Specimen extraction through natural orifices with Cai tubes in gastrointestinal surgery: a single-institute series of 234 cases / 中华胃肠外科杂志

Objective: To investigate the feasibility of Cai tube-assisted natural orifice specimen extraction surgery (NOSES) in gastrointestinal surgery. Methods: This was a descriptive case-series study. Inclusion criteria: (1) colorectal or gastric cancer diagnosed by preoperative pathological examination or redundant sigmoid or transverse colon detected by barium enema; (2) indications for laparoscopic surgery; (3) body mass index <30 kg/m2 (transanal surgery) and 35 kg/m2 (transvaginal surgery); (4) no vaginal stenosis or adhesions in female patients undergoing transvaginal specimen extraction; and (5) patients with redundant colon aged 18-70 years and a history of intractable constipation for more than 10 years. Exclusion criteria: (1) colorectal cancer with intestinal perforation or obstruction, or gastric cancer with gastric perforation, gastric hemorrhage, or pyloric obstruction; (2) simultaneous resection of lung, bone, or liver metastases ; (3) history of major abdominal surgery or intestinal adhesions; and (4) incomplete clinical data. From January 2014 to October 2022, 209 patients with gastrointestinal tumors and 25 with redundant colons who met the above criteria were treated by NOSES utilizing a Cai tube (China invention patent number:ZL201410168748.2) in the Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University. The procedures included eversion and pull-out NOSES radical resection in 14 patients with middle and low rectal cancer, NOSES radical left hemicolectomy in 171 patients with left-sided colorectal cancer, NOSES radical right hemicolectomy in 12 patients with right-sided colon cancer, NOSES systematic mesogastric resection in 12 patients with gastric cancer, and NOSES subtotal colectomy in 25 patients with redundant colons. All specimens were collected by using an in-house-made anal cannula (Cai tube) with no auxiliary incisions. The primary outcomes included 1-year recurrence-free survival (RFS) and postoperative complications. Results: Among 234 patients, 116 were male and 118 were female. The mean age was (56.6±10.9) years. NOSES was successfully completed in all patients without conversion to open surgery or procedure-related death. The negative rate of circumferential resection margin was 98.8% (169/171) with both two positive cases having left-sided colorectal cancer. Postoperative complications occurred in 37 patients (15.8%), including 11 cases (4.7%) of anastomotic leakage, 3 cases(1.3%) of anastomotic bleeding, 2 cases (0.9%) of intraperitoneal bleeding, 4 cases (1.7%) of abdominal infection, and 8 cases (3.4%) of pulmonary infection. Reoperations were required in 7 patients (3.0%), all of whom consented to creation of an ileostomy after anastomotic leakage. The total readmission rate within 30 days after surgery was 0.9% (2/234). After a follow-up of (18.3±3.6) months, the 1-year RFS was 94.7%. Five of 209 patients (2.4%) with gastrointestinal tumors had local recurrence, all of which was anastomotic recurrence. Sixteen patients (7.7%) developed distant metastases, including liver metastases(n=8), lung metastases(n=6), and bone metastases (n=2). Conclusion: NOSES assisted by Cai tube is feasible and safe in radical resection of gastrointestinal tumors and subtotal colectomy for redundant colon.

Safety and learning curve of Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy in the treatment of obesity patients / 中华胃肠外科杂志

Objective: To investigate the safety and learning curve of Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) in the treatment of obesity patients. Methods: A descriptive case series study was performed. Clinical data of obesity patients who were treated with Da Vinci robotic SADI-S in China-Japan Union Hospital of Jilin University from March 2020 to May 2021 were analyzed retrospectively. Case inclusion criteria: (1) uncomplicated obese patients with body mass index (BMI)≥37.5 kg/m(2); (2) patients with BMI of 28 to <37.5 kg/m(2) complicated with type 2 diabetes or two metabolic syndrome components, or obesity comorbidities; (3) patients undergoing SADI-S by Da Vinci robotic surgery system. Those who received other bariatric procedures other than SADI-S or underwent Da Vince robotic SADI-S as revisional operation were excluded. A total of 77 patients were enrolled in the study, including 31 males and 46 females, with median age of 33 (18-59) years, preoperative body weight of (123.0±26.2) kg, BMI of (42.2±7.1) kg/m(2) and waistline of (127.6±16.3) cm. According to the order of operation date, the patients were numbered as 1-77. The textbook outcome (TO) and Clavien-Dindo grading standard were used to analyze the clinical outcome of each patient and to classify surgical complications, respectively. The standard of textbook outcome was as follows: the operative time less than or equal to the 75th percentile of the patient's operation time (210 min); the postoperative hospital stay less than or equal to the 75th percentile of the patient's postoperative hospital stay (7 d); complication grade lower than Clavien grade II; no readmission; no conversion to laparotomy or death. The patient undergoing robotic SADI-S was considered to meet the TO standard when meeting the above 5 criteria. The TO rate was calculated by cumulative sum analysis (CUSUM) method. The curve was drawn by case number as X-axis and CUSUM (TO rate) as Y-axis so as to understand the learning curve of robotic SADI-S. Results: The operative time of 77 robotic SADI-S was (182.9±37.5) minutes, and the length of postoperative hospital stay was 6 (4-55) days. There was no conversion to laparotomy or death. Seven patients suffered from complications (7/77, 9.1%). Four patients had grade II complications (5.2%), including one with duodeno-ileal anastomotic leakage, one with abdominal bleeding, one with peritoneal effusion and one with delayed gastric emptying; two patients were grade IIIb complications (2.6%) and both of them were diagnosed with gastric leakage; one patient was grade IV complication diagnosed with postoperative respiratory failure (1.3%), and all of them were cured successfully. A total of 51 patients met the textbook outcome standard, and the TO rate was positive and was steadily increasing after the number of surgical cases accumulated to the 46th case. Taking the 46th case as the boundary, all the patients were divided into learning stage group (n=46) and mastery stage group (n=31). There were no significant differences between the two groups in terms of gender, age, weight, body mass index, waist circumference, ASA classification, standard liver volume, operative time and morbidity of postoperative complication (all P>0.05). The percent of abdominal drainage tube in learning stage group was higher than that in mastery stage group (54.3% versus 16.1%, P<0.05). The length of postoperative hospital stay in learning stage group was longer than that in mastery stage group [6 (4-22) d versus 6 (5-55) d, P<0.05)]. Conclusion: The Da Vinci robotic SADI-S is safe and feasible with a learning curve of 46 cases.

