[Assessment of setup errors of IGRT combined with a six degrees of freedom bed for patients with primary rectal cancer]

Objective: To investigate the effect of six degree of freedom (6-DOF) bed combined with cone beam computed tomography (CBCT) in the on-line correction of setup errors in patients with primary rectal cancer. Methods: The clinicopathological data of 17 patients with primary rectal cancer in Department of Radiotherapy, Third Hospital of Peking University from July 2013 to January 2014 were collected. There were 14 males and 3 females, a median age of 65 years. The difference of CBCT and 6-DOF bed combined with CBCT online correction of patients with positioning error were retrospectively analyzed. Results: Before position correction, the first CBCT verification of setup errors in the three translation directions including X (left and right), Y (in and out) and Z (up and down) directions were (0.06±0.25) cm, (0.13±0.40) cm and (-0.28±0.31) cm, respectively. The setup errors of RX (rotation pitch), RY(rolling) and RZ (left and right rotation) directions were (0.62±1.15)°, (-0.19±0.99)°, and (-0.34 ± 0.84)°, respectively . After correction of IGRT combined with six freedom of bed, the setup errors of translation X, Y and Z were (0.01±0.09) cm, (-0.01±0.05) cm and (-0.03±0.08) cm, respectively, and the setup errors of rotation RX, RY and RZ directions were (-0.16±0.40)°, (0.36±0.31)°and (-0.01±0.25)°, respectively. There were significant differences in translation direction (X, Y and Z direction) and rotation direction (Rx, RY and RZ) before and after 6-DOF bed combined with CBCT correction (all P<0.05). In the translation direction, the higher frequency range of Z-direction error value was 0.20-0.79 cm. In the rotation direction, the frequency range of error in Rx direction was 0.20°-2.99°. There was no significant difference between bone mode and gray scale model registration (P>0.05). With the progress of radiotherapy, the setup errors of X, Z, Rx, RY and RZ directions increased except Y direction. Conclusions: In radiotherapy, six freedom bed combined with CBCT is helpful to correct the setup errors of patients with primary rectal cancer. Six freedom bed may be used to correct the setup errors of patients with primary rectal cancer online. Image-guided radiation therapy (IGRT) is recommended for bone pattern registration in patients with rectal cancer.

[Dynamic changes of axial length, corneal refractive power, and refractive state after cataract surgery in infants]

Objective: To investigate the changes of axial length, corneal refractive power, and refractive state in infants with congenital cataract surgery. Methods: Retrospective cohort study. Medical records of 103 patients who underwent congenital cataract surgery in the Eye Hospital of Wenzhou Medical University Hangzhou Branch from January 1, 2015 to December 31, 2018 were reviewed. There were 61 boys and 42 girls in the study. The mean age at the surgery of 103 congenital cataract patients was (3.95±1.94) months. In patients receiving bilateral cataract surgery, only the left eye was selected for analysis. The patients were followed up for at least 1 year. The patients were divided into the groups of <4 months old and 4-12 months old according to the age at cataract surgery. The change in the axial length, corneal refractive power, and refractive state of each patient at 1 year after surgery was analyzed. Independent sample t-test, one way variance analysis and simple linear regression were used for statistical analysis. Results: There were 71 cases of bilateral cataract, including 33 in the group of <4 months old and 38 in the group of 4-12 months old, and 32 cases of unilateral cataract, including 17 in the group of <4 months old and 15 in the group of 4-12 months old. The change in the axial length of bilateral cataract children in the <4-month-old group was (2.46±1.33) mm at 1 year after surgery, which was greater than (1.52± 1.00) mm in the group of 4-12 months old (t=3.21; P<0.01). In the same surgery age group, there was no significant difference in the change of axial length among bilateral cataract eyes, unilateral cataract eyes and the contralateral eyes at 1 year after surgery (both P>0.05). One year after surgery, the axial length of the eyes in patients with bilateral cataract, the affected eyes and the fellow eyes in patients with unilateral cataract all was highly correlated with the logarithm of the actual age (r=0.68, 0.52, 0.73; all P<0.01). The corneal refractive power showed a decreased trend with the increase of age. The change in the corneal refractive power of the bilateral cataract children in the <4-month-old group at 1 year after surgery was (1.43±2.87) D, and in the group of 4-12 months old was (0.68±2.10) D, but the difference was not statistically significant (P>0.05). The chang in spherical equivalent of bilateral cataract children was (2.02±2.60) D in the <4-month-old group, greater than that in the group of 4-12 months old [(0.69±1.89) D; t=2.15; P<0.05]. The change of spherical equivalent one year after surgery in 4-12 months group, unilateral cataract eyes was significantly greater than that of bilateral cataract eyes [(2.05±0.95) D vs. (0.69±1.89) D; t=2.49; P<0.05]. The spherical equivalent of both bilateral and unilateral cataract children was highly correlated with the actual age (r=-0.51, -0.54; both P<0.01). Conclusions: The axial length is increased, the corneal refractive power is decreased, and the spherical equivalent is decreased at 1 year after surgery for congenital cataract in infants. The younger the age at cataract surgery, the greater the change in the axial length, myopia drift, and corneal refractive power. (Chin J Ophthalmol, 2021, 57: 34-40).

