[Comparison of clinical features of JAK2V617F gene mutation and non-mutation in patients with Budd-Chiari syndrome]

Objective: To investigate the clinical features of JAK2V617F gene mutation and non-mutation in patients with Budd-Chiari syndrome (BCS). Methods: 17 and 127 BCS cases with JAK2V617F gene mutation (mutation group) and non-gene mutation (non-mutation group) who were continuously treated with interventional therapy between January 2016 to December 2020 in the Affiliated Hospital of Xuzhou Medical University were selected as the research object for a comparative study. The hospitalization and follow-up data of the two groups were analyzed retrospectively, and the deadline for follow-up was June 2021. Quantitative data group differences were analyzed using the independent sample t-test and Wilcoxon rank sum test. Qualitative data group differences were analyzed with χ² test or Fisher's exact test. Mann-Whitney U test was used to analyze the differences between groups in rank data. Kaplan-Meier method was used to calculate the patient survival and recurrence rate. Results: Age [(35.41±17.10) years vs. (50.09±14.16) years, t=3.915, P<0.001], time of onset (median duration: 3 months vs. 12 months), and the cumulative survival rate (65.5% vs 95.1%; χ²=5.21, P=0.022) were lower in mutation than non-mutation group. Aaspartate aminotransferase, alanine aminotransferase, prothrombin time, Child-Pugh score, Rotterdam score, Model for End-stage Liver Disease score, hepatic vein thrombosis incidence, and the cumulative recurrence rate after intervention were higher in mutation than non-mutation group. The above all indexes had statistically significant differences (P<0.05) between the groups. Conclusion: Younger age, acute onset, severe liver injury, high incidence of hepatic vein thrombosis, and poor prognosis are the features of patients with BCS with JAK2V617F gene mutation than non-mutation.

Molecular dynamics study of three amino acids as corrosion inhibitor for copper in hydrochloric acid solution

Molecular dynamics (MD) simulation is used to study the corrosion inhibition mechanism of cysteine (Cys), glutamic (Glu) and glycine (Gly) for copper in hydrochloric acid solution. The adsorption energy and radial distribution function results show that all three amino acids can spontaneously adsorb on Cu (111) surface by chemical adsorption. The absolute value of adsorption energy and intensity is Cys > Glu > Gly. The diffusion coefficient and relative concentration curve show that all the three amino acids can inhibit the diffusion and aggregation ability of corrosion particles, so the three amino acids not only can slow down the aggregation of corrosive particles, but also effectively repel corrosive particles to protect the substrate. The inhibition ability obtained by the MD simulation shows the trend of Cys > Glu > Gly, which is consistent with the experimental results. The inhibition efficiency is determined by both the adsorption strength on the substrate surface and inhibition ability for the diffusion and aggregation ability of corrosion particles.

[Analysis of curative efficacy of transjugular intrahepatic portosystemic shunt using viabahn stent in the treatment of Budd-Chiari syndrome with extensive hepatic vein occlusion]

Objective: To investigate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) using viabahn stent in patients with Budd-Chiari syndrome (BCS) with extensive hepatic vein occlusion. Methods: Technical success rates, portal pressure gradient (PPG), complications and shunt patency rate of 25 cases with BCS with extensive hepatic vein occlusion treated by TIPS using viabahn stent were retrospectively analyzed. Color Doppler ultrasound was used for postoperative follow-up. Patency rates were evaluated by Kaplan-Meier curve. Results: The technical success rate of TIPS was 100%. Mean PPG decreased from (22.7 ± 6.2) mmHg preoperatively to (9.7 ± 2.6) mmHg postoperatively (t = 9.58, P < 0.05). Hepatic encephalopathy incidence was 8.0% (2/25), and there were no complications such as intra-abdominal hemorrhage. Twenty-five cases were followed up for 1 to 39 ( mean 19.0 ± 11.9) months, and one patient died of liver failure three months after interventional treatment. The primary patency rates at 1, 2, and 3 years after interventional treatment were 91.3%, 91.3%, and 78.2%, respectively, while the repatency rates were 100%, 92.9%, and 92.9%, respectively. Conclusion: TIPS using viabahn stent can bring better short-term and mid-term curative efficacy in treatment of BCS with extensive hepatic vein occlusion.

