Gene mutation profiles and clinicopathological features of patients with non-small cell lung cancer harboring KRAS G12C mutation: a single-center retrospective study / 中华病理学杂志

Objective: To accurately screen non-small cell lung cancer (NSCLC) patients with KRAS G12C mutation and to evaluate their clinicopathological features, prognostic factors and current treatment status. Methods: A total of 19 410 NSCLC cases diagnosed at the Department of Pathology of Shanghai Chest Hospital, Shanghai, China from January 2018 to September 2021 were retrospectively reviewed, and the cases with KRAS gene mutation detected by next-generation sequencing were included. The clinicopathological and genetic mutation data of these cases were collected and analyzed. Results: A total of 1 633 (8.4%) NSCLC patients carried a KRAS gene mutation, among whom G12C was the most frequent (468 cases, 28.7%) mutant subtype. The mutation was more commonly found in males (414/468, 88.5%), patients with a history of smoking (308/468, 65.8%), and patients with a pathological type of invasive adenocarcinoma (231/468, 49.4%). The most common co-mutated genes in KRAS G12C mutant NSCLC were TP53 (52.4%, 245/468), STK11 (18.6%, 87/468) and ATM (13.2%, 62/468). The proportion of PD-L1 expression (≥1%) in KRAS G12C mutant NSCLC was significantly higher than that in patients without G12C mutation [64.3% (90/140) vs. 56.1% (193/344), P=0.014]. Immune checkpoint inhibitors (ICIs) treatment significantly prolonged progression-free survival (PFS) in NSCLC patients (10.0 months vs. 5.0 months, P=0.011). However, combination of chemotherapy and ICIs with anti-angiogenesis inhibitors or multi-target inhibitors did not significantly improve PFS in patients with KRAS G12C mutant NSCLC (P>0.05). Patients with KRAS G12C mutation NSCLC treated with ICIs and KRAS G12C patients with TP53 mutation had significantly longer median PFS than those with STK11 mutation (9.0 months vs. 4.3 months, P=0.012). Conclusions: Patients with KRAS G12C mutant NSCLC have relatively higher levels of PD-L1 expression and can benefit from ICIs treatment. The feasibility of chemotherapy, ICIs therapy and their combination needs further investigation.

Effect of acute sleep fragmentation on cognitive function and hippocampal Homer1a expression in aged rats / 中华行为医学与脑科学杂志

Objective:To explore the effects of acute sleep fragmentation (SF) on cognitive function and the relationship between hippocampal Homer1a and synaptic plasticity in aged rats.Methods:One hundred and eight SPF grade male SD rats aged 22 to 24 months were divided into three groups according to random number table: control group (Control group), non-sleep fragmentation group (NSF group) and sleep fragmentation group (SF group), with 36 rats in each group.A sleep fragmentation model was established by sleep deprivation rod method.Morris water maze and novel object recognition tests were used to evaluate the learning and memory function of rats.Homer1a expression in hippocampus was detected by Western blot, and its distribution in CA1 area of hippocampus was observed by immunohistochemical staining.Golgi staining was used to observe the density of dendritic spines in CA1 area of hippocampus, and in vitro electrophysiological patch clamp test was used to detect the slope of field excitatory postsynaptic potential(fEPSP) from CA3 to CA1 in hippocampus.SPSS 22.0 and GraphPad Prism 9.3 softwares were used for data statistical analysis and mapping.One-way ANOVA was used for comparison among groups, and Tukey-Kramer test was used for further pairwise comparison. Results:(1)In the behavioral tests, there were statistical differences in the times of crossing the original platform, the target quadrant residence time and the new object recognition index at 1 h and 24 h among the three groups( F=13.63, 11.34, 21.26, 16.22, all P<0.01). The times of crossing the original platform in SF group((2.00±1.27) times) was lower than that of Control group ((5.67±2.16) times) and NSF group ((6.50±2.35) times) (both P<0.05). The target quadrant residence time in SF group ((9.02±4.84) s) was shorter than that in Control group ((24.73±7.37) s) and NSF group ((27.81±8.37)s) (both P<0.05). The new object recognition index at 1 h and 24 h in SF group were lower than those in Control group and NSF group (all P<0.05). (2) In Western blot assay, the expression of Homer1a protein in hippocampus of SF group(0.91±0.13) was higher than that of Control group(0.70±0.05) and NSF group(0.74±0.04)(both P<0.05). (3) In immunohistochemical staining, the optical density value of the Homer1a protein in CA1 area of hippocampus in the SF group was higher than that in the Control group and NSF group(both P<0.05). (4) In Golgi staining, the density of dendritic spines in CA1 area of hippocampus in SF group was lower than that in Control group and NSF group (both P<0.05). (5) In vitro electrophysiological test showed that the slope of fEPSP in CA3-CA1 area of hippocampus in SF group were lower than that in Control group and NSF group (both P<0.05). Conclusion:Acute SF intervention in aged rats can cause cognitive impairment, which may be associated with the inhibition of hippocampal synaptic plasticity induced by hippocampal Homer1a overexpression.

