Objective To discuss the clinical value of tumor burden score(TBS)in predicting the prognosis of patients with early-to-middle hepatocellular carcinoma(HCC)after receiving transcatheter arterial chemoembolization(TACE)combined with microwave ablation(MWA).Methods The clinical data of 79 HCC patients,who received TACE combined with MWA at the Affiliated Nantong Third Hospital of Nantong University of China from January 2013 to December 2019,were retrospectively analyzed.Time-dependent ROC curve and area under the ROC curve(AUC)were used to evaluate the accuracy of TBS(TBS2=maximum tumor diameter2+number of tumor lesions2)in predicting 5-year survival and tumor-free survival.The optimal cut-off value of TBS was selected according to K-Means method,and the HCC patients were divided into three groups for survival analysis.Cox multivariate analysis screened out the independent factors affecting the prognosis of HCC patients after receiving TACE combined with MWA.Results ROC curve statistics showed that the AUC of TBS in predicting the 5-year survival rate of HCC patients after receiving TACE combined with MWA was 0.815,which was the best value,the AUC of maximum tumor diameter was 0.684,and the AUC of tumor number was 0.640.According to the optimal cut-off value,79 HCC patients were divided into three groups:TBS≤1.9 points(n=34,43.1％,group A),1.9＜TBS≤ 3.3 points(n=25,31.6％,group B),and TBS＞3.3 points(n=20,25.3％,group C).The survival analysis indicated that the 5-year overall survival rate in group A,group B and group C was 76.5％,56.7％and 6.3％respectively.With the increase of TBS value,the 5-year survival rate of patients decreased gradually.The differences in the 5-year survival rate between each other among the three groups were statistically significant(P＜0.05).The differences in the tumor-free survival rate between each other among the three groups were also statistically significant(P＜0.05),besides,with the increase of TBS value,the tumor-free survival rate decreased gradually.Multivariate analysis revealed that TBS was an independent factor affecting the overall survival rate and tumor-free survival rate in HCC patients after receiving TACE combined with MWA.Conclusion TBS can well predict the prognosis of HCC patients after receiving TACE combined with MWA.

Objective To discuss the clinical efficacy and safety of hepatic arterial infusion chemotherapy(HAIC)combined with carrelizumab and sorafenib in treating advanced hepatocellular carcinoma(HCC).Methods The clinical data of 36 HCC patients,who were admitted to the Affiliated Nantong Third Hospital of Nantong University of China to receive HAIC combined with carrelizumab and sorafenib from August 2019 to August 2020,were collected.According to modified Response Evaluation Criteria in Solid Tumors(mRECIST),the objective response rate(ORR)and disease control rate(DCR)of the combination therapy were evaluated.The Common Terminology Criteria Adverse Events Version 5.0 developed by American National Cancer Institute was used to evaluate the clinical safety.Results After receiving 4 cycles of FOLFOX-HAIC,the ORR and DCR of the patients were 38.9％and 77.8％respectively.The patients were followed up for 30 months.The median progression-free survival(mPFS)was 306 days(95％CI:242.7-369.3),and the median overall survival(mOS)was 515 days(95％CI:2 482.5-547.5).After HAIC treatment,one patient was successfully changed to surgical operation.The overall incidence of adverse events were 100％.There were 9 adverse events(25％)above grade m,including severe abdominal pain(n=2,5.6％),nausea(n=1,2.8％),vomiting(n=1,2.8％),elevated alanine aminotransferase(n=3,8.3％),elevated aspartate aminotransferase(n=1,2.8％),and death due to pulmonary failure caused by severe immune-induced pneumonia(n=1,2.8％).Conclusion For the treatment of advanced HCC,HAIC combined with carrelizumab and sorafenib has better ORR and DCR with controllable safety,which provides a new option for the treatment of advanced HCC.However,studies with large sample size need to be conducted before its long-term survival benefit of patients can be further validated.

