Clinicopathological characteristics and prognosis of patients with small bowel tumors: A single center analysis of 220 cases / 中华胃肠外科杂志

Objective: To analyze the clinicopathological characteristics and prognosis of patients with small bowel tumors. Methods: This was a retrospective, observational study. We collected clinicopathological data of patients with primary jejunal or ileal tumors who had undergone small bowel resection in the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University between January 2012 and September 2017. The inclusion criteria included: (1) older than 18 years; (2) had undergone small bowel resection; (3) primary location at jejunum or ileum; (4) postoperative pathological examination confirmed malignancy or malignant potential; and (5) complete clinicopathological and follow-up data. Patients with a history of previous or other concomitant malignancies and those who had undergone exploratory laparotomy with biopsy but no resection were excluded. The clinicopathological characteristics and prognoses of included patients were analyzed. Results: The study cohort comprised 220 patients with small bowel tumors, 136 of which were classified as gastrointestinal stromal tumors (GISTs), 47 as adenocarcinomas, and 35 as lymphomas. The median follow-up for all patient was 81.0 months (75.9-86.1). GISTs frequently manifested as gastrointestinal bleeding (61.0%, 83/136) and abdominal pain (38.2%, 52/136). In the patients with GISTs, the rates of lymph node and distant metastasis were 0.7% (1/136) and 11.8% (16/136), respectively. The median follow-up time was 81.0 (75.9-86.1) months. The 3-year overall survival (OS) rate was 96.3%. Multivariate Cox regression-analysis results showed that distant metastasis was the only factor associated with OS of patients with GISTs (HR=23.639, 95% CI: 4.564-122.430, P<0.001). The main clinical manifestations of small bowel adenocarcinoma were abdominal pain (85.1%, 40/47), constipation/diarrhea (61.7%, 29/47), and weight loss (61.7%, 29/47). Rates of lymph node and distant metastasis in patients with small bowel adenocarcinoma were 53.2% (25/47) and 23.4% (11/47), respectively. The 3-year OS rate of patients with small bowel adenocarcinoma was 44.7%. Multivariate Cox regression-analysis results showed that distant metastasis (HR=4.018, 95%CI: 2.108-10.331, P<0.001) and adjuvant chemotherapy (HR=0.291, 95% CI: 0.140-0.609, P=0.001) were independently associated with OS of patients with small bowel adenocarcinoma. Small bowel lymphoma frequently manifested as abdominal pain (68.6%, 24/35) and constipation/diarrhea (31.4%, 11/35); 77.1% (27/35) of small bowel lymphomas were of B-cell origin. The 3-year OS rate of patients with small bowel lymphomas was 60.0%. T/NK cell lymphomas (HR= 6.598, 95% CI: 2.172-20.041, P<0.001) and adjuvant chemotherapy (HR=0.119, 95% CI: 0.015-0.925, P=0.042) were independently associated with OS of patients with small bowel lymphoma. Small bowel GISTs have a better prognosis than small intestinal adenocarcinomas (P<0.001) or lymphomas (P<0.001), and small bowel lymphomas have a better prognosis than small bowel adenocarcinomas (P=0.035). Conclusions: The clinical manifestations of small intestinal tumor are non-specific. Small bowel GISTs are relatively indolent and have a good prognosis, whereas adenocarcinomas and lymphomas (especially T/NK-cell lymphomas) are highly malignant and have a poor prognosis. Adjuvant chemotherapy would likely improve the prognosis of patients with small bowel adenocarcinomas or lymphomas.

Comparison of postoperative mid-term and long-term quality of life between Billroth-I gastroduodenostomy and Billroth-II gastrojejunostomy after radical distal gastrectomy in patients with gastric cancer: a cohort study based on a case registry database / 中华胃肠外科杂志

