Risk factors of haemoglobinuria after microwave ablation of liver tumours

AIM

To explore the risk factors predicting haemoglobinuria after ultrasound-guided percutaneous microwave ablation (MWA) of liver tumours and discuss the treatments and outcomes.

MATERIALS AND METHODS

The present study comprised 2,829 patients admitted for liver tumours treated with MWA from Jan 2011 to April 2017. Ethics committee approval was waived and informed consent for treatment procedures were obtained from the patients. Haemoglobinuria after MWA was found in 149 patients. The influence of 19 risk factors was assessed. Binary logistic regression and receiver operating characteristic (ROC) curve analysis were used for statistical analysis. The treatments and outcomes of patients with haemoglobinuria were summarised.

RESULTS

By univariate analysis, histopathology, liver cirrhosis, MWA volume, MWA energy, and MWA duration were significant risk factors. By multivariate analysis and ROC curve, MWA energy, duration, and volume were identified as predictors of haemoglobinuria after MWA. Drug treatments including kidney protection, adequate hydration, alkalisation of urine, and diuresis were administrated to the patients with haemoglobinuria. One patient progressed to acute kidney injury (AKI) while others had good clinical outcomes.

CONCLUSION

Haemoglobinuria is a controllable side effect after MWA of liver tumours, which is related to high MWA energy, long MWA duration, and great MWA volume. It usually caused few side effects on renal function with correct treatment.

Treatment of hepatocellular carcinoma in the caudate lobe: US-guided percutaneous radiofrequency ablation combined with ethanol ablation

AIM

To evaluate the technical feasibility and treatment results of ultrasound (US)-guided percutaneous radiofrequency ablation (RFA) combined with ethanol ablation (EA) for hepatocellular carcinoma (HCC) in the caudate lobe.

MATERIALS AND METHODS

The institutional review board approved this retrospective study and the requirement for informed consent was waived. From October 2009 to June 2016, there were 49 patients with HCC in the caudate lobe underwent ablation. Among them, 14 patients (12 men and two women, mean age: 49.9±14.9 years) with 16 caudate lobe HCCs (mean size: 3±1.1 cm) who underwent US-guided RFA-EA were identified. These patients were compared with patients who underwent RFA alone (n=17) and EA alone (n=18).

RESULTS

HCCs in the RFA-EA group were larger than those in the EA-alone group (3±1.1 versus 2.1±0.7 cm, p=0.028). In the RFA-EA group, all the patients achieved treatment success (14/14) and entered follow-up. After a follow-up period of 17.1±10.6 months (range, 5-36 months), local tumour progression (LTP) was detected in four tumours. The 1- and 2-year LTP rates after RFA-EA were 18.8% and 27.8%, respectively. The 1- and 2-year disease-free survival (DFS) rates were 35.7% and 13.4%. Six patients died, with the 1-, 2-, and 3-year overall survival (OS) rates of 85.1%, 63.1%, and 21%, respectively. There were no significant differences in the LTP, DFS, and OS rates between the RFA-EA group and RFA-alone or EA groups (p=0.363-0.733).

CONCLUSION

US-guided percutaneous RFA-EA appears to be a feasible and effective treatment for HCC in the caudate lobe.

Sevoflurane activates hippocampal CA3 kainate receptors (Gluk2) to induce hyperactivity during induction and recovery in a mouse model

BACKGROUND

In addition to general anaesthetic effects, sevoflurane can also induce hyperactive behaviours during induction and recovery, which may contribute to neurotoxicity; however, the mechanism of such effects is unclear. Volatile anaesthetics including isoflurane have been found to activate the kainate (GluK2) receptor. We developed a novel mouse model and further explored the involvement of kainate (GluK2) receptors in sevoflurane-induced hyperactivity.

METHODS

Maximal speed, mean speed, total movement distance and resting percentage of C57BL/6 mice were quantitatively measured using behavioural tracking software before and after sevoflurane anaesthesia. Age dependence of this model was also analysed and sevoflurane-induced hyperactivity was evaluated after intracerebral injection of the GluK2 receptor blocker NS-102. Neurones from the hippocampal CA3 region were used to undertake in vitro electrophysiological measurement of kainate currents and miniature excitatory postsynaptic potential (mEPSP).

