Anatomical and histological investigation of the area anterior to the anorectum passing through the levator hiatus / 中华胃肠外科杂志

Objective: To document the anatomical structure of the area anterior to the anorectum passing through the levator hiatus between the levator ani slings bilaterally. Methods: Three male hemipelvises were examined at the Laboratory of Clinical Applied Anatomy, Fujian Medical University. (1) The anatomical assessment was performed in three ways; namely, by abdominal followed by perineal dissection, by examining serial cross-sections, and by examining median sagittal sections. (2) The series was stained with hematoxylin and eosin to enable identification of nerves, vessels, and smooth and striated muscles. Results: (1) It was found that the rectourethralis muscle is closest to the deep transverse perineal muscle where the longitudinal muscle of the rectum extends into the posteroinferior area of the membranous urethra. The communicating branches of the neurovascular bundle (NVB) were identified at the posterior edge of the rectourethralis muscle on both sides. The rectum was found to be fixed to the membranous urethra through the rectourethral muscle, contributing to the anorectal angle of the anterior rectal wall. (2) Serial cross-sections from the anal to the oral side were examined. At the level of the external anal sphincter, the longitudinal muscle of the rectum was found to extend caudally and divide into two muscle bundles on the oral side of the external anal sphincter. One of these muscle bundles angled dorsally and caudally, forming the conjoined longitudinal muscle, which was found to insert into the intersphincteric space (between the internal and external anal sphincters). The other muscle bundle angled ventrally and caudally, filling the gap between the external anal sphincter and the bulbocavernosus muscle, forming the perineal body. At the level of the superficial transverse perineal muscle, this small muscle bundle headed laterally and intertwined with the longitudinal muscle in the region of the perineal body. At the level of the rectourethralis and deep transverse perineal muscle, the external urethral sphincter was found to occupy an almost completely circular space along the membranous part of the urethra. The dorsal part of the external urethral sphincter was found to be thin at the point of attachment of the rectourethralis muscle, the ventral part of the longitudinal muscle of the rectum. We identified a venous plexus from the NVB located close to the oral and ventral side of the deep transverse perineal muscle. Many vascular branches from the NVB were found to be penetrating the longitudinal muscle and the ventral part of rectourethralis muscle at the level of the apex of the prostate. The rectourethral muscle was wrapped ventrally around the membranous urethra and apex of the prostate. The boundary between the longitudinal muscle and prostate gradually became more distinct, being located at the anterior end of the transabdominal dissection plane. (3) Histological examination showed that the dorsal part of the external urethral sphincter (striated muscle) is thin adjacent to the striated muscle fibers from the deep transverse perineal muscle and the NVB dorsally and close by. The rectourethral muscle was found to fill the space created by the internal anal sphincter, deep transverse perineal muscle, and both levator ani muscles. Many tortuous vessels and tiny nerve fibers from the NVB were identified penetrating the muscle fibers of the deep transverse perineal and rectourethral muscles. The structure of the superficial transverse perineal muscle was typical of striated muscle. These findings were reconstructed three-dimensionally. Conclusions: In intersphincteric resection or abdominoperineal resection for very low rectal cancer, the anterior dissection plane behind Denonvilliers' fascia disappears at the level of the apex of the prostate. The prostate and both NVBs should be used as landmarks during transanal dissection of the non-surgical plane. The rectourethralis muscle should be divided near the rectum side unless tumor involvement is suspected. The superficial and deep transverse perineal muscles, as well as their supplied vessels and nerve fibers from the NVB. In addition, the cutting direction should be adjusted according to the anorectal angle to minimize urethral injury.

Progress in antitumor activity of diterpenoid alkaloids in plants of Aconitum / 中国中药杂志

Small-molecule compounds with rich sources have diverse structures and activities. The active ingredients in traditional Chinese medicine(TCM) provide new sources for the discovery of new antitumor drugs. Aconitum plants as Chinese medicinal plants have the effects of dispelling wind, removing dampness, warming meridian, and relieving pain. They are mainly used to treat inflammation, pain, rheumatism, and tumors, improve heart function, and dilate blood vessels in clinical practice. Diterpenoid alkaloids are the main active components of Aconitum plants, including C20-, C19-, C18-diterpenoid alkaloids and bis-diterpenoid alkaloids. Stu-dies have demonstrated that diterpenoid alkaloids can effectively treat lung cancer, liver cancer, breast cancer, colon cancer and other cancers. Diterpenoid alkaloids are considered as the most promising natural compounds against cancers. In this review, we summarized the chemical structures and antitumor activities of C20-, C19-, C18-diterpenoid alkaloids and bis-diterpenoid alkaloids extracted from plants of Aconitum, aiming to provide reference for further development of diterpenoid alkaloids from Aconitum as antitumor drugs.

