ObjectiveTo investigate the efficacy， safety， and cost-effectiveness of endoscopic ultrasound （EUS）-guided coil placement combined with tissue adhesive injection in the treatment of gastric varices with spontaneous shunt. MethodsA retrospective analysis was performed for the patients with acute gastric variceal bleeding and spontaneous portosystemic shunt who were hospitalized and received balloon-occluded retrograde transvenous obliteration （BRTO） combined with endoscopic tissue adhesive injection or EUS-guided coil placement combined with tissue adhesive injection in Xiangyang Central Hospital from March 2019 to September 2022. The two surgical procedures were compared in terms of efficacy （technical success rate， 5-day rebleeding rate， 1-year rebleeding rate， and time to rebleeding）， safety （the incidence rate of ectopic embolism， the amount of tissue adhesive used， and the amount of lauromacrogol used）， and cost-effectiveness （hospital costs and length of hospital stay）. The t-test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The Kaplan-Meier method was used to estimate the rebleeding. The chi-square test was used for comparison of categorical data between two groups. ResultsA total of 25 patients received successful EUS-guided coil placement and tissue adhesive injection， with a technical success rate of 100%， a median amount of 2.5 mL tissue adhesive used， a median amount of 11.0 mL lauromacrogol used， a mean length of hospital stay of 14.88±3.21 days， a mean hospital cost of 32 660.00±4 602.07 yuan， and a 5-day rebleeding rate of 0%； among these patients， 2 were lost to follow-up， and 23 patients with complete follow-up data had an incidence rate of ectopic embolism of 0% and a median time to rebleeding of 689 days. A total of 14 patients underwent modified BRTO combined with endoscopic tissue adhesive injection， with a technical success rate of 100%； a median amount of 5.0 mL tissue adhesive used during surgery， which was significantly higher than that used in EUS （U=39.000， P<0.001）； a median amount of 10.5 mL lauromacrogol used during surgery； a mean length of hospital stay of 15.38±4.94 days； a mean hospital cost of 57 583.47±18 955.40 yuan， which was significantly higher than that used in EUS （t=-6.310， P<0.001）； a 5-day rebleeding rate of 0%. No patient was lost to follow-up， and all 14 patients had an incidence rate of ectopic embolism of 0% and a median time to rebleeding of 244.50 days， with no significant difference between the two groups （χ²=1.448， P=0.229）. ConclusionEUS-guided coil placement combined with tissue adhesive injection is a relatively safe and effective technique for the treatment of gastric variceal bleeding and has a high technical success rate， a low incidence rate of serious adverse events， and similar efficacy to BRTO， with higher safety and cost-effectiveness.

Objective To evaluate the effect of the current immunization strategy for hepatitis B virus (Hepatitis B) in blocking mother-to-infant transmission in Hubei Province, and to explore the mechanism and possible influencing factors of failure of mother-to-infant blockade. Methods A multi-stage random sampling method was used to select 2 counties or districts in Hubei Province. Through maternity hospital health handbook, neonatal health record or hospital medical record system, hepatitis B virus (HBV) surface antigen (HBsAg)-positive pregnant women in 2012-2018 years were included to retrospectively investigate their delivery status and the HBV infection status of their children. Results Among the 302 newborns, 32 were positive for HBsAg, and the success rate of blockade of mother-to-infant transmission of hepatitis B was 89.45%. Further analysis showed that 68.21% (206 / 302) of newborns were delivered in township hospitals, 66.23% (200 / 302) were delivered by caesarean section and 41.72% (126 / 302) were breastfed, while 16.89% (51/302) were positive for hepatitis B virus e antigen (HBeAg), and 41.06% (124/302) were positive for anti-HBe. The vaccination rate of hepatitis B immunoglobulin (HBIG) during pregnancy was 3.31% (10/302), and the newborn HBIG vaccination rate was 94.37% (285/302). There were 84.11% (254/302) of pregnant women taking protective measures in daily life. Logistic regression analysis showed that township hospitals (OR=2.82, P<0.05), HBeAg positivity during pregnancy (OR=8.68, P<0.05), and HBIG vaccination during pregnancy (OR=12.62 , P<0.05) were risk factors for failure of mother-to-infant blockade, while anti-HBe positivity during pregnancy (OR=0.22, P<0.05), vaccination of newborns with HBIG (OR=0.20, P<0.05), and protective measures taken in daily life (OR=0.28, P<0.05) were protective factors for mother-to-infant interruption. Conclusion Deliveries in township hospitals and HBeAg-positivity during pregnancy are more likely to fail in blocking of mother-to-infant transmission of hepatitis B. HBIG vaccination during pregnancy does not reduce the risk of blockade failure. Neonatal HBIG vaccination, anti-HBe positivity during pregnancy, and protective measures in daily life can reduce the risk of blockade failure of mother-to-infant transmission of hepatitis B.

