Cholesterol,as an important component of cell membranes,plays a multifaceted role in mediating tumor immunomodulation and drug intervention.In case of cholesterol metabolic imbalance,the accumulation of cholesterol metabolic intermediates,the changes in concentrations,and the regulation of related signaling pathways can affect tumor immunity by promoting inflammation and inhibiting immune cell function.Preclinical and clinical studies have shown that controlling cholesterol metabolism can inhibit tumor growth,re-shape body immune regulation,and enhance antitumor immunity.A deep understanding of the association between immune cells and cholesterol metabolic pathways in the tumor microenvironment can help to develop novel drugs targeting cholesterol metabolism.This article reviews the multifaceted role of cholesterol and its derived metabolites in the tumor microenvironment by regulating various types of immune cells such as myeloid-derived suppressor cells,tumor-associated macrophages,dendritic cells,and T-lymphocytes,as well as the characteristics of tumor immunomodulation mediated by cholesterol metabolism and the advances in pharmaceutical re-search on improving the immune function of the body by intervening against cholesterol,in order to further provide new ideas and a thera-peutic basis for cholesterol modulation and intervention in tumor im-munotherapy.

Given the pivotal role of management accounting in optimizing economic operation of public hospitals,this study delves into the construction and application of an economic operation analysis system for public hospitals from the perspec-tive of management accounting.Three key aspects are explored to construct a systematic framework for the economic operation a-nalysis system of public hospitals:building foundational conditions,establishing a scientific,and rational indicator system,and applying diversified analysis methods.By conducting an in-depth case study of a representative sample hospital,this research summarizes the practical experience in constructing and implementing the economic operation analysis system and proposes feasi-ble management suggestions.This study aims to provide a practical guidance for public hospitals to further enhance their economic operation analysis and evaluation processes.

Given the pivotal role of management accounting in optimizing economic operation of public hospitals,this study delves into the construction and application of an economic operation analysis system for public hospitals from the perspec-tive of management accounting.Three key aspects are explored to construct a systematic framework for the economic operation a-nalysis system of public hospitals:building foundational conditions,establishing a scientific,and rational indicator system,and applying diversified analysis methods.By conducting an in-depth case study of a representative sample hospital,this research summarizes the practical experience in constructing and implementing the economic operation analysis system and proposes feasi-ble management suggestions.This study aims to provide a practical guidance for public hospitals to further enhance their economic operation analysis and evaluation processes.

The incidence of inflammatory myofibroblastic sarcoma is low, and bladder origin is more rare. We reported a 58-year-old patient with painless gross hematuria for one week. Total abdominal CT examination showed soft tissue mass in the anterior wall of the bladder, which was considered as bladder cancer, and bladder tumor resection was performed. Postoperative pathology showed inflammatory myofibroblastic sarcoma. Therefore, radical cystectomy was performed because of the high degree of malignancy. There was no recurrence during 3 years follow-up.

Objective: To evaluate the safety and efficacy of helical tomotherapy using simultaneously integrated boost and simultaneous integrated protection technique in the treatment of unresectable biliary tract cancers. Methods: The data of 23 patients with unresectable biliary tract cancer who received tomotherapy-based hypofractionated radiotherapy at Comprehensive Cancer Centre of Drum Tower Hospital,the Affiliated Drum Tower Clinical College of Nanjing Medical University between February 2015 and October 2017 were analyzed. There were 10 males and 13 females, aged from 40 to 85 years(median:58 years). Pathological type included intrahepatic cholangiocarcinomas(n=11), gallbladder cancers(n=6),extrahepatic cholangiocarcinomas(n=6). The irradiated sites covered primary tumors and areas of local invasion,including metastatic lymph nodes which were confined to the abdominal or retroperitoneal space. Dose escalation was achieved using simultaneously integrated boost(SIB) technique, and simultaneous integrated protection(SIP)technique was used to protect gastrointestinal tracts and other adjacent organs. Cox regression modal and Kaplan-Meier analysis were used to analyze the associations between patients′ characteristics and overall survival(OS). Results: The median total radiation dose was 54 Gy(range: 28-72 Gy)and median biologically effective dose(BED)was 74.4 Gy(range: 37.8-115.2 Gy).The median planning target volume(PTV)was 445.79 cm³(range:126.02-950.12 cm³). Based on the various PTV,patients received 2.4-6.0 Gy/fraction with 8-28 fractions. The local control rate was 65.2% and the median OS was 11.3 months(range:2.1-31.9 months).The most common cause of death was out-field failure and only 3 patients died of in-field failures. The longest survival was 31.9 months. BED≥70 Gy significantly improved OS,compared to BED<70 Gy(16.8 months vs.5.1 months)(HR=0.146, 95%CI:0.028-0.762, P=0.022). No patients developed grade ≥4 toxicities. Conclusions Helical tomotherapy-based hypofractionated radiotherapy is effective and well tolerated for patients with unresectable biliary tract cancer. The dose escalation with higher BED could improve the survival for such patients.

