Association of Serine/Threonine Phosphoprotein Phosphatase 4C Expression With Prognosis of Gastric Cancer / 中国医学科学院学报

Objective To investigate the expression level of serine/threonine phosphoprotein phosphatase 4C(PPP4C)in gastric cancer,and analyze its relationship with prognosis and the underlying regulatory mechanism.Methods The clinical data of 104 gastric cancer patients admitted to the First Affiliated Hospital of Bengbu Medical College between January 2012 and August 2016 were collected.Immunohistochemical staining was employed to determine the expression levels of PPP4C and Ki-67 in the gastric cancer tissue.The gastric cancer cell lines BGC823 and HGC27 were cultured and transfected with the vector for PPP4C knockdown,the vector for PPP4C overexpression,and the lentiviral vector(control),respectively.The effects of PPP4C on the cell cycle and proliferation were analyzed and the possible regulatory mechanisms were explored.Results PPP4C was highly expressed in gastric cancer(P<0.001),and its expression promoted malignant progression of the tumor(all P<0.01).Univariate and Cox multivariate analysis clarified that high expression of PPP4C was an independent risk factor affecting the 5-year survival rate of gastric cancer patients(P=0.003).Gene ontology and Kyoto encyclopedia of genes and genomes enrichment analysis suggested that PPP4C may be involved in the cell cycle.The correlation analysis showed that the expression of PPP4C was positively correlated with that of Ki-67 in gastric cancer(P<0.001).The up-regulation of PPP4C expression increased the proportion of tumor cells in the S phase,alleviated the G2/M phase arrest,and promoted the proliferation of gastric cancer cells and the expression of cyclin D1 and cyclin-dependent kinase 6(CDK6)(all P<0.05).The down-regulation of PPP4C decreased the proportion of gastric cancer cells in the S phase,promoted G2/M phase arrest,and inhibited cell proliferation and the expression of cyclin D1,CDK6,and p53(all P<0.05).p53 inhibitors promoted the proliferation of BGC823 and HGC27 cells in the PPP4C knockdown group(P<0.001,P<0.001),while p53 activators inhibited the proliferation of BGC823 and HGC27 cells in the PPP4C overexpression group(P<0.001,P=0.002).Conclusions PPP4C is highly expressed in gastric cancer and affects the prognosis of the patients.It may increase the proportion of gastric cancer cells in the S phase and alleviate the G2/M phase arrest by inhibiting p53 signaling,thereby promoting cell proliferation.

The association between body mass index and varicocele: A meta-analysis

ABSTRACT Objective: Recently, several studies have found that obesity had a protective effect against varicocele, but no meta-analysis has confirmed this finding. Therefore, we conducted this meta-analysis to investigate the association between body mass index (BMI) and varicocele. Material and Methods: We searched for studies in PubMed, Science Direct and the Cochrane Library from inception until February 2018. The association between BMI and varicocele was assessed by pooling the odds ratios (ORs). Results: Eleven eligible studies with a total study population of 1.376.658 participants were included in our analysis. According to BMI, the subjects were defined as belonging to the obese, overweight and underweight groups. Our results showed that the obese group had a lower risk of varicocele when compared with the normal weight group (odds ratio [OR] 0.46, 95% confidence intervals [CIs] 0.37-0.58). Additionally, an overweight BMI had a protective effect against varicocele (OR 0.70, 95% CIs, 0.56-0.86). However, underweight patients had a more than 30% higher risk of varicocele (OR 1.31, 95% CI, 1.04-1.64). Furthermore, there was no publication bias in any of the analyses. Conclusions: Our study demonstrates that BMI is negatively associated with the presence of varicocele.

Risk factors for hypoglycemia in preterm infants with a gestational age of ≤32 weeks / 中国当代儿科杂志

