Objective To evaluate the safety and effect of the use of micro coils in endovascular embolization of anterior communicating artery aneurysms. Methods The clinical data of 27 consecutive patients with anterior communicating artery aneurysm, who were admitted to Yancheng Municipal Third People’s Hospital to receive endovascular embolization treatment with micro coils, were retrospectively analyzed. One patient had multiple anterior communicating artery aneurysms. The efficacy and safety of endovascular micro-coil embolization of anterior communicating artery aneurysm were evaluated by the occlusion rate of aneurysm, the prognosis of the patients, the complications, the neurological function, etc. Results Successful embolization treatment of anterior communicating artery aneurysm was achieved in all 27 patients. Dual catheter technique was employed in 3 patients, stent-assisted technique was used in 3 patients, and the technical success rate was 100%. Dense embolization was obtained in 21 patients, and residual aneurysm neck was observed in 6 patients. The unobstructed parent artery was reserved in all patients, no hemorrhage due to ruptured aneurysm or dropping of steel coil was found. One patient developed recurrent hemorrhage and died two days later. Mild recurrence was seen in one patient six months after the treatment. The modified Rankin scal (mRS) score showed that 0-1 point was seen in 24 patients, 2 points in one patient, and 4 point in one patient. Conclusion The anterior communicating artery aneurysm can be safely and effectively cured when appropriate endovascular embolization technique is used.

ObjectiveTo investigate the effect and gender differences of experimental moderate pain on attentional bias towards pain-related words.MethodsWith the tourniquet around the left upper limb,32 healthy college students were asked to perform two dot-probe tasks including five kinds of pain-related words,one task with the tourniquet deflating and the other task with the tourniquet inflating to 200 mm Hg pressure.The reaction time (RT) and the error rate of recognition task were recorded.The pain intensity and distress were recorded too.Results ( 1 ) Compared with no pain condition ( RT of affective and social-threat words were (507 ± 78 ) ms,(504 ±89 )ms respectively),the react time was shorter in female in the condition of tourniquet pain,particularly for affective and social-threat words (the RT were (464 ± 79 )ms,(465 ± 72 )ms respectively,F ( 1,4) =19.157,P ＜0.01 ),but not in male.( 2 ) In condition of no pain,the reaction time of male ( (456 ± 59) ms ) was shorter than that of female (504 ± 79ms).However,in the condition of pain,the significant main effect was not found.ConclusionThe reacting time of female was shorter in condition of moderate tourniquet pain,which imply that female showed significant attentional bias towards affective and social-threat words.

The cardiovascular diseases, which have the increasing incidence and high mortality rate, have brought a great impact on people′s lives and health.Being lipid inclusions with 30~150 nm in diameter, exosomes can be secreted by most cells in the body, and proteins, lipids, nucleic acids and other substances derived from those cells are wrapped inside.Exosomes play a variety of biological roles in the communication between cells, such as mediating immune response, inflammatory response, cell migration and differentiation.Research on exosomes has made significant progress, and the roles of exosomes in cardiovascular diseases have consequently attracted more and more attention in recent years.The communication of exosomes between cardiomyocytes and between heart and peripheral tissues has provided new strategies for the diagnosis and treatment of cardiovascular diseases.Application of exosomes in the diagnosis and treatment of cardiovascular diseases such as heart failure, viral myocarditis, Kawasaki disease and dilated cardiomyopathy is summarized in this review.

Objective To explore the clinical diagnosis and management of focal nodular hyperplasia (FNH) of the liver. Methods Forty-two FNH cases treated in the past 9 years were studied retrospectively. The clinical and pathologic data were reviewed. Results Preoperative liver function test and AFP were normal. The preoperative radiography in FNH was usually not specific, with less than 50% cases were suggestive of FNH of the liver. Surgical resection resulted in a permanent cure with no significant postoperative complications. More than one year follow-up found recurrence in one case. Conclusion Clinical, laboratory and radiological findings when combined could help in establishing tentative diagnosis of FNH. Surgery is recommended in cases with equivocal diagnosis or in fear of hepatocellular carcinoma.

Objective To explore the life experiences of donors undergoing pediatric living related liver transplantation and elucidate it 's the influencing factors of quality-of-life .Methods A qualitative study was performed with a phenomenological-hermeneutic approach .Twelve living related liver transplantation donors were face-to-face interviewed by a semi-structured interview and 7-step Colaizzi method was applied for data analysis .Results Four domains and 9 sub-domains were summarized as follows :body disturbance (pain ,discomfort & physical changes) ,sense of uncertainty (recipient-dependent sensitive ,self-doubt & confusion under family pressure ) ,role conflict (patient-carer & family-social) and contentment & gratitude (willing to sacrifice ,living in the present &benefiting from social funds ) .Conclusions The levels of quality-of-life vary greatly in different donors .Body disturbance ,sense of uncertainty ,role conflict ,contentment and gratitude are the major influencing factors of quality-of-life for donors undergoing pediatric living related transplantation .

