Objective Implanting surgical meshes to support breast in periareoler mammaplasty shows an excellent prospect.But shrinking of the mesh and the adhesion formation affected the postoperative shape and palpation of the breast.The aim of this study was to compare biocompatible properties of four different polypropylene meshes (Prolene(R) ; Vypro Ⅱ(R) ; Premilene Mesh (R) and Premilene Mesh LP(R)) and to discuss the inclusion criteria of meshes in this technique.Methods The study was carried out in pigs.Four different polypropylene meshes were implanted subcutaneously in belly.90 days after implantation the mesh samples were explanted,and complications,foreign-body reaction,collagen fiber and elastic fiber formation were observed,as well as ultrastructures for the biocompatible properties.Results The biocompatible properties of each mesh were different.The foreign-body reactions determined the biocompatible properties,and affected the postoperative shape greatly.Conclusions Premilene Mesh LP o as a newer low-weight polypropylene mesh,has superior properties to the others.

Objective To investigate the mRNA expression of a proliferation inducing ligand (APRIL) and its receptors including B cell maturation antigen (BCMA),transmembrane activator.calcium modulator and cyclophilin ligand interactor (TACI) in the peripheral blood mononuclear cells (PBMCs) of patients with systemic lupus erythematosus (SEE).Methods APRIL mRNA、BCMA mRNA and TACI mRNA in PBMCs were detected by real-time quantitative PCR in 66 SLE patients and 25 normal controls.Gene expression level was measured as 2-AACT.Results The expression levels of APRIL mRNA、BCMA mRNA and TACI-mRNA were significantly increased in both active SLE group and stable SLE group compared with those in the normal controls(P<0.01 for all).The expression levels of APRIL mRNA and TACI mRNA in active SLE group were significantly higher than those in stable SLE group(P<0.01,P<0.05,respectively).But there was no significant difierence in the expression levels of BCMA mRNA between the SLE stable and active groups-Beside,the expression levels of APRIL mRNA and TACI mRNA were significantly increased in patients with lupus nephritis (LN) compared to patients with non-LN (P<0.01 for all).Conclusion The expression levels of APRIL and its receptors are significantly elevated in SLE patients.It may suggest that APRIL and its receptors play an important role in the pathogenesis of SLE.

OBJECTIVE: To determine the influence of different registration scopes and methods on kilo-voltage cone beam CT (kVCBCT) image and CT image and to estimate the appropriate clinical target volume (CTV)-to-planned target volume (PTV) margin for central-type non-small cell lung cancer in image-guided radiation therapy (IGRT). METHODS: Twenty-six patients with central-type non-small cell lung cancer (NSCLC) who received IGRT were enrolled in this study and totally 104 flames of kVCBCT scanning acquired before radiotherapy were analyzed. First, registrations were performed by gray plus manual match and were compared among different registration scopes of tumor and tumor plus vertebra. Then, the results of registration as well as time cost using tumor plus vertebra as registration scope were compared among different registration methods of gray plus manual match and bone plus manual match. At last, 200 registrations using tumor plus vertebra as the registration scope performed by bone plus manual match were recorded and the CTV-to-PTV margin was calculated. RESULTS: There was no significant difference in X, Y and Z translational and rotational movements between the registration scopes of tumor and tumor plus vertebra when gray plus manual match was used as the registration method (P>0.05). The registration results of gray plus manual match and bone plus manual match were equal when tumor plus vertebra was used as the registration scope (P>0.05), but the time cost of bone plus manual match [(1.9±0.3) min] was shorter than that of gray plus manual match [(3.1±0.2) min]. The CTV-to-PTV margins were 5.3, 4.9 and 5.7 mm in X, Y, and Z directions respectively. CONCLUSION For central-type NSCLC, tumor and vertebra can be used as registration scope and the bone plus manual match is suggested in IGRT. To avoid errors, we suggest a CTV-to-PTV margin of 6 mm.
Aged ; Carcinoma, Non-Small-Cell Lung ; radiotherapy ; Cone-Beam Computed Tomography ; Female ; Humans ; Lung Neoplasms ; radiotherapy ; Male ; Middle Aged ; Patient Positioning ; Radiotherapy Planning, Computer-Assisted ; methods ; Radiotherapy, Image-Guided ; methods

