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Objective:To study the strategies in the diagnosis and treatment of pancreatic tumors in children.Methods:The clinical data of 18 children with pancreatic tumor managed at the Children's Hospital Affiliated to Chongqing Medical University from March 2015 to September 2020 were retrospectively studied. There were 8 males and 10 females, age ranged from 3 months to 14 years and 11 months, with a median age of 8 years and 2 months. Clinical data including age, gender, pathological data, surgical methods, chemotherapy, tumor location and treatment outcomes were collected. Follow-up was conducted by outpatient visits and by telephone.Results:Abdominal ultrasound, enhanced CT and/or MRI examinations were performed on all these patients, with findings of either a cystic or solid lesion of pancreas. All patients were treated by laparotomy under endotracheal intubation and general anesthesia. The operations were all completed successfully. Among the 18 patients, there were 11 patients with solid pseudopapillary tumors and 7 patients with pancreatoblastoma (PBL). The tumors were located in the head of the pancreas in 13 patients (including 3 patients who underwent pancreaticoduodenectomy, 1 patient who underwent resection of the head of the pancreas with preservation of the duodenum, and 9 patients who underwent resection of the tumors). The tumors were located in the body and tail of the pancrease in 5 patients (including 3 patients who underwent resection of the body and tail of the pancreas with preservation of spleen, and 2 patients who underwent resection of tumors). Because of huge tumors, 1 patient had bilateral lung, left supraclavicular fossa lymph node and retroperitoneal lymph node metastasis, 3 patients were confirmed to have PBL by biopsy, and these tumors were resected completely after neoadjuvant chemotherapy. Postoperative pathology showed that all the 3 patients had PBL and were given systematic chemotherapy. Postoperative pancreatic fistula occurred in 1 patient and chylous fistula in another patient, both were discharged home successfully after conservative treatments. All patients were followed-up for 2-7 years, and all children were tumor-free.Conclusion:It is not difficult to diagnose pediatric pancreatic tumors by ultrasound, CT and MRI before operation, and postoperative pathology was needed to confirm the diagnosis. Function-preserving surgical resection was the treatment of choice for pancreatic tumors in children.
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Objective:To present the clinical characteristics and treatment on patients with ectopic adrenocorticotropic hormone(ACTH) syndrome (EAS) caused by the retroperitoneal paraganglioma.Methods:The clinical data of a case of EAS caused by retroperitoneal paraganglioma were analyzed retrospectively, and the related literature at home and abroad was reviewed.Results:The 53-year-old female patient was admitted to endocrinology department due to a fifteen-year history of hypertension, accompanied by fatigue for three months, headache and dizziness for one month. The laboratory data demonstrated severe hypokalemia, high level of serum and urinary cortisol, while the ACTH level remained unsuppressed. The 24 h urinary vanillyl mandelic acid (VMA) and serum free methoxyepinephrine (MNs) level were elevated. The abdominal computed tomographic scan suggested a retroperitoneal mass next to the abdominal aorta. After the retroperitoneal tumor resection was performed, immunohistochemical staining of the tumor revealed Syn (+ ), CgA (+ ), ACTH (focal + ). By the retrospective analysis of 22 similar cases from 16 papers and the case summarized above, we found that most patients with EAS caused by the paraganglioma could demonstrate the typical clinical features of Cushing′s syndrome, while lack of the manifestation of paraganglioma. Therefore, preoperative preparations for paraganglioma were usually neglected.Conclusions:Ectopic ACTH syndrome (EAS) originating from paraganglioma is very rare. To improve the diagnosis rate, examination for catecholamine, MNs and 24 h urinary VMA before surgery in patients with EAS is suggested. Considering surgical resection as the optimal treatment, comprehensive preoperative preparations for both paraganglioma and Cushing′s syndrome are significant. A genetic test for pheochromocytoma/ paraganglioma and lifelong postoperative follow-up are also recommend.
