【Objective】 To explore the value of controlling nutritional status (CONUT) score and related inflammatory indicators in predicting the prognosis of clear cell renal cell carcinoma (ccRCC) patients, to provide a reference for better clinical assessment and individualized treatment plan. 【Methods】 A retrospective study was conducted on 132 patients with ccRCC admitted to four comprehensive hospitals in Yibin during 2010 and 2018.Patients’ medical and follow-up records were collected, and receiver operating characteristic (ROC) curve was drawn to analyze the area under the curve (AUC) and optimal cut-off value of CONUT score and related indicators.Survival curve was plotted with Kaplan-Meier method, and the influencing factors of prognosis were analyzed with Log-rank test and Cox regression. 【Results】 During the follow-up of 62 (53, 71) months, 37 (28.03%) deaths occurred.The disease-specific survival (DSS) and progression-free survival (PFS) were 51 (41, 58) and 46 (35, 56) months, respectively.The 3-year and 5-year DSS and PFS were 84.09% and 71.97%, and 75.00% and 71.97%, respectively.The AUC of CONUT score, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) were 0.980, 0.905, 0.899 and 0.884, respectively, with the optimal cut-off values of 3.50, 3.19, 89.07 and 3.56, respectively.Cox regression showed that CONUT score (HR=0.042, 95%CI:0.013—0.140) and PLR (HR=0.182, 95%CI:0.045—0.744) were associated with DSS; CONUT score (HR=0.029, 95%CI:0.010—0.086) and LMR (HR=2.984, 95%CI:1.227—7.258) were associated with PFS. 【Conclusion】 The prognosis of ccRCC patients is related to their nutritional, immune, and inflammatory status.CONUT score and inflammatory factors (PLR, LMR) may be important predictors of DSS and PFS.

Objective To evaluate the efficacy of dexmedetomidine and dezocine used to supplement awake tracheal intubation assisted by fiberoptic bronchoscope (FOB) in elderly patients.Methods Sixty elderly patients aged 65-77 yr,of ASA physical status Ⅱ or Ⅲ (Mallampati grade Ⅰ or Ⅱ),scheduled for elective surgery under general anesthesia,were randomly divided into 3 groups (n =20 each) using a random number table:dezocine group (group DEZ),dexmedetomidine group (group DEX) and dezocine combined with dexmedetomidine group (group DEZ+DEX).Dezocine 0.1 mg/kg was injected intravenously in group DEZ.Dexmedetomidine 0.4 μg/kg was infused intravenously over 10-15 min in group DEX.In group DEZ+DEX,dexmedetomidine 0.4 μg/kg was infused intravenously over 10-15 min,and dezocine 0.1 mg/kg was injected simultaneously.Laryngeal mucous membrane was sprayed with 2％ lidocaine for topical anesthesia during infusion in all the three groups.In addition,1％ tetracaine 3 ml was injected into trachea through cricothyroid membrane.Awake tracheal intubation was performed and assisted by FOB after the end of administration in all the three groups.Cardiovascular response (MAP or HR＞30％ of baseline values) and respiratory depression (SpO2＜90％ and RR＜8 bpm) were recorded during the period between induction of anesthesia and 3 min after intubation was completed.The intubation time was recorded.The tolerance of tracheal tube was assessed in the patients.At the time of topical anesthesia,when epiglottis came into view,immediately after tracheal tube was successfully inserted into trachea,and at 3 min after successful intubation,perfusion index and Ramsay sedation score,and patients' satisfaction with the sedation (Ramsay sedation score 2-4) were recorded.Results Compared with group DEZ or DEX,the tolerance of tracheal tube was significantly enhanced,intubation time was shortened,the rate of satisfactory sedation was increased,perfusion index and the incidence of cardiovascular response were decreased in DEZ+DEX group.There was no significant difference in respiratory depression among the three groups.Conclusion Dexmedetomidine and dezocine can provide better condition for awake tracheal intubation assisted by FOB than dexmedetomidine or dezocine alone in elderly patients.

