Lower urinary tract symptoms in Parkinson's disease and multiple system atrophy / 中华老年医学杂志

Parkinson's disease(PD)and multiple system atrophy(MSA)are two common Parkinsonian syndromes with overlapping clinical manifestations, and clinical differential diagnosis is difficult.Lower urinary tract symptoms are one of the common non-motor symptoms of the two diseases.The incidence of lower urinary tract symptoms in MSA is higher, the onset is earlier, and the micturition period is more prominent.The urinary dysfunction in patients with PD is mainly caused by the central mechanism, leading to overactive bladder.MSA has more extensive lesions with both central and peripheral involvement, leading to overactive bladder and severe voiding dysfunction.Urodynamics can be used to evaluate bladder and urethral function.MSA has more prominent weak detrusor activity, residual urine volume, and early changes of urethral sphincter.The treatment of lower urinary tract symptoms in patients with PD is mainly based on anticholinergic drugs to improve overactive bladder, while in MSA patients with increased residual urine volume, intermittent catheterization is the main method to improve lower urinary tract symptoms.This article reviewed the epidemiology, pathological mechanism, urodynamics and treatment of lower urinary tract symptoms of the two diseases, so as to assist in their differential diagnosis and treatment.

Research progress on the mechanism of silibinin in preventing and treating diabetes and its complications / 中国药房

Silibinin is a kind of flavonoid extracted from the dried ripe fruit of Silybum marianum，a plant of compositae. It has a variety of pharmacological activities and can effectively prevent and treat diabetes and its complications. This paper reviews the research progress on the mechanism of silibinin in the prevention and treatment of diabetes and its complications. It is found that silibinin can prevent and treat diabetes by up-regulating the expression of estrogen receptor-α，activating the duodenum-brain-liver axis pathway and stabilizing the protein structure. It can prevent and cure the nervous system diseases of diabetes by activating glucagon-like peptide-1 receptor/protein kinase A signal pathway and inhibiting the hyperphosphorylation of tau protein. It can prevent and treat diabetic retinopathy by down-regulating the expression and activity of pro-inflammatory，pro-oxidative factors and histone deacetylase 6. It can prevent diabetic nephropathy by activating protein kinase B signal pathway and reducing the level of transforming growth factor-β1，and prevent and treat diabete’s obesity by inhibition of hepatobiliary transporter CD36 expression， and suppressing nuclear factor-κB pathway and its downstream expression of pro-inflammatory cytokines（tumor necrosis factor-α and interleukin-1β），etc.

Study on the chemical composition differences of different parts of Alpinia oxyphylla Miq.based on multivariate statistical analysis / 国际中医中药杂志

Objective:To establish the Ultra-High Performance Liquid Chromatography (UPLC) characteristic chromatogram of different parts of Alpinia oxyphylla Miq., and to compare different parts of the chemical components based on multivariate statistical analysis. Methods:The UPLC was used to establish the fingerprint of Alpinia oxyphylla Miq. . The chromatograms were matched to generate the UPLC charactersistic chromatogram of different parts. Based on the variance analysis of single factor, combined with the Principal Component Analysis (PCA) ,Cluster Analysis (CA) and the Partial Orthogonal Least Square Discriminant Analysis (OPLS-DA) to analyze the differences of different medicinal parts of Alpinia oxyphylla Miq.. Results:16 common peaks of Alpinia oxyphylla Miq. were demarcated in crude drugs, compared with the medicinal materials of Alpinia oxyphylla Miq., the peak 13 (tectochhrysin) was lost in the decoction pieces, and the shell were missing peak 5 and peak 6. The results of PCA and CA showed that 15 batches of different medicinal parts of Alpinia oxyphylla Miq. can be broadly divided into 3 categories. The OPLS-DA result showed that the value of the peak area of peaks 14 (Nootkatone), 4, 7 and 12 were the main factors affecting the chemical composition of different parts of Alpinia oxyphylla Miq. .Conclusion:The fingerprint determination method established in this study is stable and controllable, which could distinguish the different parts of Alpinia oxyphylla Miq. .

