Volume 101 ·  Issue 40 ·  2021

Liver is rich in blood supply, with soft and crisp texture, therefore its resection requires accurate and safe bleeding control techniques. The hemostatic effect of complete hepatic inflow occlusion is complete, but the side effects are comparatively serious and the blocking time is limited. The side effects of anatomical hepatic inflow occlusion are light, but there is more bleeding in the process of practice, especially the bleeding of the preserved side of the liver. Based on the dynamic watershed theory, there is traffic flow between hepatic segments and lobes, which is the reason for the poor effect of anatomic hepatic blood flow occlusion. We propose cross interface blood control maneuver. In this strategy, we use a variety of blood control methods alone or in combination, to control the borderline blood flow between segments/lobes. Therefore, compared with anatomic hepatic blood flow occlusion, this strategy can control bleeding well and reduce various side effects of total hepatic blood inflow occlusion.

The prevalence of iron-deficiency anemia (IDA) is high in China, especially among children, the elderly and pregnant women. It can be associated with a variety of diseases involving major systems, and even cause irreversible damage to the immune and nervous system. It is noteworthy that only less than 20% of the IDA population have access to timely treatment. This requires attention towards the standardized diagnosis and treatment of IDA with multidisciplinary collaboration. This article reviews the recent research updates of IDA, revealing the new findings in the harms of IDA, current challenges in the treatment of IDA, and the latest research and development progress of intravenous iron. The aim is to provide guidance and suggestions on timely diagnosis and proper treatment of IDA.

Large-scale nucleic acid screening in a specific area is the most effective means to find potential sources of infection in the community, cut off the transmission chain, and evaluate prevention and control strategies, blocking measures and effects. Its purpose is to realize early detection, early reporting, early isolation and early treatment of cases in novel coronavirus (COVID-19 for short). On the basis of national and local technical guidance documents, the expert group of novel coronavirus nucleic acid emergency detection in Guangzhou Laboratory summarized the experience accumulated by air film laboratory and fully integrated vehicle-mounted mobile laboratory in the actual operation of novel coronavirus nucleic acid emergency screening, integrated the latest clinical application progress of detection technology, and jointly compiled the Expert Consensus of novel coronavirus nucleic acid emergency detection in large-scale multi-scenario mobile laboratory, which provided a practical, scientific and standardized reference organization plan for local government departments, medical and disease control institutions and third-party inspection institutions from five aspects: overall planning, specimen collection, transportation and information management, laboratory testing management, safety management and resource guarantee, and popularized the valuable experience in overall management of large-scale screening of COVID-19 epidemic at home and abroad.

Overactive bladder (POAB) in children is more common clinically, often with urgency and frequent urination as the main symptom. If not treated in time, it can cause repeated urinary tract infections and even upper urinary tract damage. In severe cases, mental and psychological problems often occur. The diagnosis and treatment plan of POAB in China needs to be further standardized. Experts in this field have jointly discussed and formulated this consensus on the basis of fully drawing on the latest global research results, referring to Chinese and international guidelines and related literatures, in order to provide guidance for the diagnosis and treatment of POAB.

To analyze the development of upper airway in children with different characteristics.

From June 2018 to June 2020, a total of 425 children younger than 16 years old who underwent head MRI examination and did not have sleep-disordered breathing were included in the study. The length of soft palate, tongue, upper airway, mental spine clivus, adenoid thickness and nasopharyngeal width were measured in the midsagittal plane of MRI image. Single factor variance analysis was used to compare the gender differences of upper airway parameters within certain age groups. Pearson correlation analysis was used to analyze the correlation between upper airway parameters and age.

The numbers of subjects in infant, young child, preschool, school age and adolescent group were 80, 86, 90, 90 and 79, respectively. There were 219 males, accounting for 51.5% of the study population. The adenoid thickness in the preschooler group was (1.26±0.26) cm, higher than that in the female group (1.15±0.20) cm (P=0.025). The upper airway length (5.89±0.60) cm and the ratio of upper airway length/mental spine-slope length (0.73±0.08) in males were higher than those in females [(5.31±0.45) cm and 0.67±0.07, respectively, P<0.05]. There was no gender difference in other upper airway parameters among different age groups (allP values>0.05). The length of upper airway, mental spine-slope, tongue, soft palate, the width of nasopharyngeal cavity and the thickness of adenoids were positively correlated with age (r=0.932, 0.912, 0.898, 0.705, 0.734 and 0.168, respectively), all P values<0.05. Adenoid thickness was positively correlated with age from birth to age 5 years (r=0.603, P<0.001), and negatively correlated with age after age 6 years (r=-0.259, P=0.001).