Objective To investigate the application of bundles of intervention in the treatment of postoperative delirium in esophageal cancer.Methods Thirty-six cases of delirium associated with esophageal cancer(study group)after the application of bundles of intervention in the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University from November 2015 to August 2016 were analyzed,and 41 cases of postoperative delirium(control group)from January 2015 to October 2015 were treated by routine treatment.Results The mean duration of postoperative delirium was(3.6±0.8)d in the study group and(4.7± 1.2)d in the control group,and the difference was statistically significant(t =4.783,P<0.01).The incidence rates of other complications in the study group and control group were 19.4％(7/36)and 34.1％(14/41),respectively,and there was no significant difference(χ2=2.089,P=0.148).The incidence rates of accidental events in the study group and control group were 13.9％(5/36)and 31.7％(13/41),respectively,and the difference was statistically significant(χ2= 4232,P= 0.040).There was no significant difference in the postoperative exhaust time and removal of chest tube drainage time between the two groups(both P＞ 0.05),but there was a significant difference in postoperative hospital stay and hospital costs between the two groups(t values were 4.726 and 2.065,both P<0.05).Conclusions In the treatment of postoperative delirium in esophageal cancer,applying the bundles of intervention concept is feasible and effective.It can significantly reduce postoperative delirium duration and accelerate the rehabilitation of patients.

Objective: Pulmonary metastatic angiosarcoma is a rare, fatal disease that often presents as diffuse alveolar hemorrhage(DAH). In this report, clinical characteristics of pulmonary metastatic angiosarcoma were retrospectively reviewed. Methods: A total of 9 patients with angiosarcoma who presented as DAH were enrolled. Clinical data included age, gender, symptoms, smoking status, physical exam findings, pulmonary function tests, and radiology. Results: All patients were male with median age 41 years(range, 22 to 57 years). The most common symptom was hemoptysis(9/9). Other symptoms included dyspnea (5/9), cough(3/9), chest pain(3/9), fever(2/9,) and edema of the lower extremity and oliguria(4/9).The common misdiagnoses were tuberculosis(4/9), vasculitis(3/9) and other infection(1/9). Chest computed tomography showed bilateral,random distributed different-sized nodules(9/9),as well as ground-glass areas (9/9).The hearts, mainly right atrium, were the most common primary locations(7/9).Cardiac mass was the first manifestation in five patients by echocardiography(5/8).Two atrial masses were identified by computer tomography pulmonary angiography and magnetic resonance imaging respectively. Transbronchial lung biopsy failed to find malignancy. Computer tomography guided transthoracic needle biopsy was difficult to perform in most patients. Eight patients were diagnosed by surgical biopsy, either by lung biopsy(4/8) or cardiac biopsy(4/8).The median survival period was only 3 months after surgery. Conclusion Metastatic pulmonary angiosarcoma should be considered in patients with DAH and multiple glass ground opacity and nodules on chest CT. Careful cardiologic monitoring is necessary. Surgical biopsy is reliable for diagnosis.

