Abstract:Objective To analyze the mechanism of loongmycin-induced cell cycle arrest in triple-negative breast cancer cell line by bioinformatics. Methods The triple-negative breast cancer cell line, MDA-MB-468, was treated with loongmycin for 48 and 72 h. The half inhibition concentration (IC₅₀) was calculated and the cell cycle was analyzed by flow cytometry. The MDA-MB-468 cells treated with 0.8 μmol/L loongmycin for 48 h and the control cells without drug treatment were selected for transcriptome sequencing. After the data were filtered by quality control, the differential gene expression was analyzed using DESeq2 1.16.1 software. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes functional analyses and gene set enrichment analysis were performed. The protein-protein interaction network was analyzed by STRING and the docking prediction was performed using AutoDock 1.5.6 software. Results The IC₅₀ values of MDA-MB-468 cells intervened by loongmycin for 48 and 72 h were 2.733 and 0.866 μmol/L, respectively. The results of flow cytometry showed that loongmycin arrested MDA-MB-468 cell line in G₂/M phase after intervening for 48 h. A total of 1 764 differentially expressed genes were screened after intervention with loongmycin. The differentially expressed genes were mainly located in nuclear factor kappa B (NF-κB)-mediated tumor necrosis factor alpha (TNF-α) pathway and P53 pathway. G protein subunit gamma 7 (GNG7), G protein subunit gamma 11 (GNG11), C-X-C motif chemokine ligand 8 (CXCL8), adenylate cyclase 2 (ADCY2) and other genes may be the key nodes in the gene network of drug action. Loongmycin and DNA molecules, topoisomerase, gene expression regulator (proteasome 20S subunit beta 5 [PSMB5] and SET domain containing histone lysine methyltransferase 7 [SETD7]) had good combination and interaction functions. Conclusion Loongmycin has similar functions to rebeccamycin; it exerts anti-tumor activity by binding with DNA molecules in DNA-topoisomerase Ⅰ complex; and it can also affect the expression of GNG7, GNG11, CXCL8, ADCY2 and other genes by binding gene expression regulatory proteins PSMB5 and SETD7, and eventually up-regulate NF-κB-mediated TNF-α pathway and P53 pathway, leading to G₂/M arrest in breast cancer cells, which plays an anti-tumor role.

Abstract:Objective To screen up-regulated genes and signaling pathways in glioma cells after knockdown of mammalian target of rapamycin (mTOR) gene, and to explore the efficacy of simultaneously blocking mTOR signaling pathway and its bypass activation pathways in inhibiting the growth of glioma cells. Methods Five human glioma cell lines U87, U251, U373, T98, and LN229 were selected to verify the protein expression of mTOR by Western blotting. U87 cells stably transfected with short hairpin RNA targeting mTOR gene were constructed, and the most significantly up-regulated genes and signaling pathways were screened in glioma cells after knockdown of mTOR gene by high-throughput sequencing. The pathway inhibitor with the highest inhibition rate was screened by cell drug sensitivity test. The cell activity was analyzed by cell counting kit 8. Results High mTOR expression cell line U87 was screened out, and the mTOR gene knockdown glioma cell model was successfully constructed. A total of 24 528 new transcripts and 1 906 differentially expressed genes were screened out by high-throughput sequencing. The top 12 up-regulated genes with high log₂|fold change|value were located in 9 bypass activation pathways. The inhibitor of signal transducers and activators of transcription 3 (STAT3) pathway with the highest inhibitory activity was screened out by drug sensitivity test. In vitro experiments showed that the STAT3 pathway inhibitor could increase the inhibition effect of mTOR gene knockdown on the proliferation of U87 cells (P<0.05). Conclusion Knockdown of mTOR gene in human glioma cells can activate the bypass signaling pathways. The inhibition effect can be effectively enhanced by combined use of inhibitors of bypass activation pathways.