Risk factors of prostate cancer in men with PI-RADS 1-2 lesions by multiparametric MRI / 中华泌尿外科杂志

Objective:To evaluate the cancer detection rate in patients with multiparametric magnetic resonance imaging (mpMRI) PI-RADS 1-2 prior to initial biopsy, and analyze the risk factors of prostate cancer.Methods:A total of 196 patients undergoing initial prostate biopsy between July 2011 and June 2018 were retrospectively analyzed. According to ESUR PI-RADS system, the patients’ PI-RADS score was 1 and 2, with the mean age of 66.6±9.0 years, and the median PSA 7.44 ng/ml. Twenty-eight patients were enrolled with PSA<4 ng/ml but with abnormal directeral rectun examination. The rest 168 patients were enrolled with elevated PSA. According to the Epstein prostate risk classification criteria, clinically insignificant prostate cancer was defined as: PSA density ≤0.15 ng/ml 2, Gleason score≤6, less than 3 positive needles, <50% puncture length. If any of the above is not met, the diagnosis should be clinically significant prostate cancer(CsPCa). T test or Mann-Whitney U test were used for comparison between groups. Risk factors for diagnosis of prostate cancer and CsPCa were analyzed by chi square test(or Fisher’s exact probability method) and multivariate logistic regression analysis. Results:There were 42(21.4%) patients diagnosed with prostate cancer, 30(15.3%)patients were CsPCa. The negative predictive value of mpMRI was 78.6%(154/196)for prostate cancer overall, and 84.7%(166/196)for CsPCa. Patients with higher age and PSA density were associated with higher possibility of prostate cancer. Higher age, PSA level, PSA density, and lower PSA ratio were associated with higher possibility of CsPCa. Multivariate logistic regression analysis showed that PSA density>0.15 ng/ml 2( OR=2.94, 95% CI 1.45-5.95) was independent risk factor of prostate cancer.Ages over 70 years( OR=2.49, 95% CI 1.22-5.07), PSA ratio<0.2( OR=3.70, 95% CI 1.25-11.23), PSA density>0.15 ng/ml 2( OR=5.77, 95% CI 1.96-16.96) were independent risk factors of CsPCa ( P<0.05). Conclusions:The detection rate of prostate cancer was 21.4% in patients with elevated PSA or abnormal digital prostate examination but with PI-RADS score of 1-2. Higher age and PSA density were associated with higher risk of prostate cancer. The detection rate of CsPCa was 15.3%. Ages over 70 years, PSA ratio<0.2, PSA density>0.15 ng/ml 2 were independent risk factors of CsPCa.

The correlation between left atrial fat gray value and the prognosis of patients with atrial fibrillation treated by thoracoscopic radiofrequency ablation / 中国胸心血管外科临床杂志

@#Objective    To analyze the correlation between the gray value of epicardial fat and the prognosis of patients with atrial fibrillation (AF) treated by thoracoscopic radiofrequency ablation. Methods    The clinical data of 97 patients, including 75 males and 22 females with an average age of 57.8±9.4 years, who underwent thoracoscopic radiofrequency ablation in Fuwai Hospital from 2017 to 2018 were analyzed retrospectively. The left atrial fat volume and average gray scale were calculated by left atrial enhanced CT. According to the average gray scale of left atrial fat tissue, the patients were divided into three groups: a high gray scale group, a medium gray scale group and a low gray scale group. The patients were followed up at 3, 6 and 12 months after operation. The end point of follow-up was the recovery rate of sinus rhythm. Survival analysis was used to analyze the correlation between CT features of epicardial fat enhancement and prognosis. Results    After adjustment of body mass index, body surface area, gender and left atrial end diastolic diameter, regression analysis showed that the fat gray of left atrial enhanced CT was correlated with the type of AF (OR=0.30, 95%CI 0.12-0.79, P=0.014). Cox regression analysis showed that the fat gray value of left atrial CT predicted the recurrence of AF after thoracoscopic radiofrequency ablation (OR=0.92, 95%CI 0.85-0.99). The Kaplan-Meier curve showed significant difference in the long-term recurrence rate of AF among the three groups (P=0.011). The lower left atrial fat enhanced CT gray scale was, the higher long-term recurrence rate of AF was. Conclusion    The gray value of left atrial fat enhanced CT can effectively predict the recurrence of AF after radiofrequency ablation in thoracoscopic surgery.

