Volume 94  ·   Issue 07  ·  2014

When severe perioperative bleeding must consider transfusion of allogeneic red blood cells, there is a social problem that blood supply exceeds demand, which is extremely serious in China. We often use the word "blood shortage" to describe this phenomenon. Equally important, the transfusion of allogeneic red blood cells also brings the following medical problems: (1) transfusion errors, mostly human errors, such as wrong transfusion of ABO blood type; (2) Blood transfusion reaction, manifested as a variety of acute and delayed adverse reactions; (3) Transmission of transfusion-related infectious diseases, such as AIDS, hepatitis, malaria, etc.^[1]； (4) Transfusion-related acute lung injury (TRALI), its incidence is about 1/5 000, and its mortality rate can be as high as 10% after occurrence; (5) Transfusion-related immune suppression (TRIM), which may increase tumor recurrence and metastasis after surgery, and tuberculosis recurrence, etc.; (6) Complications related to red blood cell storage damage. Transfusion of red blood cells in stock for more than 2 weeks may lead to a decrease in long-term survival rate of recipients after surgery. Since anyone has a maximum tolerance for blood loss, allogeneic red blood cell transfusion has the above-mentioned major social and medical problems, and "artificial blood substitutes" with the function of carrying oxygen but without the above-mentioned disadvantages of allogeneic red blood cells have been delayed, so the strategy of restricting allogeneic red blood cell transfusion must be adopted during the perioperative period on the premise of ensuring the balance of oxygen supply/oxygen consumption of the whole body and vital organs. In other words, transfusion of allogeneic bank blood can only be a "last resort" to treat perioperative blood loss.

Cancer is the leading cause of death worldwide. The number of cancer deaths in 2008 amounted to 7.6 million, or about 13 percent of all deaths. In 2008, approximately 70 percent of all cancer deaths occurred in low-and middle-income countries. Worldwide cancer deaths are expected to continue to rise, exceeding 13.1 million by 2030^[1]。 In most parts of the world, the majority of cancer patients are in advanced stages of cancer at the time of their first medical visit^[2]。 More than 80% of patients with terminal cancer have different degrees of pain, gastrointestinal or respiratory discomfort and other symptoms, as well as psychological and social stress. The only realistic treatment options are pain relief and palliative care in order for terminal cancer patients to receive the best care, relieve their pain, pass away safely, and help their families through their grief^[2,3]。 This article emphasizes on the current situation of palliative care in China and puts forward some suggestions.

Blood safety and supply are directly related to social stability, national economy and people's livelihood, and to the fairness and accessibility of basic medical and health services for the broad masses of the people. They are important indicators for everyone to enjoy basic medical and health services. Blood transfusions can save lives, but they also come with risks. Unnecessary blood transfusion not only wastes valuable blood resources, but also may bring the risk of transfusion-borne infection, transfusion reaction, adverse outcome and even death to patients. While the shortage of blood supply is increasingly becoming a worldwide problem, irrational use of blood is also widespread. This article combines the current situation of blood management in China with the requirements of the Administrative Measures for Clinical Blood Use in Medical Institutions (hereinafter referred to as the Administrative Measures for Clinical Blood Use, Order No. 85 of the Ministry of Health, 2012-08-01), to explore the management strategies to promote scientific and rational blood use in clinical practice.

To investigate the effects of cisplatin plus hyperthermia on erythrocytes and killing human hepatocarcinoma (HepG2), gastrocarcinoma (SGC7901) and colonic carcinoma (SW620) cells in the intra-operative blood salvage from cancer surgery in vitro.

HepG2, SGC7901 or SW620 cells were mixed into the aliquot of erythrocyte concentrated from each intra-operative blood salvage of 30 patients subjected to gastrointestinal cancer surgery. The mixture cells were divided into the following groups (n=30): A group (37 ℃); B group (42 ℃); C, D, E groups (50, 100, or 200 μg/ml DDP); F, G, H, I groups (42 ℃, 25, 50, 100, or 200 μg/ml DDP). After treating for 60 min, tumor cells and erythrocytes were separated by density gradient centrifugation. The Na ⁺ -K⁺ -ATPase activity, cell count, osmotic fragility, and blood gas variables were determined in erythrocytes. Cell viability and colony formation were determined in tumor cells.