OBJECTIVE@#To investigate the risk factors for hypoglycemia after birth in preterm infants with a gestational age of ≤32 weeks.@*METHODS@#A retrospective analysis was performed for 86 neonates with hypoglycemia and a gestational age of ≤32 weeks who were admitted to the neonatal intensive care unit from January 2017 to June 2020 (hypoglycemia group). A total of 172 preterm infants with normal blood glucose who were hospitalized during the same period were randomly enrolled as the control group. Univariate analysis and multivariate logistic regression analysis were used to screen out the risk factors for hypoglycemia in preterm infants.@*RESULTS@#There were 515 preterm infants during the study, among whom 86 (16.7%) had hypoglycemia. Compared with the control group, the hypoglycemia group had significantly higher percentages of small for gestational age (SGA), cesarean section, maternal hypertension, and antenatal steroid administration (P<0.05), but significantly lower birth weight and rate of intravenous glucose use before blood glucose test (P<0.05). SGA (OR=4.311, 95%CI: 1.285-14.462, P<0.05), maternal hypertension (OR=2.469, 95%CI: 1.310-4.652, P<0.05), and antenatal steroid administration (OR=6.337, 95%CI: 1.430-28.095, P<0.05) were risk factors for hypoglycemia in preterm infants, while intravenous glucose use (OR=0.318, 95%CI: 0.171-0.591, P<0.05) was a protective factor against hypoglycemia in preterm infants.@*CONCLUSIONS@#SGA, maternal hypertension, and antenatal steroid administration may increase the risk of early hypoglycemia in preterm infants with a gestational age of ≤32 weeks, and intravenous glucose use is recommended as soon as possible after birth for preterm infants with a gestational age of ≤32 weeks to reduce the incidence rate of hypoglycemia.

Feasibility of Hei Xiaoyaosan in Preventing and Treating Alzheimer's Disease Based on Theory of 'Correlation of Liver and Kidney' Based on Ca2+-CaM/CaMKⅡ-CREB Signal Pathway / 中国实验方剂学杂志

Alzheimer's disease（AD） is an incipient aging neurodegenerative disease， which increases rapidly along with the development trend of social aging and seriously threatens the health of the people. In the absence of effective preventive measures， it will have an enormous impact on the socio-economic and healthcare system. The study found that abnormal cell signal transduction is a key link in many diseases. Cell signal transduction theory has been widely used to clarify the essence of traditional Chinese medicine visceral image and the mechanism of traditional Chinese medicine. 'Correlation of Liver and Kidney' is one of the core plates of the theory of 'Correlation of Five Organs'， which is suitable for explaining the pathogenesis of complex diseases and the correlation of multiple syndromes， and guiding the prescription of clinical syndrome. Hei Xiaoyaosan， as the first choice compound for the prevention and treatment of AD based on the theory of "Correlation of Liver and Kidney' in our team， can play the effects of prevention and treatment by soothing liver and nourishing blood， strengthening spleen and tonifying kidney， and promoting brain collaterals and dredging viscerab spirit. Based on the theory of 'Correlation of Liver and Kidney'， this paper expounds the pathogenesis of AD from the perspective of traditional Chinese medicine， and puts forward the methods and ideas of the preventing and treating of AD from Ca2+-calcium/calmodulin dependent protein （CaM）/calcium/calmodulin dependent protein kinaseⅡ（CaMKⅡ）-cyclic adenosine phosphate reactive element binding protein （CREB） cell signal transduction pathway by consulting literatures and previous studies.

Upregulation of PITX2 Promotes Letrozole Resistance Via Transcriptional Activation of IFITM1 Signaling in Breast Cancer Cells / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Although the interferon α (IFNα) signaling and the paired-like homeodomain transcription factor 2 (PITX2) have both been implicated in the progression of breast cancer (BCa), it remains obscure whether these two pathways act in a coordinated manner. We therefore aimed to elucidate the expression and function of PITX2 during the pathogenesis of endocrine resistance in BCa. MATERIALS AND METHODS: PITX2 expression was assessed in BCa tissues using quantitative reverse transcription polymerase chain reaction (RT-qPCR) and immunohistochemistry and in experimentally induced letrozole-resistant BCa cells using RT-qPCR and immunoblotting. Effects of PITX2 deregulation on BCa progression was determined by assessing MTT, apoptosis and xenograft model. Finally, using multiple assays, the transcriptional regulation of interferon-inducible transmembrane protein 1 (IFITM1) by PITX2 was studied at both molecular and functional levels. RESULTS: PITX2 expression was induced in letrozole-resistant BCa tissues and cells, and PITX2 induction by IFNα signaling powerfully protected BCa cells against letrozole insult and potentiated letrozole-resistance. Mechanistically, PITX2 enhanced IFNα-induced AKT activation by transactivating the transcription of IFITM1, thus rendering BCa cells unresponsive to letrozoleelicited cell death. Additionally, ablation of IFITM1 expression using siRNA substantially abolished IFNα-elicited AKT phosphorylation, even in the presence of PITX2 overexpression, thus sensitizing BCa cells to letrozole treatment. CONCLUSION: These results demonstrate that constitutive upregulation of PITX2/IFITM1 cascade is an intrinsic adaptive mechanism during the pathogenesis of letrozole-resistance, and modulation of PITX2/IFITM1 level using different genetic and pharmacological means would thus have a novel therapeutic potential against letrozole resistance in BCa.

