Objective To observe the characteristics of infant biliary atresia(BA)missed diagnosis by ultrasound.Methods Data of 72 BA infants missed by ultrasound(false-negative,group A),72 BA infants accurately diagnosed by ultrasound(true-positive,group B)and 72 non BA infants(controls,group C)were retrospectively analyzed.Clinical and ultrasonic features were compared between each 2 groups.Logistic regression analysis was performed to screen the impact factors for diagnosing and missed-diagnosing of BA.Results There were significant differences of total bilirubin,direct bilirubin,gamma glutamyl transpeptidase(GGT)and glutamic-oxaloacetic transaminase(GOT)between group A and C,also of total bilirubin,direct bilirubin and GGT between group B and C(all P＜0.05).Significant differences of the incidences of small gallbladder,gallbladder wall rigidity,poor gallbladder contraction function and fibrous plaques in the hepatic hilum were found between group A and B,of undetected or cystic changes in the gallbladder,gallbladder wall rigidity,poor gallbladder contraction function,fibrous plaques in the hepatic hilum and hepatic hilum cysts were noticed between group A and C(all P＜0.05),as well as of undetected or cystic changes in the gallbladder,small gallbladder,gallbladder wall rigidity,gallbladder wall thickening,poor gallbladder contraction function and fibrous plaques in the hepatic hilum were detected between group B and C(all P＜0.05).There were significant differences of display rate of common bile duct between each 2 groups(all P＜0.05).The lower incidence of fibrous plaques in the hepatic hilum and poor gallbladder contraction function were an impact factors for missed diagnosis of BA(both P＜0.05),while higher GGT,higher incidence of fibrous plaques in the hepatic hilum and poor gallbladder contraction function were all impact factors for diagnosis of BA in group A(all P＜0.05).Conclusion Infant BA missed diagnosis by ultrasound had lower incidence of fibrous plaques in the hepatic hilum and poor gallbladder contractile function.Combining with clinical data was helpful for reducing ultrasonic missed diagnosis of BA in infants.

Objective To screen the epithelial mesenchymal transformation(EMT)-related genes in lung adenocarcinoma,perform functional enrichment analysis and construct protein interaction network(PPI).Ac-cording to the competitive endogenous RNA(ceRNA)hypothesis and the effect of gene expression on the prognosis of patients,the ceRNA network was constructed.Methods The differentially expressed genes be-tween lung adenocarcinoma tissues and normal tissues were screened by gene expression map and tumor ge-nome map database,and the genes were imported into GenClip3 to obtain EMT-related genes.Metascape was used to perform gene ontology and Kyoto encyclopedia of gene and genome enrichment analysis,and STRING database was used to construct PPI and obtain EMT key genes.The relationship between key genes and prog-nosis was analyzed by Kaplan-Meier analysis.Analysis tools such as miRTarbase,miRNet database,and EN-CORI were used to construct ceRNA networks.Results In this study,156 lung adenocarcinoma EMT-related genes and their key genes cadherin 1,interleukin-6,matrix metalloproteinase-9,platelet endothelial cell adhe-sion molecule,cyclin-dependent kinase inhibitor 2A,α1-Ⅰcollagen gene,secreted phosphoprotein 1,TIMP in-hibitor of matrix metalloproteinase-1,caveolin-1 and Zeste homologue enhance core 2(EZH2)-1 were identi-fied.The PPI of key genes was predicted,and the therapeutic drugs targeting these key genes including salvia miltiorrhiza,ginseng lu,ginseng leaf and ginseng flower were also predicted.The prognostic ceRNA regulatory network of EZH2/hsa-miR-101-3p/GSEC was constructed.Conclusion This study describes using bioinfor-matics methods system in the process of EMT gene interactions,according to the lung adenocarcinoma pa-tients clinical data to construct the prognosis of the EMT process related ceRNA network,for the treatment and prognosis of lung adenocarcinoma judgment provides a new way of thinking.