Objective: The pattern of digestive tract reconstruction in radical gastrectomy for gastric cancer is still inconclusive. This study aims to compare mid-term and long-term quality of life after radical gastrectomy for distal gastric cancer between Billroth-I (B-I) and Billroth-II (B-II) reconstruction. Methods: A retrospective cohort study was conducted.Clinicopathological and follow-up data of 859 gastric cancer patients were colected cellected from the surgical case registry database of Gastrointestinal Surgery Center of Sichuan University West China Hospital, who underwent radical distal gastric cancer resection between January 2016 and December 2020. Inclusion criteria: (1) gastric cancer confirmed by preoperative gastroscopy and biopsy; (2) elective radical distal major gastrectomy performed according to the Japanese Society for Gastric Cancer treatment guidelines for gastric cancer; (3) TNM staging referenced to the American Cancer Society 8th edition criteria and exclusion of patients with stage IV by postoperative pathology; (4) combined organ resection only involving the gallbladder or appendix; (5) gastrointestinal tract reconstruction modality of B-I or B-II; (6) complete clinicopathological data; (7) survivor during the last follow-up period from December 15, 2021 to January 15, 2022. Exclusion criteria: (1) poor compliance to follow-up; (2) incomplete information on questionnaire evaluation; (3) survivors with tumors; (4) concurrent malignancies in other systems; (5) concurrent psychiatric and neurological disorders that seriously affected the objectivity of the questionnaire or interfered with patient's cognition. Telephone follow-up was conducted by a single investigator from December 2021 to January 2022, and the standardized questionnaire EORTC QLQ-C30 scale (symptom domains, functional domains and general health status) and EORTC QLQ-STO22 scale (5 symptoms of dysphagia, pain, reflux, restricted eating, anxiety; 4 single items of dry mouth, taste, body image, hair loss) were applied to evaluate postoperative quality of life. In 859 patients, 271 were females and 588 were males; the median age was 57.0 (49.5, 66.0) years. The included cases were divided into the postoperative follow-up first year group (202 cases), the second year group (236 cases), the third year group (148 cases), the fourth year group (129 cases) and the fifth year group (144 cases) according to the number of years of postoperative follow-up. Each group was then divided into B-I reconstruction group and B-II reconstruction group according to procedure of digestive tract reconstruction. Except for T-stage in the fourth year group, and age, tumor T-stage and tumor TNM-stage in the fifth year group, whose differences were statistically significant between the B-I and B-II reconstruction groups (all P<0.05), the differences between the B-I and B-II reconstruction groups in terms of demographics, body mass index (BMI), tumor TNM-stage and tumor pathological grading in postoperative follow-up each year group were not statistically significant (all P>0.05), suggesting that the baseline information between B-I reconstruction group and the B-II reconstruction group in postoperative each year group was comparable. Evaluation indicators of quality of life (EORTC QLQ-C30 and EORTC QLQ-STO22 scales) and nutrition-related laboratory tests (serum hemoglobin, albumin, total protein, triglycerides) between the B-I reconstruction group and B-II reconstruction group in each year group were compared. Non-normally distributed continuous variables were presented as median (Q(1),Q(3)), and compared by using the Wilcoxon rank sum test (paired=False). The χ(2) test or Fisher's exact test was used for comparison of categorical variables between groups. Results: There were no statistically significant differences in all indexes EORTC QLQ-30 scale between the B-I reconstruction group and the B-II reconstruction group among all postoperative follow-up year groups (all P>0.05). The EORTC QLQ-STO22 scale showed that significant differences in pain and eating scores between the B-I reconstruction group and the B-II reconstruction group were found in the second year group, and significant differences in eating, body and hair loss scores between the B-I reconstruction group and the B-II reconstruction group were found in the third year group (all P<0.05), while no significant differences of other item scores between the B-I reconstruction group and the B-II reconstruction group were found in postoperative follow-up of all year groups (P>0.05). Triglyceride level was higher in the B-II reconstruction group than that in the B-I reconstruction group (W=2 060.5, P=0.038), and the proportion of patients with hyperlipidemia (triglycerides >1.85 mmol/L) was also higher in the B-II reconstruction group (19/168, 11.3%) than that in the B-I reconstruction group (0/34) (χ(2)=0.047, P=0.030) in the first year group with significant difference. Albumin level was lower in the B-II reconstruction group than that in the B-I reconstruction group (W=482.5, P=0.036), and the proportion of patients with hypoproteinemia (albumin <40 g/L) was also higher in the B-II reconstruction group (19/125, 15.2%) than that in the B-I reconstruction group (0/19) in the fifth year group, but the difference was not statistically significant (χ(2)=0.341, P=0.164). Other nutrition-related clinical laboratory tests were not statistically different between the B-I reconstruction and the B-II reconstruction in each year group (all P>0.05). Conclusions: The effects of both B-I and B-II reconstruction methods on postoperative mid-term and long-term quality of life are comparable. The choice of reconstruction method after radical resection of distal gastric cancer can be based on a combination of patients' condition, sugenos' eoperience and operational convenience.

