Objective To observe enhancing effect of nerve regeneration on peripheral nerve defect models bridged by a new PRGD/PDLLA/VPA composite conduit.Methods In this study from February,2012 to March,2014,PRGD/PDLLA/VPA nerve conduits were tested in the rat sciatic nerve transection model.At different periods after operation,its ability to promote nerve regeneration was evaluated by sciatic functional index(SFI),electrophysiology (CMAPs,NCVs) and histologic assessment.Forty rats were randomly divided into 4 groups (n =10),group A:PRGD/PDLLA/VPA,group B:PDLLA/VPA,group C:PRGD/VPA and group D:autograft.Results At 12 weeks after surgery,the SFI value of group A (-45 ± 3.19)and group D (-42 ± 3.01)were significantly higher than those of group B(-79 ± 3.06) and group C(-72 ± 2.07)(P ＜ 0.05);The CMAPs of group A (24.89 ± 5.01) and group D (25.39 ± 5.63) were significantly higher than those of group B(14.88 ± 3.11) and C(15.00 ± 5.54);the NCVs of group A (31.42 ± 2.43) and group D (31.50 ± 2.16) were significantly higher than those of group B (20.11 ± 2.39) and group C(21.00 ± 2.13)(P ＜ 0.05).At 12 weeks after surgery,the numbers of regenerated nerve in the tube of group A (258 ± 6.18) and D(259 ± 5.59) were significantly higher than those of group B (231 ± 5.00) and group C(230 ± 5.07)(P ＜ 0.05).There was no significant difference between groups A and D(P ＞ 0.05).Conclusion These results illustrated that this new PRGD/PDLLA/VPA conduit could significantly facilitate the regeneration of short nerve defect and recovery of motor nerve,which provides a new thought for treatment of peripheral nerve injury.

Objective:To investigate the prognostic value of preoperative inflammatory indicators for hepatocellular carcinoma (HCC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 73 patients with primary HCC who underwent radical partial hepatectomy in the Beijing Tsinghua Changgung Hospital of Tsinghua University from December 2014 to July 2019 were collected. There were 57 males and 16 females, aged from 33 to 81 years, with a median age of 58 years. Results of blood examination indicators at the first time in hospital were determined for patients. Observation indicators: (1) the best cut-off values of?? preoperative inflammatory indicators calculated by the maximally selected rank statistics; (2) follow-up; (3) influencing factors for prognosis of HCC patients; (4) comparison of clinicopathological parameters of HCC patients; (5) comparison of predictive value for overall survival. Follow-up was conducted using outpatient examination and telephone interview to determine postoperative survival of patients up to September 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range). The best cut-off values ??for continuous variables were obtained using the maximally selected rank statistics based on survival at endpoint of follow-up. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Kaplan-Meier method was used to calculate survival rates, and Log-rank test was used for survival analysis. Univariate analysis was performed using the Log-rank test. Multivariate analysis was performed using the COX proportional hazard model. The time-dependent receiver operating characteristic curve (ROC) was used to compare the predictive value of independent prognostic factors. Results:(1) The best cut-off values of?? preoperative inflammatory indicators calculated by the maximally selected rank statistics: the best cut-off values of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and prognostic nutrition index (PNI) were 3.46, 131.05, and 45.65. (2) Follow-up: 73 patients were followed up for 31 months (range, 2-57 months). Twenty patients died during the follow-up. (3) Influencing factors for prognosis of HCC patients: results of univariate analysis showed that NLR, PNI, tumor diameter, and tumor differentiation degree were related factors affecting prognosis of patients ( χ2=10.213, 4.434, 5.174, 4.306, P<0.05). Results of multivariate analysis showed that NLR and tumor differentiation degree were independent factors affecting prognosis of patients ( hazzard ratio=4.429, 13.278, 95% confidence interval as 1.662-11.779, 1.056-10.169, P<0.05). (4) Comparison of clinicopathological parameters of HCC patients: of 73 patients, 64 cases had NLR<3.46 and 9 cases had NLR≥3.46. Cases with tumor length >5 cm or ≤5 cm, neutrophils, lymphocytes were 23, 41, (2.9±1.2)×10 9/L, (1.7±0.6)×10 9/L for 64 patients with NLR<3.46, versus 8, 1, (5.8±2.9)×10 9/L, (1.0±0.3)×10 9/L for 9 patients with NLR≥3.46; there were significant differences in above indicators between the two groups ( χ2=7.017, t=2.982, -3.168, P<0.05). (5) Comparison of predictive value for overall survival: time-dependent ROC curves of NLR and tumor differentiation degree for 1-, 2-, 3-, 4-year survival rates had the area under curve of 0.735,0.611, 0.596, 0.574 and 0.554, 0.583, 0.572, 0.556, respectively. NLR had better predictive value for overall survival of patients than tumor differentiation degree. Conclusion:Preoperative NLR is an independent factor affecting prognosis patients, and its predictive efficacy is better than tumor differentiation degree.

