Objective To investigate the correlation between Traditional Chinese Medicine(TCM)constitution types and disease progression in elderly patients with hypertension complicated by heart failure(HF).Methods A total of 200 eligible elderly patients treated in our hospital from June 2021 to June 2023 were recruited,and based on TCM constitution types,they were classified as balanced constitution(n=20,10.0％),qi-deficiency(n=35,17.5％),yang-deficiency(n=30,15.0％),yin-deficiency(n=21,10.5％),phlegm-dampness(n=35,17.5％),damp-heat(n=16,8.0％),blood-stasis(n=25,12.5％),qi-stagnation(n=11,5.5％),and inherited special constitu-tion(n=7,3.5％).TCM constitution,blood pressure,and cardiac function indicators were as-sessed.All patients were followed up for 1 year,and acute exacerbations was recorded to analyze disease progression.Blood pressure,cardiac function indicators,and acute exacerbation frequency were compared among different TCM constitution types,and Spearman correlation analysis was used to assess the relationship between TCM constitution types and the frequency of acute exacer-bations.Results Significant differences were observed in SBP,DBP and frequency of acute exacer-bations among elderly hypertension patients with HF having different TCM constitution types(P＜0.01).The patients with a phlegm-dampness constitution had obviously higher SBP,DBP,mean arterial pressure,stroke volume,central venous pressure and frequency of acute exacerba-tions than those with other constitution types,while the patients with a balanced constitution had the notably highest left ventricular ejection fraction(P＜0.01).Spearman correlation analysis showed that balanced,phlegm-dampness,and blood-stasis constitutions were positively correlated with the frequency of acute exacerbations in these patients(r=0.480,r=0.375,r=0.295,P＜0.01),whereas qi-deficiency constitution was negatively correlated(r=-0.235,P＜0.01).Conclusion Elderly patients with hypertension and HF are predominantly of the qi-deficiency,phlegm-dampness,and yang-deficiency constitution types.Among them,the patients with phlegm-dampness constitution exhibit notably higher blood pressure and cardiac function indicators.TCM constitution types such as balanced and phlegm-dampness are closely related to disease progres-sion in these patients.

Objective:To develop and explore the clinical value of a nomogram model for the preoperative diagnosis of proliferative hepatocellular carcinoma (HCC) based on gadoxetate disodium (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI).Methods:The preoperative Gd-EOB-DTPA-enhanced MRI data and clinical pathological data of patients with pathologically confirmed proliferative (178 cases) and non-proliferative type HCC (378 cases) from September 2017 to November 2022 were retrospectively collected. The MRI features and clinicopathological features of proliferative and non-proliferative type HCC were evaluated. Multivariate logistic regression analysis was used to determine the independent predictive factors of proliferative-type HCC. The nomogram prediction model was constructed using R software. The receiver operating characteristic curve (ROC) was used to evaluate its diagnostic efficacy. The calibration curve and decision curve analysis (DCA) were drawn to evaluate the calibration performance and clinical application value of the nomogram model. The optimal threshold for distinguishing high-risk from low-risk was determined using the Youden index. The survival prognosis of proliferative and non-proliferative type HCC was analyzed and compared using the Kaplan-Meier survival curve and the log-rank test. The measurement data were analyzed using the independent sample t-test or the Mann-Whitney U test. The count data were compared using the χ2 test. Results:There were statistically significant differences in alpha-fetoprotein (AFP) levels ( χ2=17.244, P<0.001), tumor morphology ( χ2=13.669, P<0.001), intratumoral fatty degeneration ( χ2=10.495, P=0.001), abnormal enhancement of peritumoral abnormalities during arterial phase ( χ2=37.662, P<0.001), tumor capsule ( χ2=23.961, P<0.001), intratumoral necrosis ( χ2=77.184, P<0.001), intratumoral hemorrhage ( χ2=4.892, P=0.027), peritumoral hypointense in hepatobiliary phase ( χ2=47.675, P<0.001), rim arterial phase hyperenhancement ( χ2=115.976, P<0.001), intratumoral artery ( χ2=15.528, P<0.001) and intravenous tumor thrombus ( χ2=10.532, P=0.001) between proliferative and non-proliferative type HCC groups. Multivariate logistic regression analysis showed that AFP>200 μg/L ( OR=1.561, P=0.044), no intratumoral fatty degeneration ( OR=1.947, P=0.033), intratumoral necrosis ( OR=2.084, P=0.003), peritumoral hypointensity in the hepatobiliary phase ( OR=2.314, P=0.001), and annular hyperenhancement in the arterial phase ( OR=5.557, P<0.001) were independent predictors for preoperative diagnosis of proliferative-type HCC. A nomogram model for preoperative prediction of proliferative type HCC was constructed based on the independent predictors. The area under the ROC curve model for predicting proliferative-type HCC was 0.772 (95% CI: 0.735-0.807), with a sensitivity of 69.1% and a specificity of 75.4%. The calibration curve and DCA curve showed superior calibration performance and clinical applicability of the nomogram model. The Kaplan-Meier curve showed that the recurrence free survival rate after liver resection was significantly lower in patients with proliferative-type HCC than that of non-proliferative-type HCC ( P<0.001), and the high-risk group was significantly lower than the low-risk group ( P<0.001). Conclusions:The construction of a nomogram model based on Gd-EOB-DTPA-enhanced MRI features combined with AFP >200μg/L can accurately diagnose proliferative-type HCC and predict its preoperative prognosis.