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Objective:To investigate the effects of Klotho on autophagy of human renal tubule cells under high glucose through AMP-activated protein kinase (AMPK) and extracellular signal regulated kinase (ERK) pathways.Methods:Human renal tubular epithelial cells cultured in vitro were divided into control group and high glucose group (HG group, added with 30 mmol/L glucose); According to the transfection of pcDNA3.1-vector or pcDNA3.1-Klotho, they were divided into two groups: Vector group and Klotho group; According to whether AMPK inhibitor compound C or ERK inhibitor curcumin was added after pcDNA3.1-Klotho transfection and high glucose stimulation, they were divided into four groups: HG+ Vector group, HG+ Klotho group, HG+ Klotho+ compound C group and HG+ Klotho+ curcumin group. The expression of Klotho was detected by real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) and Western blot; The relative expression of LC3-Ⅱ/LC3-Ⅰ and p-AMPK/AMPK and p-ERK/ERK were detected by Western blot; Changes of autophagosome in human renal tubular epithelial cells observed by transmission electron microscope. Results:The protein and mRNA expression of Klotho in human renal tubular epithelial cells of HG group was significantly lower than that in the control group (all P<0.05); The LC3-Ⅱ/LC3-Ⅰ in Klotho group was significantly higher than that in Vector group ( P<0.05); The number of autophagosomes in Klotho group was also significantly higher than that in Vector group ( P<0.05); p-AMPK/AMPK in Klotho group was significantly higher than that in Vector group ( P<0.05), while p-ERK/ERK in Klotho group was significantly lower than that in Vector group ( P<0.05). The protein relative expression of p-AMPK/AMPK in HG+ Klotho+ compound C group (0.44±0.04) was significantly lower than that in HG+ Klotho group (0.79±0.08) ( P<0.01); The protein relative expression of p-ERK/ERK in HG+ Klotho+ curcumin group (1.05±0.12) was significantly higher than that in HG+ Klotho group (0.56±0.05) ( P<0.01). The relative expression of LC3-Ⅱ/LC3-Ⅰ protein in HG+ Klotho+ compound C group and HG+ Klotho+ curcumin group (0.79±0.12; 0.68±0.09) were significantly lower than that in HG+ Klotho group (1.65±0.20) (all P<0.01). Conclusions:Klotho can enhance autophagy of human renal tubular epithelial cells under high glucose condition by activating AMPK and inhibiting ERK pathway.
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A pregnancy is considered high-risk when there are potential complications that may lead to dystocia or endanger the mother and unborn baby. Compared with women with a normal pregnancy, women with a high-risk pregnancy have a higher risk for poor pregnancy outcomes, which have a great impact on the maternal and infant prognosis or their families. Therefore, targeted clinical nursing care can be carried out in women who have a high-risk pregnancy to improve the prognosis of mothers and infants. Analyzing the risk factors that induce a high-risk pregnancy and actively reducing risk factors are particularly critical to achieving a good prognosis. Nursing care of women with a high-risk pregnancy should be performed based on evidence-based medicine after comprehensively analyzing the risk of each factor and weighing the pros and cons of related nursing care. Nursing care should have a clinical application value in high-risk pregnancies. This paper reviews the research advance in nursing care in high-risk pregnancies from the perspectives including risk factors, characteristics, the importance of nursing care, and the current nursing status.
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Objective@#To investigate the recovery of splenomegaly and hypersplenism after liver transplantation in children and explore the necessity of splenomegaly management before and during liver transplantation.@*Method@#The data of 22 children who were underwent liver transplantation with preoperative splenomegaly and hypersplenism who were not treated with splenomegaly before and during operation and with no recurrence of portal hypertension during postoperative follow-up in Department of Hepatobiliary Surgery, Children’s Hospital of Chongqing Medical University from December 2008 to January 2019 were collected. There were 13 male patients and 9 female patients with a median age of 6.5 months. The changes of erythrocyte, platelet, white blood cell and spleen length and thickness were analyzed by paired t-test before and at the 1st, 3rd and 6th months after surgery. Correlation analysis was performed on the change of spleen long diameter and thickness product and blood cell recovery.@*Results@#There were 21 cases of red blood cell decreased before surgery, with a mean value of(3.1±0.5)×1012/L, and(3.7±0.7)×1012/L, (4.6±0.6)×1012/L and (4.3±0.5)×1012/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the preoperative and postoperative groups were statistically significant (P<0.05). There were 7 cases of thrombocytopenia before operation, with an average of (70.0±17.0)×109/L, and (191.0±129.0)×109/L, (156.0±79.0)×109/L and (167.0±63.0)×109/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the first, third, and sixth months after surgery were significant compared with that before surgery (P<0.05). Leukocyte count decreased in 5 cases with an average value of (3.30±0.56)×109/L before surgery, (7.5±4.4)×109/L, (7.4±1.4)×109/L, (5.1± 2.5)×109/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the two groups were significant (P<0.05). The average value of preoperative spleen length times thickness was (35.7±12.9) cm2 and at the 1st, 3rd, 6th month after surgery it was (26.2±8.1)cm2, (25.2±13.4)cm2, (27.2±7.4)cm2, respectively. The differences between the first, third months after surgery were significant compared with that before surgery (P<0.05). The white blood cell and platelet counts of children before and after surgery were correlated with spleen size negatively (correlation coefficients were -0.902, -0.933, respectively), and the differences were statistically significant (P<0.05).@*Conclusions@#In the early stage of liver transplantation, the size of spleen retracts to varying degrees, and hypersplenism can be alleviated continuously. Therefore, it is unnecessary to treat splenomegaly and hypersplenism before and during liver transplantation.