ObjectiveTo investigate the features of liver injury in patients with coronavirus disease 2019 (COVID-19), and to provide a reference for clinical diagnosis and treatment. MethodsMedical records were collected from 201 patients with COVID-19 who were admitted to Xiangyang Central Hospital from January 19 to March 5, 2020, and these patients were divided into non-critical (mild/common type) group with 173 patients and critical (severe/critical type) group with 28 patients. The data on alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), direct bilirubin (DBil), and albumin (Alb) were collected. The t-test was used for comparison of normally distributed continuous data between groups, the chi-square test was used for comparison of categorical data between groups, and the Wilcoxon rank-sum test was used for comparison of ranked data between groups. ResultsAmong the 201 patients, 37 (18.4%) had liver injury, with 19 in the critical group and 18 in the non-critical group, and there was a significant difference in the incidence rate of liver injury between the two groups (67.9% vs 10.4%, χ2=52.963, P＜0.05). There were significant differences between the 19 patients with liver injury in the critical group and the 18 patients with liver injury in the non-critical group in the duration of abnormal ALT and/or AST (on admission and during hospitalization) (χ2=11.906, P＜0.05) and the increase in ALT and/or AST (Z=-2.869, P＜0.05), and most patients had mild or moderate liver injury. Among the 201 patients, only one patient had elevated bilirubin (TBil ＜2 × upper limit of normal, mainly indirect bilirubin) and had non-critical liver injury. The critical group had a significantly lower level of Alb than the non-critical group (t=-8.002, P＜0.05). Among the 201 patients, 75 had a reduction in Alb, among whom 50 (50/201, 24.9%) had a reduction on admission and 25 (25/201, 12.4%) had a reduction during hospitalization, and there were significant differences in Alb (t=-4.967, P＜0.05) and hypoalbuminemia (χ2=26.645, P＜0.05) between the two periods of time. ConclusionLiver injury is relatively common in patients with COVID-19, mainly mild or moderate liver injury. There is a low incidence rate of abnormal bilirubin and a high incidence rate of the reduction in Alb. There are significant differences in the incidence rate and severity of liver injury between the crucial and non-critical patients. Alb level can be used as one of the indicators to evaluate and predict the severity of COVID-19 patients.

Epithelial-mesenchymal transition (EMT) plays an important role in the development and pathogenesis of respiratory system. Epithelial cells are characterized by well-developed, intercellular contacts, whereas EMT triggers the sequential destabilization of cell-cell adhesive junctions. The dynamic remodeling of the epithelial cell adhesion molecules is important for maintaining the integrity and normal function of epithelium. This paper reviews the research progress of EMT in lung development, lung injury repair and chronic lung diseases, and summarizes the effect of cell junctions and cell adhesion molecules on EMT molecular events.
Cell Adhesion ; Cell Adhesion Molecules ; Epithelial Cells ; Epithelial-Mesenchymal Transition ; Respiratory System