Purtscher-like retinopathy associated with antibiotic anaphylaxis / 南方医科大学学报

We report a case of an 18-year-old woman with systemic antibiotic anaphylaxis who presented anasarca and bilateral visual loss two weeks after the intravenous use of pazufloxacin. Ancillary fundus tests revealed bilateral cotton-wool spots, Purtscher flecken, edema, and retinal arteriolar occlusion around the optic disc. After pulse corticosteroid, administration of anti-anaphylactic agent, and general support therapy for one month, the patient showed a favorable change, with the symptoms lessened or free systemically, except the continuous aggravation of fundus ischemic change. After two intravitreal injections of Ranibizumab, there were still a large area of capillary non-perfusion and neovacularizations in the binocular retina, resulting in vitreous hemorrhage. The patient's visual acuity had still light perception after right-eye vitrectomy and presented no improvement during the postoperative follow-up of two years. Literature review revealed that there were many causes associated with Purtscher-like retinopathy, and the consequent visual impairment varied significantly. Prompt management of the underlying condition is crucial in giving the patient the best chance to restore vision.

Clinical Analysis of 1593 Patients with Infectious Endophthalmitis: A 12-Year Study at a Tertiary Referral Center in Western China / 中华医学杂志(英文版)

<p><b>Background</b>Infectious endophthalmitis is a severe ocular inflammation which can cause devastating visual loss. The aim of the study was to identify the demographic and clinical features of infectious endophthalmitis in Western China for better prophylaxis and treatment of this disease.</p><p><b>Methods</b>A.</p><p><b></b>retrospective, cross-sectional study was conducted based on the medical records of inpatients having infectious endophthalmitis in a tertiary referral center in Western China between 2005 and 2016.</p><p><b>Results</b>The common cause of infectious endophthalmitis was trauma (82.6%), endogenous (7.8%), ophthalmic surgery (6.9%), and corneal ulcer with perforation (2.7%). These four etiological groups differed in age, gender, enucleation rate, visual outcome, etc. The number of cases in the first 6 years accounted for 38.7% of the total collection, which in the second 6 years accounted for 61.3%. The etiology patterns were different between these two periods. Altogether 51.3% of patients received pars plana vitrectomy, 13.9% of patients underwent evisceration, and the remaining 34.8% received other treatments. Of the 670 cases that had culture results, 266 (39.7%) were culture positive and 177 (66.5%) were Gram-positive organisms, 64 (24.1%) were Gram-negative organisms, 11 (4.1%) had fungal infection, and 14 (5.3%) were infected by multiple pathogens.</p><p><b>Conclusions</b>There was an upward trend of the occurrence of infectious endophthalmitis in Western China for the past decade. The demographic and clinical characteristics of infectious endophthalmitis in Western China had its own characteristics and differed from those of developed countries. Here, open globe trauma was the most common cause of endophthalmitis, most traumatic endophthalmitis patients were male, and most of the injuries were work related, implicate that we should strengthen the education and application of ocular safety regulation specifically targeting the workplace.</p>

Association between maternal pre-pregnancy body mass index and adverse outcomes of late preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the association between maternal pre-pregnancy body mass index (BMI) and adverse outcomes of late preterm infants (LPI).</p><p><b>METHODS</b>A total of 367 LPI who were born from January 2011 to December 2015 and admitted to the neonatal ward were enrolled. The BMI criteria for Chinese population were used to analyze the factors for maternal pre-pregnancy BMI and its association with adverse outcomes of LPI (1 minute Apgar score ≤7, delivery room resuscitation, hospitalization days after birth >7 days, and ventilation duration ≥6 hours).</p><p><b>RESULTS</b>Of all LPIs, there were 64 LPI (17.4%) in the low maternal pre-pregnancy BMI group, 243 LPI (66.2%) in the normal maternal pre-pregnancy BMI group, and 60 LPI (16.4%) in the high maternal pre-pregnancy BMI group. Low pre-pregnancy BMI was the risk factor for 1 minute Apgar score ≤7 (OR=3.243, 95% CI: 1.102-9.546) and need for delivery room resuscitation (OR=3.492, 95%CI: 1.090-11.190), and high pre-pregnancy BMI was the risk factor for hospitalization days after birth >7 days (OR=1.992, 95%CI: 1.024-3.874).</p><p><b>CONCLUSIONS</b>Abnormal maternal pre-pregnancy BMI has adverse effects on the outcomes of LPI. In order to reduce these adverse outcomes BMI should be controlled within the normal range in pregnant women.</p>

