Development and optimization of a cell screening system for farnesoid X receptor agonist / 生物工程学报

This study aims to develop an improved cell screening system for farnesoid X receptor (FXR) agonists based on a dual luciferase reporter gene system. FXR response element (FXRE) fragments from FXR target genes were cloned and inserted into upstream of firefly luciferase (Luc) gene in the plasmid pGL4-luc2P-Hygro. In combination with the internal reference plasmid containing renilla luciferase, a dual luciferase reporter gene system was developed and used for high throughput screening of FXR agonists. After studying the effects of over-expression of RXR, mouse or human FXR, various FXRE fragments, and different ratio of FXR plasmid amount to reporter gene plasmid, induction efficiency of the screening system was optimized by the known FXR agonist GW4064, and Z factor for the system reached 0.83 under optimized conditions. In summary, an improved cell screening system based on double luciferase reporter gene detection system was developed to facilitate the discovery of FXR agonists, where a new enhanced FXRE element was formed by a superposition of multiple FXRE fragments from FXR target genes, instead of a superposition of traditional IR-1 (inverted repeats-1) fragments.

Expert Consensus on Sepsis Responding Specifically to Traditional Chinese Medicine / 中国实验方剂学杂志

To give full play to the therapeutic advantages of traditional Chinese medicine （TCM） in sepsis， clarify the entry point of integrated TCM and western medicine， further standardize the clinical treatment of TCM， develop a recognized and integrated treatment protocol of TCM and western medicine， and improve the clinical efficacy on sepsis，the Chinese Association of Chinese Medicine organized TCM and western medicine experts specialized in sepsis treatment to conduct in-depth discussions on the advantages of TCM and integrated TCM and western medicine in the treatment of sepsis based on the TCM etiology and pathogenesis of sepsis， a representative acute and critical disease. They emphasized the pathogenesis characteristics of asthenia of healthy Qi and sthenia of pathogenic factors and summarized the roles of Chinese medicine in correcting the imbalance of inflammatory response， improving blood coagulation dysfunction， and relieving organ damage. Furthermore， they proposed the treatment protocol with integrated TCM and western medicine， which is expected to provide references for actual clinical treatment and scientific research.

Neurological Diseases Responding Specifically to Traditional Chinese Medicine / 中国实验方剂学杂志

In recent years， the incidence of neurological diseases has been increasing year by year. To give full play to the advantages of traditional Chinese medicine （TCM） in the treatment of neurological disorders， identify the breakthrough point of integrating TCM with western medicine， and further standardize the clinical diagnosis and treatment of TCM， the China Association of Chinese Medicine organized neurologists in TCM and western medicine to carry out in-depth discussion on the neurological diseases responding specifically to TCM and integrated TCM and western medicine， such as stroke， headache， vertigo， multiple sclerosis， and epilepsy， aiming to formulate a well-recognized and integrated treatment protocol for TCM and western medicine and improve the efficacy of neurological disorders. Furthermore， the treatment suggestions of the corresponding diseases in TCM and western medicine were proposed to provide references for clinical practice and scientific research.

Effect and Mechanism of Fuzheng Touxie Prescription on Immune Homeostasis of Drug-resistant Pseudomonas aeruginosa Lung Infection Rats / 中国实验方剂学杂志

