Thawing plateau time indicating the duration of phase transition from ice to water is the strongest predictor for long-term durable pulmonary vein isolation after cryoablation for atrial fibrillation

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Helse Vest, Norway (LBS), and the Research Council of Norway (SYC).

Background

Cryoballoon ablation is an important method for pulmonary vein (PV) isolation in treatment of atrial fibrillation (AF). Previous studies have shown that thawing time, but not freezing time or temperature, impacts PV reconnection during long-term follow-up. However, it is unknown whether the entire or only part of the thawing stage plays a critical role.

Purposes

This study aimed to clarify the relationship between the durability of PV isolation and the time of phase transition from ice to water indicated by thawing plateau (TP) time during a cryoballoon ablation.

Methods

In this retrospective study, 241 PVs from 71 patients who underwent a repeat AF ablation 526 (IQR: 412, 675) days after a cryoballoon ablation were analyzed. The predictive value of procedural parameters for the durability of PV isolation were evaluated. Definitions of different phases of the temperature-time curve are shown in Figure 1. TP Time is defined as the time from 0 to 10°C inside the balloon in the thawing period (the plateau on the curve).

Results

Reconnection was observed in 101 (41.9%) PVs of 53 patients (74.6%). Durable PV isolation was associated with significantly longer TP Time compared with PV reconnection (26.0 vs. 11.0 s, P<0.001). The proportion of durable PV isolations increased with TP Time in a dose-proportional manner (Figure 2). The cut point for PV reconnection was TP Time <15 s with a positive predictive value of 82.1% (sensitivity=63.4%, specificity=90.0%) while for durable PV isolation the cut point was TP Time >25 s with a positive predictive value of 84.6% (sensitivity=55.0%, specificity=86.1%). After the analysis of multivariable logistic regression, location of PV (P<0.01), and TP Time (P<0.05) were shown as independent predictors for durable PV isolation. None of nadir temperature, initial cooling time, effective freezing time, initial thawing time, or late warming time was independent predictor. Accumulated TP Time for all PVs showed a positive linear correlation with the plasma level of troponin T (ρ=0.624, P<0.01).

Conclusions

TP Time is an independent predictor for the durability of PV isolation, and it presents in a dose-proportional manner. TP Time <15 s predicts long-term reconnection while TP Time >25 s predicts durable PV isolation.

[The role of ROS/TXNIP/NLRP3 pathway in the skin injury of trichloroethylene sensitized mice]

Objective: To explore the mechanism of reactive oxygen species/thioredoxin-interacting protein/nucleotide-binding oligomerization domain-like receptor 3 (ROS/TXNIP/NLRP3) pathway in the skin injury of trichloroethylene (TCE) sensitized mice. Methods: In August 2020, 40 female BALB/c mice were randomly divided into control group (n=5) , solvent control group (n=5) , TCE treatment group (n=15) and TCE+(2-(2, 2, 6, 6-Tetrameyhylpiperidin-1-oxyl-4-ylamino)-2-oxoethyl) triphenylphosphonium chloride (Mito TEMPO) treatment group (n=15) . The TCE sensitization model was established. Mice in the TCE treatment group and TCE+Mito TEMPO treatment group were divided into the sensitized positive group and the sensitized negative group according to the skin erythema and edema reactions on the back of the mice 24 h after the last stimulation. The mice were sacrificed 72 h after the last stimulation, the back skin of the mice was taken, and the skin lesions were observed. Immunohistochemistry (IHC) was used to detect the expression level of NLRP3, and the Western Blot was performed to detect the expression levels of NLRP3, apoptosis-associated speck-like protein containing a CARD (ASC) , cysteinyl aspartate specific proteinase 1 (Caspase 1) , Interleukin-1β (IL-1β) and TXNIP proteins in the skin of the mice, the reactive oxygen species (ROS) kit was used to detect the level of intracellular ROS in the back skin tissue. Results: The sensitization rates of TCE treatment group and TCE+Mito TEMPO treatment group were 40.0% (6/15) and 33.3% (5/15) , respectively, and there was no significant difference between the two groups (P>0.05) . The back skin of the mice in the TCE sensitized positive group was thickened and infiltrated by a large number of inflammatory cells. The number of mitochondria in the epidermis cells was significantly reduced, the mitochondrial crest disappeared and vacuolar degeneration occurred. TCE+Mito TEMPO sensitized positive group had less damage, more mitochondria and relatively normal cell structure. Compared with the solvent control group and corresponding sensitized negative groups, the expression levels of NLRP3, ASC, Caspase 1, IL-1β, TXNIP proteins and the content of ROS in the TCE sensitized positive group and TCE+Mito TEMPO sensitized positive group were significantly increased (P<0.05) . Compared with TCE sensitized positive group, the expression levels of NLRP3, ASC, Caspase 1, IL-1β, TXNIP proteins and the content of ROS in the TCE+Mito TEMPO sensitized positive group were significantly decreased (P<0.05) . Conclusion: ROS/TXNIP/NLRP3 pathway was activated and then encouraged the release of IL-1β, finally aggravated the TCE-induced skin injury.

