Objective : To analyze the expression and immune infiltration levels of the BMP7 gene ( BMP7) in e- sophageal squamous cell carcinoma(ESCC) ． Methods : Initially，in 274 cases of ESCC and 242 cases of normal tissues，the level of BMP7 was verified by immunohistochemistry ，and the relationship between the expression difference and the survival cycle and clinical pathological characteristics of patients with ESCC was explored，and BMP7 overexpression plasmid transfection of ESCC cells was established，and the effect of BMP7 on the biological behavior of ESCC cells was examined by CCK-8，Clone，and Transwell. Results : BMP7 expression in normal e- sophageal tissues was higher than that of ESCC(P＜0. 001) ，the expression level of BMP7 was correlated with the degree of differentiation of patients(P = 0. 006) and TNM staging(P ＜0. 001) ，and the survival of patients with high expression of BMP7 exceeded that of patients with low BMP7 (P = 0. 041) ，and the experiments of CCK-8 and Clone showed that the proliferation effect of cells in the overexpressed BMP7 group was lower than that of the control group．Transwell experiments confirmed that the cell invasion migration capacity of the overexpressed BMP7 group was less than that of the control one．The immune infiltration results showed that BMP7 was positively correlated with macrophages(P = 0. 008) and negatively correlated with γ-δT cells(P = 0. 028) ． Conclusion BMP7 is low in ESCC and associated with poor prognosis and immune infiltration levels in patients.

Objective:To develop a spot scanning carbon ion beam model based on Monte Carlo code FLUKA and verify the accuracy of physical dose.Methods:A geometric model of the treatment nozzle was established in FLUKA. Various parameters such as monoenergy nominal energy, Gaussian energy spectrum distribution, initial spot size, and beam angular distribution in the model were adjusted to match the reference data of integral depth dose (IDD) and in-air spot size measuremed experimentally. Carbon ion beam plans were generated by using the treatment planning system (TPS). The difference in output dose distribution between FLUKA and TPS was compared by the gamma analysis.Results:The differences in Bragg peak width, beam range, and distal falloff width extracted from the IDD curve between the FLUKA model and measured vaues were less than 0.1 mm, with the maximum difference in spot sizes of 0.17 mm. Under the criterion of 2 mm/2% in all the simulations, 2D- and 3D-γ pass rates were all above 95%.Conclusions:An accurate spot scanning carbon beam model was developed based on the Monte Carlo code FLUKA. It has the potential to be used for not only the verification of clinical treatment plans, but also the development of new ion beam therapy equipment and the calculation of biologically effective dose.

Polymerase chain reaction (PCR) is the gold standard for nucleic acid amplification in molecular diagnostics. The PCR includes multiple reaction stages (denaturation, annealing, and extension), and a complicated thermalcycler is required to repetitively provide different temperatures for different stages for 30-40 cycles within at least 1-2 hours. Due to the complicated devices and the long amplification time, it is difficult to adopt conventional PCR in point-of-care testing (POCT). Comparing to conventional PCR, isothermal amplification is able to provide a much faster and more convenient nucleic acid detection because of highly efficient amplification at a constant reaction temperature provided by a simple heating device. When isothermal amplification is combined with microfluidics, a more competent platform for POCT can be established. For example, various diagnosis devices based on isothermal amplification have been used to rapidly and conveniently detect SARS-CoV-2 viruses. This review summarized the recent development and applications of the microfluidics-based isothermal amplification. First, different typical isothermal amplification methods and related detection methods have been introduced. Subsequently, different types of microfluidic systems with isothermal amplification were discussed based on their characteristics, for example, functionality, system structure, flow control, and operation principles. Furthermore, detection of pathogens (e.g. SARS-CoV-2 viruses) based on isothermal amplification was introduced. Finally, the combination of isothermal amplification with other new technologies, e.g. CRISPR, has been introduced as well.
COVID-19/diagnosis* ; Humans ; Microfluidics ; Nucleic Acid Amplification Techniques ; Polymerase Chain Reaction ; SARS-CoV-2/genetics*

