Myocardial dysfunction is the most serious complication of sepsis. Sepsis-induced myocardial dysfunction (SMD) is often associated with gastrointestinal dysfunction, but its pathophysiological significance remains unclear. The present study found that patients with SMD had higher plasma gastrin concentrations than those without SMD. In mice, knockdown of the gastrin receptor, cholecystokinin B receptor (Cckbr), aggravated lipopolysaccharide (LPS)-induced cardiac dysfunction and increased inflammation in the heart, whereas the intravenous administration of gastrin ameliorated SMD and cardiac injury. Macrophage infiltration plays a significant role in SMD because depletion of macrophages by the intravenous injection of clodronate liposomes, 48 h prior to LPS administration, alleviated LPS-induced cardiac injury in Cckbr-deficient mice. The intravenous injection of bone marrow macrophages (BMMs) overexpressing Cckbr reduced LPS-induced myocardial dysfunction. Furthermore, gastrin treatment inhibited toll-like receptor 4 (TLR4) expression through the peroxisome proliferator-activated receptor α (PPAR-α) signaling pathway in BMMs. Thus, our findings provide insights into the mechanism of the protective role of gastrin/CCKBR in SMD, which could be used to develop new treatment modalities for SMD.

During the analysis of benziamidazole-class irreversible proton pump inhibitors,an unusual mass spectral response with the mass-to-charge ratio at[M+10]+intrigued us,as it couldn't be assigned to any literature known relevant structure,intermediate or adduct ion.Moreover,this mysterious mass pattern of[M+10]+has been gradually observed by series of marketed proton pump inhibitors,viz.omeprazole,pantoprazole,lansoprazole and rabeprazole.All the previous attempts to isolate the corresponding component were unsuccessful.The investigation of present work addresses this kind of signal to a pyridinium thiocyanate mass spectral intermediate(10),which is the common fragment ion of series of labile aggregates.The origin of such aggregates can be traced to the reactive intermediates formed by acid-promoted degradation.These reactive intermediates tend to react with each other and give raise series of complicated aggregates systematically in a water/acetonitrile solution by electrospray ioniza-tion.The structure of the corresponding pyridinium thiocyanate species of omeprazole(10a)has been eventually characterized with the help of synthetic specimen(10a').Our structural proposal as well as its origin was supported by in situ nuclear magnetic resonance,chemical derivatization and colorimetric experiments.

Objective To explore the risk factors of postoperative early recurrence in patients with non-small cell lung cancer(NSCLC)and establish a new Nomogram model.Methods The clin-icopathological materials of 236 NSCLC patients with surgical resection in Fuyang Hospital Affiliated to Anhui Medical University and Fuyang City People's Hospital Affiliated to Anhui Medical University from January to August 2021 were retrospectively analyzed,and all the patients were randomly divided into a modeling group(n=165)and a validation group(n=71)with a ratio of 7 to 3.The independ-ent risk factors of postoperative recurrence for NSCLC patients were determined by the univariate and multivariate Cox regression analyses,and a Nomogram model was constructed.The consistency index(C-index),calibration curve and receiver operating characteristics(ROC)curve were used to evalu-ate the predictive ability of the Nomogram model.Results The early recurrence rate of 236 NSCLC patients after surgery was 17.4％(41/236).Univariate and multivariate Cox analyses indicated that lymph node metastasis(HR=2.342,95％CI,1.214 to 4.517,P=0.011),pleural invasion(HR=2.738,95％CI,1.443 to 5.196,P=0.002),vascular invasion(HR=3.526,95％CI,1.802 to 6.899,P＜0.001)and serum D-dimer level(HR=3.656,95％CI,1.265 to 10.561,P=0.017)were the independent predictors of early recurrence and metastasis for NSCLC patients.Based on the above four variables,a Nomogram model was constructed,and the result showed that the C-index of this model in the modeling group and validation group were 0.769(95％CI,0.661 to 0.879)and 0.790(95％CI,0.682 to 0.897)respectively;the area under the curve(AUC)of this model in predicting recurrence free survival(RFS)for patients in the modeling group at 1 year and 2 years was 0.817 and 0.792 respectively,while the AUC for patients in the validation group at 1 year and 2 years was 0.782 and 0.771 respectively.The calibration curve indicated that the predicted probability of this model was consistent with the actual recurrence risk in both groups.Conclusion This Nomo-gram model has good predictive value for early postoperative recurrence of NSCLC,and is of great sig-nificance for assisting clinical doctors in accurately identifying high-risk recurrence populations.