Study on HPLC Characteristic Chromatogram and Chemical Pattern Recognition of Different Medicinal Parts of Cirsium japonicum / 中国药房

OBJECTIVE：To establish HP LC ch aracteristic ch romatogram of different medicinal parts of Cirsium japonicum ， and to compare the difference of chemical components in different medicinal parts of C. japonicum according to chemical identification method ，and to provide reference for quality control and evaluation of C. japonicum . METHODS ：Medicinal material （overground part ），leaves，flower，main stem and lateral stem of C. japonicum were determined by HPLC. According to the TCM Chromatographic Fingerprint Similarity Evaluation System （2012A edition ），the chromatograms were matched to generate the HPLC characteristic chromatogram of each medicinal part. The differences of common characteristic peak area were analyzed according to variance analysis of single factor. The chromatographic peaks were identified by comparison of reference substance. Meanwhile，the chemical pattern recognition was performed to research the different medicinal parts of C. japonicum according to principal component analysis （PCA）and cluster analysis. RESULTS ：HPLC characteristic chromatograms of medicinal material ， leaves，flower，main stem and lateral stem from C. japonicum were established respectively ，and 15 common peaks were confirmed for medicinal material ，leaves and flower of C. japonicum ；11 common peaks were confirmed in chromatograms of main stem and lateral stem from C. japonicum （absence of No. 7，9，12，13 peak）. The contents of chemical components were different greatly among different medicinal parts. No. 1，2，3，10，11 peaks were identified as neochlorogenic acid ，chlorogenic acid ， cryptochlorogenic acid ，linarin and pectolinarin. Results of PCA and cluster analysis showed that chemical pattern recognition and clustering of the flower and stem of C. japonicum were distinct and can be clustered into one category respectively. However ，the leaves distribution of C. japonicum was relatively scattered ，so it was difficult to cluster . CONCLUSIONS ：Established HPLC characteristic chromatogram-chemical pattern recognition can reflect the differences of different medicinal parts of C. japonicum integrally， comprehensively and truly ， which has vital significance for origin indentification ， quality control and overall evaluation of C. japonicum .

Study on UHPLC Characteristic Chromatograms of Euodia rutaecarpa ，Processed E. rutaecarpa Decoction Piece ， Water Decoction and Formula Granules / 中国药房

OBJECTIVE：To e stablish UPLC characteristic chrom atograms of Euodia rutaecarpa ，processed E. rutaecarpa decoction piece ，water decoction and formula granules ，and to compare its relationship and difference. METHODS ：UPLC method was used. The determination was performed on YMC Triart C 18 column with mobile phase consisted of acetonitrile- 0.1％ phosphoric acid water solution （gradient elution ）at the flow rate of 0.3 mL/min. The detection wavelength was set at 254 nm，and column temperature was 30 ℃. The sample size was 1 μL. Using limonin as reference，the characteristic chromatograms of E. rutaecarpa ， processd E. rutaecarpa decoction piece ，water decoction and formula granules （each 10 batches，totally 60 batches）were drawn. The similarity was evaluated with TCM Chromatographic Fingerprint Similarity Evaluation System （2012 edition），and to determine the common characteristic peak. The differences of ratio of common characteristic peak area were evalucoted according to variance analysis. Meanwhile ，the cluster analysis and principal component analysis （PCA） were performed to research the differences of E. rutaecarpa ，processed E. rutaecarpa decoction piece ，water decoction and formula granules by using SPSS 20.0 software. RESULTS ：Totally 16 and 17 common peaks were respectively confirmed in characteristic chromatograms of E. rutaecarpa samples and processed E. rutaecarpa samples（decoction piece ，water decoction and formula granules ）. No. 8，9，11， 17 peaks were identified as limonin ，evodiamine，rutaecarpine and glycyrrhizic acid. Compared with decoction piece ，the similarities of characteristic peak between water decoction and formula granules were lower than 0.55，while those between water decoction and formula granule were higher than 0.95. Cluster analysis and PCA results showed that E. rutaecarpa decoction piece and processed E. rutaecarpa decoction piece could be clustered into one category ；E. rutaecarpa water decoction and formula granules could be clustered into one category ；processed E. rutaecarpa water decoction and formula granules could be clustered into one category. CONCLUSIONS ：Compared with E. rutaecarpa ，processed E. rutaecarpa additionally contain glycyrrhizic acid ； main che mical components of decoction piece ，water decoction and formula granules are basically the same ，but the contents of the components between decoction piece to water decoction and formula granules are different.

