Objective To investigated the role of antithrombin Ⅲ (AT-Ⅲ) levels in the early diagnosis of disseminated intravascular coagulation (DIC) in patients with sepsis and the predictive effect of AT-Ⅲ on the development of DIC.Methods A retrospective study was conducted. Patients admitted to intensive care unit (ICU) of the First Affiliated Hospital of China Medical University from January to December in 2015 were enrolled. The patients were divided into sepsis group and non-sepsis group according to the diagnostic criteria of sepsis. In addition, sepsis patients were divided into 3 subgroups according to the international society on thrombosis and haemostasis (ISTH) scores on the first day: overt DIC (ISTH ≥ 5), non-overt DIC (ISTH 1-4) and none DIC group (ISTH = 0). Blood routine test, prothrombin time (PT), fibrinogen (Fib), D-dimer, fibrin degradation products (FDP), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores, sequential organ failure assessment (SOFA) scores and ISTH scores were recorded on the first ICU day. AT-Ⅲ was recorded during 7 days. The differences were compared among these 3 groups. Correlations of AT-Ⅲ with various parameters were calculated by using Pearson correlation analysis in sepsis group and overt DIC group. Receiver operating characteristic (ROC) curves for diagnosis of DIC with AT-Ⅲ, AT-Ⅲ+PT were drawn to evaluate the diagnostic efficiency. The AT-Ⅲ levels of DIC patients were compared between early-onset DIC and late-onset DIC during their ICU stay. The change of AT-Ⅲ levels with time and prognosis in patients with early-onset DIC was compared between groups.Results Totally 445 patients were recruited, with 138 patients in sepsis group, and 307 in non-sepsis group. There were 20 patents diagnosed with overt DIC on the first ICU day, 115 patients non-overt DIC and 3 patients of none DIC. Twenty-five sepsis patients were diagnosed overt DIC during the ICU days. AT-Ⅲ level in sepsis patients on the first ICU day were lower than that in non-sepsis patients [(55.29±13.92)% vs. (76.54±12.31)%,P < 0.01]. Patients with overt DIC had a lower AT-Ⅲ level than non-overt DIC or none DIC patients [(43.85±13.00)% vs. (56.95±13.03)%, (68.00±16.52)%, bothP < 0.05]. It was shown by Pearson correlation analysis that AT-Ⅲ level of sepsis patients on the first ICU day was negatively correlated to ISTH score and PT (r value were -0.467, -0.654, bothP < 0.01). AT-Ⅲ level of overt DIC patient on the first ICU day was negatively correlated with PT (r = -0.675,P = 0.001). It was shown by ROC curve that area under ROC curve (AUC) of AT-Ⅲ combined with PT for diagnosis overt DIC in sepsis patients was higher than that of AT-Ⅲ or PT alone (0.843 vs. 0.763, 0.834), the sensitivity 90.0%, specificity 73.7%. The cut-off value for overt DIC diagnosis in sepsis patients of AT-Ⅲ level alone was 48.5%, sensitivity was 78.0%, specificity was 70.0%. On the first ICU day, AT-Ⅲ level was risen when ISTH score improved in patients with sepsis. There was similar change of AT-Ⅲ level between patients with early-onset DIC and late-onset DIC. AT-Ⅲ level increased with DIC improvement.Conclusion AT-Ⅲ level can be used for diagnosing sepsis-associated overt DIC independently or with a combination of PT. When ISTH score improved, AT-Ⅲ level was risen in patients with sepsis associated DIC.

