1临床资料 1例42岁女性患者,4年前左手拇指根部及食指间发现一肿物,近期发现肿物快速增大,遂在当地医院进行诊治,行左手肿物姑息切除术.术中见瘤体大小约1 cm×2 cm,质硬,表面光滑,无明显包膜.术后初步诊断为左手拇指根部软组织恶性肿瘤(病理类型为透明细胞肉瘤,分期为pT1N0Mx).考虑到肿瘤距离左手腱鞘较近,多学科综合治疗(multi-dis-ciplinary treatment,MDT)及骨软外科会诊后建议术后辅助放射治疗.

Blunt cardiac trauma (BCT) is a life-threatening cardiac emergency. BCT and the resultant left ventricular trauma (LVT) include mitral valve avulsion, ventricular septal injury, and traumatic ventricular aneurysms. Only a few isolated types have been reported in the existing literature. We report the youngest patient with LVT. Moreover, it included all types of this trauma and was diagnosed at the same time. A 3-year-old girl was transported to our emergency room with severe substernal pain and upper abdominal pain after being hit by an agricultural vehicle. She was conscious the entire time, with a blood pressure of 90/50 mmHg, a heart rate of 145 beats per minute, a respiratory rate of 30 breaths per minute, and an oxygen saturation of 100% while breathing the ambient air in the emergency room. A few scattered wet rales were heard in both lungs, and no obvious murmurs were heard on cardiac auscultation. Radiological examination did not reveal any specific organ damage, including bone, abdominal organs, or skull. She was given oxygen, expectorant, and symptomatic treatment. Three days later, the child suddenly began sweating profusely, did not want to move, and exhibited weak crying. Physical examination revealed a systolic murmur of Levine grade II–III/VI heard near the cardiac apex, which was increased by inspiration. Electrocardiogram showed a sinus tachycardia with ST-T segment elevation (Panel A). An initial transthoracic echocardiogram showed multiple aneurysms in the posterior wall and inferior wall of the left ventricle (Panel B), with the abnormal aneurysms increasing during systole and decreasing during diastole (the two largest measurements were 20.9 mm × 8.0 mm and 14.1 mm × 6.4 mm, Supplementary material online, Video). Moreover, a bulge was also found in the interventricular septum, with a neck measuring 15 mm that was 7 mm deep at its widest diameter (Panel C). The apical four-chamber view with colour flow mapping revealed moderate to severe regurgitation of the mitral valve with a prolapsed anterior leaflet (Panel C). The left ventricle was enlarged, and the ejection fraction was 53% (Panel D). These ventricular aneurysms were also demonstrated by 320-slice computed tomographic scans (Panels E–H). These imaging diagnoses were confirmed by surgery for reconstruction of the left ventricle and mitral valvuloplasty (Panel I).

目的 调查全国毕业后医学教育放射肿瘤科住院医师规范化培训现状及近年来变化趋势,探讨现阶段在基地建设、学员分布和考核方式等方面存在的问题,为进一步完善放射肿瘤科毕业后医学教育政策,提升放射肿瘤科规培医师胜任能力提供参考.方法 根据《住院医师规范化培训基地认定标准(2020年修订)——放射肿瘤科专业基地认定细则》和《住院医师规范化培训内容与标准(2020年修订)——放射肿瘤科培训细则》,对2017、2018和2019年全国放射肿瘤科专业基地所在的科室规模、疾病年诊治例数、医疗设备数、临床技能年完成例数、学员分布和结业数据等关键指标,设计统计需求列表.根据住院医师规范化培训管理平台数据库建站以来原始数据并对缺失信息进行删除.选择SPSS 20.0软件进行统计分析,所有数据进行正态性检验,正态分布数据以x-±s表示;非正态分布数据用中位数(最小值,最大值)表示.结果 内蒙古、山西、青海、新疆建设兵团4个省市疾病年诊治例数共计16个指标均值不达标.在临床技能年完成例数中,北京市头颈肿瘤二维常规放射治疗指标未达标,但是头颈肿瘤三维精确放疗(包括靶区勾画)指标却高于标准15.9倍.医疗设备均数全部达标的地区只有北京、福建和山东3个省份,占9.7％(3/31);全部设备均数均未达标的省份共计7个,占22.6％(7/31).北京市每个设备数指标值均高于均值,但由于其学员人数多,设备学员人均占有量并不高,加速器、后装治疗机、模拟定位机(含CT定位机)和三维计划治疗系统学员人均占有量分别为0.42、0.09、0.15和3.73.2017、2018和2019年全国招收学员总人数分别为1358、1375和1348人,学员人数较多的为四川省、山东省和广东省,3年平均占比分别为11.54％(157/1360)、11.03％(150/1360)和9.56％(130/1360).2019年参加全国毕业后医学教育放射肿瘤科住院医师规范化培训的学员以全日制硕士专业学位研究生类型为主,占比达59.5％(803/1348).全国学员结业总人数2017年为708人,2018年为1178人,2019年为1189人,各省市自治区学员结业人数大体呈每年逐步上升趋势,年平均增长率为12.1％.结论 尽管各项指标全国各地市仍存差距,但肿瘤精准治疗技术的全国开展率在逐步提升.设备学员人均占有量存在区域差异.我国毕业后医学教育放射肿瘤科住院医师规范化培训完成度逐步提高,研究生教育与住院医师规范化培训并轨工作持续推进.

