Immune checkpoint inhibitors induced pituitary immune-related adverse events: diagnosis and management / 中华肿瘤杂志

Immune checkpoint inhibitors (ICIs) have been used in treating a wide variety of cancers, but they challenge clinicians with a series of special immune related adverse events (irAEs) resulting from activated immune system. Since June 2018, when the first programmed cell death 1 (PD-1) inhibitor, nivolumab, was approved by the National Medical Products Administration (NMPA), abundant experience has been accumulated in coping with irAEs from PD-1 and PD-1 ligand 1 (PD-L1) blockade therapies. In October 2021, the first CTLA-4 inhibitor, ipilimumab, which has a different spectrum of irAEs was also approved by NMPA. The discrepancy in clinical features of pituitary irAEs is obvious between these two types of ICIs. Pituitary irAEs include hypophysitis and hypopituitarism. In this review of latest literature, we have summarized the incidence, possible mechanisms, time of onset, clinical presentations, hormone test, pituitary imaging, treatment strategies and recovery patterns of pituitary irAEs. By referring to domestic and foreign clinical guidelines, we have proposed practical suggestions for screening, diagnosing and treating pituitary irAEs.

Pituitary immune-related adverse events induced by programmed cell death protein 1 inhibitors in advanced lung cancer patients: A report of 3 cases / 北京大学学报(医学版)

Pituitary immune-related adverse events induced by programmed cell death protein 1 inhibitors in advanced lung cancer patients: A report of 3 cases SUMMARY Programmed cell death protein 1 (PD-1) and its ligand 1 (PD-L1) have been widely used in lung cancer treatment, but their immune-related adverse events (irAEs) require intensive attention. Pituitary irAEs, including hypophysitis and hypopituitarism, are commonly induced by cytotoxic T lymphocyte antigen 4 inhibitors, but rarely by PD-1/PD-L1 inhibitors. Isolated adrenocorticotropic hormone(ACTH) deficiency (IAD) is a special subtype of pituitary irAEs, without any other pituitary hormone dysfunction, and with no enlargement of pituitary gland, either. Here, we described three patients with advanced lung cancer who developed IAD and other irAEs, after PD-1 inhibitor treatment. Case 1 was a 68-year-old male diagnosed with metastatic lung adenocarcinoma with high expression of PD-L1. He was treated with pembrolizumab monotherapy, and developed immune-related hepatitis, which was cured by high-dose methylprednisolone [0.5-1.0 mg/(kg·d)]. Eleven months later, the patient was diagnosed with primary gastric adenocarcinoma, and was treated with apatinib, in addition to pembrolizumab. After 17 doses of pembrolizumab, he developed severe nausea and asthenia, when methylprednisolone had been stopped for 10 months. His blood tests showed severe hyponatremia (121 mmol/L, reference 137-147 mmol/L, the same below), low levels of 8:00 a.m. cortisol (< 1 μg/dL, reference 5-25 μg/dL, the same below) and ACTH (2.2 ng/L, reference 7.2-63.3 ng/L, the same below), and normal thyroid function, sex hormone and prolactin. Meanwhile, both his lung cancer and gastric cancer remained under good control. Case 2 was a 66-year-old male with metastatic lung adenocarcinoma, who was treated with a new PD-1 inhibitor, HX008, combined with chemotherapy (clinical trial number: CTR20202387). After 5 months of treatment (7 doses in total), his cancer exhibited partial response, but his nausea and vomiting suddenly exacerbated, with mild dyspnea and weakness in his lower limbs. His blood tests showed mild hyponatremia (135 mmol/L), low levels of 8:00 a.m. cortisol (4.3 μg/dL) and ACTH (1.5 ng/L), and normal thyroid function. His thoracic computed tomography revealed moderate immune-related pneumonitis simultaneously. Case 3 was a 63-year-old male with locally advanced squamous cell carcinoma. He was treated with first-line sintilimab combined with chemotherapy, which resulted in partial response, with mild immune-related rash. His cancer progressed after 5 cycles of treatment, and sintilimab was discontinued. Six months later, he developed asymptomatic hypoadrenocorticism, with low level of cortisol (1.5 μg/dL) at 8:00 a.m. and unresponsive ACTH (8.0 ng/L). After being rechallenged with another PD-1 inhibitor, teslelizumab, combined with chemotherapy, he had pulmonary infection, persistent low-grade fever, moderate asthenia, and severe hyponatremia (116 mmol/L). Meanwhile, his blood levels of 8:00 a.m. cortisol and ACTH were 3.1 μg/dL and 7.2 ng/L, respectively, with normal thyroid function, sex hormone and prolactin. All of the three patients had no headache or visual disturbance. Their pituitary magnetic resonance image showed no pituitary enlargement or stalk thickening, and no dynamic changes. They were all on hormone replacement therapy (HRT) with prednisone (2.5-5.0 mg/d), and resumed the PD-1 inhibitor treatment when symptoms relieved. In particular, Case 2 started with high-dose prednisone [1 mg/(kg·d)] because of simultaneous immune-related pneumonitis, and then tapered it to the HRT dose. His cortisol and ACTH levels returned to and stayed normal. However, the other two patients' hypopituitarism did not recover. In summary, these cases demonstrated that the pituitary irAEs induced by PD-1 inhibitors could present as IAD, with a large time span of onset, non-specific clinical presentation, and different recovery patterns. Clinicians should monitor patients' pituitary hormone regularly, during and at least 6 months after PD-1 inhibitor treatment, especially in patients with good oncological response to the treatment.

