[Suprapubic-assisted laparoendoscopic single-site surgery in nephroureterectomy A case series of 4 patients]

Objective: To evaluate the feasibility and clinical value of suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) in nephroureterectomy using method of transvaginal natural orifice specimen extraction (NOSE) (SA-LESS+TV-NOSE NU). Methods: Four patients (three cases of renal pelvic carcinoma and one case of ureteral carcinoma) undergoing SA-LESS+TV-NOSE NU were enrolled between April 2015 and January 2016. After general anesthesia, the patients were placed in the lithotomy position with the affected side elevated by 60°. Two trocars were inserted at the medial margin of umbilicus, and the third one was inserted into abdominal cavity at the superior margin of pubic symphysis. The operation was performed under a direct vision with a 5.4 mm 0° flexible-tip laparoscope. Firstly, the distal ureter was isolated completely and blocked by a Hem-O-lok clip. Then, the laparoscopic nephrectomy was performed according to the standard method. Finally, the bladder cuff excision was executed and the incision was sutured. The intact specimen was placed inside a homemade bag and removed through the incision at posterior vaginal fornix. Results: All the procedures were successfully performed. The median operative time was 150 (range: 120 to 210) minutes, and the median estimated blood loss was 180 (range: 80 to 350) ml. No major perioperative complications occurred. The mean visual analogue score (VAS) of 24 hours and 48 hours after operation were 3.25 (range: 2 to 5) and 2.25 (range: 2 to 3). All the patients resumed ambulation on postoperative day 1. Pelvic drainage tube was removed on postoperative day 2-4. On postoperative day 7, urethral catheter was removed. The patients were discharged on postoperative day 7-9. During the follow-up of 20-29 months, the patient recovered well with no case of incisional hernia and pelvic, abdominal infections. The vaginal fornix incision healed well, and the umbilical and suprapubic puncture scars were not obvious. All the patients completed the patient-assessed acromegaly symptom questionnaire PASQ. The average PSAQ score of 3 months after surgery was 34.5. Three of them restarted their sex lives, with an average female sexual function index score of 16.0, which was not significantly different with that of preoperation (15.6). There was no tumor recurrence, metastasis and implantation in all cases. Conclusion: SA-LESS+TV-NOSE NU is safe and feasible for upper tract urothelial carcinoma with faster postoperative recovery, less pain, shorter hospitalization time, better cosmetic results, and does not cause negative effect on the female sexual function.

P2433Local blood viscosity and local Reynolds number are associated with coronary plaque calcium and lipid

Background

Despite being a shear-thinning non-Newtonian fluid, most computational fluid dynamic (CFD) simulations assume blood to be a Newtonian fluid with constant viscosity. The use of more realistic assumptions may deepen mechanistic understanding of the relationship between blood flow disturbances and atherosclerosis, and improve the diagnostic accuracy of CFD simulations.

Purpose

To compare associations between plaque composition and local hemodynamics at a single time point using Newtonian versus non-Newtonian rheological models in patient-specific coronary arteries. To investigate whether viscosity-based local haemodynamic indices correlate with plaque composition.

Methods

Sixteen patient-specific coronary arteries containing non-culprit plaques were reconstructed from optical coherence tomography imaging. CFD simulations using Newtonian and non-Newtonian models were performed to calculate endothelial shear stress (ESS). Local blood viscosity (LBV) and local Reynolds number (ReL) were calculated from non-Newtonian simulation data. Each haemodynamic index was distributed into quintiles, mapped in 5-degree sectors, and compared to plaque composition using logistic regression.

