Objective:To analyze the prognosis of hepatocellular carcinoma (HCC) patients with thrombocytosis (platelet count ≥350×10 9) after transcatheter arterial chemoembolization (TACE), and the effect of thrombocytosis on the prognosis of patients with HCC after TACE. Methods:Clinical data of 867 patients with HCC admitted to the Department of Interventional Radiology, the Affiliated Hospital of Xuzhou Medical University from January 2013 to May 2018 were retrospectively analyzed. After propensity score matching, 99 patients were enrolled, including 70 males and 29 females, aged (60.1±12.1) years. Patients were divided into the groups with thrombocytosis ( n=33) and without thrombocytosis ( n=66). The gender, maximum tumor diameter, Barcelona clinical liver cancer (BCLC) stage, and total bilirubin were compared between the two groups. The association of thrombocytosis with the prognosis of HCC after TACE treatment were analyzed using univariate and multivariate Cox regression. Results:After propensity score matching, the male proportion, maximum tumor diameter, BCLC stage, and serum level of total bilirubin were comparable between the groups (all P>0.05). Before TACE treatment, the platelet count of patients with thrombocytosis was (394.4±54.5)×10 9/L, which was higher than that after TACE [(278.2±86.4)×10 9/L, t=7.63, P<0.001]. The progression-free survival rates after TACE in without thrombocytosis group were 83.3%, 24.2%, and 7.6% at 3, 6 and 9 months, respectively, better than those in thrombocytosis group (51.5%, 3.0%, and 3.0%, respectively; χ2=31.24, P<0.001). The overall survival rates after TACE in without thrombocytosis group were 81.8%, 30.3%, and 4.5% at 1, 2 and 3 years, respectively, better than those in thrombocytosis group (15.2%, 9.1%, and 3.0%, respectively; χ2=27.89, P<0.001). Multivariate Cox regression analysis showed that patients of HCC with thrombocytosis had an increased risk of tumor progression ( HR=5.785, 95% CI: 3.291-10.168, P<0.001) and increased risk of death ( HR=4.090, 95% CI: 2.482-6.740, P<0.001) after TACE. Conclusion:The prognosis of TACE for HCC might be worse in patients with thrombocytosis. Thrombocytosis is a risk factor for cumulative survival and progression-free survival of HCC patients after TACE.

Objective:To evaluate the relationship between red blood cell distribution width (RDW) and prognosis of patients with hepatocellular carcinoma (HCC) andergoing transcatheter arterial chemoembolization (TACE).Methods:Clinical data of 212 patients with HCC andergoing TACE for the first time in Department of Interventional Radiology, the Affiliated Hospital of Xuzhou Medical University from January 2011 to May 2018 were retrospectively analyzed, including 184 males and 28 females, aged (56.8±11.2) years. Follow-up for survival. X-tile software was used to determine 13.1% as the optimal threshold for preoperative RDW prediction of prognosis, and enrolled patients were divided into a low level group (RDW<13.1%, n=70) and a high level group (RDW≥13.1%, n=142). Aspartate aminotransferase, total bilirubin, albumin, hemoglobin and lipoprotein a, Barcelona clinical liver cancer (BCLC) stage and other indexes were compared between the two groups. Survival analysis was performed by Kaplan-Meier method, survival rate was compared by log-rank test, and the effect of RDW on prognosis was analyzed by Cox regression. Results:The 1-year, 2-year and 3-year cumulative survival rates in RDW high level group were 34.5%, 14.1% and 6.3%, respectively, while those in RDW low level group were 64.3%, 38.6% and 21.4%, respectively, with significant difference ( χ2=23.09, P<0.001). Compared with the low level group, the levels of aspartate aminotransferase and total bilirubin were higher, the levels of albumin, hemoglobin and lipoprotein a were lower, the proportion of portal vein cancer thrombin was higher, and the stage of BCLC was later, with statistical significance (all P<0.05). Cox regression analysis showed that HCC patients with RDW≥13.1%( HR=1.732, 95% CI: 1.223-2.452, P=0.002) had poor survival prognosis after TACE. Conclusion:Preoperative RDW≥13.1% is an independent risk factor for survival after TACE in patients with HCC. RDW has potential predictive value for prognosis of patients with HCC.