Objective:To explore an early, rapid and accurate detection method of severe acute respiratory syndrome coronavirus 2 (2019-nCoV) antigen and improve the detection rate of patients with 2019-nCoV.Methods:We detected the characteristics of monoclonal antibodies (mAbs) against 2019-nCoV generated previously and established a double antibody sandwich ELISA against S protein of the virus.Results:All 12 mAbs against 2019-nCoV screened in our previous study were able to recognize purified virion and S protein. They were good candidates for detecting antibody to 2019-nCoV antigen. A double antibody sandwich ELISA established in this study could rapidly and effectively detect 2019-nCoV S protein with high sensitivity. The detection limit of 2019-nCoV S protein was lower than 1 ng/ml.Conclusions:This method could specifically detect 2019-nCoV antigen, and provided a meaningful reference for early, sensitive and specific diagnosis of COVID-19 infection.

BACKGROUND: At present, extrusion is widely used in total knee arthroplasty. Studies have shown that extrusion can aggravate early pain and increase the risk of complications after operation. Therefore, a safer and more effective method it is urgently needed in clinic. OBJECTIVE: To observe the effects of elevation and extrusion of blood-expelling method on clinical outcomes during total knee arthroplasty. METHODS: Sixty-four patients who were scheduled to undergo unilateral total knee arthroplasty for the first time were randomly divided into two groups. During total knee arthroplasty, the control group received extrusion method, while the experimental group received elevation method. The main outcomes of the two groups were compared: Visual analogue scale score, knee joint swelling, C-reactive protein, serum creatine kinase activity and postoperative complications; secondary outcomes: Tourniquet use time, Hospital for Special Surgery score, and SF-36 score. RESULTS AND CONCLUSION: (1) Visual analogue scale scores in the experimental group were significantly lower than those in the control group on the first day, the seventh day, the first month and the third month after operation (P < 0.05). (2) Knee swelling, serum creatine kinase and C-reactive protein increased in both groups after operation, but the increase in experimental group was significantly lower than that in control group (P < 0.05). (3) In terms of postoperative complications, the incidences of tension vesicles and deep vein thrombosis in the control group were higher than those in the experimental group (P < 0.05). The total complication rate was significantly higher in the control group than in the experimental group (P < 0.05). (4) There was no significant difference in tourniquet use time between the two groups (P> 0.05). (5) Hospital for Special Surgery score and SF-36 score were assessed at 1, 3 and 6 months. The results showed that it was better than before, but there was no significant difference between the two groups (P > 0.05). (6) In conclusion, elevation of blood-expelling method could alleviate early pain response, reduce inflammation reaction and soft tissue injury, and decrease the incidence of skin tension blisters and thromboembolism. It is in line with the concept of rapid recovery. Therefore, during total knee arthroplasty, elevation of blood-expelling method is a safer and more effective method than extrusion.

The medical imaging technology (MIT) specialty hasn't been set up for a long time in China, and the mode of educating students in other institutions vary greatly among different universities. There are several disadvantages in MIT specialty set up in the Affiliated hospitals of universities, such as unreasonable curriculum system, imperfections in teaching and research department, and inadequate guidance on students' innovation ability. Therefore, the solutions for alleviating the above problems that are unfavorable factors to education are proposed, so as to further improve the model of MIT specialty set up in the affiliated hospitals of universities and produce more competent graduates.

Hantavirus disease is a globally distributed, natural foci-related infectious disease caused by hantavirus, that maintaining persistent infections in their rodent hosts without apparent disease symptoms but seriously affecting the health safety of human beings. Development of the disease depends on the interaction between virus, rodent host and the individual person. Factors as significant geographical and seasonal variations, certain periodicity and contingency can all be related to the incidence of hantavirus disease. The disease is affected by climate and meteorological,environment, economic and social development, human life style and individual behaviors, etc.. Results from the analysis on main influencing factors and the nature of epidemics provide as with more evidence and information in setting up programs onto timely implementation of related prevention and control measures scientifically. By searching relevant scientific and technological literature, this paper summarizes the factors that affecting the nature of transmission and infection of hantavirus from related perspectives and factors including virus, host, climate and meteorological, meteorology, geographical environment, economic and social factors, etc.. In order to elaborate on the understanding of the epidemics and transmission characteristics of this kind of diseases, this paper provides evidence on prediction, prevention and control measures of hantavirus disease.