Establishment of Acquired Aplastic Anemia SD Rat Model / 中国实验血液学杂志

OBJECTIVE@#To establish a stable and rapidly rat model acquired aplastic anemia.@*METHODS@#The SD rats were exposed to Csγ-ray at 3.5 and 4.0 Gy ( 91 cGy/min), and intraperitoneally injected with CTX at 35 mg/( kg·d) and CHL at 45 mg/( kg·d) in d 4, 6 and 8 after irradiation; the WBC, platelet and reticulocyte counts in peripheral blood, the smears and nucleated cells counts of bone marrow were observed.@*RESULTS@#The levels of peripheral blood 3-lineage cells of SD rats treated with Csγ-irradiation combined with cyclophosphamide and chloramphenicol were significantly reduced, among which white blood cells, platelets and reticulocytes decreased rapidly, and the number of bone marrow nucleated cells decreased significantly; bone marrow pathological sections showed severe reduction of hematopoietic cells, and the non-hematopoietic cells such as fat cells increased, and a serve or lightly reduction of bone marrow cells were found.@*CONCLUSION@#The rat model established by Csγ-ray irradiation combined with cyclophosphamide and chloramphenicol meets the clinical characteristics of aplastic anemia, and this study provides a stable rat model for the study of new therapeutic drugs for acquired aplastic anemia.

Effect of miR-145 on MCF-7 breast cancer cells by regulating disintegrin-metalloproteinase-17 / 医学研究生学报

Objective MicroRNA-145 (miR-145) is underexpressed in breast cancer. The study aimed to explore the regulatory effect of miR-145 on breast cancer MCF-7 cells by investigating the association of miR-145 with ADAM17 and EGFR. Methods The MCF-7 breast cancer cells were divided into three groups: the transfection group (transfected with microRNA-145 mimics), the control group (without transfection) and the nonsense sequence group (transfected with nonsense microRNA). MTT, transwell and real-time quantitative fluorescence polymerase chain reaction(qPCR) were respectively used to detect the proliferative capacity, invasive ability and expression of MCF-7 breast cancer cells after the transfection of miR-145 in three groups. ADAM17 and EGFR mRNA and protein levels in three groups of breast cancer MCF-7 cells were detected by qPCR and western blot. Results The results of qPCR showed that the relative expression of miR-145 was significantly higher in transfection group (13964.33±1265.30) than those in control group (1.00±0.05) and nonsense sequence group (1.03±0.15) and the difference was statistically significant (P<0.01); the expression of ADAM17 mRNA in transfection group (1.71±0.08) was significantly higher than that in control group (1.00±0.07) and the difference was statistically significant (P<0.01). Compared with the nonsense sequences at 24 h, 48 h, and 72 h, the inhibition rate of MCF-7 in transfection group was significantly increased (P<0.01). The results of transwell invasion showed that the number of transmembrane cells in transfection group [(56.20±2.17)/field] was significantly lower than those in control group [(92.80±3.90)/field] and nonsense sequence group [(91.80±4.97)/field of view ] (P < 0.01). Western blot results showed that the protein content of ADAM17 and EGFR in transfection group was significantly lower than those in the control group and the nonsense sequence group (P<0.01). Conclusion MiR-145 inhibits the proliferation and invasion of breast cancer MCF-7 cell line by acting on the ADAM17-EGFR signaling pathway.