Objective To investigate the correlation between Traditional Chinese Medicine(TCM)constitution types and disease progression in elderly patients with hypertension complicated by heart failure(HF).Methods A total of 200 eligible elderly patients treated in our hospital from June 2021 to June 2023 were recruited,and based on TCM constitution types,they were classified as balanced constitution(n=20,10.0％),qi-deficiency(n=35,17.5％),yang-deficiency(n=30,15.0％),yin-deficiency(n=21,10.5％),phlegm-dampness(n=35,17.5％),damp-heat(n=16,8.0％),blood-stasis(n=25,12.5％),qi-stagnation(n=11,5.5％),and inherited special constitu-tion(n=7,3.5％).TCM constitution,blood pressure,and cardiac function indicators were as-sessed.All patients were followed up for 1 year,and acute exacerbations was recorded to analyze disease progression.Blood pressure,cardiac function indicators,and acute exacerbation frequency were compared among different TCM constitution types,and Spearman correlation analysis was used to assess the relationship between TCM constitution types and the frequency of acute exacer-bations.Results Significant differences were observed in SBP,DBP and frequency of acute exacer-bations among elderly hypertension patients with HF having different TCM constitution types(P＜0.01).The patients with a phlegm-dampness constitution had obviously higher SBP,DBP,mean arterial pressure,stroke volume,central venous pressure and frequency of acute exacerba-tions than those with other constitution types,while the patients with a balanced constitution had the notably highest left ventricular ejection fraction(P＜0.01).Spearman correlation analysis showed that balanced,phlegm-dampness,and blood-stasis constitutions were positively correlated with the frequency of acute exacerbations in these patients(r=0.480,r=0.375,r=0.295,P＜0.01),whereas qi-deficiency constitution was negatively correlated(r=-0.235,P＜0.01).Conclusion Elderly patients with hypertension and HF are predominantly of the qi-deficiency,phlegm-dampness,and yang-deficiency constitution types.Among them,the patients with phlegm-dampness constitution exhibit notably higher blood pressure and cardiac function indicators.TCM constitution types such as balanced and phlegm-dampness are closely related to disease progres-sion in these patients.

