‍ ObjectiveTo investigate the diagnostic efficacy and optimal cut-off values of alpha-fetoprotein （AFP） and alpha-fetoprotein variant L3 （AFP-L3） in hepatitis B virus （HBV）-related early-stage hepatocellular carcinoma （HCC）. MethodsA total of 1 080 patients with HBV-related HCC （HBV-HCC） who were diagnosed for the first time and not yet treated in The Third Affiliated Hospital of Sun Yat-Sen University from January 2019 to July 2022 were enrolled as HCC group in the study， among whom there were 620 patients with CNLC Ⅰ‍a-‍Ⅱ‍a HCC， and in addition， 346 patients with HBV-related chronic hepatitis B （CHB group） and 293 patients with HBV-related liver cirrhosis （LC group） were enrolled as controls. The diagnostic efficacy of AFP and AFP-L3% in screening for HBV-related early-stage HCC was analyzed， including sensitivity， specificity， and the area under the ROC curve （AUC）. The Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups； the Kruskal-Wallis H test was used for comparison between multiple groups， and the Bonferroni method was used for further comparison between two groups. ResultsThe HCC group had significantly higher levels of AFP and AFP-L3% than the CHB group and the LC group （H=542.479 and 418.974， both P<0.001）. In early-stage HCC， AFP and AFP-L3% had an optimal cut-off value of 8.7 ng/mL and 5%， respectively， and AFP alone had the largest AUC of 0.816， with a sensitivity of 66.9% and a specificity of 85.1%. There was no significant difference in AUC between AFP-L3%+AFP and AFP alone （Z=0.609， P=0.543）， but both AFP-L3%+AFP and AFP alone had a significantly larger AUC than AFP-L3% alone （AFP vs AFP-L3%： Z=8.173， P<0.001； AFP+AFP-L3% vs AFP-L3%： Z=8.802， P<0.001）. ConclusionAFP has a good value and is superior to AFP-L3% in the diagnosis of HBV-related early-stage HCC， and the screening cut-off value of AFP should be lowered in order to improve the detection rate of early-stage HCC.

Objective: To explore the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection who received entecavir alone or in combination with anluohuaxianwan for 78 weeks. Methods: Patients with chronic HBV infection were randomly treated with entecavir alone or in combination with anluohuaxian for 78 weeks. Ishak fibrosis score was used for blind interpretation of liver biopsy specimens. The improvement in liver fibrosis condition before and after the treatment was compared. Student's t test and non-parametric test (Mann-Whitney U-Test and Kruskal-Wallis test) were used to analyze the measurement data. The categorical variables were analyzed by Chi-square test method and Spearman’s rank correlation coefficient was used to test bivariate associations. Results: Liver fibrosis improvement rate after 78 weeks of treatment was 36.53% (80/219) and the progression rate was 23.29% (51/219). The improvement of liver fibrosis was associated to the degree of baseline fibrosis and treatment methods (P < 0.05). The improvement rate of hepatic fibrosis in patients treated with anluohuaxianwan combined with entecavir at baseline F < 3 (54.74%, 52/95) was significantly higher than that in patients treated only with entecavir (33.33%, 16/48), P = 0.016 and the progression rate of hepatic fibrosis (13.68%, 13/95) was lower than that in patients treated alone (18.75%, 9/48), P = 0.466. In patients with baseline F < 3, the proportion of patients with improved and stable liver fibrosis in the combined treatment group (68.1%, 32/47) was higher than that in the treatment group alone (51.7%, 15/29). Conclusion Combined anluohuaxianwan and entecavir treatment can significantly improve the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection. Furthermore, it has the tendency to improve the stability rate and reduce the rate of progression of liver fibrosis.