COVID-19 Severity and Stroke: Correlation of Imaging and Laboratory Markers

BACKGROUND AND PURPOSE

Coronavirus disease 2019 (COVID-19) appears to be an independent risk factor for stroke. We hypothesize that patients who develop stroke while hospitalized for severe COVID-19 will have higher inflammatory markers and distinct stroke imaging patterns compared with patients positive for COVID-19 with out-of-hospital stroke onset and milder or no COVID-19 symptoms.

MATERIALS AND METHODS

This is a retrospective case series of patients positive for COVID-19 on polymerase chain reaction testing with imaging-confirmed stroke treated within a large health care network in New York City and Long Island between March 14 and April 26, 2020. Clinical and laboratory data collected retrospectively included complete blood counts and creatinine, alanine aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin, and D-dimer levels. All CT and MR imaging studies were independently reviewed by 2 neuroradiologists who recorded stroke subtype and patterns of infarction and intracranial hemorrhage.

RESULTS

Compared with patients with COVID-19 with outside-of-hospital stroke onset and milder or no COVID-19 symptoms (n = 45, 52.3%), patients with stroke already hospitalized for severe COVID-19 (n = 41, 47.7%) had significantly more frequent infarctions (95.1% versus 73.3%, P = .006), with multivascular distributions (56.4% versus 33.3%, P = .022) and associated hemorrhage (31.7% versus 4.4%, P = .001). Patients with stroke admitted with more severe COVID-19 had significantly higher C-reactive protein and ferritin levels, elevated D-dimer levels, and more frequent lymphopenia and renal and hepatic injury (all, P < .003).

CONCLUSIONS

Patients with stroke hospitalized with severe COVID-19 are characterized by higher inflammatory, coagulopathy, and tissue-damage biomarkers, supporting proposed pathogenic mechanisms of hyperinflammation activating a prothrombotic state. Cautious balancing of thrombosis and the risk of hemorrhagic transformation is warranted when considering anticoagulation.

Medullary thyroid carcinoma combined with papillary thyroid carcinoma: case report and literature review

We investigated the clinicopathologic features, immunophenotype, (differential) diagnosis, pathogenesis, treatment, and follow-up of medullary thyroid carcinoma (MTC) combined with papillary thyroid carcinoma (PTC). A retrospective analysis of the clinical and pathologic features and immunophenotype was conducted in a patient with MTC and PTC. Relevant literature was also reviewed. Results of thyroid fine needle aspiration indicated malignant tumor in the right lobe of the thyroid, suggesting PTC; further analysis by biopsy confirmed this diagnosis. The left lobe exhibited MTC. Tumor metastases were absent from the lymph nodes of the left central area (0/2), and no tumor was present in the thymic tissue. In the right lobe and isthmus, PTC was observed, with a maximum infiltration diameter of 0.8 cm, and tumor metastases were absent from lymph nodes of the right central area (0/3). Immunohistochemistry of the left lobe was positive for calcitonin, CK, TTF-1, CD56, CgA, and Congo red, but negative for CK19, thyroglobulin, galectin-3, MC, and CEA, with a Ki-67 proliferation index of 1%. The right lobe was positive for CK19, galectin-3, and MC, but negative for CD56. The V600E mutation was detected in BRAF. MTC combined with PTC is a rare thyroid tumor. This condition is diagnosed mainly based on morphology, immunophenotyping, and molecular detection. It must be distinguished from other malignancies, such as thyroid follicular tumors, undifferentiated carcinoma, poorly differentiated carcinoma, transparent stellate tumor, and mixed PTC/MTC. Surgery and post-operative drug administration currently constitute the preferred treatments.

[Safety and feasibility of indocyanine green injection through accessory incision in laparoscopic right hemicolectomy]

Objective: To explore the safety and feasibility of indocyanine green (ICG) injection through accessory incision in laparoscopic right hemicolectomy. Methods: A descriptive case series study was carried out. Clinicopathological data of 29 patients with colon cancer undergoing right hemicolectomy at Department of General Surgery, Guangdong Provincial People's Hospital were retrospectively analyzed. All the patients received ICG injection through accessory incision at the beginning of operation. Results: Among 29 patients, 13 were male and 16 were female with a mean age of (60.8±7.7) years and mean body mass index of (24.3±2.8) kg/m(2); 3 were stage I, 19 were stage II, 7 were stage III. Pericolic, intermediate and main lymph nodes could be detected under near infrared fluorescence imaging (NIRFI) in all the cases. No.6 lymph nodes were observed in 3 cases, while no lymph nodes around superior mesenteric vein (SMV) were found. The average number of fluorescent lymph node was 14.2±6.1. The average developing time of fluorescence was (36.2±3.7) minutes. The average number of harvested lymph nodes was 22.4±8.2. There was no extravasation of imaging agent during the operation, and there were no intraoperative complications such as allergies, massive abdominal bleeding, peripheral organ damage, etc. Operative time was (113.1±10.7) minutes, blood loss during operation was (22.4±3.9) ml, ambulatory time was (1.2±0.4) days, time to the first flatus was (1.7±0.7) days, time to the first fluid diet was (0.7±0.4) days, and postoperative hospital stay was (5.8±1.5) days. No operation-associated complications such as anastomotic bleeding, anastomotic leakage, peritoneal bleeding, peritoneal infection, incision infection occurred after operation. Conclusion: ICG injection through accessory incision in laparoscopic right hemicolectomy is safe and feasible.

