AIM:To investigate the autophagy induced by sepsis and acute kidney injury , and the regulation of phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway in this process.METHODS: The rats were subjected to cecal ligation and puncture ( CLP) or sham operation .Histopathologic changes of the renal tissues were examined by HE staining .Blood urea nitrogen ( BUN) and serum creatinine ( SCr) were measured by chemical colorime-try.The protein expression of microtubule-associated protein light chain 3 I/II (LC3 I/II), beclin-1 and p-Akt at different time points after CLP was detected by Western blotting .In vitro, human proximal tubular epithelial cell line HK-2 were treated with LPS to induce autophagy .The protein expression of LC 3 I/II and p-Akt in the HK-2 cells after LPS treatment at different time points and different concentrations was detected by Western blotting .These molecules in HK-2 cells and apoptosis of HK-2 cells treated with LPS plus PI3K inhibitor or Akt inhibitor were also detected .RESULTS: Compared with sham group , the severe changes of renal histopathological injuries in CLP groups were observed , the levels of BUN and SCr in CLP groups were significantly increased .LC3 I/II, beclin-1 and phosphorylation of Akt gradually increased after CLP.After treatment with LPS, the expression of p-Akt (308) in the HK-2 cells gradually increased in a dose-and time-dependent fashion.The expression of beclin-1 and p-Akt (472) reached a peak at 8 h or 10 mg/L LPS treatment.Treat-ment with PI3K or Akt inhibitor down-regulated the expression of LC3 and promoted the apoptosis of HK-2 cells.CON-CLUSION:Autophagy in the kidney is induced by sepsis and acute kidney injury .PI3/Akt signaling pathway may be in-volved in this process .

Objective To explore the dynamic changes of CD34 + cells and T lymphocyte subsets and best time of harvesting peripheral blood stem cell when G-CSF was used for peripheral blood stem cell mobilization in donors and patients. Methods A total of 12 donors and 16 patients who received chemotherapy for 7 d were injected G-CSF of 300 ?g/d to mobilize peripheral blood stem cells for 5 d and flow cytometry were used to detect the changes of CD34 + cells and T lymphocyte subsets everyday for 5 d. Results ① Before G-CSF treatment, there were obvious differences in bone marrow CD34 + cells between patients and donors (P

Objective To compare diagnosis value and the clinical application of enzyme linked immunosorbent assay (ELISA) method and the immune turbidimetric method detecting serum anti cyclic citrullinated peptide (CCP)antibody in patients with RA.Methods Collected fresh serum specimen of 267 inpatients with RA in Rrheumatism Department of Xi’an Institu-te of Rheumatism from December 2014 to February 2015,and fresh serum specimen of 50 healthy blood donors from the Blood Center of Shaanxi Province respectively.Anti CCP antibody was detected by enzyme-linked immunosorbent assay (ELISA)method and the latex immunoturbidimetry assay.Evaluated the correlation of the results and clinical application to RA diagnosis.Results Sensitivity,specificity and diagnostic consistency of ELISA and latex immunoturbidimetry assay were 77.3%,86.8%,94.3% and 76.2%,80.2%,77.9% respectively.Compared two kinds of methods,the value of Kappa was 0.756,for having consistency.Throughχ2 test (χ2 =1.85,P >0.05),there was no significant difference between two meth-ods.Area of ELISA and lateximmunoturbidimetry under the ROC curve were 0.876 and 0.832 respectively.Conclusion De-tection of serum anti CCP antibody has diagnostic value in RA patients.The ELISA method and the latex immunoturbidime-try assay for detection of anti CCP antibodies had consistency.Two methods had no statistical difference,and the latex turbi-dimetric method is suitable for grassroots medical institutions.

OBJECTIVETo detect tumor cells in the peripheral blood of patients with hepatocellular carcinoma (HCC) by using the mRNA of the MAGE-1 and MAGE-3 genes as specific tumor markers.

METHODSPeripheral blood was obtained from 25 HCC patients and 20 healthy volunteers. The mRNA of the MAGE-1 and MAGE-3 genes in the peripheral blood mononuclear cells (PBMCs) was detected by nested RT-PCR. The MAGE-1 and MAGE-3 transcripts in the tumor tissues of these HCC patients were also detected by RT-PCR.

