Objective:To explore the heterogeneity among keloids before and after radiotherapy and identify the changes of key cell subpopulations and their interactions utilizing single cell RNA sequencing technology.Methods:Four patients provided a total of 12 samples, each consisting of keloid tissue before and after radiotherapy and the normal skin tissue adjacent to the untreated keloid. The keloid was divided into left and right sides from the midline, and the left-side keloid was fractionally irradiated with 20 Gy electron beam in total in 4 consecutive days. The right-side keloid was irradiated with 10 Gy in 2 fractions before surgery and 10 Gy in 2 fractions after surgery.Results:A total of 25 573 fibroblasts were analyzed and categorized into nine subgroups (fibroblasts 1-9). The proportion of fibroblast-2 increased after radiotherapy ( t=4.70, P<0.05). The number of classical monocytes and macrophages increased after radiotherapy, but there was no significant difference due to the shorter time of sample taking at 2 d after radiotherapy ( P>0.05). Macrophages (4 723 cells) were further divided into four categories. CellPhoneDB analysis showed that type-3 macrophages interacted significantly more closely with fibroblasts than type-1 and type-2 macrophages. The most prominent signaling pathways for the interactions between type-3 macrophages and major fibroblast subtypes were the collagen signaling pathway and the chemerin signaling pathway. These interactions were more pronounced in the keloid samples after radiotherapy. Conclusions:The interactions between type-3 macrophages and fibroblasts (such as fibroblast-2) may serve as an important point for future studies on radio-sensitization of keloids.

BACKGROUND: Keloids are benign fibrous growths that are caused by excessive tissue build-up. Severe keloids exert more significant effects on patients' quality of life than do mild keloids. We aimed to identify factors associated with the progression from mild keloids to severe keloids, as distinct from those associated with the formation of keloids. METHODS: In this retrospective case-control study, 251 patients diagnosed with keloids at West China Hospital between November 2018 and April 2021 were grouped according to the severity of lesions (mild [n = 162] or severe [n = 89]). We collected their basic characteristics, living habits, incomes, comorbidities, and keloid characteristics from Electronic Medical Records in the hospital and the patients' interviews. Conditional multivariable regression was performed to identify the independent risk factors for the progression of keloids. RESULTS: Eighty-nine patients (35.5%) were classified as having severe keloids. We found the distribution of severe keloids varied with sex, age, excessive scrubbing of keloids, family income, the comorbidity of rheumatism, disease duration, characteristics of the location, location in sites of high-stretch tension, the severity and frequency of pain, the severity of pruritus, and infection. Multivariable analysis revealed significant associations between severe keloids and infection (odds ratio [OR], 3.55; P = 0.005), excessive scrubbing of keloids (OR, 8.65; P = 0.001), low or middle family income (OR, 13.44; P = 0.021), comorbidity of rheumatism (OR, 18.97; P = 0.021), multiple keloids located at multiple sites (OR, 3.18; P = 0.033), and disease duration > 15 years (OR, 2.98; P = 0.046). CONCLUSION Doctors should implement more active and thorough measures to minimize the progression of mild keloids in patients who have any of the following risk factors: infection, excessive scrubbing of keloids, low or middle family income, comorbidity of rheumatism, multiple keloids located at multiple sites, and disease duration > 15 years.
Case-Control Studies ; Humans ; Keloid/epidemiology* ; Quality of Life ; Retrospective Studies ; Rheumatic Diseases ; Risk Factors

Objective:To establish a lectin enzyme-linked immunosorbent assay (lectin-ELISA) for the dection of sialylated fetuin-A and to explore the clinical diagnostic value of sialylated fetuin-A in hepatocellular carcinoma (HCC).Methods:From January 2017 to December 2020, 300 HCC patients and 160 disease controls, including 36 liver cirrhosis subgroups and 124 chronic hepatitis B subgroups, were collected from Shanghai Eastern Hepatobiliary Surgery Hospital. At the same time, 100 healthy subjects were collected as healthy controls. Lectin-ELISA method for detecting sialylated fetuin A was established based on the principle that Sambucus nigra lectin (SNA) can recognize the structure of α-2, 6-linked sialic acid residues. Differences between groups were compared using t-test or analysis of variance. Logistic regression method was used to establish the multi-index joint detection model, and receiver operating characteristic curve (ROC) was used to evaluate the efficacy of single index and joint detection model in the diagnosis of HCC.Results:A lectin-ELISA method for the detection of serum Sia-fetuin A was established. The linear regression coefficient of the system was 0.978 5, and the precision evaluation and interference experiments were in line with the clinical detection requirements. Using this method to detect serum Sia-fetuin A levels in each group, the levels of HCC group, disease control group and healthy control group were 1.362±0.310, 1.199±0.370, 1.086±0.420, respectively, and the three groups decreased in turn. The areas under the curve of Sia-fetuin A, α-fetoprotein, and their combined detection models for differential diagnosis of HCC were 0.790, 0.809, and 0.860, respectively. The diagnostic model had a sensitivity of 79.3% (238/300) and a specificity of 95.0% (247/260). Among the 300 patients in the HCC group, 138 (46%) patients were negative for serum AFP (<20 μg/L), and their serum Sia-fetuin A level was 1.364±0.305. Combining the disease control group and the healthy control group into the non-Cancer group, the serum Sia-fetuin A level was 1.146±0.381. The serum level of Sia-fetuin A in AFP-negative HCC patients was higher than that in non-HCC group ( t=6.134, P<0.001). The areas under the curve of Sia-fetuin A and the combined diagnostic model for the diagnosis of AFP-negative HCC were 0.776 and 0.919, respectively. The combined diagnostic model had a sensitivity of 93.4% (129/138) and a specificity of 77.3% (201/260). Conclusion:Serum Sia-fetuin A and combined determination model can provide a new auxiliary diagnostic index for AFP-negative HCC.

