Comparison of efficacy and safety of preoperative and postoperative concurrent chemoradiotherapies for stage Ⅲ-Ⅳ A gastric cancer / 中华放射医学与防护杂志

Objective:To compare the efficacy and safety of preoperative and postoperative concurrent chemoradiotherapies in the treatment of stage Ⅲ-Ⅳ A gastric cancer patients who underwent D2 lymphadenectomy with R0 resection. Methods:A retrospective analysis was conducted on the clinical data of patients with stage Ⅲ-Ⅳ A gastric cancer who underwent D2 lymphadenectomy with R0 resection in the Affiliated Cancer Hospital of Zhengzhou University from 2012 to 2019. Among these patients, 25 received preoperative chemoradiotherapy (group A) and 22 received postoperative chemoradiotherapy (group B). The disease-free survival (DFS), overall survival (OS), local recurrence rate, distant metastasis rate, and adverse reactions were compared between both groups. The total dose, single dose, fractions, and duration of radiotherapy for all the patients were 45-50.4 Gy, 1.8-2.0 Gy, 25-28 fractions, and 5-6 weeks, respectively. The target areas were delineated in accordance with the ASTRO and EORTC-ROG guidelines. Results:There was no statistical difference in clinical baseline characteristics between the two groups. The median follow-up was 48 months (3-72 months). The 1-year OS of group A was significantly higher than that of group B (92% vs. 54.5%, χ2= 5.68, P = 0.017). The 3-year OS and DFS of the two groups were 56% vs. 40.9% ( P> 0.05) and 51.4% vs. 31.8% ( P> 0.05), respectively. There was no significant difference in the local recurrence rate between both groups ( P> 0.05), but the distant metastasis rate of group A was significantly lower than that of group B ( χ2= 6.01, P = 0.014). There was no significant difference in digestive side effects and myelosuppression between both groups ( P> 0.05). Conclusions:For patients with stageⅢ-Ⅳ A gastric cancer after D2 lymphadenectomy with R0 resection, the preoperative and postoperative chemoradiotherapies yield similar efficacy and safety. However, compared to postoperative chemoradiotherapy, preoperative chemoradiotherapy improves the 1-year OS and reduces the distant metastasis rate.

The progress in estimation of life expectancy in elderly prostate cancer patients / 中华泌尿外科杂志

Prostate cancer is a common malignancy in elderly men. Assessment of life expectancy is crucial for the treatment decision. However, accurate evaluation of individual life expectancy is still a challenge for us. By now, the life expectancy assessment methods mainly include query life table, online prediction questionnaire, gait speed monitoring, considering complications, and comprehensive prediction model. The first three evaluation methods are more convenient and have strong clinical feasibility. Complication calculation and comprehensive model are less convenient but may improve the accuracy of life expectancy prediction. The application of comprehensive prediction model is recommended at present. The prediction methods need further optimization and verification.

Clinical study of UGT1A1 gene polymorphism in unconjugated hyperbilirubinemia after renal transplantation / 中华器官移植杂志

Objective:To explore the gene mutations of UGT1A1 * 6 and UGT1A1 * 28 in patients with unconjugated hyperbilirubinemia after renal transplantation and understand their clinical significance.Methods:UGT1A1*6 and UGT1A1*28 gene fragments in blood samples of patients with unconjugated hyperbilirubinemia after renal transplantation were detected by digital fluorescent molecular hybridization sequencing.Results:A total of 21 patients with unconjugated hyperbilirubinemia after renal transplantation were examined for UGT1A1*6 and UGT1A1*28 alleles. The results showed that there were 3 UGT1A1*28 and UGT1A1*6 combined heterozygous mutations, 4 UGT1A1*28 gene heterozygous mutations, 2 UGT1A1*6 heterozygous mutations and 4 UGT1A1*6 homozygous mutations. Among them, the mutation rates of UGT1A1*28 gene and UGT1A1*6 gene were 33%(7/21) and 43%(9/21) respectively and the total mutation rate of both was 62%(13/21).Conclusions:UGT1A1 polymorphism is associated with unconjugated hyperbilirubinemiaafter renal transplantation. By detecting the sequence of UGT1A1*6 and UGT1A1*28 gene fragments in blood samples of renal transplant patients, it is helpful to clarify the etiology of unconjugated hyperbilirubinemia after renal transplantation to confirm the diagnosis of Gilbert syndrome and rule out the effect of immunosuppressive drugs on liver function so as to guide the clinical medication of renal transplant patients.