Clinical significance of No.11p posterior lymph nodes dissection in gastric cancer surgery / 中华胃肠外科杂志

Objective: To analyze the association of No.11p posterior lymph node metastasis with clinicopathological features and its prognostic significance in gastric cancer. Methods: A single-center retrospective cohort study was conducted. Clinicopathological data of patients with primary gastric cancers undergoing No.11p posterior lymph node dissection from January 2016 to December 2020 were retrieved from the Database of Gastric Cancer, West China Hospital, Sichuan University. Case inclusion criteria: (1) gastric cancer proved by pathology; (2) radical resection with intraoperative No.11p posterior lymph node dissection; (3) operations performed by the same surgical team; (4) no previous history of other malignant tumors and no concurrent malignant tumors. Those with stump gastric cancer, history of gastrectomy, neoadjuvant chemotherapy, incomplete clinicopathological data and lost to follow-up were excluded. During the operation, the upper edge of the pancreas was retracted forward to expose the area between the upper edge of the pancreas and the splenic vessels. The proximal segment of the splenic artery was skeletonized to remove lymphatic tissue anterior and superior to the splenic artery for No.11p lymph node dissection. For patients with lymphadenopathy in the area between the splenic artery and the splenic vein, dissection was performed. The enlarged lymph nodes were labeled with titanium clips and named as No.11p posterior lymph node. Pathological examination was performed separately after the specimen was isolated. Statistical analysis was performed using R software. Results: A total of 127 gastric cancer patients, who underwent No.11p posterior lymph nodes dissection were included in this study, of which 120 patients without No.11p posterior lymph nodes metastasis (No.11p posterior lymph nodes negative) and 7 patients with No.11p posterior lymph nodes metastasis (No.11p posterior lymph nodes positive). A total of 8 metastatic No.11p posterior lymph nodes were detected in 7 patients, metastasis rate and with a ratio of 5.5% (7/127) and 6.8% (8/127), respectively. In the subgroup analysis of T3-4 stage patients, the metastasis rate and ratio of No.11p posterior lymph nodes were 9.0% (7/78) and 10.7% (8/75), respectively. Compared to negative cases, patients with No.11p posterior lymph nodes metastasis had larger tumor (P=0.002), higher proportion of Borrmann type Ⅲ and Ⅳ tumors (P=0.005), more metastatic lymph nodes (P<0.001), more advanced T stage (P=0.043), N stage (P=0.004) and TNM stage (P=0.015). In survival analysis, patients with No.11p posterior lymph node metastasis had a significantly worse prognosis than those without metastasis after adjusting for TNM stage (hazard ratio=3.009, 95% confidence interval: 1.824-4.964, P<0.001). Conclusions: The No.11p posterior lymph node metastasis in gastric cancer is associated with worse prognosis. For patients of T3-4 stage gastric cancer, No.11p posterior lymph node dissection should be emphasized during radical operation.

Co-expression of plasmid-based protein kinase Bl-specific small interfering RNA and P53 synergistically inhibits proliferation, migration and invasion of hepatocellular carcinoma cells / 解剖学报

Objective To investigate the effect of the dual expression plasmid of protein kinase B1 (Akt 1)-specific siRNA and P53 on the proliferation, migration, invasion and apoptosis of hepatocellular carcinoma (HCC) cells. Methods We constructed a dual expression plasmid that co-expressed Akt 1-specific siRNA and wild-type p53 gene (pSi-Aktl-P53). The dual expression plasmid pSi-Aktl-P53 was transfected into HepG2 cells of HCC,The expression of Aktl and P53 was detected by Real-time PCR and Western blotting. Then, the dual expression plasmid was transfected into HepG2 cells, sh- Aktl plasmid and P53 plasmid were used as control. The effects of the dual plasmid on the proliferation, migration, invasion and apoptosis of HepG2 cells were detected by CCK-8 and 5-ethynyl-2'-deoxyuridine (EdU) experiments, Wound scratch experiment, Transwell chamber experiment and flow cytometry, respectively. Results After the dual plasmid was transfected into HepG2 cells, the expression of Aktl protein was significantly reduced and the expression of P53 protein was significantly increased in HepG2 cells. Compared with the shAktl and P53 plasmids, the dual expression plasmid pSi-Aktl-P53 significantly inhibited the proliferation N migration and invasion of HepG2 cells and significantly increased the apoptosis of HepG2 cells. Conclusion The dual expression plasmid pSi-Aktl-P53 can synergistically inhibit the proliferation, migration and invasion of HepG2 cells, significantly increased the apoptosis of HepG2 cells.

