1.The effect of low glycemic index diet and exercise on plasma glucose and lipid metabolism in patients with newly diagnosed type 2 diabetes
Wenfei ZHONG ; Kaining CHEN ; Yi LI ; Tuanyu FANG ; Huachuan ZHANG
Chinese Journal of Primary Medicine and Pharmacy 2011;18(4):445-447
ObjectiveTo evaluate the effect of low glycemic index(LGI)diet and exercise on plasma glucose and lipid profiles in newly diagnosed type 2 diabetic patients. MethodsSeventeen newly diagnosed type 2 diabetic patients with FPG ≤ 10mml/L treated by LGI diet and exercise only for two months.Fasting plasma glucose (FPG),2 hours postprandial glucose(2hPG),glycosylated hemoglobin A1 C(GHbA1C),and lipid profiles were measured.The results of FPG,2hPG,GHbA1C,and lipid profiles were compared. ResultsTwo months after treatment,the level of fasting glucose(6.19 ± 0.60)mmol/L,postprandial 2h plasma glucose(8.59 ± 0.90)mmol/L,TG(1.15 ± 0.45)mmol/L,TC(4.98 ± 0.77)mmol/L,LDL(3.20 ± 0.71)mmol/L were significantly lower than (7.84 ± 1.19)mmol/L,(13.97 ± 3.35)mmol/L,TG(1.79 ± 0.75)mmol/L,TC(5.46 ± 0.27)mmol/L,LDL (3.57 ± 0.28)mmol/L,HDL(1.59 ± 0.30)mmol/L was significantly higher than(1.42 ± 0.26)mmol/L,the differences were statistically significant(all P<0.05);HbA1c(6.49 ± 0.57)% was slightly lower than(7.29 ±0.77)%,but the difference was not significant(P>0.05);No hypoglycemia was observed during the treatment. ConclusionThe exellent glycemic control and improvement of lipid profile could be achieved by low glycemic index diet and exercise only.Furthermore,no hypoglycemia occurred during the treatment.
2.Correlation between eIF3a and HE4 expression and ovarian cancer
Jing WANG ; Chenhui LUO ; Ying WANG ; Yuxi TANG ; Kaining FANG ; Liang ZENG ; Yi ZHANG
Journal of Central South University(Medical Sciences) 2014;(12):1240-1245
Objective: To investigate the correlation between eukaryotic translation initiation factor 3, subunit A (eIF3a) and human epididymis protein 4 (HE4) expression and ovarian cancer. Methods: RT-PCR or immunohistochemistry was used to examine eIF3a and HE4 mRNA or protein expression in ovarian tissues from patients with ovarian cancer (n=181) or benign ovariantumors, or from the healthy women. Results: hTere were signiifcant differences in mRNA and protein expression of eIF3a and HE4 among normal ovarian tissues, benign ovarian tumor tissues, and ovarian cancer tissues (P<0.05). hTere were signiifcant differences in mRNA expression of eIF3a and HE4 between the normal tissues and the ovarian cancer tissues, or between the benign ovarian tumor tissues and the normal tissues (P<0.001). hTe mRNA expression of eIF3a in the normal ovarian tissues was signiifcantly higher than that in the benign ovarian tumor tissues or that in the ovarian cancer tissues. hTe mRNA expression of HE4 was gradually increased from the normal ovarian tissues, the benign ovarian tumor tissues to the ovarian cancer tissues. hTe mRNA expression of HE4 in the ovarian cancer tissues was signiifcantly higher than that in the benign ovarian tumor tissues (P<0.001). Positive expression rates for eIF3a or HE4 protein in normal, benign tumor, and cancer tissues were 0, 66.7%, and 81.0% or 0, 27.8%, and 56.2%, respectively. hTere were signiifcant differences in positive expression rates of eIF3a protein and HE4 protein between the ovarian tumor tissues and benign ovarian tumor tissues, between the ovarian cancer tissues and the normal ovarian tissues, or between the benign ovarian tumor tissues and the normal ovarian tissues (P<0.001). hTe eIF3a protein expression was positively correlated with HE4 protein expression (r=0.575,P<0.05). Conclusion: The expressions of eIF3a and HE4 are associated with ovarian cancer, and extracellular regulated protein kinases may play a role in the interaction between eIF3a and HE4.
