Clinical prognosis and influencing factors of patients with hypopharyngeal squamous cell carcinoma treated by salvage surgery / 国际肿瘤学杂志

Objective:To investigate the clinical prognosis and influencing factors of patients with hypopharyngeal squamous cell carcinoma treated by salvage surgery.Methods:A total of 78 patients with hypopharyngeal squamous cell carcinoma underwent salvage surgery in Jincheng Second People's Hospital of Shanxi Province from January 2017 to January 2022 were included retrospectively. Postoperative complications were recorded. Logstic regression analysis was used to evaluate the influencing factors of survival after 5 years of salvage surgery, and receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of various influencing factors on the survival of patients with hypopharyngeal squamous cell carcinoma after 5 years of salvage surgery.Results:The incidence of complications after salvage surgery in 78 patients was 21.79% (17/78) . The median total survival time was 20.5 months. There were 21 deaths 5 years after operation. Univariate analysis showed that the age of salvage surgery ( χ2=30.25, P<0.001) , location of recurrent tumor ( χ2=8.72, P=0.013) , surgical margin status ( χ2=6.93, P=0.008) , depth of tumor invasion ( χ2=8.31, P=0.004) and whether to accept radiotherapy (chemotherapy) after salvage operation ( χ2=4.24, P=0.040) were all related to the survival of patients with hypopharyngeal squamous cell carcinoma after 5 years of salvage surgery. Multivariate analysis showed that the status of the surgical margin ( OR=26.26, 95% CI: 4.58-150.62, P<0.001) , the depth of tumor invasion ( OR=14.03, 95% CI: 3.04-64.70, P<0.001) and whether to accept radiotherapy (chemotherapy) after the salvage surgery ( OR=7.73, 95% CI: 1.68-35.54, P=0.008) were independent factors affecting the survival of patients with hypopharyngeal squamous cell carcinoma after 5 years of salvage surgery. The ROC curve analysis showed that the sensitivity of surgical margin status, tumor invasion depth and whether to accept radiotherapy (chemotherapy) after salvage surgery to predict the survival of patients with hypopharyngeal squamous cell carcinoma after 5 years of salvage surgery were 84.15%, 79.60% and 76.43% respectively, and the specificity were 76.03%, 83.51% and 69.46% respectively. The sensitivity and specificity of combined prediction of the three indicators were 92.74% and 77.98% respectively. Conclusion:The overall prognosis of hypopharyngeal squanous cell carcinoma patients after salvage surgery is satisfactory. Positive surgical margin, tumor invasion of muscle, bone tissue or lymph node capsule, and no radiotherapy or chemical therapy after salvage surgery are closely related to poor prognosis. Meanwhile, the combination of surgical margin status, tumor invasion and adjuvant treatment after salvage surgery has good efficacy in predicting postoperative survival benefit of patients.

Modified double-tract reconstruction operation in early SiewertⅡ esophagogastric junction adenocarcinoma / 中华普通外科杂志

Objective:To evaluate the safety and efficiency of a modified double-tract reconstruction procedure─proximal gastrectomy with piggyback interposed jejunal single-channel reconstruction (PJIR-STR) for early SiewertⅡ adenocarcinoma of esophagogastric junction (AEG).Method:Data of 8 SiewertⅡ AEG patients at Shanxi Tumor Hospital and undergoing PJIR-STR from May 2018 to Oct 2019 were retrospectively analyzed. The gastroesophageal reflux disease questionnaire (GerdQ) was used to score the patients at 3, 6, 12, and 18 months after surgery. The severity of postoperative reflux esophagitis was assessed by gastroscopy at 3, 6 months after surgery, using the Los Angeles Classification criteria.Result:All patients recovered well after surgery without serious complications. No obvious gastroesophageal reflux was observed in all patients at different periods (All of the GerdQ scores were <8 points.) The results of gastroscopy showed that 1 patient was diagnosed as grade B reflux esophagitis at 3, 6 months after surgery, which was responsive to conservative treatment, and the other 7 patients had no grade B or above reflux esophagitis.Conclusion:PJIR-STR is a feasible, safe reconstruction with excellent efficiency of dual anti-reflux for the SiewertⅡ AEG.