OBJECTIVE To study how to properly evaluate the curative effect of chronic sinusitis and nasal polyps management with endoscopic sinus surgery(ESS). METHODS Nasal airway resistance, olfactory function, the morphological character of mucosa in nasal and sinus cavity after ESS were surveyed by anterior rhinomanometry,T&T olfactometer standard odors for measuring olfactory sense,acoustic rhinometry and scoring measure of mucosa. RESULTS After ESS, nasal airway resistance decreased and olfactory functions improved obviously. The morphological characters of mucosa in nasal and sinus cavity affect the surgical result directly. CONCLUSION As the determining methods of nasal function after/before ESS,anterior rhinomanometry,T&T olfactometer standard odors,acoustic rhinometry and scoring measure of mucosa can be used to comprehensive estimate the curative effect of ESS objectively.

Objective To evaluate pulmonary protection of dexmedetomidine under general anesthesia in the patients with sepsis.Methods Fifty patients with sepsis,aged 50-64 yr,weighing 50-75 kg,of ASA physical status Ⅲ or Ⅳ,were randomly divided into 2 groups (n =25 each) using a random number table:control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with midazolam,fentanyl,propofol and cisatracurium,and maintained with infusion of remifentanil and propofol and intermittent iv boluses of cisatracurium.The patients were endotracheally intubated and mechanically ventilated.In group D,dexmedetomidine 1.0 μg/kg was infused over 10 min,followed by infusion at 0.4 μg · kg-1 · h-1 for 2 h before induction of anesthesia.While the equal volume of normal saline was given in group C.BIS value was maintained at 40-60.Immediately before skin incision,at 2 h after beginning of skin incision,and at 24 h after operation,arterial and venous blood samples were taken for blood gas analysis and for determination of the concentrations of serum procalitonin,interleukin-6 and tumor necrosis factor-alpha.Oxygenation index was calculated.Results Compared with group C,oxygenation index was significantly increased,the concentrations of serum procalitonin,tumor necrosis factor-alpha and interleukin-6 were decreased,and the rate of improvement of pulmonary function was increased in group D.Conclusion Dexmedetomidine (infusion at 0.4 pg · kg-1 · h 1 for 2 h after infusion of 1.0 μg/kg) before induction of anesthesia provides pulmonary protection under general anesthesia in the patients with sepsis.