Inhibitory effects of PI3K/AKT inhibitor LY294002 on retinal neovascularization in mice / 眼科新进展

Objective To explore the effects of phosphatidylinositol-3-kinase (PI3K)/serine-threonine kinase (AKT) signal pathway inhibitor LY294002 on retinal neovascularization (RNV) in oxygen-induced retinopathy (OIR) mice.Methods Totally 60 C57BL/6J mice were collected and randomly divided into the experimental group and control group,with 30 mice in each group.Then OIR model was induced by Smith methods.Rats in the experimental group were intravitreally injected with 0.5 μL LY294002,while the control group was given the same amount of phosphate buffer saline (PBS) one day before out of the incubator.Retinal sections with HE staining were applied to count the number of neovascular cell nuclei breaking through the inner limiting membrane,as well as the protein and mRNA expression of pAKT and vascular endothelial growth factor (VEGF) were detected by immunohistochemistry and RT-PCR.Results The number of retinal neovascular cell nucleus in the experimental group was obviously smaller than that in the control group (P ＜ 0.05).The protein expression of pAKT and VEGF was weakly expressed,and the absorbance (A) value of the positive cells was decreased in the experimental group compared with the control group (all P ＜ 0.05).The mRNA expression of AKT and VEGF was obviously decreased in the experimental group compared with the control group (all P ＜ 0.05).Conclusion The development of RNV in OIR mice can be markedly inhibited by LY294002 inhibiting PI3K/AKT pathway,and therefore LY294002 is expected to be an effective method for preventing vascular proliferative retinopathy.

Research progress of aquaporin 1 and 4 in diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

Diabetic retinopathy(DR), one of the most common retinal vascular disease, is one of the causes of blindness for people over the age of 50.In the early stage of DR, microvascular cells are damaged, expand, start to leak, form micro hemangioma, then show occlusion, and non-perfusion area come into being, eventually form new blood vessels because of ischemia and hypoxia of retina.Illness develop into proliferative diabetic retinopathy(PDR).With the aggravation of the disease, PDR can cause the formation of fibrovascular membrane, the more serious fibrillation of epiretinal membrane, resulting in traction retinal detachment(tRD).Present studies suggest that aquaporins, the essential component of new blood vessels, including aquaporin 1 and aquaporin 4, play a significant pole in the development of diabetic retinopathy, causing the destruction of blood retinal barrier, inducing retinal edema, even macular edema, and participating in the formation of retinal angiogenesis.

Clinical analysis on surgery of super high myopia combined with rhegmatogenous retinal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To retrospectively analyze selection of operation, surgery effect, complications and treatment methods of super high myopia combined with rhegmatogenous retinal detachment( RRD) . METHODS:A total of 47 cases(47 eyes) with the super high myopia patients combined with RRD who accepted scleral buckling of external pressure, vitrectomy combined silicone oil filling, or intravitreous gas injection were chosen in our hospital from Jan. 1, 2011 to Jan. 1, 2016. Best corrected visual acuity ( BCVA), intraocular pressure, retinal reattached rate, closure rate of holes and the postoperative complications of patients in half year were analyzed. RESULTS:Half a year postoperation, BCVA of twenty-four cases underwent vitrectomy combined silicone oil filling were improving(71%), and eight cases with scleral buckling surgery were enhanced ( 73%) . Statistical test showed the surgical treatment could significantly improve patients'eyesight, especially PPV with silicone oil, but the BCVA of patients with scleral buckling of external pressure in this study had no obvious significance according to the rank sum test. Compare with other surgery, pars plana vitrectomy( PPV ) combined silicone oil filling had more complications, such as high intraocular pressure and diplopia. CONCLUSION: The therapy of super high myopia patients with rhegmatogenous retinal detachment need many years' clinical experience, surgical skill of clinician and according to the number, the shape and the site of the retinal holes and area of detached retina, they need to choose the right means of surgery, and timely deal with postoperative complications, in order to improve the patients' postoperative retina, reset rate and visual function.

Observation of Ex - press miniature implantation with deep sclerectomy surgery for refractory glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM: To evaluate the effect for refractory glaucoma by using Ex - Press miniature implantation with deep sclerectomy.?METHODS: Thirty eyes in 24 patients with refractory glaucoma were treated by Ex- Press miniature ( P50 ) implantation with deep sclerectomy. The patients’ symptom, intraocular pressure ( IOP ) , visual acuity and complications were analyzed in a 12mo follow-up period.?RESULTS: During the follow-up period, all patients’ ocular pain was reduced. The mean IOP before operation and at the last follow-up time were 51. 15 ± 2. 60mmHg (1kPa=7. 5mmHg) and 15. 11 ± 2. 51mmHg, respectively, there was significant difference (P<0. 05). Postoperative visual acuity was improved in 8 eyes, had no significant change in 22 eyes. After operation, hyphema of anterior chamber appeared in 2 eye ( 7%) , which were obsorbed after 1wk.? CONCLUSION: Ex - Press miniature implantation combined with deep sclerectomy surgery is a relatively effective and safe treatment for the patients with refractory glaucoma. This method can significantly degrade the IOP, lessen ocular pain and reduce the complications risk.