Objective To explore the risk factors of postoperative early recurrence in patients with non-small cell lung cancer(NSCLC)and establish a new Nomogram model.Methods The clin-icopathological materials of 236 NSCLC patients with surgical resection in Fuyang Hospital Affiliated to Anhui Medical University and Fuyang City People's Hospital Affiliated to Anhui Medical University from January to August 2021 were retrospectively analyzed,and all the patients were randomly divided into a modeling group(n=165)and a validation group(n=71)with a ratio of 7 to 3.The independ-ent risk factors of postoperative recurrence for NSCLC patients were determined by the univariate and multivariate Cox regression analyses,and a Nomogram model was constructed.The consistency index(C-index),calibration curve and receiver operating characteristics(ROC)curve were used to evalu-ate the predictive ability of the Nomogram model.Results The early recurrence rate of 236 NSCLC patients after surgery was 17.4％(41/236).Univariate and multivariate Cox analyses indicated that lymph node metastasis(HR=2.342,95％CI,1.214 to 4.517,P=0.011),pleural invasion(HR=2.738,95％CI,1.443 to 5.196,P=0.002),vascular invasion(HR=3.526,95％CI,1.802 to 6.899,P＜0.001)and serum D-dimer level(HR=3.656,95％CI,1.265 to 10.561,P=0.017)were the independent predictors of early recurrence and metastasis for NSCLC patients.Based on the above four variables,a Nomogram model was constructed,and the result showed that the C-index of this model in the modeling group and validation group were 0.769(95％CI,0.661 to 0.879)and 0.790(95％CI,0.682 to 0.897)respectively;the area under the curve(AUC)of this model in predicting recurrence free survival(RFS)for patients in the modeling group at 1 year and 2 years was 0.817 and 0.792 respectively,while the AUC for patients in the validation group at 1 year and 2 years was 0.782 and 0.771 respectively.The calibration curve indicated that the predicted probability of this model was consistent with the actual recurrence risk in both groups.Conclusion This Nomo-gram model has good predictive value for early postoperative recurrence of NSCLC,and is of great sig-nificance for assisting clinical doctors in accurately identifying high-risk recurrence populations.

We introduce the background of Shanghai medical purchasing service and supervision platform (later we call it "open platform") and the effect of its implementation. We also analyze the problems occurred by medical institutions in the management of supplies, explore how to use open platform to strengthen the management of medical supplies, further optimize the structure of supplies, standardize the clinical reasonable use and charges, and ensure the quality, safety and traceability of supplies.
China ; Equipment and Supplies

Objective To observe the effects of total enteral nutrition ( TEN) and early combined parenteral nutrition ( PEN+TEN) in patients with esophageal cancer after operation .Methods The prospective,random, controlled clinical trial was adopted.One hundred patients receiving esophageal cancer operation were randomly assigned to the TEN group (50 cases) and the PEN+TEN group(50 cases).The differences in nutritional status, inflammatory response, immune status and postop-erative complications were compared in the two groups before and after operation.Results The levels of total serum protein, albumin or retinol binding protein were higher in the PEN group than the TEN group at the 10th day after operation, respective-ly[(60.1 ±6.2)g/L vs(55.3 ±9.3)g/L,(36.4 ±4.2)g/L vs(34.6 ±1.6)g/L,(43.3 ±5.9)g/L vs(34.9 ±3.3)g/L, P<0.05] .The levels of ESR or CRP were higher in PEN +TEN group than the TEN group at the 10th day after operation, re-spectively [(54.9 ±25.8)mm/h vs(31.8 ±14.2)mm/h,(30.9 ±13.2)g/L vs(15.8 ±6.1)g/L, P<0.01] .The levels of CD3+, CD4 +, or CD8 +were higher at the 10 th day after operation than at the day before surgery in TEN group [(59.6 ±9.8)％vs(68.3 ±4.4)％,(41.7 ±7.8)％vs(46.5 ±5.5)％,(23.2 ±5.5)％vs(20.0 ±2.7)％, P<0.05], but not in PEN+TEN group.The levels of IgA or IgG were significant higher in the TEN group than the PEN +TEN group at the 10th day after operation[(1.9 ±0.5)g/L vs(1.6 ±0.3)g/L,(11.9 ±3.3)g/L vs(9.4 ±2.2)g/L, P<0.01].Con-clusion The inflammatory reaction and immune function in TEN group are better than those in PEN +TEN group.Although the nutritional status is worse in the TEN group than that in the PEN group , but the rate of postoperative complications has not increased.

