Objective To investigate the clinical effect of transhepatic arterial chemoembolization(TACE)combined with tyrosine kinase inhibitors(TKIs)and programmed death receptors-1(PD-1)inhibitors(TACE+TKIs+PD-1 antibody)in the treatment of moderate advanced unresectable hepatocellular carcinoma(HCC).Methods The clinical data of 65 patients with moderate advanced unresectable hepatocellular carcinoma admitted to the Affiliated Hospital of North Sichuan Medical College from January 2020 to January 2022 were analyzed retrospectively.65 patients were treated with TACE+TKIs+PD-1 antibody.The observation indexes were tumor response,objective response rate(ORR),disease control rate(DCR),total survival time,progression free survival time,conversion operation rate and adverse drug reaction.Results The ORR of 65 p-atients with hepatocellular carcinoma was 49.2％(32/65),and the DCR was 89.2％(58/65).Among them,there were 2 patients with complete remission(CR),30 patients with partial remission(PR),26 patients with stable disease(SD),and 7 patients with progression disease(PD).Among 65 patients with hepatocellular carcinoma,18 patients were transformed into resectable hepatocell-ular carcinoma and underwent RO surgery.The conversion rate was 27.6％(18/65).65 patients were followed up for 3 to 22.4 months,The median follow-up time was 16.5 months.The median overall survival time and median disease progression free survival time of 65 patients were 14.5 months(95％CI:12.3～16.6 months)and 8.8 months(95％CI:6.9～10.6 months),respectively.After treatment,65 patients all had post embolism syndrome(abdominal pain,fever,nausea,vomiting and other symptoms),and some patients had transient abnormal liver function.Adverse drug reactions below grade 3 recovered within a few days.Some patients were associated with multiple adverse drug reactions.1 patient(1.5％)stopped using TACE because of stubborn vomiting,and 5 patients(7.6％)stopped using Lenvatinib because of severe liver function damage during treatment,2 patients(3％)stopped using Camrelizumab because of severe reactive capillary hyperplasia,one patient(1.5％)stopped using Tislelizumab because of severe hypothyroidism,one patient(1.5％)stopped the treatment of Lenvatinib and Sintilimab due to severe gastrointestinal bleeding.The adverse drug reactions of grade 3～4 occurred in other patients were alleviated after drug reduction,symptomatic treatment and hormone treatment.Conclusion TACE+TKIs+PD-1 antibody can obtain reliable clinical efficacy and anti-tumor activity in the treatment of moderate advanced unresectable hepatocellular carcinoma.