Application value of self-pulling and latter transection technique in double anti-reflux double-tract reconstruction of totally laparoscopic proximal gastrectomy / 中华消化外科杂志

Objective:To investigate the application value of self-pulling and latter transection (SPLT) technique in double anti-reflux double-tract reconstruction of totally laparoscopic proximal gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 103 patients with Siewert type Ⅱ adenocarcinoma of esophagogastric junction in clinical stage Ⅰ-Ⅱ who were admitted to Shanxi Cancer Hospital from January 2018 to January 2020 were collected. There were 65 males and 38 females, aged from 45 to 79 years, with a median age of 59 years. Of 103 patients, 49 cases undergoing totally laparoscopic proximal gastrectomy with double-tract reconstruction of SPLT were assigned into the SPLT group, 54 cases undergoing totally laparoscopic proximal gastrectomy with conventional double-tract reconstruction were assigned into the traditional group. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted by outpatient examination and telephone inter-view to detect postoperative reflux esophagitis of patients up to December 2021. Measurement data with normal distribution were represented as Mean± SD, and the t test was used for comparison between groups. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and the Wilcoxon test was used for comparison between groups. Count data were described as absolute numbers or percentages, and comparison between groups was performed using the chi-square test. Comparison of ordinal data was analyzed using the non-parameter rank sum test. Results:(1) Intraoperative situations: the operation time, digestive tract reconstruction time, volume of intraoperative blood loss, the number of inferior mediastinal lymph nodes dissected, cases with auxiliary incisions for the SPLT group were (261±48)minutes, (26±4)minutes, (114±42)mL, 8.0(6.5,9.5), 1, respectively. The above indicators were (244±42)minutes, (30±6)minutes, (118±46)mL, 5.5(4.0,8.0), 9 for the traditional group, respectively. There were significant differences in the digestive tract reconstruction time, the number of inferior mediastinal lymph nodes dissected and cases with auxiliary incisions between the two groups ( t=-3.34, Z=-4.05, χ2=4.72, P<0.05). There was no significant difference in the operation time or volume of intraoperative blood loss between the two groups ( t=1.87, -0.47, P>0.05). (2) Postoperative situations: duration of postopera-tive hospital stay and cases with postoperative complications were (11.5±2.7)days and 4 for the SPLT group, versus (12.5±4.3)days and 9 for the traditional group, showing no significant difference between the two groups ( t=-1.47, χ2=1.68, P>0.05). There were 13 of 103 patients with postopera-tive complications, including 5 cases of left pleural effusion, 4 cases of anastomotic leakage, 2 cases of mild pneumonia, 1 case of incision infection, 1 case of chylous leakage. Four patients had anasto-motic leakage at the esophagojejunostomy, the abdominal esophagus of whom was invaded by more than 1 cm. During the operation, mediastinal drainage tubes were placed through the abdominal wall. The 4 patients were cured after enteral and parenteral nutrition support and adequate drainage, and the remaining patients with complications were cured after symptomatic treatment. (3) Follow-up: of 49 patients in the SPLT group, 43 cases were followed up for (18±4)months. During the follow-up, 1 case showed reflux esophagitis by gastroscopy, with the incidence of 2.33%(1/43). Of 54 patients in the traditional group, 53 cases were followed up for (17±4)months. During the follow-up, 4 cases showed reflux esophagitis by gastroscopy, with the incidence of 7.55%(4/53). There was no significant difference in the incidence of reflux esophagitis between the two groups ( χ2=0.47, P>0.05). Conclusions:SPLT technology is feasible for double anti-reflux double-tract reconstruction of proximal gastrectomy. Compared with traditional double-tract reconstruction of totally laparos-copic proximal gastrectomy, SPLT technology can reduce the auxiliary incisions, increase the number of lower mediastinal lymph nodes dissected, and shorten the digestive tract reconstruction time.

