OBJECTIVE: To investigate the clinicopathological characteristics of anorectal mucosal melanoma (ARMM), and to evaluate the prognostic factors. METHODS: A total of 68 primary ARMM surgical specimens from 2010 to 2018 were retrospectively studied. Slides were reviewed to evaluate pathological features. Slingluff staging method was used for staging. RESULTS: (1) Clinical features: The median age at diagnosis in this group was 61.5 years, with a male-to-female ratio 1 ∶1.62. The most common complaint was blooding (49 cases). For anatomic site, anorectum was the prevalent (66.2%), followed by rectum (20.6%). At the time of diagnosis, 28 cases were stage Ⅰ (localized stage, 41.2%), 25 cases were stage Ⅱ (regional lymph node metastasis, 36.8%), and 15 cases were stage Ⅲ (distant metastasis, 22.1%). Five patients underwent wide local excision, the rest abdominoperineal resection, and 48 patients received adjuvant therapy after surgery. (2) Pathological features: Grossly 88.2% of the tumors were exophytic polypoid masses, with the median tumor size 3.5 cm and the median tumor thickness 1.25 cm. Depth of invasion below lamina muscularis mucosae ranged from 0-5.00 cm (median 1.00 cm). The deepest site of tumor invasion reached muscular layer in 27 cases, and perirectal tissue in 16 cases. Melanin pigmentation was absent or not obvious in 67.6% of the cases. The predominant cytology was epithelioid (45 cases, 66.2%). The rate for ulceration, necrosis, lymphovascular invasion, and perineural invasion was 89.7%, 35.3%, 55.9%, and 30.9%, respectively. The median mitotic count was 18/mm². The positive rate of S100, HMB-45 and Melan-A were 92.0%, 92.6% and 98.0%, respectively. The median of Ki-67 was 50%. The incidences of mutations within CKIT, BRAF and NRAS genes were 17.0% (9 cases), 3.8% (2 cases) and 9.4% (5 cases), respectively. (3) Prognosis: Survival data were available in 66 patients, with a median follow-up of 17 months and a median survival time of 17.4 months. The 1-year, 2-year and 5-year overall survival rate was 76.8%, 36.8% and 17.2%, respectively. The rate of lymphatic metastasis at diagnosis was 56.3%. Forty-nine patients (84.5%) suffered from distant metastasis, and the most frequent metastatic site was liver. Univariate analysis revealed that tumor size (>3.5 cm), depth of invasion below lamina muscularis mucosae (>1.0 cm), necrosis, lymphovascular invasion, BRAF gene mutation, lack of adjuvant therapy after surgery, deep site of tumor invasion, and high stage at diagnosis were all poor prognostic factors for overall survival. Multivariate model showed that lymphovascular invasion and BRAF gene mutation were independent risk factors for lower overall survival, and high stage at diagnosis showed borderline negative correlation with overall survival. CONCLUSION The overall prognosis of ARMM is poor, and lymphovascular invasion and BRAF gene mutation are independent factors of poor prognosis. Slingluff staging suggests prognosis effectively, and detailed assessment of pathological features, clear staging and genetic testing should be carried out when possible. Depth of invasion below lamina muscularis mucosae of the tumor might be a better prognostic indicator than tumor thickness.
Humans ; Male ; Female ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Proto-Oncogene Proteins B-raf ; Prognosis ; Melanoma/surgery*

Diagnostic Errors ; Humans ; Intervertebral Disc Degeneration ; Intervertebral Disc Displacement/diagnostic imaging* ; Lumbar Vertebrae/diagnostic imaging* ; Lymphangioma/diagnostic imaging* ; Magnetic Resonance Imaging

OBJECTIVE: To systematically evaluate the efficacy and safety of conventional therapy combined with moxibustion in the treatment of chronic obstructive pulmonary disease (COPD) in stable phase based on Meta-analysis medicine. METHODS: The randomized controlled trials (RCTs) of moxibustion as adjuvant therapy for COPD were retrieved from the databases of CNKI, Wanfang, SinoMed, PubMed, Web of Science, Cochrane Library and Ebsco. RevMan5.3 software was used for Meta analysis, and the quality of evidence was evaluated according to GRADE standards. RESULTS: A total of 16 RCTs were included, involving 1425 patients. The results of Meta-analysis showed that: compared with the conventional treatment, ①the adjuvant therapy with moxibustion had advantages in reducing the number of acute exacerbations [ CONCLUSION The efficacy of moxibustion as adjuvant therapy for COPD in stable phase is better than that of simple conventional therapy. Due to insufficient clinical evidence and the limitations of this study, clinical safety is unclear and further evidence is needed to support the results.
Humans ; Lung ; Moxibustion ; Pulmonary Disease, Chronic Obstructive/therapy* ; Treatment Outcome