Objective:To investigate the expression level of long non-coding RNA (lncRNA) CTC-338M12.4 in tongue squamous cell carcinoma tissues, and its effects on the cell cycle, cell proliferation, and migration of tongue squamous cell carcinoma cells in vitro as well as its molecular mechanisms.Methods:The Gene Expression Omnibus (GEO) database was used to obtain the lncRNA series data set GSE139869, and the differential expression of CTC-338M12.4 in tongue squamous cell carcinoma tissues and adjacent tissues was analyzed. The transcriptional expression levels of CTC-338M12.4 in human immortalized oral keratinocytes (HOK) and tongue squamous cell carcinoma cell lines HN13, TSCCa, CAL-27, Tca8113, SCC15 were detected by using reverse transcription quantitative real-time polymerase chain reaction (qRT-PCR). CAL-27 cells with the lowest expression level of CTC-338M12.4 were selected and were divided into the control group (co-transfected with vectors containing negative sequence) and CTC-338M12.4 group (co-transfected with CTC-338M12.4 overexpression vectors). The proliferation ability of CAL-27 cells in each group was detected by using cell colony formation assay, and the cell cycle distribution of CAL-27 cells was detected by using flow cytometry. The migration ability of CAL-27 cells was detected by using scratch test. The lncACTdb database was used to predict the complementary binding sites between CTC-338M12.4 and miRNA-27a-5p (miR-27a-5p), and dual-luciferase reporter gene assay was used to verify. The expression level of miR-27a-5p in CAL-27 cells of all groups was detected by using qRT-PCR. The protein expression level of related factors on JAK/STAT signaling pathway in CAL-27 cells of all groups was detected by using Western blot.Results:Analysis of GEO database data showed that transcriptional level CTC-338M12.4 in tongue squamous cell carcinoma tissues was lower than that in adjacent tissues, and the difference was statistically significant ( P < 0.01). Transcriptional level CTC-338M12.4 in tongue squamous cell carcinoma HNl3, TSCCa, CAL-27, Tca8113, and SCC15 cells was lower than that in HOK cells, and the differences were statistically significant (all P < 0.05). The transcriptional level relative expression level of CTC-338M12.4 in CAL-27 cells in the CTC-338M12.4 group was higher than that in the control group, and the difference was statistically significant ( P < 0.01). Cell colony formation assay showed that the colong number of CAL-27 cell in the CTC-338M12.4 group was less than that in the control group [(51±10) vs. (114±21)], and the difference was statistically significant ( t = 2.71, P = 0.035). Flow cytometry showed that the proportion of G 0/G 1 phase cells in CAL-27 cells in the CTC-338M12.4 group was higher than that in the control group [(64±3)% vs. (43±4)%], and the difference was statistically significant ( t = 4.87, P = 0.003). The scratch test showed that when scratching, the scratch width of both groups was similar ( P > 0.05); after scratch for 25 h, the scratch width of CAL-27 cells in the CTC-338M12.4 group was wider than that in the control group [(133±15) μm vs. (64±10) μm], and the difference was statistically significant ( t = 3.78, P = 0.009). The dual luciferase reporter gene assay showed that the relative luciferase activity of CAL-27 cells co-transfected with wild-type CTC-338M12.4 sequence and miR-27a-5p sequence was lower than that of CAL-27 cells co-transfected with wild-type CTC-338M12.4 sequence and miR-27a-5p irrelevant sequence, and the difference was statistically significant ( P < 0.001). The relative expression level of transcriptional level miR-27a-5p of CAL-27 cells in the CTC-338M12.4 group was lower than that in the control group, and the difference was statistically significant ( P = 0.003). Western blot showed that the protein expression levels of JAK/STAT signaling pathway p-JAK, p-STAT, p-Raf, p-ERK, and p-mTOR were lower than those in the control group. Conclusions:The level of lncRNA CTC-338M12.4 is low in tongue squamous cell carcinoma. CTC-338M12.4 mediates the inactivation of JAK/STAT signaling pathway via inhibiting miR-27a-5p expression in tongue squamous cell carcinoma CAL-27 cells, thereby leading to cell cycle arrest and inhibiting the cell proliferation and migration of CAL-27 cells.

Objective:To investigate the clinical, genetic, and pathological features of nemaline myopathy type 8 (NEM8) caused by KLHL40 gene variation. Methods:The clinical data, gene sequencing results, and musculoskeletal pathophysiology of two cases (a pair of twins) with NEM8 admitted to our hospital in July 2022 were collected. CNKI, VIP, Wanfang, Yiigle, PubMed, Embase, and Web of Science Database were searched with the English and Chinese terms "nemaline myopathy type 8", "nemaline body myopathy type 8", and " KLHL40" from January 2007 to February 2023. The clinical, genetic, and musculoskeletal characteristics of the NEM8 cases were summarized using the descriptive statistical analysis method. Results:(1) Case report: The mother (G2P2) of the twins (Ⅳ-2 and Ⅳ-3) was conceived by IVF-embryo transfer and delivered at 37 +1 gestational weeks. The two cases were dizygotic twins whose maternal grandmother had lip and palate cleft. The first baby (Ⅳ-1) of the woman exhibited absent left pinna, contracture at the end of both fingers, talipes equinovarus in both feet and died of respiratory failure two hours after birth. Fetal edema and fetal movement delay in the twins and varus right foot in one twin were found during pregnancy. Both cases developed intrapartum asphyxia with the clinical manifestations of generalized muscle weakness, respiratory failure, dysphagia, multiple joint contractures, and fractures. The families withdrew the treatment and the twins died after maintaining life with ventilators for 53 days after birth. Whole exome sequencing of the pedigree found c.1779G>T (p.W593C) homozygous variants of the KLHL40 gene in the twins and c.1779G>T (p.W593C) heterozygous variants of the KLHL40 gene in the parents, both were de novo. Musculoskeletal pathophysiology indicated that muscle fibers are thin and round with a fetal shape and absent rod. (2) Literature review: Among the 29 cases of NEM8, including two current cases and 27 cases retrieved from 15 papers, eight cases terminated the pregnancies, and 21 were live births; seven cases (24.1%) with positive family history; 19 cases (65.5%) were found with abnormalities during pregnancy, including abnormal fetal movements, polyhydramnios, joint contracture, and fetal edema. Of the 21 live births, 20 cases had intrapartum asphyxia, 21 had postnatal respiratory failure, 20 had generalized muscle weakness, and 19 had dysphagia. Among the 29 cases, 17 cases (58.6%) were homozygous variants of the KLHL40 gene, and 12 cases (41.4%) were compound heterozygous variants. The detection rate of c.1516A>C(p.Thr506Pro) was the highest [72.4% (21/29)], followed by c.602G>A(p.Trp201*) [17.2% (5/29)]. Out of the 15 cases who underwent musculoskeletal pathological examination, all had abnormal muscle fiber size and morphology; 10 cases had rods. Conclusions:NEM8 should be considered for those with abnormal fetal movements, polyhydramnios, joint malformation, fetal edema during the fetal period and failure to establish respiration at birth as well as postnatal generalized muscle weakness, respiratory failure, dysphagia, multiple joint contractures, and fracture. Moreover, genetic detection should be performed as soon as possible. NEM8 can be diagnosed in ones with KLHL40 gene homozygous or compound heterozygous variants and musculoskeletal pathological results of abnormal size and shape of muscle fibers, regardless of the presence of rods.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

