Objective:To investigate the risk factors and clinical significance of lymph nodes metastasis between sternocleidomastoid and sternohyoid muscle lymph node (LNSS) metastasis in thyroid cancer patients, so as to guide the reasonable dissection of LNSS region and lateral cervical lymph node in patients with papillary thyroid carcinoma (PTC) .Methods:We selected 111 PTC patients with lateral cervical lymph node metastasis who underwent radical thyroidectomy and lateral cervical lymph node dissection from Nov. 2018 to Dec. 2021 in China-Japan Union Hospital of jilin university. All patients were treated with low collar arc incision. Radical thyroidectomy and lateral cervical lymph node dissection were performed according to the guidelines, and lymph nodes in each district were grouped for pathological examination. According to whether LNSS metastasis occurred, they were divided into two groups: LNSS positive group (LNSS metastasis occurred) and LNSS negative group (LNSS metastasis did not happen). We collected the basic information of all 111 PTC patients with lateral lymph node metastasis (LLNM), preoperative color Doppler ultrasound examination and paraffin-embedded pathology and other related clinical case data. Then we described the clinicopathological features of cervical lymph node metastasis. Independent sample t test and Mann-Whitney U test were used for continuous variables, and Fisher exact test was used for data analysis for classified variables. Correlation analysis adopted binary logistics regression model, and analyzed the regularity and risk factors of LNSS metastasis. Results:In this study, the detection rate of LNSS was 64.9% (72/111), the overall LNSS metastasis rate was 7.2% (8/111), and the number of lymph node metastasis was 0-5. Univariate analysis showed that the location of LNSS metastasis was related with the cancer focus ( P<0.001), the preoperative serum thyroglobulin (Tg) level ( P=0.002), the number of lymph node metastasis in lateral cervical level Ⅳ ( P=0.001), the longest diameter of the cancer focus ( P=0.003) and the longest diameter of metastatic lymph nodes ( P=0.001) However, age, sex, whether there is lymph node metastasis in the central region (central lymph node metastasis ,CLNM), and whether there is multifocal cancer were not related to LNSS metastasis ( P≥0.05). Further multivariate analysis and work curve analysis of subjects showed that the tumor located in the lower pole ( P=0.014) and the number of lymph node metastasis in level Ⅳ more than 3 ( P=0.027) were independent risk factors for LNSS metastasis. It was found that the risk of LNSS metastasis increased when the cancer focus was located at the lower pole relative to the upper pole or middle part of the cancer focus ( OR=74.508, 95% CI: 2.373-2339.544). The number of lymph node metastasis in level Ⅳ had a positive effect on LNSS metastasis. The more lymph node metastasis in level Ⅳ, the higher the risk of LNSS metastasis ( OR=1.556; 95% CI=1.051-2.303) . Conclusions:In PTC patients with LLNM, the LNSS metastasis rate was 7.2%, and the advantages of LNSS cleaning outweigh the disadvantages. When the cancer focus is located at the lower pole and the number of lymph node metastasis in region Ⅳ is more than 3, it is necessary to pay attention to the dissection of this group of lymph nodes.