Objective:To develop and explore the clinical value of a nomogram model for the preoperative diagnosis of proliferative hepatocellular carcinoma (HCC) based on gadoxetate disodium (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI).Methods:The preoperative Gd-EOB-DTPA-enhanced MRI data and clinical pathological data of patients with pathologically confirmed proliferative (178 cases) and non-proliferative type HCC (378 cases) from September 2017 to November 2022 were retrospectively collected. The MRI features and clinicopathological features of proliferative and non-proliferative type HCC were evaluated. Multivariate logistic regression analysis was used to determine the independent predictive factors of proliferative-type HCC. The nomogram prediction model was constructed using R software. The receiver operating characteristic curve (ROC) was used to evaluate its diagnostic efficacy. The calibration curve and decision curve analysis (DCA) were drawn to evaluate the calibration performance and clinical application value of the nomogram model. The optimal threshold for distinguishing high-risk from low-risk was determined using the Youden index. The survival prognosis of proliferative and non-proliferative type HCC was analyzed and compared using the Kaplan-Meier survival curve and the log-rank test. The measurement data were analyzed using the independent sample t-test or the Mann-Whitney U test. The count data were compared using the χ2 test. Results:There were statistically significant differences in alpha-fetoprotein (AFP) levels ( χ2=17.244, P<0.001), tumor morphology ( χ2=13.669, P<0.001), intratumoral fatty degeneration ( χ2=10.495, P=0.001), abnormal enhancement of peritumoral abnormalities during arterial phase ( χ2=37.662, P<0.001), tumor capsule ( χ2=23.961, P<0.001), intratumoral necrosis ( χ2=77.184, P<0.001), intratumoral hemorrhage ( χ2=4.892, P=0.027), peritumoral hypointense in hepatobiliary phase ( χ2=47.675, P<0.001), rim arterial phase hyperenhancement ( χ2=115.976, P<0.001), intratumoral artery ( χ2=15.528, P<0.001) and intravenous tumor thrombus ( χ2=10.532, P=0.001) between proliferative and non-proliferative type HCC groups. Multivariate logistic regression analysis showed that AFP>200 μg/L ( OR=1.561, P=0.044), no intratumoral fatty degeneration ( OR=1.947, P=0.033), intratumoral necrosis ( OR=2.084, P=0.003), peritumoral hypointensity in the hepatobiliary phase ( OR=2.314, P=0.001), and annular hyperenhancement in the arterial phase ( OR=5.557, P<0.001) were independent predictors for preoperative diagnosis of proliferative-type HCC. A nomogram model for preoperative prediction of proliferative type HCC was constructed based on the independent predictors. The area under the ROC curve model for predicting proliferative-type HCC was 0.772 (95% CI: 0.735-0.807), with a sensitivity of 69.1% and a specificity of 75.4%. The calibration curve and DCA curve showed superior calibration performance and clinical applicability of the nomogram model. The Kaplan-Meier curve showed that the recurrence free survival rate after liver resection was significantly lower in patients with proliferative-type HCC than that of non-proliferative-type HCC ( P<0.001), and the high-risk group was significantly lower than the low-risk group ( P<0.001). Conclusions:The construction of a nomogram model based on Gd-EOB-DTPA-enhanced MRI features combined with AFP >200μg/L can accurately diagnose proliferative-type HCC and predict its preoperative prognosis.

Objective:To evaluate the surgical effect of repairing soft tissue defect of hand and foot with medial gastrocnemius fascia flap combined with skin graft.Methods:From January, 2018 to June, 2019, 10 patients were treated with transfers of free medial gastrocnemius fascia flaps combined with skin graft to repair soft tissue defect of hand and foot. The size of free fascial flap was 5.0 cm×8.0 cm-12.0 cm×15.0 cm. After successful transfer on the wound, the skin was grafted onto the fascial flap, and the donor site was sutured directly. The appearance and function of the recipient and donor sites were observed and the effect of the operation was evaluated. Sensory recovery was assessed by the standard set by British Medical Research Council (BMRC) at the last follow-up.Results:All the free medial gastrocnemius fascia flap survived. After 6-10 days of granulation tissue growing, the skin grafts were transferred and all survived. All patients entered follow-up for 3-9 months, with an average of 7.5 months. The tissue at the recipient sites were soft and wear-resistant without swelling or ulceration. According to the self-designed evaluation system of soft tissue defect reconstruction, 10 patients had score from 68 to 92 (average, 75.2) . At the last follow-up, sensory recovery was assessed by BMRC, 7 cases were excellent and 3 cases were good.Conclusion:The repair of hand and foot soft tissue defect by the free medial gastrocnemius fascia flap combined with skin graft has advantages in constancy of vascular anatomy of free fascia tissue, long vascular pedicle and for repair of various types of hand and foot defects. Skin of the recipient area is soft with good appearance without swelling after the reconstruction of fascia flap. It is a method of treatment in repair of soft tissue defect of hand and foot by avoiding the thinning of a flap in the second procedure.

