Objective To compare the impact of the sirolimus and tacrolimus on the tumor recurrence after liver transplantation due to HCC beyond Milan criteria.Method Sixty-one liver transplantation recipients due to HCC beyond Milan criteria,between Jan.2008 and Apri.2012,were randomized,with the informed consent,into two different immunosuppression groups: sirolimus group (n=30) and tacrolimus group (n=31).In tacrolimus group,tacrolimus was used as the basic immunosuppressant,methylprednisolone was discontinued within one month postoperatively,and mycophenolate mofetil was used within the dosage of 1.5 g/d accordingly.In sirolimus group,the immunosuppresive scheme was the same as that of the tacrolimus group within postoperative one month,and from that,tacrolimus was transferred to sirolimus.No antineoplastic agents were given before tumor recurrence.The tumor recurrence rate and the survival rate of the recipients were compared between the two groups.Result The median follow-up duration was 35.2 months (10.3～ 60.2).The tumor recurrence rate at postoperative year 1,2,3 and 4 in the sirolimus group (13.3％,36.7％,43.3％ and 53.3％) was significantly lower than that in the tacrolimus group (38.7％,67.7％,74.2％ and 77.4％),P ＜ 0.05 for all.The one-year survival rate in the recipients postoperation had no significant difference between sirolimus group and tacrolimus group (90.0％ vs.87.1％,P=0.438).The 2-,3-and 4-year survival rate in the recipients was significantly higher in the sirolimus group (53.3％,33.3％ and 20.0％) than that in the tacrolimus group (41.9％,22.6％ and 9.7％),P ＜ 0.05 for all.The liver function and renal function of the recipients at the postoperative year 1,2,3 and 4 showed no significant difference between the two groups,P＞0.05.Conclusion In comparison with tacrolimus,sirolimus could significantly reduce the tumor recurrence rate and increase the survival rate for the liver transplant recipients due to HCC beyond Milan criteria.

A new type of surface plasmon resonance ( SPR) spectroscopy system was designed and built. Here, a kind of dual photocell sensor was developed as a detection device to achieve a rapid measurement of SPR angle within a certain range. This SPR system was combined and integrated with electrochemical workstation to obtain a new type of electrochemistry-time-resolved SPR ( EC-TR-SPR ) instrument via instrumental technique. This EC-TR-SPR instrument was used to characterize the electrochemical polymerization process of aniline to validate the spectroscopic characteristics. Applications of transient electrochemical characterization methods, including chronoamperometry and differential pulse voltammetry, confirmed the time resolution and the applicability of this instrument system toward the steady state and transient electrochemical methods upon small molecular reactions. The experiment results showed that this EC-TR-SPR possessed the time resolution up to 10000 times per second (0. 1 ms), and could be used to real-time investigate the doping and de-doping of polymerization process of aniline monomer as well as the prepared polyaniline film, which could not be discriminated on a conventional electrochemical current-time curve. .

Objective: To explore the expression of hypoxia inducible factor-1α (HIF-1~) and the correlation between HIF-1α and apoptosis after traumatic brain injury.Methods: Using experimental traumatic brain injury in the rats, the expression of HIF-1α was studied by immunohisto-chemistry in cerebral tissue, apoptotic cell death was evaluated with TUNEL (transferase-mediated XdUTP nick end labeling ), and double-labeled immunohistochemistry and TUNEL methods were used to investigate the relationship between HIF-1α and apoptosis.Results: There was remarkable difference in the expression of HIF-1α between the experimental groups and the control groups (P ＜ 0.01), in the experimental groups,the expression of HIF-1α at 48 hours was highest; the evidence of apoptotic cell death after experimental traumatic brain injury was found by TUNEL; the apoptotic percentage increased or decreased according to the changes of the positive expression of HIF-1α (r = 0.99).Conclusions: The results suggest that secondary brain ischemia plays a crucial role in apoptotic cell death after traumatic brain injury; HIF-1α can prompt apoptotic cell death after experimental traumatic brain injury.

Objective To investigate the role of Notch signaling in the progression of peritoneal fibrosis in a rat model induced by high glucose dialysate. Methods Male Sprague Dawley rats were subjected to daily peritoneal dialysis (PD) with a lactate-buffered solution containing 4.25% glucose. They were sacrificed at 2 and 4 weeks after PD. The parietal thickness was measured with Masson staining. The expression of TGF-β1, E-cadherin, α-SMA and collagen Ⅰ was examined by immunoblotting. The expression of Notch ligand Jagged-1 and the negative Notch signaling regulato--Numb was analyzed by both immunoblotting and RT-PCR. The expression of a Notch nuclear target gene Hcs-1 was examined by RT-PCR. Results Both HE and Masson trichrome staining revealed an increase in peritoneal thickness with a loss of mesothelial cells and a rich of collagen matrix deposition in the submesothelial zone was evident at 4 weeks after PD. Meanwhile, compared to healthy rats, the expression of TGF-β1, ct-SMA and collagen Ⅰ was significantly increased, but the expression of E-cadherin was decreased in peritoneum after PD treatment. It was difficult to detect the Jagged-1 and Hes-1 expression in normal peritoneum, but their expression was graduaUy increased after PD. In contrast, the expression level of Numb, a negative regulator of Notch signaling, was dramatically decreased after PD. Conclusions Notch signaling is activated during the process of PD-induced peritoneal fibrosis and the activation of Notch signaling is associated with the loss of negative regulation of Notch signaling via decreased expression of Numb. Inhibition of Notch signaling via overexpression of its negative regulators such as Numb may be a novel therapeutic approach for peritoneal fibrosis in PD patients.