Objective:To investigate the inhibition of Streptococcus oligofermentans(So)on Streptococcus mutans(Sm)and the hydro-gen peroxide(H2 O2 )producibility by So under different sucrose concentration environment.Methods:The inhibition of So on Sm was observed by plating method under different sucrose concentration environment.The initial synthesis rates and production of H2 O2 by So were determined by 4-aminoantipyine-horseradish peroxidase method.Results:Under 500 mmol/L of H2 O2 ,the inhibition of So on Sm was not observed.Under the other sucrose concentration environment,the inhibition of So on Sm was as following:50 mmol/L >0 mmol/L and 1 mmol/L(P <0.05);the initial synthesis rates of H2 O2 by So under different sucrose concentrations were as following:50 mmol/L >0 mmol/L and 1 mmol/L >500 mmol/L(P <0.05);the total production of H2 O2 by So:0 mmol/L and 1 mmol/L >50 mmol/L >500 mmol/L(P <0.05).When So was inoculated before Sm,the inhibition of So on Sm was stronger than that when the two species were inoculated at the same time.Conclusion:The capability of the inhibition of So on Sm and the production of H2 O2 by So are influenced by sucrose concentration.

Objective:To investigate the association between systemic inflammation response index (SIRI) and early neurological deterioration (END) in patients with basal ganglia hemorrhage (BGH), and then set up a prediction Nomogram model for END.Methods:The retrospective cohort study was conducted. A total of 146 patients with BGH from January 2016 to December 2018 were chosen in the Affiliated Jiangyin Hospital of Southeast University Medical College. The patients were divided into the END group ( n=34) and non-END group ( n=112), according to whether END occurred or not. The normally distributed data were presented as the mean±standard deviation ( Mean± SD), and the groups were compared using the t test. The non-normally distributed data were expressed as M ( P25, P75), and this data was analysed via the Kruskal-Wallis test. Categorical variables were described as numbers of patients (%) and compared using chi-square analysis or Fisher exact test, as appropriate. Univariate analysis and multivariate logistic regression analysis were used to identify the risk factors of END occurrence, and the relationship with SIRI. Then, each factor was scored by Nomogram method to construct the prediction model. Receiver operating characteristic curve (ROC) was drawn to assess the predictive value of SIRI and Nomogram model in the occurrence of END. Results:Univariate analysis showed that the occurrence of END was associated with hematoma volume, presence of intraventricular hemorrhage, blood glucose, lymphocyte count and SIRI ( P<0.05). Multivariate logistic regression analysis showed that hematoma volume ( P<0.001), presence of intraventricular hemorrhage ( P=0.012) and SIRI ( P=0.023) are independent risk factors for END occurrence. ROC curve analysis showed that SIRI has certain predictive value for END occurrence, and the optimal cut-off value was SIRI=5.40×10 9/L. Then these risk factors were incorporated into the Nomogram. Statistically analysis showed the model had a good predictive value, and the model combining the SIRI and other prognostic factors (AUC=0.869, 95% CI: 0.804-0.935, P<0.001) showed more favorable discriminative ability than the model without the SIRI (AUC=0.811, 95% CI: 0.734-0.889, P<0.001) and the model using the SIRI only (AUC=0.716, 95% CI: 0.622-0.810, P<0.001). Conclusion:SIRI is closely correlated with the occurrence of END in patients with BGH, and the nomogram model combining the SIRI has a more accurately predictive value, which improved the early identification and screening of END, and patient outcomes.

Objective To investigate the clinical effect of mesh plug tension-free hernia repair on inguinal hernia and its impact on microenvironment related indicators in patients.Methods A total of 128 cases of patients with inguinal hernia admitted in our hospital were divided into control group and observation group with 64 cases in each group.The control group was treated with traditional hernioplasty,while the observation group mesh plug ten-sion-free hernia repair.The clinical effect and microenvironment related indicators 1d after the operation were com-pared between the two groups. Results Compared with the control group,the observation group had less blood loss during the surgery,and shorter time for recovery of out-of-bed ambulation and hospitalization(P<0.01),but no significant difference was found regarding surgery hours(P > 0.05). The VAS scores of the observation group were significantly lower than those of the control group at the same time points 1 and 3 days after operation(P <0.01). Compared with those of control group 1 day after operation,the serum beta-endorphin(β-EP)of observa-tion group was significantly reduced,but total antioxidant capacity(T-AOC),growth hormone(GH),insulin (InS)level increased significantly(P<0.01).Serum matrix metalloproteinases-9(MMP-2 and MMP-9)and tis-sue inhibitor of matrix metalloproteinases(TIMP-1 and TIMP-2)were significantly reduced(P<0.01).Acute uri-nary retention,scrotal effusion,the incidence of postoperative pain and postoperative recurrence rate of observa-tion group were significantly reduced when compared with those of control group(P < 0.01);there was no differ-ence of incidence of low thermal between the two groups(P>0.05).Conclusion Mesh plug tension-free hernia repair has a significant clinical effect on inguinal hernia with less complications,lower recurrence rate and lighter impact on microenvironment related indicators.