There are gender differences in the development of upper airway structure in children of different ages.

To explore the hub genes and mechanisms in the pathological process of non-alcoholic steatohepatitis (NASH) by bioinformatics methods.

Microarray datasets GSE89632 were downloaded from the Gene Expression Omnibus (GEO) database, which including 20 simple non-alcoholic fatty liver disease patients, 19 NASH patients and 24 healthy control individuals. The differentially expressed genes (DEGs) in patients with simple non-alcoholic fatty liver disease and NASH were compared with healthy control individuals respectively, and the intersection of the two groups of DEGs was taken. GO functional annotation and KEGG pathway enrichment analysis of DEGs were performed with DAVID 6.8 and KOBAS 3.0 separately. Protein-protein interaction network (PPI) was constructed by STRING database, then the mRNA hub genes were selected by Cytoscape software. The Attie Lab Diabetes database was used to verify the relative expression of hub genes mRNA in the liver of 4 groups of C57BL/6 mice (4-week-old normal group, 4-week-old obese group, 10-week-old normal group and 10-week-old obese group, 5 mice in each group). Spearman′s correlation analysis was performed to analyze the correlation between hub gens and prognostic clinical parameters.

From the GSE89632 dataset, 365 common DEGs (115 up-regulated genes and 250 down-regulated genes) were identified in patients with simple non-alcoholic fatty liver disease and NASH patients compared with control individuals. GO analysis showed that DEGs were mainly enriched in biological processes such as inflammatory response and immune response. KEGG pathway analysis showed that up-regulated genes were mainly enriched in cholesterol metabolism, bile secretion and fat digestion and absorption signal pathways. Down-regulated genes were mainly enriched in interleukin-17 signaling pathway, tumor necrosis factor signaling pathway, advanced glycation end products and their receptors of diabetic complications. Seven key hub genes were identified by PPI analysis, which were FOS, EGR1, FOSB, JUNB, FOSL1, MYC and NR4A1.The mRNA relative expression levels of EGR1 and JUNB in the liver of 10-week-old obese mice were lower than those of normal mice (P<0.05).The relative expression levels of NR4A1 in the liver of obese mice at 4-and 10-week-old were lower than those of normal mice at the same age (P values<0.05). Spearman′s correlation analysis showed that the expression of EGR1 was negatively correlated with the degree of hepatic steatosis (r=-0.785, P<0.001).The expression levels of FOSB, MYC and NR4A1 were negatively correlated with the level of alanine aminotransferase (r=-0.649, -0.597 and-0.580 respectively, all P values<0.001).

EGR1, FOSB, MYC, JUNB and NR4A1 might be the hub genes in the pathological process of NASH and the inflammatory and immune response in hepatocytes, IL-17 signaling pathway and TNF signaling pathway might be the key molecular mechanisms in the occurrence and development of NASH.

To retrospectively analyze the occurrence and treatment of perioperative complete atrioventricular block (CAVB) by transcatheter aortic valve implantation (TAVI).

A total of 65 patients who underwent TAVI via femoral artery in the Heart Center of Henan People′s Hospital from October 2017 to May 2021 were enrolled. Perioperative data of patients were recorded. The patients were divided into two groups according to whether complete atrioventricular block was occurred during TAVI: complete atrioventricular block group (Group CAVB) and non-complete atrioventricular block group (Group NCAVB). Multivariate logistic regression model was used to analyze the risk factors of complete atrioventricular block during transcatheter aortic valve implantation. The incidence of perioperative complications were recorded.

The patients age was (69.1±7.3) years old. and there were 35 males and 30 femals. There were 15 patients in group CAVB with complete atrioventricular block and 50 patients in group NCAVB. Multivariate analysis showed that preoperative right bundle branch block [OR (95%CI) vs 3.325 (2.132-13.061), P=0.005] and severe aortic valve calcification [OR (95%CI) vs 1.271 (1.052-3.326), P=0.030] were independent correlative factors for CAVB during TAVI perioperative period. The implantation rate of permanent pacemaker in group CAVB was 73.3% (11 cases), which was higher than 6.0% (3 cases) in group NCAVB (P<0.001).

It indicated that preoperative right bundle branch block and severe aortic valve calcification are correlative factors for complete atrioventricular block for TAVI. The implantation rate of permanent pacemaker in complete atrioventricular block group increased significantly.