Background Macrophages are essential components of the natural immune system. They play a significant role in resisting foreign bodies in the respiratory tract and maintaining the homeostasis of the internal environment of lung tissue. Objective To investigate the mechanism of macrophage pyroptosis induced by silica dust with different particle sizes. Methods The modified murine macrophage cell line, RAW-ASC cells, was cultured and divided into a blank control group, a lipopolysaccharide (LPS) group (1 μg·mL⁻¹ LPS), a nano-SiO₂ group (1 μg·mL⁻¹ LPS+100 μg·mL⁻¹ nano-SiO₂), a micro-SiO₂ group (1 μg·mL⁻¹ LPS+750 μg·mL⁻¹ micro-SiO₂), and a positive control group [1 μg·mL⁻¹ LPS+3 mmol·L⁻¹ adenosine triphosphate (ATP)]. Apart from the blank control group, cells in other groups were pretreated with LPS for 6 h, and then exposed to SiO₂ or ATP for 4 h. According to the molecular target NOD-like receptor pyrin domain-containing protein 3 (NLRP3) and reactive oxygen species (ROS), we applied MCC950 (NLRP3 inhibitor) and N-acetyl cysteine (NAC, ROS scavenger) to macrophages. CCK-8 assay was used to detect cell viability; 5-ethynyl-2'-deoxyuridine (EdU) staining was used to detect cell proliferation; lactate dehydrogenase (LDH) assay kit was used to detect LDH in supernatant; calcein AM/PI fluorescent double-staining was applied to evaluate cell rupture; 2',7'-dichlorofluorescin diacetate (DCFH-DA) fluorescent probe was used to measure the content of ROS; Western blotting was used to measure the expressions of NLRP3, apoptosis-associated speck-like protein containing CARD (ASC), Caspase-1, gasdermin D (GSDMD), and interleukin-1β (IL-1β). Results Compared with the blank group, 100 μg·mL^-1nano-SiO₂ and 750 μg·mL^-1micro-SiO₂ dust exposure reduced the cell viability to 40% and 68% (P<0.05), and the cell proliferation rate to 30% and 33% (P<0.01), respectively; they also induced cell lysis and ROS release, upregulated NLRP3, ASC, Caspase-1, GSDMD, and IL-1β at protein level (P<0.05), and induced macrophage pyroptosis. After intervening with MCC950 (10 μmol·L^-1) and NAC (10 mmol·L^-1), the expressions of NLRP3, ASC, Caspase-1, and IL-1β decreased (P<0.05), and, specifically, NAC effectively reduced ROS levels (P<0.05). Conclusion Both nano- and micro-SiO₂ dust have cytotoxicity, can upregulate ROS level, activate NLRP3 inflammasome, and promote the release of cytokines, leading to pyroptosis. These results are helpful to reveal the molecular mechanism of macrophage pyroptosis induced by SiO₂ dust.

Objective : To study the expression and clinical significance of Wnt signal secretory protein DKK1 in cervical cancer. Methods : Reverse transcription polymerase chain reaction (RT⁃PCR) was used to detect the expression of DKK1 mRNA in 30 pairs of cervical cancer tissues and adjacent normal tissues. The expression of DKK1 protein was detected by immunohistochemistry in 60 cases of cervical cancer and 30 cases of normal cervical tissue , and the relationship between the expression and clinicopathological characteristics of cervical cancer was analyzed. Results : The expression of DKK1 in cervical cancer tissues was lower than that in adjacent tissues and normal cervical tissues (P < 0. 05) . The expression of DKK1 was closely related to clinicopathological stage , tissue differentiation , lymph node metastasis and depth of invasion (P < 0. 05) . Conclusion The expression of DKK1 is low in cervical cancer and plays an important role in the occurrence and development of cervical cancer.

Objective:To summarize our experience in diagnosis and treatment of Budd-Chiari syndrome(BCS) accompanied with hepatic nodules.Methods:The clinical data of 33 patients with BCS accompanied with hepatic nodules who were treated at Henan Provincial People's Hospital from January 2012 to December 2018 were retrospectively analysed. A total of 33 patients were enrolled, including 17 males and 16 females, with an average age of 51 years. Analyze the treatment and prognosis of different types of nodules.Results:Of 33 patients, 27 were diagnosed to have hepatocellular carcinoma and 6 benign proliferative nodules. Treatment of patients with hepatocellular carcinoma included, transcatheter arterial chemoembolization ( n=1) and hepatectomy ( n=26). The survival time of these patients with hepatocellular carcinoma ranged from 10.0 to 78.0 months (mean 37.8 months). For the remaining 6 patients with benign nodules, the nodules were multiple and no malignant changes were observed on follow-up. Conclusion:For patients with BCS associated with benign nodules, no specific treatment was required. Hepatocellular carcinoma assocated with BCS had good prognosis. An aggressive surgical resectional approach is recommended to treat and to relieve the hepatic outflow obstruction.