RESULTS

Sevoflurane induced significant hyperactivities in mice under sevoflurane 1% anaesthesia and during the recovery period, characterized as increased movement speed and total distance. The hyperactivity was significantly increased in young mice compared with adults (P<0.01) and pre-injection of NS-102 significantly prevented this sevoflurane-induced hyperactivity. In electrophysiological experiments, sevoflurane significantly increased the frequency of mEPSP at low concentrations and evoked kainate currents at high concentrations.

CONCLUSIONS

We developed a behavioural model in mice that enabled characterization of sevoflurane-induced hyperactivity. The kainate (GluK2) receptor antagonist attenuated these sevoflurane-induced hyperactivities in vivo, suggesting that kainate receptors might be the underlying therapeutic targets for sevoflurane-induced hyperactivities in general anaesthesia.

[Effect and mechanism of traditional Chinese herbs against Aβ expression in brain tissues of mice with Alzheimer's disease]

Objective: To investigate the effects of gastrodin, astragaloside and paeoniflorin from three types of traditional Chinese herbs against on β-amyloid plaques and memory ability in 5XFAD Alzheimer's disease (AD) transgenic mice. Methods: Seventy 5XFAD mice were randomly divided into seven groups, namely gastrodin-high and gastrodin-low dose groups (GAS-H, GAS-L), astragaloside-high and astragaloside-low dose groups (AST-H, AST-L), and paeoniflorin-high and paeoniflorin-low dose groups (PAE-H, PAE-L), and positive control group. Negative control groups were also established. After being treated for four months, 5XFAD mice were evaluated for memory ability and Aβ plaques, and the mechanism were was explored by utilizing cell model (over-expression Aβ and β-secretase). Results: Gastrodin, astragaloside and paeoniflorin enhanced the learning and memory ability of 5XFAD mice, and reduced Aβ in the cerebral homogenate and Aβ plaques in brain. Compared with the untreated transgenic positive group, Aβ plaques was reduced in hippocampus and cortex in the GAS-H group by 70.1% and 81.0%, in the AST-H group by 62.4% and 69.6%, and in the PAE-H group by 57.6% and 66.6% (P<0.01), respectively. Aβ was reduced in the cerebral homogenate of all groups. The effects were dose-dependent. In vitro study suggested a dose-dependent effect of gastrodin, astragaloside and paeoniflorin in reducing Aβ in cell models. Gastrodin suppressed BACE mRNA level by 32.9% (P<0.01), and suppressed β-secretase protein level by 47.9% (P<0.01). Conclusions: Three types of Chinese herbs can inhibit β-amyloid plaques in brain of AD. Gastrodin reduced Aβ production and accumulation by inhibiting β-secretase. Astragaloside and paeoniflorin have no demonstrable effects against β-secretase.

The incidence, risk factors and in-hospital mortality of acute kidney injury in patients after abdominal aortic aneurysm repair surgery

Background

Acute kidney injury (AKI) is a severe complication associated with abdominal aortic aneurysm (AAA) repair. In this study, we evaluated the incidence, risk factors and in-hospital mortality of AKI in patients after the AAA repair surgery.

Methods

A total of 314 Chinese AAA patients who underwent endovascular aneurysm repair (EVAR) or open aneurysm repair (OPEN) were enrolled in this study. AKI was diagnosed according to the 2012 KDIGO criteria. Logistic regression modeling was used to explore risk factors of AKI, while risk factors associated with in-hospital mortality in AKI patients were investigated using Cox proportional hazards model and Kaplan-Meier analysis, respectively. Multicollinearity analysis was performed to identify the collinearity between the variables before logistic regression analysis and Cox proportional hazards analysis.