Compared with A [(0.30±0.08) μmol Pi/10 ⁷/h], the Na⁺ -K⁺ -ATPase activity was significantly decreased in E, H and I groups [(0.24±0.07), (0.25±0.06) and (0.24±0.07) μmol Pi/10 ⁷/h] (P<0.05). Extra-erythrocytic K⁺ in E, H and I groups [(2.16±0.37), (2.16±0.38) and (2.56±0.50) mmol/L] were significantly increased compared with A group [(1.53±0.43) mmol/L] (P<0.05). Compared with A group, osmotic fragility in E, H and I groups was significantly increased (P<0.05). Among B, C, D, E, F, G groups, only in G group colony formations of HepG2, SGC7901, and SW620 (0%±0%, 0%±0% and 0.01%±0.01%) at 14 d were completely inhibited (P<0.01) compared with A group (78.54%±7.83%, 72.28%±6.58% and 66.69%±6.69%).

Pretreatment with cisplatin (50 μg/ml) plus hyperthermia (42 ℃) for 60 min in vitro might be an effective strategy to clear tumor cells contamination but preserve erythrocytes, which is worthy to be optimized and used in the intra-operative blood salvage in cancer surgery.

To explore the effects of washed autologous blood transfusion on the recovery and hemolysis of erythrocytes from diabetic patients subjected to off-pump coronary artery bypass grafting (OP-CABG).

A total of Sixty patients were included in this study. The patients were assigned as two groups: control (C, n=30) , and diabetic group (D, n=30). Samples were taken from preoperation, prior to and after disposal of centrifuging and washing to determine the recovery and fragility of erythrocytes. Free hemoglobin and extracellular potassium were measured at 0, 4, 6, 12, 24 h after washing.

The erythrocytic recovery did not have significant difference between two groups (C group 82.6%±5.6%, D group 80.9%±6.2%, P>0.05). Under the same processing, the erythrocyte fragility in the diabetic group were significantly higher than the control group in preoperation and beforewashing (Preoperation 0.36%: D group 84.9%± 6.7% C group 78.7%± 4.6%,P=0.003; Preoperation 0.68%: D group 9.0%± 4.5% C group 1.9%± 0.8%, P=0.000; Beforewashing 0.36%: D group 80.6%± 4.9% C group 78.0%± 5.8%, P=0.000; Beforewashing 0.68%: D group 11.0%± 3.4% C group 2.4%± 0.9%, P=0.000). However, after washing there were no significant differences of erythrocyte fragility between groups. Free hemoglobin and blood potassium at 4, 6, 12, 24 h after washing were significantly increased (P<0.05) in a time-dependent manner in the two groups.But there was no obvious difference in the interior-group at the same time point.

Autotransfusion has no significant extra damage on erythrocytes from diabetic patitents undergoing OP-CABG, and the salvaged blood should be transfused as soon as possible to reduce hemolysis.

To evaluate the effect of multidisciplinary blood management strategy in adults patients undergoing valvular heart surgery.

A multidisciplinary patient blood management (PBM) strategy was instituted in Fuwai Hospital since January 2009. It includes Establishment of a multidisciplinary blood transfusion management team and designation of a coordinator; Enactment perioperative transfusion triggers (Hb<80 g/L) for adults patients undergoing cardiac surgery; recommendation of antifibrinolytics, cell salvage, reduced cardiopulmonary bypass circuit; setting up Blood Consumption Announcement and Scoring System, which regularly publishes notifications of blood volume consumed per case, per single procedure and per surgeon. Clinical date before and after multidisciplinary patient blood management strategy will be presented.

A total of 3 951 consecutive patients underwent Valvular Heart Surgery were analyzed.1 713 cases were in pre-PBM group, and 2 238 cases were in post-PBM group. Both incidence and average units of allogeneic red blood cell transfusion perioperatively in post-PBM group were decreased (28.5% vs 75.3%, P=0.000, and 1.2 U vs 4.0 U, P=0.000). The postoperative length of stay in hospital and incidence of pneumonia were reduced in post-PBM group (8.2 d vs 10.5 d, P=0.02, and 2.7% vs 3.5%, P=0.04). The post-PBM group had lower in-hospital mortality (0.6% vs 1.2%, P=0.000).

