To investigate peripheral blood mononuclear cells (PBMCs) infected by hepatitis C virus (HCV) and the influenceon T lymphocyte subset. Methods: Using non-isotopic in situ hybridization (NISH) and streptadivin-biotin-enzyme complex assay (SABC) todetect HCV-RNA, NS5 antigen and T lymphocyte subset. Results: 8(40.0% ) out of 20 patients with hepatitis C virus were HCV-RNA posi-tive in PBMCs, and among them 6(30.0％) were NS5 antigen positive simultaneously. NS5 antigen signals appeared diffusely within cyto-plasm, or in cell membrane, while HCV-RNA signals were mainly distributed in cytoplasm. Both the proportion of NS5 positive cell and HCV-RNA positive cells were very low (≤3％).The proportion of positive cellsane, while HCV-RNA signals are very low (≤3％). The proportionof CD4+ T cells was lower in the patients comparing with that in control group, the proportion of CD8+ T cells was higher, and the ratio ofCD4+/CD8+ were decreased remarkably (P＜0.01). Moreover the proportion of CD4+ T cells was lower in HCV-RNA-positive group com-paring with that in HCV-RNA-negative group, the proportion of CD8+ T cells was higher, and the ratio of CD4+/CD8+ was reversed (P＜0.01). Conclusion:HCV can infect PBMCs and replicate in patients with chronic hepatitis C;CD4+ T cells are readily damaged after PBMCsinfected by HCV, which causes the decrease or reversal of the ratio of CD4+/CD8+, undermines the ability of the body clearing virus and re-sults im chronicity of HCV infection.

Objective To study the protection effect of dexmedetomidine and ulinastatin on acute lung in-jury caused by hepatic ischemia reperfusion. Methods 50 rats were randomly divided into 5 groups: the blank group, saline group, the dexmedetomidine group, the ulinastatin group, the dexmedetomidine and ulinastatin group. Ischemia-reperfusion models were established and drugs were administrated through femoral vein. The levels of MDA, SOD and ICAM were detected. Results Compared with the blank group, the rest of the groups of PaO2, pH and SOD activity were significantly lower (P < 0.05), and BE, pathological grading, MDA, ICAM levels were significantly higher (P<0.05). PaO2, pH and SOD activity of ulinastatin group were significantly lower in the phys-iological saline group (P < 0.05), BE, pathological grading, MDA level, ICAM levels were significantly elevated in the physiological saline group (P<0.05). Conclusion Combination of dexmedetomidine and ulinastatin have protection effect on acute lung injury caused by hepatic ischemia reperfusion, its mechanism may be related to in-hibit neutrophil aggregation, improve their antioxidant capacity and inhibition of lipid peroxidation.

Objective To investigate the clinical effect of mini -plate and kuntscher pin fixation in the treatment of metacarpus and phalange fracture.Methods 113 FMB and FPB patients were divided into OSG (58 patients)and CTG(585patients)group according to random number table.Statistics of postoperative recovery and complications in the two groups were collected and analyzed after research.Results In 58 patients of OSG group,the total active bending from 2 -5 metacarpophalangeal joints to phalangeal joints of 28 cases(48.28%,χ2 =8.562,P =0.035 )were beyond 220°,19 cases (32.76%,χ2 =8.935,P =0.024)were between 180 -220°, 11 cases (51.72%,χ2 =9.365,P =0.012)were less than 180°.The total active bending fromthumb metacarpopha-langeal articulation to interphalangeal joint of 30 cases (51.72%,χ2 =9.365,P =0.012)were beyond 220°, 18 cases (31.03%,χ2 =8.747,P =0.009)were between 180 -220°,10 cases (17.24%,χ2 =8.932,P =0.041) were less than 180°(P <0.05).Conclusion AO Mini -plates surgical method has advantage of parking position accuracy,dissection stable fixation,functional recovery soon and less complication in the treatment of FMB and FPB patients,which is worthy of promotion.

