Hepatic alveolar echinococcosis (AE) is a parasitic disease with biological characteristics similar to malignant tumor. It has no obvious clinical symptoms in the early stage. Most patients have complications such as jaundice, ascites and gastrointestinal bleeding when they see a doctor. At this time, the course of disease is at an advanced stage. In addition, the incomplete resection of the AE lesion(s) leads to a high postoperative recurrence rate, which has a serious impact on the physical and mental health of patients. Based on the summary of the latest research at home and abroad and the analysis of blood supply, microvascular invasion and vascular growth factor expression in the "infiltrating zone" adjacent to the lesions of hepatic AE, this article has a deep understanding of the occurrence and development process of hepatic AE, aiming to better guide clinical practice and improve the quality of life of patients.
Humans ; Echinococcosis, Hepatic/surgery* ; Quality of Life ; Physical Examination

Since the implementation of drug registration in China, the classification of Chinese medicine has greatly met the needs of public health and effectively guided the transformation, inheritance, and innovation of research achievements on traditional Chinese medicine(TCM). In the past 30 years, the development of new Chinese medicine has followed the registration transformation model of " one prescription for single drug". This model refers to the R&D and registration system of modern drugs, and approximates to the " law-abiding" medication method in TCM clinic, while it rarely reflects the sequential therapy of syndrome differentiation and comprehensive treatment with multiple measures. In 2017, Opinions on Deepening the Reform of Review and Approval System and Encouraging the Innovation of Drugs and Medical Devices released by the General Office of the CPC Central Committee and the General Office of the State Council pointed out that it is necessary to " establish and improve the registration and technical evaluation system in line with the characteristics of Chinese medicine, and handle the relationship between the traditional advantages of Chinese medicine and the requirements of modern drug research". Therefore, based on the development law and characteristics of TCM, clinical thinking should be highlighted in the current technical requirements and registration system of research and development of Chinese medicine. Based on the current situation of registration supervision of Chinese medicine and the modern drug research in China, the present study analyzed limitations and deficiency of " one prescription for single drug" in the research and development of Chinese medicine. Additionally, a new type of " series prescriptions" was proposed, which was consistent with clinical thinking and clinical reality. This study is expected to contribute to the independent innovation and high-quality development of the TCM industry.
China ; Drugs, Chinese Herbal/therapeutic use* ; Medicine, Chinese Traditional ; Prescriptions ; Public Health

Objective: To explore the effect of perioperative chemotherapy on the prognosis of gastric cancer patients under real-world condition. Methods: A retrospective cohort study was carried out. Real world data of gastric cancer patients receiving perioperative chemotherapy and surgery + adjuvant chemotherapy in 33 domestic hospitals from January 1, 2014 to January 31, 2016 were collected. Inclusion criteria: (1) gastric adenocarcinoma was confirmed by histopathology, and clinical stage was cT2-4aN0-3M0 (AJCC 8th edition); (2) D2 radical gastric cancer surgery was performed; (3) at least one cycle of neoadjuvant chemotherapy (NAC) was completed; (4) at least 4 cycles of adjuvant chemotherapy (AC) [SOX (S-1+oxaliplatin) or CapeOX (capecitabine + oxaliplatin)] were completed. Exclusion criteria: (1) complicated with other malignant tumors; (2) radiotherapy received; (3) patients with incomplete data. The enrolled patients who received neoadjuvant chemotherapy and adjuvant chemotherapy were included in the perioperative chemotherapy group, and those who received only postoperative adjuvant chemotherapy were included in the surgery + adjuvant chemotherapy group. Propensity score matching (PSM) method was used to control selection bias. The primary outcome were overall survival (OS) and progression-free survival (PFS) after PSM. OS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the last effective follow-up or death. PFS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the first imaging diagnosis of tumor progression or death. The Kaplan-Meier method was used to estimate the survival rate, and the Cox proportional hazards model was used to evaluate the independent effect of perioperative chemo therapy on OS and PFS. Results: 2 045 cases were included, including 1 293 cases in the surgery+adjuvant chemotherapy group and 752 cases in the perioperative chemotherapy group. After PSM, 492 pairs were included in the analysis. There were no statistically significant differences in gender, age, body mass index, tumor stage before treatment, and tumor location between the two groups (all P>0.05). Compared with the surgery + adjuvant chemotherapy group, patients in the perioperative chemotherapy group had higher proportion of total gastrectomy (χ(2)=40.526, P<0.001), smaller maximum tumor diameter (t=3.969, P<0.001), less number of metastatic lymph nodes (t=1.343, P<0.001), lower ratio of vessel invasion (χ(2)=11.897, P=0.001) and nerve invasion (χ(2)=12.338, P<0.001). In the perioperative chemotherapy group and surgery + adjuvant chemotherapy group, 24 cases (4.9%) and 17 cases (3.4%) developed postoperative complications, respectively, and no significant difference was found between two groups (χ(2)=0.815, P=0.367). The median OS of the perioperative chemotherapy group was longer than that of the surgery + adjuvant chemotherapy group (65 months vs. 45 months, HR: 0.74, 95% CI: 0.62-0.89, P=0.001); the median PFS of the perioperative chemotherapy group was also longer than that of the surgery+adjuvant chemotherapy group (56 months vs. 36 months, HR=0.72, 95% CI:0.61-0.85, P<0.001). The forest plot results of subgroup analysis showed that both men and women could benefit from perioperative chemotherapy (all P<0.05); patients over 45 years of age (P<0.05) and with normal body mass (P<0.01) could benefit significantly; patients with cTNM stage II and III presented a trend of benefit or could benefit significantly (P<0.05); patients with signet ring cell carcinoma benefited little (P>0.05); tumors in the gastric body and gastric antrum benefited more significantly (P<0.05). Conclusion: Perioperative chemotherapy can improve the prognosis of gastric cancer patients.
Chemotherapy, Adjuvant ; Female ; Gastrectomy ; Humans ; Male ; Neoadjuvant Therapy ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Stomach Neoplasms/surgery*