Clinicopathologic findings and lymph node metastasis of adenocarcinoma of the esophagogastric junction / 中华普通外科杂志

Objective:By analyzing the relationship between postoperative pathology and lymph node metastasis of the adenocarcinoma of esophagogastric junction patients to explore the effect of surgical resection and lymph node cleaning scope on prognosis in different Siewert type patients.Methods:A retrospective analysis was made on 350 cases of esophageal gastric junction adenocarcinoma at Tumor Hospital of Shanxi Province from July 2014 to May 2018. Patients clinical data such as lymph node metastasis and tumor diameter, differentiation degree, infiltration depth were studied. The value of the third leg of lymph node cleaning in cardia cancer radical were discussed. Risk factors of lymph node metastasis were analyzed by Logistic regression model.Results:A total of 6 718 lymph nodes were dissected in 350 patients with adenocarcinoma of esophagogastric junction, including 1 613 positive lymph nodes, with a metastasis rate of 24.01%. The metastatic rate of Siewert type Ⅰ lymph nodes was 23.30%, 20.16%, 41.90% and 20.87% in the first, second, third and seventh groups, respectively, which was significantly higher than that of other groups. Siewert Ⅱ and Ⅲ focus on the abdominal cavity. with the increase of tumor infiltration depth, the rate of peripheral lymph node metastasis increased, and the difference was statistically significant ( P<0.01). The rate of lymph node metastasis was 83.1% in the low-differentiation group and 58.4% in the middle-high differentiation group, respectively ( P<0.01). When the tumor diameter ≥4 cm, the rate of lymph node metastasis in the patients increased significantly, and the difference was statistically significant ( P<0.05). The rate of lymph node metastasis at the third station was correlated with the depth of invasion of the gastric wall, the longest diameter of the tumor body, and the degree of differentiation of the tumor. Conclusions:The longest diameter of tumor body, the depth of infiltration and the degree of differentiation are independent risk factors for lymph node metastasis in AEG patients. For patients with type AEG Ⅰ, the mediastinal and lower esophageal lymph nodes should be thoroughly dissected during radical surgery, and the abdominal lymph nodes in groups 1, 2, 3 and 7 should be dissected. The remaining groups may have to be examined for enlarged lymph nodes to determine whether to dissect. For type Ⅱ and Ⅲ patients, splenoprotective total gastrectomy and D 2 lymph node dissection are recommended when the tumor invades the full layer of the gastric wall, the longest diameter ≥4 cm, and the differentiation degree is low.

Clinical study on two reconstruction methods of proximal gastrectomy and piggyback jejunal interposition for Siewert Ⅱ or Ⅲ adenocarcinoma of esophagogastric junction / 中华外科杂志

Objective@#To evaluate the clinical efficacy of two different digestive tract reconstruction methods in the Siewert Ⅱ or Ⅲ adenocarcinoma of esophagogastric junction underwent proximal gastrectomy and piggyback jejunal interposition.@*Methods@#A total of 84 patients with Siewert Ⅱ or Ⅲ AEG who underwent proximal gastrectomy and interposition jejunal anastomosis were enrolled prospectively according to the exclusion criteria, from October 2015 to August 2017 at Department of Digestive Minimally Invasive Surgery, Shanxi Cancer Hospital. There were 61 male and 23 female patients, aged 48-69 years with an average age of 59.7 years. They were divided into single-tract reconstruction group (n=41) and double-tract reconstruction group (n=43) according to random number table. Both groups underwent proximal gastrectomy and piggyback jejunal interposition. After side-to-side anastomosis of the remnant stomach and jejunum was performed in the single-tract group, jejunum 3 cm below the anastomosis was ligated or closed. The jejunum in the double-tract group was not treated during the operation. Relevant nutritional indicators were collected at 3 months and 6 months after operation. The data were analyzed by repeated measurement of variance analysis to determine the nutritional status.@*Results@#There was no significant difference in preoperative general condition between single-tract reconstruction group and double-tract reconstruction group (P>0.05). There was no significant difference in perioperative related indicators (P>0.05). Nutritional indicators in single-channel reconstruction group were higher than those in double-channel reconstruction group (hemoglobin: F=23.374, P=0.000; albumin: F=6.149, P=0.003; total protein: F=18.362, P=0.000; weight: F=74.255, P=0.000). The quality of life was compared half year after operation, there was no significant difference in the incidence of subjective symptoms such as reflux, heart burning, nausea and vomiting, dysphagia and sternum discomfort in the two groups (P>0.05), as well as the results of QLQ-STO22 score (27.0±3.8 vs. 27.6±3.3, t=-0.688, P=0.494). The results of gastroscopy showed that the incidence and degree of the two groups were almost the same whether in the incidence of reflux esophagitis (2/41 vs. 2/43, P=1) or in the contrast of reflux degree (Z=-1.528, P=0.127).@*Conclusion@#For patients with type Siewert Ⅱ or Ⅲ esophagogastric junction adenocarcinoma who underwent proximal gastrectomy and piggyback jejunal operation, single tract reconstruction is ideal.