Objective:To investigate the effect and mechanism of Fuzheng Touxie prescription （FZTX） on the immune homeostasis of drug-resistant <italic>Pseudomonas aeruginosa</italic> lung infection in rats at different time points. Method:A total of 168 rats were divided into a blank group （<italic>n</italic>=8），a model group （<italic>n</italic>=40），a Touxie （TX） group （<italic>n</italic>=40），an early Fuzheng （FZ） group （<italic>n</italic>=40）， and a delayed FZ group （<italic>n</italic>=40）. The blank group was given distilled water by gavage， the model group was given distilled water by gavage after infection，the TX group was given clear heat and penetrate evil drug free decoction granules（3.5 g·kg^-1） by gavage after infection， the early FZ group was given Fuzheng Touxie whole formula free decoction granules（10.75 g·kg^-1） by gavage after infection， the delayed FZ group was given clear heat and penetrate evil drug free decoction granules by gavage after infection， on the third day plus Fuzheng drug free decoction granules［（3.5+10.75） g·kg^-1］ by gavage， the three treatment groups were gavaged twice a day， 2 mL each time .Each drug treatment group was divided into five groups according to five time points （3 h，1 d，3 d，5 d， and 7 d）， with eight rats in each group. The levels of tumor necrosis factor-<italic>α</italic>（TNF-<italic>α</italic>），high mobility group protein 1（HMGB1），interleukin-10（IL-10）， and tumor necrosis factor -<italic>α</italic>-induced protein-8-like2 （TIPE2） were measured by enzyme-linked immunosorbent assay （ELISA）， and HMGB1 protein expression level by Western blot. Result:At 3 h，the TNF-<italic>α</italic> content in the drug treatment groups was higher than that in the blank group and the model group （<italic>P</italic><0.05）. At 3 d，the TNF-<italic>α</italic> content in the early FZ group and the delayed FZ group was lower than that in the model group （<italic>P</italic><0.05） and the TX group （<italic>P</italic><0.05）. At 1 d，the HMGB1 content in the TX group and the delayed FZ group was higher than that in the model group （<italic>P</italic><0.05）. At 5 d，the HMGB1 content was lower in the delayed FZ group than in the model group （<italic>P</italic><0.05）. At 7 d，HMGB1 protein expression in the model group was higher than that in the blank group （<italic>P</italic><0.05） and the early FZ group （<italic>P</italic><0.05）. At 3 d，the IL-10 content was significantly higher in both the early FZ group and the delayed FZ group than that in the model group （<italic>P</italic><0.05）. At 5 d，the IL-10 content was higher in the early FZ group than that in the TX group （<italic>P</italic><0.05）. At 7 d，the IL-10 content in the early FZ group and the delayed FZ group was lower than that in the TX group （<italic>P</italic><0.05）. At 5 d，the TIPE2 content in the early FZ group was lower than that in the model group （<italic>P</italic><0.05）. At 7 d，the TIPE2 content in the TX group and the delayed FZ group was lower than that in the model group （<italic>P</italic><0.05）. Conclusion:FZTX or modified prescription can promote the inflammatory response to eliminate pathogenic bacteria in the early stage and suppress the inflammatory response in the late stage to avoid the inflammatory cascade effect and lung tissue damage，indicating that Fuzheng drugs have an important role in maintaining the immune homeostasis of the body after infection.

Bile acid homeostasis in female mice deficient in

Bile acids (BAs) are amphipathic molecules important for metabolism of cholesterol, absorption of lipids and lipid soluble vitamins, bile flow, and regulation of gut microbiome. There are over 30 different BA species known to exist in humans and mice, which are endogenous modulators of at least 6 different membrane or nuclear receptors. This diversity of ligands and receptors play important roles in health and disease; however, the full functions of each individual BA

Screening of key genes and pathways of ischemic stroke and prediction of traditional Chinese medicines based on bioinformatics / 中国中药杂志

The aim of this paper was to explore the key genes and pathogenesis of ischemic stroke(IS) by bioinformatics, and predict the potential traditional Chinese medicines for IS. Based on the gene-chip raw data set of GSE22255 from National Center of Biotechnology Information(NCBI), the article enrolled in 20 patients with ischemic stroke and 20 sex-and age-matched controls, and differentially expressed genes(DEGs) were screened based on R language software. The DAVID tool and R language software were used to perform gene ontology(GO) biological process enrichment analysis and Kyoto encyclopedia of genes and gnomes(KEGG) pathway enrichment analysis. The DEGs were imported into STRING to construct a protein-protein interaction network, and the Molecular Complexity Module(MCODE) plug-in of Cytoscape software was used to visualize and analyze the key functional modules. Moreover, the core genes and the medical ontology information retrieval platform(Coremine Medical) were mapped to each other to screen the traditional Chinese medicines and construct drug-active ingredient-target network. Compared with healthy controls, 14 DEGs were obtained, of which 12 genes were up-regulated and 2 genes were down-regulated. DEGs were mainly involved in immune response, inflammatory process, signal transduction, and cell proliferation regulation. The interleukin-17(IL-17), nuclear factor kappaB(NF-κB), tumor necrosis factor(TNF), nucleotide binding oligomerization domain(NOD)-like receptor and other signaling pathways were involved in KEGG pathway enrichment analysis. The key modules of the DEGs-encoding protein interaction network mainly focused on 7 genes of TNF, JUN, recombinant immediate early response 3(IER3), recombinant early growth response protein 1(EGR1), prostaglandin-endoperoxide synthase 2(PTGS2), C-X-C motif chemokine ligand 8(CXCL8) and C-X-C motif chemokine ligand 2(CXCL2), which were involved in biological processes widely such as neuroinflammation and immunity. TNF and JUN were the key nodes in this module, which might become potential biological markers for diagnosis and prognosis evaluation of IS. The potential traditional Chinese medicines for the treatment of IS includes Salviae Miltiorrhizae Radix et Rhizoma, Croci Stigma, Scutellariae Radix, and Cannabis Fructus. The occurrence of stroke was the result of multiple factors. Dysregulation of genes and pathways related to immune regulation and inflammation may be the key link for the development of IS. This study provided research direction and theoretical basis for further exploring the mechanism of action of traditional Chinese medicine in the treatment of IS and searching for potential drug targets.