Objective:To elucidate the current proficiency level in diagnosing pediatric biliary atresia among Chinese sonographers and to identify contributing factors that may influence their diagnostic capabilities.Methods:A cross-sectional internet-based survey was conducted from November 6, 2021, to December 12, 2021. The online questionnaire was disseminated to a national cohort of sonographers via WeChat groups. The survey encompassed three domains: demographic data of the participants, clinical and ultrasonographic knowledge pertaining to biliary atresia, and the cognitive understanding of biliary atresia. Descriptive statistics were utilized for the evaluation of demographic information and sonographers' clinical and ultrasonographic comprehension concerning biliary atresia. A generalized linear model was employed to ascertain the determinants influencing sonographers' expertise in clinical management and ultrasonographic diagnosis of biliary atresia.Results:A total of 511 valid responses were collated. Approximately 64.77% (331/511) of sonographers indicated a lack of comprehensive understanding of the essential parameters for ultrasonographic diagnosis of biliary atresia. Regression analysis revealed that sonographers affiliated with lower-tier hospitals ( β=-0.344, P=0.002), non-pediatric institutions ( β=-0.747, P=0.004), and those with less than 15 years of professional experience ( β=0.952, P<0.001) exhibited diminished proficiency in diagnosing biliary atresia. Upon encountering suspected cases, a mere 5.48% (28/511) of sonographers expressed complete confidence in their diagnostic capabilities. Lower professional grade ( β=-0.572, P<0.001) and lack of prior experience with suspected cases of biliary atresia ( β=-0.693, P<0.001) contributed to reduced diagnostic self-assurance among sonographers. Regarding the clinical and ultrasonographic intricacies associated with biliary atresia, only 3.33% (17/511) of sonographers had a full understanding of the diagnostic significance of hepatic fibrous plaques on ultrasound for biliary atresia. Conclusion:The study underscores a pervasive inadequacy in the understanding and diagnostic confidence among sonographers in relation to pediatric biliary atresia. Various pragmatic factors, including hospital tier, years of experience, and professional ranking, exert a direct impact on the sonographers' diagnostic acumen. Given these findings, there is an exigent need for targeted educational initiatives to enhance the diagnostic proficiency in biliary atresia among sonographers.

Objective:To evaluate the role of NF-E2-related factor 2 (Nrf2)/heme oxygenase (HO-1) signaling pathway in reduction of endotoxin-induced acute lung injury (ALI) by esketamine and the relationship with NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome-mediated pyroptosis in mice.Methods:SPF male wild-type (WT) and Nrf2 knockout (KO) C57BL/6J mice, aged 6-8 weeks, weighing 20-25 g, were divided into 3 groups ( n=6 each) using a random number table method: control group (WT+ C group, KO+ C group), ALI group (WT+ ALI group, KO+ ALI group) and ALI+ esketamine group (WT+ ALI+ E group, KO+ ALI+ E group). ALI model was developed by injection of lipopolysaccharide (LPS) 15 mg/kg via the tail vein. Esketamine 10 mg/kg was intraperitoneally injected at 30 min after LPS injection, and 6 h later the medication was repeated for one time in WT+ ALI+ E and KO+ ALI+ E groups, while the equal volume of normal saline was given in the other groups. The mice were anesthetized at 12 h after LPS injection, and blood samples were obtained by cardiac puncture for determination of serum interleukin-1beta (IL-1β) and IL-18 concentrations, and bilateral lung tissues were also obtained for examination of the pathological changes of lung tissues(with the light microscope) which were scored and for determination of the content of reduced glutathione (GSH) and expression of Nrf2, HO-1 and NLRP3 inflammasome-mediated pyroptosis-related proteins (NLRP3, apoptosis-associated speck-like protein containing a CARD[ASC], pro-caspase-1, cleaved-caspase-1, gasdermin D[GSDMD]) (by Western blot). Results:Compared with the corresponding C group (WT+ C group or KO+ C group), the lung injury score and concentrations of IL-1β and IL-18 were significantly increased, the content of GSH in lung tissues was decreased, and the expression of NLRP3, ASC, pro-caspase-1, cleved-caspase-1 and GSDMD was up-regulated in WT+ ALI group and KO+ ALI group ( P<0.05), and the expression of Nrf2 and HO-1 was significantly up-regulated in WT+ ALI group( P<0.05). Compared with the corresponding ALI group (WT+ ALI group or KO+ ALI group), the lung injury score and concentrations of IL-1β and IL-18 were significantly decreased, the content of GSH in lung tissues was increased, and the expression of NLRP3, ASC, pro-caspase-1, cleved-caspase-1 and GSDMD was down-regulated in WT+ ALI+ E group and KO+ ALI+ E group ( P<0.05), and Nrf2 and HO-1 expression was significantly up-regulated in WT+ ALI+ E group( P<0.05). Compared with WT+ ALI+ E group, the lung injury score and concentrations of IL-1β and IL-18 were significantly increased, the content of GSH in lung tissues was decreased, the expression of Nrf2 and HO-1 was down-regulated, and the expression of NLRP3, ASC, pro-caspase-1, cleved-caspase-1 and GSDMD was up-regulated in KO+ ALI+ E group ( P<0.05). Conclusions:The mechanism by which esketamine reduces endotoxin-induced ALI may be related to activation of Nrf2/HO-1 signaling pathway, thus inhibiting NLRP3 inflammasome-mediated pyroptosis in mice.