Objective: To investigate the clinical and pathological features, diagnosis and treatment of primary vulvar Paget disease (VPD) , and analyze the related factors that may affect the recurrence. Methods: A retrospective study was carried out on 36 patients diagnosed as VPD pathologically from January 1983 to December 2017 at Peking Union Medical College Hospital, Chinese Academy of Medical Sciences. The clinical and pathological features, diagnosis, treatment and prognosis and the factors influencing recurrence rate of VPD were analyzed. Results: (1) Totally 94% (34/36) of VPD occurred in postmenopausal women. Pruritus was counted 86% (31/36) of the main complaint. Lesions of vulvar were main symptom which had no specificity, acting as ulcer (67%, 24/36) , erythema (50%, 18/36) , depigmentation (42%, 15/36) , sclerosis (31%, 11/36) , and pigmentation (17%, 6/36) . The lesions invaded labium majus (97%, 35/36) , sometimes labium minus (53%, 19/36) , clitoris (28%, 10/36) , perianal (25%, 9/36) , orificium vaginae (3%, 1/36) , and meatus urinarius (3%, 1/36) . Approximately 19% (7/36) of VPD coexisted with intraepithelial neoplasia or adenocarcinoma of vulvar or other part of body. (2) Diagnosis and treatment: diagnosis was confirmed histologically by biopsy or pathologies after surgery, and immunohistochemical results were helpful for differential diagnosis. Surgery was the mean treatment method, 34 of all the 36 patients (94%, 34/36) underwent surgery for at least once, while 2 patients (6%, 2/36) were performed non-operative treatment. The surgical treatment included excision of focus, wide local excision, simple vulvectomy, and extensive vulvectomy. The non-operative treatment included radiotherapy, chemotherapy, laser, photodynamic therapy, and so on. (3) Prognosis: among 36 VPD patients, 4 were lost to follow-up with a 89% (32/36) follow-up rate. Median follow-up was 35.3 months (range,1 month to 31 years) . During the follow-up period, 2 patients were unable to judge whether they will relapse for the follow-up time did not reach half a year, 8 cases were unsuccessful operation, 20 cases succeeded, the achievement ratio was 71% (20/28) . Nine of twenty cases relapsed, the recurrence rate was 45% (9/20) . The median recurrence time was 14 months after operation. One patient of the 32 followed-up patients died, the mortality rate was 3% (1/32) . (4) The related factors affected the recurrence of VPD: t test was applied to the analysis of patients′ age, rank test was used in the statistics of the time of confirmed diagnosis, the length and thickness of the resection focus. Fisher test was used to calculate whether the focus were limited to the epidermis, type of surgical procedures, distance between the margin and the focus, whether tumor cells infiltrated the margin. The results showed that none of the above terms in the first operation had significant contribution to recurrence (all P>0.05) . Conclusions VPD may be a low potential malignancy, which could slowly progress into deep invasive disease. VPD is often associated with intraepithelial neoplasia or primary tumors of the vulva or somewhere else. Operations is the first choice for VPD, but consider for its high recurrence rate after operation, close follow-up should be strongly suggested.

Background::The causal relationship between visceral adipose tissue (VAT) and gout is still unclear. We aimed to examine the potential association between them using observational and Mendelian randomization (MR) analyses.Methods::In the observational analyses, a total of 11,967 participants (aged 39.5 ± 11.5 years) were included from the National Health and Nutrition Examination Survey. Logistic regression models were used to investigate the association between VAT mass and the risk of gout. In two-sample MR analyses, 211 VAT mass-related independent genetic variants (derived from genome-wide association studies in 325,153 UK biobank participants) were used as instrumental variables. The random-effects inverse-variance weighted (IVW) method was used as the primary analysis. Additional sensitivity analyses were also performed to validate our results.Results::Observational analyses found that an increase in VAT mass (per standard deviation) was associated with a higher risk of gout after controlling for confounding factors (odds ratio [OR] = 1.27, 95% confidence intervals [CI] = 1.11–1.45). The two-sample MR analyses demonstrated a causal relationship between increased VAT mass and the risk of gout in primary analyses (OR = 1.78, 95% CI = 1.57–2.03). Sensitivity analyses also showed similar findings, including MR-Egger, weighted median, simple mode, weighted mode, and leave-one-out analyses.Conclusions::Observational analyses showed a robust association of VAT mass with the risk of gout. Meanwhile, MR analyses also provided evidence of a causal relationship between them. In summary, our findings suggested that targeted interventions for VAT mass may be beneficial to prevent gout.