Objective:To evaluate the clinical value of suspensory incision and suture technique in endoscopic full-thickness resection (EFTR) for muscularis propria tumor of gastric fundus.Methods:A retrospective analysis was performed on the data of 20 patients with muscularis propria tumor in gastric fundus and undergoing EFTR in the First Medical Center of PLA General Hospital from June 2017 to June 2019. Patients were divided into the observation group (9 cases) treated with suspensory incision and suture technique in EFTR and the control group (11 cases) treated with traditional EFTR method. The baseline data and perioperative data of the two groups were analyzed.Results:EFTR was successfully performed on all 20 patients. The tumor size of the observation group and the control group was 10.0 (7.5, 21.0) mm and 14.0 (10.0, 20.0) mm, respectively. The resection time of the two groups was 26.4±6.3 min and 35.5±11.4 min, respectively. The postoperative hospital stay was 6.4±1.0 d and 7.7±1.5 d, respectively. No postoperative delayed bleeding, perforation, or other complications occurred in the two groups.Conclusion:Using suspensory incision and suture technique is safe and effective during EFTR for muscularis propria tumor in gastric fundus, and can reduce operation time. This technique is worth applying in clinic.

Objective: To identify the characteristics including clinical features and pulmonary computed tomography (CT) features of heart failure and COVID-19. Methods: This study was a retrospective study. A total of 7 patients with heart failure and 12 patients with COVID-19 in the Second Xiangya Hospital of Central South University between December 1, 2019 and February 15, 2020 were enrolled. The baseline clinical and imaging features of the two groups were statistically analyzed. Results: There was no significant difference in age and sex between the two groups(both P>0.05), but the incidence of epidemiological contact history, fever or respiratory symptoms in the COVID-19 group was significantly higher than that in the heart failure group (12/12 vs. 0, P<0.001; 12/12 vs. 4/7, P=0.013). While the proportion of cardiovascular diseases and impaired cardiac function was significantly less than that of the heart failure group(2/12 vs.7/7, P<0.001；0 vs.7/7, P<0.001). For imaging features, both groups had ground-glass opacity and thickening of interlobular septum, but the ratio of central and gradient distribution was higher in patients with heart failure than that in patients with COVID-19 (4/7 vs. 1/12, P=0.04). In heart failure group, the ratio of the expansion of pulmonary veins was also higher (3/7 vs. 0，P=0.013), and the lung lesions can be significantly improved after effective anti-heart failure treatment. Besides, there were more cases with rounded morphology in COVID-19 group（9/12 vs. 2/7, P=0.048）. Conclusions: More patients with COVID-19 have epidemiological history and fever or respiratory symptoms. There are significant differences in chest CT features, such as enlargement of pulmonary veins, lesions distribution and morphology between heart failure and COVID-19.
Betacoronavirus ; COVID-19 ; Coronavirus Infections/diagnostic imaging* ; Heart Failure/etiology* ; Humans ; Pandemics ; Pneumonia, Viral/diagnostic imaging* ; Retrospective Studies ; SARS-CoV-2 ; Tomography, X-Ray Computed