Results

In total, 69120 sectors from 960 OCT frames were analysed. The lowest ESS quintiles were associated with underlying lipid (ESS<0.8Pa: odds ratio [OR] 1.26, p<0.001, 95% CI 1.15–1.38; ESS 0.8–1.1Pa: OR 1.71, p<0.001, 95% CI 1.58–1.85), while the highest quintile of ESS (>2.2Pa) had lower odds of underlying lipid (OR 0.89, p=0.015, 95% CI 0.82–0.98) compared to the median ESS quintile. However, in the non-Newtonian results, only the second lowest quintile of ESS (1.1–1.5Pa) was associated with lipid (OR 1.54, p<0.001, 95% CI 1.42–1.67). Low ReL was associated with lipid (ReL<28: OR 1.71, p<0.001, 95% CI 1.55–1.89; ReL 28–38: OR 1.47, p<0.001, 95% CI 1.35–1.58). Conversely, the highest quintile of ReL had decreased odds of lipid (ReL>68: OR 0.69, p<0.001, 95% CI 0.62–0.76) (FIGURE). In both the Newtonian and non-Newtonian results, lower ESS was associated with increased odds of underlying calcium. Whereas the lowest quintile of LBV had a lower odds of calcium (LBV<1.4: OR 0.60, p<0.001, 95% CI 0.52–0.71), the highest quintile had significantly higher odds of underlying calcium (LBV>1.5: OR 1.38, p<0.001, 95% CI 1.18–1.63)

Conclusions

Using the standard Newtonian assumption, low ESS is associated with underlying lipid. However, using a more realistic non-Newtonian rheological model, there is no strong or consistent relationship between ESS and underlying lipid, highlighting the importance of methodological assumptions and lingering questions in arterial CFD simulation. Non-Newtonian indices LBV and ReL are independently associated with calcium and lipid, respectively, suggesting possible mechanistic effects of local blood viscosity in atherosclerosis and implying their use as novel haemodynamic markers of atherosclerosis.

[Morphological characteristic of anal canal in patients with dyssynergic defecation and its correlation with anorectal manometry]

Objective: To evaluate the diagnostic value of three-dimensional endoanal ultrasound (3D-EAUS) for dyssynergic defecation (DD). Methods: A case-control study was performed to retrospectively collectclinical data of 46 DD patients, including 16 males and 30 females with median age of 51 (20 to 70) years, at Nanjing Hospital of Chinese Medicine from February 2012 to April 2015.All the patients met the diagnostic criteria of functional constipation of Rome III. The paradoxical contraction of puborectalis (PR) muscle was found by both rectal examination and anorectal manometry. In the same period,45 healthy volunteers, including 22 males and 23 females with median age of 48 (21 to 72) years, without pelvic operation history, and with normal defecation in recent 6 months, were enrolled as the control group. No significant differences were observed in age and gender between two groups (both P>0.05). Cleveland constipation score of DD group was higher than that of control group [15(8-24) vs. 5(1-9), t=15.720, P<0.001]. 3D-EAUS examination was performed in all the subjects. Thickness and length of internal anal sphincter (IAS) (anterior side and posterior side), thickness of PR muscle, length of external anal sphincter (EAS) plus PR muscle, and puborectalis angle were measured and compared by using student t test between two groups. Correlation between these ultrasound parameters and anorectal manometry was examined by Pearson correlation analysis. Results: Both male and female in the DD group had the greater thickness of IAS, as compared to those in the control group [male: (1.7±0.5) mm vs.(1.5±0.2) mm, t=2.516, P=0.016; female: (1.9±0.4) mm vs.(1.6±0.5) mm, t=2.034,P=0.047]. No significant differences between the two groups were observed with respect to the posterior length of IAS, length of EAS plus PR muscle, and thickness of PR muscle (all P>0.05). Compared to the control group, male in the DD group had smaller puborectalis angle during straining [(87.0±3.6)° vs. (90.5±1.8)°,t=3.502,P=0.002];female in the DD group had smaller puborectalis angle both in resting and straining [resting:(86.5±3.8)° vs. (90.1±2.1)°,t=4.047, P<0.001;straining: (84.1±4.5)° vs. (90.2±2.3)°, t=5.938, P<0.001]. Correlation analysis showed that anterior length of IAS was positively correlated with anal resting pressure (r=0.321, P=0.030); the length of EAS plus PR muscle was positively correlated with anal squeeze pressure (r=0.415, P=0.004). There were no correlations between the thickness and the posterior length of IAS and the anal resting pressure, or between the thickness of PR muscle and the anal squeeze pressure (all P>0.05). Conclusions: The 3D-EAUS can accurately assess the morphological features of anal canal in DD patients. There is a certain positive correlation between 3D-EAUS and anorectal manometry.

