Search

Objective: To establish a prediction model to help the doctor determine which patients are more suitable for transvaginal repair based on the prediction model. Design:All enrolled patients underwent CSD repair performed by a single team. All women in this study had a follow-up clinic visit at 6 months to record their menstruation and measure multiple parameters of the CSD by MRI. Setting:Retrospective study Sample: This study included 1015 women who underwent transvaginal repair of cesarean scar diverticulum (CSD) at Xinhua Hospital and Shanghai First Maternity & Infant Hospital between June 2014 and May 2021. Main outcome measures: CSD patients are categorized as having optimal healing when the menstruation duration is no more than 7 days and the thickness of residual myometrium（TRM） is no less than 5.39 mm after vaginal repair. The final nomogram is constructed to predict surgical outcomes based on pre- and postoperative variables. Results: The key factors determining optimal healing are the timing of cesarean section; menstrual cycle; CSD length, width, depth, and the myometrial layer thickness of the lower uterine segment. With the prediction model, scores are given to each parameter according to the statistics. Total scores range from 0 to 25 points with a cutoff point of 16.5. Predicted that transvaginal repair achieves optimal healing when a score greater than 16.5 points. Uterine position and preoperative TRM are the key factors affecting postoperative TRM. The width of the CSD and the thickness of the lower uterine segment are the key factors affecting postmenstrual abnormal uterine bleeding (PConclusions: We establish a prediction model system for the first time that may predict the repair effect of CSD and can potentially be useful in future clinical trials to determine which patients should be repaired or other treatment options.

Since toys are the potential sources of lead contamination for young children, we aim to compare blood lead levels (BLLs) of young children and lead-levels in toys played by the children. A total of 2249 children under 7 years old were investigated using stratified cluster sampling in 6 districts of Shanghai, their parents completed questionnaires and children’s whole blood was collected, and then BLLs were measured using tungsten atomizer absorption spectrophotometer. At the same time, 294 toys from the 6 supermarkets/ toy-stores located in the surrounding 5 districts were collected using stratified cluster sampling and lead levels in toys were measured by a portable X-ray Fluorescence instrument. The geometric mean of the BLLs was 2.02 μg/dL. After adjusting for related confounders, playing with plastic toys is a significant risk factor (β=0.067, P =0.019) for BLL-increment. Plastic toys accounted for the highest proportion (156/294, 53.06%) among the studied toys and had the highest average lead level (39.13 ppm). In the 3 districts where children’s BLLs and toys’ lead levels were both measured, the districts with higher toy lead levels had higher children’s BLLs (the average toy lead levels in Pudong-suburban vs. Xuhui vs. Yangpu supermarkets/ toy-stores: 24.62 vs. 0 vs. 15.43 ppm, P

Hypertension is a significant risk factor for cardiovascular and cerebrovascular diseases, and its development involves multiple mechanisms. Gut microbiota has been reported to be closely linked to hypertension. Short-chain fatty acids (SCFAs)—the metabolites of gut microbiota—participate in hypertension development through various pathways, including specific receptors, immune system, autonomic nervous system, metabolic regulation and gene transcription. This article reviews the possible mechanisms of SCFAs in regulating blood pressure and the prospects of SCFAs as a target to prevent and treat hypertension.

To investigate prenatal exposure to arsenic and its effect on birth size, we conducted a cross-sectional study in Wujiang City, Jiangsu, China, from June 2009 to June 2010. A total of 1722 mother-infant pairs were included in the study. A questionnaire was administered to the pregnant women and umbilical cord blood(UCB) samples were collected. Arsenic concentration in UCB was detected by inductively coupled plasma emission mass spectroscopy (ICP-MS). The birth size included birth weight, birth body length and head circumference of the newborns. The effects of arsenic exposure on birth size were assessed by multiple linear regression analysis. Arsenic concentrations in UCB ranged from 0.11 to 30.36 μg/L, the median was 1.71 μg/L. In this range of exposure, arsenic concentration was significantly negatively associated with birth weight, especially among male infants. Our results showed that prenatal exposure to arsenic level was low in Wujiang City, China. However, low prenatal arsenic exposure could have negative effects on birth weight. Our research provided evidence for the adverse effects of prenatal low-level arsenic exposure on the intrauterine growth of the fetus.