Objective:To study the safety and efficacy of using entrapped duct-to-mucosa pancreaticojejunostomy for patients with small pancreatic ducts of less than 3 mm in diameter.Methods:The clinical data of patients who underwent entrapped duct-to-mucosa pancreaticojejunostomy at Henan Province People's Hospital from January 2017 to December 2019 were retrospectively analyzed. The incidences of complication including pancreatic fistula and abdominal hemorrhage were studied. The duration to carry out the pancreaticojejunostomy and postoperative hospital study were also analyzed.Results:Of 98 patients included in this study, there were 58 males and 40 females, with an average age of 62.3 (aged 24 to 73) years. The average time of completing the pancreaticoenterostomy was (10.2±3.1) min. There were 10 patients (10.2%) who developed grade A pancreatic fistulae. There were no grade B or C pancreatic fistulae, no portoperative bleeding and no perioperative deaths. The postoperative hospital stay was (13.4±4.6) days.Conclusion:Entrapped duct-to-mucosa pancreaticojejunostomy was simple, quick, safe and effective in patients with small pancreatic ducts.

This paper briefly introduces the recent regulatory regulations issued by the European Union and the United States on the drug-device combinations. The contents include the definition of drug-device combinations, the attribute definition process, the registration requirements, the review and approval procedures, the management of production systems, and the post-marketing safety supervision. Some inspirations have been obtained from them for reference by the regulatory authorities.
European Union ; Marketing ; United States

OBJECTIVE: To detect the expression of differential expression genes(DEGs) on microarray chips of macrophages exposed to nano-silicon dioxide(SiO_2) dust, and to screen the leading signaling pathway of nano-SiO_2 dust exposure-related diseases. METHODS: The gene chip GSE13005 of RAW264.7 macrophage intervened by nano-SiO_2 dust was obtained from the public gene chip database developed by the National Center for Biotechnology Information. The macrophages in the control group were cultured in complete medium without adding SiO_2 dust, whereas the macrophages in the exposure group were treated with SiO_2 dust with the final concentrations of 5, 20, and 50 mg/L. The gene expression data of macrophages was analyzed by RMA Express 1.2.0 software and R language 3.5.1. The Kyoto Encyclopedia of Genes and Genomes(KEGG) was used to screen DEGs and perform gene ontology(GO) enrichment analysis on related genes and signaling pathways. RESULTS: A total of 67 DEGs of macrophages were screened after SiO_2 dust treatment, of which 48 genes were up-regulated and 19 genes were down-regulated. GO enrichment analysis results showed that the main functional items of participating DEGs were reaction of amine, regulation of viral genome replication,negative regulation of amino acid transport, ovulation, bronchodilator response, chemokine activity, negative regulation of muscle cell differentiation, response to lack of amino acid, positive regulation of glomerular mesangial cell proliferation, and positive regulation of vascular smooth muscle cell proliferation. KEGG signaling pathway analysis results suggested that DEGs could function through 7 signaling pathways including nuclear transcription factor-κB(NF-κB) signaling pathway, p53 signaling pathway, glioma, melanoma, toll-like receptor signaling pathway, renal cell carcinoma and salmonella infection. Further functional enrichment revealed that NF-κB signaling pathway changed most significantly after macrophages were exposed to nano-SiO_2 dust. CONCLUSION: Exposure to nano-SiO_2 could induce the abnormal expression of 67 genes in macrophages. The genes that participated in macrophage activation process induced by nano-SiO_2 dust exposure are related to NF kappa B signaling pathway.