Clinical characteristics and therapeutic effect of open globe injury / 国际眼科杂志(Guoji Yanke Zazhi)

? AIM: To analyze clinical characteristics and postoperative outcomes after open globe injury.?METHODS: Demographic characteristics ( age, gender, eye trauma, profession, cause of injury and injured part ) , as well as complications and prognosis were analyzed in 152 cases (152 eyes) of open globe injury.? RESULTS: Patients with open globe injury had an average age of 40. 45±38. 32 years old with a 5. 9:1 male-to-female gender ratio. The left-to-right eye ratio was 1. 27:1. Most patients were workers, farmers, or retired. The most common etiologies were scratches, boxing, and falls. Zone Ⅲ was the most commonly injured part. Iridoptosis or iris incarceration, retinal detachment, vitreal prolapse, hyphema or hypopyon, and vitreous hemorrhage were the most common complications. Visual acuity improved in 86 cases postoperatively but ophthalmectomy was still required in 25 eyes.?CONCLUSION: Vision can be improved after surgery in open globe injury. However, patients are usually seriously injured and improvement is minimal, thereby resulting in a great loss to patients and society.

Current research progress of choroidal metastasis / 国际眼科杂志(Guoji Yanke Zazhi)

Choroidal metastasis is one of the most common malignant tumors inside the eyes. It causes pain, hypopsia and some other related symptoms. It reduces the quality of the patients' life. It's significant for the patients to be detected and treated early, therefore they will have better vision and longer life. The treatments of choroidal metastasis are developing quickly. Both the vitreous cavity injection of targeted drug and gene therapy are hot topics of research. This paper summarizes the etiology, development, diagnosis and treatment of choroidal metastasis nowadays.

Research the correIation of vascuIar endotheIiaI growth factor and fibrosis -reIated cytokines in proIiferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

· Vascular endothelial growth factor is indispensable inducing factor in retinalangiogenesis. After the retinal neovascularization of proliferative diabetic retinopathy ( PDR ) patients, it can cause fibrovascular membrane formation, epiretinal membrane fibrosis increased, resulting in traction retinal detachment with further aggravate the condition. The recent research suggests that cytokines promote fibroblast proliferation, movement, adhesion, and secretion of extracellular matrix functions in the diabetic state of the environment changes to profibrogenic state, resulting in the accumulation and fibrosis of extracellular matrix. This paper reviewed the status quo of the correlation between vascular endothelial growth factor and fibrosis-related cytokine.

Effects of high blood glucose fluctuation on DNA damage of diabetic rat retinal tissues / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To observe the situation of rat retinal tissue DNA damage at early diabetic period, discuss the role of the blood glucose fluctuations, and provide a new method for studying the pathogenesis of diabetic retinopathy ( DR) . METHODS: SD rats were randomly divided into four groups:normal control group (NC), normal fluctuation group ( NF ) , diabetes group ( DM ) and diabetes fluctuation group ( DF ) . Diabetic models were established through intraperitoneal injection of STZ. A certain amount of glucose was injected in the rats of group NF and DF in an intraperitoneal mode three times a day after the model was established, thereby causing blood glucose fluctuations. Rats were killed and the retinal tissues were taken in the 8th week. Single cell gel electrophoresis ( SCGE ) technique was adopted for detecting DNA injury extent in the retina tissue. RESULTS:Groups NF and DF showed significant and regular fluctuations. The curve of blood glucose fluctuations was relatively stable. All values of MBG, SDBG, LAGE and M were significantly increased compared with group NC. Group DF was increased more significantly. It was statistically significant (P CONCLUSION: Rat retinal tissues have DNA injury during early diabetic period. DNA injury is gradually aggravated with blood glucose fluctuation. It indicates that high blood glucose and blood glucose fluctuation are involved in the mechanism of cell DNA injury, and they may be one of DR early event, have played a certain role in the incidence of DR.