The metabolites of salvianolic acid A and salvianolic acid B in rats were analyzed and compared by ultra-high-perfor-mance liquid chromatography with linear ion trap-orbitrap mass spectrometry(UHPLC-LTQ-Orbitrap MS). After the rats were administrated by gavage, plasma at different time points and urine within 24 hours were collected to be treated by solid phase extraction(SPE), then they were gradient eluted by Acquity UPLC BEH C_(18) column(2.1 mm×100 mm, 1.7 μm) and 0.1% formic acid solution(A)-acetonitrile(B) mobile phase system, and finally all biological samples of rats were analyzed under negative ion scanning mode. By obtaining the accurate relative molecular mass and multi-level mass spectrometry information of metabolites, combined with the characteristic cleavage law of the reference standard and literature reports, a total of 30 metabolites, including salvianolic acid A and B, were identified. Among them, there were 24 metabolites derived from salvianolic acid A, with the main metabolic pathways including ester bond cleavage, dehydroxylation, decarboxylation, hydrogenation, methylation, hydroxylation, sulfonation, glucuronidation, and their multiple reactions. There were 15 metabolites of salvianolic acid B, and the main biotransformation pathways were five-membered ring cracking, ester bond cleavage, decarboxylation, dehydroxylation, hydrogenation, methylation, sulfonation, glucuronidation, and their compound reactions. In this study, the cross-metabolic profile of salvianolic acid A and B was elucidated completely, which would provide reference for further studies on the basis of pharmacodynamic substances and the exploration of pharmacological mechanism.
Animals ; Benzofurans ; Caffeic Acids ; Chromatography, High Pressure Liquid ; Lactates ; Mass Spectrometry ; Rats ; Technology

italic>Dendrobium officinale Kimura et Migo is a rare Chinese herbal medicine, while Dendrobium crepidatum Lindl is a local medicine in Yunnan, both of which have the function of nourishing yin and stomach. To reveal the differences in chemical composition between the two species, ultra-performance liquid chromatography-quadrupole-time of flight mass spectrometry (UPLC-Q-TOF-MS/MS) was used to analyze the chemical composition of stems and leaves of D. officinale and D. crepidatum. Principal component analysis (PCA) and partial least squares discriminant analysis (OPLS-DA) were used to determine the differences in metabolites between species and parts of Dendrobium. Fifty-eight chemical compounds were identified in the two species. Analysis indicated that the side ring of alkaloids connected with nitrogen was readily cleaved during analysis. The results of PCA analysis showed that the stems and leaves of D. officinale and D. crepidatum could be easily differentiated, and the chemical constituents of D. officinale and D. crepidatum were significantly different. OPLS-DA analysis showed that there were 16 metabolite differences between the stems and 22 differences in metabolites between the leaves of D. officinale and D. crepidatum. The main metabolite differences in components between the two Dendrobium species were dendrocrepidine B, dendrocrepidine C and dendrocrepine. There were 14 differences in metabolites between the stems and leaves of D. crepidatum. In conclusion, the chemical compositions of D. officinale and D. crepidatum are quite different; the small molecular compounds of D. officinale are mainly terpenoids and flavonoids, and the content of alkaloids is low. There is no significant difference between stem and leaf. In contrast, D. crepidatum is mainly composed of alkaloids and terpenoids, with crepidamine and dendrocrepine as its unique components, and there are great differences in the components between stems and leaves. This study provides a theoretical basis for the development and utilization of Dendrobium resources.