Objective: To evaluate the feasibility and effect of transcatheter closure of ventricular septal defects(VSD) using the VSD occluder.Methods: From December 2003 to March 2005,13 VSD patients,8 males and 5 females,ranging in age from 4 to 35(15.2?10.7)years,underwent catheter closure using the VSD occluder.Tthe mean diameter of the VSD obtained by transthoracic echocardiography was 4-12(5.4?1.2) mm.Transcatheter closure was performed under transthoracic echocardiographic guidance after left ventriculography.All patients were followed up 1,3 and 6 months after the procedures. Results: The devices were successfully placed in 12 of the patients and complete closure achieved in 11.Trace residual shunt was observed in 1 patient but disappeared within 10 minutes.No severe complications were noted except 1 case of complete right bundle branch block revealed by electrocardiography. Conclusion: Transcatheter closure of VSD by the VSD occluder is a safe and effective procedure,with good immediate results.Further clinical trials are under way to assess its long-term effect.

The expression of TNF-α in the liver at different periods post Schistosoma japonica infection and the effect on liver fibrosis after supplementary injection of these eytokines were investigated. The mice infected with schistosome cercariae were divided into 3 groups: normal control group, TNF-α-untreated infection group and TNF-α-treated infection group. ABC immunohistochemistry and pathologic image multimedia quantification system were applied to dynamically detect the activity of TNF-α. The results showed that the levels of TNF-α in the liver in TNF-α-untreated infection group were slowly decreased with prolongation of infection time (from 8th, 11th, 14th to 18th week), while in the TNF-α-treated infection group, those were increased significantly after intraperitoneal injection of TNF-α at 6th week after infection. At first to 8th week after the final injection of TNF-α, the intrahepatic TNF-α levels in the TNF-α-treated infection group were significantly higher than in the other two groups (P＜0.01), and the granulomatous inflammation and fibrosis in the liver were also milder in the normal control group. It was concluded that at the early stage of Schistosoma japonica infection mouse liver mainly released Th1 cytokine and TNF-α from Th1 activated macrophages. Six weeks after infection (post egg deposition), exogenous supplement with intraperitoneal injection of TNF-α could induce the enhanced expression of Th1 cytokines and alleviate the liver granulomatous inflammation and fibrosis.

Objective:To compare the outcomes of watch&wait (W&W) strategy in patients with locally advanced rectal cancer who achieved complete clinical response (cCR) after neoadjuvant therapy, with those who obtained pathological complete response (pCR) after total mesorectal excision (TME).Methods:This is a retrospective cohort analysis study. Patients histologically proven with locally advanced rectal adenocarcinoma (stage Ⅱ-Ⅲ) who had received neoadjuvant chemotherapy were eligible between January 2014 and December 2019. In whom we included patients who had cCR offered management with W&W strategy after completing neoadjuvant therapy and follow-up ≥1 year (W&W group), and patients who did not have cCR but pCR after TME (pCR group). The primary endpoints were 3-year and 5-year overall survival (OS), colostomy-free survival (CFS), disease-free survival (DFS), non-local regrowth disease-free survival (NR-DFS), and organ preservation rate. Kaplan-Meier analysis was used for survival analysis and log-rank test was performed. For comparative analysis, we also derived one-to-one paired cohorts of W&W versus pCR using propensity-score matching (PSM).Results:A total of 118 patients were enrolled, 49 of whom had cCR and managed by W&W, 69 had pCR, with a median follow-up period of 49.5 months (12.1-79.9 months). No difference was observed in the 3-year OS (97.1% vs. 96.7%) and 5-year OS (93.8% vs. 90.9%, P=0.696) between the W&W and pCR groups. Patients managed by W&W had significantly better 3-year and 5-year CFS (89.1% vs. 43.5%, P<0.001), better 3-year DFS (83.6% vs. 97.0%) and 5-year DFS (83.6% vs. 91.2%, P=0.047) compared with those achieving pCR. The 3-year NR-DFS (95.9% vs. 97.0%) and 5-year NR-DFS (92.8% vs. 97.0%, P=0.407) did not significantly differ between the W&W and pCR groups. Local regeneration occurred in six cases, and 87.7% of patients had successful rectum preservation in the W&W group. In the PSM analysis (34 patients in each group), absolutely better CFS (90.1% vs. 26.5%, P<0.001) was noted in the W&W group. A median interval of 17.5 weeks was observed for achieving cCR, while only 23.9% of patients achieved cCR within 5 to 12 weeks from radiation completion. Patients with short-course sequential chemoradiotherapy achieved cCR significantly later when compared with those with long-course concurrent chemoradiotherapy (19.0 vs. 9.8 weeks, P<0.001). Conclusions:The oncological outcomes of W&W strategy in patients with locally advanced rectal cancer are safe and effective, significantly improving the quality of life. Longer interval for cCR evaluation may improve rectal organ preservation rate.