Establishment of Cs γ ray Combined with Cyclophosphamide and Chloramphenicol-Mediated Mouse Model of Acquired Aplastic Anemia / 中国实验血液学杂志

OBJECTIVE@#To improve and establish the mouse model with aplastic anemia (AA) mediated by Cs γ-ray irradiation combined with cyclophosphamide (CTX) and chloramphenicol (CHL) injection,so as to provide a stable model for studying the pathogenesis and treatment of AA .@*METHODS@#The BALB/c mice were exposed to Cs γ-ray of 3-5 Gy(91 cGy/min) and were intraperitoneally injected with CTX of 25 mg/(kg.d) and CHL of 62.5 mg/(kg.d) at D 4,5 and 6 after irradiation; the WBC, platelet and reticulocyte counts in peripheral blood as well as the mucleated cell count in bone marrow and bone marrow smears were detected .@*RESULTS@#The 3-lineage cells in peripheral blood of BALB/c mouse model with acquired AA were rapidly reduced, especially WBC, platelet and reticulocyte counts were lowest at D 14,the 3-lineage cells in peripheral blood were still severely reduced at D 28; the nucleated cell count in bone marrow significantly dcreased,the bone marrow hyperplasia was reduced or severely reduced; the pathological sections of bone marrow showed the severe reduction of hematopoietic cells and the increased of non-hematopoietic cells such as fat cells.@*CONCLUSION@#The mouse model with acquired AA has been established by Cs γ-ray irradiation combined with CTX and CHL injection. All detection indicators of this model reach to diagnostic criteria for acquired AA,therefore this mouse model may be used as the model for study of pathogenesis and treatment of acquired AA.

Effect of Diosgenin on Expressions of PPARγ, C/EBPα and Adipokine Secretion in Aplastic Anemia Mice / 中国实验方剂学杂志

Objective: To observe the effect of diosgenin on aplastic anemia (AA) mice and peroxisome proliferator activated receptor γ (PPARγ), CCAAT-enhancer binding protein α (C/EBPα), Adiponectin, Leptin, in order to discuss the potential mechanism of bone marrow mesenchymal stem cells in the process of adipemia. Method: BALB/c mice were randomly divided into control group and model group. The model group was established by 60Coy irradiation combined with tail vein infusion with lymphatic suspension cells of DBA/2 mice. After successful evaluation of the model, the mice were randomly divided into 6 groups:model group, low, medium and high-dose diosgenin groups (37.44,74.88,149.76 mg·kg-1·d-1), cyclosporine group (23.5 mg·kg-1·d-1), and tripterygium glycoside group (9.36 mg·kg-1·d-1), and given corresponding drugs by gavage for 14 days. After the intervention, the peripheral blood of mice in each group was detected, and bone marrow smears were collected to evaluate the proliferation of bone marrow. Bone marrow mesenchymal stem cells (BMMSCs) were isolated and cultured by adherent method and induced by adipogenesis. The mRNA and protein expressions of PPARγ, C/EBPα, Adiponectin, Leptin in BMMSCs were detected by quantitative real-time fluorescent quantitative polymerase chain reaction(Real-time PCR) and Western blot. Result: The white blood cell (WBC), hemoglobin (HGB) and blood platelet (PLT) in peripheral blood of model group were significantly lower than those of normal group (PPγ, C/EBPα, Adiponectin and Leptin in BMMSCs of the model group increased significantly (Pγ, C/EBPα, Adiponectin and Leptin in the middle-dose group diosgenin decreased obviously, which was better than those of Tripterygium glycoside group (P0.05). Conclusion: Diosgenin can promote the recovery of peripheral blood in aplastic anemia mice and improve the hematopoiesis of bone marrow. Diosgenin can reduce the expressions of PPARγ and C/EBPα, the formation of adipocytes and the secretion of Adiponectin and Leptin in adipocytes, and effectively inhibit the process of adipose tissue derived from bone BMMSCs.