This study is to investigate the chemical constituents from the whole plant Corydalis edulis. The chemical constituents were separated and purified by macroporous resin D101, silica gel, Sephadex LH-20, ODS, and semi-preparative HPLC. Their structures were determined by physicochemical properties and spectroscopic data. Four compounds were isolated from the dichloromethane and water extracts of the whole plant C. edulis, and identified as 6'-β-D-xylosylicariside B2(1),(3S,5R,6S,7E)-5,6-epoxy-3-hydroxy-7-megastigmen-9-one(2), loliolide(3), and 5,5'-dimethoxybiphenyl-2,2'-diol(4), respectively. Compound 1 is a new compound, of which the absolute configuration was established by electronic circular dichroism(ECD) calculations. Compound 4 is obtained from the plants of Papaveraceae family for the first time. Compounds 2 and 3 are firstly isolated from the Corydalis genus.
Chromatography, High Pressure Liquid ; Corydalis/chemistry* ; Glycosides/isolation & purification* ; Molecular Structure ; Phytochemicals/isolation & purification* ; Sesquiterpenes/isolation & purification*

Objective To study the combined use of ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) with hepatic artery reconstruction in the treatment of hilar cholangiocarcinoma with hepatic arterial involvement.Methods The clinical data of 7 patients with hilar cholangiocarcinoma who underwent ALPPS combined with hepatic arterial resection and reconstruction were analyzed retrospectively.The technical points and the perioperative management were analyzed.Methods At the first stage,the relationship between the tumor and the vessels were explored,the portal vein of the part of the liver to be resected was ligated and the liver was transected with a CUSA (Cavitron Ultrasound Surgical Aspirator).Then the bile duct was cut and a hepaticojejunostomy was completed.Finally,under ultrasound guidance,a bile duct drainage tube was inserted transhepatically into the part of the liver which was to be resected.Two to three weeks later,and after enough hypertrophy of the liver remnant size was confirmed,tumor resection was completed with reconstruction of the hepatic artery.Results Seven patients underwent the second stage operation,with no perioperative death.Six patients developed pulmonary infection and were treated successfully with conservative treatment.Two patients developed postoperative bile leak with secondary abdominal infection.One patient developed postoperative hepatic artery thrombosis secondary to biliary tract infection.Conclusion ALPPS combined with hepatic artery reconstruction was safe and feasible in the treatment of hilar cholangiocarcinoma with hepatic arterial involvement.

Objective To retrospectively analyze the dosimetry and efficacy of whole-brain irradiation (WBRT) with simultaneous integrated boost (SIB) by helical tomotherapy (HT) in the treatment of multiple brain metastases (BMs),and to evaluate the feasibility,efficacy,and safety of HT.Methods From 2014 to 2017,a total of 43 patients with multiple BMs (no less than 3 lesions) were enrolled as subjects.A dose of 40 Gy was delivered to the whole brain in 20 fractions,while a dose of 60 Gy was delivered to the gross target volume (GTV) in 20 fractions.Patients were reexamined by magnetic resonance imaging during treatment.The radiation field would be shrunk if GTV was reduced.Target coverage (TC),conformity index (CI),prescription isodose/target volume (PITV) ratio,and homogeneity index (HI) were assessed.Clinical indices included local recurrence-free survival (LRFS),intracranial progression-free survival (IPFS),progression-free survival (PFS),overall survival (OS),and toxicities.Results The median lesion number was 6(3-36) and the median total volume of GTV was 8.74 cm3.The TC,CI,PITV,and HI for GTV were 0.96±0.028,0.51±0.164,2.09±1.245,and 0.12±0.066,respectively,while the TC and HI for the whole brain were 0.95±0.033 and 0.43±0.161,respectively.In all the patients,26％ had replarming during treatment.The two-stage treatment reduced the radiation dose to organs at risk.The 1-year LRFS,IPFS,PFS,and OS rates were 96％,80％,39％,and 86％,respectively.No grade ≥3 toxicities were observed.Conclusions WBRT with SIB by HT achieves satisfactory conformity,homogeneity,efficacy,and safety,which is a recommended treatment plan for multiple BMs.Replanning during treatment can better protect normal tissue.