Objective To evaluate the clinical efficacy and safety of transcatheter arterial infusion with gemcitabine and nab-paclitaxel(GN)as first-line therapy in treating patients with advanced pancreatic cancer.Methods The clinical data of a total of 50 patients with advanced pancreatic cancer,who were treated with transcatheter arterial infusion chemotherapy with GN regimen at the Zhejiang Cancer Hospital of China between January 2016 and December2020,were collected The objective effective rate(ORR),progression-free survival(PFS),overall survival(OS)and treatment-related toxic reactions were analyzed.Results A total of 236 times of transcatheter arterial infusion chemotherapy were carried out in the 50 patients,with an average perfusion procedure of 4.72 times per patient.Complete remission(CR)was obtained in 0 patient,partial remission(PR)in 16 patients,and stable disease(SD)in 21 patients.The ORR was 32％,the median PFSwas5.1 months,and the OS was 9.8 months.The main adverse events included neutropenia,thrombocytopenia,vomiting,nausea,fatigue,etc.Conclusion For patients with advanced pancreatic cancer,transcatheter arterial infusion chemotherapy with GN regimen carries good short-term efficacy and safety,it can improve patient's PFS and OS to a certain extent.(J Intervent Radiol,2024,33:512-515)

Objective: To evaluate the association of long-term ambient fine particulate matters (PM_2.5) exposure with elevated blood pressure in children. Methods: From April 2012 to June 2013, we used cluster randomized sampling method to investigate 9 354 children aged 5-17 years old from 68 primary and middle schools in the seven Northeastern Cities (Shenyang, Dalian, Fushun, Anshan, Benxi, Liaoyang and Dandong) in Liaoning Province, and measured their blood pressure (BP). A spatial statistical model nested by aerosol optical depth (AOD) was used to inverse PM_2.5 concentrations. Generalized additive model was used to quantify the association between PM_2.5 exposure and blood pressure in children. To examine the associations, two-level regression model was used to evaluate individual characteristics′ modifying effect on the health influence of PM_2.5. Results: The prevalence of hypertension in children was 13.78% (1 289/9 354). The results showed that there was an associations between hypertension and pollutants, and the multivariable regression analysis indicated that the increase in mean systolic blood pressure (SBP), diastolic blood pressure (DBP), and the OR of hypertension associated with a 10 μg/m³ increase for PM₂.5 were 3.12 (95%CI: 2.71-3.54) mmHg (1 mmHg=0.133 kPa), 1.45 (95%CI:1.12-1.78) mmHg, and 1.55 (95%CI: 1.10-2.19), respectively. Compared with non-breastfeeding children (OR=2.10, 95%CI: 1.39-3.17), children who were breastfeeding (OR=1.49, 95%CI: 1.00-2.20) exhibited consistently weaker effects, and the interaction effect of P value was 0.002. Conclusion Study findings indicate that long-term exposure to PM_2.5 is associated with increased arterial BP and hypertension among the children. Breastfeeding may reduce this association.

PURPOSE: The significance of neuroendocrine differentiation (NED) in gastric carcinoma (GC) is controversial, leading to ambiguous concepts in traditional classifications. This study aimed to determine the prognostic threshold of meaningful NED in GC and clarify its unclear features in existing classifications. MATERIALS AND METHODS: Immunohistochemical staining for synaptophysin, chromogranin A, and neural cell adhesion molecule was performed for 945 GC specimens. Survival analysis was performed using the log-rank test and univariate/multivariate models with percentages of NED (PNED) and demographic and clinicopathological parameters. RESULTS: In total, 275 (29.1%) cases were immunoreactive to at least 1 neuroendocrine (NE) marker. GC-NED was more common in the upper third of the stomach. PNED, and Borrmann's classification and tumor, lymph node, metastasis stages were independent prognostic factors. The cutoff PNED was 10%, beyond which patients had significantly worse outcomes, although the risk did not increase with higher PNED. Tumors with ≥10% NED tended to manifest as Borrmann type III lesion with mixed/diffuse morphology and poorer histological differentiation; the NE components in this population mainly grew in insulae/nests, which differed from the predominant growth pattern (glandular/acinar) in GC with <10% NED. CONCLUSIONS: GC with ≥10% NED should be classified as a distinct subtype because of its worse prognosis, and more attention should be paid to the necessity of additional therapeutics for NE components.
Adenocarcinoma ; Chromogranin A ; Classification ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Neural Cell Adhesion Molecules ; Prognosis ; Stomach ; Stomach Neoplasms ; Synaptophysin