Objective To investigate the content of intestinal fatty acid binding protein (IFABP) and its clinical significance in patients with severe sepsis.Methods A prospective observational study was conducted.Fifty patients with severe sepsis admitted to intensive care unit (ICU) of the First Affiliated Hospital of China Medical University from July to December 2012 were enrolled,and 20 healthy patients served as control group.The concentrations of serum IFABP,interleukin-6 (IL-6),and tumor necrosis factor-α (TNF-α) were determined with enzyme-linked immunosorbent assay (ELISA) on days 0,1 and 3 after ICU admission.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) score,28-day prognosis,acute gastrointestinal injury (AGI) grade were recorded at the same time.Furthermore,the contents of IFABP were compared between control group and the severe sepsis group,abdominal infection group and non-abdominal infection group,the survival group and the death group,as well as among different AGI-grade groups.Correlation analysis of IFABP and inflammatory factors,IFABP and two scores,and IFABP and time of stay in ICU and mechanical ventilation were studied.Multivariate logistic regression and analysis of 28-day outcome of the patients were also studied.Results IFABP levels were increased in severe sepsis patients on days 0,1 and 3 compared with those of healthy control group (mg/L:731.90 ±53.91,592.07 ±41.94,511.85 ±47.97 vs.439.88 ±23.68,all P =0.000).There was no statistical significance of IFABP levels between abdominal infection group and non-abdominal infection group,the survival group and the death group,or among different AGI-grade groups.The correlation analysis showed that IFABP was statistically related with IL-6 (r=0.794,P=0.000),TNF-α (r=0.878,P=0.010),APACHE Ⅱ score (r=0.428,P=0.000) in patients with severe sepsis.Significant correlations were also found between IFABP and IL-6 (r=0.812,P=0.000),TNF-α (r=0.885,P=0.000) in abdominal infection group,as well as in non-abdominal infection group (IL-6:r=0.739,P=0.000; TNF-α:r=0.828,P=0.000).As shown by multivariate logistic regression analysis,SOFA scores on days 0,1,3 were the independent risk factors for death [odds ratio (OR) was 1.624 (P=0.004),1.411 (P=0.027),1.740 (P=0.012),respectively],but IFABP level,AGI grade,and APACHE Ⅱ score had no influence on death rate.Conclusion IFABP concentrations in patients with severe sepsis were significantly increased,and it is correlated well to IL-6,TNF-α and APACHE Ⅱ score,but did not related obviously with AGI grade and the prognosis of the patients.

Objective To explore the prognostic factors of endometrial carcinoma.Methods 166 patients with endometrial carcinoma in Cancer Hospital of Shantou University Medical College from May 1996 to June 2009 were analyzed retrospectively.Prognostic factors were analyzed by univariate analysis.Results The total 5-year survival rate of 166 cases was 86.7 ％.The univariate analysis showed that the age,deep myometrial invasion,lymph-node metastasis and operative-pathological staging were significantly associated with the prognosis (P ＜ 0.05).As well as,according to muhivariate Cox proportional-hazard model,3 independent factors as the age,deep myometrial invasion and lymph-node metastasis were related significantly to overall survival (P ＜ 0.05).Conclusions The 5-year survival rate of endometrial carcinoma is high.The age,deep myometrial invasion and lymph-node metastasis are independent prognostic factors of endometrial carcinoma.

Objective To evaluate clinical efficacy and survival outcomes of neoadjuvant treatment on early stage bulky cervical carcinoma.Methods A total of 155 cases with bulky stage Ⅰ b2 or Ⅱ a2 cervical carcinoma in Affiliated Tumor Hospital of Shantou University Medical College from Nov.2010 to Feb.2015 was reviewed and divided into two groups according to pre-operative treatment 108 cases in the neoadjuvant treatment group and 47 cases in the control group who underwent radical surgery directly.The clinical,pathologic,and follow-up data were analyzed retrospectively.Results The total response rate of neoadjuvant treatment was 75.0％.Histological grade in neoadjuvant treatment group was better than the other group and the rate of deep myometrial infiltration was tend to low in neoadjuvant treatment group.There was no difference in pathological type,parametrial involvement,lymph node metastasis,and lymph vascular space invasion between two groups.The rate of postoperative treatment was similar (92.6％ vs 87.2％,P ＞ 0.05).The overall survival rate of neoadjuvant treatment group was 96.4％ and the other group was 88.9％ (P =0.069).Conclusions Neoadjuvant treatment was effective for early stage bulky cervical carcinoma.It might reduce tumor histological grade and maybe improve the overall survival of patients.

Objective To explore the value of single source dual energy CT for quantitative measurement of liver fat fraction in the rabbit model of nonalcoholic fatty liver disease(NAFLD).Methods Thirty male New Zealand rabbits were randomly divided into five groups.Six rabbits were fed with standard chow as a control group for 3 weeks.TwentyGfour rabbits were divided into four groups and fed with highGfat, highGcholesterol diet to reach different stage of NAFLD model for 1 ,3 ,4 and 8 weeks respectively before dualGenergy CT scanning.1 40 keV polychromatic CT values (QC),70 keV monochromatic CT values (Mono 70 keV),slope,effective atomic number (EffectiveGZ)and fat concentration based on dualGenergy CT fat decomposition (Fat/Water)were measured.Liver samples were obtained to measure the fat fraction and staged according to Burnt staging system.Correlations between different CT indexes and fat fraction were analyzed.ROC was used to evaluate the diagnosis efficacy of different parameters.Results Correlation between fat concentration based on dualGenergy CT fat decomposition and fat fraction (r＝0.936)was better than that between 140 keV polychromatic CT values (r＝－0.838)and 70 keV monochromatic CT values (r＝－0.906),as well as effective atomic number (r＝－0.858)and slope (r＝0.863).In terms of diagnostic performance of material decomposition fat imaging,the values of area under the curve were 0.944 (stage 0 vs.stage 1 or more severe),0.995 (stage 1 or less severe vs.stage 2 or more severe)and 1 (stage 2 or less severe vs.stage 3)with optimal cutoff values of 59.310,99.5 17 and 22 3.02 3 mg/cm3 ,respectively.Conclusion The dualGenergy CT can quantitatively measure liver fat concentration as a noninvasive surrogate bioGmarker in the rabbit model of nonalcoholic fatty liver disease.DualGenergy CT derived material decomposition fat images can provide more diagnostic information at the early stage of NAFLD.