Effects of total parenteral nutrition on drug metabolism gene expression in mice

Parenteral nutrition-associated liver disease (PNALD) is a liver dysfunction caused by various risk factors presented in patients receiving total parenteral nutrition (TPN). Omega-6 rich Intralipid® and omega-3 rich Omegaven® are two intravenous lipid emulsions used in TPN. TPN could affect the hepatic expression of genes in anti-oxidative stress, but it's unknown whether TPN affects genes in drug metabolism. In this study, either Intralipid®- or Omegaven®-based TPN was administered to mice and the expression of a cohort of genes involved in anti-oxidative stress or drug metabolism was analyzed, glutathione (GSH) levels were measured, and protein levels for two key drug metabolism genes were determined. Overall, the expression of most genes was downregulated by Intralipid®-based TPN ( and ). Omegaven® showed similar results as Intralipid® except for preserving the expression of and and increasing . Total GSH levels were decreased by Intralipid®, but increased by Omegaven®. CYP3A11 protein levels were increased by Omegaven®. In conclusion, TPN reduced the expression of many genes involved in anti-oxidative stress and drug metabolism in mice. However, Omegaven® preserved expression of , suggesting another beneficial effect of Omegaven® in protecting liver functions.

Establishment of Human Bone Marrow Mesenchymal Stem Cells Radiation Injury Models Induced by X-ray / 中山大学学报(医学科学版)

@#【Objective】To establish a cell model of radiation injury of human bone marrow mesenchymal stem cells（hBMMSC），and to provide experimental basis for further study on the pathogenesis of osteoradionecrosis of the jaws（ORNJ）.【Methods】After X-ray irradiation，the gene expression change of Beclin1，Sox2，Nanog，RUNX2 and OGN in hBMMSC were evaluated by Western blot and RT-qPCR. The apoptosis rate change was detected by Annexin- V/PI double staining method. The proliferation rate change was determined by clone formation experiment. The alkaline phosphatase activity change was detected by microplate method.【Results】The gene expressions of Beclin1 increased with the doses increased，while Sox2，Nanog，RUNX2 and OGN in hBMMSC were all down- regulated after irradiation. The apoptotic rate increased，the colony formation rate decreased and the alkaline phosphatase activity decreased also.【Conclusion】X-ray irradiation can cause ionizing radiation injury of hBMMSC. We successfully established a cell model of hBMMSC radiation injury，the model can be applied to the experimental study of the pathogenesis of ORNJ.

Endoscopic ultrasound-guided fine needle aspiration for gastrointestinal lesions with inconclusive endoscopic biopsies / 中华消化内镜杂志