Objective: To explore the factors affecting the prognosis of patients with hepatocellular carcinoma (HCC) combined with portal vein tumor thrombosis (PVTT), and to analyze the clinical value of transcatheter arterial chemoembolization (TACE) combined with iodine-125 seed implantation in such patients. Methods: A retrospective analysis of 53 patients with HCC combined with PVTT was performed. In the study group, 32 cases were treated with TACE combined with iodine-125 seed implantation, and 21 cases in the control group were treated with TACE combined with sorafenib. Survival analysis was carried out on eight factors such as gender, age, Child-Pugh classification, alpha fetoprotein level, portal vein tumor thrombosis (PVTT) type, forms of liver tumor, extra-hepatic metastasis and treatment modalities. The efficacy of TACE combined with iodine-125 seed implantation and TACE combined with sorafenib was further compared. The χ ² test was used to evaluate the efficacy of the two groups. A single factor survival analysis was calculated by Kaplan-Meier estimator and multifactor survival analysis by Cox proportional hazards model. Results: All 53 patients were successfully treated. The median tumor progression time (mTTP) and median overall survival (mOS) were 8 months and 11 months, respectively. The disease control rate (DCR) of the study group for PVTT was 93.8%, which was significantly higher than that of the control group (61.9%, χ ² = 6.448, P = 0.011). The difference was statistically significant; the objective remission rate of the study group for PVTT was 75.0%. Significantly higher than 9.5% in the control group, P < 0.05, the difference was statistically significant; the DCR of the primary tumor in the study group was 50.0%, which was lower than the 70.0% of the PVTT in the control group, P = 0.231, the difference was not statistically significant. The progression of primary HCC lesions in patients with multivariate survival analysis: Child-Pugh grade A patients were compared to grade B [Hazard ratio (HR) = 0.236, P = 0.003]; no extra-hepatic metastasis (HR = 0.258, P = 0.002); and TACE combined with iodine-125 seed implantation group compared with TACE combined sorafenib group (HR = 0.372, P = 0.002), the differences were statistically significant. Multivariate survival analysis of patients with overall survival: AFP < 400 ng/mL vs. AFP≥400 ng/mL (HR = 0.389, P = 0.030); Child-Pugh grade A vs. B (HR = 0.263, P = 0.006); and no extra-hepatic metastasis (HR = 0.306, P = 0.006), the differences were statistically significant. Conclusion TACE combined with iodine-125 seed implantation for the treatment of HCC with PVTT can effectively control the progression of PVTT and intrahepatic lesions and improve the prognosis of patients.

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound,the examiner and interpreter of the image are critical care medicine physicians.The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes.With the idea of critical care medicine as the soul,it can integrate the above information and clinical information,bedside real-time diagnosis and titration treatment,and evaluate the therapeutic effect so as to improve the outcome.CUS is a traditional technique which is applied as a new application method.The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept,implementation and application of CUS.It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure.At the same time,the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications,and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS.Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group,based on the rich experience of clinical practice in critical care and research,combined with the essence of CUS,to learn the traditional ultrasonic essence,established the clinical application technical specifications of CUS,including in five parts:basic view and relevant indicators to obtain in CUS;basic norms for viscera organ assessment and special assessment;standardized processes and systematic inspection programs;examples of CUS applications;CUS training and the application of qualification certification.The establishment of applied technology standard is helpful for standardized training and clinical correct implementation.It is helpful for clinical evaluation and correct guidance treatment,and is also helpful for quality control and continuous improvement of CUS application.