Efficacy and safety of total neoadjuvant therapy versus neoadjuvant chemoradiotherapy in the treatment of locally advanced rectal cancer: a meta-analysis / 中华胃肠外科杂志

Objective: To systematically evaluate the efficacy and safety of total neoadjuvant therapy (TNT) in the comprehensive treatment of locally advanced rectal cancer. Methods: Literatures were screened from PubMed, Embase, Web of Science, Cochrane Library, CBM, Wanfang Data, VIP and CNKI from the inception date to May 2021 to collect the randomized controlled clinical trials (RCTs) of TNT followed by total mesorectal excision (TME) versus neoadjuvant chemotherapy (nCRT) followed by TME in the treatment of locally advanced rectal cancer. The data of overall survival, disease-free survival, R0 radical resection rate, pathological complete response (pCR) rate, T downstaging rate, the incidence of adverse events ≥ grade III, including neutropenia, nausea and vomiting, diarrhea, radiation dermatitis and nervous system toxicity, and the morbidity of complications within postoperative 30 days of the two groups were extracted from the included literatures. Review Manager 5.3 software was utilized for statistical meta-analysis. Results: Nine RCTs were finally enrolled including 2430 patients. Meta-analysis results showed that compared with nCRT group, patients in TNT group had longer overall survival (HR=0.80, 95%CI: 0.65-0.97, P=0.03) and higher pCR rate (RR=1.73, 95%CI: 1.44-2.08, P<0.01) with significant differences. Besides, there were no significant differences between two groups in disease-free survival (HR=0.86, 95%CI:0.71-1.05, P=0.14), R0 radical resection rate (RR=1.02, 95%CI: 0.99-1.06, P=0.17) and T downstaging rate (RR=1.04, 95%CI: 0.89-1.22, P=0.58) between two groups. In terms of treatment safety, the incidence of adverse events ≥ grade III (RR=1.09, 95%CI: 0.70-1.70, P=0.70) and morbidity of complications within postoperative 30 days (RR=1.07, 95%CI: 0.97-1.18, P=0.19) did not significantly differ between two groups. Conclusions: In the treatment of locally advanced rectal cancer, TNT may bring more survival benefits than nCRT and does not increase the incidence of adverse events and postoperative complications. Therefore, TNT could be used as a recommended treatment for patients with locally advanced rectal cancer.

Correlation between cervical vertigo and vestibular function evaluated by vestibular evoked myogenic potentials / 中国骨伤

OBJECTIVE@#To analyze the relationship between cervical vertigo and vestibular function evaluated by vestibular evoked myogenic potentials(VEMPs) and analyze the correlations between cervical vertigo and vestibular dysfunction, discuss the related factors of cervical vertigo and guide the clinical treatment of patients with cervical vertigo.@*METHODS@#A total of 75 patients with cervical vertigo as the main complaint in the outpatient clinic of the Second Hospital of Shanxi Medical University from August 2019 to July 2020 were set as the diseased group, and 60 patients without cervical and vestibular related diseases in the hospital were selected to set as non-diseased group. The age of diseased group was 12 to 70 years with an average of (46.40±10.91) years, including 25 males and 50 females;and the age of non-diseased group was 22 to 60 years with an average of(43.78±7.75) years, including 19 males and 51 females. VEMPs were performed in the two groups. The data of VEMPs were collected and the results were compared and analyzed. The patients with abnormal cervical myogenic vestibular evoked myogenic potential (cVEMP) were divided into light, moderate and severe groups. The correlation between VEMPs and cervical vertigo and its severity were analyzed by statistical method.@*RESULTS@#(1)The severity of cervical vertigo in diseased group:33 cases of mild, 34 cases of moderate, 8 cases of severe; cVEMP examination:62 cases were positive and 13 cases were negative, including 13 cases of mild, 33 cases of moderate, 16 cases of severe. The cVEMP of non-diseased group:4 cases were positive and 56 cases were negative.(2) The level of cVEMP in diseased group was higher than that in non-diseased group (P<0.001). It can be considered that there was a correlation between cervical vertigo and vestibular function.(3)The correlation between the level of cVEMP and the level of cervical vertigo in diseased group was analyzed. The Spearman rank sum test was used, and the correlation coefficient was 0.687, which was statistically significant (P<0.05). And it can be considered that the two indicators have a high degree of correlation.@*CONCLUSION@#It is feasible to evaluate the relationship between cervical vertigo and vestibular function by VEMPs. For patients with cervical vertigo, the higher the severity, the greater the positive rate of VEMPs, which indicates that it has a greater impact on vestibular function. The treatment of patients with cervical vertigo should be the combination of cervical rehabilitation and vestibular function.