Clinical study on Guizhi Mahuang Geban Decoction combined with conventional western medicine in the treatment of post infections cough / 国际中医中药杂志

Objective:To evaluate the clinical efficacy of Guizhi Mahuang Geban Decoction combined with conventional western medicine in the treatment of post infections cough (PIC), and to explore the mechanism.Methods:A total of 100 PIC patients in our hospital from January 2020 to July 2021 who met the inclusion criteria were divided into 2 groups according to the random number table method, with 50 in each group. The control group was treated with conventional western medicine, and the study group was treated with Guizhi Mahuang Geban Decoction and the treatment of the control group. Both groups were treated for 10 days. TCM symptom scores were performed before and after treatment. The levels of neurokinin A (NKA), substance P (SP), neurokinin B (NKB) and calcitonin gene related peptide (CGRP) were detected by ELISA. Adverse events were recorded and clinical effects were evaluated.Results:The total clinical effective rate was 90.0% (45/50) in the study group and 68.0% (34/50) in the control group, and there was significant difference between the two groups ( χ2=7.29, P=0.007). The scores of cough, expectoration, pharyngeal itch and total score in the study group were significantly lower than those in the control group ( t values were 8.04, 6.30, 9.03, 9.71, all Ps<0.01). After treatment, NKA [(86.08±18.21) ng/L vs. (137.68±28.29) ng/L, t=10.85], SP [(54.23±11.28) ng/L vs. (71.75±15.34) ng/L, t=6.51], NKB [(96.15±20.19) ng/L vs. (149.84±30.22) ng/L, t=10.45], CGRP [(62.93±18.35) ng/L vs. (89.59±23.25) ng/L, t=6.37] levels in the study group were significantly lower than those in the control group ( P<0.01). The incidence of adverse events was 8.0% (4/50) in the control group and 10.0% (5/50) in the study group, and there was no significant difference between the two groups ( χ2=0.13, P=0.727). Conclusions:Compared with western medicine alone, Guizhi Mahuang Geban Decoction combined with western medicine can rapidly improve patients' symptoms, improve curative effect and have better safety for PIC. Its mechanism may be related to the regulation of NKA, SP, NKB and CGRP levels.

Construction of evaluation system for clinical effectiveness of Drug Selection Guideline for Medical Institutions / 中国药房

OBJECTIVE To establish an evaluation syste m of clinical effec tiveness of Drug Selection Guideline for Medical Institutions，and to provide reference for drug selection in medical institution. METHODS Retrieved from relevant Chinese government websites ，PubMed，Embase，CBM and CNKI ，etc.，from the inception to Sept. 14th 2021，related contents of clinical effectiveness related to three secondary indicators ，such as “recommended level and strength of guideline ”“clinical pathway ”and “evidence and level of efficacy ”were extracted respectively ；evaluation system was construction for the clinical effectiveness. RESULTS A total of 5，4 and 17 policy documents or literatures were included according to “recommended level and strength of guideline”“clinical pathway ”and“evidence and level of efficacy ”，respectively.“The recommended level and strength of drug guideline”could reflect the clinical effectiveness of drugs ，and the evaluation content referred to the recommended level and strength of the selected drugs in the guidelines for corresponding indications. “Clinical pathway ”was the embodiment of drug effectiveness, and the evaluation content referred to the clinical path of whether the selected drugs were included in the corresponding indications. The evaluation contents of “evidence and level of efficacy ”were different between chemical medicine/ biological agent and Chinese patent medicine ；evidence and quality level of efficacy research for chemical medicine/biological agent referred to GRADE system ，while those for Chinese patent medicine referred to classic works or clinical experience inheritance. Therefore，the evaluation contents of this index system were the evidence and quality level of the efficacy research related to selected drugs. CONCLUSIONS The evaluation system of clinical effectiveness of drugs constructed from the perspective of drug selection in medical institutions can lay the foundation of evaluation system for the construction of Drug Selection Guideline for Medical Institutions ，and also provide reference for drug selection in medical institutions.