Objective To determine the diagnostic value of endoscopic ultrasound-guided fine needle aspiration ( EUS-FNA ) for gastrointestinal lesions with inconclusive endoscopic biopsies. Methods A retrospective analysis was performed in 65 patients who were found to have gastrointestinal lesions with inconclusive endoscopic biopsies and underwent EUS-FNA in Drum Tower Hospital. Diagnostic value of EUS-FNA was determined by comparing with surgical histopathology and follow-up results. Results This study included 41 males ( 63％) and 24 females ( 37％) with median age of 60 years. The most common lesion was diffuse infiltrative lesions ( 37, 56. 9％) , followed by submucosal protrusion types ( 17, 26. 2％) . Fifty-four cases ( 83. 1％) were malignant lesions, and 11 cases ( 16. 9％) were benign. The overall sensitivity, specificity, and accuracy of EUS-FNA for gastrointestinal lesions with inconclusive biopsies were 76. 8％ ( 95％CI: 65. 7％-87. 8％) , 100. 0％ ( 95％CI: 66. 4％-100. 0％) , and 80. 0％( 95％CI: 70. 3％-89. 7％) , respectively. Sub-group analysis showed the sensitivity, specificity, and accuracy of EUS-FNA for diffuse infiltrative lesions were 70. 6％ ( 95％CI: 55. 3％-85. 9％, 100. 0％( 95％CI:29. 2％-100. 0％) , and 73. 0％ ( 95％CI: 58. 7％-87. 3％) , respectively. For submucosal protrusions, the sensitivity, specificity, and accuracy of EUS-FNA were 68. 8％ ( 95％CI: 46. 0％ -91. 5％) , 100. 0％ ( 95％CI: 2. 5％-100. 0％) , and 70. 6％ ( 95％CI: 44. 0％-89. 7％) , respectively. Conclusion EUS-FNA has moderate diagnostic value for endoscopic biopsy-inconclusive gastrointestinal lesions. It can be an alternative option when standard methods, such as endoscopic mucosal forceps biopsy, fail to provide a definitive diagnosis.

Effect of Alpha2-macroglobulin on Anti-Oxidation and Anti-Fibrosis in Human Skin Fibroblasts after X-ray Irradiation / 中山大学学报(医学科学版)

[Objective]To explore the effect of alpha2-macroglobulin(α2M)on superoxide anion(.O2-)content, superoxide dismutase(SOD)activity and the process of cell-to-myofibroblast transformation in human skin fibroblasts (HSF)after X-ray irradiation.[Methods]HSF cells were irradiated with 0,5,10,15 and 20 Gy X-ray.The change of. O2- content and SOD activity in the supernatant of cell culture medium were measured on the first day after irradiation. The protein expression of alpha-smooth muscle actin(α-SMA)was detected by Western blot on the fifth day after irradia-tion.The most sensitive radiation dose is selected.HSF cells were irradiated with the above sensitive dose.Respectively, 1h before irradiation,1 h after irradiation,the experimental group cell culture medium was added to a final concentration of 0.25 mg/mL,0.5 mg/mL of α2M.The change of.O2-content,SOD activity and the protein expression of α-SMA were detected.[Results]HSF cells were irradiated with 5~20 Gy doses of X-ray..O2- content increased,SOD activity de-creased and α-SMA protein expression increased gradually(P<0.05).The addition of α2M at 1 h after 10Gy X-ray irradi-ation reduced the.O2- content,increased the SOD activity and downregulated the protein expression of α-SMA in HSF cells(P<0.05). There was no significant change in the administration at 1 h before irradiation.[Conclusion]HSF cells increased.O2-content significantly,while SOD activity decreased,and the tendency to transform myofibroblasts after X-ray irradiation.α2M can reduce the.O2-content,increase the SOD activity in HSF cells and inhibit the transformation of fibroblasts into myofibroblasts after irradiation.Indicating that α2M can play a role in radiation protection by anti-oxida-tion and anti-fibrosis.

Characteristics of clinicopathology and immunohistochemical molecular markers of 92 cases of heterotopic pancreas in upper gastrointestinal tract / 中华消化杂志

Objective To investigate the clinicopathological characteristics and the expression of related molecular markers of heterotopic pancreas for better understanding and avoiding overtreatment of this disease.Methods From 24th March 2009 to 10th November 2016,92 patients with heterotopic pancreas in upper digestive tract diagnosed after endoscopic submucosal dissection(ESD),were collected. Tissues were sectioned and pathologically classified by Heinrich classification.The expressions of seven different molecular markers including cytokeratin(CK)19,insulin,trypsin,Ki-67,p53,CD133 and CD56 were detected by immunohistochemistry staining. Clinical features, pathological features and immunohistochemical results were retrospectively analyzed.Analysis of variance and Kruskal-Wallis test were used.Results According to Heinrich classification,the percentages of type Ⅰ,Ⅱ,and Ⅲ of heterotopic pancreas were 27.2%(25/92),63.0%(58/92)and 9.8%(9/92),respectively.There was no type Ⅳ patients.The heterotopic pancreas mainly located in stomach with proportion being about 91.3%(84/92)of the total heterotopic pancreas.CK19(the marker of pancreas ducts),insulin(as marker of endocrine function)and trypsin(as the marker of exocrine function)were all expressed in heterotopic pancreas.The positive rate of CD56,a pancreatic neuroendocrine marker,was 66.3%(61/92).The umbilicus like depression was the typical endoscopic appearance of heterotopic pancreas,which only found in 29 patients(31.5%).The average rate of Ki-67,cell proliferation index,was(2.08 ± 1.41)%.The expression of mutant p53 was negative in all 92 cases of heterotopic pancreas.The average staining area of CD133,a marker of pancreatic cancer stem cell,was(2.53 ± 2.43)%.The average follow-up period of 92 patients was(43.6 ± 27.5)months.No relapse and malignant change were found and all patients survived after ESD.Conclusions Heterotopic pancreas has normal pancreatic construction and function.The cell proliferation index is low in heterotopic pancreas and no mutant p53 expression is found.The expression of CD133 is also low.Heterotopic pancreas is a congenital benign disease which requires a long-term follow-up rather than overtreatment.