[The metabolism of blood glucose and lipid in breast cancer patients after the first chemotherapy]

Objective: To analyze the metabolism of blood glucose and lipid in breast cancer patients after the first chemotherapy. Methods: Breast cancer patients who received chemotherapy for the first time from December 2016 to January 2020 were collected in our hospital, and their blood glucose and lipid levels were monitored. Patients were grouped according to different treatment plans. Non-parametric rank sum test was used for statistical analysis on SPSS software. Results: There were 1 356 female breast cancer patients were enrolled, blood glucose and lipid levels were compared before and after chemotherapy. Our results showed that baseline medium blood glucose was 5.2 mmol/L, lower than 5.3 mmol/L after chemotherapy (P<0.05). The baseline triglyceride (TG) was 1.2 mmol/L, lower than 1.6 mmol/L after chemotherapy (P<0.05). The baseline small dense low-density lipoprotein (sdLDL) was 0.7 mmol/L, lower than 0.8 mmol/L after chemotherapy (P<0.05). The baseline high density lipoprotein (HDL) was 1.3 mmol/L, higher than 1.2 mmol/L after chemotherapy (P<0.05). Patients' menstrual status and body mass index were related with blood glucose, TG, LDL and sdLDL (all P< 0.05). Conclusions: Abnormal metabolism of blood glucose and lipid are observed in breast cancer patients after the first chemotherapy. More awareness of cardiovascular disease in breast cancer patients might ensure their overall clinical benefits.

[The clinical significance of plasma PTX3 in patients with secondary hemophagocytic lymphohistiocytosis]

Objective: To investigate the significance of plasma pentraxin 3 (PTX3) in patients with secondary hemophagocytic lymphohistiocytosis (sHLH). Methods: Plasma PTX3 levels were tested by ELISA in 48 newly diagnosed sHLH patients, 18 healthy volunteers and 9 lymphoma controls in the First Affiliated Hospital of Nanjing Medical University from January 2017 to July 2019. Clinical parameters were collected, and the correlations with PTX3 levels were analyzed. Results: PTX3 level in newly diagnosed group was significantly higher than that of healthy control group [16.29(1.17-66.00) vs. 0.76(0.01-7.86) μg/L, P<0.01]. Patients with lymphoma-associated HLH(LHLH) had higher plasma level of PTX3 than Fhose with infection-associated HLH (IHLH) [24.29(3.36-66.00) vs. 9.56(1.17-36.50)μg/L, P<0.05]. Plasma PTX3 levels in 48 sHLH patients were positively correlated with serum ferritin (P<0.05). Receiver operating characteristic (ROC) curve for plasma PTX3 levels of sHLH and healthy controls produced a cutoff value at 3.9 μg/L, with its 86.7% sensitivity and 94.4% specificity. And ROC analysis showed that PTX3 17.5 μg/L was the critical value for diagnosis of LHLH from non-LHLH group, that the sensitivity and specificity were 63.0% and 76.2% respectively. The 1-year overall survival (OS) rate in patients with PTX3≥17.5 μg/L was significantly lower in those with PTX3<17.5 μg/L (18.5% vs. 75.8%, P<0.01). Conclusion: These results indicate the potential of PTX3 as a biomarker for diagnosis and prognosis in patients with sHLH.

Preventive intraperitoneal hyperthermic perfusion chemotherapy for patients with T4 stage colon adenocarcinoma

BACKGROUND

Hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to be an effective treatment for peritoneal tumors; whether preventive HIPEC after radical resection for T4 stage colon adenocarcinoma could decrease peritoneal recurrence remains unknown. The aim of the present study was to compare peritoneal recurrence and short-term survival in patients with T4 stage colon adenocarcinoma undergoing HIPEC plus adjuvant chemotherapy or adjuvant chemotherapy alone following surgery.

METHODS

We retrospectively reviewed T4 stage colon adenocarcinoma patients who had radical tumor resection at our institution between January 2014 and January 2019. Clinical data were extracted from the database at our institution, and patient survival and long-term complications were assessed through repeated outpatient examinations and telephone interviews.

RESULTS

A total of 352 patients were included in this study; 157 patients received postoperative HIPEC plus adjuvant chemotherapy (HIPEC group), 195 patients received adjuvant chemotherapy alone (conventional chemotherapy group). Forty-one (26.1%) patients in the HIPEC group had a peritoneal recurrence and the peritoneum was the first site of tumor recurrence in 6 (14.6%) of them. However, 73 (37.4%) patients experienced peritoneal recurrence in the conventional group, and the peritoneum was the first site of tumor recurrence in 25 (34.2%) (p = 0.019). Disease-free survival in the HIPEC group at 1 and 3 years was 93.3% and 61.1%, respectively, versus 89.3% and 51.7% in the conventional chemotherapy group (p = 0.038). Overall survival in the HIPEC group at 1 and 3 years was 100.0% and 82.7%, respectively, versus 100.0% and 76.9% in the conventional chemotherapy group (p = 0.420). The two groups did not differ with respect to severe complications.

CONCLUSIONS

Preventive HIPEC after radical surgery may decrease peritoneal recurrence and promote disease-free survival for T4 stage colon adenocarcinoma. Large-scale randomized controlled studies are needed to confirm the results of our study.