Objective: To investigate the effect and mechanism of atorvastatin (ATV) on the inflammatory response of human renal tubular epithelial cells (HK-2 cells) induced by calcium oxalate crystals. Methods: HK-2 cells were divided into control group (normal medium), ATV group (after 3 h pretreatment with 40 μmol/L ATV, replaced with normal medium), calcium oxalate crystal stimulation group (4 mmol/L calcium oxalate crystal) and ATV treatment group (after 3 h pretreatment with 40 μmol/L ATV, replaced with 4 mmol/L calcium oxalate crystals). After 12 h, the cells were collected, and the expression levels of NLRP3 and Cleaved caspase-1 were detected by immunohistochemical staining and Western blotting. The expression level of NF-κB was detected by immunofluorescence and Western blotting. The cell culture supernatant was collected to detecte the concentrations of interleukin-1β (IL-1β) and interleukin-18 (IL-18) by enzyme linked immunosorbent assay (ELISA). Results: Western blot analysis showed that the relative expression of NLRP3 (0.125±0.013 vs. 0.135±0.007) and Cleaved caspase-1 (0.090±0.014 vs. 0.095±0.006) was decreased in the ATV group compared with the control group, but the difference was not statistically significant (P>0.05). The relative expression of NLRP3 (0.315±0.021 vs. 0.135±0.007, P<0.001) and Cleaved caspase-1 (0.235±0.008 vs. 0.095±0.006, P<0.001) was significantly increased in the calcium oxalate crystal stimulation group compared with the control group. While the relative expression of NLRP3 (0.245±0.007 vs. 0.315±0.021, P<0.05) and Cleaved caspase-1 (0.170±0.017 vs. 0.235±0.008, P<0.05) in the ATV treatment group was significantly lower than that in the calcium oxalate crystal stimulation group. The results of immunohistochemical staining showed that the expression trends of NLRP3 and Cleaved caspase-1 in each group were consistent with those obtained by Western blotting. The ELISA results showed that the concentration of inflammatory factors IL-1β [(162.00±21.21)pg/ml vs. (183.50±7.78) pg/ml, P>0.05] and IL-18 [(176.50±24.12)pg/ml vs.(182.50±20.51)pg/ml, P>0.05] in the ATV group was lower than that in the control group, but the difference were not statistically significant (P>0.05). The concentrations of IL-1β[(850.50±48.79)pg/ml vs. (183.50±7.78)pg/ml, P<0.001] and IL-18 [(526.00±39.61)pg/ml vs. (182.50±20.51)pg/ml, P<0.001] were significantly increased in the cell culture medium of the calcium oxalate crystal stimulation group compared with the control group, while the concentrations of IL-1β [(452.50±36.06)pg/ml vs. (850.50±48.79) pg/ml, P<0.01] and IL-18 [(403.50±23.33)pg/ml vs. (526.00±39.61)pg/ml, P<0.05] was significantly reduced in the cell culture medium of the ATV treatment group compared with the calcium oxalate crystal stimulation group. Western blot analysis showed that the relative expression of NF-κB (0.105±0.021 vs. 0.100±0.014) in the ATV group was decreased compared with the control group, but the difference was not statistically significant (P>0.05). The relative expression of NF-κB (0.295±0.035 vs. 0.100±0.014, P<0.001) in the calcium oxalate crystal stimulation group was significantly increased compared with the control group. While the relative expression of NF-κB (0.160±0.012 vs. 0.295±0.035, P<0.05) in the ATV treatment group was significantly lower than that in the calcium oxalate crystal stimulation group. The expression of NF-κB by immunofluorescence staining was consistent with the results of Western blotting. Conclusions Calcium oxalate crystals can induce the inflammatory response of HK-2 cells, while ATV can exert anti-inflammatory effects by inhibiting the activation of NLRP3 inflammasome and decreasing the secretion of inflammatory factors IL-1β, IL-18 and the expression of NF-κB.