Objective To evaluate the image quality improvement on abdominal CT imaging by using new model-based iterative reconstruction (MBIRn)in comparison with adaptive statistical iterative reconstruction (ASiR).Methods 40 patients who underwent upper abdominal three-phase contrast-enhanced scan were included.After scanning,all the scans obtained at 180 s later injection were reconstructed by three protocol,including ASiR (combined reconstruction of 40%FBP and 60%ASiR),the MBIRn of the noise reduction settings (MBIRNR40)and the spatinal resolution settings(MBIRSTND).The thickness of the slice was 0.625 mm.The values of CT and SD of the subcutaneous fat,left erector spinae,inferior vena cava and hepatic vein (left and right branches)were measured at the branch level of hepatic vein,and the contrast noise ratio (CNR)between inferior vena cava and hepatic vein were calculated.The subj ective image quality was evaluated by two radiologists according to the noise,smoothness and small branches of the inferior vena cava and hepatic vein using 5-scoring method.The quality images obtained from ASiR method were treated as reference standard.Results For MBIRSTNDand MBIRNR40images,the subjective noise decreased and image quality increased comparing with ASiR images.Among which the MBIRNR40images had the best image with vascular smoothness score and the lowest subjective noise.Conclusion Compared with ASiR,MBIRSTNDand MBIRNR40,especially MBIRNR40improves the quality of CT images of the inferior vena cava and its branches.

BACKGROUND: So far there's no tumor maker applied in diagnosis and treatment of thymic epithelial tumors. This study is to assess the correlation between serum cytokine 19 fragment (Cyfra 21-1) and clinicopathological features and prognosis of thymic epithelial tumors (TETs). METHODS: The clinical data of 159 patients with TETs in Shanghai Chest Hospital was retrospectively analysed. Patients were divided into groups according to different tumor stages and histotypes. Serum Cyfra 21-1 was thus compared. In addition, the possible relationship between perioperative serum Cyfra 21-1 level and the recurrent status was carrid out. RESULTS: Preoperative Cyfra 21-1 serum concentrations in patiants with advanced stage (T4) and thymic carcinomas were significantly higher than that in others (P<0.001, P<0.001, respectively). When the preoperative serum level exceeds the out-off of 1.66 ng/mL, it possibly indicates the recurrence during follow up. Furthermore, the sensitivity, specificity, and positive as well as negative predictive value (PPV and NPV) of postoperative Cyfra 21-1 to predict tumor recurrence were evaluated. At a cut-off of Cyfra 21-1 of 2.66 ng/mL, the sensitivity was 0.7, the specificity was 0.925, the PPV was 0.5 and the NPV was 0.966. CONCLUSIONS The elevated level of preoperative serum Cyfra 21-1 indicates an advanced stage of tumor or a more malignant histotype (thymic carcinoma). It also probably suggests a higher risk of tumor recurrence. During the oncological follow up, in addition to regular imaging examinations, the blood test of serum Cyfra 21-1 is also suggested to improve the diagnosis of tumor recurrence in order to improve the prognosis.
Biomarkers, Tumor ; blood ; Female ; Follow-Up Studies ; Humans ; Keratin-19 ; blood ; chemistry ; Male ; Middle Aged ; Neoplasms, Glandular and Epithelial ; blood ; diagnosis ; pathology ; Peptide Fragments ; blood ; Prognosis ; ROC Curve ; Retrospective Studies ; Thymus Neoplasms ; blood ; diagnosis ; pathology

OBJECTIVETo investigate the associated high risk factors of postoperative relapse and metastasis for patients with confined tumors (grade pT1b-4a) without lymph-node metastases (pN0) in thoracic esophageal squamous cell carcinoma (ESCC).