Objective To identify-and study a monoclonal antibody (McAb) against pancreatic cancer stem cell in vitro,as well as to provide candidate antibody-drug for cancer stem cell-targeted therapy of pancreatic cancer.Methods Cell culture in serum-free medium and PKH26 staining were used to determine the existence of cancer stem cell in PANC-1 cell line.Flow cytometry was used to detect the expression of CD24 and CD44 in PANC-1 cells and sphere cells,Immunofluorescence was used to detect the expression of CD24 and antigen recognized by 15D2.The effects of 15D2 on self-renewal,proliferation and chemosensitivity to gemcitabine of PANC-1 parent or sphere cells were identified by serum-free suspension culture and CCK-8 assay,Immunohistochemistry was applied to detect the level of antigen recognized by 15D2 in cancer and adjacent tissues.Results PANC-1 cells could survive,proliferate and form sphere cells in serum-free medium.The sphere-forming rate was (2.5±0.5) ％.The percentage of CD44+ CD24+ cells population in sphere cells increased by 11.4 folds compared to PANC-1 cells,in which single nearly 97 ％ CD24+ cells was CD44+ CD24+ cells.Therefore,CD24+ was selected for cancer stem cell marker in PANC-1 in this study.The two-color immunofluorescence assay showed that 15D2 could recognize cells which was also stained by CD24.In vitro functional experiments demonstrated that 15D2 significantly suppressed the sphere formation of PANC-1 cells,with the inhibitory rate being 30.4 ％.Meanwhile,the combination of 15D2 and gemcitabine can significantly attenuate the growth of PANC-1 sphere cells.The IC50 was 0.10 μmol/L in 15D2+gemeitabine group,and 0.39 μmol/L in mlgM+gemcitabine group,Immunohistochemical results showed that the antigen recognized by 15D2 was greatly expressed in about 76.9 ％ (11/13) human pancreatic cancer tissues and hardly detected in adjacent normal tissues (10.0 ％,1/10).Conclusion McAb 15D2 can inhibit self-renewal and drug-resistance of pancreatic cancer stem cell in PANC-1 cell line,and it might become a candidate drug for target pancreatic cancer stem cell treatment.

Objective To observe the effects of Dengzhanhua Capsule on kidney tissue inflammatory cytokines in chronic renal failure rats;To explore its possible mechanism for the efficacy in chronic renal failure. Methods Sixty SD rats were randomly divided into normal control group, model group, benazepril group and Dengzhanhua group, 15 rats in each group. Chronic renal failure rat model was established by Platt 5/6 nephrectomized. Benazepril (0.29 mg/100 g) was given to rats in the benazepril group by gastrogavage. Dengzhanhua Capsule (0.3 g/100 g) was given to rats in the Dengzhanhua group by gastrogavage. Normal saline was given to rats in the normal group and the model group by gastrogavage. The whole treatment period was twelve weeks. Expressions of TGF-β1 and PAI-1 were determined by semi-quantitative RT-PCR after treatment. Concentrations of kidney tissue inflammatory cytokines IL-6 and TNF-α were determined by ELISA. Results Expressions of TGF-β, PAI-1 and IL-6, TNF-αin benazepril group and Dengzhanhua group were significantly lower than those in model group (P<0.05). Compared with benazepril group, it was significantly lower in Dengzhanhua group (P<0.05). Conclusion Dengzhanhua Capsule can reduce kidney tissue inflammatory in chronic renal failure rats, and inhibit renal fibrosis.

Objective To evaluate the effects of dexmedetomidine on the cellular immune function during analgesia with morphine after radical resection for esophageal cancer in the patients.Methods Sixty patients of both sexes,of ASA physical status Ⅰ or Ⅱ,after radical resection for esophageal cancer under general anesthesia,were randomly divided into 2 groups (n =30 each) using a random number table:control group (group C) and dexmedetomidine group (group Dex).Patient-controlled intravenous analgesia (PCIA) was performed immediately after operation in the two groups.In group C,the PCIA solution (150 ml) contained morphine 0.48 mg/kg.In group Dex,the PCIA solution (150 ml) contained morphine 0.48 mg/kg and dexmedetomidine 1 μg/kg.The postoperative visual analogue scale (VAS) scores were maintained ≤ 3.The consumption of morphine was recorded within 24,48 and 72 h after operation.The adverse effects such as nausea,vomiting,pruritus,bradycardia,hypotension,oversedation and respiratory depression were also recorded after operation.Before induction of anesthesia (T0),immediately after extubation (T1),and at 24,48 and 72 h after operation (T2-4),venous blood samples were obtained for determination of the levels of T-lymphocyte subsets (CD3+,CD4+,CD8+) and natural killer (NK) cells by flow cytometry.CD4+/CD8+ ratio was calculated.Results Compared with group C,the consumption of morphine within 24,48 and 72 h after operation and incidence of nausea,vomiting and pruritus after operation were significantly decreased in group Dex.The levels of CD3+,CD4+,CD4+/CD8+ ratio and NK cells were significantly lower at T1-4 than at T0 in the two groups.The levels of CD3+,CD4+,CD4+/CD8+ ratio and NK cells were significantly higher at T1-4 in group Dex than in group C.Conclusion Dexmedetomidine can improve the cellular immune function during analgesia with morphine after radical resection for esophageal cancer in the patients.