Effects of different drainage methods on serum bile acid and hepatocyte apoptosis and regeneration after partial hepatectomy in rats with obstructive jaundice

The aim of this study was to investigate the mechanism of hepatocyte apoptosis and regeneration after partial hepatectomy in obstructive jaundice (OJ) rats under different drainage methods of bile acid intervention. Forty male Sprague Dawley rats were randomly divided into five groups. An OJ rat model was established by the following protocols. Seven days after obstruction, an SD rats model with 70% partial hepatectomy was established by different drainage methods of OJ. Blood and liver tissue samples were collected from rats 72 h after surgery; 72 h after partial hepatectomy (PH), the liver regeneration rate, the expression of proliferating cell nuclear antigen (PCNA) and the level of mitotic index (MI) in the internal biliary drainage (IBD) group were higher than those in external biliary drainage (EBD) group (P less than 0.05). Those in the EBD group were higher compared to the OJ group (P less than 0.05). There was no significant difference among the IBD group, EBD+CA group and (SO) sham operation group (P>0.05). Bax expressions had the same trend as AI in the five groups. The expression of Bcl-2 was increased in the IBD group and EBD+CA group, which was statistically higher compared to the SO group (P less than 0.05). In conclusion, both internal and external drainage can relieve biliary obstruction. The difference in liver regeneration caused by external drainage and internal drainage may be attributed to the destruction of bile acid enterohepatic circulation, which increases hepatocyte apoptosis and affects liver regeneration.

[Tolerance and pharmacodynamics phase Ⅰ clinical trial study of chimeric anti-CD20 monoclonal antibody IBI301 in Chinese patients with CD20-positive non-Hodgkin's lymphoma]

目的

通过剂量递增的Ⅰ期临床试验，评价重组人-鼠嵌合抗CD20单克隆抗体注射液IBI301单次给药在经治疗达客观缓解的CD20⁺ B细胞非霍奇金淋巴瘤患者中的耐受性、安全性及药效学特征。

方法

纳入9例受试者，按剂量递增原则设125、375和500 mg/m²三个剂量组，每组3例逐组完成试验。3组受试者均接受单次IBI301静脉输注，125、375、500 mg/m²组IBI301的中位暴露量分别为243、690、980 mg。观察IBI301给药后不良事件（AE）发生情况。采用流式细胞术检测外周血CD19⁺、CD20⁺ B细胞比例，采用速率散射比浊法检测血清IgG、IgM水平，进行药效学评价。

结果

9例受试者发生52例次AE，包括：125 mg/m²组18例次，375 mg/m²组14例次，500 mg/m²组20例次。其中不良反应共26例次，22例次与试验药物可能有关，4例次可能无关；对症处理后均消失或恢复至基线水平。常见的AE包括WBC降低、上呼吸感染、ANC降低、消化不良、高尿酸血症、感觉异常、口腔黏膜炎和头晕。研究中未出现AE导致的用药暂停、受试者退出或试验提前中止，未发生严重AE（SAE）及剂量限制性毒性（DLT）事件。所有受试者CD20⁺、CD19⁺ B细胞比例均有不同程度下降，而IgG和IgM水平无明显变化。

结论

IBI301耐受性良好，受试者出现的不良反应均恢复，未发生SAE及DLT事件。IBI301对CD20⁺ B细胞有较好的清除作用。

[Age-related clinical characteristics and prognosis in non-senile adults with acute myeloid leukemia]

目的

探讨非老年成人初发急性髓系白血病（AML）患者年龄相关的临床特征、早期治疗反应和预后。

方法

回顾性分析2008年1月至2017年12月收治的18~65岁初发AML（非急性早幼粒细胞白血病）连续病例，分析不同年龄组患者初诊时疾病特征、早期治疗反应、复发和生存，以及相关影响因素。