3.Clinical study of microvascular invasion on prognosis of recipients after liver transplantation for liver cancer
Jianfeng WANG ; Kaining ZENG ; Haibo LI ; Yinan DENG ; Yingcai ZHANG ; Tong ZHANG ; Shuhong YI ; Genshu WANG ; Yang YANG ; Guihua CHEN
Organ Transplantation 2021;12(3):309-
Objective To evaluate the effect of microvascular invasion (MVI) on prognosis of recipients after liver transplantation for primary liver cancer (liver cancer). Methods Clinical data of 177 recipients after liver transplantation for liver cancer were retrospectively analyzed. All patients were divided into the MVI-positive group (
4.Fully automatic volumetric modulated arc therapy planning based on dose prediction combined with an iterative optimization algorithm
Jiacheng LIU ; Hanlin WANG ; Qingying WANG ; Kaining YAO ; Meijiao WANG ; Haizhen YUE ; Ruoxi WANG ; Yi DU ; Hao WU
Chinese Journal of Radiological Medicine and Protection 2021;41(11):830-835
Objective:To develope an automatic volumetric modulated arc therapy (VMAT) planning for rectal cancer based on a dose-prediction model for organs at risk(OARs) and an iterative optimization algorithm for objective parameter optimization.Methods:Totally 165 VMAT plans of rectal cancer patients treated in Peking University Cancer Hospital & Institute from June 2018 to January 2021 were selected to establish automatic VMAT planning. Among them, 145 cases were used for training the deep-learning model and 20 for evaluating the feasibility of the model by comparing the automatic planning with manual plans. The deep learning model was used to predict the essential dose-volume histogram (DVH) index as initial objective parameters(IOPs) and the iterative optimization algorithm can automatically modify the objective parameters according to the result of protocol-based automatic iterative optimization(PBAIO). With the predicted IOPs, the automatic planning model based on the iterative optimization algorithm was achieved using a program mable interface.Results:The IOPs of OARs of 20 cases were effectively predicted using the deep learning model, with no significantly statistical difference in the conformity index(CI) for planning target volume(PTV)and planning gross tumor volume(PGTV)between automatic and manual plans( P>0.05). The homogeneity index (HI) of PGTV in automatic and manual plans was 0.06 and 0.05, respectively( t=-6.92, P< 0.05). Compared with manual plans, the automatic plans significantly decreased the V30 for urinary bladder by 2.7% and decreased the V20 for femoral head sand auxiliary structure(avoidance)by 8.37% and 15.95%, respectively ( t=5.65, 11.24, P< 0.05). Meanwhile, the average doses to bladder, femoral heads, and avoidance decreased by 1.91, 4.01, and 3.88 Gy, respectively( t=9.29, 2.80, 10.23, P< 0.05) using the automatic plans. The time of automatic VMAT planning was (71.49±25.48)min in 20 cases. Conclusions:The proposed automatic planning based on dose prediction and an iterative optimization algorithm is feasible and has great potential for sparing OARs and improving the utilization rate of clinical resources.
5.Design and clinical application of simplified "All in one" hepatic vein reconstruction in right split liver transplantation
Shuhong YI ; Qing YANG ; Binsheng FU ; Tong ZHANG ; Jia YAO ; Kaining ZENG ; Xiao FENG ; Guihua CHEN ; Yang YANG
Organ Transplantation 2022;13(6):764-
Objective To introduce the simplified "All in one" hepatic vein reconstruction in right split liver transplantation, and to investigate the clinical indications, surgical procedures and clinical prognosis of this technique. Methods Clinical data of 2 recipients undergoing right split liver transplantation were retrospectively analyzed, and the simplified "All in one" hepatic vein reconstruction of right liver lobe was summarized and analyzed. In 2 cases, the right liver lobe was split
6.Classification and reconstruction of bile duct in pediatric split liver transplantation
Jinming WEI ; Xiao FENG ; Kaining ZENG ; Qing YANG ; Jia YAO ; Binsheng FU ; Tong ZHANG ; Xinru HUANG ; Boying LIU ; Guihua CHEN ; Yang YANG ; Shuhong YI
Organ Transplantation 2022;13(6):791-
