[Impact of previous cesarean delivery on pregnancy outcomes of in vitro fertilization and frozen-thawed embryo transfer]

Objective: To investigate the impact of a previous cesarean delivery on pregnancy outcomes of in vitro fertilization and frozen-thawed embryo transfer (FET). Methods: The clinical data of 1 179 patients who received in vitro fertilization and FET in Tianjin Central Hospital of Gynecology Obstetrics from January 2014 to May 2019 and had a history of the previous delivery were retrospectively analyzed. The patients were divided into four groups according to different previous delivery history and the number of embryo transferred: group A (single embryo transfer group with cesarean delivery history, n=338), group B (single embryo transfer group with vaginal delivery history, n=78), group C (double embryo transfer group with cesarean delivery history, n=444), and group D (double embryo transfer group with vaginal delivery history, n=319). The 1∶1 propensity score based on age, body mass index (BMI), infertility duration, basal FSH, basal LH, number of oocytes retrieved and high-quality embryo rate was used to match group A and B (caliper value=0.15), group C and D (caliper value=0.05), and group A and C (caliper value=0.01) respectively to reduce the influence of selection bias. The clinical pregnancy outcomes of patients were compared. Results: (1) Group A and group B were single embryo transfer groups with a total of 77 pairs of matched patients. There were no statistically significant differences in clinical pregnancy rate [42.9% (33/77) vs 45.5% (35/77)], miscarriage rate, preterm birth rate, and neonatal birth weight (all P>0.05). (2) Group C and group D were double embryo transfer groups with a total of 304 pairs of matched patients. The clinical pregnancy rate [42.4% (129/304)] and twin pregnancy rate [9.5% (29/304)] of Group C were significantly lower than those of Group D [53.0% (161/304), 15.5% (47/304) respectively; both P<0.05). There were no statistically significant in miscarriage rate, preterm birth rate and neonatal birth weight between the two groups (all P>0.05). (3) Groups A and C matched 318 pairs of patients. The two groups had no statistical significances in clinical pregnancy rate [38.4% (122/318) vs 45.6% (145/318)], miscarriage rate and preterm birth rate (all P>0.05), but the twin pregnancy rate in group C was significantly higher than that of group A [11.3% (36/318) vs 0.3% (1/318), P<0.01). (4) The occurrence of the low-birth-weight infant were related to gestational age (OR=0.41, 95%CI: 0.32-0.54) and twin pregnancy (OR=4.44, 95%CI: 1.93-10.21), and the occurrence of macrosomia was related to BMI (OR=1.18, 95%CI: 1.06-1.32). Moreover, the previous delivery method was not related to the neonatal birth weight (P>0.05). Conclusions: Patients with different delivery histories receive FET therapy, the pregnancy outcomes of single embryo transfer are not significantly different, and the success rate of double embryo transfer in patients with a cesarean delivery history is low. The neonatal birth weight is not related to the history of the cesarean section. It is recommended that patients with a cesarean delivery history choose elective single embryo transfer to ensure the success rate and to reduce the risk.

Protective effects of miRNA-589 on cerebral ischemia-reperfusion injury

To uncover the potential influence of microRNA-589 (miRNA-589) on cerebral ischemia-reperfusion injury (IRI) and the underlying mechanism, BV2 cells were stimulated by lipopolysaccharide (LPS) or conditioned medium (CM) of primary cortical neurons undergoing oxygen-glucose deprivation (OGD). Regulatory effects of miRNA-589 on the release of inflammatory factors in BV2 cells induced with LPS or CM of primary cortical neurons undergoing OGD were detected by quantitative real-time polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA). The interaction between miRNA-589 and TRAF6 was finally assessed by dual-luciferase reporter gene assay. MiRNA-589 was downregulated in BV2 cells induced with LPS or CM of primary cortical neurons undergoing OGD. Overexpression of miRNA-589 reduced the release of inflammatory factors in LPS or CM-induced BV2 cells. TRAF6 was verified to be the downstream gene of miRNA-589, and its level was negatively regulated by miRNA-589. MiRNA-589 is downregulated following cerebral IRI and alleviates inflammatory response through negatively regulating TRAF6.

[Progress in study on intervention of silica-induced pulmonary fibrosis with the exosomes released from mesenchymal stem cells]

Pneumoconiosis is an occupational disease which seriously endangers the health of workers exposed to dust. Silica is regarded as the most serious cause of pneumoconiosis because it can cause diffuse pulmonary fibrosis in workers' lung tissue. Mesenchymal stem cells (MSCs) are adult stem cells with multiple differentiation potential. As member of extracellular vesicles family, exosomes can be secreted from MSCs to regulate and intervene tumorigenesis, cardiovascular disease, immune system disorder and tissue damage disease. This article reviews the experimental results in the field of intervention of MSCs and its exosomes in silicosis research in recent years, which plays an important role in indicating direction in the future research on the mechanism and function of MSCs exosomes in the therapy of silica-induced pulmonary fibrosis.

