[Endoscopic lateral neck dissection via the breast and transoral approaches for papillary thyroid carcinoma: a report of 10 cases]

Objective: To investigate the feasibility of endoscopic lateral neck dissection via the breast and transoral approaches (ELNDBTOA) for papillary thyroid carcinoma (PTC). Methods: From February 2015 to April 2019, 10 patients with PTC (cN1b) including 1 male and 9 females aged from 22 to 53 years old received ELNDBTOA in the General Surgery Department of Zhongshan Hospital, Xiamen University. Total thyroidectomy, the central lymph node dissection and the selective neck dissection (levels Ⅱ, Ⅲ and Ⅳ) were performed endoscopically via the breast approach, and then the residual lymph nodes were dissected via transoral approach. The medical records, operation time, blood loss, complications and postoperative follow-up outcomes were analyzed retrospectively. SPSS 22.0 software package was used for statistical processing of clinical data of patients. Results: All cases were successfully treated with ELNDBTOA without transfer to open surgery. The average operative time was (362.5±79.7) min, the blood loss was (23.0±14.9) ml, and the postoperative hospital stay was (5.1±1.3) days. The mean number of harvested cervical lymph nodes were (34.2±25.8), and the mean number of positive lymph nodes were (6.5±4.9). Lymph nodes were dissected by the further dissection via oral approach in 6 patients and a total of 9 lateral lymph nodes were havested from 2 of the 6 patients, with 3 positive lymph nodes. Two patients had transient skin numbness in the mandibular area and recovered within two weeks. One patient developed transient hypoparathyroidism and recovered within two months. No secondary bleeding, recurrent laryngeal nerve paralysis, chylous leakage, neck infection, permanent hypoparathyroidism or other complications were observed. The follow-up time was from 16 to 66 months with a median of 42.5 months, no tumor recurrence or metastasis occurred, and also no obvious deformity, abnormal sensation or movement in the chest, neck and mouth was observed. Conclusions: ELNBTOA is safe and feasible, with good cosmetic outcome.

[Clinical analysis of 9 cases of a novel stent assisted intestinal bypass for preventing anastomotic leakage in laparoscopic assisted radical resection of rectal cancer]

Objective: To examine the safety and effectiveness of a novel stent assisted intestinal bypass for preventing anastomotic leakage in laparoscopic assisted radical resection of rectal cancer. Methods: The clinical data of 9 patients with rectal cancer who underwent laparoscopic radical resection and stent assisted intestinal bypass from September 2019 to June 2020 at the Department of Anus & Intestine Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University were retrospectively analyzed. There were 6 males and 3 females, aged (62.1±6.8) years (range: 53 to 75 years), underwent laparoscopic assisted radical resection of rectal cancer and stent assisted intestinal bypass. A degradable diverting stent was placed at the end of the ileum, and a drainage tube was placed at the proximal end of the stent to bypass the intestinal contents. After operation, the patients were given a diet with less residue. From the 14^th day after operation, abdomen X-ray films were taken every 5 to 7 days to observe the destination of the stent dynamically. When the stent was observed to be disintegrated into pieces, the drainage tube was clamped for 3 days to observe any side effects before the tube was removed. The operation time, the time of removing the bypass tube and the total hospital stay were recorded. Results: Laparoscopic assisted radical resection of rectal cancer and stent assisted intestinal bypass were successfully performed in all patients. The operation time was (230.4±48.0) minutes (range: 150 to 318 minutes), and the time of removing shunt tube was (28.8±4.6) days (range: 22 to 34 days). The duration of hospitalization was (21.0±8.6) days (range: 9 to 34 days). Postoperative pathological examination showed 7 cases of moderately differentiated adenocarcinoma, 1 case of moderately well differentiated adenocarcinoma and 1 case of mucinous adenocarcinoma. There were 2 cases of T1, 4 cases of T2 and 3 cases of T3. The number of lymph node dissection was 13.4±3.5 (range: 6 to 18), 3 cases were positive and 6 cases were negative. The post-operation follow-up time was 6 to 16 months, no anastomotic leakage or stenosis was found. Conclusion: Stent assisted intestinal bypass for the prevention of anastomotic leakage in laparoscopic assisted radical resection of rectal cancer is safe and feasible, and shows good short-term effect.