Value of high resolution magnetic resonance imaging for preoperative evaluation of Denonvilliers fascia in patients with rectal cancer / 中华胃肠外科杂志

Objective: Total mesorectal excision (TME) is the gold standard for surgical treatment of mid-low rectal cancer, but the postoperative incidence of urination and sexual dysfunction is relatively high. Preserving the Denonvilliers fascia (DF) during TME can reduce the postoperative incidence of urination and sexual dysfunction. In this study, high resolution magnetic resonance imaging (MRI) was used to observe the imaging performance and display of DF, so as to determine the value of this technique in preoperative evaluation of the preservation of DF. Methods: A descriptive cohort study was carried out. Clinical data of patients with rectal cancer who underwent TME and received preoperative high-resolution MRI at department of Gastrointestinal Surgery, the Third Affiliated Hospital of Sun Yat-sen University from August 2015 to June 2017 were retrospectively analyzed. The characteristics of DF were examined, and the shortest distance (d) between the anterior edge of tumor and DF was measured on high-resolution MRI. The distance d was compared between patients with stage T1-T2 and those with stage T3. Receiver operating characteristic (ROC) analysis was used to determine the predictive value of d for stage T1-T2 disease. Results: Thirty-two patients were enrolled in the study, including 27 males and 5 females with mean age of (62.9±8.9) years. DF was visualized in 96.9% (31/32) of cases on the T2WI sequence. The mean distance d in patients with stage T1-T2 disease (n=23) was (6.73±2.65) mm, and in those with stage T3 disease (n=9) was (1.30±1.15) mm (t=5.893, P<0.001). A cutoff of d >3 mm yielded specificity and positive predictive value for diagnosing stage T1-T2 disease of both 100%, sensitivity of 95.7% and negative predictive value of 90%. The optimum threshold of d was >3.05 mm, and Youden index was 0.957. Conclusions: High-resolution MRI can show the DF and accurately evaluate the relationship of DF with tumor in rectal cancer patients. Analysis on d value can provide an objective basis for the safe preservation of DF.

Study of feasibility of exchanging intensity-modulated radiotherapy plans after beam matching on two Linacs / 中华放射肿瘤学杂志

Objective:To explore the feasibility of the clinical implementation of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) plans with 6MV photon on two Elekta Linacs (Versa HD and Synergy) after beam matching.Methods:The images of 12 patients with nasopharyngeal carcinoma, central lung cancer and prostate cancer were randomly selected, and the IMRT and VMAT plans were designed. Two different dose tools of ionization chamber and three-dimensional detector ArcCheck were used to verify the individualized radiation treatment of 6MV photon beams on two Linacs and compare the differences.Results:The deviations between the doses of two Linacs (Versa HD and Synergy) measured by the ion chamber and treatment planning system were (0.32±1.32)% and (0.54±1.29)%. The differences of all plans were within the range of ±3%, and the deviations of the point dose between two Linacs were within the range of ±2% with no statistical significance (both P>0.05). The γ analysis of verification using ArcCheck showed that the passing rates of all plans under the 2mm/3% and 3mm/3% with 10% threshold conditions were over 95%, respectively. The average differences between two Linacs were 0.19%(2mm/3%) and 0.09%(3mm/3%). Conclusions:The results of performing IMRT/VMAT plans on two Linacs meet the clinical requirements and the differences between two Linacs are small. Hence, the same plans can be implemented interchangeably on different Linacs.

Research progress in role and mechanism of damage-associated molecular patterns in lung injury after acute spinal cord injury / 中华创伤杂志

Acute spinal cord injury（ASCI），commonly seen in spinal surgery，is usually caused by mechanical injury to the spine. ASCI can lead to secondary lung injury and even acute respiratory distress syndrome（ARDS），seriously endangering the life safety of patients. Damage-associated molecular pattern（DAMP）is a sort of endogenous substances released after injury，including intracellular proteins，extracellular matrix，secretory factors and nucleic acid-related products. DAMP released after ASCI activates downstream signaling pathways and participates in lung injuries. DAMP-related studies have revealed molecular mechanism of lung injury after ASCI，and explored the possible therapeutic targets of lung injury. In this study，the authors review the mechanism of action of DAMP in lung injury after ASCI and the role of different kinds of DAMP in lung injury，so as to provide new ideas for clinical treatment of lung injury after ASCI.

Comparison of segmentectomy versus lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections: A multi-center randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective    To compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections. Methods    The patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group (n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group (n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed. Results    There was no significant difference in the baseline data between the two groups (P>0.05). No perioperative death was found. There was no statistical difference in the operation time (111.2±30.0 min vs. 107.3±34.3 min), blood loss (54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration (2.8±0.6 d vs. 2.6±0.6 d), hospital stay time (3.9±2.3 d vs. 3.7±1.1 d) or pathology staging (P>0.05) between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group (0.2±0.3 L vs. 0.4±0.3 L, P=0.005; 0.3%±8.1% vs. 2.9%±7.4%, P=0.041). Conclusion    Segmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.