Objective To investigate the expression and clinical significance of microRNA-93-5p(miR-93-5p)in patients with type 2 diabetes mellitus(T2DM)complicated with coronary heart disease(CHD).Methods A total of 60 patients with T2DM(T2DM group),57 patients with T2DM complicated with CHD(T2DM with CHD group),and 60 healthy individuals(control group)were enrolled in this study from August 2019 to May 2021.The general information,serum miR-93-5p,and interleukin-6(IL-6)levels were compared among the T2DM with CHD group,control group and T2DM group;the relationships of serum miR-93-5p and IL-6 levels with low-density lipoprotein cholesterol(LDL-C),fasting insulin(FINS),high-density lipoprotein cholesterol(HDL-C),fasting blood glucose(FBG),triglyceride(TG),glycated hemoglobin(HbA1c),and total cholesterol(TC)were analyzed in T2DM with CHD patients;the influencing factors of T2DM complicated with CHD were analyzed;the predictive value of serum miR-93-5p and IL-6 for T2DM complicated with CHD was evaluated.Results The levels of LDL-C,FINS,TG,FPG,TC,HbA1c,serum miR-93-5p,and IL-6 in the T2DM with CHD group and T2DM group were significantly higher than those in the control group,while the HDL-C level was significantly lower(P＜0.01);the levels of LDL-C,FINS,TG,FPG,TC,HbA1c,serum miR-93-5p,and IL-6 in the T2DM with CHD group were significant-ly higher than those in the T2DM group,while the HDL-C level was significantly lower(P＜0.01).The serum miR-93-5p and IL-6 levels in T2DM with CHD patients were positively correlated with LDL-C,FINS,HbA1c,TC and FPG(P＜0.01),and negatively correlated with HDL-C(P＜0.01);the expression level of miR-93-5p in serum was positively correlated with IL-6(P＜0.05).LDL-C,FINS,FPG,HbA1c,TC,miR-93-5p,and IL-6 were the influencing factors of T2DM com-plicated with CHD(P＜0.05);the area under the curve(AUC)of serum miR-93-5p and IL-6 for predicting T2DM complicated with CHD was 0.888 and 0.898 respectively,with cut-off values of 2.59 and 77.98 ng/L respectively,sensitivity of 75.4％for both serum miR-93-5p and IL-6,and the specificity was 89.2％for miR-93-5p and 85.8％for IL-6;the AUC of the combined prediction of miR-93-5p and IL-6 for T2DM complicated with CHD was 0.939,with sensitivity and specificity of 91.2％and 83.3％respectively.Conclusion The serum miR-93-5p level is elevated in pa-tients with T2DM complicated with CHD,and miR-93-5p together with IL-6 may participate in the process of T2DM complicated with CHD.The combined detection of IL-6 and miR-93-5p is expected to serve as an auxiliary method for prediction of T2DM complicated with CHD.

Objective To investigate the expression and clinical significance of microRNA-93-5p(miR-93-5p)in patients with type 2 diabetes mellitus(T2DM)complicated with coronary heart disease(CHD).Methods A total of 60 patients with T2DM(T2DM group),57 patients with T2DM complicated with CHD(T2DM with CHD group),and 60 healthy individuals(control group)were enrolled in this study from August 2019 to May 2021.The general information,serum miR-93-5p,and interleukin-6(IL-6)levels were compared among the T2DM with CHD group,control group and T2DM group;the relationships of serum miR-93-5p and IL-6 levels with low-density lipoprotein cholesterol(LDL-C),fasting insulin(FINS),high-density lipoprotein cholesterol(HDL-C),fasting blood glucose(FBG),triglyceride(TG),glycated hemoglobin(HbA1c),and total cholesterol(TC)were analyzed in T2DM with CHD patients;the influencing factors of T2DM complicated with CHD were analyzed;the predictive value of serum miR-93-5p and IL-6 for T2DM complicated with CHD was evaluated.Results The levels of LDL-C,FINS,TG,FPG,TC,HbA1c,serum miR-93-5p,and IL-6 in the T2DM with CHD group and T2DM group were significantly higher than those in the control group,while the HDL-C level was significantly lower(P＜0.01);the levels of LDL-C,FINS,TG,FPG,TC,HbA1c,serum miR-93-5p,and IL-6 in the T2DM with CHD group were significant-ly higher than those in the T2DM group,while the HDL-C level was significantly lower(P＜0.01).The serum miR-93-5p and IL-6 levels in T2DM with CHD patients were positively correlated with LDL-C,FINS,HbA1c,TC and FPG(P＜0.01),and negatively correlated with HDL-C(P＜0.01);the expression level of miR-93-5p in serum was positively correlated with IL-6(P＜0.05).LDL-C,FINS,FPG,HbA1c,TC,miR-93-5p,and IL-6 were the influencing factors of T2DM com-plicated with CHD(P＜0.05);the area under the curve(AUC)of serum miR-93-5p and IL-6 for predicting T2DM complicated with CHD was 0.888 and 0.898 respectively,with cut-off values of 2.59 and 77.98 ng/L respectively,sensitivity of 75.4％for both serum miR-93-5p and IL-6,and the specificity was 89.2％for miR-93-5p and 85.8％for IL-6;the AUC of the combined prediction of miR-93-5p and IL-6 for T2DM complicated with CHD was 0.939,with sensitivity and specificity of 91.2％and 83.3％respectively.Conclusion The serum miR-93-5p level is elevated in pa-tients with T2DM complicated with CHD,and miR-93-5p together with IL-6 may participate in the process of T2DM complicated with CHD.The combined detection of IL-6 and miR-93-5p is expected to serve as an auxiliary method for prediction of T2DM complicated with CHD.