Humans ; Depressive Disorder, Major ; Motor Cortex ; Magnetic Resonance Imaging

Objective:To examine the occurrence of complications in elderly patients who have undergone radical surgery for colorectal cancer.Additionally, this study aims to identify the various risk factors associated with these complications.Methods:This study included elderly patients with colorectal cancer who underwent radical surgery at Beijing Hospital between January 2013 and December 2020.These patients were divided into two groups based on their age.In this study, we examined a total of 906 patients who underwent surgery, with 695 patients under the age of 80 and 211 patients aged 80 and above.We classified postoperative complications into two categories: medical and surgical complications.Our analysis compared comorbidities, clinicopathological factors, perioperative variables, and postoperative morbidity and mortality between the two age groups.We utilized both univariate and multivariate analyses to identify any potential risk factors for postoperative morbidity.Results:When comparing patients under 80 years old to those aged 80 or older, it was found that the latter group had a lower body mass index, worse ASA scores, and more comorbidities.Additionally, the proportion of elderly patients with right colon cancer, pT3-4, and pN+ disease was higher compared to those under 80 years old.Furthermore, the elderly patients aged 80 or older had a lower rate of laparoscopic surgery compared to those under 80 years old.The study found that elderly patients aged 80 years and older had significantly shorter operation times compared to those younger than 80 years[(191.0±70.6)min vs.(214.0±83.3)min, t=3.642, P<0.001]. However, the overall complication rate was higher in the elderly group(32.7%)than in the younger group(22.6%)( χ2=8.839, P=0.004). Upon further analysis, it was found that medical complications increased significantly(20.9% vs.7.5%, χ2=30.547, P<0.001), whereas the rate of surgical complications did not show any statistical difference(15.6% vs.16.4%, χ2=0.069, P=0.832). The mortality rate during the perioperative period was found to be significantly higher in elderly patients aged 80 years and above compared to those below 80 years(1.9% vs.0.3%, χ2=6.316, P=0.029). Further analysis revealed that age was an independent risk factor for medical complications( HR=2.822, 95% CI: 1.804-4.414, P<0.001). Laparoscopic surgery has been shown to significantly decrease surgical complications( HR=0.475, 95% CI: 0.317-0.711, P=0.001). However, if the operation time exceeds 200 minutes, there is a significant increase in surgical complications( HR=1.942, 95% CI: 1.278-2.888, P=0.002). Conclusions:The incidence of postoperative medical complications in very elderly patients with colorectal cancer who undergo radical surgery has risen, although the rate of surgical complications has remained steady.Radical surgery for elderly patients with colorectal cancer is both safe and feasible, but it is important to prioritize the prevention and management of medical complications.