Inhibitory Effect and Mechanism of Yiqi Jianpi Huayu Recipe Combined with 5-FU on Gastric Cancer / 中国实验方剂学杂志

Objective::To observe the synergistic effect and mechanism of Yiqi Jianpi Huayu (YQJPHY) recipe combined with 5-fluorouracil (5-FU) on inhibiting gastric cancer growth, and investigate its possible mechanism through polarization direction of tumor-associated macrophages (TAMs) in tumor micro-environment. Method::A total of forty 615 mice were randomly divided into four groups including control group, YQJPHY(25 g·kg-1) group, 5-FU (25 mg·kg-1) group and combined group (YQJPHY plus 5-FU), with 10 mice in each group. The gastric cancer transplantation model was induced by axillary inoculation of MFC gastric cancer cells. Changes in tumor pathology were observed with hematoxylin-eosin staining (HE) method. The contents of M1 and M2 TAMs in tumor tissues were determined with flow cytometry, while the expression of CD206 in tumor was observed with immunohistochemistry. The mRNA expressions of TAM-related genes including interleukin-1β(IL-1β), interleukin-12(IL-12), tumor necrosis factor-α(TNF-α), arginase-1(Arg1), and chitinase 3-like 3(Ym1) were detected by using quantitative real-time polymerase chain reaction (Real-time PCR). Furthermore, the mRNA and protein expressions of epithelial-mesenchymal transition (EMT) related epithelial calcium adhesion protein(E-cadherin), nervous calcium adhesion protein(N-cadherin), Zinc finger transcription factor Slug, Snail and Waveform protein (Vimentin) were detected with Real-time PCR and Western blot, respectively. Result::The gastric cancer cells in tumors were distributed in nest and/or flaky shape, with fibroblastic connective tissue reaction and inflammatory cells infiltrated in interstitium. Coagulative necrosis of tumor was observed in various treatment groups. The amount of residual cancer cells in mouse was as follows from largest to smallest: control group>YQJPHY group>5-FU group>combined group. Immunohistochemical studies showed that all treatment groups can reduce the expression of CD206 in the tumor, and the effect was most obvious in the combined group. The contents of M2-TAM in all treatment groups were lower than those in control group(P<0.05, P<0.01), and the most significant difference in the content of M2-TAMs was shown between the control group and the combined group. The contents of M1 TAMs were increased in YQJPHY and combined groups(P<0.05, P<0.01), with the largest incremental range in YQJPHY group. The expressions of Arg1 and Ym1 in YQJPHY and combined groups were lower, while IL-1β, TNF-α and IL-12 levels were higher than those in control group(P<0.05). The mRNA expressions of IL-1β, IL-12 and TNF-α in the combined group were significantly higher, while Arg1 and Ym1 mRNA expression levels were lower than those in the 5-FU group(P<0.05). As compared with the control group, the mRNA and protein expression levels of E-cadherin were up-regulated(P<0.05), while the mRNA expression levels of N-cadherin and Vimentin were down-regulation in the YQJPHY group (P<0.05), E-cadherin mRNA and protein expression levels were up-regulated, while N-cadherin, Slug, Snail, Vimentin mRNA expression as well as N-cadherin and Slug protein expression levels were down-regulated in the combined group(P<0.05). As compared with the 5-FU group, the mRNA and protein expression levels of E-cadherin were up-regulated(P<0.05), while the mRNA and protein expression levels of N-cadherin, Slug and Vimentin were down-regulated in the combined group(P<0.05). Conclusion::YQJPHY has an inhibitory effect on the growth of gastric cancer, and after being combined with 5-FU, it has a good synergistic effect on inhibiting the growth of gastric cancer and decreasing EMT. The mechanism may be related to promoting the conversion from M2-TAMs to M1-TAMs in gastric tumor micro-environment.

The management guideline and quality control of subxiphoid uniportal video-assisted thoracoscopic surgery for early-stage lung cancer / 中国胸心血管外科临床杂志

@#In recent years, subxiphoid uniportal video-assisted thoracoscopic surgery is one of the most important innovations in the field of mini-invasive thoracic surgery. Because it avoids the injury of intercostal nerve, previous studies have shown that it can significantly reduce the perioperative and long-term incision pain. The operation is technically more difficult, so the selection of patients is more strict compared with the traditional intercostal surgery. Some special surgical techniques are needed during the operation, and special lengthening instruments should be used. We hope that the experience described in this paper will be continuously supplemented and improved with the further development of this technique, and will produce greater reference value.