OBJECTIVE: To analyze the current status of diagnosis and management of acute appendicitis (AA) in China. METHODS: Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary. RESULTS: A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001). CONCLUSIONS The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.
Acute Disease ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Appendectomy ; Appendicitis ; diagnosis ; therapy ; China ; Female ; Health Care Surveys ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

Objective To compare the value of serum cystatin C (CysC),urine β2-microglobulin (β2-MG),and neutrophil gelatinase-associated lipocalin (NGAL) as a test panel with that of traditional indicators,serum Cr and urea,for detection of early renal damage in lung cancer patients after chemotherapy.Methods This prospective study collected data at our hospital on levels of serum cystatin C (CysC),urine β2-microglobulin (β2-MG),and neutrophil-gelatinase associated lipocalin (NGAL) from 63 lung cancer patients aged 60 and over.In addition,levels of traditional indicators including serum Cr and urea were also measured.Participants were divided into three groups:a prechemotherapy group,an under chemotherapy group,and a post-chemotherapy group.Results Levels of serum CysC,urine β2-MG,and NGAL in the post-chemotherapy group markedly increased,whereas levels of serum Cr and urea had no significant increase;furthermore,levels of serum CysC,urine β2-MG,and NGAL went up steadily as the time of exposure to chemotherapy drugs increased.Pearson's test showed that the sensitivity of CysC,beta 2-MG and NGAL as a panel was statistically significant for both the under chemotherapy group and the post-chemotherapy group (x2 =31.32,P=0.00;x2 =60.38,P=0.00).Conclusions Serum CysC,urine β2-MG and NGAL as a panel have good diagnostic value for early renal function damage in lung cancer patients after chemotherapy and are superior to traditional renal function indicators such as serum creatinine and urea.

Objective: To explore the clinical features of patients with synchronous lymphoma and carcinoma. Methods: The clinical data of 17 patients with Synchronous lymphoma and carcinoma from February 2012 to October 2017 were analyzed retrospectively. Results: Among 17 patients of lymphoma, 1 case HL, 2 cases B-NHL, 6 cases MZBL, 3 cases DLBCL, 1 case mantle cell lymphoma (MCL) , 3 cases NK/T- cell lymphoma, 1 case anaplastic large cell lymphoma(ALCL). In terms of 17 patients with carcinoma, 3 cases esophageal carcinoma, 3 cases gastric carcinoma, 2 cases colorectal carcinoma, 7 cases thyroid carcinoma, 1 case hepatocellular carcinoma and lung cancer. Up to 15 patients received operation, and some of them combined with chemotherapy, radiotherapy and autologous transplant. Follow-up analysis showed that 3 cases was undergoing treatment, 2 cases lost follow-up, 4 cases died, 3 cases achieved CR, 3 cases remained to be at SD, and 2 cases assessed for progression or recurrence. Conclusion The relationship between lymphoma and carcinoma was under discussion, patients with synchronous lymphoma and carcinoma were not unusual. We herein should raise awareness to avoid misdiagnosis.

BACKGROUND: Distraction osteogenesis is an effective method for large bone defects, bone tumors and osteomyelitis. However, there is a lack of a standard model in the basic research concerning distraction osteogenesis. OBJECTIVE: To establish a rabbit femoral model of distraction osteogenesis and to assess its osteogenic effect. METHODS: Twenty male New Zealand rabbits were enrolled to establish the rabbit femoral model of distraction osteogenesis using a novel distractor. Subsequently, the gross observation and X-ray examination of the specimens were performed to assess the osteogenic effect. RESULTS AND CONCLUSION: Gross observation: on day 14 after fixation, there were light-colored and dense newborn bones distributing evenly in the distraction gap, and appeared with a columnar connection with the broken ends; the boundary with normal bones became vague. On day 35, the surface of newborn bones in the distraction gap showed the same color and texture with the normal ones, the boundary between the newborn and normal bones was difficult to distinguish, and the bone mineral density was increased notably. Radiology results: on day 14 after fixation, the stent was fixed stably, the broken ends got good reduction, and cloudy shallows connecting the two ends of the normal bones in the distraction gap and increased bone mineral density were detectable. Completely calcified new-born bones, intact bone cortex and open medullary canal were further visible on day 35. These results suggest that the rabbit femoral model of distraction osteogenesis is established successfully using the self-designed single-arm distractor based on rational surgical procedures and standard operations.