[Clinical effects of retrograde anterolateral thigh perforator flaps assisted with computed tomography angiography in repairing skin and soft tissue defects around the knee or in proximal lower leg]

Objective: To investigate the clinical effects of retrograde anterolateral thigh perforator flaps assisted with computed tomography angiography (CTA) in repairing skin and soft tissue defects around the knee or in proximal lower leg. Methods: A retrospective cohort study was conducted. From May 2015 to October 2019, 17 patients with skin and soft tissue defects around the knee or in proximal lower leg were admitted to the Department of Orthopedics of Jizhong Energy Xingtai Mig General Hospital, including 12 males and 5 females, aged 16-65 years, with an average age of 35 years. The areas of skin and soft tissue defects after debridement ranged from 6.0 cm×3.0 cm to 15.0 cm×9.0 cm. The retrograde anterolateral thigh perforator flaps were designed according to the origin and distribution of the perforating branches in flaps and the length of the vascular pedicle examined with CTA and the condition of the wound to repair the wounds. The areas of resected flaps ranged from 6.5 cm×3.5 cm to 15.5 cm×9.5 cm. The wounds in donor sites of flaps were sutured directly or covered with medium-thickness skin grafts from healthy upper leg. The sources of the perforating branches in flaps were recorded. The lateral circumflex femoral artery, its branches, and the relative length of the vascular pedicle were compared between preoperative CTA detection and intraoperative observation. The survivals of the flaps were observed. At the last follow-up, the effects of flaps in repairing wounds were evaluated according to evaluation standard of efficacy satisfaction; the motion ranges of flexion and extension of the knee joint were measured, and the knee joint function was evaluated according to the Hohl knee joint function evaluation standard; the sensory function in the flap area was evaluated according to the sensory function evaluation standard formulated by the British Medical Research Council; the wound healing and the occurrence of complication affecting motor function of limb of flap donor sites was observed. Data were statistically analyzed with paired sample t test. Results: The perforating branches in flaps originated from descending branches, oblique branches, and rectus femoris branches of lateral circumflex femoral artery in 7, 6, and 4 patients, respectively. The flaps with blood supply from descending branches, oblique branches, and rectus femoris branches of lateral circumflex femoral artery were type 1, 2, and 3 retrograde anterolateral thigh perforator flaps, respectively. The preoperative CTA examination of lateral circumflex femoral artery and its branches were consistent with those observed during operation. The relative lengths of vascular pedicles of type 1, 2, and 3 retrograde anterolateral thigh perforator flaps calculated after CTA examination were 0.32±0.13, 0.56±0.07, and 0.56±0.15, which were close to 0.35±0.12, 0.52±0.10, and 0.53±0.12 measured and calculated during operation, respectively (t=0.45, 0.80, 0.31, P>0.05). All flaps survived in 17 cases without vascular crisis. At the last follow-up, 16 patients were satisfied with effects of flaps in wound repair, with 1 patient feeling average about the effect; the flexion range of knee joint was 100-120°, and the extension range of knee joint was -2-0°; knee joint function was evaluated as excellent in 9 cases, good in 7 cases, and poor in 1 case; the sensory function of the flap area reached S₄ level in 2 cases, S₃ level in 8 cases, and S₂ level in 7 cases; the wounds in flap donor sites healed well; there was no adverse effect in motor function of limbs. Conclusions: Retrograde anterolateral thigh perforator flap is an effective method for repairing skin and soft tissue defects around the knee or in proximal lower leg. Preoperative CTA examination can fully show the anatomical characteristics of the branches of the lateral circumflex femoral artery and the perforating vessels of each branch, which can guide preoperative flap design and operation, thus shortening operation time and improving flap survival rate, with good clinical effects.

Experimental Evidence of Kinetic Effects in Indirect-Drive Inertial Confinement Fusion Hohlraums

We present the first experimental evidence supported by simulations of kinetic effects launched in the interpenetration layer between the laser-driven hohlraum plasma bubbles and the corona plasma of the compressed pellet at the Shenguang-III prototype laser facility. Solid plastic capsules were coated with carbon-deuterium layers; as the implosion neutron yield is quenched, DD fusion yield from the corona plasma provides a direct measure of the kinetic effects inside the hohlraum. An anomalous large energy spread of the DD neutron signal (∼282  keV) and anomalous scaling of the neutron yield with the thickness of the carbon-deuterium layers cannot be explained by the hydrodynamic mechanisms. Instead, these results can be attributed to kinetic shocks that arise in the hohlraum-wall-ablator interpenetration region, which result in efficient acceleration of the deuterons (∼28.8  J, 0.45% of the total input laser energy). These studies provide novel insight into the interactions and dynamics of a vacuum hohlraum and near-vacuum hohlraum.