A novel "box lesion" minimally invasive totally thoracoscopic surgical ablation for atrial fibrillation

<p><b>INTRODUCTION</b>Minimally invasive surgical ablation is an emerging alternative method to catheter ablation and the full surgical maze procedure for nonpharmacologic treatment of atrial fibrillation (AF). We present a totally thoracoscopic "box lesion" radiofrequency ablation procedure in patients with paroxysmal or persistent AF.</p><p><b>MATERIALS AND METHODS</b>From June 2011 to October 2012, 14 patients with lone paroxysmal (n = 7) or persistent AF (n = 7) were enrolled in this study. Procedures were performed through 3 5-12 mm holes on each side of the chest wall. A bipolar ablation device was used to create a box lesion in the posterior wall of the left atrium that encircled the 4 pulmonary veins (achieving bilateral pulmonary vein/posterior left atrial wall isolation). Perioperative complications were recorded for all patients. Freedom from AF was assessed by 24-hour Holter monitoring every 3 months or during symptoms of arrhythmia.</p><p><b>RESULTS</b>The ablation was successfully performed in all patients, with median operation time of 128 minutes (range, 45 to 180 minutes). No operative mortality or morbidity were noted during the study period. Freedom from AF was achieved in 12 patients (85.7%) during follow-up (median follow-up 9 months). One patient with persistent AF was shifted to paroxysmal AF. No atrial flutter or atrial tachycardia was noted during the follow-up.</p><p><b>CONCLUSION</b>These early results show that totally thoracoscopic surgical ablation using a unique "box lesion" procedure for persistent or paroxysmal AF is a feasible and effective method with good short-term results. Further study is necessary to validate this result.</p>

Expression of MACC1 protein in colorectal cancer and its relationship with clinicopathological characteristics / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of metastasis-associated colon cancer 1 (MACC1) protein in colorectal cancer and its clinical significance.</p><p><b>METHODS</b>Immunohistochemistry method was used to determine the expression of MACC1 protein in colorectal cancer and normal colorectal mucosal tissues (>5 cm distance to cancer tissue). Statistic analysis was performed to investigate the association between clinicopathologic features and MACC1 expression.</p><p><b>RESULTS</b>The positive rate of MACC1 protein in colorectal cancer tissues was significantly higher than that in normal tissues [75%(72/96) vs. 14.6%(14/96), P<0.01, χ(2)=68.43]. Expression of MACC1 protein was associated with TNM staging (P<0.01, χ(2)=16.82) and distant metastasis (P<0.01, χ(2)=10.53), but not with age, gender, tumor size, differentiation degree, invasion depth, and lymph node metastasis(all P>0.05). Positive rate of MACC1 expression increased with the advanced TNM staging. When distant metastasis occurred, high expression of MACC1 protein in cancer tissues was found. During median 13(4 to 21) months of follow-up, 7 patients died, including 6(8.3%, 6/72) with high expression and 1(4.2%, 1/24) with low expression. Distant metastasis occurred in 9 patients, including 7 with high expression and 2 with low expression. Two patients had local relapse, whose MACC1 expressions were both high.</p><p><b>CONCLUSION</b>MACC1 protein is highly expressed in colorectal cancer tissues, which may be associated with the invasion and metastasis of colorectal cancer.</p>

Clinical observation on epidemic hemorrhagic conjunctivitis by optical coherence tomography / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe thickness and morphological changes of bulbar conjunctiva pre- and post epidemic hemorrhagic conjunctivitis ( EHC ) therapy by optical coherence tomography ( OCT) . METHODS: Observed morphological changes and measured the bulbar conjunctiva thicknesses of 29 cases (36 eyes) of incipient (1-2d) EHC patients, who were received and treated by department of ophthalmology, the Putuo Affiliated Hospital of Shanghai University of Traditional Chinese Medicine from May 2013 to December 2013, by OCT. Then measured the thickness again on 7, 14d after the therapy. RESULTS: Among 29 patients (36 eyes), 7d after the EHC therapy, in 27 cured eyes, the full-thickness ( before 344. 00±59. 91μm, after 230. 19±22. 16μm, t=11. 75, PCONCLUSION: The OCT is able to measure the thickness of bulbar conjunctiva in EHC patients. An significant increase was found in full, epithelial and stromal thickness of EHC patients' bulbar conjunctiva. With recovery from the disease, subepithelial fluid, interlaminar fluid and edema of the bulbar conjunctival stroma faded away firstly, which provide references for clinical therapies of the EHC.