目的 针对胸中段食管癌患者,定量评估图像引导频率对摆位误差的影响,寻求临床靶区体积到计划靶区体积(CTV-PTV)的最佳外扩值.方法 选择安阳市肿瘤医院2018-06-01-2020-01-01接受螺旋断层放疗的胸中段食管癌患者62例,每次治疗前行兆伏级CT(MVCT)扫描,获得摆位误差.分析不同图像引导频率(0％、4％、11％、19％、23％、37％和50％)对于摆位误差的影响.17例患者治疗后再次行MVCT扫描得出分次内摆位误差,结合胸中段食管运动幅度的前期研究,得出最佳CTV-PTV外扩值.结果 随着图像引导频率增加,系统误差在X(左右)、Y(头脚)、Z(腹背)3个方向逐渐减小,随机误差增减趋势不明显.即使图像引导频率达到50％,在X、Y、Z方向仍分别有1.3％、6.6％和0.2％的摆位误差>10 mm.根据17例胸中段食管癌患者分次内摆位误差,得出X、Y、Z 3个方向CTV-PTV的外扩值分别为1.48、2.48和1.80 mm.结论 随着图像引导频率的增加,摆位误差呈减少趋势,但是仍然存在一定比例误差较大的情况,建议胸中段食管癌患者每次治疗前行MVCT图像引导.此外,放疗过程中由于患者不自主运动以及食管本身运动带来的影响,仍然需要一定的CTV-PTV外扩以保证肿瘤靶区得到足够的辐射剂量.

Oesophageal perforation is a life-threatening emergency. Only three cases have been reported in which the posterior wall pericardium was simultaneously punctured by foreign body from an oesophageal perforation. We report the first highly unlikely case with the anterior wall of the pericardium punctured. A 37-year-old male was admitted with sudden bilateral chest pain and dyspnoea for 12 h. Chest computerized tomography showed bilateral pneumothorax, a small amount of effusion in the right thoracic cavity, and a high density of foreign body anterior to the pericardium (Panels A and B, Supplementary material online, Video S1). During the operation, haematoma formation was observed in the anterior mediastinum pericardial fat, and a 3.5 cm fish-bone thorn was observed in the anterior wall of the pericardium on the right ventricular surface, with obvious bleeding in the pericardium (Panels C–E, Supplementary material online, Video S2). Oesophagoscopy was performed at the same time, and an oesophageal ulceration was observed 20 cm from the incisors (Panel F).

