Objective:To investigate the application value of transanal intersphincteric resec-tion under direct vision in the Jackknife position in the anal preserving surgery for ultra-low rectal cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 15 patients with ultra-low rectal cancer who underwent transanal intersphincteric resection under direct vision in the Jackknife position, combined with laparoscopic total mesorectal excision in Huizhou Municipal Central Hospital from September 2021 to November 2022 were collected. There were 9 males and 6 females, aged (63±9)years. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical and postoperative outcomes. All the 15 patients underwent operations successfully, without conversion to open abdo-minal operation. There were 5 cases of partial ISR and 10 cases of subtotal ISR. The operation time and volume of intraoperative blood loss of 15 patients were (260±30)minutes and 20(range, 10-30)mL, respectively. The distance from anastomosis to anal margin was (1.6±0.8)cm. The duration of post-operative hospital stay was 10(range, 8-13)days, and all 15 patients underwent colonic and anasto-mosis with staplers and protective ileostomy at the terminal ileum. Three patients had postoperative complications within 30 days after surgery, of whom 1 case with grade A anastomotic leakage was cured after conservative treatment and 2 cases with anastomotic membranous stenosis were cured by anal enlargement. (2) Postoperative pathological examination. The number of lymph nodes dissected of 15 patients was 18 ±6, and the distance between the tumor and distal resection margin was 1.3(range, 1.0-2.0)cm. The surgical specimens of all 15 patients showed complete mesorectum and negative for proximal, distal and circumferential margins. Results of postoperative pathological examination showed that there was 1 case in stage pT1N0M0, 9 cases in stage pT2N0M0, 1 case in stage pT2N1M0, 1 case in stage ypT0N0M0, 2 cases in stage ypT2N0M0, 1 case in ypT3N1M0 stage. The histological subtype showed 11 cases of moderately differentiated adenocarcinoma and 4 cases of well-differentiated adenocarcinoma. (3) Follow-up. All 15 patients were followed up for 15(range, 12-24)months. No local recurrence and distant metastasis of the tumor was found, and no tumor-related death occurred. All 15 patients underwent stoma closure. The postoperative anal function assessment of 15 patients showed no disorder in 5 cases, mild disorder in 8 cases and severe disorder in 2 cases.Conclusion:Transanal intersphincteric resection under direct vision in the Jackknife position in the anal preserving surgery for ultra-low rectal cancer is safe and feasible.

The pathological hallmarks of psoriasis involve alterations in T cell genes associated with transcriptional levels, which are determined by chromatin accessibility. However, to what extent these alterations in T cell transcriptional levels recapitulate the epigenetic features of psoriasis remains unknown. Here, we systematically profiled chromatin accessibility on Th1, Th2, Th1-17, Th17, and Treg cells and found that chromatin remodeling contributes significantly to the pathogenesis of the disease. The chromatin remodeling tendency of different subtypes of Th cells were relatively consistent. Next, we profiled chromatin accessibility and transcriptional dynamics on memory Th/Treg cells. In the memory Th cells, 803 increased and 545 decreased chromatin-accessible regions were identified. In the memory Treg cells, 713 increased and 1206 decreased chromatin-accessible regions were identified. A total of 54 and 53 genes were differentially expressed in the peaks associated with the memory Th and Treg cells. FOSL1, SPI1, ATF3, NFKB1, RUNX, ETV4, ERG, FLI1, and ETC1 were identified as regulators in the development of psoriasis. The transcriptional regulatory network showed that NFKB1 and RELA were highly connected and central to the network. NFKB1 regulated the genes of CCL3, CXCL2, and IL1RN. Our results provided candidate transcription factors and a foundational framework of the regulomes of the disease.
Chromatin/genetics* ; Chromatin Assembly and Disassembly ; Gene Regulatory Networks ; Humans ; Psoriasis/genetics* ; T-Lymphocytes, Regulatory