Comparative study on prostate cancer detection rates of MRI-guided in-bore biopsy versus cognitive fusion biopsy for patients with prostate specific antigen levels<20 μg/L / 中华老年医学杂志

Objective:To compare the differences in prostate cancer detection rate between MRI-guided in-bore biopsy(MRI-BX)and cognitive fusion biopsy(COG-BX)in patients with prostate specific antigen(PSA)levels<20 μg/L.Methods:From January 2015 to December 2018, clinical data of 195 patients with PSA levels<20 μg/L were consecutively included in this retrospective study.Of these patients, 80 underwent MRI-BX procedures and 115 underwent COG-BX procedures.Clinical data including age, PSA, prostate volume, PSA density(PSAD), Prostate Imaging Reporting and Data System(PI-RADS)scores, overall prostate cancer detection rate and detection rate of clinically significant prostate cancer were compared and analyzed.Results:There was no significant difference in age, PSA, prostate volume, PSAD and PI-RADS scores between the two groups.There was no significant difference in total prostate cancer detection rate between the MRI-BX and COG-BX groups(53.8% or 43/80 vs.50.4% or 58/115, P=0.649), while the detection rates for clinically significant prostate cancer showed a significant difference between the two groups(58.1% or 25/43 vs.82.8% or 48/58, P=0.006). There was no significant difference in prostate cancer detection rate between the MRI-BX and COG-BX groups in patients with PSA<10 μg/L(45.2% or 28/62 vs.48.0% or 36/75, P=0.740), while a significant difference was found in the detection rate of clinically significant prostate cancer between the two groups in patients with PSA<10 μg/L(50.0% or 14/28 or 91.7% or 33/36, P=0.001). Conclusions:The overall prostate cancer detection rate does no differ between MRI-BX and COG-BX in patients with PSA levels<20 μg/L or with suspicious MRI lesions(PI-RADS3), but the COG-BX procedure has a higher detection rate than the MRI-BX procedure for clinically significant prostate cancer, especially in patients with PSA<10 μg/L.

Correlation between autophagy of peripheral blood mononuclear cells and clinical parameters in chronic obstructive pulmonary disease patients / 中国医师进修杂志

Objective Autophagy serves a role in the pathogenesis of chronic inflammatory diseases. The aim of the present study was to compare the autophagy levels of the peripheral blood mononuclear cells (PBMCs) in patients with chronic obstructive pulmonary disease (COPD) and healthy individuals and to assess the association between autophagy and the clinical parameters of COPD. Methods Samples of peripheral blood from 20 patients with stable COPD and 20 healthy controls were collected. PBMCs were harvested using Ficoll density gradient centrifugation. Levels of the autophagy-associated proteins ubiquitin-binding protein P62 (P62), microtubule-associated proteins 1A/1B light chain 3A (LC3 I/Ⅱ) and beclin-1 in PBMCs were detected by western blotting. Enzyme-linked immunosorbent assay kits were used to detect the serum concentrations of interleukin (IL)-6, IL-8 and tumor necrosis factor (TNF)-α. Results Western blotting demonstrated that the protein expression of P62 decreased (P62/GAPDH = 0.212 ± 0.089 vs. 0.378 ± 0.176,P = 0.001 1), but LC3 I/Ⅱ(4.94 ± 1.85 vs. 3.85 ± 1.06, P = 0.024 9) and beclin-1 (Beclin-1/GAPDH = 0.578 ± 0.126 vs. 0.149 ± 0.035, P<0.01) levels increased in patients with COPD compared with healthy controls. Serum levels of IL-6 [(11.96 ± 3.46) ng/L vs. (2.70 ± 1.72) ng/L, P < 0.01], IL-8[(20.38 ± 18.44) ng/L vs. (6.00 ± 4.08) ng/L, P=0.001 6] and TNF-α (29.50 ± 28.18 vs. 11.08 ± 12.07, P=0.010 6) increased in patients with COPD. The extent of PBMC autophagy was negatively correlated with FEV1% predicted, but positively correlated with levels of proinflammatory cytokines. The levels of autophagy in PBMCs in patients with COPD increased and were negatively correlated with FEV1% predicted and positively correlated with circulating levels of pro-inflammatory cytokines. Conclusions Autophagy may serve a role as a biomarker of the severity of COPD or as a therapeutic target for treatment of COPD.