Due to its potential adverse effects on human health, perfluorooctanoic acid (PFOA), one of the once widely used legacy per- and polyfluoroalkyl substances (PFASs), has been recently replaced by its novel alternatives including hexafluoropropylene-oxide-dimer-acid (GenX) and ammonium 4,8-dioxa-3H-perfluorononanoate (ADONA). These alternative PFASs are detected in water and exposed workers. PFASs can enter organs like thyroids, however, it is yet unknown whether the new alternatives are safer than PFOA. In the current study, we compared the thyroid disrupting effects of PFOA and its alternatives GenX and ADONA in vitro with both rat thyroid cell line FRTL5 and primary normal human thyroid (NHT) cells. Cells were exposed to ascendant doses of PFOA, GenX or ADONA for various incubation time and cell viability was assessed by WST-1 assay and LDH assay. The proliferation rate of survived cells was determined by crystal violet-based cell proliferation assay and MTT assay. The gene expression of thyroid hormone regulation-related genes in thyroid cells after exposure was quantified by RT-PCR and Western blot. Our data showed that both PFOA and GenX reduced thyroid cell viability in both dose and time dependent manner, with GenX being more toxic than PFOA at the same condition. Similarly, the proliferation rate of cells survived exposure to PFOA and GenX was considerably impaired, with GenX showing more profound adverse effect than PFOA. Unlike PFOA and GenX, ADONA showed no apparent adverse effects on the viability and proliferation of both thyroid cell types. Gene expression data revealed that all three PFASs altered gene expression in both thyroid cells and the altered gene expression seemed to be PFAS and cell type dependent. Taken together, our data reveal that the thyroid disrupting effects is increased in the order of GenX > PFOA > ADONA. Our findings will be beneficial for the guidance of the future usage of PFASs and development of better alternatives.

Children with pediatric tumors have better prognosis and longer survival than adults, suggesting that attention should be paid to the long-term complications induced by radiotherapy. In this article, the data from more than 40 clinical studies of pediatric tumor radiotherapy published in the recent decade were retrospectively analyzed. Long-term complications of nervous system, cardio-cerebrovascular system, respiratory system, endocrine system, urinary system, reproductive system, skeletal development, long-term secondary tumors were considered and the corresponding radiation dose-volume parameters were summarized, aiming to guide radiation oncology physicians and physicists to optimize radiotherapy plans for children with pediatric tumors.

目的 探讨螺旋断层治疗(HT)在治疗超长靶区(头脚方向长度超过40 cm)患者时分段获取兆伏级CT(MVCT)影像引导的必要性.方法 选取2017-01-01-2019-12-31在安阳市肿瘤医院进行螺旋断层治疗的超长靶区患者18例,分为头体组(10例)和体部组(8例).治疗前行分段MVCT扫描总计588次,每例患者获得的前后两段图像分别与定位CT图像进行配准,记录左右(x)、头脚(y)和腹背(z)方向的平移误差,计算CTV-PTV的外扩范围.采用SPSS19.0对符合正态分布的数据进行配对样本t检验,不符合正态分布的则采用Wilcoxon秩和非参数检验.结果 摆位误差从头颈到胸腹有逐渐增大的趋势.其中头体组头部和体部摆位误差在y轴方向差异有统计学意义(P=0.008),体部组体上部和体下部在x方向和z方向差异有统计学意义(P=0.001;P＜0.001).在行图像引导前提下,头颈部推荐外扩为3.5～4.0 mm,胸腹部为4.5～5.0 mm.结论 分段扫描可以最大程度减小摆位误差.超长靶区的摆位误差从低到高依次为头部、胸部和腹部,在CTV-PTV进行外扩时要注意这种变化.为了尽可能减小摆位误差,超长靶区患者每次治疗前应该行分段MVCT扫描.

Objective:To observe the feasibility of magnetic resonance (MR)-guided stereotactic body radiotherapy (SBRT) for non-small cell lung cancer, and analyze the dosimetric differences in the presence or absence of magnetic field.Methods:Three patients with non-small cell lung cancer were prospectively treated with MR-guided linac (MR linac) for SBRT, and the dose was calculated with or without magnetic field models. The differences of dose distribution with or without magnetic field models were compared. At the same time, the target coverage, plan pass rate and treatment time were described, and the complexity of the conventional accelerator backup plan and the magnetic field model were compared.Results:The treatment time of 3 patients was (36.67±6.11) min, and the average time of online adaptive planning was (14.4±1.7) min, which was basically tolerated by patients. The treatment plan pass rate (3%/3 mm) was 98.9%, the Gamma pass rate (3%/3 mm) of the online plan during treatment was 98.5% and the target coverage was 99.1%, which met the clinical needs. The dose in the low dose area of the lung was slightly lower than that in the case without magnetic field, whereas the dose in ribs and skin was slightly higher than that in the plan without magnetic field. The number of machine unit (MU) for online adaptive plan was slightly higher than that of the reference plan, and the number of MU for the conventional accelerator standby treatment plan was significantly lower than that of the MR linac plan under the same target coverage. The follow-up results showed that there was no adverse reaction, and the short-term efficacy was partially relieved.Conclusions:In the case of considering the influence of magnetic field, the treatment plan meeting the clinical needs can be obtained. It is proven that SBRT radiotherapy for lung cancer guided by magnetic resonance accelerator is feasible, whereas the treatment time and process are complex.