Anatomical relationship between fascia propria of the rectum and visceral pelvic fascia in the view of continuity of fasciae / 中华胃肠外科杂志

Objective@#To perform an anatomical observation on the extension of the mesocolon to the mesorectum and the continuity of the fasciae lining the abdomen and pelvis, in order to clarify the appropriate surgical plane of total mesorectal excision.@*Methods@#This is an descriptive study. The operation videos of 61 cases (28 males, 33 females, median age of 61) were collected. All the patients underwent laparoscopic colorectal surgery from January 2018 to December 2018 in Yangpu Hospital, including low anterior resection for rectal cancer in 25 cases, left hemicolectomy for descending colon cancer in 15 cases, and subtotal resection of the colon for intractable constipation in 21 cases. Among these 21 constipation patients, 8 received additional modified Duhamel surgeries. Gross anatomy was performed on 24 adult cadavers provided by Department of Anatomy, Shanghai Jiaotong University School of Medicine, including 23 formalin-fixed and 1 fresh cadaver (12 males, 12 females). Sixty-one patients and 24 cadavers had no previous abdominal or pelvic surgical history. The anatomy and extension of fasciae related to descending colon, sigmoid colon and rectum, especially the morphology of Toldt fascia, and the continuities of mesocolon and mesorectum were observed carefully. The distribution characteristics of the fasciae and anatomical landmarks during laparoscopic surgery were recorded and described.@*Results@#The anatomical study on 24 cadavers showed that visceral fascia was the densest connective tissue in the pelvic, posterolateral to the rectum, and stretched as a hammock to lift all pelvic organs. Among 61 patients undergoing laparoscopic surgery, 36 (59.0%) needed to free the left colon during operation, and Toldt fascia in the descending colon segment presented as potential, avascular and extensible loose connective tissue plane between the mesocolon and posterior Gerota fascia; 33 (54.1%) needed to free the rectum during operation, and Toldt fascia extended downward to pelvis as loose connective tissue between the fascia propria of the rectum and visceral fascia; the fascia propria of the rectum exposed completely in 32 (32/33, 97.0%) cases, which ran downward and fused with visceral fascia at the level of the fourth sacral vertebra. The anatomy of 24 cadavers also showed that fascia propria of the rectum fused with visceral fascia at the level of Waldeyer fascia. The fusion line of these two fasciae was supposed to be the extension of Waldeyer fascia. There were two avascular planes behind the rectum: one between the fascia propria of the rectum and visceral fascia, and the other between the visceral fascia and parietal fascia. In 8 constipation cases undergoing laparoscopic subtotal colon resection plus modified Duhamel operation, both mesocolon and mesorectum needed to be mobilized. It was obvious that the mesocolon of descending colon extended and became the mesocolon of sigmoid colon, and ran further into the pelvic and became the mesorectum. The colon fascia of descending colon served as the natural boundary of mesocolon extended downward as the fascia of sigmoid colon and the fascia propria of the rectum, respectively. Toldt fascia locating between mesocolon of descending colon and Gerota fascia extended to pelvis as the 'presacral space’ between the fascia propria of the rectum and visceral fascia. Gerota fascia in descending colon segment extended as urogenital fascia in sigmoid colon segment and visceral fascia in the pelvis, respectively. In the cadaver anatomy study, the visceral fascia served as a corridor carrying the hypogastric nerve, and ureter was observed in 23 (23/24, 95.8%) cases. The visceral fascia passed from posterior to anterior lateral of rectum, fusing with Denonvilliers fascia in a fan shape. The pelvic plexus located exactly external to the junction of visceral fascia and Denonvilliers fascia. Pelvic splanchnic nerves went through the parietal fascia toward to the inferolateral of the pelvic plexus.@*Conclusion@#Fascia propria of the rectum and the visceral pelvic fascia are two independent layers of fascia, and the TME surgical plane is between the fascia propria of the rectum and visceral pelvic fascia instead of between the visceral and the parietal pelvic fascia.