Objective:To explore the motion and influencing factors of implanted gold markers in guiding liver stereotactic body radiation therapy (SBRT) using abdominal compression.Methods:Twenty patients with oligometastatic colorectal cancer or primary hepatocellular carcinoma from January 2016 to December 2019 were included. All patients were treated with SBRT under abdominal compression, with 1-3 gold markers were implanted within 2 cm from the lesion before positioning. Four-dimensional computed tomography (4DCT) scan was used for treatment planning. The respiratory cycle was divided into 0-90% respiratory phase images based on the respiratory signal, which were reconstructed by the system (Pinnacle 3 version 9.1; Philips Medical System, Madison, WI, USA), and cone beam CT validation images before radiation exposure were obtained. The liver volume was divided into 3 parts: within 2 cm from the main hepatic portal vein, 2-5 cm from the main hepatic portal vein, and>5 cm from the main hepatic portal vein. The motion of different tumor locations was evaluated. Results:The average intrafractional motion amplitude was (2.63±2.81) mm in the cranial-caudal (CC) direction, (1.35±1.23) mm in the anterior-posterior (AP) direction, and (0.76±0.88) mm in the left-right (LR) direction, respectively. The average interfractional motion amplitude was (3.45±3.06) mm, (2.64±2.60) mm, and (2.23±2.07) mm, respectively. Both the intra-or inter-fractional motion amplitudes in the CC direction were the highest, followed by those in the AP and LR direction (all P<0.001). The motion varied at different tumor locations. The longer distance from the main hepatic portal vein, the larger the intrafractional motion (all P<0.05). To cover the 95% population-based confidence interval, the internal target volume (ITV) was suggested to include the expansion of 3.9 mm, 5.2 mm and 7.9 mm in the LR, AP and CC direction. The expansion of 4.3 mm, 4.4 mm and 6.1 mm was delivered within 2 cm from the main hepatic portal vein, and 3.5 mm, 7.3 mm and 9.7 mm>5 cm from the main hepatic portal vein, respectively. The expansion varied significantly depending on the tumor location, whereas the motion in the CC direction was the largest regardless of the tumor location. The longer distance of the tumor from the main portal vein, the larger expansion in the CC direction. The expansion of tumor > 5 cm from the main portal vein in the AP direction was larger than that of inner parts. Conclusion:Liver tumors at different locations require individual external expansion of ITV.