[Analysis of treatment modalities and prognosis of patients with gallbladder cancer in China from 2010 to 2017]

Objective: To evaluate the clinical characteristics and prognosis of gallbladder cancer (GBC) patients in China. Methods: This retrospective multicenter cohort study enrolled 3 528 consecutive GBC patients diagnosed between January 2010 to December 2017 in 15 hospitals from 10 provinces. There were 1 345 (38.12%) males and 2 183 (61.88%) females.The age of diagnosis was (63.7±10.8) years old (range: 26 to 99 years old) .There were 213 patients (6.04%) in stage 0 to Ⅰ, whereas 1 059 (30.02%) in stage Ⅱ to Ⅲ, 1 874 (53.12%) in stage Ⅳ, and 382 (10.83%) unavailable. Surgery was performed on 2 255 patients (63.92%) . Three hundred and thirty-six patients received chemotherapy or radiotherapy (9.52%; of which 172 were palliative); 1 101 (31.21%) received only supportive treatment.The patient source, treatment and surgery, pathology, concomitant gallstone, and prognosis were analyzed. Results: Among the 3 528 GBC patients, 959 (27.18%) were from East China, 603 (17.09%) from East-North China, 1 533 (43.45%) from Central China, and 433(12.27%) from West China. Among the 1 578 resectable tumor, 665 (42.14%) underwent radical surgery, 913 (57.86%) underwent surgery that failed to follow the guidelines.Eight hundred and ninety-one (56.46%) patients were diagnosed before surgery, 254 (16.10%) during surgery, and 381 (24.14%) after surgery (time point of diagnosis couldn't be determined in 52 patients) .Among the 1 578 patients with resectable tumor, 759 (48.10%) had concomitant gallstone.Among the 665 patients underwent radical surgery, 69 (10.4%) showed positive resection margin, 510 (76.7%) showed negative resection margin, and 86 (12.9%) unreported margin status.The 5-year overall survival rate (5yOS) for the 3 528-patient cohort was 23.0%.The 5yOS for patients with resectable tumor was 39.6%, for patients with stage ⅣB tumor without surgery was 5.4%, and for patients with stage ⅣB tumor underwent palliative surgery was 4.7%. Conclusions: More than half GBC patients in China are diagnosed in stage Ⅳ.Curative intent surgery is valuable in improving prognosis of resectable GBC.The treatment of GBC needs further standardization.Effective comprehensive treatment for GBC is in urgent need.

[Preliminary application of transjugular intrahepatic portosystemic shunt in individualized treatment of patients with cirrhotic portal hypertension complicated with refractory ascites and variceal hemorrhage]

Objective: To investigate the feasibility, efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in the individualized treatment of patients with refractory ascites and variceal hemorrhage caused by portal hypertension. Methods: Prospective study of clinical data of 47 patients with portal hypertension and refractory ascites and variceal bleeding admitted to the Affiliated Hospital of Xuzhou Medical University from August 2017 to December 2018, 26 males and 21 females, aged 23-75 (52±14) years old. The Viabahn stent was used to control the diameter of the shunt and the preoperative interval of PPG after individualized TIPS was determined according to the preoperative liver function Child-Pugh classification. The PPG of the Child A and B patients was <10 mm Hg (1 mmHg=0.133 kPa), Child-Pugh C grade patients with postoperative PPG interval values of 12 to 15 mmHg. The success rate, hemostasis rate, ascites remission rate, and complication rate were recorded. Results: Forty-seven patients were with a success rate of 100%, and there was no surgically related fatal complications. The portal pressure gradients of patients with Child-Pugh A, B and Child-Pugh C were reduced from preoperative (22.5±5.4), (24.4±2.6) mm Hg to postoperative (8.8±2.5), (13.2±1.1) mm Hg (all P<0.05). All the patients were followed up for 6 to 24 months, with a median follow-up of 13 months. The success rate of hemostasis in patients with upper gastrointestinal bleeding was 93.5% (29/31), the remission rate of patients with refractory ascites was 14/16, the postoperative rebleeding rate was 6.5% (2/31), the incidence of hepatic encephalopathy was 8.5% (4/47), and the shunt disorder was 2.1% (1/47). Conclusion: The use of Viabahn stent for individualized TIPS in the treatment of portal hypertension with refractory ascites and variceal hemorrhage is feasible, and the clinical efficacy is affirmative, which can reduce the incidence of postoperative hepatic encephalopathy and shunt dysfunction.