Clinical value of platelet parameters and fibrinogen level changes in stroke patients / 心血管康复医学杂志

Objective:To explore diagnostic and predictive value of platelet count (PLT),mean platelet volume (MPV),platelet distribution width (PDW) and fibrinogen (Fg) level for stroke.Methods:According to pathological pattern,a to-tal of 98 stroke patients were divided into cerebral infarction group (n＝43,including 23 cases with large size cerebral in-farction and 20 cases with lacunar infarction) and cerebral hemorrhage group (n＝45).Another 51 healthy subjects under-going physical examination simultaneously were enrolled as healthy control group.PLT,MPV,PDW and Fg level were measured and compared among three groups.Results:Compared with healthy control group,there were significant reduc-tion in PLT [ (217.86 ± 53.92)×109/L vs.(180.40 ± 32.81)×109/L vs.(174.09 ± 40.18)×109/L] and significant rise in MPV [ (8.03 ± 0.99)×10-15L vs.(9.59 ± 1.04)×10-15L vs.(8.91 ± 1.43)×10-15L],PDW [ (13.97 ± 1.22)% vs.(16.43 ± 1.07)% vs.(16.09 ± 0.97)%] and Fg level [ (3.17 ± 0.95) g/L vs.(5.01 ± 1.33) g/L vs.(4.91 ± 0.92) g/L] in cerebral infarction group and cerebral hemorrhage group,P＝0.001 all;Compared with cerebral infarc-tion group,there was significant reduction in MPV in cerebral hemorrhage group,P＝0.012.There were no significant difference in platelet parameters and Fg level between large size cerebral infarction group and lacunar infarction group,P＞0.05 all.Conclusion:Detection of PLT,MPV,PDW and Fg level possess good application value in diagnosis and prediction of stroke,which is worth extending.

Surveillance and risk assessment system of schistosomiasis epidemic focus in Hankou marshland of Wuhan City / 中国血吸虫病防治杂志

To construct a monitoring and risk assessment system of schistosomiasis epidemic focus in marshland, so as to grasp the risk of schistosomiasis transmission, and to provide the technical support for targeted prevention and control measures.The crowd and the risk source of schistosomiasis in Hankou marshland in Wuhan City were monitored to grasp the risk factors of schistosomiasis. The risk level was evaluated by the three-dimensional risk matrix and three-dimensional visualization method.The total numbers of people on holidays and working days were 59 582 and 36 382 persontimes a day respectively in Hankou marshland. Fishing and swimming were the most common ways to contact the river water. The most majority of the people exposed to river water were male (73.9%), retirees (36.1%), local residents (69.7%) and people whose income was 1000 – 3000 yuan per month (52.1%), and the awareness of protection of them was low. In spring, the average density of living Oncomelania hupensis snails was 0.993/0.1 m2, the rat density was 7.72%, and the density of wild feces was 0.78/hm2. In autumn, the average density of living snails was 0.596 /0.1 m2, the rat density was 5.22%, and the density of wild feces was 0.32/hm2. The average density of living snails, the rat density and the density of wild feces were reduced by 39.9%, 32.4% and 59.0% respectively in autumn compared with those in spring. The risk assessment results of three-dimensional matrix showed that part 1 and part 2 were medium risk, part 3 was high risk and part 4 was maximum risk. The risk assessment results of the visualization method showed that the risk level increased from part 1 to part 4, which were basically consistent with the results of the risk matrix.There is a relatively large risk of schistosome infection in Hankou marshland in 2013. The surveillance and risk assessment system of epidemic focus is feasible and scientific.

