[Clinical analysis of 24 cases of synovial sarcoma of head and neck]

Objective: To investigate the pathological characteristics, treatment and prognosis of synovial sarcoma of head and neck. Methods: The clinical data of 24 patients with synovial sarcoma of the head and neck treated in the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2020 were retrospectively analyzed. There were 16 males and eight females, aged 17 to 75 years. The pathological features, treatment and follow-up were summarized. Cumulative survival was estimated by Kaplan-Meier method. Results: All patients' diagnoses were confirmed by pathological examinations. Most cases showed the tumors were composed of spindle cells under microscope, with the characteristics of malignant tumor cells, and some tumors also showed epithelioid cell morphology, forming the typical pathological characteristics of biphasic differentiation. Except for one patient who could not tolerate surgery and the diagnosis was only confirmed by biopsy, the remaining 23 patients received surgical treatment, including three patients receiving surgical treatment alone, five patients receiving post-operative adjuvant radiotherapy, seven patients receiving post-operative adjuvant chemotherapy, and eight patients receiving post-operative adjuvant radiotherapy. Follow-up time was 3.0-114.1 months (median follow-up time: 25.2 months), including two cases of loss to follow-up, 10 cases of recurrence, five cases of lung metastases, one case of bone metastasis, and 12 cases of death. The 1-year, 3-year and 5-year survival rates for the 24 patients with synovial sarcoma of head and neck were 74.4%, 58.9% and 39.2%, respectively. Conclusion: Synovial sarcoma of the head and neck has a high recurrence rate, common distant metastasis and poor prognosis. Histopathology and immunohistochemical examinations are an important basis for diagnosis, if necessary, combined with molecular genetics. Surgical resection is the main treatment, preferring radical or expanded resection.

Acute appendicitis complicated by mesenteric vein thrombosis: A case report

BACKGROUND

Acute appendicitis with mesenteric vein thrombosis (MVT) is an uncommon condition and usually lacks specific clinical manifestations, which leads to a high rate of misdiagnosis or delayed diagnosis, especially when it is accompanied by other abdominal diseases. Prompt and accurate recognition is vital for treatment and prognosis.

CASE SUMMARY

A 37-year-old woman had a history of acute metastatic right lower abdominal pain, nausea, and fever. A contrast-enhanced computed tomography (CT) scan showed a filling defect in the mesenteric vessels. The patient was diagnosed with acute appendicitis complicated by MVT and was treated with anticoagulation and intravenous antibiotics. The follow-up CT scan showed full resolution of the thrombosis and inflammation.

CONCLUSION

Clinical awareness is essential for recognizing MVT, especially when it is accompanied by other common acute abdominal diseases, such as acute appendicitis. Contrast-enhanced CT is helpful for the diagnosis of MVT and is recommended for patients with acute abdominal diseases.

[Evaluation of inferior mesenteric vessel and ureter by contrast-enhanced abdominal pelvic CT and its clinical influence on laparoscopic rectal surgery]