From membrane surgery to compartment surgery: source tracing and discriminating / 中华胃肠外科杂志

The theory of membrane surgery actually holds the same concepts as that of traditional cancer surgery, which believes that tumor spread is regarded as an isotropic process but the tumor is confined by the block of the membrane. Therefore, the radical resection can be achieved by complete mesentery excision along the membrane plane. The surgical practice derived from these conceptions is extended excision and lays emphasis on tumor-free margins. But the theory is controversial in the view of the existence of mesorectal fascial envelope and the feasibility of complete excision of mesorectum along the "holy plane". Based on ontogenetic anatomy, the compartment theory suggeststhat tumor spread is not isotropic, and it is locally confined within the ontogenetic compartment derived from a common primordium for a relatively long phase during their natural course. Local tumor is suppressed by the boundary instead of fascia. The anatomical territory developing from each anlage primordium may be separated morphologically. Consequently, ontogenetic compartment theory states that optimal local control of cancer is achieved by whole compartment resection, irrespective of margin width. The compartment model of tumor spread provides explanations for total mesorectal excision (TME) which excises the complete rectum compartment including the rectum and its surrounding vascular and ligamentous mesenteries. The compartment theory may set up the new principles for surgical tumor treatment, namely the resection of the tumor bearing compartment rather than target organ.

The value of diffusion tensor imaging in the quantitative study of thigh muscles in amateur marathon runners / 中华放射学杂志

Objective@#To test the differences in diffusion properties-namely fractional anisotropy (FA) and apparent diffusion coefficient(ADC)-between amateur marathon runners and healthy volunteers′ thigh muscles using diffusion tensor imaging (DTI) at rest.@*Methods@#Thirty amateur marathon runners(Group A) and 20 healthy volunteers (Group B) were recruited. All were males and their age was between 28 to 53 years. All subjects underwent both thigh DTI examination. DTI parameters FA and ADC were evaluated in thigh muscles(rectus femoris, vastus lateralis, vastus intermedius, vastus medialis, adductor longus, adductor magnus, biceps femoris long head, semitendinosus and semimembranosus)in all subjects. We tested the differences in diffusion properties between GroupA and B using independent sample t test.@*Results@#The average FA value of the thigh muscles measured in Group A was (0.24±0.03), which was significantly lower than that in Group B=(0.27±0.03)(t=5.164,P<0.01). The average ADC value of the thigh muscles measured in Group A was (1.74±0.10)×10-3mm2/s, which was significantly higher than that in Group B=(1.70±0.09)×10-3mm2/s (t=2.060,P<0.05). The FA value of Group A was lower than that of Group B in the rectus femoris, vastus lateralis, vastus medialis, biceps femoris long head, semitendinosus and semimembranosus (P<0.05). The ADC value of Group A was higher than that of Group B in the vastus intermedius, vastus medialis and biceps femoris long head (P<0.05).@*Conclusions@#In the absence of positive findings from conventional MRI, DTI technique can non-invasively assess the subtle changes in the bilateral thigh muscles of amateur marathon runners at rest in the early stage of microscopic molecular level, providing important imaging evidence for early changes in skeletal muscle caused by marathon.

Quantitative T2* MRI study of knee articular cartilage of amateur marathon runners after running a half marathon / 中华放射学杂志

Objective@#To study the effects of half marathon loading on the T2* mapping assessment of knee joint cartilage.@*Methods@#Twenty male amateur marathon runners with more than three years of running age were enrolled. The T1WI, PDWI, 3D-DESS, and T2* mapping were performed on right knee joint before and after the half marathon within 3h and after a period of approximately 1 week. Cartilage was divided into 6 regions: medial and lateral femoral cartilage, medial and lateral tibial cartilage and patella and trochlea cartilage. Femoral cartilage was partitioned into central weight-bearing regions, posterior cartilage nonweight-bearing regions with the posterior boundary of the meniscus as the dividing mark. All cartilage was further divided into deep and superficial layers according to the thickness 1/2, and the ROI was delineated to obtain the T2* value of the corresponding area. One-way repeated measures analysis was performed to test the difference of T2* values pre- and post-marathon. LSD tests were used to estimate the different influences of physiological activities on each articular cartilage area.@*Results@#All cartilage areas of the knee joint did not show cartilage injury during the examination. The differences in the global T2* values of the superficial layers of the knee cartilage before and after the half-marathon marathon were statistically significant (t=5.145, P<0.05), but the global T2* value of the deep region were not (t=1.864, P>0.05). After a week, the T2* values of all cartilage areas were not statistically different from those before running (t=1.062, 0.309; P>0.05).@*Conclusion@#After a single half marathon, the changes of knee cartilage composition in male amateur marathon runners are reversible. In the absence of positive findings in conventional MRI, T2* mapping can indirectly reflect changes in biochemical composition of the articular cartilage during exercise.