Objective: To study the effects of estrogen on the degenerative changes of condylar cartilage and subchondral bone in rats. Methods: 18 female SD rats aged 6 weeks were divided into control(C),unilateral anterior cross-bite(UAC) and UAC treated with estrogen(UAC + E) groups(n = 6). UAC metal prosthesis was cemented to the left incisors of maxilla and mandible of the rats in group UAC and UAC + E. Rats in UAC + E group were given pexitoneal injection of 80 μg 17β-estradiol per day. The rats in group C were untreated. Animal were sacrificed at the 4th weeks. The micro-structure of subchondral bone was observed by Micro-CT scanning. HE staining,Safranin O staining,immunohistochemical staining,TUNEL staining and TRAP staining for the observation of pathological changes of histomorphology,extracellular matrix,chondrocyte apoptosis in condylar cartilage,and osteoclasts number in subchondral bone. Results: UAC and UAC + E group showed evident osteoarthritis(OA)-like lesions. Compare with UAC group,there was a significant decrease in the expression of proteoglycan(P ＜ 0. 05),type Ⅱ collagen(P ＜ 0. 01),and a significant increase in the number of apoptotic chondrocytes(P ＜ 0. 01) in UAC + E group. As for subchondral bone,the BV/TV,Tb. Th parameters in C and UAC + E groups were significant higher than in UAC group(P ＜ 0. 01),while the BS /BV,Tb. N,Tb. Sp parameters and the osteoclasts number in C and UAC + E groups were significant fewer than in UAC groups(P ＜ 0. 01). There was no significant difference in bone ultra-parameters and osteoclasts number between C and UAC + E groups(P＞ 0. 05). Conclusion: In the model of rat TMJOA induced by unilateral anterior crossbite prosthesis,supra-physiological level of estrogen can reverse bone loss in subchondral bone,but accelerate the degradation of condylar cartilage.

Objective To investigate the correlation between the prognostic nutritional index(PNI) and the clinicopathologic features of patients with non-small cell lung cancer(NSCLC),and to compare postoperative complications and survival between patients with High-PNI(H-PNI) and Low-PNI(L-PNI) after operation.Methods This study retrospectively reviewed and analyzed the medical records of 216 patients underwent surgery between July 2010 and December 2011 who were pathologically dignosed with NSCLC.Among these,127 patients with H-PNI,and 89 patients with L-PNI.The clinicopathologic features,median survival time and 5-year survival rates between two groups were analyzed.Results Patients in the L-PNI group had greater pathologic TNM stage,larger tumors,lower Serum albumin levels,and greater percentage of chemotherapy than those in the H-PNI group(P ＜ 0.05).The H-PNI group was associated with significantly fewer postoperative complications than the L-PNI group (P ＜ 0.05).For the patients with H-PNI,the MST was 61.6 months an the 1-,3-,and 5-year OS were 91.3 ％,80.1％,and 74.1％,respectively.For the patients with L-PNI,the MST was 49.9 months and the 1-,3-,and 5-year OS were 82.0％,63.5％,and 53.5％,respectively.There was significant difference in survival between the two groups(P ＜ 0.05).TNM staging and PNI were showed to be independent prognostic factors.Conclusion Different PNI of NSCLC has certain heterogeneity.Patients with H-PNI show better survival and lower postoperative complications rate than those with L-PNI.

BACKGROUND: Currently, there are many reports on the advantages of three portal video-assisted thoracic surgery (VATS) in the treatment of lung cancer, but there are few reports on the comparison between uniportal and three portal video-assisted thoracic surgery. In this study, we aimed to evaluate the recent curative effect of the postoperative short-term quality of life between uniportal and three portal video-assisted thoracic surgery for non-small cell lung cancer. METHODS: We retrospectively evaluated 266 patients with NSCLC who underwent intended VATS lobectomy by a single surgical team in our ward between January 2016 and August 2017. The general clinical date, perioperative data and short-term life quality were individually compared and analyzed between the two groups. RESULTS: The two groups were similar in terms of clinicopathological features, total number of dissected lymph nodes and nodal stations, postoperative complications and pulmonary complications (P>0.05). Compared with three portal VATS, the intraoperative blood loss, chest tube duration, postoperative thoracic drainage, length of stay and NRS score were significantly decreased in uniportal VATS, with significant differences (P<0.05). CONCLUSIONS As a more minimally invasive surgery, uniportal VATS can be safely and effectively performed for resectable lung cancer, which would achieve even better operation curative effect than three portal VATS.
Aged ; Carcinoma, Non-Small-Cell Lung ; pathology ; surgery ; Female ; Humans ; Lung ; pathology ; surgery ; Lung Neoplasms ; pathology ; surgery ; Middle Aged ; Operative Time ; Postoperative Complications ; etiology ; Quality of Life ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; adverse effects ; methods ; Treatment Outcome