Effects of sevoflurane combined with propofol anesthesia on synaptic plasticity in hippocampus after operation in rats with mild cognitive impairment: relationship with KCC2/NKCC1 / 中华麻醉学杂志

Objective:To evaluate the effects of sevoflurane combined with propofol anesthesia on the synaptic plasticity in the hippocampus after operation in rats with mild cognitive impairment (MCI) and the relationship with potassium-chloride cotransporter-2 (KCC2)/sodium-potassium-chloride cotransporter 1 (NKCC1).Methods:Clean-grade healthy male Sprague-Dawley rats, aged 16-18 months, weighing 440-540 g, in which MCI was induced by severe bilateral common carotid artery stenosis (BCAS). Forty-eight rats with MCI were divided into 4 groups ( n=12 each) using a random number table method: sham operation group (group Sham), sevoflurane anesthesia group (group S), propofol anesthesia group (group P), and sevoflurane and propofol anesthesia group (group SP). After disappearance of eyelash reflex, open reduction and internal fixation was performed after tibial fracture was induced in S, P and SP groups.Anesthesia method was as follows: 1.7% sevoflurane was inhaled and propofol 20 mg·kg -1·h -1 was intravenously infused for 3 h in group SP, 3% sevoflurane was inhaled for 3 h in group S, and propofol was intravenously infused at rate of 40 mg·kg -1·h -1 for 3 h in group P. The novel object recognition (NOR) test was performed at 14 days after operation, and the discrimination index in NOR test was calculated.The in vivo electrophysiological experiment was performed on 19 days after operation to measure long-term potentiation and amplitude of the field excitatory postsynaptic potential (fEPSP). The expression of KCC2 and NKCC1 was determined by Western blot, and the ratio of KCC2/NKCC1 was calculated.The density of dendritic spines in the hippocampal CA1 region was determined by Golgi-COX staining performed at 30 days after operation. Results:Compared with Sham group, the discrimination index in NOR test, hippocampal KCC2/NKCC1 ratio, density of dendritic spines in hippocampal CA1 region, and amplitude of fEPSP were significantly decreased in S and P groups ( P<0.05), and no significant change was found in the parameters mentioned above in group SP ( P>0.05). Compared with group S or group P, the discrimination index in NOR test, hippocampal KCC2/NKCC1 ratio, density of dendritic spines in hippocampal CA1 region, and amplitude of fEPSP were significantly increased in group SP ( P<0.05). Conclusion:Sevoflurane combined with propofol anesthesia does not aggravate postoperative cognitive dysfunction in the rats with MCI, which may be related to maintaining the balance of hippocampal KCC2/NKCC1 and protecting the synaptic plasticity in hippocampi.

Effect of Dihydroartemisinin on Oxidative Damage and Energy Metabolism of HepG2 Cells and Its Synergistic Effect with Sorafenib / 中国实验方剂学杂志

Objective:To explore the inhibitory effect of dihydroartemisinin （DHA） on the proliferation of HepG2 cells， elucidate the mechanism from the perspectives of oxidative damage and energy metabolism， and discuss the possibility of combined use of DHA with sorafenib （Sora）. Method:Cell counting kit-8 （CCK-8） assay was used to obtain the 50% inhibitory concentration （IC₅₀） of DHA and Sora on HepG2 and SW480 cells and Chou-Talalay method was used to obtain the combination index （CI） of DHA and Sora. HepG2 cells were classified into the control group， DHA group （10 µmol·L^-1）， Sora group （5 µmol·L^-1）， and DHA + Sora group （DHA 10 µmol·L^-1， Sora 5 µmol·L^-1） and then incubated with corresponding drugs for 8-12 h. Seahorse XF glycolytic rate assay kit and cell mito stress test kit were employed to respectively detect the glycolysis function of cells and oxidative phosphorylation function of mitochondria. DCFH-DA and lipid peroxidation MDA assay kit were separately used to analyze the intracellular levels of reactive oxygen species （ROS） and malondialdehyde （MDA）. Western blot was applied to determine the intracellular levels of heme oxygenase-1 （HO-1） and glutamate-cysteine ligase catalytic subunit （GCLC）. Result:Compared with the control group， DHA alone inhibited the ATP synthesis in mitochondrial oxidative phosphorylation and glycolysis （<italic>P</italic><0.01）， increased the levels of intracellular ROS and MDA （<italic>P<</italic>0.05）， and decreased the levels of HO-1 and GCLC （<italic>P<</italic>0.05） in HepG2 cells. DHA and Sora had synergistic inhibitory effect on proliferation of HepG2 and SW480 cells， with CI < 0.90. The DHA + Sora group showed stronger suppression of ATP synthesis in mitochondrial oxidative phosphorylation and glycolysis （<italic>P</italic><0.01）， higher levels of intracellular ROS and MDA （<italic>P<</italic>0.01）， and lower levels of intracellular antioxidation-related proteins HO-1 and GCLC in HepG2 cells （<italic>P<</italic>0.01） than the DHA group. Conclusion:DHA may increase the level of MDA by reducing HO-1 and GCLC and increasing ROS in HepG2 cells， which results in mitochondria oxidative damage， restricts cell glycolysis and mitochondrial oxidative phosphorylation， and thus finally inhibits the proliferation of HepG2 cells. DHA and Sora have synergistic inhibitory effect on the proliferation of HepG2 and SW480 cells， and the mechanism may be related to the synergistic oxidative damage that affects the mitochondrial electron transport chain and suppresses cell energy metabolism.