Objective To study the acromial angle morphologic type and measurement analysis based on CT 3D reconstruction. Methods Totally 278 cases of adult CT three-dimensional reconstruction of the shoulder morphological data were collected, and the measurement data of the different types was analyzed, its statistical significance was clarified, and the morphological characteristics to division the type of acromial angle were summarized, its diagnosis and treatment under the acromion impingement of guiding significance were discussed. Results The acromial angle was divided into three types (C shaped acromial angle, L shaped acromial angle, and double angle shaped acromial angle). Among them, L type was the most, accounting for 48. 56%, followed by C type, and double angle type was the least. In comparison of the breadth of the acromion and the length of the acromion, L type was significantly longer than C type (P<0. 05). The thickness of acromion at a point of the double angle shaped acromial angle was greater than that of the other two type (P<0. 05). In the comparison of ∠a, the double-angle type was greater than the C type（P＜0.05）, and the C type was greater than the L type（P＜0.05）. Conclusion There are significant differences in the classification and anatomical parameters of acromial angle, and the differences are statistically significant. It has certain guiding significance to the etiology and clinical diagnosis and treatment of subacromial impingement syndrome.

Objective:To investigate the effect of ginkgo biloba extract (GBE) on oxidative stress in medial prefrontal cortex and excitatory/inhibitory balance of pyramidal neurons in chronic unpredictable mild stress (CUMS)-induced depressive model mice.Methods:Totally 48 SPF grade 7-week-old male C57BL/6J mice were divided into 4 groups according to random number table method: control+ saline group (CTRL+ Veh), control+ GBE group (CTRL+ GBE), model+ saline group (CUMS+ Veh), model+ GBE group (CUMS+ GBE), with 12 mice in each group.Mice in CUMS+ Veh group and CUMS+ GBE group were established by CUMS method, and mice in CTRL+ GBE group and CUMS+ GBE group were intraperitoneally injected with GBE (70 mg/kg) once a day, and mice in CTRL+ Veh group and CUMS+ Veh group were injected intraperitoneally with 0.9% sodium chloride solution.Then, the sucrose preference test, forced swimming test (FST) and tail suspension test (TST) were performed to evaluate the depressive-like behavior of mice, and open field test (OFT) was performed to evaluate the autonomous locomotion and exploration ability and anxiety-like behavior.The content of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) in mPFC were determined by ELISA.Spontaneous excitatory postsynaptic currents (sEPSC) and spontaneous inhibitory postsynaptic currents (sIPSC) were detected by whole-cell recording.SPSS 23.0 was used for data analysis and two-factor analysis of variance(whether to get GBE, whether to mold, show as GBE×CUMS) was used for statistical analysis.Results:(1) Behavioral results: the the time spent in center and total distance of OFT and sugar preference rate of the four groups of mice were compared, and the interaction of GBE×CUMS was significant( F=24.90, 4.82, 3.91, all P<0.05). The results of simple effect analysis showed that the time spent in center ((47.15±3.58) s), the total distance((19.33±0.86) m) and the sugar preference rate((59.11±8.79)%) of the mice in CUMS+ Veh group were lower than those in the CTRL+ Veh group((61.55±2.49) s, (23.24±1.21) m, (84.02±7.45) %) (all P<0.01), and the above indexes in CUMS+ GBE group ((56.51±3.53) s, (20.75±1.31) m, (70.80±11.79)%) were higher than those in CUMS+ Veh group (all P<0.05). In the immobility time of FST and TST of mice in the 4 groups, the interaction of GBE×CUMS were significant( F=85.53, 83.39, both P<0.01). The immobility time of FST and TST in CUMS+ Veh group were higher than those in CTRL+ Veh group (both P<0.01 ), and the above indexes in CUMS+ GBE group were lower than CUMS+ Veh group(both P<0.05). (2)The results of ELISA showed that the interaction of GBE×CUMS of SOD level of mice in the 4 groups was not significant ( F=3.52, P=0.07), but the main effects of GBE factor and CUMS factor were both significant ( F=4.69, 46.93, both P<0.05). The interaction of GBE×CUMS of MDA level was significant( F=16.61, P<0.01). The level of SOD in the CUMS+ Veh group was lower than that in the CTRL+ Veh group ( P<0.01), and the level of SOD in the CUMS+ GBE group was higher than that in the CUMS+ Veh group ( P<0.05). The level of MDA in the CUMS+ Veh group was higher than that of the CTRL+ Veh group ( P<0.01), and the level of MDA in CUMS+ GBE group was lower than that of the CUMS+ Veh group ( P<0.01). (3) The results of whole-cell recording showed that the interaction of GBE×CUMS of frequency and quantification of sEPSC in the four groups were significant ( F=5.45, 6.94, both P<0.05). The sEPSC frequency and quantification in the CUMS+ Veh group were lower than those in the CTRL+ Veh group (both P<0.01), and the sEPSC frequency and quantification in CUMS+ GBE group were higher than those of CUMS+ Veh group (both P<0.05). The interaction of GBE×CUMS of frequency and quantification of sIPSC in the four groups were significant ( F=7.78, 8.96, both P<0.01). The sIPSC frequency and quantification of the CUMS+ Veh group were higher than those of CTRL+ Veh group (both P<0.01), and the above indexes of CUMS+ GBE group were lower than those of CUMS+ Veh group (both P<0.01). As for the sEPSC/sIPSC ratio, GBE×CUMS interaction was significant ( F=5.45, P=0.02). The sEPSC/sIPSC ratio of CUMS+ Veh group (0.09±0.01) was lower than that of CTRL+ Veh group (0.28±0.04) ( P<0.01), and the sEPSC/sIPSC ratio of CUMS+ GBE group (0.14±0.03) was higher than that of CUMS+ Veh group ( P<0.05). Conclusion:Ginkgo biloba extract can improve the depression-like behavior of mice induced by CUMS, reduce the oxidative stress of mPFC and improve the excitation/inhibition balance of pyramidal neurons in depressive model mice.