[Non-erythrocyte blood products transfusion in very preterm and extremely preterm infants in Chinese neonatal intensive care units]

Objective: To describe the use of non-erythrocyte blood products transfusion in very preterm and extremely preterm infants in the neonatal intensive care units (NICU) of the Chinese Neonatal Network (CHNN) in 2019, to explore the disparity between different centers, and to further investigate the rationality and standardability of non-erythrocyte blood products transfusion. Methods: This was a cross-sectional study based on the CHNN cohort of very preterm and extremely preterm infants. All 6 598 infants with gestational age (GA)<32 weeks and admitted to the 57 NICU of CHNN within 24 h of life in 2019 were enrolled. Non-erythrocyte blood products included platelet, plasma, albumin, immunoglobulin, cryoprecipitate and prothrombin complex. Infants who received at least one type of non-erythrocyte blood products were defined in transfusion group. The comparison between infants with and without transfusion was done by t-test, rank-sum test or χ² test as appropriate. Linear regression model was used to generate adjusted transfusion rate of each center, and to investigate the correlation between adjusted rate and center-level characteristics. Results: A total of 6 598 infants were enrolled in the study, with gestational age of 30.0 (28.7, 31.0) weeks and birth weight of (1 353±312) g, and 43.6 % (2 877) of them were female. Among them, 42.7% (2 816) infants were enrolled in transfusion group, with the times of transfusion as 3 (1, 6) times. Compared to the infants without any transfusion of non-erythrocyte blood products, those infants received transfusion had lower gestational age (Z=17.62, P<0.01), lower birth weight (t=18.64, P<0.01), higher proportion of small-for-gestation age (χ²=31.06, P<0.01), multiple birth (χ²=12.82, P<0.01) and intensive resuscitation in delivery room (χ²=287.52, P<0.01), as well as lower proportion of females (χ²=10.68, P<0.01) and even lower proportion of infants born in this hospital (χ²=78.23, P<0.01). Among the entire study population, albumin (25.4%, 1 674 cases), immunoglobulin (21.5%, 1 417 cases) and plasma (18.9%, 1 245 cases) were the most commonly used non-erythrocyte blood products. Overall, 60.4% (544/901) infants with gestational age <28 weeks received transfusion 4 (2, 8) times. A total of 39.9% (2 272/5 697) infants between 28-31weeks received non-erythrocyte blood products 3 (1, 6) times. The non-erythrocyte blood products transfusion rates of critically-ill and non-critically-ill infants were 62.2% (1 693/2 723) and 29.0% (1 123/3 875) respectively, and the transfusion times were 4 (2,7) and 2 (1,4) times. The transfusion rates varied significantly among different NICU, and the disparities remained obvious after adjustment (adjusted χ²=153.48, P<0.01). Conclusion: Near half of very preterm and extremely preterm infants admitted to Chinese NICU in 2019 receive non-erythrocyte blood products during hospitalization with significant disparities among different hospitals.

[Multi-center real world study of the efficacy and safety of albumin-bound paclitaxel in the treatment of advanced breast cancer]

Objective: To observe the efficacy and safety of albumin-bound paclitaxel in the treatment of metastatic breast cancer. Methods: Multi-center data of patients who accepted single-drug albumin-bound paclitaxel or combination regimens from 2013 to 2019 were collected and the efficacy and safety were evaluated. Kaplan-Meier method was used for survival analysis, while Log-rank test was used to compare the survival rates. Results: A total of 203 advanced breast cancer cases were enrolled. The median progression-free survival time (PFS) lasted for 4 months, the median overall survival(OS)was 14 months, objective response rate (ORR) was 36.0% while the disease control rate (DCR) was 81.3%. The ORRs of Luminal, human epidermal growth factor receptor 2 (HER2) overexpression and triple-negative breast cancer patients underwent albumin-bound paclitaxel treatment were 37.3%, 45.5% and 31.0%, respectively, the DCRs were 85.5%, 68.2% and 78.9%, respectively. The OS of patients with relapse or metastasis who accepted less than two and more than two chemotherapy regimens were 22 months and 11 months (P<0.000 1), the ORRs were 44.9% vs 30.4%, DCRs were 87.2% vs 77.6% (P=0.018). The ORR and DCR of patients who accepted traditional paclitaxel treatment before the albumin-bound paclitaxel treatment were 35.8% and 82.1%, respectively. The common adverse reaction of these patients was numbness of limbs, which incidence rate was 64.5% (131/203), and 61.1% (124/203) were degree 1 to 2. Other adverse reactions including decreased white blood cells, which incidence rate was 56.1% (114/203); nausea and vomit, which incidence rate was 36.9% (75/203); anemia, which incidence rate was 21.2% (43/203); decreased platelet, which incidence rate was 18.7% (38/203); hepatic dysfunction, which incidence rate was 18.2% (37/203). Conclusions: Albumin-bound paclitaxel single or combination regimen is still significant efficient for various molecular subtypes of breast cancer patients or patients with traditional paclitaxel resistance or multi-line chemotherapy failure. Early usage has better prognosis, controllable adverse reaction and prominent clinical application value.

[Reoperation and perioperative management of residual cyst wall with perineal intractable sinus after resection of presacral cyst tumors]

Objective: To investigate the reoperation and perioperative management of residual cyst wall with perineal intractable sinus after resection of presacral cyst tumors. Methods: The clinical data of 29 patients with residual cyst wall and perineal intractable sinus after resection of presacral cyst tumors in Affiliated Cancer Hospital of Zhengzhou University from January 2014 to August 2019 were reviewed, including the characteristics of the residual cyst wall with perineal intractable sinus after resection of presacral cyst tumors, surgical method, and perioperative management. Results: Twenty-nine patients with residual cyst wall and perineal intractable sinus after resection of presacral cyst tumors, including 9 cases of epidermoid cysts, 7 cases of dermoid cysts, 10 cases of mature teratomas and 3 cases of malignant cysts (including malignant transformation of caudate cyst and teratoma); The 29 patients underwent posterior approaches for cyst resection in other hospital before, of whom 1 patient underwent posterior combined with transabdominal approach. All of thes patients underwent resection of residual presacral cyst wall and perineal intractable sinus in our hospital, of whom 25 patients underwent a transperineal approach through an arc-shaped incision anterior to the apex of the coccyx, and the other 4 patients underwent transperineal arc-shaped incision combined with transabdominal approach. All of the patients were cured without serious complications occurring, postoperative pathological and the magnetic resonance imaging diagnosis showed that the residual cyst wall and perineal intractable sinus were all completely removed. Conclusion: Appropriate surgical approache and perioperative treatment for the patients with residual cyst wall and perineal intractable sinus are very important to promote the resection of residual cyst wall and the healing of perineal intractable sinus.