Quality control standard and evaluation of lung transplantation / 中国胸心血管外科临床杂志

@#The quality control of lung transplantation involves many aspects, such as team building, selection of recipients, preoperative diagnosis and evaluation of recipients, maintenance of brain-dead donors, evaluation and acquisition of donors, surgical operation, postoperative management and postoperative follow-up. Precision management is the core concept of operation quality control. Only by normalizing the operation quality control of lung transplantation to provide basic guarantee for multi-team cooperation and development of lung transplantation management in the future, building a complete lung transplantation database to excavate data resources and improve the quality of transplanta-tion, and comprehensively building a Chinese lung transplantation quality control system with multi-team participation and cooperation, can we improve the overall level of surgical diagnosis and treatment of lung transplantation in China.

Identification of Astragalus and its adulterants based on ITS2sequence and secondary structure / 药学学报

To effectively identify the Astragalus and its adulterants based on ITS2 sequence and secondary structure, in this study, 32 portions of Astragalus membranaceus (Fisch.) Bge. var. mongholicus (Beg.) Hsiao and Astragalus membranaceus (Fisch.) Bge. collected were conducted ITS2 sequence amplification and bidirectional sequencing, whose results were then spliced by CExpress software remove the 5.8S and 28S sequences at both ends to obtain a complete ITS2 sequence. In addition, 3 ITS2 sequences for each of the adulterants of Astragalus, respectively, Oxytropis coerulea, Caragana sinica, Hedysarum polybotrys, Althaea rosea were downloaded from GenBank. The intra-specific and inter-specific genetic distances were calculated by the software MEGA7 to analyze the difference of each sequence; the Neighbor-joining (NJ) method was used to construct the phylogenetic tree based on ITS2 sequence (primary structure) as well as joint ITS2 sequence and its secondary structure. The results showed that the average ITS2 sequence length of both A. mongolicus and A. membranaceus was 216 bp, and their average GC content was 50.00% and 50.46%, respectively. The similarity of ITS2 sequence length and GC content between the two kind of Astragalus and Oxytropis coerulea was the highest, while the ITS2 sequence length and GC content of Althaea rosea showed great differences with those of Astragalus. The inter-specific distance between Astragalus and Oxytropis coerulea was the smallest, while that between the medicinal Astragalus and Hedysarum polybotrys, Caragana sinica as well as Althaea rosea was great. The phylogenetic trees constructed based on the ITS2 sequence (primary structure) and joint ITS2 sequence and its secondary structure showed that the topological relations of the two phylogenetic trees were basically the same, and both could effectively identify the Astragalus and its adulterants. What’s more, the addition of secondary structure information made end branch of the phylogenetic tree become more in its construction, and the distinguish ability and approval rating were also improved, which further reflected the genetic relationship of Astragalus and its adulterants. This provides some scientific basis for classification and accurate identification of Astragalus and its adulterants.

Efficacy and safety of the long-acting fusion inhibitor albuvirtide in antiretroviral-experienced adults with human immunodeficiency virus-1: interim analysis of the randomized, controlled, phase 3, non-inferiority TALENT study / 中华医学杂志(英文版)

BACKGROUND@#Albuvirtide is a once-weekly injectable human immunodeficiency virus (HIV)-1 fusion inhibitor. We present interim data for a phase 3 trial assessing the safety and efficacy of albuvirtide plus lopinavir-ritonavir in HIV-1-infected adults already treated with antiretroviral drugs.@*METHODS@#We carried out a 48-week, randomized, controlled, open-label non-inferiority trial at 12 sites in China. Adults on the World Health Organization (WHO)-recommended first-line treatment for >6 months with a plasma viral load >1000 copies/mL were enrolled and randomly assigned (1:1) to receive albuvirtide (once weekly) plus ritonavir-boosted lopinavir (ABT group) or the WHO-recommended second-line treatment (NRTI group). The primary endpoint was the proportion of patients with a plasma viral load below 50 copies/mL at 48 weeks. Non-inferiority was prespecified with a margin of 12%.@*RESULTS@#At the time of analysis, week 24 data were available for 83 and 92 patients, and week 48 data were available for 46 and 50 patients in the albuvirtide and NRTI groups, respectively. At 48 weeks, 80.4% of patients in the ABT group and 66.0% of those in the NRTI group had HIV-1 RNA levels below 50 copies/mL, meeting the criteria for non-inferiority. For the per-protocol population, the superiority of albuvirtide over NRTI was demonstrated. The frequency of grade 3 to 4 adverse events was similar in the two groups; the most common adverse events were diarrhea, upper respiratory tract infections, and grade 3 to 4 increases in triglyceride concentration. Renal function was significantly more impaired at 12 weeks in the patients of the NRTI group who received tenofovir disoproxil fumarate than in those of the ABT group.@*CONCLUSIONS@#The TALENT study is the first phase 3 trial of an injectable long-acting HIV drug. This interim analysis indicates that once-weekly albuvirtide in combination with ritonavir-boosted lopinavir is well tolerated and non-inferior to the WHO-recommended second-line regimen in patients with first-line treatment failure.@*TRIAL REGISTRATION@#ClinicalTrials.gov Identifier: NCT02369965; https://www.clinicaltrials.gov.Chinese Clinical Trial Registry No. ChiCTR-TRC-14004276; http://www.chictr.org.cn/enindex.aspx.