【Objective】 To investigate the quality changes of suspended red blood cells (SRBCs) prepared from the blood of Tibetan high Hb population, and explore the availability and safety of blood collected from Tibetan high Hb population. 【Methods】 The voluntary blood donors were grouped according to the Hb concentration at the initial screening: female blood donors from Tibet Autonomous Region (>3 500 m) with Hb≥190 g/L and male blood donors with Hb≥210 g/L were classified as plateau high hemoglobin group. A total of 13 male blood donors from Tibet Autonomous Region were recruited. And the female blood donors (n=13) with Hb(115~165) g/L and male blood donors (n=12) with Hb(120~185) g/L from Chengdu were classified as control group. Whole blood of 200 mL specification was centrifuged to remove the plasma, and MAP additive solution was added to prepare SRBCs, then SRBCs were divided into four aliquots (50 mL/bag and stored at 4℃. Parameters as blood routine, free Hb and hemolysis rate were measured aseptically at day 1, 14, 21, 35 of storage. And 10 mL SRBCs was used to extract membrane proteins for tyrosine phosphorylation detection of band 3 protein. 【Results】 The RBCs counts(×10¹²/L), hematocrit(%) and hemoglobin(g/L) of Tibetan high Hb group and control group were 6.76±0.95 vs 4.65±0.52, 63.3±6.8 vs 43.1±4.4 and 214.4±19.8 vs 143.2±16.9 (P<0.01). The erythrocyte deformability test on the day 1, 14, 21, 35 of storage showed that the deformability of SRBCs prepared from Tibetan high Hb group was significantly lower than that of the control group under shear stress of 3, 5.33, 9.49, 16.87, and 30 Pa, while the hemolysis rate of SRBCs prepared from the Tibetan high Hb group and the control group on the day 1, 14, 21, 35 were 0.050 2±0.040 2 vs 0.022 2±0.011 1, 0.055 4±0.043 vs 0.032 1±0.028 7, 0.061 2±0.025 9 vs 0.034 3±0.031 7 and 0.069 6±0.032 0 vs 0.044 0±0.033 3 (P<0.05). Western blotting showed that the cytoplasmic N-terminal Y21 of band 3 protein of SRBCs prepared from Tibetan high Hb group was highly phosphorylated. 【Conclusion】 The deformability of SRBCs prepared from the Tibetan high Hb group was significantly lower while the hemolysis rate of SRBCs was higher than that of the control group. The hemolysis rate of the SRBCs at the end of storage prepared from the Tibetan high Hb group meets the requirements of the national standard GB18469-2012(<0.8%). The increase of hemolysis rate of SRBCs prepared from the Tibetan high Hb group was closely related to the phosphorylation of band 3 protein.

To study the clinical effect of non-ampullary duodenal mucosal lesions treated by endoscopic resection. A retrospective analysis was performed on the data of 58 cases of duodenal non-ampullary mucosal lesions treated by endoscopic resection from January 2016 to June 2019 from 3 hospitals. Among 58 cases, 27 lesions (46.6%) were located in the duodenal bulb and 31 (53.4%) in the duodenal descending part (including the ball-drop boundary). Forty-six patients (79.3%) received endoscopic mucosal resection, 7 (12.1%) received endoscopic submucosal dissection and 5 (8.6%) received pre-cut endoscopic mucosal resection. Few postoperative complications were found except for 1 case of intraoperative bleeding, 1 case of delayed bleeding 2 days after surgery, 1 case of lesion residual and 2 cases of postoperative abdominal pain. No perforation occurred. Endoscopic treatment of non-ampullary duodenal mucosal lesions is safe and effective.