Effect of adenosine kinase small interfering RNA modified corneal endothelial cells on the proliferation and secretion of regulatory T cells / 中华实验眼科杂志

Objective To investigate the role of adenosine kinase (ADK) small interfering RNA (siRNA) modified corneal endothelial cells on the proliferation and secretion of regulatory T cells (Treg cells).Methods The experiment was divided into transfected group and non-transfected group,FAM-ADK siRNA was transfected into corneal endothelial cells with Lipofectamine 3000 in transfected group,and the average mass concentration of adenosine was detected by high performance liquid chromatography in both groups.The experiment was divided into control group (transfected with control siRNA),rapamycin group (added 10 ng/ml rapamycin to culture supernatant after transfected with control siRNA) and ADK siRNA group (added 10 ng/ml rapamycin to culture supernatant after transfected with ADK siRNA).TUNEL staining was used to detect the proportion of apoptosis.Flow cytometry was used to detect the expressions of intercellular adhesion molecule-1 (ICAM-1),vascular cell adhesion molecule-1 (VCAM-1) and E-selectin in corneal endothelial cells.The cells were divided into single cultured group (lymphocytes were cultured separately),co-culture group (lymphocytes were co-cultured with corneal endothelial cells) and ADK siRNA group (lymphocytes were co-cultured with ADK siRNA transfected corneal endothelial cells),and the proportion of CD4+ CD25+ Foxp3 + Treg cells was detected by flow cytometry,and the content of interleukin-10 (IL-10) and transforming growth factor-β (TGF-β) in the supernatant was detected by ELISA in the three groups.The access and use of clinical specimens was approved by Ethic Committee of Tianjing Taida Hospital (TD201705140901).Results Flow cytometry showed that 95.1％ of the endothelial cells expressed siRNA.The average mass concentration of adenosine in the supernatant of the transfection group was significantly higher than that in the control group ([38.020±6.658] ng/ml vs.[1.663 ±0.581] ng/ml) (t =5.437,P =0.006).TUNEL staining showed that the average apoptotic cell proportion of corneal endothelial cells in the rapamycin group was significantly higher than that in the control group,and the average apoptotic cell proportion of corneal endothelial cells in the ADK siRNA group was significantly lower than that in the rapamycin group,with significant differences between them (t =3.763,P =0.020;t =4.405,P =0.012).Flow cytometry showed that the average fluorescence intensities of ICAM-1,VCAM-1 and E-selectin in the ADK siRNA group was weaker than that in the control group (4.060± 1.179 vs.11.600±2.427,3.600 ± 1.234 vs.11.030 ± 2.291,5.223 ± 1.734 vs.24.270 ± 4.332),with significant differences between them (t =2.794,P =0.049;t =2.857,P =0.046;t =4.081,P =0.015).The proportions of Treg cells in the single cultured group,co-culture group and ADK siRNA group was significantly different (F =12.890,P =0.007),and the proportion of Treg cells in the ADK siRNA group was significantly lower than that in the co-culture group (t =3.650,P =0.022).ELISA assay showed that,the contents of IL-10 and TGF-β in the supernatant in the single cultured group,co-culture group and ADK siRNA group were significantly different (F =20.960,P =0.003;F =27.320,P=0.001),and the content of IL-10 and TGF-β in the supernatant in the ADK siRNA group was significantly higher than that in the co-culture group,respectively (t =4.492,P =0.011;t =5.280,P =0.006).Conclusions ADK siRNA modified corneal endothelial cells can induce Treg cells to proliferate and secrete IL-10 and TGF-β,which provides a new method for induction of corneal allograft immune tolerance.