RESULTSOf the 25 HCC patients, MAGE-1 and MAGE-3 mRNA were positive in 44% (11/25) and 36% (9/25) of PBMCs respectively, and in 68% (17/25) and 56% (14/25) of HCC tissues respectively. In the PBMCs of the 25 HCC patients, 16 (64%) samples were detected to express at least one type of MAGE mRNA. MAGE mRNA were not detected in the PBMCs from the patients whose tumors did not express the MAGE genes, nor in the PBMCs from the 20 healthy donors. The positive rate of MAGE mRNA in the PBMCs was closely correlated with the TNM stages and the diameter of tumors, but there was no correlation between the positive rate of MAGE mRNA in PBMCs and tumor differentiation degree or serum alpha-FP level. Of 9 HCC patients whose serum alpha-FP was normal or slightly elevated (< 50 ng/ml), 6 were MAGE-1 and/or MAGE-3 mRNA positive in their PBMCs.

CONCLUSIONMAGE-1 and MAGE-3 mRNA could be specifically detected with high percentage in the PBMCs of HCC patients by our method. They can be used as specific tumor markers for the detection of the circulating HCC cells, and the detection results may be helpful to evaluate the prognosis of HCC patients.

Antigens, Neoplasm ; Carcinoma, Hepatocellular ; genetics ; Humans ; Leukocytes, Mononuclear ; Liver Neoplasms ; genetics ; Melanoma-Specific Antigens ; Neoplasm Proteins ; RNA, Messenger ; genetics

Objective To evaluate the defecation function of patients with low rectal cancer after laparoscopic-assisted transanal total mesorectal excision (TaTME),and analyze the influencing factors.Methods The retrospective case-control study was conducted.The clinicopathological data of 55 patients with low rectal cancer who underwent laparoscopic-assisted TaTME in the First Hospital of Jilin University from May 2017 to December 2018 were collected.There were 39 males and 16 females,aged (60-± 11) years,with a range from 24 to 80 years.Among the 55 patients,21 were in TNM stage Ⅰ,14 were in TNM stage Ⅱ,and 20 were in TNM stage Ⅲ;24 were in pathological stage T1-2 and 31 were in pathological stage T3.Observation indicators:(1) surgical and postoperative conditions;(2) follow-up;(3) analysis of influencing factors for postoperative defecation function.Follow-up was performed using questionnaires by telephone interview to detect the complications at 3 and 6 months after surgery up to June 2019.The measurement data with normal distribution were expressed as Mean± SD,and comparison between groups was done using the t test.Count data were expressed as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test or Fisher exact probability.Univariate and multivariate analyses were performed using logistic regression models.Results (1) Surgical and postoperative conditions:55 patients successfully underwent laparoscopic-assisted TaTME without conversion to open surgery.The operation time,volume of intraoperative blood loss,diameter of postoperative pathological specimen,time to urinary catheter removal,distance between the anastomostic stoma and anal verge,and tumor diameter were (246±62) minutes,(69±27) mL,(3.5±0.7) cm,(2.1±0.9) days,(2.4±0.5) cm,and (3.9-± 1.6)cm,respectively.(2) Follow-up:55 patients were followed up at 3 months and 6 months after surgery,and the low anterior resection syndrome questionnaires were completed.Among the 55 patients,35 had low anterior resection syndrome at 3 months after surgery,and 24 had low anterior resection syndrome at 6 months after surgery,showing a significant difference (x2 =4.42,P＜0.05).There was no new onset low anterior resection syndrome in 55 patients after 3 months.(3) Analysis of influencing factors for defecation function:univariate analysis showed that the distance between the anastomotic stoma and anal verge and tumor diameter were influencing factors affecting defecation function of patients at 3 months after surgery (x2 =19.075,8.185,P＜ 0.05).The distance between the anastomotic stoma and anal verge was a influencing factor affecting the defecation function of patients at 6 months after surgery (x2=9.183,P＜0.05).Multivariate analysis showed that the distance between the anastomotic stoma and anal verge ＜ 2 cm,and tumor diameter ＞5 cm were independent risk factors affecting the defecation function of patients at 3 months after surgery (odds ratio =1.135,6.057,95％ confidence interval:1.089-1.323,1.206-30.435,P＜0.05).The distance between the anastomotic stoma and anal verge ＜ 2 cm was an independent risk factor affecting the defecation function of patients at 6 months after surgery (odds ratio =2.724,95％ confidence interval:1.982-3.066,P＜0.05).Conclusions The incidence of low anterior resection syndrome after laparoscopic-assisted TaTME for low rectal cancer is high.Distance between the anastomotic stoma and anal verge and tumor diameter are independent risk factors for the postoperative defecation founction.