[Research progress on the immunological pathogenesis of occupational medicamentosa-like dermatitis due to trichloroethylene]

Occupational exposure to trichloroethylene can induce a series of immune diseases which include systemic rash, multiple system and organ damage, which are defined as occupational medicamentosa-like dermatitis due to trichloroethylene (OMLDT) . This article reviews the research progress of the role of T cell immunity, humoral immunity and complement system in the immunological pathogenesis of OMLDT to provide theoretical basis for the diagnosis and treatment of OMLDT.

[Research advances on the regulation of interleukin-17 signal transduction and the implication of interleukin-17 in sepsis]

Sepsis remains a leading cause of death in critical patients. Both excessive inflammatory response and long-term immunosuppression can lead to the death of sepsis patients. As a key pro-inflammatory cytokine, interleukin-17 (IL-17) plays an important role in the body's inflammatory response and immune system. The signal transduction of IL-17 is a key link in maintaining the body's health and participating in the onset and development of sepsis. This review mainly summarizes and discusses the regulation of IL-17 signal transduction and pathogenic and protective role of IL-17 in sepsis.

Conophylline Suppresses Angiotensin II-Induced Myocardial Fibrosis In Vitro via the BMP4/JNK Pathway

We studied the effects and mechanisms of action of conophylline in different concentrations in the original in vitro model of myocardial fibrosis (treatment of cardiac fibroblasts isolated form the hearts of newborn rats with angiotensin II). Viability, collagen content, and expression of related protein in cardiac fibroblasts were assessed using the MTT-test, Sircol assay, and Western blotting, respectively. Conophylline markedly protected the cultured cells against the development of angiotensin II-induced fibrosis, which was seen from reduced viability of fibroblasts, decreased collagen content, and down-regulation of the expression of α-smooth muscle actin (α-SMA). Conophylline did not affect the TGF-β pathway altered by angiotensin II, but markedly decreased the level of bone morphogenetic protein-4 (BMP4) enhanced by angiotensin II and BMP4 itself. Conophylline produced no effect on phosphorylation of α-SMA and Smad homologue-1/5/8, the classic BMP4 downstream pathway elements, but reduced the level of c-Jun N-terminal kinase (JNK) elevated by BMP4. Conophylline did not inhibit the development of myocardial fibrosis in the presence of JNK activator anisomycin. Thus, conophylline inhibited angiotensin II-provoked myocardial fibrosis via the BMP4/JNK pathway.

[Clinical and pathological analysis of ocular adnexal diffuse large B-cell lymphoma]

Objective: To summarize the clinical and pathological characteristics of diffuse large B-cell lymphoma of ocular adnexal (OA-DLBCL). Methods: A retrospective case series study. Twenty-three cases of OA-DLBCL were collected in Tianjin Eye Hospital from January 2005 to December 2018. The clinical manifestations and imaging examination results were analyzed. The pathological characteristics and immune subtypes were analyzed with hematoxylin and eosin staining and immunohistochemistry. Eighteen patients completed the follow-up. Overall survival (OS) time was from the date of diagnosis to the date of death or the final follow-up (April 30, 2020). Clinical stages were analyzed by the Ann Arbor classification; Kaplan-Meier plots were used to visualize survival outcomes. The different risk groups were compared using Log-rank test. Results: There were 13 males and 10 females. The median age was 65 years (range, 43 to 82 years). Twenty-two patients had unilateral lymphoma (14 left eyes, 8 right eyes), and one patient had bilateral lymphoma. The OA-DLBCL was in the orbit in 14 patients, in the lacrimal gland in two patients, in both the lacrimal gland and the orbit in three patients, in both the lacrimal sac and the orbit in one patient, in the conjunctiva in one patient, in both the conjunctiva and the orbit in one patient, and in the skin of eyelids in one patient. Imaging examinations showed the tumors were of irregular soft tissue density. MRI showed the tumors were close to the extraocular muscles or ectocinerea. Centroblastic morphology was present in 21 specimens, and 2 specimens had immunoblastic morphology. Six patients were of germinal center B cell-like (GCB) type, and 17 were of non-GCB type. There were 2 patients with double expression of cellular-myelocytomatosis viral oncogene and B-cell lymphoma 2. The follow-up time ranged from 25 to 156 months, and the median follow-up time was 48 months. Five of them had primary OA-DLBCL, and 13 patients had secondary OA-DLBCL. Five patients were at the Ann Arbor clinical stage ⅠE, one was at stage ⅢE, and 12 were at stage ⅣE. During the follow-up, 8 patients survived, and 10 died. The 1-, 3-, and 5-year OS rates were 88.9%, 71.4% and 41.7%, respectively. Log-rank analysis indicated that the Ann Arbor clinical stage and age were related to the OS of OA-DLBCL (χ²=7.448, 8.804; both P<0.01). The gender, tumor size, molecular typing, Ki-67 index, and bone invasion were not related to the OS of OA-DLBCL (all P>0.05). Conclusions: OA-DLBCL mainly occurrs in the elderly population, unilaterally, and in the orbit. Most molecular types are non-GCB subtypes. The Ann Arbor clinical stage and age are associated with prognosis. (Chin J Ophthalmol, 2021, 57: 366-371).