Objective: To analyze the stress distribution of different types of bone tissue around porous titanium implant in different mechanical loads and to further evaluate the biomechanical properties of porous titanium implant. Methods: Finite element (FE) models of implant restorations for the maxillary first premolar was established, and the diameter of implants in the models was 4.1 mm. Five models was constructed according to diameter of implant central pillar and the thickness of outer porosity: solid group (group A), central pillar 1.5 and 3.1 mm and outer porosity 30% (group B and C), central pillar 1.5 and 3.1 mm and outer porosity 40% (group D and E). Different loads (150 N vertical force, 50 N lateral force) were applied to the occlusal surface of implant restorations in type Ⅲ bone and maximal von Mises stress was evaluated. Meanwhile, a couple of simplified maxillary part models varied in four types of bone were constructed with the implants bearing load of simulation ultimate force to evaluate the stress distribution of different types of bone. Results: With different mechanical loading, the stress value of bone tissue around porous implant (group B-E) was greater than that in the solid structure (group A). Under the load of simulation ultimate force, the maximum stress of the bone rised with the increase of porosity and thickness of the porous implant. And the maximum stress value of the surrounding bone tissue changed with the change of bone. Under vertical loading, the maximal von Mises stress of the bone around solid implants of group A was 17.56 MPa, which was a little lower than that of group B and C. And the maximal equivalent von Mises stress of group D and E was 69.24 MPa. The results of lateral force and simulation ultimate force loading were similar. The stress of the bone tissue around implant increased with the decrease of bone quality. The maximum stress value of group D implant was 134.95 MPa. Conclusions Porous structure of the implant is conducive to transmit stress to surrounding bone tissue and increases the mechanical stimulation of bone. However, if the value and direction of load are inappropriate or quality of bone is poor, pathological stress may be produced.

Objective: To compare the biomechanical characteristics of four-implants mandibular overdentures supported by Locator attachment or bar-clip attachment under different mechanical loads using three-dimensional finite element analysis method. Methods: Two different models of four-implants supported mandibular overdentures using Locator attachment and bar-clip attachment (hereinafter called Locator model and bar-clip model) were established. Each model was subjected to five different mechanical loading conditions: 100 N vertical loading in central incisor (vertical load of incisor), 100 N vertical loading or oblique loading in canine (vertical or oblique loads of canines), 100 N vertical or oblique loading in mandibular first molar (vertical or oblique loads of mandibular first molar). The stress distributions in implants, peri-implant bone and mucosa were recorded under the above five conditions to evaluate the effects of different attachments on the biomechanical properties of implant-supported mandibular overdentures. Results: Regardless of loading conditions and types of attachments, the stress concentration in implants were located at the neck of implants, and the stress concentration in peri-implant bone was located in the cortical bone. The stress values in mucosa were always much smaller than those in implants and cortical bone. Regardless of loading positions (on canine or on mandibular first molar), the maximum stress at the bone interface around the implant under lateral loading was much higher than that under vertical loading. Under various loading conditions, the stress in implants and cortical bone of the Locator model (the highest von Mise stress value was respectively 79.5 and 22.3 MPa) were lower than that of bar-clip model (the highest von Mise stress value was 110.3 and 28.7 MPa respectively) while the maximum compressive stress in mucosa (0.198 MPa) in Locator model was slightly higher than that in the bar-clip model (0.137 MPa). Conclusions In clinical practice, the lateral force applied to the implant-retained overdenture should be minimized to avoid complications caused by pathological loads. Under the same loading condition, the stress distributions in overdenture using Locator attachment are more dispersed, which is more conducive to long-term stability of implants.

We investigated the molecular characteristics of the full-length genome of 14 dengue serotype 1 virus (DENV-1)strains isolated in Sino-Myanmar border region in Yunnan Province,China during 2013-2015.Isolation of dengue virus was using C6/36 cell culture method.Viral RNA was extracted from virus isolates,and then the full-length genome was amplified by RT-PCR.The homology and phylogenetic analysis was made on the nucleotide and deduced amino acid sequences by bioinformatics software including ClastalX1.83 and MEGA6 etc.Results showed that fourteen strains of DENV-1 isolated from dengue fever cases,of these,9 strains from Ruili City of Dehong Prefecture,3 from Lincang Prefecture,2 from Kunming City.RT-PCR and sequencing indicated that the full-length genes (10 735 nt) of 14 DENV-1 strains were obtained,and their open reading frame (95-10 271) were coded 3 392 amino acid residues.The genotypes of DENV-1 were revealed by homology and phylogenetic analysis based on structural and non-structural proteins.Thirteen were genotype Ⅰ (G-Ⅰ) (7 from indigenous cases in Ruili and Lincang and 6 from imported case from Myanmar to Ruili,Lincang and Kunming),and 1 G-Ⅲ from imported case from India to Kunming.The phylogenic analysis indicated that the 13 isolates from Yunnan divided into 2 phylogenic subgroups,and they had a closer genetic relationship with the strains isolated from Southeast Asia.The gene sequences of the 13 G-Ⅰ strains have been acquired,the rate of their nucleotide homology and amino acid homology were 97.02 ％-100 ％ and 98.78 ％100 ％ respectively.Compared with 6 strains from Southeast Asia,nucleotide homology and amino acid homology were 96.53％-99.53％ and 97.33％-100％ respectively.Compared with prototype strain (US_Hawaii) of DENV-1,nucleotide homology and amino acid homology were 93.76％-94.45 ％ and 95.86 ％-96.91％ respectively.Compared with US_Hawaii strain,there were 44 and 150 different sites in amino acid of structural and non-structural proteins,respectively.The G-1 of DENV-1 have been popular in Sino-Myanmar border region in Yunnan,2013-2015.They have genetic diversity but multiple transmission sources were from Myanmar,and should strengthen control cross-border spread of dengue fever in this region.It is necessary to further study that change of the amino acid sites of Yunnan strains of DENV-1 is related to its antigenicity and pathogenicity.