Expression and significance of CCN1 in oxygen-induced retinal neovascularization of mice / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To explore the expression and significance of cysteine- rich 61 ( CCN1/Cyr61 ) in oxygen - induced retinal neovascularization ( RNV) of mice and study the inhibition effect of CCN1 specific siRNA on RNV. METHODS:Two hundred healthy C57BL/6J mice were chosen and randomly divided into control group, hyperxia group, hyperxia control group and CCN1 treated group, with 50 mice in each group. The hyperxia control group was treated with vector plasmids by intravitreal injection. The CCN1 treated group received CCN1 siRNA recombinant plasmids by intravitreal injection. Adenosine diphosphate-ase ( ADPase) stained retina flat-mounts was performed to assess the retinal vascular profiles, HE staining was applied to count the number of vascular endothelial cell nuclei breaking through the internal limiting membrane, protein and mRNA level expression of CCN1 were measured by immunohistochemistry, Western blot and RT-PCR. RESULTS: There were large nonperfusion area and a large number of vascular endothelial cell nuclei breaking through the internal limiting membrane ( 25. 25 ± 1. 26;23. 12 ± 1. 16 ) in the hyperxia group and the hyperxia control group. Regions of nonperfusion and vascular endothelial cell nuclei (8. 47±1. 15) were decreased in the CCN1 treated group compared to the hyperxia group and the hyperxia control group. Compared with the control group, there were high protein and mRNA expression of CCN1 in the hyperxia group and the hyperxia control group. The expression of CCN1 protein and mRNA were decreased in the CCN1 treated group compared with the hyperxia group and hyperxia control group (all P CONCLUSlON: The abnormal expression of CCN1 has close relation with RNV. The development of RNV can be markedly inhibited by RNA interference targeting CCN1, which, we believe, will provide new molecular targets and a rationale for clinical developing new strategy for ROP therapy.

The effect of Delta-like ligand 4 monoclonal antibody on retinal neovascularization and vascular endothelial growth factor expression / 中华实验眼科杂志

Background Studieshowed thaDelta-like ligand 4 (Dll4) participatein the deveopmenof retinal celland angiogenesis.The Dll4-Notch pathway and vasculaendothelial growth facto(VEGF) are thoughto be critical mediatorof neovascularization undehypoxiconditions.The relationship between Dll4 and VEGF inovery cleaand furtheresearch ineeded.Objective Thistudy wato observe the inhibition of Dll4 on experimental retinal neovascularization and VEGF expression.MethodThe retinal neovascularization animal model wainduced by oxygen-induced retinopathy (OIR) in 5-day-old SPF SD ratby rearing the new postnatal ratwith the motherattogethein closed box with oxygen level a(80±2) ％ till 12-day-old.The ratwere then raised in normal aifo5 days.Aftethat,2.5μl (0.5 μg) of Dll4 monoclonal antibody wainjected into the mid-vitreoucavity in the righeye(Dll4 injected group) and PBwaused in the same way in the fellow eye(PBcontrol group) in the 12-day-old rats.Retinawere isolated in the 17-day-old rats,and retinal vasculamorphology waexamined by adenosine diphosphatease (ADPase) staining of retinal flatmounts,and the endotheliocyte nuclei above the internal limiting membrane were counted in the retinal tissue-slices.Reverse transcription PC(RT-PCR) waused to detecthe mRNexpression level of Dll4,VEGF,VEGF receptor-1 (VEGFR-1),VEGFR-2 and neuropilin-1 mRNin the retinas.Statistical analysiwaperformed by the paired t-test.The care and use of the animalcomplied with the Guidance Suggestion issued by the Ministry of Science and Technology of Chinin 2006.ResultThe Dll4 mRNexpression in the retin(Dll4 mRNA/β-actin mRNA) wa0.22± 0.06 and 0.98 ± 0.13 in the Dll4 injected group and the PBcontrol group,respectively,with statistically significandifference (=21.839,P =0.000).No significandifferencewere found in the expression of the VEGF mRNA,VEGFR-1 mRNand VEGFR-2 mRNin the retinabetween the two group(t=0.463,P=0.649;=1.687,P=0.109;=-1.674,P=0.111).Compared with the PBcontrol group,the expression of neuropilin-1 mRNwasignificantly elevated in the Dll4-injected group (0.73±0.08 vs.0.64±0.07) (t=-2.677,P=0.015).ADPase staining showed thathere were much more new blood vesselin the Dll4 injected group than those of the PBcontrol group.The numbeof nuclei structurally adjacento the vitreal side of the internal limiting membrane wa(63.6± 11.6)/slide in the Dll4 injected group,which wamore than thaof the PBcontrol group a(35.1±5.2)/slide (=-7.879,P =0.000).ConclusionDll4 playan essential role in the procesof pathological angiogenesiin the retina.Dll4 ithoughto be feedback regulatoof VEGFR,which participatein the procesof restraining pathological vasculogenesis.