Simultaneous endovascular aortic repair and coronary artery bypass grafting / 中华胸心血管外科杂志

Objective To summarize experience of concomitant endovascular aneurysm aortic repair(EVAR) and coronary artery bypass grafting(CABG) for patients of severe coronary artery disease(CAD) complicated with infra-renal abdominal aortic aneurysm(AAA) or infra-renal abdominal penetrating aortic ulcer(PAU).Methods Between January 2013 and December 2016,13 patients with severe CAD and infra-renal AAA/PAU who underwent CABG and EVAR were enrolled in this study.12 patients (92.3 ％) were male and 1 patient was female (7.7 ％),the mean age of(63.7 ± 7.3) years.11 patients with CAD related symptoms,2 patients with AAA/PAU related symptoms,abdominal aortic lesions include:AAA in 3cases,PAU in 10 cases,2 patients combined with PAU of the thoracic aorta.CABG and EVAR manipulations were performed according to the routine protocol,patients who were combined with thoracic aorta PAU were treated with thoracic endovascular aortic repair (TEVAR) simultaneously.Results 7 patients received EVAR followed by CABG;6 patients received CABG followed by EVAR,TEVAR were performed in 2 patients.For all the patients,there were 11 cases of CABG were performed under the cardiopulmonary bypass(CPB) (ON-PUMP) and 2 others cases were performed without CPB(OFF-PUMP).On the average(2.5 ± 0.7)grafts were performed.The time of aortic clamp and CPB averaged were(50.7 ± 16.5)min and (58.0 ± 11.2)min respectively for the ON-PUMP CABG patients.Totally 30 thoracic aorta and abdominal aorta stent grafts were implanted in 13 patients.The duration of postoperative mechanical ventilation time was (17.8 ± 7.0) hours,Median intensive care stay was (2.7 ± 1.9) days,while hospital stay was(8.1 ± 2.4)days.All the patients was discharged.1 patient suffered wound unhealing 2 days after discharging,followed by sternal infection,he was re-admitted and received pectoralis major myocutaneous flap transfer operation,29 days after this operation,he suffered sudden cardiac arrest and eventually dead.The other 12 surviving patients was followed up for 1 ～ 36 months,The results showed that the patency of the grafts in all patients was good,no EVAR related secondary interventions were required.Conclusion For the patients with surgical indications,the procedure of one stage CABG and EVAR completed by one surgical team was safe and feasible.Comparing with the traditional one stage or staged surgical repair,this strategy showed less surgical trauma,shorter operation time,lower perioperative risks,more efficacy and more conducive to the overall management of patients.

Therapeutic value of EUS-guided dehydrated ethanol lavage for pancreatic cystic neoplasms / 中华消化内镜杂志

Objective To evaluate the safety and feasibility of endoscopic ultrasonography(EUS)-guided dehydrated ethanol lavage on treatment of pancreatic cystic neoplasms(PCN). Methods The data of 15 patients with PCN treated by EUS-guided dehydrated ethanol lavage in Nanjing Drum Tower Hospital from April 2014 to December 2016 were retrospectively analyzed. All the patients underwent EUS-guided fine needle aspiration, and then the cyst cavity was lavaged with dehydrated ethanol. The curative effects and complications were evaluated after the procedure. Results Each patient had one operation and all the operations were successful. No operation-related intraoperative or postoperative complications occurred. Patients were followed up for a median time of 15 months(range from 3-30 months).Twelve patients finished a long term follow-up,including 6 cases of complete remission and 6 cases of partly remission. None of the patients underwent surgical resection. Conclusion Dehydrated ethanol lavage is safe and feasible for treatment of PCN.

Malignant progression and survival analysis for intraductal papillary mucinous neoplasms based on risk stratification / 中华消化内镜杂志