To explore the effect and possible mechanism of circ_0023990 on the radiosensitivity of thyroid cancer cells.

qRT-PCR was used to detect the expression of circ_0023990 in the cancer tissues of 55 patients with thyroid cancer and thyroid cancer cell lines (TPC-1, KTC-1, FTC-133 and CAL-62), and the relationship between the expression of circ_0023990 in cancer tissues and the clinical characteristics of the patients were analyzed. Thyroid cancer cells TPC-1 and KTC-1 were divided into sh-circ_0023990 group, sh-NC group, sh-circ_0023990+anti-miR-873-5p group, sh-circ_0023990+anti-miR-NC group, miR-873-5p group, miR-NC group, miR-873-5p+pcDNA-ANXA2 group and miR-873-5p+pcDNA group, and then clone formation experiment was used to detect cell radiosensitivity. After each group of cells was irradiated with 4Gy radiation, the expression of γH2AX protein in the cells was detected by Western Blot. The dual luciferase reporter gene experiment verified the targeting relationship between circ_0023990 and miR-873-5p or miR-873-5p and ANXA2.

The expression of circ_0023990 in thyroid cancer tissues was higher than that in normal tissues (2.15±0.09 vs. 0.97±0.05, P<0.05), and its expression was closely related to tumor size, lymph node metastasis and TNM staging of patients with thyroid cancer (P<0.05). The expression of circ_0023990 in thyroid cancer cell lines (TPC-1, KTC-1, FTC-133 and CAL-62) were higher than that of normal thyroid cells HTori-3 (3.16±0.38, 2.63±0.28, 1.82±0.24, 1.71±0.22 vs. 1.00±0.10, allP<0.05). The survival scores of TPC-1 and KTC-1 cells in the sh-circ_0023990 group were significantly lower than those in the sh-NC group (P<0.05), and the sensitization ratios were 2.482, 1.643; The survival scores of TPC-1 and KTC-1 cells in the sh-circ_0023990+anti-miR-873-5p group were higher than those in the sh-circ_0023990+anti-miR-NC group (P<0.05), and the sensitization ratios were 0.305, 0.441, respectively. The survival scores of TPC-1 and KTC-1 cells in the miR-873-5p group were lower than those in the miR-NC group (P<0.05), and the sensitization ratios were 2.044, 1.653 respectively. The survival scores of TPC-1 and KTC-1 cells in the miR-873-5p+pcDNA-ANXA2 group was higher than that in the miR-873-5p+pcDNA group (P<0.05), and the sensitization ratios were 0.496, 0.686, respectively. The expression of γH2AX protein in TPC-1 and KTC-1 cells of the 4 Gy+sh-circ_0023990 group were higher than that in the 4 Gy+sh-NC group (2.68±0.27 vs. 1.87±0.25, 2.46±0.19 vs. 1.77±0.14; allP<0.05), but the expression of γH2AX protein in TPC-1 and KTC-1 cells of the 4 Gy+sh-circ_0023990+anti-miR-873-5p group were lower than that in the 4 Gy+sh-circ_0023990+anti-miR-NC group (1.13±0.09 vs. 1.69±0.09, 1.11±0.08 vs. 1.60±0.08; bothP<0.05). The expression of γH2AX protein in TPC-1 and KTC-1 cells in the 4 Gy+miR-873-5p group were higher than that in the 4 Gy+miR-NC group (2.35±0.16 vs. 1.84±0.14, 2.26±0.12 vs. 1.77±0.13; bothP<0.05), but the expression of γH2AX protein in TPC-1 and KTC-1 cells of the 4 Gy+miR-873-5p+pcDNA-ANXA2 group were lower than that in the 4 Gy+miR-873-5p+pcDNA group (1.96±0.12 vs. 2.41±0.12, 1.92±0.07 vs. 2.28±0.12; bothP<0.05). circ_0023990 targeted the negative regulation of miR-873-5p, and ANXA2 was the target gene of miR-873-5p.

circ_0023990 was highly expressed in thyroid cancer tissues and cell lines, and it may promote the radiotherapy resistance of thyroid cancer cells in vivo through regulating miR-873-5p/ANXA2 axis.

To establish the reference interval of vitamin A for Chinese children and adolescents by indirect approach.