Accuracy Analysis of Distinguishing the Cooperation Degree during Image Completion Test by Eye Movement Parameters

Abstract

Objective To analyze the differences in accuracy of different eye movement parameters in distinguishing the cooperation and non-cooperation during image completion test of patients with mental disorders caused by craniocerebral trauma. Methods One hundred and forty cases of patients with mental disorders caused by craniocerebral trauma who took psychiatric impairment assessments were collected. The 21 pictures from "image completion" of Wechsler intelligence test were used as stimulating pictures, then divided into cooperation group and non-cooperation group according to binomial forced-choice digit memory test and expert opinions. The eye movement parameters of research subjects during completion of images were obtained by the SMI eye-tracker. The accuracy of eye movement parameters in distinguishing the cooperation or non-cooperation of patients with mental disorders caused by craniocerebral trauma in psychiatric impairment assessments were evaluated by the ROC curve. Results During the process of the image completion test, the area under curve （AUC） value of frequency of blink, frequency of fixation, pupil size, frequency of saccade, latency of saccade, average acceleration of saccade, the average and peak longitudinal velocity of saccade was above 0.5. When it comed to a specific stimulating picture, the AUC value of frequency of blink in looking at a specific stimulating picture could be above 0.8, and the AUC value of X axis diameter of pupil size could be above 0.7. Conclusion The accuracy of eye movement parameters in distinguishing the cooperation or disguise of patients with mental disorders caused by craniocerebral trauma is related with the stimulating picture. The accuracy of frequency of blink in distinguishing cooperation and non-cooperation is better than that of other eye movement parameters.

ALK-1-positive inflammatory myofibroblastic tumor of the thyroid complicated by Hashimoto's thyroiditis: report of a rare case and a literature review

BACKGROUND

Inflammatory myofibroblastic tumors (IMTs) of the thyroid are extremely rare soft-tissue tumors. In the literature, IMTs are sometimes called plasma cell granulomas (PCGs) or inflammatory pseudotumors, which often causes ambiguity. To date, 17 cases of PCGs and five cases of thyroid IMTs have been reported. These cases reveal that IMTs of the thyroid are often negative for the anaplastic lymphoma kinase (ALK-1) gene. To provide further information on this rare lesion, we present a case of an ALK-1-positive thyroid IMT and a review of IMTs of the thyroid.

CASE PRESENTATION

A 34-year-old Chinese woman presented with a painless neck mass that had persisted for over a month. Ultrasonography revealed a 4.28 × 2.53 cm² hypoechoic mass, in the left lobe of the thyroid gland. Serum levels of thyroglobulin and anti-thyroglobulin antibodies were high. Subsequently, left lobectomy was performed. Macroscopically, the lesion was a gray-brown nodular mass with a partial envelope. Histologically, two different lesion types were observed. The first lesion showed classic spindle cell proliferation, with spindle cells arranged in fascicles, accompanied by mature inflammatory cells. The other lesion showed a large number of infiltrating lymphocytes, with lymphoid follicles in the remaining thyroid gland, which was atrophic. Immunohistochemical staining showed that the spindle cells were negative for CK19, CyclinD1, Gelectin-3, EMA, CD34, S100, Bcl-2, and STAT-6, but strongly positive for ALK-1, vimentin, and TTF1. CK was focally expressed, and the Ki-67 index was 5%. A diagnosis of IMT was proposed according to immunohistochemical findings and morphology. Hashimoto's thyroiditis was confirmed according to serum levels of thyroglobulin and anti-thyroglobulin antibodies and morphology. The patient did not receive adjuvant therapy. She remained alive without disease recurrence for 10 months after lobectomy.

CONCLUSIONS

IMTs should be considered in the diagnosis when spindle cell proliferation accompanied by mature inflammatory cells is observed, spindle cells are mildly atypical, and myofibroblast differentiation is present in the thyroid. A uniform diagnostic term is crucial to avoid ambiguity. Clinicians and pathologists should be aware of the necessity for long-term follow-up, especially in ALK-positive cases. The therapeutic potential of ALK-1 positivity should be explored further.

[Observation on the effect of liquid paraffin as adjuvant therapy in treating residual wounds of patients with severe burns]