Objective To investigate the anatomical classification of left intrahepatic bile duct (LHD) and the pattern of bile duct reconstruction during pediatric split liver transplantation and their relationship with postoperative biliary complications. Methods Clinical data of 75 pediatric recipients undergoing split liver transplantation were analyzed retrospectively. Before splitting the donor liver, iopromide injection was used for retrograde cholangiography through the common bile duct. According to the patterns of intrahepatic bile ducts in the second, third and fourth segments, the anatomical classification of LHD of the donor liver was determined. The biliary reconstruction regimens for different classification types of LHD were summarized. The incidence and treatment of biliary complications after pediatric split liver transplantation were analyzed. Results Among 75 donor livers, the anatomical classification of LHD included 57 cases (76%) of type Ⅰ, 9 cases (12%) of type Ⅱ, 4 cases (5%) of type Ⅲ and 5 cases (7%) of type Ⅳ LHD, respectively. Among 75 pediatric recipients, 69 cases (53 cases of type Ⅰ, 8 type Ⅱ, 4 type Ⅲ and 4 type Ⅳ) underwent the left hepatic duct-jejunum Roux-en-Y anastomosis, 1 case received common bile duct-jejunum Roux-en-Y anastomosis (type Ⅳ), and 5 cases underwent the left hepatic duct-common bile duct end-to-end anastomosis (4 cases of type Ⅰ and 1 type Ⅱ). Postoperative biliary complications occurred in 6 cases (8%), including 3 cases of biliary anastomotic stenosis, 2 cases of biliary anastomotic leakage and 1 case of bile leakage on the hepatic resection surface. Among 6 recipients, 4 cases were classified as type Ⅰ and 2 cases of type Ⅲ LHD. No significant difference was observed in the incidence of biliary complications between typical type and anatomical variant type of LHD (all
7.Anatomic classification and reconstruction of right intrahepatic bile duct in the donor liver of split liver trans-plantation
Jinming WEI ; Binsheng FU ; Qing YANG ; Tong ZHANG ; Xiao FENG ; Kaining ZENG ; Jia YAO ; Hui TANG ; Guihua CHEN ; Yang YANG ; Shuhong YI
Chinese Journal of Digestive Surgery 2024;23(2):272-279
Objective:To investigate the anatomic classification and reconstruction of right intrahepatic bile duct in the donor liver of split liver transplantation (SLT).Methods:The retrospective and descriptive study was constructed. The clinical data of 85 patients who underwent SLT in the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to January 2022 were collected. There were 65 males and 20 females, aged 45(range, 1-82)years. Observation indicators: (1) surgical conditions; (2) anatomy of right intrahepatic bile duct; (3) bile duct reconstruction; (4) postoperative biliary complications; (5) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range) or M( Q1, Q3).Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Surgical conditions. Of the 85 donor livers, 11 donor livers were split between the left and right hemilivers, and 74 donor livers were split between the classic right trilobe and left lateral lobe. The cold ischemia time of 85 donor livers was 291(273, 354)minutes, and the operation time, anhepatic phase time and volume of intraoperative blood transfusion of 85 recipients were (497±97)minutes, 51(40, 80)minutes and 8(7, 12)U. (2) Anatomy of right intrahepatic bile duct. Of the 85 donor livers, there were 47 donor livers with classic bile duct anatomical model (type 1), of the ratio as 55.3%(47/85), and 38 donor livers with anatomical variants, of the ratio as 44.7%(38/85). Of the 38 donor livers with anatomical variants, 7 donor livers were type 2, 16 donor livers were type 3a, 2 donor livers were type 3b, 2 donor livers were type 3c, 1 donor liver was type 4, 3 donor livers were type 5a, 4 donor livers were type 5b, 3 donor livers were type 6. For bile duct splitting patterns of the 85 donor livers, 84 donor livers were split with the main trunk of common hepatic duct preserving in the right hemiliver or right trilobe, and 1 donor liver were treated with complete left and right hemiliver splitting to preserve the main trunk of the common hepatic duct in the left hemiliver and the right hemiliver in the right hepatic duct (type 1 bile duct anatomical model). There were 84 donor livers with only one bile duct opening, and 1 donor liver with two bile duct openings (type 3c bile duct anatomical model). (3) Bile duct reconstruction. Of the 85 recipients, there were 69 recipients with common bile duct end-to-end