Computed tomography (CT) has become a very important method for preoperative examination for hilar cholangiocarcinoma.In this article,the multidetector helical CT findings of 20 patients with hilar cholangiocarcinoma who were confirmed by surgical pathological examination or biopsy in the Ruijin Hospital of Shanghai Jiaotong University from September 2010 to September 2012 were retrospectively analyzed to investigate the value of muhidetector helical CT in the diagnosis and resectability evaluation of hilar cholangiocarcinoma.All the 20 patients received dynamic contrast enhanced CT scanning after abdominal plain scanning,including arterial phase and portal venous phase scanning.Six patients received additional delayed phase scanning for 3-4 minutes.Muhi-phase reconstruction (MPR) and CT angiography were performed after the scanning.The location and sizes of lesious,the range of invasion of adjacent vessels,swelling of lymph nodes of hilar and retroperitoneum,and hepatic metastasis were recorded.The results showed that only 8 lesions were found on CT plain scanning,and they were presented as hypodense nodules.All lesions were showed on contrast enhanced images.Five cases with infiltrating type were showed as focal wall thickness of hilar bile duct,ringlike enhancement appeared on arterial phase scanning,and the enhancement was more apparent in portal venous and delayed phasc scanning.Eight cases with intraductal growing type demonstrated as intraductal nodules,obvious enhancement was detected on delayed phase scanning,and the dilation of intrahepatic bile duct was also found.Seven cases of tumoral type showed as mass located in hilar region and involved adjacent vessels and partial hepatic parenchyma.Diffused or local dilation of bile duct could be seen on CT images.Combination of 2and 3-dimensional reconstruction images can show more clearly of hilar cholangiocarcinoma lesions,invasion of hepatic arery or portal vein,segmental atrophy and metastasis of lymph nodes and liver.One-stop CT examination combined with axial multiphase dynamic contrast enhanced scanning with MPR and CT angiography of multidetector helical CT can clearly show the lesions of hilar cholangiocarcinoma,improve the preoperative tumor staging and help to design the surgical treatment.

Objective To investigate the distribution and effect of class Ⅰ integron in 40 strains of clinical multi-resistant Enterobacter cloacae. Methods Kirby-Bauer method was used to analyze the drug resistance of 40 strains of multi-resistant Enterobacter cloacae and the drug resistance gene was analyzed by polymerase chain reaction (PCR). Results 28 strains (70.0%) of 40 clinical isolates were observed to contain class Ⅰ integron. Drug resistance test showed their resistance rate to 10 kind of an-tibaeterials as follow: 7.5% to imipenem, 5.0% to meropenem, 75.0% to piperacillin-tazobactam,55.0% to amikacin, 12.5% to cefepime, 52.5% to ceftazidime, 55.0% to cefotaxime, 90.0% to ceftriaxone;81.8% to ticarcillin-clavutanic acid, and 85.0% to ciprofloxacin. Conclusion This study shows that the resistance situation of Enterobacter cloacae isolates is very serious, and class Ⅰ integron may play an important role in the muhidrug resistant mechanism.

Objective To assess the value of emergency interventional embolization in treating traumatic spleen rupture. Methods A total of 74 patients with traumatic spleen rupture, who were encountered at authors’ hospital during the period from July 2007 to July 2013, were enrolled in this study. The clinical data were retrospectively analyzed. The patients were divided into embolization group (n = 38) and surgery group (n = 36). Interventional splenic artery embolization was carried out in the patients of the embolization group, and surgical repair was employed in the patients of the surgery group. The operation time, the amount of blood loss during the procedure, the hospitalization days, the preservation rate of the spleen and the occurrence of procedure- related adverse events were recorded, and the results were compared between the two groups. Results No significant difference in the operation time existed between the two groups (P = 0.061). The amount of blood loss during the procedure, the hospitalization days and the occurrence of procedure- related adverse events in the embolization group were significantly lower than those in the surgery group (P < 0.05), while the preservation rate of the spleen of the embolization group was significantly higher than that of the surgery group (P = 0.026). Conclusion Emergency interventional embolization is a safe procedure for the treatment of traumatic spleen rupture, this technique can improve the preservation rate of the spleen when compared with traditional surgical repair treatment.

Objective To investigate the effects of human leptin ( hLEP) gene transfection on rat bone marrow stro-mal cells ( rBMSCs) .Methods rBMSCs were cultured and transfected with adenoviruses encoding hLEP ( Ad5-hLEP-EGFP) in vitro as experimental group while rBMSCs transfected with Ad 5-EGFP and non-transfected were control groups.The proliferation was detected by MTT and the expression of collagen type Ⅰ(Col-Ⅰ) and alkaline phosphatase ( ALP) were assessed by real-time PCR.The ability of mineralized nodule forming was also examined by Alizarin red staining .The combination of transfected rBMSCs and β-tricalcium phosphate (β-TCP ) was con-structed and the osteogenic ability of the construction was evaluated in nude mice .Results hLEP could be trans-fected into rBMSCs successfully by adenovirous .After transfection , the proliferation was not affected while Col-Ⅰand ALP expressions were more pronounced in rBMSCs transfected with Ad 5-hLEP-EGFP ( P<0.05 ) .Alizarin red staining showed the ability of mineralized nodule forming was also up-regulated in Ad5-hLEP-EGFP group (P<0.05).In addition, the transfected rBMSCs adhered to β-TCP and survived well and the combination showed more new bone like tissue formation in nude mice compared to control groups .Conclusions rBMSCs transfected with hLEP might be potently used in bone or periodontal tissue regeneration .