结果

共收集1 097例患者，男性591例（53.9%），中位年龄42岁。随着年龄的增长，患者WBC显著下降（P=0.003)，PLT显著上升（P=0.034），骨髓原始细胞比例显著下降（P=0.021）。SWOG危险度在各年龄组的分布差异无统计学意义（P=0.063）。NPM1阳性伴FLT3-ITD阴性的患者比例随年龄增长显著上升（P<0.001)。多因素分析显示，在总人群中，年龄增加是获得形态学无白血病状态（MLFS）（P=0.053）、完全缓解（CR）（P=0.004）和总生存（OS）（P=0.070）的不利影响因素，但在接受标准诱导治疗的患者中，年龄增加仅与CR相关（P=0.075），而与MLFS和OS无关。

结论

非老年初发AML患者的临床、细胞遗传学和分子学特征随年龄变化而不同。在接受标准诱导治疗的患者中，年龄增加与获得MLFS和OS均无显著相关性。

Incidence and predictors of aorta calcification in patients with systemic lupus erythematosus

Objective

Artery calcification, as subclinical atherosclerosis, is attracting attention. The aim of this study was to determine the prevalence and risk factors of artery calcification in patients with systemic lupus erythematosus.

Methods

641 patients with systemic lupus erythematosus were enrolled in the study. Demographic, clinical, and laboratory characteristics were collected. Calcification score was quantified from the multi-detector computed tomography scan image using the Agatston Score method.

Results

The total incidence of artery calcification was 25.9% (166/641), of which the percentages of aorta calcium and coronary artery calcification were 23.1% (148/641) and 8.4% (54/641), respectively. In multivariate models, systemic lupus erythematosus patients with artery calcification had longer disease duration than patients without artery calcification ( p < 0.05). Presence of serositis (OR 2.559, 95%CI 1.414–4.632), pneumonia (OR 2.022, 95%CI 1.102–3.711) and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score (OR 1.049, 95%CI 1.004–1.095) were independently associated with increased risk of aorta calcium, while the duration of corticosteroids use (OR 1.039, 95%CI 1.002–1.078) and cyclophosphamide therapy (OR 8.251, 95%CI 2.496–27.279) were independently associated with increased risk of coronary artery calcification in systemic lupus erythematosus patients. In systemic lupus erythematosus patients, aorta calcium was prone to occur at a younger age compared to coronary artery calcification, and aorta calcium score was positively correlated with age.

Conclusions

Systemic lupus erythematosus patients had a much earlier onset and higher incidences of aorta calcium than coronary artery calcification. Presence of serositis, pneumonia, and higher SLEDAI score may predict increased risk of aorta calcium.

[Effects of platelet-rich plasma on the survival of ultra-long dorsal random flaps in rats]