To meet the needs of management of medical case information and biospecimen simultaneously, we developed a novel medical case information system integrating with biospecimen management. The database established by MS SQL Server 2000 covered, basic information, clinical diagnosis, imaging diagnosis, pathological diagnosis and clinical treatment of patient; physicochemical property, inventory management and laboratory analysis of biospecimen; users log and data maintenance. The client application developed by Visual C++ 6.0 was used to implement medical case and biospecimen management, which was based on Client/Server model. This system can perform input, browse, inquest, summary of case and related biospecimen information, and can automatically synthesize case-records based on the database. Management of not only a long-term follow-up on individual, but also of grouped cases organized according to the aim of research can be achieved by the system. This system can improve the efficiency and quality of clinical researches while biospecimens are used coordinately. It realizes synthesized and dynamic management of medical case and biospecimen, which may be considered as a new management platform.
Biological Specimen Banks ; Database Management Systems ; Humans ; Medical Records Systems, Computerized ; Medical Records, Problem-Oriented

Objective:To explore the volume resolution of prostate motion target by four-dimensional (4D) ultrasound.Methods:The prostate ultrasound model was selected, and the group comparison study was conducted using 4D ultrasound to outline the prostate target under different motion amplitudes (A) and motion period (T). The simulated A value was set as 0.5 mm, 1 mm, 2 mm, 3 mm, 4 mm, and 5 mm, respectively. The T value was set as 1 s, 2 s, 3 s, and 4 s, respectively. The volume of the target of the model prostate was calculated, and the static ultrasound image of the target was used as the control group to analyze the difference between two groups.Results:When the model was still, the size of the target of ultrasound was consistent with that of CT scan ( P>0.05). When the A values were 0.5 mm and 1 mm, there was no statistical difference between the volume in period 1-4 s and the volume in the target at rest (all P>0.05). When the A values were 2 mm and 3 mm, and the T values were 1 s, 2 s and 3 s there was statistical difference between the volume of target and that of of static ultrasonic target (all P<0.05). When the A value was 2 mm and the T value was 4 s, there was no statistical difference between the target volume and the static target volume ( P=0.710). The range within the group was 6.7 cm 3, and the standard deviation was 1.15 cm 3. When the A value was 3 mm and the T value was 4 s, the volume repeatability of the target was poor, and the range within the group was 14.4 cm 3; when the A values were 4 mm and 5 mm, and the T values were 1-4 s, the range within the group was 3.27-17.63 cm 3 and 6.51-21.02 cm 3, respectively. The volume repeatability of the target under each period was extremely poor, which could not meet the clinical requirements. Conclusion:4D ultrasound can provide reliable reference data for patients′ target delineation within 1-4 s of motion cycle and within 1 mm of motion amplitude, which exerts on effect upon the original position of probe.

Objective:To develop a 3D visualization technology-assisted patient positioning system for radiotherapy and compare it with traditional patient positioning method for breast and pelvic radiotherapy.Methods:A total of 40 patients receiving radiotherapy in Changzhou No.2 People′s Hospital from June 2020 to April 2021 were selected for this study, including 20 patients with breast cancer and 20 patients with pelvic cancer.3D visualization reconstruction was carried out using the CT data of the patients for positioning. Then the 3D visualization models were integrated with the real treatment environment and were then shifted to the isocentral positions of accelerators through interactive operations. Based on this, the patients were actually positioned. Every week, all of the patients were firstly treated with traditional positioning, followed by 3D visualization-guided positioning. As a result, 240 times of positioning data of all patients were collected in three weeks. They were compared with the data of cone-beam CT(CBCT)-guided positioning, which served as the gold standard.Results:The absolute positioning errors of 3D visualization-guided positioning along x, y and z axes were (1.92±1.23), (2.04±1.16), and (1.77±1.37)mm, respectively for patients with breast cancer and were (2.07±1.08), (1.33±0.88), and (1.99±1.25)mm, respectively for patients with pelvic cancer. Compared with traditional positioning method , the accuracy of 3D visualization-guided positioning along x、 y, and z axes was increased by 38.83%, 52.40% and 33%, respectively for patients with breast cancer and was improved by 36.84%, 54.04% and 52.58% for patients with pelvic cancer, with all differences being statistically significant along y and z axes ( t=2.956-5.734, P< 0.05). Meanwhile, the error distribution of the two positioning method was statistically significant along in y axis for patients with breast cancer( χ2=7.481, P<0.05) and was statistically significant along each axis for patients with pelvic cancer( χ2=5.900, 6.415, 7.200, P<0.05). Conclusions:The positioning method guided by 3D visualization technology can effectively improve the positioning accuracy of patients with breast cancer and patients with pelvic cancer and is of value in potential clinical application.

The radiotherapy modulators used in clinic have disadvantages of high toxicity and low selectivity. For the first time, we used the

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.