Objective: To investigate the efficiency and safety of domestic tyrosine kinase inhibitor (TKI) dasatinib (Yinishu) as second-line treatment for patients with chronic myeloid leukemia in chronic phase (CML-CP). Methods: A retrospective analysis of clinical data of CML-CP patients who received domestic dasatinib as second-line treatment in the CML collaborative group hospitals of Hubei province from March 2016 to July 2018 was performed. The optimal response rate, the cumulative complete cytogenetic response (CCyR), the cumulative major molecular responses (MMR), progression free survival (PFS), event free survival (EFS) and adverse effects (AEs) of the patients were assessed at 3, 6 and 12 months of treatment. Results: A total of 83 CML-CP patients were enrolled in this study. The median follow-up time was 23 months. The optimal response rates at 3, 6 and 12 months in 83 CML-CP patients treated with dasatinib were 77.5% (54/71), 72.6% (61/75) and 60.7% (51/69), respectively. By the end of follow-up, the cumulative CCyR and MMR rates were 65.5% (55/80) and 57.1% (48/73), respectively. The median time to achieving CCyR and MMR was 3 months. During follow-up time, the PFS rate was 94.0% (79/83) and the EFS rate was 77.4% (65/83). The most common non-hematological AEs of dasatinib were edema (32.5%), rash itching (18.1%) and fatigue (13.3%). The common hematological AEs of dasatinib were thrombocytopenia (31.3%), leukopenia (19.3%) and anemia (6.0%). Conclusion Domestic dasatinib was effective and safe as the second-line treatment of CML-CP patients and it can be used as an option for CML-CP patients.

Objective: To establish a near-infrared diffuse reflectance spectroscopy(NIRS) identification model for crude products,counterfeit products and processed products of Calamina by principal component analysis(PCA) and support vector machine(SVM) algorithm. Method: NIRS of crude products,counterfeit products and processed products of Calamina were collected,the characteristic spectrum segments were selected,the preprocessing method and the optimum principal component number were optimized,and the PCA-SVM qualitative model was established. Result: The characteristic spectrum segment of analysis model was 7 500-4 000 cm^-1.Spectra were preprocessed by the first-order derivative method(FD).The optimum principal component number was 5. And the optimum internal parameters of SVM[penalty factor(c)=0.25 and kernel function parameter(g)=8] were screened by applying the grid search algorithm.In the PCA-SVM qualitative model,the prediction accuracy rate was 100%for the 5-fold cross validation,and the prediction accuracy rates also were 100%both for training set and test set. Conclusion: PCA-SVM analysis model of NIRS for Calamina samples has a high prediction accuracy rate,and it can be used for the rapid and nondestructive identification of crude products,counterfeit products and processed products of Calamina by combining the diffuse reflection technique on solid powder.

Objective: To investigate the efficiency and safety of domestic tyrosine kinase inhibitor (TKI) dasatinib (Yinishu) as second-line treatment for patients with chronic myeloid leukemia in chronic phase (CML-CP). Methods: A retrospective analysis of clinical data of CML-CP patients who received domestic dasatinib as second-line treatment in the CML collaborative group hospitals of Hubei province from March 2016 to July 2018 was performed. The optimal response rate, the cumulative complete cytogenetic response (CCyR), the cumulative major molecular responses (MMR), progression free survival (PFS), event free survival (EFS) and adverse effects (AEs) of the patients were assessed at 3, 6 and 12 months of treatment. Results: A total of 83 CML-CP patients were enrolled in this study. The median follow-up time was 23 months. The optimal response rates at 3, 6 and 12 months in 83 CML-CP patients treated with dasatinib were 77.5% (54/71), 72.6% (61/75) and 60.7% (51/69), respectively. By the end of follow-up, the cumulative CCyR and MMR rates were 65.5% (55/80) and 57.1% (48/73), respectively. The median time to achieving CCyR and MMR was 3 months. During follow-up time, the PFS rate was 94.0% (79/83) and the EFS rate was 77.4% (65/83). The most common non-hematological AEs of dasatinib were edema (32.5%), rash itching (18.1%) and fatigue (13.3%). The common hematological AEs of dasatinib were thrombocytopenia (31.3%), leukopenia (19.3%) and anemia (6.0%). Conclusion: Domestic dasatinib was effective and safe as the second-line treatment of CML-CP patients and it can be used as an option for CML-CP patients.
Antineoplastic Agents ; Dasatinib/therapeutic use* ; Humans ; Imatinib Mesylate ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy* ; Protein Kinase Inhibitors ; Retrospective Studies ; Treatment Outcome

Antineoplastic Agents/therapeutic use* ; Dasatinib/therapeutic use* ; Humans ; Leukemia, Myeloid, Chronic-Phase/drug therapy* ; Prognosis ; Protein Kinase Inhibitors ; Treatment Outcome