Objective: To observe the effect of liquid paraffin as adjuvant therapy in treating residual wounds of patients with severe burns. Methods: From January 2016 to October 2017, 58 patients with residual wounds in the later stage of severe burns were admitted to Beijing Jishuitan Hospital. Those patients met the inclusion criteria of this study and were enrolled in this retrospective cohort study. All the patients received wound disinfection, petrolatum gauze dressing change and silver ion-bearing antimicrobial dressing every other day to treat the residual wound until wound healing. From January to November 2016, 29 patients who were treated with iodophor and normal saline to clean and disinfect the wound before dressing change were enrolled in normal saline group, including 22 males and 7 females, aged (38±12) years. From December 2016 to October 2017, 29 patients who were treated with iodophor and liquid paraffin to clean and disinfect the wound before dressing change were enrolled in liquid paraffin group, including 20 males and 9 females, aged (37±12) years. The effective rate of treatment, infection control rate, and bacterial positive ratio of wound on post first treatment day (PFTD) 7, 14, and 21 and the complete wound healing time of patients were compared between the two groups. Data were statistically analyzed with independent sample t test, Wilcoxon rank-sum test, chi-square test, and Pearson chi-square test, continuity correction chi-square test, and Fisher's exact probability test after Bonferroni correction. Results: (1) On PFTD 7, 14, and 21, the effective rates of wound treatment in patients of liquid paraffin group were 34% (10/29), 59%(17/29), and 79%(23/29), respectively, which were significantly higher than 10% (3/29), 24% (7/29), and 38% (11/29) of normal saline group (χ(2)=5.857, 7.108, 10.235, P<0.05 or P<0.01). (2) The wound infection control rates in patients of liquid paraffin group on PFTD 7 and 14 were 79% (23/29) and 90% (26/29), respectively, which were significantly higher than 31% (9/29) and 52% (15/29) of normal saline group (χ(2)=13.663, 8.321, P<0.01). The wound infection control rate in patients of liquid paraffin group on PFTD 21 was 100% (29/29), which was significantly higher than 69% (20/29) of normal saline group (P<0.01). (3) The bacterial positive ratios in the wounds of liquid paraffin group were similar to those of normal saline group on PFTD 7 and 14 (χ(2)=2.097, 2.583, P>0.05). On PFTD 21, the wound bacterial positive ratio of liquid paraffin group was 8% (3/39), which was significantly lower than 49% (17/35) of normal saline group (χ(2)=13.625, P<0.01). (4) The complete wound healing time of patients in liquid paraffin group was 15.0 (11.0, 20.0) d, which was significantly shorter than 22.0 (15.0, 27.5) d of normal saline group (Z=2.256, P<0.05). Conclusions: In the treatment of residual wounds of severe burn patients, liquid paraffin as adjuvant therapy can effectively improve the treatment effective rate and the infection control rate of wounds, decrease the bacterial positive ratio, and shorten the wound healing time.

Application of Deep Compression Technique in Spiking Neural Network Chip

In this paper, a reconfigurable and scalable spiking neural network processor, containing 192 neurons and 6144 synapses, is developed. By using deep compression technique in spiking neural network chip, the amount of physical synapses can be reduced to 1/16 of that needed in the original network, while the accuracy is maintained. This compression technique can greatly reduce the number of SRAMs inside the chip as well as the power consumption of the chip. This design achieves throughput per unit area of 1.1 GSOP/([Formula: see text]) at 1.2 V, and energy consumed per SOP of 35 pJ. A 2-layer fully-connected spiking neural network is mapped to the chip, and thus the chip is able to realize handwritten digit recognition on MNIST with an accuracy of 91.2%.

[Clinical features of 9 cases of Brucella endocarditis]

Objective: To explore the clinical characteristics of patients with Brucella endocarditis. Methods: The clinical data of 9 patients with Brucella endocarditis admitted to Beijing Ditan Hospital from October 2008 to August 2018 were retrospectively analyzed. Through the electronic medical record system of the hospital. Through assessing the electronic medical record system of the hospital, demographic data, main symptoms, vital signs, blood culture, Rose Bengal Plate Agglutination Test, echocardiography, electrocardiogram, chest imaging and other clinical data of included patients were inquired and recorded. Patients were followed up by telephone for medication, operation and outcome. Results: The 9 patients were all Han nationality, aged from 25 to 66 years, 7 out of 9 patients were male, and they came from Hebei, Shandong, Shanxi, Inner Mongolia and Beijing. Of the 9 patients, 5 were farmers, 2 were self-employed, 1 was a technician, and 1 was unemployed. Of the 9 cases, 8 had a history of close contact with cattle and sheep, and 5 had a history of eating beef and mutton. Rose-Bengal Plate Agglutination Test and blood culture were positive in all 9 patients. Aortic valve was involved in 7 out of 9 patients, mitral and tricuspid valve was involved in 1 patient, respectively, and aortic dissection occurred in 1 patient. Condition of 1 patient rapidly deteriorated after admission and finally died during hospitalization despite antibiotic therapy, the remaining patients received long-term antibiotic treatment. A total of 7 patients who underwent valve replacement were followed up. One patient died of cerebral hemorrhage 6 months after operation, and the remaining 6 patients recovered well after valve replacement. Heart failure occurred in all 9 patients, and pericardial effusion occurred in 8 patients. Electrocardiogram showed low voltage of the QRS complex in the limb in 3 cases and poor R-wave progression in V(1)-V(3) lead in 2 cases, and sinus tachycardia in 2 cases. One patient developed non-specific ST-T abnormalities. All patients had fever, 7 patients complained of weakness, and 6 patients complained of palpitations. Among the 9 patients, 7 cases had anemia, 7 patients had pneumonia, 6 had bilateral pleural effusion, 4 had thrombocytopenia. Creatinine was above normal in 4 patients, urine protein was positive in 3 patients, Delta Bilirubin was higher in 3 cases. Conclusions: Patients with Brucella endocarditis often suffer from heart failure and have severe complications. Adequate antibiotic therapy in combination with valve replacement is effective for the treatment of patients with Brucella endocarditis.

Exosomal miR-182 regulates the effect of RECK on gallbladder cancer

BACKGROUND

As the most common biliary malignancy, gallbladder cancer (GC) is an elderly-biased disease. Although extensive studies have elucidated the molecular mechanism of microRNA 182 (miR-182) and reversion-inducing-cysteine-rich protein with kazal motifs (RECK) in various cancers, the specific role of exosomal miR-182 and RECK in GC remains poorly understood.

AIM

To explore the relationship between exosomal miR-182/RECK and metastasis of GC.