Objective: To observe the effects of platelet-rich plasma (PRP) on the survival of ultra-long dorsal random flaps in rats. Methods: Sixteen male Sprague Dawley rats aged 6 to 8 weeks (the same below) were sacrificed to collect whole blood of 9 to 10 mL from each rat, and PRP was prepared by modified APPLE method. The platelet count of retained whole blood and PRP detected by automated blood cell analyzer showed that PRP was made successfully. The other thirty-two rats were collected and divided into PRP group and control group according to the random number table, with 16 rats in each group. One rectangular ultra-long random flap with area of 8 cm×2 cm was made on the back of each rat and replanted in situ. The equidistant 3 points were designed on both sides of the flap of each rat. Rats in PRP group were injected with 0.1 mL PRP from dermis and subcutaneous tissue of each injection point, while rats in control group were injected with the same volume of normal saline. Eight rats in each group were sacrificed at post operation hour (POH) 24 and on post operation day (POD) 7. On POD 7, survival of flaps of rats in 2 groups was observed, and the survival rates of flaps were calculated. On POD 7, the proximal, middle, and distal flaps of rats in 2 groups were collected, and histological changes of the flaps of rats in 2 groups were observed with hematoxylin-eosin staining. At POH 24 and on POD 7, flaps in 3 to 4 cm to pedicles were taken to detect mRNA expressions of vascular endothelial growth factor (VEGF), platelet-derived growth factor AA (PDGF-AA) and PDGF-BB by real-time fluorescent quantitative reverse transcription polymerase chain reaction, and to determine content of nitric oxide by nitrate reductase method. Data were processed with t test. Results: (1) On POD 7, flaps of rats in PRP group were dry without purulent exudate, and covered with scab, and the pink new skin emerged after scab fell off. On POD 7, flaps of rats in control group were with a large amount of inflammatory exudates, 1/2 to 2/3 of flaps at the distal were with necrosis and covered by scab which was not easy to be stripped. The survival rate of flap of rats in PRP group was (67±6)%, significantly higher than (52±10)% of rats in control group (t=1.94, P<0.05). (2) There were no obvious inflammatory cell infiltration and a number of microvessels, and fibrous tissue arranged neatly in the proximal flaps of rats in PRP group. There were a few of inflammatory cell infiltration and a number of microvessels, and fibrous tissue arranged slightly disorderly in the middle flaps of rats in PRP group. There were many more inflammatory cell infiltration and microvessels, a small amount of vascular embolism, and fibrous tissue arranged disorderly in the distal flaps of rats in PRP group. There were a large number of inflammatory cells infiltration and a few of microvessels, and fibrous tissue arranged disorderly in the proximal, middle, and distal flaps of rats in control group. (3) At POH 24 and on POD 7, mRNA expressions of VEGF, PDGF-AA, and PDGF-BB of rats in PRP group were significantly higher than those of rats in control group (t=6.46, 5.61, 2.88, 10.18, 6.10, 7.67, P<0.001). (4) At POH 24, content of nitric oxide in flap of rats in PRP group was (5.0±0.9) μmol/g, significantly higher than (3.4±0.9) μmol/g of rats in control group (t=19.14, P<0.001). On POD 7, content of nitric oxide in flap of rats in PRP group was (3.3±0.8) μmol/g, which was close to (3.0±0.6) μmol/g of rats in control group (t=2.93, P>0.05). Conclusions: PRP can improve the survival rate of ultra-long dorsal random flap in rats, which may be related to regulation of angiogenesis related factors, increase of nitric oxide content, and inhibition of excessive apoptosis of cells of PRP, so as to alleviate ischemical reperfusion injury and improve microcirculatory disturbance.

Is lower low-density lipoprotein cholesterol associated with lower androgen and erectile dysfunction in men?

BACKGROUND AND AIMS

Therapeutic possibilities now exist to lower low-density lipoprotein cholesterol (LDL-C) to very low levels. However, substantial controversy remains in clinical practice with regard to its safety, and the question of whether low LDL-C levels per se may provoke adverse effects in humans arises. We aimed to explore the association of LDL-C with androgen and erectile dysfunction (ED) in a general population of men.

METHODS AND RESULTS

A total of 4203 men without hormone replacement therapy were enrolled from 22 sites in East China. Total testosterone (T) and Free T were assessed. Free androgen index (FAI) was calculated. The IIEF-5 questionnaire was used to assess ED. We found that free T and FAI gradually and markedly increased with increasing LDL-C levels. Using linear regression, after adjusting for age, educational level, economic status, smoking status, drinking status, BMI, diabetes, and use of lipid-lowering medication, LDL-C was positively associated with free T (B = 0.175, 95% CI: 0.084, 0.266) and FAI (B = 0.064, 95% CI: 0.016, 0.112). Meanwhile, there was a U-shaped curvilinear relationship between LDL-C and prevalence of ED. In the logistic regression analysis, compared to those with LDL-C among the 10th-90th percentile, the ORs of ED in men in the lowest and highest deciles were 1.938 (95% CI: 1.121, 3.349) and 1.804 (95% CI: 1.117, 2.916), respectively.

CONCLUSION

Lower LDL-C levels were significantly associated with lower free T and lower FAI in a general population of men. Moreover, both low and high levels of LDL-C might be risk factors for ED.

