BACKGROUND:Fibrin glue has been widely used in breast surgery, but due to the limitation of cases, there are some differences in clinical effects.
OBJECTIVE:To systemicaly review the clinical effect of fibrin glue in breast surgery.
METHODS: We searched China Journal Ful-text Database (CNKI), VIP database, Wanfang Database for clinical randomized controled trials related to fibrin glue used in breast surgery published from March 2002 to March 2014. A Meta-analysis was done in included studies using Rev Man 5.2 statistical software.
RESULTS AND CONCLUSION:A total of 11 studies, with 1 043 cases, were enroled for the Meta-analysis. Meta-analysis showed that the postoperative 1-day drainage amount and total drainage amount were significantly lower in the fibrin glue group than the control group [WMD=-85.62, 95%CI(-128.86,-42.39), P=0.000 1;WMD=-167.27, 95%CI (-210.05,-124.49),P < 0.000 01]. In addition, the fibrin glue group was superior to the control group in the postoperative seroma rate [OR=0.30, 95%CI (0.21, 0.44),P< 0.000 01]. Application of fibrin glue in breast cancer surgery can significantly reduce postoperative drainage and seroma rate.

Objective:To analyze the ultrasonographic images and clinical characteristics of congenital mesoblastic nephroma (CMN), and to investigate the differential performances with Wilm′s tumor (WT).Methods:Twenty-one cases of CMN patients confirmed by pathology from December 2008 to December 2019 in Beijing Children′s Hospital, Capital Medical University were collected as the CMN group, and in the same criterion, 51 cases of WT patients were taken as WT group. Ultrasonographic images and clinical characteristics were collected retrospectively, and then the tumor size, site, echo and age were compared and analyzed between the two groups. ROC curve was used to evaluate the differential performance.Results:The difference analysis showed that except for echo ( P=0.694), there were statistically significant differences in tumor size, site and age between the two groups (all P<0.05). In prenatal, the incidence of CMN was significantly higher than WT (61.9% vs 3.9%, P<0.001), and the specificity was 96.1%. The median age (interquartile range) of CMN after birth was significantly earlier than WT( Z=-4.044, P<0.001). The area under the ROC was 0.949, the best cutoff was 112.5 days, with a sensitivity of 87.5% and a specificity of 93.9%. Conclusions:It is difficult to distinguish CMN and WT by echo, but the diagnosis performance can be improved through combining tumor size with site, especially age.

OBJECTIVETo study telomerase activity (TA) and its variation in bone marrow mononuclear cells from patients with myelodysplastic syndrome (MDS) at different stages in comparison with normal bone marrow cells and leukemic cells.

METHODSThe TA was semi-quantitatively determined in mononuclear cells from 20 normal bone marrow samples, 21 patients with MDS at different stages and 32 cases of acute leukemia by using a polymerase chain reaction-enzyme linked immuno-sorben assay (PCR-ELISA) kit.

RESULTSThe TA in normal bone marrow cells was in the range of 0 to 0.3 units (U) with a mean of 0.11 +/- 0.08 U. Among them, 3 samples were considered positive in accordance with the standard recommended by the kit's pamphlet. In bone marrow cells from patients with acute leukemia, the TA was ranging from 0 to 0.96 U with a mean value of 0.42 +/- 0.26 U. The positive rate was 78.1% which was significantly different from that in normal bone marrow (BM) (P < 0.01). In case of myelodysplastic syndrome, the average level of TA was 0.27 +/- 0.19 U (ranging from 0 to 0.97 U) with a positive rate of 66.7%. In comparison with normal BM cells, the difference was significant (P < 0.05). Particularly, the MDS high-risk subgroup exhibited a significantly higher activity of telomerase (P < 0.05). In comparison with INT-1 and INT-2 subgroups in MDS patients based on international prognostic scoring system (IPPS), the difference in TA was also significant (P < 0.05). The abnormality in cell karyotype was not correlated with TA.

CONCLUSIONThe normal bone marrow cells demonstrate TA at a marginal level while a remarkably increasing level may be seen in acute leukemia patients. The BM cells from MDS patients display a moderate TA among which the high risk MDS subgroup with a poor prognostic IPPS score exhibited markedly higher TA.

Adolescent ; Adult ; Bone Marrow Cells ; enzymology ; Child ; Female ; Humans ; Leukocytes, Mononuclear ; enzymology ; Male ; Middle Aged ; Myelodysplastic Syndromes ; enzymology ; Telomerase ; metabolism

Objective To construct a prokaryotic expression vector pET-22b+with Middle East respiratory syndrome ( MERS) coronavirus nuclocapsid protein( NP) gene and to express and purify N protein.Methods N gene amplified by PCR was inserted into the prokaryotic expression vector pET-22b+.Recombinant plasmid was confirmed using DNA elec-trophoresis and sequencing.NP was expressed in E.coli BL21(DE3) by IPTG induced and purified by cation exchange chromatography using the AKTA purification system.Results The NP gene sequence was proved to be correct by sequen-cing and the protein was expressed in both soluble and insoluble forms in E.coli BL21 ( DE3 ) after IPTG induction.The purity and concentration of recombinant protein was improved obviously by cation exchange chromatography and enrich-ment.Conclusion Recombiant NP of high purity and concentration is purified and will facilitate NP functional research.