Synthesis and Anticancer Activities of Glycyrrhetinic Acid Derivatives

A total of forty novel glycyrrhetinic acid (GA) derivatives were designed and synthesized. The cytotoxic activity of the novel compounds was tested against two human breast cancer cell lines (MCF-7, MDA-MB-231) in vitro by the MTT method. The evaluation results revealed that, in comparison with GA, compound 42 shows the most promising anticancer activity (IC₅₀ 1.88 ± 0.20 and 1.37 ± 0.18 μM for MCF-7 and MDA-MB-231, respectively) and merits further exploration as a new anticancer agent.

Correlation between MTHFR gene methylation and pre-eclampsia, and its clinical significance

We investigated the correlation between 5,10-methylenetetrahydrofolate reductase (MTHFR) gene methylation and pre-eclampsia, and its clinical significance, by comparing methylation in the MTHFR gene promoter of the placenta and peripheral venous blood in pre-eclampsia and normal gravidas. We enrolled 259 gravidas from the People's Liberation Army 202nd Hospital, China, between January 2011 and September 2011, including 127 pre-eclampsia and 132 nor-mal gravidas. Methylation levels of the MTHFR gene in placentas in two sets of gravidas were detected by methylation-specific polymerase chain reaction, plasma homocysteine levels were detected by enzyme-linked immunosorbent assay, and folic acid and vitamin B12 levels were detected by electrochemiluminescence. The chi-square test results were analyzed using the SPSS19.0 statistical software. In placentas, the methylation indices were 26.8% (34/127) and 15.2% (20/132) in the pre-eclampsia and normal groups, respectively (χ(2) = 5.30, P < 0.05, odds ratio (OR) = 2.04, 95% confidence interval (95%CI) = 1.10-3.73). In peripheral venous blood, the methylation indices were 22.8% (29/127) and 12.1% (16/132) in pre-eclampsia and normal groups, respectively (χ(2) = 5.17, P < 0.05, OR = 2.15, 95%CI = 1.11-4.15). The plasma methylation level of the pre-eclampsia group was consistent with the normal group. The plasma homocysteine level in the pre-eclampsia group was higher than in the normal group (P < 0.05). Levels of folic acid and vitamin B12 in the pre-eclampsia and normal groups were not statistically significant (P > 0.05). Patients with pre-eclampsia have hypermethylation in the MTHFR gene promoter, which may be one of its causes.

[Annexin A5 gene polymorphism (-1C/T) and the susceptibility to pneumoconiosis in coal works]

OBJECTIVE

To explore the role of -1C/T single nucleotide polymorphism within Annexin A5 gene in the genetic susceptibility to coal worker's pneumoconiosis (CWP).

METHODS

Four hundred and seventy CWP Han chinese patients and 428 Han chinese controls were enclosed in present case-control study. All subjects were exposed to coal dusts. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to detect the -1C/T SNP in Annexin A5 gene for all subjects. The relationship between the -1C/T SNP in Annexin A5 gene and CWP was analyzed.

RESULTS

CT/TT genotype in -1C/T SNP was associated with a significantly decreased risk of CWP, as compared with the CC genotype among subgroups exposed to coal dusts for ≥ 27 years (adjusted OR = 0.65, 95%CI: 0.44 - 0.98, P = 0.039) and patients with CWP at stage II (adjusted OR = 0.55, 95%CI: 0.34 - 0.90, P = 0.028).

CONCLUSION

The results of present study suggest that the Annexin A5 -1C/T polymorphism may be involved in the development of CWP in Han Chinese coal miners.

The Incidence and Types of Acid-Base Imbalance for Critically ill Patients in Emergency

Objective

To explore the incidence and types of acid-base imbalance or disorder (ABD) for critically ill patients in emergency room.

Methods

Clinical data of all critically ill patients managed in the resuscitation room were collected prospectively during the period from 1st December 2008 to 31st March 2009. Arterial and venous blood samples were taken simultaneously for blood gas analyses and serum electrolytes. Acid-base homeostasis or imbalance was judged according to the criteria.