Objective: To evaluate optical coherence tomography(OCT)for predicting invasion depth of early esophageal cancer(EEC) and to compare OCT and magnifying endoscopy-narrow band imaging (ME-NBI)in clinical performance. Methods: Twenty-eight patients who were diagnosed with EEC and accepted OCT and ME-NBI before endoscopic submucosal dissection(ESD)were enrolled in this prospective study. On the basis of OCT and ME-NBI images, real-time prediction of EEC invasion depth was conducted. Postoperative pathological results were taken as golden standard to compare the accuracy of OCT and ME-NBI in evaluation of EEC invasion depth. The procedure time and incidence of complications during evaluation process were also analyzed. Results: The overall accuracy of OCT and ME-NBI in predicting invasion depth of 28 EEC patients were 67.9% (19/28) and 75.0% (21/28) respectively, with no significant difference(P>0.05). The accuracy of OCT and ME-NBI in distinguishing lesions located in epithelium/lamina propria mucosa (EP/LPM) lesions were 78.9%(15/19) and 68.4% (13/19), with no significant difference(P>0.05). The procedure time of OCT was significantly shorter than that of ME-NBI (6.0±2.9 min VS 16.3±5.4 min, P<0.001). Conclusion The ability of OCT to predict invasion depth of EEC and distinguish lesions located in the EP/LPM is comparable with that of ME-NBI. Besides, OCT requires shorter procedure time for evaluation.

Objective To assess the efficacy and safety of autologous skin-grafting surgery ( ASGS) in the prevention of esophageal stenosis after complete circular endoscopic submucosal tunnel dissection ( ESTD) for early esophageal cancer. Methods Between January 2018 and March 2018, five patients with early esophageal cancer underwent complete circular ESTD and ASGS in Chinese PLA General Hospital. The skin-graft survival situation, and occurrence of esophageal stenosis and complications were observed by endoscopy follow-up. Results Complete circular ESTD and ASGS were successfully performed in all 5 patients, and no complications including perforation, bleeding, wound infection or stent migration occurred. The mean skin-graft survival rate was 86. 0％. Four patients did not experience esophageal stenosis over the mean follow-up of 9. 5 months. One patient experienced esophageal stenosis after operation, and underwent endoscopic balloon dilatation. No stenosis occurred in 8 months of follow-up. Conclusion ASGS is a safe and effective method to prevent esophageal stenosis after complete circular ESTD.

Objective: To investigate the relationship between blood lipid level and in-hospital death in patients with aortic dissection (AD). Methods: Our retrospective study included in 2 groups: AD group, n=153 patients which was further divided into 2 subgroups:Thoracic AD subgroup, n=73 and Abdominal AD subgroup, n=80; Control group, n=50 patients with isolated hypertension at the same period. Blood lipid levels were compared among different groups and subgroups; HDL-C levels were studied by correlation analysis between AD survivor and in-hospital died AD patients. Results: Compared with Control group, AD group had increased TC [3.89 (3.19, 4.61) mmol/L] vs [3.58 (2.70, 4.33) mmol/L], decreased HDL-C [1.02 (0.86, 1.25) mmol/L vs 1.52 (1.22, 1.76) mmol/L] and lower ratio of HDL-C/TC [0.28 (0.22, 0.34) vs 0.45 (0.31, 0.67)], all P<0.01. Compared with Abdominal AD subgroup, Thoracic AD subgroup had the lower ratio of HDL-C/TC [0.27 (0.20, 0.33) vs 0.30 (0.24, 0.36)], P<0.05. Compared with AD survivor, the in-hospital died AD patients had the lower HDL-C level [0.82 (0.69, 1.04) mmol/L vs 1.06 (0.89, 1.33) mmol/L], P<0.01. Spearman correlation analysis revealed that HDL-C level was negatively related to in-hospital death of AD (correlation coefficient =-0.353). Conclusion: AD patients had abnormal lipid metabolism, blood HDL-C level was negatively related to in-hospital death in AD patients.