The prevalence and associated factors of metabolic syndrome among Tibetan pastoralists in transition from nomadic to settled urban environment / 中华流行病学杂志

Objective: To study the prevalence and associated factors of metabolic syndrome (MS) among Tibetan pastoralists in transition from high altitude nomadic to settled urbanized environment, especially dietary factors. Methods: The community-based cross-sectional study included 920 Tibetan adults (men 419, women 501). Data were collected using questionnaires, anthropometric measurements, and biomarker tests. Questionnaires included socio-economic, lifestyle characteristics and food consumption. Principal component analysis was used to identify dietary patterns. The risk factors of MS and its components were analyzed by logistic regression model. Results: The prevalence rates of MS and its components were 32.8% (MS), 83.7% (decreased HDL-C), 62.1% (central obesity), 36.7% (elevated blood pressure), 11.8% (elevated TG), and 7.9% (elevated blood glucose), respectively. The prevalence of overweight was 31.2%, obesity 30.3%. Multivariate analysis showed smoking was associated factor for both of decreased HDL-C (OR=1.239, 95%CI: 1.025-1.496) and elevated TG (OR=1.277, 95%CI: 1.038-1.571). Alcohol drinking appeared as associated factor of elevated TG (OR=1.426, 95%CI: 1.055-1.927). However, physical activity showed as a protective factor for central obesity, decreased HDL-C, and elevated TG. With the increase of age, the adherence to the urban and western dietary patterns decreased, and that to the pastoral dietary pattern increased. By quintiles of dietary pattern scores, the urban dietary pattern was significantly associated with MS (trend test P=0.016). Conclusions: Tibetan pastoralists had high prevalence of both MS and obesity. Smoking, alcohol drinking, the transition from pastoral dietary pattern to urban dietary pattern and inadequate physical activity served as associated factors for MS and its components.

Comparison between laparoscopic-assisted natural orifice specimen extraction surgery and conventional laparoscopic surgery for left colorectal cancer: a randomized controlled study with 3-year follow-up results / 中华胃肠外科杂志