Objective:To investigate the impact of elevated glucose-induced RNA oxidation on pancreatic β-cell function, activity, and underlying molecular mechanisms.Methods:Rat pancreatic islet β-cell tumour INS-1 cells were cultured in vitro and subjected to nucleic acid oxidation assessment using isotope dilution ultra-high performance liquid tandem mass spectrometry(ID LC MS/MS)following high glucose exposure.In vitro simulation of increased RNA oxidation in INS-1 cells was achieved using 8-oxoguanosine-5'-triphosphate(8-oxoGTP).Cell proliferation was evaluated through CCK-8 assay, apoptosis was measured via flow cytometry, and gene expression of insulin(INS), pancreatic-duodenal homologous cassette 1(PDX1), cysteine-aspartate proteinase 3(Casp3), and cysteine aspartate protease 6(Casp6)was analyzed at the mRNA level.Additionally, whole transcriptome sequencing was performed to elucidate the molecular mechanisms underlying the impact of RNA oxidation on INS-1 cells.Results:Elevated glucose levels induced an increase in RNA oxidation within INS-1 cells.This heightened RNA oxidation led to the inhibition of INS-1 cell proliferation, a reduction in mRNA levels of INS and PDX1 genes, and the promotion of apoptosis-related casp3 and casp6 gene mRNA synthesis.Transcriptome sequencing analysis unveiled that the elevated RNA oxidation caused differential expression of mRNA, lncRNA, miRNA, and circRNA in INS-1 cells.This included a significant down-regulation of transcription factors such as Mafa, Pdx1, Pax6, and Mnx1, alongside an up-regulation of various miRNAs like rno-miR-124-3p, rno-miR-133a-3p, rno-miR-3120, rno-miR-212-3p, and rno-miR-7a-2-3p.These molecular changes contributed to the altered expression of associated lncRNAs, ultimately hindering insulin synthesis and secretion, as well as β-cell proliferation.Conclusions:Increased RNA oxidation down-regulates the levels of key β-cell transcription factor mRNAs, contributes to the differential expression of related non-coding RNAs(ncRNAs), particularly lncRNAs, impacts β-cell insulin synthesis and secretion, hinders cell proliferation, and serves as a significant factor in β-cell dysfunction and decreased activity in type 2 diabetes mellitus(T2DM).

Objective:To investigate the effect of adjuvant radiotherapy on the prognosis of patients with N 2 stage non-small cell lung cancer (NSCLC) undergoing radical resection. Methods:The data of 1 208 patients with NSCLC who received radical lung cancer resection combined with chemotherapy or post-operative adjuvant radiotherapy and chemotherapy from SEER database of the United States from 2004 to 2016 were included in the study. 627 patients received radical lung cancer resection combined with chemotherapy (surgery + chemotherapy group), and 581 patients received radical lung cancer resection combined with radiochemotherapy (surgery + radiochemotherapy group). We analyzed and compared the effect of postoperative adjuvant radiotherapy on the prognosis of patients with N 2 stage NSCLC undergoing radical resection. The 1∶1 propensity matching method was used to analyze the prognosis of the two groups. Results:In the two groups of patients with stage N 2 NSCLC included in the study, the median survival time was 51 months in the operation + radiotherapy and chemotherapy group, and the 3- and 5-year cancer specific survival rates were 58.3% and 44.9%, respectively. The median survival time was 50 months in operation + chemotherapy group, and the 3- and 5-year cancer specific survival rates were 59.9% and 46.5%, respectively. There was no statistically significant difference between the two groups in cancer specific survival ( P>0.05). The result of subgroup analysis showed that the cancer specific survival of patients in operation + radiotherapy and chemotherapy group was significantly worse than that in operation + chemotherapy group ( χ2=5.085, P<0.05). Multivariate Cox regression analysis showed that age, gender, G stage, T stage and the number of lymph node metastasis were the important factors affecting the cancer specific survival of patients with N 2 NSCLC ( Wald =15.236, 7.039, 4.841, 10.155, 11.192, respectively, P<0.05). After propensity matching, there was no statistically significant difference in cancer specific survival ( P>0.05) between the two groups. However, in the T 1 NSCLC patients, the cancer specific survival of operation + radiochemotherapy group was significantly worse than that of operation + chemotherapy group ( χ2=5.364, P<0.05), while the cancer specific survival of operation + radiochemotherapy group was significantly better than that of operation + chemotherapy group in T 3-4 subgroup( χ2=4.486, P<0.05). According to the tendency matching of pathological subgroups, the cancer specific survival of surgery + radiochemotherapy group was significantly better than that of surgery + chemotherapy group ( χ2=6.279, P<0.05) in the non adenocarcinoma subgroup. And the multivariate Cox regression analysis indicated that postoperative radiotherapy was an important factor for cancer specific survival in patients with N 2 non adenocarcinoma non-small cell lung cancer ( Wald=7.300, P<0.05). However, before and after propensity matching in lung adenocarcinoma subgroup, there was no statistically significant difference in cancer specific survival between the surgery + radiochemotherapy group and the surgery + chemotherapy group ( P>0.05). Conclusions:Postoperative adjuvant radiotherapy can improve the prognosis of patients with T 3-4 or non-adenocarcinoma N 2 NSCLC. But, for other patients with N 2 non-small cell lung cancer, the choice of postoperative adjuvant radiotherapy should be cautious, especially for T 1 stage.