目的 汇总肿瘤患儿诊疗的镇静特点、镇静前准备、镇静方案和药物选择、镇静中的监测及评估等方面研究进展,以期为临床医护人员开展肿瘤患儿的镇静工作提供参考.方法 以"镇静、麻醉、肿瘤、儿童、患儿"为关键词,检索2000-01-01-2021-07-01中国知网及Pubmed相关文献.纳入标准:与儿童患者诊疗过程中镇静/麻醉相关文献;与肿瘤患儿诊疗过程中镇静/麻醉相关文献;与肿瘤患者诊疗过程中镇静/麻醉相关文献;程序化镇静相关文献.排除标准:与成年患者诊疗过程中镇静/麻醉相关文献.最终纳入分析文献43篇.结果 国内外对于儿童镇静/麻醉的研究均有报道,但针对肿瘤患儿的研究较少见.其中以患儿镇静药物及镇静方案的选择研究报道较多,镇静药物的选择主要包括水合氯醛、巴比妥类药物、苯二氮卓类药物、右美托咪定、静脉麻醉药、吸入性麻醉药物等.而关于镇静方案的实施主要涵盖镇静前的准备、镇静前评估、镇静期间的监测以及镇静提供者四大方面.但目前仍未明确哪种镇静方案对于肿瘤患儿的临床效果最佳.结论 镇静方案及镇静药物的有效性与安全性仍需进行大样本、多中心的前瞻性研究验证,继续探索适合肿瘤患儿的镇静模式,不断完善肿瘤患儿镇静方案,最大可能的为肿瘤患儿提供安全、舒适的服务与体验.