Comparative study on the morphology of crown, alveolar ridge crest and gingival in maxillary anterior region / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the correlation among the morphology of crown, alveolar ridge crest and gingiva in maxillary anterior region of adults and to provide anatomical basis for clinical implant esthetics.</p><p><b>METHODS</b>Sixty Han-Chinese with healthy peridontium were selected in this study. The curvature of labial alveolar crest, the length and height of inter-proximal bone were measured on 3-D model reconstructed from cone-beam CT (CBCT) images, and the curvature of free gingiva, the width and height of inter-dental papilla and central incisor crown were evaluated on casts. The ratio of crown width to height was ranked and the 10 ranked highest were categorized as group Short-Wide (SW), the 10 ranked lowest were selected as group Long-Narrow (LN).</p><p><b>RESULTS</b>In maxillary anterior region, the curvature angle of both alveolar crest and marginal gingiva were significantly different among different tooth regions, but the alveolar and gingival curvature was significantly correlated in the same region (P < 0.05). The morphology of inter-proximal bone and papilla was significantly correlated (P < 0.01), except the region between central and lateral incisors (P = 0.625, P > 0.05). Compared to group SW, group LN formed a pronounced scalloped contour of gingival margin (P = 0.002) and slender inter-dental papilla (P = 0.000).</p><p><b>CONCLUSIONS</b>The free gingival curvature and inter-dental papillary morphology are significantly correlated with the morphology of crown and alveolar ridge crest in maxillary anterior region of Han-Chinese. Individuals with long-narrow crown, pronounced scalloped marginal gingiva and slender inter-dental papilla are susceptible to risk implant esthetics.</p>

Application of Infliximab in treating of severe polyarticular juvenile idiopathic arthritis / 中华实用儿科临床杂志

Objective To investigate the safety and efficacy of infliximab in the treatment of severe polyarticular juvenile idiopathic arthritis(JIA).Methods Forty-four patients with severe polyarticular JIA were treated with infliximab (3 mg/kg) on week 0,2 and 6,respectively,and then they were treated every 8 weeks,plus methotrexate or and leflunomide for oral intake,and meanwhile physical therapy and functional rehabilitation were carried out.Patients were assessed by the American College of Rheumatology (ACR) response criteria (30,50,70) on week 2,6 and 14 and followed up,including swollen joint count,tender joint count,duration of morning stiffness and fever,body functions,lab inflammatory index like CRP,ESR changes.Results Among 44 cases,according to ACR response criteria,which represents 30％,50％,70％ improvement from baseline,the cure rates with infliximab therapy in swollen joint count,tender joint count,duration of morning stiffness,CRP,ESR were achieved in 47.7％ (21/44 cases),20.5％ (9/44 cases),and 11.4％ (5/44 cases) of patients with JIA on week 2 ; 63.6％ (28/44 cases),43.2％ (19/44 cases),and 13.6％ (6/44 cases) of patients on week 6 ;81.8％ (36/44 cases),52.2％ (23/44 cases),27.2％ (12/44 cases) on week 14,respectively.Inflammatory index like CRP,ESR with infliximab treatment decreased considerably compared that before treatment(P ＜0.05).Side effects from infliximab treatment were well-tolerated.There was no abnormality in the liver and kidneys or complicated infections,and no negative cases turned into the positive.Conclusions Treating severe polyarticular JIA with infliximab showed a rapid cure rate,safety and better tolerance.

Safety and efficacy of prophylactic single antibiotics administration in selective open colorectal surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the safety and efficacy of prophylactic single antibiotic administration in selective open colorectal surgery.</p><p><b>METHODS</b>Two hundred and seventy-five patients undergoing selective open colorectal surgery in the Peking Union Medical College Hospital from October 2009 to October 2011 were retrospectively reviewed. Prophylatic single antibiotic administration was used by intravenous infusion 30-60 min before incision. No antibiotics would be given after operation if there was no surgical site infection(SSI). According to the incidence of postoperative SSI, unexplained use of antibiotics, anastomotic leakage and distant-site infection, the clinical outcome was assessed to be prophylactic success, prophylactic failure or distant-site infection, respectively.</p><p><b>RESULTS</b>There was no intraoperative or postoperative antibiotics related drug anaphylaxis in all the 275 patients. By prophylactic single antibiotic administration, there were prophylactic success in 243 patients(88.4%,243/275), prophylactic failure in 23(8.4%,23/275), distant-site infection in 9(3.3%,9/275). In the 23 patients with failed prophylaxis, there were SSI in 13(4.7%,13/275) patients, postoperative use of broad-spectrum antibiotics for unexplained fever in 2(0.7%,2/275), postoperative anastomotic leakage in 8(3.6%,8/222).</p><p><b>CONCLUSION</b>Prophylactic single antibiotic administration in selective open colorectal surgery is safe and effective.</p>