BackgroundLymphovascular invasion (LVI) is defined as the existence of cancer cells in lymphatics or blood vessels. This study aimed to evaluate the prognostic value of LVI in stage Ⅱ colorectal cancer (CRC) patients with inadequate examination of lymph nodes (ELNs) and further combined LVI with the TNM staging system to determine the predictive efficacy for CRC prognosis. Adjuvant chemotherapy (ACT) was then evaluated for stage Ⅱ CRC patients with LVI positivity (LVI +).MethodsThe clinicopathologic records of 1420 CRC patients treated at the Third Affiliated Hospital of Soochow University between February 2007 and February 2013 were retrospectively reviewed. LVI was examined by hematoxylin-eosin (HE) staining. Kaplan-Meier analysis followed by a log-rank test was used to analyze survival rates. Univariate and multivariate analyses were performed using a Cox proportional hazards model. The Harrell’s concordance index (C-index) was used to evaluate the accuracy of different systems in predicting prognosis.ResultsThe LVI status was significantly associated with pT stage, degree of differentiation, tumor stage, serum CEA and CA19-9 levels, perineural invasion (PNI) and KRAS status. The 5-year overall survival (OS) rate of stage Ⅱ patients with < 12 ELNs and LVI + was less than stage ⅢA. Multivariate analyses showed that LVI, pT-stage, serum CEA and CA19-9 levels, PNI and KRAS status were significant prognostic factors for stage Ⅱ patients with < 12 ELNs. The 8th TNM staging system combined with LVI showed a higher C-index than the 8th TNM staging system alone (C-index, 0.895 vs. 0.833). Among patients with LVI + the ACT group had a significantly higher 5-year OS and 5-year disease-free survival (DFS) than the surgery alone (SA) group (5-year OS, 66.7% vs. 40.9%, P = 0.004; 5-year DFS, 64.1% vs. 36.3%, P = 0.002).ConclusionsLVI is an independent prognostic risk factor for stage Ⅱ CRC patients. Combining LVI with the 8th TNM staging system improved the predictive accuracy for CRC prognosis. ACT in stage Ⅱ CRC patients with LVI + is beneficial for survival.

Background Spontaneous hemopneumothorax (SHP) is defined as the accumulation of >400 mL of blood in the pleural cavity in association with spontaneous pneumothorax. This rare clinical disorder may be life-threatening. Case presentation A 71-year-old woman presented with a 1-month history of recurrent bloody stool, and electronic colonoscopy suggested a rectal mass. Laparoscopic radical resection of rectal cancer was performed. Two days later, she developed chest tightness, shortness of breath, and slight pain in the left chest. Emergency chest radiography revealed mild left pneumothorax and pleural effusion. SHP was suspected and a thoracic drain was inserted. However, the patient developed hemorrhagic shock 3 hours after drainage. She underwent emergency video-assisted thoracic surgery (VATS), which revealed left lung tip rupture with bleeding and adhesive band fracture at the top of the left thoracic cavity. The ruptured lung tissue was removed and electrocoagulation at the adhesion band was performed for hemostasis. The patient was discharged on postoperative day 11. At the time of this writing, she had developed no SHP recurrence or any other complications. Conclusions This case shows that conservative treatment may have serious consequences in patients with SHP. Thus, chest X-ray examination and VATS should be performed in patients with SHP.

Background To investigate the prognostic value of pre-treatment serum alpha-fetoprotein (AFP) levels in patients with gastric cancer (GC). Methods PubMed, EMBASE, Medline and Web of Science databases were systematically searched for studies published between January 01, 1998 and December 31, 2018 that investigated the relationship between pre-treatment serum AFP levels and prognosis of patients with GC. Hazard ratios (HR) for overall survival (OS), disease-free survival (DFS), and their corresponding 95% confidence intervals (CIs) were evaluated. Results 13 studies involving 9099 patients with GC were included in the meta-analysis. High pre-treatment serum AFP levels were significantly associated with poor outcome in patients with GC. Although there was significant heterogeneity between studies, sub-group analyses found that studies of ‘non-China’ countries, sample size

Background: Programmed death-ligand 1 (PD-L1) is a programmed death 1 (PD-1) ligand that plays a pivotal role in the inhibition of the T-cell-mediated immune response. The expression of PD-L1 is associated with the prognosis and clinical outcomes of multiple tumors. However, the prognostic value of PD-L1 overexpression in colorectal cancer is still controversial. In this study, we sought to clarify this by presenting a meta-analysis of relevant studies. Methods: Databases including PubMed, Web of Science, and EMBASE were systematically searched for studies concerning the expression of PD-L1 and survival in colorectal cancer. The reported hazard ratios (HR) with 95% confidence intervals (CI) of overall survival, disease-free survival, and recurrence-free survival in the included studies were analyzed by fixed effects/random effects models. Results: Fifteen studies involving 3078 patients with colorectal cancer were included in our meta-analysis. Overexpression of PD-L1 was found to be associated with poor overall survival (HR 1.83; 95% CI 1.21, 2.79; P = 0.005) and poor recurrence-free survival (HR 2.78; 95% CI 1.43, 5.42; P = 0.003). However, no correlation was found between PD-L1 overexpression and poor disease-free survival (HR 1.23; 95% CI 0.83, 1.82; P = 0.305). Overexpression of PD-L1 indicating poor survival held true across different geographical areas, sample sizes, analysis types, sources of HRs, and cell types. Conclusion: Overexpression of PD-L1 is associated with worse prognosis in patients with colorectal cancer and can guide physicians in the application of PD-1/PD-L1 immune checkpoint-targeted therapy.