The value of diffusion tensor imaging in the quantitative study of thigh muscles in amateur marathon runners / 中华放射学杂志

Objective To test the differences in diffusion properties?namely fractional anisotropy (FA) and apparent diffusion coefficient(ADC)?between amateur marathon runners and healthy volunteers′thigh muscles using diffusion tensor imaging (DTI) at rest. Methods Thirty amateur marathon runners(Group A) and 20 healthy volunteers (Group B) were recruited. All were males and their age was between 28 to 53 years. All subjects underwent both thigh DTI examination. DTI parameters FA and ADC were evaluated in thigh muscles(rectus femoris, vastus lateralis, vastus intermedius, vastus medialis, adductor longus, adductor magnus, biceps femoris long head, semitendinosus and semimembranosus)in all subjects. We tested the differences in diffusion properties between GroupA and B using independent sample t test. Results The average FA value of the thigh muscles measured in Group A was (0.24 ± 0.03), which was significantly lower than that in Group B=(0.27±0.03)(t=5.164,P<0.01). The average ADC value of the thigh muscles measured in Group A was (1.74±0.10)×10?3mm2/s, which was significantly higher than that in Group B=(1.70±0.09)×10?3mm2/s (t=2.060,P<0.05). The FA value of Group A was lower than that of Group B in the rectus femoris, vastus lateralis, vastus medialis, biceps femoris long head, semitendinosus and semimembranosus (P<0.05). The ADC value of Group A was higher than that of Group B in the vastus intermedius, vastus medialis and biceps femoris long head(P<0.05). Conclusions In the absence of positive findings from conventional MRI, DTI technique can non?invasively assess the subtle changes in the bilateral thigh muscles of amateur marathon runners at rest in the early stage of microscopic molecular level, providing important imaging evidence for early changes in skeletal muscle caused by marathon.

Quantitative T2*MRI study of knee articular cartilage of amateur marathon runners after running a half marathon / 中华放射学杂志

Objective To study the effects of half marathon loading on the T2* mapping assessment of knee joint cartilage. Methods Twenty male amateur marathon runners with more than three years of running age were enrolled. The T1WI, PDWI, 3D?DESS, and T2*mapping were performed on right knee joint before and after the half marathon within 3h and after a period of approximately 1 week. Cartilage was divided into 6 regions: medial and lateral femoral cartilage, medial and lateral tibial cartilage and patella and trochlea cartilage. Femoral cartilage was partitioned into central weight?bearing regions, posterior cartilage nonweight?bearing regions with the posterior boundary of the meniscus as the dividing mark. All cartilage was further divided into deep and superficial layers according to the thickness 1/2, and the ROI was delineated to obtain the T2* value of the corresponding area. One?way repeated measures analysis was performed to test the difference of T2*values pre?and post?marathon. LSD tests were used to estimate the different influences of physiological activities on each articular cartilage area. Results All cartilage areas of the knee joint did not show cartilage injury during the examination. The differences in the global T2*values of the superficial layers of the knee cartilage before and after the half?marathon marathon were statistically significant (t=5.145, P<0.05), but the global T2*value of the deep region were not (t=1.864, P>0.05). After a week, the T2* values of all cartilage areas were not statistically different from those before running (t=1.062, 0.309; P>0.05). Conclusion After a single half marathon, the changes of knee cartilage composition in male amateur marathon runners are reversible. In the absence of positive findings in conventional MRI, T2* mapping can indirectly reflect changes in biochemical composition of the articular cartilage during exercise.

Surgical therapy for colorectal cancer with synchronous liver metastasis / 中华普通外科杂志

Objective To evaluate curative effect and related prognosis factors of synchronous colorectal cancer with liver metastasis.Methods The clinicopathological and follow-up data of 47 patients undergoing surgical treatment with synchronous colorectal cancer with liver metastasis at Shanghai Jiaotong University Affiliated Sixth People's Hospital and Tongji University Affiliated Yangpu Hospital from Jun 2013 to Jan 2018 were retrospectively analyzed.Results All 47 patients were followed up and themedian followup time was 38 months (2-65 months),after simultaneous colorectal and hepatic neoplasm radical surgery,added in 41 patients by postoperative chemotherapy.There was no perioperative mortality and the postoperative complication rate was 34％.The 1-,3-,and 5-year overall-survival rates were 87％,53％,and 15％,respectively.The disease-free survival rates were 81％,43％,and 9％,respectively.Multivariate results showed tumor differentiation,serum CEA level and adjuvant chemotherapy are independent prognostic factors for patients with synchronous colorectal cancer liver metastasis (P ＜ 0.05).Conclusions Colorectal cancer with synchronous liver metastasis treated by simultaneous resection of colorectal cancer and liver metastases are the widerly adopted treatments.Long-term survival is closely related to the degree of primary neoplasm differentiation,serum CEA level at diagnosis,and postoperative adjuvant chemotherapy.