Objective To establish the methodology of combining BOLD and 1H-MRS for investigating correlation between the deactivation in medial prefrontal cortex (MPFC) and gamma-aminobutyric acid (GABA) concentration by acupuncture at LI4 (Point Hegu),and to optimize the experimental technique and procedure.Methods Twenty healthy adult volunteers were enrolled.During fMRI-BOLD scanning,each subject received acupuncture at right LI4 (Point Hegu).MRS scanning was based on MEGA-PRESS sequence,and ROIs were located at bilateral MPFC.The task BOLD fMRI was block design,including 3 stimulations (30 s) with 2 intervals (2 min).Then MRS scanning was performed before and after BOLD.The quantitative values of the BOLD positive and negative activations (Pm) and GABA concentrations were calculated.Results All 20 subjects completed BOLD fMRI scanning,and met the postprocessing requirements.MRS images of 9 subjects with good image quality were included in analysis.Among all 20 subjects,positive activation (Pm=1.17± 0.16) was observed in 9,while negative activation (Pm =-1.31 ± 0.17) was observed in 11 subjects.The GABA average values before and after the acupuncture were (19.93 ±1.04) nmol/L and (20.04±0.81)nmol/L,respectively,and the average amplitude between post-and pre-acupuncture was (0.11 ± 1.60)nmol/L.Conclusion The success rate of this method for quantitative study of brain function established multimodal-functional (BOLD-fMRI and MRS) was acceptable,and the multimodal brain function changes as well as the quantitative values were observed in the brain region during acupuncture.Combined BOLD and MRS quantitative method is feasible for testing acupuncture response in the brain.

Objective To explore the possibility and safety of the simultaneous esophagectomy and off-pump coronary artery bypass grafting(OPCABG) in patients suffering from esophageal cancer combined with coronary artery and summarize the clinical experiences.Methods We retrospectively analyzed the clinical dates of 5 patients performed at the Henan province Chest Hospital from May 2009 to December 2014.The related literature was reviewed.Results All patients were performed the simultaneous esophagectomy and OPCABG through the single left posterolateral thoracotomy 4cases and through median sternotomy and left thoracotomy 1 case.Instrument anastomosis under aortic arch 2 cases and above aortic arch 1 case , left neck anastomosis by hand 2 cases.Coronary artery three ressel disease 3cases, double-vessel 1 case, left main single vessel 1 case.There was no hospital death in this series.Postoperative complications included arrhythmia,anastomotic fistula and pneumonia.Only one patient was still alive, the other patients died of tumor recurrence or metastasis and median survival time was 20.6 months.Conclusion Simultaneous esophagectomy and OPCABG is a safe and feasible treatment modality in patients with severe CAD and esophageal cancer and it may be more beneficial for the patient with early esophageal cancer.

Background and purpose:Esophagorespiratory ifstula is often accompanied with life-threatening pulmonary infection. Though the pulmonary infection can be controlled temporarily by conservative medical treatment or stent placement, but patients have a poor quality of life and short survival time. This study was to investigate the effectiveness and security of surgical treatment for patients with esophagorespiratory fistula.Methods:We retrospectively analyzed the clinical data of 7 patients with esophagorespiratory ifstula after surgical treatment between Jun. 2009 and Oct. 2013 in Henan Province Chest Hospital. The causes were the following: esophageal cancers (4 cases), congenital ifstula (1 case), diverticulum (1 case) and trauma (1 case). All patients underwent surgical treatment through thoracotomy. Surgical treatment consisted of esophagectomy gastroesophageal anastomosis and pulmonary lobectomy in 2 patients, esophagectomy gastroesophageal anastomosis and tracheal ifstula repair in 1 patient, remnant stomach repair and pulmonary lobectomy in 1 patient, esophageal ifstula repair and pulmonary lobectomy in 2 patients and esophagotracheal ifstula double deligation in 1 patient.Results:There was no perioperative death. The incidence rate of postoperative complications was 57% (4/7). Two patients got severe pulmonary infection. One patient suffered from esophageal-tracheal fistula recurrence and underwent elective jejunostomy. One patient had thoracic cavity infection. Six patients resumed normal eating after postoperative recovery. Follow-up was acquired in all cases. Three cases with benign ifstula remained well without recurrence. Four cases with malignant ifstula had an average survival time of 18.8 months (11–28 months).Conclusion:Once congenital esophagorespiratory ifstula is conifrmed, surgical management is recommended as early as possible. The selective surgical treatment for malignant esophagorespiratory ifstulas according to patient’s condition could improve the life quality and lengthen the survival time.