Jejunal interposed single-tract and double-tract reconstruction after proximal gastrectomy for Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction: a prospective randomized controlled study / 中华消化外科杂志

Objective To investigate the clinical efficacy of jejunal interposed single-tract and doubletract reconstruction after proximal gastrectomy for Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG).Methods The prospective study was conducted.The clinicopathological data of 108 patients with Siewert type Ⅱ and Ⅲ AEG who were admitted to the Affiliated Tumor Hospital of Shanxi Medical University between August 2013 and November 2016 were collected.All the patients underwent proximal gastrectomy and were allocated into the 2 groups by random number table,including patients using single-tract jejunal interposition reconstruction in the single-tract group and patients using double-tract jejunal interposition reconstruction in the double-tract group.Digestive tract reconstruction:after end-to-side anastomosis between distal jejunum and esophagus and side-to-side anastomosis between posterior wall of the gastric remnant and jejunum,single-tract jejunal reconstruction was done through ligating jejunum at 3 cm below the anastomotic stoma,and then side-to-side anastomosis between proximal jejunum and jejunum was performed in the single-tract group.Patients in the double-tract group used the same digestive tract reconstruction,but jejunum was not ligated.The postoperative pathological examinations showed that patients with positive lymph nodes or tumor invading all layers of gastric wall underwent chemotherapy.Observation indicators:(1) intra-and post-operative situations;(2) follow-up situations.Follow-up using telephone interview was performed to detect postoperative complication,gastrointestinal function and body mass index (BMI) up to November 2017.Measurement data with normal distribution were represented as-x± s and comparison between groups was analyzed using t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was analyzed using the nonparametric test.Repeated measurement data were analyzed by the repeated measures ANOVA.Comparisons of count data were done using chi-square test.Ordinal data were analyzed by the Kruskal Wallis H test.Results One hundred and eight patients were screened for eligibility,including 55 in the single-tract group and 53 in the double-tract group.(1) Intra-and post-operative situations:total operation time,digestive tract reconstruction time,volume of intraoperative blood loss,time to initial anal exsufflation,postoperative complications,cases with gastroesophageal reflux,intestinal obstruction and Visick grading ＞ Ⅱ and duration of postoperative hospital stay were respectively (145±26) minutes,(30±6) minutes,(181±37) mL,(53± 16) hours,1,1,1,(10.0±2.4) days in the singletract group and (139±29)minutes,(26±3)minutes,(176±31)mL,(50±17) hours,3,0,3,(9.4±l.4)days in the double-tract group,with no statistically significant difference between groups (t =0.725,0.219,0.162,-0.576,x2 =2.960,5.830,t =-0.993,P＞0.05).Four patients with gastroesophageal reflux received motilium and omeprazole therapy for 2 weeks,and were improved by symptomatic treatment such as increasing the solid food intake.One patient in the single-tract group had internal hernia-induced intestinal obstruction and was cured by reoperation.There was no anastomotic leakage,bleeding,infection,dumping syndrome and gallstone between groups.Of 108 patients,71 underwent 6-cycle SOX chemotherapy,including 67 with perigastric lymph node metastasis and 4 with tumor invading all layers of gastric wall.(2) Follow-up situations:108 patients were followed up for 12.0-48.0 months,with a median time of 28.6 months.During the follow-up,bowel sound in the double-tract group and single-tract group was 8 times / minute (range,5-12 times / minute) and 3 times /minute (range,2-5 times/ minute),with a statistically significant difference between groups (Z=-0.692,P＜0.05).The single food intake,serum gastrin level,ratio of serum pepsinogen Ⅰ and Ⅱ levels and BMI from preoperation to postoperative 12 months were from (1 117± 129)mL to (817± 127)mL,from (12±5)pmol/L to (41±13) pmol/L,from 11.3±2.8 to 5.1±2.2,(65±7)kg to (63±5) kg in the single-tract group and from (1 095±118)mL to (783±80)mL,from (10±4)pmol/L to (40±10)pmol/L,from 12.4±2.9 to 4.2±1.3,from (63±6) kg to (58±6)kg in the double-tract group,respectively,with no statistically significant difference in single food intake,serum gastrin level and ratio of serum pepsinogen Ⅰ and Ⅱ levels between groups (F =0.468,0.108,0.161,P＞0.05).There was a statistically significant difference in changing trend of BMI between groups (F=24.930,P＜0.05).Conclusion Jejunal interposed single-tract and double-tract reconstruction after proximal gastrectomy for Siewert type Ⅱ and Ⅲ AEG have the same surgical safety and don't affect secretion function of gastric remnant,but there are frequent bowel sounds and obvious weight loss.