Objective:To investigate the predictive value of a nomogram based on clinical factors and gadobenate dimeglumine (Gd-BOPTA)-enhanced MRI for predicting the expression of Glypican-3 (GPC-3) in hepatocellular carcinoma (HCC).Methods:The clinical and imaging data of 85 patients with HCC confirmed by pathology in the Provincial Hospital of Shandong First Medical University from July 2018 to June 2021 were retrospectively collected. All the patients underwent Gd-BOPTA-enhanced MRI scan before operation. According to the expression of GPC-3 by immunohistochemistry, the patients were divided into GPC-3 positive group (55 cases) and GPC-3 negative group (30 cases). The clinical data of patients were collected, including gender, age, hepatitis, cirrhosis, alpha-fetoprotein (AFP), alanine aminotransferase, aspartate aminotransferase, and glutamine transferase levels. The MRI qualitative signs including tumor margin, ring enhancement, intratumoral hemorrhage, enhanced capsule, and satellite nodules were reviewed. MRI quantitative parameters including the largest tumor diameter, Gd-BOPTA-enhanced tumor-to-liver parenchyma signal ratio (TLR) and tumor enhancement ratio (TER) in arterial phase (AP), portal venous phase (PP), and hepatobiliary phase (HBP) were calculated. The independent sample t-test or Mann-Whitney U test were used to compare the quantitative data between the two groups, and the χ2 test was used to compare the qualitative data between the two groups. Multivariate logistic regression analysis was used to identify the independent predictors of GPC-3 expression, and a nomogram model was established. The receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of each independent factor and nomogram, and DeLong test was used to compare differences in area under the curve (AUC). Results:There were significant differences in AFP, tumor margin, intratumoral hemorrhage, and TLR-AP, TLR-PP and TLR-HBP between GPC-3 positive and negative groups (all P<0.05). Multivariate logistic regression results showed that AFP≥20 μg/L, intratumoral hemorrhage and TLR-HBP were independent predictors of GPC-3 positive expression in HCC (OR=3.816, 4.788, 0.001, all P<0.05). The preoperative clinical and Gd-BOPTA-enhanced MRI nomogram model for predicting GPC-3 expression in hepatocellular carcinoma was established. The AUC of AFP≥20 μg/L, intratumoral hemorrhage, TLR-HBP and nomogram model in predicting GPC-3 positive expression were 0.688, 0.697, 0.808, and 0.879, respectively. The AUC of nomogram model was significantly better than those of the other three single indicator ( Z=3.82, 4.13, 2.04, P<0.001,<0.001,=0.042). Conclusion:The nomogram model based on indicators of clinical and qualitative and quantitative Gd-BOPTA-enhanced MRI has better performance in predicting the expression of HCC GPC-3 before surgery, which is higher than those of each single indicator.

BACKGROUND/OBJECTIVES: This study aimed to investigate cancer-specific survival (CSS) and associated risk factors in elderly gastric cancer (EGC) patients. SUBJECTS/METHODS: EGC patients (≥ 70 yrs) who underwent curative gastrectomy between January 2013 and December 2017 at our hospital were included. Clinicopathologic characteristics and survival data were collected. Receiver operating characteristic (ROC) analysis was used to extract the best cutoff point for body mass index (BMI). A Cox proportional hazards model was used to determine the risk factors for CSS. RESULTS: In total, 290 EGC patients were included, with a median age of 74.7 yrs. The median follow-up time was 31 (1–77) mon. The postoperative 1-yr, 3-yr and 5-yr CSS rates were 93.7%, 75.9% and 65.1%, respectively. Univariate analysis revealed risk factors for CSS, including age (hazard ratio [HR] = 1.08; 95% confidence interval [CI], 1.01–1.15), intensive care unit (ICU) admission (HR = 1.73; 95% CI, 1.08–2.79), nutritional risk screening (NRS 2002) score ≥ 5 (HR = 2.33; 95% CI, 1.49–3.75), and preoperative prognostic nutrition index score < 45 (HR = 2.06; 95% CI, 1.27–3.33). The ROC curve showed that the best BMI cutoff value was 20.6 kg/m 2 . Multivariate analysis indicated that a BMI ≤ 20.6 kg/m 2 (HR = 2.30; 95% CI, 1.36–3.87), ICU admission (HR = 1.97; 95% CI, 1.17–3.30) and TNM stage (stage II: HR = 5.56; 95% CI, 1.59–19.43; stage III: HR = 16.20; 95% CI, 4.99–52.59) were significantly associated with CSS. CONCLUSIONS Low BMI (≤ 20.6 kg/m2 ), ICU admission and advanced pathological TNM stages (II and III) are independent risk factors for CSS in EGC patients after curative gastrectomy. Nutrition support, better perioperative management and early diagnosis would be helpful for better survival.