【Objective】 To investigate the removal efficacy of inflammatory cytokines and blood compatibility of modified PBTNF. 【Methods】 Acrylic acid (AA) was firstly UV-grafted onto the surface of PBTNF to negatively charge the surface of the material. Subsequently, the three positively charged polyelectrolytes, DA, PEI, and CS were respectively electrostatic self-assembled with GO on the surface of PBTNF, forming two layers of film with GO as the outer layer: PBTNF-(DA/GO)2, PBTNF-(PEI/GO)2, PBTNF-(CS/GO)2. 【Results】 Scanning electron microscopy results showed that compared with the PBTNF grafted with AA, the adhesion of particles was observed on the surface of the three modified materials, and the photo shows that the color of the material surface was deepened after electrostatic self-assembly. The results of wettability showed that the surface hydrophilicity was significantly improved, indicating that the electrostatic self-assembled membrane was successfully immobilized on the surface of PBTNF. The removal efficiency (%) of IL-1β for PBTNF-(DA/GO)2, PBTNF-(PEI/GO)2 and PBTNF-(CS/GO)2 were 69.00±7.36 vs -2.35±2.69 vs -1.59±3.26 (P<0.05). The removal efficiency of IL-6 (%) were 40.15±1.86 vs -13.46±5.72 vs -1.21±3.41 (P<0.05). The removal efficiency of IL-8 (%) were 96.90±0.97 vs 17.84±11.74 vs 43.68±17.38 (P<0.05). The removal efficiency of TNF-α (%) was 44.46±2.50 vs 14.90±7.12 vs 20.64±1.22 (P<0.05). Plasma protein adsorption results (total protein, immunoglobulin G, albumin) and red blood cell deformability index showed that there was no statistical difference among the three modified PBTNFs and the control group (P>0.05). Although the red blood cell osmotic fragility (g/L) of the three modified PBTNFs is higher than that of the former: control group vs PBTNF-(DA/GO)2 vs PBTNF-(PEI/GO)2 vs PBTNF-(CS/GO)2: 4.39±0.05 vs 4.62±0.02 vs 4.48±0.03 vs 4.90±0.03 (P<0.05), the hemolysis rate (%) of them were all less than 5%, and PBTNF-(DA/GO)2 performed the lowest hemolysis rate which was (0.03±0.01)% (compared with PBTNF-(PEI/GO)2, P<0.05). The coagulation function test results showed that compared with the control group, the fibrinogen (g/L) of the three modified PBTNFs had no statistical difference (P>0.05); the activated partial thrombo plastin time (S) slightly extended, but all within the normal range of clinical standard; and the prothrombin time (S) of PBTNF-(CS/GO)2 was prolonged(P<0.05). 【Conclusion】 Among the three positively charged polyelectrolytes, including DA, PEI, and CS, PBTNF-(DA/GO)2 performed the best removal rate of inflammatory cytokines, and the blood compatibility evaluation results showed that PBTNF-(DA/GO)2 had no significant effect on red blood cells and coagulation function. Consequently, in the study of inflammatory cytokines adsorption, DA is expected to be the optimal polyelectrolyte assembling with GO for further research.