Objective: To evaluate the mid-term efficacy of laparoscopic-assisted natural orifice specimen extraction surgery (NOSES) colectomy using the Cai tube in the treatment of left colorectal cancer. Methods: A prospective randomized control trial (China Clinical Trials Registration Number: ChiCTR-OOR-15007060) was performed. Sixty patients with left colorectal cancer at Department of Gastrointestinal Surgery of Zhongshan Hospital from September 2015 to August 2017 were prospectively enrolled. Case inclusion criteria: (1) left colorectal adenocarcinoma (rectal cancer with distance ≥ 8 cm from tumor low margin to anal edge, sigmoid colon cancer, descending colon cancer and left transverse colon cancer) confirmed by preoperative pathology; (2) satisfactory conditions of conventional laparoscopic surgery; (3) maximum diameter of the tumor < 4.5 cm confirmed by preoperative abdominal and pelvic CT or MRI; (4) BMI < 30 kg/m2. Case exclusion criteria: (1) benign lesions, mucinous adenocarcinoma, signet-ring cell carcinoma and other special pathological types of tumors confirmed by preoperative pathological examination; (2) multiple or recurrent cancers; (3) with a history of neoadjuvant chemoradiotherapy; (4) obvious regional infiltration or distant metastasis indicated by preoperative imaging examination; (5) intestinal obstruction, intestinal perforation, etc. Participants were randomly assigned to NOSES group (using the Cai tube) and conventional laparoscopy (CL) group by random number table method. Clinical data between two groups were compared and analyzed, including perioperative conditions, tumor exfoliation cell detection and bacterial culture results of intraperitoneal lavage fluid, postoperative complications (Clavien-Dindo grading), postoperative pain [visual simulation scoring (VAS) assessment], anal function (Kirwan anal function grading assessment), and postoperative 3-year disease-free survival (DFS), overall survival (OS), overall recurrence rate, and local recurrence rate. Results: A total of 60 patients were enrolled, with 30 in the NOSES group and 30 in the CL group. All the patients in the NOSES group successfully completed operation with Cai tube. Baseline data between the two groups were not significantly different (all P>0.05). There were no statistically significant differences between two groups in conversion rate to open surgery, number of lymph node harivested, proximal and distal resection margin of tumor, negative rate of circumferential margin, operation time, blood loss, inflammatory indexes, postoperative anal function, postoperative hospital stay, hospitalization cost, morbidity of postoperative complications (Clavien-Dindo grade II or above) (all P>0.05). Compared to the CL group, the NOSES group had lower maximum postoperative VAS score (2.5±0.3 vs. 5.1±0.4, t=3.187, P<0.01), and fewer use of additional postoperative analgesia [6.7% (2/30) vs. 33.3% (10/30),χ2=6.670, P=0.02]. The postoperative time to gas passage was shorter in the NOSES group [(2.2±1.4) days vs. (3.1±1.2) days,P=0.026]. No tumor cells and bacterial contamination were found in abdominal lavage fluid before and after operation in either group. The anal function at postoperative 3-month of all the patients in the NOSES group was Kirwan grade I to II, while in the CL group, anal function of 2 cases (6.7%) was Kirwan grade III, and of 28 cases was also Kirwan grade I to II, whose difference was not statistically significant (P>0.05). In the NOSES group and the CL group, 3-year DFS was 96.7% and 83.3% (P=0.090), OS was 100% and 90% (P=0.096), overall recurrence rate was 3.3% and 10.0% (P=0.166), and local recurrence rate was 3.3% and 3.3% (P=0.999), respectively, whose differences were not statistically significant (all P>0.05). Conclusions: In the treatment of left colorectal cancer, compared with conventional laparoscopic colectomy, NOSES colectomy using Cai tube exhibits less scar, less postoperative pain, shorter recovery of gastrointestinal function, and similar mid-term outcomes. Given proper surgical indications, the surgical procedure is safe and feasible.

Influenza A virus exposure may cause increased symptom severity and deaths in coronavirus disease 2019 / 中华医学杂志(英文版)

BACKGROUND@#The coronavirus disease 2019 (COVID-19) outbreak occurred during the flu season around the world. This study aimed to analyze the impact of influenza A virus (IAV) exposure on COVID-19.@*METHODS@#Seventy COVID-19 patients admitted to the hospital during January and February 2020 in Wuhan, China were included in this retrospective study. Serum tests including respiratory pathogen immunoglobulin M (IgM) and inflammation biomarkers were performed upon admission. Patients were divided into common, severe, and critical types according to disease severity. Symptoms, inflammation indices, disease severity, and fatality rate were compared between anti-IAV IgM-positive and anti-IAV IgM-negative groups. The effects of the empirical use of oseltamivir were also analyzed in both groups. For comparison between groups, t tests and the Mann-Whitney U test were used according to data distribution. The Chi-squared test was used to compare disease severity and fatality between groups.@*RESULTS@#Thirty-two (45.71%) of the 70 patients had positive anti-IAV IgM. Compared with the IAV-negative group, the positive group showed significantly higher proportions of female patients (59.38% vs. 34.21%, χ = 4.43, P = 0.035) and patients with fatigue (59.38% vs. 34.21%, χ = 4.43, P = 0.035). The levels of soluble interleukin 2 receptor (median 791.00 vs. 1075.50 IU/mL, Z = -2.70, P = 0.007) and tumor necrosis factor α (median 10.75 vs. 11.50 pg/mL, Z = -2.18, P = 0.029) were significantly lower in the IAV-positive group. Furthermore, this group tended to have a higher proportion of critical patients (31.25% vs. 15.79%, P = 0.066) and a higher fatality rate (21.88% vs. 7.89%, P = 0.169). Notably, in the IAV-positive group, patients who received oseltamivir had a significantly lower fatality rate (0 vs. 36.84%, P = 0.025) compared with those not receiving oseltamivir.@*CONCLUSIONS@#The study suggests that during the flu season, close attention should be paid to the probability of IAV exposure in COVID-19 patients. Prospective studies with larger sample sizes are needed to clarify whether IAV increases the fatality rate of COVID-19 and to elucidate any benefits of empirical usage of oseltamivir.