Objective: To assess the anatomic relationship of inferior mesenteric artery (IMA)/inferior mesenteric vein (IMV) with ureter by contrast-enhanced abdominal pelvic CT, in order to provide guidance for vascular management and ureteral protection in laparoscopic rectal surgery. Methods: A retrospective cohort study was conducted. Image data of contrast-enhanced abdominal pelvic CT at Department of Medical Radiography of Peking University First Hospital in November 2018 were enrolled. Exclusion criteria: (1) previous history of abdominal or pelvic surgery; (2) scoliosis deformities; (3) missing images; (4) minors; (5) inferior mesenteric vascular disease or tumor involvement resulting in suboptimal imaging; (6) poor image quality. Finally, contrast-enhanced abdominal pelvic CT data of 249 cases were collected, including 120 males and 129 females with mean age of (60.1±13.4) years. Multi-planar reconstruction (MPR) and maximum intensity projection (MIP) were used to evaluate the anatomic relationship of IMA/IMV with ureter. IMA root location, IMA length, branch types of IMA, distance between major branches, distance between IMA/IMV and ureter at the level of root of IMA, left colic artery (LCA) root, abdominal aortic bifurcation, and sacral promontory were measured and association between IMA/IMV and ureter site was summarized. Results: The distance from IMA root to the aortic bifurcation and sacral promontory was (42.0±8.5) mm and (101.8±14.0) mm, respectively. The length of IMA was (38.5±10.7) mm. The proportion of IMA roots locating at levels of the 2nd, 3rd, and 4th lumbar vertebra was 3.2% (8/249), 79.5% (198/249), and 17.3% (43/249), respectively. The higher the level of the lumbar vertebra, the longer the IMA [length of IMA originating from the 2nd, 3rd, 4th lumbar vertebra level: (42.4±10.9) mm, (39.5±10.4) mm, (33.0±10.9) mm, respectively; F=7.48, P<0.001]. In 111 cases (44.6%), LCA arose independently from IMA (type 1), and the distance between LCA and the first branch of sigmoid artery (SA) was (15.0±7.4) mm; in 56 cases (22.5%), LCA and SA had a common trunk (type 2), with a length of (11.0±8.5) mm; in 78 cases (31.3%), LCA branched with SA at the same point (type 3); LCA was absent in 4 cases (1.6%)(type 4). The length of IMA in LCA-deficient type 4 was (54.8±18.0) mm, which was longer than (38.2±10.5) mm in LCA-presence type (type 1, type 2 and type 3) and the difference was statistically significant (t=-3.11, P=0.002). The distance between the ureter and IMA was the longest at the level of IMA root [(35.7±8.1) mm], was the shortest at the level of the aortic bifurcation [(22.4±6.4) mm], and the distance between the ureter and IMA in different planes was significantly different (F=185.70, P<0.001). The distance between the ureter and IMV was the longest at the level of the sacral promontory [(21.1±9.0) mm], was the shortest at the level of LCA root [(12.0±5.7) mm], whose difference was also statistically significant (F=87.66, P<0.001). Conclusions: CT post-processing techniques including MPR and MIP can efficiently and accurately assess the branch types of IMA and anatomical relationship between IMA/IMV and ureter, and provide insights into laparoscopic rectal surgery for surgeons. IMA/IMV and ureter depart farthest at the level of IMA root. Artery first and plane second strategy in the middle approach of laparoscopic rectal surgery is considerable and feasible.

[Preoperative evaluation using multi-slice spiral CT angiography of right-side colon vascular in laparoscopic radical operation for right colon cancer]

Objectives: To examine the value of multi-slice spiral CT angiography (MSCTA) in the analysis of anatomical variation and structural classification of right colon vessels. Methods: From August 2015 to August 2017, 198 patients (96 of whom underwent laparoscopic radical resection of right colon cancer) at Department of General surgery of Peking University First Hospital were retrospectively collected, and the results of abdominal enhanced CT scan were collected and three-dimensional reconstruction of blood vessels was performed. There were 104 males and 94 females. The age was 64(27) years (M(Q(R)), range: 19 to 87 years). Right gastroepiploic vein, anterior superior pancreaticoduodenal vein, right colonic vein (RCV), superior right colonic vein, ileocolon artery or vein (ICA or ICV), middle colon artery or vein (MCA or MCV) and Henle trunk were observed and recorded respectively. The anatomical relationship between the positions of blood vessels, the length of Henle trunk and surgical trunk were measured. Results: ICV and ICA were the most constant anatomic structures. The ICV/ICA of all patients came directly from SMV/SMA, 36.9% (73/198) ICV going in front of SMV and 63.1% (125/198) behind SMV. 72.2% (143/198) of the patients had RCV imported into Henle trunk and the rest into SMV. Middle colonic vein (MCV) could be observed in 81.3% (161/198) of the cases. 81.4% (131/161) of MCV were imported into SMV, 16.8% (27/161) into Henle trunk, 1.2% (2/161) into the first jejunal vein and 0.6% (1/161) into the splenic vein. Henle trunk was divided into 4 types, among which the occurrence probability of gastric node and pancreatic trunk was the highest. The dry length of Henle trunk was (0.82±0.39) cm (range: 0.37 to 1.68 cm). The length of surgical trunk was (2.54±0.83) cm (range: 1.57 to 3.95 cm). Accuracy of MSCTA results was 96.9%(93/96). Conclusions: Anatomical variation of blood vessels in the right colon is common. Abdominal CT angiography can accurately determine the anatomical structure of the blood vessels in the right colon.