Objective: To establish a fluorescent bead-based multiplex assay for the simultaneous detection of seven viral diseases endemic in Africa. Methods: The genomic sequences of the viral pathogens causing Rift valley fever, Yellow fever, Marburg virus disease, Ebola virus disease, Lassa fever, Crimean-Congo hemorrhagic fever and Chikungunya fever were compared, PCR detection target fragments were selected, and amplification primers and hybrid probes were designed. The reference samples of related pathogens were prepared by chemical synthesis of DNA and in vitro transcription RNA. The sensitivity and stability of the detection method were evaluated. The specificity was evaluated by testing 30 samples of suspected dengue fever, and hantavirus diseases, and 32 healthy human blood samples. Results: The fluorescent bead-based multiplex assay could specifically detect the corresponding pathogen, the detection limit was at a range of 10²-10⁵ copies/ μl, the specificity was 100%, and the intra-assay coefficient of variation was below 12%, and the inter-assay coefficient of variation was below 15%. Conclusions A fluorescent bead-based multiplex PCR assay for the simultaneous detection of seven viral diseases endemic in Africa was established, which may provide a new choice for the screening of suspected infectious diseases.

Objective: To investigate the effect of miR-124 on the invasion and migration of esophageal cancer KYSE170 cells by regulating autophagy. Methods: miR-124 mimic was transfected into esophageal cancer KYSE170 cells. Transwell assay was used to detect the change of invasion and migration ability of cells. Dual luciferase reporter gene assay was used to verify the targeted regulation of BECN1 (Beclin1) by miR-124, and Western blotting was used to analyze the expressions of BECN1, P62 and LC3 protein. siRNA targeting BECN1 was transfeted into KYSE170 cells, and then the cell invasion and migration ability was calculated by Transwell assay. The expressions of BECN1, P62 and LC3 protein were detected by Western blotting. miR-124 mimic and BECN1 over-expression plasmid were co-transfected into KYSE170 cells, and then Transwell assay was used to detect the changes of cell invasion and migration ability, and Western blotting to examine the expression levels of autophagy-related gene. Results: The invasion and migration ability of KYSE170 cells were significantly inhibited after transfection with miR-124 mimic (All P<0.05). The expression of autophagyrelated protein P62 was increased, and the expression of BECN1 and LC3 was significantly decreased (All P<0.01); in addition, the activity of luciferase reporter gene was also significantly reduced (P<0.01). Silencing BECN1 expression inhibited the invasion and migration of esophageal cancer KYSE170 cells (P<0.01). However, after co-transfection with BECN1 over-expression plasmids, the effects of miR-124 mimic on the autophagy, invasion and migration of esophageal carcinoma KYSE170 cells were significantly weakened (P<0.01), it was also accompanied with lower P62 expression, and higher LC3 expression (P<0.01). Conclusion: miR-124 mimic can inhibit the invasion and migration of esophageal carcinoma cells. The mechanism may be related to the autophagy-related gene BECN1 expression.

Objective To investigate the combined effects of somatostatin (SST) and cisplatin (DDP) on proliferation and apoptosis in gallbladder cancer cells,and to investigate the mechanism of the combined effects.Methods We performed immunohistochemistry to detect the PTEN expression in gallbladder cancer.We then investigated the combined effects of SST and DDP on cell proliferation in vitro with CCK-8 assay and analyzed the interaction between these two drugs using isobologram analysis.We also investigated the combined effects on cell proliferation in vivo using a xenograft nude mouse model.FITC-Annexin V/PI assay and TUNEL staining assay were performed to detect the proportion of apoptosis after combined treatment in vitro and in vivo.Reactive oxygen species and mitochondrial membrane potential were detected with DCFH-DA assay and JC-1 staining assay after the combined treatment.We finally detected the PTEN and p-AKT associated proteins using western blotting after the combined treatment.Results PTEN was abnormally decreased in gallbladder cancer tissues.PTEN expression was negatively correlated with cancer differentiation and was positively correlated with patients'survival time.DDP treatment decreased while combined treatment with SST induced PTEN expression and inhibited AKT activation by reversing resistance to DDP.Isolated SST or DDP treatment inhibited gallbladder cancer GBC-SD and SGC996 cell proliferation which was dose-dependence.These two drugs synergistically inhibited gallbladder cancer cell growth in vivo and in vitro.Isolated SST or DDP treatment induced cell apoptosis and combined treatment induced cell apoptosis the most.SST inhibited AKT activation but did not induce ROS.DDP induced ROS resulting in increased cell apoptosis.Either SST or DDP alone increased the levels of cytoplasmic cytochrome C protein and activated caspase-3.Conclusions SST enhanced growth inhibition by cisplatin in gallbladder cancer cells through inducing PTEN expression.This study provides the theoretical basis for further combined clinical chemotherapeutic applications.

