Objective:To analyze the expression of tubulin-tyrosine ligase-like 12 (TTLL12) in hilar cholangiocarcinoma and its adjacent tissues, and to explore the relationship between TTLL12 and clinicopathological features and prognosis of patients with hilar cholangiocarcinoma.Methods:The carcinoma tissues and paracancerous tissues of 45 patients with hilar cholangiocarcinoma who had been operated in Qingdao Municipal Hospital from January 2016 to December 2020 were collected to prepare paraffin sections, including 27 males and 18 females, aged (58.8±8.5) years. The expression of TTLL12 and Ki-67 was detected by immunohistochemical staining. According to TTLL12 expression in cancer tissues, 45 patients were divided into negative group ( n=15) and positive group ( n=30). The relationship between TTLL12 positive expression and clinicopathological features such as lymph node metastasis and tumor differentiation was analyzed. The correlation between TTLL12 and Ki-67 expression in cancer tissues was analyze by Spearman correlation analysis. Kaplan-Meier method was used for survival analysis, and log-rank test was used to compare the survival rate. Results:Immunohistochemical staining showed that the expression of TTLL12 and Ki-67 in 45 patients with hilar cholangiocarcinoma was significantly higher than that in paracancerous tissues. The expression of TTLL12 in hilar cholangiocarcinoma was positively correlated with that of Ki-67 (correlation coefficient was 0.601, P<0.001). The positive expression rates of TTLL12 and Ki-67 in 45 cases of hilar cholangiocarcinoma were 66.7% (30/45) and 77.8% (35/45), respectively, which were higher than those in adjacent tissues 11.1% (5/45) and 15.6% (7/45), and the differences were statistically significant ( χ2=11.25, 29.01, both P<0.001). The positive expression of TTLL12 and Ki-67 in hilar cholangiocarcinoma was correlated with lymph node metastasis and tumor differentiation (all P<0.05). The median overall survival time was 44 months in TTLL12 negative group and 21 months in TTLL12 positive group. The 5-year survival rate of TTLL12 carcinoma tissue negative expression group was 33.1%, which was better than that of TTLL12 carcinoma tissue expression positive group (18.3%), and the difference was statistically significant ( χ2=6.12, P=0.013). Conclusions:The expression of TTLL12 in hilar cholangiocarcinoma was higher than that in paracancerous tissues, and there was a positive correlation between TTLL12 and Ki-67 in carcinoma tissues. The positive expression of TTLL12 is closely related to tumor differentiation, lymph node metastasis and poor prognosis of patients. TTLL12 may be a marker for predicting the prognosis of patients with hilar cholangiocarcinoma.

Objective:To investigate the influence of trimethylamine N-oxide(TMAO)on the development of early neurological deterioration(END)in diabetic patients with acute ischemic stroke.Methods:In this cross-sectional study, 108 type 2 diabetes patients with acute ischemic stroke treated at the Department of Neurology in the Affiliated Wuxi People’s Hospital of Nanjing Medical University between October 2019 and November 2020 were consecutively recruited.END was defined as an increase in the National Institutes of Health Stroke Scale(NIHSS)≥ 2 points and exclusion of intracranial hemorrhage or bleeding transformation in cranial imaging evaluation within 5 days of initial deterioration of neurological dysfunction.The patients were divided into 2 groups, an END(n=36)group and a non-END group(n=72). Fasting plasma TMAO was measured using isotope dilution liquid chromatography coupled to tandem mass spectrometry.Results:Of the 108 patients, 36(33.3%)were diagnosed with END, and their plasma TMAO levels were significantly higher compared with patients without END( Z=-3.500, P<0.001). For prediction of END, the area under the ROC curve for plasma TMAO levels was 0.707(95% CI: 0.603-0.811, P<0.001). The frequencies of END in subjects grouped via tertiles of TMAO were 22.2%, 19.4% and 58.3%, respectively, with significant differences between the 3 groups( χ2=14.979, P=0.001). Univariate analysis showed that elevated TMAO( OR=1.160, 95% CI: 1.050-1.282, P=0.004)was associated with END.A multivariate logistic regression model further confirmed the association between TMAO and END( OR=1.145, 95% CI: 1.033-1.269, P=0.010). Conclusions:Increased plasma TMAO levels are associated with END in diabetic patients with acute ischemic stroke.