OBJECTIVETo study the micrometastasis distribution in liver tissue surrounding hepatocellular carcinoma (HCC), and provide reference for appropriate surgical safety margin.

METHODSThirty-six patients with HCC but without clinical metastasis underwent hepatectomy. Their specimens showing ample surgical margin were made into giant sections. Tumor micrometastasis in liver tissue around the primary tumor were examined microscopically. In each specimen, the surrounding tissue was divided into proximal(p) and distal(d) areas. In either area, three lines of demarcation 0.5 cm, 1.0 cm, and 2.0 cm away from the margin of the primary tumor were designated as L(0.5), L(1.0) and L(2.0). Therefore, the surrounding tissue was divided into six zones - Z(p0.5), Z(p1.0), Z(p2.0) and Z(d0.5), Z(d1.0), Z(d2.0). The maximum micrometastasis spread distance (MMSD) and density (D(p0.5), D(p1.0), D(p2.0) and D(d0.5), D(d1.0), D(d2.0)) in each zone were analyzed after search for micrometastasis in the giant sections.

RESULTS72.5% (111/153) micrometastases were found in form of microscopic tumor emboli. Their spread distance could be up to 6.1 cm. In 66.7% (24/36) specimens, micrometastases were found in the surrounding tissue. In 91.7% (22/24) of them, the distal MMSD was less than 3 cm. The proximal MMSD was less than 1.5 cm in 92.3% (12/13). The comparison of micrometastasis density in the different zones were D(d0.5) > D(d1.0) > D(d 2.0); D(p0.5) > D(p1.0) > D(p2.0); D(d1.0) > D(p1.0); D(d2.0) > D(p2.0) with significant differences.

CONCLUSION(1) Micrometastases of HCC exist mainly in form of microscopic tumor emboli, (2) The longer the distance from the primary focus, the lower the micrometastasis incidence, (3) In zones more than 0.5 cm away from the primary focus, tumor micrometastasis incidence is significantly lower in the proximal zones than that in the distal zones and (4) For HCC patients without clinical metastasis, a surgical margin of 3 cm wide in the distal area and 1.5 cm wide in the proximal area may reduce the rate of postoperative recurrence.

Carcinoma, Hepatocellular ; secondary ; surgery ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; pathology ; surgery ; Neoplasm Metastasis ; Neoplasm Recurrence, Local

Objective To examine the prognostic value of four important driver gene mutations in patients with radical resection of pancreatic cancer. Methods The clinical data and follow‐up data of pancreatic cancer patients undergoing radical pancreatectomy and targeted sequencing from January 2016 to March 2018 at Department of Hepato‐Biliary‐Pancreatic Surgery, Changhai Hospital were retrospectively analyzed.There were 159 males and 88 females,aged of (60.8±8.7)years(range:33-83 years) and preoperative CA19‐9 of (492.4 ± 496.6)kU/L(range: 2-1 200 kU/L). One hundred and fifty nine cases of tumors were located in the head and 88 cases in the body and tail of the pancreas. After univariate analysis of clinical pathological factors (including gender, age, preoperative CA19‐9, tumor location, tumor differentiation, pathological T and N stage, Micr. perineural invasion, Micr. lympho‐vascular invasion, resection margin), the variable whose P<0.1 was included in COX regression model with four important driver gene mutations to find which mutation was related to prognosis independently. The number of gene mutations and KRAS subgroups were analyzed by Kaplan‐Meier curve.Results Among 247 patients,the number of KRAS,TP53, SMAD4 and CDKN2A mutations was 212 cases(85.8%), 160 cases(64.8%), 66 cases(26.7%) and 44 cases (17.8%),respectively.KRAS mutation was correlated with the tumor differentiation and pathological T stage (χ2=24.570/6.690, P=0.000/0.035), TP53 mutation was correlated with the tumor differentiation and the resected margin(χ2=5.500/4.620, P=0.019/0.032), and CDKN2A mutation was correlated with gender(χ2=16.574,P=0.000).COX regression model analysis showed that only KRAS mutation was an independent risk factor for disease free survival and overall survival(HR=1.776, 95%CI: 1.079-2.923, P=0.024; HR=1.923, 95%CI: 1.016-3.639, P=0.045); KRASG12D mutation was associated with shorter OS(P=0.007). Conclusion KRAS and its subgroup KRASG12D mutation can be used as a prognostic index for patients with radical resection of pancreatic cancer.