[Childhood acute promyelocytic leukemia complicated with thrombosis: four cases and literatures review]

Objective: To investigate the clinical characteristics and prognosis of children with acute promyelocytic leukemia (APL) complicated with thrombosis. Methods: The clinical profiles of four APL patients complicated with thrombosis treated at the First Affiliated Hospital of Zhengzhou University between January 2012 and December 2019 were reviewed. Literature search and review covered the China national knowledge infrastructure, Wanfang database, China biology medicine disc and PubMed using the key words of "acute promyelocytic leukemia" and "thrombosis" up to June 2020. Results: Four patients included one male and three females with an age range of 4-13 years. In two patients, thrombosis occurred intracranially, both patients presented with seizure and hemiplegia. In one patient, thrombosis occurred in spleen, the patient presented with severe abdominal pain. In the last patient, thrombosis occurred in liver, the patient presented with abdominal pain, distension and ascites. Thrombosis occurred during the course of retinoic acid treatment in three patients, it occurred before the initiation of the treatment in one patient. Thrombosis was confirmed by imaging examination in all four patients. After thrombolytic and anticoagulation treatment, the vessels were recanalized and the symptoms were alleviated in 3 cases, the fourth patient died of hepatic venous thrombosis. Literature search identified no similar reports in Chinese journals, 11 case reports were found in English journals. In these 15 patients, 9 were male and 6 females with an age range of 3-16 years. Thrombus located in brain in 6 cases, in lower limbs for 3 cases, in liver for 3 cases, in spleen in 2 cases and in coronary artery for 1 case. In 10 cases thrombosis occurred before the induce treatment and in 5 cases occurred during the induction treatment. After surgery, thrombolytic and anticoagulation treatment vascular recanalization was observed in 10 patients, and in those patients, the symptoms were relieved, death occurred in 5 patients, including three patients with hepatic venous thrombosis. Conclusions: Thrombosis may occur before or during the treatment for APL. Both arterial and venous thrombosis may occur in patients with APL. Imaging examination is a reliable method for its diagnosis. After treatment, most patients had good prognosis with recanalization of blood vessels, but the mortality rate was high for patients with hepatic venous thrombosis.

LncRNA XIST promotes proliferation and cisplatin resistance of oral squamous cell carcinoma by downregulating miR-27b-3p

Chemotherapy resistance has become a major obstacle to effective treatment of human cancer. This study aimed to investigate the effect of lncRNA XIST on cell proliferation and cisplatin (CDDP) of oral squamous cell carcinoma (OSCC). RT-qPCR and Western blot analysis were used to detect mRNA and protein expression. CCK-8 and flow cytometry assays were explored to evaluate CDDP sensitivity in OSCC cells. The relationship between lncRNA XIST and miR-27b-3p was confirmed by luciferase reporter assay. The results showed that lncRNA XIST was upregulated in OSCC tissues, cell lines, and CDDP-resistant OSCC cells. Functionally, upregulation of lncRNA XIST promoted cell proliferation, enhanced CDDP resistance, and inhibited apoptosis in OSCC cells. In addition, lncRNA XIST acts as a molecular sponge for miR-27b-3p in OSCC. Downregulation of miR-27b-3p partially reversed the tumor suppression effect and CDDP chemosensitivity of XIST knockdown in CDDP-resistant OSCC cells. In conclusion, lncRNA XIST promotes cell proliferation and enhances resistance to CDDP in OSCC by downregulating miR-27b-3p.

[Clinical manifestations of Langerhans cell histiocytosis with multisystem involvement in 53 children]

Objective: To analyze the clinical characteristics and long-term outcome of Langerhans cell histiocytosis with multisystem involvement (MS-LCH) in children, and to evaluate the efficacy of modified DAL-HX83/90 protocol. Methods: This retrospective study included 53 patients with MS-LCH admitted to the Department of Pediatric Hematology and Oncology, First Affiliated Hospital of Zhengzhou University from January 2011 to May 2019. Modified DAL-HX83/90 protocol was used in all patients as an initial treatment. The patients were divided into the group with (RO+) or without (RO-) risk organ involvement. The RO+group was further divided into two groups, as RO+Ⅰ group (lung involvement only) and RO+Ⅱ group (extra-pulmonary, with or without lung involvement). The clinical characteristics and the long-term outcome were summarized. Event-free survival (EFS) and overall survival (OS) curves were analyzed with Kaplan-Meier method. Univariate and multivariate analysis of prognostic factors including age, sex, risk organ involvement and response to 6-week induction were analyzed with Log-Rank test and Cox proportional hazards models. Results: Among the 53 children with MS-LCH, 34 were male and 19 were female. The age of onset was 21 months (3 months-13 years). There 22 were in RO+group, with 12 in RO+Ⅰ group and 10 in RO+Ⅱ group, and 31 in RO-group. The follow-up period was 51 (12-144) months. The overall response rate of 6-week induction was 89% (47/53), and the recurrence rate was 30% (16/53). The 5-year EFS and OS were (67±6) % and (83±5) %, respectively. Univariate analysis showed that the 5-year EFS and OS of patients who responded well to 6-week induction chemotherapy were significantly higher than those who had no response ((76±6) % vs. 0, (88±4) % vs. (41±22) %, χ² = 34.743, 10.608, both P<0.05). The 5-year EFS and OS of RO-group were significantly higher than that of RO+group ((80±7) % vs. (49±10) %, (93±4) % vs. (70±10) %, χ²=6.022, 4.793, both P<0.05). And the 5-year EFS of RO+Ⅰ group was significantly higher than that of RO+Ⅱ group ((83±10) % vs. (10±9) %, χ²=9.501, P=0.002). While age and sex were not significantly associated with 5-year EFS and OS (all P>0.05). Cox proportional hazard regression model showed that response to 6-week induction chemotherapy was the independent risk factor for EFS (HR=13.114, 95%CI 3.759-45.742, P<0.01) and OS (HR=7.748, 95%CI 1.542-38.920, P=0.013). Conclusions: Most of the children without risk organ involvement treated with modified DAL-HX83/90 protocol could achieve long-term survival. However, the children involved liver, spleen, or hematopoietic system had a high risk of disease progression and recurrence.

