Objective To explore the effect of melatonin on mitochondria in streptozotocin (STZ)-induced diabetic rats and its potential mechanism. Methods The diabetic rat models were induced by intraperitoneal injection of STZ, and the diabetic rats were randomly divided into two groups: diabetes mellitus group (DM group) and melatonin-treated group (DM± MT group). The normal non-diabetic rats were served as control group. Mitochondrial membrane potential and mitochondrial swelling were measured, the expression of voltage-dependent anion channel (VDAC)was assayed by immunohistochemistry in the heart, liver and kidney among the different groups after 8 weeks. Results (1)Compared with DM group, mitochondrial membrane potential in the heart,liver and kidney were significantly elevated in DM± MT group (553.6± 193.5 vs. 311.4 ± 133.7;745.7±115.8 vs. 358.9±158.7; 951.6±246.1 vs. 425.8±177.9, all P＜0.05). (2)Compared with DM group, mitochondrial swelling in the heart, liver and kidney was reinforced in DM ± MT group. (3)Compared with DM group, the expressions of VDAC in the heart, liver and kidney were significantly up-regulated in DM± MT group (76.93 ± 8.263 vs. 58.59 ± 7.62, 50.69 ± 6.33 vs.40.11±6.30, 77.86±8.59 vs. 61.44± 12.86, all P＜0.05). Conclusions Melatonin has protective effect on the activity of mitochondria in the heart, liver and kidney in diabetic rats possibly by up-regulating the expression of VDAC.

Objective To evaluate the image quality and radiation dose of prospective electrocardiography-triggered coronary 320-slice volume CT angiography with different kV, and the feasibility of coronary scan with ＜ 1 mSv radiation dose.Methods Eighty consecutive patients were randomly divided into two groups equally.The tube voltage according to paradigm was 100 kV in group A and 120 kV in group B.All raw data in group A was reconstructed by the software AIDR in CT system to create a new group named as A1. Such parameters as the mean intraluminal attenuation (SI),noise (SD),signal-to-noise ratio (SNR),contrast-to-noise ratio (CNR),effective radiation dose(E) and image quality score measured in group A were compared with those in group B.The values such as SI,SD,SNR,CNR,image quality scores were compared between group A and group A1.The significance of group B and group A1 was compared in SI,SD,SNR,CNR,image quality scores as well.Results E in group A was significantly lower than that in group B[ E =(0.67 ± 0.18) mSv in group A vs.E =(3.08 ± 1.04) mSv in group B].The value of E in group A was decreased by 78％ compared to group B(t =- 14.30,P＜0.05 ).There was no significant difference in mean image quality scores between two groups(4.57 ± 0.57in groupA vs.4.59 ± 0.59 in group B,t=-1.17,P＞0.05).The values of SI,SD,SNR,CNR in group A were (570.8 ±131.5)HU,25.1 ±6.9,24.5 ±9.1,19.8 ±6.1.And the values of SI,SD,SNR,CNR in group B were (460.6 ± 14.3) HU,15.1 ±3.6,31.7 ±7.7,29.3 ±6.8.The values of SI and SD in group A were significantly higher than those in group B(t =4.49,8.18,P ＜0.05). The values of SNR and CNR in group A were lower than those in group B (t =-4.24,-6.19,P＜0.05).The valuesofS1,SD,SNR,CNR,image quality scores in group Al were (557.9 ±24.5) HU,21.1 ±6.0,27.7±10.0,23.4±7.8,4.60 ± 0.56.There was no difference in the SI and the image quality scores between group A and group A1 ( t =1.09,- 1.90,P ＞ 0.05).Conclusions 320-slice volume CT with 100 kV tube voltage and prospective ECG-triggered technique can reduce the radiation dose to less than 1 mSv and obtain optimal images in diagnosis of coronary arterial diseases.