Antibodies, Neutralizing/immunology* ; Antibodies, Viral/immunology* ; COVID-19/virology* ; COVID-19 Vaccines/immunology* ; Humans ; SARS-CoV-2/pathogenicity* ; Spike Glycoprotein, Coronavirus/immunology* ; Vaccines, Inactivated/immunology*

OBJECTIVE: To assess the early clinical effects of oblique lateral lumbar interbody fusion (OLIF) combined with posterior long-segment internal fixation through O-arm CT navigation for the treatment of degenerative scoliosis. METHODS: The clinical data of 15 patients with degenerative scoliosis treated by OLIF combined with posterior long-segment internal fixation through O-arm CT navigation between April 2016 and December were retropectively analyzed. There were 3 males and 12 females, aged from 55 to 73 years old with an average of (62.2±5.3) years. The operation time, intraoperation blood loss, the rate of excellentand good of pedicle screw placement, and complications were recorded. Before surgery, 1 week after surgery and at the final follow-up, the visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the patients' clinical symptoms;standing X-ray film, lumbar spine CT examination was performed at 6 months after surgery to observe coronal scoliosis Cobb angle, lumbar lordosis (LL), intervertebral space height, sagittal vertical axis (SVA), intervertebral fusion, etc. RESULTS: The mean operation time and intraoperative blood loss were respectively (98.7±16.8) min and (50.2±10.7) ml in OLIF surgery, while were (101.5±23.4) min and (63.1±19.7) ml in the surgery of posterior long segment internal fixation. The total mean operation time and intraoperative blood loss were (200.2±40.2) min and (113.3±30.4) ml. All patients were followed from 12 to 25 months with an average of (16.5±5.3) months. Low back pain VAS, lower limb pain VAS and ODI reduced from preoperative (6.8±1.6), (6.2±1.1) scores and (64.6±10.4)% to (1.4±1.0), (1.0±0.5) scores, and (15.8±4.5)% at the final follow-up, the differences were statistically significant(<0.05). Coronal scoliosis Cobb angle and SVA decreased from preoperative (20.3±13.5)°, (42.3±16.5) mm to (5.5±3.1)°, (25.1±10.9) mm at the final follow-up, and the differences were statistically significant (<0.05). LL and intervertebral space height increased from preoperative (25.8±8.2)°, (5.9±2.7) mm to (39.3±9.1)°, (10.9±1.2) at the final follow-up, and the differences were statistically significant(<0.05). Total 240 nails were placed through O-arm CT navigation with the rate of excellent and good of 96%(230/240). Six months after operation, CT of lumbar spine showed interbody fusion of bone. One patient developed anterior medial pain in the left thigh, and two patients experienced transient lefthip flexion after surgery, both of whom recovered during subsequent follow-up. CONCLUSION The early clinical effect of oblique lateral lumbar interbody fusion combined with posterior long segment internal fixation through O-arm CT navigation is satisfactory in treatment of degenerative scoliosis. It has the advantages of minimal invasion, accurate navigation of nail placement, high bone fusion rate and few complications. It can provide new options for minimally invasive treatment of degenerative scoliosis.
Aged ; Female ; Humans ; Imaging, Three-Dimensional ; Lumbar Vertebrae ; Male ; Middle Aged ; Retrospective Studies ; Scoliosis ; Spinal Fusion ; Surgery, Computer-Assisted ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVE: To explore the safety and effectivity of ultrasonic bone knife in osteotomy of degenerative kyphosis. METHODS: The clinical data of 32 patients with degenerative kyphosis treated from February 2014 to May 2016 were retrospectively analyzed. There were 12 males and 20 females, aged 50 to 71 years with an average of (62.1±12.3) years. Preoperative Cobb angle was 25.3° to 36.7° with an average of (28.6±10.2) °. All patients underwent multi-segment Ponte osteotomy combined with posterior long segmental internal fixation. According to different osteotomy tools, the patients were divided into traditional tool group (group A, 18 cases) and ultrasonic bone knife group (group B, 14 cases). The operation time, laminectomy time, number of osteotomy segments, intraoperative blood loss, postoperative drainage, hospitalization time and postoperative complications were recorded.Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate clinical outcomes before and 1 month after surgery. RESULTS: All the patients were followed up from 8 to 24 months with an average of 16.4 months. There were no significant differences in operative time and hospitalization time between two groups (>0.05). Intraoperative single laminectomy time of group A was more than that of group B (<0.05). The number of osteotomy segments in group A was less than that in group B (<0.05). Intraoperative blood loss and postoperative drainage in group A were more than that in group B (<0.05). There were no significant differences in VAS and ODI between two groups (>0.05). There were no dural, nerve and spinal cord injuries in both groups, and there were no complications such as improper operation of the instrument and nonunion of the osteotomy. CONCLUSION The use of ultrasonic bone knife for Ponte osteotomy is safe and effective. It can effectively save the time of single laminectomy while reducing the amount of intraoperative blood loss and postoperative drainage. The safety and clinical efficacy of ultrasonic bone knife are no less than traditional tools.