Clinical observation of endogenous endophthalmitis caused by liver abscess / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the clinical feature and treatment of endogenous endophthalmitis caused by liver abscess. METHODS: A total of 9 eyes (7 cases) with endogenous endophthalmitis caused by liver abscess in our hospital from 2005 to 2010 were analyzed retrospectively. Microorganism was cultivated with blood or vitreous in all patients.4 eyes were performed vitrectomy. 2 eyes were injected antibiotics in vitreous cavity. 3 eyes were only treated with antibiotics.RESULTS: Two cases (2 eyes) were diagnosed with endophthalmitis firstly, then found liver abscess; 4 eyes were with diabetes mellitus, and 1 eye with abnormal glucose tolerance. Cultivation of microorganism was positive in 6 eyes (67%), including Pneumonia cray-research, Candida albicans and Escherichia coli. 5 eyes had useful vision after treatment, 1 eye had light perception,3 eyes became blindness. CONCLUSION: As an ocular emergency, endogenous endophthalmitis caused by liver abscess can severely damage visual function. Timely consultation, early diagnosis, proper systemic and topical anti-infective and anti-inflammatory treatment are the most effective methods for controlling infection. Vitrectomy with intravitreal antibiotics plays an important role in preserving useful vision function in patients.

Study on pharmacokinetic of vancomycin in normal and endophthalmitis eyes in rabbit / 中华实验眼科杂志

Background Vancomycin has been increasingly recommended for the management of endophthalmitis,but few research report has been published about the pharmacokinetics of intravitreal vancomycin up to now.It is necessary to have an exact method to measure the concentration of vancomyein in animal eyes after intravitreal injection.Objective This study was to observe and compare the phamacokinetical process of vancomycin in serum,vitreous and aqueous humor between normal and infected rabbit eyes.Methods Seventy-two healthy adult rabbits were randomly divided into normal group and infected group and 36 rabbits for each.The animal models of endophthalmitis were established by intravitreal inoculation of 2000 CFU/ml staphylococcus aureus in the right eyes of rabbits in the infected group.Once endophthalmitis developed,0.1 ml vancomycin ( 10 g/L) solution was injected into the vitreous of every rabbit.The peripheral blood,vitreous and aqueous humor samples were respectively collected in 4 rabbits for each group at 0.5,2,4,6,12,24,48,72 and 84 hours after injection for detection of vancomycin concentration by high performance liquid chromatography(HPLC-UV).3p97 software was used to create fit parameters of pharmacokinetics.This experiment followed the Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission (Version 1988).Results The accuracy of HPLC fitted the detecting request of biological specimen.The concentration-time data of vancomycin in normal rabbit aqueous humor and vitreous was subject to two-compartment model.The pharmacokinetic parameters were separately as following:Cmax was 50.16 mg/L and 751.42 mg/L,t1/2was 51.04 hours and 53.21 hours.The concentration-time data of vancomycin in infected rabbit aqueous humor and vitreous was subject to one-compartment model.The pharmacokinetic parameters were separately as following:Cmaxwas 24.94 mg/L and 687.66 mg/L,t1/2was 11.42 hours and 12.91 hours.The concentration of vancomycin in serum was much lower and almost undectable.The concentration of vancomycin in vitreous was gradually reduced as the prolong of time after injection in both normal group and infected group,but a obvious decline after increased level was scen in aqueous humor.Compared with normal group,the concentrations of vancomycin in both vitreous and aqueous humor were reduced at various time points(P＜0.05,P＜0.01 ).Conclusions HPLC is simple,highly sensitive and specific for the pharmacokinetic analysis of vancomycon.These results indicate that pharmacokinetic parameters of vancomycin alter in pathological condition,which is helpful for us to establish the better treatment guidelines for endophthalmitis.

CTGFsiRNA ameliorates retinal cells apoptosis in the streptozotocin-induced diabetic rat / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To detect the effect of CTGF on the apoptosis in the diabetic retina with small interfering RNAs (siRNA) targeting with CTGF. ·METHODS: A total of 60 rats were divided into six groups including control group, diabetic 4,8,12,16 weeks group, and interference group. Diabetic rats were induced by STZ intra-peritoneal. At 4, 8, 12, 16 weeks after diabetic setting up, retinas were obtained from control, diabetic rats and diabetic animals treated by intravitreal injection of CTGFsiRNA to suppress the expression of CTGF mRNA. Retinal cells apoptosis was detected by Tunnel staining and mRNA expression of CTGF was analyzed by RT-PCR.·RESULTS: The levels of CTGF and the apoptosis in the retinas of diabetic rats were significantly higher than those in the controls. Apoptosis occurred at 4 weeks after a diabetic model setting up, became serious with the diabetes developing, while CTGF elevated at 8 weeks. The cell apoptosis counts increased to 25.8cells/mm2 at 24 weeks of diabetes. SiRNA-mediated inhibition of CTGF mRNA resulted in a significant decrease in apoptosis. Significant correlations were found between CTGF and apoptosis in the retina.·CONCLUSION: These results suggest that CTGF might be involved in retinal cells apoptosis which is a characteristic of early diabetic retina. siRNA targeting CTGF seems to have the advantage of ameliorating retinal cells lost.