Secondary metabolites from Corynespora cassiicola J9, an endophytic fungus associated with Blumea balsamifera (L.) DC / 药学学报

Chemical investigation on the rice culture of Corynespora cassiicola J9, an endophyte inhabiting in Blumea balsamifera (L.) DC. resulted in isolation of eight compounds, including a new depsidone derivative, corynether C (1), and seven analogues, corynether B (2), corynetherlactone A (3), corynether A (4), diaryl ether (5), corynesidone C (6), corynesidone D (7), and corynesidone A (8). Their structures were deduced based on 1D and 2D NMR spectroscopy, and HR-ESI-MS data. All of the isolated compounds were evaluated for inhibitory activities against Lissorhoptrus oryzophilus Kuschel by the leaf spray assay. Unfortunately, none of them showed inhibitory effects.

The physical development and associated factors of ninth grade students in China / 中华疾病控制杂志

Objective To analyse the status and related factors of physical development of ninth grade students in China,so as to provide reference and scientific basis for the development of adolescent’ physical health promotion programs.Methods Multiple linear regression and binomial Logistic regression models were used to analyse the data from 7 840 ninth grade students in the 2016 China Education Panel Survey.Results There were differences in the distribution of height and weight between urban and rural and between boys and girls.From the age of 14 to 16,boys were taller and heavier than girls(height cm：171.69±6.95 vs 161.54±5.58, weight kg：60.43±13.19 vs 53.21±11.69), and urban students were taller and heavier than rural students(height cm：167.93±8.16 vs 165.80±7.94；weight kg：58.18±13.16 vs 55.94±12.78). The rate of physical fitness of boys was lower than that of girls(51.8% vs 87.8%), and that of urban boys was lower than that of rural boys(45.7% vs 58.9%), and that of urban girls was higher than that of rural girls(92.0% vs 84.6%). The average age of first spermatorrhea was 13.62±1.23 years for boys and 12.87±1.07 years for girls. Sexual development of urban students appeared earlier than rural students. Multivariate linear regression analysis showed that height and weight were related to bring single-child and sleep time. Height was also related to parents’height, nationality, family economic level and exercise time, weight was also related to parents’ weight (all P<0.05). Binomial Logistic regression analysis showed that physical fitness level was related to gender, nationality, nutritional status, weight, high calorie intake, exercise time, etc (all P<0.05). Correlative factors of male first spermatorrhea were nationality, urban residence, singleton , sleep time, physical fitness level, while female menarche was related to exercise time, lunch spot and nutritional status (all P<0.05). Conclusions Comprehensive efforts and cooperation are needed to promote the normal development and physical health of the students.

Trends and risk factors of overweight and obesity among Chinese middle school students / 中华疾病控制杂志

Objective To investigate the trends and risk factors of overweight and obesity in Chinese middle school students. Methods Data from the China Education Panel Survey conducted in 2014, 2015 and 2016 were used (8 616, 8 762, 7 614; age range 11-18 years old). Overweight and obesity were defined according to Chinese sex-age-specific body mass index (BMI) cutoffs. Relationships between risk factors and BMI, overweight and obesity were tested, using linear regression and logistic regression models. Results The overall prevalence of overweight and obesity in 2016 was 15.3% (17.9% in boys, 12.6% in girls). From 2014 to 2016, the prevalence of overweight and obesity was increasing steadily. After adjusting for age and sex in 2016, being only-child, self-perceived being overweight or obese, or living in urban area were associated with higher BMI (β(SE)=0.23(0.10), β(SE)=2.83(0.14), β(SE)=0.23(0.11), respectively). Self-perceived being overweight or obese was associated with overweight and obesity (OR=4.20, 95% CI: 2.97-5.40). Conclusions Overweight and obesity rates among Chinese middle school students increased steadily from 2014 to 2016. Efforts should be made on childhood obesity prevention and control, especially target at those being only-child, living in urban areas.

Relationship between human galectin 3 and myocardial infarction range, coronary thrombosis load and ventricular remodeling in patients with acute myocardial infarction / 中国实用内科杂志