Multidisciplinary patient blood management strategy significantly reduced blood transfusion, morbidity and mortality in patients underwent valvular heart surgery. It save plenty of blood resources.

To evaluate the efficacies of modified chitosan, an adhesive prevention substance, as a biological barrier for preventing adhesion after Cesarean section.

A total of 250 cases undergoing primary Cesarean section from January 2011 to June 2012 at our hospital were recruited. They were randomly divided into experiment (n=130) and control (n=120) groups. The experiment group received modified chitosan during Cesarean section while no adhesive prevention substance was offered for the control group. Postoperative flatus time, postoperative infection and pelvic adhesion were used to evaluate the clinical efficacies.

For the experiment group, the average postoperative flatus time was(25±7)hours. Three cases had postoperative infections with a postoperative infection rate of 2.3%. There were 2 cases of pelvic adhesion (pelvic adhesion rate: 1.5%) during the postoperative follow-up period. For the control group, the average postoperative flatus time was(34±11)hours. Five cases had postoperative infections with a postoperative infection rate of 4.2%. There were 5 cases of pelvic adhesion (pelvic adhesion rate: 4.2%) during the postoperative follow-up period. There were significant inter-group differences in postoperative flatus time, postoperative infection and pelvic adhesion (P<0.05).

Modified chitosan can prevent pelvic adhesion after Cesarean section.

To explore the value of modified Allis technique in closed reduction of posteriorly dislocated hip.

For the control group, 98 cases of dislocated hips with PipkinⅠ/Ⅱfracture were studied retrospectively and their success reduction rates analyzed. For the experimental group, 36 cases with similar injury were studied prospectively. And the modified Allis technique was used and the success reduction rates were analyzed.

Among the control group, 32 cases were reduced with a success rate of 67.3%. The success rate was 69.4% for the experimental group. And 97.2% of those unresponsive to the Allis technique were all successfully reduced by the modified Allis technique.

The modified Allis technique is efficacious for posteriorly dislocated hips with PipkinⅠ/Ⅱfracture.

To explore the methods in the diagnosis and treatment of ankle fracture with Wagsaffe fragment.

Among 1 201 patients, there were 18 cases of concurrent Wagstaffe fractures at our hospital between January 2009 to January 2012. There were 11 males and 7 females with an average of 37.4 (17-54) years. The causes of injuries were fall (n=10), sports-related injury (n=4), traffic injury (n=3) and high-altitude fall (n=1). All of them had lateral malleolar fracture. Other injuries included internal malleolar fracture (n=16), posterior malleolar fracture (n=8) and disruption of medial deltoid ligament (n=3). According to the Lauge-Hansen system, all fractures were of supination-external rotation type. The fractures of fibula and Wagstaffe were explored through an anteriolateral approach. The lateral malleolar fracture was fixed with plate While Wagstaffe fragment secured with lag screw or thread. Disrupted anterior tibiofibular ligament was restored. Other treatments included open reduction and internal fixation of medial and posterior malleolus, repair of medial deltoid ligament and screw fixation of disrupted tibiotibular syndesmosis. Ankle function was evaluated by the Baird-Jackson criteria.

Wagstaffe fracture occurred at a rate of 1.5% in ankle fractures. Wagstaffe fracture was found in 4.4% of ankle fracture of supination-external rotation type. Seventeen patients were followed up over an average follow-up period of 16.8 (12-25) months. All radiographs showed union of all fractures and normal mortises. Baird-Jackson ankle functional score was from 81 to 99. In all 17 patients, 9 were rated as excellent, 5 as good and 3 as fair. The excellent and good rate was 87.4%. At the latest follow-up, 14 patients resumed their preinjury activities.