Expression of hMLH1 in rectal intraepithelial neoplasm and early rectal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore whether the abnormality of hMLH1 gene may be an early event of carcinogenesis in rectal carcinoma, and to evaluate the diagnostic value in differentiation between intraepithelial neoplasm and early stage of colorectal carcinoma.</p><p><b>METHODS</b>The expression of hMLH1 protein in 28 cases with early invasive rectal carcinoma(EIRC), 36 cases with rectal intraepithelial neoplasm(RIEN), and 30 cases with normal rectal mucosa(NRM) which were collected through surgical operations were detected by PV-9000 immunohistochemical method.</p><p><b>RESULTS</b>The positive expression rates of hMLH1 protein were 100%(30/30), 77.8%(28/36), and 39.3%(11/28) in NRM, RIEN, and EIRC respectively. The difference was statistically significant between RIEN and EIRC(P=0.002), and the difference was also statistically significant between RIEN and NRM(P=0.006). The positive expression of hMLH1 was not related to age, gender, tumor maximum diameter, dysplasia, tumor types, and distance from the anal verge in RIEV group(P>0.05). In EIRC group, hMLH1 was associated with tumor differentiation(P<0.05).</p><p><b>CONCLUSION</b>hMLH1 gene deletion may be an early event during carcinogenesis of rectal carcinoma, which may be useful in differentiation of intraepithelial neoplasm from early rectal carcinoma.</p>

Acquiring laparoscopic skill for colorectal surgery: based on the experience of a colorectal surgeon / 中华外科杂志

<p><b>OBJECTIVE</b>Laparoscopic colorectal surgery is a skill-dependent procedure. The present study aims to analyze the learning curve of a properly trained surgeon, with basic laparoscopic techniques, to become skillful in performing laparoscopic colorectal operations.</p><p><b>METHODS</b>A series of non-selective, consecutive 189 cases of laparoscopic colorectal surgery were accomplished, from December 2009 to February 2012, by one surgeon with years of skilled technique in laparoscopic cholecystectomy, rich experience in assisting laparoscopic colorectal surgery, and experience of approximately 180 procedures of gastric and colorectal surgery annually. 170 out of 189 procedures were radical operations for colorectal neoplasma, including right colectomies in 28 cases, left colectomies in 5 cases, sigmoidectomies in 28 cases, high Dixon procedures in 45 cases, low Dixon (total mesorectal excision, TME) procedures in 41 cases and Miles procedure in 23 cases. 19 other patients underwent combined procedures for multi-primary tumors or inflammatory enteritis. All these procedures were analyzed according to time span (the earlier half and later half) in respect to length of surgery, intraoperative blood loss, number of lymph nodes retrieved, intraoperative events and postoperative complications.</p><p><b>RESULTS</b>For radical right colectomy, the D2 dissection conducted in the earlier phase (n = 8) had the similar length of surgery, more blood loss and less LN retrieval, compared with the D3 dissection conducted in recent phase (n = 20). The earlier performed high Dixon procedures (n = 22) consumed longer time than the later procedures (n = 23) consumed, but with similar blood loss and LN retrieval. Low Dixon (TME) procedures showed significant differences in length of surgery and blood loss relative to time span. Recently performed simoidectomy and Miles procedures showed a trend of shorter time consumed compared with earlier performed procedures. Conversion ratio to open surgery was 1.05%. Adverse effects occurred in 8 cases of surgeries, including intestinal injury (3/189), insufficient distal margin (2/189), intraoperative bleeding (2/189) and vaginal injury (1/76). There was no operative death. Chief complications included urinary retention 5.82%, ileus 4.76%, anastomotic leak 4.24%, perineal infection 23.08% (6/26), wound dehiscence 2.65%, gastrointestinal bleeding 1.59%, peritoneal infection 1.06%. Surgery for distal rectum tended to have more complications, such as urinary retention, anastomotic leak and perineal infection. The later performed low Dixon procedures produced insignificantly fewer anastomotic leaks than those in the earlier phase.</p><p><b>CONCLUSIONS</b>For a trained surgeon with basic laparoscopic techniques, there are at least 15 - 25 cases of different procedures needed for him/her to become skilled to perform laparoscopic surgery. The learning curve should also depend on the annual number of colorectal surgeries.</p>