【Objective】 To explore the correlation between blood coagulation function and hemoglobin(Hb) content in male Tibetan population in Tibet by analyzing and comparing the indexes of blood coagulation function in male Tibetan population with different Hb contents, so as to provide the basis for formulating blood donation criteria and blood component quality standard suitable for high altitude area. 【Methods】 Male Tibetans in Tibet during November 2018 to January 2019 were randomly selected and divided into three groups according to the Hb content. The healthy male volunteers in plain area were taken as the control. The plasma PT, APTT, TT, Fg, coagulation factor Ⅱ(FⅡ), FⅤ, FⅦ, FⅧ, FⅨ, FⅩ, FⅪ, FⅫ and protein C(PC) content of each group were measured and compared. 【Results】 The Fg was not different by groups(P>0.05); PT, APTT and TT in group C (Hb>210 g/L) in Tibet were significantly higher than those in controls [PT( s) : 11.48±1.18 vs 13.79±3.73; APTT( s) : 36.71±2.93 vs 43.30±4.56; TT( s) : 15.77±0.95 vs 17.94±2.43, P<0.05] ; some coagulation factors (IU / mL) decreased significantly(FⅡ: 0.98±0.10 vs 0.89±0.11; FⅤ: 0.86±0.13 vs 0.65±0.12; FⅦ: 0.93±0.18 vs 0.74±0.14; FⅩ: 0.96±0.16 vs 0.83±0.20; FⅧ: 0.79±0.08 vs 0.66±0.06; FⅪ: 0.86±0.13 vs 0.66±0.14, P<0.05); the content of ATⅢ decreased significantly(116.37±18.81 vs 96.84±14.66, P<0.05). There was no significant difference between group A (120 g/L≤Hb≤185 g/L) and group B (185 g/L0.05), except PC conctent of group A was slightly higher than that of group B. 【Conclusion】 The plasma characteristics of Tibetan male with Hb content more than 210 g/L is different from that in plain and other high altitude area, such as prolonged coagulation time and significantly decreased coagulation factor content. Therefore, it is important to put forward the health examination requirements for blood donors and quality standards for whole blood and blood components suitable for high altitude areas in Tibet.

【Objective】 To investigate the blood compatibility of transfusion sets for single use, the loss, damage and activation of blood components after passage through the transfusion sets. 【Methods】 Transfusion sets (sample A and B) were assessed by comparing samples of blood component taken prior to and after passage through. The following makers of damage/activation were evaluated: Red blood cells (RBCs)-supernatant free hemoglobin (FHb) and potassium(K⁺ ) amount; platelet concentrates (PCs)-pH, hypotonic shock response (HSR), supernatant lactate dehydrogenase(LDH), CD62P; fresh frozen plasma(FFP) – prothrombin fragments 1 and 2 (F1+ 2), fibrinopeptide A (FPA), coagulation factor Ⅻa (FⅫa), Thrombin-antithrombin complex (TAT). 【Results】 After passing through two types of transfusion sets, the loss of RBCs, PCs and FFP were less than 5%. There is no statistic difference for the change of FHb and K⁺ of RBCs(P>0.05). There were no statistics for pH, LDH(U/L) and CD62P(%) after platelet concentrates passing through both transfusion sets. There was no statistics for the HSR after passing through the sample A, while there was a small but statistically significant increase in the HSR of sample B (37.17±6.49 vs 40.75±6.24, P<0.05). After FFP passing through the transfusion giving sets, there were no statistical difference for F1+ 2, FPA, FⅫa and TAT (P>0.05). 【Conclusion】 Two types of transfusion sets caused negligible effects on RBCs, platelet concentrates and FFP.

Epigenetics refers to genetic regulation patterns that gene expressions, which lead to the phenotype variance, are modified in the absence of changes of DNA sequence. Epigenetics mainly includes DNA methylation, histone modification, and non-coding RNA regulation. During the development of the teeth, conventional gene regulation and epigenetics synergistically regulate the spatial and temporal expression of genes, which involved in cell proliferation, differentiation and finally the formation of teeth. Exploration of the epigenetic regulation mechanisms during tooth development can provide multiple clues and ideas for the research of tooth regeneration. This article reviewed the significant roles of epigenetic regulation in tooth development.

