ObjectiveTo explore the application value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) quantitative parameters and apparent diffusion coefficient (ADC) value in evaluating the differentiation degrees and T stages of rectal cancer.MethodsThe patients with rectal cancer from November 2017 to November 2019 in the Sichuan Provincial People’s Hospital were collected. The volume transfer constant (Ktrans), flux rate constant (Kep), and extravascular extracellular volume fraction (Ve), and ADC values of the tumors were measured and compared in the patients with the different differentiation degrees and T stages. The receiver operating characteristic (ROC) curve analysis was performed.ResultsAll of 53 eligible patients were included, including 13 cases of high differentiation, 30 cases of medium differentiation, and 10 cases of low differentiation; 5 cases of T1 stage, 8 cases of T2 stage, 24 cases of T3 stage, and 16 cases of T4 stage. ① There were statistical differences in the Ktrans and ADC values among the different differentiation degrees of rectal cancer (P=0.004, P<0.001), and no statistical differences in the Kep and Ve values (P>0.050) among them. The Ktrans value was increased with decreased differentiation degree (P<0.050), the ADC value was decreased with decreased differentiation degrees (P<0.050). ② There were statistical differences in the Ktrans and ADC values among the different T stages of rectal cancer (P=0.002; P=0.007), and no statistical differences in the Kep and Ve values (P>0.050) among them. The Ktrans and ADC values were statistically different between the T2 and T3 stages of rectal cancer (P=0.009, P=0.013). ③ The Ktrans and ADC values could distinguish the high and medium differentiation degrees of rectal cancer, its area under ROC curve (AUC) values were 0.677 and 0.763, respectively, and the corresponding best thresholds were 0.180/min and 1.179 mm2/s; The Ktrans and ADC values could distinguish the medium and low differentiation degrees of rectal cancer, its AUC values were 0.693 and 0.967, and the corresponding best thresholds were 0.281/min and 0.906 mm2/s; The Ktrans and ADC values could distinguish the T2 and T3 stages of rectal cancer, its AUC values were 0.862 and 0.742, and the corresponding best thresholds were 0.204/min and 1.579 mm2/s.ConclusionDCE-MRI quantitative parameters and ADC value before surgery to determine the different differentiation degrees and T stages of rectal cancer have certain reference value, the best Ktrans and ADC thresholds to distinguish different differentiation degrees and T2 to T3 stages can be obtained through statistical analysis.
ObjectiveTo explore the application of the dorsal foot hexagonal flap for reconstruction of the web space in the fourth and fifth toe syndactyly combined with polydactyly.MethodsBetween May 2016 and October 2019, 27 patients (34 feet) with the fourth and fifth toe syndactyly combined with polydactyly were treated, including 12 males and 15 females with an average age of 22.8 months (range, 10 months to 8 years). There were 7 bilateral feet and 20 unilateral foot. Twenty-four of which were incomplete and 10 were complete syndactyly of the fourth and fifth toes, and the fifth toes showed various degrees of fibular deflection. All the 34 feet were treated with one-stage reconstruction of the toe web with the dorsal foot hexagonal flap, and the correction of the fibular deviation of the fifth toe was made by removing the tibial polydactyly and using the articular surface dressing or wedge osteotomy.ResultsAll wounds healed by first intention without skin-frafting. All patients were followed up 6-36 months (mean, 18 months). There was no flexion contracture and obvious scar hyperplasia in all the patients, and the width and slope of the toe webs were normal. Three of the 34 webs developed web creep, and the rest of the toe webs were normal in depth. All 34 feet were corrected with peroneal fibular deviation, and the function of toe flexion was good. All parents of the children were satisfied with the outcome.ConclusionThe reconstruction of toe webs with dorsal foot hexagonal flaps for the treatment of the fourth and fifth toes syndactyly combined with polydactyly requires no skin graft. The operation is simple with high survival rate of the flap, the appearance and function of the toes are good, and the effectiveness is satisfactory.
Objective To observe the effects of extracellular-signal regulated kinase (ERK) 1/2 inhibitor U0126 on hepatoma carcinoma cell proliferation and apoptosis. Methods Hepatoma SMMC-7721 cell strain was divided into blank control group and different concentrations of U0126 groups. The proliferation inhibition was measured by MTT assay. FCM was used to analyze the cell cycle distribution and apoptosis. Results U0126 obviously inhibited cell proliferation, induced cell apoptosis and G0/G1 phase cell cycle arrest. There were significant differences between control group and different concentrations of U0126 groups on cell proliferation and apoptosis （P＜0.05， P＜0.01）. Conclusion Blocking ERK1/2 pathway may be an important treatment strategy for liver cancer.
【Abstract】ObjectiveTo study the expressions of matrix metalloproteinase 2 (MMP2) and carbohydrate antigen 50 (CA50) in colorectal carcinoma, cancer-adjacent mucosa （2 cm from the nether edge of tumor）, cancerdistant mucosa （5 cm from the nether edge of tumor） and normal colorectal mucosa, and to elucidate their effects on the development of colorectal carcinoma. MethodsThe expressions of MMP2 and CA50 were detected immunohistochemically in 40 cases of colorectal carcinoma, cancer-adjacent mucosa, cancer-distant mucosa and 10 cases of normal colorectal mucosa. Results①The expression intensity and positive rates of MMP-2 and CA50 increased significantly in turn by normal mucosa, cancer-distant mucosa, cancer-adjacent mucosa and colorectal carcinoma. ②The expression of MMP2 was correlated with CA50 in colorectal carcinoma. ③The expression of CA50 in colorectal carcinoma was closely associated with tumor differentiation, and the expression of MMP2 in colorectal carcinoma was closely associated with differentiation and Dukes stages as well. ConclusionOver expression of MMP2 facilitates the malignant progress of colorectal carcinoma; CA50 is a reliable marker of malignance in colorectal carcinoma; CA50 and MMP2 may have synergetic effects on the development of colorectal carcinoma.