As an easily misdiagnosed condition, Wagstaffe fracture is associated with ankle diastases and prone to occur in ankle fracture of supination-external rotation type. Accurate reduction and stable fixation facilitate the restoration of stable syndesmosis in the treatment of ankle fracture with concurrent Wagsaffe fragment.

To compare the effects of short-term and long-term thromboprophylaxis after total hip replacement on coagulation indicators in plasma sampled before and 1, 7 and 35 days post-operation.

A total of 40 patients scheduled for elective total hip replacement were randomly assigned into the short-term (n=20) or long-term (n=20) thromboprophylaxis groups on oral rivaroxaban 10 mg once daily for 7 or 35 days. The primary efficacy hemostatic variables included thrombin-antithrombin complexes (TAT), prothrombin fragment 1+ 2 (F1t2), D-dimer and fibrinogen (Fib) preoperatively and at Days 1, 7 and 35 postoperatively. And ultrasonography was performed on all patients preoperatively and at days 7 and 35 postoperatively to exclude deep vein thrombosis of lower extremities.

None of them had deep vein thrombosis (DVT) of lower extremities. Among them, TAT, F1+ 2, D-dimer and Fib post-operation were higher than those preoperative baseline values. TAT and D-dimer peaked at day 1 postoperatively while the peaks of F1+ 2 and Fib appeared at day 7 postoperatively. At Day 35 post-operation, the levels of TAT and F1+ 2 in the long-term thromboprophylaxis group were significantly lower than those of the short-term thromboprophylaxis group (P<0.05).

The status of hypercoagulability may sustain at least 35 days after total hip replacement. Though not completely eliminated, it can still be reduced by prolonged thromboprophylaxis. However, according to ultrasonography, the effects of short-term and long-term thromboprophylaxis on the incidence rate of DVT remain to be further explored.

To explore the changes of executive function in patients with temporal lobe epilepsy and analyze its correlation with P300 event-related potentials.

Fifty patients with temporal lobe epilepsy and 30 age, gender and education-matched healthy control subjects were assessed by neuropsychological tests, including Montreal cognitive assessment (MoCA), working memory, verbal fluency, trail making, digit span, digit symbol and Stroop color-word interference to detect P300 event-related potentials.

In temporal lobe epilepsy group, the scores in MoCA, verbal and non-verbal working memory, verbal fluency, digit span, digit symbol and Stroop test were lower than those of the normal control group. And trail making tests A and B became prolonged (P<0.05). Comparing with normal control group, temporal lobe epilepsy patients had prolonged latency [(332±33)ms] and decreased P300 amplitude[(10±8)μV] (P<0.05). Comparing epileptogenic focus group on the left and right sides, there was statistically significant difference in verbal working memory (P<0.05). There was a negative correlation of P300 latency and MoCA, non-verbal working memory, digit span and digit symbol test scores (r=-0.29--0.45, P<0.05). And a positive correlation of P300 amplitude and MoCA, non-verbal working memory, digit symbol conversion and Stroop scores was also found (r=0.37-0.47, P<0.05). P300 amplitude was more relevant to overall cognitive level and executive functions.

Temporal lobe is involved in the regulation of executive functions. Besides a wide range of cognitive impairment, temporal lobe epilepsy patients have a number of executive dysfunctions, including working memory, cognitive flexibility, attention and inhibitory control ability. And an impairment of verbal working memory is evident in left-sided lesion. Their manifestations include decreased latency and amplitude of P300 on executive function tests. Therefore these two objective parameters may be employed to evaluate the cognitive impairment in patients with temporal lobe epilepsy.

To assess the diagnostic value of hepatobiliary phase imaging with GD-EOB-DTPA for hepatocellular carcinomas (HCC) in cirrhosis.

A total of 43 cirrhotic patients with 45 HCC lesions underwent the examinations of T₂WI, DWI, T₁WI in-phase and opposed-phase and dynamic contrast enhancement and hepatobiliary phase. Two separate analyses of imaging set with and without hepatobiliary phase images were performed. The confidence scores for HCC diagnosis, consistency, area under the receiver operating characteristic (ROC) curve and sensitivity and positive predictive values of two observers were compared.