Objective To evaluate the clinicopathological characteristics and prognosis of cervical adenocarcinoma patients with stage Ⅰ b1-Ⅱ b treated with radical hysterectomy and systematic lymphadenectomy.Methods The clinical,pathologic and follow-up data of 118 cases of cervical adenocarcinoma with stage Ⅰ b1-Ⅱ b treated with radical hysterectomy and systematic lymphadenectomy in Cancer Hospital of Shantou University Medical College from Dec.2003 to Nov.2015 were analyzed retrospectively.Results 118 patients of cervical adenocarcinoma with stage Ⅰ b1-Ⅱ b had a median age of 46 years at diagnosis.28 cases were postmenopausal and 90 cases were premenopausal.There were 77 cases in phase Ⅰ b1,25 in stage Ⅰ b2,4 in stage Ⅱ a1,7 in stage Ⅱ a2,5 in stage Ⅱ b.The rate of ovarian metastasis was 3.39％.The 3-year recurrence-free survival rate of the patients was 81.6％.The 3-year overall survival rate of the patients was 83.9％,and 89.10％ for stage Ⅰ b1,73.7％for stage Ⅰ b2,100％ for stage Ⅱ a1,83.3％ for stage Ⅱ a2,60.0％ for stage Ⅱ b.The 3-year overall survival rates of the patients who receive non-chemoradiotherapy,chemotherapy,radiotherapy and chemoradiotherapy after operation were 90.6％,100％,84.6％ and 70％ respectively.The result of Cox proportional hazards regression model analysis indicated that lymph lode metastasis and ovarian metastasis was the independent prognostic factor of desease-free survival,ovarian metastasis and deep myometrial invasion was the independent prognostic factor of overall survival.Conclusions Premenopausal cases are more common than postmenopausal cases in cervical adenocarcinoma with stage Ⅰ b1-Ⅱ b.Ovarian presevation is feasible for early-stage cervical denocarcinoma after full assessment.Pelvic irradiation with concurrent chemotherapy can lead a better prognosis for the patients with pathological risk factors.

Primary central nervous system lymphoma (PCNSL) is a highly aggressive malignant lymphoma. As most chemotherapy drugs have difficulty in crossing the blood-brain barrier, PCNSL shows a difficulty in clinical treatment, a high recurrence rate and a poor prognosis. Early identification of relapsed patients and prompt initiation of salvage therapy play a critical role in the improvement of patients' prognosis. Brain biopsy is the gold standard to identify recurrence, while the risk of operation failure and complications is still high. Non-invasive imaging techniques are beneficial for early identification of recurrence in PCNSL and can provide an important basis for guiding relapsed patients to adjust treatment plans in time. However, there is no unified evaluation standard for imaging methods of monitoring the relapsed lesions of PCNSL. With the further research of the pathophysiological mechanism of PCNSL, biomarker detection has become a new method to identify recurrence and more clinical evidence is still needed in the future.