Odontogenic maxillary sinusitis(OMS)is a subtype of maxillary sinusitis(MS).It is actually inflammation of the maxillary sinus that secondary to adjacent infectious maxillary dental lesion.Due to the lack of unique clinical features,OMS is difficult to distinguish from other types of rhinosinusitis.Besides,the characteristic infectious pathogeny of OMS makes it is resistant to conventional therapies of rhinosinusitis.Its current diagnosis and treatment are thus facing great difficulties.The multi-disciplinary cooperation between otolaryngologists and dentists is absolutely urgent to settle these questions and to acquire standardized diagnostic and treatment regimen for OMS.However,this disease has actually received little attention and has been underrepresented by relatively low publication volume and quality.Based on systematically reviewed literature and practical experiences of expert members,our consensus focuses on characteristics,symptoms,classification and diagnosis of OMS,and further put forward multi-disciplinary treatment decisions for OMS,as well as the common treatment complications and relative managements.This consensus aims to increase attention to OMS,and optimize the clinical diagnosis and decision-making of OMS,which finally provides evidence-based options for OMS clinical management.

Endo-periodontal lesions(EPLs)involve both the periodontium and pulp tissue and have complicated etiologies and pathogenic mechanisms,including unique anatomical and microbiological characteristics and multiple contributing factors.This etiological complexity leads to difficulties in determining patient prognosis,posing great challenges in clinical practice.Furthermore,EPL-affected teeth require multidisciplinary therapy,including periodontal therapy,endodontic therapy and others,but there is still much debate about the appropriate timing of periodontal therapy and root canal therapy.By compiling the most recent findings on the etiology,pathogenesis,clinical characteristics,diagnosis,therapy,and prognosis of EPL-affected teeth,this consensus sought to support clinicians in making the best possible treatment decisions based on both biological and clinical evidence.

Objective : To compare the inflammatory reaction of peritoneal macrophage after Pg-LPS stimulated in healthy rabbit and hyperlipidemia rabbit. Methods : 12 New Zealand rabbits were randomly divided into 2 groups with 6 rabbits in each group, and normal diet and high-fat diet were fed to them respectively. The hyperlipidemia model was set up after 6 weeks. The peritoneal macrophage in normal and hyperlipidemia group were isolated and cultured, and then the cells in both groups were respectively divided into 3 groups: control, 1 μg/mL Pg-LPS, and 1 μg/mL E.coli-LPS. After 24 h treatment, the expressions of C-reaction protein (CRP), interleukin-1β (IL-1β), interleukin-6 (IL-6) , interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) were detected by realtime PCR. Results : The levels of CRP, IL-1β, IL-6, IL-8, and TNF-α were higher in hyperlipidemia control group than normal control group. The expressions of inflammatory substances were increased after stimulated by Pg-LPS, and statistically higher in hyperlipidemia rabbit group than normal group (P < 0.05). Conclusion Pg-LPS can enhance the mRNA expressions of inflammation related factors in peritoneal macrophage in hyperlipidemia rabbit.

Humans ; Adult ; Serum Albumin, Human ; Consensus ; Cardiac Surgical Procedures ; Thoracic Surgery

Due to the insufficient long-term protection and significant efficacy reduction to new variants of current COVID-19 vaccines, the epidemic prevention and control are still challenging. Here, we employ a capsid and antigen structure engineering (CASE) strategy to manufacture an adeno-associated viral serotype 6-based vaccine (S663V-RBD), which expresses trimeric receptor binding domain (RBD) of spike protein fused with a biological adjuvant RS09. Impressively, the engineered S663V-RBD could rapidly induce a satisfactory RBD-specific IgG titer within 2 weeks and maintain the titer for more than 4 months. Compared to the licensed BBIBP-CorV (Sinopharm, China), a single-dose S663V-RBD induced more endurable and robust immune responses in mice and elicited superior neutralizing antibodies against three typical SARS-CoV-2 pseudoviruses including wild type, C.37 (Lambda) and B.1.617.2 (Delta). More interestingly, the intramuscular injection of S663V-RBD could overcome pre-existing immunity against the capsid. Given its effectiveness, the CASE-based S663V-RBD may provide a new solution for the current and next pandemic.

Recent clinical studies have shown that mutation of phosphatase and tensin homolog deleted on chromosome 10 (PTEN) gene in cancer cells may be associated with immunosuppressive tumor microenvironment (TME) and poor response to immune checkpoint blockade (ICB) therapy. Therefore, efficiently restoring PTEN gene expression in cancer cells is critical to improving the responding rate to ICB therapy. Here, we screened an adeno-associated virus (AAV) capsid for efficient PTEN gene delivery into B16F10 tumor cells. We demonstrated that intratumorally injected AAV6-PTEN successfully restored the tumor cell PTEN gene expression and effectively inhibited tumor progression by inducing tumor cell immunogenic cell death (ICD) and increasing immune cell infiltration. Moreover, we developed an anti-PD-1 loaded phospholipid-based phase separation gel (PPSG), which formed an in situ depot and sustainably release anti-PD-1 drugs within 42 days in vivo. In order to effectively inhibit the recurrence of melanoma, we further applied a triple therapy based on AAV6-PTEN, PPSG^@anti-PD-1 and CpG, and showed that this triple therapy strategy enhanced the synergistic antitumor immune effect and also induced robust immune memory, which completely rejected tumor recurrence. We anticipate that this triple therapy could be used as a new tumor combination therapy with stronger immune activation capacity and tumor inhibition efficacy.