The serum retinol samples from 28 provinces, autonomous regions and municipalities in China between January 2016 and June 2019 were examined by high performance liquid chromatography in third-party clinical laboratory institutions. Using a cross-sectional study, descriptive statistics of serum vitamin A levels in children and adolescents aged 0-18 years were carried out in population, region and season. The distribution parameters of vitamin A levels were calculated iteratively by the expectation-maximization (EM) algorithm, and the reference interval was established.

A total of 1 096 597 cases were included in the analysis, including 631 017 males and 465 580 females, with a median age of 3(1, 6) years. Before the age of 4 years, the median serum vitamin A level increased with age [median level and its quartiles was 0.15 (0.11, 0.18) mg/L for neonates, 0.23 (0.18, 0.29) mg/L for infants aged below 1 year, and 0.27 (0.20, 0.34) mg/L for kids aged 1-<4 years]. The median serum vitamin A level was stable at the age of 4-8 years (median level ranged from 0.27 to 0.29 mg/L). Afterwards, the median serum vitamin A level reached 0.30 mg/L at the age of 9 years, and then an increasing trend with age was observed till 18 years. The median serum vitamin A level was higher in south area (male:0.33 mg/L; female:0.34 mg/L), compared with other areas (0.24-0.30 mg/L). The variation of the median serum vitamin A level among seasons was within 0.03 mg/L. Based on EM algorithm using indirect approach, the reference intervals of vitamin A for Chinese children and adolescents were as follows: newborn, 0.27-0.47 mg/L; infants aged below 1 year, 0.36-0.56 mg/L; children aged 1-<7 years, 0.35-0.54 mg/L; children aged 7-<16 years, 0.46-0.60 mg/L; and teenagers aged over 16 years, 0.38-0.59 mg/L.

The EM algorithm can provide a basis for the establishment of vitamin A reference interval for Chinese children and adolescents, and the established reference interval needs to be further verified by direct method.

To compare the clinical effects of single-incision robot-assisted laparoscopic radical prostatectomy (RARP) with and without extraperitoneal special channel device.

The clinical data of 70 patients who had undergone RARP in the Robotic Minimally Invasive Surgery Center of Sichuan Provincial People′s Hospital from September 2020 to February 2021 were analyzed retrospectively, including 29 cases who were operated on without special channel device (group A) and 41 cases with special channel device (group B). All operations were performed by robot-assisted single-incision retrograde bladder neck exfoliation via extraperitoneal approach in patients by the same operator. The operation time, intraoperative blood loss, the bladder neck urethral anastomosis time, postoperative hospital stay, postoperative exhaust time, positive rate of incisal margin, indwelling time of urinary catheter, retention rate of postoperative erectile function, satisfaction rate of immediate postoperative urine control, positive rate of postoperative lymph node pathology, incision length, treatment cost and the rate of prostate specific antigen (PSA)lower than 0.2 μg/L at 6 weeks after operation were compared between the two groups.

All 70 cases were operated successfully. The difference of age[ (68.9±3.9) vs (69.4±5.4) years], preoperative PSA level[14.1(6.3, 19.8)vs13.7(5.8, 18.1)μg/L], prostate volume[44.8(30.7,172.6)vs 56.3(40.9,163.4)ml ] of the two groups was not statistically significant(allP>0.05). The difference of operation time [ (59.1±18.5) vs (59.6±18.0) min ], intraoperative blood loss [93(66,198)vs 95(68,203) ml ], bladder neck urethral anastomosis time [ (12.6±1.3) vs (13.7±2.8) min ], postoperative hospital stay [ (8.1±2.3) vs (9.1±1.3) d], postoperative exhaust time [ (1.4±0.6) vs (1.3±0.6) d], positive rate of incisal margin (20.7% vs 19.5%), indwelling time of the urinary catheter after operation [ (6.8±1.5) vs (7.1±2.0) d ], the retention rate of postoperative erectile function (31.0% vs 27.0%), the satisfaction rate of immediate postoperative urine control (79.3% vs 75.6%), the positive rate of postoperative lymph node pathology (17.2% vs 14.6%), the length of incision [ (5.1±0.5) vs (6.1±0.4) cm ], the rate of PSA lower than 0.2 μg/L at 6 weeks after operation (86.2% vs 83.0%) of the two groups was not statistically significant(allP>0.05). The operation cost of group A[(62 000±4 000) yuan]was lower than group B[(68 000±4 000) yuan] (P<0.05).

Extraperitoneal non-special channel device single-incision RARP is safe and feasible.

