ObjectiveTo investigate the mechanism by which Liuwei Dihuang Erzhiwan combination inhibit the lung metastasis of spontaneous breast cancer in mice by regulating the recruitment of myeloid-derived suppressor cells （MDSCs）. MethodThree hundred and eighty SPF-grade 10-month-old female breeders of Kunming mouse were palpated at the mammary gland site once every 3 days. Mice that have not had a lump touched after being raised for 6 months are used as control group. After tumor development， the mice were randomized into model， positive control （paclitaxel， intraperitoneal injection at 0.01 g·kg^-1 every other day for 22 d）， Liuwei Dihuangwan （0.65 g·kg^-1·d^-1 by gavage）， Erzhiwan （5.41 g·kg^-1·d^-1 by gavage）， and Liuwei Dihuang Erzhiwan combination （6.05 g·kg^-1·d^-1 by gavage） groups. The mice were euthanised when the tumor reached a diameter of about 15 mm， and the tumor and lung tissues were collected. The survival time， tumor mass， and lung metastasis rate of tumor-bearing mice were recorded. Hematoxylin-eosin （HE） staining was used to observe the histopathological and morphological changes of mouse tumor and lung tissues. Immunofluorescence （IF） was used to detect the distribution of MDSCs in tissues of mice in each group by double-staining of MDSCs cells with lymphocyte antigen 6 complex site G6D （Ly6G） and CD11 antigen-like family member B （CD11b）. Western blot was employed to determine the protein levels of matrix metalloproteinase-9 （MMP-9）， transforming growth factor-β （TGF-β）， zinc finger transcription factor 1 （Snail1）， and E-cadherin in the tumor tissue and CC motif chemokine 9 （CCL9） and CC motif chemokine receptor 1 （CCR1） in the lung tissue. ResultDuring the modelling period， the paclitaxel group and Chinese medicine intervention groups had longer median number of days of survival and lower tumor weight， lung metastasis rate， and lung nodule than the model group （P<0.05， P<0.01）. HE staining showed an increase in tumor cell necrosis in the paclitaxel group and the Liuwei Dihuang Erzhiwan combination group. The paclitaxel group and Chinese medicine intervention groups had lower fluorescence intensity of MDSCs in the tumor tissue than the model group （P<0.05， P<0.01）. Compared with the normal control group， the model group showed increased fluorescence intensity of MDSCs in the metastatic lung tissue （P<0.01）， which， however， was decreased in the paclitaxel group and Chinese medicine intervention groups （P<0.01）. The model group showed higher protein levels of MMP-9， TGF-β， and Snail1 and lower protein level of E-cadherin in the tumor tissue than in the normal control group （P<0.01）. Compared with model group， paclitaxel and Chinese medicine interventions downregulated the protein levels of MMP-9， TGF-β， and Snail1 （P<0.05， P<0.01） and upregulated the protein level of E-cadherin in the tumor tissue （P<0.01）. Moreover， the Liuwei Dihuang Erzhiwan combination group had lower protein levels of TGF-β and Snail1 than the Liuwei Dihuangwan group and Erzhiwan group （P<0.05）. In the metastatic lung tissue， the expression of CCL9 and CCR1 was higher in the model group than in the normal control group， paclitaxel group， and Chinese medicine intervention groups （P<0.05， P<0.01）. ConclusionLiuwei Dihuang Erzhiwan combination inhibit tumor growth， prolong survival time， and reduce the occurrence of lung metastasis in the mouse model of spontaneous breast cancer by reducing the recruitment of MDSCs in the tumor and lung tissues and modulating the phenotypes of epithelial-mesenchymal transition （EMT）-related molecules and the expression of CCL9/CCR1.