Application of three-dimensional visualization technique in preoperative planning of progressive hilar cholangiocarcinoma

OBJECTIVE

This study aims to investigate the role of three-dimensional visualization technique in the diagnosis and treatment of progressive hilar cholangiocarcinoma.

METHODS

From January 2014 to February 2017, a three-dimensional visualization model was set up in 23 patients with progressive hilar cholangiocarcinoma. The distributions and variations of the hepatic portal ducts were observed. The tumors were classified based on Bismuth classification. The simulation operation was performed and the operation plan was established.

RESULTS

All 23 patients revealed a clear relationship between the intrahepatic and extrahepatic ducts, as well as the tumors and ducts. An individualized surgery program was established through the accurate calculation of liver volume and residual liver volume. Among these patients, 13 patients completed radical resection of hilar cholangiocarcinoma combined with massive hepatectomy. No bile leakage occurred and no operative death was found.

CONCLUSION

For patients with progressive hilar cholangiocarcinoma, the optimized three-dimensional visualization technique can accurately demonstrate the dilated biliary tract system, provide a new standard to determine the presence of tumor and peripheral vascular invasion, help in establishing a reasonable individualized operation plan, reduce the incidence of bile leakage and liver failure after the operation, and improve the success rate of operation.

Enhanced P, N and C removal from domestic wastewater using constructed wetland employing construction solid waste (CSW) as main substrate

Construction solid waste (CSW), an inescapable by-product of the construction and demolition process, was used as main substrate in a four-stage vertical subsurface flow constructed wetland system to improve phosphorus P removal from domestic wastewater. A 'tidal flow' operation was also employed in the treatment system. Under a hydraulic loading rate (HLR) of 0.76 m3/m2 d for 1st and 3rd stage and HLR of 0.04 m3/m2 d for 2nd and 4th stage of the constructed wetland system respectively and tidal flow operation strategy, average removal efficiencies of 99.4% for P, 95.4% for ammoniacal-nitrogen, 56.5% for total nitrogen and 84.5% for total chemical oxygen demand were achieved during the operation period. The CSW-based constructed wetland system presents excellent P removal performance. The adoption of tidal flow strategy creates the aerobic/anoxic condition intermittently in the treatment system. This can achieve better oxygen transfer and hence lead to more complete nitrification and organic matter removal and enhanced denitrification. Overall, the CSW-based tidal flow constructed wetland system holds great promise for enabling high rate removal of P, ammoniacal-nitrogen and organic matter from domestic wastewater, and transforms CSW from a waste into a useful material.

A promising approach of reject water treatment using a tidal flow constructed wetland system employing alum sludge as main substrate

This study examined a novel reuse of alum sludge, an inescapable by-product of drinking water treatment process when aluminium salt is added as a coagulant, as the main medium in a laboratory-scale multi-stage constructed wetland (CW) system for reject water treatment. Such reject water is a main concern in municipal wastewater treatment plant (MWWTP) for increasing the organic and nutrient loading. A 'tidal flow' strategy was employed to enhance the wetland aeration to stimulate organic matters (OM) and ammoniacal-nitrogen (N) oxidation while the 'step feed' operation was adopted to supply the necessary amount of carbon source for denitrification. The results reveal that alum sludge acting as P adsorbent can secure the P removal. Meanwhile, high removals of N and OM can also be obtained due to the active bacteria growth on the alum sludge surface. The results show that average removal efficiencies of 65.4 +/- 12.3% for chemical oxygen demand (COD), 67.8 +/- 9.2% for five-day biochemical oxygen demand (BOD5), 33.6 +/- 17.0% for N and 99.5 +/- 0.49% for P can be achieved over a period of 190 days. This indicates that novel reuse of alum sludge as medium in CW system can provide a promising approach for reject water treatment. Therefore, it will significantly reduce the amount of pollutant feedback through reject water recycling in a MWWTP.