OBJECTIVE: To investigate the expression changes of human galectin 3(Gal-3)in patients with acute myocardial infarction undergoing emergency PCI and to assess the relationship between Gal-3 level and myocardial infarction range,coronary thrombotic load and ventricular remodeling.METHODS: Totally 62 patients with AMI who underwent emergency PCI in the department of cardiology of our hospital from January to August of 2018 were selected. Blood samples were taken for Gal-3 determination immediately after admission, 3 and 5 days after PCI. Troponin I was measured in 24 hours after PCI.Echocardiography was completed 24 hours after PCI. The patients were divided into three groups according to the results of coronary angiography: the single-vessel disease group, the two-vessel disease group and the three-vessel disease or the left main disease group.Gensini cumulative index was calculated. According to the imaging of coronary angiography, the coronary thrombus load was divided into 0-5 grades. The changes of Gal-3 level on admission to hospital,and at 3 and 5 days after PCI were analyzed and their relationship with troponin, coronary artery diseaseand thrombus load was analyzed.RESULTS: 1. Gal-3 levels were gradually reduced on admission, at 3 days after PCI and 5 days after PCI,which were respectively(93.38 ± 9.37)ng/L,(82.76 ± 7.43)ng/L and(72.71 ± 7.58)ng/L, and there were statistically significant differences among the three groups(F=99.17,P0.05). No correlation was found between Gal-3 levels and Gensini cumulative index(P>0.05). 3. The patients were divided into the group with thrombus level 0(T0 group)and the group with thrombus level 1-5(T1-5 group). Compared to the T0 group,the admission level of Gal-3 was significantly higher in the T1-5 group,which was(95.6±7.31)g/L vs.(89.62±11.3)ng/L,and the difference between the two groups was statistically significant(P=0.014). Similarly, the Gal-3 level of the T1-5 group was significantly higher than that of the T0 group on the 3 days after PCI and 5 days after PCI(P=0.017,P=0.006). Pearson correlation analysis showed that the level of Gal-3 on admission, 3 days after PCI and 5 days after PCI were all positively correlated with troponin I(CTNI)at 24 hours after PCI;there was a negative correlation with left ventricular ejection fraction(LVEF).CONCLUSION: Gal-3 is released in the acute phase of AMI,and decreases gradually within 5 days after emergency PCI. The level of Gal-3 is associated with the coronary thrombus load in patients with acute myocardial infarction. The heavier the thrombus load, the higher level the Gal-3. Gal-3 level is positively correlated with the extent of myocardial infarction, and negatively correlated with LVEF, reflecting that Gal-3 is involved in ventricular remodeling after actue myocardial infarction.

Influencing factors of severity and aggravationof coronary heart disease / 心血管康复医学杂志

Objective :To explore influencing factors of severity and aggravation of coronary heart disease (CHD ). Methods : A total of 132 CHD patients ,who were treated in our department from Mar 2015 to Mar 2017 ,were en-rolled .According to Gensini score ,patients were divided into mild disease group (n＝64) ,moderateand severe dis-ease group (n＝68).Relevant clinical data were collected ,and single-factor and multi －factor regression were used to analyze risk factors of coronary artery disease aggravation .Results :Clinical data indicated that diabetes mellitus (DM) ,smoking ,age ,body mass index (BMI) and blood lipids were influencing factors for coronary artery disease severity ( P＜0-05 or ＜0-01).Single factor regression analysis indicated that age ,smoking history ,DM history and dyslipidemia were influencing factors for coronary artery disease aggravation , P＜0-05 or ＜0-01 .Logistic multi－factor regression analysis indicated that dyslipidemia and smoking history were independent risk factors of aggrava-tion of coronary artery disease .(OR＝3-249 ,7-135 , P＝0-008 ,0-001).Conclusion : Severity of coronary artery disease is closely related with DM ,smoking history and dyslipidemia in CHD patients .And dyslipidemia and smok-ing history are independent risk factors for coronary artery disease aggravation .

Implementing antimicrobial management toimprove susceptibility of Pseudom onas aeruginosa to carbapenems / 中国感染控制杂志

Objective To analyze susceptibility of clinically isolated Pseudomonas aeruginosa(PA)to carbape-nems,and observe the effect of classified management of antimicrobial agents on carbapenem susceptibility.Methods PA isolated from Peking University Cancer Hospital between October 2012 and March 2014 were collected,uni-variate analysis and multivariate logistic regression analysis were adopted to study the risk factors for non-suscepti-bility to carbapenems,susceptibility of PA to carbapenems before and after the implementation of classified manage-ment of antimicrobial agents was analyzed.Results A total of 125 strains of PA were isolated,mainly from patients with esophageal cancer(n=30,24.0%)and colorectal cancer(n=29,23.2%);the main specimens were drainage fluid and wound secretion(n=62,49.6%);the main source departments were surgical wards(n=86,68.8%). Univariate analysis showed that non-susceptibility of PA to carbapenems was related to strains from surgical wards,hospitalization within 3 months,carbapenem exposure,and length of hospital stay>4 weeks. Logistic regression analysis showed that 3 independent risk factors were:strains from surgical wards,exposure to carbapenems,and length of hospital stay>4 weeks. Susceptibility of PA to carbapenems after implementation of antimicrobial man-agement was 74.6%,which was higher than 53.4% before management(P= 0.015).Conclusion Strains from surgical wards,carbapenem exposure,and length of hospital stay>4 weeks are independent risk factors for no-sus-ceptibility of PA to carbapenems;susceptibility of PA to carbapenems is increased after strict implementation of antimicrobial classified management system.

Quality Standard Establishment Glycyrrhizic Acid in Compound Loquat and Pentoryverine Granule / 中国药师

Objective: :To establish a quality standard for glycyrrhizic acid in compound loquat and pentoryverine granule.Methods: TLC was applied in the qualitative detection of glycyrrhizic acid.An HPLC method was used for the quantitative determination of glycyrrhizic acid.A C 18 (250 mm× 4.6 mm ,5 μm)column was used.The mobile phase was a mixture of methanol-0.2 mol·L-1 ammonium acetate-acetic acid(60∶39∶1).The flow rate was at 1.0 ml·min-1 , and the detection wavelength was at 250 nm.Results: The TLC spots were clear and well separated without interference from the negative sample.The calibration curves were linear within the range of 0.01-1.01 g·L-1 (r=1.000 0).The average recovery was 103.2% (RSD %=1.8% , n =9).Conclusion: The method is simple and accurate, which can be used for the quality control of compound loquat and pentoryverine granule.