METHODS

Paired GC and adjacent normal tissues were collected from 78 patients. Quantitative polymerase chain reaction was employed to detect miR-182 and exosomal miR-182 expression, and Western blotting was conducted to determine RECK expression. In addition, the effects of exosomal miR-182/RECK on the biological function of human GC cells were observed. Moreover, the double luciferase reporter gene assay was applied to validate the targeting relationship between miR-182 and RECK.

RESULTS

Compared with normal gallbladder epithelial cells, miR-182 was highly expressed in GC cells, while RECK had low expression. Exosomal miR-182 could be absorbed and transferred by cells. Exosomal miR-182 inhibited RECK expression and promoted the migration and invasion of GC cells.

CONCLUSION

Exosomal miR-182 can significantly promote the migration and invasion of GC cells by inhibiting RECK; thus miR-182 can be used as a therapeutic target for GC.

[Five million wear simulation and particle analysis of carbon-based nano-multilayer coatings titanium alloy femoral head]

Objective: To analyze the wear debris characteristics ofcarbon-based nano- multilayer coatings on Ti(6)Al(4)V alloys and compared with the cobalt chromium molybdenum alloy (CoCrMo) femoral head to evaluate the friction and wear performance of the new coated femoral head. Methods: Three groups were set up in the wear simulation experiment according to the type of femoral head. Group A: imported Cobalt-Chromium-Molybdenum alloy femoral head (CoCrMo); group B: Titanium alloy femoral head (Ti(6)Al(4)V) with carbon-based nano-multilayer coatings; group C: domestic Cobalt-Chromium-Molybdenum alloy femoral head (CoCrMo). All heads were jointed with an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup. Serum samples were collected and stored in the hip joint simulator. After the sample has been digested and diluted, it was filtered through 5 μm, 1.2 μm and 0.4 μm filters, and the filter paper was collected for testing. Scanning electron microscope (SEM) was used to randomly select regions on the filter to obtain images of wear debris. Energy dispersive X-ray spectroscopy (EDS) was used to determine the elemental type of the particle and to eliminate possible contamination. The composition and structure of the abrasive chips were measured using Fourier transform infrared spectrometer (FTIR). The parameters related to the wear debris includingparticle size, shape, number and volume were calculated. The differences in correlation parameters between the groups were compared to evaluate the friction and wear properties of the new coated joints. Results: The main component of the wear debris produced was UHMWPE, and the particle size was mostly below 1 μm. The submicron particle ratio of group B was 49.4%, which was significantly lower than that of the group A and C (75% and 60%, respectively; χ(2)=66.032, 31.754, both P<0.017). The shape was mainly round, and there was no statistical difference between the groups (χ(2)=0.590, P=0.744). The number of particles in group B was significantly less than that of group C on all filters (t=9.960, 8.019, 5.790, all P<0.01), and less than group A on the 0.4 μm filter (t=7.810, P=0.000). Conclusion: The frictional wear performance of the new carbon-based nano-multilayer coatings femoral head is significantly better than that of the domestic femoral head, and even partially exceeds the imported femoral head level, which helps to reduce the production of particles and prevent osteolysis and aseptic loosening induced by UHMWPE particles.

Upregulation of miR-34c after silencing E2F transcription factor 1 inhibits paclitaxel combined with cisplatin resistance in gastric cancer cells

BACKGROUND

MicroRNA 34c (miR-34c) has been reported to be associated with malignant types of cancer, however, it remains unknown whether miR-34c is involved in chemoresistance in gastric cancer (GC).

AIM

To investigate the effect of miR-34c and its upstream transcription factor E2F1 on paclitaxel combined with cisplatin resistance in GC cells.

METHODS

Paired GC tissues and adjacent normal tissues were randomly sampled from 74 GC patients. miR-34c and E2F1 were detected by real-time quantitative PCR (qPCR) and Western blot. In addition, the drug resistance of GC cells to paclitaxel and cisplatin was induced by concentration gradient increasing methods, and changes in miR-34c and E2F1 during this process were measured. Furthermore, E2F1 and miR-34c overexpression or underexpression vectors were constructed and transfected into drug-resistant GC cells. MTT was employed to test the sensitivity of cells to paclitaxel combined with cisplatin, qPCR was adopted to detect the expression of miR-34c, Western blot was applied to detect the expression levels of E2F1, drug resistance-related proteins and apoptosis-related proteins, and flow cytometry was used for the determination of cell apoptosis and cell cycle status.

RESULTS

E2F1 was overexpressed while miR-34c was underexpressed in GC. After inducing GC cells to be resistant to paclitaxel and cisplatin, E2F1 expression increased while miR-34c expression decreased. Both silencing E2F1 and over-expressing miR-34c could increase the sensitivity of drug-resistant GC cells to paclitaxel combined with cisplatin, promote cell apoptosis and inhibit cell proliferation. Among which, silencing E2F1 could reduce the expression of drug resistance-related proteins and apoptosis-related proteins, while over-expression of miR-34c could upregulate the expression of apoptosis-related proteins without affecting the expression of MDR-1, MRP and other drug resistance-related proteins. Rescue experiments demonstrated that inhibiting miR-34c could significantly weaken the sensitization of drug resistant cells, and Si E2F1 to paclitaxel combined with cisplatin.

CONCLUSION

E2F1 inhibits miR-34c to promote the proliferation of GC cells and enhance the resistance to paclitaxel combined with cisplatin, and silencing E2F1 is conducive to improving the efficacy of paclitaxel combined with cisplatin in GC cells.