OBJECTIVE:To observe the efficacy and safety of prednisone combined with human immunoglobulin(pH4)for intra-venous injection in the treatment of idiopathic thrombocytopenic purpura. METHODS:85 patients with idiopathic thrombocytopenic purpura were divided into control group(42 cases)and observation group(43 cases). Control group received 1.6 mg/(kg·d)Predni-sone tablet,orally,for continuous 4 weeks;observation group received 400 mg/(kg·d)human immunoglobulin(pH4)for intravenous injection,intravenous injection,for continuous 5 d,then 1.6 mg/(kg·d)Prednisone tablet,orally,for continuous 4 weeks. All pa-tients were given Adrenal color hydrazone tablet,Vitamin C tablet and other conventional treatment. Clinical efficacy,platelet number, T lymphocyte subsets(CD3+,CD3+CD4+,CD3+CD8+,CD19+),TNF-α,IL-6 before and after treatment,time of platelet number reached normal and reached peak value,peak value of platelet number and the incidence of adverse reactions in 2 groups were ob-served. RESULTS:The total effective rate and peak value of platelet number in observation group were significantly higher than control group,time of platelet number reached normal and reached peak value were significantly shorter than control group,the differences were statistically significant(P<0.05). Before treatment,there were no significant differences in platelet number,T lymphocyte sub-sets,IL-6 and TNF-αlevel in 2 groups(P>0.05);after treatment,platelet number,CD3+and CD3+CD4+in 2 groups were significant-ly higher than before,and observation group was higher than control group,IL-6,TNF-αlevel,CD3+CD8+and CD19+were signifi-cantly lower than before,and observation group was lower than control group,the differences were statistically significant(P<0.05). And there was no significant difference in the incidence of adverse reactions in 2 groups(P>0.05). CONCLUSIONS:Prednisone com-bined with human immunoglobulin(pH4) for intravenous injection shows better efficacy than prednisone alone in the treatment of idio-pathic thrombocytopenic purpura,it can increase platelet number,adjust immune function,and do not increase the incidence of ad-verse reactions.

OBJECTIVETo investigate the prognosis of patients with N1 non-small cell lung cancer, and to compare the clinicopathological features and survival between patients with unexpected N1 (cN0-pN1) and expected N1 disease (cN1-pN1) after operation for non-small cell lung cancer.

METHODSThis study retrospectively reviewed and analyzed the medical records of 183 patients who underwent surgery and pathologically diagnosed with N1 non-small cell lung cancer between January 2006 and December 2010. Among them, 78 patients had negative findings before surgery (cN0-pN1 group), and 105 patients had positive findings before surgery (cN1-pN1 group). The clinicopathological features, median survival time and 5-year survival rates between the two groups were analyzed.

RESULTSPatients in the cN1-pN1 group had greater pathologic T stage, larger tumors, greater number and stations of positive N1 lymph nodes, and greater percentage of pneumonectomy than those in the cN0-pN1 group (P < 0.05). For the patients with cN0-pN1, the MST was 47.0 months and the 1-, 3-, and 5-year OS were 85.9%, 57.4%, and 42.5%, respectively. For the patients with cN1-pN1, the MST was 30.0 months and the 1-, 3-, and 5-year OS were 74.3%, 44.6%, and 28.8%, respectively. There were significant differences in survival between the two groups (P < 0.05). The locoregional recurrence rate of cN0-pN1 group was lower than in the cN1-pN1group (P < 0.05). The multivariate analysis showed that T staging and N staging before surgery, lymph node metastasis to multiple N1 stations and adjuvant chemotherapy were independent prognostic factors.