Clinical significance of MR-guided prostate biopsy based on diffusion-weighted imaging abnormalities for prostate cancer diagnosis in elderly men / 中华老年医学杂志

Objective To evaluate the diagnostic efficacy of magnetic resonance(MR)-guided prostate biopsy based on abnormal diffusion weighted imaging for prostate cancer in elder men.Methods From July 2014 to Dec 2016,56 patients (age≥ 65 years) with diffusion weighted imaging (DWI)abnormalities undergoing MR-guided prostate biopsy were retrospectively evaluated.According to pathological diagnosis,patients were divided into prostate cancer and non-prostate cancer groups.The clinical data of two groups were analyzed.The correlation of Gleason score,prostate specific antigen(PSA),and the location and number of biopsy were compared.Results Among 56 cases,32 (57.1％)were diagnosed as prostate cancer,and 24 (42.9％)as chronic prostatitis and prostatic hyperplasia (non-prostate cancer).There were statistically significant differences between prostate cancer and non-prostate cancer in age[(73.0±5.7)vs.(70.1±4.3)year]and PSA[(9.3±6.0)μg/L vs.(6.0± 3.9)μg/L] (both P＜0.05),and no statistical differences in biopsy location and biopsy number(t =2.08,2.37,P＞ 0.05).Gleason score had no correlation with PSA level and biopsy location and biopsy number(r=0.189、-0.183、0.082,P＞0.05).Conclusions MR-guided prostate biopsy based on MR-DWI has some merits,such as accurate positioning,fewer numbers of biopsy,and lower false-negative rate.

Clinical efficacy of the laparoscope-assisted transanal total mesorectal excision for middle-low rectal cancer / 中华消化外科杂志

Objective To explore the clinical efficacy of laparoscope-assisted transanal total mesorectal excision (La-TaTME) for middle-low rectal cancer.Methods The retrospective cross-sectional study was conducted.The clinical data of 16 patients with middle-low rectal cancer who underwent La-TaTME in the Peking University Third Hospital from August 2015 to August 2016 were collected.Sequential surgery of La-TaTME was applied to patients in the same team,with laparoscopic surgery first and then transanal surgery.Observation indicators:(1) operation and postoperative recovery situations:conversion to open surgery,anastomosis method,operation time,volume of intraoperative blood loss,intraoperative complications,time for out-of-bed activity,time for liquid diet intake,postoperative complications and duration of postoperative hospital stay.(2) postoperative pathological situations:length of surgical specimen,tumor diameter,distance from tumor to resected distant intestinal canal,complete degree of mesorectum,circumferential resection margin,pathological T stage,pathological N stage,number of lymph node detected and tumor cell differentiation.(3) follow-up.Patients in stage Ⅲ-ⅣV of TNM stage of RC underwent postoperative adjuvant chemotherapy.Follow-up using outpatient examination was performed once every 3 months postoperatively to detect the patients' survival and tumor recurrence up to December 2016.Measurement data were represented as M (range).Results (1) Operation and postoperative recovery situations:all the 16 patients underwent successful La-TaTME without conversion to open surgery,including 10 with colorectal anastomosis,3 with colon-canalis analis anastomosis and 3 with permanent colostomy.Operation time and volume of intraoperative blood loss were 290 minutes (range,215-420 minutes) and 50 mL (range,30-100 mL),respectively.One patient had intraoperative complication,showing broken ends ischemia of sigmoid colon after dragging out resected rectum from the anus,following free splenic flexure of colon,about 5 cm ischemic sigmoid colon were resected,and descending colon-rectum anastomosis was performed.Time for out-of-bed activity and time for liquid diet intake were 1 days (range,1-3 days) and 2 days (range,1-9 days),respectively.Among 3 patients with postoperative complications (Ⅱ stage of ClavienDindo),2 with incomplete intestinal obstruction were improved by gastrointestinal decompression and total parenteral nutrition,and 1 with presacral infection was improved by drainage and antibiotic therapy.Duration of postoperative hospital stay was 7 days (range,5-21 days).(2) Postoperative pathological situations:length of surgecal specimen,tumor diameter and distance from tumor to resected distant intestinal canal were respectively 18.0 cm (range,12.0-24.0 cm),3.5 cm (range,0.5-6.8 cm) and 2.5 cm (range,1.0-5.0 cm).Evaluation of mesorectum of surgical specimen:14 patients had complete mesorectum of surgical specimen and 2 had nearly complete mesorectum.There was no residual tumor at circumferential resection margin,proximal and distal ends.Pathological T stage of 16 patients:T0 (pathological complete response after neoadjuvant therapy),T1,T2 and T3 stages were found in 1,1,4 and 10 patients,respectively.Pathological N stage:12,2 and 2 patients were detected in N0,N1 and N2 stages,respectively.Number of lymph node detected was 16 (range,6-32).Tumor cell differentiation:no tumor cell (pathological complete response after neoadjuvant therapy),high-,moderateand low-differentiated tumors were respectively detected in 1,2,7 and 6 patients.(3) Follow-up.All the patients were followed up for 12 months (range,4-16 months).There were no local tumor recurrence or distant metastasis and death.Conclusion La-TaTME may be a new,safe and effective resection for middle-low rectal cancer.