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OBJECTIVE@#To detect the expression of miR-99a-5p in myelodysplastic syndrome (MDS), to predict the target genes and to analyze its function by using bioinformatics.@*METHODS@#The expression levels of bone marrow miR-99a-5p in MDS patients were detected by qRT-PCR, and the correlation of miR-99a-5p expression with clinical pathological characteristics, percentage of marrow blasts , chromosome karyotype and peripheral blood hemogram were analyzed. The target genes of miR-99a-5p were predicted by Targetscan, Miranda and Microcosm, and the intersection of the predicted results of 3 softwares was used as a potential target gene for miR-99a-5p.@*RESULTS@#The expression level of bone marrow miR-99a-5p in MDS patients was significantly higher than that of healthy controls (P<0.01); According to the prognostic score of IPSS, MDS patients were divided into relatively low risk group (including low risk group and intermediate risk group 1) and relatively high risk group (including intermediate risk group 2 and high risk group). Analysis showed that the expression level of bone marrow miR-99a-5p in relatively low risk group was 2.40 times higher than that in healthy control group (P<0.01), the expression level of bone marrow miR-99a-5p in relatively high risk group was 6.66 times higher than that in healthy control group (P<0.01), the expression level of miR-99a-5p in relatively high risk group was 2.80 times higher than that in the relatively low risk group ( P<0.01) ; the expression level of bone marrow miR-99a-5p in t-MDS group was 6.35 times higher than that in healthy control group (P<0.001). There was a significant positive correlation between the expression level of miR-99a-5p and the percentage of marrow blasts (P<0.01), but the expression of miR-99a-5p did not correlate with chromosome karyotype and peripheral blood hemogram; In this study it was obtained that ST5 might participate in pathological mechanism of MDS by bioinformatic analyses and references.@*CONCLUSION@#The expression levels of miR-99a-5p is up-regulated in MDS patients, and its expression showed a rising tendency which may be involved in the pathogenesis of MDS by regulating target gene ST5.
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Humans , Bone Marrow , Computational Biology , Karyotyping , MicroRNAs , Myelodysplastic SyndromesABSTRACT
Objective To investigate the recovery of splenomegaly and hypersplenism after liver transplantation in children and explore the necessity of splenomegaly management before and during liver transplantation.Method The data of 22 children who were underwent liver transplantation with preopera-tive splenomegaly and hypersplenism who were not treated with splenomegaly before and during operation and with no recurrence of portal hypertension during postoperative follow-up in Department of Hepatobiliary Surgery,Children's Hospital of Chongqing Medical University from December 2008 to January 2019 were collected.There were 13 male patients and9 female patients with a median age of 6.5 months.The changes of erythrocyte,platelet,white blood cell and spleen length and thickness were analyzed by paired t-test before and at the 1st,3rd and 6th months after surgery.Correlation analysis was performed on the change of spleen long diameter and thickness product and blood cell recovery.Results There were 21 cases of red blood cell decreased before surgery,with a mean value of(3.1±0.5)X 1012/L,and(3.7±0.7)×1012/L,(4.6±0.6)×1012/L and(4.3±0.5)×1012/L at the 1st,3rd and 6th months after operation,respective-ly.The differences between the preoperative and postoperative groups were statistically significant(P＜0.05).There were 7 cases of thrombocytopenia before operation,with an average of(70.0±17.0)×109/L,and(191.0±129.0)×109/L,(156.0±79.0)×109/L and(167.0±63.0)×109/L at the 1st,3rd and 6th months after operation,respectively.The differences between the first,third,and sixth months after sur-gery were significant compared with that before surgery(P＜0.05).Leukocyte count decreased in 5 cases with an average value of(3.30±0.56)×109/L before surgery,(7.5±4.4)×109/L,(7.4±1.4)× 109/L,(5.1±2.5)×109/L at the 1st.3rd and 6th months after operation,respectively.The differences between the two groups were significant(P＜0.05).The average value of preoperative spleen length times thickness was(35.7±12.9)em2 and at the 1st,3rd.6th month after surgery it was(26.2±8.1)cm2,(25.2±13.4)cm2,(27.2±7.4)cm2,respectively.The differences between the first,third months after surgery were significant compared with that before surgery(P＜0.05).The white blood cell and platelet counts of children before and after surgery were correlated with spleen size negatively(correlation coefficients were-0.902,-0.933,respectively),and the differences were statistically significant(P＜0.05).Conclusions In the early stage of liver transplantation,the size of spleen retracts to varying degrees,and hypersplenism can be alleviated continuously.Therefore,it is unnecessary to treat splenomegaly and hyper-splenism before and during liver transplantation.