Results

Among 314 patients, 94 (29.9%) developed AKI after AAA repair surgery. Severity of AKI and ruptured AAA were independently associated with an increase in in-hospital mortality in AKI patients after AAA repair. Kaplan-Meier analysis identified severity of AKI as being negatively associated with hospital survival in AKI patients. Risk factors associated with AKI included cardiovascular disease (OR 3.169, 95% confidence interval (CI) 1.538 to 6.527, P = 0.002), decreased eGFR (OR 0.965, 95%CI 0.954 to 0.977, P < 0.001), ruptured AAA (OR 2.717, 95%CI 1.320 to 5.592, P = 0.007), renal artery involvement (OR 2.903, 95%CI 1.219 to 6.912, P = 0.016) and OPEN (OR 2.094, 95%CI 1.048 to 4.183, P = 0.036). Further subgroup analysis identified OPEN as an important risk factor of AKI in ruptured AAA patients but not in ruptured AAA patients. The incidence of AKI was significantly lower in EVAR than in OPEN (27.1% vs. 42.8%) and, similarly lower in nonruptured AAA than in ruptured AAA (26.2% vs. 48.1%).

Conclusion

One-third of AAA patients developed AKI after repair surgery. Severity of AKI was associated with reduced survival rate in AAA patients who developed postoperative AKI. Decreased preoperative creatinine clearance, cardiovascular disease, ruptured AAA and OPEN were independent risk factors for postoperative AKI in all 314 AAA patients. Although a lower rate of incident AKI was observed in EVAR compared with OPEN, subgroup analysis of ruptured AAA versus nonruptured AAA showed that EVAR was an independent protective factor for AKI only in ruptured AAA patients but not in nonruptured AAA patients.

Effect of micro-particles on cavitation erosion of Ti6Al4V alloy in sulfuric acid solution

The influences of micro-particles on ultrasonic cavitation erosion of Ti6Al4V alloy in 0.1M H₂SO₄ solution were investigated using mass loss weight, scanning electron microscopy (SEM) and white light interferometer. Mass loss results revealed that the cavitation erosion damage obviously decreased with increasing particle size and mass concentration. Open circuit potential recorded during cavitation erosion shifted to positive direction with the decreased mass loss. Meanwhile, the mass loss sharply decreased with applying a positive potential during the entire ultrasonic cavitation erosion, and the relationship between the open circuit potential and the cavitation erosion resistance was discussed.

Enhancement of cavitation erosion resistance of 316 L stainless steel by adding molybdenum

The influence of Mo on ultrasonic cavitation erosion of 316 L stainless steel in 3.5% NaCl solution were investigated using an ultrasonic cavitation erosion (CE) facility. The morphologies of specimen after cavitation erosion were observed by scanning electron microscopy (SEM). The results showed that the addition of Mo can sharply decrease the mean depth of erosion (MDE) of 316 L SS, implying the increased resistance of cavitation erosion. In order to better understanding the influence of Mo on the cavitation erosion of 316 L SS, the semi-conductive property of passive films on 316 L SS containing different concentrations of Mo were studied by Mott-Schottky plot. Based on Mott-Schottky results and semiconductor physics, a physical model was proposed to explain the effect mechanism of Mo on cavitation erosion of 316 L SS.

[CT findings of inflammatory myofibroblastic tumor of different pathological types]

Objective: To explore the computed tomography(CT) features of inflammatory myofibroblastic tumor(IMT) in different pathological types, and improve the diagnostic level of this disease. Methods: The CT features of 29 cases pathologically confirmed IMTs were retrospectively reviewed along with a literature review to analyze the CT features and pathological correlations, and three kinds of pathological classification of IMT in patients with gender , shape, boundary and location were respectively analyzed by Chi-Square test. Results: The age ranges from 2 to 78 years.There were 7 cases of mucinous blood vessel type and 13 cases of spindle cell type and 9 cases of fiber type.Immunohistochemically, Vimentin (22/29) and SMA (28/29) were positive in all the cases, ALK (4/29) and CD-67(6/29) were partly positive expression, other markers such as S-100 were negative expression.The Chi-Square test showed that there were statistically differences in the gender of the patients. Conclusion: The CT and clinical features differ according to pathological types of IMT. Its final diagnosis still needs to be combined with pathology and immunohistochemistry result. In all, CT has a role in assessing the extension of IMT and especially about the relationship with adjacent organs which can effectively direct the establishment of clinical treating scheme.

Qualitative and quantitative determination of coumarin using surface-enhanced Raman spectroscopy coupled with intelligent multivariate analysis

Coumarin is harmful to health but still used in cosmetics, tobacco, or illegally added into food as a spice in trace amounts so that it is exceedingly difficult to be determined accurately.