Objective:To evaluate the performance of the European Evidence-based Guidelines on Pancreatic Cystic Neoplasms (EEGPCN)(2018) and International Association of Pancreatology(IAP) Guideline(Version 2017) in predicting high grade dysplasia/invasive carcinoma-intraductal papillary mucinous neoplasm(HGD/INV-IPMN).Methods:A retrospective analysis of 363 patients,who underwent surgical resection in Changhai Hospital affiliated to Navy Medical University from January 2012 to December 2018 and were pathologically identified as (intraductal papillary mucinous neoplasm, IPMN),was performed. The patients,including 230 males and 133 females,aging (61.7±10.1) years(range:19 to 83 years). The proportion of HGD/INV-IPMN who met with the absolute indication(AI) of EEGPCN and high risk stigma(HRS) of IAP were compared. The binary Logistic regression analysis was used to find the independent risk factors of HGD/INV-IPMN.Eight combinations of risk factors derived from relative indication/worrisome feature or risk factors in this study,were made to evaluate the diagnostic efficacy. The area under curve(AUC) of receiver operating characteristics was used to evaluate the the cutoff value of risk factors(①CA19-9≥37 U/ml,②diameter of main pancreatic duct 5.0-9.9 mm,③enhancing mural nodule<5 mm,④(acute) pancreatiti,⑤ acyst diameter ≥40 mm,⑤ bcyst diameter ≥30 mm, ⑥thickened or enhancing cyst walls,⑦neutrophile granulocyte to lymphocyte ratio(NLR)≥2, ⑧cyst located in head, uncinate or neck,⑨carcinoembryonic antigen(CEA) ≥5 μg/L) number for predicting HGD/INV-IPMN.The accuracy,sensitivity,specificity,positive predictive value,negative predictive value,true positive,true negative,false positive,false negative,positive likelihood ratio,negative likelihood ratio,Youden index and F1 score were calculated. Results:Ninety-two patients(49.5%) of 186 ones who met AI and 85 patients(48.3%) of 176 ones who met HRS were respectively confirmed as HGD/INV-IPMN. In those patients who were not met AI,tumor location,thickened/enhancing cyst wall,CA19-9 elevated,NLR≥2 and CEA elevated were significantly ( P<0.05) correlated with HGD/INV-IPMN. And tumor location(head/uncinate/neck vs. body/tail, OR=3.284,95% CI:1.268-8.503, P=0.014),thickened/enhancement cyst wall (with vs.without, OR=2.713,95% CI:1.177-6.252, P=0.019),CA19-9(≥37 U/L vs.<37 U/L, OR=5.086,95% CI:2.05-12.62, P<0.01) and NLR(≥2 vs.<2, OR=2.380,95% CI:1.043-5.434, P=0.039) were the independent risk factors of HGD/INV-IPMN. Patients with ≥4 risk factors of 9 in combination Ⅷ(①②③④⑤ b⑥⑦⑧⑨) were diagnosed as HGD/INV-IPMN with the moderate accuracy(71.0%),moderate sensitivity (62.0%) and moderate specificity (73.0%). Patients with ≥4 risk factors of 9 in Combination Ⅶ(①②③④⑤ a⑥⑦⑧⑨) were diagnosed as HGD/INV-IPMN with the highest specificity(83.0%) and patients with ≥3 risk factors of 8 in combination Ⅵ(①②③④⑤ b⑥⑧⑨) were diagnosed as HGD/INV-IPMN with the highest sensitivity(74.0%). The AUC for diagnosis of HGD/INV-IPMN in combination Ⅵ,Ⅶ and Ⅷ were 0.72,0.75 and 0.75,respectively. Older patients and younger patients could respectively refer to combination Ⅶ and combination Ⅵ to improve the management of IPMN. Conclusions:Patients who meet AI of EEGPCN should undertake resection, otherwise the method we explored is recommended. The method of improvement for diagnosis of HGD/INV-IPMN is relatively applicable and efficient for decision-making of surgery, especially for younger patients with decreasing of missed diagnosis and elder patients with decreasing of misdiagnosis.