Objective To explore the diagnosis and treatment of Kaposiform hemangioendothelioma (KHE),deepen the understanding of KHE and Kasabach-Merritt phenomenon (KMP),and discuss the optimal treatment for KHE.Methods From January 2008 to August 2016,13 cases of KHE were confirmed by surgery or biopsy pathology and admitted to the First Affiliated Hospital of Sun Yat-Sen University,and the clinical diagnosis and treatment were analyzed retrospectively.Results There were 13 patients(7 males and 6 females) with a median age of 1.0 years(0.2-10.0 years),and 84.6%(11/13 cases) were infants and young children,76.9% (10/13 cases) involved with deep tissue,23.1% (3/13 cases) were associated with KMP and they were younger than 1 year old,and 15.4% (2/13 cases) coexisted with hemangioma or lymphangioma.The location,extent and infiltration depth of the lesion were observed by imaging examinations and histopathology showed nodule shaped spindle tumor cells.Radical resection was considered if possible.Dose of Vincristine (0.5 mg/m2 weekly) and Propranolol [1 mg/(kg·d)] were administered.The prognosis was different in thirteen cases undergoing different treatments.After 3 months to 9 years follow-up,41.7% (5/12 cases) survived after tumor treatment.Conclusions KHE happens mostly in infants and young children,with varying clinical manifestations and a high recurrence rate.The diagnosis of KHE is based on histological examination,computed tomography and magnetic resonance imaging while it still need explicit pathological diagnosis is needed.KHE may be accompanied by hemangioma or lymphangioma.Prognosis is affected by many factors and the comprehensive treatment is required.KMP should be remedied preferentially,individual treatment protocol and long term follow-up are necessary.

BACKGROUND: Postoperative cholangitis is a common but severe complication after Kasai portoenterostomy for biliary atresia (BA). This study aimed to identify its prognostic factors. METHODS: Two sets of liver paraffin-embedded tissue samples were collected from BA patients who received Kasai portoenterostomy (n = 25 and n = 31, respectively). Patients were divided into non-cholangitis and cholangitis groups. The infiltration of CD4+, CD8+, CD45RO+, CD68+ cells and expression of Beclin1 were quantitatively evaluated in immunohistochemical analysis. RESULTS: Cholangitis group had a significantly lower CD8+ T cell infiltration but a higher CD45RO+ cell infiltration, and a lower Beclin1 level than non-cholangitis group (all P < 0.01). Multivariate logistic regression analysis indicated that infiltration of CD8+ cells (odds ratio [OR], 0.112; 95% confidence interval [CI], 0.022–0.577) and CD45RO+ cells (OR, 3.88; 95% CI, 1.37–11.03), and Beclin1 level (OR, 0.088; 95% CI, 0.018–0.452) were independent influence factors for early postoperative cholangitis. Receiver operating characteristic (ROC) analysis showed that area under ROC curve (AUROC) values for CD8+ cells, CD45RO+ cells and Beclin1 were 0.857, 0.738 and 0.900, respectively. CONCLUSION: Our findings demonstrated the CD8+ cells, CD45RO+ cells and Beclin1 level possessed the prognostic value for early postoperative cholangitis following Kasai operation, which may be helpful to develop new prevention and treatment strategies for postoperative cholangitis.
Biliary Atresia* ; Cholangitis* ; Humans ; Liver ; Logistic Models ; ROC Curve ; T-Lymphocytes*

Objective The primary aim of this study was to examine the proportion and natural history of Helicobacter pylori (Hp) negative bleeding peptic ulcers. Methods The study was designed as a multiple-center, case-control study conducted in 14 endoscopy centers in China from April 2006 to March 2007. Each center was expected to recruit 30 peptic ulcer patients with bleeding ( PUB group) and 30 without (PU group). All screened patients with upper gastrointestinal bleeding received endoscopy within 24 hours of admission. Biopsy specimens were taken from the antrum to determine Hp infection by rapid urease test and pathology. Patients with negative Hp infection at first examination were asked to receive urease breathe test (UBT) one month later. Results A total of 617 patients were enrolled with 263 in PUB group and 354 in PU group. There is no significant difference in demographic characters between 2 groups ( P ＞0. 05). The rate of Hp infection in PUB group ( 161/263, 61.2% ) was significantly lower than that in PUgroup (311/354, 87. 9%, P ＜0. 001 ). The incidence of complex ulcer in Hp positive PUB patients was 7.5% ( 12/161 ), which is significantly higher than that in Hp negative PUB patients ( 1/102, 1.0% , P =0. 018). In PUB group, no significant differences were found between Hp positive and negative patients in regarding of age, sex, rates of haematemesis, duodenal ulcer and gastric ulcer, and size of ulcer ( P ＞0. 05 ). Among 102 Hp negative cases in PUB, no positive case was found in UBT one month later. Conclusion We have demonstrated a rise in the incidence of Hp negative bleeding ulcers in China. The idiopathic ulcer was not rare, and might have a higher tendency to cause bleed.