Objective:To understand the iodine nutrition states of children in Dongtai City Jiangsu Province by analyzing the urinary iodine level of children aged 0 - 12 years old (prepubescent children), so as to provide scientific reference for prepubescent children's reasonable iodine nutrition intake.Methods:Under the guidance of the "National Iodine Deficiency Disorders Monitoring Program" (2016), Dongtai City was divided into 5 districts according to the east, west, south, north and middle locations. In each district, children aged 0 - 7 years old who underwent physical examination in township hospitals and prevention and health centers were selected to collect urine samples for urine iodine testing. One township was selected from each district, and one primary school was selected from each township. At least 90 children aged 8 to 12 (half boys and half girls) were selected from each primary school to collect urine samples for urine iodine testing. The urinary iodine levels of children of different genders, ages and regions were compared and analyzed.Results:A total of 2 934 urine samples were collected. The median of urinary iodine was 191.9 μg/L, ranging from 1.4 to 627.9 μg/L, the proportion of urine iodine content < 50 μg/L was 5.5% (162/2 934), the proportion of 50 - 99 μg/L was 10.9% (319/2 934), the proportion of 100 - 199 μg/L was 37.4% (1 096/2 934), the proportion of 200 - 299 μg/L was 28.3% (829/2 934), and the proportion of ≥300 μg/L was 18.0% (528/2 934). A total of 1 535 and 1 399 urine samples of boys and girls were collected. The medians urinary iodine of boys and girls were 202.3 and 177.7 μg/L, respectively, and the difference was statistically significant ( Z = - 5.487, P < 0.05). There were 106, 1 539, 753 and 536 cases of infants (0 - 12 months old), early childhood (1 - 3 years old), preschool children (4 - 6 years old), and school-age children (7 - 12 years old), the medians urinary iodine were 169.8, 189.6, 169.9 and 243.7 μg/L, respectively, the difference was statistically significant ( H = 127.395, P < 0.05). There were 642, 699, 422, 738 and 433 cases in different regions (east, west, south, north and middle) and the medians urinary iodine were 194.2, 172.7, 196.8, 200.5 and 196.6 μg/L, respectively, the difference was statistically significant ( H = 29.461, P < 0.05). Conclusions:Children aged 0 - 12 years old in Dongtai City are not deficient in iodine on the whole, but those with urinary iodine value higher than 200 μg/L account for a large proportion. Therefore, a reasonable iodine nutrition plan should be implemented according to the actual situation. In addition, individual iodine deficiency and excess should also be paid attention to.

Objective:To study the significance of induction chemotherapy and subsequent comprehensive therapy for overall survival rate (OS) and larynx dysfunction-free survival rate (LDFS) in patients with advanced hypopharyngeal carcinoma.Methods:Patients who met the inclusion criteria with the diagnoses of advanced hypopharyngeal carcinoma between 2011 and 2017 received 2 or 3 cycles of TPF regimen induction chemotherapy. Patients who attained complete response (CR) received radical chemotherapy. Patients who attained partial response (PR) and the reduction of tumor volume was more than 70% were defined as large PR and received concurrent chemoradiotherapy. When the tumor volume reduction of PR patients was less than 70%, they were defined as small PR. (CR+large PR) group was defined as effective group. Patients who did not reach CR and large PR were defined as uneffective group and underwent radical surgery and received adjuvant radiotherapy as appropriate after the surgery. The end points of the study were OS, progression-free survival (PFS) and LDFS. Chi-square (χ 2) test was used for correlation analysis. Survival analysis was performed by the Kaplan-Meier method with a Log-rank test. Cox proportional hazards model was used for univariate and multivariate survival analysis. Results:A total of 260 patients were enrolled in the study. The follow-up period ranged from 5 to 83 months, with an average of 24.7 months. The 3-year and 5-year OS rate was 46.0% and 32.6%, respectively. The 3-year and 5-year PFS rate was 41.0% and 26.6%, respectively. The 3-year and 5-year LDFS rate was 37.9% and 24.8%, respectively. Poor outcome of induction chemotherapy, advanced N stage, strong positive Ki-67 immunohistochemistry (all P<0.001) were negative prognostic factors. The advanced clinical stage was positively related to the poor outcome of induction chemotherapy ( P=0.015). There was no significant difference in OS and PFS between the large PR group and the small PR group (all P>0.005). Conclusion:TPF regimen induction chemotherapy and subsequent comprehensive therapy for patients with advanced hypopharyngeal carcinoma may improve the quality of life of patients, with high OS rate and LDFS rate.