Abstract:Objective To investigate the short-term prognosis of hepatocellular carcinoma (HCC) patients treated with ultrasound-guided microwave ablation and its influencing factors. Methods The clinical data of 410 HCC patients who underwent microwave ablation in our hospital from Jan. 1, 2017 to Jun. 30, 2018 were analyzed retrospectively. The rates of local tumor progression (LTP), intrahepatic distant recurrence (IDR), recurrence-free survival (RFS) and overall survival (OS) were estimated by Kaplan-Meier test. The influencing factors of RFS were analyzed by log-rank test. The influencing factors of RFS and LTP were analyzed by Cox proportional hazard regression model. The risk factors of early recurrence (within 2 years after operation) were analyzed by binary multivariate logistic regression. Results The 1-, 2- and 3-year OS rates were 96.8%, 88.3% and 75.4%, respectively. The 1-, 2- and 3-year RFS rates were 71.1%, 59.2% and 53.7%, respectively. The 0.5-, 1-, 2- and 3-year LTP rates were 4.6%, 11.9%, 13.9% and 14.4%, respectively. The 1-, 2- and 3-year IDR rates were 19.7%, 30.4% and 34.9%, respectively. Log-rank univariate analysis showed that diabetes mellitus (DM), hepatitis B virus (HBV)-DNA index, tumor number, tumor size, tumor location and whether meeting Milan criteria or not were influencing factors of RFS in HCC patients after microwave ablation (all P<0.05). Multivariate Cox proportional hazard regression analysis showed that DM (hazard ratio [HR]=1.757, 95% confidence interval [CI] 1.156-2.670, P=0.008), multiple tumors (HR=1.763, 95% CI 1.231-2.525, P=0.002), tumor maximum diameter ≤3 cm (HR=0.619, 95% CI 0.441-0.838, P=0.005), and unfavorable tumor location (HR=1.567, 95% CI 1.084-2.256, P=0.017) were independent influencing factors of RFS. Binary multivariate logistic regression analysis showed that DM (odds ratio [OR]=2.165, 95% CI 1.071-4.376, P=0.032), tumor location (OR=2.033, 95% CI 1.144-3.613, P=0.016), and tumor maximum diameter ≤3 cm (OR=0.530, 95% CI 0.299-0.940, P=0.030) were influencing factors for early recurrence of HCC after microwave ablation. Conclusion HCC patients have good short-term prognosis after microwave ablation, and DM, tumor location and tumor size are risk factors of early recurrence.

Abstract:Objective To investigate the conventional and contrast-enhanced ultrasonographic features of clear cell renal cell carcinoma (ccRCC) and renal angiomyolipoma (RAML), and to explore the application value of the 2 methods in the differential diagnosis of ccRCC and RAML. Methods The conventional and contrast-enhanced ultrasound images of 88 foci in 86 ccRCC patients and 38 foci in 31 RAML patients who were diagnosed by pathology, enhanced computed tomography (CT), magnetic resonance imaging (MRI) examination or follow-up were analyzed retrospectively. The size, echo, boundary and vascular architecture of the tumor were observed by conventional ultrasound, the indexes including the modes of perfusion and clearance, intensity and uniformity of perfusion, and peripheral ring enhancement were observed by contrast-enhanced ultrasound, and the value of ultrasonographic features of the conventional and contrast-enhanced ultrasounds in the differential diagnosis of ccRCC and RAML was analyzed. Results There were significant differences in the echo level, blood supply distribution, perfusion modes, perfusion intensity, uniformity and peripheral ring enhancement between ccRCC and RAML (all P<0.05). ccRCC was dominated by hypoechoic (78.41%, 69/88), rich blood supply (53.41%, 47/88), rapid wash-in (95.45%, 84/88), hyperperfusion (93.18%, 82/88) and heterogeneous perfusion (71.59%, 63/88), and peripheral ring enhancement was more common (34.09%, 30/88) in ccRCC; while RAML was dominated by non-hypoechogenicity (86.84%, 33/38), poor blood supply (68.42%, 26/38), hypoperfusion (65.79%, 25/38) and homogeneous perfusion (84.21%, 32/38), rapid or slow wash-in each accounted for 50.00% (19/38), and peripheral ring enhancement was rare (10.53%, 4/38). The accuracy and sensitivity of conventional ultrasound combined with contrast-enhanced ultrasound in the differential diagnosis of ccRCC and RAML in the hypoechoic group were better than those of conventional ultrasound (accuracy 89.19% vs 59.46%, sensitivity 89.86% vs 57.97%; both P<0.01); the accuracy, sensitivity and negative predictive value for the differential diagnosis of ccRCC and RAML in the non-hypoechoic group were better than those of conventional ultrasound (accuracy 78.85% vs 55.77%, sensitivity 84.21% vs 36.84%, negative predictive value 89.29% vs 64.71%; all P<0.05). Conclusion Conventional ultrasound combined with contrast-enhanced ultrasound has high clinical value in the differential diagnosis of ccRCC and RAML; some atypical foci, however, need to be diagnosed comprehensively by combining other examinations.