[Establishment and primary clinical application of metabolic evaluation database of urolithiasis]

Objective: To establish the metabolic evaluation database of urolithiasis, perform metabolic evaluation, and provide instructions for treatment and prevention of urolithiasis. Methods: This metabolic evaluation database was developed by JAVA and was established by Oracle11g database and Browser/Server framework. We extracted the clinical data of all patients who had complete information, and analyzed their risk factors of stone formation, stone-related medical history, blood and urine tests results and 24-hour urine analysis. Results: A total of 360 patients diagnosed as urolithiasis were included in this research. Male to female ratio was 1.9∶1, and the urolithiasis was first diagnosed at (35.5±13.5) years old. Family history was positive in 39.7% of patients. Metabolic syndrome occurred in 35.0% of patients. Overweight or obesity occurred in 73.2% and 50.0% of male patients, respectively. Abdominal obesity in 62.3% and 56.1% of male and female patients, respectively. Among all patients, 67.5% had high urine sodium, 53.6% had hypercalciuria, 41.1% had hypocitraturia, 29.7% had hyperuricosuria, 22.5% had hypomagnesuria, 15.8% had hyperoxaluria, 11.7% had hyperphosphoraturia, and 36.4% had low urinary volume. Conclusions: The prevalence of overweight or obesity, abdominal obesity, hypertension, diabetes, and metabolic syndrome in stone patients were significantly higher than those in general population. The number of 24-hour urinary abnormalities was positively associated with body mass index. The interventions on high urinary sodium, low urinary volume, obesity and metabolic syndrome were important to the treatment of urolithiasis. This database would facilitate the metabolic evaluation, provide evidence for the treatment and prevention of urolithiasis, and lay foundation for finding important controllable risk factors of urinary stone.

[Application of external diaphragm pacemaker combination with high-flow nasal cannula in offline patients with postoperative severe cerebral hemorrhage]

Objective: To investigate the offline clinical effect of external diaphragm pacemaker (EDP) combination with High-flow nasal cannula oxygen therapy in postoperative severe cerebral hemorrhage patients. Methods: A total of 123 severe postoperative severe cerebral hemorrhage patients with tracheotomy and mechanical ventilation (MV) were selected, who were admitted in NICU of PLA Rocket Force Characteristic Medical Center from October 2016 to December 2019. These patients were randomly divided into the High-flow nasal cannula (HFNC) group (n=63) and HFNC+EDP group (n=60). In the HFNC group, the HFNC was given to the patients who were off ventilator. The HFNC+EDP group was added on the basis of treatment in the HFNC group, once a day and 30 minutes each time. Results: Compared to the HFNC group, the oxygenation index (OI) of the HFNC+EDP group was higher in the next 1, 12, 24 and 48 hour [(209±15) mmHg vs (218±18) mmHg, (215±14) mmHg vs (222±17) mmHg, (223±13) mmHg vs (235±15) mmHg, (236±7) mmHg vs (257±12) mmHg,P<0.05]. The offline time was shorter [(13±3) d vs (12±3) d,P<0.05]. The excursion of diaphragm was higher [(1.94±0.08) cm vs (2.91±0.11) cm,P<0.05]. The length of stay in NICU was shorter [(33±14) d vs (28±9) d,P<0.05]. The Glasgow Coma Scale (GCS) was higher when being discharged from the NICU (5.9±2.1 vs 7.8±0.4, P<0.05) and the hospital (9.9±2.1 vs 11.0±2.0, P<0.05). Conclusions: EDP combination with HFNC can increase the excursion of diaphragm, shorten the offline time and length of stay in the NICU, thereby enhancing the early recovery and improving the prognosis.

[Attaches the great importance of routine biopsy in vertebral augmentation]

Vertebral compression fractures(VCFs) are severe and common complications of osteoporosis. Most VCFs were caused by osteopenia or osteoporosis. Nevertheless, spinal metastases probably result in pathological fractures that easily confused with osteoporotic vertebral compression fractures(OVCFs). Using biopsy during vertebral augmentation(VA) is considered as the golden standard protocol to rule out pathological VCFs. Up to data, conventionally using biopsy during VA is suggested by more and more researchers to confirm the etiology of VCFs and to avoid missed diagnosis and misdiagnosis of spinal metastases with pathological vertebral fractures as the first manifestation. For patients with spinal metastases, histological evaluation of vertebral biopsy specimens is convenient for further treatment.