In the Journal of Thoracic Oncology, Tian et al.1Tian S. Hu W. Niu L. Liu H. Xu H. Xiao S.Y. Pulmonary pathology of early-phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer.J Thorac Oncol. 2020; 15: 700-704Abstract Full Text Full Text PDF PubMed Scopus (965) Google Scholar reported one patient who died of coronavirus disease-2019 (COVID-19) after undergoing lung lobectomy for adenocarcinoma. Bonomi et al.2Bonomi L, Ghilardi L, Arnoldi E, Tondini CA, Bettini AC. A rapid fatal evolution of coronavirus disease-19 (COVID-19) in an advanced lung cancer patient with a long time response to nivolumab [e-pub ahead of print]. J Thorac Oncol. https://doi.org/10.1016/j.jtho.2020.03.021, accessed March 31, 2020.Google Scholar presented a patient with metastatic lung cancer who died rapidly after contracting COVID-19. Russano et al.3Russano M, Citarella F, Vincenzi B, Tonini G, Santini D. COVID-19 or lung cancer: what should we treat [e-pub ahead of print]? J Thorac Oncol. https://doi.org/10.1016/j.jtho.2020.04.001, accessed April 10, 2020.Google Scholar believed that patients with tumors had a higher risk of lethal COVID-19 complications. This news seems foreboding for patients with cancer who also acquire COVID-19. Therefore, because of the dramatic COVID-19 outbreak, extreme caution is required to ensure COVID-19 is not misdiagnosed as lung cancer and to consider that COVID-19 can coexist in patients with lung cancer. However, the high-resolution computed tomography (CT) findings of some patients with COVID-19 are dominated by ground-glass opacity–like changes, and these patients can even have only one localized lesion, with vacuoles, pleural traction, and invasion of pulmonary capillaries. These observations are also highly consistent with and are classic CT findings of lung cancer. Differentiating lung cancer from COVID-19 is a challenge in Wuhan, the epicenter of the outbreak currently on controlled levels of infection, and wherein the number of patients with early-stage lung cancer and those with asymptomatic COVID-19 is increasing.4Ouyang W, Yu J, Zhang J, Xie C. Alert to potential contagiousness: a case of lung cancer with asymptomatic SARS-CoV-2 infection [e-pub ahead of print]. J Thorac Oncol. https://doi.org/10.1016/j.jtho.2020.04.005, accessed April 16, 2020.Google Scholar,5Meng H, Xiong R, He R, et al. CT imaging and clinical course of asymptomatic cases with COVID-19 pneumonia at admission in Wuhan, China [e-pub ahead of print]. J Infect. https://doi.org/10.1016/j.jinf.2020.04.004, accessed April 12, 2020.Google Scholar This adds to the problem of identifying those with asymptomatic COVID-19. The doctors' concerns are twofold. First, patients with COVID-19 are being mistakenly treated for lung cancer, and these individuals could undergo an unnecessary operation. Second, patients with lung cancer with COVID-19 during the perioperative period can experience severe complications or nosocomial infection events. We took the following measures to distinguish them. First, the patients admitted to the hospital were asked about their detailed medical history, including any contact history with patients having COVID-19 and whether they had had fever, cough, diarrhea, sore throat, or other symptoms in the past 2 weeks. After stating their medical history, the patients signed a declaration form consenting to disclose their medical history without any concealment; otherwise, they would bear the legal responsibility. Second, chest CT examination, routine blood parameters, blood IgG and IgM analyses, and nucleic acid examination of pharyngeal swab specimens were performed on the patients and their companions on hospital admission. Third, only those patient companions whose tests revealed negative results were allowed to accompany the patient, and only a minimum number of people were allowed to accompany the patients. If the patients were diagnosed as having suspected COVID-19 in the above examination, they were admitted to the ward for patients with suspected COVID-19 for further investigation. If the diagnosis was confirmed, the patients were transferred to the infected area for treatment. Fourth, newly admitted patients were placed in protective isolation in single rooms. After repeated body temperature monitoring, if there were no abnormalities, and if none of the symptoms mentioned above were present after 24 hours, the patient underwent a second pharyngeal swab for nucleic acid examination. If the test result was negative, the patient was transferred to the general ward for 2 to 3 days. Patient indicator information of COVID-19 was announced in the department medical staffs' WeChat group and was updated daily. Fifth, hospitalized patients wore masks at all times; visitors and discussions with other patients were strictly prohibited. Sixth, the department ward for suspected COVID-19 and the general ward were managed by different sets of staff, and the staff were strictly prohibited from changing wards. They also needed to follow strict protective measures among themselves, such as wearing a mask if two or more people slept in the same duty room. Seventh, patients going out for checks or eating were assigned a special route, and there was regular disinfection by professionals. Eighth, routine bronchoscopy was performed before lung surgery and nucleic acid examination was also performed along with an analysis of secretions from the lower respiratory tract. Ninth, after several days (generally 1–2 weeks) of examination and surgical preparation, patients with lung cancer and with no evidence of COVID-19 underwent a routine operation. A Rapid Fatal Evolution of Coronavirus Disease-19 in a Patient With Advanced Lung Cancer With a Long-Time Response to NivolumabJournal of Thoracic OncologyVol. 15Issue 6PreviewCoronavirus disease-19 (COVID-19) is now a pandemic disease. In Italy, the first set of cases were documented at the end of January 2020 reporting a dramatic spread. Liang et al.1 reported an increased risk of COVID-19 for patients with cancer, having poorer prognosis than those without cancer. We present a case of a rapid fatal evolution of COVID-19 in a patient with metastatic lung cancer in partial remission with immunotherapy since 2013. Full-Text PDF Open ArchivePulmonary Pathology of Early Phase 2019 Novel Coronavirus PneumoniaJournal of Thoracic OncologyVol. 15Issue 5PreviewWe read the publication on "Pulmonary pathology of early phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer" with great interest.1 Tian et al.1 concluded that "the lungs of both patients exhibited edema, proteinaceous exudate, focal reactive hyperplasia of pneumocytes with patchy inflammatory cellular infiltration, and multinucleated giant cells" and noted that "these changes likely represent an early phase of the lung pathology of COVID-19 pneumonia." Although this pathologic finding might be a lung abnormality in COVID-19, it should not be referred to as COVID-19 pneumonia because the patients did not have pneumonia. Full-Text PDF Open ArchiveAlert to Potential Contagiousness: A Case of Lung Cancer With Asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 InfectionJournal of Thoracic OncologyVol. 15Issue 6PreviewThe novel coronavirus disease 2019 (COVID-19) has become a global pandemic and affected more than 1 million people all over the world.1 This disease is notably linked to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Nowadays, asymptomatic SARS-CoV-2 carriers are causing concern.2 We previously reported that patients who had cancer were at an increased risk of COVID-19.3 Here, we report a case of an asymptomatic SARS-CoV-2 carrier with lung cancer who might be contagious. Full-Text PDF Open ArchiveCoronavirus Disease 2019 or Lung Cancer: What Should We Treat?Journal of Thoracic OncologyVol. 15Issue 7PreviewManagement of patients with lung cancer in the era of coronavirus disease 2019 (COVID-19) has become a global concern. We read with great interest the article written by Zhang et al.,1 who first reported the treatment and outcome of a patient with lung cancer infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A 57-year-old Chinese man affected by advanced lung adenocarcinoma harboring EGFR L858R mutation continued targeted therapy with osimertinib despite development of COVID-19 pneumonia. Full-Text PDF Open Archive