Purpose/Significance To clarify the construction mode and key factors of data sharing in Chinese medical alliances,and to provide references for promoting data sharing in medical alliances.Method/Process Taking children's medical alliance of Yangtze River Delta as an example,Delphi method and qualitative interview method are used to explore the key contents and effect evaluation of specialty alliance construction,and the key factors of specialty alliance data sharing are defined based on the technology-organization-environment framework;SWOT analysis model is used to propose development strategies.Result/Conclusion Member hospitals are less satisfied with the construction effect of information interconnection.Key factors for realizing data sharing in specialty alliances include:support from government administrative departments,uniform and systematic compatibility of information standards,information security emergency response,patient privacy protection and informed consent,willingness of department directors to share,and internal communi-cation and compensation mechanism of alliances.

Objective:To study the efficacy of three-dimensional (3D) CT reconstruction combined with 3D color printing compared with traditional imaging technology in treatment of complex hepatobiliary calculi treated with laparoscopy and choledochoscopy.Methods:A retrospective study was conducted on 128 patients with complex hepatobiliary calculi who underwent hepatobiliary surgery at the Qingdao Chengyang People’s Hospital, Qingdao Municipal Hospital Affiliated to Qingdao University and Qingdao University Affiliated Hospital from January 2019 to December 2019. A comparison was made between patients who underwent three-dimensional CT reconstruction combined with 3D color printing (the study group, n=62) and the traditional imaging technology group (the control group, n=66) on operation time, intraoperative blood loss, liver blood flow occlusion time, stone clearance rate, postoperative complication rate, and recurrence of calculi after operation. Results:The study group was significantly better than the control group in operation time, intraoperative blood loss, porta hepatis occlusion time, hospital stay and treatment cost (all P<0.05). The stone clearance rate of the study group was 96.8% (60/62), which was significantly higher than that of the control group (86.4%, 57/66) ( P<0.05). The incidence of postoperative complications in the study group was 3.2% (2/62), which was significantly lower than that in the control group (18.2%, 12/66) ( P<0.05). There was no significant difference in the stone recurrence rate between the two groups (all P>0.05). Conclusion:Three-dimensional CT reconstruction combined with 3D color printing contributed significantly to the surgical treatment of complex intrahepatic bile duct stones as these imaging technologies significantly improved surgical accuracy, improved stone clearance and reduced postoperative complication rates, and reduced surgical treatment costs.

Objective:To evaluate the gastric emptying of orally administered enzyme-hydrolyzed rice flour solution before surgery in the patients undergoing laparoscopic cholecystectomy and effect on insulin resistance.Methods:One hundred patients, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-64 yr, with body mass index of 19-30 kg/m 2, scheduled for elective laparoscopic cholecystectomy under general anesthesia, were divided into 2 groups ( n=50 each) using a random number table method: water group (group C) and enzyme-hydrolyzed rice flour group (group M). Routine fasting and water deprivation were executed at 1 day before operation in two groups, and 300 ml water in group C or 300 ml enzyme-hydrolyzed rice flour solution in group M were taken orally at 2-3 h before induction on the day of surgery.Bedside antrum ultrasonography was used to calculate the gastric volume (GV) before oral administration (V 0), immediately after oral administration (V 1), and before induction (V 2), and then the ΔGV (GV 1-GV 0) was calculated.Fasting plasma glucose and insulin CONCENTRATIONS were measured on admission to hospital (T 1) and on an empty stomach on 1st morning after surgery (T 2), and then the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated according to HOMA steady-state model formula.Visual analog scale (VAS) scores for subjective comfort (thirst, hunger, fatigue and anxiety) and grip strength were assessed before anesthesia (T 3) and before leaving PACU (T 4). Reflux and aspiration during induction, nausea and vomiting within 24 h after surgery, and anal exhaust time after surgery were recorded. Results:There was no significant difference in GV at V 0, V 1 and V 2 between the two groups ( P>0.05). Compared with the baseline at V 0, no significant was found in the GV at V 2 in both groups ( P>0.05). The fasting plasma glucose and insulin concentrations and HOMA-IR were significantly increased at T 2 than at T 1 in both groups ( P<0.05 or 0.01). Compared with group C, the fasting plasma glucose and insulin concentrations and HOMA-IR were significantly decreased at T 2, VAS scores for hunger, fatigue and anxiety were decreased at T 3, 4, grip strength was increased at T 3, 4, the postoperative anal exhaust time was shortened, and the incidence of nausea was reduced in group M ( P<0.05). No reflux and aspiration happened during induction in either group. Conclusion:The gastric emptying of 300 ml enzyme-hydrolyzed rice flour solution orally administered at 2 h before surgery is normal in the patients undergoing laparoscopic cholecystectomy, which does not increase the risk of reflux and aspiration during anesthesia induction, reduces postoperative insulin resistance, and increases patient′s subjective comfort, and enhances the postoperative recovery of intestinal function.