Studies on OAZI-1 protein complex in inducing specific antitumor effects in mice / 中国免疫学杂志

Objective:To analyze whether the OAZI-1 (ornithine decarboxylase antizyme inhibitor-1) protein complex isolated from tumor cells could induce specific antitumor effects in the experiment mice .Methods:OAZI-1 protein complexes were isolated from B16-F1 melanoma cells by immune magnetic beads coated with OAZI-1 antibody and used as the vaccine to immune the C 57BL/6 mice.After immunization,the mice were inoculated subcutaneously with live B 16-F1 cells and then tumor formation and growth were ob-served.ELISA was used to determine the level of cytokine IFN-γin the serum of immunized mice.Lactate dehydrogenase assay (LDH) was performed to evaluate killing effect of spleen lymphocytes on B 16-F1 cells.The mice immunized by purified OAZI-1 from prokaryotic expression and PBS were used as controls in the animal experiment .Results: Compared with the control mice ,the spleen lymphocytes ( effector cells ) from the mice inoculated with OAZI-1 protein complexes had stronger killing ability on B 16-F1 cells (target cells).At three different effector:target ratio (10:1,50:1,100:1),the killing ability of these spleen lymphocytes were 46.2%, 59.5%and 92.5% respectively,which was significantly higher than the spleen lymphocytes from the mice inoculated with purified AZIN-1 protein (36.1%,26.8% and 45.9%) or inoculated with PBS (24.6%,24.0% and 27.2%).In addition,the content of serum anti-tumor cytokine IFN-γwas also significantly higher in the mice inoculated with OAZI-1 protein complexes (538.3 pg/ml) than the mice inoculated with purified AZIN-1 ( 256.2 pg/ml ) or with PBS ( 131.0 pg/ml ) .When B16-F1 live cells were subcutaneously inoculated into the immunized mice described above ,the tumor formation rate was only 40%in the mice immunized with OAZI-1 protein complex ,but 100%in the mice immunized with PBS or purified OAZI-1.The growth of inoculated tumors in the mice immunized with OAZI-1 protein complex was also much slower than the control mice .Conclusion:The results in this study suggest that the OAZI-1 protein complex isolated from B 16-F1 tumor cells could contain some tumor antigens .When used as tumor vaccine to inoculate mice ,this complex can induce anti-tumor immune killing activity in experimental animals .

Laparoscopic Versus Open Resection of Small Bowel Gastrointestinal Stromal Tumors: Systematic Review and Meta-Analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Laparoscopic resection (LAP) for small bowel gastrointestinal stromal tumors (GISTs) is not as common as for stomach. This study aimed to evaluate the safety and efficacy of LAP for small bowel GISTs with systematic review and meta-analysis.</p><p><b>METHODS</b>The Web of Science, Cochrane Library, Embase, and PubMed databases before December 2016 were comprehensively searched to retrieve comparative trials of LAP and conventional open resection (OPEN) for GISTs of small bowel with a relevance of review object. These researches reported intraoperative and postoperative clinical course (operation time, blood loss, time to first flatus and oral intake, hospital stay, morbidity, and mortality), oncologic outcomes, and long-term survival status.</p><p><b>RESULTS</b>Six studies involving 391 patients were identified. Compared to OPEN, LAP had associated with a shorter operation time (weighted mean difference [WMD] = -27.97 min, 95% confidence interval [CI]: -49.40--6.54, P < 0.01); less intraoperative blood loss (WMD = -0.72 ml; 95% CI: -1.30--0.13, P = 0.02); earlier time to flatus (WMD = -0.83 day; 95% CI: -1.44--0.22, P < 0.01); earlier time to restart oral intake (WMD = -1.95 days; 95% CI: -3.31--0.60, P < 0.01); shorter hospital stay (WMD = -3.00 days; 95% CI: -4.87--1.13, P < 0.01); and a decrease in overall complications (risk ratio = 0.56, 95% CI: 0.33-0.97, P = 0.04). In addition, the tumor recurrence and long-term survival rate showed that there was no significant difference between the two groups of patients.</p><p><b>CONCLUSIONS</b>LAP for small bowel GISTs is a safe and feasible procedure with shorter operation time, less blood loss, less overall complications, and quicker recovery. Besides, tumor recurrence and the long-term survival rate are similar to open approach. Because of the limitations of this study, methodologically high-quality studies are needed for certain appraisal.</p>