Objective:To explore the application of ArcCheck system in the validation of Helical and Direct tomotherapy plans for esophageal cancer and summarize relevant experience.Methods:The Helical and Direct tomotherapy verification plans were established for 32 patients with esophageal cancer at different positions according to the doctor′s instructions, which were verified by the ArcCHECK system to compare the passing rate of the results.The correlation between the volume of the target area and the passing rate of the planned verification was analyzed. The therapeutic verification plan with a small target volume was made. The target area was placed at the center of ArcCHECK phantom and the area of detectors to statistically compare the verification passing rates.Results:Helical plan showed a significantly higher passing rate than the Direct plan ( P<0.01). The correlation coefficients between the target volume and the passing rate of the Helical and Direct plans were -0.364 and -0.042, and the P values were 0.041 and 0.819, respectively. For the Helical plan, when the 3%/2mm criterion was adopted, there was significant difference between placing the high-dose area at the center of the phantom and the area of detectors ( P=0.005), and the passing rate of the latter was higher. There was no significant difference in the other cases (all P>0.05). Conclusions:The passing rate of the Helical plan is generally higher than that of the Direct plan, which may be related to the angular response of the ArcCHECK detector and the fact that more reference points are not included for calculation due to low-dose radiation. In addition, it may also be related to the higher requirements of Direct plan for tomotherapy dose control system. In the Helical verification plan, when the 3%/3mm criterion is adopted, the larger the target volume, the higher the possibility of lower passing rate, whereas the correlation coefficient between them is relatively low. The high-dose area can be verified by the plans at the center of the phantom or the detection point. With the comprehensive consideration, we suggest putting it at the center of the phantom.

There is increasing evidence that liver cancer stem cells (LCSCs) contribute to hepatocellular carcinoma (HCC) initiation and progression. MicroRNA (miRNA) plays a significant functional role by directly regulating respective targets in LCSCs-triggered HCC, however, little is known about the function of the miRNA-302 family in LCSCs.

1病例资料 慢性血栓栓塞性肺动脉高压(chronic thromboembolic pulmonary hypertension,CTEPH)是临床上常见的潜在致命性疾病,病死率20％～35％[1].治疗该疾病常规方法有两种[2-3]:第一种是心肺移植手术,该手术方式较大,操作简单,短期生存率也较高.第二种为肺动脉内膜剥脱术(pulmonary endarterectomy,PEA),是治疗CTEPH最重要的手段之一,也是唯一的根治手段.据文献[4]报道,认为该手术方式术中深低温停循环是非常必要的.

