Background:The purpose of this study was to analyze cases of AO31-A2 intertrochanteric fractures (ITFs) and to identify the relationship between the loss of the posteromedial support and implant failure.Methods:Three hundred ninety-four patients who underwent operative treatment for ITF from January 2003 to December 2017 were enrolled.Focusing on posteromedial support,the A2 ITFs were divided into two groups,namely,those with (Group A,n =153) or without (Group B,n =241) posteromedial support post-operatively,and the failure rates were compared.Based on the final outcomes (failed or not),we allocated all of the patients into two groups:failed (Group C,n =66) and normal (Group D,n =328).We separately analyzed each dataset to identify the factors that exhibited statistically significant differences between the groups,In addition,a logistic regression was conducted to identify whether the loss of posteromedial support of A2 ITFs was an independent risk factor for fixation failure.The basic factors were age,sex,American Society of Anesthesiologists (ASA) score,side of affected limb,fixation method (intramedullary or extramedullary),time from injury to operation,blood loss,operative time and length of stay.Results:The failure rate of group B (58,24.07％) was significantly higher than that of group A (8,5.23％) (x2 =23.814,P ＜ 0.001).Regarding Groups C and D,the comparisons of the fixation method (P =0.005),operative time (P =0.001),blood loss (P =0.002)and length of stay (P =0.033) showed that the differences were significant.The logistic regression revealed that the loss of posteromedial support was an independent risk factor for implant failure (OR =5.986,95％ CI:2.667-13.432) (P ＜ 0.001).Conclusions:For AO31-A2 ITFs,the loss of posteromedial support was an independent risk factor for fixation failure.Therefore,posteromedial wall reconstruction might be necessary for the effective treatment of A2 fractures that lose posteromedial support.

Objective To evaluate the feasibility and effectiveness of the application of IQQA (Intelligent/interactive Qualitative and Quantitative Analysis) three-dimensional reconstruction technique in precise laparoscopic or robot-assisted laparoscopic partial nephrectomy (LPN or RAPN) for renal hilar tumors.Methods The study retrospectively reviewed 11patients with hilar tunors from February 2016 to February 2017.Of the 11 patients,4 were women and 7 were men,with an average age of 51 years (range 38 to 70 years).The average tumor size was 3.1 cm (range 1.7 to 4.3 cm).For tumor stage,9 patients were in T1a stage and 2 patients were in T1b stage.Tbe average R.E.N.A.L score was 8.7 (range 7 to 10).The mean preoperative GFR was 40.6 ml/min (range 32 to 45 ml/min).IQQA three-dimensional reconstruction technique was applied for the purpose of precise navigation and resection of the tumors.Multivariate analysis was used to identify predictors of warm ischemia time,estimated blood loss,major perioperative complications,and postoperative renal function.Results All 11 laparoscopic or robot-assisted laparoscopic hilar partial nephrectomies were successfully completed without conversion to a hand-assisted or an open approach.Under the navigation of IQQA,all tumors were found precisely at the first time during surgeries.The final pathologic examination revealed that all the 11 patients were clear cell renal cell carcinomas.The mean operative time was 142 minutes (range 90 to 230 minutes),with a mean warm ischemia time of 24 minutes (range 17 to 33 minutes).The estinated blood loss was 146 ml (range 50 to 400 ml).No intraoperative complications occurred.Two patients suffered from postoperative complications.One patient with gross hematuria was recovered by consistent bladder irrigation.The other patient with postoperative hemorrhage needed transfusion.All patients had negative margins on the final pathologic examination.At a mean follow-up period of 3 months,the mean GRR is 22.5 ml/min (range 13 to 34 ml/min) without any disease recurrence.Conclusions With peculiar features,such as accurate location,complete resection and fewer perioperative complications,the application of IQQA three-dimensional reconstruction technique in precise partial nephrectomy represents a safe and effective procedure for hilar tumors.