CONCLUSIONSDifferent clinical features of N1 non-small cell lung cancer has certain heterogeneity. Patients with unexpected N1 disease show better survival and lower locoregional recurrence rate than did those with expected N1 disease.

Carcinoma, Non-Small-Cell Lung ; diagnosis ; Chemotherapy, Adjuvant ; Humans ; Lung Neoplasms ; diagnosis ; Lymph Nodes ; Lymphatic Metastasis ; Multivariate Analysis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Pneumonectomy ; Prognosis ; Retrospective Studies ; Survival Rate

Objective To study the profiles and function of small RNA (sRNA)gene during chondrogenesis in rats so as to clarify the mechanisms of chondrocytes proliferation and differentiation.Methods All the sRNAs were identified from the female SD rats femoral head cartilages at three time points:at birth,ablactation and maturation,and three sRNA libraries were constructed.The Solexa sequencing and the bioinformatics analysis were employed to be blasted with the genomes of SD rats.Results The perfect match reads in the three libraries were screened out,which were correspondent to the 21 7 921 (41.23%),1 96 650 (38.74%)and 245 436 (41.54%)unique sRNA sequence,respectively.The percentages of 20-24 nt sRNA were 71.94% (d0),72.85% (d21),and 86.39%(d42).Half of clean sequences were 22 nt sRNA.The distribution characteristics of the reads were in line with the high-quality sRNA.More than 62% clean reads were from mature miRNA while the ratios in the three libraries were only 0.69%,0.78% and 0.63%.About 60% of the unique sRNA could not be matched with miRBase20.0 or Rfam9.1.Conclusion The distribution model of miRNA in the three libraries indicates that the miRNAs with different functions or from different sources are involved in the regulation of chondrocytes proliferation and differentiation in bone development and formation.

Objective To investigate the prognosis of patients with N1 non-small cell lung cancer, and to compare the clinicopathological features and survival between patients with unexpected N1 ( cN0-pN1) and expected N1 disease ( cN1-pN1) after operation for non-small cell lung cancer.Methods This study retrospectively reviewed and analyzed the medical records of 183 patients who underwent surgery and pathologically diagnosed with N1 non-small cell lung cancer between January 2006 and December 2010. Among them, 78 patients had negative findings before surgery ( cN0-pN1 group ) , and 105 patients had positive findings before surgery ( cN1-pN1group ) .The clinicopathological features, median survival time and 5-year survival rates between the two groups were analyzed.Results Patients in the cN1-pN1 group had greater pathologic T stage, larger tumors, greater number and stations of positive N1 lymph nodes, and greater percentage of pneumonectomy than those in the cN0-pN1 group ( P<0.05) .For the patients with cN0-pN1, the MST was 47.0 months and the 1-, 3-, and 5-year OS were 85.9%, 57.4%, and 42.5%, respectively.For the patients with cN1-pN1, the MST was 30.0 months and the 1-, 3-,and 5-year OS were 74.3%, 44.6%, and 28.8%, respectively.There were significant differences in survival between the two groups ( P<0.05) .The locoregional recurrence rate of cN0-pN1 group was lower than in the cN1-pN1group ( P<0.05 ) .The multivariate analysis showed that T staging and N staging before surgery, lymph node metastasis to multiple N1 stations and adjuvant chemotherapy were independent prognostic factors. Conclusions Different clinical features of N1 non-small cell lung cancer has certain heterogeneity.Patients with unexpected N1 disease show better survival and lower locoregional recurrence rate than did those with expected N1 disease.