OBJECTIVE: To investigate the application value of narrow band imaging (NBI) in early diagnosis of pharyngolaryngeal tumors. METHOD: A total of 106 patients received NBI endoscopy in the endoscopic diagnosis. Lesions found under the white-light endoscopy mode and NBI endoscopy mode were compared in the morphology of capillaries on lesiorn surface and the clarity of lesion rim. Biopsy was performed in suspected areas with those two endoscopies for the lesions found under white-light endoscopy and NBI endoscopy, the morphology of capillaries on the surface of lesion and the clarity of lesion boundary were compared between both. Biopsy was performed for suspected areas under two modes, and specimens were preserved in 10% formaldehyde for pathological examination. The characteristic, position and endoscopic diagnosis under two modes were recorded. All the patients underwent corresponding laryngeal tumor resection according to the histopathological result of biopsy, and the histopathological result of resected tissues was taken as the gold standard for diagnosis. The biopsy detection rate and biopsy correct detection rate of malignant lesions in two groups were calculated and statistical compared. RESULT: The diagnostic accuracy under white-light mode was 75.47%, while that under NBI mode was 96.23%, and the difference between them was statistically significant (χ² = 18.375, P < 0.01). The biopsy correct detection rate under white-light mode was 82.08%, while that under NBI mode was 95.28%, and the difference between them was statistically significant (χ² = 12.071, P < 0.01). The correct detection rate of malignant tumor under white-light mode was 48.15%, while that under NBI mode was 92.59%, and the difference between them was statistically significant (χ² = 10.083, P < 0.01). CONCLUSION Using NBI endoscopy to observe the morphological changes of capillaries on the pharyngolaryneal mucosa surface can increase the detection rate of early pharyngolaryngeal tumors, so it is worth to be widely applied.
Biopsy ; Early Detection of Cancer ; Endoscopy ; Humans ; Laryngeal Neoplasms ; diagnosis ; surgery ; Larynx ; surgery ; Narrow Band Imaging ; Pharyngeal Neoplasms ; diagnosis ; surgery

BACKGROUNDSelf-monitoring of blood glucose (SMBG) by individuals with type 2 diabetes (T2D) is crucial for long-term health, yet numerous cultural, economic and health factors can reduce SMBG. Most studies on SMBG adherence have come out of the US and Europe, and their relevance to Asia is unclear. The aims of the present study were to assess the current state of SMBG in China and analyze demographic and diabetes-related characteristics that may influence it.

METHODSIn this multi-center, cross-sectional study, 5 953 individuals with T2D from 50 medical centers in 29 provinces across China filled out a standardized questionnaire that requested information on demographic characteristics, education level, occupation, income, lifestyle risk factors, duration of diabetes, chronic complications, and frequency of SMBG. Respondents were also asked whether their glycosylated hemoglobin (HbA1c) had been checked in the past 6 months. The most recent values for fasting plasma glucose, 2-hour postprandial blood glucose and HbA1c were recovered from medical records.

RESULTSOnly 1 130 respondents (18.98%) performed SMBG with the recommended frequency, while 4 823 (81.02%) did not. In fact, nearly 2 105 (35.36%) reported never performing SMBG. In the subset of 3 661 individuals on insulin therapy, only 266 (7.27%) performed SMBG at least once a day, while 1 210 (33.05%) never performed it. In contrast, 895 of 2 292 individuals (39.05%) on diet/exercise therapy or oral hypoglycemic therapy never performed it. Multivariate Logistic regression identified several factors associated with SMBG adherence: female gender, higher education level, higher income, longer T2D duration and education about SMBG.

CONCLUSIONSSMBG adherence in our Chinese population with T2D was less frequent than that in developed countries. Several factors influence SMBG adherence: gender, education level, income, T2D duration, therapy regimen and exposure to education about SMBG.

Adult ; Blood Glucose ; metabolism ; Blood Glucose Self-Monitoring ; statistics & numerical data ; China ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; blood ; Female ; Humans ; Male ; Middle Aged