After adding hepatobiliary phase, there was a significant increase of confidence scores in diagnosing HCC by both observers (P<0.05) and the consistency of two observers also increased. The area under the ROC curve improved by both observers, but no significant differences were detected (P>0.05). The sensitivity increased significantly (P<0.05) and no significant differences were observed for the positive predictive values by both observers (P>0.05).

Hepatobiliary phase imaging may improve the diagnostic confidence and sensitivity of GD-EOB-DTPA for HCC in cirrhosis.

To evaluate the medium-long term effectiveness of eversion (eCEA) and conventional (cCEA) carotid endarterectomy on carotid artery stenosis.

We searched MEDLINE (1970-2012.12), Ovid (1970-2012), CBM (1970-2012.12) and CNKI (1970-2012.12) database. Relevant journals and dissertation were also hand searched. Study selection and assessment, data collection and analyses were undertaken by two reviewers independently according to the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analyses were performed through software STATA 11.2.

A total of 21 studies were deemed eligible (8 617 eCEA and 7 830 cCEA procedures), six of which were randomized and 14 non-randomized. Base on 15 121 patients underwent carotid artery stenosis including 16 447 cases, eCEA was association with a shorter mean operation time (WMD -85.00 min, P<0.001), internal carotid artery clamp time (WMD -3.9 min,P<0.01) and less shunt usage (OR=0.20, P<0.01). Furthermore, eCEA was associated with significant reduction in 30-day mortality (OR=0.59, P=0.013), perioperative stroke (OR=0.63, P=0.044), residual restenosis (OR=0.51, P=0.019) and carotid artery occlusion (OR=0.44, P=0.001). Although eCEA did not reduce medium-long term all-caused mortality (OR=0.81, P=0.143) during follow-up time, eCEA presented with a significant reduction in late residual restenosis (OR=0.34, P<0.01) and carotid artery occlusion (OR=0.30, P<0.01). A sub-analysis was performed on studies directly comparing eCEA with patch CEA (CEA+ P), eCEA replicated the finding on perioperative stroke, 30-day mortality, and stroke-related death within short term and late residual restenosis. Concerning outcomes of RCT, eCEA presents with a significant reduction in the residual restenosis (OR=0.43, 95%CI: 0.27, 0.69, P<0.01) and carotid artery occlusion (OR=0.11, 95%CI: 0.02, 0.62, P=0.012) during following-up time.

Eversion CEA compared to conventional CEA may be associated with a short operation time and a short block time. eCEA appears to be associated with better 30-day mortality and stroke outcome than cCEA. Eversion CEA may be more effective for long-term prevention of restenosis, however, in the long term, it is not associated with a reduction in all-cause mortality.

To explore the value of contrast-enhanced ultrasound(CEUS)as a new method in evaluating the correlation between muscle perfusion deficits and collateralization in lower extremity arterial disease (LEAD).

Ultrasound contrast agent was injected into peripheral vein of 80 control subjects and 80 LEAD patients. Its appearance in calf muscle was detected by contrast-enhanced ultrasound. Time intensity curves (TIC) and time to peak intensity (TTP) were analyzed. And collateral formation was evaluated by computed tomography angiography(CTA).

TTP in LEAD group was statistically higher than that in control group (59.1 vs 38.6 s, P<0.01). The TTP difference between two investigators who evaluate the row data in a blinded way was 0.29 s and the area under receiver operating characteristic (ROC) curve 0.92. A TTP cutoff at 47.5 s was associated with 91% positive predictive value statistically. TTP in LEAD with bad collateralization was statistically higher than that in LEAD with good collateralization (67.9 vs 50.4 s,P<0.01).

As a consistent method of evaluating muscle perfusion deficits, CEUS shows a good correlation with the extent of collateral formation in LEAD.

To compare the clinical characteristics of riboflavin responsive lipid storage myopathy (RR-LSM) versus polymyositis (PM).

The clinical data were collected and analyzed for 26 RR-LSM and 15 PM patients from 2003 to 2011 at Peking University First Hospital .