Abstract:Objective To analyze the incidence and clinicopathological characteristics of female patients with primary breast cancer admitted to 6 hospitals in Chongqing from 2010 to 2019. Methods The clinical and pathological data of female primary breast cancer patients who were newly diagnosed and hospitalized from Jan. 2010 to Dec. 2019 were collected from 6 hospitals (the Second Affiliated Hospital of Chongqing Medical University, Yongchuan Hospital of Chongqing Medical University, University-Town Hospital of Chongqing Medical University, the Third Affiliated Hospital of Chongqing Medical University, Chongqing Municipal Southeast Hospital, and the People’s Hospital of Tongliang District, Chongqing City), and a database of clinicopathological characteristics of breast cancer patients was established. The clinical characteristics and trends of the female breast cancer inpatients in Chongqing in recent 10 years were analyzed retrospectively, including the number of cases, age of diagnosis, pathological type, clinical stage, molecular subtype and surgery type. Results A total of 1 921 female breast cancer inpatients were enrolled. The number of diagnosed cases increased year by year in recent 10 years. The median age was 54 years old, with the peak in 45-54 years old (784 cases, 40.81%). There were 1 276 (66.42%) postmenopausal patients. The major pathological type was invasive ductal carcinoma (1 387 cases, 72.20%). The clinical stages at the time of diagnosis were mainly at 0-Ⅱ stages (1 448 patients, 75.38%). The positive cases of estrogen and progesterone receptors and human epidermal growth factor receptor 2 (HER-2) were 1 304 (67.88%) and 699 (36.39%), respectively. Molecular subtype of Luminal B accounted for 49.40% (949 cases) followed by Luminal A (17.39%, 334 cases), triple-negative breast cancer (16.40%, 315 cases) and HER-2 overexpression (15.20%, 292 cases). Modified radical mastectomy was the main surgery type (1 388 patients, 72.25%), while the rate of breast conserving surgery was increased gradually and the rate of sentinel lymph node biopsy was decreased gradually since 2012. The multivariate logistic regression analysis showed that HER-2 positive, triple-negative breast cancer and Ki-67 index>14% were risk factors for clinical stage of female breast cancer inpatients (all P<0.05). The trend of the diagnosed age was decreased gradually and the proportion of HER-2 positive was increased gradually in the past 10 years (both P<0.01), while the clinical stage had no significant change (P>0.05). Conclusion The number of female breast cancer patients shows an increasing trend in Chongqing from 2010 to 2019. The peak onset age is 45-49 years old, and the diagnosed age shows a downward trend. The patients with early stage breast cancer account for a large proportion and have no significant change with year. HER-2 positive, triple-negative subtype and Ki-67 index>14% are the risk factors of clinical stage of breast cancer.