Efficacy and tolerability of one-site versus two-site phacotrabeculectomy: a meta-analysis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the efficacy and tolerability of one-site versus two-site phacotrabeculectomy in the treatment of patients with coexisting cataract and glaucoma. METHODS: A comprehensive literature meta-analysis was performed according to the Cochrane Collaboration methodology to identify controlled clinical trials comparing one-site with two-site phacotrabeculectomy. The studies meeting the predefined criteria were reviewed systematically by meta-analysis. Efficacy estimates were measured by standardised mean difference (SMD) for the percentage intraocular pressure (IOP) reduction from baseline to end point, odds ratio (OR) for the percentage having a best-corrected visual acuity (BCVA) of 0.5 or better after surgery and relative risk (RR) for complete success rates. Tolerability estimates were measured by RR for adverse events. All of outcomes were reported with 95% confidence interval (CI). Data were synthesised by Stata 10.1 for Windows. RESULTS: Two-site phacotrabeculectomy was associated with numerically greater, and significant efficacy than one-site in lowering IOP(SMD,-0.19;95% CI, -0.33 to -0.04; P=0.01). Numerically greater, but nonsignificant proportions of two-site patients than one-site patients had a BCVA of 0.5 or better (OR, 0.65; 95% CI, 0.30 to 1.39; P=0.26).Numerically greater, but nonsignificant proportions of two-site patients than one-site patients achieved the target IOP without anti-glaucoma medication at the end point (RR, 0.94; 95% CI, 0.84 to 1.04; P=0.22). Furthermore, there was no significant difference in adverse events between two surgical procedures.CONCLUSION: The efficacy of two-site phacotrabeculectomy appears to be superior to one-site phacotrabeculectomy. One-site and two-site phacotrabeculectomy are similarly tolerable in postoperative adverse events.

A new chromone derivative from Berchemia lineata / 药学学报

To study the chemical constituents from the root of Berchemia lineata (L.) DC., nine compounds were isolated from the EtOAc extract by using silica gel, RP-C18 silica gel column chromatography and preparative HPLC. Based on the spectroscopic analysis, their structures were identified as 5-hydroxy-7-(2'-hydroxypropyl)-2-methyl-chromone (1), (-)-(1'R, 2'S)-erythro-5-hydroxy-7-(1', 2'-dihydroxypropyl)-2-methyl-chromone (2), naringenin (3), eriodictyol (4), (+)-aromadendrin (5), (+)-taxifolin (6), (+)-catechin (7), (+)-epigallocatechin (8) and quercetin (9). Among them, compound 2 is a new chromone derivative. Compound 1 is a known chromone derivative and isolated from this genus for the first time. Compounds 3-9 are known flavonoids and isolated from this plant for the first time.

Efficacy and tolerability of one-site versus two-site phaco-trabeculectomy: a meta-analysis of randomized controlled clinical trials / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Phacotrabeculectomy can be performed using one-site or two-site incisions. This meta-analysis evaluated the efficacy and tolerability of one-site versus two-site phacotrabeculectomy in the treatment of patients with coexisting cataract and glaucoma.</p><p><b>METHODS</b>A comprehensive literature search was performed according to the Cochrane Collaboration methodology to identify randomized controlled clinical trials comparing one-site with two-site phacotrabeculectomy. Studies meeting our predefined criteria were included in the meta-analysis. Efficacy estimates were measured by weighted mean difference (WMD) for the percentage intraocular pressure (IOP) reduction from baseline to end point, relative risk (RR) for the proportion of patients with a best-corrected visual acuity (BCVA) of 0.5 or better after surgery and complete success rates. Tolerability estimates were measured by RR for adverse events. All of outcomes were reported with 95% confidence interval (95%CI). Data were synthesised by Stata 10.1 for Windows.</p><p><b>RESULTS</b>Two-site phacotrabeculectomy was associated with greater reductions in IOP than the one-site procedure (WMD: -5.99, 95%CI: -10.74 - -1.24, P = 0.01). A greater proportion of patients also achieved a BCVA of 0.5 or better (RR: 0.91, 95%CI: 0.74 - 1.12, P = 0.36) and the target IOP without anti-glaucoma medication at the study end point (RR: 0.94, 95%CI: 0.83 - 1.07, P = 0.34) after two-site than one-site phacotrabeculectomy, but the differences were not significant. There were no significant differences in adverse events between two surgical procedures.</p><p><b>CONCLUSIONS</b>Two-site phacotrabeculectomy is superior to one-site phacotrabeculectomy in reducing IOP, but other post-operative effects are similar. One-site and two-site phacotrabeculectomies have similar adverse event rates.</p>