Objective To observe the outcome of selective posterior rhizotomy (SPR) for cerebral palsy children with different gross motor function before operation. Methods 132 cases accepted SPR were grouped with their grades of Gross Motor Function Classification System (GMFCS), and their outcomes were compared. Results The muscle tension, gross motor function and activities of daily living improved in all the groups after SPR (P<0.01). The muscle tone decreased the most in grade I (P<0.01). The gross motor ability improved the most in grade II(P<0.001). The activiti es of daily living improved the most in grades I and IV (P<0.05). Conclusion The outcome of SPR for children with cerebral palsy is various with the gross motor function before operation.

Objective:To investigate the safety and effectiveness of robot-assisted total knee arthroplasty (TKA).Methods:From August 2021 to March 2022, the data of 69 patients who received robot-assisted TKA for inflammatory disease of knee in 6 hospitals were collected, including 24 males and 45 females, aged 52±6 years (range, 46-72 years), including 53 cases of knee osteoarthritis,10 cases of rheumatoid arthritis, and 6 cases of traumatic arthritis. Imaging data examination of patients was completed according to the multicenter specification. Preoperatively, the patient's CT data were extracted before surgery and a personalized prosthesis positioning plan was designed by the robotic system to determine the prosthesis size, lower limb force lines, and femoral and tibial osteotomy volumes; intraoperatively, the osteotomy template was robotically controlled to complete the osteotomy according to the prosthesis positioning plan, and the intraoperative osteotomy volumes were measured to verify the accuracy of the robot-assisted TKA osteotomy with the preoperative planning. Postoperatively, the lateral angle of the distal femur, the medial angle of the proximal tibia and the hip-knee-ankle angle were measured in the coronal plane according to radiographs; the postoperative outcome was evaluated 3 months after operation, using the American Knee Society score (KSS), including the KSS knee score and functional score.Results:The operative time was 97.3±2.3 min (range, 80-110 min) and the amount of bleeding was 320.0±6.2 ml (range, 300-350 ml) in 69 patients. Three months after operation, the mean range of motion of knee joint was increased from 82.2°±1.1° before surgery to 119.7°±0.8° after surgery ( t=27.65, P<0.001), and the line of force of lower limb was improved from 160.9°±0.5° before surgery to 178.0°±0.2° after surgery ( t=32.03, P<0.001). KSS-knee score increased from 54.8±0.7 points before operation to 85.0±0.5 points after operation, and KSS-functional score increased from 56.5±0.7 points before operation to 85.9±0.4 points after operation, the difference was statistically significant ( t=35.45, 36.58, P<0.001). The proportion of patients with intraoperative femoral and tibial osteotomies within 2 mm osteotomy error compared with preoperative planning was 97% for the lateral tibial plateau, 100% for the medial tibial plateau, 100% for the lateral distal femur, 99% for the medial distal femur, 93% for the lateral posterior femoral condyle, and 100% for the medial posterior femoral condyle; The proportion of patients with postoperative anteroposterior X-ray measurement angle error within 3° was: 100.0% for the distal lateral femoral angle, 100.0% for the proximal medial tibial angle, and 100% for the hip-knee-ankle angle. No complications occurred in all patients except for one case in which fat liquefaction occurred in the postoperative wound. Conclusion:Robot-assisted TKA is a safe and effective surgical method for the treatment of inflammatory disease of knee with accurate prosthesis installation and good postoperative recovery of lower limb alignment.