Research Progress on the Establishment of Animal Model with Immune Thrombocytopenic Purpura - Review / 中国实验血液学杂志

Immune thrombocytopenic purpura (ITP) is a chronic and recurrent autoimmune disease, which seriously affects the life quality of patients. At present, a series of new advances have been made in the pathogenesis of ITP, particularly, in the abnormal cellular immunity. However, in the medical studiess generally research of ITP cellular immunity was limited. Therefore, it is urgent to establish an ideal ITP model for the study of ITP pathogenesis, so as to contribute to promote the ITP new treatment progeamme. In this review, the passive modeling inclinding anti-platelet serum modeling, monoclonal antiboty modeling, and active modeling including NZW× BXSB rat modeling, antigenic mimicry modeling, immune splenic cell transplantation modeling, transgenic model, fetal and neonatal allsimmune thrombocytopenia modeling and so on, are summarized.

The protective effect of Klotho on apoptosis of MC3T3-E1 osteoblasts induced by dexamethasone / 中国药理学通报

Aim To explore the effect of Klotho (KL) gene transfection on the apoptosis of MC3T3-E1 osteo-blasts induced by dexamethasone(DEX). Methods MC3T3-E1 osteoblasts were transfected by recombinant adenovirus containing KL gene(Ad-KL) and recombi-nant adenovirus containing green fluorescent protein (GFP) gene(Ad-GFP). The apoptosis model was con-structed. The transfection efficiency of Ad-KL and Ad-GFP in cells were observed using inverted fluorescent microscope, and the level of KL mRNA and protein was detected by qPCR and Western blot,respectively. The cell viability after different concentrations of DEX acting on the cells and the viability of every research group were determined by cell counting kit-8 (CCK-8) assay. The apoptotic rate was evaluated by flow cytom-etry. The level of mRNA and protein was analyzed by qPCR and Western blot, respectively. The level of caspase-9 protein was detected by immunofluorens-cence assay. Results Cells were transfected by Ad-KL and Ad-GFP successfully. KL group and KL +DEX group had higher level of KL mRNA and protein than that in other groups. The optimum concentration of DEX was 2.0 mmol·L-1. When DEX acting on the cells, the cells viability decreased and apoptotic rate increased obviously in DEX group and GFP + DEX group. The level of Bax mRNA and protein presented a upward trend in DEX group and GFP +DEX group, while the level of Bcl-2 mRNA and protein was oppo-site. But after KL transfecting MC3T3-E1 osteoblasts, the markers described above in KL group had more dramatic improvement than in DEX group and KL +DEX group. Conclusions High-dosage DEX can in-duce the apoptosis of MC3T3-E1 osteoblasts, and the pro-apoptosis effect of high-dosage DEX in MC3T3-E1 osteoblasts can be suppressed by up-regulating KL gene expression level, suggesting that the glucocorticoid-in-duced osteoporosis might be improved by up-regulating KL gene expression level, and it may be a new target for the treatment of latrogenic osteoporosis induced by high-dosage glucocorticoid in clinic.

Selective inhibition of endothelin receptor A improves white matter le-sions in hypertensive rats / 中国病理生理杂志

AIM:To observe whether selective inhibition of endothelin receptor A(ETRA)improves white matter lesions(WMLs),and explore the mechanism.METHODS:Sprague-Dawley rats(n=33)were randomly divided into sham operation group(n=9),treatment group[stroke-prone renovascular hypertensive rats-modified 2 vessel occlu-sion(RHRSP-modified 2VO)+ambrisentan(n=12)]and placebo group[RHRSP-modified 2VO +vehicle(n =12)].Drug and vehicle administration was performed from 17th to 20th week and monitoring of systolic arterial pressure was performed weekly.Morris water maze test was conducted to evaluate the function of cognition.The protein levels of en-dothelin-1(ET-1)in the cortex,corpus callosum and caudate putamen were quantitatively analyzed respectively.The se-verity of WMLs and the relationship between ET-1 and vessels were observed by the method of histopathology.RESULTS:The difference of systolic arterial pressure between treatment group and placebo group was not significant.The animals in treatment group exhibited shorter escape latency(P<0.05),more times of crossing platform(P<0.05), lower level of ET-1 in corpus callosum and caudate putamen(P<0.05),respectively,improved WMLs severity(P<0.05)and lower binding level of ET-1 to vessels compared with the placebo group.CONCLUSION: Selective inhibition of endothelin receptor A improves the severity of WMLs and ameliorates the cognitive function.