OBJECTIVETo demonstrate the feasibility of extralevator abdominoperineal excision (ELAPE) for locally advanced low cancer in China.

METHODSA prospective multicenter clinical trial was carried out by 7 general hospitals across China from August 2008 to October 2011. A total of 102 patients underwent ELAPE for primary locally advanced low rectal cancer. There were 60 male and 42 female patients. The patients' characteristics, complications and prognosis were recorded.

RESULTSAll patients underwent the ELAPE procedure successfully. The median operating time was 180 minutes (range 110-495 minutes) and median intraoperative blood loss was 200 ml (range 50-1000 ml). The rates of sexual dysfunction, perineal complications, urinary retention, and chronic perineal pain were 40.5%, 23.5%, 18.6% and 13.7%, respectively. Chronic perineal pain was associated with coccygectomy (12 months postoperatively, t = 8.06, P < 0.01), and the pain might gradually ease over time. Reconstruction of pelvic floor with biologic mesh was associated with lower rate of perineal dehiscence (χ(2) = 13.502, P = 0.006) and overall perineal wound complications (χ(2) = 5.836, P = 0.016) compared with primary closure. A positive circumferential margin (CRM) was demonstrated in 6 (5.9%) patients, and intraoperative perforations occurred in 4 (3.9%) patients. All CRM involvement and intraoperative perforation located at anteriorly and anterolaterally. The local recurrence was 4.9% at a median follow-up of 35 months (range, 18-58 months).

CONCLUSIONSELAPE performed in the prone position for low rectal cancer leads to a reduction in CRM involvement, intraoperative perforations, and local recurrence, but it might result in a little high rate of perineal wound related complications. Reconstruction of pelvic floor with biologic mesh might lower the rate of perineal wound complications.

Adult ; Aged ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Male ; Middle Aged ; Perineum ; surgery ; Postoperative Complications ; Prognosis ; Prospective Studies ; Rectal Neoplasms ; surgery ; Treatment Outcome