The impact of TRAIL on proliferation of secretory prostate cancer PC-3 cell and LMO2 gene expression

OBJECTIVE

To determine the expressions of TRAIL protein and LMO2 gene in prostate cancer tissues with different differentiation degree and identify the influence of TRAIL on prostate cancer PC-3 cell proliferation.

PATIENTS AND METHODS

Surgical specimens from a total of 30 prostate cancer patients with radical prostatectomy were collected. The subjects were divided into three groups according to the different degrees of differentiation. TRAIL positive rate was detected by immunohistochemistry (IHC). LMO2 expression was assessed by Real-time PCR and Western-blot. PC-3 cell proliferation was determined by CCK-8 assay.

RESULTS

The positive rate of TRAIL protein was significantly higher in moderately differentiated group (80%) and well differentiated group (100%) compared with that in poorly differentiated group (54.55%), respectively (χ2 = 27.33, p < 0.05; χ2 = 40.12, p < 0.01). Streptavidin-peroxidase (SP) assay showed that TRAIL protein expression in well-differentiated group was significantly higher than that in moderately differentiated group and poorly differentiated group. qRT-PCR result demonstrated that LMO2 mRNA levels in moderately and well-differentiated group were significantly increased compared to that in poorly differentiated group (p < 0.001). Also, the proliferation rate of PC-3 cells in well-differentiated group was significantly higher than that in well-differentiated and moderately differentiated groups (p < 0.05).

CONCLUSION

Our data indicated that the positive rate of TRAIL protein increased in a prostate cancer differentiation dependent manner.

[Prognostic significance of blood count at the time of achieving morphologic leukemia-free state in adults with acute myeloid leukemia]

目的

探讨首次获骨髓无白血病状态时血细胞恢复程度[包括完全缓解（CR，ANC≥1.0× 10⁹/L和PLT≥100×10⁹/L）、PLT未恢复（CRp）、ANC和PLT均未恢复（CRi）]对初治成人急性髓系白血病（AML）患者预后的影响。

方法

回顾2008年1月至2016年2月北京大学人民医院收治的获得骨髓无白血病状态后持续化疗AML（非急性早幼粒细胞白血病）连续病例，分析诊断时疾病特征、诱导化疗方案、首次诱导化疗反应以及骨髓无白血病状态时血细胞计数与预后的关系。

结果

352例患者，男179例（50.9%），中位年龄44（17~65）岁。按美国西南肿瘤组（SWOG）标准分组：低危87例（24.7%），中危171例（48.6%），高危46例（13.1%），未知48例（13.6%）。单体核型16例（4.5%），FLT3-ITD突变阳性41例（11.6%）。首次获骨髓无白血病状态时血细胞恢复程度：CR 299例（84.9%），CRp 26例（7.4%），CRi 27例（7.7%）。存活患者中位随访16（2~94）个月，30个月累积复发（CIR）、无病生存（DFS）和总生存（OS）率分别为47.5%、46.0%和58.6%。多因素分析显示，骨髓无白血病状态时血细胞恢复不良是影响患者CIR、DFS和OS的共同不利因素（HR=1.4，95% CI 1.0~1.9，P=0.037；HR=1.5，95% CI 1.1~2.0，P= 0.003；HR=1.5，95% CI 1.1~2.0，P=0.017）。此外，SWOG分组危险度高和FLT3-ITD突变阳性是影响患者CIR、DFS和OS的共同不利因素；确诊时外周血原始细胞比例高是影响患者DFS的不利因素；年龄大和确诊时骨髓原始细胞比例高是影响患者OS的不利因素。

结论

持续化疗的成人AML患者，首次获骨髓无白血病状态时血细胞恢复程度是影响预后的独立因素。

[Change in peripheral nervous conduction velocity in patients with occupational chronic mercury poisoning and related influencing factors]