An in vivo and in vitro study on the effect of tooth liquid polish seaIant on the bond strength of orthodontic brackets / 中国组织工程研究

BACKGROUND: BISCOVER LV is a low-viscosity, ligh-cured resin formulation that can be directly coated on the tooth enamel surface for resin polishing inside and outside the mouth or bracket bonding for enamel demineralization. OBJECTIVE: To evaluate the effect of tooth liquid polish sealant on the shear bond strength of orthodontic brackets and the failure rate of bracket bonding. METHODS: (1) In vivo test: 30 teenager patients under orthodontic treatment were randomly selected. BISCOVER LV was used to deal with the upper and lower dentitions on the left side, and then the brackets were bonded by a light-cured resin adhesive (Transbond XT). The upper and lower dentitions on the right side were directly bonded with the brackets by Transbond XT. After 1 month, the failure rate of bracket bonding was detected in each patient. (2) In vitro test: 60 extracted orthodontic teeth were selected and randomized into two groups:BISCOVER LV group and non-BISCOVER LV group. The following procedures in the in vitro test were the same as those in the in vivo test. Two groups of specimens were thereafter soaked in the artificial saliva, the shear bond strength of the brackets was tested, and then the adhesive remnant index was recorded. RESULTS AND CONCLUSION: (1) In the in vivo test, there was no significant difference in the failure rate of bracket bonding between two clinical groups (11.43% vs. 9.64%; P＞0.05). (2) In the in vitro test, there was no significant difference in the shear bond strength of the brackets[(9.24±2.06) MPa vs. (9.59±2.24) MPa; P＞0.05] as well as in the adhesive remnant index record between the two groups. Therefore, we can make the conclusion that the use of tooth liquid polish sealant for prevention of enamel demineralization has no effect on the bond strength of brackets.

The research progress on Notch signaling pathway in the regulation of Treg/Th17 cells / 天津医药

Notch family,a kind of important transmembrane signaling proteins,is highly evolutionarily conserved in the development process of multicellular organisms. Notch signaling pathway can precisely regulate cell development process through the interaction between neighboring cells,such as cell proliferation,differentiation and apoptosis.The regulatory T (Treg)cells and T helper 17(Th17)cells are new types of CD4+T cell subsets.In the physiological state of the organism,they can secrete relevant various kinds of cytokines,and systematically regulate the balance of immune system.In recent years, more and more studies have found that close relationship between Notch signaling pathway and Treg/Th17 cell balance, which is extensively involved in the various diseases. Therefore, this paper briefly reviewed the regulation mechanism of Notch signaling pathway on Treg/Th17 cells in diseases such as hematological diseases and autoimmune diseases.

Research progress on biologic repair of rotator cuff injury / 天津医药

Rotator cuff injury is a common shoulder disease,which often results in pain and limited motion of shoulder and reduces the quality of life.There are some limitations for current treatments,which often lead to repair failure or reinjury of rotator cuff.Therefore,a novel repair technique is needed.Biologic repair represents a novel technique in the management of rotator cuff injury,and has the potential to restore the normal histological structure of rotator cuff.Biologic repair involves the application of growth factors and/or cells to promote the regeneration of rotator cuff tendons. This study reviewed the literatures on biologic repair of rotator cuff injury,and presented the research progress.