Objective To compare volar plating and nonoperative treatment for senile comminuted fractures of the distal radius. Methods From October 2012 to June 2015, 46 senile comminuted fractures of the distal radius ( AO types B and C ) were treated surgically or conservatively. Twenty old patients were managed by open reduction and fixation with a volar locked plate. They were 7 men and 13 women, with an average age of 67. 9 ± 10. 7 years, including 7 cases of AO type 23-B and 13 cases of AO type 23-C. Twenty-six patients were managed with closed reduction and plaster cast. They were 8 men and 18 women, with an average age of 66. 2 ± 11. 5 years, including 10 cases of AO type 23-B and 16 cases of AO type 23-C. The 2 groups were compared in terms of follow-up time, union time and wrist functional scores and complica-tions. Results There was no significant difference between the 2 groups in follow-up time ( P > 0. 05 ) . Fractures in the 2 groups all united about 11 weeks after surgery. According to Dienst scoring for reduction, the volar plating group had 13 excellent cases, 4 good ones, 2 fair ones and one poor case, with an excellent to good rate of 85. 0％ while the nonoperative group had 5 excellent cases, 10 good ones, 5 fair ones and 6 poor ones, with an excellent to good rate of 57. 7％. A significant difference was shown between the 2 groups ( P <0. 05 ) . At final follow-ups, the volar plating group had significantly lower Gartland & Werley wrist functional score ( 2. 16 ± 1. 82 ) and complication rate ( 30. 0％, 6/20 ) than the nonoperative group [ 6. 62 ± 3. 78 and 53. 8％( 14/26 ) , respectively ] ( P <0. 05 ) . Conclusion In treatment of senile comminuted fractures of the distal radius, volar locked plating may lead to better functional recovery and fewer complications than nonoper-ative management. However, one should take full account of the physical condition and preference of the patient when surgery is chosen.

Objective To evaluate the diagnostic value of MSCT in the differentiation of thymic epithelial tumours (TET)with the maximum diameter equal or less than 3 cm.Methods A retrospective analysis of pathological and imaging data of 56 patients with pathologically confirmed TET with the maximum diameter equal or less than 3 cm was performed.According to the 2004 WHO classification,56 TETs were classified as low-risk thymomas(types A/AB/B1),high-risk thymomas (types B2/B3)and thymic carcinomas (type C).The CT manifestations of TET in each group,including shape of tumor,tumor edge (smooth or spiculate protuberance), presence of small nodule around tumor,enhancement degree,pleura invasion and fat space around tumor,were analyzed retrospectively.The differences in the CT manifestations among three types were compared using chi-square test.If the sample number was too small, Fisher 's exact test was used.Results Compared with high-risk thymomas (23 cases)and thymic carcinomas (6 cases),regular round shape was more often observed in low-risk thymomas (27 cases)(χ2 =73,P <0.001;χ2 =116,P <0.001)and the mediastinum-lung interface was more likely to bulge (χ2 = 3.41,P =0.046;χ2 =7.39,P =0.01).Blurred edge,spiculate protuberance and pleural invasion and so on were significantly more common in high-risk thymomas and thymic carcinomas (P <0.001)and they were the most common in thymic carcinomas (χ2 =11.5,P =0.009).There was a significant difference between type B2 thymomas and thymic carcinomas (χ2 =31.52, P <0.001),however there was no significant difference between type B3 thymomas and thymic carcinomas (χ2 =6.96,P =0.07). Conclusion MSCT can accurately show the shape of tumor,tumor edge,presence of small nodule around tumor,enhancement degree,pleura invasion,which can predict the histologic type of thymomas and also can provide information for preoperative diagnosis and prognosis evaluation.