Objective:To study the change of bifrontal metabolite concentration in patients with mild cognitive impairment (MCI) and its relationship with substantia alba demyelination using magnetic resonance spectroscopy (MRS) combined with linear combination of model (LCModel) quantitative technique.Methods:From May 2016 to December 2018, 25 patients with MCI (group A; 12 males, 13 females, age (60.5±5.2) years) and 15 healthy control subjects (group B; 6 males, 9 females, age (59.5±3.5) years) in the Second Affiliated Hospital of Shantou University Medical College were prospectively enrolled. The MCI patients were classified into 2 subgroups according to MRI results: group A1 with substantia alba demyelination (7 males, 4 females, age (62.1±3.9) years) and group A2 without substantia alba demyelination (5 males, 9 females, age (59.2±5.8) years). Software LCModel was used to quantitatively analyze the MRS original data and measure the absolute concentration of N-acetylaspartate compound (NAA), creatine compound (Cr), choline-containing compound (Cho), myoinositol (mI) and ratios of NAA/Cr, Cho/Cr, mI/Cr, NAA/mI in bilateral frontal lobe. Independent-sample t test was used to analyze the inter-group differences of the above parameters, while Pearson correlation analysis was performed to analyze correlations between the above parameters and cognitive function scores. Results:Compared with group B, group A had higher mI of both left and right frontal lobes (left: (5.19±1.28) vs (4.32±0.83), right: (4.87±1.11) vs (3.85±0.98); t values: 2.34, 2.93, both P<0.05); the mI/Cr of right frontal lobe in group A was also higher (1.19±0.31 vs 0.98±0.25; t=2.21, P<0.05), while the NAA/mI of right frontal lobe was lower (1.37±0.34 vs 1.78±0.47; t=-3.16, P<0.01). Differences of other parameters between group A and group B, and those between group A1 and group A2 were not significantly different ( t values: -1.70 to 1.35, all P>0.05). The mI of right frontal lobe was negatively correlated with Montreal Cognitive Assessment (MoCA) score and Mini-Mental State Examination (MMSE) score( r values: -0.35, -0.38, both P<0.05), on the contrary, NAA/mI of right frontal lobe was positively correlated with the cognitive function scores ( r values: 0.43, 0.40, both P<0.05). Conclusion:MCI may be related to the loss or dysfunction of neurons in the right frontal lobe, and MRS can provide theoretical basis for early recognition of MCI to some extent.

Alzheimer's disease (AD) is the most common senile neurodegenerative disease characterized by progressive cognitive dysfunction, psychological and behavioral abnormalities, and impaired ability of activities of daily living. A family with a total of 3 patients were admitted to the Department of Neurology of Xiangya Hospital, Central South University in 2018. The proband showed memory decline as the presenting symptoms, and subsequently showed psychological and behavioral abnormalities, personality changes, seizures, and motor retardation. Definite diagnosis of early-onset familial AD (EOFAD) with missense mutation of presenilin 2 (PSEN2) (c.715A>G p.M239V) was established by whole exome sequencing (WES) technology. We reported the mutation in Chinese Han population for the first time, which expanded the mutation spectrum ofPSEN2 gene and aid to enrich the characterization of clinical phenotype in EOFAD associated to PSEN2 mutations. Patients with early onset age and complex clinical manifestations of AD can be diagnosed with the help of genetic testing to avoid misdiagnosis.
Activities of Daily Living ; Alzheimer Disease/genetics* ; Humans ; Mutation ; Neurodegenerative Diseases ; Presenilin-1/genetics* ; Presenilin-2/genetics*