Abstract:Objective To investigate the risk factors of the superior mesenteric vein (No.14v) lymph node metastasis in gastric cancer patients and their impact on prognosis. Methods The clinical data of 214 gastric cancer patients who underwent radical gastrectomy and No.14v lymph node dissection in our department from Apr. 2014 to Aug. 2018 were retrospectively analyzed. The patients were divided into 2 groups (No. 14v lymph node negative and positive groups) according to the postoperative pathological results, and pathological characteristics of the 2 groups were compared. The risk factors of No. 14v lymph node metastasis were analyzed by multivariate logistic regression. The relationship between No. 14v lymph node metastasis and the prognosis of patients with TNM stage Ⅲ or Ⅳ gastric cancer was analyzed by Cox proportional hazard regression model. Results No. 14v lymph node metastasis occurred in 34 (15.9%) patients. Univariate analysis showed that No. 14v lymph node metastasis was correlated with the age, depth of tumor invasion, lymph node metastasis, distal metastasis, TNM stage, differentiation level, tumor maximum diameter, neuroinvasion and vessel invasion (all P<0.05). Multivariate logistic regression analysis showed that TNM stage (odds ratio[OR]=2.749, 95% confidence interval[CI] 1.947-3.882, P<0.01), age (OR=2.773, 95% CI 1.140-6.745, P=0.025), and No. 3 (OR= 5.430, 95% CI 1.643-17.949, P<0.01) and No. 6 (OR=10.244, 95% CI 2.830-37.081, P<0.01) lymph node metastases were independent risk factors for No. 14v lymph node metastasis. Multivariate Cox proportional hazard regression analysis showed that No. 14v lymph node metastasis was an independent risk factor for the prognosis of patients with TNM stage Ⅲ or Ⅳ gastric cancer with age ≤65 years (hazard ratio[HR]=4.065, 95% CI 1.469-11.249, P=0.007). Conclusion For advanced gastric cancer patients with late TNM stage (especially late N stage) or with No. 3 and No. 6 lymph node metastases, No.14v lymph node dissection is recommended during operation.

Abstract:Objective To investigate the effect of lidocaine on the comfort of patients with transnasal endotracheal intubation after oral and maxillofacial surgery. Methods This is a randomized, single-blind, parallel controlled clinical trial. A total of 106 patients undergoing elective oral and maxillofacial surgery in the Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from Apr. to Jun. 2020 were selected and randomly divided into 3 groups (transnasal endotracheal intubation was indwelled for more than 12 h after surgery in all patients): lidocaine pumping group (35 cases, injected intravenously with 1.5 mg/kg [20 mg/mL] loading dose of lidocaine in surgical intensive care unit [SICU] after operation, and then pumped with 1.5 mg·kg^－1·h^－1 [diluted to 10 mg/mL with normal saline] for 12 h), lidocaine spray group (35 cases, lidocaine aerosol sprayed twice every 2 h through artificial airway with an interval of 2 min and 2 sprays each time in SICU after operation) and control group (36 cases, injected with 0.075 mL/kg loading dose of normal saline intravenously in SICU after operation, and then pumped with 0.15 mL·kg^－1·h^－1 infusion continued to 12 h). The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), visual analogue scale (VAS) score of incision pain, VAS score of postoperative sore throat, and frequencies of nausea/vomiting and cough were recorded every hour in SICU. Results Compared with the control group, no significant differences were observed in the SBP, DBP, MAP or HR in the lidocaine pumping group and lidocaine spray group (all P>0.05). However, the RR of the patients in both groups were lower than that in the control group (both P<0.05). As for comfort signs, lower VAS scores of postoperative sore throat and lower frequencies of nausea/vomiting and cough were recorded in the lidocaine pumping group and lidocaine spray group (all P<0.05); the VAS scores of incision pain were decreased in the lidocaine pumping group (P<0.05), but were similar in the lidocaine spray group and control group (P>0.05). Patients in the lidocaine pumping group had lower VAS scores of incision pain and postoperative sore throat and lower frequency of cough than patients in the lidocaine spray group (all P<0.05). The SBP, MAP and the frequencies of nausea/vomiting and cough in the patients of both treating groups were decreased during 1-12 h in SICU (all P<0.05), and the DBP was also decreased in the lidocaine pumping group (P<0.05). Only frequencies of nausea/vomiting and cough were decreased in the control group (both P<0.05). Conclusion Lidocaine intravenous and surface anesthesia can improve the comfort of patients with transnasal endotracheal intubation after oral and maxillofacial surgery, without causing serious adverse reactions. Furthermore, intravenous injection way is more effective.