Objective:To investigate the effectiveness, safety, and advantages of modified radical neck dissection by gasless unilateral axillary approach (GUA-MRND) in the surgical management of selected patients with papillary thyroid cancer.Methods:We retrospectively analyzed patients with papillary thyroid cancer who underwent GUA-MRND (endoscopic group, n=16) versus unilateral open modified radical neck dissection (MRND) (open group, n=32) during the period from Jan. 2019 to Jun. 2021, including the differences in surgical efficiency, complication rate, and incisional satisfaction.Results:Compared MRND with GUA-MRND, the patients were younger ( P<0.05) , operative time and postoperative drainage anterior ( P<0.01) were slightly inferior in the latter, but it had obvious advantages in cervical swallowing discomfort and incision satisfaction evaluation ( P<0.05) . There was no significant difference in the incidence of temporary recurrent laryngeal nerve injury, intraoperative and postoperative bleeding, hematoma, infection, lymphatic or chylous leakage and supraclavicular numbness after surgery ( P>0.05) . The number of dissected lymph nodes in area II in the GUA-MRND was lower ( P<0.05) , but it was significantly higher ( P<0.01) in area III. And the average regional cleaning efficiency in the GUA-MRND was level Ⅲ (35.5%) , level Ⅵ (28.59%) , level Ⅳ (23.21%) , level Ⅱ (7.18%) and level Ⅴ (7.12%) , suggested that GUA-MRND had higher efficacy for level III, level Ⅵ and Level IV. Conclusion:GUA-MRND is safe, effective, and has high cosmetic satisfaction in the treatment of selected patients with lateral cervical lymph node metastases from papillary thyroid cancer.

Objective: To improve the N biomarker in the amyloid/taueurodegeneration system by radiomics and study its value for predicting cognitive progression in individuals with mild cognitive impairment (MCI). Materials and Methods: A group of 147 healthy controls (HCs) (72 male; mean age ± standard deviation, 73.7 ± 6.3 years), 197 patients with MCI (114 male; 72.2 ± 7.1 years), and 128 patients with Alzheimer’s disease (AD) (74 male; 73.7 ± 8.4 years) were included. Optimal A, T, and N biomarkers for discriminating HC and AD were selected using receiver operating characteristic (ROC) curve analysis. A radiomics model containing comprehensive information of the whole cerebral cortex and deep nuclei was established to create a new N biomarker. Cerebrospinal fluid (CSF) biomarkers were evaluated to determine the optimal A or T biomarkers. All MCI patients were followed up until AD conversion or for at least 60 months. The predictive value of A, T, and the radiomics-based N biomarker for cognitive progression of MCI to AD were analyzed using Kaplan-Meier estimates and the log-rank test. Results: The radiomics-based N biomarker showed an ROC curve area of 0.998 for discriminating between AD and HC. CSF Aβ42 and p-tau proteins were identified as the optimal A and T biomarkers, respectively. For MCI patients on the Alzheimer’s continuum, isolated A+ was an indicator of cognitive stability, while abnormalities of T and N, separately or simultaneously, indicated a high risk of progression. For MCI patients with suspected non-Alzheimer’s disease pathophysiology, isolated T+ indicated cognitive stability, while the appearance of the radiomics-based N+ indicated a high risk of progression to AD. Conclusion We proposed a new radiomics-based improved N biomarker that could help identify patients with MCI who are at a higher risk for cognitive progression. In addition, we clarified the value of a single A/T/N biomarker for predicting the cognitive progression of MCI.

Objective:To investigate the feasibility and safety of endoscopic thyroidectomy by gasless unilateral axillary approach.Methods:A matching study was conducted to analyze 21 patients with etgua of Zhejiang Provincial People’s Hospital from Mar. 2019 to Sep. 2021, including 8 cases of bilateral radical thyroidectomy and 13 cases of unilateral radical thyroidectomy + contralateral lobectomy (benign) . At the same time, 23 patients who underwent conventional thyroidectomy were matched as controls, including 8 cases of bilateral radical thyroidectomy and 15 cases of unilateral radical thyroidectomy + contralateral lobectomy (benign) . The operation process was recorded, and the differences in operation safety, postoperative recovery and incision satisfaction between endoscopic group and open group were compared.Results:The operation time in the endoscopy group was longer than that in the open group. The postoperative drainage volume in the endoscopy group was larger than that in the open group. There was no significant difference in the amount of intraoperative bleeding, postoperative stay in hospital or the incidence of complications. The neck pain scores in the endoscopic group were lowter than those in the open group. In terms of postoperative cosmetic satisfaction, the endoscopic group was higher than the open group.Conclusion:Endoscopic bilateral thyroidectomy by gasless unilateral axillary approach is a safe and effective surgical method, and has high cosmetic satisfaction.