Female ; Heart Atria ; diagnostic imaging ; surgery ; Heart Neoplasms ; diagnostic imaging ; surgery ; Humans ; Leiomyomatosis ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Middle Aged ; Ultrasonography

OBJECTIVETo explore the relationship between DNA mismatch repair (MMR) and clinicopathologic features and prognosis in patients with stages II and III colon cancers.

METHODSThe clinical and pathological data of 440 patients with stage II/III colon cancer after radical resection were retrospectively reviewed and analyzed. Immunohistochemical staining was used to assess the expression of MMR proteins (MLH1, MSH2, MSH6 and PMS2), and the correlation between DNA MMR and clinicopathological features and prognosis of colon cancers was analyzed.

RESULTSOf the 440 tumor samples tested for DNA mismatch repair status, 90 (20.5%) demonstrated defective DNA mismatch repair and 350 (79.5%) had proficient DNA mismatch repair. Defective DNA mismatch repair (dMMR) was associated with young patients (≤ 60), proximal colon cancer, stage II, poorly differentiated adenocarcinoma and mucinous adenocarcinoma (P<0.05 for all). Among the 440 patients, 126 (28.6%) cases had recurrence or metastasis and 93 (21.1%) died during the median follow-up of 61.0 months. The five-year disease-free survival (DFS) rate was 82.2% among the patients with tumor exhibiting dMMR, significantly higher than that in patients with tumors exhibiting pMMR (68.9%, P=0.02). The univariate and mutlivariate analyses showed that the MMR status is an independent factor affecting 5-year disease-free survival and overall survival (OS) in colon cancer patients (P<0.05 for both).

CONCLUSIONSDefective DNA mismatch repair (dMMR) is associated with patients with proximal colon cancer, stage II and poorly defferentiated adenocarcinoma and mucinous adenocarcinoma. The prognosis for patients with dMMR is better than those with pMMR. dMMR may be a useful biomarker for the prognosis of colon cancer.

Adaptor Proteins, Signal Transducing ; metabolism ; Adenocarcinoma ; genetics ; metabolism ; mortality ; pathology ; Adenocarcinoma, Mucinous ; genetics ; metabolism ; mortality ; pathology ; Adenosine Triphosphatases ; metabolism ; Age Factors ; Analysis of Variance ; Colonic Neoplasms ; genetics ; metabolism ; mortality ; pathology ; DNA Mismatch Repair ; DNA Repair Enzymes ; metabolism ; DNA-Binding Proteins ; metabolism ; Disease-Free Survival ; Humans ; Mismatch Repair Endonuclease PMS2 ; MutL Protein Homolog 1 ; MutS Homolog 2 Protein ; metabolism ; Neoplasm Recurrence, Local ; Nuclear Proteins ; metabolism ; Prognosis ; Retrospective Studies ; Survival Rate

Objective To study the diagnostic value and clinical efficacy of endoscopic ultrasound-guided fine needle aspiration ( EUS-FNA ) for mediastinal and abdominal lymphadenopathy. Methods Thirty patients who underwent EUS-FNA for mediastinal or abdominal lymphadenopathy between May 2009 and December 2015 were reviewed. The clinical efficacy of EUS-FNA was evaluated by pathological results and the follow-up. The EUS-FNA effect on clinical decision was also analyzed. Results Lesions were located in the mediastinum in 10 cases and in the abdomen in 20 cases. The total diagnostic accuracy, sensitivity, specificity, positive predictive value ( PPV) and negative predictive value ( NPV) of EUS-FNA were 96. 7%, 94. 7%, 100. 0%, 100. 0% and 91. 7%, respectively. Of all the 30 cases, 20 lymph glands were of unknown origin. The diagnostic accuracy, sensitivity, specificity, PPV and NPV of EUS-FNA in these lesions were 95. 0%, 88. 9%, 100. 0%, 100. 0% and 91. 7%, respectively. The combination of cytological and histological examination had higher accuracy ( 96. 7% VS 73. 3%, P=0. 026) and sensitivity ( 94. 7%VS 57. 8%, P= 0. 019 ) than cytological examination only. Immunohistochemistry stains were performed in 12 neoplastic cases, and 11 ( 91. 7%) were confirmed. The diagnosis by EUS-FNA had positive impact on clinical decisions in 27 patients ( 90. 0%) . Conclusion EUS-FNA is an effective approach for mediastinal and abdominal lymphadenopathy, and the result has a positive impact on clinical decisions. The combination of cytological and histological examination and application of ancillary techniques, such as immunohistochemistry stains, can improve the diagnostic efficacy of EUS-FNA.