Objective To explore the effect of head nurses′tutoring and commenting on nursing ward round. Methods The nursing ward rounds performed during August 2013 to July 2014 were assigned as the control group and those nursing ward rounds during August 2014 to August 2015 as observation group: in the former group routine nursing ward rounds were done once a week and in the latter the rounds were performed by head nurses′tutoring and commenting once every week. The two groups were compared in terms of examination performances of nursing ward rounds, doctors′ and nurses′ satisfaction degree, nurses′ and student nurses′evaluation on the ward rounds and their critical thinking ability. Results The examination performances and the satisfaction degree in the observation group were significantly higher than those of the control group (P<0.05). The nurses in the observation group thought the head nurse′s commenting at ward rounds could be more effective than those from the control group in their improvement of theoretical knowledge and clinical ability (P<0.05). In terms of critical thinking by California Critical Thinking Disposition Inventory-Chinese Version), the total score and the scores on its dimensions in the observation group were significantly higher than those of the control group. Conclusion The nursing ward rounds by head nurses′tutoring and commenting can help the nurses to strengthen their ability in nursing ward rounds and improve their theory and clinical practice so that the nursing quality is improved.

Objective To investigate the social support and the quality of life of colorectal patients with permanent colostomy,and to examine the stability and change of the social support and the quality of life during the post-operative recovery period.Methods A convenience sample of 30 colorectal patients with permanent colostomy were recruited initially.19 completed the follow-up interview 3 months later.Social Support Rating Scale (SSRS) and the Quality of Life Instrument for Cancer Patients(QLICP) were used to measure the social support and the quality of life.Results The dimensions of SSRS were on decline during 3 months after surgery.The scores of the physical and psychological domains of QLICP increased and the scores of the social,general and specific domains decreased but not significantly during the 3 months after surgery.The scores of specific domain were negatively correlated with the scores of utilization degree of social support,as well as the correlation of scores of specific domain and the total scores of social support.Conclusions The enterostomal therapist should pay attention to the change regulation and relationship between social support and life quality of patients with permanent colostomy,and provide them with physical,psychological,psychiatric and social support according to their demands in order to promote their recovery.

This study investigated the effects of hyperoxia on dynamic changes of thioredoxin-1 (Trx1) and thioredoxin reductase-1 (TrxR1) in alveolar type II epithelial cells (AECII) of premature rats. Pregnant Sprague-Dawley rats were sacrificed on day 19 of gestation. AECII were isolated and purified from the lungs of premature rats. When cultured to 80% confluence, in vitro cells were randomly divided into air group and hyperoxia group. Cells in the hyperoxia group were continuously exposed to 95% O(2)/5% CO(2) and those in the air group to 95% air/5% CO(2). After 12, 24 and 48 h, cells in the two groups were harvested to detect their reactive oxygen species (ROS), apoptosis, TrxR1 activity and the expressions of Trx1 and TrxR1 by corresponding protocols, respectively. The results showed that AEC II exposed to hyperoxia generated excessive ROS and the apoptosis percentage in the hyperoxia group was increased significantly at each time points as compared with that in the air group (P<0.001). Moreover, TrxR1 activity was found to be markedly depressed in the hyperoxia group in comparison to that in the air group (P<0.001). RT-PCR showed the expressions of both Trx1 and TrxR1 mRNA were significantly increased in AECII exposed to hyperoxia for 12 and 24 h (P<0.01), respectively. At 48 h, the level of Trx1 mRNA as well as that of TrxR1 mRNA in the hyperoxia group was reduced and showed no significant difference from that in the air group (P>0.05). Western blotting showed the changes of Trx1 protein expressions in the hyperoxia group paralleled those of Trx1 mRNA expressions revealed by RT-PCR. It was concluded that hyperoxia can up-regulate the protective Trx1/TrxR1 expressed by AECII in a certain period, however, also cause dysfunction of the cytoplasmic thioredoxin system by decreasing TrxR1 activity, which may contribute to the progression of oxidative stress and cell apoptosis and finally result in lung injury.