[3D printing non-coplanar template-assisted 125-iodine seed implantation for thorax movement tumor: individual template design method]

Objective: To compare the dosimetric data between preoperative plans and postoperative verification in computed tomography CT-guided and 3D printing template-assisted 125-iodine ((125)I) seed implantation for thorax movement tumor and to explore the feasibility and accuracy of the individualized template design method. Methods: A total of 35 patients, 20 males and 15 females with median age of 62 (17-87) years old, who registered from January 2016 to December 2017 applied with 3D printing guided template assisted radioactive seed implantations in Peking University Third Hospital were included in this study. (125)I seeds with a prescribed dose of 110-180 Gy were impanted. 3D printing templates were designed and produced for 35 cases. The dosimetric parameters: D(90), minimum peripheral dose (mPD), V(100), V(150), V(200), conformal index (CI), external index (EI), and homogeneity index (HI) were compared between pre-and post-plannings. Statistical method was two group of related non-parameters test. Results: The design and production of 35 cases' templates were in place well. Compared with the preoperative planning, the postoperative D(90), V(100), V(150), V(200), mPD, CI, EI and HI differences were 5.57%, 0.34%, 0.33%, -1.20%, 21%, 2.8%, -14.2%, 4.71%, -10.4%. All the included dosimetry parameters changed slightly after surgery compared with before surgery, but the difference was not statistically significant(all P>0.05). Conclusions: The dosimetric parameters of postoperative verification are consistent well with the preoperative planning and have good accuracy, the results could meet the clinical requirements.

[Survival time and influencing factors in multidrug-resistant tuberculosis patients in Wuhan, 2006-2014]

Objective: To investigate the survival time of multidrug-resistant tuberculosis (MDR-TB) patients and the influential factors in Wuhan. Methods: The relevant information were collected from TB management information system, cause of death reporting system and medical records by trained doctors. The univariate and multivariate Cox proportional hazards model were applied to analyze the factors affecting survival time of patients. Results: A total of 552 patients with MDR-TB were included in the analysis. After the diagnosis of MDR-TB, the cumulative survival rates from the first year to the third year were 0.94, 0.88, and 0.80, respectively. The mortality density of MDR-TB patients was 6.52/100 person-years, and the median survival time was (89.52±1.85) months. Kaplan-Meier analysis showed that the cumulative survival rate of the standardized treatment group was significantly higher than that of the non-standardized treatment group (Log rank=101.070, P<0.001). Compared with the patients aged <30 years, the HR of the patients aged 30-years and ≥60 years were 2.987 (95%CI: 1.268-7.036), 4.957 (95%CI: 1.942-12.653). Compared with the patients with the education level of high school and above, the HR of the patients with education level of junior high school/primary school and below were 1.908 (95%CI: 1.152-3.160), 1.681(95%CI: 1.033-2.735). Compared with the patients without diabetes, the HR of the patients with diabetes was 1.961(95%CI: 1.347-2.854). Compared with the patients without other serious diseases, the HR of the patients with other serious diseases was 2.597 (95%CI: 1.820-3.706). Compared with the patients who had been treated less than one time, the HR of the patients having previous treatment with more than 2 times was 1.611 (95%CI: 1.077-2.409). Compared with patients receiving standard MDR regimen treatment, the HR of the patients receiving no standard MDR regimen treatment was 3.155 (95%CI: 2.132-4.670). Conclusions: The cumulative survival rate of MDR-TB patients without standard treatment was significantly lower than that of patients with standard treatment. Older age, low educational level, diabetes mellitus, other serious diseases, more than two times treatment in the past, and receiving no multi-drug resistance regimen treatment were the risk factors affecting the survival of MDR-TB patients.

Magnetoelectric Coupling by Piezoelectric Tensor Design

Strain-coupled magnetoelectric (ME) phenomena in piezoelectric/ferromagnetic thin-film bilayers are a promising paradigm for sensors and information storage devices, where strain manipulates the magnetization of the ferromagnetic film. In-plane magnetization rotation with an electric field across the film thickness has been challenging due to the large reduction of in-plane piezoelectric strain by substrate clamping, and in two-terminal devices, the requirement of anisotropic in-plane strain. Here we show that these limitations can be overcome by designing the piezoelectric strain tensor using the boundary interaction between biased and unbiased piezoelectric. We fabricated 500 nm thick, (001) oriented [Pb(Mg_1/3Nb_2/3)O₃]_0.7-[PbTiO₃]_0.3 (PMN-PT) unclamped piezoelectric membranes with ferromagnetic Ni overlayers. Guided by analytical and numerical continuum elastic calculations, we designed and fabricated two-terminal devices exhibiting electric field-driven Ni magnetization rotation. We develop a method that can apply designed strain patterns to many other materials systems to control properties such as superconductivity, band topology, conductivity, and optical response.