OBJECTIVE: To investigate the clinical outcome of single or double-segment pedicle subtraction osteotomy (PSO) for the treatment of old thoracolumbar osteoporotic compression fractures with kyphosis. METHODS: The clinical data of 26 patients with old thoracolumbar osteoporotic compression fractures with kyphosis who underwent surgery from January 2015 to June 2017 were retrospectively analyzed. There were 12 males and 14 females, aged from 58 to 72 years old with an average of 65.6 years. The time interval from fracture to surgery was (8.2±1.5) years. According to different surgical methods, the patients were divided into single-segment PSO group (group A) and double-segment PSO group(groupB). The perioperative data, preoperative and postoperative imaging data and postoperative complications were recorded, and the Oswestry Disability Index (ODI) and visual analogue scale (VAS) were used before and after surgery to evaluate the clinical effect. RESULTS: All patients were followed up for 6-24 months with an average of 14.5 months. There was a statistically significant difference in operation time and intraoperative blood loss between the two groups (<0.05). There was no significant difference in total drainage volume and length of hospital stay (>0.05). The postoperative correction angle of the single segment PSO group was (33.3± 9.4) ° with the correction rate of 85.3% and the double segment PSO group was (41.0±13.5) ° with the correction rate of 92.7%, and there was statistical significance between two groups (<0.05). There were no significant differences in postoperative lumbar lordosis (LL), sagittal vertical axis (SVA), and ODI, VAS between two groups (>0.05). One case of cone injury occurred in the single-segment PSO group and recovered after treatment. There were no complications of spinal cord injury in the double segment group. Loose screws occurred during surgery in three patients in the single-segment PSO group and one patient in the double-segment PSO group (<0.05). All 4 patients were re inserted with screws after using bone cement to reinforce the nail pathway. There were no complications such as anterior spinal vascular and nerve damage or osteotomy unfusion. CONCLUSION Both single-segment PSO and double-segment PSO can achieve good orthopedic and clinical effects in the treatment of old thoracolumbar osteoporotic fractures with kyphosis. For patients with correction angles greater than 40° , the double-segment PSO provides a better correction angle and is safer, but it is with longer operation time and more intraoperative bleeding.
Aged ; Female ; Humans ; Kyphosis ; Lumbar Vertebrae ; Male ; Middle Aged ; Osteoporotic Fractures ; surgery ; Osteotomy ; Retrospective Studies ; Thoracic Vertebrae ; Treatment Outcome

A method of ultra-high performance liquid chromatography coupled with quadrupole/electrostatic field Obitrap high-resolution mass spectrometry(UHPLC-Q-Exactive MS) was established to comprehensively identify the metabolites of carnosic acid in rats. After oral gavage of carnosic acid CMC-Na suspension in rats, urine, plasma and feces samples were collected and pretreated by solid phase extraction(SPE). Acquity UPLC BEH C_(18 )column(2.1 mm×100 mm, 1.7 μm) was used with 0.1% formic acid solution(A)-acetonitrile(B) as the mobile phase for the gradient elution. Biological samples were analyzed by quadrupole/electrostatic field Obitrap high-resolution mass spectrometry in positive and negative ion mode. Based on the accurate molecular mass, fragment ion information, and related literature reports, a total of 28 compounds(including carnosic acid) were finally identified in rat samples. As a result, the main metabolic pathways of carnosic acid in rats are oxidation, hydroxylation, methylation, glucuronide conjugation, sulfate conjugation, S-cysteine conjugation, glutathione conjugation, demethylation, decarbonylation and their composite reactions. The study showed that the metabolism of carnosic acid in rats could be efficiently and comprehensively clarified by using UHPLC-Q-Exactive MS, providing a reference for clarifying the material basis and metabolic mechanism of carnosic acid.
Abietanes ; Animals ; Chromatography, High Pressure Liquid ; Mass Spectrometry ; Rats ; Solid Phase Extraction