Objective To investigate the expression of FNDC5 in hepatocellular carcinoma (HCC) and its relationship with clinicopathological characteristics and prognosis of HCC patients.Methods Immunohistochemistry and qRT-PCR were used to detect the expression of FNDC5 in HCC tissues,and the relationship between its expression and clinicopathological parameters and prognosis.Results FNDC5 was mainly expressed in the cytoplasm of HCC cells,weakly expressed in the nucleus.Among the 30 liver cancer tissues,FNDC5 was weakly positive in 5,positive in 19,and strongly positive in 6 cases.QRT-PCR assay showed that FNDC5 was highly expressed in HCC tissues with vascular invasion.The incidence of vascular invasion in the high-expression of FNDC5 was 30％ (9/30),which was significantly higher than that of the FNDC5 low-expression group [6.7％ (2/30),] and the difference was significant (x2 =15.026,P ＜0.05).There was no significant correlation between FNDC5 level and age,sex,HBsAg,and alpha-fetoprotein (AFP) level in HCC (P ＞ 0.05).Conclusion FNDC5 level in the liver cancer tissues is closely related to the occurrence of vascular invasion.

OBJECTIVE: To explore the integration method and technical realization of artificial intelligence bone age assessment system with the hospital RIS-PACS network and workflow. METHODS: Two sets of artificial intelligence based on bone age assessment systems (CHBoneAI 1.0/2.0) were developed. The intelligent system was further integrated with RIS-PACS based on the http protocol in Python flask web framework. RESULTS: The two sets of systems were successfully integrated into the local network and RIS-PACS in hospital. The deployment has been smoothly running for nearly 3 years. Within the current network setting, it takes less than 3 s to complete bone age assessment for a single patient. CONCLUSIONS The artificial intelligence based bone age assessment system has been deployed in clinical RIS-PACS platform and the "running in parallel", which is marking a success of Stage-I and paving the way to Stage-II where the intelligent systems can evolve to become more powerful in particular of the system self-evolution and the "running alternatively".
Age Determination by Skeleton ; Artificial Intelligence ; Bone and Bones ; Hospital Information Systems ; Hospitals ; Humans ; Radiology Information Systems ; Systems Integration