OBJECTIVETo analyze the rate of postoperative vessel thrombosis and its management after free tissue transfers in head and neck region.

METHODSEight hundred and forty-nine consecutive free flap transfers were performed from May 1999 to September 2004. Among them, the flaps with postoperative vessel thrombosis were selected and reviewed. Data concerning each case included time of vessel thrombosis, kind of thrombosis, time of emergent exploration, and salvage of free flaps.

RESULTSAmong the 849 free flaps, postoperative vessel thrombosis occurred in 28 free flaps, between 8 to 120 hours after operation. There were 5 arterial thrombosis, and 23 venous thrombosis. Thirteen flaps were salvaged after emergent exploration, and 15 flaps were lost. The rate of postoperative vessel thrombosis was 3.3% in this group, the salvage rate of flap was 46.4%, and the overall successful rate was 98.2%.

CONCLUSIONClinical monitoring after free flap transfer in head and neck region is very important and effective. In case of vessel thrombosis, emergent exploration is the only effective way to salvage the flap.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Free Tissue Flaps ; adverse effects ; Head ; surgery ; Head and Neck Neoplasms ; surgery ; Humans ; Male ; Microsurgery ; Middle Aged ; Neck ; surgery ; Postoperative Complications ; Reconstructive Surgical Procedures ; Tissue Transplantation ; adverse effects ; Vascular Surgical Procedures ; Venous Thrombosis ; etiology ; Young Adult

BACKGROUNDIt is important to study the factors affecting the clinical mortality of the severe multiple trauma population. The present study was aimed to identify the potential risk factors that could affect mortality rate of acute lung injury (ALI) in severely injured multiple trauma population and to investigate the effects of certain risk factors on the prognosis of different patient subpopulations.

METHODSThis is a follow-up study treating trauma as a single cause for emergency department (ED) and emergency intensive care unit (EICU) admissions. Patients identified with severe multiple trauma with early onset of ALI were enrolled from five trauma centers. Nineteen potential risk factors affecting the prognosis of ALI were examined by univariate and multivariate Logistic regression analyses to identify the ones that affected the mortality of these severe multiple trauma patients.

RESULTSThere were 687 multiple trauma patients with post-traumatic ALI admitted to ED and EICU during the study period. The six risk factors that affected the mortality with unadjusted odd ratios (ORs) and 95% confidence intervals (CIs) were Acute Physiology Score and Chronic Health Evaluation Score (APACHE) II score, Injury Severity Score (ISS), duration of trauma, age, aspiration of gastric contents, and disseminated intravascular coagulation (DIC). Specific risk factors also affected different patient subpopulations at different degrees (surviving beyond 24 hours, 72 hours, 28 days and with multiple blood transfusions and higher injury scores).

CONCLUSIONSFactors of APACHE II score, ISS and aspiration of gastric contents that could predict the mortality of ALI may exist in the early stage of trauma. Duration of trauma and DIC that greatly affected and predicted the short- and long-term development and mortality of ALI deserve special attention. Elderly patients (aged beyond 65 years) were the independent risk factor for the secondary sepsis and deterioration of pulmonary function. Patients with these risk factors need aggressive supportive care as early as possible in order to prevent further aggravation.

APACHE ; Acute Lung Injury ; mortality ; pathology ; Adult ; Confidence Intervals ; Female ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Multiple Trauma ; mortality ; pathology ; Odds Ratio ; Risk Factors

OBJECTIVETo investigate the plasma level of extracellular histones in patients with silicosis, and to explore the role of extracellular histones in the pathogenesis of pulmonary fibrosis in silicosis.

METHODSSixty-two patients with silicosis were enrolled as the silicosis group, consisting of 23 patients with stage I silicosis, 25 with stage II silicosis, and 14 with stage III silicosis; sixty workers who had a history of occupational exposure to silica dust for more than 2 years and had not been diagnosed with silicosis were enrolled as the silica dust exposure group; sixty-five healthy workers without a history of occupational exposure to dust were enrolled as healthy controls. Enzyme-linked immunosorbent assay was applied to measure the plasma levels of plasma extracellular histone (H4) and transforming growth factor-β(TGF-β).