Sequencing and Serologic Identification of S1 Genes of Infectious Bronchitis Viruses Isolated during 2012-2013 in Guangxi Province, China / 病毒学报

We wished to ascertain the prevalence as well as the genetic and antigenic variation of infectious bronchitis viruses (IBVs) circulating in the Guangxi Province of China in recent years. The S1 gene of 15 IBV field isolates during 2012-2013 underwent analyses in terms of the similarity of amino-acid sequences, creation of phylogenetic trees, recombination, and serologic identification. Similarities in amino-acid sequences among the 15 isolates of the S1 gene were 54.3%-99.6%, and 43.3%-99.3% among 15 isolates and reference strains. Compared with the vaccine strain H120, except for GX-YL130025, the other 14 isolates showed a lower similarity of amino-acid sequences of the S1 gene (65.1-81.4%). Phylogenetic analyses of the S1 gene suggested that 15 IBV isolates were classified into eight genotypes, with the predominant genotype being new-type II. Recombination analyses demonstrated that the S1 gene of the GX-NN130048 isolate originated from recombination events between vaccine strain 4/91 and a LX4-like isolate. Serotyping results suggested that seven serotypes prevailed during 2012-2013 in Guangxi Province, and that only one isolate was consistent with the vaccine strain H120 in serotype (which has been used widely in recent years). The serotype of recombinant isolate GX-NN130048 was different from those of its parent strains. These results suggested that not only the genotype, but also the serotype of IBV field isolates in Guangxi Province had distinct variations, and that increasing numbers of genotypes and serotypes are in circulation. We showed that recombination events can lead to the emergence of new serotypes. Our study provides new evidence for understanding of the molecular mechanisms of IBV variations, and the development of new vaccines against IBVs.

Clinical study on ambulatory surgery for thyroid / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the advantages and clinical value regarding the ambulatory surgery for thyroid.
@*METHODS@#A total of 66 patients (including 16 cases of differentiated thyroid cancer, 50 cases of benign thyroid tumors) from June 2014 to April 2015 in Center for Ambulatory Surgery of Xiangya Hospital were enrolled for this study and served as an exprimental group. All patients met pre-established ambulatory surgery criteria for thyroid. According to medical records, 133 patients with similar conditions to the experimental group were chosen as a control group. All of operations in two groups were completed by the same doctors. The time of operation, amount of bleeding during operation, drainage after the operation, operation method, resection range, histological features, surgical complications, average days of hospitalization, average hospitalization cost, the rate of re-admission and the satisfaction of patients were compared between the 2 groups. 
@*RESULTS@#Time of operation and amount of bleeding during operation were not significantly different between the 2 groups (P>0.05). In terms of drainage after operation and resection range, there were obvious differences between the 2 groups (P0.05), but average days of hospitalization and average hospitalization cost were less in the experimental group (P<0.05). Patients were satisfied with ambulatory thyroid surgery (P<0.05).
@*CONCLUSION@#Under certain criteria, ambulatory surgery for thyroid is a new operation method, which is safe, high-efficient, convenient, economy and time-efficient. It can decrease average days of hospitalization and average hospitalization cost obviously, and provide a reasonable choice for certain patients. The selection of endoscopic thyroid surgery was not conflict with selection of ambulatory thyroid surgery.