[Effect of consolidation before allogeneic hematopoietic stem cell transplantation for non-favorable acute myeloid leukemia patients with first complete remisson and negative minimal residual disease]

目的

探讨异基因造血干细胞移植（allo-HSCT）前巩固化疗对第1次形态学完全缓解且微小残留病阴性（CR₁/MRD⁻）中/高危急性髓系白血病（AML）患者预后的影响。

方法

对2010年1月至2019年3月在CR₁/MRD⁻状态下接受allo-HSCT的155例中/高危AML（不含急性早幼粒细胞白血病）患者进行回顾性分析。

结果

全部155例患者中，102例获得CR₁/MRD⁻后接受移植前巩固化疗（巩固组），53例获得CR₁/MRD⁻后直接行allo-HSCT（非巩固组），两组中位年龄分别为39（18~56）岁、38（19~67）岁。巩固组、非巩固组移植后5年总生存率分别为（59.3±7.5）%、（62.2±6.9）%（P=0.919），无复发生存率分别为（53.0±8.9）%、（61.6±7.0）%（P=0.936），累积复发率分别为（21.9±5.4）%、（18.3±6.0）%（P=0.942），非复发死亡率分别为（22.4±4.3）%、（28.4±6.5）%（P=0.464）。多因素分析显示，移植前是否接受巩固化疗及其疗程（<2个/≥2个）对预后无显著影响。

结论

中/高危AML患者可在获得CR₁/MRD⁻后直接进行allo-HSCT。

[The diagnostic value of tremor analysis for defining the Parkinson's disease subtype]

Objective: To find more objective evidence and support for clinical classification of Parkinson's disease by means of tremor analysis in patients with early confirmed Parkinson's disease. Methods: A cross-sectional study was conducted to collect 65 patients with early Parkinson's disease treated in the Third Hospital of Peking University from January 2015 to December 2016. Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn-Yahr scale (H-Y scale), Mini-mental state examination (MMSE), Hamilton depression scale (HAMD) were recorded in all patients. According to the ratio of UPDRS rigidity score to tremor score, the patients were divided into tremor dominant (TD), postural instability/gait difficulty (PIGD) and mixed types. All patients were examined by tremor analysis and the results were analyzed and compared. Results: Among the 65 patients, the mean age of onset was (63±10) years, the course of disease was (14±8) months. Twenty-one patients were classified to TD group, 28 patients were classified to PIGD type, and 16 patients with mixed type. There was no significant difference in frequency and amplitude of tremor between the three groups (P>0.05), but the proportion of alternating contraction and harmonic resonance of active and antagonistic muscles in TD group was significantly higher (P<0.05). Twenty patients (71.4%) in TD group showed typical Parkinson's disease manifestations in tremor analysis. Only four patients (14.3%) in PIGD group showed the typical manifestations. More patients in PIGD group showed no clear main peak of tremor at rest. Some patients showed 6-8 Hz/sec peak frequency in posture position and simultaneous contraction of the active and antagonist muscles. These two manifestations occured simultaneously in mixed type patients, including 10 cases (62.5%) with typical Parkinson's disease manifestations. Conclusion: As an objective electrophysiological method to evaluate tremor type, tremor analysis can be used as an important assistant method for clinical classification of Parkinson's disease. It can provide information of the pathway of pathological loss in different types and give important hints in prognosis and treatment.

[Effect of the number of previous spontaneous abortions on the first in vitro fertilization cycle]

Objective: To investigate the effect of the number of previous spontaneous abortions on the first in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycle. Methods: A retrospective case-control study was conducted to analyze the clinical data of 1 279 patients who received IVF/ICSI treatment for the first time from July 2014 to July 2018 in Tianjin Central Hospital of Gynecology Obstetrics;they were divided into 0 time group (group A, n=924), 1 time group (group B, n=267) and 2 times group (group C, n=88) for comparison, according to the previous frequency of spontaneous abortions. Results: There were no statistically significant differences in age, basal testosterone, estradiol, progesterone, prolactin and embryo quality in group A, B and C (all P>0.05). The biochemical pregnancy rate of group C (9.1%) was higher than those of the other two groups (4.1% and 4.1%; all P>0.05). The clinical pregnancy rate of group A (42.5%) [>group B (40.4%) and >group C (35.2%)] was not statistically significant(P>0.05).Early abortion rate in group A (8.9%) was<group B (15.7%), also <group C (38.7%), there were significant differences (all P<0.05).The live birth rate of group C (21.6%) was significantly lower than that of group A (35.5%; P<0.05), but the difference between group C and group B (30.7%) was not statistically significant (P>0.05). Conclusions: Women with a history of one- or two-time spontaneous abortion have no obvious effect on embryo quality, and have a negative impact of clinical pregnancy rate, early abortion rate, live birth rate in the first IVF/ICSI cycle; especially for patients with a history of two times spontaneous abortion, early abortion rate has a significant increase, live birth rate decreases significantly, suggesting that patients with a history of two times of spontaneous abortion should find the causes of miscarriage according to the process of recurrent spontaneous miscarriage and receive treatment if necessary before subsequent pregnancy.