Abstract:Objective To evaluate patients’ cognition, attitude and influencing factors of genetic counseling on gynecologic tumor, so as to improve its efficiency and implementation. Methods Patients who visited the Clinic of Genetic Counseling of the Department of Gynecological Oncology, Obstetrics & Gynecology Hospital of Fudan University from Mar. 25, 2020 to Mar. 26, 2021 were enrolled. Based on clinical practice, patient feedback and literature reading, a questionnaire survey was designed to analyze the general information and patients’ cognition and attitude towards genetic counseling. Patients were classified according to their general characteristics to analyze the potential factors affecting their cognition and attitude. Results A total of 104 valid questionnaires were collected. Thirty-six patients (34.6%) “felt well enough” before genetic counseling, patients with malignant tumors were more likely to accept genetic counseling than those with endometrial atypical hyperplasia (P=0.048), and those with radical surgery were more likely to accept genetic counseling than those with fertility-preserving treatment (P=0.008). Other patients had various concerns about genetic counseling, and patients without a past history of cancer were more afraid of detected with gene mutations (P=0.017). Patients from developed areas were more anxious about the potential genetic diseases than those from developing areas (P=0.013). Parous patients were more worried about the increased risk of other tumors than nulliparous women (P=0.008). Seventy-four patients (71.1%) wanted to know whether the disease was hereditary through genetic counseling. Patients with higher education level and with positive family history of cancer wanted to know whether the disease was hereditary more than patients with lower education level (P=0.024) and without family history of cancer (P=0.009). Fifty-two patients (50.0%) wanted to know whether their offspring could be effectively prevented if they had genetic diseases, while patient with higher education level (P=0.002), with fertility-preserving treatment (P=0.018), and with demand of fertility preservation (P=0.003) were more eager to know that. A total of 25 patients had germline pathogenic or suspected pathogenic gene mutations. After genetic counseling, 19 patients (76.0%) understood that screening tests should be done as the risk of cancer in other systems increased, 14 patients (56.0%) agreed early intervention could be taken once gene mutation was reported, 10 patients (40.0%) agreed that preimplantation genetic testing (PGT) could be used for genetic block in patients who wanted to have children, 13 patients (52.0%) agreed that the results of genetic test could indicate the disease prognosis and therapeutic targets for further therapy, and only 7 patients (28.0%) knew the measures for early screening of other systems. Conclusion Education, areas, disease type, treatment, family history of cancer, history of cancer, obstetric history and demand of fertility preservation can affect patients’ attitude towards genetic counseling. However, the understanding of the diseases and the related system screening and family genetic risk management are not satisfying among patients with germline pathogenic or suspected pathogenic gene mutations after a genetic counseling.

Abstract:Objective To explore the inhibiting effect of Astragalus membranaceus on the growth of renal cell carcinoma by promoting the activity of follicular helper T cells (Tfh cells). Methods A mouse model of renal cell carcinoma was established in 56 BALB/c mice, and then they were evenly divided into Astragalus membranaceus treatment group and control group. The mice in the Astragalus membranaceus treatment group were given 0.5 mg/g Astragalus membranaceus extract by tube feeding every day, while the mice in the control group were given the same volume of purified water every day. Three mice were sacrificed on days 0, 9, 12, 15, 18 and 21 respectively after modeling in both groups, the effect of Astragalus membranaceus extract on the growth of renal cell carcinoma was evaluated by measuring the tumor volume, and the Tfh cell proportion in tumor tissue was analyzed by flow cytometry. The remaining 10 mice were sacrificed on day 21 after modeling in both groups, the proportions of CD8⁺ T cells and Tfh cells were detected by flow cytometry, and the effect of Astragalus membranaceus extract on Tfh cells was explored by detecting the expression of cytokines. Results Compared with the control group, the volume of tumor in the Astragalus membranaceus treatment group was significantly smaller on days 18 and 21 (P<0.05), accompanied by an increase in Tfh tumor infiltration (P<0.05). The mRNA expression level of interleukin 21 (IL-21) in Tfh cells of the Astragalus membranaceus treatment group was significantly higher than that of the control group on day 21 (P<0.05), and the proportion of tumor-infiltrating CD8⁺ T cells was positively correlated with the proportion of tumor-infiltrating Tfh cells (r²=0.700, P=0.003) and the mRNA expression level of IL-21 in Tfh cells (r²=0.673, P=0.004). Conclusion Astragalus membranaceus can slow down the growth of renal cell carcinoma in mice, and may exert anti-tumor immune effects through Tfh cells.