METHODSClinicopathological and follow up data of ESCC patients undergoing radical surgical resection as primary treatment in the Department of Thoracic Surgery, Shanghai Chest Hospital between January 2004 and December 2012 from Hospital Database were retrospectively collected. The inclusion criteria were as follows: (1) the first development of ESCC confirmed by histopathology without lymphatic and distant metastasis; (2) pathological stage of pT1bN0M0 to pT4aN0M0 according to the Union for International Cancer Control (UICC) in 2009; (3) curative trans-thoracic esophagectomy with R0 (tumor-free surgical margin) resection, using the Ivor-Lewis or McKeown procedure; two-field lymphadenectomy or three-field lymph node dissection based on the positive results of preoperative cervical ultrasonography examination or CT scan; (4) without adjuvant chemotherapy and/or radiotherapy before and after operation; (5) complete follow-up data. Logistic regression analysis was employed to identify the clinicopathological factors affecting the postoperative relapse and metastasis.

RESULTSA total of 112 patients were eligible, including 94 male cases and 18 female cases; age of (58.6±7.7) years; squamous carcinoma of upper thorax in 25 cases, of middle thorax in 67 cases and of lower thorax segment in 20 cases; 12 cases of high-differentiated ESCC, 49 cases of moderate-differentiated ESCC, poorly-differentiated ESCC in 48 cases; 4 cases of I(a stage, 9 cases of I(b, 24 cases of II(a, 62 cases of II(b, 13 cases of III(a; the tumor length >4 cm in 43 cases, ≤4 cm in 69 cases. Forty-three (38.4%) patients presented relapse or metastasis during the follow-up, including 24 (21.4%) of loco-regional relapse, 13 (11.6%) of distant metastasis, and 6(5.4%) of both above. Multivariate regression analysis revealed that poorly-differentiated tumor (OR=1.899, 95%CI:1.233-2.925, P=0.004), upper-middle location (OR=2.351, 95%CI:1.188-4.653, P=0.014), and tumor length >4 cm (OR=2.381, 95%CI:1.009-5.618, P=0.048) were independent risk factors of overall postoperative relapse and metastasis for thoracic ESCC with stage pT1b N0M0-T4aN0M0. Further stratified analysis identified that only poorly-differentiated tumor (OR=1.730, 95%CI:1.121-2.671, P=0.013) was an independent risk factor of loco-regional relapse, whereas pathological stage II(b-III(a (OR=3.372, 95%CI:1.206-9.428, P=0.021) was an independent risk factor of distant metastasis.

CONCLUSIONSPoorly-differentiated tumor, tumor length >4 cm, and upper-middle location may be regarded as high risk factors for predicting overall relapse and metastasis of pN0 thoracic ESCC patients after esophagectomy. Moreover, poorly-differentiated tumor is the only independent risk factor of postoperative loco-regional relapse, meanwhile it should be noted that pathological stage II(b-III(a is closely related to postoperative distant metastasis.

Objective To develop and validate a method for detecting factor 8 gene (F8) mutations in hemophilia A patients by Ion Torrent semiconductor sequencing .Methods Intron 22 and intron 1 inversions of F8 gene were identified by long distance PCR (LD-PCR), other mutations in the F8 gene were identified by Ion Torrent sequencing.Candidate variants were validated by Sanger sequencing .Sanger sequencing was applied to screen HA carriers from 11 female family members in the 8 pedigrees.One pregnant woman was offered prenatal diagnosis via analyzing the fetal DNA obtained through amniocentesis . Results Four missense mutations ( c.1331A >C, 1648C >T, c.6506G >A, c.6544C >T), two frameshift mutations ( c.2393 _2394insT, c.6320delG), one splicing mutation ( IVS5 +5G >A), one nonsense mutation (c.43C >T) and one Inv22 mutation were identified in all nine probands respectively . Among 11 female family members, 10 females were identified to be HA carriers, and one didn′t carry the maternal pathogenic mutation.Prenatal diagnosis result showed that the fetus inherited the wild -type maternal allele and was predicted to be unaffected by HA .Conclusion The targeted Ion Torrent sequencing is a reliable and efficient method to detect F8 mutations in patients with Hemophilia A disease .