The role of radiotherapy in primary central nervous system lymphoma / 中华放射肿瘤学杂志

Objective To explore the role of radiotherapy in the treatment of primary central nervous system lymphoma. Methods Clinical data of 60 patients diagnosed with primary central nervous system lymphoma from September 2010 to December 2017 were retrospectively analyzed. Among them, 50 cases were diagnosed by histopathological examination after stereotactic biopsy or tumor resection and 10 patients were diagnosed by gadolinium enhanced magnetic resonance imaging ( MRI) . Fifty-two patients underwent chemotherapy, and 45 of them received methotrexate-based chemotherapy, 25 received rituximab-based regimen. Twenty-seven patients were given with planned whole brain radiotherapy, while 33 patients were not. Salvage radiotherapy was delivered in 9 patients after treatment failure. Results The median follow-up time was 28 months ( 5-70 months) . The median overall survival time and median progression-free survival time of the whole patients was 22 months ( 5-65 months) and 13 months ( 5-55 months) , respectively. The 4-year overall survival rate and progression-free survival rate were 61% and 33%, respectively. The 4-year overall survival rates between patients with and without planned whole brain radiotherapy were 68% and 54% ( P=0.083) . The 4-year progression-free survival rates between patients with and without planned whole brain radiotherapy were 47% and 20% ( P=0.014) , respectively. Patients with and without salvage whole brain radiotherapy had a 4-year overall survival of 49% and 68%, respectively ( P=0.398) . Among patients who received whole brain radiotherapy, patients with a lower dose of ≤36 Gy had a similar overall survival compared with those with a higher dose of>36 Gy ( 80% vs. 45%, P=0.136) . Conclusions Radiotherapy is part of the comprehensive treatment of primary central nervous system lymphoma. Planned radiotherapy may bring clinical benefits to patients during the comprehensive therapy. However, the irradiation dose to the whole brain should not be too high because of neurotoxicity.

Total mesorectal excision: fascial surgery or compartment surgery / 中华消化外科杂志

Total mesorectal excision (TME) improves the prognosis of patients with rectal cancer (RC) and now is being established as the gold standard for RC surgery.Local spread of tumor is thought to be contained within a defined intact visceral mesorectal fascial envelope.Therefore,surgical dissection along correct plane with complete mesorectum excision is the essence of TME.Recent literatures stated that TME with the guidance of membrane anatomy could improve tumor radicality and reduce genitourinary dysfunction.But TME remains the object of ongoing controversy.In fact,the conventional function anatomy can't provide theoretical support for TME.Observations of the anatomical studies found that "Holy Plane" was unlikely to become an almost impenetrable barrier to the spread of carcinoma and it didn't ensure complete excision of mesorectum along the correct surgical plane.Compartment theory based on the ontogenetic anatomy suggested that tumors were always locally confined to a compartment derived from a common embryologic origin (primordium) for a relatively long phase.The potential reasons lie in that tumor propagation is primarily suppressed at the compartment borders.The compartment model of tumor spread provides explanations for TME which excise the complete rectum compartment including the rectum and its surrounding vascular and ligamentous mesenteries.The compartment theory may set up the new principles of tumor radicality.