Observation on Effect of Atractylodesin Ⅱ on Gastric Cancer Cells Based on Macrophage Polarization / 中国实验方剂学杂志

Objective:To investigate the anti-tumor effect mechanism of atractylenolide Ⅱ by studying its effect on macrophage polarization. Method:Phorbol myristate acetate （PMA） was used to induce THP-1 cells differentiation into macrophages， and methylthiazolyldiphenyl-tetrazolium bromide（MTT）colorimetric assay was used to detect the effect of different concentrations of atractylenolide Ⅱ on macrophage growth at different time points to screen out the safe concentration of atractylenolide Ⅱ. The macrophages were treated with different concentrations of atractylenolide Ⅱ for 24 hours and then were co-cultured with gastric cancer cells. The survival of the two types of cells was observed under light microscope. The proliferation of gastric cancer cells was detected by MTT assay to determine the effective administration concentrations of atractylenolide Ⅱ. Cells were divided into blank group， model group， atractylenolide Ⅱ high dose group （200 mg·L-1）， atractylenolide Ⅱ medium dose group （100 mg·L-1）， and atractylenolide Ⅱ low dose group（50 mg·L-1）. Wound healing assay was carried out to observe the effects of different concentrations of atractylenolide Ⅱ on the migration and morphology of gastric cancer cells. The expression levels of M1 and M2 macrophage surface markers CD86 and CD206 were detected by flow cytometry analysis（FCM）. Quantitative polymerase chain reaction（Real-time PCR）and Western blot were used to detect M1， M2 macrophage-associated tumor necrosis factor （TNF） -α， human leukocyte antigen 2 （HLA-DRA）， CD80， transforming growth factor （TGF）-β， interleukin （IL） -10 and IL-6 genes and protein expression. Western blot was used to detect intracellular phosphatidyl inositol kinase （PI3K） and p-PI3K protein expression in macrophages. Result:When the concentration of atractylenolide Ⅱ was 1， 10， 50， 100， 200 mg·L-1， it showed no inhibition on macrophage growth. As compared with the model group， macrophages treated with 50， 100， 200 mg·L-1 atractylenolide Ⅱ significantly inhibited tumor cell proliferation （P<0.01）. As compared with the model group， the migration rate of tumor cells in the atractylenolide Ⅱ （200，100 mg·L-1） groups decreased （P<0.05）. The expression levels of CD86 on M1 macrophage surfacen in the atractylenolide Ⅱ （200，100，50 mg·L-1） groups were increased（P<0.05，P<0.01）， and the expression levels of CD206 on M2 macrophagen in the atractylenolide Ⅱ （200 mg·L-1） group were decreased （P<0.05）. The expression levels of M1 macrophage-associated cytokines TNF-α， HLA-DRA， CD80 mRNA in the atractylenolide Ⅱ （200，100 mg·L-1） groups were increased（P<0.05，P<0.01）， and TNF-α protein expression in the atractylenolide Ⅱ （200 mg·L-1） group was increased （P<0.05）， M2 type macrophage-associated cytokine TGF-β mRNA expression levels in the atractylenolide Ⅱ （50 mg·L-1） group were decreased， and IL-10， IL-6 protein expression levels in the atractylenolide Ⅱ （200 mg·L-1） group were decreased （P<0.05，P<0.01）. The expression levels of p-PI3K protein in the atractylenolide Ⅱ （200，100 mg·L-1） groups were also decreased（P<0.05，P<0.01）. Conclusion:Atractylenolide Ⅱ could induce the polarization of macrophages to M1 type by reducing the expression of p-PI3K in macrophages and inhibiting the proliferation and migration of gastric cancer cells.