Objective:To investigate the efficacy and safety of the modified gasless unilateral axillary approach (MGUAA) endoscopic thyroid surgery in treatment of papillary thyroid microcarcinoma (PTMC) .Methods:From Jan. 2019 to Dec. 2019, 90 patients receiving PTMC (cT1N0M0, cI stage, 8th, 2017 AJCC) therapy by modified gasless unilateral axillary approach endoscopic thyroid surgery (MGUAA group, n=41) , and conventional open thyroid surgery (OS group, n=49) were retrospectively analyzed. Ninety patients were enrolled in the study, including 14 males and 76 females,with the mean age (42.1±12.0) years.The effectiveness of central lymph node dissection (CLND) , the operation time, the types of operation, the amount of drainage, the duration of hospital stay, the related complications, the postoperative pain of neck and axillary and the cosmetic satisfaction were compared between the two groups.SPSS 25.0 statistical software was used for statistical analysis, the measurement data was expressed by ±s, paired t test was used to compare the measurement data between groups, and Chi-square test was used to campare the count date between groups. Results:The mean age (35.0±8.6) years and the amount of surgical bleeding (12.3±7.3) ml in the MGUAA group were significantly lower than those (48.1±11.1) years and (16.1±4.3) ml in the OS group ( P<0.01) , while the mean operation time (99.1±19.5) min, the mean amount of drainage (221.4±67.9) ml and the postoperative drainage tube placement time (5.0±0.8) days were significantly higher than those of (70.6±17.8) min, (98.3±63.7) ml and (3.8±1.0) days in the MGUAA ( P<0.01) . There was no significant difference in the number of lymph nodes of CLND or the duration of hospital stay between the two groups ( P>0.05) . In terms of surgical complications, the transient recurrent laryngeal nerve injury, the postoperative hematoma, the postoperative infection, and the lymphatic leakage had no significant difference between the two groups ( P>0.05) . The MGUAA group had significant advantages in avoiding the postoperative dysphagia in front of neck, the postoperative pain of neck, and cosmetic satisfaction over the OS group [ (0.0% vs 28.6%) , (14.6% vs 71.4%) , (1.1±0.3) score vs (2.4±0.5) score ( P<0.01) ]. Whereas in axillary area pain on the surgical side, the MGUAA group was inferior to the OS group ( P<0.01) . Conclusion:The modified gasless unilateral axillary approach endoscopic thyroid surgery is a feasible, safe and cosmetically operation for PTMC (cT1N0M0, cI stage, 8th, 2017 AJCC) .