Objective:To investigate the short-term and long-term efficacy of laparoscopic surgery for colorectal cancer in elderly patients aged 80 and over.Methods:This study included patients aged 80 and over with sigmoid or rectal cancer who had undergone radical surgery in Beijing Hospital between January 2013 and December 2020.Of the enrolled patients, 47 underwent laparoscopic surgery, and 44 received open surgery.After 1∶1 propensity score matching(PSM), there were 32 cases in each group.Patient clinicopathological characteristics, surgery data, post-operative outcomes and long-term survival were compared.Results:Before PSM, there were significant differences in sex composition and tumor locations between the open surgery and laparoscopic surgery groups.After PSM, there was no significant difference in clinicopathological characteristics between the two groups.Before and after PSM, the operative time for laparoscopic surgery was statistically longer than that for open surgery.The intraoperative blood loss, the postoperative complication rate and the number of harvested lymph nodes were not significantly different between the two groups before and after PSM.Before and after PSM, the postoperative hospital stay in the laparoscopic operation group was shorter than that in the open surgery group, but the difference was not statistically significant.Before PSM, the 1-year, 3-year and 5-year survival rates of the open surgery group were 92.4%, 69.5% and 58.1%, respectively, and the 1-year, 3-year and 5-year survival rates of laparoscopic group were 91.3%, 79.8% and 69.5%, respectively.There was no significant difference in overall survival between the two groups before PSM( χ2=0.591, P=0.422). After PSM, the 1-year, 3-year and 5-year survival rates in the open surgery group were 89.3%, 67.1% and 52.2%, respectively, and the 1-year, 3-year and 5-year survival rates in the laparoscopic surgery group were 90.6%, 74.3% and 65.0%, respectively.There was no significant difference in the overall survival between the two groups after PSM( χ2=1.316, P=0.251). Conclusions:For elderly colorectal cancer patients aged 80 and over, laparoscopic surgery and open surgery have similar rates of complications and long-term survival.This study provides evidence for the safety of laparoscopic surgery.Further prospective randomized controlled clinical trials are needed to confirm these findings.

Objective:To explore the effect of Vancomycin on immune hemolysis and coagulation in children with non-Hodgkin′s lymphoma (NHL), thus providing the basis for the diagnosis and treatment of hemolytic anemia and coagulation dysfunction caused by Vancomycin, and guiding the rational use of drugs in children with NHL.Methods:From January 2018 to January 2019, 31 children with NHL treated with monotherapy of Vancomycin in Beijing Children′s Hospital, Capital Medical University were collected.Plasma samples within 1 week of Vancomycin medication were collected for detecting the anti-Vancomycin antibody by microcolumn gel method.The laboratory diagnostic and coagulation function indexes of hemolytic anemia before and after Vancomycin medication were analyzed using the paired sample t test. Results:Fourteen out of 31 children with NHL were positive for the anti-Vancomycin antibody, and among them, 10 cases had positive direct antiglobulin test (DAT). In NHL children with positive anti-Vancomycin antibody, their red blood cell count (RBC)[(2.75±0.07)×10 12/L vs.(3.18±0.07)×10 12/L], platelet count (PLT)[64.29±14.87)×10 9/L vs.(91.36±16.84)×10 9/L] and hematocrit (HCT)[(23.02±0.83)% vs.(29.19±1.98)%] were significantly reduced after Vancomycin medication than those before treatment (all P<0.01). On the contrary, total bilirubin (TB) [(51.96±15.52) μmol/L vs.(39.34±13.40) μmol/L], direct bilirubin (DB)[(31.30±13.98) μmol/L vs.(26.38±12.61) μmol/L], indirect bilirubin (IB)[(21.81±2.89) μmol/L vs.(13.75±1.63) μmol/L] and lactate dehydrogenase (LDH)[(208.6±16.85) U/L vs.(60.93±16.00) U/L] in them were significantly enhanced after Vancomycin medication than those before treatment (all P<0.05). Prothrombin time (PT)[(13.94±0.58) s vs.(11.66±0.30) s] and partial thromboplastin time (APTT)[(36.01±2.64) s vs.(28.09±0.98) s] were significantly prolonged in them after vancomycin medication than those before treatment (all P<0.01). A higher international normalized ratio (INR)(1.25±0.05 vs.1.05±0.02) was detected in NHL children with positive anti-Vancomycin antibody after medication ( P<0.000 1). In NHL children with negative anti-Vancomycin antibody, significantly higher PT (12.99±0.35) s vs.(11.82±0.27) s and INR (1.18±0.03 vs.1.07±0.03) were detected after Vancomycin medication (all P<0.000 1), while other indexes were similar before and after treatment. Conclusions:The anti-Vancomycin antibody may cause immune hemolysis and coagulation dysfunction in children with NHL.In order to prevent serious adverse events caused by drug antibodies, comprehensively clinical symptoms should be considered, drug antibodies and laboratory test results should be detected.