Differentiation of human umbilical cord-derived mesenchymal stem cells into annulus fibrosus-like cells by co-culture / 临床与实验病理学杂志

Purpose To induce the differentiation of hu-man umbilical cord mesenchymal stem cells ( HUCMSCs) into annulus fibrosus (AF) cells by in vitro co-culture technique and to investigate the morphological and histological changes of HUCMSCs after co-culture. Methods HUCMSCs and AF cells were isolated from the normal neonatal umbilical cord and New Zealand white rabbit. Transwell six-well plates were used for co-culture with the cells seeded at the ratio of 1 ∶ 1, HUCMSCs cultured alone served as controls. After two weeks of co-culture, morphological changes were observed by inverted microscope. Real-time PCR was used to detect the expression of typeⅠcolla-gen, aggrecan and SOX-9 gene in HUCMSCs. Immunocyto-chemical staining and toluidine blue staining were used to detect the synthesis of cell matrix such as type Ⅰ collagen and aggre- can. Results The morphology of HUCMSCs in control group was long-fusiform, the morphology of HUCMSCs in co-culture gradually became short-fusiform or polygonal, and began to ap-pear synapse, showing the morphological features of AF-like cells. Real-time PCR results showed that typeⅠcollagen, aggre-can and SOX-9 mRNA were significantly increased in the co-cul-ture group (P＜0. 05). Immunocytochemical staining and tolui-dine blue staining showed that type I collagen and aggrecan were positive, respectively. Conclusion In vitro co-culture technol-ogy can induce HUCMSCs to differentiate into AF-like cells, which is expected to provide a new kind of seed cells for the bio-logical treatment of degenerative disc disease.

Progress on side effects of drugs induced by aortic binding / 中国药理学与毒理学杂志

Some drugs, such as hydralazine, imidazole, muzolimine, rofecoxib, AZD5248 and ZD4407, have aortic binding character. The mechanism by which aortic binding impairs of elastin formation is analyzed here.Aortic binding research methods,such as[14C]labeled compound quantitative analysis,quantitative whole body autoradiography studies,in vitro benzaldehyde and propionic aldehyde reactivity assay and in vitro[14C]labeled compound competitive aortic tissue binding assay,are summa-rized.Studies show that aorta binding may induce side effects of drugs,which should become a health concern.

Risk factors of polycystic ovarian syndrome among Li People

OBJECTIVE@#To study the relevant risk factors of polycystic ovarian syndrome (PCOS) of Li People so as to provide basis for early diagnosis and treatment of PCOS.@*METHODS@#With case-control study method, 285 cases of PCOS of Li People were as recruited case group, and 580 cases of non-PCOS of female Li People as control group. Questionnaire was adopted to collect data regarding risk factors of PCOS, then the risk factors of PCOS was searched by univariate and multivariate analysis.@*RESULTS@#Multivariate analysis showed that the risk factors of PCOS included in menstrual cycle disorder (OR = 5.824), bad mood (OR = 2.852), family history of diabetes (OR = 7.008), family history of infertility (OR = 11.953), menstrual irregularity of mother (OR = 2.557) and lack of physical exercise (OR = 1.866).@*CONCLUSIONS@#To target the high risk factors of menstrual cycle disorder, family history of diabetes, family history of infertility, family history of diabetes, bad mood and lack of physical exercise of female population, we should implement early screen, diagnose and treatment of POCS in order to reduce the incidence rate of PCOS and improve prognosis of PCOS.

Risk factors of polycystic ovarian syndrome among Li People

Objective: To study the relevant risk factors of polycystic ovarian syndrome (PCOS) of Li People so as to provide basis for early diagnosis and treatment of PCOS. Methods: With case-control study method, 285 cases of PCOS of Li People were as recruited case group, and 580 cases of non-PCOS of female Li People as control group. Questionnaire was adopted to collect data regarding risk factors of PCOS, then the risk factors of PCOS was searched by univariate and multivariate analysis. Results: Multivariate analysis showed that the risk factors of PCOS included in menstrual cycle disorder (OR = 5.824), bad mood (OR = 2.852), family history of diabetes (OR = 7.008), family history of infertility (OR = 11.953), menstrual irregularity of mother (OR = 2.557) and lack of physical exercise (OR = 1.866). Conclusions: To target the high risk factors of menstrual cycle disorder, family history of diabetes, family history of infertility, family history of diabetes, bad mood and lack of physical exercise of female population, we should implement early screen, diagnose and treatment of POCS in order to reduce the incidence rate of PCOS and improve prognosis of PCOS.