Selection and implementation of single nucleotide polymorphism markers for parentage analysis in crossbred cattle population

Crossbreeding is an essential way of improving herd performance. However, frequent parentage record errors appear, which results in the lower accuracy of genetic parameter estimation and genetic evaluation. This study aims to build a single nucleotide polymorphism (SNP) panel with sufficient power for parentage testing in the crossbred population of Simmental and Holstein cattle. The direct sequencing technique in PCR products of pooling DNA along with matrix-assisted laser desorption/ionization time-of-flight MS method for genotyping the individuals was applied. A panel comprising 50 highly informative SNPs for parentage analysis was developed in the crossbred population. The average minor allele frequency for SNPs was 0.43, and the cumulative probability of exclusion for single-parent and both-parent inference met 0.99797 and 0.999999, respectively. The maker-set for parentage verification was then used in a group of 81 trios with aid of the likelihood-based parentage-assignment program of Cervus software. Reconfirmation with on-farm records showed that this 50-SNP system could provide sufficient and reliable information for parentage testing with the parental errors for mother-offspring and sire-offspring being 8.6 and 18.5%, respectively. In conclusion, a set of low-cost and efficient SNPs for the paternity testing in the Simmental and Holstein crossbred population are provided.

[Types and treatment of easily-missed, misdiagnosed intestinal obstruction after radical radiotherapy of cervical cancer]

Objective: To investigate the types and treatment methods of easily-missed, misdiagnosed intestinal obstruction after radical radiotherapy of cervical cancer. Methods: The clinical data of 21 patients with intestinal obstruction after radical radiotherapy of cervical cancer in our hospital from May 2013 to May 2019 were collected, including the radiation dose, obstruction symptoms, surgical methods and treatment outcomes. The types and treatment methods of intestinal obstruction after radical radiotherapy of cervical cancer were further investigated. Results: The intestinal obstruction occurred in 21 patients with cervical cancer after radical radiotherapy. All patients were initially diagnosed as rectal obstruction and underwent the transverse colostomy. The obstruction symptoms were successfully resolved in 15 patients while failed in other 6 patients who then underwent the re-operation. Four patients with rectal obstruction accompanied by middle or terminal ileum obstruction underwent ileostomy, the other 2 patients with terminal ileum obstruction underwent the transverse ileal anastomosis and partial intestines exclusion surgery. All of the obstruction symptoms were alleviated. Conclusions: Rectal is the major obstruction site of the cervical cancer patients with intestinal obstruction after radical radiotherapy. However, a possibility of obstruction at the middle or end of the ileum also exists. Therefore, it is very important to avoid misdiagnosis and conduct appropriate operative treatment according to the obstruction site.

[The value of "posterior approach, uncinate process priority, artery first" in laparoscopic pancreatoduodenectomy]

Objective: To explore the value of "posterior approach, uncinate process priority, artery first" in laparoscopic pancreatoduodenectomy. Methods: The clinical data of 200 patients who underwent laparoscopic pancreatoduodenectomy from January 2018 to April 2019 in the Second Department of Hepatobiliary and Pancreatic Surgery, the First Hospital of Jilin University were analyzed retrospectively. Meanwhile, the advantages of "posterior approach, uncinate process priority, artery first" were analyzed. Results: Two hundred patients were treated with "posterior approach, uncinate process priority, artery first". The average total operation time was (260.2±50.1) min, sample cutting time was (86.6±18.7) min, intraoperative bleeding volume was 50 (50-100) ml, average number of lymph node dissection was (19.2±7.4), and average hospitalization time was (17.9±9.9) days. Conclusion: The "posterior approach, uncinate process first, artery first" approach not only protects the variant hepatic artery, but also allows early detection of SMA, clarifies the positional relationship between the tumor and SMA, realizes R0 resection, and reduces the amount of bleeding during operation and shortens the operation time, which is safe and feasible in clinical setting.

[The value of serum glypican-3 level in aided diagnosis of patients with primary hepatocellular carcinoma]

Objective: To investigate the clinical value of glypican-3 (GPC3) detection in the diagnosis and therapy-monitoring of primary hepatocellular carcinoma (HCC). Methods: From March 2018 to May 2019, the patients with HCC were enrolled as the experimental group(n=166)from Fudan University Shanghai Cancer Centre, while the specimens from health control group(n=94) and benign control group (n=50) were analyzed. The serum of GPC3 and alpha fetoprotein (AFP)levels were respectively detected by ELISA and chemiluminescence. GPC3 detections combined with AFP etc. in accuracy of HCC diagnosis were explored by using Logistic regression analysis. Results: The serum GPC3 level in patients with HCC ［0.210 (0.048, 0.801)mg/L］ ［Median (quartile Q1, Q3)］ was significantly higher than those in healthy controls ［0.029(0.019, 0.052)mg/L］ and benign controls ［0.033(0.021, 0.043) mg/L］ (Z=-7.69, P<0.001).The serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and AFP were significantly different among the three groups (Z=-7.02, -6.85, -8.36 respectively, P<0.001). Among the serological indicators, it was related to ALT and AST (Z=-3.77, -4.09 respectively, P<0.001).The Cut-off level of GPC3 was determined as 0.077 mg/L by ROC curve. The sensitivity of the combined detection of serum GPC3 with AFP for HCC was up to 87.82%, the specificity was 77.86%, the negative predictive value was 84.29%, and the positive predictive value was 82.53%.The HCC-GPC3 model was constructed by using Logistic regression analysis. The area under the ROC curve was 0.882, the total sensitivity was 91.10%, and the total specificity was 72.73%. Further analysis showed that the serum GPC3 of patients with HCC was significantly lower ［0.454(0.019, 0.286) mg/L］ than that before surgery［0.608(0.039, 0.554）mg/L］(Z=-7.32, P<0.001). Conclusion: The detection of serum GPC3 can be applied to aid diagnosis and therapy-monitoring of HCC.The combination of GPC3 and AFP can improve the diagnostic efficiency of HCC.