Objective: To investigate the efficacy and feasibility of laparoscopic resection for gastric gastrointestinal stromal tumor (GIST) in unfavorable location by comparing with open surgery. Methods: Clinicopathological and follow-up data of 176 patients with gastric GIST in unfavorable location admitted at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to December 2017 were analyzed retrospectively. There were 94 males and 82 females, aging of (57.4±12.7) years (range: 20-90 years). Of the 176 patients, 64 underwent laparoscopic surgery (laparoscopic group) and 112 underwent open surgery (open group). One-to-one propensity score matching (PSM) was performed to balance the covariance between laparoscopic group and open surgery group. Before PSM, the differences between the two group in tumor size and modified National Institutes of Health risk classification were significant. After PSM, there were 63 pairs (63 cases in laparoscopic group and 63 cases in open group) and the baseline characteristics were comparable between the two groups(P>0.05). The difference of short-term outcome between the two groups were compared using t test, χ² test or Wilcoxon rank-sum test. The survival curve was established by Kaplan-Meier method and the Log-rank test was used to compare the survival of the two groups. Results: The operation time of laparoscopic group was shorter ((141.6±100.6) minutes vs. (100.4±67.7) minutes, t=2.681, P=0.008), the hospitalization cost was higher ((5.2±0.7) ten thousand yuan vs. (4.2±0.8) ten thousand yuan, t=7.357, P=0.000) than open group. The time to first flatus ((49.1±8.2) hours vs. (71.0±4.6) hours, t=-18.482, P=0.000) and preoperative hospital stay ((10.3±6.0) days vs. (14.8±7.6) days, t=-3.717, P=0.000) was shorter in laparoscopic group. With a median follow-up time of 44 months (range: 10 to 154 months), the 1-, 3-, 5-year relapse-free survival rates in the laparoscopic group and open group were 98.3%, 92.1%, 92.1% and 100%, 86.3%, 83.2%, respectively (χ²=0.696, P=0.404). The 1-, 3-, 5-year overall survival rates in the laparoscopic group and open group were 96.6%, 94.7%, 94.7% and 100%, 91.1%, 81.4%, respectively (χ²=0.366, P=0.545). Conclusions In experienced medical centers, laparoscopic resection is safe and feasible for GIST in unfavorable location. Compared to open surgery, laparoscopic resection achieves a faster postoperative recovery and a similar long-term prognosis.