Objective:To investigate the efficacy, safety and advantages of gasless unilateral axillary approach (GUAA) in endoscopic thyroid surgery.Methods:A total of 334 patients who underwent the GUAA endoscopic thyroid surgery (GUAA group) or conventional open thyroid surgery (OS group) in the Department of Head and Neck Surgery of Zhejiang Cancer Hospital from January 2017 to June 2018 were retrospectively analyzed. There were 45 males and 289 females, aged from 12 to 72 years old, of whom 139 patients were assigned to GUAA group and 195 patients to OS group. Pathological results included papillary thyroid carcinoma (282 cases), nodular goiter (41 cases) and thyroid adenoma (11 cases). Surgical exploration development curve of GUAA group was drawn and was divided into two parts: the technical exploration stage and the technical stable stage. Surgical efficiency, incidences of complications, and incision satisfaction were compared between GUAA group in technical stable stage and OS group. SPSS 25.0 software was adopted for statistical analysis.Results:The mean age in GUAA group was younger than that in OS group, with a significant difference [(35.3±9.5) years vs. (48.1±10.6) years, t=11.31, P<0.01]. The cases in the endoscope group were divided into technical exploration stage for 51 cases and technical stable stage for 88 cases according to the exploration and development curve. In unilateral radical thyroidectomy and unilateral thyroid lobectomy, the mean operation time [(90.6±18.6) min and (93.5±22.0) min] and postoperative drainage volumes [(121.5±87.6) ml and (155.5±69.1) ml] of GUAA group in the stable stage were more than those of OS group [(61.6±15.6) min and (46.5±8.4) min] and [(93.2±42.3) ml and (78.9±48.7) ml]. The difference was statistically significant ( t=12.28, 7.23, 3.35 and 3.05 respectively, all P<0.05), but there were no significant differences in surgical bleeding volumes between two groups [(12.7±6.8) ml vs. (13.5±7.7) ml, t=0.74, P>0.05 and (16.3±14.1) ml vs. (11.9±5.1) ml, t=1.05, P>0.05]. Compared with OS group, GUAA group had the lower incidence of anterior cervical discomfort during swallowing (2.3% vs. 29.2%, P<0.01) and the higher incision satisfaction score (1.1±0.5 vs. 2.8±0.7, t=21.12, P<0.01), however, GUAA group had the higher incidence of supraclavicular (or infraclavicular) numbness after surgery (5.7% vs. 0, P<0.01). And there was no significant difference in the incidences of temporary recurrent laryngeal nerve injury, bleeding, hematoma, infection, lymphatic leakage or chylous leakage after surgery between two groups ( P>0.05). Conclusion:GUAA endoscopic thyroid surgery is a safe method with high cosmetic satisfaction.

Objective To investigate the change of plasma visfatin in patients with coronary heart disease and its clinical significance.Methods A total of 310 patients with coronary heart disease (ACS group:n =217; SAP group:n =93) and of 90 healthy subjects with a matched age and gender were included in this study.The plasma concentration of visfatin of each subject was measured using ELISA assay,and each patient underwent selective coronary angiography examination.A total of 85 cases of patients in CHD group underwent 64-slice CT coronary imaging to evaluate the main plaque within the coronary.Results The visfatin,LDL,BMI,blood glucose levels was significantly higher in CHD group[ ( 128.18 ± 13.86)ng/ml,(3.63 ± 1.48) mmol/L,( 26.18 ± 1.82) kg/m2,(7.25 ± 2.03 ) mmol/L] than in control group [ (75.96 ± 10.27 )ng/ml,(2.64 ± 0.53 ) mmol/L,( 23.51 ± 0.89 ) kg/m2,(5.11 ± 1.53 ) mmol/L,P ＜ 0.05 ],respectively.The visfatin level in the ACS group [ ( 145.57 ± 19.95 ) ng/ml ] was significantly higher than the SAP group [ (110.79 ±7.78)ng/ml,P ＜0.05].The visfatin concentration gradually increased with the aggravation of the complexity of coronary lesion types and severity of coronary lesions( P ＜ 0.05).The plasma visfatin concentrations in Soft plaque group and the fibrous plaque group were significantly higher than calcified plaque (P ＜ 0.05).HDL-C and Gensini score of coronary lesions were negatively correlated ( r =- 0.055,P ＜0.05) ; LDL-C,Glu,and visfatin was positively correlated with coronary lesions Gensini score ( r =0.464,0.279,0.531,P ＜ 0.05 ),respectively.Conclusions The plasma visfatin level in patients with Coronary heart disease increased and affected its lipid metabolism.It may be an important inflammatory factors promoting arterial atherosclerosis occurs and development,which has a certain value to the judgment of coronary lesions and plaque stability combined with 64-slice spiral CT examination.