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Identification accuracy of traditional Chinese medicine is crucial for the traditional Chinese medicine research, production and application. DNA barcoding based on the mitochondrial gene coding for cytochrome c oxidase subunit I (COI), are more and more used for identification of traditional Chinese medicine. Using universal barcoding primers to sequence, we discussed the feasibility of DNA barcoding method for identification commonly-used medicinal snakes (a total of 109 samples belonging to 19 species 15 genera 6 families). The phylogenetic trees using Neighbor-joining were constructed. The results indicated that the mean content of G + C(46.5%) was lower than that of A + T (53.5%). As calculated by Kimera-2-parameter model, the mean intraspecies genetic distance of Trimeresurus albolabris, Ptyas dhumnades and Lycodon rufozonatus was greater than 2%. Further phylogenetic relationship results suggested that identification of one sample of T. albolabris was erroneous. The identification of some samples of P. dhumnades was also not correct, namely originally P. korros was identified as P. dhumnades. Factors influence on intraspecific genetic distance difference of L. rufozonatus need to be studied further. Therefore, DNA barcoding for identification of medicinal snakes is feasible, and greatly complements the morphological classification method. It is necessary to further study in identification of traditional Chinese medicine.
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Animals , DNA Barcoding, Taxonomic , Medicine, Chinese Traditional , Molecular Sequence Data , Phylogeny , Reptilian Proteins , Genetics , Snakes , Classification , GeneticsABSTRACT
To identify some medicinal animals of Lacertilia, in total 59 individuals belonging to 12 species 7 genera 3 families, we used the universal barcoding primers to sequence these species, compared with other homologous sequences (564 bp) obtaining from the GenBank and finally constructed phylogenetic trees using Neighbor-joining, Maximum parsimony and Bayesian inference, respectively. As a result, the mean content of G + C (46.5%) was lower than that of A + T (53.5%). As calculated by Kimera-2-parameter model, the whole individuals mean distance for interspecies and intraspecies was 35. 5% and 1.7%, respectively. The mean distance for interspecies was 21 times as much as that for intraspecies. The mean distance for intraspecies of Gekko swinhonis, Hemidactylus frenatus and G. gecko was greater than 2%, respectively. Further analyses suggested that geographical groups of the three species might be of different subSpecies, even species. Of course, incorporating morphological characters and other unlinked genetic markers in future studies will offer further insights into the divergence. On the basis of phylogenetic trees constructed by COI, our results indicated that the taxonomy of the category (family, genus, and species) by DNA barcoding is consistent with morphological characters. Therefore, DNA barcoding is a useful tool for both identification and phylogeny of medicinal animals of Lacertilia, particularly for nonprofessor identifying authentication of Chinese crude drugs of these species.
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Animals , DNA Barcoding, Taxonomic , Electron Transport Complex IV , Genetics , Lizards , Classification , Genetics , Medicine, Chinese Traditional , Molecular Sequence Data , Phylogeny , Reptilian Proteins , Genetics , Sequence Analysis, DNAABSTRACT
This paper describes the heart of class supplies involved in bidding and purchasing code library classification principles and, in the hope of medical supplies through the establishment of bidding and purchasing code library to assist the health authorities and medical institutions for effective quality control. Clinical research oriented, CT, volume, operation cost, cost per capita, BEP.