The mean onset ages of RR-LSM and PM were (29±10) and(43±15) years while the durations before definite diagnosis were(8.2±8.0)and(2.6±3.7)years respectively. There were significant inter-group differences in onset age (P=0.001) and duration before definite diagnosis (P=0.003). No significant inter-group difference existed in the frequency of limb weakness, dysphagia, neck weakness, dyspnea or myalgia. Dysmasesia occurred in 65.38% of RR-LSM and 26.67% of PM patients and significant inter-group difference existed (P=0.017). All RR-LSM patients had exercise intolerance with a fluctuating course. Both groups had extra-muscular symptoms and it was more obvious in PM. Mean creatine kinase (CK) level was(1475±1796)U/L in RR-LSM and(4062±3448)U/L in PM patients with significant inter-group difference (P=0.017).

Comparing with PM patients, RR-LSM patients tend to have an earlier onset, a longer diagnosis delay time, fluctuating weakness, a higher frequency of dysmasesia. But there are fewer extra-muscular symptoms and a smaller elevation of CK level.

To explore the correlation between ischemic stroke (IS) and the polymorphism of human leucocyte antigen (HLA) gene.

Antigen, allele, haplotype of HLA-A, B, C, DRB1, DQB1 in 94 IS patients and 503 healthy controls were detected by PCR-SBT.

(1) There were 11 antigens, 17 alleles in HLA-A locus, 20 antigens, 34 alleles in HLA-B locus, 11 antigens, 16 alleles in HLA-C locus, 13 antigens, 26 alleles in HLA-DRB1 locus, 5 antigens, 13 alleles in HLA-DQB1 locus in IS group.(2) The allellic frequency of HLA-A*31∶01(P=0.016 9, RR=2.827), HLA-B*37∶01(P=0.006 6, RR=4.613)and HLA-DRB1*11∶06(P=0.000 2, RR=37.981)in the IS patients was higher than that in healthy controls.(3) The haplotypic frequency of HLA-DRB1*11∶06-DQB1*03∶01(P=0.001, RR=38.52)in the IS patients was higher than that in healthy controls.

The susceptibility association of HLA-B*37∶01, HLA-DRB1*11∶06 and HLA-DRB1*11∶06-DQB1*03∶01 with IS and HLA gene play a genetic role in the occurrence of.

To construct a recombinant adenoviral vector carrying and co-expressing vascular endothelial growth factor 165 (VEGF165) and stromal cell derived factor 1 (SDF-1) and explore its co-expression in ischemic brain tissue in rats.

The VEGF165 and SDF-1 genes were directionally connected with internal ribosome entry site (IRES). And the double gene co-expression recombinant shuttle plasmid pDC316-VEGF165-IRES-SDF-1 was built with homologous recombination. The resultant plasmid pDC316-VEGF165-IRES-SDF-1 and backbone plasmid pBHGlox_E1, 3Cre were transfected into HEK293 cells by liposome and the recombinant adenoviral particles capable of infection were acquired. With the rounds of amplification, the purified adenoviral vector Ad5-VEGF165-IRES-SDF-1 was obtained with a titer of up to 1×10¹⁰ IU/ml. The rat model of middle cerebral artery occlusion (MCAO) was established by intra-luminal suturing. And the viral vectors were transfused into the lateral ventricle by a stereotactic microinjection. The expressions of VEGF165 and SDF-1 in ischemic brain tissue were examined by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot.

The results of PCR, double enzyme digestion and gene sequencing showed that both the recombinant plasmid and the constructed adenoviral vector were expressed. And the adenoviral vector Ad5-VEGF165-IRES-SDF-1 could mediate a co-expression of VEGF165 and SDF-1 in ischemic cerebral tissue.

The recombinant adenoviral vector carrying VEGF165 and SDF-1 are successfully constructed. And Ad5-VEGF165-IRES-SDF-1 may mediate a co-expression of VEGF165 and SDF-1 in ischemic cerebral tissue of rats.

To explore the effects of transplanted neural stem cells (NSCs) on synaptogenesis in an Alzheimer′ disease (AD) murine model and related mechanism.