Objective:To investigate the prognostic value of preoperative inflammatory indicators for hepatocellular carcinoma (HCC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 73 patients with primary HCC who underwent radical partial hepatectomy in the Beijing Tsinghua Changgung Hospital of Tsinghua University from December 2014 to July 2019 were collected. There were 57 males and 16 females, aged from 33 to 81 years, with a median age of 58 years. Results of blood examination indicators at the first time in hospital were determined for patients. Observation indicators: (1) the best cut-off values of?? preoperative inflammatory indicators calculated by the maximally selected rank statistics; (2) follow-up; (3) influencing factors for prognosis of HCC patients; (4) comparison of clinicopathological parameters of HCC patients; (5) comparison of predictive value for overall survival. Follow-up was conducted using outpatient examination and telephone interview to determine postoperative survival of patients up to September 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range). The best cut-off values ??for continuous variables were obtained using the maximally selected rank statistics based on survival at endpoint of follow-up. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Kaplan-Meier method was used to calculate survival rates, and Log-rank test was used for survival analysis. Univariate analysis was performed using the Log-rank test. Multivariate analysis was performed using the COX proportional hazard model. The time-dependent receiver operating characteristic curve (ROC) was used to compare the predictive value of independent prognostic factors. Results:(1) The best cut-off values of?? preoperative inflammatory indicators calculated by the maximally selected rank statistics: the best cut-off values of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and prognostic nutrition index (PNI) were 3.46, 131.05, and 45.65. (2) Follow-up: 73 patients were followed up for 31 months (range, 2-57 months). Twenty patients died during the follow-up. (3) Influencing factors for prognosis of HCC patients: results of univariate analysis showed that NLR, PNI, tumor diameter, and tumor differentiation degree were related factors affecting prognosis of patients ( χ2=10.213, 4.434, 5.174, 4.306, P<0.05). Results of multivariate analysis showed that NLR and tumor differentiation degree were independent factors affecting prognosis of patients ( hazzard ratio=4.429, 13.278, 95% confidence interval as 1.662-11.779, 1.056-10.169, P<0.05). (4) Comparison of clinicopathological parameters of HCC patients: of 73 patients, 64 cases had NLR<3.46 and 9 cases had NLR≥3.46. Cases with tumor length >5 cm or ≤5 cm, neutrophils, lymphocytes were 23, 41, (2.9±1.2)×10 9/L, (1.7±0.6)×10 9/L for 64 patients with NLR<3.46, versus 8, 1, (5.8±2.9)×10 9/L, (1.0±0.3)×10 9/L for 9 patients with NLR≥3.46; there were significant differences in above indicators between the two groups ( χ2=7.017, t=2.982, -3.168, P<0.05). (5) Comparison of predictive value for overall survival: time-dependent ROC curves of NLR and tumor differentiation degree for 1-, 2-, 3-, 4-year survival rates had the area under curve of 0.735,0.611, 0.596, 0.574 and 0.554, 0.583, 0.572, 0.556, respectively. NLR had better predictive value for overall survival of patients than tumor differentiation degree. Conclusion:Preoperative NLR is an independent factor affecting prognosis patients, and its predictive efficacy is better than tumor differentiation degree.

Objective    To analyze the effectiveness of in vitro fenestration versus bypass surgery techniques in the treatment of type B aortic dissection involving the left subclavian artery by thoracic endovascular aortic repair (TEVAR). Methods    Among the 53 patients with type B aortic dissection involving the left subclavian artery admitted to our center from January 2017 to October 2020, 23 underwent in vitro fenestration + TEVAR (a fenestration group with 18 males and 5 females aged 53.6±5.3 years), and 30 patients underwent left common carotid artery-left subclavian artery bypass + TEVAR (a bypass group with 24 males and 6 females aged 51.8±3.8 years). The effectiveness and safety between the two groups were compared. Results    The surgical success rate was 100.0% in both groups. And there was no death within postoperative 30 days and during the follow-up. There was no endoleak immediately postoperatively and during 1-year follow-up in the two groups. The operation time and hospitalization expenses in the fenestration group was less or shorter than those in the bypass group (P<0.05). The reduction in blood pressure of the left upper limb in the fenestration group was greater than that in the bypass group (P<0.05). There was no symptom of left upper limb ischemia, dizziness or hoarseness in both groups. Conclusion    The two methods of reconstruction of the left subclavian artery are safe and effective. In vitro fenestration can reduce surgical trauma and costs, and bypass surgery can provide better forward blood flow for the left subclavian artery.

The current epidemic of Corona Virus Disease 2019 (COVID-19) poses a serious threat to people′s health and lives. Following the national policies and deployment, medical community in China invests large amounts of medical resources to help Hubei. However, some hospitals nationwide have suspended outpatient and inpatient services. The authors analyze the underlying causes of suspension of medical services and its harm to patients, and summarize the optimization of disease diagnosis and treatment during the COVID-19 outbreak. In further, they propose reasonable suggestions on safe medical management in general hospitals outside the epidemic area, in order to attract the attention of medical institutions and medical colleagues.