Application value of vessel-guided lymph node dissection in the laparoscopic radical gastrectomy (D2) of distal gastric cancer / 中华消化外科杂志

Objective To investigate the application value of vessel-guided lymph node dissection (LND) in the laparoscopic distal gastrectomy (D2) of distal gastric cancer.Methods The retrospective crosssectional study was conducted.The clinicopathological data of 157 patients who underwent laparoscopic distal gastrectomy (D2) of distal gastric cancer in the Affiliated Tumor Hospital of Shanxi Medical University from October 2012 to July 2015 were collected.Patients used vessel-guided LND that was divided into 4 steps:middle colic vessel-guided LND in the upper pyloric region,gastroduodenal artery-guided LND in the lower pyloric region,common hepatic artery-guided LND in the right upper margin of pancreas and splenic artery-guided LND in the left upper margin of pancreas.Observation indicators:(1) surgical and intraoperative situations,(2) postoperative pathological results,(3) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative 3-year survival rate up to June 2017.Measurement data with normal distribution were represented as xes.The survival rate was calculated using the Kaplan-Meier method.Results (1) Surgical and intraoperative situations:157 patients underwent successful laparoscopic distal gastrectomy (D2) of distal gastric cancer.Operation time,LND time,volume of intraoperative blood loss,time for initial out-of-bed activity,time to initial anal exsufflation and time of postoperative abdominal drainage-tube removal were (178± 38) minutes,(61 ± 27) minutes,(87 ± 40) mL,(1.2± 0.4) days,(2.8 ± 1.3) days and (7.5 ± 2.6) days,respectively.Of 157 patients,10 with postoperative complications were improved by conservative treatment,including 5 with intestinal obstruction,3 with anastomotic fistula and 2 dying of pulmonary infection;other patients didn't have complications.Duration of hospital stay of 157 patients was (9±3)days.(2) Postoperative pathological results:total number of LND,numbers of LND in the lower pyloric region and in the upper margin of pancreas were 34.6±11.0,4.8±2.1 and 12.3±4.7,respectively.TNM staging:26,33,18,24,37 and 19 patients were respectively detected in stage Ⅰ a,Ⅰ b,Ⅱa,Ⅱ b,Ⅲa and Ⅲb.(3) Follow-up situations:142 of 157 patients were followed up for 6-56 months,with a median time of 27 months,and postoperative 3-year survival rate was 67.6％.Conclusion The vessel-guided LND is safe and effective in the laparoscopic distal gastrectomy (D2) of distal gastric cancer,and the operation steps can be simplified.

Decoction Amount Changes of Verbascoside and Gallic Acid in Single Decoction and Combined Decoction of Rehmanniae Radix Preparata,Corni Fructus and Poria / 中国药房

OBJECTIVE:To investigate the decoction amount changes of verbascoside,gallic acid in single decoction and com-bined decoction of rehmanniae radix preparata,corni fructus and poria,and provide scientific basis for further study of effective substance basis. METHODS:The single decoction,combined decoction with each 2 medicine and combined decoction with the 3 medicines of rehmanniae radix preparata,corni fructus and poria,were respectively prepared. HPLC was adopted to detect and com-pare the decoction amount of active component verbascoside in rehmanniae radix preparata and active component gallic acid in cor-ni fructus in each group. RESULTS:Compared with single decoction of rehmanniae radix preparata,the decoction amount of ver-bascoside was decreased in combined decoction of poria+rehmanniae radix preparata(P<0.01),decoction amount of verbascoside was increased in combined decoction of corni fructus+rehmanniae radix preparata or combined decoction with the 3 medicines(P<0.01). Compared with single decoction of corni fructus,the decoction amount of gallic acid in each combined decoction was de-creased (P<0.01). CONCLUSIONS:The combined decoction of rehmanniae radix preparata,corni fructus and poria has certain promotion and inhibition effects on the decoction of verbascoside in rehmanniae radix preparata and inhibition effect on the decoc-tion of gallic acid in corni fructus. It is speculated verbascoside may be one of the main components in combined decoction playing the role of effectiveness.