Objective: To investigate the change in peripheral nervous conduction velocity in patients with occupational chronic mercury poisoning and related influencing factors. Methods: From February 2011 to December 2014, urinary mercury examination and neural electromyography were performed for 104 patients with occupational chronic mercury poisoning. The data on age, type of work, working years of mercury exposure, and past medical history were collected, and peripheral nervous conduction velocity and its correlation with age, working years of mercury exposure, and urinary mercury concentration were analyzed. Results: All the 104 patients with occupational chronic mercury poisoning had a mean of 45.37±9.82 years, median (P(25), P(75)) working years of 7 (3, 11) , and a median (P(25), P(75)) urinary mercury concentration of 88.50 (56.25, 163.03) μg/g Cr. The major clinical manifestations of peripheral nerve injuries were numbness of extremities (20.2%) , hypopselaphesia/hypalgesia or hyperpselaphesia/hyperalgesia (9.6%) , and bone/muscle pain in the extremities (6.7%) . Neural electromyography showed an increase in denervation potential (fibrillation potential or positive sharp wave) and a detection rate of abnormal peripheral nervous conduction velocity as high as 65.4%. The patients with an older age and more working years had a higher incidence rate of abnormal sensory conduction velocity of the ulnar nerve. There were significant reductions in motor and sensory conduction velocities of the median nerve, motor and sensory conduction velocities of the ulnar nerve, motor conduction velocity of the common peroneal nerve, and the sensory conduction velocity of the superficial peroneal nerve (P<0.05) , with the increase in urinary mercury concentration. Conclusion: Patients with occupational mercury poisoning have a high rate of abnormal neural electromyographic findings, which can be used as an important method for early identification of chronic peripheral nerve injuries induced by mercury poisoning. The degree of peripheral nerve injuries increases with the increasing time of mercury exposure and urinary mercury concentration.

[Detection and Analysis of the peripheral lymphocytes micronucleus rate of radiation workers in a city]

Objective: To perform lymphocyte micronucleus analysis on radiation workers with long-term exposure to low doses ionizing radiation, Evaluate the health condition of radiation workers, and provide the evidence for strengthening surveillance of radiation workers. Methods: From January 1, 2013 to December 21, 2016, a statistical analysis and evaluation was conducted of the peripheral lymphocytes micronucleus rate in 5 901 radiation workers who had undergone medical examinations of employees at Chinese Academy of Medical Sciences Institute of Radiation Medicine. Results: The micronucleus rates in radiation workers of the on-job group were higher than the pre-job group (P<0.01) . Significant difference was found among the different sex (t=5.97) , different types (χ(2)=378.69) , different levels of work units (χ(2)=115.48) . Significant difference was found among the micronucleus rates of 672 radiation workers of the on-job group from 2013 to 2016 (χ(2)=92.57, P<0.01) . Conclusion: The peripheral lymphocytes micronucleus rate of radiation workers were significantly higher than non-contact workers. Significant increasing trend of micronucleus rates was noted among the radiation worker with increasing exposure time. The peripheral lymphocytes micronucleus rates of interventional therapy workers were highest. The peripheral lymphocytes micronucleus rates of Private hospitals workers were highest. This phenomenon deserves attention. Protection needs to be strengthened to ensure the health of radiation workers.

[Value of MRI in the pre-operative diagnosis and classification of oblique vaginal septum syndrome]

Objective: To explore the role of MRI in the pre-operative diagnosis and classification of oblique vaginal septum syndrome (OVSS) . Methods: A retrospective analysis of the clinical records and pre-operative MRI images of 19 patients with surgery proved OVSS was carried out. Two experienced radiologists reviewed the pre-operative pelvic MRI of the 19 patients in consensus blind to the surgery results. Characteristics including malformations of the uterus, cervix and vagina, the diagnosis of the disorder and classification were evaluated. Pre-operative MRI diagnosis and classification were correlated with surgical findings. Results: Mean age of onset of symptoms for the 19 patients was 15 years (ranged 9-25 years) , and mean age of menarche was 12 years. Ten patients suffered from dysmenorrhea or lower abdominal pain, 5 patients complained of vaginal discharge, 3 patients had a history of irregular menstruation, 1 patient suffered from primary infertility. All 19 patients showed uteri didelphys. Eighteen patients showed vaginal oblique septum.One patient showed cervical atresia.MRI was completely correlated with the surgery in the pre-operative diagnosis of OVSS. MRI classification was in line with surgery in 17 patients, including 9 patients with imperforate septum (typeⅠ) , 6 patients with perforate septum (type Ⅱ) , 1 patient with imperforate septum and cervical fistula (type Ⅲ) , and another one with cervical agenesis (type Ⅳ) . One case of type Ⅱ was misdiagnosed as type Ⅰ, another one of type Ⅰ was misdiagnosed as type Ⅲ. Pre-operative MRI classification was correlated with surgery in 17 out of 19 patients. Conclusion: Pre-operative MRI allows excellent manifestation and accurate diagnosis of OVSS, and could also facilitate the evaluation of the classification.