[Combined multiple artery-first approach to pancreatoduodenectomy]

Objective: To investigate the clinical application of combined multiple artery-first approach to pancreatoduodenectomy. Methods: The clinical data of 53 patients who were diagnosed with peripancreatic head tumor at Department of Biliary-Pancreatic Surgery of Second Affiliated Hospital of Harbin Medical University between June 2013 and June 2015 was retrospectively analyzed.Pancreatic enhanced CT scan, magnetic resonance cholangiopancreatography, ultrasonography and tumor marker detection were applied for all the patients preoperatively.The 53 patients were operated by combined multiple artery-first approach(superior+ posterior approach, superior+ inferior approach, posterior+ inferior approach, superior+ posterior+ inferior approach) according to individualized therapeutic concept.And 42 patients underwent pancreatoduodenectomy, 9 patients underwent palliative operation and 2 patients just received exploratory operation. Results: Forty-two peripancreatic head tumor patients underwent pancreatoduodenectomy by applying combined multiple artery-first approach.The median operation time and intraoperative blood loss were (5.4±3.1)hours and (366±297)ml and the harvested lymph node and duration of hospital stay were 19±5 and (14.0±5.6)days.Nine patients underwent "total mesopancreas excision" and the rate of postoperative pancreatic fistula and R0 resection were 38.1% and 88.1%. Anomalous origin hepatic right artery was detected in one patients during the operation and no death occurred within 30 days postoperatively. Conclusion: According to the tumor location and patient's condition, individualistically applying combined multiple artery-first approach can reduce intraoperative blood loss, terminate unnecessary surgery, detect anomalous origin artery, make the tumor resection more radical and pancreatoduodenectomy more safety.

[Progress of application for enhanced recovery after surgery in pancreaticoduodenectomy]

Due to the large surgical trauma and postoperative complications, the perioperative management of pancreaticoduodenectomy has been one of the urgent problems to be solved by the surgeons. With the development of modern medicine, enhanced recovery after surgery (ERAS) comes into being, basing on anti-stress mechanism and multi-disciplinary team, and the perioperative management of pancreaticoduodenectomy has been optimized and improved continuously. The surgeons through a range of measures that had evidence-based medicine basis to mitigate the extent of surgical trauma stress, reduce the incidence of postoperative complications, shorten patient recovery time previously healthy state, and achieve maximize benefit for patients. Currently, the ERAS application in the specific aspects of pancreaticoduodenectomy remains contentious. However, with the emergence of evidence-based medicine, ERAS is constantly being refined. Therefore, this article combined with ERAS guidelines and expert consensus is of great significance to deepen the research and understanding of ERAS in pancreaticoduodenectomy.

Analysis of competitive binding of ligands to human serum albumin using NMR relaxation measurements

The competitive binding of two ligands, ibuprofen (IBP) and salicylic acid (SAL), to human serum albumin (HSA) was studied by using nuclear magnetic resonance (NMR) relaxation measurements. When the concentration of one ligand was increased in the solution containing IBP, SAL and HSA, the fractions of free IBP and SAL were increased because of the competitive binding. The 1H relaxation rates (R1) of both ligands were subsequently decreased. If a ligand is in fast exchanging between the free and bound forms, the observed 1H relaxation rate is a weighted average of that for the free ligand and the protein-ligand complex. The concentrations of the free and bound ligands can be quantitatively derived from the relaxation rates. The results presented in this work revealed that IBP and SAL shared certain low-affinity binding sites on the HSA molecule, in addition to the same high-affinity binding site of AIII.