Objective To evaluate the potential malignancy, prognosis and risk factors for intraductal papillary mucinous neoplasm(IPMN), which were classified into different risk levels based on Fukuoka guideline. Methods A retrospective analysis of patients with IPMN diagnosed at Nanjing Drum Tower Hospital from 2009 to 2016 was conducted. Clinical characteristics,treatment and prognosis of IPMNs were analyzed. Results A total of 94 IPMN patients were included and divided into 3 groups according to Fukuoka guideline,46 patients in high-risk(HR)group,30 in group of worrisome features(WF), and 18 in low-risk(LR)group. For patients undergoing surgery treatment, there were 5 cases(19.2%,5/26)in HR group and 2 cases(12.5%,2/16)in WF group whose postoperative pathological findings were malignant (P=0.690). The 5-year survival rates after operations were 73.9% and 77.0% in HR and WF group, respectively(P=0.830). For patients without surgery treatment, in a 5-year follow-up, there were 6 cases (33.3%,6/18),2 cases(16.7%,2/12)and 0(0.0%,0/18)progressing into pancreatic cancers in HR, WF and LR groups,respectively(P<0.05). In addition,among the three groups,the 5-year survival rates were 49.5%,85.7% and 100.0%(P=0.025). Jaundice was significantly related to prognosis(P<0.01) and the hazard ratio was 8.883(95%CI:2.953-26.721). Conclusion Jaundice is a predictive risk factor for survival of IPMN. As for the treatment to IPMN, patients in HR group should receive surgery treatment while those in LR group can be followed up. For patients in WF group,the treatment should be customized, with evaluation of predictive risk factors,and operations can be performed when needed.

Treatment of ultrasonography guidance percutaneous nephrolithotomy Ⅰ period combining pneumatic ultra-sosonic and holmium laser lithotrips in 120 cases of complex renal calculi / 中国基层医药

Objective To assess the clinical efficacy of ultrasonography guidance percutaneous nephrolithot-omyⅠ period combining pneumatic ultrasosonic and holmium laser lithotrips of complex renal calculi.Methods Patients were under the general anesthesia in lithotomy position.By cystoscope first to one side retrograde insertion F5 ureteral catheter,the position to prone position was changed.Under ultrasonography guidance puncture target after the success of the calyx,fascia dilator gradually expanded from F8 to F20 channel was established.Then percutaneous nephroscope combining pneumatic ultrasosonic and holmium laser lithotripsy were administrated.Results One sided single channel was 92 cases,one sided dual channel was 11 cases,one sided three -channel was 1 case.On both sides single channel was 13 cases,one side of the dual channel and other side of the single channel was 3 cases.The operation time was (72 ±24)min.Intraoperative bleeding was in 50 -150mL,with an average of 80mL,and there's no intraoper-ative blood transfusion.2 cases of postoperative had secondary bleeding,in which 1 case remitted after non -operative treatment,the other case was treated in DSA downward super selective renal artery embolization to stop the bleeding. Postoperative hospital stay was 7 -14d,with an average of 10d.There were no septic shock,water uptake,water intoxi-cationand complications such as pleural effusion.One week after the CT,stones free rate was 91.7%(110 /120),in which 10 cases of residual stone with diameter <5mm,needn't surgery removed again.They were treated with oral platoon stone drugs,drinking lots of water and a moderate amount of sports such as processing.All cases were followed up for 6 months to 18 months,with no urinary tract infection,stone recurrence and the long -term complications such as perinephric space effusion.Conclusion As long as establish proper percutaneous renal channel,with intraoperative operating norms,combining pneumatic ultrasosonic and holmium laser,ultrasonography guidance percutaneous nephro-lithotomy Ⅰ period clear renal calculi is completely can be done.And it can shorten operation time,and has clear renal calculi with high efficiency,small trauma and less long -term complications.It is safe and effective,and worthy of clinical popularization and application.

The impacts of the left ventricular size for infants with total anomalous pulmonary venous connection on the early results of anatomical correction / 中华胸心血管外科杂志