[Retrospective analysis of curative effect of total pelvic organ resection and anal preservation in 20 patients with recurrence of cervical cancer after radical radiotherapy]

Objective: To explore the surgical method and effect of en bloc pelvic resection and anal preservation after radical radiotherapy for cervical cancer. Methods: Clinical data of 20 cervical cancer patients with central recurrence after radical radiotherapy underwent en bloc pelvic resection in the Tumor Hospital of Zhengzhou University and Hainan Provincial People's Hospital from January 2013 to December 2017 were retrospectively analyzed. The operative time, intraoperative blood loss, length of stay, postoperative anal function and postoperative complications were evaluated. Results: The median operation time of 20 patients with anal preservation after en bloc pelvic resection was 135.2 min, the median intraoperative blood loss was 680 ml, and the median hospitalization time was 16.5 days. Among them, 18 patients had good postoperative healing, and the anal function gradually returned to normal within 6 months after surgery, defecated 1~2 times per day.One patient showed incomplete adhesion between the external colon and the anus. One patient presented with pre-sacral infection. Postoperative pathology confirmed the recurrences in 20 patients, of which 11 cases were squamous cell carcinoma, 7 cases were adenocarcinoma, 2 cases were adenosquamous cell carcinoma. Conclusions: It is safe and reliable to preserve anus after en bloc pelvic resection for cervical cancer patients with radical radiotherapy. The anus function is good enough to improve the postoperative life quality of patients significantly.

[Effect of silent information regulator 1 on the LPS induced lncRNA expression of macrophages in mice]

Objective: To investigate the effect of Silent information regulator 1 (Sirt1) on the expression profile of long non-coding RNA (lncRNA) in macrophages upon lipopolysaccharide (LPS) treatment. Methods: Peritoneal macrophages (PM) were isolated from nine wild-type C57BL/6 male mice (wild-type group) and nine myeloid-specific Sirt1 knock-out mice (knock-out group). RNA samples were extracted from macrophages stimulated with 1 μg/ml LPS. Sequencing and the differentially expressed lncRNA were screened after the RNA was quantified. The threshold set for up-and down-regulated genes was a fold change (wild-type group/knock-out group) ≥2 and P≤0.05. Afterwards, gene ontology (GO) and pathway enrichment analysis were conducted and co-expression network map was constructed. Results: Four hundred and forty five lncRNA genes were differentially expressed (185 lncRNA genes were up-regulated and 260 lncRNA genes were down-regulated). Two hundred mRNA genes were differentially expressed (113 mRNA genes were up-regulated and 87 mRNA genes were down-regulated). It was found that the differentially expressed lncRNA genes and the predicted corresponding target genes were mainly distributed in the regions of biological processes of macrophage inflammatory response, macrophage chemotaxis and cell metabolism by GO and pathway enrichment analysis. Conclusion: lncRNA expression profile changes significantly in LPS induced macrophages isolated from Sirt1 knock out mice, which is closely related to the function of macrophages.

[Exploration of potential beneficial people of neoadjuvant chemotherapy based on clinical staging in gastric cancer: a single center retrospective study]

Objective: To evaluate the accuracy of the clinical staging by comparing preoperative clinical stage and pathological stage in gastric cancer patients, and to explore the potential beneficial population of neoadjuvant chemotherapy for gastric cancer. Methods: We retrospectively collected the clinical data of consecutive patients with gastric cancer who met the inclusion criteria (gastric adenocarcinoma, undergoing laparoscopic or open D2 radical operation, definite cTNM and pTNM) for admission of the Gastrointestinal Center of Peking University Cancer Hospital from July 2013 to April 2019. Patients with the number of harvested lymph nodes less than 16, history of gastric operation or preoperative radiochemotherapy were excluded. Preoperative clinical stage was obtained from abdominal and pelvic enhanced CT by radiologists, and postoperative pathological stage was derived from postoperative pathology reports. The concordance rate between preoperative clinical stage and postoperative pathological stage, and the proportion of pathological stage I in patients with specific preoperative clinical TNM stage were analyzed and compared. The potential beneficial population of neoadjuvant chemotherapy were considered as pI < 5%. Relationship between clinical features and concordance rate of stage was further analysed. Results: A total of 459 patients were included in the analysis, including 321 males and 138 females with mean age of 60 (23 to 85) years old. The concordance rate from T1 to T4 between preoperative clinical T staging and postoperative pathological T staging was 82.5% (33/40), 31.1% (28/90), 34.4% (62/180), and 55.0% (96/149), respectively. The concordance rate from N0 to N3 between preoperative clinical N staging and postoperative pathological N staging was 58.8% (134/228), 22.1% (19/86), 23.6% (26/110), and 54.3% (19/35), respectively. The sensitivity and specificity of abdominal enhanced CT in the diagnosis of lymph node metastasis were 64.5% (171/265) and 69.1% (134/194) respectively. The clinical stage of cT3/T4 patients with pathological stage I was 9.1% (30/329), and the sensitivity of corresponding pathological stage III was 94.8% (164/173), while the cT3/4+cN1-3 patients with pathological stage I stage was 1.4% (3/218), and the sensitivity of corresponding pathological phase III was 76.9% (133/173). Tumor location was associated with the concordance of cT/pT staging [gastroesophageal junction: 64 (56.6%), upper stomach: 9 (9/17), middle stomach: 31 (40.3%), lower stomach: 97 (39.9%), whole stomach: 4(4/9), χ(2)=9.845, P=0.043]; the degree of tumor differentiation was associated with the concordance of cN/pN staging [poorly differentiated: 94 (42.3%), moderated differentiated: 92 (41.1%), well differentiated: 12 (12/13), χ(2)=13.261, P=0.001], whose differences were statistically significant (all P<0.05). Conclusion: Based on a single-center retrospective data from Peking University Cancer Hospital, we think that the potential beneficial population of neoadjuvant chemotherapy for gastric cancer are those clinically staged as cT3/4+N1-3.