Hemodynamic Analysis of Postoperative Rupture of Unruptured Intracranial Aneurysms after Placement of Flow-Diverting Stents: A Matched Case-Control Study

BACKGROUND AND PURPOSE

Postoperative rupture of intracranial aneurysm has been reported as a fatal complication after flow-diverter placement. We assessed several hemodynamic variables to explore risk factors in the postoperative rupture process.

MATERIALS AND METHODS

We enrolled 10 patients with intracranial aneurysms, treated with flow diverters between September 2014 and December 2018, who experienced postoperative aneurysm rupture (postoperative aneurysm rupture group). We matched these subjects 1:2 with 20 patients with postoperative unruptured (postoperative unruptured group) intracranial aneurysms based on clinical and morphologic factors. Using computational fluid dynamics, we assessed hemodynamic changes pre- and posttreatment between the 2 groups on a number of qualitative and quantitative parameters.

RESULTS

In the postoperative aneurysm rupture group, the proportion of patients with aneurysms with an unstable flow pattern increased to 60.0% after treatment, while the proportion in the postoperative unruptured group decreased to 20.0%, a significant difference between the 2 groups (P = .028). Energy loss in the postoperative unruptured group decreased after treatment but increased in the postoperative aneurysm rupture group. The reduction ratio of energy loss showed a significant difference between the 2 groups (22.73% ± 53.59% for postoperative unruptured versus -158.81% ± 183.95% for postoperative aneurysm rupture, P = .02). Other parameters and changes of pre- and posttreatment hemodynamic parameters showed no significant difference between 2 groups.

CONCLUSIONS

Compared with pretreatment, unstable flow pattern and higher energy loss after Pipeline Embolization Device placement for intracranial aneurysm may be the important hemodynamic risk factors related to delayed aneurysm rupture.

[Changes of surgical interventions on necrotizing pancreatitis]

Objective: To investigate the changes of surgical invitations on necrotizing pancreatitis in recent 14 years by reviewing single center data. Methods: One thousand and eighty patients with necrotizing pancreatitis who received surgical invitation were involved in the study.All the patients were treated at Department of Pancreatic Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2005 to December 2018. Six hundred and seventy-eight were males and 402 were females. The median (range) age of the study patients was 45 (20-76) years.The etiology of the disease was related to cholelithiasis in 335 cases(31.02%), hyperlipemia in 302 cases(27.96%), alcohol in 226 cases(20.93%), endoscopic retrograde cholangiopancreatography in 28 cases(2.59%), pregnancy in 50 cases(4.63%), idiopathic factors in 72 cases(6.67%) and other causes in 67 cases(6.20%). The patients were divided into two groups according to the time of admission. Group 1 included 1 475 patients that admitted from January 2005 to December 2010, and group 2 included 1 539 patients that admitted from January 2011 to December 2018. The surgical interventions, morbidity and mortality of the two group were compared, and χ(2) test was used for the statistical test. Results: Two hundred and sixty-six among the 1 080 cases were treated with drainage procedures because of the pseudocyst.One hundred and seventy-five drainage procedures were performed between January 2005 and December 2018, which account for 11.87%(175 /1 475) of all patients of necrotizing pancreatitis; 91 drainage procedures were performed between January 2011 and December 2018,which account for 5.91%(91/1 539) of all patients of necrotizing pancreatitis. Eight hundred and fourteen cases received surgical intervention for infection of necrotizing tissues. Of these cases, 410 cases received percutaneous catheter drainage(PCD) of retroperitoneal fluid or residual infection. Debridement of necrotic tissues was performed on 756 cases. Of these cases, 32 cases received minimal invasive retroperitoneal debridement with/without denotes video assistant,4 cases received transluminal endoscopic debridement, 21 cases received laparoscopic debridement, and 709 cases received open laparotic debridement.Three hundred and sixty-five cases were admitted to our institute during January 2005 to December 2010, and the other 391 cases were admitted to our institute from January 2011 to December 2018. Of the first period, all debridement were performed with open laparotic procedures. Of the second period,debridement were performed with open laparotic procedures and minimal invasive procedures. The average times of surgical invasion, morbidity of principal local complications and mortality of the two periods were 1.27 and 1.34,28.22%(103/365) and 29.92%(117/346),and 6.03%(23/365) and 6.91%(27/346), respectively. Conclusions: Minimal invasive procedures can be considered for debridement in patients with necrotizing pancreatitis in some selected conditions.The involvements of minimal invasive procedures in treatment of necrotizing pancreatitis don't decrease the morbidity of principal local complications and mortality in recent years. Rational surgical procedures and appropriate surgical timing are the keys to improve the efficacy of necrotizing pancreatitis.