BACKGROUND: Kyphoplasty-assisted bone cement augmentation can be used in lumbar pedicle screw fixation of osteoporotic patients.OBJECTIVE: To assess the fixation strengths of loosened sacral screws augmented with kyphoplasty-assisted and traditional bone cement techniques.METHODS: Fresh sacra were harvested from nine osteoporotic cadavers. After testing bilaterally placed unicortical and bicortical pedicle screws, two unicortical pedicle screws with the traditional and kyphoplasty-assisted cement augmentations were established on the same sacrum. Following 2000 cyclic compression loading to screw head on a MTS machine, their maximum pull-out forces were recorded and compared. RESULTS AND CONCLUSION: The bone mineral densities of nine specimens were ranged from 0.61 to 0.77 g/cm2 (0.71 g/cm2 in average). The mean maximum pull-out forces of unicortical and bicortical screws, and traditional and kyphoplasty-assisted cement screws were 203, 325, 437, and 565 N, respectively. The pull-out force was significantly higher in bicortical screw compared with unicortical (P < 0.05); however, these two fixations exhibited markedly lower pull-out strength compared with two cement augmentation techniques (P < 0.05). The pull-out strength was significantly higher in kyphoplasty-assisted cement augmentation group compared with traditional bone cement technique (P < 0.05). In addition, a significant positive correlation was exhibited between bone mineral density and pull-out force for the four fixations (P < 0.05). Results demonstrated that traditional and kyphoplasty-assisted cement augmentations can serve as the salvage technique for loosening sacral screw. However, kyphoplasty-assisted augmentation can provide higher stability.

This study investigated the effects of hyperoxia on dynamic changes of thioredoxin-1 (Trx1)and thioredoxin reductase-1 (TrxR1) in alveolar type Ⅱ epithelial cells (AECⅡ) of premature rats.Pregnant Sprague-Dawley rats were sacrificed on day 19 of gestation.AEC Ⅱ were isolated and purified from the lungs of premature rats.When cultured to 80％ confluence,in vitro cells were randomly divided into air group and hyperoxia group.Cells in the hyperoxia group were continuously exposed to 95％ O2/5％ CO2 and those in the air group to 95％ air/5％ CO2.After 12,24 and 48 h,cells in the two groups were harvested to detect their reactive oxygen species (ROS),apoptosis,TrxR1 activity and the expressions of Trx1 and TrxR1 by corresponding protocols,respectively.The results showed that AEC Ⅱ exposed to hyperoxia generated excessive ROS and the apoptosis percentage in the hyperoxia group was increased significantly at each time points as compared with that in the air group (P＜0.001).Moreover,TrxR1 activity was found to be markedly depressed in the hyperoxia group in comparison to that in the air group (P＜0.001).RT-PCR showed the expressions of both Trx1 and TrxR1 mRNA were significantly increased in AEC Ⅱ exposed to hyperoxia for 12 and 24 h (P＜0.01),respectively.At 48 h,the level of Trx1 mRNA as well as that of TrxR1 mRNA in the hyperoxia group was reduced and showed no significant difference from that in the air group (P＞0.05).Western blotting showed the changes of Trx 1 protein expressions in the hyperoxia group paralleled those of Trx1 mRNA expressions revealed by RT-PCR.It was concluded that hyperoxia can up-regulate the protective Trx1/TrxR1 expressed by AEC Ⅱ in a certain period,however,also cause dysfunction of the cytoplasmic thioredoxin system by decreasing TrxR1 activity,which may contribute to the progression of oxidative stress and cell apoptosis and finally result in lung injury.