RESULTSCompared with healthy controls [(0.82±0.67) μg/ml], the silica dust exposure group[(4.14±2.85) μg/ml] and silicosis group[(9.50±5.04) μg/ml] had significant increases in plasma level of H4 (P<0.01). The plasma level of H4 was significantly correlated with the stage of silicosis(r=0.8955, P=0.0388). The silicosis group had a significantly higher plasma level of TGF-β than the silica dust exposure group and healthy controls(P <0.05). In the patients with silicosis, the plasma level of H4 was significantly correlated with that of TGF-β(r=0.5375, P<0.01).

CONCLUSIONThe plasma level of extracellular histones increases significantly in the pathogenesis of silicosis, and extracellular histones may play an important role in the progression of fibrosis in silicosis.

Case-Control Studies ; Disease Progression ; Dust ; Histones ; blood ; Humans ; Occupational Exposure ; Silicon Dioxide ; Silicosis ; blood ; pathology ; Transforming Growth Factor beta ; blood

OBJECTIVE: To discuss the causes for changes of opinions in reappraisals of mental disabilities due to traffic accidents. METHODS: Fifty-one reappraisals of mental disorders due to traffic accidents from October 2009 to October 2011 in the Institute of Forensic Science, Shaoxing Seventh People's Hospital, were retrospectively analyzed. RESULTS: In the reappraisals, the opinions about disability grade changed in 30 cases (58.82%), including 8 cases increased and 22 cases decreased. According to the causes of changing the opinions, there were 8, 10 and 2 cases related to different understandings of appraisers in the severities of mental disorders, subjective judgements and certain psychiatric symptoms, respectively. Also, there were 10 cases related to different appraisal time. CONCLUSION Appraisals of mental disabilities should grasp the appraisal time, decrease the changes of opinions due to the differences of appraisers and correctly understand the orders of rules and clauses.
Accidents, Traffic ; Adult ; Aged ; Brain Injuries/psychology* ; Disability Evaluation ; Female ; Forensic Psychiatry ; Humans ; Intellectual Disability ; Intelligence ; Male ; Mental Disorders/psychology* ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Time Factors ; Young Adult

Background: In the era of intensity-modulated radiotherapy (IMRT), the role of neoadjuvant chemotherapy (NACT) in treating ascending-type nasopharyngeal carcinoma (NPC) is under-evaluated. This study was to compare the efficacy of NACT followed by IMRT (NACT + RT) with the efficacy of concurrent chemoradiotherapy (CCRT) on ascending-type NPC.Methods: Clinical data of 214 patients with ascending-type NPC treated with NACT + RT or CCRT between December 2009 and July 2011 were analyzed. Of the 214 patients, 98 were treated with NACT followed by IMRT, and 116 were treated with CCRT. The survival rates were assessed using Kaplan –Meier analysis, and the survival curves were compared using a log-rank test.Results: The 4-year overall survival, locoregional failure-free survival, distant failure-free survival, and failure-free survivalrates were not significantly different between the two groups (all P > 0.05). However, patients in the CCRT group exhibited more severe acute adverse events than did patients in the NACT + RT group during radiotherapy, including leukopenia (30.2% vs. 15.3%, P = 0.016), neutropenia (25.9% vs. 11.2%, P = 0.011), and mucositis (57.8% vs. 40.8%, P = 0.028). After radiotherapy, patients in the CCRT group exhibited significantly higher rates of xerostomia (21.6% vs.10.2%, P = 0.041) and hearing loss (17.2% vs. 6.1%, P = 0.023).Conclusions: The treatment outcomes of the NACT + RT and CCRT groups were similar; however, CCRT led to higher rates of acute and late toxicities. NACT + RT may therefore be a better treatment strategy for ascending-type NPC.

Objective:To understand the current status of kidney transplant patient empowerment and explore the factors affecting kidney transplant patient empowerment.Methods:This study was a cross-sectional survey. From September to November 2022, convenience sampling was used to select 201 patients who were followed up by the Renal Transplantation Department of Shanghai General Hospital as the study subject. A survey was conducted using the Patient General Information Questionnaire, Client Empowerment Scale (CES), General Self-Efficacy Scale (GSES), Nurse-Patient Trust Scale, and Chinese Version of Chronic Illness Resource Survey (CV-CIRS). Multiple linear regression analysis was used to explore the influencing factors of empowerment levels in kidney transplant patients.Results:A total of 201 questionnaires were distributed and 197 valid questionnaires were collected, with an effective recovery rate of 98.01% (197/201). The total empowerment score of 197 kidney transplant patients was (161.85±13.08). Multiple linear regression analysis showed that willingness to participate in health decision-making, general self-efficacy, and chronic disease resource support were the influencing factors for kidney transplant patient empowerment ( P<0.05) . Conclusions:The empowerment of kidney transplant patients is at a moderate to upper level. The willingness of patients to participate in health decision-making, general self-efficacy, and chronic disease resource support are influencing factors for kidney transplant patient empowerment.