Vegetable and Fruit Consumption among Chinese Adults and Associated Factors: A Nationally Representative Study of 170,847 Adults / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>This study examined vegetable and fruit (VF) consumption rate and its associated factors among Chinese adults.</p><p><b>METHODS</b>Nationally representative data from the 2013 China Chronic Disease Surveillance survey were used. Dietary intake data, including VF consumption during the last 12 months, were collected. All analyses were weighted to obtain nationally representative estimates. Associations between VF consumption and other factors (e.g., meal frequency and physical activity) were examined through logistic regression analysis.</p><p><b>RESULTS</b>The average fruit consumption was 102.3 g/day (95% CI: 97.0-107.6) and the average vegetable consumption was 350.6 g/day (95% CI: 339.3-361.8). Over half (53.2%, 95% CI: 50.9-55.4) of Chinese adults met the VF consumption of 400 g/day recommended by the World Health Organization (WHO). Rural residents had a higher prevalence of low VF consumption rate than urban residents [49.20% (95% CI: 46.2%-52.2%) vs. 44.0% (95% CI: 41.7%-46.3%) P < 0.01]. Old age (OR = 1.01, 95% CI: 1.00-1.01), low educational level, low income, minority ethnicity (OR = 1.41, 95% CI: 1.15-1.74), underweight (OR = 1.17, 95% CI: 1.03-1.33), single marital status (OR = 1.20, 95% CI: 1.08-1.33), low health literacy, irregular breakfast (OR = 1.20, 95% CI: 1.04-1.38) or lunch (OR = 1.58, 95% CI: 1.26-1.99) habits, and no leisure-time physical activity were associated with low VF consumption.</p><p><b>CONCLUSION</b>Only half of Chinese adults met the VF consumption recommended by the WHO. Low socio-economic status, irregular diet, and poor health literacy were likely associated with low VF consumption. National efforts and programs are needed to promote VF consumption.</p>

Analysis of metabolic pathway of terpenoids in Blumea balsamifera / 中国中药杂志

In order to provide a theoretical basis for the regulation of active ingredient, the terpenoids metabolic pathway and specific enzymes in Blumea balsamifera are investigated. Basing on transcriptome information, B. balsamifera terpenoids metabolic pathway was analyzed in KEGG data base. Four metabolic pathway of terpenoids were found in KEGG data base. They were terpenoid backbone biosynthesis, monoterpenoid biosynthesis, diterpenoid biosynthesis, sesquiterpenoid and triterpenoid biosynthesis, contained 103, 10, 29,59 genes, respectively. Through the analysis of the enzyme and product in the pathway, the result showed that there were 8 kinds of monoterpenes, 3 kinds of diterpenes, 3 kinds of triterpenes and sesquiterpenes. The mainly key enzymes were deoxyxylulose 5-phosphate synthase, HMG-CoA reductase and allyl transferase system. In B. balsamifera, there were relatively few monoterpenes synthetic enzymes, while the type of products was much more than other terpenes. This may be relate to the non-specific catalytic characteristic of monoterpene synthase. It is expected to improve the yield of terpenoids in B. balsamifera by analysis the pathways and regulation the key enzymes.

Effects of spironolactone towards rabbit atrial remodeling with rapid pacing

This study aimed to observe the effects of spironolactone towards the rabbit atrial remodeling with rapid atrial pacing [RAP]. 30 rabbits were randomly divided into control group, RAP group and spironolactone group, with 10 rabbits in each group. RAP was performed at the speed of 800 beats/min for 8 h, atrial effective refractory period [AERP] was determined before and at the 1[st], 2[nd], 4[th], 6[th] and 8[th] of the pacing, the expressions of atrial muscular calcium channel alpha 1C subunit and beta 1 subunit mRNA were performed the RT-PCR detection, and ultrastructural changes of atrial myocytes were observed. AERP of RAP group shortened, with poor frequency adaptability; the expressions of calcium channel alpha 1C subunit and beta 1 subunit mRNA decreased 22% and 26%, respectively, when compared with the control group; ultrastructure of atrial myocytes changed significantly. AERP of spironotlactone group shortened less that RAP group, and the frequency adaptability was maintained, the decreased expressions of calcium channel alpha 1C subunit and beta 1 subunit mRNA significantly reduced. RAP could cause atrial remodeling, while spironolactone could inhibit RAPinduced atrial remodeling