Effect of acellular repair patch of small intestinal submucosa of porcine in repairing of soft tissue defects of hand / 中华显微外科杂志

Objective:To compair the outcomes of repairing soft tissue defects of hand between a biodegrad- able repair patch—porcine small intestinal submucosa (SIS) and skin grafting.Methods:From December, 2017 to December, 2018, 36 cases of hand soft tissue defect were treated and analyzed retrospectively. According to the defect area and treatment methods, 36 cases were divided into 2 groups: SIS group (21 cases) and grafting group(15 cases). In SIS group, the area of soft tissue defects was 2.0 cm×1.5 cm-9.0 cm×3.5 cm with an average of 5.3 cm×2.1 cm, treat- ed with SIS; In grafting group, the area of soft tissue defects was 9.0 cm×4.0 cm-16.0 cm×9.0 cm with an average of 12.0 cm×8.5 cm, treated with autologous skin grafting after wet dressing. Wound healing was evaluated at 14, 21 and 28 days, and 3 months after the surgery according to the appearance of colour, elasticity, sensory recovery and prog- noses of partial tendon exposure.Results:All patients were followed-up for 3 to 10 months, with an average of 5 months. All wounds in both groups were completely healed; the appearance was normal, and the skin elasticity and sensation had recovered. Sensation recovery in SIS group: 14 cases were good (66.6%), 5 cases were fine (23.8%), and 2 cases were bad (9.6%); in grafting group: 9 cases were good (60.0%), 4 cases were fine (26.0%), and 2 cases were bad (14.0% ). Wound healing effect in SIS group: 14 cases were good, 5 cases were fine, and 2 cases were bad; in grafting group: 9 cases were good, 4 cases were fine, and 2 cases were bad.Conclusion:The SIS patch can be used in the reconstruction of soft tissue defects in hand. There was no significant difference in colour compared to the sur- rounding skin and left no scar. The patch is an ideal repair material for superficial skin defects.

Efficacy and safety of Yangzheng Xiaoji capsule combined with radiotherapy and chemotherapy in the treatment of gastric cancer and its influence on immune function / 中国基层医药

Objective@#To explore the efficacy and safety of Yangzheng Xiaoji capsule combined with radiotherapy and chemotherapy in the treatment of gastric cancer and its influence on immune function.@*Methods@#From October 2016 to October 2018, 80 patients with gastric cancer in the First People's Hospital of Yongkang were divided into two groups according to the random number table, with 40 cases in each group.The control group received conventional radiotherapy plus chemotherapy, namely oxaliplatin, 5-fluorouracil combined with calcium leucovorin conventional chemotherapy.The observation group received Yangzheng Xiaoji capsule on the basis of the control group.The clinical symptoms, objective tumor efficacy, TCM symptoms and signs score, safety, immune function of the two group were observed.@*Results@#The total effective rate of the observation group was 87.5%, which was significantly higher than 72.5% of the control group(χ2=3.52, P<0.05). The RR, DCR of the observation group were 62.5%, 87.5%, respectively, which were significantly higher than 30.0%, 72.5% of the control group(χ2=4.31, P<0.05). The TCM symptoms and signs scores of the two groups after treatment were significantly improved compared with those before treatment(all P<0.05), which of the observation group after treatment was significantly lower than that of the control group(t=5.13, P<0.05). There were no statistically significant differences in WBC, Hb and PLT of the observation group before and after treatment(t=1.24, 1.62, 1.37, all P>0.05), and there were statistically significant differences in WBC, Hb and PLT of the control group before and after treatment(t=4.85, 3.64, 3.85, all P<0.05), and the WBC, Hb and PLT of the observation group were significantly higher than those of the control group after treatment(t=6.37, 4.15, 5.27, all P<0.05). In the observation group, leukopenia decreased in 4 cases, hemoglobin decreased in 6 cases and transaminase increased in 6 cases, which were significantly lower than 8 cases, 10 cases and 10 cases in the control group (χ2=4.26, P<0.05). Before treatment, there were no statistically significant differences in the levels of CD3＋, CD4＋, CD8＋, CD4＋/CD8＋ between the two groups(all P>0.05). There were no statistically significant differences in the levels of CD3＋, CD4＋, CD8＋, CD4＋/CD8＋ of the observation group before and after treatment(t=2.14, 2.08, 1.69, 2.47, all P>0.05), and compared with before treatment, the levels of CD3＋, CD4＋, CD4＋/CD8＋ of the control group were significantly decreased(t=5.12, 4.26, 5.38, all P<0.05), while the level of CD8＋ was significantly increased(t=3.86, P<0.05). After treatment, the levels of CD4＋, CD4＋, CD8＋, CD4＋/CD8＋ of the observation group were significantly better than those of the control group (t=4.79, 3.52, 4.28, 3.61, all P<0.05).@*Conclusion@#Yangzheng Xiaoji capsule combined with radiotherapy and chemotherapy can improve the curative effect of patients with gastric cancer, and it has high safety, less toxic and side effects, and can improve the immune function of patients with gastric cancer.It is worthy of promoting.