Objective To investigate the significance of whole mount sections after radical prostatectomy in the diagnosis of prostate cancer.Methods The data of 210 patients with radical prostatectomy in the Department of Urology of Northern Jiangsu People's Hospital from April 2018 to July 2015 were collected,of which 150 cases (control group) were examined with routine tissue section examination and 60 cases (study group) were examined with whole mount sections.The age of the study group and the control group were (69.0 ± 5.0) years and (70.0 ± 7.0) years respectively,and PSA was (18.8 ± 2.5) ng/ml and (19.3 ± 2.1) ng/ml respectively.The BMI of the study group was (23.0 ± 1.2) kg/m2,and the control group was (22.8 ± 0.6) kg/m2.The preoperative Gleason score of the study group and the control group were 7.9 ±0.9 and 7.7 ± 1.6 respectively.There were 137 patients (91.3％) with clinical stage cT1-T2 and 13 patients with cT3(8.7％) in control group.In the study group,there were 51 cases (85.0％) with clinical stage cT1-T2,and 9 cases with cT3 (15.0％).There was no significant difference between the two groups (P ＞ 0.05) in term of the patients' demographics.The postoperative Gleason score,positive surgical margin,seminal vesicle invasion lymph node metastasis and pathological stage were compared between the two groups.Results The median prostate volume of the study group was 45.2 (18.3-121.5) ml,and 47.1 (2 1.3-124.2) ml in the control group.The operation time of the study group was 138.2 (119.5-234.1) mins,and 133.5 (116.8-228.2) mins in the control group.In the control group,there were 8 cases(5.3％) with seminal vesicle invasion,and 8 cases (5.3％) with lymph node metastasis.The pathological stages were pT2-T3 in 145 cases(96.7％),and pT4 in 5 cases (3.3％) in control group.The postoperative Gleason score was 8.0 ± 0.9 in control group.In the study group,17 patients (28.3％) with seminal vesicle invasion were pathologically indicated,and there were 6 patients (10.0％) with lymph node metastasis.The pathological stages were pT2-T3 of 57 cases(95.0％),and pT4 of 3 cases (5.0％),postoperative Gleason score was 7.7 ± 1.0 in study group.There was no statistically significant difference in seminal vesicle invasion,lymph node metastasis,pathological stage and postoperative Gleason score between the two groups (P ＞ 0.05).There were 23 patients (15.3％) with positive margins in the control group,and 28 patients(46.7％) in the study group,which showed significant difference (P ＜0.01).For small lesions,there were 7 cases (4.7％) and 22 cases (36.7％) in the control group and the study group,respectively,which showed significant difference (P ＜ 0.01).There were 17 cases (28.3％) of increased Gleason score in the study group,while 31 cases (20.7％) in the control group,with no statistical difference (P =0.232).Conclusions The whole mount section technique can effectively improve the positive surgical margin and the small lesions detection rate in the pathological evaluation of radical prostatectomy,and provide a precise pathological diagnosis for the postoperative treatment and follow-up of the patients.

MicroRNA (miRNA) is a kind of small non-coding RNA that regulates gene expression at the posttranscriptional level through inhibition of translation or degradation of messenger RNA.MiRNA is involved in the regulation of many cellular biological processes,and its abnormal expression closely relates to development of tumors.MiR-483 plays an important role in the tumorgenesis or development,meanwhile,its role in digestive system tumors has aroused widespread attention.

OBJECTIVETo compare the long-term survival and postoperative complications of distal gastric cancer patients between Billroth I((BI() and Billroth II((BII() reconstruction.

METHODSClinicopathological data of 992 patients with distal gastric cancer who underwent D2 curative gastrectomy in our department from May 2008 to April 2015 were recorded, including 207 patients of BI( reconstruction and 785 of BII( reconstruction, were retrospectively analyzed. Patients presenting a previous history of cancer, gastric resection or cytotoxic chemotherapy, and those presenting liver or intraperitoneal tumor dissemination or unresectable infiltration into contiguous organs were excluded. Patients in BI( and BII( group were selected using gmatch methods based on age (±10 years), gender, tumor size (±1 cm), differentiated degree and depth of invasion in order to reduce the selection bias of clinicopathological characteristics. The final number of patients matched was 191 respectively.

RESULTSCompared with BII( group, the BI( group had a significantly shorter operation time (181.7 min vs. 220.7 min, P=0.000) and a shorter postoperative hospitalization stay (7.6 days vs. 8.1 days, P=0.046). The postoperative complications including anastomotic leakage, wound dehiscence, wound infection, intraperitoneal hemorrhage, intestinal obstruction, duodenal stump fistula, pulmonary infection and fever had no significant difference(P>0.05). Three-year survival between two groups was comparable (82.9% vs. 78.7%, P=0.379).

CONCLUSIONSCompared with BII(, BI( reconstruction is more suitable for patients with distal gastric cancer.