Objective: To investigate the effect of long-chain non-coding RNA Fez family zinc finger protein 1 antisense RNA1 (lncRNA FEZF1-AS1) on the biological function of hepatocellular carcinoma (HCC). Methods: SMMC771 and BEL-7402 cells were transfected with sh-FEZF1-AS1 and OE-FEZF1-AS1, respectively. The expression of lncRNA FEZF1-AS1 was detected by real-time quantitative PCR. Cell proliferation was detected by Cell Counting Kit-8 (CCK-8), and apoptosis was detected by flow cytometry. The effects of lncRNA FEZF1-AS1 on invasion and migration were detected by Transwell and wound healing assays. The expression levels of adhesion molecules were detected by Western blot. The effect of lncRNA FEZF1-AS1 on the in vivo growth was verified by nude mice xenograft experiments. Results: The silencing or ectopic expression of lncRNA FEZF1-AS1 inhibited or promoted the proliferation of hepatocellular carcinoma cells. CCK-8 assay showed that the proliferation abilities of SMMC7721 and BEL-7402 cells in sh-FEZF1-AS1 transfection group significantly decreased, achieving (35.43±4.06)% and (34.68±3.97)%, respectively, on the fifth day. There were significant differences between sh-FEZF1-AS1 group and sh-NC group [52.21±8.46)% and (53.76±7.64)%] (all P<0.05). In contrast, the proliferation ability of SMMC7721 and BEL-7402 cells transfected with OE-FEZF1-AS1 was significantly increased, achieving (83.49±6.92)% and (80.31±3.13)%, respectively, on the fifth day. There were significant differences between OE-FEZF1-AS1 and OE-NC group [53.03±8.84)% and (55.11±7.09)%] (all P<0.05). The subsequent flow cytometry results showed that cell apoptotic rates of SMMC7721 and BEL-7402 cells transfected with sh-FEZF1-AS1 were (13.02±1.38)% and (11.88±1.29)%, respectively, which were significantly higher than those in sh-NC groups [(5.57±1.46)% and (8.06±1.42)%, respectively, all P<0.05]. In contrast, the apoptotic rates of SMMC7721 and BEL-7402 cells transfected with OE-FEZF1-AS1 were (3.01±0.39)% and (3.22±0.43)%, which were significantly lower than those in OE-NC groups [(6.68±0.96)% and (6.63±0.45)%, all P<0.05]. In addition, knockdown or overexpression of lncRNA FEZF1-AS1 expression inhibited or enhanced the migration and invasion abilities as well as the levels of adhesion molecules in hepatocellular carcinoma cells. After 30 days of feeding under the same conditions, the tumor volumes of sh-FEZF1-AS1 and sh-NC SMMC7721 cells xenograft mice models were (0.26±0.03) cm³ and (0.63±0.06) cm³, respectively, showing significant difference (P<0.05). The tumor volumes of sh-FEZF1-AS1 and sh-NC BEL-7402 cells were (0.31±0.02) cm³ and (0.72±0.08) cm³, and the difference was statistically significant (P<0.05). Conclusion lncRNA FEZF1-AS1 may strengthen the growth, migration and invasion of hepatocellular carcinoma cells.