Efficacy and safety of Yangzheng Xiaoji capsule combined with radiotherapy and chemotherapy in the treat－ment of gastric cancer and its influence on immune function / 中国基层医药

Objective To explore the efficacy and safety of Yangzheng Xiaoji capsule combined with radiotherapy and chemotherapy in the treatment of gastric cancer and its influence on immune function .Methods From October 2016 to October 2018,80 patients with gastric cancer in the First Peopleˊs Hospital of Yongkang were divided into two groups according to the random number table ,with 40 cases in each group.The control group received conventional radiotherapy plus chemotherapy ,namely oxaliplatin,5 －fluorouracil combined with calcium leucovorin conventional chemotherapy.The observation group received Yangzheng Xiaoji capsule on the basis of the control group.The clinical symptoms ,objective tumor efficacy,TCM symptoms and signs score ,safety,immune function of the two group were observed.Results The total effective rate of the observation group was 87.5%,which was significantly higher than 72.5%of the control group(χ2 ＝3.52,P＜0.05).The RR,DCR of the observation group were 62.5%, 87.5%,respectively,which were significantly higher than 30.0%,72.5% of the control group ( χ2 ＝4.31, P ＜0.05).The TCM symptoms and signs scores of the two groups after treatment were significantly improved compared with those before treatment(all P＜0.05),which of the observation group after treatment was significantly lower than that of the control group (t＝5.13,P＜0.05).There were no statistically significant differences in WBC ,Hb and PLT of the observation group before and after treatment ( t＝1.24,1.62,1.37,all P＞0.05),and there were statistically significant differences in WBC ,Hb and PLT of the control group before and after treatment (t＝4.85,3.64,3.85,all P＜0.05),and the WBC,Hb and PLT of the observation group were significantly higher than those of the control group after treatment(t＝6.37,4.15,5.27,all P＜0.05).In the observation group,leukopenia decreased in 4 cases, hemoglobin decreased in 6 cases and transaminase increased in 6 cases,which were significantly lower than 8 cases, 10 cases and 10 cases in the control group (χ2 ＝4.26,P＜0.05).Before treatment,there were no statistically signifi－cant differences in the levels of CD +3 ,CD+4 ,CD+8 ,CD+4 ／CD+8 between the two groups (all P＞0.05).There were no statistically significant differences in the levels of CD +3 ,CD+4 ,CD+8 ,CD+4 ／CD+8 of the observation group before and after treatment(t＝2.14,2.08,1.69,2.47,all P＞0.05),and compared with before treatment ,the levels of CD +3 , CD+4 ,CD+4 ／CD+8 of the control group were significantly decreased ( t＝5.12,4.26,5.38,all P＜0.05),while the level of CD+8 was significantly increased (t＝3.86,P＜0.05).After treatment,the levels of CD +3 ,CD+4 ,CD+8 ,CD+4 ／CD+8 of the observation group were significantly better than those of the control group (t＝4.79,3.52,4.28,3.61,all P＜0.05).Conclusion Yangzheng Xiaoji capsule combined with radiotherapy and chemotherapy can improve the curative effect of patients with gastric cancer ,and it has high safety,less toxic and side effects,and can improve the immune function of patients with gastric cancer.It is worthy of promoting.

Effect of dexmedetomidine on pulmonary function in elderly patients with mild obstructive ventilatory dysfunction under protective ventilation during laparoseopic gallbladder surgery / 国际生物医学工程杂志

Objective To evaluate the effect of dexmedetomidine on pulmonary function in elderly patients with mild obstructive ventilatory dysfunction under protective ventilation during laparoseopic gallbladder surgery. Methods Sixty patients were included who underwent laparoseopic gallbladder surgery with general anesthesia. For the all subjects, the age ranged from 65 to 75 years old, the body mass index range was 18.5～23.9 kg/m2, and the ASA grade wasⅡorⅢ. In the subject selection, the gender was not limited, and the included subjects were diagnosed with mild obstructive ventilation dysfunction by preoperative pulmonary function tests. All the subjects were randomly divided into 2 groups (n=30), including dexmedetomidine group (group D) and control group (group C). In the group D, dexmedetomidine was intravenously infused at a dose of 1 μg/kg 10 min before and after the general anesthesia induction, and at a rate of 0.4μg/(kg·h) after tracheal intubation until the end of operation. Group C was given an equal volume of normal saline. Airway peak pressure (Ppeak), mean airway pressure (Pmean), airway plateau pressure (Pplat), and positive end-expiratory pressure (PEEP) were measured at 5 min after intubation (before pneumoperitoneum) (T1), end of pneumoperjtoneum (T2), and 10 min after the end of pneumoperitoneum (T3). The driving pressure (DP) was calculated. The blood samples of the radial artery were collected for blood gas analysis, and PaO2 and PaCO2 were recorded. The oxygenation index (PaO2/FiO2), respiratory index (RI), dead space ventilation rate (VD/VT), and alveolar-arterial oxygen partial pressure difference (A-aDO2) were calculated. The time of removal of the tracheal tube and the occurrences of complications such as hypercapnia and hypoxemia within 48 hours after extubation were recorded. Results Compared with group C, Ppeak, Pmean, DP, RI, VD/VT and A-aDO2 at T1, T2, T3 were decreased in group D, PaO2/FiO2 was increased, postoperative extubation time was shortened, and the incidence of hypoxemia was reduced within 48 h after operation (P<0.05). Compared with T1, Ppeak, Pmean, DP, RI, VD/VT and A-aDO2 at T2 were increased, and PaO2/FiO2 was decreased(P<0.05). Conclusions Dexmedetomidine can improve the pulmonary function in elderly patients with mild obstructive ventilatory dysfunction under protective ventilation during laparoseopic gallbladder surgery.