Objective: To study serum HCV antibody (anti-HCV) with geographic distribution characteristics in Zhejiang Province. Methods: A stratified random cluster sampling method was used. Serum samples of the surveyed population were collected from selected hospitals, anti-HCV antibodies were examined, then hepatitis C infection rates among different genders, regions and age groups were analyzed. The anti-HCV rate was compared using the χ ² test. Results: The average anti-HCV positive rate in Zhejiang Province was 0.24% [95% confidence interval (CI): 0.16% ~ 0.32%]. The antibody positive rate in the plain area was 0.32% (95% CI: 0.19% ~ 0.45%), which was significantly higher than the coastal islands 0.05%(95% CI: 0.00% ~ 0.12%, χ ² = 7.638, P < 0.05). There was no significant difference between plain area and hilly area 0.22% (95% CI: 0.03% - 0.41%). There was no statistically significant difference in anti-HCV positive rates between males and females (χ ² = 2.238, P = 0.135). The highest positive rate of anti-HCV (0.93%) was in the population aged 56-60 years and the lowest in the population aged less than 20 years. Anti-HCV positive rate of all age groups in 2017 was lower than that of 2006 seroepidemiological study of hepatitis C. Conclusion Zhejiang Province is a region with low anti-HCV positive rate and the disease prevalence further reduced than 10 years ago. The positive rate of anti-HCV in plain areas is higher than islands. Middle-aged and elderly people are the age group with high prevalence, and the anti-HCV positive rate in people under 20 years old is exceptionally low. Gender differences in anti-HCV positive rate have little effect.

Chronic cerebral hypoperfusion leads to white matter injury (WMI), which subsequently causes neurodegeneration and even cognitive impairment. However, due to the lack of treatment specifically for WMI, novel recognized and effective therapeutic strategies are urgently needed. In this study, we found that honokiol and magnolol, two compounds derived from Magnolia officinalis, significantly facilitated the differentiation of primary oligodendrocyte precursor cells (OPCs) into mature oligodendrocytes, with a more prominent effect of the former compound. Moreover, our results demonstrated that honokiol treatment improved myelin injury, induced mature oligodendrocyte protein expression, attenuated cognitive decline, promoted oligodendrocyte regeneration, and inhibited astrocytic activation in the bilateral carotid artery stenosis model. Mechanistically, honokiol increased the phosphorylation of serine/threonine kinase (Akt) and mammalian target of rapamycin (mTOR) by activating cannabinoid receptor 1 during OPC differentiation. Collectively, our study indicates that honokiol might serve as a potential treatment for WMI in chronic cerebral ischemia.
Magnolia ; White Matter ; Brain Ischemia/metabolism* ; Oligodendroglia/metabolism*

Metformin is currently a strong candidate anti-tumor agent in multiple cancers. However, its anti-tumor effectiveness varies among different cancers or subpopulations, potentially due to tumor heterogeneity. It thus remains unclear which hepatocellular carcinoma (HCC) patient subpopulation(s) can benefit from metformin treatment. Here, through a genome-wide CRISPR-Cas9-based knockout screen, we find that DOCK1 levels determine the anti-tumor effects of metformin and that DOCK1 is a synthetic lethal target of metformin in HCC. Mechanistically, metformin promotes DOCK1 phosphorylation, which activates RAC1 to facilitate cell survival, leading to metformin resistance. The DOCK1-selective inhibitor, TBOPP, potentiates anti-tumor activity by metformin in vitro in liver cancer cell lines and patient-derived HCC organoids, and in vivo in xenografted liver cancer cells and immunocompetent mouse liver cancer models. Notably, metformin improves overall survival of HCC patients with low DOCK1 levels but not among patients with high DOCK1 expression. This study shows that metformin effectiveness depends on DOCK1 levels and that combining metformin with DOCK1 inhibition may provide a promising personalized therapeutic strategy for metformin-resistant HCC patients.
Animals ; Antineoplastic Agents/therapeutic use* ; Carcinoma, Hepatocellular/metabolism* ; Cell Line, Tumor ; Clustered Regularly Interspaced Short Palindromic Repeats ; Genome ; Humans ; Liver Neoplasms/metabolism* ; Metformin/therapeutic use* ; Mice ; Phosphorylation ; Synthetic Lethal Mutations ; Transcription Factors/metabolism* ; rac GTP-Binding Proteins/metabolism*