Objective: To investigate the expression and distribution of FNDC5/Irisin in pancreatic cancer tissues and adjacent tissues, and to analyze its correlation with clinicopathological features. Methods: Collection of archived wax blocks from 64 patients diagnosed with pancreatic cancer after surgical treatment from January 2015 to December 2018 in the Department of Pathology, Affiliated Qingdao Municipal Hospital of Qingdao University, and 30 tissues collected intraoperatively from January 2016 to December 2018 Samples, all collected samples included tumor tissue and corresponding adjacent tissues (>2 cm from the tumor edge). Real-time quantitative PCR (qRT-PCR) and immunohistochemistry were used to detect the expression of FNDC5/Irisin mRNA and its positivity in pancreatic cancer tissues and adjacent tissues, and to analyze its relationship with clinicopathological features of pancreatic cancer. Results: qRT-PCR showed that the expression of FNDC5/Irisin mRNA in pancreatic cancer tissues was higher than that in the corresponding adjacent pancreatic tissues, the difference was statistically significant (P<0.05). The immunohistochemistry results showed that the positivity of FNDC5/Irisin in pancreatic cancer tissues was 59.4%, and the positivity of FNDC5/Irisin in adjacent tissues was 28.1%, and the positivity of FNDC5/Irisin in cancer tissues and adjacent pancreatic tissues was significantly different (P<0.05); the expression level of FNDC5/Irisin was not related with the gender, age, tumor size, degree of differentiation, and tumor stage.(P>0.05), but FNDC5/Irisin expression was associated with liver and lymph node metastasis (P<0.05). Conclusion The positivity of FNDC5/Irisin in pancreatic cancer tissues is significantly higher than that in adjacent pancreatic tissues, and it is correlated with liver and lymph node metastasis in pancreatic cancer.

BACKGROUND: Mesenchymal stem cells can protect and repair the liver of rats with liver failure, but the mechanisms are not completely clear. OBJECTIVE: To explore the protective effects and related mechanisms of intravenous injection of human adipose-derived mesenchymal stem cells on acute liver failure in rats. METHODS: Thirty-six Sprague-Dawley rats (provided by Qingdao Daren Fucheng Animal Husbandry Co., Ltd. in China) were randomly divided into control group, model group and transplantation group. Animal models of acute liver failure were established by intraperitoneal injection of D-galactosamine in the model group and the transplantation group. One day after modeling, the rats in the transplantation group were injected with human adipose-derived mesenchymal stem cell suspension, and those in the model group were injected with the same amount of saline. After 1 and 3 days of cell transplantation, the serum levels of alanine aminotransferase, aspartate aminotransferase, and total bilirubin were measured. Three days after cell transplantation, the serum levels of tumor necrosis factor-α, interleukin-6 and interleukin-10 were detected, the pathological changes of the rat liver were observed by hematoxylin-eosin staining, and the activity of glycogen synthase kinase-3β protein in the liver tissue was detected by western blot. RESULTS AND CONCLUSION: Compared with the model group, there was a significant reduction in the serum levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin, tumor necrosis factor-α, interleukin-6 and interleukin-10 in the transplantation group (P < 0.05). Inflammation and necrosis of liver tissues in the transplant group were alleviated compared with the model group. The activity of glycogen synthase kinase 3β in the liver tissue of the transplanted group was lower than that of the model group (P < 0.05). Overall, these results indicate that human adipose-derived mesenchymal stem cells can alleviate hepatic inflammation and pathological injury, and improve the liver function in rats with acute hepatic failure. Moreover, the mechanism may be related to the inhibition of glycogen synthase kinase 3β activity.

Objective To evaluate the efficacy and safety of X-ray guided endoscopic gastrojejunostomy using stent in treatment of malignant gastric outlet obstruction ( GOO ) . Methods Six hospitalized patients with malignant GOO underwent X-ray guided endoscopic gastrojejunostomy using stent in the department of gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University between March 2017 and June 2017. The technical success rate, clinical success rate, procedure time, adverse events and follow-up were recorded and analyzed in this retrospective study. Results The stent was successfully placed in the 6 patients with 100％ ( 6/6) technical success rate. The mean procedure time was 91. 7±51. 8 min. After the procedure, all patients were fed liquid or semi-liquid diet, and the GOO score system was increased from 0-1 before operation to 2-3 after operation. The clinical success rate was 100％(6/6). Peritonitis was observed in 2 patients during operation, and resolved by abdominal drainage. Gastrointestinal bleeding occurred in 1 patient after operation, which was resolved with conservative treatment. During a mean follow-up period of 78. 6 days (range 32-100 days), there was no recurrence of obstruction symptoms except that 1 patient died because of tumor progress 60 days after procedure. Conclusion The X-ray guided endoscopic gastrojejunostomy using stent is feasible and safe to treat malignant GOO with a reliable short-term efficacy.