Abstract:Objective To investigate the protective effect of naringenin on hypoxia-injured myocardial cells. Methods A hypoxia-injured myocardial cell model was established with rat myocardial cell line H9c2 cells and identified by lactate dehydrogenase (LDH) cytotoxicity test kit. The experiment was divided into 5 groups: control group, model group, and naringenin low-, medium- and high-dose groups (20, 40 and 80 μmol/L). Cell proliferation inhibition rate was detected by cell counting kit 8; cell hypertrophy was detected by indirect immunofluorescence; cell apoptosis was detected by flow cytometry; the protein expression of apoptosis-related proteins B-cell lymphoma 2 (Bcl-2), Bcl-2 associated X protein (Bax) and caspase 3 was detected by Western blotting; and the mRNA expression of vascular endothelial growth factor (VEGF), NK2 homeobox 5 (Nkx2.5) and alpha-smooth muscle actin (α-SMA) in H9c2 cells was detected by qRT-PCR. Results Compared with the control group, the activity of LDH in cell supernatant of the model group was significantly increased (P<0.01), indicating that the hypoxia-injured myocardial cell model was successfully constructed. Compared with the model group, the inhibition rate of cell proliferation was significantly decreased in each dose group of naringenin (P<0.05, P<0.01); the hypertrophy of H9c2 cells in each dose group of naringenin was significantly alleviated (P<0.05, P<0.01); and the proportion of apoptotic cells was significantly decreased in the medium- and high-dose naringenin groups (both P<0.01). Compared with the model group, the expression levels of apoptotic proteins caspase 3 and Bax in each dose group of naringenin were significantly decreased, while the expression levels of apoptosis inhibition-related protein Bcl-2 were significantly increased (P<0.05, P<0.01). Compared with the model group, the mRNA expression level of Nkx2.5 in high-dose naringenin group was significantly increased (P<0.01), the mRNA expression levels of VEGF were significantly increased in medium- and high-dose naringenin groups (P<0.05, P<0.01), and the mRNA expression levels of α-SMA were significantly decreased in each dose group of naringenin (all P<0.01). Conclusion Naringenin has a protective effect on hypoxia-injured myocardial cells of rats.

Abstract:Nucleotide binding oligomerization domain (NOD) and leucine-rich-repeat-containing protein X1 (NLRX1), a member of the NOD-like receptor (NLR) family, is an important regulator of the immune system. Studies have shown that NLRX1 could regulate nuclear factor kappa B signaling and typeⅠinterferon generation, regulate reactive oxygen species production, participate in autophagy, cell death and innate immunity response, and affect c-Jun N-terminal kinase and mitogen-activated protein kinase pathways. NLRX1 is closely related to the development and progression of respiratory virus infection, chronic obstructive pulmonary disease, obstructive sleep apnea hypopnea syndrome and lung tumors. Therefore, it is of great significance to understand the role and mechanism of NLRX1 in these diseases.