Study on the expression of epidermal growth factor receptor protein during benzo(a)pyrene induced carcinogenesis / 中华预防医学杂志

Objective@#To explore the expression of epidermal growth factor receptor(EGFR) protein during benzo(a)pyrene (BaP) induced carcinogenesis.@*Methods@#This study, we firstly utilized immunofluorescence assay and Western-blot to examine EGFR expression of the BaP which was constructed previously by project team induced malignant transformation human bronchial epithelial cell (BTC) and the control (16HBE cell). Then, we selected 36 healthy SD rats, divided into two groups according to simple random method, 18 rats each group. The constructed rat lung neoplasm model induced by pulmonary injection of BaP (10 mg/ml of BaP solution in 0.2 ml corn oil), contrast group use 0.2 ml corn oil, lung tissue was collected and the EGFR expression of lung tissue was detected by immunofluorescence assay and Western blot. T analysis was used to test the different of EGFR between two groups.@*Results@#Immunofluorescence analysis showed that the EGFR expression in BTC was significantly higher than 16HBE cell. Meanwhile, Western blot also was used to confirmed this result, the relative expression of EGFR protein in the rats of the model group the control group were 1.04±0.13 and 2.32±0.12, respectively, and the difference was statistically significance (t=12.39, P<0.001). In vivo, well-defined tumor was found in the rat with pulmonary injection of BaP, and the lung showed diffuse alveolar septal thickening, alveolar wall destruction and pulmonary alveoli fusion, which suggested that the rat lung neoplasm model was constructive successfully. Furthermore, we found the EGFR expression of lung was increased dramatically in the rat lung neoplasm model by immunofluorescence detection and Western blot. The relative expression of EGFR protein in the rats of the model group the control group were 0.21±0.03 and 1.30±0.07, respectively, and the difference was statistically significance (t=12.84, P<0.001).@*Conclusion@#Expression of EGFR protein was increased during BaP carcinogenesis, and EGFR may play an important role in the carcinogenesis of BaP.

Research Progress on the Function of Intestinal Flora in Type 2 Diabetes Mellitus / 现代检验医学杂志

Type 2 diabetes mellitus is a metabolic disorder characterized by hyperglycemia caused by multifactors.The incidence of type 2 diabetes is gradually increased.Its prevention and treatment are paid more and more attention.Intestinal flora is one of the hot spots in recent years.A large number of studies have shown that intestinal flora is closely related to the occurrence and treatment of type 2 diabetes mellitus.Intestinal flora is expected to be a new direction for the improvement and treatment of type 2 diabetes mellitus.In this paper,the relationship between type 2 diabetes and intestinal microflora in recent years,pathogenesis and treatment were summarized.

Lumbar interbody fusion with porous biphasic calcium phosphate enhanced by recombinant human bone morphogenetic protein-2/silk fibroin sustained-release microsphere in a sheep model / 中国组织工程研究

BACKGROUND: The authors have studied the porosity, pore size, mechanical strength, in vitro biological activity,ectopic osteogenic activity of porous biphasic calcium phosphate enhanced by recombinant bone morphogenetic protein-2/silk fibroin sustained-release microsphere (BCP/rBMP-2/SF). However, further investigation on the osteogenic ability of the composite bone graft material is warranted based on a reliable animal model, which will provide experimental data for the clinical application of the composite material in the spinal fusion.OBJECTIVE: To investigate the osteogenic efficacy of BCP/rBMP-2/SF in a sheep lumbar interbody fusion model.METHODS: Sixteen healthy adult sheep were divided into two groups randomly. All sheep were operated on the left extraperitoneal approach and intervertebral discs of L1/2, L3/4, and L5/6 were exposed respectively. Three of the following four materials were randomly implanted into the L1/2, L3/4, and L5/6 of each animal: autologous iliac, BCP/rhBMP-2/SF,BCP/rhBMP-2 or BCP/SF.RESULTS AND CONCLUSION: The group of BCP/SF/rhBMP-2 achieved a similar fusion rate compared with the group of autologous iliac at 12 and 24 weeks after operation, and they were significantly better than the other two groups. These findings indicate that the novel new artificial bone, BCP/rhBMP-2/SF, can obtain similar lumbar fusion results compared with the autologous iliac. It is expected to be applied to clinical practice in the future by further improving its properties.

Delivery of recombinant enhanced green fluorescent protein to Pichia pastoris cell wall directed by a mammalian nonclassical secretion signal peptide / 生物工程学报

A mammalian nonclassical secretion sequence derived from mouse Engrailed2 homeoprotein (En2) was used to direct the secretion of the enhanced green fluorescent protein from Pichia pastoris. This signal peptide conferred the transport of enhanced green fluorescent protein into periplasm through an endoplasmic reticulum-golgi independent pathway, without inducing severe unfolded protein response as compared with Saccharomyces cerevisae α-factor preprosequence. This study implies that this mammalian nonclassical signal peptide could be developed as a useful tool for delivering cargoes to the cell surface of yeast.