[The clinical values of neutrophil-to-lymphocyte ratio as an early predictor of anastomotic leak in postoperative rectal cancer patients]

Objective: To assess the clinical value of neutrophil-to-lymphocyte ratio (NLR) in predicting anastomotic leak of postoperative rectal cancer patients. Methods: The clinical data of 787 rectal cancer patients who underwent anterior resection from January 2014 to December 2017 in Affiliated Tumor Hospital of Zhengzhou University were collected. The postoperative numbers of white blood cell (WBS) on postoperative day (POD)1, 3 and 5 were detected, and the NLR was calculated. The relationship of NLR and the incidence of anastomotic leak was analyzed, and the area under the receiver-operating characteristic (ROC) curves was calculated. The accuracy of postoperative NLR in predicting the incidence of anastomotic leak was evaluated. Results: WBC counts of patients with leak on POD1, POD3 and POD5 were 13.2×10(9)/L, 9.1×10(9)/L and 8.9×10(9)/L, respectively, while those of patients without leak were 12.9×10(9)/L, 9.0×10(9)/L and 8.8×10(9)/L. The WBC count was not significantly different between patients with or without leak (P>0.05). The average NLR values of patients with or without leak were 13.3 and 11.6 on POD1, 10.9 and 7.6 on POD3, 9.3 and 5.3 on POD5, respectively. The NLR values of patients with leak on POD3 and POD5 were significantly higher than those of patients without leak (P<0.05). The cutoff value of NLR on POD3 was 8.6, the sensitivity and specificity of detecting the leakage was 73.2% and 75.6%, respectively, and the area under curve (AUC) was 0.744. The cutoff value of NLR on POD5 was 5.5, the sensitivity and specificity was 69.6% and 75.5%, the AUC was 0.726. The multivariate analysis result showed that NLR >8.6 was an independent factor for anastomotic leak prediction. Conclusion: Postoperative NLR on day 3 is useful in predicting anastomotic leak and can decrease the incidence of complication in rectal cancer patients who underwent anterior resection.

Effects of residual superdoses of phytase on growth performance, tibia mineralization, and relative organ weight in ducks fed phosphorus-deficient diets

This study was conducted to determine the effects of residual superdoses of phytase on growth performance, tibia mineralization, and relative organ weight in ducks fed phosphorus-deficient diets. In Exp. 1, 4 kinds of commercial phytase were used to determine retention rate of phyatse with the phytase C being the highest via both high water-bath temperature (90%) and pelleting (50%), followed by phytase A, B, and D. In Exp. 2, a total of 560 male ducks were blocked based on body weight, and then allocated randomly to 7 treatments (5 replicates with 16 birds per replicate). Treatments included a maize-soybean meal-based diet with recommended calcium and 4.0 g non-phytate phosphorus (nPP)/kg starter diet or 3.8 g nPP/kg grower diet (positive control; PC), an nPP-deficient diet with 1.3 g nPP/kg starter diet or 1.1 g nPP/kg grower diet (negative control; NC), NC diets with increasing levels of residual phytase C (500, 1,000, 2,000, 3,000, and 4,000 units/kg feed) after pelleting. Birds fed NC diets had lower (P < 0.05) average daily gain (ADG) and average daily feed intake (ADFI) throughout the experiment compared with those fed PC diet. Supplementing NC diet with increasing residual superdoses of phytase improved (P < 0.05) ADG and ADFI quadratically in the entire experiment, while reduced feed-to-gain ratio (P < 0.05) quadratically during day 0 to 14. On day 14 and 35, birds fed NC diet had lower (P < 0.05) tibia length, weight, ash, calcium, phosphorus, and manganese contents than those fed PC diet. Increasing residual superdoses of phytase in NC diet increased (P < 0.05) tibia weight and ash, calcium, phosphorus contents quadratically on day 14 and 35. NC treatment increased (P < 0.05) the duodenum, jejunum, ileum, and cecum index compared with other treatments on day 14 and 35. Taken together, feeding increasing residual superdoses of phytase could counteract or exceed the negative effects of NC diet on growth performance, tibia mineralization, and relative organ weight in ducks.

[Evaluation of postoperative complications registration status of gastric cancer by medical information: A single center feasibility study]

Objective: To explore the feasibility of assessing complications registration through medical information. Methods: A descriptive case series study was performed to retrospectively collect medical information and complication registration information of gastric cancer patients at Department of Gastrointestinal Cancer Center Ward I, Peking University Cancer Hospital from November 1, 2016 to March 1, 2017 (the first period), and from November 1, 2018 to March 1, 2019 (the second period). Case inclusion criteria: (1) adenocarcinoma confirmed by gastroscopy and biopsy; (2) patients undergoing open surgery or laparoscopic radical gastrectomy; (3) complete postoperative medical information and complication information. Patients who were directly transferred to ICU after surgery and underwent emergency surgery were excluded. Because difference of the complication registration procedure at our department existed before and after 2018, so the above two periods were selected to be used for analysis on enrolled patients. The prescription information during hospitalization, including nursing, medication, laboratory examination, transference, surgical advice, etc. were compared with the current Standard Operating Procedure (SOP, including preoperative routine examinations, inspection, perioperative preventive antibiotic use, postoperative observational tests, inspection, routine nutritional support, prophylactic anticoagulation, and prophylactic inhibition of pancreatic enzymes, etc.) for gastric cancer at our department. Medical order beyond SOP was defined as medical order variation. Postoperative complication was diagnosed using the Clavien-Dindo classification criteria, which was divided into I, II, IIIa, IIIb, IVa, IVb, and V. Medical order variation and complication registration information were compared between the two periods, including consistence between medical order variation and complication registration, missing report, underestimation or overestimation of medical order variation, and registration rate of medical order variation [registration rate = (total number of patients-number of missing report patients)/total number of patients], severe complications (Clavien-Dindo classification ≥ III), medical order variation deviating from SOP and the corresponding inferred grading of complication. The data was organized using Microsoft Office Excel 2010. Results: A total of 177 gastric cancer patients were included in the analysis. The first period group and the second period group comprised 89 and 88 cases, respectively. The registrated complication rate was 23.6% (21/89) and 36.4% (32/88), and the incidence of severe complication was 2.2% (2/89) and 4.5% (4/88) in the first and the second period, respectively. The complication rate inferred from medical order variation was 74.2% (66/89) and 78.4% (69/88), and the incidence of severe complication was 7.9% (7/89) and 4.5% (4/88) in the first and second period, respectively. In the first and second period, the proportions of medical order variation in accordance with registered complication were 36.0% and 45.5% respectively; the proportion of underestimation, overestimation and missing report were 5.6% and 4.5%, 4.5% and 4.5%, 53.9% and 45.5%, respectively; the registration rate of medical order variation was 46.1% and 54.5%; the number of case with grade I complications inferred from medical order variation was 34 (38.2%) and 25 (28.4%), respectively; and the number of grade II was 12 (13.5%) and 15 cases (17.0%), respectively. The reason of the missing report of medical order variation corresponding to grade I complication was mainly the single use of analgesic drugs outside SOP, accounting for 76.5% (26/34) and 64.0% (16/25) in the first and second period respectively, and that corresponding to grade II complication was mainly the use of non-prophylactic antibiotics, accounting for 9/12 cases and 5/15 cases, respectively. Conclusions: Medical information can evaluate the morbidity of complication feasibly and effectively. Attention should be paid to routine registration to avoid specific missing report.