Objective: This study aimed to investigate the relationship between the genetic variation of CD55 promoter and the risk of esophageal cancer. Methods: A total of 700 esophageal cancer patients recruited between April 2008 and December 2012 at Tangshan Grongren Hospital and Tangshan Renmin Hospital, and 700 frequency matched controls were randomly selected from a pool of cancer free subjects recruited from a nutritional survey. Genotypes of CD55 rs2564978 polymorphism among all subjects were conducted by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The OR and 95%CI were calculated by non-conditional Logistic regression to evaluate the association of CD55 rs2564978T/C polymorphism with the risk of esophageal cancer. Results: The average age of cases and control was (60.04±9.19) and (59.21±9.98) years old. Compared with CD55 rs2564978 TT carriers, the individuals with CC genotype had a significantly higher risk of esophageal cancer (OR=1.94, 95%CI:1.42-2.66) . When stratified by sex, this genetic variation affected the risk of esophageal cancer among both males (OR=1.92, 95%CI:1.37-2.70) and females (OR=2.34, 95%CI:1.04-5.27). When stratified by age, the CD55 rs2564978 CC was associated with the susceptibility of developing esophageal cancer among younger individuals (OR=1.79, 95%CI:1.19-2.68) and older people (OR=2.32, 95%CI:1.41-3.83).When stratified by drinking status, CC genotype carriers increase the risk of esophageal cancer when drinking (OR=1.93, 95%CI:1.03-3.63) or not drinking (OR=1.95, 95%CI:1.36-2.80). When stratified by smoking status, CC genotype was associated with the risk of esophageal cancer among non-smokers (OR=1.79, 95%CI: 1.13-2.83), light smokers (less than 30 packs/year, OR=1.86, 95%CI:1.31-2.64) and heavy smokers (more than 30 packs/year, OR=2.67, 95%CI:1.28-5.57). Gene-environmental interaction analysis showed that CD55 rs2564978T/C polymorphism interacted with smoking status to increase the risk of esophageal cancer. Conclusion CD55 rs2564978 polymorphism effects on the risk of esophageal cancer.

Objective To evaluate the correction rate,accuracy of pedicle screw fixation and overall clinical efficacy of intravertebral osteotomy and internal fixation surgery with the assistance of 3D printing guide plates in treatment of severe kyphosis.Methods A single-center nonrandomized clinical pilot study was conducted on 19 patients(8 males and 11 females)with severe kyphosis undergoing intravertebral osteotomy between December 2018 and June 2023.Seven of them(CAD group)had preoperative planning with computer-aided design(CAD)and intraoperative guidance of individualized 3D printing guide plates.And another 12 patients(control group)were corrected with conventional pedicle screw placement.Postoperative evaluation included assessment of posterior Cobb angle,spinal angular correction rate,accuracy of pedicle screw placement and Oswestry Dysfunction Index(ODI)questionnaire.Results The 19 patients were at a mean age of 48.0 years,and followed up for 26.4(9～54)months.All of them achieved relatively satisfactory corrective results,with those of the CAD group having a correction rate of 96.83％and those of the control group of 86.61％.There were no statistical differences in average intraoperative blood loss(857 vs 1 045 mL)and average operative time(344 vs 402 min),but significant difference was observed in average length of hospital stay(11 vs 18 d,P＜0.05)between the 2 groups.A total of 278 nails were placed in this study,including 70 guide-assisted pedicle screws,97.1％of which were grade A or B.In the control group,208 pedicle screws were placed,93.8％of which were grade A or B.Postoperative CT/X-ray scanning displayed that both groups achieved certain correction for kyphosis.No obvious difference was found in the average spinal angular correction(43.37° vs 36.10°),and significantly higher correction rate was seen in the CAD group than the control group(96.83％vs 86.61％,P＜0.01).The ODI value was notably lower in the CAD group than the control group(P＜0.05).Conclusion CAD-assisted preoperative planning,surgical simulation and individualized 3D printing guide plates can promote surgical correction and accuracy of pedicle screw placement and improves the quality of life of patients with severe kyphotic deformity.