[Changes of surgical interventions on necrotizing pancreatitis]

Objective: To investigate the changes of surgical invitations on necrotizing pancreatitis in recent 14 years by reviewing single center data. Methods: One thousand and eighty patients with necrotizing pancreatitis who received surgical invitation were involved in the study.All the patients were treated at Department of Pancreatic Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2005 to December 2018. Six hundred and seventy-eight were males and 402 were females. The median (range) age of the study patients was 45 (20-76) years.The etiology of the disease was related to cholelithiasis in 335 cases(31.02%), hyperlipemia in 302 cases(27.96%), alcohol in 226 cases(20.93%), endoscopic retrograde cholangiopancreatography in 28 cases(2.59%), pregnancy in 50 cases(4.63%), idiopathic factors in 72 cases(6.67%) and other causes in 67 cases(6.20%). The patients were divided into two groups according to the time of admission. Group 1 included 1 475 patients that admitted from January 2005 to December 2010, and group 2 included 1 539 patients that admitted from January 2011 to December 2018. The surgical interventions, morbidity and mortality of the two group were compared, and χ(2) test was used for the statistical test. Results: Two hundred and sixty-six among the 1 080 cases were treated with drainage procedures because of the pseudocyst.One hundred and seventy-five drainage procedures were performed between January 2005 and December 2018, which account for 11.87%(175 /1 475) of all patients of necrotizing pancreatitis; 91 drainage procedures were performed between January 2011 and December 2018,which account for 5.91%(91/1 539) of all patients of necrotizing pancreatitis. Eight hundred and fourteen cases received surgical intervention for infection of necrotizing tissues. Of these cases, 410 cases received percutaneous catheter drainage(PCD) of retroperitoneal fluid or residual infection. Debridement of necrotic tissues was performed on 756 cases. Of these cases, 32 cases received minimal invasive retroperitoneal debridement with/without denotes video assistant,4 cases received transluminal endoscopic debridement, 21 cases received laparoscopic debridement, and 709 cases received open laparotic debridement.Three hundred and sixty-five cases were admitted to our institute during January 2005 to December 2010, and the other 391 cases were admitted to our institute from January 2011 to December 2018. Of the first period, all debridement were performed with open laparotic procedures. Of the second period,debridement were performed with open laparotic procedures and minimal invasive procedures. The average times of surgical invasion, morbidity of principal local complications and mortality of the two periods were 1.27 and 1.34,28.22%(103/365) and 29.92%(117/346),and 6.03%(23/365) and 6.91%(27/346), respectively. Conclusions: Minimal invasive procedures can be considered for debridement in patients with necrotizing pancreatitis in some selected conditions.The involvements of minimal invasive procedures in treatment of necrotizing pancreatitis don't decrease the morbidity of principal local complications and mortality in recent years. Rational surgical procedures and appropriate surgical timing are the keys to improve the efficacy of necrotizing pancreatitis.

[Effect of lead exposure on the accumulation of copper and iron in central nervous system of rats]

Objective: To investigate the dynamic changes of copper and iron contents in brain tissue, body fluids and barriers of rats exposed to lead at different periods in order to provide a theoretical basis for the study of the mechanism of lead nerve injury. Methods: Sixty-four healthy adult SPF male SD rats were randomly divided into control group and lead exposure group, after one week of adaptive feeding, rats in the lead exposure group were treated with 250 mg/L lead acetate, and rats in control group were treated with ordinary drinking water, the experimental period was 12 weeks. After exposure for 3, 6, 9 and 12 weeks, the samples including blood, choroid plexus, cerebrospinal fluid, cortex, hippocampus, striatum, hypothalamus, amygdala, substantia nigra and cerebellum were obtained. Lead, copper and iron content in all kinds of samples were detected by Inductively Coupled Plasma Mass Spectrometry(ICP-MS). The measurement data were presented as Mean±SD, Comparison of metal contents in different tissues of rats at different time analyzed using repeated measurement analysis of variance, Two-variable correlation analysis using Spearman correlation test.The relationship between lead exposure experiod and copper and iron in samples was studied by using trend test. Results: After 12 weeks of lead exposure compared with the control group, lead contents in cortex, hippocampus, striatum, hypothalamus, amygdala, substantia nigra and cerebellum of rats were 2.21, 2.44, 2.95, 3.53, 4.01, 1.85 and 2.86 folds of control group, and the differences were statistically significant(P<0.05). At the same time, lead content in blood, cerebrospinal fluid,choroid plexus, brain microvessels and bones increased. The increase rate in the amygdala and cerebrospinal fluid ranked first among brain tissue or barrier,which were 4.01 and 3.0 folds respectively. Compared with the control group, Compared with the control group, copper content in cortex,hippocampus, striatum, hypothalamus,amygdala, cerebellum,blood,cerebrospinal fluid,choroid plexus and cerebral microvasculature showed an increasing trend among rats following 3,6,9,12 weeks of lead exposure. Copper content change in the striatum was highest among all brain tissue. The increase rate of copper content in the striatum was at the top among brain tissues. After 12 weeks of lead exposure,copper content in brain microvessels was 4.98 folds higher than that of the control group (P<0.05). After lead exposure at different periods,the iron content in the cortex, hippocampus, striatum,cerebrospinal fluid,choroid plexus and brain microvessels of experimental rats all increased(P<0.05). And the iron increase rate in the hypothalamus or cerebrospinal fluid increase ranked first among brain tissues or body fluid the most obviously. Conclusion: With the increase of exposure time, lead exposure can changes in the contents of copper and iron in different brain tissues,body fluids and barriers in rats,among which, the contents of copper and iron in the amygdala,cerebrospinal fluid and brain microvessels increase significantly. This may be related to nerve damage from lead exposure.