Objective To investigate the effect of long?chain non?coding RNA Fez family zinc finger protein 1 antisense RNA1 ( lncRNA FEZF1?AS1) on the biological function of hepatocellular carcinoma (HCC). Methods SMMC771 and BEL?7402 cells were transfected with sh?FEZF1?AS1 and OE?FEZF1?AS1, respectively. The expression of lncRNA FEZF1?AS1 was detected by real?time quantitative PCR. Cell proliferation was detected by Cell Counting Kit?8 ( CCK?8), and apoptosis was detected by flow cytometry. The effects of lncRNA FEZF1?AS1 on invasion and migration were detected by Transwell and wound healing assays. The expression levels of adhesion molecules were detected by Western blot. The effect of lncRNA FEZF1?AS1 on the in vivo growth was verified by nude mice xenograft experiments. Results The silencing or ectopic expression of lncRNA FEZF1?AS1 inhibited or promoted the proliferation of hepatocellular carcinoma cells. CCK?8 assay showed that the proliferation abilities of SMMC7721 and BEL?7402 cells in sh?FEZF1?AS1 transfection group significantly decreased, achieving (35.43± 4.06)% and ( 34.68± 3.97)%, respectively, on the fifth day. There were significant differences between sh?FEZF1?AS1 group and sh?NC group [52.21 ± 8.46)% and (53.76 ± 7.64)%] ( all P＜0.05). In contrast, the proliferation ability of SMMC7721 and BEL?7402 cells transfected with OE?FEZF1?AS1 was significantly increased, achieving (83.49±6.92)% and (80.31 ± 3.13)%, respectively, on the fifth day. There were significant differences between OE?FEZF1?AS1 and OE?NC group [53.03 ± 8.84)% and ( 55.11 ± 7.09)%] ( all P＜0.05). The subsequent flow cytometry results showed that cell apoptotic rates of SMMC7721 and BEL?7402 cells transfected with sh?FEZF1?AS1 were ( 13.02 ± 1.38)% and ( 11.88 ± 1.29)%, respectively, which were significantly higher than those in sh?NC groups [(5.57±1.46)% and (8.06±1.42)%, respectively, all P＜0.05]. In contrast, the apoptotic rates of SMMC7721 and BEL?7402 cells transfected with OE?FEZF1?AS1 were (3.01 ± 0.39)% and ( 3.22 ± 0.43)%, which were significantly lower than those in OE?NC groups [(6.68±0.96)% and (6.63±0.45)%, all P＜0.05]. In addition, knockdown or overexpression of lncRNA FEZF1?AS1 expression inhibited or enhanced the migration and invasion abilities as well as the levels of adhesion molecules in hepatocellular carcinoma cells.After 30 days of feeding under the same conditions, the tumor volumes of sh?FEZF1?AS1 and sh?NC SMMC7721 cells xenograft mice models were (0.26±0.03) cm3 and (0.63±0.06) cm3, respectively, showing significant difference (P＜0.05). The tumor volumes of sh?FEZF1?AS1 and sh?NC BEL?7402 cells were (0.31±0.02) cm3 and (0.72±0.08) cm3, and the difference was statistically significant ( P＜0.05). Conclusion lncRNA FEZF1?AS1 may strengthen the growth, migration and invasion of hepatocellular carcinoma cells.

OBJECTIVE: To evaluate the efficacy and adverse effects of levonorgestrel-releasing intrauterine system (Mirena) in the treatment of adenomyosis. METHODS: The clinical data of 75 patients with adenomyosis who had Mirena insertion in Women's Hospital,Zhejiang University School of Medicine from September 2013 to December 2013 were retrospectively analyzed. The patients were followed up to 39 months. The efficacy and adverse effects were assessed. RESULTS: Pictorial Blood Loss Assessment Chart (PBAC) scores were decreased significantly after Mirena insertion both in patients with menorrhea (118±13 vs. 29±33, <0.01) and normal menstruation (82±15 vs. 14±13, <0.01); the patients with menorrhea showed a more significant decrease in PBAC score than those with normal menstruation (90±35 vs. 69±19,<0.01). The visual analogue scale (VAS) score decreased significantly after Mirena insertion compared with pre-treatment[7(6,7) vs. 1(0,2), <0.01]. The expulsion of Mirena occurred in 18 cases (24.0%); 9 cases (12.0%) had no effect and 28 cases (37.3%) had changes of menstruation patterns. Multivariate Cox regression analysis showed that the expulsion of Mirena was not associated with post-treatment VAS score, PBAC score before and after treatment or menstrual stabilization time (all >0.05). CONCLUSIONS Mirena is effective and safe in the long term management of adenomyosis, but about one third patients may require further treatment because of the expulsion or ineffectiveness of Mirena.
Adenomyosis ; Female ; Humans ; Intrauterine Devices, Medicated ; adverse effects ; standards ; Levonorgestrel ; administration & dosage ; adverse effects ; standards ; Retrospective Studies