Objective To investigate the natural changes of high-risk HPV (HR-HPV) in women with negative for intraepithelial lesion or malignancy (NILM) for regulating HR-HPV screening.Methods Four hundred and thirty-three newly-diagnosed women were enrolled from January 1st,2015 to December 31,2015 in Beijing Obstetrics and Gynecology Hospital.The ages of these patients were between 22 and 74 years,the average age was (45±21) years old.Two hundred and sixty-three cases were less than 50 years old,170 cases were more and equal to 50 years old.One hundred and fifty-six cases were HR-HPV positive,277 cases were HR-HPV negative.Follow up tests were conducted for all 433 patients,who were screened by ThinPrep cytologic test (TCT) combined with HR-HPV and were diagnosed with NILM,for a period of 1 year (at the 3,6,9 and 12 months intervals respectively),if the TCT results are abnormal and the HR-HPV test results are positive,will follow up colposcopy directed cervical biopsy.Results (1) HR-HPV natural changes:of 156 NILM cases with HR-HPV infection,42 cases (26.9％,42/156) turned negative within 3 months,88 cases (56.4％,88/156) turned negative within 6 months,99 cases (63.5％,99/156) turned negative within 9 months,and 100 cases (64.1％,100/156) turned negative within 12 months.The negative conversion ratio at 3,6,9 and 12 months for women at childbearing age (＜50 years) were significantly higher than those at non-childbearing age (≥50 years old;all P＜0.05).Of 277 NILM cases without HR-HPV infection,35 cases (12.6％,35/277) had new HR-HPV positive infections within 3 months,70 cases (25.3％,70/277) had new infections within 6 months,80 cases (28.9％,80/277) had new infections within 9 months,and 83 cases (30.0％,83/277) had new infections within 12 months.The new infections rate at 3,6,9 and 12 months for women at childbearing age (＜50 years old) were slightly higher than those at non-childbearing age (≥50 years old;all P＞0.05).(2) The progress of cervical leision:of 156 NILM cases with HR-HPV positive,no case progressed during 12 months follow-up.Of 277 NILM cases with HR-HPV negative,4 cases progressed to cervical intraepithelial neoplaisa (CIN) with HR-HPV infection and TCT abnormal during 12 months follow-up,including 2 cases pathology diagnosed with CIN Ⅰ,1 case with CIN Ⅱ,and 1 case with CIN Ⅲ.The progression rate was 1.4％ (4/277),which accounts for 4.8％ (4/83) of new HR-HPV infections cases in women.Conclusions The results of cytology combined with HR-HPV screenings suggest every 6 months for simple HR-HPV positive women,colposcopy directed cervical biopsy is recommended to assess cervical lesions if necessary.Cytology combined with HR-HPV screenings suggest every 12 months for simple HR-HPV negative women to early detection of cervical leision.

Volume dynamics is a two-compartment dynamical model using hemoglobin (Hb) derived plasma diluted level as input data and urine output as input variable through consecutive repeated measurements of Hb concentration in the blood during infusion. It could be applied to evaluate and guide crystalloid fluid rehydration for patients with dehydration or hypovolemia and during anesthesia or surgery. Volume dynamics could be also used to quantificate of strains, hypovolume, and the change of fluid distribution and elimination caused by anesthesia or surgery. The factors which influence the volume resuscitation are complex, including gender, age, hemodynamic state [mean arterial pressure (MAP)], health and stress state, renal function, consciousness, surgical or anesthesia state and so on, which may affect the half-life, distribution, and volume of the fluid. This article summarizes and analyzes the pathophysiological changes of crystalloids fluid in vivo, in order to provide reference for volume management in critically ill patients.