The level of mercury contamination in mariculture sites at the estuary of Pearl River and the potential health risk

In the present study, the Hg contamination in mariculture sites located at the estuary of Pearl River was to investigate with an attempt to analyse associated health risks of dietary exposure to both total mercury (THg) and methyl mercury (MeHg) in cultured fish and shellfish. The highest total mercury concentration (7.037 ± 0.556 ng L^-1) of seawater was observed at Zhuhai Estuary. The Hg concentrations of sediment in Guishan Island were significantly higher (p < 0.05) than in Daya Bay (away from the Pearl River). Besides, the both THg and MeHg levels in sediment at mariculture sites were higher (p < 0.05) than corresponding reference sites. It was attributed to the fact that mariculture activities increased Hg loading and promoted MeHg production. The vertical distribution of Hg in sediment cores demonstrated that mercury methylation mostly occurred at the sediment-water interface. Results of health risk assessments showed that fish consumption would impose a higher risk to children but less to adults, while shellfish produced in the studied area was safe for consumption.

Alternative splicing directs two IL-20R2 isoforms and is responsible for the incomplete gene knockout via the exon I ablation

Two heterodimeric receptors consisting of interleukin (IL)-20R2 are shared by three of the IL-20 family of cytokines, IL-19, IL-20 and IL-24. Along with IL-22, these cytokines are downstream effectors of IL-23 and have been implicated in keratinocyte functions and the pathogenesis of psoriasis. Surprisingly, whereas knocking out either the IL-23 or IL-22 gene abolished imiquimod-induced psoriatic phenotypes in mice, similar attempt for IL-20R2 had little effect. Here, we report that the apparent disparity may result from a new IL-20R2 isoform encoded by an alternatively spliced transcript which survived the previous attempt for IL-20R2 gene knockout via the exon I deletion.

[The diagnosis and treatment of primary thyroid lymphoma]

Primary thyroid lymphoma (PTL) refers to the malignant tumor of primary lymphoid tissue in the thyroid, accounting for approximately 5% of all thyroid malignancies and less than 3% of all extranodal lymphomas. PTL usually develops in females more than 50 years old. Most of PTL cases are non-Hodgkin's lymphomas. The major pathological subtypes are mucosa-associated lymphoid tissue lymphoma and diffuse large B-cell lymphoma. Treatment options for individual pathological subtypes are also different, so pathological diagnosis is very important. The main treatment options include surgical treatment, radiotherapy, chemotherapy, targeted therapy and combined therapy. The main aims of surgical treatment are to obtain a determined diagnosis and to relieve airway pressure, . The prognosis of PTL is generally excellent.

[Value of gemstone spectral CT imaging in diagnosis of solitary pulmonary nodule]

OBJECTIVE

To observe the diagnostic efficiency of gemstone spectral CT imaging in diagnosis of solitary pulmonary nodule (SPN).

METHODS

A total of 114 patients with SPN proved by pathology (from the First Affiliated Hospital of Zhengzhou University and 13 cooperative hospitals) underwent spectral CT from July 2014 to July 2015.All the patients were divided into malignant group(63 cases), inflammatory group(32 cases) and tuberculosis group(19 cases) .Iodine concentration(IC), normalized iodine concentration(NIC) and slope rate of spectral curve(40-80 keV) in both arterial and venous phase were measured and calculated.The one-way ANOVA and LSD were used to analyze parameters among 3 groups.ROC curves were taken to calculate the diagnostic efficiency and the diagnostic sensitivity and specificity .

RESULTS

IC, NIC and slope rate of spectral curve had statistically significant differences in both phases (all P<0.05). The malignant group was the highest, and the tuberculosis group was the lowest(all P<0.05). When NIC(venous phase)>0.31, NIC>0.28, NIC>0.21, the sensitivity of diagnosing malignant and inflammatory SPN, malignant and tuberculosis SPN, inflammatory and tuberculosis SPN were respectively 81.0%, 85.7%, 84.4%, and the specificity of them were 71.9%, 94.7%, 84.2%, respectively.