Study of DNA demethylation acting on DNA methyltransferase gene and microRNA in B-cell acute lymphocytic leukemia cell line / 白血病·淋巴瘤

Objective To explore the function of 5-Aza-CdR in B-cell acute lymphocytic leukemia cell line NALM-6 and its influence on the expression of microRNA (miRNA) in the cells. Methods NALM-6 was treated with different concentrations of 5-Aza-CdR. Cell proliferation was detected by methyl thiazolyl tetrazolium (MTT) test, and DNA methyltransferase (DNMT) mRNA expression level was detected by reverse transcription PCR (RT-PCR). The expression changes of miRNA were detected by miScript miRNA PCR Array chip in cells after methylation. Results NALM-6 cell growth was inhibited by different concentrations of 5-Aza-CdR processing time, reaching to the maximum inhibitory rate was (74.163 ±0.381) %. 5-Aza-CdR affected concentrations was inversely proportional with expression level of DNMT mRNA. After 1 000 μmol/L of 5-Aza-CdR was dealed with cell 72 h, the relative expression of DNMT-1 was reduced to 0.453 ±0.021, DNMT-3L was 0.003±0.001, DNMT-3B was 0.395±0.019. MiScript miRNA PCR array sieved out 3 miRNA (miR-184, miR-23a-3p, miR-34a-5p) associated with DNA methylation. Conclusions 5-Aza-CdR down regulates the expression of DNMT gene in NALM-6 cells, and inhibits the proliferation of cells. MiR-184, miR-23a-3p and miR-34a-5p are related to DNA methylation in the occurrence and development of B-cell acute lymphocytic leukemia.

Clinical application of laparoscopic-assisted radical gastrectomy for advanced gastric cancer / 肿瘤研究与临床

Objective To study the feasibility and safety of laparoscopy-assisted D2 radical gastrectomy for advanced gastric cancer. Methods From June, 2006 to July 2009, 11 patients with gastric cancer received laparoscopy-assisted gastrectomy for gastric cancer. According to UICC TNM classification of gastric cancer, 6 cases were with Stage Ⅱ, 2 cases with Stage Ⅲ A, 1 case with Stage Ⅲ B, and 2 cases with Stage Ⅳ. Under the assistance of laparoscope, dissociation of the stomach and lymph nodes clearance were performed first; then gastrectomy was performed on a 6 cm incision, samples were collected, and alimentary tract was inoculated. Results Among the 11 cases, 2 cases were performed radical total gastrectomy, 1 case was performed proximal partial gastrectomy, 7 cases were performed distal partial gastrectomy and 1 case with open surgery. The mean operation time: 350 min for total gastrectomy, 320 min for proximal partial gastrectom,266 min for distal partial gastrectomy. The mean number of harvested lymph nodes was 21.3 (11-38), incisal edge was 5.6 (4.0-9.6) cm. The mean time was 72 (36-110) hrs for gastrointestinal function recovery, 59 (26-86) hrs for patients to take general activity, and 76 (48-116) hrs to take liquid food. No complication was observed. Conclusion Laparoscopy-assisted D2 radical gastrectomy for advanced gastric cancer is safe and feasible. Compared with open surgery, it also has the advantages of small wound and fast recovery.

Significance of competency model construction for clinical teachers in medical colleges / 中华医学教育探索杂志

Reference for clinical medical education reform is provided through discussion on the research status quo of competency model,the basic information of clinical teachers in medical colleges in China,and the importance and significance of constructing competency model for clinical teachers.