The clinical data of two children with Imerslund-Gräsbeck syndrome (IGS) who were admitted to the First Affiliated Hospital of Zhengzhou University in August 2019 was analyzed retrospectively. The two cases were siblings, aged 8 years and 8 months and 6 years and 2 months, respectively. These two boys had megaloblastic anemia, low level of vitamin B₁₂, hyperhomocysteinemia, accompanied by proteinuria and renal tubular injury, while they showed normal folate level and renal function. Blood tandem mass spectrometry and urine organic acid analysis suggested methylmalonic acidemia (MMA). The initial diagnosis was MMA with homocysteinemia. No known pathogenic gene mutation related to MMA was found by gene sequencing. Compound heterozygous variants of amnionless (AMN) gene were detected: c.43+5G>A and c.C717G. The corrected diagnosis was IGS. Both brothers were treated with long-term intramuscular injection of vitamin B₁₂. After follow-up for one year, these two cases had no clinical symptoms, and their blood indicators remained normal, but proteinuria and renal tubular injury persisted. Blood tandem mass spectrometry and urine organic acid analysis alone may easily lead to misdiagnosis, but combined with genetic testing can improve the accuracy of diagnosis of IGS. Lifelong parenteral vitamin B₁₂ replacement therapy can effectively reverse the clinical and biochemical results, but is uncertain in alleviating albuminuria and renal tubule injury. It′s necessary to monitor the renal function regularly.

This article reports a case of an elderly woman who went to the doctor due to lymph node enlargement, rash and anemia. During the course of the disease, she had sudden acute hemolysis, acute renal injury and myocardial infarction. Perfect relevant examination indicated that the patient had cold agglutinin syndrome and type Ⅲ cryoglobulinemia at the same time. In view of the fact that the histopathology of lymph node biopsy has not been reported at this time, after rituximab and symptomatic supportive treatment, the patient's clinical symptoms improved, hemoglobin rose, renal function and myocardial enzymes returned to normal. The lymph node histopathology finally confirmed the diagnosis of angioimmunoblastic T-cell lymphoma (AITL). After one course of chemotherapy, the patient's cervical lymph nodes shrank significantly, and cold agglutinin and cryoglobulin turned negative. AITL can show abundant immune phenomena, and rituximab combined with chemotherapy is effective for secondary cold lectin syndrome and cryoglobulinemia.

Karyotype analysis in amniotic fluid cell culture is the gold standard for prenatal diagnosis, but some special rearrangements of fetal chromosomes caused by parental chromosome abnormalities will appear to be inconsistent with theory and easily lead to misdiagnosis. In this paper, a case of fetal dup (14q) was reported, which was found to be caused by paternal chromosome inversion recombination by traditional cytogenetic analysis combined with gene microarray. It is suggested that the combination of multiple diagnostic methods can improve the diagnostic accuracy and reveal the etiology, avoid misdiagnosis and misdiagnosis, and prevent possible birth defects.

Nonalcoholic steatohepatitis (NASH) will be the leading cause of liver transplantation in the United States and is associated with increased mortality from SARS-CoV-2 pneumonia. There is currently no FDA-approved drug available to slow down the pathological progression of NASH, and since animal models cannot fully reproduce the pathology of human NASH, a novel experimental method that can bridge the current gap in human cognition of NASH pathology is yet to be developed. In this study, stem cells were isolated from irreversibly damaged livers of end-stage NASH patients, which proliferated, underwent hepatic differentiation and exhibited extensive ductal organoid characteristics. Transcriptomic analysis of liver organoids from NASH patients revealed significant upregulation of both pro-inflammatory cytokines and cytochrome P450-related pathways and known markers of liver fibrosis and tumor, to a patient-specific degree. Functionally, NASH liver organoids exhibit decreased passaging and growth capacity and distinctive features of NASH liver, including decreased albumin production, increased lipid accumulation induced by free fatty acids, increased sensitivity to apoptotic stimulation, and enhanced cytochrome P450 metabolism. Following liver differentiation, the ability of NASH liver organoids to dedifferentiate back to the bile duct state is reduced, which is consistent with the known decrease in NASH liver regeneration capacity. The present study also found that NASH liver organoids are more susceptible to SARS-CoV-2 or vesicular stomatitis virus challenge, accompanied by upregulation of ubiquitin D expression. The results of this study suggest that extracting stem cells directly from the irreversibly damaged liver of NASH patients and culturing liver organoids opens up new experimental pathways for personalized disease modeling and drug development, and may contribute to the study of slowing down NASH disease progression and counteracting NASH-related SARS-CoV-2 effects.