Fuzheng Huayu recipe, a traditional Chinese compound herbal medicine, attenuates renal interstitial fibrosis via targeting the miR-21/PTEN/AKT axis / 中西医结合学报

OBJECTIVE@#MicroRNAs (miRNAs) may be viable targets for treating renal interstitial fibrosis (RIF). Fuzheng Huayu recipe (FZHY), a traditional Chinese compound herbal medicine, is often used in China to treat fibrosis. This study sought to assess the mechanisms through which FZHY influences miRNAs to treat RIF.@*METHODS@#RIF was induced in rats by mercury chloride and treated with FZHY. Hydroxyproline content, Masson's staining and type I collagen expression were used to evaluate renal collagen deposition. Renal miRNA profiles were evaluated using a miRNA microarray. Those miRNAs that were differentially expressed following FZHY treatment were identified and subjected to bioinformatic analyses. The miR-21 target gene phosphatase and tensin homolog (PTEN) expression and AKT phosphorylation in kidney tissues were assessed via Western blotting. In addition, HK-2 human proximal tubule epithelial cells were treated using angiotensin II (Ang-II) to induce epithelial-to-mesenchymal transition (EMT), followed by FZHY exposure. miR-21 and PTEN expressions were evaluated via quantitative reverse transcription-polymerase chain reaction (qRT-PCR), while E-cadherin and α-smooth muscle actin (α-SMA) expressions were assessed by immunofluorescent staining and qRT-PCR. Western blotting was used to assess PTEN and AKT phosphorylation.@*RESULTS@#FZHY significantly decreased kidney collagen deposition, hydroxyproline content and type I collagen level. The miRNA microarray identified 20 miRNAs that were differentially expressed in response to FZHY treatment. Subsequent bioinformatic analyses found that miR-21 was the key fibrosis-related miRNA regulated by FZHY. FZHY also decreased PTEN expression and AKT phosphorylation in fibrotic kidneys. Results from in vitro tests also suggested that FZHY promoted E-cadherin upregulation and inhibited α-SMA expression in Ang-II-treated HK-2 cells, effectively reversing Ang-II-mediated EMT. We also determined that FZHY reduced miR-21 expression, increased PTEN expression and decreased AKT phosphorylation in these cells.@*CONCLUSION@#miR-21 is the key fibrosis-related miRNA regulated by FZHY. The ability of FZHY to modulate miR-21/PTEN/AKT signaling may be a viable approach for treating RIF.

Application standard of mechanical suture technique in thoracoscopic surgery and management of complications / 中国胸心血管外科临床杂志

@#The precise resection and suture of bronchia, vascular and pulmonary tissue are the key techniques in thoracic surgery. Mechanical suture technique has gradually become a routine operation in thoracic surgery. However, at present, there is still a lack of consensus and guidelines on the application of this technique in thoracic surgery, neither strong evidence-based medical support. In this study, we discuss the application standard of mechanical suture technique in thoracoscopic surgery, irregular treatment techniques, intraoperative complications, and management principles to promote the standardized application of mechanical suture technique. We also explain the shortcomings of the technique in order to promote the further improvement and perfection.

Temporal and spatial distribution characteristics of NSCLP in Gansu Province from 2010 to 2016 / 中华疾病控制杂志

Objective To investigate the temporal and spatial distribution characteristics of non-syndromic cleft lip with or without palate (NSCLP) who born in Gansu Province from 2010 to 2016, and to establish a predictive model for developing the strategies for the prevention and control of NSCLP. Methods Spatial epidemiological research method and geographical information systems (GIS) were used to conduct thematic mapping, spatial correlation analysis, high/low clustering analysis, hotspot analysis and Kirging interpolation prediction for NSCLP patients in Gansu Province from 2010 to 2016. Results From 2010 to 2016, the aggregation trend of NSCLP incidence in 89 counties in Gansu Province was different obviously, the southeast area was high and the northwest was low. Based on the data of the cumulative incidence of NSCLP from 2010 to 2016 in Gansu, the spatial distribution of NSCLP presented positive spatial correlation (Moran’I=0.274，Z=7.814，P<0.001) and the aggregation type was high-high cluster(Getis Gi=0.000 003，Z=4.381，P<0.001), with 22 hot spots. The Kirging interpolation prediction results showed that the main prevalence trend of NSCLP in Gansu extended from Longdong to Longxi and Longnan areas. Conclusions The geographical distribution of NSCLP had a positive spatial correlation and a high-high aggregation type in Gansu from 2010 to 2016. The high aggregation area is concentrated in Longdong, Longxi and Longnan of Gansu, which suggest that it is essential to focus on prevention and control in these areas.