Clinical application of the lateral branch of lateral circumflex femoral artery in the anterolateral thigh perforator flap / 中华显微外科杂志

Objective To investigate the feasibility and technique of using the anterolateral thigh perforator flap pedicled with the lateral branch of the lateral circumflex femoral artery (LBLCFA) to repair soft tissue defect of extremities.Methods Eighty-six cases of anterolateral thigh perforator flap transplantation were performed from May,2014 to May,2018.A total of 37 cases of soft tissue defect of extremities were treated by anterolateral thigh perforator flap used the LBLCFA as vascular pedicle,of which there were 19 cases of upper limbs and 18 of lower limbs.There were 27 cases of defects caused by trauma,and 10 by soft tissue tumor resection.The flaps were designed centering around the point proximal to the midpoint of the iliac-patellar line.The dimensions of soft tissue defect were from 9.0 cm×6.0 cm to 26.0 cm×10.0 cm,and the flap were from 10.0 cm×7.0 cm to 27.0 cm×11.0 cm.The length of vascular pedicle ranged of 7.0-13.0 cm,with an average of 11.5 cm.The donor sites were directly sutured.All of the patients were followed-up regularly in the outpatient department.Results All the flaps survived and the donor sites were primarily healed.Of these 37 cases,2 trauma patients and 2 patients treated with local radiotherapy had poor wound healing,but still healed after multiple dressing changes.All the patients were followed-up for 3-26 months,with an average of 13 months.The texture,color and elasticity of the flap were similar to the surrounding tissue of the recipient sites,while only a linear scar remained at the donor sites.Ten tumor patients were treated with routine radiotherapy and chemotherapy after the repairation;there was no tumor recurrence during the follow-up period.Conclusion The LBLCFA gives off a relatively large and thick perforator proximal 5.0-7.0 cm of the iliacpatellar line,which locates in the upper lateral side,travels parallel to the vastus lateralis,and give off the skin and muscular perforators.The lateral branch can be used as pedicle to make into perforator flap or chimeric flap,which provides a novel selection of vascular pedicel for anterolateral thigh perforator flap.When the descending branch does not provide a thick and large perforator,the LBLCFA has important practical value and is worth utilizing in the clinic.

Isolation and identification of Oct4 RNA-binding proteins / 上海交通大学学报（医学版）

Objective: To identify the RNA binding proteins of Oct4, a key factor of embryonic stem cells. Methods: Total RNA was extracted from mouse embryonic stem cells (R1), which was reverse-transcribed into cDNA. Then PCR product of Oct4 mRNA were transcribed into Oct4 mRNA. Finally the candidate RNA-binding proteins were eluted applying the streptomycin affinity chromatography, and submitted for high-performance liquid chromatography combined with the mass spectrometry. The identified RNA binding proteins were further confirmed by RNA immunoprecipitation (RIP). Results: 121 RNA binding proteins of Oct4 3' untranslated region (UTR) and Oct4 5' UTR were identified with liquid chromatography / mass spectrometry. There were 11 proteins with the number of peptide spectrum matches more or equal to 2, and 7 of them were selected for additional confirmation using RIP method. RIP results showed that Oct4 interacted with DSP, SOD1, LMNA, NPM1, PSIP1, NCL and HDGF. Among them, HDGF had the strongest binding ability to Oct4 mRNA. Conclusion: Identification of Oct4 RNA binding proteins will provide a theoretical basis for the regulation mechanism of Oct4, and will be a basis for the further study of its function.

Association between depression behavior and expression of calreticulin precursor, tropomyosin 1, milogen activated prolein kinase 1 and dual specificity mitogen-activated protein kinase 1 in spontaneous diabetes mellitus rats / 实用医学杂志