CONCLUSION

Spectral CT imaging is helpful to diagnosis of SPN, and venous phase NIC can get high sensitivity and specificity for qualitative diagnosis of SPN.

Induction of Cytochrome P450 Activity by the Interaction of Chlorantraniliprole and Sinigrin in the Spodoptera exigua (Lepidoptera: Noctuidae)

The joint toxicity of chlorantraniliprole, a novel insecticide that acts on ryanodine receptors, and sinigrin, a natural plant defense compound from brassicaceous vegetables, to the larvae of Spodoptera exigua (Hübner) was determined in this paper. Additionally, the joint effects of the two compounds on cytochrome P450 enzyme activity and on the expression levels of mRNA of three P450 genes (including CYP9A9, CYP6B, and CYP4G37) and an NADPH cytochrome P450 reductase gene (HQ852049) were investigated. The toxicity of the mixture of chlorantraniliprole and sinigrin to fourth-instar S. exigua larvae was 1.60-fold higher than the toxicity of the chlorantraniliprole-only treatment after 24 h. Induced by chlorantraniliprole and sinigrin, the specific activity of the P450 O-deethylase was affected in a time-, dose-, and organ-specific manner in fifth-instar S. exigua larvae. The effects were more pronounced in the midgut than in the fat body. The specific activity of the P450 O-deethylase in almost all treatments increased at 12, 24, and 36 h posttreatment compared with that in the control. Based on real-time PCR analyses, the expression levels of the P450 genes CYP9A9, CYP6B, and CYP4G37 and the NADPH cytochrome P450 reductase gene HQ852049 in fifth-instar S. exigua larvae were induced by chlorantraniliprole and sinigrin, and the trends were similar to the specific activity of the P450 O-deethylase. Therefore, the CYP9A9, CYP6B, and HQ852049 in the tested genes were the most inducible genes that were expressed when the S. exigua larvae were exposed to chlorantraniliprole and sinigrin.

Prospective purification of perivascular presumptive mesenchymal stem cells from human adipose tissue: process optimization and cell population metrics across a large cohort of diverse demographics

BACKGROUND

Adipose tissue is an attractive source of mesenchymal stem cells (MSC) as it is largely dispensable and readily accessible through minimally invasive procedures such as liposuction. Until recently MSC could only be isolated in a process involving ex-vivo culture and their in-vivo identity, location and frequency remained elusive. We have documented that pericytes (CD45-, CD146+, and CD34-) and adventitial cells (CD45-, CD146-, CD34+) (collectively termed perivascular stem cells or PSC) represent native ancestors of the MSC, and can be prospectively purified using fluorescence activated cell sorting (FACS). In this study we describe an optimized protocol that aims to deliver pure, viable and consistent yields of PSC from adipose tissue. We analysed the frequency of PSC within adipose tissue, and the effect of patient and procedure based variables on this yield.

METHODS

Within this twin centre study we analysed the adipose tissue of n = 131 donors using flow cytometry to determine the frequency of PSC and correlate this with demographic and processing data such as age, sex, BMI and cold storage time of the tissue.

RESULTS

The mean number of stromal vascular fraction (SVF) cells from 100 ml of lipoaspirate was 34.4 million. Within the SVF, mean cell viability was 83 %, with 31.6 % of cells being haematopoietic (CD45+). Adventitial cells and pericytes represented 33.0 % and 8 % of SVF cells respectively. Therefore, a 200 ml lipoaspirate would theoretically yield 23.2 million viable prospectively purified PSC - sufficient for many reconstructive and regenerative applications. Minimal changes were observed in respect to age, sex and BMI suggesting universal potential application.

CONCLUSIONS

Adipose tissue contains two anatomically and phenotypically discreet populations of MSC precursors - adventitial cells and pericytes - together referred to as perivascular stem cells (PSC). More than 9 million PSC per 100 ml of lipoaspirate can be rapidly purified to homogeneity using flow cytometry in clinically relevant numbers potentially circumventing the need for purification and expansion by culture prior to clinical use. The number and viability of PSC are minimally affected by patient age, sex, BMI or the storage time of the tissue, but the quality and consistency of yield can be significantly influenced by procedure based variables.