The prognostic value of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system in triple-negative breast cancer

The American Joint Committee on Cancer (AJCC) released its 8th edition of cancer staging implemented in early 2018. This study aims to compare anatomic staging (AS) with prognostic staging (PS) based on the updated AJCC 8th edition staging manual. A retrospective single-center analysis of 313 triple-negative breast invasive ductal carcinoma patients who received surgery at department of breast surgery in the Fourth Hospital of Hebei Medical University from 01/2010 -12/2012 was performed. All cases were restaged using the AJCC 8th edition AS and PS system. The 7-year disease-free survival (DFS) and the 7-year overall survival (OS) rates were 76.30% and 78.27%, respectively. Applying the PS system, 277 (88.5%) patients of the AS groups were upstaged to the PS groups, 31 cases with IIIC and 5 cases with IV unchanged (11.5%) and no cases downstaged. Both 7-year DFS and 7-year OS were significantly different in the different AS and PS groups (all, p<0.001). The PS system was found to provide better prognostic information in patients with AS group IIB. A total of 43 patients with AS group IIB were upstaged by PS system, in which 30 patients were +2 upstaged to PS IIIB, and 13 patients were +3 upstaged to PS IIIC. PS IIIB and IIIC from AS IIB had significant differences in 7-year DFS (χ2=5.628, p=0.014) and 7-year OS (χ2=6.037, p=0.018). Both AS and PS systems proposed in the 8th edition of the AJCC breast cancer staging manual had prognostic value in TNBC. Moreover, the PS system predicts clinical outcomes of TNBC patients more accurately than the traditional AS system.

A green and facile synthesis for rGO/Ag nanocomposites using one-step chemical co-reduction route at ambient temperature and combined first principles theoretical analyze

Recently, graphene decorated with various inorganic nanoparticles, such as Pt, Au, Ag, TiO₂ and Fe₃O₄, among which Ag nanocomposites are good candidates for electronics, optics, electrochemistry and catalysis. However, preparation techniques for Ag nanoparticles/carbon matrix hybrids require tedious multi-step processes often involving toxic reducing agents/high temperatures which is not viable for scalable production. Here, a facile, one step and eco-friendly chemical co-reduction route was utilized to synthesis of a new nanocomposites by Ag nanoparticle anchored on reduced graphene oxide (rGO) at ambient temperature and combined first principles theoretical analyze their interfacial adsorption behavior, is reported. In this way, graphene oxide (GO) and Ag⁺ simultaneously reduced by thiourea dioxide (TD) without using any additional reduced reactants. Results indicated that GO was successfully reduced to rGO and well-dispersed Ag nanoparticles with sizes of 6-7 nm, anchored on the surface of rGO sheets. Reduction mechanism was attributed to the synergistic effect of its hydrolysis products in aqueous media. The experiment and theoretical calculation results obtained demonstrate this method to be applicable to the synthesis of other metals on rGO sheets in order to improve wettability and interfacial bonding between rGO and metal and may possibly find various forthcoming medicinal, industrial and technological applications.

[Efficacy and safety of domestic dasatinib as second-line treatment for chronic myeloid leukemia patients in the chronic phase]

目的

探讨国产酪氨酸激酶抑制剂（TKI）达沙替尼（商品名：依尼舒）二线治疗慢性髓性白血病慢性期（CML-CP）患者的疗效及安全性。

方法

回顾性分析2016年3月至2018年7月湖北省CML协作组成员医院收治的二线服用国产达沙替尼的CML-CP患者的病例资料，统计患者治疗3、6和12个月时最佳反应率、累积完全细胞遗传学反应（CCyR）率、累积主要分子学反应（MMR）率、无进展生存（PFS）、无事件生存（EFS）情况及不良反应情况。

结果

共纳入83例CML-CP患者，中位随访时间为23（4~45）个月，达沙替尼治疗3、6、12个月最佳反应率分别为77.5%（54/71）、72.6%（61/75）、60.7%（51/69）。至随访截止，累积CCyR率、MMR率分别为65.5%（55/80）、57.1%（48/73），达CCyR和MMR的中位时间均为3个月。随访时间内，PFS率为94.0%（79/83），EFS率为77.4%（65/83）。国产达沙替尼最常见非血液学不良反应为水肿（32.5%），其次为皮疹瘙痒（18.1%）、乏力（13.3%），血液学不良反应主要有血小板减少（31.3%）、白细胞减少（19.3%）和贫血（6.0%）。