[Establishment of a CT image radiomics-based prediction model for the differential diagnosis of silicosis and tuberculosis nodules]

Objective: To establish a CT image radiomics-based prediction model for the differential diagnosis of silicosis and tuberculosis nodules. Methods: A total of 53 patients with silicosis and 89 patients with tuberculosis who underwent routine CT scans in Suzhou Fifth People's Hospital from January to August, 2018 were enrolled in this study. AK/ITK software was used to segment the images to obtain 139 silicosis lesions and 119 tuberculosis lesions. For each lesion image, 396 features were extracted, and feature dimension reduction was applied to select the most characteristic feature subset. Support vector machine (SVM) , feedforward back propagation neural network (FNN-BP) , and random forest (RF) were implemented using R software (Rstudio V1.1.463) , and the algorithm that achieved the largest area under of the receiver operating characteristic (ROC) curve (AUC) was selected as the final prediction model. Results: RF was the best prediction model for the differential diagnosis of silicosis and tuberculosis nodules, with an accuracy of 83.1%, a sensitivity of 0.76, a specificity of 0.9, and an AUC of 0.917 (95% confidence interval: 0.8431-0.9758) . RF had a significantly larger AUC than SVM and FNN-BP (P<0.05) . Conclusion: CT image-based RF prediction model can be used to differentially diagnose silicosis and tuberculosis nodules.

[The study of AAV9 expression in cochleae of mice at different ages]

Objective: To determine the extent of transfection and expression of adeno-associated virus (AAV) serotype 9 (AAV9) in the cochleae of mice at different ages. Methods: AAV9-green fluorescent protein (GFP) was inoculated into the cochlea of mice via the round window membrane (RWM) or through cochleostomy at different ages. Four groups were divided according to ages and injection sites: P1SM group, AAV9-GFP was delivered to the scala media by cochleostomy at postnatal day 1; P1RW group, AAV9-GFP was delivered to the scala tympani via RWM at postnatal day 1; P9RW group: AAV9-GFP was injected through RWM at postnatal day 9; and P30RW group, adult mice (P30) were injected through RWM. GFP expression in cochlear whole mount was analyzed and auditory brainstem response (ABR) tests were conducted one month after virus injection (for each animal, only left cochlea was injected and the right side was used as a control). GraphPad Prism 5 statistical software was used for data analysis. Results: All of inner hair cells (IHCs) and most of outer hair cells (OHCs) were transfected via two approaches at P1 injection. There was no significant difference in ABR threshold between injected ears and untreated ears (P>0.05). All of the IHCs and parts of OHCs (69% in apical turn) were transfected via RWM at P9. The strongest GFP expression was observed near the apical turn. Cochlear inoculation via RWM at P30 led to transgene expression in only IHCs. The ABR threshold of injected ears in P9RW group and P30RW group was significantly higher than that of contralateral ears (P<0.01). Conclusions: AAV9 can be highly expressed in the inner and outer hair cells of the cochlea and hearing sensitivity can be preserved if virus injections are performed in neonatal mice. After AAV9 is transfected into the inner ear of adult mice, it is only expressed in the inner hair cells, which leads to the increase of the ABR response threshold of mice. Transfection efficiency is significant higher in neonate mice than in P9 and adult mice.

[Feasibility and safety of the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure]

Objective: To investigate the feasibility and safety of the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure. Methods: A retrospective cohort study was performed. Clinical data of 157 colorectal cancer patients undergoing the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure at Gastrointestinal Surgical Department of Guangdong Provincial People's Hospital from July 2015 to June 2018 were retrospectively analyzed. Of 157 cases, 17 were transverse colon cancer, 94 were descending colon cancer, 25 were sigmoid cancer and 21 were rectal cancer; 89 were male and 68 were female; mean age was (61.8±10.3) years and mean body mass index was (23.2±3.7) kg/m(2). The medial approach "four-step method" in the laparoscopic mobilization of splenic flexure was performed as follows: (1) The root vessels were treated with the "provocation" technique to expand the Toldt's gap. This expansion was extended from the lateral side to the peritoneum reflex of left colonic sulcus, from the caudal side to the posterior rectal space, and from the cephalad side to the lower edge of pancreas. (2) The left colonic sulcus was mobilized, converging with the posterior Toldt's gap. Mobilization was carried out from cephalad side to descending colon flexure, freeing and cutting phrenicocolic ligament and splenocolic ligament, and from caudal side to peritoneal reflex. (3) Gastrocolic ligament was moblized. Whether to enter the great curvature of stomach omentum arch when the gastrocolic ligament was cut, that was, whether to clean the fourth group of lymph nodes, should be according to the tumor site and whether serosal layer was invaded. (4) Transverse mesocolon was moblized and transected at the lower edge of the pancreatic surface, merging with the posterior Toldt's gap, and from lateral side to lower edge of the pancreatic body, merging with the lateral left paracolonic sulcus. Safety and short-term clinical efficacy of this surgical procedure was summarized. Results: All the patients completed this procedure. During operation, 3 cases were complicated with organ injury, including 1 case of colon injury, 1 case of spleen injury and 1 case of pancreas injury. No operative death and conversion to open surgery was found. The average operation time was (147.5±35.1) minutes, the average intra-operative blood loss was (40.8±32.7) ml and the average number of harvested lymph node was (16.1±5.8), including (4.0±2.3) of positive lymph nodes. The first exhaust time after surgery was (41.3±20.6) hours, the fluid intake time was (1.5±1.3) days, the postoperative hospital stay was (5.2±2.3) days. Eight (5.1%) cases developed postoperative complications, and all were improved and discharged after conservative treatments. According to the TNM classification system, postoperative pathology revealed that 31 patients were stage I, 51 were stage II, 53 were stage III, 22 were stage IV. Conclusion: The medial approach "four-step method" is safe and feasible, which can effectively decrease the operation difficulty of the laparoscopic mobilization of the splenic flexure.