A case of retroperitoneal Castleman's disease with paraneoplastic pemphigus / 中南大学学报(医学版)

Paraneoplastic pemphigus is a rare autoimmune bullous dermatosis, which is caused by potential neoplasm, especially the Castleman's disease. Castleman's disease associated with paraneoplastic pemphigus is misdiagnosed frequently and easily in clinical practices. Furthermore, it is reported that the mortality rate for this disease is very high. Bronchiolitis obliterans is the most common complication and the most important cause of death. There was a female patient presenting recalcitrant mucocutaneous erosions, ulcers and scattered erythemas in the body. The patient was diagnosed and treated for pemphigus vulgaris with little success in Xiangya Hospital, Central South University in January 2015. Further investigations confirmed the diagnosis of paraneoplastic pemphigus with retroperitoneal tumor. Subsequently, the patient was treated with tumor resection in combination with intravenous immunoglobulin and corticosteroids. The pathology revealed that it was the Castleman's disease. Her mucocutaneous performance recovered obviously and the bronchiolitis obliteran did not appear in the follow-up. Castleman's disease associated with paraneoplastic pemphigus should be considered when mucosal and skin lesions showing no improvement under corticosteroids. Early and complete removal of the tumor together with immunotherapy could be beneficial to the patient's prognosis.

Transabdominal-transanal total mesorectal excision combined with liver metastasis resection for synchronous low rectal liver metastasis / 中华消化外科杂志

Objective To investigate the application value of transabdominal-tansanal total mesorectal excision combined with liver metastasis resection for synchronous low rectal liver metastasis.Methods The retrospective descriptive study was adopted.The clinical data of a male patient with synchronous low rectal liver metastasis who was admitted to the Peking University Third Hospital in November 2015 was collected.Transabdominal-transanal total mesorectal excision combined with liver metastasis resection was performed after multidisciplinary team conference.The liver metastasis resection,vascular disconnection,lymph node dissection and upper and middle mesorectal disconnection were done by transabdominal approach.Then complete mesorectal excision and specimen removal of rectum and liver were done by transanal approach.The intraoperative status (operation method,operation time,volume of intraoperative blood loss,blood transfusion),occurrence of postoperative complications,results of pathological examination and follow-up were observed.The patient was followed up by outpatient examination till January 2016.Results The operation was performed successfully without severe perioperative complications.The operation time and volume of intraoperative blood loss were 360 minutes and 170 mL,respectively.The patient did not receive intraoperative blood transfusion,without urinary retention and presacral abscesses.The patient was discharged at postoperative day 9.The postoperative pathological results showed high-differentiated rectal protruded adenoma and high-middle differentiated adenocarcinoma metastasis in the liver tissue with the negative resection margins.The tumor sizes of rectum and liver metastasis were 5.0 cm × 5.0 cm× 1.5 cm and 1.5 cm × 1.0 cm × 1.5 cm,respectively.The tumor node metastasis (TNM) stage was stage Ⅳ (pT3N0M1).The patient had a good life quality during the follow-up of 1 month.Conclusion Transabdominal-transanal approach might provide an alternative operative approach and resection method for synchronous low rectal liver metastasis,with a good short-term outcome.

Survey and Suggestion for Ethical Review of Paediatric Clinical Trials / 中国医学伦理学

This article surveyed the protocols and informed consent forms of 15 paediatric clinical trials which had been reviewed by the hospital′s institutional research board from 2008 to 2013 .This survey reevaluated and made suggestions on the protocols and informed consent forms, focusing on the risk level, protocol design back-ground, risk minimization measures, the required elements as well as the language expressions of informed consent forms and finding out the shortage of informed consent and give appropriate advices.

Clinical application of a novel posterior lumbar fusion method and the short-term observation of its effect / 中华外科杂志

<p><b>OBJECTIVE</b>To increase local blood supply of bone graft, a novel posterior lumbar spine fusion method with orthotopic paraspinal muscle-pediculated bone flaps was constructed, and the fusion rate and clinical effect.were observed.</p><p><b>METHODS</b>From June 2007 to December 2010, 117 patients of lumbar spinal stenosis or lumbar destabilization treated with the novel posterior lumbar fusion method were studied, 49 males and 68 females, aged from 40 to 77 years, average 61.5 years. Clinical effect was evaluated by JOA and VAS score preoperatively and postoperatively, and the fusion result was evaluated by three-dimensional CT reconstruction postoperatively.</p><p><b>RESULTS</b>Seventeen cases lost of follow up, the rest were followed up from 7 to 38 months, average 19 months. There was significant difference between pre- and postoperative JOA and VAS score (P < 0.01), the preoperative JOA score was 10.3 ± 1.9, and 25.4 ± 4.2 at the latest follow-up, the improvement rate was 81.0% ; the preoperative VAS score was 8.5 ± 0.8, and 2.3 ± 0.4 at the latest follow-up. The three-dimensional CT reconstruction showed that 126 of the 133 segments formed solid fusion in 100 patients who completed the follow-up, the fusion rate was 94.7%.</p><p><b>CONCLUSION</b>The novel posterior lumbar fusion method make the bone graft position more precise, stable and increases the fusion rate, which can effectively reduce pseudarthrosis and have a promising clinical effect.</p>