Relationship between Radiological Stages and Prognoses of Pneumocystis Pneumonia in Non-AIDS Immunocompromised Patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although radiological features of pneumocystis pneumonia (PCP) in non-Acquired Immune Deficiency Syndrome (AIDS) immunocompromised patients have been reported by other authors, there were no studies on the radiological stages of PCP previously. This study aimed to elucidate the radiological stages and prognoses of PCP in non-AIDS immunocompromised patients.</p><p><b>METHODS</b>Retrospective analysis of radiological manifestations and prognoses of 105 non-AIDS PCP immunocompromised patients from August 2009 to April 2016 was conducted. Chest radiograph was divided into three stages: early stage (normal or nearly normal chest radiograph), mid stage (bilateral pulmonary infiltrates), and late stage (bilateral pulmonary consolidations); chest high-resolution computed tomography (HRCT) was also divided into three stages: early stage (bilateral diffuse ground-glass opacity [GGO]), mid stage (bilateral diffuse GGO and patchy consolidations), and late stage (bilateral diffuse consolidations).</p><p><b>RESULTS</b>The case fatality rate (CFR) of all patients was 34.3% (36/105), all of them took routine chest X-ray (CXR), and 84 underwent chest CT examinations. According to the CXR most near the beginning of anti-PCP therapy, 18 cases were at early stage and CFR was 0 (0/18, P< 0.01), 50 cases were at mid stage and CFR was 28.0% (14/50, P> 0.05), and 37 cases were at late stage and CFR was 59.5% (22/37, P< 0.01). According to the chest HRCT most near the beginning of anti-PCP therapy, 40 cases were at early stage and CFR was 20.0% (8/40, P> 0.05), 34 cases were at mid stage and CFR was 47.1% (16/34, P> 0.05), and 10 cases were at late stage and CFR was 80.0% (8/10, P< 0.05); barotrauma, including pneumothorax, pneumomediastinum, and pneumohypoderma, was found in 18 cases and the CFR was 77.8% (14/18, P< 0.01).</p><p><b>CONCLUSIONS</b>Based on the radiological manifestations, the course of PCP in non-AIDS immunocompromised patients can be divided into three stages: early stage, mid stage, and late stage. The prognoses of patients treated at early stage are good, and those at late stage are poor. Furthermore, the CFR of patients with barotrauma is high.</p>

Living near a Major Road in Beijing: Association with Lower Lung Function, Airway Acidification, and Chronic Cough / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The effects of near-road pollution on lung function in China have not been well studied. We aimed to investigate the effects of long-term exposure to traffic-related air pollution on lung function, airway inflammation, and respiratory symptoms.</p><p><b>METHODS</b>We enrolled 1003 residents aged 57.96 ± 8.99 years living in the Shichahai Community in Beijing. Distances between home addresses and the nearest major roads were measured to calculate home-road distance. We used the distance categories 1, 2, and 3, representing <100 m, 100-200 m, and >200 m, respectively, as the dose indicator for traffic-related air pollution exposure. Lung function, exhaled breath condensate (EBC) pH, and interleukin 6 levels were measured. As a follow-up, 398 participants had a second lung function assessment about 3 years later, and lung function decline was also examined as an outcome. We used regression analysis to assess the impacts of home-road distance on lung function and respiratory symptoms. As the EBC biomarker data were not normally distributed, we performed correlation analysis between home-road distance categories and EBC biomarkers.</p><p><b>RESULTS</b>Participants living a shorter distance from major roads had lower percentage of predicted value of forced expiratory volume in 1 s (FEV1% -1.54, 95% confidence interval [CI]: -0.20 to -2.89). The odds ratio for chronic cough was 2.54 (95% CI: 1.57-4.10) for category 1 and 1.97 (95% CI: 1.16-3.37) for category 2, compared with category 3. EBC pH was positively correlated with road distance (rank correlation coefficient of Spearman [rs] = 0.176, P < 0.001).</p><p><b>CONCLUSIONS</b>Long-term exposure to traffic-related air pollution in people who live near major roads in Beijing is associated with lower lung function, airway acidification, and a higher prevalence of chronic cough. EBC pH is a potential useful biomarker for evaluating air pollution exposure.</p>

Effect of Inhaled Budesonide on Interleukin-4 and Interleukin-6 in Exhaled Breath Condensate of Asthmatic Patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Studies of interleukin (IL)-4 and IL-6 in the exhaled breath condensate (EBC) of asthmatic patients are limited. This study was to determine the effect of inhaled corticosteroid (ICS) treatment on IL-4 and IL-6 in the EBC of asthmatic patients.</p><p><b>METHODS</b>In a prospective, open-label study, budesonide 200 μg twice daily by dry powder inhaler was administered to 23 adult patients with uncontrolled asthma (mean age 42.7 years) for 12 weeks. Changes in asthma scores, lung function parameters (forced expiratory volume in 1 s [FEV1], peak expiratory flow [PEF], forced expiratory flow at 50% of forced vital capacity [FEF50], forced expiratory flow at 75% of forced vital capacity, maximum mid-expiratory flow rate) and the concentrations of IL-4 and IL-6 in EBC were measured.</p><p><b>RESULTS</b>Both asthma scores and lung function parameters were significantly improved by ICS treatment. The mean IL-4 concentration in the EBC was decreased gradually, from 1.92 ± 0.56 pmol/L before treatment to 1.60 ± 0.36 pmol/L after 8 weeks of treatment (P < 0.05) and 1.54 ± 0.81 pmol/L after 12 weeks of treatment (P < 0.01). However, the IL-6 concentration was not significantly decreased. The change in the IL-4 concentration was correlated with improvements in mean FEV1, PEF and FEF50 values (correlation coefficients -0.468, -0.478, and -0.426, respectively).</p><p><b>CONCLUSIONS</b>The concentration of IL-4 in the EBC of asthmatic patients decreased gradually with ICS treatment. Measurement of IL-4 in EBC could be useful to monitor airway inflammation in asthmatics.</p>