Objective To investigate the mechanism underlying sufentanil postconditioning-induced reduction of myocardial ischemia-reperfusion (I/R) injury in rats through evaluating the relationship between phosphatidylinositol 3-kinase/serine-threonine kinase (PI3K/Akt) signaling pathway and mitochondrial permeability transition pore (mPTP).Methods Forty-eight pathogen-free healthy male SpragueDawley rats,aged 3 months,weighing 250-300 g,were divided into 4 groups (n=12 each) using a random number table:sham operation group (group S),group I/R,sufentanil postconditioning group (group SP) and snfentanil postconditioning plus PI3K inhibitor wortmannin group (group SP +W).The rats were anesthetized with 20％ urethane 5 ml/kg.Myocardial I/R was induced by ligation of the anterior descending branch of left coronary artery for 30 min,followed by 120 min reperfusion.Sufentanil 1.0 μg/kg was injected via the sublingual vein at 5 min before reperfusion in SP and SP+W groups.Wortmannin 15 pμg/kg was injected via the sublingual vein at 5 min before reperfusion,and then sufentanil 1.0 μg/kg was given in group SP+W.Blood samples were taken from the abdominal aorta at the end of reperfusion for detection of serum cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) concentrations.The rats were then sacrificed and hearts were removed for determination of cell apoptosis (by TUNEL),nicotinamide adenine dinueleotide (NAD+) content (by speetrophotometry),and expression of phosphorylated Akt (p-Akt) in myocardial tissues (by Western blot).Apoptosis index (AI) was calculated.The myocardial mitochondria and cytoplasm were isolated for detection of the expression of cytochrome c (Cyt c) and apoptosis-inducing factor (AIF) using Western blot.Results Compared with group S,the serum cTnI and CK-MB concentrations and AI were significantly increased,the content of NAD+ was decreased,the expression of p-Akt was up-regulated,the expression of Cyt e and AIF in mitochondria was down-regulated,and the expression of Cyt c and AIF in cytoplasm was up-regulated in I/R,SP and SP+W groups (P＜0.05).Compared with group I/R,the serum cTnI and CK-MB concentrations and AI were significantly decreased,the content of NAD+ was increased,the expression of p-Akt was up-regulated,the expression of Cyt c and AIF in mitochondria was up-regulated,and the expression of Cyt c and AIF in cytoplasm was down-regulated in group SP (P＜0.05).Compared with group SP,the serum cTnI and CK-MB concentrations and AI were significantly increased,the content of NAD+ was decreased,the expression of p-Akt was down-regulated,the expression of Cyt c and AIF in mitochondria was down-regulated,and the expression of Cyt c and AIF in cytoplasm was up-regulated in group SP+W (P＜0.05).Conclusion Sufentanil postconditioning can activate PI3K/Akt signaling pathway,inhibit mPTP opening,mitigate mitochondrial injury and inhibit apoptosis in cardiomyocytes,thus attenuating myocardial I/R injury in rats.

Background: The application of thoracic endovascular aortic repair (TEVAR), a minimally invasive operation, in the aortic arch has been a challenge of cardiovascular surgery in recent years. This study aimed to investigate management of the vertebral artery with coverage of the left subclavian artery (LSA) during TEVAR.Methods: From January 2007 to September 2014 in the Department of Cardiothoracic Surgery at Wuhan General Hospital of Guangzhou Military Region, 160 patients underwent LSA closure or partial coverage during TEVAR of an aortic lesion near the LSA. The vertebral artery treatment, the reason for the surgical approach selection, and the prognosis were analyzed.Results: In 94 patients with partial LSA coverage during TEVAR, no treatment was provided for the vertebral arteries, revealing blood flow of the left vertebral artery forward into the skull after surgery. For 66 patients with full LSA coverage (closure) during TEVAR, right carotid artery-left common carotid artery bypass surgery was performed before TEVAR in ten patients, without any treatment for the vertebral artery, showing reverse blood flow of the left vertebral artery after surgery. Left common carotid artery-LSA bypass surgery was performed before TEVAR in four patients; right common carotid artery-left common carotid artery-LSA bypass surgery was performed before TEVAR in three cases, and 6 out of these 7 patients underwent proximal LSA ligation, showing no obvious blood flow in the left vertebral artery. The closure of the LSA aortic arch opening using an occluder was performed in one patient, preserving the forward blood flow in the left vertebral artery. Among the 160 patients in this study, postoperative recurrent laryngeal nerve injury occurred in one patient after right common carotid artery-left common carotid artery-LSA bypass surgery, and the remaining 159 patients had no significant severe complications or death within 1 postoperative month.Conclusions: Appropriate management of the aortic arch branch vessels may expand the application of TEVAR to the aortic arch and reduce complications, especially for high-risk patients who have a difficult time tolerating thoracotomy.