Abstract:Intervertebral disc degeneration (IVDD) has been one of the most significant contributors to low back pain. Despite the favorable outcomes resulted from surgical intervention, early prevention and alleviation of IVDD have been a research focus. Therefore, it is particularly important to investigate the potential mechanism of IVDD. Increasing studies have suggested that multiple systems in our body are involved in the process of IVDD directly or indirectly. This article reviews the mechanism of IVDD from the perspectives of nerve, immune and endocrine systems, hoping to provide new insights into the future prevention and treatment of IVDD.

Abstract:Objective To develop a built-in operation lamp for peacetime and wartime, and to preliminarily observe its trial effect. Methods A built-in operation lamp was designed and developed with polycarbonate as the main shell material, light emitting diode (LED) as light source, ultra-micro button battery as power supply, and powerful rubidium magnet as fixing device. Clinical trials were carried out in many military and local hospitals, and the trial effect was observed. Results The built-in operation lamp was successfully developed, showing good effect in the preliminary clinical trials. The device could assist the operation for deep human tissue with much clearer lighting of the operative field. Additionally, the surgeon could adjust the light freely without itinerant nurses’ help. The device could provide lighting for battle field emergency surgery independently, and could be used on naval ships without restriction of sea conditions during medical service training and non-battle military missions of naval force due to its high portability, mobility and concealment. Conclusion The built-in operation lamp in this study has a great clinical and military value and deserves further study.

Abstract:Objective To analyze the incidence, fatality, types and characteristics of blast injuries in modern warfare, so as to provide reference for developing effective treatment measures on battle field and for establishing war wound database. Methods Retrieval strategy and literature inclusion criteria were obtained according to preferred reporting items for systematic reviews and meta-analyses (PRISMA), and all the literatures on the incidences, characteristics, mechanisms and special injury conditions of blast injuries were retrieved. Results A total of 31 articles were included in the analyses, consisting of 32 474 blast injury casualties of US army during Operation Enduring Freedom, Operation Iraqi Freedom (including Operation New Dawn), the Cole attack incident and the combat conflict in Croatia. The incidence of blast injuries was 15.8%-89.5% on the head, face and neck, 1.8%-80.8% on the trunk, 45.2%-96.6% on the limb, and 15.4%-70.6% on other parts. According to the analyses of different injury mechanisms, impact injuries and penetrating injuries caused by explosions in open spaces accounted for the main part, while burns were the main injuries caused by explosions in closed spaces such as explosions in ship cabin. The most severe blast injuries was caused by fixed explosive device, and strong injury control and surgical resuscitation forces should be deployed. Conclusion Most of the casualty data are from the mature war wound database of the US army, which provides the data basis for trauma epidemiology research. A war wound database of PLA should be established as soon as possible to provide basic data for developing war wound treatment guidelines and improving protective equipment and comprehensive medical support.

Abstract:Objective To investigate the effect of electret electrostatic field on migration of macrophages. Methods The －2 000 V polypropylene electret was prepared by low temperature plasma discharge (grid controlled constant voltage corona discharge) at room temperature. The charge storage stability of the electret under storage and experimental conditions was studied by conventional isothermal surface potential decay measurement. The mouse macrophages (RAW264.7 cells) in logarithmic growth phase were treated by ultraviolet sterilized electret. The cell migration and morphological changes under the electret electrostatic field were analyzed by cell scratch test, Transwell assay and fluorescent probe tracing. Results The surface potential of －2 000 V electret was stable at 70% of its initial value when it was placed at room temperature and normal humidity for 14 d. There was no significant difference between the surface potential of －2 000 V electret in cell incubator for 28 h and that for 0 h (P>0.05). The results of the cell scratch test showed that after exposed to the electret electrostatic field for 28 h, the migration and proliferation ability of RAW264.7 cells to scratch area was enhanced, and the scratch area decreased. The results of the Transwell assay showed that the number of transmembrane cells in electret treated group increased compared with the control group at 12 and 24 h (both P<0.01). The results of the fluorescent probe tracing showed that RAW264.7 cells became larger, expanded, with increased ruffling, and produced protuberant structures such as plate-shaped pseudopodia and filamentous pseudopodia under the action of negative electret. Conclusion The prepared －2 000 V electret can provide a stable electrostatic field in vitro and continuously act on cells. The electrostatic field can promote the macrophages to become larger, extended, with increased ruffling, and produce protuberant structures such as plate-shaped pseudopodia and filamentous pseudopodia, which can improve the migration ability of macrophages.