Objectives:To assess the prognostic impact of the neoadjuvant rectal (NAR) score following neoadjuvant short-course radiotherapy and consolidation chemotherapy in locally advanced rectal cancer (LARC), as well as its value in guiding decisions for adjuvant chemotherapy.Methods:Between August 2015 and August 2018, patients were eligible from the STELLAR phase III trial (NCT02533271) who received short-course radiotherapy plus consolidation chemotherapy and for whom the NAR score could be calculated. Based on the NAR score, patients were categorized into low (＜8), intermediate (8-16), and high (＞16) groups. The Kaplan-Meier method, log rank tests, and multivariate Cox proportional hazard regression models were used to evaluate the impact of the NAR score on disease-free survival (DFS).Results:Out of the 232 patients, 24.1%, 48.7%, and 27.2% had low (56 cases), intermediate (113 cases), and high NAR scores (63 cases), respectively. The median follow-up period was 37 months, with 3-year DFS rates of 87.3%, 68.3%, and 53.4% ( P＜0.001) for the low, intermediate, and high NAR score groups. Multivariate analysis demonstrated that the NAR score (intermediate NAR score: HR, 3.10, 95% CI, 1.30-7.37, P=0.011; high NAR scores: HR=5.44, 95% CI, 2.26-13.09, P＜0.001), resection status ( HR, 3.00, 95% CI, 1.64-5.52, P＜0.001), and adjuvant chemotherapy ( HR, 3.25, 95% CI, 2.01-5.27, P＜0.001) were independent prognostic factors for DFS. In patients with R0 resection, the 3-year DFS rates were 97.8% and 78.0% for those with low and intermediate NAR scores who received adjuvant chemotherapy, significantly higher than the 43.2% and 50.6% for those who did not ( P＜0.001, P=0.002). There was no significant difference in the 3-year DFS rate (54.2% vs 53.3%, P=0.214) among high NAR score patients, regardless of adjuvant chemotherapy. Conclusions:The NAR score is a robust prognostic indicator in LARC following neoadjuvant short-course radiotherapy and consolidation chemotherapy, with potential implications for subsequent decisions regarding adjuvant chemotherapy. These findings warrant further validation in studies with larger sample sizes.

Objectives:To assess the prognostic impact of the neoadjuvant rectal (NAR) score following neoadjuvant short-course radiotherapy and consolidation chemotherapy in locally advanced rectal cancer (LARC), as well as its value in guiding decisions for adjuvant chemotherapy.Methods:Between August 2015 and August 2018, patients were eligible from the STELLAR phase III trial (NCT02533271) who received short-course radiotherapy plus consolidation chemotherapy and for whom the NAR score could be calculated. Based on the NAR score, patients were categorized into low (＜8), intermediate (8-16), and high (＞16) groups. The Kaplan-Meier method, log rank tests, and multivariate Cox proportional hazard regression models were used to evaluate the impact of the NAR score on disease-free survival (DFS).Results:Out of the 232 patients, 24.1%, 48.7%, and 27.2% had low (56 cases), intermediate (113 cases), and high NAR scores (63 cases), respectively. The median follow-up period was 37 months, with 3-year DFS rates of 87.3%, 68.3%, and 53.4% ( P＜0.001) for the low, intermediate, and high NAR score groups. Multivariate analysis demonstrated that the NAR score (intermediate NAR score: HR, 3.10, 95% CI, 1.30-7.37, P=0.011; high NAR scores: HR=5.44, 95% CI, 2.26-13.09, P＜0.001), resection status ( HR, 3.00, 95% CI, 1.64-5.52, P＜0.001), and adjuvant chemotherapy ( HR, 3.25, 95% CI, 2.01-5.27, P＜0.001) were independent prognostic factors for DFS. In patients with R0 resection, the 3-year DFS rates were 97.8% and 78.0% for those with low and intermediate NAR scores who received adjuvant chemotherapy, significantly higher than the 43.2% and 50.6% for those who did not ( P＜0.001, P=0.002). There was no significant difference in the 3-year DFS rate (54.2% vs 53.3%, P=0.214) among high NAR score patients, regardless of adjuvant chemotherapy. Conclusions:The NAR score is a robust prognostic indicator in LARC following neoadjuvant short-course radiotherapy and consolidation chemotherapy, with potential implications for subsequent decisions regarding adjuvant chemotherapy. These findings warrant further validation in studies with larger sample sizes.