anastomosis to common bile duct of donor liver (38 donor livers with type 1 bile duct anatomical model, 5 donor livers with type 2 bile duct anatomical model, 14 donor livers with type 3a bile duct anatomical model, 2 donor livers with type 3b bile duct anatomical model, 1 donor liver with type 4 bile duct anatomical model, 3 donor livers with type 5a bile duct anatomical model, 4 donor livers with type 5b bile duct anatomical model, 2 donor livers with type 6 bile duct anatomical model), 11 recipients with jejunum anastomosis to common bile duct of donor liver (7 donor livers with type 1 bile duct anatomical model, 2 donor livers with type 2 bile duct anatomical model, 1 donor liver with type 3c bile duct anatomical model, 1 donor liver with type 6 bile duct anatomical model), 3 recipients with jejunum anastomosis to common hepatic duct of donor liver (1 donor liver with type 1 bile duct anatomical model, 2 donor livers with type 3a bile duct anatomical model), 1 recipient with jejunum anastomosis to right hepatic duct of donor liver (type 1 bile duct anatomical model), 1 recipient with common hepatic duct end-to-end anastomosis to right posterior branch of donor liver combined with jejunum of the recipient Roux-en-y anastomosis to common hepatic duct of donor liver (type 3c bile duct anatomical model). (4) Postoperative biliary complications. Of the 85 recipients, 6 cases had postoperative biliary complications, with an incidence of 7.1% (6/85). Of the 6 recipients with postoperative biliary complications, there were 5 recipients with donor liver with type 1 bile duct anatomical model, including 3 cases undergoing postoperative biliary stricture with biliary leakage and 2 cases undergoing postoperative biliary anastomotic stricture, 1 recipient with donor liver with type 3b bile duct anatomical model and undergoing postoperative biliary anastomotic stricture and bile leakage in the liver section. Cases with biliary complications were 5 in the 47 recipients with donor liver with classic bile duct anatomical model and 1 in the 38 recipients with donor liver with anato-mical variants, showing no significant difference between them ( P>0.05). (5) Follow-up. There were 83 recipients receiving followed up for 52(12,96)months. During the follow-up period, 2 recipients died due to non-biliary complication factors (1 donor liver with type 1 bile duct anatomical model and 1 donor liver with 3a bile duct anatomical model). Conclusion:The anatomical classification of right intrahepatic bile duct of donor liver in SLT is mainly classical bile duct anatomical model, and the bile duct reconstruction scheme is mainly common bile duct of donor liver end-to-end anasto-mosis to common bile duct of recipient.
8.Inhibition of proliferation of adult T-cell leukemia cells by celastrol.
Jinyong FANG ; Kaining YI ; Zaowen SONG ; Mengyun CHEN ; Lingling XU ; Tiejun ZHAO
Chinese Journal of Biotechnology 2018;34(9):1491-1499
We studied the effect of celastrol on the proliferation and apoptosis of adult T-cell leukemia (ATL) cells. After treating adult T-cell leukemia cell lines with different concentrations of celastrol, we analyzed the cell proliferation by MTT and colony formation assays. Flow cytometry was conducted to detect cell apoptosis by Annexin V-FITC/PI staining. Western blotting and dual-luciferase reporter assay were done to study the mechanism how celastrol suppressed the growth of adult T-cell leukemia cells. Celastrol could significantly inhibit the proliferation of adult T-cell leukemia cells, and induce apoptosis of ATL cells. With the increase of the concentration of celastrol, the ratio of Bax/Bcl-2 protein was up-regulated. The Caspase-3/7 protein was cleaved and activated after treatment with celastrol. Moreover, the expression of HTLV-1-encoded viral protein Tax was significantly inhibited in the celastrol treated cells. Taken together, these results indicated that celastrol effectively inhibited the proliferation of adult T-cell leukemia cells by regulating the expression of Bcl-2 family protein, and induced cell apoptosis by activating Caspase dependent pathway. In addition, celastrol could inhibit the expression of viral protein Tax. This study will provide an experimental basis for the clinical application of celastrol in the treatment of adult T-cell leukemia.