Rituximab therapy for severe pediatric systemic lupus erythematosus / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze the safety and efficacy of anti-CD20 monoclonal antibody in treatment of severe pediatric systemic lupus erythematosus (PSLE).</p><p><b>METHOD</b>The diagnosis of PSLE was made according to the criteria for the classification of systemic lupus erythematosus revised by the American College of Rheumatology in 1997. Severe cases with PSLE was selected by the following criteria: age ≤ 16 years, number of important organs involved > 1, SLEDAI score > 10 points and poor response to conventional immunosuppressive treatment. These patients received 2 doses of 375 mg/m(2) rituximab (RTX), 2 weeks apart. Clinical, laboratory findings and drug side effects were recorded at RTX initiation, 2 weeks, 1 month, 3, 6 and 12 months after infusion.</p><p><b>RESULT</b>A total of 20 patients. Male to female ratio was 1:3, were enrolled. They were 5-16 years old. The course of disease was (3.0 ± 2.5) years (range: 1 month-7 years), patients were followed up for 12 - 36 months [median: (27.0 ± 7.8) months]. Delirium and cognitive disorders were significantly improved in 10 cases of lupus encephalopathy after 1 month. Lupus nephritis in children were eased slowly, 14/15 patients with lupus nephritis were improved after 2-3 months. Four cases of lupus pneumonia were significantly improved within 1 month. Decreased blood cells counts were relieved at 1 month in 16/18 cases. Cellular immune function was assessed 2 weeks after application of anti-CD20 monoclonal antibody; we found B-cell clearance in 19 patients (95%). B lymphocyte count of 18 patients (90%) was restored within one year. SLEDAI score was reduced obviously. Dose of corticosteroid ranged from (45.0 ± 4.7) mg/m(2) before drug use to (12.0 ± 2.7) mg/m(2) 12 months later (P < 0.001). After the drug use, 5 patients had pneumonia within 6 months; 2 cases who suffered from aspergillus pneumonia and Pneumocystis carinii pneumonia respectively were severe. They accepted mechanical ventilation and anti-inflammatory support after being transferred to the intensive care unit, and their conditions improved at last. No death occurred. In 2 patients the disease recurred with B-cell recovery after 15 months and 18 months. Administration of another cycle of rituximab resulted in remission again in one case but not in the other.</p><p><b>CONCLUSION</b>Anti-CD20 monoclonal antibody is effective and safe in treatment of severe PSLE. But severe infections may occur in some cases. Focusing on prevention and early treatment can reduce the probability of adverse reactions.</p>

Changes in plasma angiotensin II and circadian rhythm of blood pressure in hypertensive patients with sleep apnea syndrome before and after treatment / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To explore the changes in plasma angiotensin II (Ang II) and circadian rhythm of blood pressure among hypertensive patients with sleep apnea syndrome (SAS) before and after continuous positive airway pressure (CPAP) or surgical treatment.</p><p><b>METHODS</b>A total of 180 essential hypertension patients were enrolled in our study. The determination of plasma Ang II concentration, ambulatory blood pressure (ABP), and polysomnography (PSG) monitoring were performed before and 3 months after CPAP or surgical treatment.</p><p><b>RESULTS</b>Patients were classified into three groups by their apnea-hypopnea index (AHI): essential hypertension group (EH group, n = 72; AHI< 5), essential hypertension with mild SAS group (EH+mild SAS group, n = 60, 5 ≤ AHI < 20), and essential hypertension with moderate and severe SAS group (EH + moderate-severe SAS group, n = 48, AHI ≥ 20). The concentrations of plasma Ang2 in the above three groups were 13.42 ± 3.27, 16.17 ± 3.82, and 18.73 ± 4.05 ng/mL respectively before treatment, and Ang2 concentration in EH patients combined with SAS was significantly higher than that in EH group (all P < 0.05). After treatment the values in the latter two groups significantly decreased to 14.67 ± 2.56 and 15.03 ± 3.41 ng/mL respectively (P < 0.05). The incidence of non-dipper blood pressure curve in EH patients was 31.9%, and those in hypertensive patients with mild SAS and moderate-severe SAS were 51.7% and 58.3%, respectively before treatment. The incidence of non-dipper blood pressure curve in the EH patients with mild SAS was significantly higher than that of patients with EH alone (P < 0.05). After CPAP treatment or surgery, the incidence of non-dipper blood pressure curve in the two SAS groups was significantly decreased to 38.3% and 39.6%, respectively (P < 0.05).</p><p><b>CONCLUSIONS</b>Ang II might play a role in blood pressure variability in patients with obstructive SAS. CPAP or surgical treatment can improve blood pressure disorder and decrease plasma Ang II level in patients with obstructive SAS.</p>