ObjectiveTo investigate the effect of ankyrin-repeat domain-containing protein 22 （ANKRD22） on the proliferation， invasion， and migration of human hepatoma cells and its molecular mechanism. MethodsThe TCGA database was used to analyze the expression level of ANKRD22 in normal liver tissue and hepatocellular carcinoma tissue and its association with prognosis. Western Blot and qRT-PCR were used to measure the expression of ANKRD22 in human normal liver cells （L-02） and human hepatoma cells （Huh7， HepG2， MHCC-97H， SK-HEP-1， and SMMC-7721）； CCK-8 assay， EdU， wound healing assay， and Transwell assay were used to observe the effect of ANKRD22 on the proliferation， invasion， and migration of hepatoma cells； Western Blot was used to investigate the association of ANKRD22 with cyclins and EMT-related proteins； KEGG and ssGSEA analyses were performed to investigate the mechanism of action of ANKRD22 in hepatoma cells， and related experiments were conducted for validation. The independent-samples t-test was used for comparison of continuous data between two groups； a one-way analysis of variance was used for comparison between multiple groups， and the least significant difference t-test was used for further comparison between two groups. ResultsIn the TCGA database， the expression level of ANKRD22 in hepatoma tissue was significantly higher than that in normal liver tissue （t=5.083， P<0.05）， and the patients with a high expression level of ANKRD22 had longer overall survival and disease-related survival than those with a low expression level of ANKRD22 （P<0.05）. The expression level of ANKRD22 in various human hepatoma cell lines was higher than that in human normal liver cells （all P<0.05）. Cell proliferation assay showed that the ANKRD22 overexpression group had significantly higher EdU positive rate and proliferation rate than the Vector group （t=19.60 and 6.72， both P<0.001）， and compared with the si-NC group， the si-ANKRD22#2 group and the si-ANKRD22#3 group had significantly lower EdU positive rate and proliferation rate （all P<0.001）. Compared with the Vector group， the overexpression group had significantly higher expression levels of Cyclin E1， Cyclin D1， CDK7， and CDK4 （t=3.54， 4.95， 6.34， and 5.19， all P<0.01）， and the si-ANKRD22#2 group and the si-ANKRD22#3 group had significantly lower expression levels than the si-NC group （all P<0.001）. The overexpression group had a significantly lower expression level of P27 than the Vector group （t=6.12， P<0.001）， and the si-ANKRD22#2 group and the si-ANKRD22#3 group had a significantly higher expression level than the si-NC group （both P<0.001）. Invasion and migration experiments showed that compared with the Vector group， the ANKRD22 overexpression group had significantly higher migration rate and number of crossings through the membrane （migration group and invasion group） （t=5.01， 25.60， and 3.67， all P<0.05）， and compared with the si-NC group， thesi-ANKRD22#2 group and the si-ANKRD22#3 group had significantly lower migration rate and number of crossings through the membrane （migration group and invasion group） （all P<0.01）. The overexpression group had significantly higher expression levels of N-cadherin， Vimentin， and Snail than the Vector group （t=12.13， 8.85， and 13.97， all P<0.001）， and the si-ANKRD22#2 group and the si-ANKRD22#3 group had significantly lower expression levels than the si-NC group （all P<0.001）； the overexpression group had a significantly lower expression level of E-cadherin than the Vector group （t=4.98， P<0.01）， and the si-ANKRD22#2 group and the si-ANKRD22#3 group had a significantly higher expression level than the si-NC group （both P<0.001）. The KEGG enrichment analysis and the ssGSEA analysis showed that ANKRD22 was associated with the PI3K/AKT/mTOR signaling pathway in hepatocellular carcinoma， and the overexpression group had significantly higher expression levels of p-AKT/AKT， p-PI3K/PI3K， and p-mTOR/mTOR than the Vector group （t=12.21， 3.43， and 9.75， all P<0.01）， and the si-ANKRD22#2 group and the si-ANKRD22#3 group had significantly lower expression levels than the si-NC group （all P<0.001）. ConclusionANKRD22 is highly expressed in hepatoma cells and can promote the proliferation， invasion， and migration of hepatoma cells and the activation of the PI3K/AKT/mTOR signaling pathway.

Bacitracin is a broad-spectrum polypeptide antibiotic, which is formed by 11 amino acids residues. Precursor amino acids supply might be the limit factor during bacitracin fermentation. First, our results demonstrated that increasing Ile and Leu supplies were regarded as the efficient strategies for the enhanced titer of bacitracin. Then, the amino acid permease YhdG, which was identified as the BCAA permease, was deleted and overexpressed in DW2, respectively. Our results showed that knocking out of permease YhdG could improve bacitracin production remarkablely. The bacitracin titer of the yhdG deficient strain DW2ΔyhdG reached 917.35 U/mL by flask fermentation, increased by 11% compared with that of DW2. In addition, the bacitracin titer was decreased by 25% in the YhdG overexpressed strain. Meanwhile, the intracellular concentrations of BCAA were higher than DW2 during the biosynthesis of bacitracin. The above results suggested that the permease YhdG might act as an exporter for branched chain amino acids in B. licheniformis DW2. Taken together, the increasing intracellular concentrations of branched chain amino acids by deleting amino acid permease YhdG could improve bacitracin titer. This study provided a new strategy for high-level production of bacitracin.