Results

A total of 766 cases were collected and the incidence of ABD was 97.3% (N=745). Simple acid-base disorder (SABD) was present in 149 cases (20.0%). Dual acid-base disorder (DABD) was present in 525 patients (70.5%) while triple acid-base disorder (TABD) was found in 71 patients (9.5%). After calculating the anion gap (AG), the incidence of metabolic acidosis increased from 72.2% (N=538) to 91.0% (N=678) and the rate of missed diagnosis for metabolic acidosis was 20.6% (140 out of 678 cases). Meanwhile, the incidence of TABD increased from 1.6% (N=12) to 9.5% (N=71) and the rate of missed diagnosis for TABD was 83.1% (59 out of 71 cases). Similar phenomenon was observed when potential bicarbonate was calculated. The incidence of TABD increased from 1.1% (N=8) to 9.5% (N=71) and the rate of missed diagnosis of TABD was 88.7% (63 out of 71 cases). Patients with TABD (77.9±10.7 years old) were older (P<0.01) than the groups of SABD and DABD. APACHE II scores and the incidence of multiple organ dysfunction syndrome (MODS) were significantly higher among TABD patients. Mortality of patients with TABD on the first, second, third and seventh days were 14.1%, 23.9%, 26.8% and 38.0% respectively and were significantly higher than SABD and DABD.

Conclusion

The incidence of ABD in our group of critically ill patients was 97.3%. The commonest type of ABD was DABD. Calculating AG and potential bicarbonate could help us to uncover metabolic acidosis and TABD in time. Patients with TABD had a poorer prognosis. Age and APACHE II scores were key factors closely related to TABD.

A simple predictive model for blood-brain barrier penetration

A simple two-descriptor model to predict blood-brain barrier penetration is derived from a training set of 79 compounds: log BB = - 13.31V2 + 9.601V - 2.231PSA - 0.5290 (n = 79, r2 = 0.83) where log BB is the logarithm of the ratio of the steady-state concentration of the compound in the brain to in the blood, V (nm3) is the molecular volume, PSA (nm2) is the polar surface area which is defined as the sum of the van der Waals surface areas of oxygen atoms, nitrogen atoms, and attached hydrogen atoms in a molecule, n is the number of compounds, and r is the correlation coefficient. The model is validated by a leave-one-out procedure and an external test set (25 compounds). The results indicate that the model developed is statistically sound and is sufficiently reliable and robust for predictive use. The descriptors in the model can be easily computed and it is suitable for the rapid prediction of the blood-brain barrier penetration for a wide range of drug candidates.

[Direct upconversion sensitization luminescence of Tm(0.1)Yb(10.9): oxyfluoride glass]

This paper studied the direct upconversion sensitization luminescence of Tm(0.1)Yb(10.9): oxyfluoride glass pumped by 966 nm diode laser. We found that there are strong 474 nm three-photon upconversion fluorescence of 1G4-->3H6 transition. As well as there are weak 362, 452 and 650 nm three-photon upconversion fluorescence of 1D2-->3H6, 1D2-->3F4, 1G4-->3F4 and 681 nm two-photon upconversion fluorescence of 3F3-->3H6 transitions respectively. Their upconversion mechanism has been analyzed and discussed simply.

Activation of the cardiac interleukin-6 system in advanced heart failure

OBJECTIVES

The study objective was to assess the cardiac expression of interleukin-6 (IL6) and its receptor (IL6R) in advanced heart failure.

BACKGROUND

While IL6 plasma levels are elevated and associated with an impaired prognosis in advanced heart failure, little is known about the intracardiac expression of the IL6 system.

METHODS

Heart tissue was obtained from 20 patients (n=10, idiopathic dilated cardiomyopathy, age 44+/-15 years; n=10, ischemic cardiomyopathy, age 55+/-8 years) at the time of transplantation. Left and right ventricular tissue was subjected to in situ hybridization, Northern blot analysis, and RT-PCR. Signals were quantified by densitometric scanning and corrected for G3PDH-mRNA levels. Right ventricular biopsy specimens (n=11) of patients with arrhythmias and normal cardiac function served as controls. In addition, data were correlated with cardiac catheterization and echocardiography data obtained at transplant evaluation.

RESULTS

Ventricular IL6 and IL6R transcripts were detected in all explant specimens examined. Expression of both mRNA species was higher than in controls (P=0.001). Left ventricular IL6 mRNA levels correlated positively with heart rate (r=0.77; P=0.009), pulmonary capillary wedge pressure (r=0.53; P=0.03), right atrial pressure (r=0.77; P=0.003), and inversely with left ventricular ejection fraction (r=-0.61; P=0.03). Right ventricular IL6 mRNA levels correlated inversely with cardiac index (r=-0.48; P=0.05). IL6R expression did not correlate with hemodynamic data.