Objective To reduce the risk of cervical spinal cord injury,the most medial point of the cervical intervertebral disc that the posterior percutaneous endoscopic sheath could reach was evaluated.And that could help to determine the indication of posterior percutaneous endoscopic cervical discectomy for cervical intervertebral disc herniation.Methods Cervical MRI images for 50 randomly selected patients,21 males and 29 females with ages from 20 to 60(average 33.5± 10.03 years),were analysed.All 50 patients underwent MRI examination at our institution between January 2014 and December 2017.As 50％ of the zygapophyseal joint was preserved,on the cross-section T2-weighted MRI images,when the sheath just touched the spinal cord,the intersection point of the medial wall of sheath and cervical spinal cord (Point L) was the most medial point of the posterior percutaneous endoscopy could get.The distance between Point L and the line through and tangent to the most lateral point of cervical disc border was the length of the line section DL.The distance between the middle sagittal line of the cervical disc and the line through and tangent to the most lateral point of cervical disc border was the length of the line section D.D1/D was the most medial distance ratio of the posterior percutaneous endoscopic cervical discectomy when 50％ of the lateral zygapophyseal joint was preserved.In the same way,D'1/D was the most medial distance ratio of the posterior percutaneous endoscopic cervical discectomy when 75％ of the lateral zygapophyseal joint was preserved.Results When 50％ of the lateral zygapophyseal joint was preserved,the upper limit of 95％ confidence intervals of the most medial distance ratio that the posterior percutaneous endoscopy could get were 78％,76％,81％,93％ in C3,4,C4,5,C5,6,C6,7 respectively.This meant that the most medial distance the posterior percutaneous endoscopy could get were the 78％,76％,81％,0.93％ of the length of the line section D in C3,4,C4,5,C5,6,C6,7 respectively.The most medial distance the posterior percutaneous endoscopy could get in C5,6 or C6,7 was longer than that in C3,4,C4,5.Conclusion When 50％ of the lateral zygapophyseal joint was preserved,the upper limit of the most medial distance ratio that the posterior percutaneous endoscopy should get were 78％,76％,81％,93％ in C3,4,C4,5,C5,6,C6,7 respectively.This meant that the most medial distance the posterior percutaneous endoscopy could get were the 78％,76％,81％,93％ of the length of line section D in C3,4,C4,5,C5,6,C6,7 respectively.If the resected disc was beyond this range,the cervical spinal cord should be in the risk of being injured.

Objective To investigate the effect of immature dendritic cell (imDC) derived from donor-derived bone marrow induced by alkaloid sinomenine (SN) on the Th1/Th2 cytokines in venous blood of receptors,and to probe into the mechanism which imDC induced by SN can lead transplantation immune tolerance.Methods Inbred strain Wistar and Sprague Dawley (SD) rats were selected as kidney transplant donor and recipient,respectively.Vessel sutures of the microsurgery technique were used to build the bilaterally renal transplantation model of rats.By the injection of imDC to the recipient rats preoperatively,enzyme-linked immunosorbent assay (ELISA) was used to determine the level of the interleukin (IL)-2,IL-4,IL-10 and interferon-γ (INF-γ).Results (1) Successful rate of transplantation was 89.5％.Arterial anastomosis time was (12.5 ±5.7)min,and venous anastomosis time was (17.3 ± 3.4)min.(2) The content of the IL-2,INF-γ,IL-4 and IL-10 in SN-imDC 106 group was (17.25 ± 3.41) pg/ml,(239.80 ± 9.06) pg/ml,(337.60 ± 25.07) pg/ml,and (1 432.00 ± 106.39) pg/ml,respectively.Among the same concentration,the level of the IL-4 and IL-10 that stood for the Th2 cytokines was significantly higher in SN-imDC group than imDC group and control group (P ＜ 0.05),and was significantly higher in SN-imDC 106 group than SN-imDC 105 group (P ＜ 0.05).Among the same concentration,the lever of IL-2 and INF-γ that stood for the Th1 cytokines was significantly lower in SN-imDC group than imDC group and control group (P ＜ 0.05),and was significantly lower in SN-imDC 106 group than SN-imDC 105 group (P ＜ 0.05).Conclusions (1) The use of microsurgery for anastomosis could make the model of singel kidney transplantation in rats.(2) Specific imDC induced by SN could induce the migration to Th2 immune response,which proved imDC induced by SN could mediate immune tolerance to the recipient.