Twenty 9-month-old APP/PS1 double transgenic mice were randomly divided into 2 groups. One group received NSCs transplantation (NSC group) in bilateral hippocampi while another group received an equal volume of 0.01 mol/L phosphate buffer saline (PBS group) as a negative control group. Ten wild-type mice were selected as the positive control group (WT group) without any treatment. After 8-week transplantation, the expressions of synaptophysin (SYN) and growth associated protein-43 (GAP-43) proteins in hippocampal areas were analyzed by immunofluorescence and Western blot. The number and structure of synapses in transplanted regions were observed by electron microscopy.

(1) Immunofluorescence staining showed that NSC-induced neurons highly expressed SYN and GAP-43 at the protein levels; (2) the expression of SYN and GAP-43 significantly increased in the NSC group versus the PBS group (F= 58.367, P<0.01;F= 75.296, P<0.01). No difference existed in the SYN level between NSC and WT groups (P>0.05). However, the GAP-43 expression was significantly higher than that of the WT group (P<0.01); (3) ultrastructure showed that the number of synapses in the NSC group with normal morphology (12.1±2.1) increased than that in the PBS group (6.5±2.2) (F= 15.981, P<0.01). No difference existed between NSC and WT groups (11.0±1.4) (P>0.05).

NSC-induced neurons increase the number of synapses by an up-regulation of synaptic proteins, SYN and GAP-43. Thus synaptogenesis may be a key factor in improving the symptom of AD mice.

Hepatocellular carcinoma (HCC) easily invades the portal vein and forms portal vein tumor thrombosis (PVTT). In the past, scholars considered that main portal vein tumor thrombosis was an absolute contraindication to hepatic artery chemoembolization (TACE). In recent years, several clinical studies have confirmed the feasibility of TACE in the treatment of hepatocellular carcinoma with portal vein tumor thrombus^[1,2,3]。 At present, the drug-loaded microparticle chemoembolization TACE represented by DC microspheres is widely used in the treatment of liver cancer and has achieved good curative effect. However, there are few domestic research reports on the simple application of microparticle embolization agent TACE in the treatment of liver cancer complicated with portal vein tumor thrombus. In this study, 6 patients with liver cancer with rich blood supply portal vein tumor thrombus were treated with gelatin sponge microparticles (GSPs) TACE with a diameter of 350~560 μ m, which is reported as follows.

Neuroendocrine factors act on tumor cells and tumor microenvironment and regulate many important links in tumor growth and malignant transformation through complex signal transduction pathways. At present, many basic studies have shown that the beta signaling pathway involved in epinephrine and noradrenal gland can affect the progression of breast cancer through multiple processes, and these processes can be inhibited by beta blockers^[1]。 The discovery led scholars to suggest that beta blockers, a commonly used drug to treat cardiovascular disease, may improve the prognosis of breast cancer^[2]。 The results of several existing observational epidemiological studies also give more optimistic estimates of the potential of this drug. This paper will further present the epidemiological research progress of the relationship between β-blockers and the prognosis of breast cancer under the background of molecular oncology research results.

The normal sex of human body includes chromosomal sex, gonadal sex, external genital sex and social sex. Sexual developmental diseases are a group of congenital diseases characterized by anatomical abnormalities of chromosomes, gonads and accessory sexual organs. Its overall incidence rate is about 1/5 500^[1]。 In recent decades, great progress has been made in the classification, pathological mechanism, surgical treatment, hormone therapy and psychotherapy of sexual developmental diseases. The latest research on the classification, diagnosis and treatment of sexual developmental diseases is summarized as follows.

Because of its exact decompression effect, laminectomy is gradually widely used and becomes a common procedure in spine surgery^[1]。 However, laminectomy will cause postoperative complications such as spinal instability, dura mater and nerve root adhesion, which restricts the application of laminectomy. Therefore, some scholars improve posterior spinal decompression or use combined internal fixation and fusion technology to effectively reduce the occurrence of postoperative spinal instability, and the application of various new anti-adhesion technologies and materials can also prevent the occurrence of dura adhesion. The following reviews the development and application of laminectomy, the mechanism of formation and prevention of postoperative complications such as spinal instability and dura adhesion.