Objective To explore the relationship of the preoperative serum alanine aminotransferase(ALT)/aspartate aminotransferase(AST)ratio and imaging features to the prognosis of patients with hepatocellular carcinoma(HCC)after receiving transarterial chemoembolization(TACE),and to develop a nomogram model used for predicting the patient's overall survival(OS).Methods A total of 211 patients,who were diagnosed as HCC and were treated with TACE as the initial therapy at the Guangci Branch of the First Affiliated Hospital of Soochow University of China between July 2016 and July 2020,were enrolled in this study.The patients were randomly divided into the modeling group(n=139)and validation group(n=72).The receiver operating characteristic(ROC)curve was used to determine the optimal cutoff value of AST/ALT ratio.The univariate and multivariate Cox regression analyses were conducted in the modeling group to screen out the independent predictors affecting HCC patient's OS and to establish a prognostic model.Harrell consistency index(C-index)was used to evaluate the predictive ability of the nomogram model for OS in HCC patients,and the calibration curves were plotted to assess the predictive accuracy of the nomogram model.Results No statistically significant difference in the baseline feature distribution existed between the modeling group and validation group(P＞0.05).The median OS of the modeling group and validation group was 28.5 months(95％CI:22.1-34.9)and 25.1 months(95％CI:19.2-29.0)respectively,the difference was not statistically significant(x2=1.395,P=0.322).The optimal cutoff value of AST/ALT ratio for predicting OS was 1.10,and the area under curve(AUC)value was 0.674(95％CI:0.604-0.753).The Cox regression analysis indicated that the tumor number(HR=2.080,95％CI=1.245-3.475,P=0.005),tumor capsule(HR=1.771,95％CI=1.128-2.780,P=0.013),irregular marginal enhancement(HR=1.884,95％CI=1.190-2.984,P=0.007),and AST/ALT ratio(HR=2.450,95％CI=1.506-3.987,P＜0.01)were the independent prognostic factors for HCC patients receiving TACE treatment.Based on the above variables,a nomogram model for predicting OS was established,and the C-index values in the modeling group and validation group were 0.733(95％CI:0.650-0.826)and 0.770(95％CI:0.688-0.862)respectively.The calibration curves showed that no significant deviations existed between the predictive curves of the prognostic model and the ideal reference curves for one-,2-and 3-year OS.Conclusion The nomogram model,which is established based on the tumor number,imaging features and preoperative AST/ALT ratio,has an excellent value in predicting the prognosis of HCC patients treated with TACE.

Objective:To investigate the predictive value of neutrophil-lymphocyte ratio (NLR) for Trousseau’s syndrome (TS) in patients with acute multiple cerebral infarctions (AMCI).Methods:The patients with AMCI in Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine from July 2013 to March 2022 were retrospectively enrolled. The demographic and baseline clinical data of patients with TS and those without TS were compared. Multivariate logistic regression analysis was used to determine the independent influencing factors of TS-AMCI, and receiver operating characteristic (ROC) curve was used to evaluate the predictive value of NLR for TS-AMCI. Results:A total of 59 patients with AMCI were enrolled, including 43 males and 16 females, aged 64.9±14.0 years. There were 16 patients in the TS-AMCI group and 43 in the non-TS-AMCI group. The proportions of patients with diabetes mellitus, hypertension and previous stroke or transient ischemic attack in the TS-AMCI group were significantly lower than those in the non-TS-AMCI group (all P<0.05), while the proportion of patients with ischemic heart disease were significantly higher than that in the non-TS-AMCI group ( P<0.05). The proportion of patients with bilateral infarction in the TS-AMCI group was significantly higher than that in the non-TS-AMCI group ( P<0.001). The D-dimer, NLR, white blood cell count, neutrophil count, monocyte count, percentage of neutrophils, total cholesterol and low-density lipoprotein cholesterol in the TS-AMCI group were significantly higher than those in the non-TS-AMCI group (all P<0.001), while the lymphocyte count, lymphocyte percentage, red blood cell count, hemoglobin and hematocrit were significantly lower than those in the non-TS-AMCI group (all P<0.001). Multivariate logistic regression analysis showed that high NLR was an independent predictor of TS-AMCI (odds ratio [ OR] 2.897, 95% confidence interval [ CI] 1.270-6.527; P=0.011), while high hemoglobin was independently negatively correlated with TS-AMCI ( OR 0.839, 95% CI 0.723-0.975; P=0.022). ROC curve analysis showed that the area under the curve of NLR for predicting TS-AMCI was 0.929 (95% CI 0.831-0.979; P<0.001). When the NLR cutoff value was 4.01, the corresponding Youden index was 0.744. At this time, the sensitivity and specificity were 100% and 74.42% respectively. Conclusion:NLR has high predictive value for TS-AMCI.