9.Workflow and error analyses of patient setup based on open-face mask immobilization combined with AlignRT for head tumor radiotherapy
Junyu LI ; Hao WU ; Jingxian YANG ; Shun ZHOU ; Zihong LU ; Songmao YU ; Jixiang CHEN ; Meijiao WANG ; Kaining YAO ; Yi DU
Chinese Journal of Radiological Medicine and Protection 2022;42(8):590-597
Objective:To propose a markless patient setup workflow based on the optical surface monitoring system (AlignRT) and open-face mask immobilization for whole-course head tumor radiotherapy, assess the setup time and repositioning frequency of the proposed workflow, and conduct a comparative analysis of the differences, correlation, and consistency of the setup errors of the AlignRT and cone beam CT (CBCT) systems.Methods:A retrospective analysis was conducted for the data on the errors of 132 fractionated setup based on open-face mask immobilization of 33 head tumor patients. AlignRT-guided markless patient setup workflow was applied throughout the radiotherapy. Meanwhile, the body structures automatically generated by the treatment planning system were used as body references. The 6-degree-of-freedom (6DoF) setup errors (lateral, vertical, longitudinal, rotation, pitch, roll, and yaw directions), setup time, and repositioning frequency of the AlignRT and CBCT systems were recorded and analyzed. The Wilcoxon and Spearman analyses were used to statistically assess the differences and correlation of the setup errors of the two systems. Moreover, the Bland-Altman analysis was employed to evaluate the consistency of the two systems.Results:The 6DoF setup errors of CBCT were within the clinical tolerance (linear motions: -0.30 to 0.30 cm; rotational motions: -2.0° to 2.0°). The setup time and repositioning frequency of CBCT were (98 ± 31) s and 1.51% (2/132), respectively. There was no significant difference in setup errors between the two systems except those in x-axis ( Z = -3.11, P= 0.002), y-axis ( Z = -7.40, P<0.001), and Pitch ( Z= -4.48, P<0.001). There was a significant positive correlation between the setup errors along lateral ( rs = 0.47, P<0.001) and vertical ( rs = 0.29, P = 0.001) directions, rotation (Rtn; rs = 0.47, P<0.001), pitch (Pitch; rs = 0.28, P = 0.001) and roll (Roll; rs = 0.45, P<0.001) of the two systems. The 95% limits of agreement (95% LoA) of 6DoF setup errors were -0.12 to 0.09 cm, -0.07 to 0.17 cm, -0.19 to 0.20 cm, -1.0° to 0.9 °, -1.0° to 1.5°, and -0.9° to 1.0°, respectively. The 95% confidence interval (95% CI) of 95% LoA was -0.14 to 0.11 cm, -0.09 to 0.19 cm, -0.23 to 0.23 cm, -1.2° to 1.1°, -1.2° to 1.7°, and-1.0° to 1.1°, respectively, all of which were within the permissible error ranges. The 6DoF setup error difference of 3.41% (27/792< 5%) was beyond the 95% LoA. The maximum absolute differences of 6DoF setup errors within the 95% LoA were 0.12, 0.16, 0.19 cm, 0.9°, 1.5°, and 1.0°, respectively. Conclusions:The proposed markless setup workflow based on AlignRT combined with open-face mask immobilization for whole-course head tumor radiotherapy exhibits reasonable agreement and consistency with the patient setup using CBCT, with acceptable clinical efficiency. It can be applied to the first radiotherapy and the real-time monitoring of therapy to improve the safety and thus is of value in clinical applications.
10.Diagnosis and treatment of the portal vein complications for children undergoing spilt liver transplantation
Kaining ZENG ; Qing YANG ; Jia YAO ; Hui TANG ; Binsheng FU ; Xiao FENG ; Haijin LYU ; Huimin YI ; Shuhong YI ; Yang YANG
Organ Transplantation 2024;15(1):63-69
Objective To investigate the diagnosis and treatment strategy of the portal vein complications in children undergoing split liver transplantation. Methods The clinical data of 88 pediatric recipients who underwent split liver transplantation were retrospectively analyzed. Intraoperative anastomosis at the bifurcating site of the portal vein or donor iliac vein bypass anastomosis was performed depending on the internal diameter and development of the recipient's portal vein. A normalized portal venous blood stream monitoring was performed during the perioperative stage. After operation, heparin sodium was used to bridge warfarin for anticoagulation therapy. After portal vein stenosis or thrombosis was identified with enhanced CT or portography, managements including embolectomy, systemic anticoagulation, interventional thrombus removal, balloon dilatation and/or stenting were performed. Results Among the 88 recipients, a total of 10 children were diagnosed with portal vein complications, of which 4 cases were diagnosed with portal vein stenosis at 1 d, 2 months, 8 months, and 11 months after surgery, and 6 cases were diagnosed with portal vein thrombosis at intraoperative, 2 d, 3 d (n=2), 6 d, and 11 months after surgery, respectively. One patient with portal vein stenosis and one patient with portal vein thrombosis died perioperatively. The fatality related to portal vein complications was 2% (2/88). Of the remaining 8 patients, 1 underwent systemic anticoagulation, 2 underwent portal venous embolectomy, 1 underwent interventional balloon dilatation, and 4 underwent interventional balloon dilatation plus stenting. No portal venous related symptoms were detected during postoperative long term follow up, and the retested portal venous blood stream parameters were normal. Conclusions The normalized intra- and post-operative portal venous blood stream monitoring is a useful tool for the early detection of portal vein complications, the early utilization of useful managements such as intraoperative portal venous embolectomy, interventional balloon dilatation and stenting may effectively treat the portal vein complications, thus minimizing the portal vein complication related graft loss and recipient death.