Objective To investigate the effect of long?chain non?coding RNA Fez family zinc finger protein 1 antisense RNA1 ( lncRNA FEZF1?AS1) on the biological function of hepatocellular carcinoma (HCC). Methods SMMC771 and BEL?7402 cells were transfected with sh?FEZF1?AS1 and OE?FEZF1?AS1, respectively. The expression of lncRNA FEZF1?AS1 was detected by real?time quantitative PCR. Cell proliferation was detected by Cell Counting Kit?8 ( CCK?8), and apoptosis was detected by flow cytometry. The effects of lncRNA FEZF1?AS1 on invasion and migration were detected by Transwell and wound healing assays. The expression levels of adhesion molecules were detected by Western blot. The effect of lncRNA FEZF1?AS1 on the in vivo growth was verified by nude mice xenograft experiments. Results The silencing or ectopic expression of lncRNA FEZF1?AS1 inhibited or promoted the proliferation of hepatocellular carcinoma cells. CCK?8 assay showed that the proliferation abilities of SMMC7721 and BEL?7402 cells in sh?FEZF1?AS1 transfection group significantly decreased, achieving (35.43± 4.06)% and ( 34.68± 3.97)%, respectively, on the fifth day. There were significant differences between sh?FEZF1?AS1 group and sh?NC group [52.21 ± 8.46)% and (53.76 ± 7.64)%] ( all P＜0.05). In contrast, the proliferation ability of SMMC7721 and BEL?7402 cells transfected with OE?FEZF1?AS1 was significantly increased, achieving (83.49±6.92)% and (80.31 ± 3.13)%, respectively, on the fifth day. There were significant differences between OE?FEZF1?AS1 and OE?NC group [53.03 ± 8.84)% and ( 55.11 ± 7.09)%] ( all P＜0.05). The subsequent flow cytometry results showed that cell apoptotic rates of SMMC7721 and BEL?7402 cells transfected with sh?FEZF1?AS1 were ( 13.02 ± 1.38)% and ( 11.88 ± 1.29)%, respectively, which were significantly higher than those in sh?NC groups [(5.57±1.46)% and (8.06±1.42)%, respectively, all P＜0.05]. In contrast, the apoptotic rates of SMMC7721 and BEL?7402 cells transfected with OE?FEZF1?AS1 were (3.01 ± 0.39)% and ( 3.22 ± 0.43)%, which were significantly lower than those in OE?NC groups [(6.68±0.96)% and (6.63±0.45)%, all P＜0.05]. In addition, knockdown or overexpression of lncRNA FEZF1?AS1 expression inhibited or enhanced the migration and invasion abilities as well as the levels of adhesion molecules in hepatocellular carcinoma cells.After 30 days of feeding under the same conditions, the tumor volumes of sh?FEZF1?AS1 and sh?NC SMMC7721 cells xenograft mice models were (0.26±0.03) cm3 and (0.63±0.06) cm3, respectively, showing significant difference (P＜0.05). The tumor volumes of sh?FEZF1?AS1 and sh?NC BEL?7402 cells were (0.31±0.02) cm3 and (0.72±0.08) cm3, and the difference was statistically significant ( P＜0.05). Conclusion lncRNA FEZF1?AS1 may strengthen the growth, migration and invasion of hepatocellular carcinoma cells.

Objective To evaluate the outcome of surgical approaches in patients of gastric cancer with portal hypertension.Methods The clinical data of 80 patients with portal hypertension undergoing curative surgery for gastric cancer or simultaneous surgery for portal hypertension were retrospectively analyzed.Results The radical gastrectomy alone had no tremendous impact on postoperative liver function.But simultaneous surgery for portal hypertension affected patients' liver function dramatically (P =0.018).For those who underwent surgery for portal hypertension simultaneously,the incidence of complications in Child B patients was much higher than that in Child A patients (P =0.018).However,the incidence of complications did not differ between Child A and B patients who underwent radical gastrectomy alone.In addition,patients undergoing simultaneous surgery for portal hypertension had more severe complications than those who underwent radical gastrectomy only (P =0.042).Age ＞ 50 (P =0.012),tumor stage (P =0.015),and simultaneous surgery for portal hypertension (P =0.007) were the independent risk factors for postoperative liver dysfunction.The survival time of patients undergoing simultaneous surgery for portal hypertension was significantly shorter than that of patients undergoing radical gastrectomy only (in Child A patients,P =0.009,in Child B patients,P =0.000).Conclusions Individualized surgical approaches for the treatment of gastric cancer with portal hypertension should be decided by preoperative liver function.Simultaneous management of portal hypertension was not recommended.