Objective:Since December 2019, novel coronavirus infection has occurred in Hubei province and spread throughout the country quickly. This new crown viral pneumonia was named as coronavirus disease of 2019 (COVID-19) by WHO. However, at present, there is a high incidence of acute aortic dissection in winter and spring. How to prevent the spread of the epidemic and choose the appropriate treatment is an important topic for the patients with acute aortic dissection.Methods:From January 16, 2020 to February 26, 2020, a total of 37 of acute aortic dissection operations were carried out in several cardiovascular surgery centers in Hubei Province. There were 18 cases of Stanford type A aortic dissection and 19 cases of Stanford type B aortic dissection. There were 10 cases (55.55%) with ascending aorta replacement and 7 cases (38.89%) with Bentall procedure for aortic root surgery, and total arch replacement with stented elephant trunk implantation were performed in 14 cases (77.8%). In 19 patients with Stanford type B aortic dissection, thoracic endovascular aortic repair was performed, with the left subclavian artery chimney technique in 2 cases.Results:No deaths occurred within 30 days of hospitalization. Preoperative nucleic acid testing excluded 7 cases of novel coronavirus infection, and 3 suspected cases underwent emergency surgery. the three-level protective standard was adopted in the majority of the surgeries(62.2%, 23/37), and 11 patients were negative in the reexamination of viral nucleic acid after the operation.Conclusion:During the epidemic period, patients with acute aortic dissection should be carefully identified with actife COVID-19 before surgery. The treatment principles-" prevention and control of pneumonia epidemic should be emphasized, conservative medical management should be taken in the comfirmed cases, the selective operation should be delayed as far as possible, and the operation should be reasonable performed in critical cases" should be followed, which can save patients' lives to the greatest extent and prevent the spread of the virus.

Hilar cholangiocarcinoma (HCCa) is a biliary malignancy that seriously affects the survival of patients.Radical resection is the only cure method for patients to achieve long-term survival.However,due to the low rate of radical resection,its prognosis is poor.In this article,surgical treatment strategies of HCCa in the precision surgery era,3D image evaluation in the curative resection,surgical procedure decision and the preservation of liver parenchyma in the hepatic resection are discussed combined with the research progress at home and abroad.

The 8th Japan-China Hepato-Pancreato-Biliary Symposium was held in Tokyo,Japan from 22nd to 23rd November 2018.The meeting was convened coincidently with the 80th Annual Congress of Japanese Surgical Association,which attracted the participation of Chinese and Japanese hepatobiliary and pancreatic surgeons.The symposium aimed to explore the latest achievements and clinical issues of diagnosis and treatment for hepato-pancreato-biliary diseases.In this article,authors reviewed the up-to-date research information in order to share the experience,achievements and new information in the field of hepatobiliary and pancreatic diseases with colleagues.

AIM: To study the roles of Toll-like receptor 4 ( TLR4 ) and TLR4 activator lipopolysaccharide ( LPS) in colonic inflammation recovery .METHODS:Normal intestinal epithelial cells were cultured with LPS in vitro. The subgroups of the intestinal epithelial cells with differential expression of TLR 4 ( low, normal and high ) were construc-ted by the technique of lentivirus transfection .The cells with normal and high expression of TLR 4 were induced by LPS for 0 h, 2 h and 4 h.Inflammatory cytokines TNF-α, IL-6 and IL-8 in the culture supernatant were detected by ELISA .The mRNA levels of TNF-α, IL-6, IL-8, IL-10 and IL-1βwere detected by qPCR .The cell mobility was also monitored by wound healing assay .RESULTS:The protein expression of TLR 4 was significantly higher after LPS treatment than that in control groups of both cells with TLR4 normal and high expression (P<0.05).The inflammatory cytokines TNF-α, IL-6, IL-8 and IL-1βat mRNA and protein levels were also significantly increased after LPS treatment compared with control group (P<0.05).The protein levels of TNF-α, IL-6 and IL-8 between the 2 groups were also different with statistical sig-nificance ( P<0.05 ) .Higher mobility was observed in the cells with TLR 4 high expression compared to control cells . CONCLUSION:LPS induction might play a role in the activation of TLR 4-mediated inflammatory pathways by up-regula-ting the expression of inflammatory cytokines at both transcriptional and translational levels .