Objective:To compare and analyze the predictive value of different inflammatory factors and tumor markers in intrahepatic cholangiocarcinoma and to develop a new and effective preoperative prognostic scoring system.Methods:102 and 72 cases with intrahepatic cholangiocarcinoma who underwent radical surgery in Tianjin Medical University Cancer Institute and Hospital and the Affiliated Hospital of Weifang Medical University were selected as the experimental group and the validation group, respectively. Clinicopathological and follow-up data were collected. Cox proportional-hazards model was used to analyze the predictive value of different prognostic markers. The relationship between prognostic markers and clinicopathological data was analyzed by rank sum test, χ2 or Fisher's exact test. Results:Among the direct inflammatory factors, tumor markers and combined inflammatory factors, prognostic inflammatory index (PII), carbohydrate antigen (CA) 19-9 and systemic inflammation score (SIS) were the most significant predictive factors for postoperative survival outcomes in patients with intrahepatic cholangiocarcinoma. The prognostic inflammatory and tumor score (PITS) was proposed as a new prognostic scoring system for intrahepatic cholangiocarcinoma. PII and CA19-9 were included into the scoring criteria for prognostic stratification of patients. PITS was an independent predictor of tumor-free survival and overall survival in patients with intrahepatic cholangiocarcinoma. Patients with high-grade PITS had later tumor grade and higher frequency of vascular invasion.Conclusion:PITS is highly effective prognostic scoring system for patients with intrahepatic cholangiocarcinoma. In addition, PITS is recommended for preoperative prognostic stratification in patients with intrahepatic cholangiocarcinoma.

Objective To analyze the clinical efficacy of microwave ablation in the colorectal cancer with simultaneously multiple liver metastases that was initially evaluated as potentially resectable.Methods The patients with potentially resectable colorectal cancer with simultaneous multiple liver metastases treated in the De-partment of General Surgery of the First Affiliated Hospital of Hebei North University,the Center of Minimally Invasive Therapy in Oncology of Traditional Chinese and Western Medicine in Dongzhimen Hospital of Beijing U-niversity of Chinese Medicine,and the Second Department of General Surgery in the Fourth Hospital of Hebei Medical University from October 1,2018 to October 1,2020 were selected in this study.The general data,pathological features,treatment methods,and clinical efficacy of the patients were collected.According to the treatment methods,the patients were assigned into a surgical resection group(conversion therapy + laparoscopic primary resection +hepatectomy)and a microwave ablation group(conversion therapy +laparoscopic primary re-section +microwave ablation).The surgical indicators(operation duration,time to first postoperative anal ex-haust,hospital stay,etc.)and postoperative complications(anastomotic stenosis,anastomotic hemorrhage,incision infection,etc.)were compared between the two groups.The survival period was followed up,including the overall survival period and disease-free survival period,and the survival curves were drawn to analyze the clinical efficacy of the two treatment regimens.Results A total of 198 patients with potentially resectable color-ectal cancer with simultaneous multiple liver metastases were included in this study.Sixty-six patients were cured by neoadjuvant chemotherapy(FOLFOX or FOLFIRI),including 30 patients in the surgical resection group and 36 patients in the microwave ablation group(with 57 tumors ablated).After the first ablation,54(94.74%)tumors achieved complete ablation,and all of them reached no evidence of disease status after re-ablation.The microwave ablation group had shorter operation duration,less intraoperative blood loss,shorter time to first post-operative anal exhaust,shorter time of taking a liquid diet,shorter hospital stay,and lower hospitalization cost than the surgical resection group(all P<0.001).In addition,the microwave ablation group had lower visual analogue scale score(P<0.001)than the surgical resection group.The incidences of complications such as inci-sion infection(P =0.740),anastomotic fistula(P =1.000),and anastomotic stenosis(P =1.000),the over-all survival period(P =0.191),and the disease-free survival period(P =0.934)showed no significant differ-ences between the two groups.Conclusions For patients with colorectal cancer with simultaneous multiple liver metastases initially assessed as potentially resectable,laparoscopic primary resection +surgical resection/microwave ablation after conversion therapy was safe,effective,and had similar survival outcomes.Microwave ablation outper-formed surgical resection in postoperative recovery,economy,and tolerability,being worthy of clinical promotion.