Observation of long-term efficacy and life quality in allergic rhinitis treated with acupoint catgut embedding therapy combined with acupuncture-moxibustion therapy / 中国针灸

<p><b>OBJECTIVE</b>To observe the impacts of acupoint catgut embedding therapy and acupuncture-moxibustion therapy on the long-term efficacy and patient's life quality in the treatment of allergic rhinitis.</p><p><b>METHODS</b>Sixty-nine patients were randomized into the combined acupuncture-moxibustion and acupoint catgut embedding therapy group (combined therapy group, 36 cases) and an acupuncture-moxibustion group (33 cases). In the acupuncture-moxibustion group, acupuncture was applied at Yingxiang (LI 20), Shangyingxiang (EX-HN 8), Yintang (GV 29), Shangxing (GV 23), Tongtian (BL 7) and Zusanli (ST 36). Moxibustion was applied at Zusanli (ST 36), Feishu (BL 13), Dazhui (GV 14) and Fengmen (BL 12). In the combined therapy group, on the basis of the treatment as acupuncture-moxibustion group, the catgut embedding therapy was applied at Feishu (BL 13), Fengmen (BL 12), Pishu (BL 20), Shenshu (BL 23), Zhongwan (CV 12) and Qihai (CV 6). The treatment duration was 4 weeks in the two groups. The clinical efficacy of allergic rhinitis and rhinoconjunctivitis quality of life questionnaire (RQLQ) score were observed before and after treatment as well as in the 4-weeks follow-up after the end of treatment respectively.</p><p><b>RESULTS</b>The markedly effective rate was 72.7% (24/33) in the combined therapy group and 48.4% (15/31) in the acupuncture-moxibustion group after treatment. The efficacy was similar between the two groups (P > 0.05). It was 57.6% (19/33) in the combined therapy group and was 22. 6% (7/31) in the 4-week follow-up after treatment, indicating the long-term efficacy in the combined therapy group was superior to that in the acupuncture-moxibustion group (P<0. 05). Scores of RQLO after treatment and in 4-week follow-up after treatment in both groups were improved as compared with those before treatment (all P < 0.05). In 4-week follow-up, the improvements in sleep and affection in the combined therapy group were superior to the acupuncture-moxibustion group (3.27 +/- 3.23 vs 4.61 +/- 3.56, 3.48 +/- 3.67 vs 5.81 +/- 4.15, both P < 0.05).</p><p><b>CONCLUSION</b>The acupoint catgut embedding therapy combined with acupuncture-moxibustion therapy are safe and effective in the treatment of allergic rhinitis and display the more roles in the long-term efficacy.</p>

In vitro cartilage production using an extracellular matrix-derived scaffold and bone marrow-derived mesenchymal stem cells / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Cartilage repair is a challenging research area because of the limited healing capacity of adult articular cartilage. We had previously developed a natural, human cartilage extracellular matrix (ECM)-derived scaffold for in vivo cartilage tissue engineering in nude mice. However, before these scaffolds can be used in clinical applications in vivo, the in vitro effects should be further explored.</p><p><b>METHODS</b>We produced cartilage in vitro using a natural cartilage ECM-derived scaffold. The scaffolds were fabricated by combining a decellularization procedure with a freeze-drying technique and were characterized by scanning electron microscopy (SEM), micro-computed tomography (micro-CT), histological staining, cytotoxicity assay, biochemical and biomechanical analysis. After being chondrogenically induced, the induction results of BMSCs were analyzed by histology and Immunohisto-chemistry. The attachment and viability assessment of the cells on scaffolds were analyzed using SEM and LIVE/DEAD staining. Cell-scaffold constructs cultured in vitro for 1 week and 3 weeks were analyzed using histological and immunohistochemical methods.</p><p><b>RESULTS</b>SEM and micro-CT revealed a 3-D interconnected porous structure. The majority of the cartilage ECM was found in the scaffold following the removal of cellular debris, and stained positive for safranin O and collagen II. Viability staining indicated no cytotoxic effects of the scaffold. Biochemical analysis showed that collagen content was (708.2-44.7) µg/mg, with GAG (254.7 ± 25.9) µg/mg. Mechanical testing showed the compression moduli (E) were (1.226 ± 0.288) and (0.052 ± 0.007) MPa in dry and wet conditions, respectively. Isolated canine bone marrow-derived stem cells (BMSCs) were induced down a chondrogenic pathway, labeled with PKH26, and seeded onto the scaffold. Immunofluorescent staining of the cell-scaffold constructs indicated that chondrocyte-like cells were derived from seeded BMSCs and excreted ECM. The cell-scaffold constructs contained pink, smooth and translucent cartilage-like tissue after 3 weeks of culture. We observed evenly distributed cartilage ECM proteoglycans and collagen type II around seeded BMSCs on the surface and inside the pores throughout the scaffold.</p><p><b>CONCLUSION</b>This study suggests that a cartilage ECM scaffold holds much promise for in vitro cartilage tissue engineering.</p>