BACKGROUND: Preliminary studies have found that ligustrazine can effectively improve the levels of nitric oxide and prostaglandin E2, and alleviate the inflammatory response of osteoarthritis, but the related mechanism remains unclear. OBJECTIVE: To observe the effect of ligustrazine on the expression levels of type Ⅱ collagen fiber α 1, vascular endothelial growth factor (VEGF) mRNA and miR20b in the articular cartilage of knee osteoarthritis model, and to explore the mechanism of ligustrazine for early-stage knee osteoarthritis in rats. METHODS: Healthy male Sprague-Dawley rats were randomized into normal, model, high- and low-dose ligustrazine, and positive control groups. Rats in the latter four groups were used to establish the model of early-stage knee osteoarthritis by intra-articular injection of papain, and were then intragastrically given the administration of normal saline, 100 and 50 mg/kg ligustrazine, and 24 mg/kg celecoxib, respectively. The normal group was given the same volume of normal saline. The treatment in each group lasted for 6 weeks. Then, the rat cartilage was taken, and changes of cartilage tissues were assessed by Mankin scores. Expression levels of type Ⅱ collagen fiber α 1, VEGF mRNA and miR20b in the cartilage were detected by qRT-PCR. RESULTS AND CONCLUSION: The order of Mankin scores was as follows: normal group < high-dose ligustrazine group < positive control group < low-dose ligustrazine group < model group (P < 0.05). The mRNA expression levels of type Ⅱ collagen fiber α 1 and VEGF were the highest in the normal group, followed by the high-dose ligustrazine group, positive control group, low-dose ligustrazine group, and model group (P < 0.05). The expression level of miR20b was significantly up-regulated except the model group, and its order was follows: high-dose ligustrazine group < positive control group < low-dose ligustrazine group. Our results indicate that ligustrazine has a positive effect on early-stage knee osteoarthritis in rats, and the possible mechanisms by which ligustrazine promotes cartilage repair are to up-regulate miR20b expression and to inhibit VEGF mRNA expression.

BACKGROUNDAcute aortic dissection is a life-threatening cardiovascular emergency. Pentraxin-3 (PTX3) is proposed as a prognostic marker and found to be related to worse clinical outcomes in various cardiovascular diseases. This study sought to investigate the association of circulating PTX3 levels with in-hospital mortality in patients with acute Type A aortic dissection (TAAD).

METHODSA total of 98 patients with TAAD between January 2012 and December 2015 were enrolled in this study. Plasma concentrations of PTX3 were measured upon admission using a high-sensitivity enzyme-linked immunosorbent assay system. Patients were divided into two groups as patients died during hospitalization (Group 1) and those who survived (Group 2). The clinical, laboratory variables, and imaging findings were analyzed between the two groups, and predictors for in-hospital mortality were evaluated using multivariate analysis.

RESULTSDuring the hospital stay, 32 (33%) patients died and 66 (67%) survived. The patients who died during hospitalization had significantly higher PTX3 levels on admission compared to those who survived. Pearson's correlation analysis demonstrated that PTX3 correlated positively with high-sensitivity C-reactive protein (hsCRP), maximum white blood cell count, and aortic diameter. Multivariate logistic regression analysis demonstrated that PTX3 levels, coronary involvement, cardiac tamponade, and a conservative treatment strategy are significant independent predictors of in-hospital mortality in patients with TAAD. The receiver operating characteristic curve analysis further illustrated that PTX3 levels on admission were strong predictors of mortality with an area under the curve of 0.89. A PTX3 level ≥5.46 ng/ml showed a sensitivity of 88% and a specificity of 79%, and an hsCRP concentration ≥9.5 mg/L had a sensitivity of 80% and a specificity of 69% for predicting in-hospital mortality.

CONCLUSIONHigh PTX3 levels on admission are independently associated with the in-hospital mortality in patients with TAAD.

Adult ; Aged ; Aneurysm, Dissecting ; blood ; mortality ; Aortic Aneurysm ; blood ; mortality ; C-Reactive Protein ; metabolism ; Female ; Hospital Mortality ; Humans ; Logistic Models ; Male ; Middle Aged ; Serum Amyloid P-Component ; metabolism