Objective To observe the clinical efficacy and safety of ticagrelor,a new antiplatelet agent,in patients with ST-Segment elevation myocardial infarction (STEMI) underwent emergency PCI.Methods Selected 174 patients with STEMI receiving emergency PCI treatment from January 2013 to July 2014 in Nanjing General Hospital of Nanjing Military Area Command,and randomly divided into clopidogrel group (preoperative taking 600 mg of clopidogrel,n =88) and ticagrelor group (preoperative taking 180 mg of ticagrelor,n =86).Compared platelet inhibition rate,renal function before and after treatment,major clinical cardiovascular events and bleeding events 30 d after treatment,adverse drug reactions of two groups.Results (1) Arachidonic acid pathway inhibition rate of the two groups were compared,the difference was not statistically significant (P ＞0.05).Compared two groups of patients with adenosine phosphate pathway inhibition rate,ticagrelor group was higher,the difference was statistically significant ((71.82 ± 19.97) ％ vs.(38.96 ± 27.55) ％;t =-7.569,P ＜0.001).(2) Compared major cardiovascular events of ticagrelor group(5 cases) and clopidogrel group (15 cases),ticagrelor group was decreased.There was significant differences (P =0.02) between the two groups.Bleeding events compared to between ticagrelor group (15 cases) and clopidogrel group (11 cases),no statistically significant difference was found(P =0.617).Conclusion Clinical efficacy of ticagrelor in acute ST-segment elevation myocardial infarction treated with primary PCI is superior to clopidogrel in which can reduce the risk of cardiovascular events in patients and without an increase in severe bleeding.

Objective To investigate whether IL-24 can inhibit the growth of pancreatic cancer in immune-competent mice,which could be mediated by tumor-targeting oncolytic adenovirus (ZD55-IL-24).Methods Crystal violet staining assay was used to evaluate the anti-proliferative influence of ZD55-IL-24 on Panc02.The tumor growth curve,the tumor formation curve,TUNEL assay,cytotoxic T lymphocyte (CTL) killing assay and serum cytokines detection were used to assess anti-tumor efficacy of ZD55-IL-24 for pancreatic cancer in immune-competent mice.Results ZD55-IL-24 significantly inhibited the growth of pancreatic cancer cells in vitro.Lower tumor formation and slower tumor growth were identified in ZD55-IL-24 group,compared with ZD55-EGFP group or PBS group.ZD55-IL-24 induced pancreatic cancer cells'apoptosis,and mediated anti-cancer immunity by increasing killing responses of CTL to cancer cells and up-regulating serum γ-IFN and IL-6 levels.Conclusion ZD55-IL-24 can induce anti-tumor immunity and suppress pancreatic cancer growth in immune-competent mice.