Objective To analysis the clinical features of Stanford B aortic dissection and explore the clinical methods of thoracic endovascular aortic repair(TEVAR).Methods 26 cases that diagnosed with Stanford B aortic dissection and accepted operations with TEVAR were retrospective analyzed their clinical data,including the best operation time,operation method choice,and prognosis.18 cases of intestinal ischemia with superior mesenteric artery was oppressed false lumen but superior mesenteric artery completely or mainly opened aortic true lumen.These cases received emergency TEVAR.8 cases of intestinal ischemia with superior mesenteric artery was completely or mainly opened aortic dissection false lumen,were treated emergency TEVAR with using special pathological anatomy and surgical skills.The processes of emergency TEVAR succeed without perioperative mortality.Results Intestinal ischemia was disappeared in 22 cases with one week,and 4 cases of patients with symptoms improved without further surgery.Conclusion If we can guarantee the superior mesenteric artery fluent,TEVAR is an effective method for treating Stanford B aortic dissection,and should be taken in early time.

Objective To investigate the degree and the mechanism of brain damage induced by cardiac arrest and resuscitation in rats.Methods A total of 16 male Sprague Dawley rats were randomly divided into the sham group and cardiac arrest/cardiopulmonary resuscitation (CA/CPR) group.The model of cardiac arrest induced by asphyxia was established and CPR was performed.Serum protein neuron specific enolase (NSE) and S100β was detected by enzyme linked immunosorbent assay (ELISA).The levels of B cell lymphoma/leukemia-2 associated X protein (bax),B cell lymphoma/leukemia-2 (bcl-2),Caspase-3 protein were measured by Western boltting.Neuronal apoptosis was examined by TdT-mediated dUTP nick end labeling (TUNEL) method and morphological changes of rat brain were ob served.Results S100β levels in CA/CPR group were (4.488 ± 0.762),(6.003 ± 0.718) and (5.913 ± 1.817) ng/ml at 0,3,6 h after resuscitation respectively,statistically higher than in sham group (P =0.010,0.000,0.038).The levels of NSE were (15.628 ± 3.750) ng/ml in CA/CPR group and (9.376 ±2.865) ng/ml in the sham group at 6 h after resuscitation,with the difference being statistically significant (P =0.038).Serum proteins NSE and S100β were on a rise,and there was significant differ ence in the S100β protein levels at 0,3 h was statistically significant (P =0.031,0.012).As compared with sham group [for bax,(0.326 ±0.041);for Caspase-3,(0.394 ±0.038);for bcl-2,(0.212 ± 0.039)],the bax [(0.731 ±0.018)],and Caspase-3 (0.445 ±0.028) protein levels were increased,and bcl-2 [(0.125 ± 0.036)] levels were reduced in CA/CPR group with the difference being statistical ly significant (P =0.000,0.001,0.003).The changes in brain tissue morphology were more obvious in CA/CPR group than in sham group.The apoptosis rate of neurons in CA/CPR group was (29.72± 6.29) ％,higher than that in sham group (P =0.000).Conclusion Five minutes of cardiac arrest in rats causes significant damage to brain tissue,and the damager gradually aggravates over time,whith may be related to the triggering of apoptosis.

Increasing evidence supports that microRNA (miRNA) plays a significant functional role in cancer progression by directly regulating respective targets. In this study, the expression levels of miR-105-1 and its target gene were analyzed using genes microarray and hierarchical clustering analysis followed by validation with quantitative RT-PCR in hepatocellular carcinoma (HCC) and normal liver tissues. We examined the expression of nuclear receptor coactivator 1 (NCOA1), the potential target gene of miR-105-1, following the transfection of miR-105-1 mimics or inhibitors. Our results showed that miR-105-1 was downregulated in HCC tissues when compared with normal liver tissues and patients with lower miR-105-1 expression had shorter overall survival (OS) and progression free survival (PFS). Moreover, NCOA1 was confirmed to be a direct target of miR-105-1. Furthermore, concomitant high expression of NCOA1 and low expression of miR-105-1 correlated with a shorter median OS and PFS in HCC patients. In conclusion, our results provide the first evidence that NCOA1 is a direct target of miR-105-1 suggesting that NCOA1 and miR-105-1 may have potential prognostic value and may be useful as tumor biomarkers for the diagnosis of HCC patients.