Perioperative safety and prognosis analysis of cases underwent total thoracoscopic pneumonectomy for pulmonary malignancy in single center / 中华胸心血管外科杂志

Objective To investigate the safety and efficacy of total thoracoscopic pneumonectomy for malignant lesion from a single-center pneumonectomy database.Methods A retrospectively analysis of 43 cases of malignant lesions in patients underwent total thoracoscopic pneumonectomy from surgical database of Shanghai Pulmonary Hospital from December 2013 to August 2017 was conducted,and then the mortality,complications,and disease recurrence were summarized.Results All lesions in 43 patients were pathologically comfirmed malignant,including 39 non-small cell lung cancers and 3 small cell lung cancers and 1 pulmonary metastasis.Complete thoracoscopic pneumonectomy was pedormed in 43 patients.The average operation time was (181.1 ± 68.0) min,blood loss was (146.5 t 113.6) ml,mean tube length was (8.4 ± 3.4) days.Perioperative mortality was 2.3％ (1/43).The complication rate of grade 3 or above was 16.3％.Median follow-up was 18 months,with 9 cases occuning local recurrence or distant metastasis;6 cases suffered from cancer-related death while non-cancer related death happened in 1 patient.Conclusion For selected locally advanced pulmonary malignant lesion,total thoracoscopic pneumonectomy is an alternative to open thoracic surgery with a better perioperative safety and satisfied mid-term oncologic survival.

Current status of clinical trials about thoracic surgery in lung cancer / 中华胸心血管外科杂志

The incidence of lung cancer in China ranks first and second among men and women respectively .Meanwhile, lung cancer is also the leading cause of death in malignant tumors in China .Surgical treatment is of great significance in impro-ving the prognosis of patients with lung cancer, and the number of related clinical trials is increasing year by year.Through a retrospective review of clinical trials in the field of lung cancer and thoracic surgery on the Clinicaltrials .gov platform, this arti-cle finds that relevant clinical trials focus on treatment , perioperative management and basic research.Although the clinical tri-als in China started late, they have developed rapidly and the number of clinical trials ranked second.In addition, there are some shortcomings in the clinical trials of China in terms of trial design and research scope , and there is still a gap between Chinese and foreign trials.

A self-designed odontoid guider for minimally invasive treatment of odontoid fractures of Anderson-D'Alonzo type Ⅱ / 中华创伤骨科杂志

Objective To compare the surgical effects between minimally invasive anterior ondontoid screw fixation assisted by our self-designed odontoid guider and open anterior ondontoid screw fixation in the treatment of odontoid fractures of Anderson-D'Alonzo type Ⅱ.Methods From July 2011 to July 2016,28 adults with odontoid fracture of Anderson-D'Alonzo type Ⅱ were treated at Department Ⅱ of Spinal Surgery,Hospital of 89 Army Group of Chinese PLA.Of them,15 were treated by minimally invasive anterior ondontoid screw fixation assisted by our self-designed odontoid guider (guider group) while the other 13 by open anterior ondontoid screw fixation (open group).All the patients were male,aged from 31 to 59 years (average,42.7 years).The 2 groups were compared in terms of incision length,operation time,intraoperative bleeding,intraoperative fluoroscopic frequency and hospital stay.Results There were no significant differences between the 2 groups of patients in their preoperative general data,indicating they were compatible (P ＞ 0.05).All the patients were followed up for 12 to 45 months (average,22.1 months).The internal fixation was in good place and clinical union achieved in all the 28 patients.The incision length (2.2 ± 0.1 cm),operation time (45.0 ± 3.1 min),intraoperative bleeding (29.0 ± 2.3 mL) and intraoperative fluoroscopic frequency (15.5 ± 1.9 times) for the guider group were all significantly less than those (2.9 ±0.7 cm,61.6±3.8 min,51.6±3.9 mL and 21.7±3.2 times,respectively) for the open group (P ＜0.05),but there was no significant difference between the 2 groups in hospital stay (6.5 ± 0.5 d versus 6.5 ± 0.6 d) (P ＞ 0.05).Conclusion In the treatment of odontoid fractures of Anderson-D'Alonzo type Ⅱ,compared with open anterior ondontoid screw fixation,the minimally invasive anterior ondontoid screw fixation assisted by our self-designed odontoid guider may lead to a smaller incision,shorter operation time,less blood loss and a lower fluoroscopic frequency.