Towards the development of a novel construction solid waste (CSW) based constructed wetland system for tertiary treatment of secondary sewage effluents

This study was conducted to examine the possibility of using construction solid waste (CSW), an inevitable by-product of the construction and demolition process, as the main substrate in a laboratory scale multi-stage constructed wetland system (CWs) to improve phosphorus (P) removal from secondary sewage effluent. A tidal-flow operation strategy was employed to enhance the wetland aeration. This will stimulate aerobic biological processes and benefit the organic pollutants decomposition and nitrification process for ammoniacal-nitrogen (NH(+)(4)-N) removal. The results showed that the average P concentration in the secondary sewage effluent was reduced from 1.90 mg-P/L to 0.04 mg-P/L. CSW presents excellent P removal performance. The average NH(+)(4)-N concentration was reduced from 9.94 mg-N/L to 1.0 mg-N/L through nitrification in the system. The concentration of resultant nitrite and nitrate in the effluent of the CSW based CWs ranged from 0.1 to 2.4 mg-N/L and 0.01 to 0.8 mg-N/L, respectively. The outcome of this study has shown that CSW can be successfully used to act as main substrate in CWs. The application of CSW based CWs on improving N and P removals from secondary sewage effluent presents a win-win scenario. Such the reuse of CSW will benefit both the CSW disposal and nutrient control from wastewater. More significantly, such the application can transfer the CSW from a 'waste' to 'useful' material and can ease the pressure of construction waste solid management. Meanwhile, the final effluent from the CSW-based CWs can be used as non-potable water source in landscape irrigation, agriculture and industrial process.

Two continuous spectrophotometric assays for methionine aminopeptidase

Two spectrophotometric assays have been developed for methionine aminopeptidases (MetAPs). The first method employs a thioester substrate which, upon enzymatic removal of the N-terminal methionine, generates a free thiol group. The released thiol is quantitated using Ellman's reagent. The MetAP reaction is conveniently monitored on a UV-VIS spectrophotometer in a continuous fashion, with the addition of an excess of Ellman's reagent into the assay reaction. Two tripeptide analogues were synthesized and found to be excellent substrates of both Escherichia coli MetAP and human MetAP2 (k(cat)/K(M) = 2.8 x 10(5) M(-1) s(-1) for the most reactive substrate). In the second assay method, the MetAP reaction is coupled to a prolyl aminopeptidase reaction using Met-Pro-p-nitroanilide as substrate. MetAP-catalyzed cleavage of the N-terminal methionine produces prolyl-p-nitroanilide, which is rapidly hydrolyzed by the prolyl aminopeptidase from Bacillus coagulans to release a chromogenic product, p-nitroaniline. This allows the MetAP reaction to be continuously monitored at 405 nm on a UV-VIS spectrophotometer. The assays have been applied to determine the pH optima and kinetic constants for the E. coli and human MetAPs as well as to screen MetAP inhibitors. These results demonstrate that the current assays are convenient, rapid, and sensitive methods for kinetic studies of MetAPs and effective tools for screening MetAP inhibitors.

A direct spectrophotometric assay for peptide deformylase

A direct UV-VIS spectrophotometric assay has been developed for peptide deformylase. This assay employs a novel class of peptide mimetics as deformylase substrates which, upon enzymatic removal of the N-terminal formyl group, rapidly release free thiols. The released thiols are quantitated using Ellman's reagent. A variety of peptide analogues that contain beta-thiaphenylalanine or beta-thiamethionine as the N-terminal residue were synthesized and found to be excellent substrates of the peptide deformylase from Escherichia coli (k(cat)/K(M) = 6.9 x 10(5) M(-1) s(-1) for the most reactive substrate). The deformylase reaction is conveniently monitored on a UV-VIS spectrophotometer in a continuous fashion. The versatility of the assay has been demonstrated by its application to kinetic characterization of the deformylase, pH profile studies, and enzyme inhibition assays. The assay can also be performed in an end-point fashion. The results demonstrate that this assay is a simple, highly sensitive, and rapid method to study kinetic properties of deformylases without the use of any coupling enzymes.