Preliminary efficacy of video-assisted anal fistula treatment for complex anal fistula / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the preliminary efficacy of video-assisted anal fistula treatment (VAAFT) for complex anal fistula.</p><p><b>METHODS</b>Clinical data of 11 consecutive patients with complex anal fistula undergoing VAAFT in our department from May to July 2015 were reviewed. VAAFT was performed to manage the fistula under endoscope without cutting or resection.</p><p><b>RESULTS</b>VAAFT was successfully performed in all the 11 patients. The internal ostium was closed using mattress suture in 10 cases, and Endo-GIA stapler in 1 case. The mean operative time was (42.0±12.4) min, mean hospital stay was (4.1±1.5) d. Complication included bleeding and perianal infection in 1 case respectively. After 1 to 3.2 months follow-up, success rate was 72.7%(8/11), and no fecal incontinence was observed.</p><p><b>CONCLUSION</b>Video-assisted anal fistula treatment is an effective, safe and minimally invasive surgical procedure for complex anal fistula with preservation of anal sphincter function.</p>

Posterior Decompression and Lumbar Interbody Fusion with Internal Fixation Treating Degenerative Lumbar Scoliosis / 天津医药

Objective To assess the clinical outcomes of posterior decompression and lumbar interbody fusion with internal fixation treatment for degenerative lumbar scoliosis (DLS). Methods Ninety-eight patients underwent surgery for DLS were retrospectively reviewed in this study. The mean age of the patients(male 35 and femail 63) was (56±9) years. The mean Cobb angle of curves was (26±9)° and the mean scoliosis Cobb angle of lumbar was (19±11)° in patients before surgery. A posterior medial incision was made for spinal exposure. According to the preoperative plan, patients were operated with posterior de-compression and lumbar interbody fusion with internal fixation. The clinical outcomes were assessed by the JOA scores.The preoperative and postoperative Cobb angle was recorded. Results The mean follow-up time was (3.7±2.4) years. The mean JOA scores were improved from (10±2) points preoperatively to (26±3) points at the last follow-up. The excellent or good outcome rates were 89.7%for patients with surgery. The average interbody fusion time was (5.7±1.4) months. The mean postoperative Cobb angle was (6±2)° at the last follow-up, and the mean Cobb angle correction was (17±4)°, with the correction rate of 59.2%. The mean lumbar lordosis angle was (12±3)°. There was no failure in internal fixation. Conclusion The posterior decompression and lumbar interbody fusion with internal fixation appears to be a reasonable option for degenerative lumbar scoliosis.

Lead compound optimization strategy (2)--structure optimization strategy for reducing toxicity risks in drug design / 药学学报

Idiosyncratic adverse drug reactions (IDR) induce severe medical complications or even death in patients. Alert structure in drugs can be metabolized as reactive metabolite (RM) in the bodies, which is one of the major factors to induce IDR. Structure modification and avoidance of alert structure in the drug candidates is an efficient method for reducing toxicity risks in drug design. This review briefly summarized the recent development of the methodologies for structure optimization strategy to reduce the toxicity risks of drug candidates. These methods include blocking metabolic site, altering metabolic pathway, reducing activity, bioisosterism, and prodrug.

Meta-analysis of replacement time for long-term indwelling catheter in patients with silicone catheter in China / 现代临床护理

ObjectiveTo explore the best time for replacing the long-term indwelling catheter in patients with silicone catheter.MethodsDomestic literature were retrieved and analyzed using Cochrane systematic review,and the meta-analysis of randomized controlled trials was conducted in accordance with inclusion criteria and exclusion criteria so as to look into the most suitable time for replacing the indwelling catheter for patients with silicone catheter at clinical trials.The replacement frequency for the catheters of different size together with the relevant infections in urinary tract infection and relative risk(RR)were used as values for effectiveness of interventions.ResultsA total of 11 literature were retrieved. Meta-analysis results suggested that the RR values of urinary tract infections when the catheters were replaced once every two weeks vs. every four weeks,and once every three weeks vs. every four weeks were 0.51[95% CI(0.40,0.66),P <0.001],0.79[95% CI(0.58,1.08),P = 0.14],respectively.The urinary infection rate of replacing a silicone cathether every 2 weeks was higher than that of every 4 weeks,but there was no difference between that of every 3 weeks and 4 weeks.Conclusion According to the nature of silicone catheter material as well as the clinical indexes, it is most reliable to replace a silicone catheter every four weeks to reach a best clinical outcome.