Background The IQ-motif-containing GTPase-activating protein (IQGAP) family comprises three members, IQGAP1, IQGAP2 and IQGAP3. IQGAP3 is the latest addition to the family. This study mainly investigated the novel marker IQGAP3 at serum and tumor tissue levels compared with the markers B7-H4 and cyclooxygenase-2 (COX-2) in patients with colorectal cancer (CRC) and in healthy individuals, aiming to evaluate the diagnostic and prognostic value of IQGAP3 for CRC. Materials and methods Serum samples were collected prior to any therapy in 118 CRC patients and as part of a routine examination in 85 healthy individuals. Serum IQGAP3, B7-H4 and COX-2 levels were measured using commercially available ELISA kits. Immunohistochemistry was performed to detect the IQGAP3, B7-H4 and COX-2 in tumor tissues and normal para-carcinoma tissues. The receiver operating characteristics (ROC) curve and the area under the curve (AUC) were used to evaluate and compare the diagnostic value of different serum tumor markers. Univariate and multivariate analyses were performed to identify the prognostic risk factors for CRC. Results IQGAP3, B7-H4 and COX-2 showed low or high expression in tumor tissues while no expression in normal para-carcinoma tissues. Serum levels of IQGAP3 in CRC group were significantly higher than those in healthy control group (P

Additional file 1. Correlation of serum IQGAP3, CEA and CA19-9 levels with clinicopathological features in 118 CRC patients. One hundred eighteen CRC patients who met the inclusion criteria were analyzed in this study. The correlation between clinicopathological characteristics and serum tumor markers were analyzed.

Supplemental material, Supplementary_material_2 for Programmed death-ligand 1 and survival in colorectal cancers: A meta-analysis by Huihua Cao, Qing Wang, Zhenyan Gao, Zhan Yu, Yugang Wu and Qicheng Lu in The International Journal of Biological Markers

Background: Dental caries is a well-known biofilm-mediated disease initiated by Streptococcus mutans, which should infect and colonize in a milieu perfused with components of the mucosal immune system. Little is known, however, regarding the relationship between the natural secretory IgA activity and S. mutans of a variety of diverse genotypes. Objectives: The current study aimed to use spousal pairs to investigate the natural immunoreactivity of salivary secretory IgA to different genotype strains of S. mutans. Patients and Methods: Indigenous strains were characterized from nine spousal pairs using polymerase reaction chain (PCR) and arbitrarily primed polymerase chain reaction (AP-PCR) by genotype monitoring. Unstimulated submandibular/sublingual secretions were collected and the concentrations of secretory IgA were determined by the enzyme-linked immunosorbent assay (ELISA). Each saliva sample was examined by Western blot to analyze the immunoreactivity of naturally occurring salivary secretory IgA antibodies for his/her own indigenous strain, spouse’s strain and reference strains including S. mutans GS-5 and Ingbritt (C). Results: The results showed that naturally induced salivary IgA antibodies against S. mutans were present in all subjects. Almost all subjects had the similar individual immunoblotting profiles to different genotype strains. Conclusions: The current study indicated that the immunoreactivity of secretory IgA might have no direct correlation with the colonization of indigenous flora and rejection of exogenous strains in adults. The relationship of microbes, host and dental caries should be in the light of coevolved microecosystem as a whole, but not caused by one factor alone.

A new approach based on sensitivity analysis for optimizing the microstructure development during the forging processes is proposed in this work. The analytical sensitivities of the recrystallization volume fraction and dynamically recrystalized grain size with respect to the design variables are derived. The mean grain size in each finite element is introduced so that the complex recrystallization mechanics, such as no recrystallization, partial recrystallization and complete recrystallization are all considered. The objective is to minimize a function describing the variance of mean grain size and the average value of mean grain size in the whole final product. Two constraints are imposed on die underfill and excessive material waste. Two different kinds of design variables are considered, including state parameter (initial shape of billet) and process parameter (die velocity). The optimization scheme is demonstrated with the design of a turbine disk made of Waspaloy in non-isothermal forging process. The optimal initial shape of billet and the die velocity are obtained.