Objective To explore the relationship between DNA mismatch repair ( MMR ) and clinicopathologic features and prognosis in patients with stages Ⅱ and Ⅲ colon cancers. Methods The clinical and pathological data of 440 patients with stage Ⅱ/Ⅲ colon cancer after radical resection were retrospectively reviewed and analyzed. Immunohistochemical staining was used to assess the expression of MMR proteins ( MLH1, MSH2, MSH6 and PMS2 ) , and the correlation between DNA MMR and clinicopathological features and prognosis of colon cancers was analyzed. Results Of the 440 tumor samples tested for DNA mismatch repair status, 90 (20.5%) demonstrated defective DNA mismatch repair and 350 (79.5%) had proficient DNA mismatch repair. Defective DNA mismatch repair ( dMMR) was associated with young patients (≤60), proximal colon cancer, stage Ⅱ, poorly differentiated adenocarcinoma and mucinous adenocarcinoma (P<0.05 for all). Among the 440 patients, 126 (28.6%) cases had recurrence or metastasis and 93 ( 21. 1%) died during the median follow?up of 61. 0 months. The five?year disease?free survival (DFS) rate was 82.2% among the patients with tumor exhibiting dMMR, significantly higher than that in patients with tumors exhibiting pMMR (68.9%, P=0.02). The univariate and mutlivariate analyses showed that the MMR status is an independent factor affecting 5?year disease?free survival and overall survival(OS) in colon cancer patients (P<0.05 for both). Conclusions Defective DNA mismatch repair ( dMMR) is associated with patients with proximal colon cancer, stage Ⅱ and poorly defferentiated adenocarcinoma and mucinous adenocarcinoma. The prognosis for patients with dMMR is better than those with pMMR. dMMR may be a useful biomarker for the prognosis of colon cancer.

Objective To explore the relationship between DNA mismatch repair ( MMR ) and clinicopathologic features and prognosis in patients with stages Ⅱ and Ⅲ colon cancers. Methods The clinical and pathological data of 440 patients with stage Ⅱ/Ⅲ colon cancer after radical resection were retrospectively reviewed and analyzed. Immunohistochemical staining was used to assess the expression of MMR proteins ( MLH1, MSH2, MSH6 and PMS2 ) , and the correlation between DNA MMR and clinicopathological features and prognosis of colon cancers was analyzed. Results Of the 440 tumor samples tested for DNA mismatch repair status, 90 (20.5%) demonstrated defective DNA mismatch repair and 350 (79.5%) had proficient DNA mismatch repair. Defective DNA mismatch repair ( dMMR) was associated with young patients (≤60), proximal colon cancer, stage Ⅱ, poorly differentiated adenocarcinoma and mucinous adenocarcinoma (P<0.05 for all). Among the 440 patients, 126 (28.6%) cases had recurrence or metastasis and 93 ( 21. 1%) died during the median follow?up of 61. 0 months. The five?year disease?free survival (DFS) rate was 82.2% among the patients with tumor exhibiting dMMR, significantly higher than that in patients with tumors exhibiting pMMR (68.9%, P=0.02). The univariate and mutlivariate analyses showed that the MMR status is an independent factor affecting 5?year disease?free survival and overall survival(OS) in colon cancer patients (P<0.05 for both). Conclusions Defective DNA mismatch repair ( dMMR) is associated with patients with proximal colon cancer, stage Ⅱ and poorly defferentiated adenocarcinoma and mucinous adenocarcinoma. The prognosis for patients with dMMR is better than those with pMMR. dMMR may be a useful biomarker for the prognosis of colon cancer.