Effects of sorafenib combined with chemoembolization and radiofrequency ablation for large, unresectable hepatocellular carcinomas / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The prognosis of unresectable large hepatocellular carcinomas is poor. This study evaluated the efficacy and safety of sorafenib combined with transcatheter arterial chemoembolization and radiofrequency ablation in the treatment of hepatocellular carcinomas larger than 5 cm.</p><p><b>METHODS</b>The treatment of 22 patients with large, unresectable hepatocellular carcinomas (5.0-16.5 cm) treated with sorafenib after transcatheter arterial chemoembolization combined with radiofrequency ablation between 2007 and 2011 was reviewed. The local effects, survival rates, toxicity, and prognostic factors were analyzed.</p><p><b>RESULTS</b>During a follow-up of 9-49 months, 19 patients died and three survived. The median overall survival was 32 months. The overall cumulative 12, 24, and 36-month survival rates were 85.9%, 66.8%, and 23.5% respectively. Technical effectiveness was achieved in 12 out of 28 lesions (42.85%) at the first CT check. The median time to tumor progression was 21 months. The progression-free survival rates at 6, 12, and 24 months were 90.9%, 72.0%, and 38.4%, respectively. Combined therapy was generally well tolerated. There was only one major procedure-related complication, biloma (4.5%). Sorafenib-related adverse events exceeding grade 3 were hand-foot skin reaction (2/22, 9.1%), gastrointestinal hemorrhage (1/22, 4.5%), and diarrhea (2/22, 9.1%). The absence of vascular invasion before treatment was found to be the best prognostic factor in the univariate analysis.</p><p><b>CONCLUSIONS</b>Sorafenib combined with transcatheter arterial chemoembolization and radiofrequency ablation is a promising approach to the treatment of large, unresectable hepatocellular carcinomas. However, large-scale randomized clinical trials are needed to determine the future role of this treatment.</p>

Effects of different decellularization methods on biomechanical properties and histological structure of annulus fibrosus in pigtail / 医用生物力学

Objective To investigate effects of different de-cellularization methods on biomechanical properties and histological structure of annulus fibrosus in pigtails and provide experimental evidence for the construction of tissue engineering annulus fibrosus. Methods Sixty Fresh annulus fibrosus were dissected from caudal disks of pigs and randomly assigned to 4 groups with 15 in each group. Triton X-100 group(Group A): annulus fibrosus were treated with hypotonic Tris-HCl buffer for 48 hours and de-cellularized with Triton X-100, DNase Ⅰ and RNase A. SDS group (Group B): annulus fibrosus were subjected to 3 cycles of freeze-thaw and subsequently de-cellularized with SDS, DNaseⅠ and RNase A. Trypsin group (Group C): annulus fibrosus were de-cellularized with Tris buffer containing trypsin, DNase Ⅰ and RNase A. Control group: fresh annulus fibrosus underwent no treatment. After the de-cellularization process was completed, hematoxylin-eosin (HE) staining was carried out to examine the efficacy on cell removal, and the ultrastructure of annulus fibrosus were observed by scanning electron microscopy. The collagen content, glycosaminoglycan (GAG) content and biomechanical parameters in each group were also detected. Results HE staining and scanning electron microscopy showed that no residual cells were found in Group A, B and C. The structure of annulus fibrosus in Group A was not disturbed, while that in Group B and C was damaged severely and slightly, respectively. There was no statistical difference in collagen content among Group A, B and C, as compared to the control group (P>0.05). But the GAG content was significantly more lower in Group A, B and C than in the control group (P0.05), while these parameters of Group B were lower than those in the control group (P<0.05). Conclusions The Triton X-100-treated annulus fibrosus retained the major extracellular matrix composition after cell removal and preserved the major structure and mechanical strength, which is preferable for the construction of tissue engineering annulus fibrosus.