Gastrectomy ; Gastroenterostomy ; Humans ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Stomach Neoplasms ; surgery

OBJECTIVETo identify the risk factors of esophagojejunal anastomotic leakage (EJAL) and its impact on prognosis of gastric cancer patients after curative total gastrectomy.

METHODSClinical and follow-up data of 1254 gastric cancer patients who underwent radical total gastrectomy at the Department of Digestive Surgery, Xijing Hospital, from January 2012 to May 2015 were retrospectively collected. Risk factors of EJAL and prognostic factors of patients were analyzed respectively. In order to reduce the influences of other prognostic factors on survival, patients with and without EJAL were selected using Gmatch methods based on the results of prognostic factor analysis. Survival of those with or without EJAL was examined before and after match respectively.

RESULTSEJAL occurred in 31 of 1 254 patients(2.5%). The leakage was diagnosed at a median of 6 (range, 4-12) days after surgery. Multivariate analysis demonstrated that preoperative low serum albumin(<35 g/L)(P=0.018), pulmonary insufficiency(P=0.006), long duration of operation(≥240 min)(P=0.001) were independent risk factors of EJAL. All the patients were followed up for 3-40(median 18) months. Multivariate analysis showed that age(≥65, P=0.000), intraoperative blood transfusion (P=0.016), EJAL (P=0.000), tumor location (distal, P=0.020; total, P=0.001), depth of invasion (T4, P=0.005) and lymph node metastasis (N2, P=0.002, N3, P=0.000) were prognostic predictors. Twenty-six patients with EJAL were successfully matched to 104 patients without EJAL in a ratio of 1/4 ratio. Patients with EJAL had a significantly worse overall 3-year survival rate than those without (44.3% vs. 66.7%, P=0.002).

CONCLUSIONSEJAL after curative total gastrectomy leads to worse survival. Patients with preoperative low serum albumin, pulmonary insufficiency and long duration of operation should be taken care of during perioperative period to prevent the occurrence of EJAL.

Aged ; Anastomotic Leak ; Female ; Gastrectomy ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; surgery ; Survival Rate

OBJECTIVETo compare the survival rate of proximal gastrectomy and total gastrectomy in the treatment of esophagogastric junction (EGJ) adenocarcinoma (Siewert II( types), and to provide reference for clinical choice.

METHODSA total of 533 patients with Siewet II( type EGJ adenocarcinoma were screened. All the patients underwent radical operations and were pathologically diagnosed as Siewet II( type EGJ adenocarcinoma in Xijing Hospital of Digestive Diseases from May 2008 to March 2014. These patients all had complete followed-up data. Finally, 234 patients were enrolled into the retrospective study, and divided into proximal gastrectomy group(117 patients) and total gastrectomy group (117 patients) based on the matching of age, sex, tumor size, TNM staging, and differentiation. The survival rate was compared between the two groups.

RESULTSIn proximal gastrectomy and total gastrectomy group, the overall 3-year survival rate was 65.6% and 62.6% respectively, and the overall 5-year survival rate was 53.8% and 44.5% respectively. No significant difference was found between the two groups (P=0.768). In subgroup analyses of 3-year survival rate between proximal gastrectomy group and total gastrectomy group, the results were as follows: 72.8% and 80.4% respectively (P=0.423) for tumor diameter ≤4 cm, 57.9% and 46.5% (P=0.239) for tumor diameter >4 cm, 83.3% and 83.3% (P=0.998) for high differentiated EGJ adenocarcinoma, 68.2% and 53.3% (P=0.270) for moderate differentiated EGJ adenocarcinoma, 56.1% and 69.6% (P=0.280) for poorly differentiated EGJ adenocarcinoma, 64.8% and 56.0% (P=0.451) for mucinous EGJ adenocarcinoma, 80.0% and 76.9% (P=0.912) for T1-2 stage EGJ adenocarcinoma, 64.3% and 60.4% (P=0.610) for T3 stage, 50.0% and 62.5% (P=0.953) for T4a stage, 92.3% and 100% (P=0.380) for stage I( EGJ adenocarcinoma, 79.6% and 66.3%(P=0.172) for stage II(, 42.6% and 49.5% (P=0.626) for stage I I(. All above differences between the two groups were not significant(all P>0.05).

CONCLUSIONProximal gastrectomy and total gastrectomy are comparable in terms of 3-year and 5-year survival rates.

Adenocarcinoma ; diagnosis ; surgery ; Esophageal Neoplasms ; diagnosis ; surgery ; Esophagogastric Junction ; pathology ; surgery ; Gastrectomy ; Humans ; Neoplasm Staging ; Retrospective Studies ; Stomach Neoplasms ; diagnosis ; surgery ; Survival Rate