[Clinical observation on treatment of 40 cases of apoplexy hemiplegia complicated shoulder-hand syndrome with electro-acupuncture]

The authors treated 40 cases of shoulder-hand syndrome of apoplexy hemiplegia with electro-acupuncture (EA) and filiform needle acupuncture (FNA) respectively. The results showed that EA had better results in treating hand back swelling, hand skin temperature elevating and the bending finger caused pain than that with FNA (P < 0.05). The finger joint and shoulder joint improvement (the functional scoring increased for 3 points or more) in EA was also better than that of FNA (P < 0.05). The total marked effective rate was higher in EA group (75%) than that in FNA (50%), P < 0.05). It suggested that EA produced rhythmic muscle contraction which had a "shoulder-hand pump" like action, and is significant in eliminating hand back swelling and preventing atrophy of hand muscles.

[Relation of coronary heart disease based on traditional Chinese medicine syndrome differentiation and prostaglandin, blood platelet function, and protein C]

The relationship between 68 cases of thromboxane B2(TXB2), 6-keto-prostaglandin F1 alpha (6-K-PGF1 alpha), beta-thromboglobulin (beta TG), platelet factor 4 (PF4), protein C antigen (PC:Ag), total-proteins (T-Ps) with coronary heart disease (CHD) based on TCM syndrome differentiation were studied. 45 cases of male, 23 cases of female, they were divided into 30 cases of blood stasis group and 38 cases of Qi syndrome group. 39 healthy subjects of same age and sex were chosen as the control group. The results were as follows: The TXB2, beta TG, PF4 in CHD were higher than those of control. 6-K-PGF1 alpha was lower (P less than 0.05, P less than 0.01) respectively. The TXB2 in blood stasis was significantly higher than that of Qi syndrome while the 6-K-PGF1 alpha in Qi Syndrome was significantly lower than that of blood stasis syndrome (P less than 0.01). The PC:Ag, T-Ps in CHD were higher than those of the control. The PC:Ag in blood stasis was lower and was higher in Qi syndrome (P less than 0.01). It showed that microthrombosis formed in blood stasis group caused blood flow slowly, while coronary-pathy and/or coronary spasm were the major pathologic change in Qi syndrome. Elevated PC:Ag, T-Ps in Qi syndrome showed that there were complementary action to hypercoagulation in Qi syndrome to eliminate coagulation factor to prevent coagulation happening and stimulation of fibrinolysin activator, promoting fibrinogenolysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Mutation frequencies from X-rays, ultraviolet light, and methyl methanesulfonate in Chinese hamster ovary cells incubated with 3-aminobenzamide

An inhibitor of polyadenosine diphosphoribose polymerase, 3-aminobenzamide, had no effect on survival or mutagenesis in Chinese hamster ovary cells exposed to X-rays or u.v. light. After exposure to methyl methanesulfonate, 3-aminobenzamide increased cell killing and mutagenesis at the 6-thio-guanine-resistance locus, but had no effect on mutagenesis at the ouabain-resistance locus. These results are consistent with the greater role played by polyadenosine diphosphoribose in cells damaged by alkylating agents rather than by radiations.

Potentiation of sister chromatid exchange by 3-aminobenzamide is not modulated by topoisomerases or proteases

Poly(ADP-ribose) is synthesized in response to DNA strand breaks and covalently modifies numerous intracellular proteins. We have proposed that this modification regulates, i.e., inhibits, the activity of these enzymes, e.g., topoisomerases and proteases, which could otherwise cause additional DNA damage or alterations in chromatin structure. Inhibition of poly(ADP-ribose) polymerase by 3-amino-benzamide (3AB) in cells exposed to DNA-damaging agents would, according to this proposal, eliminate the regulatory role of ADP-ribosylation. When Chinese hamster ovary cells are cultured with methyl methanesulfonate (MMS) and 3AB, a synergistic increase in sister chromatid exchange frequency is observed. We investigated the regulatory role of poly(ADP-ribose) polymerase to see if topoisomerases or proteases are involved in this synergistic increase. Cells were exposed to MMS or the intercalating agent 4'-(9-acridinylamino)methanesulfon-m-anisidide (m-AMSA), 3AB, and either the topoisomerase inhibitor novobiocin or the protease inhibitor antipain. Neither novobiocin nor antipain affected the synergistic response of MMS and 3AB or the additive response of m-AMSA and 3AB. These results suggest that topoisomerases or proteases do not account for the effect of 3AB on sister chromatid exchange frequency after DNA damage.