ObjectiveTo study the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting and evaluating the efficacy of neoadjuvant chemoradiotherapy (NCRT) in the middle-low locally advanced rectal cancer (LARC).MethodsThe patients were included prospectively who were clinically diagnosed as the LARC and were scheduled to undergo the NCRT and total mesorectal excision (TME) in the Sichuan Provincial People’s Hospital from February 2018 to November 2019. The routine MRI and DCE-MRI were performed before and after the NCRT, then the TME was performed. According to the score of tumor regression grade (TRG), the patients with TGR score of 0, 1 or 2 were classified as the response to NCRT group, and those with TRG score of 3 were classified as the non-response to NCRT group; in addition, the patients with TGR score of 0 or 1 were classified as the good-response group, with TRG score of 2 or 3 were classified as the poor-response group. The differences of quantitative perfusion parameters of DCE-MRI between two groups were compared, including the volume transfer constant (Ktrans), flux rate constant (Kep), and extravascular extracellular volume fraction (Ve) and the change rates of these parameters (ΔKtrans, ΔKep, and ΔVe).ResultsForty-one patients who met the inclusion criteria were included in this study, including 27 cases in the response to NCRT group and 14 cases in the non-response to NCRT group; 11 cases in the the good-response group and 30 cases in the poor-response group. ① The values of Ktrans before the NCRT and the ΔKtrans in the response to NCRT group were higher than those in the non-response to NCRT (P<0.05), while the other indexes had no significant differences between these two groups (P>0.05). The area under the receiver operating characteristic curve (AUCs) of Ktrans and ΔKtrans in predicting the efficacy of NCRT were 0.954 and 0.709, respectively. When the optimal thresholds of Ktrans and ΔKtrans were 0.122/min and –24.2%, the specificity and sensitivity were 85.7%, 96.3% and 100%, 51.7%, respectively. ② The Ktrans value in the good-response group was higher before NCRT and which was lower after NCRT as compared with the poor-response group (P<0.05). The absolute value of the the ΔKtrans and ΔKep in the good-response group were higher than those in the poor-response group (P<0.05). The other indexes had no significant differences between these two groups (P>0.05). The AUC of Ktrans before NCRT in predicting the efficacy of NCRT was 0.953. When the optimal thresholds of Ktrans before NCRT was 0.158 /min, the specificity and sensitivity were 88.7% and 90.9%, respectively. The AUC of ΔKtrans in predicting the efficacy of NCRT was higher than that of the ΔKep (0.952 versus 0.764, Z=2.063, P=0.039). When the optimal threshold of ΔKtrans was –38.8%, the specificity and sensitivity were 76.7% and 100%, respectively.ConclusionsDCE-MRI can predict and evaluate the effect of NCRT in patients with middle-low LARC, especially Ktrans and ΔKtrans (change rate before and after NCRT) have a high diagnostic efficiency.
ObjectiveTo evaluate the effectiveness of unstable pelvic fractures treated by cannulated screw internal fixation with the assistance of three-dimensional (3D) printing insertion template.MethodsThe clinical data of 10 patients who underwent surgical treatment for unstable pelvic fractures by cannulated screw internal fixation with the assistance of 3D printing insertion template between May 2015 and June 2016 were retrospectively analysed. There were 7 males and 3 females with an average age of 37.5 years (range, 20-58 years). The causes of injury included falling from height in 5 cases, crushing from heavy load in 1 case, and traffic accidents in 4 cases. The interval from injury to admission was 1-5 hours (mean, 3.1 hours). The fracture situation included 6 cases of sacral fracture, 1 case of right sacroiliac joint dislocation, and 3 cases of iliac bone fracture. There were 10 cases of superior and inferior pubic rami fracture, including 3 cases on the left side (2 cases of suprapubic fracture adjacent to symphysis pubis), 2 cases on the right side, and 5 cases on the bilateral. All fractures were classified according to the Tile system, there were 4 cases of type B2, 1 of type B3, 4 of type C1, and 1 of type C2. The radiological outcome was evaluated by Matta scale, and the positions of the iliosacral screw and superior pubic ramus screw were evaluated according to 3D reconstruction of CT postoperatively. The functional outcome was evaluated by Majeed function scale.ResultsThe average time of each screw implantation was 30 minutes, and the average blood loss per screw incision was 50 mL. The time of implantation of each sacroiliac screw was 24-96 seconds (mean, 62 seconds), and the time of implantation of each suprapubic screw was 42-80 seconds (mean, 63.2 seconds). The hospitalization duration was 17-90 days (mean, 43.7 days). All incisions healed by first intention. All patients were followed up 12-22 months (mean, 15.6 months). The radiological outcome was excellent in 8 cases and good in 2 cases according to Matta scale; and 3D reconstruction of CT demonstrated that all the 9 iliosacral screws were placed as type Ⅰ, and all the 13 suprapubic ramus screws were placed as grade 0 on the first postoperative day. No complication such as neurovascular injury, screw back out or rupture, or secondary fracture displacement was observed during the follow-up. At 6 months after operation, the X-ray films showed good fracture healing in all the 10 patients. The functional outcome was excellent in 9 cases and good in 1 case according to Majeed scale at 1 year after operation. One patient sustained Tile C2 pelvic disruption complicated with L5 nerve root injury achieved complete nervous functional recovery at last follow-up.ConclusionIt has advantages of precise screw insertion and lower risk of neurovascular injury to treat unstable pelvic fractures by cannulated screw internal fixation with the assistance of 3D printing insertion template, which can be a good alternative for the treatment of unstable pelvic fractures.