Abstract:Objective To explore the surgical techniques and safety of combined segment resection of inferior vena cava without reconstruction for retroperitoneal tumors. Methods The data of 27 patients with retroperitoneal tumors involving inferior vena cava admitted to the Department of Retroperitoneal Tumor Surgery of Peking University International Hospital from Mar. 2015 to Feb. 2020 were retrospectively analyzed. All the patients underwent combined segment resection of the inferior vena cava without reconstruction. The inferior vena cava was divided into 4 segments: segmentⅠ (from the bifurcation of the common iliac vein to 2 cm below the entrance of the renal vein), segmentⅡ (from 2 cm below the renal vein to 2 cm above the renal vein), segmentⅢ (from 2 cm above the renal vein to below the diaphragm) and segmentⅣ (supradiaphragmatic segment). According to the inferior vena cava segmentation and collateral circulation, the surgical plans were formulated, the related postoperative complications of the inferior vena cava resection were observed, and the preoperative and postoperative renal function indicators were recorded and compared. Results The surgery was successfully completed in all the 27 patients without operative death, with R0 resection in 22 cases and R1 resection in 5 cases, including 11 cases of segmentⅠ inferior vena cava resection, 5 cases of segmentⅡ, 6 cases of segment Ⅱ+Ⅲ, and 5 cases of segmentⅢ. Ten cases were combined with right nephrectomy, 4 cases with hepatometastasis resection, 3 cases with right hemicolectomy, 2 cases with small intestine partial resection, and 2 cases with right iliac artery artificial vessel reconstruction. The creatinine level of the patients with right nephrectomy was (58.1±14.5) μmol/L before operation, and was (63.1±16.2) μmol/L 2 weeks after operation, showing no significant difference (P>0.05). Six cases had moderate or large amount of ascites (the average drainage volume of ascites was more than 400 mL/d one week after operation), and 5 cases had lower extremity edema which gradually returned to normal about 2 weeks after operation; 4 cases had renal insufficiency after operation, and 2 of them recovered after short-term hemodialysis replacement therapy. Conclusion Retroperitoneal tumors can invade different parts of the inferior vena cava. Segment resection without reconstruction is safe and reliable when collateral circulation has been fully established or reconstruction is predictable. Accurate preoperative assessment can effectively guide the surgical approach and control the risk of postoperative complications.

Abstract:Objective To investigate the effect of transthoracic echocardiography on locating the catheter tip during totally implantable venous access port (abbreviated as port) implantation in children. Methods The clinical data of 200 patients with malignant tumor who received port implantation in our hospital from Mar. 2015 to Jun. 2020 were retrospectively analyzed. The patients were divided into X-ray positioning group (105 cases) and ultrasound positioning group (95 cases) according to the catheter tip positioning mode. The general information, operation duration, the rate of ideal catheter tip position and postoperative complications of the 2 groups were analyzed. Results There were no significant differences in age, gender, height, weight, body mass index or tumor types between the 2 groups (all P>0.05). The mean operation duration of the X-ray positioning group and ultrasound positioning group was (57.79±6.39) min and (49. 84±4.34) min, with significant differences (P<0.01). The rates of ideal catheter tip position in the X-ray positioning group and ultrasound positioning group were 92.4% (97/105) and 96.8% (92/95), with no significant difference (P=0.167). There were no significant differences in postoperative wound infection rate, catheter-related thrombosis, fibrin sheath formation around catheter, ectopic catheter, catheter-related bloodstream infection or unplanned port removing (all P>0.05). Conclusion Transthoracic echocardiography can directly and accurately monitor the catheter tip position in real-time during venous access port implantation in children, and has the advantages of X-ray irradiation free, short operation duration, simple equipment requirements and convenient operation, making it worthy of clinical application.

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