Child ; Humans ; Circulating Tumor DNA ; Lymphangioma ; Family ; Hemangioendothelioma ; Sarcoma, Kaposi

Objective: To investigate transport mechanism of cyperotundone in Caco-2 cell model and provide experimental basis for clinical application of Cyperi Rhizoma. Method: The toxicity of cyperotundone with different concentrations to Caco-2 cells was investigated by methyl thiazolyl tetrazolium (MTT) colorimetry, in order to determine the concentration of administration in transport test. The content of cyperotundone was determined by liquid chromatography-mass spectrometry (LC-MS) with apparent permeability coefficient (P_app) and cumulative transport capacity as indexes. The chromatographic conditions were as following:mobile phase of acetonitrile (A)-water (B) for gradient elution (0-1.5 min, 35%A; 1.5-2 min, 35%-90%A; 2-4 min, 90%A; 4-4.1, 90%-35%A; 4.1-8 min, 35%A), the flow rate at 0.3 mL · min^-1, injection volume of 1 μL, and temperature of column at 30℃. The mass spectrometric conditions was electrospray ionization (ESI) and positive ion mode, the detection ions of cyperotundone and osthole (internal standard substance) were m/z 219.2-110.9 and m/z 245.0-189.0, respectively. Effect of concentration of cyperotundone, administration time, ethylenediamine tetraacetic acid (EDTA) and P-glycoprotein (P-gp) inhibitor on the transmembrane transport of cyperotundone on in vitro cell model were investigated. Result: Cyperotundone didn't have significant toxicity to Caco-2 cells at 3-90 mg · L^-1 after incubation for 4 h. The transportion of cyperotundone in Caco-2 cell model was related to the concentration and time to a certain extent, its P_app was higher than 1×10^-6 cm · s^-1, which indicated that absorption of cyperotundone was good, the efflux rate (ER) of cyperotundone was 0.5-1.5.There was no significant difference in bidirectional P_app of cyperotundone after the addition of cell bypass transport inhibitor (EDTA) and P-gp transport inhibitor (verapamil). Conclusion: The transport mechanism of cyperotundone in Caco-2 cell model is mainly passive diffusion, and cell bypass transport and P-gp are not involved in its transport.

ObjectiveTo explore the content difference of gallic acid，protocatechuic acid，catechin，total flavonoids， and total polysaccharides in Cynomorii Herba between different producing areas and the correlation between effective components and environmental factors. MethodNinety-five batches of Cynomorii Herba samples were collected from 12 major producing areas in five provinces （autonomous regions）， including Gansu，Inner Mongolia，Xinjiang，Qinghai， and Ningxia，and the geographical-climatic factors such as altitude，longitude and latitude，climate type，annual average frost-free period，annual rainfall，annual sunshine hours，annual average temperature， and annual average evaporation were recorded. The content of gallic acid，protocatechuic acid， and catechin in Cynomorii Herba was determined by high-performance liquid chromatography （HPLC），and the mathematical model of the correlation between the content of chemical components and environmental factors was optimized and established. ResultPearson correlation analysis showed that protocatechuic acid content in Cynomorii Herba increased with the increase in annual average frost-free period and annual average temperature， and catechin content increased with the increase in the annual average frost-free period，annual sunshine hours， and annual average evaporation，while total polysaccharides content decreased with the increase in altitude. Redundancy analysis （RDA） showed that the annual average frost-free period， annual average evaporation，annual sunshine hours， and altitude had great influences on the content of effective components in Cynomorii Herba. Curve fitting showed that the optimal conditions for the growth of Cynomorii Herba were as follows： altitude of 800-2 000 m，annual average frost-free period of 80-110 d， annual rainfall of 110-300 mm，annual sunshine hours of 2 400-3 000 h， annual average temperature of 2.2-8.8 ℃，and annual average evaporation of 1 700-2 500 mm. ConclusionThe content of effective components in Cynomorii Herba is diverse in terms of producing areas and shows a clear response rule to environmental factors. The areas suitable for growing and artificial cultivation introduction are those with high altitude，short annual average frost-free period，low annual rainfall，large average evaporation，long sunshine hours， and low annual average temperature.