Discussion on “NorthwestQi should be scattered and cooled” in theHuangdineijing / 国际中医中药杂志

“NorthwestQishould be scattered and cooled” is the earliest recapitulation of adjust measures to local conditions. This paper elaborated its theory and practice, so as to remind our modern doctors pay more attention to disease prevention and treatment in different geographical environments, not only improve and develop its theory, but also innovate its use,by deepening the understanding of diagnosis and treatment. In addition, it is very important that modern doctors should be responded flexibly to more and more complicated changes in the environment.

Analysis of risk factors affecting the prognosis of pancreatic neuroendocrine tumors / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pancreatic neuroendocrine tumors (pNETs) are a type of tumors with the characteristics of easy metastasis and recurrence. Till date, the risk factors affecting the prognosis are still in the debate. In this study, several risk factors will be discussed combined with our cases and experience.</p><p><b>METHODS</b>Thirty-three patients diagnosed as pNETs were enrolled and the clinical features, blood tests, pathological features, surgical treatment, and follow-up data of these patients were collected and analyzed.</p><p><b>RESULTS</b>In this study, operation time of G3 cases was longer than G1/G2 cases (P = 0.017). The elevated level of tumor markers such as AFP, CEA, Ca125, and Ca19-9 may predict easier metastasis, earlier recurrence, and poor prognosis (P = 0.007). The presence of cancer embolus and nerve invasion increases along with the TNM stage (P = 0.037 and P = 0.040), and the incidence of positive surgical margin increased (P = 0.007). When the presence of nerve invasion occurs, the chance of cancer embolus and lymph node metastasis also increases (P = 0.016 and P = 0.026).</p><p><b>CONCLUSIONS</b>pNETs were tumors with the features of easy recurrence and metastasis and many risk factors could affect its prognosis such as the elevated levels of tumor markers and the presence of nerve invasion, except some recognized risk factors. If one or more of these factors existed, postoperative treatments may be needed to improve prognosis.</p>

Clinical features of 30 cases of primary hyperthyroidism complicated with thyroid cancer / 中华内分泌外科杂志

Objective To study the epidemiological and clinical features of primary hyperthyroidism complicated with thyroid cancer.Methods Clinical data of 30 cases of hyperthyroidism complicated with thyroid cancer(hyperparathyroidism group)were retrospectively analyzed.They were chosen from the 365 cases of primary hyperparathyroidism treated by operation from Jan.2002 to Jun.2011.At the same time,30 cases of thyroid cancer without hyperparathyroidism were randomly taken out as the control group.Results The incidence of thyroid cancer in primary hyperparathyroidism was 8.22％ (30/365).The median course,preoperative diagnostic rate of thyroid cancer,and lymph nodes metastasis rate for hyperparathyroidism group and control group was 875.00 vs 120.00 days(z =-2.501,P ＜0.05),40.0％ (12/30) vs 66.7％ (20/30) (x2 =4.286,P ＜0.05),and 20.0％ (6/30) vs 46.7％ (14/30) (x2 =4.800,P ＜ 0.05) respectively.All patients were followed up with the average of 4.5 years,ranging from 1 month to 9 yeas and a half.1 case(3.3％)in hyperparathyroidism group recurred hyperthyroidism 5 years after surgery.1 case(3.3％)recurred thyroid cancer 1 year after surgery and received operation again,and 1 case(3.3％)died half a year after operation from respiratory failure caused by lung metastasis of thyroid cancer in the control group.Conclusions Hyperthyroidism complicated with thyroid cancer has the characteristics of high incidence rate of thyroid cancer in the hyperthyroidism patients,long course,high preoperative misdiagnosis rate,low lymph node metastasis rate,favorable prognosis and so on.