BACKGROUND AND OBJECTIVEPatients with malignant tumor are at high risk of thrombophilia, which contributes to thromboembolism. Surgical treatment is one of the critical risk factors. In this study, changes and clinical significances of blood coagulation of lung cancer patients pre- and post operation were investigated.

METHODSA prospective, controlled study were carried out in 74 lung disease patients, who were divided into lung cancer group and benign lung disease group. In each group, pre- and postoperative changes in prothrombin time (PT), activated partial thromboplastin time (APT), platelet count (PLT), D-dimer (D-D) and fibrinogen (Fib) and clinical performances were observed and compared in intra- and intergroups.

RESULTSThe concentration of Fib both in lung cancer group and its subgroup (adenocarcinoma of lung) increased, preoperative differences between benign lung disease group and subgroup (squamous cell carcinoma of lung) was significant (P < 0.05). PT (postoperative 1st to 7th day) in lung cancer group prolonged, APTT (postoperative 3rd to 7th day) reduced, Fib (postoperative 3rd to 7th day) and D-D (postoperative 1st to 7th day) increased, PLT reduced on the 1st, 3rd day but then increased on the 5th, 7th day after operation, the difference between pre- and post-operation was significant (P < 0.05). D-D and PT in lung cancer group on the 7th day was longer than in benign lung disease group (P < 0.05). One pulmonary thromboembolism (PTE) case in lung cancer group occurred, while in benign lung disease group none venous thromboembolism (VTE) appeared.

CONCLUSIONPatients with lung cancer are in high hypercoagulable state, and prone to VTE. It is necessary to take some interventions to avoid VTE.

Adult ; Aged ; Blood Coagulation ; physiology ; Female ; Fibrinogen ; metabolism ; Humans ; Lung Neoplasms ; blood ; metabolism ; surgery ; Male ; Middle Aged ; Partial Thromboplastin Time ; Platelet Count ; Prospective Studies ; Prothrombin Time

Objective To explore the efficacy of non-T cell depletion haploidentical hematopoietic stem-cell transplantation for T lymphoblastic lymphoma (T-LL). Methods 3 T-LL patients achieving complete remission received haploidentical bone marrow stem cell transplantation with granulocyte-colony-stimulating factor (G-CSF) mobilized bone marrow grafts from related donor without T-cell depletion. Two of them received a myeloablative conditioning regimen consisting of high-doses of cyclophosphamide and cytarabine with total body irradiation, whereas the other was preconditioned with busulfan, cyclophosphamide and cytarabine. All patients received strengthened phophylaxis regimen including rabbit anti-thymocyte globulin against acute graft-versus-host disease. Results All patients had rapid hematopoietic engraftment with the median time for neutrophil and platelet recovery being 12 days and 13 days, respectively. They are still alive without relapse at a median follow-up of 24 months (range: 9-75 months). Conclusion Treatment related toxicity can be acceptable in non-T cell depletion haploidenfical hematopoietic stem-cell transplantation for T-LL and the patients may achieve long term survival.

Objective To summarize the clinical features of graft failure (GF)after non-T-cell depleted haploidentical hematopoietic stem cell transplantation (Haplo-HCT), and to investigate the causes and treatment. Methods A retrospective analysis was carried out on 174 patientswho accepted the non-T-cell depleted Haplo-HCT from Jan 2012 to Dec 2013. The patients′ donor specific anti human leukocyte antigen antibodies (DSA) from the peripheral blood serum were detected and those DSA positive patients were treated by immunoglobulin or plasma exchange before transplatation. Results A total of three patients with acute myeloid leukemia got GF, the incidence rate was 1.72%. The patient with primary GF was given a secondHaplo-HCT, but did not get implanted with leukemia remission and three lineages persistently low , he was died of pulmonary infection eight monthes after the second transplant. One of the secondary GF patients was given peripheral blood mononuclear cells(PBMNCs) mobilized by granulocyte colony stimulating factor (G-CSF) from the donor, and got full donor chimerism on day 16 after infusion. The disease-free survival has been for 18 months. The other case was found that DSA was positive, the mean fluorescence intensity (MFI) value was 15000, then Rituximab and PBMNCs mobilized by G-CSF were administrated successively. On day 14 after infusion the partient got full donor chimerism , and MFI turned negative. The patient has been disease-free survival for 41 months. Conclusion Graft failure is a rare but fatal complication after non-T-cell depletedHaplo-HCT, Rituximab followed by PBMNCs are effective measures for DSA related GF, as were worthy of further study.