Objective To investigate the impacts of the left ventricular size for infants with total anomalous pulmonary venous connection(TAPVC) on the early results of anatomical correction.Methods From Jan 2010 to Jun 2013,103 cases of TAPVC children under 1 year of age received biventricular correction in our hospital,including 65 males and 38 females with the mean body weight of(5.3 ± 1.3) kg.Taking left ventricular end-diastolic volume index(LVEDVI) of 20 ml/m2 as a boundary,all the children were divided into two groups:Small LV group and the Near normal LVgroup.Various factors including age,body weight,pathological type,pulmonary venous obstruction and restricted atrial septal defect were compared between the two groups.The Z value were introduced to demonstrate the small extent of the left atrium and left ventricle of TAPVC patients in comparison with the normal children.TAPVC correction surgery were performed with conventional median sternotomy,moderate hypothermic cardiopulmonary bypass and combined malformations were treated simultaneously.Results 45 patients were classified to Small LV group and 58 patients were classified toNear normal LV group.71.1％ of all Small LV patients was diagnosed as the obstruction type of TAPVC,the ratio was significantly higher than that of theNear normal LV group.The Z value of left ventricular end-diastolic diameter in theSmall LV group was significantly lower than that of the Near normal LV group.The mean CPB and aortic clamping time of all patients were (96.6 ± 34.4) min and (58.0 ±21.1) min respectively.There were 4 early postoperative death and the overall mortality was 3.9％.No patient was dead of low cardiac output.The duration of postoperative mechanical ventilation,ICU stay and vasoactive drugs application in Small LV group was significantly longer than that of Near normal LV group.Conclusion TheSmall LV,which should be viewed as relative dysplasia of left ventricle ,is more common in obstructive type of TAPVC.As long as the sizes of mitral valve and aortic valve were not significantly reduced,anatomic correction can be implemented and need not to concern the reducing degree of left ventricle.Nevertheless,the prevention and treatment of low cardiac output in the operation and early postoperative period were still key points for small LV patients to achieve good surgical results.

Technical refinement of seminal vesiculoscopy and clinical application in seminal vesicle disease / 中华泌尿外科杂志

Objective To refine the technique and improve the efficacy of seminal vesiculoscopy in the diagnosis and treatment of seminal vesicle disease.Methods The refined techniques of seminal vesculoscopy,using a patent catheter into the slit-like ejaculatory duct orifice through the verumontanum and another patent catheter introduced into seminal vesicle lumen,were performed in 58 cases,including intractable hematospermia in 42 cases and azoospermia in 16 cases.Results Seminal vesiculoscopy was successfully entered into the seminal vesicular lumen in 46 patients (79％) within 2-3 min.There was no obvious ejaculatory duct orifice in 12 of 16 azoopermia cases,and transurethral resection of verumontanum was performed,then seminal vesiculoscope was directly entered into seminal vesicle lumen.Symptoms of hematospermia were disappeared in 25 cases (60％),improved in 11 cases (26％),and azoospermia were cured in 6 cases (37％),improved in 5 (31％),unchanged in 5 (31％) during the follow-up period of 6-36 months (average 18 months).There were no major or minor complications in this series,and no urine reflux into ejaculatory duct in 19 cases demonstrated by contrast medium.Conclusion Refined seminal vesiculoscopy was technically safe,efficient,simple,and potentially widely used in the cases of hematospermia and ejaculatory duct obstructions.

Effect of Qiguiyin Decoction on multidrug-resistant Pseudomonas aeruginosa infection in rats / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the effect of Qiguiyin Decoction, QGYD) on multidrug-resistant Pseudomonas aeruginosa infection in Sprague-Dawley (SD) rats.</p><p><b>METHODS</b>A pseudomonal infection model in SD rats was established by injecting multidrug-resistant P. aeruginosa intraperitoneally. Infected rats were randomized into four groups treated with Pure water, QGYD, ceftazidime, or combined QGYD and ceftazidime. Blood samples were obtained from the abdominal aorta. Serum was then collected and analyzed by peptide array for immune responsiveness to multidrug-resistant beta-lactamase proteins, including Verona integronen-coded metallo-beta-lactamase 1 (VIM-1), Sao Paulo metallo-beta-lactamase 1 (SPM-1), and Temoniera (TEMs). Blood levels of interleukin-1β (IL-1β), interleukin-4 (IL-4), and interferon-γ (IFN-γ) were assessed by enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>QGYD enhanced antibody reactivity against VIM-1 [epitopes 7-11 and 36-40] and TEM-1 [epitopes 26-27, 52-55, and 66-70]. QGYD treatment restored the compromised antibody reactivity against VIM-1 [epitopes 53-54 and 56-58] and SPM-1 [epitopes 16-19 and 82-85] following pseudomonal infection. Serum levels of IL-1β and Th1/Th2 in the rats were significantly elevated following pseudomonal infection (P<0.05 orP<0.01). In contrast, QGYD and combination QGYD and ceftazidime treatment restored the elevated serum IL-1β and Th1/Th2 levels to normal (P>0.05).</p><p><b>CONCLUSIONS</b>QGYD improves the immune response to pseudomonal infection in rats by stimulating the production of protective antibodies against drug-resistant proteins VIM-1, SPM-1, and TEM-1. In addition, it protects the immune system and maintains immune responsiveness by restoring IL-1β and Th1/Th2 levels.</p>