo‐oophorectomy. There was no evidence of recurrence for 109 months postoperatively.ConclusionsWe found that low‐grade endometrial stromal tumours with extensive adipocytic and prominent rhabdomyoblastic differentiation are misdiagnosed because they are infrequent. They must be differentiated from rhabdomyosarcoma with accurate identification of adipocytes, and long‐term follow‐up is needed.     

医疗设备验收全流程信息管理系统的设计和实现

目的 开发一套医疗设备验收信息管理系统,实现验收工作全流程的信息化,实现验收过程记录电子化,提高验收流程执行的效率和质量,为后续医疗设备全生命周期管理提供数据基础.方法 依托已经实现的基于结构化消息流的医疗设备全生命周期管理系统,采用流程优化和规则电子化,设计覆盖验收全流程和辅助自动化的管理系统.结果 实现和实施了一套...     

儿童期灾难性癫痫综合征的外科治疗

儿童灾难性癫痫综合征是指特发于儿童期间,以癫痫发作频繁、严重,药物控制不佳,并最终导致儿童发育迟缓、智能障碍的一组癫痫综合征[1,2].它不是单指某一癫痫综合征或疾病,而是指具有灾难性后果,尤其是累及智力和大脑发育的癫痫综合征的总称.这类癫痫发作严重,药物难治,致残率和死亡率高,是外科治疗的潜在目标,尤其是考虑到儿童的发育潜能,早期外科干预是儿童灾难性癫痫的重要手段[1,3].