Objective:To investigate the evaluation value of one-stop whole-brain dynamic volume CT angiography and CT perfusion imaging (CTA-CTP) in the cynomolgus monkeys models of middle cerebral artery occlusion (MCAO).Methods:Ten adult cynomolgus monkeys were selected and examined by head and neck CTA-CTP and craniocerebral MRI to rule out craniocerebral space-occupying lesions or cerebrovascular malformation. Under guidance of digital substraction angiography (DSA), the right femoral artery was dissected and monkey autologous thrombosis was injected into the right middle cerebral artery (MCA) through microcatheter to prepare MCAO models. Whole brain DSA was performed intraoperatively to observe whether the model was successfully prepared, and head and neck CTA-CTP was performed 24 h and 7 d after modeling to determine the locations and brain blood flow changes of ischemic lesions. The monkeys were sacrificed 8 d after modeling, and the brain tissues were stained with 2,3,5-triphenyltetrazolium chloride (TTC).Results:Among the 10 cynomolgus monkeys, one was excluded because of preoperative cerebrovascular malformation, and one died of cerebral hernia caused by cerebral hemorrhage during the experiment. The remaining 8 MCAO models were successfully prepared. Intraoperative DSA orthography showed unclear M1 segment and distal branch of MCA. Brain CT scan 24 h and 7 d after modeling showed obvious cerebral ischemic lesions in the right MCA blood supply area, and the infarct extent 7 d after surgery was more obvious than that 24 h after surgery. CTA examination showed obvious blood flow interruption imaging in the in M1 segment of MCA on the right side, the distal vessels were not clearly displayed and the distal branches of the infarct side 7 d after surgery were obvious decreased as compared with those 24 h after surgery. CTP scan showed that the cerebral blood volume of the right cerebrum was obviously reduced as compared with that of the left cerebrum, which was consistent with the blood supply area of MCA; and the infarct cores and penumbra areas 7 d after surgery were obvious increased as compared with those 24 h after surgery. TTC staining showed that the ischemic lesions of the brain tissue on the slices were gray and involved multiple layers, and the range was roughly consistent with the infarction sites shown by DSA and CT imaging.Conclusion:One-stop whole brain dynamic volume CTA-CTP has good evaluation value in imaging findings in MCAO animal models.

Objective: To investigate the expression and clinical significance of exosomal miR-1231 in plasma of pancreatic cancer (PC) patients and pancreatic cancer cells. Methods: A total of 16 patients who were diagnosed with pancreatic cancer in Hunan Cancer Hospital were collected from April 2016 to August 2017. Meanwhile, 16 healthy volunteers were recruited as the healthy control group at the same period. The plasma exosomes were extracted, and the levels of miR-1231 were detected by qRT-PCR in PC and healthy control groups. Moreover, the clinicopathological significance of exosomal miR-1231 expression was analyzed. Furthermore, the expression of exosomal miR-1231 was detected in several pancreatic cancer cells (MIA PaCa-2, PANC-1, SW1990, AsPC-1 and BxPc-3) and two normal pancreatic epithelial cells (HPDE and human primary pancreatic epithelial cell). Results: qRT-PCR results showed that the expression level of miR-1231 in plasma exosomes of pancreatic cancer patients (1.06±0.46) was significantly lower than that in healthy controls (2.30±0.99; P<0.05). The levels of exosomal miR-1231 in patients with stage Ⅰ-Ⅱ (1.515±0.531), no distant metastasis (1.236±0.461) and no lymph node metastasis (1.337±0.522) were significantly higher than those with stage Ⅲ-Ⅳ (0.848±0.224), distant metastasis (0.757±0.278) and lymph node metastasis (0.838±0.261), respectively (P<0.05 for all). In addition, there were no correlation between exosomal miR-1231 expression and age, sex, smoking history, CA19-9 levels and tumor sites (P>0.05). Furthermore, the expression level of exosomal miR-1231 in pancreatic cancer cell lines (0.142±0.135) was significantly lower than that in normal epithelial cells (1.127±0.179; P<0.05). Conclusions The downregulation of exosomal miR-1231 in plasma of pancreatic cancer patients and pancreatic cancer cells suggests that it is related to the initiation and development of PC. It may be a new diagnostic and prognostic marker for PC.

Objective To investigate the significance of MRI T2 fluid-attenuated inversion recovery hyperintense vessel sign (FLAIR HVS)in clinical prognosis evaluation of the patients with acute middle cerebral artery irnfarction.Methods The data in 57 inpatients with acute middle cerebral artery infarction in our hospital from Aug.2013 to Aug.2015 were retrospectively analyzed.All cases were performed the intact MRI examination(ineluding FLAIR,DWI and MRA)and CTA.The infarct volume with DWI,national institute of health stroke scale(NIHSS)score and modified Rankin Scale(mRS)score on 30 d after discharge were performed the comparative analysis.Results Fifty-seven cases of middle cerebral artery occlusion were divided into the distal HVSgroup and non-distal HVS group(8 cases in proximal HVS group,21 cases in HVS negative group).The infarction volume of DWI sequence,NIHSS scores at admissiom and discharge and mRS score on 30 d after discharge in the distal HVS group were superior to those in the non-distal HVS group(P＜0.05).Conclusion MRI-T2 FLAIR sequence HVS has certain reference value in the prognosis evaluation in the patients with middle cerebral artery occlusion.