Decision analysis supports the use of drain amylase-based enhanced recovery method after esophagectomy

Postesophagectomy anastomotic leak is a common postsurgical complication. The current standard method of detecting leak is esophagram usually late in the postoperative period. Perianastomotic drain amylase level had shown promising results in early detection anastomosis leak. Previous studies have shown that postoperative day 4 amylase level is more specific and sensitive than esophagram. The purpose of this study is to determine if implementing a drain amylase-based screening method for anastomotic leak can reduce length of stay and hospital cost relative to a traditional esophagram-based pathway. The drain amylase protocol we propose uses postoperative day 4 drain amylase level to direct the initiation of PO intake and discharge. We designed a decision analysis tree using TreeAge Pro software to compare the drain amylase-based screening method to the standard of care, the esophagram. We performed a retrospective review of postesophagectomy patients from a tertiary academic medical center (University hospital Cleveland medical center) where amylase level was measured routinely postoperatively. The patients were separated into amylase-based pathway group and the standard of care group based on their postop management. The length of stay, costs, complications, and leak rate of these two groups were used to inform the decision analysis tree. In the base-case analysis, the decision analysis demonstrated that an amylase-based screening method can reduce the hospital stay by one day and reduced costs by ∼$3,000 compared to esophagram group. To take the variability of the data into consideration, we performed a Monte Carlo simulation. The result showed again a median saving of 0.71 days and ∼$2,500 per patient in hospital cost. A ballistic sensitivity analysis was performed to show that the sensitivity of postoperative day 4 amylase level in detecting a leak was the most important factor in the model. We conclude that implementing an amylase-based screening method for anastomotic leak in postesophagectomy patient can significantly reduce hospital cost and length of stay. This study demonstrates a novel protocol to improve postesophagectomy care. Based on this result, we believe a prospective multicenter study is appropriate.

The expression of circulating tumor cells in peripheral blood of patients with non-small cell lung cancer and its detection

This study aimed to investigate the expression of circulating tumor cells (CTCs) in peripheral blood and relevant detection methods as well as the clinical values of determination of CTCs for the diagnosis of non-small cell lung cancer (NSCLC). Peripheral blood specimens were acquired from the patients with NSCLC who came to the Thoracic Surgery Department of Jining No.1 People’s Hospital, Shandong, China for the first visit between January 2015 and November 2016. Whether there was metastasis of CTCs or not was determined by detecting the number of epithelial cell adhesion molecules (EpCAM) which had expression in the CTCs of the peripheral blood with fluorescence polymerase chain reaction. Moreover, the correlation between the expression level of EpCAM of patients with NSCLC during postoperative adjuvant treatment and the efficacy of adjuvant therapy was initially explored. The expression level of EpCAM of the NSCLC patients was remarkably different to that of the patients with benign lung diseases. The expression level of EpCAM of the patients with NSCLC was notably different with that of the healthy volunteers. The expression level of EpCAM of the patients with NSCLC was much higher than that of patients with benign lung diseases and the volunteers. Moreover, the expression level of NSCLC at stages I, II and IIIA had significant differences; the expression level of EpCAM tended to increase as the stage of NSCLC developed. The expression level of EpCAM in CTCs of peripheral blood can be regarded as a reference for the early diagnosis and detection of NSCLC before and after surgery.