[Analysis of herpes zoster incidence and hospitalization in three areas of Beijing in 2015 based on health information system of medical institutions]

Objective: Using data of health information system (HIS) of medical institutions to study the incidence and hospitalization of herpes zoster in three districts of Beijing. Methods: According to the different level of economic development and geographical features in Beijing, 3 districts of Xicheng, Changping and Miyun were chosen and all 110 medical institutions of the first level and above in the 3 districts are included in the survey. All the outpatient and inpatient herpes zoster cases in 2015 were retrospectively reviewed by HIS system. After distinguishing the reduplicated cases, Using the first outpatient case as a molecule and the resident population as denominator to estimate the annual incidence rate, as well as the annual hospitalization rate was estimated based on primary diagnostic hospitalized cases as molecule and the resident population as denominator. Results: A total of 32 313 primary visit outpatient cases were investigated, of which 18 360 cases (56.8%) were women and 20 923 cases (64.8%) were ≥50 years old. The overall estimated incidence of the 3 districts was 8.8‰ with an increase trends with age and reached to the highest in ≥80 years old (30.5/1 000). The incidence of Xicheng, Changping and Miyun districts are respectively 16.2‰, 4.0‰ and 5.7‰. A total of 701 primary visit inpatient cases were identified, of which 366 cases (52.2%) were women and 651 cases (92.9%) were ≥50 years old. The estimated annual hospitalization rate was 19.4/100 000, with the primary and secondary diagnostic hospitalization rate are respectively 5.9/100 000 (212 cases) and 13.5/100 000 (489 cases). The disease types of secondary diagnostic inpatient herpes zoster cases were as follows: cardiovascular disease (19.0%, 93 cases), stroke (14.5%, 71 cases), pneumonia/chronic obstructive pulmonary disease (14.1%, 69 cases), tumor (12.5%, 61 cases) and diabetes (5.7%, 28 cases). Conclusion: Most of the herpes zoster cases in Beijing are over 50 years old, and the incidence of female is slightly higher than male. This disease should become a public health issue of great concern.

[The effective mutation of epidermal growth factor receptor in synchronous multiple primary lung cancers: study of clinical, radiographic and pathological factors]

Objective: To investigate the clinical, pathological and CT features associated with the effective mutation of epidermal growth factor receptor (EGFR) in multiple primary lung cancers (MPLCs) , and to determine the target population of EGFR mutations tests. Methods: A total of 558 nodules from 232 patients with MPLCs who underwent surgery in the Cancer Hospital of Chinese Academy of Medical Sciences from August 2017 to December 2017 were selected. Two hundreds and sixteen nodules were detected by DNA direct sequencing. Chi-square test and Mann-Whitney U test were used to compare the clinical, pathological and CT features of 216 nodules in the EGFR effective mutation group and the non-effective mutation group. Logistic regression analysis was used to explore the independent risk factors of EGFR mutation. The cut off value was determined using the receiver operating characteristic(ROC) curve. Of 232 cases 558 nodules of surgically resected MPLCs, EGFR mutation of 216 nodules was determined by direct DNA sequencing. Results: There were 58 males and 174 females with MPLCs(male︰female=1︰3). There were 117 cases of age ≥59 years old and 115 cases of age <59 years old. There were 192 non-smokers, accounting for 82.8% of all patients. There were 2-7 nodules in the patient's lungs, of which 170 patients had two nodules in the lungs, 44 patients had 3 nodules, and another patient had 7 nodules. Among them, 216 nodules were detected by EGFR gene, 136 were effective mutations, and 80 were non-effective mutations (including wild type and null mutation). EGFR effective mutation group and non-effective mutation group were statistically significant in lung adenocarcinoma patients with different gender, age, smoking history, histological type, and differentiation degree (P=0.006, 0.002, 0.002, 0.015, 0.025).Among them, the effective mutation group were 107 females, 85 cases≥ 59 years old, 117 cases with no smoking history, 68 acinar-based, 89 moderate differentiation. In the count data, 127 nodule edges were lobed, and only 9 nodule edges were smooth. Among the measurement data, the GGO CT value was approximately (-459±147) HU in the EGFR mutation group, with statistical difference (P=0.037). The GGO diameter was approximately (11±9)mm,P=0.279.Multivariate Logistic regression analysis showed that GGO diameter (OR=0.873, 95%CI: 0.780-0.997; P=0.018) and smooth margins (OR=0.183,95%CI: 0.041-0.824; P=0.027) were independent protective factors of effective mutations of EGFR. Conclusions: In MPLCs, effective EGFR mutation is more common, and associated with elder female, age≥59 years, non-smoking, GGO attenuation <-548 HU, moderately differentiated, predominant invasive papillary adenocarcinoma. Patients with MPLCs and these risk factors may be encouraged to have postoperative EGFR molecular test.