Objective To investigate the association between depression behavior and the expression of calreticulin precursor, tropomyosin I, milogen activated prolein kinase 1 and dual specificity mitogen-activated protein kinase 1 in spontaneous diabetes mellitus rats. Methods Twenty adult male healthy rats (control group) and 40 spontaneous diabetic rats were studied. Forty spontaneous diabetic rats were further divided into diabetes group and diabetic depression group, and the latter was to construct depression model. The depressive behavior of the 3 groups was measured by sucrose water consumption test and wilderness test. The expression level of calreticulin precursor, tropomyosin 1, milogen activated prolein kinase 1, and dual specificity mitogen-activated protein kinase 1 in the hippocampus of the 3 groups was measured by western blot. Results In the 15 th day and 22 nd days of stress, the amount of sucrose water drinking of the rats in diabetic depression group was significantly lower than that of the control group and the diabetes group (P < 0.05) , and there was no significant difference between the control group and the diabetic group (P> 0.05). The score of field test and vertical score in the diabetic depression group were significantly lower than those of the control group and the diabetes group (P < 0.05) , but there was no significant difference between the control group and the diabetic group (P> 0.05). The expression of calreticulin precursor, tropomyosin 1, milogen activated prolein kinase 1, and dual specificity mitogen-activated protein kinase 1 in the hippocampus of diabetic depression group was significantly lower than that in the control group and the diabetic group (P < 0.05) , and there was no significant difference between the control group and the diabetic group (P> 0.05).Conclusions The depressive behavior of spontaneously diabetic rats is associated with the decrease of the expression level of calreticulin precursor, tropomyosin 1, milogen activated prolein kinase 1, and dual specificity mitogenactivated protein kinase 1 in the hippocampus of rats.

DNA-PKcs functions in cellular hyper-radiosensitivity / 中华放射医学与防护杂志

Objective@#To explore the functions of DNA-PKcs in cellular low dose hyper-radiosensitivity.@*Methods@#Colony-formation assay was used to detect the survival fractions of M059K and M059J cell lines treated by X-ray irradiation. Micronucleus assay and γ-H2AX foci assay were used to measure the radiation-induced DNA damage. Western blot was used to detect the relative expression levels of phospho-Chk1, total Chk1, phospho-Chk2 and total Chk2 of M059K and M059J cells.@*Results@#The hyper-radiosensitivity was observed in M059K cells irradiated with X-ray of doses lower than 1 Gy. DNA damage levels did not show HRS/IRR in the cell lines we used. pChk1/Chk1 in M059K cells was significantly increased during 20 min to 60 min after 0.2 Gy X-ray irradiation (t=14.157, 13.661, 14.177, 11.317, 14.512, P<0.05); pChk2/Chk2 in M059K cells was markedly increased during 20 min to 50 min after 0.2 Gy X-ray irradiation (t=13.182, 13.868, 14.155, 14.477, P<0.05).@*Conclusions@#M059K cells show the phenomenon of low dose hyper-radiosensitivity, which may be related to activation of proteins in G2/M phase checkpoints regulated by DNA-PKcs.

Chemical constituents from the fruit bodies of Daedalea dickinsii / 中成药

AIM To study the chemical constituents from the fruit bodies of Daedalea dickinsii (Berk.) Yasuda.METHODS The methanol extract from the fruit bodies of D.dickinsii was isolated and purified by silica,Sephadex LH-20 and HPLC,then the structures of obtained compounds were identified by physicochemical properties and spectral data.RESULTS Six compounds were isolated and identified as (22E,24R)-ergosta-5,7,22-trien-3β-ol (1),(22E,24R)-5α,8α-epoxyergosta-6,22-dien-3β-ol (2),stellasterol (3),6-methoxycer-evisterol (4),16-acetylpolyporenic acid C (5),and 3 α-carboxyacetoxy-24-methylene-23-oxolanost-8,24 (31)-dien-26-oic acid (6).CONCLUSION Compounds 1-4,6 are isolated from this fungus for the first time.

The influence of liraglutide on ERp46 in non-alcoholic fatty liver disease rats / 中华内分泌代谢杂志

Objective Rats were fed with high-fat diet and were successfully induced the models with non-alcoholic fatty liver disease,and to investigate the effects of liraglutide on the expression of ERp46.Methods Thirty male Sprague-Dawley rats were assigned to normal chow group(NC,n=10)and high-fat diet group(n=20),after 12 weeks,the high-fat diet group rats were divided into high-fat diet group(HF,n=10)and liraglutide group(100L,n=10) and treated with normal saline and liraglutide(100 μg/kg)for 4 weeks respectively. Liver tissues were measured by hematoxylin-eosin(HE),Oil Red O staining,hepatic triglyceride(TG),and hyperinsulinemic-euglycemic clamp test(HECT). Hepatocyte apoptosis rate were evaluated by TdT-mediated dUTP nick-end labeling(TUNEL),and the expressions of ERp46 mRNA and protein were measured.Results Compared with the NC group,the liver tissues in the HF group have steatosis,insulin resistance,and the percentage of apoptosis was significantly increased. ERp46 mRNA and protein expressions were decreased(P<0.05). Compared with the HF group,liraglutide treatment was sufficient to reduce steatosis,insulin resistance,apoptosis,and increase the ERp46 mRNA and protein(P<0.05). Furthermore,the expression of ERp46 protein in the liver was negatively correlated with hepatocyte apoptosis rate,and positive correlated with glucose infusion rate(GIR, P<0. 05). Conclusion Liraglutide may up-regulate the expression of ERp46 to improve IR and hepatocyte apoptosis in NAFLD rats.