Objective To explore the curative effects of acupuncture, ultrashort wave combined with kinesio taping in the treatment of chronic ankle sprain for clinical references. Methods All 80 patients with chronic ankle sprain were randomly assigned to the control group and the treatment group. The control group was given the treatment of acupunc-ture and ultrashort wave, and the treatment group was further given the treatment of kinesio taping on the basis of acupuncture and ultrashort wave. One course of treatment lasted for seven days,and the treatment lasted for two courses of 14 days in total. The differences of clinical efficacy were observed between the two groups of patients. VAS and A Modern Practical Handbook of Orthopedics were applied for evaluation before and after the treatment. Results VAS scores and curative effective rate in the two groups all improved,and the improvement in the treatment group was more significant than that in the control group (P<0.01). Conclusion The application of acupuncture, ultrashort wave com-bined with kinesio taping in the treatment of chronic ankle sprain is effective in alleviating pain and improving ankle function.

Objective To investigate how to avoid and deal with injuries to the aberrant right posterior hepatic duct during laparoscopic cholecystectomy (LC).Method We studied 1 710 patients who underwent LC in our unit from January 2011 to November 2013.There were 5 patients with right posterior hepatic duct abnormally,and this paper analysed the cases.Results In the 5 patients,one patient had the right posterior hepatic duct draining into the gallbladder body (Ⅰ A type),two patients had the right posterior hepatic duct draining into the cystic duct (ⅢA type),and two patients had the cystic duct draining into the right posterior hepatic duct (ⅢB type).There was no damage to the right posterior hepatic duct during operation.One patient was converted from LC to open operation.The major aberrance was class Ⅲ.Conclusions Variant bile duct is an important cause of bile duct injuries during LC.The right posterior hepatic duct variation is the most common form.To raise our vigilance and fully understand the types of aberrant right posterior hepatic duct,reasonable use of preoperative MRCP and intraoperative cholangiography in selected patients are fundamental.Aberrant right posterior hepatic duct injuries can effectively be avoided.

This paper summarized the characteristics, rehabilitation needs, and situation and problems of stroke dysfunction in China. Approaches and methods of family rehabilitation were also discussed.

OBJECTIVE: To analysis the causes and treatment for postnasal drip syndrome. METHOD: One hundred patients were tested by routine examination of otolaryngology, nasal endoscopy, fiberoptic laryngoscopy and nasal sinuses CT. Choice allergen test and nasopharynx X-ray were taken based on the symptoms and signs. Patients were treated accordingly for different causes, such as flushing the nasal cavity by herbal liquid, using glucocorticoid locally, taking medicine of improving the sticky film cilium function, immunotherapeutic or operation. RESULT: The causes included chronic rhinitis 22 cases (22%), chronic sinusitis or nasal polyp 31 cases (31%), allergic rhinitis 28 cases (28%), adenoid vegetation 16 cases (16%), chronic nasopharyngitis 3 cases (3%). All patients were treated accordingly and total cure rate was 82% after 6 months follow up. CONCLUSION The causes of postnasal drip syndrome are complicated. It is critical to check the cause and chose adaptable therapy for good result.
Adolescent ; Adult ; Aged ; Child ; Chronic Disease ; Cough ; etiology ; therapy ; Female ; Humans ; Immunotherapy ; Male ; Middle Aged ; Nose Diseases ; etiology ; therapy ; Rhinitis ; etiology ; therapy ; Sinusitis ; etiology ; therapy ; Young Adult

Objective To sum up the surgical characteristics,indications and curative effects of burst fracture by anterior decompression,bone grafting and internal fixation.Methods Since Sep 2004,6 cases with the average age of 32 who were with thoracolumbar spine burst fracture and spinal cord injury of 12-day mean time,were treated with anterior decompression,bone grafting and Z-plate steel plate internal fixation.Before the operation,pateients were classified according to the ASIA classification: 4 cases of grade C,2 cases of grade D;Kyphotic angle(Cobb)15~40?;and vertebral canal 50%~60%.Results The follow-up lasted from 6 to 16 months(average 11 months) and it was found that incision recovered better,no infection of thoracic,abdomen,no grafting loosing or braking occurred.According to the ASIA classification,the functional recovery of spinal cord was 1~2 grade.The Denis assessment showed 5 cases was light back pain,1 case needed medication from time to time but didn't affect the life and work and spine was in order.Conclusion Surgical treatment of thoracolumbar fracture by anterior decompression,bone grafting,internal fixation can provide sufficient decompression,high rate of fusion of the implanted bone,stability in the spine and vertebral body,better recovery of neurological function and satisfied curative effects.It is the best choice for thoracolumbar burst facture and spinal cord injury.