Objective:To explore the effects of mindfulness-based stress reduction training (MBSRT) on anxiety and depression levels and sleep quality of clinical nurses.Methods:Totally 90 clinical nurses from the Second Hospital of Harbin Medical University were selected by convenient sampling from April 2018 to June 2019, and were divided into experimental and control groups according to the order of enrollment, with 45 cases in each group. Nurses in the control group received routine sleep and emotional guidance, while nurses in the experimental group underwent MBSR training on this basis. Self-Anxiety Scale (SAS) , Self-Depression Scale (SDS) , and Pittsburgh Sleep Quality Index (PSQI) were used to evaluate the intervention effect in both groups 1 day before the intervention and the day when the intervention was completed. Finally, 44 nurses in the experiment group and 45 in the control group completed the study.Results:Before the MBSRT intervention, there was no statistically significant difference in the SAS, SDS, and PSQI scores between the two groups of nurses ( P>0.05) . After the intervention, the SAS and SDS scores of nurses in the experimental group were lower than those of the control group, and the differences were statistically significant ( t=-3.117, -3.498; P<0.05) ; the total PSQI score and scores in such dimensions as subjective sleep quality, sleep latency, sleep continuity, sleep efficiency, sleep disorder, hypnotic drug use, and daytime dysfunction in the experimental group were lower than those of the control group, and all differences were statistically significant ( P<0.05) . Conclusions:MBSRT can effectively reduce the level of anxiety and depression and improve the sleep quality of clinical nurses.

Although immunotherapy has revolutionized cancer treatment and achieved remarkable success across many different cancer types, only a subset of patients shows meaningful clinical responses. In particular, advanced prostate cancer exhibits overwhelming de novo resistance to immune checkpoint blockade therapy. This is primarily due to the immunosuppressive tumor microenvironment of prostate cancer. Therefore, it is paramount to understand how prostate cancer cell-intrinsic mechanisms promote immune evasion and foster an immunosuppressive microenvironment. Here, we review recent findings that reveal the roles of the genetic alterations, androgen receptor signaling, cancer cell plasticity, and oncogenic pathways in shaping the immunosuppressive microenvironment and thereby driving immunotherapy resistance. Based on preclinical and clinical observations, a variety of therapeutic strategies are being developed that may illuminate new paths to enhance immunotherapy efficacy in prostate cancer.
Male ; Humans ; Prostatic Neoplasms/pathology* ; Prostate/pathology* ; Immunotherapy ; Tumor Microenvironment

OBJECTIVES: Restoration of blood circulation within "time window" is the principal treating goal for treating acute ischemic stroke. Previous studies revealed that delayed recanalization might cause serious ischemia/reperfusion injury. However, plenty of evidences showed delayed recanalization improved neurological outcomes in acute ischemic stroke. This study aims to explore the role of delayed recanalization on blood-brain barrier (BBB) in the penumbra (surrounding ischemic core) and neurological outcomes after middle cerebral artery occlusion (MCAO). METHODS: Recanalization was performed on the 3rd day after MCAO. BBB disruption was tested by Western blotting, Evans blue dye, and immunofluorescence staining. Infarct volume and neurological outcomes were evaluated on the 7th day after MCAO. The expression of fibroblast growth factor 21 (FGF21), fibroblast growth factor receptor 1 (FGFR1), phosphatidylinositol-3-kinase (PI3K), and serine/threonine kinase (Akt) in the penumbra were observed by immunofluorescence staining and/or Western blotting. RESULTS: The extraversion of Evans blue, IgG, and albumin increased surrounding ischemic core after MCAO, but significantly decreased after recanalization. The expression of Claudin-5, Occludin, and zona occludens 1 (ZO-1) decreased surrounding ischemic core after MCAO, but significantly increased after recanalization. Infarct volume reduced and neurological outcomes improved following recanalization (on the 7th day after MCAO). The expressions of Claudin-5, Occludin, and ZO-1 decreased surrounding ischemic core following MCAO, which were up-regulated corresponding to the increases of FGF21, p-FGFR1, PI3K, and p-Akt after recanalization. Intra-cerebroventricular injection of FGFR1 inhibitor SU5402 down-regulated the expression of PI3K, p-Akt, Occludin, Claudin-5, and ZO-1 in the penumbra, which weakened the beneficial effects of recanalization on neurological outcomes after MCAO. CONCLUSIONS Delayed recanalization on the 3rd day after MCAO increases endogenous FGF21 in the penumbra and activates FGFR1/PI3K/Akt pathway, which attenuates BBB disruption in the penumbra and improves neurobehavior in MCAO rats.
Animals ; Rats ; Blood-Brain Barrier/metabolism* ; Brain Ischemia ; Claudin-5/metabolism* ; Infarction, Middle Cerebral Artery/metabolism* ; Ischemic Stroke/metabolism* ; Occludin/metabolism* ; Phosphatidylinositol 3-Kinases/metabolism* ; Proto-Oncogene Proteins c-akt/metabolism* ; Rats, Sprague-Dawley ; Receptor, Fibroblast Growth Factor, Type 1/metabolism* ; Reperfusion Injury/metabolism*