Research on knee posteromedial complex / 中华创伤骨科杂志

Injury to the knee posteromedial complex can cause serious joint dysfunction,leading to rotational instability and degeneration of cartilage.Lack of overall understanding of the knee posteromedial complex can often result in ineffective clinical treatment of the injury.On the basis of extensive review of domestic and international literature about the injury to the knee posteromedial complex in recent years,this article summarized the anatomy,biomechanics and function of the structure,and analyzed the classification and treatment of the iniurv.

Association study between a genetic polymorphism in cytochrome P450 19 gene rs10046 and colon and rectal cancer / 中国医师杂志

Objective To investigate the relationship between the polymorphism of cytochrome P450 19 (CYP19) gene rs10046 and the risk of colon and rectal cancer.Methods Using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) to analyze gene polymorphism in CYP 19 gene rs10046 in 198 cases of colon and rectal cancer patients (case group) and 309 cases of healthy controls (control group).The genotype frequency and relative risk of CYP19 gene rs10046 between the two groups were compared and the relationship with the clinicopathological features of colorectal cancer was analyzed.Results In case group,the prevalence rates of CYP19 rs10046 genotypes C/C,C/T and T/T were 28.3％,44.4％ and 27.3％,respectively,and 17.2％,51.8％ and 31.1％ in the control group,respectively,with statistical significant difference (P ＜ 0.05).Compared with wild-type C/C,the susceptibility of colorectal cancer with the genotypes of C/T and T/T was decreased by 0.521 (95％ CI:0.330-0.822)and 0.532 (95 ％ CI:0.322-0.880) respectively.Moveover,in the non-smoking group,the risk of colorectal cancer with genotype T/T or C/T was decreased by 0.409 (95％ CI:0.210-0.798) compared with genotype C/C.The interaction was not exist in smoking group.Conclusions The polymorphism of CYP19 gene rs10046 is related to the susceptibility of colon and rectal cancer.The T/T,C/T genotype of CYP19 rs10046 decrease the risk of colon and rectal cancer,and which might be the protective factor of colon and rectal cancer.

Advances in surgical diagnosis and treatment of mitral valve prolapse in children / 中华实用儿科临床杂志

Mitral valve prolapse is a disease which causes mitral regurgitation,which is one of the common causes of mitral insufficiency.With the aggravation of blood reflux,mitral valve prolapse will eventually lead to pulmo-nary hypertension,heart failure and even death in children.The main diagnostic methods include chest X－ray,echocar-diography,spiral CT and magnetic resonance imaging.Mitral valvuloplasty is the main surgical method for mitral valve prolapse in children.It includes valvuloplasty,annuloplasty,tendon chordoplasty,edge－to－edge mitral valve repair, and so on.Now,the progress in surgical diagnosis and treatment of mitral valve prolapse in children were reviewed in or-der to provide a meaningful reference for its individual treatment.

Minimally invasive closed reduction and internal fixation with fully threaded headless cannulated compression screws for repair of distal radius fracture: study protocol for a randomized controlled trial / 中国组织工程研究

BACKGROUND: Conventional open reduction internal fixation and external fixation are not ideal treatment options for distal radius fracture. Minimally invasive surgery for distal radius fracture results in less trauma than other techniques;fully threaded headless cannulated compression screws can increase the stability of fracture fragments and contribute to functional recovery after wrist fracture. Our previous studies have found that minimally invasive closed reduction and internal fixation of distal radius fracture with fully threaded headless cannulated compression screws obtains satisfactory curative efficacy, especially for fracture involving the wrist joint, but no more than two fracture fragments.OBJECTIVE: We hypothesized that minimally invasive closed reduction and internal fixation with fully threaded headless cannulated compression screws provides better stability than conventional methods, and can effectively promote the early recovery of wrist function.METHODS: In this prospective, randomized, controlled trial, we will recruit 60 outpatients with distal radius fracture from the Department of Orthopedic Surgery, Central Hospital Affiliated to Shenyang Medical College, China. Patients will be assigned to one of two treatment groups: C-arm fluoroscopy-assisted minimally invasive closed reduction and internal fixation with fully threaded headless cannulated compression screws (experimental group) or open reduction (palmar and dorsal incisions) and internal fixation with titanium plate (control group). Internal fixation will be maintained for 24 weeks in both groups. Our primary outcome measure will be X-ray and CT examinations 24 weeks after surgery.Secondary measures include patient-rated wrist evaluation scores, used to evaluate wrist joint function; fracture healing time; and Visual Analogue Scale score, used to evaluate the severity of the patient's pain. This trial has been registered at ClinicalTrials.gov (identifier: NCT02784678). The study protocol has been approved by the Ethics Committee of Central Hospital Affiliated to Shenyang Medical College, China. The trial protocol will be performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association (General Assembly of the World Medical Association, 2014).DISCUSSION: With this study, we hope to confirm that minimally invasive closed reduction and internal fixation with fully threaded headless cannulated compression screws for distal radius fracture repair has advantages over conventional open reduction internal fixation with titanium plates, providing superior fragment stability and allowing for early rehabilitation exercise of the wrist joint, which improves recovery of function. We hope to show that minimally invasive closed reduction and internal fixation with fully threaded headless cannulated compression screws is suitable surgical method for repair of distal radius fracture.