Objective To investigate the predictive value of preoperative serum tumor markers test for lymph node metastasis of intrahepatic cholangiocarcinoma (ICC).Methods The retrospecgtive cohort study was conducted.The clinicopathological data of 69 patients with ICC who were admitted to the Xinhua Hospital of Shanghai Jiaotong University between May 2006 and May 2016 were collected.Among 69 patients with pathological diagnosis,24 with lymph node metastasis were allocated into the lymph node metastasis group and 45 without lymph node metastasis were allocated into the non-lymph node metastasis group.Tumor markers of the 2 groups were preoperatively detected,including alpha-fetoprotein (AFP),carcinoembryonic antigen (CEA),prostate specific antigen (PSA),CA19-9,CA125,CA242,CA153,CA724,CA211,neuron-specific enolase (NSE) and squamous cell carcinoma antigen (SCC).Receiver operating characteristic (ROC) curve was built,and critical value,sensitivity and specificity were calculated based on ROC curve.Coincident rate between significant indicators and results of pathological examination was calculated.Observation indicators:(1) overall positive rates of tumor markers;(2) comparison of tmmor markers levels in the 2 groups;(3) tumor markers predicted ROC curve of lymph node metastasis and coincident rate between ROC curve and results of postoperative pathological examination.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (Q25,Q75) and comparison between groups was analyzed using the Wilcoxon rank sum test.Comparison of count data was analyzed by the chi-square test and Fisher exact probability.The statistically significant indicators were analyzed by the ROC curve.Results (1) Overall positive rates of tumor markers:positive rates of AFP,CEA,PSA,CA19-9,CA125,CA242,CA153,CA724,CA211,NSE and SCC in 69 patients were 27.5％ (19/69),29.0％ (20/69),4.3％ (3/69),69.6％ (48/69),36.2％ (25/69),50.7％ (35/69),26.1％ (18/69),21.7％ (15/69),62.3％ (43/69),31.9％(22/69) and 21.7％(15/69),respectively.Positive rates of AFP,CEA,CA19-9,CA125,CA242,CA153,CA724,CA211,NSE and SCC were more than 20％,which became comparison indicators of 2 groups.(2) Comparison of tumor markers levels in the 2 groups:levels of CA19-9,CA125,CA242 and CA211 were 284.9 U/mL (42.5 U/mL,730.3 U/mL),63.6 U/mL (23.4 U/mL,172.1 U/mL),71.7 U/mL (25.6 U/mL,138.9 U/mL),6.7 μg/L (3.9 μg/L,17.5 μg/L) in the lymph node metastasis group and 58.0 U/mL (25.9 U/mL,405.9 U/mL),18.2 U/mL (11.7 U/mL,33.8 U/mL),11.0 U/mL (3.7 U/mL,41.7 U/mL),3.7 μg/L (2.7 μg/L,6.9 μg/L) in the non-lymph node metastasis group,respectively,with statistically significant differences between the 2 groups (Z=2.016,3.213,3.143,2.482,P＜0.05).(3) Tumor markers predicted ROC curve of lymph node metastasis and coincident rate between ROC curve and results of postoperative pathological examination:area under the ROC curve of CA19-9,CA125,CA242 and CA211 were respectively 0.648 [95％ confidence interval (C I):0.515-0.781,P＜0.05],0.736 (95％ CI:0.608-0.864,P＜0.05),0.731 (95％ CI:0.603-0.859,P＜0.05),0.714 (95％ CI:0.581-0.847,P＜0.05).The positive critical value,sensitivity and specificity of CA19-9,CA125,CA242 and CA21 were 150.6 U/mL,35.7 U/mL,43.4 U/mL,6.0 μg/L and 62.5％,66.7％,70.8％,62.5％ and 71.1％,82.2％,77.8％,75.6％,respectively.The coincident rate between ROC curve and results of postoperative pathological examination of CA 19-9,CA 125,CA242 and CA211 were 68.1％ (47/69),76.8％(53/69),75.4％(52/69),71.0％(49/69),respectively.Conclusion The levels of serum CA19-9,CA125,CA242 and CA211 can effectively predict lymph node metastasis of patients with ICC.