Objective To evaluate the effect of HTK solution on myocardial protection during valve replacement surgery.Methods 42 patients with rheumatic heart disease were randomized to receive 4∶1cold blood (control group,n =21 ) and HTK ( protective gronp,n =21 ) cardioplegic solution during valve replacement.The changes of CO and CI were collected at different time points including pre-operation,postoperative 6 hours,12 hours and 24 hours.Aortic clamping time,the ratio of spontaneous cardiac rhythm recovery and inotropic drugs application were calculated,and mechanical ventilation support time and the incidence of arrhythmia were recorded.Results The measurements of CO and CI showed that there was significant higher level in protective group at postoperative 12 hours and 24 hours [ 12 h:(4.82 ± 0.18 ) L/min vs ( 3.50 ± 0.32 ) L/min,( 3.80 ± 0.48 ) L/( min · m2 ) vs (2.79 ± 0.39) L/( min · m2 ) ;24 h:(4.97±0.45)L/min vs ( 3.81 ±0.19)L/min,(4.22±0.17)L/(min · m2) vs (2.91 ±0.21)L/(min·m2 ),P ＜ 0.05].The clinical parameters including aortic clamping time,incidence of cardiac arrhythmia,inotropic support,duration of mechanical ventilation and length was lower than in control group [ (53.6 ±24.3 ) min vs ( 68.9 ± 26.1 ) min ; ( 1.8 ± 1.3 ) min vs ( 2.3 ± 1.2 ) min ; ( 33 ± 11 ) min vs ( 42 ± 13 ) min ;(10.2±2.1) μg/(kg · min) vs (15.7 ±3.8) μg/(kg · min);(14.6 ±4.8)h vs (20.7 ±5.1)h,P ＜0.05].The auto-beating rate was higher than in control group (90％ vs 67％,P ＜0.05).Conclusions HTK solution is better than classical blood cardioplegia in myocardial protection during valve replacement.

Objective To explore the association between plasma resistin levels and acute coronary syndrome. Methods Four hundred patients were divided into coronary heart disease (CHD) group（310）and control group（90）according to the coronary Angiography (CAG). And CHD group was divided into ACS subgroup（n＝217）and SAP subgroup（n＝93）according to the clinical information. 85 cases in CHD group were underwent 64-slice spiral computed tomography coronary artery imaging. The severity and extent of coronary lesions were analyzed by CAG and graded by means of Gensini coronary score system. Resistin level in plasma of all patients was determined by enzyme linked immunosorbent assay. Results Resistin levels in CHD group［(889.1±248.2)pg/ml］ were significant higher compared with the control group［(261.6±111.9)pg/ml］ (P＜0.05), and resistin levels in ACS subgroup［(1260.0±368.0)pg/ml］ were much higher than that in SAP subgroup［(518.3±128.4)pg/ml］ (P＜0.05). Conclusions The resistin levels of patients with acute coronary syndrome increased significantly and might be associated with the vulnerable plaque. Resistin levels and 64 slice spiral computed tomography coronary artery imaging can be used to detect the vulnerable plaque in CHD patients.

ObjectiveTo investigate a new way to prevent hyperacute rejection (HAR) during liver xenotransplantation through blocking the xenograft with recipient blood serum before transplantation.MethodsTwenty guinea-pig (GP) and Sprague-Dawley (SD) rats were pair-matched as donor and recipient randomly.Before transplantation,blood serum collected from other SD rats was inactivated at 45 ℃ in water bath for 30 minutes.Guinea-pig donor livers from experimental group ( n =10 ) were pre-perfused by 0.1％ solution of this blood serum,and donor livers from control group (n =10) were treated by Ringer solution.Then orthotopic liver xenotransplantations were performed by the modified two-cuff technique immediately.Liver morphology changes and survival rate and time of recipients were observed,and histopathological lesions were detected by HE staining,and liver ALT level was evaluated.ResultsThe operation time and anhepatic phases between two groups were not different significantly ( P ＞ 0.05 ).The survival rate of recipients from experimental group was higher,and its survival time was longer than that of control group significantly (P ＜ 0.01 ).The liver histological changes such as thrombosis and interstitial bleeding in experimental group was less severe than that in control group (P ＜0.01 ).The level of ALT in blood serum of rats from experimental group were lower than that from control group significantly ( P ＜ 0.05).ConclusionsThe results suggested that blocking the donor graft with recipient blood serum inhibits HAR during liver xenotransplantation.