Background:Helicobacter pylori (Hp)infection is correlated with the development of chronic gastritis,peptic ulcer, mucosa-associated lymphoid tissue lymphoma and gastric cancer.Studies showed that Lactobacillus acidophilus could improve the eradication rate of Hp and reduce the occurrence of side-effects.Aims:To evaluate the efficacy of compound Lactobacillus acidophilus tablets combined with bismuth-containing quadruple therapy for the treatment of failed eradiction of Hp infection.Methods:One hundred and eighty patients with Hp-positive peptic ulcer in whom standard triple therapy failed were enrolled and then randomly assigned into experimental group and control group.Patients in experimental group received compound Lactobacillus acidophilus tablets 1 g tid for 14 days,followed by rabeprazole 10 mg bid +amoxicillin 1 000 mg bid +furazolidone 100 mg bid +bismuth 300 mg qid for 10 days.Patients in control group received rabeprazole 10 mg bid +amoxicillin 1 000 mg bid +furazolidone 100 mg bid +bismuth 300 mg qid for 10 days.13 C-urea breath test was conducted at least 4 weeks after completion of the course,Hp eradication rate and side-effects were evaluated. Results:No significant differences in PP eradication rate and ITT eradication rate were found between experimental group and control group (PP:81.2% vs.78.2%,χ2 =0.241,P =0.623;ITT:76.7% vs.75.6%,χ2 =0.031,P =0.861).Incidences of nausea and vomiting (2.4% vs.11.5%),diarrhea (0 vs.9.2%)in experimental group were significantly decreased than those in control group (P <0.05).Conclusions:Compound Lactobacillus acidophilus tablets combined with bismuth-containing quadruple therapy is efficient for Hp-positive patients with failed standard triple therapy and can reduce side-effects.

Objective To evaluate the therapeutic efficacy and safety of endoscopic sphincterotomy (EST) combined with large balloon dilation for bile duct stones.Methods A total of 83 patients with common bile duct stones were randomly divided into 2 groups to receive standard EST (n =41,EST group) or EST plus large balloon dilation (n =42,EPLBD group),respectively.The number of endoscopic session,operation time,rates of successful complete stone retrieval,mechanical lithotripsy,and procedure related complication were compared between the two groups.Results The rate of early procedure-related complications was similar in 2 groups (9/41 vs.7/42,P ＞0.05),including perforation ( 1/41 vs.0/42,P ＞0.05),bleeding (5/41 vs.2/42,P＞0.05) and pancreatitis (3/41 vs.5/42,P＞0.05).The rate of successful complete stone removal was also similar in 2 groups (39/41 vs.41/42,P ＞ 0.05 ).However,EST group needed more procedure time (38.8 ±4.3 min vs.29.2 ±5.3 min,P ＜0.01 ) and use of mechanical lithotripsy to achieve complete stone removal (9/41 vs.2/42,P ＜ 0.05 ).Only one patient in EPLBD group ( 1/42,2.4％ ) needed a second ERCP to clear bile duct stone,while in EST group,8 patients underwent a second procedure ( 19.5％,P ＜ 0.05 ).Conclusion For endoscopic removal of common bile duct stones,EST combined with larg4e balloon dilation is as safe and effective as EST,while easier in manipulation.

Objective To explore the disparity of severity of cardiac dysfunction and recovery among different glycometabolic patients in the early phase of acute myocardial infarction (AMI) . Methods Consecutive 111 AMI patients without known diabetes underwent continuous glucose monitoring. Patients with different glycometabolic status were compared in terms of cadiac dysfunction and recovery at admission and 3month follow up. Results Compared to patients with normglycemia and transient hyperglycemia, patitents with persistent hyperglycemia were more likely to grade Killip Ⅱ or above,which were 13.3% (4/30) ,33. 3% ( 12/36) ,55. 6% (25/45), 20. 0% ( 6/30), 41.7% ( 15/36 ) and 93.3% (42/45) ( Ps ＜ 0. 01 ). In-hospital left ventricular ejection fraction (LVEF), mitral valve protodiastolic E peak velocities (E) and its ratio to late diastolic (E/A) decreased significantly ( LVEF :0. 52 ± 0. 02,0. 48 ± 0. 01 and 0. 37 ± 0. 02; E: [0. 65 ± 0. 41]m/s,[0.55 ± 0.02] m/s and [0.39 ±0. 12]m/s;E/A:1. 15 ±0.08,1.02 ±0.06 and 0.61 ±0.02,respectively) ( Ps ＜ 0. 01 ), whereas LVESV and WMSI increased significantly ( LVESV: [25.83 ± 0. 51] ml,[31.26 ± 1.23] ml, [37, 72 ± 1.01] ml; WMSI: 1.5 ± 0. 3,1.8 ± 0. 2 and 2. 6 ± 0. 4, respectively) ( Ps ＜ 0. 01 )There months after AMI,patitents with persistent hyperglycemia were more likely to grade NYHA Ⅱ or above compared to patients with normglycemia and transient hyperglycemia [67.5% (27/40), 10.0% (3/30) and 11.8% (4/34),respectively] (P ＜0. 01 ). Echocardiographic recovery was observed in each group,but less in persistent hyperglycemia patients. Conclusion Cardiac function of patients with persistent hyperglycemia suffered more severely from AMI and difficult to recover.