Objective:To assess the efficacy and safety of different antithrombotic strategies in patients following transcatheter aortic valve replacement(TAVR).Methods:A computerized search was performed to identify all relevant publications from PubMed, EMbase, CNKI and Wangfang databases.Non-randomized controlled trials of oral anticoagulant(OAC) vs. antiplatelet therapy(APT)and vitamin K antagonists(VKAs) vs. non-vitamin K antagonist oral anticoagulants(NOACs)after TAVR were collected, and the effects on postoperative bleeding, cerebrovascular events and all-cause mortality were analyzed.A meta-analysis was performed using RevMan 5.2 software provided by the Cochrane Collaboration. Results:A total of 9 studies were included.Compared with APT, the incidence of bleeding events caused by OAC increased(20.3% vs. 26.3%, OR=1.20, 95% CI: 1.04-1.39, P=0.01), while the incidence of cardiovascular events and all-cause mortality had no statistical difference.In the OAC group, all-cause mortality was lower in the VKAs group than in the NOACs group(9.8% vs. OR=0.73, 95% CI: 0.55-0.97, P=0.03). However, there was no statistical significance in cardiovascular and bleeding events( P>0.05). Conclusions:Compared with patients receiving APT, the incidence of bleeding events is higher in patients taking OAC.In patients taking OAC, VKAs can significantly decrease the mortality compared with NOACs.

Objective:To analyze and compare the short-term efficacy and safety of sintilimab and tislelizumab in neoadjuvant therapy for advanced esophageal squamous cell carcinoma.Methods:The clinical data of 95 patients with esophageal squamous cell carcinoma who received neoadjuvant chemotherapy (paclitaxel + nedaplatin) combined with immunotherapy in the Department of Thoracic Surgery of the Affiliated Hospital of North Sichuan Medical College from January 2021 to October 2022 were collected. According to the different use of immune drugs, they were divided into the sintilimab group ( n=58) and the tislelizumab group ( n=37). The objective remission rate (ORR), adverse reactions, R0 resection rate, pathological complete response (pCR) rate, etc. were analyzed and compared between the two groups after neoadjuvant therapy. Results:After 2 cycles of neoadjuvant therapy, the sintilimab group and the tislelizumab group had a similar ORR [72.4% (42/58) vs. 56.8% (21/37), χ2=2.48, P=0.115]. The main adverse reactions of the two groups of patients included gastrointestinal reactions (nausea, vomiting, diarrhea), hematological toxicity, hypothyroidism, alopecia, liver and kidney dysfunction, pneumonia, etc. The incidence of grade 3 adverse reactions was less than 15%, with no grade 4 adverse reactions. The incidence of hypothyroidism in the sintilimab group was significantly higher than that in the tislelizumab group [56.9% (33/58) vs. 16.2% (6/37) ], with a statistically significant difference ( χ2=15.45, P<0.001) ; There was no statistically significant difference in surgical resection ( χ2=1.26, P=0.661) and pCR rate [31.0% (18/58) vs. 32.4% (12/37), χ2=0.02, P=0.886] between the two groups of patients. In terms of postoperative complications, both groups of patients experienced partial pulmonary infections and anastomotic fistulas, but the incidence was relatively low [19.0% (11/58) vs. 24.3% (9/37), 3.4% (2/58) vs. 2.7% (1/37) ], with no statistically significant difference ( χ2=0.39, P=0.532; χ2<0.01, P>0.999) . Conclusion:For preoperative neoadjuvant therapy of advanced esophageal squamous cell carcinoma, the use of either sintilimab or tislelizumab in addition to chemotherapy has good short-term efficacy and safety. Thyroid function should be monitored carefully when using sintilimab.

Objective To evaluate the causes of medical-devices-related pressure ulcer in intensive care unit ( ICU) and to come up with the countermeasures .Methods Patients were recruited between April 2011 and April 2012.A team of five nurses was in charge with the data collection , consultation of the nursing record and investigation of the possible reasons of medical-devices-related pressure ulcer .Results Among a total of 2 240 ICU patients, thirty-seven patients (1.65%) had medical-devices-related pressure ulcer, within which eighteen ( 48.65%) pressure ulcer was related to mechanical ventilation device and nine ( 24.32%) pressure ulcer was because of the orthopedic fixation devices .Medical devices which induced to pressure ulcer in the first three were mask and strap , orthotics and t shoes , endotracheal intubation and fixed belt .After the intervention treatment was given according to the pressure ulcer care guidelines , twenty-eight patients was healed , with healing time 4-12 d, six cases died , and three cases was in automatic discharge .Conclusions The use of ventilation devices and orthopedic fixation are the major causes of pressure ulcer .The key point to prevent pressure ulcer is to decompress tissue and skin , and strengthen the care for pressing areas .