Estimation of postmortem interval (PMI) is one of the important research contents in forensic pathology, and it has always been the focus and hot spot of research work. In recent years, scholars at home and abroad have made some research progress in estimating PMI by using ocular tissue. After death, the changes of cornea, aqueous humor, iris, lens, vitreous humor and retina all show time sequence change rule highly related to PMI. This paper reviews the research progress of PMI estimation based on the morphological, biochemical, molecular and genetic material changes of different ocular tissue structures after death, and discusses the existing problems and development trends.
Humans ; Postmortem Changes ; Time Factors ; Autopsy ; Vitreous Body ; Forensic Pathology

Cardiac magnetic resonance (CMR) imaging provides accurate anatomic information and advanced soft contrast, making it the reference standard for assessing cardiac volumes and systolic function. In this review, we summarize the recent advances in CMR sequences. New technical development has widened the use of CMR imaging beyond the simple characterization of myocardial scars and assessment of contractility. These novel CMR sequences offer comprehensive assessments of coronary plaque characterization, myocardial fiber orientation, and even metabolic activity, and they can be readily applied in clinical settings. CMR imaging is able to provide new insights into understanding the pathophysiologic process of underlying cardiac disease, and it can help physicians choose the best treatment strategies. Although several limitations, including the high cost and time-consuming process, have limited the widespread clinical use of CMR imaging so far, recent advances in software and hardware technologies have made the future more promising.
Cardiac Volume ; Cardiology ; Cicatrix ; Heart Diseases ; Magnetic Resonance Imaging

Objective Hypothyroidism(HypoPT) is one of the most common complications of thyroid reoperation,and hypocalcemia caused by HypoPT is a difficult problem in clinical practice.This study aims to investigate the risk factors for hypoealcemia after reoperation of thyroid cancer.Methods Data of 106 patients who underwent reoperation for thyroid cancer from 2013 to 2018 were retrospectively analyzed.According to the parathyroid area involved in the reoperation,the reoperation was graded:low-risk group,intermediate-risk group and high-risk group.Parathyroid hormone(PTH) and total calcium(Ca) levels were monitored at 12 to 24 hours after surgery.The follow-up period was at least 6 months.The PTH cut-off values of postoperative hypocalcemia were analyzed by ROC curve.The chi-square test and logistic regression analysis were used to analyze the risk factors of postoperative hypocalcemia.Results The incidence of transient HypoPT after reoperation was 35％,and the permanent HypoPT was 1.9％.The grade of reoperation was positively correlated with postoperative HypoPT.The ROC curve showed that the PTH cut-off values of postoperative hypocalcemia was 15 pg/ml and area under curve(AUC) was 0.636(95％ CI:0.530-0.742,P＜0.017).Univariate and multivariate analysis showed that reoperation grade and postoperative PTH＜15 pg/ml were independent risk factors for postoperative hypocalcemia.Conclusion The grade of reoperation and postoperative PTH value ＜15 pg/ml can predict postoperative hypocalcemia.