结论

国产达沙替尼二线治疗CML-CP患者具有较好的疗效及安全性，可作为CML-CP患者的治疗选择。

[Percutaneous endoscopic transforaminal lumbar interbody fusion for lumbar spinal stenosis]

Objective: To evaluate the clinical effects of percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) for L(4/5) single-segment lumbar spinal stenosis. Methods: From September 2016 to March 2018, 7 patients with L(4/5) single-segment lumbar spinal stenosis were treated by PE-TLIF in the Department of Orthopedics, Beijing Chaoyang Hospital. There were 1 male and 6 females, with a mean age of (57±13) years(43-77 years). The operation time, intraoperative blood lose, blood transfusion and complications were recorded, and the pain relief effects were evaluated by visual analog scale (VAS) score and Oswestry dability index (ODI). The indexes before and after the operation were compared with t test. Results: The average of follow-up time was 13.3 months (6-21 months), and the clinical symptoms relieved significantly. The VAS scores of low back pain and leg pain at 3-day postoperatively and at the last follow-up were (2.28±0.48), (1.57±0.53) and (0.42±0.53), (0.14±0.37), respectively; and the VAS scores were significantly improved when compared with those before the operation[(7.42±0.78), (6.14±1.77)](t=19.718, 6.672, 18.520, 7.937, all P<0.05). At the last follow-up, the ODI score was also significantly lower than that before surgery (54%±10% and 15%±9%, t=12.551, P<0.05). During the follow-up period, one patient had transient hyperreflexia after surgery, and the other 6 patients had no significant complications. None nerve root injury or lower extremity paralysis occurred. Conclusion: PE-TLIF can obtain satisfactory short-term results in the treatment of single-segment lumbar spinal stenosis, with a lower incidence of complications and rapid recovery after surgery.

Glucagon-like peptide-1 receptor agonists and fracture risk: a network meta-analysis of randomized clinical trials

Our network meta-analysis analyzed the effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on fracture risk. By combining data from randomized controlled trials, we found that GLP-1 RAs were associated with a decreased bone fracture risk, and exenatide is the best option agent with regard to the risk of fracture. This study is registered with PROSPERO (CRD42018094433).

INTRODUCTION

Data on the effects of GLP-1 RAs on fracture risk are conflicted. This study aimed to analyze the available evidence on the effects of GLP-1 RAs on fracture risk in type 2 diabetes mellitus patients.

METHODS

Electronic databases were searched for relevant published articles, and unpublished studies presented at ClinicalTrials.gov were searched for relevant clinical data. All analyses were performed with STATA 12.0 and R software (Version 3.4.4). We estimated the risk ratio (RR) and 95% confidence interval (CI) by combining RRs for fracture effects of included trials.

RESULTS

There were 54 eligible random control trials (RCTs) with 49,602 participants, including 28,353 patients treated with GLP-1 RAs. Relative to placebo, exenatide (RR, 0.17; 95% CI 0.03-0.67) was associated with lowest risk of fracture among other GLP-1 RAs. Exenatide had the highest probability to be the safest option with regard to the risk of fracture (0.07 ‰), followed by dulaglutide (1.04%), liraglutide (1.39%), albiglutide (5.61%), lixisenatide (8.07%), and semaglutide (18.72%). A statistically significant inconsistency was observed in some comparisons.

CONCLUSION

The Bayesian network meta-analysis suggests that GLP-1 RAs were associated with a decreased bone fracture risk compared to users of placebo or other anti-hyperglycemic drugs in type 2 diabetes mellitus patients, and exenatide is the best option agent with regard to the risk of fracture.

[Relevant molecular characteristics analysis on malignant transformation of interstitial cells induced by tumor stem cells in glioma microenvironment]