Circadian blood pressure variability and plasma neopterin level before and after surgery for obstructive sleep apnea syndrome / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the change of circadian blood pressure variability (BPV) and plasma neopterin before and after surgery (uvulopalatopharyngoplasty) for patients with obstructive sleep apnea syndrome (OSAS).</p><p><b>METHODS</b>A total of 382 OSAS patients underwent uvulopalatopharyngoplasty were divided into three groups based on polysomnography (PSG) results: mild OSAS (n = 206), moderate OSAS (n = 108) and severe OSAS (n = 68). Plasma neopterin, 24-hour ambulatory blood pressure monitoring (ABPM), PSG were measured before and 3 months after surgery.</p><p><b>RESULTS</b>Plasma neopterin increased in proportion to severity of OSAS before surgery (15.08 nmol/L, 27.68 nmol/L and 37.32 nmol/L in patients with mild to severe OSAS) which were significantly reduced post surgery (9.92 ng/ml, 15.07 ng/ml and 18.54 ng/ml, all P < 0.05 vs. pre-surgery). The incidence of non-dipper curve in three OSAS groups were 50.2%, 72.7% and 86.5%, respectively before surgery and the values decreased to 34.8%, 48.2% and 49.2% after surgery (all P < 0.05 vs. pre-surgery). Relevance analysis indicates that D-value of nocturnal and diurnal blood pressure was negatively correlated with plasma neopterin.</p><p><b>CONCLUSION</b>Our findings indicated that plasma neopterin and the incidence of non-dipper could reliably reflect OSAS severity and could thus be used to evaluate the surgery efficacy. Plasma neopterin might be an important player in the pathophysiology of OSAS via modulating blood pressure variability.</p>

Effect of nitric oxide derived from endothelial nitric oxide synthase on tumor angiogenesis / 癌症

<p><b>BACKGROUND AND OBJECTIVE</b>Studies have shown that nitric oxide (NO) derived from endothelial nitric oxide synthase (eNOS) is expressed widely in tumor tissues and regulates tumor angiogenesis. However, the results are controversial. This study was to investigate the effect of NO on tumor angiogenesis and its mechanism.</p><p><b>METHODS</b>C57BL/6 mice inoculated with Lewis lung cancer cells were randomly divided into three groups. Mice in the NO group were inoculated with lung cancer cells transfected with eNOS gene, mice in the L-NAME group with L-NAME, an eNOS antagonist, and mice in the control group with normal saline. Plasma concentration of NO and the number of endothelial progenitor cells (EPCs) in peripheral blood were detected . Tumor vessel density, CD133+ cells, and the expression of VEGF-VEGFR in tumor tissues were also measured.</p><p><b>RESULTS</b>Four weeks after inoculation of Lewis cells, tumor volume was significantly larger in control group [ (3022 +/- 401) mm(3)] than in the L-NAME group [ (1204 +/-97) ) mm(3)] and in the eNOS group [(1824 +/- 239) mm(3)] (P<0.01). eNOS protein and NO production increased significantly in Lewis lung cancer cells transfected with eNOS gene. But the number of CD133-positive cells and vessel density in tumors were significantly lower in the eNOS group than in the control group [(48+/-19) / HPF vs. ( 103 +/- 27)/ HPF, (19+/- 7) HPF vs. (31 +/- 9) HPF, P<0.05]. The number of EPCs in peripheral blood was not statistically different between each group. The levels of NO in blood and tumor tissue significantly decreased after the treatment of L-NAME, while the tumor vessel density reduced to 12+/- 5/ HPF (P<0.01, vs. the control group; P<0.05, vs the eNOS transfected group). The number of EPCs in blood and that of CD133-positive cells in tumor tissue were significantly smaller in the L-NAME group than in the control group (P<0.05).</p><p><b>CONCLUSION</b>No derived from eNOS inhibits angiogenesis and tumor growth, which may be due to its suppression on either the mobilization or homing of EPCs via VEGF binding to VEGFR.</p>