Effect of human germinal sheathed cells injected into the brain on neurological and motor function impairment in rats after traumatic brain injury / 中国组织工程研究

BACKGROUND: One of the main causes of the failure of central nerve regeneration is that the microenvironment (lack of nerve growth factor, inhibitory factor produced by excretion and formation of glial scar) in the injured central nerves is not favorable for the regeneration of axons. Therefore, it is important to improve the microenvironment of injured area for the regeneration of axons. Recently, olfactory ensheathing cells (OECs) have been attracting much attention as a key method to treat central nervous injury.OBJECTIVE: To investigate the effect of OECs on traumatic brain injury (TBI) in rats and whether they can reduce neurological impairment after TBI.DESIGN: A randomized controlled experimental trial based on experimental animals.SETTING: Department of neurosurgery in a hospital affiliated to a university.MATERIALS: The experiment was conducted in the Central Laboratory of Department of Neurosurgery, Kaifeng Railway Hospital from April 2003 to August 2003. Altogether 100 healthy adult SD rats of either gender,weighting 250- 350 g, were randomly divided into four groups: normal group, TBI group, normal saline group and OEC group with 25 rats in each. Each group was further divided into five subgroups with 5 rats in each.INTERVENTIONS: The models of TBI in rats were established, and OECs were transplanted into brain tissues immediately after injury. The scores of nerve injury were assessed in the rats at day 1, day 4, week 1, week 2 and week 4. The distribution of OECs in brain tissues was observed after the rats were sacrificed.MAIN OUTCOME MEASURES: Neurological function recovery of rats and distribution of OECs in brain tissues.RESULTS: At week 2 and week 4 after operation, neurological severity scores (NSS) in OEC group significantly differed from those of TBI group and normal saline group. HE staining or immunohistochemistry of GFAP and p75 revealed that OECs could survive in the transplanted site and migrate toward the surrounding tissues. The total number of p75 positive cells in five coronal tissue slices of 6 μm thick was added up at different intervals. The results showed that the number of OECs was decreased with the passing time.CONCLUSION: OECs can survive in the transplanted site and migrate to the surrounding tissues when they are transplanted into the iujured brain tissues immediately after TBI. Giving OECs can reduce neurological and motor dysfunction induced by TBI.

Expression changes of tau protein and microtubule-associated proteins in testis intersitium of rats / 中华男科学杂志

<p><b>OBJECTIVE</b>To examine the expression of the tau protein and microtubule-associated proteins in the testis interstitium of aged and young rats.</p><p><b>METHODS</b>Sprague-Dawley male rats were divided into a young group(6 months, n = 10) and an aged group(28 months, n = 10). The two steps immunohistochemistry method with the antibody against tau protein and MAP alpha was performed on the testis tissues of the rats.</p><p><b>RESULTS</b>The results showed that the immunoreactive cells of tau protein of the testis interstilial of the aged rats obviously increased(P < 0.001) than those of the young, while the immunoreactive cells of the microtubule-associated proteins decreased(P < 0.01) in the aged.</p><p><b>CONCLUSION</b>The changes in the expression of the tau protein and microtubule-associated proteins may be related to the aging process of the testis.</p>

Related pathogen examinations and therapeutic choices for chronic prostatitis following sexually transmitted diseases / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the etiologic relationship between sexually transmitted diseases(STDs) and chronic prostatitis (CP), and to evaluate the effect of multiple treatment on CP following STDs.</p><p><b>METHODS</b>Seventy-two cases of CP after STDs were randomly divided into three groups: Group A (treated with levefloxatin), Group B (treated with Levofloxacin, terazosin and microwave), and Group C (treated with levofloxacin, Chinese traditional medicine and microwave), all treated for thirty days. The pathogens related to STDs in the prostatic fluid of all the patients had been examined before treatment. The efficacy was evaluated among the three groups by comparing the count of leukocytes and the scores of NIH-CPSI before and after treatment.</p><p><b>RESULTS</b>The pathogens related to STDs were found in the prostatic fluid of 7 patients. The count of leukocytes and the scores of NIH-CPSI decreased after treatment in the three groups, more markedly in Groups B and C than in Group A.</p><p><b>CONCLUSION</b>There is no strict etiological causality between STDs and CP. Multiple treatments are superior to single antibiotic treatment.</p>