BACKGROUND:Slow growth of peripheral nerve, muscle denervation atrophy and fossilization of motor end plate fol owing sciatic nerve injury cause irreversible limb function disorders. Umbilical cord mesenchymal stem cells have been widely used in multi-disciplinary research, but studies concerning umbilical cord mesenchymal stem cells delaying denervated muscle atrophy in rats fol owing peripheral nerve injury are rarely reported.
OBJECTIVE:To observe the value of human umbilical cord mesenchymal stem cells transplantation to delay denervated muscle atrophy of rats after sciatic nerve injury.
METHODS:Umbilical cord blood was col ected from healthy parturient woman after ful-term delivery. In the experimental group, the rat’s Sunderland IV degree sciatic nerve injury model was established by 5 mm denervation, epineurial repair, and 5 mm smal gap transplantation of umbilical cord mesenchymal stem cells. In the control group, after modeling, the same volume of normal saline was injected into the smal gap. The main outcome measures included the sciatic nerve function index, the wet weight of triceps surae,sciatic nerve latency, action potential conduction velocity and amplitude,and skeletal muscle fiber cross section area maintenance rate.
RESULTS AND CONCLUSION:After 4, 8 and 12 weeks of modeling, the sciatic nerve function index values, the wet weight of triceps surae and skeletal muscle fiber cross section area maintenance rates in the experimental group were significantly higher than those in the control group (P<0.05). After 12 weeks of modeling, electromyography results showed sciatic nerve latency was significantly lower, but action potential conduction velocity and amplitude were dramatical y higher in the experimental group than the control group (P<0.05, P<0.001). Human umbilical cord mesenchymal stem cells transplantation in denervated muscle atrophy rats after sciatic nerve promotes nerve growth, delays denervated muscle atrophy, maintains the denervatied neuromusle’s morphology and function.

OBJECTIVE: To analyze and explore the association between the 1607(1G/2G) single nucleotide polymorphism (SNP) in promoter of matrix metalloproteinase-1 (MMP-1) gene and susceptibility of head and neck cancer (HNC) by Meta-analysis. METHOD: By the end of January 2014, the published literatures were collected for the case-control studies evaluating the relationship between HNC and -1607 SNP of MMP-1 gene from English and Chinese literature databases according to the inclusion and exclusion criteria. Then the meta-analysis, the heterogeneity, bias and sensitivity of the results of the eligible literatures were conducted by Stata 10. 0. RESULT: A total of 9 studies including 2049 patients with HNC and 2158 controls were extracted for systematic review on the association of MMP-1 (-1607) 1G/2G SNP with the risk of HNC. Meta-analysis which based on random effects model showed that MMP-1 (-1607) 1G/2G SNP can significantly increase the risk of HNC[1G2G + 2G2G vs. 1G1G: OR = 1.45, 95% CI 1.25-1.68, P < 0.01; 2G2G vs. 1G1G + 1G2G:OR = 1.77, 95% CI 1.37-2.30, P < 0.01; 2G vs. 1G: OR = 1.52, 95% CI 1.26-1.85, P < 0.01; 2G2G vs. 1G1G: OR = 2.06, 95% CI 1.41-3.01, P < 0.01). CONCLUSION MMP-1 (-1607) 1G/2G SNP has close relationship with HNC susceptibility, people who with 2G2G genotype carriers are susceptible to HNC.
Asia ; Asian Continental Ancestry Group ; Case-Control Studies ; Genotype ; Head and Neck Neoplasms ; enzymology ; ethnology ; genetics ; Humans ; Matrix Metalloproteinase 1 ; genetics ; Polymorphism, Single Nucleotide ; Promoter Regions, Genetic