CONCLUSIONS

In advanced heart failure, cardiac IL6/IL6R mRNA expression is increased and may play a role in the pathophysiology of advanced heart failure.

Left-ventricular expression of interleukin-6 messenger-RNA higher in idiopathic dilated than in ischemic cardiomyopathy

During end-stage heart failure, plasma levels of interleukin-6 (IL6) are elevated. This cytokine exerts a negative inotropic influence on the myocardium. The production site of IL6 is unclear. We examined the hypothesis that IL6 in end-stage heart-failure patients is produced in the myocardium itself and is differentially regulated according to etiology. Cardiac tissue was obtained from 27 patients (idiopathic dilated cardiomyopathy, (DCM) 9/6 m/f, age 46 +/- 14 y; ischemic cardiomyopathy (ICM), 11/1 m/f, age 55 +/- 8 y) at the time of transplantation. The tissue was subjected to IL6 Northern-blot analysis. Signals were quantified by densitometric scanning after normalization to G3 PDH mRNA. Data were compared by Mann-Whitney test between DCM and ICM patients, divided by chamber origin. IL6 transcripts were found in all patients. In DCM, left-ventricular IL6 mRNA expression was higher than in ICM (p = 0.006). Median right-ventricular as well as left- and right-atrial IL6 mRNA expression was not significantly different in both groups. In summary, in end-stage heart failure, IL6 mRNA is consistently expressed in the myocardium. Left-ventricular expression is higher in DCM than in ICM. These data support the concept of a potentially reversible inflammatory component in the etiology of DCM which is more pronounced than in patients with ICM of comparable clinical severity.

Studies on the hazardous effects and the maximum allowable concentration of pyrophyllite dust

Pyrophyllite (H2Al2Si4O22) dust (P-dust) is a mixture of silica (10-40%), different proportions of a luminium oxide (Al2O3), and various metal compounds. People with occupations known to be associated with exposure to P-dust include miners, other industrial workers and persons engaged in artistic carving. Currently, little is known about pyrophyllite pneumoconiosis from P-dust. This study was designed to investigate the hazardous effects of P-dust and to suggest a maximum allowable concentration (MAC) of the dust. This study included four parts: (i) Occupational epidemiology survey in 781 workers from 1 pyrophyllite mine (PM) and four pyrophyllite carving mills (PCM), with a registration rate of 98%. (ii)

IN VITRO STUDIES

Six groups of rats were exposed to different levels of P-dust; the cytotoxicity of P-dust on rat alveolar macrophages (AM) was investigated by determining the potassium content of AM and the activity levels of lactate dehydrogenase (LDH) in AM culture fluid, (iii) Mineralogical analysis of P-dust: The contents of silica (SiO2), aluminum (Al), ferrum (Fe), nickel (Ni), zinc (Zn) and copper (Cu) in both PM-dust and PCM-dust were determined. (iv) Determination of P-dust MAC: Using the life-talbe method, an investigation of the hygiene standard of P-dust was carried out in 625 workers exposed to either PM-dust or PCM-dust, upon whom routine radiographs were performed. The results suggest that the risk of developing pneumoconiosis from pyrophyllite dust is significantly higher for PM workers than for PCM workers. The prevalence rate of PCM-dust pneumoconiosis is significantly higher in men than in women. The content of SiO2 and Al2O3 in the mixture of P-dust is the most important factor in the etiology of pyrophyllitosis. Depending on the different P-dust MAC values, we suggest that 2 mg/m3 and 4 mg/m3 should be considered as the MAC for PM-dust and PCM-dust, respectively, and 3 mg/m3 for P-dust. We believe that establishing different hygiene standards is more accurate even though workers are exposed to the "same" dust.

[Comparative study of harmful effect of pyrophyllite dust in two mines]

Labour hygienic investigation of dust factor and epidemiological investigation of pneumoconiosis were carried out in two pyrophyllite mines (A and B). Effects on experimental animal and pulmonary macrophage by the pyrophyllite-mixed dust collected from these two mines were studied. Workers of long term exposure to the dust suffered from pneumoconiosis. Pneumoconiotic lesions in lung tissues of dust-administered animal and cytotoxic effect of the dust on macrophage were found. Prevalence of pneumoconiosis in Mine A was 43.46%, but pneumoconiosis patient was not found in Mine B. The phenomenon was discussed.