Objective: A variety of interstitial cells in tumor microenvironment (TME) based on glioma stem cells(GSC) have the function to promote malignant progression of tumors, but whether these interstitial cells have already undergone malignant transformation and their related molecular characteristics are still poorly understood. Methods: Human SU3-RFP glioma stem cells (GSC) stably transfected with red fluorescent protein (RFP) and interstitial cells from enhanced green fluorescent protein (EGFP) transgenic nude mice were co-cultured in vitro. SU3-RFP cells were also inoculated in different tissues of EGFP-Balb/c nude mice. Immortal EGFP(+) cells were monocloned either from co-culture cells in vitro, or from their xenografts in vivo. These immortal EGFP(+) cells were confirmed to bear characteristics of tumor cell via chromosomal analysis and tumorigenicity assay. Related molecular phenotypes of these cells were further detected through RT-PCR, flow cytometry and immunochemistry(IHC) techniques. Results: (1) Two EGFP(+) cell lines were obtained in vitro, and 5 EGFP(+) cell lines were obtained in vivo tumorigenic experiments. Seven EGFP(+) cell lines all have characteristics of self-renewal, heteroploid of chromosomes and 100% tumorigenicity. (2) Cell surface marker analysis showed cell origin of these cell lines were macrophages (tMΦ1 and tMΦ2 ), dendritic cells (tDC1 and tDC2), fibroblasts (tFB), oligodendrocytes (tOG) and BMSC cells (tBMSC), respectively. (3)All of these seven cell lines co-expressed Sca-1 and c-myc, and have Sox-2 or Nanog expression also, which suggest that they may bear molecular characteristics of mesenchymal stem cells or pluripotent stem cells. Conclusions: (1) Tumor stromal cells in TME have undergone malignant transformation, which is related to the tissue remodeling of TME by GSCs, and not limit to the specific type of their parasitic tissues. (2) Tumor cells originated from GSC and tumor interstitial cells, respectively, are two major types of tumor cells with different origins in glioma parenchyma, can not be simply regarded as tumor heterogeneity, transformed interstitial cells of TME may have the potential to serve as new targets for target diagnosis and therapy.

Buffering agent via insulin-mediated activation of PI3K/AKT signaling pathway to regulate lipid metabolism in lactating goats

Ruminants are often fed a high-concentrate (HC) diet to meet lactating demands, yet long-term concentrate feeding induces subacute ruminal acidosis (SARA) and leads to a decrease in milk fat. Buffering agent could enhance the acid base buffer capacity and has been used to prevent ruminant rumen SARA and improve the content of milk fat. Therefore, we tested whether a buffering agent increases lipid anabolism in the livers of goats and influences of milk fat synthesis. Twelve Saanen-lactating goats were randomly assigned to two groups: one group received a HC diet (Concentrate: Forage=60:40, Control) and the other group received the same diet with a buffering agent added (10 g sodium butyrate, C(4)H(7)NaO(2); 10 g sodium bicarbonate, NaHCO(3); BG) over a 20-week experimental period. Overall, milk fat increase (4.25+/-0.08 vs. 3.24+/-0.10; P<0.05), and lipopolysaccharide levels in the jugular (1.82+/-0.14 vs. 3.76+/-0.33) and rumen fluid (23,340+/-134 vs. 42,550+/-136) decreased in the buffering agent group (P<0.05). Liver consumption and release of nonesterified fatty acid (NEFA) into the bloodstream increased (P<0.05). Phosphatidylinositol 3-kinase (PI3K), protein kinase B (AKT) and ribosomal protein S6 kinase (p70S6K) up-regulated significantly in the livers of the buffering agent group (P<0.05). It also up-regulated expression of the transcription factor sterol regulatory element binding protein-1c (SREBP-1c) and its downstream targets involved in fatty acid synthetic, including fatty acid synthetase (FAS), stearoyl-CoA desaturase (SCD-1) and acetyl-CoA carboxylase 1 (ACC1) (P<0.05). The BG diet increased insulin levels in blood (19.43+/-0.18 vs. 13.81+/-0.10, P<0.05), and insulin receptor was likewise elevated in the liver (P<0.05). Cumulatively, the BG diet increased plasma concentrations of NEFA by INS-PI3K/AKTSREBP-1c signaling pathway promoting their synthesis in the liver. The increased NEFA concentration in the blood during BG feeding may explain the up-regulated in the milk fat of lactating goats.

In vitro corrosion behavior and biocompatibility of nanostructured Ti6Al4V

Ti6Al4V (TC4) alloy has long been used as a bone interfacing implant material in dentistry and orthopedics due to its excellent biocompatibility and mechanical properties. The performance of TC4 can be further tailored by altering its grain structures. In this study, by means of sliding friction treatment (SFT), a nano-grained (NG) surface layer with an average grain size of ≤100 nm on the topmost surface was successfully generated on coarse-grained (CG) TC4 alloy sheet. It was shown that the NG surface possessed notably enhanced corrosion resistance in physiological solution compared to the CG surface, due to the formation of thicker and denser passive film facilitated by surface nanocrystallization. Additionally, the NG surface with stronger hydrophilicity favorably altered the absorption of anchoring proteins such as fibronectin (Fn) and vitronectin (Vn) that can mediate subsequent osteoblast functions. The in vitro results indicated that the NG surface exhibited remarkable enhancement in osteoblast adherence, spreading and proliferation, and obviously accelerated the osteoblast differentiation as compared to CG surface. Moreover, the NG surface also demonstrated good hemocompatibility. These findings suggest that SFT can endure bio-metals with advanced multifunctional properties for biomedical applications.