Apoptosis of circulating lymphocytes induced by whole body gamma-irradiation and its mechanism

We studied the apoptosis of mousecirculating lymphocytes and its mechanism induced by 2, 4, 6, and 8 Gy of whole-body gamma-irradiation and the expression of bax and bcl-2 gene products as related to apoptosis. We found that, in the early stage after irradiation (4th-7th day), the percentage of lymphocyte apoptosis increased rapidly. Four hours after 2, 4, 6, and 8 Gy of gamma-irradiation, the apoptotic lymphocytes were 2.6, 3.8, 5.5, and 10.4 times those in the controls, respectively. A good correlation was found between the intensity of apoptosis and the radiation dose. As the radiation dose increased, the absolute counts of peripheral lymphocytes decreased sharply; 4 hours after 2, 4, 6, and 8 Gy of gamma-irradiation, the lymphocyte counts were 82, 63, 47, and 22% of the controls, respectively. The peak value of lymphocyte apoptosis was observed on the 7th day after irradiation using the in situ terminal labeling method, and the apoptotic lymphocytes were found to be 16 times the number in the controls. These results were in accordance with those obtained by the May-Grünwald-Giemsa staining method. The absolute counts of peripheral lymphocytes dropped to their lowest value on the 7th day after irradiation, suggesting that lymphocyte apoptosis might be the major cause of lymphocytopenia in the early stage after irradiation. The abnormal expression of bax and bcl-2 gene products in irradiated lymphocytes was closely related to apoptosis in peripheral lymphocytes.

Apoptosis of lymphocytes in canine peripheral blood induced by shock vibration and its mechanism

We investigated the mechanism of apoptosis induced by shock vibration in canine peripheral lymphocytes, the T-lymphocyte changes, and the expression of p53 and bax gene products related to apoptosis using the techniques of immuno- and enzyme cytochemistry. We noted obvious apoptosis after delivery of 80, 100, and 200 acceleration of gravity values (G values). The percentage of apoptotic lymphocytes was directly proportional to the G value. On the 3rd day after injury, the number of apoptotic lymphocytes reached the peak value, which was about 5 to 8 times the amount in the control group. On the contrary, on day 3 after injury, T lymphocytes decreased and were about 50% of the control group. On the other hand, we found that the percentage of p53 and bax-positive lymphocytes distinctly increased and, on the 3rd day after injury, their number was, respectively, about 2.3 and 1.8 times that in the control groups, suggesting that they may play an important role in lymphocyte apoptosis. The above-mentioned results provide an important basis for further study of the mechanism of shock-vibration injury, its prevention, and treatment.

The relative spatial distribution of in vitro-CFCs in the bone marrow, responding to specific growth factors

Haemopoietic progenitor cells are stimulated by a range of growth factors which promote colony growth in culture. The progenitors are a part of an age-structured developmental hierarchy in the tissue. The growth factors, although overlapping in their effects, stimulate cells preferentially at different stages in this programme. Femoral bone marrow was fractionated into axial (close to the central venous sinus) and marginal (close to the bone surface) cells. Progenitors which responded to IL-3, GM-CSF, G-CSF, M-CSF and SCF were then assayed in soft agar cultures. Consequent plots of their spatial distributions showed that the more primitive cells in vitro (responding to IL-3) were concentrated close to the bone surface. The peak concentrations of cells responding primarily to growth factors with progressively more affinity to more mature progenitor cells correspondingly appeared progressively further from the bone surface and closer to the point of release at the central venous sinus. This suggests that the developmental/maturational process in haemopoiesis is accompanied by a progressive movement of cells from the bone surface towards the central axial regions of the bone cavities. The most primitive cells are however exposed, close to the centre of the cavity, by a combination of SCF and G-CSF (or by a 50-fold increase in G-CSF concentration alone). These results corroborate earlier data which indicate a developmental movement of cells from the centre of the marrow tissue towards the bone surface and back again, sequentially encountering a series of growth factors which promote their differentiation into mature cells, for release at the central venous sinus.

Effects of artemether on peripheral T, B, T mu and T gamma lymphocytes in beagle dog

The effects of intramuscular injection of Artemether on peripheral T, B, T mu and T gamma lymphocytes in beagle dogs was investigated cytochemically. Doses used were 6, 19, and 32 MKD, respectively. Results showed that after injection of Artemether for 15 successive days, the T, B, and T mu lymphocytes of the 19 and 32 MKD groups were markedly reduced and the T gamma lymphocytes of all 3 dosage groups were decreased to zero. 28 days after cessation of the drug, T, T mu and T gamma lymphocytes had recovered to control levels, while the B lymphocytes of the 19 and 32 MKD groups remained markedly lower than those of the control groups. The differences and similarities of the effects on the peripheral T, B, T mu and T gamma lymphocytes produced by the 3 dosages of Artemether and the relationship between the changes of T, B lymphocytes and immunological function of beagle dogs are discussed.